216 Anatomy Applied to Medicine and Surgery. 



membrane, or, in place of infolding the ulcer, it may be 

 first excised and the edges treated by inversion of thq 

 walls, but, if the resulting wound in the stomach be too 

 large for this procedure to be safely adopted, then the 

 perforation should be walled off from the general abdomi- 

 nal cavity by gauze packing. If the operation be for 

 hemorrhage, the ulcer may be excised, or the bleeding 

 point may be secured after the stomach has been opened. 

 Sub-phrenic abscess, occupying the lesser sac of the peri- 

 toneum, may be evacuated by opening the great omentum 

 between the stomach and the transverse colon, gauze hav- 

 ing first been arranged so as to shut off the general peri- 

 toneal cavity around the site of the proposed opening. 



Gastrotomy consists in a simple incision into the stom- 

 ach for the removal of a foreign body, or for exploratory 

 purposes, etc., and in this operation the stomach is ex- 

 posed through an abdominal incision in the middle line. 

 Hemorrhage from stomach wounds is generally of no 

 great moment, but, to reduce it to a minimum, the incision, 

 if small, should be made transversely to the long axis of 

 the stomach, so as to be parallel to the vessels which run 

 beneath the serous coat. A larger wound should, if pos- 

 sible, be made in a longitudinal direction and about mid- 

 way between the two curvatures so as to avoid the large 

 vessels situated at these curvatures, but should the foreign 

 body be distinctly felt, the gastric incision is best made 

 directly over it. 



Gastrostomy is an opening into the stomach for the 

 purpose of keeping up nutrition where the oesophagus is 

 obstructed to such a degree that the entrance of food into 

 the stomach by the usual channel is prevented. The ab- 

 dominal incision should be placed in the left linea semi- 

 lunaris, or it may be made parallel with and about one 

 inch from the left costal margin. In making this incision, 



