Dr. Underwood's treatise on the diseases of children : with directions for the management of infants.

Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Underwood's treatise on the diseases of children : with directions for the management of infants. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    after the child had puked up a great quantity of meconium, and not only the belly, but also the face, was become exceed- ingly tumid, and the eyes had not been opened for some time. The manner of doing this operation must, in different cases, depend so much on the discretion of the operator, that I shall do no more than describe that which I made use of in the in- stance alluded to; and this may possibly be acceptable, as the operation is not often performed with success. [In two cases a perfect cure was effected ; these children were both operated upon by the late Mr. Chevalier, who with a scalpel made a very free incision through the integuments, till he distinctly felt the fluctuation of meconium in the rectum; he then carried his instrument through the membranous expan- sion, or pouch, in which, in these cases, the rectum generally terminates ; taking care, effectually, to divide it by a crucial incision; thus completely destroying its valvular structure. Both these children recovered without difficulty, and possessed the faculty of retaining, or expelling the faeces, nearly as well as if no malformation had ever existed. One of them is now flfteen years of age.—S. M.] It may be previously observed, that it ought to be postponed as long as it safely can, that the depending part of the bowel may be distended, and pushed as low down as possible ; the reason for which is sufficiently obvious: and to this delay I am much inclined to attribute the success with which it was fol- lowed in the operation I performed. This was not determined upon by my colleagues till the third day. A longitudinal incision was then made, of about half an inch, above and below the part where the anus ought to have been, which was marked by a little excrescence; a small bistoury was afterwards thrust up in the usual direc- tion of the bowel for more than an inch. No meconium fol- lowing this puncture, I examined carefully with my finger, and feeling something like the fluctuation meconium would make, I introduced a trocar, and withdrawing my finger, I carne up the instrument in such a direction as to avoid injuring tlm bladder, or forcing the point against the os coccygis, for near an inch furtlier ; making allowance, however, foi