Chap, xvii.] THE SMALL INTESTINES. 309 



by a direct ulcerative process, have been lodged here, 

 and have caused fatal results. Some most remarkable 

 substances have, however, been passed with safety 

 through the valve ; and, in addition to those mentioned 

 when speaking of the stomach (page 302), instances may 

 be given where an irregular gold plate, fixing several 

 teeth and provided with one or two hook-like processes, 

 has been swallowed and passed per anum without 

 trouble. Other substances are not so easily passed. 

 Thus, in the intestines of one lunatic were found three 

 cotton reels, two bandages partly unrolled, some 

 skeins of thread, and a pair of braces. It is in the 

 ileo-csecal region, moreover, that intussusception most 

 frequently occurs. In this condition one part of the 

 bowel is prolapsed, or " telescoped," into another, 

 and more or less obstruction ensues. In the 

 present locality the narrow ileum is prolapsed or 

 intussuscepted into the capacious caecum. Sometimes 

 it is prolapsed through the valve, while in other 

 instances the ileum and valve sink into the colon 

 entire, the valve forming the summit of the "intus- 

 susceptum." By a gradual increase of the condition it 

 may at last happen that the intussuscepted bowel will 

 reach the ileum ; and the ileo-csecal valve has, in fact, 

 been recognised protruding from the anus. 



liaparotomy. In this procedure the abdomen is 

 opened from in front for the purpose of exploration, 

 or for the relief of a piece of bowel strangulated by a 

 band, and under certain other circumstances. It much 

 more frequently concerns the small bowel than the 

 large. The incision is usually made in the middle 

 line below the umbilicus, and a cut from three to 

 four inches long is usually found to be sufficient. It 

 may be made in either of the semi-lunar lines or 

 over any spot especially indicated by the disease. 

 Enterotomy is the operation of opening the small 

 intestine above some obstruction that threatens to be 



