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80 per cent. solution of carbolic acid and convey the drop that remains on the probe to the bed of the fissure, and pass the point of the probe back and forth with considerable force so as to work in the acid well. Otherwise, could the fissure not be brought well to view, then apply a 4 per cent. solution of cocaine as best you can to the fissure, and then introduce the speculum, being particular to have the slot slide of the speculum directly over the fissure. This will bring the fissure nicely to view; then proceed with treatment as above. It is very easy to locate the fissure (if not too high up in rectum) by requesting your patient to strain down while pressing apart the nates.

Another method to cure fissure is by dilatation or stretching the sphincters.

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POLYPUS OF THE RECTUM.

These growths are frequently met with in the rectum, and should be treated by ligating. For this purpose the knot-tier is brought into use. It can readily be seen by a mechanical eye how to manipulate it; i. c., make the surgeon's noose, then fasten the inner end of the suture to the knot-tier. Now slip the noose over the polypus and get it as much to the base of the polypus as can be; then make traction on the outer end of the ligature, and at the same time make traction on the end within the rectum by pushing on the knot-tier. Once well done, it need never be repeated. Ligature must be tight enough to cut off all blood nourishment.

PRURITUS.

Put your patient on the same treatment as for catarrh, as this annoying disease or rather symptom, is, as a general thing, the result of internal rectal causes.

Proceed for local treatment as follows: Apply to the affected membrane or skin an 80 per cent. solution of pure carbolic acid once in five days, and have the patient wear absorbent cotton between the nates.

Dust the parts well with the following powder:

R Hydrarg, chlor. mite,

Bismuth subnit.,

Acid. boric., powd...aa equal parts Mix. Sig.-Apply as necessary. Or an ointment may be used by adding vaseline to the above formula.

For the night make a solution of boracic acid, as much as hot water will dissolve, then add one-third glycerine. Wet a pledget of cotton with this and pass up into the rectum, leaving a portion outside. Could this not be done by the patient, then instruct to inject about a teaspoonful of the catarrh formula or a solution of boracic acid, and keep the outside moist during the night.

The foregoing plan should be followed a few weeks, and, if a failure, then resort to a solution of corrosive sublimate, 10 grains to the ounce of water, and paint the itching parts, etc. Also try a strong solution of menthol, applied to the outside parts; it will relieve as if by magic. By using the above as directed you can radically cure any and all cases that may apply to you for relief.

Remember to continue the treatment as for catarrh, as much will be accomplished by this treatment.

SPASMODIC CONTRACTION OF SPHINCTERS.

This painful and irritable condition can only be overcome by stretching the muscles of the anus (sphincters). This treatment gives almost immediate relief. It is best accomplished by introducing the two index fingers well into the rectum, with backs of fingers together, and pulling in the directions of the coccyx and the perineum, until a resistance is overcome, which requires a considerable outlay of strength cn the part of the surgeon.

STRICTURES.

Strictures sometimes result from healing ulcers. For their relief we must depend upon bougies, by passing and retaining from 15 to 30 minutes and from 2 to 4 times a week, soft rubber bougies, and the

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POCKETS AND PAPILLAE OR FRINGES. This condition is a discovery of Prof. Pratt, of Chicago, to whom alone all credit is due, and I would suggest right here to every physician who makes rectal diseases a specialty, that he should obtain the Professor's work on Orificial Surgery. Much

more can be learned of these diseases than can be given in this paper. Prof. Pratt says that the pockets are more important, more unobserved and consequently more neglect

ed than all other diseases of the rectum.

The pockets are simply small blind canulas, from one-eighth to one inch in length or depth, and their number varies from one to ten, when found; their mouths are in the same situation as the bases of the papillae, one on each line, running parallel with each other, but always separated by a partition, their direction pointing towards the anus, and they are very superficial, hugging the mucous membrane closely. The bottom of these pockets is very sensitive, the patient often flinching even while partially under an anesthetic, when touched or found with the barbed hook.

TREATMENT.

Take the barbed hook, enter the pocket from above, raise it slightly, and with long handled scissors or bistuory, snip it off. The operation of cutting the fringes is so simple and the pain so slight that it is not necessary to use an anesthetic except where fissure exists in very nervous subjects.

Now, Brother M. D's, I am done, and hope that you may have the best of results with the methods of treatment herein given. I further hope to see frequent reports through the columns of the Medical World.

Gothenburg, Neb. W. P. Smith, M. D.

Treatment of Hay Fever-Certain Signs of Approaching Death.

Editor Medical World:-The World has again arrived, and, as usual, the table is again loaded with the choicest fruit of the season. Dr. J. F. McCluny, page 378, by his article, suggests to me something of which I have often wished to speak. We are so apt to look to some foreign land, or to large chemical laboratories, for our specifics in medicine. We like a foreign title to our preparations, and if there be any name or design upon the container that seems mysterious, or which we do not

understand, we are very apt to carry the article in our pocket case all the more for such confusion. If we knew our native herbs, growing around us in profusion, many a cure would loom up and many a pain be avoided. How often has many a learned man scoffed at a suggestion given by some old "granny," and the same being applied later, effected a cure?

There are many old, quaint, unscientific compounds which will produce results that, did they result from some "antitoxical" remedy, they would be lauded to the four quarters of the globe, and sold at "$5.25 per 1500 units."

hay-fever patients full doses of syrup of If Dr. Devereux, page 390, will give his hydriodic acid (Hostelley's), he will get good results. Twenty drops of this syrup every two hours is, I dare say, useless. Give for effect, if they take four ounces fever with this syrup, and generally abort daily. I have treated many cases of hay the attack or render it mild. Give drams i every two hours for 48 hours, or until signs of abatement appear. Then reduce signs of return appear, give again the large to dram i every three hours. When any

dose. Good results will follow.

I have a request to make that will be a decided benefit to every World reader when my work is complete. I am compiling a table or chart of the "Signs of Approaching Death" in the different diseases. Remember, I want no signs of an unfavorable prognosis, but simply a certain sign that death is approaching. When I say a certain sign, I of course mean a sign that is reasonably certain. I have a case to illus

trate.

Before I received my degree I saw a case of a young child, 3 or 4 years old, that had at 10 A. M. of the same day drank a cup of lye. The child lingered almost motionless after the first hour, until about 6 P. M., when a decided improvement was apparent to the public eye. The attending physician came about this time, and surprised us all by gravely announcing that the child would die before sunrise next morning. At 3 A. M. the child expired. I have often since desired to know whether that doctor was positive of that, if so, by what means. I kindly request all physicians, knowing of such signs of approaching death, to communicate to me personally, giving sign, disease, and, if possible, the length of time that will probably elapse before death enIf you have any signs that are not always certain, you may give them, but

sues.

state their degree of certainty if possible. I will tabulate all signs received, giving credit to the right party, and will publish the same in The World, and thus benefit the entire army of World readers.

Some time ago The World published an account of Dr. Matchette's liquor cure. I do not know how near a specific that home treatment is, but if it is as good as their tobacco remedy, it is all right. Two days' treatment "fixed me," and I was an inveterate chewer of tobacco since my 12th year. When so many fraudulent cures are on the market it is worth a thing or two to know which is good. Dr. Matchette, of Chicago, has cured thousands of the liquor habit at his sanitarium, and The Dr. Matchette Tobacco Cure Company are doing a similar service all over the United States from the same place. Akron, Pa.

J. D. Albright, M. D.

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Acid salicylic

Made into twelve powders.

.grs. vii

.grs. xx

Cocaine.

Editor Medical World:-I wish to say in regard to Dr. J. W. Crenshaw's cases, in which he used a hyperdermic injection of a four per cent. solution of cocaine, that I think he may be, in a measure, right in attributing the symptoms he got to the drug used.

A one per cent. solution is plenty strong enough to produce complete local anesthesia. I should even prefer a one-half of one per cent. solution to a four per cent. With the weaker solution you can use more in bulk, and produce an anesthetic action over a larger area.

I had some enlarged veins ligated under a one per cent. solution, using forty minims, and got a very marked effect of the general system. I assure you, however, that it was .a very novel experience to see your own flesh cut into, sponged out and probed and sewed up, and not feel a particle of pain, not so much as you would to have your finger nails cut by another.

Newport, N. H. D. M. Currier, M. D.

Conservative Surgery-Help Nature in Her
Efforts.

Editor Medical World:-An article in September's number, under the caption of "Nature's Method of Repairing a Stump," attracted my especial attention. In indorsing the treatment of expectancy as

de

This fall, for experiment, I dispensed it scribed, I desire, right here, to emphasize in one mixture for one half the cases.

R Chloral

Syr. lactucarium,
Aquae cinnamonil
Acetanilid

Acid salicylic

....dr. iss

....aa oz. ii
...grs. xxiv
..gr. xlviii

Rub up the syrup of lactucarium with chloral, the cinnamon water with acetanilid and salicylic acid; mix the two solutions. Sig. Dose, one teaspoonful evThis dose for a child ery three hours. four or five years old. Use any good antiseptic spray or gargle locally in Of course you look after the secretions and excretions; also the sequelae-rheumatism and dropsy, of they should occur.

throat.

Tell Bro. Marsden to give his lady patient the following, for chronic diarrhea and dyspepsia

R Bismuth salicylate
Zinc sulpho. carb.,
Papoid

......oz. 1 ..aa dr. iss

M. Divide into sixty capsules or powders. Give one before each meal and at

bedtime.

this injunction: Assist nature all you possibly can in her reparative efforts, particularly in wounds and injuries of the hand and phalanges. When it is taken into consideration that the majority of bodily accidents that frequently occur are chiefly received by laborers and mechanics, and that the loss of a finger or the contraction of a tendon means, in many instances, the loss of a situation or the abandonment of a trade, the responsibility of operative interference in preference to a more conservative course is a question that must always be seriously weighed by the attending physician. Many surgeons are too hasty in the use of a knife, and many others are too lax in their attention upon wounds of are often deemed the extremities, which

For Bro. Hammer's dandruff, would try: trivial, but subsequently may prove very

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M. Sig.-Sponge scalp thoroughly ev

ery morning with an ounce.

refractory. I have known physicians to order a mere poultice upon a punctured wound of a joint, where a light splint and

When Dr. Everts gets that all the "year bandage, assisted with a soothing antisepround" fluid, tell him to report.

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tic lotion, would prevent a deformity and weeks of untold suffering. And I have

seen cases of lacerations and contusions where iodoform powder had been prescribed, and a necrosis of tissue resulted, because the prescriber had not exercised a little discernment in evacuating confined coagula, the removal of a loose matrix, or the proper cleansing of the affected parts. from debris. It is astonishing how nature will often re-assert herself in endeavors to restore what is destroyed, if only patiently encouraged, and a recent case of my own, which I had deemed hopeless of saving a digit, aptly illustrates this assertion.

F. S., age 26, occupation jeweler, while engaged in drawing flat wire between two rollers on August 19, 1895, in some unaccountable way, had the palmar aspect of the right index finger, distal end, stripped of its flesh. Saw case 15 minutes afterward. Both lateral arteries were spouting and bone exposed, and denuded its entire length. Periosteum uninjured. Nail intact, and connected with a half inch in width of tissue on dorsum to joint. Advised amputation. Patient demurred. Wrapped finger in iodoform gauze and appointed an hour for its removal. Upon his return he explained that the loss of a portion of the injured member meant a reduction of one-half his income, due to his additional calling, that of a professional musician. Upon this statement I was induced to try conservative measures, and after five days of strict antiseptic treatment, and finding parts remaining "in statu quo," I changed the treatment by applying an ointment of lanoline combined with a small percentage of aristol and carbolic acid. Of course, some suppuration ensued, but new granulations started at once, and by September 9 had risen to the even contour of the finger. At this date (September 25), parts are healed, and he has a good use of the member.

W. S., jeweller, severed end of thumb by a power press on March 28, and J. E. D., printer, severed part of the left index finger by a paper cutter on August 15. Strips of adhesive plaster were applied to mould ends into roundness in both cases, before applying the gauze, with excellent_resus. I prefer the adhesive plaster of the U. S. P. in preference to the rubber preparations, as the former can be drawn through an alcoholic flame and made somewhat aseptic before applying. The strapping method is old, but, aided by antisepsis, ought not to be discarded, as re-amputation in a majority of cases can be avoided.

J. M., butcher, age 20, cellulitis of ight

middle finger. Had been under treatment. eight days by a neighboring physician Lefore I saw the case, June 17, 1895. Finger swollen double its normal size,nail loosened, and small openings about distal end, through which pus was oozing. Removed nail, enlarged openings, and discovered last phalanx necrosed. Curetted cavity of all sloughs, and thoroughly irrigating wound with 1-1000 cor. sub. sol., I bound the parts wth "pink" gauze. Daily irrigations with the sublimate solution was maintained until pus ceased to appear. Healed in three weeks, saving bone with only a partial deformity of new nail later on.

Mrs. H. O. Same as case above, affecting middle finger, left hand. Had also been treated by a physician before I saw her, August 8, 1895. Same treatment as above, excepting a varying of carbolic acid sol. I-40, alternately at each dressing. Healed August 31 in good condition, also saving bone.

G. M., age 29, jeweler. While employed at a "drop" received, on February 28, the full weight of the instrument upon his right thumb. Immediately called upon the nearest physician, who recommended amputation. Declining, he called upon another, who advised the same. Two hours later I saw him. Bone fractured, flesh lacerated, and thumb lengthened one-half inch. I fixed the member upon a splint, removed nail and shreds of tissue. Antiseptic treatment. Hemorrhage quite free for a week, so that the dressings required changing daily. Healed with slight deformity at the end of six weeks. Use of thumb unimpaired. I could continue to narrate a dozen such cases as given above, but hope I have been explicit enough in my plea to assist nature in her reparative efforts, by the few demonstrations here given.

Frederick W. Duncker, M. D. Newark, N. J.

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Infectious Phlebitis. Editor Medical World:-On August 26 I was called to see Mrs. S., and on arriving, found, after examination, that she was fairly well on in the first stage of labor. The presentation was vertex L. O. A. She was delivered of a large boy, after being in labor about 4 hours. This was her fourth child. In about ten minutes, after making slight traction upon the cord and friction cver uterus, she was delivered of the placenta. Now, this was a complete physiological labor without any mechanical interference. Her lying-in chamber wasn't very inviting, especially the bed in which she was lying, but it was a hard matter to set things to rights at that late hour. I use antisepsis in all my obstetrical cases. I gave the woman an antiseptic injection and washed the external genitals with carbolized water. I

saw that all soiled linen was removed and everything was, as I thought, in fine shape. I left, saying that I would call the following day.

I called next day, August 27, at 3 P. M., and, on examination, found her pulse 114, temperature 100 1-2 degrees. I asked her if she had had a chill, receiving a negative reply. She said she was feeling real comfortable. I gave her a vaginal injection of a 5 per cent. carbolic acid solution and left. The same evening, at 9 P. M., I was hastily summoned, stating that her bowels were very bad. On my arrival the following conditions presented themselves: She had a chill shortly after I left in the afternoon and her bowels became very bad, moving 12 or 15 times in a few hours, and were very offensive. She said she had considerable pain in the bowels, with no tympanites or swelling. Her pulse was 120, temperature 101 1-5 degrees. The lochia had ceased to flow, and when I inserted my fingers into the os, there was a very offensive discharge on my fingers. I ordered carbolized water injections to be used every three hours continuously, day and night,and for the bowel trouble put her on acid sulph. aromat. and tr. opii. deod. and whisky to lower the temperature. The next day, August 28, I called at 9 A. M. and found her perspiring freely, a great deal of headache, and pictured a very anxious look, with brain a good deal disturbed. Her pulse was 132, temperature 103 2-5 degrees. 103 2-5 degrees. Bowels somewhat checked. She had slept scarcely any the previous night. I told the nurse to continue the vaginal injections of warm carbolized water, to be repeated

every three hours. The evening of the same day I called again, and found her still perspiring. The nurse said she had been resting at intervals during the day, bowels moved three or four times. The lochia commenced to flow again. Her pulse was 136, and very weak and thready; temperature 101 4-5 degrees. On August 29, at 9.30 A. M., I saw the case again. The nurse said she had rested at intervals the previous night. She was still perspiring, but not so freely. Her bowels moved four times since I last saw her, and she had a good deal of pain before they would move. The pulse had dropped to 110, temperature, 98 degrees. I ordered the injections to be given every four hours. August 30, at 2.30 P. M., I called, and the nurse informed me that she had rested poorly all night, being disturbed so much by her bowels moving so often. She had also dreamed such horrible dreams. Still some slight pain in bowels. Her pulse was 96, temperature normal. I ordered the injections to be used three times daily. August 31, at 10 A. M., I cailed again, and found her perspiring slightly. She had rested well all night. Bowels completely checked. The pulse was 90 (but very weak), temperature 98 degrees. September 2, at 10 A. M., I called and found her bright and cheerful, having rested well all night. Bowels moved twice in two days. Her pulse was 84, temperature normal. September 3, at 6 P. M., I saw her again, and found her looking bright and feeling good, having rested well all night, with but one natural movement from bowels. Her pulse was 84, temperature 98 degrees. She perspires no more and has no more pain. I discharged the case.

This case developed into puerperal septicemia inside of 24 hours after labor, and labor was conducted under antiseptic principles. I never make an examination without at first antiseptisizing my hands, and I always follow labor with an antiseptic injection. Puerperal septicemia is autogenetic and the infection comes either from patient, nurse, or doctor. I carried out antisepsis throughout, and had been attending no cases of erysipelas, or any zymotic diseases previous to the attendance on this case. The nurse had not touched this case prior to the development of this disease, hence I claim that the source of infection was the patient. Had there been a piece of placenta retained in uterus the case would have been very easily explained. The placenta was not adherent and came away easily. There

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