168 
P A T a H O L O G Y. 
propofed to divide the (tridtured gut, in order to fecure 
the efcape'of the contents of the bowels, the confinement 
of ’which muff, as he obferves, produce extreme diftrefs 
and danger. He adds, that the carrying up a cutting in- 
ftrument into the midft of a cancerous difeafe muff be 
expedted to produce ulceration, and, in this way, haften 
the deftrudtion of the patient; but that, in cafes of this 
kind, every thing that can be propofed is fubjedt to ob¬ 
jection. His words are ; “ On a propofe de faire alors la 
fedlion de l’un de ces points intermediares, afin d’affurer 
le paffage des matieres. Ce parti a de grande inconveniens 
fans doute. Porter l’inftrument tranchant au milieu ou 
tout presd’une affedtion cancereufe, c’eft hater l’ulcera- 
tion, qui doit confommer la ruine du malade ; mais, 
dans des cas de cette nature, on ne peut rien entreprendre 
que de tres defedtueux.” Upon this point it has been 
very properly obferved, that operative furgery fhould 
rarely, if ever, be recommended, unlefs where the chances 
are decidedly in favour of its fuccefs : and, if this opinion 
is right, it mud unqueftionably be wrong to advife an 
operatioh in a difeafe of inevitably fatal event. It can 
only tend to bring difcredit upon that branch of furgical 
pradtice, which, from the pofitive good that, under pro¬ 
per diredtion, it is capable of conferring, lays the faireft 
claim to the regard and confidence of mankind. 
Some pradtitioners have tried mercury in this malady, 
but with little fuccefs. Should we be fuccefsful at any 
future period in the treatment of fcirrhus, we may per¬ 
haps entertain better hopes of the complaint in queftion, 
though the conflant irritation to which it mull be fub- 
jedted in this part will render its cure a matter of great 
difficulty. Default, in his Oeuvres Chirurgicales, men¬ 
tions cafes which were cured by tents ; but it is now ge¬ 
nerally under(tood,that thefe were merely fnnplcftridtures. 
3. Prodtica tenefmus. A tenefmus is a frequent and 
infatiable propenfity to ftool, without being able to pafs 
any thing, notwithllanding the mod violent ed’orts. It 
may be occafioned by any kind of irritation, either of the 
redtum itfelf or of the neighbouring parts ; by acrid fub- 
dances taken into the body; by fome of the dronger 
purges, as aloes, fcammony, elaterium, Sec. or by fympa- 
thetic irritations. It is often very pernicious, both from 
the exceffive uneafinefs it occafions to the patient, and 
from exhauding his drength ; and by the frequent and 
vain ed'orts bringing on a prolapfus ani, and communica¬ 
ting the violent irritation to the neighbouring parts, as the 
bladder, See. When arifing from local acrimony or from 
the life of cathartics, it may be deemed an idiopathic af¬ 
fedtion ; but more generally it is found as a fymptom of 
other complaints, as dyfentery, haemorrhoids, helminthia, 
codivenefs, calculus of the bladder, and pregnancy. 
The treatment, when Amply diredted to the relief of 
the uneafy fenfation, confilts in injedting anodyne and 
mucilaginous enemata, and in exhibiting oleaginous ca¬ 
thartics. A clyder of darch, or of ltarch and opium, 
forms the bed remedy with which we are acquainted for 
the relief of tenefmus. In mod cafes, however, we have 
to diredl our attention to the didant irritation of which 
this complaint is fymptomatic. 
4. Prodtica marifea, (Haemorrhois, Cullen.) Piles. 
Specific charadter,livid and painful tubercles orexcrefcen- 
ces, ufuallywith a difeharge of mucus or blood. Of piles 
we have the four following varieties. 
ot.r P. cceca, (H. cceca, Cull.) The blind piles: pain and 
tubercles without difeharge. 
( 3 . P. mucofa, (H. mucofa, Cull.) Tubercles pale and 
mucous; they are moreover tranfparent, compreffible, 
highly eladic, and often produced in the courfe of a few 
hours. This variety is fuppofed to arife from a depofition 
of ferum only beneath the lkin. 
y. P. cruenta, (H. cruenta, Cull.) The bleeding piles. 
Tubercles florid and bleeding: they confid fometimesin 
didention or a varicofe date of the hemorrhoidal veins; 
more frequently of blood effufed into the cellular tiffue. 
They are opake, of a dark colour, the blood firming evi¬ 
dently through the flein ; and are of a firmer confidence, 
and more flowly formed, than the preceding variety. 
5 . P. polypofa. Polype-like excrefcences ftioofing 
from a (lender root; bulbous; foft and compreffible; red 
orreddilh; chiefly internal. 
Piles in general occafion only a flight degree of incon¬ 
venience; but fometimes they give rife to ferious .griev¬ 
ances, either by burfling and pouring out fuch quantities 
of blood as reduce the patient to the lowed date of de¬ 
bility, and dangeroufly impair his health ; or by exciting 
inflammation around them, and caufing abfeeffes and 
fidulas; or by becoming conftridted by the fphindter ani 
mufcle, fo as to produce exceedingly acute pain ; or, 
ladly, by affuming a malignant character. 
P. marifea arifes mod commonly from fome obdruftion 
in the circulation through the haemorrhoidal veins. 
Habitual negledl of the bowels favouring the accumula¬ 
tion of hardened faeces in the redtum ; (training to void a 
confined dool; the preffure of the gravid uterus, or of 
any preternatural tumours; a fedentary life; fudden 
and violent exertion; lifting heavy weights; have, in 
their turn, been the means of bringing on this difeafe, 
and may be confidered as fome of its mod frequent caufes. 
The fird appearance of all the varieties of marifea is 
generally connedted with pain and inflammation. The 
patient ufually complains of an uneafy fenfe of weight 
and fullnefs, as well as of heat about the parts, particu¬ 
larly fevere in paffing a motion. If the inflammation re¬ 
main unfubdued, the fundament becomes very painful ; 
the patient can then neither walk, ride, nor fit, the only 
tolerable date being that of abfolute red in the reclined 
pofition ; and, during the continuance of this date, paffage 
of a motion is followed by extreme didrefs. With thefe 
fymptoms there is generally more or lefs feverilh heat and 
redleffnefs, and perhaps even delirium. 
The marifeae may be numerous, or otherwife. Some¬ 
times a Angle fwelling only exids ; more frequently there 
are feveral furrounding theanus. Occafional haemorrhage 
is in mod cafes connedted with marifea. Perhaps in tire 
effort to pafs a motion, bleeding comes on while the 
parts are inflamed; in this cafe, the blood generally 
flows from within the anus, though it may occafionally 
fpring from fome part of the external fwelling. Some¬ 
times the bleeding will fird occur, and frequently in the 
abfence of every other fymptom ; or at lead without pain, 
inflammation, or external tumour. 
Many refpedtable writers affirm, that hemorrhoids 
which are not very troublefome, and difeharge only mo¬ 
derate quantities of blood, are rather falutary than hurt¬ 
ful to the conditution, and require no particular treat¬ 
ment. Among thefe, it may be fufficient to mention, 
Stahl, Sabatier, and Petit. This opinion has, however, 
met with fome oppofition. In Dr. Rees’s Cyclopaedia, 
article Hemorrhoids, it is drongly argued againd. The 
writer of that article admits the general falutary effedt of 
leeching in hemorrhoids, but affirms that the relief thus 
obtained arifes from its curing other difeafes in the con- 
fiitution which might be as well or better relieved by 
taking blood from the arm. The writer of that article 
proceeds es follows : “ Entertaining, as we do, a total 
difbelief of the dodtrine, that the bleeding from piles is 
ever really ferviceable to the fydem, we (hall never at¬ 
tempt to re-produce a difeharge of blood from them, 
when fuch is fuppreffed ; but, at the (ame time, fince a 
perfon with piles may alfo have complaints which require 
bleeding, we perceive no reafon why, in fuch cafes, any 
change (liould be made in the common mode of taking 
away blood, or that venefedtion in the arm (hould be 
abandoned for the employment of the leeches or the lan¬ 
cet in another part. We know, that it is approved as a 
general maxim, to take away blood as near as poffible to 
the feat of a difeafe : and to this method we alfo give our 
decided approbation. It is for this reafon, that we often 
preferibe the application of leeches to the anus, in cafes 
of inflamed protruded hemorrhoids. But, as we do not 
1 credit 
