Imagens das páginas
PDF
ePub

presenting, a strong probe bent was passed through the rectovaginal opening, the point being pressed firmly towards the surface; an incision three-quarters of an inch long was made through the integument midway between the commissure of the vagina and the point of the coccyx; the point of the probe was then cut on and brought through the wound. I now discovered that the communication between the bowel and the vagina was by a narrow tube, and that by firm pressure at the bottom of the wound the pouch of the intestine could be indistinctly felt pressing downward when the child strained. The incision was cautiously continued to a depth of an inch and three-quarters, when the bowel was reached, and a puncture made with the point of the scapel: a probepointed bistoury being then introduced, and the opening enlarged so as freely to admit the finger, on the withdrawal of which a considerable quantity of fæces were discharged. About two ounces of blood were lost during the operation. A full-sized lithotomy tube was secured in the wound, and retained for eight days, being removed only when it was necessary to clean it, and in examination of the parts. The artificial opening evinced a strong tendency to contraction, which was counteracted by the daily introduction of the finger for the first fortnight, and subsequently a number four rectum bougie which has been introduced and retained for some minutes daily. The bowel is also washed out with three ounces of thin gruel. The child is now two years and a half old, and has progressed most favourably; its health is good, it feeds well, and the bowels act freely, and it has control over them. The size of the bougie has been gradually increased.

Mr. Mantell* operated, in September, 1786, on a female child with imperforate anus: a small opening existed between the rectum and vagina. In the spring of 1788, he had to repeat the operation in consequence of the closure of the artificial anus: another surgeon had previously performed the operation for the second time.

Mr. Copland Hutchinson was consulted respecting a female child, four weeks old, in whom the anus was occluded, and a communication existed between the rectum and vagina, through which the faces passed freely. The mother would not consent to any operation. Mr. Bathurst, of Strood, had a child under his care in whom the fæces passed per vaginam; there was also an external opening at the anus, but not larger than would admit a probe; it was dilated by bougies, and the abnormal aperture between the rectum and vagina closed spontaneously.

OPENING IN THE SACRAL REGION.

La Faye, in page 358 of Principes de Chirurgie,' records a case of deficiency of a portion of the sacrum, the rectum opening at the lower part of the back.

* Memoirs of the Medical Society of London,' vol. iii., pp. 389

392.

† Op. cit., p. 265.

TERMINATING IN A COMMON OPENING WITH THE

GENITO-URINARY ORGANS.

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 cloace 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.

OTHER ORGANS TERMINATING IN THE RECTUM.

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

CHAPTER XX.

HABITUAL CONSTIPATION.

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 fœtor 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

« AnteriorContinuar »