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hand, thrust it from the cutaneous surface entirely through the thickness of the flap, causing its point to emerge a short distance from the side of the artery. Then by forcibly inclining the head of the pin away from the artery, it causes the point to press upon the vessel with sufficient firmness to close its calibre-now carry the point on into the tissues a short distance beyond, and thrust it out again through the cutaneous surface. Thus the artery is compressed between the middle portion of the needle and the soft parts of the flap. For this proceeding one of the longest pins will be needed if the flaps are of any considerable thickness.

Second Method. For this method, select a needle of the proper size, armed with a fine annealed iron wire to facilitate its removal; thrust it into the fresh surface of the wound at a short distance from the bleeding vessel, pass it on and cause its point to emerge as near the vessel as possible without transfixing it; then on again over the vessel, completely compressing it; then dip the point once more into the fresh surface close to the vessel on the opposite side; continue to force it on, causing the point of the needle to emerge a second time upon the cut surface. This bridges over the artery and completely occludes it. The degree of pressure exerted is slight, but sufficient to stop the bleeding in the smaller vessels. There are other methods, shortly to be described, which are preferable. A pin may be used if the bleeding point to be secured lie sufficiently near to allow the head of the pin to be brought outside of the lips of the wound.

[graphic]

FIG. 4-The needle threaded to admit of its being withdrawn. Second method.

Third Method.-A needle, threaded with a twisted annealed iron wire, is thrust into the soft parts on one side of the artery, carried on behind it, and then the point is made to emerge upon the opposite side of the vessel. Pass a loop of wire over the point of the needle-bring the wire back over the track of the artery and behind the eye-end; draw up the wire with sufficient force to close the vessel, and then fix it by a half twist around the shank of the needle.

[graphic]

FIG. 5.-The third method, by means of a needle threaded with iron wire, and a loop of annealed iron wire.

Fourth Method. This is merely a modification of the third; a pin being substituted for the threaded needle. When the vessel to be secured is so situated that the head of the pin can be left external to the lips of the wound without any undue strain

[graphic]

FIG. 6.---The fourth method, by means of a long pin and a loop of iron wire. ing of the parts, the fourth method can be performed more easily than the third, and both the wire and the pin can be re

moved with greater facility than where the threaded needle is used.

By the third and fourth methods the tube of the artery is compressed between the pin below and the wire above, and no more force should be used in tightening the wire than just suffi

A

FIG. 7.-The mechanism of the third and fourth methods-viz., direct compression of the artery between the loop and the needle or pin. Third and fourth methods.

cient to stop the bleeding. It will also be found in practice that a simple half turn around the needle is sufficient to fix it securely.

The first, second, third, and fourth methods were devised and first described by Professor Simpson. The third and fourth methods are very reliable even for the larger vessels, and have a very wide range in their application.

[graphic]

FIG. 8.-The appearance of the parts at the termination of the first step of

the fifth or Aberdeen method with a threaded needle.

Fifth Method or the Aberdeen Twist.-There are two varieties of this method, "differing from each other only in the extent of rotation given to the instrument by which the twist is effected." An armed needle or a long pin is the only instrument required in either variety.

[graphic][merged small]

In the first variety of the Aberdeen method the instrument is made to undergo a half rotation. Enter the instrument a few lines to one side of the bleeding artery, pass behind it, and then make the point to emerge a few lines on the other side of the the vessel. This terminates the first stage. In the words of

[graphic]

FIG. 10.-The fifth or Aberdeen method; the appearance of the parts after making the half rotation and fixing the needle.

Professor Pirrie, "the second step consists in twisting the needle or the pin to the extent of half a rotation, so as to bring its head to the side where its point was situated before making the twist; the instrument being now above, instead of below the

[graphic][merged small]

artery, and well pressed down upon it. The third step consists in sending the point of the instrument into the tissues beyond the artery for the purpose of securing it in the proper position and retaining the twist."

Second Variety of the Aberdeen Method.-This is preferable to the first variety, being more simple, requiring only a quarter

[graphic]

FIG. 12. The appearance of the parts at the termination of the first step of the fifth or Aberdeen method, by the twist, before making the quarter rotation with the needle.

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