Jejunostomy is an operation occasionally called for as a means of giving relief and prolonging life in patients suffering from advanced disease of the stomach, where on exploration it is discovered to be impracticable to perform gastrectomy, gastrostomy, or gastroenterostomy. The indications for the operation in cancer cases are :

(1) Extensive cancer of the stomach too advanced for gastrectomy, and in which no healthy spot of sufficient size on the stomach wall can be found for the purpose of gastrostomy or gastroenterostomy.

(2) After complete gastrectomy, when it has been impossible to satisfactorily unite the oesophagus to the intestine.

In non-malignant cases it may be required in : (1) General cicatricial contraction of the stomach, simple in character, and due to the swallowing of caustic fluid, in which the stomach has been so far damaged that it no longer performs its functions or even allows of the proper passage onwards of food.

(2) In very extensive gastric ulceration with deformity of the stomach, as in hour-glass contraction, where it is impracticable to perform any of the ordinary operations with probability of success.

(3) As a means of giving the stomach and duodenum rest in severe hgematemesis or melaena, when a longer operation could not be borne.

It has also been suggested in pronounced hyper-chlorhydria in preference to gastroenterostomy in order to avoid peptic ulcer of the jejunum; but as the latter is extremely rare and practically only associated with anterior gastroenterostomy-a method that is being replaced by the posterior operation-I do not think surgeons generally will be likely to endorse Neumann's suggestion.