so frequently. They should be treated upon their first
appearance when the chances of a permanent cure without an operation are
much better.

PHYSICIANS' TREATMENT for Internal Piles.--What to do first. The cause
should be removed. Restore a displaced womb. Regulate the bowels, liver,
diet, and habits. Much can be accomplished by these measures if properly
used, in allaying inflammation diminishing pain and reducing the size of
the piles. These measures will not cure them if they are large, overgrown
and protruding. When the piles are inflamed, strangulated or ulcerated,
the patient should remain in bed in a recumbent position and hot
fomentations of hops, etc., and hot poultices, of flaxseed, slippery elm,
bread and milk, the ice bag, or soothing applications and astringent
remedies, should be applied to the parts. In some cases cold applications
are the best. The cold or astringent applications give the best results
where the piles are simply inflamed and the sphincter muscle does not act
spasmodically, jerkily. But when the piles are strangulated, "choked
tight" by the sphincter muscle, hot fomentations, poultices and soothing
remedies give the most relief, because they reduce spasmodic contractions
of the muscle and allay the pain. Instead of the poultices and
fomentations, the "sitz" bath can be used. Put in the steaming water,
hops, catnip, tansy, pennyroyal, etc., and the steam arising will
frequently give great relief. This can be given frequently; ten to twenty
drops of laudanum can be added to the poultices when the piles are very
painful.

1. For inflamed piles, the following combinations may be used:--

Gum Camphor 1 dram
Calomel 12 grains
Vaselin 1 ounce

Mix thoroughly and apply freely around the anus and in the rectum on the
piles.

The external parts should always be bathed with hot water, thoroughly,
before using.

2. Gum Camphor 2 drams
Chloretone 1 dram
Menthol 20 grains
Ointment of Zinc Oxide 1 ounce

Mix and apply directly to the piles.

3. When there is a slight bleeding, water of witch-hazel extract, one to
two ounces to be injected into the rectum. This witch-hazel water freely
used is good for external piles also. This is good and well recommended.

[DIGESTIVE ORGANS 151]

4. If the protruded pile is inflamed and hard to push back, the following
is good and recommended highly: