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Show 112 rnzrnnxsiunu AN cs. I'RETERNATURAL ANUS. there they have been extracted by the lithotomy forceps of the largest size. The concretion may not, however, descend entirely into the rectum; but, lodging in the last turn of the colon, it may double down and press upon the rectum, so as eiTectually to obstruct the bowels, and yet be within reach of along flexible injection piper. 41 11;) But a case which I have frequently seen is less accountable it is a tistulous opening which is the consequence of a severe attack of colic apparently, and when the general uneasiness subsiding leaves a fixed pain in some part of the belly, with a hardness and partial swelling, to be distinguished by the feel, and painful on pressure. This first attack is followed by an occasional recurrence. At last, an inflamed tumour of the in tcguments rises, and bursting, discharges pus. By and bye PRll'l‘ERNATUBAL ASKS. feculent matter passes, and u. preternatural anus is formed. This, however, is not a direct communication with the intes- Tue pretei'natural or artificial anus is a fistulous opening on the belly, communicating with the intestine. It is produced "7%?" 4.130 W "WM i\\ most frequently by the sloughing of a herniary tumour, or by wounds penetrating the belly, and wounding the intestines ; or sequently in this case the discharge is less in quantity, the in consequence of inflammation and adhesion of the intestines to the walls of the belly, and following that, an abscess which luids do not entirely forsake the tract of the canal. Still any irregularity of diet brings on the pain and distention of the, bursts through the integuinents. We shall not speak here of the circumstances which give a peculiarity to the case of her- belly, with suppressed dig large. nia. The wound of the belly opening the peritoneal cavity, guests-34..» -< though the instrument has not wounded the intestine, will tine are everted, and form a painful and irregular tumour; and one or two ligatures; but it does not adhere, and from the sometimes there is a prolapsus of the intestines, which is in swelling of the lips, the ligatures have to be cut out : the in- danger of strangulation, like a hernia. The faces, too, having 11) receptacle, are discharged in their regular course down- Wards. Further, if this opening -x‘>§!iilitl€5 long, and dis charges freely, it has this bad Ctlll'-€Uz'illi‘il"€, that the lower part: where it presents. Here a slough forms, and being cast oil} the feces escape by the wound, and a very troublesome fistula succeeds. If the integuments and bowels are both wounded, the process is very nearly the same, if the patient is not (16stroyed by the first rising of the inflammation, or if the intesr tines are not excited to pour out their contents into the gene- . The preternatural anus has this evil consequence-about. the rectum there are muscles which support the coats of the gut, and draw it up when the feces are excluded; but here there being no sphincter or levator, he inner coats of the intes- sometimes be followed by an evacuation of feces, and a kind of anus in the place. It happens thus-The cut is united by testine is then seen behind the incision, and adhering round the inner margin of the wound ; but it is black and unhealthy , w T... _. "f... ..;(\L. . tine. The probe passes in all possible directions. The inflam; mation and snppuration preceding the progress of the feces, has made passages betwixt the muscles or their tendons ; con-- ral cavity; for the neighbouring intestines coherc, and are massed together, while that portion which is next the wound of the integuments throws out its contents by the wound I of the intestine being no lon‘ " "2‘: ‘iied by the presence of the feces, it contracts, and ifius vioient spasms when we attempt 10 plug the opening, and force the alinient to take its proper rout. All this absorbing surface, too, is lost to the system, and debility and inanition is the consequence, i f the opening into the intestine be high in the canal. in this complaint we int j: paliia‘te matters, by Halli}; such rrircular compresses as restrain the tumour of the inner coal» at the intestine, and which may at the same time allow the '* See a case by Mr. lIey, p. 494 lifts to pass. and by adapting; vessels to reeeive the discharge. " "3. l'. I) |
