commencement
of an inflammation, due to modification of the blood-vessels and
surrounding tissues.

Chronic inflammation, sooner or later, leads to secondary
degenerations, that is, new products of the protoplasm, the most common
of which is fatty degeneration. In this form fat granules and globules
arise, which are at first minute, later on larger; these in certain
organs, such as the liver, may become so pronounced as to entirely
replace the original tissue. Another degeneration--which, however, is
found only in chronic systemic disturbances, such as tuberculosis or
syphilis--is the waxy or amyloid degeneration, a peculiar chemical
change the exact nature of which is unknown.

Various chemical changes are by no means uncommon.

An important question is the decision as to the length of time an
inflammation has lasted; and this at best can be determined only
approximately and after long experience. The older the inflammation,
the more the connective tissue has developed; this connective tissue is
at first soft, but soon becomes more and more dense; the result being a
varying degree of hardness of the organs.

Again, secondary degenerations are more pronounced in long-standing
processes. In comparatively fresh cases blood-vessels are still more or
less numerous and the tissue appears red, while in older cases these
vessels become completely obliterated, and the tissues take on a white,
glistening color, becoming harder and denser as the years advance. If a
process has lasted twenty or thirty years, the changes to the eye and
touch are practically the same as after forty or sixty years.

The changes, as here described, will be the same upon any mucous
membrane; and in the large intestine can be easily studied and are
perfectly characteristic.

Rarely does an infant escape repeated attacks of inflammation of the
integument of the anus and the mucous membrane of the anal canal. The
inflamed integument is treated and healed, but no attention is given to
the inflamed mucous membrane so that the inflammation in time becomes
chronic, involving the rectum also. Should the infant be so fortunate
as to escape inflammation (proctitis) of these organs during the
wearing of the diaper, there are numerous other exciting causes of
inflammation which it will not be likely to escape, hence the almost
universal symptom of constipation among civilized people; and hence
later in life you hear the familiar expression, "I have a touch