added 3j, spts. lav. co., and directe l'a teaspoonful to be given every hour to children above five years old, reducing the dose to younger children.

Dr. H. C. Simpson's case, page 125, March WORLD, is very distressing, and, I do not doubt will attract the sympathy and careful thoughts of many of the brethren more able to advise than I am; but in the enumeration of medicines tried, I find no mention of ox gall, nor of any special anti-ferment. I would prescribe for him, if he were my patient, and I did not know him to be a physician, as follows: Believing the flatus to be caused by fermentation, I would give :

Malarial Hematuria. Editor MEDICAL WORLD:

The dread disease bearing the name found in the caption of this paper made its debut, as definitely as the writer can ascertain, in this section of country, coincidently with the scourge of yellow fever that infested La Grange and other towns below on the Colorado River, in the fall of 1875.

There being no little similarity in the symtoms and sequelae of the two affections, it has impressed the laity as originating as a sequence of its more dreadful predecessor-yellow fever.

The text-books give but little space to its consideration in view of the grave results that inevitably obtain wherever it manifests itself as a complication of malarial toxemia.

It is thus described by Flint under Pernicious Intermittent Fever: "A form claiming distinct notice has prevailed in different parts of the Southern states of this country during the last twenty years.

Its most distinguishing feature is hematuria. It has been called hematuric Malarial fever. The term hemorrhagic is, however, to be

preferred inasmuch as, not infrequently, the hematuria is accompanied by hemorrhage in other situations, and the latter is sometimes the case without the presence of blood in the urine. Hemorrhagic malarial fever is not to confounded with intermittent or paroxysmal hematuria and hemoglobinuria.

As described by Michel, McDaniel, Norcum, Webb, and other observers in the Southern States hemorrhagic malarial fever, in the first, second or third paroxysm, presents the character of simple intermittent. The pernicious paroxysm commences with a severe rigor. At the commencement of the hot stage, urine is voided, containing, in greater or less quantity, blood."

Following the writer's observation at the bedside of the affection, the theory advanced concerning the cause of the jaundice that ensues, being of a hematogenous nature, strikes him as appearing very plausible; for the reason that the manifest prostration is not commensurate to the chill that precedes, which frequently is very slight, giving strength to the belief that the dissolution of the patient is caused by the etiological factor malaria, in consequence of destruction of his red blood-corpuscles by the

which the blood-vessels lose their normal tonicity, allowing a general diapedesis or extravasation of his life-giving element.

The physician's attention is divided between antagonizing the causative influence and sustaining the powers of life till nature can reassert herself and throw off, through her many viaducts of excretion, the poison to which she often succumbs.

There is some diversity of opinion as to the most efficient line of treatment: some resorting to measures that would seem to approach rashness, for the reason that the patients vitality is lowered by excessive catharsis with a view to stimulating the dormant secretory organs.

The simile in which the liver may be compared to an arena in which the Knights of Science have ruffled plumes and shattered lances, is well conceived, and may be happily applied to the existing difference of opinion respecting the cholagogue action of certain drugs; more especially the preparations of mercury.

Amongst a few of those who place credence in the action of calomel to arouse the dormant functions of this organ there seems to exist a morbid desire to stimulate (?) the hepatic secretions even at the risk of producing an exsanguine condition of the patient.

This propensity would be pardonable if the misconceived desire were in the limits of salivation; but unless there appear in the stool large

quantities of bile following the administration. of the drug, there is no rest for either the patient or the physician. Yet there are others who in their strict adherence to the expectant treatment fail in the main of meeting the indications.

It is evident from the treatment that has become almost stereotyped as curative in other types of malaria, that we can't afford to depart from our old routine of calomel and quinine when we have to do with an affection pre-eminently an exageration of the same disease manifesting itself in the superlative degree of intensity.

It seems rational to take a stand between conservatism and rashness and to meet the indications for treatment by acting on the secretions that the nourishment and medicine may become assimilated and appropriated; the one sustaining the vital forces, while the other, acting in unison, meets the other requirements by its powers to antoganize and eliminate. West Point, Texas. DR. J. SAMUEL PRICE.

Diseases of the Rectum.
(THIRD. PAPER).

Treatment of Hemorrhoids.

Editor MEDICAL WORLD:

This paper will be devoted specially and wholly to the treatment of "external piles." For treatment of external piles, see second paper, page 465 of Dec., 1888, WORLD. After the arrangements are made for the treatment of a case of piles, give the patient a full dose of comp. cathartic pills and secure a thorough evacuation of the bowels. This done and we

are ready to operate. We are now proposing to treat all of the tumors, say seven of them, at one sitting and keep the patient quiet in bed for ten days. Some of the piles in this case protrude easily; others remain within the rectum. In most every case like this it is necessary to administer an anesthetic, and chloroform is best for reasons yet to be stated; hence it will require three persons to operate on the case, two of you must be competent physicians, the third may be any competent person. Do not attempt to operate until the patient is profoundly anesthetized. Commence by grasping the largest protruding pile with a "Byrne Double Tenaculum Forceps" (this is the best instrument yet made for the purpose), and place the forceps in the hand of your assistant. Place a strong ligature around this pile and, before tightening the ligature loop, press the cord well down to the base of the tumor and tie it securely. If a very large tumor divide it by passing a needle around with the ligating silk through it at the base and tie

each half, and then all together. Tie two more of the larger tumors in the same manner.

You have four piles yet to treat. If they are not protruding sufficiently to treat externally, insert a bivalve speculum and inject them with a styptic, cut off the ligated tumors down to ligature and press all back into the rectum. Insert an anodyne suppository, or some ointment with a hard rubber ointment instrument, and place the patient in bed. Be sure to have the bladder emptied just before you give the anesthetic, and also see to it that the patient urinates often enough after the treatment; you may have to use a catheter the first day or two. Feed the patient a plain and not bulky diet, and his bowels need not move for the whole ten days. However, there will be no harm done if they do. Use anodynes only as specially required. Many patients will not complain of pain sufficient to disturb them; others require anodynes for the first four or five days. Now we will take another case of seven tumors, but differently situated-so situated as to render it necessary to treat him and keep him going about his business. Place him on the table in your office (you do not need an assistant), insert a bivalve speculum, and, with the assistance of the patient," coax" the largest tumors down so they will remain protruded, or at least one of them. Properly inject the proper quantity of the proper styptic into this one tumor. Press it back into the bowel, insert some suitable ointment into the rectum and let the patient go about his business. If convenient for him he should call at your office in a week, but if not so convenient, he should call at least in twelve to fifteen days, at which time he will ordinarily be in condition for further treatment. If the treatment of the first tumor was satisfactory in every respect, you may treat one more of the larger tumors and two of the smaller ones in the same manner and with the same styptic as before used, giving the patient the same directions as on the former occasion.

At the next sitting treat all of the remaining tumors.

In the first case the patient will usually be well of the piles in 15 to 18 days. In the second case it will require 40 to 60 days. This is an ordinary case of uncomplicated piles. To go over the cases: It is not safe to ligate all seven of the piles, since it will cause greater pain and shock, and also be very likely to produce marked contraction of the sphincter when the wounds are all healed. It is not safe to inject with a styptic all of the seven tumors at one time, since there may be some idiosyncrasy contra-indicating the use of the styptic selected. It is, however, safe to select a styptic and inject a safe quantity into one or two tumors, and

when you observe that it acts well use it again and more of it, if need be, or to discontinue its use if it acts badly, and use another and in less quantity, perhaps, for the time. There is great There is great diversity of opinion in the profession in regard to the use of a styptic in the treatment of piles. Several writers, and writers, too, within the last "twelve months," have discoursed very extensively and learnedly upon the dangers of "injecting piles." These writers of "great erudition" and "greater verbosity," themselves admit with a "prolixity" of diction, that they have not practically and experimentally proven and demonstrated that it is dangerous to inject a styptic into pile tumors. They assume a theory, and support it by imaginary cases of thrombosis, embolism, etc., resulting in hemiplegia, paraplegia, or something else.

The actual cases of death or of serious injury, in sufficient number, arising from the injection of a styptic into piles, are wanting to prove the assumption. The writer has himself injected a styptic into pile tumors over twenty thousand times, and has had no direct death from it, and only three remote deaths where the evidences were really clear that death resulted from the treatment. Two of these cases were, to the writer, clear cases of embolic apoplexy; the third hemiplegic semisideratus. We do not for a moment maintain that it is not dangerous to inject a styptic into piles, but it is the

how, where and what" that constitutes the danger. To skilfully inject the right quantity of the proper styptic is demonstrably as safe, and is attended by the least pain of any operation that has yet been made for the cure of piles.

The styptic can be used more nearly on all occasions and in all conditions than any other treatment. To bunglingly and ignorantly make any surgical operation and secure a bad result, or do great harm to the patient is nothing at all against the legitimacy of the operation which has been remotely imitated. To "write," to "speak," to "lecture" on a theory directly opposed to the demonstrated facts in actual practice is the personification of bigotry and ig

norance.

The "how" is of as much importance as the "where" and "what."

First have a syringe armed with a good needle that works perfectly; no leaking, no jerking. Get the pile tumor well in view. In. sert the needle well down at the base of the tumor and carry it up to (but not through) the apex. Inject the styptic slowly and withdraw the needle at the same time slowly. Hold the point of the needle just within the pile tumor at the point of insertion for a few seconds, to allow the coagulum to form with sufficient den

sity to close the opening in the wall of the pile tumor made by the needle. The idea is to seal the opening so that none of the contents, whether blood or coagulum, may escape. It is desirable to inject the styptic into the central portion of the tumor and form a coagulation of the contents of the pile, and not injure the sack or the walls of the pile tumor. If there is disintegration of the tissue of the outer coverings of the pile, it is likely to burst the sack in defecation, or from some other cause, and there may be as a result hemorrhage or ulceration from exposure of a raw surface. The principle of the injection is to disturb or to "shut off" nutrition from the tumor, and let the pile die a natural death. The ligature acts in the same way. The people, the intelligent, thinking people, require a treatment that is humane. The day for treating piles with the red hot poker, the poker used to poke the fire in a coal stove, is past, except it be in the public hospital, pauper practice of some of the "learned writers "above referred to. The thermo-cautery will cure, and there are cases where it is practical. The clamp will cure, excision will cure, electrolysis will cure; but one-fifth of the whole adult population of the United States (and territories) that are afflicted with hemorrhoids to such a degree requiring treatment, do not propose to be treated by any such means. An heirloom that has been handed down from father to son, from mother to daughter, is, "the cure is worse than the disease." They do not have to be" treated. The people have been taught for generations that piles could not be cured other than by the clamp, cautery or ligature. The patient that has sought relief at the hands of his physician had gone home disappointed, and with the depressing and discouraging feeling that he is to be, during life, the victim of a loathsome and a hopelessly incurable disease. His son grows up, daily conscious of the affliction of his father, and to the thousandth time quotes to inquiring friends that old Doctor Mullethead says, "the piles can't be cured." The people have had the impression that hernia, interstitial nephritis or cancer were minor ailments as compared to piles. The one in a thousand of these sufferers that persists and insists on an examination for piles, and in very truth has a nice and easily cured case of piles, receives no comfort further than "it is dangerous to treat you for piles; a cure of piles would cause consumption, and your chances of life are better to live along as you are." Noble exponent of the learned profession he (dis)graces. The writer's facilities for observation in this direction have been extensive, and the superstition, bigotry and ignorance in regard to the treatment of piles is appalling, and in every

sense humiliating and disgraceful to the profession. The writer's practical experience leads him to the firm conviction that every case of uncomplicated piles can be cured, and that it will tend to improve the general health in every instance, and that, if proper facilities are afforded, every case can be cured by the injection of a styptic, and that no other treatment is so safe or successful, or attended by so little pain and inconvenience.

Formulæ for styptics, ointments, etc., in next paper. E. H. DORLAND, M. D. 4329 Lake Avenue, Chicago.

Taylorville, Ill.

O. T. PRATT, M.D.

[We once inadvertently admitted in our col umns a prescription calling for, as one of its ingredients, a tincture of white pine. An avalanch of letters from all over the United States, asking what is the tincture of white pine, revealed to us the fact that there is no such thing known in pharmacy as white pine. We will be obliged to Dr. Pratt if he will kindly tell our readers in the next number what is the fluid extract of white pine bark which he uses; the botanical name of the tree; in what locality it may be found; how he prepares the fluid extract, and where it may be obtained. We desire all the remedies proposed in THE MEDICAL WORLD to be freely accessible to the entire profession; and those that are not known well we desire to at once make them known.-ED.]

To Prevent, Mitigate or Cure Nasal Catarrh. Editor MEDICAL WORLD:

In no text-book have I seen what I now communicate. It is written for the benefit of hu

manity; but particularly for the medical profession.

It is an universal physiological fact that all mucous surfaces are lubricated or served by their own or other secretions. The nasal is no exception to the rule; then, the use of a handkerchief, or cleansing the nose in any manner, i.e., its interior while on the street, in street cars, on dusty roads, in crowded rooms, theatres, stables or any other environment where the Schneiderian mucous membrane is subject to irritating matters, gases or what not, is to be scrupulously avoided. Under the influence of cold or other irritating agencies, the membrane is more active than when in a pleasant room at home, and under the circumstances remove only the secretion that is external, and this only for appearance sake. When out doors in the cold, nature throws out this secretion to shield and protect this membrane, and to be continually removing it by blowing the nose is to intensify the trouble. Not only from experience, but also from practice have I found this injunction to be of signal benefit in treating nasal catarrh in all the phases. I subscribed to THE WORLD immediately after reading the Z. T. DANIEL, M.D., first copy sent me. Washington, D.C.

REPLIES.

Editor MEDICAL World:

After a long silence I again greet you with my mite. On page 41 (Jan. 1889) Dr. Adams asks for aid. I confidently expected to see it given by Dr. Waugh in February number, but as he gives nothing definite, I will give my humble opinion based on two similar cases. The spasm is no doubt caused by a reflex neurosis from ovarian disease. This produces the "pressure and piercing pains," and then. there is tonic spasm, or contraction of the arterial circulation first in cerebellum and medulla oblongata, extending gradually to cerebrum, coming on and passing off slowly, coexisting with the development and decline of sub-acute ovaritis, a frequent sequence of ovarian disease. The short spasm of unconsciousness, "during which time respiration would be almost suspended," and "the attacks Simulating gastralgia," and "the rigid contraction of the flexor muscles," are all the results of reflex action. The almost suspended respiration and deglutition is owing to deficient circulation at base of fourth ventricle, and also in the cervicle arteries, diminishing the action of the pneumogastric and spinal accessory nerves. If the diminished circulation from contracted arteries were not from reflex action, there would be greater danger of sudden death.

M. S. Teaspoonful three or four times daily. After the first course of the latter prescription, iodide of iren ▲j may be used in place of mercury biniodide.

In Dr. Allen's case, "sick stomach of pregnancy" (page 83), I would give gr. pill ergotine, three times a day. Counter-irritation over third, fourth and fifth dorsal vertebræ, and a wad of absorbent cotton filled with borax and soda salicylate aã placed against os uteteri, and renew every day. Report results to THE MEDICAL WORLD. W. B. STEERE, M.D.

Gonorrhea, A Failure.

Editor MEDICAL WORLD:

Some months ago I was consulted by a railroad man who had gonorrhea-exposed some eight days previous. There was but little discharge and no pain. I had been wishing for a case, without urgent symptoms, in which I could try the plan of Mr. Frith. Bichloride mercury gr. r, aqua 3j, injected warm. So I put up a supply. I also gave the common balsam copaiba, sp. niter, etc., mixture. I saw nothing of the patient for ten days, when he reported discharge increased and some pain, and wanted to be cured and no fooling, so I decided to try the plan of Milton. Nit. silver gr. to the 3, injected through tube to seat of inflammation. Some pain followed this procedure. I gave him a mixture of sul. zinc, gr. ij, chloride of zinc, gr. to the 3j, to be used three times daily, and instructed him to call every evening for me to use the silver injection, which he did and reported a good deal of pain and discharge. I reduced the injection and it caused no pain then, but several hours after he was in misery; urination was very painful. I changed balsam mixture for acetate potass. and sp. nitre, and ordered penis held in