178 



PILKS 



I'IMiRIM 



lias littlf sensibility, and occasions comparatively 

 lull"- annoyance : lint when it is iiifluuifil (from 

 strangulation I iy t!u> sphincter muscle, <>r from any 

 other cause) it is exquisitely tender to the touch, 

 ami is ilu- SIM! of hunting anil stinging sensations, 

 rendering tin- exacnation of tin- hoxxels (ami some 

 times of i ! bladder also) diflicult anil painful. In 

 women an inflamed pile may cause pain in tlie 

 luirk, irritation of MM xvomK with iniicoiis dis 

 charge, anil niaiiy other anomalous symptoms. In 

 severe cases the patient ran neither stmul nor sit 

 with comfort, ami only timls relief in tlie horizontal 

 position. In internal ]>iles the meet important 

 symptom, sometimes the lirst to ! noticed, i- 

 ha-morrliage, which may lie so profuse or so often 

 re|.cated as t<i threaten the patient's life. 



I'iles may he caused by any circumstances which 

 cause congestion in the lower Itnwel, such as IHXII- 

 lions ami sedentary habits of life, pregnancy, and 

 Mich diseases of the liver as tend t<i check the 

 return of lilood from the veins of the rectum. 

 Mnii-over. anything that causes irritation of the 

 rectum, such as c\ee -ive "se of purgatives, dysen- 

 tery, inflammation of the prostate gland. &r., may 

 cause |iile-. lint of all causes constipation is prob- 

 ably the most frequent ; it operates in producing 

 them partly hy the pres-me of the accumulated 

 and hardened f.-cces upon the veins carrying the 

 blood away from the rectum, and partly hy the 

 straining and irritation such fieces occasion during 

 their evacuation. 



In the treatment of piles it is expedient to relieve 

 the consented state of the lower Imwel by one or 

 two doses of sulphate of magnesia, and a cooling 

 lalile diet, after which the continued use of 

 mild laxatives should be resorted to. A teasiNion- 

 ful of an electuary, consisting of an ounce of con- 

 fection of senna, half an ounce of cream of tartar, 

 and half an ounce of sulphur, if taken in the middle 

 of the day, usually nets gently almt bedtime, 

 which is far the liest time for the bowels of patients 

 of this kind to act, as the parts irritated hy the 

 passage of the evacuation become ipiictcd during 

 tin- night. In long standing caws, in which there 

 w general relaxation of tin- mucous membrane, the 

 confection of pepper iii doses of a drachm may lie 

 Ifiven thrice ilaily with advantage, or a scruple of 

 common pitch may lie taken at licdlinie in the 

 form of pills or in capsules. Preparations of witch 

 hazel (HniHiiinrli.i rii-i/imi-n) are also useful. 

 Amongst the milder forms of local treatment must 

 lie mentioned (I) the injection of the rectum with 

 cold water both before and after the motion; (2) 

 washing the anils with vellow soap and water after 

 cadi evacuation this should never be omiticd by 

 any one who snll'ers from piles ; (3) the application 

 if gall ointment or of other astringents; and (4) 

 the injection of astringent lotions, as. tor instance, 

 of sulphate of iron, in the proportion of a grain to 

 an mince of water. When the piles arc inflamed, 

 leeches to the amis (but not applied directly to the 

 tumours) are sometimes required ; but the inllam 

 minion generally snlisides under the influence of 

 r.'"t in the horizontal position, fomentation!-, poul- 

 tices, and low diet. In severe and prolonged cases 

 operative interference Itccomes necessary. For 

 -\t.-riial piles i.-moval with scissors is usually 



ployed. In ceitain forms of internal piles the 



application of caustics, cs|>ccially nitric acid, some 



ti s .iitlj,.,.- \\licie their removal is required it 



mny lie effected either by ligature or by eantcrisa 

 lion. 



The treatment of the haemorrhage that frequently 

 accompanies piles requires a few words. If the 

 bleeding i moderate in i|uantity, and hns continued 



for some time will t inducing weakness or any 



other bad symptom, it is not exjH-dient to interfere 

 with it. When, however, it obviously required 



checking, the effect of cold water injected into the 

 rectum, as already recommended, should In- tried. 

 and, in case of its failing, astiingent injections 

 should be had recourse to. At the same time the 

 patient should remain in the horizontal position, 

 anil take the medicines usually prescribed for 

 internal ha-morrhage, amongst which may ! t\- 

 cially mentioned witch-hazel, oil of turpentine, in 

 doses of twenty drops three or four times a day, or 

 ergot of rye in divided doses to the extent of a 

 drachm daily. In rare cases it is necessary to tie 

 a vessel, or to touch it with a red-hot wire ( through 

 the speculum), or to plug the aims. 



i I. a i.. 'a hat'), the upper expanded 

 portion ol many Fungi (q.v.). 



IMlewort. See 



Pilgrim (jtal. jiellegrijio, Lat. peregrinns, 'a 

 visitor of foreign lands ). A pilgrim is one who 

 visits, with religious intent, some place reputed to 

 possess es|iecial holiness. The early Christians, 

 like the .lews and the pagan (ienliles, regarded 

 certain places with special religious interest ; above 

 all, the Holy Land, and particularly I he scenes of 

 tlie Passion of our Lord at Jerusalem. St Jerome 

 refers the practice of visiting Jerusalem to the dis 

 covery of the Holy Cross by Si Helena. He him- 

 self was a zealous pilgrim : and throughout the 

 4th, nth, and (itli centuries pilgrims habitually 

 undertook the long and perilous journey to the 

 Holy Land from almost every part of the \\Yst. 

 Other sacred places, too. were held to be lit objects 

 of the same xisits of religions veneration. The 

 tombs of the a|xistles Peter and Paul, and of tin- 

 martyrs in the catacombs at Home, are so described 

 hy St Jeionie. St liasil speaks in the same terms 

 of the tomb of the Forty Martyrs ; and the historian 

 Theodorct tells of not only visiting such sanctuaries, 

 but of hanging up therein, as olVerings, gold and 

 silver ornaments, and even models of hands, feel. 

 exes, \-c. , in commemoration of the cures of dis 

 eases supernatu rally obtained as the fruit of these 

 pious visits. The Pilgrimage, however, pre- 

 eminently so called, xvas that of the Holy Land : 

 and, even after Jerusalem had been occupied by the 

 Saracens, the lilieity of pilgrimage, on payment of 

 a tax, was formally secured by treatx : and it \\ a - 

 from the necessity of protecting pilgrims from out 

 rage that the well known .Military Orders liad 

 their origin. The Crusades may IK- regarded as a 

 pilgrimage on a great scale : the direct object ! 

 to secure for the Latin Christians immunity of pil 

 gi image. On the oilier hand, the final abandon 

 ment of the ( 'rusades led to a great eMensioii of 

 what may be called domestic pilgrimage, and drew 

 into religions notice and veneration many shrine- 

 in F.urope, xvhich, after the lapse of time, became 

 celebrated places of pious resort. The chief pi. 

 of pilgrimage in the West were, in Italy- Koine. 

 Lord to d|.v. i, Assisi ; in Spain Compostella, 

 (iiiadahijic, Montserrat: in France Foiirxicies at 

 Lyons (i|.v.), St Penis; in Germany -Maria /ell. 

 Cologne. Trcves; in Sxvitxerland Kinsiedelii : in 

 Kngland Walsingham, Canterbury, and many 

 otheis of minor note; in Scotland, \\hilhorn, 

 Whitckirk (near North licrxvick), I^iretto (near 

 Mussclhurgh ), Scone, Dundee, Paisley, and Me] 

 lose; in Ireland. Lough Derg (ij.v.), and nianx 



Iilaces connected with the life or death of the early 

 rish saints. The pilgiim commonly bound liim>eif 

 only by a temiKiiaiv voxv (differing in this from tin- 

 palmer), xvhich terminated with tlie actual visit to 

 the place of pilgrimage, or at least with the return 

 home, and by xvhich he x\ as bound for the time tx> 

 chastity ami to certain other ascetic observances, 

 The cost u ..... consisted of a black or gray galiardine, 

 girt with a cincture, from which a shell and scrip 

 \\cic suspended, a broad hat, ornamented with 



