. Rectal and anal surgery : with description of the secret methods of the itinerant specialists. ugh, iftubercle exists in the ulcer itself, it may require to bescraped. Such cases, however, are more medical thansurgical, and require the same general treatment as is givento other tuberculous patients. When the ulcers are dependent upon the depraved con-dition of the system caused by Brights disease of thekidneys, they will usually be incurable, but still the use ofmild but free washings will alleviate the local symptoms. Whenever ulcers occupy a large portion of the circum-ference of the rectu
. Rectal and anal surgery : with description of the secret methods of the itinerant specialists. ugh, iftubercle exists in the ulcer itself, it may require to bescraped. Such cases, however, are more medical thansurgical, and require the same general treatment as is givento other tuberculous patients. When the ulcers are dependent upon the depraved con-dition of the system caused by Brights disease of thekidneys, they will usually be incurable, but still the use ofmild but free washings will alleviate the local symptoms. Whenever ulcers occupy a large portion of the circum-ference of the rectum, or anus, the contraction during theirhealing tends always to induce strictures, which can only beprevented by mechanical dilatation, a subject which we willconsider fully in the section on strictures. CHAPTER VIII. PROLAPSE OF THE RECTUM. There are three forms of rectal prolapse: 1. Prolapse of-themucous membrane alone, as repre- sented in Fig. 34. 2. Prolapse of all the rectal coats. This varietybrings down the peritoneum if the extrusion proceeds tosome distance, as is shown in Fig. Fig. .34.—Pkolapse of Mucous Membbane {Esmarch). 3. Pi-olapse of the upper part of the rectum into thelower, which is the same accident wliicli is called invagina-tion or intussiiS(^ei)tion in other parts of the canal. Prolapse of the Mucous Membrane.—This is the mostfi-equent variety, and the majority of cases are in childrenunder five years of age. The acute cases are generally inchildien, and are usually produced by simple excess ofstraining at stool. The mucous membrane is very loosely 6 81 82 HUCTAL AND ANAL SUIiGKRY. attaclied to tlie parts l)eneatli, and readily ])r(>trades. Kelseysays the first attack always comes on gradually, but this isprobably an error, as it often occurs as a sudden accidentin young children who have shown no sign of it straining, we have for causes paralysis, excessivedilatation, and ulcerative destruction of the sphincters, or ofany par
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