302 PROLAPSUS ANI. 



as Hertwig says, in three forms: Istly, the rectum protrudes 

 through the sphincter, and hangs behind the anus; 2ndly, 

 the anus drops forward, and there is eversion of its mucous 

 membrane; Srdly, there may be only a portion of mucous 

 membrance on one side protruding. 



In the first form there is a decided eversion, and a red swol- 

 len intestine is observed to hang through the anus to the 

 extent of an inch, five or six inches, or even a foot and a- 

 hal There is great difficulty in replacing it, or pushing the 

 finger through the opening. In the second form the eversion 

 is deeper; and in the third, there is a chance of confusion with 

 rectal polypi. 



Causes. Violent straining, especially in diarrhoea, tym- 

 panitis, or when worms produce great irritation. Prolapsus 

 ani is not uncommon in cases of difficult labour, and is some- 

 times the result of back-raking, an operation which I am 

 glad to have an opportunity of condemning. It is at best 

 useless, and always dangerous. Exploration of the pelvic 

 organs per rectum may be necessary, but the evacuation of 

 the rectum by the hand is at all times superseded by injec- 

 tions. 



Treatment The cause of the prolapsus must be overcome, 

 whether it be diarrhoea, a foetus in utero, or other removable 

 agent. The rectum is replaced by the hand, and usually a 

 strong dose of opium must be given to allay irritation. In 

 cattle, any straining may be stopped by squeezing the back, 

 or placing a surcingle round the body. Locally, warm water 

 injections, and in some cases, injections of lead and opium 

 lotion. 



Eeturning the rectum is not always easy, and when the 

 reduction has been effected the organ again protrudes. The 

 local application of ice or an astringent wash, and the ap- 

 plication of a truss, may be of some service. There are cases 



