The principles of surgery . ought in-to close contact with healthy struc-tures; and consequently there maybe less chance of suppuration, ulce-ration, and hemorrhage. Besides, ithas been thought important—espe-cially in the case of the carotid—toavoid the double impulse which asingle ligature has to sustain; theone direct from the heart; the otherdependent on the collateral Most certainly, if the ordinaryoperation have been improperly con-ducted ; that is, if in our attempts toexpose the vessel cleanly, it havebeen detached too extensively fromits surrounding connections—therebyr
The principles of surgery . ought in-to close contact with healthy struc-tures; and consequently there maybe less chance of suppuration, ulce-ration, and hemorrhage. Besides, ithas been thought important—espe-cially in the case of the carotid—toavoid the double impulse which asingle ligature has to sustain; theone direct from the heart; the otherdependent on the collateral Most certainly, if the ordinaryoperation have been improperly con-ducted ; that is, if in our attempts toexpose the vessel cleanly, it havebeen detached too extensively fromits surrounding connections—therebyrendering the occurrence of eitherulceration or sloughing more thanprobable—let two ligatures be ap-plied ; one at each extremity of theseparated portion. The effects of the ligature, well applied, are as follows:—1 here ismechanical arrest of the arterial flow at the deligated point; throwing astress on the collateral circulation ; and, by weakening the main current, 1 Chassaignac. Gaz. des Hopitaux, Nov. 30, Fig. 183. Carotid of a dog; 48 hours after deli-gation. Recent effects of ligature. At a, thearterial coats cut across. Plasma begun around ;and a clot on either aspect of the deligated 184. Carotid of a dog; 6 days after deliga-tion. Artery cut across. The contracted endsoccupied by coagulum. In the sheath pinnedout, external vessels (a) are seen coursing on-wards to occupy the interior. 500 EFFECTS OF LIGATURE ON THE ARTERY. 1S6. on the distal aspect of the ligature, favoring coagulation of the aneu-rismal contents, with solidification of the tumor. The interna andmiddle coats are at once cut through ; the former cleanly, as with a resile on each side of the ligature, and the noose of this embracesonly the external coat. The cut surfaces of the internal coat arc keptin close contact; and, being cleanly incised, in close apposition and freefrom compression by the ligature, they unite by adhesion. Fibrinousexudation takes place for this
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