interfered with. I have always used, however, a loop of ileum because resection of the ileum is safer than resec¬ tion of the sigmoid. In all of my cases operative recov¬ ery was absolutely smooth, and the new vagina seems to take the place very satisfactorily of the natural organ. I was induced to use the bowel for this purpose because a very extended study of the literature of artificial vag¬ inas had shown that in cases of entire absence all other methods resulted in almost complete failure, although full of promise in many cases when the patient left the operating-table. The favorite method of operating had been by transplantation of pieces of skin, to line the artificial canal. In all of these cases, however, to the reports of which I had access, the ultimate results had been very unsatisfactory owing to cicatricial contraction. By the use of the bowel a normal mucous membrane is provided, surrounded by normal connective and mus¬ cular tissue, and with an ample blood-supply. Theoret¬ ically and practically, therefore, such a vagina would seem to fulfil to the highest degree all the requirements.The dangers of operation are simply those inherent to any other deliberate resection and anastomosis .of intes¬ tine; but the operation is one which should certainly not be undertaken by a tyro in surgery. My first operation took over two hours, the last one about half that time, and I think that in an uncomplicated case the operation should be made within the hour. There is, of course, no hemorrhage to amount to anything, and if the field of operation is carefully protected there should be no shock. The danger, therefore, would be merely the danger of a possible infection from the intestine, and that danger in the hands of an expert is very slight. Nevertheless, the danger should be fully explained to the patient, who would then decide whether the operation would be worth while.In addition to the four cases of my own, a successful operation has been reported by Mueller2 and one by Mori.3 Thus we have six successful cases with no mor¬ tality. (So far as I can learn neither Mori nor Mueller refer in any way to my own previous work, although my publications preceded theirs by several years. I under¬ stand, however, that such a failure to give credit is in certain foreign medical circles not looked on as either unetheical or dishonorable).So very little is really known of the mechanical cause of the twisting of the omentum that the report of this case is interesting and may serve to throw some light on the subject.Less is known of the symptom-complex leading to a correct diagnosis of such torsions. This is demonstrated, by the fact that in some sixty odd cases recently col¬ lected, extending over a period of twenty-seven years since 1882, when the first report was macie by Oberst, only one case was diagnosed as such before the opera¬ tion.Corner and Pinches lead one to be satisfied with a diagnosis at the operating table "and not a differential one beforehand. Fuller points out. the difficulty of diagnosis and says that ...
