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chectic difpofitions ; but they very feldom are attended with fo copious an haemorrhage as to endanger life on the fudden, tho* this has fometimes happened. The fudden flopping them is always dangerous, and often brings on immediate fatal fymp- tums ; fchirrufes of the vifcera, inflammations, melancholy, madnefs, vomiting of blood, and dropfies, and jaundices, often are the confequence of fuch practice. Thofe perfons who have them while very young, generally are attended regularly with them thro' their lives, and feldom live to be very old ; on the contrary when they do not appear till perfons are ad- s, and continue regular and moderate afterwards,
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they promife a long life. Finally, when the Hemorrhoids are continual, and flow without anyintermiflions, there is great caufe to fufpect a fchirrous or ulcerated itate of fome of the abdominal vifcera. Method of Treatment. When the Hemorrhoids have never yet appeared, but there arc figns of their approaching, it is not always advifeable to forward or promote their difcharges, for they feldom anfwer exactly to expectation ; but when there is room to fear the fuccefs, it is better to endeavour at a re- vullion by bleeding in the arm or foot, and at the fame time to itrengthen the tone of the parts by a decoction of yarrow or the like medicines. And the bleeding is to be repeated afterwards at ftated periods, and the ufe of the internal means continued ■ if necefTary ; but when the Hemorrhoids have already been ufed to flow, as foon as the patient feels the fignals of their approach, their difcharge is always to be gently promoted, by a moderate ufe of elixir proprietatis, or tincture of black hellebore, or its refin made with fpirit of wine ; and exter- nally by the application of leeches, or, if that is not fufficient, by opening the veins with a lancet. Junker's Confp. Medic. p. 47.
During the time of the flux, if that be moderate, there is no occafion for any afliftance from medicines, but a proper diet is to be obferved ; all windy foods are to be avoided, as alfo all aftringent ones ; the ufe of fpirituous liquors is to be re- trained, and the mind kept quiet and free from the com- motions of any of the paflions. When the difcharge is too fmall, it is to be promoted ; and when it is really too great, and the ftrength of the patient cannot bear it, then the nitrous, cinnabarine, and abforbent medicines are to be given, as pow- ders prepared of fal prunellse, cinnabar either native or anti- monial ; if there he urgent neceflity fome gentle opiate may be added to thefe, as the pill deftyrace, or de cynogloiTo. Af- ter this, gentle clyftersare to be injected, and then the ufe of fpectfics is to be entered on ; among thefe, a decoction of ■the common yarrow is of lingular virtue : decoctions of maiden hair alfo and other of the like herbs are of great ufe. After the fit is over, bleeding muft be repeated at the equinoxes, and gentle purges given at times, efpecially fmall dofes of rhu- barb, which has an abftergent virtue that renders it peculiarly proper ; and this may be given even in the time of the fit, in fmall dofes. Mlind Hemorrhoids, Hemorrhoides cece, the name given by medical writer? to what are vulgularly called the piles. The blind and external piles are infarctions of the external hemorrhoidal veffels about the orifice of the inteflinum rectum, which fometimes form fimply turgefcent, foiwetimes inflam- matory tumors; and are meant by nature for the difcharge of blood from this part to relieve Hemorrhages, The blind piles are of two kinds, either fimply turgefcent, or tumid, the latter kind are painful, the former wholly indolent. The turgefcent blind piles refemble a foft tranfparent veficle ■ filled with a blackifh blood, and arc attended with no fenfible uneafinefs, except at the time of going to ftool, when they occafion a fenfation refembling that of a bean or plum {tone, or the like, flopping in the pafl'age ; and at times there is an un- common heat in the parts.
The tumid blind piles are fituated a little deeper within the verge of the extremity of the inteftine, and refemble a hard and inflammatory tumour ; thefe are properly indeed no other than furunculi of this part, and occafionvery violent and exquifite pains from the fenfibihty of the nervous and mufcular coat which lines the inteftines. Many authors befide thefe reckon under the name of blind piles all the tumid excrefcences and fungous and ulcerated protuberances that happen about the anus : thefe are diftinguifhed indeed by the appellation of fpurious He- morrhoids ; they ufually owe their origin to venereal taints, but fometimes arife from the turgefcent piles, which, in bad habits, and bodies fubject to ulcerofe ferofities, fometimes dege- nerate into thefe dry and verrucofe fwellings, and are called thymi^ marifei, and feus ani. Junker's Confp Med. p. 233. The external or blind piles differ from the internal, in regard to the veficles to which they owe their origin, the internal arifing from the vena porta, the external from the vena cava ; they differ alfo in their fize, and in the quantity of blood theydif- charge ; the internal ones ufuallydifcharge a moderate quantity, and if they are any waydifturbed they will throw offa great deal; whereas the external rarely bleed at all, but only fhew themfelves in thefe blind tumors. The internal alfo have their regular pe- riods, and very frequently obferve the monthly difcharges of the menftrua in women, returning as regularly in men as thefe in that fex: the others have no regular periods, but princi- pally appear about fpring and autumn ; and they appear the Suppl. Vol. I.
larger, and have the more blood derived to them, the oftener they have already arifen in a perfon. Their magnitude is very dif- ferent in different perfons ; in fome they are of the fize of a hazel-nut, in others of a walnut, and in fome they often grow to the fize of a pigeon's or even a hen's egg. The turgefcent piles either break naturally, or are to be opened byafurgeon; and when this is done, they not only difcharge the blood they contained, but alfo fupply a farther quantity after- wards. The tumid ones have all the figns of inflammatory tumors, attended with the mofl exquifite pains. Perfons fuhjetl to them. The turgefcent external piles are princi- pally incident to thofe of a phlegmatic and pituitous habit ; they often indeed appear in women during their going with child, with- out their being of this temperament, efpecially toward the latter part of their time, if they fit much j and fometimes they hap- pen even during the labour pains, when the fcetus preffes hea- vily upon the pelvis. Caufes of them. The general caufe of them is a plethora at- tended with athicknefs of the blood; whence nature, attempt- ing to relieve herfelf by an hemorrhage of thefe veffels, de- rives a larger quantity of blood than ordinary into them, where it remains, and according to its different ftate, forms either Ample veficles, or inflammatory tumors. The accidental caufes which bring them on, are immoderate attritions in thefe parts, from riding long journeys in perfons unufed to that exercife, froman itching or fharp humour about the part, from the painful voiding of the excrements in perfons very coffive, and from labour pains in women. Junker fays that they are fometimes got by fitting down in the feat in which a perfon has been juft fitting, who has the ulcerated piles, while it is yet warm from him. To thefe it is to be added, that they frequently come on from an omiflion of accuftomed bleedings, from an improper ufe of aloetic, helleborine, and other hot medi- cines^ and from too high feafoned foods, and the immoderate ufe of fpirituous liquors. Prognojlics in them. The blind piles are always in a ftate of tendency to a falutary end, that is to the evacuation of part of the abundant blood in plethoric habits ; but from the fmallnefs of the veflcls where they are formed, they very often mils of the proper end. When they either burn: naturally or are opened by art, they then afford for fome time a difcharge that may fupply the place of that by the internal Hemorrhoids. When they burit of themfelves, they eafdy become ulcerated afterwards, but this is not attended with any violent pain. As foon as opened, the veffel which formed the tumor becomes flaccid and rugofe in that part, and forms a fort of papula? or little tubercles, which, if not taken care of in the proper way, often continue to difcharge a fmall quantity of blood at every time the perfon has a hard ftool ; and even in fome cafes thefe papula have continued without intermiflion difcharging a fmall quantity of blood for many years ; fometimes alfo they dege- nerate into ferpiginous and pruriginous little ulcers, which are called ferpigo ani, or pruritus ani. This is a troublefome complaint, and is not unfrequent in people fubject to the ex- ternal Hemorrhoids, tho' not much regarded by authors ; it never fpreads far, but often continues many months in the fame fpot ; and if by unfkilful treatment it be repelled from thence, it fometimes returns again more violently in the neighbouring parts, and fometimes occafions diforders of a worfe nature in the more diftant ones. Junker's Confp. Med. p. 239. 1 he tumid and turgefcent piles are both without danger to the life of the patient, unlefs in fuch cafes where ihey are violently fupprefled, on perfons who have been long fubject to them. The tumid are however attended with one danger which the turgefcent are free from; this is, that if unikilfully managed, they will fometimes come to a fup. juration, which ter- minates often in a fiftulous ulceration. This too often happens when they are cut too deeply into, during the time of their ripening, and arc kept open too long afterwards without being well cleanfed. When hemorrhoidal affections become ulcerous, they are more contagious than almofl: any other difeafe ; and as this is not commonly known, many fuffer by it. Method of cure. The turgefcent piles, if treated in the com- mon way of tumors and little ulcers by a fkilful furgeon, are very rarely attended with any bad confequenccs. The tumid give much more trouble. The firft attempt muft be to dif- cufs them ; and to this end bleeding in the foot is one of the firft things to be done, in cafes where there is a plethoric habit, and very ftrong decoctions of yarrow are to be given, feveral dofes in a day, and external remedies, fuch as the un- guentum linarias, and the root of the fcrophularia, are to be applied ; thefe are by fome efteemed fpecifics, and botanical authors boafl: wonders of their effects. If by thefe means, after three or four days trial, there appears no hope of their being difcufled, then they are to be matu- rated by all means and with all fpced that may be. To this purpofe a cataplafm of a roafted onion with Hnfeed oil and veal fat, is by many greatly recommended ; and when the pains are violent, internal medicines are to be given, fuch as nitre with the cooling emulfions, and when neceffary a gentle opiate. Oil of eggs is greatly recommended alfo for external ufe, to allay the pain. When they are brought to maturation, they are to be carefully opened by the hand of a furgeon ; and the cleanfing and healing them up is then to be forwarded by 13 B all
