al these lesions; (4) the method by which an organism attempts to
render inert the noxious elements introduced from without or arising
within it; (5) a disturbance of the mechanism of nutrition of an organ
or tissue, affecting the structures concerned in its function."

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 laesa).

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 muc