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1 ounce
      Rose water enough to make 8 ounces

Mix. Keep in contact with the itching area by means of gauze or cotton while the itching is intense.

8. For injections into the rectum for rawness of the mucous membrane, the following is well recommended. Use three drams of this at one time.

      Fluid extract Witch Hazel 2 ounces
      Fluid extract Ergot 2 drams
      Fluid extract Golden Seal 2 drams
      Compound tincture Benzoin 2 drams
      Carbolized Olive or Linseed Oil 1 ounce
      Carbolic acid 5 per cent

Mix and shake well before using.

9. For the same purpose:— Ichthyol 1 dram Olive oil 1 ounce

Mix and apply in the rectum on a piece of cotton.

[146 MOTHERS' REMEDIES]

PILES. (Hemorrhoids).—Hemorrhoid is derived from two Greek words, meaning blood and flowing with blood. "Pile" is from a Greek word meaning a ball or globe. Hemorrhoids, or piles, are varicose tumors involving the veins, capillaries of the mucous membranes and tissue directly underneath the mucous membrane of the lower rectum, characterized by a tendency to bleed and protrude. They were known in the time of Moses.

Varieties.—There are the external (covered by the skin) and the internal (covered by mucous membrane).

Causes.—Heredity. More frequent in males. Women sometimes suffer from them during pregnancy. Usually occurs between the ages of twenty-five and fifty. Sedentary life, irregular habits, high-grade wines and liquors, hot and highly seasoned and stimulating foods. Heavy lifting. Those who must remain on their feet long or sit on hard unventilated seats for several hours at a time. Railway employees, because they take their meals any time and cannot go to stool when Nature calls, causing constipation. Purgatives and enemata used often and for a long time. Constipation is perhaps the most frequent cause: when a movement of the bowels is put off for a considerable time the feces accumulate and become hard and lumpy and difficult to expel. If this hard mass is retained in the rectum, it presses upon the blood vessels interfering with their circulation and by bruising the vessels may induce an inflammation of the veins when the hardened feces are expelled; straining is intense, the mass closes the vessels above by pressure and forces the blood downward into the veins, producing dilatation when the force is sufficient. One or more of the small veins near the anus may rupture and cause a bloody (vascular) tumor beneath the mucous membrane or skin.

External Piles.—Two kinds, venous piles and skin or simple enlarged tags of skin. Venous piles usually occur in robust persons. They come on suddenly and are caused by the rupture of one or more small veins during the expulsion of hardened feces. There may be one or more, and may be located just at the union of the mucous membrane and the skin. Their size is from a millet-seed to a cherry, livid or dark blue in color, and appear like bullets or small shots under the skin. At first they cause a feeling of swelling at the margin of the anus; but as the clot becomes larger and harder, there is a feeling of the presence of a foreign body in the lower part of the anal canal (or canal of the anus). The sphincter muscle resents this and occasionally contracts, spasmodically at first, producing a drawing feeling; later these contractions become longer and more frequent, and there is intense suffering caused by the pile being squeezed, and this suffering may be so great that sleep is impossible without an opiate. Because of the straining, irritation of the rectum and pain in the sphincter, the piles soon become highly inflamed and very sensitive. The clot may be absorbed without any treatment. Occasionally it becomes ulcerated from the irritation, infection takes place and an abscess forms around the margin of the anus terminating in a fistula.

[DIGESTIVE ORGANS 147]

Skin Piles. (Cutaneous).—These are enlarged tags of the skin. They frequently follow the absorption of the clot in the venous piles where the skin is bruised and stretched. There may be one or many and usually have the skin color. These cause less suffering than the venous variety, and sometimes they exist for years, without any trouble, providing care is taken; but when bruised from any cause, such as a kick or fall, sitting on a hard seat, stretching of the parts during stool, or when they become irritated by discharges from the rectum or vagina, they become inflamed and cause much annoyance and pain. When they are acutely inflamed they swell greatly, are highly colored, swollen, painful, and extremely sensitive to the touch and cause frequent spasmodic contractions of the sphincter muscle and may finally result in an abscess. The pain is usually confined to the region of the anus, but may go up the back, down the limbs or to the privates.

MOTHERS' REMEDIES FOR PILES. Sulphur and Glycerin for.—"Equal parts of sulphur and pure glycerin. Grease parts." This preparation is very healing, and will often give relief even in severe cases.

2. Piles, Strongly Recommended Remedy for.—

    Extract Belladonna 15 grains
    Acetate lead 1/2 dram
    Chloretone 1 dram
    Gallic acid 15 grains
    Sulphur 20 grains
    Vaseline 1 ounce

Mix.

In protruding, itching and blind piles, this ointment will give you almost instant relief. If kept up several days it will promote a cure."

3. Piles, Good Salve for.—"Red precipitate two and one-half drams, oxide of zinc one dram, best cosmoline three ounces, white wax one ounce, camphor gum one dram." It is much better to have this salve made by a druggist, as it is difficult to mix at home. This it a splendid salve and very good for inflammation.

4. Piles, Smartweed Salve for.—"Boil together two ounces of fresh lard and half an ounce smartweed root. Apply this to the piles three or four times a day." This is very healing, and has been known to cure in many cases when taken in the early stages.

5. Piles, the Cold Water Cure for.—"Take about a half pint of cold water and use as an injection every morning before trying to have a movement of the bowels." This simple treatment has cured many cases where the stronger medicines did not help.

6. Piles, Simple Application and Relief from.—"Mix together one tablespoonful plain vaselin and one dram flower of sulphur. Apply three times daily and you will get relief."

7. Piles, Steaming with Chamomile Tea for.—"A tea made of chamomile blossoms and used as a sitz bath is excellent; after using the sitz bath use vaselin or cold cream and press rectum back gently."

[148 MOTHERS' REMEDIES]

PHYSICIANS' TREATMENT for Piles.—What to do first.—The palliative treatment of both varieties of external piles is the same. In all cases the patient should lie flat on his back in bed and remain there for a few days. Highly seasoned foods and stimulants, tea, coffee, whisky, wine, etc., must be discarded. Secure a daily half liquid stool by the use of small doses of salts, Hunyadi or Abilena water. Cleansing the parts with weak castile soap water is essential to allay the pain, reduce the inflammation and soothe the sphincter muscle; cold, or if it is more agreeable, hot applications may be kept constantly on the parts. Hot fomentations of hops, smartweed, wormwood, or poultice of flaxseed, or slippery elm, or bread and milk give almost instant relief in many cases; while in others soothing lotions, and ointments or suppositories are needed.

The lead and laudanum wash is always reliable.

Lead and Laudanum Wash.—

      Solution of Subacetate of Lead 4 drams
      Laudanum 20 drams
      Distilled water enough to make 4 ounces

Mix thoroughly and apply constantly ice cold on cotton to the sore parts.

The following ointments, lotions, and suppositories to be used freely within the bowels and to the piles, are effective in relieving the pain, reducing inflammation and diminishing pain and spasm in the sphincter.

1. Ointment of Stramomium 1-1/2 drams
      Ointment of Belladonna 2-1/2 drams
      Ointment of Tannic Acid 1/2 ounce

Mix thoroughly and apply inside and outside the anus.

2. Camphor Gum 1 dram Calomel 12 grains Vaselin 1 ounce

This must be thoroughly mixed. Apply freely within the anus and to the piles. Good for the pain.

3. For External Piles cleanse them well with a sponge dipped in cold water, and then bathe them with distilled extract of witch hazel.

4. If there is much itching with the piles use the following salve:—

      Menthol 20 grains
      Calomel 30 grains
      Vaselin 1 ounce

Mix and apply to the piles.

5. I use quite frequently the following for sore external piles:

Chloroform and Sweet oil in equal parts

Apply freely with cotton or on to the piles. Ten cents will buy enough to use.

[DIGESTIVE ORGANS 149]

Operation for Piles.—When these measures do not relieve the pains or the piles become inflamed from slight causes and often, it is best to operate. This can be done in a few minutes with a local anesthetic and the patient frequently goes to sleep afterward, almost free from pain. Inject a three per cent solution of eucaine, or six per cent solution of cocaine. Thoroughly cleanse the part and hold the buttocks apart, pierce the pile at its base with a thin sharp-pointed curved knife, laying it open from side to side. Remove the clot with a curette, cauterize the vessel and pack the cavity with gauze to prevent bleeding and to secure drainage.

Cutaneous (skin) piles are operated upon as follows.—Each one is grasped in turn with a pair of strong forceps and snipped off with the scissors, or removed with a knife. Close the wound with sutures, if necessary, and dress it with gauze. Small ones need no sutures. Be careful not to remove too much tissue. Much after-pain can be prevented by placing in the rectum a suppository containing one-half grain of opium or cocaine before either of the above operations are performed. The after treatment is quite simple. Keep the patient quiet, cleanse the parts frequently, and secure a soft daily stool. Cleanse with tepid boiled water with clean sterilized gauze and give salts in small doses, one to two drams to produce a stool.

INTERNAL PILES. Symptoms.—The two prominent symptoms are bleeding and pain. The bleeding is usually dark. It may be slight and appear as streaks upon the feces or toilet paper; it may be moderate and ooze from the anus for some time after a stool, or it may be so profuse as to cause the patient to faint from loss of blood while the "bowels are moving." Death may follow in such a case unless the bleeding is stopped. The blood may look fresh and fluid or if retained for some time, it looks like coffee grounds, sometimes mixed with mucus and pus. Patients who bleed profusely become pale and bloodless, and are very nervous and gloomy and they believe they are suffering from cancer or some other incurable trouble. The

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