Medical and surgical monographs, / by Dr. J. Clendinning .. [and others].

Date:
1839
Catalogue details

Licence: Public Domain Mark

Credit: Medical and surgical monographs, / by Dr. J. Clendinning .. [and others]. Source: Wellcome Collection.

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    account for this, since suppurating cavities in the neighbourhood of the rectum are known to heal very kindly and readily—as, for instance, that which results from the operation of lithotomy. When the sinus, as it almost always does, penetrates between the fibres of the sphincter, the obstinacy in question may be ascribed to the frequent motion and separation of the sides of the cavity, which must result from the action of the muscle. But even this obstacle to recovery is not always present, since the fistula some- times lies quite superficially under the skin and mucous membrane, without passing through the muscular fibres at all. In such cases, it seems most probable that the detached and denuded state of the mucous coat of the gut impedes the healing action. Treatment of Fistula in Ano.—It appears from the records of surgery, that the treatment of fistula in ano, until within the last hundred years, was extremely complicated and severe. The indu ration surrounding the walls of the sinus being. attributed to a peculiar morbid action resident in the part, it seemed to admit of no remedy except by destruction or removal; and the cavity itself was thought to require complete division of the gut, throughout the whole of its extent affected, with subsequent dressings of the most careful kind. In conformity with these principles, we find that after the patient had been prepared by bleeding, purging, and regulated diet, corrosive sublimate, or other powerful escharotics, were introduced into the fistula, so as to bring away a slough in the form of a cylinder; that pieces of gentian root, or sponge tent, were next inserted to dilate the cavity, and, by thinning the par- tition between it and the gut, facilitate the third step of the opera- tion, which consisted in dividing the septum to its farthest extent; and that, until the cure was completed, various carefully medicated dressings were daily introduced. Such being the esta- blished principles of practice, different practitioners followed out the objects which they kept in view by a variety of methods. Some, instead of the slow and uncertain action of caustic, employed a knife for removing the callosities, either scooping them out at once, or cutting freely through them in several directions, so as to inflict what was deemed sufficient injury to insure their destruction by sloughing or suppuration. Some divided the septum between the gut and sinus by means of knives, or scissors, or apparatus contrived for the purpose, such as what was called the probe-razor ; and others thought it better to transfix the gut with a needle, so as to include the partition in a ligature of thread, or lead wire. The treatment thus conducted was not only tedious and painful, but often attended with alarming consequences. Inflammation and constitutional disturbance were apt to follow, and the exten- sive incisions practised for the removal of callosities, or dividing the septum of a deeply penetrating sinus, frequently occasioned very formidable hemorrhage, as well from its amount as the diffi- culty of arresting it. 'The cure, moreover, was not always com- plete, a discharge of matter occasionally still continuing, in conse- quence of the deep wound not healing at the bottom; and we have
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