ON COCCYDYNIA AND HEMORRHOIDS 265 



elicited that there had been absolutely no diarrhoea nor 

 exaggerated peristalsis of the bowel, and that the fluid 

 discharged was pale, in fact quite colourless, when examined 

 on the carpet of his bedroom and in the basin of the 

 W.C., where the greater quantity of it was discharged, 

 with the slight exception of a few very minute flakes and 

 shot-like particles of faecal matter which had evidently 

 been detached from the anal extremity of the rectum, 

 which was otherwise empty, the solid faecal matter not 

 having as yet descended into it ; there was thus no faecal 

 matter. The bowels still continued confined, and there 

 was no feeling of discomfort or as if they were going to 

 be moved, and there were no piles or solution of continuity 

 of the mucous membrane. Whence then could this serous 

 or watery discharge which would measure from one to 

 two ounces have come, and what did it indicate ? That 

 the fluid could have reached the anal extremity of the 

 bowel without admixture with alvine or faecal matter it 

 was impossible to conceive, and that the faecal matter 

 which was discharged represented only what was present 

 in the otherwise empty recto-anal extremity of the bowel 

 was equally apparent, rendered it necessary to seek a 

 solution of the problem in another direction. That the 

 serous or lymphoid fluid in question came from the blood 

 circulation it was also impossible to conceive, inasmuch as 

 no haemorrhage took place, and no solution of the con- 

 tinuity of the lining mucosa of the bowel could be found, 

 nor could local congestion or hyperaemia be discovered ; 

 hence we were and are driven by elimination of all possible 

 likely causes or sources of the discharge to admit that it 

 must have come from the inferior or posterior eliminatory 

 apparatus of the cerebro-spinal lymph cavity, and that, in 

 this case, it represented, it may be, the exaggerated physio- 

 logical performance of a constantly operative and impera- 

 tively necessary excretory function. The actual cause of 

 the accumulation of the cerebro-spinal fluid had been the 

 sustained and effective contraction of the anal sphincter, 

 which, on being overcome by sympathy with the kindred 

 vesical operation then in process, allowed the accumulated 

 excretion of the coccygeal gland to escape as already 

 narrated. 



