ecomes necessary for the sufferer to press them back, but in some
instances this is impossible. Frequently during the protrusion one of
the hemorrhoidal veins gives away, and this is followed by a free escape
of blood, and ulceration may ensue. Not infrequently with this disease
the patient loses strength and flesh, and the face becomes pale and
puffy, assuming a waxy appearance. Many times there is nausea, with
vertigo. Is consequence of the relaxation, the bowel may descend when on
the feet, or with some extra muscular effort, especially when stooping.
These symptoms may not all be present in one person, and, indeed,
sometimes are somewhat obscure; when such is the case, an examination by
a competent physician will always determine the true character of the
complaint at once.

[Illustration: Fig. 3.
H. _i._ Internal hemorrhoidal veins. H. _m._ Middle
hemorrhoidal veins. H. _e._ External hemorrhoidal
veins. S. _i._ Internal sphincter muscle, S. _e._ External
sphincter muscle. ]

TREATMENT. Notwithstanding the well established fact that piles are
readily cured by the appropriate treatment, hundreds of thousands of
people suffer untold tortures from them because of the popular
impression that they cannot be cured. All cases are not, however,
amenable to the same form of treatment, for various unhealthy conditions
of the system are often concerned in their production and perpetuation,
and must, of necessity, be remedied by appropriate treatment, before a
cure of the piles can be expected. It will, therefore, become apparent
that the avoidance of causes is of paramount importance. Some of these
causes are external, and wholly under the control of the patient, while
others depend upon diseases that are curable; it frequently happens that
while other diseases are being remedied, the piles disappear Without any
special attention.

Diseases of the urinary apparatus, as stricture of the urethra,
enlargement of the prostate gland, and stone in the bladder, dysentery,
diarrhea, and constipation,--all cause piles, by the irritation, and
determination of blood, which they induce; these difficulties must be
removed by appropriate treatment.

Some years since, we ascertained that we were using in our practice
remedies which, in addition to other virtues, possessed a direct
specific influence upon the vessels concerned in the formation of piles.
These agents enter into the composition of Dr. Pierce's Golden Medical
Discovery, wh