io6 ON THE CATGUT LIGATURE 



aneurysm of the upper part of the femoral, of idiopathic origin. This case was 

 of such special interest that I hope, on a future occasion, to make it the subject 

 of a paper before this Society. In all these cases, except two, catgut prepared 

 by the old method was emplo3^ed, and in all these nine cases the result was 

 satisfactory, and recovery perfect, except as regards the poor young woman 

 who has still the pulsating tumour in her neck 



As to the mode of applying the ligature, I have alwa3^s used a single reef- 

 knot with short-cut ends, tying it sufficiently tightly to cause the giving way 

 of the internal and middle coats. This latter point is not, perhaps, essential, 

 as I long ago surmised,^ and as Mr. Barwell's experience with his aortic bands 

 appears to indicate. But if, as is the case with catgut, the form of the ligature 

 admits of it, the injury done to the deeper tunics is, I believe, advantageous, 

 by leading to a salutary corroborative process of repair. 



Why, it may naturally be asked, has my own experience been more satis- 

 factory with the catgut ligature than that of many other surgeons ? There 

 are, I believe, two reasons for this. One is that I have never ventured to tie 

 an artery of considerable size in its continuity without having taken pains to 

 ascertain that the catgut was of thoroughly reliable material ; and the other 

 reason is that I have adopted strict antiseptic means of treatment, not only 

 during the earlier stages of the case, but to the last. So long as any part of 

 the wound remains unhealed, antiseptic treatment of the strictest kind ought, 

 I believe, to be employed. Even though the sore may seem to be superficial, 

 there may still exist a sinus leading down to the site of the ligature ; and if 

 ordinary treatment, as distinguished from antiseptic, be employed, down this 

 sinus the septic process may advance and invade the ligature, and lead at 

 last to disaster from haemorrhage. I know that this has actually taken place. 



But although the catgut prepared after the old method answers very well 

 if it be in proper condition, there is this great objection to that method : that 

 it requires a long time in order to produce the requisite quality. At least two 

 months are needed to make the ligature at all trustworthy. It is better at the end 

 of six months, and still better at the end of a year. I possess catgut prepared 

 in this way twelve years old. I have brought here a sample of such catgut, 

 which has been steeping in warm blood-serum since this morning, and it will 

 be seen that it remains translucent, and is comparatively firm, instead of being 

 opaque and soft, like the unprepared catgut in the same serum. 



Now, the length of time that the present method requires is a very serious 

 objection. It places the surgeon who has not prepared the catgut for himself, 

 and kept it for a long time, at the mercy of the person who supplies it ; and 



' Cf. p. 98 of this volume. 



