tracheotomy would prove more successful than any other treatment. Experiments hitherto have not been sufficiently numerous to establish its value as a remedial resource.]

75. H. M. MAGENDIE, believing that the fluid parts of the blood were diminished by the inability of the patient to swallow fluids, and by the continued transpiration from the surfaces, injected a pint of water, of the temperature of 30° of REAUMUR, into the veins of a man in an advanced stage of rabies. The patient immediately became tranquil, and his pulse, in twenty minutes, fell from about 150 to 80. The spasms ceased, and he drank a glass of water. He continued to improve until the fifth day, when abscesses, primary and secondary, appeared, in consequence of portions of lancets, which had broken during attempts to bleed him in the feet during the paroxysm, having remained in the wounds. He died early on the ninth day.-(Journ. de Physiol., t. iii., p. 386.)

been most commonly prescribed, more especial- | cided opinion that death in hydrophobia resultly with opium, or with belladonna, or other nar-ed from suffocation produced by spasm of the cotics, as mentioned by MEASE, BUCHOLZ, Nu- laryngeal muscles, and that the operation of GENT, and many others. And these medicines have not only been administered by the mouth, but also in enemata, and in various combinations. Ether was thus given with opium by MEASE; with phosphorus by ZINCKE; with the succinated spirit of ammonia, with camphor, &c., by several other physicians. Musk has been exhibited in similar modes and combinations-with opium, belladonna, camphor, &c. ; and with cinnabar, creta, and opium, forming the pulvis Cobbii or Tunguinensis; but there is no sufficient evidence of its efficacy. In a case which I attended with Mr. DENDY, the spirit of turpentine received for the first time a sufficient trial-a trial demonstrative of its want of efficacy in this malady.-(b) Electricity and galvanism were recommended by Rossi and ALDINI, but no permanent benefit was derived from them. The nitrous oxide gas was administered by Dr. BARDSLEY with little effect. 72. E. Tonics of various kinds have also been tried, but with no marked benefit. Nur vomica 76. In a malady so little under the control was given by ROUGEMONT and SCHULZE, and of medical treatment as this confessedly is, restrychnia by Dr. BARDSLEY. The mineral acids, liance cannot reasonably be placed on any sinmore especially the hydrochloric, have been rec-gle remedy; and hence various means have ommended by MEINHARD, AGRICOLA, MALDEN, been often employed, coetaneously or successANCELLI, BRUGNATELLI, and others; and, prob-ively, to arrest its progress, or to combat its ably after bleeding, the chlorate of potash and the chloric ether are deserving a trial. The mineral salts, especially the nitrate of silver, the preparations of zinc, the muriated tincture and other preparations of iron, have likewise been prescribed, the last by Dr. ELLIOTSON, BRIGHT, and others. The several vegetable tonics, especially the cinchona and cascarilla barks, sulphate 77. (a) B. D. MAUCHART long ago directed of quina, &c., have also been suggested, vari-blood-letting from the arm of the side in which ously combined, and aided by other means, as the injury was inflicted, and a quantity of blood wine, aromatics, antispasmodics, &c.; but, al- to be taken great in proportion to the time though MEASE, LOFTIE, and others have con- which had elapsed from the infliction of it. If ceived that advantage might be derived from the patient had become melancholic, or if any this class of medicines, especially when thus of the symptoms of the invasion of the malady associated, or combined with anodynes or nar- existed, he ordered the blood-letting to be carcotics, no satisfactory evidence that benefit has ried to the production of full syncope. He next been derived from them, when the disease is ordered the cicatrix to be scarified and the developed, has hitherto been furnished. Dr. bleeding from it to be encouraged; afterward SEMMOLA has insisted upon the employment of the mithridate, rue, theriaca, &c., to be conchlorine, both internally and externally, as a stantly applied to it, and these and similar subprophylactic and as a means of cure. stances to be taken internally. He farther di73. F. Diuretics were recommended for rabies rected a copious diaphoresis to be kept up, and by AVICENNA; but STAHL considered that no prescribed the same or similar means both to advantage could be derived from them unless prevent the malady and to cure it when it apthey are given in so large doses and so fre- peared, success having been said to follow this quently as to produce bloody urine; and with plan even where the disease was fully develthis view cantharides and the meloé proscara-oped. It would be impossible for me to nobæus have been prescribed by numerous writers, even since the empirical reputation of the latter in rabies has been shown to be, like all other nostrums, without any foundation.

74. G. Tracheotomy was advised to be performed by Drs. RUSH and PHYSIc in America, and recently by Mr. MAYO, with the view of averting death as long as possible, believing that this issue was more immediately produced by spasm of the laryngeal muscles; but it is doubtful whether or no spasm of these muscles is more concerned in producing this result than spasm, or even than paralysis, of other muscles or parts.

more distressing symptoms. Numerous combinations of the medicines noticed above, either as prophylactics or as curative agents, have been advised by writers, but advised rather as suitable means for trial than recommended from satisfactory, or even from any experience of their efficacy.

tice within reasonable limits, other associated means which have been suggested by authors. The reader will find most of them in the numerous works and papers referred to in the sequel; and he will farther observe that substances confidently recommended, either empirically or by professional credit, as most effcacious remedies in this malady, have, after a time, altogether lost their reputation, not merely from having been displaced from public or medical favour by newer means, but because they have been found totally inefficacious when employed.

78. (b) The uncertain or fluctuating views [In a recent conversation (Nov. 23, 1849) as to the pathology of rabies have tended not with Dr. MARSHALL HALL, he expressed the de-only to render equally uncertain the plans and

of rabies in the earlier as well as in the more advanced stages of the developed malady, and reflecting upon what I have myself observed, I may be permitted to state the means in which I am disposed to place reliance when the disease has declared itself: Bleedings from the arm to syncope, or large cuppings on the nape of the neck, repeated, or carried as far as the habit of body and circumstances of the case will permit, have a greater amount of evidence in their favour than other remedies, and are moreover more consistent with the lesions observed after death. After bleeding, the nerves proceeding to the cicatrix may be divided, and the cicatrix itself laid freely open, suppuration from it being as speedily and freely produced as possible. Immediately upon opening the cicatrix, &c., a free perspiration should be procured and kept up by a hot-air bath, for which the materials are always at hand-namely, blankets and a lamp-or by a vapour bath. In other respects the treatment must depend much on circumstances, and on the predominance or urgency of particular symptoms, for which emetics, mercurials, purgatives, enemata, anodynes, narcotics, antispasmodics, stimulants, tonics, &c., may be employed according to the procession and severity of the morbid phe

means of treatment, but also to increase the number of substances advised as specifics with the utmost confidence which ignorance imparts to empirical means. As certain contagious maladies have been cured by medicines viewed as specific means, or such as may be depended upon for the removal of these maladies, so has it been expected that rabies was to be cured by some particular remedy which, if once found out, might be proclaimed as the true panacea. Hence various substances have been from time to time thus dignified, and enjoyed a short-lived popularity. At a time when credulity was not limited to a few individuals, but extended to scientific and corporate bodies, or, rather, when individuals were so generally credulous as to impart this character to the societies which they constituted, certain substances received a reputation from this weakness of the human mind, and at a time when it was most implicitly believed by all physicians from Oxford and Cambridge, but by themselves only, that all learning and knowledge were concentrated in themselves alone, the ash-coloured liverwort was dignified by these physicians with the name of the Pulvis antilyssus. Subsequently other empirical remedies have thrown the college nostrum in the shade, and the virus inoculated by the bite of a viper, the guaco-juice, the Scutel-nomena. laria laterifolia, the Alysma Plantago, the Ophi- BIBLIOG. AND REFER.-Aristoteles, Hist. Animal., 1. viii. orhiza mungos, the Genista tinctoria, the Thalic--Plinius, 1. xxix., cap. 5.-Celsus, De Med., 1. v., cap. 27. trum flavum and angustifolium, the Delphinium-Galenus, De Locis Affect., l. vi., c. 5.-Oribasius, Synopconsolida, the Anagallis purpurea [Mikania Gua-sis, &c., 1. viii., ch. 13.—Calius Aurelianus, Acut. Morb., 1. iii., ch. 9.-Paulus Egineta, 1. v., c. 3.—Avicenna, Canon, co], phosphorated ether or phosphorated water 1. iv., fen. vi., tr. 4, c. 5.-F. Ponzetti, De Venenis, lib. iii. [common salt locally applied], and numerous Venet. fol., 1492-J. Bravius de Piedra Vitta, De Hydroother substances, have, in different countries phobia Natura. Salamanca, 8vo, 1571.-H. Mercurialis, Tractatus de Maculis pestiferis et Hydrophobia. Patav., and at successive periods, enjoyed their unde4to, 1580.-H. Fracastorius, De Morbis contagiosus (1. ii., c. served and short-lived reputations, and sunk 10; iii., c. 9, Opp. om.). Ven., 4to, 1584.-A. Baccius, De into congenial oblivion. It may be added, for rabidi Canis Morsu. (Append. ad Prolegom. de Venenis). the information of those who take delight in Rom., 4to, 1586.-4. Mancinelli, Opusculum floridum de Morsu Canis, &c. Venet., 12mo, 1587.-J. Bauhinus, Denk. empirical remedies, that in almost every town, würdige Historie von etlichen wüthenden Wölfen, &c. in every country, may be found some old man Mömpelg., 8vo, 1591.-A. Roscius, Epistola de Morsu Ca or old woman who rejoices himself or herself, nis rabidi (etiam in Hildan. Opp.). Basil., 8vo, 1608.Camerarius, Memorab., cent. xvi., No. 100.-Fernelius, Do or knowingly deceives the neighbours and all abdit. Rer. Causis, 1. ii., cap. 14.-B. Codronchus, De Ra the credulous within reach, in all ranks, with bie, seu Hydrophobia. Francf., 18mo, 1610.-T. Spackthe professed possession of a specific against mann, A Declaration of such grievous Accidents as comrabies; and that these specifics, according to monly follow the Biting of mad Dogges. 1613.-M. Hamel, Traité de la Morsure de Chien enragé. the amount of patronage conferred upon them, Lissieux, 8vo, 1620-J. Caranta, De Morsu Canis rabidi. have at different times enjoyed a reputation, Savil., 4to, 1623.-Fabricius Hildanus, cent. i., obs. 99; ii., which was overturned only after numerous obs. 98; iii., obs. 87; iv., obs. 88.-J. ab Aromatariis, De Rabie contagiosa. Francf., 4to, 1625.- Bartholinus, Hist proofs of their want of efficacy. The Ormskirk Anat., cent. v., obs. 52-Palmarius, De Morbis contagiopowder and the pulvis Tunguinensis are suffi- sis, p. 266 (caused by the kiss of a rabid patient).- Durcy, cient illustrations of the popular faith in vaunt- De stupendo Infortunio ex Lupo rabiente. Divion, 8vo, ed but worthless specifics, and the credulous 1661.-Zacutus Lusitanus, De Prax. admirab., l. iii., obs. 87; et Prax. Med. Prin. Hist., 1. v.-J. Varismani, De rabconfidence they inspired. Numerous recent de- idi Canis Morsu et de Hydrophobia. Regiom, 8vo, 1686. ceptions, absurdities, and fooleries-deceptions-Heister, Wahrnehmungen, b. ii. Neuhans, Homo hy. on so large a scale as to comprise the whole drophobus. Hannov., 12mo, 1689.-Paullini, Cynographia, range of disease-have thrown these and other sec. iv., cap. ii.-T. Ravelly, Traité de la Maladie de la Kage. Par., 12mo, 1696.-T. Mayerne, in Philosoph. Transact, absurdities into the shade, and have proved hu- No. 191.-R. Lentilius, De Hydrophobia Causa et Cura. miliating illustrations of human nature, demon- Ulmæ, 12mo, 1700.-P. A. Bufaletti, Lettera sopra uno strative of the extent to which knavish preten- Idrofobo, divenuto tale coll' Impeto dello Sdegno. Mau rata, 8vo, 1702.-Lister, in Philosoph. Transact., No. 147. sion, with a designing sacrifice of human life-A. B. Scaramucci, Lettera sopra un Idrofobo. Maurata, to selfish acquisition on the one hand, and cred- 8vo, 1702.-H. Ridley, Observations de Asthmate et Hy. ulous patronage on the other, lower the just drophobia. Lond., 8vo, 1703.-Callisen, Syst. Chirurg. hodiern, vol. i., p. 595.-M. Hamel, Traité de la Morsure d'un estimate of moral and intellectual endowment, Chien enrage. Lissieux, 8vo, 1704.-Kennedy, in Philos. and sink the general standard of common sense Transact., No. 242.-R. J. Camerarius, et T. G. Scharf, De and sagacity, as manifested throughout the com- Alysso Clave (Haller, Diss. ad Med., vol. i.). Tub., 4to, 1609.-Mead, in Philos. Transact., No. 323; and Mechanicmunity, from the highest places, through all al Account of Poisons.-P. Hunauld, Entretiens sur la ranks, classes, and grades, down to the lowest Rage et ses Remèdes, 12mo, 1714.-Bonet, Sepulchretum, sinks of wretchedness. &c., l. i., sect. 8 and sect. 13, p. 341.-Fuller, in Philosoph. Trans., No. 448.-Mortimer, in ibid., No. 443.-Nourse, in ibid., No. 545.-Hartley, in ibid., No. 448.-Peters, in ibid., No. 475.-Wollaston, in ibid., No. 448.-Callisen, in Soc. Med. Hann. Collect, vol. i., No. 32 (caused by a rabid dog

79. I. Treatment advised by the Author.-After the review which I have now taken of the treatment which has been recommended for the cure

Lond., 4to,

Edin. Med. and Surg. Journ., vol. xxvi., p. 139; in ibid.,
vol. xxxii., p. 378; and Lond. Med. Repository, 1826, vol.
ii., p. 448.-M. V. Lenhosock, Die Wuthkrankheit, nach bi-
sherigen Beobactungen und neueren Erfahrungen Pathol.
in Therap. dargestel., 8vo. Leips., 1837.-J. N. Sauter, Die
Behandlung der Hundswuth in polizellicher, prophylak-
tischer u. therap. Hinsicht, 8vo. Const., 1838.-Long, in
Dublin Journ. of Med. Sciences, &c., Jan., 1837, p. 447.—
Davey, Lancet, Feb., 1837, p. 739; ibid., March, 1837, p. 827.
-Bennett, in Library of Medicine, vol. ii., p. 246.-G. Bre-
schet, Recherches expérimentales relatives au Mode de
Transmission de la Rage, in Comptes rendus de l'Acad.
Roy. des Sciences, &c., t. xi., p. 485.-Rochoux, in Dict.
de Méd., 2d edit., art. Rage.-De Haume, in Lond. Med.
Gazette, Dec. 30, 1837, p. 538.-J. Burne, in Brit. and For.
Review, July, 1838, p. 268; and in London. Med. Gazette,
April, 1838, p. 100.-J. M. Chelius, System of Surgery, &c.
Translated from the German, with additional Notes and
Observations, 2 vols. Lond., 1845, vol. i., p. 361, et seq.
[AMER, BIBLIOG. AND REFER.-On Blood-letting in Hy.
drophobia, Medical Repository, N. S.. vol. ii., p. 19-82;
vol. iii., p. 375.-L. Bartlett, in Med. Repository, vol. iii.,
p. 383.-On Scull-cap, Medical Repository, vol. xiv., p.
232.-H. Alden, in Communications of Med. Society of
Connecticut, vol. i., 1810, p. 80.-James Thacher, Observa-
tions of the Hydrophobia, &c., 8vo, p. 302. Plymouth,
Mass., 1812.-Idem, in Med. Repos., vol. i., p. 175.-James
Mense, in ibid., vol. v., p. 292.-J. R. Core, in ibid., vol. v.,
p. 257.-J. G. Knauff, in ibid., vol. vi.. p. 391.-J. C. Rous-
seau, On Hydrophobia, in North Am. Med. and Surg. Jour,
vol. viii., p. 73; a very good Essay.-George Russell, Case
of Hydrophobia from the Bite of a Racoon. N. England
Journal, vol. xii., p. 363.-W. P. C. Barton, on the Proph-
ylactic Virtues of Scutellaria lateriflora, or Scull-cap,
Phil. Med. and Phys. Jour., vol. i., p. 383. Dr. B. very
clearly proves its inertness in this disease.-John Barnes,
Am. Med. Recorder, vol. v., p. 650. Essay on Hydropho
bia, in ibid., vol. ix., p. 82; vol. x., p. 177.-B. Rush, in
Medical Repository, vol. vii., p. 105.-Robert Barton, in
ibid., vol. viii., p. 15.-S. P. Hildreth, in ibid., vol. vii., p.
359; ibid., vol. vi., N. S., p. 95.-Felix Pascalis, in ibid.,
N. S., vol. v., p. 138.-R. K. Hoffman, Account of an epi-
demic canine Rabies, in ibid., vol. v., N. S., p. 138.-L.
Spalding, On Scutellaria lateriflora, Pamphlet:; also in Med.
Repos., vol. v., p. 430.-C. A. Lee, Cases of Hydrophobia,
with Dissections, Am. Journ. Med. Sciences. See works
on Practice, under "Scarlatina."]
RECTUM AND ANUS, DISEASES OF THE.-
CLASSIF.-GENERAL AND SPECIAL PATHOLOGY.
1. Disease is rarely limited to either the one
or the other of those parts, but commonly ex-
tends to both when originating in either. Af-
fections of the rectum and anus, whether func-
tional or structural, cannot be satisfactorily un-
derstood unless the structure, functions, and
sympathies of these parts are duly considered.

ib., vol. xx., p. 323, 520.-Physick and others, in ibid., vol. xx., pluries; and ibid., vol. xxi. and xxii., pluries.-B. Mosely, On Ilydrophobia, its Prevention and Cure. Lond., 8vo, 1809.-G. Lipscomb, The History of canine Madness and Hydrophobia. Lond., 8vo, 1809.-A. Portal, Mém. sur la Nature et la Traitement de plus. Mal., t. ii., 38.-M. Ward, Facts on opiate Friction in spasmodic Diseases; also an Attempt to investigate the Nature of Hydrophobia and Tetanus. Manchest., 8vo, 1809.-J. Wendi, Ueber den tollen Hundsbiss. Bresl., 8vo, 1811.-Willan, Reports of the Dis. of London, p. 218.-J. Gillman, A Dissertation on the Bite of a rabid Animal. Lond., 8vo, 1812.-T. F. A. Lalouette, Essai sur la Rage. Paris, 8vo, 1812.-T. Thatch er, Observations on Hydrophobia. Plym., 8vo, 1812.-J. O'Donnel, Cases of Hydrophobia, with Observations, &c. Lond., 8vo, 1813.-Tymon, Edin. Med. and Surg. Journ., vol. ix., p. 24.-Wynne, Rice, Particulars of a successful case of Hydrophobia. Shrewsb., 8vo, 1813.-C. H. Parry, Cases of Tetanus and Rabies contagiosa, &c. Lond., 8vo, 1814.-A. Marshall, The morbid Anatomy of the Brain in Mania and Hydrophobia. Lond., 8vo, 1815.-Vogelsang, in London Medical Repository, vol. iv., p. 500.-H. A. Gocden, Von der Bedeutung und der Heilmethode der Wasserscheu. Bresl., 8vo, 1816.-B. Gnecchi, Observazioni sulla Rabbia, e del relativo Metodo di Cura. Milan, 8vo, 1817.-Biancani, in Edin. Med. and Surg. Journ., vol. iv., p. 109.-Clarke, in ibid., vol. iv., p. 431.-R. Reid, On the Na ture and Treatment of Tetanus and Hydrophobia. Dub., 8vo, 1817. Morler, in Edin. Med. and Surg. Journ., vol. iv., p. 504.-H. Edmonstone, in ibid., vol. x., p. 495; and vol. xi., p. 141.-Marcet, in ibid., vol. vi., p. 500.-J. Dixon, in ibid., vol. viii., p. 213.-P. V. Swingin, Untrügliches Heilmittel wider den Bliss toller Hunde. Petersb., 8vo, 1817.-Marc, Dict. des Sc. Méd. (art. Hydrophobie), t. xxii. Paris, 1818.-Brera, in Mem. Soc. Ital. Scienza Moden., t. xvii.-G. Pinckard, Cases of Hydrophobia. Lond., 8vo, 1819.-Trolliet et Villermè, in Dict. des Sciences Médicales, vol. xlviii., p. 47.-T. Simon, Considérations sur la Nature et le Traitement de la Rage. Paris, 8vo, 1819.-L. Spald ing, A History of the Introduction of Scutellaria lateriflora as a Remedy of Hydrophobia. New York, 8vo, 1819.-Pre vitali, Osservazioni pratiche sull' Idrofobia, e nuova Cura profilattica della medesima. Milan, 8vo, 1820.-J. C. Riffe, Natur und medicinische Geschichte der Hundswuth Krankheit. Leips., 8vo, 1820.-Ballingal, in Edin. Med. and Surg. Jour., vol. xi., p. 74; and xvi., p. 209.-N. M. Day, in ibid., vol. vi., p. 7.—Albers, in ibid., vol. xi., p. 413. -Berry, in ibid., vol. ix., p. 26.-R. Wynne, in ibid., vol. X., p. 495.-R. Pearson, in ibid., vol. xvi., p. 158.-Reid, in ibid., vol. xv., p. 292.-J. Johnson, in ibid., vol. xv., p. 212.-F. W. Sieber, Ueber die Begründung der radical Cur ausge brochener Wasserscheu. Münch, 8vo, 1820.-Brandreth, in Edin. Med. and Surg. Journ., vol. xxiii., p. 76.—L. F. Troilliet, Nouveau Traité de la Rage. Lyon, 8vo, 1820.Gorey, Recherches sur l'Hydrophobie, 8vo. Paris, 1821.H. Julius, Kurzer Unterricht von der Hundswuth. Hamb., 8vo, 1821.-F. Magendie, in Journ. de Physiolog., t. iii., p. 382.-B. Gaspard, in ibid., t. iv., p. 132.—A. F. C. de St. Martin, Monographie sur la Rage. Paris, 8vo, 1828.-M. Marrochetti, in Magendie's Journ. de Physiolog., t. V., P. (a.) As respects structure, the fully developed 275.-J. Booth, Practical Observations on Hydrophobia. Lond., 8vo, 1824.-Urban, Journ. des Progrés des Sciences states of the mucous membrane, of the conMéd., t. ii., p. 43; t. iii., p. 261.-4. Capello, Memoria sull' necting cellular tissue, and of the muscular Idrofobia. Rom., 8vo, 1824.-Marochetti, Hufeland's Jour., coats of the intestinal outlet; the numerous March, 1824; and in Archives génér. de Méd., t. ix., p. 80, 247.-Chomel, Dict. de Méd. (art. Hydrophobie), t. xi. Par., mucous follicles with which this part is provid1824.-Hewitt, Trans. of Med. and Chirurg. Soc. of Lon- ed; the connexions of the veins of the rectum don, vol. xiii., p. 264.-A. T. Thomson, in ibid., vol xiii., p. and anus with the mesenteric and portal veins, 298.-Marcet, in ibid., vol. i., p. 132.-G. Gregory, in ibid., and of the nerves with the ganglial and spinal; vol. xiii., p. 250.-J. L. Magistel, Mém. sur l'Hydrophobie, 2d ed., 8vo. Paris, 1824.-F. Fierée, Considérations sur la the plicated state of the internal surface, adRage, &c. Paris, Svo, 1824.-Omodei, Annali universali di mitting of great distention when accumulations Medicina. June, 1825.-4. J. L. Magistel, Mémoire sur of fæces or of flatus take place in the rectum; l'Hydrophobie (2d edit.). Paris, 8vo, 1824.-P. Ménière, in Archives génér. de Méd., t. xviii., p. 526.-R. White, Doubts the folds of mucous membrane, both transverse of Hydrophobia as a specific Disease. Lond., 8vo, 1826.- (transverse valves - rectal valves of HOUSTON) J. Reid, in Edin. Med. and Surg. Journ., No. 134, p. 109.- and longitudinal, existing in the internal surG. Girard, Réflexions sur le nonexistence du Virus ra- face, and the development of these folds during bique. Lyon, 8vo, 1827.—J. A. Hoffmann, Rabiei caninæ ad Celsum usque Hist. critica, 8vo. Leips., 1829.-T. Mur- irritation or contraction of the bowel; the liaray, Remarks on the Disease called Hydrophobia. Lond., bility to congestion of the congeries of veins 12mo, 1830.-C. H. Hertwig, in Archives génér. de Méd., t. of the rectum and anus from irritation of the xvii., p. 587.-W. Youatt, On canine Madness. Lond., 8vo, 1830; and Lectures on, in Veterinarian Journ., 1838, p. 1. mucous surface, or from interrupted circulation -Jolly, Dict. de Méd. Prat. (art. Hydrophobie), t. x. Paris, through the mesenteric and portal veins, or 1832.-J. L. Bardsley, Cyc. of Pract. Med. (art. Hydro- from certain positions; the interposition of, phobia), vol. i, Lond., 1832-Xanthos, in Archives génér. and the support furnished by adipose matter; de Méd., t. vi., p. 119.-Semmola, in ibid., t. xviii., p. 434. -Mayer, in ibid., t. xix., p. 421.-Villette, in ibid., t. xx., p. the various alterations of sensibility, and the 129, 451.-Pleindour, in Revue Médicale, t. i., 1826, p. 223. numerous sympathies, in which nervous and -M. M. Laennec, in ibid., t. i., 1825, p. 257.-Locher-Balber, vascular connexions involve the rectum and in ibid., t. iv., 1825, p. 118; and Edin. Med. and Surg. Jour., vol. xxiv., p. 432.-Lambert, in Journ. des Progrés des Sci anus, constitute an assemblage of circumences Med., 2d ser., t. ii., p. 240.-Trolliet e Martin, instances which, individually and collectively, re

RECTUM AND ANUS--MALFORMATION-FOREIGN BODIES, AND CONCRETIONS IN THE. 643

quire due consideration in all our investigations into the nature and treatment of the affections to which these parts are liable.

2. (b) The functions of the rectum and anus are not confined merely to the giving exit to the contents of the bowels. The rectum allows, in some degree, the fæces to accumulate within it, until opportunity and the consequent irritation and distention admit of their expulsion; and on frequent occasions, when want or neglect of such opportunity, or mechanical obstruction at the verge of the anus, or a weakened or paralyzed state of the muscular coats of the bowel, causes accumulations of fæces and of flatus, remarkable distention, not only of the rectum, but also of the colon, is thereby produced, so that the former fills up a very large space in the pelvic cavity. The rectum, moreover, in connexion with the colon, produces more or less of change in the blood circulating to its mucous surface. The numerous follicles with which this surface is studded actively aid in depurating the blood and in removing materials which, if allowed to remain, might act injuriously when carried into the portal and pulmonary circulations, while the secretions which they furnish constitute a portion, and facilitate the evacuation of the intestinal excretions. The rapidity and amount of absorption by the internal surface of the rectum, whether by venous imbibition or by lymphatic absorption, as demonstrated in health and disease, and by the injection of fluids, simple, medicated, or poisoned, are of great importance as respects not merely disease of this bowel, but also the administration of medicinal agents.

will receive but a brief consideration in this place, especially as several of them require surgical treatment, although neither so generally nor so frequently as many surgical writers maintain. The strictly medical discussion of these diseases will chiefly engage my attention, and with a due regard to the importance of the topics which will successively come before me. Much misapprehension has existed, and still more misrepresentation has gone forth, respecting the sources, the nature, the frequency, and the treatment of several of these diseases, both medical and surgical; and while not only in practice, but also in publications, deception, mystification, and injurious means have been resorted to or recommended by a few, the nature and treatment of these maladies have been elucidated by several able, experienced, and honest writers, to whom and to my own observations I shall chiefly refer.

3d.

4th.

5. I. MALFORMATIONS OF THE RECTUM AND ANUS fall not within the province of the physician beyond a recognition of their nature and consequences, as all attempts to remedy them belongs to the province of the surgeon. These malformations are, 1st. Imperforation of the anus. 2d. Imperforation of the rectum. Unnatural termination of the rectum. Termination of other organs into the rectum; It is chiefly and, 5th. Absence of the rectum. the first and second of these which admit of surgical aid; and the writers referred to furnish ample directions for the best manner of affording it. I may add, that the anus may be so formed as hardly to amount to a malformation requiring surgical aid, although sometimes occasioning or heightening disorders which are more or less medical. This outlet may be either too small or narrow, congenitally, or too large. The former may be so considerable as to interfere with the function of defæcation, and lead to serious consequences. Hence the occurrence of such a conformation should be kept in mind in cases of fæcal retentions during infancy and childhood. A large or wide anus is not infrequent; and when the sphincter ani is impaired in power, prolapsus of a portion of the rectum is thereby favoured, and a portion of the mucous secretion of the lower part of the bowel, sometimes with a little fluid fæces, occasionally escapes.

3. (c) The sympathies of the rectum and anus are of importance not only as respects the diseases of these parts themselves, but also those of the other divisions of the alimentary canal and of the several associated and related parts, more especially the urinary and generative organs. Continuity of surface, membrane, and structure; contiguity of position, and the mutual support derived therefrom, and from the interposed and surrounding adipose tissue; the connexions consisting of vascular communications and of nervous distribution-an abundant distribution of organic or ganglial nerves in connexion with the ganglia and plexuses supplying 6. II. FOREIGN BODIES IN THE RECTUM, AND the urinary, generative, and intestinal viscera -an evident accession of spinal nerves, both LACERATION OF THE RECTUM AND ANUS, although sensory and motory, to these nerves and gan- strictly belonging to the surgeon, should receive glia, and to the structures of the rectum and due attention from the practical physician.anus, this accession becoming more marked A. Foreign bodies may be lodged in the rectum and abundant as the anus is approached-and in three ways: 1st. The body may have been the muscular apparatus with which the out- swallowed, and have passed along the alimentlets of the intestinal, the urinary, and the gen- ary canal without occasioning much or even ital canals are provided, combine to associate any disorder until it reached the lower part of various phenomena affecting these parts, and the rectum, where it is retained. 2d. Concreto develop numerous sympathies in disease. tions may form in the bowels, or indigestible A knowledge, or a due recognition of these substances may collect and concrete in them, sympathies, especially in respect of their sources or gall-stones may pass into them and occaand relations, very materially assists our re- sion obstruction in the rectum. searches into the nature and treatment, not these are not always foreign to the œconomy, only of the affections to which the intestinal they are as respects the healthy functions of outlet is liable, but also of those which impli- the bowels, and there act as foreign bodies. cate the rest of the canal, and which are seated 3d. Various substances or bodies may be introin the urinary and sexual organs. This knowl- duced accidentally or voluntarily into the recedge, moreover, is often one of the chief aids tum through the anus, and occasion mechanical which we possess in the appropriate adminis-irritation, or obstruction, or ulceration, or intration of curative means. flammation, according to the nature, form, or

4. (d) The diseases of the rectum and anus consistence of such bodies.

Although