A bit of a bum job

May 11, 2013

Don’t ask how my husband and I started discussing this topic, but I am so old now that the treatments we recommended for certain conditions are no longer used. Superceded by “evidence based medicine”. In the old old days a treatment or procedure might be thought to be a jolly good idea in theory and so, hey ho, it would be tried out, written up and before you know it, it would be routine. Before you had to do clincial trials and stuff and actually find objective evidence that the treatment worked better than doing nothing.
The procedure I remember in particular is known’s as Lord’s procedure. I did it as a House Surgeon and also had to keep people asleep who were having it done when I was an anaesthetist. The latter role was much much harder because the procedure was intensely, agonisingly painful and would cause people’s hearts to go in to weird rhythms, threatening to stop, so you had to make sure they were really deeply unconscious before the surgeon started.
Because the procedure was one to alleviate piles and/or fissures (splits). It was really barbaric. The patient would be in the lithotomy position – on their back with their legs up in stirrups (like in the old days birthing mothers were made to be). The surgeon would then get ready to manually dilate the anus. The aim was to insert four fingers of each hand in to the anus, with the hands being turned back to back not in the praying, palms-together position. Then you would stretch as hard as you could – pulling your hands apart at each side of the anus – so like ripping the bum cheeks apart. You only ever pulled in that direction not up and down. And basically over 3 or 4 minutes, you would stretch this poor soul’s bum until you thought you’d done enough. It was during the stretching that the heart rate would go all over the place. And I think we can all see why.
The procedure (named after the doctor who dreamt it up, not after the House of Lords routine entertainment of each other) was used for years until eventually somebody did do more robust research and found that although it appeared pretty effective straight away, 20 years on people actually had trouble not dribbling shit so perhaps knackering their sphincter maybe wasn’t the best thing to be doing.


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