342 
TREATMENT OF PERIPROCTITIS. 
septic infections material is destroyed in the digestive tract. Most of 
the published cases have been due to simple purulent cellulitis, leading 
to formation of abscesses.. In man, however, by far the commonest 
cause is tuberculous infection. 
The course of the disease depends principally 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 an 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 neighbourhood or at the side of the 
anus. From here pus may burrow along the muscles of the thigh, and 
cause emphysematous swelling and lameness. 
Exploration per rectum determines the extent and position of the dis¬ 
ease. 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 as low as possible to favour 
drainage. If at all possible, division of the sphincter ani must be 
avoided. In females the vagina forms a convenient and safe route for 
arriving at abscesses lying below the rectum. Wilke perforated the 
abscess wall through the vagina with the finger, and emptied an abscess 
the size of an ostrich egg, which lay about 12 inches from the anus. 
In purulent cellulitis affecting the upper wall of the rectum, drainage 
into the bowel should only be chosen when the abscess cannot be 
