HEMOSTASIS. m1 
L 
pression. This hemorrhage is arrested with cauterization, cold irri. 
gations, phenicated lotion, or by a compressive dressing. 
In general practice, the Esmarch method is not rigorously applied, 
Often only the circular constriction is used, Generally speaking, it 
is better to use it when the tissues are seriously injured or infiltrated 
with pus or infectious liquids, which, crushed in by the compressors, 
might give rise to serious accidents ; but as the hemorrhage is some- 
times very abundant on account of the venous stasis, it may be re- 
duced by the application of a second constricting cord to the other 
end of the region to be operated upon. 
Mediate compression, with the fingers, of the principal arterial 
trunk, which distributes blood to the parts to be operated upon, is 
seldom used ; if it is employed, it must be kept up until complete 
hemostasis is definitely obtained. During the operation it can be 
suspended in cases where the ends of the divided arterioles are hard 
to find; small spurts of blood then indicate their location. When 
the garrot has been used, it is sometimes useful for the same reason 
to diminish the constriction. 
A strict diet for twenty-four hours before an operation is also a 
means of reducing the hemorrhage during bloody operations. 
II. Hemostasis During and After the Operation.—Most of the 
processes mentioned above are only applicable to a limited number 
of regions; and often, during the progress of an operation, the blood 
flows freely from numerous small divided blood-vessels, veins or 
arterioles. 
There is only a slight hemorrhage, or none at all, when one has 
recourse to the processes for bloodless exzresis : actual cauteriza- 
tion, thermo-cautery, galvano-cautery, caustics, linear crushing, tear- 
ing, elastic ligature, etc. 
As an excellent means of ‘hemostatic dizeresis, actual cautery is, 
also, often used to make punctures or remove tumors. It has been 
abandoned for the destruction of neoplasms, since it seldom gave 
good results: under the scar produced by the cauterization, the 
irritated tumor would grow again. The red-hot iron, worked like 
a bistoury, is still used to make some excisions. When carried to 
white heat, it cuts the blood vessels too rapidly, and their oblitera- 
tion is then incomplete; if it is only dark red it cuts them, at the 
same time stimulating the retraction of the coats of the vessels ; so 
that this heat is the proper one to obtain good hemostasis. Intro- 
duced into the tissues, the actual cautery soon cools off ; and its 
repeated application is necessary to divide a layer of tissue or excise 
atumor. On that account, the thermo or galvano-cautery are better 
instruments ; with the zoocautery one can make punctures, deep 
incisions, and excisions, without hemorrhage. 
The écraseur of Chassaignac, almost unused now by surgeons tor 
