PILES, OR HEMORRHOIDS. 457 



is a good deal of constitutional irritation, the nervous system generally being 

 deranged in, as we say, sympathy with the local irritation. The pain produced by 

 an evacuation is sometimes so severe that the patient avoids defecation as long as 

 possible, and even abstains from food with the view of lessening the necessity for 

 the frequency of the act. If you have reason to suppose that you are suffering from 

 fissure and not piles, we advise you to consult your doctor at once. We give this 

 advice, not because the complaint is a dangerous one, but because it is so situated 

 that it would be well-nigh impossible for you to make an application at all satisfac- 

 torily without some assistance. It is of little or no use applying to a non-medical 

 friend to help you, for the fissure is so small that it would probably escape the 

 notice of one untrained in the investigation of such matters. On consulting your 

 doctor you will, of course, say at once that you have reason to suspect that you have 

 fissure of the anus. There is often a great deal of mock modesty about these 

 matters, and the doctor often obtains the required information only after a con- 

 siderable amount of beating about the bush. You will find that it will simplify 

 matters if you say at once what it is you think you are suffering from. 



Fistula of the anus is another complaint we have known mistaken for piles. It 

 usually forms as the result of an abscess, running up by the side of the gut. Some- 

 times it follows kicks, blows, or bruises 011 the lower part of the body. Here, again, 

 little or nothing can be done without the assistance of a medical man. The mere 

 fact of its position renders it almost impossible to treat it without extraneous help. 



Before leaving the subject of piles, we will say a word or two about diet and 

 other accessory measures. "When the complaint occurs in debilitated persons, benefit 

 will be derived from a tonic and nutritious plan of treatment. In the great majority 

 of instances, however, more particularly when occurring about the middle period of 

 life, piles are connected with a plethoric state of the system, and then we recommend 

 abstinence from coffee, peppers, spices, and all stimulating and highly-seasoned food. 

 In these cases, too, beer, wine, and spirits must be taken in the very strictest mode- 

 ration. The best drink at all events for the summer months is a light claret. 

 A liberal supply of well-cooked vegetables, and plenty of ripe, wholesome fruit, is 

 enjoined. Sedentary habits, and the habitual use of soft cushions and feather beds, 

 undoubtedly favour the formation of piles, and do much to retard the progress of 

 a cure. The pain attending piles which do not bleed may often be relieved by 

 .washing the parts with cold or tepid water. In an attack of bleeding piles, it is a 

 good plan, in addition to bathing the part, to drink a tumblerful of cold water, and 

 then to lie down for an hour or two. The horizontal posture is conducive to recovery. 

 In many cases of piles, great relief follows an occasional injection of about a pint of 

 water into the lower bowel. It acts beneficially by constricting the blood-vessels, 

 and it also gives tone to the relaxed tissues, and softens the motions before evacuation. 

 "When piles are very painful, the unfortunate sufferer may obtain relief by sitting 

 over the steam of hot water. When the attack is a very severe one, he may have 

 to keep his bed, or recline for the greater part of the day on a couch. People 

 troubled with piles often find it a good plan to acquire the habit of going to stool at 

 night, immediately before retiring to rest, instead of in the morning, so as to obtain 

 the benefit of a long rest in the horizontal position after each motion. 



