190 THE ADDRESS IN SURGERY DELIVERED BEFORE 



or fourth day — never practically during the first week, we may say. The external 

 coat, pinched in by the ligature, is always strong enough to resist the impetus 

 of the blood, however near the ligature may be to a branch, till the tissue has 

 undergone alteration, till it has become softened by the granulating process 

 through the irritating influence of the septic ligature. But if the ligature be 

 not septic, nor in any other respect irritating, there is nothing to weaken the 

 external coat. Why should it be weakened ? On the contrary, as experiment 

 has shown in one instance, the catgut itself, becoming replaced by living tissue, 

 acts as a strengthening ring instead of making the vessel weaker. Hence I felt 

 justified in applying it as near as possible to the aneurysmal tumour, though 

 this was just about the most frequent place of origin of the profunda. Catgut 

 a good deal thicker than that which I have shown was used, the ends being of 

 course cut short, and all went well. There was no appearance of suppuration 

 from the vicinity of the ligature, and the enormous mass gradually became 

 absorbed. Being much emaciated, the man put on fat so fast that we were 

 deceived at first with respect to the diminution of the coagulated blood, which 

 was actually going on much more rapidly than we inferred from our measure- 

 ments. Ultimately all that great mass disappeared, and the patient, first 

 hobbling with crutches, then walking with a stick, is now a hale man, 

 using no stick at all. I should add that in the performance of the operation, 

 though I cut down higher up than the apparent upward limit of the aneurysm, 

 when I divided the deep fascia I found that the extravasated blood extended 

 further than the swelling, so that I cut into the coagula of the aneurysm. What 

 would, in all probability, have been the result of such a procedure without 

 antiseptic treatment ? 



Mr. President, I have hitherto felt some hesitation in publishing cases of 

 this kind, lest I should lead my professional brethren to do that which would 

 only end in disaster. An eminent London surgeon wrote to me some time ago 

 asking for catgut, as he wished to use it for tying the external iliac. I wrote 

 back to him saying that if he did not feel sure he could avoid putrefaction in 

 the wound, I would not advise him to use catgut, because, if the wound should 

 putrefy, the catgut lying there, without any means of withdrawing it, would 

 perhaps lead to unhealthy ulceration and so occasion secondary haemorrhage, 

 as happened in a case of Sir Philip Crampton's ; which was of course not treated 

 antiseptically. But with the spray I feel that, in operations of this sort, safety 

 is a matter of certainty. Any one of you who chooses may, I believe, tie the 

 femoral artery with no more danger than in making a cut in the skin on the 

 hand ; and with much less danger than making a cut in the skin on the hand 

 without antiseptic treatment in an ordinary hospital. 



