The regulation of the bowels should be such that the fecal mass be kept soft and nonirritating and abdominal straining at stools prevented. The continuous use of saline laxative medicines for more than a week is generally harmful. After that time, remedies should be used which are intestinal muscle stimulants, and care should be taken to avoid the irritation caused by liquid movements. Cascara is a most satisfactory drug for this purpose and when intelligently used is probably helpful to all such cases. Cold water enema are sometimes more satisfactory than drugs. The cold water causes an immediate evacuation and regulates the bowels to move at a definite time each day. The cold water treatment, if carried on for a period of two weeks, will often institute the regular movement of the bowels for quite a lengthy time afterward and impresses upon the patient the great benefit derived from regular evacuations.

Bleeding, associated with pain and the protrusion, can, as a rule, be relieved by the application of the formula of the late Dr. Cathartic, which is as follows:

Si Apply after reduction to the hemorrhoid mass.

The hard rubber pile pipe makes an excellent means by which the application of an ointment may be made up above the internal sphincter muscles. The use of suppositories is another excellent manner of applying these pain relieving and astringent remedies to the hemorrhoid area as when they melt the parts are well bathed with the contained drugs. For this purpose, the following formulas are recommended.

Si Use immediately after stool and upon going to bed.

When excoriations, ulceration or bleeding exist, chloroform in quantities of from five to ten grains sometimes gives relief. Ichthyology, combined with other drugs, is used in almost all of the rectal suppositories for this purpose. The following as given by Cuttle is of great value.

M ft. In suppository number one.

The use of opium or its derivatives to relieve the sphincter spasm is to be condemned, because of its constipating effects, and the danger of acquiring the drug habit. The passage of a full-sized bogie, which is allowed to remain within the grasp of the sphincter five to ten minutes, is of much benefit to these patients. Where the spasm of the sphincter is well-marked, it is a good plan to examine the patient for the possibility of a coexisting fissure.

The palliative treatment of hemorrhoids is that form of treatment used by the so-called pile doctors, and it is to their credit that they learn of the habits and thoroughly understand the condition of the patient before advising such treatment. They remove the cause by the use of drugs and regulate the bowels: they relieve pain and the reduction of the hemorrhoid mass by astringents and analgesics. There is no doubt that many thousands of people are greatly benefited or cured by such methods.

Operative Treatment. Operative treatment consists in either the gradual or forcible dilatation of the sphincters, cauterization, injection, ligation, clamp and cattery, crushing, and excision.

Dilatation for the cure of hemorrhoids, as advocated by some operators, is probably of value only in those cases of hemorrhoids associated with ulcer or fissure which has caused a spasm of the sphincter muscles. How over-straining the sphincter muscles to such an extent as to cause a relaxation can benefit the hemorrhoid area is hard to understand, as the mucous membrane is held in position and prevented from prolapsing by the tonic contraction of the sphincter muscle to a certain extent. In operating on hemorrhoids, it is unnecessary, from my experience, to dilate the sphincter muscles in the majority of cases as the relaxation due to the general anesthetic is sufficient to relieve the normal muscle tone, permitting the operator to manipulate the hemorrhoid area without difficulty.

Electrolysis for hemorrhoids is limited to small internal hemorrhoids as a rule, and in patients in whom the radical operation is contraindicated. The method I use is as follows: The hemorrhoid is brought into view and either well painted over with a solution of cocaine hydrochloride (4% ) or injected with the same solution. After five or ten minutes, the needle is introduced and the current permitted to Mow through the tumor for a period of from ten to fifteen minutes at each treatment. The treatments should be given not oftener than every five or six days, dependent upon the condition of the hemorrhoid after the former treatment. The electrical current may be that supplied with the Le-Blanche elements or if the street current be available, the Mackintosh cabinet. The positive current hardens the tumor, coagulates the blood and will, in some instances, shrink it to such an extent as to make it a painful mass. The negative pole softens and moistens the mass so that the operator may centralize the effect of one pole by using the other according to his judgment at the time of the treatment.

This treatment has been described by most men of experience as ineffectual and unreliable, but some have had success in a few selected cases. This method of treatment, however, does not receive unanimous endorsement.

Electrolysis might prove the ideal method of treating the nae void or capillary hemorrhoid, when the hemorrhoid can be brought down far enough to make the applications within sight.

Capillary or Nae void Hemorrhoids. Nitric acid treatment by cauterization. The treatment of hemorrhoids by the use of nitric acid has been described especially for its use in the capillary variety of hemorrhoids. It is used for this variety as the safest and most effectual treatment. In these cases, a conical speculum is introduced and the slide drawn out until the pile protrudes into the opening within, it is wiped dry with absorbent cotton and acid applied all over the surface by means of a wooden applicator. The speculum is held in place for four or five minutes until the acid thoroughly attacks the tumor within. The parts are washed off with a solution of bicarbonate of soda to remove the excess of acid.