216 
DEPARTMENT OF SURGERY. 
marian to expect organic or functional disorders to contra-indi¬ 
cate surgical interference when making his ante-operative 
examination ; but it is advisable, when an emaciated subject 
presents itself in this connection to take in the whole situation, 
and allow nothing to pass unnoticed which may reveal itself in 
the form of such dreaded sequelae as renal insufficiency, as¬ 
thenia, or surgical shock. 
MURPHY BUTTON. 
A, and B, open ; C, closed. 
If the pathological conditions which have reduced the 
vitality of the animal are localized in the intestines and, if the 
surgeon concludes that immediate action would relieve and im¬ 
prove the condition of the patient, he should at once resort to 
vigorous and skillful measures, and employ such means that' 
will economize strength and shorten the operation ; and some¬ 
thing, in the way of medication, should be administered to tone, 
stimulate and strengthen the depleted system. In such cases 
the Murphy Button would be applicable in approximation or 
end-to-end anastomosis, as it can be adjusted in less time than it 
would require to make the sutures indicated under such circum¬ 
stances. (Its application will be considered under intestinal 
surgery.) 
In weighing the respective merits of the different stitches 
used in intestinal approximation and anastomosis, or, in sutur¬ 
ing surgical wounds made in the intestines, we shall consider 
them in the order named, and shall mention the advantages 
and disadvantages of each method as observed by experienced 
surgeons who have performed the operations in question and 
carefully noted the respective value of each method ; and, be¬ 
sides, we are indebted to S. G. Burkholder, M. D. V., M. D., 
