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. If this precaution is not taken, in a thick or rigid abdominal wall the cutaneous aspect of the incision may be brought into accurate apposition, while a gap will exist between the more posterior structures. Such imperfect apposition is a frequent cause of ventral hernia. The mass-sutures should not be removed for two weeks. The early removal of sterile sutures is of no advantage whatever, and may cause ventral hernia. The writer often leaves them in for three weeks. After the sutures are removed the incision should be strapped with adhesive plaster. The application of a buried suture of catgut or of silver wire, passed through the muscle and fascia, is a useful addition to the mass-suture and an additional preventive of hernia. Various methods of uniting the tissues by sutures in separate layers are used. A very good method is to close the peritoneum by a continuous suture of fine silk, then to unite the muscle and fascia by a continuous suture of catgut, and finally to close the cutaneous edge with an interrupted or a continuous suture of silkworm gut or silk. The subcuticular or the intra-cutaneous suture (Fig. 206) is very convenient for this purpose. If the abdominal wall be fat, it is advisable to introduce a second catgut suture through the subcutaneous fat. When the structures are united in layers, a hematoma sometimes forms between two planes of suture, and, if not absorbed, the anterior portion of the wound may break down. This accident, which is caused by hemorrhage after the sutures are secured, may be prevented by employing, in addition to the usual dressing, a compress of gauze placed over the incision. CHAPTER XLI. TREATMENT AFTER CELIOTOMY. The after-treatment of celiotomy is usually very simple. A special nurse is required for the first three days. The patient should lie upon her back for the first two or three days; after this she may be moved partly upon either side, and a pillow may be placed behind her for support. The head may be supported by one or two pillows. Much comfort is experienced by raising the knees over pillows. The patient often complains bitterly of backache, which may be relieved by slipping a folded sheet or towel under the small of the back.