5. Crushing

Crushing of piles has been suggested by Pollock and the method further improved by Allingham,1 who devised a very ingenious apparatus for this purpose, namely, the "screw-crushing instrument." The operation begins with the dilatation of the sphincters. The hemorrhoid is then drawn into the screw-crusher by means of a hook, and this being intrusted to an assistant the bar is pushed up and screwed home as tightly as possible. The pile should be crushed longitudinally and not transversely. The projecting portion of the pile is cut off with the knife or scissors and the pressure kept up for about one minute. According to Allingham crushing is a very satisfactory method of removing internal piles.

6. Thermo-Cautery (Paquelin) And Galvano-Cautery

Lan-genbeck introduced the method of operating upon piles by means of thermo-cautery. Each pile is seized with a volsellum forceps and drawn well down. The clamp is then applied so as to embrace its base. The portion above the clamp is cut off with a pair of scissors and the cautery-iron, heated to a dull red heat, is repeatedly applied to the stump until all the vessels are well seared.

Instead of using the Paquelin, galvano-cautery may be applied for the removal of hemorrhoids, the technique being identical with the former. Bardeleben and also Ro-senheim strongly recommend the latter method.

1 Allingham: "Diseases of the Rectum." 1896, p. 153.

7. Extirpation Of Hemorrhoids, Followed By Suture

This method was first introduced by von Esmarch 1 in Germany and by Whitehead in England. It is not, however, extensively used as it is quite complicated, besides giving rise to many disagreeable complications. Thus Allingham has noticed the following sequels of such an operation: 1. Anal stricture. 2. Loss of sensation and control over the anus. 3. Irritation of the mucous membrane due to frequent discharges of mucus and at times accompanied by bleeding.

After any of the above-named operations it was customary to employ an astringent in order to prevent a movement of the bowels for a few days. Contrary to this method E. Graser2 is of the opinion that such patients are better off when having a free movement shortly after the operation. He administers soon after its performance a small dose of castor oil and instructs the patient to have an evacuation while in a warm sitz bath. Cleansing of the anus is very easily obtained in this manner. After an antiseptic washing a piece of cotton or linen, thickly smeared with an ointment, is introduced into the rectum. This procedure has usually to be performed once daily. According to Graser, the patients if thus treated are almost without pain, and are able to get up and be out of bed five or seven days after the operation. For some time after its performance it is advisable to have the patient introduce bougies of varying size into the rectum in order to prevent the formation of a stricture.