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 before finding an outlet. There will be pain in the muscles of the buttocks, called myalgia; and pain at the end of the spine, called coccygodynia. For this latter pain do not, I pray you, as is so often done, have your spine removed by the too ready surgeon. No need of it at all. You might just as sensibly have the muscles cut out for myalgia. Pus in fistulous channels may burrow for several years through the muscular and connective tissue structures before finally forming an external opening through the integument; although its nearness to the surface is frequently marked by a localized puffiness and inflammation, which, however, may disappear for a time without forming an external opening. This condition of affairs results in periodical attacks of coccygodynia, myalgia and neuralgia of the buttocks and lower extremities. The important question with the victim of abscess and fistula is, "How did I get it? I don't care for the various and numerous names you give to these fistulas: what I should like to know is, How does it come about that I, an apparently healthy person, have such a nasty disease?" Simply years of neglect, is my answer. Neglect is due sometimes, and perhaps generally, to ignorance of the thing neglected. The laity can in large measure blame the medical profession for it, and especially those surgeons who have long made a specialty of the treatment of anal and rectal diseases. CHAPTER XXII. THE ORIGIN AND USE OF THE ENEMA.