1008 THE ORGANS OF DIGESTION. 



on each side of the wound are brought into apposition, and in this way the wound i& 

 closed. Gastrostomy is performed in two stages: The first stage consists in opening the 

 peritoneal cavity and stitching the stomach to the abdominal wall. The second stage consists in 

 opening the stomach after a*few clays have elapsed and adhesions formed between the peritoneal 

 surfaces of the stomach and abdominal wall. The operation is usually performed by an 

 oblique incision about one finger's breadth below and parallel with the margin of the 

 left costal cartilages, commencing an inch and a half from the median line and being about 

 three inches in length. Some surgeons prefer a straight incision, beginning opposite to the 

 end of the eighth intercostal space, and passing down for three inches over the Rectus abdominia 

 muscle. The skin, fasciae, and muscles are to be severally divided down to the peritoneum. 

 Howse recommends that the sheath of the Rectus should be opened longitudinally, and the fibres 

 of this muscle separated, and not cut, in the same direction, so as to secure a sphincter-like action 

 around the opening. After the peritoneum has been opened the stomach is recognized by its 

 pink-red color and smooth surface. It is to be pulled up into the wound and sutured to the 

 opening. This may be done in several ways, but in whatever way it is done the following points 

 should be carefully attended to: (1) In taking up the stomach only to pass the needle through 

 the serous and muscular coats, and avoid puncturing the mucous membrane. (2) To take up 

 plenty of the muscular coat. (3) In passing the needle through the parietes of the abdomen to 

 be careful to include the parietal peritoneum. (4) To enclose a circle of the stomach at least an 

 inch in diameter. If the symptoms admit of it, the parts are now to be left quiet for four 01 

 five days, and a small puncture is then to be made through the exposed portion of the stomach. 

 and a gum elastic catheter passed through it into the viscus, through which fluid can be injected, 

 in small quantities at first. In more urgent cases it may be necessary to make the opening much 

 earlier. 



Excision of the pylorus has occasionally been performed, but the results of this operation are 

 by no means favorable, and in cases of cancer of the pylorus gastro-enterostomy is generally pre- 

 ferred. The object of this operation is to make a fistulous communication between the stomach, 

 on the cardiac side of the disease, and the small intestine, as high up as is possible. 



THE INTESTINAL CANAL. 



This, in the form of a curved tube, passes uninterruptedly from the pylorus 

 to the anus. It has a remarkable length of about six times the height of its pos- 

 sessor, though in the adult it may be independent of the age, height, or weight. 

 In this relation man stands midway between the herbivores, e. g. rabbit with very 

 long intestine, and carnivores, e. g. lion, whose intestine is three times the length 

 of its body. There is some evidence to prove that vegetarians may have a longer 

 intestine than those living on a mixed or a flesh diet. The wall of the intestine 

 offers throughout a serous, muscular and mucous coat presenting many modifica- 

 tions, by which the upper four-fifths is distinguished as small intestine and the 

 lower fifth as large intestine. 



The Small Intestine. 



By this term is understood the part of the alimentary canal extending from 

 the pylorus to the ileo-csecal valve. Its average length is about 8 metres or 

 (Luschka) 25 feet, or 6 metres longer than the whole body ; Treves says 22 feet, 

 and Quain 22- feet. The extremes found are 34 feet and 8 feet. Its circumfer- 

 ence decreases from the stomach toward the large intestine from 12.8 cm. to 9.5 

 cm. Its capacity, inflated and dried, is 15 pints. The wall of the ileum is so thin 

 and translucent that a newspaper may be read through it. 



The small intestine is divided into three parts : 



1. Duodenum (12-finger intestine) ; 



2. Jejunum (empty intestine) ; 



3. Ileum (curved or twisted intestine). 



The Duodenum. 



The duodenum, begins at the sulcus pyloricus and ends at the duodena- jejunal 

 angle or flexure, where it becomes jejunum. It was named by Herophilus, but it 

 possesses neither the length nor the breadth of twelve fingers. 



A better name would be intestinum pancreaticum (Luschka) on account of its 

 intimate relation to the pancreas. In the adult male its axial length is 30 cm. 

 (or 10-12 inches), and its usual circumference 12 or 13 cm. (1.5 to 2 inches in 

 diameter). Authors fail to agree on its direction and form. 



