Ligature

Also: tying off a vessel, vascular ligation

Tying off a bleeding blood vessel with thread. Described by the Roman writer Celsus in the first century AD, then largely lost from practice for centuries.

Questions this entry answers

  • How did Roman surgeons stop bleeding?
  • Who invented tying off blood vessels in surgery?
  • How were Roman soldiers treated for wounds?

Definition

A ligature is a thread tied around a blood vessel to stop it bleeding. Ligation is the act of tying it.

Historical context

In De Medicina, written in the reign of Tiberius, Aulus Cornelius Celsus describes tying off severed vessels with linen thread. For long periods after antiquity, surgeons relied instead on cautery, burning the vessel closed, before ligature returned to general use in European surgery.

How it worked

The surgeon found the cut vessel in the wound, drew it out and tied it with thread, above and sometimes below the cut. In limb amputation, Celsus is cited for the use of iron clamps as well. Without anaesthesia as we know it, and without antisepsis, the patient was held still by assistants, and the ligature itself could later become a site of infection.

What it meant for the patient, the soldier, the civilian

For a soldier bleeding from a deep wound, a surgeon who could find and tie the vessel was the difference between a wound and a death. The procedure was done awake, with other men holding him down. If he survived it, the next danger was the days of fever that might follow.

Examples from history

  • Roman military medicine. Our research on The Hands That Survived Rome draws on Celsus's account of tying vessels with linen thread.

Sources

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Primary source

  1. Celsus, De Medicina, Book V, 26.21. Trans. W. G. Spencer, Loeb Classical Library, 1938.

    Not yet checked against the source

Scholarly secondary source

  1. Majno, Guido. The Healing Hand: Man and Wound in the Ancient World. Harvard University Press, 1975.

    Not yet checked against the source

  2. Salazar, Christine F. The Treatment of War Wounds in Graeco-Roman Antiquity. Brill, 2000.

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