DEPARTMENT OF SURGERY. 
285 
(a) Granny knot .—The knot known as the granny knot is a 
tie consisting of two loops, one upon the other (Fig. 9 a). The 
loops do not lie in the same line and it often becomes a slip¬ 
knot ; for this reason it should not be used in ligating sutures 
unless a third loop is applied. 
(b) Sailor's knot .—The sailor’s knot consists of two loops 
lying one upon the other in the same line (Fig. 9 b). The ends 
come out side by side through a vertical loop at each end of the 
knot, and when drawn up form a square knot. It is some¬ 
times known as the “ square or reef knot,” and is very reliable 
in ligating silk, linen or cotton stitches, but not considered so 
for catgut sutures, and should not be used to ligate catgut stitches 
that are located where they cannot be watched carefully. 
\c) Friction knot .—There are a number of ways of making 
friction knots, but the one most generally used consists of a 
simple loop to which is added a surgeon’s knot (Fig. 9 c\ which 
makes a very good knot to use in ligating catgut stitches. An¬ 
other method of making a friction knot is by placing one sur¬ 
geon’s knot upon another. The chief objection to this is the 
size of the knot, which in many instances is supposed to be 
absorbed. When catgut sutures can be relieved by another 
suture, the sailor’s knot is preferred, but when this cannot be 
done, the first mentioned knot (Fig. 9 c) should be used in 
ligating the stitches. 
(a) Surgeon's knot .—The surgeon’s knot is formed by pass¬ 
ing the thread twice through the same loop (Fig. 9 d). This 
knot is used in ligating arteries, and to prevent stitches from 
slackening while they are being tied. In tying catgut stitches 
it can be applied to a single loop in order to prevent them from 
slackening after they have been tied. 
( e) Combined surgeon and sailor's knot. —This knot consists 
of two loops; the first is a surgical knot and the second a sailor’s 
knot. It is a knot that is often used instead of the sailor’s knot, 
when the tension of the stitches is likely to slacken before the 
second loop can be applied, but when this danger is not obvi¬ 
ous, the sailor’s knot is preferable. 
Summary. 1. Th t granny knot should not be used in tying 
stitches employed in making abdominal or intestinal sutures. 
2. The sailor's knot should be used in ligating silk, cotton 
and linen stitches; and catgut, when one suture is relieved by 
another. 
3. The friction knot (Fig. 9 c) is the only reliable knot 
for catgut stitches, and should always be used when the 
