It is chiefly in the female constitution that violent or excessive hemorrhages occur exhausting life, which is reanimated by the process termed transfu sion, for the revival of which the public is indebted to Dr. Blundell, who has now performed it repeat edly with success. The best apparatus is that in vented by Reid, which is delineated in Fig. 13 of Plate DXV. A vein of the arm of a healthy per son should be opened, as in phlebotomy, and the blood received into the cup a, from which the tube b conducts it to the bottom of the syringe c, whence it is propelled along the tube d, into the small pipe e, inserted in the vein of the expiring patient.
The diseases of the rectum are piles, tubercles, sarcomatous tumours, and ulceration ; stricture of the rectum, abscess near the anus, fistula in ano, prolapsus ani, and imperforate anus. Piles, or hemorrhoids, arise from constipated bowels, press ing and impeding the circulation of the hemorrhoidal veins, or from relaxation of the bowels, produced by diarrhoea while these veins are not sufficiently supported, or from one or other of these causes, especially the first occurring in pregnancy ; and hence pregnant women are most subject to them, for the pressure of the uterus becomes also a cause. They are small purple coloured turnouts situated around the anus, consisting either in a distended thickened varicose state, or rupture of these veins, the blood, in the latter case, being most frequently diffused in the cellular tissue around them. Piles are divided into external, internal, blind, and open. The external are situated outside of the anus, the internal within the rectum ; the blind are such as do not bleed, while the open bleed.
Piles are a most troublesome complaint, pre venting the patient from either walking or even sitting with comfort, since he is only easy in a hori zontal attitude ; and not unfrequently the pain is most excruciating, particularly on going to stool, when they sometimes bleed to such an extent as to debilitate the individual, and give to his counte nance the peculiar exsanguineous aspect. The great Copernicus bled to death from this disease. The treatment consists in removing the cause, which, when constipation, by mild laxatives, and in laying them open with a lancet or bistoury, or applying leeches to them, and afterwards by fomentations or poultices. After the inflammation has been sub dued, by the application of the ointment of gall nuts, or a decoction of oak bark. When piles are lanced, care should be taken that hemorrhage does not flow internally in the rectum, for patients have thus bled to death. Sponge is the best suppressor of bleeding in this part. When neither pregnancy nor diarrhoea is the exciting cause, an alterative course of mercury is beneficial ; but the last men tioned disease must be checked by astringents. A
rectum bougie or tallow candle is an excellent dis cutient, which should be inserted at bed time, and allowed to remain during the night, care being taken that it is properly fastened to a belt round the loins, and that the hemorrhoids are reduced within the anus. All kinds of constipating stimu lant food ought to be abstained from, and the pa tient should avoid exercise, and sit on a hard chair. When piles are large and pendulous, they ought to be removed with the knife ; ligatures should never be applied, as they have produced symptoms of strangulated hernia and tetanus.
Tubercles of the rectum frequently follow hemor rhoids or constipation, and consist of an indurated state of the solitary glands of this intestine; the mucous tunic being arranged into irregular hard folds, and the muscular subdivided by membranous septa, the whole wall of the gut being much thick ened and hardened, and this condition of the rec tum is seldom discovered before it has assumed the carcinomatous action. The patient is troubled with irregularity of his stomach and bowels, with vomiting, cliolic, diarrhoea, and dysentery. The disease next forms a stricture, and often extends to the colon, when more than one of these constric tions is present; in this ease, there is greater ir regularity of the bowels, for the patient occasion ally has no motion for days, which either passes in the form of an earth worm, or is liquid from medi cine, and he experiences considerable pain and straining at stool. The tubercles next become malignant and ulcerate, when his sufferings are generally truly deplorable. There is a voracious appetite, a constant vomiting, and a burning pain in the stomach and over the whole abdomen, with lancinating burning pains of the rectum and anus; together with hectic fever, and an inclination to go to stool every moment. This ulceration of the rectum occasionally extends to the urinary bladder, forming a communication between them, when sometimes the recces flow into the bladder, and at other periods the urine into the rectum, and on some occasions they flow promiscuously into each other; and towards the end of the flow of the urine, air gurgles along the urethra, producing a loud and unpleasant sound: on rare occasions there is little or no pain. In some cases, a total obstruction to the passage of the feces along the colon takes place, when this intestine acquires so prodigious a magnitude as to deceive us for ascites. In other cases, the ulceration is fungoid, bleeding and dis charging a great quantity of pus at every evac uation of the feces, with little or no pairs.