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PILES. (Hemorrhoids).—Hemorrhoid is derived from two Greek words, meaning blood and flowing with blood. "Pile" is from a Greek word meaning a ball or globe. Hemorrhoids, or piles, are varicose tumors involving the veins, capillaries of the mucous membranes and tissue directly underneath the mucous membrane of the lower rectum, characterized by a tendency to bleed and protrude. They were known in the time of Moses.
Varieties.—There are the external (covered by the skin) and the internal (covered by mucous membrane).
Causes.—Heredity. More frequent in males. Women sometimes suffer from them during pregnancy. Usually occurs between the ages of twenty-five and fifty. Sedentary life, irregular habits, high-grade wines and liquors, hot and highly seasoned and stimulating foods. Heavy lifting. Those who must remain on their feet long or sit on hard unventilated seats for several hours at a time. Railway employees, because they take their meals any time and cannot go to stool when Nature calls, causing constipation. Purgatives and enemata used often and for a long time. Constipation is perhaps the most frequent cause: when a movement of the bowels is put off for a considerable time the feces accumulate and become hard and lumpy and difficult to expel. If this hard mass is retained in the rectum, it presses upon the blood vessels interfering with their circulation and by bruising the vessels may induce an inflammation of the veins when the hardened feces are expelled; straining is intense, the mass closes the vessels above by pressure and forces the blood downward into the veins, producing dilatation when the force is sufficient. One or more of the small veins near the anus may rupture and cause a bloody (vascular) tumor beneath the mucous membrane or skin.
External Piles.—Two kinds, venous piles and skin or simple enlarged tags of skin. Venous piles usually occur in robust persons. They come on suddenly and are caused by the rupture of one or more small veins during the expulsion of hardened feces. There may be one or more, and may be located just at the union of the mucous membrane and the skin. Their size is from a millet-seed to a cherry, livid or dark blue in color, and appear like bullets or small shots under the skin. At first they cause a feeling of swelling at the margin of the anus; but as the clot becomes larger and harder, there is a feeling of the presence of a foreign body in the lower part of the anal canal (or canal of the anus). The sphincter muscle resents this and occasionally contracts, spasmodically at first, producing a drawing feeling; later these contractions become longer and more frequent, and there is intense suffering caused by the pile being squeezed, and this suffering may be so great that sleep is impossible without an opiate. Because of the straining, irritation of the rectum and pain in the sphincter, the piles soon become highly inflamed and very sensitive. The clot may be absorbed without any treatment. Occasionally it becomes ulcerated from the irritation, infection takes place and an abscess forms around the margin of the anus terminating in a fistula.
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Skin Piles. (Cutaneous).—These are enlarged tags of the skin. They frequently follow the absorption of the clot in the venous piles where the skin is bruised and stretched. There may be one or many and usually have the skin color. These cause less suffering than the venous variety, and sometimes they exist for years, without any trouble, providing care is taken; but when bruised from any cause, such as a kick or fall, sitting on a hard seat, stretching of the parts during stool, or when they become irritated by discharges from the rectum or vagina, they become inflamed and cause much annoyance and pain. When they are acutely inflamed they swell greatly, are highly colored, swollen, painful, and extremely sensitive to the touch and cause frequent spasmodic contractions of the sphincter muscle and may finally result in an abscess. The pain is usually confined to the region of the anus, but may go up the back, down the limbs or to the privates.
MOTHERS' REMEDIES FOR PILES. Sulphur and Glycerin for.—"Equal parts of sulphur and pure glycerin. Grease parts." This preparation is very healing, and will often give relief even in severe cases.
2. Piles, Strongly Recommended Remedy for.—
Extract Belladonna 15 grains
Acetate lead 1/2 dram
Chloretone 1 dram
Gallic acid 15 grains
Sulphur 20 grains
Vaseline 1 ounce
Mix.
In protruding, itching and blind piles, this ointment will give you almost instant relief. If kept up several days it will promote a cure."
3. Piles, Good Salve for.—"Red precipitate two and one-half drams, oxide of zinc one dram, best cosmoline three ounces, white wax one ounce, camphor gum one dram." It is much better to have this salve made by a druggist, as it is difficult to mix at home. This it a splendid salve and very good for inflammation.
4. Piles, Smartweed Salve for.—"Boil together two ounces of fresh lard and half an ounce smartweed root. Apply this to the piles three or four times a day." This is very healing, and has been known to cure in many cases when taken in the early stages.
5. Piles, the Cold Water Cure for.—"Take about a half pint of cold water and use as an injection every morning before trying to have a movement of the bowels." This simple treatment has cured many cases where the stronger medicines did not help.
6. Piles, Simple Application and Relief from.—"Mix together one tablespoonful plain vaselin and one dram flower of sulphur. Apply three times daily and you will get relief."
7. Piles, Steaming with Chamomile Tea for.—"A tea made of chamomile blossoms and used as a sitz bath is excellent; after using the sitz bath use vaselin or cold cream and press rectum back gently."
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PHYSICIANS' TREATMENT for Piles.—What to do first.—The palliative treatment of both varieties of external piles is the same. In all cases the patient should lie flat on his back in bed and remain there for a few days. Highly seasoned foods and stimulants, tea, coffee, whisky, wine, etc., must be discarded. Secure a daily half liquid stool by the use of small doses of salts, Hunyadi or Abilena water. Cleansing the parts with weak castile soap water is essential to allay the pain, reduce the inflammation and soothe the sphincter muscle; cold, or if it is more agreeable, hot applications may be kept constantly on the parts. Hot fomentations of hops, smartweed, wormwood, or poultice of flaxseed, or slippery elm, or bread and milk give almost instant relief in many cases; while in others soothing lotions, and ointments or suppositories are needed.
The lead and laudanum wash is always reliable.
Lead and Laudanum Wash.—
Solution of Subacetate of Lead 4 drams
Laudanum 20 drams
Distilled water enough to make 4 ounces
Mix thoroughly and apply constantly ice cold on cotton to the sore parts.
The following ointments, lotions, and suppositories to be used freely within the bowels and to the piles, are effective in relieving the pain, reducing inflammation and diminishing pain and spasm in the sphincter.
1. Ointment of Stramomium 1-1/2 drams
Ointment of Belladonna 2-1/2 drams
Ointment of Tannic Acid 1/2 ounce
Mix thoroughly and apply inside and outside the anus.
2. Camphor Gum 1 dram Calomel 12 grains Vaselin 1 ounce
This must be thoroughly mixed. Apply freely within the anus and to the piles. Good for the pain.
3. For External Piles cleanse them well with a sponge dipped in cold water, and then bathe them with distilled extract of witch hazel.
4. If there is much itching with the piles use the following salve:—
Menthol 20 grains
Calomel 30 grains
Vaselin 1 ounce
Mix and apply to the piles.
5. I use quite frequently the following for sore external piles:
Chloroform and Sweet oil in equal parts
Apply freely with cotton or on to the piles. Ten cents will buy enough to use.
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Operation for Piles.—When these measures do not relieve the pains or the piles become inflamed from slight causes and often, it is best to operate. This can be done in a few minutes with a local anesthetic and the patient frequently goes to sleep afterward, almost free from pain. Inject a three per cent solution of eucaine, or six per cent solution of cocaine. Thoroughly cleanse the part and hold the buttocks apart, pierce the pile at its base with a thin sharp-pointed curved knife, laying it open from side to side. Remove the clot with a curette, cauterize the vessel and pack the cavity with gauze to prevent bleeding and to secure drainage.
Cutaneous (skin) piles are operated upon as follows.—Each one is grasped in turn with a pair of strong forceps and snipped off with the scissors, or removed with a knife. Close the wound with sutures, if necessary, and dress it with gauze. Small ones need no sutures. Be careful not to remove too much tissue. Much after-pain can be prevented by placing in the rectum a suppository containing one-half grain of opium or cocaine before either of the above operations are performed. The after treatment is quite simple. Keep the patient quiet, cleanse the parts frequently, and secure a soft daily stool. Cleanse with tepid boiled water with clean sterilized gauze and give salts in small doses, one to two drams to produce a stool.
INTERNAL PILES. Symptoms.—The two prominent symptoms are bleeding and pain. The bleeding is usually dark. It may be slight and appear as streaks upon the feces or toilet paper; it may be moderate and ooze from the anus for some time after a stool, or it may be so profuse as to cause the patient to faint from loss of blood while the "bowels are moving." Death may follow in such a case unless the bleeding is stopped. The blood may look fresh and fluid or if retained for some time, it looks like coffee grounds, sometimes mixed with mucus and pus. Patients who bleed profusely become pale and bloodless, and are very nervous and gloomy and they believe they are suffering from cancer or some other incurable trouble. The first the patient notices he has internal piles is when a small lump appears at the end of the bowel during a stool and returns spontaneously; afterwards the lump again protrudes after the stool and others may appear. They become larger and larger, come down oftener and no longer return spontaneously, but must be replaced after each stool. As a result of this handling, they grow sensitive, swollen, inflamed and ulcerated, and the sphincter muscle becomes irritable. Later on one or more of the piles are caught in the grasp of the sphincter muscle and rapidly increases in size. It is then hard to relieve them, and when returned they act as foreign bodies, excite irritation and they are almost constantly expelled and the same procedure goes on at each stool. The sphincter muscle contracts so tightly around them as to cause strangulation and unless properly treated they become gangrenous and slough off.
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Recovery, Pain, etc.—The pain is not great in the early stages, but when the muscle grasps and contracts the pile or piles it becomes terrible and constant. Piles rarely end fatally. Palliative treatment does not afford a permanent cure. They frequently return, but by care and diet many can be kept from returning so frequently. They should be treated upon their first appearance when the chances of a permanent cure without an operation are much better.
PHYSICIANS' TREATMENT for Internal Piles.—What to do first. The cause should be removed. Restore a displaced womb. Regulate the bowels, liver, diet, and habits. Much can be accomplished by these measures if properly used, in allaying inflammation diminishing pain and reducing the size of the piles. These measures will not cure them if they are large, overgrown and protruding. When the piles are inflamed, strangulated or ulcerated, the patient should remain in bed in a recumbent position and hot fomentations of hops, etc., and hot poultices, of flaxseed, slippery elm, bread and milk, the ice bag, or soothing applications and astringent remedies, should be applied to the parts. In some cases cold applications are the best. The cold or astringent applications give the best results where the piles are simply inflamed and the sphincter muscle does not act spasmodically, jerkily. But when the piles are strangulated, "choked tight" by the sphincter muscle, hot fomentations, poultices and soothing remedies give the most relief, because they reduce spasmodic contractions of the muscle and allay the pain. Instead of the poultices and fomentations, the "sitz" bath can be used. Put in the steaming water, hops, catnip, tansy, pennyroyal, etc., and the steam arising will frequently give great relief. This can be given frequently; ten to twenty drops of laudanum can be added to the poultices when the piles are very painful.
1. For inflamed piles, the following combinations may be used:—
Gum Camphor 1 dram
Calomel 12 grains
Vaselin 1 ounce
Mix thoroughly and apply freely around the anus and in the rectum on the piles.
The external parts should always be bathed with hot water, thoroughly, before using.
2. Gum Camphor 2 drams
Chloretone 1 dram
Menthol 20 grains
Ointment of Zinc Oxide 1 ounce
Mix and apply directly to the piles.
3. When there is a slight bleeding, water of witch-hazel extract, one to two ounces to be injected into the rectum. This witch-hazel water freely used is good for external piles also. This is good and well recommended.
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4. If the protruded pile is inflamed and hard to push back, the following is good and recommended highly:—
Chloretone 1 dram
Iodoform 1 dram
Gum Camphor 1 dram
Petrolatum 1 ounce
Mix and use as a salve.
5. An ointment composed of equal parts of fine-cut tobacco and raisins, seedless, chopped fine and mixed with enough lard, makes a good ointment to apply on both external and internal piles.
6. Tea of white oak bark, boiled down so as to be strong, and mixed with lard and applied frequently, is good as an astringent, but not for the very painful kind. It will take down the swelling.
7. Take a rectal injection of cold water before the regular daily stool. This will soften the feces and decrease the congestion.
Preventive Treatment.—This is very important and includes habits and diet and other diseases. If the patient is thin and pale give tonics. Correct any disease of any neighboring organ. Attend to any disease that may be present.
For Constipation.—Take a small dose of salts or hunyadi water so as to have one semi-solid stool daily. If necessary remove any feces that may even then be retained, by injections of soap suds or warm water containing oil. Discontinue injections as soon as a daily full stool can be had without it.
Habits.—Full-blooded people should not use upholstered chairs as the heat of the body relaxes the tissues of the rectum. A cane seated chair is best or an air cushion with a hollow center. It is best to rest in bed, if possible, after stool for the rest relieves the congestion and soreness. An abundance of out-door exercise, when the piles are not present, or bad, consisting of walking or simple gymnastics may usually be indulged in; violent gymnastics and horseback riding must be avoided. A daily stool must be secured.
Diet.—Such patients should avoid alcoholic beverages, spiced foods, strong coffee, and tea, cheese, cabbage, and old beans.
Foods Allowed.—Potatoes, carrots, spinach, asparagus, and even salads, since they stimulate intestinal action and thus aid in keeping the stool soft. Stewed fruits, including grapes, oranges, pears, and apples. Water is the best to drink. Meats: tender broiled, boiled or baked beef—do not eat the inside part to any great amount. Other meats, but no pork or ham, fresh fish, chicken. The foods should not be too highly seasoned; vinegar is not to be used to any extent and this excludes pickles, etc.
PERIPROCTITIS. Abscess Around the Anus and Rectum. (Ano-rectal) (Ischio- rectal Abscess).—This is an inflammation of the tissues around the rectum which usually terminates in the above named abscess. It occurs mostly in middle-aged people. Men are affected more often than women.
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Causes.—Sitting in cold, damp hard seats; horseback riding, foreign bodies in the rectum such as pins, fish-hooks, etc., blows on the part, kicks, tubercular constitution, etc.
Symptoms.—Inflammation of the skin, like that of a big boil, some fever, throbbing pain, swelling of the part, heat and fullness in the rectum, these symptoms increase until the pus finds an outlet into the rectum.
PHYSICIANS' TREATMENT for Periproctitis.—Little can be done in a palliative way. It generally terminates in an abscess. Make the patient as comfortable as possible, by applying cold or hot things to the part, rest in bed, mild laxatives to keep the bowels open. Cut it open as soon as possible, and it should be laid wide open, so that every part is broken up. Then it should be thoroughly washed and scraped out. Sometimes it is necessary to use pure carbolic acid to burn out the interior. The dressing should be as usual for such wounds and removed when soiled and the wound washed out with boiled water and then gauze loosely placed in the bottom and in every corner of the wound. The dressing should be continued until all has been healed from inside out. Be sure to leave no cotton in to heal over it. Such patients should be built up with nourishing foods, and should remain quietly in bed. Cod liver oil is good for some patients. Iron, etc., for others. Keep the bowels regular. Outdoor life and exercise. If treated right it should not return.
FISTULA IN ANUS.—This usually follows the abscess. It has two openings, one upon the surface of the body near the anus, and the other in the rectum. There are a great many varieties of fistula, but it is unnecessary to name them. What can be done for them?
PHYSICIANS' TREATMENT.—If the general health is good an operation is the best thing to do, but patients in the last stage of consumption, nephritis, diabetes, or organic heart disease, are not apt to receive much benefit from an operation. The patient in poor condition should be given the treatment suitable to his condition, according to the advice of a trusted physician.