Suture (medicine)

“ The accompanying illustrations well indicate this arrangement of sutures and teeth (Figs. 26 and 27) ; the importance of these facts will be emphasized later. All traces of the facial aspect of these sutures disappear quite early in life.
Figs. 26 and 27.—Diagrams to represent the normal human upper jaw of a child, with four and six incisors respectively, and also indicating the five intermaxillary sutures. (After Albrecht.)
EG, MG, XG. Endo-, meso-, and exo-gnathion. e. Inter-endognathic suture. f. Endo-mesognathic suture. g. Exo-mesognathic suture. i1. Central incisor. i2. Lateral incisor. ”

“ Doubtless the unskilful treatment, employed by the ancients, in cases of this kind, the use of the bloody suture without proper means to retain the parts in a suitable situation, the abuse of irritating remedies applied externally, the imprudent administration of oily substances, and, still more, the motions of the patient, contributed not a little to the production of those accidents, which no longer occur in the practice of the moderns, since the nature and treatment of the disease is better understood. ”

“ Sutures, like ligatures, were a common cause of suppuration in or around the edges of the wound. Therefore, in the hope of avoiding this trouble, they were made of silver wire, which was inconvenient to handle, and gave pain at the time of removal of the sutures. At the present time they are of silkworm-gut, catgut, silk or horsehair; they are made aseptic by boiling, and can be left any number of days without causing suppuration and can then be removed without pain. Next may come the consideration of surgical dressings. ”

“ In thinking over this striking difference between the effects of the two kinds of suture, it seemed to me clear that it depended on the silk imbibing blood and serum, which, undergoing decomposition in its interstices, grew more irritating the longer the process continued; whereas the metal gave no hold to the organic liquids, which were shed unaltered as fast as they were effused. From these and other analogous considerations, I taught my class at that time that decomposition of the organic liquids was the essential cause of suppuration. ”

“ In operations such as advancement, where sutures are used, it is desirable that the face should be covered with sterile muslin, with a hole cut in it for the eye, so as to prevent the sutures being contaminated from the skin of the face. The eyelids are again washed in 1–2,000 perchloride of mercury lotion, and the conjunctival sac is washed out with a strong stream of boric lotion or normal saline by means of a sterilized irrigator or an undine (Fig. 77) which has been kept in a bowl of lotion. ”

“ At first he settled down to practice in Montgomery, Alabama, devoting himself mainly to the diseases of women. He had for some two years used the clamp suture of Marion Sims in vesico-vaginal fistula, but became convinced that this and the usual methods were at fault. He pondered deeply on the subject for some seven weeks and discovered one day while buttoning his vest that something similar to a button might be combined with the old interrupted suture with its independent action, and the "button suture" was the outcome. After this Bozeman had 100 per cent, of cures instead of twenty-five. ”

“ Although the employment of buried sutures has made abdominal incisions more secure in the process of healing, and renders them firmer after union, and thus reduces the chances of a yielding scar, and saves the patient the inconvenience of an abdominal hernia or the annoyance of wearing an abdominal belt, it renders the patient liable to another discomfort, namely, stitch-abscess. This complication arises from a variety of causes—for example, imperfect sterilization of the suture material, or of the patient’s skin preceding the operation. ”

“ A long straight needle with a spear-point is convenient for introducing the mass-suture. A gauze sponge should be placed beneath the incision as the sutures are introduced, to prevent injury of the intestines and the escape of blood into the peritoneum. When the pad is removed, the omentum, if readily found, should be drawn down behind the incision. Before each suture is secured the sides of the incision should be drawn forward by traction on the ends of the suture, to ensure accurate apposition upon the posterior or peritoneal aspect. ”

“ Sutures.—Twisted silk sutures are to be preferred, as they do not invite sepsis, as softening catgut does, and retain the parts during the entire time required for healing, while the latter is liable to become separated by uneven absorption, allowing the wound to gape at that point and causing more or less of a cicatrix, so intolerant to patients of this class.
Dressings.—Bulky bandages are not required; they heat the parts, and look unsightly. The author employs antiseptic adhesive silk plaster for covering all external wounds, except where the hair prevents its use. ”

“ A suture appearing in a wound, when the bone is laid bare, on whatever part of the head the wound may have been inflicted, is the weakest point of the head to resist a blow or a weapon, when the weapon happens to be impinged into the suture itself; but more especially when this occurs in the bregma at the weakest part of the head, and the sutures happen to be situated near the wound, and the weapon has hit the sutures themselves. ”

“ I shall begin, then, with Aristotle, the contemporary of our author, who, in his work “On the History of Animals,” gives the following very inaccurate description of the sutures of the human skull: “The female cranium has one circular suture, but men generally three, which unite in one point. But a male skull has been seen not having a suture.” [747] Celsus describes the sutures in the following terms: “Ex ceteris, quo suturæ pauciores sunt, eo capitis valetudo commodior est. ”

“ SUTURE. (Sutura, lat.) A seam, stitch, joining together. Applied particularly to the line which marks the joining of the whorls of the spire. The suture is distinguished as simple, as in most cases; or double, when accompanied by a parallel groove close to it; marginated, when produced into a ledge by the matter which fills up and covers it; obsolete, when it is filled up so as not to be visible, as in the case of Ancillaria.
SYLVICOLA. Humph. Cyclostoma, Lam. ”

“ For generations sulphur ointment has been a standard remedy, and nothing else is needed, although many other remedies and combinations have been recommended. A warm bath should first be taken to soften the skin, and soap used vigorously to remove the dead epidermis covering the cuniculi. ”

“ For the symptoms of the attendant catarrh of the sac see below. In infected cases with obstruction of the lachrymo-nasal duct, it has been known to extend to the bone and even to open into the sinuses, or tooth follicles. (Gerard, Leblanc) .
The condition is found in horses, cattle and dogs.
Treatment. In fistula resulting from simple traumatism, nothing more may be requisite than rest and soothing astringent applications. Sutures are sometimes resorted to but are liable to cause itching and do more harm than good. ”

“ After this is securely done, remove the testicle and sew the inner
membranes that envelop the rupture and testicle with what is called a
"tobacco pouch suture." Draw it together firmly and tie and cut off
suture about one-half inch from the knot. Your operation is now
complete. Do not sew the outer incision in the scrotum, as it would have
a tendency to accumulate dirt and hold pus. It should have a free
drainage. Wash with one of the above mentioned antiseptics twice daily
until thoroughly healed. Also feed laxative foods that are easily
digested.
SORE FEET
CAUSE: Filth ”

“ The poison of the germs has killed all the leucocytes and also all the cutis immediately around them, and now digestive fluids from the dead leucocytes is turning the whole dead mass into liquid pus. The boil has "come to a head." There is a little lump on the skin and through its thin covering of cuticle can be seen the yellow pus. (From Emerson's "Essentials of Medicine.")
Inflammation may be treated by means of hot applications, cold applications, or counter-irritants. The effect of heat is to dilate the vessels and hence to increase the flow of blood to the injured part. ”

“ It takes some time for the sulphur to do its work, therefore persevere in its use till the humors, or pimples, or blotches, disappear. Avoid getting wet while taking the sulphur.
2. Try This Recipe: Wash the face twice a day in warm water, and rub dry with a coarse towel. Then with a soft towel rub in a lotion made of two ounces of white brandy, one ounce of cologne, and one-half ounce of liquor potasse. Persons subject to skin eruptions should avoid very salty or fat food. A dose of Epsom salts occasionally might prove beneficial. ”

“ Hence there is a good deal of truth in the belief that a freely acting skin is always a safeguard against disease.
The second variety of tubes, those which furnish an oily-like fluid to the skin, resemble in-great part those which serve for the office of perspiration. At the extremity away from the surface of the body, each one has a gland, the oil gland, which secretes the oily material. The pores or outlets which open on the skin, however, are a good deal larger than the similar orifices of the perspiratory tubes, but they are not distributed so equally throughout the body. ”

“ The seeds of Water-cresses, heat, yet trouble the stomach and belly; ease the pains of the spleen, are very dangerous for pregnant women, yet they provoke lust: outwardly applied, they help leprosies, scald heads, and the falling off of hair, as also carbuncles, and cold ulcers in the joints.
Mustard seed, heats, extenuates, and draws moisture from the brain: the head being shaved and anointed with Mustard, is a good remedy for the lethargy, it helps filthy ulcers, and hard swellings in the mouth, it helps old aches coming of cold. ”

“ The softening of the swelling is not a mere change of solid substance into a fluid, as if by decay, but it is the result of an active process, which we call suppuration. When this process is properly performed, good pus is made, or as the old writers in medicine rather quaintly expressed it, laudable pus. ”

“ Another instructive experiment is to dress a granulating sore with some of the putty above described, overlapping the sound skin extensively, when we find in the course of twenty-four hours that pus has been produced by the sore, although the application has been perfectly antiseptic; and, indeed, the larger the amount of carbolic acid in the paste the greater is the quantity of pus formed, provided we avoid such a proportion as would act as a caustic. The carbolic acid, though it prevents decomposition, induces suppuration obviously by acting as a chemical stimulus ”

“ An antiseptic powder is dusted over the parts operated on, and small gauze dressings are applied with the aid of strips of silk isinglass plaster. A small tampon of cotton, well dusted over with an antiseptic powder, is placed into each nostril.
The dressings are changed the second day, when the resultant swelling will have practically subsided. The sutures in the columna are removed the fourth day preferably, and those of the wings about the sixth day. Complete cicatrization follows in about ten days, when the patient can be discharged. ”

“ If the suture is made too tight the subsequent swelling may cause the stitch to tear out. In order to make a firm suture the depth of the stitch should be the same as the distance the stitch is from the edge of the wound. The deeper the suture the more tissue is embraced and the fewer the number of stitches required. In tying a suture the square or reef knot should be used. Closure of wounds by means of adhesive plaster, collodion, and metal clamps is not practiced to any great extent in veterinary practice. ”

“ Injuries of the Soft Parts of the Face.—Owing to its free blood supply, the skin of the face has great vitality, and even when severely lacerated it not only survives, but shows such resistance to bacterial infection that primary union frequently takes place. In plastic operations, also, even extensive flaps seldom become infected, and they heal so rapidly that the sutures can be removed in two or three days. ”

“ The author has sought to obviate the first of these difficulties by the use of deep silver sutures instead of the superficial ones described by Emmet. They should be introduced before tightening the vaginal sutures, and should be passed far around in the posterior vaginal wall, their points of entrance and exit being the same as for the three lower unsecured superficial external sutures in Fig. 14. The second difficulty may be overcome by further denuding a triangular surface in the vaginal sulcus on each side, the base of the triangle corresponding [p. 165] to the line a b, Fig. ”

“ More or less pus may appear after the lapse of the first week, and the larger the wound, the more likely this is to happen. And here I would desire earnestly to enforce the necessity of persevering with the antiseptic application in spite of the appearance of suppuration, so long as other symptoms are favorable. The surgeon is extremely apt to suppose that any suppuration is an indication that the antiseptic treatment has failed, and that poulticing or water dressing should be resorted to. But such a course would in many cases sacrifice a limb or a life. ”

“ A mustard sitz bath will often hasten and alleviate the initial stage of menstruation, and is sometimes used to expedite the appearance of the eruption in measles and scarlatina. The domestic remedy of hot water and mustard for children's feet in cases of cold or threatened cold may be of some use in drawing the blood to the surface and thus tending to prevent an excessive vascular dilatation in the nose or bronchi. The proportion of an ounce of mustard to a gallon of water is a fair one and easily remembered. ”