CHAPTER IX. NON-MALIGNANT ULCERATION OF THE RECTUM AND ANUS Varieties.— Simple Ulcers.— Generally due to Traumatism.— Various Forms of Injury to which Rectum is Subject.— Sodomy.— Injury of Rectum in Labor. — Ulcers due to Surgical Interference. — Fissure or Irritable Ulcer. — Nothing Distinctive in the Ulcerative Process. — Characteristics of Irritable Ulcer. — Theories concerning this Form of Ulcer. — Description. — Herpes. — Tubercular Ulceration. — Distinction between True Tubercular Ulcer and a Simple Ulcer in a Tuberculous Person. -rDescription of Each. — Scrofulous Ulceration.— Esthiomene. — Rodent Ulcer. — Dysentery. — A Cause of Stricture. — ^Venereal Ulceration . — Gonorrhoea. — Chancroids. — Chancroidal Stricture. — Discussion. — ^True Chancre. — Secondary and Tertiary Syphilitic Ulcerations. — Diagnosis of Syphilitic Ulcers. — Ano-rectal Syphiloma as a Cause of Ulceration. — Ulcera- tion Secondary to Stricture. — Gangrene. — Symptoms of Ulceration. — Gravity of the Disease. — Diagnosis. — Treatment. — Greneral and Local Measures. — Treatment of Fissure. — Fissure Complicated with Polypus. — Treatment by Rest, Fluid Diet and Incision of the Sphincter. — Local Applications.
The many different varieties of non-malignant ulcers which are met with at the anus and within the rectum may best be classified, from the stand-point of etiology, into the following groups: 1. Simple. 2. Tuber- cular. 3. Scrofulous. 4. Dysenteric. 5. Venereal. 6. Those due to stricture. 7. Those due to gangrene around the rectum.
Simple Ulcers, — These are almost always of traumatic origin, and the most frequent traumatism to which the rectum is subject is, perhaps, that arising from the presence and passage of hardened faeces. From this cause alone, or from this, combined with their extrusion from the anus, the surface of projecting hsemorrhoidal tumors may become ulcerated for a considerable extent ; and, by this means, a fissure is often produced within the grasp of the sphincter.
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