HAEMORRHAGE FROM THE INTESTINES. 



611 



the rectum. The variety of injuries that the rectum has to bear, the 

 frequency of acute and chronic diseases of neighboring organs, in which 

 the rectum is implicated, abundantly explain the frequency of chronic 

 catarrh, and at the same time the frequency of relaxation of the haemor- 

 rhoidal veins. 



It is usually supposed that general plethora induces haemorrhoids, 

 and that bleeding piles are of critical significance in plethoric condi- 

 tions. It cannot be denied that persons, who, particularly after they 

 have attained their growth, consume more than is required for the 

 support of the body, are often affected with haemorrhoids ; and also 

 that gout, chronic catarrh, and other diseases, which are also frequent 

 in such persons, are usually better after haemorrhoidal haemorrhage. 

 Nevertheless, we should hesitate about referring either the haemor- 

 rhoids or the other diseases, in these cases, to a general plethora, to an 

 absolute increase of the contents of the vessels, as the permanent 

 occurrence of such a state has not been fully proved ; and there is 

 good reason to suppose that the overfilling of the vessels leads to 

 increased excretion till the disproportion has been removed. The 

 changes that the blood undergoes from too great a supply of nourish- 

 ment (abnormal concentration?) are not thoroughly understood, and 

 hence the pathogeny of the diseases developing under such circum- 

 stances is quite obscure. 



Haemorrhoids are rarer in children than in adults ; this is explained 

 by the greater rarity of the above-mentioned obstructions to the cir- 

 culation, and of chronic gastric catarrh, during childhood. On the 

 other hand, it is evident how a sedentary life, the use of irritating food, 

 the misuse of drastic purges, the frequent and clumsy use of enemata, 

 may rank among the exciting causes of haemorrhoids. If it be true, as 

 is said, that piles are less frequent in women than in men, and in tem- 

 perate climates than in hot ones, and that they are induced by exces- 

 sive venery, we cannot so readily explain the fact by the causes above 

 given. 



ANATOMICAL APPEARANCES. As the haemorrhages from the upper 

 part of the intestine are almost always capillary, their source can rarely 

 be recognized on autopsy. Occasionally, after capillary haemorrhages, 

 a considerable extent of the mucous membrane is found suffused with 

 blood, which is a sign that the haemorrhage has taken place into the 

 tissue of the membrane and not on its free surface. After haemor- 

 rhages caused by ulcers in the intestine, coagula generally adhere to 

 the ulcers which have bled, and the edges and base of the ulcer are 

 suffused with blood. The blood is sometimes fluid, sometimes slightly 

 coagulated, rarely red, but usually chocolate-brown, or transformed to 

 an adhesive, black, tarry mass. 



