GASTEOTOMY. 377 



time is the general nile. The principal indication is cleanliness in 

 the removal of the discharges, and of any mncosities or food that 

 may escape over its surfaces. H. Bouley has experimentally 

 proved that to obtain the cicatrization of oesophageal wounds it is 

 essential "■to feed the animals loith food of fibrous texture, and 

 nothing hut pure water to drink."' By respecting this indication 

 all danger of complications is avoided. 



The possible accidents and complications ai*e: xoounds of the 

 blood vessels during the first steps of the operation, but the 

 hemoiThage that f oUows may be stopj^ed by pressure or ligature ; 

 iedeinatous sicelling of the w^ound, suggesting the infiltration of 

 food or pus in the surrounding cellular tissue. It may terminate in 

 a simple abscess, or it may be the precursor of a fatal gangrenous 

 complication: purulent infection, seiyticmmia, tetanus, are also 

 possible sequelse of oesophagotomy, but a faithful and judicious 

 application of antiseptic means in dressing and nursing the 

 patients wiU. usually baffle the possible evil. 



GASTEOTOMY— EUMENOTOI^IY. 



This title, in our opinion, ought to include the puncture or in- 

 cision of the rumen, when designed to liberate confined gases or 

 to remove the solid contents which may have accumulated in that 

 viscerse. In the first case it is indicated when the tympanitic 

 condition of the first compartment of the stomach exhibits 

 alarming symptoms and resists all ordinary remedial indications ; 

 and in the second, when the gases of the rumen are mixed with 

 the aHmentary mass contained in that organ and a larger opening 

 than that made by the trocar becomes necessary, for their re- 

 moval. In either case the left flank must be the seat of election 

 for the operation, the rumen occupying that side of the abdomen, 

 and situated at a point equally distant from the last rib, the 

 angle of the ilium and the transverse process of the lumbar 

 vertebrae. Tabourin suggests the last intercostal space as the 

 proper place for the operation. The instruments necessary are a 

 large trocar (Fig. 367) with a straight and a curved bistoury. The 

 gastrotomes invented by Brogniez (Fig. 3G8) and Sajoux are too 

 complicated. The animal must be in the standing position. 



Puncture of the mmen. — The operator, facing the left flank, 

 makes an incision throuj^h the skin, about an inch and a half lonq-, 



