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1911 Journal of the American Medical Association  
History.\p=m-\Mr.B., a retired farmer, aged 62, presented himself at my office complaining of pain in the abdomen, and alternate attacks of constipation and diarrhea. The personal and family history was negative. The patient had always been well, with the exception of having been confined to his bed for a few days, some years ago, on account of having been kicked in the abdomen by a horse. Examination of the abdomen revealed a mass about the size of an orange in the cecal region. The patient
more » ... ion. The patient had observed the occurrence of ribbon stools. Operation.\p=m-\April29, 1910, at the German Hospital, I did a laparotomy and found an extensive involvement of the cecum, appendix and adjacent glands. A macroscopic diagnosis of carcinoma was made and the following operation performed: The ileum was clamped and divided three inches from the ileocecal junction. The cut proximal end was closed and Fig. 1.-External appearance of tumor and surrounding structures In case of adenocarcinoma of the cecum. inverted like the stump of an appendix. The field was carefully cleared of a large number of diseased glands. The cecal mass was dissected away, and removed with some six inches of the ascending colon. The cut end of the colon was closed in the same manner as the divided ileum. A side-to-side anastomosis between the ileum and colon was then made. The wound was drained with gauze and gutta-percha. Postoperative History.-The temperature never rose above 100 F., nor the pulse above 90. The patient reacted from the operation without shock. Liquid nourishment was given on the second day: the patient had a formed bowel movement on the sixth and was allowed solid food on the twelfth. A fecal fistula developed from the inverted ileum on the tenth day after the operation, but closed at the end of the fourth week. With this exception the recovery and convalescence were uneventful. Six weeks after the operation the patient Fiií. 2.-Appearance of inside of bowel in ease of adenocarcinoma of I he cecum. left the hospital apparently well, and remained well up to the time of writing this report. Microscopic examination showed the growth to be an adeno¬ carcinoma. It is not possible to say whether or not the growth is of appendicular or cecal origin. An ordinary electric fan can be converted into a satisfactory centrifuge in the following manner: The fan and guard are detached from the motor and the latter is firmly screwed to a solid board about a foot square. A set of bevel gears is obtained from the head of an old sewing-machine\p=m-\theold-style Singer for example; or if no machine is at hand on which an autopsy is permitted, the gears can be obtained at small cost from the factory. One of these gears is attached by a set-screw to the motor-shaft; the other is attached to a steel rod
doi:10.1001/jama.1911.02560060014003 fatcat:62ft25b4ofedxnra6chegwi2te