. A manual of operative surgery . is of the development of this branch of intestinal surgery isto be found in Souths edition of Cheliuss Surgery (vol. i.,page 456). To Ramdohr in 1780 is ascribed the honour of having beenthe first successfully to unite the bowel by suture after com-plete division. Since that time invention has run riot among methods foruniting the intestine, and the forms of suture which have beenconsidered as especially adapted to the bowel are now legion. The methods devised have been not only very numerous,but also very varied. Some are imperfect, others are bizarre, 244 AB
. A manual of operative surgery . is of the development of this branch of intestinal surgery isto be found in Souths edition of Cheliuss Surgery (vol. i.,page 456). To Ramdohr in 1780 is ascribed the honour of having beenthe first successfully to unite the bowel by suture after com-plete division. Since that time invention has run riot among methods foruniting the intestine, and the forms of suture which have beenconsidered as especially adapted to the bowel are now legion. The methods devised have been not only very numerous,but also very varied. Some are imperfect, others are bizarre, 244 ABDOMINAL OPERATIONS [part ii not a few are merely curious, many are ingenious, the majorityare elaborate. It is possible, however, to arrange the greater number of theprocedures that have been devised under the following divisionsor plans :— Methods.—i. The divided bowel is brought into the abdominalwound and is retained there. No immediate attempt is made toclose the breach in the intestine. An artificial anus is of necessitv. FIG 69.—MURPHYS BUTTON AND ROBSONS BOBBIN. The left-hand figure shows the small size of Murphys button suitable for use in the smallintestine. The right-hand figure shows Robsons decalcified bone bobbin. established. The closure of this faecal fistula is left to a subsequentperiod. This method is chiefly adapted for cases in which an annularconstriction of the gut is present with much dilatation of theproximal part, the intestine below being contracted. Excisionof the strictured part with immediate end-to-end union beingalmost impossible, the method offers a means of draining theintestine with fair safety, and of allowing the upper part to con-tract. A Pauls glass tube should be inserted in each end. Thechief risk comes in the second operation, when the two portionsare freed and sutured. 2. The two halves of a Murphys button are secured by suturein each end of the divided intestine, and are then fitted a few additional Lemberts su
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