Introduction.

The great diversity of opinion which characterizes the literature on the anatomy of the rectum, our discouraging record of compromise with the obstipated, paucity of definite knowledge of the etiology and pathology of stricture of this organ, the lack of safe and sure measures for acquiring this knowledge, the inefficacy of the methods generally employed in the treatment of rectal stricture, and the too heroic colostomy occasionally applied by the surgeon on the one hand, or else the supine inertia of the physician on the other hand,—all compel the search for a demonstrable conclusion to the matter.

That the rectal valve is the chief anatomic feature of the rectum is capable of demonstration. That in certain diseases of this organ it is to be reckoned with as the most important etiologic factor, or, in other words, that the rectal valve provides a ready foundation on which strictures may be quickly built, it shall be the attempt of this treatise to prove. If it is proved that the rectal valve exists, it will then be imperative that a method of diagnosis almost universally practised be abandoned, and it will also be necessary that the methods of treatment of certain obstructive lesions be modified; possibly, too, a new point of view may be afforded from which to study congenital malformation of the rectum.

A quarrel which is so archaic, so involved, and in which there is such multiplicity of contradiction concerning a matter of scientific interest, can not with proper understanding and with perfect fairness be referred to without the free and exact quotation of the expressed opinion of the distinguished workers in this field.

I ask no consideration for my ipse dixit, but on the contrary undertake to present such evidence in support of my claims as reasonably may be considered documentary, such as photographs of specimens, certified drawings of historic specimens and of microscopic appearances of valve-sections, together with the detailed descriptions of the simple procedures by which my own findings may be readily verified. Anticipating, however, that some may complain that the technic for the anatomic research is too elaborate and the opportunity for its practice by the ordinary student too rare, I would bespeak a general interest in the subject by offering to the physician—after quoting sufficient of the literature to exhibit the precise status of the subject—a certain simple and practical method of inspection of the rectum, the employment of which will discover a basis for the prosecution of this investigation while at the same time it provides him with a ready resource for the discovery of many of the diseases of the rectum.[1]