It might be compared to a rhagade or chap in the web between the toes or fingers. In its recent state it presents the appearance of a longitudinal tear of from three to five-eighths of an inch in length, looking raw and bloody, with ragged and somewhat everted edges; and may be complicated with polypi (Fig. 20), or a hemorrhoid occupy its base, called the “sentinel” pile. It is aroused from its slumbers by a mechanical disturbance of the slightest nature, hence the name irritable. The act of defecation being followed by a dull, sickening, sometimes lancinating pain lasting three hours or more, incapacitating the subject from labor. The mere introduction of the finger may produce a deathly pallor and possibly syncope. Ask the patient to extrude the parts, then gently pull down the mucous membrane and apply a ten per cent. solution of cocaine to the tract with a camel’s hair brush or silver canula attached to a hypodermic syringe; carrying the solution fully to the top of the fissure, which may be out of sight. If any unguent has been used about the fissure it should be subjected to a hot water irrigation before using the cocaine, as cocaine will not take effect on a greasy surface. When the tract is sufficiently anæsthetized to introduce a speculum, apply on the end of a probe wrapped with cotton, 95 per cent. carbolic acid, and prescribe the following ointment for daily use: ℞ Acidi Salicyl. ʒ ss Vaselini ℥ ss M. If unsuccessful after making two or three thorough applications of carbolic acid, inject into and beneath the bed of the fissure, in a sufficient number of places to encompass its length, possibly two, a few drops of the hemorrhoidal compound; and produce a slough. The object is to destroy the original ulcer and convert it into some other form that will heal. I have never seen a resulting sore from carbolic acid that was slow to heal. A physician who had been a great sufferer from the effects of a fissure informed me that he had been etherized twice and the sphincters thoroughly stretched, and had submitted to incision three times, all of which had proved fruitless, and was finally permanently cured by the use of salicylic acid and vaseline. [Illustration: FIG. 21.—Ointment Applicator.] PROLAPSUS RECTI. A prolapse of all the coats of the rectum, amounting in some instances to complete invagination, is of such rare form, occurring mostly during infancy, that it might be considered practically out of the list of rectal ailments. Prolapse of the mucous coat of the bowel is not an uncommon affection, and is a frequent complication of internal hemorrhoids. When the hemorrhoids are cured the prolapsus usually disappears.