colon is brought into the muscle but not through it, the muscles being sutured above and below this point ; the long suture from the end of the bowel hangs out of the incision. A strip of gauze is inserted to the end of the bowel to keep the muscles apart. The procedure is employed as a safety valve to relieve gas should stasis with great distention occur between the fourth and sixth days. Peritonitis causes most of the deaths by necrosis of the union from distention. In a series of twenty cases we have had no deaths from the use of the Murphy button and the safety-valve method. By drawing on the projecting suture and using small pointed forceps along the taut thread, the bowel is readily opened and gases permitted to escape. If not required by the sixth day, the suture is cut, the gauze removed and the opening allowed to close. If the suture is not needed, the healing is not prolonged ; if needed, closure is usually effected within a short time. (Fig. 4). This safety valve is of great benefit in about 15 per cent, of the cases. Should the peritoneal cavity be contaminated, drainage is secured by stab incision with drain in the loin.The method of operation described is safe and re¬ markably effective for tu¬ mors, granulomas and fis¬ tulas. In cases of toxemia the general condition is im¬ proved, and in 80 per cent, the constipation is im¬ proved. The general im¬ provement made in the lat¬ ter cases is somewhat less marked than in operations of necessity for tumor and obstruction (Fig. 5). In operating on the left colon for obstructive conditions by the Mikulicz -Bruns method or by resection, appendicostomy is of great value.Not including the rec¬ tum, there were 262 resec¬ tions of the large intestine for malignancy. Of the patients who recovered and who were operated on more than five years ago, 54 per cent, are alive. Of those operated on more than three years ago, 67.5 per cent, are alive. From January, 1898, to Dec. 31, 1915, the right half of the colon was resected for tumors, disease and stasis in 235 cases, with an operative mortality of 12.5 per cent. In our early work the operability was lower, the mortality lower and the permanency of cure higher. This led to an increase in the operability of these other¬ wise hopeless cases, with the result that there was an increase in the mortality and a decrease in the perma¬ nency of cure; but considered from the standpoint of the total number of cases seen, a great increase in the number cured. The present operability is 62 per cent. Unless the operability percentage is given, statis¬ tics in regard to the results of operations for malig¬ nancy are misleading.Moderation in Eating.-For the sake of health, medicines are taken by weight and measure ; so ought food to be, or by some similar rule.-Skelton. Fig. 5.-Aseptic method of inverting mucous membrane by a running suture.
BOSTONWhether or not its truth is admitted, the originality of Lane's idea and the brilliancy with which he translated the thought into action must be admired. Chronic infectious arthritis had ...
