600 TREATMENT OF PERIPROCTITIS. 



rectum becoming infected. Metastatic abscesses have been seen 

 here during the course of strangles. In females peri- or para-proctitis 

 may result from injury of the vagina. 



The loose connective tissue surrounding the end of the rectum 

 appears particularly liable to cellulitis, and it depends principally 

 on the action of the infecting material what course the disease takes. 

 Most of the published cases have been due to simple purulent cellu- 

 litis, leading to formation of abscesses. 



The course of the disease depends on where the abscess perforates ; 

 should it discharge into the peritoneal sac, death from purulent 

 peritonitis is inevitable ; but when perforation occurs into the 

 rectum, or the abscess is punctured from this point, recovery often 

 follows. The case is still more favourable where the discharge occurs 

 outwardly beside the anus. Wilke succeeded in opening the abscess 

 from the vagina, a method which deserves preference, as avoiding 

 the bad results of perforation outwardly or into the rectum. In 

 the latter case there is always danger of the formation of anal fistula. 



Symptoms. Periproctitis is first announced by interference 

 with the passage of faeces, caused by swelling and abscess formation. 

 The animals show slight but continued symptoms of colic ; defecation 

 is difficult and painful, and is either suppressed or accompanied 

 by groaning. There is usually slight fever. Only where cellulitis 

 extends to close under the outer skin does swelling occur in the neigh- 

 bourhood or at the side of the anus. From here infection may extend 

 under the fascia and between the muscles of the thigh, and cause 

 further suppuration, emphysema and lameness. 



Exploration per rectum determines the extent and position of 

 the disease. The posterior portion is empty, but in front of this 

 the bowel is swollen and its lumen narrowed. In a case of Moller's 

 in a horse, a painful fluctuating swelling, almost as large as a child's 

 head, could be detected on the upper wall of the rectum, about 

 8 inches from the anus. This had so diminished the passage that 

 there was scarcely room below to pass two fingers. The rapid 

 development of the symptoms, the soft, fluctuating, painful character 

 of the swelling, and the moderate fever, distinguish the condition 

 from tumour formation. 



Treatment. When an abscess has already formed, and attention 

 been called to its existence, nothing usually remains but to give 

 exit to the pus, and as it is of importance to effect this in the least 

 dangerous way, the path usually chosen is that through the vagina 

 or the skin and tissue lying around the rectum. The latter is preferable 

 if the abscess be close to the anus, and the puncture must be made 



