PROCTITIS.
The cause of the inflammation of the rectum is most frequently found to be an extension of the dysenteric process from the colon, and in the cases of females it is often of gonorrhoea] origin.
The first step in the treatment is to remove when possible theexciting cause, and a search should be made for foreign bodies, fissures, polypi, piles, ulcers, stricture or worms.
In the acute stage, warm poultices, hot fomentations or hot sitz baths may be tried, after which, or whilst sitting in the bath, the rectum may be irrigated by a stream of warm water. If arrangement is made for the return of the water, the injection can be carried out for considerable periods without dilating the inflamed bowel or exciting spasm in the sphincter. Iced water injections may be thus used, and at a later stage antiseptic solutions, as Boracic Acid, and at later stages still astringent agents may be injected.
Tenesmus, which withstands warm or cold irrigation, must be relieved by enemata of Laudanum and Starch, or by a 1-gr. Morphia suppository. A most reliable local anodyne is the late B.P. Ungt. Conii applied by the finger or by an ointment introducer. The bowels must be kept free by Castor Oil administered by the mouth.
The chronic stage of proctitis is best treated by dilatation of the anal sphincter and a thorough brushing of the mucosa by a 5 per cent. solution of Nitrate of Silver or 25 per cent. Argyrol. (See also under Anus, Fissure of, and Pruritus of, where a list of local anal sedatives will be found.) Ulceration of the rectum is often present in the chronic stages of dysenteric, tuberculous, or syphilitic inflammation, and there is little hope of relieving the accompanying proctitis as long as an open sore remains. The best procedure is to forcibly dilate the sphincter and curette the surface of the ulcer, after which Nitrate of Silver may be applied in strong solution or used as the solid stick. When the ulcer can be easily reached the speediest and most satisfactory method of treatment is excision by the knife. In severe cases healing will not take place till a temporary opening is made in the colon to divert the faxes through an artificial anus. The proctitis and ulceration which is caused by long i mpacted scybalie generally resolve soon after the evacuation of the fieces.
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