File:Abdominal surgery (1889) (14779389081).jpg

Identifier: abdominalsurgery1889smit (find matches)
Title: Abdominal surgery
Year: 1889 (1880s)
Authors: Smith, James Greig, 1834-1897
Subjects: Abdomen Abdomen
Publisher: London : Churchill Bristol : Arrowsmith
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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e been inserted on the opposite sides of the divided gut, inthe exact line in which the Lembert sutures are to be placed;the two on each side are gathered together in the blades of catch-forceps, and gentle and steady traction made on them by anassistant. This raises a well-defined fold along the edge of thebowel; into this fold the sutures are inserted. The insertion ofthese quilt-stitches makes certain that equal distances of thebowel are arranged for suturing, and also by raising a fold makesthe insertion of stitches more easy, and ensures their beingplaced in a straight line. The whole operation is carried outwhile the parts are resting on a warm sponge-cloth lying on theabdominal wall, and while several- sponges packed into thecavity keep back the bowels. The assistant, with one hand, ENTERORRAPHY. 485 holds one pair of forceps, and steadies the clamps by theirextremities; with the other he holds the other pair of forceps.About a dozen ordinary milliners needles are threaded with
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Fig. 67. Drawing to show niethod of Intestinal Suture.(For description see Text.) 486 RESECTION OF INTESTINE. the fine silk selected for the purpose. Each needle carriessufficient silk to make three sutures—say, eighteen inches inlength altogether. Three stitches may be placed as a continuousuture with one thread eighteen inches long; the loops aredivided, and another threaded needle is taken up. If the needleis not too sharp, the insertion of the sutures may be carried outwith great practical facility and almost physiological precision.Halsteds statements as to the resisting nature of the strongfibrous coat are verified at every stitch : it is scarcely possibleto ignore them. The needle passes readily through the serousand muscular coats, then it is checked; a rapid change from thevertical to the horizontal position picks up a few threads of thetough fibrous coat, and the needle emerges, to be inserted in thesame way on the other side. Thus the sutures are placed along one side of

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