Anal fissure is sometimes produced by a superficial excoriation or ulceration of the outlet of the bowel, analogous to that so frequently observed upon the inside of the lips, the tongue, and other parts of the mouth. Bodenhamer[13] mentions having seen several severe cases of this disease produced by a kind of _aphthous ulceration_ in nursing mothers, and one in a child. They were attended with extreme burning pain and more or less anal spasm. He also states that in these cases the ulcerations of the anus were contemporaneous with similar ulcerations of the mouth; their coexistence and the exact similarity of their appearance left little doubt as to their identity. Harrison Cripps[14] states that a source from which these ulcers sometimes take their origin is a little marginal abscess which has led to the destruction of the portion of the muco-cutaneous surface lying over it. The anus is liable to a species of chapping resembling that of the lips in winter, which sometimes results in extremely painful fissures. Such a condition is supposed to be induced by the influence of a dry atmosphere or by some slight disturbance in the general health, rendering the parts friable and liable to crack from the slightest violence. Fissure is sometimes of syphilitic origin. Finally, it may be due to mechanical injuries, such as uterine displacement, the severe straining efforts made in parturition, the careless use of the enema syringe, the awkward employment of instruments by the surgeon in the diagnosis and treatment of rectal diseases, etc. ----- Footnote 1: "Anal Fissure," 1868, p. 45. Footnote 2: "Principles and Practice of Surgery," vol. i, p. 416. Footnote 3: "Intestinal Diseases of Children," p. 295. Footnote 4: Andrews, "Rectal and Anal Surgery," Chicago, 1889, p. 69. Footnote 5: _Op. cit._, p. 69. Footnote 6: Ball, "The Rectum and Anus," Philadelphia, 1887, pp. 128-129. Footnote 7: _Op. cit._, pp. 69-70. Footnote 8: Bodendamer (_op. cit._, p. 58) calls attention to a fact of some importance as bearing upon this point—to wit, that in some cases of constipation, while the diaphragm and other abdominal muscles act with considerable energy, the anal sphincters remain more or less contracted, and yield but slowly, so that the indurated feces contuse and abrade the surface of one or more points of the mucous membrane, which abrasions, if they do not heal, lay the foundation of the disease. Footnote 9: Instances of this condition as the cause of anal fissures are mentioned by T. B. Curling in his "Observations on the Diseases of the Rectum," second edition, London, 1855. Footnote 10: T. J. Ashton, "Diseases of the Rectum," second American from the fourth English edition, 1865, p. 46. Footnote 11: Allingham, "Diseases of the Rectum," fifth edition, London, 1888, p. 208. Footnote 12: _Op. cit._, p. 209. Footnote 13: _Op. cit._, p. 59. Footnote 14: