which the parts may be frequently bathed; an
ointment of nut-gall and opium; or extract of belladonna and
glycerin, equal parts. Sitting in cold water, night and morning, in a
tub also will prove serviceable. The more rapid and effectual method
of cure consists in opening of the recent pile by the surgeon, or
clipping off the fleshy projections. The bowels should always be kept
regular in any form of piles by small doses of Glauber's or Epsom
salts taken in a glass of hot water on rising, or some mineral water.
In case these do not agree, extract of cascara or compound licorice
powder may be taken at night. Equal parts of sulphur and cream of
tartar is an old-fashioned domestic cathartic of which a teaspoonful
may be taken each morning to advantage in piles.

=Internal Piles.=--In the beginning patients with internal piles feel
as if the bowels were not wholly emptied after a passage, and
sometimes there is difficulty in urinating and also pains in the
hollow of the back and in the thighs. There is often pain on movement
of the bowels, and blood follows the passage. Later, blood may be lost
at other times, and the loss may be so great as to cause pronounced
paleness and weakness. Itching is a frequent occurrence. Mucus and pus
(matter such as comes from an abscess) may also be discharged. Loss of
sexual desire and power is not uncommonly present. There may be no
external protrusions; but bleeding, itching, and pain during movement
of the bowels are the chief symptoms. If the pain is very severe
during and also after a passage, it is probable that there is also
present a fissure or crack in the flesh, or ulcer at the exit of the
bowel which needs surgical attention. It not infrequently happens that
the piles come out during the bowel movement, when they should be
thoroughly washed, greased, and pushed back. Sometimes this is
impossible, although after lying down for a while and applying ice or
cold water the mass may shrink so as to admit of its return. When a
large mass is thus protruded and cannot be returned, and becomes
nipped by the anus muscles, it undergoes inflammation and is very
painful, but a cure often results from its destruction. Such a mode of
cure is not a safe or desirable one, however.

=Treatment.=--The cold sitz baths in the morning or injections of a
half pint of ice water after a passage are useful. Ointments may be
introduced into the bowel upon the finger, or, better, with hard
rubber plugs sold