ous 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.

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.

The inflamed, thickened and indurated integument near the anus takes on
the form of folds, wrinkles or rugae, of more or less prominence; but as
these extend out over the buttocks they become more and more
obliterated, leavi