DEPARTMENT OF SURGERY. 
281 
but the internal surface does not have the same synulotic en¬ 
vironment ; the muscular coats are not held together so firmly 
as the serous ; the mucous coats are not kept in apposition ; 
the wound is exposed to infection from within ; foreign sub¬ 
stances prevent cicatrization ; faecal matter accumulates at the 
point of intersection ; and, a number of other conditions which 
have a tendency to make an unfavorable seat for immediate 
union, could be mentioned in this connection. 
The advantages of this method can be summed up as fol¬ 
lows : i. The stitches are not subject to infection from within. 
2. They can be applied rapidly, almost as quickly as the most 
simple method. 
Indications :—This method may be used when the operator 
desires to shorten the procedure, or when the patient’s condi¬ 
tion is such that it could not endure a long operation. 
(b) End-to-end anastomosis. —In this form of anastomosis 
the success of the operation will depend greatly upon the 
ingenuity of the operator. If the ends to be united are of the 
same dimensions the operation is as simple as that of approxi¬ 
mation ; but if one end is larger than the other, the larger one 
should be reduced to the calibre of the smaller by a longitudinal 
suture, which can de made by the Lembert method. The ap¬ 
plication of Lembert’s sutures in this operation is the same as 
in approximation, and the results are the same. 
(d) Enterorraphy. —This is an operation (Fig. 5) which is 
frequently indicated in veterinary practice, and will be fully 
described elsewhere. The object of enterotomy is usually to 
remove some obstruction from the intestinal tract, and should 
be done carefully, the wound should be well irrigated and 
made aseptic, and the incision properly stitched. The tech¬ 
nique is the same as in other operations, and the stitches are 
made across the wound (Fig. 5 a) ) and in ligating them the 
edges are turned into the intestine, as in Fig. 4. • 
3. Czerny's Suture. —This is a very ingenious method of 
suturing intestinal wounds, and consists of a series of interrupted 
stitches (Fig. 5 b) which are made as follows : a needle armed 
with catgut is passed through the serous coat into the muscular 
and out of the edge of the wound between the muscular and 
mucous coats of one end (Fig. 4 a) ; the needle is then passed 
into the edge of the other end between the muscular and muc¬ 
ous coats, then through the serous coat at the same distance 
from this edge of the wound as the point of entrance is from 
the other edge. This constitutes one of the stitches ; which, 
