I wish to pay tribute to the many workers, too numerous to mention, who by clinical observation and development of new equipment have made proctoscopy a safe, relatively easy, and increasingly useful fact-finding procedure in the diagnosis and management of pathologic conditions of the rectum. Owing to refinements in procedure in this phase of endoscopy, diagnosis is more accurate and treatment more intelligent today than at any time in medical history. Indications for proctosig-moidoscopy may be summarized briefly as any rectal complaint. Unfortunately in 25 per cent of all cases treatments or operations for hemorrhoids have preceded the discovery of cancer of the rectum or sigmoid by less than six months. No specific procedure should be done on the rectum without proctosigmoidoscopy. I know of no contraindication except when digital examination shows it to be impossible, in which case plans may be made to make it possible.
Success in obtaining information by endoscopy depends in great measure upon making the examination as painless as possible. This is especially true of proctoscopy. We know from the patients themselves that examination and operation are delayed because they are reputed to be very painful. This need not be so, and precautions must be taken to see that the examination, while not pleasant, is not painful. To fulfill this requirement it is essential that the patient be properly prepared and that the instruments be well lubricated and familiar to the hands of the examiner.
To avoid the necessity for repeating the examination, the bowel. . .