pressing upon it, but as it increases in quantity it gives rise to severe and distressing symptoms; there will be violent spasm attended with great pain; there will also be a constant desire to go to stool, although the bowels are free from fæcal accumulation. In other cases there will be no local symptoms of the existing mischief, and the constitutional ones may be obscure and perplexing. Sir Benjamin Brodie* mentions the case of a gentleman he attended, in whom an abscess formed by the side of the rectum, and who was not conscious of any local symptoms. He had been for some time subject to headache and languor, and was obliged to go home and lie down during the day. The first notion he had of the existence of the purulent collection was its bursting one day while he was walking. As mentioned, the pus in these abscesses is not of a healthy character; it is, for the most part, of a dark colour, and frequently excessively fetid: the latter circumstance may be owing to its contamination with fæces entering by a small aperture in the intestine, though I suspect it more frequently depends on the transudation of gases or fluids; indeed, the stench is often much more fetid and offensive than any unlimited quantity of feculent matter. In a case I operated on in 1853, the fœtor was intolerable, and *Medical Gazette,' vol. xvi., p. 26. a free use of the chloride of lime was necessary in the ward of the infirmary where the patient was; and I remember a similar case, some years since, at University College Hospital: in neither could any connection with the bowel be detected, and they both healed without forming fistula, or requiring anything more than keeping the incision from closing till the cavity had filled from the bottom. Gangrenous abscess usually occurs in those whose constitutions have been impaired by luxurious living, or by debauchery and excesses. The symptoms commence with rigours attended with fever: the pulse at first is full and hard, the tongue is coated, the skin dry and hot, there is great thirst, loss of appetite, and general restlessness; but the character of the symptoms soon changes, the fever becomes of the adynamic type, the pulse is then weak, quick, and irregular, the countenance flushed, the tongue becomes brown and dry in the centre, and the edges red and glazy, and, in the worst forms, the lips and teeth are covered with sordes. The secretions and excretions are disordered, extreme debility and prostration are present, accompanied with more or less stupor. With the early constitutional symptoms a deep-seated pain near the rectum is complained of, which increases and becomes of a burning character; if the part be examined, hardness will be found, which rapidly extends, and the integument assumes a livid colour. Tenesmus and dysuria are more likely to be present and severer in this than in other forms of abscess which we meet with near the neck of the bladder, except those occurring between the prostate and rectum. Traumatic abscesses occur from violence from without, as from gun-shot wounds, punctures, and contusions; and from within by the entanglement by the sphincter of various foreign bodies which either pierce the intestine or produce perforating ulceration. Abscess from the first cause is seldom seen except in the practice of military surgery. M. Ribes mentions the case of an officer who received a musket-ball in the right buttock, which passed into the rectum, fracturing the tuber ischii in its course; the external wound healed in about six weeks, when an abscess formed in the right side of the perineum this was opened, and a fragment of bone and some pieces of cloth were extracted. Bushe had a soldier under his care who was wounded in India, the ball passing into the rectum; the opening into the intestine healed, but the external one remained fistulous till two pieces of cloth were removed, several months after receipt of the injury. Numerous interesting cases of traumatic abscess, * 'Mémoires de la Société Médicale d'Emulation,' tome ix. † Op. cit., p. 235. occurring from the entanglement of foreign substances within the rectum, are on record, among them the following. Le Dran relates a case, which occurred to M. Destendau, of a man who for nine months laboured under fistula caused by the lodgment of a piece of bone.* Petit extracted a needle, which for six months had occasioned excruciating pain during defecation. In another case he removed a small triangular bone which had been the cause of great pain for several months. In a third case there was extensive mortification around the anus, from the lodgment, of ten days' duration, of a chicken-bone. In a fourth case he opened an abscess which contained shot and feculent matter. Shearman relates a case of a fish-bone being swallowed and discharged twelve months afterwards from an abscess by the side of the anus. Harrison§ describes a case of an abscess resulting from an apple-core, swallowed eight months previously. Sir B. Brodie || relates the following: "I was sent for to a gentleman with a very large abscess formed by the side of the gut. He suffered * 'Observations de Chirurgie,' tome ii, observation lxxxvi., p. 222, Paris, 1731. Traités des Maladies Chirurgicales,' Ouvrage posthume de J. L. Petit, tome ii. 6 § Memoirs of the Medical Society of London, vol. v., 1796. Medical Gazette,' vol. xvii., p. 27. a great deal of local pain; had a very frequent pulse, brown dry tongue, very hot skin, and typhoid symptoms. I opened the abscess, and let out a quantity of putrid offensive matter, which sufficiently explained the typhoid symptoms under which the patient laboured. And after I had opened the abscess, I introduced my finger into the cavity, and sticking across it I found a long fish-bone, which I extracted. The fish-bone had evidently penetrated through the mucous membrane of the bowel, and in all probability some small portion of feculent matter had passed by the side of the fish-bone, thus accounting for the remarkable putridity of the matter." Mr. Green tells of a case in which the pelvis of a snipe was removed from a large abscess. A case was mentioned at a meeting of the Pathological Society of London, in December, 1856, of a lady who had an abscess in the ischio-rectal fossa, which was opened; and Mr. South, on making an examination, found that it had been produced by a fish-bone having perforated the coats of the rectum: the bone was nearly two inches in length, and about half of it was projecting into the cavity of the abscess. The symptoms and consecutive consequences of abscess in this region are greatly increased in severity by the implication of the integrity of the intestine : much, however, will depend upon the habits and R |