Deep wounds of the chest and abdomen presented often insurmountable problems. One of the only instruments available for seizing and holding displaced or severed arteries was the sharp, slender hook called a tenaculum.
The surgeon would hook and hold the blood vessels with the instrument as an assistant or second surgeon tied them off to control the bleeding.
Union surgeon William Williams Keen explained:
"The surgery of the chest lagged far behind that of the head and the abdomen because when the chest was opened the lung collapsed and breathing became embarrassed, or impossible, if both sides were opened.
"In the depths of a wound the tissues could not be seized and drawn up to the light and the bleeding vessel quickly clamped. Our only resource was to try to pass a tenaculum through the vessel and tie it with silk. Usually we were only successful after several attempts. Meanwhile that vessel and others were all bleeding; the others had to wait their turn. We had no retractors by which we could get a good view of the depth of such a wound."
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