A swelling or lump which often appears immediately after injection of piles of any considerable size just above the verge, is of no consequence and will subside within a few days. A similar swelling sometimes results from a severe attack of internal hemorrhoids, which some speak of as the developing of an external pile, but I do not see that such formations are anything more than marginal swellings, caused by the irritation above.
SECONDARY HEMORRHAGE.
About the time the tumor is thrown off, between the third and fourth day, and sometimes later, before the healing surface becomes strong, or should the portal circulation become obstructed and the hemorrhoidal vessels congested, secondary hemorrhage may rarely occur. It is easily controlled by the use of Monsel’s Salt, to which a little morphia should be added, carried in a small piece of wet absorbent cotton, and held on the ruptured vessel by the end of the finger until the hemorrhage ceases. A few minutes will usually suffice. Knowing where you operated will be a guide to the place of application. The injection of a strong solution of tannic acid will be sufficient in mild cases. I have never known a secondary hemorrhage, following carbolic acid injection, amount to anything more than an easily controlled venous hemorrhage. Am inclined to think secondary hemorrhage is most likely to occur when a pile breaks down from a partial injection, leaving the vessels unprotected in places, or from an injection too deeply into the substance of the bowel; yet, I have seen all these conditions time and again without the least tendency to hemorrhage.
CARBOLIC ACID POISON AND EMBOLUS.
With a fifty per cent. solution of carbolic acid and the combination given, carbolic acid poison and embolus are entirely out of the question. The only danger of embolus lies in the too sparing use of a weak solution of carbolic acid, injected slowly into the unobstructed calibre of a coursing vein. While a strong solution quickly and generously applied would destroy the tissue and obliterate the vessel as effectually as the hot iron.
SLOUGHING.
The extensive sloughing that I have heard of so much I have never experienced, and am not able to conceive of such an occurrence, except it be in a very low state of vitality; but can imagine how a pile would slough if a few drops of carbolic acid were deposited in the center, or deeply into its base, leaving the apex and greater portion of the growth with a free circulation. A weak solution taking effect in the interstices of the most tender part of a hemorrhoid, but not sufficiently strong to attack the more fibrous portion, would doubtless result in inflammation and slough. A pile with a thin delicate covering and internal structure can be cured by an injection of water, while those of a more tough and fibrous character would only be exasperated by such annoying treatment and behave in a bad manner.
In looking over the comments of Kelsey, Andrews and others regarding the injection of hemorrhoids, it appears quite evident that they have not given the subject scientific study. It would seem that representative men and authorities, after a knowledge of the brilliant results following the treatment in many cases, attended by accidents in others, would seek to know and try to obviate the cause or causes of these unexplained irregularities.
They never improved upon the method in its primitive and undeveloped state, but seemed willing to magnify and enlarge upon all the accidents and complications arising from and following the indiscriminate use of all sorts of injection compounds, in the hands of the ignorant and inexperienced, and in diverse and unfavorable conditions for treatment.
How about the old methods? Only a few months since my attention was attracted to a gentleman of prominence, in middle life, strong body and good habit, who had been operated upon for the removal of piles by ligature. He was seven months in recovering, during which time two fistulas developed. I do not mention this case as an isolated one, because we all know that excessive and prolonged pain, causing in some instances lock-jaw and death, retention of urine, sloughing and stricture by contraction of tissue, abscess, fissure, fistula, intractable ulceration, hemorrhage, immediate or secondary, great and lasting prostration and slow recoveries, saying nothing about the dangers of anæsthesia etc., are not uncommon when the old methods are practiced.