a blow or a fall bruising the
tissues, or by sharp, hard substances--such as pieces of bone or
nutshell--from within the canal, lacerating it. But wounds of this
character are very infrequent compared with chronic inflammation
(proctitis) as the exciting cause. There are several varieties of
proctitis recognized as the exciting cause of abscess and fistula,
namely, traumatic, dysenteric, diphtheritic, gonorrheal, catarrhal,
etc. The reader should not only pardon me, but should be grateful if by
adding another name to the list I point out the most common cause,
namely, _diaper-itic proctitis_. As pointed out in the first chapter or
two, the improper use of the diaper will evidence its deplorable result
when the period of manhood or womanhood is reached, by some of the many
symptoms of proctitis.

Proctitis may be considered as acute, subacute or chronic according to
the duration of the process; or as atrophic or hypertrophic from the
structural changes induced. But no matter about the cause and character
of the proctitis, the question is, Have you inflamed anal and rectal
canals? If you have, then the very annoying symptom, abscess or
fistula, is liable to occur any day. Can you afford to take the
chances?

Just under the mucous membrane of the anus and rectum there is a layer
of loose, fatty, connective tissue, called areolar tissue. When it is
invaded by inflammation, abscess and fistula may occur. On the outside
of the rectal wall, at the terminal portion, there is also much loose,
fatty (areolar) tissue filling the ischio-rectal fossa, which is very
prone to suppuration, and inflammation here is called periproctitis.
This is the most common and serious seat and source of the septic
process, which process is usually the proximate cause of death after
capital surgical operations upon the rectum. Beside the abundance of
fatty tissue--whose function is to serve as a cushion to the rectum at
its terminal portion and at the back and sides of the wall--there is a
triangular space in front of the rectum containing fatty areolar
tissue, which space is often the location of a pus cavity. Pus, like
all fluids, follows the path of least resistance. The progress of
imprisoned pus may take weeks, months and years before an abnormal
communication between the abscess and the external portion of the body
is completed. The imprisoned contents of the abscess cavity and the pus
canal or fistula often give rise to much annoyance befor