Mr. Avery was taken from the body of a girl who died in Charing Cross Hospital: the ulceration extended three inches up the intestine, and occupied the whole internal surface to that extent.

Venereal ulcers of the rectum are seldom met with except in those of the most depraved morals; and when they occur they often take on a phagedænic action, from the constitution being worn out by vice and debauchery, death speedily terminating the sufferings of the unhappy victims in this country this form of disease is rarely seen except in those prostitutes residing in the neighbourhood of the Docks or other low localities, and who, during their brief period of existence, are constantly under the influence of spirituous liquors.

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Syphilitic ulceration not unfrequently leads to perforation of the recto-vaginal septum in the female, and recto-vesical walls when occurring in the male: records of such cases are more numerous in the writings of foreign authors than in those of this country.

The treatment must be varied according to circumstances. In phagedæna we must try to arrest the morbid action by the application of the concentrated nitric acid, taking care not to induce perforation of the bowel. The constitutional powers must be maintained by nutritious food, stimulants, quinine, &c.

Ulceration occurs in cases of stricture of the rectum

above the constricted part, as a consequence of pressure of accumulated fæces; the whole thickness of the intestine may be perforated, giving rise to abscess, which may open externally by the side of the anus, or perforate the serous cavity of the abdomen, producing fatal peritonitis.

In the treatment of this last form of ulceration our attention must be directed to the cause, and if that cannot be remedied we shall be able to do but little to mitigate the effect.

Superficial ulceration treated with nitrate of silver.

Mrs. T, of middle age, delicate constitution, had been subject to mucous diarrhoea. Three weeks previous to consulting me, she experienced great pain at stool and afterwards, of a smarting, burning character; she had purulent discharge, and complained of a sense of a weight in the rectum, pain up the sacrum and in the loins, and bearing down of the womb. By examination I discovered extensive superficial ulceration near the upper margin of the sphincter. I injected an enema of decoction of linseed, and afterwards passed the solid nitrate of silver over the ulcerated surface. I directed she should confine herself to the couch, aud that her diet should consist of broths and farinaceous foods, and desired her to have a hot hip-bath each night before retiring to bed. Her bowels were kept easy, and enemata of four ounces of mucilage with liquor plumbi diacetatis and tinctura opii, were injected into the bowels twice a day. Twelve days sufficed to effect a cure.

Superficial ulceration treated with nitric-acid lotion.

Mr. H sought my advice on account of purulent discharge from the anus, great pain in defecating, continuing for some hours afterwards; he also had irritability of the bladder. He was accustomed to high living, and attributed his indisposition to having swallowed a spicula of a bone of a partridge, which injured the bowel in its passage outwards. By examination I detected a superficial ulcer, somewhat less than a shilling in size, the edges were inflamed, and the surface covered with a tenacious muco-purulent matter. I applied the nitric-acid lotion on the occasion, put him on spare diet, enjoined the recumbent position, and directed the administration of an enema every day. He made a rapid recovery.

Ulceration of the mucous membrane; incision of the sphincter.

Mrs. L for several months had suffered pains in the rectum at and after defecating, accompanied by purulent discharge, which she attributed to internal piles: she took various empirical remedies recommended by friends, being unwilling to seek medical assistance; but, her sufferings increasing, she ultimately placed herself under my care. Her bowels had always been constipated, seldom acting without medicine. Some years previously she had hæmorrhoids, which were removed by operation. I examined the bowel, and discovered above the sphincter an ulcer on the right side of the intestine of the size of a shilling; the edges were indurated, the surface pulpy. Being unwilling to submit to an operation, a variety of applications were used, the nitrate

of silver, nitric acid, and others of a less active character; the recumbent position was adhered to, and a light diet observed; the bowels were kept easy by laxatives and emollient enemata, but the ulcer did not heal. Finding no benefit from the treatment, she consented to the operation proposed. I divided the sphincter, carrying the incision through the centre of the ulcer; an opiate was given after the operation. The wound was dressed in the usual manner; it granulated from the bottom, healed kindly, and in less than a month she had quite recovered.

Ulceration, its extension arrested by nitric acid, and division of the sphincter afterwards.

Mr. William Bennett requested me to see F. M——, æt. forty-one, of broken-down constitution. Somewhat less than a fortnight previously he began to experience pain in the rectum and anus; it increased in severity each day, and was excruciating when the bowels were moved his linen was stained with pus and blood. When I saw him, febrile symptoms were strongly marked, the skin being hot, his face flushed, tongue dry and brown in the centre, and the margins and point preternaturally red; the pulse feeble and quick : he was much prostrated. By the finger, introduced into the bowel at its posterior part, a large ulcerated surface was felt, commencing a quarter of an inch from the anus. On dilating the anus the edges of the ulcer were perceived to be irregular, abrupt, and highly inflamed; and the surface was covered with an ash-coloured slough: from the recent accession of the symptoms it must have extended rapidly. A large enema

was at once administered, which unloaded the bowel. I then applied nitric acid to the surface and edges of the ulcer: a dose of opium was given immediately afterwards. On the following day, perceiving the ulcerative process to be arrested, I divided the sphincter on each side, cutting from within outward in the usual manner; lint was placed between the edges of the wounds, and three-fourths of a grain of morphine. in solution was directed to be taken immediately, and six grains of Dover's powder and two of gray powder at bedtime; a poultice to be applied to the part, and renewed at night. The powder was repeated twice a day for a short time: he remained in bed, and his diet was restricted to broth and arrowroot. The constitutional symptoms subsided; the third day he had some castor oil, and the dressings came away, when the bowels acted; after which a lotion of nitrate of silver was used to the ulcer, and simple lint to the incisions. The plan was continued till the parts were quite healed, which occupied little more than a month.