PATHOLOGY. 
a found capacious portion of the bowel between the 
ftriClure and this fp hinder, though in the advanced 
ftages of the difeafe even this often becomes indurated. 
Indeed the fcirrhus fometimes occupies nearly the whole 
cavity of the reCtum ; implicates in thickening and in¬ 
duration all its coats, particularly the mufcular; and, 
after a time, abrafion or ulceration of its internal mem¬ 
brane takes place, attended by a ferous, or thin and fa¬ 
mous, difcharge. The fevere fufferings of the patient 
during the progrefs of this dreadful malady, and its more 
rapid advance to a fatal termination, will help to diftin- 
guilh it from other fpecies of contraction, when it would 
be difficult fometimes to decide from mere local invefti- 
gation. 
In addition to thefe remarks, and the diagnoftic figns 
we have drawn between this difeafe and Ample ftriCture, 
when fpeaking of the latter difeafe, we copy, from Mr. 
White and Dr. Sherwin the following remarks. Along 
with the great and permanent pain about the facrutn, 
/hooting down the thighs as before noticed, the burning 
heat and pain of the reCtum, “ the patient gradually ex¬ 
periences a difficulty in evacuating faeces of a thick con¬ 
fluence. As the paffage becomes obftruCied, the faeces 
acquire a thinner confidence, and the firlt complaint 
which he makes is of a loofenefs.” On this paragraph of 
Dr. Sherwin, Mr. White remarks, that, “although it 
may be very true, that the diforder fometimes arrives at 
the above-mentioned flage before any application is made 
for relief, yet it does not follow from thence, that a 
diarrhoea is a primary fymptom ; becaufe the hiftory of 
cafes clearly demon/trates that the complaint in general 
does exift for a confiderable length of time before a diar¬ 
rhoea comes on; and I believe it will be commonly 
found in a very advanced ftage, whenever fpontaneous 
diarrhoea takes place.” 
Dr. Sherwin further remarks, “He (the patient) con¬ 
tinues in other refpeCts apparently in good health ; his 
appetite is but little impaired ; reiterated fcanty evacua¬ 
tions, amounting in the whole to a fufficient quantity to 
keep the ftomach eafy, preferve a fort of balance in the 
intellinal canal : but, by degrees, the cavity of the gut 
becomes lefs permeable; opiates and teftaceous powders 
have perhaps been had recourfe to, and the frequent need¬ 
ing to ftool abates. The patient and his friends flatter 
themfelves he is getting well; but he foon falls off in his 
appetite for food. The abfence of ftools is fometimes 
attributed to this caufe, till the-lower part of the abdo¬ 
men by degrees acquires a remarkable prominence, at¬ 
tended with uncommon rumbling of wind in the belly, 
like gurgling of water in a bottle. By degrees a total 
fuppreffion of ftools takes place ; the tumour of the ab¬ 
domen increafes; the uncommon rumbling of wind be¬ 
comes more audible, fo as to engage the attention of the 
friends and vilitants of the patient. The diftention gra¬ 
dually increafes, till the ftomach is opprefled, and a vo¬ 
miting comes on. The vomitingis not very frequent at 
firft ; but, by degrees, every thing fwallowed is vomited 
up. Severe pains are felt from diftention in various parts 
of the abdomen ; and a true iliac paffion of the chronic 
kind comes on, and continues as long as the patient 
lives, unlefs he is accidentally relieved by a free dif¬ 
charge of thin faeces, which will fometimes unfufpefledly 
give a refpite to his fufferin'gs. In confequence of which, 
the appetite for food will again return ; the patient will 
again appear to be getting well: but the anxious foli- 
citude of his friends at this period will urge him to get 
down a confiderable quantity of generous nouri/hment, 
till a repetition of the fame fcene takes place, and the 
unhappy man is alternately tantalized and worn out, 
either with a ftoppage or a purging. 
“ If affiftance is not called in till the patient arrives at 
this deplorable ftate of the difeafe, the want of ftools, 
the great pain, vomiting, and tenfenefs of the abdomen, 
may be pronounced an inflammation of the bowels, or 
an iliac paffion of the acute kind. If powerful means are 
Vol. XIX. No. 1295. 
167 
employed under fuch idea, it is eafy to conceive that the 
laft moments of the patient muft be rendered doubly dif- 
treffing.” 
The conftant inclination to ftool which attends this 
diforder may be diftinguilhed from a. common tenefmus 
by attending to the followingcircurriftances. A common 
tenefmus is generally fudden in its attack, or elfe it fol¬ 
lows from purging or dyfentery ; it is often the confe¬ 
quence of draltic cathartics, and is always attended with 
confiderable pain, and moft frequently with a-mucous 
difcharge tinged with blood, inftead of feces; whereas, 
that which accompanies the fcirrhous reCtum is attended 
with little or no pain, but with powerful ineffectual 
/trainings; during which, there will be often a difcharge 
of wind ; and the mucus fqueezed out is flimy, but al¬ 
ways more or lefs black, and the excrementitious matter 
is very feldotn tinged with blood. In the common te¬ 
nefmus, the impetus feems entirely fpent on the fphinc- 
ter ani, and there is more or lefs of a protrufion of the 
gut: but in the /training from a fcirrhous reCtum, the 
patient is not fenfible of that diftrefs at the fundament 
which is experienced in the other; and, as foon as the 
fmall portion of excrementitious mucus is voided, he is 
able to rife immediately from the ftool ; but in the com¬ 
mon tenefmus he is under the neceffity of /training long, 
even after the expulfion of all that he knows, from his 
feelings, will at that effort be evacuated ; and, after he 
is able to rife from the ftool, there /till continues a burn¬ 
ing fenfation, urging in a continual expulfion : where¬ 
as in the fcirrhous reCtum, after the patient has /trained 
hard, whenever a fmall quantity arrives at the anus, it 
is fquirted out with flight efforts, and little or no un- 
eafinefs follows ; nor does the countenance /how that ex¬ 
treme diftrefs which generally attends a fpafmodic ftric- 
ture of a common tenefmus. It may alfo be obferved, 
that there is very little emaciation of the body or lofs of 
ftrength until the diforder is far advanced; the counte¬ 
nance then becomes fallow, and in forne inltances the 
pulfe is quick, and is accompanied by heCtic fymptoms. 
The following defcription of the appearances on dif- 
feCtion are detailed by Df. Baillie : “It (the fcirrhus) 
fometimes extends over a confiderable length of the gut, 
viz. feveral inches; but generally it is more circumfcribed. 
The peritoneal, mufcular, and internal, coats, are much 
thicker and harder than in a natural ftate. The mufcular 
too is fubdivided by membranous fepta, and the internal 
coat is fometimes formed into hard irregular folds. It 
often happens that the furface of the inner membrane is 
ulcerated, producing cancer. Every veftige of the na¬ 
tural ftrudure is occafionally loft, and the gut appears 
changed into a griftly fubftance.” 
In the advanced ftage of contracted reCtum, an abfcefs 
often forms near the anus, and common fi/lula is pro¬ 
duced on the abfcefs burfting, which renders it liable to 
be miftaken for the original complaint. If operation for 
fiftula be performed under thefe unfavourable circuin- 
ltances, it aggravates the fufferings of the patient. Some¬ 
times it happens in the female fubjeCt, that, in confe¬ 
quence of an abfcefs. forming, or the inteftine becoming 
ulcerated, a communication is formed between the rec¬ 
tum and the vagina, and the liquid part of the feces pafs 
through the aperture, and are difcharged by the vagina. 
The prognofis of this dreadful difeafe, which Dr. Sher¬ 
win wrote 30 years ago, ftill remains too true: he fays, 
“ The difeafe comes on in the moft gradual and imper¬ 
ceptible manner : flow in its progrefs, but terrible in its 
confequences; it yields not to medical a/fiftance, bu.t 
muft under the belt management become ultimately fatal. 
It however admits of palliation ; and, if early difcovered, 
will alfo admit of the laft moments of the patient being 
refcued from unavailing, miftaken, and diftrefling, at¬ 
tempts to cure. It is therefore an objeCt of the moft fe- 
rious attention of the humane practitioner.” 
Attempts at cure have not, however, been wanting. 
M. Delpech, in his Precis Elementaire, tom. iii. has 
X x propofed - 
