The Stewart and Ryfkogel Methods in the Surgery of Epithelioma of the Lip

J. Clark Stewart, M.D.
JAMA. 1913;60(12):926. doi:10.1001/jama.1913.04340120052027.
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To the Editor:  —The article on "Operation for Epithelioma of the Lower Lip," by Dr. Ryfkogel (The Journal, Feb. 15, 1913, p. 507), condemns my operation for cancer of the lower lip on grounds which I think do not exist.After admitting that my operation fulfils the conditions necessary in an ideal operation, Dr. Ryfkogel goes on to say that the "resulting infection and sloughing is frequently extensive and severe, so that death has not infrequently occurred." As far as I am able to learn this is not true, and Dr. Ryfkogel is either misinformed or has had some very unfortunate experiences. I have personal knowledge of about four hundred operations of this type by several operators, and in not one has either sloughing or death occurred, or severe infection. In the earlier days of the operation slight infection from the mouth through Wharton's duct occurred quite regularly, but


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