Licence: Public Domain Mark
Credit: The rectum and anus : their diseases and treatment. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![eventually producing a spontaneous cure, which, how- ever, is frequently incomplete, as the entire pile seldom dies, and the ragged portion which remains is likely to give trouble at some future time. Bleeding during the separation of the sloughing pile is not of uncommon occurrence. The treatment to be adopted may be either temporary, or radical. In the first instance re- duction of the piles within the sphincter should be attempted : and if the case is seen early, and is not complicated by much external inflammation, re- duction can usually be readily effected. In order to accomplish this, it is best to try and re])lace the most central portion first by passing the finger into the rectum, and as it is withdrawn to force up the remainder of the prolapsed portion. It is, however, better practice to obtain the permission of the patient to perform the radical operation at once ; and, owing to the very severe pain usually attendant on this condition, there is no difficulty about this. I on one occasion had under care a patient who had previously obstinately refused to have any operation performed on his piles, but who became loud in his entreaties to have them removed once strangulation super- vened. Should piles be operated on during inflamma- tion ? is a question upon which considerable difler- ence of opinion has been expressed. Those surgeons who oppose operation appear to me to base their objections purely upon theoretical grounds : no bad results, as far as I know_, have been recorded; and, OR the other hand, those surgeons who have made a practice of operating express themselves favourably to it. My own practice, when called to a case of strangulated piles, is to recommend the immediate administration of an anaesthetic, dilatation of the sphincters, and the complete removal of all piles that](https://iiif.wellcomecollection.org/image/b21229387_0267.jp2/full/800%2C/0/default.jpg)
