the stricture; and a demonstration may be thus obtained that this and no other disease is present.

The treatment of ordinary cases of stricture of the rectum is no less simple in theory than satisfactory in its practical results. In stricture of the rectum, as in stricture of the urethra, if a bougie of a size calculated easily to fill the stricture be passed into the narrowed part daily, or every second, third, or fourth day, according to the irritability of the patient, and retained for from ten minutes to a quarter of an hour at each introduction, the pressure of the bougie causes the absorption of the lymph, on which the inflammatory thickening of the walls of the canal depends; the patient is thus enabled gradually to introduce larger and larger instruments, and the channel is at length restored to its original calibre.

A diet carefully regulated, the use of mild aperient medicines, of injections of tepid water, and of anodyne suppositories, are important accessories in the treatment of stricture of the rectum.

In the use of instruments for contraction of the rectum, the point to be constantly the most thought of and studied is gentleness. If any considerable degree of force is used, the bowel will be torn: if pressure is made against the stricture with too large an instrument, the adjacent and sound part of the bowel is certain to give way sooner than the stric

ture. The canal of the urethra is often torn in this manner by the pressure of an instrument too large to enter the strictured part.

In stricture again of either canal, if by dexterous management an instrument too large is successfully forced through the contracted part, it may yet produce most serious consequences. If such an instrument is forcibly passed into a stricture of the urethra, the patient in a few hours after the operation is seized with shivering, and symptomatic fever follows, which will last several days. If similar violence is done to the rectum, the surgeon being anxious rapidly to complete the dilatation of the stricture, within twenty-four hours shivering supervenes, as in the former instance: but here it has a more serious character; it is probably the precursor of peritonitis, to which the patient may in a few days fall a sacrifice. There is a singular consent between the pelvic mucous passages and the peritoneum. If a stricture either of the vagina or of the rectum be roughly dealt with, peritonitis is liable to ensue; notwithstanding that the violence is done at a part of either canal, which is not covered with peritoneum.

Such violence is not merely mischievous, but it is utterly unjustifiable on any ground: it can be used only through a mistake of the principle of dilatation; the object of which is not mechanically to stretch the narrowed canal, but to excite

by moderate pressure the absorption of that which thickens and contracts it.

Division of a stricture of the rectum has sometimes been recommended. I have done this operation upon some occasions, but my experience is not in favour of it. It is liable to produce troublesome bleeding; and what is obtained by the division must be kept open by the use of bougies, by which in nearly the same time simple dilatation might have been effected.

It is not always easy to distinguish stricture of the rectum from incipient carcinoma.

A lady about forty-five years of age had suffered severely from piles, which were removed five years ago by the ligature. It was stated to her that they did not grow from the fore-part of the rectum. Some months after this the lady began to feel a tightness and sense of obstruction in the rectum. These sensations gradually became more distressing: much effort and straining were necessary to pass the fæces, which were narrow, flattened, and in fragments. After two years of suffering, this patient applied to me for advice. There was an induration, which began two inches within the rectum, and occupied twothirds of the circumference of the gut. The central and broadest part of the induration was towards the vagina; at this part it was two-thirds of an inch in depth. The part was acutely sensible. I recommended that the bowels should be

relieved every morning by means of a lavement of tepid water, and that a soft wax bougie should be introduced into the narrowed part every second day. Under this treatment, combined with the occasional use of aperient medicine, a decided amendment took place: the narrowed part yielded to a certain extent, and there was a proportionate alleviation of all the symptoms. But in a short period the patient became worse again; the introduction of the bougie now gave more pain; it was therefore discontinued. The passage was indeed certainly freer, but the induration towards the vagina was not lessened. Under these circumstances I wished Mr. Copeland to see the case with me. The impression which the examination made upon our minds was, that the disorder was likely to prove carcinoma.

The plan which the patient followed was slightly modified. The use of the bougie for a time was not resumed. The increased sensibility of the part went away. But it was not long before the patient again complained of the contraction returning; upon which the bougie was again used, but for a shorter period than on the first occasion. Since then at intervals the patient has occasionally had recourse to this remedy again. She is now materially better: the narrowing has lost its doubtful character: the induration is less in extent, and the projecting band has little more than the character

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of a thickened fold of mucous membrane. Some discharge of matter per raginam took place, and continued for several weeks, about a year ago. am disposed to think that it proceeded from the induration, which may have suppurated, and the abscess have broken into the vagina at that time. This account was written four years ago. The lady has suffered no further inconvenience from the complaint.

Stricture of the rectum is occasionally met with in combination with a dilated sac of intestine below it. The stricture with the part above is then borne down as a sort of inward prolapsus into the lower and dilated portion of the rectum. This disease is liable to be overlooked, but when discovered, yields, like other stricture, to dilatation by means of the common wax bougie.

Stricture of the rectum is a disease of extremely rare occurrence. It is, however, a common trick of charlatanism to represent the complaint as frequent, and to put upon a course of treatment by instruments patients who have no stricture to remove. Some months ago, I saw, in consultation with Mr. Copeland, a lady of rank, who for several years preceding, had been under systematic and almost daily treatment for stricture of the rectum; the question proposed for our consideration was, whether this plan required to be continued; it turned out on examination, that there was no