In many cases the time that is saved ceedingly annoying. Retention of urine occurs sometimes, but not so frequently as after the ligature. Slight bleeding sometimes occurs at non-cauterized points when the clamp has been removed, but it will not do any harm when a firm wedge-shaped compress is placed over the anus and supported by a well-ad justed T-bandage.
Experience has shown that haemor rhage will occur just as frequently from the slipping of the ligature, when it or is represented by the length of time that it requires for the ligature to come away. Granting that some healing takes place while the ligature is sloughing, it will require as long for the remaining portion of the ulcer to heal as after the cautery operation; for the ulcerated surface after the latter seems to heal more readily than after the former operation. The pain after the cautery operation is insig nificant if care has been used to avoid cauterizing the shin; but when it has been touched, if only slightly, the pain is ex the stump has been severed too closely, as after the clamp-and-cautery operation.
It is not probable that either tetanus or pyiemia will follow the cautery oper ation, for there is no constriction of ter minal nerve-filaments, and the danger of sepsis has been minimized by searing the exposed surfaces. So far as a radical cure is concerned, the cautery and the ligature operations are on a level, for when either one has been performed as previously described a permanent cure will follow in every case.
One hundred to one hundred and fifty haemorrhoid cases seen both during and after the operation with clamp and cau tery. Apart from the fact that none of them had a single bad symptom of any kind, there were three points chiefly remarkable about them. First, the ex tremely small amount of blood lost; secondly, the trivial degree of pain after ward; third, the short time during which treatment lasted. Burghard (Lan cet, Apr. 6, '93).
Clamp-and-cautery method considered preferable to all others. H. R. Colston (Virginia Med. Monthly, Apr., '95).
tin two hundred and sixty-seven eases treated during five years at the N. Y. Post-graduate Hospital, the clamp-and cautery method employed and preferred to all other procedures. CHARLES B. KELSEY, Assoc. Ed., Annual, '96.] Advantages of the clamp and cautery: It is antiseptic; there are no sloughs to separate as in the ligature operation; there are no ligatures or sutures to offer any chance for infection; it is a radical cure; the operation is a rapid one; the time of convalescence can be definitely fixed—the eighth day.
The record of haemorrhage, pyiemia, or The clamp-and-cautery operation can be done expeditiously and with little loss of blood; the cauterized base of the pile is rendered aseptic by the cautery; there is no pain following the operation; re tention of urine is extremely rare; con valescence is brief and uninterrupted,— confinement in bed from three to seven days is sufficient. Trowbridge (Boston Med. and Jour., May 30. '05).
There is a decided advantage in favor of the clamp and cautery. Rarely, after this operation, is it necessary to pre scribe an opiate. J. E. Davi; (N. Y. Med. Jour., June 15, '95).
death is almost negative. In five hun dred eases operated upon in Mt. Sinai. by the above method, there has not been a single death. One case of pyminia from which the patient recovered is re corded, and a few slight haemorrhages; and, so far as can be ascertained, there have been no recurrences. Vaux (Ca nadian Pract., Dee., '96).
The writer's objection to the clamp and-cautery operation is that in haem orrhoids having a broad base the clamp picks up the haemorrhoids and also a large portion of the mucous membrane, and on the removal of the clamp the edges of the mucous membrane separate and leave a large ulcer, which is slow to heal. George W. Crary (N. Y. Med. Jour., Feb. 12, '98).
Clamps.—Until recently pile-clamps on the market were constructed like scissors. When that portion of a tumor external to the clamp was cut off, tissues except those nearest the heel slipped through before the operator had a chance to cauterize them. In this way patients were subjected to a serious, if not fatal, hemorrhage.
Some three or four years ago the writer constructed a clamp with the blades at right angles to the handle (see Fig. 5). This insures the blades' remain ing parallel, distributing equal pressure, no matter how far apart they are, so that not the slightest portion of tissue can slip through and escape cauterization. When this clamp is used limorrhage is im probable, if not impossible.