ANUS, Pruritus of.
The removal of the cause usually effects a speedy cure when this trouble some affection arises from the irritation of anal fissure, fistula, piles, polypi, condvlomata or threadwonns. Where much eczema is present, the treatment of this disease should be closely attended to, and Tarry compounds are indicated in combination with remedies used to allay the incessant itching.
The pruritus may be the local manifestation of a general neurosis. Such patients often suffer from insomnia, and the slightest scratching of the skin about the anus is sufficient to bring on a severe nocturnal attack of pruritus. The general neurotic condition, often the result of prolonged mental strain, anxiety, or grief. demands constitutional treatment, as change of scene, brain rest, tonics—like sea-bathing--Phosphorus, Zinc, Arsenic, Quinine and Iron. Valerianates and Antipyrine in small doses, by lessening the irritability of the peripheral sensory nerves, are of great value.
The Ungt. Conii, which may he made of double the old B.P. strength, is the best local application. It should be inserted with the finger after defecation and upon retiring to rest. The proprietary ointment known as Resinol is also valuable, and it may be used mixed with an equal weight of the hemlock compound, or the latter may be made into a suppository alone or with Ichthyol. Cocaine, Morphia, Belladonna and Menthol relieve the itching for a time, but often cause in the long run aggravation of the symptoms by inducing a hypersensitive condition of the sensory terminals.
An application containing 3o mins. Creosote or Carbolic Acid and 3o grs. Camphor in r oz. Lard ;s often useful, but Ungt. Conii will make a better basis than the lard. Where greasy compounds fail, the part, after a small cold-water enema and free ablution with cold or tepid water, may be freely dusted over with Bismuth Carbonate, Fuller's Earth, Zinc Oxide, or Calamina, and this form of treatment is valuable in women, where the anal pruritus is sometimes caused by a small quantity of vaginal discharge trickling over the anal region, even when there may be no prominent vulvar irritation complained of. Lotions are'seldom efficacious; the parts
may, however, he advantageously sponged over with Borax or Boric Acid solution, which effectually removes the remnants of the greasy applica tions before renew ng them again. Solution of Chloral Hydrate, r dr. to 5 oz. water, may be tried. Sometimes the introduction of a pledget of lint soaked in Lig. Cale. Chlorinate; within the anus affords relief till the patient falls asleep.
In long-established cases no relief need be expected until the patient has been taught to avoid scratching the anal region, and it is a practical point of great value in the treatment to inform him that he may relieve the itching of the anus by vigorously scratching the skin over the buttocks, and this will not do any harm.
Banks's plan of searing the anal margin by the thermo-cautery often affords relief, hut the writer has seen it produce afterwards an intolerable aggravation of the condition owing to the formation of scar tissue and thickening of the skin in the anal folds.
In intractable cases defying all local applications Ball's method of dissecting up a flap of skin on each side of the anus, after which all the underlying cutaneous nerves are to be severed, should be resorted to.