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922. Though our art can do so little towards the cure of this disease, we mu3t, however, palliate the uneasy symptoms of it as well as we can. The symptoms especially urgent, are the cough and diarrhoea. The cough maybe in some, measure relieved by demulcents, (873); but the relief obtained by these is imperfect and transitory, and very often the stomach is disturbed by the quantity of oily, mucilaginous, and sweet substances, which are on these occasions taken into it.

923. The only certain means of, relieving the cough, is by employing opiates. These, indeed, certainly increase the phlogistic diathesis of the system; but commonly they do not so much harm in this way, as they do service by quieting the Cough and giving sleep. They are supposed to be hurtful by checking expectoration: but they do it for a short time only; and, after a sound sleep, the expectoration in the morning is more easy than usual. In the, advanced state of the disease, opiates seem to increase the sweatings that occur; but they compensate this, by the ease they afford in a disease which cannot be cured.

924. The diarrhoea which happens in the advanced state of this disease, is to be palliated by moderate astringents, mucilages, and opiates.

Rhubarbj so commonly prescribed in every Vol. r. Hh

diarrhoea, and all other purgatives, are extremely pernicious in the colliquative diarrhoea of hectics. Fresh subacid fruits, supposed to be always laxative, are often, in the diarrhoea of hectics, by their antiseptic quality, very useful.

CHAP. V.

OF THE HiEMOAIlHOIS; OR, OF THE HEMORRHOIDAL SWELLING AND FLUX.

SECT. I.

Of the Phenomena and Causes of the Hcemorrhu.

925. A Discharge of blood from small tumours on the verge of the anus, is the symptom which generally constitutes the Hsemorrhois; Or, as it is vulgarly called, Haemorrhoidal Flux. But a discharge of blood from within the anus, when the blood is of a florid colour, shewing it to have come from no great distance, is also considered as the same disease; and physicians have agreed in making two cases or varieties of it, under the names of External aud Internal Haemorrhois,

926. In both cases it is supposed that the flow of blood is from tumours previously formed, which are named Haemorrhoids, or Piles; and it frequently happens, that the tumours exist without any discharge of blood; in which case, however, they are supposed to be a part of the same disease, and are named Haemorrhoides Caecae, or Blind Piles.

• 927. These tumours, as they appear without the anus, are sometimes separate, round and prominent, on the verge of the anus; but frequently the tumour is only one tumid ring, forming, as it were, the anus pushed without the body.

928. These tumours, and the discharge of blood from them, sometimes come on as an affection purely topical, and without any previous disorder in other parts of the body; but it frequently happens, even before the tumours are formed, and more especially before the blood flows, that various disorders are felt in different parts of the body, as headaeh, vertigo, stupor, difficulty of breathing, sickness, colic-pains, pain of the back and loins; and often, together with more or fewer of these symptoms, there occurs a considerable degree of pyrexia.

The coming on of the disease with these symptoms, is usually attended with a sense of fulness, heat, itching, and pain in and about the anus.

Sometimes the disease is preceded by a discharge of serous matter from the anus: and sometimes this serous discharge, accompanied with some swelling, seems to be in place of the discharge of blood, and to relieve those disorders of the system which we have mentioned. This serous discharge, therefore, has been named the Haemorrhois Alba.

929. In the haemorrhois, the quantity of blood discharged is different upon different occasions. Sometimes the blood flows only upon the person's going to stool, and commonly, in larger or less quantity, follows the discharge of the faeces. In other cases, the blood flows without any discharge of faeces; and then, generally, it is after having been preceded by the disorders above mentioned, when it is also commonly in larger quantity. This discharge of blood is often very considerable; and, by the repetition, it is often so great, as we Could hardly suppose the body to bear but with the hazard of life. Indeed, though rarely, it has been so great as to prove suddenly fatal. These considerable discharges occur especially to persons who have been frequently liable to the disease. They often induce great debility: and frequently a leucophlegmatia, or dropsy, which proves fatal.

The tumours and discharges of blood in this disease, often recur at exactly stated periods.

930. It often happens, in the decline of life, that the haemorrhoidal flux, formerly frequent, ceases to flow; and, upon that event, it generally happens, that the persons are affected with apoplexy or palsy.

931. Sometimes haemorrhoidal tumours are affected with considerable inflammation; which, ending in suppuration, gives occasion to the formation of fistulous ulcers in those parts.

932. The haemorrhoidal tumours have been often considered as varicous tumours or dilatations

of veins; and it is true, that in some cases varicous dilatations have appeared upon dissection. These, however, do not always appear; and I presume it is not the ordinary case, but that the tumours are formed by an effusion of blood into the cellular texture of the intestine near to its extremity. These tumours, especially when receatly formed, frequently contain fluid blood; but, after they have remained for some time, they are commonly of a firmer substance.

933. From a consideration of their causes, to be hereafter mentioned, it is sufficiently probable, that haemorrhoidal tumours are produced by same interruption of the free return of blood from the veins of the lower extremity of the rectum; and it is possible, that a considerable accumulation of

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