PATHOLOGY, 
170 
being {imply cut through at their bafes. In performing 
this operation we are direfted to fave fome portion of {kin, 
on which account the fcalpel is preferable to the fciffors. 
Another mode of removing piles is by a ligature palled 
round their bafe. This is an eligible plan when the fwellings 
are fituated high up the reftum, where the danger of bleed¬ 
ing is fomewhat alarming ; but it is tedious, feveral days 
often parting before the tumours drop off; and it is alfo lefs 
cleanly, and attended with much more pain than is occa- 
fioned by the knife. There are very good furgeons how¬ 
ever, who employ the ligature in preference to the 
knife, and of courfe where bleeding has produced much 
debility it is the belt method. When the marifcas are 
numerous, we fnall often fucceed, as Mr. Ware firft ob- 
ferved, in relieving the patient, by cutting off only one of 
them ; for, if an accurate enquiry be made, he believes it 
will be found that the patient will point to one, or at 
mo ft to two, of the tumours, from which all the pain 
proceeds. 
If the hemorrhage which fometimes follows the opera¬ 
tion of cutting off piles brings on alarming fymptoms of 
exhauftion, we mud diftend the reSum with a piece of 
fponge of fuch fize as will make therequifite degree of 
prefl'ure upon the opening of the bleeding veffel. Some 
dip the fponge in a ftyptic lotion ; but the beft way is to 
introduce that fubftance quite dry into the inteftine, and 
let it expand there with the blood which would be im¬ 
bibed by it. 
When we meet with cafes of long {landing which we 
have reafon to believe connected with difordered func¬ 
tion of the ftomach and bowels, a very ftrift attention 
to diet is called for. This is at all times indeed of the 
ffrft importance, lince it is quite obvious that, the irrita¬ 
tion of the parting of {tools being the chief fource of irri¬ 
tation, every mean which diminifhes their volume and 
acrimony muft be a powerful agent in expediting the 
cure. If, after flopping the bleeding front piles, biliary 
difturbance occurs, we fhall do well to reproduce the dif- 
charge by anal leeching after the manner defcribed when 
fpeaking of Coproftalis. Oleaginous cathartics will alfo 
be found ufeful. 
5. Proftica exania, (H. procedens, Cullen.) Falling 
down of the fundament. Inverfion and prolapfe of the 
villous tunic of the reftum, from relaxation of the 
fphinfter, with more or lefs tumour. This fpecies con- 
fifts of two varieties. 
a.. P. {implex, confifts in a protrufion of a part of the in¬ 
ternal membrane of the- re£1 urn, which, becoming in¬ 
verted, and parting out at the anus, forms a red foft flattifli 
circular tumour. It is frequently obferved in children, 
affefted with tenefmus or dyfentery, in thofe who are 
fufiering a fit of the ftone, or undergoing the operation 
of lithotomy. Women, having internal hemorrhoids, 
and in the violent efforts of labour, are alfo fubjeft to 
the fame accident. Its common caufe is too-violent and 
repeated exertions of the redlum itfelf, excited by fome 
fource of irritation about the extremity of this inteftine. 
Thus, the too-frequent employment of aloetic medicines, 
the aftion of which particularly affefts the large intes¬ 
tines, often occafions the above complaint. The fame 
thing refults from afcarides, which, lodging about the 
lower part of the reft urn, occafionally caufe excertive ir¬ 
ritation. Habitual coftivenefs, hemorrhoids ; in a word, 
everything which, by ilimulating the reftum, excites 
too violent an aftion of this inteftine, may induce this 
' complaint. In the early and moft fimple ftage of this 
difeafe, the fwelling may be eafily reduced by compref¬ 
ling it with the fingers, and the reduction may be main¬ 
tained by the application af a bandage, which will keep 
up moderate prelfure ; and, even in fevere and more ad¬ 
vanced cafes, the reduftion may be readily effefted by the 
following procefs. The patient being in bed, lying 
upon his fide, or, what is better, on the abdomen, while 
his buttocks are raifed rather higher than the reft of the 
body, the furgeon is to make ltrong but equal preffure, 
with the palm of his hand, on the lower portion of the 
prolapfed inteftine. By continuing fuch preffure, the 
inteftine may, in general, be eafily reduced. But, if this 
plan {hould not fuffice, the upper part of the protruded 
inteftine muft be compreffed with the fingers of one hand, 
(previoufly oiled,) while the lower part is preffed upward 
by the palm of the other. In this way we are almoft fure 
to fucceed, unlefs, from having too long delayed the re¬ 
duftion, the gut has become fwollen and inflamed, when 
it will be impoffible to reduce the part before fuch fymp¬ 
toms have been fubdued. For this purpofe it may be 
proper to take blood from the patient, in fuch quantity 
as his ftrength will allow. The inteftine may alfo be fo¬ 
mented; and, when the fwelling has been diminiftied 
by thefe means, there will be no difficulty in replacing 
the parts in the manner juft mentioned. 
After the bowel has frequently defcended, the fphinc- 
ter fometimes becomes fo weakened, that it can no longer 
keep the part fupported. Hence different bandages have 
been devifed for fupporting the anus after its reduftion. 
A oomprefs, doubled feveral times, is ufually applied to 
the anus, and fupported in this pofition by means of a T 
bandage ; and, in many cafes, this anfwers very well. 
A machine was invented by Mr. Gooch, which has the 
double advantage of fupporting the inteftine more fe- 
curely than any other with which we are acquainted, and 
of allowing the patient to take a great deal more exercife 
than he could do without its affiftance. M. Bernard has 
invented an inftrument which confifts of an oblong oval 
body, rounded at one end, and terminating at the other 
in a narrow, rather long, neck, with a flat border at its 
extremity. The body of this inftrument, which is made 
of elaftic gum, when introduced into the inteftine be¬ 
yond the fphinfter, dilates and fupports the gut, while 
the fphinfter embraces its neck, and the border of this' 
part of the inftrument hinders it from afcending too far 
up the reftum. A. firing is alfo attached to the edge, 
which tends to prevent the occurrence. This peffary is 
very fmooth, and confequently cannot do any injury 
to the parts. It is alfo very light, being only compofed 
of a very thin, though tolerably folid, fubftance. As it 
is pierced at its termination, it does not impede the 
difcharge of air, which might otherwife incommode the 
patient. 
When the inteftine is protruded at the time the patient 
is at {tool, the part is to be immediately replaced. This 
the patient fhould accuftoin himfelf to do without affift¬ 
ance ; and then the bandage, or peffary, is to be applied. 
In order to ftrengthen the lphinfter ani and adjacent parts, 
the weaknefs of which muft, in the majority of cafes, be 
regarded as the entire caufe of the difeafe, the patient 
ffiould take preparations of bark and Heel, and make ufe 
of the cold bath. Aftringent injeftions, particularly 
fuch as are compofed of an infufion of gall-nuts, or oak- 
bark, are alfo ferviceable. 
With refpeft to the ulcerated, inveterate, and ir¬ 
reducible, cafes of exania, we may attempt the extirpa¬ 
tion of fuch difeafes with the knife. 
( 3 . P. fpafmodica. The tumour large and irritated ; and 
the inteftine contrafted by a fpafm of the fphinfter. This 
ferious diforder has been confounded with the previous va¬ 
riety, in which a confiderable portion of the colon,caecum, 
and even fometimes of the ilium, becomes everted and 
puffied out at the anus. (Morgagni de Sed. et Cauf. Morb. 
Ex. xxxiii.) The tumour has been alfo miftaken for a 
marifca ; and Dr. Cullen has, perhaps, given fome coun¬ 
tenance to the error, by defcribing one of his fpecies of 
heinorrhois as produced by a prolapfe of the anus. 
The hemorrhoidal tumour is dull and livid; that 
from a prolapfe of the anus is fleffi-coloured, fome¬ 
times wrinkled, at others fmooth and {hining. For¬ 
mer praftitioners confidered this occurrence in the 
fame point of view as P. exanise {implex : they believed 
that the whole of the reftum became everted, in 
confequence of the relaxation of the fphinfter and leva- 
tores 
