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February 19, 1898


Author Affiliations

Lecturer on Diseases of the Rectum in the Cleveland College of Physicians and Surgeons (Medical Department of the Ohio Wesleyan University), Surgeon for Diseases of the Rectum in the Cleveland General Hospital, Member of the American Medical Association, Member Ohio State Medical Society, Member Cleveland Medical Society, Member Cuyahoga County Medical Society, etc. CLEVELAND, OHIO.

JAMA. 1898;XXX(8):406-413. doi:10.1001/jama.1898.72440600006002b

I should be unmindful of the history of human experience should I harbor the hope that the several affirmations set forth in this paper would be accepted without disagreement by a body of medical men. Remembering, however, that there is very little progress in knowledge except along lines where soundest casuists doubt, I propose for discussion the problem of difficult defecation in infants.

It is generally recognized that infants strain at stool.

The infant strains at stool because of the imperfect development of the anatomic features concerned in the mechanism of expulsion. These are as follows:

  1. The infant's lower gut is muscularly deficient.

  2. Its mobility within the abdomen is obstructive to defecation.

  3. The rectal valves are obstructive.

  4. The infant's anus not being sufficiently expansible is also obstructive.

The specimens of infant recta and sigmoid here shown are the first taken in my research on this subject, and are fairly illustrative