Varicosity Of The Veins Of The Rectum, constituting Hemorrhoids, is, next to the preceding, undoubtedly the most frequent form, and is that which has been commonly regarded as the expression or crisis of a special (often hereditary) diathesis. Although we are now fully aware that too great a latitude has been allowed to the theory of hemorrhoids, yet hitherto no positive facts have been brought forward on which a better theory can be founded. It is worthy of remark, that even to the most recent times, erroneous views have often been promulgated regarding the nature of local hemorrhoidal disease, in consequence of our departing from the original view, that hemorrhoidal tumors are dilated varicose veins. We have convinced ourselves on innumerable occasions, that hemorrhoids are ordinary varicosities; and if we must, on the one hand, reject the opinion that they are produced by extravasation and sanguineous infiltration of the cellular tissue (Recamier, Gendrin), we, on the other hand, find no reasons for ascribing to them a peculiar erectile nature (Cruveilhier).

This varicosity affects the small veins, which freely anastomose with one another at the extremity of the rectum, and which lie thickly imbedded under the mucous membrane in the subjacent cellular tissue encircling its lower expanded portion. A certain number of these become dilated and stand out, sometimes. as separate knots, sometimes as a row of nodular swellings, thus causing the lower border of the rectum to protrude; or they may be within the rectum: it is only rarely, however, that they occur above the external sphincter. In a less developed stage of the disease, and at the beginning, they are small; but, after repeated swellings, they attain the size of a bean, a hazel-nut, or a walnut. They are then protruded from the gut when the bowels are moved, the rectum is choked up with them, and they are constricted by the border of the anus, which not unfrequently gives them a pedicled form. At first the swelling disappears without leaving a trace; the oftener, however, that they swell, so much the more is the mucous membrane of the rectum, in which they lie, left in persistent folds and elongations, which project externally; and finally, when repeated inflammations have taken place, a recession of the knots (varices) no longer occurs, and they assume a condition which renders them capable of still further enlargement, but not of any diminution.

Hemorrhoidal knots at first form roundish, simple sacs, which, however, afterwards become sinuous, and partitioned in their interior; their walls at first are thin, and collapse on being cut; they gradually, however, become thick and rigid, in consequence of repeated inflammations. One, or very commonly several fine venous branches open into the cavity of each knot, whose lining membrane is undoubtedly composed of the inner coat of the veins. The veins adhere, as a general rule, very tenaciously to the mucous membrane of the rectum, but they may be at first easily detached from the cellular tissue and the muscular coat. The cellular tissue lying between them is, like the mucous membrane, in a state of injection, reddening, and tumefaction - in short, in a condition of stasis.

The hemorrhages which occasionally proceed from the varicose swelling of the veins in the rectum, are doubtless dependent in some cases on the rupture of a varix, and of the tense and thin mucous membrane covering it. True capillary hemorrhages of the mucous membrane itself are, however, incomparably more frequent.