4. Ulcers of the Fundament.
We have already seen how fissures and ulcers of the fundament were a not unusual consequence of the vice of the pathic, yet not the faintest indication of the fact is to be found in the medical Writers. The knowledge possessed by the Ancients as to affections of the fundament have been collected with a very considerable degree of completeness by Aëtius,[400] especially as copying Galen; the remaining authorities treat them as a rule in conjunction with the corresponding affections of the genitals, and mostly recommend the same remedies for them. So far therefore as they are concerned we refer back to the information given in connection with the latter. At the same time the remark may be permitted that this juxtaposition of the two seems to point to the Ancients having held, as we maintain they did, the view that affections of the genitals and affections of the anus arose from like causes and were of like character, as is shown by their dealing with the one and the other class of diseases on the same general lines.
Ardentes dolores (burning pains)[401] and pruritus (itching)[402] of the anus are not uncommon. Inflammations[403] often supervene as a consequence of fissures, morbid growths and ulcers. Rhagades (cracks) and fissures[404] are found either in the sphincter muscle or in the rectum, and are an accompaniment of condylomata, whenever the latter become inflamed and spread, causing the surrounding tissue to rupture; the edges frequently assume a callous condition, and then require to be broken down and thus transformed into a simple ulcer. Often abscesses are set up[405] as a result of the inflammation, and these are liable to lead to fistulas. The ulcers[406] on occasion assume the character of the νομὴ φαγέδαινα (eating and spreading ulcer). Supposing them situated on the sphincter ani, they must neither be cut nor cauterized, as severance of the muscle makes it impossible for the patient to retain the faeces. This loss of retentive power may also occur apart from any operation, if the νομη (spreading ulcer) destroy the muscle. Supposing on the contrary the νομὴ to be below the sphincter, knife or cauterizing iron may either of them be employed. In some instances ulcers lead to a morbid growth at the orificium ani, that must be obviated by means of pipettes of lead.[407] In other cases rhagades (cracks) and ulcers lead eventually to morbid outgrowths.