If you have removed all of the ano-rectal sacculated mucosa in a case, and have omitted to remove the one or more ano-muco-cutaneous sacs or dilated veins that are so often present around the anus, and have also neglected to cure the chronic proctitis, then the sacculated mucosa may, by some hook or crook, become excited again into an acute inflammatory condition, the sphincter muscles may grip tighter than usual, and lo, thrombus has taken place in a vein, and the wrinkled, shriveled, skinny tab or sac looks like a miniature balloon, and your dismissed patient is in a troubled state of mind to have everything come back on him so soon! The cure was all right so far as it went, but there was the disease and some of the old external symptoms to tell the tale of an incompleted treatment. Those muco-cutaneous sacs at the enteric crater’s mouth are just so many thermometers at its vent to tell the temperature occasioned by the fire of inflammation within, and they will damage your reputation as a proctologist if they be not removed. By all means get rid of these symptoms and indicators of trouble within; and if there should by chance be a little of the old proctitis remaining that wants to assert itself by making trouble, in becoming acute, it will be surprisingly handicapped in its efforts, and the chances are all in your favor; and you will, moreover, from time to time, hear what So-and-So said about the very successful treatment of his or her case. Sacculated mucosa, muco-cutaneous sacs, submucous channels, etc., having their source in the rectum and anus, are all of a similar origin, the result of serous exudation. These symptoms of proctitis vary in development and number according to the nature and progress of the disease. In those cases that are quite exempt from sacculated mucosa (piles) you may expect to find submucous channels largely developed, and _vice versa_. Too much stress cannot be placed upon the serious results of auto-intoxication by the absorption of mucus from channels and cavities that will hold from three to eight or more ounces of fluid at one time. They are no doubt rapidly emptied by the process of absorption into the system. I have not referred to the fatalities of the hypodermic treatment of sacculated mucosa (piles or hemorrhoids) because of the fact that none have ever occurred within my knowledge among those using either this or a similar method of treatment. CHAPTER XXIII. ABSCESS AND FISTULA INVOLVING ANUS, RECTUM, AND NEIGHBORING REGIONS.