Note 48 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 8)

[From my own observations and dissections I have long been convinced that there are two distinct and well marked varieties of hemorrhoidal tumours; one of which essentially consists in an enlargement of the capillary vessels of the mucous and submucous cellular tissue, the other in the formation of a small sac filled with fluid, coagulated, or organised blood. The latter, situated at the verge of the anus, or immediately within it, are composed partly of skin, partly of mucous membrane; they vary in size, from a pea to that of a small marble, are of a red florid complexion, hard and tender to the touch, and exquisitely painful when inflamed. The blood which they contain is at first fluid, but soon coagulates, and ultimately, if allowed to remain, becomes organised. Hence, in cases of long standing, the tumour is generally of a hard, gristly consistence, pale, and free from pain, producing no other than mechanical inconvenience.

In the other variety, the tumour is situated within the bowel, from six lines to two inches above the external orifice. Consisting, as was before intimated, in a varicose condition of the capillary vessels, especially the venous: it is soft and compressible, of a deep purple colour, extremely liable to bleed, and of various sizes, from a small bean to that of an almond or upwards. It rarely occurs as an isolated swelling, but in groups or clusters, as many as six or eight being sometimes situated upon a surface not more than an inch and a half or two inches in diameter.—ED.]