436 OPERATIONS. 
writer, to accomplish the purpose which that little knife was specially 
made for, was accustomed to employ a bistoury larger than those in 
ordinary use among gentlemen of his profession. 
Where you anticipate much bleeding, always endeavor, if possible, to 
divide the main artery with the first incision. This is by far the most 
humane, and therefore the safest practice. The vessel, being divided, 
can be taken up, and all further flow of blood thereby checked. But if 
the artery be left to the last, it remains to fill the smaller branches. 
These are of necessity frequently severed. Each, as it is cut, bleeds 
more or less freely; thus the hemorrhage is far greater, and the opera- 
tion far more difficult, than if the main trunk had been secured at the 
earliest possible period. 
Always tie both ends of an artery; because, though the main stream 
flows through that portion of the vessel nearest the heart, yet the other 
half, being fed by the smaller trunks, and the current having a tendency 
to regurgitate, a considerable quantity of the vital fluid may flow out of 
the mouth, which, in general opinion, has no medium of supply. 
If, during an operation, you make an accidental incision into a vessel, 
either take it up, (which is the better way,) or cut it short off when there 
is a chance of its retracting and of the bleeding being thus arrested. 
Vessels of large size may, when requisite, be excised and tied; the 
vital current being afterward carried on by the dilatation of the lesser 
ducts. 
To tie an artery it is imperative to secure the end of the vessel; this, 
if possible, should be accomplished with the forceps. When the mouth 
of the vessel is much retracted, it may be necessary to employ the knife ; 
but that practice should be viewed only as the last resort of the profi- 
cient surgeon. 
The end of the artery being fixed and drawn forth, a piece of strong 
silk, thrice twisted, (after the method represented in 
the inferior circle of the annexed illustration,) is 
passed over the vessel. The silk is then drawn tight, 
and will generally remain fixed. However, sad acci- 
dents have occurred by operators trusting to so 
( doubtfal a security; for that reason it is always 
advisable to make another twist, (as shown in the 
smaller circle of the illustration,) which will render 
—_, the knot secure. 
THR LOUP BY MEANS OF Even a vessel of the second magnitude may be 
WHICH THE ENDS OF AR- . a . . . 
TERIES ARE SECURED. obliterated, as the carotid artery or the jugular vein, 
without life being necessarily sacrificed. However, 
it is always well to spare these parts, or when either is lost to arrange so 
