a. — The peritonaeum.

It. — The kidney.

c. — The mesentery.

d. — The bowels.

e. — The colon.

/. — The spine.

Figure 3, represents the operation of Littrd for the formation of an
artificial anus at the right groin. After Bernard and Huette.

a, a. — The outline of the colon.

h, b. — The extent of inguinal incision in the integuments.

c, c. — An instrument passed beneath the distended colon, in order to
bring it to the front wound.

d. — The point of the colon which is to be perforated.

Figure 4, represents the shape and appearance of the anus formed by
the operation of Littre'. The long diameter of the opening corresponds to
the line of the groin, and the bowel is so attached to the edges of the in-
cision in the abdomen as to prevent contraction of the orifice, or the escape
of the bowel into the abdomen. After Bernard and Huette.

Figure 5, represents the operation of Littre', as modified by Pillore.
Section of the ca;cuni. After Bourgery.

Figure 0, represents Pillore's operation for iliac artificial anus completed.
The wound in the intestine united to the wound in the integument by six
I <;ints of twisted suture. After Bourgrry.



PlahnXV



l'i(j . I .



Fiq. Z




d..




"iW^.'^^^*




Fiuf 3




'A^^^^£-'^^^



Fia.



'%%^

d: :%





PLATE XVI.

Plate XVI. illustrates Callisen's operation for abdominal artificial anus,
as modified by Amussat.

EXPLANATION.

Figure 1, represents the operation of Amussat, for tlie formation of aa
abdominal anus in the left lumbar region.

After Bernard and Huetle.
a. a. — The outlines of the descending colon.
6, 6. — The extent of the incision in the integuments.

c, c. — An instrument placed beneath the bowel to render it prominent.

d, d. — Ligatures passed through the bowel in order to attach it to the

sides of the wound, before it is perforated.
Figure 2, represents the appearance of the artificial anus formed in
Amussat's operation, showing the position of the sutures and the character
of the opening. After Bernard and Huette.

Figure 3, represents the lumbar artificial anus established bj' Amussat.

After Bonrgery.



PlaLeXVl



F"J '



.^^ia^^~




Fvg 3



Ftg. Z





ON THE

CONGENITAL MALFORMATIONS

OF THE

RECTUM AND ANUS.



CH^I^TER I.

INTKODUCTION.

SECTION L

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17 2



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INTUODUCTION. 19

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20 INTKODUCTION.

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22 INTEODTTCTION.

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INTKODUCTION. 23

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INTUODUCTION. 25

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Page (C. G.) Boston Medical and' Surgical Journal. Vol.