_Internal Piles_, though not usually painful, are by their frequent bleeding a cause of anæmia and debility; they lie inside the orifice of the bowel, but sometimes they come down on straining, and are then nipped by the muscle surrounding the opening, and may swell up, become very painful, and bleed profusely. _Treatment._—Keep the bowels freely but gently opened by taking cascara regularly; if the piles come down they should be returned, and an ointment of galls and opium or an injection of hazeline (one tablespoonful mixed with seven of water) used. Tannin, five grains to the ounce, or sulphate of iron, three to five grains to the ounce, may be used instead of hazeline. Hazeline suppositories are often of great use for internal piles, but ordinary suppositories do not keep well in very hot countries; if they are taken to the tropics they should therefore be specially made and packed. If the piles bleed profusely or cause great pain, an operation will be necessary. _External piles_ do not bleed, but from time to time they become inflamed and swollen, causing great agony. _Treatment._—The bowels should be kept well opened; the sufferer should lie with his hips raised; hot fomentations should be frequently applied, and the piles should be well greased. Glycerine of belladonna, smeared on a pad of lint, is a valuable application, as is dry calomel powder. Some sedative, such as Dover’s powder, may be necessary to procure rest and sleep. _Plague._ There are two chief varieties of plague, the bubonic and the pneumonic. _Causes._—Bubonic plague, which is due to a small vegetable organism, the _Bacillus pestis_, exists primarily as a disease in rats and other rodents, such as the Manchurian marmot and the Californian brown squirrel, and is transmitted from these animals to man by means of the flea. It is the rat flea that is chiefly concerned in the spread of plague. Both the brown and the black rat are affected and, speaking generally, the black rat is the more dangerous, as it lives in closer association with man. It is now known that certain forms of merchandise, especially grain and, to a lesser extent, raw cotton, are more to be dreaded as vehicles of the bubonic plague infection than the infected human being.