importance. Any measure which can be instituted for the imme¬ diate relief of postoperative pain following rectal surgery is a worthy consideration. In Dr. Bacon's method it is hoped that in the hands of others it will prove an equally good panacea for the relief of pain. I myself have used several of the oil soluble anesthetic preparations obtainable through the drug trade. The results have not been too uniform. The first consideration in which I differ with Dr. Bacon is in the shaving of the perianal tissues preoperatively. This I believe produces in many cases a folliculitis to be followed by considerable annoyance from the outgrowing hair. Clipping of the hair certainly is adequate.In the second consideration I can see no logical reasoning to the weight-dosage ratio in spinal anesthesia for anorectal sur¬ gery. I find 50 mg. of procaine hydrochloride sufficient in the average hemorrhoid case irrespective of weight. I am willing to agree that suturing of perianal tissues in Dr. Bacon's hands is certain to be a success and probably a valuable aid in healing of the parts. However, to advocate the wide dissemination of this method of dealing with perianal tissues certainly will lead to many unsatisfactory results, perianal abscesses, prolonged annoyance and discomfort.Dr. Louis J. Hirschman, Detroit: The preparation of patients is important and so are many of the things used for postoperative relief, but I should like to say a word or two about operative procedures as mentioned by Dr. Bacon. He has correctly stated that the principal cause of postoperative pain in rectal surgery is the contraction of the sphincter muscle. That is very important. We must remember not to divulse the sphincter, particularly when the divulsion is merely a tug of war between the operator and the patient. If the patient is under general anesthesia the operator wins out, but does it at the expense of a torn and overstretched, ecchymosed sphincter. Then the contractions of the sphincter do cause a great deal of pain. Another thing which insults the rectum is the use of postoperative packing. Many surgeons still pack the rectum full of rubber and gauze, and anything else that is handy, and then forget that a peristaltic stimulation is caused by a filled rectum, whether it is by stool or by gauze, and the peristaltic effort to expel this will cause a great deal of pain. I wish to differ with Dr. Bacon in one important matter. Remember that one of the most sensitive organs of the body is the skin. Every stitch we put into it traumatizes it just so much more. Whether one uses wire, silk or linen, every unnecessary needle hole causes unnecessary trauma to the skin and produces postopera¬ tive pain. So does the indiscriminate use of so many unnecessary instruments on the skin edges. One should remove rectal lesions with as small an incision as possible and use the sphincter as a purse string. The incisions pull together nicely without suture and one avoids the evulsive, ineffective malalinement. No matter how careful one is during the operatio...
