Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/195/
183 
ANUS. 
5. No anus, but the rectum is continued 
pervious as far as the integuments, which in 
some cases are then prominent, and of a violet 
colour, from the meconium appearing through 
in the situation which the anal opening should 
occupy. In other cases the skin is thick and hard, 
and gives no indication of the situation of the 
rectum. In such circumstances the surgeon must 
divide the integuments, either by a crucial or by 
a transverse and longitudinal incision, and then 
proceed cautiously until he exposes the dis¬ 
tended rectum. When the skin only inter¬ 
venes, the prognosis as to the result" of this 
operation may be favourable, as the sphincters 
are probably perfect; but when the cul-de-sac 
of the rectum is deep-seated, then experience 
affords but little encouragement to hope for 
success. Death is inevitable in such cases, 
unless relief can be afforded, and but very few 
cases of successful operations are on record.* 
6. The anus and the continuous portion of 
the rectum are so contracted as scarcely to 
admit of any fluid discharge : we have even seen 
it scarcely pervious to air, so that on forcing in 
a grooved director, a considerable burst of flatus 
has escaped. This contraction may exist be¬ 
low, and yet the rectum be perfectly natural 
above. This contraction is sometimes not 
sufficiently noticed for several days or perhaps 
weeks after birth, because occasionally there is 
a small discharge of fecal matter ; it ultimately, 
however, excites attention from the great diffi¬ 
culty, straining, pain, and crying manifested 
at each evacuation. This condition of the 
parts sometimes admits of relief, by simple 
dilatation, by introducing a soft bougie, or 
some prepared sponge, which should °be re¬ 
placed after each evacuation, and secured, if 
possible, by adhesive plaster and a bandage. 
Should these means fail, an effectual cure may 
be obtained, as we have seen, by a division of 
the circumference. This may be done by intro¬ 
ducing into the rectum a button-pointed bis¬ 
toury for about an inch on a director, and 
dividing the wall of the intestine transversely, 
towards the ischium, first on one side, and then 
on the other, to the depth of about one quarter 
of an inch. The part must be carefully dressed, 
and the edges of each wound kept separate by 
lint. The success of the operation greatly de¬ 
pends on the care in the after treatment, par¬ 
ticularly in renewing the dressing whenever it 
has been displaced. 
The anus is occasionally found much con¬ 
tracted in new-born children who are con¬ 
taminated by syphilis, and may be mistaken for 
a congenital malformation, especially of the kind 
last noticed, though not one in the strict sense 
of the expression; yet as it generally occurs 
at birth, it deserves the consideration of the 
practitioner in midwifery, whose attention is 
often first called to it by the same symptoms 
that attend the congenital malformation of this 
opening, namely, pain, difficulty, and straining 
at each evacuation, and a peculiarly small aper¬ 
ture. On examination, how'ever, there are 
* See some observations by Petit, Mem. de 
1 Acad, de Chirurg, t. i. p. 378. 
other appearances which will assist in explain¬ 
ing the real nature of the case, such as brown 
or dark discolouration of the surrounding parts, 
also considerable moisture, frequently excoria¬ 
tion, and even superficial ulceration in the adja¬ 
cent structures. Small fissures in the anus, also, 
are observable, discharging tenacious matter. 
Similar appearances may exist about the com¬ 
missures of the lips; some soft granulations or 
condylomata are also often present in the im¬ 
mediate vicinity of the anus ; these frequently 
extend into the canal for a very little way. 
Other constitutional symptoms also are usually 
present, such as copper-coloured blotches on 
the skin, a tendency to cracking and excoriation 
of the skin about the hands and feet, and but¬ 
tocks, an imperfect development of, or a ten¬ 
dency to a separation of the nails, general 
emaciation, suspicious appearances about the 
mouth and tongue, and a remarkable and 
peculiar hoarseness in crying. Many, if not 
most of these symptoms, aided sometimes by 
the history of the parents, will lead the prac¬ 
titioner to distinguish this contraction of the 
anus from the congenital malformation before 
described. The distinction is important, as the 
treatment in both is totally different; the syphi¬ 
litic contraction invariably yields to gentle 
courses of mercury, administered in such form 
and dose as the circumstance of the case shall 
denote to be necessary. The local complaint 
disappears as the constitution is restored to 
health. Soothing, emollient applications are 
the best topical remedies ; should there be any 
ulceration or excoriation about the part, the 
surface should be slightly stimulated daily, 
either by caustic or by the ordinary mercurial 
lotions. 
Morbid conditions.—The anus is the seat of 
several morbid affections, some of which pro¬ 
ceed from a specific cause ; others are merely 
local. The specific diseases are syphilis and 
cancer ; and the most common local derange¬ 
ments to which the anus is subject are, super¬ 
ficial ulcerations, excoriations, fissures, with or 
without contraction of the orifice from exces¬ 
sive irritability of the sphincter muscle, pro¬ 
lapsus ani, haemorrhoids, fistula in ano, polypi, 
&c. Some of these last mentioned affections 
must, strictly speaking, be considered as ap¬ 
pertaining to the rectum, under which head 
the reader will find them noticed. As, how¬ 
ever, the anus is more or less engaged in these 
diseases, we shall make some observations on 
each. The anus is also subject to laceration in 
parturition, and from other causes. 
Syphilis affects the anus at all ages ; its ap¬ 
pearances in the infant have been already 
noticed. In the adult it may present the primary 
venereal ulcer, which will have the same cha¬ 
racter here as elsewhere, only somewhat modi¬ 
fied by the position and function of the part. 
The primary ulcer may be produced either by 
the direct application of the virus, or by ex¬ 
tension of ulceration from the neighbouring 
organs, as not unfrequently occurs in the 
female. \\ hen the chancre is confined to the 
anus, which is very seldom the case, it may be 
difficult to discriminate between it and ulcéra-
        

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