WOUNDS. 173 



extending over the forehead and temples, and poll of the 

 head, is very apt to follow their application : and there is 

 always more or less apprehension of this spreading to the 

 brain, on account of the known connexion and sympathy 

 there exists between the pericranium externally and the dura 

 mater internally. In these wounds of the scalp the matter 

 is very apt to burrow extensively underneath the skin, on 

 which account, in general, free incisions with the scalpel 

 form one very important part of their treatment. 



The Twisted Suture. — In introducing this, it is not my 

 object to recommend that known to surgeons, but one similar 

 to that veterinarians are in the habit of pinning up the 

 necks of horses with after bleeding. Everybody knows 

 how this simple contrivance answers for closing the orifice 

 made in venesection ; and I have found it of other use in 

 practice : indeed, in cases where it is sufficient to preserve 

 apposition, I prefer it to any other form of suture. 



Removal of the Sutures. — It must be remembered, 

 although sutures are employed to produce adhesion or union 

 by the first intention, yet they, being foreign bodies, will 

 soon become sources of irritation, and require removal. It 

 is true they would ulcerate their way out were they suffered 

 to remain : it is, however, advisable to withdraw them, 

 which may easily be done with forceps, first dividing them 

 with scissors. Generally speaking, sutures should be re- 

 moved on the third day : cases do occur, however, in which 

 they can be allowed to remain until the fifth and even the 

 sixth day. It is seldom that we succeed in accomplishing 

 perfect adhesion. Commonly, about the third or fourth day 

 the exterior of the wound becomes tumid, stretching the 

 stitches, and oozing an acrid matter : this is the signal for 

 the withdrawal of the sutures. When union by the first 

 intention is effected, the parts, though warmer than natural, 

 and somewhat tumid, remain perfectly dry — free from any 

 discharge. 



The Sutures being removed, the sides of the wound 

 are again open, and we behold a large sore, which has to 

 heal by the tedious process of granulation. This opera- 



