Part 1

OBSTIPATION

A PRACTICAL MONOGRAPH ON THE DISORDERS AND DISEASES OF THE RECTAL VALVE

THOMAS CHARLES MARTIN, PH. D., M.D.

OF CLEVELAND, OHIO

Fellow of the American Proctologic Society, Professor of Proctology in the Cleveland College of Physicians and Surgeons, Proctologist to the Cleveland General Hospital, etc.

THE PHILADELPHIA MEDICAL PUBLISHING CO 1899

TO MY GENEROUS COLLEAGUES I GRATEFULLY DEDICATE THIS LITTLE BOOK. T. C. M.

“I deny their existence, and if they did exist I would deny that their use was to support the fecal mass. For many years I have searched for these folds and I have yet to encounter them. In my opinion, they existed only in the author’s mind’s eye.”--JOSEPH M. MATHEWS, M.D., Diseases of the Rectum, p. 37.

CONTENTS

Prefatory.

Introduction.

A Chronologic Review of the Literature of the Rectal Valve.

The Chronology of Atmospheric Inflation of the Rectum for its Inspection.

The Examination of the Rectum.

Topographic Anatomy.

The Rectal Valve.

Defecation.

Obstipation in Infants.

Obstipation in the Adult.

Diagnostic Observations.

Cases of Obstipation Radically Treated.

List of Illustrations.

PREFATORY.

That man is guilty of a most reprehensible foolhardiness who undertakes any of the operations herein recommended without first familiarizing himself with the anatomy of the rectum under the conditions specified.

The benefit which accrues to the obstipated patient is measured by the judgment and skill which the operator exercises in the selection of his subject, in the application of the proposed methods, and in the subsequent treatment of his patient.

Obstipation may be defined as that condition of obstructed defecation which is due to the presence in the rectum of an organic obstacle to the descent of the feces through it. Constipation, on the other hand, is that condition of delayed defecation which results from a prolonged retention of the feces in higher portions of the gut. Constipation may exist independently of any obstruction and may be due to any of several causes, such, for instance, as faulty habits and diet, imperfect innervation or modified secretion--the consequence of disease or accident. Obstipation and constipation may coexist.

INTRODUCTION.

The great diversity of opinion which characterizes the literature on the anatomy of the rectum, our discouraging record of compromise with the obstipated, paucity of definite knowledge of the etiology and pathology of stricture of this organ, the lack of safe and sure measures for acquiring this knowledge, the inefficacy of the methods generally employed in the treatment of rectal stricture, and the too heroic colostomy occasionally applied by the surgeon on the one hand, or else the supine inertia of the physician on the other hand,--all compel the search for a demonstrable conclusion to the matter.