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CHAPTER II.

INFLAMMATION AND EXCORIATION OF THE ANUS.

Simple inflammation and excoriation of the anus is not of infrequent occurrence in warm weather, particularly in individuals disposed to obesity. Longcontinued walking, horse-exercise, long journeys in carriages with soft and warm seats, often produce it. It may also be a consequence of errors in diet, or indulgence in high living: the too frequent use of large doses of calomel and cathartic medicines will often excite inflammatory action in this region; a vitiated condition of the excretions from the alimentary canal, the irritation of worms, of diarrhoea, and of dysentery, may be the exciting cause, and among the poorer classes they arise from a neglect of cleanliness.

The symptoms will be similar to those of superficial inflammation in other parts; at first slight itching will be experienced, succeeded by a feeling of heat and smarting, accompanied by redness and tumefaction; walking and sitting, by the friction and heat which they cause, will increase the pain.

In directing the remedial means, the exciting cause must be first considered. If the inflammation and

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excoriation are the result of obesity and excessive exercise, either on foot, horseback, or riding many hours in a carriage, it will be only necessary to wash the parts two or three times a day, to apply powdered oxide of zinc, or hair powder, and to keep a fold of lint or linen between the buttocks: it may sometimes be advisable to enforce the observance of the horizontal position. Enemata will be the best means of keeping the bowels open. Should the cause depend on a depraved state of the excretions, this condition must be remedied by the exhibition of appropriate medicines, small doses of mercury and chalk, with extract of taraxacum, or blue pill with hyoscyamus and extract of colocynth, to be taken at night; and the following morning, Eochelle salts with infusion of senna, or a bitter tonic infusion: the sulphate of magnesia, dilute sulphuric acid, and the compound infusion of gentian, or infusion of cascarilla, make a good purgative; other similar combinations may be prescribed: the remedies are to be continued until the alvine discharges become healthy. The same local treatment as that previously recommended must be adopted. If dysentery or diarrhoea be the cause, the effect will cease with the subsidence of these diseases. If the abuse of cathartic medicines has set up the disease, it will be only necessary to discontinue them, and to apply some slightly astringent

INFLAMMATION AND EXCORIATION OF THE ANUS. 21

lotion locally, and the effect will be removed. When inflammation and excoriation have been produced by a neglect of cleanliness, the observance of different habits is the first step towards a cure; soap and water must be used several times daily: if the hair around the anus has become matted together by the discharge and filth, forming an incrustation over the excoriated surface, it must be softened by the application of linseed-meal poultices, and the free use of the hip-bath and soap; on no account must it be removed by cutting the hairs, otherwise the stumps left will cause much irritation and distress, until they have again attained a certain length. Some time since I witnessed the misery thus induced in a labouring man, and the excoriation prevented healing for a considerable time by this thoughtless procedure. When the parts are sufficiently cleansed, poultices, impregnated with opium and a solution of acetate of lead, or bint saturated with lotions of nitrate of silver, sulphate of zinc, or acetate of lead, may be kept to the parts; or ointments of the nitrate of mercury, bichloride of mercury, oxide of zinc, &c, may be applied. The recumbent position must be maintained, and the bowels acted on by cooling laxatives and emollient enemata.

CHAPTER III.

EXCRESCENCES OF THE ANAL REGION.

The fine skin surrounding the anal orifice and the mucous membrane at the verge of the anus are subject to various morbid growths, designated by authors of past ages by the fanciful appellations of scycoma, fici, mariscae, cristae, porrus, condylomata, verrucae, &c. These growths differ much in appearance, consistency, and sensibility, some being acutely painful, whilst others occasion but little suffering.

In one form they will be observed as distinct and separate tumours, with a smooth surface, sometimes slightly lobulated, having a constricted base, and usually flattened in form, owing to their compression between the nates; they vary in size from a pea to that of a chestnut, or larger; and commence as small folds of skin, soft and pliable at first, like the healthy tissue, but, as they increase in size, become of firmer consistence by the development in their interior of a fibre-cellular tissue. Others will be met with partaking of the character of warts, and consisting of clusters of enlarged arborescent papilla), rising to one or two inches above the surface of the skin, and in some cases entirely surrounding the anus, the aperture of which is hidden in the morbid growth. The appearance of this form of disease is well illustrated by the wood engraving of an aggravated case of warty growth occurring in a boy aged fourteen, a patient at the Blenheim Dispensary.

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The most common cause of excrescences of the anal region is some local irritation: thus we frequently meet with them as a complication of several diseases

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