The vital fluid is contained in corresponding vessels, styled arteries and veins; but the former only are active powers. In the veins the blood is propelled by the adventitious aid of other muscular organs, secured in each step by valves. It is evident, therefore, that for the necessary support of the body, the action must bear some proportion to the resistance; for were either too great, the arteries would be emptied or infarcted. On inquiry, it appears that the proportion of the action to the resistance differs in different periods of our existence. Sir Clifton Wintringham showed, by experiment, that the density of the coats of the veins was greater in proportion to that of the coats of the arteries in young persons than in old. This proportion is gradually changing; and, after the acme of life, they are more nearly equal, or the resistance of the veins is little in proportion to the action of the arteries. If we look at the progressive growth of the body, we shall find this very wise distribution answers some important purposes; for the arteries, thus kept full, contribute to the evolution of the organs in succession; a change probably effected by expanding the nervous fibrils, which we have styled the moule intcneure; and the same resistance-throws the fluids into the exhalants, by which the nutritious particles are applied. This arrangement is no longer useful than during the increase of the body. The proportional action and resistance are, for a time, stationary; but at last the veins yield, and venous plethora is conspicuous. This is the period for apoplexies, for humoral asthmas, for infarcted viscera, and, to come nearer our object, for the bleeding piles.

In this succession we have already shown that the enlargement of the head first takes place, and its vessels are consequently filled. We trust it has not escaped our readers that we have anxiously pointed out the magnitude, the extent, and the dilatable structure of the venous system of the cerebrum, to show that nature carefully designs to keep the arteries full. Her object in this is from the present purpose; but though the resistance of the veins is considerable, a rupture of arteries, so carefully secured by a bony resisting covering, is prevented, and the anastomosing branches of both carotids yield to any increased impetus very easily in the nose. Haemorrhages, from that organ, prevent the active haemorrhagia cerebri; an appellation given by Hoffman to apoplexies in young persons. Where the resistance in early age is considerable, it probably disappears more quickly; and from fifteen to thirty-five this danger from distended arteries is chiefly perceptible -in the lungs. This point we have fully considered in the article Haemoptysis, q. v. It next appears in the epigastric, and successively in the hypogastric, region.

If in early age we perceive active haemorrhages in the brain, in the more advanced periods we perceive similar effects from venous plethora. We then find those apoplexies and palsies from a languid circulation, in other words, from weakened resistance of the venous system. In the lungs wc find, from the same cause, humoral asthma and hydrothorax; in the epigastric region, infarctecl liver, and the morbus niger; in the hypogastric, haemorrhoids. If we judge right, haemorrhoids are of two kinds. It is a disease of youth, as well as of maturer age; and, in the former, is often acutely painful, without evacuations; in the latter, less commonly painful, but usually attended with bloody discharges. In each it seems a salutary determination from parts otherwise overcharged; and this we think is proved by many facts. In the very painful haemorrhoids of young persons, saturnine and cold applications, which relieve pain, often induce sickness and faintness. In speaking of fistula, we have shown that checking the discharge is often injurious, and that consumptive symptoms frequently follow the operation and the healing of the wound. We will admit that such consumptions are connected with the state of the liver; but so far as we have seen, and the cases are not few, the age is not that of biliary congestions, but of accumulations in the lungs, viz. the consumptive period, from fifteen to thirty-five, generally from eighteen to thirty. It appears then highly probable that congestions on the thoracic viscera are relieved by others on these parts, and we thus see the connection of haemorrhoids with the general health, independent of any venous.connection with the liver. In these cases, the parts inflamed are carunculae already mentioned, and the inflammation is active. Yet in the haemorrhois of advanced life, such congestions evidently take place. The disease is the venous, and the tumours, in the greater number of instances, varices: they bleed, and the patient is relieved. Congestion and inconvenience follow, to be again obviated by a recurrence of the haemorrhage.

Those who are of a lax habit, disposed to eat heartily, and drink freely; who indulge in ease, and are habitually costive; are the most subject to this disorder.

Haemorrhoids are, however, often local diseases: when the uterus presses on the neighbouring trunks of the veins, the haemorrhoidal vessels swell, and often discharge blood. When resinous purgatives, which are slowly dissolved, and act only on the rectum, are exhibited, the piles follow; and this effect is particularly produced by aloes, sometimes by rhubarb. These are, in general, true varices; and the tumours are livid, soft, and bleed freely on being punctured; but the other tubercles in the anus, styled pi/es, are hard, and exquisitely painful.

The eruption of the haemorrhage in the open piles is often preceded by spasmodic strictures, flatulencies, pain about the os sacrum, and various other symptoms, which disorder the whole frame. In the beginning of excessive discharges the blood is black and grumous, afterwards redder, and at last it is mucous; at length the strength is impaired, the pulse is languid and trembling, a cachexy, a fatal hectic, or dropsy, comes on.

The piles are always readily distinguished; and attention is only required to prevent their being confounded with the colic, dysentery, or with syphilitic tumours about the anus.

When attended with an infarcted liver or spleen, a fatal hectic is the consequence: when the discharge is excessive, a dropsy. On the contrary, moderate discharges from the haemorrhoidal veins are supposed to relieve a constitution oppressed by the gout, asthma, sciatica, diseases of the kidneys or bladder, hypochondriasis, hysteria, or mania. Those discharges only are deemed morbid by which the patient is enfeebled, and the constitution injured.

The general indications are, 1. To take off* the increased impetus to the seat of the disease by bleeding and small doses of ipecacuanha. 2. To induce an astric-tion on the relaxed vessels; and for this purpose alum, the oak bark, or galls, may be employed. 3. To avoid all irritation, by regulating the stools, avoiding violent exercise and highly seasoned meats. An incautious use of improper diet will render the best medicines ineffectual in this disease. In general it should be light, cooling, and laxative. If, however, the distinctions we have endeavoured to establish be well founded, the haemorrhoids of young persons should be treated as active inflammation, or a deposition of morbid matter, and the general regimen of Hectics, q. v. with a little more active depletion, may be employed.

Bleeding at proper intervals, where there is a sanguine plethora, will in some measure prevent the returns, or at least moderate their violence. Topical bleeding by leeches or punctures are also useful, though care must be taken that the leeches do not escape into the rectum. If that accident should happen, injections of a solution of common salt are the proper remedy; but the animal is soon gorged, and may then be destroyed.

When the disorder assumes a chronic form in the more advanced periods of life, and the piles do not bleed, they are attended with considerable pain; in which case dossils of lint, dipped in warm olive oil, may be applied; or olive oil, with an equal portion of brandy, or of tincture of opium, may be spread on soft rags, and retained by the T bandage. Saturnine applications relieve pain; but we have often found them produce sickness and faintness. Emollient fomentations and poultices, when the pain is excessive and inflammation violent, are useful. In this case also Mr. Ware recommends cutting out the principal pile, which is usually larger than the surrounding ones, with a pair of crooked scissors. This relieves the pain and inflammation; and the haemorrhage, he says, is trifling. It could not be then an inflamed varix. If the piles are troublesome by their bulk, they may be dressed with a mixture of simple lime water, adding a small quantity of camphorated spirit of wine and a little of the cerussa acetata. See Gall.AE.

The bowels must be kept lax; and for this end the electarium e cassia is preferable to the electarium e senna comp. Sulphur, and the oleum ricini, are also useful laxatives. The former is supposed to have a specific effect in this disease, though later practitioners consider it only as a mild laxative. The long time during which it remains in the intestines, previous to its operation, seems to show that it acts exclusively on the rectum, and supports in some measure the idea of a specific action. The walnut is supposed to have a similar effect, and the preserved walnut is said to be a very useful laxative in this complaint. A mixture of soap and wax we have found highly useful. When the intestine protrudes after a stool, the patient should be placed in bed, the protruded gut supported, and in this case the sphincter relaxing the intestine is restored.

If the case requires the assistance of a surgeon to check the haemorrhage, a cooling purge may be administered, and, five or six hours before any operation, a clyster injected. The patient must then be laid in the proper position, and the operator may tie up the bleeding veins with a needle and thread; taking hold of any tubercles with the forceps, he may tie or cut them off. If the haemorrhage continues, lint, with proper compresses, and the T bandage, should be applied. If the veins are high in the rectum, it must be distended with a convenient instrument until the operator can reach them. If the blind piles encompass the anus so as to prevent the discharges by stool, and prove otherwise troublesome, the largest may be removed by a ligature; the application of warm spirit of wine, or other repel-lants, will not disperse it. If the distended vein is high and inflamed, it may be opened with a lancet. When-from long continued piles a fistula is apprehended, ward's paste is sometimes useful. It consists of a pound of elecampane root, with half as much black pepper, and a pound and half of fennel seeds, made into a paste with honey. When the piles are apparently continued from relaxation, two drachms of the tincture of muriated iron, with about a drachm and a half of opium, and four ounces of barley water, may be injected as a clyster twice a day.

See Hoffman; Heister's Institutes; Lobb on Painful Distempers; Le Dran's Operations; Cullen's First Lines, vol. ii. p. 424. edit. 4; Bell's Surgery, vol. i. p. 249; White's Surgery, p. 383.

Haemorrhoides excedentes; immodicae; poly/tosa, belong to the hae 'morrhois tumens; the haemorrhoides decoloratae; the hae' morrhoides albae and mucidae, differ only in the appearance of the discharge, which is mucous, not bloody. See Haemorrhoides.