Remarks on the treatment of piles and allied affections, including pruritus ani / by T. Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the treatment of piles and allied affections, including pruritus ani / by T. Lauder Brunton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    be one factor in producing congestion of the liver; but I think it is probable that portal congestion is generally due to obstruction in or beyond the liver. Nor do I think that obstruction to the flow of blood through the liver necessarily leads to enlarge- ment of the liver, although it may do so. I believe—though it may be difficult to prove—that either the liver itself or the portal vein within it may present an obstacle to the passage of blood, and thus lead to portal congestion without the liver becoming any larger. On looking at a section of the liver during fasting and digestion, one is struck by the great difference in the size of the cells in these two conditions, the cells being much larger after food. This difference must necessarily lead to a certain amount of compression both of the biliary and venous radicles, and thus hinder to a certain extent the passage of blood through the organ. The walls of the portal vein may also contract and present a certain hin- drance. Whenever any portal obstruction occurs it will tend to increase the pressure in the haemorrhoidal veins, and thus lead to their distension, notwithstanding the fact that the blood in them has another channel of exit. We can readily see that one cause of such an obstruction might be continuous enlargement of the hepatic cells from too abundant feeding, such as gave rise to congestion of the stomach in Alexis St. Martin, as observed by Dr. Beaumont through the fistula in his patient’s stomach. Another cause of portal congestion is, I think, exposure to cold, although whether this acts through the cells of the liver or through its veins I am unable to say. We notice in the case of internal piles the sphincter ani may affect them either beneficially or injuriously, according to the circumstances under which the pile is to be found. So long as the pile remains inside, the sphincter ani tends to support and thus to ease it, and will, indeed, aid the circulation of the blood within it. • But if the internal pile should become protruded and grasped by the sphincter ani, the contraction of the muscle will prevent the returning of the venous bloodj will increase distension in the veins, and render the pile tense and painful. A somewhat similar action to that of the sphincter ani is said by Verneuil to be exerted by the muscular fibres of the rectum upon the superior haeinorrhoidal veins. These veins pass through little openings, which have been compared to buttonholes 1 in the muscular wall of the rectum. There are two sets of these 1 buttonholes at right angles to each other, the first set occurring in