. American practice of surgery ; a complete system of the science and art of surgery . ved. This is why palhative treatment offers so httle encouragement,because, even if it prove successful in effecting the heahng of the ulcer, the latteris likely to recur when the first constipated stool is passed. Surgical operationsmay result in the production of fissure-like ulcerations, but, not having any scartissue, they heal up promptly and permanently. The most usual exciting causeof fissure in ano is the repeated passage of hard fecal masses, which tear througha crypt of Morgagni. It is the repeated
. American practice of surgery ; a complete system of the science and art of surgery . ved. This is why palhative treatment offers so httle encouragement,because, even if it prove successful in effecting the heahng of the ulcer, the latteris likely to recur when the first constipated stool is passed. Surgical operationsmay result in the production of fissure-like ulcerations, but, not having any scartissue, they heal up promptly and permanently. The most usual exciting causeof fissure in ano is the repeated passage of hard fecal masses, which tear througha crypt of Morgagni. It is the repeated recurrence of these tears that bringsabout the peculiar characteristics of an anal fissure, a certain amount of scartissue forming in the repeated attempts at healing. Polypi or polypoid hemorrhoids are frequently associated with fissures, andare situated at the upper or internal end of the fissure. They doubtless standto each other in the relation of cause and effect, the fibrous tissue at the base ofthe polypus not yielding to the necessary dilatation of the parts in the passage. Fig. -lUustrates a Fissure in Ano with an Internal Hemorrhoid Overhanging the Upper Portion. of a constipated movement. A^Tiatever may be the direct cause of thenarrowing of the anal canal, there can be no doubt that the presence ofhemorrhoids, both by narrowing the outlet of this canal and by producingchanges in the connective tissue of the parts, favors the development of a theory advanced by Ball—^that typical fissures are due to the tearing ofthe crypts of Morgagni, through the action of small fecal masses which becomelodged in the little pockets, and which then in turn are pressed upon by otherhard fecal masses, thus causing the edges of the valves to tear—seems to bevery reasonable, when we call to mind how frequently w^e find the typical fissurecorresponding in general appearance and outline Y\ath the condition as depictedin Fig. 325. This theory is further supported by
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
