If it be true, as stated by enthusiasts on the subject of rectal pockets and papillæ, that they are frequently found in old, deep-seated, chronic diseases, where the presence of rectal trouble is never suspected by any local signs, we have, then, a sufficient reason to account for their having escaped the notice of specialists. Andrews makes a labored effort, and with apparent success, to show that the so-called “pockets and papillæ” are normal structures. That the pockets are the _sacculi Hornei_ (Fig. 22), which are little depressions situated just above and intimately connected with the verge of the anus, caused by the reticulated arrangement of bands of muscular and connective tissue, beneath a delicate mucous membrane and deepened by the corrugating action of the sphincter ani. That the papillæ are little dot-like prominences frequently found between the lower ends of the _sacculi Hornei_, and when somewhat enlarged resemble in appearance the _carunculœ myrtiformes_ of the vagina. That these little papillæ, with their adjacent “pockets,” constitute the so-called “pockets and papillæ” of the itinerant. [Illustration: FIG. 22.—S. _Sacculi Hornei._ P.P. Papillæ, magnified three diameters. (Andrews.)] [Illustration: FIG. 23.—P. _Bone fide_ rectal pocket with adjacent papillæ, not magnified at all.] I have seen just what Dr. Andrews very correctly describes, and will say, after carefully reading his explanation, I am fully convinced that he never saw what is meant by the discoverer of rectal pockets and papillæ. And further beg to say that the doctor must concede that there are others, who are not itinerants, capable of identifying a diseased surface when they see it, and pointing out its place of location. [Illustration: FIG. 24.—Other varieties of papillæ and a simple form of rectal pocket.] It will be seen by a reference to the appended clipping, that Andrews has been making his microscopical dissections nearly an inch below where true rectal pockets are found. And I can conscientiously attest that true papillæ bear no resemblance, in the least, to his papillæ or _carunculœ myrtiformes_ at the anal verge. [Illustration: FIG. 25.—Represents figure 22, showing reticulated arrangement under post mortem relaxation. C.C.C. Columnæ recti. S. Sacculi Hornei. P.P. Papillæ. (Andrews).] Rectal pockets are doubtless a duplicature of the mucous membrane, forming cul-de-sacs with their mouths looking upwards. They are removed through a speculum by raising the outer wall with a blunt hook and excised with a pair of scissors, or slit through their center with a knife, and carbolic acid applied to the remaining flaps. [Illustration: FIG. 26.—Author’s Knife-hook for slitting down pockets.]