On surgical diseases of women / by I. Baker Brown.

  • Isaac Baker Brown
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On surgical diseases of women / by I. Baker Brown. Source: Wellcome Collection.

    400/468 (page 336)
    in the veins, and forms a semi-solid tumour, whilst the cel- lular tissue around becomes thickened, and the mucous membrane covering them excessively vascular and sensitive. I allude here to internal haemorrhoids of a varicose nature. The following cases will illustrate the preceding remarks :— Case XXII. — Hemorrhoids : Congestion of the uterus : Cure. — L. C, set. 31, unmarried ; had suffered for several years from three or four large piles, which, she stated, protruded in the act of walking, and also created great uneasiness in the sitting posture. Every three or four weeks she lost a considerable quantity of blood from them. Her bowels were seldom opened more than once in three or four days, and then only from taking some aperient. After each act of defaecation, she had always increased inconvenience and pain. She suffered much from indi- gestion, headache, and general lassitude. I first inquired as to the menstrual function, and found that, although she was generally regular every four weeks, the quantity was very small, and the discharge seldom continued more than one day, and that at this time she generally lost a considerable quantity of blood from the haemorrhoids. On making a digital examina- tion per vaginam, I found the uterus enlarged and painful to touch, and lower in the vagina than normal. I directed that three leeches should be applied to the os uteri, and that the bleeding should be encouraged by a hip- bath immediately on their removal ; that the bowels should be freely opened by a saline aperient, and that this treatment should be pursued once a week. She was further directed to take twice a day the sixteenth part of a grain of the bichloride of mercury, and her diet was ordered to be simple, nutritious, and unstimulating. The result of these measures was that, at the next menstrual epoch, there was a more copious uterine discharge, and an absence of bleeding from the haeinorrhoidal vessels. The same treatment was con- tinued for another month, and resulted in an improvement in menstruation, both in quantity and in the duration of its flow ; the uterus had much decreased, being nearly of its normal size, and not painful to touch. I now considered it advisable to remove the haemorrhoids, which I did by passing a ligature of twine around the base of each. I then placed the patient in bed, giving her a grain of opium every four or six hours, for the purpose not only of affording relief from pain, but also of constipating the bowels till the ligatures should come away, which they did in five or six days. The case progressed satisfactorily, and the patient returned to the country perfectly recovered. This case presents some striking practical facts, which will serve to illus- trate my preliminary remarks. 1. The bleeding from the haemorrhoids at the menstrual epoch. It is a fact that haemorrhoids are always more troublesome at the time of menstruation, because more blood is circulating through the blood-vessels of the rectum as well as of the uterus ; and if there be any obstruction in the uterine vessels to prevent the menstrual flux, then the haemorrhoids often bleed freely. 2. The enlarged and inflamed uterus, with the decrease of the men- strual flux. 3. The great relief afforded by the antiphlogistic treatment. 4. In ligaturing the haemorrhoids I prefer twine. Its advantages over silk are very marked :—first, in procuring a quicker separation of the tumour ; and, secondly, in causing less pain to the patient. It will also be observed, that I preferred the ligature to the scissors in the removal of these tumours, acting upon the golden rule laid down by my old and esteemed friend,