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fissure touched with nitrate of silver: the operation was performed while she was under the influence of chloroform. After the third day the fissure was dressed with the following :—spermaceti ointment one ounce, acetate of lead six grains, extract of belladonna a drachm; the bowels were kept easy'by taking a teaspoonful of the following electuary every night:—
r^ Confectionis Sennae, Potassae Bitartratis, Extracti Taraxaci, ana partes equates. M.
When the spasmodic action of the spincter had subsided the ointment was discontinued, and four ounces of water, containing eight grains of sulphate of zinc and a dram of tincture of lavender, were injected into the bowel night and morning. She recovered in less than a month, and all symptoms of stricture of the rectum entirely disappeared.
Fissure on the posterior part of the rectum, and external
Mrs. H , a)t. twenty-nine, married, a patient at the
Blenheim Dispensary, in the autumn of 1851, suffering from ulceration of the lips, fissures of the tongue, and general ailment: in the early part of February, 1852, she was prematurely confined of a dead child. On the 2nd of March she again placed herself under my care, complaining of smarting of the anus on defecation, followed by extreme aching, which continued for one or two hours. Examination revealed an external pile, the sphincter was strongly contracted, and within the margin of the anus, at the posterior part, a fissure existed. The pile was excised, and an ointment containing opium directed to be applied to the fissure; a laxative confection was also prescribed. The confection not acting on the bowels sufficiently, she took, on alternate nights for a few times, five grains of blue pill and one drop of croton oil, which unloaded the bowels thoroughly. She then resumed the electuary, and injected into the bowel twice daily six ounces of infusion of linseed. Before the end of the month she had quite recovered.
Fissure leading to the formation of an ulcer; sympathetic affection of the urinary organs.
In 1851, I was consulted by Mr. , set forty-five. He
had suffered for about eight weeks previously severe pain at the anus, extending up the sacrum to the loins, each time his bowels were moved: it first commenced after a very costive motion. He was much troubled by a frequent desire to micturate; and had noticed his linen slightly stained with blood and matter. Leading a sedentary life, and being of costive habit, he had for several years taken large quantities of Morrison's pills.
On examination, finding the sphincter ani strongly contracted, and taking into consideration the other symptoms, I suspected the existence of an ulcer, the result of fissure. An attempt to introduce the speculum inducing intolerable pain, chloroform was administered, and the instrument then used: an ulcer was exposed on the left side, of oval form, and nearly an inch in its vertical diameter; the edges were sharp and indurated, and the surface an ash colour. Mercury with chalk and Dover's powder were prescribed to be taken at bed-time, and a teaspoonful of confection of senna and sulphur in the morning, to be followed by an emollient enema. He was directed to observe the recumbent position. From the appearance of the ulcer I deemed incision necessary, but it was objected to, and a wish expressed that other means should first be tried: nitrate of silver was applied on three separate occasions, and other applications were had recourse to during a period of six weeks, but without advantage. I then insisted on the necessity of the operation, to which the patient gave his consent. Having administered chloroform, I introduced into the rectum the forefinger of the right hand, and passed upon it a probe-pointed straight bistoury, and made an incision through the ulcer, dividing the mucous membrane, submucous cellular tissue, and possibly a few muscular fibres. From the time of the operation the ulcer rapidly improved, and in less than three weeks he was restored to health and comfort
Fissure degenerating into an ulcer; sympathetic affection of the urinary organs; incision.
Mr. S , aet. thirty-nine, a gentleman residing in the
country, had suffered for some time pain in the rectum, and frequent desire to micturate. His usual medical attendant, considering the symptoms depended on irritation of the urinary organs, prescribed appropriate medicines to allay that condition, and catheters were also introduced into the urethra, but without benefit. On his arrival in town he applied to me. In stating his case he complained of great pain at the anus during the act of defecation, increasing to intense agony, and continuing for about two hours afterwards. The bowels were constipated, and from the pain he suffered he put off the calls of nature as much as possible: his bladder was very irritable, having frequent desire to pass his urine. By digital examination of the bowel, an ulcer, with indurated edges, was felt on the left side. Having ordered means by which the bowels were fully relieved, the following day I incised the ulcer, by transfixing its base with a small curved knife, and cutting into the open side of a speculum previously passed into the bowel. The ulcer presented a foul, indolent surface, with defined raised margin. The after treatment was the same as has been advised, and a rapid recovery ensued.
NEURALGIA OF THE ANUS AND EXTREMITY OF THE RECTUM.
That the rectum and anus are occasionally affected by a morbid exaltation of sensibility, independently of inflammatory action in a recognizable form, or the existence of any appreciable lesion to account for the pain experienced, cannot be doubted; nor is there any reason why these parts should be exempt from this affection, when we find it attacking not only the face, limbs, but other parts of the body, supplied by the cerebro-spinal nerves; and modern investigations into the pathology of the nervous system furnish abundant evidence that organs supplied by the ganglionic nerves are also affected by neuralgia.
This disease, in its substantive form, will be most frequently met with in anaemic individuals, in whom the nervous sensibility is generally excessive and often deranged. Females whose systems have been depressed by menorrhagia, or frequent child-bearing, particularly if the labours have been attended with violent floodings, are liable to become the subjects of