and returns spontaneously; afterwards the lump again protrudes after the stool and others may appear.  They become larger and larger, come down oftener and no longer return spontaneously, but must be replaced after each stool.  As a result of this handling, they grow sensitive, swollen, inflamed and ulcerated, and the sphincter muscle becomes irritable.  Later on one or more of the piles are caught in the grasp of the sphincter muscle and rapidly increases in size.  It is then hard to relieve them, and when returned they act as foreign bodies, excite irritation and they are almost constantly expelled and the same procedure goes on at each stool.  The sphincter muscle contracts so tightly around them as to cause strangulation and unless properly treated they become gangrenous and slough off.

[150 Mothers’ remedies]

Recovery, Pain, etc.—­The pain is not great in the early stages, but when the muscle grasps and contracts the pile or piles it becomes terrible and constant.  Piles rarely end fatally.  Palliative treatment does not afford a permanent cure.  They frequently return, but by care and diet many can be kept from returning 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.