The right diet for the haemorrhoidal is a big chapter and would lead me away from what I am specially pleading for in bad cases, viz:- external treatment combined with the internal. Neither will succeed alone, because external treatment will only aid so long as the mass cannot be thoroughly dealt with from the circulation, and local treatment is only child’s play beyond certain points, and utterly valueless to do more than influence the local mass it entirely fails to cure any case of itself and is to be discontinued as soon as this can be reached well from within; but so long as the mass is, as it were, a something outside of the body, so long must it be dealt with from the outside – a rightly chosen remedy being simultaneously administered internally. The saturated piece of lint or other suitable material that has lain all night at the anal orifice, should be burned, and never used a second time; it is important to insist on this, as otherwise the part may get poisoned, as it is difficult to thoroughly cleanse a small piece of linen.
Then again, all aperients must be absolutely forbidden this is of prime importance, and if a patient (the case being a bad one) will not absolutely give in on this point I invariably decline the case. There is nothing for it but this. Of course the diet must be modified accordingly. The physician who allows aperients cannot CURE bad piles though he treats them with all the skill of Hippocrates, Galen, Sydenham, and Hahnemann combined why? Because the peristaltic action set up by the aperient acts from above downwards, and therefore increases the haemorrhoidal mischief mechanically, to begin with, and then by increasing the active congestion and finally making the hypostasis worse than ever.
Further it is almost of equal importance to forbid the patient to go to stool until he positively cannot hold out any longer that is course in very severe cases. Why? Because Haemorrhoidal sufferers have often a knack of pressing at stool as if they were parturient the abdominal press acts upon the whole contents of the belly and thus the pressure from above brought to bear upon the piles will do more harm in a few moments than the best directed efforts of any physician can mend by the time another stool takes place.
It is simply possible to cure very severe cases unless aperients be totally abandoned and unless all use of the abdominal press be, for the time, given up.
“But Doctor, I have taken aperients every day thirty years, also I must have them; and I must also have a motion everyday, or I am so dreadfully uncomfortable, and have such a fulness in my head; and besides I dread the suffering of a stool if I put it off, it is too lawful.”
Then patient to go Mr Smith and get him to do the necessary operation, for unless you obey in these points, it is simply not possible to cure such a bad case a yours with medicines; with absolute obedience it is possible, and very probably.
Be it well understood that the question is now of very severe cases where the rectum is prolapsed and perhaps almost strangulated.
In simple cases it is often not needful to bother the patient with any change of diet whatever but it becomes a necessary condition of success.
I have interwoven these remarks with the narration of this case to motive my prescription which was Hamamelis virginica locally in the manner above described, and Aloes Soc. 6, one pilule four times a day. This in August 1876.
Of course it will be objected that as I used Hamamelis externally, and Aloes internally, I do not know how much of the curative action is due to each respectively. This I grant and the scientific value of the prescription is thereby is thereby lessened, no doubt. The gentleman was away from home at the time at the seaside for his holidays, and this prescription was forwarded to him by post. I had previously seen him through several pretty bad attacks of gout, and he had mentioned his haemorrhoids to me several times, but he never really consulted me about them, because in truth he did not believe there was any medicinal cure for them, and he did not intend undergoing any operation for them so long as he could manage to replace them together with the bowel, after each motion. Now however being at the seaside, they suddenly became worse either from the sea air or his long walks or some other cause, and being in lodgings, he missed the various little contrivances present in his bath-room at home. Moreover they were so much worse that walking had become most painful and barely possible. Hence he applied to me.
He did not write to me again and remained a way about six weeks Neither did he call upon me on his return but two or three weeks thereafter I met him accidentally, and then received his warm thanks for having relieved him of his great trouble. He informed me that he was quite well all the piles had disappeared and the bowel no longer came down at stool at all; the bowels too, acted naturally. Fully twenty years this gentleman had almost daily suffered the horrors of a painful stool and prolapsed bowel, followed by the torture of getting it back again. Many months later I attended one of his children for fever and learned that he continued quite well.
In the face of this experience is any one at all astonished that I am a strong advocate for the medicinal treatment of piles and other manifestations of the venous diathesis? In this case I made no alteration whatever in diet and there was no need to forbid aperients, as he had abandoned them for many years in favour of nux, Sulphur, Belladonna, and Opium, which he knew well how to use, Indeed alvine constipation was not as important element in this case, it was more a proctostasis.
Perhaps any further experience on the subject of the amenability of diseases of the veins to medicinal treatment may be needless, but there are two very bad cases recorded in my case book that deserve detailed narration, because they were about as bad as such cases can well be, and they being out another little auxiliary of mine- I mean posture. Minor cases I omit entirely.
ON THE IMPORTANCE OF POSTURE IN THE MEDICINAL TREATMENT OF SEVERE CASES OF PILES.
When a patient has suffered far a number of years either from continued chronic haemorrhoids, or when he has had attacks of piles for a more or less lengthened period with the well-known general orgasmus humorum, there comes some fine day such a violent attack, or the defecatory effort has been unduly prolonged, from some cause or other that the piles and the prolapsed bowels cannot be replaced at all, and then something must be done. There is no help for it; the patient lies writhing in pain, half-doubled up, and often moans and weeps like a child.
Now, what have we to deal with in such cases? Naturally, cases differ exceedingly, and each one must be individualized and treated on its own merits. It is no use confining one’s ideas to the rectum, although all th misery is at present concentrated there, and yet time presses, and patient appeals for prompt relief.
Some cases of piles depend upon a disturbance in the brain, others upon a spinal affection especially about the cauda equina. Some are due to a liver complaint, and some to portal congestion; others, again, are connected with a disturbance around the neck of the bladder, the prostate, the spermatic veins, the uterus, the ovaries; or they may arise from chronic constipation, or be due to a really local cause in the rectum itself, mere proctostasis, or be merely a topic expression of general varicosis. Then, again, the lungs and the rectum are often in wondrous sympathy with one another. So each case has to be looked at all round as to the other constituent organs and parts of the same economy. Then there are various economy. Then there are various nosological forms that complicate piles pregnancy, phthisis, gout, general plethora, cephalic congestion with threatened apoplexy (how often does apoplexy follow a wrong treatment of piles!) heart affections, and syphilis. Syphilitic haemorrhoids are at times the most painful of any, and the pain is often an inch or two above the sphincter.
But with all the varieties there is always one prominent and distressing condition, viz: HYPOSTASIS, in other words, much of the distress is due to the hypostatic congestion, and this it is that an operation gets rid of and nothing else; only, with the operation not only is the bath emptied but the baby has been forgotten and poured out with it.
I have adopted the very simple plan of raising the buttocks above the horizontal by means of various little horizontal by means of various little mechanical contrivances improvised at the same time, according to the circumstances of the patients two or three pillows serve the purpose. Every one is familiar with the contrivances for raising the heads of sick people; well I just reverse the process and raise the lower part of the trunk, and this is a great help in very severe cases, such as the following:- In january 1880 a gentlemen, about 40 years of age residing in London came under j my observation. He had suffered for many years from constipation and piles with prolapse and he had a sorry time of it at every movement of the bowels, as the large haemorrhoidal masses came down together with the rectum so that the whole resembled a big dahlia in configuration and in colour; moreover the constriction of the sphincter seemed so great that on my first visit there seemed no inconsiderable danger of gangrene. His elder brother had suffered similarly and been operated years ago, but had latterly got as bad as before the operation. My patients sister, however a kindhearted capable maiden lady, who, instead of wasting her precious life nursing poodles goes into the courts and alleys of this huge city, carrying words of comfort, and healing many with the aid of a Homoeopathic vade Mecum and a pocket-case of she was confident that homoeopathy could cure her brother, and this was the more desirable as he was very more desirable as he was very nervous and timid, and almost fainted at the very thought of an operation. Moreover he is by no means a strong man, as indeed no one is at the end of fifteen years of haemorrhoidal miseries and bleeding.
Burnett was one of the first to speak about vaccination triggering illness. This was discussed in his book, Vaccinosis, published in 1884. He introduced the remedy Bacillinum. He authored twenty books, including the much loved "Fifty Reason for Being a Homeopath." He was the editor of The Homoeopathic World.