The treatment of this disease, when it occurs during pregnancy, is two-fold—general and local. We must remove the cause by such means as excite a brisker action of the bowels; and our choice of aperients must be directed to those which act efficiently but mildly, and without irritating the lower bowel itself.[[24]] Next to small and repeated doses of castor oil—say a tablespoonful,—the most desirable form of aperient that can be employed is the confection of senna, that is, lenitive electuary, combined with sulphur and magnesia. Of the following form, a dessert-spoonful or more should be taken, at first, twice daily:—Confection of senna, two ounces; flowers of sulphur, one ounce; carbonate of magnesia, two drachms and a half. In conjunction with this medicine, much benefit may be derived by the injection of half a pint of warm or cold water—whichever soothes most—as a lavement; but it must be administered very cautiously, to avoid irritating the parts with the pipe of the instrument.
It is important that medicine, in frequent use, should be so taken as to act upon the bowels in the evening only; for if the bowels are acted upon in the morning, the patient being obliged to move about all day, will suffer considerable distress and local irritation; whereas, if the bowels are not evacuated till the evening, the horizontal position, and the perfect rest of a long night, will obviate all inconvenience.
Great assistance may be afforded in the cure, and also in alleviating pain, by external applications to the tumours themselves. If, however, the piles are swollen and inflamed, and the pain experienced great, half a dozen leeches, or from half a dozen to a dozen, should be first applied in their immediate neighbourhood, the parts fomented, and then warm bread and water poultices renewed every three hours.
These remedies will afford very considerable relief; and, when the inflamed state is subdued, an ointment must be applied to the tumours and around them night and morning, composed of two drachms of powdered galls, half a drachm of camphor, and two ounces of lard; or composed of one drachm of powdered black hellebore root, rubbed down in one ounce of lard. The latter preparation will, for some time after its application, give much pain, but proportionate relief will follow.
The diet must be sparing in quantity, mild in quality, and such as to leave after its digestion, as little to pass through the bowels as possible.
I would beg attention to one more observation on this subject. The removal of piles by operation, during the pregnant state, is perhaps never justifiable. Let the patient, therefore, consult her medical attendant in time, and not by a false delicacy expose herself to an evil which it is her duty to endeavour to prevent.
Enlargement of the Veins of the Legs.
This is a frequent, but not very troublesome, accompaniment of the latter months of pregnancy. It arises in some degree from the pressure of the womb upon the large venous trunks, impeding to a certain extent the free flow of blood through them. It is frequently remarked in pregnant women who have passed a certain age; but it is particularly unusual for it to happen, in the case of young women, even during a series of repeated pregnancies.
When first observed, if the veins have not become knotty,—that is, having little lumps or swellings in their course up the leg,—the only means which it is necessary to employ, is the application of a muslin or cotton bandage,—six yards in length, and as wide as three fingers—from the sole of the foot up to the knee, and sufficiently firm to give support to the venous trunks. This bandage well and equally applied to the limb, with a little aperient medicine twice a week, and the recumbent position for two or three hours in the middle of the day, will cure this form of the affection.
When after a time the veins, more and more distended, have become lengthened, tortuous, coiled up or knotty, the female begins to experience a sense of heaviness, numbness, and sometimes very acute wandering pain, through the whole of the affected limb. In a more advanced stage, in proportion as the knotty tumours increase, the limb becomes generally swollen.