which the patient endures, require speedier relief. This is obtained by dividing the sphincter on one side. The incision should be as before transverse, neither forward nor backward, but lateral.

The wound should not be allowed to heal by adhesion, but by granulation. The effect of which is, that for several days the strain and tension of the part are completely removed; when the morbid sensibility disappears, and with it the preternatural thickening.

A sort of tic douloureux occasionally is situated at the extremity of the bowel. In some cases the paroxysm of nervous pain occurs very seldom, and is of short duration, in which case no local treatment is requisite. When the pain has been constant, and the ordinary means of allaying neuralgia have failed, it has been found serviceable to perform the operation of dividing the sphincter.

SECTION VI.-OF STRICTURE OF THE RECTUM.

ALL the mucous passages in the body are liable to become constricted; the urethra, the gullet, the windpipe, the lachrymal duct, and the rest. They are narrowed through inflammatory contraction and thickening at one or more parts. But in addition to structural and permanent narrowing, those mucous canals which are surrounded with muscular fibres are liable to spasmodic stricture; that is

to say, to temporary narrowing produced by spasm of the fibres which surround them: the spasm over, the canal is of the same dimensions as before. The spasm in all these cases depends upon an irritated state of the mucous lining of the canal, which brings on by consent spasm of the surrounding muscular fibres.

To consider spasmodic stricture first.

We may begin by inquiring what part of the lower intestine is the seat of spasmodic stricture? What I have seen of the complaint disposes me to think that no single point is more liable to this affection than another. The cases, however, to which I refer, have been anything but satisfactory. They have left me with the impression that both the rectum, and the sigmoïd flexure of the colon, are liable to partial contractions of their muscular tunic, capable of obstructing the passage of the fæces, and of making resistance to the introduction of instruments. This irregular and spasmodic action generally goes with a vitiated state of the secretions; and is more frequently relieved by a regulated diet and aperient medicine, and the use of injections, than by the employment of instruments.

The symptoms which denote the existence of this complaint are, irregular action of the bowels, with a sense of difficulty in emptying the intestine, uneasiness of the lower part of the belly above the

left groin before the bowels are relieved, weight and uneasiness about the sacrum, occasional discharge of mucus, the motions sometimes natural, commonly either relaxed or in fragments,—no other disease being ascertainable.

One of the best instances which I can give of the disorder is the following: it contains a very useful lesson as to its treatment. The patient is a physician, who is now through his judicious selfmanagement restored to perfect health. The extract which I shall quote from a letter, in which at my request he favoured me with an outline of his case, that had several times been the subject of communication with me before, will convey to the reader an idea of the suffering which may attend this kind of disorder.

"In my life," says the writer of this communication, "I never knew what it was to have a single action of the bowels without the aid of medicine, or to be free for many hours together from all the wretchedness of disorder and of remedies in conjunction, excepting for two short intervals of time, during one of which I trusted simply to the use of injections of warm water, and during the other, when I took the white mustard-seed, and that with so singular an effect, that for a while I thought I had quite got rid of my complaint. With the exception of these two intervals, I have never been able till lately to say there is in life

that which is worth living for, or in other and more proper words, I did not know what it was to wish to live. To say nothing of the medical discipline which I have undergone again and again, I have been examined and treated for stricture of the rectum and of the sigmoïd flexure of the colon for years, and for years never passed anything from my bowels larger than a horse-bean, if solid, or of the little finger, if of a softer consistence. Oftentimes have I been quite incapacitated for exertion, and never able to enter upon my professional duties with anything like alacrity or cheerfulness. It is now nearly two years ago since I came to the resolution of abandoning all remedial measures: to leave off at once physic, injections, and the bougie: to take nothing in the shape of food that could by possibility irritate the stomach or bowels, and to leave them to act of and for themselves, when they could no longer retain their contents. I had, as you may suppose, difficulties in bringing about so entire a change. At first I suffered much inconvenience from a sense of fulness in the bowels and in the head. But this I contrived to obviate by the very occasional use of an injection of warm water, determining with myself to overcome the disposition to contraction by making the contents of the lower bowels the means of dilating them. By a steady perseverance in this course of discipline, I have perfectly recovered; know nothing

now of that distress of feeling which for at least twenty years made life burdensome to me; I have seldom or ever occasion to have recourse to medicine, and then only as a man in perfect health would do. I should tell you, that at one time such was the state of the stricture in the rectum, that the largest-sized urethra-bougie alone would pass, and that at another the contraction was so far in the intestine that a bougie of three feet in length was considered necessary to reach it."

It may be instructive to place in contrast with the preceding case another, which I shall again give in the words of my patient, who describes, in the third person, his own case. In this instance the idea of abandoning medicine appears likewise to have been resorted to, but not with an equally good effect; for it led to a very serious attack of obstruction of the bowels. In this instance, again, the use of the bougie has proved salutary. There exists, however, in this patient a point at which the bowel is so constantly found narrowed, that it is more than probable that he labours under permanent stricture of the rectum, in addition to that tendency to general irregular contraction of the adjacent bowel, which constitutes spasmodic stric

ture.

"A gentleman, now in his fifty-eighth year, who from early youth had been subject to a very irregular action of the bowels amounting frequently