(512 AFFECTIONS OF THE INTESTINAL CANAL. 



The varioosities of the rectum, which are termed blind piles, usually 

 occur at the end of the rectum, above the sphincter and at the edge 

 of the anus. The former are called internal, the latter external piles. 

 At first the venous dilatation is diffuse and forms a thick blue net, 

 afterward single varices appear, and not unfrequently the anus is sur- 

 rounded by a wreath of the latter. At first the varices are small and 

 have a broad base, they appear and disappear at intervals ; later they 

 may attain the size of a cherry or even become larger. As the inter- 

 nal varices are pressed through the anus, when the bowels are evacu- 

 ated, and draw the mucous membrane after them, the latter often 

 forms a pedicle for them and they remain outside of the anus ; even 

 then they sometimes appear tense, at others relaxed ; but the sacs 

 once formed never disappear. The appearance and structure of the 

 haemorrhoidal tumors change in the course of time. At first they are 

 bluish and their walls are thin and delicate ; if repeated chronic inflam- 

 mations subsequently cause them to adhere to the mucous membrane, 

 they lose then* bluish look, and become hard and thick- walled. Not 

 unfrequently neighboring varices coalesce, only rudiments of their par- 

 titions remain, and thus large, sinuous sacs are formed, into which 

 several veins open. Occasionally a thrombus forms in the varices, 

 filling them up and causing their obliteration and ulceration. Large 

 varices which are extruded during defecation may inflame and even 

 mortify from the pressure ; in other cases there is inflammation and 

 ulceration of the mucous membrane at the root of the haemorrhoidal 

 tumor and haemorrhoidal ulcers result ; in still other cases the inflam- 

 mation attacks the surrounding connective tissue, and we have peri 

 proctitis, and, as a result of this, may have rectal fistula. 



Bleeding piles result sometimes from the rupture of varices, but 

 small haemorrhages are mostly caused by overfilled capillaries. 



According to Virchow's description, on anatomical examination of 

 the rectal mucous membrane, we find it " relaxed, often in puffs and 

 folds, slightly thickened, grayish-white; the submucous tissue is in- 

 creased and relaxed ; both are very vascular. It is usually covered 

 with tough, whitish mucus, which chiefly consists of detached epithe- 

 lium, with a mixture of mucus." 



SYMPTOMS AND COURSE. Haemorrhages in the upper part of the 

 intestine are, as above stated, symptoms of severe diseases, and mus* 

 be described when speaking of these. 



The description of haemorrhoids given in the old text-books, and 

 which still corresponds to the popular idea, distinguishes three groups 

 of symptoms : 1. The local difficulties which are caused by the catarrh, 

 +he varices, and the haemorrhages, "mucous or blind and bleeding 

 pi I s ; " 2. Periodical difficulties, both local and general, which precede 



