is, I believe, admitted even by those who never do it. Their objection to completing the operation in this way is based upon a case having occurred in which the gut being twisted, the wrong end was sewn up and dropped back, with of course a fatal result, and Mr. Christopher Heath admits this to be a formidable argument against the practice in question. But a method has occurred to me of obviating such a danger, though as yet no opportunity has occurred of practising it on the living body. In lumbar colotomy where the gut is not much distended, and cannot easily be found, it is usual to distend ic with air or water pumped in per anum. Why should not this method be adopted in inguinal colotomy to enable the operator to decide which is the lower end of the bowel 1 With the gut held between the finger and thumb, the distension

on one or the other side would soon prove it. A bougie might even be passed up in cases in which ulceration, &c., did not bar its use. The fasces would have to be washed out through the cut end successfully done by Mr. Jesset, or, if possible, this should be done per anum. The objection that mucus will still accumulate in the rectum remains, but won't it collect nearly as much if a really efficient spur is provided 1 And consider^ ing that a short mesentery, and a consequently deficient spur are of fairly frequent occurrence, I think the suggestion deserves a trial, as it removes one of the greatest admitted dangers in the more radical operation.

I am,


Inguinal Colotomy; a Suggestion.

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