A prospective, randomized, double-blind study was performed to compare preoperative antibiotic preparation with neomycin (group 1), neomycin and tetracycline (group 2), and placebo (group 3) in patients undergoing elective intestinal surgery. The 196 patients were approximately equally distributed among the three study groups, which proved similar to each other in terms of age, sex, diagnosis, site of lesion, and operative procedure. There were significantly (P < 0.01) fewer patients with postoperative wound sepsis in the neomycin-tetracycline group (group 2) than in either of the two other groups. Postoperative wound infection rates in groups 1 and 3 were nearly identical. Most infections contained both aerobic and anaerobic bacteria. Eight of nine episodes of septicemia due to Bacteroides fragilis occurred in patients in groups 1 and 3.

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FELLOW IN SURGERY, THE MAYO FOUNDATIONPARTIAL or complete obstruction of the duodenum at the duodenojejunal angle, resulting from a congenital anomaly, is exceedingly rare. The condition is usually found at necropsy rather than at operation. A review of the records of The Mayo Clinic disclosed only two such cases. They are reported herewith.REPORT OF CASES.-CASE I.-The patient, a man aged nineteen, the fourth child of healthy parents, born at full term, and breast fed, was perfectly well and developed normally until the age of two years, at which time attacks of abdominal pain appeared. The mother did not recall that the patient ever had had difficulty prior to the time of weaning. The pain occurred at intervals of from two to three weeks and was quite generalized, varying in intensity and beginning very soon after the ingestion of food. It was frequently associated with vomiting, which occurred from a few minutes to several hours after meals and in all instances afforded considerable relief. Often vomiting was induced, the patient finding that he derived immediate benefit by emptying his stomach. Certain foods did not seem to be a factor in precipitating the pain. Any food or even fluid caused the distress to persist during an attack and the patient had made it a practice to defer eating until all pain had subsided; otherwise the disturbance might last over a period of two or three days. May 24, 1927, the patient had the most severe attack since the onset of his illness. At that time the appendix was removed. The surgeon reported that the appendix was normal but was on the left side; he believed that all the abdominal viscera were congenitally on the left side, and that this anomaly was responsible for the attacks. One week after the operation the patient had an attack in all respects identical with the previous ones. He was unable to eat on account of the constant distress, with the result that he lost twenty-five pounds. Before coming to the clinic he was kept on a strict milk diet, with complete rest in bed for a period of a month without any benefit. In spite of his handicap the patient had been able to attend school and to do a moderate amount of light work during vacation.The general examination was essentially negative except for marked emaciation. Rontgenograms of the stomach were negative. A pre-operative diagnosis of chronic intermittent intestinal obstru&ion (congenital anomaly) was made.Exploration revealed chronic intestinal obstruction due to congenital malformation of the small intestine apparently at the duodenojejunal angle. The duodenum was dilated to about three times normal size; the distal half was completely covered with peritoneum *

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