Observations on the diseases of the rectum / by T.B. Curling.

  • Thomas Blizard Curling
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the diseases of the rectum / by T.B. Curling. Source: Wellcome Collection.

    112/184 (page 96)
    ^ Strictures are the most favourable cases for treatment, and the most benefited by dilatation. A common caution given by writers on this affection is, to avoid mistaking a fold in the mucous membrane of the bowel, or the prominency of the sacrum, for an impediment in the passage, as it appears that they have, in many instances, been taken and treated for stricture of the rectum. I need not repeat this caution, because I consider it a safe rule never to attempt the mechanical dilatation of a stricture unless the contraction be within reach of the finger. I have stated that the ordinary seat of stricture is about two inches from the anus, and that when situated as high up as the point at which the rectum begins, the stric- tured part is sometimes forced down low enough to admit of being felt by the surgeon. But in these cases the passage of a bougie through a contracted opening is by no means an easy matter; for the part being loose, the point of the instrument is very liable to catch in a fold of the mucous membrane, and to push the bowel before it, beyond the reach of the finger, without pene- trating the stricture. In the case alluded to at page 87, this difficulty occurred, so that I could make no progress at all with bougies: I had recourse, therefore, to a tw^o-bladed instrument contrived by Weiss, a modi- fication of his dilator, and similar to what has sometimes been used in the dilatation of a phymosis. This being small, could be carried along my finger up to the stric- ture, and passed through it, and then, by turning a screw, and separating the blades, I managed to dilate the contraction. The patient derived temporary relief from this proceeding, being able to pass his motions afterwards with greater freedom; but the case was a very bad one, and so much difficulty was found in con-