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evaluated by a physician to determine the diagnosis. If necessary he can perform x-rays of the gastrointestinal tract. Hemorrhoids The veins of the rectum frequently become enlarged or tender, with sudden onset of brisk red bleeding. Called hemorrhoids, these annoyances are due primarily to our sedentary lifestyle, with the modern emphasis on refined foods containing little fiber. Sitting for prolonged periods or straining with bowel movements increases the venous pressure in the rectal area with the consequent development of these protruding veins. External hemorrhoids are clusters of veins at the opening to the rectum (anus). They may develop a clot or thrombosis. These become excruciatingly painful and usually show an area of purplish or dark discoloration. Although gradual resolution will occur in 2-3 weeks with sitz baths, the most prompt relief is obtained by the incision of the thrombosed hemorrhoid, removing the offending clots. This can be done with local anesthesia. Recurrence is uncommon. Treatment of the internal hemorrhoid, which more commonly bleeds and ulcerates, is usually conservative. Hot and cold sitz baths are given, described in the chapter on Hydrotherapy. In combination with a high fiber diet, they will usually allow the condition to subside. At least two tablespoons of bran, with an abundance of fresh fruits and vegetables, are advisable to keep the stool soft. Aim at producing one or more substantial soft bowel movements daily. Surgical treatment of refractory hemorrhoid disease was formerly a very painful and costly procedure. The development of the band ligation has changed this. A small rubber band is placed around the hemorrhoid high above the area of sensation, completely obliterating the hemorrhoid (varicosity). Two or three treatments in the office are necessary to complete this treatment. They are spaced at least three weeks apart to avoid excessive scarring. Rectal suppositories provide some relief from the pain of hemorrhoid disease, and may be purchased over-the-counter at most pharmacies. However, complications such as prolapse of the rectum or malignancy may present. The final decision on hemorrhoids is best handled by a physician. Appendicitis As in many above conditions, appendicitis has been linked to the consumption of refined foods. Quite rare in rural Africans, this acute situation is seen most commonly in individuals obtaining little dietary roughage. The pain of appendicitis usually comes on suddenly, and is associated with nausea