as the hardness and bulk of the fæces occasion a greater or less effort or pressure upon the anus. While the gut is thus pushed out, it often happens, that the sphincter ani is contracted before the gut is replaced; and, in consequence thereof, a strong constriction is made, which preventing the fallenout gut from being replaced, and at the same time preventing the return of blood from it, occasions its being considerably swelled, and its forming a tumid ring round the anus.

938. Upon the sphincter's being a little relaxed, as it is immediately after its strong contraction, the fallen-out portion of the gut is commonly again taken within the body; but, by the frequent repetition of such an accident, the size and fulness of the ring formed by the fallen-out gut, is much increased. It is therefore more slowly and difficultly replaced; and in this consists the chief uneasiness of hæmorrhoidal persons.

939. As the internal edge of the ring mentioned, is necessarily divided by clefts, the whole of ten assumes the appearance of a number of distinct swellings; and it also frequently happens, that some portions of it, more considerably swelled than others, become more protuberant, and form those small tumours more strictly called Hæmorrhoids, or Piles.

940. From considering that the pressure of fæces, and other causes interrupting the return of venous blood from the lower extremity of the rectum, may operate a good deal higher up in the gut than that extremity, it may be easily understood, that tumours may be formed within the anus; and probably it also happens, that some of the tumours formed without the anus, as in 939, may continue when taken within the body, and even be increased by the causes just now mentioned. It is thus that I would explain the production of internal piles, which, on account of their situation and bulk, are not protruded on the person's going to stool, and are often therefore more painful. The same internal piles are more especially painful, when affected by the hæmorrhagic effort, described in 745, and 769.

941. The production of piles is particularly illustrated by this, that pregnant women are frequently affected with them. This is to be accounted for, partly from the pressure of the uterus upon the rectum, and partly from the costive habit to which pregnant women are usually liable. I have known many instances of piles occurring for the first time during the state of pregnancy; and there are few women that have born children, who are afterwards entirely free from piles. The Stahlians have commonly asserted, that the male sex is more frequently affected with this disease than the fe

male; but in this country I have constantly found it otherwise.

942. It is commonly supposed, that the frequent use of purgatives, especially of those of the more acrid kind, and more particularly of aloetics, is apt to produce the hæmorrhodial affection; and as these purgatives stimulate chiefly the great guts, it seems sufficiently probable that they may excite this disease.

943. I have now mentioned several causes which may produce the hæmorrhoidal tumours and flux as a topical affection only; but must observe farther, that although the disease appears first as a purely topical affection, it may, by frequent repetition, become habitual, and therefore may become connected with the whole system, in the manner already explained with respect to hæmorrhagy in general, in 748.

944. The doctrine now referred to, will, it is apprehended, apply very fully to the case of the hæmorrhoidal flux; and will the more readily apply, from the person who has been once affected being much exposed to a renewal of the causes which first occasioned the disease; and from many persons being much exposed to a congestion in the hæmorrhodial vessels, in consequence of their being often in an erect position of the body, and in

an exercise which pushes the blood into the depending vessels, while at the same time, the effects of these circumstances are much favoured by the abundance and laxity of the cellular texture about the rectum.

945. It is thus that the hæmorrhoidal flux is so often artificially rendered an habitual and systematic affection; and I am persuaded, that it is this which has given occasion to the Stahlians to consider the disease as almost universally such.

946. It is to be particularly observed here, that when the hæmorrhoidal disease has either been originally, or has become, in the manner just now explained, a systematic affection, it then acquires a particular connection with the stomach, so that certain affections there excite the hæmorrhoidal disease, and certain states of the hæmorrhoidal affection excite disorders of the stomach.

It is perhaps owing to this connection, that the gout sometimes affects the rectum. See 525.

SECT. II.

Of the cure of Hæmorrhoidal affections.

947. Almost at all times it has been an opinion amongst physicians, and from them spread amongst the people, that the hæmorrhoidal flux is a salutary

evacuation, which prevents many diseases that would otherwise have happened; and that it even contributes to give long life. This opinion, in later times, has been especially maintained by Dr. Stahl, and his followers; and has had a great deal of influence upon the practice of physic in Germany.

948. The question arises with respect to hæmorrhagy in general, and indeed it has been extended so far by the Stahlians. I have accordingly considered it as a general question, (767, 780); but it has been more especially agitated with regard to the disease now under our consideration: and as to this, although I am clearly of opinion, that the hæmorrhois may take place in consequence of the general state of the system (769), or, what is still more frequent, that by repetition it may become connected with that general state (943), and in either case cannot be suppressed without great cau. tion; I must beg leave, notwithstanding this, to maintain, that the first is a rare case; that generally the disease first appears as an affection purely topical, (935, 942), and that the allowing it to become habitual is never proper. It is a nasty disagreeable disease, ready to go to excess, and to be thereby very hurtful, as well as sometimes fatal. At best it is liable to accidents, and thereby to unhappy consequences. I am therefore of opinion, that not only the first approaches of the disease are to be guarded against, but even that, when it has