the Biliary Secretions, with some New and Practical Observations on the various appearances of this important Secretion; connected by an appropriate and successful mode of Treatment, and the whole illustrated and confirmed by a numerous List of Cases; by John Faithhorn, formerly surgeon in the East India Company's service. 8vo.

An Essay on the Venereal Disease; by Richard Carmichael, M.R.I.A. Part I. 4to.

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Animated Nature, or Elements of the Natural History of Animals: illustrated by short Histories and Anecdotes; by the Rev. W. Bingley, A. M. 12mo.

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Experiments and Observations on the Atomic Theory and Electrical Phenomena; by Wm. Higgins, Esq. F. R. S. and M.R.I.A. 8vo.

T. Dobson has in the Press

Dr. Cullen's First Lines of the Practice of Physic, with Notes and Additions, by B. S. Barton, M. D. Professor of the Theory and Practice of Medicine in the University of Pennsylvania.

Swediaur on the Venereal Disease, complete. Translated from the French, by Thomas T. Hewson, M. D.

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The publication of this Number of the Eclectic Repertory has been delayed for three months, on account of the Printers having been called off to military duty.

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Observations upon the Ligature of Arteries, and the Causes of Secondary Hemorrhage; with a Suggestion of a New Method of employing the Ligature in Cases of Aneurism. By BENJAMIN TRAVERS, Esq. Demonstrator of Anatomy at Guy's Hospital. Surgeon to the Hon. East India Company, and to the London Infirmary for Diseases of the Eye.

[From the London Medico-Chirurgical Transactions for 1813.] THE adhesive inflammation is the primary resource of nature under local injury. It is employed in doing the repairs of the fabric which the other modes of inflammatory action secretly undermine or openly destroy. Suppuration and ulceration are invariably actions of destruction, when uncontrolled by the process of adhesion. This fact is strikingly exemplified in abscesses of the viscera which open externally, and in sloughs of the intestine per anum, as I had lately occasion to show in detail. The single tube of the intestine, after division

See" An Inquiry into the Process of Nature in repairing Injuries of the Intestines, illustrating the treatment of penetrating wounds and strangu lated Hernia." London, 1812.

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or loss of substance, is united, and forms a perfect tube again; that of the artery is obliterated: for the faculty of adhesive inflammation, upon which both phenomena depend, resides in the opposite surfaces of these canals, and coagulable lymph, which coats over the tied bowel, seals up the tied artery.

Before this adhesive inflammation was understood, surgeons attributed its proper results to other causes. The obliteration of an artery, included in a ligature, was supposed to be caused by the coagulation of the blood in the vessel: and as the existence of a coagulum of blood depended upon the exclusion of a portion of it from the circulation, if the ligature was placed in the vicinity of a large branch, the coagulum was not formed, and hemorrhage was inevitable. This was the doctrine recently taught in our schools, and illustrated by preparations; which, however, illustrate other points that might more accurately explain them.

The permanent obliteration of an artery can only be effected by an inflammatory adhesion of its internal surfaces. The adhesive inflammation of the internal or cuticular coat of arteries is sometimes, but rarely, spontaneous; it is excitable in this, as in other parts, by pressure and by wound.

1. I have seen the aorta just below its curvature, and in another subject, a little above its bifurcation, partially filled by pure lymph, without any aneurismal tendency.

2. The obliteration of an artery by pressure is a more frequent occurrence, as in the natural cures of aneurism and in those effected by art. I have a preparation showing the total obliteration of the right subclavian artery by an aneurism of the arch of the aorta. Mr. Blount informs me that he lately saw an aneurism of the thigh, under the care of Mons. Dubois in Paris, cured by steady pressure upon the vessel continued for twenty-four hours. It is not to my purpose to quote or relate cases, because these facts are familiar.

3. It was discovered by the celebrated Desault, that a round ligature drawn tight upon an artery, made a clean cut of its internal coat, and the experiments of Jones, devised and exe-.

cuted with equal felicity, have established, that the obliteration of an artery tied with a round ligature, is only the cicatrization of this cut. To ascertain with precision the effects of ligatures of various sizes, both flat and round, I have repeatedly examined the appearances left upon the cuticular coat of the artery after applying them, and the following is a report of such experiments upon the carotid, iliac, and femoral arteries of the human subject.

From these observations it appears that the flat ligature, as it is diminished in breadth, and admits of being more strictly applied, i. e. as it approaches to the form and size of the round Ligature, imitates its operation, but fails to produce a simple incised wound, which every body knows is the wound best disposed to unite by adhesion. The inclusion of substances soft or hard in the round ligature does not materially alter its effect.

It being established that the internal coat of an artery is prone to take on the adhesive inflammation, and that it is only by virtue of this inflammation that the vessel can be permanently obliterated, it is not a question of difficult solution, whether the mere apposition of sound surfaces, the apposition of bruised and lacerated surfaces, or the apposition of fresh cut surfaces is the condition most favourable to union. What is the result of our familiar observation in practice, of the

comparative efficacy of pressure, of bruising and tearing, and of cutting, to excite adhesive inflammation? The obliteration of a hernial sac under the pressure of a truss, of an artery overlaid by a heavy tumour, and in general the cementing of entire surfaces, is a chronic process. Contused and lacerated wounds oftener suppurate or even slough, than kindly take on the adhesive inflammation. Surgeons anxious to procure a rapid union of parts, incise them for that purpose, as in the hare lip. The severe operation for hydrocele by incision rarely fails of its object.

It is curious to observe the revolution which has taken place within a few years in this branch of surgical practice, since experimental inquiry has furnished the true explanation of the principle upon which the ligature acts.

Mr Hunter and the surgeons who after him practised the operation for the popliteal aneurism, were in the habit of applying the ligature with force only sufficient to bring the sides of the vessel in contact; and some included an extraneous body, as a piece of cork or wood, or a roll of linen, to prevent the lesion of the artery in the act of tightening the ligature. The fear of cutting the coats of the vessel was uppermost in the minds of all, and next to this, the fear of quickening the process of ulceration, and the casting off of the ligature. Scarpa, Richerand, and the other eminent surgeons of the continent are still fettered by these fears. But we see that they are groundless; that, on the contrary, the security and effect of the ligature are ensured by its cutting the middle and internal coats, which it does without danger to the outer, however applied; and that retarding the process of ulceration when the ligature has done its duty, is not only useless but mischievous, as it increases the danger of secondary hemorrhage.

Jones, whose scientific and comprehensive view of this important branch of surgery,* must excite universal regret for

* See "A Treatise on the process employed by Nature in suppressing the hemorrhage from divided and punctured Arteries, and on the use of the ligature, with observations on secondary hemorrhage." London, 1802: