234 Anatomy Applied to Medicine and Surgery. 



of all cases of intussusception. In this form ( ileo-caecal ) 

 the entering bowel is composed of the ileum and 

 caecum, preceded by the ileo-caecal valve, which forms the 

 apex of the tumor and, as it increases, it does so at the ex- 

 pense of the receiving bowel, in this case, the colon. As 

 the entering bowel progresses along the colon, the mesen- 

 tery becomes stretched, thus causing the tumor to assume 

 a curved appearance, the concavity being directed towards 

 the umbilicus. In volvulus the sigmoid flexure is gener- 

 ally affected, forming about 80% of cases of this condi- 

 tion, and the chief factor in its production is an elongated 

 meso-colon, due, often, to chronic constipation, since in 

 this, the weight of the bowel drags on the sigmoid meso- 

 colon thus stretching it. At the same time the parietal 

 attachment of the meso-colon becomes relatively narrower 

 so that a twist of it around its own axis is liable to occur 

 and a volvulus result. Rupture of the intestine may be 

 caused by a blow or by a kick from a horse, etc., and when 

 it does occur, the relative order of the parts of the intes- 

 tines affected is, first, jejunum; then the ileum; then the 

 duodenum and, lastly, the colon. 



Operative work on the Intestine. For clos- 

 ing intestinal wounds, Lambert's suture is the simplest 

 and the one mOst generally employed. About two-thirds 

 of the intestinal wall is composed of mucous membrane, 

 while the remaining third consists of the serous, muscular 

 and the submucous coats. Of these, the last is much the 

 stronger, and Halstead has demonstrated that each suture 

 should include some of this structure. He says that : "A 

 delicate thread of this tissue is very much stronger and 

 better able to hold a stitch than a coarse shred of the en- 

 tire thickness of the muscular coat." In Lambert's 

 suture a fold of about one-tenth of an inch is picked up on 

 either side of the wound, so that the inner row of needle 



