172 INJURIES. 



If there be any prospect of a cure by tbe first intention, 

 one end of the ligature should be cut ofi" quite close to the 

 knot, (a reef one) and the ends should be carefully gathered 

 and brought out at one corner or another of the incision, 

 after it is put together. If there is no intention of ap- 

 proximating and retaining the edges, both ends of all the 

 ligatures had better be cut off close to the knots (Liston's 

 Introductory Lecture in the ^ Lancet' for June 1, 1844). 



The needle generally used is here represented. The old 

 crooked form, however, is useful in situations where you cannot 

 turn the other very well. The interrupted suture is the one 

 commonly applied. Use one, two, three, or more sutures, 

 according to the length of the wound, distant about half an 

 inch from each other, using a double or single ligature, and 

 knot them twice : this being called the reef knot. The blood 

 is allowed to coagulate around their edges. At the end 

 generally of two days the sutures are snipped through and 

 withdrawn. Isinglass silk, isinglass plaster, gold-beater's 

 skin (the prepared peritoneum of the ox), or silk gauze, may 

 be used afterwards to give support ; the latter is the best ; 

 I have used it for fifteen years past. The quilled suture — 

 made by placing the barrel of a quill, and tying the ligature 

 over it, and then another quill — is used only in one opera- 

 tion, that for lacerated perinseum ; so long as there is any 

 bleeding, wet cloths may be applied; the patient's limb 

 wetted and covered with oiled silk, the discharge being 

 moderated by some astringent solution. Now and then the 

 cure will be aided by giving support by mean^ of bandages. 

 (Liston's Lecture.) 



There is a case, however, in which we must hesitate be- 

 fore we make use of sutures, or wherein, if we do, it will 

 become our duty narrowly to watch their operation. This 

 case is, wound of the scalp. Inflammation and suppuration, 



