ON COCCYDYNIA AND HEMORRHOIDS 263 



in fact we may say entirely, situated in the posterior and 

 lateral aspects of the anal termination of the rectum, and 

 why ? because the excretory outlets of the coccygeal gland, 

 according to our view of the matter, are largely latero- 

 posterior, and pass through the textures of the usually 

 fistulous parts, and, therefore, are subject to all the morbid 

 influences, pre-disposing and exciting, which are operative 

 in bringing about disease in this region, such, for example, 

 as may arise from stasis of exuding lymph in or occlusion 

 of one or more coccygeal gland outlets, and consequent 

 inflammation and suppuration, with local abscess, tissue 

 destruction, and recovery, with a more or less permanent 

 sinus, peri-anal or endo-anal, or both. Moreover, the 

 occurrence of suppuration and necrosis of the tissues 

 involved in the evolution of perineal abscess may be said 

 to be naturally or anatomically prone thus to leave a cavity 

 with communicating sinus or sinuses which lend them- 

 selves to the passive collection of coccygeal gland excretion, 

 to its greater or lesser retention, and to its continuous or 

 intermittent discharge through the fistulous opening or 

 openings, a condition of things which may easily become 

 permanent, and be, as it were, a supernumerary cyst or 

 bladder, and the quasi-functional exit or exits of the 

 coccygeal organism in perpetuity. 



In connection with the inferior or posterior termination 

 of the cerebro-spinal cavity, many other local departures 

 from the normal anatomical condition might be referred 

 to, and many consequent local troubles might be enumer- 

 ated, as related to these, in the way of cause and effect ; 

 but let it suffice to say that all these anatomical, physio- 

 logical, and pathological occurrences are due, primarily, 

 to the metamorphic character of the structures involved, 

 and are the residual products of the great developmental 

 differentiation to which the neurenteric canal is subjected 

 in embryonic times ; around this condition of meta- 

 morphism of structure and function, we are persuaded 

 that a great many peculiar and otherwise anomalous patho- 

 logical occurrences might be grouped with advantage to 

 nosology, as well as therapeutics and surgical procedure, 

 in many other localities besides the one under discussion. 



Since writing the above, we have had an opportunity 



