HEMORRHOIDS. 



81 



Operation, a dose of morphia may be given to promote quietness 

 and sleep ; and after 53 or 4 days a dose of castor oil, which will 

 bring away the contents of the bowel, and the dressings of the 

 wound. Subsequently it will only be necessary to attend to clean- 

 liness, and prevent the ed^es from uniting. 



If the opening be very high in the rectum, it is better to use the 

 ligature in preference to the knife, on account of the danger of 

 hemorrhage from the hemorrhoidal arteries. The ligature only is to 

 be used in phthisical cases; it gradually cuts itself out, and leaves 

 the part solid behind it. A blind fistula may be readily converted 

 into a complete one by puncturing the intestine should it be an ex- 

 ternal fistula, or the skin in case it should be an internal one. 



FISSURE OF THE ANUS. 



This is an ulceration or cracking of the skin and mucous mem- 

 brane, on the verge of the anus ; and is attended with intense pain, 

 especially upon going to stool. It results very often from dyspepsia, 

 and this circumstance must materially affect the treatment. Altera- 

 tives and laxatives are necessary to bring the bowels into a healthy 

 condition. The local applications are caustics and anodynes, such 

 as nitrate of silver, which has a soothing as well as antiphlogistic 

 power ; opium, in the various forms, of ointment, solution, and 

 poultice. Sometimes it is necessary to excise the part, or divide the 

 sphincter ani muscle. 



HEMORRHOIDS. 



Piles, or hemorrhoids, are divided into external and internal. 

 They are more common in males than in females, and rarely occur 

 in children. The predisposing causes are whatever tends to deter- 

 mine the blood to the rectum, such as constipation, pregnancy, 

 sedentary habits ; and the exciting causes may be purging, diar- 

 rhcea, &c. 



External Tiles are a congeries of varicose veins, surrounded by 

 condensed cellular tissue. In some cases, bleeding occurs from 

 ulceration of the skin or mucous membrane covering them. When 

 they do not bleed, they are said to be blind. When the blood has 

 coagulated, they become hard. Usually, there is more than one. 



The palliative treatment consists in the application of astringent 

 and anodyne ointments, made of galls, opium, &c., and the regula- 

 tion of the bowels with laxatives, such as sulphur, rye mush with 

 molasses, &c. 



The radical treatw.ent is removal by scissors or bistoury ; arrest- 

 ing the hemorrhage, and producing a hfealthy ulcer. A recent tense, 

 single pile, may be successfully cured sometimes by freely eva- 

 cuating its contents by a lancet. 



Internal Files may be of the same nature as external ones, or of 



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