A practical treatise on the causes, symptoms, and treatment of spermatorrhoea / by M. Lallemand ; translated and edited by Henry J. McDougall.

  • Claude François Lallemand
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the causes, symptoms, and treatment of spermatorrhoea / by M. Lallemand ; translated and edited by Henry J. McDougall. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    and opiate eneraata, and emollient poultices when the tumours be- come prolapsed and painful. In this state too, much atid immediate relief may be obtained by puncturing the most distended tumours with a lancet; the swelling goes down, the pain is relieved, and often the hemorrhoid withers away and becomes completely obliterated. The practice of applying leeches to these tumours cannot be too much reprobated. The leech-bites increase the irritation, and it is evident that the effect desired, viz., that of emptying the tumour of its con- tents, cannot be accomplished by these creatures, their bite not being sufficiently deep to extend through the coats of the tumour. When the hemorrhoids are sufficiently large and numerous to im- pede defecation, they must be unhesitatingly removed—especially when they become hard and begin to degenerate. Care must be taken in operating for the removal of these tumours when internal to the sphincter, to cauterize the bleeding surface with the heated iron, after each stroke of the knife.1 There is no occasion to form a deep slough—it is simply necessary to close the orifices of the bleeding vessels. For this purpose the small olive-shaped cauterizing irons are the most convenient. Pollutions caused by Cicatrices in the Neighbourhood of the Anus. —Accidental cicatrices in the neighbourhood of the anus, or within the rectum, may cause very serious pollutions on account of the ob- stacle they present to free defecation. It is evident that these pollu- tions can only be relieved by incising such cicatrices, and prevent- ing the union of the incisions by introducing an instrument capable of dilating the part to the full dimensions of the rectum. Pollutions caused by Fissure of the Anus.—I need not repeat what 1 When hemorrhoids are situated -within the sphincter ani, their removal by the knife is dangerous with any amount of caution. It is far better, by directing the patient to strain as at stool, to cause the tumours to project beyond the sphincter, and then to transfix them through the base with a fixed needle carrying a double ligature. An unarrned needle may be passed undt rneath the first, and the ligatures tied on each side, underneath the second needle. This proceeding causes little pain when the por- tions strangulated consist only of mucous membrane ; should, however, a portion of skin be included, the suffering is generally intense—ample reason for avoiding the ap- plication of a ligature when the piles are external. The strangulated portions seldom give any further trouble, and unless the stools be carefully examined, even the liga- tures, are generally discharged unnoticed. The ligatures for this purpose should consist of fine, smooth, even, and very strong whip-cord. Silk, however often doubled, will seldom bear the force required to draw the ligature tight, and, besides, this repeated doubling makes a thick cord which does not so perfectly strangulate the tumour. In external hemorrhoids, when recent and inflamed, the practice of puncturing with a lancet cannot be too strongly recom- mended. The hemorrhage that takes place relieves the congestion of the hemor- rhoidal veins as well as the irritation of the neighbouring parts, and by gently pressing the tumour, if it have not already disappeared on the following day, a small clot will generally be discharged, after which the pile will for the most part shrink up and give no further trouble. When, however, external piles are of long standing, they should be freely removed by the knife. Smart hemorrhage sometimes follows, con- tinuing for a few minutes ; no danger is to be apprehended from this, as it soon ceases spontaneously, or, at all events, may be immediately arrested by light pressure with a compress of lint. [II. J. McD.]