PRURITIS ANI.

Excluding all discoverable local causes whereby the presence of this obstinate affection may be explained, such as piles, ulcer, fistula, oxyuris vermicularis, eczema marginatum, etc., and take the disease unalloyed, or as it may exist in a state pure and simple, and assure a patient thus afflicted that he can be quickly and permanently cured, would not only be presuming too much, but would be stepping beyond the legitimate bounds of all past recorded experiences.

To furnish something of an idea to those who are not already familiar with this seemingly trivial yet rebellious complaint, I here quote the language of Dr. Hoyt, who uses words somewhat extravagantly in the beginning but palliates his feelings down later on with lotio niger.

“With what anguish its unhappy victims battle through innumerable sleepless nights fighting this demon of so-called local epilepsy, with its long array of itching, burning, exuding, corroding, exhausting, and blaspheming characteristics, as though they had been brewed by the chemistry of hell. The whole organization becomes a chaotic discord, the disposition is cruelly warped, the countenance shows a sad picture of living woe, the carriage is nearly lost to all laws of equilibrium, and the complete being merges into a throbbing phantom of despair, trembling upon the very threshold of idolized suicide.

“Of course I speak of the most aggravated cases, instances that seldom occur within the experiences of general practitioners. Wherefore then these phenomena? What is the mighty influence that yields so much distress, as all these objective symptoms are but an appearance outflowered by some subtle and specific force. The meager literature upon this subject hobbles upon the crutches of hypothetical inferences, telling you perhaps it is capillary congestion or chronic proctitis, or neurotic hyperæsthesia or eczema, or malaria, suggesting a panoramic array of remedial agencies all unsatisfactory, thereby confessing to a sad condition of helpless empiricism.

“My comprehension of this subject compels me to endorse the parasitic theory, though it may excite your disapproval, and perhaps your ridicule, yet it can be easily verified by directing your management towards the destruction of the parasite, when all symptoms will disappear. Mercury is quoted as nearly a specific for the annihilation of these marauders, and the very best method of administration is by using Lotio Niger.

“Thrice daily the patient should relax, the respiration of the cutaneous surface by the free application of hot water, just as hot as it can be comfortably endured. Then immediately afterwards while the skin is made absorbent by the action of the liquid heat, it should be saturated with this medicine in the most thorough manner. Within three days time the itching will be reduced fifty per cent., but the complete result is attained only after a continued use of from four to eight weeks.

“In many cases there will remain points or patches where the agent does not seem to act, and to these I usually apply the regular unguentum hydrargyri. Avoid all soaps and ointments except as above stated, thereby preventing the obstruction to absorption of the remedy as it has to enter the pores of the skin in order to act upon these energetic enemies that hold their victims under such a terrible bondage.”

It is characteristic of pruritis for the paroxysms of itching to come on mostly after the patient gets warm in bed, at which time the annoyance may be further increased by a moisture or exudation about the anus.

In longstanding cases the skin becomes thickened, horny in texture, and loses its pigment and elasticity. Sometimes portions of the radiating folds will become so hypertrophied and elongated, from the effects of gouging and scratching, that they look like and are sometimes called external piles, which in reality are nothing of the sort, but properly speaking would come within the range and meaning of non-syphilitic condylomata.

I have successfully removed these formations by the same process adopted for the cure of piles. They go through similar changes after injection and open up a cavity surrounded by a ragged, thick, calloused skin, which, after first being cocainized, can be trimmed off with a pair of scissors. If there are several large tabs I do not operate on all at one sitting.

Fig. 29.—Thickened condition of the skin in pruritis (Esmarch).

In the treatment of pruritis ani, a thorough search for a local cause and its removal will find a lasting reward in the results obtained.

Of the obscure local causes, perhaps animal and vegetable parasites are the most difficult to find. The injection of a decoction of quassia bark or lime water and carbolic acid, will be efficacious in dislodging the oxyuris vermicularis, which may or may not be seen, like small pieces of white thread lodged between the anal folds.

For the vegetable parasites, tricophyton, etc., (microscopical) sulphurous acid ranging from 50 per cent. up is an old tried remedy. Immoderate eating, drinking coffee, and smoking excites the itching with some. Whenever it be decided that no local or constitutional disease can be found as an assignable cause, and that it is purely neurotic in character, we commence to grope in the darkness for remedies. What relieves one will not another; and what relieves for a time will lose its effects altogether.

Hot water compresses, a little short of scalding, are good for relief and a good intercurrent remedy. Among the remedies highly recommended are linseed oil, thuja occidentalis, carbolic acid, citrine ointment, oil of cade, oxide of zinc, compound tincture of green soap, black wash, and galvanism. The anode is placed over the perineum and base of scrotum and the cathode against the anus or within the grasp of the sphincters. Claimed to be a specific. Nerve stretching by divulsion of sphincter muscles is also recommended.

Formulæ:

℞Ung. Citriniʒ ii
Balsam. Peruʒ iss
Acid. Carbol.gr. xx
Sulphurisʒ iii
Cerat. Simp. vel Lanolini℥ i
M.
℞Hyd. Chlor. Mit.℈ iv
Adipis℥ i
M. Said to be specific for pruritis ani or vulvæ.

℞Hyd. Chlor. Mit.ʒ i
Balsam. Peruʒ iss
Acid. Carbol.gr. xx
Lanolini℥ i
M. et sig. Apply after hot sponging.
℞Ol. Cadiniʒ i
Acid. Salicyl.gr. xv
Ung. Zinci Oxidi q. s. ft.℥ i
M.
℞Saponi viridis}ā ā℥ i
Ol. Cadini}
Alcohol.}
M. (Kelsey).
℞Liq. Carbon. Detergentis (Wright’s).
Glycerinæā ā℥ i
Zinci Oxidi}ā ā℥ ss
Calamini Prep.}
Sulphuris Precip.}
Aquæ Puræ℥ vi
M. (Allingham).