In the following pages I have endeavored to give a concise yet thorough account of the two affections Fissure of the Anus and Fistula in Ano, in respect to their etiology, symptomatology, diagnosis, and treatment. It has not been my object to write upon rectal fistulÆ in general.

While the two subjects treated in this volume have been ably written on at various times and by different authorities, it is undeniable that no organ of the body is more neglected by both the laity and the profession than is the rectum.

The neglect upon the part of the laity is largely attributable to carelessness in regard to regularity of habit and to want of cleanliness in this portion of the body. This neglect is the prime factor in the causation of many of the rectal maladies frequently encountered by the specialist. Furthermore, patients suffering from rectal diseases, especially women, often from a false sense of modesty defer their visit to a physician as long as possible, allowing their trouble to proceed from bad to worse, and when their suffering finally becomes almost unbearable and a doctor is consulted they refuse to allow him to make a rectal examination; in this way error in diagnosis occurs, and consequently relief is not obtained. The use of improper paper for toilet purposes often occasions the production of rectal diseases.

The profession as a body find other fields of labor more inviting than the study and treatment of rectal diseases, the diagnosis of which to be complete and satisfactory must in every case be based upon an ocular and thorough digital examination. As a result of this unattractiveness, even amounting to repulsiveness, to the general practitioner, most of the affections of the lower bowel are treated by him as "piles," the diagnosis being usually made by the patient, and accepted by the physician without question or personal examination. Such being the case, it is no wonder that when the surgeon prescribes equal parts of ung. acid. tannici et ung. belladonnÆ, or a similar salve, to every patient complaining of rectal trouble, a cure does not often result.

A knowledge of these facts has led me to hope that a brochure upon the subjects herein treated might excite a deeper professional interest in rectal maladies if issued as a volume of the Physician's Leisure Library Series, which by its moderate price permits of a wide circulation.

I desire to express my obligations to the publisher, Mr. George S. Davis, for the attractive style in which the work has been issued, and to Dr. B. W. Palmer, of Detroit, Mich., for valuable suggestions while the work was passing through the press; also to my friend Dr. G. G. Davis, of Philadelphia, for the original drawings furnished, from which a number of the illustrations have been executed, and to Messrs. Chas. Lentz & Sons, surgical cutlers of Philadelphia, for the use of various cuts of instruments.

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