–After any oper ation for piles a well-adjusted pad to the anus, held in place by a T-bandage, sup ports the parts and renders the patient more comfortable, and tends to arrest any bleeding that might otherwise take place. I do not use suppositories, al though many high in authority recom mend the immediate employment of sup positories containing morphine, opium, belladonna, etc., for the relief of pain. As a rule, they produce an uncomfort able feeling and cause the patient to strain in his endeavors to force them out. When I am compelled to use anything for the relief of pain I prefer an hypo dermic injection of grain of mor phine. Ordinarily, this will not have to be repeated. When the pad applied to the anus becomes dry and hard, the anus should be sponged off with warm water and a new pad applied.
If the patient has been purged before the operation, it is not necessary to check intestinal action with opium, for no movement will occur before the third day. In case it does not, a Seidlitz pow der or a dose of salts should be admin istered. If there is reason to believe the faeces are hard, an injection of soap-suds should be given to soften them.
Patients should be urged to remain in bed until the ulcerations have almost or entirely healed. Then, when they begin taking active exercise, the danger of the ulceration becoming chronic will be slight. The ulcerated surfaces should be cleansed daily, and, if there is the least tendency to become chronic, an applica tion of calomel or silver nitrate (15 grains to the ounce) will stimulate them.
In case of retention of urine, hot stapes or poultices should be applied over the pelvis. This will frequently en able them to void urine independent of the catheter. If a catheter is used, a soft-rubber one is preferable, but should be cleansed in boiled, filtered water be fore and after each introduction. The diet after an operation should be limited to liquids and semisolids for the first four or five days; but patients should have nourishing soups, beef-tea, and soft boiled eggs.
The Smith operation of clamp and cautery for haemorrhoids when properly executed is one of the most satisfactory in surgery. The technique of the opera tion is somewhat different from that of most operations; yet, having employed it in over three hundred cases, the method is thoroughly recommended. The evening before the operation the pa tient is given 1 ounce of castor-oil, in the morning he receives an enema.
Under general anesthesia the anus is thoroughly stretched • and the rectum cleansed. Forceps are attached to each limorrhoid, the pile-clamps are applied, and the pile is burned evenly and slowly down to a solid button above the bite of the clamp (baked would probably be a more expressive term), never burning off smoothly along the clamp and never cutting off a pile with scissors previous to burning, although the skin may be cut to the subcutaneous tissue, if in volved.
The small soldering irons are found to be the best for the purpose. Usually three groups of vessels need to be de stroyed, anteriorly, and laterally and with a little practice all the hremor rhoids can be grasped and included in three eschars. To prevent future con traction at least three separate one-half inches of mucous membrane in normal condition should line the anal opening. No more than four large piles, as a rule. should be removed by this method. If there be other small piles between they can be punctured with the small point cautery. The surrounding parts are protected from excessive heat or acci dental slipping of the iron by a square of asbestos cloth with a cut in one side to allow it to slip beneath the clamp.
A little vaselin is applied to the anus on gauze and the patient put to bed. No tube or pack is inserted into the rec tum; the operator who employs them has had reason to fear haemorrhage, which is an occasional occurrence where the tops of the piles are cut away before cauterization or when they are not all marked at first with forceps, necessi tating search and disturbance after some of the eschars are properly placed. Morphine is not often needed, but may be given the first day if necessary for pain. The bowels are moved on the fourth day by castor-oil. The only dressing is a little vaselin on cotton ap plied to the external parts. C. II. Mayo (St. Paul Med. Jour., Mar., 1901).
Prognosis.—In cases where bleeding, inflammation, and strangulation have been relieved by palliative measures, pa tients should be warned that they will probably have another attack. On the other hand, when all piles, dilated veins, and redundant tissue have been removed by the clamp-and-cautery or ligature operation, it is safe to tell them that they will not have a relapse.