to be able to reach the closet, which would be about as bad as a paralyzed sphincter, and lastly it can offer no advantages over the ligature.

There is what is known as the "American operation," which is the same as the Whitehead operation, only the cut is first made in the upper part of the mucous membrane and then dissected down to the true skin around the anus. The amount of mucous membrane and the locality of each are the same, and the only difference in the two operations is the point where the dissections begin. I can not see where either of the two operations can have any advantage or preference over the other.

A few years ago there was a great tidal wave which swept from one end of the country to the other in favor of the hypodermic injection of carbolic acid for the cure of hemorrhoids. For a few years this was the popular form of treatment, and was pushed by the irregulars until it run into the ground. It destroyed the lives of a vast number of patients. This treatment was as follows: A solution of say twenty per cent carbolic acid was injected into the pile tumor with a hypodermic syringe, and the amount of inflammation it produced caused enough sloughing to destroy the tumor.

The bad results from this treatment have justly about relegated it into oblivion. There are other operations, but they are now seldom done and need not be mentioned.

The palliative treatment of internal hemorrhoids can very safely be limited to good hygiene, obeying the laws of health, the non-indulgence in alcoholics, keeping the alimentary canal in an active condition, keeping all the secretory organs, especially the liver, in a healthy state, and the liberal use of cold water injections after every action of the bowels to keep the rectum clean. The regular use of injections of cold water will do more for the relief of internal hemorrhoids than all other palliative remedies combined. As to salves and ointments, they are generally used by putting the unguent upon the finger and introducing it into the rectum, when it will be found that as the finger is passed through the external sphincter all the ointment is pushed back upon the finger and not a particle of it gets into contact with the pile. Ointments may do some good in external piles, but they are of little or no good in the internal. In a few cases I have found that hot water was more grateful to the sufferer than cold, but as an injection the cold water should always be used.

FLAT LICK, Ky.

THE PERITONEUM OF THE DOG.

BY BYRON ROBINSON, M. D.

Professor of Gynecology in Chicago Post-Graduate School.

I am familiar with no special work on the dog's peritoneum and have been unable to secure any monograph on the subject, hence the following remarks will be chiefly from my investigation of the serous cavity of the dog. Having examined, post-mortem, over two hundred dogs, chiefly following experimental operations on the abdominal viscera, I am convinced that visceral anatomy can be well and profitably studied on the dog, and that students who intend to become abdominal surgeons should be taught how to properly experiment and not to mutilate. In abdominal experiments which are chiefly carried out on the dog, anatomy is just as important in a dog's peritoneum and demands for success just as much respect as man's. So far as inflammation of the peritoneum is concerned the process is analogous and similar in progress and effect in both man and dog. On opening a dog's peritoneal cavity by an incision extending from the xiphoid cartilage to the pubic bone, and by a transverse incision extending from the navel on either side to the outer edge of the quadratus lumborum muscles, one will observe a great omentum covering almost the whole of the viscera except the stomach and liver. This double-bladed bag extends to the floor of the pelvis. It lies between the viscera and anterior abdominal wall and does not roll up among the intestines or about the navel (transverse colon) in dogs as it does in man. The posterior mesogaster or great omentum is far more liberal and extensive in dog than man. It will pass far out of any hernial orifice in the dog's abdominal wall artificially produced for that purpose. In the dog it is plain to see that the mesogaster posterior arises from the mid-dorsal wall and is inserted into the greater curvature of the stomach, for by lifting up the stomach the root of the great omentum can be traced directly back to the vertebral column. The spleen is six to eight inches long and lies in the left end of the great omentum between its blades. The pancreas is some ten inches long and lies between the blades of the mesogaster and mesoduodenum. About one third of the pancreas lies close to the right portion of the great stomach curve, and about two thirds lies in the mesoduodenum corresponding to the curve of the duodenum, that is, the pancreas lies entirely in the mesogaster

posterior. In the human it would be noted that the pancreas lies in the gastro-colic omentum and mesoduodenum. This fact holds good in the human, for, though the pancreas appears behind the peritoneum in man, it is in reality in the mesentery proper and only stripped of its serous layer of flat epithelium. The dog has a long, free duodenum (twelve inches) with a very long mesentery (five inches), which plainly carries the pancreas in its curve. Now, man's pancreas was once in the same condition and situation; when in the fetal stage man possesses a free duodenum and a long mesoduodenum, while the dog permanently retains his with its pancreatic contents all covered with a serous layer of shining epithelium on both sides. Man also retains permanently his mesoduodenum with its pancreatic contents, but minus the shining, serous epithelial layer on both sides of the mesoduodenum. These layers in man have been displaced by irregular growths of viscera. It must be remembered that a typical mesentery of any mammal consists of three distinct layers, viz: (a) two serous epithelial layers, one each side of the mesentery; (b) the mesentery proper, the real neuro-vascular visceral pedicle, consisting of blood-vessels, nerves, lymphatics, fibrous and connective tissue, all woven in a web. The great intestinal loop in a dog has not rotated sufficiently to rob the mesoduodenum of its serous layer and appropriate it to its growing and moving cecum as is the case with man. The permanent stage of a dog's viscera represents, according to my embryologic observations, the stage of man's viscera in about the tenth fetal week. The posterior mesogaster or great omentum in the dog is an enormously elongated, double-bladed peritoneal fold extending from the mid-dorsal wall, behind the stomach, to the floor of the pelvis. It is a depression in the right side of the mesogaster. The circumference or mouth of this sac is contracted to a small aperture which admits two to three fingers in a dog. This aperture lies between the vena cava inferior (posterior) and the portal vein, known as Winslow's foramen in man. This great sac can be inflated by forcing air through its mouth. Curiously enough the blades of the great omentum do not adhere or coalesce as they do in man, but a slight degree of adhesion is found in dogs' great omentum. By tearing through the layers of the great omentum one can easily inspect the interior of the so-called lesser omental cavity. It is similar to that of man. It is divided into two departments by a fold of peritoneum, known as the ligamentum gastro-pancreaticum, produced by the gastric artery projecting up the serous membrane. The right department of

the lesser omental cavity is the smaller, and should be called the atrium bursa omentalis or bursa omenti minoris. The cavity contains Spigel's lobe of the liver, and is entered from the right by Winslow's foramen(foramen omenti minoris). It is entered from the left by Huschke's foramen (foramen omenti majoris). (I term this aperture Huschke's foramen in honor of Prof. Huschke, who wrote the first scientific description of the peritoneum in 1844 in "Sommering's Handbuch der Eingewiede.") The left end of the lesser omental cavity embraces all the remainder of the sac and reaches from behind the stomach to the pelvis. It has no viscus within its cavity as the right portion has. The two departments of the lesser omental bag are divided by the septum bursa omentalis, that is, the ligamentum gastro-pancreaticum. The left sac has only one opening, and that is Huschke's foramen (foramen omenti majoris). There is but a very short transverse colon in a dog, and hence no relation as in man between the great omentum and transverse colon, that is, the dog has no gastro-colic omentum. The relation of the transverse colon and great omentum in a dog's permanent adult state has just begun to assume relations at the right side exactly as it begins in the human fetus at about the tenth week. In the dog's peritoneum is where I first learned to reject the theory of coalescence of the great omentum to the upper blade of the transverse mesocolon, a theory almost universally held by past and present anatomists. I would substitute for the coalescence theory that of displacements or appropriation.

Beginning with the large intestinal peritoneum, we find it covers a cecum without an appendix situated just to the left of and anterior to the navel. The large gut of a dog is about twelve inches long, held to the mid-dorsal wall by a median mesentery; the large bowel has no appendix, no ascending colon, no sigmoid flexure, no appendicæ epiploicæ, no sacculations or bands (tenia coli), just a plain, round, smooth gut lying on the middle on the dorsal wall. Hence comes our old word, rectum, from the early anatomists studying structure from animals instead of man. The small intestine of a dog is some eight feet long, with a long mesentery of about five inches. Now, as the rotation of the great intestinal loop has only proceeded in a dog about one quarter of a turn (in man it is over one half a turn) we can easily note that a dog has a common mesentery (mesenterium commune). The large and small intestines (including duodenum) hang in a single, unbroken, uninterrupted, double-bladed membrane, all arising from the mid-dorsal line. No original mesenteric insertion is yet changed, and only the

slightest piece about the cecum where it has begun its irregular growth and consequent travels toward the right iliac fossa.

Figure 1 (after Chaveau, 1891,) is an excellent drawing of a dog's open abdomen, designed to show the viscera covered by peritoneum: (a) stomach; (b) duodenum; (c) jejunum; (d) ileum; (e) the short cecum,

which possesses no appendix in a dog; (f) shows the beginning of an ascending colon, rather too long for a dog; (g) transverse colon; (h) origin of descending colon; (i) great omentum, thrown up over the chest and held by hooks; (k) spleen; (7) mesentery; (m) pancreas. (1) aorta; (2) superior or great mesenteric artery; (3) artery of duodenum; (4) artery of large intestine; (5) small mesenteric artery. The small intestines are pushed to the left in order to expose the mid-dorsal and right side regions.