Volume 1

A manual for the practice of surgery / by Thomas Bryant.

  • Thomas Bryant
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: A manual for the practice of surgery / by Thomas Bryant. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    the anus, not only arrests bleeding, but gives great comfort in this as in almost all anal operations. When a cutting operation is inexpedient, as in “bleeders,” or, when Division by the patient will not submit to it, the division of the fistula with a g^vMic metallic wire, heated by the galvanic cauteiy, is a faultless method, cautery. Indeed, in all cases of fistula, where this apparatus can be obtained, it is the best means. It readily divides the tissues, the two ends of the wire being made to project through the two orifices of the fistula, thus burning their way out with a sawing movement. There is little pain at the time, and scarcely any after, with no loss of blood, and, what is more, no need of any subsequent dressing, as a cauterized surface must heal by granulation. When this plan cannot be followed, the treatment by ligature has Treatment by been adopted. Mr. Luke revived the practice in 1845, but it has now hgature fallen into desuetude. Were I called on to adopt the practice, I should ° ® *• use an india-rubber ligature. In rare cases, fistula may be treated by injection, a daily injection of Injections, the sinus with some tincture of iodine, sulphate of zinc, or nitrate of silver having been followed by a cure; yet such cases are too excep- tional to justify the recommendation of such treatment. When the patient’s condition is such as to forbid any hope of repair Wlien in the wound taking place, the operation for fistula should be set operation aside; but the existence of pulmonary mischief, if not far advanced, is no argument against its adoption; nay, it may be made use of as au argument in favour of surgical interference—recent investigations, as already alluded to in an early chapter, having indicated that the long existence of suppuration is liable to set up tuberculous disease. Practically, how’ever, it is undoubtedly true, that fistula may be divided, and heal in far from healthy subjects, and the general health improve after the operation. Hsemorrhoids or Piles. In a clinical point of view, these may be divided into the bleeding” On and “non-bleeding.” The former are generally the internal, and ^‘*'’1°''''*'°'^® composed of a highly vascular tissue, involving the mucous membrane ^ of the rectum and the submucous tissue, with enlarged arteries and veins. Where the arterial element predominates, the tumour has a bright red strawberry aspect; where the venous, a dusky hue. They are closely allied to nsevoid structure and discharge arterial blood. The non-bleeding or external piles are composed of the loose folds of External skin that surround the anus; or a varicose, inflamed or ruptured vein. When inflamed, these folds become cedematous and infiltrated with organized inflammatory products, and appear as fleshy growths of various degrees of density. The venous hffimorrhoids also become swollen, and appear as bluish, tense, and painful tumours. When in an active state, they may encroach upon the mucous membrane of the rectum and appear as large as a walnut, but, as a rule, they are about the size of a nut. They rarely give rise to much annoyance when cleanliness is observed; but, under other circumstances, they cause much local irritation, Wlien swollen or inflamed, however, they give great distress, from the sensitive condition of the skin at these parts. External piles also are occasionally the cause of hmmorrhage, the blood at times coming direct from an ulcerated vein, and is then venous. At