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uncommon Circumsan es. 97sae was talien sor a mort time with a violent Purging, Whicli threatened her immediate dissolution.
She was much eXtenuated in the coui se of herdisease ; and , at one time, it Was With great difficulty that a mortification, frona pressure in theregion of the os sacrism, WaS PreVented. This account was draWn UP by a relation of
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self the tro able to acquaint young practitioners with a complaint that frequently occurs, is very tro abies me, may eastly be mi stat en, and the mi italae be pro luetive of very serious consequences to the suffere r. You who praetisse in the metropolis, by dat lyconferen ce with one another, learia many thinia
Medicat Observations and Inquiries, vol. iv. p. Iz3. Read November I , I 768.
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pity in praetice, as weli as in a disposition to
I siali relate one single case particularly, assonae useful hinis may be collected from it, asweli as frona some other cases of the like ten
dency, susscient, I hope, to te ad the yoUng prac titioner into a method os distinguisaing this dis
order frona others, Whicli, thoiagh in sonae ap- pcarances the fame, are diametri catly Opposite. Not long since I Was destred to visit an elderly gentieman, labouring, as it Was supposed, underan obstinate diari hora. He Was in the COUntry, under the Care C f a Very sensibie and experien ceda pothecaryi Who, froin the Patient's and attendia anis complainis and informations, Was ii luce lio belleve it a diarrhoea, and had trealed it as uch, in a Very Proper manner. The gentieman had very frequent motions to. stool, and the motions extrem ely Uigent. Someth in excrement was always dis charged on these
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occasions : the pains gradu atly lessened sor atinae, and then returned with the like violen ceand the fame effects. Rhubarb, testacea, demulcenis, anodynes, hau been occasionalty given ; but the dis order stili Continued, and the patias and discliarges, thoughrather tesse frequent, seemed to be more violent. From the violence of these retiarns, I begata tosus pedi they procee led frona sonae obstruction in the rectum. The patias were previous to the dis charge; a tenesmus always succeeds it. On en-quiry, Ι found my patient Was always disposed tobe costive; that he had been so many days preceding this disse ase; that he had not passed a figured stool os a sortia ight: I guessed theresore, that the dis charge of thin excrement Was forceuhy the painful throws past the obstructing col
It proved as I had suspected, and the younginan performed his part so Weli as to bring awaya very large lump of hardened faeces, whichcould not by any other means have been disecharged. Emollient clysters, and olly relaxingeraughis, soon brought aWay the rest, and 'ur
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Another casse, not altogether dissimilar, may he wortii mentioning. Ι was destred to visit agentieWoman near siixty years of age, of a constitution rather plethoric, and, to appe arance, healthy, excepi from the essedis of the presentindisposition. She complained of very slaarp, but intermitting pains os ali the paris about the pelvis. She compared them to labour patias in respect of violence, but os longer duration ; just, sie sald, as is the womb, bladder, and ait milhinher, Were forcing ou twards : every half hour almost they returned, and had so continued near a monili besore I was called to her. An ingeniolas apothecary, Conversant in mid wifery, had suspected that s me harde ned forces in the rectum increased the mal ady, is they werenot the sole cause of it. He Was permitted to ex amine ; but, by introducing the finger as high aspossibie, he could discover nothing of this hind, but found the uterus much enlarged and very hard, compressing the rectum in such a manneras to prevent any thing but What was in a very
liquid state frona passing, and such kind of liquid stools were dis charged very frequently, soas to imitate a genuine diarrhia. The uterus, When examin ed, was exquisitesypa inful to the touch. The urine was discli argedwith much dissicut ty, oming, as it Was supposed, so the increased bulk of the uterus.
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pretiy actiVe purgatives, gentie ones haVing noeffect, whicli never falled, at the sanae time, to increase these forcing patias immoderately. Thish ad rendered the use of anodynes necessary at night, to allay the irritation produced by the
PurgatiVes. Though frona the account given me, there Was much reason to apprehend the uterus was in a very morbid state, probably Verging to a Cancer, as seemed after ards to be more evidently
the case . yet that sonae hard faeces might be onecause of the present patia, seemed to me not improbabie. The apothecary, at my request, examined there tum again With his finger ; but soland no foeces He then introduced a smali tallow candie, and pumed it gently past the compressed pari. Upondrawing it oui, he observed sonae excrementstiching to it. This induced hi in to passi it again to the obstrue ting place, and, by degrees, he disse lodged a very large masse of hardened excrement, whicli feli into the rectum, and being there brohewith the finger and the scoop, was extracted. An emollient clyster brought aWay the rest, and sae now complained of nothing but fatigue and
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An opinion that purgative, or even laxative medicines destroy, or, in sonae degree, frustrate the essicacy of the bark, has contributed not alitile to produce many troubles me accidenis Ofthis kind: sor, as a large quantity of barii is ge neralty used in the cure of an agite, and as thebark is indissolubie in the stomach and boweis, it eastly unites With the faeces, and forms withthem sirch large, ham, compast y bala, as calaby no means passi the Aphin Ier ani, without eX-quisite pain and dissiculty, and sonaetimes notwithout the aid of instruments. When this is the case, the patient Complainsos excruciating forcing patias abolit the anAS ;but remitting. Some thin excrement is dis Charged, and the pain abates. A fres h spasmo
dic emori sollows, and with the like successi. Itis a Lind of spontaneotis spasm os ali the parisin, or connected immediately with ine pelvis, forthe exclusion of this irritating substance. Should such a thin discli arge, attended with patia, leadany one to suppose it a diarrhoea, anil, in Consequence of such a supposition, treat it with astringenis and optates, it is evident that greater mi1-chief would ens Ue.
Should the description given by the patient,
and the preceding circumstances of the Case, in duce one to doubt whether the disse asse is owino
to constipation, a triat attended with no danger, arad, in molt cases, with litile dissiculty, will soon
clear up the matter. I f the patia remiis, and returns with violence after a slaori remission, and
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the patient has either talien the barii, or been long costive, there is reason to apprehend the complaints are the conseqhiences of constipation, and can probably be relieved by no other meansso sasely and speedily, as by manual Operation But it appears, that a search with the fingeronly, is not in ali cases sufficient : the lodgment may be above iis reach. A 1 mali tallow candiemay be passed si far as to put the assair Out Osdoubi, and should be recommended where, frona ConCUrrent eviden ce, such a lod2ment is suspeei ed.