HEMORRHAGE. | 
hetent, there is no danger of the ligature making its way by 
ulceration through the external coat before that event is 
completed. See Jones, p. 172. 
Since the arteries are themfelves furnifhed with arteries 
from thofe which furround them, and fince they can only be 
in a found ftate, while they continue to receive a due fupply 
of blood through the vafa vaforum, it muit be evident, that, 
tying an artery in a place where it is completely detached 
from all its furrounding natural connections, muft be particu- 
larly unfavourable. Such portion of the artery is not ina 
fit tate for inflaming and throwing out the neceflary quantity 
re 
H ir. Abe 
nethy in fpeaking of aneurifm, the beft Englifh furgeons 
et 
great floughing of the furface of the wound, &c. tends to 
hinder that. molt defirable effet of the ligature, the divifion 
of the internal and middle coats of the artery. 
Of courfe, when the veffel is under a certain fize, the fur- 
geon cannot avoid tying a {mall portion of flefh together 
with it ; but ftill fuch portion ought to be as little as poffible, 
in order that the patient may not be put to unneceflary pain, 
and that asmuch of the wound may heal by adhefion as cir- 
cumftances will allow. 
When the mouth of a cut artery is wide and very vifible 
the furface of a wound, it is beft to take hold of it with _ 
a pair of {pring forceps, (fee Plate II. fg. 11.) and tie it as 
nearly as poffible to the part where it begins to be furround- 
edwith fleth.- However, nothing except the artery fhould 
be included in the ligature, neither nerve nor mu cle. Whe 
the artery is of {maller fize and lefs diftin@, it cannot be fo 
conveniently taken up with the forceps, and furgeons, for the 
purpofé of tying it, ufually raife it, together with a fmall 
portion of the flefh, by means of the tenaculum. (See 
Plate 11. fig- 9+) se — 
Surgeons fhould make it a maxim never to employ more 
sprigs oes are eflentially neceflary for the removal of all 
ik of hemorrhage. Ligatures a€t as foreign bodies in 
t 
man {mall itetes, which bleed at firft for a few minutes ; 
but which then fpontaneoufly ceafe to pour forth any blood — ftan 
ind gi ere a 
to a very great extent. In hemorrhages, from the {maller 
order of arteries, compreffion ought rather to be trufted 
than 
by keeping the oppofite furfaces of the wound in contact, 
to promote adhefion, while the operation of the ligature, as 
. 4 4n the j j ‘ 
an extraneous fubftance, is prejudicial 
mentioned. 
In confequence of cicatrization being hindered by the con- 
- tinuance of ligatures in wounds, it is always. 
t - 
» 
to take them away, as foonas they are loofe enough for this 
purpofe. The celerity with which ligatures become detached, 
is, generally fpeaking, in proportion to the {mall fize of the 
tied veffels, and the little quantity of additional fubftance 
included with them in the ligature. From {mall arteries 
ligatures are often detached in three or four days; with 
uch arteries as the radial and ulnar, the procefs frequently 
takes up a week ; while, with veflels equal in fize to the 
femoral, inguinal, and axillary arteries, the ligature generally 
remains firnily attached ten days or a ortnight. en it 
lerate the ulceration of the external coat of the artery, by 
d. How 
which means the feparation is effected. owever, as Drs 
Jones has explained, great caution is requifite in endeavour- 
ing to expedite this event. ould always remem 
artery, by rendermg the ligature loofe, diminifhes very muct 
its power of promoting ulceration through the reft of the 
arte : : 
”’ > Jones, p. 162: : 
Ligatures, in confequence of being applied in an impro- 
per and carelefs manner, have fometi ipped off the. end 
of the artery, and dangerous and hemorrhages been: 
the confequence. Some furgeons have endeavoured to avert 
from themfelves by impu t ent to the 
violent impetus of the blood. Dr. Jones more accurately 
refers it to the clumfinefs of the ligature, which prevent® 
its lying compaétly and fecurely round the artery 5 oF te 
its not having been applied tight enough, left it fhould cut 
through the coats of the artery too foon 3 or, finally, to 1ts 
having that very infecure hold of the artery, which 
deviation from the circular applicatior muft neceffarily occa 
on. : 
by this fuid being determined into the collateral branchess 
as foon as the ligature is applied. Neither is there “si 
pulfation for fome way above the tied extremity of the vefl 
The artery alfo, after its frit retraction, undergoes only an 
inconfiderable and gradual change of this kind. 
Ps ¥73 : A 
The fubje&, juft now noticed, is one deferving of fome 
attention. Mr. Aftley Cooper met with fome inftances 1» 
which the ligatures flipped fuddenly off the end of the at- 
tery, in the operation be popliteal aneurifm. The 
ce-led him to adopt a plan, whichis deferibed by Dronis> 
and confits in paffing the end of the ligature through *¢ 
part of the artery below where the knot has been maces 
_ then tying the two ends of the ligature together in anadd 
d tional knot. Now, fince this tau method of hinder 
ing the ligature from flipping is not needed, when the artery 
cefs hy which the wound is healed; fo that they fhould nest 
De der Se NOL the bfolute 460 : pre 
