SURGICAL HEMOSTASIA. 533 



(c) Plugging. — This mode of compression is chosen as a per- 

 manent hemostatic to arrest hemorrhages which occur upon the 

 surface of natural cavities, or upon wounds where the injured 

 vessel cannot be reached. This is done with balls, or pledgets of 

 oakum or sponge, carried with a forceps to the bottom of the 

 cavities, or with sachets, arranged in the manner of the tampon, 

 impregnated with an astringent solution or a cold mixture, the 

 whole being kept in place by the dressing which closes the cavity. 

 It is used in cases of epistaxis and hemorrhages from the uterus, 

 or those following castration. But with all its advantages it is an 

 uncertain mode, and opposes but a sUght obstacle to the hemor- 

 rhage ; besides which it irritates, by the pressure of the plugging 

 material on the parts with which it is in contact, where it acts in 

 the maimer of a foreign body, which in fact it is, giving rise to 

 some pain, and perhaps stimulating muscular contractions, and 

 thus exciting the hemorrhage anew. However, these objections 

 are not of sufficient weight to contrarindicate its employment 

 as a ready and efficacious means of hemostasia, or to prevent 

 it from being wisely appreciated and largely employed by the 

 surgeon. 



(B) — LiGATUBE. — The Ugature is the typical and obvious means 

 of hemostasia — the hemostat par excellence — perfect m its sim- 

 pUcity, though consisting simply in tying a circular thread or 

 cord around the wounded vessel with sufficient tension to close its 

 channel, suppress the circulation, and convert the tube into a 

 cord. It can be applied either on the out extremity of an artery, 

 or upon its continuity. It is seldom appHed upon veins, however, 

 from its UabUity to induce phlebitis, but still, it is resorted to in 

 wounds of large veins, or when the hemorrhage cannot be con- 

 trolled by other means. 



As with compression, ligature may be immediate or mediate, 

 and may also be divided into temporary and permanent— tem- 

 porary, when its continuance depends upon some contiagency — 

 permanent, when it is to remain until it is eliminated by suppura- 

 tion, or becomes organized and absorbed, as when the ligating 

 thread is composed of some special animal fibre— which is the 

 kind most commonly used. 



The instruments required for this operation are : tenaculum, 

 aneurism needle, Hgature materials, ordinary dissecting or bull- 

 dog forceps, scalpel or bistoury, and the grooved director. 



