104 ON THE CATGUT LIGATURE 



which I have been relating appears to have been one of these. The micrococci, 

 developing for a protracted period in the interstices of the hempen ligature, 

 produced their special fermentation of the serum in its most aggravated form. 

 The acid serum became a cause of irritation ; and thus the ligatures, which 

 otherwise, being unirritating in their own substance, might have become encap- 

 suled, and in due time absorbed, became causes of suppuration. One of the 

 six ligatures still remained unaccounted for. In due time we sent the patient 

 home with a small sinus remaining, a little pus always discharging from it ; 

 but it was not until the middle of September that the last ligature came away, 

 altogether unaltered. Now, gentlemen, there is no doubt whatever that, if I had 

 had catgut which I could have trusted for the operation, the catgut ligatures 

 would have been disposed of within two or three weeks, and the healing, instead 

 of requiring eight months, would probably have been completed in a fortnight. 

 Here, then, we have an illustration of the great disadvantage which may arise, 

 even under antiseptic treatment, from the use of the ordinary forms of ligature. 

 Animal ligatures of another kind have been provided by Mr. Barwell, in 

 order to remove these difficulties, namely strips of the mingled yellow elastic 

 and unstriped muscular tissues which constitute the arterial wall, obtained by 

 cutting spirally the aorta of one of the larger animals. But, though fully admit- 

 ting the efficiency of these ligatures in his hands, I am given to understand 

 that their form and size render them by no means very convenient, and, inde- 

 pendently of this, I cannot but feel that it is unsatisfactory, if it can be avoided, 

 to have a special material for this particular object, and that it would be better, 

 if possible, to have the catgut in a thoroughly reliable condition. Catgut, of 

 which I have samples here, is to be had all over the world in abundance. It is 

 beautifully strong and smooth ; it is made of various sizes suitable for all surgical 

 requirements, and is extremely cheap. Wholesale, it is sold at 12s. per gross, 

 that is to say, one penny per hank. But, as it comes from the maker, it is 

 entirely unfit for the purposes of the surgeon. However beautiful it is in the 

 dry state, it becomes soft and pulpy soon after it has been placed in blood- 

 serum. In one of these glasses is a piece of unprepared catgut which was placed 

 in warm serum this morning, obtained from the blood of a cow, and within 

 half an hour it was in the condition in which it is at the present time — swollen, 

 soft, and pulpy. A knot tied upon it in its present state would hold as little 

 or scarcely better than would one on a piece of the slippery intestine from which 

 the catgut is derived. It is essential, in order to fit the catgut for the purposes of 

 the surgeon, that it be altered in its physical constitution so as to be no longer 

 liable to this softening effect by the serum of the blood. It is a remarkable 

 circumstance that the blood-serum softens catgut even more than water does. 



