DEPARTMENT OF SURGERY. 
437 
anaesthetized and placed in the most favorable position to open 
the abdomen at the place selected. If the indication for the 
operation is an abdominal wound with visceral injury, or a pro¬ 
lapse of the intestine complicated with a perforation or lacera¬ 
tion of the part protruding, the incision made to open the ab¬ 
domen must pass along the longitudinal axis of the accidental 
wound, but it must be remembered, however, that the hair 
must be clipped and shaved before the incision is made ; a sur¬ 
gical wound with a hispid edge always makes a suspicious 
wound; but, if the operation comes under the second classifica¬ 
tion of Indications for Abdominal Surgery (Vol. XXIV., No. 
3, Surg. Dep’t), the place for the incision is left to the discre¬ 
tion of the operator ; and may be made as described under 
“Celiotomy” (Vol. XXIV., No. 5). In all cases the abdominal 
cavity should be explored sufficiently to ascertain the extent of 
the injury, but unnecessary manipulation of the viscera should 
be avoided. The contents of the intestine should be removed 
either through the wound or an opening made in the part to be 
resected. When this is done the diseased or injured portion 
should be resected, being as careful as possible to avoid un¬ 
necessary haemorrhage and arresting unavoidable haemorrhage. 
It is absolutely necessary to arrest all haemorrhage in all intes¬ 
tinal operations. In resecting all the diseased portion and sur¬ 
rounding tissue that may become pathological must be re¬ 
moved, or if the demand for resection is an accidental wound all 
the lacerated tissue that is likely to become gangrenous must 
be included in the resection, but no part should be included in 
it unnecessarily; it is proper to be conservative and save as 
much of the injured portion as possible, and good judgment 
should be exercised in differentiating tissues. After the re¬ 
section is made, the ends are approximated and sutured by 
the most appropriate method. If the procedure is to be 
shortened, the Murphy Button may be used, and if it can¬ 
not be obtained, Jobert’s method of approximation may be 
used, as it is the most simple method, but not the most reliable 
(Vol. XXIV., No. 3). If a good reliable result is desired from 
a clean aseptic intestinal approximation, the sutures should be 
made by the Czerny-Feinbert method (Vol. XXIV., No. 4, Fig. 
6). This method will prolong the operation, but its reliabil¬ 
ity will compensate for the ordeal. An approximation sutured 
by the Czerny method (Fig. 7) is not so substantial as the 
Czerny-Lembert suture. The Fetnbert suture can also be uti¬ 
lized for this purpose (Fig. 8) and is a very good safeguard 
