In nineteenth-century medicine, specialists grouped themselves around a number of structures and functions of the body. This chapter focuses on those surgeons who came to regard their understanding of the rectum as an area of special expertise and a means to status and prosperity. According to them, their knowledge meant that rectal surgery was safe in their hands, not in those of general surgeons or general practitioners. The institutional basis of rectal specialisation in Britain came to be the Fistula Infirmary, later St Mark's Hospital, founded in London in 1835 by Frederick Salmon. Only when he was nearing retirement at the end of the 1850s did he appoint other surgeons to the staff of St Mark's. Prominent surgeons such as James Syme, Benjamin Brodie and Astley Cooper recommended ligation of piles rather than excision. In the treatment of fistula, rectal surgeons agreed among themselves that fistulous tracks needed to be laid open along their whole length.