D/SEASES OF THE RECTUM AND ANAL REGION 209 



narrowing the lumen of the lower bowel and anal orifice by 

 the subcutaneous injection of sterilized wax. 



2. Proctopexia, or ventrifixation of the bowel — i.e., lapar- 

 otomy and the fixation of the bowel to the abdominal wall 

 b}' sutures. 



3. Amputation. 



In each case the most careful attention to antiseptic pre- 

 cautions (see p. 21) must be observed to insure success, and 

 provided this is done a tolerably satisfactor\- prognosis ma)- 

 be given. Amputation is the most serious of the three, but 

 e\'en with this the result is good if the patient has not become 

 too weak to stand the operation. 



Gersuny's Wax Operation. — The patient is placed on the 

 operating-table in the abdominal position and chloroformed, 

 the lower bowel having been washed out bj- an antiseptic 

 enema (warm boric acid or chinosol solution). The operator 

 then allows the rectum to be prolapsed as far as it will come 

 down (even assisting in the process with the finger) on to a 

 sterilized mackintosh cloth or piece of jaconet, where it is 

 carefully cleansed. The wax to be used (a special variet}- of 

 white paraffin wax melting at 105°, properl}' sterilized, and 

 put up in convenient-sized, wide-mouthed bottles) has pre- 

 viously been melted b}' placing it in a bowl of hot water, and 

 is now drawn up into a sterilized s}Tinge. A thermometer is 

 placed in the water to guard against scalding, as the heat 

 at which it should actually be injected is just above that at 

 ^\■hich the wax melts. A fold of the mucous membrane of 

 the bowel is picked up between the finger and thumb in a 

 longitudinal direction, the needle is inserted, and the wax 

 slowl)- injected. During the process, to prevent clogging in 

 the needle, an assistant covers this with a hot swab ; as soon 

 as the injection is completed, this is changed to ice-cold water, 

 which is poured over the pillar of wax thus formed in order 

 to make it ' set.' The process is repeated two, three, or 

 perhaps four times, pillars of wax being formed on opposite 



14 



