102 ON THE CATGUT LIGATURE 



bitter disappointment, the case ending in disaster from secondary haemorrhage, 

 or the treatment proving abortive through the channel of the vessel becoming 

 opened up again at the site of the ligature. Hence many surgeons have been 

 induced to return to silk, even though using strict antiseptic treatment — render- 

 ing the silk aseptic by steeping it in a suitable lotion, and cutting the ends short. 

 This practice has, however, by no means proved uniformly successful. As an 

 instance of unsatisfactory result, I may mention a case which was recorded by 

 Mr. Glutton in the last volume of our Transactions. He tied the external 

 iliac artery with silk under strict antiseptic precautions, and the wound healed 

 within a week ; but, as I learned from a letter which he was good enough to 

 send me at the time, ' six weeks after the operation a little blister formed, and 

 fluid began to escape, forming a small scab, and in three months the loop which 

 had been placed around the artery came away.' Such a result was not at all 

 surprising to me, seeing that what induced me to try the animal ligature was 

 the discovery of a small abscess about the remains of a partially absorbed silk 

 thread which I had applied in the same manner as Mr. Glutton, and, as it so 

 happened, to the same artery.^ It can hardly be doubted that suppuration 

 proceeding from the immediate seat of the ligature must be a source of danger. 

 As an illustration of the mischief which a ligature of ordinary material may do, 

 I may mention a case of goitre in a young woman on whom I operated on the 

 28th of January last year. It was of moderate dimensions ; but the effect on 

 the respiration was so considerable that I determined to remove it, following 

 Dr. Patrick Heron Watson's plan of preliminary deligation of the thyroid vessels 

 circumferentially to the tumour. If this be effectually done, the operation is 

 bloodless ; so that, as the laryngoscope applied by Dr. Felix Semon, who had 

 recommended the case to my care, showed that the anterior wall of the trachea 

 was pressed backwards considerably by the growth, I adopted a measure which 

 I believe would in all cases of removal of the thyroid prove advantageous, 

 namely, after the preliminary deligation of the vessels, I divided the tumour 

 in the middle line, so as, in the event of adhesion to the trachea, to be able to 

 remove the two halves of the growth at leisure, dissecting it off from the trachea 

 more or less completely as may be desired, leaving some portions at the adherent 

 parts, and thus avoiding the deadly risk of perforation of the air-passage. But 

 in order that the circumferential ligature of the thyroid vessels may be secure, 

 it is essential that the material employed should be very strong, so that the 

 tissues round about the tumour, including the vessels, may be thoroughly tight- 

 ened up. I possessed no catgut which I felt was resistant enough to bear the 

 full strength of my hands, and therefore I was compelled to use the hempen 



* See ' Observations on Ligature of Arteries on the Antiseptic System ' (p. 86 of this volume). 



