VENOUS.—This variety is of more fre quent occurrence than the capillary; the tumors are large and vary in size from one-half to one inch across their bases, are covered by mucous membrane, hav ing a glistening appearance, are a bluish or livid color, and are formed as a result of a dilatation of the veins in the mucous and submucous tissues.
Treatment of Internal — PALLIATIVE. — Palliative measures afford relief in many cases, while in a few they may reduce the piles altogether. When these are small and cause but little suffering, the treatment is simple. In the first place, errors in diet and habits of living should be corrected. When piles are protruded and inflamed the patient should assume the recumbent position and keep perfectly quiet, and soothing or astringent lotions and oint ments should be applied constantly. When these fail relief can often be had from ice and poultices made of flaxseed, corn-meal, and onions. The symptoms of a congested liver should at once be counteracted.
When piles are not large or strangu lated they can be made to contract by the application of pure nitric acid. The tumors must be returned above the sphincter at the earliest opportunity. If the patient must work he may get some comfort from a pile-supporter. The bowels should be kept open at all times and the patient instructed to cultivate regular habits as to the time his bowels should be moved.
In haemorrhoids large injections of cold water at 40° to 50° F., either plain or containing boric acid or antipyrine, are productive of much good in the abate ment of inflammation, congestion, and in arresting small bleedings. J. E. Davis (N. Y. Med. Jour., June 15, '95).
For internal hemorrhoids excellent re sults obtained from tincture ferri per chloridi and hazelin, 20 drops of each in an ounce of water internally, twice daily, and injections per «nuM of tincture ferri perchloridi, 4 drachms, and hazelin, 4 drachms. The injection is best given at bed-time, so that it may be retained. N. C. Mitra (New Orleans Med. and Sung. Jour., Nov., '95).
Calomel in the form of a suppository is very beneficial in hemorrhage due to piles. In a series of cases, mostly of
old standing, the results were highly satisfactory. It immediately arrests the bleeding, lessens the frequency and chances of its occurrence, and greatly re duces the size of the haemorrhoids. Not more than from 12 to 15 suppositories were used in a single case, 1 suppository being introduced daily into the rectum, and left there for twelve or twenty-four hours, according as the condition of the case demanded. J. Klewtzow (Vratch, Feb. 25, '99).
A bland diet, especially sweet milk, is absolutely injurious on account of the lack of stimulation of the peristalsis. Great care should be paid to the toilet of the anal region after defecation, a so lution of tannin or alum on a cotton wad being used. An ascending douche is of value. In giving enemata, a soft sound should be used, and all irritating sub stances like glycerin, salt, etc., should be avoided. Except in extreme cases, purgatives should not be given. To con trol hemorrhage, which occurs even when the feces are normal, a teaspoonful of fluid extract of hamamelis Virginica in a wineglassful of water three times a day for four weeks, then twice a day for a month, and then once a day for another month, is to be recommended. If the hemorrhage is severe, a powerful dose of opium should be given and the bleeding spot tamponed with gauze. After it has been arrested for three days a dose of castor-oil is to be taken. I. Boas and F. Karewsky (Tiler. der Gegen wart., Nov., '99).
For local use against pain and excoria tion, the following suppository is recom mended:— 4 Chrysarobin, I grains.
Iodoform, grain.
Extract of belladonna, "/,„ grain.
Cacao-butter, 30 grains.
M. For one suppository. Two or three may be used daily. Boas (Cen tralb. f. Then, Dec., '99).
- Operations when properly performed always effect a permanent cure, and in a shorter time than is required for even temporary relief by palliative measures; the suffering is much less when there are no complica tions. The operation is a trivial one, in suring complete cure; it should be rec ommended, and performed at once, re gardless of any inflammation.