92 OBSERVATIONS ON LIGATURE OF ARTERIES 



had passed after the operation, was found surrounded on all sides by compact 

 tissue ; and in the present case, so long a period as ten months having elapsed 

 before the puriform condition was observed in an apparently incipient stage, 

 it is probable that the thread had lain for a long time inert, producing irritation 

 only when partially absorbed. If, then, we inquire how the disintegrating silk 

 could prove a source of mechanical irritation, it seems not improbable that it 

 may have been from the sharp and jagged fragments of the fibre perpetualh' 

 fretting the elements of the living tissue around them. This view, if correct, 

 would explain the curious fact observed by Lawrence and others, that when 

 fine silk ligatures had been left with short-cut ends in a stump, though the wound 

 might heal without their separation in the first instance, they were liable 

 to make their appearance subsequently, sometimes at so late a period 

 as seems to exclude the idea of putrefaction having occurred from organisms 

 introduced into the threads. Indeed, such ligatures occasionally showed them- 

 selves encapsuled in little nodules in the cicatrix, without suppuration occurring 

 at all.^ In other words, the apparently soft silk, instead of remaining, like 

 a smooth leaden pellet, permanently embedded in the place where it was first 

 introduced, made its way to the surface with or without suppuration, like a 

 sharp spiculum of rigid glass ; the silk being in its minute structure comparable 

 to the pellet when in the primitive condition of smooth continuous fibres, and 

 to glass spicula when in the form of jagged fragments as the result of partial 

 absorption. 



But whatever may be thought of this explanation, it is clear that if there 

 is any chance of silk, though used antiseptically, giving rise, even in exceptional 

 cases, to abscess in the vicinity of an artery tied with it, this is a serious objection 

 to its employment ; and as the near approach to suppuration in the present 

 instance was undoubtedly occasioned by the persistent presence of the thread, 

 the case, while interesting as affording evidence that silk is susceptible of absorp- 

 tion, suggests the expediency of substituting for that material some other sub- 

 stance which can be more readily taken up by the tissues. 



The use of ' animal ligatures ', of catgut, leather, or tendon, was long since 

 tried and abandoned as unsatisfactory ; - but after the experience which the 

 antiseptic system has afforded of the disappearance, without suppuration, of 

 large dead pieces of skin and other textures, there could be little doubt that 

 threads of animal tissue, if applied antiseptically, would be similarly disposed of. 



And even if chemical processes should have been used in preparing such 

 threads, it did not seem likely that this would interfere with their absorption ; 



^ See Cooper's Surgical Dictionary, yih edition, article Aneurysm. 

 ^ Op. cit., articles Aneurysm and Ligature. 



