. Transactions of the Pathological Society of Philadelphia . ort has been greatly added to; also that the pro-gress of the growth since the operation has been but little, if any. Thus far, I have spoken simply of left lumbar and left iliac to the modern advancement made in intestinal surgery, rightlumbar and right inguinal colotomy are operations, I hope, of the trust, at this time, no surgeon who is abreast with the times wouldthink of either of the two last-mentioned operative procedures, but wouldopen the abdomen of his patient, remove the growth—if possible, byresecti
. Transactions of the Pathological Society of Philadelphia . ort has been greatly added to; also that the pro-gress of the growth since the operation has been but little, if any. Thus far, I have spoken simply of left lumbar and left iliac to the modern advancement made in intestinal surgery, rightlumbar and right inguinal colotomy are operations, I hope, of the trust, at this time, no surgeon who is abreast with the times wouldthink of either of the two last-mentioned operative procedures, but wouldopen the abdomen of his patient, remove the growth—if possible, byresection—and reestablish the continuity of the canal, either by lateralimplantation, or, better, lateral apposition by perforated decalcified boneplates or rubber rings. Where it is not possible to remove the growthin the cases last referred to, sooner than establish an artificial anus, makea lateral anastomosis. In carcinomatous disease of the upper portion of the rectum, colotomyoffers the only operative means of relief. In carcinomatous disease of Fig. Pad. THE DIGESTIVE SYSTEM. 37 the sigmoid flexure, or of the descending colon, lateral anastomosis byileo- or colo-rectostomy may be feasible, but here I give preference tolumbar eolotoruy ; elsewhere I prefer anastomosis. James R., hostler, aet. 38 years. Admitted to the German HospitalJuly 26, 1890. Family history negative. Has had pain on defecation,and discharge of blood-stained matter. On examination, an ulceratingmass was found high up in the rectum, involving the entire calibre ofthe gut. August 16. Left lumbar colorrhaphy Considerable tympanites. ISth. Gut opened; immediate relief from tympany. Wound wasdressed twice daily. Primary union. Patient discharged September 6th. The patient was able to regulate the movement of the bowels at theend of two weeks. He improved markedly in health and strength. Fig. 3.
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