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solution of equal parts of carbolic acid and sweet oil is carefully applied to the bottom of the fissure, the speculum withdrawn, and a half ounce of sweet oil injected with a small, smooth syringe and retained.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. INDEX. Air, relation of, to common diseases, 227. Albuminuria of pregnancy, 241; in enteric fever, Alcohol and heredity, 336. Alcohol as a remedial agent, 340. Anemia, inhalation of oxygen in, 36; pernicious Anesthesia, cocaine, gastrostomy by aid of, 583. Antifebrine in ataxia, 39; recent observations Antipyrine in whooping-cough, 36; accidental effects of, 39; in gastralgia, 498; and antifeb- Antipyretics, effects of in treatment of disease, Antiseptic, chloroform water as an, 331. Arnica montana, action of on circulation, 170. Astringents in hydrops bronchialis, 172. Ataxia, locomotor, confined to arms, 367; anti- Atony of intestines in its relations to Graves' Cancer, infectiousness of, 313; histology of, 314; Carbolic acid in trachoma, 183. Carbuncles, carbolic acid in, 425. Carcinoma of peritoneum, 456; of Fallopian Cerebral localization and disturbances of sight, Chancres, extra-genital, 275. Children diagnosis of febrile disease in 116; Chloroform, death under, 149; water as an anti- Cholera, natural history and epidemiology of, 373. Cleft palate, elements of success in the opera- Cocaine anaesthesia, gastrostomy by aid of, 583. Color-blindness, 518. Coniine, cases of poisoning from, 40. Conium, treatment of rectal pain with, 341. Atrophy of muscles, hereditary, 363; of liver, Consumption, of grinders, 3; pulmonary, 226; surgical treatment of tubercular, 278; treat- Corpulence and its evils, 374. Corrosive poisoning, case of, 47. Creoline, as an internal medicine, 486. Cystitis, painful forms of, 276; use of pichi in Delivery of the after-coming head, 548. Diachylon ointment, 340. Diagnosis of frebrible disease in children, 116. Diarrhoea, infantile, treatment of, 249. Diet, effect of upon skin diseases, 54. Digestion, recent advances in the physiology and Digitalis, when to prescribe, 498. Eczema solare, protection against by a red veil, Electricity as death penalty, 283; katalytic ac- Emboli, liver-tissue, 534. Empyema, micro-organisms in, 457. Endarteritis, chronic, some complications of, 83. Erythema, contribution to study of, 474. Fallopian tube, carcinoma of, 560. Fever, significance of, 316; typhoid, early diag- Fistula, resection of intestine for, 129. Foetus, parasitic, 164. Food for the sick, preparation of, 209. Fracture of os calcis, 291; of external condyle Gangrene, pathology of from embolism and Gaskell's researches on spinal and cranial nerves, Gastralgia, antipyrine in, 498. Gastrostomy by aid of cocaine anaesthesia, 583. Glasgow, peculiar febrile disease in, 520. Goitre, endemic, 64. Graves' disease, atony of the intestines in its Gumma in trachea, 224. Headache, very early syphilitic, 223; menthol and Hemidrosis, permanganate of potash in, 366. Hemorrhagic infarction, notes on, II. Herpes digitalis, 311; zoster in children, 547. Hog cholera, bes: antiseptic solution for microbe Hydrastis canadensis, 497. Hydrochloric acid, absence of free in contents Hydronephrosis, death of a parturient woman Hydrops bronchialis, astringents in, 172. Hysteria, abdominal pressure in, 360; and hys- Ichthyol, 173. Indigo forming substances in pleural exudate, 311. Infants, water, sugar, salt and fat in diet of, 251; Intestinal diseases in children, naphthaline in, Intestinal invagination, operative treatment of, Intestinal obstruction, operative treatment of, 144; Iodide of iron, tonic and alterative properties Iodide of potash in diphtheria, 183. Iodol, 35. Ipecacuanha in diseases of throat and respiratory 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- Lactation, some observations on, 549; by gavage Lactic acid in chronic purulent inflammation of Laparotomy, a year's work in, 396. Larynx, successful case of total extirpation of, Lepra, transmission of to rabbits, 2. Liver, case of red atrophy of, 170; laparotomy Lochia, vaginal and uterine, 166. Loofah, the, 453. Lung diseases in children, external revulsives in treatment of, 557. Massage, 581; treatment of constipation by, 64. Measles, an epidemic of, 240. Meningitis, case of acute, 309; tuberculous, 391. Mental diseases, hydrotherapy in, 77. Menthol in laryngeal and pulmonary phthisis and Menthol and saffrol in headache, 488. Mercury, therapeutic value of salicylate of, 349. Musculo spiral nerve, paralysis of after fracture of Myxomatous degeneration of chorion, 108. Nail, swallowing of; treatment with hydrochloric Naphthaline in intestinal diseases of children, Nasal catarrh, etiological factor in, 7. Nephroraphy, successful for floating kidney, 579. Nerve, pneumogastric, pathology of ganglion of Nerve-fibres, degeneration and regeneration of, Nerves, distribution of cutaneous upon dorsum Neuritis, multiple, following diphtheria, 221. Nymphomania, malarial or paroxysmal, 267. Ocular symptoms, due to nasal disease, 521. Oil of turpentine in diphther a and croup, 38. Os calcis, structure of, and cases of fracture of, Ovariotomy, case of, 266. Ovariotomy, intestinal obstruction after, 556. Ovum, human, 327. Oxalate of cerium in sea-sickness and other dis- Oxygen, transport of, 165; inhalation of in ane- Pancreas, cyst of, 305, 306. Paresis, recognition of incipient general, 376. Pathology, progress in, 153. Perineum, how to guard when head is passing, Peritoneum, method of cleansing, 268; carcinoma Peritonitis, treated by laparotomy, 274; treated Petroleum, is it a poison? 330. Phosphorus poisoning, case of, 462. Physiology, progress in, 158; and histology, Phthisical lesions, lobar arrangement of, 210. Placenta, separation of, 553. Pleuritic effusion, intra-plural injection of steril- Pleuritis, purulent, cured by incision and drain- Pneumogastric, pathology of ganglion of trunk of, Pneumonia, treatment of, 223; antipyretics in Pott's disease, treatment of pressure paralysis of Puberty, precocious, case of tumor of right ovary Rachitis in fœtus, 415. Raynaud's disease, case of, 373. Rectal diseases, painless treatment of, 587. Rheumatic orchitis, 375. Rheumatism, katalytic action of electricity in, Salicylate of mercury, therapeutic value of, 349. Salicylate of sodium in tonsilitis, 334. |