FISSURE of the anus is often found associated with piles, though it quite as often occurs singly. It consists of a superficial ulcerations of the mucous membrane in the form of a crack just within the sphincter muscle, and is accompanied by excessively acute pain. It is generally found in patients of a sycotic temperament, who are liable to similar ulcerations near other orifices. This, again, is considered by the old school as a purely surgical affair, and the treatment recommended is free incision through the centre of the ulcer. I shall show that this is an unnecessary proceeding: fissure is a consitutional affection, and is curable by constitutional treatment.
CASE XIV. FISSURE.
Some years ago I treated a gentleman in the country who had long been a sufferer from rectal troubles, and had been treated variously for a variety of conditions, including salt-water injections for supposed worms. These injections had the effect of greatly aggravating his sufferings. On making an examination I found a fissure which accounted for all the trouble. The bowels were not at all constipated, in the fact the patient was very liable to diarrhoea, but the actions occasioned great pain nevertheless. His constitution was of the type described by Hahnemann as “sycotic,” and by Grauvogl as “hydrogenoid,” and as Nitric acid corresponded to this as well as the local symptoms, I prescribed that medicine, with the very greatest relief.
CASE XV. PILES COMPLICATED WITH FISSURE.
L. H., 42, Barrister and Journalist, consulted me on April 18, 1902, on account of piles, from which he had suffered more or less for eight years. Some months previously to my seeing him he had got run down through over work, his digestion began to go wrong, and his piles became worse. They became complicated by Pruritus and attacks of violent pain, robbing him of his rest at night.
The patient came of a delicate family. His father, who is still living, is asthmatic. His mother was asthmatic, and died at 59 of phthisis. One sister had hip disease. He himself had always suffered from delicate mucous membranes. He suffered from violent and exhausting sneezing fits. He had had the uvula excised, a polypus and a piece of bone removed from the nose. He was liable to shivering, followed by sneezing fits, and readily took cold. His feet were inclined to be cold and slightly damp. His tongue was dirty. Appetite good for breakfast, but not good for other meals, though he had sudden sinking before lunch. Much flatulence passing both ways. Is liable to liver attacks. Whisky and soda aggravates his condition. The bowels are fairly regular, but he occasionally has to take Cascara. On examined I found a small fissure in the anus, a small pile protruding from the centre, and round the anus an area of skin looking like wash-leather, which I have often found present in cases of the kind.
Before coming to me this patient had been advised to go into a home, have an operation, lie up for three weeks, and he wound be all right afterwards. It was not convenient to give up three weeks of his work, so he sought my advice. I told him that in my opinion medicines were quite capable of curing him, but surgery certainly was not.
Rx Thuja 30 at bedtime; a lotion of Hamamelis O.
April. 21. After playing golf on the previous Saturday, had severe cutting pain in the rectum, which kept him awake at night. The next day he again played golf, and dined out the same evening. This night the pain came on before he went to bed. The pain was worse when standing or sitting. I directed him to go on with the powders and ordered an ointment of Graphites 2x 3i to Cetacean ointment z3i. This proved of great service to him in the subsequent treatment.
I now found it necessary to alter the patient’s mode of living. During the greater part of the week he was working at full pressure, and his work was largely night-work. His duties frequently required him to attend public dinners, which invariably proved trying to his digestion. But neither of these were doing him so much harm as the exercise which he thought it was necessary for his liver that he should undergo.
Now exercise is a very good thing for a man who has plenty of energy to spare, but it is a very pernicious thing for a brain worker who is spending all the energy he has to spare, and perhaps more, in brain work. There are very few persons who are strong enough to do much of both at the same time. It is a different thing when a man is on holiday and freed from the strain of daily work. He can then put his energies into physical exertion without hurting himself provided he does not overdo it. But it cannot be too clearly understood that exercise in itself is not by any means always a good thing. So I stopped Mr. H —‘s golf right away, and told him when he had an opportunity to rest both mind and body to take it. And as for his public dinners, I advised him to eat little and drink less. He soon found the advantages of following my advice.
May I. Has had a cold on him. Stools very hard and difficult; always perfectly firm; dark yellow, with slight loss of blood. Can stand and walk better.
Rx Sulphur 30, night and morning. In case of an attack of pain coming on, I ordered an ointment of 4 grains of Cocaine to one ounce of White Vaseline.
May 8. Has been better. Cold has disappeared. Bowels act fairly, without pain. Cocaine ointment not required. Wakes heavy. Has stuffed feeling in the nose. Much sneezing.
Repeat Sulph. Rx Cepa 30, discs, one every two hours, if required for colds.
May 22. Very much better generally, but has had a chill from night work. Still wakes up heavy. Examination of the parts showed that the irritated appearance has much diminished. There was no longer any soreness in the fissure, and the pile was shrivelling.
June 2. As a result of dinners and champagne obstinate constipation came on. Feels heavy and oppressed.
Rx Nux v. 3x, every three hours, when required for constipation.
June 5. Bowels acting more easily. Anus looks much better. Liver smaller.
Rx Sulph. 30, night and morning.
June 23. Has had return of itching. Has had to take Nux Vomica at times. Bowels moved; stools small, dark, and greenish. Sleep fair. Appetite improved.
July 10. Has been better. Bowels fair. Very little pain Sleep good.
Rx Psorinum 30, night and morning.
After this I did not see the patient again till November 7, 1902. He had been very well in the meantime, but a dinner had upset him, and brought on diarrhoea.
Rx Sulph. 30, and Psoricum 30, on alternate weeks.
March 10, 1903. Has kept fairly well.
Rx Sulphur, night and morning.
April 28, 1903. After two glasses of claret, had a severe attack of pain in the night. Abdomen distended, almost tympanitic.
Rx Ranunculus fic. 3x, a dose every two hours. Ranunculus fic O, ten drops to half a pint of water, to make a lotion.
May 3, 1903. Much better. I now gave the patient discs of Nux v. 3. with directions to take two of them immediately before and two immediately after a public dinner. This proved perfectly effective in neutralising the unpleasant effects he generally experienced after one of these functions.
May 27, 1903 Has had much distention. A hot pain rises from epigastrium into the mouth. Recently not sleeping well. Has had a bad cold. Lost his appetite for tobacco.
Rx Phosphorus 12, night and morning.
June 8. Very much better. He continued under this remedy till August 20, 1903, when I saw him for the last time. Since then he has continued well.
CASE XVI FISSURE.
Mr. R.T., a professional man, about 50, consulted me on April 26, 1900, for excessive pain on passing motions. He was fair, tall, rather stout, subjects to biliousness, E
with black spots floating before the eyes, but had good health generally. Family history good. He had been twice vaccinated, but it did not take much on either occasion. He was subject to colds in the head, which generally commenced in the throat. As a boy he used to have attacks of painful indigestion, and these were followed by rheumatism in the right arm. The bowels were his weakest part in youth. Once he had sunstroke. Had had malarial fever. Three or four years before I saw him he had piles. A year before he had much worry. At that time he had a slight pain in the anus after sitting on a hard leather chair. Six months later a stiff motion would cause pain. For the last three weeks has had much bearing down pain in rectum. Spirits depressed.
Tongue whitish; appetite very good. He is very fond of salt, but salt food makes him worse. Pulse 72. Sleep good. Feels better towards evening. Has some pain in the back like lumbago.
Has dry eczema between fingers and toes, which comes in Spring, and is worse when he eats salt food. Has warts on the chest which have been cauterised.
The bowels act daily about 9 A.M. He always had pain with the stool. An enema caused violent pain, and gave him eight hours of agony. I found the cause of the pain was a fissure at the right side of the anus. There were also some smallish piles. The necessary examination gave great pain, which he felt for some days after.
Rx Nitric acid 30, 28 powders, one night and morning.
May 10, 1900. He was very bad all the first and second days; after that was better. Now has a good deal of bearing down. Feels as if the rectum was not fully emptied. Stools fairly easy. Dry feeling just inside sphincter. He is worse when standing and better when sitting. Pain in the back has gone. The cold in the head has passed away.
Rx Causticum 12, three times a day. Hamamelis O for lotion.
May 16. Pain has been worse.
May 17. Soreness. pain shooting up rectum, with dryness. Discontinued Causticum.
May 24. Feels heart’s pulsation in piles. Pain is now burning, there are no shoots. One day had agony to pass water. Stool greyish, tinged with blood.
Rx Sulphur 30, ter die. Rx Suppos. cocain. 4 to gr. v. cocoa butter. To be used when the pain is severe.
May 31. On this occasion he gave me the following report. Three days after the visit was the best day he had had for two months. The next day had a very difficult stool, with pain and burning. Next day a fairly easy stool; and the day after, diarrhoea. Soreness after stool. Eczema better. On whole a much better week. I found piles had developed externally on the right side of the anus in a figwart appearance.
Repeat. June 9. Is suffering from bile. Two days after visit had a very bad stool with blood, and after it the right leg felt numb. The stool is more painful, but the pain does not last as long after
Rx Nux Vomica 30, ter die. After two courses of this the patient again took Causticum as prescribed on May 10, resuming the course interrupted on May 17.
On Sept. 4., 1900, I heard from him that this remedy, after causing ” a copious flow of bile to assist digestion seems to have done wonders.”
I have seen this gentleman frequently since then, but not as a patient he has remained well.