THE ROOTS OF THIS surgical specialty can be traced to the itinerant rectal surgeons of medieval Europe, who traveled from village to village plying their technical expertise. In 19th century America, the itinerant role was most prominently assumed by Milton Mitchell (1834-1887), a native Kentuckian. He attended the proprietary Kentucky School of Medicine, Louisville, for less than 1 year in the late 1860s and soon began to limit his practice to the injection treatment of hemorrhoids. Like most itinerants, Mitchell was self-taught and unpublished. Territorial rights were sold relative to his treatments and by the late 1870s, the Midwest was overrun with "pile doctors," plying a Mitchell-like message. The most well known was Alexander Brinkerhoff (died 1887), who was considered by the allopathic medical community to be both a nuisance and a quack. He made monthly tours of towns throughout Ohio and Indiana and was even so bold as to privately publish a lengthy monograph titled, Diseases of the Rectum and New Method of Rectal Treatment (1881). The 266-page volume proved little more than a massive advertisement for the Brinkerhoff treatment of piles and other rectal and anal problems.
Samuel Gant's Diagnosis and Treatment of Diseases of the Rectum, Anus, and Contiguous Textures (1896) was a scholarly effort written by the 27-year-old surgeon. The chromolithographic plates were quite striking, as typified by this figure showing a case of rectal prolapse.
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