CLOSURE OP A WOUND. 383 



the mouth of the vein or artery must be slightly drawn out 

 from the contiguous , surface, by means of a small hook, call- 

 ed by surgeons a tenaculum, and easily procured from any 

 blacksmith. While the mouth of the vessel is thus held ex- 

 posed, an assistant must surround it with a noose of thread, 

 which, on being secured with a double knot, will effectually 

 close it. The thread ought to be of white silk, though any 

 undyed thread, which is firm, round, and capable of standing 

 a pull, will answer the purpose. Care must be taken to 

 place the thread, before tying it, fairly behind the point of 

 the tenaculum, so as to avoid including the instrument with- 

 in the ligature — a circumstance which would lead to the 

 slipping' of the noose and failure of the operation. The 

 hook is now to be withdrawn, and one end of the ligature cut 

 off by scissors a short distance from the noose. The re- 

 maining threads are allowed to hang out of the wound, so as 

 to admit of their removal when they become loose, which 

 does not, however, take place till the termination of the first 

 four days, and they are frequently retained for a longer pe- 

 riod. At each time the wound is dressed, after the fourth 

 day, the ligatures should be gently pulled, or, which is pref- 

 erable, twisted, to disengage them, if at all loose, so that the 

 wound may be more speedily closed. Before proceeding to 

 any operation where bleeding is expected, the operator should 

 provide himself with a few well-waxed threads, each twelve 

 inches long, so that no delay may ensue on a. division of 

 large vessels. 



REMOVAL OF EXTRANEOUS MATTER. 



Dirt is best removed by washing with a sponge or old 

 linen rag and warm water. Other foreign bodies may in 

 general be extracted by the finger and thumb. In some 

 cases, however, it may be necessary to enlarge the wound 

 with a fine-edged knife, in order to facilitate the removal of 

 substances which, from their shape or situation, cannot be 

 otherwise displaced. 



CLOSURE OF A WOUND. 



The last thing to be done is to bring the edges of the 

 wound into as accurate contact as the state of the parts wil) 

 at the moment permit, vjithout, however, using any force. 

 This, with a little care, is readily accomplished, the only 



