DEPARTMENT OF SURGERY. 
489 
but it might in some cases be practical. The indication for 
such a procedure is generally cancer of the rectum or growths 
that cannot be removed. If the patient is near death from the 
disease or growth, and it is evident that the relief of the obstruc¬ 
tion would prolong life for two or three weeks, and if any ad¬ 
vantage can be gained by such an extension of life, the operation 
should be performed, otherwise it should never be undertaken. 
Operation .—The patient should be cast, secured and anaesthe¬ 
tized, the site of the incision chosen, the hair clipped and sur¬ 
face shaved and rendered as near aseptic as possible ; the incis¬ 
ion is made through the walls and a loop of the intestine is 
brought through the incision and a stiff sterilized rod passed 
under the loop through the mesentery. If temporary drainage 
is required, an incision is made into the loop and a tube in¬ 
serted ; but for permanent drainage (artificial anus) the incision 
should not be made into the intestine for at least three or four 
days, when the adhesions of the intestine and the edges of the 
surgical wound made in the wall are complete. No sutures are 
required, and when the intestine is cut, it should be cut as near 
the posterior part of the loop as possible, which will atrophy 
and is soon out of sight; the anterior portion of the loop should 
protrude beyond the external surface of the walls to prevent 
the faeces from running over the surrounding skin. The chief 
object in view is to prevent infection, and the wound should be 
dressed accordingly. 
After-treatment .—If the dressings are properly and carefully 
applied from the beginning, the wound will unite by primary 
union ; the management of the wound depends chiefly upon the 
care taken to prevent infection. The best anus is the one that 
the mucous membrane is gripped by the parietal muscles; it 
never dribbles, and yields only to intestinal contractions and is 
closed by the contraction of the oblique muscles. 
6. Enterorraphy .—In enterorraphy we include all intestinal 
sutures, and it will be impossible to consider all of them in de¬ 
tail, or to select any one of the methods that can under all cir¬ 
cumstances be considered the best, for under certain conditions 
one may be practical while under another it may be counter- 
indicated ; therefore the operator in each instance should select 
the method which he thinks will meet the requirements. 
The needle used in making intestinal sutures should be 
round, with no cutting edge, and slightly curved at the point. 
The point should not be too sharp, so that in passing through 
the tissues it will not penetrate blood vessels, but push them 
