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PLATES
ILLUSTRATING A
TREATISE
ON THE
MALFORMATIONS,  INJURIES,  AND  DISEASES
RECTUM  AND ANUS,
GEORGE J^USHE, M.  D
FORMERLY PROFESSOR OF ANATOMY AND PHYSIOLOGY, &c.
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            NEW-YORK:



FRENCH & ADLARD, 46 BROADWAY.
MDCCCXXXVII. 

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PLATE  I
Fig. 1.   Fissure of the Anus.   (See page 108.)
Vm. 11.   An Internal Hemorrhoidal Tumour, as large as a pullet's egg.  (See page 151.)
            This tumour was of seven years' standing, and for months bled profusely:
1  removed it. with the ligature. 
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PLATE  II.
Fig.   I.   Internal Hemorrhoidal Tumours, prolapsed.   (Seepage 152.)  I excised the
            tumours here depicted from a strong, young woman:  the hemorrhage was
            alarming during the operation.  (See page 183.)

Fig.  II.   This drawing was taken from  Mr. H., on whom I operated two years ago.
            The more central and darker coloured protuberances are internal hemorrhoi-
            dal tumours prolapsed, while the more external and whitish nodules are por-
            tions of skin elongated, thickened,  and somewhat indurated, partly from
            the repeated  protrusion of the internal hemorrhoidal  tumours, and partly
            from the previous  extravisation of blood.  (See page 163.)   The skin,
            whether hypertrophied or not, becomes engorged when the internal hemorr-
            hoidal tumours protrude, in consequence of the  sudden interruption of the
            circulation, and if the prolapsus be allowed to continue, inflammation will
            ensue.  When the  internal hemorrhoidal tumours are removed,  the elon-
            gated, thickened, and indurated skin generally returns to its original state
            in a few  months; therefore, there is no necessity for removing it,—indeed
            such a proceeding would inevitably be followed by contraction of  the anus.
            Both Hey and Kirby committed this error,  and if I may be allowed to form
            an  opinion from the examination of several persons  operated on  by B.
            Dupuytren, he also made the same mistake.

Figs. 111. IV. and V.  Sections of internal hemorrhoidal tumours, which I removed from
            three different persons.  They seem to consist of arteries and  veins, sup-
            ported by cellular tissue.  (See page 152.)

Figs. VL and VII.  Internal hemorrhoidal tumours, which have  undergone   a  semi-
            cartilaginous conversion.  (See page 159.) 
 
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PLATE IV.
 I.   A posterior view of complete  prolapsus several inches  of the  rectum.
        (See pages 203, 204.)  The case here depicted, was that of a youth who
        laboured under stone in the bladder.  I performed the operation for li-
        thotomy successfully, and the protrusion subsided.
II.   Chronic prolapsus of two lateral flaps of the mucous membrane.  (See page
        204.)   The whitish protuberances surrounding the lateral flaps, are por-
        tions of hyperthrophied integument.  (See explanation to fig. ii. plate ii.)
        This drawing was taken from Mr. M.  I removed the flaps, and in a few
        days he returned to Albany quite well. 
                     PLATE  V.


Prolapsus  of a circular fold of the mucous membrane, which is hard and
   ulcerated in many points.  (See  page 212.)
The skin about the anus thickened, indurated, and furrowed, from constant
   rubbing to  relieve itching.   A patch of  eruption may be seen a short
   distance above and without the anus,   (See page 220.) 
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PLATE  VI.
A bunch of mucous polypi, which I removed from the rectum of a West
   Indian gentleman.
Represents an ulcerated sarcomatous polypus of the rectum.  It is  of  a
  fibro-lardaceous structure, pretty solid, of a yellowish white or dirty white
  colour, with some blood vessels running  through it, and irregularly ulce-
  rated on the surface.   The subject of this disease was a gentleman, seventy-
  three years of age.   For several years, he had laboured under angina pec-
  toris, and for upwards of eighteen months he was led to suppose that he
  had, in addition to his old malady, a scirrho-contracted state of the rectum.
  He died suddenly, during one of his  attacks of angina, whicja depended
  upon organic  lesion of the heart and  aorta: thus, he  was saved a  few
  months suffering.
 Excessive destruction of the skin and cellular tissue adjacent to the rectum,
  produced by gangrenous inflammation.   A probe  is passed beneath the
  strip of integument in front of the anus, to show the extensive devastation
  of the cellular membrane.  The man whose case is here exhibited, was
  a waiter in one of the hotels.   His constitution, which was never very good,
  was still farther  impaired by late  hours,  eating  unwholesome food  in
  abundance, and drinking almost all liquors freely.   (See page 234.) 
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                     PLATE  V.


Prolapsus of a circular fold of the mucous membrane, which is hard and
   ulcerated in many points.  (See  page 212.)
The skin about the anus thickened, indurated, and furrowed, from constant
   rubbing to  relieve itching.   A patch of  eruption may be seen a short
   distance  above and without the anus.   (See page 220.) 
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PLATE  VIII.
Fig.  I.       The ebony  rectum bougie mounted on a stalk of whale-bone.  (See
                page 284.)

Fig.  II.      The method of introducing the bougie just described.  (See page 284.)

Fig.  III.     The fissure knife.  (See page 105.)

Fig.  IV.     The perineal pin.  (See page 82.)

Fig.  V.      The end to screw on when the needle is removed.

Fig.  VI.     The needle.

 Fig.  VII.     The needle used in sewing the recto-vaginal partition.   (See  page  85.)

 Fig.  VIII.    The probe pointed bistoury recommended for small  fistulas in the  sub-
                  stance of, or within, the sphincter ani.  (See pages 254-5.)

Fig.  IX.      The sharp pointed bistoury recommended for small incomplete internal
                 fistula, situated in the substance of, or within, the sphincter ani.  (See
                 page 255.) 
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PLATE  IX.
 Fig.   I.     Forceps for prolapsing internal hemorrhoidal tumours.   (See page 188.)

 Fig.   If.   ^ Forceps for withdrawing the needle.  (See page 188-9.)

 Fig.   Iff.    Needle carrier armed with the needle.  (See page 188.)

 Fig.   IV.    The needle.  (See page 188.)

 Fig.   V.     The dilating rectum bougie.  (See page  285.)

 Fju.   VI.    The wire which runs through it, with the plates attached.

 Fig.   VII.   The handle.

 Fig.   VIII.  The pin for securing the tube and handle together.

Fig.  IX.    A view of the inside of one of the four ivory sections.

Fig.  X.     A view of the plates looking from the distal extremity of  the wire.

Fig.  XI.    The tube of the instrument for stopping hemorrhage.   (See page 185-6.)

Fig.  XII.    The instrument for stopping hemorrhage with a  portion of intestine tied
               over it—fit for use.  (See page 185-6.)
THE END, 
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