ON PILES OR HŒMORRHOIDS.
As this disease is generally considered to be of a delicate nature, and one about which the afflicted are unwilling to speak, we shall say a few words on them. Piles constitute a disease that may be very slow or very rapid in its progress. The patient complains of an occasional itching or soreness at the rectum after an evacuation, more particularly if subject to constipation, or if he be an irregular liver: when, after a while, he will be surprised on discovering, subsequent to some straining effort, a knot of elastic but irregularly formed tumors, of a size varying from a hazel-nut to a horse-bean, springing out apparently from the rectum, that in a few days, if they continue, will become sore, and probably be attended with a discharge of blood.
| 1. Rectum. 2. Hœmorrhoids. 3. Perineum. View larger image |
1. Rectum.
2. Hœmorrhoids.
3. Perineum.
Another patient will experience similar symptoms, as regards the pain, swelling, and discharge of blood, except that they will be increased in severity, and be more transitory in their appearance and stay. Upon examination, a perceptible difference will be discovered. In the former instance the tumors will be seen to proceed from the outer edge of the rectum, and will be found to be covered with the common skin. Professional men designate this form of the disease “External Piles.”
| 1. Inner part of Rectum. 2. Orifice of Rectum. 3. External Piles. 4. Internal Piles. View larger image |
1. Inner part of Rectum.
2. Orifice of Rectum.
3. External Piles.
4. Internal Piles.
In the latter, the tumors are, as it were, squeezed out of the rectum, and swell in a very short space of time to an enormous size. They are of a much more vivid blood-red color, and will be found to be covered only by the lining membrane of the lower gut. These are called “Internal Piles.”
| 1. Inner part of Rectum. 2. Orifice of Rectum. 3. Internal Piles. View larger image |
1. Inner part of Rectum.
2. Orifice of Rectum.
3. Internal Piles.
Now piles are nothing more nor less than dilated veins, like varicose veins in the leg or any other part. The office of veins is to receive the surplus blood of the arteries, after having parted with that necessary supply for the nourishment of every structure they are severally distributed to, and to convey it back to the circulating organ, the heart—and the mesenteric hœmorrhoidal veins, from their dependant and confined position, the circulation in and above them being liable to so many interruptions from the frequent hardened state of the fæces in the rectum, become distended with blood, which acting really like a wedge, dilates them in time to the size we meet them. On the removal of the cause, the blood flows on, and the swelling subsides, and the patient feels no further inconvenience until a recurrence of the pressure. After repeated attacks, the veins become inflamed, and lymph, a sort of defensive mucus, is “thrown out” on the cellular membrane covering the veins, and becomes organized into an indurated texture, which increases with each attack of inflammation, and at last gives them that fleshy appearance which resembles a specific growth (see annexed cut).
View larger image
The distinction between External and Internal Piles is as follows: In both instances the same veins are diseased. In external piles, the lowermost portion of the hœmorrhoidal veins are dilated, and are thrust by the outer side of the rectum, carrying before them the common skin, which dilates and constitutes the external coat of the piles. The rectum is a portion of gut of four or five inches in length, and of nearly a uniform width; the lower end, constituting the orifice, is, as it were, tied round with a contracting and yielding band of muscular fibres, forming a muscle called the Sphincter Ani. It is a muscle of great power, and, from its connexion with the neighboring muscles of similar strength, helps to afford that support to the contents of the pelvis, that otherwise would descend, and be always forming a projecting tumor. External piles consist, then, of a protrusion of the hœmorrhoidal vein or veins between the cellular union of the sphincter with other muscles, constituting, in fact, a hernia or rupture in the perinœum. Internal piles is that condition of the hœmorrhoidal veins, where, from their dilatation, they become protruded with the fæces, when, from the contraction of the sphincter acting like a ligature, they can not regain their situation until emptied of their contents. Inflammation soon ensues, and the various changes I have and shall hereafter consider take place.
Having stated the cause of piles, namely, pressure on, and thereby prevention of, the circulation of the blood through the hœmorrhoidal veins, it follows that persons mostly annoyed with constipation must be the most likely to be afflicted with piles; hence, free and intemperate livers, great wine-bibbers, feeble and relaxed constitutions, those, again, who take little exercise, and pregnant women, and women who have borne many children, seldom escape them. It is rarely that piles attack people in the lower class of life, and those who have to work hard for their livelihood and are much in the open air, which accounts for the prevalence of this disease in the upper ranks of society. The treatment of piles is very simple, if proceeded with at the commencement of the complaint, the grand object being to prevent constipation. An excellent adjunct to the cure of incipient piles, is the warm bath. Its tendency to overcome local congestions, and thereby equalize the circulation of the blood, is well known. The best medicine a hœmorrhoidal patient can take is Turkey rhubarb, to be chewed freely, or castor oil, in doses of one or two teaspoonfuls every morning, or some mild electuary, which should be continued until the piles subside.
The diet during this treatment should be temperate and laxative. Fruits should be used freely, and also coarse bread, rye and Indian mush and molasses; wine and exhilarating stimulants being avoided, and, where admissible, as much out-door exercise taken as possible. An excellent plan is also to inject half a pint or more of cold pump or spring water up the rectum every morning, and suffer it to remain for twenty or thirty minutes, if possible. Where the piles have been of several days’ continuance, and are very much swollen, puncturing them with a needle, and so relieving the tension by evacuating, or at least diminishing their contents, that the obstruction shall be overcome, is serviceable. After this, pledgets of lint dipped in cold water, the patient preserving the horizontal posture, may be applied, or an astringent lotion may be used.
Where there is much swelling and inflammation, leeches applied to the neighboring parts will afford relief. It is impolitic, although some surgeons recommend it, to apply leeches on the tumor, as the bites are oftentimes very difficult to heal. Where the piles will admit of it, attempts should be made to empty them, and press them to their places, after which a pad may be worn to prevent their descent. In the commencement of the disease, where there is much heat and itching, a mild and astringent ointment will prove of considerable utility, and a wash of powdered opium, dissolved in flaxseed tea, will relieve pain and soreness.
A very excellent and practical method in the treatment of piles (the internal I am now speaking of) is to deposite a pear-shaped bougie or pessary in the rectum, and suffer it to remain as long as possible. The wearing of bougies gives no pain or even uneasiness, and the patient may pursue his or her ordinary occupation without hinderance: the bougie should be worn from one to several weeks. It affords constant pressure against and support to the dilated veins, and enables them to regain their tone and strength; and I have known numerous instances where a lasting cure has been effected. One of the most alarming consequences of piles is hœmorrhage or bleeding; and it is really wonderful what an extensive loss of that fluid a patient can sustain. Day after day, and week after week, have I known instances of constant bleeding from internal piles, by which the constitution of the patient has been almost broken up. This symptom mostly prevails with females, nor is it limited, although more prevalent, to those who are pregnant. There is naturally a strong objection on the part of a delicate and susceptible female to submit to a professional examination, and consequently it is rarely done, until the urgent necessity of the case, lest death should ensue, induces the patient to consult her medical adviser, that he becomes acquainted with the real nature of the case. Where there is ulceration of the piles, and they are very numerous, and the bleeding frequent and profuse, the only effectual cure is their removal. Where the operation is objected to, the next method is to employ astringent enemata, which must be regulated by the medical attendant.
The celebrated Weir’s balsam (248½ Grand Street) has the credit of effecting miraculous cures. It is a medicine of deserved repute, and ranks high with professional men. Pitch pills have been extolled.
Now, where piles, both external and internal, do not yield to the means suggested, or the patient may not think proper to avail himself of them, the next best step is their removal; and this is done either by excision or by ligature. Both processes are safe in the hands of a medical man, and are neither attended with any pain nor suffering worth notice.
Among the annoyances incident to the rectum, is an occasional preternatural contraction of the sphincter muscle. It is generally the consequence of local irritation set up by purgatives, by which the orifice becomes sore and excoriated, which, if not timely relieved, ulcerates, constituting cracks also, and in process of time a portion sloughs away, and the adjacent edges unite, and thereby diminish the calibre of the opening. This disease may be congenital, that is, the individual may be born with a contracted or narrow sphincter. The treatment, naturally enough, is to dilate the orifice, which is to be attempted by the introduction of bougies, after the mode advised for the cure of stricture, of which this in reality is a form. The cracks of the sphincter are occasionally obstinate to heal; and the ulceration will spread within the rectum. When that is the case, the application of any stimulative ointment will promote a healthy action.
In inveterate cases division of the sphincter is necessary, which is to be done with a scalpel, and the incision should be made from within laterally, by which injury to the perineum is avoided. The operation is very simple, and by no means painful or dangerous: the cure is perfect. Appropriate medical treatment must not be neglected.