nder and painful, and often becoming inflamed, is to have them taken
off. But never let that be done with a knife. The bleeding would, in
such a case, be very excessive, and most likely fatal. The history of
knife operations for the excision of Pile tumors is written in blood,
and the tombstone stands as a monument of condemnation of the practice.
No trustworthy surgeon will at this day attempt it.

But however dangerous may be the knife operation, there is no danger at
all to be apprehended from removing the tumors by a _ligature_. To
accomplish this, take a soft cork about three-fourths of an inch in
diameter, and one inch long--make a hole through the center from end to
end, about one-eighth of an inch in diameter--cut crucial grooves in the
top of the cork about an eighth of an inch deep, bevel down the lower
end nearly to an edge, make a cord of saddler's silk, three fold twisted
together and waxed, about eight or ten inches long, double this in the
middle and pass the loop down through the cork out at the sharp end, the
two loose ends of the string being out at the grooved end. Make a strong
hickory stick about three-sixteenths of an inch in diameter, and just
long enough to pass across the square end of the cork. Now have the
patient protrude the Pile tumors as far out as possible, being placed on
his knees with the head bent to the floor, pressing out firmly as if to
evacuate the bowels. Let the tumors be dried as much as possible by
gently pressing a soft, dry cloth to them; then let the loop of the
string projecting from the flattened end of the cork, be pushed on over
the largest tumor, and held down at its base, while an assistant places
the stick in one of the grooves, ties the two ends of the cord firmly
down over the stick, or _toggle_, by a square bow knot; then turn the
stick round once, twice, or more, until the pressure upon the tumor is
sufficient to strangulate it perfectly, and prevent the string from
slipping off. Care should be taken to keep the cord down to the base of
the tumor while it is being tied and tightened, as in many cases the
base is much the larger part of the tumor, and the cord tends to slip
up. After the ligature is applied and tightened, apply arnicated water
to the parts, and a large, warm poultice of superfine slippery elm bark,
wet so as not to be too soft and slippery, on the face of which Arnica
may be put. Keep it on with a T bandage. The patient must be put to bed
and kept