The Intestines. 235 



points is one-tenth of an inch from the wound, and one- 

 tenth inch apart, and, on tightening the sutures the serous 

 coats on either side are inverted and approximated. 

 Enterectomy means resection or removal of a portion of 

 the intestine, and, in it, the ends of the bowel may be 

 joined "end to end" or "side by side" (i.e., lateral anastomo- 

 sis) by a variety of forms of intestinal suture or by means 

 of mechanical appliances. Of the former, Lambert's is 

 the one most used, and of the latter, Murphy's button. As 

 a rule, the site of the incision is the linea alba, although it 

 may be over the particular part of the bowel involved, 

 especially when the median incision would not allow 

 the freest scope for the proper handling of the diseased 

 portion. When the abdomen has been opened and a loop 

 of the bowel drawn out, it is often difficult to satisfy 

 oneself as to which is the upper and which the lower end, 

 and, as a point of some importance in differentiating the 

 respective ends, the relation to the posterior wall of the 

 mesentery belonging to the loop of bowel withdrawn, may 

 be of assistance. If the surgeon supports the exposed 

 loop with his left hand, and, if he can pass the index finger 

 of the right hand down the left side of the mesentery be- 

 longing to this particular portion of bowel and along it to 

 its vertebral attachment and thence unopposed towards 

 the left flank, that part of the exposed loop directed to- 

 wards the patient's head is the upper end. If, however, 

 the finger on passing down on the left side of the bowel 

 be conveyed to the right flank, the bowel is evidently re- 

 versed. Enterotomy means an incision into the bowel 

 and is occasionally performed in urgent cases of intestinal 

 obstruction when the patient is in danger of immediate 

 death from the obstruction and in it the median incision 

 is the one usually adopted. In appendicitis, the incision 

 mav be internallv near the rectus or externally towards 



