ON THE CATGUT LIGATURE iii 



one, and one has baffled me. I have tried various materials, as you will naturally 

 suppose. One substance that suggested itself was tannic acid, so as to convert 

 the fibrous tissue of the catgut into leather. I succeeded well enough in some 

 respects with tannic acid applied in different ways, but in one respect I did 

 not succeed. I have not obtained by means of tannic acid a kind of catgut 

 that is not too speedily absorbed. Even a piece of kid-leather, cut into a suitable 

 shape for sutures, and rendered aseptic, became too rapidly absorbed. 



Chromic acid was another agent which I very naturally tried on account of 

 its well-known effect in hardening tissues. Chromic acid alone does not work 

 very well ; but I found that the addition of some other substances to it aided 

 its action very greatly. By adding, for instance, to the watery solution a little 

 glycerine, thus producing a reducing action on the chromic acid, we get a differ- 

 ent sort of liquid, which acts much more energetically on the catgut. I was 

 highly delighted with the results of the action of this mixture of chromic acid 

 and glycerine ; and just at this time (June 1876), it happened that Mr. Oliver 

 Pemberton, of Birmingham, applied to me for a piece of catgut, for the purpose 

 of ligaturing the external iliac artery in a remarkable case of three aneurysms 

 in one limb — two in the femoral artery, and one in the popliteal. I thought 

 I could not do better than send him a piece of my recently prepared chromic 

 catgut. I did so ; and a month afterwards he wrote to me, saying that nothing 

 could be more satisfactor\- than the result. He had operated antiseptically ; 

 the wound had united by first intention ; and, so far as the case could go well, 

 all had gone well. There was, indeed, gangrene of the lower part of the leg, 

 which Mr. Pemberton had predicted would occur in consequence of the existence 

 of four successive obstructions in the course of the arterial channel ; viz. the 

 ligature and three solid aneurysms. But the case, under proper management, 

 was doing well. Four weeks later, however, Mr. Pemberton wrote to me again, 

 telling me that, soon after his last report, the patient had begun to show signs of 

 suppuration about the seat of the wound. After a while the abscess opened 

 in the cicatrix, and one day the ligature which he had placed on the artery 

 was found lying unaltered on the granulations.^ It is now on one of the cards 

 before you — an over-prepared ligature, which had come away, rigid and wire- 

 like, making its way out, as a piece of glass might have done, by mechanical 

 irritation. This opened my eyes for the first time to the possibility of having 

 catgut over-prepared. This over-preparation by means of chromic acid is, 

 I understand, to be found illustrated in a large German school at the present 

 time. I have been told by an American physician, who has lately been in 

 London after spending some time at that school, that the catgut ligatures come 



' For an account of this case by Mr. Pemberton, sec Lancet, August 4, 1877. 



