LIGATURE (ante). The ligature had been partially applied by the Roman surgeons, :but it fell into disuse during the dark ages, and was not revived till 1536-37, when the ,celebrated Ambroise Pare (q.v.) introduced it while in Italy with the army of marshal Ilene de Mont-Jean. This example did not, however, suffice to make the practice gen ,eral, and it was long before it was introduced into England, where, as late as 1761, it needed advocates in cases of wounded arteries. Thirty years after this, John Hunter employed the ligature in the treatment of aneurism in a new way, viz., by tying the artery at a considerable distance from the aneurismal sack, and where it was in a healthy condition. Rut this great improvement was coldly received.
Ligatures are applied chiefly: 1. For removing tumors of various kinds, such ss hemorrhoids of the rectum, and fibrous, fleshy, and erectile tumors in various parts; 2. For arresting hemorrhage in arteries, either at the time of an amputation, or any operation in which an artery is divided, or when an artery is wounded by accident; 3. For arresting the flow of blood, to diminish either the supply of blood going to a part, •or theflow ablood in an aneurismal or otherwise weakened artery.
Ligatures are of various materials, as linen thread or twine, silk, animal membrane, such as the gut of the silk-worm, deer-skin, catgut, gold, silver, platinum, or lead wire. The principles indicating the use of these various materials vary with circumstances. It is often desirable, instead of keeping a wound open, to close it immediately, in which •case the ligature must be of snch material that it can be left in the wound and allow of the flesh to heal over it. Linen thread or silk will not then answer. because of the irri tation they would create. Fine gold and silver wire has been successfully used in such •cases, the ends of the ligature being cut off short. After a while the small piece of liga- • ture will make its way to the surface, after having fulfilled its office, or it may- become •covered with a cellular capsule. The older surgeons used animal membranes, btu with
indifferent success. Wardrop used the gut of the silk-worm, and catgut was employed by sir Astley Cooper, with a view to absorption of the ligature. In one patient of COoper's, 80 years of age, the wound healed in four days; another in twenty, and it was supposed that the material was absorbed. Other surgeons who attempted to imi tate the process failed; the catgut was often found too weak, or wanting in firmness; and sir Astley himself, after having some unsuccessful cases, abandoned the use of this material and returned to that of the ordinary' hempen thread. The wire ligature now ,so much used, and which in many modern operations is absolutely necessary for sue eess, is an American invention. It originated with Drs. Physick and Levert, who per, formed several operations with threads of gold, silver, platinum, and lead. When the ends of the ligature were cut off close to the vessels they.usnally became imbedded in a cellular capsule, and did not occasion irritation. But this practice also fell into disuse, to be revived in recent times with certain modifications which render it almost one of the necessary adjuncts of modern surgery. The use of the catgut ligature has also recently been revived with the very important improvement of treating it with a solution, of carbolic acid.
The immediate effects on an artery of a ligature applied with sufficient force are the• division of the internal and middle coats and the constriction of the outer one. See. ARTERY, ante. An examination of the vessel a few days after will reveal the formation ' of a pyramidal coagulum, composed of plastic matter at its base and a fibrinous clot at its apex. The vessel at this point will also be surrounded by coagulable lymph. At the expiration of two or three months the end of the artery will be convertea into a tibro cellular cord as far up as the first branch above the ligature.