disappointed at finding that the protrusion returned; yet she remarked that the bowel admitted of being replaced with greater ease than before. Some soreness in the part, however, was now observed; blood too was passed from the bowel; there was irritation of the bladder; and for the first time, a protrusion took place during the act of micturition.

Upon examining the bowel on the sixth day after the operation, it was found to be in the following condition. The mucous membrane, when the bowel was prolapsed, appeared darker and fuller of blood. The little portions of membrane which had been tied had come away; the ligatures, however, had not yet separated, but remained fixed in the shallow ulcers which they had produced they were divided and removed. From this time the local complaint improved daily the protrusion became less and less, then did not recur each time the bowels acted, and in a fortnight had entirely ceased.

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A strange accident ensued in this young lady's recovery; after a few days she became deranged; but the alienation did not last many weeks, and for some time that I occasionally heard accounts of her, she enjoyed perfect health of body and mind.

There are cases of prolapsus, which result from weakness and relaxation of the sphincter of the nature of palsy; this complaint occurs either alone,

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or in combination with weakness of the legs. In either case the only local remedy is the palliative one, already described, of the ivory ball and spring.

SECTION IV.-OF FISSURE OF THE RECTUM.

FISSURE of the rectum is a small ulcer of the mucous membrane, which is liable to form immediately above the sphincter, and is met with more commonly on the back part of the intestine, than in front or laterally. The ulcer is generally oblong, a third to three-quarters of an inch in length. The edges are sometimes raised and hard; in other cases, their want of elevation and softness, and the shallowness of the ulcer, render the complaint difficult of detection.

The complaint usually originates in costive bowels, and its commencement often is a transverse rent of the mucous membrane from the pressure of hardened fæces in their expulsion. The crack so formed does not heal, but remains an ulcer.

The patient is sometimes aware at the time that some injury has taken place, from the unusual pain attending the relief of the bowels, and the soreness afterwards. In other cases the symptoms supervene gradually. They consist of pain, aching, soreness within the bowel, brought on by evacuating its contents, and remaining for a longer or shorter period, the pain being in time very severe,

and a sense of weight and uneasiness being at last always present.

The simplest treatment is often sufficient to cure this troublesome complaint. It is frequently only necessary to keep the bowels slightly relaxed, the motions semiliquid; and the ulcer will spontaneously heal, when no longer torn open daily by the passage of hardened fæces. But additional means are sometimes necessary: these are, first, the application of ointments to the sore. The best for the purpose are those which contain the milder preparations of mercury; but they require to be varied, and sometimes other applications succeed when these fail. Where there is great pain and tenderness, suppositories of opium and lard are occasionally more useful. Sometimes the application of lunar caustic, on the other hand, takes off the irritability of the ulcer.

When these means fail, the second resource is an operation, which is not of a very serious nature. It consists in dividing the sphincter laterally; if possible, the incision should include one part of the ulcer, but this is not necessary. The main object is to give perfect freedom to the passage from the intestine, and to take away the strain upon the part where the ulcer is. The wound is not to unite by adhesion; which may be prevented by introducing into it a pledget of lint dipped in oil, and renewing the same as often as necessary.

In one case, in which the ulcer was situated to the fore-part of the rectum, I divided the sphincter laterally, but the operation proved ineffectual. Afterwards extending the opening of the bowel, I pared off with scissors the hard edges of the ulcer, which then healed.

SECTION V.-CONTRACTION OF THE ANUS. CONTRACTION of the anus may be either spasmodic and temporary, the result of undue action of the sphincter muscle, or it may consist in permanent thickening and induration of the orifice of the intestine.

Spasmodic contraction of the anus is most commonly met with as a symptom of fissure of the rectum, and disappears when that complaint is cured; but sometimes it occurs as an independent disorder.

In the latter case it forms a kind of cramp, which often comes on suddenly. The patient, who has gone to bed quite well, awakes in violent pain. The sphincter muscle is hard, and in strong action, so that a small bougie cannot be introduced without difficulty. In some cases these paroxysms recur daily, in others only two or three times a-year. In some, again, the attack of spasm comes on gradually, and after producing uneasiness for several days, gradually wears off; in others, it

is sudden in its invasion, and sudden in leaving the patient.

The complaint generally depends upon a confined state of the bowels: and a brisk cathartic at night, with an aperient draught in the morning, will often be sufficient to cure it. Or the patient finds it enough to use a lavement of warm water, upon which the spasmodic contraction wears off.

When the pain is very severe, an ounce of tepid water, with twenty or thirty drops of the liquor opii sedativus, should be injected into the bowel, and at the same time some aperient medicine taken. Sometimes the spasm is relieved by extending the circular sphincter muscle, and keeping its fibres on the stretch. The patient for this purpose may introduce a large mould candle into

the anus.

There are cases in which this disease produces long-continued and most serious suffering, in which the anus becomes permanently contracted and hardened, constituting a kind of permanent stricture, and generally combining both permanent and spasmodic contraction. The motions are always passed with difficulty and with pain, and all the common symptoms of stricture of the rectum are present.

In this more aggravated form, the complaint is slow to yield to the simple remedies which have been recommended; and the complicated sufferings