or crack in the flesh, or ulcer at the exit of the bowel which needs surgical attention. It not infrequently happens that the piles come out during the bowel movement, when they should be thoroughly washed, greased, and pushed back. Sometimes this is impossible, although after lying down for a while and applying ice or cold water the mass may shrink so as to admit of its return. When a large mass is thus protruded and cannot be returned, and becomes nipped by the anus muscles, it undergoes inflammation and is very painful, but a cure often results from its destruction. Such a mode of cure is not a safe or desirable one, however.

Treatment. The cold sitz baths in the morning or injections of a half pint of ice water after a passage are useful. Ointments may be introduced into the bowel upon the finger, or, better, with hard rubber plugs sold for the purpose; or suppositories may be employed. An ointment, containing sixty grains of iron subsulphate to the ounce of lard (or, if there is much itching, an ointment consisting of orthoform, thirty grains, with one-half ounce of lard), will prove of value. Also the injection of one-half pint cold water, containing a teaspoonful of extract of hamamelis, after a passage, affords relief. Two or three grains of the subsulphate of iron may be employed in suppositories, and one of these may be introduced three times daily. The compound gall ointment or the glycerite of tannin will be found to act successfully

in some cases. When one remedy does not serve, try another. The only positive cure for piles consists in surgical operation for their removal. Self-treatment is not recommended, as the physician can do better, and an examination is always advisable to rule out other conditions which may be mistaken by the layman for piles.

Causes. Piles are seen chiefly in adults, in those in advanced life, and in those who exercise little but eat much. Constipation favors their occurrence, and the condition is commonly present in pregnant women. Fatigue, exposure, horseback exercise, or an alcoholic debauch will cause their appearance. Certain diseases also occasion the formation of piles.

CHAPTER II

Skin Diseases and Related Disorders

Household Remedies for Itching-Chafing and Chapping-Hives, Cold Sores and Pimples-Ringworms, Warts and CornsEczema and other Inflammatory Disorders.

No attempt will be made to give an extended account of skin diseases, but a few of the commoner disorders which can be readily recognized by the layman will be noticed. Although these cutaneous troubles are often of so trivial a nature that a physician's assistance is unsought, yet the annoyance is often sufficient to make it worth while for the patient to inform himself about the ailment. Then the affections are so frequent that they may occur where it is impossible to procure medical aid. Whenever an eruption of the skin is accompanied by fever, sore throat, headache, pains in back and limbs, vomiting, or general illness, one of the serious, contagious, eruptive diseases should be suspected, particularly in children, and the patient must be removed from contact with others, kept in isolation, and a physician immediately summoned.

ITCHING (Pruritus).—Itching is not a distinct disease by itself, but a symptom or sign of other skin

or general disorders. Occasionally it must be treated as if it were a separate disease, as when it occurs about the entrance to the bowel (anus), or to the external female sexual parts (vulva), or attacks the skin generally, and is not accompanied by any skin eruption except that caused by scratching, and the cause be unascertainable. Itching, without apparent cause, may be due to parasites, as lice and fleas, and this must always be kept in mind; although debilitated states of the body and certain diseases, as gout and diabetes, are sometimes the source. Commonly, itching is caused by one of the many recognized skin diseases, and is accompanied by an eruption characteristic of the particular disorder existing, and special treatment by an expert, directed to remedy this condition, is the only reasonable way to relieve the itching and cure the trouble.

It may not, however, be improper to suggest means to relieve such a source of suffering as is itching, although unscientific, with the clear understanding that a cure cannot always be expected, but relief may be obtained until proper medical advice can be secured. The treatment to be given will be appropriate for itching due to any cause, with or without existing eruption on the skin, unless otherwise specified. If one remedy is unsuccessful, try others.

For itching afflicting a considerable portion of the skin, baths are peculiarly effective. Cold shower baths twice daily, or swimming in cold water at the proper

time of year, may be tried, but tepid or lukewarm baths are generally more useful. The addition of saleratus or baking soda, one to two pounds to the bath, is valuable, or bran water obtained by boiling bran tied in a bag in water, and adding the resulting solution to the bath. Even more efficient is a bath made by dissolving half a cupful of boiled starch and one tablespoonful of washing or baking soda in four gallons of warm water. The tepid baths should be as prolonged as possible, without chilling the patient. The bran water, or starch water, may be put in a basin and sopped on the patient with a soft linen or cotton cloth and allowed to evaporate from the skin, without rubbing, but while the skin is still moist a powder composed of boric acid, one part, and pulverized starch, four parts, should be dusted on the itching

area.

Household remedies of value include saleratus or baking soda (one teaspoonful to the pint of cold water), or equal parts of alcohol, or vinegar and water, which are used to bathe the itching parts and then permitted to dry on them. Cold solution of carbolic acid (one teaspoonful to the pint of hot water) is, perhaps, the most efficacious single remedy. But if it causes burning it must be washed off at once. Dressings wet with it must never be allowed to become dry, as then the acid becomes concentrated and gangrene may result. Calamine lotion (p. 159) is also a serviceable preparation when there is redness and swelling of the skin.