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.