In addition to this treatment which must be carried out by a physician the patient must observe the following rules: Go to stool daily, and as near the same time as is convenient, correct errors of diet. Drink an abundance of water and eat sufficient fruit. Take plenty of outdoor exercise; take a cold bath every morning followed by a thorough rubbing. Dress warmly in winter and cool in summer. Change of temperature or climate if the case demands it. Be temperate in all things affecting the general health. Stretching the sphincter must be done carefully, but in a thorough manner. It can only be done properly by an experienced person. Stretching of the sphincter closes the opening so that the feces are not passed at all times. It is circular in shape. Sometimes this grows larger, stiffer, or it acts spasmodically. The opening is often so tight in some people that it is difficult to introduce even a finger, and it frequently produces a spasm of pain in the bowels, stomach and head to do so. This kind will produce constipation or make it worse. In such cases it should be stretched thoroughly but carefully so that the muscle will be able to close the opening and the bowel contents will not pass at any time unhindered. There are two methods of stretching the muscle--forcible or gradual. The forcible method is generally done by inserting the two thumbs into the anus and stretching the muscle thoroughly in every direction until there is no resistance. (Dilators are made for this purpose, but unless they are very carefully used they will tear the muscle). The forcible method should be done under an anesthetic. Gradual stretching is done when an anesthetic cannot be used. It is better to do too little than to do too much at the first sitting. The muscle is very stubborn sometimes, and it requires careful handling or the irritability will be increased. An instrument in the hands of a careful man is all right. They can be stretched by the fingers or the Wales' bougie, thus: Patients should come to the office two or three times a week, the instrument (bougies) are introduced and allowed to remain within the bowel until the muscle resistance is overcome, and many times their withdrawal will soon be followed by a copious stool. Forcible stretching is seldom required more than once, if a large sized instrument is used from time to time afterward, just as in gradual stretching; when thorough dilatation has been accomplished, the muscle instead of acting as an impassable barrier to the discharge of the feces, now offers only passive resistance, but sufficiently strong, however, to prevent any unpleasant accidents, yet not strong enough to resist the power of the expulsory muscles when the latter are brought into full play during stool. Large quantities of feces do not now accumulate; consequently the pressure upon the mucous membrane and neighboring nerves is eliminated, and the bowel regains its normal sensibility and strength.