These effects or changes give rise to the five cardinal symptoms of inflammation: pain, heat, redness, swelling and impaired function (dolor, calor, rubor, tumor, functio læsa).

Proctitis may exist many years before the pain and heat become noticeable or are complained of by the victim of this insidious disease, the bodily symptoms of which are well expressed before the local trouble demands attention and treatment. The sufferer from proctitis is unable to detect the change from a normal color of the mucous membrane (a light, muddy gray) to an extremely abnormal one (a fiery redness). The swelling or puffiness of the mucous membrane becomes more marked as repeated attacks of subacute and acute inflammation occur, from year to year, over a period of twenty or more years. During all this time impairment of the function and structure of the anal and rectal canals is incessantly going on. The nervous and muscular spasmodic contraction of the diseased anus and rectum, which in time become more or less permanently constricted, steadily increases the stagnation and engorgement of blood in the dilated arteries, veins, arterioles, venous rootlets and capillaries. All of the circulatory vessels, especially the smaller ones, become enlarged, varicose; and an aggregation of varicosed vessels forms a tumor called a pile or hemorrhoid. Inflammation interferes with nutrition of the anal and rectal tissues, rendering them friable or weak and easily broken; whence the bleeding and painful fissure or the anal ulcer, which so often are the outcome of proctitis and an accompaniment of piles.

As already stated, piles are one of the symptoms of proctitis, and all cases of piles involve more or less irritability and contraction of the anal canal and the terminal portion of the rectum through which the fecal matter is forced. All the muscular ability of the rectum, assisted by straining effort of the abdominal muscles, is concentrated upon the feces to force it through the constricted portion of the lower bowel. The force exerted not only develops pile tumors, but carries out with the feces those tumors that had reached considerable proportions; thus the frail diseased mucous membrane is torn, and another symptom added to a chronic disease. Observation for over twenty years has convinced me that chronic proctitis usually exists fifteen, twenty or more years before piles are developed (if developed at all), from daily pressure on the inflamed, congested, dilated, varicose, friable blood-vessels and surrounding tissue.

Piles are easily and quickly cured without any annoyance to the sufferer. Chronic proctitis may be cured, but not quickly, as time is required to undo damage to tissues so long invaded by inflammatory process. Any one that allows a continuance of "a touch of the piles," as the expression is, and omits to take proper treatment as soon as this "touch" is felt, simply invites or takes chances of some form of cancer of the lower bowel later in life.

All other forms of disease of the lower bowel will yield to treatment satisfactory to physician and patient, but I am sorry to say cancer cases are numerous, and up to the present time we have no cure for this dreadful disease. If you value health, if you desire to avoid future suffering and disease, be sure that the lower bowel is free from inflammation, for with such freedom you will escape the many symptoms of proctitis described in my treatise on diseases of the anus and rectum.

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CHAPTER XX.

PRURITUS OR ITCHING OF THE ANUS.

One of the many symptoms of proctitis is the existence of anal channels from which an inflammatory product exudes through the skin, causing painful itching of the skin around the anal margin and not infrequently around the buttocks to the distance of three, six or even more inches from the anal orifice. An aggravated form of pruritus ani is much more trying to physical endurance than severe pain. Sometimes the torture is so great that a portion of the body will be covered with cold perspiration.

The natural color of the integument about the anus slowly changes to a dull whitish appearance. As the pathological process goes on, the skin becomes thickened and parchment-like. In exceptional cases the mucous membrane of the anal canal becomes toughened and hardened like cardboard. As a consequence there is a degree of inertia in the muscular action of the parts affected.