Annals of surgery . was carefully considered at that time, but we did not deem it awise procedure. Had I then had Dr. Murphys buttons I couldhave done the anastomosis so quickly that I think it would havebeen perfectly feasible, but his paper was not published untilthree days after the first operation was done. The duration of the second operation was considerable, as thedissection of the artificial anus was very tedious on account of thewidespread adhesions. Although these adhesions were a seriousdifficulty in the second operation, they have given me a confidencein the security of Maydls oper
Annals of surgery . was carefully considered at that time, but we did not deem it awise procedure. Had I then had Dr. Murphys buttons I couldhave done the anastomosis so quickly that I think it would havebeen perfectly feasible, but his paper was not published untilthree days after the first operation was done. The duration of the second operation was considerable, as thedissection of the artificial anus was very tedious on account of thewidespread adhesions. Although these adhesions were a seriousdifficulty in the second operation, they have given me a confidencein the security of Maydls operation for artificial anus, which isnot without satisfaction. As soon as I had made a diagnosis I closed the right lateralwound, which required, of course, but a very few minutes. It maybe asked why not make a median incision above the umbilicus,both for the purpose of making the diagnosis and of doingimmediately an ileo-colostomy in the transverse colon, instead of 1 N. Y. Medical Record, December 10, 1892. Il Ml Photograph of the patients abdomen (as she lay on her right side) to show the three incisions. IL EO-COL OS TOM Y BY Ml R PffY*S B UTTON. 659 making three incisions. I think this would not haadvisable for the following reasons : The valve was soapparently the focus of the attacks of pain prior to the firstoperation that I thought it possible the obstruction might 1any point in the ascending colon, and an incision in the medianline above the umbilicus, unless it were so large as to admit thehand, would not have given me access to the entire ascendingcolon nearly so well as the lateral opening; and again, in case Ihad found by the right lateral opening that the malignant tumorcould be removed, I should have proceeded to excise it at could not have been done, of course, nearly so well througha median incision as through a lateral one on account of theadhesions. In fact, now that I have made two incisions onseveral occasions in abdominal operation
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