1888 The Lancet  
SURGEON TO THE HOSPITAL. 'GENTLEMEN,-I wish to-day to call your attention to several cases illustrating the causes, effects, and treatment of chronic constipation, and to make some remarks upon the subject from the surgical point of view. CASE 1.-In the Egremont ward there is a young and apparently healthy man. He gives a history of gradually increasing constipation for the past two or three years; the bowels acting sometimes every second day, but often only every third or fourth day. This he
more » ... tributes to mere carelessness, and neglect to give the bowels the opportunity of evacuation. But during the last fortnight a fresh symptom has arisen, for which he comes to the hospital. It is this: that even when he feels the desire to defecate, he has great difficulty in obtaining a passage of fasces; so that, though the bowel feels full, he often gives up the attempt till next day; and this he is the more inclined to do because defecation is accompanied and followed by very severe pain. The pain radiates from the anus, is severe enough to make him feel sick and faint, and lasts from an hour to three hours after the bowels act. He begged me not to examine the bowel without an anaesthetic, as an attempt to do so had, he said, given him such great pain that he could not bear its repetition. The symptoms pointed so clearly to the presence of an ulcer of the anus that we deferred any examination till the bowels had been cleared by a dose of castor oil. Then he was placed under the influence of ether, and in the lithotomy position, and the rectum examined. The forefinger of each hand
doi:10.1016/s0140-6736(02)16034-x fatcat:rn4hntdkezhkrixiwen6wgdl6m