HEMORRHOIDS.
The treatment may be either palliative or operative for both external and internal piles. In most instances palliative measures are preferable where the presence of the haemorrhoids is causing little discomfort or loss of blood, and often such treatment by removing the primary cause permits the varicosity to shrivel or wither up.
Constipation must he sedulously guarded against; the bowels may require occasionally a brisk saline purge to unload the liver, but the physician should aim at the rational method of curing the constipation by securing a semi-solid or soft motion at least once daily. This can only be satisfactorily accomplished by small doses of laxatives as Aloes, or Cascara in combination with Nux Vomica as in the ordinary dinner pill. Large doses of aloes are injurious. When a purgative action is required, this drug should not be selected, but small doses arc invaluable; they exercise a certain degree of stimulating or tonic action upon the muscular coat of the atonic veins which is highly beneficial. It should, therefore, never be administered even in small doses when the piles are inflamed. Confection of Senna, Sulphur or Compound Liquorice Powder, Stewed Prunes and pure Olive Oil are also excellent laxatives. The diet should be such as w ill not tend to cause portal congestion; high living, alcohol, and sedentary occupations or such as entail prolonged standing must be avoided, and cold or damp to the feet should he prevented by suitable clothing and foot-wear. The administration by the mouth of Ward's Paste (Confection of Pepper) is still a valued agent, and many retain a belief in the efficacy of Tar Pills. Local measures consist in extreme cleanliness; only the softest tissue paper should be gently used after defecation; the anal region be sponged freely with cold water afterwards, and again before retiring to rest. A small enema of cold water is in many cases very beneficial, especially when a severe aching pain follows defecation where internal piles are present, which tend to prolapse; these should always he gently pushed up beyond the grasp of the sphincter. Any unirritating astringent ointment may be applied at the same time with the finger or an ointment introducer. The best routine application is the
following': R. Lint.
Ext. Hanzamel. Liq. 3j.
Liq. Carijonis Deterg. iitxxx. Misce.
This relieves any pruritus which may be present, and its astringent effect can be intensified by the addition of so grs. Persulphate of Iron, if hemorrhage is troublesome. Gall and Opium Ointment alone or with the addition of Belladonna Extract, Ilazeline or Calomel and Dilute Citrine Ointment, with s per cent. Cocaine are also good local applications.
Inflamed piles or what is commonly known as " an attack of piles " due to thrombosis of the vein may be either external or internal. Their preven tion will consist in the observance of the above-mentioned measures, especially by the exercise of a gentle pressure applied after defecation so as to prevent the mass of internal piles being strangulated by the sphincter. When this latter result has already occurred all attempts at reduction are painful and generally futile. Inflamed external piles can never be pushed within the sphincter. Where the pain is very severe the pile may be incised under antiseptic precautions and the clot squeezed out. This is followed by immediate relief, and allows the patient to continue at work. If more than one pile he affected the patient should be ordered to bed and a large enema of warm water slowly administered so as to thoroughly wash out the colon. The agonising pain is best relieved by hot fomentations or poultices smeared over with the Green Extract of Belladonna and sometimes by iced applications or a piece of smooth ice introduced within the sphincter.
Leeches to the margin of the anus always afford a considerable degree of relief, but anodyne suppositories or ointments are generally of little value owing to the tension of the parts. By such palliative measures the patient may be tided over his few days of suffering, after which it may be found that the piles have become obliterated through the forma tion of firm thrombi in their interior, or the strangulation caused by the pressure of the sphincter may have been sufficient to effect their per manent destruction.