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April 8, 1939


Author Affiliations


JAMA. 1939;112(14):1406. doi:10.1001/jama.1939.02800140104024

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To the Editor:—  In The Journal February 18 an article by Blaisdell refers to my work on the anatomy of the anal sphincter and the etiology of fistula. After reading Dr. Blaisdell's article several times I feel that both he and the discusser, Dr. Hill, have overlooked several important points in my work and that they have failed to correlate certain age-old clinical observations with actual anatomic manifestations. Some of these observations are that:

  1. There is a definite relation between the internal and external orifices of a fistula. A fistula having its external orifice situated behind a plane passing transversely through the center of the anus usually has its internal aperture in the posterior commissure of the anus at points corresponding to 5 or 7 on the clock, the posterior median line being considered as 6 o'clock.

  2. A subcutaneous fistula has its external opening within 1 inch of

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