Proctorial, or inflammation of the rectum is a common disease in the adult and child, associated with a colitis. The onset of an intestinal catarrh may not be definitely confined to any portion of the tract, but later resolve itself into a colitis, sigmoid, or proctorial Beginning with the same cause in the adult, a sigmoid and a proctorial are very commonly associated. The vulnerability of the child to either of these diseases seems even greater than the adult, when we consider the frequency of intestinal troubles in children.

The common form of proctorial is a simple catarrh inflammation of the lower end of the intestinal canal, divided into the acute, strophic, and hypertrophy

Acute Catarrh Proctorial follows the well-known course of catarrh inflammations, and is dependent upon idiosyncrasies, habits, environments, hereditary influences, etc. The disease may begin in the rectum, or from any portion of the bowel above, and therefore brings with it very frequently the treatment of all the intestinal canal.

The use of the proctorial has revealed this disease to our eyes, in either the adult or child.

Symptoms. Acute catarrh proctorial is a sudden inflammatory process, varying in degree as to severity and cause. It is sometimes accompanied by a chill and rise in temperature at the onset, with a coated tongue, headache, a feeling of fullness, heat and weight in the rectum, tenements, bearing down and a desire to maturate This condition causes the sufferer to imagine there is a foreign body in the rectum, and he tries to dislodge it by frequent attempts at stool. The mucous membrane becomes swollen, and the caliber of the rectum thereby decreased.

The patient seeks the recumbent position rather than walking about. At first, there is a discharge of the fecal fluid; later this becomes bloody, mixed with mucus. If the inflammation continues uncontrolled, ulceration and sloughing may follow. When this occurs, pus will be added.These attacks may only run the ordinary course of a catarrh inflammation and subside within seven or eight days, or may become chronic, with an indefinite period of invalidism.Etiology.

Intestinal parasites, foreign bodies, impacted feces, exposure to cold, prolapse of the rectum, drugs, - such as arsenic or corrosive sublimate, and insusceptible are common causes. Rheumatism is probably a factor in its causation. Attacks of acute indigestion are very often associated with acute proctorial in a mild form. Polyp, adenoidal, villus growths, papillary and various other new growths may be present, and acute catarrh inflammations may appear as periodic exacerbation, particularly in the rectum and sigmoid.

Treatment

Treatment must be directed to the cause or source of irritation. When due to intestinal infection or putrefaction the bowels should be evacuated at once by saline cathartics or lavage. Insist upon absolute rest in bed. in the horizontal position, which is in fact the best place. Abdominal massage is contraindicated in these cases, although of value in ordinary constipation. Every day for a period of two weeks give injections of cold or warm water into the rectum with the double current rectal irrigation, for ten or fifteen minutes. The temperature of the water should be that most agreeable to the patient. Instead of water a solution of either of the following will be found more useful: five per cent. (5%) witch-hazel, or twenty per cent. (20%) aqueous fluid extract Kramer The use of either Kramer or witch-hazel has given me the best results. The irrigating fluid returns as fast as it enters, and therefore is not dangerous. After the irrigation the rectum should be drained out through the irrigation Flax seed tea. with opium and Kramer, is sometimes very effective in relieving the tenements

The Diet should afford the patient food of nourishing character, non-irritating and easily digested. Restrict the diet to thin gruel, broths, - such as beef, mutton, or chicken, or some of the prepared foods, as peptides or Merlin’s These are preferable to the milk diet in order to avoid constipation and irritation of the sensitive mucous membrane by any undigested debris or hard fecal matter.

Should the inflammatory condition have produced ulceration, the irrigation must be continued for a period long enough to ensure perfect healing. In addition some antiseptic powder, such as bismuth, should be insufferable through a tubular speculum, with the patient in the knee-chest position.

After the acute symptoms have subsided in cases due to chronic constipation, and the intestine has been thoroughly emptied, the treatment should be to prevent recurrences due to fresh accumulations. An endeavor should also be made to prevent the bacterial growth by the administration of some non-irritating intestinal antiseptic by mouth.

The Prognosis is ordinarily very good in these cases, particularly when the patient has sufficient mental stability to persist in the treatment and diet for a sufficient time after the attacks to thoroughly control the digestive disturbance. The ordinary articles of diet which are indigestible to these patients are in general as follows: green vegetables, raw fruit, game, crabs, lobster, crayfish or any variety of crustacean, hashes, rich gravies, stews, pastry, alcohol, fats, and pork (lean bacon sometimes excepted).

Strophic Catarrh Inflammation of the colon, and rectum is characterized by its thinned-out, almost transparent mucous membrane, the membrane being so much denuded of its glandular elements as in some cases to make plainly visible the underlying net-work of veins and arteries, with an occasional area left bare that from the denudation of the epithelium, resembles a small ulcer. This condition is the result of a long continued chronic strophic inflammatory process. It may begin in young adult life in the form of a hypertrophy inflammation and continue to old age.

The mucous membrane looks granular, with portions more or less congested and tessellated The air pressure will be sufficient to balloon the whole cavity to such an extent as to almost burst the bowel, and so distort it as to make the passage of the kaleidoscope much more difficult than with the hypertrophy variety, which, being heavier, holds the contour so much better and assists in rinsing the course of the bowel lumen. The surface is dry, maybe rough, or glistening smooth, inelastic, and, as mentioned, very light in weight. The crypts of Lieberman are greatly bared of their epithelial lining, excepting at the bottom.