HAEMORRHAGE FROM THE INTESTINES. 613 



the swelling of the varices and the haemorrhage from the rectum, and 

 are relieved by the latter, " moh'mina hsemorrhoidalia ; " 3. Permanent 

 difficulties, which indicate constitutional disease, or disease of some dis- 

 tant organ, but which are also relieved by the haemorrhoidal bleeding, 

 " misplaced haemorrhoids," or, if haemorrhages occur elsewhere, " vica- 

 rious haemorrhoids." 



We should strike the latter from the list of haemorrhoids. li a 

 venous abdominal plethora, dependent on cirrhosis of the liver, is im- 

 proved by haemorrhoidal bleeding, and the dyspepsia, flatulence, and 

 hypochondria disappear for a time, this does not justify us in regarding 

 these symptoms as signs of a haemorrhoidal disease. We have jus+ 

 as little right to regard bronchial catarrh, or attacks of gout occurring 

 in a plethoric person, as anomalous or misplaced haemorrhoids, because 

 these diseases remit after a haemorrhoidal bleeding. 



In regard to molimina haemorrhoidalia, we must agree with Virchow, 

 who regards it as a symptom of returning rectal catarrh. The patient 

 has a feeling of burning and tension in the rectum, just as occurs in 

 other mucous membranes in acute catarrh or relapsing chronic catarrh. 

 There are also severe sacral and dorsal pains, which remind us of the 

 headache in catarrh of the nose and frontal sinus. The general state 

 of the patient is disturbed in the same way by catarrh of the rectum 

 as it is by catarrh of other parts ; the patients become relaxed, slug- 

 gish, and depressed. The inconveniences which the varices, swelled 

 by the increased hyperaemia, cause, complete the picture of haemor- 

 rhoidal hyperaemia. In many cases, at the height of the attack, there 

 is a haemorrhage, which has a favorable influence on the catarrh and 

 the fulness of the varices, so that the patient feels relieved, or even 

 free from all trouble. If, after a tune, he be again affected with mo- 

 limina, we cannot blame him for longing for the haemorrhage that re- 

 lieves him. If we can remove the catarrh and swelling of the varices 

 in any other way, as by removing constipation, which has caused the 

 increased congestion and hyperaemia of the rectum, the molimina dis- 

 appear without a haemorrhage. 



The local difficulties that the haemorrhoids excite vary with the 

 number, size, and fulness of the varices. At first they are slight, the 

 patients have the feeling of a foreign body in the anus, and pain only 

 occurs when there is a hard stool. When the anus is surrounded by 

 large varices, or when individual tumors have become very large, and 

 are very tense, the patients have constant pain, cannot sit down, and 

 even a soft passage gives them great suffering, which only disappears 

 slowly, and which not unfrequently causes the patients foolishly to retain 

 their passages. The pain becomes most severe when large varices are 

 protruded through the anus, strangulated there, and become inflamed. 



