RECTUM. 



by the conftipation which it produces ; by the fenfc of 

 weight which the patient feels about the fundament ; and 

 alfo by the poffibility of ailually touching the indurated 

 obftrufting body, when a finger is introduced up the 

 reftum. 



Oily emollient clyftcrs, and carminative draughts, will 

 ferve for expelling fuch concretions as are not of too firm a 

 confifteuce ; but the extraftion of tiiem is abfolutely ne- 

 celTary when they are particularly hard. The operation is 

 to be done with a fpoon, or fuitable forceps, properly oiled ; 

 and, after the concretion has been removed, an emollient 

 clyiler is to be adminillered, in order to allay any irritation 

 which may have been caufed by the introduttion of the 

 requifite initruments. When the fphinfter ani contrafts fo 

 forcibly, that the operation is attended with extreme pain 

 and difficulty, we are advifed by furgical writers to make a 

 dilatation of the anus, by praclifing an incifion at its pofte- 

 rior angle. A wound made in this direction cannot do 

 injury to any part of confequence, whilft there would be a 

 rifl< of wounding the urethra in the male, or the vagina in 

 the female fubjcft, if the cut were made at the anterior 

 angle. An incifion, carried laterally, would be apt to in- 

 jure the pudic veflels. A divifion of the fibres of the 

 fphintler ani does not produce any material permanent 

 vveaknefs of its action, and a paralyfis of this mufcle, ac- 

 cording to Richerand, can never proceed from fuch a caufc. 

 Nofographie Chirurgicale, tom. iii. p. 414. edit. 2. 



The hard concretions which lodge in the reftum cannot 

 be reached witli the finger when they are fituated high, 

 and, in this circumftance, the furgeon mull ufe a probe, or 

 found, in order to allure himfelf pofitively of their prefencc, 

 their moveablenefs, and their fize. 



With regard to foreign bodies lodged in this intelline, 

 fome have been fvvallowcd, and have palled through the 

 whole extent of the alimentary canal ; while others have 

 been pulhed up the anus to a greater or lefler height. 

 The extraftion of thefe lalt is generally attended with a 

 great deal of difficulty, and even demands on the part of 

 the operator more than ordinary fagacity, in confequence 

 of the various Ihapcs, the hardnefs, and the fragility of 

 thefe different bodies. GUfs phials, inftrument cafes, (but- 

 tles, &c. have been introduced into the reftum by maniacs. 

 One perfon of this defcription put into his redlum a flint- 

 ftone, which did not admit either of being extrafted, or 

 broken, owing to its hardnefs, and flippery furface, and 

 which in the end caufed the patient to die in the greatell 

 agony, with fwelling and gangrenous mifchief in the abdo- 

 men. Marchetti has recorded an inltance, in which a pig's 

 tail, hardened by cold, was forcibly thruft up the reftum 

 of a girl of the town. This extraneous body could not 

 be withdrawn, as the fhort bridles, which all inchned out- 

 ward, immediately came into contaft with and pierced the 

 inner part of the bowel. It remained in the part fix 

 days, and occafioned a train of alarming fymptoms, fuch as 

 fever, vomiting, fwelling of the abdomen, and obftinate 

 conftipation. Marchetti faftened a ligature to the end of 

 tiie foreign body, which protruded at the anus, and then 

 palled the ligature through a long piece of reed, which he 

 introduced up the reftum, in order that tlie foreign body 

 might be drawn through this lube without the intelline 

 being lacerated. The experiment was completely fuccefs- 

 ful. Obf. Med. Chir. p. 126. 



In another example a piece of wood, three inches long, 

 and two in width, was introduced into the reftum. Colic, 

 lenfion of the abdomen, fever, conftipation, and difficulty 

 of making water, came on, and lafted fix days. The im- 

 poffibility of removing the extraneous fubftance with a 



pair of forceps, led to the idea of ufing a borer, which, 

 having been palled up the rettum under the guidance or the 

 linger, was inferted deeply enough into the piece ot wood 

 to draw it out. The txtradtion, however, could not be 

 clfofted without a great deal ot pain. Sec Melangei. de 

 Chirurgie, par M. Saucerotte, p. 484. Memoircs del' Aca- 

 demic de Chirurgie, tom. v. p. 605. l^aft'us, Tathologie 

 Chirurgicale, tom, ii. p. 569, edit. 2. 



Reciu.m, Congenital and Syphililic Contra3'tons of its in- 

 ferior Portion. A contraction of the lower end of the 

 reftum is fometimes an original malformation ; but more 

 frequently it arifes from what has been confidered by various 

 furgical authors to be a venereal thickening ol the parietes 

 of this intelline. If this be really a fyphilitic difordcr, a 

 circumftance which is to be doubted, it is certainly as 

 grievous as any of the more common effccls ot the venereal 

 difeafe. Excrefcences grow from the mucous membrane at 

 the reftum, and difcharge a purulent matter, which is con- 

 tinually oozing from the anus. When a finger is palled 

 within this aperture, the irregularities occafioned by the 

 tumour may be plainly felt. Such wriiers as believe in tlie 

 fyphilitic nature of this complaint inform us, that the truth 

 of this may be known by the antecedent and co-exillent 

 fymptoms of the venereal difeafe. They admit, however, 

 that the diforder almoft always lafts after the cure of every 

 other mark of fyphihs, and they caution us not to perfiit 

 ralhly in adminillering mercury any longer for a difeafe 

 which cannot be further benefited by it. Thefe circum- 

 llances are quite fuffitient to prove that there is not much 

 reafon for the doftrine, that this fort of contraftion of the 

 lower end of the reftum is venereal. 



Such writers as confider the complaint te be connefted 

 with fyphilis, of courfe recommend the exhibition of mer- 

 cury, and they further advife the frequent injeftion into th; 

 reftum of a weak folution of the oxymuriate of the fam.e 

 mineral. Tents, fmeared with mercurial ointment, are alfo 

 recommended to be paffed into the bowel. The latter ap- 

 plications are ftated to have the advantage; ill, of op- 

 pofing, by mechanical pred'ure, the further increafe of the 

 excrefcences ; 2dly, of dilating the contrafted part ; and, 

 jdly, of afting on the difeafe by their medicinal quality. 



For our own part, we much doubt the reality of the 

 venereal Hature of the foregoing complaint. The language 

 of the advocates for fuch a doftrine mult raife fufpicions, 

 that they are influenced in their judgment more by pre- 

 judice than reafon. " The venereal affeftion of the coats 

 of the reftum (fays one of thefe writers) almoft always lafts 

 after the total extinftion of the fyphilitic virus. Then, we 

 ought to be content with the employment of dilating me- 

 chanical means, without perfilliiig in the ufe of medicines, 

 which would ferve only to ruin the patient's conftitution. 

 An elaftic gum cannula is to be preferred, and it Ihould be 

 of a conical Ihape, in order that it may be gradually intro- 

 duced further and further, in proportion as the dilatation 

 of the bowel is effefted." Richerand, Nofographie Chirurg. 

 tom. iii, p. 418, edit. 2. 



In cafes of congenital contraftion of the reftum, the 

 only plan which can be adopted, is that of making an in- 

 cifion through the pofterior part of the inteftine. 



Rectum, Polypi of. Sometimes, though not often, 

 polypi grow from the mucous membrane of the reftum, 

 and by tneir fize obftruft the paflage of thofcfeces. Their 

 exillence is at firil manifefted by an uneal'y fenfe of heavi- 

 nefs, and afterwards they are protruded outwardly in the 

 efforts which the patient makes at llool. The anus contraft- 

 ing after their expulfion, their roots become llrangulated, fo 

 that they cannot return, and exceffive agony is produced. 

 5 I" 



