Correctional abscess or per-proctorial are the terms commonly designated to mean the collection of pus or suppuration in the region about the anus and the lower segment of the rectum. This inflammation may be circumscribed or diffuse. The pus extends or burrows along the lines of least resistance and is held between the planes of fascia and blood vessels which are able to resist dissolution. An abscess which is not incised, as a rule extends until it reaches either the skin, mucous or serous surface, through which it may discharge itself. In this manner, a collection of pus in the mischief-rectal Fosse will find its way along the anterior fascia of the elevator an and discharge itself between the internal and external sphincters into the rectum. An abscess may discharge itself through the skin and rectal wall, forming a complete fistula. Thus it is to be seen that a fistula necessarily begins as an abscess, simple in its onset, but may burrow and rupture at different points, causing a complicated fistulous tract. Abscesses in this region are necessarily forced to pursue a definite course which is changed by the relations of the original site of the abscess cavity to the surrounding planes of tissue and blood vessels.

The abscesses found in this region are divided into superficial and deep, dependent in most instances upon the division made by the elevators an muscles. In addition, we may have abscesses which have their origin in the urethra, Bartholdi’s glands, prostate gland, or the bony structure about the pelvis, which burrow into the mischief-rectal Fosse Classification. The anal, mischief-rectal, retro-rectal, and sew prior pelvis-rectal abscesses are all phases of infection found in this region.

The anal, including elementary abscesses, are a result of an infection of the follicles, the same in every respect as the fur uncle found in any portion of the body. The sub-chge-mentary is a lymphatics and is simply infection carried through the lymphatics. The mischief-rectal, as their name denotes, are confined to the mischief-rectal Fosse, or peristaltic space. They originate ordinarily through the lymphatics.

Etiology. Infection may occur through either the lymphatics or the blood current carrying infectious bacteria from surrounding tissue; or locally from ulcers, fissures, thrombotic internal piles, tears of the mucous membrane or from degenerated growths in the rectum. Males seem to be more subject to rectal abscess formation, particularly at the age of thirty. Persons who have a constitutional condition in which the resisting power and vitality are lowered, either from acute diseases or from the prolonged ravages of chronic diseases, are probably the most frequent sufferers. Influenza and tuberculosis are no doubt the most frequent precursors of this disease, due to their depressing influences permitting invasion of the per-rectal space with the intestinal bacteria. The bacteria are the communist coil, streptococcus Diogenes, staphylococcus Diogenes, and tubercular bacilli, which may be found singly or in multiple varieties in these abscesses. We may have specific infection due to erysipelas, typhoid, syphilis, or tuberculosis. The deep abscess is generally of the phlegmatic type, but may become gangrenous, with necrosis and diffuse sloughing of the surrounding tissue.

Superficial Cutaneous Abscesses found in the skin are due to infection of the follicles near the anal outlet and are identical with the fur uncle or acne abscess found in other portions of the body. The subcutaneous and sub mucous abscess are due in almost all instances to infection as the result of a lesion in the anal canal or rectum. The infection is carried through either the lymphatics or blood vessels into the cellular tissue, causing a circumscribed inflammation and later an abscess.

The Mischief-rectal Fosse forms an easily invaded region because the fat and deficient blood supply render its resisting power extremely low and when infection is carried within its tissue the result is a very quick abscess formation. In fact, the resisting power of the fatty tissue is so low that the tendency is, as a rule, to involve the entire cavity. Fortunately this Fosse is mostly hemmed in on all sides by strong resistant tissue in the form of fascia and muscles, which impede extension. The barrier to rupture into the rectum is incomplete, however, at the interval between the internal and external sphincter muscles, the most common point of exit for abscesses discharging into the rectum. The lateral extension of pus to the opposite side of the rectum is also made possible by the weak point at the junction of the elevators an and the upper surface of the staphylococcal ligament. The weakness against rupture of the abscess into the rectum at this point in the barrier is supposed to be due to prolonged straining during defecation, particularly in the median line posterior, as the attachment of the staphylococcal ligament to the external sphincter muscle and the incomplete attachment of the elevators an muscles form a most fixed point; here straining weakens and attenuates the tissue. This weakness permits easy access to the Fosse and when we consider the frequent occurrence of trauma from straining and the subsequent formation of a fissure it is no surprise to so often find the opening of a fistula at this point of vulnerability. An abscess will sometimes burrow down through the separation between the superficial and deep fibers of the external sphincter, at the point where the longitudinal muscle fibers of the rectum pass through it to the skin. Many abscesses follow the course of these fibers and form a complete fistula.

Pus may completely surround the lower part of the rectum in this manner, discharging posterior in the middle line, after an invasion of both sides at the weak point formed at the junction of the elevator an and the anew-coccyx lira men In the diagnosis of the different forms of disease in this region the excellent division of the anal region by Good-sail and Miles has been of great aid and is well worthy of a thorough understanding in the treatment of rectal diseases. The description of this scheme as given in their text is as flows: