Pile instrument is used in aiding and relieving severe hemmoroid ‘tumor’ enlargement via the lid where you can pack with snow or fill with cold water. You introduce the metal end via a lubricated balm and the slots on the tip edge help channel and drain the blood or expel fluid . A unique device to help cure from 1868 and comes in original box. Looks like a nice ready made that Duchamp would have liked to use as art. Measures: 2 3/4” x 2”W . The small container seems to be silver or silver plate