88 OBSERVATIONS ON LIGATURE OF ARTERIES 



Case of Ligature of the External Iliac Artery on the Antiseptic System} — On 

 the 29th of January, 1868, I was requested by Dr. Fergus to see a lady 

 fifty-one years of age, who was suffering from an inguinal aneurysm which had 

 existed for four years, but had of late been markedly on the increase, causing 

 agonizing pain, which had confined her to bed for the last four weeks, and had 

 considerably reduced her strength. The aneurysm was of the size of a large 

 orange, affecting the uppermost part of the left femoral artery, and extending 

 a little above Poupart's ligament. Any delay appearing undesirable, I tied the 

 external iliac on the following day, in presence of Dr. Fergus, and assisted by 

 Messrs. Hector Cameron, Appleton, and James Coats. There was nothing 

 peculiar in the operation, except that the incision was made a little further 

 outward than usual, in order to avoid the upper part of the aneurysm. The 

 only bleeding vessel that required attention was twisted. The ligature employed 

 had been previously steeped for two hours in strong fluid carbolic acid, pre- 

 pared by adding a small proportion of water to the crystals. The tightty 

 twisted thread requires a considerable period of immersion to ensure thorough 

 soaking with the liquid ; and the acid does not impair the tenacity of the fibre. 

 At the time of the operation, the superfluous acid was removed by transferring 

 the silk to a solution of carbolic acid in thirty parts of water ; and the same 

 lotion was used for the sponges, and also for washing the aneurysm-needle before 

 it was passed round the vessel. The artery having been tied, and the ends 

 of the ligature cut short, the wound was freely treated with the watery solution, 

 some of which was poured in, to make sure that it penetrated to every part. 

 The edges of the skin were then brought together with silver sutures, except 

 in the middle, where I introduced a pledget of lint steeped in a solution of the 

 acid in five parts of olive-oil ; passing it deeply, but leaving one end projecting 

 externally, to serve as a drain for blood and serum. I then applied an external 

 antiseptic dressing, the details of which I need not now describe. The pledget 

 of lint was cautiously withdrawn on the following day, under cover of a pretty 

 large piece of lint imbued with the antiseptic oil ; and the external dressing 

 was reapplied, and afterwards changed at intervals proportioned to the diminu- 

 tion of the serous discharge, which, at the end of a fortnight, was estimated at 

 about three minims in three days. At this time, some portions of lint, which 

 had been left till then undisturbed, were removed, when the wound was found 

 quite free from pus, being perfectly cicatrized where the sutures were intro- 

 duced ; while the central part, where the pledget was placed after the operation, 



' The report of this case down to the account of the condition of the patient on July 25, 1868, has 

 been inserted here from the address on the Antiseptic System of Surgery (p. 5 1 ), and has been omitted 

 from that address (p. 65). 



