SISCE the time when Metchnikoff suggestcd that the large intestine, with its teemiiig myriads of bacteria, is a source of chronic poisoning, the removal of which would indefinitely prolong life, the idea that the colon is indeed a fons et origo mali has always found certain supporters.
The belicf that purgation is always of benefit to the health is universal and primitive. The more subtle idea that the deleterious processes of the large bowel might be due simply t o the activities of the bacteria contained in it, has more recently been the foundation of attempts to check the normal intestinal flora by the introduction of lactic-acid bacilli.
For more than a decade, Lane has been elaborating his doctrine of intestinal stasis. At first this merely formulated the connection between delay of the intestinal contents, t h e formation of certain thickened bands which tied the gut into various kinks, and a state of chronic auto-intoxication in which loss of flesh, abdominal pain, lassitude, and nervous depression were the chief symptoms. But of late years the effects of intestinal stasis have more and more been said t o be responsible for the direct or indirect causation of disease. And not only has the theory of the causative relation between stasis and disease extended, but the methods of treatment suggested have become more and more daring. A t first the exhibition of paraffin, then the division of one or more kinks, was indicated. But soon the actual diversion of the small intestine into the termination of thc large was regarded as necessary in order t o avoid the cesspool of the colon. Evidence rapidly accumulated, however, that this ileosigmoidostomy must often be followed by a removal of the excluded colon, which otherwise became more of a cesspool than ever. And now colectomy-primary and complete-is boldly claimed to be the proper treatment to cure the evils of stasis in their worst forms. Is this theory founded on f a c t ? Is it the ,discovery of a fundamental truth, or merely an alluring delusion ? And further: If the theory be true in whole or in part, how ought it to guide our practice ?
Does it follow that if stasis is the cause of a morbid condition, thc trcatnient of the latter will consist, primarily, in removing thc intestinal intoxication ? Suppose, for example, that it was proved that arteriosclerosis was the result of a sedentary life; it would not follow that the treatment of advanced vascular degeneration would consist in athletic exerciscs. Similarly, if an ileal kink can cause cancer of the pylorus, this is not a reason for treating gastric carcinoma by colectomy. But what of less fatal diseases, e.g., gastric and duodenal ulceration f It has never yet been proved that these result from stasis, though it is abundantly clear that the two conditions arc ofteii