The principles of surgery . carcity of assistance, admitting of the bleeding orifices beingmore rapidly secured. Secondly, because it is very difficult, if notimpossible, for the assistant who secures the noose, to include the extre-mity of the instrument along with that of the vessel—a casualty notunlikely to occur with the ordinary forceps, among inexperienced fingers,or even with much expertness in a deep and narrow wound. Especialcare is taken that nothing but arterial tissue is included in the noose;and, to this end, the surrounding textures are pushed back by the fingernail, if need be.
The principles of surgery . carcity of assistance, admitting of the bleeding orifices beingmore rapidly secured. Secondly, because it is very difficult, if notimpossible, for the assistant who secures the noose, to include the extre-mity of the instrument along with that of the vessel—a casualty notunlikely to occur with the ordinary forceps, among inexperienced fingers,or even with much expertness in a deep and narrow wound. Especialcare is taken that nothing but arterial tissue is included in the noose;and, to this end, the surrounding textures are pushed back by the fingernail, if need be. By the interposition of other tissues than the arterial, at least threedangers are encountered. 1. The inner coat is not divided; does notresile from the bight of the ligature, and so become favorably situatedfor adhesion; but remains in its embrace, and must slough, inflame, andulcerate. 2. Nerve or vein, being usually in close apposition to theartery, is likely to be included ; and deligation of either is sure to induce. 313 TIIE TYING OF ARTERIES. results both painful and dangerous. 3. There is a larger extent ofslouch rendered unavoidable. For its separation, a proportionally greatamount of inflammation and ulceration must ensue ; and thus the dangerof secondary hemorrhage is increased. On the other hand, if the vessel, by laxity of the surrounding parts,be much protruded in an isolated state, the noose should be appliednear the base of such projection ; otherwise the vital power necessaryfor subsequent occlusion might prove deficient. In obedience to thissound maxim, it may happen that after application of the ligature, aconsiderable portion of bare artery is left dangling in the wound. It iswell to abbreviate this, by knife or scissors; for obvious reasons. Butin ordinary wounds this is seldom required. The first noose is drawn tightly; not with force sufficient to endangera tearing through of all the tunics ; but soFig 107. as to insure the giving way of the internal a
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