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sequence of the acridness and irritating properties of the excrementitious matter; and there are very few who have not themselves, when suffering from temporary derangement of the digestive organs, experienced, during defecation, the acute scalding and irritation so frequently attending that condition. Another frequent source of irritation is the very general habit, among many individuals, of having recourse improperly and too frequently to powerful and drastic purgatives. Dysentery and diarrhoea, particularly when neglected or improperly treated, will lead to the formation of stricture, and it may also result from the cicatrization of ulcers attending the former disease. Since the last edition of this work I have had two medical men under my care, with stricture resulting from dysentery. One was an army surgeon, who suffered severely while with the army in the Crimea; the other came from the West Indies, where he had long resided. Stricture of the rectum is also caused by a deposit of fat or fibrous tissue exterior to the bowel, but more frequently the coats of the intestine will be found infiltrated with the morbid growth. A case is recorded by Mr. Travers * of an excessive growth of fat external to the tunics of the rectum causing contraction. I have in my possession a specimen of stricture of the rectum, from a * 'Mcdico-Chirurgieal Transactions,' vol. xvii., p. 361.
deposit of fibrous tissue external to its coats: it occurred in a woman, aged fifty-four, who had been ailing for twenty years, and for the last three years had been subject to relaxed bowels, occasionally passing blood. Ten days previous to death she was seized with severe pain in the abdomen, which subsided in a few hours. After this constipation followed, and on the eighth day she took some castor oil; vomiting supervened, with great distension of the abdomen and considerable pain; no evacuation of the bowels was obtained. On the following day she was admitted into a public infirmary. She was much exhausted, and complained of great pain in the abdomen, which was large and tympanitic. The previous history of the case indicating disease of the rectum, an examination was made, and a contraction of the bowel found to exist at three inches from the anus, surrounded by a dense mass of morbid structure. She died the day after her admission from exhaustion. On post-mortem examination, the intestines were found greatly distended. No peritoneal inflammation existed. The rectum was contracted at the part already mentioned, and was surrounded by a large mass, having the appearance of fat, and very dense; but by the aid of the microscope, as well as subjecting the specimen to the action of ether, it was found to be composed of fibrous tissue alone.
The specimen was brought before the Pathological Society,* and is faithfully represented by the engraving.
Injuries by foreign bodies, or from attempts to extract them; lacerations of the mucous membrane, or of the whole thickness of the intestinal walls, also produce stricture: in the latter case it is usually very intractable, as is urethral stricture, the result of laceration by external violence; operations for fistula * Sec ' Pathological Transactions,' vol. vi., p. 201.
in ano, and the extirpation of haemorrhoids, when improperly performed, have given rise to this affection. Authors also mention syphilis, metastasis of cutaneous eruptions, and suppression of discharges that have existed for some time, and have become habitual, as causes of stricture of the rectum. Others are of opinion that there is frequently a predisposition to contraction of the rectum; and one recent author thinks this is not only the case, but asserts he has "repeatedly noticed several members of the same family afflicted with- stricture."
It must not be supposed, as some writers would lead us to do, that stricture of the rectum is a very frequent disease: those who have had the greatest opportunities and the most extended fields for observation, whose acumen in the diagnosis of disease, and whose integrity is most to be relied on, have not met with this affection as a common occurrence. In the museums of our hospitals the pathological specimens are few, and those who are in the habit of seeing large numbers of post-mortem examinations meet with examples of it but seldom. In a large parochial infirmary in which I have had opportunities of examining many bodies, I have seldom discovered stricture of the rectum. In public and private practice I have met with not a few cases of dyspepsia, in which the symptoms simulated those of stricture, and, had I been induced to use bougies at the same time that internal remedies were prescribed, I might have deluded myself with the belief that I had cured a disease which, in reality, had never existed: however, I have the greater satisfaction in knowing I relieved all the symptoms and discomfort of the patients by very simple constitutional treatment. Dr. Bushe * remarks, "Organic stricture is supposed by many to be of very common occurrence, but I have not found it to be so; for the cases I have seen bore no proportion to the number I ought to have met with, were the statements made in books correct."
The most usual seat of stricture of the rectum is within two or three inches of the anus, and it can readily be detected by the finger: occasionally it is found higher up, even in the sigmoid flexure of the colon, but these cases are very few, and their absolute existence has not generally been known till after death; on the contrary, the cases in which stricture was supposed to have existed, and absence of all contraction has been demonstrated by post-mortem examinations, are by no means rare. Some writers have expressed opinions that stricture is most common about the termination of the colon: Mr. White f
• Op. cit., pp. 264-5.
t 'Observations on Strictures of the Rectum and other Affections,' by W. White, Third Edition, Bath, 1820, p. 47.