ground for supposing that stricture had existed, and that in all human probability, the only complaint ever present had been functional irregularity of the action of the bowels.

As the substances which may be impacted in the rectum are of several kinds, and are derived from various sources, so the symptoms which they produce are different, and each kind requires to be considered separately. They are, first, the natural alvine contents unduly accumulated; secondly, hard intestinal concretions; thirdly, hard and indigestible substances that have been swallowed; fourthly, hard substances introduced into the rectum through the anus by design or accident.

I. Accumulations of the natural contents of the rectum in a mass too large to admit of being expelled by the efforts of the bowel, sometimes, but very rarely, take place in adults; they occur rather less unfrequently in children, but are not very uncommon in aged persons.

This ailment is liable to result in children from neglect of attention to the relief of the bowels. If the contents of the lower intestine are not expelled, some absoption of their liquid parts takes

place, the mass is thus lessened, and is rendered more solid and less stimulating, at the same time that, by an inverted action of the intestine, it is forced retrogressively along the canal.

In this manner collections of fæces, drier and firmer than natural, often disposed in little round hard fragments, or scibala, are liable to accumulate in any part of the great intestine from the rectum upwards, and to form a source of obstruction.

The symptoms which are caused by such accumulations vary in different cases. Sometimes many days pass,-a fortnight or three weeks, without the ailment being discovered. For this period the bowels have not acted, but the child's appearance has not altered so as to attract observation. Gradually, however, he loses his appetite and colour; has headach, is sick and vomits, the belly is full, tumid, uneasy. Having learned that these symptoms have been preceded, and are attended by entire costiveness, it is best to begin with unloading the intestine by means of injections. For this purpose, warm water with soap dissolved in it, or barley water, a quart containing a tablespoonful of salt, will commonly answer.

When the lower part of the bowel has been by these means cleared, aperient medicines should be given by the mouth, to unload the upper part of the great intestine, and clear the whole passage. Further means than injections of emptying the

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lower bowel are commonly unnecessary; sometimes, however, the accumulation is in so great a mass, and so solid, as to resist the entrance of liquid, and it is necessary to use a scoop in addition to the syringe, in order to loosen and dislodge the obstructing masses.

Mechanical means are required for two different cases under this head. On the one hand, the accumulation often cannot be moved from above, owing to its quantity, till that is diminished by getting rid of the lower portion of the mass. On the other hand, great collections of fragments, sufficient entirely to disorder the digestive apparatus, will accumulate in different parts of the great intestine, and yet allow daily, and even frequently, some passage to liquid secretion.

A publican, aged thirty-five, had been bed-ridden for six months. He lay supported in bed in an inclined position: if he lay down he was oppressed and uneasy; if he stood up, he vomited. He was corpulent, and ate voraciously. The bowels would act with medicine, but not without. This resulted from an accumulation in the great intestine, higher than could be reached by examination. The most powerful drastics were given, but without dislodging it. It was then advised to inject very large quantities of tepid water. After nine pints had been slowly and cautiously thrown into the intestine, an immense discharge of scibale took

place. The injection, but in less quantity, was repeated daily for a week, and for that period more scibalæ continued to be discharged. After the accumulation had been thus got rid of, an alterative course of medicine and regulated diet perfectly restored the health of the patient.

In elderly persons the accumulation is often not in scibalous fragments, but the intestine is filled with a mass of cohesive substance, like putty. This is probably less stimulating than ordinary fæces, and the intestine again, from age, is torpid. Elderly persons often have repeated attacks of the nature I am now describing, and after having got over two or three, sink eventually under a return. However, by constant attention to the action of the bowels, the disorder may be often prevented; and when it has decidedly recurred, it often gives way to the prompt use of drastic purgatives. It is wonderful how little inconvenience is caused to the patient by large accumulations of this description.

I attended, with Mr. Drew, of Gower street, an elderly lady, who was labouring under this complaint the belly was large and full, but not tense or tender upon pressure. In conjunction with strong purgative medicines and purgative injections, the hot bath and venesection to the extent the pulse and her age justified, had been tried, but ineffectually. The complaint gave way, however,

under the use of oil of croton, of which she took three drops, a drop every two hours: the bowels then began to act, an immense quantity of fæcal matter was discharged, and she was restored to health. Two years afterwards this lady died of a return of the same complaint.

The following case exemplifies other features of such an attack, and the necessity of using mechanical means to unload the intestine :

I was requested by Mr. Reid of Bloomsburysquare to see an elderly lady. She had generally enjoyed excellent health, and had been accustomed to take a good deal of exercise. But ten weeks previously she had been attacked with rheumatism, which had confined her to her bed. The bowels during this ailment gradually became inactive, and at length were never moved without medicine. The medicine which agreed best was castor oil, but even this failed to give sufficient relief. The quantity of fæces passed was small, and its expulsion caused some pain of a spasmodic character, which remained for hours afterwards. These pains occasionally came on at other times, and were accompanied with throbbing, and a sense of stoppage in the rectum. To relieve her sufferings, it was necessary to give opium, which increased the constipation. Upon examining the rectum, Mr. Reid found that it contained a quan

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