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The mortality rate in this group of 150 patients was 6.67 per cent. For the most part, these patients were young and it would be expected that the mortality rate would be lower than in older patients when cancer and other complications increase the risk. Only 20 per cent of our patients underwent surgery.

Intraluminal pressures of the rectum and anal sphincter were observed in three healthy control subjects at rest and after rectal distention. Nineteen patients, who had undergone a pull-through operation, were studied under identical conditions.

In our experience we have found that the incidence of hemorrhage in patients with diverticular disease is greater than that usually reported by others. We believe this is because patients who have acute or emergency conditions are more likely to go to community hospitals than to medical centers.

This report is based on information obtained from 44 patients upon whom I performed pull-through operations for cancer of the rectum. I feel that the results are somewhat discouraging, and I am hopeful that some means to improve them can be established. One discouraging feature is that only 14 (34 per cent) of 44 patients have normal bowel movements without leakage, without the need to wear pads and without enemas. Only 20 (45 per cent) have a sensation of warning before defecation. In some patients in my series the physiology of the anal canal was within the normal range, and possibly some of the sensory nerve fibers were not removed. Apparently it is justifiable to conclude that, to achieve continence, an effort should be made to preserve the epithelium of the anorectal area and the internal sphincter muscle. The operation, in my opinion, is highly selective. It has a place in the treatment of cancer of the rectum. By March 1, 1969, I had performed 102 pull-through operations.