ng no clue to the direction of the channel which
leads from the site of inflammation; which latter, however, may be
learned from the itching, or from the burning sensation with some
soreness, over portions of their length.

During a practice extending over twenty years, I have found only two
cases in which one of these channels was the seat of a slight abscess.
It is not usual that pus formations occur in these inflammatory
channels. At the margin of the opening from the rectum to the anal tube
are five or six small crescent-shaped loops, semi-lunar valves,
separated by vertical ridges (the anal columns). Naturally in chronic
proctitis the zone of tissue just above the sphincter muscles and
slightly within their grasp at the upper portion of the anal tube,
would suffer greatly from the morbid process, owing to the abnormal
constriction of the tissues and to the incidental pressure and injury,
from time to time, as the stool passes the diseased region. Just under
the mucous membrane covering the anal columns and semilunar valves is
the fatty tissue forming a bed upon which the mucous membrane rests. It
is sufficiently lax to permit considerable movement of the mucous
membrane on the muscular coat beneath it. The frail, fatty, loose
connective tissue in the grasp of the sphincter muscles would be the
first to become impaired by inflammatory process, the product of which
finds its way down and out under the mucous membrane of the anal canal
and integument of the buttocks for quite a distance, occasioning
itching, pain, soreness or burning in the integument covering the
course of the channel.

Here we have the pathological reason why local remedies to the outer
surface of the skin will not cure pruritus ani. Also the reason why
dieting is useless, and why internal remedies are worthless for the
cure of anal itching; for the itching, as shown, is the result of an
inflammatory product in the channels under the skin of the victim,
numbering from five to twenty. Over fifteen years ago I discovered the
cause of the great suffering from painful itching at the anus and
contiguous tissues and have been able to give instant relief, and in a
little time permanent cure, in every case treated since then. It is
well for those who have an occasional attack of pruritus ani to take
treatment at once for proctitis proper, as well as for this symptom,
itching resulting from these channels. The proctitis, if neglected,
will only be the mean