Licence: Public Domain Mark
Credit: The rectum and anus : their diseases and treatment. 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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![from which it will be seen that Maisonneuve, in his later practice, was the first to use digital dilatation, practically in the same way that it is done at the present day; and not only did he employ it for the treatment of anal fissure, but he also recommended it for the cure of interna] haemorrhoids. The method has found but little favour, however, with most modem surgeons as a means of cure in itself, although all admit its very great utility as a pre- liminary step to almost all rectal operations. The operations of ligature, cautery, or incision, as practised now, after a preliminary dilatation under an anaesthe- tic, contrast very favourably with the similar opera- tions as performed previously : as it was then necessary to keep the patient awake, in order that he might protrude the piles for the operator. Usually, at the first touch, the piles were retracted, and the anus drawn up; and when, after repeated urging by the surgeon to bear down, he made the attempt, he was rewarded with the tightening of a ligature, or touch of the actual cautery. Is it to be wondered at that, under these circumstances, operation was much dreaded by patients, and frequently impossible for the surgeon satisfactorily to complete. Now, how- ever, all pain is avoided by anaesthesia, and dilatation enables the surgeon to make a thorough exploration of the entire rectum, and treat whatever he may find. Haemorrhage need not be so much feared, because, having the part completely under command, a liga- ture can be applied to any bleeding point requiring it : moreover, the temporary paralysis produced by the dilatation adds much to the comfort of the patient after operation. The painful spasm so much com- plained of formerly is not so troublesome, and reten- tion of urine, which was so often seen, especially in the male, is now comparatively rarely met with. Still, however, some of the French surgeons recommend](https://iiif.wellcomecollection.org/image/b21229387_0283.jp2/full/800%2C/0/default.jpg)
