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of a well-made double-action pump. Before using the injecting apparatus it should be filled with fluid, otherwise the air contained will be forced into the patient's bowels, and cause much pain and annoyance: this precaution is highly necessary, for it is astonishing how much suffering will be induced if it is disregarded.

It is stated by all English writers on the subject, that diseases of the rectum prevail almost entirely in the better classes of society: from opportunities I have had, I can vouch that this statement is erroneous, and that they exist among the working classes to an incredible extent; but from certain prejudices and popular opinions they entertain, as well as for other reasons, they seldom seek relief at our hospitals.

CHAPTER I.

IRRITATION AND ITCHING OF THE ANUS.

Itching at the anus is a very common affection: it is more generally a symptom of disorder or irritation in some portion of the alimentary canal than a substantive disease; but so distressing is it in many cases, that it forms the most prominent feature of the patient's ailments. It occurs more frequently at or after the meridian of life than at an earlier period, though it is occasionally met with at all ages. It is most commonly caused by the presence of ascarides in the rectum, or of other entozoa infesting some portion-of the intestinal tube; by the accumulation of faeces in the rectum and colon; by the improper use of mercurial and other purgatives; by irritation about the neck of the bladder and prostate gland; by derangement of the digestive organs, and a depraved condition of the excretions and secretions, particularly of the liver and kidneys. It may follow the recovery from dysentery, and very generally precedes and accompanies haemorrhoidal and other affections of the rectum. Females sometimes suffer much

from pruritus ani during the period of gestation; and it not unfrequently depends on derangement, or occurs at the cessation of the menstrual function. Errors of diet, particularly the indulgence in highly-seasoned dishes and too great a quantity of wine, will produce it; unwholesome food will also have the same effect: this was illustrated in the case of a professional friend who suffered severely from this affection, induced by indulging his taste for game that had been kept till it had become completely putrid: the disease left him shortly after the shooting season was over; and the following year, being dissuaded from gratifying his appetite for the unsavoury food, he was free from the affection, save on one or two occasions when he could not refrain from partaking of some birds that were particularly high.

Itching of the anus commonly occurs in feeble and debilitated constitutions; and is sometimes accompanied by an eruption of papula) or tubercles, which may also coexist in other parts of the body; but in the greater number of cases no eruption will be perceptible. The itching is often most distressing on getting warm in bed, and frequently prevents the patient sleeping till he is completely worn out.

When the disease is of long standing, and the patient has yielded to the strong incentive to scratch and irritate the part, the skin around the anus will become thickened and furrowed, the furrows assuming a radiated direction diverging from the centre of the anus. They vary in number and length, and, though often deep, are generally free from ulceration if due attention to cleanliness is observed; but should this have been neglected, and irritating secretions have accumulated, inflammation will be induced, followed by excoriation and ulceration.

In the spring of 1854,1 attended a married woman, a patient at the Blenheim Street Dispensary, who suffered most severely from a pruriginous condition of the anus and vulvae. She was the mother of several children; and when she applied to me was in the fifth month of pregnancy. From the commencement of gestation she had experienced intolerable itching around the anus and posterior part of the vulvae, rendering her life perfectly miserable. The skin, by scratching and irritation, had become rough and indurated, and deeply fissured, but was free from ulceration. In consequence of not being able to sleep at night, and her torments being but little mitigated during the day, her general health was much impaired. The treatment consisted of aperients, tonics with acids, and various local applications; a solution of the nitrate of silver affording most relief. But although by the treatment adopted her sufferings were much diminished, they did not

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