Seldom may one find a disease so little understood as pruritus ani. There is great dissension in regard to its cause. The variety of remedies which have been offered proves that nothing has been produced resembling a cure. DIRECT AND INDIRECT PRURITUS Montague1 distinguished two types of pruritus, direct and indirect. The latter is called by others essential or idiopathic pruritus. In the direct type of pruritus, local anal diseases such as fistulas, fissures, ulceration of the anus and rectum, polyps, papillae and hemorrhoids have been given as causes. In the indirect type of pruritus, Montague regarded the itching as a referred sensation caused by disorders in distant organs, i. e., the stomach, gallbladder and appendix and other organs. Montague expressed the belief that whenever a viscus is the seat of a disease a stream of afferent stimuli is generated and transmitted to the central nervous system. The irritant