. Annals of surgery . on to-day. ln(|uiry ilevelo])cd the fact that this improvement was notdue to the advent of the X-ray as a help in diagnosis; before this methodof examination was in current use there had been a drop from 22 to 13months in duration of symptoms. Judging from this series, it ajipears that for many months these patientsconsistentlv i)resent siptonis which can hardly escape recognition, and yet,in the face of this fact. the\- fail to ap[)reciate the significance of these 214 CAXCER OF THE COLON symptoms or to investigate the cause of the trouble; this state oi affairsapparentl
. Annals of surgery . on to-day. ln(|uiry ilevelo])cd the fact that this improvement was notdue to the advent of the X-ray as a help in diagnosis; before this methodof examination was in current use there had been a drop from 22 to 13months in duration of symptoms. Judging from this series, it ajipears that for many months these patientsconsistentlv i)resent siptonis which can hardly escape recognition, and yet,in the face of this fact. the\- fail to ap[)reciate the significance of these 214 CAXCER OF THE COLON symptoms or to investigate the cause of the trouble; this state oi affairsapparently presents an excellent opportunity lor an effort to bring thepublic to understand that persistently recurring partial obstruction, or unex-plained alKloniinal pain accompanied b\- blood in the stools, may be a warningof serious trouble. Reduction of the duration of symptoms offers more tjnanfurther technical elaboration of the operative treatment. Pathological Features.—The tumors are almost uniformly adenocarci-. W^ ^ Vi ^ Fic. 4.—p. N. 31610. .Wenocarcinoma of the colon showing direct extension of thegrowth in the bowel wall, undermining the normal mucosa. The advancing edge of the can-cer is well sllown in the lower right-hand portion of the picture. noma and show a definite tendency to reproduce roughly the glands in the wallof the bowel. Most of the growths have a decided excess of epithelium with acorrespondingly limited amount of fibrous tissue, so that there is usuallyproduced a fairly large mass. The extreme scirrhous type resulting fromfibrous overgrowth and producing a marked degree of obstruction is infre-quent in this series. There is found at times a certain amount of colloiddegeneration. In the earlier cases perforation of the bowel with a secondaryabscess is not infrequent, there lieing 16 such cases, the latest of which wasrecognized in 1913. Excepting one case which ai)])arently shows a carci- 215 ROBERT T. MILLER noma developing from a benign adenoma, th
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
