Should there be an undue protrusion at stool, pursue the same course recommended for the examination of internal hemorrhoids. If protrusion be absent, direct the patient to lie on the side with knees drawn up, separate the buttocks and inspect the anus; or, in other words, all that presents to view externally at the terminal orifice of the rectum. Now draw down and evert the mucous membrane at the verge with the thumbs, asking the patient at the same time to extrude the parts as much as possible. This will enable you to see all there is half an inch or more above the entrance. Next, anoint the finger, pass in gently and examine all the surface limited by the sphincters, a distance upwards of not over an inch, being careful lest you be deceived by the mobility of the tissue, when introducing the finger, and a small marginal growth be carried up and appear as one of internal origin. Any one familiar with vaginal examinations can detect a rough or a broken mucous membrane, an indurated spot or prominence as soon as touched. Next, feel above the internal sphincter, keeping in mind the anatomy of the parts, turn the finger slowly, posteriorly you can hook it behind the muscle. Here is situated the bottom or floor of the rectum which forms a cul-de-sac (Fig. 11). By asking the patient to strain down moderately, its surface will be thrown up against the end of the finger and in this manner properly explored. [Illustration: FIG. 11.—Lateral section of rectum; normal curve. R. Rectal pouch. C. _cul-de-sac_ of the rectum. E. S. External sphincter. I. S. Internal sphincter. H. Hilton’s white line. P. Position of prostate gland.] A digital examination reveals, in the normal state, a soft, velvety, unbroken mucous membrane, the parts pliable and yielding, with no reflex excitability of the sphincters. The position and sensibility of the uterus should be noted in the female, and size of the prostate gland in the male of advanced years. The first three or three and a half inches of the rectum can be brought within reach of the finger. Explorations farther up will require a rectal sound and a long tubular speculum. Nine-tenths of all rectal ailments are found within the first two inches. Therefore, few general practitioners will ever be called upon to treat anything beyond the reach of the finger or the scope of a common speculum. All hemorrhoids of any appreciable size, or other tumorous growths in the same vicinity, will show at defecation and can be treated while the parts are extruded. All abrasions, ulcerations, indurations, etc, are discoverable by the sense of touch. Hence, it will be seen that the uses of the speculum are narrowed down to a few in number. Namely: in that of bringing to view for observation and treatment diseased surfaces previously located; small, soft hemorrhoids and other minor affections which may have escaped detection by a careful digital examination.