. The principles and practice of surgery. hese are permitted to remain downtoo long they often become strangulated by the sphincter, and swell enormously. In some cases they have sloughedoff, and a spontaneous cure has been effected, but always at the hazardof forming a stricture wThen the cicatrization is completed. To reduce them under these circumstances is not always an easy mat-ter ; but this can generally be accomplished if, while the patient isresting upon his back, with the hips elevated, the surgeon, having cov-ered the mass with a piece of lint smeared with cerate, grasps the tu-mors
. The principles and practice of surgery. hese are permitted to remain downtoo long they often become strangulated by the sphincter, and swell enormously. In some cases they have sloughedoff, and a spontaneous cure has been effected, but always at the hazardof forming a stricture wThen the cicatrization is completed. To reduce them under these circumstances is not always an easy mat-ter ; but this can generally be accomplished if, while the patient isresting upon his back, with the hips elevated, the surgeon, having cov-ered the mass with a piece of lint smeared with cerate, grasps the tu-mors with his fingers, so as to press with their extremities upon themargin of the sphincter, and then bears up steadily for a few sphincter will often, under this pressure, be coaxed to dilate, andthe tumors may then pass in easily. When, from frequent extrusion, the sphincter has become relaxed,they are liable to fall down at any hour of the day, and at most incon-venient seasons. A pad, or a compress, supported by a bandage,50. Internal Piles. 786 H^EMOEEHOIDS. sometimes affords relief in these cases ; and when they do not thepatient must be advised to have his regular daily stool at bedtime, andnot in the morning. After an evacuation the sphincter remains relaxedand open, sometimes two or three hours ; but during the night it re-covers its contractile power, and, if not put upon the stretch in the morn-ing again, the patient may escape these annoyances during the day. An operation for the radical cure of internal piles will in most casessooner or later become necessary, and delay can seldom be properlyadvised. Surgeons are not without expedients in this class of cases;but we shall dismiss most of the methods devised, and sometimes prac-tised, with very few words :— Excision.—Since Dupuytren has told us how he used to thrust a red-hot iron up the rectum to arrest a bleeding caused by cutting off inter-nal piles, very few have ventured to imitate his example. No o
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