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Show or THE serum: AND TENACULUM. OF THE TENACULUM. geon must be again exercised. Whether is it an oozing from the general surface and lesser arteries; or is it a large vessel which requires the dilatation of the wound; or is it the trunk which lies deep which is wounded; is it better to cut and tie it higher in the limb ? If the surgeon be an anatomist, the performance of this last operation is always easy : if he be not, and yet have allowed himself to be thrust into a. situation of responsibility, there is no measure of disgrace and confusion which can be adequate to his crime. wards the point, to enable the surgeon to catch the mouth of the artery more easily*. "‘0 33' 01" THE NEEDLE AND TENACULUM. Ir- an artery situated amongst loose cellular membranes bleeds, it should be tied if possible. If we use only compres- -,-3v,~.u-;-._K:1m¢m‘~-.-- ‘. x4350"! ., tNUtA ‘ sion, and it do not succeed, the re-traction of the artery, and the lowing of the blood from the swelled cellular membrane, and the adhering of coagula, make at last a very confused and ditlicult operation. Where an artery lies against a bone, we ma y with more propriety trust to the compress and band age. In clean cuts, and especially in surgical operations, we should be able to judge of the size and force of the artery from the jet of the blood, and we should take it. up at that moment if it can ever be necessary at. all. By the pressure of the finger, it is made to bury itself among the fat and cellular membrane, or by allowing it to bleed, it exhausts itself. But in both these cases it may be stopped, only during the faintness, cold, and dread of the patient ; and though the vessel may not be discoverable again before the flaps are laid down, yet upon the re rival of the patient, and when he is put into bed, it breaks out again, and requires the whole dressing of the wound to be un~ done. T he tenaeulum is an instrument in common use for drawing out the artery in open wounds, so as to enable the surgeon fair~ ly to tie its mouth. I have given What I conceive to be the necessary curve to it, making the curve a little more acute to- The tenaculum is put into the surgeon's hand during an operation, with. the ligature hanging on it thus (fig. 1.) He catches the artery, and pulls it out, and the ligature is brought down towards the vessel by the assistant, and tied (as in fig. 2. If the artery is large, or lies deep, then it is transfixed, and the curve of the instrument directs the ligature into the bottom of the wound. In drawing the ligature, the assistant should, with his fore-fingers placed on the ligature near the knot, push it down into the wound, at the same time that he draws. Large ligatures slip from the end of the vessels, upon the first wasting of the cellular membrane. Small ligatures are more apt to be fixed amongst the granulations. A ligature * For country practice, or the use of the army surgeon, where there may be occasion to tie an artery without the aid of an intelligent assistant, the curve ot'tlie tenacuium should be a full half-circle, and the handle made 1‘03")": thatit may hans‘ so as to draw out the artery whilst the Sin-SC"n ties it, |
