File:Interstate medical journal (1906) (14597224119).jpg

Identifier: interstatemedica1319unse (find matches)
Title: Interstate medical journal
Year: 1906 (1900s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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s and from all statistics,we know, however, that as a rule, the seat of the cancer is easily reachedby digital examination; it is therefore not far from the upper borderof the sphincter. Now if we take into consideration the fact, that thecancer frequently extends much further down, especially in the sub-mucosa, than the palpating finger can make out, and if, from comparisonwith the microscopical specimens described above, we assume the exist- StjRGICAli TREATMENT IN CARCINOMA RECTI. ::t:; Cnce of similar conditions in cancer of the rectum, we must agree that,in the vast majority of cases, it is a dangerous undertaking to save thesphincter. I am Fully conscious of the importance of the sphincter muscle,but I believe it is dangerous to arrange the plan of the whole operationwith respect to it. Surgeons who plan a rectal operation for cancer, im-bued with the paramount importance of the sphincter, are liable to savethe sphincter, even if they should find, in the course of the operation,
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Microscopical drawing III. that the carcinoma- reaches further down than anticipated. It is hardlynecessary to add that at the proximal end of the cancer, likewise, thesurgeon must proceed far beyond the diseased tissue. But not only thelocation of the cancer makes the saving of the sphincter in most casesa hazardous undertaking; the functional result of the preserved sphincteris usually far beneath the expectations. Comparatively few cases havegood control and most cases are not much better off than those wherein JONAS. the sphincter has been sacrificed, especially if an artificial anus, made byone of the modern methods, replaces the function of the lost sphincter.The only gain is the greater probability of a recurrence. While we agreethat the essential feature of the normal sphincter, reflex action, is alwayswanting in the artificial anus, the annoyance of the artificial anus to thepatient is usually not so very great. A short time after the operation,the bowel evacuates its content

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