Neither age nor sex are exempt from this strictural change, although it more usually selects the grown up and female portion of society. It is, generally speaking, the consequence of constipation, or the reverse—diarrhœa or dysentery—or it may follow in the wake of child-bearing. Piles are a frequent precursor. The ordinary symptoms are at first a slight difficulty in voiding the fæces, which assume the form of the passage through which they have to pass, presenting at one time a flattened tape-like shape, at others a spiral appearance, and again the natural form, but of very small diameter.
As the disease advances, the pain increases, upon going to the water-closet, and after the act may be observed a small or copious discharge of mucus, or blood, from the anus. If the bowels be constipated, there is necessarily a great deal of straining during fæcation, that soon establishes spots of inflammation that rarely resolve, but run on to ulceration; small lodgments then of fæcal matter take place in the cellular membrane; and without detailing the pathological phenomena, it may suffice to say, that sooner or later the whole rectum becomes diseased, and fistula, with its attendant miseries, lends a speedy help to close life’s brief pilgrimage.
Patients afflicted with rectal diseases lose flesh rapidly. From the constant pain and annoyance they endure, their general health gets undermined, the digestion becomes faulty, the countenance flags and looks care-worn, hectic fever awaits the break-up of functional regularity, and a lingering exhaustion closes the scene.
Stricture of the rectum is a curable disease; but the less complicated, the greater are the chances of recovery. The principles of treatment bear a near resemblance to those for stricture of the urethra. After having ascertained the situation and size of the contraction, a proper-sized bougie may be introduced, and suffered to remain as long as it occasions no inconvenience. The introduction should be repeated every or every other day, increasing the size of the bougie until the dilatation be fully perfected. After vigilance is necessary to prevent a recurrence, and the bougie can not with propriety be entirely laid aside, or the disease will return with increased violence. There are, however, cases that require more imperative means, such as the use of the bistouri, an instrument for the division of stricture of the rectum, which, if the resort be objected to, it behooves persons with the premonitory symptoms to attend to them, that the operation may be rendered unnecessary. There are many excellent palliative medicines that the invalid will derive much comfort from in diseases of the rectum; and enemata constitute a powerful means of relief. The title of stricture of the rectum is fortunately more familiar than the disease is frequent; and what is more consolatory to persons of feeble health, the complaint seldom extends beyond two or three inches from the orifice, so that it need not be feared beyond the reach of relief. See annexed drawing:—
| 1. Rectum. 2. Orifice of Rectum. 3. Stricture of the Rectum, with internal hæmorrhoids in the lower portion. View larger image |
1. Rectum.
2. Orifice of Rectum.
3. Stricture of the Rectum, with internal hæmorrhoids in the lower portion.
There are some surgeons who state all diseases to emanate from a disordered liver, a weak stomach, or a “broken wind;” and there are others in this town who are never consulted but they deem the use of the rectum bougie indispensable. The limit to structural disorganization of the bowel is not afforded by stricture; there are, unfortunately, many diseases springing therefrom, and many totally independent of such; but their detail here would exceed the titular object of the book. Enough has been stated to convince any person teased with any of the enumerated symptoms, that however simple may be his malady in his own opinion, it is impolitic to overlook or neglect it.