In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which might be excessive and prove hurtful to one, may be very moderate, and even salutary to another. That only is to be esteemed dangerous which continues too long, and is in such quantity as to waste the patient’s strength, hurt the digestion, nutrition, and other functions necessary to life.
When this is the case, the discharge must be checked by a proper regimen, and astringent medicines. The DIET must be cool but nourishing, consisting chiefly of bread, milk, cooling vegetables and broths. The drink may be chalybeate water, orange-whey, decoctions or infusions of the astringent and mucilaginous plants, as the tormentil root, bistort, the marsh-mallow-roots, &c.
Old conserve of red roses is a very good medicine in this case. It may be mixed with new milk, and taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its being seldom taken in such quantity as to produce any effects; but when taken as here directed, and duly persisted in, I have known it perform very extraordinary cures in violent hæmorrhages, especially when assisted by the tincture of roses; a tea-cupful of which may be taken about an hour after every dose of the conserve.
The Peruvian bark is likewise proper in this case, both as a strengthener and astringent. Half a drachm of it may be taken in a glass of red-wine, sharpened with a few drops of the elixir of vitriol, three or four times a-day.
The bleeding piles are sometimes periodical, and return regularly once a month, or once in three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical discharge of blood from the hæmorrhoidal veins.
In the blind piles bleeding is generally of use. The diet must be light and thin, and the drink cool and diluting. It is likewise necessary that the body be kept gently open. This may be done by small doses of the flowers of brimstone and cream of tartar. These may be mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftner if necessary. Or an ounce of the flowers of brimstone and half an ounce of purified nitre may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day.
Emollient clysters are here likewise beneficial; but there is sometimes such an astriction of the anus, that they cannot be thrown up. In this case I have known a vomit have a very good effect.
When the piles are exceeding painful and swelled, but discharge nothing, the patient must sit over the steams of warm water. He may likewise apply a linen cloth dipped in warm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possible, or, if they will fix upon the piles themselves, so much the better. When leeches will not fix, the piles may be opened with a lancet. The operation is very easy, and is attended with no danger.
Various ointments, and other external applications, are recommended in the piles; but I do not remember to have seen any effects from these worth mentioning. Their principal use is to keep the part moist, which may be done as well by a soft poultice, or an emollient cataplasm. When the pain however is very great, a liniment made of two ounces of emollient ointment, and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied.