Obstipation : $b a practical monograph on the disorders and diseases of the rectal valve

Description

"Obstipation" by Thomas Charles Martin is a medical monograph written in the late 19th century. It argues that the rectal valve is a real and clinically crucial structure whose pathology underlies many cases of obstructed defecation, distinguishing this from ordinary constipation. The work emphasizes careful anatomical study, direct visualization via proctoscopy, and modified treatment strategies for strictures in both infants and adults. The opening of the monograph defines obstipation versus constipation and explains the need to resolve long-standing disputes about rectal anatomy, especially the existence and role of the rectal valve. Martin reviews the literature chronologically, contrasting authorities who deny valves with those who describe them, and sets out to prove their presence with photographs, microscopic sections, and reproducible inspection methods. He traces the development of atmospheric inflation and proctoscopy (from Sims and Van Buren onward), then details how to examine the rectum noninstrumentally in the knee-chest position and instrumentally with an anoscope and proctoscope, including patient positioning and lighting. A topographic anatomy follows, distinguishing the fixed anal segment from the movable abdominal rectum, describing the sphincters, levator ani, and visible anal landmarks, and warning against common diagnostic errors. He then presents cast and histologic evidence for semilunar rectal valves, outlines their typical number and placement, and links their function to staged fecal transit during defecation. The section closes by introducing obstipation in infants, attributing their straining to immature musculature, excessive bowel mobility, obstructive valves, and a tight anus. (This is an automatically generated summary.)

Subjects

• Rectum -- Diseases
• Constipation
• Proctology
• RC