soft bands were tied lightly on it. This fact hardly gained the universal and complete confidence of surgeons until further vivisections performed by Lister, Brücke, and others, showed that the smooth lining of the vessel was the chief factor in preventing coagulation, and that intravascular clots are formed most readily when the lining of the vessel was injured and the blood ceased to move. Instead of timidly tying a loose knot for fear of injuring the vessel, the surgeon now ties a firm ligature so as to rupture its lining coat, or at least to apply sufficient pressure to cut off its nutrition and thus cause its death in order to make a starting-point for the coagulation which must occur to secure its permanent closure.
Another great objection to the old ligatures was the delay they caused in coming away. This wearied the surgeon and exhausted the patient. The ligature was sometimes pulled away before its time, and this often gave rise to the much-dreaded secondary hæmorrhage. In counseling that the ligature be left alone, Petit adds the remark, as a kind of consolation, that he finds them generally to come away of themselves in about two or three months. Of this sort of annoyance we hear nothing now. Experiment on the lower animals has taught us the existence of the lymphatics and their absorbing power. Experiments upon living animals has shown us that this power of absorbing extends to such things as catgut, a material readily made into strong cords. Properly prepared catgut is, therefore, almost universally used as a ligature, the ends are cut off short, and the knot is left to be absorbed, and never once thought of again.
And, lastly, the edges of the wound are brought together with stitches of silver wire, silk, catgut, horse-hair, according to whether much or little traction or more or less coaptation is demanded. Undue tension, compression, gaping, and irregularity of the wounded part, are all avoided; a means of exit for serous oozing, etc., is provided by non-irritating drainage-tubes. The antiseptic dressings are applied carefully and exactly. Large tents, dossils of lint, rude compresses are not thought of. The aseptic wound heals without swelling or inflammation. No throb disturbs the patient's rest. No drop of pus comes from the cut surface. Fever, tetanus, pyæmia, second hæmorahage, as well as the old dread of the bleeding during the operation, are all nearly forgotten.
To the minds of the surgeons of the last century such a method of operation and such a mode of healing would probably suggest the longed-for magic remedies by means of which many hoped to replace the cauteries, caustics, compresses, and filthy dressings with which they strove to heal the open wounds of their exhausted and cachectic patients.—Lancet.
