98 OBSERVATIONS ON LIGATURE OF ARTERIES 



as to form a strong cul-de-sac, the irregularities of which had been smoothed 

 over by a little fibrinous deposit, which had assumed the characters of a firm 

 fibrous tissue, and presented a free surface undistinguishable from that of the 

 lining membrane of the artery (Fig. 2). 



At the situation of the distal ligature the structure of the vessel seemed 

 entirely unaffected. The middle coat was seen in longitudinal section as a pink 

 streak between two white lines, representing the external and internal tunics, 

 neither thicker nor thinner than in neighbouring parts. The catgut threads 

 had been tied too gently to produce rupture of the internal and middle layers, 

 and their presence and the constriction which they occasioned, whatever may 

 have been their effect in the first instance, had left no permanent marks of 

 disturbance ; while the fleshy band that had replaced them, though in time it 

 would doubtless have dwindled down to an insignificant filament, was at least 

 a temporary addition to the strength of the artery. 



These appearances at the distal ligature are calculated to revive under 

 a new aspect the old question whether it would not be better always to avoid 

 rupture of the internal and middle coats, which could easily be done by using 

 a pretty thick piece of catgut softened by steeping it in a watery solution of 

 carbolic acid. In this way the wall of the vessel would be left from first to last 

 entirely intact. This, however, is probably a matter of indifference. Indeed, 

 judging from the condition of the artery at the cardiac ligature, the injury done 

 to the vessel at the outset by tight tying seems to lead to changes which increase 

 its power of resistance, which was certainly severely tested in the present instance. 



It appears, then, that by applying a ligature of animal tissue antiseptically 

 upon an artery, whether tightly or gently, we virtually surround it with a ring 

 of living tissue, and strengthen the vessel where we obstruct it. The surgeon, 

 therefore, may now tie an arterial trunk in its continuity close to a large branch, 

 secure alike against secondary haemorrhage and deep-seated suppuration — ■ 

 provided always that he has so studied the principles of the antiseptic system, 

 and so carefully considered the details of the mode of dressing best adapted to 

 the particular case in hand, that he can feel certain of avoiding putrefaction 

 in the wound. For my own part, I should now, without hesitation, undertake 

 ligature of the innominate, believing that it would prove a very safe procedure. 



Catgut, manufactured from the small intestine of the sheep,^ may be had 

 at a low price, from the thickness of a horsehair upwards. As sold in the shops, 

 however, it is quite unfit for the purposes of the surgeon. For, when moistened 

 with water or with the animal fluids, it becomes not only very soft and weak, 



* I need hardly remark that catgut is of [a totally different nature from so-called silkworm's gut 

 which is in reahty unspun silk. (See also p. 84 of this volume.) 



