418 HEALTH AND DISEASE 



The introduction of the quilled suture is best effected by means of 

 a curved needle with an eye towards the point (fig. 418). This, on being 

 armed with a double thread of the material employed, is passed through 

 the lips of the wound from side to side. The looped end is then seized 

 with the left hand and retained on one side of the wound, while the needle 

 is withdrawn, leaving the double thread projecting from the other side. 



This having been repeated as often as necessary, the loops are twisted, 

 and the cylindrical material above referred to, after being notched here and 

 there to receive the thread, is passed through them. A second piece of the 

 same substance is tied to the opposite side of the wound by the free ends 

 of the projecting threads. 



Stitching up the Wound. In dealing with superficial wounds, or 

 with those to which pressure may be applied, the edges, after being brought 

 accurately together, are secured by one or another of the several forms of 



suture, according to 

 the character of the 

 wound. 



Fig. 41 8. -Curved Suture Noedle with Eye at Point " 1S lm POrtant ID 



inserting stitches that 



they be made to take a good hold, to guard against tearing out. For 

 this purpose they should be passed through the skin at least half an 

 inch from the wound on one side, and brought out a similar distance 

 from it on the other. If interrupted stitches are used they must be 

 placed from half an inch to an inch apart. The edges must be per- 

 fectly level one with the other, so that folding or puckering of the 

 skin may be avoided. In order to assure this, the edges should be 

 brought into apposition and the points marked through which the sutures 

 are to pass, or the edges should be held together by an assistant. The 

 stitches must not be tied until all have been inserted, and then care 

 must be taken not to draw them tighter than is necessary to bring the 

 lips of the wound together. Overdrawn sutures obstruct the circulation 

 of the tissues through which they pass, and excite irritation in the part, 

 and interfere with the healing process. 



Where a bandage can be applied over the dressing, its employment is 

 most desirable, and in some cases it is indispensable to a speedy reunion of 

 the wound. By careful adjustment it should be made to exercise gentle 

 and uniform pressure on the divided parts, and by so doing keep them in 

 close apposition, thereby preventing the accumulation of effused fluid, and 

 favouring the healing by the first intention. 



In those cases where bandages cannot be applied with effect, and 

 especially in the case of large wounds inflicted on parts of the body where 



