Under the name of lupoid ulceration Ball describes the so-called rodent ulcer as one in which the essential element is a chronic intractable form of ulceration in the neighborhood of the anus and genital organs. Cripps states that this disease is seldom met with in the rectum, and that few instances of its recurrence are on record. S. G. Gant has called at tention to the fact that this variety of ulcer is frequently confused with cancer of the rectum and with tubercular ulcer ation, owing to the severe pain experi enced, the amount of tissue destroyed, and its tendency to break out again and again,as well as its liability to increase in extent in spite of all treatment. Young and old persons are alike subject to it. The same authority states that this ulcer ation is not always rapid in its course, some patients living for years, while the disease slowly spreads and death finally ensues as the result of hemorrhage or from a diarrhoea and its attending state of exhaustion. It is a superficial form of ulceration, and the character of the dis charge is principally serous, containing but little pus.
The chancroidal form of ulcer of the rectum is rarely seen in this country. I have seen but one such case. Messrs. Andrews state that in the hospital of Saint-Lazare, in Paris, they were shown numerous cases of chancroid of the rec tum and the anus, caused by the practice of sodomy. These authors have also met with a few instances of this disease in cases of retrovaginal fistula in which the virus entered the rectum through the fistulous opening.
Regarding the syphilitic forms of ul ceration of the rectum, it may be said that, in this country, at least, the only common manifestation is the mucous patch. It is my belief that the mucous patch exists more frequently within the rectum than is generally believed. In the late stages of syphilis a form of ulceration occurs in the rectum which often assumes extensive proportions and results in the formation of stricture of the bowel.
Treatment.—In dealing with all cases of rectal ulceration rest is of primary im portance, for the healing process will not take place if the patient be permitted to follow the usual habits of life. The medicinal treatment must be adapted to the nature of the lesion as well as to the relief of any general disturbance. In cases of simple ulceration the use of an enema of flaxseed-tea is of advantage in cleansing the bowel and to procure an evacuation. A pint or more may be used once or twice a day. An astringent injection may be employed, such as fluid extract of hydrastis, 1 to 2 tablespoonfuls to 6 or S ounces of water; a solution of nitrate of silver, 2 to S grains to the ounce. Insufflation of various powders may be used with benefit, such as iodo form, subiodide or subgallate of bis muth; calomel and the subnitrate of bismuth, equal parts, etc. In this con dition I have found the following injec tion valuable:— 1; Fluid hydrastis, 2 drachms.
Fluid extract of ergot, 2 drachms. Compound tincture of benzoin, 2 drachms.
Fluid extract of hamamelis, 2 ounces.
M. Sig.: To be well shaken before using. One-half ounce at a time, to be injected into the rectum every day.
Pain can be allayed by the use of iodo form suppositories, 5 to 10 grains each, used every six to twelve hours. Opiates are injurious and sometimes dangerous.
No plan of treatment with which I am familiar will do much toward perma nently curing the tubercular ulceration. Curettage and the application of iodo form have been used with temporary success only. Similar results are given by most writers.
In syphilitic ulceration of the rectum we must depend upon mercury and the iodide of potassium. Antiseptic ment of the local condition must be regularly and frequently carried out upon general principles observed in ul cerative processes elsewhere.
- The most common cause of rectal stricture is septic ulceration, and the next most common is probably protracted labor. Syphilis and dysentery, thought by some to be very common as a cause, are responsible for comparatively few eases. The following operation is recom mended: a preliminary colotomy is first performed so as to enable the surgeon to wash the bowel and in this way pro tect any ulceration present above the stricture so that it may have a chance to heal by avoiding contact with Neal matter. After dilating the sphincters, a circular incision is made around the muco-entaneous margin, separating the gut from the sphincters and freeing it upwardly by dissection. Slight traction is made until healthier gut appears at the anal opening, and the loosened por tion of the rectum may be excised. Two eases in which this operation brought about perfect recoveries. F. C. Wallis (Brit. Med. Jour., Oct. 6, 1900).
The body should be protected from undue exposure to cold and the diet should be carefully regulated. Stale bread, meat, milk, eggs, etc., may be used, but vegetables, as a rule, are to be avoided.
Congenital Malformations of the Rec tum and the Anus.
The proportion of infants born with malformations of the lower portion of the intestinal tract is comparatively small. Harrison Cripps states that 1 case occurs in about every 45SS births. So far as published reports show, males form the larger percentage of cases.
Malformations of the rectum and anus result from arrested development of the so-called gut-tract during the early stages of foetal life.
The most practical classification for the use of the general practitioner is that of J. M. Mathews:— Congenital malformations of the anus: (1) narrowing or partial occlusion, (2) total occlusion, and (3) complete absence.
Malformations of the rectum: (1) par tial occlusion, (2) complete obliteration, (3) unnatural termination, (4) complete absence of the rectum. and (5) communi cation with the vagina.
The symptoms are self-evident in cases of malformations of either the rectum or the anus. In all the varieties—except that of the partial occlusion of the anus and in those somewhat rare cases in which the bowel opens into the vagina, urethra, or bladder, or in some abnormal, but external, surface of the body—there will be signs of total obstruction of the bowels, such as distension of the abdomen and possibly faecal vomiting. (See also TUMORS OF THE RECTUM AND Axus. )