claims in the high court of Vital Bankruptcy. What poor business
policy, and what a wretched tenant! For fifteen or more years we may
have had warning "touches of the piles," sometimes accompanied with
indigestion, constipation, diarrhea and insidious auto-infection and
occasionally with local symptoms in and around the anal canal and its
external orifice; these to an intelligent tenant should have been
evidence of proctitis, or worse, of periproctitis--inflammation of the
connective tissue of the rectal tube. What have we done? We have
disregarded the warnings of our ungeared, disordered machine, or else
we have merely tinkered with it. The human factory receives less
attention than does the commercial. Soon, all too soon, the silver cord
is loosed and the golden bowl broken, and just before that event,
frightened, but too late, we do a little more tinkering under a
doctor's direction, and spill the contents--of the golden bowl with
which we were so careless--spill it into another world, to begin our
folly over again!

Do you know that this occasional "touch of the piles" over a period of
many years, and all that it involves, is a precursor and an invitation
to the development of that deadly enemy, Cancer--a worse disaster than
financial ruin? It is my duty to utter a warning here. Only one making
a specialty of the diseases of the alimentary canal is aware of the
frequency of the occurrence of cancer in the lower bowel resulting from
chronic inflammatory process, induration, etc. I have been, again and
again, shocked and alarmed at the reckless neglect that has brought on
this as yet incurable disease--cancer.

These remarks apply well to what I have to say on Abscess and Fistula
at the terminal portion of the intestinal canal. It is the old, old
story of being "touched by the piles for many years," and neglect,
ending in dread and despair at the necessity of being bored full of
holes by pus seeking an outlet. The victim wonders at the spread of the
local trouble, and that an opening for the pus canals has frequently to
be made three to sixteen inches away from the seat of the abscess. In a
former chapter the subject of proctitis and piles was gone into, and
some idea given of the invasion of inflammation in the rectal and anal
tissues.

In exceptional cases the exciting cause of anal and rectal abscess and
fistula, or of abscess and fistula of the buttocks, may be a traumatic
injury or accident, produced, say, by