Fig. 10.—Position for operating, or making a rectal examination. Engraving kindly furnished by Sharp & Smith, who manufacture one of the best office and operating chairs combined, on the market. It works without “cranks,” “levers,” or “ratchets.” Upholstering is entirely protected during an operation.
It is unnecessary for a lady to disrobe herself for examination, or suffer immoderate exposure. A cloth cover should be used, when a lady patient is placed on the chair, the same as in gynæcological practice.
RECTAL EXAMINATION.
The first step to be taken in making an examination of the rectum, where disease of this organ is present or suspected, will be to obtain a history of the case as given by the patient, supplemented by questions naturally suggested. This will furnish an idea of what might be looked for, but the patient’s interpretation will often be found quite erroneous and misleading.
Should there be an undue protrusion at stool, pursue the same course recommended for the examination of internal hemorrhoids. If protrusion be absent, direct the patient to lie on the side with knees drawn up, separate the buttocks and inspect the anus; or, in other words, all that presents to view externally at the terminal orifice of the rectum. Now draw down and evert the mucous membrane at the verge with the thumbs, asking the patient at the same time to extrude the parts as much as possible. This will enable you to see all there is half an inch or more above the entrance.
Next, anoint the finger, pass in gently and examine all the surface limited by the sphincters, a distance upwards of not over an inch, being careful lest you be deceived by the mobility of the tissue, when introducing the finger, and a small marginal growth be carried up and appear as one of internal origin.
Any one familiar with vaginal examinations can detect a rough or a broken mucous membrane, an indurated spot or prominence as soon as touched. Next, feel above the internal sphincter, keeping in mind the anatomy of the parts, turn the finger slowly, posteriorly you can hook it behind the muscle. Here is situated the bottom or floor of the rectum which forms a cul-de-sac ([Fig. 11]). By asking the patient to strain down moderately, its surface will be thrown up against the end of the finger and in this manner properly explored.
