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'0. Imperforate rectum ; an incision more than two
inches in depth necessary before the intestine
In the whole range of surgical pathology, no class of diseases among civilized communities is so prevalent, causes more suffering, or 'induces so many varied and distressing sympathetic affections as those of the rectum ; happily for the sufferers none succumb more readily to judicious, and, in the majority of cases, to simple treatment, when it is put in force at an early period of the malady; but unfortunately it often happens, from a mistaken delicacy on the part of patients, or from some other cause, proper advice is not sought till the constitution has become seriously deranged, or the local affection no longer endurable; or it may be that, under preconceived and erroneous notions as to the nature of the affection, or from the prominence and severity of some one of the sympathetic effects, the sufferers
are induced to adopt a variety of empirical remedies which fail to afford the desired relief and restoration of health, and which are often productive of the most pernicious results.
From the important functions of the rectum, from the constant or recurrent pain attending diseases affecting it, induced each time the bowels evacuate their contents, and the serious constitutional disturbance these diseases excite, they require the careful attention and deep consideration of the surgeon. In past ages and in the present time a popular idea has prevailed that a deeper knowledge of, and a more intimate acquaintance with, the diseases of any certain organ is obtained by an exclusive consideration of that particular part; but no greater fallacy can be conceived, it being only by a comprehensive view, and after due consideration of all the symptoms produced, and the various phases presented by disordered function and organic change in the various parts of the animal economy, that a just conclusion as to the fons et origo mali can be arrived at. Perhaps few classes of disease exemplify the necessity of a wide and mature .consideration more than those implicating the rectum, either primarily or secondarily; for the same symptoms will often be found existing under the opposite conditions of cause and effect. Thus, in the female, many instances have occurred of stricture of the rectum being supposed to exist, and a long and useless treatment had recourse to, when ultimately all the patient's sufferings were found to depend on a displaced uterus, or on some morbid enlargement or growth of that organ ; and the converse is not unfrequently the case, of a. patient being treated for leucorrhea or uterine disease, whilst the real source of the symptoms has been in some affection of the rectum. In the male also will be observed stricture of the urethra, diseases of the prostate gland and bladder simulating those of the rectum; or, on the other hand, diseases of this portion of the alimentary canal producing irritability and other disturbance of the genitourinary organs. Nor is it in contiguous parts alone that the reaction of one organ on the other is met with; it is necessary therefore to bear in mind the more remote sympathies induced in the cephalic, thoracic, and abdominal viscera, as evinced by headache, vertigo, impaired vision, palpitation of the heart, gastric distension, pain, and sickness; and deranged secretion from the kidneys, as exhibited by the various urinary deposits.