A TAMPON FOR CONTROLLING A SEVERED INTERCOSTAL ARTERY, WITH OTHER POSSIBILITIES
CAPTAIN, R.A.M.C. (RETIRED). ON one occasion, at Rawal Pindi, India, I experienced the mischance when operating on a case of empyema, the Dieulafoy's aspirator being unavailable, to nick the intercostal artery, whilst using the large trocar furnished in the military operating case. The recognised treatment then was, and seemingly now is, to plug the wound with a dossil of lint saturated with perchloride of iron, or, failing this, to resect a portion of rib and then to tie the severed, or
... severed, or partially severed, artery. But of course in peace time, and presumably also in war time, the occasion permitting, one would be very chary of tampering with the rib of a soldier, whereby a weak spot might be constituted. Treatment by perchloride of iron in the present case was ultimately successful. But had I been near an instrument maker I would have had made a small tampon of stiff indiarubber of a fusiform shape such as is shown in the illustration. I would have inserted the collapsed round end into the pleural cavity, filled the tampon with water from the nozzle, and then having attached tapes to the stirrups, would have forcibly drawn the now swelled, rounded, hard, and solid indiarubber directly outwards, whereby such pressure would be made upon the nicked intercostal artery as to control it easily, whilst the affixing tapes to the chest wall by means of sticking plaster would complete the matter. Such an invention or contrivance as the above has not hitherto been employed for the control of haamorrhage where pressure can readily be applied to bone, and nowadays when operations are common for the treatment of bronchiectasis by ligature of branches of the pulmonary artery the possibilities of such a tampon would appear to be great. To instance: the needles shown, affixed to the nozzle and passed through a wound, should readily control the femoral artery in Hunter's canal ; axillary; brachial ; an artery lying on interosseous membrane ; the subclavian, by passing the needle under the clavicle ; branches of the facial and internal maxillary passed outwards from inside the mouth; as a substitute for Davy's external iliac compressing rod-in this case the indiarubber being of stouter substance and of the shape shown in the diagram. ' Again, the deep gluteal vessels might be compressed against the femur or ligaments ; whilst run through the palm the deep palmar arch should be thus controlled without danger of sloughing, for with a water tampon the pressure will be evenly distributed, whilst the main point is backward pressure on bone by the forcible drawing of the tampon towards one. Sandown. I.W.