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 AT L A S o f
SUTURING
TECHNIQUES
 N OTICE
Medicine is an ever-changing science. As new research and clinical experience
broaden our know ledge, changes in treatment and drug therapy are required.
The author and the publisher o this w ork have checked w ith sources believed
to be reliable in their e orts to provide in ormation that is complete and gener-
ally in accord w ith the standards accepted at the time o publication. How ever,
in view o the possibility o human error or changes in medical sciences, nei-
ther the author nor the publisher nor any other party w ho has been involved
in the preparation or publication o this w ork w arrants that the in ormation
contained herein is in every respect accurate or complete, and they disclaim
all responsibility or any errors or omissions or or the results obtained rom
use o the in ormation contained in this w ork. Readers are encouraged to con-
rm the in ormation contained herein w ith other sources. For example and in
particular, readers are advised to check the product in ormation sheet included
in the package o each drug they plan to administer to be certain that the
in ormation contained in this w ork is accurate and that changes have not been
made in the recommended dose or in the contraindications or administration.
This recommendation is o particular importance in connection w ith new or
in requently used drugs.
 AT LAS o f
SUTURING
TECHNIQUES
Approaches to Surgical Wound,
Laceration, and Cosmetic Repair

J onathan Kantor, MD, MSCE, MA

Adjunct Assistant Professor of Dermatology
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania

Medical Director
Florida Center for Dermatology, PA
St. Augustine, Florida

New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
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 To my parents, or pushing and believing rom the very beginning.

To my kids, or giving me the time, patience, inspiration, and love that w as needed
to see this project—and myriad others—through to completion.

And to Bella, my passionate partner in love and li e, or making it all possible.

This page intentionally left blank
 CONTENTS

Foreword xi
Preface xiii
Acknowledgments xv

CHAP TER 1 INTRODUCTION 1

CHAP TER 2 THE SURGICAL TRAY 5

SUTURE MATERIALS, KNOT TYING, AND

CHAP TER 3
POSTOPERATIVE CARE 11

SUTURE TECHNIQUES FOR DEEPER STRUCTURES:

CHAP TER 4
THE FASCIA AND DERMIS 23
C

4.1. The Simple Buried Dermal Suture 24

4.2. The Set-Back Dermal Suture 27
4.3. The Buried Vertical Mattress Suture 31
4.4. The Buried Horizontal Mattress Suture 35
4.5. The Butterf y Suture 38
4.6. The Running Subcuticular Suture 42
4.7. The Backing Out Running Subcuticular Suture 48
4.8. The Percutaneous Vertical Mattress Suture 52
4.9. The Percutaneous Set-Back Dermal Suture 56
4.10. The Percutaneous Horizontal Mattress Suture 61
4.11. The Running Buried Dermal Suture 65
4.12. The Running Set-Back Dermal Suture 68
4.13. The Running Buried Vertical Mattress Suture 72
4.14. The Running Percutaneous Set-Back Dermal Suture 76
4.15. The Running Percutaneous Buried Vertical Mattress Suture 81
4.16. The Pulley Buried Dermal Suture 85
4.17. The Pulley Set-Back Dermal Suture 89
4.18. The Pulley Buried Vertical Mattress Suture 94
4.19. The Hal Pulley Buried Vertical Mattress Suture 99
4.20. The Double Butterf y Suture 103
4.21. The Hal Pulley Buried Dermal Suture 108

vii
viii CONTENTS
4.22. The Suspension Suture 111
4.23. The Percutaneous Suspension Suture 115
4.24. The Tie-Over Suture 118
4.25. The Buried Vertical Mattress Suspension Suture 121
4.26. The Fascial Plication Suture 124
4.27. The Corset Plication Suture 127
4.28. The Imbrication Suture 131
4.29. The Guitar String Suture 134
4.30. The Dog-Ear Tacking Suture 137
4.31. The Buried Purse-String Suture 140
4.32. The Percutaneous Purse-String Suture 144
4.33. The Figure 8 Double Purse-String Suture 148
4.34. The Stacked Double Purse-String Suture 152
4.35. The Bootlace Suture 156
4.36. The Buried Tip Stitch 160
4.37. The Backtracking Running Butterf y Suture 163
4.38. The Stacked Backing Out Subcuticular Suture 167
4.39. The Running Locked Intradermal Suture 171

CHAP TER 5 SUTURE TECHNIQUES FOR SUPERFICIAL

STRUCTURES: TRANSEPIDERMALAPPROACHES 175
A

5.1. The Simple Interrupted Suture 176

5.2. The Depth-Correcting Simple Interrupted Suture 179
5.3. The Simple Running Suture 182
5.4. The Running Locking Suture 187
5.5. The Horizontal Mattress Suture 192
5.6. The Locking Horizontal Mattress Suture 196
5.7. The Inverting Horizontal Mattress Suture 200
5.8. The Running Horizontal Mattress Suture 203
5.9. The Running Horizontal Mattress Suture with Intermittent Simple Loops 207
5.10. The Running Alternating Simple and Horizontal Mattress Suture 212
5.11. The Running Locking Horizontal Mattress Suture 216
5.12. The Cruciate Mattress Suture 220
5.13. The Running Oblique Mattress Suture 223
5.14. The Double Locking Horizontal Mattress Suture 226
5.15. The Running Diagonal Mattress Suture 231
5.16. The Vertical Mattress Suture 235
5.17. The Shorthand Vertical Mattress Suture 239
5.18. The Locking Vertical Mattress Suture 242
5.19. The Running Vertical Mattress Suture 246
5.20. The Running Alternating Simple and Vertical Mattress Suture 250
5.21. The Hybrid Mattress Suture 255
5.22. The Tip Stitch 258
5.23. The Vertical Mattress Tip Stitch 261
5.24. The Hybrid Mattress Tip Stitch 265
5.25. The Pulley Suture 269
5.26. The Purse-String Suture 272
5.27. The Winch Stitch 276
5.28. The Dynamic Winch Stitch 279
 CONTENTS ix
5.29. The Lembert Suture 283
5.30. The Combined Horizontal Mattress and Simple Interrupted Suture 286
5.31. The Lattice Stitch 290
5.32. The Adhesive Strip Bolster Technique 293
5.33. The Frost Suture 297
5.34. The Running Pleated Suture 299
5.35. The Running Bolster Suture 303
5.36. The Combined Vertical Mattress-Dermal Suture 306
5.37. The Cross Stitch 310

Horizonta l S imple Running

ma ttre s s inte rrupte d s ubcuticula r
s uture s uture s uture

CHAP TER 6 SUTURING TIPS AND APPROACHES BY

ANATOMICAL LOCATION 315
Burie d S e t-ba ck Pulle y s e t-ba ck
ve rtica l de rma l de rma l s uture
ma ttre s s s uture
s uture

6.1. The Chest, Back, and Shoulders 316

6.2. The Arms 320
6.3. The Legs 323
6.4. The Hands and Feet 326
6.5. The Scalp 328
5.6. The Forehead 330
6.7. The Eyelids 332
6.8. The Lips 334
6.9. The Nose 336
6.10. The Ears 339

Index 341

Videos are available by accessing QR codes that can be ound throughout the book.
Videos are also accessible via www.Atlaso SuturingTechniques.com.
This page intentionally left blank
 CONTENTS
FOREWORD

Th e m inute you get aw ay rom backseat to the glitz and appeal o f ap

undam entals—w hether its proper and gra t dynamics and aesthetic proce-
tech nique, w ork eth ic or m ental dures. O nly single chapters in textbooks
preparation—the bottom can all out and rare journal articles are available to
o your game, your schoolw ork, your detail the broad suturing armamentarium
job, w hatever you’re doing. available to the surgeon. Fortunately, w ith
this atlas, Dr. Kantor has superbly lled a
Get the undamentals dow n and the void that has not yet been addressed—the
level o everything you do w ill rise. keystone o cutaneous surgery—suture
—Michael Jordan technique.
Dr. Kantor’s passion or this topic is
O nly th e very lucky discover th e readily apparent. Techniques that are
keystone. amiliar to most and some w ith w hich
—Wallace Stegner, Angle of Repose m any are unacquainted are equally
explored in com prehensive detail. All
Cutaneous reconstructive and aesthetic methods include discussion o application,
surgery has experienced a meteoric evolu- suture m aterial choice, and procedure
tion. Intricate f ap and gra t procedures m ech anics. Unique to th is atlas are
have been developed to restore surgically Dr. Kantor’s tips and pearls or each tech-
a ected patients to a norm al, unoper- nique as w ell as the caveats o draw backs
ated appearance. These techniques have and cautions. Each method is diagram-
enjoyed w ide exposure in manuscripts, matically illustrated and supplemented
textbooks, and pro essional m eetings. by online videos.
And yet, as innovative as these proce- It is not an exaggeration to say that
dures may be, their ability to re-create th is atlas is unique and innovative.
norm alcy w ill ail dram atically unless There is no other re erence that explores
meticulous attention is paid to the key- this topic w ith such detail, clarity, and
stone o surgical undamentals—suture comprehension. For those o us attempt-
technique. Unless the scars are intrinsic to ing to provide our patients w ith the very
tissue movement and trans er approach, best that reconstructive and aesthetic
the ideal o invisibility, a reconstructive surgery can o er, this atlas is invalu-
procedure w ill not be ully restorative, able. We ow e Dr. Kantor a huge debt
only partially corrective. Whatever mar- o gratitude or sh aring h is expertise
vels o repair have been achieved, all the and passion.
patient and the outside observer w ill see
and appreciate is the visibility or lack Leonard Dzubow, M D
thereo in the resultant scar. Without Former Professor and Director of M ohs
meticulous attention to this undamen- and Dermatologic Surgery
tal, the optim al end point w ill not be University of Pennsylvania
achieved. Sadly, attention to the details Philadelphia, Pennsylvania
o suture technique has to date taken a Private Practice, M edia, Pennsylvania

xi
This page intentionally left blank
 CONTENTS
PREFACE

The undamental building blocks o sur- w ith tips on closures based on anatomic
gical repairs o the skin and so t tissues location, providing a regional approach
are basic suture placem ent techniques to repair choices.
that becom e second nature to experi- This text is unique in that it includes
enced surgeons and yet remain mysteries approximately 200 pro essional draw ings
to novices. O ten, it is attention to the as w ell as almost 450 clinical photographs,
subtleties o suture choice and placement breaking dow n each technique to its un-
that explain w hy particular clinicians have damentals. Rather than simply show ing
di erent and more ideal outcomes than photographs o w ounds a ter they have
their peers. been closed w ith the various techniques,
Despite a burgeoning literature support- this atlas includes photographs taken
ing the importance o suture technique rom the surgeon’s perspective at every
choice and its potential impact on long- critical stage during the course o each
term cosmesis, a thorough, comprehen- technique. Videos o each tech nique, as
sive discussion o the available array o w ell as som e undam ental approach es
suturing techniques has not been included to instrument handling, are also embed-
in the canon o general and reconstructive ded in the text; Q R codes are included
surgery. Most texts ocus instead either or each chapter, permitting the reader
on general operative principles or the to im m ediately re erence alm ost 100
speci c use o f aps in particular recon- narrated videos, m ost per orm ed on a
structive areas. Un ortunately, even the proprietary skin substitute designed to
best-designed f ap can be undone by less- e ectively demonstrate technique rom
than-optimal suturing techniques. the perspective o the clinician.
This book w as designed to ll this Each technique chapter is divided into
void, providing an organized, clear, and our sections: Application, w here the back-
comprehensive representation o many ground o the technique, and its ideal area
o the suturing techniques available to o applicability, is discussed; Technique,
those engaged in skin and so t tissue w hich breaks dow n the technique in
reconstruction. The text is divided into a step-by-step ashion; Tips and Pearls,
our main parts: First, the introductory w here variations, subtleties, and ne-
section addresses undamental principles tuning approaches are discussed; and
o w ound closure, instrum ent choice, Drawbacks and Cautions, w here the poten-
suture material choice, and approaches tial pit alls o each technique are addressed
to the instrument tie used in skin and so t in detail. This unique com bination o
tissue repairs; second, techniques usu- step-by-step draw ings, photographs, and
ally per ormed w ith absorbable sutures videos—as w ell as the comprehensive
are discussed in detail, w ith a separate discussion in each chapter—permits the
chapter dedicated to each approach; reader to grasp the undamentals o each
third, techniques generally per orm ed approach and decide w hat approaches
w ith nonabsorbable sutures are addressed m ay be use ul additions to their ow n
in detail; and nally, a section is included personal surgical armamentarium.

xiii
xiv PREFACE
Com mon synonyms are included at legends, to quickly build a com ort level
the start o many o the chapters; there w ith a w ide array o approaches.
is broad regional variability in technique This text is aimed at those w ho per orm
nomenclature, and this text has aimed to the bulk o skin and so t tissue recon-
present each technique as a variation on a structive procedures, rom derm atolo-
ew basic themes. Conceptualizing each gists and plastic surgeons to emergency
approach in this w ay permits the budding medicine physicians, general surgeons,
surgeon to ocus on core technical skills and am ily practice physicians. While
and then build slow ly on these. For the this text may be very help ul to medical
advanced reader, this approach helps bet- students and postgraduate trainees, oth-
ter organize the literature and highlight ers, including physician assistants, nurse
some techniques that may have been over- practitioners, and the many other medical
looked. There ore, some liberty has been providers engaged in skin and so t tissue
taken in naming techniques so that the repairs, should hope ully bene t rom its
names in this atlas ideally convey some approach as w ell.
in ormation regarding the mechanics o Shi ting tension deeper, aw ay rom the
each approach. No slight is intended on epidermis and to the deep dermis and
the brilliant artists w ho have contributed ascia, is the undamental principle o all
to developing many o these approaches. skin and so t tissue surgery w hen closing
This text is meant to be used as an atlas; de ects under tension. Techniques that
as such, w hile it may be read cover to accomplish this goal are repeatedly high-
cover, the reader may then notice some lighted in the text, as such approaches
redundancy in the text o select chapters, have the potential to dramatically impact
as some o the advantages and disadvan- clinical outcomes or the better, as has
tages o closely related approaches may been amply show n by a spate o recent
be very similar. For many, this atlas may randomized controlled trials. Hope ully,
be best utilized by rst review ing the this atlas w ill inspire others to not only
introductory sections, i desired, and then reexamine their approach to suture place-
re erring to technique choices as needed; ment but contribute to the literature—and
the budding surgical maestro, how ever, innovate—as w ell.
may pre er a ront-to-back reading o the
text, or even a review o the gures and Jonathan Kantor, M D
 ACKNOWLEDGMENTS

Thanks to the entire team at McGraw -Hill under his w ing and gave me advice and
Education, rom Anne Sydor, w ho w as opportunities or w hich I w ill alw ays
there w hen this all started, to Peter Boyle, be grate ul, and is the model o w hat a
superstar editor Karen Edmonson, and mentor should be.
Armen O vsepyan, w ho saw the project I am deeply indebted to the great Bill
through to ruition. Also thanks to Craig James—master dermatologist, teacher,
Durant and Rob Fedirko at Dragonf y and mentor. His passion or dermatology,
Media or their patience and artistry w ith compassion or patients, and ethical rigor
the many gures. remain a model or me to this day.
Thanks to those w ho came early on Thanks to Matt Beshara, w ho took a
to model w hat a person o the w orld second-year medical student under his
should be, and w hose aith in me, w hether w ing and taught him the undamentals
deserved or not, permitted me to grow and o surgical instrument handling.
f ourish. The late Rabbi Eliezer Cohen, I w ill be eternally grate ul to Len
Rabbi Moshe Englander, Ed and Susan D z ubow —surgical m aestro, brilliant
Kodish, and many others had an immea- innovator, and a true m ensch and m en-
surable impact on my li e. tor. He is and w ill alw ays be m y m odel
A special thanks to my colleagues at the or th e ideal derm atologic surgeon,
University o Pennsylvania and around and this book w ould never have been
the w orld—especially those w ho helped w ritten w ere it not or his inspiration
me early on in my career. and support.
Without the brilliant David Margolis,
I w ould not be here today. He took me

xv
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PREFACE. Thk Chronicle of Flofe ** as s to English aistorjr,

with two ■ * period from the depart* n ? & the twenty-third year of
toe . 01 u* i. « '^96. it is founded on an earii • ' c "s Scotus, one of
the many ± 10 41 Island of Saints," beti un j < ,p « Marianus
entered the J 01 Cologne about the year K two y a raras v drew into
complete secli n at Fulda, and removed in iOoy, still as a recluse, to
Mencz, where he ended his days ; his death being variously assigned
to the years 1083 or 1086. This long seclusion afforded him leisure
for composing a Chronicle, extending from the creation of the world
to the close of his own life; but which is of comparatively little
interest to ourselves, as even the latter portion of it relates almost
entirely to the German empire or the Popedom, and contains only a
few short references to events connected with this island. Florence
has preserved these, in making the work of Marianus the basis of his
own Chronicle. The rest of his materials for the earlier period of
English history are chiefly supplied by Bede, the Saxon Chronicle, the
Lives of Saints, and Asser's Life of Alfred j1 of the latter of which he
gives 1 Florence copied Asser so literally that he has twice adopted
expressions employed by the former, which might lead us to suppose
that the chronicler had personally examined the positions on which
two of the battles he describes were fought. See pp. 63 and 70 of
the present volume.
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BOHN'S ANTIQUARIAN LIBRARY. FLORENCE OF

WORCESTER'S CHRONICLE.
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BOHN'S ANTIQUARIAN LIBRARY. FLORENCE OF

WORCESTER'S CHRONICLE.
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? • THE CHRONICLE OF .FLORENCE OF WORCESTER, -4 //

WITH THE TWO CONTINUATIONS; COMPRISING ANNALS OF
ENGLISH HISTORY, FROM THE DEPARTURE OF THE ROMANS TO
THE REIGN OF EDWARD I. TRANSLATED FROM THE LATIN, WITH
NOTES AND ILLUSTRATIONS, By THOMAS FOKESTEK, A.M.
LONDON : HENRY G. BOHN, YORK STREET, COVENT GARDEN.
MDCCCLIV.
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1055. \\<\ Ha.-.v; - ; •.;;• V- •.! .KARY T.{.:. 7i... ;: ..•, OF .

tfKo. li 1 1 if ;;/vvl;; U06S JUNt 28, 1938 HARVARD r UNIVERSITY
LIl^'A^Y MAV 10 1974 LONDON: PETTEB AND GALFTN, PRINT EBS,
PLAYHOUSE YARD, ADJOINING THE "TIMES" OFFICE. r *7 ft *■> x
 PREFACE. The Chronicle of Florence of Worcester, so far as
it relates to English history, with its two Continuations, embraces the
period from the departure of the Romans in the year 446, to the
twenty-third year of the reign of Edward I. in 1295. It is founded on
an earlier Chronicle, compiled by Mar i anus Scotus, one of the many
learned Irishmen sent forth from the " Island of Saints," between the
sixth and eleventh centuries. Mar i anus entered the Irish monastery
of St. Martin at Cologne about the year 1056 ; two years afterwards
he withdrew into complete seclusion at Fulda, and removed in 1059,
still as a recluse, to Mentz, where he ended his days ; his death
being variously assigned to the years 1083 or 1086. This long
seclusion afforded him leisure for composing a Chronicle, extending
from the creation of the world to the close of his own life; but which
is of comparatively little interest to ourselves, as even the latter
portion of it relates almost entirely to the German empire or the
Popedom, and contains only a few short references to events
connected with this island. Florence has preserved these, in making
the work of Marianus the basis of his own Chronicle. The rest of his
materials for the earlier period of English history are chiefly supplied
by Bede, the Saxon Chronicle, the Lives of Saints, and Asser's Life of
Alfred j1 of the latter of which he gives 1 Florence copied Asser so
literally that he has twice adopted expressions employed by the
former, which might lead us to suppose that the chronicler had
personally examined the positions on which two of the battles he
describes were fought. See pp. 63 and 70 of the present volume.
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almost an exact transcript, carrying t ! i o .series of events

[own to the year 888. He then reverts to the Saxor Chronicle, which
continues to be his main resource until lit approaches his own times;
not, however, exclusively, for during one period he has scarcely
extracted any thing fron it, and in treating of events of later times,
especially thus of the reign of Edward the Confessor, his narrative i
much mure circumstantial than any to be found in th existing
manuscripts of that record. Florence has ala largely collected from
other sources, and selected his material* with groat fidelity, industry,
and judgment. He is therefore justly ranked nest to Bede, and the
compilers of the Saxon Chronicle, anion;: the authorities for early
Kuidish history, auo even on the ground which they travel together,
his work, fa from being superseded, forma a valuable supplement to
them, "On the nones [the 7th] of July, 1118, died Florence the monk
of Worcester, whose acute observation and indefatigable industry
have rendered this Chronicle of Chronicles preeminent," Such is the
brief record, inserted by John, who was also a monk of Worcester, in
his continuation c" le Chronicle, which supplies nearly all the
information w Dssess respecting our eminent annalist. Orderieus
Vital!, ideed, who flourished about the same period, notices the
Chronicle, but in terms which have occasioned some perplexity to
the editors of Florence. The passage, certainly, contains no less than
two grave errors; but, allowing for these, there appears less difficulty
than has been supposed in reconciling it with the probable state of
the facts. Ordericus informs us that during his visit to England, met
with a work at Worcester, of whieli he gives the follow ing account ;
— " John of Worcester, a native of England, ; a monk of Worcester, a
man of venerable character and grea learning, in the additions which
he has made to the chronicles of Marianus Scot us, has gathered
faithful accounts of kin| William, and of the events which occurred in
his reign, am in those of his sons, William Rufus and king Henry, to
the present day," Then, after a very exact account of the chronicle of
Marianus, lie says: — ."John of Worcester, who fol lowed, recorded
the events of nearly a century, and, by order
 PREFACE. Vll of the venerable Wulfstan, bishop rind monk,
appended his continuation to the chronicle of Marianus, succinctly
relating many things worthy of observation in the histories of the
Romans [the popedom], the French, Germans, and other nations."1
In this passage, Ordericus incorrectly describes the " continuation of
the chronicle of Marianus," which he saw at Worcester, as recording
the events of nearly a century, while, as it will presently appear, it
could only have embraced a period of about thirty-four years. He has
also committed the more serious error of attributing the work to a
person whose share, if any, in it was very small, suffering the name
of Florence, the real author, to escape his observation. This has led
Mr. Thorpe to suggest, " that during Wulfstan's lifetime, and while
Florence was engaged on his work, the labours of John were
bestowed on the original Chronicle of Marianus, and that the
manuscript containing those labours is no longer known to exist."8
But the theory of bishop Wulfstan's distribution of the task between
the two monks of Worcester, and of John's being employed on the
original chronicle of Marianus, is, it should seem, sufficiently refuted
by John's express statement already quoted, that it was " Florence's
knowledge and industry which raised- the Chronicle of Chronicles,"
meaning clearly the whole work, to its pitch of pre-eminence; and it
would still leave us in the same dilemma as to Ordericus's omission
of any reference to the labours of Florence, whatever they may have
been. The learned editor proceeds to inquire, " Can any part of any
copy of the Chronicle of Marianus Scotus, embodying Florence of
Worcester, be pointed out as answering the description given by
Orderic of the labours of the monk John?" The reply is, that the
Chronicle of Florence of Worcester, in the existing manuscripts,
embodying Marianus Scotus, to reverse the phrase, does precisely
answer the description given by Ordericus, as far as regards its
general character, with the exception of the two errors into which he
has fallen. 1 Ordericus Vitalis, b. iii. c. 15 ; pp. 493, 494, in Bonn's
edition. 3 Preface to the English Historical Society's edition of
Florence, d. iv.
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viii PREFACE. There is sufficient ground for inferring that

Floren commenced his work at the instance of bishop Wulfst and we
find his additions to, and " continuation " Miuiiiiiiis, comprising
events, both domestic and t'nivkn, the specific periods corresponding
with the description Orderieus, namely, the reign of William and hia
twf sons ; although the Norman historian has unaccountably repro*
tented that period as extending in round numbers to hundred years.
The misapprehension of the passage of Orderieus appear to have
arisen from connecting two paragraphs which have n« such
connection in the pages of the Norman monk. I fifteenth Chapter of
his third Book, Orderieus gives a shot account of some authors who
had written of the times of kinj William and his two sons; and he
mentions first, William of Poitiers, and Guy, bishop of Amiens. He
then proceeds," the next paragraph, to describe the labours of
Marianua, ai the monk of Worcester, whom ho calls John ; but
without any further reference to those of William of Poitiers and Guy
of Amicus. Mr. Thorpe, however, reads the passage of Orderieus
differently. He says : "After due praise bestowed on those works he
then goes on to say, that a monk of Worcester, named John,
faithfully extracted from William of Poitiers, and Guy of Amiens, that
which he added to the Chronicles of Marianus Scotus concerning
William the Conqueror and his sons," &c. It may be doubted whether
either of the two monks of Worcester ever saw the works of th*
French authors here referred to, and, probably, there are no parts of
the Chronicle which can be traced to them ; but the words here
printed in Italics are not contained in Orderieus, and we venture to
think that the passage will not bear the turn they give it.1 If this
view be correct, the ground* on which the genuineness of Florence's
work is questioned will be so far narrowed. A little attention to dates
will put the matter in a clear light. Jt appears from internal evidence
that Orderieus, a monk of fit, Evroult, in Normandy, commenced his
own great work some time before the year 1123, perhaps about
1120. He seems to have made no great progress when he undertook
 PRB7ACB. IX iey to England for the purpose, it may be
supposed, of ing materials for the English annals, which are closely
oven with those of Normandy during the latter portion history. He
informs us that he spent five weeks at ind, in the time of abbot
Geoffrey ;* and as we find in ►urse of his work that this abbot died
on the 5th June, ; we are able to fix within limits sufficiently
accurate e present purpose the period of Ordericus s journey gland,
during which he made the visit to Worcester. ) Wulfstan was raised
to that see in 1062, but as Maritimself carried on his Chronicle to
1083, it must have ubsequently to the latter year that the bishop
employed ice in the labour of amplifying and continuing it. Wulflied
in 1095, but Florence survived till June, 1117, so lere was ample
time between the death of Marianus and n, a period of upwards of
thirty-four years, for a recluse industry and intelligence to have
completed the task. Icus himself only lived to 1141 or 1142, so that
it is iible that he could have seen a Continuation containing ents of a
century after the death of Marianus, that is, ling to the year 1183 ;
far in the reign of the third, 1 of the second, Henry, iters standing
thus, and Ordericus coming to Woraccording to these calculations,
some three or four after the death of Florence, he would find the
Chro)f Marianus in the state in which he describes it, as augd and
carried forward to the reign of Henry I. It naturally be in the hands
of the monk John, who nployed in further continuing it ; and there
being, as i Scoti chronicis adjecit, de r^ege Gulielmo, et de rebus
quae sub sub filiis ejus Gulielmo Rufo et Henrico, usque hodie conit,
honeste deprompsit." In the editions, both of Duchesne and nete d*
Histoire de France, the passage forms the commence>f a new
paragraph, and, as the words in his evidently apply to 'onicle of
Marianus, and cannot well be referred to deprompsit, is nothing in
the sentence to connect the latter word with n of Poitiers, and Guy
of Amiens. M. Dubois, the French tor of " Ordericus," thus reads it :
" Jean de Worcester . . i parle convenablement, dans les additions
aux chroniques de tais Marien, tant du roi Guillaume que des
evenements qui sont sous lui, et sous ses fils Guillaume le Rous et
Henri, jusqu'a irs." a B. iv. c. 16. 3 B. xiii.
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: appears from the manuscripts, no break in the annals c

quent on the change of authors, wo can only suppose, « Sir. I'ctrie,
that these circumstances led him to ascribe merit of the whole work
to the surviving continuato Ma.ria.uus, with whom lie conversed ; or
that, having tailed liim, or his notes being imperfect, lie confusi the
name of John, his personal acquaintance, with that ( Florence, when
ho gnt back to Normandy and resumed h own labours. However this
may be, tin.- statement .if (lid rleus, possibly originating in a slip of
his memory, or his pe can hardly be allowed to cast a shadow of
doubt c genuineness of [lie t.'lironicle, us being the work of Florenc
when it is weighed airuiiist the direct testimony of his broth monk of
the same house, writing on the spot, and immediate after ins
death,1 This view of the case disarms the criticism that the e
tinuator, John of Worcester, "is hardly identical with other monk of
the same name and place spoken of by Ordfl* ricus Vitalia;"* to say
nothing of the improbability of the being two such persons engaged
in the work at nearly t same period. With respect to the authorship
of the first Continu* tion — independently of what may be gathered
from careful examination of the passage in Ordericus, — the is
internal evidence that it was compiled by a monk Worcester named
John, who was eotemporary with the cvei which he records. One of
these circumstances is sulhcien indicated by an entry under the year
1038, in which the w says, That ho was eotemporary with the
occurrences which lie lates, appears incidentally from his mode, of
speaking of 1 " Stephen, where he says: "He was, uay is, at the pre
1 M. Le Prevest, the learned editor of the Ordericus pu'uli by the
French Historical Society, says hi his note on the pas jn dispute :— ''
i'loreiit de Worcester, el nun pas J win, a continue cli M) nil lie1 Je
sen ilevaiic'u-r J'3Iarianus"|, nun pas pi'mlanl |ui'. i' sicole inais du
IOS3 a HIT, en y ajoutant heaucoup dfl fails "-'-*■ l'histoire
li'Anglcterrt1." - Tome ii. p. 160. * Preface tu the E. H. Society's
edition of Florence, p. vi:
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PBEFACB. zi _* moment, desirous of peace;" and he

mentions Henry de ^ Blois, bishop of Winchester,1 and Milo, earl of
Hereford,2 as i; living characters from whom he had received certain
informa"' tion; whence we also learn that he had access to the
highest sources of intelligence. The most striking passage ,!" in the
volume is, perhaps, that in which he paints, as an eyewitness, the
fearful scenes which occurred during an assault i on Worcester by
the partisans of the empress Maud, when an i infuriated rabble burst
into the' abbey church whilst he and " the rest of the monks were
chanting primes in the choir.8 i" Indeed, like his predecessor
Florence, he is naturally more diffuse and circumstantial than other
chroniclers respecting i p occurrences connected with
Worcestershire, the neighbouring " I counties, and the borders of
Wales. The first Continuation of Florence brings the annals down ( to
the close of the year 1141, the period of Stephen's capthi ^vity,
after losing the battle of Lincoln. As several of the v| manuscripts,
however, terminate with the year 1131, it "has h J teen supposed
that the history of the last ten years was the r £ work of another
cotemporary writer ; but so far from there j being internal evidence
of any such change, the entry in which [ John, the monk of
Worcester, introduces his own name, was inserted as late as 1138.
While, therefore, there is no reason . i J to doubt that the original
Chronicle is the genuine pro, f duction of Florence, the authorship of
the first Continu4 ation may be safely ascribed to John, the monk of
Worcester, ■ The work of continuation appears to have been now
sus■ pended, and the interval between the years 1141 and 1152, ;
when Henry II. ascended the throne, is filled up in one of the ; best
manuscripts by a transcript from the History of Henry of he i*j
Huntingdon. The scene of labour was then shifted from Worcester to
Bury St. Edmund's, as appears from the frequent entries of
occurrences connected with that locality j inserted in the second
Continuation, which was compiled by >lisM JqJjjj
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that it is of any value. De Taster carries on the through the

reigns of Henry IT., Richard I., and John, to th* year 1205, the forty-
ninth of Henry III., in which the battli of Evesham was fought. The
remainder of the second Continuation appears to hav* been also the
work of a monk of Bury, from its constant r»i ference to matters
connected with that town and abbey. These notices, more or less
dispersed throughout this portion of the Chronicle, are not without
interest, particularly iron the light they throw ou the exactions levied
by the Norman kings on the religious houses, a subject on which the
writers appear to have been very sensitive. Much curious information
is also furnished on the general taxation of the kingdom, and
monetary affairs of the time. The history is carried on through the
latter years of the reign of Henry III., until nearly the close of that of
Edward I.; where it terminates abruptly in the year 1295. This
second Continuation of the Chronicle, which is no* for the first time
presented to the English reader, has been translated from the text of
the Historical Society's edition, printed from a manuscript, once the
property of lor! William Howard,1 and now belonging to the College
of Arms. The Society's text has also been used in translating the
Chronicle and the first Continuation ; its basis being a valuable
Manuscript in the library of the C. C. College, Oxford, which appears
to have formerly belonged to the abbey of Worcester. The Chronicle
of Florence of Worcester, with its first Continuation, was originally
published in 1392, by lord William Howard, from two manuscripts
then in his possession, and now in the library of Trinity College,
Dublin, and was reprinted at Frankfort, in 1601, with Matthew of
Westminster. Prefixed to all the copies, are lists of the popes from St.
Peter to Honorius II,, who died in 1130; of the seventy disciples ; of
the Jewish high-priests, both before and after the captivity; and of
the archbishops and bishops of tho several English sees, from the
time of St. Augustine to that rf ' Lord William Howard was the? third
son of Thomas, duke of Norfolk, warden of the Scottish marches}
tho "Belted Will" ' Walter Scott's Lay of tbe List iliastrel.
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