ON THE CATGUT LIGATURE 105 



It might have been expected, a priori, that a solution of a colloidal substance 

 like albumen would have been much less disposed than water to permeate and 

 soften an animal tissue like catgut ; but it is otherwise, and therefore we cannot 

 test the trustworthiness of catgut by steeping it in warm water, as I formerly 

 used to do. In order to be sure that a given specimen will answer the purpose 

 in so far as the knot is concerned, that it shall not slip, it is needful that we 

 should steep it in blood-serum, a somewhat troublesome process, as it involves 

 sending to a slaughter-house for blood. 



The method of preparing catgut which I published long ago answers the 

 purpose very well, even for the ligature of arteries in their continuity, provided 

 certain conditions be complied with ; such, at least, is my own experience. 

 This, indeed, has not been very extensive, but it has been sufficient to deserve 

 consideration. I have tied altogether nine large arteries in their continuit\^ 

 with prepared catgut. Of these, one was a case of ligature of the carotid, in 

 a young woman, aged twenty-two, with a pulsating tumour below the angle 

 of the jaw, in the situation of a carotid aneurysm and with all the symptoms of 

 that disease. The application of the ligature reduced to a certain degree the 

 pulsation and the dimensions, but the further cure which we hoped for did not 

 take place. She left the hospital with a pulsating tumour ; and I heard only 

 yesterday from the medical man under whose care she is in Scotland, that this 

 tumour, for which I tied the carotid artery in 1874, still exists as a pulsating 

 swelling, if anything, rather on the increase. But though, as regards the cure 

 of the disease, the ligature was unsatisfactory, nothing could be more beautiful 

 in its effect as respects the healing of the wound without suppuration, and the 

 permanent obstruction of the vessel at the seat of ligature. 



A case of traumatic arterio-venous aneurysm of the temporal arter}*, in 

 a young man lately under my care in King's College Hospital, may be men- 

 tioned in this category, partly because the greatly dilated condition which the 

 naturally small artery had assumed brought it up towards the dimensions of 

 a large trunk, and partly because the concurrent ligature of the largely dilated 

 veins would, without antiseptic means, have been justty regarded as of con- 

 siderable danger. The others were all cases of ligature of the femoral. Six 

 were popliteal aneurysms. Four of these presented nothing deserving of special 

 remark. One was a diffuse aneurysm, extending up to the junction of the lower 

 and middle thirds of the thigh, and the other was an enormous diffuse aneur3-sm 

 reaching up to Poupart's ligament, so that it was necessary for me to tie the 

 femoral artery about the situation of the ordinary origin of the profunda, and 

 even there my incision opened into the aneurysmal clots. 



The last case that remains to be mentioned was a large arterio-venous 



LISTER II I 



