XLIX.

Case of Cancer of the Rectum.

By H. M. PAINE, M. D., and H. G. PRESTON, M. D.

The following report of an ordinary case of cancer of the rectum is not presented on account of any new or unusual symptoms; the principal points of interest are, the minute record of its history and the accurate delineation of the post-mortem appearance of the part, as illustrated by the accompanying engraving.

Mr. farmer, aged seventy-one years, has been ill for two or three years. His present symptoms commenced with what he supposed to be an attack of piles, from which he had not before suffered for more than thirty years. Since the beginning of the attack he has been suffering from frequent bloody discharges, which are not painful nor of sufficient importance to keep him from regular attention to business. The discharges were accompanied with paroxysms of pain which were always relieved by free alvine evacuations. At length these attacks occurred oftener; during the past year they were attended by violent pain and vomiting. During the past summer these paroxysms of pain occurred at intervals of three weeks, and were so severe that he was obliged to keep entirely quiet for from twelve to twenty-four hours, at home; still he was well enough to be about until the severe cold weather of winter. Sometime in January, 1871, he gave up going out of doors altogether, and of course relinquished all work or application to business matters.

At that time he experienced occasional attacks of pain as if located in the pubic bones, resembling not that of colic as much as the soreness of a boil. Two or three weeks ago, the usual movement of the bowels not taking place, the patient resorted to the use of an active cathartic, which produced a very copious evacuation, attended with a great deal of pain; afterward the passages were small in size, yet came away with such force and accompanied by such a quantity of flatus that it seemed to the patient as if they would "blow him up,” to use his own expression.

Many years ago, when he had the attack of piles, it was associated with the formation of small external tumors and accompanied with

355 quite copious hemorrhages. For two months past he has suffered in like manner from bloody evacuations, which, during the past week, have been copious, in clots, and of a very dark color. When daily evacuations take place he suffers little or no pain, but when there is inactivity of the bowels, requiring the assistance of cathartics, there is very troublesome vomiting and severe pain.

A year ago he suffered from many of these attacks, but has never vomited blood. The pain occurs usually about the time a movement should take place. A very frequent symptom is a sensation of extreme fullness of the bowels, a feeling as if they were crowded. Soon an inclination to an evacuation follows, which sometimes consists only of a discharge of bloody matter in small quantity, a teaspoonful or two; sometimes, however, of a greater amount, and at intervals of from one to four hours. With the bloody discharges there is no admixture of fæcal matter. The discharge is always of a dark color; the evacuations are usually preceded by a discharge of urine from the bladder. Recently he has not lost more than a gill of blood in the course of twenty-four hours. Within a day or two past the evacuations of fæcal matter are scanty, of a dark color and very offensive. Recently he has experienced sharp, angry, lancipating, stinging, but not burning pains in the rectum.

The patient has suffered lately from pain in the testicles, several hours at a time, sometimes continuing twenty-four hours; the pain is indescribable; an aching or drawing more than lancinating; the testicles hang down heavily in the scrotum, and are not perceptibly enlarged; the patient looks pale and haggard, and has had that appearance for two or three months past.

The foregoing statement was recorded at my first visit to the patient, in the month of June, 1871. His condition remained about the same for two or three months, his symptoms at times slightly improving, then relapsing again, each paroxysm being rather more aggravated than any preceding one. He grew weaker and suffered more and more pain. After the first of September, his sufferings were so intense, the constant use of morphine was required in order to render his condition even tolerable.

During the month of August a swelling formed in the hypogastrium, apparently as large as a quart measure. It was hard, round, and the touch indicated the presence of a firm, solid tumor.

a large, corpulent person, hence the exact dimensions and character of the swelling could not be easily and clearly defined.

During the last few weeks the patient suffered from frequent attacks of vomiting of very offensive matter. Fæcal evacuations were obtained only by enemas of warm water and an occasional dose of some mild cathartic, were very offensive and attended by very severe pain.

The patient finally died on the fifth of October. The disease proved to be cancer, involving the rectum for about twelve inches in extent, commencing three or four inches from its lower extremity. The tumor in the hypogastrium proved to have been caused by large collections of hardened fæcal matter, with which the large intestine was filled throughout its whole extent. The appearance of the diseased mass is well represented by the accompanying engraving.

Dr. H. G. Preston, of Albany, accompanied me at my first visit, and also several times subsequently, in order to render such surgical aid as the case required. He also conducted the post-mortem

examination.