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.”