SURGICAL HEMOSTASIA. 531 



by approximating the edges of the wound, as much as possible, 

 by means of interrupted, pin, or a quill sutui'e ; or sometimes 

 a circular bandage of dry or compressed sponge, cut into small 

 pieces, may be used in the same manner as the oakum with ex- 

 cellent effect, especially when the hemorrhage is abundant, or 

 ligation become impracticable. 



The objection to the mode of compression, generally speaking, 

 is its liability to become loosened in consequence of the softened 

 and yielding condition of the surrounding tissues. For this rea- 

 son the mode of applying the force directly is not often practiced, 

 or, at least, is adopted only when the hemorrhages are small and 

 controllable by slight pressure, or in case of the section of an in- 

 comj^ressible artery, like that of a bone. 



In order to increase the effect of direct pressure the surgeon 

 sometimes has recourse to the joint use of some of the physico- 

 chemical hemostatics before mentioned. 



( a ) Immediate Lateral Compression. — This is practiced 

 against hemorrhages due to lateral wounds of blood vessels, and 

 is applied directly upon the opening in the vessel. The method 

 of its application does not differ from that of direct compression, 

 and it is Hable to the same objections in its irritating effect upon 

 the surface of the wound and consequent interference with cica- 

 trization, and the danger of a renewal of the bleeding. More- 

 over, if the vessel is without a solid resting-place, and there is no 

 sufficient resisting point, hemorrhage is not arrested. But again, 

 in a contrary condition, it may be followed by gangrene or the 

 obUteration of the vessel, and if the wound is of such a form that 

 this last accident cannot be avoided it is better to have immediate 

 recourse to the ligature. It remains, then, that this mode of hem- 

 ostasia is only ad\dsable when the wound is small and the artery 

 small and superficial, or in such a position that it cannot be ligated. 



Immediate lateral compression, however, can be made with 

 great benefit with the finger upon the wound, pressing with the 

 necessary force to prevent the escape of the blood, without clos- 

 ing the cahbre of the vessel. The finger is kept in position for 

 one or two hours, with an occasional insi)ection to discover whether 

 the hemorrhage has ceased, and when it is I'emoved there remains 

 but a simple wound, easy to dress. 



This mode of compression has the advantage of obviating the 

 accidents that may occur from excessive external pressure main- 



