PROLAPSUS RECTI 67 



.used so as to bring the medicaments into direct con- 

 tact with the dilated veins. In cases where the 

 above treatment is ineffectual a resort must be had 

 to surgical interference. The piles may be removed 

 either by ligation or by clamps and the actual cau- 

 tery. By the former method, the piles are picked 

 up separately with forceps and ligated by passing 

 around them a curved needle armed with the liga- 

 ture, after first cutting a groove around the base of 

 each with blunt-pointed scissors. Where the clamp 

 is used the pile is picked up as before, the clamp 

 applied, and the loop removed with the cautery. In 

 operating by either method a general anesthetic is 

 advisable. 



After-treatment.^After the operation the patient 

 should be kept without food for twenty-four hours 

 and for the next week allowed only small quantities 

 of milk, beef tea, or other sloppy diet. Small doses 

 of opium should be given three times a day to keep 

 the bowels at rest, but if no movement of the 

 bowels has taken place by the fourth day a warm 

 enema of oil should be given. Locally, the parts 

 must be kept clean and dressed with antiseptics, 

 such as chinosol ointment or suppositories. 



Prolapsus Recti 



This condition generally occurs suddenly during 

 the course of or after recovery from some debilitat- 

 ing illness. 



Cause. — Debility, constipation, diarrhea, hemor- 

 rhoids, rectal irritation and the consequent straining 

 are all important causes of prolapsus recti. 



Symptoms. — The patient shows a disposition to 

 hide, and is quieter than usual. The floor on which 

 it has lain down is blood-stained, as are also the 

 hind quarters. Examination, which is resented, re- 

 veals the prolapsed gut, congested and, it may be. 



