MEMBERS OF THE BRITISH MEDICAL ASSOCIATION 271 



that, a longer time being required for the absorption of the more substantial 

 material, it may remain longer as a mechanical barrier to the force of the 

 circulation. 



[In this point of view there is another important advantage possessed by 

 catgut properly prepared, viz. that it is much less rapidly absorbed than that 

 which has been for a shorter time in the preparing liquid. 



I would strongly advise any surgeon, who proposes to ligature an artery 

 in its continuity with catgut, to test for himself the quality of the article ; since 

 those who sell it are tempted, if their stock of old catgut has run out, to supplv 

 that which has not been long enough prepared. In order to ascertain if it is 

 trustworthy, a piece should be steeped for an hour in water about the tempera- 

 ture of the body, as in a vessel at a suitable distance from the fire. If then 

 a reef-knot tied upon it does not slip, it is fit for use. And it will be well for 

 the surgeon to keep a stock of the material for special purposes like these, testing 

 it in the first instance in the manner described, after which he will be sure that, 

 being still kept in the preparing liquid, it will be at least equally good at any 

 subsequent period. If these points are attended to, there will be no further 

 complaints about untrustworthiness of the catgut.^] 



I have now, Gentlemen, to bring before you two cases illustrating a some- 

 what interesting example of the usefulness of the catgut, namely, for the arrest 

 of haemorrhage from a wounded vein. 



Nineteen days ago I removed this patient's mamma, and at the same time 

 cleared out the entire contents of the axilla, thus taking away, along with the 

 fat, a number of scirrhous lymphatic glands, one of which lay immediately 

 beneath the clavicle. In performing the operation, you may cut freely enough 

 on the side towards the chest ; but towards the axillary vessels, the glands. 



' When it is requisite that the cord should be able to withstand all the strain to which the human 

 hands can subject it, as, for example, if it be used for the pedicle in ovariotomy (in wliich case, I may 

 remark, the pedicle would have to be well subdivided), the material must be of specially strong quality 

 to begin with. Catgut consists of the peritoneum, together with muscular fibres, of the small intestine 

 of the sheep ; and the common kinds are either the entire tube of the gut, or longitudinal strips (accord- 

 ing to the thickness required) simply twisted, dried, and subjected to sulphurous-acid vapour, or other 

 chemical agents. But for special purposes, as, for example, the manufacture of fiddle-strings, the cord 

 is made of several narrow strips twisted together, and is then very much stronger. Such catgut can 

 be obtained of the musical-instrument makers, but is of course then unprepared in our sense, unfit for 

 surgical purposes, and must be kept in the preparing liquid for a due length of time. For the sake of 

 those who wish to prepare catgut for themselves, I may repeat here the proportions wliich I have found 

 the best for the purpose. Add one measure of water to ten parts by weight of crystaUizcd carbolic acid, 

 mix and add one measure of the mixture to five measures of oUve-oil, in a suitable jar or wide-mouthed 

 bottle ; then at once introduce the catgut, the hanks being opened up to allow access of the liquid to 

 them ; cover, and set aside in a cool place. Some water is gradually precipitated to the bottom of 

 the vessel, and it is necessary to prevent any part of the gut from coming in contact with this 

 precipitated water. A simple way of ensuring this is to put in as many marbles as will cover the bottom 

 of the vessel. 



