The treatment of piles is something that seems to have changed little over the centuries.  The theories as to the cause for piles, although vastly different between then and now, are forgotten once it comes to finding a cure for this common malady.  We can easily imagine some physician during colonial years trying to give his own twist of the common theory for piles at the time, saying something like

‘you have a little too much ‘entia or energy” (or whatever he/she called it back then) down there, tied up right where everything is supposed to be coming out.  It’s looking for the way to go, by way of the vessels, and out it came, hot with fire and sanguine in every aspect of its nature.’    

No matter what the cause, the treatment is the same: get rid of the pile, avoid the fistula.

The recipe we are provided with in which a lead mortar is used to grind down the ingredient and stir them up to form a paste.  The act of stirring up the powdery grains in this mortar has the effect of pulling off some of the lead itself into the mixture.  This is why the paste becomes a dark color.  Even more interesting is the fact that this particular use of lead for making a drying paste that can be applied to swollen piles remained on drug store shelves for a century or two.  There once was a paste that one could buy for treating hemorrhoids, that was dark blueish grey in color, enough to stain any undergarments one might wear in a disgusting way, one of the most popular such over the counters, which as a child I can recall finding in my grandmother’s medicine chest.  

Osborn says (misspellings corrected): “Often from the piles there proceeds a fistula.”  Osborn was somewhat trained in surgery.  This is what assisted him in obtaining his position as a Field Surgeon during the Revolutionary War.   Some of his references mentioned in the vade mecum are important surgical writings, and he has some knowledge of the use of other devices that surgeons are more aware of than simply apothecarian-style physicians, so suffice it to say he knew something about medicine as well as surgery. 

Scattering the fistula with a poultice means that one is taking whatever is there (fire, heat, bad blood, etc.) and trying to disperse it through the body, in order to prevent it from forming a route from the innards outward.  The poultice he recommends is made from ‘Wite Lily’ and New Milk–the color white in opposition to the black bile sequestered down below, the whitish, aquatic humoural color (water – clear or white) designed to cool the burning flesh below and within the body near the piles.  Together the lead paste and new milk form the two main treatments for the Piles, in black and white.