Lectures on the operations of surgery : and on diseases and accidents requiring operations . of the vessel. The next thing that occurs, at least in the vesselFig. 7. itself, is its conversion into a solid cylinder by the organization of the coagulum. By some it is sup-posed, that the coagulum is first absorbed, and thenlymph effused, but surely this would be a uselesslabour, inasmuch as the basis of the clot is preciselywhat nature requires for the accomplishment of herobject. In fact, the changes which take place aresimply these: there is first, from the divided arte-rial tissues, effusion of
Lectures on the operations of surgery : and on diseases and accidents requiring operations . of the vessel. The next thing that occurs, at least in the vesselFig. 7. itself, is its conversion into a solid cylinder by the organization of the coagulum. By some it is sup-posed, that the coagulum is first absorbed, and thenlymph effused, but surely this would be a uselesslabour, inasmuch as the basis of the clot is preciselywhat nature requires for the accomplishment of herobject. In fact, the changes which take place aresimply these: there is first, from the divided arte-rial tissues, effusion of a small quantity of lymph orplasma between the coagulum and the walls of thevessel; then adhesion between the clot and thesewalls; next, absorption of the colouring particles ofthe coagulum, and lastly, its complete vessel thus becomes a solid cylinder, and iflarge, remains as a fibrous cord during the lifeofthe individual, becoming, however, less and lessuntil it is often a mere thread, (Fig. 7,) but if smallit is absorbed off as high as the collateral branch(Fig. 8).. HEMORRHAGE. 25 While these changes are taking placewithin the vessel, the ligature, in con- Fig. 8. sequence of the irritation it develops, issoon imbedded in a mass of coagulablelymph, which adheres to the artery forsome distance above and below the knot,and thus assists the internal coagulum inpreventing secondary hemorrhage. Byand by progressive, and in some casesulcerative absorption is set up, and theligature is loosened and detached. Ifthis process be interfered with, eitherby inflammation, or the unnecessary andfoolish handling of the ligature, or if thepatient be labouring under any consti-tutional disease which prevents the ready coagulation of the bloodand its subsequent organization; as soon as the ligature is loosened,the blood is forced out, and in this way we have secondary hemor-rhage. It is always important, therefore, carefully to watch ourpatient about the period at which we e
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