CLOSURE OF A WOUND. 



151 



place the thread, before tying it, fairly behind the point 

 ot the tenaculum, so as to avoid including the instru- 

 ment within the ligature, a circumstance which would 

 lead to the slipping of the noose and failure of the 

 operation. The hook is now to be withdrawn, and 

 one end of the ligature cut off by scissars within 

 a little of the noose. The remaining threads are 

 allowed to hang out of the wound, so as to admit 

 of their removal when they become loose, which does 

 not, however, take place till the termination of the first 

 four days, and they are frequently retained for a much 

 longer period. At each time the wound is dressed, 

 after the fourth day, the ligatures should be gently 

 pulled, or, which is preferable, twisted, to disengage 

 them, if at all loose, so that the wound may be more 

 speedily closed. Before proceeding to any operation 

 where bleeding is expected, the operator should pro- 

 vide himself with a few well- waxed threads, each 

 twelve inches long, so that no delay may ensue on a 

 division of large vessels. 



(107.) Removal of Extraneous Matter, Dirt is best 

 removed by washing with a sponge or old linen rag 

 and warm water. Other foreign bodies may in general 

 be extracted b\' the finger and thumb. In some cases, 

 however, it may be necessary to dilate or enlarge the 

 wound with a fine-edged knife, in order to facilitate tne 

 removal of substances which, from their shape or situa- 

 tion, cannot be otherwise displaced. 



(108.) Closure of a Wound. The last thing to be 

 done is to bring the edges of the wound into as accu- 

 ra*;e contact as the state of the parts will at the moment 

 p*»tiint, without, however, using any force. This, with 



