SURGERY. 207 



The apparatus necessary for tying an artery is much like that required 

 in operations for aneurism : a straight edged scalpel {fig. 5), a B "omfield 

 tenaculum artery forceps, aneurismal needle, &c. The artery is to be 

 elevated by a tenaculum or forceps at or near the spot where the ligature 

 is to be applied, and this passed beneath or over the artery to be severed 

 and tied by an assistant {pi. 139, fig. 3, a, the vessel held by the surgeon 

 with the forceps, /;, the thread, (/, d^ passed round, and the knot tied by the 

 assistant). 



Sometimes a vessel is tied by simply passing a thread round it, without 

 laying it bare, the extremities of the thread being then tied tightly together. 

 PI. 139, fig. 2, fl, the bleeding vessel ; &, c, points where the needle is first 

 passed in and out ; t/, e, points where this is done a second time. 



The method of torsion consists in twisting the extremity of the severed 

 vessel several times round with sliding forceps {pi. 140^ figs. 35, 36, 37). 



PI. 139, fig. 4, is intended to show the usual points of incision either in 

 tying wounded arteries, or in performing operations on aneurism : a b, inci- 

 sion for laying bare the superior thyroid artery, which begins near the 

 angle of the lower jaw, over the submaxillary gland, and descends an inch 

 and a half to the lower border of the thyroid cartilage ; c c?, incision for 

 exposing the carotid artery. This, two and a half inches long, passes along 

 the inner border of the sterno-cleido-mastoid ; ef, Zang's incision for the 

 same purpose as the last. It descends from the top of the cricoid cartilage, 

 between the two portions of the sterno-cleido-mastoid on its outer margin, 

 and ends one quarter of an inch above the clavicle ; g h, Zang's incision 

 for exposing the subclavian artery above the clavicle. It commences two 

 inches above the clavicle, on the posterior margin of the sternal extremity 

 of the sterno-cleido-mastoid, and passes obliquely downwards and outwards 

 to the middle of the upper margin of the clavicle ; ^ k, Hodgson's incision 

 for the same purpose as the last, along the upper margin of the clavicle, to 

 the point of attachment of the trapezius to the clavicle ; I m, incision for 

 exposing the subclavian along the inner margin of the scalenus anticus 

 immediately over the sternal end of the clavicle, three inches long ; 

 n 0, incision for exposing the subclavian beneath the clavicle ; q r. Rust 

 and Zang's incision for the same purpose; s t, Lisfranc's incision for expos- 

 ing the axillary artery in the axilla ; uv, incision for the brachial artery in 

 the middle of the arm ; w x, incision in the left arm for the same purpose, 

 a little higher up; yz, incision for the same purpose in the bend of the 

 elbow ; '• ''j incision for the radial artery along the upper portion of the 

 forearm ; ■'' \ the radial artery over the carpus ; *' ", the ulnar artery in the 

 superior portion of the forearm ; '■ ', ulnar artery over the carpus ; "■ '", inci- 

 sion for the descending artery according to Cooper ; "' '"', internal iliac after 

 Stevens ; "' '\ do. after Abernethy and Scarpa ; "' ", do. after Cooper ; 

 "• ", for exposing the crural artery below the groin ; "' ^'', do. in the middle 

 of the thigh ; "' ", the posterior tibial artery along the upper third of the leg 

 after Marjolin ; "• ", do. in the middle of the leg, after Lisfranc ; "• ", do. 

 behind the inner ankle ; "- '", incision for the anterior tibial in the middle 

 of the leg ; "- "', do. in the lower part of the leg. 



ICOXOGRAPHIC ENCYCLOPAEDIA. — VOL. II. 68 913 



