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

ORIGINAL COMMUNICATIONS 30S
covered by a rubber cul, should be well
lubricated and first passed upward and forward
until the spinctures are passed, then
upward and backward. While the finger
There are various specula on the market,
but for m )bt purposes there is none better
or easier of introduction than an ordinary
small or medium sized Sims' vaginal specuis
passing through, note the condition of the lum.
sphicters. If there is a twitching, tender The speculum or proctoscope should first
muscle, it indicates an acute trouble near
the margin: if it is hard and firm, it indibe
thoroughly lubricated and introduced by
a firm but gentle pressure against the sphinccates
a chronic condition: if relaxed, you
would expect some malignant or exhaustter,givingsufl&cient
lime for relaxation of the
muscle. In passing through the anal canal,
ing disease.
Between the spicters we must look out for
the instrument is held at an angle of 45 degress
to the table or on a line with the
openings of fistulas, fluctuations, foreign
bodies, etc. I'urther on, we note whether
the membrane has its normal folds or
whether it is smoothed out— the latter indieating
stony—whether the mucous mempatient's
body while in the knee-chest posi-
tion. After passing the sphincter, the tube
is lowered until it is parallel with the line
of the table. If the proctoscope is being
used, the obturator is now removed, when
brane is soft and pliable or harsh and dry
showing insufilcient secretion. Polypi,
carcinoma, stricture and ulceration may be
air will rush in and inflate the canal so that
the tube may be further guided to the desir-
ed height; the parts inspected and applicafelt
if present, and their nature determined tions of the necessary remedies made by
by the sense or toucli if the finger tip be
sufficiently educated. One can scarcely
hope to be a successful proctologist until
means of dressing forceps or applicators,
By this means the whole of the rectum
may be very easily examined; and by the
he is able, to some extent, to recognize what use of the longer tube or sigmoidoscope,
he feels. the whole of the sigmoid or, as claimed by
While the finger is in the rectum, the
coccyx should be grasped to see if there is
some, the lowest extremity of the descend-
ing colon may l)e inspected. This high
tenderness or inflammation there. The examination should only be attempted by
prostate in man, ovaries, tubes and uterus one having had some experienee in the use
in the female .should be palpated to ascer- of these instruments, and is best done then
tain if these be enlarged, inflammed or ab with a specialty devised pneumatic scope
normally situated. Often, diseases of these with an electric light attachment with which
organs have their symptoms referred to the the bowel is dilated just ahead of the instruregion
of the rectum and vice versa. If ment. The small electric light at the distal
gynecologists would supplement their vaginal
by a rectal examination, much addiend
makes the passage of the instrument
much easier and decreases the danger of
tional information would ofien be gained, injury to the mucous membrane,
and probably occasionnll\' a'sist materially 304 East Grace Street.
in making a correct diagnosis. Upon withdrawa!
of the finger, the character of the Mercuric Cataphoresis versus Radiodischarge,
blood, pus or mucus should be tberapy and Excision In the
noted, and also, the odor.
An instrumental examination is necessary
When we wish to explore higher than three
or four inches of the rectum. The general
impression that this is extreme' V painful
and that a general anesthetic is necessary
is entirely fallacious, for with proper care
Treatment of Cancer.
py ^medee Granger, M. D., New Orleans. La.,
Lecturer on Radialogy and Electro-Physics,
N. O. Polyclinic; Radiologist to the Char-
ity Hosijltal; Member Societe Francsise
d'Electrotherapie, Paris, etc.
It has been my good fortune for the past
and gentleness there is usually very little four years to have charge of the X-Ray and
pain, but more the sensation of discomfort.
Before passing the speculum or proclo-
Electro-Therapeutic
Charity Hospital at
Department of the
New Orleans, and I
scoiie, the finger should always be gently have been afforded a splendid opportunity
passed into the rectum for the double pur- to study this unfortunate and only too compose
of lubricating the canal and stretch- moii affliction. There 1 have seen not only
ing, to some extent, the muscle. Another
and important purpose is to be sure of no
obstruction to the passage of the iiistruthe
failures of the X-Raysbut also of surg-
ery. A large percentage of the cases refer-
red to the Department for X-Ray treatment
ment. The knee chest position is probably
the best for instrumental examination, getare
patients suffering from recurrence fol-
lowing excision—which in most instances
ting the chest as close as possible to the
table, the thighs perpendicular to it and
was radical and thorough. These poor un-
fortunates now inoperable by any method
flexing the back to the fullest extent before are sent to the Department in the hope that
beginning. the X-Rays might help them. In a few