136 ELEMENTAKY OPERATIONS. 



to the following kinds: the T and V shaped, the crucial, the 

 elliptic, and the semi-lunar. The branches of these compound in- 

 cisions are made in the same manner as for the simple kind ; when 

 two incisions are to meet at a given point, the second one must be 

 made, not to begin, but to terminate at that point ; when two 

 incisions are to unite, one above the other, the lower one is to be 

 made first, to avoid the flow of blood from the upper, which would 

 cover and conceal it ; and when two incisions are to meet at their 

 extremities, it is proper that the ends of the second incision should 

 start a short distance beyond the commencing point of the first, 

 and terminate with a similar space from the end of the first in- 

 cision. In other words, the junction of the extremities of the two 

 incisions must never be by a perfect acute angle. The angle must 

 always have a shght prolongation formed at one extremity, by the 

 extension of one, and at the other by that of the other incision. 

 These rules are not absolute, but may be changed as circumstances 

 may require. 



In the T-shajyed incision, a straight cut is carried j)erpendicu- 

 larly upon the middle of another. In the V-shaped, there are 

 two straight incisions meeting at an acute angle by one of their 

 extremities, this angle, as we have just said, having a small pro- 

 longation on one of its lines at their junction. The V-shaped in- 

 cision may open in every dii'ection. Sometimes the two incisions 

 are made to meet at a right angle, to form the L-shaped incision. 



In the crucial incision, two straight cuts are made to meet at 

 their middle, usually at a right, sometimes at an acute angle, 

 forming an X-shaped incision. This is made in three stejDs, first, 

 a simple straight cut ; second, the first part of the second incision 

 as in the T-shaped form, and third, the second part of the second 

 incision ending, not beginning, at the point of junction of the in- 

 cision made in the first two stejDS, and in such a manner as to be 

 the continuation of the incision made on the second step. This 

 incision may also be made in two cuts, when the skin is hard and 

 adherent to the deeper tissues, by making the second incision 

 with one stroke of the knife, passing at the middle of the first. 



The elliptic incision is made with two curved cuts, so united at 

 their extremities as to leave between them an elliptical space. The 

 semi lunar or crescentic incision is formed by two cui'ved ones, 

 the circumferences of which are turned in the same dii-ection, 

 lea^^-nf]f between them a form like that of the new moon. 



