The pathology, diagnosis and treatment of diseases of the rectum and anus / by Charles B. Kelsey.

  • Kelsey, Charles B. (Charles Boyd), 1850-1917.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: The pathology, diagnosis and treatment of diseases of the rectum and anus / by Charles B. Kelsey. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    in the direction of the axis of the tube, but constantly against the wall, and at the points of greatest curvature the resistance is greatly increased. To these let us add the contraction of the cicatrix after extirpation, and the natural redundancy of the mucous membrane which may block up the new anus by an actual prolapse, and we have the factors which account for the clinical fact so often seen. On the other hand, the constant es- cape of faeces, which at first almost always follows these severe surgical operations upon the rectum, is best explained by the irritation of the wound and the constant reflex action which it excites. That the folds of mucous membrane, such as have been de- scribed, are of the nature to form an obstruction to the passage of the faeces, would seem to admit of no reasonable doubt. But this obstruction is passive, and not active, and is by no means sphinc- teric in character. When it is sufficiently great to form a real obstruction to the descent of faeces, the condition is an abnormal one, but such a condition is sometimes seen, and is one which is not to be disregarded in the pathology of stricture of the rectum. From a study of the literature of this question, and from the results of dissections and experiments which we have personally been able to make, we are led to the following conclusions : 1. What has been so often and so differently described as a third or superior sphincter ani muscle is in reality nothing more than a band of the circular muscular fibres of the rectum. 2. This band is not constant in its situation or size, and may be found anywhere over an area of three inches in the upper part of the rectum. 3. The folds of mucous membrane (Houston's valves) which have been associated with these bands of muscular tissue stand in no necessary relation with them, being also inconstant, and varying much in size and position in different persons. 4. There is nothing in the physiology of the act of defecation, as at present understood, or in the fact of a certain amount of continence of faeces after extirpation of the anus, which neces- sitates the idea of the existence of a superior sphincter. 5. When a fold of mucous membrane is found which con- tains muscular tissue, and is firm enough to act as a barrier to the descent of the faeces, the arrangement may fairly be con- sidered an abnormality, and is very apt to produce the usual signs of stricture.