If possible, the cause of the prolapse should be ascertained. A catarrhal . dition of the rectum, a polypus, rides, a phimosis, or a stone in the blad der should always receive the proper treatment before a satisfactory result can be obtained in dealing with the la psus.
Astringent applications for the relief of prolapsus are generally useless. Cold water applied to the anus, either with a sponge or as a douche, is as serviceable a remedy as any drug. The astringent remedies advised, in this connection, are: alum, tannin, sulphate or chloride of zinc, chloride of iron. etc.
In chronic prolapsus ani the introduc tion of fragments of ice into the anus during the reduction of the prolapse has always been successful even in the grav est cases. The suppositories should be cone-shaped, artificially frozen, measure 2 V, to 3 inches in length, and in diameter at the base 1 to 1 V, inches. One of these is enveloped in a piece of iodoform gauze, which should cover it like a glove-finger, and is pushed into the centre of the pro lapse, which can thus be readily reduced, the ice and gauze being carried up with the protruded bowel. Usually no painful sensation is produced and the tampon is not expelled. After each defecation a new gauze and ice tampon is introduced. The prolapse occurs more and more rarely, and soon ceases. This result is due to the relief of congestion and the increased contractility of the rectal tissues under the influence of the mechanical and thermic excitation. Hajech (Revue Men. des Mal. de l'Enf., Nov., *99).
Cauterization, either by the actual cautery or by the employment of the nitrate-of-silver stick is a very satisfac tory method. Excision of elliptical strips of the mucous membrane is some times necessary and often suffices for ef fecting a cure. Hypodermic injections into the coats of the bowel is not to be advised. Vidal, quoted by the Andrews, has used ergotine, in this manner, with asserted success.
lionig's operation for prolapse of the rectum consists in narrowing the anal aperture. 3 wedge-shaped piece is re moved front the edge of the anus, the elliptical incision being so made that one end lies within the anus and the other end on the outer skin. The excised
wedge includes skin, mucous membrane, arcolar tissue, and muscle. Care must be exercised in sewing up the deeper portions of the wound. his cases were thus op erated on and in two, after nine and three months, respectively, a slight return was noticed. In the others, up to the pres ent time, no prolapse had occurred. C. Francke (Dent. Zeit. f. Chir., Mar., '99).
The treatments to be recommended are: 1. For prolapse of the mucous membrane only: reclining posture, adhe sive straps. cauterization, or amputa tion. 2. For reponable, 11011 -ulcerated prolapse of all the coats of the rectum and colon the cause is to be removed, if possible, massage and electricity being tried. Should these fail, colopexy is indicated. 3. For incar cerated irreponable ulcerated prolapse: circular resection, according to the tech nique of Mikuliez and Nicoladoni. The operation of colopexotorny, proeto-coc cypexy, proeto-sarco-eoecvpexv, proeto sarcopexy, Gersuny's twist, and the circular suture of Thiersch are rarely indicated. ,T. Rawson Pennington (Cleve land Med. Gaz., Aug., 1901).
Non-malignant Ulceration.
It is a matter of surprise that erosions of the mucous membrane of the rectum are not more frequently produced and Lccome the starting-points of ulceration, as a result of the irritation to which the bowel is exposed from the presence and passage of fcecal matter. It is true that ulceration frequently exists and is not recognized; but, nevertheless, its fre quency, compared with that of other rec tal lesions, is extremely limited.
Symptoms. — Ulceration within the rectum, as a rule, occasions well-marked, though in no sense essentially pathogno monic, symptoms. The same signs are often observed in cases of stricture of the rectum. The doubts as to the nature of the trouble may readily be cleared by making a digital examination. The symp toms noted are pain, tenesmus, diarrhoea (often alternating with spells of constipa tion), and discharge. These also suggest dysenteric attacks, and it is no unusual experience to see cases of ulceration treated for dysentery.