to any small, hard tumor, flaps, tabs of flesh or wart-like excrescence
about the anus, whether of syphilitic or non-syphilitic origin.
They may take the form of one of the radiating folds, or flattened
transversly by the pressure of the buttocks, and consist of a hypertrophy
of the skin from localized inflammation or irritation, and sometimes
continue to grow after the cause has been removed.
A cutaneous tag as a relic of an external hemorrhoid, after it has lost
its identity and become dense in structure, is properly a condyloma;
also a warty vegetation developed from the papillary layer of the derma.
Certain forms of condylomata are pathognomonic of ulceration and other
serious changes going on above. The discharge at the anus producing these
fleshy tags.
Some writers prefer to limit the meaning of the word to certain varieties
of growths about the anus. But it appears less liable to confuse, to use
it in a literal and a generic sense; making the varieties associated with
their causes, qualifying terms: as syphilitic, non-syphilitic, warty,
cancerous, innocent, etc.
The objection to cocainizing condylomatous growths of any size, and
excising them, is the annoyance from the bleeding that sometimes follows,
which will often break through a heavy crust of Monsels’ salt. The
prettiest way to remove them is by galvano-cautery. When electricity is
not at hand, carbolic acid injection is equally as effective. It may be
necessary where the skin is thick and horny in texture, to afterwards
trim off the remaining ragged edges with the scissors.
NEURALGIA.
Neuralgia of the rectum as a clinical entity is rare indeed. Mention is
made here simply in acknowledgment of the affection, having met with but
one case, and that in a very nervous and delicate lady, who maintained
that she was cursed with a rectal ulcer.
In obedience to this idea her physician had examined the rectum, under
anæsthesia, and found what he called a rectal ulcer at a point where the
uterine cervix rests on the rectum. His diagnosis was, no doubt, founded
upon her belief, and as an apology for the examination and treatment
resorted to, which put her to bed for six weeks.
There were no symptoms of rectal ulcer, other than pain, and no lesion
found by a digital examination or seen through a speculum. She insisted
on taking chloroform and a more thorough examination made. This was done
without revealing anything more than what had already been ascertained,
and the diagnosis of neuralgia confirmed.
Pain continued, periodical or irregular, in the absence of mechanical
pressure (uterine) or structural lesion, in the region of the sphincters,
or higher up, is diagnostic. If in the sphincters alone, dilitation may
be sufficient. When higher up, constitutional treatment with galvanism is
advised.
APPENDIX.
Injection formula of:—
Dr. Shuford.
℞ Sodæ Bibor.
Acidi Salicyl. ā ā ʒ i
Glycerinæ ℥ i
Acidi Carbolici ℥ iii
Misce.
Dr. Yount. (5 per cent. sol.)
℞ Acidi Carbolici gr. xxiv
Aquæ Destil. ℥ i
Misce.
(3 per cent. sol.)
℞ Acidi Carbolici gr. xviss
Aquæ Destil. ℥ i
Misce.
Dr. Green. (A traveling pile doctor.)
℞ Acidi Carbolici ℥ i
Creosoti gtt. x
Acidi Hydrocyan. gtt. i
Olei Olivæ ℥ i
Mix and unite by heat in a water bath. Inject enough
to turn the tumor an ashen grey color.
Rorick.
℞ Acidi Carbolici 40 per cent.
Fl. Ext. Ergotæ 15 ”
Glycerinæ 15 ”
Aquæ Dest. 30 ”
Misce.
Brinkerhoff.
℞ Acidi Carbolici ℥ i
Olei Olivæ ℥ v
Zinci Chloridi gr. viii
Misce.
Largest piles, 8 minims.
Medium piles, 4 to 8 ”
Small piles, 2 to 3 ”
ERRATA.
Page 5, 1st line, _there in_ for _there is_.
” 17, _Weaker solution_ for _Weaker solutions_.
” 22, _Bism. Subuit._ for _Bism. Subnit._
” 22, _Iodoformis_ for _Iodoformi_.
” 23, _Resin Cirate_ for _Resin Cerate_.
” 52, _After the treatment_ for _The after-treatment_.
” 57, _Three inches_ for _Three and a half inches_.
” 64, _Incisions_ for _Incision_.
Transcriber’s Note: The errata have been corrected.
INDEX.
Abscess, 47, 53
Allingham, 47, 50, 51, 57
Andrews, 31, 43, 52, 67
Brinkerhoff, 97
Condylomata, 93
Divulsion, 78
Dorland, 26
Errata, 97
Etheridge, 86
Fissure, 62
Fistula, 47
Flushing the Colon, 13, 36, 84
Hall, 58, 84
Hemorrhoids, 7
Varieties of, 7
Examination of, 8
Diagnosis of, 9
Treatment of, 13
Injection of, 19
Injection formula, 15
After-pain, 21
After-treatment, 22
Accidents, 29
Marginal Swelling and Abscesses, 29
Secondary Hemorrhage, 30
Carbolic Acid Poison, 31
Embolus, 31
Sloughing, 31
Hilton, 41, 43
Hoyt, 33, 54, 72
Kelsey, 31, 48
Mathews, 52
Neuralgia, 94
Pratt, 72, 79
Proctitis, 82
Prolapsus Recti, 65
Pruritis Ani, 72
Rectal Pockets and Papillæ, 67
Rectum, 41
Resumé, 37
Ringer, 38
Rorick, 97
Shuford, 17, 96
Sphincter Muscles, 41, 43
Sulphur, 13, 38
Shoemaker, 38
Sir Alfred B. Garrod, 38
Syringe and Needle, 27
Turner, 3
Ulcer, Stricture, etc., 55
Yount, 5, 96