Licence: Public Domain Mark
Credit: The rectum and anus : their diseases and treatment. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![Chap. XXIV.] Excision: Details of Operation, t^xt^ is empty, except immediately before the act of defie- cation. Recurrence of the disease usually takes place as nodular masses in the cicatrix; or in the deep lumbar glands, livei-, or other internal organs. When oc- curring in the cicatrix, a secondary operation is often attended with good results. And even where not suitable for removal, these secondary growths arc usually much less painful than the primary disease, owing to the destruction of the sensory nerves of the region at the time of operation. Death from internal cancer is also considerably less painful than that from unchecked cancer of the rectum. The most complete and accurate directions as to the selection and the details of operations for excision of rectal cancer are those given by Volkmann.* He classifies the cases met with under three heads : 1. Where there is a localised nodule of disease which can be removed by dilatation of the anus, and the wound closed by suture; this is not attended with difficulty unless situated high up. 2. Where the greater pro- portion of the rectal circumference, including the anus, is diseased; in this case the anus must be sur- rounded by an incision extending into the ischio-rectal fossa, the rectum dissected up, and amputated above the seat of disease. Yolkmann, in the paper alluded to, recommends the brino-ins: down and suturincf of the divided rectal tube to the skin, drainage tubes being inserted between the stitches. 3. Where the disease is altogether above the anus, involving the entire circumference of the bowel. A deep posterior incision to the coccyx is the first essential procedure in this instance ; the rectum is then incised round its circumference above the external sphincter, the bowel dissected up and amputated. This operation is open to an objection not applicable to the other two,](https://iiif.wellcomecollection.org/image/b21229387_0367.jp2/full/800%2C/0/default.jpg)
