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with critical information about children with chronicphysical, developmental, behavioral, or emotionalconditions that are beyond those of normally devel-oped children. The EIF contains the following:• Parent or guardian contact information• Primary care and specialty physician contact

information• Diagnoses• Allergies• Critical procedures to avoid• Immunization status• Life-saving maneuvers or interventions• Relevant past medical history

AAP and ACEP have established an agreementwith the MedicAlert Foundation to use its 24-hour

Emergency Response Center as a central repositoryfor these forms, once they have been completed bythe child’s physician. Children who are registeredwith MedicAlert receive a medical identificationbracelet or necklace. In the event of an illness or in-jury, a health care professional can call the MedicAlertFoundation toll-free from anywhere in the world to re-quest information. Within minutes, the EIF can befaxed to the health care professional.

The EIF can be downloaded from both the AAPand the ACEP Web sites at www.aap.org andwww.acep.org, respectively. Forms are also availablein packets of 100 for a nominal fee. In addition, cam-era-ready forms have been published in ACEP’s An-nals of Emergency Medicine and AAP’s Pediatrics.

A Look Back: Early ligatures

Surgery has played a central role in health and healing and was considered to be both a manual and magical art in the1800s. Supplies commonplace today, such as ligatures, posed major problems for early surgeons. In 1700, threads used assewing ligatures were not absorbed by the body and worked their way out, resulting in infections and fistulas. JohnHunter’s (1728-1793) trick was to leave the ligature threads long enough that they could be pulled out later. Early ligatureswere made of animal tissue or parchment. Philip Sung Physick (1768-1837) discovered a superior material, “catgut,”made of sheep intestines.

In the 1800s, preparing ligatures was still time consuming and cumbersome. Ligatures contained silkworm gut,silver wire, and strings or cords made from animal tissue and whalebone. These materials, though,were limited compared with violin strings. A catgut derivative, violin strings were readilyavailable, easily prepared and preserved, and cheap. In 1887, “guidelines” for transforminga violin string into an antiseptic ligature were developed:• Select 4 sizes of the best quality violin strings in this proportion:

Violin string Amount Use

E and A strings 12 each Best for smaller vessels and bleeding pointsD strings 6 Best adapted for large vessels (radial, ulnar, tibial)Harp strings 2 or 3 This string is twice as large as the D string and best

suited for iliac, subclavian, common carotid, and femoral sutures

• Place the violin strings in a glass bottle or jar that contains enough pure oil of juniperberries to completely cover them.

• Tightly cork the bottle to prevent aspiration for 24 hours to ensure asepsis.• Figure 1 represents a convenient apparatus, with a perforated cork, for storing

these sutures. Threads are drawn out and cut as required.An alternative method to juniper berries was a chromic acid catgut ligature. Vio-

lin strings immersed in a chromic acid, water, and glycerine solution for 7 to 8 monthsand preserved in carbolic acid and glycerin would resist absorption for 20 to 60days.—Linda Manley, RN, BSN, CEN, CCRN

References

Haeger K. The illustrated history of surgery. New York: Bell Publishing Co; 1988. p. 194.

Wyeth JA. Textbook on surgery. New York: D Appleton and Company; 1887. p. 1-3.