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, a reluctant permission for the passage of the feces; and this inhibition results, consequently, in some degree of constipation. And this constipation reacts more or less on the peristaltic action of the bowels and in time defeats the function of peristalsis. All this will react on the inflammatory processes at the anus, which originally engendered the constipation. The narrow and contracted strait or canal through which the feces must pass, gives a tape-like shape to the stools. The anal and rectal mucous membrane is of a firm and tough structure, similar to the integument at the bottom of a boy's heel. After many years' observation of diseases of the anus and rectum I am forced to conclude that as a rule inflammation exists in the tissues twenty or more years before the severe symptoms, such as piles, fissure, anal pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula, are sufficiently annoying to compel the sufferer to seek medical aid. I believe it to be of as much importance to give early attention to disease of the anus and rectum as to teeth and eyes, or even more. CHAPTER XV. BALLOONING OF THE RECTUM--Continued. In the last chapter a description was given of the anatomy of the anus and rectum; and it was shown how a chronic inflammatory process involving these organs develops stricture in the parts invaded; and it was shown how a partial stricture of the anal canal results in ballooning or dilatation of the lower part of the rectum. The primary cause of all the symptoms of rectal disease is chronic inflammation (proctitis) involving the whole structure of the anal tubes and in a few cases the sigmoid flexure as well.