Operation for artifical anus / By J. Mason Warren, M.D.

  • Jonathan Mason Warren
Date:
[1848]
Catalogue details

Licence: Public Domain Mark

Credit: Operation for artifical anus / By J. Mason Warren, M.D. Source: Wellcome Collection.

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    she must die the following night, and that it was quite useless to attempt the operation. These depressed turns generally passed off after a time, and then the patient was very urgent to have the treat¬ ment continued, but for the moment they were sufficiently discour- raging to the surgeon. The numerous fistulous openings, with the effusion of fecal matter into the groin and back part of the thigh, occasioned considerable embarrassment in pursuing the treatment for discovering the end of the intestine. Added to this, and caused by it, the thighs were flex¬ ed nearly to a right angle with the body, and were constantly in the way of the instruments used for exploring the artificial openings. The instrument used, I conceive to possess great advantages over that of Dupuytren. In fact, it consisted of, or may be almost exact¬ ly represented by, a common pair of old-fashioned polypus forceps, with the branches detached and united by a movable pivot, instead of a fixed joint, the handles perforated with a screw-vice, and the jaws serrated throughout. It is less clumsy than that of Dupuytren, causes more complete strangulation, and does its work in less than half the time.* By an examination of the cases of this distinguished French surgeon, it will be found, that the enterotome generally separated about the seventh or eighth day: in the present instance it came away on the third, yet no effusion or other evil conse¬ quence resulted, although the patient was as little provided with the materials for forming plastic lymph as can well be imagined. She was, in fact, almost exsanguineous. In the relation of this case we have only mentioned the course of treatment ordinarily pursued by Dupuytren, without alluding to the methods of Physick, Gross, and others in this country, or in Europe, who have done so much to advance this branch of surgery. A case of a similar kind to that narrated, occurred to me in an infant some years since, and as it illustrates one of the accidents liable to take place at any moment in patients laboring under this unfortunate affection, namely, a prolapse of the end of the bowel, the details may be here given. I was requested by the medical attendant of the family to see an infant eight months old, and received the following history from him. He was first called to it when three weeks old : the parents stated to him, that for a few days subsequent to its birth it was in much distress, and had no alvine evacuation until the cord sepa¬ rated, when an exudation took place at the navel, followed by much relief. Shortly after, a small red tumor appeared at this spot, from the central portion of which the fecal evacuations occurred ; there was no discharge per anum. He directed them to make use of a compress and bandage over the tumor, and under this treat¬ ment the child began to have evacuations by the anus, to gain strength and flesh. I advised that this treatment should be perse¬ vered in. * I am not aware of the name of the inventor of this instrument, or whether it was constructed for the purpose for which it was employed in the former case.