HAEMORRHAGES FROM THE INTESTINES. 609 



fomentations, and open the abscess early to prevent perforation of 

 the rectum or bladder. [After recovery watch for fecal accumu- 

 lations at these points.] 



CHAPTER VII. 



HAEMORRHAGES AND VASCULAR DILATATIONS OF THE INTESTINE. 



ETIOLOGY. Haemorrhages from the upper part of the intestinal 

 canal occur from the same causes as haemorrhages of the stomach. 

 They most frequently result from excessive congestion of the portal 

 circulation, such as occurs particularly in cirrhosis of the liver. In 

 other cases, vessels of the intestinal mucous membrane are eroded by 

 liberation ; such haemorrhages occur during typhoid fever, dysentery, 

 and in some few cases of consumption of the intestines. Lastly, there 

 are haemorrhages in the intestinal canal which must be referred to dis- 

 ease of the walls of the vessels, although the microscope shows no 

 change of structure ; among these are to be classed the intestinal 

 haemorrhages in yellow fever (?), scorbutus, etc. 



Varicose dilatations of the haemorrhoidal veins (blind piles, haemor- 

 rhoids) and bleeding from the vessels of the rectum (bleeding piles) 

 are among the most frequent of affections. It is not long since these 

 were regarded as symptoms of a specific constitutional disease, hasmor- 

 rhoidal disease, and, according to the former opinion, they were the 

 most favorable shape that the disease could assume ; the case was far 

 more serious if the disease were " misplaced," that is, affected the 

 head, breast, or abdomen. This view has been generally given up, 

 since it has been found how much the occurrence of venous dilatation 

 and bleeding in the rectum is due to mechanical causes, and how little 

 tenable is the idea of " misplaced haemorrhoids." Nevertheless, the 

 pathogeny and etiology are still somewhat obscure. 



Obstruction of the circulation, which is the most frequent cause of 

 congestion everywhere, must be regarded as the most common cause 

 of haemorrhoids, with which general name we shall designate the ve- 

 nous dilatations and haemorrhages occurring in the rectum. 



The escape of blood from the haemorrhoidal veins may be caused : 



1. By collections of faeces in the rectum, by tumors in the pelvis 

 or the gravid uterus ; and these are the most frequent causes of haemor- 

 rhoids. 



2. The escape of blood may be impeded by obstruction of the por- 

 tal vein. Hence we shall mention haemorrhoids as one of the most 

 frequent symptoms due to the congestion in cirrhosis of the liver, 

 Overfilling of the portal veins appears to have a similar effect, and 

 perhaps this best explains the frequent occurrence of haemorrhoids in 

 drunkards. During digestion there is an increased flow of fluids from 



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