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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    the teiTible risk of litcmorrhage caiinot Le said to ])e altogetlier absent. The degenerate structiire of the vessel near the ligature, unlike the arterial wall in its normal condition, is prone to ulcera- tion, and the organisiug coagulum is similarly circumstanced; so that an unhealthy state of the wound may open up the calibre of an ai'tery tied in the most favourable Situation.* Again, when the parts about the vessel coinmunicate with loose cellular interspaces in important regions, as is the case with the iliac artevies or the subclavian, diffuse suppuration is fre- quently a cause of death. Finally, the eure is always reudered tedious by the time required for the Separation of the ligature; while the presence of an external wound during the period thus protracted involves a risk, by no means inconsiderable in some localities, of hospital gangrene or erysipelas. The Antiseptic System, however, places this brauch of surgery, like most others, in a new light. One point which it has brought out in striking relief is, that a portion of dead tissue is' not neces- sarily thrown off by suppuration, but, unless altered by putrefaction or artificially imbued with stimulating salts, serves as.pabulum for the surrounding living parts, which remove it by a •eme process of absorption. Hence, the death of a portion of the iexternal coat included in the ligature does not of itself render it a cause of sup- puration. And I conceived that if a silk thread, steej)ed in some liquid capable of destroying the septic organisms in its interstices, were tied round an artery, and left with short-cut ends in a wound dressed antiseptically,-|- the foreign body, soon losing, by diffusion * It has beeil long since noticed that hismorrhage occurs more frequenlly from the distal than from the cardiac end of the vessel. This seems at first sight contrary to what might be expected, since the cardiac end is subjected to much greater strain. The explanation is, I believe, afForded by some facts which I had occasion some years ago to point out. (See the Croonian Lecture on the Coagulation of the Blood, Proceedings of the Royal Society, vol. xii., No. 56.) It was then shown that a perfectly undistuibed coagulum resembles liealthy living tissne in failing to induce coagulation in blood near it; but that, on the otlier band, while a clot is, from its softness, peculiarly liable to laceration and other disturbance, a disturbed coagulum acts like injured tissue in impressing upon neighbouring blood a coagulating tendency. Hence, when a ligature has been tied round an artery, althougii a minute clot necessarily forms upon the injured internal and middle coats, it would undergo no increase if the blood in the vessel were absolutely quiescent. But the pulsations of the artery operatc as a disturbing cause to the clot already formed, which consequently increases in proportion to tlie degree of the disturbance; and as this is much greater at the cardiac side, the clot grows more quickly there, and forms a more secnre barrier against the pressure of the blood. t In usiiig the expression dressed antiseptically, I do not niean inercly dressed with an antiseptic, but dressed so as to ensurc absence of pulrefaction.