n inflated balloon: hence the name.

Anatomists describe the rectum as terminating in a forward pouch, which
is close to the prostate gland in the male and the lower part of the
vagina in the female. In some cases there may be such a slight pouch,
due to the anal canal not following the direction of the rectum, and
slightly turning backward; but in most cases such a normal pouch is not
perceptible or observed through the speculum. The small pouch sometimes
found on the anterior wall of the rectum I have thought due to a very
acute inflammation on the verge of forming abscess, which often occurs
in the triangular space. (See 4 in diagram in pamphlet cited above.)

Immediately above the sphincter muscles on the posterior wall of the
rectum the greatest dilatation is found (as shown by the bent probe),
and extends on each side with less depth about the anterior wall of the
rectum.

The greater portion of the lower part of the rectum, which part is
about three inches long, is usually involved in the dilatation or
ballooning. Often the upper half or more of the anal canal is also
dilated with the rectum, leaving the sphincter muscles quite bare of
fatty tissue, with anal length of a quarter of an inch or less.

Your attention was called to a sleeve containing sand, and the bulging
or dilatation above the puckered wrist-band that was an inch or more
broad. Now suppose there were two strong rubber rings at the lower end
of the wrist-band, whose power of resistance to pressure is much
greater than the tissues above them forming the wrist-band. Naturally,
the tissues which form the upper part of the wrist-band would dilate
the same as the terminal portion of the sleeve just above the
wrist-band.

Similar changes in structure or formation take place in diseases of the
anal and rectal canals which result in ballooning of the rectum; and
two frail constricted sphincter muscles are left to guard this balloon,
filled, as it so often is, with feces and gas.

Chronic inflammation, that results in contraction of the circular
muscular fibres, will sooner or later constrict the gut so that it will
lose its normal power to expand without causing pain. The anal canal
may be said to be strictured to the degree in which it is unable to
dilate normally, and this strictured condition usually grows from bad
to worse.

The first symptom of rectal disease is usually an affection of the
anus, which affection occasions an inhibition, that is