Remarks on a treatise on the rectum [by James Syme] / [A.W. Cockburn].

  • Cockburn, Archibald William, 1814-1862.
Date:
[1838?]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on a treatise on the rectum [by James Syme] / [A.W. Cockburn]. Source: Wellcome Collection.

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    The error into which the above-named surgeons have fallen is in sup¬ posing that the internal aperture in a complete fistula is ever beyond a certain distance from the extremity of the anus. Professor Syme lays down as a universal law, that “ in complete fistula, the internal opening does not lie farther from the anus than an inch and a quar¬ ter.” In addition to the manifest absurdity of limiting the internal opening to any minute measurement, the names of the high and re¬ spected authorities whom he has himself quoted, are quite sufficient to prevent practitioners being misled by Professor Syme’s statements. He modestly however, admits, that his views “ are still far from being generally adopted,” although they have been before an ungrate¬ ful public, in his “ systematic work on surgery,” and in reports of his hospital practice, occasionally published. His “ systematic work” we have never read, nor do we intend to do so; as to the reports, when they contain true statements, with no facts suppressed {vide Lancet,) we may perhaps be led to give them some credit. He lays down another universal law as to the operation for fistula, which is likewise erroneous. He says, “ In performing the operation, it is merely necessary to divide the parts lying between the external and internal apertures.” Now, it is evident that he is speaking of what is sufficient to be done when the fistulous track extends higher up than the internal aperture. Experience proves the reverse of his statement. In no case, where it can be done with safety, is only part of a sinus to be laid open — it must be laid open its entire length, or little good is done; and this rule applies especially to fistula in ano. Unless the knife reach the extreme depth of the canal, it had better be laid aside—the haemorrhage, which is occasionally smart, but which can always be commanded, is not to deter the surgeon from this only effectual means of finally curing the disease. Having laid down the principles which he advocates, he proceeds to consider the different stages of fistula, and their treatment. Abscess is the first stage of fistula, and in his treatment of it he is wrong.— He says, “ so soon as fluctuation” can be perceived, it is considered right to evacuate the matter. When there is pain and induration at the side of the anus, indicating the approaching formation of matter, a free incision should be made. Fluctuation and pointing are not to be waited for — a free incision is to be made before they are percep¬ tible externally; and it is only by this active practice that abscesses are prevented from proving subsequently troublesome. We are told not to operate for fistula when “ there is a phthisical condition of the patient.” This remark applies to all operations; but in an operation of minor consequence, as fistula, we find few cases where the patient is consumptive, in which his lungs are in such a state as to preclude the propriety of operating. But we would not operate on a phthisical subject for the reason given us by Professor Syme, viz. “ that the refusal to operate requires a very painful ex¬ planation.” This is a fresh proof of the sensibility we previously suspected he possessed. It is not only in fistula, however, that he reluctantly draws forth his knife when there is an organic disease for¬ bidding it. For our memory recalls to us a case of cancer of the lip in an old man, past relief, not only from the extent of ulceration, but