Annual and analytical cyclopaedia of practical medicine . fair pulling. If the pile is very large,a small portion may now Ije cut off, tak-ing good care to leave sufficient stumpbeyond the ligature to guard against itsslipping. When all tlie luvniorrhoids are omy position, with the limits well flexedon the abdomen and held in position byClovers crutch, presents a better viewof the parts after the sphincter has beendivulsed. Sitting upon a high stool infront of the patient, the operator has thefree use of his hands and can apply theligature with more ease and in a shortertime than when the pati
Annual and analytical cyclopaedia of practical medicine . fair pulling. If the pile is very large,a small portion may now Ije cut off, tak-ing good care to leave sufficient stumpbeyond the ligature to guard against itsslipping. When all tlie luvniorrhoids are omy position, with the limits well flexedon the abdomen and held in position byClovers crutch, presents a better viewof the parts after the sphincter has beendivulsed. Sitting upon a high stool infront of the patient, the operator has thefree use of his hands and can apply theligature with more ease and in a shortertime than when the patient is placed onthe side. After all of the piles have beenligatcd and those portions external to the. Fig. 1.—Correct method of applying the ligature. {GcDit.) thus tied they should be returned withinthe sphincter. After this is done anysuperabundant skin which remains ap-parent may be cut off; but it should notbe too freely excised, for fear of contrac-tion when the wound heals. A pad ofgauze is then placed over the anus; thisis covered with a tight T-handage, as itrelieves pain most materially and pre-vents any tendency to straining. To secure a cure by the ligature it isnot essential to follow in detail the va-rious steps as just recorded. The lithot- ligature cut off, the stump should beplaced within the bowel. Patients suffer considerably for thefirst twenty-four hours because the sen-sitive nerves have been included in theligatures. The pain during the secondand third days is frequently quite annoy-ing, though in some cases it will be veryslight. The lower part of the rectumpresents a sensation of heat and are often awakened after theo]ioration by sudden cont
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