450 THE TREATMENT OF DISEASES. 



as the hamamelis lotion ; or the drug may be applied in the form of a cerate or 

 ointment. 



A tincture made from horse-chestnut (JEsculus hipj)ocastanum) is used for some 

 kinds of piles. When the piles are due to congestion of the liver it will usually be 

 found to be inferior to nux vomica or sulphur, of which we shall speak presently. 

 When the piles are associated with enlarged veins in the legs, and bleed much, 

 hamamelis is a better remedy. But when the only associated symptom or appreciable 

 cause is a confined condition of the bowels, sesculus is the drug to be employed. 

 The dose is three drops of the tincture in a little water every three hours, and a 

 lotion or injection may be made by adding two tea-spoonfuls to half a pint of water. 



Nux vomica is useful for piles which do not bleed, especially when the patient 

 also suffers from dyspepsia, congestion of the liver, and confined bowels. From five 

 to ten drops of the tincture of nux vomica may be taken in a tumblerful of cold 

 water twice a day, half an hour before breakfast and dinner. It usually acts as a 

 laxative, and will often overcome the most obstinate constipation. 



In ordinary simple cases of piles it is a good plan to keep the bowels moderately 

 relaxed by occasionally taking a tea-spoonful of some electuary, such as confection of 

 sulphur or confection of senna. We have already given a formula for a confection 

 containing both sulphur and senna (Pr. 59), and this usually answers admirably. 

 The old-fashioned sulphur and treacle is as good as anything. These laxatives 

 should not be employed when any of the specific remedies for piles, such as hama- 

 melis, hydrastis, or horse-chesnut, are being administered. As a local application the 

 ointment of galls and opium is extremely useful, and often affords great comfort 

 to the sufferer. 



When piles become inflamed, the best remedy is tincture of aconite, a drop in a 

 tea-spoonful of water every ten minutes for the first hour, and subsequently hourly 

 until the pain subsides. For the excessive pain often associated with piles an 

 aconite lotion may be employed in addition to its internal administration. The lotion 

 is made by adding two tea-spoonfuls of the tincture of aconite to half a pint of 

 water. 



Sufferers from piles would do well to use what is called medicated paper or curl 

 paper. It can be procured in packets at any chemist's. When the piles are very- 

 painful it may be necessary to use a piece of sponge dipped in cold water. It is 

 said, but with what truth we know not, that the printer's ink in newspapers is 

 injurious, and by the irritation it causes favours the development of piles. 



Many people who think they have piles are in reality suffering from fissure. A 

 fissure is a small chap, crack, or ulcer situated just within the anus, or orifice of the 

 bowel. It occurs most commonly in women, and especially in those of a weakly 

 constitution. The sufferer complains of pain, usually of a severe burning character, 

 on the passage of a motion, especially if a hard one ; occasionally it occurs at the 

 time of defecation, but more frequently it commences a few minutes afterwards, and 

 it may continue for two, four, or even eight hours. This pain is very severe, and 

 peculiarly wearing and burning. It may extend all round the hips and even down 

 the thighs. Sometimes it gives rise to irritability of the bladder, or even to symp- 

 toms similar to those resulting from derangement of the womb. Often enough there 



