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Haemorrhoids : Their Nature

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 has 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, 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 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 cursory examination of his 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 and a practically safe and innocent expression in the piles, and sent it in upon more vital parts of the organism. 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 give 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. Quaint'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 troublesome, 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 exist, may aggravate their condition.

One prolific source of piles must not be overlooked, and that is that 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.

Cases of haemorrhoids

To judge by my experience, there must be something in the atmosphere of the Houses of Parliament, or in the habits they engender, conducive to the production of haemorrhoids as well as influenza, and the first case I will mention here is that of a prominent politician who consulted me some years ago.

Case I - bleeding haemorrhoids

The patient was a tall, spare man, dark complexioned, between fifty and sixty years of age, who had travelled much about the world, undergone a good deal of exposure in open-air sports, and, without indulging to excess, was fond of a good dinner and his pipe. For five years, and especially for the last two, he had been much troubled with piles, which protruded, bled periodically, discharged continually a mucous fluid, and occasioned much heat, bearing-down sensation, and discomfort. The motions were at times constipated and light-coloured. The urine was thick after taking any wine. Without having actual pain in the liver he was often conscious of possessing that organ.

Before coming to me he had consulted his ordinary medical man, a well-known consultant in town, who had told him there was nothing for it, if he wished to be relieved of his trouble, but to make up his mind to lie up for three weeks and undergo an operation.

As it was not convenient to lie up for three weeks just then-not to mention a possibly longer period - my patient, who had some acquaintance with homoeopathy, determined to give it a trial. It was near the end of March when he called upon me, and I put him on Nitric acid 12. A month later he called again, and reported that he had been quite free from any inconvenience until a few days before his visit. He had been dining out, and had a little return in consequence, with constipation, but no bleeding and no bearing down.

Rx Nux v. 30.

After this I saw nothing of him till the following September, when he had a slight reminder of his trouble after a fishing expedition in which he had done a good deal of wading.

Rx Calc. c. 30, in powders, one night and morning. This kept him right till the following April, when Lycopodium as given, and he has had hardly any trouble since.

I will now give the case of the patient referred to in my introductory chapter.

Case II - obstinate constipation; marginal pile

This patient was a lady of very gouty family, past middle life. She had always been of a constipated habit, and had dosed herself freely with pills and other kinds of aperients. She had, however, partially escaped from the dominion of the latter by the aid of a domestic work on homoeopathy, from which she learned the virtues of Nux and Sulphur, after which she had very little trouble in that way. I was called to see her for an attack of perityphlitis, and after she had got quite well of this, the attack of piles developed without any symptoms of constipation. There was a large protrusion, but in its origin it was partly external and partly internal, with great pain and discomfort. There was also some ulceration.

When I discovered the extent of the disease I came to the conclusion that it would take a long time to cure, and I then made the suggestion that an operation would be the most satisfactory way of ridding her of the trouble. But my patient, who was of a very sensitive temperament, was so terrified by the idea that I did not venture to repeat the advice, and though the complete cure did take some time, the acute symptoms were subdued in a few days by the internal and local use of Hamamelis, so that she was soon able to return to her ordinary avocations. AEsculus was given later with good effect. What remained of the pile was not so important as a return of the constipation, and it was whilst under treatment for this that the pile finally disappeared.

The origin of this patient's constipation is instructive, and may serve as a warning to those who have the care of young girls. When about fourteen years of age, she was sent to some friends on a visit. Whilst there, she was dreadfully constipated, and being very timid, said nothing about it. On this occasion she went eight days without an action. On another occasion when again on a visit, but to another place, the same thing happened; but this time she fainted, and when she revived she confessed what was the mater. Purgatives were there and then administered, and had to be continued ever after, till she came under the influence of homoeopathy.

The medicine which I found give the most help was Natrum mur, indicated by the largeness of the motions, and the feeling as if something remained in the bowel after the action. Magnes. Mur., Hydrastis, and Lycopodium also did good service, but it was not till Natrum mur. 200 was given that the condition was completely mastered.

I advised, in addition, the use of whole-meal bread, but that by itself had no effect, and, moreover, it had been tried before.

Case III - constipation and bleeding piles

A governess, aged 30, consulted me at the Homoeopathic Hospital on Nov. 9, 1887. She had been suffering from bleeding piles for nine months. She had never had them before, and attributed the attack to excessive walking and overwork. She was inclined to be constipated before the attack came on, and had been much so the last six weeks. Before coming to me she had attended at the Westminster Hospital. The bowel was then prolapsed, and had been returned by the doctor who attended her. He said, however, there was nothing to be done further but an operation. This so terrified her that she never returned, but came to the Homoeopathic Hospital instead.

There was much aching pain of the bowel, worse at night, preventing sleep. The stools were large, hard, and knotty. Before the prolapse occurred she had taken a strong pill. The bowel remained in that condition for a fortnight.

Rx Ac. nit. 12, gtt. 1 quarter die.

Nov. 22. - Very much better.

After this there was no more thought of operation. The medicine relieved her so completely that I saw nothing of her till the end of the following June, when I made this note :-

June 30, 1888. - Has been much better. Now only feels the piles when out of health. Motions regular. Feels weak, and is sleeping badly, waking at 4 a.m. Is constipated, which is very unusual; is very nervous. Frontal headache.

Rx Ignat. 12, gtt. 1 ter die.

July 4. - Very much better; feeling quite different. Feels worse in damp weather.

After this she saw me at rare intervals, and had Nitric acid 12 again and Dulcamara 12 (which always relieved her when feeling the effects of damp weather). She complained at times of pain in the left ovarian region. In February 1889, and abscess formed near the anus and broke, but healed rapidly under Silica 30. On April 10 of that year she had constipation, small green stools; this was relieved promptly by Phosphorus. All the time she continued to discharge her duties, which were heavy, and eventually she got quite well.

I will now relate two cases of an acute character.

Case IV - piles following influenza

A lady, who had recently recovered from an attack of influenza, suddenly, after stool, experienced great pain accompanying haemorrhage and the appearance of a pile. The case being quite recent, and there being no complications, a short course of Hamamelis, given internally and applied as a lotion, completely relieved and permanently cured the patient. The lotion gave immediate relief.

Case V - acute piles

This patient was so impressed with the relief obtained in her own case, that she came to consult me a short time after on behalf of a friend. This was a young unmarried lady who was subject to headaches, which had formerly been greatly relieved by Lycopodium. The attack of piles had come on suddenly apropos of nothing definite. There was, according to the account I received, a good deal of protrusion, with bleeding and pain. I did not see this patient, but I prescribed Hamamelis, and in a very short time she was well.

I may here say that Hamamelis, or Witch Hazel, has a very wide range of usefulness, in conditions of varicosis and piles. It has a very definite relationship to the venous system, and is one of the first medicines to be thought of where the veins are at fault. Of course it must be used with judgement, and cannot be expected to cure in all cases. Those cases which depend for their origin on some deep constitutional dyscrasia will require the appropriate remedies. Hamamelis may be given in almost any attenuation with good effect. For a lotion, twenty to thirty drops of the strong tincture to the pint. It may be used either cold or warm.

Case VI - rapid relief of an acute condition

As an example of what may sometimes be done in an emergency. I will mention the case of Lord X, who came to me one morning in great distress, suffering from prolapsed piles, with excessive soreness and discharge, he having an important engagement to address a political meeting in the country the same evening.

Now there is one remedy which in my experience is more useful than any other where excessive soreness is the leading symptom, and that remedy is Causticum. This I ordered him, with directions to take a dose every half-hour till relieved, and then less often until he returned. With this assistance he soon obtained relief, and was able to make a long journey and fulfil his engagement with very little inconvenience.

Case VII - piles in an infant

Prolapse of the bowel is not at all an uncommon occurrence in children, and is generally associated with constipation and straining. But it is by no means common to have a genuine attack of piles in an infant. This, however, did occur in an infant girl, aged thirteen months, whom I was asked to see. The little patient had been constipated since her birth, but the mother was greatly alarmed by the appearance of the swelling. When the case was described to me I expected to find prolapse, but on examination I found it was a genuine pile. Sulphur 30 was prescribed and in a very short time the pile disappeared.

Case VIII - bleeding piles with irritation

An elderly gentleman, who consults me in the city sometimes, had an attack of bleeding piles some year or two ago. He is of a scrofulous habit, and as a child lost the sight of one eye from inflammation, and many years before I saw him he had fistula, which was operated on.

When he first consulted me he was suffering from bleeding piles with a good deal of irritation about the parts, and constipation at the same time. His general as well as local symptoms pointed to Sulphur, and this gave him great relief. An attack of influenza interrupted the progress of the case, and when he was getting better of this a severe attack of bleeding came on and continued. Taking into consideration the constitutional habit of the patient, I prescribed a single dose of Bacillinum 100; the blooding stopped at once, and though I have since prescribed for him for other ailments, he has never been further troubled with this.

When piles have continued for a number of years the tissues of the part - skin and mucous membrane - covering the varicosities become largely hypertrophied, and it is not always possible to reduce the hypertrophy by medicines. But it is almost always possible to combat the attendant sufferings, and reduce them to a minimum. If the power of the sphincter muscles of the orifice has been lost, it will be necessary to wear some kind of support, provided it cannot be restored. I will now mention a case of the kind.