Vol. 60, 1909 - University of North Carolina at Chapel Hill

,i(M THE CHARLOTTE MKDICAI, JOURNAL.
diseases often has a tendency to assume mistaken for vesical, urethral, prostatic,
serious proportions and result in destruction vaginal or uterine affections,
of tissue and loss of function of the parts, To begin with, when a patient presents
or may in some instances become malig- himself for treatment, the history of the case
nant. There is no portion of the body to should be carefully taken, allowing the
which this applies more forcibly than to the patient to tell his story in his own words,
rectum. While this may be a little tiresome to the
Medicine and surgery have undergone a physician, still, if he has been an attentive
very complete revolution during the last listener, it will have the effect of putting
decade or so; old slip-shod methods and the patient somewhat at his case and will
guess work will do no longer, for the pa- engender in him more confidence in the
tients expect and demand more than a physician. While this appears in itself of
casual glance and the asking of a few ques- little consequence, it often means a great
tions. It is not uncommon even now for a deal, for if the patient is unduly excited,
patient suffering from some rectal trouble embarrassed, or lacks confidence in the phyto
call to see the doctor and inform him that sician, the examination to follow will hardly
he wishes treatment for his piles; for the be successful.
patient often has no conception of other Age, vocation, habits, mode of living,
diseases of these parts, and the physician, previous diseases, present symptoms and
after asking a few unimportant questions, how long present should all be gotten and
will write a prescription for some ointment recorded, and if deemed necessary, his anto
be applied as directed. The patient may cestry should be inquired into, though
or may not have piles—the ointment may heredity is of very little importance in rectal
possibly do good, but most probably will diseases. It is very important in prescribnot;
but, at any rate, you will admit that ing a diet and the amount and kind of exthe
patient has not received a square deal, ercise a patient should take (which is nee-
He is most assuredl}' entitled to a careful essary in rectal diseases), that we should
and painstaking examination to elicit, if have a clear idea of his present habits in
possible, the true nature of his malady. these respects, for it would hardly be to our
A correct diagnosis having been made credit to advise more exercise for a profesand
the proper treatment given, good re- sional acrobat or foot-ball player, or to insults
will be gotten in the great majority of form him tliat he was eating too much meat
cases. Without the proper examination, when he might be a vegetarian. Just very
it is fallacy to hope for betterment except recently, a lady told me that she had changby
mere chance. ed doctors because when she asked the
Diseases of the anus and rectum often former physician the cause of her child's
progress very rapidly, and the delay of a sickness, he stated that it was due to drinkfew
days in receiving the proper treatment ing too much milk, when the fact was that
may convert the simplest trouble into one the child had a great dislike for milk and
of very great magnitude, thereby causing had not drunk a glass of it for a year,
the patient a great deal of suffering, loss of Such little mistakes have caused many a
time, expense and probably endangering doctor the loss of a patient: but they would
his life. As an example, take a case of not happen if we enquired a little more
thrombotic hemorrhoids, which is one of the closely into their regimen,
simplest of conditions to treat and can be The Sims' or left lateral is the best all
cured in three or four days, but which, not around position for the physical examinainfrequently,
if left alone, results in fistula tion; still others, as the knee-chest or lithotor
perirectal abscess, often taking weeks or omy positions may, at times, be preferable,
months of careful attention to effect a cure. We should first carefully inspect the anal
Again, as in other portions of the body, it region, noting the shape and size of the
is most important that an early diagnosis orifice, color of the skin, whether unduly
of malignant disease of the rectum and anus dry or moist, any ulceration, fissure orfistulshould
be made, for it is only in the early ous opening, external, protruding or interstages
that we can expect to eradicate can- nal hemorrhoids, polypi, etc. By having
cer. the patient strain, at the same time pulling
With a little experience, an examination the buttocks well apart, we can gain a fair
of the rectum and sigmoid is made quite as view of the lower part of the anal canal,
easily and as satisfactorily as an examina- By palpation, any tender points, fistulous
tion of the vagina, and should be made tracts or fluctuation indicating abscess may
quite as much of a routine. If we made be made out. Digital examination is one
more frequent rectal examinations, the of the most valuable means of diagnosis of
diagnosis of a great many of the obscure disease in the first three or four inches of
pelvic lesions would be cleared up; for it is the rectum and sliould always precede the
uot rare for diseases of the rectum to be instrumental examination. The finger,