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Updated: May 25, 2025
In a cloth on a bench opposite were rolled up a portion of the malar bone, some fragments of the os frontis, one entire right parietal bone, detached from its fellow along the sagittel suture, and from the occipital along the lambdoidal suture, perhaps taking with it some of the occipital bone together with some of the squamous portion of the temporal bone.
When the ladies overtook them in the morning, Alister was reading, from an old manuscript volume of his brother's which he had found in a chest, a certain very early attempt at humour, and now they disputed concerning it as they watched the fire. It had abundance of faults, and in especial lacked suture, but will serve to show something of lan's youthful ingenium.
On observing the living Podura, the mouth seems a simple ring, with a minute labrum and groups of hairs and spinules, which the observer, partly by guess-work, can identify as jaws and maxillæ, and labium. But in studying the parts rendered transparent, we can identify the different appendages. The labrum, or upper lip, is separated by a deep suture from the clypeus, and is trapezoidal in form.
For proper union care must be exercised to bring the wound edges accurately together and not allow hair, or oil, or dressings to come between them. In large wounds he considers stitching indispensable, and recommends for this a fine, square needle. The preferable suture material in his experience was silk or linen.
He only knew that he could not get on without her; that never a suture that she had prepared made trouble for him after an operation: and that none other of the hundred nice details upon which the astounding results of modern surgery depend was likely to go wrong if it were she who was responsible. At five o'clock that afternoon the Green Inn came back.
The second case was that of a man in whom almost the entire stomach was removed, and the pyloric and cardiac ends were stitched together in the wound of the parietes. The third case was that of a man of sixty-two with carcinoma of the pylorus. After pylorectomy, the line of suture was confined with iodoform-gauze packing.
When it is impossible thus to approximate the ends satisfactorily, the muscle or tendon is exposed by incision, and the ends brought into accurate contact by catgut sutures. This operation of primary suture yields the most satisfactory results, and is most successful when it is done within five or six days of the accident.
If there is nothing to apprehend from hemorrhage, it is only necessary to draw the lids together, and unite that portion which has been separated by a suture, and place a hood over the whole. We do not recommend the stuffing of the orbit with lint, except in case of hemorrhage, as its presence will sometimes produce violent inflammation, which may extend to the brain.
The circulation being controlled by a tourniquet, or the artery itself occluded by a clamp, fine silk or catgut stitches are passed through the outer and middle coats after the method of Lembert, a fine, round needle being employed. The sheath of the vessel or an adjacent fascia should be stitched over the line of suture in the vessel wall.
He recognized that wounds of the intestines were surely fatal unless leakage could be prevented. Accordingly he suggested the opening of the abdomen and the sewing up of such intestinal wounds as could be located. He describes a method of suture for these cases and seems, like many another abdominal surgeon, even to have invented a special needleholder.
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