| A. | Excision of Wrist—radial incision. |
| B. | Excision of Wrist—ulnar incision. |
CHAPTER I.
LIGATURE OF ARTERIES.
Ligature of Arteries.—In a work of this nature there is no room for any discussion of the principles which should guide us in the selection of cases, or of the pathology of aneurism, or the local effects of the ligature on the vessels. One or two fundamental axioms may be given in a few words:—
1. In selecting the spot for the application of the ligature, avoid as far as possible bifurcations, or the neighbourhood of large collateral branches.
2. A free incision should be made through the skin and subjacent textures, till the sheath of the artery is reached and fairly exposed.
3. The sheath must be opened and the artery cleaned with a sharp knife till the white external coat is clearly seen. The portion cleaned should, however, be as small as possible, consistent with thorough exposure, so that the ligature may be passed round the vessel without force.
4. As the artery should never be raised from its bed, it is generally advisable to pass the needle only so far as just to permit the eye to be seen past the vessel. The ligature should then be seized by a pair of forceps and gently pulled through, the needle being cautiously withdrawn. When catgut is used, it is better to pass the unarmed needle till the eye is visible, then thread and withdraw it, thus pulling the catgut through.