SURGERY. 
author, in order to convey a lively and firm 
conviction in the mind of the student, of the 
established, and in its application to practice, 
most important fact, tiiat cut surfaces, if 
placed “neatly and evenly in contact with 
each other,” ‘will adhere: that from the 
slightest to the most serious wound, the pro- 
cess of healing is not in the smallest degree 
accelerated, but, on the contrary, greatly re- 
tarded by balsams, astringent gums, oint- 
ments, and other idle inventions for “ raun- 
difying, incarning, or cicatrizing of wounds.” 
We repeat then this most important practical 
rule, than in endeavouriug to heal recent 
wounds, the whole duty oi a surgeon consists 
in securing bleeding vessels, and then bring- 
ing the edges of such wounds as accurately 
as possible in contact. “ The rest we leave 
to nature.” 
When this union can be effected and re- 
tained (which it can in a great number of in- 
stances) without the aid of stitches, so much 
the better. This is likewise another im- 
provement in modern surgery. In the most 
trivial wounds, the older surgeons were used 
to torture the patient with stitching, when 
the object, as it is now most satisfactorily 
proved, can be obtained with more readiness 
and safety by the mere application of a sim- 
ple adhesive plaster. As this, however, is 
not always the case, v r e are to proceed in de- 
scribing those circumstances in which the 
sewing of a wound is, and those in which it is 
not, necessary or proper. 
When the skin merely is divided by a lon- 
gitudinal cut, the edges of the wound are to 
be brought together by the adhesive plaster, 
by common court-plaster, or by a plaster of 
diachylon. “ In applying such plaster, we 
are careful first to let the bleeding subside, 
then to make an assistant put the lips of the 
wound neatly together ; then we apply one 
end of the sticking-plaster to the skin on one 
side of the wound, and let it fix there so that 
' we may pull by it ; then we pull that edge by 
the plaster ; then moisten the remaining half 
( of the plaster ; then lay it neatly down over 
the opposite edge of the wound ; then apply 
i successive plasters till w ; e have crossed the 
: whole line of the wound ; then, if any one of 
i the slips of plaster has lost its hold by the 
oozing out of the blood, we take it gently off, 
wipe the surface, and apply a new one neatly, 
i until we have got the whole clean and fair, 
all the plasters sticking soundly ; and, lastly, 
; we lay a compress over the wdrole, which we 
bind down a little with a circular roller, in 
order to prevent internal bleeding.” This 
substitute for sutures is to be employed, 
likewise, in lleshy wounds which do not pene- 
trate deep : it is to be used in parts where 
■ the skin lies close upon the bone, as in the 
back of the hand, and upon the hairy scalp. 
Even, however, in superficial wounds, when 
they are angular it will sometimes be necessary 
to employ one stitch of the needle in the 
| situation of the angle, which will thus be sup- 
ported while sticking-plasters, in the manner 
| just directed, are to be applied to the sides of 
the wound, where the lips can be easily 
i brought into contact. 
When wounds, even although they may 
not be very deep, are made in parts which 
| are constantly subjected to the action of 
1 strong muscles, as in the cheeks or lips, a 
[. stitch of the needle is to be employed ; or that 
I suture made use of which is termed the twist- 
ed or hare-lip suture, from its bein g prin- 
cipally had recourse to in order to unite the 
cut edges of a hare-lip. The manner of using 
this* suture is the following : The broad 
edges of the wound are brought as nearly and 
neatly as possible in contact, and transfixed 
at opposite points with pins employed for the 
purpose. In the hare-lip operation, two of 
these pins are inserted, one at the edge of the 
lip, and one in or above the middle of the 
cut ; we then twist a thread from one to the 
other pin, in the form of a figure of 8. (See 
fig. 9 in the Surgical Plates.) 
In long and deep wounds among muscular 
substance, stitching will generally be requi- 
site, and in proportion to their length must 
the stitches be multiplied. We are com- 
monly directed by authors to make “for each 
inch of the wound, one stitch of the needle,” 
passing, according to the extent of the wound, 
so many separate ligatures, which, after being 
all passed, are to be each tied over the sur- 
face, first by a single, then by a slip-knot. 
In this manner is the interrupted suture of 
the antients formed ; which they distinguish- 
ed from the continued suture, from the latter 
being sewed in the manner of a continued 
seam all along the wound. In each interstice 
of the interrupted suture, it will be neces- 
sary to lay one strip of adhesive plaster. 
When the wound is still deeper, so that the 
stitches cannot go to the bottom, the com- 
press, and what is called the uniting bandage, 
must be applied after stitching. This is form- 
ed by putting a double-headed roller round 
the part, passing one head through a slip in 
the opposite side, and drawing both at once. 
“ If the wound is pretty deep among the 
muscular flesh, so that the several stitches 
of the interrupted suture would make (if tied 
by the common knots) an awkward and pain- 
ful suture, likely' to excite inflammation, we 
then convert the interrupted suture into what 
is called the quilled suture ; which is made 
by splitting each end of the ligature (after the 
stitches are made) into two threads ; then 
laying a quill or bougie along each -side of the 
wound, we tie all the ligatures of one side 
round one bougie ; then draw that bougie 
tight down, by pulling the ligatures from the 
other side ; then tie the ligatures also on the 
other side, round the opposite bougie; so that 
the two bougies, like two large rolls, keep the 
sides of the wound neat and even.” This 
suture is not often employed. 
After describing these different methods of 
effecting union between the divided edges of 
a wound, it is necessary to caution the reader 
further against using them indiscriminately 
in very deep muscular wounds. “ Stitches 
after all can support only the edges of the 
wound, while it is the compress and the unit- 
ing bandage that must support all below.” 
Thus stitches carried to a great depth have 
not only failed of their object, but have too 
often been the immediate occasion of con- 
vulsions, inflammations, and their long and 
dreadful train of consequences. 
Stitches must also be employed cautiously 
if the patient, previous to the accident, lias 
not been in firm health; or where he is to be 
exposed during the cure to the contaminated 
and deadly atmosphere of a crowded, filthy, 
and un ventilated hospital. 
With respect to the manner of arresting 
the bleeding, when one principal, or several 
735 
ramifications of an artery are divided in a 
wound, so that profuse hamiorrhage takes 
place, the application of the tourniquet (fig. 
10) is called for. The arteries are afterwards 
to be taken up, and secured in, the following 
manner : The tourniquet being a little loosen- 
ed in order to discover the artery, an assistant 
makes a noose on the ligature to be em- 
ployed: this being placed over the tenaculum 
(see fig. 11), the sharp point of this instru- 
ment is pushed through the sides of the 
bleeding vessel ; and?o much of it taken out 
from the surrounding flesh, as is sufficient to 
afford surface for a secure knot, which the 
assistant makes upon it. 
If, from the depth of the wound, the tena- 
culum cannot be used, the crooked needle is 
to be employed instead ; and if it is to be pass- 
ed under the artery, as little of the muscular 
substance as possible is to be included in the 
ligature. If the artery to be secured is 
superficial, and lies against bone, as in the 
temple, in the hand, or the foot, it will be best 
secured by a firm compress. If it is con- 
venient to make this compress within the 
wound, it may be formed of a piece of sponge 
cork, folded leather, or linen. Such appli- 
cation will necessarily for a time interrupt the 
cure by 7 adhesion. 
When the wound has been sewed, the ends 
of the ligatures that are round the arteries 
are to be left hanging from its corners. 
Such then is the immediate business of the 
surgeon, viz. to arrest haemorrhage ; and to 
bring as speedily as possible the divided 
edges of the wound into contact, in order to 
ensure the commencement of that adhesive 
process already spoken of. lint with the 
closing of the wound the surgeon’s business 
is not finished. For the most part, indeed 
if the junction has been duly effected, if the 
patient is in health and properly managed, 
a certain degree of union will ~ be shortly- 
formed, the ligatures that have been em- 
ployed will come away on the fourth or fifth 
day, and the adhesive action that is goino- on 
will not amount either to actual inflammation 
(although it is called the adhesive inflam- 
mation), or be accompanied by any system- 
atic irritation of consequence. In the pro- 
gress, however, of cure, in all wounds that 
have been closed by ligature, some degree 
of actual inflammation is always produced * 
and for this reason, that the ligatures them- 
selves cannot but act as local irritants. Now 
if the tendency in the system is to inflame ; 
if the stitches have been carried too deep, or 
the ligatures are too lightly pulled; if there is 
blood poured out under the skin, by which 
it is separated from the parts below ; if, in a 
word, any cause has place of either sepa- 
ration or undue irritation ; instead of the 
kindly progress of this adhesive natural and 
healthy action, pain, inflammation, and swell- 
ing of the parts, will ensue ; and if these arise 
to any extent, “ you must immediately un- 
do your bandage, draw out your pins, or 
cut your stitches, and take away every thing 
that is like stricture upon the wound : these 
prudent measures may abate the risino- j n _ 
flam mation, and prevent the total separation 
of the skin ; while you may still endeavour to 
keep the wound tolerably close by the more 
gentle means of sticking-plasters. 
“ But should the inflammation rise still 
higher, and should you perceive that a total 
