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As Andral expresses himself, there sometimes appears to be a tendency in the terminal orifices of the digestive, urinary, and genital canals to be confounded together in a cavity more or less analogous to the cloacæ of birds. Sometimes the urethra occupies its normal position, and the recto-vaginal septum may be partially or entirely absent. All these malformations depending of course on an arrest in the development in various degrees of one or other of the stages through which the parts pass in their formation.


The lusus of the ureters opening into the rectum has been seen, but it is an anomalous condition extremely rare.



HABITUAL constipation is one of the most prevalent and troublesome functional disorders to which mankind is subject. Its sympathetic effects extend to every organ of the body, and often occasion great distress and anxiety to the sufferers, leading them to apprehend the existence of the most serious organic disease. Neither can it be doubted that many of the pathological changes in structure of the viscera of the head, chest, and abdomen, have their origin in functional derangement, induced either sympathetically by constipation and consequent derangement of the assimilative organs, or by the retention of excrementitious matter. Of the sympathetic effects on the brain and nervous system thereby induced we have evidence during infancy and youth in convulsive fits, chorea, and other nervous affections, and in adults in the giddiness, drowsiness, headache, pains extending to various parts of the body, and that distressing mental depression denominated hypochondriasis, which not unfrequently terminates in permanent perversion of intellect, or even in a more distressing manner. The sympathetic effects on the lungs and heart are indicated by cough and palpitation. The reaction on the stomach is marked by disordered appetite, vomiting, eructations, and a sense of gnawing and sinking at the precordia. We have evidence of the kidneys being affected in their morbid secretions, as marked by the various deposits we find in the urine. The exhalant functions of the lungs and skin also become deranged, as indicated by the fætor of the breath and perspiration; and many of the distressing and unsightly diseases of the skin have their origin in constipation and morbid accumulations in the bowels. Nor do the genito-urinary organs escape: thus urethral, vaginal, and uterine discharges and irritability of the bladder are frequently induced. The countenance of those who are the subjects of habitual constipation is dull and heavy, the eyes lack their lustre, and the tongue is observed to be deeply notched transversely. It has been shown that many of the affections treated of in the preceding chapters often have their origin in this common cause.

To enter fully into the causes, symptoms, and remote sympathetic diseases and effects of constipation would far exceed the limits and objects of the present


work, but a few remarks on the most common causes of constipation, depending on torpor of the colon, and the means of obviating that condition, will not be out of place.

Habitual constipation as a constitutional effect occurs in those whose vital powers are naturally low : thus during the earlier periods of life we most frequently meet with it in delicate females ; but as age advances, and the organic functions become enfeebled, we find it prevailing in either sex. The most frequent accidental causes are sedentary. habits, and the very common practice of not attending to the first calls of nature to evacuate the bowels. Fæcal accumulations are thus favoured, the bowel becomes distended, and in some instances to an amazing extent; its vital contractility is diminished, and it is rendered incapable of expelling its contents. Yet, notwithstanding this condition, frequently neither the patient nor medical attendant suspects the real mischief that exists, from the fact that diarrhæa may at the same time be present, consequent on the irritation induced by the overloaded state of the bowel. I have many times been consulted by patients suffering from the effects of fæcal accumulations, who assured me their bowels invariably acted regularly each day; and what they asserted was quite correct; yet they were the subjects of torpor of the colon and fæcal accumulations. On


inquiring more particularly into such cases, it will be discovered, that though the bowels have been moved daily, the evacuations have been scanty, and that a sense of fulness and discomfort in the bowel remains ; the fact being, that accumulations had been gradually increasing, and the softer and more recent excrementitious matter had passed over that which had been retained and become hardened.

The habitual use of large and warm enemata relax and distend the rectum, and enervate its functions ; one of the effects of which is to promote the occurrence of a form of intussusception and slight invagination of the bowel, the upper portion descending into the lower, occasioning many distressing symptoms; a dull, heavy pain and fulness is felt in the loins and sacral region, defecation is difficult and painful, and the calls to stool frequent: the evacuations are small, or passed in lumps ; or being rendered fluid, from an increased secretion from the mucous surface, the result of irritation, are ejected as if from a syringe. These symptoms often induce a suspicion of the existence of stricture of the rectum, and the suspicion, although entirely groundless, may be apparently confirmed if an endeavour be made to pass a bougie, and it be arrested in the edge or fold of the semi-prolapsed portion of the intestine.

In the treatment of habitual constipation, the ob

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