SUPPRESSION OP HEMORRHAGE 59 



be severed. There are so many patterns of these instru- 

 ments now on the market that a selection of the hest 

 is not an easy matter. Personally, I prefer the pattern 

 known as the Mayo-Ochner, which is of the "rat's- 

 tooth" type and very efficient. For ease in getting the 

 ligature to slip down the forceps, Greig-Smith's pattern 

 can be recommended, and the larger sizes are especially 



, useful for ligating large vessels. 



As to the ligature material, some prefer silk, others 

 catgut, but I prefer the material known as "Chinese 

 twist, ' ' which can be obtained in all sizes, can be readily 

 sterilized, and stands great strain. Nothing is more an- 

 noying when ligating a vessel than to have the ligature 

 material break at a critical moment. 



In the ease of small vessels, where no ligature is re- 

 quired, I have found that Blunk's hemostatic forceps 

 are convenient and reliable. 



Tumors 



There are certain operations in which the question of 

 the arrest or control of hemorrhage is of special im- 

 portance. Tumors in the region of the shoulder, also 

 known as "collar" tumors, in some cases depending on 

 the presence of Botryomyces but in others having a 

 doubtful etiology, need special care. 



When ordinary treatment fails — that is, locating the 

 abscess by means of a trocar and cannula, free incision, 

 curetting the cavity, and plugging with tow soaked in 

 tincture of iodin — then excision must be resorted to. 



A knowledge of the anatomy of this region, and of 

 the firm consistency of the tumor aiid its extensive 

 attachments, indicates that serious hemorrhage is likely 

 to occur iinless care be taken in the technic of the opera- 

 tion. The position of the carotid artery should be 

 carefully noted, so as to avoid injuring this vessel. Bu>t 

 in my experience the vessel which is most likely to be 



