608 AFFECTIONS OF THE INTESTINAL CANAL. 



the resulting peritonitis soon causes death. The course of rheumatic 

 perityphlitis is perfectly similar, while in the metastatic form deatl 

 usually results from the constitutional disease before suppuration and 

 |>erforation take place. 



At the commencement of the disease, as in typhlitis, we apply 

 leeches ; this application may be repeated several times ; subsequently 

 warm poultices may be used. The abscess should be opened as soon 

 as there is fluctuation. 



Periproctitis is an inflammation of the connective tissue surround- 

 ing the rectum ; sometimes it develops in the course of acute and 

 chronic inflammations and degenerations of the rectum ; again it ac- 

 companies affections of the pelvis, or of the organs situated in the pel- 

 vis ; at other times, like perityphlitis, it is one symptom of extensive 

 metastatic inflammations. We also see periproctitis develop very often 

 in patients who have consumption of the lungs and intestines. The 

 cause of this complication is obscure, for the dependence of the inflam- 

 mation of the connective tissue on a suppuration of caseously degener- 

 ated lymphatic glands has not been proved. 



Acute periproctitis may end in resolution, but more frequently 

 leads to abscesses which may subsequently perforate outwardly or into 

 the intestine. Chronic periproctitis leads to decided thickening and 

 induration of the inflamed connective tissue, but it also almost always 

 ends in partial suppuration, and fistulous ulcers form and are difficult 

 to heal. 



At the commencement of acute periproctitis we find a hard, pain- 

 ful tumor in the perinseum, or in the vicinity of the coccyx. On intro- 

 ducing the finger into the rectum, we often recognize infiltration of the 

 connective tissue by the feeling. The patient cannot sit up, and has 

 the severest pain on defecation ; if the inflammation terminates in sup- 

 puration, and the abscess perforates inwardly, the pain at stool in- 

 creases, there is severe tenesmus, and, finally, purulent, stinking masses 

 are evacuated per anum. This is the way that internal incomplete 

 rectal fistulas are formed. If the abscess perforates externally, fluc- 

 tuation occurs in the middle of the hard swelling in the perinasum, or 

 near the coccyx, and, after the covering has been pierced, the above- 

 described masses are evacuated. This process may cause an external 

 incomplete rectal fistula. The symptoms of chronic periproctitis are 

 usually obscure till the disease induces stricture of the rectum, and are 

 hidden by the symptoms of disease of the mucous membrane, or other 

 original disease. If abscesses form, there is severe pain along with the 

 symptoms above described. 



At first, we should attempt to bring the imflammation to resolution, 

 particularly by the use of cold ; later, we should apply cataplasms and 



