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the chronic form, and induce various changes in the tissues of the rectum and colon, and parts adjoining, such as ulceration, simple or fistulous, thickening, induration, and contraction of the coats of the intestine, stricture, spasmodic stricture, spasmodic contraction of the sphincter ani, fissure, &c.

Chronic proctitis may occur primarily as well as be the result of the acute or subacute form of the disease.

Asthenic acute proctitis occurs chiefly in cachectic and exhausted constitutions, or may be caused by the poisonous and depressing properties of the exciting cause, as when occurring from exposure to the emanations of foul privies.

In the treatment, the first thing to be considered is the nature of the predisposing and exciting causes, and the activity and character of the inflammatory action. If the inflammation has been produced by the lodgment of foreign bodies, by the accumulation. and induration of fæcal excretions, or alvine concretions, they must be dislodged by mechanical means, all possible gentleness being observed in the operation. If the presence of ascarides is the cause, they must be expelled from their habitation by the administration of vermifuge medicines, and the use of oleaginous and terebinthinate enemata. Having attained these objects, the bowels should be kept free from irritation by the

use of emollient enemata, and attention to the quality of the ingesta. In the sthenic form of the disease, and in plethoric individuals, it will be necessary to take blood locally by cupping over the sacrum and on the perineum, or by the application of leeches around the anus; the bleeding being promoted by the patient sitting over warm water after the leeches have fallen off, or by the use of hot linseed-meal poultices. The warm bath, semi-cupium, or hip-bath, will afterwards be serviceable.

The state of the excretions and secretions must be attended to. Hydrargyrum cum cretâ and the pulvis ipecacuanha compositus will be beneficial; if pain and tenesmus be complained of after depletion, the compound ipecacuanha powder, or simple ipecacuanha powder with henbane, extract of hop, or extract of poppy, may be administered: great relief will also be experienced by the administration of enemata, of four or six ounces of infusion of linseed, containing from thirty to sixty minims of laudanum. the irritability of the rectum by these means has been somewhat allayed, the bowels should be moved by fresh castor oil or olive oil, or by the confection of senna and sulphur, with or without the addition of copaiba, according to circumstances. Diluents should be taken freely, and all stimulating ingesta avoided.

After

The subacute and chronic forms will require the same treatment slightly modified. The abstraction of blood will be less necessary than in the acute form, but the warm bath or hip-bath, and soothing and emollient enemata, will be equally beneficial and necessary in the former states of the affection as in the latter. If excoriation, heat, and irritation are experienced, great relief will be afforded by the use of a cooling and anodyne lotion, such as a solution of the diacetate of lead, with acetic acid and wine of opium; pledgets of lint, saturated with it, being kept constantly applied to the parts.

The

The asthenic form of inflammation of the rectum rarely admits of depletion, either general or topical. It has a greater tendency than the other varieties of inflammation to spread up the intestinal canal, therefore our endeavours must be directed to prevent and limit the extension of the diseased action, and to support the vital powers of the constitution. first object is to be obtained by the use of the warm bath or hip-bath, followed by stimulating embrocations applied over the sacrum and to the hypogastrium; warm terebinthinate epithems, applied on flannel, will be of great service; demulcent and anodyne enemata should be employed early in the treatment, and are always beneficial. The constitutional treatment will consist of the administration

of small doses of quinine with camphor, ipecacuanha, and the sedative extracts; castor oil, either alone or with turpentine, should be prescribed to move the bowels, or the confection of senna with the extract of taraxacum and bitartrate of potash.

Should ulceration or sphacelation occur, the treatment recommended in Chapter VIII.* must be adopted.

In this, as in all other diseases of the rectum, great care is necessary in administering an enema not to injure the bowel with the pipe of the instrument, and there will be less probability of mischief occurring if the jet be made of elastic gum tube instead of metal or ivory.

The specific form of proctitis, arising from gonorrhœal or syphilitic infection, must be treated in conformity with the principles of treatment for the diseases occurring in other parts. Enemata should not be used in these cases, lest they should favour their extension, but strict cleanliness must be enjoined the use of cooling and anodyne lotions, and such other means as are usually employed to allay local inflammation, must be put into requisition.

The occurrence of peritonitis will be a most serious complication, and demand active and prompt measures in the treatment. In plethoric individuals blood

* Page 79.

diarrhoea. It may be either the cause or consequence of abscess of the rectum and anus, or be the result of one of the forms of proctitis described in the previous chapter.* Ulceration is often occasioned by the entanglement and lodgment of the fæces in the mucous follicles of the rectum; in which case several ulcers will generally exist.

Ulceration of the rectum is frequently found as a complication of disease existing in other organs, rather than as a primary and simple lesion. We meet with it associated with tubercular diseases of the lungs and liver, and tubercular deposits in other parts of the body. In children it is often a complication of thrush, of disease of the mesenteric glands, and a consequence of chronic diarrhoea. Diseases of the urethra and prostate gland in the male, and of the uterus in the female, also give rise to ulceration of this bowel.

Ulcers in this region will assume different forms and phases, in like manner as when they occur in other and exposed parts of the body, being similarly influenced by the causes producing them, and the state of the constitution of the individual. They vary in size as well as number, and are either superficial or involve the whole thickness of the coats of the intestine. If produced by the lodgment of fæces in * Page 73.

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