ABSCESS AND FISTULA.
In our daily affairs we take thought for the future and reason from
cause to effect. We observe, anticipate, expect and suspect. This is a
commendable practice, for it is the one that is most likely to lead to
success. Can we not acquire a similar attitude and habit in regard to
our health? Habit is sub-conscious attention. Can we not give
sub-conscious attention to the little details of such bodily functions
as are liable to get out of order? Can we not by a settled habit, that
is, by the formation of a second nature, assure our vital success, on
which the continuance of the enjoyment of life so much depends? If some
part of a complicated machine gets out of order it must be repaired at
once or damage may result to other parts of it. Again, if our business
accounts will not balance, the error must be found and corrected at
once, or the evidence of it will annoy us sooner or later. Why should
not such prompt care and attention be given to the human mechanism, to
the economy of vital functions? It is not often that we neglect disease
of the hands, head, face or neck because the exposure of such disease
to public gaze might embarrass us; but alas for the portion of the body
out of sight, especially for the internal organs, when they fail to
perform their functions normally. Most of us allow the mechanism of the
human body to shift as best it can and as long as it can, should it
happen to become ungeared, ignoring the frequent warnings which the
ever increasing morbid changes and wreckage give us. And then we
surrender and succumb. What else can we do? Our vital creditors file
their 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 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 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.