THE THORACIC AND ABDOMINAL WALLS 159 



chosen depending upon which organ is to be operated upon. 

 Carefully arrest all haemorrhage either with artery forceps or 

 tampons of aseptic wadding, puncture the peritoneum, insert 

 a director, and with the aid of a scalpel or scissors make an 

 incision of the required length. 



After doing whatever is necessary to the internal organs, 

 remove all blood from the neighbourhood of the wound, 

 suture the peritoneum with fine silk, and the muscles with 

 silk, and the skin with silkworm gut. The peritoneum and 

 muscles may be taken together, and some practitioners 

 suture all three layers (peritoneum, muscles, and skin) at 

 once, but this method cannot be as safe as if they are 

 taken separately. A continuous suture may be used for the 

 peritoneum, but interrupted sutures are unquestionably the 

 best for the muscles and skin, as, if septic infection takes 

 place, it is necessary to remove one or two for the cleansing 

 and dressing of the wound. 



The sutures should be placed close ; if far apart a piece of 

 omentum is apt to protrude, and the bowel may follow it. 

 About a third of an inch is a fair distance. In order to 

 complete the operation, the exterior is carefully dried with 

 ether and aseptic wadding and covered with iodoform (or 

 orthoform) and collodion, as already directed on p. 50. 



Occasionally in large dogs, where a long incision has been 

 made, a bandage is useful over this to give support to the 

 edges of the wound ; but in the majority of cases this is not 

 necessary, and only forms a source of annoyance and irrita- 

 tion to the patient. Care must be taken to keep the 

 animal perfectly quiet and on low diet for about ten days, 

 and on no account to allow it to go up and down steps or to 

 jump from a height. Neglect of these precautions is liable 

 to lead to the reopening of the wound and escape of the 

 intestines. Water should also be aUowed sparingly, and 

 care should be taken, above all, to avoid any food or ad- 

 mixture of foods which might produce vomiting. Such a 



