The disease which bears this name is not protrusion of the rectum, but eversion of the mucous membrane of the rectum. During the act of defaeca-tion it is natural for this membrane to be a little exposed, and when the act is over to be again removed from sight. The same thing occurs to a thickened mucous membrane, perhaps also the seat of piles; with this difference, however, that the eversion is greater and is not temporary. Under the irritation of haemorrhoidal growths, worms, drastic purges, attacks of diarrhoea, or of dysentery, etc., the peristaltic action of the bowel is increased and there is violent straining. The coats of the bowel and the muscular sphincter become lax, and folds of mucous membrane appear externally. But in true prolapsus, there is protrusion, not of one coat only, but of all the coats of the intestine - a comparatively rare accident.

* A case illustrating the treatment of fistula will be found in the Appendix. † See Appendix.

The symptoms are obvious enough.

In treating a case of this kind the particular cause must be discovered and removed; for until that be done, the eversion or protrusion will return shortly after the part has been put into its right place. The part should be thoroughly cleansed with douches of cold water for the purpose of removing dirt, and, by astringing its vessels and reducing its size, enabling the operator to return it with greater facility. After having dried the surface, the part should be returned as gently as possible. The difficulty is, not to get it in, but to keep it in. Cold injections are beneficial. The remedies for piles, or for worms, or for diarrhoea whatever be the cause of the disorder - must be given. In obstinate cases, which do not yield to these measures because of great laxity of tissue, an operation is necessary.