ARTERY, PATHOLOGICAL CONDITIONS OF. 



240 



of actual loss of blood, it is not easy to pro- 

 cure a dissection which can satisfactorily shew 

 the condition of the vessel at the moment it 

 begins to bleed, and no subsequent examination 

 can be relied on, because the pressure or other 

 means used to stop the bleeding may in the 

 course of a very few days alter the appearances 

 completely. I have availed myself of every 

 opportunity that occurred, and state the results, 

 not with the presumptive hope of being able 

 to establish any general principle, but to excite 

 others to inform themselves on every case fa- 

 vourable to the further prosecution of the in- 

 quiry, and, perhaps, in some respects to justify 

 the opinions I have formed. It is worthy of re- 

 mark, that secondary haemorrhage occurs much 

 more frequently in the arteries of the lower than 

 of the superior extremities or of the neck, and 

 all the specimens I have examined were of the 

 femoral that had been tied from half an inch 

 to an inch and half below the profunda. In 

 all, the portion of the artery above the ligature 

 gave indications of inflammation extending 

 nearly as high as the common iliac ; the lining 

 membrane more or less vascular ; the portion 

 of the vessel between the ligature and profunda 

 of its natural size or slightly diminished ; its 

 cavity occupied by the remains of a coagu- 

 lum. Above that point the calibre of the 

 trunk was evidently increased, and the texture 

 of its coats less resisting. The inferior por- 

 tion resembled a vessel simply cut across, 

 its calibre diminished, its internal coat dis- 

 coloured, its divided edge smooth and even, 

 not rough, jagged, or irregular, as would pro- 

 bably be the case if it had been the seat of 

 ulceration. 



When a ligature is tied tightly round an 

 artery, every thing included within its noose 

 is killed, but this is only a very small ring of 

 the cellular coat, the internal and middle being 

 as completely divided as if it had been done 

 with a knife. When the absorbents have de- 

 tached the connection of this ring with the 

 remainder of the cellular coat, there is nothing 

 (so far as the vessel is concerned) to retain it 

 farther, nor is it of use in preventing haemor- 

 rhage : it might be withdrawn, only that being 

 entangled in lymph or granulations from the 

 adjacent parts, such a proceeding would dis- 

 turb the divided vessel before the curative 

 process was complete. This process is in some 

 instances, perhaps, never attempted in the 

 inferior portion, although such a deviation 

 from the usual course is probably not frequent ; 

 when it does happen, the cure is more tedious 

 and longer of accomplishment, and when inter- 

 terrupted prematurely, of course it is from this 

 portion that the blood is poured out. 



Whatever the process is by which the ex- 

 tremities of the two segments are closed, it is 

 certainly not the same in both. This fact I 

 was enabled to verify in one of the cases al- 

 ready alluded to, namely, that of the man who 

 died on the sixteenth day after the operation 

 for popliteal aneurism, and whilst the ligature 

 still remained undetached from the artery. 

 The vessel was carefully removed from the 

 body, and on being slit up, the lining mem- 



brane of the portion at the cardiac, side of the 

 ligature was of a pale yellow cftlour and nearly 

 of its natural appearance, with the exception 

 of one or two broad spots of a very li^ht pink 

 colour. A large coagulum extended upwards 

 from the seat of the ligature, the base of which 

 was attached to the lymph situated there. The 

 ligature was still firm, but on attempting to 

 tear it away, the lower portion of the vessel 

 easily separated from it, leaving it still fixed 

 firmly on the upper section : a circumstance 

 which explained a fact I had frequently wit- 

 nessed, that of secondary haemorrhage occur- 

 ring before the final separation of the cord. 

 Below the spot where it had been tied the 

 vessel appeared to be of a deep pink colour 

 approaching to carmine, the seat of which 

 colouring matter was in the cellular tissue 

 between the fibrous and internal coats. This 

 cellular substance seemed to be hypertrophied 

 and largely congested with blood, whilst it 

 caused the lining membrane to be thrown into 

 transverse rugae or folds. On pulling off this 

 membrane, it was pale, transparent, and colour- 

 less devoid of any proper vascularity : and 

 on looking along the slit-side of the vessel the 

 fibrous coat and the internal membrane were 

 seen like white lines with the congested cellu- 

 lar tissue between them. There was not a 

 particle of coagulum either of blood or lymph 

 in any portion of the vessels below the liga- 

 ture. 



It may be objected that in this very dissec- 

 tion, the appearances would warrant a belief 

 that a more active form of inflammation was 

 present in the distal portion of the vessel, 

 because of the deeper tint of colour and the 

 superior thickness of the cellular tissue there 

 observed. Such, however, was not the im- 

 pression of those who witnessed the dissection. 

 There was no result of inflammation visible 

 after seventeen days, neither adhesion, nor sup- 

 puration, nor ulceration : there was merely a 

 congested condition of the part a condition 

 not found in other structures or situations to 

 lead to any of the usual products of inflam- 

 mation. 



An artery, the coats of which have been 

 divided by a ligature, is subject to the same 

 conditions as if it had been severed with a 

 knife : its cavity must be obliterated from the 

 wounded spot to the next collateral branch 

 above and below. Now, the constitutional 

 causes that can delay or impede this oblite- 

 ration, if any, are not sufficiently known ; but 

 it is obvious that any local interference may 

 (as in a case of open haemorrhage) prove sin- 

 gularly perilous. During the first few days, 

 whilst the continuity of the cellular coat is 

 still unbroken, there is no cause for apprehen- 

 sion; but afterwards, any irregularity of diet, 

 any excitement of the circulation, any unwary 

 motion, any injudicious meddling with the 

 ligature; in short, any one circumstance that 

 can interfere with or disturb the operations of 

 nature within the part before they are perfect 

 and complete, will have a much more intimate 

 connexion with the production of secondary 

 haemorrhage than any of the causes hitherto 



