In order to inspect the anus internally and also the rectum it is necessary to introduce a speculum. This method of inspecting the rectum is called proctoscopy. Of the many specula devised for this purpose I would mention those of Sims, Allingham, and Kelly as the most practical (see Figs. 10, 11, 12). Kelly's speculum, which consists of a hollow metallic tube provided with an obturator, is best suited for this purpose. Before inserting the instrument it must be thoroughly smeared with sweet oil or vaseline. In cases in which the rectal region is inflamed or ulcerated, it is necessary, in order to avoid too much pain, to induce anaesthesia of these parts by painting them with a ten-per-cent cocaine solution or by the introduction of a suppository of opium with belladonna or of cocaine. It is hardly necessary to say that endoscopy of the rectum must not be performed until after a thorough evacuation of the bowels. It is best to wash out the gut before examining with the speculum. When the speculum is in position a portion of the rectal mucosa becomes visible when good light is thrown into the endoscopic tube. The source of light is immaterial, although it is best to have electric light.

Usually a small electric lamp with a reflecting mirror fastened to the head of the examiner best serves the purpose. The higher up the bowel has to be examined the longer the speculum must be. After the full insertion of the instrument the highest portion of the bowel is first examined, and while gradually drawing out the speculum the entire area of the bowel through which it passes will be brought into view. Small ulcers, atrophic and congested conditions can thus be easily recognized and malignant growths detected at an early period.

Fig. 10. - Sims' Rectal Speculum.

Fig. 11. - Allingham's Rectal Speculum.

Fig. 12. - Kelly's Rectal Speculum.