OBSERVATIONS ON LIGATURE OF ARTERIES 

 ON THE ANTISEPTIC SYSTEM 



[Lancet, 1869, vol. i, p. 451. Corrected February 1870.] 



Various attempts have been made, both in the early part of the century 

 and more recently, to improve the ligature, or to supersede it by other methods. 

 Nevertheless, for obstructing the calibre of an arterial trunk in its continuity, 

 no means hitherto devised have proved superior to a small silk thread tied in 

 a secure knot, with the ends left projecting from the wound. Yet, as is implied 

 by the numerous efforts at improvement, the ligature in this form is far from 

 perfect. The internal and middle coats are ruptured by the constricting noose, 

 while a portion of the tough external coat is pinched together and deprived 

 of its vitality. The dead tissue, becoming contaminated by the putrefaction 

 which occurs in the interstices of the silk fibres, acts, together wdth the septic 

 ligature, as a cause of irritation to the neighbouring parts of the arterial wall, 

 which consequently degenerate into an imperfect structure, inadequate to 

 withstand the powerful cardiac impulse ; and even before the slough separates 

 by suppuration, the blood breaks through the feeble barrier, unless it be fortified 

 by a firm plug of internal coagulum. Hence, if a considerable branch takes 

 origin close to the part tied, the formation of a clot being prevented by the 

 current of blood, secondary haemorrhage is the inevitable consequence ; and 

 thus the ligature is inapplicable in situations otherwise eligible for it. such as 

 the femoral artery near Poupart's ligament, the origins and endings of the 

 iliacs, and the innominate. 



Even when the thread is distant from any considerable branch, the terrible 

 risk of haemorrhage cannot be said to be altogether absent. The degenerate 

 structure of the vessel near the ligature, unlike the arterial wall in its normal 

 condition, is prone to ulceration, and the organizing coagulum is similarl}^ 

 circumstanced ; so that an unhealthy state of the wound may open up the 

 calibre of an artery tied in the most favourable situation.^ 



^ It has been long since noticed that haemorrhage occurs more frequently from the distal than 

 from the cardiac end of the vessel. This seems at first sight contrary to what might be expected, since 

 the cardiac end is subjected to much greater strain. The explanation is, I beheve, afforded by some 

 facts which I had occasion some years ago to point out. (See the Croonian, Lecture ' On the 

 Coagulation of the Blood,' printed in vol. i, p. 109.) It was then shown that a perfectly undis- 

 turbed coagulum resembles healthy living tissue in failing to induce coagulation in blood near it ; 

 but that, on the other hand, while a clot is, from its softness, peculiarly liable to laceration and other 

 disturbance, a disturbed coagulum acts like injured tissue in impressing upon neighbouring blood a 

 coagulating tendency. Hence, when a ligature has been tied round an artery, although a minute clot 



