Licence: Public Domain Mark
Credit: The rectum and anus : their diseases and treatment. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![disappear spontaneously, can the patient return it, or is it constantly present % Disctiarg'e.—Bloody, mucous, or purulent? Foetid % Mixed with faeces % Occurring before or im- mediately after defsecation^ or independent of the act % Faeces.—Diarrhoea, or constipation % Consistence ] Of normal size % Tape-like, or lumpy % Having now clearly obtained the subjective pheno- mena, we should, if there is a suspicion even of rectal disease, insist on a complete local examination. Under no circumstances is the attendant justified in pre- scribing without careful examination, although often he will be asked by his patient to prescribe something for the piles. I have seen a case of extensive malignant disease of the rectum, which had passed all hope of useful treatment under the care of a medical man, who had rested satisfied with the statement of the sufferer that she was suflfering from piles, and who never had made an examination. Of some diseases the symptomatology is tolerably diagnostic; as, for instance, if the patient has severe pain continuing for some hours after defsecation, if the motions are small and tape-like, and if they are streaked on one side with bloody mucus, there is a very strong probability that there is a painful fissure present; but without examination we cannot possibly say that the fissure is the only rectal disease; indeed, in a large proportion of cases we find more than one pathological condition present. £xamiiiatioii.—If possible the patient should have the bowel emptied by an enema immediately beforehand. In some cases this is absolutely essential; as, for instance, where it is necessary to use a speculum for the exploration of the higher portions of the mucous membrane. Position.—By far the most convenient position for ordinary examination is the semiprone of Marion](https://iiif.wellcomecollection.org/image/b21229387_0017.jp2/full/800%2C/0/default.jpg)
