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tum seems to be that by Brodie, in 1827, publislied in the London " Med. and Phys. Journal." Breschet, in the dic- tionary in sixty volumes, only mentions lacerations and fissures of the sphincter and of the end of the rectum. In 1833 Mayo reported the case benoquin cream 20 of a woman who tore through the recto-vaginal septum in an effort at defecation. Bushe, Pyl, Adelmann, monobenzone benoquin Stein, and Needham have published new cases; but there is a marked absence of any reference to the condtion in the standard works on dis- eases of the rectum. Liston, Quain, Syme, Curling, Smith, Allinghara, and the dictionaries of Dechambre and Jac- coud, limit themselves to mentioning the accident, and to referring to the cases of Brodie and Mayo. Spontaneous rupture of the rectum is a very rare accident. Including that of Roch^, there are only nine recorded cases, and these are all in adults, and six out of seven in females. In the five cases benoquin price which are reported with com- pleteness, the existence of old and ex- tensive prolapsus is noted in four. The rupture is always produced at the mo- ment of an effort ; four times during defecation, once in vomiting (Brodie), once in an effort to lift a heavy weight (Stein). benoquin cream for sale The case of Roch6 comes un- der the first class, though the effort oc- curred during attempts at replacing the prolapse. None of tlie observations make any reference to previous losses of blood, haemorrhoids, or inflammation of the rectum ; benoquin 20 the patients suffered from prolapsus, but with that exception were well. The rupture occurred sud- denly (the hour is often mentioned) at the time of making a violent abdominal expulsive effort. Suddenly acute buy benoquin cream pain is experienced in the abdomen, and a large mass is found protruding from the anus. Sometimes it is noted that a flow of blood preceded the issue of tlie intestine. The general condition be- comes speedily aggravated, the face becomes pale and llippocratic, and the extremities cold, though the intelligence remains clear. It appears that reduc- tion of the prolapse immediately fol- lows the issue of the intestines. Very soon the efforts of the patient to expel the mass with which the rectum is filled cause fresh portions of the intes- tine to escape from the abdomen, and these spread themselves out between the thiglis. The visceral mass which is thus expelled is generally large, and composed of small intestine with its mesenteric attachment. buy benoquin The length of the intestinal loops may be two benoquin monobenzone cream metres, or even five benoquin online (Adelmann). In Stein's case the mass included several loops of small intestine, and two benoquin cream inches of tlie cjBCum. Among the intestinal loops, those which are most altered in appear- ance are those which have issued from the body first. These have a violet color, sometimes livid ; their walls in some places show spots of benoquin vitiligo ecchymosis, and are generally inert and sometimes paralyzed ; they may become much dis- tended by gas and faices. Their serous surface is dulled, and sometimes cov- ered with exudations, and the mesentery participates to a greater or less extent in the changes. If an effort is made to practice the rectal touch, a pedicle may be followed up into the rectum, and by this means the rupture may sometimes be found. The relaxed spliincter op- poses no obstacle to the exploration. If the rupture be high enough buy benoquin online up, the mass of intestine may prevent the en- trance of the hand, and in this way prevent the diagnosis of the seat of the lesion. The existence of a rupture is, however, none the less evident ; the ap- pearance of the serous surface of the intestine, and, above all, the presence of the mesentery, should prevent any possibility of mistaking the condition for invagination. Under such circum- stances one indication exists — reduc- tion. This is not always an easy task. Brodie and Adelmann encountered in- surmountable difficulties, and were forced to have recourse to laparotomy. Needham was forced to remove the constriction before reducing. Stein, after having tried in vain the reduction by elevating the pelvis, cut the intes- tine to allow the escape of the con- tents, with the ho])o of establishing an

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