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uniting the mucous membrane and the outer being the original Lembert suture by means of which considerable surfaces of the peritoneal coat are inverted and brought into apposition. It is this outer layer of sutures which favors rapid and strong union, the closing of the mucous coat and its inversion being done more to serve as a protective cover- ing or a sort of buttress to prevent the intestinal contents from coming in contact cleocin suspension with the real line of union. Though I think that the inner row is undoubtedly cleocin t pads of advantage, yet without it very many cases have been carried through successfully. The mucous membrane as a means of order cleocin online union is esteemed so lightly by certain operators that they recom- mend that its projecting portion be cut off and all the coats made even before the suturing is commenced. This seems to me to be a mistake, as even when not sewed its mere in- version must form a useful covering to cleocin suppositories the main line of suture. As reo-ards the material, it makes little difference whether silk or catgut be employed, provided it be aseptic. A fine, round needle is generally preferable, the intestinal wall of- fering but little resistance to its introduction. Special forms of intestinal needles, such cleocin topical solution as cleocin oral that of Hagedorn, are also em- ployed with equal satisfaction. What is, however, more important than either the needle or the material, is the character of the tissue through which the sutures are passed. If the circulation of this is im- paired, every attention to the details in adjusting the stitches will be of no avail. As it has been expressed, " where one sews is more important than how one sews." Not only must the sutures be introduced in sound tissue, but the greatest care must be taken that no part of the in- testine be united which is separated in the minutest degree from its mesentery. In the case reported, as is very common- ly done, I removed a wedge of the mesentery, its cleocin 2 base cor- cleocin cost responding with the exsected gut. I do not think now that this is the best practice, and in future I should cut off the mesentery close to its attachment along the border of the intestine, and allow the resulting fullness to arrange itself in 284 Mt'COSH: RBSBOTION OF OANORENOUS INTESTINE IN HERNIA. [N. Y. Mbd. Jodk., fohlH, pitrliaps uniting tin- lnwcr iiiii:;lc with ;i fiw siitiircH. W'lu'ii a \v('(irr(« is romovcd, the I'lirllicr iiwav the ciil i> iiiadit fnuii the raii(dics of those vt'sscls spread out in a fan-slia|>c(l nianiicr, many of them may l)t> nccdh-sslv buy cleocin t cut ofT from tlio main source from whicli iMincH tho l>lood which thc\ carry to the intcslimil walls. Now, this same portion of intestine may not have hecn removed, and to deprive it cleocin t acne at su(dialime of a certain i>ri'poitiou of its Mood-supply may he followed hy disastrous constMpu'nces. This may cleocin cream acne he of no sinjuilicanee when only a few inches are removed, hut when a loiicleocin phosphate believe that tissues could be brought into apposition which were in condition to favor rapid primary union. 3. As the sphace- lated portion was part of the small intestine, and as the patient was old and not particularly well nourished, I cleocin 100 mg feared, if a temporary anus was established, that before it could be closed her strength would be so diminished as to offer but little prospect of a successful result. This leads rae to discuss briefly the advantages and dis- advantages of the two operations. The strong point in favor of immediate resection and suture is that, if recovery results, the patient is cured and no further cleocin antibiotic surgical procedure is de- manded. If, on the other hand, an artificial anus be estab- lished, cleocin iv but one step toward cure has been effected. In the great majority of cases the opening is situated at a point which does not permit the food to be brought into contact with a sufficient length of the intestinal canal to properly nourish the patient. Hence inanition results in very many cases, and in not a few cases death, before an attempt cleocin 900 mg can be made to close the artificial anus. In a small number of cases, however, the opening is at such a point that nutrition continues unaffected and no sec- ondary operation is demanded to prevent death from starva- tion. Such patients, nevertheless, are afilicted with a dis- gusting deformity which is constantly cleocin topical gel forcing itself not only on their own attention but on that of their family cleocin tablets and friends. When a colotomy has been done because of malignant dis- ease, the patient will endure the presence of his false anus with patience, for it prevents suffering and prolongs his life. It is quite otherwise when no advantage is to be

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