Intestinal irrigation

by Alcinous B. Jamison

The profuse serous exudation resulting from proctitis and sigmoiditis makes its way from the diseased area into the neighboring regions like lava from an active volcano, carrying with it an intense burning inflammation, destroying normal fatty tissue as it advances, owing to its extremely acrid character. Is it any wonder that we find dilated veins and arteries in the lower rectal and ano-rectal canal and around the anus where stasis of the blood has existed for a great many years? The real wonder is that thrombus in the veins around the anus does not occur more frequently than it does. What is the necessity of calling such a pathological change in the caliber of a vein and the weakening of its walls “thrombotic pile”? Thrombus is a clot of blood in a vein, and there is no use in adding the word “pile.” The aggravated character of the inflammation accounts for the hypertrophied and the cicatricial tissue so often found around the anal vent of proctitis cases. The Biblical suggestion that sacculated mucosa, commonly termed piles or hemorrhoids, is a disease, accounts for the numerous names used to designate the particular variety of the disease—whether it be an internal or an external pile tumor. It is very wrong to so mislead “scientific” medical men. Had they only known that the numerous sacs, bags, prolapsed pouches, longitudinal and transverse folds of the ano-rectal mucous membrane, and the ragged, jagged, prolapsed, pouched muco-cutaneous tissue around the anus, as well as the fissure-in-ano, pruritus ani, fistula, are only symptoms of a disease, all of the many abnormal changes and the other symptoms could have been prevented many generations ago by simply treating their exciting cause. But it is never too late to learn things that will benefit mankind.

Don’t for a moment think that all of the structural changes on the mucous membrane and about the anus mentioned above indicate an affliction only skin deep, or even the depth of the mucous membrane. They are far worse than that. You will find all the muscular structure of the anal organ and that of the rectum sigmoid flexure severely invaded by the inflammatory process and its fibrinous exudation, and also the external tissues that surround and support the organs.

We have circular and longitudinal muscular tissue entering into the structure of the anus and rectum. The sphincter muscles are two large and strong muscles that close the anal orifice and guard its vent very effectually if they are not destroyed by a surgeon’s knife.

The acrid burning serum coming in contact with the muscular tissue excites an aggravated inflammation in its structure as elsewhere. The constant irritation results in more or less permanent contraction of the sphincter muscles in which fibrinous exudation takes place, binding the contracted muscular fibers together. In time their expansibility is lost in many cases, and in other cases partially so, necessitating divulsion of the sphincters in order to break up the adhesions and establish a somewhat normal circulation of the blood in the diseased parts, also in order to relieve the irritation to the nerves distributed to the organs and their marked reflex excitement. In some cases an expansion of the sphincters for one and a half inches or two inches is quite sufficient; other cases may require a little more thorough divulsion; but never weaken or paralyze the sphincters, as your patient needs their normal use, and you need the reputation of never causing incontinence of feces. Guard the usefulness of the sphincters as you would a valuable treasure.

As a rule, I treat all of the ano-rectal sacculated mucosa in cases where divulsion is required before performing the dilatation to break up the adhesions, and very frequently the muco-cutaneous sacs and distended veins as well. It may be well to delay the divulsion—with which there is usually no hurry—until you determine how many U-shaped (or hairpin shaped) mucus channels and recto-anal mucus fistulas there may be present that have passed down under the recto-anal mucous membrane, down to the integument about the anus, and then pressed immediately upward again along the outer wall of the anus and rectum, to the extent of six inches or more. There may be three, four, six, or more of them quite prominent as to length and size.

For the treatment of the recto-anal sacculated mucosa the injection method is par excellent. For the removal of the muco-cutaneous sac a double V-shaped incision, the proper depth, length, and width, will remove the surplus or redundant tissue, after which the edges are brought together with a catgut suture,—or omit the suture if you think best,—followed by the home attention as prescribed for fissure-in-ano in a previous chapter. At the time of removing the sacculated tissue attention may also be given to the mucus channel; or you may, if you wish, leave it so that at some future treatment you can give it the desired attention. A one or two per cent. solution of alypin, cocain, or beta eucain will produce the necessary local anesthesia for a painless operation. I remove only one muco-cutaneous sac at a treatment, which permits the patient to go about as usual without much inconvenience.

If you have removed all of the ano-rectal sacculated mucosa in a case, and have omitted to remove the one or more ano-muco-cutaneous sacs or dilated veins that are so often present around the anus, and have also neglected to cure the chronic proctitis, then the sacculated mucosa may, by some hook or crook, become excited again into an acute inflammatory condition, the sphincter muscles may grip tighter than usual, and lo, thrombus has taken place in a vein, and the wrinkled, shriveled, skinny tab or sac looks like a miniature balloon, and your dismissed patient is in a troubled state of mind to have everything come back on him so soon!

The cure was all right so far as it went, but there was the disease and some of the old external symptoms to tell the tale of an incompleted treatment.

Those muco-cutaneous sacs at the enteric crater’s mouth are just so many thermometers at its vent to tell the temperature occasioned by the fire of inflammation within, and they will damage your reputation as a proctologist if they be not removed. By all means get rid of these symptoms and indicators of trouble within; and if there should by chance be a little of the old proctitis remaining that wants to assert itself by making trouble, in becoming acute, it will be surprisingly handicapped in its efforts, and the chances are all in your favor; and you will, moreover, from time to time, hear what So-and-So said about the very successful treatment of his or her case.