272 PRACTICE OF PHYSIC. 



DCCCCXXXIX. As the internal edge of the ring men- 

 tioned, is necessarily divided by clefts, the whole often assumes 

 the appearance of a number of distinct swellings ; and it also 

 frequently happens, that some portions of it, more considerably 

 swelled than others, become more protuberant, and form those 

 small tumours more strictly called Haemorrhoids or Piles. 



DCCCCXL. From considering that the pressure of fasces, 

 and other causes interrupting the return of venous blood from 

 the lower extremity of the rectum, may operate a good deal 

 higher up in the gut than that extremity, it may be easily un- 

 derstood that tumours may be formed within the anus ; and 

 probably it also happens, that some of the tumours formed 

 without the anus, as in DCCCCXXXIX., may continue when 

 taken within the body, and even be increased by the causes 

 just now mentioned. It is thus that I would explain the pro- 

 duction of internal piles, which, on account of their situation and 

 bulk, are not protruded on the person^ going to stool, and are 

 often therefore more painful. The same internal piles are 

 more especially painful when affected by the haemorrhagic ef- 

 fort, described in DCCXLV. and DCCLXIX. 



DCCCCXLI. The production of piles is particularly illus- 

 trated by this, that pregnant women are frequently affected with 

 them. This is to be accounted for, partly from the pressure of 

 the uterus upon the rectum, and partly from the costive habit 

 to which pregnant women are usually liable. I have known 

 many instances of piles occurring for the first time during the 

 state of pregnancy ; and there are few women that have borne 

 children, who are afterwards entirely free from piles. The 

 Stahlians have commonly asserted, that the male sex is more 

 frequently affected with this disease than the female ; but in 

 this country I have constantly found it otherwise. 



DCCCCXLIT. It is commonly supposed, that the frequent 

 use of purgatives, especially of those of the more acrid kind, 

 and more particularly of aloetics, is apt to produce the haemorr- 

 hoidal affection ; and as these purgatives stimulate chiefly the 

 great guts, it seems sufficiently probable that they may excite 

 this disease. 



DCCCCXLIII. I have now mentioned several causes which 

 may produce the hoemorrhoidal tumours and flux as a topical 



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