The Chronology of Atmospheric Inflation of the Rectum for its Inspection.
Reading edition
Proctoscopy has proved an open sesame to a newer proctology.[4] As there seems to be some confusion of opinion concerning the time of its origin and the chronology of its evolution, the present time is opportune for a brief historic review of the subject.
In 1845 Dr. J. Marion Sims[5] discovered by a chance that a hollow or tubular pelvic viscus would inflate provided the orifice were opened at a time when the patient’s hips were higher than the chest. He elaborated the manner of this discovery to a method of procedure. He first used the knee-chest posture, and subsequently the semiprone-semiflexed position with elevated hips. This posture became known as Sims’ posture, and the instrument which he designed as Sims’ speculum. The first published account of his method appeared in 1852, in the January number of the American Journal of the Medical Sciences.
In 1871 Dr. Wm. H. Van Buren,[6] of New York, was the first to publish an account of the use of the identical postures and Sims’ speculum for atmospheric inflation and inspection of the rectum and sigmoid flexure.
In 1882 Dr. Wm. Allingham[7] employed elevation of the patient’s hips and a tubular speculum, and achieved the same results. In subsequent editions of his book in 1888 and 1896 he repeats a description of his rather crude operation for inspection of the rectum through a cylindric tube.
In 1887 Dr. Alfred Cooper[8] described a similar posture, and suggested the use of two retractors for the purpose of opening the anus.
In 1887 Dr. Walter J. Otis,[9] of Boston, published in Leipsic a monograph on the subject of rectal inspection, and described the use of the knee-chest posture and of two retractors.
In 1887 Prof. Esmarch[10] described a method similar to that of Dr. Otis.
In 1895 Dr. Howard A. Kelly[11] described a method of proctoscopy by means of tubular speculums which are very similar in construction to those of Dr. Edmund Andrews, which Dr. Andrews first described in 1887.
Dr. Kelly’s article, however, was the first to catch the attention of the general profession, and to him is due the credit of pointing out to a multitude of physicians the possibility of rectal inflation for inspection by such means. Kelly’s technic and tubular speculums are far superior to those of Mr. Allingham, who first employed a similar method in 1882.
In 1896 I published in the July number of Mathews’ Quarterly Journal of Rectal and Gastro-Intestinal Diseases, under the title of “Proctocolonoscopy and Its Possibilities,” a description of a technic and new instruments which increased the areas exposed to view, and which facilitated access to the part for the treatment of disease.
In 1896 A. Ernest Maylard[12] briefly referred to the various methods.
Review of the literature on rectal inflation for rectal inspection establishes the fact that Van Buren is entitled to the credit for priority; that Marion Sims was the discoverer of the possibility of atmospheric inflation of the hollow pelvic viscera; that there is much similarity in the methods of the various operators quoted, some using similar instruments and dissimilar technic, and vice versa; and it is made obvious, also, that he who would most insist upon a credit for originality must sometimes discount with the erudite his reputation for literary research.
The time has arrived when the profession must recognize that the rectum need no longer be regarded a darkest continent. There remains, however, something further to be desired in the way of an easier and more convenient method of manipulation to secure inspection, but I am confident that ere long the profession will accept the newer mechanic means and contrivances which will render a proctoscopy of as practical simplicity as is laryngoscopy. But it behooves us to remember the words of Dr. Edmund Andrews: “The false method is that of the bungler and amateur, who is only right by haphazard; the true one is that of the professional expert, who can not be balked by petty obstacles, but who will reach success when others have failed, not less by his dogged persistence and thoroughness than by his superior knowledge.”