Practical observations on some of the diseases of the rectum, anus, and contiguous textures

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Preface To The First Edition

The object of the present work is simply to call the attention of the non-medical reader to a class of diseases of most frequent occurrence, and which, as a general rule, are but. very imperfectly understood by him ; diseases too, to which he is daily liable, or from some one of which he is already suffering. This work will point out in a concise, plain and familiar manner the exact location of each disease ; its nature, its principal causes, its most prominent symptoms, the evil consequences of procrastinating its proper or judicious treatment, as well as the numerous, inefficacious and often extremely dangerous, painful and cruel methods which are at the present day advocated and adopted for its relief. This information will enable the general reader to avoid the causes of those diseases, and thus to remain free from their annoyance ; and it will also enable him, should he be so unfortunate as to be afflicted with any of them, to guard against the vile practices of the ignorant and presumptuous empiric, as well as, to shun the unnecessary, the cruel and dangerous operations of the scientific surgeon, commonly so called ; but often in reality, nothing more than the mere operator.

The many works already written upon this subject, are by

PREFACE TO THE FIRST EDITION.

no means suitable for the especial and beneficial study of the unfortunate sufferer himself. These works were especially written for the profession, are very diffuse and abound in technicalities, all of which is highly important and very interesting to the accomplished surgeon, but afford but very little practical information to the general reader. Indeed they are almost entirely destitute of that essential and practical knowledge which those require who are anxious to avoid the causes of those diseases, as well as those whose health and happiness have been more or less sacrificed to the ravages of them. Such is now the rapid diffusion of knowledge of every kind, both scientific and general, among all classes of persons, that but few can be found who would not be desirous to read something which they could at once understand and appreciate, in relation to this important subject.

For omitting the treatment of those diseases in the present work, some may be disposed to censure the author ; but he would remark that he is decidedly opposed to u publishing cures for the multitude." Too many works of this class are already in existence, for the good of the community at large. The instruction they need, is how to preserve their health. Books giving such instruction, are real acquisitions. When, however, they do become sick, it is then the especial and exclusive province of fhe physician to restore them to health. The object of the work has already been stated : it is, simply to instruct in the first place all who are willing to be instructed, how they may prevent those affections. This is of the greatest importance ; for the reader should never forget that it is much easier to prevent disease than to cure i* ;

Preface To The Fiest Edition

that " an ounce of preventive is worth more than a pound of cure.'" The prevention of disease should, therefore, be the first consideration of the community at large ; for no individual, however uninformed he may be, but can by proper instruction be taught with certainty how to anticipate and prevent disease

The author would again remark that another reason for not giving the treatment of those diseases in this work, is that they are difficult to treat under the most favorable circumstances, and he presumes, therefore, that none would desire or attempt to treat them, who do not possess the indispensable pre-requisite, a complete knowledge of their pathology, as well as a complete knowledge of the anatomy and physiology of the parts concerned. Without this, none can treat them with discrimination and success, and this kind of knowledge is not to be obtained from books alone ; it is by minute dissections of the parts, and by attending patients suffering from those maladies, that the surgeon can ever acquire that .quickness, that peculiar tact, and that experience which alone can render him able and skillful in their treatment.

The late and lamented Doctor James Johnson, of London, in his valuable treatise on Derangements of the Liver, makes the following very just and pertinent -remarks on this subject : — " These are," says he, " the glorious fruits of that wide system of charlatanism which pervades these islands, and which must prove as strong ' a preventive check? to population as the statistical philosopher can desire ! It is on this account, I have been solicitous to portray the causes of dis-

6 PREFACE TO THE FIRST EDITION.

ease as beacons to general readers ; but to attempt to teach them how to use the remedies, when they are actually overtaken with illness, would be to furnish them with the letters of Belleropiion, for their own destruction ! "

"Some good and much harm are every day done by the family medicine chest, and patent medicine warehouse. If the experienced physician is often at a loss what to prescribe, and frequently finds it most prudent to prescribe nothing at all, what infinite mischief must be hourly produced by the patient, and the still more ignorant quack, pouring drugs of which they know little, into a body of which they know less ! The dictionaries of popular medicine, and gazettes of health slay annually their thousands ; not directly, by the actual injury of the remedies which they congregate without knowledge or discrimination, but eventually, by procrastinating the interference of the regular practitioner till the period of cure is past, or until the disease has taken that hold on the constitution or part, which will baffle all future remedial means."

The following medico-legal opinion on this subject, may be in place here : —

A person once observed to an eminent lawyer, that " Buchanh Domestic Medicine" was a good book, because it qualifies every man to be his own physician. How far that may be the case, observed the man of law, I will not presume to determine ; but I may be allowed to speak decidedly as to my own profession, and so I hesitate not to pronounce, that every man who is his own lawyer, has a fool for a client.

The author has addressed this small work in an especial manner to the general reader, rather than to the profession,

Preface To The First Edition. 7

for the reason that medical men generally, can scarcely ever be induced to examine, adopt or introduce any practice which in the least conflicts with their own, unless the public are in the first place impressed with the importance of it. As soon as the public understand the subject well, and appreciate the importance of it, then and not till then, will the profession wheel into rank. Hence it is the policy of the author to address the public first, and afterwards the profession.

Such a work as is here attempted, the author is well convinced, from extensive observation, to be very much needed by the general reader. Whether this will therefore, completely supply the desideratum, will be for those to determine for whom it was written.

It may not be improper here also to remark, that it is the design of the author, at no distant day, to present also to the profession a complete practical work on the diseases of the Anus and Rectum, which will contain all that relates to the subject, from the earliest ages, down to the present period, together with the results of his own experience. The work to be illustrated by numerous colored plates, and exemplified by a very large number of cases.

Were the author disposed to make an apology for the many imperfections of this little work, he would remark that it was written at intervals, " snatched" from professional engagements, during the months of July and August.

Louisville, September 30th, 1846.

Preface To The Second Edition

The first edition of this work was issued from the press seven years ago, and the author does not now deem it necessary to trouble the reader with many prefatory remarks. The work has neither sought nor obtained any other patronage than the approbation of those to whom it was addressed. This it has obtained. The present edition is much improved in many respects, the addition of the plates not being among the least of its improvements.

In consequence of the author having devoted his special attention to the medical and surgical treatment of the diseases named in this work, he has been subjected to much unjust and unmerited abuse from many of the profession. It appears, in this country, that whenever a surgeon or physician, without any regard whatever to his surgical or medical ability, acquirements or standing, commences to practice any speciality, he is at once denounced by his brethren as a quack, an empiric, sl mere specialist, &c. Now, such a course of opposition, to say the least of it, is very illiberal, very unjust, very unkind ; but it doubtless has arisen mainly from the fact that so many are practicing specialities, in the United States, who are entirely destitute of any medical preface" to the second edition. 9

education ; or, indeed, education of any kind. In Europe, some of the most eminent of the profession are engaged in the practice of specialities, and they are universally considered superior in their profession. The truth is, that the most important, and the most valuable results have been effected by such concentration of thought, of purpose and of practice upon one particular point ; it tends greatly to increase the stock of pathological and physiological knowledge ; and by improving a part, it leads to the gradual perfection of the whole.

Civilization, with its accompanying increase of wealth and population, is universally followed by the minute division of labor, and the rendition into fragments of the pursuit of every art and science. The science of medicine, which embraces all that relates to the human organization and its injuries, has not escaped this universal law; having been at an early period divided into two grand divisions — medicine and surgery / and these again, at the present day, subdivided into almost as many parts as there are maladies. This state of things, in the medical profession, is productive of much good, provided the surgeon or physician practicing any one branch, has, in the first place, that general knowledge and scientific attainment which are always absolutely necessary for the efficient practice of medicine in its most comprehensive sense ; for, without this general knowledge, he can; never succeed in the practice of any one particular branch.. To render himself competent, he requires not only a regular education, and a general knowledge of the various branches of medical science, but engrafted upon this,, a.

10 PREFACE TO THE SECOND EDITION.

minute, accurate professional knowledge of the particular branch of medicine or surgery which he practices. That branch of surgery, for instance, to which the author gives his attention, calls into exercise all our anatomical, all our physiological, and all our surgical knowledge ; indeed, it is a speciality which embraces the whole body, and a scientific knowledge of the treatment of those diseases will be a means of greatly improving surgery in general.

After a successful practice of about eighteen years in the treatment of the diseases mentioned in this work, it will not be deemed necessary for the author to stand forth and defend his peculiar method here ; this will be done before the proper tribunal — the profession, in his large forthcoming work. He places his claims for support upon something more tangible than mere assertions, and refers, not without a strong feeling of pride, to the many evidences in the South and South-west where he has resided, and to the many proofs adduced in this work.

In conclusion, he returns his most grateful thanks to his

numerous patrons and friends, at whose hands, for so long a

time, he has received so many favors, and to whose service

he is still ready to devote the remainder of his days.

Saint Nicholas Hotel, )

New York, Dec. 1, 1854. \

Contents

Page Introduction 7 , - 15

Chapter I

WHY ARE ANAL AND RECTAL DISEASES, NOW, OF SO MUCH MORE FREQUENT OCCURRENCE THAN THEY WERE FORMERLY ?

The increase of anal and rectal affections, and the causes. The abuse of purgative medicine and its evil consequences ; Quaiu's case of death from excessive purgation induced by Morrison's pills ; the Southern gentleman and Brandreth's pills ; Physic ! Physic !! Physic !!! the motto of most all the quacks, for the cure of all diseases ; nostrums and patent right medicines ; the unity of disease and the unity of remedy, a most pernicious doctrine, and generally adopted by all quacks ; the popularity of this doctrine among the masses, and the causes why it is so ; Dr. Flint on the abuse of purgative medicine ; tight lacing and its evil consequences 21

Chapter II. Statistics

The difficulty of obtaining correct statistics ; the causes of this difficulty ; interesting statistics relative to fistula in ano; the celebrated Peter de March etti is said to have cured above six hundred cases of fistula by the knife, caustic, and the red-hot iron ; the Author has cured upwards of seven hundred cases of fistula in ano, in seventeen years, without either the knife, the actual or potential cautery 26

Chapter III. The Anatomy Of The Rectum And Anus

The position, form, capacity, calibre, attachments, division and structure of the rectum ; the three coats of the rectum ; the peritoneal, the muscular, and the mucous coat ; the longitudinal and circular fibres of the muscular coat ; the mucous glands and absorbent vessels of the rectum ; the arteries, ▼eins and nerves of the rectum; the anatomy of the anus ; the two sphincter ani muscles ; their important office ; the great importance of a knowledge of the natural as well as morbid action of these two muscles 28

CHAPTER IY.

THE PHYSIOLOGY OF THE RECTUM AND ANUS.

The rectum is the terminal depot of the intestinal canal for the reception of the faecal matter ; the utility of the peculiar position and form of the rectum ; its peristaltic, or worm-like motion ; the call of nature ; the process of defecation ; the peculiar nervous endowment of the rectum ; the act of defecation under the control of, or in obedience to the will ; the frequency of this act ; its uncertainty and causes ; should, as a general rule, take place once, daily ; the evil consequences when longer delayed ; it generally takes place in the morning ; and the causes 36

12 CONTENTS.

Page CHAPTER V.

CONSTIPATION.

Constipation a fruitful source of numerous diseases. The common causes ; want of attention to the calls of nature ; evil consequences of neglecting them ; want of proper accommodations for relieving the bowels a frequent cause of constipation ; water-closets and cabinets d'aisance. Peculiarities respecting the action of the bowels in some persons. The prophylactic treatment of constipation. Daily visiting the water-closet. Enemata ; their use and abuse ; proper instruments for administering them ; exercise ; diet ; brown bread and the antiquity of its use by different nations ; ripe fruits, and when they should be eaten , broiled bacon ; mustard seed ; bran ; cold water ; friction of the abdomen ; early rising 41

CHAPTER VI.

HAEMORRHOIDS PILES.

Vast numbers suffering from this disease ; description and symptoms of piles ; bleeding from piles; extraordinary cases of haemorrhage from piles; should this disease be radically cured in every iostance ? medical treatment of piles generally empirical; surgical treatment alone to be depended upon for a complete and radical cure ; superstitious treatment of haemorrhoids : excision and cauterization by knife, scissors, caustics and red-hot iron ; objections to these methods ; fatal cases by excision with the knife, reported by Sir A. Cooper; spontaneous cure of piles; the case of the celebrated Home Tooke; concluding remarks; letters from persons afflicted with piles, and from persons cured of piles 58

CHAPTER VII.

FISTULA IN ANO.

This disease noticed by Hippocrates, Celsus, Galen, <fec. ; Astruc and Dionis relate an interesting circumstance relative to this disease ; the case of Henry V. and Louis XIV. ; the complete history of the latter case as given by Dionis ; definition of the term fistula ; description, classification, formation, causes, and symptoms of fistula ; who are the victims of fistula ? Objectionable methods of treating fistulae ; incision and excision by the knife ; cauterization by the heated iron and by caustic ; the erroneous opinions which led to the adoption of these methods ; the knife operation the most fashionable method ; the indications of this operation as contended for by the moderns ; the falsity of these; the true indications pointed out; serious objections to the knife operation ; the method by caustics or escharotics ; the autiquity of this method ; the objections to the caustic method ; (ho method by apolinose or ligature as ancient as surgery itself ; objections to the ligature as used by both the ancients and moderns; improvements made by the author in the use of the ligature ; the peculiarities of his method ; Dr. Luke's method by ligature ; natural cure of fistula ; letters from persons afflicted with fistula ; publications and letters from persons cured of fistula, &c 97

CONTENTS. 13

Page CHAPTER VIII.

ABSCESS NEAR THE RECTUM AND ANUS.

Description of anal and rectal abscesses ; the causes and symptoms of these ; numerous foreign bodies removed from such abscesses ; a warning to persons what they swallow ; desperate cases cured ; letters from persons cured, and from those having the disease * . . 168

CHAPTER IX.

COMPLICATION OF ANAL ABSCESS, OR FISTULA ANI, WITH PHTHISIS PULMONALIS.

Explanation of the connection between consumption and anal abscess and fistula ; the opinions of Laennec, Bordeu, Andral, Lewis, and Clark ; Dr. McDowell's letter to the author on this subject ; the author's answer to the important question, should persons having this complication ever be cured? important cases cured; letters from persons laboring under this complication ; worst kind of advice ; death from procrastination 177

CHAPTER X.

FISSURE OF THE ANUS.

Description of anal fissure ; the causes and symptoms of anal fissure ; the popular method of treating this painful disease ; objections to this method ; letters from persons afflicted with anal fissure ; persons cured of this tor-

menticg disease by the author 183

CHAPTER XI.

PROLAPSUS OF THE RECTUM.

Description of prolapsus recti ; causes of falling of the bowel ; how to distinguish this disease from piles ; the importance of this distinction : the common method of treating this disease ; objections to this method ; letters from persons afflicted with this troublesome and painful disease. 192

CHAPTER XII.

Description of ulceration of the lower bowel; appearance of the ulcers; causes and symptoms of this disease ; 'ulceration of the rectum difficult to cure ; the causes of this difficulty ; letters from persons having this disease. 198 CHAPTER XIII.

INFLAMMATION AND EXCORIATION OF THE ANUS.

The causes and symptoms of this disease ; how to cure it, and how to avoid it. 203 CHAPTER XIV.

PRURITUS (ITCHING) OF THE ANUS.

The description, causes, and symptoms of this rebellious affection ; should this disease ever be cured ? Dr. Lettsome's opinion ; to treat it with success, the cause of it must be well understood 205

CHAPTER XV.

EXCRESCENCES OF THE ANUS.

The description and appearance of vegetations, or warty tumors of the anus ; fanciful appellations given to them by the ancient Greek, Latin, and Arabic authors ; causes of this disease ; cases cured 207

14 CONTENTS.

Page CHAPTER XVI..

POLYPUS OF THE RECTUM.

The term polypus, why used by surgeons to designate this kind of tumor ; this disease considered uncommon by authors generally ; the author differs from this in opinion ; the number of cases treated by him ; the description, causes, and symptoms of polypoid tumors of the rectum ; diagnosis, or how to distinguish rectal polypi : spontaneous cure of this disease ; letters from persons afflicted with this affection 209

CHAPTER XVII.

NEURALGIA OF THE ANUS.

Definition of the term neuralgia ; it is a most agonizing disease ; Mons. Velpeau's description of it ; causes and symptoms of anal neuralgia ; five cases

treated by the author ; Dr. Bushe's description of a case.. 211

CHAPTER XVIII.

SPASMODIC CONTRACTION OF THE SPHINCTER AKL

The description, nature, causes and symptoms of this painful disease ; it resembles fissure of the anus ; the common treatment of it, is division of

the sphincter ani muscles ; no necessity whatever for this operation 221

CHAPTER XIX.

ORGANIC STRICTURE OF THE ANUS.

Description, causes, and symptoms of this serious disease ; cases cured by the author 223

CHAPTER XX.

STRICTURE OF THE RECTUM.

This disease is considered by some the golden egg of the quacks - it is difficult to treat successfully ; diversity of opinion with regard to the situation of rectal stricture ; description of this disease ; symptoms ; Dr. Bushe's

description ; cases cured by the author 226

CHAPTER XXI.

MALIGNANT DEGENERATION OF THE RECTUM.

Description of this dreadful malady ; causes and symptoms ; the diagnosis sometimes difficult ; the pretensions of empirics regarding the cure of cancer ; excision of the anal canal ; objections to this outrageous operation ;

cases seen and treated by the author 233

CHAPTER XXII.

FISTULA IN PERIN.EO— URINARY FISTULA.

A description of this disgusting disease ; the causes and symptoms ; the popular treatment: objections to this ; cases cured by the author; letters from

persons having this disease 241

CHAPTER XXIII.

VAGINAL FISTULA.

A most distressing disease ; divided into vesico-vaginal, ure thro -vagi oal and recto-vaginal ; description of vaginal fistula ; causes ; some objectionable methods of treating vesico-vaginal fistula ; most difficult to cure ; a case cured by the author ; a number of cases of recto-vagiual fistula cured by the author 248

Introduction

The diseases incidental to the Anus and Kectum, or Lower Bowel, are of frequent occurrence among all classes of persons, and in consequence of their seat, as well as their nature, are perhaps the occasion of more suffering and of more annoyance to the patient, than with few exceptions, anyother class of diseases. Of extreme frequency, we know of none more difficult to treat successfully, we find none per haps less generally understood, and none certainly, in which a rational treatment is more necessary. Who will attempt to affirm that they are as well understood as they should be, or that they have been studied and treated with that care and discrimination which their importance demands ? Such is the ignorance on this subject, even in the profession, that a very able medical reviewer has observed that, " beyond the treatment of Fistula in Ano and Haemorrhoids, {piles,) the surgery of the rectum and ovnus is a sort of land of the Cimmerians, where quacks alone can breathe, and humbug darkens the air." But are not those diseases just as susceptible as any others of exact observation, of scientific analysis, and of safe, mild and appropriate treatment ? Is it indeed impossible for light ever to dawn upon this region, darkened by humbug and inhabited by quacks ?

16 INTRODUCTION".

Did surgeons but devote half the time and attention to this class of diseases, which they bestow upon some others of less importance, and did patients consult none but those whom they positively knew to be qualified, quackery, in these instances, would at once cease, and Messrs. Humbug, that large and flourishing Firm, would soon be compelled to close doors.

The great incertitude which characterizes the medical as well as the surgical treatment of those diseases, and which continually manifests itself in alternate timidity and cruelty of practice, is caused by the erroneous, the conflicting, and the arbitrary or dogmatic opinions which to so great an extent still 'prevail concerning their true character and treatment. It is, therefore, a matter of no surprise that so many patients afflicted with those affections, fall into the hands of empirical, unprincipled, or reckless practitioners, whose deceptions are favored by the mystery and secrecy arising from their situation ; and who are thereby encouraged and emboldened to perform and to repeat, painful, dangerous and unnecessary operations ; or to apply the most severe and often worse than useless applications.

The delicate situation of those diseases forms an almost insurmountable obstacle in the minds of many patients, especially if they are females, to seek and to obtain relief; and even when they do seek it, there is often nothing presented to their choice, but the formidable operations of the surgeon on the one hand, or the multitudinous nostrums of the quack on the other ; hence they are too often induced by

INTRODUCTION. 17

these several causes to postpone, from time to time, the proper treatment of their maladies until it is often too late.

The truth is, too little attention is paid to those affections, both by physicians and patients, and they are in this respect often, both to blame. Physicians are too apt, after hearing their patients describe their sufferings in the anal region, to treat them lightly by merely replying, " 0, it is nothing hut the piles, /suppose, you will he well in a day or two,' 7 &c, and then prescribing some salve merely. In most all such cases, a minute examination should be made, for two chances to one, if some serious disease, or complication will not be found to exist. The reasons, however, why this is not done are obvious. An examination is not a very pleasant thing, either to the surgeon or to the patient. But if the surgeon consults his own reputation, or the welfare of his patient, he will insist on an examination, especially when positive symptoms are complained of, or when suspicious ones, not otherwise well accounted for, do exist.

" It would be useless," says a fine writer, " to dwell on the necessity of the surgeon being thoroughly acquainted with these painful maladies. Their distressing nature weighs heavily on a patient's comfort and repose of mind, and he anxiously seeks for relief at the hands of science ; but too often he does not obtain it. How then can a physician or surgeon practice with a clear conscience, who does not keep himself on a par with the knowledge of the age. In other professions, ignorance may be folly ; in ours, it is crime. 77

In consequence of these various considerations and of the fact that these diseases prevail to a considerable extent,

18 INTRODUCTION.

especially in the South and South-west, the author was induced to turn his attention directly to them, and some eighteen years have placed under his immediate care and observation a very large number of patients, both male and female, from the different states of the Union ; many of these having previously undergone treatment by some of the best surgeons of our country. He has devoted these eighteen years almost exclusively to the treatment of those diseases, to their investigation anatomically, pathologically and physiologically, and having resided in Louisville, Ky., and New Orleans, La., his opportunities for observation and experiment, have been ample, and he has not failed to avail himself of every source of information within his reach. He has consulted and studied with great care all the authorities on this subject, both ancient and modern — both European and American. Although the labor in this field of investigation is by no means inviting or pleasant, but rather repulsive and disgusting, yet it must be admitted by all to be highly important ; for upon it, the life, health, comfort and convenience of so many, so much depend. No subject, however, should be considered degrading or unworthy of anxious attention, which involves such serious consequences, or which has for its object the improvement of the healing art, or the extension of our knowledge of nature's operations. No standard is known by which to determine the respectability of any branch of the medical profession, than its capacity of saving life and suffering, and exciting the powers of the understanding. This subject is now beginning to attract the attention of the most eminent of the profession, and the author knows of none in

INTRODUCTION. 19

the whole compass of medicine and surgery, possessing more practical importance or scientific interest.

It is admitted by all practical surgeons, that those diseases are difficult to treat, under the most favorable circumstances. Any attempt, therefore, at the diminution of that difficulty, should be meritorious, and any degree of success attending it, should be a subject of congratulation. Although the author does not in the present work give his peculiar method of treating those diseases, for reasons already stated, he nevertheless refers with pleasure to his triumphant success in their treatment, as furnishing the most satisfactory and incontestable evidence of its superior excellence. He, however, holds no secrets on this subject; but will most cheerfully at any time, until his large work appears, communicate his method most freely to any regular physician or surgeon who should feel so much interest in it, as to be induced to call on him.

PRACTICAL OBSERVATIONS, ETC.

Chapter I

"Why are Anal and Rectal Diseases now of so much more frequent occurrence than they were formerly 1

That those affections in the United States have of late years greatly increased in their ratio, is a fact confirmed by the experience of the oldest and best physicians and surgeons of our country. The causes of this increase are obvious, and all who will investigate this subject as I have done, will come to the same conclusion.