Food prepared according to the modern modes of cookery, is one of the causes which favors the developement of this derangement. People live too exclusively upon bolted wheat flour. The branny portion of a kernel of wheat consists of various nutritive elements, with more than five times the amount of phosphate of lime contained in fine bolted flour. Those who daily use boiled cracked wheat are not troubled by constipation. There is no dryness or hardness of the feces, and the bowels are evacuated without discomfort.
Treatment. Prevention is always better than cure; hence, a few hygienic directions may not be amiss. Do not disregard the intimations of nature, but promptly respond to her calls. If there is constipation, overcome it by establishing the habit of making daily efforts to effect a movement of the bowels. Taking regular exercise by walking, and lightly percussing or kneading the bowels for five minutes daily, help to increase their activity. The habit of early rising favors the natural action of the bowels. Drinking a glass of water on rising exerts a beneficial influence. The food should be such as will excite the mucous secretion of the large intestines, and arouse its muscles to action. For this purpose, there is no one article that excels coarsely-cracked boiled wheat. Graham bread, mush, cakes, gems, and all articles of diet made from unbolted wheat flour are valuable auxiliaries, and may be prepared to suit the taste. Take the meals at stated hours; be punctual in attendance, regular in eating, and thoroughly masticate your food. Irregularity in the intervals between eating, disturbs the functions of the intestine. The use of ripe fruits, such as apples, pears, grapes, figs, and prunes, in proper quantities, is sometimes very beneficial. Trivial or unimportant as these hygienic suggestions may appear, yet were they observed, constipation, as well as most of the diseases incident to it, would be obviated. A large proportion of the cases will yield to the foregoing hygienic treatment without the employment of medicines. Should it be necessary, however, to employ an aperient to relieve the constipation, Dr. Pierce's Golden Medical Discovery will act most congenially, and will be followed by no constipating reaction, which invariably occurs when drastic cathartics are employed. Its operation is mild, bringing about a healthy action by promoting the biliary and other secretions, thus aiding nature in establishing normal functional activity in the bowels. Recourse should be had to it before employing any thing more strongly cathartic. However, should it prove too mild in its aperient effects, small doses of Dr. Pierce's Pleasant Pellets may be employed daily to assist it. Unlike other cathartics, they produce a secondary tonic effect upon the bowels, which renders their influence more lasting than that of other purgatives. We cannot too strongly discourage the injurious custom which many people have of frequently scouring out their bowels with strong cathartics. It is a bad practice, and cannot fail to do injury. The greatest benefit is derived, not from cathartic doses, but from taking only one or two of the "Pellets" per day, or enough to keep the bowels regular, and continuing their use for several weeks, in connection with Dr. Pierce's Golden Medical Discovery, strictly carrying out the hygienic treatment heretofore advised.
The medical treatment of individual cases sometimes involves many considerations relative to the particular circumstances and complications presented. The peculiar susceptibility of the constitution, as well as the diseases incident to constipation, must be taken into account. Symptomatic derangement should not be treated as primary, although it is by inexperienced physicians. If the patient be afflicted with uterine disease, piles, nervous affections, falling of the lower bowel, or fistula, they should be treated in connection with this disease. For these reasons, we would advise our readers to submit all complicated cases, or those that do not yield to the course heretofore advised, to a physician of large experience in the management of chronic diseases, and not assume the great responsibility and the dire consequences which are very liable to arise from the improper treatment of such cases. We have been called upon to treat thousands of cases of this troublesome affection, and as a result of our vast experience, and in consequence of our original and improved methods of diagnosis, it is not generally necessary that we should see and examine the patient in person. We can almost always determine the exact nature of the patient's malady, and its stage of advancement, without seeing the subject in person.
PILES. (HEMORRHOIDS.)
There are few maladies more common than this, and few which are more annoying. Piles consist of tumors formed within the rectum and about the anus, by dilatation of the hemorrhoidal veins and thickening of their walls. Sometimes, when attended by considerable inflammation, or when the attacks are very frequent, there is thickening of the adjacent cellular and mucous tissues.
There are two general forms of this disease, the external or blind piles, in which the tumors are outside the anus, and the internal or bleeding piles, in which the tumors are formed within the sphincters, although after their formation they may protrude. The external piles are commonly made up of thick tissues; upon one side, the skin forms the covering, while on the inner surface is the mucous membrane of the bowel. It is this surface which is most tender and irritable and liable to inflammation. The internal form of the disease is situated from a half an inch to two and a half inches above the sphincter muscle of the anus. The tumors are usually round, oval or cylindrical in form. They may be scattered over the surface of the bowel, or clustered together. The illustrations (Figs. 1 and 2) show the two forms of the disease. The two protruding tumors in Fig. 2, illustrate the usual form of prolapsing internal piles, whilst the one highest up in the bowel shows the form most commonly met with. It is seldom that one pile tumor is found alone, there usually being two or three, and sometimes as many as five or six, in a cluster. Fig. 3 shows the manner of distribution of the veins in the rectal region. The small venous loops, or bulb-like terminations of the veins H. i., are the points at which the piles most frequently occur.
Causes. Whatever tends to favor an undue accumulation of blood in the hemorrhoidal veins predisposes to piles. For this reason the affection is frequently a result of diseases of the heart and liver, which cause an obstruction in the circulation of the blood through the portal vein. Mechanical pressure from tumors in the abdomen, pregnancy, or an enlarged or misplaced uterus, is not infrequently a cause of the disease, by keeping the hemorrhoidal veins over-distended. Those diseases which provoke much straining, as stricture, inflammation or enlargement of the prostate gland, and stone in the bladder are also active causative agents. The most common cause of all, however, is constipation; and persons of indolent, sedentary and luxurious habits of life are the ones most frequently affected with this derangement. The following are also prolific causes of piles, viz.: pelvic tumors, violent horseback exercise, indigestion, pregnancy, habitual use of drastic cathartics, diarrhea, dysentery, sitting on heated cushions, long-continued standing posture, diseases of the liver, worms, the wearing of tight corsets, eating highly seasoned or indigestible food, and the use of alcoholic stimulants. No age is exempt from piles, nor is the disease peculiar to either sex. Aside from the serious inconvenience and pain which are experienced with most forms of piles, there is a tendency to fistula, and to cancer in the rectal region. It is important, therefore, that the disease should not be allowed to run on unchecked.
Symptoms. The most common symptoms at first are slight uneasiness, such as a little soreness or itching at the verge of the anus, and at times lancinating pains. These sensations are more severe as a rule if the bowels are constipated. If the piles are external they frequently become inflamed, swollen and painful, and in some instances they suppurate, which usually results in relief. When internal piles have increased to any considerable extent, or have become inflamed, they produce not only itching at the extremity of the bowel, pain in the back, etc., but also a sensation of fullness in the rectum, as though some foreign body were present, and, on action of the bowels, there is a sensation as though a portion of the fæces had not been expelled. When the internal piles become large, they frequently come down with fæcal matter from the bowel, as illustrated in Fig. 2, and this prolapsus becomes more and more marked with the progress of the disease, until, in many cases, the tumors are forced down at each action of the bowels, causing excruciating pain until they are properly replaced. Usually, in the early stages, they recede spontaneously; however, after a time it becomes necessary for the sufferer to press them back, but in some instances this is impossible. Frequently during the protrusion one of the hemorrhoidal veins gives away, and this is followed by a free escape of blood, and ulceration may ensue. Not infrequently with this disease the patient loses strength and flesh, and the face becomes pale and puffy, assuming a waxy appearance. Many times there is nausea, with vertigo. Is consequence of the relaxation, the bowel may descend when on the feet, or with some extra muscular effort, especially when stooping. These symptoms may not all be present in one person, and, indeed, sometimes are somewhat obscure; when such is the case, an examination by a competent physician will always determine the true character of the complaint at once.