206 OPERATIONS ON THE SKIN AND CELLULAE TISSUE. 



needle with a double thread or cord, thus dividing the growth 

 into separate halves, each having its own distinct ligatiu'e, tied 

 on opposite sides of the peduncle. 



Third Method, Midtiple Ligature. — At times, the tumor may 

 have a sufficiently wide base to require the addition of a third 

 ligature in order to secure a sufficient amount of constriction to 

 slough the entire mass, in which case special needles become 

 necessary. These are longer than the ordinary ones, though 

 more or less flexible, and with an eye in the centre, additional to 

 that at the extremity, according to indications. 



When the tumor is to be divided into three j)ortions two 

 needles are necessary, and a correspondingly long thread. The 

 needles being passed together through the base of the tumor, with 

 sufficient intervals between to divide it into three nearly equal 



Fig. 231.— Treble Ligature. 



parts, leave, when drawn through, three hgatures with which to 

 enclose separately the central and two lateral portions of the 

 l^eduncle. 



If it becomes necessary to aj)ply four ligatures, two different 

 needles are necessary, one (female) long, having an eye in the 



Fig. 232.— Female Needle. Fig. 233.— Male Needle. 



centre, and another (male) of the ordinary form, with the eye at 

 its extremity, but of a size which will permit its passage with a 

 double thread through the central eye of the other. This male 

 needle is to carry a long, double thread. The manipulation is 

 very obvious. The first needle is inserted far enough to bring 

 the central eye half way through the growth, and the second 

 needle is passed through it, and out at the other side; then, di-aw- 

 ing out the first, two double ligatures are left, or one for each 

 quarter of the tumor. All that then remains is the tying of the 

 four knots. 



To describe it more in detail, the female needle is inserted in 



