

APANAGE. 



400 



AN fS. DISEASES OF. One of the most frequent diseases of this 

 part of UM body is that which 1s commonly known by the name of 

 FtstoX or KfhJa n Ana. This disease consists of a fistula or sinus 

 by the side of UM rectum. It sometimes opens externally, without 

 communicating with the bowel, and is then termed blind < 

 fistula. U man frequently ^mTVi" 8 "**"* with the bowel, without 

 opening externally, and is then called blind internal fistula. Usually, 

 however, these sinuses have an opening internally and externally, and 

 the disease then constitutes complete fistula. In this latter form pus, 

 flatus, and feculent matter, an discharged from the openings. It U 

 accompanied by heat of the parts, great discomfort, and sometimes 

 p.lt. and spasm of the sphincter muscles. It is sometimes attended 

 with acute inflammatory symptoms, and the general health suffers. 



When this kind of abscess occurs, the healing is prevented by three 

 circumstances: !. The fistulous condition of the cavity. 2. The 

 presence of foreign matters. 3. The frequent motion of the part by 

 the action of the neighbouring muscles. 



This disease originates most frequently in the interior of the bowel 

 by a small ulcer, which, extending, at last produces a second opening. 

 It is often found in persons labouring under pulmonary consumption, 

 and its persistence and inconvenience are increased by the constant 

 cough which accompanies that disease, 



The treatment of fistula is simple, and usually very successful. By 

 laying open the whole of the sinus and dividing the sphincter, the two 

 main obstacles to the cure of this ^'yy are removed. The mode of 

 operating in this case is simple. A grooved probe is introduced into 

 the external opening until it pnimes out at the internal opening. A 

 probe-pointed bistoury is then introduced along the groove, and the 

 sinus is laid open through its whole length. Usually no important 

 s divided in this operation, so that all that is necessary after 



An opiate should be given 



vessels are 



is to introduce a slight dressing of lint 



after the operation. 



ffcrmorrkuidi or Pilet consist of an enlarged condition of the veins 

 supplying the anus and rectum. This disease is divided into two 

 kinds, external and internal. It seldom occurs before puberty, and is 

 more common in females than males, and in the rich and luxurious, 

 than in the poor and hard-worked. This arises from the fact that 

 whatever tends to determine blood to the lower part of the rectum, 

 and to retard the return of blood from that part, favours piles. Thus 

 they come on in pregnant females, in persons troubled with habitual 

 constipation, abdominal tumours, obstructions in the portal system of 

 veins, and in those who lead sedentary lives or who feed too well. 



External piles consist of a congeries of varicose or enlarged veins, 

 which are surrounded by a condensed and enlarged connective tissue, 

 and are covered partly by mucous membrane and partly by loose rugose 

 integument. The parts are sometimes inflamed, at other times free 

 from any capillary derangement. The mucous or rugose surface occa- 

 sionally becomes ulcerated. It is under these circumstances that the 

 coats of one or more of the veins give way, and they bleed to a greater 

 or less) extent. When this does not take place they do not bleed. 

 These two states are called respectively Nettling and blind piles. 



The treatment of this form of piles may be either palliative or 

 radical. The radical cure consists in removing the parts either by the 

 scissors or bistoury, and leaving them to heal in the ordinary way, or 

 a ligature may be passed round the enlarged vessels, and the strangu- 

 lated part left to slough off. When this operation is not thought 

 desirable, much may be done to relieve the enlargement and pain of 

 pflea by a palliative treatment Whatever will remove the loading of 

 UM vessels in the lower part of the bowels will relieve them. Thus 

 parturition removes them when caused by pregnancy. If the part is 

 U.il mi, purgatives, poultices, and anodyne applications may be 

 bad recourse to. Astringent applications combined with opium may 

 be applied, as gallic and tannic acids. The purgatives most to be 

 recommended are castor oil, or an electuary with the confection of 

 senna, sulphur, and cream of tartar. In cases where the liver is 

 affected, UM sUte of this organ should be specially attended to. 



Imtmal piles, are of three kinds : 1. Varicose veins surrounded by 

 enlarged connective tissue, and covered by mucous membrane, and 

 UlssrtUg or blind. 2. Tumours of the nature of sarcoma. 8. A con- 

 gerUs of blood-vessels ressrnbling erectile tissue, and occurring in the 



, 



lubmuoous cunuectite tissue. This last form U the most common. 

 They may protrude from the anus or not When they do not, they 

 descend occasionally when the bowels are acted on, and become very 

 troublesome till they an returned. If not replaced they become con- 

 stricted and inflamed or bleed. In these cam bleeding usually occurs 

 when the bowels an acted on. When the tumours an replaced, no 

 great inconvenience oocun. If, however, the bleeding continues, the 

 patient becomes pale, thin, and weak; noise, hi the ean, giddiness, 

 and palpitation of the heart come on, in fact all the symptoms of 

 anannia sH in. 



The treatment in this case may be either palliative or radical Fre- 

 quently the latter course should at once be had recourse to. The 



placed round it; but when UM base is broad, a needle with two liga- 

 tures is pawed directly through the tumour, and a ligature is tied round 

 each half of UM tumour. This operation is very painful and difficult, 



and wherever circumstances will admit, is greatly facilitated by the use 

 of chloroform. After UM operation, opiates should be given. 



Nitric acid has bwn recently rf"nmwnM in these oases, but unless 

 the tumours an small, and the cases slight, this remedy is liable to fail, 

 and after the infliction of much pain the operation must be had 

 recourse to. 



Should the palliative treatment be had recourse to, all those points 

 to which reference has been made under the head of external piles. 

 must be attended to. Astringent remedies and opiates must be injected 

 into the bowels. The bowels must be regulated, the liver looked to, 

 and when the hemorrhage is considerable, gallic and tannic acids, with 

 acetate of lead, must be given internally. 



Prolapttu Ani is a very frequent and troublesome affection of the 

 lower bowels. In consequence of relaxation, the rectum passes down, 

 and becoming averted protrudes itself beyond the anus. This pro- 

 trusion may be either partial or romplttt. It is called complete when 

 the entire bowel comes down, and partial when the mucous coat alone 

 descends. The latter is the most frequent, and sometimes accompanies 

 internal piles. Children and old persons are more liable to the com- 

 plete form. The quantity of bowel or membrane which passes down 

 varies in size, from a mere annular enlargement to a tumour as large as 

 a child's head. It is sometimes accompanied with inflammation, and 

 the mucous membrane throws off a coloured discharge. Great pain 

 and uneasiness are often felt, and general languor and debility are 



I'll -< lit. 



The treatment is either palliative or radical. When this dinnaiie 

 depends on general constitutional weakness, tonics, change of air, and a 

 proper regimen will restore the patient to health. The bowel should 

 always be returned as speedily as possible, and this may be done by 

 proper pressure after lubricating the parts. When they are inflamed, 

 leeches should be applied and rest secured before attempting reduction. 



The radical cure is effected by removing one or more of the redundant 

 folds of the mucous membrane by the knife or ligature. The cicatrix 

 thus formed contracts and sustains the replaced parts, or the bowel may 

 be left intact, and a portion of the redundant external integument may 

 be removed, which by its subsequent contraction prevents the painful 

 protrusion. 



Imperfurate Anut. Children are occasionally bom without an anal 

 orifice. Three forms of this malformation are described : 1. The 

 rectum may be fully developed, and have its orifice closed by an exter- 

 nal membrane, or a septum may be developed at some distance from 

 the orifice. In the treatment of thin form of imperf orate onus, nothing 

 more is required than an incision through the occluding membrane. 

 2. The rectum terminates at some distance from the perineum, and 

 there is a mere depression where the anal orifice ought to be. This is 

 the most common form. It requires a more serious operation than the 

 last The meconium should be allowed to accumulate, and pressure 

 being mode on the abdomen, on incision must be made down to the 

 bowel, and a passage thus established. 3. In this form the rectum ia 

 very deficient or altogether absent An operation like the last may be 

 performed, and failing this, on attempt may be made to form what in 

 called an nrtiftriai anut. This operation is performed not only for 

 imperforate onus, but in cases where, from tumours, or the impactiou 

 of foreign matters, the fiscal matter does not find its way to the anal 

 orifice. The sigmoid flexure of the colon is the port which is preferred 

 for this operation. It may be reached from before or behind. The 

 former in the easiest operation ; the latter is the most convenient 

 position for the new opening to the patient In performing the latter 

 operation, on incision is made midway between the last false rib and 

 the crest of the ileum. The colon is then secured, an incision made 

 into it. and the edges of the bowel brought in contact with the external 

 wound by means of ligatures. This operation has been successfully 

 performed in cases of non-malignant tumours and other causes of the 

 unpaction of the lower bowel. In children with imperforate onus how- 

 ever it seldom succeeds, ss other malformations often exist which 

 speedily terminate the life of the patient 



APANAGE (Apanayita*, Apanamextum), the provision of lands or 

 feudal superiorities assigned by the kings of France for the mainte- 

 nance of their younger sons. 



The prince to whom the portion was assigned was called the apa- 

 Haguf ; and he was regarded by the ancient law of that country as 

 the true proprietor of all the seigniories dependent on the apanage, to 

 whom the fealty (foi) of all subordinate feudatories within the domain 

 was due, as to the lord of the " dominant fief." 



Under >he first two races of kings, the children of the deceased 

 monarch usually made partition of the kingdom amongst them ; but 

 the obvious inconvenience of such a practice occasioned a different 

 arrangement to be adopted under the dynasty of the Capets, and the 

 crown was permitted to descend entire to the eldest son, with no other 

 dismemberment than the severance of certain portions of the domi- 

 nions for the maintenance of the younger branches of the family. 

 Towards the close of the thirteenth century, the rights of the 

 apanagist were still further circumscribed ; and at length it become an 

 established rule, which greatly tended to consolidate the royal autho- 

 rity in that kingdom, that, upon the failure of lineal heirs male, the 

 apanage should revert to the crown. 



The period at which this species of provision was first introduced 

 into the law of France, the source from which it was borrowed, and 



