Diseases of the rectum and anus / by Alfred Cooper and F. Swinford Edwards.

  • Cooper, Alfred, Sir, 1846-1908.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the rectum and anus / by Alfred Cooper and F. Swinford Edwards. Source: Wellcome Collection.

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    having on the previous day (wliilo suffering from a large irre- ducible scrotal hernia) had an enema of two pints of soap and water administered to him in the out-patient department. The injection did not completely rctnm at the time, and the patient stated that diu-ing the night he had been up fi'eqncntly at stool, passiug small quantities of blood, for which reason he was admitted into the hospital. When Mr. Edwards saw the patient, he found swelling and emphysema aronnd the anus, and a large opening about one inch up the bowel. After fi'eely incising the peri-anal swelling, it was discovered that the rectum was almost entirely separated from the structures around it. In the course of time the lower part of the rectum and adjacent tissues sloughed away, so that the bowel terminated in a cavity, surrounded by granulation tissue, in which large masses of faeces collected. These were removed from time to time with the finger or a lithotomy scooj). The general disturbance, which had been of a marked character, subsided imdcr appropriate treatment. After three months' stay in hospital, the patient was attacked by typhoid fever, which termi- nated fatally three weeks afterwards. A post-mortem examination revealed many iutestiual ulcers, the bases of several of which con- sisted only of peritoneum. The lower part of the rectum had been converted into a cavity bounded by dense cicati'icial tissue. The wall of the heart was extensively calcareous. It is probable that when the injection was given, the nozzle of the sylingo ])cnetrated the wall of the rectum, and that much of the fluid was driven into the suiTounding cellular tissue, and gave rise to the subsequent inflammation and sloughing. Lacerated wounds of the rectum are wont to occur from falls upon sharp and hard objects, e.g.^ a wooden stake, leg of a chair, a pitchfork, or portion of iron palisade. In children, injury to the rectum some- times occurs through the breaking of a chamber-pot, and in these cases considerable laceration of the peri- nseum is generally associated with the injury to the bowel. When a hard pointed object, e.(/.^ a stake, is driven into the rectum, the bladder and other adjacent organs seldom escape injury. It is worthy of note that in some of these cases, the viscera have been seriously injured without any cutaneous wound. Gunshot wounds of the rectum sometimes occur