Hemorrhoids

“ It will slough off neatly and heal readily. It is peculiar of the injection of internal piles or of the same strength of medicine into or beneath the mucous membrane, that it tightens and takes up a slack of the membrane permanently, without apparent lessening of the calibre of the gut. It is also peculiar of the treatment and cure of internal hemorrhoids by injection, that no cicatrix, cicatricial tissue or contraction results, unless the operation has been extensive, involving both sides, and an active inflammation has been excited by extraneous causes. ”

“ Hemorrhoids, being by far the most common among this class of ailments, and the greatest bone of contention regarding the best manner of effecting a radical cure, will take precedence in our consideration, and receive the attention that their importance and dignity justly merits. ”

“ It is an indisputable fact that until within the past few years, an operation for the radical cure of hemorrhoids was considered so formidable an undertaking, that their treatment, outside of palliative measures, was almost entirely eschewed by the general practitioner.
“No fact is better known to the profession,” says Dr. S. S. Turner, U. S. Army, “than that nearly all men, doctors not excepted, will suffer more than the pain and inconvenience of a thousand operations, rather than undergo an operation for removal by any of the methods in vogue. ”

“ With some, the injection into external hemorrhoids is quite painful at the first contact of medicine, but immediately thereafter subsides. Where the tumor is very sensitive, external or internal, precede by a hypodermic of from three to five minims of a five per cent. solution of cocaine. Introduce the needle point barely underneath the covering of the growth and force out one drop. ”

“ A little practice will enable any one to see the simplicity of the entire procedure. If you should make a mistake when operating through a speculum, and land the whole charge into a fold or saggened portion of the bowel do not be alarmed, as it will only be a little more painful and longer in healing. Injection into internal hemorrhoids is not painful to any degree, therefore if the patient complains much you might suspect that you are invading the tissue of the bowel. ”

“ It is claimed that before puberty females are more subject to it than males; after that age the reverse obtains, except during pregnancy.
Internal hemorrhoids are round, oval, or sometimes cylindroid-shaped tumors covered by mucous membrane; they are smooth, granular, or rough to the touch, much less sensitive and painful than the inflamed external variety, and are situated within the rectum it may be an inch or two above the internal sphincter muscle. They occur in groups or scattered over the surface of the bowel. ”

“ Inject from 3 to 30 minims, or more, according to the size of the tumor. There is no rule to regulate the quantity by count. The object is to inject a sufficient quantity to permeate the entire substance of the tumor, its texture being much more spongy than the surrounding tissue, and not extend beyond its base of attachment.
Here is where many make a mistake in the injection of hemorrhoids. Some are prone to use too much, even though the solutions be weak, and apply it too deeply, reaching to and destroying the muscular coat of the bowel, causing prolonged pain, deep sloughing, etc. ”

“ On account of the pressure of the womb on the rectum, and also on account of the constipation which is so frequent during pregnancy, hemorrhoids or piles are quite frequent [99] among pregnant women. The treatment of hemorrhoids consists in removing the cause: wearing a well-fitting abdominal belt, and relieving the constipation. Injecting into the rectum about half a pint of cold water three times a day is very useful. For the intolerable itching sometimes present in hemorrhoids the following ointment will be found very grateful: menthol, 5 grains ”

“ Hemorrhoids are virtually varicose veins which protrude from the rectum, but, unlike those in the legs, are extremely painful. As it is the straining incident to constipation that causes these engorged veins to prolapse, this condition constitutes 140one more reason for preventing constipation. A pregnant woman whose bowels move freely every day rarely has hemorrhoids.
Should hemorrhoids appear, the first step is to have them gently pushed back into the rectum. The patient can usually do this for herself, quite satisfactorily, after lubricating her fingers with vaseline or cold cream. ”

“ Although the development of hemorrhoids cannot always be prevented, it is a well-known fact that constipation renders the chance of their appearance much greater. In a measure, therefore, regular, daily evacuation of the bowels serves to prevent the ailment, and also to cure it, once it has developed. But walking and even standing aggravate hemorrhoids. The recumbent posture, as might be expected, is of itself frequently enough to give relief. It is much more likely to do so, however, if the hips are elevated by placing a pillow under them. ”

“ After the application of the ligature, using a compress that has been dipped in oil and the bandage adapted for the anus, we order the patient to remain quiet, and treat the bowels with tepid oil and honied water, and afterwards we use a cataplasm made of crumbs of bread and saffron; and after the falling off of the hemorrhoids the cicatrization is to be promoted by wine. Leonides has not recourse to the ligature, but having seized the hemorrhoids and held them for some time with the forceps used for operations on the uvula he cuts them off with a scalpel. ”

“ The regular physician considers the local hemorrhoidal enlargements in themselves the chronic disease, while the Nature Cure practitioner looks upon hemorrhoids as Nature's effort to rid the system of certain morbid encumbrances and poisons which have accumulated as a result of sluggish circulation, chronic constipation, defective elimination through kidneys, lungs, and skin and from many other causes. ”

“ The aggravated character of the inflammation accounts for the hypertrophied and the cicatricial tissue so often found around the anal vent of proctitis cases. The Biblical suggestion that sacculated mucosa, commonly termed piles or hemorrhoids, is a disease, accounts for the numerous names used to designate the particular variety of the disease—whether it be an internal or an external pile tumor. It is very wrong to so mislead “scientific” medical men. ”

“ Hemorrhoids of the bladder due to obstructed circulation is not infrequently the source of the bleeding. The amount of blood transuded varies very greatly, though it is seldom so great as to prostrate the patient. In all cases when it is considerable it is of great importance to localize the bleeding point. The urethra can be excluded if there is no bleeding between the acts of micturition. The differential diagnosis between hemorrhage from the bladder or kidney is less easy. ”

“ In all cases of rectal ulcer of any considerable gravity, absolute rest, both of the parts and the body, is to be maintained. Hot water irrigations and a complete destruction of the diseased surface by carbolic acid, are the first things to be thought of, together with a liquid diet.
Convert the ulcer into a carbolic acid sore and use an iodoform suppository. In fact the treatment is very similar [62] to that recommended as an after treatment in a bad case of hemorrhoids, with such variations as the ingenuity will suggest. Bismuth, oxide of zinc, eucalyptus, mercury, resin cerates, etc. ”

“ The wholesale stretching of the sphincter ani muscles as a “cure all” is certainly to be deprecated as unscientific, illogical, and without the advantages or benefits claimed for it by rattling and noisy fanatics. Divulsion injudiciously employed may be followed by a long and tedious recovery, complicated with very undesirable sequelæ and thereby excites much adverse criticism.
The case of a lady recently came under my observation, who, although in average health, complained a little as many women do, and thought she was troubled with hemorrhoids. ”

“ The abdomen is full and not sensitive to pressure. The tongue is coated and usually pale and flabby. In appearance the patient exhibits a general want of tone; the skin is white or muddy, the muscles are soft, and the expression indicates the depression of spirits, the lassitude, and the inertia which he feels. Hemorrhoids are very likely to [p. 707] exist. Such a condition may last for months or years without much change. Under proper treatment recovery may take place, but if entirely neglected or improperly treated the disease inevitably becomes worse. ”

“ J. Junction of skin with mucous membrane. E. Everted bowel.
There can be no mistake in discriminating between a [11] large hemorrhoid and the bowel, but to distinguish a small, blanched hemorrhoid, located on the upper margin of the internal sphincter from an irritated and saggened portion of the bowel, when looking through a speculum, is more difficult. The bowel presents a more smooth and continuous surface, while the hemorrhoid is more uneven and irregular, and bleeds freely when scratched. Sometimes a victim of piles will call and speak of his piles having come down and are hanging out. ”

“ If the attack is severe, live a whole day or even two days, if necessary, upon pure, cold, soft water alone.” I would substitute hot water and hot lemonade, followed for several days by liquid foods only. Of these bran gruel is the best. When there is some internal heat, and even considerable inflammation, tepid sitz-baths and cold compresses are of great benefit. An enema of hot water relieves the pain incident to hemorrhoids. For cases not of long standing, the following recipe will seldom fail to relieve ”

“ It matters not what form of tumor presents itself for treatment, whether of the capillary variety, distinguishable in being of small size, flat or sessile, made up of the terminable branches of the arteries, the beginning of the veins and the capillaries which join them, punctated, granular surface with thin covering and likely to bleed on the least provocation, or the arterial hemorrhoid with the arteries and veins freely anastomosing, larger, and presenting the glazed appearance of a very ripe strawberry, liable to inflammation, erosion, prolapse and hemorrhage ”

“ A tumor, properly injected, cannot inflame, because there is nothing to inflame, the circulation is stopped and thus it is as effectually strangulated as by a ligature, with the advantages of the immediate local anæsthetic, antiphlogistic, [17] auterant and antiseptic properties of carbolic acid. The base of attachment heals, while the dead tissue, which is rendered non-inflammatory and antiseptic, disintegrates and is thrown off between the third and fourth day, a process that fortifies against secondary hemorrhage. ”

“ A weak, thin, watery solution, aside from doing poor work, is much more liable to diffuse itself and be carried into the circulation like a hypodermic of morphia, than a solution sufficiently strong to act as a cauterant, destroying the tissue, forming a compact and an insoluble coagulum and strangulating the circulation at once.
A solution, weak or strong, when deposited to any depth beneath the surface, with live tissue and the circulation passing on all around it, will of necessity excite pain, inflammation and a slough, the same as a splinter in the flesh. ”

“ It is a rare condition, and must be distinguished from hematuria, or blood in the urine, which is common. In both conditions chemic tests will show hemoglobin, but in the latter the microscope will reveal the presence of red corpuscles. Urines which contain notable amounts of hemoglobin have a reddish or brown color, and may deposit a sediment of brown, granular pigment.
Hemoglobinuria occurs when there is such extensive destruction of red blood-cells within the body that the liver cannot transform all the hemoglobin set free into bile-pigment. ”

“ The blood vessels of the lymph gland, greatly congested, contain almost exclusively red blood cells. As a rule, the lymph follicles and the lymph cords take little part in the process. If there is any change in these structures, it is a rarefication. Occasionally, hemorrhage is encountered in a follicle or even in a cord, and this hemorrhage may involve not only the cells of the cord, but its supporting reticular structure, and may form the nucleus of a subsequent necrotizing or suppurative focus. ”

“ The PROGNOSIS is in the highest degree unfavorable, and in those cases, few, indeed, in number, in which there were symptoms like leukæmia and which disappeared under treatment, the doubt remains whether they were true examples of the disease. When once established, the spleen and glands enlarged, the hemorrhages and dropsies present, and the blood condition marked, death is the only termination to be expected. Specially unfavorable signs are a tendency to hemorrhage, persistent diarrhoea, early dropsy, rapid increase in the splenic tumor, great excess of colorless corpuscles, and high fever. ”

“ A slight exciting cause is all that is necessary to produce their rupture. The primary cause is the false membrane, and, in some cases, vascular granulations, which have rapidly formed, perhaps in twenty-four hours—conditions eminently favorable to the production of hemorrhage. In cancerous, tubercular, and dyscrasial conditions of the blood, the blood-vessels are especially weak and easily give way, owing to the defective nutritive properties of the blood itself, just as, in typhoid fever, we have nasal and intestinal hemorrhage, and in typhus, petechiæ. ”

“ Purpura haemorrhagica (acute hemorrhagic purpura) is a more serious form, in which, in addition to the phenomena already mentioned as affecting the skin, there is a tendency to the occurrence of hemorrhage from mucous surfaces, especially from the nose, but also from the mouth, lungs, stomach, bowels, kidneys, &c., sometimes in large and dangerous amount. Great physical prostration is apt to attend this form of the disease, and a fatal result sometimes follows the successive hemorrhages, or is suddenly precipitated by the occurrence of an extravasation of blood into the brain. ”