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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    above the anus, just in the place where retractions of the rec- tum are most often found. If, after turning the rectum so that its mucous surface is external, it is moderately distended Ijv insufflation, the muscle will be seen to be made up of fibres collected into bundles. Its breadth is from six to seven lines in front, and about an inch behind. Its thickness, on the contrary, is much greater in front, where the fibres appear to be collected in the angle which corresponds to the union of the first and second curves, of the rectum, while behind they are scattered over its convexity. After thus adopting the description of ~Ne- laton, Velpeau] brings out one other anatomical point—the attachment of the muscle posteriorly to the front of the sacrum. The functions ascribed to the muscle by Nelaton were those of keeping the rectum empty until a short time before the act of defecation ; separating the fsecal mass and preventing its regur- gitation during defecation : and of opposing the continuous and involuntary escape of faeces after the destruction of the lower sphincters. Hyrtl refers to this description, and himself describes the muscle as being six or seven lines in breadth anteriorly and an inch posteriorly, but does not always find it present. He also in one case demonstrated the attachment to the sacrum. Sap- pey admits its frequent existence, and locates it at the level of the base of the prostate, in the middle portion of the rectum, six, seven, eight, or sometimes nine centimetres from the anus. It never completely surrounds the rectum, but only one-half or two-thirds of its circumference ; and it appears to him to be caused by a grouping of the circular muscular fibres, some being gathered from below upward, and others from above downward, to the same point. Its breadth is one centimetre and its thickness two or three millimetres. Situated sometimes in front, sometimes behind, and again laterally or anterolater- al ly, it is constant in nothing except its direction perpendicular to the axis of the bowel. In place of one, he has sometimes found two bands at opposite points and different levels, and in one specimen which he has preserved there were three. Henle adopts Sappey's description in the main. Petrequin found the muscle irregularly oblique, less marked in the front wall than in the back, and consisting of a collection of weak bands of Velpeau: Traitu d'Anat. Chirurg., 3me ed., 1837, Introduction, p. 39.