THE SPIROCHÆTA PALLIDA (TREPONEMA PALLIDUM) IN SYPHILIS
Journal of the American Medical Association (JAMA)
rectal region as described above, though I have succeeded a number of times in blocking limited areas for operation on painful lesions involving the anal margin. A brief recital of the case referred to will perhaps be of interest here : Patient.-On Feb. 27, 1900, I was called to see Mr. J. B., aged 23, whom I found in bed. History.-For several years he had been a sufferer and supposed his trouble was merely the ever-popular "piles." Examination.-I found three well-developed internal hemorrhoids
... nternal hemorrhoids situated well up in the anal canal, an exquisitely painful fissure with its external "sentinel pile," and, as was to be expected, a spasmodic and hypertrophied sphincter. Operation.-I advised the patient that a general anesthetic would be necessary. He consented, but his dread of it was so great that I determined first to attempt the operation by blocking the nerve supply of the entire region. This was done on the following day, after the manner outlined above, with complete success, and with practically no pain The sphincter was divulsed, the internal hemorrhoids ligated and removed, the fissure curetted and incised, and the "sentinel pile" amputated. The patient left the hospital in six days.