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to an alternation of costiveness and dysentery, was, about fifteen years ago, strongly urged by a physician to abstain from medicine, and to let the bowels alone. This experiment was tried with great resolution. In spite of much suffering and increasing feverishness, the patient took no medicine for more than a week. Inflammation however ensued. Intolerable pain in the abdomen, and simultaneous vomiting and purging, reduced him to an alarming state in the middle of the night. Skilful medical assistance was fortunately obtained without loss of time, and the acute symptoms were subdued. The patient's general health however grew worse. His bowels were never at rest. Acrid mucus was incessantly formed, and frequently passed, leaving the sufferer in a state of great weakness. Blood was sometimes observed in the mucus. Scarcely anything was passed without great effort and pain. Spasmodic contractions of the rectum were constantly attendant on every attempt to ease it. Great emaciation and prostration of muscular power took place, as also restlessness at night, amounting sometimes to the most painful startings from sleep. After a few ineffectual attempts to perform a cure, treating the case as one of liver derangement, he confined himself to the use of the common purgatives for the paroxysms of the complaint, and of a small quantity of rhubarb and ginger before dinner, for the

daily symptoms. Though very slowly, yet he improved from year to year; but owing to the unsettled state of the bowels, he could hardly venture out of his house. By the advice of a friend, he tried, about two years ago, the daily use of lavements by means of Read's syringe. He has used nothing but tepid water. At first the lavement produced great nervous weakness; but this symptom disappeared in a short time. At present he enjoys a certain degree of comfort and ease, which entirely depends on the use of the lavement early in the morning. From a local examination, it has lately been ascertained, that the rectum is contracted to about half an inch diameter, at a distance of about five inches from its termination. The daily passing of a wax bougie, softened by heat, is attended with little or no pain. The distension of the contracted part by this mechanical means relieves the spasmodic contractions, which the patient frequently feels a little above the sigmoïd flexure."

I shall conclude my remarks upon the subject of spasmodic stricture of the rectum with the following case, which was communicated to me by Mr. Crosse of Norwich. I will give it in his own words. It is unnecessary to state, that that eminent provincial surgeon was not the practitioner through whose mismanagement the fatal termination of the case was produced.

The case is one in which the coats of the intestine were remarkably thin, which gave rise to an imperfectness in the action of the bowels (as explained at page 90,) which was erroneously considered to proceed from stricture. In every point of view this serious case is full of interest.

"A young woman of delicate frame was supposed to have stricture of the rectum, which led her medical attendant to employ in no very gentle manner a firm bougie. After much difficulty the instrument was made to pass; but the patient in a few hours became very ill, vomited, and was chilly, and in about forty-eight hours died. It was found that the bougie had perforated the coats of the bowel at the sigmoïd flexure, about seven inches from the anus, and had entered the peritoneal cavity. The preparation, which is in my collection, shows the rectum to be capacious for an inch or two next the anus; but all the rest of the bowel preserved, being a length of eight or nine inches, is very contracted, so that it would only admit a small instrument half an inch in diameter; and at the same time its coats are very delicate and attenuated, readily allowing the bougie, in the hands of a boisterous surgeon, to perforate them. There is a great abundance of adipose substance and of fatty appendages about the sigmoïd flexure of the colon. The bowel presents no thickening or partial contraction, but a smallness of calibre

generally, with remarkable delicacy and thinness of the coats-accounting for the presence of of symptoms, during the life of the patient, which might have led to the supposition that stricture existed."

Permanent stricture of the rectum consists in a partial thickening of the submucous coat of the bowel and of the adjacent cellular texture; through which means a smooth ring is formed, generally from a third to half an inch in depth, which projects into and narrows the channel. Sometimes the thickening does not include the whole circle of the intestine, but a segment only. It is presumable that this thickening results from chronic inflammation.

The ordinary seat of stricture of the rectum is from two and a half to four inches from the orifice of the gut. But sometimes it occurs at a greater distance, at six to seven inches for example; and a contraction of the same nature is occasionally met with in different parts of the colon.

The symptoms of stricture of the rectum are the common and necessary consequences of the excretory canal being narrowed at one part.

The fæces are passed in small and narrow and flattened portions. The quantity voided at a time is inconsiderable, from the effort required to pass it through the stricture. The bowel being thus insufficiently relieved, the effort has to be repeated frequently during the day; and it is only after

The

many efforts that all its contents are passed. narrowed portion of the canal is extremely sensible; which is owing partly to the thickening which forms it being originally produced by an inflammation, partly to the irritation of the mucous lining of the stricture, which is occasioned by the more forcible pressure of the fæces against it. When the bowels act, in addition to a sense of obstruction in the part, pain is experienced and tenesmus, and mucus is voided; and at other times a sense of weight and tightness, with general uneasiness, is felt. The habitual confinement of the bowels alternates with periods of looseness and purging. Uterine irritation, irritation of the bladder and urethra, numbness and pain down the thighs and legs, are occasionally concomitant symptoms.

But if these symptoms are common to every affection by which the channel of the rectum is narrowed, in what manner is a case in which they occur proved to be a stricture?

It has been mentioned, that the seat of stricture, in nineteen cases out of twenty, is near the orifice of the bowel; that is to say, within the distance which admits of examination by the finger. In common cases, therefore, no difficulty exists in identifying the disease: the finger may be passed into the smooth and firm narrow ring which forms

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