Rectal bleeding is so commonly associated with hemorrhoids that one is apt to be careless and fail to make either an ocular or digital examination to verify the diagnosis. Too often, the diagnosis of hemorrhoids, as given by the patient, is accepted as sufficient. Bleeding from the rectum is often the only symptom which prompts the patient to consult the physician.

Bleeding may be found in the stool when associated with severe catarrh diseases of the colon or rectum, internal hemorrhoids, polyp, ulcer of the rectum, fissure in anew,'dysentery, prolapse, malignant and non-malignant growths and erosion of the mucous membrane due to stricture or impacted feces. In addition to these causes, bleeding may be present as a complication of such constitutional diseases as typhoid fever, malaria, yellow fever, and with some cases of anemia, purport scorbutic, kidney and heart diseases where changes in the blood occur.

It is hard to understand why the average practitioner will permit his learning and judgment to be superseded by the opinion of the layman who makes the diagnosis of hemorrhoids, and simply asks for treatment.

The Diagnosis of bleeding, from the stomach or small intestine may be made from the fact that coagulated blood from the upper portion of the alimentary canal would be incorporated with the digestive residue, while blood from the lower portion is often evacuated independent of the fecal mass in the form of a slight or severe hemorrhage.

Internal Hemorrhoids, when eroded, are the most frequent source of bleeding and probably the one cause responsible for most of the mistakes in diagnosis. Fissure in anew and ulcer are the next frequent and a quite common cause of bleeding, but permit me to emphasize the fact that their presence do not conclusively exclude the possibility of the coexistence of rectal cancer.

Adenoidal of the Sigmoid and Rectum are more frequent than is suspected on account of giving the symptoms of a protracted diarrhea. This disease in the early stages gives the ordinary symptoms of rectal bleeding, but later presents a picture of sepsis {septicemia), simulating that of cancer long before a malignant degeneration has occurred. These growths, when extensive, irritate the intestinal canal so greatly that a constant discharge of blood, fecal matter and broken-down tissue takes place. These non-malignant growths are too often allowed to progress to malignancy.

Cancer is found more frequently in the rectum than in any other portion of the small or large intestine and when we consider the advantages of early operation, it seems that more care should be exercised to recognize this one malady before involvement of the surrounding tissue and organs has taken place. Early operation is most promising either in an attempt at radical cure or the prolongation of the patient's life.

These patients present vague symptoms at first. As a rule, the patient complains of fullness in the pelvis, due to pressure according to the location of the growth. The pain in the early stages is very little excepting at the margin of the anus. When the growth is situated high up, the fullness of the rectum is complained of more than any other symptom, and there is a constant desire to expel the mass. Stricture, hemorrhoids, fissure or prurient an may be present at the same time. As a result of the ulceration and inflammation, blood is quite early in its manifestation.

A number of persons who present themselves for treatment with a history of bleeding from the rectum after stools deserve special attention. After the most careful examination no pathological lesion may be revealed either in the form of cancer, hemorrhoids, fissure, ulceration or hypertrophy of the sphincters. Examination of the blood, kidneys, heart and liver will not elicit any systemic or primary cause of diseased condition. In fact, nothing that will account for the presence of blood will be found. Therefore, in the absence of an etiological factor to assist in the diagnosis, I have considered the bleeding of hemophiliac origin, the result of the ordinary pressure exerted by the normal sphincter muscles in contraction upon the mucous membrane. My only treatment has been dilatation of the sphincters, either with or without a general anesthetic. This form of treatment seems to be of benefit for a variable period.