153 
PATHOLOGY. 
than the fcirrhus, and not generally of fo hard and un¬ 
yielding a ftruCture. The cleared: diagnofis is derived, 
however, from the introduction of a canula, as recom¬ 
mended by Mr. Coley of Bridgnorth, in a paper read to 
the Medico-Chirurgical Society. This gentleman having 
a patient under his care, whom he was unable to afford 
relief to by a common bougie, fince that inftrument 
invariably bent upon itfelf, had recourfe to a tin canula, 
for the purpofe of giving fupport to the yielding bougie. 
The experiment fucceeded ; and, having occalion fome 
time after to increafe the diameter of his canula, Mr. 
Coley found that, by holding a lighted candle at the 
end of it, he could readily diftinguifh the contracted part 
of the inteftine. 
In the treatment of this affeCtion, the principal part 
conlifts in removing the caufes of irritation by diet of 
the lead irritating kind, as jellies, fago, &c. and evacua¬ 
ting the bowels daily by clyders of warm u’ater. When 
injections cannot be thrown up in the ordinary way, 
from the contracted date of the pafl'age, a large hollow 
bougie may be fadened (indead of a common pipe) to a 
bladder, by which means they may be conveyed beyond 
the obltruCtion. 
Nervous irritation may belefl’ened byconium, hyofcia- 
raus, &c. and the combination of the blue pill with them 
is generally required to promote the biliary difcharge, 
which is of courfemuch deranged in cafes of long ftand- 
ing. If purgatives are given by the mouth, none of this 
clafs fhould luperfede cador oil. It is fcarcely neceflary to 
add, that aloetic cathartics tend to increafe the complaint. 
In refpeCI to the regulation of the alvine excretions it 
is proper to remark, that attention to this part is not only 
neceflary in the camdipated date of the bowels, attendant 
on the early dage of the difeafe, but alfo in its more ad¬ 
vanced progrefs, when diarrhoea has fupervened, becaufe 
the evacuations are feldorn in fuflicient quantity to re¬ 
lieve the bowels, without the aid of laxatives. 
The local application of the bougie is the next thing 
to beconfidered. This will often produce much irrita¬ 
tion and aggravation, unlefs nervous excitement be re¬ 
moved by emptying the bowels and regulating the diet 
previous to its ufe. Before employing this indrument, 
we diould be well allured that fcirrhus is not prefent, as 
it uniformly aggravates that difeafe. The bougie fhould 
be, at fil'd, of fuch a fize as to pafs the driCture without 
conliderable refidance, led irritation and inflammation 
be excited. The fize diould alfo be increafed very gra¬ 
dually till the parts become accudoined to the flimulus. 
There being always more or lefs of fpafmodic aCtion ex¬ 
cited by the bougie, it fhould be introduced flowly and 
gently, waiting a little when it touches the driCture, be¬ 
fore it is puflied through. At fird it diould not remain 
longer than half an hour in the reCtum ; if there be 
much irritation, not fo long. By degrees it may be al¬ 
lowed to remain eight or ten hours at a time, with little 
or no inconvenience to the patient. In general, it may 
be pafied daily. From four or five to eight or ten weeks 
will elapfe before the flriflure admits a full-fized bougie; 
even then, the indrument mud be gradually left ofl’. It 
is found that the natural aCfion of the bow'els is gene¬ 
rally much improved by the application of the bougie. 
As auxiliaries we may mention the hip-bath, and injec¬ 
tions with extraCt of poppy. The former may be ufed 
for a few minutes before employing the bougie ; and the 
anodyne injection after the bougie contributes to leflen 
the morbid irritability of the part. With refpeCI to the 
kind of bougie, we fhould prefer that ufed by Mr. Coley, 
though perhaps, this is not a matter of the fird importance. 
Mr. Coley’s bougies are compofed of lint rolled up, tied 
•at the lower end with dring, which forms a loop about 
three inches long, for the purpofe of being fecured to a 
T bandage. They are to be immerfed in a compofition of 
lead four parts, and wax one part; and then drawn 
through a wooden frame, having holes of various diame¬ 
ters. Great advantage, our author obferves, will be de¬ 
rived from making the points conical. His manner of 
applying them difl’ers from the common mode in this, 
that they are wholly concealed within the re€tum, as will be 
prefentiy deicribed ; which he confiders a great improve¬ 
ment, as it enables the patient to walk about, or even 
ride on horfeback, during the ufe of them. He advifes 
them to remain in the bowel, if poflible, all night; which, 
he thinks, has the efteCt of promoting the abforption of 
difeafed ftruCture, by long-continued preflure, as well as 
of refilling the tendency to contraft. At the fame time, 
he obferves, that the difcharge of the cerate, produced 
by the heat and moidure of the anus, is avoided; the 
cerate not being melted by any portion of the inteftine above 
the J'phinSter. 
Mr. White mentions a variety of this difeafe, which 
arifes in confequence of venereal infeCtion. “When the 
diforder proceeds fronrthis caufe, it generally commences 
with an appearance either of ulceration, or excrefcence 
about the verge of the anus. The fphinCter ani becomes 
gradually contracted ; and, the difeafe extending up¬ 
wards within the reCtum, a conliderable tlrickening and 
induration of the coats of the intefline take place, which 
produce great irregularity and contraction in the pafl'age. 
Sometimes there is a continued line of contraction from 
the anus, as far as the finger can reach, then terminating 
in a kind of cartilaginous border, the inner membrane 
having a thickened and condenfed feel. There is often 
a difcharge indicating a difeafed, if not ulcerated, flute 
of the inner membrane above the contracted portion of 
inteftine. All the cafes which I have hitherto met with 
of this nature, have occurred in females, and they have 
uniformly proved incurable, when attended with the 
ftruClural derangement juft deferibed.” 
The reCtum is alfo liable to contraction from tubercles 
fituated immediately above the fphinCter ani, very differ¬ 
ent from the foft bluilh hasmorrhoidal tubercles which 
often furround the anus. Thefe lafl protrude when the 
patient (trains ; and, when returned within the fphinCter, 
no hardnefs can be perceived in the gut. It isthereverfe 
with the other tubercles; they do not come below the 
fphinCter, and they have an indurated feel. 
The fpecies of contraction noticed as the confequence 
of venereal infection, Mr. W. has found exafperated by 
the bougie, even when conjoined with a regular courfe 
of mercury. “ In the tuberculated ftate, however, ari- 
fing from afimilar caufe, (he fays,) the bougie will be found 
of great fervice.” In fcirrhus of the reCtum, the bou¬ 
gie would manifeftly be improper. 
Sometimes ftriCture is attended by prolapfus ani, flefhy 
excrefcences, or luemorrhoidal tubercles, udiich prove 
a hindrance to the ufe of the bougie, and require to be 
previoufly removed by ligature or the knife. But, in 
doing this, he muff be careful not to include any portion 
of the prolapfed inteftine, which fometimes comes down 
with the excrefcence. The prolapfus ani, however, 
which occurs as the confequence of ftriCture in the rec¬ 
tum, is very partial, and unlike the common prolapfus. 
Whilft the whole of the lower portion of the reCtum pro¬ 
trudes from a relaxation of the fphinCter, this only occu¬ 
pies one fide of the anus, forming a pendulous flap. It is 
neceflary to puftithis flap gently up with the fingerbeyond 
the fphinCter, to make way for the bougie to pafs, which 
otherwife would be apt to get entangled in the prolapfed 
portion of tire inteftine. The ufe of the bougie will 
fometimes overcome this impediment; but, if it fhould 
continue after the pafl’age is dilated, and prove trouble- 
fome, the pendulous part may be removed with the knife, 
and the patient freed from future inconvenience. 
With regard to the divifion of the ftriCture, as prac¬ 
ticed by Wifeman and others, there can be no doubt of 
the expediency of the operation in fome inftances, where 
the bougie fails, and the ftriCture is of a cartilaginous 
hardnefs. See the article Surgery. 
Genua 
