Venereal diseases of the rectum and anus are infrequent in this country. They are observed most often as a complication or secondary to infection at some other portion of the body. However, this statement does not mean that gonorrhea, chancres and chancres have not been frequently observed primarily in the anew-rectal region.

Gonorrheal Proctorial occurs as a primary infection, but is more often observed secondary to a vaginal infection.

The Symptoms are those of an acute inflammation of the rectum. The sensation of heat, becoming so pronounced later a> to cause actual pain and tenements with an almost unbearable desire to defecate, are the first symptoms of the disease. There is also a dull aching pain over the sacrum and later constitutional disturbances, which begin with fever, rapid pulse and general weakness. The stools may contain blood and pus. The pus at first, is of the ordinary type seen in cases of urethritis, but may become of a brownish, yellow or greenish color later. The mucous membrane becomes swollen, red and tense, bleeding easily when touched. The inflammation may cause ulceration, which fortunately is superficial and seldom undermines the mucous membrane.

Treatment. The anal region can easily be kept clean with some antiseptic solution, such as Thievery’s, dichloride of mercury or carbolic acid.

The recognized specific remedies for the destruction of the streptococci, such as nitrate of silver solution, 1-12500; argon in ; argyle: permanganate of potash. 1-4000, and Protagoras should be used in the form of rectal irrigation each day for a week. The double current rectal irrigation should be used so as to permit the immediate return of the solution. Care should be exercised to drain out the rectum thoroughly afterward Warm solutions give more comfort, but exceptionally cold may be preferred. Opium in the form of a suppository may be necessary to relieve the pain and tenements Rest in bed is indicated in the majority of cases.

Chancres are encountered in this region secondary to vaginal infection, as a rule.

Diagnosis. The period of incubation is ordinarily from two to five days. The lesion generally occurs in the form of multiple sores, varying in size from a pea to a dime, with irregular edges. These ulcers have a soft, inflamed base, which exudes a copious, purulent secretion and have a tendency to spread or undermine the skin, sometimes assuming a vertiginous or photogenic character.

Symptoms. The lymphatics of the inguinal region become swollen and tender very early in the course of the disease. as the result of infection. The presence of chancre ulcers within the anal canal cause great pain, particularly during defecation. These ulcers resemble the non-specific fissure in character, but are more apt to be present in greater number and size. The secretions from the ulcers excite a prurient Stricture of the rectum or anal canal may result from extensive ulceration.

Treatment. Efforts to prevent further extension and the destruction of the bacterial factor by frequent mild antiseptic irrigation are of the first importance. The actual cattery, nitric acid, sulfuric acid or carbolic acid, are all of positive value for the destruction of these ulcers and the prevention of extension. The cauterization in this instance aims to leave a barrier of sterile tissue which prevents extension into the bordering tissue, in the manner recommended in the treatment of tubercular abscesses and fistula After thoroughly cleaning the parts, a dry antiseptic powder, such as calorie, chloroform, Bristol, orthonormal, salicylic acid or Doric acid, should be applied.Chronic Chancre Ulcers should be stimulated with is-thyol, balsam of Peru, or nitrate of silver.

Syphilis manifests itself in the anew-rectal region in the form of condemnatory, summations deposits, ulcerations, mucous patches and chancres.

Chancres are encountered within the rectum or about the anal canal in the fun of the characteristic single, firm, cup like sores, having rounded inaugurated edges. The chancres have no tendency to undermine the surrounding skin or mucous membrane, unless of the mixed variety. They are sometimes mistaken for an ordinary fissure or ulcer in the anal canal. These ulcers do not, however, cause the severe pain at defecation which is so pronounced with the common fissure.

The Symptoms and lesions of the different stages of syphilis are the same as manifested from infection at other points of the body. Condemnatory of syphilitic and those of non-syphilitic origin, in some instances confuse one, particularly in unclean subjects. Syphilis within the rectal or anal canal manifests itself usually in the form of fissures, ulcers or a proliferating proctorial These affections within the rectum are commonly associated with a very irritating discharge from the lesion, and when mercury is administered by mouth, the intestinal affection is still more irritated by the drug. Sometimes when an ulcer or a proctorial exists from this cause, the bowel movements become so frequent and the tenements so annoying that the condition is almost intolerable during the period of its use. Patients become weak and emaciated and some other method of administration becomes imperative. We are then forced to use in unctions or treat hypodermic-ally, in order to give the required amount of mercury to control the systemic disease. Salvadoran has not been used by me in a sufficient number of cases to recommend its use, as yet, in all subjects.

Condemnatory datum (of syphilitic origin) appear at first as a slightly inflamed, small, red pimple, soon changing to a whitish, flat, modulated mass with a mucosa excretion. They increase very rapidly in number and tend to coalesce if not kept clean.

The treatment of syphilitic affections in this region is constitutional and local along the lines laid down by the authorities in this special work, which promises very soon to bring about most excellent results within a much shorter period than the treatment heretofore recommended.

Condemnatory Rumination are the result of moisture due to the prolonged irritation from a gonorrheal, chancre, or gonorrheal discharge, and appear in the form of warts, vegetation or papillary Either of these growths appear usually in patches attached by small pedicures The secretions are very abundant and have an offensive odor, usually much more pronounced than condemnatory of specific nature. The associated prurient is most annoying and intractable to treatment. When the growth is extensive, the formation of ulcers and fissures cause extreme pain and annoyance.

Treatment. The condemnatory rumination require only local treatment directed to drying up the secretion and keeping the parts free from the discharge. The parts should be kept clean with some mild antiseptic wash and the surface dusted with powdered zinc, alum, tannin or calorie Cauterization with carbolic, sulfuric or nitric acid acid may be necessary if healing is not rapid. Cauterization of the base with the Jacqueline cattery is the best and most rapid method of cure. After the growth has been cut off with the scissors, the surface should be kept dry with one of the dusting powders suggested above.