Practical remarks upon stricture of the rectum, especially in relation to its connexion with fistula in ano, and ulceration of the bowel, with a new and improved form of bougie for the treatment of this affection / by Jolliffe Tufnell.

  • Tufnell, Jolliffe.
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Practical remarks upon stricture of the rectum, especially in relation to its connexion with fistula in ano, and ulceration of the bowel, with a new and improved form of bougie for the treatment of this affection / by Jolliffe Tufnell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    instruments, as hitherto employed, have been variously con- structed as to material, consisting of wax, gum-elastic, ivory or bone, polished metal and membrane; but all similarly cir- cumstanced in this one respect, viz., that they have had no central cavity admitting of an artificial exit for the intestinal contents, and entrance for such medicaments as the surgeon may choose to apply to the structures implicated in the dis- ease. It would be a contradiction were I now to introduce an instrument purporting to be superior, and advocate then the employment of any other; but it is not from prejudice or fancy that I recommend its adoption, but from the conviction that in practice every object that can possibly be obtained by the old pattern is equally gained by the new, with additional ad- vantage. Being a hollow tube, no sooner is the central guid- ing rod withdrawn, than free exit is given to mucus, pus, blood, or other fluid secretion which may be lodged in the pouch-like cavity which exists almost invariably above the stricture; and not only are these otherwise retained, and decomposing matters drawn OS' and got rid of, but, by fitting the nozzle of a syringe to the free end of the bougie, by means of a coupling-joint of vulcanized rubber, a stream of tepid water may be gently thrown up into the cavity of the intestine above the stricture, breaking up any solid lump of faecal matter that may be lodged, thereby freeing the patient of the accumulation which forms the main source of irritation, and relieving him from the prin- cipal cause of suffering in this disease. I advise, then, for the reasons stated, the employment of a tubular gutta-percha bougie, of suitable dimensions, and of one or other of the forms depicted in the illustration ; the small stemmed for preference, if the bulk of the larger be considered as likely to prove a source of inconvenience, by its distending the anus. Next, as to the administration of chloroform during the introduction of the bougie. Now, however useful the employ- ment of an anaesthetic may be for the purpose of making any primary or exploratory examination of the bowel, I am satis- fied that the subsequent distention of the stricture by the bou- gie should not be carried on under its use, and for this reason, namely, that an undue amount of injury is likely to be inflicted upon the intestine when the patient is unconscious, which will be afterwards resented by the system; and fever or feverish action may be excited in consequence, from which the health of the individual will correspondingly suffer. So far, indeed, from time being gained, and the process of cure accelerated, it will, in all probability, be materially retarded by so doing. The plan now introduced afl’ords the means of conducting O