chap, xvii.] ABDOMINAL VISCERA. 331 



and four pebbles. The -whole mass weighed 2 Ibs. 8 ozs. 

 The patient was a lunatic. The pylorus has an average 

 diameter of 16 mm. This about corresponds to the 

 diameter of a sixpenny-piece. In spite of the narrow- 

 ness of the pylorus, large substances that have been 

 swallowed have been passed by the anus without 

 trouble. Among these may be noted a metal pencil- 

 case 4| inches long, ten ounces of garden nails and 

 fragments of crockery-ware swallowed by a lunatic ; a 

 fork, a door-key, and other strange bodies. Needles 

 and similar sharp substances that have been swallowed 

 have travelled out of the stomach or bowels and have 

 found their way to the surface at various points in the 

 body. In a patient under my care at the London 

 Hospital I extracted from beneath the skin, near the 

 groin, a needle swallowed some months previously. 

 In a case reported in the Lancet, a needle was ex- 

 tracted from the middle of the thigh six months after 

 it had been swallowed, and like instances are recorded 

 elsewhere. 



Gastrotomy and gastrostomy. Gastrotomy 

 consists in opening the stomach through the anterior 

 abdominal wall for the purpose of removing a foreign 

 body ; gastrostomy, in opening the stomach in a like 

 situation with the object of establishing a gastric 

 fistula through which the patient may be fed in cases 

 where the gullet is occluded by disease. The un- 

 covered part of the stomach, accessible in these opera- 

 tions, is represented by a triangular area, bounded on 

 the right by the edge of the liver, on the left by the 

 cartilages of the eighth and ninth ribs, and below by a 

 horizontal line passing between the tips of the tenth 

 costal cartilages (Fig. 30). The incision in these opera- 

 tions must be situate in this triangle, and may be made 

 either parallel to, and about two fingers' breadth from, 

 the free border of the costae, or along the left semi- 

 lunar line. In the former incision the three flat 



