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I t is the purpose of the following paper to discuss briefly the methods which have been used in the operation for directing the blood of the portal vein into the vena cava, and to describe a new instrument for cut t ing the opening between the veins. The operation is named after N. V. Eck (i), who conceived the idea of establishing an artificial anastomosis between the portal vein and the vena cava, in order to relieve the congestion of the portal system in cirrhosis of the liver. Never a t tempted upon the human being, the operation performed on dogs has yielded a great par t of the experimental facts concerning the normal physiology of the liver, and still offers an invaluable method for approaching many problems of metabolism. I shall leave aside for the present the question of the changes in the animal economy which follow the diversion of the portal blood current, simply appending a list of the literature bearing upon the subject. The necessity of a stringent asepsis during a surgical procedure requiring between one and two hours for its completion is self-evident. The unusual difficulties encountered are peculiar to this operation and are purely of a mechanical nature: one is referable to the inaccessibility of the site of the opera t iontha t portion of the portal vein extending about five to eight centimeters below the opening of the vena pancreatico-duodenalis, and the somewhat longer section of the vena cava between the

THE ARTIFICIAL ANASTOMOSIS BETWEEN THE PORTAL VEIN AND THE VENA CAVA INFERIORECK'S FISTULA