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protrusion, patient, external, time, times and condition

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STAXIS are recommended. Transfusion sometimes becomes necessary, but it should be conducted with unusual care, owing to the morbid condition of the vascular walls. The best hxmostatic is the transfusion of entire blood, of which but a small quantity will some times stop an otherwise uncontrollable hmniorrhage. (llayem.) Case in a girl of 13, coming from a family of bleeders, and herself subject to severe attacks of epistaxis, menstru ated for the first time in July, 1900, and who on December 6. 1900, had been flow ing for two weeks, and in extron is. There was marked pallor and weakness, the respiration was sighing; tempera ture, 102° F. (35.3° C.): pulse, 150. Salt solution injections and packing with ferric subsnlphate, which had to be re peated three times because of leaking, were of no avail. On December Sth she was delirious, and death was expected. As a last resort a half pint of 1-per-cent. solution of sterilized gelatin was in jected under the breast during the morn ing and again in the afternoon. The lummorrhage ceased, and the patient re covered. C. H. Hare (Boston Med. and Surg. Jour., July IS, 1901).

HEMORRHOIDS.—Gr., from uictu, blood, and pertaining to.

Definition.—A vascular tumor of the mucous membrane of the rectum, the anus, or both.

Varieties. — Hemorrhoids may be classified into two varieties: external and internal.

They are called external when the skin alone is involved, and the tumor is ex ternal to the external sphincter muscle, while the internal are covered by the mucous membrane. It often happens, in long-standing cases, that internal piles protrude outside the anus, yet, when they are returned into the bowel, they will remain for a short time, at least; but the external cannot be pushed up into the bowel. Should only a portion be returned while the other remained on the outside, it might properly be termed a combination pile.

When there is any protrusion around the rectum, or swelling, it is necessary to ascertain when this protrusion ap pears, whether it is always present, or whether it only occurs at stool; whether it is brought on by long, hard straining or by a very slight exertion. We should

also know whether it disappears spon taneously, or whether the patient has to restore it; and, if so, whether such restoration is easy or difficult. If at the time of examination the protnision is down, one should observe the direc tion of the rugie, whether circular or running up and down; also the condi tion of the mucous membrane of the parts, whether it is healthy, excoriated, or ulcerated; whether such protrusion is regular or irregular, and whether it is attached by sessile or peduncular base. No diagnosis of a rectal condition is ever complete or reliable until both digital and ocular examinations have verified the opinion gained from the sub jective history and questioning.

In preparing a patient for a first rec tal examination, personally an enema is not given until after the finger and spec ulum have been introduced to learn the habitual condition of the parts. Having learned this, then a rectal irrigation, or salt and soap-sud enema should be given the patient, and the bowels moved. This will be advantageous for two pur poses: first, the cleansing of the parts, and, secondly, the bringing down of any protrusion which ordinarily occurs at the time of the patient's going to stool. The commode or toilet to which the pa tient retires should be in close prox imity to the doctor's office, in order that he can see such protrusion before it re tires spontaneously; and, if there be a bleeding protrusion, to avoid any un usual delay in examination and unneces sary soiling of the patient's clothes. J. P. Tuttle (International Jour. of Sing., Jan., 1901).

Symptoms and Diagnosis.—There is usually a sense of fullness and heat, throbbing pain, tight sphincter, with irresistible tendency to strain, and some times an itching sensation. When in flammation is present to any degree, the patient will be uncomfortable in any position he may assume, and may also have a slight elevation of temperature.

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