272 MEDICAL JURISPRUDENCE When caused by injury rupture may take place at the point of impact, or in some cases at a distance from it. In the former case the margins of the rupture are clean cut, and in the latter they are usually ragged and irregular. Rupture usually occurs at the commencement of the jejunum, and in the lower three feet of the ilieum, but very rarely in the large intestine. However, it must be remembered that rupture of the large intestine at the junction of the sigmoid with the rectum may occur from straining at stool without the presence of chronic ulceration or any other disease. Death occurs immediately from shock or subsequently from peritonitis owing to the expulsion of the contents into the peritoneal cavity. In three out of ten cases of mechanical violence to the small intestine that came under my observation death occurred from peritonitis on the third, fourth and sixth day respectively after the rupture. In one case the intestine was diseased and it was the chronic ulcer that had given way. If a rupture is very small the mucous membrane becomes everted and closes the little opening and thus prevents the escape of the intestinal contents. The power of locomotion or other muscular exertion may be preserved after these injuries. Rectum.—Owing to its anatomical situation in the hollow of the sacrum the rectum is rarely injured except from wounds through the perinaeum and ischiorectal fossa, but it may rupture spontaneously. Allen37 reports a case in which a male, aged 54 years, felt a sudden moderately severe pain in the lower part of the abdomen, while walking to his work after his midday meal. On examination a transverse tear, 14 inches long, was observed in the anterior wall of the first part of the rectum. The rectum and splenic colon were normal. Fatal injuries of the rectum are sometimes produced by the forcible thrusting of a blunt weapon through the anus, a method of torture, which is occasionally resorted to in India for adultery and theft. Roy Chowdhury reported to me a case, in which he examined the body of one Bhogla, aged 11 years, and he found that a bamboo, 12 inches long, had been thrust through the anus into the abdominal cavity, where it produced a tear of the transverse colon and then entered the pleural cavity tearing through the diaphragm. A case38 is reported, where the husband of a woman inserted a chopstick into the rectum of a man, 30 years old, who was found in bed with his wife. The chopstick remained in the lower bowel for fifty days, and then penetrated the ascending colon making two per- forations and causing peritonitis. The chopstick was removed by an operation and the two perforations were repaired. The patient recovered. Severe injuries of the rectum may also occur from the self-insertion through the anus of a foreign body, such as a bamboo piece, a bottle, etc., owing to perverted sexual practice, from falling accidentally on an iron railing or any projecting point or from sitting forcibly upon a piece of a broken bottle or broken china. Pillai39 describes the case of a Burman male who sustained a penetrating wound of the anus by falling down a paddy heap, 14 feet high, on to a forked stick used for supporting a country cart. The wound involved the anus and surrounding skin. Two loops of the small intestine, each about 1J feet long, with a piece of omentum, about If feet long, were protruding through the wound and lying loose over the peri- nseum. The gut was lacerated, gangrenous and offensive. On examination by the fingers a gaping wound was felt on the right side of the rectum, extending into the abdominal cavity. The abdomen was tympanic and tender. Recovery took place after an operation. James40 also describes a case in which a farmer, 18 years old, while working in the hay fields jumped backward from a waggon and impaled himself upon the upright handle 37. Lancet, Sep. 4,1948, p. 378; vide also Arnold S. Aldis, Lancet, Sep. 25, 1948, p. 511. 38. Paul Teng, Western Jour. Surgery, Obstetrics and Gynaecology Oct. 1947 : Medical Press, Dec. 17, 19*7, ^ $45, - -- 39. Ind. Med. Gaz.> Sej^ 1933, j>. 519. 40. Lancet, Feb. 11, 18$9, p. 326.