The removal of haemorrhoids, poly poid growths, fistula, and fissure will en able remedies applied for the relief of a pruritus to affect a cure, when otherwise the disease will prove intractable. J. M. Mathews ("Diseases of the Rectum," '92, pp. 494-97) alludes to a fact which is worthy of emphasis, viz.: that when pru ritus is established, the treatment of any organ or local condition which caused the affection will not cure the pruritus.
The pruritus associated with varicose veins of the rectum may be relieved by measures calculated to tone up the part and to lessen any tendency to congestion. Bathing the anus night and morning and after a movement of the bowels will often accomplish this purpose. To prove efficacious a sponge must be soaked in cold water and squeezed dry by press ing it against the anus. This procedure must be repeated about a dozen and a half or more times at each bathing. An other excellent treatment is to use an injection into the bowel daily of about 2 drachms of the following formula: 4 Fluid extract of hamamelis, 1 fluidounce.
Fluid extract of ergot, 2 flui drachms.
Fluid extract of hydrastis, 2 flui drachms.
Compound tincture of benzoin, 2 fluidrachms.
Carbolized olive-oil or linseed-oil (oil, 5-per-cent. carbolic acid), 1 fluidounce.
M. Shake well before using.
Sig.: One to 2 drachms as an injec tion.
Pruritus Ani per se.—All discoverable local or constitutional causes of this dis ease having been excluded, we are brought to the consideration of a class of cases, by no means small in number, to which the term "neurotic" has been ap plied. That the condition is due to a neurosis, reflex or otherwise, is a little difficult to confirm, but it is a plausible explanation, and is a theory warmly ad vocated by Mathews. These cases often tax the physician's resources to their limit. What relieves one patient will utterly fail in another, and what gives relief for a time may lose its effect en tirely. Furthermore, it is impossible to state, with any degree of precision, as to the form in which remedies should be used, for, as stated by the Allinghams, "in cases which appear best suited to ointments the ointments may utterly fail, and a powder which you feared would be utterly useless may effect a cure." Therefore they advise their readers "to ring the changes between ointments, lotions, powders, and caus tics." Hot water applied as hot as can be borne to the region of the anus, while it may temporarily increase the itching, acts as a temporary relief when employed at bed-time, provided the parts be not rubbed. It also paves the way for the application of other remedies, by making the parts more susceptible to their ac tion.
Among the curative remedies recom mended may be mentioned black wash, nitrate-of-mercury ointment, nitrate of silver in solution, chloroform, compound tincture of green soap, carbolic acid, calomel ointment, balsam of Peru, tinct ure of aconite and of belladonna (equal parts), camphor and carbolic acid (equal parts), menthol, and the hyposulphite of sodium.
The treatment which tends to the best results is a light breakfast, no luncheon, a good dinner, plenty of hot water an hour before and between meals, and correct. habits. One method is conducive to the best results in all cases where no exciting cause or causes remain: that of stretching the rectum under anesthesia for from three to five minutes. After this, a sharp curette
should remove every vestige of the thickened and parchment-like mem brane. Mathews (Dunglison's Col. and Clin. Rec., Aug., 'OS).
Combination most relied upon: Car bolic acid, 10 to 20 parts; salicylic acid, 2 to 10 parts; boric acid, 5 parts; glyc erin or cold cream, 100 parts. There is always an existing cause for the disturb ance, and this should earnestly be sought and relieved. Ichthyol may be used with benefit when there is pain. J. P. Tuttle (Med. News, Jan. 27, 1900).
Prolapse of the Rectum.
The term "prolapses," or "procidentia recti," signifies a protrusion through the anus of any part of the rectum, consist ing of mucous membrane, either alone or combined with one or more of the coats of the bowel. Occasionally the pro truded part contains within its folds a loop of the small intestine.
There are three forms of rectal pro lapse: (1) prolapse of the mucous mem brane alone [partial prolapse]; (2) pro lapse of all the coats of the rectum [pro cidentia recti]; and (3) prolapse of the upper portion of the rectum into the lower, called invagination, or intussus ception, in other parts of the intestinal tract.
Prolapse of the Mucous Membrane.— In this variety the mucous membrane only is extruded, sliding away, as it were, from the muscular coat by the stretching of the loose submucous tissue which con nects the two coats. The prolapse, in these cases, is necessarily limited, the protrusion being seldom more than an inch or two in length. This condition may occur at any age, though it usually occurs at the two extremes of life.
Symptoms.—The prolapse may be im mediate as a result of vomiting, coughing, etc., or it may come on more gradually. The more the bowel is protruded, the more the parts become stretched and re laxed and favor the repetition of the descent of the rectum. When the attack conies on suddenly, there is apt to be considerable pain, and a tumor-like mass, red in color, projects from the anus. Frequently, blood is seen oozing from its surface. If the prolapse be of one that has often occurred, the mucous membrane shows evidences of superficial catarrhal ulceration. In some instances the submucons inflammation causes the surface of the protrusion to appear per fectly smooth, but usually the mucous membrane appears as bright-red folds, with sulci between them, which radiate from the anal aperture. At first the pro trusion only occurs at stool, and is read ily reduced; in some cases it becomes spontaneously reduced. In chronic cases it becomes more difficult to replace, and may occur independent of fxcal action. In these cases the mucous membrane is greatly thickened and the submucosa more or less infiltrated; a muco-purulent discharge is common, while bleeding, though slight, often occurs. The pro trusion of internal haemorrhoids is fre quently associated with prolapse of the mucous membrane; this condition, how ever, ought always to be readily dis tinguished from the disease under con sideration. }hemorrhoids are more iso lated and are much firmer to the touch.