Note 45 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 7)

[In a case of artificial anus which came under the notice of the late Dr. Physick, in 1808, relief was afforded by the following procedure. A crooked needle, armed with a ligature, was passed from one portion of the intestine to the other through the contiguous sides, about one inch within their orifices. The ends of the ligature were then tied with moderate firmness at the external aperture, where they were left protruding. In this situation it gradually made its way through the parts which it embraced by ulcerative action, at the same time that it produced strong adhesion between the two folds of the bowel. After several weeks had elapsed, Dr. Physick divided with a bistoury all the parts which now remained included within the noose of the ligature, thus establishing a direct communication between the upper and lower extremities of the gut.

Dr. Lotz, of Pennsylvania, succeeded a few years ago in curing a case of a similar kind, by means of an instrument which possesses some advantages over that of Dupuytren, and an account of which is published in the eighteenth volume of the American Journal of the Medical Sciences. It is composed of two blades, each six inches long, which are worked by two screws, and which terminate in front in two fenestrated branches, twelve lines in length by three in width. One blade being inserted into each extremity of the gut, they are carefully adjusted by tightening the screws, and are thus made to compress the intervening membranes. The pressure may be increased or diminished at pleasure. In the case treated by Dr. Lotz, the portion of the bowel corresponding with the fenestræ was excised with a gum-lancet on the fourth day from the application of the instrument, and in this manner a direct passage was created between the two ends of the tube.—ED.]