its way
through the cellular tissue to the surface. Others contend that the
cause of this disease consists in an abscess, which burrows in the
tissues and makes its exit into the rectum, or through the skin, or
both. No doubt it may originate in both ways. It can readily be seen
that when an internal opening is once established, the _foeces_ which
enter into it must sooner or later work their way to the surface,
burrowing through those parts which offer the least resistance, until a
place of exit is reached.

DIAGNOSIS. The disease may be suspected, if there has been an abscess in
the parts involved, or if the patient has been subject to pain in the
rectum, and the parts are tender, tumid, or indurated. When the fistula
opens externally, the linen will be moistened and soiled with pus, or a
bloody fluid, and when the tract is large, the _foeces_ may pass through
it. A careful exploration with a probe, passed into the external opening
while the finger is in the rectum, generally reveals the direction of
the tract; but, sometimes, in consequence of the tortuous course of the
canal, the probe cannot he made to follow it. When the fistula is
incomplete, and opens internally, the probe is passed into the rectum
and directed outwards, when it may be felt externally. In such cases, a
tumor, caused by the contents of the fistula, may generally be seen
protruding near the anus, and the pain will be considerably increased
during defecation, by the _foeces_ passing into it and disturbing its
walls. The examination should be made with the greatest possible care,
for it is attended with more or less pain.

TREATMENT. When constitutional derangement exists, it must be rectified,
or any treatment will be liable to result in failure. The comfort of the
patient may be greatly promoted by attention to the bowels, keeping
their contents in a soluble condition, and the liver active, so as to
prevent congestion of the rectum and adjacent structures. This can best
be done by careful attention to hygiene, and the use of "Golden Medical
Discovery" and "Pellets," in sufficient quantities to produce the above
named effects.

A _radical cure_, however, cannot be accomplished except by surgical
means, for which we have the _knife, ligature, caustic, stimulating
injections, etc.,_ which may be varied to suit the emergency, but which
should never be employed except by a competent surgeon. Constitutional
conditions materially influence the cure,