— The method of Vicq D'Azyr — Modifications of it by Martin
and Velpeau — The method of Barton — Dieffenbach proposes two
methods, _. - -..-_ 231—235
section III.
Cases and Remarks, - 236 — 277
CHAPTER VIII.
THE SEVENTH SPECIES OF MALFORxMATION.
section I.
Description. — In this singular species of malformation, the ureters,
the vagina or the uterus may terminate in tlie rectum by an ab-
normal orifice — IIow the ureters tenuinate in the rectum — How
TABLE or CONTENTS. XV
I' AUK.
the vaii'ma or tlic uterus ti'ruiinates in the rectum — In these
cases tlie menstrual evacuation passes by the anus — I'he possibility
in such cases iif impregnation taking place by coitus jJcr (luiim,
and even parturition per ndum safely ellected — The celebrated
Thesis of M. Louis on this subject — Ihe presentation of this thesis
causes him to be prosecuted by the Parliament of Paris ; and the
Doctors of the Sorbonnc interdict him — The Pope grants him
absolution — His Thesis published in 1754, - - _ 278 — 279
SECTION II.
The Treatment. — Surgery seems altogether out of the question in
some, ifuot all, of these cases, . . - - - 279 — 280
section iii.
Cases and Remarks, __._-__ 280 — 282
CHAPTER IX.
THE EIGHTH SPECIES OF MALFORMATION.
SECTION I. PAGE
Description. — The rectum in this species is entirely absent, and
the colon generally ends in a cul-de-sac — There is no sign of a
normal anus present, yet an abnormal one does occasionally exist
— The pelvis in these instances is sometimes abnormally small and
contracted— Some authors arrange under the head absence of the
rectum , cases in which there is only a partial absence of the rectum
— The importance of this distinction — Hovr to establish the diag-
nosis — The manner of conducting the exploration, - - 283 — 284
section ii.
The Treatment, - - - - 284—285
section iii.
Cases anu Remarks, - - - - 285—289
CHAPTER X.
THE NINTH SPECIES OF MALFORMATION.
SECTION I.
Description. — In this species the rectum and the colon are both
wanting, and some other portion of the intestinal canal termi-
nates externally in an abnormal anus — No normal anus ever
exists — Fortunately this species of malformation is but seldom
met with — Sometimes there is no abnormal anus — The explora-
tion and the diagnosis, - -.-_ 290 291
SECTION II.
The Treatment. — Many of the cases of this species admit of pal-
liative treatment only, - - __. 291 292
section iii.
Cases and Remarks, - _-_-_ 292 294
section iv.
Recapitulation — A table comprising 287 cases, - - - 294
XVI TABLE OF CONTENTS.
CIIAPTERXI.
ABDOMINAL ARTIFICIAL ANUS.
SECTION I.
PAGE.
Genekal Remarks — The term artificial amis indiscrimately applied
to the 'preternatural anus — This term is strictly applicable only to
such an anus as is designedly established by the surgeon — Preter-
natural abdominal anus, a merefascal fistula of the small intestines
— Two operations proposed and advised for the formation of an
ai'titicial anus in the abdomen — The establishment of su-ch an
anus should never be attempted, only as the last alternative —
Amussat and Tiigel on the contrary, however, recommend it first
and last — Some able surgeons proscribe the operation altogctlicr —
Their objections considered — Important considerations in relation
to the operation, - _ _ _ 295 303
SECTION II.
The History of the Operation. — Littre', the first individual in
modern times who suggested the idea of forming an anus in the
abdomen — Pillore, the first surgeon who executed the operation
of Littre, in a modified form — Callisen in 1770 publishes another
operation for forming an anus in the abdomen — The estimation in
which Callisen's operation was held — Amussat in 1839 revives,
improves and executes the operation of Callisen, - 304—309
section iii.
The Proceeding of Littre, . _ _ _ 309 311
section iv.
Cases and Remarks, - - - _ . gu 301
SECTION V.
Compendium. — A table comprising 25 cases, in which the operation
of Littre' was performed on new-born children, - - 321 — 322
section vi.
The Proceeding of Littre, as Modified by Pillore, - 323 — 324
SECTION vii.
The Proceeding of Callisen, - - _ _ 324 — 325
section viii.
Oases and Remarks, - - - 326 — 328
section ix.
The Proceeding of Callisen, as Modified by Amussat, 328 — 334
section x.
Cases AND remarks, - _ . _ . 334 — 345
section xi.
Appreciation, - - _ - _ 345 — 345
section xii.
The Proceeding of Martin, - - _ _ 347 — 343
CORRIGENDA.
PAGE
•29. The ninth line from the top, for Ohirurgie read d« Chirurgie.
49. The top line, for (i/xiommiMaf read (XftdominaJ.
129. The fourteenth line from (he bottom, for <>e Recini read 01. Ricini.
168. The twenty first line from the bottom, for Iriaugular read triangular.
175. The ninth line from the top, for mdeoraie read mnderate.
191. The eighteenth line from the top, for Jnuraal read Journal.
202. The top line, for cases which read cases in which.
335. The eighth line from the bottom, for dilate read dilute.
Explanation of plate third. The second line from the top, for Case X/7/read Case XJ^VII.
EXPLANATION OF THE PLATES.
PLATE II.
Some of the Instruments employed in Proctoplasty, Colotomy, &c.
Figure 1,
Figure 2.
Figure 3.
Figure 4.
Figure 5.
Figure G.
Figure 7.
Figure 8.
Figure 9.
Figure 10.
Figure 11.
Figure 12.
EXPLANATION.
Small Bi-valve Speculum Ani.
Operating Scalpel of medium size.
Small size Scalpel for delicate work.
Probe-pointed curved Bistoury.
Cooper's Hernial Bistoury.
Gurved Sharp-pointed Bistoury.
Straight Sharp-pointed Bistoury.
Flexible-Silver grooved Director.
Bull-dog Forceps of Listen, for pulling down the end of the
rectum.
Tumor Forceps, for drawing down the blind end of the rectmn.
Round-bellied Scalpel, for making the first incision of the
perinasum.
Silver Anal Canula,
Plar.p 11
PLATE III.
Plate III. represents a case of membranous occlusion of the Anus, as seen
tij Von Amnion. [Vide Case XIII.]
EXPLANATION.
Figure 1, presents the external appearance of this case.
After Von Amman,
a — The penis in a constant state of erection.
h — A. considerable pit or depression near the natural situation of the
anus.
Figure 2, presents the appearance of the intestines. After Von Ammon.
a^ a, a. — The descending colon greatly distended with gas and meconium,
just where it terminates in the rectum.
h. — The small intestines turned over on the right side.
Figure 3, presents the inferior portion of the rectum.
After Von Ammon.
a. — The rectum.
h. — The place at which the anus was closed.
c. — A sound in the orifice made by the operation.
Figure 4, presents the rectum laid open through its entire length.
After Von Ammon.
a. — The inner surface of the rectum.
h. — The folds of the rectum, or columns of Morgagni.
c. — The internal sphincter, forming a wreath-like mass, from which the
membrane grew which had closed the anus.
cj^ (J, — The cut surfaces of the rectal walls greatly thickened.
Plate 111.
FlQ. /.
J:'
\ "/
^ - / I
PLATE lY.
EXPLANATION.
Figure 1, represents tlie external appearance of an imperforate anus and
rectum, in a new-born infant. [Third Species.]
a. — The prominent and continuous raphd.
Figure 2, represents the parts immediately concerned in a case of imper-
foration of the anus and rectum, as they were observed by Von Ammon in
a five months' foetus. [Vide Case L.] After Von Ammon.
ffl.— The rectum.
h. — The cul-de-sac of the rectum.
c. — The cord-like rudiment of the rectum.
d. — The sigmoid flexure of the colon.
Figure 3, gives a representation of the parts concerned in Dr. W. P
Hill's case of imperforate anus and rectum. [Vide Case LXILJ
a. — A portion of the perinfeum.
t, h. — The ureters.
e. — The rectum terminating upon the neck of the bladder,
d.: — The urethra.
«.. — The- bladder.
Plate IV
ife ^
PLATE V.
Plate V. gives a full representation of the celebrated case of M. Amussat,
and his peculiar operation. [Vide Case XLII.j
EXPLANATION.
Figure 1, is an imaginary representation of this case. M. Amussat, in
order to render the details of his operation intelligiVjle, gave a plan of the
parts a-s he supposed them to exist before the operation. He took pains to
make the analogy as complete as possible, by taking his sketch from a left-
side view of the interior of the pelvis, in a female child who died a few
days after birth. All the organs of the pelvis had been cut in two, part of
the rectum was removed, to represent the deficient portion of the intestine,
and the anus was made to communicate with the vagina. After Boitrgery.
a, h. — The anus and vulva, which were properly formed, and communi-
cated with the vagina onl3^
c. — The extremity of the rectum forming a cul-de-sac below tne sacro-
vertebral angle, and having no communication with either the anus
or vagina.
fZ.— The bladder.
e. — The superior portion of the rectum.
Figure 2, represents Amussat's operation in this case.
After Bourgery.
«, h. — The fingers of an assistant.
c. — The sound introduced into the vagina.
d. — The loop of a ligature.
f. — The bistoury.
Figure 3, represents the conclusion of this operation. The horizontal
wound is closed by sutures, and the margins of the longitudinal wound are
united to the divided portions of mucous membrane. After Bourgery,
k-'^
I
/r'>
PLATE VI.
EXPLANATION.
Figure 1, represents a case -of complete imperforation of the rectnm,
situated some distance above a normal anus. fFourtli Species.]
After Baillie.
a. — The rectum.
h. — The cul-de-sac and termination of the rectum.
c. — The normal anus.
d. — A bougie introduced into the short anal canal, as far up as to the
blind end of the rectum.
e. — The anterior surface of the bladder.
/. — The posterior surface of the bladder.
g. — A part of one of the ureters.
Figure 2, represents the part concerned in a case oNmperforation of the
rectum above a normal anus, as observed by Mr. Ford. [Vide Case LXX.]
a. — The rectum laid open through its entire length.
b. — The ligamentous substance described by Mr. Ford.
c. — The normal anus.
d. — The place at which the rectum was occluded.
Plate VI
Fij. /.
/
w<.
.i>«t»v
6' d
PLATE VII.
Plate YII. gives a representation of the rectum and part of the colon of
a new-born infant, seen by Yon Amnion, in whom existed a membranous
closure of the rectum three-fourtlis of an inch above a normal anus. The
child was in a dj'ing state when Von Amnion was called, and no operation
was performed. [Fourth Species.] {Op. Clt. Tah. X. Figs. 9, 10, 11.)
EXPLANATION.
Figure 1, presents a front view of the rectum, from the point of occlu-
sion to its connection with the colon. After Von Ammon.
a. — The rectum greatlj' distended.
/;. — The cul-de-sac of the rectum and point of occlusion.
c. — The sigmoid flexure of the colon.
(J.— The bladder.
Figure 2, gives a lateral view of the rectum in the same case.
After Von Ammon.
a. — The large sack-like rectum.
b. — The point of occlusion of the rectum.
r. — The circular fibres of the external sphincter.
L — The normal anus.
e. — The bladder, small and contracted.
/. — The urethra.
g. — The sigmoid flexure of the colon.
Figure 3, represents the inferior portion of the rectum laid open from
the verge of the anus to the occluding membrane. After Von Ammon
a. — The blind sac of the rectum.
h. — The membranous closure of the rectum.
<r, c. — The cut surfaces of the parietes of the rectum.
PLATE VIII.
Plate VIII. gives a full representation of the interesting case reported
by M. Cruveilhier of a new-born infant in whom there existed an imper-
foration of the anus and a prolongation of the rectum. [Vide' Case CV. )
EXPLANATION.
Figure 1, represents the perinaeum and the genitals of this case.
After Cruveilhier.
a — The artificial opening made at the normal situation of the anus.
h. — The rugose and prominent raphe' which became linear as soon as meco-
nium was voided.
c. — The abnormal aperture, or anus.
Figure 2, gives a clear idea of the origin, the direction and the termina-
tion of the accidental canal. After Cruveilhier.
a. — The rectum.
/'. — The cul-de-sac of the rectum.
f, c, c. — The accidental canal from its origin the rectum, to its termina-
tion at the glans penis.
d. — The glans penis.
Figure 3, presents still a further view of the relation of the parts of the
same case. After Cruveilhier.
a. — The bladder.
h, h. — The rectum.
c. — The cul-de-sac of the rectum.
rf.— The origin of the accidental canal.
Plate Vlli
X.
FUf.J.
Wl
Ct-.-i
FCcj.Z.
F,^.3.
PLATE IX.
EXPLANATION.
Figure 1, gives a horizontal section of the pelvis, representing an imagi-
nary case by Von Amnion, in which the anus is imperforate, and the rectum
comnmnicates with the vagina. After Von Ammon.
«, a. — The rectum and sigmoid flexure of the coloin.
&.— The bladder.
c. — The vagina.
d. — The recto-vaginal opening.
e. — A small elastic urethral bougie introduced by the vagina through the
recto-vaginal opening into the rectum,
/,/. — The uterus with the ovaria.
g The symphysis pubis.
li. The soft parts of the anal region. •
i. — The blind end of the rectum.
A". — The superior extremity of the left leg.
Figure 2, represents the parts immediately concerned in the case of an in-
fant, as seen by Wreisberg, in whom the anus was imperforate, and the rec-
tum terminated in the bladder. [Vide Case CXXXIV.] After Vun Ammon.
a. — The rectum.
h. — The bladder laid open.
c. — The urethra.
d. — The penis.
e, e. — The umbilical arteries.
/. — The umbilical vein.
g. — The ligament leading from the bladder to the umbilicus.
h. — The urachus within the ligament.
i. — The recto-vesical opening.
Figure 3, represents the remarkable case of Casimir de Chonski in which
the rectum was absent, and the colon terminated in the bladder by a pro-
longation. In this case existed bilobation of the bladder, of which \t i>i sl
beautiful specimen, umbilical hernia, and a "preternatural anus. [Vide
Case CXXXV.] After Von Ammon.
a. — The ileum severed.
^.— The annulus umbilicalis.
c. — The funiculus umbilcalis.
d. — Hernia umbilicalis.
e. — Vena umbilicalis.
/• — The colon descending with a considerable curve and prolongation, to
communicate with the bladder.
9, g. — The bilobed bladder.
/t.— The termination of the prolonged colon in the bladder, between the
ureters.
i, i. — The ureters.
j- — A probe in the preternatural anus.
k. — The urethra severed.
/, m. — The two vasa deferentia.
Plate IX
PLATE X.
EXPLANATION.
Figure 1, represents the very interesting case reported by Mr. Lucas,
in which the rectum terminated in a cul-de-sac two inches above its natu-
ral outlet, and communicated with the bladder. [Vide Case CXXXVI]
After Mieban.
a. — The rectum, terminating nearly two inches from the anal aperture.
I). — The bladder.
c. — A probe passed through a small opening by which the pouch-like
termination of the rectum communicated with the bladder.
d. — A probe passed from the anal aperture upwards, showing its deter-
mination in the bladder ; the vesical oritice being guarded by a val-
vular fold of mucous membrane.
f, e, c. — A probe passed from the external orifice of the urethra aloug
that tube into the bladder.
/. — The distended portion of tho urethra, the diameter of which is equal
to a No. li bougie.
g. — The distended scrotum communicating with the urethra for fully
half its length, and lined with a coating of lymph, which presented
extravasation of the urine, and the liquid fasces into the cellular tissue.
/;. — A small cul-de-sac corresponding to the urachus.
Figure 2, represents the case reported by the late Dr. Steele, of Saratoga
Springs, in which the rectum terminated in the neck of the bladder.
[Vide Case CXXXIX.]
a. — The rectum and r)art of the colon.
6.— The bladder.
r. — The penis.
Figure 3, represents an imaginary section of the pelvis, to explain the
imperforation of the anus, and the urethra as they were supposed to exist
in M. Roux de Brignole's case.
ffl, a. — The interior of the bladder.
h, h. — Section of the prostate.
c. — The vesicula seminales.
d. — The vas deferens.
f, e. — The interior of the rectum..
/; — Supposed termination of the rectum in front of the neck of the bladder.
g. — The penis.
h. — The opening of the meatus.
i. — The bulb of the urethra.
k. — The root of the right corpus cavernosum.
I. — Section of the pubis.
ni. — Space between the pubis and the bladder.
n, — The urachus.
0. — The muscles of the abdomen.
p. — The skin.
q, r. — The peritonaeum lining the cavity of the abdomen.
>v, s. — The sacrum.
/, t. —The incision in the perinseum.
n. — The bistoury, its point in the rectum.
P]Qr o Y
PLATE XI.
Plate XI. gives the representation of a remarkable foetus observed by
M. Cruveilhier, in which the anus was imperforate, and the rectum termi-
nated in the bladder. [Vide Case CXL.]
EXPLANATION.
Figure 1, represents the ano-perinseal region of this case. It will be
observed that the perinseimi is enormous in its antero-posterior diameter.
After Cruveilhier.
Figure 2, represents a section of the pelvic cavity containing the soft
parts. After Cruveilhier.
a. — The bladder.
h. — The rectum which opens into the bladder, and with the base of
which is perfectly confounded.
c, c. — The ureters.
d. — The prostatic portion of the urethra.
Figure 3, represents the rectum of this same case, opening into the
posterior part of the bas-fond of the bladder by a large infundibuliform
aperture. After Cruveilhier.
a. — The rectum opening behind the bladder.
h. — The prostatic portion of the urethra.
c. — The infundibuliform aperture of the rectum communicating with
the bladder.
d. — The bladder laid open, showing its interior.
PlnhnX
Fifj. 1.
^^I^r
' itiy
iS^g!*'"'
Fii^ 3. jl
PLATE XII.
Plate XII. gives the representation of the case of a male child, present-
ing an imperforation of the anus with the rectum terminating in the blad-
der. It was seen by Von Amnion, and operated on without success.
s
EXPLANATION.
Figure 1, gives the external appearance of this case.
After Von Ammon.
a, a. — The thighs slightly elevated.
h. — A depression or pit in the exact situation of the absent anus.
c. — The scrotum.
d. — Another depression corresponding with the termination of the rec-
tum within.
Figure 2, represents a side view of the internal parts directly concernec
iu this case. After Von Ammon
«.— The bladder.
h. — The inferior extremity of the colon.
c. —The rectum adhering to and terminating in the posterior part of tht
bladder between the insertion of the ureters.
d, d. — The ureters.
e,f. — The remaining portion of the integument and cellular tissue of tht
perinajum not cut away.
g. — The place where the depression was, and into which the bistour;y
was plunged.
Figure 3, presents another view of the relation existing between tin
several internal parts of this case. After Von Avimov.
ffl. — The bladder, presenting its posterior aspect.
h, h. — The ureters, the right one presenting a remarkable turn in it.
c, c. — The kidneys.
d. — The portion of the perinseum not removed, in which the depression
was at the normal situation of the anus.
e. — The rectum laid open and its cavity exposed, so that the ojifice com-
municating with the bladder is distinctly seen.
/. — The recto-vesical orifice between the ureters.
V
n \'
FL(f. I.
I
PLATE XIII.
EXPLANATION.
Figure 1, represents the case reported by Fleischmann, in which the
anus and the rectum were entirely wanting, and the colon terminated in a
blind sac. The abdomen is opened and its parietes turned over, tha^
aflfording a correct view of the situation of the intestines, especially show-
ing the character of the descending colon. [Vide Case CCLIV.]
After Von Amman.
a. — The liver above the commencement of the ascending colon.
b. — The ascending colon which here takes place of the caecum, and is
divided into two branches, from one of which springs the appendi-
cula vermiformis.
c. — The descending colon, hanging loosely in the abdominal cavity.
d. — The blind end of the colon,
e, e, e, e. — The parietes of the abdomen.
Figure 2, represents the anatomical condition of the colon in a case of
imperforation of the anus and rectum, as observed by Von Ammon. The
descending colon presents several sac-like dilations before passing down
behind the bladder to terminate in a cul-de-sac in the rectum.
After Von Ammon.
a. — The descending colon.
6, &. — The sac-like dilations of the colon.
c. — The bladder, behind which the colon passes.
d, e.— The small intestines in a normal condition.
PlateX
Fi-vi . I
Fiq. 2.
PLATE XIV.
Plate XTV. gives a representation of the case of a male child presenting
an imperforation of the anus and rectum, unsuccessful!}- operated on by Von
Amnion. The autopsy in this interesting case clearly revealed the cause
of the failure of the operation. l"he rectum for about two-thirds of its
entire length was greatly dilated, presenting the form of a pouch ; but
gradually tapered off, and terminated blindly in a small point within a
few lines of the posterior wall of the scrotum.
Notwithstanding the incision was made in the proper place, and deep
enough, yet it entirely failed to reach the rectum, because this organ was
further removed from the sacrum towards the front than the natural, and
thus occupying an abnormal position. [Vide page 102.] Had this fact
been previously known to Von Amnion, and his incision directed much
more towards the inter-pubic space than towards the sacrum, the rectum
would doubtless have been easily opened. (Opus Citatum, S. 48.)
EXPLANATION.
Figure 1, represents a front view of the pelvic region of this case. The
scrotum and penis are much corrugated, and drawn closely to the abdo-
men, the latter presenting a para-phimosis congenita. The right half of
the scrotum is turgid, and contains the ttisticle, w^hilst the left half presents
less turgesence, the testicle not having descended into it.
After Von Ammon.
«, a. — The interior parietes of the abdomen.
b. — The symphysis of the pubis.
c. - The scrotum.
d. — The penis.
f. — The right half of the scrotum.
/', q. — The dilated rectum.
//, /. — The colon with its sigmoid flexure much smaller in diameter than
natural.
Figure 2, represents a side view of a portion of the contents of the
j)e]vis.
After Von Ammon.
a. — The rectum.
'^- — 'f he rectum terminating blindly in a conical point beneath the penis.
'■•. — The bladder opened from the side.
d. — The urethra opened from the side,
f- — The artificial orifice made at the normal situation of the anus.
Figure 3, presents a po.-terior view of the contents of the pelvis.
After Von Ammon.
a, a. — Both halves of the scrotum.
h. — A probe indicating the entrance and the direction of Von Ammon's
incision behind the rectum, and between it and the sacrum,
f, c. — The superior part of the rectum descending in the form of a cone
in front of the incision.
(■?, d. — The intestines,
f, e. — The interior surface of the peritongeum.
PlateXlV.
Fuf. 1.
PLATE XV.
Plate XV. gives representations of the operation for the formation of
abdominal artificial anus.
EXPLANATION.
Figure 1, presents a front view of the surgical relations of the colon.
After Bernard and Huette.
a^ a. — The integuments.
h, h. — The external oblique muscle.
c. — The internal oblique muscle.
d. — The transversalis muscle.
e. — The lower edge of the liver.
/. — The distended caecum.
g. — The descending colon with the sigmoid flexure seen below.
h. — The transverse colon.
Figure 2, presents a posterior view of the parts concerned, as shown by-
removing the dorsal structures. After Bernard aud Huette.