About the time that Kelsey, after having deposited five drops of a carbolic acid solution in the center of a large tumor, observed it looking dark, angry and inflamed from the intrusion of a foreign substance, would have been a fitting moment for a full dose of carbolic acid, of suitable strength and in sufficient quantity to pervade the entire structure and form a compact coagulum; strangulating the circulation, cauterizing the tissue and thereby checking the inflammatory action at once; then followed up by the liberal application of hot water and a sponge.
The method that I adopt and recommend for the removal of piles, not only does the work neater and cleaner than the more heroic measures in vogue, but robs the patient of the terrors of etherization, as well as the dreaded consequences incumbent upon and more or less inseparable from operations of violence, in a peculiarly organized and sensitive locality; and, as Dr. E. F. Hoyt, of New York, says: “There is not a hemorrhoidal case possible but what can be obliterated by this means; and I am at a loss to explain why so many cling to methods that carry so much havoc and suffering. If every college in the land would have this subject demonstrated by men of experience and learning, all other means would soon lose recognition.”
I shall not take up time and space in enumerating cases but will briefly mention three of quite recent date, and of more than common interest on account of some of the associated history given.
Manuel L., aged 39, capitalist, had arranged his business affairs and prepared for the possible results of a ligature operation. All being in readiness, he was placed on the operating table by a prominent surgeon, who, upon examination, found the hemorrhoids to look so formidable in appearance that he refused to proceed further, stating that the operation might prove fatal.
On his first visit to me, he was asked to use the commode and strain out the piles, which presented to view a large, continuous hemorrhoidal mass encircling nearly one-half the bowel on one side, with five distinct and typical tumors on the other, similar to [Fig. 1]. He was directed to lie on the operating chair with the large growth oil the upper side, and about 30 minims of the carbolic acid preparation was injected in three different places in the mass, the protrusion returned and the bowels constipated for four days; after which the bowels were moved by an enema of slippery elm water, when not a vestige of the growth could be seen, and no pain.
He put his hand back to push in the bowel, as he had been accustomed for the past eight years, and found it gone; whereupon he said if this had occurred in the day of miracles, he would think me Jesus Christ. One operation is all that is required for the remaining five tumors, and both piles and prolapsus are cured by two operations. In fact, the smaller tumors should have been taken first, when the opportunity to get at them was much better.
The only inconvenience suffered was from an effort to hold the bowels, and the after-pain, which lasted about 14 hours, but was not severe; during which time an opium suppository was introduced every two or three hours. He stated that he was just getting over an attack of La Grippe and had been purged pretty freely, consequently did not evacuate the bowels previous to operation, but advised a liquid diet for the first three days.
George P., aged 37, druggist, had a continuous hemorrhoidal mass occupying both sides of the bowel when protruded, being separated only by an anterior and a posterior commissure. Glaring fibrous bands seemed to bind down the enlargements in places, presenting anything but an inviting case. He also had an arterial hemorrhoid attached just above the verge, constantly hanging out and exciting the external sphincter; looked like and was about as large as a medium sized strawberry, irritable and eroded.
The history of the case and the extreme ungainly appearance of the protrusion induced me to have it photographed. It is approximately represented in [Fig. 2], but does not show the fibrous bands. The patient was placed on the side opposite the larger mass, which was injected at four different points. The bowels were constipated for four days by the occasional introduction of an opium suppository and then moved by enema, when the man shed tears of joy on having no pain at stool and finding no protrusion on that side. The next operation took the other side, together with the strawberry, and the case discharged, cured of piles and prolapsus.
Both of these gentlemen had been told time and again that the carbolic treatment was ineffectual and dangerous. One ex-army surgeon and college professor said he would not attempt any of the heroic operations in the second case, as there was too much tissue involved; that he would only agree to treat it by making local applications twice a week.