Licence: In copyright
Credit: Aids to surgery / by Joseph Cunning. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
363/420 page 353
![The veins may be varicose and cause no symptoms till an attack of thrombosis is induced by exposure to cold, alcoholic excess, the use of strong purgatives, or conges- tion of the liver. Piles are either external, internal, or both. External Piles are situated below the external sphincter and covered with skin. Internal Piles above it and covered with mucous membrane. External piles appear as folds of skin radiating from the anus, each containing a central varicose vein. They cause no symptoms unless inflamed, when the pile becomes dis- tended with blood-clot. The inflammation subsides in a few days, leaving the pile larger and firmer than before. The Treatment of external piles when uninflamed con- sists in preventing constipation, keeping the parts clean, and applying hamamelis ointment. They seldom need removal, except when associated with internal piles. Inflamed piles should be treated by rest, a larg-e warm enema, and fomentations. If there is much pain, the pile should be incised and the blood-clot turned out. Internal Piles are at first soft, but if existing long become harder. The mucous membrane covering them is deep red and thickened, and the piles may protrude during defascation. There may be discharge of mucus and blood with the motions. The mucous membrane is smooth and shiny in the piles which do not bleed readily, roughened and granular from dilated capillaries in those that bleed. The Symptoms consist of a feeling of fulness and bleeding, which if persistent leads to an;emia. The piles may become prolajDscd, and even strangulated by the sphincter. The bleeding is beneficial in some cases of cirrhosis of the liver and heart disease. Complications.—Phlebitis in a pile, known as 'an attack of piles,' causes it to become blue, swollen, and tender. The attack may subside and lead to natural cure, or suppuration may come on, and perhaps cause pyaemia. Strangulation may follow ])rolapse, ancl lead to sloughing, with the danger of pyitmia. Prolapse may become chronic, and fissure of the anus may be associated. Treatment—General.—Constipation must be prevented by taking confectio sennas daily, and avoiding excess in eating or drinking.](https://iiif.wellcomecollection.org/image/b21510891_0363.jp2/full/800%2C/0/default.jpg)
