Evolving trends in the treatment of anorectal diseases

During the first half of this century, the safe and effective treatment of benign anorectal disorders perhaps did more to establish our specialty as a viable and distinct entity than anything else. A thorough understanding of anorectal anatomy and physiology, improved methods of local anesthesia, and an appreciation of proper postoperative care made the care of patients with diseases of the rectum and anus the domain of true specialists. Hirschman stated, "It is the action of the profession itself which has created the special field of proctology--the anus and rectum being organs peculiar to themselves and being subject to many medical and surgical diseases in the same way as the eye, the ear, the nose, the genital and urinary organs; and call for just as much special medical and surgical care. The general surgeon knows nothing about, and cares less for, the medical treatment of these organs; and the general practitioner who is able to treat the medical conditions is not, as a rule, properly equipped to do so. Thus, the proctologist came into existence--a man who, by special study of this particular region of the body, is able to give special care of either a surgical or medical nature, and often both in the same case, as may be required."