ues.

Pile formations are a symptom of chronic proctitis of fifteen, twenty
or more years duration. Proctitis (inflammation of the anus or rectum)
and periproctitis (inflammation of the connective tissue about the
rectum) are by no means uncommon inflammatory processes. The mucous
membrane like the skin is liable to injury or poisons and especially so
at the orifices of the body. Let inflammation set in: if it be not
cured at once, it will invade the canal, especially a canal like the
rectum; in which case it will establish itself throughout from six to
ten inches of its length, sometimes taking in the sigmoid flexure and
even the colon. Just how long chronic inflammation confines itself to
the mucous membrane before invading the areolar or lace-like connective
tissue and the muscular tissue of the organ, I am unable to state.

The first symptom or indication that all the tissues are involved in
the inflammatory process will most naturally be constipation. You have
observed that inflammation of a portion of the skin on the arm, trunk
or leg does not disturb the muscular movements of the region involved,
except when the muscles underneath the skin are affected also, as in
the case of deep burns where the movements are very much disturbed by
the irritability, soreness and contraction of the diseased muscles.
There is also an adhesive product excreted from the inflamed tissue
that binds the muscular fibres of an organ together, and you have
contraction of the organ and its usefulness impaired. Now, as this is
precisely the pathological or diseased condition which chronic cases of
proctitis and periproctitis present, you will readily understand how
spasmodic and partial stricture or contraction occurs in the sore
muscles (circular and longitudinal) of the anus and rectum. The length
and the bore of the canal are diminished, and thus the circulation of
the blood arrested by the pressure or gripping of the contracted
muscles. This congestion of the blood brings about an anatomical change
in the structure of the mucous membrane, which we call piles: a mere
symptom of inflammation.

Medical authors have defined inflammation as follows: "(1) A series of
changes constituting the local reaction to injury; (2) a series of
changes that constitute the local attempt at repair of actual or
referred injury of a part; (3) a series of local phenomena that are
developed in consequence of primary lesion of the tissues and that tend
to he