RESUMÉ.
Do not operate during an attack of piles.
Operate with the tumor, or tumors, on the upper side.
Handle the parts with extreme gentleness and deliberation.
See all that can be seen and treat all that can be treated without the aid of a speculum.
Protect the under parts from excoriation by waste and overflow of medicine.
Evacuate the bowels previously and constipate for four days after operation on large growths, or when several small tumors are taken at one time.
Hot water sponge compresses, early, often and continuously, are indispensable and unequaled for the relief of a pain, swelling and soreness. To be effective it should be applied as hot as can be borne.
Wait until the soreness disappears before performing a second operation. This will require from one to two weeks, according to the extent of the first operation and the physical condition of the patient.
Take great pains and care to perform a neat operation. A certain amount of ingenuity and tact are required, which, unfortunately, all do not possess. If a bungling job be made, the bowel punctured, a pile injected on one side only and the surfaces excoriated, do not attribute an unnecessary amount of pain and suffering to the preparation used or the method employed.
As a general alterative and curative agent in many diseases, and particularly to relieve and prevent hemorrhoidal congestion in rectal troubles, sulphur in small doses, persisted in for some time, probably has no equal. The most convenient form for administration is a palatable tablet (Wyeth & Co.), containing 2½ grains, or 5 grains with 1 grain of cream of tartar. Reference to the learned articles on the physiological and therapeutical uses of sulphur, by Dr. John V. Shoemaker, published in the Dietetic Gazette, Sir Alfred B. Garrod in the Lancet, and in Ringer’s hand-book of therapeutics, will be amply repaid.
Fig. 10.—Position for operating, or making a rectal examination. Engraving kindly furnished by Sharp & Smith, who manufacture one of the best office and operating chairs combined, on the market. It works without “cranks,” “levers,” or “ratchets.” Upholstering is entirely protected during an operation.
It is unnecessary for a lady to disrobe herself for examination, or suffer immoderate exposure. A cloth cover should be used, when a lady patient is placed on the chair, the same as in gynæcological practice.