BECTOB. 764 RECTUM. Church the title of rector is frequently given to a parish priest or to the superior of a college or a religious house, more especially the superior of a Jesuit seminary or college. A 'missionary rector' in this Church is a priest appointed by the bishop to certain parishes in England, and in the L'nitcd States to the charge of any parish. Some few are known as •irremovable rectors' ; these cannot be transferred to other parishes or removed for any other cause than proved miscon- duct. In academic usage the title of rector is given in many places to the head of a college or of a university. In this .sense it was employed by the colonial institution of America until the middle of the eighteenth century, for instance, the head of Yale College was called rector. BECTTJM (abbreviation of Lat. rectum inics- tinum. straight intestine). The lowest (or, in animals, the most posterior) part of the large intestine. Some anatomists include the sigmoid llcxure of the large gut as a part of the rectum. In this view, the first part of the rectum consists of a loop beginning in the left iliac fossa and ending opposite the third piece of the sacrum. When unfiddcd this loop resembles the Greek capital letter omega, and is about 17% inches in length. It lies wholly within the pelvis, and it is attached by a mcso-colon to the abdominal and pelvic wall. The remaining part of the rectum extends from the middle of the third piece of the sacrum to the anus. The term rectum should be limited to this portion, free of meso- colon, lying in the hollow of the sacrum to the tip of the coccyx, thence curving backward and downward to the anal orifice. The portion that lies against the sacrum is about 3% inches long, the remaining part about 1% inches long. The upper part of the rectum proper is covered with the peritoneum, which ceases at a point five inches above the anus. The structure of the rectum is considered under Intestine (q.v. ). BECTXTM, DisE.sEs of the. The rectum is the scat of a number of congenital deformities. Imperforate anus or entire absence of the anus is sometimes found in newly born children. Oc- casionally the rectum opens into the vagina or urethra. These conditions have to be met with prompt surgical measures. An imperforate anus is punctured or incised and kept open by bougies until healing takes place, and a preternaturally narrowed rectum or anus is dilated with rectal sounds, or with the finger. Sometimes an arti- ficial anus has to be made, either at the natural site or higher up in the inguinal region. In feeble or ill-nourishc<l children prolapse of the rectum or anus is apt to occur from diarrhoea and exces- sive straining at stool, or in connection with worms, stone in the bladder, or other irritation. Prolapse is reduced by the application of cold compresses, and gentle replacement of the pro- truding tissue with the fingers. It is then re- tained by a pad, and recurrence is combated by the use of astringent and antiseptic injections. A perfect cure, however, is only to be secured by the removal of the causative condition. Adults are subject to numerous disorders of the rectum. Inflammation (proctitis) results from constipation and from chronic diarrhnea and dysentery. Ulceration of the rectum may be due to abrasions from hardened faecal masses, to syphilis, or to tuberculosis; it may be single or uuiltiple. Ulcers are treated locally by cleansing and astringent injections, with constitutional remedies adapted to the individual case. Spasm of the rectum ( proctospasm) or sphincter ani is a not uncmnmon manifestation of neurasthenia and hysteria, but its most usual causes are anal fissure and hemorrhoids. Strictvire, which may result in complete occlusion, may be simple or malignant. It is often caused by cancer of the rectum. When due to cancer the pain is intense and lancinating, and the patient has an emaciated appearance. The stools are often flat- tened out like ribbons, and contain blood and mucus. Stricture of the rectum is best treated by laxatives, cleansing injections, and by grad- ual dilatation with soft rubber bougies. In the case of cancer, however, these measures are only palliative. Here it is often necessary to remove a part or all of the rectum and stitch the colon to the edges of an artificial opening in the abdomi- nal wall at the groin, thus forming a new anus. Patients can thus live in comparative comfort. Fissure of the anus is a crack at the anal open- ing, producing spasm of the sphincter muscle. It causes violent burning pain during defection, and the dread of this sutt'ering results in volun- tary inaction of tfie bowels and habitual consti- ])ation. Intense itching often accompanies fis- sure. Strict cleanliness and the application of healing ointments usually sulllce to cure this condition. Touching with the point of a stick of lunar caustic is a valuable remedy. Fistula in ano consists of the unhealed track of an abscess adjacent to the lower part of the rectum on the verge of the anus. An abscess in this region heals with great difficulty, because of the con- stant movement of these parts and the passage of faeces, which reinfect and irritate it. Fistula is not unconunonly associated with hemorrhoids, cancer, or stricture. These are the varieties of fistula: The hlind cxtrnial terminates in a cul- de-sac near the bowel and opens at or near the margin of the external sphincter; the hUyid in- ternal fistula opens into the bowel and has no external orifice: the eomplelr has both an in- ternal and an external opening. The symptoms are passage of wind and f;?ees through the open- ing and of a discharge which stains the clothing. Repeated attacks of inflammation ensue and new abscesses form. Treatment in all varieties of fistula is free incision and cutting out of the fistulous tract. See Fistula. Hemorrhoids or piles are venous tumors situ- ated either Avithin, without, or on the margin of the anus, and are caused by congestions and in- flanunation of the abundant vascular areas of the rectum. (See Piles.) Polypus of the rectum is a tumor attached by a narrow pedicle, and origi- nating in a relaxed fold of the mucous membrane, or in granulation tissue springing from an ulcer, or in a mass of hemorrhoids. The only remedy is removal. Pruritis of the anus is a symptom of many diseases, both local and distant. It may and often does accompany such widely diverse affec- tions as piles, fissure, seat worms, ec/ema. nerve disturbances. Bright's disease, jaimdice. consti- pation. The itching is almost unbearable and is worse at night. The general treatment will depend on the exciting cause. Locally sedative lotions and ointments are employed and strict cleanliness observed. Eczema (q.v.) often af- fects this region.
