teries pass in a longitudinal direction giving off a large number of lateral, circular branches, which freely anastomose. They arise from the inferior mesenteric, internal iliac, and internal pudic. The veins are similarly arranged, forming about the lower end of the rectum the hemorrhoidal venous plexus. The principal vein trunks from this plexus follow the general longitudinal course of the arteries and empty into the inferior mesenteric and internal iliac veins. It is the varicose condition of this hemorrhoidal plexus of veins that constitutes piles.

The papillæ which are found in every normal rectum and which “orificial" surgeons are taught to remove with as much care as though they were imps of malignity, are centers for nerves of special sense, as are the papillæ circumvallatæ of the tongue and the sensory papillæ of the lips, and should be respected even though they do occupy an humble and obscure portion of the body.

INSTRUMENTS.-The instruments necessary for this operation are to be found in every surgeon's armamentarium. They are: a large bivalve rectal speculum, a pair of strong "T" forceps with deeply serrated jaws and free open space between the shanks, an inch or more in length, the "T" being at least an inch long, long-handled tenaculum straight from the angle to the point, a scalpel, a good needle-holder, plenty of round, full curved needles, and good cat-gut.

THE OPERATION.-The patient having been prepared by a thorough cleansing externally and internally, is completely anesthetized and placed on the operating table in a good light. The anus is thoroughly dilated with a speculum, about an inch of the diseased tissue is caught up with the tenaculum, thrust deeply into the mass, and drawn into the jaws of the "T" forceps far enough to include the length of tissue which the operator desires to remove, remembering that the part removed is double the length drawn into the forceps.

Close the forceps tightly. Pass a suture deeply into the tis sues close to each end of the "T" of the forceps, and tie firmly. Pass three or more sutures from above downward, around the "T" well beyond the bite of the forceps, leaving the ends long enough to tie easily. Cut off the tissues close to the forceps, and tie the sutures. By leaving the ends of the first two sutures long enough for the assistant to hold, the remaining ones are more

easily tied. Then cut the sutures off close.

This is repeated around the rectum as necessary, always leaving a half inch of tissue undisturbed between the bites of the forceps. The line of each incision should be a little above or below its predecessor, thus making a broken line of cicatrices around the rectum, and thereby diminishing the possibilities of stricture, as contraction is most apt to follow a cicatrix.

Make no effort to remove the whole of the varicosity, for if a third of it is removed the rest will disappear. Preserve as much of the healthy rectum as possible, and do not remove even a single papilla, if it can be avoided, unless it shows disease. Preserve the circumference of the ampulla analis as much as possible.

There is but little loss of blood, even in the worst cases, but should a "spouter" continue to bleed after the sutures are tied, pass another around it. Blow iodoform into the wounds, pack loosely with iodoform gauze, and keep the patient in bed for from ten days to two weeks. The gauze should be removed in six or eight hours. Should there be any indurated external pile tumors. they should be snipped off after the other work is done.

It may be urged that this method will cause an irregular puckering where the tissue is removed, and leave pouches, in the intervals, which will be difficult to empty, but experience proves this not to be the case. The great elasticity and contractility of the part helps nature to shape what remains into a perfect rectum, with all the tactile and special sense of the organ unimpaired.

The "slit" operation is in favor with many of our best surgeons, and answers the purpose beautifully in most of the milder cases, but where much tissue is to be removed it should not be considered, as the rectal caliber is too greatly diminished thereby. It is exceedingly rare that the circumference of the rectum should be diminished, but quite common that it should be shortened.

The doctor calls attention to the following case, illustrative of his method of operating in this class of cases:

"A man about seventy years of age had a varicose condition of the entire hemorrhoidal plexus, with chronic prolapse and hypertrophy of the mucous membrane of twenty years' durationan ideal case for the Whitehead or American operation. I gave him this operation, and in three or four months he reported with, as he expressed it, 'the best rectum in Franklin county.' In this case we encircled the entire rectum, and removed about one and a

half inches of its longitude with each bite of the forceps. The accompanying photogravure will aid in a better understanding of the operation."

EXPLANATION.-This cut is from a photograph of a section

of the rectum and anus laid open, with about an inch of the integument. Numbers 1 and 2 represent the ligatures at each end of the "T"; numbers 3 and 4 show the ends of the sutures held by forceps while the tissue is about to be severed close to the "T"; number 5 shows the exsection completed, with the sutures in place. In this case about an inch of the tissues are removed from the length of the rectum."

Columbus Medical Journal.

A Bi-Weekly Journal Devoted to the Advancement of the
Medical and Surgical Sciences.

THE INHUMANITY OF ANTIVIVISECTION. There is a vast field for humanity in this world of ours. To recapitulate the cruelties habitually perpetrated upon animals in the name of Sport and Commerce would be like quoting a timehonored proverb-a work of supererogation.

And still these

practices proceed unencumbered by unfriendly legislation and unhampered by humane restriction, while the labor which, if properly directed, would accomplish untold good in these lines, is devoted to harassing humane study and embarrassing scientific investigation. The unfortunate degenerates, who in the face of real de