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In 1930, having observed marked advantages of a perineal colostomy in resections of the pelvic colon, I eliminated a permanent abdominal opening in any case in which the lesion was considered surgically removable. Since this change in technic 220 patients with cancer of the large intestine have been treated by operation. In twenty-six instances the disease was so advanced that only an exploration or colostomy was done. In 103 the rectosigmoid was resected with the formation of a perineal anus but without sphincter control. After the first three or four months of adjustment these patients have been very appreciative of the perineal opening, quite different from the attitude of many who have been left with an abdominal colostomy. An abdominal colostomy necessitates a pad or other protection. With an adequate perineal opening, although without sphincter control, 5 per cent of my patients require no local protection, special diet or other more...

The surgical treatment of hypertension by sympathetic resection has met many objections in the last few years. One of these concerns the specific value of sympathectomy in the reduction of blood pressure in the patients who have undergone operation. In 1939 Volini and Flaxman 1 followed the course of the blood pressure of 17 hypertensive patients operatedon for different reasons not related to their hypertension. They observed in almost every case a decided reduction of the blood pressure after the operation. They arrived at the conclusion that the blood pressure reduction attributed to nerve resection was actually due to the general conditions to which every patient who is operated on is subjected: bed rest, anesthesia, sedatives, operative shock and special diet. On these bases they denied the specific effect of sympathetic nerve resection on hypertension. In September 1943 Adamson and Dubo 2 arrived at a similar conclusion. Following more...

The average hospital to-day is inadequately equipped to feed patients properly according to modern dietetic principles. The chief fault lies with the medical staff rather than with the administrative department of the hospital. These are sweeping statements, but I believe they are justified. If true, the statements should not be interpreted as indicating neglect of patients, either on the part of the institution or on the part of the members of the staff, but merely as evidence of the fact that scientific dietetics is a subject of recent development with which the profession at large is not yet thoroughly familiar. But these principles are now known, and the time is not far distant when the hospital or the physician who feeds patients in the old way will justly be accused of neglect. Up to a short time ago the feeding of patients was a matter of empiricism. By experience we more...

In a previous paper, 1 the value of the specific gravity of the urine as a test of kidney function was discussed. It was pointed out that if the specific gravity of the urine is to be employed as a functional test, certain conditions must be fulfilled: First, a sufficient amount of solid wastes must be presented to the kidneys for excretion. This was obtained by a special diet. Second, the amount of water available for the excretion of these wastes must be limited. This condition was observed by restricting the fluid intake. The purpose of these conditions was to impose maximal strain on the kidneys and to secure the most concentrated urine possible. Under these conditions it was found that normal individuals were able to concentrate the urine to a specific gravity of 1.026 or above. Diseased kidneys were unable to concentrate to 1.026. The more severe the renal more...

To the Editor:— In answer to several inquiries about the phenylalanine-poor diet for phenylketonuric children, mentioned in the Correspondence section ofThe Journal, Sept. 28, 1957, page 392, in general, it has been a problem to provide a satisfactory diet of this type, especially for older children. I have seen a 3-year-old child fight every spoonful of his new diet, while his 2-month-old brother completely accepted the change in his formula. This surely has been the experience of others. In small babies the problem of acceptability is minimal, and it is easier to provide the essentials of a well-rounded diet. All proteins in foods that have been tested contain about 5% of phenylalanine by weight. Thus it is impossible to devise a satisfactory home diet markedly deficient in phenylalanine and yet adequate in protein as required for growth and repair. The basis of the special diet is a synthetic mixture more...

The strikingly beneficial value of a special diet for patients with pernicious anemia has been demonstrated recently by Minot and Murphy.1A diet containing, among other factors, a large quantity of complete proteins in the form of liver, and which was relatively low in fat, caused forty-five consecutive cases to show a prompt, rapid and distinct remission of the anemia coincident with marked symptomatic improvement, except for pronounced disorders due to spinal cord lesions. We have studied certain changes in the composition of the blood in ten of these cases which were in the Peter Bent Brigham Hospital between November, 1925, and March, 1926. Our observations were made for the purpose of determining some of the physiologic changes that occurred in cases of pernicious anemia treated by this method. Our results are reported in this paper. CLINICAL MATERIAL AND METHODS USED The clinical material consisted of ten typical cases more...