Writing for 75 Years Of Medical Progress, Louis J. Hirsch-man, M.D., Founder and Emeritus Professor of Proctology, Wayne University Medical College, made the following ob­servation:

"In the mind of many laymen and a few physicians, the chief function of the proctologist is to treat hemorrhoids, or 'piles.' The disease of hemorrhoids was known and described as far back as biblical days, and is one of the commonest diseases which afflicts mankind. Even seventy-five years ago there had been little advance made in the palliative or in the surgical treatment of hemorrhoids. Because some people thought that any rectal disease was an evidence of uncleanli-ness, they refrained from consulting their family physician from a sense of shame or false modesty. As a result, many quacks, charlatans and imposters promised to treat hemor­rhoids and rectal diseases 'without surgery or detention from business or one's ordinary occupation.' It was really not until 1878 that reputable physicians began to realize that there was much to be desired in the treatment of the patient suffer­ing from hemorrhoids."

Dr. Hirschman's observation about reticence to discuss rectal disease not only is pertinent to proctology, but in some aspects is equally pertinent to urology and to most diseases and disorders that involve the bladder, and sexual organs as well.

This "hush-hush" attitude certainly worked to a disadvan­tage in the health of thousands of persons in the past. Today's enlightenment is a big factor in bringing relief and cure to many thousands who, years ago, might have suffered in silence, mistakenly inspired by unnecessary shame and false modesty.

The proctologist in modern medicine generally treats dis­eases of the colon, rectum, and anus. Among the typical dis­eases treated by proctologists are cancer, papillitis, cryptitis, abscess, fistula, anal ulcer, hemorrhoids, pruritis, and a good many other disorders.

It is not unusual, however, that most of the public may associate proctology with hemorrhoids. Reports indicate that about one-third of all adults at one time or another suffer from hemorrhoids or other diseases of the anus or rectum.

Hemorrhoids are described as "Livid and painful swellings formed by dilatation of blood vessels at the anus; piles." Folk medicine yields many treatments for the condition.

One treatment of the 17th and 18th centuries was fre­quently suggested and used by many. "Take Album Graecum reduced to an impalpable powder, mixing it up with a suffi­cient quantity of goose grease, and by grinding it up well in a Leaden mortar, reduce it to a black Oyntment. To be ap­plied moderately warm to the part affected." Medicinal Ex­periments, Robert Boyle (1626-1691).

Other so-called remedies were composed of many ingredi­ents used as ointments and suppositories. Most of them were of little value except to ease the pain and discomfort for the time being. As Dr. Hirschman explains: "The use of sup­positories and ointments is of no avail whatsoever, excepting possible palliation, in the treatment of hemorrhoids."

Here, again, is a field in which the public has spent an un­told amount of money for "remedies" that are worth little, if anything, for relief of an ailment.

Dr. Hirschman's observation about the use of suppositories and ointments as anything but a possible "palliation" in the treatment of the disorder is widely shared by medical au­thorities.

In a medical review of hemorrhoids in 1958, Consumer Reports observed that: "Suppositories are of little value either in controlling bleeding or in relieving the pain of hemor­rhoids." The report goes on to say that ointments containing anesthetic drugs such as Benzocaine, Pontocaine and Nuper-caine "seem to have a mild pain-relieving effect in some cases of external hemorrhoids."

Surgery generally is recognized to be the most satisfactory answer to the cure of hemorrhoids after they are fully de­veloped. An injection method usually is considered to be suitable only for uncomplicated internal hemorrhoids that are bleeding and do not respond to medical measures. External ones do not lend themselves to the injection treatment and generally must be removed.

When there is bleeding and when hemorrhoids become obviously inflamed, ulcerated, or interfere with bowel function, surgery usually is indicated.

The operation is not considered to be dangerous. The usual hospital stay is from four to seven days. About 90 per cent of the operations result in permanent cures with no recurrence.

As there may be some postoperative bleeding, a method to control such bleeding has come into use in recent years. A French urethral catheter with a small balloon is introduced into the rectum. The balloon is distended and gentle traction is exerted upon the catheter and it is taped to the buttocks for 24 to 36 hours. It may prevent a return trip to the operat­ing room and additional anesthesia.

Although a treatment known as "diathermy" may be talked about for hemorrhoids, it is not mentioned nor advocated for that purpose by accepted medical sources.

Diathermy is, in essence, an oscillating electric current of high frequency that is used to produce heat in a particular area beneath the skin for treatment of certain disorders such as a low back pain, neuralgia, or similar conditions.

Surgically, the term may refer to "electrocoagulation" in which the generated heat is sufficient to coagulate tissue cells and destroy tissue. In medical use, as defined from surgical use, the tissues are warmed to a point short of tissue destruc­tion.

It may be noted at this point that polyps of the anus and rectum are quite common. Dr. Rothenberg has stated: "It is the feeling of most medical men that these polyps or polypoid growths can, in time, become cancerous. It has therefore become common practice to advise their removal as a pro­phylactic measure." He explains that the surgery frequently can be performed without anesthesia in the doctor's office. "In these cases," he continues, "they are destroyed electrically by cauterization or fulguration, or are removed with a snare." If the condition does not lend itself to office treatment, the polyp usually is excised surgically at a hospital.

Hemorrhoids which are not complicated or cause only slight bleeding at infrequent intervals may require only treat­ments to correct the underlying cause: irregularity of bowel evacuation, prolonged sitting upon the toilet, chronic con­stipation or other conditions.

A few home remedies have brought temporary relief to many sufferers.

Hot sitz baths and hot towels are favorite treatments. In using the hot towels, soak one with hot water and wring it until it is partly dry. With the patient resting face down, the hot towel should be placed between the buttocks, resting firmly against the rectal region. A dry towel over the moist towel will hold the heat longer.

The sitz bath already has been described, and probably will be more convenient than application of the hot towel.

When hemorrhoids are itchy or raw and not painful, tem­porary relief sometimes may be obtained by applying zinc oxide ointment in a fairly thick amount on an enema tip to internal piles. The ointment may be simply applied to surface ones. A covering of cotton will protect the clothing.

If a hemorrhoid should protrude during a bowel movement, it frequently can be replaced with gentle pressure through several folds of toilet tissue.

Usually you should have a doctor's care when you have hemorrhoids. When there are indications of bleeding this may be especially important. A complete rectal examination prob­ably will reveal how much treatment is necessary. Injection treatments or surgery generally bring permanent cure for hemorrhoids.

Fistulas, fissures, abscesses, polyps and other conditions should be the problems of your doctor. It is seldom that you will not have marked symptoms of pain, extreme discomfort, bleeding, or other obvious disturbances to alert you to such disorders.

Rectal itching, called pruritis ani, is one of the most annoy­ing of ailments. Pruritis ani has been defined as "an itching of the anus and perineum, which is worse after bowel move­ments and at bedtime, grows progressively worse and aggra­vated by scratching."

There may be several causes for the itching. In children it may come from pinworms, and occasionally adults in the families may have the same trouble.

In the case of pinworms, old household remedies usually included enemas and the use of a vermifuge. One old folk remedy for worms consisted of one ounce of fresh wormseed leaves and a pint of milk boiled with a little orange peel. A wineglassful of the remedy was to be taken morning and night. Today a medicine, Delvex, is effective without the in­convenience of enemas and other procedures.

As in many other conditions the cause of the itching should first be ascertained and treated. When not caused by worms, hydrocortisone ointment is prescribed frequently for persistent cases of pruritis and is very effective.

Home treatment for the condition has long followed a fairly familiar pattern. Cleanliness of the rectal area is im­portant. Wash with warm water and a soft cloth, carefully rinsing away the soapy water. Frequently, rubbing alcohol is then applied to kill germs that may be present, and corn starch or talc may be dusted over the area.

As there is seepage in many cases, many people complete the above procedure by making a small wick of cotton and inserting it far enough into the rectal opening to make it stay in place. The cotton absorbs the seepage and prevents it from irritating the skin.

In all events, when the condition persists, a doctor should be consulted. The cause may be much more serious than the immediate discomfort of the symptom.

UROLOGY—Urology is generally defined as the department of medicine which has to do with the urine and urinary tract and includes the genito-urinary tracts of the male and female. Most of the diseases encountered in urology already have been discussed in previous chapters. Chemotherapy and modern surgery have kept pace with new diagnostic tech­niques in urology to greatly improve effectiveness of the urologist.

In the annals of folk medicine there have been various remedies for disorders that fall under the urologist's scope of attention. Some of these have been discussed in previous chapters.

However, one disorder that has not been explored is the uncomfortable and extremely annoying condition called cystitis.

Although a few men suffer from it, it is mostly a woman's ailment, and is defined as inflammation of the bladder.

Usually attacks begin with a burning, stinging sensation during urination, while the urge to urinate becomes exceed­ingly frequent, sometimes only a few moments apart. Urine may appear to be cloudy, and sometimes blood is present.

As with any persistent, annoying disorder, a doctor should be consulted if the condition continues, or increases in intensity.

Germs causing cystitis can be introduced into the urinary outlet of women by the improper use of toilet tissue. In clean­ing the rectal area, the tissue should be kept away from the genital zone, and a front-to-back stroke should be used.

Women for many generations have known that a copious intake of water, ginger ale, lemonade, or orange juice may help an attack of cystitis.

Providing a woman is not on a salt-restricted diet, two teaspoonfuls of baking soda in water every two or three hours for two or three days may be helpful.

The position assumed in sexual intercourse occasionally can bring on cystitis. This occurs when the man's angle of entrance presses the penis firmly against the front wall of the vagina. This may catch the urinary tube against the pelvic germs and force the germs along.

With the many drugs now available to clear up infections, it is highly advisable to consult a doctor when an attack of cystitis doesn't clear up promptly or when it recurs. There is no point in suffering from the ailment when help is readily available.

VENEREAL DISEASES—Although the problem of venereal diseases still is very much with us, and the statistics reveal that there are many new cases each year in this country, it is now largely a social and preventive problem.

Gonorrhea, the most common, is far from being stamped out. It is caused by an organism called gonococcus which cannot live outside the body and dies off very quickly. The infection can only be contracted through sexual intercourse with an infected person. The incubation period is from two to five days and there is no reported immunity for it.

Symptoms, with men, are a burning and prickling in the fore part of the urethra and a rather slimy discharge that becomes green and pus-like. It can spread to the prostate gland.

With women the disease is first evidenced by a negligible discharge and "dripping" after urination. When the next menstrual period comes, after infection, the inflammation usually spreads to the womb and Fallopian tubes.

Antibiotics—mainly penicillin—are specifics for the disease.

Syphilis is the most severe of the venereal diseases. The spirochete of syphilis can barely exist outside the human body, and infection usually comes only through direct contact, generally sexual. It can only penetrate the body where there are skin abrasions.

Symptoms develop in three stages. Usually the first stage is marked by the forming of a hard, painless ulcer on the geni­tals, varying in size from a pinhead to a dime. Several such sores may develop.

About five weeks after the first stage, a secondary stage is marked by skin eruptions.

In the tertiary stage (late syphilis)—about three years later —ulcers may form on the skin, but usually on internal organs. The nervous system may become involved and disorders of the mind, and degeneration of the spinal cord may occur.

In 1906 August von Wassermann discovered the blood test for syphilis, known as the "Wassermann reaction." In 1909 Paul Ehrlich of Frankfurt discovered, in what was called "No. 606," a remedy for syphilis. He called it salvarsan. In 1912 he brought out a more easily administered and less toxic neo-salvarsan.

In 1942 and 1943 penicillin took the place of the previous weapons against syphilis, and can cure the disease in its early stages. We probably shall not know if all the belated conse­quences of syphilis can be completely cured by penicillin until 1965 when enough time will have elapsed to complete clinical studies.

Chancre, the so-called third venereal disease, is caused by bacteria and contracted through direct contact in sexual inter­course.

The symptoms are soft ulcers with a surrounding red and painful area. If untreated they spread and do not heal for weeks. Usually they are found on the outer sex organs and in their vicinity.

The germ is destroyed by terramycin and the illness may be cured very quickly

Folk medicines for venereal diseases were, obviously, lack­ing in effectiveness.

For syphilis, one European remedy consisted of a decoction of aspen leaves, boiled in water into a tea that was to be taken with sugar or honey. Another folk remedy consisted of applying salted cucumbers to a chancre to bring about immediate reduction in the swelling.

There seems to be no historical references to syphilis until the 15th century. It was claimed that Columbus had dis­covered a new disease as well as a New World. At any rate, within a few years after his return the disease had spread over Europe in a scourge that claimed thousands.

It is possible that gonorrhea was known among the ancients. Egyptian writings from 3500 B.C. mention plant extracts for conditions that indicate gonorrhea. Many believe that there are definite Old Testament references to the disease. Hip­pocrates refers to the illness by description. Arabian, authors recommend surgical methods to relieve the condition.

Early remedies for the disease included injections of sea water, occasionally fortified with vinegar; injections of human milk and oil of violets with a touch of saffron and camphor if pruritis was present; and pomades of various types were applied to abscesses.

One of the first prophylactics of note from John of Gaddes-den (1230-1361) who was physician to Edward II of Eng­land: "If anyone wishes to preserve his penis from all blemish, when he comes from having relations with a woman having anything suspicious, he should wash with cold water mixed with vinegar ..."

Contemporary statistics on venereal diseases are partly guesswork because quite a few cases of both syphilis and gonorrhea are not reported. It is believed that around 2 million cases of syphilis need treatment each year, and that some million cases of gonorrhea develop in the nation annu­ally. For 1959, three national health organizations reported a general VD rise in 29 states and 49 major cities.

The U. S. Department of Health, Education and Welfare has estimated that more than half the infectious venereal dis­ease cases are among teen-agers and young adults. Teen-agers in large cities seem to make up the largest segment. New York City reported a 78.3 per cent increase of syphilis among its 15-to-19-year-olds in 1959.

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