MR. COSTELLO ON THE TORSION OF ARTERIES. 211 
back, or refoulees , by a zigzag movement of the first forceps. 
One, two, or three, or more, of those refoulures or machures 
may be made ; and from some of the arteries treated in this way, 
I saw the following results. The outer or cellular coat inflames, 
and plastic lymph is exuded. The internal membranes fall into 
the same circumstances as in the case of torsion, but with this 
difference,—that the number of diaphragms arranged to form 
clots is in the ratio of the machures made on the artery. 
In no instance, when properly employed, either in animals or 
in man, has the twisted artery been observed to ulcerate, or be¬ 
come gangrenous. Its effects, and the organic changes which 
it produces, appear to be these :—the internal membranes are 
broken; they become narrow, or, rather, roll up and join, so as 
to form a cut de sac ; they pour out plastic lymph, which adheres 
to the clot, which is formed immediately and invariably between 
this point and the nearest collateral. The outer membrane forms 
another cul de sac f and its internal surface pours out plastic 
lymph also. A similar process takes place between the outer 
surface and the surrounding parts. 
Let us now see what takes place when the ligature is employed. 
—1st. Jones states that the middle and inmost membrane, when 
cut by the ligature, join, and that the cellular membrane remains 
entire, the blood passing through the collaterals.—2d. A clot 
is formed in the arterial tube, if there be no collateral vessel im¬ 
mediately near it.—3d. An inflammation of the cut membranes 
takes place, and they become agglutinated by the plastic lymph 
which they pour out. The same process obtains on the outer 
surface.—4th. The portion of the artery comprised in the liga¬ 
ture ulcerates, and it is only when this process is complete that 
the ligature drops off. 
We can now appreciate the advantages or disadvantages in¬ 
herent in either method. When torsion or refoulement of the 
internal membranes is employed, the wound may be united by 
the first intention. There is no foreign body in the wound, and 
there is no danger of consecutive hemorrhage. 
When the ligature is had recourse to, there is a foreign body 
in the wound, which must be thrown off by ulceration or gan¬ 
grene. It often happens that the ulcerative process extends to 
the surrounding parts, and consecutive hemorrhage takes place, 
when the end of the artery and the ligature are thrown off. 
Moreover, the external wound sometimes heals before the liga¬ 
ture is detached. In this case there is danger of an unmanage¬ 
able fistula. One of the great advantages, therefore, of torsion 
is, that it allows immediate union of the wound, as will be par¬ 
ticularly evident in hemorrhages of the epiploon, and in aneu- 
