a peduncle or footstalk sometimes capable of sound cicatrization after being divided; in the third form which polypus of the rectum assumes, the tumour is of a firmer consistency, smoother surface, and more regularly spheroidal, or of oval form. In the Rév. Médico-Chirurgicale,'* M. Leclayse describes a fungous tumour of the rectum attended with bloody discharge occurring in children. He records three cases the ages of the patients were respectively six months, five years, and eight years. The growths appear to be of the character of the second form of polypus described by Mr. Syme; and their removal was effected by the application of nitrate of silver.

The experience of Mr. Syme and Dr. Bushe, as well as the inference to be drawn from the majority of cases of this affection that have been recorded, lead to the conclusion that these growths most frequently occur in adults, though the greater number of cases observed by Sir Astley Cooper were in young subjects: only one case of a child with polypus of the rectum has at present come under my observation.

The symptoms of polypus of the rectum will at first be rather annoying than painful, the patient being troubled by mucous discharge from the anus soiling his linen; as the polypus increases, weight and fulness of the rectum, tenesmus and the sensation

* Tome vii., p. 346.

*

of the presence of a foreign body will be complained of. If it be situated near the anus it will be protruded at stool, and will require to be replaced by the hand; if it has acquired any size, and is pyriform in shape, some difficulty may be experienced in returning it within the bowel; or if long and narrow, as in one case in which I operated, it will be always protruded. When the attachment of a polypus is near the anus, the irritation it produces will cause spasmodic contraction of the terminal portion of the intestinal canal. Dr. Bushe had a patient in whom the bowel contracted with so much force as to detach the tumour. The polypus was of the mucous species. After the polypus has attained a certain development, diarrhoea and dysenteric symptoms will be present, consequent on the irritation to which the intestine is subject; flatulent distension of the stomach and bowels, and other sympathetic affections, will exist; and if it be of the character of the second species mentioned by Mr. Syme, the fæces will be besmeared with blood or pus; they will also be contorted and figured, leading to the supposition that stricture of the rectum exists.

In the benign polypi, the health will not usually be much affected, but in the malignant variety there is a sallow cachectic appearance of the countenance, the

* Op. cit., p. 228.

appetite fails, the tongue is furred, and lancinating pains in the rectum, extending up the sacrum and down the thighs, and flatulent distension of the stomach and bowels will be experienced. As the disease advances, ulceration attacks the morbid growth and extends to the coats of the intestine, a copious fetid, purulent discharge, and hæmorrhage to a considerable extent occur, by which the strength is greatly reduced; defecation is performed with difficulty, and attended with great agony; emaciation takes place, and the patient at last sinks, worn out by pain, irritation, and hectic.

Polypi of the rectum are usually solitary, but occasionally there may be more than one.

Mucous polypi are not very sensible; but they should be removed as soon as discovered, there being a possibility of their degenerating in structure, and proving fatal. Ligature presents the best means

for their removal, and is that which I have hitherto adopted. Bushe recommends excision of polypi, and thinks there is no cause for the apprehension of hæmorrhage. Sir Astley Cooper experienced considerable bleeding in one case, in which he excised a polypus: he usually removed them by ligature. Mr. Syme has always had recourse to that method. If the peduncle is near the anus, its connection with the intestine may be brought into view by injecting

some warm water into the bowel, and at its expulsion the tumour will be prolapsed, when it must be seized with a pair of forceps and pulled down, and its point of attachment to the bowel will be seen; a ligature should then be applied around its origin, after which it may be cut off by a pair of scissors, taking care not to cut it so close that the ligature may be in danger of slipping off. If the polypus be sessile, or its stalk broad, the base should be transfixed by a needle carrying a double ligature, and tied in two portions. When situated higher up the gut, and the base not easily accessible to the fingers, a canula, similar to those employed in ligaturing polypi of the uterus, must be employed, or the ligature may be passed through a portion of gum elastic catheter. A medical gentleman engaged in extensive practice in one of the chief seaport towns brought his mother to me, requesting my advice: for several years she had experienced great discomfort and annoyance from a polypoid growth, about six inches in length and one inch and three-quarters in diameter, connected with the posterior part of the rectum, about five inches from the orifice: it was attended with a copious muco-sanguineous discharge. I recommended its removal, and Sir Benjamin Brodie, who also saw the lady, concurred in my opinion. The patient was put under the influence of chloroform by Mr. Potter,

and Mr. Knaggs making traction on the growth with a pair of strong forceps, I was able to carry a double ligature through the base, and effectually strangulate it; I then cut it off near its connection. The ligatures came away in a few days, and the lady experienced not the slightest inconvenience from the day of the operation.

Previously to operating, the bowels should be freely acted on, that they may not require to be relieved for several days afterwards. Subsequent treatment is seldom necessary with respect to the local affection, which is the only subject of consideration now before us.