78 



Dr. W. It. Gowers on the Automatic [Mar. 15, 



and the cord. Other observations were made on two patients with para- 

 plegia, due probably to disease of the dorsal region of the spinal cord, in 

 whom there was reason to believe that the lumbar enlargement of the 

 cord was free from material damage. In each case there was not the 

 slightest voluntary power to retain the contents of the rectum. It was 

 found that in each the condition of the sphincter was essentially the same, 

 and that it was in a state of high reflex activity. The most uniform 

 results were obtained in the case of injury to the sacral nerves. Finally 

 these results were compared with those obtained by the same method 

 when voluntary power was intact. 



The instrument employed was a small cylinder of thin india-rubber, 

 supported at each end on a wooden plug, the anterior extremity of which 

 was conical, to facilitate its introduction. The chamber within commu- 

 nicated by means of a flexible tube with the cavity of a tympanum pro- 

 vided with a writing lever, by which the variations in the pressure were 

 recorded on a revolving drum (Marey^s cardiograph). A small metal 

 tube passed through the middle of the cylinder, by which air could be 

 injected into the rectum without disturbing the instrument. A smaller 

 instrument, the rubber cylinder of which was only one inch in length, 

 was used to ascertain the effect produced by different portions of the 

 lower end of the bowel. 



The first fact ascertained was that in each case, although the incon- 

 tinence of faeces was complete, the sphincter was habitually in a state of 

 continuous, slightly varying contraction. That this tonic state was not 

 due to the presence of the instrument within the anus is shown from 

 the fact that it existed before the introduction of the instrument, and 

 that any irritation of the anus, as by movement of the instrument, pro- 

 duced a well-defined effect of a different character. The same tonic con- 

 traction is shown in every tracing obtained. After a disturbance caused 

 by the introduction of the instrument was over, the pressure continued 

 nearly the same throughout, being marked only by a few very slight and 

 irregular variations. 



This continuous contraction was, however, inhibited by any irritation 

 applied to the mucous membrane of the rectum. Such an irritation was 

 readily effected by the injection of a small quantity of air into the rectum. 

 The result of such an injection is shown in the tracing (fig. 1). A rapid 

 fall in pressure occurred (a), due to the relaxation of the sphincter, which 

 was in some cases so complete that the instrument fell out. After a brief 

 period of complete relaxation, contraction occurred, at first slight, and 

 then slowly increasing, indicated by the rise of the lever (6), until the ori- 

 ginal pressure was attained. In most cases the rise was to a higher point 

 than the original pressure, and a subsequent slight fall occurred until the 

 initial pressure was reached. 



When the irritation was produced by a solid body, a slight brief in- 

 crease in the contraction preceded the relaxation of the sphincter. This 



