The diet during this treatment should be temperate and laxative. Fruits should be used freely, and also coarse bread, rye and Indian mush and molasses; wine and exhilarating stimulants being avoided, and, where admissible, as much out-door exercise taken as possible. An excellent plan is also to inject half a pint or more of cold pump or spring water up the rectum every morning, and suffer it to remain for twenty or thirty minutes, if possible. Where the piles have been of several days’ continuance, and are very much swollen, puncturing them with a needle, and so relieving the tension by evacuating, or at least diminishing their contents, that the obstruction shall be overcome, is serviceable. After this, pledgets of lint dipped in cold water, the patient preserving the horizontal posture, may be applied, or an astringent lotion may be used. Where there is much swelling and inflammation, leeches applied to the neighboring parts will afford relief. It is impolitic, although some surgeons recommend it, to apply leeches on the tumor, as the bites are oftentimes very difficult to heal. Where the piles will admit of it, attempts should be made to empty them, and press them to their places, after which a pad may be worn to prevent their descent. In the commencement of the disease, where there is much heat and itching, a mild and astringent ointment will prove of considerable utility, and a wash of powdered opium, dissolved in flaxseed tea, will relieve pain and soreness. A very excellent and practical method in the treatment of piles (the internal I am now speaking of) is to deposite a pear-shaped bougie or pessary in the rectum, and suffer it to remain as long as possible. The wearing of bougies gives no pain or even uneasiness, and the patient may pursue his or her ordinary occupation without hinderance: the bougie should be worn from one to several weeks. It affords constant pressure against and support to the dilated veins, and enables them to regain their tone and strength; and I have known numerous instances where a lasting cure has been effected. One of the most alarming consequences of piles is hœmorrhage or bleeding; and it is really wonderful what an extensive loss of that fluid a patient can sustain. Day after day, and week after week, have I known instances of constant bleeding from internal piles, by which the constitution of the patient has been almost broken up. This symptom mostly prevails with females, nor is it limited, although more prevalent, to those who are pregnant. There is naturally a strong objection on the part of a delicate and susceptible female to submit to a professional examination, and consequently it is rarely done, until the urgent necessity of the case, lest death should ensue, induces the patient to consult her medical adviser, that he becomes acquainted with the real nature of the case. Where there is ulceration of the piles, and they are very numerous,