Many railway-employees suffer from haemorrhoids as a result of irregularities in living, combined with the jarring motion of the train.
The cutaneous variety of external pile is classified as redundant, hyperplastic, or hypertrophie. The distinctive feature of the redundant pile is the superabun dance of the anal integument brought about by the stretching it receives from the subjacent varicose external hmm orrhoidal veins when they are fully distended, as during defecation. The hyperplastic pile appears in the form of a pendulous cutaneous tag, associated with an abrasion, fissure, or ulceration of the anal verge, and is the result of an inflammatory hyperplasia; while the term hypertrophie indicates that the swelled, thickened, radiating anal folds associated with the eczematous inflam mation are the result of an inflammatory or irritative hypertrophy. J. Walter Otis (Amer. Jour. Med. Sci., Feb., '95).
The causes of hmmorrhoids are: 1. Diminution of the forces that normally move the venous blood from the rec tum to the heart. 2. Obstruction of the venous outflow from the rectum. 3. Pre disposition.
From these views of the etiology of Immorrhoids may be easily deduced the principles of prophylaxis. Wallace A. Briggs (Occidental Med. Times, Dec., '95).
Haemorrhoids consist essentially in the new formation of young blood-vessels by a process of germination from the older vessel-walls and the consequent forma tion of a cavernous tissue. Inflamma tory changes, such as thrombosis and endophlebitis, may also occur within the neoplasm, but are absent in the majority of eases. Venous stasis has nothing to do with haemorrhoids, being at most a secondary phenomenon. George Rein bach (Beitrag zur klin. Chirurgie, vol. xix, No. 1, '97).
External Haemorrhoids.
External piles are so common that few persons arrive at middle age without hay ing suffered from them. They are classi fied into thrombotic and cutaneous va rieties.
Thrombotic or venous piles consist of elevations of skin near the anal margin, oval in form and of a livid color or slightly tinged with blue, filled with a hard clot of blood inclosed in a sac. The
amount of pain depends upon the inflam mation. Usually it becomes severe and will continue until the clot is turned out or suppuration takes place. These tumors form quickly, and present them selves during the act of defecation, fol lowing an attack of constipation, neces sitating great straining. They have the appearance and feeling similar to that of a bullet beneath the skin, and are gen erally single. They are caused by excess ive eating, irregular habits, and any thing that is conducive to constipation.
Unless external haemorrhoids become irritated or inflamed they will cause little inconvenience; in fact, many persons go through life with them and suffer very little. When the parts are not properly attended, they frequently become acutely inflamed and cause much pain and an noyance until they are removed.
Treatment of External Haemorrhoids. —The treatment of external piles may be palliative or operative. The latter is always to be preferred unless the patient refuses to submit to a trivial operation. In such a case much relief is to be had from the use of certain palliative meas ures.
—In all cases attention should be paid to the diet. The use of highly-seasoned food and stimu lants, such as tobacco, whisky, wines, and beer, should be discontinued, and a simple diet substituted. The bowels should be kept open by the use of Vichy, Hunyadi, Frcidrichshall, or some other mineral water. If there are symptoms of a congested liver, a few calomel par vules, 1/,, grain, or the blue pill properly administered will prove beneficial. Fre quent hot baths should be taken, and the anus washed with Castile soap and water. If the pile belong to the first variety, containing a hard clot, frequent applications of an ointment composed of 4 Morphine sulphate, G grains. Calomel, 12 grains.
Vaselin, 1 ounce.
will soothe the parts and reduce the in flammation. The old-time lead-and opium wash, either hot or cold, applied constantly, affords great relief: 4 Lead-water, 4 drachms.