SURGICAL HEMOSTASIA. 535 



it between vessels wliicli are perfectly intact and those whicli 

 have been partially cut through or otherwise injured. 



The Immediate Ugating of an artery entirely divided includes 

 but two steps : the prehension of the artery and the adjustment 

 of the hgature. 



When drawn out of its position with the proper forceps the 

 artery must be carefully examined for possible adhesions, and 

 especially any nervous threads which may be attached to its sur- 

 face — all of which must be dissected. 



In j)lacing the ligature many operators carry the thread, form- 

 ing a loop, with the forceps, and on seizing the artery and seeing 

 that it is clear from the surrounding tissues, they slip the loop 

 down over the instrument upon the vessel, to be tied by an assist- 

 ant. The apparent simplicity of this movement is deceptive ; too 

 often the loop of the ligatm-e adheres to the wound, the ends roll 

 over themselves and one another, the Ugature cannot be properly 

 placed over the vessel, and the knot is tied over the forceps before 

 the thread has reached the artery. To avoid this it is better, when 

 the vessel has been weU secured and isolated, to have the assistant 

 apply the ligature by its middle upon the jaws of the forceps, be- 

 hind the hand of the surgeon holding them, in order to be free iii 

 his movements. Then making first a simple knot, without twist- 

 ing the thread, and tying it close to the forceps, he then, with the 



Fig. 458.— Applying the Ligature. 



thumbs, pushes the thread further along the artery, and ties it by 

 pressing the thumbs together with sufficient firmness to rupture 

 the internal membrane of the vessel. If the wound be deep, in- 

 stead of the thumbs both indexes are used to cany the thread 

 along the artery and tie it. The forceps is then removed and 



