152 
PATHOLOG Y. 
longer than ufual, and paffing round on the infide of the 
jejunum like a broad ring. The canal of the gut was ne- 
celfarily much narrowed at this ring ; but no mifchief 
had arifen from it. This malformation, however, might 
have laid the foundation for future mifchief; fome fub- 
llance too large to pafs might have refted on the ring, and 
produced inflammation, ulceration, and untimely death.” 
And, in a cafe publifhed by Dr. Combe, in the fourth 
volume of the Tranfaftions of the College of Phyficians 
of London, where there was an uncommon pulfation in 
the aorta, dilfeftion difcovered the lower part of the 
ilium, as far as the colon, contracted for the fpace of three 
feet, to the flze of a turkey-quill; the aorta was in a per¬ 
fectly healthy ftate. 
The fymptonis indicating the prefence of ftrifture in 
the reCtum, as chiefly copied from the accurate work of 
Mr. W. White, are, habitual coftivenefs ; occaflonal un- 
eafinefs, arifing from a fenfe of fulnefs in the courfe of 
the tranfverle arch of the colon, but more efpecially to¬ 
wards the termination of its figmoid flexure, chiefly occa* 
fioned from wind meeting with fome obftruCtion down¬ 
wards. The patient is often fenfible of theaggravation of 
this fymptom from a variation in the quality or quantity 
of his food. Sometimes the fulnefs may be felt externally, 
in the courfe of the figmoid flexure of the colon. Al¬ 
though this fymptom frequently happens to be the firlt 
to arreft the patient’s attention, and continues fome time 
before any particular local inconvenience is experienced 
from the palling of the feces, yet this by no means inva¬ 
riably occurs. Befides the fenfe of fulnefs juft noticed, 
other fenfations are often excited in the courfe of the 
colon ; viz. acute pain, a fenfe of p re flu re when the feces 
accumulate above the It rift ure ; violent fpafmodic con¬ 
tractions in different parts of the inteftine, which ufually 
happen after the colon has been exerted by expelling the 
feces. Sometimes the patient feels as if tightly girded 
with a cord. It may be proper to notice, that thefe dif¬ 
ferent fenfations are in general aggravated, in proportion 
as the ftrifture is feated high up in the reftum. Sooner 
or later the patient experiences an uneafinefs on going to 
ftool, attended with difficulty in voiding the feces. As 
the diforder advances, thealvine excretions become gra¬ 
dually more fcanty, the feces are ejefted fometimes flat, 
at others of a triangular form. They are fmaller than 
natural; and are often difcharged with a fquirt, fome¬ 
times accompanied by a l'udden and loud explofion of 
Wind. 
The fame phenomena are thus concifely defcribed by 
Dr. R. White in the fourth volume of the Memoirs of the 
London Medical Society. “ When a perfon fomewhat 
advanced in life is troubled with frequent conftipation, 
complains of fulnels and weight in thertomach, with re¬ 
peated inclination to difcharge the contents, and uneafy 
rumbling in the belly, and diftention in the lower part of 
it, with a fenfation of numbnefs toward the upper part 
of the facrum, extending down the reftum; repeated 
fruitlefs efforts being alfo made to pafs a ftool, attended 
with a fenfe of conltriftion and tenefinus high up in the 
reftum, and flatus, which feemed to the patient to oc¬ 
cupy the intermediate fpace, burfts forth; clyfters failing 
as well as medicines, and the complaint unattended with 
fever or pain ;—it will be reafonable to expeft fome me¬ 
chanical ©bftruftion in the paffage.” 
After an evacuation, a fenfation commonly continues 
for fome time, as if the w'hole of the feces had not been 
expelled. This by degrees goes off, and the patient feels 
himfelf tolerably eafy until the next time of going to 
ftool, when a fimilar fenfation recurs. 
With regard to the leffened diameter of the feces juft 
noticed, which mult neceffarily be the cafe whenever a 
permanently-contrafted ftate of the gut takes place, there 
are fome exceptions. If the ftrifture indeed fliould hap¬ 
pen to be fo low in the reftum as not to allow room for 
the accumulation of feces, it muft appear evident that 
they will be found uniform in diameter, in proportion to 
the degree of ftrifture, while they continue to be dif-' 
charged in a figured ftate. And alfo, when the ftrifture 
is high up in the reftum, fo long as the gut below re¬ 
tains its natural expulfive power, an accumulation will be 
prevented, and the diminifhed fize of the feces will con¬ 
tinue. But, as the diforder increafes, the inferior por¬ 
tion of the inteftine gradually lofes that power;'and, 
when the contraftion becomes confiderable, a fmall quan¬ 
tity of feces only paffes at a time through the ftrifture, 
and, not being fufficient to ftimulate the lower part of 
the reftum, (which in a great rneafure is deprived of its 
natural aftion,) an accumulation goes on from time to 
time, until at length it becomes difficult to remove ; and, 
on thofe occalions, feces of a natural fize have been 
fometimes difcharged. 
Pain of the back, about the facrum, is a very common 
attendant on ftrifture in the reftum, and fometimes a 
primary lymptom; the pain frequently (hooting down 
the thighs, and in fotne inftances to the foies of the feet. 
Haemorrhage is alfo a frequent occurrence, as well as a 
mucous difcharge. Mr. White alfo has found pain in 
the back part of the head a ufual lymptom of this 
difeafe. 
When the foregoing fymptoms lead us to fufpeft the 
prefence of ftrifture, manual examination inuft be had 
recourl'e to. Indeed the matter can only be determined 
by this method. “This ought to be performed in the 
nioft careful and attentive manner, feeing there is a pof- 
fibiliry of miftaking the complaint either for a difeafed 
proftate gland, or fora fcirrhous uterus, efpecially if the 
hardnefs is attached to the cervix uteri, or back part of 
the v3gina. In profecuting the examination, the firlt 
ftepto be taken (after the bowels have been emptied) is 
to introduce the finger (oiled) as high up the reftum as 
poffible, at the fame time defiring the patient to bear' 
down, as if going to ftool. For, if the examination is 
firft made by introducing a bougie, it may happen that 
the inftrument is pu(hed between the folds of the intef¬ 
tine, particularly if there (hould be particular laxity of 
its internal membrane; and the practitioner may be led 
to fuppofe there is a ftrifture, when in reality none ex- 
ifts. If, however, on introducing the finger, neither 
ftrifture nor induration can be difcovered in the reftum, 
a bougie, ten or twelve inches in length and pretty thick, 
muft be introduced, and paffed as high as the termination 
of the colon; which will ealily be done, if ftrifture is 
not likewife prefent at the lower part of the reftum. 
This complaint is liable to be confounded with diar¬ 
rhoea, dyfentery, piles, indeed with almoft every chronic 
cli(eafe of the inteftines, and, above all, with fcirrhus 
uteri, and fcirrhus of the reftum. So much difficulty, 
indeed, occurs in refpeft to the former, that Dr. White 
fays, “ Symptoms of the contracted reftum in the female 
are fo fimilar to that of a lcirrhous uterus, that I do not 
know any mark whereby the one difeafe can be diftin- 
guiftied from the other, excepting that in the latter the 
urinary biadder is more liable to be atfefted than in the 
former; though fometimes pain and difficulty in difcharg- 
ing the urine attend that alfo.” 
In diftinguilhing this cafe from Proftica callofa, or 
fcirrhus of the reftum, we fliould notice, that, in Am¬ 
ple ftrifture, pain is only experienced on going to ftool; 
while, in a fcirrhous ftate of the reftum, the fufferings 
are not only greater at thefe times, but there is alfo, at 
other times, great pain about the facrum, often (hooting 
down the thighs, as well as a fenle of burning heat and 
pain in the reftum. In this laft deplorable difeafe, efpe¬ 
cially in its advanced ftages, the feces palled are gene¬ 
rally in a liquid ftate, fo that the difeafe may be con¬ 
founded with a chronic dyfenteric complaint. In ftric- 
tures of the reftum, there is little emaciation or lofs of' 
ftrength until the diforder is far advanced; the counte¬ 
nance then becomes fallow; and, in fome inftances, the 
pulfe is quick, with other heftic fymptoms. Moreover, 
as we before remarked, the Ample ftrifture is higher up 
than 
