The pathology, diagnosis and treatment of diseases of the rectum and anus / by Charles B. Kelsey.

  • Kelsey, Charles B. (Charles Boyd), 1850-1917.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: The pathology, diagnosis and treatment of diseases of the rectum and anus / by Charles B. Kelsey. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    vagina or urethra, and its lower at the upper wall of the rectum. The angle of junction of these two curves is well marked, meas- uring from twenty to thirty degrees ; and the curve is not with- out influence in the function of defecation, since, by it, an ob- struction is formed to the downward course of the faeces. The lateral curve is generally a single one from left to right, starting at the left sacro-iliac synchondrosis and ending at the median line at a point opposite the third sacral vertebra, from which point it generally passes straight on to the anus. This curve may, however, pass beyond the median line to the right in its lower portion, and again return to the median line at the anus. It is subject to many variations, and the upper portion may be more or less twisted on itself like the sigmoid flexure. The sigmoid flexure may occupy an unnatural position, and the rectum, instead of commencing at the left sacro-iliac junc- tion and curving toward the right, may commence at the right and curve toward the left. In one case, reported by Cruveil- hier,1 where the sigmoid flexure was in the natural position, the rectum passed almost transversely to the right side as far as the right sacro-iliac junction, and then returned again very obliquely to the left side. Divisions.—For convenience of description the rectum is usually divided into three portions, named first, second, and third, from below upward. The first extends from the anus to the tip of the prostate; is about an inch and a half long; is firmly closed by the sphincters ; and gives attachment to a por- tion of the levator ani muscle. On account of the direction of this portion, which is the reverse of that next above, the finger should never be passed toward the sacrum, or even directly in- ward in making an examination ; but rather toward the pubes. Bearing this simple anatomical point in mind will often save the patient much unnecessary suffering. The second portion is often described as reaching from the apex of the prostate to the recto- vesical fold of peritoneum ; but, as the point of duplicature of the peritoneum is not only variable in different individuals, but at different times in the same individual, it is better to adopt a fixed bony point, as the third piece of the sacrum; in which case the middle portion will measure about three inches in length. This portion, it will be remembered, is convex back- 'Anat. Path , Amer. Edition, 1844, p. 377.