. American practice of surgery ; a complete system of the science and art of surgery . ISEASES OF THE ANUS AND RECTUM. 803 which is hkcly to leave Httle tags or teats. There are many cases, however,which cannot be accounted for by Balls theory. Pathology.—Tim pathological changes vary from a very slight tear or fissureto a deep ulceration, both of which conditions are associated with fibrousinfiltration which is the essential pathological feature of fissure i7i am. Thisexplains the readiness with which they tear. Among the microscopic changeswhich M. Hartmann found in excised fissures (op. dt.
. American practice of surgery ; a complete system of the science and art of surgery . ISEASES OF THE ANUS AND RECTUM. 803 which is hkcly to leave Httle tags or teats. There are many cases, however,which cannot be accounted for by Balls theory. Pathology.—Tim pathological changes vary from a very slight tear or fissureto a deep ulceration, both of which conditions are associated with fibrousinfiltration which is the essential pathological feature of fissure i7i am. Thisexplains the readiness with which they tear. Among the microscopic changeswhich M. Hartmann found in excised fissures (op. dt., p. 442), the followingis worthy of note:—Deep down in the smooth muscular layer, the fibres of whichwere more or less separated by fibrous tissue, he found that the nerve-trunks,which also were surrounded by this same tissue, showed evidences of interstitialand intrafascicular neuritis. These conditions almost certainly account for thesevere and persistent pain so generally characteristic of these cases. Symptoms.—The characteristic symptom of fissure in ano is the peculiar. Fig. 326.—The Drawing Represents an Irritable Ulcer of the Anus. pain which attends it, and which continues for some time after an evacuationof the bowels. There is no disease of the anus or rectum in which, simply fromthe character of the symptoms, and more particularly of the pain, one may,without an actual examination, make as correct a diagnosis as in fissure in patient, as a rule, feels perfectly comfortable until he has a stool; and,furthermore, the pain does not ordinarily follow the stool immediately, butcomes on in from fifteen to twenty minutes thereafter. This pain is of a dull,aching character, and it soon increases until it becomes almost unbearable. Itmaintains this degree of severity for several hours, and then it gradually sub-sides. In exceptional cases the pain is less pronounced; it may last for onlya few minutes after the stool, to recur again at the next one; each time,
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
