. Transactions of the Pathological Society of Philadelphia . mbar operations as well, when the urgency of the cases does not demandan immediate opening. Indications for the operation: Carcinoma of the rectum, either in theform of a growth or a stricture, too high to render practicable the THE DIGESTIVE SYSTEM. 35 removal through the perineum or back by excising the coccyx, and,perhaps, one or two of the lower segments of the sacrum, or throughboth the perineum and the back. Stricture of the terminal part of the sigmoid flexure and of the upperpart of the rectum, with symptoms of obstruction, t
. Transactions of the Pathological Society of Philadelphia . mbar operations as well, when the urgency of the cases does not demandan immediate opening. Indications for the operation: Carcinoma of the rectum, either in theform of a growth or a stricture, too high to render practicable the THE DIGESTIVE SYSTEM. 35 removal through the perineum or back by excising the coccyx, and,perhaps, one or two of the lower segments of the sacrum, or throughboth the perineum and the back. Stricture of the terminal part of the sigmoid flexure and of the upperpart of the rectum, with symptoms of obstruction, too high to treat suc-cessfully by dilatation, divulsion, or division. Incurable cases of recto-vaginal or recto-vesical fistula. Extensiveand otherwise incurable cases of ulceration of the rectum, making life aburden to the patient. Imperforate anus, where operation through the perineum and backproves of no avail. Irremovable growths of the pelvis, causing obstruction by making pres-sure upon the rectum. In this connection, I will make mention of a Fig. Showing the artificial anus. The two openings drawn apart so as to bring out the spur. supra-pubic cystotomy that had to be done by a colleague in one of ourhospitals for retention of urine, occasioned by pressure of such a growthagainst the base of the bladder. Here it was only possible to pass acatheter when the patient (male) was anaesthetized. When should the operation be done ? I believe the position held bymost surgeons in regard to the operation of colotomy, namely, that it isonly to be thought of as a last means of relief in cases of carcinoma ofthe rectum and sigmoid flexure, also in strictures of small calibre other-wise incurable, is a too conservative one. We must all admit that thechief factor in the rapid growth of carcinoma involving the bowel is theirritation to which it is constantly subjected, first, by the peristalticaction of the bowel, and, secondly, by the passage of fecal matter throughthe involved por
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