Rectum

“ The inflammation extends to the cellular tissue round the rectum, with swelling and increased pain; the pain is aggravated by pressure, and the patient is unable to sit erect. As the painful symptoms abate, puriform discharge from the membrane of the gut takes place, and often is very profuse. The morbid action sometimes extends to the other intestines, attended after a time with mucous or even bloody evacuations. When the affection is confined to the rectum, the feces and vitiated secretion are distinct from each other, and the former are usually of their natural appearance ”

“ A patient who had been told that her womb was retroverted and pressing upon her rectum, interfering with the descent and passage of the feces, was troubled with hypersensitiveness of the lower bowel. This condition Mitchell designated as the excitable rectum. Patients in whom it is present apparently have diarrhœa; certainly they have many movements daily. Single stools, however, are small, and may be quite natural or they may seem constipated. The smallest accumulation of fecal matter in the rectum excites to defecation. One case had small scybalous passages every half hour. ”

“ The contractility of texture is, in the system of which we are treating, in proportion to the number of fleshy fibres. Thus, all things being equal, the rectum, when empty, contracts upon itself with much more force than the other large intestines; the contraction of the ventricles is much greater than that of the auricles, and that of the œsophagus is much greater than that of the duodenum, &c. ”

“ If the accumulation occurs in the rectum, the introduction of a tube or bougie is prevented by the impacted mass, which can be gotten away only by the fingers or by some instrument. The colon and rectum may be dilated to their utmost capacity with an enormous amount of feces, enough to fill a common-sized pail, and both the patient and medical attendant be deceived as to the sufferer's condition by the fact that he has his daily number of stools. ”

“ After surrounding the small intestine it becomes the posterior layer of the mesentery and so again reaches the posterior abdominal wall, down which it runs until the rectum (R) is reached. The anterior surface of this tube is covered by peritoneum to a point about 3 in. from the anus, where it is reflected on to the uterus and vagina (V) in the female and then on to the bladder (B) ; in the male, on the other hand, the reflection is directly from the rectum to the bladder. ”

“ In a person prepared for the operation the rectum is emptied by purgative medicine and an enema; and the bladder, which in a stone patient seldom contains more than eight ounces of urine, occupies the hollow of the flaccid or contracted rectum. Care has been taken not to distort these parts by the introduction of an instrument into the urethra, nor by more distention than was sufficient to preserve a general outline. ”

“ It is more probable that it is in some way subservient to defecation. The rectum is nothing more than the terminal portion of the cæcum: it is always short, and provided with a sphincter or strong annular muscle, which closes the aperture when not in action. Its muscular tunic is very thick, its parietes very variable in form, and it is from them that the excrements acquire their particular figure. ”

“ Now this weight, in a flexible organ like the colon, must cause a sagging down, exerting a serious strain upon its attachments to the abdominal wall, and by its pressure upon the sphincters will induce prolapse of the rectum. That is one reason why so many people find it almost impossible to receive enough water to make the treatment successful. When a physician, or trained nurse, is administering a high enema, it is a common practice to hold a folded towel against the rectum, to guard against this pressure and its possible results. ”

“ If the abnormally constricted condition of the anal orifice has been growing from bad to worse for years, the locality immediately above the anal canal will become dilated or cavernous (caused by retained feces or gases) , which cavity is called ballooning of the rectum. When a speculum is introduced into the rectum (as shown on page 14 of pamphlet How to Become Strong) , and through it a bent probe is inserted to determine the depth of the dilatation or abnormal cavity, it is as if one were poking inside of an inflated balloon: hence the name. ”

“ Neglect to establish or continue a habit of daily regularity in defecation leads to the accumulation in the rectum of masses of feces. Resisting the desire to empty the bowel interrupts the necessary reflex acts, and finally the muscular excitability and response to the presence of feces are entirely wanting. The continued contact of fecal matter with the mucous membrane wears out its susceptibility; the over-distension of the rectum enfeebles the power of its muscular wall, as is the case when all hollow muscular organs—stomach, heart, bladder—are overstretched. ”

“ The process occasioning the separation of the mucous membrane from its areolar attachment or bed often extends the whole length of the rectum, giving the mucous membrane the loose and raised appearance that a piece of thin silk would have if laid on over that surface. The fatty or areolar tissue under the skin about the anus suffers likewise by being destroyed, leaving a hollow cavity or a large channel of great length under the skin. ”

“ The anal and rectal mucous membrane is of a firm and tough structure, similar to the integument at the bottom of a boy's heel. After many years' observation of diseases of the anus and rectum I am forced to conclude that as a rule inflammation exists in the tissues twenty or more years before the severe symptoms, such as piles, fissure, anal pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula, are sufficiently annoying to compel the sufferer to seek medical aid. ”

“ The propriety of introducing the whole hand into the rectum is very questionable. In occlusion of the gut by compression and traction the cause should be found, and, if possible, removed. An abdominal or pelvic tumor may be pushed out of the way of the compressed bowel, a cyst punctured, a displaced womb replaced.
[p. 865] Great care should be taken to support the strength of the patient by concentrated and nutritious food, and in the later stages by stimulants. When the bowels are distended by gas an injection into the rectum of ten grains of sulphate of quinia will often give marked relief. ”

“ When the external genitals cannot be removed, the vagina and rectum, after they have been freed from the surrounding tissues, are put on the stretch toward the head of the body and cut through as close to the pubic outlet as possible. When this is carefully done it is possible to secure the inner labia and the urethra intact. The rectum is cut as close to the anus as possible. The organs are then stripped up to the brim of the pelvis, then held up perpendicularly while the remaining connections are severed. ”

“ It is always better to precede by an injection of warm water, which may not only unload the rectum and give the patient greater confidence in the effort to extrude the parts, but washes away the mucous and retained feces in and about the sphincters. When the examination has been carried to this point and no satisfactory cause found to explain the trouble complained of, the finger and speculum will be required to complete the diagnosis. ”

“ The alimentary canal has, typically, the form of a bent tube with a ventral concavity, constituted (when an anus is present) of three sections, viz. an œsophagus, a stomach, and a rectum. The œsophagus and sometimes the rectum are epiblastic in origin, while the stomach always and the rectum usually are derived from the hypoblast [139] .
Fig. 218. Diagram of an embryo of Pleurobranchidium. (From Lankester.)
f. foot; ot. otocyst; m. mouth; v. velum; ng. nerve ganglion; ry. residual yolk spheres; shs. shell-gland; i. intestine. ”

“ I sometimes direct that the woman should take every day a small dose of oil, in a cup of water gruel or oatmeal gruel.
Severe pain in the bowels and rectum is sometimes caused by a column of hard and indurated feces, which remain for a number of days in the rectum and colon. Not only pain but inflammation, and other serious ills, may result if such a condition is neglected. If taking injections does not suffice to give relief, manual assistance is necessary. ”

“ It is very fortunate for the sufferer from ballooning of the rectum to have in or near the anal canal those painful hints or symptoms of a very grave and long existing disease whose constitutional symptoms were well marked but attributed to other causes, especially to disease of the liver—an organ of so much solicitude that the poor liver-worshipping patient ought to receive more gracious response from it. ”

“ Wounds of the cæcum and ascending colon are those which have the best prognosis, and after these of the rectum. The comparatively good prognosis in these parts is what would be expected, on account of their greater fixity, and lesser tendency to be covered by the small intestine.
An extra-peritoneal wound of any of these portions of the bowel is more dangerous than an intra-peritoneal, and more likely to give rise to septicæmia. ”

“ By asking the patient to strain down moderately, its surface will be thrown up against the end of the finger and in this manner properly explored.
Fig. 11.—Lateral section of rectum; normal curve. R. Rectal pouch. C. cul-de-sac of the rectum. E. S. External sphincter. I. S. Internal sphincter. H. Hilton’s white line. P. Position of prostate gland.
A digital examination reveals, in the normal state, a soft, velvety, unbroken mucous membrane, the parts pliable and yielding, with no reflex excitability of the sphincters. ”

“ The most common displacement, or the most common way for the womb to tip, is backwards and at the same time it usually falls downward. You remember, the rectum is directly back of the womb, so, if the womb is tipped backwards, it presses against the rectum. This tends to prevent the feces, or bowel movement, from passing out naturally and helps to produce constipation. ”

“ After the small intestine is opened the enterotome is introduced through the ileocæcal opening and the large intestine cut in the anterior tænia as far as the rectum. The opening of the intestine within the body should be left until all the other abdominal organs have been examined, because of the disagreeable mess made by the escape of the intestinal contents into the cavity. ”

“ The labrum is large, and forms a chamber above the mouth, into which food is driven by the limbs, as in the Phyllopoda, food being taken while the animal swims or lies on its back. The oesophagus runs vertically to join a small stomach, which bends sharply backwards and passes gradually into an intestine. In the last segment of the abdomen the intestine joins a short, thin-walled rectum, provided with radial muscles, by means of which it can be dilated. The dilatation of the rectum leads to an inhalation of water through the anus, which may possibly serve as a means of respiration. ”

“ Those formed of wood have in my hands answered well, and have often achieved a success that has exceeded my expectations. The shape and size best suited to individual cases experience soon teaches. A not unfrequent obstacle in treating cases by the rectum plug will be found to consist in the intolerance by the rectum in some patients at first of its presence ”

“ Has for many years suffered from all the inconveniences of a fissure of the rectum, combined with bad digestion, undue nervous excitability, and sleepless nights. Is very anxious to be cured. It being thought that all these symptoms might be due to a painful fissure of the rectum, the ordinary operation for this affection was performed on December 12. The bowels were opened in a few days without pain, and the fissure was healing well. ”

“ Fig. 269.—Portion of tracheal system of nymph of Aeschna cyanea. R, R, R, R, rectum; A, anus; td, dorsal; tv, ventral, tracheal tubes; M, Malpighian tubes. (After Oustalet.)
These rectal gills obtain air from water admitted into the rectum for the purpose; the extremity of the body being armed with projections of variable form, that can be separated to allow ingress and egress of the fluid, or brought into close apposition so as to close the orifice. The water so taken in can, by some species, be ejected with force, and is used occasionally as a means of locomotion. ”

“ It may be stated without reservation that the rectal canal cannot be involved in chronic inflammation without involving the anal canal, and vice versa. One half of civilized people are suffering from chronic constipation, and very nearly the remainder from semi-constipation. The semi-constipated are now under consideration. The chronic cases are those that have a complete impaction of feces in the terminal portion of the sigmoid and rectum ”