The practice of surgery / by James Gregory Mumford ... with 682 illustrations.

  • James Gregory Mumford
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford ... with 682 illustrations. 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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    described in the last paragraph, must be done bHndly. CurHng and Anders state that by the perineal operation surgeons have failed to find the bowel in 30 per cent, of these cases. For this reason it is good practice, in the case of such complete rectal occlusion, to open the abdomen above the pubes, to establish an artificial anus in the groin, and later, perhaps after many months, when the child is well-nourished and vigorous, to make a secondar}' operation by the combined method,— working from above and below,—in order to bring down the rectal pouch. This is the intelligent and proper surgical method. Blind groping from below is dangerous; especially to be condemned is blind aspiration from below, because thus one is almost certain to open the peritoneal cavity and is likely to smear it with meconium. Rectal occlusion combined with fistula into the other organs pre- sents another problem difficult of treatment. Fortunately, the con- dition is rare. The operation begins like that for uncomplicated oc- clusion. When the bowel is low down, it should be reached by the perineal route. Then the bladder or urethra must be separated,—a difficult matter,—and it is well, as a preliminary, to pass a small sound through the urethra or bladder into the rectum, and so to locate the lowest point of the latter organ. Often the point of the sound, when it is directed toward the anus, may be felt in the anal cleft. Deep dissection of the perineum will then develop the fistula, which must be clamped, cut off, and the bowel and vesical openings turned in and sutured. If the fistula is placed high, so as not easily to be reached, the abdomen should be opened, an artificial anus established, and later a secondary operation done to close the rectovesical fistula. In all these operations abundant provision for drainage must be made, and every pains must be taken to prevent soiling the peritoneum with meconium and feces. At the best, these operations show a high mortality, and Anders publishes the following table: Cases. Mortality. Proctoplasty .44 29 per cent. Incision 27 33 Colostomy 21 52 Puncture' 4 50 INFLAMMATIONS Inflammations about the rectum and anus are manifold, and lead to a great variety of results, depending upon the origin of the infection. They may give rise to hemorrhage or to intestinal obstruction through peritonitis. Owing to the extremely septic condition of the normal rectal mucosa, these inflammations are frequently acute and sometimes fatal. Septicemia, pyemia, general peritonitis, and gangrene may result, and must be treated appropriately when they are discerned. Such alarming conditions call for extensive drainage and excision of the necrotic portions. Foreign bodies, such as fish-bones, safety-pins, and gall-stones, may lodge in the rectum, and great fecal masses may become inspissated and plug the outlet. Many years ago I saw, at the ]\Iass-