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.
POLYPUS.
These innocent growths can be successfully removed, when within reach and most of them are, without the loss of blood or the infliction of pain, by carbolic acid injection to act as a styptic and deaden the sensibility, while the scissors is used to sever their connection with the bowel.
Allusion is made, in speaking of the diagnosis of hemorrhoids, to the different forms and varieties of polypi, consequently no further description of them will be given here. Polypi, being more dense and fibrous than hemorrhoids, are not readily permeated by the injection compound. Neither can the hemorrhoidal needle be used with any advantage unless they be large and soft in structure. Therefore a small hypodermic needle is selected and 95 per cent. carbolic acid. This strength of carbolic acid is not only a powerful styptic and cauterant, but its fluidity permits it to be forced throughout the fibrous structure with ease.
The action of the acid should extend fully to the base of the polypus, which is then clipped off a little outside of the line. The stump goes through similar changes to that of hemorrhoids after injection. In long or pediculated polypi, it will only be necessary to apply the acid at the base sufficiently to intercept the circulation before excision.
A little cocaine may be used first, if the parts are very sensitive, and the same precaution should be taken with regard to the protection of the adjacent and surrounding parts from the excoriating effects of the carbolic acid, as recommended when operating on hemorrhoids.