[Illustration] The distinction between External and Internal Piles is as follows: In both instances the same veins are diseased. In external piles, the lowermost portion of the hœmorrhoidal veins are dilated, and are thrust by the outer side of the rectum, carrying before them the common skin, which dilates and constitutes the external coat of the piles. The rectum is a portion of gut of four or five inches in length, and of nearly a uniform width; the lower end, constituting the orifice, is, as it were, tied round with a contracting and yielding band of muscular fibres, forming a muscle called the _Sphincter Ani_. It is a muscle of great power, and, from its connexion with the neighboring muscles of similar strength, helps to afford that support to the contents of the pelvis, that otherwise would descend, and be always forming a projecting tumor. External piles consist, then, of a protrusion of the hœmorrhoidal vein or veins between the cellular union of the sphincter with other muscles, constituting, in fact, a hernia or rupture in the perinœum. Internal piles is that condition of the hœmorrhoidal veins, where, from their dilatation, they become protruded with the fæces, when, from the contraction of the sphincter acting like a ligature, they can not regain their situation until emptied of their contents. Inflammation soon ensues, and the various changes I have and shall hereafter consider take place. Having stated the cause of piles, namely, pressure on, and thereby prevention of, the circulation of the blood through the hœmorrhoidal veins, it follows that persons mostly annoyed with constipation must be the most likely to be afflicted with piles; hence, free and intemperate livers, great wine-bibbers, feeble and relaxed constitutions, those, again, who take little exercise, and pregnant women, and women who have borne many children, seldom escape them. It is rarely that piles attack people in the lower class of life, and those who have to work hard for their livelihood and are much in the open air, which accounts for the prevalence of this disease in the upper ranks of society. The treatment of piles is very simple, if proceeded with at the commencement of the complaint, the grand object being to prevent constipation. An excellent adjunct to the cure of incipient piles, is the warm bath. Its tendency to overcome local congestions, and thereby equalize the circulation of the blood, is well known. The best medicine a hœmorrhoidal patient can take is Turkey rhubarb, to be chewed freely, or castor oil, in doses of one or two teaspoonfuls every morning, or some mild electuary, which should be continued until the piles subside.