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 first the patient notices he has internal piles is when a small lump appears at the end of the bowel during a stool