Piles (hemorrhoids) are not the result of either the normal or abnormal growth of the tissues of the anal and rectal mucous membrane. They are developed by the combination of pathological and physiological conditions: (1) chronic inflammation or proctitis; (2) stricture of the anal canal and lower portion of the rectum, which may be spasmodic, or more or less permanent, which stricture pinches or constricts the canal, thereby inhibiting the circulation of the blood; (3) the pressure or straining effort during the act of defecation, occasioned by the constricted canal, which effort brings on greater local congestion and constriction of the tissues. Pile formations are a symptom of chronic proctitis of fifteen, twenty or more years duration. Proctitis (inflammation of the anus or rectum) and periproctitis (inflammation of the connective tissue about the rectum) are by no means uncommon inflammatory processes. The mucous membrane like the skin is liable to injury or poisons and especially so at the orifices of the body. Let inflammation set in: if it be not cured at once, it will invade the canal, especially a canal like the rectum; in which case it will establish itself throughout from six to ten inches of its length, sometimes taking in the sigmoid flexure and even the colon. Just how long chronic inflammation confines itself to the mucous membrane before invading the areolar or lace-like connective tissue and the muscular tissue of the organ, I am unable to state. The first symptom or indication that all the tissues are involved in the inflammatory process will most naturally be constipation. You have observed that inflammation of a portion of the skin on the arm, trunk or leg does not disturb the muscular movements of the region involved, except when the muscles underneath the skin are affected also, as in the case of deep burns where the movements are very much disturbed by the irritability, soreness and contraction of the diseased muscles. There is also an adhesive product excreted from the inflamed tissue that binds the muscular fibres of an organ together, and you have contraction of the organ and its usefulness impaired. Now, as this is precisely the pathological or diseased condition which chronic cases of proctitis and periproctitis present, you will readily understand how spasmodic and partial stricture or contraction occurs in the sore muscles (circular and longitudinal) of the anus and rectum. The length and the bore of the canal are diminished, and thus the circulation of the blood arrested by the pressure or gripping of the contracted muscles. This congestion of the blood brings about an anatomical change in the structure of the mucous membrane, which we call piles: a mere symptom of inflammation.