Piles consist of small tumours situated on the verge of the anus, or fundament, which are sometimes separate, round and prominent; but sometimes the tumour consists of an enlargement of the whole of the entrance to the gut. In some cases there is a discharge of blood from these tumours, particularly when the patient goes to stool, and then the disease is known by the name of bleeding Piles; and in others there is no discharge, when they are called blind Piles.

Piles may be occasioned by habitual costiveness, fulness of habit, indulgence in food of too stimulating a quantity, too free a use of heating wines or spirituous liquors, excesses of various kinds, the suppression or drying up of some long-accustomed evacuation, and by a use of strong aloetic purgatives; and are most apt to arise in those of a robust habit, and who lead a sedentary life. Much riding on horseback will sometimes bring them on. Pregnant women are frequently afflicted with Piles, owing to the pressure of the womb upon the rectum or lower portion of the gut, which interrupts the proper flow of blood from the part, and produces the costiveness to which such women are liable.

The Piles are sometimes accompanied by a sense of weight in the back, loins and bottom of the belly, together with a pain or giddiness in the head, dryness in the mouth and throat, general feverishness, sickness at the stomach, and flatulency in the bowels. On going to stool a pungent pain is felt in the fundament, and tumours, varying in size from that of a pea to a hen's egg, are perceived to project beyond its edge. If these break, a quantity of blood is then voided, and the patient immediately feels easier; but if they continue unbroken, he experiences great torture every time he goes to stool, and feels an inconvenience even in sitting down on any hard seat. The tumours are sometimes so considerable as, by their pressure upon the bladder, to produce much irritation, and even pain in voiding urine, to which there is a frequent desire.

Piles are by no means dangerous, but they often prove both troublesome and disagreeable; they are sometimes attended with a considerable degree of inflammation, which proceeding to suppuration, terminates in ulcers or a fistula. Even when altogether internal, they impede by their bulk the passage of the faeces, give rise to very acute pain whenever the bowels are emptied, and gradually bring on that train of evils which necessarily follows long-continued constipation.

Treatment

In the treatment of Piles proper attention must be paid to the cause, and as that generally arises from constipation, the bowels must be kept gently relaxed by something that will not irritate the lower portion of the gut, (the rectum); and as that is the particular portion of the bowels on which aloes acts, it follows that the use of that drug, or any preparation containing it, must be avoided by those who are subject to Piles.

When the tumours are attended with much pain, and a considerable degree of inflammation, relief is frequently obtained by the application of a few leeches, followed by the application of rags dipped in cold water. In severe cases, accompanied by great pain, and inflammation, considerable temporary relief may be afforded the patient by puncturing the tumour with a lancet.

Where the tumours are numerous and troublesome, but not attended by much inflammation, pressure is the most effectual remedy; and however large these bodies may project at stool, or at other times, if the patient lies down on his back, and makes a gradual but constant pressure with his fingers, they will almost always contract within the fundament, and by means of a small linen pad and a bandage, properly applied, may be prevented from returning. Considerable relief may be obtained by inserting a piece of soap (not too hard), cut about the size and shape of the thumb, into the gut, about an hour or two before the usual time of going to stool.

In a most violent case of both external and internal Piles, which had resisted every treatment for several weeks, immediate relief was said to be obtained by taking forty drops of Tincture of Digitalis; and by repeating the medicine to the extent of thirty-five drops of the tincture, morning and evening, a rapid recovery was effected.

A decoction of Oak bark, or a decoction of Galls, has been often used to foment the part; and the following Ointment, smeared over the fundament three or four times a day, has also been much used:-

Galls in fine powder...........................Two Drams.

Powdered Opium...............................One Dram.

Fresh Lard......................................One Ounce.

The following has been a favorite remedy in piles:-

Confection of Senna (Lenitive Electuary) Two Ounces.

Milk of Sulphur................................One Ounce. - Mix, and take about the bulk of a Walnut, once or twice a day.

In my own practice, I have found that one or two teaspoonfuls of Milk of Sulphur, taken in a little milk, every morning before breakfast, if persevered in, will always effect a cure. I have never known it fail, even in cases of long standing. The reason is plain: the disease is usually caused by allowing the bowels to get into an irregular state; and by obviating this, and preventing a continuance of the irritation, nature will effect the cure herself.

Persons afflicted with Piles should not ride on horseback, or sit on hard seats; they should be careful in their diet, avoiding stimulants of every kind.