Remarks on the treatment of piles and allied affections, including pruritus ani / by T. Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the treatment of piles and allied affections, including pruritus ani / by T. Lauder Brunton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/19 (page 9)
    course the saline ought not to be too violent, or it will tend to cause local congestion and make matters worse. Aloes bears an evil repute on account of its irritant action upon piles, but its effect depends upon the quantity given; and while a large dose of an aloetic pill will almost of a certainty produce rectal irritation, small doses such as grain of aloin three times a day with each meal, will tend to lessen piles by keeping up a gentle peristaltic action and preventing constipation. My friend, Mr. Archer, tells me that he has used with invariable success half an ounce of castor-oil given to begin with, and followed up by half a drachm every morning for a month. > I have already discussed the prevention of portal congestion from chills, but when it has occurred a useful application is a hot- water india-rubber bag, with a plush or flannel covering, put under the back of the neck, and a similar one over the liver. This tends to restore the equilibrium of the circulation and lessen portal congestion. Exercise is useful in keeping the liver free, but this exercise must be of a certain kind. As I have already said, the liver is a very spongy organ, the blood pressure within it is very low, and the pressure under which bile is secreted is also very low. Both blood and bile, therefore, tend to stagnate within it, but this stagnation is lessened by the liver being rhythmically squeezed, more or less forcibly, between the diaphragm and abdominal muscles. In a person standing or sitting upright, or lying on either side, this {squeezing action is very slight; in a supine posture it is slightly j greater. In ordinary walking it is also very slight, but in walking lup a hill, and especially in climbing a mountain, the amount of ]pressure to which the liver is subject is considerable, because the 1 muscles of the abdomen in such exercise are actively contracting, jand the movements of the diaphragm during the panting breathing 'which occurs on exertion are much greater than when a person is t quiet, A similar process of squeezing occurs in brisk horse exercise, (either trotting or cantering, and thus riding is frequently beneficial ffor piles, notwithstanding the increased local irritation from contact Awith the saddle. Another useful exercise is to touch the toes xwith the fingers, keeping the knees straight, several times every : morning. A regular action of the bowels is of the utmost importance lin preventing piles, because it tends not only to keep the circu- llation through the liver free, but prevents straining. The difierent