EXAMINATION OF THE INTESTINES. 1073 



branches to the small intestines ; and of these intestinal branches the 

 dissector may trace the primary, secondary and tertiary arches of anasto- 

 mosis. If the left branch of bifurcation of the middle colic artery be 

 followed, it will lead the dissector to the left colic, and so to the trunk of the 

 inferior mesenteric artery, with its accompanying vein and nerves, situated 

 to the left of the mesentery ; and to study these the intestines must now 

 be turned over to the right side. In addition to the left colic, the sigmoid 

 branch of the inferior mesenteric artery will then also be seen, and the first 

 part of the superior hsemorrhoidal vessels before they descend into the 

 pelvis upon the meso-rectum (p. 412). 



The dissector will now tie the intestine, a little below the termination of 

 the duodenum, with two ligatures about an inch and a half distant, and 

 will divide it between the ligatures ; in like manner he will secure and 

 divide the great intestine at the lower extremity of the sigmoid flexure : he 

 will then remove from the body the whole length of intestine between the 

 upper and lower ligatures. To do this properly, he must begin from above, 

 and pulling the ligatured extremity upwards with his left hand, with his 

 right apply the scalpel lightly to the edge of the mesentery, close to the 

 bowel. By this means the whole small intestines may with ease be re- 

 moved, and the mesentery left in the abdomen. The large intestine may 

 now also be removed as far as the rectum. The intestines are to be taken 

 to the trough, and there they are to be thoroughly cleaned, by having 

 water run through them from the jejunal end. They may then be spread 

 out on a table and inflated, iu order that the relative length and diameter 

 of the different parts may be observed, the arrangement of muscular bands 

 on the colon, and other facts as to their structure (pp. 840 and 854). The 

 small intestine is to be separated from the great, several inches above the 

 caecum. A portion near the upper end may be cut separate, inflated and 

 dried, in order to show the valvulse conniv elites which are thus put upon 

 the stretch. The remainder is to be slit open in its whole extent, which 

 may be best done with a pair of scissors, one of the points of which has 

 been blunted with a small piece of cork ; the appearance of the mucous 

 membrane in the different parts is then to be studied, attention being parti- 

 cularly directed to the distribution of the villi and valvulse conniventes 

 (p. 842), and to the patches of Peyer's glands (p. 846). The great intes- 

 tine is next to be divided some inches beyond the csecal valve, and the 

 remainder is to be slit up and its mucous membrane examined. Lastly, 

 the caecum is to be very carefully washed, and the structure and action of 

 the csecal valve studied, by filling the portion of colon with water (p. 852). 

 The water will be returned although the portion of ileum be left untied, and 

 the position of the valve when closed may thus be seen. The caecum may 

 then be slit open on the side opposite the valve, and the vermiform appen- 

 dage may also be opened to observe its glandular structure. 



5. Stoma-ch and Duodenum, Pancreas, Spleen, and Liver. The duo- 

 denum and stomach are to be slightly inflated, and the arteries arising 

 from the coeliac axis are to be dissected (p. 406). The student may begin 

 by dissecting the splenic artery, following its course to the spleen, and 

 observing its branches to the pancreas, to the stomach, the vasa brevia, and 

 the left gastro-epiploic artery. Let him next trace the coronary artery of 

 the stomach aloug the small curvature of that organ. Then, iu following 

 out the hepatic artery to its division into right and left branches, he will 

 find the pyloric branch anastomosing with the coronary artery ; the cystic 

 branch going to the gall-bladder ; and the gastro-duodenal branch dividing 



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