tity of clayey fæces, which he removed with a scoop. Water was then injected, and more fæces were returned with it. This operation gave the patient temporary relief; but in the course of a few days the pain gradually returned, and became more intense than ever, coming on in paroxysms, especially when the bowels were moved, a thin fluid, however, being all that passed. It was at this period that I saw the patient in consultation with Mr. Reid. The accumulation of fæces in the rectum had returned in a surprising quantity; but there was great tenderness and soreness about the sphincter, which indisposed the patient to allow the trial of any further mechanical relief. However, with care and gentleness, the orifice was gradually dilated, an immense volume of fæces was brought away, and the rectum, which was unusually capacious, was at length emptied. The pain then subsided: a dose of castor oil which was administered, brought away on the following day more fæcal matter that had been accumulated above, and the relief was complete.

II. By intestinal concretions I mean such as are directly produced from substances which have been swallowed as food or medicine. Of these there are, doubtless, many that have not yet been submitted to chemical analysis. But Dr. Marcet and Dr. Wollaston examined some, which proved to be

concretions of caseous matter. Others have been composed of oat-cake. And magnesia, where taken in large doses and repeatedly, has been consolidated in the bowels into hard masses of formidable magnitude.

Such concretions being of slow increase; cause a gradual invasion of abdominal uneasiness, pain, nausea, vomiting, finally, local irritation, when they reach the lower bowel. It is then only that their existence is positively ascertainable; when their removal is to be practised by the mechanical means which their shape and resistance render necessary. The following instance, given by a late eminent American surgeon, conveys a just idea of this form of disorder :

A female, aged thirty-five, had been for some years subject to constipation and repeated attacks of colic; the former had increased, attended with sickness of the stomach, and the latter had become more frequent, from which she only experienced relief when her bowels were moved, a task not accomplished without great difficulty and painful efforts joined to the use of much purgative medicine. Dr. Bushe was called to visit her in one of these

paroxysms. "I found her," he says, "sallow, emaciated, dejected. From the severe bearing-down pains, together with the sense of weight and fulness in the sacral region which she complained of, I was led to make an examination of the rectum,

when I found the mucous membrane slightly protruding, the sphincter excessively irritable, and a large concretion distending the pouch of the rectum. I now apprized her of the nature of the case, and the absolute necessity of removing the foreign body, to which she willingly consented. For this purpose, the patient being placed in a suitable position, I introduced a strong and long pair of lithotomy forceps, with which cautiously laying hold of the concretion, I slowly and steadily extracted it, with no more injury than slight laceration of the mucous membrane, although, on measurement, it proved to be six inches and threequarters in circumference, and two inches and a-half in length. The bowels were then freely washed out with injections: leeches and fomentations were applied to the anus, the recumbent position was enjoined, and a speedy recovery ensued."

III. Hard and indigestible substances that have been swallowed, and have made their way down to the rectum, have been most commonly portions of bone. They generally pass through the bowels without creating disturbance, and are first suspected through the pain and irritation which they produce in the rectum. The ordinary period that they take to traverse the length of the intestinal canal is about eight days. Their extraction is a mechanical operation, in which the surgeon must be

guided by their shape, magnitude, consistence, position.

IV. Foreign substances directly introduced into the rectum, either require the same management as the cases last described, or in their introduction, produce wounds, which combine with the common features of local injuries those of laceration of the intestine.

SECTION VIII.-OF DEFECTS OF THE LOWER BOWEL EXISTING AT BIRTH.

THE lower part of the intestine is liable to malformations of various kinds, which are discovered at, or shortly after birth. Many of these admit of being completely repaired: others are irremediable.

These imperfections are referrible to three heads, -obstructions of the orifice, or in the intestine above it ;-deficiency of part, or of the whole, of the rectum ;—improper terminations of the rectum in other parts, of other parts in the rectum.

I. Congenital obstructions of the bowel are either partial or complete. Partial obstruction is, when the bowel is perfect everywhere but at its opening, and when that, instead of being natural, is a narrow canal, not much larger than will admit a probe, nor capable of giving passage from within to more than liquid fæces. This defect of structure is liable to escape observation for many weeks,

owing to the want of consistence of the alvine evacuations; but sooner or later, that is to say, when the faces become more solid,—it causes obstruction, uneasiness and distension of the belly, loss of appetite, vomitings, emaciation. As soon as the defect is discovered, it may be rectified. The method to be employed for this purpose depends upon the size of the opening. When that is not extremely small, it will often allow of dilatation by means of a sponge-tent, or conical bougie of waxed cloth. When the aperture is too closely contracted for this, it requires to be enlarged by the division of its border. The operation is unattended with danger, and is, at the same time, much less fretting and troublesome to the infant, than the more tedious process of dilating. Add to which, that the child's health may be suffering from obstruction, and prompt, as well as complete relief may be required.

When a proper aperture has been made, it is generally unnecessary to use artificial means to prevent its closing again: the passage of the contents of the bowels will probably be sufficient. The direction in which the incision is to be made, depends upon the place of the existing aperture, in relation to the bowel and to the middle line of the body. The division of parts should be very trifling in extent, as it is easily enlarged, if that should prove necessary; and the less its extent, the more