Fig. 5.
Male pelvic organs viewed from the right side (the right ilium and a portion of the ischium and the pubic bone, together with their soft parts, have been removed). 1, auricular surface of the sacrum; 2, tuberosity of the sacrum; 3, ischium; 4, pubic bone; 5, psoas muscle; 6, erector spinal muscle; 7, glutei muscles; 8, obdurator muscles; 9, external sphincter of anus; 10, rectum; 11, sigmoid flexure; 12, bladder; 13, ureter; 14, vas deferens; 15, seminal vesicles; 16, prostate; 20, lateral vesicle ligaments; 21, hypo-gastric artery; 22, hypo-gastric vein; 23, external iliac artery; 24, abdominal aorta. (Boas.)
The abdominal and pelvic organs are cushioned or held in place somewhat by the network of fatty tissue that surrounds them, and the rectum is no exception to the rule. The outer or serous wall is surrounded by an abundance of loose areolar tissue, which is divided into cellular spaces. When this tissue also is invaded by inflammation, the condition is spoken of as periproctitis; and we have a result somewhat similar to that which occurs in the areolar tissue just under the mucous membrane and integument, as previously described.
As the inflammatory product is discharged into this spongy or fatty connective tissue it is slowly forced in some direction, which is naturally downward, if not too much obstructed by firm tissue; at all events, it follows the line of least resistance and forms usually quite a large channel and several cavities along its course. The channel may begin at an elevation of four or more inches on the outside of the rectum (Fig. [5]). Should it form in front of the rectum, the seminal vesicles (15) and the prostate gland (16) would suffer greatly by its presence.
As the inflammatory process burrows its way downward, it finally reaches the soft fatty connective tissue under the skin. It then continues along this in one or more directions for a distance of two or more inches. Several of these long, large pus-less channels may exist for many years, or for a lifetime, without sufficient evidence of their existence along their route accurately to locate them. Itching, pain, and color of the skin often indicate the presence of such a channel under the integument. The author has frequently found large channels extending up along the outer rectal wall for four inches, and extending out into the deep tissues of the buttocks in various directions, without making their presence and ravages known to the victim.
Such numerous pathological conditions have led the author to conclude that an abscess just under the skin and the discharge of pus are merely incidents in the history of such maladies. Think of it: your body may be bored with channels or holes of varying diameters and lengths, while you yourself may be ignorant of what is occurring! The mucous membrane may be lifted from the connective tissue for the whole length of the rectum, and the skin about the anus may also be in this condition. You know that your health is not good, but you are ignorant of the cause. The formation of pus at some period of the channel’s inroads, or of an abscess, would seem a kindly act of Nature, for the presence of so serious a disturber to health would thus become known.
I have not overdrawn this picture of periproctitis and of submucous tissue channels. The victims could scarcely be worse off than they are. I want boys and girls, young men and young women, to learn the facts concerning the local dangers of proctitis; for, when they once realize the seriousness of this disease because of its many grave symptoms, they will give it proper attention before these effects manifest themselves. You cannot neglect so important a portion of your body as the anus and rectum and not seriously endanger the organs that lie close to them. No wonder so many men are troubled with inflammation and induration of the prostate gland. The percentage of such cases would be greatly reduced were proctitis and periproctitis denied the existence they now enjoy for years, and often for a lifetime.
In view of all that has been advanced concerning these local pathological conditions, is it strange that almost everybody is constipated, and that we need some simple sovereign aid to further the scientific treatment of the physician—an aid such as the enema has proved to be?