Piles should not be injected when in flamed, strangulated, large and hyper trophied, or external. When they are injected promiscuously the treatment will frequently be followed by great pain, swelling, sloughing, abscess, fistula, phle bitis, pywmia, long delay from business, partial cure, and occasionally death. When used in selected cases, however, a cure is obtained quickly with little pain. The preparations are the same as for any other rectal operation. It is well to warn patients when they have several tumors that two or three treatments may be necessary to effect a complete cure. An ordinary hypodermic syringe and a small speculum are the only instruments required. To avoid accidents it is well to observe the following rules:— 1. Cleanse the anus and surrounding parts.
2. Place the syringe and needle in boil ing water until everything is in readi ness.
3. Accurately gauge the amount to be injected.
4. Force the air out before introduc ing the needle.
5. Inject the fluid slowly in the pen dulous portion.
6. Inject from 2 to 5 drops in small and 5 to 10 in large piles.
7. Leave the needle within until the pile turns white.
S. Do not inject the tissue beneath the pile.
9. As the needle is withdrawn make pressure with the index finger to prevent the escape of the fluid and arrest hmmor rh age.
10. Promptly return all tumors.
11. Make a fresh solution for each in jection.
12. Keep the patient in the recumbent position one-half hour after the opera tion.
13. Only a fluid or semisolid diet should be permitted for a few days.
14. Weak in preference to strong solu tion should be employed.
15. Inject only one or two piles at a sitting.
As to the solutions to be injected, almost all the caustics in the vegetable and mineral kingdoms have been tried, with varying success. The most success ful results have been obtained, however, from carbolic acid in combination with glycerin, alcohol, olive-oil, and water. Experience has shown that the weaker solutions cause fewer complications and give better results than the stronger.
The following formula is very satisfac tory:— Carbolic acid, 12 grains. Glycerin, 1 drachm.
Water, 1 drachm.—M.
Iodine, iron, ergot, and ergotinc have been extensively used, but have no ad vantages over carbolic acid.
An ordinary case of hwmorrhoids can be cured by injection and the patient still be able to work. It is an error to use oil in any injection. The author uses for a single syringeful B. Acid. carbolic., 2 to 5 drops. Alcohol (pure), 10 to 20 drops. Distilled water, enough to make 1 drachm.—M.
Two to 3 minims to be injected along side each pile as the needle is withdrawn. The syringe and rectum should be clean and not more than three haemorrhoids injected at once.
One must be careful not to enter the vessel with the needle. If a man is at work, one haemorrhoid at a time should lie treated every four or five days. Car ter S. Cole (The Post-graduate, Nov., '95).
By injecting carbolic acid into the piles a sure cure may be obtained with out any risk or fear of consequences.
All that is required is to adhere to cer tain rules laid down by experience, as 'ever inject, inflamed or irritated piles; never employ a speculum; inject the smaller piles first ; handle the parts with great gentleness; apply vaselin to pro tect the parts from overflow of fluid; do not operate :1 second time until all Soreness disappears.
The mode of procedure is to insert the needle at or near the apex of the pile, and inject slowly, drop by drop, until the tumor changes color. Then re move excess of lluid with glycerin or Monson; solution on cid ton held over he opening. If blood follows, not enough has been injected, and the procedure unit be repeated immediately. As much as a drachm may be used for one in jection. Pain will lw relieved by hot water. No sloughing, swelling, or ab scess will follow this little operation.
The solutions used are of varying com position:— Carbolic acid, I ounce. Zinc chloride, 8 grains. Olive-oil, 5 ounces.
Carbolic acid, 2 drachms.
Glycerin, 2 drachms.
Fluid extract of ergot, 1 drachm. Water, 2 drachms.
Carbolic acid, 12 grains. Glycerin, 1 drachm. Water, 1 drachm.
Carbolic acid, 30 grains.
Extract of witch-hazel, 6 drachms. Distilled water. 6 drachms.
Henry M. Woolman (Med. Council, Dec., 1901).
Whitehead's Operation.—Mr. White head describes his operation as follows: "By the aid of scissors and a pair of dis secting forceps the mucous membrane is divided at its junction with the skin around the entire circumference of the bowel, every irregularity of the skin being carefully followed. The external and the internal sphincters are then ex posed by rapid dissection and the mucous membrane and the attached hemor rhoids, thus separated from the submu cous bed upon which they rested, are pulled bodily down, any undivided points of resistance being snipped and the hmm orrhoids brought below the margin of the skin." The mucous membrane above the hmnorrhoids is now divided trans versely in successive stages and the free margin of the severed membrane above is attached, as soon as divided, to the free margin of the skin below by a suitable number of silk sutures, which he does not remove. He prefers the lithotomy position and uses torsion to arrest hmin orrhage in preference to the ligature. Mr. Whitehead claims that piles are not individual tumors, but that they are only a part of the general plexus of the veins associated with the superior hmmor rhoidal, each radicle being similarly, if not equally, affected by the initial cause, either constitutional or mechanical. He believes that all vessels should be ex posed, and that the entire pile-bearing area should be removed. The operation has not become general either in this country or in England; in fact, few, if any, perform it either in an ordinary or a severe case.