Imagens das páginas
PDF
ePub

fested by a sense of sinking, weight, constriction, and pain at the epigastrium. The result of this impression is extended to the surface of the body; the cutaneous vessels contract, inducing pallor, and the blood, driven from the surface, accumulates in the internal organs, producing various functional disorders of the stomach, derangement of the liver, jaundice, diarrhoea, or hæmorrhagic discharge from the rectum.

Internal irritation from a variety of sources will produce these affections. Ascarides, which infest the lower portion of the alimentary canal, are not an infrequent cause; irritation arising from diarrhoea and dysentery will excite the hæmorrhoidal discharge, and we shall observe it not unfrequently as a crisis in other diseases: thus it occurs in fevers, particularly bilious and gastric fevers; also when inflammation has attacked the brain or any of the organs lodged in the thoracic and abdominal cavities; and in other conditions of the system, as hypochondriasis, &c.

Diseases of contiguous organs, by inducing an afflux of blood to the pelvic viscera, and by extension of inflammation and irritation, are common causes of hæmorrhoids we observe them accompanying disease of the prostate gland; occurring as a consequence of stone in the bladder; the effect of stricture of the urethra, consequent on the vascular turgescence and

violent straining in micturition, attendant on the aggravated forms of the latter affection.

Excessive venery and masturbation, by producing relaxation of the system, and by determining the blood to the organs in the pelvis, produce hæmorrhoidal disease.

Certain purgatives and drastic medicines, as aloes, scammony, gamboge, black hellebore, rhubarb, the neutral salts, &c., particularly if prescribed in too frequent and too large doses, induce hæmorrhoids: they act directly by irritating the mucous membrane of the rectum, and by inordinately exciting that portion of the intestine, and the lower part of the colon. Of all medicines, calomel and the other preparations of mercury have been productive of most mischief in the affections we are now considering, as well as inducing other diseases of the digestive organs. It is not from the use of the mineral, but its general abuse, that the evil arises: the practice is justly reprobated by Drs. Copland, Elliotson, and other writers on the practice of medicine. It may, however, be questioned whether all the medicines first mentioned, when properly administered, exert much influence in inducing the disease, and whether it is not rather to the state of the constitution rendering these medicines necessary that we should ascribe the local affections. They will severally readily repro

124

duce the hæmorrhoidal flux when once it has taken place, but it is not to be inferred from this that they will cause the disease, as morbid action having once occurred in a part is much more easily re-established even by slighter causes; therefore, before attributing the malady to medicines, it is essential to ascertain if there may not be other causes to which it may owe its origin.

As well as to living above par, conjoined with a deficiency of exercise, we shall be able to trace the disease in some people to eating various alimentary substances, particularly highly-seasoned dishes, spices, onions, shallots, &c.; to partaking of very hot or cold beverages, or too great a quantity of stimulating drinks: certain wines, such as claret, champagne, also cider and beer, will, in some individuals, readily induce the affection.

The local application of cold or heat, as sitting on stone seats, on the cold and damp ground, on damp cushions, the habit of standing with the back to the fire, riding rough horses, prolonged walks in hot weather, travelling a number of consecutive hours in a carriage, sitting on pierced seats whereby the blood gravitates to the anus, consequent upon its being unsupported, and on the obstruction to the circulation from the pressure on the surrounding parts; stimulating pediluvia, irritating and large

enemata, are other causes of hæmorrhoidal affections.

The symptoms attending hæmorrhoidal diseases vary much, and are greatly influenced by the state of the general health of the patient, the exciting cause whether accidental or constitutional, and the complications with which they are associated, and also by the piles being internal or external.

:

In the first attack, the patient will probably experience but slight inconvenience. If the disease is only of the congestive form there will be itching and a sense of weight and fulness in the rectum, with uneasiness in the perineum in a few days bleeding may occur, but does not always take place in the early attacks, and when it does it is usually critical, all the symptoms and discomfort disappearing for the time. If the disease does not thus subside, but is permitted to increase, or when several attacks have been experienced, the symptoms will be augmented in number and severity; and, in addition to the weight and fulness at first felt, there will be heat and throbbing, the pain at stool will be greater, and will continue for some time afterwards: pain will also be felt up the sacrum, in the loins, and down the thighs; after a short time a flow of bright blood will be observed either preceding or after defecation ; usually increasing in quantity with the duration of

the disease, and often becoming the most prominent symptom, and causing great derangement of the general health. As the disease progresses, a feeling of the presence of a foreign body in the rectum will be experienced, and at stool one or more tumours will be protruded; at first they are retracted spontaneously after the action of the bowels, but, in process of time, from increase in size and loss of tone in the parts, it becomes necessary for the patient to replace them with his hand. Should the piles become constricted by the sphincter, many of the symptoms of intussusception or strangulated hernia may be induced. In weak and debilitated persons the sphincter loses its tone, the anal orifice becomes dilated, and the hæmorrhoidal tumours will then descend upon the slightest exertion, or even when he is in the erect position, causing great annoyance and discomfort in this condition they will be liable to ulceration from the friction to which they are exposed by contact of the clothes. A mucous discharge soiling the linen is a frequent symptom; it is sometimes so profuse as to run down the patient's legs whilst standing; it may also be very acrid, and produce excoriation of the external parts, adding greatly to his other sufferings.

:

By sympathy and contiguity, the irritability and sensibility of the bladder and urethra will be in

« AnteriorContinuar »