Reply to Professor Christison's criticism in the Edinburgh Medical and Surgical Journal for April 1827, on Dr. Mackintosh's evidence in the case of Mrs. Smith, tried for poisoning / [John Mackintosh].
- Mackintosh, John, -1837
- Date:
- [1827]
Licence: Public Domain Mark
Credit: Reply to Professor Christison's criticism in the Edinburgh Medical and Surgical Journal for April 1827, on Dr. Mackintosh's evidence in the case of Mrs. Smith, tried for poisoning / [John Mackintosh]. Source: Wellcome Collection.
15/60
![{ illtABT j THE LANCET. Vol. II.] LONDON, SATURDAY, APRIL 27, 1833. [1832-33. CASE OF PROLAPSUS ANI TREATED AT THE HOTEL DIEU, PARIS, ACCORDING TO THE NEW METHOD INTRODUCED BY M. LE BARON DUPUYTREN. There is no particular fact in surgery, however simple it may appear, which may not give rise to important practical obser- vations. In like manner there are many affections, which, though apparently tri- fling, are calculated to produce the greatest inconvenience, and yet may he readily re- moved by means at once simple and effica- cious. Prolapsus ani is a disease of this nature. On the 3rd of March 1833, a case was presented at the above hospital, upon which, previous to operating, M. Dupuytren made the following observa- tions :—■ Prolapsus ani consists in the eversion of the inner membrane of the rectum, which, forming a kind of invagination, descends within itself, and at length projects beyond the sphincter to the extent of two, three, four, five, or even six inches. Usually the intestine comes out every time the pa- tient goes to stool; in other cases it de- scends only when the patient has remained in the standing posture for a long period; while, in other cases, the gut may become everted at any time, which shows that the relaxation is carried to a great extent, and that prolapsus takes place without any effort on the part of the person af- fected. In general the gut is easily re- turned ; but sometimes the sphincter ani produces such a degree of strangulation, that the projecting membrane becomes at first dark-red, then black, and at length falls into a state of gangrene. Should you happen to see such a case of strangulation as I have described, you are to endeavour to reduce the gut in the following manner. The patient must lie on the abdomen, and the pelvis must be raised conveniently by No. 504. pillows placed betwen the thighs; some pledgets of wet lint are then to be placed round the base of the tumour, and gentle pressure exercised in order to reduce its vo- lume. After this a compress should be placed on the centre of the orifice of the intestine, which is to be returned by gentle pressure into the abdomen. When reduction by this means is altogether im- possible, we may be compelled to have recourse to scarification of the gut, but as the employment of cutting instruments maybe attended by ulceration or inflamma- tion of the large intestines, they are to be avoided as much as possible. The same observation is applicable to the use of leeches, which may be followed by ex- ternal or internal hemorrhage, ulcera- tions, &c. But though the reduction be accom- plished, we have still to combat the tend- ency to prolapsus, which depends on the weakened action of the sphincters, or per- haps on certain causes producing strong contraction of the muscular fibres, in- verting the large intestines, such as chronic inflammation. In the latter case, our first care will be to combat the inflamma- tory action which gives rise to the dis- ease ; but when the prolapsus depends on a want of action in the sphincter ani, the best method of cure is that which has for its object the diminution of the cutaneous and mucous parts which surround the anus. The practical question to consider is, How can we best assist the action of the sphincters ? Cold-baths alone are fre- quently sufficient for this purpose; but the remedy is tedious, expensive, and re- quires constant attention. A better mode consists in removing some of the folds of skin which surround the margin of the anus, so as to diminish the extent of the soft parts which dilate when the patient goes to stool, and to determine adhesion between the skin and neighbouring parts. When the patient is placed in a conve- nient posture, the operator, holding in his hand a common forceps (with the points rather blunt, so as not to pinch the skin), seizes successively several of the folds of skin which surround the margin of the](https://iiif.wellcomecollection.org/image/b20444217_0015.jp2/full/800%2C/0/default.jpg)
