DISEASES OP HEART, BLOOD VESSELS, AND LYMPHATICS. 81 



but it is not advisable to use the tincture of iron if it can be avoided, 

 as it is a caustic, and retards healing by causing a slough. The arti- 

 cles may be saturated with vinegar in cases of necessity, or tannic acid 

 or alum dissolved in water may be used instead. The article (which- 

 ever is used) should be left in the wound sufficiently long to make sure 

 that its removal will not be followed by a renewal of the hemorrhage. 

 It must remain there one or two days in some instances. 



An iron heated until it is white and then pressed on the bleeding ves- 

 sel for three or four seconds is occasionally used. It should be at white 

 heat and applied for a moment only, or else the charred tissue will 

 come away with the iron and thus defeat the purpose of its application. 



Compression may be applied in different ways, but only the most 

 convenient will be mentioned. To many wounds bandages may easily 

 be applied. The bandages may be made of linen, muslin, etc., suffi- 

 ciently wide and long, according to the nature of the wound and the 

 region to be bandaged. Bed sheets torn in strips the full length make 

 excellent bandages for this purpose. Cotton batting, tow, or a piece 

 of sponge may be placed on the wound and firmly bound there with 

 the bandages. 



In many instances ligating the vessel is necessary. A ligature is a 

 piece of thread or string tied around the vessel. Ligating is almost 

 entirely confined to arteries. Veins are not ligated unless very large 

 (and even then only when other means are not available) on account 

 of the danger of phlebitis, or inflammation of a vein. The ligature is 

 tied around the end of the artery, but in some instances this is diffi- 

 cult, and it is necessary to include some of the adjacent tissue, although 

 care should be taken that a nerve is not included. To apply a liga- 

 ture, it is necessary to have artery forceps (tweezers or small pincers 

 may suffice) by which to draw out the artery in order to tie the string 

 around it. To grasp the vessel it may be necessary to sponge the 

 blood from the wound so that the end will be exposed. In case the 

 end of the bleeding artery has retracted, a sharp-pointed hook, called 

 a tenaculum, is used to draw it out far enough to tie. The ligature 

 should be drawn tightly, so that the middle and internal coats will be 

 cut through. 



Another method of checking hemorrhage is called torsion. It con- 

 sists in catching the end of the bleeding vessel, drawing it out a little, 

 and then twisting it around a few times with the forceps, which lacer- 

 ates the internal coats so that a check is effected. This is very effec- 

 tual in small vessels, and is to be preferred to ligatures, because it 

 leaves no foreign body in the wound. A needle or pin may be stuck 

 through the edges of a wound, and a string passed around between the 

 free ends and the skin (PI. XXVIII, fig. 10), or it may be passed 

 around in the form of a figure 8, as is often done in the operation of 

 bleeding from the jugular vein. 



61386—08 6 



