. Tri-State medical journal . n the plan. Mr. Whitehead, after clearing out and trying todisinfect the rectum, commences by a circular incisionfollowing Hiltons white line, that is to say thejunction of the skin and mucous membrane along theverge of the anus, S. S. Then he dissects up themucous membrane with the attached piles, hemorr-hoidal veins, arteries, nerves and connective tissue,thus stripping bare the tube of the intestinal sphincteras high as the piles extend—generally about an inch,so that the dissected parts hang loose in the anuslike a cuff of bloody tissue. The cuff is then cut o
. Tri-State medical journal . n the plan. Mr. Whitehead, after clearing out and trying todisinfect the rectum, commences by a circular incisionfollowing Hiltons white line, that is to say thejunction of the skin and mucous membrane along theverge of the anus, S. S. Then he dissects up themucous membrane with the attached piles, hemorr-hoidal veins, arteries, nerves and connective tissue,thus stripping bare the tube of the intestinal sphincteras high as the piles extend—generally about an inch,so that the dissected parts hang loose in the anuslike a cuff of bloody tissue. The cuff is then cut offabove the level of the piles along the line B. B. andtaken away, and the arteries ligated as fast as mucous membrane is then drawn down andstitched to the cut edge of the skin, hoping for aunion by first intention. This hope, however, fre-quently fails in which case the stitches give way, themembrane draws up into the rectum and a tubular orannular ulcer results, which contracts in healing andcauses Fig. 1. S. S.—The lower circular inci-sion along Hiltons whiteline. of mucous membranedissected loose from thesphincter. B. B.—Dotted line showing theplace for the upper circu-lar incision. * Read before the Mitchell District Medical Society, at West Baden, July 5,1895. 332 WHITEHEADS OPERA77ON—ANDREWS. Certain persons, calling themselves Orificial Surgeons, have slightly-changed the order of procedure by pulling down the mucous membrane andmaking the upper incision first, and the lower one last. For this slight,variation they have invented the pompous title of the American Opera-tion. The final effect is the same in both, and, as the hemorrhoidal ves-sels are all gone the patient is permanently cured, since there is nothingleft of which piles can be made in the future, just as a patient who has hadboth his jaws excised will never have any more trouble with his teeth, orif his foot is amputated he will never have any more corns on his
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Keywords: ., bookcentury1800, bookdecade189, booksubjectmedicine, bookyear1895
