A Case of Artificial Anus Following Herniotomy 1Read before the Bristol Medico-Chirurgical Society, March 13th, 1901.

On November 24th, 1900, a woman came under my care at the Infirmary with right femoral hernia that had been strangulated for a week. She had had much poulticing and much taxis, and the symptoms of obstruction were complete. The skin was red and cedematous all round the tumour, and her general condition was grave in the extreme. On cutting through the skin, fecal matter exuded in more than one place, and the intestine was found to be sloughy and quite adherent at the stricture, and the patient was too bad to undergo a prolonged operation. I divided the stricture and packed it with gauze, and opened the knuckle of intestine freely. A fortnight later sloughs and suppuration had disappeared, and the two ends of bowel were evident in the groin, surrounded by much soreness from the acrid nature of the fecal discharge. To try and remedy this and to keep the patient nourished, the opening in the bowel being not very far from the pylorus, I introduced a glass tube bent upon itself, the ends encased in india-rubber tubing, and it was curious to see the contents of the alimentary canal passing through the tube. This did not prevent leakage, and I could not press it down enough so as to effectually alter the spur. On December 18th I made an attempt to close the anus by an extra-peritoneal operation, but abandoned it, as I could not get enough