HAEMORRHAGE FROM THE INTESTINES. 615 



obstruction, is relieved by an occasional haemorrhoidal bleeding, or 

 where there is a remission of bronchial catarrh, or other disease, which 

 usually exists in patients of forty years or upward, who lead a luxu- 

 rious life, the cessation of the bleeding may prove serious. But, as in 

 these cases the relief depends solely on the loss of blood, and as this 

 can be replaced by local blood-letting, the injury practically only occurs 

 when the physician fails to see that the latter is indicated 



TREATMENT. Where the repeated collection of hard faeces excites 

 the catarrh and varices of the rectum, the causal indications require 

 the regular evacuation of the bowels ; but we should only use drastic 

 purges, such as aloes and colocynth, when absolutely necessary, as we 

 fear their irritant effect on the mucous membrane of the rectum, and 

 should generally prefer flowers of sulphur or precipitated sulphur, 

 which have long been used in the treatment of haemorrhoids ; sulphur 

 is generally given in combination with tartrate of potash. One of the 

 commonest prescriptions is $. sulphur, depur. 3 ij, potass, bitart. ss, 

 syrup, limonis, sacch. albi ana f iij, H. ft. pulv. S. A teaspoonful two 

 or three times daily. 



If we do not succeed with this prescription, we may add some 

 senna or rhubarb to it. Another popular way of prescribing sulphur 

 is the pulvis glycyrrhiza compositus, of which a few teaspoonfuls may 

 be taken during the day. Enemata are not generally advisable ; for, 

 even if carefully used, they are liable to irritate the rectum. Where 

 cirrhosis of the liver, or diseases of the lungs or heart, cause the 

 haemorrhoids, we cannot usually fulfil the causal indications. In these 

 cases, also, the administration of sulphur is advisable, so that a second 

 evil may not be added to the first. As we have mentioned overfilling 

 of the portal veins, from excess in eating and drinking, as among the 

 causes of haemorrhoids, so the casual indications require that such 

 patients should not eat too frequently or too much. Finally, in those 

 patients who, besides other troubles, have haemorrhoids from excessive 

 eating, we must lay down the most stringent rules. If there be a true 

 plethora in such cases, it can only be explained on the supposition that, 

 when the serum of the blood contains an increased amount of protein 

 substances, particularly of albumen, it requires an abnormal fulness 

 of the blood-vessels to cause the separation of the same amounts of 

 fluid that are excreted with a normal fulness of the vessels. If the 

 normal amount of albumen exists in the blood, we may regard it as 

 proved that the amount of urine excreted diminishes with the increase 

 of albumen in the serum of the blood. The above hypothesis also 

 corresponds to the general belief of the laity and physicians : a man 

 does not become full-blooded by eating or drinking too much, but by 

 eating nourishing food and drinking spirituous liquors. Without en 



