Treatment of hemorrhoids, and other non-malignant rectal diseases — John Shaqi
Treatment of hemorrhoids, and other non-malignant rectal diseasesAgnew, W. P. (William Penn)
Science
Treatment of hemorrhoids, and other non-malignant rectal diseases
Agnew, W. P. (William Penn)
Hemorrhoids; Rectum -- Diseases
For the purpose of obviating these very unsatisfactory and highly
objectionable results, we have a choice of any one, or all of three
different methods, viz: treatment by injection, treatment with the
fistulatome, and treatment by the galvano-cautery as practiced by Dr.
Shotwell; who, fully appreciating the dangers of muscular section, has
hit upon a plan both new and commendable.
[Illustration: FIG. 14.—Varieties of Fistula. (Gosselin.)]
The sub-cutaneous, or sub-mucous fistula can be cocainized and slit up
with a pair of scissors, and the tract cleansed and cauterized with
a solution of carbolic acid, a comparatively trivial affair; but the
external blind, the internal blind, the complete, the complete with
diverticula etc., are varieties which call forth a decidedly greater
amount of ingenuity and thought in bringing them to a successful issue.
The treatment by injection, sometimes classified as a “non-operative
method,” has been so successful in the hands of many, that it is stoutly
affirmed that any case curable by the usual heroic methods is equally
curable by this method. Different preparations have been used, chief of
all being carbolic acid, ranging in strength from 50 per cent. up.
In adopting the carbolic acid treatment, probably the better way after
preparing the sinus, will be to use a 95 per cent. the first time
and subsequently a 50 per cent. solution; protecting the parts from
excoriation by any suitable unguent and absorbent cotton. Hot water
compresses to relieve pain and reduce swelling. Iodoform, Eucalyptol,
etc., in the _interim_. Judgment will be required in not making too many
irritant applications and granulation thus hindered for want of rest.
The object is to destroy the pyogenic membrane by the cauterizing effects
of the acid and get up a granulating carbolic acid sore. It may be
necessary to evacuate the bowels and constipate for several days to give
the muscles rest, or resort in extreme cases to divulsion. The sinus
must have constant, free external drainage until the healing process is
complete. Allingham recommends the introduction of the small end of a
bone collar button to keep the orifice open, with a hole drilled through
its centre for drainage.
As a preliminary step the external orifice should be dilated with a
laminaria tent or other appropriate means. The fistulous tract explored
with a common probe and thoroughly cleansed with hot water introduced
through a flexible silver canula; which is also used for the injection of
a 5 or 10 per cent. solution of cocaine to obtund the sensibility.
[Illustration: FIG. 15.—Bone Stud]
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