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Philadelphia: W. B
of ichthyol, hydrastis, krameria, and free sign up bonus no deposit required casino soda, potas-
sium permanganate, or boric acid, to reduce the free online casino games no deposit bonuses in-
flammation and heal the ulcers.
When enterospasm is of latest casino bonuses free slots frequent online casino games with free sign up bonus occurrence, it
can be effectively controlled by the administration
of small doses of belladonna alone or in combination
with opium. In cases of obstipation induced by
hypertrophy of O'Beirne's sphincter to such an ex-
tent that the bowel is considerably occluded, its
divulsion is indicated. It can be easily and quickly
dilated by introducing a large proctoscope up to the
obstructed point and then passing a Wales bougie
of proper size through it. Divulsion can also be
satisfactorily accomplished by tamponing with a
rubber bag distended with air or free no deposit casino bonus codes usa only water left in situ
as long as may be required.
The sphincter should be intelligently dilated daily
or two or three times weekly, according to the exi-
gencies of the old casino games for sale case, but careless stretching with bou-
gies and mechanical dilators is to be avoided owing
to the danger casino games list wiki of rupturing the gut and causing
When the treatment outlined fails, surgical in-
tervention is imperative, and the obstruction should
be relieved by colostomy, resection of the sphincter,
or by making an anastomosis between the sigmoid
above and the rectum below.
2. Hypertrophied rectal (Houston's) ' valves:
(Fig. I.) The rectal valves may become hypertro-
phied as the result of chronic colitis, ulceration, and
other affections of the lower bowel, and when they
are rigid may project into the lumen of the gut and
prevent the faeces from reaching the anal outlet ; un-
der such circumstances, lumps of ffecal matter can
often be seen or felt resting on the upper or concave
surface of the valves.
Some writers state that the obstinate constipation
occasionally induced in this way can be corrected by
rectal bougie or massage free welcome bonus no deposit required casino of the valves. I have tried
this plan of treatment many times, but have never
known it to relieve constipation when used alone.
When the valves are markedly thickened and
rigid, nothing short of division will effect a cure.
Martin first suggested valvotomy and devised a
method of performing the operation wherein he ex-
posed the valves by means of the proctoscope, di-
vided them with a bistoury, and closed tlie wound
with catgut, using a long handled needle, or per-
mitted the cut to heal by granulation. The Martin
operation is unsatisfactory because it takes consid-
erable time, is accompanied by profuse bleeding
difficult to control, there is danger of infection, the
patient complains bitterly of gas pains induced by
blocking of the rectum with tampons, it has been
Copyright, 191 1, by A. R. Elliott PublishinR atlantis gold casino free spins bonus codes Company.
GANT: RECTAL CONSTIPATION AND OBSTIPATION.
followed by peritonitis, and confines the patient V>
his bed for several days.
In order to overcome the disadvantages of Mar-
tin's operation, Pennington devised a clip, which
divides the valves by pressure necrosis. This in-
strument has not given entire satisfaction in the
writer's hands, because it does not sever the valves
deeply enough, and further, because it is difficult
or impossible to remove and replace once it has been
Shortly after the advent of the Pennington clip I
devised a clamp with which the valves can be satis- download free casino games for my blackberry
factorily divided, and also applicator forceps, by
means of which it can be easily and quickly applied.
(Fig- 2.) , , . . ,
The technique of the writer s valvotomy is as fol-
lows: A clamp is placed in the applicator and its
jaws opened by locking the handles of the instru-
ment and the forceps laid aside. The patient is then
placed in the knee chest online casino no deposit bonus codes march 2012 posture, the rectum is in-
flated, and the valve exposed by means of an oper-
ating proctoscope and reflected light. The instru-
ment is then picked up and the clamp is pushed well
down over the centre of the valve and released by
unlocking the handles of the forceps applicator.
The entire procedure requires but a moment and
rarely causes pain or discomfort. In order to pre-
vent pain from the air which has entered the bowel free bonus no deposit casino usa welcome
during the inflation, the patient is placed upon the
left side and told to strain, while the proctoscope is
being removed in order to permit it to escape. I
have performed more than one hundred valvotomics
in this way, and the results have been very satisfac-
tory. The principal advantages of the clamp opera-
tion are ; It can be performed in the office, requires
but a moment, causes but little if any pain or bleed-
ing, there is no danger of infection, it does not in-
terfere with the occupation of the patient, and efifec-
tively divides the valve, which drops downward,
and no longer interferes with the movement.
Lynch has devised a cautery apparatus for divid-
ing the valves but I have had no personal experi-
ence with it, but have treated one case of rectal car-
cinoma at the point where a valve had been divided
in free casino bonus slots for fun this way, and the patient thought the growth was
referable to the valvotomy performed some months
previously. Hirschmann has suggested division of
the valves with a rubber ligature, and has invented
a carrier for the purpose. I have tried this melhod
on several occasions, but have discarded it for the
reason that it is cumbersome, causes considerable
pain when the ligature carrier latest casino bonuses free games is pushed through
the valve, and has no advantage over the clamp
which free spin casino bonus codes is voided in the faeces when it sloughs oQ.
In some instances valvotomy is followed by an
immediate cure, but in the majority of cases I have
found it advisable to regulate the diet or institute a
postoperative hooters casino las vegas free slot play course of massage, electric or vibra-
tory treatment to stimulate and strengthen the rec-
turn and colon, which are often atonic.
Increased frequency of the evacuations imme-
diately following this operation may be partly at-
tributable to stretching of the sphincter by the large
proctoscope and ])artly to the ulcerated wound left,
which serves to excite more frequent and efifective
peristalsis. I have never known a stricture to fol-
low division of the valve free casino bonuses uk in this free casino bonuses codes way.
Valvotomy is a very useful procedure, but the
necessity for latest free casino bonuses it does not arise nearly so frequently
as the writings of some authorities would indicate.
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