HEMORRHAGE. 
parts, the internal coat of the artery is torn through by it. 
Dr. Thomfon added, at the fame time, with his ufual can- 
dour and liberality, that the fa& had been firft noticed by 
Monfieur Default. Dr. Thomfon = alfo demonftrated to 
r. Jones, on a portion of artery taken from the human 
to it. 
firft effets of the ligature upon an artery are a complete 
divifion of its Snaigk and middle coats, an oppofition of its 
wounded furfaces, and an obftru€tion to the circulation of 
the blood through its canal. There is a fmall quantity of 
blood at reft juft within the extremity of the artery, it there- 
fore coagulates; but it does not appear in every inftance 
to form at once a coagulum, capable of filling up the canal 
Indeed, 
traction, as may prevent the formation of a complete coagu- 
: in this 
omplifhed, 
sonfiderable quantity of lymph is effufed between its coats, 
and among the parts furrounding its extremity 5 fo that in 
: pun th 
ligature occafions ulceration of the part around which it is 
fimple incifed wounds. For this reafon, Dr. Jones recom 
mends us to take the utmo 
efcape of any biood. Now 
that a broad flat ligature fhould make fuch a wound in the 
internal and middle coats of the artery, as is mot favourable 
to adhefion ; becaufe it is fearcely poffible to tie it {moothly 
around the artery, which is very likely to be thrown into 
folds or to be puckered by it, and, confequently, to have aa 
irregular bruifed wound, made in its middle and internal coats. 
And, even if it fhould make a proper wound, yet by covering 
a confiderable {pace of the external furface of the artery, it 
may deftroy the very veffels which pafs on it in their way to 
the cut furfaces of the internal and middle coats, and thereby 
render them incapable of inflami i 
¥ 
167—1 
When the form of the ligature is irregular, the internal and 
middle coats of the arte ill p 
y 
porrtts that, in order that fuch an effufion of 
lymph may happen as will prodnce adhefion, it is neceflary 
_ that thefe coats be completely divided all round the arte 
Hence he infers, that fecondary hemorrhage will Hy 
place as foon as the ligature has ulcerated through any part 
of the parietes of the artery, and that it will be more co« 
pious and frequent as the ulceration advances, 
reafon, fhews the impropricty of 
, in fuch a manner, that 
herefore : 
the a parts, and produce hemorrhage. Jones, 
yi ETE 
Phi judicious writer advifes the ag ST of ligatures 
which are round and very firm. Thefe fhould be tied with 
defi a : is to pro- rather more than fufficient tightnefs to cut through the in- 
an imnedinte ee kan ee 10 x et ag respond ternal and middle coats of the artery. By this means, : 
n of the internal and middle coats of the artery. The cut furfaces will be more a kept in contact ; the 
mplifhment of the latter object affords the only lafting pn 4 away of the ligature will be expedited, and. the 
fit aout a recurrence of the bleeding. gepoonigen eee “4 As tie tothe! peters asd gat 
Von SVL nm Bence only be obtained in clean | 4k herent, 
i 
