110 CHAPTER III. LOCAL AFFECTIONS OF THE LOWER BOWEL. THE lower extremity of the alimentary canal, the straight intestine, or rectum, is the seat of a variety of troublesome complaints, the disposition to which originates in the following causes. Above this organ are placed masses of bowels, the circulation in which forms one great system, having its most dependent part here. The blood, therefore, gravitates to the rectum, whenever the body is upright, so that, under the most favourable circumstances, the hemorrhoidal* veins are exposed to more strain and pressure than most other veins. And when it is recollected that cold, passions of the mind, irregularities in diet, tend to throw the blood inwards upon the bowels, it will easily be understood that there may often be congestion enough of these vessels to determine local swellings, inflammations, effusions. The main channel, again, for the return of the blood from the bowels, is through the liver, and it is hardly too much to say, that every disturbance of the function of that organ acts as an impediment * The veins of the rectum are called hemorrhoidal, from their disposition to bleed. to the passage of the blood through it, and tends in the same degree to increase the congestion of the vessels of the lower bowel. In addition, the sensibility of this part of the canal, the acrid nature of its contents, the peculiar muscular structure with which it terminates, -all contribute to heighten its liability to disease, while its situation exposes it to several kinds of mechanical injury. There are, however, rules, deducible from these same considerations, the observance of which tends materially to prevent the occurrence of many of the troublesome complaints which are to form the subject of the present chapter. I. Abstemiousness in diet and temperance, recommendable on every other ground, are essential on this,―inasmuch as their neglect gorges the vessels of the bowels with blood, the effects of which are, as it has been explained, most felt at the lowest part. II. Adequate means (of which the various kinds have been described in the preceding chapter) should be taken to prevent costiveness, which is productive of local disease here;-first, by causing general fulness of the abdominal system of vessels; secondly, by the muscular pressure against the return of blood by the hemorrhoidal veins to which it leads. III. The lower bowel should not be allowed to remain for any time unrelieved of its contents; but this can only be secured by causing the contents of the upper intestines to descend to the lower bowel at a convenient time. There is but one way of accomplishing this object, which is through the influence of habit on the inward organs. If the lower bowel is relieved daily at the same hour, the upper intestines will bring their contents to the rectum towards that hour. IV. Every time the bowels are relieved, ample washing with soap and water is to be practised, so as completely to purify the part. This rule, which is one of common cleanliness, is sufficient of itself to prevent half the more trivial ailments about the rectum. The disorders which are incurred through neglect of these rules, or by original imperfection, or tendency to disease, or casual injury, will be considered under the following heads. Fulness of the hemorrhoidal vessels and hemorrhage; piles and excrescences; prolapsus, or protrusion and inversion of the bowel; fissure of the mucous membrane; spasm and contraction of the orifice; stricture of the rectum; obstruction of the passage of the bowel by its contents; want of perforation at birth; laceration of the bowel; abscess and fistula; cancer. 113 SECTION 1.-FULNESS OF THE HEMORRHOIDAL THESE disorders require to be considered together, as they generally go together, the second being commonly at once the effect and the natural relief of the first. They often, however, occur separately, -that is to say, congestion of the vessels of the rectum is not, necessarily, followed by bleeding; and, on the other hand, bleeding from the rectum is not necessarily preceded by symptoms of local vascular turgescence. So, it is desirable to look at the subject in three points of view, and to consider separately, hemorrhoidal congestion, hemorrhoidal congestion with bleeding, and bleeding from other causes *. 1. Any cause whatsoever that disturbs the body or mind, is liable to produce the first affection, which, however, is most commonly to be traced to errors of diet, neglect of aperient medicine and exercise, or exposure to cold. But without any assignable cause, this complaint often makes its appearance. The symptoms of hemorrhoidal congestion are sensations of weight, aching, fulness, heat at the * I pass over the consideration of hemorrhage from ulceration in fever, in phthisis, from the action of poisons, from cancer or ulceration of the rectum, from local injuries. fundament; the aching pain sometimes extends to the loins, and round the lower part of the belly, sometimes down one or both thighs. The local uneasiness is increased, when the bowels act. These symptoms supervene gradually, are at their height in twenty-four hours, and remain troublesome two, three, or four days; then gradually wear off. The proximate cause of these symptoms is local determination of blood, or something approaching towards inflammation. The vessels are turgid, the part hot, as in an inflammation, and there is a disposition to local swelling from effusion of the serum of the blood and lymph. The means which relieve an attack of this kind are the following:-rest, and that in the recumbent posture; abstinence from wine and heating food; laxative medicine, such as one or two drachms of lenitive electuary, an ounce and a-half of infusion of rhubarb with three drachms of manna and a drachm of tartrate of potass, or a Seidlitz powder, the local application of cold or warm water, whichsoever being tried gives the most ease. Generally cold applications are preferable. If the pain is very severe, leeches are to be applied. 2. Congestion, with bleeding, is the addition of that symptom to those which have been described. The bleeding is, in some cases, to a certain degree accidental, that is to say, it sometimes only takes place upon the action of the bowels, that is to |