ESMARCH'S METHOD. 163 



A more refined method is to use a rubber cord or tube. A rubber 

 cord as thick as a man's forefinger and twenty to thirty inches in length 

 is passed around the Hmb above the knee or hock in a stretched 

 condition," The ends are united by a simple knot or a strong cord. 



Esmarch's method is most valuable when, in amputating limbs in 

 small animals or excising some very vascular organ like the uterus, one 

 wishes to minimise bleeding. When properly carried out it enables 

 operations to be performed as though on the dead body ; no bleeding 

 occurs, and all parts, the normal as well as the pathologically altered, 

 are distinctly visible. Its inventor published a description of the 

 system in 1873 under the title of ' Artificial Ischa^mia.' It consists in 

 applying an elastic bandage, formed preferably of vulcanised rubber 

 (though a fabric of rubber threads covered with cotton is sometimes 

 used), to the limb or organ to be removed, commencing always at the 

 periphery. The strong pressure exercised by the spirals of the bandage 

 as they advance over the tissues gradually drives the contained blood 



towards the trunk. When the parts - _. 



to be excised have thus been rendered .-'''"' "'^-x^ 



bloodless a thick rubber cord is applied 



with considerable pressure immediately / \ 



above the bandage. This compresses ( 

 the arteries and practically brings circu- 

 lation to a standstill. The ends of the 

 cord are secured by tying or preferably 

 as shown in Fig. 1S7. The cord is 



stretched and slipped into the first of Fig. 187.— Catch for rubber cord used 

 the incomplete cylinders; is then with Esmarch's bandage. 



carried once or twice around the limb, stretched tightly to allow it to 

 be inserted in the second cylinder, and then sharply released. Its 

 elasticity causes it to swell up and to be firmly held in position within 

 the cylinder. The bandage is then removed and the operation 

 performed below the cord. 



In this method two systems are associated, the blood being first 

 expelled from the parts and the bloodless condition afterwards main- 

 tained by the tourniquet-like action of the rubber cord. When the 

 part to be enveloped in the bandage is the seat of a wound of any 

 notable extent the latter can first be covered with a layer of w^adding 

 or with a compress. The operation terminated and the vessels ligated 

 the cord is cautiously loosened. It not infrequently happens, if the 

 surface has not been cauterised, that abundant haemorrhage follows 

 from the numerous small arterioles and capillaries, due in large 

 measure to vaso-motor paralysis, the effect of prolonged compression. 



