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By Basil C. Morson

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In patients with poor sphincter control Probanthine reduces the intra-colonic pressure and so enables the patients to retain barium more easily. T h u s it is hardly ever necessary to use a self-retaining rectal catheter. A prone film is taken to show the state of haustral folds in the left colon. After this first filling the patient is allowed to evacuate in the lavatory and the next patient is brought into the room. It is convenient to deal with the patients in groups of three. W h e n the first patient returns, a post-evacuation film is taken; the rectal tube is re-introduced and barium run into the sigmoid.

Apart from the above, specific enquiries should be made about the patient's weight and particularly any recent alteration; also any deteriora­ tion in general health and well-being. Enquiries should also be made about past history and particularly about any previous operations or illnesses known to the patient. In some cases the family history may be of great relevance and must be sought in detail, particularly with regard to a family history of polyps or large-bowel cancers; but this is seldom needed at the first interview.

Proctoscopy A simple tubular proctoscope will be found the most useful instrument for most routine rectal work and for most purposes the Milligan-Morgan instrument, which is about three inches long with an internal diameter of just over an inch, will be found the most useful size. This instrument is also made in smaller sizes which are useful in the examination of children or those with anal spasm or stenosis. ) non-tooth dissecting forceps of the Emmett's type is extremely useful for swabbing out during proctoscopy.

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