Part 12

She became so enthused over the result, that she took up the study of rectal diseases for the benefit of others, as a missionary, so to speak; and it is needless to say that the physicians who failed to detect the cause of her trouble did not reap any of the emoluments of her labors, but there were several irregular practitioners who were ready listeners, took in some handsome fees as a reward. Her motto, true to a grateful nature, was to “praise the bridge that carries you over.”

CONDYLOMATA.

Condyloma, from kondulos Gr., a “knot,” or “tubercle,” may be applied 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 ”