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and vagina, and the large intestine of a child. Ten months before her death, in an endeavour to administer an enema, a clyster-pipe was forced through the adjacent walls of the rectum and vagina. At the part thus injured there is a small depression in the wall of the vagina, and a long, pale, and irregular cicatrix in that of the rectum. Near the cicatrix, also, there are traces of small healed ulcers of the mucous membrane of the rectum. Just below the cicatrix, at the distance of about an inch from the margin of the anus, the canal of the rectum is reduced to an eighth of an inch in diameter, and the adjacent tunics are indurated. Above this structure the intestine is greatly dilated, and contained a large bucketful of fluid fæcal matter.

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The rectum is sometimes perforated by unskilful attempts to introduce a catheter into the bladder. the summer of 1852, I was sent for to see an Irishman who had retention of urine: the bladder was greatly distended, and reached nearly to the umbilicus: forcible attempts had been made to relieve it, and the catheter had been made to enter the penis till the rings were brought into contact with the glans, but no urine flowed. I discovered the point of the instrument had been thrust through the urethra immediately anterior to the prostate, and had passed into the rectum. By keeping my finger in the bowel, I

succeeded without much difficulty in passing an instrument of moderate size into the bladder, and, to prevent any mischief, I ordered it to be retained for a day or two within ten days I was able to pass a full-sized catheter, and the man did very well.

CHAPTER XVIII.

FOREIGN BODIES IN THE RECTUM.

WE may be called upon to remove, by mechanical means, various substances from the rectum, either in consequence of their obstructing this outlet, producing inflammation, or interfering with the integrity of the intestine.

These substances may be divided into two classes, one being formed in the body, the other being introduced from without. To the first class belong biliary, intestinal, and fæcal concretions; while the second will include a long list of heterogeneous substances which have been swallowed, either accidentally or intentionally, or introduced into the rectum through the anus by the individuals themselves with a view to obviate costiveness, from a morbid state of the imagination, or by accident, or they may have been introduced by other persons from feelings of mischief or revenge. Those swallowed either by accident or intentionally, in consequence of a perverted condition of the mind, include portions of bones, the bones of

fish and small birds, the stones of fruit, coins, knives, pins, needles, nails, sealing-wax, brown paper, cedar pencils, &c.; and among the variety of substances that have been introduced through the anus, according to the testimony of accredited authors, may be mentioned, bottles, pots, cups, a knitting-sheath, a shuttle with its roll of yarn, a pig's tail, ferrules, rings, pieces of wood, ivory, metal, horn, cork, bone, &c.

Foreign bodies that have been swallowed do not usually occasion much inconvenience in their passage through the intestinal canal, though it is sometimes marked by considerable irritation. Should the substance not be discharged with the fæces, but become entangled in the rectum, it will give rise to inflammation accompanied by tenesmus, violent straining, and perhaps prolapsus; by perforation of the tissues of the intestine it will lead to the formation of abscess and fistula; or partial or total obstruction may be produced, followed by enteritis or peritonitis: these effects will be greatly influenced by the size, form, shape, and nature of the substance. When intestinal or fæcal concretions are the cause, the symptoms are gradual in their accession, and are preceded by signs of derangement of the stomach, liver, and bowels: at first, the local disturbance is marked by a feeling of weight, distension, and pain in the rectum, followed by obstinate constipation, great straining to relieve

the bowels, attended with more or less prolapsus of the mucous membrane and congestion of its vessels; and if the patient be not relieved, enteritis, peritonitis, and death will ensue. When the foreign substance has been introduced through the anus, the symptoms are more rapid in their development, and if the bowel has been at the same time injured, they will be more or less serious in their character in proportion to the extent and nature of the lesion.

It is seldom that we can gain any information from the patient when the substance has been swallowed, as it often happens that he is unconscious of the circumstance; but if it has passed into the rectum from without, the patient may then be able to make us acquainted with its nature and the manner of its introduction, unless he be of unsound mind, or was insensible at the time of the occurrence.

For extracting the various foreign substances it may be our duty to remove, instruments of different sizes and shapes, and effecting different objects, will be required, much depending on the form of the body to be extracted, and the material of which it is composed, and on the ingenuity and tact of the surgeon. Should the substance be a bottle, or jar of glass or earthenware, it will be a good plan to insert slips of thin ivory, wood, or gutta percha, between it and the bowel, and thus form a tube around it which

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