. American practice of surgery ; a complete system of the science and art of surgery . ds are pulled down and outside of the externalsphincter. Beginning at the line of juncture of the skin and mucous mem-brane—knoUii as Hiltons white line—the mucous membrane is divided and SURGICAL DISEASES OF THE ANUS AND RECTUM. 869 dissected up around the entire circumference of the rectum, and the dissectionis carried up to the beginning of the internal sphincter muscle. The mucousmembrane, together whh the inchided hemorrhoids, having been completelyfreed from the submucous and muscular coats, is pulled
. American practice of surgery ; a complete system of the science and art of surgery . ds are pulled down and outside of the externalsphincter. Beginning at the line of juncture of the skin and mucous mem-brane—knoUii as Hiltons white line—the mucous membrane is divided and SURGICAL DISEASES OF THE ANUS AND RECTUM. 869 dissected up around the entire circumference of the rectum, and the dissectionis carried up to the beginning of the internal sphincter muscle. The mucousmembrane, together whh the inchided hemorrhoids, having been completelyfreed from the submucous and muscular coats, is pulled down below the marginof the skin. The mucous membrane above the hemorrhoids is now dividedtransversely, in successive stages, and the free margin of the severed membraneabove is attached, as soon as it is di\aded, to the free margin of the skin below,by a suitable number of sutures. A complete ring of pile-bearing mucousmembrane is thus removed. Throughout the operation bleeding vessels aredealt with bv torsion or ligation. The incision around the anal margin is to be Fig. -Stump of Excised Hemorrhoid held byrhmi]) and Ready for Apphing Cauterj^(Tuttle. Courtesy of D. Appleton A: Co., New iork.) made entirel}^ in the mucous membrane, and no skin, however redundant,should be sacrificed. In the three hundred cases in which, according to Dr.^Miiteheads published report, he perfomied this operation, not a single in-stance of secondary hemorrhage occurred. An ice-bag is applied to the rectumfor the first few days, the bowels are mo\Td on the fourth day, the patient sitsup the same day, and he resimies his work at the end of two weeks. Dr. White-head further claims, for this operation, that it is as free from risk as any other,that the pain follomng it is less severe, and that the loss of blood at the timeof the operation is inconsiderable. We cannot admit that his claims for thisoperation have been fully borne out by the experience of other operators. Itis .stated by many
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
