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Painless Treatment of Rectal Diseases.

In a paper read before the Ohio State Medical Society, DR. H. M. BROWN, of Hillsboro, Ohio, spoke of the treatment of hemorrhoids, fissures and ulcers. It is his practice with external hemorrhoids to take an eight per cent. solution of cocaine, fill a hypodermic syringe with it and inject it directly into the tumor. It swells up like a bladder, and is completely anæsthetized almost immediately. He then takes a pair of scissors, curved upon the flat, and cuts the pile off close up to the anus to which it is attached. Some absorbent cotton is saturated with Monsel's solution and applied to control hemorrhage. Except in rare instances, the patient is never troubled with the pile again. Occasionally there may remain an irritable crack at the site of the operation, which may be easily cured thus: Introduce a bivalve speculum, dilate it to the utmost, brush the parts with a twenty per cent. solution of cocaine, and then apply chromic acid. Great care should be exercised in the application or the treatment will not be painless.

Regular fissures of the rectum he treats with cocaine and dilatation also. A solution of equal parts of carbolic acid and sweet oil is carefully applied to the bottom of the fissure, the speculum withdrawn, and a half ounce of sweet oil injected with a small, smooth syringe and retained. If the first application does not cure, this should be repeated at intervals of a week until the fissure is well. Cases of irritable or hysterical rectum are so simple in their cure, he says, and yield so quickly, that it is a pleasure to have them under observation. Inject a few drops of a twenty per cent. solution of cocaine and wait about three minutes, then introduce the bivalve speculum and dilate completely. Repeat every other day, and the patient will be well in two weeks.

For regular pile sacs or internal hemorrhoids, he introduces an Aloe speculum, of medium size, in the direction of the tumor to be treated, waits until it runs full of blood; then, with the long-needled hypodermic syringe made for this purpose, injects deeply into the sac fifteen drops of a six per cent. solution of cocaine, made with fluid extract of hamamelis, instead of water. In a few minutes he injects near the site of the puncture already made five drops of equal parts of glycerine and carbolic acid. Always remember, he says, to treat hemorrhoids inside the rectum; should they protrude return them before beginning treatment.

In the successful treatment of rectal ulcers there are four cardinal points to be observed, viz.: (1) Prevention of constipation; (2) absolute cleanliness; (3) thorough exposure of the ulcer cavity, so that it can be plainly seen while treated; (4) the application of some remedy that will insure rapid and thorough granulation of the indolent sloughing surface. After each evacuation the patient is directed to wash out the rectum with a pint or more of warm water, injected with a large, curved, rectal syringe, then evacuated again immediately, thus freeing the rectum from any irritating substance for the time being. The night injection should be followed by one of an ounce of water containing about fifteen grains of boracic acid, five grains of sulphate of zinc, three grains of alum, to be retained.

To expose the ulcer well, the patient should be placed on the left side, with the knees well drawn up toward the chin. With a small, dull, uterine curette the ulcer should be gently scraped out thoroughly until the surfaces are some

what freshened, then the cleaned cavity should be brushed with a twenty per cent. solution of cocaine, a cotton-wrapped probe dipped into a solution of equal parts of carbolic acid and oil of ergot, and quickly applied, until the surface changes to a fresh color. Then remove the speculum, inject a half ounce of sweet oil, and the treatment is finished for that time. It should be repeated at intervals of sixteen days, and cure will nearly always come from a few weeks to several months, according to the severity of the case.-Memphis Medical Monthly, July, 1888.

Nephrotomy.

MR. A. G. MILLER, Lecturer on Surgery in the School of Medicine, Edinburgh, reports three cases of nephrotomy in the Edinburgh Medical Journal, June, 1888, and concludes his paper with the following suggestions:

"1. If a suppurating kidney is aseptic, leave it alone if you can. The kidney may recover, or may shrivel up and become a mass of cicatricial tissue. That the latter result is possible has been frequently perceived on the post-mortem table.

"2. If incision is necessary in an aseptic case, the utmost antiseptic precautions should be employed till the wound is soundly healed; for septic infection may mean death, especially in the young.

"3. If the suppuration is septic, prefer nephrectomy to nephrotomy, provided the other kidney is sound. Incision may be employed advantageously as a preliminary to excision. Such a procedure, according to ОTIS (Boston Med. and Surg. Journal, October, 1887), 'robs a subsequent nephrectomy of much of its danger' (the mortality of the latter varying, according to his tables, from 31.48 per cent. to 54.44 per cent.).

"MR. GODLEE also says that a contracted kidney is removed with less risk to life than a large one. 'Hence the great advantage of draining such a kidney, and allowing it to shrink before taking it away.'

"At the conference held in Paris in 1886 (Revue de Chirurgie, November, 1886), the general opinion seemed to be in favor of nephrectomy, preceded by nephrotomy, being the best treatment for suppuration connected with the kidney."

Rare Cause of Intestinal Obstruction.

Among the rarest causes of intestinal obstruction is the blocking of the canal by a mass of round worms. STEPP (Centralblatt f. d. med. Wissenschaften, 27, 1888) has recently recorded an instance in a boy, four years old, who died with symptoms of acute obstruction an hour and a half after medical aid was first summoned. Post-mortem examination showed that the intestine was completely obstructed by a twisted mass of some forty or fifty round worms, lodged just above the ileocæcal valve. The ileum contained some thirty-five more higher up, and there were a few in the stomach and oesophagus. The boy's mother gave him some "worm medicine" two days before he died, and a meal of smoked bacon and sauerkraut on the following evening. Dr. Stepp thinks that the worms, weakened by the medicine, were dislodged in numbers by the violent peristalsis set up by the injudicious meal of the following evening, and so rolled down in a tangled mass too large to pass the ileo-cæcal valve.--British Med. Journal, July 14, 1888.

Abscess, tuberculous, of brain, 166.

Acetphenetedine, 483.

Aconitine in syphilitic headache, 186.
Actinomycosis, primary of brain, 167.

INDEX.

Air, relation of, to common diseases, 227.

Albuminuria of pregnancy, 241; in enteric fever,
362.

Alcohol and heredity, 336.

Alcohol as a remedial agent, 340.
Alcoholic paralysis of nerves, 312.

Anemia, inhalation of oxygen in, 36; pernicious
and bothriocepholus latus, 68.

Anesthesia, cocaine, gastrostomy by aid of, 583.
Anatomy, recent progress in, 17, 156, 323.
Angiosarcoma of breast, 437.
Antagonism of drugs, 177.

Antifebrine in ataxia, 39; recent observations
upon, 195, 506.

Antipyrine in whooping-cough, 36; accidental

effects of, 39; in gastralgia, 498; and antifeb-
rine, notes on, 174; effects of, in children
with scarlatina and acute bronchitis, 175; in
hemorrhage and ulcers of the leg, 349; use of
in labor, 336, 546.

Antipyretics, effects of in treatment of disease,
357; in croupous pneumonia, 332; in chorea,
360.

Antiseptic, chloroform water as an, 331.
Aortic aneurism, case of, 198.

Arnica montana, action of on circulation, 170.
Arsenic in chorea, 338; poisoning, 487.
Asthma, 530.

Astringents in hydrops bronchialis, 172.

Ataxia, locomotor, confined to arms, 367; anti-
febrine in, 39.

Atony of intestines in its relations to Graves'
disease, 363.

Cancer, infectiousness of, 313; histology of, 314;
primary, of left kidney, 161; primary of Fal-
lopian tube, 395; successful method of disin-
fecting the room in, 347; terebene in advanced
stages of uterine, 171.

Carbolic acid in trachoma, 183.

Carbuncles, carbolic acid in, 425.

Carcinoma of peritoneum, 456; of Fallopian
tube, 560.

Cerebral localization and disturbances of sight,
152.

Chancres, extra-genital, 275.

Children diagnosis of febrile disease in 116;
treatment of convulsions in, 555, external re-
vulsives in the treatment of lung diseases in,
557; apex beat of the heart in, 558; after-
treatment of tracheotomized, 560; results
which follow tracheotomy in for diphtheria,
561; salicylate of bismuth in the treatment of
diseases of, 562.

Chloroform, death under, 149; water as an anti-
septic, 331.

Cholera, natural history and epidemiology of, 373.
Chorea, arsenic in, 338; antipyrine in, 360.
Chorion, myxomatous degeneration of, 108.
Clarke's column, 478.

Cleft palate, elements of success in the opera-
tion for, 568.

Cocaine anaesthesia, gastrostomy by aid of, 583.
Cocaine in lithotrity, 431; physiological effects
of, 41; poisoning with, 342; peculiar effect of,
345.

Color-blindness, 518.

Coniine, cases of poisoning from, 40.

Conium, treatment of rectal pain with, 341.
Constipation, treatment of, with massage, 64;
treatment of habitual in infants, 541.

Atrophy of muscles, hereditary, 363; of liver, Consumption, of grinders, 3; pulmonary, 226;
case of red, 70.

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surgical treatment of tubercular, 278; treat-
ment of by residence at high altitudes, 385.
Convulsions, treatment of in children, 555.
Corns, treatment of, 285.

Corpulence and its evils, 374.

Corrosive poisoning, case of, 47.

Creoline, as an internal medicine, 486.
Cyst of pancreas, 305, 306.

Cystitis, painful forms of, 276; use of pichi in
chronic, 387.

Delivery of the after-coming head, 548.
Dextrocardia, congenital, 167.

Diachylon ointment, 340.

Diagnosis of frebrible disease in children, 116.
Diaphoretic pill, 339.

Diarrhoea, infantile, treatment of, 249.

Diet, effect of upon skin diseases, 54.

Digestion, recent advances in the physiology and
pathology of, 538.

Digitalis, when to prescribe, 498.
Diphtheria, cauterization of the throat in, 372;
tracheotomy in, 291; permanganate of potash
in, 329; and croup, treatment of with oil of
turpentine, 38; iodide of potash in, 183; mul-
tiple neuritis following, 221; in Montreal, 259.
Doses, small, therapeutics of, 490.
Dysidrosis, atypical, 479.

Eczema solare, protection against by a red veil,
370.

Electricity as death penalty, 283; katalytic ac-
tion of in rheumatism, 501; in incontinence
of urine, 536.

Emboli, liver-tissue, 534.

Empyema, micro-organisms in, 457.

Endarteritis, chronic, some complications of, 83.
Endocarditis, treatment of severe, 215.
Enteric fever, treatment of, 202.
Epilepsy, case of, 364; gastric, 378.
Epithelioma, treatment of with mild caustics,
299; amputation of left half of tongue for, 439.
Ergot, midwifery without, 393.

Erythema, contribution to study of, 474.
Excision of hip followed by amputation, 436.
Eye, connection of diseases of and of nose, 519.

Fallopian tube, carcinoma of, 560.

Fever, significance of, 316; typhoid, early diag-
nosis in, 361; enteric, albuminuria in, 362.
Filaria sanguinis hominis, 305.

Fistula, resection of intestine for, 129.
Fotation, case of arrested, 392.

Foetus, parasitic, 164.

Food for the sick, preparation of, 209.

Fracture of os calcis, 291; of external condyle
of humerus, treatment of, 423; of the first rib
alone, 563.

Gangrene, pathology of from embolism and
arterial thrombosis, 308; spontaneous of penis,
440.

Gaskell's researches on spinal and cranial nerves,
480.

Gastralgia, antipyrine in, 498.
Gastrolites, 532.

Gastrostomy by aid of cocaine anaesthesia, 583.
Genito-urinary surgery, 136.

Glasgow, peculiar febrile disease in, 520.
Glioma of medulla oblongata, 463.

Goitre, endemic, 64.

Graves' disease, atony of the intestines in its
relations to, 363.

Gumma in trachea, 224.
Gynecology, progress in, 263.

Headache, very early syphilitic, 223; menthol and
saffrol in, 448; inveterate, with cases, 511.
Heart, presence of ganglia in, 167; comparative
action of various drugs on, 338; the mammal-
ian, 470; apex beat of, in children, 558.
Hebra's water-bed, 423.

Hemidrosis, permanganate of potash in, 366.
Hemoglobinuria from walking, 371.
Hemorrhage, sub-cranial; secondary trefining,
448.

Hemorrhagic infarction, notes on, II.
Hernia, umbilical, management and treatment
of, 118; treatment of by use of sponges, 128;
treatment of sac in strangulated, 140.

Herpes digitalis, 311; zoster in children, 547.
Hip, excision of followed by amputation, 436.
Histology of cancer, 314.

Hog cholera, bes: antiseptic solution for microbe
of, 347.

Hydrastis canadensis, 497.
Hydrocephalus, 269.

Hydrochloric acid, absence of free in contents
of stomach, 165.

Hydronephrosis, death of a parturient woman
from, 270.

Hydrops bronchialis, astringents in, 172.
Hydrotherapy in mental disorders, 77.
Hyoscyamine, poisoning with, 187; and atropine,
485.

Hysteria, abdominal pressure in, 360; and hys-
tero-epilepsy in soldiers, 214; hysteria and
syphilis, 201; relation of to phthisis, 533.

Ichthyol, 173.

Indigo forming substances in pleural exudate, 311.
Induction balance and telephonic probe, 133-
Infantile diarrhoea, treatment of, 249.

Infants, water, sugar, salt and fat in diet of, 251;
lactation by gavage for premature, 559.
Inflammatory foci, thermo-electri: measure-
ments of, 152.

Intestinal diseases in children, naphthaline in,
250.

Intestinal invagination, operative treatment of,
247.

Intestinal obstruction, operative treatment of, 144;
acute; early operation; success.ul result, 575;
after ovariotomy, 556; rare cause of, 588.
Intestine, resection of, 291.

Iodide of iron, tonic and alterative properties
of, 38.

Iodide of potash in diphtheria, 183.
Iodine, poisoning with, 329.

Iodol, 35.

Ipecacuanha in diseases of throat and respiratory
organs, 332.

Joints, relation of locomotor ataxia to, 67.

Kefir, imitation, 341.

Kephir as a food for infants, 389.

Kidney stone, practical observations on, 301.

Labor, sectional anatomy of, 155; use of antipy-
rine in, 546.

Lactation, some observations on, 549; by gavage
for premature infants, 559.

Lactic acid in chronic purulent inflammation of
middle ear, 35.

Laparotomy, a year's work in, 396.

Larynx, successful case of total extirpation of,
578.

Lepra, transmission of to rabbits, 2.
Lithotrity, cocaine in, 431.

Liver, case of red atrophy of, 170; laparotomy
for diseases of, 429; atrophy of, 524; physi-
ological variations in shape and position of, 163.
Liver-tissue emboli, 534.

Lochia, vaginal and uterine, 166.
Locomotor ataxia, relation of diseases of joints
to, 67.

Loofah, the, 453.

Lung diseases in children, external revulsives

in treatment of, 557.
Magneto-therapy, 243.

Massage, 581; treatment of constipation by, 64.
Mastoid cells, relative frequency of suppuration
in, 574.

Measles, an epidemic of, 240.

Meningitis, case of acute, 309; tuberculous, 391.
Menstruation after double oöphorectomy, 561.
Menstruation, precocious and early pregnancy,
103.

Mental diseases, hydrotherapy in, 77.

Menthol in laryngeal and pulmonary phthisis and
other diseases, 188.

Menthol and saffrol in headache, 488.

Mercury, therapeutic value of salicylate of, 349.
Metabolism in typhoid fever in childhood, 328.
Metrorrhagia at puberty, 114.
Midwifery without ergot, 393.
Moderate drinkers, mortality of, 362.
Mortality of moderate drinkers, 362.
Mouths, infant with two, 467.

Musculo spiral nerve, paralysis of after fracture of
humerus, 276.

Myxomatous degeneration of chorion, 108.

Nail, swallowing of; treatment with hydrochloric
acid, 535.

Naphthaline in intestinal diseases of children,
250.

Nasal catarrh, etiological factor in, 7.
Nasal disease, eye symptoms due to, 521.
Nephrectomy, case of, 577.
Nephrectomy for sarcoma, 571.
Nephrolithotomy, 431.

Nephroraphy, successful for floating kidney, 579.
Nephrotomy, 588. ♦

Nerve, pneumogastric, pathology of ganglion of
trunk of, 473.

Nerve-fibres, degeneration and regeneration of,
160.

Nerves, distribution of cutaneous upon dorsum
of hand, 310; anomalies in distribution of,
459; spinal and cranial, Gaskell's researches
on, 480.

Neuritis, multiple, following diphtheria, 221.
Nitroglycerine in diseases of the heart and kid-
ney, 38; use of, 181, 186.

Nymphomania, malarial or paroxysmal, 267.

Ocular symptoms, due to nasal disease, 521.
Esophagotomy, 442.

Oil of turpentine in diphther a and croup, 38.
Oophorectomy, menstruation after double, 561.
Ophthalmology in Europe, 445.
Orchitis, rheumatic, 375.

Os calcis, structure of, and cases of fracture of,
293.

Ovariotomy, case of, 266.

Ovariotomy, intestinal obstruction after, 556.
Ovary, painful fibroma of, 102; tumor of light in
a child, 398.

Ovum, human, 327.

Oxalate of cerium in sea-sickness and other dis-
orders, 356.

Oxygen, transport of, 165; inhalation of in ane-
mia, 36.

Pancreas, cyst of, 305, 306.

Paresis, recognition of incipient general, 376.

Pathology, progress in, 153.

Perineum, how to guard when head is passing,
266.

Peritoneum, method of cleansing, 268; carcinoma
of, 456.

Peritonitis, treated by laparotomy, 274; treated
with saline purgatives, 380; ante-partum, 245.
Permanganate of potash in diphtheria, 329; as
an emmenagogue, 351; in a case of hemi-
drosis, 366.

Petroleum, is it a poison? 330.
Phenacetine, 483, 505.

Phosphorus poisoning, case of, 462.
Photography of skin made easy, 283.
Phrenic nerve, origin of, 2.

Physiology, progress in, 158; and histology,
year's work in, 467.

Phthisical lesions, lobar arrangement of, 210.
Phthisis, sulphide of calcium in pulmonary, 187;
menthol in laryngeal and pulmonary, 188; im-
prisonment and, 377; hypodermic injection of
antiseptics in, 486; tertiary syphilis of the
lung and, 535; relation of hysteria to, 534.
Placenta prævia, 255.

Placenta, separation of, 553.

Pleuritic effusion, intra-plural injection of steril-
ized air for, 441.

Pleuritis, purulent, cured by incision and drain-
age, 586.

Pneumogastric, pathology of ganglion of trunk of,
473.

Pneumonia, treatment of, 223; antipyretics in
croupous, 332.

Pott's disease, treatment of pressure paralysis of
by plaster of Paris jacket, 565.
Pregnancy, early, and precocious menstruation,
103; albuminuria of, 241; after removal of
cancer of vagina, 244; 12 cases of ruptured
tubal, 254; mechanical treatment of vomiting
of, 262; vaginismus during, 393; extra-uterine,
laparotomy for, 403; with unruptured hymen;
delivery through perineum, 554.
Preserved foods, poisonous action of, 345.
Prognosis in valvular lesions of heart, 231.
Psoriasis, iodide of potash in, 193.

Puberty, precocious, case of tumor of right ovary
in a child with, 398; metrorrhagia at, 114.
Puerperal fever, prevention of in private prac-
tice, 121.

Rachitis in fœtus, 415.

Raynaud's disease, case of, 373.

Rectal diseases, painless treatment of, 587.
Rectal pain, treatment of with conium, 341.
Retina, distortion of objects due to disease of,
532.
Rheumatic family histories, frequency of in non-
rheumatic patients, 526.

Rheumatic orchitis, 375.

Rheumatism, katalytic action of electricity in,
501; analysis of 500 cases of acute,

Salicylate of mercury, therapeutic value of, 349.
Salicylate of soda in polyuria,

Salicylate of sodium in tonsilitis, 334.
Salicylated plaster, use of in dermatology, 73.
Salicylic acid in beer, 35; in skin diseases, 337.
Salivary glands, effects of camphor on, 184.
Salt in dermal hygiene, 43.

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