no ON THE CATGUT LIGATURE 



hot be satisfactory ; it would only have, in a more aggravated form, the incon- 

 venience of the extremely long period which our old method demands. Besides 

 that, it by no means fulfils all the conditions that are required for a perfectly 

 satisfactory state of the catgut for surgical purposes. These conditions I will 

 now mention. In the first place, I have spoken of a short period of preparation. 

 This is very desirable. Then it is essential that the catgut should have proper 

 strength, so as to bear any reasonable strain that the human hands can put 

 upon it, in the thicker forms, as when used, for instance, in such cases as the 

 circumferential ligature of the thyroid vessels in the removal of a goitre, or for 

 securing the pedicle in ovariotomy. And it is not sufficient that it should be 

 strong to start with ; it is easy to get catgut strong in the dry state ; it is neces- 

 sary that it should be strong after steeping in blood-serum for a while. Take, 

 for example, the case of tumour of the thyroid. I employed six ligatures, and 

 in a former case, where the tumour was larger, I thought it prudent to pass 

 as many as eight, so as to subdivide more the mass that had to be tied ; but 

 it is not convenient to tie each of these ligatures as soon as it is passed, and 

 the process of passing takes a considerable time. Now it would be a very sad 

 thing if the residence of the catgut among the tissues soaked with serum for 

 a few minutes, or even a quarter of an hour, should render it so soft that it 

 should give way when we put the strain of the hands upon it. That, then, 

 is another essential point, if the material is to be useful for all the purposes 

 for which it is desired. Then, again, it is necessary that a knot tied upon it 

 should hold with absolute security, not merely in the first instance, but after 

 soaking for an unlimited time in blood-serum. It is further needful that it 

 should not be too rigid ; for, as we shall see immediately, it is possible for catgut 

 to be over-prepared ; in which case it may remain almost like a piece of wire 

 among the tissues, and ultimately, perhaps, come away by suppuration in 

 consequence of the mechanical irritation which it produces. But while the 

 animal juices must be able to soften it sufficiently to render it mechanically 

 unirritating, yet, on the other hand, it will not do for it to be too rapidly disposed 

 of by absorption. If it is to do duty for the ligature of an artery in its con- 

 tinuity in the immediate vicinity of some large branch, it must remain for a con- 

 siderable time of good strength, unabsorbed ; and, when it is at length absorbed, 

 it is desirable that it should be removed in such a manner that, while it is 

 reduced in thickness, it shall still, as long as any of it remains, retain its 

 tenacity. 



Now, these are a series of conditions which, I assure you, it is not easy to 

 fulfil completely. I have in various experiments complied with some of them 

 easily enough, but failed in others. Sometimes I have succeeded with all but 



