HEMORRHAGE. 
clumfy ligatures mutt be the leaft calculated for cutting 
through the internal and middle coats of the artery, a thing 
which is fo effential and defirable. ‘ 
ing the bleeding arteries, in cafes of 
one end of each ligature, the other 
morrhage with the needle and ligature, 
through the flefh on each fide of the mouth of the sei | 
piercing the patient’s flefh with the needle; nor can the 
practice of including the flefh in this way in the ligature be 
at all juftifiable upon any rational or really ufeful principle. 
e will not fay, however, that there can never be a cafe, i 
which it is neceffary to ufe a needle and ligature for the fup- 
flion of hemorrhage. When it is defrable to introduce 
a lirature clofel er anartery, which has not been com 
pletely cut ahs 8 and which has been fufficiently brought 
ito view, we agree that a needle may ometimes d 
vantage. But, even in fuch inftances, the fharp points of 
the common needles are fomewhat dangerous ; fo that the 
ft prudent furgeons ufually employ an eye-probe, or an 
aneurifm-needle eae purpofe. The moft approved aneu- 
rifm-needle is reprefented in Plate Il. fig. 10. rando 
thrutts into the fefh with the needle and ligature, for the 
| ae of ftopping an hemorrhage, muft ever meet with the 
approbation oP a well-informed furgeon. The injury and 
pain, which are invariably occafioned by fuch prattice, are 
uite unwarrantable ; and the mifchief which be done 
f the moft formidable and fatal defcription. When a 
when 
the opera 
without di: 
‘20 contri 
dle coats 
trary, occafions a* gradu 
the artery, and, of courfe, hemorrhage 
*r violence as the ulceration advances. The improper 
rm and thicknefs of the ligature may alfo tend to the fame 
bad confequences. See Jones, p..176 
avy one ligature is ufed in the ag 
jfeed of applying two and dividing the artery between es 
we. 7 ‘fame principles as thofe 
Which were fome years ago pointed out by Mr. Abernethy, 
rvations i 
an. 
ied, and the artery cut through, “t 
eli to the part at sik its conneétion with the furrounding 
e, in p 
3 With regard to the occurrence of .fecondary hemorrhage, 
cellular membrane is complete.” In the other mode, “a 
confiderable portion of the artery is. detached from the fur- 
rounding cellular membrane, and the ligature applied, per- 
haps, in the centre of this detached portion ; or, even if it 
be applied at the upper end, {till there remains a confiderable 
portion of detached artery below it; now, when we con- 
fider that the arteries receive their veffels from the furround- 
ing cellular membrane, it mutt be evident, that if we deprive 
it of thefe veffels, it cannot undergo thofe changes which 
d upon vafcularity, viz. inflammation and adhefion ; 
a 
o 
ee 
and, confequently, the ligature cannot produce thofe effects 
on which the fuccefs of the operation depends ; but the por- 
tion of artery dying, and burfting or floughing, hemorrhage 
takes place if the Costar be applied on the centre of the 
detached portion of the artery, when the artery gives way, 
the hemorrhage will proceed both from the upper an lower 
portions; but if it be applied on the veflel at its con- 
neGtion with the furrounding cellular membrane, either 
above or below, the hemorrhage will then proceed from only 
one part of the artery, which will be that which has 
the detached portion of the artery for its extremity.” Jones, 
away, 
important fa¢t in relation to the operation for aneurifms, and 
cti continu- 
feems likely to lead to a new practice. For if 
ance of a ligature in a wound is produétive of irritation, and 
preventive of union by the firft intention ; if, alfo, fecondary 
hemorrhage is fometimes a confequence © form and 
bad application of the ligature: we have no hefitation in 
thinking, that the fimple plan of juft tying an artery with a 
thin round ligature, hrough its internal and middle 
coat, and then taking it altogether away, promifes to lead to 
One of the chief objects to be 
would be to detach the 
a little bit of lint on 
during the time employed in fecurin 
: te eral ae 
Should it not 
introducing a fm 
the blood proceeds. : é 
Sympathetic inflammatory fever is the confequence of all 
PRD wounds, whether thefe be occafioned by ac- 
cidents, or operations. By fuch febrile diiturbance, the 
aétion of the whole arterial fyitem is rendered more vehe- 
nce duri 
ment. Hence ng its predominance, the patient is = 
ticularly expofed to the danger of frefh hemorrhage, The 
bleeding occafioned by the impetuous motion of the blood, 
arifes either from veffels, which previoufly effufed little orno 
blood, or from fuch as did bleed before, but were not effec 
tually fecured. : gt Meee 
“In this cafe, if the patient be very plethoric, the. per- 
4Ke2 formance 
i» 
