These venous swellings often cause so much pain and trouble, are so often chronic and unyielding to medical treatment, that surgical interference becomes now and then a necessity. The operation for their relief and cure is an extremely common one, and nowadays is limited to a very few different methods.
The carbolic acid treatment which has found favor with many consists in the injection into the pile of a small amount of carbolic acid dissolved in glycerine or water. The process is simple and almost painless, especially if done after numbing the parts with a three per cent cocaine solution. The carbolic coagulates the blood and albumen of the tissues and causes a death of the parts with a subsequent sloughing and puckering. The advantage of this procedure lies in the ability of the patient to be up and about. The danger lies in the risk of setting free a clot in the circulation, causing most serious consequences and even ' death. It should be used only in selected cases and then not too freely. Not over a stronger solution than two per cent. in strength should be used.
A second method, and by far the oldest, is to encircle the pile with a ligature and allow it to eat through, thus destroying the pile and causing it to heal behind the ligatures. This method is painful, requires ether and necessitates rest in bed. A third way is to burn off the pile by means of a cautery and clamp. It is far preferable to the ligature, requiring but a few days' stay in bed, and is less painful. A fourth, and the most scientific method, is one just coming into prominence, and consists in dissecting out the pile area and sewing the flaps of mucous membrane and skin together.
Numerous washes, ointments, and lotions have been used to temporize, but the only sure and thorough way to treat obstinate piles which remain after continued and unsuccessful attempts to remove the original cause, is to remove them once for all. The, following salve will be found useful: cocaine, eight grains; gall ointment, half an ounce; mix. Smear well over the piles and then push them up into the bowel. Piles should always be returned into the bowel when possible; this of itself, when practicable, oftentimes constitutes a cure.
Whenever a small, round, hard pile is seen on the outside and is very painful, it should be incised, after numbing with a cocaine solution, and the clot turned out. This simple and painless procedure works great relief and often a cure.
The bowels are to be kept open daily by a solution of the citrate of magnesia (one half bottle), which keeps the bowels loose and causes no pain in defecation.
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