CARCINOMA OF THE RECTUM.
DR. L. L. MCARTHUR said that some years ago he presented a paper before the Chicago Gynwcological Society in which he recommended extirpation of the lower part of the rectum for carcinoma, whether it involved the sphincter or not, by an inci sion through the posterior vaginal wall. This method meets the cases in the female very satisfactorily in the majority of in stances, but once in a while a carcinoma is encountered whose lower border is situated on a level with the tip of the cervix. In such a position this incision is inadequate, and under those cir cumstances the much abused Kraske operation can be utilized in many cases.
He passed around a specimen of adenocarcinoma of the rectum which was removed by the ICraske incision without dis turbance of the sacrum, and described the Kraske incision, as well as modifications of it.
He presented the specimen because of two or three interest ing points in connection with the case. The patient had no idea that she had carcinoma, and consulted her physician, Dr. Evarts, because of a slight laceration of the perineum which had existed for a number of years, and which she desired to have repaired. In making a bimanual examination, a tumor was felt behind the uterus and found to be adenocarcinoma of the rectum. Patient had had constipation, which existed all her life, but to which she had paid very little attention. In removing a carcinoma high up in the rectum, where the peritoneum has to be opened, he urged that a preliminary artificial anus be made. This was done by the muscle-splitting operation. In making this muscle-splitting operation, the patient has a certain degree of control which she does not get if the muscle is cut instead of separated. In doing the operation, a single catgut stitch is taken on each side of the aponeurosis of the external oblique so as to make a rounded edge for constriction of the bowel rather than a sharp cutting edge. He found it an easy matter to make the artificial anus, which was established satisfactorily, and at the end of six days the patient was up, and was going about in a week. Fourteen days after the operation the patient was able to walk around the hospital and to go out-doors, the artificial anus then closed, with primary union by operation.