econdary haemorrhage includes the use of
local measures to arrest the bleeding, the employment of general
measures to counteract the accompanying toxaemia, and when the loss of
blood has been considerable, the treatment of the bloodless state.

_Local Measures to arrest the Haemorrhage._--The occurrence of even
slight haemorrhages from a septic wound in the vicinity of a large blood
vessel is to be taken seriously; it is usually necessary to _open up the
wound_, clear out the clots and infected tissues with a sharp spoon,
disinfect the walls of the cavity with eusol or hydrogen peroxide, and
_pack_ it carefully but not too tightly with gauze impregnated with some
antiseptic, such as "bipp," so that, if the bleeding does not recur, it
may be left undisturbed for several days. The packing should if possible
be brought into actual contact with the leaking point in the vessel, and
so arranged as to make pressure on the artery above the erosion. The
dressings and bandage are then applied, with the limb in the attitude
that will diminish the force of the stream through the main artery, for
example, flexion at the elbow in haemorrhage from the deep palmar arch.
Other measures for combating the local sepsis, such as the irrigation
method of Carrel, may be considered.

If the wound involves one of the extremities, it may be useful; and it
imparts confidence to the nurse, and, it may be, to the patient, if a
Petit's tourniquet is loosely applied above the wound, which the nurse
is instructed to tighten up in the event of bleeding taking place.

_Ligation of the Artery._--If the haemorrhage recurs in spite of packing
the wound, or if it is serious from the outset and likely to be critical
if repeated, ligation of the artery itself or of the trunk from which it
springs, at a selected spot higher up, should be considered. This is
most often indicated in wounds of the extremities.

As examples of proximal ligation for secondary haemorrhage may be cited
ligation of the hypogastric artery for haemorrhage in the buttock, of the
common iliac for haemorrhage in the thigh, of the brachial in the upper
arm for haemorrhage from the deep palmar arch, and of the posterior
tibial behind the medial malleolus for haemorrhage from the sole of the
foot.

_Amputation_ is the last resource, and should be decided upon if the
haemorrhage recurs after proximal ligation, or if this has been followed
by gangrene of the limb; it should also be consider