Abstract

anoperianal abcess and fistula, anal pruritus, and hypertrophic anal papillae. Each of these can be diagnosed by inspection or use of the examiner's eyes and careful palpation or digital examination. It would seem then that proctoscopy would be of little aid as these common lesions can be detected without its use. But no anorectal examination is complete wit' o it poroctoscopy for, until rectal adenocarcinoma has been ruled out in every case, a cancer must be thouaht of as mimicking the symptoms of these lesions or existing at the same time in the rectal ampulla or rectosigmoid of the paticnt having one or more of these common anal diseases. Rectal adenoma or polyp and rectal adenocarcinoma or cancer are on the increase because more patients are living to an age where anaplastic tissue changes are more commonly found and because more doctors are becoming convinced that proctoscopy is to be executed as a part of a general physical examination. A maxim for all surgeons who do proctology can be stated: No anorectal operation should be done until a thorough proctoscopy has been performed. In addition to ruling out malignancy, the careful proctologic surgeon wishes to rule out latent ulcerative rectocolitis, latent amebiasis, multiple polyposis, diverticulitis, and other specific inflammatory proctitis cases as tuberculosis, salmonellosis, shigellosis, brucellosis, and aller-y for he knows that anorectal surgical procedure done with any of these conditions present is a definite invitation to a stormy postoperative period, delayed tissue healing, and possible catastrophy. All of these lesions can be detected at proctoscopy. While they may pose a difficult differential diagnosis, other procedures such as the bacteriologic

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