« AnteriorContinuar »
also affected the posterior wall of the vagina, the mucous membrane of which was not ulcerated, yet she complained of more pain in this part than in the rectum. T saw a similar case in consultation with Dr. Bidsdale. The whole of the digestive organs become deranged, causing flatulent distension of the stomach and intestines, and acute pains in the abdomen: as the disease advances, hiccough, eructations, nausea, and vomiting are present; the appetite fails, emaciation and loss of strength ensue, the countenance assumes the peculiar leaden hue indicative of malignant disease, anasarca and hectic supervene, and under continuous suffering the vital powers succumb. Sometimes obstruction takes place, and the patient dies with the symptoms of internal strangulation; or ulceration having extended up the bowel, rupture takes place during an expulsive effort, and fatal peritonitis occurs. This happened to Dr. , an eminent physician residing in Lincolnshire, who sent for me in July, 1859, the day before he died. His bowels had not been moved for eight days previously to my seeing him: I passed a small O'Beirne's tube and injected some thin warm gruel, which had the effect of bringing away large quantities of faecal matter; this was repeated several times. I left him on the following morning to return to town: subsequently he had several free evacuations: late in the afternoon, while at the closet, he suddenly exclaimed, "something has given way:" great abdominal pain ensued, which continued, in spite of all that was done, till he died.
In the commencement, unless the disease is within reach of the finger, and occurs as hardened tubercles or irregular fungoid growths, the diagnosis of the disease is not easy, and requires a close and accurate consideration of all the symptoms, and a familiarity with the various phases and phenomena of malignant disease, to arrive at a just conception; but in the advanced stage the excessively severe shooting pain, the foetid puriform discharge, the rapid progress of the affection, and the peculiar unhealthy aspect of the countenance, lead to a correct conclusion. Yet the latter appearance is not invariably present, as was illustrated in a man aged fifty, who applied at the Blenheim Dispensary, in 1852, affected with fungoid disease, the masses of which nearly filled the pelvis; his countenance remained clear, and his general health was not much disturbed for a considerable time; he lost blood at stool, and a copious haemorrhage followed any examination, even when conducted with the greatest care and gentleness.
In the treatment of this disease all our efforts will be unavailing in effecting a cure ; but by well-directed means we shall be able to mitigate the sufferings, and even to prolong existence. Narcotics are the remedies chiefly to be relied on to afford ease from pain; they must be administered by the mouth and by the rectum. It will be desirable, in most instances, to confine the patient to a couch, as walking, or even the upright position, will aggravate all the symptoms, in consequence of the vessels of the rectum becoming congested by the gravitation of blood. Great attention must be paid to diet, which should be nutritious, bight, and easy of digestion; all stimulating and heating articles of food being strictly forbidden. The bowels must be kept open by small doses of castor or olive oil, and, after each dejection, emollient and anodyne enemata must be used. Suppositories of hyoscyamus and conium, separately or conjoined, with or without the addition of camphor; also opium and its various preparations will be required to allay the distressing pain. The warm hip-bath, by its soothing effects, will be a useful adjunct in the treatment, and as it produces no fatigue to the patient, may be used at all periods of the disease. Irritation is to be allayed by injections of warm oil, lime-water and oil, and decoction of marsh-mallows with opium. If there is acrid and foetid discharge, emollient and mucilaginous enemata, containing chloride of zinc, well diluted, Peruvian balsam, creosote, &c, must be used. According to the patient's condition, we may prescribe the various preparations of iron, or vegetable tonics witb- alkalies; arsenic is sometimes prescribed for cancerous diseases of other parts, but its usefulness in this or similar cases may be questioned. Morphia and other preparations of opium become indispensable, as the disease advances, to assuage the pain and procure sleep. The tolerance of this drug by the system, when affected with cancer, is extraordinary; doses will be required to procure ease, which, under other circumstances, would prove fatal to half a dozen individuals. A lady I attended with carcinoma, which went on to ulceration, took eight grains of morphia in twenty-four hours, besides using narcotic suppositories and enemata, and, notwithstanding these large doses, her sufferings were most acute: her case was one of the most distressing that could be witnessed; she ultimately sank exhausted by pain and constitutional irritation. In fungoid disease, the haemorrhage at times is very profuse: an endeavour to arrest it must be made by the application to the sacrum of bladders containing pounded ice, the injection of iced water, enemata containing mineral and vegetable astringents, as the preparations of lead, zinc, copper, alum, tannic acid, infusion of matico, &c.
Lisfranc proposed excision of the rectum, when affected with carcinomatous disease, and he has performed the operation several times: other surgeons have also had recourse to the same proceeding, but the results' are by no means favourable. In the greater number of cases the disease returned within a short period in an aggravated form; and it is questionable whether those reported to have been cured were not instances of simple induration, and not true cancer. I have never seen the rectum removed, and should be very unwilling to undertake the operation, from a conviction that I should not be rendering benefit to the patient in the slightest degree; and in saying this, I believe I utter the sentiments of the majority of British surgeons.