A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese.

  • Cooper, Samuel, 1780-1848.
Date:
1844
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Licence: Public Domain Mark

Credit: A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese. Source: Wellcome Collection.

Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.

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    large intestines may also be emptied by means of a mild unlrritating clyster, and half an ounce of the oleum ricini should be exhibited. Ill the habitual prolapsus ani the patient himself is generally accustomed to re- duce the part, or it goes up of itself when he lies down. When, however, the inflammation and swelling are argent, the part ought on no account to be irritated by repeated attempts at reduction. The practitioner should rather have recourse to the antiphlogistic plan, especially leeches, fomentations, pr cold washes, and the exhibition of the oleum ricmi; and when the swelling has been lessened the reduction may be again attempted. When the reduction is prevented by a spasmodic resistance, the use of an anodyne poultice or fomentations, a clyster of the same quality, the warm bath, and the internal use of opium, are the best means. Should the complaint not give way to the preceding remedies, and the symptoms become more .and more pressing, the particular situation of the stric- ture should be examined with a probe, and divided either with a knife and director or with a concealed bistoury. Some writers speak of the employment of a speculum ani; but on account of the globuiar form of the disease, it must be di.llicult ol application. Cases are recorded ia which the protruded part, either in the state of gangrene or of chronic hardness, thick- eniug, and elongation, has been removed with a knife or ligature. (See Cheselden's Ana omy, Ac. 1741; Kerstens, fiistoria Scdis procidu.cE, resectionefeliater sanalx, Kiton, 1779; Wliately,in Mid. Tracts and Qbserv. vol. 8, No. 16.) However, I should apprehend that in the circum- stance of gangrene, the measures best .calculated lor stopping its course, detaching the sloughs, and keep- ins up the patients strength, must always be more prudent than such an operation. The reduction having been effected, it is proper to introduce the fore-finger up the rectum in order to as- certain that no intussusception exists above the anus within the sphincter. The bowel is then to be kept in its place by quietude and the recumbent posture, and if there be a great tendency to relapse it will be proper to apply to the fundament a piece of sponge or com- .presses, supported with the T bandage. But if such means should not answer, and an habitual prolapsus ani should recur a^ain and again, which is not unfre- quent when the disease has been neglected, or its causes have long remained unremoved, the apparatus described by Mr. Gooch may be tried with more hope of success. {Chir. Works, vol. 2, p. 150, edit. 1792.) Others have used perforated balls of ivory. Callisen found the introduction of a piece of ,sponge within the rectum, fastened to a silver probe, give effectual sup- port. In France, instruments made of elastic gum have been employed with advantage for supporting the rectum. - {Richerand, Nosogr. Chir. t. 3, p. 444, ed. 4.) On account of the elasticity and unirritating quality of this substance, I conceive it is better calculated than any other material for the construction ol' such instruments. It cannot be denied, however, that all foreign bodies in the rectum create senous annoyance,. In the female sex, a vaginal pessary, rather prominent behind, usually hinders the recurrence of a prolapsus ani. The late Mr. Hey published some highly interesting remarks on the cure of the procidentia ani in adults. In one gentleman the disease took place whenever he had a stool, and continued for some hours, the gut gra- dually retiring, and at last disappearing, until he had ■occasion to go to the privy again. After each stool, he nistd to place himself in a chair, and obtain a little re- lief by making pressure on the prolapsed part; andtie then was in the habit of going to bed, where the intes- tine by degrees regained its natural situation. While til bow 'lVas down there was a copious discharge <■ i. nf a thin mucous fluid blended with blood. the pari was up, the anus was constantly sur- m i ^h -a thin, pendulous flap of integuments, ger T0U»thaCing down to the extent of three-fourths of ne n'h Around the arms there were also several soft ?e}- - .,f a bl uish colour, situated at the basis and at tubercUsof abiufc.. w ' fl These were evi. thuinuerpartofthep^ dently formed by- e*ton yrf ^ habU_ patient, pr™?;1*^£ had been afflicted for 8C. ual attacks ^ Cach stool, protuberances at and mucus. For these complaints he applied to Mr. Sharp, who gave him an ointment to be applied after eachstoo' s«me soapy pills to be taken, and recom mended fie use of a clyster a little before the tune of ttoinT to stool. The latter remedy, however, could not be adopted, and no material benefit was derived from the others. Some years afterward, when Mr Hey wan consulted, the loregoing symptoms continued; in addi- tion to which there was the grievanc. of the pmlap. sus, which came on at every time ol going to stool, and lasted for several hours. This judicious surgeon at first advised the patient to wash the prolapsed part with a lotion composed of an • infusion of oak-bark, lime-water, and spirit of wine, and keeping on the to mour compresses, wet with this fluid, and supported by the T bandage. The disease, however, was too ob stinate to be cured by this treatment. Nor could Mr. Hey succeed in reducing the bq,we) when it came down. Although (says he) the prolapsed part of the intestine consisted of the whole inferior extremity of the rec- tum, and was of considerable bulk, yet the impediment to reduction did not arise from the stricture of the sphincter ani; lor i could introduce my finger with ease'during the ' procidentia; but it seemed to arise frdm the relaxed state of the lowest part of the intes- tine and of the cellular membrane which connects it with the surrounding parts. My attempt proved vain as to its immediate object, yet it suggested an idea wlutfi' led to a perfect cure of this obstinate disorder The relaxed state of the part which came down at every evacuation, and the want of sufficient stricture in the sphincter ani, satisfied me that it was impos- sible to afford any effectual relief to my patient unless I could bring about a more firm adhesion to the sur- rounding cellular membrane, and increase the proper action of the sphincter. Nothing seemed so likely to effect these purposes as the removal of the pendulous .flap and the other protuberances which surrounded the anus. This operation was performed on the 13th of November. On the 15th the gut protruded and did not gradually retire as it used to da Mr. Hey at tempted to procure ease by means of opiates and fo- mentations, and avoided immediately trying to reduce the prolapsed part. However, the prolapsus conti nuedso long that the appearance of the part begauto alter, and therefore, on the 16th he made an attempt at reduction, and succeeded with great ease. Howiver, as a good deal of pain in the hypogastrium was still complained of, the patient was bled in the evening, and gently purged with the oleum ricini. These means gave relief; but as some pain in the belly yet continued, an opiate was given. A low diet, linseed tea, lac 'amygdalae, <S£c. were ordered, and a little of the oleum ricini every morning, or every other morning, with an opiate after a stool had been procured. By proceed- ing in this manner for some days, regular stools were procured without any permanent inconvenience. My patient recovered very well, and was freed from this distressing complaint, which had afflicted hint so many years.-(See Hey'sPract. Obs. p. 438, A c. cd.'Z.) This and some other cases which this gentleman has related, convincingly exemplify the necessity of paying attention to the removal of excrescences, he- morrhoids, tmd other tumours, situated about the lower part of the rectum,-in cases of prolapsus ani; forun less this object be accomplished, the disease may resist every other treatment. Mr. Ilowship prefers the liga- ture for the extirpation of the protuberances; but heartily commends the -principle of the treatment pro- posed by Mr. Hey.- (Pfact. Obs. on Diseases of tkt Lower Intestines, p. 163, ed. 3.) An elderly gentleman, whom I know, was troubled for many years with a prolapsus ani, which used to come on several time»a week, sometimes at the privy, and sometimes on otb?r occasions. Several of the first surgeons were con- sulted, who failed hi affording permanent benefit, be cause they omitted to extirpate some hemorrhoidal ex crescences, situated at the lower part of the rectum; for,, when these were afterward removed, the prolapsus ani entirely disappeared. Dupuytreji, finding that the excision of piles, which so often accompany prolapsus ani, commonly prevented the return of the latter complaint, was l'ed to cut off more or less considerable portions of the internal mem braue of the rectum. However, as in one case a pro- fuse hemorrhage took place, and, in another, a tedious suppuration, he has subsequently adopted the plan of