Paralysis of the Reetum. 373 



the abdominal muscles may be entirely inadequate to effect defeca- 

 tion so that the faeces have to be removed by the hand. The 

 pressure on the bladder often leads to incontinence of urine, if 

 the paralysis of the vesical sphincter has not already brought this 

 about. 



The trouble is not unfrequently associated with paresis and 

 wasting of the muscles of the quarter. 



Treatment. The first consideration is the removal of the cause. 

 If fracture of the loins or pelvic bones, or severe sprain of the 

 lumbar region, slings are usually requisite to obviate renewed 

 injury in lying down and rising. Simple inflammation of the 

 cord or its membranes may be met by laxatives, blisters and per- 

 haps bromides. In the old and debilitated, tonics, rich food, open 

 air, and sunshine, with locally, blisters or stimulating embroca- 

 tions, will be demanded. In case of poisoning by ptomaines or 

 toxins the disease which produces them must be attended to, and 

 elimination favored as far as compatible with existing weakness. 

 In all cases the rectum must be frequently unloaded with the 

 band or soapy injections, and its walls may be stimulated by 

 giving of nux vomica, or by the hypodermic use of eserine, 

 ergotin or barium chloride. Blisters or stimulating embroca- 

 tions may be applied over the croup or between the thighs, or 

 mustard or tobacco may be added to the injections. 



