82 SURGERY. 



a sarcomatous character ; but more frequently they consist of an ab- 

 normal development of the submucous cellular tissue, having the 

 nature of erectile tissue : the tumour has a broad base, and its sur- 

 face resembles a strawberry; at stool they protrude, and are at- 

 tended with hemorrhage. The general health will suffer by emacia- 

 tion, indigestion, pain, and there may result fistula, prolapsus, and 

 disease of the genital organs. 



Treatment. — In the first place, the stomach and bowels must be 

 regulated by laxatives ; — disorder of the liver must also be cor- 

 rected, since any obstruction of the portal circulation in that organ 

 predisposes to hemorrhages, or congestion of all the chylopoietic 

 viscera ; there being no v'alves in the veins forming the portal vein. 

 Great benefit will result from the use of astringent injections, such 

 as solutions of zinc, oak bark, &c. ; but the radical cure consists in 

 the removal of them, by strangulating with a Hgature or wire ap- 

 plied by means of a double canula. 



Piles should not always be cured in elderly persons, especially 

 those with tendency to diseases of the head. 



PROLAPSUS ANI. 



This is an eversion and protrusion of the rectum beyond the 

 anus, and is dependent upon relaxation. 



The extent of the protrusion varies very much in different cases ; 

 in some instances being confined to a small portion of the mucous 

 membrane; in others the rectum, and perhaps a portion of the 

 sigmoid flexure escape. In children, worms, diarrhoea, straining, 

 and crying may promote the disease. In old persons, it is brought 

 on by enlarged prostate, stone, coughing, &c. When the gut ha- 

 bitually descends, the tumour is red and large. 



The treatment consists in removing the cause ; in regulatmg the 

 bowels, and carefully replacing the intestine after each protrusion. 

 The evacuation should be made in the recumbent position. 



The general habit should be invigorated by tonics, and the tumour 

 should be bathed with cold astringent washes. It may be necessaiy 

 to lubricate the parts before reducing them, and afterwards a T 

 bandage should be worn, to prevent the prolapse. 



In extreme cases, operations have been performed. A fold of the 

 mucous membrane has been removed, in order to contract the in- 

 testine ; and a portion of the sphincter has been cut out, in order to 

 diminish the orifice of the anus. 



ENCYSTED RECTUM. 



This consists of an enlarged and diseased condition of the sac of 

 the mucous membrane of the rectum, just above the anus. 



The treatment consists in drawing down these sacs with a bent 

 probe, and excising the sac with a pair of scissors. 



