Tenesmus is sometimes the precursor of dysentery, but often it prevails
alone for a short time, and then ceases. The affection is an irresistible
desire of evacuation, discharging nothing but some bloody or mucous
matter, which is the cause of the whole complaint, being an œdematous
inflammation in the rectum, which creates the impression of fæces lodged
in the intestine, and a desire of evacuation. And Galen relates that a
stone has sometimes been discharged by the anus in attacks of tenesmus.
But tenesmus often arises in consequence of fæces being retained in the
small intestines, and is increased by astringents and obstruents, but
immediately removed by acrid injections, such as honied-water with salts,
or by any of the emollients taken by the mouth, such as damascenes, dried
figs, the herb mercury, or the whey of milk; for when the fæces are
evacuated, the complaint immediately ceases. When the tenesmus occurs
without such a cause, it will be proper to allay the inflammation by
barley-flour heated, the embrocations from wine, myrtle-oil, rose-oil,
or the oil of unripe olives, applied to the loins and lower belly. The
mucous matters shut up in the rectum must be cleared away by an injection
of honied water. And salt and water when injected often effects the
purpose, or six drachms of salts in a hemina of hot water. But we must
mitigate the pain and intense sufferings by sitting in a hip-bath
of fenugreek, mallows, or linseed. Sometimes the following hip-bath
will effect the purpose: Of bramble, of myrtle, of the flowers of the
pomegranate, of bays, and of green cypress shoots, mixing these in equal
parts, boil in water. It is the Marcellian. When the inflammation and
irritation are deep-seated, we must use injections of some of the juices
of grain boiled with some of the astringents. And sweet oil injected and
retained for several hours has the effect of removing the violent pain.
When the desires to go to stool are frequent, we must apply a ball of
warm threads to the anus, or warm bran in a bag, or a sponge, or some
such thing.
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COMMENTARY. See the authors referred to in the preceding Section.
Celsus recommends the tepid bath, emollient and astringent applications
to the rectum, such as butter and roses, or alum wrapped in wool and
applied, the remedies for tormina, and an austere wine every alternate
day.
Aëtius may be referred to as an author who has treated of this affection
in a very accurate manner, although nearly to the same effect as our
author. Among other things he mentions the application to the anus of a
sponge soaked in a solution of galls in vinegar.
Nonnus defines tenesmus to be an inflammation of the rectum, and says
that it is to be benefited by injections of the oil of rue, or of wine
and honey with brine; by hip-baths of astringent decoctions, such as
myrtles, bays, &c. or by fomentations with a sponge.
Avicenna describes two varieties of tenesmus, the false, which is
occasioned by the lodgment of hardened fæces in the intestines, and is to
be cured by emollient clysters, &c.; and the true, which, if occasioned
by cold, is to be relieved by fomenting the parts with a sponge or the
like soaked in hot water; if by hard pressure, a sponge is to be squeezed
out of hot oil and applied; if by an aposteme, it is to be treated upon
general principles by bleeding and embrocations; if by a flux, remedies
suited to that complaint are to be given; and, if by ulcers, the common
applications to them are to be used. Haly Abbas treats fully of tenesmus,
like Avicenna. In several of his prescriptions poppies and opium occur.
When produced by retention of scybalæ, he recommends powerful evacuants,
such as colocynth, prunes, turbit, scammony, &c. One of Serapion’s
prescriptions contains burnt lead, sumach, myrrh, &c. By a stone, said
by our author and Galen to be sometimes discharged in cases of tenesmus,
must have been meant an alvine concretion of a hard nature.