An attempt is herewith made to group the rectal diseases commonly existing together; to differentiate these diseases when occurring separately, and to suggest others that might present similar symptoms. A reference should then be made to the more comprehensive description of the disease in the text to further assist in the diagnosis and the treatment.

Malformations of the Anus should be looked for at the time of birth by every conscientious attendant, and this important habit or system of examination should be included in the regular duties of the accouter. An examination which reveals total obstruction prior to the ingestion of food and intestinal putrefaction gives these infants the only opportunity for operation when the colon is free from bacterial growths.

Statistics lead us to believe that about one child in every ten thousand is born with some deformity in this region. The rectum emptying into the vagina forms fully half of the malformations so that the examination of infants at birth should be regularly made by the attending physician instead of depending upon the nurse, who in many instances has no idea as to the character of the deformities to be sought in this region. Her only knowledge of a disturbance in the natural function is the total absence of the discharge of zirconium. Nor does it include the ability to diagnostic ate deformities that would cause the discharge of fecal matter at some unnatural place, as the vagina or urethra. Usually she will not make such a discovery during the first day, and is apt to wait until the physician calls on the following day before making a report. The small finger of the average adult hand will do no harm when introduced into the rectum of a newly-born infant.

Deformities of the anus are easily discerned by an ocular and digital examination. Either a total absence of the normal anal canal will be noticed, or a depression at the proper site will be found. When a membranous occlusion, either partial or complete, is present, a bulging caused by the pressure of the retained zirconium is evident. If the occlusion is located higher up in the anal canal at the pectin, the diagnosis may be delayed until symptoms occur, if the finger is not introduced. Malformations of the rectum which do not permit fecal discharge manifest the defect within twenty-four or forty-eight hours, and give rise to the general symptoms of intestinal obstruction. The condition of the child is then exceedingly grave and surgical aid is imperative.

When the deformity is such that the end of the rectal pouch is situated an inch from the normal site of the anus no impulse will be felt at the perineum, but when the distance is less it is usually elicited. When the rectum empties itself into an adjacent organ - the bladder, vagina, urethra, or uterus, the discharge of zirconium at an abnormal place will be noticed. An examination at the time of birth would in this instance relieve the attendant of adverse criticism and prepare for the proper course of treatment.

Catarrh Diseases of the colon, sigmoid and rectum are usually manifested by digestive disturbances, constipation, diarrhea, or both, with the discharge of blood, pus and mucus. Strophic catarrh colitis is commonly associated with constipation, the result of diminished mucus secretions, but this is not invariably the rule until the condition is very severe, and of long duration.

Rectal Polyp. As a rule, the first indication of the existence of rectal polyp, when located low down, is the occurrence of tenements after defecation or when the mass happens to engage the sphincter muscles. Their presence is usually sufficient to make defecation painful from the pressure upon the swollen and eroded mass.

Blood will be discharged when sufficient injury has been done to the polyps to erode the mucous membrane covering it or the surrounding rectal anal or rectal wall. Fissures are often a complication existing with polyp. A proctorial is often excited as the result of the irritation caused by the presence of polyp which acts as a foreign body. The diagnosis can be made only by rectal examination with either the finger, speculum or proctorial. Digital exploration will easily detect the pedicab. Rectal polyp are usually single unless of the myxomatosis type which are found high up in the rectum or sigmoid. Malignant growths are not peculated and tend to surround the gut involving the epithelial layer. Polyp have been mistaken for rectal prolapse on visual examination but are easily differentiated by examination with the finger.

Prurient Agni may be confused with marginal eczema (ring worm) and when suspected, a microscopic examination will affirm the diagnosis by finding the fungus (trichinosis). The widespread characteristic involvement of the superficial tissue occurring in prurient an, and the intense intermittent itch, will render a diagnosis easy. Prurient an is secondary to some constitutional or intestinal disease.

Abscess Formation in the rectum, when in the deeper tissues, will often present symptoms of pain which are most indefinite as to exact location. When an abscess is forming in the mischief-rectal Fosse it will sometimes simulate the pain of a fissure or a bruised hemorrhoid. The chief symptom is pain, which may be indefinitely located, but is peculiarly constant and increasing in character until relief from the pressure is obtained by the rupture or an incision of the abscess. Palpation may reveal fluctuation and swelling. Fever is a constant symptom in all abscess formations of any size and, when noted, will assist in the establishment of the diagnosis.

Fistula may give rise to symptoms of irritation within or outside of the rectum, resulting from the discharge of pus or the interference with the normal contraction of the muscles situated within the area affected by its presence. When suspected, it is well to remember that it may terminate in any part of the rectum, upon the skin, or into a neighboring organ and give rise to symptoms accordingly. Prurient, rectal tenements, painful defalcation. and irregularity of the bowels are very common symptoms associated with fistula which discharge their contents into the rectum or anal canal. External incomplete fistula seldom give rise to more than a slight degree of discomfort because of the opportunity AF-forded the sufferer to keep the parts clean with water.