Parasitology of Scabies

In 8 %, of the cases inoperability was due to the poor general condition of the patient, and in 32% to the advanced state of the growth.With regard to age, operability was greatest between 40 and 49, and declined in patients older or younger than this.Inoperability of the carcinoma itself was determined by the presence of one or more of the following conditions: local fixation of the growth, hepatic metastases, peritoneal carcino- matous plaques, or extensive involvement of the abdominal lymph glands.Laparotomy was usually necessary to decide on the existence of these contraindications.Local fixity of the growth was noted in 23.9% of the generally operable cases, and in 18.9% of the cases that had laparotomy performed.The fixation was usually in front to the related pelvic or abdominal viscera.Growths involving the anterior wall of the rectum were much less frequently operable than those confined to the other quadrants of the bowel.The operability of anterior growths in women was higher than in men.The adhesions producing fixation were usually, but not invariably, inflammatory in character.Hepatic metastases were palpable in 11.5% of the cases pro- ceeding to laparotomy.The presence of concealed undetected metastases is postulated in another 14.3% of these cases.Nodules of growth in the peritoneum or extensive involvement of the abdominal lymph glands were noted in 11.1 % of cases submitted to laparotomy.These conditions, however, were seldom the sole cause of inoperability.In endeavouring to secure a high operability rate the impor- tance of having available several radical procedures of varying severity is stressed.The operative mortality rate for all operable cases having some form of surgical treatment was 15.6%, for cases submitted to combined excision 18.7%, and for those submitted to perineal excision 7.9%.I wish to express my thanks to the honorary staff of St.