THE BRITISH MEDICAL ASSOCIATION 183 



pared, you will, I believe, see good reason to be satisfied with it. That which 

 I now show is extremely fine, much finer than any silk commonly employed ; 

 and yet with a piece like this I should not hesitate to tie the femoral artery in 

 a stump. If you choose to use it thicker for a large vessel, 3'ou can do so. It 

 is conveniently carried on a little winder, in a capsule appended to a caustic- 

 case. The catgut, as tied in the ordinary reef-knot with the ends cut short, 

 seems to me to be a perfect haemostatic. It has all the simplicity and universal 

 applicability of the ligature, with, at the same time, the virtual absence of 

 any foreign body from the wound. If putrefaction be avoided, it is rapidly 

 absorbed, and you may reckon as certainly on the absence of any interference 

 with primary union on the part of such ligatures, as if there were no ligatures 

 at all. Should putrefaction occur, I was at first uneasy lest the prepared catgut 

 might soften and permit haemorrhage. I was, therefore, at the pains to test 

 some of the prepared catgut in the following manner. I tied some pieces of 

 it at intervals round a cylinder of india-rubber, so as to pinch the india-rubber 

 to a considerable degree of constriction, and then introduced it into putrid 

 serum of blood, and kept it for a week at a temperature of about 90°. At 

 the end of this period the india-rubber was still constricted, showing that the 

 catgut had retained its hold in the putrid hquid, in spite of the constant strain 

 of the elastic material upon the knots. No doubt, in such parts of a wound 

 as actually putrefy, the little bits of catgut must come away like shreds or 

 sloughs of cellular tissue ; but I am bound to add that this is onh' a matter of 

 presumption : for, although I have used nothing but this ligature for securing 

 vessels in wounds for more than two years, excepting torsion, which I com- 

 paratively rarely resort to, and though in certain classes of cases putrefaction 

 cannot be avoided, in no instance have I seen the catgut knot come 

 away, nor have I ever known secondary haemorrhage or abscess caused 

 by its use. 



I have spoken of the injury that the stimulating carbolic-acid lotion inflicts 

 on the tissues by irritation. The great disadvantage of this is, that it causes 

 an unusually large flow of serum during the first twenty-four liours or more, 

 and you must provide a special exit for the serum, else you will have incon- 

 venience from tension, which will lead to suppuration, though not of the putre- 

 factive kind. For the purpose of guarding against this, I introduce, at the 

 most dependent ]mrt of the wound, a strip of lint steeped in a solution of carbohc 

 acid in about ten parts of olive oil, to serve as a ' drain '. This is drawn out 

 under the spray in twenty-four or forty-eight hours. If \'0U drew it out without 

 providing an antiseptic atmosphere, you would certainly have putrefaction. 

 In some cases, a fine drainage-tube is convenient for this purpose, if we)! steeped 



