DIVULSION.
Forced dilitation as a means of relief and cure for certain forms of rectal trouble, although a much abused and somewhat barbarous practice, has positive and undoubted merits. It is only justified, however, in peculiar and isolated cases.
The wholesale stretching of the sphincter ani muscles as a “cure all” is certainly to be deprecated as unscientific, illogical, and without the advantages or benefits claimed for it by rattling and noisy fanatics. Divulsion injudiciously employed may be followed by a long and tedious recovery, complicated with very undesirable sequelæ and thereby excites much adverse criticism.
The case of a lady recently came under my observation, who, although in average health, complained a little as many women do, and thought she was troubled with hemorrhoids. Through the advice of her physician, a college professor, she submitted to the operation of stretching on general principles. Irritability of the rectum followed, with soreness and continued pain. Finally two large sympathetic buboes developed, which suppurated, and were slow in healing. This happened a little over a year ago, I am reliably informed, and she has not yet fully recovered.
A number of cases have come to my notice where stretching was practiced for the cure of piles, imaginary spasmodic stricture, etc., without the least benefit, except, possibly, that accruing to the physician.
Fig. 30.—Graduated Rectal Dilators. (Pratt’s).
A young married man, foreman of a printing-office, complained at times of slight pain in the region of the liver. His physician, an editor of a medical journal, made an examination of the rectum with a speculum, and informed him that it would be necessary, to preserve his health, to undergo the operation of stretching the sphincters.
The day was appointed and hour set for the operation, which, fortunately for the young man, was “nipped in the bud” by the physicians arriving a little late; and through the advice of a friend he seized the opportunity and “skipped out,” came to my office, and was examined. His bowels were regular, there was no history of rectal disease, and not the least sign of any; nor was there a shadow of an excuse for an operation.
The cases in which divulsion seems to be of greatest benefit are found mostly among women of a peculiar high nervous tension or organization, where the muscles become hypertrophied from repeated spasm, and constipation resulting from ineffectual efforts to expel the feces. In such cases forced dilitation is followed by the most satisfactory results.
It should be accomplished with patient lying on the side, and under the most profound anæsthesia. Rectal dilators, which distribute the force evenly all around, may first be used, then the thumbs, or the thumb of right hand and index finger of the left, or two fingers of each hand, to completely paralyze the muscles. The process should be slow and gentle, and caution exercised lest the tissue give way from the application of undue force.
Local causes should always be sought, and excluded if practical, before heroic measures are adopted for the relief of spasmodic sphincter. There are instances where tightness of the sphincters exist, superinducing constipation, etc., not traceable to any appreciable cause. These cases may be relieved without the aid of general anæsthesia, by graduated dilators or rectal bougies, accomplishing little at a time, daily or tri-weekly.
When constipation depends upon inertia, or a lack of expulsive power of the rectum, I think moderate dilitation advisable and decidedly beneficial.