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Transverse wound of the anterior wall of the rectum two inches from the anus; no trace of ulceration in the neighborhood. Adelmann : Longitudi- nal rent two and a half inches long, at two and a half inches from the anus; the mucous membrane congested, and apparently eroded in some places ; 200 grammes of sanguinolent fluid in the peritoneal cul-de-sac. Pyl : Rupture of the posterior wall of the rectum at an inch from the anus; four fingers could be passed through it and into the peri- toneal cavity ; effusion of blood into the peritonaeum. Mayo : Eupture of the recto-vaginal septum at two inches from the anus, large enough to admit the end of the index-finger. Stein : Rupture ten inches long Biaxin Xl 500mg in the anterior wall. These facts show great variabil- ity in the seat and extent of the lesion. The exact state of the rectal wall is very important. The mucous mem- brane was found healthy by Brodie, and diseased by Adelmann. In the author's case it appeared absolutely healthy to the naked eye, but a microscopic exam- ination showed that it was inflamed and infiltrated with white globules. The microscope should then be the test in every case ; and the reports of Brodie and others — that the rectal wall was absolutely healthy — are open to question. The author also insists upon the abundant infiltration of blood in the difl:crent layers of the bowel in his SUEOERY. 553 own patient. The blood formed sub- serous tumors like leeches gorged with blood ; the mucous and serous layers were dissected; the wound in Biaxin 500 Mg the serous membrane was twice as large as that in the mucous ; and, again, a point worthy of note, all of the patients were the subjects of prolapse. Two authors have sought to pene- trate the mechanism of rupture of the rectum, Ashton and Adelmann. Ashton adopted an explanation applicable both to complete and to incomplete ruptures. The ruptures are Antibiotic Biaxin caused by indurated masses of faeces which push before them a fold of the mucous membrane and Biaxin Antibiotic tear it from side to side. To this the author opposes the fact that the rupture is often vertical, and the ab- sence of hard ftecal matters in the peri- tonajum, or even in the rectum. The theory of Adelmann may perhaps apply in certain cases. It is, he says, not alone a prolapse of the mucous mem- brane, but a veritable hernia of the rec- tum, which increases until the perito- nseum comes out of the anus with the other Biaxin Buy Online tunics. Then, when any violence is applied to the mucous membrane, the pressure exercised Biaxin Price by the intestinal mass is sufficient to rupture the perito- neal cul-de-sac, and this mechanism furnishes at the same time an explana- tion of the unequal tearing of the dif- ferent tunics. The Order Biaxin author agrees with this theory, except in so far as it has to do with violence to the mucous mem- brane causing the final rupture. The existence of a prolapse, and the engage- ment of intestinal loops in the perito- neal cul-de-sac, he admits. In this way a true hernia is formed, of which the reversed Buy Biaxin rectal wall is the sac. These hernia) have been described by Uhde under the Biaxin Online title of hedroceles, Antibiotics Biaxin and a re- markable example is given by Cheap Biaxin Ashhurst (" Amer. Jour, of the Med. Sci.," July, 1874), who reports a case Biaxin Cost taken from the practice of Ohle, of Dresden, in which the invaginated colon formed a tumor which filled the rectum. A physician, who was called to treat Biaxin Order the vomiting and obstinate constipation from which the patient suffered, Biaxin Xl 500 opened the tumor, and found within five appendices epi- Biaxin Xl Biaxin 500mg ploicaj, and in the middle a portion Purchase Biaxin of small intestine. Ohle did Biaxin Antibiotics a laparotomy, and sutured Biaxin 500 the wound in the colon, but the patient die
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