say, when the strain upon the turgid hemorrhoidal vessels is increased, and the mucous surface is compressed. If the bleeding is inconsiderable in quantity, the fact of its occurrence does not modify the treatment of the complaint. However, it is less often necessary to apply leeches, where there is spontaneous bleeding; and cold applications are, in this case, essentially preferable to warm.

Congestion with hemorrhage sometimes puts on the character of an acute febrile attack. The patient experiences shiverings, followed by pain in the loins, and symptomatic fever, which, after a few hours, is relieved by a copious discharge of blood from the rectum. Such attacks are not frequent, and their nature is seldom ascertained before the critical hemorrhage occurs, which relieves them.

The proper treatment antecedently to the hemorrhage, is the local application of leeches, and saline aperient medicine.

Congestion with hemorrhage ofter recurs to a slight extent, lasting two or three days, whenever the system is overcharged and disordered. The complaint has then the use of clearing the system, and probably often averts some other attack, and is so far salutary. It is not, however, by any means safe to rely on this mode of relief, and to calculate upon so compounding for a course of indulgence. The same congestion, which leads to

salutary bleeding, is liable, at the same time, to lead to structural disease. Occasional hemorrhage from the bowel, if moderate, is least to be interfered with in persons who have spit blood, or have shown a disposition towards apoplexy.

3. The cases in which the hemorrhage is out of all proportion to the local congestion and is the only local symptom which presents itself, are of more consequence than those yet adverted to.

The quantity of blood which is sometimes thus lost is enormous: four pints have been passed in a few hours: a pint daily for a month: these are, of course, extreme and rare cases: but to a less, though highly prejudicial extent, such hemorrhages are common, producing an exsanguinated appearance, weakness, swelling of the legs, palpitation of the heart, headach, faintness, vertigo, extreme nervousness, spasmodic difficulty of swallowing, and the whole train of such symptoms.

The source of these great bleedings is the same as of the lesser: there is no rupture of vessels; the blood transudes through their coats, and pours from the whole surface, but commonly from some points more than from others. It is just the same in bleeding from the lungs, or from the nose. No vessel is torn, but the blood passes freely through the thin membranous tubes, which ought to contain it. Such bleedings, again, are in part only local ailments; the blood, indeed, finds vent at one part

in preference to another, but that which makes it flow at all, is some general influence, and the place of the hemorrhage is comparatively accidental. Accordingly, in the most remarkable cases of the class, the discharge of blood from one part of the general inward mucous surface will sometimes cease, and commence upon another: after hemorrhage from the bowel has ceased, bleedings from the nose will supervene: these may be alternate with vomitings of blood: these, again, with spitting of blood from the lungs. All these ceasing, the patient may have apoplexy.

But of these different constitutional hemorrhagies that from the bowel is the least locally injurious and troublesome. Blood poured out in the brain causes cerebral apoplexy; in the lungs, pulmonary apoplexy; in the stomach, vomiting and disturbed digestion; from the bowel it passes away leaving no consequences. In such cases, therefore, it becomes a question, whether any attempt should be made to suppress the flow of blood, or whether pains should not rather be taken to keep up, or even to restore, this comparatively innocuous vent.

There are instances, in which great judgment is required to determine which course is to be pursued. When the habit is full, and the disposition to hemorrhage strongly marked, for the time the hemorrhoidal discharge may require to be encouraged. Generally, however, this is not the case;

but the two objects may be pursued together,—of suppressing the flow of blood, and of correcting the plethoric condition of the body.

There are two means by which hemorrhage from the rectum may be stopped. The first is applicable to all cases, in which it is safe to attempt to arrest the bleeding; it consists in the use of cold, and local styptics. These are applied in the following ways:-by daily injection of cold water, or of a few ounces of infusion of catechu, or of the same, with five to ten grains of sulphate of zinc, or of a strong solution of alum. Astringent injections are not to be used in a greater quantity than five or six ounces; the best time for their application is before rising, when they are retained longer. Or a suppository of Ward's paste and soap, in equal parts, may be introduced into the rectum at night, or a drachm of the same medicine may be swallowed in pills, two or three times a day.

A gentleman, who has consulted me, has formerly spit blood, and is now liable, on very slight occasions, to pass blood from the bowel: he labours under slight habitual protrusion of the lining membrane when the bowels act: this, if roughly treated, always bleeds: he, therefore, never uses, after an evacuation, any means but free washing with alum-water, and in this way obviates the daily recurrence of hemorrhage.

The blood which flows from the rectum is of a

bright scarlet colour: in some cases of protrusion

it may be seen to exude from the vascular mucous surface. It often appears to flow from one or two points more than the rest, and spins out freely as if from a ruptured vessel. This has led surgeons, in some cases, to apply a ligature to the bleeding point; nor wholly without advantage, when the patient is becoming daily weaker through loss of blood. For a few days afterwards the bleeding does not return, owing to the slight inflammatory action which supervenes till the ligatures are thrown off.

In general, when there is a strong disposition to hemorrhage from the rectum, any mechanical cause will excite it,the fæces firmer than natural, any common irritant used as a local application, and the like; and, on the other hand, the use of drastic or smart aperient medicine.

Nevertheless, cases of hemorrhage from the bowel are occasionally met with, unattended with local heat, not excessive in quantity, and in persons of a strong and rigid fibre, where the only successful treatment is repeated active purging.

It is needless to add, after what has been said, that those in whom an habitual or periodical hemorrhage from the bowel has been stopped, require to observe the greatest caution as to moderation in diet, use of aperient medicine, and the