Although we have not observed a single case of embolism or con ditions which might indicate this in ninety-two cases thus treated up to 1010, yet we have lately so modified this method that we no longer form bars by injection, but we now prepare sterile rods of hard paraffin, S HIM. in diameter and from 6 to S em. long, which we place parareetally under the skin. For this we introduce a sufficiently large trocar near the anal opening similar to the needle; after we have pierced the skin we withdraw the stylet and push the blunt canula forward into the parareetal tissues to the hilt, thus avoiding all bleeding. We then intro duce the prepared paraffin rod through the canula and push it up as high as possible with a- probe, and now remove the canula over the rod and the probe, and lastly we remove the probe. The small opening in the skin closes at once or may be closed with a clamp. After-treatment and results are the same as in injecting the bars.
Instillation is only a more precise way; the rod has a measured size and position, while the bar has an irregular shape and position and is therefore not as easily removed in cases of infection as the smooth straight rod; the technic is also easier because the molten paraffin hardens very quickly and we had therefore to work very rapidly.
When we have diagnosed a gangrenous prolapse we must avoid all operative measures until the IIILICOus membrane is healed. Once the gangrene has progressed so far that we can no longer loosen the loops of intestine, then we will have to consider a resection of the prolapse, because an attempt at a forcible redressement might lead to a peri tonitis from perforation of the gangrenous part. Lenard proposes that we should make a fecal fistula at the signmid flexure and remove the prolapse gradually with intestinal clamps, as had been advised before by Weinlechner in such cases though less radically. A hard rubber tube is introduced into the lumen of the prolapse until it reaches above the anus; after replacing a possible hernia we ligate the prolapse just outside the anus with a piece of rubber tubing, and in from eight to ten days it will come off. This last method has the disadvantage that we cause intestinal loops or peritoneal folds to become gangrenous, still in very weak patients who could not stand an operation we may have to choose it as our last resort; elevating the pelvis, most careful examination, and, if necessary, replacing the contents of peritonea] pockets may aid us in avoiding danger.