OBSERVATIONS OX LIGATURE OF ARTERIES 87 



Again, when tlie parts about the vessel communicate with loose cellular 

 interspaces in important regions, as is the case with the iliac arteries or the 

 subclavian, diffuse suppuration is frequently a cause of death. Finally, the 

 cure is always rendered tedious by the time required for the separation of the 

 ligature ; while the presence of an external wound during the period thus pro- 

 tracted involves a risk, by no means inconsiderable in some localities, of hospital 

 gangrene or erysipelas. 



The Antiseptic System, however, places this branch of surgery, like most 

 others, in a new light. One point which it has brought out in striking relief is, 

 that a portion of dead tissue is not necessarily thrown off by suppuration, but, 

 unless altered by putrefaction or artificially imbued with stimulating salts, 

 serves as pabulum for the surrounding living parts, which remove it by a sure 

 process of absorption. Hence, the death of a portion of the external coat in- 

 cluded in the ligature does not of itself render it a cause of suppuration. And 

 I conceived that if a silk thread, steeped in some liquid capable of destroying 

 the septic organisms in its interstices, were tied round an artery, and left with 

 short-cut ends in a wound dressed antiseptically,^ the foreign body, soon losing, 

 by diffusion into the circulation, the stimulating salt with which it was saturated 

 at the outset, and being in its own substance as unstimulating chemically as 

 a pellet of lead from a fowling-piece, would either remain, like the latter, per- 

 manently encapsuled, or itself experience absorption together with the dead 

 tissue in its grasp. In either case, being destitute of irritating properties, it 

 should leave the primitive strength of the arterial coats unimpaired ; when the 

 objection to tying near a large branch would cease to exist. The wound mean- 

 while would, under proper management, close rapidly, without any deep-seated 

 suppuration, and would be efficiently protected against the evil influences of 

 impure atmosphere. In short, the ligature of an arterial trunk in its continuity 

 would be brought to a state of perfection. 



I have subjected these theoretical views to the test of experience ; and 

 though the results have not turned out in all respects exactly as I had anticipated, 

 yet those finally arrived at appearing satisfactory, I now present to the profession 

 an account of all that I have done in the subject.- 



necessarily forms upon the injured internal and middle coats, it would undergo no increase if the blood 

 in the vessel were absolutely quiescent. But the pulsations of the artery operate as a disturbing cause 

 to the clot already formed, which consequently increases in proportion to the degree of the disturbance : 

 and as this is much greater at the cardiac side, the clot grows more quickly there, and forms a more 

 secure barrier against the pressure of the blood. 



* In using the expression ' dressed antiscptically ', I do not mean merely ' dressed \\-ith an antiseptic ', 

 but ' dressed so as to ensure absence of putrefaction '. 



* A brief account given in the original of the case of ligature of the carotid artery' in the horse with 

 silk thread on the antiseptic system more fully reported at p. 64 of this volume, has been omitted in this 

 place. 



