PATHOLOGY. 171 
tores ani, and that it then drew after it other portions 
of the inteftinal canal. But they ought to have been 
undeceived by the ftrangulation which generally occurs 
under fuch circumftances, and which not only throws a 
great obftacle in the way of the redudtion of the difplaced 
part, but even fometimes brings on mortification. Be¬ 
tides, the connexions of the redtum with the neighbour¬ 
ing parts, by means of the cellular fubftance which fur- 
rounds it, and the attachment of this inteftine to the 
pofterior furface of the urinary bladder, render the above 
origin of the complaint impoflible. Such an explanation 
could only be admitted with regard to thofe protrufions 
of the redtum which come on in a very flow manner. 
This account could not afford a fatisfadtory explanation 
of certain cafes, in which the everted inteftine prefents 
a very enormous tumour. Fabricius ab Aquapendente 
mentions his having feen tumours occafioned by a pro- 
lapfus of the redtum, which were as long as the fore-arm, 
and as large as the fill. In the Melanges des Curieux de 
la Nature, we find an account of a tumour of this fort, 
which was two feet long, and occurred in a woman from 
parturition. Nor is a more fatisfadtory reafon afligned 
for thefe cafes, by fuppofing that they originate from a 
relaxation of the villous coat of the redtum, and its fe- 
paration from the mufcular one. We are not authorifed 
to imagine that fuch a feparation can take place to a con- 
fiderable extent, nor fo fuddenly as to give ril? to the 
phenomena fometimes remarked in this difeafe. But 
more accurate obfervations have removed all doubt upon 
this fubjedt. In the fourth volume of the Memoires de 
l’Academie de Chirurgie, we read an account of a pre¬ 
tended prolapfus of the redtum, which, after death, was 
difcovered to be an everfion of the ccecum, the greater 
part of the colon being found at the lower end of this 
inteftine, and molt of the redtum at its upper part. This 
everfion began at the diftance of more than eleven inches 
from the anus, Snd^terminated about five or fix fron? this 
opening, the tumour, formed by the difeafe, having been 
reduced fome time before the child’s death. It was im¬ 
poflible to draw back the everted part, in confequence of 
the adhefions which it had contradted. Another diftinc- 
tion has evinced the fame fadt. A child, after fuffering 
very acute pain in the abdomen from receiving a blow, 
had a prolapfus of the inteftine through the anus, about 
fix or feven inches long. This was taken for a prolapfus 
of the redhim. After death, the termination of the 
bowel out of the anus was found to be nothing lefs than 
the ccecum, which had palled through the colon and rec¬ 
tum, to make a protrufion at the anus. 
This difeafe occurs alfo, as an effedt, in obftinate cof- 
tivenefs, ftone in the bladder, labour, and helminthia po- 
dicis. 
In this place we have to detail the meafures to be adop¬ 
ted for the removal of concretions and extraneous bodies 
from the redtum. Thefe concretions may be formed in 
the larger inteftines, and efpecially in the redtum, by the 
mere accumulation and protradted lodgment of the fasces. 
Sometimes, however, thefe mall'es of indurated matter 
include no extraneous fubftance; in other inftances, their 
nucleus is a biliary calculus; but in molt cafes they are 
merely compoledof the fasces in a dry hardened ftate. 
Whatever may be the nature of thefe fubftances, their 
exiftence may be known by the conftipation, complete or 
partial, which they produce; by the fenfe of weight 
which the patient feels about the fundament; of touch¬ 
ing the indurated obftrudting body, by a finger intro¬ 
duced in ano. Oily emollient clyfters, and carminative 
draughts, will ferve for expelling fuch concretions as are 
not of too firm a-confiftence; but the extradtion of them 
is abfolutely neceflary when they are particularly hard. 
The operation is to be done with a fpoon, or l'uitable 
forceps, properly oiled ; and, after the concretion has 
been removed, an emollient clyfter is to be adminiftered, 
in order to allay any irritation which may have been 
Vol. XIX, No. 1295. 
caufed by the introduction of the requifite inftruments. 
When the fphindler ani contracts 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 pradtifing an incifion at its pujlerwr angle: 
a wound made in this diredtion cannot injure any part of 
confequence, whilft there would be a rifk of wounding 
the urethra in the male, or the vagina in the female fub- 
ject, if the cut were made at the anterior angle; and an 
incifion carried laterally would be apt to injure the pudic 
veflels. A divifion of the fibres of the fphindter ani does 
not produce any material permanent weaknefs of its ac¬ 
tion ; and a paralyfis of this mufcle, according to Riche- 
raud, can never proceed from fuch a caufe. 
The hard concretions which lodge in the redtum can¬ 
not be reached with the finger when they are fituated 
high ; and, in this circumftance, the furgeon muft ufe a 
probe, or found, in order to aflTure himfelf pofitively of 
their prefence. 
The extraction of fubftances which madnefs or folly 
have caufed to be introduced into this fituation is often 
attended with a great deal of difficulty, and has even de¬ 
manded, on the part of the operator, more than ordinary 
fagacity, in confequence of the various fhapes, the hard- 
nefs, and the fragility, of thefe different bodies. Glafs 
phials, inftrument-cafes, fhuttles, &c. have been intro¬ 
duced into the redhim by maniacs. One perfon of this 
defcription put into bis redhim a flint-ftone, which did 
not admit either of being extradled or broken, owing to 
its hardnefs and flippery furface, and which in the end 
caufed the patient to die in the greateft agony, with 
fwelling and gangrene in the abdomen. Marchetti lias 
recorded an inftance, in which a pig’s tail, hardened by 
cold, was forcibly tliruft up the redtum of a girl of the 
town. This extraneous body could not be withdrawn, 
as the ftiort briftles, which all inclined outward, immedi¬ 
ately came in contadl with and pierced the inner part of 
the bowel. It remained in the part fix days, and occa¬ 
fioned a train of alarming fymptoms ; fuch as fever, vo¬ 
miting, fwelling of the abdomen, and obftinate conftipa¬ 
tion. Marchetti faftened a ligature to the end of the fo¬ 
reign body, which protruded at the anus, and then pafled 
the ligature through a long piece of reed, which he in¬ 
troduced up the redtum, and drew the pig’s tail through 
this tube without lacerating the inteftine. In another 
cafe, a piece of wood, three inches long and two in width, 
was lodged in the redtum. Colic, tenfion of the abdomen, 
fever, conftipation, and difficulty of making water, came 
on, and lafted fix days. The impoflibility of removing 
the extraneous fubftance with a pair of forceps, led to 
the idea of ufing a borer, which, having been pafled up 
the redtum under the guidance of the finger, was in¬ 
ferred deeply enough into the piece of wood to draw 
it out. 
Order II. Splanchnica, [Gr. appertaining to the vif- 
cera.] Diforders affedting the collatitious Vifcera. 
This Order contains four Genera. 
Genus I. Iderus , [Gr. from the yellow or golden co¬ 
lour.] Yellow Jaundice. Generic charadters—Yellow- 
nefs of the fkin; white faeces; urine faffron-coloured, and 
communicating a faftron dye. The courfe of the bile 
obfti udted. This genus has the following five fpecies. 
1. Idterus cholceus. Specific charadter; the courfe of the 
bile obftrudted from its own vifeidity, or from lofs of con- 
tradlility in the bile-dudts ; general languor ; naufea ; dyf- 
pepfia ; and occalional pain or uneafinefs at the ftomach. 
2. Idterus chololithicus. (I. calculofus, Cullen.) The 
courfe of the bile obftrudted by bilious concretions in 
thedudls; frequent retching occurs in this complaint, 
with acute pain in the hypogaftric region, increafed upon 
eating. 
3. Idterus fpafmodicus. The courfe of the bile ob- 
ftftidted by fpalinodic contradtion of the bile-dudts: the 
Y y difeafe 
