614: AFFECTIONS OF THE INTESTINAL CANAL. 



Hsemorrhoidal bleedings usually occur during defecation; if they 

 are of capillary origin, only a small quantity of blood adheres to the 

 fceces ; if they come from ruptured varices, several ounces of blood are 

 often lost. It is only in rare cases that there is sufficient haemorrhage 

 to cause danger. 



The so-called mucous haemorrhoids consist of the passage of the 

 above-described catarrhal secretion ; this is sometimes evacuated with 

 the faeces, sometimes squeezed out of the rectum without any admix 

 ture of faeces. Frequently only the symptoms of mucous piles are 

 present, and it is only subsequently that those of blind and bleeding 

 piles occur. 



From the usually prolonged action of the injurious influences causing 

 them, it may be readily understood that the course of this disease is 

 usually tedious. If the causes act only for a time, the haemorrhoids 

 may disappear forever, after lasting only a short time. 



The variation of the symptoms of haemorrhoids, after they have 

 lasted a long time, has led to the most varied hypotheses. They have 

 been compared to menstruation, and even the changes of the moon 

 were claimed to have an influence on their course. The causes of the 

 unpleasant feelings of the patient at one time, and his comfort at an- 

 other, may often be discovered ; the occurrence of constipation has ob- 

 structed the escape of blood from the rectum ; or a debauch has caused 

 an overfilling of the portal vein, and a consequent congestion of the 

 haemorrhoidal vessels ; or they have been exposed to some other source 

 of injury, which in them has not induced a nasal or bronchial catarrh, 

 but has excited an increase of the rectal catarrh, because the rectum 

 was the locus minoris resistentiae. In other cases, the exciting causes 

 cannot be discovered, but this also happens in the temporary exacerba- 

 tions of other diseases, and so we are not justified in any adventurous 

 hypotheses. 



We hear a great deal about the dangerous effect of the arrest of 

 habitual bleeding from haemorrhoids. This belief is not altogether 

 without grounds, but we should not consider the bleeding as Nature's 

 attempt at a cure. The rectum is probably the part whose diseases 

 have least effect on the organism, and patients in whom the rectum is 

 the part soonest affected, when they are exposed to injurious influences, 

 are better off than those whose stomach or bronchi are affected undei 

 similar circumstances. If they be affected with disease of one of the 

 last-mentioned organs, when exposed to injury, we may deplore it, but 

 if they have haemorrhoids, they are just as correct in saying " all right " 

 as one is who, having been exposed, begins to sneeze, and thereupon 

 concludes he is only going to have a cold in the head, and not a worse 

 disease. In cases where abdominal plethora, dependent on mechanical 



