On diseases of the rectum and anus / by Harrison Cripps.

  • William Harrison Cripps
Date:
1907
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the rectum and anus / by Harrison Cripps. Source: Wellcome Collection.

    152/704 (page 76)
    In examining a patient supposed to be suffering from piles, there can be no difficulty in making a diagnosis should the piles actually be down at the time of observa¬ tion, but it generally happens when an examination is made that there is no protrusion to be seen. Let us then consider, under these somewhat em¬ barrassing circumstances, how to establish a diagnosis. It might seem a simple matter to pass the finger within the bowel, and to feel wTh ether there may be haemorrhoidal swellings present; nevertheless it is by no means easy to make sure of this by digital examination alone. If a surgeon has had considerable experience in rectal cases, he will be able to detect by the finger any abnormal redundancy of the mucous membrane, and occasionally, by a peculiar soft bulbous feeling, will recognise haemor- rhoidal dilatation. Those who are commencing practice will gain little positive knowledge by the finger as regards the existence of internal piles. This is not to be wTondered at, wTien it is remembered that the chief bulk of an internal haemor¬ rhoidal tumour is composed of dilated veins, which whilst within the bowel are comparatively collapsed and empty, only assuming the form of distinct tumours on protrusion from the anus, when they become engorged with blood from loss of external support. Of course a digital examination must be made, to ascertain that there is no graver disease, such as cancer, stricture, or internal ulceration, to which the haemor¬ rhoidal trouble may be only secondary, but this should be deferred till the last part of the examination. In order then to examine for piles, and to bring them into view if present, the patient lying as described, must be told to strain gently downwards, as if about to pass a motion. At the same time, the surgeon should gently draw upon the margin of the anus with the tips of the fingers : after a while, if prolapse or internal haemorrhoids be present, sufficient protrusion can be obtained to