taken place for some time, from whatever cause it may have proceeded, the flux is always to be moderated, and the necessity of it, if possible, superseded.

949. Having delivered these general rules, I proceed to mention more particularly, how the disease is to be treated, according to the different circumstances under which it may appear.

When we can manifestly discern the first appearance of the disease to arise from causes acting upon the part only, the strictest attention should be employed in guarding against the renewal of these

causes.

950. One of the most frequent of the remote causes of the hæmorrhoidal affections, is a slow and bound belly, (936): and this is to be constantly obviated by a proper diet; which each individual's own experience must direct; or, if the management of diet be not effectual, the belly must be kept regular by such medicines as may prove gently laxative, without irritating the rectum. most cases, it will be of advantage to acquire a habit with respect to time, and to observe it exactly.

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951. Another cause of hæmorrhois to be especially attended to, is the prolapsus or protrusion of the anus, which is apt to happen on a person's having a stool, (937). If it shall occur to

any considerable degree, and at the same time be not easily and immediately replaced, it most certainly produces piles, or increases them when other. wise produced. Persons, therefore, liable to this prolapsus, should, upon their having been at stool, take great pains to have the gut immediately replaced, by lying down in a horizontal posture, and pressing gently upon the anus, till the reduc tion shall be completely obtained.

952. When the prolapsus of which I speak is occasioned only by voiding hard and bulky fæces, it should be obviated by the means mentioned in 950, and may be thereby avoided. But in some persons it is owing to a laxity of the rectum; in which case it is often most considerable upon occasion of a loose stool: and then the disease is to be treated by astringents, as well as by proper artifices for preventing the falling down of the gut.

953. These are the means to be employed upon the first approaches of the hæmorrhoidal affection; and when from neglect it shall have frequently recurred, and has become in some measure established, they are no less proper. In the latter case, however, some other means are also necessary. It is particularly proper to guard against a plethoric state of the body; consequently, to avoid a se dentary life, a full diet, and particularly intemperance in the use of strong liquor, which, as I

should have observed before, is, in all cases, of hæmorrhagy of the greatest influence in increasing the disposition to the disease.

954. I need hardly repeat here, that exercise of all kinds must be a chief means of obviating and removing a plethoric state of the body; but upon occasion of the hæmorrhoidal flux immediately approaching, both walking and riding, as increasing the determination of the blood into the hæmorrhoidial vessels, are to be avoided. At other times, when no such determination has been already formed, those modes of exercise may be very properly employed.

955. Cold bathing is another remedy that may be employed to obviate plethora, and prevent hæmorrhagy; but it is to be used with caution. When the hæmorrhoidal flux is approaching, it may be dangerous to turn it suddenly aside by cold bathing; but during the intervals of the disease, this remedy may be employed with advantage; and in persons liable to a prolapsus ani, the frequent washing of the anus with cold water may be very useful.

956. These are the means for preventing the recurrence of the hæmorrhoidal flux; and in all cases, when it is not immediately approaching, they are to be employed. When it has actually

come on, means are to be employed for moderating it as much as possible, by the person's lying in a horizontal position upon a hard bed; by avoiding exercise in an erect posture; by using a cool diet; by avoiding external heat; and by obviating the irritation of hardened fæces by the use of proper laxatives, (950). From what has been said above, as to the being careful not to increase the deter mination of the blood into the hæmorrhoidal vessels, the propriety of these measures must sufficiently appear; and if they were not so generally neglected, many persons would escape the great trouble, and the various bad consequences, which so frequently result from this disease.

957. With respect to the further cure of this disease, it is almost in two cases only that hæmorrhoidal persons call for the assistance of the physician. The one is, when the affection is accompanied with much pain; and of this there are two cases, according as the pain happens to attend the external or the internal piles.

958. The pain of the external piles arises especially when a considerable protrusion of the rectum has happened; and when, continuing unreduced, it is strangled by the constriction of the sphincter; while, at the same time, no bleeding happens, to take off the swelling of the protruded portion of the intestine. Sometimes an inflammation super

venes, and greatly aggravates the pain. To relieve the pain in this case, emollient fomentations and poultices are sometimes of service; but a more effectual relief is to be obtained by applying leeches to the tumid parts.

959. The other case in which hæmorrhoidal persons seek assistance, is that of excessive bleeding. Upon the opinion so generally received, of this discharge being salutary, and from the observation, that upon the discharge occurring, persons have sometimes found relief from various disorders, the most part of persons liable to it are ready to let it go too far; and indeed the Stahlians will not allow it to be a disease, unless when it has actually gone to excess. I am, however, well persuaded, that this flux ought always to be cured as soon as possible.

960. When the disease occurs as a purely topical affection, there can be no doubt of the propriety of this rule; and, even when it has occurred as a critical discharge in the case of a particular disease, yet, when this disease shall have been entirely cured and removed, the preventing any return of the hæmorrhois seems to be both safe and proper.

961. It is only when the disease arises from a plethoric state of the body, and from a stagnation.

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