(From blood, and to flow). The hemorrhoids, or piles. A discharge of blood from the haemorrhoidal veins, called the open or bleeding piles: when instead of this haemorrhage there are large tumours, generally painful at the lower part of the rectum, they are called the blind piles. The disease is placed by Dr. Cullen in the class pyrexia, and order haemorrhagiae; and he defines it a heaviness, or pain of the head, giddiness, pain of the loins and of the anus; livid painful tubercles about the anus, from whence blood generally issues, which sometimes also flows without the appearance of any tumours. He distinguishes four species:

1. Haemorrhois tumens, when there are external swellings on the edge of the anus, called mariscae, distinguished by the terms bloody and mucous.

2. Haemorrhois procidens, when the piles are external, and caused by a bearing down of the anus.

3. Haemorrhois fluens, when the piles are internal, without external tumour or bearing down of the anus.

4. Haemorrhois caeca, when there are pains and tumour about the anus, without any discharge of blood. In some cases there is a discharge only of mucus; and the disease is then called leucorrhois.

Dr. Cullen thinks the haemorrhois often depends upon a certain state of the whole body; but it is often a mere local complaint. He would, not, therefore,

H AE M 731 H AE M refer a complaint of this sort to local diseases; because some piles, though in the beginning they may be merely-local, if they should return often, as is usual, at length become habitual, and a general disease. Every species of the piles should be arranged therefore, in his opinion, amongst general diseases.

From dissections, this disease is supposed to be an ec-chymosis in the cellular membrane of the lower part of the rectum, from the extremities of the neighbouring vessels: if this be true it accounts for the great loss of blood without loss of strength; for it is gradually emptied into the ecchymosis, and from thence only-pours out in appearance so copiously.

There is seldom much discharge from the external haemorrhoidal vessels, but they readily admit of painful varices. The internal haemorrhoidal vessels not only-discharge copiously, but, when this discharge is suppressed, disorders of the liver, spleen, pancreas, mesentery, and intestines, seem to be produced.

These general views of haemorrhois have, however, always appeared to us unsatisfactory. Though the lax texture of the haemorrhoidal veins admits of congestion, and, when a part of the intestine is inverted, the sphincter necessarily checks the return of the venal blood; yet these circumstances by no means explain the phenomena of this intricate disease. We have frequently alluded to the opinions of the German physicians, at the head of whom is Stahl, that the discharge is salutary, to repel it dangerous, and to promote it the best method of relieving various diseases of the viscera and head. Dr. Cullen is willing to refer all these effects to the haemorrhage having been long established and become habitual. A distinction, however, so obvious could not have readily escaped even a prejudiced observer; but we believe it to be a fact, that even repelling the painful varices, or checking the discharge before it has become habitual, sometimes produces inconvenience. It is not also easily explained why such inconsiderable tumours should form an obstruction capable of exciting the action of the whole arterial system, and pouring out blood from its branches. If it is a fact also, that diseases of the liver are relieved by these discharges, it would be singular that the external as well as the internal tumours should have equally such a salutary effect, since the internal haemorrhoidal vein only contributes to form the vena portae. In short, every- view of this kind is attended with considerable difficulties, which can only be eluded by at once denying all connection of haemorrhoids with the -general system, except when it becomes an habitual discharge. But it appears rash and presumptuous to deny, at once, what has been established in the opinion of able and experienced practitioners; opinions not hastily taken up, and as quickly resigned, but apparently resting on facts, the result of the observation of many years, in different and distant countries.

It may then be asked, are the haemorrhoids varices only portions of veins enlarged ? They may be so in many instances; but round, circumscribed, rumours are not readily explained, when we consider that the haemorrhoidal veins have no valves: the very acute pain attributed to inflammation is not readily explicable, when we consider the great laxity- of the coats of the veins, and the very few vessels found on them. Add to this, that an haemorrhoidal tumour, when punctured, seldom bleeds; that leeches do not more quickly fill themselves in this part than any other of the body. It is highly probable then that these tumours are not varices, but small follicles inflamed, generally painful, and on the evacuation of a costive stool excruciatingly so. Such small bodies, suspected to be glands, certainly exist near the verge of the anus, and have been supposed to resemble the ca-runculae myrtiformes at the entrance of the vagina.

If these are admitted to be the substance of the haemorrhoidal tumours, many of the difficulties will be removed, and some consistency given to the various phenomena of the disease; but to elucidate this subject, we must enlarge a little, as we have proposed, on the progressive changes in the balance of the circulation. We had purposed to defer it to the article Man (Homo), where we intended to collect all those circumstances relative to his structure and constitution, both mental and corporeal, which cannot with advantage be displayed in distinct articles; but the application of these considerations will be more obvious in this place.