An obstruction in the circulation of the haemorrhoidal artery, thus producing a congested state of the rectum, particularly about the anus, gives rise to small tumors or lumps, called piles. These lumps may be external, or so far within the rectum as to be imperceptible to sight, and they may or may not bleed, and are therefore spoken of as either external, internal, bleeding, or blind piles.

They may be occasioned by a constitutional taint, in which case, if partially removed, they are liable to return at any time. They may give rise to, or be combined with various forms of chronic disease, when close and careful observation is necessary to produce permanent relief.

The exciting causes are, use of stimulants, such as, spirits, coffee, spices, etc, or frequent use of cathartics; constipation or the contrary; depressing emotion, great mental exertion, sedentary life, riding on horseback. They frequently occur during pregnancy, from wearing tight clothes, or from worms. They are generally attended with considerable heat, burning, tearing, or cutting pain, and weakness and pain about the small of the back.

The food should be such as to keep the bowels moderately open; heating or stimulating drinks should be avoided, cathartics consigned to oblivion, and the sur-geons's knife allowed to rest quietly in its case. The habit of cutting off these tumors, is not only revolting treatment, but generally productive of far more evil than good.

Treatment.* - I have found in these cases great advantage in the use of the sitz-bath. It has a tendency to reduce the inflammation, and remove in a great degree the sufferings of the patient.

Nux-v. is a prominent remedy in almost every form of this disease, and particularly useful when occasioned by constipation, abuse of stimulating drinks, sedentary life with mental exertion, worms, compression of the abdomen, swelling of the abdominal organs, and in pregnancy.

Dose

A powder, or six globules, may be taken every six or twelve hours according to the symptoms.

Sulphur is also a prominent remedy, particularly in blind or flowing piles of a chronic nature. It is also strongly indicated for haemorrhoidal colic with contractive pains about the umbilicus.

Dose

Same as Nux, with which it may often be alternated, the Sulphur, in the morning, and the Nux at night.

Belladonna is an excellent remedy in bleeding piles, especially where there is severe pain in the small of the back. It may be followed with advantage by Hepar-s.

Dose

Two drops, or twelve globules, in a tumbler of water, a tablespoonful every six hours.

Sabina is also a valuable remedy, especially in bleeding piles, with discharge of bright, red blood, or blood mixed with mucus.

* For general directions as to the administration of remedies, see page 12.

Dose

Same as Belladonna.

Arnica - when the tumors are swollen and painful to the touch, and also where there is pain in the back.

Dose

Three drops in a glass half full of water and give a table-spoonful every four hours. Bathe the parts three times a day with a mixture of ten drops of Arnica to two tablespoonfuls of water.

Hamamelis - Is a very valuable remedy especially in bleeding piles attended with pain.

Dose

Same as Arnica both in its external and internal administration.

Pulsatilla - is of benefit where there is blood and mucus discharged with the faeces, with painful pressure on the tumors.

Dose

Give the same as Nux. Much relief may frequently be obtained by throwing up with a syringe from time to time a small quantity of cold water.

Capsicum, Carb

v., and Arsenic, are also useful in flowing piles. In old and distressing tumors, Nit.-ac., Mur-ac., Calcareau, Lycopodium are frequently indicated.

The various forms of this disease, and its combination with other difficulties, render it advisable, particularly in chronic cases, to employ the skill and experience of the physician, rather than trust to home treatment.