This consists of an abscess occurring in some portion of the cellular tissue around the anus. As suppuration occurs the pus can be detected by the touch, and which sooner or later makes its way to the surface and is discharged. While the abscess is forming the patient is considerably feverish, and feels a tenderness about the anal region. At first the discharge is a bloody pus, which in time becomes watery and acrid, or sanious. The channel through which it passes is called the fistula. If it communicates with the rectum, the flatula is said to be complete; but if it does not perforate the mucous membrane, it is said to be incomplete or blind. Fistula is more liable to occur in scrofulous and consumptive persons than in others, though it may be caused by piles, habitual constipation, or the presence of foreign bodies in the rectum.

TREATMENT. -- During the active inflammatory state the bowels should be evacuated by a mild purge, and if the pain is severe, an opiate may be given. Flaxseed poultices, or hot fomentations, should be applied, and as soon as fluctuation is quite evident, an incision should be made and the pus evacuated. A weak decoction of white oak bark may then be injected and the parts drawn together by adhesive straps. The poultices should be continued as long as there is any hope to prevent a flatulous opening. If the fistula does occur, it gives great annoyance, and is quite difficult to cure. The surgical treatment consists in introducing a ligature through the fistulous opening into the bowels and out the anus, securing it to a small piece of cork, and twisting it once or twice a day until it cuts through, or by dividing the septum by a knife and healing it from the bottom. Others cauterize the fistula, and attempt to stimulate adhesive granulations in that way. I grant that success attends all these surgical operations, but I do not see the propriety of subjecting the patient to all the attendant pain and confinement to bed when a cure can be as radically effected in as short a space of time by purely medicinal treatment. I have cured very many cases, and in no instance have resorted to cauterization or the knife. Consultation, either in person or by letter is free with reference to such cases. (See page 390.)