Neither age nor sex are exempt from this strictural change, although it more usually selects the grown up and female portion of society. It is, generally speaking, the consequence of constipation, or the reverse—diarrhœa or dysentery—or it may follow in the wake of child-bearing. Piles are a frequent precursor. The ordinary symptoms are at first a slight difficulty in voiding the fæces, which assume the form of the passage through which they have to pass, presenting at one time a flattened tape-like shape, at others a spiral appearance, and again the natural form, but of very small diameter. As the disease advances, the pain increases, upon going to the water-closet, and after the act may be observed a small or copious discharge of mucus, or blood, from the anus. If the bowels be constipated, there is necessarily a great deal of straining during fæcation, that soon establishes spots of inflammation that rarely resolve, but run on to ulceration; small lodgments then of fæcal matter take place in the cellular membrane; and without detailing the pathological phenomena, it may suffice to say, that sooner or later the whole rectum becomes diseased, and fistula, with its attendant miseries, lends a speedy help to close life’s brief pilgrimage. Patients afflicted with rectal diseases lose flesh rapidly. From the constant pain and annoyance they endure, their general health gets undermined, the digestion becomes faulty, the countenance flags and looks care-worn, hectic fever awaits the break-up of functional regularity, and a lingering exhaustion closes the scene.