ARTHRITIS OF GASTRO-INTESTINAL ORIGIN, ITS DIAGNOSIS AND TREATMENT
Authors: H. W. MARSHALL
Journal: JAMA (1910)

had then turned the fascia of the reclus in from above, leav¬ ing only the posterior portion of the fascia, thus extending the abdomen at least two inches.Six weeks later, 1 made two incisions, one on each side midway between the umbilicus and anterior superior spine of the ilium, and parallel to the fibers of the fascia of the external oblique.The fascia was over¬ lapped for two inches on each side, as shown in article in Surgery, Qyneoology unit Obstetrics, thus changing the entire contour of the patient's abdomen.The patient is doing her own work and feels absolutely well.In two other cases I did the same thing.Dr. C. F. 1'.Koitssia.i.. Chicago: I emphatically believe in the surgical treatment of enteroptosis.I have had some little experience and endorse the view of intra-abdominal pressure being a causative factor of great importance.In seventy-four women and two men operated on for enteroptosis by a new method, sixty-three had previous diagnosis and were deliber¬ ately operated on for its relief.Eighteen of them had previously been operated on for gynecological troubles without relief.My work has been in aggravated cases, in patients prostrated, useless, and with life a burden.They have been mostly those complieated with pelvic troubles and in quite a large percentage (lie small intestines were principally involved, being prolapsed into the lower pelvis below the promontory of the sacrum and bent back around its acute angle, usually with the uterus pressed down, retroverted and the fundus resting on the intestines, compressing them against the sa¬ crum.The operation is done through a transverse or the usual incision, above the symphysis.After raising the intestines and emptying the pelvis completely of intestines, packing them out of-the way, an incision is made in the posterior peritoneum about one inch long just to the right ol the rectum, cither transversely or longitudinally.;then grasping the cul-de-sac of Douglas, or, in some cases, the neck of the uterus, well down with a tenaculum forceps and approximat¬ ing it posteriorly to the sacrum just below the promontory and stitching it into the cut in peritoneum with ohromicized catgut or silk, a linn anchorage is secured for the uterus posteriorly and permanent suspension.The same procedure is carried out to the left of the rectum with or without incising the peritoneum.The sutures are continued on each side from these central points of suspension for sewing the broad ligaments on the same level to the sacral peritoneum, a half- inch below the promontory, until the true pelvis is entirely closed up by a diaphragm of double layers of peritoneum.Which experience has shown to be of ample strength to keep the abdominal organs out of the pelvis.I have deferred reporting this work in the hope of having Some of these patients come through pregnancy, but have so far waited in vain.However, I do not believe the condition produced would materially interfere or complicate natural labor, especially if one were not in too great baste.Such patients should have ample dilatation of the cervix before resorting to the use of forceps.Dr. »I.II.CARSTENS, Detroit: Prevention is the great desideratum.The illustrations of Dr. Smith show the pecul¬ iar shape of the body, which indicates the tendency toward general abdominal ptosis.This being the ease, we should Prevent the latter by systematic development of the body by physical exercise and not loo much school work.Why do we have so much ptosis and neurasthenia ?Because many of the girls ¡it this age arc ambitious; they want to learn and to * Bacteriologic examinations by Mr. Carl Ten Broeck and Mr.