The principles of surgery . ingclot; its base resting on thearterial tissue at the deliga-ted point; its apex loose, andnearly on a level with thenearest collateral — slender though inmost cases it is—will doubt-less have the effect of remov-ing the bloods impulse fromthe site of exudation and or-ganization, and so will faci-litate completion of the pro-cess of occlusion. Whenceit is obvious how anatomicalknowledge may often be ofservice, in directing selectionof the site of deligation, toa point where no collateralbranch is given off in theimmediate and cardiac vici-nity. Otherwis
The principles of surgery . ingclot; its base resting on thearterial tissue at the deliga-ted point; its apex loose, andnearly on a level with thenearest collateral — slender though inmost cases it is—will doubt-less have the effect of remov-ing the bloods impulse fromthe site of exudation and or-ganization, and so will faci-litate completion of the pro-cess of occlusion. Whenceit is obvious how anatomicalknowledge may often be ofservice, in directing selectionof the site of deligation, toa point where no collateralbranch is given off in theimmediate and cardiac vici-nity. Otherwise, there mightbe, instead of rembra; an in-creased tumult of circulationat the part which is under-going the process of obstruc-tion. Plastic exudation is notlimited to within the vessel. It occurs, and more extensively, onits exterior; forming a dense swelling of some size, within whichthe ligatures noose is deeply imbedded. The highly important, andeven essential character of this external exudation of plastic fibrin,. Fig. 185. Carotid of a dog; 96 hours after advanced. The ligature seen imbedded in a largemass of organized plasma. Fig. 186. Carotid of a dog. 13thday after deligation. The ligature detached, and comingaway in the groove formed in the organized plasma. EFFECTS OF LIGATURE ON THE ARTERY. 501 Fi<?. 187. 18S. is fully elucidated by the experiments of Mr. Spence; from whose un-published drawings the illustrations herewith given are derived. Hehas shown clearly that the internal clot, so far from being, as was sup-posed by Manec and others, essential to the separation of the ligaturewithout hemorrhage, is not unfrequently wanting when the vessel hasbeen successfully tied; the closure being entirely effected in these casesby the plastic exudation between the cut edges of the internal coats,and by the bulky fibrinous mass whichforms within and around the sheath. It isthis external exudation which, becomingvascularized, forms the medium where
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