The Abdomen 199 



Hemorrhoids are composed of varicose or dilated veins of the 

 hemorrhoidal plexus. When they have for their covering the skin 

 about the anus they are termed "external," and when they are 

 limited by the mucosal membrane within the anus they are termed 

 "internal." Both may co-exist, when they are described as "mixed." 

 The external variety is usually seen as a cluster of small cutaneous 

 projections made up chiefly of hypertrophied perirectal connective 

 tissue, which may be secondary to inflammation of the anus or 

 rectum, and not truly hemorrhoidal. When the external veins 

 are involved, phlebitis may lead to thrombus, and they are then 

 apt to rupture, forming a soft tumor, which may -suppurate, and 

 eventually become a fistula. The internal variety is composed of 

 numerous enlarged vessels, hypertrophied connective tissue, and 

 mucous membrane. This variety may exist in the form of a 

 tumor composed of a varicose vein, connective tissue, and a 

 few arterial twigs, which tends to protrude, especially during de- 

 fecation, or as a collection of sessile ulcerating excrescences which 

 are very prone to bleed when irritated by fecal masses. 



The cause of hemorrhoids may be sought in anything which 

 may obstruct the portal circulation, such «is coprostasis, hepatic 

 congestion and cirrhosis, enlarged prostate, proctitis and other 

 diseases of the rectum, and chronic cardiac disease. These con- 

 ditions lead to stasis in the hemorrhoidal veins, the more easily 

 on account of the freedom of the latter from the valves. 



Symptoms and Diagnosis. The chief symptom in the early 

 stages is pruritis, manifested by the animal constantly dragging 

 the anus along the floor or licking the parts. Later there appear 

 the hemorrhoidal knots, and if the veins burst, considerable local 

 swelling. The pain may cause suspension of defecation. In the 

 internal variety there may be passage of blood. Rectal explora- 

 tion is painful. 



Hemorrhoids may be confounded with polypi, which, however, 

 have a distinct pedicle, with prolapsus, and with suppuration of the 

 anal pouches, to diflferentiate from which a careful examination 

 is necessary, or with neoplasms, which are usually characterized 

 by induration. 



Treatment. Simple pruritis and hemorrhoids of recent origin 

 or free from ulceration are amenable to medication and regulation 

 of diet. Treatment consists of administration of remedies which 



