These are small tumors which form just within or just external to the anus, from dilatation of the veins of the part. When within the anus, they are known as internal hemorrhoids, which, from their tendency to bleed profusely at stool, are known as bleeding piles; and when about the verge of the anus they are known as external hemorrhoids. The latter class is generally much the more painful, though otherwise far less serious than the former.

The principal causes of hemorrhoids are constipation of the bowels, violent straining at stool, the use of concentrated food, and obstruction to the portal circulation from pregnancy, or from tumors in the abdomen, or disease of the liver.

The Treatment of Piles or Hemorrhoids

As palliative means, the most useful measures are simple unguents in cases of external piles; and in cases of internal piles, the use of warm water or linseed tea enemas before moving the bowels, and a small enema of cold water immediately after. The cool sitz bath, up spray or douche, and other applications to the anus are also useful Suppositories of various sorts are also useful for the purpose of allaying irritation. The radical cure of the affection is accomplished most certainly by means of the ligature applied by a competent surgeon. Within a few years the country has been canvassed by a horde of "pile doctors," who claim to be able to accomplish a painless cure by means of a secret remedy. The treatment employed by these quacks consists of injections of the tumors with a mixture of oil or glycerine and carbolic acid in varying proportions. The process is successful in most cases, but is not wholly free from danger. We have employed it in a number of cases with success, though in many respects we prefer the older operation.