490 
DEPARTMENT OF SURGERY. 
aside instead. The needle should be inserted in such a manner 
so as to give it the best possible hold on the tissue. The intes¬ 
tinal sutures used generally have already been described (Rev., 
XXIV., No. 3), and it will be unnecessary to recapitulate. 
Suture Material .—The material employed in suturing must 
be carefully sterilized, and should be selected according to the 
function it is supposed to perform. Catgut, silk, linen and Chi¬ 
nese silk supply the best suture material required in enterorra- 
phy. Catgut should be used when the stitches are to be absorbed 
and can be relieved by a secondary series. All other suture 
material may be used when the stitches are to be sloughed off 
and passed out with the contents of the intestine. 
Sutures .—The suture employed in enterorraphy may be 
either continuous or interrupted. The continuous suture can 
be used in making stitches that are cast off into the intestine, 
and in this connection are favored by operators. The chief ad¬ 
vantage in its use is the rapidity with which it can be applied. 
The chief objection to continuous sutures is that they only 
remain firm as long as all the stitches remain secure, but they 
can be employed to good advantage with a secondary row of 
stitches. The interrupted sutures have already been mentioned 
and described. 
After-treatment .—Shock is the first condition that requires 
attention. Stimulants should be given per rectum, and con¬ 
tinued if the operation involved the part of the intestinal tract 
anterior to the floating colon, but if the part involved is located 
in the floating colon stimulants may be administered per os; 
however, rectal feeding is always preferable, because the pres¬ 
ence of stimulants or food may stimulate the action of the intes¬ 
tine and interfere with the wound. The first food should be 
such as can be absorbed by the stomach and should be given in 
very small quantities. Strychnia may be given hypodermi¬ 
cally to prevent paralysis of the intestine. Morphia may be 
used in the first stage, but after the third day mild salines should 
be given in small doses, and the remainder of the treatment is 
the same as in other intestinal operations. 
7. Gastrectomy .—There is but little known of the total ex¬ 
tirpation of the stomach ; even in human surgery the operation 
has not been performed often enough to observe all the detail 
of the after-treatment. The management of such cases must 
yet be carefully studied before the operation is a success, and it 
should be performed when the opportunity presents itself if it 
be for no other purpose than to lay out a course of after-care. 
