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TREATMENT OF ACUTE PROLAPSUS ANI
1529 was surrounded by a zone of hypersemic liver tissue. Amoebae were found in the lining membrane of the main abscess and in the pus from the three patches of softening in the liver. I was not able to examine - the intestines. CASE 7.-The patient, an Irishman, aged twenty-three years, complained of abdominal pains for two months. He gave the following history of dysentery: Eight months before admission his ship-which, by the way, condensed water for her own use-was lying off Java for six weeks. He went on shore once, but did not drink any cold water.
section, yellow in colour, and each
As the engines were busy working the cranes loading the ship they could not be spared for the purpose of condensing water, so a quantity was brought off from the land. A few - days after drinking this water five men out of a crew of thirty were attacked with dysentery, four very severely, the patient having only a mild attack. The present illness began two months before admission with severe aching pain in the right hypochondrium, constipation, depression of spirits and increasing sallowness of complexion. There was profmse sweating, but there were no rigors. On admission the patient was sallow-faced and rather emaciated; he was suffering from severe abdominal pain. There were slight bulging in the right hypochondrium, considerable tenderness on palpation and oedema of the skin over the lower ribs. The liver was slightly enlarged upwards in the
axilla, but downwards it extended almost to the umbilicus, the edge
being well defined and
the surface smooth.
There
apparent enlargement of the left lobe. The stools were apparently normal, but some amoebse were found. The temperature was high and remittent. There were no was no
rigors or sweats and
no jaundice. The diagnosis of hepatic confirmed by the exploring needle and subsequently about fifteen ounces of chocolate cGloured pus were removed by operation. While opening the abscess both the peritoneum and right pleura were accidentally opened and
abscess
was
alter the size of the swelling. Astringents, either in the form of an ointment or of suppositories, I have found to be useless. Regulation of the bowels and the recumbent position are necessary, but a week often passes before nature brings about recovery. It is obvious that if the prolapsus could be kept up for a few hours a speedy cure might be anticipated and this led me to employ pads and a T bandage, but it was almost impossible to prevent the descent of a small swelling in this way owing to the awkward situation in the hollow of the buttocks. Under these circumstances and in the absence of thrombosis which would call for incision I have successfully used as a pessary a full-sized Tait’s cervical dilator. After replacing the prolapsus with the finger the vulcanite uterine dilator is lubricated and inserted for one inch up the rectum and is retained in position by a collar of dentists’wax (Stent’s composition) supported by cotton wool and a firmly applied T bandage. The pessary not only prevents a descent of the swelling while in position but by its pressure it favours absorption of the oedema and it empties the engorged veins ; it should be inserted at night and retained until the following morning. This treatment I have found to bring about a complete cure ; there has been no tendency to relapse and the patient has been able to rise and resume his occupation without discomfort. Olive-shaped pewter pessaries have been used for this purpose but they are dependent for their position and retention upon the action of the sphincters which cannot be relied upon in these cases. In the chronic condition of prolapsus ani arising from atony of the levator and sphincter ani muscles much benefit cannot be expected from treatment by pessary. The following case was the first one treated by me in this way. On June 22nd, 1897, a man complained that for two days he had been in pain from a swelling which he took to be a hasmorrhoid. On examination a tense, bluish, semi-lunar swelling was found occupying the right margin of the anus, the mucous membrane being continuous with the skin at the outer circumference. The patient stated that he had pushed up the swelling repeatedly but that it always returned in a few minutes. This I found to be the case. I then gave him a full-sized Tait’s dilator 22’r in. long and 4 in. in greatest diameter and conical in shape, for which a collar was made as described above so as to grasp the pessary thus improvised at one inch from its point and prevent it from slipping entirely into the The patient was directed to return the prolapse bowel. when in bed and immediately to insert the pessary well lubricated and supported by a T bandage; he was also strongly advised to remain in bed on the following day until seen by me. Next morning however I received a note to the effect that he felt quite recovered and I heard afterwards that the pessary was worn until 4 A M. when it slipped out but the prolapse did not show any tendency to return and has not done so up to the present time. I have requested Messrs. Fergusson and Co. to make the pessary described above. Eastbourne.
BRITISH ORTHOPAEDIC SociETY.—An ordinary was held on Nov. 5th at the National Orthopaedic meeting TREATMENT OF ACUTE PROLAPSUS ANI Hospital, Mr. Muirhead Little being in the chair.-Mr. Reeves exhibited three cases, one of Doubtful Congenital BY FRANK ELVY, M.R.C.S. ENG., L.R.C.P. LOND. Dislocation of the Left Hip, Double Equino-Varus, and of both Groups of Anterior Tibial Muscles. The Paralysis ACUTE prolapsus ani occurs frequently at childbirth, but second case was that of a child sufferiDg from Extreme as the patient has to keep her bed irrespectively of the anal Equino-Varus on the Left Side with Congenital Absence of trouble the condition does not assume so much importance as the Fibula. The third case was one of Congenital Fracture of when the sufferer is an active man of business to whom the the Tibia and Malformation of the Hip,-Dr. Risien Russell, Mr. Tubby, Mr. Little, and Mr. Noble Smith joined in the time and rest necessary for recovery are serious matters. A discussion.-Mr. A. H. Tubby showed a boy, aged nine years, succession of these acute cases in many respects similar led i upon whom he had performed Arthrodesis at both Ankles for me to adopt a treatment which has given encouraging results. Flail-like Foot.-Remarks were made upon the case by The pathology of the condition appears to be a slipping or Mr. Jackson Clarke, Mr. Little, and Mr. Robert Jones.-Mr. forcing down of the mucous membrane investing the Wm. Thomas exhibited a photograph and gave details of a sphincter and of the mucous membrar.e immediately above doubtful case of Traumatic Spinal Caries which had been it. Spasm of the sphincters, impeded venous return, and the subject of an action-at-law. He also showed a skiagram cedema result in the formation of an elastic and exceedingly representing an Injury to the Epiphyseal Line of the Radius tender, livid or purple swelling occupying either a portion with subsequent Arrest of the Growth of that Bone.-Mr. or the whole of the circumference of the anal aperture. The Jackson Clarke showed the skiagram of a marked case of Flat swelling can be returned above the sphincter without much foot in a girl about ten years of age.-Mr. Noble Smith read .difficulty by the finger but in the course of a few minutes a paper on Spasmodic Wry.neck.-Dr. Risien Russell and M many cases the prolapsus has recurred. The application other members joined in the discussion which followed.of heat or of cold in the form of an ice comprem relieves the discomfort but does not Effect a cure or materially
Mr. Jackson Clarke read a paper and exhibited skiagrams of cases of Coxa Vara in Infants.
drawings and
section, yellow in colour, and each
As the engines were busy working the cranes loading the ship they could not be spared for the purpose of condensing water, so a quantity was brought off from the land. A few - days after drinking this water five men out of a crew of thirty were attacked with dysentery, four very severely, the patient having only a mild attack. The present illness began two months before admission with severe aching pain in the right hypochondrium, constipation, depression of spirits and increasing sallowness of complexion. There was profmse sweating, but there were no rigors. On admission the patient was sallow-faced and rather emaciated; he was suffering from severe abdominal pain. There were slight bulging in the right hypochondrium, considerable tenderness on palpation and oedema of the skin over the lower ribs. The liver was slightly enlarged upwards in the
axilla, but downwards it extended almost to the umbilicus, the edge
being well defined and
the surface smooth.
There
apparent enlargement of the left lobe. The stools were apparently normal, but some amoebse were found. The temperature was high and remittent. There were no was no
rigors or sweats and
no jaundice. The diagnosis of hepatic confirmed by the exploring needle and subsequently about fifteen ounces of chocolate cGloured pus were removed by operation. While opening the abscess both the peritoneum and right pleura were accidentally opened and
abscess
was
alter the size of the swelling. Astringents, either in the form of an ointment or of suppositories, I have found to be useless. Regulation of the bowels and the recumbent position are necessary, but a week often passes before nature brings about recovery. It is obvious that if the prolapsus could be kept up for a few hours a speedy cure might be anticipated and this led me to employ pads and a T bandage, but it was almost impossible to prevent the descent of a small swelling in this way owing to the awkward situation in the hollow of the buttocks. Under these circumstances and in the absence of thrombosis which would call for incision I have successfully used as a pessary a full-sized Tait’s cervical dilator. After replacing the prolapsus with the finger the vulcanite uterine dilator is lubricated and inserted for one inch up the rectum and is retained in position by a collar of dentists’wax (Stent’s composition) supported by cotton wool and a firmly applied T bandage. The pessary not only prevents a descent of the swelling while in position but by its pressure it favours absorption of the oedema and it empties the engorged veins ; it should be inserted at night and retained until the following morning. This treatment I have found to bring about a complete cure ; there has been no tendency to relapse and the patient has been able to rise and resume his occupation without discomfort. Olive-shaped pewter pessaries have been used for this purpose but they are dependent for their position and retention upon the action of the sphincters which cannot be relied upon in these cases. In the chronic condition of prolapsus ani arising from atony of the levator and sphincter ani muscles much benefit cannot be expected from treatment by pessary. The following case was the first one treated by me in this way. On June 22nd, 1897, a man complained that for two days he had been in pain from a swelling which he took to be a hasmorrhoid. On examination a tense, bluish, semi-lunar swelling was found occupying the right margin of the anus, the mucous membrane being continuous with the skin at the outer circumference. The patient stated that he had pushed up the swelling repeatedly but that it always returned in a few minutes. This I found to be the case. I then gave him a full-sized Tait’s dilator 22’r in. long and 4 in. in greatest diameter and conical in shape, for which a collar was made as described above so as to grasp the pessary thus improvised at one inch from its point and prevent it from slipping entirely into the The patient was directed to return the prolapse bowel. when in bed and immediately to insert the pessary well lubricated and supported by a T bandage; he was also strongly advised to remain in bed on the following day until seen by me. Next morning however I received a note to the effect that he felt quite recovered and I heard afterwards that the pessary was worn until 4 A M. when it slipped out but the prolapse did not show any tendency to return and has not done so up to the present time. I have requested Messrs. Fergusson and Co. to make the pessary described above. Eastbourne.
BRITISH ORTHOPAEDIC SociETY.—An ordinary was held on Nov. 5th at the National Orthopaedic meeting TREATMENT OF ACUTE PROLAPSUS ANI Hospital, Mr. Muirhead Little being in the chair.-Mr. Reeves exhibited three cases, one of Doubtful Congenital BY FRANK ELVY, M.R.C.S. ENG., L.R.C.P. LOND. Dislocation of the Left Hip, Double Equino-Varus, and of both Groups of Anterior Tibial Muscles. The Paralysis ACUTE prolapsus ani occurs frequently at childbirth, but second case was that of a child sufferiDg from Extreme as the patient has to keep her bed irrespectively of the anal Equino-Varus on the Left Side with Congenital Absence of trouble the condition does not assume so much importance as the Fibula. The third case was one of Congenital Fracture of when the sufferer is an active man of business to whom the the Tibia and Malformation of the Hip,-Dr. Risien Russell, Mr. Tubby, Mr. Little, and Mr. Noble Smith joined in the time and rest necessary for recovery are serious matters. A discussion.-Mr. A. H. Tubby showed a boy, aged nine years, succession of these acute cases in many respects similar led i upon whom he had performed Arthrodesis at both Ankles for me to adopt a treatment which has given encouraging results. Flail-like Foot.-Remarks were made upon the case by The pathology of the condition appears to be a slipping or Mr. Jackson Clarke, Mr. Little, and Mr. Robert Jones.-Mr. forcing down of the mucous membrane investing the Wm. Thomas exhibited a photograph and gave details of a sphincter and of the mucous membrar.e immediately above doubtful case of Traumatic Spinal Caries which had been it. Spasm of the sphincters, impeded venous return, and the subject of an action-at-law. He also showed a skiagram cedema result in the formation of an elastic and exceedingly representing an Injury to the Epiphyseal Line of the Radius tender, livid or purple swelling occupying either a portion with subsequent Arrest of the Growth of that Bone.-Mr. or the whole of the circumference of the anal aperture. The Jackson Clarke showed the skiagram of a marked case of Flat swelling can be returned above the sphincter without much foot in a girl about ten years of age.-Mr. Noble Smith read .difficulty by the finger but in the course of a few minutes a paper on Spasmodic Wry.neck.-Dr. Risien Russell and M many cases the prolapsus has recurred. The application other members joined in the discussion which followed.of heat or of cold in the form of an ice comprem relieves the discomfort but does not Effect a cure or materially
Mr. Jackson Clarke read a paper and exhibited skiagrams of cases of Coxa Vara in Infants.
drawings and