Observations on ligature of arteries on the antiseptic system / by Joseph Lister.

Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: Observations on ligature of arteries on the antiseptic system / by Joseph Lister. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    OBSEEVATIO^^S LIGATURE OF ARTERIES OX THE ANTISEPTIC SYSTEM. Various attempts have been made, both in the early pari of the Century and more recently, to improve the ligatiire, or to supersede it by other metliods. Nevertlieless, for obstructing tlie calibre of an arterial trunk in its continuity, no means hitlierto devised have proved siiperior to a small silk thread tied in a secure knot, with the ends left projecting froni the wound. Yet, as is implied by the numerous efforts at improvement, the ligature in this form is far from perfect. The internal and middle coats are ruptured by the constrict- ing noose, while a portion of the tough external coat ia pinched together and deprived of its vitality. The dead tissue, becoming contaminated by the putrefaction which occurs in the interstices of the sOk fibres, acts, together with the septic ligature, as a cause of Irritation to the neighbouring parts of the arterial wall, which consequently degenerate into an imperfect structure, inadequate to withstand the powerful' cardiac impulse; and even before the slough separates by suppuration, the blood breaks through the feeble barrier, unless it be fortified by a firm plug of internal coagiilum. Hence, if a considerable brauch takes origin close to the part tied, the forraation of a clot being prevented by the cur- rent of blood, secondary hsemorrhage is the inevitable consequence; and thus the ligatiu'e is inapplicable in situatious otherwise eligible for it, such as the femoral artery near Poupart's ligament, the origins and endings of the iliacs, and the innominate. Even when the thread is distant from any considerable brancli,