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excised, and stricture, cancer, perforating ulcer, gangrene, and some gunshot wounds, demand that it be done.
Second.—The method heretofore adopted of suturing the divided ends of the bowel is dangerous, because tympanites, by pressing upon the heart and lungs, interferes with the vital processes in a patient already worn down by disease and shock, and, by distension, causes traction upon the sutures in such degree as, in many instances, to cause their giving way, which is followed by fecal extravasation, peritonitis, and death.
Third.—These dangers are, to a great extent, obviated by making an artificial anus, thus permitting the escape of gases as they form.
Fourth.— Artificial anus is easily cured by a plastic operation, such as is fully described above.
Fifth.-If that portion of the bowel which constitutes the eperon be cut away (being careful not to cut away the mesenteric attachments) at the time of the first operation, no future operation will be found necessary, as the artificial anus will close spontaneously by cicatricial contraction.
Sirth.—The successful cases reported in the paper prove the propositions to be true.
Since the foregoing paper was read, at St. Paul, I wrote a letter, published in the New York Record for August 5, 1882, in which the reasons why artificial anus should be made, in cases of excisions of the intestinal canal, are more fully given; and since the letter was written I have made my seventh enterotomy, being for imperforate rectum in a babe five days old. Being unable to reach the cul de sac of the bowel through the incision first made, I enlarged my room after the method of Verneuil's modified Amussat, excising the coccyx, then excising the end of the bowel and stitching the bowel, after dragging it down, with numerous catgut sutures in the opening in the perineum. The patient, though born prematurely, is at this date doing very well, having no trouble whatever with the artificial anus. I shall report the case in full, with its progress, at another time and place.
MINUTES OF THE SECTION ON STATE
TUESDAY, June 6, 1882. The Section on State Medicine met at Workmen's Hall, Odd Fellows' Block, at the corner of Fifth and Wabashaw Streets, and was called to order, at three o'clock P. M., by the Chairman, Dr. ALBERT L. Gihon, Medical Director United States Navy.
The Secretary, Dr. JAMES H. Sears, of Texas, called the roll of the elected members of the Section, to which but three responded. There was a fair attendance of the members of the Association.
The Chair presented twenty-five special reports of the elected members of the Section, received in reply to a circular signed by the Secretary and himself, calling for information as to the progress of State Medicine in the States they severally represented. These reports mainly consisted of statistical data, and were, on motion, laid on the table for subsequent action. The Secretary read the following :
INDIANA STATE MEDICAL SOCIETY,
Indianapolis, Ind., May 9, 1882.) The following communication from the Wayne County Medical Society was unanimously adopted, and a copy ordered to be forwarded to the American Medical Association at its next session :
RICHMOND, IND., May 8, 1882. At a regular meeting of the Wayne County (Ind.) Medical Society, held on the 4th inst., the following preamble and resolution were unanimously adopted, and a copy directed to be forwarded to the next session of the Indiana State Medical Society.
JOSEPH IUTZI, M. D.,
Secretary Whereas, Jenner's six thousand inoculations of variola after vaccinia, and accumulated testimony since Jenner's day, fully