One would naturally suppose that the majority of mistakes result from lack of knowledge, but in my experience, it is not so, and the great majority of mistakes, in diagnosis at any rate, are due to carelessness.

Neglecting to examine the bowel with a finger

The commonest mistake of all in regard to rectal conditions is the failure of the doctor, who first sees the patient, to examine the bowel with his finger. It is still a surprise to me why doctors invite trouble in this way, yet they continue to do so, although any doctor can keep a box of rubber cots on his consulting room table and make a rectal examination without any difficulty.

Too often one finds that a doctor has been in attendance for some weeks without having made any attempt to examine the bowel, with the result that some gross error in diagnosis has been made. The patient naturally resents such maltreatment when he discovers, as he must do, that the condition might have been found much earlier.

Results of neglecting to make an examination are sometimes much more serious than the mere inconvenience to which the patient is subjected by being put on the wrong treatment. I have frequently seen cases in which a patient had for months been under treatment for piles, who, on examination, was found to have a malignant growth quite low down in the rectum, which as the result of the delay, had become inoperable.

No rectal examination for three months

Only just recently I had a case brought to me by a doctor, who had only seen the patient the night before. Previous to this, the patient had been under treatment by another doctor for some three months, and during that time a most careful investigation had been made of his urine, bladder, etc., and X-ray photographs had been taken after a bismuth meal, but no examination had been made of the rectum, although the patient’s symptoms pointed clearly to the bowel; in fact, the patient had been told that there was nothing the matter with his rectum because the X-ray photographs did not show anything. As a matter of fact, there was a malignant growth, which was almost inoperable, in the rectum, which could be easily felt with the finger.

Lady treated for ‘piles’ for a month without examination

Not long ago I was asked to see a lady, aged 55, who while staying at her country house had had considerable discomfort in the rectum, accompanied by lack of control over the bowel and slight diarrhoea. She sent for her local doctor, who, without making any examination, diagnosed piles, and prescribed an ointment and a bismuth mixture.

After a continuation of this treatment for a month without any good result, the patient came up to London and saw another doctor, who promptly made an examination of the rectum and found a large stercolith about the size of an orange just within the rectum. I was subsequently called in, and it took me three-quarters of an hour with a chisel and hammer, under an anaesthetic, to remove it.

High-frequency electricity to the rectum

I had another case of a young lady, who had for some months been under the care of a London physician for a constitutional ailment. She went to him one day and said that she was suffering, she thought, from piles, and that for a week she had had considerable pain in the rectum. 

He did not examine her, but sent her to an institution to have high-frequency electricity applied to the rectum. The applications were made for almost a week, without benefit, and it was then discovered that there was a large swelling at the side of the anus, and I was asked to see the patient.

I discovered a large ischio-rectal abscess which, on being opened, was found to contain a pint of foul pus.