The inflamed, thickened and indurated integument near the anus takes on the form of folds, wrinkles or rugæ, of more or less prominence; but as these extend out over the buttocks they become more and more obliterated, leaving 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.