INSTRUMENT FOR FACILITATING THE OF HOLLOW VISCERA.
Through the courtesy of Dr. O'Hara that day, he had used these forceps on a case of tubercular peri tonitis which, after an operation a year ago, developed a faecal fistula in the line of the incision. After freeing up the adhesions, he found the perforation in the bowel to be over two inches, necessitating a resection of the ileum. The rapidity and ease with which the forceps were used was surprising, and the time con sumed in resecting the gut and making an end-to-end anastomosis was probably not over five or six minutes. He could fully bear out all the claims Dr. O'Hara made for the instrument, and he called attention particularly to the simplicity of the forceps, their easy application, and the impossibility of leakage while the anas tomosis is being done.
Dr. Huntington said that he would hesitate to make end to-end anastomosis between the small and large bowel by at tempting to close a portion of the large bowel and then attaching the small bowel to the resulting aperture. There is a fault in that procedure that does not, however, minimize the value of the in strument. He personally did not approve of the metallic button, and believed, if accurate statistics of the operations done by the Murphy button throughout this country to-day could be furnished, surgeons would have a list of tragedies that would be appalling. He had used it fourteen times, and if he included one which was reported six days after the performance of the operation, and since he left home, as being probably a success, he had but two successes to record.
DR. DAVIS remarked that the question of time in doing an anastomosis with this instrument as compared with .that of the Murphy button had been raised. It seemed to him that it was perfectly easy to decide the relative time consumed by comparing the two procedures. In the first place, with the Murphy button, it is required to place the two ends in place and fix each with a purse-string suture. That 'would take probably longer than the clamping of these two forceps to the gut. In the second place, the Murphy button is usually reinforced by Lembert's sutures around the button. If that is done, then it is a question of sur rounding the entire circumference of the gut by Lembert's su tures. That is all Dr. O'Hara does.
The gut being the same in both instances, the time consumed in applying the Lembert's sutures around the gut in both the Murphy button and these forceps would be approximately the same. Therefore, if the button was applied with a single row of sutures, and if Dr. O'Hara only used a single row of sutures in his operation, then it would appear that both operations could be done in the same time. In other words, it would take no longer to make the operation with Dr. O'Hara's forceps than it would take with the Murphy button reinforced with a single layer of Lembert's sutures.