I have been requested to address you on the subject of hemorrhoids, viewed so far as possible from the standpoint of making my remarks of value and interest to the general practitioner. Time permits of only a brief synopsis of the subject.
Without making a thorough examination of a given case, no certain diagnosis can be made and no plan of treatment can be carried out with any degree of satisfaction. In most departments of medicine this fundamental principle is carefully observed, but possibly owing to a false sense of modesty on the part of patients afflicted with rectal trouble, some physicians are led to treat such persons without an exploration, either visual or digital, of the affected region. Consequently, it is not an infrequent occurrence for me to see a patient with an external hemorrhoid, greatly aggravated by the vain efforts made to push it within the anus. This
ADLER LH. INTERNAL AND EXTERNAL HEMORRHOIDS.WITH SPECIAL REFERENCE TO THEIR TREATMENT. JAMA. 1905;XLIV(3):193–196. doi:10.1001/jama.1905.92500300025001g
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