The operation of removing the rectum is now almost two centuries old.
Faget performed it in 1739, but Listfrane first successfully extirpated
the rectum for cancer in 1826. The results of the operation in nine
cases were embodied in a thesis by one of his students (Penault, Thesis,
Paris, 1829), and in 1833 the great surgeon himself gave to the world a
complete account of his operation and method, thus establishing the
procedure as a surgical measure. The results in these cases were not
calculated to create any great enthusiasm, for the mortality was high
owing to the lack of aseptic technique. The methods described in older
books give us five varieties of operation for extirpation--the perineal,
the sacral, the vaginal, the abdominal and the combined. In this paper I
shall only endeavor to describe briefly the two methods used by Dr.
Tuttle. Before describing these methods in detail it may be well to
consider the preparation of the patient, which is practically the same
in each. In order to obtain the best results, it is necessary to
increase the patient's strength as far as possible by forced feeding for
a time, to empty the intestinal tract of all hard and putrifying faecal
masses, to establish as far as we may intestinal antisepsis and to
check, in a measure, the purulent secretion from the growth. It requires
from 7 to 10 days, or longer, to properly prepare a patient for this
operation. The diet best calculated to obtain a proper condition of the
intestinal tract is generally conceded to be a nitrogenous one. The
absolute milk diet is not so satisfactory as a mixed diet composed of
meat, strong broth, milk and a small quantity of bread and refined
cereals. The patient should be fed at frequent intervals, and as much as
he can digest. Along with this forced feeding one should administer
daily a saline laxative which will produce two or three thin movements,
and to disinfect the intestinal canal one should give through the
stomach three or four times a day sulpho-carbolate of zinc, grs. iiss.,
in form of an enteric pill. On the day previous to the operation the
perinaeum, sacral region and pubis should be shaved, dressed with a soap
poultice for two hours, then washed and dressed with bichloride
dressing, which should be retained until patient is anesthetized.
Notwithstanding all of these preparations, it is impossible to obtain
absolute asepsis of the affected area, and so many fatalities occur from
infection that it is deemed wise by many surgeons to make an artificial
inguinal anus as a preliminary procedure in all extirpations of the
rectum.