sional cases in private practice, for the simple reason that there are no hospitals of any size which create a demand for them. Providence Hospital is under the nursing of Sisters of Charity. The Columbia Hospital can accommodate but a few, and from its peculiar field of labor the profession generally sees but little of its workings. The Freedmen's Hospital also takes a few, but its wards are not utilized by the mass of the profession. What the new Garfield Hospital is going to do remains a problem. Its friends believe that it will grow in importance and usefulness, as there is a positive need for it, and will before long furnish a suitable field for professional growth. The women could do a great deal, but they are already overburdened with entertainments for the benefit of the Children's Hospital, which should have been mentioned with the others as a small but well-defined field for nurse-training, of the Garfield Hospital, church orphanages, etc., etc., which task their ingenuity and time very seriously. To be a success such enterprises must become fashionable; perhaps some day the Nurses Training School may attain to that proud distinction. Writing of fashion, doctors' lunches have become quite the thing. We have had two here recently, one given by Dr. Toner to Dr. Warren Bey, and the other by Dr. Jos. Taber Johnson to Dr. Mundé, of New York, and very enjoyable affairs they were, only Johnson's punch was a little too strong to be taken in the middle of the day by any one who still had his rounds to make. A conversation on this subject was overheard as occurring between two ladies: "What are all these doctors' buggies doing here?" "It is a doctor's lunch, my dear.” A doctor's lunch! Well I never heard of doctors stopping to have a formal lunch before." The American Surgical Association were certainly favored by Dame Nature during their meeting here this week. All the foliage was well out, and everything looks fresh and bright, and even the heat, with the exception of one day, Friday, was tempered to an agreeable degree. The city is looking its best now, and may give to some others of our medical neighbors the desire to reside permanently among us, when they retire from active practice, of course, and follow in the footsteps of Dr. Hammond, who is said to be about to build a marvel of a house on the Mexican plan, with a large central court roofed in with glass, etc. The late Dr. Marion Sims we know also intended to take up his residence here. ments, seemed to be always on hand and rendering himself particularly useful and agreeable. Very few of the Washington medical profession seemed to be present, and a number of faces were missed from the assemblage, such as Professor Gross and his son, Dr. J. C. Warren of your city, and others; but the general impression given, which was heightened by the manner and appearance of the President, Dr. Moore, of Rochester, N. Y., was that of a quiet, dignified, and earnest body of men, and the papers read and discussions held upon them partook of the same character; but as they will be fully reported in your columns elsewhere it is not necessary to particularize them here. Among those present, however, we must mention J. S. Billings, M. D., LL. D. (Edinburgh), U. S. A., whose latest honors do not seem to embarrass him. Think of a man leaving this country on April 2d, going to Edinburgh and participating with honor in the tercentary of her University, and being back at his post on April 30th, in twenty-eight days. Professor Gross's paper, which was on Wounds of the Intestines, was read in his absence, and a telegram sent by the Association expressing to him their pleasure and profit in listening to his paper and their sympathy and hope for his speedy recovery. There were some forty members registered by the close of the meeting on May 3d, and a resolution was passed to dispense with the annual dinner, but notwithstanding that fact, twenty of the members dined together formally at one of the hotels. Quiet receptions were held on several evenings at the houses of physicians, and upon invitation from Professor Baird the Washington fish-hatchery establishments were visited. In the election of officers the following were selected: President, Dr. William T. Briggs, Nashville, Tenn.; Vice-Presidents, Dr. J. C. Hutchinson, Brooklyn, N. Y., Dr. E. H. Gregory, St. Louis, Mo.; Secretary, Dr. J. R. Weist, Richmond, Va.; Treasurer, Dr. John H. Brinton, Philadelphia, Penn.; Recorder, Dr. J. J. Ewing Mears, Philadelphia, Penn.; Council, Drs. Henry F. Campbell, Augusta, Ga., Hunter McGuire, Richmond, Va., P. S. Conner, Cincinnati, Ohio, and Dr. J. S. Billings, D. C. The Association will meet in Washington again in April, 1885, and Dr. Billings was elected chairman of the Committee of Arrangements. In regard to the Code question, it may perhaps interest you to know that while nothing was said in the meetings with regard to it further than the reading of the report of the Secretary on the first day, to the effect that several resignations had taken place in consequence of the strict adherence of the Association to the Code, and these resignations appeared to be forced, the general tenor of conversation among the members was that the Code of the American Medical Association was to be taken as a matter of course. The meetings of the American Surgical Association were held in a large room in the National Museum, and surrounded by the park of the Smithsonian Institution. The room was so arranged that by a series of large screens the small body of men for the attend ance was not large-could be shut off quite satisfactorily from the empty space around, and the screens served the purpose of sounding boards, not as well as could be wished however; and as work is still going on in different parts of the open building an occasional sound would reverberate through into the room, annoying Dr. Flint, of the navy, who was exerting himself to relieve the meeting of all such disturbances. An occasional group of visitors would lounge in from the main hall, take a look at the Indian pictures which hung on the walls, and after listening for a few mo- A BILL to prevent the spread of pleuro-pneumonia ments pass out, evidently thinking that the other curi- and other contagious diseases among cattle has finally osities were of more interest. Dr. Basil Norris, of the passed both houses of Congress, under the stimulating army, who was chairman of the Committee of Arrange-supervision of a committee appointed by a convention Miscellany. A BILL TO PREVENT THE SPREAD OF CON- : Deaths reported 2273 (no reports from St. Louis, New Orleans, Buffalo, District of Columbia, Milwaukee, and Providence) under five years of age, 1632; principal infectious diseases (smallpox, measles, diphtheria and croup, whoopingcough, erysipelas, fevers, and diarrhoeal diseases) 331, consumption 345, lung diseases 316, diphtheria and croup 88, scarlet fever 69, diarrhoeal diseases 38, measles 32, typhoid fever 32, cerebro-spinal meningitis 16, erysipelas 16, malarial fevers 14, whooping-cough 12, puerperal fever nine, small-pox four, typhus fever one. From measles, Chicago eleven, New York nine, Baltimore seven, Brooklyn three, Philadelphia and Cincinnati one each. From typhoid fever, Philadelphia fourteen, Chicago seven, Pittsburg three, New York two, Nashville, Charleston, Lowell, Worcester, New Bedford, and Andover one each. From cerebro-spinal meningitis, Baltimore four, New York three, Chicago and Brockton two each, Cincinnati, Fall River, Lawrence, New Bedford, and Quincy one each. From erysipelas, New York five, Philadelphia, three, Boston and Newton two each, Brooklyn, Chicago, Baltimore, and New Bedford one each. From malarial fevers, New York and Brooklyn three each, Chicago two, Baltimore, New Haven, Nashville, Fall River, Chicopee, and Spencer one each. From whooping-cough, New York four, Baltimore three, Cincinnati two, Philadelphia, Brooklyn, and Chicago one each. From puerperal fever, Brooklyn three, Chicago two, New York, Philadelphia, Boston, and New Haven one each. From small-por, Philadelphia, Chicago, Cincinnati, and Pittsburg one each. From typhus fever, Cincin nati one. One case of small-pox was reported in Boston, Cincinnati one; scarlet fever 65, diphtheria 20, typhoid fever four, and measles four in Boston. In 103 cities and towns of Massachusetts, with an estimated population of 1,404,364 (estimated population of the State 1,955,104), the total death-rate for the week was 15.63 against 16.60 and 16.00 for the previous two weeks. In the 28 great towns of England and Wales, with an estimated population of 8,762,354, for the week ending April 12th, the death-rate was 20.4. Deaths reported 3418: acute diseases of the respiratory organs (London) 285, whooping-cough 192, measles 142, scarlet fever 63, fever 49, diphtheria 28, diarrhoea 25, small-pox (London eight, Liverpool four, Newcastle three, Birmingham, Sheffield, and Sunderland two each, Derby and Hull one each) 23. The death-rates ranged from 14.9 in Leicester to 31.3 in Wolverhampton; Sheffield 16.1; London 19.1; Leeds 20.1; Birmingham 20.2; Derby 20.3; Birkenhead 21.2; Nottingham 21.9; Blackburn 22.2; Newcastle-on-Tyne 22.4; Liverpool 22.6; Sunderland 22.9; Manchester 25.6. In Edinburgh 22.4; Glasgow 28.7; Dublin 23.0. For the week ending April 12th, in the Swiss towns, there were 56 deaths from consumption, typhoid fever 27, lung dis eases 25, diarrhoeal diseases 14, whooping-cough five, diphtheria and croup four, scarlet fever two, small-pox, measles, and erysipelas each one. The death-rates were, at Geneva 31.6; Zurich 23.6; Basle 19.4; Berne 33.3. The meteorological record for the week ending April 26th, in Boston, was as follows, according to observations furnished by Sergeant O. B. Cole, of the U. S. Signal Corps : 1 O., cloudy; C., clear; F., fair; G., fog; H., hazy; S., smoky; R., rain; T., threatening. OFFICIAL LIST OF CHANGES IN THE MEDICAL CORPS OF THE NAVY DURING THE WEEK ENDING MAY 3, 1884. HARVEY, H. P., passed assistant surgeon, detached from Naval Hospital, Chelsea, and ordered to St. Mary's. MCCARTHY, R. H., passed assistant surgeon, ordered to Naval Hospital, Chelsea. WAGGENER, J. R., passed assistant surgeon, detached from St. Mary's, and ordered to the Hartford. WISE, J. C., surgeon, detached from the New Hampshire, and ordered as member of Board of Examiners at Annapolis. CRAIG, T. C., assistant surgeon, promoted to passed assistant surgeon. OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF OFFICERS SERVING IN THE MEDICAL DEPARTMENT UNITED STATES ARMY FROM APRIL 26, 1884, TO MAY 2, 1884. SHUFELDT, ROBERT W., captain and assistant surgeon. Relieved from temporary duty in Surgeon-General's Office, and ordered to report to Lieutenant-Colonel Basil Norris, surgeon United States Army, attending surgeon Washington, D. C., for temporary duty in his office. Paragraph 6, S. O. 100, A. G. O., April 30, 1884. BARROWS, C. C., first lieutenant and assistant surgeon. Relieved from duty at Fort Grant, A. T., and ordered to report for duty at Whipple Barracks, A. T., relieving First Lieutenant W. E. Hopkins, assistant surgeon, who, upon being relieved, will report for duty as post surgeon at Fort Grant, A. T. Paragraph 1, S. O. 31, headquarters Department of Arizona, April 21, 1884. PHILLIPS, JOHN L., first lieutenant and assistant surgeon (Fort Warren, Mass). Ordered to report for temporary duty to the commanding officer at Fort Preble, Me. Paragraph 1, S. O. 81, headquarters Department of the East, April 28, 1884. CUYLER, JOHN M., colonel and surgeon, retired. Died at Morristown, N. J., April 26, 1884. Changes in Stations of Medical Officers. (Paragraph 2, S. O. 101, A. G. O., May 1, 1884.) HEGER, ANTHONY, major and surgeon. From Department of Texas to Department of the East. HAPPERSETT, J. C. G., major and surgeon. From Department of Texas to Department of the East. BENTLEY, EDWIN, major and surgeon. From Department of the East to Department of Texas. MIDDLETON, PASSMORE, captain and assistant surgeon. From Department of Texas to Department of Missouri. From DeFrom De From DepartFrom Depart KOERPER, E. A., captain and assistant surgeon. partment of the East to Department of Dakota. DICKSON, J. M., captain and assistant surgeon. partment of the East to Department of California. GIRARD, A. C., captain and assistant surgeon. ment of Dakota to Department of Missouri. GIRARD, J. B., captain and assistant surgeon. ment of Arizona to Department of the East. From HALL, J. D., captain and assistant surgeon. From Department of Dakota to Department of the Columbia. HALL, WM. R., captain and assistant surgeon. From Department of Missouri to Department of Texas. CUNINGHAM, T. A., captain and assistant surgeon. Department of the East to Department of Missouri. MCCREERY, GEO., first lieutenant and assistant surgeon. From Department of Arizona to Department of Dakota. COCHRAN, J. J., first lieutenant and assistant surgeon. From Department of Missouri to Department of Arizona. SUFFOLK DISTRICT MEDICAL SOCIETY. — The Section for Clinical Medicine, Pathology, and Hygiene will meet at 19 Boylston Place, on Wednesday, May 14th, at 7.45 o'clock. Dr. E. G. West will report a case of Myxoedema with Autopsy. Drs. F. Minot, R. T. Edes, Streeter, R. H. Fitz, F. G. Webber, J. J. Putnam, W. H. Whitney, and E. G. Cutler will take part in the discussion. Dr. W. N. Bullard will present an account of A Typhoid Epidemic. Dr. Morton Prince will open the discusALBERT N. BLODGETT, M. D., Secretary. sion. NORFOLK DISTRICT MEDICAL SOCIETY. The annual meeting will be held at Rockland Hall, No. 2343 Washington Street, Roxbury District, Boston, on Tuesday, May 13, 1884, at two P. M. The Board of Censors will meet at one o'clock. Order of business: Report of Committees, Report of the Treasurer, Election of Officers, Incidental Business. Communications: A Case of Criminal Abortion with Retention of a Portion of the Secundines. E. F. Dunbar, M. D. The Treatment of Fractures of the Femur without Splints. D. B. Van Slyck, M. D. G. D. TOWNSHEND, M. D. Secretary. BOOKS AND PAMPHLETS RECEIVED. - One Hundredth An niversary of the Foundation of the Medical School of Harvard University. Addresses and Exercises. October 17, 1883. Cambridge. John Wilson & Son. 1884. Studies from the Pathological Laboratory of the University of Pennsylvania. No. XV. The Bacillus Tuberculosis and the Etiology of Tuberculosis. Is Consumption Contagious? Second Communication. By H. F. Formad, B. M., M. D. (Reprint from Philadelphia Medical Times.) Philadelphia. 1884. Congenital Lipoma. By A. Jacobi, M. D. (Reprint.) Jersey City. 1884. Contagious and Infectious Diseases. Measures for their Prevention and Arrest. Small-Pox (Variola), Modified Small-Pox (Varioloid), Chicken Pox (Varicella), Cow Pox (Variola Vaccina), Vaccination, etc. Illustrated by eight Colored Plates. Circular No. 2. Prepared for the Guidance of the Quarantine Officers and Sanitary Inspectors of the Board of Health of the State of Louisiana. By Joseph Jones, M. D. Baton Rouge. 1884. Elementary Principles of Electro-Therapeutics, with 135 Illustrations. Prepared by C. M. Haynes, M. D. Designed for the use of Students and Physicians. Published by the McIntosh Galvanic and Faradic Battery Company. Chicago, Ill. Original Articles. EXCISION OF A PORTION OF INTESTINE, IN CLUDING PART OF THE ILEO-CECAL VALVE, FOR THE CURE OF FECAL FISTULA IN RIGHT GROIN.1 BY C. B. PORTER, M. D., Surgeon Massachusetts General Hospital. DURING the past five years great improvements. have been made in the methods of operating on the intestinal tract, and to-day it is one of the most interesting and progressive of all the departments of abdominal surgery. Up to the year 1877-1878 an occasional bold operator had ventured to perform certain operations on the intestinal tract, such as suture of wounded intestine, or even resection of portions of gangrenous intestine found in the hernial sac, but, as a rule, the surgeon was content when dealing with strangulated hernia to leave the gangrenous bowel to slough off, or, at most, to remove it, and, in either case, to hope to obtain an artificial anus that could be treated later by various plastic operations and occasionally cured. In diseases of the intestine, such as stricture, malignant or otherwise, the only recognized operation was the formation of an artificial anus at some point. This operation was generally performed in the left loin for the relief of strictures of the rectum or the sigmoid flexure. The treatment of wounds of the intestine was almost always expectant, and, unless the intestine was lying outside the abdomen with its cut edges exposed, no treatment except rest and opium was adopted. Cases of suture with or without excision are, however, to be found recorded previous to the period mentioned. In 1727 Ramdohr excised about two feet of gangrenous intestine found in an inguinal hernia. One end was invaginated in the other and secured by sutures, and the patient recovered. Up to the year 1873 there had been recorded eighteen cases of resection of a portion of the intestinal tract, followed by circular suture. The operation is indicated (1) In cases of gangrenous hernia; (2) for the cure of artificial anus; (3) for new growths or stricture of the intestine; (4) for certain cases where tumors of other abdominal or gans are so closely united to the intestines that they cannot be separated; (5) for internal strangulation and invagination with gangrene; (6) For lacerations and wounds of intestines. The first two indications are most frequently met, and it is in these cases that the operation has been most often performed. 8 In the tables of Madelung2 and Bouilly are collected fifty-four resections for gangrenous herniæ, followed by circular suture, with twenty-eight deaths, giving a mortality of a little over fifty per cent. Operations for the cure of artificial anus are next in frequency. Of these I find twenty-five cases with nine deaths, a mortality of thirty-six per cent. The first of these operations was performed by Dr. R. A. Kinloch, of South Carolina, in 1863, for artificial anus following gunshot wound of the intestine. The patient recovered after the formation of a fæcal fistula. Madelung gives nine cases of resection for new growths, seven cases of prolapsed and wounded intes 1 Read before the Surgical Section of the Suffolk District Medical Society, March 5, 1884. 2 Ueber Circuläre Darmnaht und Darmresection. Chir. 1882, xxvii., p. 277. 8 Revue de rgie, May, 1883, p. 362. Arch. f. klin. tines from abdominal injuries, three cases of wounds during laparotomy, and three cases of internal stranperformed by German surgeons, and it is to them that gulation. The greater part of these operations was we are mostly indebted for our present knowledge of the subject. England and America have furnished a very small number of cases. In Bouilly's table is mentioned the successful case of Dr. W. Fuller, of New York. To this we can add two cases reported by Dr. Ill, of New York, one of which recovered. Up to date there have been recorded so far as I can discover one hundred and four cases of resection of intestine, with forty-nine deaths, a mortality of fortyseven per cent. Of these one hundred and four cases there have been recorded four cases where resection followed by suture of the intestine has been performed in the United States, with three recoveries. Beside the hundred and odd cases reported above, there are others on record where the exact lesion is not stated, or where wounds of the intestine made for different objects, or caused by accident, have been united by suture. These are all interesting as bearing on this operation and its history, and show still farther the feasibility of intestinal suture. Perhaps the case to be read cannot strictly be classed with the tabulated cases as it was not a resection of the whole calibre of the bowel; so small a bridge, however, united the large and small intestine that the operation was practically the same. 6 The The method of operating has been thoroughly described in all the journals both at home and abroad, but a brief account of some of the important details in The the operation is, perhaps, not out of place here. two principal points to be observed are the prevention of the entrance of fæces into the abdominal cavity, and a very careful adjustment of the serous surfaces. intestine should be drawn out of the abdomen and surrounded by warm, carbolized towels, and, in cases where laparotomy has been performed, some operators bring the edges of the abdominal incision together with one or two temporary sutures, leaving outside only the knuckle of intestine that is to be operated upon. Various methods have been employed to prevent the oozing of fæces from the cut intestine, some preferring digital compression above and below the wound, while others use different forms of clamps for the purpose. Madelung and others advise excising a somewhat wedge-shaped piece of the intestine, the apex of the wedge pointing toward the mesentery. The united intestine forms therefore an obtuse angle, and the point of suture is thus wider than the rest of the intestine. Many forms of suture have been employed, among them the most important are the invagination suture of Jobert, now seldom used, and the Lembert suture with its various modifications by Czerny and others. It is always to be remembered that scrous surfaces must be opposed. This is very perfectly done by the Lembert-Czerny stitch, which is applied as follows: A row of very fine stitches is taken near the cut edge of the intestine through the serous and muscular coats only, a very fine half curved needle being used. These stitches should be near enough together to completely 4 New York Medical Record, 1882, vol. xxii., p. 430. 5 New York Medical Record, 1883, vol. xxiv., p. 311. 6 It may be mentioned here that there has been one case of resection of the pylorus in the United States, that of Dr. C. M. Richter, of San Francisco. [Western Lancet, 1882, vol. xi., p. 289.] The patient died the day following the operation. close the wound and allow no liquid contents of the bowel to pass through the interspaces. A second row of sutures is then placed outside the first, the needle passing as before only through the serous and muscular coat, including a wider portion of the intestinal wall but not reaching the first row of stitches. In this way the peritoneal surfaces are rolled in and thoroughly opposed. A slight ridge is, of course, made on the inside of the bowel, but if the incisions have been made as recommended above, the lumen is not materially narrowed. Two forms of suture have been used, silk and catgut, and opinions differ as to which is better. Silk is not open to the objection that it may be too quickly absorbed, as is sometimes the case with fine catgut; while catgut is supposed to be less irritating, and to cause less ulceration than silk. Some operators use silk for one row, generally the inner, and catgut for the other. Whichever material is at hand can safely be used if thoroughly carbolized, and a good result can be expected for wounds of this sort when properly treated, as they heal more rapidly and with less irritation than almost any other. When we consider the results thus far obtained in a class of cases always severe, may we not hope and expect to see the operation much more generally adopted in this country instead of being looked upon as an experimental operation performed only by reckless surgeons in foreign hospitals? The history of the operation shows it to have been most carefully worked out by a great series of experiments on animals and a cautious advance, step by step, until the operation now stands as one not only justifiable, but most advisable and proper in certain cases. My patient, Mrs. B., aged sixty-seven, entered the Massachusetts General Hospital August 8, 1883. She had a right inguinal hernia at the age of eight years, and at some subsequent time, date unknown, had developed the same condition on the left side. Three years previous to her admission the heruia of the right side became strangulated. An operation for relief was performed, and according to her statement a portion of the intestine sloughed, and artificial anus was formed in the right groin. Twelve days previous to entrance the hernia of the left side became also strangulated. Herniotomy was performed, the intestine returned into abdominal cavity, and she entered for the care of the resulting wound on left side. In about two weeks this wound was healed, and the only remaining trouble was the almost constant discharge from the artificial anus on right side. September 12th patient was etherized, and an operation for closure of the fistula was performed by Dr. John Homans. The edges were refreshed and closed by silk sutures. Two days subsequent it was noticed that the dressings were soiled by fæcal matter. From that time to December 1st, about two months and a half, the condition varied, the opening would apparently close for a few days more or less, and then suddenly break out again with fæcal discharge. December 2d a small abscess formed two and a half inches nearer the median line, which also discharged fæces. December 10th she had a chill and high temperature, which ushered in an attack of erysipelas, from which she had recovered December 31st. Patient was extremely anxious to have another operation for cure, as she was in such a deplorable condition. Alone in the world, without friends, entirely dependent upon charity, the offensive condition in which she was would prevent her from obtaining any employment, and she would have no home but the almshouse. I talked with her a number of times, explaining fully the danger of any radical operation for cure, and she always insisted that it was her right to demand at my hands anything which afforded a chance of relief, stating that she preferred to die rather than live as she was. According to her wishes I operated January 11, 1884, the bowels having been cleaned out by cathartic and enemata. The condition was this: two fæcal fistulæ in right groin, one about one and one half inches from spine of pubes, and the other about three inches farther outside; each about one inch above Poupart's ligament. A bougie was passed into one of the fistulous openings (the one highest up in the groin) emerging from the other opening three inches lower down. This was then cut down upon, the tissues consisting of hard cicatricial masses, and the entire cavity laid open. This cut divided the lower margin of the abdominal ring, and laid open the hernial sac; the incision was then prolonged downwards to expose the whole sac, making a wound through the skin of abdominal wall four inches long. Two openings into the intestine were found about one inch apart. These were connected by a cut made on the director dividing the superficial epigastric artery, which was first tied with a double ligature. The opening in the intestine was then seen to be in the ileum and cæcum, just at their union. The finger passed readily into the large intestine, but the attempt to introduce it into the small intestine through the ileo-cæcal valve was impossible as the cicatricial contraction involved the valve itself, and the opening was not larger than a small lead pencil. The dilator was introduced and this opening stretched, then with the forefinger of the left haud introduced into the opening a dissection was made to release the intestine from its cicatricial attachments to the abdominal wall, necessitating a section of the muscles from the external abdominal ring outwards for about four inches. This done, the intestine was free from all but its mesenteric attachments. To close up the wound in the intestine the expediency of cutting out a complete section of the intestine was considered, but was not thought wise, as it would involve removing the vermiform appendix and portions of cæcum and ileum. The cicatricial margin of the opening was trimmed off. The opening then involved about four fifths of the calibre of the bowel. The edges of this wound were then approximated, but as one side was small and the other large, intestine, the edges would not lie together smoothly. To obviate this difficulty a longitudinal cut was made in the small intestine, thus giving a longer edge of cut surface, and forming a sort of oval-shaped wound, which could be approximated accurately to the cut edge of the large intestine. wound was then sewed up with silk sutures as follows: The needle was entered about one half inch from the wound, penetrating the peritoneal layer, then traversing the middle layer (muscular) of the gut, and emerging one eighth inch from the margin of the wound, having left the mucous layer untouched. The needle was then entered at the opposite side of the wound, in a corresponding manner traversing the middle layer, and emerging about one half inch from the wound. Ten sutures were introduced in this way. When these were drawn tight they rolled in the free margin of the wound, thus bringing two serous surfaces in contact, and turning the cut edge into the interior of the bowel. The |