Myxomatosis are slow in growth and present the characteristics of a cyst or fluid mass on palpation. They do not form metastases but when imperfectly removed are likely to recur and a certain proportion undergo a sarcomas degeneration. The most common site of these tumors is on the buttocks between the gluten muscles. They are sometimes found in the form of multiple, soft polyp

Myopia are tumors seldom found in the rectum. The are composed of muscular tissue intermingled with fibrous tissue generally, and are described as myxomatosis-fibroblast

Andromache is composed of smooth, hard, firm cartilaginous tissue and is one of the rarest of rectal neoplasms.

Lymphatic This variety of non-malignant growths is occasionally found in the rectum. It originates from the lymphoid tissue or the solitary nodes throughout the large intestine. It is formed of a reticulum of branching cells which are united by their long extremities and within the meshes thus formed are found round cells with circular nuclei. Lymphatic do not produce different symptoms than those of other polyp, excepting that they do not bleed nor discharge mucus or pus. When mucus is associated with their presence it is due to a catarrh proctorial excited by the presence of the growth, or to an irritation of its external surface. They are always single, slightly ambulated, of soft consistence, and of a bright red color.

There are many rare histological types of non-malignant neoplasms which have been found in the rectum or anal region, but their occurrence is so infrequent that a description here is hardly of practical use.

General Diagnosis. Polyp of the rectum are common growths in both children and adults. They are probably more common in women and children than in men. These growths are situated at any place, from the anew-rectal junction to the large intestines. They may occur singly or in large multiple growths which hear the characteristics of their pathological nature, being smooth, irregular or globular in shape. Their consistency may vary from a softness to a hard, friable or a tough tumor which may be very small or large in size. Rectal polyp, as a rule, are peculated, rounded tumors which are Runyon-fibroblasts or denominators in character. The most common in children is that which probably originates in an inflamed solitary follicle. Polyp of the rectum may also include lymphoma, myopia, angiosperm, iterator and other pathological forms. The disease is commonly confused with hemorrhoids, prolapse or malignant growths, while the symptoms, due to the irritation and destruction of tissue, are often mistaken for a protracted diarrhea, ulceration, bleeding from hemorrhoids, or catarrh colitis. The diagnosis should be made with the aid of the kaleidoscope or the proctorial and a piece of the tissue submitted to microscopic examination when the growth is extensive. When a polyps exists singly, with its peculated base to verify its chief characteristic, a diagnosis of its exact pathological condition can be more easily made after its removal. One of the chief diagnostic points in differentiating a polyps from a malignant growth is this distinct tendency to the formation of a pedicab, while in cancer or sarcoma there is not this characteristic, unless the malignancy is secondary to adenoid which have this tendency to malignant transformation.

The Symptoms are those due to irritation and tenements, the result of the presence of the foreign body in the rectum. There may be the discharge of blood, mucus and broken down tissue, but ordinarily, when the polyp are single, the patient will present himself for the cure of hemorrhoids. Prolapse of the rectum and hemorrhoids often follow and are associated as a result of the constant effort to expel the mass, when low down. A prolapse of the rectum should be recognized with the finger. The treatment of rectal polyp is dependent upon the number and their pathological nature. When the polyps is peculated and only a few in number, ligation and cauterization of the stump is the ordinary treatment. The ligature should not be too fine or so tight as to allow it to cut through the pedicab in less than three days, as bleeding from the stump is often profuse if the ligature slips off or cuts through before granulation become firm. Cauterization without ligation is a most unsafe method of treatment owing to the great liability to hemorrhage.

Should the rectum be the seat of a large number of these growths, particularly of the denominators type, irrigation by means of a double current irrigation made for that purpose is more suitable than the above treatment. The irrigating fluid should be of a temperature not less than 110 degrees or not more than 120 degrees F., and either of the following solutions may be used: Twenty per cent. aqueous extract of Kramer ; ten per cent. witch-hazel; ten to twenty per cent. peroxide of hydrogen, or plain water. A pint to a gallon of the solution may be used at one time if care is exercised to have the fluid return readily. The irrigation should be given every day for a week and later on alternating days. After a few weeks there is generally a marked improvement in these extensive growths and as the associated inflammation subsides, the irrigation may be lessened to three times a week.

When polypeptide growths are located high up in the rectum or sigmoid and it is evident from their situation that irrigation from below would prove ineffectual, a left side inguinal colostomy or an appendicitis is indicated which will afford the only satisfactory means of irrigating the bowel from above. At the same time, if a colostomy is the operation chosen, it will turn aside the fecal current and lessen irritation. This operation affords relief from the many symptoms of auto-intoxication and the drain upon the patient's system from diarrhea and loss of blood. The colostomy indicated under these circumstances should be of the temporary form, may be closed within from one to six months, and can be made without prolonged surgical shock or danger to the patient.

The method suggested by Ant or Cuttle, permitting the extra-peritoneal closure of the artificial anus, will be found the best, and is explained under a separate chapter.

Gibbon’s Valvular Colostomy is, in some cases, the only operation to be chosen, and while not affording the advantages Of turning aside the fecal current, it permits flushing out of the entire colon and rectum.

It might not be inadvertent to state that recent investigations point to the opinion that polyp treated by the ligature or other surgical methods, when the base is not healed promptly, sometimes take on a malignant character.

Viewing the subject from this point it would seem that the irrigation form of treatment of all multiple polypeptide growths in the rectum and sigmoid is indicated as the safest and most conservative. To advise and carry out this manner of treatment is sometimes very difficult as the speed with which surgical treatment relieves the subject is a great boon and persuasive point in favor of operation. The irrigation treatment necessarily takes months to eradicate the disease, although at the same time it relieves the underlying inflammation in the mucous membrane in which the polypeptide growth originated.