HAEMORRHOIDS AND HABITUAL CONSTIPATION BY JOHN H. CLARKE, M.D.
SOME four-and twenty years ago I received from a patient a very valuable lesson in the treatment of haemorrhoids, which has been of the greatest service to me ever since. With the impatience of youth, the progress of the case seemed to me so slow, that I advised the patient, a lady past middle life, to undergo an operation. This she emphatically refused to do, and insisted that I should cure her by medicines; and I did. From that day to this I have not had occasion to advise operation in any case of the kind, in a large experience both in hospital and in private practice. I do not maintain that I have succeeded in curing all cases; but those which were not actually cured were so far benefited that no operation has been required.
And here I may say a word about the time required for medicinal cures in chronic cases. It was my impatience in the case I have alluded to that led to the suggestion of operative measures. The patient herself was quite willing to wait as the event showed. I am convinced that if medical men realised that haemorrhoids are based on a constitutional state that is remediable, they would not so readily condemn patients to the surgeon’s knife. But constitutional states require time for their change, and it is as ridiculous to expect to effect it in a short time, as it would be to expect a patient in typhoid fever to be well in a few days. And it must be remembered that though the ways of surgery are apparently more expeditious, surgery never cures a constitutional state. On the contrary, after a surgical operation the organism has to recover from the shock, and this may take a long time, and perhaps may never be complete. And this is especially true in cases like those of piles, where the constitutional morbid condition is left untouched by the operation, or is diverted to some vital organ. I have recorded such a case in my book on Diseases of the Heart’s in which a fatal result followed such an operation. As the case is one of great importance it may be useful to give it here in full.
Sir S. E., a prominent Indian civilian, consulted me some years ago about a persistent cold in the head. Enquiring into its origin I found it had continued for about two years, dating from a time a little subsequent to an operation he had undergone for piles. The piles. The piles gave him but little inconvenience, but he was persuaded to have them ” cured” by operation. Of course an operation never did, and never could, ” cure” piles: it can only remove the haemorrhoidal swellings without touching the constitutional condition on which they depend. The constitutional disease from which Sir S. E. suffered would be called ” Psora” by Hahnemann, and “Gout” by other pathologists. The basis of gout ( as I hope at some future time to show) is the psoric miasm of Hahnemann. Be that as it may, the operation was performed; the cold in the head came on and something much worse than that. Noticing a peculiar quality in the patient’s pulse, I made a curiosity examination of hi heart, and there found extensive degeneration of the aortic valves. On my putting one or two questions, but in such a way as not to excite any alarm, my patient said he knew his heart was all right, ” The doctors examined me carefully and said it was quite sound before I was put under the anaesthetic.” Beyond giving general directions I said no more about it, as it could not have helped matters to have done so; but the sequence of events was quite clear to me. Before the operation he had no heart disease.
The operation disturbed the morbid constitutional element, which at that time had a practically safe and innocent expression in the piles, and sent it in upon more vital parts of the organisms. The chronic nasal catarrh and the diseased heart were the consequences. Sir S. E. only called upon me twice. A few months later I read in The Times that he had been found dead in his bed at a hotel in Edinburgh. I have no hesitation in saying that to operate for piles is as dangerous as it is unnecessary. Piles are not by any means difficult to cure by constitutional means, and when cured thus the patient is cured, and no dangerous after-effects are to be feared.
As another proof of the constitutional nature of piles, I may mention the case of a patient I once attended who suffered from very severe headaches. In her own experience she had found that a strong infusion of cayenne pepper would always relieve her headache, but with the invariable result of inducing an attack of piles. Here it is evident that the headache and the piles were merely different manifestations of one and the same constitutional state, which an operation could not possibly have relieved. To have ” cured” this patient the operator would have had to remove the head as well as the piles.
Dr. F.H. Lutze, of Brooklyn, records a similar case in the Medical Advance of May 1905: A married lady, 26, mother of two children, had tonsillitis with severe headache; the left tonsil more swollen and inflamed than the right; pain worse on swallowing saliva, but swallowing anything was difficult and painful. For this she had taken ” Pepper tea,” as she called it, meaning an infusion of Capsicum, which relieved the throat somewhat, but produced severe burning and bleeding haemorrhoids. She received Mercurius biniodatus 200, which cured the headache and tonsillitis as well as the haemorrhoids. Dr. Lutze makes the same remark about this patient that I did of my case, namely, that for surgery to cure the patient the head as well as the haemorrhoids would have had to be removed.
And yet the affection is completely given over to the surgeon in old school practice, as is shown by the most recent text – books on medicine. Pepper’s Text-book of the Theory and Practice of Medicine makes no mention of haemorrhoids as a disease for medicinal treatment. Quain’s Dictionary of Medicine does, indeed, devote an article to the subject; but it is a surgeon who writes it, and though he gives advice for the internal and local treatment of mild cases, his general conclusion is as follows:-
” External piles when large and trouble some, and internal piles when of such a size as to protrude at stool and to be subject to inflammation, ulceration, and frequent bleeding, can be removed only by operation.”
The experience of every careful homoeopathist leads to a diametrically opposite conclusion, and one of the objects of this treatise is to demonstrate that piles are curable by constitutional remedies without any assistance from surgery.
That piles are not a mere local affair is proved, among other things, by the fact that they very often run in families. Gouty persons are especially liable to be troubled with them. In fact, piles are one of the commonest manifestations of gout. Moreover, piles are closely associated with the whole abdominal circulation, especially that of the liver. Essentially piles are a varicose condition of the veins distributed to the lowest portion of the rectum or lower bowel, with more or less hyperplastic growth of connective tissue. In this position there is a very rich network of veins which communicate freely with the portal and general venous systems. If piles occur outside the sphincter muscle which constricts the orifice they are called external, if within the muscle they are internal. Sometimes they are partly one and partly the other. Since, then, piles are essentially varicose veins (with a covering of skin or mucous membrane) they will naturally be dependent on the state of the venous system to which they belong. Now the veins of the internal abdominal organs belong to the portal system and discharge their contents into the liver. Any affection, therefore, of that organ which impedes the blood-flow through it, tells on the veins of the rectum, and may give rise to piles, or if piles already exists, may aggravate their condition.
One prolific source of piles must not be overlooked, and that is the habit of constantly taking purgative drugs for the relief of constipation. All varieties of pills containing aloes are very apt to bring on piles, and many drugs which are not purgatives (as in the Cayenne pepper cases cited above) will also do it.