The anal mucous membrane or muscular apparatus are often irritated and kept in a condition of pain, by cystitis, vulcanologist, displacements and adhesion of the uterus or ovaries. Stricture in the per-rectal tissue from old inflammations around the uterus often cause pain which is referred to the rectum, when the primary and pathological origin lie in the parametrize

Reflex pain, which is described by the patient as shooting down the legs, is common to diseases which are located in the rectum, anal ring or pelvic organs and must not be accepted as being worthy of much diagnostic significance in the differentiation of these diseases. Pressure from a tumor of the uterus or its appendages is quite as likely to cause pain of this character as the constant irritation from a rectal ulcer.

Pains referred to the floor of the pelvis and the sacral region are so intimately associated with disease of the rectum. anus and the female pelvic organs that very often our only means of correct diagnosis is by elimination or exploratory tracheotomy Heretofore pains in the back and within the pelvic cavity were all supposed to be due to a laceration of the cervix, weakened elevators an, or a prolapse of the uterus. Later, the ovaries, tubes or adhesion of the different generative organs were the objective points for operation and were removed in order to relieve these symptoms. While in many instances relief is attained by such treatment it should not be taken as a fact that all sacral and pelvic pain is due to disease of these organs and for the benefit of humanity a broader scope of learning will emphasize the usefulness of proctorial

These pains may be due to rheumatism or strain of the ilia-sacral synchronizes and necessitate treatment from that point of view. Therefore, a rectification of disease in the female pelvic organs, the removal of hemorrhoids or the cure of rectal ulcer will not cure the pain in patients suffering from disease of this joint. Sometimes we meet with cases which represent a combination of these conditions, particularly after child birth, when there exists a rupture of the perineum, rec-photocell, hemorrhoids, a fissure in anew, a partial prolapse of the uterus and a traumatize to the ilia-sacral joints which has terminated in rheumatism. A cure of either one of these conditions is not likely to relieve the pain and suffering due to the others, so that the gynecologist, to obtain success, must broadly consider the cause and effect of pathological conditions within the pelvic cavity. The question becomes one of complete differentiation, diagnosis and the exact determination of the causes; then, the institution of radical and effective treatment to each and all of the diseased conditions in either organ.

The rectum is functionally intended as a receptacle for the fecal mass prior to expulsion; the expulsion of its contents at regular periods, and the absorption of the fluids contained in the feces. These physiological functions may easily be interfered with to a variable degree by diseases of the female organs of the pelvis or. mechanically by pressure from them. Irritation from inflammation, pressure from a retro-vetted uterus, or adhesion which cause deformities in the form of triangulations or stricture, either interfere with peristalsis of the lower bowel, with the normal supply of blood, or the nerves which maintain its equilibrium.

Parturition, procreation, menstruation and parturition are the functions of the female genital organs and are often altered very much by affections of the rectum as follows:

Parturition is affected by acute inflammations, fissures, painful rectal ulcerations, traumatizes, either surgical or direct violence and by large growths of the rectum.

Menstruation may be delayed by constipation or brought on by a diarrhea, and caused to act vicariously by any discharge, hemorrhage or profound shock to the nervous apparatus of the rectum in the form of a surgical operation.

Procreation may be interfered with by fecal impaction which causes an acute flexible of the uterus.

Parturition may be interfered with temporarily by a foreign body or fecal impaction of the lower rectum, hypertrophy of the elevator an muscles, which prevent a full relaxation of the perineum, and totally impeded by the presence of a large fibroid or other tumor of the rectum.

The rectum is also used for the absorption of nutrient ENE-mate Its wonderful osmotic power is well illustrated in the Murphy irrigation which consists of a physiological saline solution intended to assist the system in the neutralization of bacterial poisons. The Fowler position and these saline irrigation have together given us ample reason to regard the lower intestinal canal as offering a most valuable adjunct in the treatment of surgical cases complicated by pus in the lower abdomen.

Affections of the sigmoid flexible, such as periodontists, diverticulitis and sigmoid, are often overlooked, due to the assumption that all pain over the left inguinal or ilia region is the result of tubal or ovarian disease. The symptoms of pain or tenderness which are made worse by walking, deep pressure on abdominal examination or palpation through the vagina, invariably suggest to the gynecologist the possibility of ovarian disease, which may exist associated with an affection of the sigmoid, as an impaction of feces, hypertrophy catarrh, strangulation, or any of the diseases of the sigmoid flexible mentioned above. These conditions are commonly present together, as verified by sigmoid examinations, and are often due to primary affections of the uterine appendages, but must be treated with the original cause to ensure relief. These sigmoid affections are diagnostician by means of the kaleidoscope or in some cases only by opening the abdomen.

Auto-intoxication resulting from the absorption of putrid material or bacteria by the intestinal mucous membrane is more recently being regarded as a common cause of mental and nervous disorders by neurologists: and the influence of the disorders of the intestinal tract upon the system in general is attracting rigorous study.

Rectory is partly or wholly due to a separation of the elevator an muscles and the patient not only suffers from the ordinary vaginal symptoms due to the bulging posterior vaginal wall, but from distortion of the rectal cavity and weakened physiological action of these muscles in defecation. As a result fecal accumulation and irritation of the rectum takes place.

In conclusion we learn that to make a complete diagnosis the relation of gynecology to proctorial must be understood, because the diagnosis is often based upon the differentiation of symptoms, irrespective at first as to their origin and then, by elimination, the determination of the primary cause. It points out the absolute necessity of a broad knowledge regarding the diseases of the rectum by the general practitioner.

It is lamentable to admit that the average practitioner cares little and does still less in the study and treatment of these diseases.