Sections through this tumour showed a small focus of carcinoma, at an early stage of development. The story of this patient emphasizes the importance of keeping in touch with affected members even when they profess to be in good health, and illustrates the fact that malignant disease may arise in the absence of any symptoms due to the polyposis.
Case 2.-The second patient was a boy, aged 17, marked by an arrow in the family pedigree (Fig. 576) in which 24 adult members are recorded. Nine of these 24 are known to have inherited polyposis and 5 have died from intestinal cancer.
This family was first investigated by MI. Tom Rowntree in 1950, and the information available at that time was published (Rowntree, 1950), but in this earlier version of the family pedigree the patient now being reported was not included because at that time he had not been traced and his existence was unknown to us. We knew that his mother had died of rectal cancer at the age of 22, but only subsequently did we discover that she had had an illegitimate son who had been brought up by in-law relatives. This boy at the age of 17 began to have diarrhcea, which was investigated by barium meal, and polyposis coli was discovered. His doctor then referred him to this hospital, where the diagnosis was confirmed, and inquiry into his family connexions showed the linkage with the family previously investigated.
When first examined at St. Mark's Hospital G. C. was 17 years of age. He appeared healthy and his only complaint was persistent diarrhoea for the last six weeks, unaccompanied by blood or excess of mucus. Sigmoidoscopic examination revealed large numbers of adenomatous polyps in the rectum, which were treated by fulguration in several sessions. Then the rectum having been cleared of polyps, colectomy and ileorectal anastomosis was carried out.
The colon from this patient is illustrated in Fig. 577 and a close-up of one region in Fig. 578. It will be seen that the mucosa was thickly carpeted with rounded adenomatous tumours. In some regions more than thirty tumours were visible in a square inch. An estimate of the total number of tumours calculated from the average density and surface area gave a figure in excess of 5000. The histological picture was that of adenomas undergoing active epithelial proliferation but with no indication of malignancy. This second case illustrates the importance of keeping in touch with a O F T H E N I P P L E 48 1 polyposis family, and of taking responsibility for the examination of relatives.
SUhlMARY
A review is presented of a series of 60 cases of familial polyposis coli treated by major surgery at St. Mark's Hospital between the years 1918 to 1954 inclusive.
For purposes of analysis we have presented these cases as two series, the earlier one consisting of the 21 cases treated between 1918 and 1945, and the later one consisting of 39 cases treated between 1946 and 1954. The change in the main methods of treatment