By definition, a quack is one who practices a form of medicinal system without qualification, training and registration from the appropriate council or authority1 . Some of these practitioners successfully promoted their medical and surgical abilities and their remedies to a gullible public. Although many may have been harmless, a number of them may be considered to be rather dubious and dangerous. Alternative medicine has always had an attraction for some members of the community, and this allurement has even extended into the twenty-first century. Quacks are practicing in every field of medicine, field of surgery being no exemption. Quackery in sur gical field mainly revolves round the treat ment of anal canal diseases i.e. piles, fistula-in-ano, fissure-in-ano etc. Quacks in this field are often more popular than the regu lar practitioners. One can find their advertisements, signboards and offices in every township.

They have neither a recognized degree nor a license to practice medicine and yet a number of quacks are running their “dispensaries” with impunity in every part of the country. Most of them have oneroom chambers. They even put up signboards in front of their dispensaries, claiming to be specialized doctors and even handout prescriptions on their letterheads. They even dare to drive away a qualified one from the area of their operations. A large number of patients from all walks of life and different cross sections of society, visit these quacks for their anal and perianal ailments. Some of them are happy, too, for visiting them and declaring that their ailments were cured. But many of them have to repent for life, mainly because their original problem gets complicated and have to pay a heavy cost for getting out of such complications. Incidentally, most quacks claim to be super-specialists in their fields of expertise.
Many of these piles specialists claim to treat piles within an hour with a “magic wand” and people, especially from the lower strata of society, becomes an easy prey to such baits. In the name of providing relief within an hour, these quacks inject various corrosives directly into the piles thereby causing severe inflammation and causing excruciating pain to the patients. At times a single needle is used for injecting medicine in many patients. This can result in higher incidence of blood borne infections like hepatitis and AIDS in patients visiting them.
Throttling Hemorrhoids or the Patient? The way quacks treat large prolapsing or interno-external hemorrhoids is based on simple principle, throttle the mass to obscure the blood supply, create necrosis and eventual sloughing of the pile mass from its place. Various threads, ligatures and banding materials are used to carry out this maneuver. But the patient has to pass through a nightmare of severe pain, huge thrombotic lump at their bottom, bleeding and other septic symptoms. Few may get relieved once the mass is sloughed off, but it leaves behind a large wound, which takes month to heal with eventual anal stenosis or stricture. The complications of such as mass hemorrhoidal ligation include bacterial septicemia or toxemia, bleeding and thrombosis, supralevator abscess, delayed massive rectal bleeding, perianal abscess, perianal fistula, and painful priapism. Many patients have reported with pelvic cellulitis with progression to shock and death.

Lot of patients visits quacks for anal canal ailment in the hope of low cost, operation less cure. Most of them face incomplete, irrational treatment and suffer from prolonged morbidity. They are shy to come forward to tell about these complications and to consult appropriate experts until when they are in miserable situation5 . It is unfortunate that people approach quacks for their low charges, but ultimately end up paying more because of the wrong treatment they undergo. The innocent patient is easily taken for a ride due to an easy access to such quacks and the promise of early relief. There is a need to educate the masses about the dangers of being treated by the quacks. The Medical Associations and law enforcing agencies are required to deal with these pretentious charlatans, offering quack remedies with iron hands6 . Conclusions Lack of awareness among the public, and apathy on the part of enforcement agencies, has brought about a situation where quacks are thriving in the country. To distinguish quacks from registered doctors, doctors should display their certificates in their clinics, abiding by the new ethical code of conduct of MCI. A good deal of public education is necessary to create awareness about anal canal diseases and their scientific treatment and modern short stay, curative, patient friendly surgical options.