It must be allowed that there is little or no opportunity for the prevention of haemorrhoids by dietetic treatment. It is doubtful whether any errors or peculiarities of diet have any relation to their occurrence; in fact their causation is curiously obscure, and the old theories of a hemorrhoidal diathesis, of plethora, and of hepatic congestion may be discarded.

We have these anatomical facts, that the veins which undergo this dilatation are those veins which in all positions of the body, sitting, standing, or lying, are always in a dependent state, that the outgoing veins from the haemorrhoidal plexus have no valves, and that the tissue in which they lie is subjected daily to expulsive pressure. Though these phlebectasies arise in veins which communicate both with the portal and with the general venous systems, it is clear that they are not the result of a rise in pressure in either of these systems. As regards the portal system, it is the general experience that haemorrhoids are by no means common with cirrhosis of the liver, and as regards the general venous system it is equally certain that they do not occur in cases of backward pressure resulting from failure of the right side of the heart. It is possible that in some cases habitual excess of food and abuse of alcohol may be contributing factors, but it must be allowed that haemorrhoids are common enough in spare energetic men leading a clean and active life. Haemorrhoidal formation is in fact mainly a local condition due to local causes. A sedentary life, especially if this is combined with the use of soft cushions and chairs, seems without doubt to have some part in the causation. The connexion with pregnancy is undoubted. Constipation often co-exists with haemorrhoids, and it was formerly thought to be an important cause, but even here the connexion is neither close nor constant, and in many cases it is found that the haemorrhoids are the cause rather than the effect of the constipation.

Though haemorrhoids do not seem to be due to any gross error of diet, it is necessary to inquire into the habits of a patient in whom a haemorrhoidal tendency exists, and to ensure the establishment of a spare and temperate diet, perhaps with such alterations as may tend to relieve constipation. In many cases, however, there is little or no room for improvement in these respects.

When haemorrhoids are already formed and have begun to give rise to discomfort from time to time, there is greater opportunity for dietetic treatment. Especially is this the case when inflammation has set in. The correct line of treatment is shown by the aggravation of the trouble which inevitably results from a continuance of full meals with alcohol, and such a diet should be adopted as will provoke but little gastro-intestinal hyperaemia. Meals should be small and simple, and five small meals in the day are better than three large ones. Meat should be diminished in amount, and in an acute stage may well be discarded altogether. All spices and condiments should be forbidden. No alcohol should be allowed, and except in small quantities the patient is better without tea or coffee. It is recommended by some that the amount of fluid taken should be diminished, but it is doubtful whether any advantage is so gained. The diet, therefore, should consist largely of milk slightly diluted or as blancmange or in weak tea, with butter, eggs, carbo-hydrates as toast, milk puddings, potato and honey, • stewed fruit and green vegetables such as spinach and cauliflower.