. American practice of surgery ; a complete system of the science and art of surgery . 317 and 318.) SURGICAL DISEASES OF THE ANUS AND RECTUM. 775 Treatment.—Whore there is complete atresia, whatever is necessary mustbe done at once, to afford the child any chance for life. On the other hand, inthose cases in which there is an exit for the meconium and fluid feces a moreconservative course may l)e adopted until the child has grown older and strongerand is better able to stand an operation. In such cases the opening, if smalland within reach, may be dilated. The prune object, in all operations
. American practice of surgery ; a complete system of the science and art of surgery . 317 and 318.) SURGICAL DISEASES OF THE ANUS AND RECTUM. 775 Treatment.—Whore there is complete atresia, whatever is necessary mustbe done at once, to afford the child any chance for life. On the other hand, inthose cases in which there is an exit for the meconium and fluid feces a moreconservative course may l)e adopted until the child has grown older and strongerand is better able to stand an operation. In such cases the opening, if smalland within reach, may be dilated. The prune object, in all operations formalformations of th(> anus and rectum, is to give an exit to the intestinal con-tents, and to restore the parts as nearly as possibl(> to their normal functionalactivities. Amussat, in 1835, was the first to lay down the cardinal principleswhich have since guided surgeons in their attempts to correct these malforma-tions. He advised the free and wide dissection of the perineum, with removalof the coccyx, if necessary, in order to gain more room for reaching the Fig. 310.—In the Case Represented in the Drawing the Anus Opened at the Tip of the Coccyx. He also advised opening the peritoneum, when necessary, through this the rectum was found, he advised that it be dissected loose from itsattachments, brought down outside the wound, opened, and, after the contentshad been discharged, attached (without too much tension) to the skin marginof the wound at its normal position, if possible. But, if it was found impractica-ble to bring it dow^n to the normal position, then he advised attaching it to thesides of the space left by the resection of the coccyx. From Amussats day tothe present time all methods of operating upon an imperforate anus and uponmalformations of the rectum have been based upon his recommendations. Weshall consider the treatment of these malformations in the light of the presentadvances in surgery, in a general way, and shall point ou
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