AS this disease is generally considered to be of a delicate nature, and one about which the afflicted are unwilling to speak, we shall say a few words on them. Piles constitute a disease that may be very slow or very rapid in its progress. The patient complains of an occasional itching or soreness at the rectum after an evacuation, more particularly if subject to constipation, or if he be an irregular liver: when, after a while, he will be surprised on discovering, subsequent to some straining effort, a knot of elastic but irregularly formed tumors, of a size varying from a hazel-nut to a horse-bean, springing out apparently from the rectum, that in a few days, if they continue, will become sore, and probably be attended with a discharge of blood. [Illustration: 1. Rectum. 2. Hœmorrhoids. 3. Perineum.] Another patient will experience similar symptoms, as regards the pain, swelling, and discharge of blood, except that they will be increased in severity, and be more transitory in their appearance and stay. Upon examination, a perceptible difference will be discovered. In the former instance the tumors will be seen to proceed from the outer edge of the rectum, and will be found to be covered with the common skin. Professional men designate this form of the disease “External Piles.” [Illustration: 1. Inner part of Rectum. 2. Orifice of Rectum. 3. External Piles. 4. Internal Piles.] In the latter, the tumors are, as it were, squeezed out of the rectum, and swell in a very short space of time to an enormous size. They are of a much more vivid blood-red color, and will be found to be covered only by the lining membrane of the lower gut. These are called “Internal Piles.” [Illustration: 1. Inner part of Rectum. 2. Orifice of Rectum. 3. Internal Piles.] Now piles are nothing more nor less than _dilated veins_, like varicose veins in the leg or any other part. The office of veins is to receive the surplus blood of the arteries, after having parted with that necessary supply for the nourishment of every structure they are severally distributed to, and to convey it back to the circulating organ, the heart—and the mesenteric hœmorrhoidal veins, from their dependant and confined position, the circulation in and above them being liable to so many interruptions from the frequent hardened state of the fæces in the rectum, become distended with blood, which acting really like a wedge, dilates them in time to the size we meet them. On the removal of the cause, the blood flows on, and the swelling subsides, and the patient feels no further inconvenience until a recurrence of the pressure. After repeated attacks, the veins become inflamed, and lymph, a sort of defensive mucus, is “thrown out” on the cellular membrane covering the veins, and becomes organized into an indurated texture, which increases with each attack of inflammation, and at last gives them that fleshy appearance which resembles a specific growth (see annexed cut).