The following is an excerpt of "Health and Disease with Recipes Including Sexology - A Life Preserver for All Mankind", published by E. B. Foote M.D in 1900. Doctor Foote is a celebrated doctor, who wrote - in a very lengthy manner - various medical books for the lay persons, including "Medical Common Sense", "Plain Home Talk, Embracing Medical Common Sense".

Hemorrhoids or Piles

E.B. Foote, M.D. circa 1900

In introducing this essay, I will first explain that the rectum is the third and last portion of the large intestines, and was so named by the mistaken anatomists of old, under the supposition that this portion of the gut was straight. The illustrations, Figs. 161 and 162, show just about how straight it actually is, and how erroneous it was to christen it after the Latin term rectus! As the name, however, does not give anybody any distress, we will turn our attention to those disease of the rectum which do.

The most common affection of the rectum and its termination, is piles. All persons subject to constipation, or diarrhea, are apt to be troubled with piles, and some have them who are not subject to the irregularity of the bowels. Itching piles are those which often present no distinct elevations, but great irritation of the anus and sometimes a puffiness of the surrounding membranes. Then there are cases where an eruption of an itching character breaks out about the anus which may also be called itching piles. The most troublesome piles, however, are those of a tumorous and varicose nature, such as are represented in the annexed illustration, Fig. 165.

The arteries of the rectum are numerous, and whether the enlargements are simply varicose or tumorous, the blood presses in upon the affected parts, and alarming hemorrhages in some cases take place. I once had an interesting case of this kind, who, before becoming my patient, had for more than a year been subject to daily excessive hemorrhages from the rectum, and to such a frightful extent as to give her a death-like paleness, and such weakness that she cold with difficulty keep from her bed. Her friends despaired of her recovery after the failure of the family physician to relieve her. She was a Jewess, and her gratitude on being restored under my treatment found expression in the naming of her first-born after the author, who, by invitation, was present at the peculiar ceremony of circumcision. This was all contrary to the canons of the Jewish religion, which forbid the adoption of Christian names, and prohibit religious fellowship with those outside their fold. But she insisted that Dr. F. had saved her life, that the baby was the offspring of her recovery, and the opposition of friends to the course she chose to pursue did not prevail.

The immediate causes of piles may be briefly given as everything which tends to irritate or unduly heat the anus or rectum. Hard fecal plugs, and watery and scalding stools may include an attack of piles. Considering the vascularity of the rectum, it is frightful to think of a large dry fecal plug, as hard and irregular as a stone, descending the rectum, scratching and pushing along, abrading the lining in one place, and so distending it in another that blood actually exudes from the congested membrane. But there are those who are so ignorant of the peculiar structure of the rectum that they allow constipation to produce these fecal plugs which are thrown off every few days for weeks and months, until the most obstinate diseases of the rectum are induced.

Carelessness in the selection of instruments for cleansing the parts after stool often induces irritation which develops piles. This evil is so excessively prevalent, particularly in rural districts, that I must beg the indulgence of the reader for a moment while I call attention to it. Nothing is more common than to find in the “little-house” of a farmyard, a huge pile of corn-cobs for the purpose indicated. Even chips are sometimes resorted to. Now, to fractionize the external skin with a harsh substance like either of those, would be sufficient to produce eruptions or sores upon anyone affected with blood impurities; but applied to the delicate member of the anus, no one addicted to the practice can escape having piles unless his blood is remarkably pure. Leaves of plants are often used with like results. The leaves of almost all descriptions of vegetation are more or less bearded or coated with a kind of fuzz, which when brought in contact with the mucous membrane, causes irritation. Coarse brown paper is nearly as unsuitable, inasmuch as it is too rough and harsh, while a newspaper is equally objectionable, because of the irritating properties of the ink with which it is printed.

It would be well if all would regard this matter of sufficient importance to provide themselves with paper which is manufactured and sold expressly for the purpose. If not, only the softest and most pliable brown paper, such as would answer to wipe the mouth or nose in the absence of a handkerchief, should be employed.

People of sedentary habits should also be guarded as to what they use for seats. Sitting in cushioned chairs covered with worsted, enameled cloth, or other heating material, tends to produce irritation in the anus. If a person is at all predisposed to piles, cane-seated chairs are far preferable to any other, and a wood-bottomed chair is decidedly better than the one that is luxuriously upholstered.

The anatomical relation of the blood-vessels of the rectum to the liver is such as that the return flow of blood from the hemorrhoidal veins at the rectum or anus is obstructed when the liver is congested, and therefore liver torpor is the most common cause of the engorgement and swelling of the veins which constitute pile tumors. It is seldom possible to do much for permanent relief of piles without giving due attention to the liver, and relieving the torpid state of circulation there which dams back the blood into the veins below, at the rectum. Local treatment, whether medicinal or surgical, is not likely to be truly curative. Soothing ointments (particularly my Magnetic Oitment No. 1, and Pine Cones, No.1 of Sanitary Bureau list) will give great relief from soreness, heat, and the results of chafing, and for a time seem to cure; and the various operations by knife, clamps, and cautery will, of course, at once destroy the piles thus treated, but the veins there are numerous, tortuous, and lengthy, so that after a few pile tumors have been removed, if the cause is not, another lot is likely to be produced. Some cases are so severe as to call for very prompt relief by the aid of surgery, and some of the most successful operations are done without any pain to speak of, but unless constitutional treatment be at once adopted for removal of causes, there may soo n be another call for operation. On the other hand, if the patient can bear his discomfort a little longer, the right sort of constitutional treatment, combined with soothing and astringent local applications, will often do wonders in the way of reducing large, protruding, and bleeding piles, and render any sort of surgical operation unnecessary. Piles that bleed enough to gradually impair the general health, and weaken sexual vigor in course of time, do not always protrude and cause soreness and chafing. Their main annoyance is from bleeding at stool, and perhaps some pain then, and these may not be enough o compel due attention to proper treatment, but it is unwise to neglect it.

The most skilful treatment, however, is liable to fail in any case, unless proper attention is paid to personal habits. I have already spoken of constipation, and advised means for overcoming the difficulty, in an essay devoted to that subject; but the importance of avoiding a constipated condition of the bowels is so essential to success in removing hemorrhoidal affections, I must be pardoned for introducing matter here which may almost seem like repetition. First, and all-important, after giving attention to dietetic rules, is regularity in attending to the calls of Nature. Every man, woman, and child should have a stated hour, from which he or she should reluctantly deviate if the house is on fire. Persons accustoming the bowels to move at a certain time of day will find that organ ready to respond to his or her efforts, and they will further find that if they pass much beyond the usual time, constipation will exhibit itself.

The habit many have, of reading or thinking intently on business or domestic affairs, of nursing griefs and taking a retrospect of a gloomy past, or in fact, of engaging the mind either in reflection or diversion, white at stool, tends to retard the bowels in the exercise of their functions, and consequently produces constipation. The Harbinger of Health very sensibly gives utterance to the following language on the subject: “Any metnal occupation foreign to the proper and prompt performance of the function is positively certain to stamp the impress of disease upon the weakest part; and, inasmuch as, while engaged in this particular function, the vessels and fibres of the rectum are distended and principally taxed, so is inattention at the time most likely to produce on or more of the above-mentioned forms of hemorrhoidal disturbances.” By concentrating the will upon the parts which expel the faeces, costive persons will find it much easier to relieve themselves of excrementitious matter.

Prominent among the remedial exercises suited to persons affected with piles, is horseback riding. The jolting of the diseased parts upon the saddle quickens circulation, and helps thereby relieve congestion, and when piles are tumorous it promotes absorption. Theodore Parker once facetiously remarked that the”outside of a horse is good for the inside of a man.” This was said, of course, with more especial reference to dyspeptics and those who do not take much exercise, for the outside of a horse is equally good for the outside of a man. Women would be quite as much benefited by horseback riding as men, if they would adopt some costume which would enable them to ride gracefully astride. It is questionable whether they derive any greater advantages from equestrian exercise than exhilarating joltings and the breathing of the pure atmosphere of heaven. Their cramped position on the saddle does not allow a free and easy play of the muscles, such as men experience with both feet in the stirrups, and presenting an untwisted front. Women have yet to work a reform in this matter. There is no good reason why a woman should put one of her limbs to sleep over the pommel, and occupy a distorted position every time she takes a horseback-ride. While fashion may treat with scorn and contempt the suggestion that a woman should ride astride like a man, common-sense cries out against the present ridiculous custom. Already in some parts of the Untied States women are giving up the uncomfortable and unhygienic side-saddle for such as is used by the masculine equaterian. It is to be hotped that this fashion will spread, and that the side-saddle will become a thing of the past.

For external piles, and especially those of a varicose nature, or falling of the rectum, the Pile Compressor (see page 1227) yield great relief and comfort. The effect of the wearing of this ingenious instrument in cases of external piles, is very similar to that produced by frequent horseback-riding. The continuous gentle pressure of the congested parts serves to relieve them of their painful and sometimes unendurable distention, and to induce a more natural circulation of the blood in them. For those who have not the time or means to indulge in equestrian exercise, and particularly for women who ar ecopelled by King Custom to seat themselves on the saddle as to derive little advantage therefrom, the Pile Compressor is invaluable.

Even if under skilful treatment for the removal of both the disease and its cause, something is needed to give relief while the good work is going on, for piles cannot be permanently cured in a few weeks under any system of treatment. Then, there are persons advanced in life, who cannot be cured, and who consequently, require something to render them comfortable. To such I would most urgently recommend the Pile Compressor; while those of all ages, suffering with falling of the rectum or bowel who adopt it, will pronounce this mechanical invention an inestimable blessing. In would also advise digital dilatation of the rectal orifice, using some good ointment in place of soapsuds, as advised in the essay on constipation. This can be done after thoroughly cleansing he parts with soap and water.

Falling of the Rectum

In persons of relaxed fibre, after long-continued constipation, or the opposite trouble, diarrhea, the lower bowel may “turn wrong-side out” or roll down and out through the sphincter muscle. Ordinarily, the anus is tight enough, and the membrane above firm enough to prevent this, but it will happen even to children, and the sooner the protruding part is returned the better. Using my magnetic ointment, or even a good quality of Vaseline, not only aids in effecting the return of the protruding parts, but soothes and strengthens, so that the liability to recurrence is lessened. In persons of middle age addicted to the use of tobacco, simple cases of falling rectum, if not from constipation or diarrhea, may result from the relaxing effect upon the tissues of this region by the steady use of tobacco. It may not be excessive use, judging by the amount used per day by the ordinary slave to tobacco, but year after year the influence of the tobacco habit tells, and the relaxation becomes so fixed as the status of the part that no remedies, local or constitutional, will avail until the tobacco habit has been lived down, and the drug entirely let alone for some time. In elderly persons the relaxed, drooping parts may be due to other causes, the rectal looseness being in fact hardly more evident than the general flabbiness of the tissues. The Pile Compressor is a relief for that – and in such cases may be more properly called the rectal supporter.

Stricture of the Rectum

Is an annoying and generally painful affection which may result from neglected obstinate constipation, local inflammation, cancer or syphilitic ulcers, or anything which causes an abrasion or great irritation in the lining of the canal. The stricture may consist of a thickening of the walls of the rectum, causing a partial obliteration of the canal; adhesion of some portions of the walls, after the healing of abrasions or abscesses; or it may be caused by indolent tumors forming therein, or remaining after a severe attack of piles. Stricture of the rectum is a most troublesome difficulty, because it obstructs the passage of the excrementitious matter, and in some cases to such as degree as to prove fatal. The symptoms attending stricture in this locality are – difficulty in passing feces even when they are soft and pliable; passage of feces in small fragments, sometimes streaked with blood; and, when caused by thickening of the walls of the rectum, the expulsion of narrow flattened feces. Here is something which may be especially benefited by daily resort to digital stretching of the lower part of the rectum. In some obstinate cases it will be necessary to resort to instrumental dilatation, win which case the services of a physician will be required; but, with many it will be sufficient to first thoroughly cleanse the parts with soap and water, and then, employing my ointment or some other oleaginous preparation possessing properties favoring relaxation, lubricate one finger and introduce that; after enlarging the parts as much as possible with one, lubricate and introduce the second finger in addition, and make such movements with the two fingers as will tend to stretch the constricted parts. In obstinate cases which resist self-applied orificial surgery, both constitutional and local treatment are necessary, and the patient cannot do better than to reply wholly upon the advice of the physician in whom he may entertain confidence. In cases living at a distance, the author can give such directions as will enable the patient to administer the local treatment himself, or herself.

Fistula-in-Ano

Is a troublesome and dangerous affection, which is liable to result from neglected or badly treated piles. It may also occur in persons of scrofulous diathesis without the provocation of any previous disease in the anus or rectum. It commences not far from the anus, and usually announces its approach by itching, or pain, or uneasiness, although in some cases no unpleasant symptom is experienced until it begins to discharge its prurulent matter, and then this discharge may be the only evidence of its existence. So long as it has but one opening it is called incomplete, but when the abscess has proceeded so far as to penetrate the rectum, or any other cavity, it is said to be complete. The annexed cuts, Figs. 167, 168, represent a complete fistula-in-ano. Sometimes it has several openings in to the rectum or other parts, and the canal is in some cases so complete as to have a lining almost like the mucous membrane. I once had a case of fistula which opened perfect communication between the rectum and the urethra, so that at stool some of the fluid portion of the feces passed out of the mouth of the penis. When the abscess is active, large quantities of prurulent matter issue thereform, especially at stool when it is pressed by the descending feces. When much inflammation is present the affection is terribly painful.

In most cases of fistula, the blood should receive the first attention of the physician, and the knife should be the last resort, because if the latter be employed, it still remains necessary to purify the blood or the fistula, or an abscess of some kind will be likely to return. It would consequently seem the more sensible plan, in all cases, to have suitable blood-treatment at the outset. This may suffice to cure the difficulty. If it does not, neither time nor money will have been unnecessarily wasted, because the constitutional treatment cannot be safely dispensed with, however successful the operation, and many cases are not in fit condition to make good recovery without a course of preparatory, purifying treatment. When the patient is fit for operation, it need not be feared, as there is no danger from it, and the result is almost sure to be entirely satisfactory.

Fissure of the Anus

Ulcerations are liable to take place in any part of the body when anything like a scrofulous or a syphilitic taint exists in the system. Chronic ulcer of the stomach is perhaps more frequent than ulceration of the bowels, but the most common, if least serious, ulcer occurs at the anus, and is quite analogous to a “crack in the lip” of the mouth. It is called “anal fissure,” and is painful out of all proportion to its size, the pain being sharp and severe during stooling, and continuing long after. Bleeding may occur with it. It is practically incurable while constipation lasts, owing to the wear and tear of its situation, and even when the bowels move comfortably it is often obstinate. Anodyne ointments relieve; lunar caustic touching stimulates healing action; a knife operation is sometimes necessary’ but with this, as in cases of ulceration elsewhere, there is a fault in the blood which much be corrected to encourage Nature’s own reparative processes.

Another very distressing disease of this part, often with very little to show for it, but generally due to more or less local eczema, is obstinate itching or pruritus-ani, which may disturb sleep at night or make its victim uneasy all day. It is due to either the visible, local lesion, to irritating (unnatural) secretions from the intestines, or worms, or in some cases it seems to be purely nervous. All these anal troubles may be considerably relieved by appropriate local treatment, but removal of the particular cause in each case is the only means of permanent relief. The lower bowel being the slop-bucket of the body, receives its worst or most noxious substances, and yet, in health, fecal waste is not really irritating to the parts that must contain it and retain it for a while; but in disease, or as a result of various numerous disorders anywhere along the route of the stomach and bowels, the fecal evacuation may become even excoriating. The membranes at the outlet may be only tickled to the point of persistent itching, or they may be scalded, excoriated, and lacerated. So once more we learn that the art of health from mouth to the extremity of the alimentary canal, consists mainly in learning to keep clean all through’ that there is such as thing as “clean dirt,” even in fecal parlance; and that unclean, diseased, and acrid discharges from above are what intimate rectal diseases.