OF TREATMENT IN SURGERY 65 



among the hair. Here is the artery, sht up to show the condition of the interior. 

 At the cardiac side of the place where the hgature was apphed there was, as 

 you see, an adherent coaguhim, an inch and a quarter in length. But at the 

 distal side there was no adherent clot, doubtless in consequence of the circula- 

 tion through a large branch, about as big as the human vertebral, which came 

 off, you will observe, as close to the situation of the ligature as was possible. 

 The cul-de-sac formed by the distal end, though it showed indications of the 

 puckering of the divided internal and middle coats, was completely cicatrized, 

 the smooth lining membrane of the artery being continuous over the irregular 

 surface. Why it was that the immediate vicinity of so large a branch did not 

 lead to secondary haemorrhage, was clear from the state of things beside the 

 ligature, which lay embedded in a firm fibrous structure, with not only no pus, 

 but no granulations, no softening of tissue around it. The portion of the external 

 coat included in the noose, though doubtless killed by the violence with which 

 it was pinched, had not been thrown off as a slough, but, being unstimulating, 

 because undecomposing, it had been absorbed and reproduced by the living parts 

 near it ; while the thread had been bridged over externally by dense fibrous 

 tissue, so that the vessel showed but little appearance of constriction where it had 

 been tied, and it appears to be as strong at this part as at any other. You may 

 form some estimate of its strength from the manner in which it resists the traction 

 to which I now subject it. Here is the Hgature with its short cut ends, apparently 

 unchanged, except that it was divided in my search for it in its fibrous bed. 



This case confirms the hope I ventured to express at the meeting of the 

 British Medical Association in Dublin last autumn,^ that the antiseptic s\'stem 

 would free the deligation of a large artery in its continuity of the two essential 

 elements of danger to which it is now liable, viz. an unhealthy condition of the 

 wound, and secondary haemorrhage. Thus encouraged, I felt justified in 

 carrying a similar practice into human surgery.- 



The success of these cases of ligature depends, as we have seen, upon the 

 circumstance that not only a neutral foreign body, but a portion of dead tissue, 

 if simply protected from putrefaction, is entirely devoid of irritating properties. 

 A good example of this fact is presented by a case at present under my care. 



Case of Acute Necrosis treated on the Antiseptic System. — The patient is 

 a boy, eight years of age, who was admitted into the infirmary on the 25th of 

 January, 1868, having, five days previously, received a violent blow upon the 



' See p. 45 of this volume. 



• The first part of the report of the case of Ligature of the External Iliac Artery, the first of that 

 nature to which the antiseptic system was applied, was here given, but has been omitted, being inserted 

 at the proper place in the next paper, ' Observations on Ligature of Arteries on the Antiseptic 

 System' (see p. 88). 



LISTER 11 F 



