PATHOLOGY. 
credit that the ftoppage of bleeding from piles is likely 
ever to prove a caufe of any difeafes, but rather of an 
improvement of the health, we are far from being an¬ 
xious to fee the hemorrhage renewed in any form what¬ 
ever. But, fuppofing fome illnefs were aftually to be the 
efteft of a fuppreflion of bleeding from the tumours, fuch 
illnefs could only be imputed to a conftitutional ple¬ 
thora, induced by the ufual evacuation of blood not 
taking place. Here the redundant and hurtful quantity 
of the circulating fluid might be much more conveniently 
and certainly drawn from the arm, in the common way, 
than by applying leeches to the tumour, or punfturing 
them with a lancet. The blood, in this circumftance, is 
not taken away for the relief of the piles, but of fome 
other affe< 5 lion ; and, confequently, the principle of bleed¬ 
ing as near as poflible to the feat of the difeafe is not 
at all obferved, as fome may fuppofe it is, in drawing 
blood from the fwellings themfelves.” 
With regard to this fubjeft, we may obferve, that there 
can be little doubt but that, in cafes manifeftly depen¬ 
dent on preffure of the hemorrhoid veins, the lofs of 
blood may be ufelefs, perhaps hurtful ; but it cannot be 
queftioned, that piles in many inftances arife from a dif- 
ordered date of the abdominal vifcera; and that they 
ierve materially to relieve the local plethora of thofe or¬ 
gans. Hence we fee them arife often in dyfpeptic and 
bilious complaints, which they then relieve in a very 
effeftual manner. To fay that general bleeding would 
afford equal relief to thefe complaints, is to affert what is 
contrary to experience ; and it is equally abfurd to fay, 
that in this cafe the blood is not taken from the part af- 
fefted, fince a glance at the connexions of the hsemor- 
rhoidal veins, fhows that they are literally continued from 
the portal fyftem. The frequency of the above-men¬ 
tioned caufes of marifca compel us therefore to fay, that 
in difmiffing fo unceremonioufly the obfervation of the 
old praftitioners, that the bleeding from piles is often 
falutary, we (hould aft very haftily. We cannot help 
quoting the appropriate fentiments of Dr. Parr, who 
(though he deemed the danger of flopping hemorrhoi¬ 
dal difcharges inexplicable) fays, however, that “ it ap- 
ears rafh and prefumptuous to deny, at once, what has 
een eftablifhed in the opinion of able and experienced 
praftitioners; opinions not haftily taken up, and as 
quickly refigned, but apparently refting on fafts, the 
refult of the obfervation of many years, in different and 
diftant countries.” 
Dr. Parr is of opinion, that this complaint in old age 
is often indicative of difeafe in the venous fyftem in ge¬ 
neral. “If in early age we perceiveaftive hemorrhages 
in the brain, in the more advanced periods we perceive 
fimilar effefts from venous plethora. We then find thofe 
apoplexies and palfies from a languid circulation ; in other 
words, from weakened refiftance of the venous fyftem. 
In the lungs we find, front the fame caufe, humoral afth- 
ma and hydrothorax 5 in the epigaftric region, infarfted 
liver, and the morbus niger; in the hypogaftric, hemor¬ 
rhoids. If we judge right, hemorrhoids are of two 
kinds. It is a difeafe of youth, as well as of maturer age ; 
and, in the former, is often acutely painful without eva¬ 
cuations, in the latter lefs commonly painful, but ufually 
attended with bloody difcharges. In each it feems a fa¬ 
lutary determination from parts otherwife overcharged ; 
and this we think is proved by many fafts. In the very 
painful hemorrhoids of young perfons, faturnine and 
cold applications, which relieve pain, often inducefick- 
nefs and faintnefs. In fpeaking of fiftula, we have fhown 
that checking the difcharge is often injurious, and that 
confumptive fymptoms frequently follow the operation 
and the healing of the wound. We will admit that fuch 
confumptions are connefted with the ftate of the liver ; 
but fo far as we have feen, and the cafes are not few, the 
age is pot that of biliary congeftions, but of accumula¬ 
tions in the lungs, viz. the confumptive period, from 
fifteen to thirty-five, generally from eighteen to thirty. 
169? 
It appears then highly probable that congeftions on the 
thoracic vifcera are relieved by others on thefe parts ; and 
we thus fee the connexion of hemorrhoids with the ge¬ 
neral health, independent of any venous connexion with 
the liver. In thefe cafes, the parts inflamed are carun- 
culas already mentioned, and the inflammation is aftive. 
Yet in the hemorrhois of advanced life, fuch congeftions 
evidently take place. The difeafe is the venous, and the 
tumours, in the greater number of inftances, varices: 
they bleed, and the patient is relieved. Congeftion and 
inconvenience follow, to be again obviated by a recur¬ 
rence of the hemorrhage.” 
The inflamed and irritable ftate of the fphinfter which 
thefe complaints have a tendency to produce, often makes 
it contraft fpafmodically on the hemorrhoid, and occafion 
great pain and diftrefs. Mr. Howfhip mentions two cafes 
in which the contraftion was fo powerful and continued, 
that the ftrangulated hemorrhoid floughed off. 
In fpeaking of the treatment of this complaint, we 
(hall of courfe pafs over all cafes arifing from permanent 
preffure on the hemorrhoidal veins, as from pregnancy, 
&c. Thefe can only be relieved by the removal of the 
caufe. For the treatment of all the varieties, the fame 
meafures are indicated, except that, as the marifcas are 
only vifiblejuft after the patient has been at ftool, in 
fuch cafes the praftitioner is obliged to take this oppor¬ 
tunity of performing operations, or of applying reme¬ 
dies. 
The relief of the fecond variety is eafily accomplifhed. 
Abfolute reft for a few days, attention to the bowels, 
and warm bathing of the parts, will comprife all that is 
required. 
As the P. M. cruenta, or bleeding piles, often produce 
much furrounding inflammation, they will require, in ad¬ 
dition to abfolute reft, an aftive treatment. If the pa¬ 
tient is of a full habit, and the parts are very turgid and' 
painful, an important ftep will be the application of cup- 
ping-glafles near the parts. Leeches will occafionally 
anfvverthe purpofe ; but, if it be required to takeaway 
five or fix ounces of blood fpeedily, the operation of. cup¬ 
ping is much more certain and manageable. If necef- 
fary, the bleeding may afterwards be encouraged by fo¬ 
menting with warm water, or a poppy-head decoftion. 
Should the bowels be confined, it may be prudent to de¬ 
lay, for a little while, the additional difturbance incurred 
by the paflage of a ftool, perhaps containing hardened 
faeces, until the fymptoms are fomewhat relieved ; al¬ 
though the procuring a cool and gently-relaxed ftate of 
the bowels is always important; andindeed, till this point 
is gained, little real progrefs in improvement can be 
made. Should feverifh fymptoms demand attention, fa- 
line or antimonial diaphoretics may, if neceffary, be added 
to aperients; and, when they have operated fatisfaftorily, 
we may direft an opiate at night. A falve, made of el¬ 
der-ointment and the powder of oak-galls, in equal parts, 
may be applied to the tumours, together with linen wet 
with the lotio aquae lithargyri acetati. This latter is 
more particularly neceffary in conjunftion with leeches, 
when the cafe is accompanied with confiderable pain and 
inflammation. 
Painful fpafm of the fphinfter is to be relieved by the 
continued ufe of warm fomentations, or occafionally by 
gentle fteady preffure upon the tumid parts, by which 
means part of the blood will be made to pafs inward by the 
hemorrhoidal veins, relieving the fenfe of outward fullnefs. 
When the pain and inflammatory ftate of piles is owing 
to their being conllrifted by the fphinfter-ani mufcle, it 
is evident that the mode of relief confifts in pufliing the 
tumours with the finger a little within the reftum, where 
they are not liable to fuffer from preffure. When marif- 
cae materially obftruft the paflage of the fasces, or are very 
painful, and fubjeft to profufe bleedings, and the means 
above mentioned are ineffeftual, the removal of the tu¬ 
mours (hould be recommended. 
Piles are removed with a knife or fciffors, the tumours 
being 
