210 OPERATIONS ON THE SKIN AND CELLULAR TISSUE. 



less suddenly and firmly, but never with sufficient force to pro- 

 duce an immediate section, an operation which could have been 

 more easily performed, and with less pain, with the bistoury. To 

 avoid this section, apply the constriction slowly, and in accordance 

 with the effects produced, and the resistance encountered by the 

 ligature. If the tissues are soft and frangible, it would be unsafe 

 to comjolete the constriction at once, and it should be deferred 

 to a later period ; if, on the contrary, it is hard and resisting, the 

 ligature may be drawn tightly, and firmly tied at once. Ordinary 

 traction on the ligature may be made with the hands only, but 

 when extra strong and steady traction is required, wooden holders 

 will prove of great assistance. These means of securing the Hga- 

 ture on the tumor are successful so long as it is comparatively 

 superficial, but if it is situated at a certain depth, special instru- 

 ments are required. Among these is one particularly adapted to 

 the removal of growths from the natural cavities, such as the 

 nasal, rectal, vaginal or inguinal regions. It consists of a wooden 

 or metallic tube, of variable length, through which the loop of a 

 double, strong, waxed hgature can be introduced into the cavity 



Fig. 248.— Ligature Carrier. 



and adjusted around the base of the tumor, and when in position, 

 tightened by traction on the thread at the mouth of the tube, and 

 so secured that the constriction can be maintained at any degree 

 of tightness, and increased or relaxed at pleasure. 



3d. — Elastic Ligature. 



This is but a variation from the ordinary ligature, in which 

 an india-rubber cord or tubing of suitable diameter is substi- 

 tuted for the other means of constriction. It is applied like the 

 others at the base of the tumor, and secured in the same manner. 

 The peculiarity of its action arises, of course, from its elasticity, 

 the result of which is a constant unrelaxing, self-regulating con- 

 striction, which continues automatically until the ablation is 

 eifected. 



The growth upon which the elastic Hgature is apj)Hed soon 

 begins to undergo changes, which may be at first unnoticeable. 



