Note 8 — VI THE MEDICAL SCHOOL AT SALERNO

It seems hard to understand how so useful an auxiliary to the surgeon as the ligature,—it seems indispensable to us,—could possibly be allowed to go out of use and even be forgotten. It will not be difficult, however, for anyone who recalls the conditions that obtained in old-time surgery. The ligature is a most satisfying immediate resource in stopping bleeding from an artery, but a septic ligature inevitably causes suppuration and almost inevitably leads to secondary hemorrhage. In the old days of septic surgery secondary hemorrhage was the surgeon's greatest and most dreaded bane. Some time from the fifth to the ninth day a septic ligature came away under conditions such that inflammatory disturbance had prevented sealing of the vessel. If the vessel was large, then the hemorrhage was fast and furious and the patient died in a few minutes. After a surgeon had had a few deaths of this kind he dreaded the ligature. He abandoned its use and took kindly to such methods as the actual cautery, red-hot knives for amputations, and the like, that would sear the surfaces of tissues and the blood-vessels, and not give rise to secondary hemorrhage. A little later, however, someone not familiar with secondary risks would reinvent the ligature. If he were cleanly in his methods and, above all, if he were doing his work in a new hospital, the ligature worked very well for a while. If not, it soon fell into innocuous desuetude again.