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DEPARTMENT OF SURGERY. 
when the required number is applied and ligated, completes 
the Czerny suture. This method holds the serous and mus¬ 
cular coats together and brings the mucous coat in apposition, 
which is supposed to cover the stitches and prevent them from 
becoming infected from within ; this, however, is not always 
the case ; occasionally the folds are not complete and stitch 
suppuration follows. It is generally conceded that it is a little 
more reliable than the Jobert suture, but experienced operators 
who have tried the Czerny suture and compared its results with 
those of other sutures do not adopt the method when more reli¬ 
able ones can be used instead. 
With the Lembert suture, it makes the most reliable intes¬ 
tinal suture (Fig. 5), which has been improperly called the 
Czerny suture by some authors. 
4. Chapufs Suture .—This method of suturing is seldom 
used, but is one of the most reliable in suturing intestinal ap¬ 
proximations and end-to-end anastomosis. The procedure is 
long and tedious ; the stitches are numerous, and if the tech¬ 
nique is correct, the result is reliable. The method consists of 
three rows of stitches, viz.: (a) Muco-mucous ; (b) Musculo- 
muscular, and (F) Sero-serous sutures. 
(#) The muco-mucous sutures are the stitches that are ap¬ 
plied to bind the mucous coats of the ends to be approximated. 
(£) The musculo-muscular sutures are those that are used 
to bind the muscular coat of each end together. 
(c) The sero-serous suture is the suture that is applied to 
bring the serous coats in apposition. 
The ligature used in making the muco-mucous suture may 
be of silk, but that used in making the other two sutures should 
be of catgut. The technique in approximations is as follows : 
divide the mucous from the muscular coat for a distance of one 
centimetre from the edge of the wound, and with a needle 
armed with silk or catgut, make the required number of 
stitches necessary to keep the mucous coat of each end in ap¬ 
position, having as many stitches ligated in the lumen as pos¬ 
sible. The next step is to apply the musculo-muscular suture, 
which should be made of catgut, and carefully ligated. The 
third series of stitches should be made carefully, bringing the 
serous coats together ; which, if properly done, will unite, leav¬ 
ing but a small cicatrix. 
5. Czerny-Lembert Suture (Fig. 4? 5 > 6.)—This method 
of making intestinal sutures consists of two rows of interrupted 
stitches, one surrounding the other ; the inner row is made up 
