DEPARTMENT OF SURGERY. 
377 
edge of the one made in the stomach (Fig. io-f) with two rows 
of stitches, one (h) passing through the muscular and serous 
coats of both stomach and intestine, and the other binding the 
mucous coats. The musculo-serous series of stitches should 
be made of catgut and those binding the mucous coats may 
be made with silk. 
If desired, as many of the stitches as possible in the mus¬ 
culo-serous series may be ligated on the inside (h), but if it is 
more convenient to ligate them on the serous surface it can be 
done with the assurance that the results will be as satisfactory 
as if ligated otherwise. The stitches of the mucous coat may 
be either continuous or interrupted, the interrupted, however, 
are preferable, and should be so applied as to bring the edges 
together properly and bind them firmly. 
In case that the portion of the intestine between the pylorus 
and the part anastomosed, it should be resected and the ends 
approximated; in no instance should the natural lumen of the 
intestinal tract be disconnected, and when the intestinal oper¬ 
ation is complete the.abdominal incision should be sutured, as 
in celiotomy. 
After-treatment .—Shock must be treated as in all other op¬ 
erations ; absolute rest should be enforced ; peristalsis arrested 
by opiates ; enemata containing carminatives should be used to 
relieve flatulence ; and pain must be relieved by medication. 
If indications of internal hsemorrhage follow, the cavity must 
be opened and the haemorrhage arrested ; symptoms of sepsis 
and peritonitis demand cold packs, and if unchecked the cavity 
must be reopened, the septic fluids washed out and the cavity 
irrigated with antiseptics ; but if none of these complications 
appear the wound should not be redressed until the seventh or 
eighth day. 
Nothing should be introduced into the stomach for the first 
two or three days, excepting now and then a very small quan¬ 
tity of alcohol and warm water ; nutritious enemata should be 
substituted for food ; stimulants may be given hypodermically ; 
subcutaneous injections of a normal salt solution may be used 
to stimulate circulation and slacken thirst; liquid food in small 
quantities should be given after the second or third day and 
digestible food after the sixth. 
The patient should not be permitted to over exert himself 
for at least a period of thirty days and the abdominal incision 
should be supported by an improvised truss. 
{To be continued.') 
