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 |   Related post: recovery from shock, I would not feel justified in suggesting the possibility of keeping up or saving human life in such cases by forced respiration. I offer the cases of Mr. Baere and Mr. Van Orden as instances from which it is reasonable to infer that forced respiration may be expected to give results in shock to be obtained by no other means. 7j Niagara St., Buffalo, N. Y. TWO CASES OF STRICTURE OF THE RECTUM: EXTERNAL PROCTOTOMY. BY WALTER B. PLATT, F.R.C.S. (Eng.), OF BALTIMORE, MD. Case I. Syphilitic stricture of rectum; recto- vaginal fistula; external proctotomy ; entire relief from difficulty of defecation. — M. W., married, a small, thin, dark-complexioned woman, about thirty- five years of age. For three years patient had had difficulty and pain in defecation, with constipa- tion ; some blood passed at stool. She attributed her stricture to an operation for fistula in ano ; no history of syphilis, or physical signs, except circular, pigmented spots on legs. The patient had, however, led an irregular life, and is now living with a negro. If no laxative was taken, bowels moved but once a week, and then with diarrhoea and pain. Apart from this she considered herself in fair health. Fluid fecal ' In Case III., the gurgling of blood in the lungs could be heard ten feet from the patient. Digitized by 668 STRICTURE OF THE RECTUM. [Medical Neks matter sometimes issued from vagina. She had a very lax anus, surrounded by a fringe of external piles, flat and bluish. One and one-half inches up the rectum a great narrowing of the calibre of the bowel was felt, which barely admitted the tip of the forefinger. It appeared to be Tadagra Soft more in the superior part of the bowel. It was found, after the operation, to be three-fourths of an inch long, and somewhat longer on the inferior than on the upper surface. It was granular within, and very hard and inelastic to the touch. The stricture could be moved from side to side with the finger-tip. After some weeks of anti-syphilitic and tonic treatment, the case was deemed eminently suitable for Tadagra Professional external proctotomy, which was accordingly done November 20, 1887. The patient being etherized, the skin and part of the adjacent tissues from the anus to the coccyx were divided with the thermo- cautery knife. Its use was so unsatisfactory that recourse was had to the knife to complete the opera- tion. The skin, sphincter, lower rectum, and stricture being divided in the median line from above downward (the stricture by Buy Tadagra the introduction of a long stricture knife), the bowel above the stricture could be plainly felt — smooth, soft, elastic, and apparently not abnormally dilated. The hem- orrhage was very free for a moment after the division of the rectum, and the blood was bright red in color. The flow was checked with little trouble by the free use of hot water and pressure with hot sponges. An oiled linen rag was introduced into the rectum, and filled with sponges, so as to exert pressure upon the rectal walls and the cut surfaces. One-fourth grain of morphia was given twice in the following twenty- four hours, and the sponges removed at the end of that time. There was considerable brownish dis- charge, and a little blood and pus escaped when the sponges and the oiled rag were removed. The wound was now thoroughly washed out twice daily with warm carbolized water, and iodoform dusted in as far as practicable ; a pad of absorbent cotton ap- plied over all. December g. Nineteen days after operation a Tie- mann's soft-rubber conical rectal bougie (No. 6) was passed. loth. No. 7 passed. igth. Passed No. 10. I have five times passed No. Tadagra Softgel Capsule 8 since last note. It gives the patient some pain to go about and uneasiness to sit down. Patient has a good stool every second or third day, after using licorice powder. She has control over flatus and feces, she looks well, and eats the same food as before the operation. Some time after this the patient was seen by my nurses going about the street. She said she was in good condition, and had one stool daily by smoking a cigarette. She did not consider a bougie any longer necessary, although she was advised to have it passed once a week. Case II. Syphilitic stricture of the rectum : recto- vaginal fistula ; external proctotomy ; entire relief form symptoms. — F. W.,aslender, small, pale woman, set. twenty-five, married. There was a clear history of infection nine years ago, when she had a sore Tadagra Prof Related links: What Is Bystolic, cheap retin a no prescription, Penegra Express, Dutasteride 0.5 Mg, Buy Seroquel, Furadantin Oral Suspension, Azelaic Acid 20 Percent Cream, Mircette 28, Hoodia Slimming, best price on alli
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