SURGERY. 
finally, the blood coagulates in the orifice. 
Thus the sides of the vessel grow together. 
But death would often take place before 
the bleeding stopped in this way, particu- 
larly if the vessel were lai'ge ; or, at all 
events, great danger would arise from the 
bleeding. H6nee it is always desirable to 
tie the mouth of fhe bleeding vessel, which 
secures us at once from all alarm on the 
subject of hemorrhage. A ligature, when 
properly applied, is found to cut through 
the two internal coats of an artery ; the in- 
flammation thus excited in tlie vessels of 
the part is attended with an etfusinn of 
coagulating lymph, which, together with the 
coagulation of the blood, effectually closes 
the tube, before the separation of the 
thread, which is seldom delayed beyond a 
fortnight. The ligature should include the 
artery only ; or, vchen it is small, as little 
surrounding matter as possible ; when the 
vessel is laige, it may be drawn out with 
the forceps : in the latter case a tenaculum 
must be used. As much force may be em- 
ployed, in drawing the knot, as can con- 
veniently be exerted by the hands. 
The use of tlie ligature, in hemorrhage, is 
preferable to every other means : the tour- 
niquet may be placed on the limb, until 
the vessel is found and secured. When the 
main arterial trunk of a part is compressed 
by the pad of this instrument, there is no 
immediate danger of bleeding. 
The tourniquet, in common use, for which 
we are indebted to a French surgeon, Petit, 
consists ol a band and buckle, a pad, and a 
sort of brass bridge, capable of being ele- 
vated and depressed by means of a screw. 
The band is first buckled round the limb in 
such a manner that the pad, which is attach- 
ed to the band, is placed exactly over the 
artery. The bridge, over which the band 
proceeds, is to be then raised by turning 
the screw, and thus a due degree of pres- 
sure is produced. It affords, however, only 
a temporary security. When a tourniquet 
cannot be procured, pressure may be made 
hy any simple ligature round the limb, 
twisted to the requisite tightness by means 
of a stick. 
Compresses and bandages will sometimes 
stop bleedings by their mechanical pres- 
sure ; but are inferior to the ligaturcL. If 
the bleeding vessel cannot be found, if there 
be rather a general oozing than an hemor- 
rhage from any considerable vessel, or if the 
artery lie against a bone, as those of the 
scalp, this method may be employed. ■ 
When a large artery has received a small 
wound, as the brachial in bleeding, the fol- 
lowing plan may be tr ied. Apply a tour- 
niquet so as to command tlie flow of blood 
into the vessel. Bring the edges of the ex- 
ternal wound into contact. Bind on firmly 
vvitli a roller a graduated compress, with 
the apex placed exactly in the situation of 
the wound of the artery. A longitudinal , 
compress has sometimes been added in the 
course of the ivssel, above the wound ; but 
it would probably impede the circulation 
too much. Then let the limb be kept per- 
fectly quiet. 
The use of agaric, of the actual and poten- 
tial cautery, and ol styptics, as means of ar- 
resting hemorrhage, are banislied from mo- 
dern surgery. 
Wlien bleeding is stopped, and all foreign 
bodies, or coagula of blood, have been re- 
moved, the sides of the wound should be 
approximated by means of sticking-plaster, 
assisted, if necessary, by the position ot the 
part, by bandage, &c. In forty eight hours 
the sides of a wound, healed in tliis way, 
will be agglutinated, and the, process by 
which they are united, is named “ union by 
the first intention.” Sutures were formerly 
employed in the treatment of such wounds, 
but tlieir use is restricted now to the very 
few cases where the sticking-plaster can- 
not be conveniently applied, as the hare- 
lip, &c. They have fallen into disrepute as 
a general mode of treating wounds, prin- 
cipally because they tend to increase in- 
flammation. The new wounds wliich they 
make, their irritation as extraneous bodies, 
the forcible manner in which they drag the 
living parts together, and their incapacity, 
in general, to accomplish any useful pur- 
pose, which position, adhesive plaster and 
bandages cannot effect, are strong motives 
for reprobating tlieir general employment. 
They often bring on such irritation as to 
render their removal necessary. 
The sides of a wound, treated in the way 
now described, thro wont coagulating lymph, 
which joins them together. This forms an 
uniting medium, through wliich new vessels 
shoot from the opposed surfaces. We can- 
not help admiring the celerity with which 
this uniting process is completed. The 
w'onnd produced in amputating a thigh is 
often securely united in seventy-two hours ; 
and the principles now detailed apply to 
tlie management of all wounds made by 
surgical operation. 
Punctured womdsKte. often attended with 
more pain, inflammation, &c. than others. 
Enlarging their orifice is au mmecessary 
