This fact of a possible incarceration, which, however, seldom hap pens in children, together with the danger of hremorrhage or infection, makes an otherwise good prognosis for this condition more serious.
The object of the treatment is to reduce the prolapse, and to hold it in place. The first procedure is much the easier and succeeds in most cases, except in those of incarcerated prolapse, a very rare occurrence in childhood.
It is best to proceed by covering the prolapsed portion of the rectum with a bit of gauze, well spread with vaseline, and by pressing slowly from the periphery, so to replace the tumor into the rectal cavity. This often permanently succeeds if one is careful that no constipation occurs, and that the child passes its movements with as little abdom inal pressure as possible, as when it sits on the vessel with its legs hanging down, or w-hile in a dorsal position. When this does not succeed, a bandage can be applied, as has been often recommended (by Basewi, L. Furst and others).
Local treatment of the rectal mucosa, tending to contract it, can be tried. Thus, Hippocrates sprinkled a mixture of rind of pomegranate, cypress seeds and alum, upon the prolapsed mucosa. Lloyd strokes the
part viith lunar caustic, Woods, Allingham and others recommend touching it with fuming nitric acid, Broca, enemata of cold borax water. When these procedures do not succeed, the application of red hot iron, or therrno-cautery, must be considered, either linear or punctiform cicatrices of the mucosa are made at the point of transition between the anal epithelium and the mucous membrane. I have seen permanent cure result from both procedures. As has been said, an irreducible prolapse in childhood is exceptional, and, therefore, the operative removal of the mass, or resection of the prolapse, as has been per formed by Heineke, Hochenegg and others, is rarely considered. Broca, who has had large experience in the surgery' of children has had, as yet, no opportunity to perform this operation.
It is evident that, after a complete and satisfactory replacement of the prolapse, care must be exercised to improve the child's nutrition, to overcome the amernia, and to regulate the digestion.