In surgery, cautery is the searing or burning of living flesh by a hot iron (actual cautery) or a caustic substance (potential cautery). The name is thus also given to a heated metal instrument used for burning or searing organictissue. Research Cautery
Colostomy is the operation of opening into the colon, or lower portion of the intestine. This procedure is one of the most important in abdominal surgery. It is sometimes necessary as a life- saving measure. It may be temporary or permanent as an artificial anus in the radical treatment of rectal cancer. Because of its appearance, its inconvenience and the very thought of an artificial opening in the abdominal wall a great deal of care is necessary to allay the anxieties of patients and their relatives when colostomy is necessary.
In some cases of acute intestinal obstruction the surgeon explores the abdomen and finds perhaps a large mass in the region of the pelvic colon or rectum that cannot be removed. An emergency colostomy is then performed in the transverse colon with the immediate purpose of saving life and with the further objective of providing temporary drainage should the growth be removable at a later date. In some such cases, when at first sight the primary cause of the obstruction seems beyond any possibility of surgical removal, after several weeks of colostomy drainage the infection subsides and the affected portion of bowel may then be removed. Colostomy may be necessary as a preliminary to other operations involving removal of the large bowel. Such an occasion arises if diverticulitis has produced vesico-colic fistula (between the colon and bladder). In some cases of severe incontinence due to abnormality or injury to the anus, a left iliac colostomy enables the patient to be free of the terrible inconvenience of perpetual soiling in the perineum. Injuries or abnormalities of the spinal cord produce paralysis of the anal sphincter mechanism and sometimes colostomy is essential. Congenital absence of the rectum or anus requires an emergency colostomy within a day or so of birth.
There are two main forms of colostomy. First is the loop colostomy which has two limbs. The opening is at the apex of the loop and the bowel has not been divided completely across. A variation of the loop colostomy is the double- barrel form in which the two limbs of the loop are separated by a piece of skinrafter complete division. This is also described as a defunctioning colostomy as it prevents the spill of faeces from the proximal to the distalloop. A second variety is the spur colostomy where a spur is formed by suturing the two ends together for several centimeters inside the abdomen. This is of particular value if the colostomy is temporary as the spur can be destroyed by a crushing clamp without risk of peritonitis or perforation since the limbs have become sealed together. When the spur breaks down, the artificial opening on the surface shrinks and sinks back below the skin level. The aim is that this should close spontaneously without further operation. The third type is the terminal colostomy in which the distal portion of bowel is removed completely or in the case of excision of rectum the lower end is closed to form a blind end. In grave emergencies the simplest form of colostomy is performed in which a loop of colon is brought out through the abdominal wall, where it is held by the insertion of a glassrod passed through a small hole in the mesentery. The ends of the glassrod are connected by a loop of rubber tubing which forms a 'bucket handle' . The abdominal wall is closed around the protrusion of the colostomy. Exteriorisation is another way of performing a colostomy. If a growth is present in a part of the bowel which can be brought readily through the abdominal wall (e.g. transverse or pelvic colon) the affected loop containing the growth is left outside and the peritoneum, muscles and skin are closed around the base of the loop where the two limbs converge. The loop of colon containing the growth is then removed, leaving two open ends of el which can later be joined by crushing the spur between them. This operation avoids the handling of growth or unprepared bowel while the peritoneal cavity is open and so diminishes the risk of peritonitis. A formal operation for closure is required if a spur has not been made.
At the end of the operation a small incision is usually made in the apex of the loop to allow the immediate discharge of gas and faecal material which is collected as cleanly as possible before the patient leaves the theatre. A dressing of petroleum jelly gauze or tullegras is applied on the exposed bowel. The skin incision may be sealed with Whitehead's varnish and a pad of cellulosetissue and wool is bandaged lightly over the opening. For fear of contaminating the abdominal wound before the peritoneal cavity has become sealed, the former practice was to leave the colostomy unopened for 48 hours. The initial opening may be enlarged by the surgeon two or three days after the colostomy has been raised. The bowel is usually divided (without anaesthetic) by an electric cautery which seals the blood vessels and prevents bleeding from the very vascular mucousmembrane and muscle wall of the bowel. A method of draining the colostomy is by the use of Paul's tube. This is an angled wide glass tube which is inserted through a hole in the colostomy loop. It is tied in position in the same way as the caecostomy catheter and connected to a bedside jar with wide, thin, latex tubing. Research Colostomy
A counter-irritant is a remedy applied to the body externally which relieves a discomfort somewhere else by producing a local irritation. They effect relief by reflex action due to the sensation they impart to the nerves of the skin below. The term is more specifically applied to such irritating substances as, when applied to the skin, redden or blister it, or produce pustules, purulent issues, etc. The commonest traditional counter-irritants were such materials as mustard, turpentine, cantharides or Spanish fly, croton-oil, and the cautery. Research Counter-irritant
Rabies (Lyssa) is an acuteinfectious viral disease of the nervous system transmitted by the saliva of infected animals, particularly dogs. The animals most liable to be afflicted with rabies are dogs; but cats, wolves, foxes, etc, are also subject to it.
The early symptoms of rabies in the dog are such as restlessness and general uneasiness, irritability, sullenness, an inclination for indigestible and unnatural food, and often a propensity to lap its own urine. As the disease proceeds the eyes become red, bright, and fierce, with some degree of strabismus or squinting; twitch-ings occur round the eye, and gradually spread over the whole face. After the second day the dog usually begins to lose perfect control over the voluntary muscles. He catches at his food, and either bolts it almost unchewed, or, in the attempt to chew it, suffers it to drop from his mouth. This want of power over the muscles of the jaw, tongue, and throat increases until the lower jaw becomes dependent, the tongue protrudes from the mouth, and is of a dark, and almost black colour. A peculiar kind of delirium also comes on, and the animal snaps at imaginary objects. His thirst is excessive, although there is occasionally a want of power to lap. His desire to do mischief depends much on his previous disposition and habits. He utters also a peculiar howl, and his bark is altogether dissimilar from his usual tone. In the latter stages of the disease a viscid saliva flows from his mouth, and his breathing is attended with a harsh, grating sound.
The loss of power over the voluntary muscles extends, after the third day, throughout his whole frame, he staggers in his gait, and frequently falls. On the fourth or fifth day of the disease the dog dies, sometimes in convulsions, but more frequently without a struggle.
With regard to man the rabid virus seems to be more violent when it proceeds from wolves than from dogs. It appears to be contained solely in the saliva of the animal, and does not produce any effect on the healthy skin. But if the skin is deprived of the epidermis, or if the virus is applied to a wound, the inoculation will take effect. The development of the rabid symptoms is rarely immediate; it seldom takes place before the fortieth or after the sixtieth day, but in some cases has occurred after six months or even longer. It begins with a slight pain in the scar of the bite, sometimes attended with a chill; the pain extends and reaches the base of the breast, if the bite was on the lower limbs, or the throat, if on the upper extremities. The patient becomes dejected, morose, and taciturn. He prefers solitude, and avoids bright light; frightful dreams disturb his sleep;
the eyes become brilliant; pains in the neck and throat ensue. These symptoms precede the rabid symptoms two or three days. They are followed by a general shuddering at the approach of any liquid or smooth body, attended with a sensation of oppression, deep sighs and convulsive starts, in which the muscular strength is much increased. A foamy, viscid slaver is discharged from the mouth; the deglutition of solid matters is difficult; the respiration hard; the skin warm, burning, and afterwards covered with sweat; the pulse strong; the fit is often followed by a syncope; the fits return at first every few hours, then at shorter intervals, and death takes place generally on the second or third day. The treatment for rabies at the start of the 20th century consisted in preventing its development, which may be effected by applying a ligature, where possible, to impede the circulation from the wound, by sucking it, and thoroughly cauterizing it either with nitrate of silver or with iron heated to a white heat, the pain of cautery being less as the temperature is greater. If these means are not available, any burning substance and most acids were used.
Louis Pasteur put forward a method of preventing the development of the disease by a system of successive inoculations with rabid virus of greater and greater intensity; the inoculation being made the first day with marrow which has been extracted from the rabid animal 12, 10, and 8 days; then the second day with marrow extracted 6, 4, and 2 days; the third day with one day's marrow, etc. Louis Pasteur's method was favourably reported on by an English commission (1886-1887), but there is doubt regarding the number of cures really performed. As a contemporary critic of the Pasteur system remarked, every one who is bitten and inoculated is counted in the list of cures, though there is nothing to prove that he ever contracted the rabies. Despite the lack of scientific proof, Pasteur's dubious innoculation are still in use 100 years later, and there is still no cure for rabies though with careful medical attention patients have survived. Research Rabies
The Probert Encyclopaedia was designed, edited and programed by
Matt and Leela Probert
Abbreviations
Research Cautery
