616 AFFECTIONS OF THE INTESTINAL CANAL. 



tering into the question whether, in so-called plethora, there is actually 

 an increase of the amount of blood, or only an increase of the blood- 

 cells, or of the albumen in the blood (polycythaemia and hyperalbumi- 

 nosis, Vogef), certain rules of life may be laid down for the affected 

 persons which correspond to the physiological and practical view of 

 the affection : 1. The use of protein substances must be limited ; the 

 patient should only eat a little meat or egg once a day, but should 

 eat vegetables, fruit, rice, etc. 2. The consumption should be increased ; 

 the recommendation of long walks and energetic muscular exercise, 

 and drinking plenty of water, which hasten the transformation of ma- 

 terial, is just as rational as forbidding spirituous liquors, and tea and 

 coffee, which seem to retard the transformation. 3. Such patients 

 are very greatly benefited by saline purgatives, particularly by the 

 moderate and continued use of glauber salts and chloride of sodium, 

 as they occur in the waters of Marienbad, Kissengen, Homburg, 

 Soden, etc. The use of the waters at Karlsbad requires great precau- 

 tions, on account of the high temperature of the springs. If it be 

 proved that, by this treatment, the blood grows richer in salts, and 

 poorer in albumen (G. Schmidt, Vogel), there would be a rational ex- 

 planation of its brilliant results in the treatment of plethora. 



The indications from the disease do not present any further rules 

 in cases where occasional moderate suffering is speedily relieved by the 

 occurrence of spontaneous haemorrhage ; we content ourselves with ful- 

 filling the causal indications as well as possible. But if the patients are 

 tormented with severe molimina, which do not disappear after the re- 

 moval of any existing constipation, we should apply from four to six 

 leeches about the anus. After the leeches drop off, we should encour- 

 age the bleeding, by placing the patient on a night-stool, with a vase 

 of warm water under it. The same proceeding is advisable when great 

 fulness and excessive tension of the varices cause severe pain, or if 

 haemorrhoids are accompanied by painful tenesmus. We should let 

 moderate bleeding continue, particularly when it promises relief from 

 troublesome symptoms, and should only use cold or styptics when the 

 loss of blood is considerable. Haemorrhoids that have come down and 

 been strangulated should be replaced by continued careful pressure 

 with a bit of oiled linen, while the patient rests on his knees and 

 elbows, with the body bent far forward. Inflamed haemorrhoids should 

 be covered with cold-water compresses, or bladders filled with cold 

 water. We will not discuss the operative treatment. 



With our view of haemorrhoids, we cannot follow the ruling custom, 

 and speak also of remedies for " bringing on suppressed piles." Luckily 

 for the patients, the remedies recommended for this end, such as peri- 

 odical abstraction of blood, warm sitz-baths, irritating suppositories. 



