Rupture of the Intestine. — SoUpeds. 333 



in mass, and sometimes engaged in pouches outside the walls of 

 the gut. In other cases, the walls of the intestine have been per- 

 forated by hard woodj' stalks of straw or hay ( Mollereau) or of 

 still more woody plants as in a case observed by the author, and 

 in which the pylorus was perforated. Sometimes the exudate or 

 blood extravasation attending on petechial fever, or verminous 

 embolism will pave the way for the rupture. Perforations by 

 pieces of wire (Schmidt) or other metallic bodies are also ob- 

 served. Adhesive peritonitis has also rendered the walls friable 

 and predisposed to rupture. 



Jejunum and Ileum. Lesions are most frequent toward the 

 termination of the ileum and resulting from obstructions of the 

 bowel or the weakening of the walls by disease, or both. Ulcera- 

 tions, abscess of the closed follicles opening into the peritoneum, 

 and neoplasms of various kinds are to be especially noted among 

 the causes. The impaction of the Ccccum, blocking the ileo- 

 csecal valve is also among the observed factors. Other instances 

 have been traced to deep cauterization of an umbilical hernia, 

 the enclosed loop of small intestine becoming inflamed and per- 

 forated. The author has observed one in.stance from clamping 

 of a hernia in which the contained intestine was adherent to the 

 hernial sac. 



Caecum. From its position on the lower part of the ab- 

 domen and from its habitual plenitude with food or water, this 

 organ is especially exposed to direct mechanical injuries and 

 ruptures. A sudden fall, more especially if the umbilical region 

 strikes on a stone or other projecting solid body, kicks with 

 heavy boots or with the feet of other animals, blows with a cow's 

 horn or a boar's tusks, and violent contact with stumps, poles 

 and other objects may be the occasion of the rupture. These are 

 usually found near the base of the viscus and across its longi- 

 ttidinal direction. 



Inflammations, connected with punctures, calculi, parasites, 

 etc., may render the walls so friable that they give way under 

 slight strain or injury. Abscesses have been found in the walls 

 of the viscus leading to perforation, and extension of inflamma- 

 tion from an umbilicus cauterized for hernia has determined 

 adhesion and perforation. 



Colon. The loaded colon is even more liable to mechanical 



