AM S. 



183 



5. No anus, but the rectum is continued 

 pervious as far as the integuments, which in 

 some cases are then prominent, and of a violet 

 colour, from the meconium appearing through 

 in the siiuation which the anal opening should 

 occupy. In other cases the skin is thick and hard, 

 and gives no indication of the situation of the 

 rectum. In such circumstances the surgeon must 

 divide the integuments, either by a crucial or by 

 a transverse and longitudinal incision, and then 

 proceed cautiously until he exposes the dis- 

 tended rectum. When the skin only inter- 

 venes, the prognosis as to the result of this 

 operation may be favourable, as the sphincters 

 are probably perfect ; but when the cul-de-sac 

 of the rectum is deep-seated, then experience 

 affords but little encouragement to hope for 

 success. Death is inevitable in such cases, 

 unless relief can be afforded, and but very few 

 cases of successful operations are on record.* 

 6. The anus and the continuous portion of 

 the rectum are so contracted as scarcely to 

 admit of any fluid discharge : we have even seen 

 it scarcely pervious to air, so that on forcing in 

 a grooved director, a considerable burst of flatus 

 has escaped. This contraction may exist be- 

 low, and yet the rectum be perfectly natural 

 above. This contraction is sometimes not 

 sufficiently noticed for several days or perhaps 

 weeks after birth, because occasionally there is 

 a small discharge of fecal matter ; it ultimately, 

 however, excites attention from the great diffi- 

 culty, straining, pain, and crying manifested 

 at each evacuation. This condition of the 

 parts sometimes admits of relief, by simple 

 dilatation, by introducing a soft bougie, or 

 some prepared sponge, which should be re- 

 placed after each evacuation, and secured, if 

 possible, by adhesive plaster and a bandage. 

 Should these means fail, an effectual cure may 

 be obtained, as we have seen, by a division of 

 the circumference. This may be done by intro- 

 ducing into the rectum a button-pointed bis- 

 toury for about an inch on a director, and 

 dividing the wall of the intestine transversely, 

 towards the ischium, first on one side, and then 

 on the other, to the depth of about one quarter 

 of an inch. The part must be carefully dressed, 

 and the edges of each wound kept separate by 

 lint. The success of the operation greatly de- 

 pends on the care in the after treatment, par- 

 ticularly in renewing the dressing whenever it 

 has been displaced. 



The anus is occasionally found much con- 

 tracted in new-born children who are con- 

 taminated by syphilis, and may be mistaken for 

 a congenital malformation, especially of the kind 

 last noticed, though not one in the strict sense 

 of the expression; yet as it generally occurs 

 at birth, it deserves the consideration of the 

 practitioner in midwifery, whose attention is 

 often first called to it by the same symptoms 

 that attend the congenital malformation of this 

 opening, namely, pain, difficulty, and straining 

 at each evacuation, and a peculiarly small aper- 

 ture. On examination, however, there are 



* See some observations by Petit, Mem. de 

 1'Acad. de Chirurg. t. i. p. 378. 



other appe-.ira.nces which will assist in explain- 

 ing the real nature of the case, such as brown 

 or dark discolouration of the surrounding parts, 

 also considerable moisture, frequently excoria- 

 tion, and even superficial ulceration in the adja- 

 cent structures. Small fissures in the anus, also, 

 are observable, discharging tenacious matter. 

 Similar appearances may exist about the com- 

 missures of the lips ; some soft granulations or 

 condylomata are also often present in the im- 

 mediate vicinity of the anus ; these frequently 

 extend into the canal for a very little way. 

 Other constitutional symptoms also are usually 

 present, such as copper-coloured blotches on 

 the skin, a tendency to cracking and excoriation 

 of the skin about the hands and feet, and but- 

 tocks, an imperfect development of, or a ten- 

 dency to a separation of the nails, general 

 emaciation, suspicious appearances about the 

 mouth and tongue, and a remarkable and 

 peculiar hoarseness in crying. Many, if not 

 most of these symptoms, aided sometimes by 

 the history of the parents, will lead the prac- 

 titioner to distinguish this contraction of the 

 anus from the congenital malformation before 

 described. The distinction is important, as the 

 treatment in both is totally different; the syphi- 

 litic contraction invariably yields to gentle 

 courses of mercury, administered in such form 

 and dose as the circumstance of the case shall 

 denote to be necessary. The local complaint 

 disappears as the constitution is restored to 

 health. Soothing, emollient applications are 

 the best topical remedies ; should there be any 

 ulceration or excoriation about the part, the 

 surface should be slightly stimulated daily, 

 either by caustic or by the ordinary mercurial 

 lotions. 



Morbid conditions. The anus is the seat of 

 several morbid affections, some of which pro- 

 ceed from a specific cause ; others are merely 

 local. The specific diseases are syphilis and 

 cancer ; and the most common local derange- 

 ments to which the anus is subject are, super- 

 ficial ulcerations, excoriations, fissures, with or 

 without contraction of the orifice from exces- 

 sive irritability of the sphincter muscle, pro- 

 lapsus ani, haemorrhoids, fistula in ano, polypi, 

 &c. Some of these last mentioned affections 

 must, strictly speaking, be considered as ap- 

 pertaining to the rectum, under which head 

 the reader will find them noticed. As, how- 

 ever, the anus is more or less engaged in these 

 diseases, we shall make some observations on 

 each. The anus is also subject to laceration in 

 parturition, and from other causes. 



Syphilis affects the anus at all ages ; its ap- 

 pearances in the infant have been already 

 noticed. In the adult it may present the primary 

 venereal ulcer, which will have the same cha- 

 racter here as elsewhere, only somewhat modi- 

 fied by the position and function of the part. 

 The primary ulcer may be produced either by 

 the direct application of the virus, or by ex- 

 tension of ulceration from the neighbouring 

 organs, as not unfrequently occurs in the 

 female. When the chancre is confined to the 

 anus, which is very seldom the case, it may be 

 difficult to discriminate between it and ulccra- 



