ENTEROTOMY. 
53 
ascertain by the perusal of my limited library all the advocates concur 
in the manner of its performance, which I presume you all know. In 
giving a brief sketch of the procedure as I usually follow, I am 
obliged to ask your forbearance, for I have nothing to improve it, but 
am doing it to induce my younger colleagues to lay hand at work and 
make use of a therapeutic manual which has been too long underrated, 
perhaps discarded by one and dreaded by another. 
The point of selection is indicated by the most exaggerated tym¬ 
panitic resonance on percussion between the external angle of the 
illium, posterior border of last rib, external margin of the transverse 
processes of the lumbar vertebra and about 4 inches beneath the latter, 
on the right side, which is preferable, lest I observe contraindications 
when I attack the left side or inferior walls. If the escape of gas does 
not prove satisfactory, I do not hesitate to tap both Hanks, and if 
necessary would repeat the puncture at some other spot. The prepar¬ 
atory measures are simply to remove the hair from the chosen spot, oil 
the canula and be supplied with a sound to remove obstructions, which 
might by the current of egressing gas be forced into the orifice of the 
canula. Some authors advise a small incision to be made into the skin 
after the removal of the hair which would facilitate the passage of 
the trocar, though in my estimation it is scarcely necessary if a delicate 
instrument is used with a calibre measuring 1-16 of an inch and 6-8 
inch long. The trocar is taken into the right hand with the handle 
well braced in its palmar surface, the index finger extended over the 
canula to mark the depth I choose to grant its insertion, which is 
usually about 4 inches, then I thrust the instrument forcibly into the 
intestine in a slightly oblique direction from above downward, so that 
when the bowel recedes the orifice of the canula is not obstructed by 
the relaxed intestinal walls, then I remove the stylet “always retaining 
the left thumb and fore finger on the flange of the canula to secure its 
position,” and the gas will readily escape provided the liquid or solid 
material within the bowel does not obstruct the canula when the use 
of the sound would be called upon to remove the barrier and tl;e escape 
of superfluous gas wall continue until the bowel becomes entirely 
evacuated, then I will draw the canula and depend upon nature for 
cicatrization. It has been suggested to apply a piece of adhesive 
plaster over the wound, which is very proper if an incision is made. 
In some cases, profuse hemorrhage may occur after the removal of the 
canula no doubt due to laceration of some arteriole in the skin or 
