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the lacunæ, they will be moderate in size, deep, and if they have existed any length of time, the edges will be indurated and prominent.

The symptoms of ulceration of the rectum are a discharge of sanious, purulent, or muco-purulent matter oozing from the anus, soiling the patient's linen and producing great discomfort, and perhaps excoriation of the external parts; pain in the gut extending up the sacrum to the loins, or sense of weight in the bowel, aching down the inside of the thighs, smarting at stool, and, if the ulcer be situated near the verge of the anus, there will also be spasm of the sphincter, as in fissure of that part; the fæces will be besmeared with blood and pus, and the patient will be troubled with tenesmus, and irritation of the urinary organs. Mr. Colles, speaking of the pain and discharge in this disease, says, "At times the quantity of discharge is much lessened, and then the sufferings of the patient are aggravated; but on the flowing off of a large quantity he experiences great relief;" this I presume must have been due to the acute and excessive inflammatory action, and not depending alone upon the quantity of matter secreted by the ulcer.

*

When the ulcer is situated just within the external sphincter, and spasm of that muscle does not exist, it

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should be taken freely from the arm, and a large number of leeches applied to the abdomen, followed by hot anodyne fomentations, or by, what is much better, a flannel wrung out of hot water, and freely sprinkled with warm turpentine; calomel and opium must be administered more or less frequently, according to the urgency of the symptoms, and counterirritation established on the lower extremities by stimulating pediluvia and sinapisms.

The hip-bath and anodyne enemata, and a strict observance of the horizontal position, will be most efficacious in relieving the bearing-down pains experienced by females suffering from proctitis.

When the urinary organs are affected, and dysuria and strangury induced, the warm hip-bath will be required, which if insufficient to afford relief, we shall be called upon to direct other measures, particularly if retention of urine should take place; then it would be advisable to prescribe a full dose of morphine in addition to the bath: tartar emetic, in frequent and nauseating doses, will generally relax the spasmodic condition of the muscles preventing micturition; but if these means fail, and the bladder is much distended, it must be relieved by the gentle introduction of the catheter.

CHAPTER VIII.

ULCERATION OF THE RECTUM.

Ir is intended in this chapter to treat of ulcers resulting from simple or specific inflammation, or occurring as a complication or effect of other diseases and lesions. Those originating in fissure have already been considered.

Perhaps the most frequent cause of simple ulceration of the mucous membrane of the rectum arises either from bruising and subsequent inflammation, or from the surface being abraded, and a slight laceration produced by the passage of indurated fæces: it occurs in persons of constipated habit, in whom the mucous membrane of the rectal pouch is often relaxed, and in the act of defecation a small portion slipping down below the upper margin of the sphincter, becomes jammed between it and the fæcal mass, producing one of the lesions mentioned, and leading to ulceration.

It occurs not unfrequently as a consequence of dysentery, either acute or chronic, and of colliquative

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.

the lacunæ, they will be moderate in size, deep, and if they have existed any length of time, the edges will be indurated and prominent.

The symptoms of ulceration of the rectum are a discharge of sanious, purulent, or muco-purulent matter oozing from the anus, soiling the patient's linen and producing great discomfort, and perhaps excoriation of the external parts; pain in the gut extending up the sacrum to the loins, or sense of weight in the bowel, aching down the inside of the thighs, smarting at stool, and, if the ulcer be situated near the verge of the anus, there will also be spasm of the sphincter, as in fissure of that part; the fæces will be besmeared with blood and pus, and the patient will be troubled with tenesmus, and irritation of the urinary organs. Mr. Colles,* speaking of the pain and discharge in this disease, says, "At times the quantity of discharge is much lessened, and then the sufferings of the patient are aggravated; but on the flowing off of a large quantity he experiences great relief;" this I presume must have been due to the acute and excessive inflammatory action, and not depending alone upon the quantity of matter secreted by the ulcer.

When the ulcer is situated just within the external sphincter, and spasm of that muscle does not exist, it * 'Dublin Journal,' vol. v., p. 156.

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