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first the patient notices he has internal piles is when a small lump appears at the end of the bowel during a stool and returns spontaneously; afterwards the lump again protrudes after the stool and others may appear. They become larger and larger, come down oftener and no longer return spontaneously, but must be replaced after each stool. As a result of this handling, they grow sensitive, swollen, inflamed and ulcerated, and the sphincter muscle becomes irritable. Later on one or more of the piles are caught in the grasp of the sphincter muscle and rapidly increases in size. It is then hard to relieve them, and when returned they act as foreign bodies, excite irritation and they are almost constantly expelled and the same procedure goes on at each stool. The sphincter muscle contracts so tightly around them as to cause strangulation and unless properly treated they become gangrenous and slough off. [150 MOTHERS' REMEDIES]

Recovery, Pain, etc.—The pain is not great in the early stages, but when the muscle grasps and contracts the pile or piles it becomes terrible and constant. Piles rarely end fatally. Palliative treatment does not afford a permanent cure. They frequently return, but by care and diet many can be kept from returning so frequently. They should be treated upon their first appearance when the chances of a permanent cure without an operation are much better.

PHYSICIANS' TREATMENT for Internal Piles.—What to do first. The cause should be removed. Restore a displaced womb. Regulate the bowels, liver, diet, and habits. Much can be accomplished by these measures if properly used, in allaying inflammation diminishing pain and reducing the size of the piles. These measures will not cure them if they are large, overgrown and protruding. When the piles are inflamed, strangulated or ulcerated, the patient should remain in bed in a recumbent position and hot fomentations of hops, etc., and hot poultices, of flaxseed, slippery elm, bread and milk, the ice bag, or soothing applications and astringent remedies, should be applied to the parts. In some cases cold applications are the best. The cold or astringent applications give the best results where the piles are simply inflamed and the sphincter muscle does not act spasmodically, jerkily. But when the piles are strangulated, "choked tight" by the sphincter muscle, hot fomentations, poultices and soothing remedies give the most relief, because they reduce spasmodic contractions of the muscle and allay the pain. Instead of the poultices and fomentations, the "sitz" bath can be used. Put in the steaming water, hops, catnip, tansy, pennyroyal, etc., and the steam arising will frequently give great relief. This can be given frequently; ten to twenty drops of laudanum can be added to the poultices when the piles are very painful.

1. For inflamed piles, the following combinations may be used:—

      Gum Camphor 1 dram
      Calomel 12 grains
      Vaselin 1 ounce

Mix thoroughly and apply freely around the anus and in the rectum on the piles.

The external parts should always be bathed with hot water, thoroughly, before using.

2. Gum Camphor 2 drams
      Chloretone 1 dram
      Menthol 20 grains
      Ointment of Zinc Oxide 1 ounce

Mix and apply directly to the piles.

3. When there is a slight bleeding, water of witch-hazel extract, one to two ounces to be injected into the rectum. This witch-hazel water freely used is good for external piles also. This is good and well recommended.

[DIGESTIVE ORGANS 151]

4. If the protruded pile is inflamed and hard to push back, the following is good and recommended highly:—

      Chloretone 1 dram
      Iodoform 1 dram
      Gum Camphor 1 dram
      Petrolatum 1 ounce

Mix and use as a salve.

5. An ointment composed of equal parts of fine-cut tobacco and raisins, seedless, chopped fine and mixed with enough lard, makes a good ointment to apply on both external and internal piles.

6. Tea of white oak bark, boiled down so as to be strong, and mixed with lard and applied frequently, is good as an astringent, but not for the very painful kind. It will take down the swelling.

7. Take a rectal injection of cold water before the regular daily stool. This will soften the feces and decrease the congestion.

Preventive Treatment.—This is very important and includes habits and diet and other diseases. If the patient is thin and pale give tonics. Correct any disease of any neighboring organ. Attend to any disease that may be present.

For Constipation.—Take a small dose of salts or hunyadi water so as to have one semi-solid stool daily. If necessary remove any feces that may even then be retained, by injections of soap suds or warm water containing oil. Discontinue injections as soon as a daily full stool can be had without it.

Habits.—Full-blooded people should not use upholstered chairs as the heat of the body relaxes the tissues of the rectum. A cane seated chair is best or an air cushion with a hollow center. It is best to rest in bed, if possible, after stool for the rest relieves the congestion and soreness. An abundance of out-door exercise, when the piles are not present, or bad, consisting of walking or simple gymnastics may usually be indulged in; violent gymnastics and horseback riding must be avoided. A daily stool must be secured.

Diet.—Such patients should avoid alcoholic beverages, spiced foods, strong coffee, and tea, cheese, cabbage, and old beans.

Foods Allowed.—Potatoes, carrots, spinach, asparagus, and even salads, since they stimulate intestinal action and thus aid in keeping the stool soft. Stewed fruits, including grapes, oranges, pears, and apples. Water is the best to drink. Meats: tender broiled, boiled or baked beef—do not eat the inside part to any great amount. Other meats, but no pork or ham, fresh fish, chicken. The foods should not be too highly seasoned; vinegar is not to be used to any extent and this excludes pickles, etc.

PERIPROCTITIS. Abscess Around the Anus and Rectum. (Ano-rectal) (Ischio- rectal Abscess).—This is an inflammation of the tissues around the rectum which usually terminates in the above named abscess. It occurs mostly in middle-aged people. Men are affected more often than women.

[152 MOTHERS' REMEDIES]

Causes.—Sitting in cold, damp hard seats; horseback riding, foreign bodies in the rectum such as pins, fish-hooks, etc., blows on the part, kicks, tubercular constitution, etc.

Symptoms.—Inflammation of the skin, like that of a big boil, some fever, throbbing pain, swelling of the part, heat and fullness in the rectum, these symptoms increase until the pus finds an outlet into the rectum.

PHYSICIANS' TREATMENT for Periproctitis.—Little can be done in a palliative way. It generally terminates in an abscess. Make the patient as comfortable as possible, by applying cold or hot things to the part, rest in bed, mild laxatives to keep the bowels open. Cut it open as soon as possible, and it should be laid wide open, so that every part is broken up. Then it should be thoroughly washed and scraped out. Sometimes it is necessary to use pure carbolic acid to burn out the interior. The dressing should be as usual for such wounds and removed when soiled and the wound washed out with boiled water and then gauze loosely placed in the bottom and in every corner of the wound. The dressing should be continued until all has been healed from inside out. Be sure to leave no cotton in to heal over it. Such patients should be built up with nourishing foods, and should remain quietly in bed. Cod liver oil is good for some patients. Iron, etc., for others. Keep the bowels regular. Outdoor life and exercise. If treated right it should not return.

FISTULA IN ANUS.—This usually follows the abscess. It has two openings, one upon the surface of the body near the anus, and the other in the rectum. There are a great many varieties of fistula, but it is unnecessary to name them. What can be done for them?

PHYSICIANS' TREATMENT.—If the general health is good an operation is the best thing to do, but patients in the last stage of consumption, nephritis, diabetes, or organic heart disease, are not apt to receive much benefit from an operation. The patient in poor condition should be given the treatment suitable to his condition, according to the advice of a trusted physician.

[KIDNEY AND BLADDER 153] DISEASES OF THE KIDNEYS AND BLADDER.

KIDNEYS.—The kidneys are deeply placed and cannot be felt or distinctly identified when normal. They are most accessible to pressure just below the last rib, behind. The right kidney usually lies lower than does the left, but even then, the lower part of this kidney is an inch above the upper part of the hip bone, or an inch above a line drawn around the body parallel with the navel. The kidney is about four inches long. The long axis of the kidneys corresponds to that of the twelfth rib; on an average the left kidney lies one-half inch higher than the right.

[Illustration: Kidneys, Ureters and Bladder.]

As stated before, each kidney is four inches long, two to two and one-half in breadth, and more than one inch thick. The left is somewhat longer, though narrower, than the right. The kidney is covered with what is called a capsule. This can be easily stripped off. The structure of the kidney is quite intricate. At the inner border of each kidney there is an opening called the pelvis of the kidney, and leading from this, small tubes penetrate the structure of the kidney in all directions. These tubes are lined with special cells. Through these tubes go the excretions (urine) from the body of the kidneys, to the pelvis, and from the pelvis through the ureters, sixteen inches long, to the bladder.

[154 MOTHERS' REMEDIES]

KIDNEY TROUBLE. MOTHERS' REMEDIES.—1. Kidney Trouble and Inflammation of the Bladder, Cornsilk for.—"Get cornsilk and make a good strong tea of it by steeping slowly, and take one ounce three or four times a day. This acts well on the kidneys, and is a harmless remedy to use."

2. Kidney Trouble, Flaxseed and Lemons for.—"Make a tea by placing the flaxseed in a muslin or linen bag, and suspend it in a dish of water, in the proportion of about four teaspoonfuls for each quart of water. After allowing the seeds to soak for several hours remove the same and tea will be ready for use. The addition of a little lemon juice will improve the flavor. Give in quantities as may be found necessary."

3. Kidney Trouble, Temporary Relief for.—"Rub witchhazel on stomach and back; use freely." This is an old-time remedy, and can be relied upon to at least give temporary relief. The witch hazel has a very soothing effect upon the parts affected.

4. Kidney and Bladder Trouble, Buchu Leaves for.—"Get five cents' worth of buchu leaves at any drug store, and make a good strong tea of it by steeping. This acts nicely on the kidneys. This remedy is easily prepared, and is not expensive."

5. Kidney Trouble, Common Rush Root for.—"Take a handful of the root of common rush in one and one-half pints of water, boil down to one pint. Dose:—One tablespoonful every two or three hours. For a child ten years, give one teaspoonful four times a day. For a child of four to six years, one-half teaspoonful four times a day."

6. Kidney Trouble, Effective and Easy Cure for.—

    "Fluid Extract of Cascara Sagrada 1 ounce
    Fluid Extract of Buchu 2 ounces
    Fluid Extract of Uva Ursi 2 ounces
    Tincture Gentian Comp 1 ounce
    Simple Syrup 1 pint

Mix the above ingredients and give a teaspoonful four times a day. This is a very good remedy, as the cascara sagrada acts on the bowels and the buchu and uva ursi acts on the kidneys, carrying off

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