280 
DEPARTMENT OF SURGERY. 
czerny-eembert sutures. 
Fig. 4. Lateral view, a —Czerny’s suture ; b —Lembert’s suture. 
Fig. 5. a —Lsmbert’s suture ; b —Czerny’s suture. 
out again, never penetrating the mucous coat. We shall con¬ 
sider the application of this method in the following operations, 
viz.: 
(a) Intestinal approximations. ($) End-to-end anastomoses. 
(V) Enteiorraphy. 
(a) Intestinal approximations (Fig- 8).—In this proced¬ 
ure, the ends of the intestine to be approximated are brought 
together and the required number of stitches applied ; the dis¬ 
tance between the stitches being left to the judgment of the 
operator. The stitches should be made of catgut,,which is 
readily absorbed, leaving no foreign substance in the cicatrix 
formed by the union of the two ends. The stitches (Fig. 8) 
are made with a needle armed with catgut and passed through 
the serous coat into the muscular and along the longitudinal 
axis of the intestine for a distance of from five to eight milli¬ 
meters and through the serous coat from within out; the needle 
is then passed through the serous and into the muscular coat 
of the other end to be approximated, in the same manner as 
before ; making the point of entrance at the same distance from 
the edge of this end as the point of exit is from the edge of the 
other end ; this then constitutes one of the ligatures (“stitches”) 
which make up the Fembert suture. This should be repeated 
until the required number of stitches have been applied.. They 
should then be ligated carefully, one by one, with special care 
taken to apply uniform tension to them. By ligating them 
the serous coats of the two ends are brought together and the 
free edges are turned into the lumen of the intestine. The 
serous coats readily unite, leaving but a very small cicatrix, 
