PRURITUS OR ITCHING OF THE ANUS.
One of the many symptoms of proctitis is the existence of anal channels
from which an inflammatory product exudes through the skin, causing
painful itching of the skin around the anal margin and not infrequently
around the buttocks to the distance of three, six or even more inches
from the anal orifice. An aggravated form of pruritus ani is much more
trying to physical endurance than severe pain. Sometimes the torture is
so great that a portion of the body will be covered with cold
perspiration.
The natural color of the integument about the anus slowly changes to a
dull whitish appearance. As the pathological process goes on, the skin
becomes thickened and parchment-like. In exceptional cases the mucous
membrane of the anal canal becomes toughened and hardened like
cardboard. As a consequence there is a degree of inertia in the
muscular action of the parts affected.
The inflamed, thickened and indurated integument near the anus takes on
the form of folds, wrinkles or rugæ, of more or less prominence; but as
these extend out over the buttocks they become more and more
obliterated, leaving no clue to the direction of the channel which
leads from the site of inflammation; which latter, however, may be
learned from the itching, or from the burning sensation with some
soreness, over portions of their length.
During a practice extending over twenty years, I have found only two
cases in which one of these channels was the seat of a slight abscess.
It is not usual that pus formations occur in these inflammatory
channels. At the margin of the opening from the rectum to the anal tube
are five or six small crescent-shaped loops, semi-lunar valves,
separated by vertical ridges (the anal columns). Naturally in chronic
proctitis the zone of tissue just above the sphincter muscles and
slightly within their grasp at the upper portion of the anal tube,
would suffer greatly from the morbid process, owing to the abnormal
constriction of the tissues and to the incidental pressure and injury,
from time to time, as the stool passes the diseased region. Just under
the mucous membrane covering the anal columns and semilunar valves is
the fatty tissue forming a bed upon which the mucous membrane rests. It
is sufficiently lax to permit considerable movement of the mucous
membrane on the muscular coat beneath it. The frail, fatty, loose
connective tissue in the grasp of the sphincter muscles would be the
first to become impaired by inflammatory process, the product of which
finds its way down and out under the mucous membrane of the anal canal
and integument of the buttocks for quite a distance, occasioning
itching, pain, soreness or burning in the integument covering the
course of the channel.
Here we have the pathological reason why local remedies to the outer
surface of the skin will not cure pruritus ani. Also the reason why
dieting is useless, and why internal remedies are worthless for the
cure of anal itching; for the itching, as shown, is the result of an
inflammatory product in the channels under the skin of the victim,
numbering from five to twenty. Over fifteen years ago I discovered the
cause of the great suffering from painful itching at the anus and
contiguous tissues and have been able to give instant relief, and in a
little time permanent cure, in every case treated since then. It is
well for those who have an occasional attack of pruritus ani to take
treatment at once for proctitis proper, as well as for this symptom,
itching resulting from these channels. The proctitis, if neglected,
will only be the means of increasing the size, length and number of
these channels. In chronic, sub-acute and acute stages of proctitis
there is more or less secretion of inflammatory product; and often the
sufferer is able to discover, in dejections from the bowels, a yellow
syrup-like fluid, of the consistency of glycerine or white of egg, at
times streaked with blood and purulent matter indicating ulceration.
Should the proctitis be cured and these channels remain, there may be
sufficient inflammatory product in the channels to ooze through the
skin to the outer surface, and excite itching; or if a portion of the
channel escapes treatment, the same symptom may be expected at any
time.
The size and length of these channels are best determined by making a
small opening into them through the integument, then inserting a silver
probe in both directions, determining the distance under the mucous
membrane of the anal tube and the distance under the skin of the
buttocks.
In some cases a few of these channels open into the rectum just above
the internal sphincter muscles and become filled with water during the
use of the enema taken to move and cleanse the bowels. As a rule, one
end of the channel is under the mucous membrane of the terminal portion
of the rectum, and the other somewhere under the skin of the anus or of
the buttocks.
I presume that no disease of the human body has been assigned more
reasons for its existence, with the exception of constipation, than
that mere symptom of a disease, anal pruritus; a symptom which
"Regulars" call a "disease," but "Irregulars" know to be only a
symptom. It is very amusing to observe how they fill pages in their
text-books, guessing, wondering and paying their respects to the
imaginary quack doctors, "who are reaping a harvest of ill-gotten
gain." The usual medical writer is a compound of ignorance, egoism and
garrulity, and this may account for the great crop of reasons for
"diseases." However, the writers in question are not so much to blame
after all, even though they do belong to county medical societies; for
how can they well resist the literary itch with which most of them are
afflicted? Let them keep on writing while victims of pruritus ani wear
out their weary lives scratching through weary nights--nights that
extend into years, until permanent invalidism seems to be their destiny
and end. Who, verily, are the medical quacks? I will leave it to a jury
composed of those who have been cured of pruritus ani.
I have yet to meet the first case of pruritus ani that is without the
presence of the channels above described. There may be cases of itching
at the anus and these channels entirely absent, but I have yet to
discover such a case and I very much doubt if it exists. I am happy to
inform the reader that all cases of pruritus ani are cured with ease
and without any restrictions as to diet, and without internal remedies
for the blood, nervous system, etc., given by doctors that guess. The
causes are easily discovered; the symptoms are easily found and
removed; the victim of pruritus ani may therefore escape from the
labyrinth of error of the medical authors and practitioners who ought
to be educators instead of "obstacators"--obstacles and
stumbling-blocks in medical progress.