The treatment of ulcerative colitis in this country has always been regarded as medical. Like most Australian surgeons, we have had little experience of the surgical treattnent of this condition because patients suffering from ulcerative colitis are only referred for surgical treatment as a last resource. In three metropolitan hospitals over a ten-year period, the Royal Melbourne (in this hospital the ten-year period did not include the last two years), the Alfred, and St. Vincent's, 341 patients suffering from ulcerative colitis were admitted. Of these, 87 died and 23 were treated surgically (in one hospital 3 cases, in another 5, and in a third 15). There were 6 cases of appendicostomy, 6 of ileostomy, 5 of colostomy, 1 of ileosigmoidostomy, 1 of ileocolostomy, and 1 of colectomy. Of the 6 patients subjected to enterostomy 5 died.* From these figures we may infer that in Victoria the incidence of ulcerative colitis is material; that its treatment has been mostly medical and has not been very successful; and that what little surgical treatment has been practised has not been of much value. This paper is founded on a relatively small series of cases, but they were desperate ones, and the later cases reflect team work by the authors-a necessary method of work in this critical surgery which demands painstaking and scientific preparation, often synchronous operating, small bedside operations, skilful post-operative methods, and constant surgical attention.

No abstract

No abstract

No abstract

SINCE I have learnt the great value of operating on the distal colon by the simple but safe method of operating on a distal colon which has been completely defunctioned and, furthermore, adequately prepared (a method described in the British Medical Journal1 and the Medical Press and Circular2), it was only natural that I should extend this method to operations on the rectum, and in particular to those dangerous operations in which it is necessary to unite the rectum to the sigmoid. The object of this paper, therefore, is to discuss the surgery of the rectum and lower sigmoid, and to put forward some methods of operating on the rectummethods which depend for their proper performance on the principle of operation on the defunctioned rectum.This paper is based on the experience gained from clinical material consisting of about 60 patients, on whom rectal resection has been carried out.Problems in the Surgery of the Rectum.-In the surgery of the rectum, the surgery of carcinomatous growths is the most exacting of the rectal problems, for they are of frequent occurrence, being rather more than one-third of the carcinomatous growths of the whole of the alimentary canal (Miles4).The surgery of carcinoma of the rectum is, however, well worth while ; for, although the operation is difficult and serious and the patient runs a high operative risk, nevertheless, if he recovers, he may in quite a majority of cases enjoy a considerable length of life ; for about 50 per cent of cases of carcinoma of the rectum are of a moderate type of malignancy. Indeed, many patients on whom I have operated for carcinoma of the rectum have lived from ten to fifteen years. On the other hand, a proportion of carcinomas of the rectum are of the ' invasive ' type, spreading rather quickly into the rectal wall, and invading the glands and even metastasizing to the liver. This type is not very amenable to even the most radical of operations.A problem in the surgery of the rectum almost as exacting as that of rectal carcinoma is the surgery of inflammatory diverticular tumour of the sigmoid, for, in many cases, the whole sigmoid colon is involved. So that, in this disease, as well as in the case of rectal carcinoma, the great disability resulting from its surgical treatment is that the standard operative procedures render the patient incontinent, making him, as it were, a social leper. While in malignant disease of the rectum or the recto-sigmoid region there may be some excuse for this, in innocent disease of these regions there is none.The Author's Studies in the Surgery of the Rectum.-My attention has been directed to two studies in relation to the surgery of the rectum. The first study aimed at lessening the difficulties, and therefore the dangers, of the standard operation for carcinoma of the rectum, that is, at reducing the high operative mortality, by simplifying the operation. The second sought to devise methods for the removal of the more ' benign ' and more favourably situated carcinoma