A most important point in the management of Piles, and one often neglected, is to replace the prolapsed tumors. The tumors will be protruded from within the anus by the act of evacuating, and if left in that condition, will be pressed upon by the external parts, chafed and inflamed. In all such cases, the patient should take particular pains to return the tumors into the rectum; and to aid in that process a little oil may be applied when they will be easily pushed back, and the sphincter of the bowel will close below them, preventing any chafing, and the consequent inflammation. For _Bleeding Piles_, _Ipecac_ and _Bell_. are very efficient remedies. They may be alternated every half hour, or oftener if the bleeding is severe, or at longer intervals when it is only slight. _Hamamelis V._, (Witch Hazel,) will in nearly all cases arrest the bleeding at once. It should be applied to the parts and taken internally at the same time. Drop doses to be put on the tongue once in fifteen or twenty minutes. An infusion of the _Hamamelis_ may be taken internally in doses of half a teaspoonful, and the same injected into the bowel with excellent effect. The most effectual way, and the best for obtaining permanent relief from Piles when the tumors have become hard, and remain all the time so as to pass out of the anus at every evacuation, being constantly more or less tender and painful, and often becoming inflamed, is to have them taken off. But never let that be done with a knife. The bleeding would, in such a case, be very excessive, and most likely fatal. The history of knife operations for the excision of Pile tumors is written in blood, and the tombstone stands as a monument of condemnation of the practice. No trustworthy surgeon will at this day attempt it.