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THE 
 
 General Practitioner 
 
 AS A 
 
 Specialist 
 
 A Treatise Devoted to the Consideration of 
 Medical Specialties 
 
 BY 
 
 J. D. ALBRIGHT, M. D. 
 
 Third Edition 
 Revised, Enlarged and Illustrated 
 
 PUBLISHED BY THE AUTHOR 
 
 PHILADELPHIA, PENNSYLVANIA 
 I904 
 
COPYRIGHTED BY 
 
 J. D. ALBRIGHT, M. D. 
 1904. 
 
 ALL, RIGHTS RESERVED. 
 
PREFACE TO THE THIRD EDITION. 
 
 The complete exhaustion of former editions of this work 
 has rendered the publication of this, the Third edition, 
 necessary. 
 
 The sense of a well defined feeling of uncertainty present 
 when, thirty months ago, the Second edition of several 
 thousand copies, was launched into a comparatively unex- 
 plored sea, is at this time agreeably absent. The cordial 
 reception extended former editions and the many letters of 
 approbation and encouragement received, give instead the 
 assurance of a continuation of good will and support. That 
 this volume will merit the approval of those into whose 
 possession it may come, is my most sincere wish. 
 
 Taking advantage of the opportunity, the extent of the 
 work has been somewhat enlarged ; new matter has been 
 added and certain subjects have been more thoroughly 
 considered. Several illustrations, reproduced from original 
 photographs, are also a new feature. 
 
 As many of the methods of treatment are to a certain 
 extent, an evolution, developed to their present state of 
 perfection by the combined efforts* of several minds following 
 the same course, proper credit cannot easily be given. I 
 have, however, made an effort to give credit in the text for 
 suggestions and assistance, wherever due. 
 
 Should I have failed in thi? ; by oversight neglected one, 
 or overlooked another, let him accept this, my expression 
 of thanks cheerfully acknowledged. 
 
 '3 
 
Dr. T. W. Williams, of Milwaukee, Wis., has con- 
 tributed the chapters under his name, to whom inquiries con- 
 cerning the same should be addressed. 
 
 Continuing my former policy, I will be pleased to 
 correspond or co-operate with any physician into whose 
 hands this may come, recognizing the mutual benefits that 
 accrue from combined efforts and exchange of ideas, and 
 that, if the fates so decree, greater good may be accom- 
 plished. "For this was the manner in former time in Israel. 
 * * * for to confirm all things, a man plucked off his 
 shoe and gave it to his neighbor." 
 
 THE AUTHOR. 
 
 Philadelphia, Pa. 
 January 1904. 
 
PREFACE TO THE SECOND EDITION. 
 
 The gratifying reception accorded the first edition of 
 this work by the medical profession throughout the United 
 States and Canada, as evidenced by the hundreds of com- 
 mendatory letters received and the rapid exhaustion of the 
 entire edition, has prompted the author, in preparing the 
 second edition, to revise and considerably enlarge it. 
 
 In addition to the matter contained in the first edition, 
 the author has complied with the general demand for further 
 and more detailed consideration of some of the subjects 
 therein treated, and has, in addition thereto, added chapters 
 devoted to the consideration of other specialties. 
 
 During the past year the author has investigated and 
 purchased a number of the more recent Secret Systems, 
 advertised and sold to the medical profession, all of which 
 are disclosed in this edition. 
 
 The author wishes to acknowledge valuable suggestions 
 and assistance from Drs. R. St. J. Perry, C. L. Dana, F. W. 
 McCanon and E. L. Goodall ; also from the writings of 
 Agnew, Waugh, Monroe and others who have received due 
 credit throughout the work. 
 
 Thanking the profession for their liberal expressions 
 of appreciation and substantial support, the author hopes to 
 merit their continued approbation. 
 
 The author will be pleased to correspond or co-operate 
 with any physician into whose hands this may come. 
 
 July ist, 1901. 
 
INTRODUCTORY TO FIRST EDITION, 
 
 To that large body of energetic and progressive physi- 
 cians who have learned to recognize the value of concen- 
 trated effort in any one direction, and who appreciate the 
 exceptional advantages to be derived from the use of meri- 
 torious remedies and methods of treatment, this work is 
 respectfully offered. 
 
 To such, no apology is necessary, as it will fill a vacancy 
 that has long been known to exist; no work of the kind 
 having ever before been placed at their disposal. 
 
 To the minority of the profession, those who are con- 
 tented with their quarter and half century-old methods and 
 ideas, and who without investigation unhesitatingly condemn 
 progress in every form and wherever found, this work will 
 not appeal. 
 
 If the highly gratifying results attainable by the use of 
 the information detailed in the following pages be a criterion, 
 no one will hesitate to credit the statement that it embodies 
 the latest and most advanced ideas now employed by the 
 leading specialists in their respective lines of work. 
 
 That it will be the means of accomplishing "the greatest 
 good to the greatest number," thereby bringing health and 
 happiness to the patient and professional and financial suc- 
 cess to the physician, is the wish of 
 
 THE AUTHOR. 
 
 May, 1900. 
 
DISEASES OF THE RECTUM 
 
 AND ANUS. 
 
 In these days of Specialism, when so large a number 
 of general practitioners are deserting the ranks to seek fame 
 and fortune along the lines of specialties, it is somewhat 
 strange that the extensive and fertile field of Rectal Diseases 
 is so frequently overlooked and so generally avoided. There 
 is no specialty in medicine in which the material is so plenti- 
 ful ; the indications for treatment so clearly defined ; the 
 results so generally satisfactory ; the patients so uniformly 
 grateful, and the opportunities for revenue so excellent. 
 
 No part of the body is more prone to disease than the 
 rectum, and there are no diseases which as a class are less 
 understood. There are no diseases so uniformly annoying 
 and painful, and none so silently and submissively endured. 
 
 In former years, aside from the employment of purely 
 surgical means, the regular medical profession, with but 
 few exceptions, devoted but little time and attention to the 
 treatment of diseases of the rectum and anus, consequently 
 a large portion of this practice passed into the hands of 
 itinerants and charlatans, who have ever been alert to take 
 advantage of opportunities neglected by the profession. 
 
 If there were any ground for the opinion. I have heard 
 expressed, that the treatment of rectal diseases suggested a 
 lack of dignity, it would probably be found to spring from 
 the impressions made by the disreputable men and methods 
 formerly associated in this branch of medicine. The title 
 "traveling pile doctor" certainly implies no dignity and less 
 honor, but the legitimate rectal specialist is not to be men- 
 tioned in comparison and bears no relation to him whatever. 
 
 7 
 
8 DISEASES OF THE 
 
 The impression that rectal work is unclean and unpleasant 
 is probably a strong factor in influencing a physician to 
 adopt some other line of work, yet this should have but little 
 weight when one considers it in comparison with genito- 
 urinary, gynecological or obstetrical work. 
 
 Persons of ordinary intelligence and the usual sense of 
 delicacy will foresee the desirability of cleanliness, and in 
 their behalf it must be said, the external appearance of filth 
 is but rarely noticed. 
 
 Granting that prior to the inauguration of stringent 
 medical legislation, the country was infested with "traveling 
 pile doctors," whose ignorance prevented them from treat- 
 ing rectal diseases except for revenue only, we must admit 
 that the irregular rectal specialists of to-day are not in their 
 class. As stated in an editorial in the Medical Record, "the 
 modern irregular practitioner is less of a fool and an igno- 
 ramus than his predecessor. He is sometimes a man of good 
 medical education and experience." Regular practitioners 
 entering this field have in the modern irregular specialist a 
 competitor worthy of their steel, yet by their methods of 
 awakening interest among persons afflicted with rectal dis- 
 eases, the regular practitioner is benefited. 
 
 This fact is perhaps responsible for the interest that 
 has been aroused and which is apparent on all sides, as 
 evidenced by the attention that is now being directed toward 
 this class of diseases, as well as the treatment of hernia by 
 the injection method, the treatment of cancers, etc., all of 
 which have for many years been practically in the hands of 
 the irregulars. 
 
 As I stated in an article published in the Medical Brief, 
 in December, 1898, on the importance of directing attention 
 toward specialties, "Show me a branch in which the special- 
 ist or 'institute' thrives, and I will show you a branch which 
 the general practitioner has neglected." 
 
 However, if "straws indicate the course of the wind," 
 and unless all signs fail, the end of another decade will find 
 the majority of the medical profession strongly advocating 
 
RECTUM AND ANUS. 9 
 
 and diligently practicing many means and methods which 
 to-day are strenuously opposed and possibly denounced by 
 many of them. The change of attitude toward the non-sur- 
 gical treatment of rectal diseases is demonstrated by the 
 many leading articles that appear in high grade medical pub- 
 lications, written by men of high professional standing and 
 of excellent repute. 
 
 The treatment of hemorrhoids constitutes the major 
 portion of the work of the rectal specialist, yet as he treats 
 these cases successfully he will naturally be led to the inves- 
 tigation and treatment of other forms of rectal diseases, by 
 virtue of the close relationship existing between different 
 diseases. Before passing on to the consideration of the sev- 
 eral diseases that appear in the rectum, the advantages and 
 disadvantages of the injection treatment of hemorrhoids, 
 quoting several writers, will be reviewed, as to the inexperi- 
 enced, or possibly prejudiced, mind there is nothing so con- 
 vincing as evidence. 
 
 If it were not a matter of regret that so strong a preju- 
 dice could exist in so honorable and respected a profession, 
 it would be amusing to record the objections that physicians 
 opposed to this method of treatment offer against it. I 
 have before me a clipping from a Western medical journal, 
 written by a Professor of Surgery in a medical college of 
 the West, in which he says : "If sloughing takes place after 
 the injection of carbolic acid into a pile tumor, it will prob- 
 ably be from throwing the fluid through the vein into the 
 areolar tissue beneath. Knowing this to be the case, I was 
 very careful not to do this, but the sloughing came just the 
 same." Later on he states that the solution used was 16% 
 carbolic acid and "this sloughing I consider one of the most 
 serious objections to this mode of treating piles." I should 
 very much like to know how or by what means he expected 
 the tumor to disappear. 
 
 When sloughing is limited to the tumor which is dead- 
 ened by the injection of a proper fluid, no danger to the 
 patient can exist, neither will it cause any inconvenience, but 
 
lO DISEASES OF THE 
 
 if the sloughing involves the bowel, the fluid was either 
 improperly injected or the proper fluid was not used. Pos- 
 sibly from inexperience he lacked the proper skill necessary 
 to inject the fluid properly, and as he was probably seeking 
 evidence to condemn the treatment, he used a solution of 
 only 16% of carbolic acid strength ; too weak to cauterize 
 and prevent absorption, and a great deal weaker than is 
 used by the successful practitioners using this method. It 
 is more than passing strange that a man, generally well 
 informed, should attempt to instruct others in a subject con- 
 cerning the principles of which he is comparatively ignorant. 
 In a review of the comments of prominent physicians who 
 are opposed to the non-surgical treatment of the rectum, 
 notably the injection treatment of hemorrhoids, the follow- 
 ing objections seem to be the most general: 
 
 i. Danger. Andrews of Chicago has reported a num- 
 ber of deaths due to the sequences following the injection of 
 certain fluids into hemorrhoids, but he fails to state the 
 number of persons who have died from the effects of surgi- 
 cal operations for the relief of similar conditions ; neither 
 did he employ a fluid such as is now considered the only 
 rational and proper one to inject into hemorrhoidal tumors. 
 The indiscriminate injection of irritating fluids has never 
 received the sanction of the successful physicians using this 
 method, and carelessness in injecting, so often combined 
 with the use of an improper fluid, cannot be expected to 
 produce satisfactory results. The use of a suitable fluid, 
 properly injected, is uniformly curative and is as free from 
 danger and serious consequences as the lancing of a felon 
 or the extraction of a tooth. 
 
 2. . It is not uniformly curative. This objection would 
 be a poor one if it were true, but it is not true. With the 
 exception of cutaneous external hemorrhoids the treatment 
 is absolutely curative, if the proper fluid is employed and 
 carefully injected. The surgical operation for hemorrhoids 
 is not only not uniformly curative, but in many cases the 
 results of the operation are far worse than the original condition. 
 
RECTUM AND ANUS. II 
 
 3. It is a tedious treatment. This objection is not 
 well taken. Patients prefer mild means to severe ones and 
 if a choice were offered them, the large majority would pre- 
 fer a slow but certain cure to a speedy operation of which 
 the outcome is uncertain. 
 
 4. It is not applicable to all piles. This is true. No one 
 ever claimed that all external piles should be injected. The 
 injection treatment is principally a form of treatment for 
 internal piles, and as such it is a decided success. 
 
 On the other hand, prominent advocates of this method 
 have this to say against the ligature, clamp and cautery, and 
 the knife. 
 
 Dr. S. S. Turner. U. S. Army, says : "Mr. Whitehead's 
 operation is so self-evidently bloody, tedious and difficult 
 that no general practitioner and few specialists will care to 
 undertake it. Xo amount of assertion by Mr. Whitehead 
 in favor of its simplicity, will deceive any one who has 
 studied anatomy." 
 
 Allingham says of the clamp and cautery, "In my opin- 
 ion it has little to recommend it. As far as my most careful 
 researches have led me to a conclusion, it is quite six times 
 as fatal as the ligature properly and dextrously applied." 
 
 Dr. Haynes says of the ligature, "I have frequently 
 made Allingham's ligature operation. It is easy and effect- 
 ual, but followed by retention of urine and great pain, lasting 
 in some cases seven days. One of my cases died from lock- 
 jaw and a similar result followed a case in the Episcopal 
 •Hospital in Philadelphia." 
 
 Dr. J. W. Hallum, in an article in a leading medical 
 journal, says: "The treatment of hemorrhoids by carbolic 
 acid injection is a method that I hesitate to present and advo- 
 cate, not because of its defects, but on account of its oppo- 
 nents." He further says that in ten years' practice of the 
 method, he has never had any alarming symptoms, no 
 ■secondary hemorrhage and no sloughing other than the 
 pile itself, and without a single failure. 
 
12 DISEASES OF THE 
 
 The honor of being- the originator of the injection 
 method of treating hemorrhoids has been accorded to Colles 
 of Dublin, who first employed the method in 1874, although 
 he was closely followed by Sturgeon of this country, who 
 practiced the same method the same year. 
 
 Agnew of San Francisco reported cures by this method 
 as early as 1877, and has been employing it with success ever 
 since. 
 
 Numerous others could be mentioned who have prac- 
 ticed the method for over twenty years. 
 
 Those of the profession who imagine that this mode of 
 treating hemorrhoids is still in a crude and imperfect state, 
 and that the perhaps unsatisfactory results obtained by a few 
 isolated and inexperienced practitioners are a criterion by 
 which the value of the treatment is measured, are laboring 
 under a delusion and existing in a state of lethargy from 
 which they cannot emerge too quickly. 
 
 The close relationship existing between different forms 
 of diseases of the rectum and anus, many of which resemble 
 each other so closely that the differential diagnosis is not 
 always easy, and as the treatment of one disease often neces- 
 sitates the treatment of others, those coming within the scope 
 of this work will be considered. Those of a malignant 
 nature will be omitted. 
 
 The diseases of the rectum and anus which can be suc- 
 cessfully treated by the general practitioner may be said to 
 be, Hemorrhoids, Rectal L'lcers, Rectal and Anal Fissure, 
 Rectal and Anal Fistula, Rectal Polypus and Prolapse of the 
 Rectum. In connection with these may be included the 
 treatment of Pruritus, Eczema and Constipation. 
 
 Each of these will receive attention in their order, 
 special attention being given to diagnosis and treatment. 
 Works on anatomy are at the disposal of all practitioners, 
 and a lengthy anatomical description of the rectum and a 
 histological and pathological study of its structure in health 
 and disease could serve no purpose in a work of this nature. 
 
RECTUM AND ANUS. 1 3 
 
 Enough of this will, however, be given to place the subject 
 clearly before the reader. A complete and exhaustive study 
 of the anatomy of the parts will amply repay the practitioner 
 for the time and labor so spent. 
 
 Hemorrhoids. 
 
 Hemorrhoids are usually defined as tumors largely 
 composed of varicose or dilated veins of the lower part of 
 the rectum, surrounded and infiltrated by connective tissue. 
 This is correct with the exception that the arteries may be 
 also involved. Hemorrhoids are divided into two general 
 classes, Internal and External. This classification has an 
 anatomical and pathological basis and serves as a guide to 
 treatment. Internal hemorrhoids originate and have their 
 attachments above the external sphincter and are within the 
 grasp of this muscle. External hemorrhoids have their 
 origin in the anal membrane or at the muco-cutaneous junc- 
 tion, and when the sphincter is closed, are external to it. 
 Internal hemorrhoids when of sufficient size, protrude 
 through the sphincter during straining, but they may be 
 returned into the bowel, where they will remain until again 
 forced down. External hemorrhoids cannot be forced into 
 the bowel, but remain constantly on the outside. It is as 
 a rule not difficult to make a diagnosis between internal and 
 external piles, but it is important that it should be correctly 
 made, as the treatment of the two forms is essentially differ- 
 ent. 
 
14 DISEASES OF THE 
 
 Internal hemorrhoids are subdivided into three varieties 
 and are named according to their character, the Venous, 
 Capillary and Arterial. Different writers have mentioned 
 many other varieties, named according to their shape and 
 characteristics, but it is unnecessary to mention them as 
 their treatment is practically the same. 
 
 External hemorrhoids are divided into two classes, the 
 Venous and Cutaneous. The former are again subdivided 
 into the varicose and the thrombic. The Cutaneous are 
 also again divided into the redundant, the hyperplastic and 
 the hypertrophic. 
 
 Mixed hemorrhoids may also exist, partly within the 
 sphincter and partly without. 
 
 The rectum receives its blood supply from the superior, 
 middle and inferior hemorrhoidal arteries. The superior 
 hemorrhoidal is a continuation of the inferior mesenteric, 
 and by a number of branches descends between the mucous 
 and muscular coats of the rectum nearly as far as its lower 
 end, anastomosing with each other, with the middle and the 
 inferior hemorrhoidal arteries. The middle hemorrhoidal 
 artery is a branch of the anterior trunk of the internal iliac 
 and supplies the lower part of the rectum, anastomosing 
 with the others. The inferior hemorrhoidal arteries are two 
 or three in number, arising from the internal pudic. They 
 supply the sphincters and integument of the anal region. 
 
 The veins of the rectum are the superior, middle and 
 inferior hemorrhoidal. The superior veins which are alone 
 implicated in the formation of internal hemorrhoids, are 
 tributaries of the inferior mesenteric, while the middle and 
 inferior veins are alone implicated in the formation of exter- 
 nal hemorrhoids, are tributaries of the internal iliac. There 
 is free anastomosis between the internal and external venous 
 systems, being known as the hemorrhoidal plexus. The 
 inferior mesenteric forms part of the vena portae and the 
 blood is thus circulated through the liver. This illustrates 
 the connection with internal hemorrhoids and interference 
 with the portal circulation, as any obstruction in the latter 
 
RECTUM AND ANUS. 1 5 
 
 would necessarily be responsible for greater pressure in 
 the hemorrhoidal veins. This is illustrated in the common 
 occurrence of persons experiencing more inconvenience from 
 their piles when bilious. As the external venous system 
 empties into the internal iliac, the interruption or obstruc- 
 tion of the portal system does not influence external piles, 
 except to such an extent as may be due to the anastomosis 
 between the two systems, as this blood passes through the 
 common iliacs and inferior vena cava to the heart. 
 
 Internal piles are covered by mucous membrane only, 
 which is usually thickened and changed in color and con- 
 sistence, according to the length of time they have existed, 
 and the variety to which they belong. 
 
 Those of Venous origin are by far the most common. 
 They may assume almost any shape and size and are bluish 
 in appearance unless when strangulated, when they may 
 assume a purplish hue. These tumors may be small, round, 
 soft, spongy and smooth or may take the form of a large 
 corrugated mass filling' the entire lower portion of the rec- 
 tum. They are not painful unless when inflamed and stran- 
 gulated, do not bleed easily, but when existing in large 
 numbers or when a number have coalesced, a movement of 
 the bowels may cause quite profuse hemorrhage. 
 
 Hemorrhoids of Capillary origin are usually of a dark 
 color, are smaller than the venous, more delicate, bleed easily 
 when touched by a probe and are not painful. They seldom 
 protrude unless when accompanied by large tumors. 
 
 Arterial hemorrhoids are bright red in appearance, very 
 irritable, bleed freely, are of delicate structure when they 
 first make their appearance and are subject to prolapse. 
 
 External piles. The varicose form of external piles 
 is a varicosed condition of the external hemorrhoidal veins, 
 with or without infiltration and thickening of the surround- 
 ing tissue. It is usually of a bluish or purplish tint, smooth 
 or corrugated, even or irregular. The thrombic pile is due 
 to a thrombus in the external hemorrhoidal veins, is hard 
 and tense, painful and liable to inflammation. The throm- 
 
1 6 DISEASES OF THE 
 
 bus may be absorbed and the tumor disappear or it may 
 develop into a cutaneous tab, mentioned under that variety. 
 
 Of the cutaneous variety the redundant form is com- 
 mon in those having internal piles and are often caused by 
 a weakening of the sphincter, allowing the anal edges to 
 prolapse. 
 
 The hyperplastic form is due to hyperplasia of the con- 
 nective tissue from abrasions, fissure or ulceration. 
 
 The hypertrophic form is a hypertrophy of the normal 
 radiating folds of the anus, the result of an eczematous 
 inflammation or the remnant of one of the forms of venous 
 piles that has undergone spontaneous cure. 
 
 Rectal Examinations and Treatment. 
 
 As a rule, all persons with rectal trouble imagine they 
 have piles, and the majority of physicians accept the patient's 
 diagnosis of the ailment without an examination. A palli- 
 ative ointment is prescribed and the patient receiving no ben- 
 efit, consults the first itinerant "pile doctor" that comes 
 within reach and is promptly cured. At the next meeting 
 of the medical society the question of how to eliminate the 
 quack will be discussed, but no definite conclusion will be 
 reached. 
 
 When a person with rectal disease consults the physi- 
 cian, he should be allowed to give his own account of the 
 trouble as he understands it, after which the physician will 
 proceed to make inquiries regarding points not mentioned 
 by the patient. The principle points to be determined are, 
 the length of time the disease has existed, whether there is 
 pain or itching, discharge of blood, feces or mucus, condi- 
 tion of the bowels, whether there is protrusion at one or both 
 sides of the anus during the act of defecation and whether 
 the protrusion can be replaced with or without difficulty. 
 
 If from the outline given by the patient there is reason 
 to suspect the presence of hemorrhoids, or other rectal dis- 
 
RECTUM AND ANUS. 1/ 
 
 ease, an examination should be made. This will but seldom 
 be objected to by male patients, but females sometimes 
 seriously object. To such it is by far the better plan to say, 
 "Unless you will permit an examination to be made, I must 
 refuse to accept your case for treatment. Unless I can treat 
 you intelligently and correctly, I prefer not to treat you at 
 all. A failure to effect a cure in your case would incur a 
 useless expense on your part and compromise my profes- 
 sional reputation," or something along that line. Such a 
 statement will at once convince the patient that you are con- 
 scientious and do not wish to treat her simply in order to 
 obtain the fee that would result, and but rarely fails to cause 
 her objections to be laid aside. Occasionally a female patient 
 will wish time to consider so grave a matter as to submit to 
 an ocular examination, and if so she should not be inter- 
 fered with. In the large majority of cases she will return 
 before you expect her. 
 
 The digital examination is at best but a poor excuse 
 for the ocular. After much experience the touch can be 
 educated to distinguish piles from polypi and ulcers from 
 catarrh of the rectum, but to the beginner in this work, 
 nothing short of an ocular examination should be counte- 
 nanced. It will be far better to begin the treatment of this 
 class of diseases with perfect cures in a few cases, than many 
 imperfect ones. 
 
 For the purpose of making thorough examinations, a 
 table thirty-four to thirty-six inches high is preferable to a 
 surgical chair, the latter being too low for comfortable 
 work. The top should be padded or covered with blankets. 
 Fully as important as the table may be, none the less so is a 
 good light. 
 
 No artificial light equals that of the sun radiated through 
 a frosted glass or a clear pane shaded by a thin white curtain. 
 In cities and towns where gas can be obtained an excellent 
 light can be secured by means of the incandescent mantles 
 now so generally used. In the country where gas or electric 
 lights are not in use a light in every particular as bright 
 
lb DISEASES OF THE 
 
 can be obtained from gasoline, consumed in a mantle of 
 similar construction as those used for the regular illuminat- 
 ing gas. 
 
 An ordinary reflector properly located will aid 
 materially in concentrating the light. The small pocket 
 electric light is a neat and convenient affair and can be used 
 to great advantage in rectal examinations. If the patient has 
 stated that protrusion occurs, he should be directed to go to 
 the closet and make an effort to strain it down. If unsuc- 
 cessful, a sufficient quantity of water should be thrown into 
 the rectum to produce an action, or the usual time at which 
 the patient's bowels move may be selected for the examina- 
 tion. The advantage of this procedure is that if the trouble 
 is prolapse of the rectum it can at once be determined, and 
 if piles, their location can easily be ascertained and noted 
 for future reference. For examination the patient is placed 
 on one side, the knees drawn up or extended on a wing 
 attached to the lower end of the table. A general view of the 
 anus is taken and any abnormalities noted. Before an 
 internal examination is made, the protrusion must be 
 returned and the parts well oiled for the introduction of the 
 speculum. If an injection of water was not given for the 
 purpose of causing a protrusion, it is well to do this as it 
 will wash away the mucus and retained feces. This is also 
 a good plan when a disease other than piles exists when there 
 is no protrusion, except when ulcer is suspected, as in the 
 latter case the presence and location of mucus is of diagnos- 
 tic value. While some writers advocate the examination and 
 treatment of hemorrhoids without the use of the speculum, 
 no good reasons for this method exist. The use of the 
 speculum is not difficult nor painful to the patient, and its 
 aid cannot be over-estimated. 
 
 In the selection of the speculum considerable judgment 
 should be exercised. The ordinary bi-valve speculum is not 
 as satisfactory as several others in the market. Whatever 
 else may be said of the methods of Brinkerhoff, it is beyond 
 all doubt true that he devised the best speculum that exists 
 
RECTUM AND A XLS. 
 
 19 
 
 0618a 
 
 No. 3 Brinkerhoff 's 
 Rectal Speculum, length 
 5 inches, outside diameter 
 l'A inch. 
 
 to-day. One of its best features is the reflecting end, inclined 
 inward, which reflects a splendid light on the rectal mem- 
 brane as the slide is withdrawn. The accompanying cut will 
 illustrate its appearance and design. Next to the Brinker- 
 
20 DISEASES OF THE 
 
 hoff speculum, the O'Neil is probably the best, and indeed it 
 has features superior to the former, the principal one being 
 the expansion of the distal end of the speculum in the rectum. 
 Its reflecting powers are not quite as good as those of the 
 Brinkerhoff, but it enables a larger view of the rectum being 
 taken at one introduction. Xo speculum with which I am 
 acquainted is superior to either of these. Several sizes should 
 be carried, a small and medium size beincr the most used. 
 
 THE O'NEIL SPECULUM. 
 
 Wittt a small and medium size Brinkerhoff and a medium 
 size O'Neil, all work can be done. The patient being placed 
 in a position so that the light will be thrown into the rectum. 
 the speculum is oiled and introduced. Olive oil is usually 
 recommended for this purpose, but its smell is so disagree- 
 able after a short exposure to the air that it is better to use 
 one of the hydro-carbon oils, liquid petrolatum or vaseline. 
 A small quantity of oil is also introduced just within the 
 rectum. Introduce the speculum slowly, giving the muscles 
 time to relax, bearing in mind that all movements about the 
 rectum must be easy and gentle to prevent spasmodic con- 
 traction of the sphincter. Never use a cold speculum. After 
 the instrument has been introduced its entire length, the 
 <=lide is gradually withdrawn and an inspection made of the 
 
RECTUM AND AX US. 21 
 
 membrane protruding through the opening. When the slide 
 is withdrawn no effort should be made to return it, but the 
 speculum must be withdrawn and the slide then replaced and 
 again introduced, turning the speculum slightly so as to 
 expose another portion of the bowel. From three to four 
 introductions are required to view the entire interior of the 
 rectum. The patient should be instructed to bear down 
 occasionally during the examination so as to distend the 
 parts and fill up the capillaries or veins. The examination 
 having revealed the condition of affairs, treatment will be 
 instituted accordingly, as hereafter detailed. 
 
 In the light of our present positive knowledge, begotten 
 by personal and the accumulated experience of many special- 
 ists, it is not presumptive to make the statement that in anv 
 and every case of true hemorrhoids, a cure can be effected 
 without in the least endangering the life of the patient or 
 without the resort to a painful surgical operation. 
 
 The popular dread of surgical operations is well known, 
 and indeed there are sufficient reasons for it, and any other 
 means by which we can safely obtain the same end is 
 appreciated and gratefully accepted by the general public. 
 Persons afflicted with hemorrhoids will readily submit to the 
 injection treatment if assured that the treatment is safe, 
 practically painless and curative. This we can guarantee. 
 The advocates of the injection method are divided on the 
 subject of the advisability of injecting External piles, 
 although the treatment is recommended by no less an 
 authority than Agnew, but condemned by the majority of 
 others. The injection of the external venous pile is with- 
 out doubt admissible, but this treatment in the cutaneous 
 form, for the removal of the skinny tabs, is useless. More 
 will be said of this under the treatment of external piles. 
 For internal piles of all varieties, the injection treatment is 
 universally applicable. The diagnosis of the different 
 varieties, while desirable from a technical point of view, is of 
 little or no advantage when it comes to treatment. A suffi- 
 cient classification as far as pertains to the treatment is that 
 
22 DISEASES OF THE 
 
 .which differentiates the internal from the external, and the 
 .venous from the cutaneous external piles. 
 
 Patients will frequently consult a physician in regard to 
 hemorrhoids when they are in a state of strangulation or 
 inflammation, after several days of unsuccessful attempts to 
 relieve this condition. If the ordinary efforts at reduction 
 fail, place the patient in the knee-chest position, allowing the 
 intestines to gravitate toward the chest. The protruded and 
 inflamed mass is now covered with a pledget of cotton wet 
 with a 10% solution of cocaine which is held in place for 
 a few minutes. Vaseline is now applied to the piles and 
 one finger inserted into the rectum. With the other hand 
 gently press on each tumor in succession and empty them of 
 their blood, returning them into the rectum as rapidly as 
 emptied. If this method is not successful hot water injec- 
 tions may be given and the process repeated. The cases 
 that resist this method of reduction are very rare. The 
 injection treatment must never be employed when piles are 
 in a state of inflammation, but palliative measures must be 
 instituted to reduce the congestion. For this purpose hot 
 douches, hot sitz baths, soothing ointments, such as are here- 
 after mentioned, or injections of distilled extract of witch 
 hazel are employed. When piles are very large, a similar 
 preparatory treatment will lessen the tendency to local con- 
 gestion after treatment. The patient should have the bowels 
 evacuated before the treatment, so that no movement will 
 occur for a day or two afterward. A laxative of cascara 
 sagrada, senna, or other gentle aperients may be employed. 
 If there is but little tendency to constipation, laxatives are 
 not necessary, as an easy movement does not interfere with 
 the injected piles. The injections are made with the ordinary 
 hypodermatic syringe with a set screw on the piston by which 
 the amount injected can be regulated. The needle should be 
 three or four inches long, gold pointed preferred, and 
 supplied with a sheath by which the point can be exposed 
 sufficiently to enter the pile and not pass through it. A 
 difference of opinion exists between practitioners using the 
 
RECTUM AND ANUS. 2$ 
 
 injection method for treating piles as to whether injections 
 should be made into them while protruded, without the use 
 of the speculum, or using the speculum, inject them inside 
 of the rectum. Each method has its advocates whose claims 
 are well supported, but in so far as my experience teaches, 
 the internal method is to be preferred. 
 
 Carbolic acid, in various strengths and different com- 
 binations, has been proven to be the most satisfactory agent 
 for the purpose of curing piles by the injection method. A 
 common error in preparing solutions for this purpose is that 
 the carbolic acid is used in too weak a solution. Although 
 prominent and successful operators employ carbolic acid in 
 ten to twenty per cent, solution, and claim to cure a large 
 percentage of cases, it has been demonstrated beyond ques- 
 tion that better results are obtained when it is used in fifty 
 or more per cent, solution. 
 
 Dilute carbolic acid is painful, is not cauterant, and 
 does not cause sufficient sloughing to remove the tumor. 
 When used in fifty to sixty-five per cent, solution its action 
 is anesthetic and cauterant, and the slough produced will be 
 sufficient to eradicate the tumor entirely. The much harped 
 theory of a clot forming and passing along the veins to the 
 heart is not possible when fifty per cent, or stronger solution 
 is used, as such a fluid at once coagulates the blood and 
 immediately stops the circulation in the part. When the 
 object of all injections is to cause coagulum formation and 
 devitalization of the parts, so that a slough will result, it 
 seems poor practice to inject just enough to cause a few 
 clots and set up a severe inflammation. The occasional bad 
 results that are reported as arguing against the injection 
 method, would, if investigated, be found to have been 
 produced by using one of these weak solutions which only 
 tantalize a pile tumor and often incapacitate the patient. 
 Carbolic acid in weak solutions is painful and dangerous, and 
 in addition to the local effects, may be absorbed and cause 
 toxic symptoms, but in strong solutions it is non-absorbable. 
 
24 DISEASES OF THE 
 
 promptly coagulates blood and serum, acts as its own anes- 
 thetic and is perfectly safe. 
 
 It is safe to say that one-half of the medical profession 
 is not thoroughly acquainted with this feature of carbolic 
 acid. Fearing to use carbolic acid in a strong solution, they 
 employ one that is but little more than carbolized water, and 
 by so doing they invite the very effect that they seek to avoid. 
 
 In this connection extracts from writers on this point 
 will be quoted which should convince any physician of the 
 absolutely reliable agent we have in carbolic acid, used in 
 strong solution. 
 
 Dr. Agnew says : "I have always maintained that there 
 is absolutely no danger of carbolic acid poisoning from the 
 local use of strong solutions, and I am borne out in my belief 
 both by reason and experience. In strength of fifty per cent. 
 up, carbolic acid will cauterize the tissue of hemorrhoids as 
 effectually as the hot iron, and will strangulate the circulation 
 at once. It coagulates albumen instantly and spends its force 
 and exhausts itself right there and then, leaving none to be 
 absorbed. Strong solutions also guard against embolism 
 by forming a tough, compact and insoluble coagulum ; the 
 coagulum being strengthened and its component parts closely 
 bound together into one solid, conglomerate mass by the 
 fibrous tissue forming the network of a hemorrhoidal tumor. 
 A weak, thin watery solution, aside from doing poor work, 
 is much more liable to diffuse itself and be carried into the 
 circulation like a hypodermic of morphia, than a solution 
 sufficiently strong to act as a cauterant, by which the tissue 
 is destroyed, a tough, compact and an insoluble coagulum is 
 formed, and the circulation strangulated at once." 
 
 Dr. Dorland, of Chicago, says: "When a compact 
 coagulum is formed and the muscular structure of the bowel 
 is not touched by the styptic, it is impossible to do harm, all 
 the learned theory to the contrary notwithstanding. A weak 
 solution forms little globules in a tumor and we can imagine 
 one so small as to be carried into the circulation." 
 
 Dr. Havnes of Los Angeles, Cal., treated fifteen cases 
 
RECTUM AND ANUS. 2$ 
 
 of hemorrhoids, ranging from a mild to a severe type, with 
 weak solutions of carbolic acid, with anything but satisfac- 
 tory results. Five cases were treated with five minim 
 injections of a two per cent, solution at intervals of ten days. 
 The pain was intolerable and crural phlebitis occurred in one 
 case which confined the patient two months. In the remain- 
 ing ten cases five minims of a five per cent, solution were 
 employed with better satisfaction, but there was more or 
 less pain and partial failure to cure. The fifteenth case was 
 treated thus until but two small but annoying tumors 
 remained. These were constricted at their base by the wire 
 of a nasal snare, and pure carbolic acid, crystals liquefied by 
 heat, was injected into each tumor until each turned white. 
 He announced as the result of this treatment that the case 
 was cured with but slight inconvenience, and that two other 
 cases similarly treated were equally satisfactory. 
 
 Dr. Hoyt of New York, says : "There is not a hemor- 
 rhoidal case possible which cannot be obliterated by this 
 means, and I am at a loss to explain why so many cling to 
 methods that carry so much havoc and suffering. If every 
 college in the land would have this subject demonstrated by 
 men of experience and learning, all other methods would 
 soon lose recognition." 
 
 Dr. Howard Crutcher, of Chicago, has treated eight 
 hemorrhoidal tumors at one time, using one hundred and 
 sixty drops of pure carbolic acid, with the results of total 
 obliteration of the tumors without the slightest unfavorable 
 symptom. 
 
 The complete strangulation of the circulation renders 
 inflammation of the tumor impossible, as inflammation can- 
 not occur in tissue where there is no circulation, and the 
 solidity of the coagulum renders the liability to embolism 
 exceedingly remote. Accidents and complications may 
 occasionally occur, but these occur in the practice of every 
 physician, no matter what method he employs. Used intelli- 
 gently and properly, carbolic acid injections will cure more 
 cases of hemorrhoids with less inconvenience to the patient. 
 
26 DISEASES OF THE 
 
 than any other method with which we are at present 
 acquainted. 
 
 Dr. Hoyt of New York, in a recently published article 
 sums up the comparative advantages of this method as 
 follows : 
 
 "A large number of persons adopt these ideas that 
 would never subject themselves to other methods. 
 
 "As the surface of a hemorrhoidal tumor is never 
 broken, there is no such thing as post-operative hemorrhage. 
 
 "A skillful application of this system leaves pain out 
 of the experience of patients and they can attend to their 
 usual affairs. 
 
 "A case thoroughly restored is permanent; but if it had 
 to be treated every year, the advantages would still exist. 
 
 "Any substance injected into animal tissue travels in 
 the direction of the least resistance; hence in these matters 
 it does not invade deeper relations to their detriment. 
 
 "The general health improves from the first day, and 
 so the patient is not sick a long time after he gets well. 
 
 "The greatest advantage of this interstitial invasion, as a 
 means of destroying hemorrhoids, is that there are no dis- 
 advantages." 
 
 Hemorrhoidal Ixjection Fluids. 
 
 As formulae for the injection of hemorrhoids the follow- 
 ing are rational in composition and satisfactory in action. 
 Other popular combinations are mentioned at the close of this 
 chapter. 
 
 The following combination is the one I most frequently 
 employ. It fills every requirement and will produce results 
 that cannot be excelled by any other formulae, for the simple 
 reason that it obliterates the hemorrhoids effectively with 
 as little disturbance as is possible with any other. I have 
 used other combinations which are just as good, Agnew's 
 for instance, yet I see no reason why I should prefer it to 
 this one. 
 
RECTUM AXD A XL'S. 2/ 
 
 If Carbolic Acid — Pure fl. 5 ij-iij. 
 
 Purified Sperm Oil fl. 5 ij. 
 
 Mix. Sig. Inject sufficient into each tumor to change 
 its appearance to grayish or white. 
 
 The quantity required depends entirely upon the size of 
 the tumor. In small tumors, where three minims only are 
 required, the stronger solution may be used, while in large 
 tumors, where sometimes two to four drachms are required, 
 the fifty per cent, solution may be used. This formula is 
 equal to the best. 
 
 When carbolic acid is mentioned, I refer to the pure 
 crystalized article, which for the purpose of forming solu- 
 tions is liquefied by heat, without the addition of either water 
 or glycerine. I formerly used Calvert's acid, but I have 
 since learned that the American chemist can produce an 
 acid in every particular the equal of the English product, and 
 at a cost almost seventy-five per cent. less. I use either 
 Merck's dry crystals or Mallinckrodt's best grade acid. 
 
 Olive oil, sweet almond oil or glycerine may be used as 
 a diluent, but the sperm oil is I think preferable to a 
 vegetable oil. Glycerine is not so desirable on account of 
 its hygroscopic character. There is apparently more liability 
 to pain and tenderness when glycerine is used, due probably 
 to a certain degree of engorgement caused by its attraction 
 of moisture from the surrounding parts. The glycerine is 
 also not absorbed as readily as the oils and thereby produces 
 a larger sloughing area. 
 
 The liquid petrolatums, vaselines and the other hydro- 
 carbon oils are not miscible with carbolic acid. 
 
 Dr. Agnew's solution is one which produces very satis- 
 factory results. It combines with carbolic acid, acetate of 
 lead, borax and glycerine. The coagulating action of the 
 acid is undoubtedly augmented by the addition of the acetate 
 of lead. The formulae for making this fluid are : 
 
28 DISEASES OF THE 
 
 ^ Acetate of Lead, 
 
 Biborate of Soda aa o ij. 
 
 Glycerine, Price's fl. § j. 
 
 Mix in a graduate and pour into a two ounce vial, and 
 let stand for twenty-four hours. The solution of the salts 
 is hastened by placing the vial in a warm water bath and 
 letting it remain there for fifteen or twenty minutes. The 
 glycerine can be better handled and its measurements more 
 accurately made by warming it and also the graduate. 
 
 This solution having been made, the fluid can be com- 
 pounded. 
 
 I£ Acid Carbolic, liq. cryst fl. 5 j. 
 
 Distilled Water fl. ij. 
 
 Glycerite of Lead and Borax fl. 3 vj. 
 
 Mix. Sig. Solution for hemorrhoids. 
 
 The object of the water in the formula is to lessen the 
 syrupy consistence of the fluid. Without the water it is 
 rather heavy for hypodermatic injection, as it does not pass 
 through the needles freely. Dr. Agnew says of this com- 
 bination : "The addition of the acetate of lead is designed to 
 restrict the action, and that of the borax to lessen the irri- 
 tating properties of the acid. The acetate of lead not only 
 keeps within limits the distribution of the acid at the time 
 the solution is forced out of the syringe, but of itself com- 
 bines with a certain portion of the albumen of the blood and 
 tissues, forming the albuminate of lead." He further says 
 that he has experimented with carbolic acid in different 
 strengths and if he were to change his formula it would be 
 toward an increase, rather than a diminution of the quantity 
 of the acid. This fluid also turns pile tumors grayish or 
 white, and must be used in sufficient quantity to produce this 
 change. Piles of a delicate texture and covering, undergo 
 change of color more quickly and to a greater degree than 
 those more fibrous and tousrher in character. - • - 
 
RECTUM AND ANUS. 29 
 
 INJECTING THE FLUID. 
 
 After an examination has been made and the location of 
 the piles discovered, the patient should lie on the side 
 opposite to that to which the piles are attached, and the 
 speculum introduced so that the tumor will protrude down- 
 ward through the fenestrum when the slide is withdrawn. 
 (The Brinkerhoff speculum is referred to.) In this position 
 the fluid injected will gravitate toward the apex of the now 
 pendant pile, and will not so easily permeate the structures 
 underlying its base, neither will any damage be. done by 
 overflow of the fluid on the mucous membrane, as in case 
 of an overflow it will be caught in the speculum. An over- 
 flow will not occur when the injection is properly made and 
 the needle not withdrawn too quickly. After the tumor has 
 been exposed, ask the patient to bear down and introduce the 
 needle with a quick thrust. There is in many cases no pain 
 whatever connected with the introduction of the needle, 
 patients frequently not knowing that the needle has been 
 inserted, and the use of cocaine before injecting is entirely 
 unnecessary. The needle should be inserted about midway 
 between the apex and the middle of the tumor and the fluid 
 injected a minim at a time, watching for the change of color 
 before mentioned. Large tumors cannot be thoroughly 
 injected by one insertion of the needle, on account of the 
 coagulum formation about the needle, and as many more 
 injections must be made as are required to permeate the 
 entire tumor. 
 
 Keep the needle in place for a few minutes after suffi- 
 cient fluid has been injected, and withdraw carefully. If 
 blood follows its withdrawal, enough fluid has not been 
 injected and the needle should be re-inserted and more 
 injected. Large tumors are frequently divided into separate 
 cavities, probably through anastomosis of veins, and in these 
 cases the entire tumor cannot be permeated by one injection. 
 
3© DISEASES 0E THE 
 
 The injection of the fluid is attended with but little pain, 
 and is only momentary. If a great deal of pain is com- 
 plained of, the deeper tissues are probably being invaded. 
 The powerful anesthetic action of carbolic acid compounds 
 of this strength quickly deaden all sensibility. After the 
 needle has been removed, the tumor may be smeared with 
 vaseline and the speculum removed. The pain which some- 
 times follows an injection, will appear within four hours, if 
 it appears at all. Persons with piles usually do not seek 
 relief until they have suffered the most excruciating pain, 
 consequently a little pain, such as sometimes follows injec- 
 tion, is usually not complained of, except in nervous or 
 irritable persons whose slightest discomfort causes consider- 
 able disturbance. To such, an opium suppository may be 
 given for use if required, and hot sitz baths ordered, or if 
 severe, it may be controlled by morphine. Sympathetic 
 paralysis of the bladder or stricture of the urethra some- 
 times occurs, rarely however, and is only temporary. It 
 may be relieved by hot baths, hot applications to the bladder 
 and perineum or by the catheter. It will subside with that 
 of the inflammation of the rectum. For retention of urine, 
 when the catheter cannot be passed on account of the spasm 
 of the urethra, give one-third grain of pilocarpine every 
 half hour, until complete relaxation takes place and free 
 diaphoresis has been established, or pass the Faradic current 
 through the bladder. If the bowels incline toward a move- 
 ment, while the first inflammatory effects are present, inject 
 slippery elm water into the rectum, hot, so as to make the 
 passage easy. Usually however, there is so little inflamma- 
 tion that no attention need be paid to the action of the 
 bowels, particularly as an evacuation usually precedes the 
 treatment, to which reference has been made. In cases where 
 the tumors injected have been very large, the patient should 
 refrain from active exercise for a few days, but in small and 
 medium sized tumors this injunction need not be given. It 
 is best not to inject more than two small or medium, or one 
 large sized tumor at one treatment, and ten davs to two weeks 
 
RECTUM AND ANUS. 3 I 
 
 should elapse between treatments. Small tumors should be 
 treated first as after the large ones have been removed, the 
 small ones are difficult to locate. Agnew recommends the 
 treatment of a number of tumors at one treatment, and while 
 it may be safe and proper practice, there are several reasons 
 against this procedure. Physicians may be guided as their 
 experience dictates in this matter. 
 
 Ninety-five per cent, of cases require no attention what- 
 ever after the treatment, and can follow their usual vocation. 
 In the remainder, minor complications may occur, some of 
 which have already been referred to. Secondary hemor- 
 rhage but rarely occurs, and can usually be checked by the 
 introduction into the rectum, against the bleeding surface, of 
 several pieces of ammonio-ferric alum, and kept in place 
 by compression obtained by plugging the rectum with cotton. 
 The other usual methods of controlling hemorrhage, the 
 hemostatic forceps, the ligature or torsion may be employed. 
 
 Extensive ulceration and sloughing will not occur unless 
 when the deeper tissues have been invaded by the fluid. 
 This will not occur if the injection is made with the tumor 
 in a pendant position, as before directed. If the ulceration 
 should show indisposition to heal, the usual treatment for 
 ulceration of the rectum may be employed. 
 
 The complications referred to will only occur in rare 
 cases, and are no excuse whatever for a condemnation of 
 the method. If all other treatments were safe, the objec- 
 tions might be sustained, but the contrary being more 
 applicable to other forms of treatment, no reasonable argu- 
 ments can be offered against the adoption of this eligible 
 method of treating hemorrhoids. 
 
 Having noticed previously, the employment of weaker 
 solutions of carbolic acid by successful specialists in this 
 work, a few formulae, with comments by their advocates, 
 will follow. While not for a moment, questioning the state- 
 ments of these men, nor wishing to detract from whatever 
 influence their conclusions may have upon those who follow 
 their example, I cannot but endeavor to impress the thought 
 
2,2 DISEASES OF THE 
 
 that whatever good results may be obtained by the use of 
 carbolic acid in weak solutions, they are but a foretaste of 
 the brilliant achievements attainable by the use of the strong' 
 solutions. Advocates of weak solutions, less than thirty-five 
 per cent, are on the right track, although somewhat hampered 
 by their views in this matter, but I have infinitely more 
 admiration for them than for the hide-bound individuals 
 who condemn the method without investigation of its merits 
 and who base their opinions on the results following its 
 application by the ignorant non-graduate itinerant "pile 
 doctor," instead of those attained by intelligent, educated and 
 successful practitioners. While the bulk of the profession is 
 condemning the treatment, those of it who have been progres- 
 sive enough to enter upon it, will continue to prosper. "The 
 harvest is plenty, but the laborers are few." 
 
 Dr. Monroe, of Louisville, uses 
 
 I£ Carbolic Acid, pure fl. 3 j. 
 
 Olive Oil fl. 3 iij. 
 
 Mix by putting bottle in hot water. 
 
 Sig. Inject into tumors a sufficient quantity to turn 
 them white. Several days before operating, he advises the 
 use of calomel and soda for action upon the liver. This 
 should be followed by one or two seidlitz powders. One 
 hour before operating, the patient should use an injection 
 of one pint of warm water in which a teaspoonful of boracic 
 acid has been dissolved. 
 
 Dr. R. D. Mason of Omaha, uses Carbolic Acid in 
 50% solution, with glycerine and water, and also reports 
 good results from the use of the formula of Dr. Agnew. 
 
 He recommends the following formula also, but to com- 
 pound it properly, some skill is required. 
 
RECTUM AND ANUS. 
 
 33 
 
 I£ Napthaline 3 ij. 
 
 Acid Carbolic fl. 5 ij 
 
 Hydrastine Mur g rs . iij. 
 
 Morphine Sulph g- rs . v j < 
 
 Acid Tannic errs. xv. 
 
 Fl. Ext. Ergot fl. 5 iv. 
 
 Mix. Dissolve the naphthaline in ether before mixing 
 with the other ingredients. 
 
 Sig. Inject one or two drops into each tumor at first, 
 and gradually increase to six or eight drops as required. 
 
 Dr. Eliot, of Washington, D. C, recommends the fol- 
 lowing : 
 
 R Acid Carbolic, 95% fl. 5 ij. 
 
 Fid. Ext. Ergot fl. 3 ij. 
 
 Mix. Sig. Inject according to size of tumor. 
 
 Dr. Shuford's Formula. 
 
 I? Sodium Biborate 3 j 
 
 Acid Salicylic 3 j 
 
 Acid Carbolic fl. 5 ^j 
 
 Glycerine . fl 5 : 
 
 Mix. Sig. Inject three to five drops in small, and 
 eight to ten or more in large ones. 
 
 Dr. Shu ford claims for this formula, that it is compara- 
 tively painless, causes no accidents and is eminently success- 
 ful. The hypertrophy disappears and is thrown off, leaving 
 a smooth, healthy mucous surface. 
 
 Overall's Formula. 
 
 I> Acid Carbolic, 
 
 Glycerine, 
 
 Fl. Ext. Ergot aa p. e. 
 
 Mix. Sig. Inject three to eight drops. 
 
34 DISEASES OF THE 
 
 Dr. Hoyt recommends, 
 
 ^ Acid Carbolic n\ lxxx. 
 
 Ext. Hamamelis, Distilled. 
 
 Distilled Water aa fl. 5 vj. 
 
 Mix. Sig. Inject sufficient to produce a paleness of 
 the surface of the pile, injecting the fluid a drop at a time. 
 
 Rorick's Formula. 
 
 I> Acid Carbolic fl. 3 ij. 
 
 Glycerine fl. 3 ij. 
 
 Fid. Ext. Ergot fl. 3 j. 
 
 Distilled water fl. 3 iss. 
 
 Mix. Sig. Inject from two to ten drops, according 
 to size of tumor. 
 
 The following is given by Mason, stating that he 
 received it from one who paid fifty dollars for it. 
 
 IJ Carbolic Acid fl. 5 iv. 
 
 Acetate of Lead 3 j. 
 
 Salicylic Acid gr. xxx. 
 
 Cocaine Mur gr. x. 
 
 Aqua Dest, 
 
 Glycerine aa q. s. ft. fl. § j. 
 
 Sig. Use in same manner as other compounds. 
 
RECTUM AND ANUS. 35 
 
 External Hemorrhoids. 
 
 This variety of piles is not difficult to recognize. They 
 appear at the verge of the anus, either as a dark blue, or 
 purplish venous tumor, or as a cutaneous excrescence or 
 skinny tab. Venous piles are very often of an irritable nature 
 and cause the patient considerable inconvenience. They are 
 also subject to inflammation. They vary in size from that 
 of a pea, to that of an olive, and may number from one to 
 four or more. The cutaneous excrescences are usually the 
 remnant of a venous tumor, which has undergone spon- 
 taneous cure. External piles are a frequent source of con- 
 siderable itching. 
 
 In regard to injecting external venous piles, a difference 
 of opinion still exists. At best, it can only reasonably apply 
 to the treatment of recently formed venous tumors, as they 
 soon become fibrous and contain a clot. Dr. Agnew advises 
 the injection of this variety, the treatment being applied 
 after the manner of treating internal piles. Of the treat- 
 ment he says : "Notwithstanding the small amount of cut- 
 ting required in the removal of an external hemorrhoid by 
 excision, there are some who are decidedly averse to being 
 treated by any plan involving the use of the knife or scissors. 
 Patients will readily submit to this treatment, although 
 informed that a longer time is required for the complete 
 eradication of a tumor thus treated, and that more pain and 
 inconvenience may be experienced from the effects of the 
 operation than would be from that by excision. This treat- 
 ment has the disadvantage that it does not instantly remove 
 the tumor as does excision, but has the advantage of being 
 a bloodless operation." Replying to objections to the treat- 
 ment given by Dr. Matthews, he says, "The reasons given 
 by Dr. Matthews for his disapproval of the treatment of 
 external hemorrhoids by injection, are concentrated in the 
 statements that 'the inflammation excited would be great, the 
 
36 DISEASES OF THE 
 
 pain intense and ulceration might possibly follow." These 
 statements, as I have demonstrated time and again, are cer- 
 tainly not borne out by experience, and are to me, therefore 
 of a purely chimerical character. I have never seen anything 
 more than ordinary swelling follow an injection, a limited 
 amount of controllable pain, and a rapid healing of the 
 broken surface, though not as rapid as that after a removal 
 by excision." 
 
 After injection of external venous hemorrhoids, three 
 or four days are required for the removal of the tumor, and 
 patients thus treated should be directed to take but little 
 exercise until the coagulum has been thrown off. The 
 covering of external hemorrhoids is more dense and fibrous 
 than that of the internal, and after the coagulum separates 
 it is sometimes advisable to trim off the ragged edges left, 
 with a scissors. If the injection seems more painful at the 
 first contact of the solution, or when tumors are exceptionally 
 tender, the skin may be injected with a 10% cocaine solution, 
 and as anesthesia is produced the interior of the tumor may 
 be reached and immediately anesthetized. Follow this 
 immediately with the injection of the hemorrhoidal fluid and 
 no fear of cocaine absorption need be felt, as the carbolic 
 acid will so coagulate the contents of the tumor that circula- 
 tion is impossible. The tumor should be injected thoroughly, 
 following same directions as detailed under internal treat- 
 ment, although the speculum need not be used, in fact it 
 could not be used. The summit of the tumor should be 
 slightly opened after injection, so that the clot will have an 
 .easy egress. This simple procedure will prevent much of 
 the attending discomfort. 
 
 The injection of hard fibrous masses, or cutaneous tabs 
 is not to be considered. It is against all theory of this treat- 
 ment and in practice condemns itself. Cutaneous tabs are 
 usually nothing but fibrous tissue and skin, contain no clot 
 and are usually not troublesome. Their removal should be 
 accomplished by clipping them off with a scissors after 
 anesthesia of tin- parts, by the Schleich infiltration method. 
 
RECTUM AND AX US. 37 
 
 Thrombotic tumors, which will be found to be hard and 
 firm, liable to inflammation and painful, should be incised 
 and the clot removed. This operation is simple and under 
 local anesthesia, painless. 
 
 A 20% solution of cocaine is applied to the tumor and 
 held in place for ten minutes. This will deaden external 
 sensation and a weaker solution can then be injected, or the 
 Schleich method may be employed and anesthesia of the 
 skin produced. In making - these injections, care must be 
 taken to make them into the skin, and not into the tumor. 
 After skin anesthesia has been produced the solution may be 
 thrown in the sub-structure. The formula of the Schleich 
 solution is prepared in tablet form by manufacturing' chem- 
 ists and can readily be obtained, with full directions for use. 
 After anesthesia is complete, with a sharp knife make a verti- 
 cal incision through the skin and turn out the clot. Syringe 
 out the cavity with Hydrozone,* which thoroughly cleanses 
 the cavity and stops the slight hemorrhage that occurs. Now 
 apply to the cavity, with a camel's hair brush, a solution of 
 equal parts of glycerine and carbolic acid, pack with 
 absorbent cotton and apply a T bandage. After forty-eight 
 hours, remove the dressing, wash cavity again with Hydro- 
 zone, dust with boracic acid and dress as before. No further 
 attention is usually required. Preceding a bowel move- 
 ment, after the operation, give an injection of elm bark water, 
 to insure an easy passage. For the relief of the inflamma- 
 tory symptoms of external piles, various formulae have 
 been devised. Several are appended. Also a formula for an 
 excellent application to internal hemorrhoids after injection. 
 
 *Marchand's Hydrozone is the strongest solution of peroxide of 
 hydrogen on the market, being of 30 vol. strength. Bottles containing 
 it are now corked with an Automatic Safety Valve Stopper, which pre- 
 vents bursting of bottles and the annoying popping of corks when bot- 
 tles are opened. 
 
38 DISEASES OF THE 
 
 I£ Cocaine Muriate gr. xv. 
 
 Ergotin gr. be. 
 
 Ichthyol gr. Ixv. 
 
 Calomel gr. xlv. 
 
 Vaseline, 
 
 Lanoline aa 5 iv. 
 
 Mix. Sig. For the relief of inflamed and painful 
 venous tumors or tabs. Apply to parts on muslin, keeping 
 in place with bandage. 
 
 H Acid Tannic gr. xv. 
 
 Bismuth Sub. Nit gr. xxv. 
 
 Acid Carbolic gtt. xij. 
 
 Morphine Sulphate gr. viij. 
 
 Vaseline q. s. ad. "% j. 
 
 Mix. An excellent application after operation, or where 
 astringent or anodyne treatment is indicated. Useful as a 
 general palliative. 
 
 I£ Bismuth Sub Nit, 
 
 Iodoform aa o j. 
 
 Powd. Opium gr. xij. 
 
 Ext. Belladonna gr. iv. 
 
 Ol. Eucalyptus gtt. vj 
 
 Cacao Butter q. s. 
 
 Ft. Suppos. Xo xij. 
 
 The oil disguises the iodoform. Recommended by 
 Agnew for controlling pain after injection. Useful in any 
 internal irritation or inflammation. 
 
RECTUM AND ANUS. 
 
 39 
 
 3^ Rosin, 
 
 Chian Turpentine, 
 
 Mutton Tallow aa 5 j. 
 
 Myrtle Wax 3 jj. 
 
 Olive Oil fl. § v. 
 
 Mix. Melt together and stir until cold. Useful as an 
 application to ulcers which show indisposition to heal. 
 
 3^ Calomel 5 j. 
 
 Powd. Opium 5 ss. 
 
 Carbonate of Lead 3 ij. 
 
 Oxide of Zinc * ij. 
 
 Olive Oil l i v . 
 
 Fresh Lard, without salt 5 i v . 
 
 Mix. Triturate in mortar until thoroughly mixed. A 
 useful ointment for irritable piles, internal or external. 
 
 T$ Acid Gallic o- r . xx. 
 
 Charcoal 3 ], 
 
 Ext. Witch Hazel o- r . xxx. 
 
 Ext. Hemlock o- r . xxx. 
 
 Cacao Butter q. s. 
 
 Ft. Suppos. No x. 
 
 To be inserted into the rectum for bleeding piles, either 
 from the action of the feces or the constant annoying oozing 
 of blood. 
 
4-0 DISEASES OF THE 
 
 All of these formulae aie merely palliative, although in 
 some mild cases, permanent relief seems to be obtained. The 
 majority of these are not piles however, but merely an 
 eczematous or pruritic condition, diagnosed as piles by the 
 patient, and not investigated by the physician. 
 
 For insertion into the rectum after injection of piles, if 
 large, and there is reason to suspect more than ordinary 
 reaction, the following may be applied to the tumors instead 
 of vaseline, as before recommended. 
 
 E Bismuth Sub Nitrate gr. lx. 
 
 Ichthyol gr. xxx. 
 
 Cacao Butter 3 iv. 
 
 Mix by melting the cacao butter and stirring the 
 ichthyol into it, and triturate the bismuth in a mortar with 
 the mixture and add, 
 
 R- Acid Carbolic o ss. 
 
 Simple Cerate 5 iss. 
 
 Benzoinated Lard q. s. ad. § iv. 
 
 Mix. Sig. Apply before removing speculum, or, intro- 
 duce by means of a suppositor. 
 
 OINTMENT SUPPOSITOR. 
 
RECTUM AND ANUS. 4 1 
 
 Rectal Ulcer. 
 
 Ulceration of the rectum is more common than is 
 usually supposed. It is a frequent cause of reflex disturb- 
 ances which none but a rectal specialist would recognize. 
 Ulcers are found in all parts of the rectum but more com- 
 monly in the lower third. It may exist merely as a slight 
 solution of the continuity of the mucous membrane or in 
 any stage of ulceration between that and a deep-seated, tissut 
 destroying, well defined ulcer. 
 
 When located high in the rectum, its presence is not 
 noticed by the patient as quickly as when close to the 
 sphincter, where the nerve supply is the greatest. The 
 symptoms of rectal ulcer may conveniently be divided into 
 Direct and Reflex. The direct symptoms are moisture 
 about the anus, more or less itching, inflammation and 
 oedema of the anal tissues, stools streaked with blood and 
 mucus, or followed by a discharge of a scum resembling 
 boiled starch, desire to remain long at stool, tenesmus, inflam- 
 mation of the rectum, a sense of weight and a dull heaw 
 feeling in the lower part of the rectum. 
 
 The reflex symptoms are numerous. The chief of these 
 being a morning diarrhoea. There is usually considerable 
 flatus, and feces pass in small lumps or scybala. The desire 
 for stool is frequently urgently felt immediately on rising in 
 the morning, and subsides after several attempts to evacuate 
 the bowels have been made. This symptom is usually not 
 classed as. reflex, but its presence cannot be satisfactorily 
 accounted for under any other premises. Patients who make 
 the statement that an inclination to stool is felt immediately 
 after a cold drink or certain food is taken, should be sus- 
 pected of having rectal ulcer. Constipation may alternate 
 with diarrhoea, but the latter is present more than two-thirds 
 
4^ DISEASES OF THE 
 
 of the time. In addition to these symptoms, there may be 
 dizziness, irritability of the bladder, eroticism, emissions, 
 hysteria, nausea or vomiting, pain in the lumbar region, 
 sallow complexion, burning of the soles of the feet, and in 
 females neuralgic pains in the ovaries and womb. 
 
 Examination for rectal ulcer is made with the speculum. 
 The ulcer is more frequently found on the posterior surface 
 of the rectum, but often on the anterior. When anterior, the 
 bladder reflex symptoms are more marked. On examination, 
 a well developed rectal ulcer is easily recognized by the 
 ragged edges, sometimes elevated and gristly, with the 
 mucus discharge occupying the space between them. In 
 some cases the ulcer presents a clear cut edge, as though cut 
 with a punch, with a well defined offset toward its floor. If 
 the mucus or scum is wiped off, the ulcerated bottom will be 
 exposed to view. It frequently bleeds and is quite tender. 
 Never instruct patients to take an injection before presenting 
 themselves for an examination for ulcer, as the mucus would 
 thereby be removed. In well marked cases it could be dis- 
 tinguished even if the mucus were removed, but in others, 
 the presence Of it assists its location. Rectal ulcer may termi- 
 nate in a cure, deep tissue infiltration and death, or it may, 
 by cicatrical contraction, cause stricture of the rectum. 
 
 TREATMENT. 
 
 When seen early, the cure of rectal ulcer is not difficult, 
 but when seen later, after considerable of the mucous mem- 
 brane has been destroyed, its cure, while usually certain, is 
 quite tedious. The treatment is a combination of home and 
 office treatment. The latter consists of first wiping away the 
 mucus and thoroughly cleansing the ulcer with Hydrozone. 
 applied full strength, or in 50% solution, with a small 
 syringe. The ulcer is now dried and a solution of nitrate of 
 silver, sixty grains to the ounce of distilled water, is applied 
 with a cotton tipped probe. Eight or ten drops may 
 be dropped on the ulcer if preferred, instead of the cotton 
 
RECTUM AND ANUS. 43 
 
 application. Alternating with this application, or instead of 
 it. the ulcer may be touched in a similar manner with a solu- 
 tion of carbolic acid in sperm oil, two parts of the former to 
 one part of the latter. 
 
 Whenever carbolic acid, or any mixture containing 
 twenty-five or more per cent, of it is applied to mucous sur- 
 faces, and in rectal work especially, a solution of equal paits 
 of alcohol and water should be applied to the parts touched 
 with the acid almost immediately afterward to neutralize its 
 effect and limit its action. To allow a strong solution of 
 carbolic acid unlimited action on mucous surfaces or an ulcer 
 would often lead to undesirable results. After having 
 applied the dilute alcohol by means of a cotton swab, the 
 ulcer is again dried and dusted with Special Protonuclein 
 (Reed & Carnrick). This preparation must not be con- 
 founded with the Protonuclein which is intended for internal 
 use. It is stronger than the latter and is intended for 
 external use only. Suppositories containing five to ten grains 
 of the Special Protonuclein are also of value and one may 
 be inserted after each office treatment, and once daily by the 
 patient. As the following home treatment is used at night, 
 and the ointments in the morning, the suppository may be 
 inserted about the middle of the day. 
 
 Office treatment should be applied twice or three times a 
 week in the first part of the treatment, gradually increasing 
 the intervals between treatments as the case improves. 
 
 For home treatment, the following "Ulcer Specific" is 
 used : 
 
 1^ Ext. Witch Hazel, Distilled fl. 5 viss. 
 
 Fl. Ext. Hydrastis, aqueous fl. 5 iiss. 
 
 Acid Carbolic Tit xxx. 
 
 Glycerine fl. o ix. 
 
 Mix. Mix the glycerine with the acid and add the 
 hvdrastis. Mix well and add the witch hazel last. 
 
44 DISEASES OF THE 
 
 Sig. Mix one-half teaspoon ful of this mixture with 
 one-half teaspoonful of corn starch and two tablespoonfuls 
 of warm water. Inject into the rectum with a hard rubber 
 syringe and retain all night. Repeat every night. 
 
 If there is occasional bleeding, the following "Ulcer 
 Compound'" will give better results : 
 
 1> Monsell's Solution of Iron fl. 3 iv. 
 
 Glycerine fl. 5 iv. 
 
 Acid Carbolic fl. 5 ss. 
 
 Ext. Witch Hazel. Distilled fl. 5 j. 
 
 Mix. Sig. Use in the same manner as the "Ulcer 
 Specific." 
 
 Another good formula for use in ulceration is : 
 
 K Fl. Ext. Hydrastis, aqueous fl. 5 iv. 
 
 Tr. Calendula, Lloyd's fl. § j. 
 
 Tr. Echafolta, Lloyd's fl. 5 vj. 
 
 Ext. Witch' Hazel, Distilled, q. s. ad. . fl. 5 iv. 
 Mix. L~se in the same manner as the "Ulcer Specific." 
 
 In the morning after the patient's bowels have been 
 moved and are at rest, the following ointment, introduced 
 into the rectum, at the location of the ulcer, with an ointment 
 injector, will be a useful adjunct: 
 
 R Balsam Peru o ss. 
 
 Ext. Matico 5 ss. 
 
 Sulphur lac gr. xlv. 
 
 Ext. Belladonna gr. iij. 
 
 Acid Carbolic fl. 3 ss. 
 
 Vaseline o iij- 
 
 Mix. Insert the usual quantity as above directed. 
 
 This treatment, properly and diligently applied will 
 result in a cure of the vast majority of rectal ulcers in from 
 two to five months. Patients should be impressed with the 
 tedious work before them, and their best efforts and assist- 
 ance solicited. 
 
RECTUM AND ANUS. 45 
 
 Fistula. 
 
 Next to hemorrhoids, fistula is the most common disease 
 that attacks the rectal and anal region. Hospital reports 
 usually place fistula first in point of frequency, but this is 
 due to the fact that persons with hemorrhoids do not apply 
 to the public institutions for relief as readily as those 
 afflicted with the more serious disease, fistula. In private 
 practice hemorrhoidal cases are first in point of frequency. 
 
 Fistula is usually the result of an abscess which has 
 failed to heal and from which the pus burrows its way out 
 through the loose areolar tissue, or similar burrowing from 
 an abscess which has never been open. 
 
 This process may continue for some time without any 
 special inflammatory action and without discomfort to the 
 patient, thus giving the impression that treatment is unneces- 
 sary until trouble is experienced. This is certainly unwise, 
 yet well meaning but poorly informed physicians have been 
 known to advise patients with fistula not to interfere with 
 it until compelled to do so on account of inconvenience and 
 discomfort. It is probably true in all cases that the older 
 the fistula the more difficult and stubborn the cure. 
 
 VARIETIES. 
 
 The varieties of fistula are complete, internal incom- 
 plete, external incomplete and complex. The complete fistula 
 has both an internal and external opening, an internal incom- 
 plete has an internal but no external opening, an external 
 incomplete has an external but no internal opening, and a 
 complex fistula is one with a number of openings, branches, 
 pockets or pouches with which the main sinus connects at 
 various points. 
 
 Further division is usually made by dividing fistulae 
 into two general classes : ( i ) Those whose origin is super- 
 ficial and (2) Those whose origin is deep. 
 
46 DISEASES OF THE 
 
 Those of superficial origin are termed anal fistulae, while 
 those of deeper origin are termed rectal. 
 
 Anal fistulae are those which have their internal opening 
 between the two sphincters, where a slight depression is felt, 
 while the external opening is usually close to the margin of 
 the anus. Rectal fistulae have their internal openings at 
 various distances above the internal sphincter. From a 
 surgical point of view this distinction is of importance as 
 should the tissues between the two openings be divided it 
 is apparent that in anal fistula only the external sphincter 
 would suffer, while in rectal fistula both of the sphincters 
 would be involved in the operation. One may find either of 
 the four varieties of fistulae in either the anal or rectal region. 
 
 DIAGNOSIS. 
 
 Diagnosis of fistula, when the conditions about the anus 
 and rectum are carefully observed, is usually not difficult, 
 yet the almost invisible external opening of a fistula may 
 be overlooked during several apparently careful examina- 
 tions. In cases of this sort it is evident that patients are not 
 acquainted with their true condition but come to the physi- 
 cian on account of the various symptoms which they may 
 have. 
 
 When there is no known external opening, thus not 
 clearly establishing the existence of a fistula, certain symp- 
 toms of this condition should be borne in mind. 
 
 The presence of a purulent discharge from the rectum, 
 itching at and about the anus, swelling and the formation 
 of a tumor which on palpation gives evidence of containing 
 liquid matter, the formation of an abscess, or when a history 
 of abscess is given, and soreness at one or more localized 
 spots in the ischio-rectal region should always lead one to 
 suspect fistula and careful examination made. 
 
 When symptoms of fistula exist the most careful 
 examination should be made for a minute opening with a 
 lip-like margin, or it may have the appearance of the fresh 
 sting of a bee; a small wheal with a tiny spot in the center. 
 
RECTUM AND ANUS. 47 
 
 ii a probe is pressed into this opening considerable resistance 
 may be offered, but the probe will usually penetrate and will 
 often ghde freely along the canal and appear at the internal 
 opening. When the canal is tortuous the location of the 
 internal opening is difficult or impossible. Too much pressure 
 must not be exerted as the probe can without very much 
 difficulty be pressed through the tissues. In these cases, as 
 in all others where the internal opening has not been located 
 the following procedure will solve the problem With a 
 suitable syringe, either the hypodermatic with the dull 
 canula attached, or the hard rubber in cases of larger external 
 openings, inject sufficient milk to distend the fistulous track- 
 while with the speculum introduced the interior is observed 
 and the escape of the milk noticed. 
 
 Should no internal opening exist the distension caused 
 by the_ injection of the milk will enable the examiner to 
 determine the course and extent of the pouch and thereby 
 be guided tor future treatment; yet in the obscure external 
 openings, when one suspects fistula from the presence of 
 discharge from the rectum, the internal opening must of 
 necessity exist if there is a fistula. It may however be a 
 true internal incomplete fistula. 
 
 External openings of fistulae may appear at unexpected 
 places. Matthews has reported a case which had two 
 external openings, one over the sacrum and the other over 
 the last lumbar vertebra. In this case the abscess began 
 several inches distant from the rectum and the pus bur- 
 rowed in an opposite direction and had no connection with 
 the rectum. 
 
 ABSCESS. 
 When seen early, at the beginning of or during the 
 existence of an abscess in this region, whether superficial or 
 deep-seated, prompt treatment should be instituted by the 
 application of hot poultices to hasten its formation, and the 
 pus evacuated as soon as fluctuation is noticed. After treat 
 ment will then be similar to the same condition in any other 
 location. 
 
48 diseases of the; 
 
 TREATMENT. 
 
 Treatment for fistula may be either by surgical means, 
 by the use of cauterants, caustics, escharotics and antisep- 
 tics, or by the ligature. In the former and latter treatment 
 the object is the division of the tissues between the internal 
 and external openings, while by the method of local applica- 
 tions the fistulous track is cleansed and stimulated to granu- 
 lations and subsequent healing of the parts. 
 
 The treatment by local applications is not applicable to 
 all cases, yet it is certain that a much larger percentage are 
 curable than the advocates of the knife are willing to admit, 
 and it is also worthy of mention that fistulae which have 
 resisted treatment by local means and which eventually 
 drifted into the hands of our surgical friends, were dis- 
 charged in a condition infinitely worse than before the cut- 
 ting operation. It is true that thousands of fistulae are 
 cured by surgical means and the patients discharged in 
 perfect condition, yet a large number of those so treated 
 would have been as readily cured by the milder means with- 
 out the liability to greater woes. Division of the tissues, 
 often including the sphincters, is liable to cause permanent 
 incontinence of feces, which as Dr. Kelsey says "is always 
 considered by the patient a very poor exchange for a fistula 
 which was causing comparatively little suffering or 
 annoyance." 
 
 I do not hesitate to say that while my impressions of 
 surgical means for the cure of fistula remain as they now 
 are, I would not employ this method except in small anal 
 fistulae where but a few fibres of the external sphincter are 
 involved. 
 
 Anal fistulae, those which involve only the external 
 sphincter, having their internal opening between the two 
 sphincter muscles can be laid open under local anesthesia 
 only, but for the rectal variety, surgical anesthesia must be 
 induced. The process of opening the track of the fistula 
 
RECTUM AND ANUS. 49 
 
 involves the use of the grooved director and following" its 
 groove with a sharp bistoury, dividing the tissues. Details 
 of this operation can be found in text books on surgery. 
 
 TREATMENT BY THE LIGATURE. 
 
 The use of the ligature for division of the tissues 
 between the two openings of a fistula can be traced to remote 
 ages. It is said to have been recommended by Hippocrates, 
 the father of medicine who lived three or four centuries B. 
 C, and its use has been revived from time to time. Its 
 advantages are chiefly that no anesthetic is required, no cut- 
 ting operation is performed and there is no loss of blood. 
 
 This method is adapted only to simple sinuses and not 
 to fistulae of the complex variety. Two varieties of ligature 
 are employed and there are also two methods of division of 
 the tissues. These are ulceration and strangulation. 
 
 If it be decided to divide the tissues by ulceration the 
 silk ligature is usually used and simply tied in a loose knot. 
 Jt usually accomplishes its Avork in two to three weeks. 
 
 Better results are obtained if the elastic ligature is used 
 and the tissues divided rapidly by strangulation. The process 
 is as follows. After a thorough evacuation of the bowels, 
 and douching of the rectum with a tea spoonful of boracic 
 acid in a pint of warm water, the patient is ready for the 
 treatment. Thread a silver probe or aneurism needle with 
 silk thread, to which a rubber ligature is attached, pass 
 the probe through the fistula from the outside until the 
 threaded point is within the rectum. Cut the thread and 
 withdraw the probe backwards through the fistula. The 
 thread should be four or six inches long, so that it can be 
 handled easily. With forceps grasp the thread in the rectum 
 and draw the ligature through the fistula. An artery forceps 
 attached to the outside end of the ligature will prevent its 
 being drawn into the opening. Pass both ends of the liga- 
 ture through a perforated shot or piece of lead ,and draw 
 them moderately tight, and compress the lead with a tooth 
 forceps, as rubber ligatures do not tie well. This method 
 
50 DISEASES OF THE 
 
 will divide the tissues in from four to ten days, depending on 
 the bulk of tissue enclosed. If the ligature tears before 
 cutting itself out, repeat the operation. The fistula should 
 be cleansed daily with diluted Hydrozone. Use no oint- 
 ment, as the rubber will decompose if brought in contact 
 with it. After cutting through, dress antiseptically after the 
 manner of other open sores. 
 
 The elastic ligature has the advantage over the silken 
 one, in that it exerts its function continuously and evenly 
 and requires no readjusting unless in case of an accidental 
 tearing. When silk is used for the strangulation method it is 
 tied very tightly around the tissues and should be readjusted 
 every five to seven days. 
 
 The elastic ligature used is about one tenth of an inch 
 in diameter, yet while in action, being tense, its cutting edge 
 is very much diminished and as the intervening tissues are 
 cut through its force becomes lessened. 
 
 When the amount of tissue to be divided is considerable 
 the ligature will probably not cut its way out on account of 
 the relaxation which follows its passage through. In these 
 cases it is best to begin with the ligature moderately tight 
 and readjust it every two or three days. 
 
 This method of treating fistula is endorsed by Dr. 
 Candler of Chicago, in the following extract of an article 
 by him in the Surgical Clinic : 
 
 "Taking the ordinary complete fistula, investigation will 
 show that it is not a mere straight channel of even diameter. 
 In nine cases out of ten the two terminals will be of small 
 caliber, but between them will be a cavity varying in size 
 and shape. This cavity often has canals ramifying in all 
 directions. When the patient will submit to having the 
 fistula slit up and the walls dissected out we get a radical 
 cure, but people do not like steel around their anus, so the 
 next best thing to use is the ligature — or in very mild cases 
 where the caliber is small and the fistula straight and com- 
 plete— curettage and packing. 
 
RECTUM AND ANUS. 5 1 
 
 "A fistula presenting, thoroughly wash the parts with a 
 strong antiseptic solution, (i-iooo bichloride will do), then 
 gradually dilate the sphincter and with a flexible probe find 
 the main orifices ; then with a small nozzle syringe flush out 
 the tract; at the same time with the finger and thumb try 
 to outline the shape and extent of the central pouch. If 
 this seems to be extensive it is better to inject into it a solu- 
 tion of ichthyol and boro-glyceride with glycerine, in the 
 following proportions : 
 
 ^ Ichthyol 5 j. 
 
 Boro-glyceride 5 ij. 
 
 Glycerine 5 iv. 
 
 Mix. 
 
 "Repeat this injection daily for three days and at the end 
 of that time wash again most thoroughly and then pass the 
 elastic ligature. Draw the two ends out and clamp them 
 with a metal button or lead bullet, making just enough ten- 
 sion to firmly constrict the tissue embraced. Have the 
 patient call on you in twenty-four hours and then insert the 
 nozzle of your syringe alongside the rubber and wash out the 
 tract. Then tighten up on the ligature. When the patient 
 calls again the work may be done; if not repeat. 
 
 "The advantage of taking the trouble of cleansing the 
 parts is that you give the parts behind the ligature a chance 
 to heal under fairly aseptic conditions, while if you leave 
 things alone you have a cutting and granulating going on in 
 the presence of filth. 
 
 "All blind fistulas can be treated this way by making 
 them complete, and after all, this is the best thing to do. A 
 blind external fistula may often be cured by curetting 
 under cocaine and then packing for twenty-four hours with 
 iodoform gauze. Then dust in Protonuclein and pack. 
 
 "By this method the majority of rectal fistulae can be 
 'treated at home' with perfect success and much profit. 
 During treatment the patient should be kept saturated with 
 calcium sulphide. After passing the ligature, keep the 
 
52 DISEASES OF THE 
 
 bowels closed for forty-eight hours then open them with 
 a full dose of castor oil or saline. Order the parts washed 
 after each stool with a mild creosol or similar solution." 
 
 TREATMENT BY LOCAL APPLICATIONS. 
 
 Local applications of certain remedies which combine 
 cleansing antiseptics, cauterants, caustics and tissue stimu- 
 lants form a treatment for fistula that at once appeals to the 
 physician as well as patient. As a cleansing and antiseptic 
 agent Hydrozone occupies the first position and as such is 
 endorsed by many writers in the treatment of fistula. It 
 penetrates deeply into the ulcerated tissues, destroys all pus 
 formations and stimulates granulations. 
 
 Bichloride of mercury is also of value especially in 
 cases where there is marked decomposition or foul odor. 
 Permanganate of potassium is also of considerable value in 
 the latter conditions. 
 
 Carbolic acid, Nitrate of silver and Nitrate of copper 
 are probably the most useful cauterants and caustics. 
 
 Carbolic acid may be used in ninety-five or in not less 
 than seventy-five per cent, solution. When the latter is 
 employed the best diluent is sperm or olive oil. 
 
 Nitrate of silver is best employed in solutions of forty 
 to sixty grains to the ounce of water. 
 
 Nitrate of copper is applied by means of passing a 
 copper probe which has been dipped into pure nitric acid 
 along the fistulous canal after the usual cleansing procedures. 
 
 As a tissue stimulant Protonuclein (Reed & Carnrick) 
 is of pronounced value. Here, as in rectal ulcer, the Special 
 preparation is employed. By a stimulation of the white 
 corpuscles and inciting them to greater activity in combating 
 the destructive changes which are going on, it acts as a physi- 
 ological cell irritant and causes a proliferation of normal, 
 healthy granulation cells. 
 
 Being prepared for the application of this treatment the 
 lower bowel is cleansed by a solution of Hydrozone. fifty 
 
RECTUM AND ANUS. 53 
 
 per cent, and the fistula is irrigated with Hydrozone, full 
 strength. 
 
 For the irrigation of the bowel any suitable syringe is 
 used, but for the sinus the hard rubber syringe with long 
 nozzle is best, as all parts of the canal can be reached and 
 considerable force used. 
 
 The introduction of the nozzle of the syringe will some- 
 times cause some little excitation of the internal surfaces and 
 assist the cure, but it is good routine practice to slightly 
 irritate or scarify the track of the fistula by means of a probe 
 slightly roughened, and passing it up and down several 
 times. 
 
 The carbolic acid of the desired strength having been 
 prepared, attach a silver probe canula to an ordinary hypo- 
 dermatic syringe and draw some of the acid into the barrel 
 of the syringe. If an internal opening exists place a wad of 
 cotton around the tip of the fore-finger of one hand and 
 insert it into the rectum and over the opening, so as to 
 prevent any of the acid from entering the bowel. Insert 
 the canula well up in the fistula, practically in contact with 
 the cotton pressed on the opening, and as the canula is 
 slowly withdrawn press out the acid, a drop at a time until 
 the external opening is reached. Press along the canal 
 with the finger a few moments for the purpose of distributing 
 the acid, and press out the excess if there be any. After 
 a minute or two pass a probe, tipped with cotton and wet 
 with dilute alcohol, up and down the track of the fistula and 
 immediately afterward syringe it out with a little water. 
 These applications are made once a week or once in two 
 weeks according to the indications of the case. After drying 
 the parts apply Special Protonuclein throughout the fistula 
 by means of a powder blower or other suitable means. This 
 part of the treatment should be performed twice a week, 
 preceded by a cleansing irrigation with Hydrozone. 
 
 Treatment by Nitrate of Silver solution is applied in the 
 same manner as the Carbolic Acid, but this can be used more 
 freely than the acid, in fact sufficient should be used to reach 
 
54 DISEASES OF THE 
 
 all parts of the fistulous track, the excess being allowed to- 
 run out. During this treatment the external parts should 
 be lightly covered with vaseline to prevent discoloration and 
 irritation of the skin as the excess escapes. 
 
 The carbolic acid seems most beneficial in the early 
 part of the treatment, while nitrate of silver is indicated 
 when the granulations are slow in forming and the surfaces 
 indisposed to heal. However either remedy is used almost 
 exclusively by some operators while others alternate thera 
 to advantage. 
 
 Be careful that the external opening is not healed before 
 the interior has done so. Internal incomplete fistula, is not 
 easily treated in this manner, and self treatment by the 
 patient, using the Ulcer Specific given under rectal ulcer, as 
 directed there, can be employed. In connection with the 
 treatment just given, an occasional douching of the fistulous 
 canal with bichloride solution, i-iooo will be beneficial. 
 Keep the canal clean by daily flushings with a 2% Carbolic 
 acid solution, except after Protonuclein has been thrown 
 into the fistula. This should be allowed to remain undis- 
 turbed 36 hours. Wearing a piece of iodoform gauze in the 
 canal, packed in lightly and renewed once every two days is 
 often beneficial, acting both as an irritating and stimulating 
 agent. Iodine has been recommended for injecting fistulae 
 but the remedies mentioned are more preferable. The 
 injection of pure eucalyptol, thoroughly permeating every 
 part of the fistula is often followed by good results. Even 
 when carbolic acid or nitrate of silver are used an occasional 
 injection of eucalyptol will be of benefit and hasten the 
 healing process. 
 
 Ointments are of little value in this disease, in fact it 
 is a question whether the introduction of oils and fats is 
 not decidedly contraindicated. Cleanliness, antiseptics and 
 stimulation being the three leading points, little is to be 
 gained by other measures. 
 
RECTUM AND ANUS. 55 
 
 DR. MASON'S TREATMENT FOR FISTULA 
 WITHOUT CUTTING. 
 
 This treatment is quite similar to that used by Dr. 
 Bennett, Austin, Tex. "Prepare the patient by the use of 
 cathartic medicines, enemata and restricted diet so that the 
 colon will be as nearly empty as possible. Syringe the 
 fistulous track with a solution of peroxide of hydrogen and 
 follow with plain water. After this is done anesthetize the 
 track with a ten per cent, solution of cocaine. Now fill a 
 good sized rubber or glass syringe with a saturated solution 
 of nitrate of silver. Place a rubber finger cot on the index 
 finger and place it firmly over the internal opening of the 
 fistula if it can be found. 
 
 It can usually easily be located by careful search with 
 the finger in the bowel. Put cosmoline on the skin to 
 prevent it from being burned by the fluid that runs out. 
 Introduce the syringe point firmly into the external opening, 
 completely closing it, and with the finger over the internal 
 opening, force the intervening cavity full of the silver solu- 
 tion, holding it there for a short time. This will fill to the 
 fullest extent not only the main track but also any branches 
 that may be present. Remove the syringe and with the 
 finger massage the fistula thoroughly to bring the medicine 
 into contact with all parts. In case the internal opening 
 cannot be located, force the solution in just the same, but 
 before doing this inject an ounce of sweet oil into the rec- 
 tum so that should any of the solution enter the bowels no 
 harm will be done. Nothing should be put into the fistula 
 after the silver solution has been injected. Unless the 
 external opening is quite large a crucial incision should be 
 made to secure a good drainage. The entire lining of the 
 fistula will slough away in five or six days and healthy 
 granulations spring up to take its place. The external 
 opening must be kept well dilated so as to allow free drain- 
 age, and a moist corrosive sublimate dressing applied for 
 
56 DISEASES OF THE 
 
 a few days. If the first treatment is not sufficient to cure, 
 repeat the operation after two or three weeks." 
 
 The general health of persons having fistulae is usually 
 below par, especially when the disease has existed for some 
 time and the discharge profuse. There has been some 
 inclination among writers to associate fistula with pulmonary 
 tuberculosis, yet beyond that predisposition which a condi- 
 tion of lowered vitality affords, it is probably erroneous to 
 associate the two. It may also be said that the systemic 
 conditions which predispose to tubercular disease also render 
 the person more liable to fistula. 
 
 Persons who are poorly nourished, anemic, and in whom 
 fat is noticeably absent, have but little power of resistance 
 against the pathogenic organisms which are liable to be 
 introduced into the body and proliferate there, and conditions 
 which in the robust and well nourished are scarcely noticed, 
 here become painfully apparent. 
 
 Allingham of London, who has had ample opportunity 
 for observation, reports that of fistulous patients seen during 
 a period of seven years, fifteen per cent, were more or less 
 tubercular, although many of them were thus classified who 
 merely gave evidence of predisposition to tuberculosis or 
 presented some of the early signs of the disease. 
 
 Another writer who has made observation in this con- 
 nection says : about twelve per cent, of fistulous patients 
 are subject to tuberculosis, and about five per cent, of tuber- 
 cular subjects have fistula. 
 
 From this it will be seen that the percentage is not 
 sufficiently high to warrant any other connection between the 
 two conditions, than the one previously mentioned ; the pre- 
 disposition which a condition of lowered vitality affords. 
 
 In this connection it is not necessary to more than 
 remind the practitioner to attend to the general treatment of 
 these patients. Much good can be accomplished by the 
 administration of tonics, reconstructives, tissue builders, 
 etc. Iron and arsenic are especially valuable, also the hypo- 
 phosphites and cod liver oil. 
 
RECTUM AND ANUS. 
 
 Rectal and Anal Fissure, or 
 Irritable Ulcer. 
 
 Fissure of the anus and rectum is probably the most 
 painful disease that affects this region. As implied by its 
 name, this disease consists of a fissure or crack in the mucous 
 membrane of the lower part of the rectum and usually 
 extends outward involving the anus. 
 
 As the anus is that point at which mucous membrane 
 ends and skin begins, it is evident that a fissure in that 
 locality involves both the anus and lower part of the rectum. 
 The length of a fissure may vary from one fourth to three 
 fourths of an inch, and in depth it may appear only as a 
 delicate red line or it may extend downward through the 
 mucous membrane and connective tissue to the sphincter 
 muscle. The edges may be smooth, or ragged and everted. 
 
 The symptoms of fissure are first, pain. This may be 
 ?o severe that the victim will suffer the most excruciating 
 agony. Pain is more acute during defecation and continues 
 .for several hours afterward. When the fissure is located 
 over the sphincter, the pain usually begins with the passage 
 of feces. When situated higher, above the muco-cutaneous 
 junction, the pain is more severe an hour or two after stool, 
 and is of dull aching character. 
 
 Fissure is easilv recognized. An ocular examination 
 being all that is necessary. When a fissure has existed for 
 some time, a peculiar cutaneous excrescence appears at the 
 anal verge, which by some is considered a diagnostic sign, 
 but its absence does not imply that no fissure exists. With 
 the finger, draw the mucous membrane downward and the 
 fissure, if present, can readily be recognized. When it 
 extends downward, involving the skin, its presence is notice- 
 able immediately on inspection. 
 
58 DISEASES OF THE 
 
 On separating the folds of mucous membrane which 
 sometimes overlap the fissure, and following its course 
 upward, the fissure will be found to lead to a small ulcer, 
 most frequently elliptical in shape, which is extremely- 
 irritable. 
 
 TREATMENT. The surgical treatment of this con- 
 dition consists of dilating the sphincters, advised by all 
 authors of text books and taught in all schools. This 
 method of treatment is not uniformly curative and has dis- 
 advantages which appeal to the patient. General anesthesia 
 is probably the principal objection. Patients should be 
 fully informed of the slow progress that will be made by 
 local treatment, yet withal, the majority will prefer it. 
 
 LOCAL TREATMENT. 
 
 Local treatment must be directed toward converting the 
 fissure into a simple sore. This is done by applications of 
 carbolic acid, pure. The applications may be made without 
 the use of the speculum, if the fissure can be exposed to view, 
 but if not the speculum must be used. A small speculum 
 should be used as the sphincters are very irritable in these 
 cases and contract readily. Before inserting the speculum, 
 the parts may be cocainized by the application of a 10% 
 solution, applied on cotton. The speculum is now well oiled 
 and passed into the rectum, the fenestrum of same being 
 so placed that when the slide is removed, the fissure will 
 appear in the opening. A probe is now tipped with cotton 
 and dipped into pure carbolic acid and drawn through the 
 fissure and over the ulcer several times until it has turned 
 white. The excess, if any, should now be wiped off and a 
 bit of cotton twisted to the length of the fissure and laid 
 into it. Two or three applications of this nature will convert 
 the fissure into a simple sore, the healing of which can be 
 stimulated by applications of nitrate of silver, forty grains 
 to the ounce. The ragged edges can be trimmed off or 
 cauterized with stick nitrate of silver or pure carbolic acid. 
 The little tab or cutaneous excrescence should be removed. 
 
RECTUM AND ANUS. 59 
 
 If soreness follows the application of the acid, a sup- 
 pository of opium and belladonna may be inserted as 
 required. After the fissure has been thus treated and its 
 irritability removed, the patient is given an ointment for 
 thorough applications externally. The formula for this is, 
 
 I£ Acid Salicylic gr. xx-xxv. 
 
 Morphine Sulphate gr. iss. 
 
 Ext. Belladonna gr. xx. 
 
 Ung. Lead Subacetate 5 ij. 
 
 Simple Cerate 5 ij . 
 
 Mix. If this ointment causes pain, lessen the amount of 
 salicylic acid, until later in the treatment, and gradually 
 increase. As salicylic acid has the power to disorganize 
 calloused tissue, its use is indicated especially when the 
 rough and tough edges exhibit an inclination to resist other 
 treatment. 
 
 Dr. Geo. J. Monroe, of Louisville, a well known writer 
 and rectal specialist, treats fissure by forcible dilatation or 
 by local applications. For treatment by the latter method, 
 he proceeds as follows. 
 
 Wash the parts with tar soap and water, then wash 
 with hydrogen dioxide; saturate absorbent cotton with a 
 20% solution of cocaine, press a part of this into the anus 
 and a part on the outside. In eight or ten minutes remove 
 this, apply hydrogen dioxide to fissure and follow this with 
 an application of balsam Peru. Repeat this daily. He also 
 uses nitrate of silver applications, three grains to the ounce, 
 applied with a camel's hair pencil. This may be repeated 
 every other day. The nitrate of silver treatment is not used 
 in connection with the one in which balsam Peru is used, 
 unless to stimulate the ulcer. In addition to either treatment, 
 be gives patients the following ointment. 
 
6o DISEASES OF THE 
 
 E Menthol, 
 
 Carbolic Acid aa 5 j . 
 
 Sweet Almond Oil fl. o ij. 
 
 Zinc Oxide 3 ss. 
 
 Benzoinated Lard, or 
 
 Simple Cerate § iv. 
 
 Mix. Apply twice a day. 
 
 Dr. Agnew's treatment, aside from dilatation in patients 
 who will not allow this operation is as follows : He uses 
 carbolic acid applications, to convert the fissure into a simple 
 sore, and after the fissure has lost its irritability, he snips 
 off the tough edges with a scissors, and supplies the patient 
 with the following ointment for use at home. 
 
 R> Acid Salicylic gr. xv-xxx. 
 
 Morphine Sulphate gr. i-ij. 
 
 L ng. Belladonna .3 ss. 
 
 Mix. Apply twice daily. 
 
 Instead of salicylic acid, bichloride of mercury may be 
 employed in the following manner. 
 
 1^ Mercuric Chloride, Gorros gr. ij-iv. 
 
 Morphine Muriate gr. ij-iv. 
 
 Ung. Belladonna 5 j. 
 
 Mix. Use twice daily. 
 
 If there is an indisposition to heal, after the irritability 
 is lessened, and the ragged edges removed, he applies nitrate 
 of silver, stick, to the inactive sore to stimulate it. Apply 
 gently so as to leave a thin coating of albuminate of silver 
 over it. Bichloride of mercury may also be used for this 
 
RECTUM AND ANUS. . 6l 
 
 purpose, gr. ss. to water fl. 5 iv. Apply with a camel's hair 
 brush after the sore has been dried with absorbent cotton. 
 Two grains of muriate of morphine, added to the bichloride 
 solution will render it painless. Cleansing with peroxide of 
 hydrogen and filling the fissure by a covering of flexible 
 collodion, after cleansing with peroxide is recommended, as 
 it supplies protection and rest to the parts. For the purpose 
 of converting the fissure into a simple, tolerant ulcer, he 
 also advises the use of his hemorrhoidal fluid, injected in two 
 or three places along the fissure, into and beneath the bed 
 of the ulcer, one or two drops being used. This produces 
 a slough and at once brings ease to the patient. Deep fissures 
 should not be so treated, as sloughing of the sphincter might 
 result. 
 
 Another treatment consists of applying a strong solution 
 of cocaine to the parts, to facilitate the introduction of the 
 speculum, after which a pledget of cotton, wet with carbolic 
 acid, pure, is laid in the track and allowed to remain for a 
 few moments. This produces complete anesthesia of the 
 parts and a very sharp bistoury is then gently drawn through 
 the bottom of the track, two or three times, or sufficiently 
 often to be sure that a little depth has been reached. Finally 
 the point of the knife is pressed into the tissue more firmly 
 at several places, as if making punctures. The after treat- 
 ment is the same. 
 
62 DISEASES OF THE 
 
 TREATMENT OF FISSURE BY DILATATION OF 
 THE SPHINCTERS. 
 
 The objects in view when treating fissure by dilating the 
 sphincters are to rupture the bed of the fissure and changing 
 the form of the attending ulcer, and to give the parts the 
 necessary rest by the paralysis of the muscles. 
 
 The operation is performed in the manner described in 
 the chapter devoted to that subject. 
 
 After dilatation the fissure should be examined and if 
 the surrounding mucous membrane is thickened or overhangs 
 along the edges it should be trimmed off. The skiny tab 
 usually accompanying fissure should also be removed, after 
 which the ulcer and torn fissure are dusted with either aristol 
 or iodoform, preferably the latter, and a suitable dressing 
 applied and held by a T bandage. 
 
 If pain or soreness follow, apply hot water externally 
 and introduce a suppository of either opium or cocaine, or 
 opium and belladonna. Two or three days should elapse 
 before a movement of the bowels takes place, and if the 
 flushing previous to the operation was of sufficient quantity 
 there will be no desire for a movement before this. Should 
 there be an indisposition to heal, especially the ulcer, touch 
 lightly with carbolic acid, seventy-five per cent, solution 
 after a cleansing with hot bichloride solution, i-iooo. 
 
 The use of the salicylic ointment will also be of service 
 in assisting the removal of the superfluous tabs of mem- 
 brane and promote the healing process. 
 
RECTUM AND ANUS. 63 
 
 Prolapse of the Rectum. 
 
 Prolapse of the rectum frequently occurs in children, 
 and in adults is not by any means rare. This condition may 
 appear in three forms : Partial, when the prolapsed portion 
 consists of mucous membrane alone. Complete, when the 
 prolapsed portion consists of not only mucous membrane 
 but also the muscular coats of the rectum. The other form 
 is really invagination of the bowel as in this condition the 
 upper or movable part of the rectum prolapses into the lower 
 part. 
 
 Fortunately the latter condition is rare, as it is extremely 
 serious and unless seen in its early stage almost invariably 
 requires an operation. 
 
 Partial prolapse is most frequently associated with 
 internal hemorrhoids, the protrusion of which force the 
 mucous membrane down and beyond the verge of the anus. 
 In these cases a cure of the piles will cure the prolapse. 
 This form also occurs frequently in children and is due to 
 diarrhoea, worms or other irritations which cause the child 
 to bear down. Simple prolapse of the mucous membrane 
 but seldom exceeds a length of two inches, is thin to the 
 touch and gives evidence of being mucous membrane only. 
 When the protrusion is longer, thicker and more fleshy to 
 the touch it is probably the complete form of prolapse. If 
 seen late, especially if there exists an irritable sphincter 
 which is likely to be somewhat contracted, strangulation 
 may be present and cause the patient most severe pain. In 
 extreme cases of complete prolapse part of the peritoneum 
 may descend, and with it parts of the intestines, the bladder 
 or an ovary. 
 
 The third variety is recognized when it has protruded 
 externally, by observing that when the finger is passed along 
 the external surface of the protrusion it will not stop when 
 
64 DISEASES OF THE 
 
 the level of the anus is reached, but will continue upwards 
 into the body. In both other varieties the external surface 
 of the prolapsed portion will be found continuous with the 
 membrane of the anus. 
 
 TREATMENT. 
 
 PARTIAL PROLAPSE. 
 
 If hemorrhoids exist, as is often the case, direct treat- 
 ment toward their removal and treat the prolapse later. 
 if necessary. In children it is not uncommon to find that 
 they have one or two attacks of this trouble and are 
 subsequently free from it entirely. Before applying" the 
 stronger applications necessary in adults and obstinate cases. 
 it is best to annoint the prolapsed membrane thoroughly with 
 an astringent ointment, such as of gallic or tannic acid, ace- 
 tate of lead or bismuth, and return the parts into the body. 
 Or, simple reduction and an injection of half an ounce of the 
 Ulcer Specific mentioned under the treatment of rectal ulcer, 
 immediately afterward. The bowels should be kept under 
 restraint for a few days by means of astringents or opium, 
 and the first movement secured by means of an enema. 
 
 "When more radical measures are necessary Carbolic 
 Acid is perhaps the safest and best remedy, used by injection. 
 
 A ten to fifteen per cent, solution in equal parts of water 
 and glycerine should be injected at two or three places, about 
 half an inch above the margin of the anus, about the location 
 of the internal sphincter, to the edge of which the adhesions 
 are intended to attach the mucous membrane. Eive to eight 
 minims should be injected at each spot, and care must be 
 exercised so as to deposit the fluid just beneath the mucous 
 membrane, into the sub-mucous space, the object being to 
 excite sufficient inflammatory action to cause an exudation 
 of plastic serum, to produce adhesions between the mucous 
 membrane and the muscular coats. 
 
RECTUM AND ANUS. 65 
 
 The following formula may be used for injection: 
 
 ^ Acid Carbolic fl. 3 j. 
 
 Glycerine fl. 3 iv. 
 
 Aqua q. s. ad fl. § j. 
 
 Mix. 
 
 Ergotin has been recommended for these injections, but its 
 use is more liable to be followed by abscesses than that of 
 carbolic acid. The following ointment is an excellent one 
 for use in simple prolapse, or after injections. 
 
 "B Ext. Ergot 3 ij. 
 
 Acid Boracic 3 ij. 
 
 Ext. Conium gr. xv. 
 
 Iron Subsulph gr. xl. 
 
 Cocaine Muriate gr. viij. 
 
 Vaseline 5 j. 
 
 Mix. Apply into rectum after reduction of prolapse, 
 or on the prolapsed portion before reduction. 
 
 Mason recommends the following: "Apply cocaine to 
 the protruded mass and then make from four to six stripes 
 along the long axis of the prolapse with fuming nitric acid. 
 After this has been done, oil the parts well and replace the 
 prolapsed portion. Do not allow a bowel movement for four 
 days and then only in the recumbent position and as a result 
 of an injection of oil or flaxseed solution. This operation 
 is painless, safe, easy to perform and will cure nearly every 
 case." 
 
 COMPLETE PROLAPSE. 
 
 Treatment for this condition demands an examination 
 as to its cause. It may be due to a relaxed sphincter which 
 allows the lower portion of the rectum to descend. In these 
 
66 DISEASES OF THE 
 
 cases a shortening of the sphincter by contraction is indi- 
 cated. This is usually accomplished by means of the actual 
 cautery and necessitates quite an extensive and elaborate 
 preparation not generally at the command of the general 
 practitioner. This also applies to the treatment of a swollen, 
 engorged or hypertrophied condition of the protruded mass, 
 for which the best treatment is excision of sufficient of the 
 enlarged portion to relieve the tendency toward protrusion. 
 Contraction of these parts by the actual cautery is also 
 practiced by some operators, as is also the knife in operations 
 for contracting the sphincter. 
 
 The third variety, or invagination, is usually not seen 
 until considerable engorgement and perhaps strangulation 
 has taken place and reduction is impossible. In these cases 
 secure a good surgeon without delay as it is a formidable 
 condition and one that requires all the surgical skill of the 
 best operators. 
 
 Rectal Polypus. 
 
 Polypi may occur in the rectum, arising as they do from 
 mucous membrane, wherever located. The varieties are 
 similar to those which are found in the nose, and their 
 removal may be accomplished in the same manner. The 
 subject is mentioned however for the purpose of referring 
 to their removal by the injection method, in a similar man- 
 ner as hemorrhoids. They can be distinguished from piles 
 by their color, being of a pinkish tint and bleeding easily 
 when of the mucous variety. Any mucous polypus can be 
 permanently removed by injecting it in a similar manner as 
 hemorrhoids, but when the tumor is hard and fibrous, its 
 removal is best accomplished by the snare. If polypi are 
 mistaken for hemorrhoids, as they frequently are, and treated 
 as such, no harm will result, but their removal perfectly 
 accomplished. 
 
RECTUM AND ANUS. 67 
 
 Reflex Irritation Due to Rectal 
 Diseases. 
 
 Rectal diseases are a prolific source of all manner of 
 abnormal conditions and especially of peculiar nervous mani- 
 festations, due to what is termed reflex irritation. 
 
 The generous nervous endowment of the lower end of 
 the rectum is responsible for these conditions. At the verge 
 of the anus the sensory nerves are most abundant, which 
 explains the extremely sensitive condition of this part; 
 while at a distance of two or three inches above the anus the 
 sympathetic nerves predominate. This accounts for the 
 difficulty of locating the cause of many reflexes, should the 
 lesion be located in the portion of the rectum where the 
 sensory nerves are not so prominent, and where the sensi- 
 bility is not sufficient to enable the patient to locate the 
 trouble. 
 
 Prof. Pratt has said : "In all pathological conditions, 
 surgical or medical, which linger persistently in spite of all 
 efforts at removal, from the delicate derangements of the 
 brain substance that induce insanity and the various forms 
 of neurasthenia, to the great variety of morbid changes 
 repeatedly found in the coarser structures of the body, there 
 will invariably be found more or less irritation of the rectum, 
 or the orifices of the sexual system, or both." 
 
 Orificial surgeons are often accused of attributing too 
 much to reflex irritation, yet it is true that much that should 
 be recognized by medical practitioners is too frequently over- 
 looked. 
 
 Among the disorders which may be caused by rectal 
 irritation, and toward which attention should be directed 
 should they prove refractory, may be mentioned, abdominal 
 
68 DISEASES OF THE 
 
 pains, headache, insomnia, digestive disturbances, irritability 
 of the bladder, nervousness, melancholia, irritability, sexual 
 weakness, nervous prostration, and abnormal conditions of 
 any nature that indicate a perversion of the nervous equip- 
 ment. 
 
 The local lesions that are liable to cause either or several 
 of these reflex disturbances are generally fissure and irritable 
 ulcer, undiscovered fistula, rectal ulcer, proctitis and a form 
 of colitis characterized by the discharge of mucous casts of 
 the bowels, tenesmus and considerable pain. 
 
 A full consideration of this subject would require more 
 space and ability than are at my disposal and all I can hope 
 to do is to direct attention to the factor of rectal diseases in 
 the production of the obscure pathological conditions so 
 frequently met with, and which so persistently resist the 
 action of symptomatic treatment. 
 
RECTUM AND ANUS. 69 
 
 Dilatation of the Sphincters. 
 
 Forcible dilatation of the sphincter muscles of the rectum 
 is undoubtedly practiced with injudicious frequency by 
 many rectal operators. It has been recommended as a 
 curative measure for practically all the abnormal conditions 
 that may be found in or about the rectum and anus and on 
 this account, when practiced by its ardent but unwise advo- 
 cates, has become the cause of much damage and untold 
 suffering. 
 
 That there are certain indications in which dilatation of 
 the sphincters will benefit, none will deny, but when prac- 
 ticed as a routine treatment under circumstances in which it 
 is entirely uncalled for, it becomes little less than malprac- 
 tice. 
 
 It is indicated in all conditions where spasmodic muscu- 
 lar contractions occur, regardless of what other disease may 
 or may not be present ; in fissure it is unquestionably of ser- 
 vice and its application is quite general. 
 
 In any condition of abnormal tightness of the sphincters, 
 forcible dilatation will afford relief; in cases of obstinate con- 
 stipation when the movement is followed by a feeling of 
 exhaustion or depression, especially in persons of a highly 
 excitable nervous temperament ; people who can laugh until 
 they cry and cry until they are a wreck ; especially women, 
 will find relief after a thorough dilatation. Women subject 
 to hysteria are frequent sufferers from rectal diseases, and 
 will usually be benefited. 
 
 As is well known, the external sphincter is the last of 
 the voluntary muscles to undergo relaxation due to anesthe- 
 sia ; also that stretching this muscle is of decided value in 
 
yo DISEASES 0? THE 
 
 reviving a person when anesthetics have been administered 
 too freely. . 
 
 This is also the case when persons have become uncon- 
 scious from drowning, action of narcotics, heart failure and 
 coma from various causes. 
 
 Before attempting to dilate the sphincters be sure that 
 the patient is thoroughly anesthetized; otherwise spasmodic 
 contractions will surely occur. Two methods are used ; the 
 hands of the operator and the instrument known as the 
 rectal dilator. Both methods have their advocates and there 
 are good reasons for recommending either one of them. 
 
 Those advocating the use of the hand, more correctly 
 the thumbs and forefingers, argue that as the muscles are 
 gradually dilated the slight yielding sensation can be felt 
 and used as a guide and thus too great a degree of dilatation 
 avoided. On the other hand, advocates of the rectal dilator 
 argue that by the use of the instrument the degree of dilata- 
 tion is always evident, subject to measure by the foot rule, and 
 the limit of the instrument will always be a silent witness in 
 the instance of suits for malpractice which are liable to fol- 
 low any sort of medical or surgical treatment. In the light 
 of legal difficulties the operator who trusts to his senses and 
 stops the stretching when he considers that sufficient force 
 has been expended, would undoubtedly be somewhat eclipsed 
 by the mute steel witness of the advocate of the instrumental 
 dilator. This line of argument has but recently been pre- 
 sented to me, and I deem it of sufficient value to give it space 
 here. 
 
 Perfect anesthesia having been induced insert the 
 thumbs of both hands or the thumb of one hand and the first 
 and second fingers of the other into the anus, and gradually 
 yet forcibly produce complete relaxation and paralyzation 
 of the muscles. Care must be taken not to rupture the exter- 
 nal sphincter, an accident that is liable to occur when the 
 force used is too great or too rapid. The appearance of 
 the mucous membrane protruding from the anus will indicate 
 sufficient manipulation. 
 
RECTUM AND ANUS. 7 1 
 
 Kneading the external' sphincter and the use of the 
 graduated hard rubber dilators will aid in overcoming the 
 resistance and lessen the liability of rupturing the muscle. 
 In women the rectum is capable of greater dilatation and it 
 should be borne in mind that their support anteriorly is less 
 tense and durable than in the male. 
 
 When the expanding dilator is used for forcible dilata- 
 tion the usual preliminaries are observed and the instrument 
 introduced. By the use of the set screw gradual expansion 
 of the blades is obtained until the desired degree of dilatation 
 is reached. 
 
 Any of the expanding dilators will be found applicable 
 for this treatment, yet none of them are better than the 
 regular Pratt sigmoid speculum. 
 
 In order to avoid the usual defecation due to anesthesia 
 as well as dilatation, see that the bowels are thoroughly 
 evacuated by a flushing half an hour previous to the opera- 
 tion. 
 
 For treatment of fissure by dilatation of the sphincters., 
 see under Fissure. 
 
 RECTAL DILATATION WITHOUT ANESTHESIA. 
 
 From an article in the Medical World, by William L. 
 Dickinson, M. D., Professor of Rectal Diseases, Saginaw 
 Valley Medical College, Saginaw, Mich. 
 
 "A patient comes to us, and having made an examination 
 we inform him that he can be cured provided he is willing 
 to have an operation, and that it will be necessary for him to 
 take an anesthetic. Reluctantly he consents to our proposi- 
 tion and returns home, with the understanding that the 
 operation is to be performed as soon as he can be prepared 
 for it. But having talked with friends, he decides not to take 
 the chloroform and calls us up by telephone to inform us 
 that he has changed his mind and will not have the operation 
 just at present, as he seems to feel some better. In a few 
 days we learn that the patient has gone to another doctor, 
 
72 DISEASES OF THE 
 
 a,nd that the other doctor has promised to do what he can 
 for him, without the use of chloroform, and we also know 
 that if the patient gets any benefit whatever from the treat- 
 ment, that his influence will always be in favor of the doctor 
 who did not insist on giving chloroform. We may know 
 that he used very poor judgment and was very foolish not to 
 follow our advice and be permanently cured, but on the other 
 hand, he may know that he feels much better now, and as he 
 did not have to take the chloroform he will not worry about 
 what may occur in the future. 
 
 The time honored treatment of anal fissure by dilatation 
 under chloroform anesthesia was both effective and speedy; 
 but we can accomplish the same results in a little longer 
 time by painting the fissure with a ten per cent, solution of 
 cocaine and then dilating the sphincters with Pratt's rectal 
 dilators, commencing with the smallest, and increasing to the 
 largest size that the patient can stand at each treatment. By 
 the forcible dilatation of the sphincters under an anesthetic 
 we can usually cure our patient by one treatment, whereas 
 under the gradual dilatation method it may require two or 
 three weeks to accomplish the same result, but when a patient 
 consults us and we explain the two methods to him, he 
 nearly always chooses the longer method if he can possibly 
 spare the time to make the requisite number of calls at our 
 office. This is quite natural, as every one shrinks from any- 
 thing called an operation, and readily takes up the treatment 
 that is nearly painless. It is well to paint the fissure with a 
 ten per cent, solution of nitrate of silver after the dilatation. 
 I instruct the patient to return in three days for another 
 treatment, and to apply to the fissure, twice daily, after bath- 
 ing with hot water, and ointment composed of 
 
 Orthoform grs. xx. 
 
 Ichthyol 5 i j . 
 
 Lanolin § j . 
 
 Mix. 
 
 Many persons who are now great sufferers from the 
 common diseases of the rectum, would gladly have an opera- 
 
RECTUM AND ANUS. 
 
 73 
 
 tion for their relief if we could only assure them that they 
 could be cured, and without the necessity of losing conscious- 
 ness. We would also make more financially, and keep many 
 a patient from going to some man who perhaps knows little 
 or nothing about the case, but does have a far better knowl- 
 edge of human nature than we, and also understands the 
 business side of the profession. 
 
 I consider it a duty we owe to our patients and also to 
 ourselves, to do all in our power to keep them from going to 
 the irregular practitioner, for as regular, educated physi- 
 cians, we ought to be able to cope with all diseases of the 
 rectum in an intelligent manner, and thus give entire satis- 
 faction to our patients." 
 
 GRADUATED 
 
 RECTAI. 
 
 DILATORS, 
 AND 
 PRATT'S 
 
 SIGMOID 
 SPECULUM 
 AND 
 
 DILATOR. 
 
 lOCHEB & SON. 01 
 
DISEASES OF THE 
 
 Diseases of the Anus. 
 
 Pruritus Ani. 
 
 Obstinate itching of the anus is one of the most torturing' 
 conditions imaginable. Patients frequently consult the 
 physician with a statement that they have itching piles, but 
 on examination, hemorrhoids are usually found absent, 
 unless possibly external tabs which have become inflamed 
 and oedematous. Pruritus may, however, accompany almost 
 every disease of the rectum, and while perhaps technically 
 not a disease, but a symptom, it frequently causes more 
 annoyance and acute torture than many of the more serious 
 diseases. Physicians as a class, excepting only those who 
 have made the study and treatment of rectal diseases a 
 specialty, do not usually credit this condition with the 
 importance it deserves, consider it a trivial complaint easily 
 relieved, prescribe an ointment or a wash, and because the 
 patient, who has probably consulted some other physician, 
 does not return, imagine he has been cured. 
 
 If many physicians have underestimated this condition, 
 Dr. Hoyt, of New York, cannot be accused of committing 
 this error, as the following, quoted from his contributions 
 to the literature on the subject, will prove: 
 
 "With what anguish its unhappy victims battle through 
 innumerable sleepless nights, fighting this demon of so-called 
 local epilepsy, with its long array of itching, burning, exud- 
 ing, corroding, exhausting and blaspheming characteristics, 
 as though they had been brewed by the chemistry of hell ! 
 The whole organization becomes a chaotic discord, the dis- 
 position is cruelly warped, the countenance shows a sad 
 picture of living woe. the carriage is nearly lost to all laws 
 of equilibrium, and the complete being merges into a throb- 
 bing phantom of despair, trembling on the very threshold 
 of idolized suicide. 
 
RECTUM AND ANUS. 75 
 
 "Of course I speak of the most aggravated cases, 
 instances that seldom occur within the experience of general 
 practitioners. Wherefore then these phenomena? What is 
 the mighty influence that yields so much distress ? 
 
 "The meagre literature upon the subject hobbles upon the 
 crutches of hypothetical inferences, telling you perhaps it is 
 capillary congestion, or chronic proctitis, or neurotic hyper- 
 aesthesia, or eczema, or malaria, suggesting a panoramic 
 array of remedial agencies, all unsatisfactory, thereby con- 
 fessing to a sad condition of helpless empiricism." 
 
 The paroxysms of itching usually become more acute 
 after the patient has retired for the night, the warmth of the 
 bed seeming to increase the moisture of the parts, although the 
 itching may continue more or less during the day. When 
 the disease has existed for some time the skin about the 
 anus becomes thickened and somewhat puckered, the folds 
 numbering as many as six or seven radiating from the anus, 
 and which on separating reveal crevices of varying depths, 
 containing a moist secretion. 
 
 The cause of this condition has been variously ascribed 
 to parasites, seat worms, acidity of the alimentary tract, uric 
 acid, proctitis, neurotic conditions, etc. 
 
 TREATMENT. 
 
 Constitutionally, if acidity of the alimentary tract exists, 
 or an excess of uric acid, the proper remedies must be pre- 
 scribed to overcome these conditions. 
 
 Potassium bicarbonate, sodium hyposulphite and salicyl- 
 ate are indicated in the former condition, and lithia, acetate 
 of potassium and alkaline waters in the latter. 
 
 Locally the use of sodium hyposulphite, two ounces to a 
 pint of water, applied by means of wet cloths is often of 
 service. If seat worms are present an injection of decoction 
 of quassia will dislodge them and give ease to the patient, but 
 in my opinion true pruritus ani is never caused by seat 
 
7'J DISEASES OF THE 
 
 worms. They may and do cause itching, but not the charac- 
 teristic condition usually noticed. The theory of microscopi- 
 cal parasites of either animal or vegetable origin is more 
 tenable from the fact that anti-parasitic remedies very fre- 
 quently give better results than any other treatment. 
 
 This theory is endorsed by Hoyt, who recommends the 
 use of Black Wash (Calomel and Lime Water), three times 
 a day, applied to the anus immediately after bathing the parts 
 with water as hot as can be borne. At certain points or 
 patches where this remedy fails to act he applies Ung. 
 Hydrargyri. 
 
 For vegetable parasites sulphurous acid is an effective 
 remedy. It may be used in fifty per cent, or stronger 
 solution. When used pure its action is quite severe, but 
 exterminates the parasites. Several applications of a fifty 
 to sixty-five per cent, solution are usually preferable to one 
 of full strength. 
 
 Citrine ointment, carbolic acid, ammoniated mercury and 
 sulphur are among the most highly recommended remedies. 
 I recently cured a case by two applications of a seventy-five 
 per cent, solution of carbolic acid into the crevices between 
 the folds of the skin, followed by the usual application of 
 dilute alcohol. 
 
 The floors of these crevices had all the appearance of 
 mucous membrane, from their long exclusion from air, and 
 secreted a moisture that was present in considerable quantity. 
 Mason recommends carbolic acid applications to the skin, 
 using it in ninety-five per cent, solution. After either of 
 these applications the epidermis will peel off and leave a new 
 surface which may require a soothing dressing. Several 
 applications, made a few weeks apart, may be necessary. 
 
 If the skin has a very harsh and dry appearance, a satu- 
 rated solution of nitrate of silver should be painted about the 
 anus and for a distance of several inches outward. This 
 will stimulate the skin and it will resume a healthy appear- 
 ance after two or three applications. As soon as this 
 solution has dried, apply to the anus and surrounding parts, 
 
RECTUM AND ANUS. 
 
 71 
 
 citrine ointment, full strength. (Ung. Hydrarg. Nitratis). 
 Dress with cotton and bandage. After three or four days 
 rhe applications of nitrate of silver are discontinued, but the 
 ointment should be used for several weeks, or until cured, 
 if the usual progress is made. 
 
 Applications of hot water will momentarily increase the 
 itching, but after that there will be considerable relief. 
 
 When more or less varicosity of the hemorrhoidal ves- 
 sels exists, the following compound will be of service. 
 
 3 Fl. Ext. Witch-hazel fl. 5 ij 
 
 Fl. Ext. Ergot fl. = ss. 
 
 Fl. Ext. Hydrastis fl. 5 ss. 
 
 Tr. Benzoin Comp fl. 5 ss. 
 
 Carbolized Linseed Oil (5 per cent.) . fl. 3 ij 
 
 Mix. Shake well before using. 
 
 Sig. Inject one to three drachms into the cavitv of the 
 rectum, once a day. 
 
 The following formulae will be found useful, as indi- 
 cated. 
 
 1^ Acid Carbolic gtt. xx. 
 
 Sulphur 5 iij. 
 
 Citrine Ointment o ss. 
 
 Lanoline or Simple Cerate 5 ss. 
 
 Mix. 
 
 Ammoniated Mercury is perhaps as useful a remedy as 
 is at our command. The following ointment has served me 
 well. 
 
 1^ Acid Carbolic m, xl. 
 
 \mmoniated Mercury 3 ij. 
 
 Bismuth Sub Nitrate 3 ij. 
 
 Vaseline ^ ij. 
 
 Mix. 
 
7^ DISEASES 0E THE 
 
 Calomel, in ointments is a remedy that frequently gives 
 good results, although treatment that cures some cases will 
 totally fail in others. 
 
 B Calomel gr. lxxx. 
 
 Benz. Lard § j. 
 
 Mix. 
 
 lent. 
 
 ]$ Acid Carbolic gtt. xx. 
 
 Calomel . . : 5 j. 
 
 Balsam Peru 3 iss. 
 
 Lanoline § j. 
 
 Mix. 
 
 I£ Acid Salicylic gr. xv. 
 
 Oil of Cade 3 j. 
 
 Ung. Zinc Oxide § j. 
 
 Mix. 
 
 For the itching of external piles, the following is excel- 
 
 1$ Acid Tannic 5 ss. 
 
 Powd. Camphor gr. xx. 
 
 Powd. Alum gr. x. 
 
 Powd. Opium gr. v. 
 
 Acid Carbolic TTL x. 
 
 Vaseline % j. 
 
 Mix. Apply three times daily. 
 
 
RECTUM AND ANUS. 79 
 
 Tar ointment, prepared as follows, is highly recom- 
 mended : 
 
 .1$ Fresh Tar g vii j . 
 
 Glycerine g xvj . 
 
 (by weight.) 
 
 Starch 3 vj . 
 
 Mix. Rub the starch with the glycerine and mix with 
 the tar. Put on hot stove and stir until brought to the 
 boiling point, then remove and stir until cold. Apply on 
 muslin and keep in place with a T bandage. 
 
 T> Acid Carbolic 5 ij . 
 
 Acid Salicylic 3 iss. 
 
 Sodium Biborate 3 j. 
 
 Glycerine § j . 
 
 Mix. Sig. Apply as necessary. 
 
 A good formula. 
 
 I> Citrine Ointment, 
 
 Resin Cerate aa p. c. 
 
 Mix. Wash anus with soap and water and apply lightly 
 once or twice a day, rubbing in well. 
 
 I£ Campho-phenique fl. 3 j. 
 
 Losophan gr. xx. 
 
 Petrolatum "% j . 
 
 Mix. Apply night and morning. 
 
80 DISEASES OF THE 
 
 Eczema of the Anus. 
 
 Eczema is frequently met with, and is one of the com- 
 mon causes of irritation of the anus. It is caused by lack of 
 cleanliness after defecation, constipation, the passage of 
 irritating mucus, or discharge from a fistula. Eczema fre- 
 quently extends backward toward the coccyx and sacrum 
 for three or four inches, causing much discomfort. It 
 usually occurs in persons whose general health is not good. 
 When the surface is inflamed and cracked, the following is 
 a good remedy: 
 
 I> Powd. Zinc Oxide gr. lx. 
 
 Camphor Liniment fl. 3 j. 
 
 Lime Liniment fl. 3 vj. 
 
 Mix. Clean parts and apply olive oil and wipe dry with 
 wool, and apply this preparation, rubbing it in well. Cover 
 with a layer of dry cotton and bandage. When the surface 
 has become dry, apply the following powder: 
 
 1$ Powd. Zinc Oxide gr. lx. 
 
 Powd. Gum Camphor gr. lx. 
 
 Powd. Corn Starch o j- 
 
 Mix. 
 
 The following lotion is also valuable, especially when the 
 skin is oedematous: 
 
 fy Liq. Plumb. Subacetate fl. g ss. 
 
 Alcohol fl. 5 j- 
 
 Glycerine fl- 5 j- 
 
 Rose Water fl. o xi j- 
 
 Mix. Apply on wet cloths, continually until the oedema 
 has disappeared. 
 
 The usual treatment for eczema in other locations may be 
 employed in eczema of the anus. Cleanliness alone will do 
 much toward the cure. 
 
RECTUM AND ANUS. 8 1 
 
 Cocaine Solutions for Rectal Work. 
 
 The use of cocaine has been somewhat restricted on 
 account of the fear of absorption into the circulation and the 
 resulting toxical effects. 
 
 This fear, while to a certain extent warranted, is carried 
 coo far by many, as the dangers attending the use of cocaine 
 are more imaginary than real. Toxical effects are produced 
 in but a small percentage of cases, and not all of them are 
 by any means alarming. 
 
 For local applications it is useless to attempt to produce 
 any appreciable effect short of a fifteen to twenty per cent, 
 solution, while for injecting into the tissues a four to eight 
 per cent, solution will suffice. 
 
 I am becoming somewhat more partial to weaker solu- 
 tions for injection, not on account of the danger of stronger 
 solutions, but in order to obtain the benefit of the more 
 bulky injections. Filling the tissues full of water alone will 
 render minor operations, where but a single thrust or cut is 
 necessary, practically painless. 
 
 For the prevention of toxical effects, it is suggested that 
 carbolic acid be added to cocaine solutions. In addition to 
 preventing absorption, this mixture keeps better than 
 cocaine alone, its anesthetic action is increased and there is 
 no tendency to inflammatory reaction after its use. I never 
 use cocaine solutions without the addition of carbolic acid. 
 One drop of pure carbolic acid being added to each drachm 
 of solution. 
 
 If unfavorable symptoms should occur, notably heart 
 failure, inhalations of nitrite of amyl, will antagonize its 
 action. 
 
 The Schleich method of securing anesthesia with but a 
 minimum of cocaine is very well adapted to rectal work, and 
 can be recommended for all minor operations such as the 
 removal of cutaneous tabs, cutting through small fistulae, etc. 
 
82 
 
 DISEASES OF THE 
 
 The formulae of these solutions follow. Tablets of the 
 various strengths are supplied by the majority of pharma- 
 ceutical firms. 
 
 STRONG. 
 
 Cocaine muriate gr. iij. 
 
 Morphia muriate. . . gr. 2-5 
 
 Sodium chloride gr. iij. 
 
 Distilled water, sterilized fl. 5 iijss. 
 
 M. 
 
 NORMAL. 
 
 Cocaine muriate gr. iss. 
 
 Morphia muriate gr. 2-5 
 
 Sodium chloride gr. iij. 
 
 Distilled water, sterilized fl. § iijss. 
 
 M. 
 
 WEAK. 
 
 Cocaine muriate gr. 1-6 
 
 Morphia muriate gr. 2-5 
 
 Sodium chloride gr. ii j . 
 
 Distilled water, sterilized fl. § iijss. 
 
 M. 
 
 The normal solution is the one generally employed, and 
 of this three ounces may be used. The strong solution is 
 used when the tissues are actually inflamed. Of this one 
 ounce may be injected during one operation. The weak 
 solution is used when the previous injection has been inade- 
 quate and further anesthesia is desired in the deeper tissues. 
 As much as four ounces may be injected. 
 
 METHOD OF INJECTION. 
 
 Injection is rendered painless by applying cocaine, or 
 ether spray, at the site of puncture. The needle is intro- 
 duced within the skin, and a few drops of solution pressed 
 out so that the skin itself is distended by the fluid, which 
 occasions a white wheal. Even pressure is now applied until 
 this wheal is enlarged to the size of a penny. The needle is 
 then withdrawn, and inserted again within the radius of the 
 
RECTUM AND ANUS. 83 
 
 first anesthetized wheal, and this process is continued until 
 the line of incision is marked out. Finally, when the skin 
 is anesthetized, the subcutaneous and deeper tissues are 
 infiltrated. In operating upon inflamed parts the infiltration 
 is commenced in the surrounding healthy tissue, and wheal 
 after wheal is formed until the region to be operated upon is 
 saturated, which is to be known by the disappearance of the 
 inflamed color and the appearance of the white zone of infil- 
 tration. 
 
 Dr. Schleich claims that this process of anesthesia is 
 absolutely devoid of danger. It is essential that sufficient 
 fluid — preferably warmed to 8o°-ioo° F. — be employed to 
 render the tissue tense. Ice-bags to the edematous area will 
 enhance the anesthesia, and constriction greatly assists 
 in prolonging it. 
 
 COCAINE AND SUPRARENAL EXTRACT. 
 
 The value of suprarenal extract as a hemostatic and 
 anesthetic agent is now generally known. In combination 
 with cocaine and eucaine as in the following formula the 
 combined effects of the three drugs are obtained. Five to 
 six minims injected into the skin or part to be operated on, 
 will produce sufficient anesthetic action for small operations. 
 
 Cocaine muriate gr. v. 
 
 Beta-eucaine gr. v. 
 
 Sodium chloride gr. x. 
 
 Dried suprarenal gland gr. xxx. 
 
 Water fl. 5 j. 
 
 In making this combination, the suprarenal is mixed 
 with the water, .the eucaine and salt are added after filtration, 
 and last of all, just before using, the necessary quantity of 
 cocaine is added. This makes a 1 per cent, solution of the 
 cocaine and eucaine, which may be freely used in the mucous 
 membrane without fear of poisoning. 
 
84 
 
 RECTAL INSTRUMENTS. 
 
 INSTRUMENTS FOR RECTAL WORK. 
 
 The illustrations of Rectal Instruments herein shown are 
 from electrotypes kindly furnished by Max Wocher & Son, 
 Cincinnati, O. 
 
 The Albright Rectal Set. 
 
 This set contains one medium Brinkerhoff rectal specu- 
 lum ; one rectal dressing or polypus forceps ; one silver probe ; 
 one suppositor for ointments ; two improved syringes with 
 caps ; one pure silver probe-pointed canula, for the explora- 
 tion and injection of sinuses, fistulae, etc. ; one guarded long- 
 point gold pointed needle, for injecting hemorrhoids; one 
 ordinary hypodermic needle and four metal screw-top bottles 
 for holding ointments, etc. Fine Morocco case. 
 
 Any physician not already equipped with a set of rectal 
 instruments, cannot do better than to purchase one of these 
 sets. It is compact and complete and furnishes the principal 
 
RECTAL INSTRUMENTS. 
 
 85 
 
 instruments for the treatment of rectal diseases. Variations 
 in the same can be made to order. Purchasers of rectal 
 instruments, especially those purchasing the Brinkerhoff 
 speculum, should be careful to see that the slides in them are 
 carefully made, as I have found by experience that certain 
 manufacturers who list this instrument, do not use the 
 customary care in making their goods, and turn out Brinker- 
 hoff speculums that are absolutely worthless. Messrs. Wocher 
 and Son, have arranged this case for me, with the Brinker- 
 hoff speculum, and I am pleased to state that their products 
 are very accurate in mechanical construction, the slides of the 
 speculums, both the Brinkerhoff and O'Neil, are well made, 
 and the instruments eive excellent satisfaction. 
 
 \ 
 
 SON, OIN.. O 
 
 Hemorrhoidal Syringe and Canula Set. 
 
 This case contains a solid barrel syringe, with cap, 
 holding thirty-five minims ; one pure silver probe-pointed 
 canula for the exploration and injection of sinuses, fistulae, 
 etc. ; one ordinary hypodermic needle and one long-point, 
 gold pointed needle for the injection of hemorrhoids, having 
 a slide cover with set screw by means of which the distance 
 the needle is inserted can be resrulated. Fine Morocco case. 
 
86 
 
 RECTAL INSTRUMENTS. 
 
 NEEDLE AND CANULA. 
 
 This illustration shows the guarded needle, with gol 
 point and the flexible probe canula, made of pure silver. 
 
 %M*ss&sfe. 
 
 
 Portable Electric Light Outfit. 
 
 The accompanying illustration shows a portable electric 
 light outfit that is convenient and useful when examinations 
 are to be made on cloudy days, at night, or whenever sun- 
 light is not available. It has a universal attachment for con- 
 necting with either rectal, vaginal or nasal speculum, with 
 lamp ; a tongue depressor and otoscope, both with light 
 attachments, and a diagnostic lamp. 
 
 The battery has four cells and is quite durable. 
 
CONSTIPATION. 87 
 
 Constipation. 
 
 Constipation has been aptly termed "the disease of 
 civilization." This is significant but not correct, as consti- 
 pation is not a disease per se, but rather a symptom of a 
 disease, or an evidence of an abnormal condition or imperfect 
 functional action of some part of the alimentary canal. 
 
 The lesson taught by the small boy, who when asked 
 by his teacher to name the most important canal in the world, 
 replied "the alimentary," might well be impressed upon our 
 memory and our actions governed accordingly. 
 
 Dr. Jamison, of New York, in his work on Intestinal 
 Diseases, says, "As I have already said, the chief ill of 
 'civilized' people is Proctitis ; the chief symptom of proctitis 
 is constipation ; the chief symptom of constipation is dyspep- 
 sia, the chief symptom of dyspepsia is neurasthenia, and so 
 on and so on — all of them the outcome of imperfect elimina- 
 tion of morbid matter from the intestinal canal." 
 
 In a normal state, the rectum is empty ; not a receptacle 
 for feces, but a conduit during the act of defecation. Should 
 the desire for evacuation not be responded to, the feces will 
 be returned into the sigmoid cavity. Frequent repetitions of 
 this common occurrence will in a comparatively short time 
 lead to inflammation and to a certain extent a loss of normal 
 power, and instead of the feces being returned into the sig- 
 moid cavity, will distend the rectum into a more or less 
 roomy pouch, a receptacle for the fecal matter that then 
 becomes an irritant foreign body and a cause of auto- 
 toxemia. 
 
 As this matter is allowed to accumulate, its liquid and 
 gaseous portions are absorbed and the resulting hardened 
 mass, by pressure on the circulatory system obstructs the 
 flow of blood to and from the parts, causing congestion, 
 more inflammation, dilation of the veins, hemorrhoids, etc. 
 
88 CONSTIPATION. 
 
 Ever since 1496, when Gatenaria, an Italian, invented 
 an appliance for taking an enema, the harmful effects of 
 intestinal irritants, powerful cathartics and liver stimulants, 
 as remedies for the cure of constipation, have beeen recog- 
 nized. The free use of saline cathartics which cause an addi- 
 tional secretion of fluids into the intestinal canal is of little 
 more value, as the resultant loss of fluids, for the next por- 
 tion of digestible matter can only result in continued if not 
 greater constipation. 
 
 In the matter of intestinal irrigation, the use of depura- 
 tory enemas of either water or oil, or either in combination 
 with other substances, the lay public has probably for some 
 time occupied a position in advance of the profession, as it 
 is a fact that while the physician but seldom recommends a 
 systematic course of this method for the purpose of relieving 
 constipation and curing the attendant inflammation, very 
 many of the more intelligent laity practice colonic flushings 
 and general depurant procedures with scrupulous regularity. 
 Any physician who has observed the passing of the chronic 
 dyspeptic, neurasthenic, phlegmatic and hypochondriacal 
 patient and the evolution of a normal, healthy, active and 
 care-free person, from a course of intestinal irrigation sys- 
 tematically employed, must of necessity become an enthusi- 
 astic advocate of the method. 
 
 In many cases the results are little short of marvelous ; 
 in all of them sufficient benefit is derived to fully justify the 
 practice. 
 
 Irrigation of the alimentary canal is not necessarily 
 limited to the introduction of water and solutions into it 
 through the rectum, but a great deal of good can be accom- 
 plished by the regular and systematic drinking of generous 
 quantities of water. This will insure effective irrigation of 
 the assimilative and eliminative organs ; preserves health 
 when present and assists in its restoration when absent, by 
 restoring activity of the principal organs of the digestive 
 svstem. 
 
CONSTIPATION. 89 
 
 Very few realize how essential water is to digestion and 
 to the digestive canal after its function is completed. There 
 exists a great natural demand for water to carry on the 
 normal functions of the system, for both atmosphere and heat 
 draw moisture from the body and a considerable amount is 
 utilized in this manner. 
 
 An organism composed of over seventy-five per cent, of 
 water requires a generous supply for subsistence — a supply 
 equal to the expenditure of vitality involved in carrying on 
 the numerous functions of the body and brain. 
 
 The following may be followed as a fair schedule for 
 the use of water as a remedy ; using it with a view of obtain- 
 ing its physiological action. 
 
 On arising in the morning one pint of water should be 
 taken to cleanse the stomach of whatever debris remains 
 from the previous day's food and for its invigorating action. 
 The temperature of the water may be that which is most 
 agreeable, but should not be ice-cold. During breakfast, 
 which should follow during the next hour, at least half a pint 
 should be taken, more if agreeable. The idea that liquids 
 drunk during a meal weaken and impair the gastric juice 
 may influence some against this practice, yet experience 
 proves that there is really no ground for this theory, and no 
 objection to it. The water rapidly leaves the stomach and 
 does not in the least interfere with proper digestion. About 
 an hour before the noon meal a half to one pint should be 
 drunk and during the meal a similar quantity, if not produc- 
 tive of uneasiness. About four or five o'clock in the after- 
 noon half to one pint should be drunk as a cleanser before 
 the evening meal, during the ingestion of which a similar 
 quantity is disposed of. Should there be no inconvenience 
 from a full bladder during the night, a glass or two will be 
 beneficial, taken before retiring. These quantities should be 
 taken with the same regularity as is observed in taking 
 medicine, and are in addition to the water required for 
 ciuenchinsr anv thirst that mav occur during- the intervals. 
 
90 CONSTIPATION. 
 
 At first the quantities named may seem excessive to 
 some patients, and until accustomed to the great change 
 smaller amounts may be taken, but should be steadily 
 increased until the full quantities mentioned can be taken 
 without inconvenience. 
 
 It is a singular fact that constipated people drink but 
 little water. It has been suggested that this very fact is 
 responsible for their condition, but such is not entirely the 
 case. It is, however, not surprising to find constipation in 
 people who drink less than two pints of fluids daily, nor to 
 note the great change and general improvement that takes 
 place after beginning a systematic course of water treatment. 
 It is not always best to inform the patient that water is the 
 only remedial agent needed, as by so doing you are liable to 
 be called a water doctor, or a water crank, and your patient 
 will soon find some drug doctor who will heartily agree with 
 him, and continue the drug treatment they all love so well. 
 
 In order to keep your patient under observation, it is 
 well to prescribe or furnish a remedy which will serve as an 
 incentive to follow the treatment. For this purpose a tonic 
 or other remedy, should the patient be in need of it, may be 
 given at the hours mentioned, with directions to follow it 
 always with the water. Should no actual remedy be indi- 
 cated a placebo will answer very well. 
 
 Persons in health should make water drinking a habit, 
 as eating, exercising, etc. Regularity and system is as essen- 
 tial for the harmonious working of the vital organs as it is 
 for the relations of the departments in a business. Some 
 training is, however, necessary in most cases, and what is at 
 first not agreeable will in a short time become so. 
 
 Water is the most wholesome of all drinks. Wholesome 
 in the German expresses a thought even more potent. In 
 English we define the word as "Tending to promote health 
 or contributing to it," but the German "Heilsam" expresses 
 even more, "Healing, or possessing healing properties." It 
 quickens the appetite, aids and strengthens digestion, is most 
 effective in the work of elimination, prevents clogging and 
 
CONSTIPATION. * 91 
 
 removes interstitial deposits. It cleanses, irrigates, purifies 
 and invigorates. 
 
 Diseases caused by a lack of irrigation will cause an 
 accumulation or congestion of the contents of the gastro- 
 intestinal canal, and the victim of slow transit complains of 
 indigeston, biliousness, flatulency, uric acid symptoms, etc. 
 Dyspeptics of this order require a thorough internal bath 
 from above and from below. 
 
 ENEMAS. 
 When They Should be Taken. 
 
 To re-establish the normal physiological relations called 
 health, after many years of perverse relations and disorderly 
 practices, obviously requires time and intelligent attention 
 to the prescribed directions. The factors that militate against 
 the removal of curable diseases are : ( 1 ) The neglect of a 
 local disorder until it has had time to exhaust the general 
 vitality of the system. 
 
 (2) Inattention on the part of the patient after he has 
 obtained temporary or partial relief. (3) The patient arbi- 
 trarily setting his own time limit for the cure of the disease. 
 (4) Wilful disobedience of prescribed directions. (5) 
 Inability to realize the importance of having the cause 
 removed, as well as the local symptoms. (Jamison). 
 
 In all cases of proctitis or colitis, with the many attend- 
 ant symptoms and ills, no better means for relieving and 
 removing these undermining disorders can be adopted than 
 the regular practice, twice a day, of intestinal irrigation by 
 means of enemas night and morning. During the long period 
 of relaxation at night, the functions of elimination and repair 
 proceed under abnormal conditions. There may be excessive 
 fermentation and bacterial putrefaction which generate 
 poisonous gases that are absorbed and bring about the condi- 
 tion of malaise complained of on arising in the morning. At 
 this time a small enema is advisable to relieve the excessive 
 
92 CONSTIPATION. 
 
 pressure from gases and feces. Half to one pint of water 
 should be injected and expelled at once. This removal of the 
 contents -of the rectum and perhaps of the sigmoid will per- 
 mit the contents of the ascending and transverse colon to 
 pass more readily toward and into the sigmoid flexure, and 
 when half an hour or more has passed, it is time for the 
 regular and complete evacuation of the bowels by the inter- 
 nal bath or flushing of the colon. 
 
 Before retiring another small enema should be taken, 
 and at once expelled. This before-retiring enema will often 
 do so much for the patient that it will be soon found unnec- 
 essary to take the preliminary morning injection, inasmuch 
 as fermentation and gas are no longer present. 
 
 FLUSHING THE COLON. 
 
 Flushing the colon is a discovery of great value, 
 although brought to notice in an irregular way, and has a 
 place as a remedial agent with which every physician should 
 become familiar. Various devices have been exploited as 
 ideal instruments for the correct application of this means, 
 yet no special apparatus is necessary, not even the long and 
 filthy rubber tube which is known as the colon tube. This 
 article, when introduced and insinuated into and through 
 twelve or eighteen inches of the bowel is liable to cause a 
 great deal more irritation and subsequent inflammation than 
 is compensated for by the benefit derived from its use. An 
 ordinary fountain syringe with a capacity of one gallon, and 
 the ordinary small vaginal tube is all the paraphernalia 
 necessary, and is preferable to the bulb syringe, as the force 
 is entirely that of gravity. 
 
 The water used for colonic flushings should be moder- 
 ately hot, as when tepid water is used severe cramps are liable 
 to follow. The position of the body for flushing the colon 
 may be either the genu-pectoral or flat on the back with the 
 hips elevated, both feet on the floor so that an additional 
 elevation of the hips may be obtained by slight exertion. 
 
CONSTIPATION. 93 
 
 The tube should be introduced into the rectum beyond 
 the internal sphincter, the flow of water being controlled by 
 the stop cock supplied with fountain syringes, or by the hand 
 of the patient. Should the desire for evacuation become 
 irresistible after a small quantity of water has been injected, 
 the rectum should be unloaded and a second or third attempt 
 should be made. Success usually follows one or two futile 
 attempts. The quantity of water necessary to produce free 
 evacuation varies in different individuals, being a matter of 
 capacity, but averages two to three quarts. After the proper 
 amount has been passed into the bowel the patient may 
 retain it from five to ten minutes. If a diuretic action is also 
 desired it may be retained twenty to thirty minutes. When 
 retained half an hour a considerable portion of the water 
 is absorbed and immediate and copious urination is not infre- 
 quent. In these cases the action on the colon is largely lost, 
 as only a portion of the water injected is passed out through 
 the rectum. Water alone, or the addition of four ounces of 
 glycerine to three quarts of water, is all that should ever be 
 used for this purpose. 
 
 Do not imagine that a daily movement of the bowels 
 precludes impaction of the colon. The daily excreta may be 
 twenty- four to forty-eight hours over due. Stools black or 
 dark green with a foul and carrion-like odor always indicate 
 age, and flushing is indicated. The chief symptoms of auto- 
 toxemia may be said to be fermentation, flatulency, some- 
 times to such an extent as to encroach on the breathing and 
 cause acceleration of the heart and consequent vertigo and 
 headache, sallow complexion, furred tongue, foul breath, 
 muddy sclerotics, chloasmic spots, defects of vision, malaise, 
 especially on arising, and from internal pressure, dropsical 
 swelling or numbness of the lower extremities. 
 
 Bear this in mind when baffled by a stubborn headache, 
 especially of the recurrent type and among women. 
 
 As to the drug treatment in these disorders it is but just 
 to say that very often complications or conditions exist, the 
 treatment of which demand certain drugs. In our quest of 
 
94 CONSTIPATION. 
 
 knowledge and the holding fast to that which is good, let us 
 not forget nor forsake the remedies that have been found of 
 service to us. I have never been able to see any advantage 
 result from the use of aloin or podophyllin in the treatment 
 of patients having disease of the intestinal tract, particularly 
 hemorrhoids. Undoubtedly the best remedy for laxative 
 effect is cascara sagrada, given either in the form of fluid 
 extract, aromatic extract or the dry extract. Its action is 
 mild, causes no griping and produces a generous stool. Com- 
 bined with senna it is more active, yet frequently irritating 
 when disease of the bowels exists. 
 
 Glycerine is well suited as a diluent, aiding the cascara 
 by its depletive action. In atonic conditions strychnine is a 
 valuable remedy, as is well known. 
 
 Abdominal massage, following the direction of the colon 
 is of frequent benefit, as is also a systematic course of exer- 
 cise. Diet plays no small part in the action of the bowels and 
 much can be accomplished if the patient is willing to pay 
 attention to this particular. 
 
 Food which supplies but a minimum of nourishment 
 and leaves a large amount of residue should be avoided. 
 Regularity of meals is important, as is in fact regularity in 
 all things. Food known to have laxative properties, such 
 as prunes, fresh fruits, figs or dates may be taken in proper 
 quantities, also food containing large proportions of liquids. 
 The various soups, broths, bouillons, etc., need not be indi- 
 vidually mentioned. Cereals, bran bread, the new breakfast 
 foods and the like are indicated, the coarse particles of which 
 are said to cause an additional amount of peristaltic action. 
 
HERNIA. 95 
 
 HERNIA. 
 
 The Protrusion of any Viscus from its Natural Cavity, 
 through Normal or Artificial Openings in the Surrounding 
 Structures. 
 
 INGUINAL HERNIA. 
 
 A Protrusion of the Abdominal Contents through the 
 Abdominal Parietes, into or through the Inguinal Canal. 
 
 Treatment op Inguinal Hernia by the 
 Injection Method. 
 
 A Thoroughly Reliable, Practically Painless and Abso- 
 lutely Safe Treatment for a Distressing and Dangerous 
 Affection. 
 
 Although originated by a physician and surgeon who 
 stood at the very pinnacle of the profession, the treatment of 
 reducible hernia by the injection method, has, until within 
 the last decade, been practically lost to the legitimate practi- 
 tioner. 
 
 The conception and practical application of the method 
 of treating hernia by the use of injections of irritating sub- 
 stances into the inguinal canal, with a view of exciting a 
 sufficient degree of inflammation therein to cause a closure 
 thereof by the formation of adhesions, was in a former edition 
 of this work credited to Dr. George Heaton, but further 
 investigations and researches prove conclusively that the 
 honor of the discovery belongs to no other than the dis- 
 tinguished Philadelphia surgeon, Prof. Joseph Pancoast, 
 M. D., whose memory is revered by the medical profession of 
 the world. 
 
96 HERNIA. 
 
 In his "Treatise upon Operative Surgery," published in 
 1844, he records the treatment of thirteen cases of hernia by 
 this method, while Surgeon to the Philadelphia Hospital, in 
 1836, using Lugol's Solution of Iodine or Tr. Cantharides. 
 
 According to Dr. Joseph H. Warren, the date of Dr. 
 Heaton's first operation was 1840. He first practiced his 
 profession in Alton, 111., but after a short time removed to 
 St. Louis. In 1842 he located in Boston, and although he 
 had previously successfully treated hernia by this method, 
 it was in the latter city that he first came to prominence, not 
 only by the success that attended his work, but also on 
 account of a controversy between himself and a committee 
 appointed by the American Medical Association to investigate 
 the subject. 
 
 Shortly afterward he went to London and Paris, where 
 he was given a cordial reception and was invited to perform 
 his operation in various hospitals. Returning from Europe 
 he again resumed his practice in Boston, and continued his 
 work until near the time of his death, in July 1879. 
 
 Dr. Heaton, although not the originator of the method, 
 deserves much credit for taking up the work and to a certain 
 extent perfecting it. 
 
 After experimenting with the remedies used by Prof. 
 Pancoast, he discarded them and began the use of the extract 
 of White Oak Bark, and compounds of which it was the 
 chief ingredient. 
 
 Dr. Jos. H. Warren, also a Boston practitioner and 
 intimate friend of Dr. Heaton, continued the work after 
 the death of the latter, and in addition to devising a number 
 of special instruments, principally syringes and needles, made 
 some additions to the Heaton formula which, in his opinion, 
 made it more efficient and less dangerous ; for it must be 
 remembered that although many remarkable cures were 
 effected in the practice of these two physicians, their method 
 was by far more severe, and the resulting inflammation con- 
 siderably more pronounced than at the present stage of the 
 
HERNIA. 97 
 
 treatment. Their custom was to give large single injections, 
 thus causing an intense degree of inflammation, and to keep 
 the patient in bed for a period of two weeks. One treatment 
 was often sufficient to cure the hernia, yet not infrequently 
 was it necessary to repeat the injections several times. 
 
 Under such circumstances it is not difficult to under- 
 stand that prospective patients soon began to rate this opera- 
 tion with those of major surgery, and considering the pain 
 caused by the introduction of the heavy spiral needles used, 
 preferred an anesthetic and the radical operation by the knife. 
 
 After reading Warren on "Hernia" and treatment by 
 the method of sub-cutaneous injection, as he called it, one 
 cannot fail to receive the impression that although he had 
 performed the operation many times and cured numerous 
 persons, he was constantly in dread of ill effects. This is 
 shown by his hesitancy in urging others to take up the work, 
 and the constant references to the necessity of extreme 
 caution. He also condemned the use of the ordinary sharp 
 hypodermic needle, and referred to the liability of penetrat- 
 ing the epigastric artery. 
 
 The success attending the modern methods of giving 
 injections, viz: with a sharp needle plunged through the 
 pubic tissue, and the utter impossibility of injuring any 
 vessels of the canal, prove that his fears were unfounded 
 even under ordinary precaution, and with but a fair knowl- 
 edge of the subject. Elsewhere in this volume explicit yet 
 simple directions are given, which if followed render the 
 operation, if so simple a procedure can be so termed, entirely 
 void of the slightest danger. 
 
 Contemporary with Warren, among those who mani- 
 fested interest in this method of treating inguinal hernia. 
 Drs. Davenport, Janney, J. Mason Warren, and others of 
 more or less prominence might be mentioned. 
 
 As previously stated, notwithstanding the high profes- 
 sional standing of these and other physicians, the method 
 was not endorsed by the profession at large and for a number 
 of years little or nothing was heard of it. The unsatisfactory 
 
98 HERNIA. 
 
 termination of the conference between Dr. Heaton and the 
 committee appointed by the A. M. A. to investigate the 
 method, due chiefly to the inclination of Dr. Heaton to retain 
 the secret he claimed to have discovered, may also in a 
 measure have contributed to the decline of interest along 
 this line of work. 
 
 Within the last decade, however, this method has been 
 revived and has received the attention it merits at the hands 
 of intelligent and careful practitioners, until it to-day occupies 
 a place among the few certainties in medical or surgical 
 practice. Much of the opposition that is found against this 
 method originates in a similar manner to that existing against 
 other well known and reliable forms of treatment for numer- 
 ous diseases, i. e., its use by irregular practitioners. It is 
 however true, and I believe quite generally conceded 
 that this class of practitioners have been largely responsible 
 for the general awakening on this subject that is apparent 
 to even the casual reader of medical literature. 
 
 This manifest interest in the subject, now entertained 
 by men of high professional and unquestioned ethical stand- 
 ing, is now rapidly assuming the characteristics of a boome- 
 rang to the irregulars, in as much as it is reclaiming to the 
 general practitioner a class of business which formerly was 
 almost exclusively in the hands of the class of practitioners 
 before mentioned. This is precisely as it should be, as the 
 general practitioner who will give the subject the necessary 
 attention to become familiar with the details of the treatment, 
 can apply the same with the same degree of success that 
 attends the specialist in this work, and bring it within the 
 reach of a larger number of unfortunate sufferers. 
 
 Prior to the perfection of this method of treating hernia, 
 neither medical, surgical nor mechanical skill could produce 
 anything toward the alleviation of persons thus afflicted, 
 beyond an uncertain and actually dangerous operation, or 
 a more or less uncomfortable truss. 
 
HERNIA. 99 
 
 Makers of trusses frequently claim curative action for 
 their ware, but unless in very small or recent cases these 
 statements are not supported by facts ; facts that can be 
 confirmed in the experience of any practitioner. That the 
 truss has proved a failure as a curative agent, is now admit- 
 ted by practically all except those interested in their sale. 
 While hitherto it has been the only resort of the ruptured, 
 the continual pressure on the parts, by exciting a certain 
 degree of inflammation about the region of the external ring, 
 frequently causes a closing of this opening, leaving an in- 
 complete hernia behind it ; in reality a more complicated 
 affair than at its first appearance. 
 
 The principle of the injection method is the same as 
 that of the radical cure operation ; that of closing the canal 
 and preventing the descent of the bowel, membranes, or 
 both, but it possesses the advantage over the former method 
 in that it affords perfect safety, freedom from pain, no 
 detention from business or labor, fully 90 % of cures in 
 cases to which it is adapted, and what to many is a consoling 
 assurance, if it does not cure, it will do no harm. 
 
 When it is remembered that competent statisticians have 
 informed us that the number of persons afflicted with either 
 of the various forms of hernia, equal, if not exceed one-tenth 
 of the male population, the vast amount of clinical material 
 that is allowed to drift to the dealer in trusses, can easily be 
 imagined. 
 
 ADAPTABILITY. 
 
 Any form of reducible hernia is adapted to this method 
 of treatment, providing a truss can be obtained that will 
 retain the same under ail conditions and circumstances. 
 Perfect retention must absolutely be maintained in order to 
 obtain perfect results, and if the treatment is properly applied, 
 every failure of cure can be traced to negligence in this 
 particular, if the truth is told. Size of hernia, length of 
 time it has existed, and age of patient, while to a certain 
 extent determining the outcome, are all secondary to this one 
 
IOO HERNIA. 
 
 essential ; perfect and continual retention. Without this no 
 cure can be effected. The case may be greatly benefited, 
 but it cannot be cured. Impress this point on every patient. 
 Presuming that retention is perfect the vast majority of 
 hernia patients can be cured. The time required will vary 
 and will be determined by the age of the patient, size of 
 hernia, variety of hernia, occupation of patient, tension of 
 abdominal walls, condition of canal and obedience of instruc- 
 tions. Recent and small herniae are obviously more readily 
 cured than those of long standing and large size. If the 
 physician employing this method of treatment wishes to 
 guarantee a cure in every case accepted for treatment, care- 
 ful selection of patients should be practiced, and no positive 
 assurance given until after the truss has been worn for 
 several weeks and retention found perfect. In every com- 
 munity one or more individuals will be found who are noted 
 for the large herniae they have, the size of which is often 
 astonishing. I have been consulted by persons with double 
 hernia as large as half their abdomen, where there was no 
 trace of internal or external ring, and all signs of a canal 
 obliterated ; the scrotum enlarged to the size of a gallon 
 measure or more, being in fact a part of the abdomen. To 
 attempt to treat cases of this sort, or even of much less 
 gravity, is folly. On account of this method of treatment 
 not being adapted to all cases of hernia, physicians opposed 
 to it do not hesitate to condemn it, not thinking of the many 
 instances under other circumstances i in which they make an 
 effort to relieve a patient, knowing that a cure is impossible 
 in the particular case under treatment. 
 
 It is a fact worthy of mention, and I think of congratu- 
 lation, that the physicians who oppose this treatment are 
 usually ignorant of its technique, or being surgeons, recog- 
 nize the inroads it will eventually make on the radical cure 
 operation. 
 
 Barring the extremely large herniae referred to, and 
 those of moderate to large size which cannot be perfectly 
 retained within the abdomen, I do not hesitate to make the 
 
HERNIA. IOI 
 
 assertion that fully 90 % of cases are curable, and more than 
 95 % will be decidedly benefited. I base my assertions on 
 my experience in a practice largely devoted to this specialty, 
 having treated a large number of patients. 
 
 TIME REQUIRED FOR A CURE. 
 
 As before stated, the time required to effect a cure will 
 vary in different cases. Recent and small herniae are cured 
 in from four to six treatments, while the hernia that has 
 existed for a longer period, and which is of larger size, will 
 require from eight to twelve, or more injections. Patients 
 are usually treated once a week, or as soon as the effects of 
 the former injection have disappeared. If inconvenient for 
 the patient to make his appearance weekly, longer intervals 
 may be allowed. This does not interfere with the cure, but 
 necessarily retards it. No detention from business or labor 
 is necessary, and yet if the patient is occupied at labor 
 requiring heavy lifting, it is well to caution him and advise 
 moderation, if possible. Running, jumping, dancing or other 
 active exercise, when unnecessary, should be avoided as 
 much as possible. 
 
 THE SYRINGE AND NEEDLE. 
 
 As far as I have been able to ascertain, all individuals or 
 companies who are engaged in the sale of private formulae 
 and fluids for curing hernia, have special syringes for sale, 
 which naturally are recommended as being the best on the 
 market and essential to success. I have found these state- 
 ments contrary to facts, and my experience leads me to 
 believe that while the instruments they offer are of good 
 quality and may be used with satisfaction, they are by no 
 means necessary to insure success. The prices at which they 
 are sold are usually double their real value, and bearing this 
 fact in mind, the object of their manufacture is apparent. 
 
 The injections may be given with an ordinary hypoder- 
 matic syringe, provided with a set screw on the piston by 
 which the quantity of the fluid injected can be regulated. 
 
102 HERNIA. 
 
 The needle should be longer and heavier than the ordinary, 
 so as to be long enough to penetrate the pubic tissue, and 
 strong enough to avoid the possibility of breaking during 
 the operation. I find some additional advantage in having 
 a syringe somewhat heavier than ordinary, as it gives a 
 greater firmness in manipulation. 
 
 A syringe with supports at the piston end, by which it 
 may be grasped by two fingers gives a comfortable steadi- 
 ness and makes slow and careful injection more certain. 
 
 HERNIA SYRINGE AND NEEDLE. 
 
 These syringes, together with two suitable needles, can 
 be furnished by instrument dealers at a small advance over 
 the ordinary instrument. Three dollars is amply sufficient 
 to cover the cost of a good, heavy syringe and a pair of extra 
 long and heavy needles. 
 
 There are several varieties of hernia needles in the 
 market, but these are intended especially for introduction 
 through the scrotum, and are made on the trocar and canula 
 order, the point being protected by the sheath after the skin 
 of the scrotum has been pierced, and then by gentle manipu- 
 lation is passed up through the canal to the point at which 
 the fluid is to be deposited. This method of introducing 
 the needle has never commended itself to me, and it is some- 
 what gratifying to note that one of the more prominent 
 physicians interested in this treatment, and who devised a 
 special needle for introduction through the scrotum, has 
 now also come to the conclusion that the direct introduction 
 
HERNIA. 103 
 
 through the pubic tissue is the better of the two. In certain 
 cases, where there is either a difficulty in invaginating the 
 canal or in plunging the needle through the integument and 
 fibrous edges of the muscles, the needle can advantageously 
 be introduced through the scrotal wall. A sheathed needle 
 should always be used when this is done, as it is practically 
 impossible to pass the needle up to the point at which the 
 fluid is to be deposited, with the point of the needle exposed. 
 
 THE TRUSS. 
 
 Bearing in mind the importance of perfect retention, 
 the selection of a truss deserves special consideration. During 
 the several years in which I have paid special attention to 
 the treatment of hernia and the fitting of trusses, I have made 
 a special effort to become familiar with the different styles 
 of trusses on the market, and I have examined and used 
 nearly all of them with a view of arriving at some conclusion 
 as to the best one to use. 
 
 The wire spring truss, in my opinion, more fully meets 
 the requirements of an ideal support than any other, and it 
 is this style that I now exclusively employ, except in very 
 small or easily retained herniae, where I use the elastic. 
 
 There are a number of trusses on the market which 
 embody the wire spring principle, yet are faulty in detail and 
 absolutely worthless for practical use, especially in connec- 
 tion with the treatment of hernia by injection, where the 
 most rigid care and accuracy is necessary. 
 
 Since the publication of the second edition of this work 
 I have devised and have had manufactured a truss which in 
 my opinion embodies all that can be desired of a perfect and 
 practical appliance. It has been with some reluctance that 
 I have taken this step, for fear of having my motives 
 questioned or misconstrued, as according to the tenets of the 
 profession, a physician cannot embark to any great extent 
 into any enterprise without having the cry of commercialism 
 raised. 
 
104 HERNIA. 
 
 Commercialism, which I believe is defined as the legiti- 
 mate chase after the elusive dollar, is however more or less 
 interwoven with the other commendable characteristics of 
 the human race, and without it the physical decay and 
 destruction of our nation itself could be presaged. 
 
 To withhold any useful article or contrivance from 
 those for whom it is intended and whom it would benefit, for 
 fear of being accused of being commercial, is undoubtedly 
 unwise, and it is difficult to make the distinction between 
 having an article marketed by dealers and receiving a royalty 
 on sales, or to attend to the filling of orders personally. 
 Having therefore considered the subject in the various lights, 
 I have reached the conclusion that the best interests of those 
 who choose to favor me with their patronage, and my own 
 as well, will be best served by the course I have chosen, and 
 I therefore recommend the Albright truss to the exclusion 
 of all others purporting to be similar in construction and 
 involving the same principle, and will supply the profession 
 according to demand. 
 
 This truss does not encircle the body as do the hard 
 rubber spring trusses, but the rear pad rests in the depres- 
 sion behind the greater trochanter, while the retaining pad 
 rests over the location of the hernia. 
 
 The wire spring passes from one to the other over the 
 crest of the ilium. Two bands of webbing encircle the 
 body and fix it firmly in its position. 
 
 The device for adjusting and holding the pad in its 
 proper position is an improvement over the older patterns and 
 consists of a series of grooves on the spring into which 
 similar grooves on the clasp fit, while a set screw insures 
 absolute rigidity. 
 
 The rear pad is attached by means of a ball and socket 
 joint which is self adjustable under all conditions and in 
 all positions. 
 
 The desirable features of this truss are: It gives that 
 necessary upward and inward pressure which more than any 
 other retains a hernia properly. Mere inward pressure is 
 
HERNIA. I05 
 
 not sufficient, while the downward pressure sometimes 
 obtained from trusses which have lost their shape is decidedly 
 injurious. With this truss such deviation from the correct 
 pressure is impossible. The pad rests, when properly 
 adjusted, over the inner ring and not over the outer ring 
 as is the case with many; it is easily adjusted to variations 
 in the shape of different persons whose circumferential 
 measurements are the same ; it is comfortable to the wearer 
 from the very moment of its adjustment. Being so radically 
 different from the usual style of trusses, patients will 
 frequently imagine that it must of necessity be uncomfort- 
 able, yet they can be assured that such is not the case. Apart 
 from an occasional chafing due to a slight curve of the body 
 which may have been overlooked in fitting, but which can 
 be readily overcome, no difficulty exists from this cause. 
 
 Last but not least, is the assurance that when once 
 properly adjusted it cannot possibly move from the seat of 
 the hernia, regardless of the position of the wearer. So 
 firmly indeed is it held in position that it is with difficulty 
 that the proper adjustment is disturbed without loosening 
 the bands, even when attempting to do so. 
 
 VARIETIES OF PADS. 
 
 The pads with which my truss may be equipped com- 
 prise all the usual styles and in addition a new style of spring 
 pad. This consists of an oblong border of leather covered 
 rubber and a distinctly separate oblong central hard rubber 
 pad which adjusts itself to the various degrees of pressure 
 by means of an enclosed spring. Being automatic in its 
 action it is especially valuable in cases where undue strain- 
 ing is liable to occur, as in lifting, coughing, etc. As a pad 
 suitable to all cases it is perhaps the most desirable. In 
 addition, the hard rubber, cedar, water and coil spring can 
 be furnished. Elastic trusses fitted with either of these pads 
 can also be furnished. 
 
 One occasionally meets with a hernia of such magnitude 
 or irregularity that no ready-made contrivance will retain it, 
 
io6 
 
 HERNIA. 
 
 nor can one be devised in all cases, yet as this subject is 
 here viewed only in the light of rendering a hernia amenable 
 to treatment by the injection method, the subject of special 
 appliances need not be discussed, as it is safe to assume that 
 as a rule, any hernia that cannot be retained by my truss and 
 the pads with which it is regularly fitted, is not a suitable 
 case for treatment. In a somewhat extensive practice of this 
 specialty I have treated but few cases in which other than 
 the regular equipment was required. 
 
 THE ALBRIGHT TRUSS, SHOWING NEW AUTOMATIC SPRING PAD. 
 
HERNIA. 
 
 IO; 
 
 When a suitable truss is worn by the patient when he 
 applies for treatment, no matter what its style, if it fulfills 
 the requirements and retains the hernia perfectly, no change 
 is advised. 
 
 See illustrations of truss and note particularly the posi- 
 tion of the truss on the body. Proper and exact fitting is 
 essential to success. The size of the truss required will be 
 found by measuring the circumference of the body on a line 
 with the point at which the hernia first appears. 
 
 THIS ILLUSTRATES THE POSITION THE TRUSS SHOULD OCCUPY 
 
 WHEN PROPERLY ADJUSTED. 
 
 FRONT VIEW. 
 
io8 
 
 HERNIA. 
 
 THIS ILLUSTRATES THE POSITION THE TRUSS SHOULD OCCUPY 
 
 WHEN PROPERLY ADJUSTED. 
 
 REAR VIEW. 
 
 THIS ILLUSTRATFS THE MECHANISM OF THE NEW 
 AUTOMATIC SPRING PAD. 
 
 Explanation of Cut. — The central hard rubber oral pad 
 G, is suspended on the coil spring E, which is attached to the 
 button shank B, and all attached t'< the fixed plate C. This 
 Suspension of the pad in the center of a fixed , soft rubber ring 
 cushion F, permits a gentle and beneficial extra pressure on 
 the internal ring without the risk of the pad sinking in too 
 far. Its action is entirely automatic. 
 
HERNIA. IO9 
 
 FLUIDS FOR INJECTION. 
 
 When one considers the numerous compounds used, all 
 of different composition, by the many successful hernia 
 specialists, but one impression is made and but one conclusion 
 can be reached; that the application of the treatment; the 
 method of injecting; the technique of the operation; are 
 undoubtedly of more importance than the fluid used. In 
 other words, no matter what the composition of the fluid, if 
 the injections are not properly made the result will be 
 unsatisfactory; yet on the other hand it is also true that no 
 matter how skillfully the treatment is applied, unless the 
 fluid used be a proper one, the result will also be disappoint- 
 ing-. It is probably true that one could name a hundred 
 drugs which could rationally be incorporated into a fluid for 
 the injection treatment of hernia, and it is only by experi- 
 ment and observation that the compounds most successfully 
 employed are suggested and perfected. While injections of 
 alcohol, iodine, creasote, sulphate of zinc and other single 
 remedies may cure a case now and then, it must not be 
 inferred that uniform success will follow their use in a num- 
 ber of cases, as repeated trials will prove to the satisfaction 
 of any one who is of the opinion that any irritant will suf- 
 fice. In selecting ingredients with which to compound a 
 fluid that will yield satisfactory results in a large percentage 
 of cases, certain essential indications must be met, namely : 
 a proper degree of irritation must be produced to cause a 
 sufficient quantity of plastic exudation ; hardening of the tis- 
 sues after the exudation so as to render re-absorption impos- 
 sible ; solidification of the exudate and its stimulation to tissue 
 formation ; a certain degree of anesthesia ; and always, 
 asepsis. 
 
 The fluids used by the early operators who employed 
 this method of curing hernia, were, as before stated, more 
 or less crude and unsatisfactory. The results were not only 
 unsatisfactory in many cases, but frequently the reaction was 
 
110 HERNIA. 
 
 such that its general use was abandoned on account of the 
 dangers attending it. 
 
 In the light of more recent investigation and experiment, 
 our knowledge of chemistry has been called to our aid, and 
 substances which by themselves would be worthless or harm- 
 ful, may by skillful combination be rendered safe and useful 
 agents. 
 
 The following formulae for hernial fluids are those 
 upon which I now most rely and employ to the practical 
 exclusion of all others, except for the purpose of experi- 
 ment. Neither of them was perfected in a day, but by many 
 trials and experiments, both clinically and chemically, during 
 a period of seven years or more, their present state of perfec- 
 tion was attained. These fluids have been used by several 
 hundred physicians whom I have supplied, and every claim 
 I have ever made has been substantiated and endorsed by 
 many of them. I therefore do not hesitate to commend them 
 to the profession as worthy of their confidence. 
 
 The following is the formula of 
 
 Universal Hernial Fluid No. i. 
 
 1^ Sulphate of Zinc 3 j. 
 
 Carbolic Acid, cryst gr. xl. 
 
 Guaiacol n\ lx. 
 
 Powd. Cantharides gr. xxv. 
 
 Fl. Ext. Quercus Alba fl. % j. 
 
 Fl. Ext. Hamamelis Virg fl. % j. 
 
 Glycerite of Tannic Acid fl. 5 j. 
 
 Glycerine, C. P q. s. ad. fl. % v. 
 
 Mix as directed. 
 
 Mix the carbolic acid and guaiacol with the glycerine 
 and transfer into an eight ounce bottle. Triturate the sul- 
 phate of zinc and cantharides separately until reduced to a 
 fine powder and add these, with the other ingredients, to the 
 contents of the bottle. Mix thoroughly and place the bottle 
 
HERNIA. 1 1 I 
 
 at some convenient point and shake the mixture three or 
 four times a day for at least thirty days, when it may be 
 filtered and is ready for use. 
 
 All utensils used in its manufacture should be 
 thoroughly sterilized, as the introduction of germs into the 
 inguinal canal is no doubt a frequent cause of the serious 
 inflammation sometimes reported by physicians using fluids 
 which have been extemporaneously or carelessly prepared. 
 The presence of carbolic acid or guaiacol in a fluid is not 
 sufficient to render it sterile, as certain bacteria flourish in 
 the presence of carbolic acid, and the necessary precautions 
 must be taken in its manufacture if all possibility of infection 
 would be avoided. 
 
 The entire absence of the slightest unpleasant effect from 
 the use of fluids prepared by myself is perhaps largely due 
 to the care exercised in their manufacture. 
 
 The following is the formula of 
 
 Universal Hernial Fluid No. 2. 
 
 J£ Sulphate of Zinc 5 j. 
 
 Carbolic Acid, cryst n\ xl. 
 
 Creasote -^ i XX x. 
 
 Fl. Ext. Thuja Occ fl. 5 ss. 
 
 Fl. Ext. Ouercus Alba fl. % j. 
 
 Fl. Ext. Hamamelis Virg fl. 5 ij. 
 
 Glycerine, C. P q. s. ad. fl. 5 v. 
 
 Mix as directed. 
 
 Mix the carbolic acid and creasote with the glycerine 
 and transfer into an eight ounce bottle. Triturate the sul- 
 phate of zinc until reduced to a fine powder and with the 
 fluid extract of white oak and other ingredients, add to the 
 contents of the bottle. Mix thoroughly and place the bottle at 
 some convenient point and shake the mixture three or four 
 times a day for at least thirty days, when it may be filtered 
 and is ready for use. 
 
 Note. — The creasote used is not beechwood creasote, 
 
112 HERNIA. 
 
 but that obtained from the destructive distillation of coal tar. 
 Some physicians located in the West have written me stating 
 that the article could not be obtained, yet as it is so common 
 in the East it seems hardly possible. In this section all drug- 
 stores sell it as a remedy for toothache. 
 
 The same precautions should be taken in the manufac- 
 ture of this fluid as in the preceding one. 
 
 The purpose of allowing the mixture to stand for thirty 
 days before filtering is to allow the chemical changes to take 
 place, as for example between the zinc sulphate, carbolic 
 acid and the tannin in the white oak and witch-hazel, and in 
 the glycerite of tannin in fluid No. I ; and to prevent pre- 
 cipitation after filtration. If filtered shortly after the mixture 
 is made there will be considerable precipitation within a few 
 days thereafter. 
 
 In as much as I here mention two fluids for injection, 
 the question will naturally arise, when shall No. I be used ; 
 when shall Xo. 2 be used; which is the better of the two; 
 why not use only one fluid? etc. 
 
 Answering these questions is a task in which one may 
 find difficulty in expressing himself clearly, as practical 
 experience is the only real and true guide. 
 
 My experience with both fluids has been quite extended 
 and results so eminently gratifying, that were I asked to 
 select one and use it exclusively, the choice would cause me 
 considerable concern. 
 
 Either fluid is adapted to all cases, and all curable cases 
 will be cured by the use of either fluid. The difference how- 
 ever is this ; Fluid No. 1 is more irritating and causes rather 
 more exudation than No. 2. This is chiefly due to the Can- 
 tharides which it contains ; also more astringent on account of 
 the larger quantity of Tannic acid, as the No. 2 fluid con- 
 tains no tannic acid other than that furnished by the fluid 
 extracts of white oak and witch-hazel. For these reasons 
 No. 1 is more especially indicated in the treatment of older 
 persons, or in cases where the hernia has existed for many 
 
HERNIA. II3 
 
 years and caused the surrounding tissues to become more 
 hardened and fibrous. 
 
 In these cases the irritation necessary to produce the 
 required exudation must be stronger than in young and 
 recent cases, where these changes have not yet occurred. 
 One may however also occasionally find one of the latter 
 cases in which the exudation, inflammation and usual tender- 
 ness is not developed by the quantity of No. 2 usuallv 
 injected, and in these cases it is also recommended that the 
 No. 1 fluid be substituted. While larger injections of No. 2 
 would have practically the same effect, causing a relatively 
 greater amount of irritation, there is this objection; when 
 the quantity injected is too large, the law of gravitation 
 asserts itself, and the fluid, instead of remaining permanently 
 at the desired point, gravitates either downward into the 
 scrotum, or if the patient is lying on an operating chair 
 with the head lower than the feet (as described later on), it 
 may flow into the abdominal cavity. Neither of these cir- 
 cumstances would give rise to any reasons for alarm, as the 
 fluid being aseptic, would do no harm, merely exciting 
 an innocent inflammation, but not being part of the treat- 
 ment, such irregularities are to be avoided. 
 
 Summarizing then, the difference between the fluids is 
 practically a matter of strength. The same results will be 
 attained by the use of either fluid if the dosage is regulated. 
 No fixed rule for dosage can be given. Certain cases will 
 be cured by the average injection of three minims, while 
 others will require an average of ten. When an injection 
 of ten to fifteen minims of Fluid No. 2 is not followed by the 
 proper degree of reaction, it may be still further increased,. 
 or Fluid No. 1 resorted to and given in five to ten minim 
 doses. If Fluid No. 1 be used in the beginning of a case,, 
 and the quantities injected do not produce too much inflam- 
 mation, no change will be necessary. Fluid No. 1 can be- 
 adapted to the use of all cases, attention being given to- 
 dosage. No. 2 is recommended in children or in cases where 
 small doses of the other irritate too much. As the physician 
 
114 HERNIA. 
 
 becomes familiar with the treatment, and bears in mind 
 that the dose of any fluid, no matter what its composition, 
 is to be regulated by the effect produced by former injec- 
 tions, he will have no trouble whatever, but he will be 
 entirely guided by his good judgment. 
 
 Physicians who do not have the facilities or inclination 
 to prepare fluids according to my formulae, can obtain either 
 fluid, prepared according to the methods described, at the 
 rate of One Dollar per bottle, containing one ounce of fluid. 
 Sent prepaid by mail. . This quantity will be sufficient to 
 treat six or more patients. 
 
 I claim no proprietary interest in either of my fluids, 
 and any one possessing ordinary skill in compounding medi- 
 cines can prepare them properly, due caution being observed 
 in the purchase of the ingredients. My only claim is that 
 when prepared by myself they are guaranteed to be accurate, 
 clean, effective, and as reliable as pure drugs and careful 
 attention to detail can make them. Less quantities than the 
 above will not be sold, as the fluids are prepared in large 
 quantities and immediately bottled and sealed. 
 
HERXIA. 115 
 
 DIRECTIONS FOR TREATMENT. 
 
 Technique of the Operation. 
 
 GENERAL DIRECTIONS. 
 
 First, if the patient is not already supplied with a well 
 fitting truss, one that perfectly retains the hernia under all 
 conditions and circumstances, procure one that will do so. 
 If the patient does not already wear a truss, have him do so 
 for a few weeks before beginning the treatment. If the her- 
 nia exhibits a tendency to protrude during the night while 
 the patient is in bed, the truss must be worn constantly. If 
 the day truss should prove uncomfortable at night, an elastic 
 support may be substituted. If there is no such tendency, 
 the truss may be removed after lying down, but it must be 
 replaced before rising. Do not begin the treatment until the 
 patient tells you that the hernia never comes down, as it 
 will be useless to try to close the canal as long as the hernia 
 occasionally descends and again opens and distends it. After 
 the treatment is begun it is a good plan to have the patient 
 wear a light support while in bed. This support may be 
 either an ordinary elastic truss or a homemade appliance. 
 A simple device of this kind can be made by sewing a lump 
 of lead, half spherical in size, between two pieces of cloth, 
 made to encircle the body, with an under strap to keep it in 
 place. The lead can be molded in this fashion by pouring 
 the molten metal into a dry cup and allowing it to cool. 
 Place the round side inwards. I formerly did not insist on 
 this detail, but experience has taught me that the procedure 
 is a wise one. Patients, when informed that a truss need 
 not be worn when in bed, are liable to form the opinion that 
 as long as they remain in bed, whether in the upright or 
 horizontal position, the truss can be laid aside. Of course 
 the more intelligent patients will understand what is meant, 
 
Il6 HERNIA. 
 
 but many will interpret your directions literally. As an 
 illustration, I will mention a case that gave me considerable 
 trouble. I could get no clue to the secret until inadvertently 
 the patient informed me that the hernia gave him "some 
 trouble" while cohabiting. In this case, because he was in 
 bed at the time, he followed my instructions and did not 
 wear the truss. I now instruct all male patients to wear the 
 truss when this act is performed. 
 
 TREATMENT. Place the patient in a reclining posi- 
 tion, remove the truss and clean the pubes with some anti- 
 septic solution. If the hernia shows a tendency to descend 
 during this manipulation, tilt the chair or table backward 
 sufficiently, raising the feet higher than the head, until 
 the hernia slips into the abdomen. Now draw fluid into 
 your syringe, exclude the air by elevating the needle and 
 pressing the piston until a drop of fluid escapes without bub- 
 bling, wipe the needle clean of fluid, set the set screw on the 
 piston to the amount you wish to inject, invaginate the canal 
 with the forefinger of the left hand, introduce the needle 
 through the pubic tissue into the canal with the right hand, 
 and make the injection at the point indicated in the special 
 directions. Remove the needle, massage the parts for a 
 minute, replace the truss and let the patient go about his 
 business. The operator, if right handed, should stand on 
 the left side of the patient, whether operating on either a 
 right or a left hernia. If left handed, the opposite applies. 
 Before inserting the needle, grasp the integument with the 
 forefinger in the canal and the thumb of the same hand and 
 elevate them slightly. This allows a space between the 
 finger and the floor of the canal, on which the cord and 
 vessels lie, and prevents all danger of injuring them. Pass 
 the needle in a lateral direction through the pubic tissues, 
 directly beyond the end of the inside finger, until the needle 
 has entered the canal. This can be determined by directing 
 the point, now inside, toward the end of the finger. If cor- 
 rectly located, there will be nothing between the finger in the 
 
HERNIA. 
 
 117 
 
 THIS ILLUSTRATES THE METHOD OF GIVING THE INJECTIONS 
 IN THE TREATMENT OF HERNIA. 
 
 canal and the needle point, but the scrotum which was 
 brought up with it. The prick of the needle can easily be 
 felt on the finger of the operator. 
 
 After the injection has been made, withdraw needle, 
 return the fluid remaining in the syringe into the vial, cleanse 
 the needle by drawing a little alcohol through it and place it 
 in either a solution of carbolic acid or a fresh and clean piece 
 
Il8 HERNIA. 
 
 of absorbent cotton. Before using the needle and syringe 
 again, cleanse with alcohol in the manner just mentioned. 
 
 A short time after the injection has been made, the 
 patient will experience a feeling similar to a bruise at the 
 point at which the injection has been made, which will con- 
 tinue for several days. This is due to the irritation caused 
 by the fluid and the resulting inflammatory action. This 
 inflammation causes the exudation necessary for the healing 
 process. The amount of inflammatory action differs in differ- 
 ent persons, and it should be merely sufficient to cause a 
 moderate amount of uneasiness, and not sufficient to inca- 
 pacitate the patient. In giving the dosage of the fluid I 
 shall specify minims, not drops. One minim of an alcoholic 
 fluid is not the same as one drop, and it varies also accord- 
 ing as to whether the fluid is dropped from a graduate or 
 through needles of different caliber. According to the needle 
 I use, one minim is equal to five drops as they fall from the 
 needle. This is, however, unimportant. The piston of the 
 syringe being graduated and being supplied with a set screw, 
 the number of minims can be accurately ascertained. No 
 matter which fluid is used, always begin with one minim, or 
 even less, and note the result. Ask the patient to return in 
 a day or two, and if there is no inflammatory action worth 
 noting, repeat the injection, giving two minims, and again 
 ask him to report in a few days. Be guided by the effect 
 produced and repeat or not according to the condition of the 
 patient. Never inject when there is inflammatory action 
 present. In this manner the dose can be regulated, and 
 when the quantity that causes the proper amount of soreness 
 is ascertained, continue that dose until its effects are less 
 marked, when another increase can be made. In the 
 majority of cases, four to five minims will be sufficient to 
 produce the desired action, and yet occasionally a person will 
 be found in whom ten to fifteen minims have to be used in 
 order to do this. If the inflammatory action is such that the 
 patient cannot exercise freely and follow his usual occupa- 
 tion, the dose given was too large, and less must be given in 
 
HERNIA. 119 
 
 the future. Cases in which the inflammation has been 
 unusually strong will be found well advanced toward the 
 cure, after it subsides, which it will do after twenty-four to 
 forty-eight hours. This is the compensation for the incon- 
 venience experienced. Beyond the discomfort of the patient, 
 there is no undesired effect. After the effects of one injec- 
 tion have worn off, another may be given, no matter whether 
 it is in three days or two weeks. Instruct the patient to 
 report as soon as the soreness has disappeared, when you will 
 again treat him. No interference with the ultimate cure 
 will be experienced if the injections are given at longer inter- 
 vals than as indicated by the disappearance of the soreness, 
 but the period in which the cure will be effected will neces- 
 sarily be lengthened. Should sympathetic swelling occur in 
 either the cord or adjacent structures, no alarm need be felt. 
 Injury to the cord or vessels is impossible if directions for 
 introducing the needle are followed. If it should occur 
 through clumsy work at this point, and much swelling 
 occur, treat as you would inflammation anywhere. I have 
 never seen a case of this sort, but have heard of it through 
 other writers. 
 
 In the Female the same general rules apply, but invagi- 
 nation can scarcely be accomplished. In large herniae a 
 manipulation that approaches invagination can be prac- 
 ticed, but in the smaller cases this is impossible. Here the 
 round ligament is used as a guide for depth, and after grasp- 
 ing the integument with the forefinger and thumb of the 
 left hand, pass the needle through it from above downward 
 on a line with the body, so that after the needle has pierced 
 the tissues and passed through them, the point will be located 
 under the finger and thumb. 
 
 After the needle has been introduced, still elevating the 
 tissues, raise the syringe so that it will be at right angles to 
 the body, pointing directly downward. The injection should 
 always be made where the protrusion first appears, and the 
 needle should be introduced directly over this spot. This 
 point should be marked with a blue pencil while the patiert 
 
120 HERNIA. 
 
 is standing, so as to easily locate it while lying down. The 
 round ligament can easily be located by its tough, cord-like 
 touch. 
 
 The injection should be made at about the same depth 
 as this ligament is felt. While women are not as easily 
 treated as men, the operation is not at all difficult, and if 
 properly injected, they will be cured in less time than a simi- 
 lar hernia in a man, as the hernial canal is usually smaller. 
 Flabby abdominal walls render a cure more difficult and 
 tedious. 
 
 After four to six injections have been made, or more 
 in large and long standing cases, and the hernia has not been 
 down during that time, and there is reason to suppose that 
 the treatment has progressed favorably, a test may be made. 
 Be sure to instruct the patient not to dare to make an effort 
 to test himself during the treatment, but insist that he fol- 
 low instructions in this particular explicitly. The manner 
 of making a test is similar to the diagnosis of hernia. The 
 first test should be made while the patient is lying down. 
 Remove the truss and instruct the patient to cough. If no 
 impulse is noted while in this position, the patient may rise 
 and the experiment be repeated. Always press your hand 
 firmly against the parts while the patient coughs for a test, 
 so that in case there should be a weakness present, the her- 
 nia would not descend and thus do considerable damage to 
 the adhesions which had formed. If no impulse is noticed 
 while patient coughs while standing, the treatment may be 
 discontinued temporarily, but the patient instructed to con- 
 tinue wearing his truss for a month or more, and report at 
 the end of that time. The night support may now be dis- 
 continued. After a month the patient is again tested, and if 
 no impulse is felt, the case may be discharged with direc- 
 tions to wear the truss for another month while at work, if 
 a laboring man, but to remove it while about the house or 
 when not at work. After that time it may be discarded 
 altogether. If the patient's occupation is of a light nature, 
 
HERNIA. 121 
 
 the truss may be discarded entirely after wearing it a month 
 after the test. 
 
 In case an impulse is noticed when the test is made, the 
 treatment must be continued as before, and occasionally 
 tested until the desired results are obtained. 
 
 After a few injections are made, small nodules will be 
 noticed to be forming in the canal. This is as it should be, 
 and represents the new tissue formation which is taking 
 place and which is necessary to the closure of the canal. In 
 large herniae, where the canal is more distended and the 
 surface much larger, two injections may be given at one 
 visit, one nearer the outer margin of the ring, and the other 
 more toward the inside. Young and middle aged persons 
 make the best subjects, although persons well advanced in 
 years can be cured if sufficient time is allowed. Old per- 
 sons usually require larger doses than others on account of 
 their tissues not being as highly vascular and active in pro- 
 ducing the exudate as in younger persons. Infants and 
 children under five or six years of age are usually unsatis- 
 factory patients, as they cannot describe the degree of inflam- 
 mation present, they usually cry and struggle during the 
 treatment, which causes the hernia to descend, remove or 
 disturb the truss if not continually watched, and as a rule 
 cause more vexation than their parents are willing to pay 
 for. If you should accept children for treatment, do not fall 
 into a common error and treat them for half the usual fee, as 
 after a short experience you will regret it. If I should ever 
 undertake to cure a child of the age given, my charges would 
 be a certain fee per treatment and no promises made. Chil- 
 dren of the ages of eight to ten years are excellent subjects, 
 and are usually rapidly and perfectly cured. 
 
 In Double Hernia, each side may safely be treated at 
 each visit, the soreness resulting being no more than if only 
 one side is injected. 
 
 Some physicians advise the use of an anesthetic before 
 introducing the needle, usually cocaine, but this is entirely 
 unnecessary. The pubic tissues are not sensitive, and in 
 
122 HERNIA. 
 
 persons with hernia are usually thinner than in sound per- 
 sons. Use a sharp needle and introduce quickly and none 
 will complain of the very slight pain caused by the prick of 
 the needle. Others recommend the addition of cocaine to 
 the fluid. This may be necessary with some fluids, but I 
 have never heard any one complain of more than a slight 
 burning, and not more than can easily be borne for a few 
 minutes. Again, the use of cocaine combined with the 
 fluid is not theoretically nor practically of value. Before the 
 cocaine could anesthetize the membrane, the irritants would 
 make their presence felt, as cocaine requires a short time 
 in which to act. If cocaine is ever used inside, it should be 
 injected a minute or two before the fluid. I have no use for 
 it and do not advise it. With either of the fluids given here 
 it is unnecessary. A hot water bag before and after injec- 
 tion, is also sometimes recommended. It is applied directly 
 over the seat of the hernia after the injection has been made, 
 and allowed to remain five or ten minutes. 
 
 SPECIAL DIRECTIONS. 
 
 Read Carefully. 
 
 In order that these directions may be fully and clearly 
 understood, a brief outline of the anatomy of hernia will be 
 given. A thorough familiarity with this subject is essential 
 for the correct diagnosis and proper treatment of hernia. 
 
 OBLIQUE INGUINAL HERNIA. 
 
 This variety of hernia is sometimes called Indirect or 
 External Oblique. In this variety the intestines escape from 
 the abdominal cavity at the internal ring, where the sper- 
 matic cord passes out of the abdomen, taking the same 
 course as the cord along the inguinal canal, through the ex- 
 ternal ring and into the scrotum. When a hernia passes 
 through the external ring it is termed a complete hernia, if 
 not, an incomplete. The external form of hernia is so called 
 because it passes, in its descent, to the outer side of, or 
 
HERNIA. 
 
 123 
 
 external to the epigastric artery. The cord is always behind 
 the hernia. 
 
 DIRECT OR INTERNAL INGUINAL HERNIA. 
 
 In this variety the protrusion passes directly through 
 the abdominal walls and descends through the external ring 
 into the scrotum. It is called internal, because it passes, in 
 its descent, to the inner side of the epigastric artery. 
 
 In some cases this form of hernia breaks into the. ingui- 
 nal canal and passes down through it. In the majority of 
 cases, however, it passes directly through the tissues and 
 into the external ring. If a direct hernia passes into the 
 inguinal canal but does not pass through the external ring, 
 it is called an incomplete direct hernia. Direct hernia is not 
 near as frequently met with as the oblique form, the per- 
 centage being probably one in five or eight. The differen- 
 tial diagnosis between the two varieties can be made by the 
 location of the point at which protrusion is first noticed, 
 being more external in the oblique form. 
 
 The direction in which a direct hernia descends is 
 always more directly downward, or may even be slightly out- 
 ward from the point at which the protrusion is first noticed, 
 while in the oblique, it is always downward and inward 
 pointing toward the pubic bone. Bearing in mind the direc- 
 tion of the inguinal canal, the diagnosis can easily be made. 
 When the two forms exist in the same person, as I have 
 seen several times, the diagnosis is likely to be difficult, 
 unless this possibility is borne in mind. 
 
 Either of the other varieties of hernia are readily 
 recognized and no special reference need be made to them 
 here. A careful detailed study of hernia will materially 
 benefit any practitioner who wishes to make a success of the 
 injection method of treatment. 
 
124 HERNIA. 
 
 Where to Deposit the Fluid. 
 
 In Oblique Hernia, invaginate the canal with the left 
 forefinger, as directed in the general directions, carrying the 
 end of the finger well up to the internal ring, where the 
 hernia escapes from the abdomen. Introduce the needle as 
 directed before, about half an inch below this point, and after 
 the needle has been passed through the tissues, direct its 
 point upward toward the internal ring. As the finger in the 
 canal is elevating the tissues, the needle can be turned in this 
 manner without touching any of the contents of the canal. 
 Deposit the fluid as close to the internal ring as possible, 
 rotating the needle somewhat during the expulsion of the 
 fluid, so as to distribute it well. When the internal ring can- 
 not positively be located, as is the case frequently in large 
 herniae, deposit the fluid well up in the canal, where the 
 protrusion first appears. 
 
 In Direct Hernia, if the breach in the abdominal wall 
 can be outlined, deposit the fluid, well distributed, in the tis- 
 sues just below this point. As no canal can be determined 
 in this form of hernia, it usually makes its first appearance 
 at the external ring, and when the location of the breach 
 cannot be determined, deposit the fluid just inside of the 
 external ring. More judgment is necessary to treat this 
 variety of hernia than any other, as no two cases are exactly 
 alike. Bear in mind the principles of the treatment ; to 
 cause adhesions between the tissues through which the in- 
 testines escape, and deposit the fluid accordingly. 
 
 In all cases, begin the treatment at the highest point that 
 shows weakness. If this rule is not followed, the lower 
 portion of the canal or course of the hernia will become 
 closed and cannot be invaginated, thus rendering further 
 treatment impossible. As the upper portion closes, make the 
 injections lower down. 
 
HERNIA. 125 
 
 Femoral Hernia. The injection treatment of hernia 
 was first only advocated as a cure for Oblique or Direct 
 Hernia., but its well known principle has been successfully 
 applied to the treatment of Femoral Hernia, also. Accurate 
 instructions for treating this variety cannot easily be given, 
 as the characteristic features of different cases vary. Any- 
 one who has had experience in treating other forms, and 
 who will exercise judgment, will be able to treat these cases 
 by following the lines of the general principles of the method, 
 making the injections always close to the point at which the 
 protrusion first appears, and gradually closing the femoral 
 canal through which it descends. Retention, is of course, 
 essential. 
 
 Umbilical Hernia. In this form of hernia no canal 
 exists. A breach in the abdominal wall, in the vicinity of 
 the umbilicus, allowing the protrusion to escape. Sometimes 
 it burrows under the skin and descends to some extent. A 
 cure of this form of hernia necessarily implies an approxi- 
 mation and connection of the edges of the breach, a process 
 impossible without surgical interference. Some of these 
 cases can, however, be relieved to some extent, by the follow- 
 ing procedure : A hard rubber spring truss having a pad large 
 enough to suit the case, with a button large enough to afford 
 good retention, should be obtained. Injections should be 
 made, two or three at each visit, around the edges of the 
 breach, and repeated as in other forms of hernia. By this 
 method the skin and muscles which are often detached, can 
 again be united, and the opening which permits the hernia to 
 descend between them is thereby closed. 
 
 In these cases there is usually an abundance of loose, 
 flabby, skin and tissue, which often defeats all attempts to 
 improve the condition. 
 
 The operation of dividing the skin and bringing the 
 edges of the ruptured muscles into contact, and stitching 
 them together, is one that requires but little surgical ability, 
 and the results are usually such that will warrant it. A firm 
 support should always be worn. 
 
126 HERNIA. 
 
 THE RAPID METHOD OF CURE. 
 
 By repeating injections as often as the sensitiveness of 
 the patient will allow, any form of inguinal hernia can be 
 cured in a comparatively short time, varying from one- 
 third to one-half the time required by the regular method. 
 The procedure is as follows : 
 
 The patient must be willing to desist from all work or 
 exercise for a period of from ten to twenty days, according 
 to the case, and for the greater part of the time must remain 
 in a reclining position. 
 
 Repeat the injections as often as the patient's condition 
 will allow, giving him to understand that he must expect 
 a considerable degree of soreness. The injections are usually 
 made every two or three days, and the truss must be worn 
 constantly, day and night. The pressure thus given will 
 keep the parts in contact and will thus cause a rapid closure 
 of the canal. Some cases will not allow an injection every 
 two days, on account of too much inflammation, and it 
 should only be repeated when the patient tells you that 
 although there is a considerable degree of soreness present, 
 he will be able to stand a little more. Beyond the discomfort 
 of the patient there will be no unpleasant features, and as in 
 the regular method, no danger. 
 
 After treatment has been thus continued for ten to 
 twenty days, according to the progress of the case, the patient 
 may resume moderate exercise, still wearing the truss, and 
 the treatment continued as may be necessary. After this 
 period of treatment, tests may be made, as in the other 
 method. Before making the tests, it is well to wait three 
 or four days without an injection, to allow the inflammation 
 to subside and the adhesions to become firm. Continue the 
 treatment as directed until no impulse is felt on coughing. 
 Preliminary tests may be made at any time while the patient 
 is lying down. The standing test is the one referred to as 
 deferred until the inflammation has subsided. 
 
HERNIA. 127 
 
 After the treatment is discontinued, the patient should 
 wear the truss as directed in the regular method, and dis- 
 card gradually. 
 
 In persons in whom difficulty is experienced in retaining 
 the hernia, a week's treatment by this method will usually 
 result in success in this particular, when the treatment can be 
 completed by the regular method. 
 
 Careful attention to these directions will be productive 
 of but one result, a complete and permanent cure in all 
 curable cases. A little experience will make any physician 
 an adept in the application of the treatment, and will be 
 productive of the highest degree of success. 
 
 A WORD OF ASSURANCE. 
 
 If there is any one question asked more frequently by 
 physicians who are interested in this method of curing 
 hernia, than any other, it is this : Is there no danger of Per- 
 itonitis, Orchitis, Cellulitis, injuring the Epigastric Artery, 
 etc.? My answer is candidly and positively, "No, None 
 Whatever." Not a single unfavorable symptom has ever 
 occurred in my practice, nor has any been reported to me 
 by the many physicians who have used my fluids. The 
 reports of such accidents that are sometimes seen in medical 
 journals are the result either of an unsafe fluid or clumsy 
 operating. I have been treating hernia seven years, and 
 have not in a single instance been called to account for pro- 
 ducing more than a moderately severe degree of inflamma- 
 tion. As before mentioned, this will occur when too large 
 doses are injected, but I have never prescribed as much as 
 a piece of ice to relieve it. My only advice has been, "take 
 a rest if you feel like it, it will be all right in a day or two." 
 
 These strong inflammations always benefit the patient a 
 great deal, and calling attention to this will usually be suf- 
 ,cient compensation to them for their temporary incon- 
 venience. 
 
128 HERNIA. 
 
 OTHER INJECTION FLUIDS FOR HERNIA. 
 
 The great interest that is being manifested on all sides 
 in this successful method of treating hernia, naturally results 
 in a number of different compounds being employed as 
 agents to produce the irritation and inflammation necessary 
 to effect a cure, many of which are doubtless of value. A 
 number of the better known formulae will here be given. 
 These have been obtained from medical journals and from 
 physicians who originated them and used them in their prac- 
 tice. Such comments as suggest themselves are appended 
 thereto. 
 
 Dr. Souder's Formulae. 
 
 In a series of articles published by Dr. Souder, the fol- 
 lowing formulae are given. 
 
 Fluid No. i. 
 
 1^ Zinc Sulphate gr. ij . 
 
 Creasote TTt iij. 
 
 Fid. Ext. Hamamelis. 
 
 Glycerine aa TT\, xxx. 
 
 Mix. Inject 2 to 4 minims. 
 
 Fluid No. 2. 
 
 ^ Fl. Ext. Quercus Alba ' .'. fl. § iv. 
 
 Reduce by heating to fl. § j . 
 
 Alcohol fl. I j. 
 
 Acid Carbolic Til ij . 
 
 Mix. Inject 1 to 3 minims. Repeat when reaction has 
 disappeared. This formula has been discarded as it causes 
 too much pain. 
 
HERNIA. I29 
 
 Fluid No. 3. 
 
 1$ Guaiacol. 
 
 Beechwood Creasote aa 171. ij. 
 
 Zinc Sulphate gr. ij. 
 
 Fl. Ext. Hamamelis TIX xxx. 
 
 Glycerine ni xxx. 
 
 Mix. Inject 2 to 3 minims. 
 
 This fluid is the same as No. 1, with the addition of the 
 guaiacol. 
 
 It is the formula now used by the doctor, and the one 
 on which he depends in the majority of cases. 
 
 The Heaton Formula. 
 
 I£ Ext. Quercus Alba gr. xiv. 
 
 Fid. Ext. Quercus Alba fl. 5 j. 
 
 Morphia Sulphate gr. ij. 
 
 Mix and heat in a capsule over a sand bath until a 
 homogeneous solution is formed. 
 
 Dr. Heaton's formula is sometimes given in which four 
 grains of morphine sulphate are added to the above quan- 
 tity. The quantity injected varies from five to fifteen drops, 
 as may be required. 
 
 After Heaton came Warren, who employed this fluid. 
 
 I£ Fl. Ext. Quercus Alba % viij. 
 
 Reduce to § ij by heat. 
 
 Alcohol, 90 % 3 vi. 
 
 Ether Sulphuric 3 iv. 
 
 Morphine Sulphate gr. iv_ 
 
 Mix. Inject 15 to 20 minims in small and recent her- 
 niae, and 25 to 50 minims in large or old herniae. 
 
 "This fluid will cause a marked reduction of pulse and 
 temperature, and it may be necessary to put a hot water bot- 
 
I'30 HERNIA. 
 
 tie to the patient's feet. This reduction may last as long as 
 forty-eight hours and give a decided advantage in obtaining 
 a more local effect of the irritant." Dr. Souder used this 
 combination on six patients and all suffered intense pain for 
 days thereafter. The use of a fluid that causes such disas- 
 trous results is entirely unwarranted. 
 
 The Fidelity Fluid. I have on several occasions seen 
 this fluid stated to be Fluid Extract of Ergot. Any physi- 
 cian who has ever seen this fluid, could not possibly make 
 this assertion. It is no more ergot than tincture of green 
 soap. The following formula was given me by a physician 
 who obtained it from one of the operators of the company, 
 with the assurance that it is the correct formula. When 
 compounded, it makes a fluid identical in appearance and 
 odor, with the genuine. 
 
 I£ Acid Carbolic 95 % 
 
 Glycerine. 
 
 Alcohol aa p. e. 
 
 Tr. Iodine q. s. to color 
 
 to the color of sherry wine. 
 
 Dr. Walking's Fluid. 
 
 This fluid is one of those for which the formula is given 
 in such a manner that it cannot be prepared without further 
 instructions. 
 
 1^ Complex Salts of Aldehyde 30 % 
 
 Iodo-ethylate of Guaiacol 30 % 
 
 Sulpho-tannate of Zinc 20 % 
 
 Free Guaiacol 5 % 
 
 Beech wood Creasote 15 % 
 
 The following note follows the formula : "These rare 
 and expensive chemicals are separately prepared and then 
 combined in strict conformity with their respective affinities 
 and dosage, and dissolved in an antiseptic medium." 
 
HERNIA. 131 
 
 Dr. Robinson's Fluid. 
 
 I> Acid Carbolic, 95 % fl. 3 ij. 
 
 Glycerine, C. P fl. 5 iv. 
 
 Tr. Iodine, U. S. P fl. 3 ij. 
 
 Potassium Permanganate 5 j . 
 
 Caramel gr. xv . 
 
 "Mix. First add the glycerine to the carbolic acid, after 
 which add the iodine and caramel, and then the potassium 
 salt in crystals. Allow it to stand for about three weeks, 
 shaking daily. At the end of this time it is ready for use. 
 Inject eight drops at a time." 
 
 In this formula two points that are neither pharma- 
 ceutically correct not therapeutically indicated, stand out so 
 prominently that they demand criticism. The first is, the 
 addition of potassium permanganate to an organic compound. 
 This salt of potassium is such a strong oxidizing agent that 
 it undoubtedly impairs the value of an otherwise plausible 
 formula. The second is, the addition of caramel. What indi- 
 cation is met by the addition of burnt sugar to a formula for 
 this purpose is more than can be imagined. Caramel is used 
 for only one purpose in pharmacy, as a coloring agent. The 
 color of a hernial fluid is certainly immaterial to its effect. 
 Giving the dose in drops is also faulty. 
 
 O. E. Miller's External Astringent. The O. E. Mil- 
 ler Hernia Cure Company were among the first to revive this 
 method, some ten or fifteen years ago. Their injection fluid 
 was the same as the Heaton formula, while externally they 
 used a preparation known as "External Astringent." It was 
 given to the patient for use every night. The formula was 
 furnished by a physician who conducted one of the offices of 
 the company. He states that he "made gallons of it." 
 
 External Astringent. 
 1^ Tr. Iodine Comp. 
 
 Soap Liniment aa p. e. 
 
 Mix. On standing for a week or two, with frequent 
 
132 HERNIA. 
 
 shaking, this mixture loses its iodine color and becomes a 
 clear fluid at the bottom with the oily substance in the lini- 
 ment at the top. When shaken, it becomes milky in appear- 
 ance. 
 
 Dr. Provost's Fluid. 
 
 ^ Guaiacol, pure n\ xxx. 
 
 Zinc Sulphocarbolate gr. x. 
 
 Creasote, Beechwood Tl\ xxx. 
 
 Glycerite of Tannin q. s. ad. fl. 5 j. 
 
 Mix. Reduce 10 to 50 % with alcohol and inject four 
 or five drops of the weakest solution, gradually increasing 
 to twelve drops. Increase strength of solution according to 
 reaction. 
 
 There are hundreds of other formulae floating about 
 medical journals, many of which are similar to those already 
 given, while others do not commend themselves sufficiently 
 to give them room. With this collection of formulae, there 
 is surely no necessity to wish for any more. A few others 
 are however given under "Secret Systems Exposed." 
 
TRUSSES. 133 
 
 TRUSSES. 
 
 No matter how thoroughly the subject is understood; no 
 matter how carefully the treatment is given ; no matter how 
 much is claimed for the injection fluid used, hernia cannot 
 be cured by the injection method unless the , patient is 
 properly fitted with a suitable truss. Three-fourths of the 
 unsuccessful or unsatisfactory results following this treat- 
 ment can be directly traced to lack of attention to this 
 important detail. 
 
 Fully one-half of the trusses in daily use do not fit the 
 persons wearing them. Careful observation is the basis of 
 this assertion, and it can be verified by anyone desiring to 
 do so. 
 
 This condition of affairs is due to several causes ; the 
 chief of which is the general custom of physicians to refer 
 their ruptured patients to instrument dealers and druggists, 
 many of whom are no more capable of fitting a truss to a 
 person properly, than they are to perform the operation for 
 the radical cure. Another cause is due to an unaccountable 
 idea that some ruptured persons have, that hernia is an 
 evidence of loose morals or that it is due to some immoral 
 action on their part. This portion are unwilling to purchase 
 a truss personally, but order one by mail and simply wear it, 
 whether it fits or not. 
 
 Mail order houses advertise trusses ; department stores 
 sell them over the counter and fakirs carry them through 
 the country. In the majority of instances the "fitting" is 
 done by the person who intends to wear it. I am not one 
 who would make the claim that none but a physician can 
 properly fit a truss, for any intelligent person can in a 
 reasonably short time become proficient in the art if he 
 applies himself, but how often is this done? The principal 
 idea is to sell the truss, and if it does not fit, sell another 
 one. Being a physician does not necessarily imply that one 
 can fit a truss properly, for unless some attention has been 
 
1 34 TRUSSES. 
 
 given to the subject, the degree of "M. D." carries with it 
 no guarantee whatever. 
 
 WHY TRUSSES FAIL. 
 
 Trusses fail to retain the protrusion properly for various 
 reasons. It ma)' cause pain to the wearer, necessitating a 
 frequent shifting of the offending parts, thus permitting the 
 hernia to protrude more or less, with corresponding irrita- 
 tion. 
 
 It may fail to retain the hernia on account of being of 
 improper size, or the adjustment may be faulty. 
 
 The pad may be too small and practically enter the 
 opening and allow the hernia to protrude on the side of it. 
 The French truss, with its strong spring of steel and a small 
 convex pad is particularly apt to be faulty in this respect. 
 
 The pad may be too large and cause undue pressure on 
 other parts, principally the cord, and cause hydrocele of the 
 cord ; or on the arteries and interfere with the nutrition of 
 the testicle. 
 
 The pad may rest on the external ring and allow an 
 incomplete hernia behind it. 
 
 SELECTION OF PAD. 
 
 The shape of the pad should conform to the nature and 
 size of the opening. Whether round or oval, I prefer either 
 a flat, slightly convex or full convex pad. I have never been 
 able to see any advantage in the concave pad, as recom- 
 mended by some, nor with the pneumatic collar around the 
 edge of the pad. The flat pad is less satisfactory than the 
 convex, yet in certain cases of direct hernia, I have found this 
 shape quite satisfactory. The selection of the properly 
 shaped pad is a matter upon which a considerable amount of 
 good judgment can be exercised to advantage. Explicit 
 directions to suit every case cannot be reasonably expected, 
 yet I will endeavor to mention some of the leading indica- 
 tions, which may be borne in mind. 
 
 In case a hernia is difficult to retain, even when properly 
 
TRUSSES. 135 
 
 fitted, and consequently requires a strong spring, a pad 
 should be selected that is not too hard. In these cases a cellu- 
 loid, hard rubber or uncovered wood pad will probably 
 irritate. A spring pad covered with soft kid or chamois, 
 or a water pad is best suited for this class of hernia. 
 
 Persons employed at trades that soil the clothing and 
 body, such as machinists, moulders, mill-workers, miners, 
 etc., should, if possible, be supplied with either a wood, 
 rubber or celluloid pad, .for which a home-made covering 
 can be made, which can be thrown away when soiled. The 
 spring or water pads can be similarly protected if the harder 
 pads cause annoyance. In this manner the pads can be kept 
 clean and their usefulness extended. 
 
 Size of Pads. When the Hernia is small and not hard 
 to retain, a pad should be selected that is large enough to 
 furnish good marginal pressure, so as to avoid its entrance 
 through the opening and aggravate the hernia. This does 
 not necessarily call for a large pad, but one just large enough 
 to accomplish its purpose. As the protrusion is slight it 
 requires no more than the ordinary convexity. 
 
 In the large majority of cases no particular attention 
 need be paid to the size of the pad used, as the pad usually 
 supplied with standard trusses meets the necessary require- 
 ments. It is only in the larger herniae, when the regular 
 pads prove insufficient, that a special pad will be called for. 
 The automatic spring pad, fitted with an oval collar of leather 
 covered rubber, and a separate oblong hard rubber pad in 
 the center, which adjusts itself automatically to different 
 degrees of pressure by means of an internal coil spring on 
 which it is mounted, is perhaps the most desirable pad for 
 general use. 
 
 In unusual cases, a good rule to remember is : The 
 larger the breach in the abdominal walls, the larger and 
 more convex should be the pad. A large opening is always 
 indicated by the freedom with which the hernia descends, 
 or the forcible and prompt impulse. 
 
136 TRUSSES. 
 
 I have frequently been able to furnish complete and 
 perfect retention by the use of a double elastic truss, worn 
 for a single hernia, and fitted with only one pad. The 
 strong leather support with which double trusses of this 
 kind are equipped being just the proper support. 
 
 Persons with thin abdominal walls do not require as 
 much convexity of pad as those who are stout and fatty in 
 those parts, but unless in the latter cases, no distinction is 
 made. 
 
 The prevention of chafing is frequently a point that 
 requires attention, although with the form of truss that I 
 have used most frequently, this annoyance is reduced to the 
 minimum. The proper adjustment of the wire spring which 
 can be easily bent and made to conform with the curves of 
 the body, is the first essential, and the other is to keep the 
 pads firm in their proper position by the proper adjustment 
 of the bands. 
 
 The regular equipment of trusses, according to order, 
 will in most cases prove satisfactory if properly adjusted. 
 It is only in the unusual cases that special equipment is 
 required, and it is these that often tax the ingenuity of the 
 best and most expert fitters. 
 
CANCER. 137 
 
 CANCER. 
 
 True Cancer; An Epithelial, Neoplasm. 
 
 For some unknown reason the treatment of epithelioma 
 by the application of caustics and other local applications, 
 has for many years past remained, with a few notable excep- 
 tions, in the hands of irregular, non-graduate and ignorant 
 practitioners. Persons without a trace of education or in- 
 formation on any other subject, and not infrequently with 
 but a superficial knowledge of cancer and its treatment, have 
 nevertheless so persistently and I may say, so successfully 
 used this method of treatment, that it is to-day known in 
 every village and hamlet of this and other countries, and is 
 at last receiving recognition by college professors, and is 
 indeed being taught in some modern schools of medicine. It 
 is to be hoped that this treatment will commend itself to all 
 progressive physicians and that by its intelligent use we may 
 obtain even more information of a positive nature in regard 
 to the cause, the painless treatment and the absolute cure of 
 this interesting disease. 
 
 Etiology. 
 
 In regard to the etiology of cancer much has been 
 written but little is known. That its primary cause is an ir- 
 ritant admits of no doubt, but what the nature of the irritant 
 that causes the local new growth of the epithelial cells may 
 be, we know no more now than was known half a century 
 ago when its pathology was demonstrated. The untiring 
 and often heard of searcher for microbes has at least a dozen 
 times proclaimed to the world that at last he has discovered 
 the varmint, and that henceforth all that will be necessary to 
 cure cancer will be to locate and exterminate him, but all of 
 
I38 CANCER. 
 
 these discoveries have faded into the mere suspicion of an 
 idea, in the light of unbiased, careful and intelligent investi- 
 gation. That the primary cause of cancer will sooner or 
 later be discovered, cannot be doubted, but until then, the 
 less said the better. Other and more essential points will 
 therefore be taken up and dwelt upon; predisposing causes, 
 pathology, diagnosis and treatment. 
 
 Age. 
 
 From the observation of physicians who have made the 
 study and treatment of cancer a specialty, we have abundant 
 proof that the majority of cases of cancer are found in the 
 aged. This leads us to believe that the senile changes which 
 take place in the tissues and epithelium with advancing 
 years have some relation to the growth of the neoplasms 
 under consideration, but further than this nothing can be 
 said with certainty. 
 
 Heredity. 
 
 Not infrequently do we find that cancer occurs more 
 frequently in families in which it has once appeared, although 
 persons not related, but occupying the same residence, have 
 been known to develop cancer in succession, thus rendering 
 it necessary for us to consider the liability of direct conta- 
 gion, as cancer is undoubtedly capable of being transmitted 
 by contact. Thus when it occurs successively in families, 
 each and all using the same linens, dishes, utensils or imple- 
 ments, heredity cannot be said to be entirely substantiated. 
 
 Locality. 
 
 The frequency with which cancer occurs in a portion of 
 several states in the central part of the United States, has 
 given that locality the name of "The Cancer Belt," but as in 
 other instances, we cannot explain the relation which climate, 
 soil or location bears to the primary cause of the disease. 
 
CANCER. I39 
 
 Traumatic Causes. 
 
 A popular idea obtains that cancer will result from trau- 
 matic or constantly irritating causes, (and this is in fact in 
 line with the best information we have, even though the 
 nature of the necessary irritant is unknown,) and it is very 
 commonly supported by indisputable facts. Its frequency on 
 the lips or tongue of the pipe smoker, particularly the short 
 stemmed one; on the cervix of the uterus after laceration; 
 or appearing after warts or other cutaneous growths have 
 been irritated or forcibly removed, can surely not be satis- 
 factorily explained by terming it a coincidence. 
 
 Numerous other and largely theoretical causes have at 
 various times been brought forward, but which have never 
 been accepted as feasible. Among the most notable may be 
 mentioned the theory of Cohnheim, in which he claims that 
 cancer is caused by the stimulation, late in life, of cells which 
 have retained their embryonic condition, and the parasitic 
 protoplasmic body found in cancerous growths by Foa and 
 Plimmer, but which proved to be degenerate products of the 
 disease instead of its cause. 
 
 Pathological Observations. 
 
 The term Cancer, like Dyspepsia and Catarrh, is one 
 that is much misused. Prior to the pathological demonstra- 
 tions of malignant growths, after which they were classified 
 and re-named, all malignant growths were termed Cancer. 
 Cancer, strictly speaking, is always an epithelial neoplasm; 
 a new growth of epithelial cells, although in its progress and 
 growth more or less connective tissue is included. In struc- 
 ture these growths are composed of pegs or columns of cells, 
 which infiltrate first into the connective tissues and later into 
 the underlying structures even including bones. The epi- 
 thelial ingrowths contain globular masses of flattened cells, 
 the so-called cell nests or epidermic pearls, while the sur- 
 rounding fibrous stroma is usually infiltrated with small 
 cells. When the quantity of connective tissue included in 
 the growth is large, the growth will be relatively more solid 
 
I4O CANCER. 
 
 and firm. The growths that are softer are usually of more 
 rapid growth and do not contain as much connective tissue. 
 As text books on the subject of pathology are convenient 
 to all practitioners it will be unnecessary to cover this point 
 to any greater extent, and we will pass on to two more 
 essential points, Diagnosis and Treatment. 
 
 Diagnosis. 
 Any cutaneous or mucous surface covered with squam- 
 ous epithelium may be attacked by cancer. When the dis- 
 ease attacks the skin, the parts most commonly involved 
 are the nose, lip, penis, scrotum, vulva, or the anus. The 
 mucous surfaces most commonly involved are those of the 
 tongue, gums, palate, larynx, alimentary canal, bladder, os 
 uteri or in fact any organ or part thereof which is composed 
 of epithelial cells. 
 
 Varieties. 
 Three distinct varieties of epithelioma are met with : 
 The Superficial, Deep-seated and Papillomatous. 
 
 The Superficial Variety 
 is sometimes known as Discoid Epithelioma or Rodent Ulcer. 
 As its name indicates it begins and exists for some time, as 
 a flat, superficial, firm, reddish or yellowish tubercle, or an 
 aggregation of such, as a warty excrescence or a localized 
 degenerative patch. Sooner or later, sometimes after months 
 or years, the surface becomes excoriated and a yellowish or 
 brownish crust appears. This excoriation gradually spreads 
 and develops into a superficial ulceration which slowly in- 
 creases in size. The ulcer usually has an uneven cauliflower- 
 like appearance, base and margins indurating, but with no 
 evidence of surrounding inflammation, secretes a thin watery 
 fluid which dries into a firm adherent crust, and obstinately 
 resists the action of such treatment as usually cures common 
 ulcers and sores. When the nearest lymphatic glands are 
 enlarged the diagnosis is practically certain. The general 
 health usually remains as usual and the presence of a super- 
 ficial epithelioma may cause but little trouble, unless, as fre- 
 quently is the case, it develops into the deep-seated variety. 
 
CANCER. 141 
 
 The Deep-seated Variety. 
 
 may develop from the superficial form or may begin as a 
 tubercle or nodule in the skin. A typical growth of this 
 nature will appear as a reddish, waxy, shining tubercle or 
 nodule, highly vascularized and more deeply seated than the 
 former variety. Deep-seated ulceration takes place which 
 enlarges in all directions, the edges being everted as a rule, 
 with an atrophic center which increases in depth and invades 
 muscle, cartilage and bone. It bleeds easily and gives rise to 
 considerable burning pain. Its secretion is a scanty, pale yel- 
 lowish purulent fluid of a decidedly foul and decaying odor. 
 The neighboring lymphatics always enlarge and fre- 
 quently break down and suppurate. If left alone it pursues 
 a progressive course and death eventually ensues from in- 
 anition, septicaemia, hemorrhage, or involvement of the vital 
 parts. 
 
 The Papillomatous Variety. 
 
 is usually a last stage of either of the other two forms or may- 
 begin independently as a papillary or warty growth. It pre- 
 sents an ulcerated, fissured and papillomatous surface, bright 
 florid color, is very vascular and bleeds easiiy. Pain is 
 usually present in a greater or lesser degree. It discharges 
 a dirty looking, foul, viscid, irritating fluid which dries into 
 crusts. Lymphatic glands are involved and frequently break 
 down. It terminates in death from sapremia or exhaustion. 
 
 The form of cancer that is known as Carcinoma Cutis, 
 while a superficial growth, and liable to occur as a primary 
 affection, is but seldom met with as such, but more fre- 
 quently is secondary to cancer of the female breast or of the 
 internal organs, and is therefore largely without the domain 
 of treatment by this method. Paget's disease of the nipple 
 has also recently been classed among these growths, 
 although it resembles eczema very much, and has been 
 termed an eczematoid epitheliomatosis. 
 
 The diagnosis of cancer of the skin is to be differentia- 
 ted from the following: from syphilis by the history, dura- 
 
142 CANCER. 
 
 tion, character of the base and edges, slow progress, charac- 
 ter of the discharge and in doubtful cases by treating for 
 syphilis as a therapeutic test; from warts or warty growths 
 it can be differentiated by the discharge and tendency to 
 crusting, break down and ulcerate; from lupus by the pecu- 
 liar and multiple deposits of this disease, the tendency to 
 scar formation and its frequent beginning in early life. 
 
 TREATMENT OF CANCER. 
 
 Cancer Specialists have always claimed and attempted 
 more than they could reasonably expect from the caustic 
 treatment, and it is on this account that this eminently suc- 
 cessful method of treatment has not received the recognition 
 which it so richly merits, if indeed it has not been respon- 
 sible for the disrepute in which it is held by many physicians. 
 
 The caustic treatment of cancer is applicable to all 
 varieties of epithelial neoplasms, providing their anatomical 
 location is not such as to preclude the practicability of apply- 
 ing the same. It is not applicable and should not be em- 
 ployed in malignant growths of great size, or which involve 
 the vital parts, the removal of which could only be accom- 
 plished at an unwarrantable risk to the patient and profes- 
 sional reputation. It is the indiscriminate application of 
 this method that is accountable for the lack of confidence in 
 it which is so apparent on all sides. 
 
 In properly selected cases, intelligently and carefully 
 applied, the caustic method of treating cancer will effect a 
 large percentage of cures, and has the advantage of appeal- 
 ing to persons who justly dread the knife, produces no shock, 
 requires no anesthetic, is free from danger, often causes but 
 trifling pain and is highly remunerative to the practitioner. 
 
 Cancer of the skin or mucous membrane, being a local 
 disease except in its last stages, can be cured by local treat- 
 ment, although in many cases a constitutional remedy is 
 advantageous as a corrective of any systemic disease which 
 may be present and possibly have an influence upon the 
 growth. 
 
CANCER. 143 
 
 There is ground for the belief that certain drugs exert 
 a beneficial influence over malignant growths, even though 
 their action cannot in all cases be depended upon. In cases 
 in which the disease spreads slowly and in which there is no 
 immediate danger to be feared by delaying active treatment, 
 internal medication will at least do no harm. 
 
 Arsenic 
 is probably the principal remedy that has been advocated as 
 a constitutional remedy for cancer, being recommended by 
 Lassar, who however also used in connection with it a paste 
 known as Lassar's paste, formula of which is given later. 
 
 Cheudonium Majus. 
 is recommended by a number of physicians who have devoted 
 considerable time to the study and treatment of cancer, and 
 it is still under observation. 
 
 While not willing to assert that this drug will ever be- 
 come a recognized remedy, constitutionally, for cancer, it 
 is encouraging to be able to state that the opponents of 
 constitutional treatment are not yet willing to assert that it 
 does not benefit certain forms of the disease. 
 
 LOCAL TREATMENT is the only method at present 
 perfected upon which we can place dependence, and of this 
 there are several forms. 
 
 The surgeon will naturally find recourse to the knife 
 and claim that excision is the only means of cure. How un- 
 certain and unsatisfactory this treatment is, is too well 
 known to be entitled to further comment. 
 
 Let it suffice to say that no human power can ascertain 
 the degree of infiltration that has taken place, and when 
 these growths are thus removed there is nothing to guide 
 the operator as to the amount of tissue he shall remove, 
 and he either removes too little and thus allows some of the 
 neoplasm to remain to again develop, or he removes more 
 than is necessary and thereby subjects the patient to risk, 
 excessive shock and subsequent disfigurement. 
 
144 CANCER. 
 
 The Thermo-Cautery and Galvanism 
 have their advocates, but this method is open to the same 
 objection as excision, as the operator cannot differentiate 
 between healthy and diseased tissue. 
 
 The X-Rays. 
 
 Judging from the amount of space given to articles in 
 medical journals on the treatment of epithelioma and other 
 malignant growths by means of the X Rays, there would be 
 some ground for the belief that much good can be accom- 
 plished by this new treatment. It is a subject too extensive 
 for consideration here, and attention is merely directed to- 
 ward it. 
 
 Alcohol 
 
 injected in and around cancerous growths, seems to exert a 
 good influence over these growths and many cures are re- 
 ported. 35 to 50 % solutions are injected into the surround- 
 ing tissues. 
 
 CAUSTIC REMEDIES. 
 
 As a softening agent and for the removal of the super- 
 ficial layers of epithelium, Salicylic Acid is a valuable agent. 
 It may be employed either pure or in a mixture with starch, 
 in powder form, or as an unguent, prepared with vaseline. If 
 this is not used as a preliminary, the surface of the cancer 
 should be scraped with a curette until slight bleeding occurs. 
 After this has ceased the caustic can be applied. 
 
 Nitrate of Silver 
 
 has frequently been mentioned as a caustic for the treatment 
 of cancer but its action is too superficial and does not destroy 
 the deeper structures, in fact it frequently rather stimulates 
 the growth than retards it. It is of no value. 
 
 Lactic Acid 
 
 is a remedy that does not attack normal tissues but it is at best 
 only a feeble caustic and is not by any means reliable. 
 
CANCER. I45 
 
 Sulphuric Acid 
 
 is recommended by some but it has the disadvantage of 
 destroying healthy and diseased tissue alike, an undesirable 
 feature. It is also extremely painful. 
 
 Nitric Acid 
 
 is better and superficial growths have often been success- 
 fully removed by its use. It should be applied with a glass 
 rod. 
 
 Pyrogaluc Acid 
 
 has been much used and with considerable success. It is 
 best adapted to superficial growths. It may be applied in 
 powder form or in the form of an ointment with lard, in 
 strength of twenty-five to seventy-five per cent. Curetting 
 of the surface should precede its application. It is but 
 slightly painful and does not attack healthy tissue. An ap- 
 plication, when made, should be allowed to remain for a 
 week or more and a fresh one applied until the desired 
 result is obtained. It is of no value in deep seated and 
 largely infiltrated growths. 
 
 Chloride oe Zinc. 
 
 This is one of our best remedies and one which has 
 been advocated for many years. It is effective without a 
 doubt and produces a clean slough and there is no danger of 
 constitutional poisoning. It is not the least painful remedy 
 that can be employed but its curative action admits of no 
 doubt. 
 
 Caustic Potash 
 is especially adapted to use when cancer involves or appears 
 on mucous surfaces. It is best applied in liquid form by 
 means of a glass rod, following its application immediately 
 with one of dilute acetic acid. A slough forms, which ex- 
 tends into the healthy tissue, but leaves a clean healthy 
 ulceration which heals without difficulty. 
 
I46 CANCER. 
 
 Arsenious Acid. 
 
 In arsenic we have the best caustic with which we are at 
 present familiar. It is applicable to all cases of cutaneous 
 cancer, whether superficial or deep. Its action is not severely 
 painful and can usually be borne without any or only small 
 quantities of opiates. Its action is strictly selective, in that 
 it acts only on the carcinomatous growth, never attacking 
 or damaging healthy tissue, and seems to exert the proper 
 degree of caustic action needed for the destruction of the 
 growth. It is never absorbed although used in large quanti- 
 ties and over large surfaces. 
 
 The remaining scar is usually insignificant and if the 
 growth removed was small it is frequently impossible to lo- 
 cate the site thereof a short time afterward. The surface of 
 the growth should always be curetted before applying arse- 
 nic as its action on unbroken skin is slow and tedious. 
 When the growth to be removed is larger than four square 
 inches it is advisable to treat only part of it at one time, in 
 order to limit the inflammatory reaction which results. The 
 application of the caustic should always extend at least one- 
 half to one inch over the healthy tissue as infiltration usually 
 extends that distance into it. 
 
 The surrounding tissues will swell considerably during 
 the action of the caustic, but this need cause no concern 
 whatever, as it will subside in a day or two. Should the eye 
 be closed by swelling, when treatment is applied to the face, 
 no alarm need be felt. The eye will not be injured. It is 
 also well to bear in mind that as infiltration always extends 
 into the healthy tissues for some distance, that the slough 
 that will be loosened will be considerably larger than the 
 original growth. No healthy tissue will however be re- 
 moved and healing of the ulceration usually proceeds unin- 
 terruptedly under ordinary care. Regarding the treatment 
 of skin cancers with arsenious acid, used in the form of a 
 paste, usually known as Marsden's paste, Prof. John A. 
 Wveth, M. D.. said in a lecture delivered at the New York 
 
CANCKR. 147 
 
 Polyclinic, "If I had a superficial epithelioma develop any- 
 where on my body where I could use Marsden's paste, I 
 would prefer that method of treatment to the knife. If the 
 disease had existed so long that the paste alone could not 
 be relied upon, I would prefer to have the malignant pro- 
 cess first cut or scraped away, and then have the paste ap- 
 plied. In this way we get more satisfactory results than by 
 any other treatment I know of." 
 
 The formula of Marsden's paste is sometimes seen in 
 slightly different proportions, but when seen in the weaker 
 forms the formula is usually intended to be applied to the 
 tender surfaces, as the lip, anus, glans penis, etc. Some- 
 times morphine is added, sometimes cocaine. The follow- 
 ing formula is the one preferred by Prof. Wyeth and given 
 by many others : 
 
 ty Acid Arsenious 5 ij. 
 
 Powd. Acacia 5 j. 
 
 Cocaine Muriate grs.x to xviij 
 
 Mix. 
 
 Add a small quantity of water and rub into a paste to 
 the consistency of rich cream. The paste should always be 
 freshly prepared and spread on a piece of rubber plaster and 
 applied as soon as the oozing of blood from the curetting 
 has ceased. It should be allowed to remain from eighteen to 
 thirty-six hours, when if required another fresh application 
 can be made. When a cancerous growth has been thoroughly 
 and sufficiently cauterized by this method, on removal of the 
 plaster the neoplasm will be found to be black and necrosed, 
 and surrounded by a swollen and inflamed area. A flax seed 
 poultice is then applied and continued until the slough 
 separates. After the slough separates, if any cancerous tis- 
 sue remains not necrosed, or if the hard nodular base or 
 margin remains unaffected, another application of the paste 
 is necessary. This may be made weaker, only one drachm 
 of arsenious acid, and eight or ten grains of cocaine, and 
 allowed to remain a shorter time. 
 
148 CANCER. 
 
 When all cancerous tissue has been destroyed, a simple 
 dressing is all that is necessary. It usually heals without 
 interruption. Protonuclein internally and externally is 
 always beneficial. 
 
 Various other formulae will here follow^ with such com- 
 ments as have suggested themselves. No physician is ex- 
 pected to give all of them a trial, although many of them 
 have merit and are possibly better adapted to some forms 
 than the favorite formula first mentioned. For this reason 
 every available formula, deemed of apparently sufficient 
 value, will be found in the following pages, and these com- 
 prise, I believe, practically everything that is known in the 
 treatment of cutaneous cancer by local applications of caus- 
 tics and other tissue destroying agents. 
 
 Fuschius' Paste. 
 1^ Arsenious Acid. 
 
 Vegetable Charcoal. 
 
 Powd. Serpentaria aa q j. 
 
 Mix. Make into a thick paste with water and apply. 
 
 Esmarck's Caustic Powder. 
 I£ Acid Arsenious. 
 
 Morphine Sulphate aa 3 j. 
 
 Mercurous Chloride, mild 5 j- 
 
 Powd. Acacia 5 vj. 
 
 Mix. Make into a paste as needed by adding water. 
 This is said to be practically painless. 
 
 Guy's Arcanum. 
 
 A secret formula, much used in former years. 
 
 I£ Acid Arsenious. 
 Powd. Sulphur. 
 
 Hog's Fennel, (Peucedanum Off.) 
 Ranunculus Sylvestris aa ." j. 
 
 Mix. Make into paste with water. 
 
CANCER. 149 
 
 Februre's Treatment for Cancer. 
 
 I> Acid Arsenious gr. x. 
 
 Distilled water Oj. 
 
 Mix. When dissolved add 
 
 Fl. Ext. Conium fl. o J- 
 
 Liq. Plumb. Subacetate fl. 5 iij. 
 
 Tr. Opium fl. o j. 
 
 Mix. Use as a wash and apply locally, allowing it to 
 dry, every morning. 
 
 Internally with the above. 
 
 I? Acid Arsenious gr. ij. 
 
 Powd. Rhubarb 3 iv. 
 
 Syr. Chicory fl. o viij . 
 
 Water q. s. ad. Oj. 
 
 Mix. Sig. Teaspoonful night and morning. 
 
 Cerny's Liquid Caustic. 
 
 I£ Acid Arsenious 5 j. 
 
 Alcohol, 
 
 Water aa % vj . 
 
 Mix. After a preliminary curetting and cleansing of 
 the surface of the cancer, the mixture is applied with a 
 brush. Allow to dry and apply no dressing. Apply thus 
 daily gradually increasing the strength until the proportion 
 of arsenic is two drachms to the above quantity of alcohol 
 and water. The cancer will become covered with a scab 
 which will gradually thicken and change from yellowish to 
 black, and will gradually become detached by suppuration 
 and can easily be removed. After removal the solution is 
 again applied in the former strength, and the result is 
 watched. If a thin, easily detachable, yellow pellicle only 
 is formed, the cancer is destroyed and the ulceration will 
 heal up. If a dark, firm and adherent crust appears, the 
 cancerous tissue is not all removed and the treatment must 
 be repeated. 
 
150 CANCER. 
 
 Treatment may occupy from one to three months, which 
 is objectionable. It is, however, painless, and is on this 
 account desirable. 
 
 Hebra's Paste. 
 I£ Acid Arsenious 5 j. 
 
 Mercuric Sulphide, red 3 iij. 
 
 Vaseline o n J • 
 
 Mix. 
 
 Martin's Powder. 
 
 I£ Acid Arsenious 5 j . 
 
 Powd. Cancer Root, (Orobanche Virg) . . 3 j. 
 Mix. Apply dry to ulcerations. 
 
 Frere Come's Paste. 
 I£ Acid Arsenious gr. x. 
 
 Mercuric Sulphide, red gr. xl. 
 
 Animal Charcoal gr. x. 
 
 Mix. Make into paste with water as needed for use. 
 
 The Zinc Salts. 
 
 As has been previously mentioned, Chloride of Zinc is 
 one of the best remedies at our command, and has many 
 strong adherents who claim very excellent results. 
 
 In mixing preparations containing chloride of zinc the 
 mixture should be stirred with a horn spatula, as iron will 
 be quickly corroded. Probably an aluminum spatula would 
 also answer. The zinc salts form a whitish or grayish eschar 
 which can be removed in from seven to fourteen days, and 
 when it begins to loosen it is advisable to apply an elm bark 
 or flaxseed poultice to facilitate its removal. These salts 
 cause considerable pain, but it can be largely controlled by 
 morphia or other anodynes. The most popular salt of zinc 
 is the chloride, although the nitrate and sulphate are some- 
 times used. 
 
CANCER. J 5 J 
 
 The following formula is perhaps the most popular for 
 the application of the chloride: 
 
 I£ Powd. Sanguinaria i part. 
 
 Powd. Galangal 3 P arts 
 
 Zinc Chloride q. s. 
 
 Mix the two powders and gradually add sufficient 
 chloride of zinc to make a thick paste consistent enough to 
 be formed with the fingers. Form a piece of this paste into 
 a shape that will cover the cancer and about one-fourth of 
 an inch on each side of it, and one-eighth of an inch in 
 thickness. 
 
 Apply this to the cancer and retain in place with strips 
 of adhesive plaster and apply a soft compress and bandage. 
 Let it remain in place for twenty-four hours and apply a 
 fresh plaster. Repeat this process for three or more days, 
 until the tumor becomes shriveled and devitalized. Dress 
 with basilicon ointment daily and allow the slough to be- 
 come detached without using any traction. This will take 
 place in a week, approximately. 
 
 Continue dressing with basilicon ointment until healed. 
 The Galangal and Sanguinaria with Chloride of Zinc form a 
 paste without the addition of water. It should be made 
 fresh each morning. The small variety of Galangal Root, 
 Maranta Galanga, is the root preferred. 
 
 Dr. Bright' s Formula. 
 Dr. Bright, of Lexington, Ky., published the following 
 formula as his most successful treatment for cancer, and is 
 highly recommended by other physicians who have used it 
 for more than twenty-five years : 
 
 I£ Solid Ext. Podophyllum 3 j. 
 
 Zinc Chloride 3 iij- 
 
 Starch 3 ss. 
 
 Red Saunders 3 ss. 
 
 Water, q. s. to make a thick paste. 
 
152 CANCER. 
 
 Spread on cotton cloth one-fourth of an inch in thick- 
 ness, sufficiently large to cover the cancer and embracing 
 one-fourth of an inch of margin. Bind in place with adhe- 
 sive plaster and allow it to remain twenty-four hours. Re- 
 move and apply freshly after washing the surface of the 
 cancer. Repeat three or four days in succession or until 
 the surface of the growth becomes hard and white. Poul- 
 tice as previously detailed for six or eight days and the 
 slough will fall out. The poultices should be renewed every 
 six hours. If the cancerous tissue is not all removed, re- 
 apply as before. When all is removed dress with an oint- 
 ment composed of equal parts of white wax, mutton tallow 
 and lard, melted together and stirred until cold. Before 
 dressing wash the edges with warm water and castile soap 
 and remove filth and hardened crusts. A good dressing 
 other than the above may be made by adding Balsam Peru, 
 one drachm to one ounce of vaseline. During treatment 
 give anodynes as required, also aperients and such consti- 
 tutional treatment as the patient may require. 
 
 Bougard's Cancer Paste. 
 
 I£ Mercuric Sulphide, red, 
 
 Ammonium Chloride aa. gr. xl. 
 
 Mercuric Chloride, Corros gr. iv. 
 
 Acid Arsenious gr. viij. 
 
 Wheat Flour. 
 
 Starch. 
 
 Zinc Chloride aa § j. 
 
 Water, boiling % iss. 
 
 Mix. Dissolve the chloride of zinc in the boiling water. 
 Mix all the other ingredients in a glass mortar, and pour 
 the solution of the zinc slowly into the mortar, stirring 
 briskly until thoroughly mixed. Let stand twenty-four 
 hours. 
 
CANCER. 153 
 
 Apply on muslin after preliminary curetting and let it 
 remain for twenty-four hours. The poulticing and after 
 treatment are the same as when Marsden's paste is used. 
 
 This is an active preparation, but acts on healthy tissue 
 as well as on diseased. It is used by several well known 
 New York Dermatologists with good success. 
 
 Felix's Paste. 
 
 I£ Zinc Chloride gr. ex. 
 
 Wheat Flour gr. cxij . 
 
 Starch gr. xxxvi j . 
 
 Mercuric Chloride, Corr. . . .'. gr. j. 
 
 Iodol. 
 
 Croton Chloral. 
 
 Acid Carbolic Cryst. 
 
 Camphor aa gr. x. 
 
 Mix. Make into a paste with water. Apply and let 
 it remain six to twenty-four hours. 
 
 Sherman's Paste. 
 I£ Zinc Chloride. 
 
 Alum aa gr. v 
 
 Acid Tannic gr. ij 
 
 Persulphate of Iron gr 
 
 Glycerine q. s. to make paste. 
 
 nj. 
 
 The following formula is used by several Western can- 
 cer specialists : 
 
 I? Zinc Chloride. 
 Podophyllum. 
 
 Powd. Opium aa 5 ij. 
 
 Mix. Make paste and apply to cancer, spread on a 
 muslin cloth. It is something similar to the Bright for- 
 mula before given, and general directions given there will 
 here apply. 
 
154 CANCER. 
 
 Hundreds of other formulae containing Arsenious Acid, 
 Chloride of Zinc, Sulphate of Zinc and Nitrate of Zinc, as 
 also those containing alkaline remedies could be furnished, 
 but it would be a useless repetition and could serve no other 
 purpose than to confuse the practitioner and occupy 
 valuable space. A few other formulae are however given 
 hereafter which are advocated and used by their adherents. 
 As an addition to our fund of general knowledge on the 
 subject they are valuable, even if they served no other 
 purpose. The majority of secret remedies are often nothing 
 more than old combinations under a different disguise and 
 these formulae may assist in their recognition. 
 
 Davisson's Cancer Remedy. 
 ty Sodium and Potassium Tartrate. 
 
 Sulphur. 
 
 Zinc Sulphate. 
 
 Arsenious Acid aa § j. 
 
 Mix well and add the yolks of eight eggs and beat into 
 a batter. Bake in an oven until dry and hard. Powder the 
 mixture and when ready for use make a paste with sufficient 
 for one application by the addition of the yolk of an egg. 
 Spread on sore and cover with muslin or cheese cloth and 
 apply a coating of yolk of egg alone. Bind in place with 
 bandage and allow it to remain until swelling and inflamma- 
 tion appears and disappears. Remove and poultice. Cu- 
 rette, scarify or blister the skin if the cancer is not ulcer- 
 ating, before applying. 
 
 Lassar's Paste. 
 
 I£ Acid Salicylic gr. x. 
 
 Powd. Starch 3 ij. 
 
 Zinc Oxide 3 ij. 
 
 Lard 3 iv. 
 
 Mix. 
 
 This preparation was originated by Lassar who used it 
 
CANCER. 155 
 
 in connection with Arsenic internally. It is designed for 
 slow work, gradual destruction of tissue, and is not as satis- 
 factory as other previously given formulae. It is also recom- 
 mended for eczema, dermatitis, warts, etc. 
 
 Salicylic Acid may be used in considerably stronger 
 proportions, as for instance : 
 R Acid Salicylic. 
 
 White wax aa 3 j . 
 
 Parafine. 
 
 Oil of Sweet Almonds aa 3 ij. 
 
 Mix. Melt with gentle heat and stir until cold. 
 
 VEGETABLE REMEDIES. 
 
 Certain remedies of vegetable origin enjoy somewhat of 
 a reputation in the treatment of cancer of the skin. Some 
 have already been referred to while others will follow. 
 Dr. Lombard's Remedies. 
 
 Doctor Lombard, now dead, was formerly located in 
 Maine, where he had the reputation of being a successful 
 "cancer doctor." The remedies he employed were given to 
 the profession after his death by a physician who attended 
 him during his last illness and to whom they were confided, 
 whether with the understanding that they were to be kept 
 secret or not, is unknown to me. 
 
 When the cancer was small he used the inspissated juice 
 of 
 
 Phytolacca Decandra, 
 which was applied in the form of a plaster and repeated until 
 sloughing took place. The after treatment was a dressing 
 with simple cerate. 
 
 If the cancer was large he used a paste composed of 
 
 Zinc Chloride and Powd. Sanguinaria, 
 
 until an eschar was produced, when the Phytolacca plaster 
 
 was applied as in the smaller varieties until the mass 
 
 sloughed away. 
 
156 CANCER. 
 
 Phytolacca Root has also been employed, in the fol- 
 lowing combination : 
 
 ^ Solid Ext. Phytolacca. 
 
 Solid Ext. Podophyllum. 
 
 Solid Ext. Sanguinaria. 
 
 Acid Chromic. 
 
 Carbon Tetra Chloride, aa equal parts. 
 Mix. Apply in the form of a paste. 
 
 Cheudonium Majus. 
 
 This drug was first exploited by Denissenko, who claims 
 to have obtained good results from its use. His method of 
 using it is to give internally thirty to seventy-five grains of 
 the extract, dissolved in water, every day throughout the 
 treatment, and to inject into the substance of the tumor, at 
 different points, as close to the margin of the growth as 
 possible, from two to four minims of a mixture of equal 
 parts of the extract, glycerine and water, not to exceed a 
 syringeful in all. The frequency with which these injections 
 are given is not stated in the literature at my disposal. The 
 surface of the tumor is also painted with this mixture. 
 
 The effects of the treatment noted were : 1 . The sal- 
 low hue of the skin disappeared. 2. Softening of the tu- 
 mor set in. 3. After from three to five days, there formed 
 at the points of injection, fistulous tracts about which the 
 softening process progressed with special rapidity. 4. In 
 from fifteen to twenty days a line of demarcation could be 
 distinguished between the morbid and the healthy tissue. 
 5. The tumor diminished in size and gradually grew less. 
 Sufficient time has not elapsed to give further reports of this 
 treatment. 
 
 Alveloz Milk. 
 A juice derived from a Brazilian plant known as 
 Euphorbia Heterodoxia, possesses the power of dissolving 
 fibrin and is somewhat caustic. In the treatment of cancer 
 
CANCER. 157 
 
 it is applied with a camel's hair brush and in twenty-four 
 hours a strong decoction of tobacco is applied. In twenty- 
 four hours the Alveloz is repeated and again the tobacco in 
 the same order until the diseased tissue sloughs out. It is 
 not used much in this country, neither is its value entirely 
 established. 
 
 The internal use of Butternut, in the form of an extract 
 of the bark, constituted the treatment of one Samuel 
 Thompson, the author of a work on botanic remedies. He 
 advised the use of ten grains of the solid extract every four 
 hours. 
 
 FOR INTERNAL CANCER, with or without Local 
 Manifestations. 
 
 A treatment for internal cancer, existing either in con- 
 junction with or independently of external growths or ul- 
 cerations, was given me by a well known physician who has 
 had experience with it, and who uses, it in all scrofulous or 
 tuberculous conditions as well as in malignant neoplastic 
 growths. He considers it one of his best remedies. 
 
 ^ Fl. Ext. Rumex Crispus fl. 5 j. 
 
 Fl. Ext. Phytolacca Decandra fl 3 j. 
 
 Syrup. 
 
 Water aa fl. § ivss. 
 
 Mix. Sig. One ounce three times daily. 
 In local manifestations, or in purely local epithelioma, 
 ulcers or indolent sores he uses the following ointment : 
 
 ty Fl. Ext. Phytolacca Decan fl. 3 j. 
 
 Fl. Ext. Rumex Crispus fl. § ij. 
 
 Yellow Wax o j- 
 
 Benzoinated Lard 5 iij. 
 
 Melt the last two ingredients and remove from fire. 
 Add the fluid extracts to the hot mixture and stir until cold. 
 
 Apply several times daily. 
 
158 CANCER. 
 
 PROTONUCLEIN. 
 
 Among the newer remedies for the treatment of can- 
 cerous growths, the biological remedy Protonuclein merits 
 a prominent position. In the second edition of this work 
 this remedy was mentioned and its use advocated, especially 
 as an after dressing in cases that appeared difficult to heal. 
 Its physiological action however, when taken internally, 
 seems now to be quite as important and the many reports of 
 physicians that have since appeared in medical periodicals 
 substantiate every claim then made for it. 
 
 Nucleins of vegetable origin are in the market, but these 
 differ materially from the animal product, both in form and 
 action. My experience with the former has, however, been 
 somewhat limited, having always used the Protonuclein 
 made by Reed & Carnrick. 
 
 Its local action in the treatment of Epithelioma and other 
 malignant growths is similar to that in the treatment of rectal 
 ulcers, fistulae, etc., yet in addition we here obtain its anti- 
 toxic action, by which the germs and germ products are 
 promptly destroyed and what is probably more important, 
 this result is not alone obtained from the remedy directly, but 
 by the stimulation given the cellular structures themselves, 
 which effect remains even after the activity of the remedy 
 has been expended. 
 
 One of its most important indications is the use of the 
 Special Protonuclein powder as a dressing after the cancer- 
 ous growth has sloughed away from the action of local ap- 
 plications of caustics and cauterants. 
 
 These openings have very frequently been quite difficult 
 to heal, yet with this remedy at our command we can ap- 
 proach one of the most formidable conditions without the 
 usual apprehension. 
 
 In tumors where the skin is as yet unbroken this remedy 
 may be used hypodermatically, being injected into the base 
 of the growths, as close to the dividing line between the 
 affected and unaffected part as possible. Ten grains of the 
 
CANCER. 159 
 
 Special powder are mixed with one drachm of pure water 
 at a temperature of 98 to 100 degrees. Allow the mixture 
 to stand for twenty minutes, thoroughly shaking it at inter- 
 vals. Finally permit the insoluble particles to settle and 
 draw off ten minims of the supernatant fluid and inject. Pre- 
 pare freshly for each day's use. This is to be repeated twice 
 a day. The same treatment can also be applied in open sores 
 of a malignant nature, in addition to the internal administra- 
 tion. 
 
 Internally, in all cases the regular Protonuclein is to be 
 given in such doses as seem warranted. Three to ten grains, 
 three times a day, may be given, according to effect desired 
 and its action on the patient. Continued increase of pulse 
 indicates longer intervals between doses. Continued in- 
 crease of temperature indicates smaller doses at shorter 
 intervals. General urticaria indicates smaller doses at longer 
 intervals. This latter condition indicates an excess of cellu- 
 lar activity and is a positive order for smaller doses. 
 
 It is best administered two hours before meals, or when 
 the stomach is empty. 
 
 Locally, use the Protonuclein Special as one would an 
 ordinary dusting powder. Always cleanse the parts before 
 applications with Hydrozone until all pus formations are 
 cleared away. As many of the other antiseptics destroy or 
 modify the action of the Protonuclein, no other solutions 
 should be used, unless washed off after their action has been 
 secured. If slight pain should follow the application of the 
 powder, no anxiety need be felt as it will disappear in ten to 
 twenty minutes. 
 
 As a dressing after the caustic treatment it is without an 
 equal and should always be used, whether the wound exhibits 
 any inclination to be difficult to heal or not. 
 
l6o CANCER. 
 
 SODIUM ETHYLATE TREATMENT. 
 
 Given a case of cancer, first cleanse the ulcer with pure 
 Hydrozone. Place the patient in a position so that it will 
 remain in contact with the ulcer until ebulition has ceased. 
 
 Dry the parts with absorbent cotton and pour over or 
 into the ulcer cavity a ten per cent, solution of cocaine and 
 allow it ten minutes time for action. Dry again and apply 
 to the surface full strength Ethylate of Sodium, which can 
 be obtained by allowing the crystals to deliquesce. This 
 agent is a strong and painful caustic, and the application of 
 cocaine does not always entirely prevent pain. When it 
 touches the ulcer a peculiar change is observed. If the 
 wound is clean the fluid spreads itself out rapidly, and where 
 there is diseased tissue the part turns instantly black. The 
 rest of the surface becomes brown. If the ulcer is not clean 
 the entire surface turns black. An application is made over 
 the whole surface. Over the black parts the ethylate soon 
 becomes gummy and must not be disturbed. The entire 
 surface is now covered with the following powder : 
 
 J^ Acetanilide 3 j. 
 
 Aristol 3 ij . 
 
 Acid Boric § j. 
 
 Mix. 
 
 Considerable oedema follows the first application but 
 soon disappears. Pain also entirely ceases as soon as the 
 caustic action is completed. 
 
 Spread a piece of wadding with vaseline and cover the 
 ulcer, apply cotton and bandage. Dress the sore every day, 
 wash ulcer clean and re-touch such spots with the ethylate 
 as show signs of diseased tissue. Use a glass rod in making 
 the applications. Cures are effected in from two to five 
 weeks. Throughout the treatment, give the patient one or 
 two three grain tablets of protonuclein, three times a day, 
 two hours before meals. This remedy is important in this 
 
CANCER. 1 6] 
 
 connection as it increases the white blood corpuscles and 
 assists in removing the oedema. 
 
 Dr. Gunn's Cancer Remedy. 
 
 The following formula appears in Dr. Gunn's "Family 
 Physician," and I have seen it endorsed recently by several 
 physicians practicing in Kentucky, who used it with success : 
 ty Red Oak Bark. 
 
 White Oak Bark. 
 
 Phytolacca Root. 
 
 Persimmon Bark. 
 
 Viburnum Prun. Bark. 
 
 Sheep Sorrel. 
 
 Red Clover Blossoms aa. ^ ij. 
 
 Blackberry Root § iv. 
 
 Cinnamon Bark § j. 
 
 Boil the above in five gallons of water until reduced 
 to one gallon. Strain and add 
 
 Alum. 
 
 Sodium Biborate aa f, iv. 
 
 Sig. Wash the cancer with this three or four times a 
 day until the cancer is devitalized. Dress with a salve made 
 of 
 
 Mutton Suet. 
 
 Yellow Wax. 
 
 Crude Turpentine. 
 
 Sweet Gum aa equal parts. 
 
 Mix by melting all together over a slow fire. When all 
 have melted, remove from fire and stir until cold. 
 
 Sig. Apply on muslin and keep in place by bandage. 
 
162 DRUG ADDICTION. 
 
 DRUG ADDICTION 
 
 Notwithstanding the oft repeated assertion, even by 
 such as claim to have had opportunity for systematic obser- 
 vation, that the extent of drug addiction in our country is 
 constantly being over-estimated, and that the danger to be 
 feared from an increase of the same is more imaginary than 
 real, the fact remains that drug addiction, especially that of 
 opium or its alkaloids, and cocaine, is to-day a cruel, merci- 
 less monster whose almost relentless grasp holds in a thral- 
 dom infinitely worse than slavery, its legion of victims in all 
 parts of the world. 
 
 The far-reaching effect of drug addiction cannot be 
 imagined, much less accurately determined, and only such as 
 have had the opportunity of observing a bright, intellectual 
 and promising young man gradually lose his ambition, his 
 character, his manhood, his all, and sink into an oblivion 
 worse than death, can understand the full import of the 
 assertion that drug addiction constitutes a most effective 
 barrier to the elevation of some of our brightest minds, and 
 too frequently clouds the most brilliant intellects. 
 
 Morphine daily incapacitates the noble, busy physician, 
 defiles the sacred desk, sullies the ermine of the bench, ruth- 
 lessly enters every profession and fastens its terrible and 
 merciless fangs upon every class of people. 
 
 No station in life is exempt from the baneful influences 
 of this steadily growing evil ; all classes contribute their quota 
 to the insatiable army, who, as without a leader, invariably 
 meet the same fate, unless rescued by such of the medical 
 profession who have given the subject sufficient attention to 
 
DRUG ADDICTION. 163 
 
 recognize the truly charitable service that can be rendered 
 in such cases, and who not necessarily consider the substan- 
 tial financial returns accruing therefrom. 
 
 The treatment of drug addiction is so little understood 
 by physicians in general, that it is almost universally regarded 
 as an incurable disease, and by their inattention to it they 
 practically confess themselves inadequate to the task of 
 curing it. 
 
 The successful treatment of drug addictions demands 
 three requisites as follows : 
 
 1. The confidence of the patient. Everyone knows the 
 intense degree of secretiveness that develops in an opium or 
 morphine habitue. The fear of an interruption in his supply 
 is sufficient to rouse an almost superhuman energy to fore- 
 stall it, and indeed the most careful vigilance on the part of 
 the shrewdest physician is often entirely inadequate to cope 
 with the schemes of the most ignorant victim of drug addic- 
 tion. Many habitues will object to treatment for the reason 
 that they have all experienced the pangs of withdrawal, and 
 have an idea that if treatment would be taken, they will be 
 obliged to pass through extreme torture before they can 
 obtain freedom, and consequently postpone the attempt from 
 one season to another. There are but few institutions now 
 in business who practice the sudden withdrawal system unless 
 it is done under the influence of certain other narcotics, which 
 system is perfectly rational and proper, but applicable only 
 to those who are strong and vigorous. Some institutions 
 claim from ninety to ninety-five per cent, of cures by this 
 method, known as the "Quick Cure" system, but in order to 
 obtain these results, the cases must be carefully selected. 
 Confidence therefore is the first prime requisite to be sought 
 for; without it everything will fail. The physician must 
 assure his patient that in case he is not fully supported by the 
 treatment, that if a craving for the drug comes on, he will see 
 to it that he is supplied with enough to meet his needs, and 
 in no instance must this promise be broken. If the patient 
 
164 DRUG ADDICTION. 
 
 is once disappointed, rest assured he will institute measures 
 to prevent any such calamity in the future. 
 
 The next requisite is, the patient must be willing to be 
 cured. Paradoxical as it may seem, one is frequently con- 
 sulted by opium or morphine addicts for relief from the crav- 
 ing, while at the same time they are daily consuming more 
 of the drug than they actually need to be free from annoy- 
 ance, and who after treatment, after the craving has been 
 removed, express and often gratify a desire for a single dose, 
 merely to note the results. The results are too well known 
 to require mention, and too strong injunction against such 
 procedure cannot be given. The collaboration of the patient 
 with the physician is absolutely essential. 
 
 The third requisite. The physician who essays the 
 successful treatment of drug addictions must possess the 
 means to cure, and exercise good judgment in employing 
 them. An adequate and reliable knowledge of the various 
 phases presented by a number of these cases, and the special 
 means to be employed in effecting successful terminations 
 can only partially be obtained by reading and study ; actual 
 experience is necessary. It is by experience only that the 
 physician will be able to accurately determine the patient's 
 needs, whether he really requires the drug or whether he 
 only thinks so ; to accurately determine the amount of actual 
 suffering some may endure without complaint, and also to 
 make a liberal allowance for the profuse and exaggerated 
 pleadings of those whose most trifling discomfort renders 
 them unconsolable. In these later named cases, the judi- 
 cious use of a hypodermatic injection of distilled water will 
 often clear up a diagnosis. 
 
 TREATMENT. 
 
 In the treatment of drug addictions several points must 
 be considered as bearing directly on the object for which the 
 remedies are employed. The first is, to relieve the patient of 
 the craving he possesses for the drug, and to enable him to 
 discontinue its use. 
 
DRUG ADDICTION. 1 6.5 
 
 The second is, to combat the physical and mental dis- 
 turbances that take place during the period of withdrawal, 
 and to render this process as free from pain and discomfort 
 as possible. The third is, to prevent the patient from return- 
 ing to the use of the drug, a relapse. In the selection of 
 cases, good judgment again is necessary. Let no one for a 
 moment imagine that the treatment of drug addictionists 
 can be compared with a political job to which no work and a 
 fat salary is attached, nor that all cases are curable, for to 
 one who thus allows his mind to wander, the disappointment 
 will be keen. A certain number of cases are in reality easy 
 to cure, others are more or less difficult and still others are 
 incurable. 
 
 Among the latter class, we note those who are very 
 feeble and usually of an advanced age, say from 70 years 
 upward. The pathological changes that have taken place in 
 these subjects, are beyond repair ; the digestive and elimina- 
 tive processes, have practically been abolished; the gastric 
 secretions have been almost entirely checked; peristaltic 
 movements are very much decreased; the sensibility of the 
 alimentary mucous membranes is so benumbed that there is 
 anorexia, simply because the patient does not know he is 
 hungry. These cases live on their reserve of former years, 
 to which the waste of flesh and loose skin is ample testi- 
 mony. The mind of these cases becomes narrow, and the 
 range of reason is diminished to but a small portion of its 
 former latitude. In these cases, which are so well marked 
 that they cannot fail to be recognized, treatment is useless. 
 Xo system of medication can restore the practically dead 
 cells any more than the dead body, a combination of cells, 
 can be brought to life. The only hope that can be extended 
 to such, is that of being made as comfortable as possible, un- 
 til death ends the scene. 
 
 In passing judgment on cases which might be supposed 
 to belong to this class, one must be guarded, unless guided 
 by reliable judgment, ripened by experience, and if a pos- 
 sible chance of recovery may be hoped for, a treatment here- 
 
1 66 DRUG ADDICTION. 
 
 after referred to, should be begun as an experiment, and the 
 subsequent course determined from results obtained. 
 
 Another class of incurables is that in which a malignant 
 and painful disease co-exists with the addiction, and which 
 in truth caused its formation. It will be entirely useless for 
 any one to speculate on the curability of these cases, as the 
 analgesic action of opium is the only comfort possible for 
 them to obtain. If the drug is removed, the pain returns and 
 the patient is at once in agony, and becomes uncontrollable 
 in a short time. No method of treatment can cure these 
 cases, no matter what claims may be made for it; the drug is 
 not taken for its delightful sensations, nor from the craving 
 born of a habitual use of it, but as a panacea for pain, than 
 which there is no better remedy, and the only link between 
 the mortal and the immortal. 
 
 Among this class may be mentioned those afflicted with 
 epitheliomatous growths, chronic sores or ulcers, renal or 
 hepatic calculi, stone, or any disease or condition, which 
 while it exists, renders the person thus afflicted subject to 
 considerable pain. Before attempting to cure the addiction, 
 the existing cause must be removed. Nothing other than 
 this can be of the least avail, nor merit the suspicion of hope. 
 In contra-distinction to the above must be noted the imagi- 
 nary pains which the majority of addicts will refer to the 
 stomach, or other internal organ, as an excuse for taking 
 their accustomed drug. Where no other symptoms can be 
 located, nor an intelligent diagnosis made of some disease of 
 which a symptom would be the pain referred to, the state- 
 ments must be taken at their real value, disregarded entirely, 
 and treatment at once instituted for the removal of the crav- 
 ing. This done, the pain will be seen to have mysteriously 
 vanished. 
 
 Curable cases may also be divided into several classes, 
 according to length of time the habit has been present, path- 
 ological changes and vitality of the addict. First, we notice 
 the young, vigorous, recent addict in whom the structural 
 changes are practically unnoticeable and a cure easily and 
 
DRUG ADDICTION. l6y 
 
 quickly effected. Second, the addict of two or more years 
 standing, in whom the pathological changes are becoming 
 apparent, but confined as yet to slight derangements of the 
 digestive system. Third, the addict of many years standing, 
 in whom pathological changes may be found representing 
 all stages of retrograde metamorphosis. The possibility of 
 their cure depends entirely on the degree of tissue degenera- 
 tion that exists, and the manner in which they respond to 
 the vitalizing and reconstructive treatment given them. 
 
 MODES OF WITHDRAWAL. 
 
 While explicit and detailed directions are given in the 
 instructions accompanying the following methods of treat- 
 ment, for the withdrawal of the drug, it will not be amiss to 
 review in a general way, the various modes of withdrawal 
 which have in the past been practiced and variously com- 
 mented upon, and the phenomena that attend them. 
 
 Three modes of withdrawal of the drug can be employed, 
 i. The Gradual Reduction Method. 2. The Sudden or 
 Abrupt Withdrawal. 3. The Rapid Reduction Method. 
 
 THE MODE OF GRADUAL REDUCTION. 
 
 This method implies the gradual decrease of the drug 
 in such quantities as the condition of the patient will allow, 
 manifested by either the absence or presence of what Dr. 
 Albrecht Erlenmeyer, in his work on the Morphine Disease, 
 has termed "the phenomena of abstinence." The more pro- 
 nounced these phenomena, the slower must be the reduction 
 of the opiate. 
 
 This method of reduction is not looked upon with favor 
 by a number of well known writers on the subject. The 
 objections expressed to it are principally, the difficulty of con- 
 trolling the patient so as to prevent him from obtaining 
 morphine secretly, thus necessarily preventing a cure ; the 
 next is, the claim that the patient can better endure stronger 
 and more severe withdrawal symptoms for a short time, than 
 lesser and more prolonged disturbances ; and the third is, 
 
1 68 DRUG ADDICTION. 
 
 the longer period during which the patient must remain 
 under treatment. These objections will be touched upon 
 seriatim. 
 
 Control of the Supply : — As has before been men- 
 tioned the full and complete confidence of the patient must ab- 
 solutely be reposed in the physician, and the patient must be 
 firm in his determination to be cured, and must co-operate 
 with him. If either of these two essentials are wanting, it 
 is useless to attempt to effect a cure by using this method of 
 withdrawal, and other and more forcible means must be 
 employed. 
 
 When the patient trusts the physician implicitly, knowing 
 that he will receive from him sufficient of the drug to sustain 
 him, there is no reason whatever for declining to use this 
 method. 
 
 Endurance op SupPering: — Erlenmeyer claims that 
 the sum total of suffering experienced by the gradual with- 
 drawal, will be greater than by the sudden or rapid method. 
 Whether this be true or not, depends entirely on the medi- 
 cinal treatment administered at the time. From his remarks 
 in this connection, it would seem that we are to-day perhaps 
 in possession of knowledge regarding the use of certain 
 drugs, to prevent serious withdrawal symptoms, with which 
 this German authority was not acquainted fifteen years ago, 
 and which we employ with good advantage. It is at any 
 rate, a fact quite positively established that by the use of 
 remedies selected for the purpose, we are enabled to tide a 
 selected class of patients successfully, and practically pain- 
 lessly, over the period of withdrawal, without much difficulty. 
 
 Long Duration op Treatment: — This is an objection 
 that will have but little weight with many patients. If the 
 patient is such that he is willing to take plenty of time in 
 effecting a cure in this manner, it would seem to be of little 
 concern to his physician, providing of course, the patient is 
 willing to meet the necessarily increased professional fee. 
 The majority of patients, who are eligible for treatment by 
 this method, are of the intelligent, professional class, and 
 
DRUG ADDICTION. 169 
 
 have the ability of comparing the advantages of one method 
 of treatment with another, selecting the one best suited to 
 their circumstances, and abide by the consequences. 
 Points of Favor. 
 In contra-distinction to the objectionable features, accord- 
 ing to those opposed to the method, the following may be 
 mentioned as points in favor of it. It is not necessary that 
 the patient be taken to a hospital, asylum or sanatorium 
 especially equipped for handling this class of patients, but 
 treatment can be instituted at the patient's home, often with 
 but little if any interference with his daily routine of work. 
 The withdrawal symptoms are not so conspicuous as in the 
 case of sudden withdrawal, and with proper treatment, can 
 be almost entirely prevented or overcome. While being far 
 from recommending this method in all cases, I do not hesi- 
 tate to state that in the light of our present knowledge of 
 remedies for carrying the patient over this critical period, 
 the method is decidedly advantageous and occupies a place 
 in the treatment of drug addictions which is distinctly its 
 own. 
 
 THE MODE OF SUDDEN WITHDRAWAL. 
 
 This is the method known as that of Levinstein, and con- 
 sists of suddenly withdrawing the supply of morphine, 
 imprisoning the patient in a padded cell, and allowing him 
 to fight the fierce battle in such a manner as he may be able 
 to do. Physicians are in attendance to administer stimulants 
 in case of collapse or impending death. Its advantages are 
 claimed to be, certainty of cure and rapidity of cure, the 
 struggle being over in from four to six days. The cruelty 
 of this method beggars description. Tongue cannot describe 
 nor pen portray its horrors. 
 
 Its employment is an infliction of a punishment, greater 
 than the vast majority of morphine habitues can bear, and 
 if collapse or death does not ensue, their subsequent condi- 
 tion is such, that a relapse is practically certain. In success- 
 ful cases the rapidity of cure cannot be denied, but its dan- 
 
I/O DRUG ADDICTION. 
 
 gers and probable failure, cannot but condemn it. It is a 
 relic of the past, and deserves no consideration except for 
 condemnation. 
 
 THE MODE OF RAPID WITHDRAWAL. 
 
 When the condition or intelligence of the patient is not 
 such as to class him among those to whom the gradual mode 
 of reduction is applicable, the rapid method is recommended. 
 Under this method the supply of the drug is reduced by one- 
 half daily, until the point of crisis is reached, when, unless 
 threatened by collapse, the patient is given no more mor- 
 phine. Reductions can usually be made for several days 
 in this rapid manner until the drug is reduced to a certain 
 quantity, without material inconvenience to the patient, but 
 as the limit of reduction is reached, abstinence phenomena 
 will appear. 
 
 Under proper treatment, this period of crisis can be 
 passed with but moderate suffering, although it is rare that 
 patients will not complain considerably during it. Twenty- 
 four to thirty-six hours, will usually witness the disappear- 
 ance of the symptoms, and the patient will proceed on the 
 course to recovery. The withdrawal symptoms are to some 
 extent increased as compared with the gradual method, but 
 are infinitely less than by the sudden method. From six to 
 twelve days is usually all the time required to render the 
 patient free from the desire for morphine, although subse- 
 quent treatment is continued. 
 
 The advantages or points in favor of this method are. 
 Certainty of success, entire absence of danger of collapse, a 
 short duration of the symptoms produced by abstinence, and 
 the short time required to effect a cure. Wnen patients 
 cannot be depended upon to co-operate with the physician 
 in the employment of the gradual reduction method, by which 
 the drug is imperceptibly reduced, no alternative is open. 
 Rapid reduction must be practiced, and the crisis must be 
 endured. The rapid and gradual reduction methods are but 
 different degrees of the same plan, and in either case the 
 
DRUG ADDICTION. 171 
 
 reduction can be made as rapid as indicated before, or to a 
 certain extent modified. 
 
 DISTURBANCES DUE TO WITHDRAWAL. 
 
 When the supply of morphine is cut off, or when the 
 reduction has reached the point at which crisis occurs, certain 
 symptoms, previously referred to as abstinence phenomena, 
 will appear. One of the principal of these is purely psychic, 
 purely a product of the imagination. It is the fear that the 
 patient harbors at the probability or possibility of future suf- 
 fering. This fear is present when the patient is absolutely 
 comfortable, with no wish to be expressed or no desire 
 ungratified. In certain individuals, this state of the mind is 
 extremely pronounced, rendering their control very difficult, 
 and a restoration of confidence practically impossible. Hal- 
 lucinations and destructive inclinations frequently are mani- 
 fested, furious outbursts of rage alternate with the most 
 piteous appeals for relief, attempts at suicide or murder are 
 indeed not beyond the possibilities. 
 
 When these symptoms first appear, before the disturb- 
 ance becomes too great, every possible effort should be made 
 to retain the confidence of the patient. 
 
 Among other symptoms of withdrawal, the following 
 are the most prominent : pain in any part, difficulty in swal- 
 lowing, threatened collapse, delirium, nausea and vomiting, 
 diarrhoea, cramps, insomnia, and irritability of the bladder 
 or incontinence of urine. 
 
 Carefully analyzed all the true symptoms, due to the 
 want of morphine can be grouped as follows : 
 
 (1) Those due to the lack of the customary stimulus 
 to the brain cells, which stimulus has become so indispensable 
 to functional activity that it is almost akin to vital force itself. 
 These are chiefly restlessness in various degrees, sometimes 
 amounting to actual pain, insomnia, hallucinations, and the 
 reflex symptoms previously mentioned. (2) Those due to 
 the sluggishness of the circulation due to cardiac weakness, 
 caused by the absence of the customary nerve force to this 
 
17-2 DRUG ADDICTION. 
 
 organ. These are the various degrees of collapse, coldness, 
 cold and clammy perspiration, muscular weakness, etc. These 
 symptoms, due to either of these causes, also appear and are 
 modified or augmented by the lesser or greater disturbance 
 of either the brain or heart, or both of them in conjunction. 
 (3) Those due to the excessive secretion of acid in the 
 stomach. 
 
 TREATMENT OF ABSTINENCE SYMPTOMS. 
 
 Since the publishing of the last edition of this work, in 
 1 90 1, considerable new light has been cast upon the treatment 
 of abstinence symptoms, and in fact, as to avoid or ameliorate 
 these constitutes the painless cure of the addiction, one may 
 say that the entire subject stands to-day in a position never 
 before occupied, and that more is known of the successful 
 treatment of drug addiction than ever before. 
 
 Treatment of the abstinence symptoms necessarily re- 
 solves itself to a treatment of the cause. While formerly 
 many of them were looked upon as due to "nervousness, con- 
 stitutional disturbances," and other vague terms, I am now 
 absolutely certain that all of them can be traced to one or 
 more of the above three causes. Since recognizing this fact 
 and directing treatment to the organs primarily disturbed, 
 as soon as recognized, a very considerable portion of those 
 symptoms that were once looked upon as unavoidable, are 
 now entirely avoided or immediately dispelled on their 
 appearance. 
 
 Some of the secondary and reflex symptoms, when they 
 occur, or cannot be overcome by treatment of the organ from 
 which they originate, require such treatment as they would 
 demand were they not associated with the treatment of the 
 morphine disease. 
 
 Nitro-glycerine has an action during the morphine re- 
 duction craving that is especially desirable. Apart from its 
 action on the heart it exerts an influence on the disturbed 
 brain cells that produces, in a mild degree, the feeling of 
 morphine euphoria. In doses of i-ioo to 1-75 grain it relieves 
 
DRUG ADDICTION. 173 
 
 the restlessness and craving. Combined with amyl nitrite 
 inhalations its effect is increased. It is useful in chilliness 
 and gives rise to a sense of warmth. 
 
 Erythroxylon Coca. The fluid extract is valuable for 
 the relief of restlessness. Half teaspoonful doses repeated 
 as required will afford best results. 
 
 For excessive perspiration, atropine is the remedy. 
 1-100 grain twice or three times in twenty-four hours will 
 be sufficient. 
 
 For insomnia, Galvanism is an excellent remedy. Neg- 
 ative pole to the forehead, positive pole to the back of the 
 neck. Four to eight cells will be sufficient. Sleep often 
 occurs within ten minutes of its application. 
 
 As the craving becomes more marked the heart's action 
 will be found correspondingly weaker. A strong cardiac 
 impulse is absolutely incompatible with any particular degree 
 of suffering. When it becomes weak, faint, and rapid, spar- 
 teine or digitalis must be administered in sufficient doses to 
 maintain what may be considered a fair normal action. The 
 necessary quantities vary in different individuals and cannot 
 be specifically stated. 
 
 Hyperacidity of the Stomach. This distressing symp- 
 tom causes more genuine uneasiness and misery than can be 
 imagined by one who has not seen the expression of those 
 in its throes. Pyrosis almost beyond limit is frequently 
 observed, while the offensive sour breath gives ample testi- 
 mony that this symptom, at least, is not imaginary. 
 
 As soon as the first sign of hyperacidity manifests itself, 
 sixty grains of Bicarbonate of Soda should be given, and 
 repeated in similar doses as often as necessary to keep the 
 stomach sweet. The relief derived from this simple remedy 
 is little short of magical and is not limited to the stomach 
 alone, but the entire system is benefited in a most marked 
 degree. 
 
 The Vapor bath taken in moderation or as agreeable, 
 will be found valuable, especially at night before retiring. 
 I do not altogether recommend that it should take the place 
 
174 DRUG ADDICTION. 
 
 of the hot tub baths, but rather that as an agreeable varia- 
 tion it will prove grateful and beneficial. 
 
 Physostigmine Salicylate, a salicylate of the alkaloid of 
 the Calabar bean, is a drug that exerts a particularly happy 
 effect in dispelling the symptoms due to the withdrawal of 
 morphine. This remedy was first used by Prof. Waugh, of 
 Chicago. He employed it in doses of i-ioo gr. hypoder- 
 matically. He states that it produces a sense of comfort, 
 fully equal, if not superior, to morphine. 
 
 Pain may assume the neuralgic type and follow the 
 course of the greater nerve trunks, it may affect the muscu- 
 lar structures, or may be confined to the bones. When 
 neuralgic or muscular in character, the chief dependence is 
 placed in sodium salicylate, the bromides, and when possible, 
 local counter irritation. Collapse requires stimulants, 
 brandy, champagne, strychnine, nitro-glycerine, or sparteine 
 for the heart, hot water applications or faradism. 
 
 Nausea and vomiting, may be relieved by ingluvin, bis- 
 muth, oxalate of cerium, or if carefully used, cocaine. Diar- 
 rhoea requires bismuth, acetate of lead, extract of geranium, 
 zinc sulphocarbolate, etc. Cramps and pains in the bones, 
 are much relieved by hot water applications, in fact a bath 
 in water as hot as can be borne, is often followed by a com- 
 plete cessation of all the disturbances. No limit to hot water 
 bathing need be observed ; patients may spend as much time 
 in it as they wish. Delirium calls for bromides, or what is 
 better, Bromidia, containing potassium bromide, chloral 
 hydrate, hyoscyamus and indian hemp. Doses may be regu- 
 ated according to effect produced. Trional or sulphonal fre- 
 quently produce restful sleep. 
 
 Cystic irritability and urinary difficulties, scalding, incon- 
 tinence and neuralgia of the bladder, are often very trouble- 
 some. These symptoms alone, have been known to cause 
 the patient to become uncontrollable and decline to continue 
 the treatment. Various remedies are suggested in this con- 
 dition ; belladonna, triticum, hydrangea, boracic or benzoic 
 
DRUG ADDICTION. 175 
 
 acid, sandalwood or saw palmetto, being- remedies that may 
 be employed with good results. 
 
 Taking as a basis of treatment therefore each of these 
 organs, the brain, heart and stomach, it is scarcely necessary 
 to point out that no absolute schedule of treatment can be 
 outlined, and right here let me say by way of parenthesis, 
 that this is the weak point in all ready-made treatments or 
 fixed formulae. No two cases can be treated alike, and the 
 results that attend the use of any proprietary or fixed formula 
 are at best very doubtful, as to permanent results. 
 
 The most important factors being heart depression, ner- 
 vous irritability and hyperacidity, the relief of either of these 
 conditions may alone be sufficient to enable a patient to get 
 well who might otherwise be unable to endure the crisis, 
 yet when each indication is simultaneously met by a remedy 
 that overcomes the cause of suffering, all unpleasant effects 
 are frequently entirely avoided. 
 
 Although as just stated, no two cases of drug addiction 
 can be treated in exactly the same manner, a majority can be 
 brought to a satisfactory termination by methods of treat- 
 ment somewhat similar. In the treatments hereafter outlined 
 I wish it to be remembered that no iron clad rules can be laid 
 down. The formulas given are those most frequentlv em- 
 ployed, and the progress of the treatment should be regarded 
 as being typical of a satisfactory case. Variations in great 
 numbers abound. Different indications must be met as they 
 occur, yet on the whole, after carefully reading every line of 
 this entire subject, any physician will be able to successfully 
 treat this class of diseases. It will at least serve as a path 
 along which he can travel, making his own observations, and 
 as he wends his way, let him occasionally pause and record 
 that which seems new and interesting, as landmarks for those 
 who mav come after him. 
 
I76 DRUG ADDICTION. 
 
 Heroin and Dionin. 
 
 Both of these drugs remove all desire for morphine 
 because they are nothing more or less than compounds con- 
 taining morphine, and the idea that is now fast gaining 
 ground that these drugs can form a basis for the treatment 
 of morphine addiction, is entirely unwarranted. 
 
 A medical man quite recently, in a letter announced to 
 me with great joy that he was now entirely free from the 
 cursed drug, morphine, and that he was entirely sustained by 
 a quantity of heroin, less than one-third of the usual quan- 
 tity of morphine taken ! Compare this statement to that of 
 an inebriate who finds that he can get along well without 
 whisky when he uses alcohol, and you will appreciate the 
 position of a heroin addict. The craving following the use 
 of heroin or dionin is infinitely greater and more unmanage- 
 able than that of morphine. It is indeed second only to 
 cocaine. 
 
 Double Addiction. 
 
 When morphine is associated with some other drug 
 addiction, the first indication is to withdraw the additional 
 stimulant, no matter what it may be. In the case of alcohol 
 there is usually' but little trouble in discontinuing it ; indeed 
 after a short time without it the patient is usually better sat- 
 isfied, as morphine seems to be more satisfying. These two 
 drugs are to a certain extent antidotal to each other. Never 
 attempt to increase the whisky allowance in a double addic- 
 tion and expect thereby to reduce the morphine and cure the 
 patient. The result of such a procedure would most likely 
 be delirium tremens. 
 
 Cocaine addiction, in addition to that of morphine, can 
 also usually be given up with little or no craving. Here also 
 the morphine becomes more satisfying. Do not try to reduce 
 the morphine while reducing the cocaine. Be content with 
 doing one thing at a time. When cocaine alone is the drug 
 
DRUG ADDICTION. 17! 
 
 for which there is a craving, a more difficult proposition is 
 presented. Here it is sometimes a good plan to substitute 
 morphine for cocaine, gradually of course, until no more 
 cocaine is needed. The cure of the morphine addiction is 
 then conducted on the same plan as in other cases. 
 
 Preparatory Treatment. 
 
 For Opium or Morphine Addicts. 
 
 As previously stated, the extremely debilitated victim,, 
 the physical wreck, is as a rule incurable. Take as an exam- 
 ple, a person that is only partially able to attend to his per- 
 sonal needs, in an extreme state of emaciation, without appe- 
 tite, practical paralysis of the bowels, living only on the drug 
 which has almost annihilated his cellular structures, and it 
 requires no great degree of ordinary intelligence to conclude 
 that the last ray of hope has fled. 
 
 In cases in which these changes have not progressed to 
 that point, and in fact in all cases considered curable, I have 
 found it advisable to place them on a course of preliminary 
 reconstructive treatment for a few weeks or a month prior 
 to the time when the regular treatment is instituted. In 
 addition to reconstruction, special attention must be paid to 
 elimination. 
 
 For this purpose, cathartics, salines, diuretics and dia- 
 phoretics are indicated. Calomel, phosphate of soda, acetate 
 of potassium and pilocarpine are valuable ; by their use the 
 alimentary tract will be thoroughly cleared out, the torpid 
 liver will be stimulated, the secretions of the kidneys will 
 
1/8 DRUG ADDICTION. 
 
 become more profuse and the skin and emunctories aroused 
 to normal action. For nerve and tissue reconstruction, cin- 
 chona, nux vomica, phosphoric acid, gentian and valerian, 
 used according to the requirements of the case, will be of 
 excellent service. . During preliminary treatment, the daily 
 allowance of the drug can often be very materially reduced 
 without any inconvenience to the patient. 
 
 As a tissue builder and reconstructive agent of the first 
 order, Protonuclein (Reed & Carnrick), in doses of ten to 
 twenty grains a day, is a remedy that deserves special men- 
 tion. Its action is two-fold ; it stimulates leucocytosis and 
 combats the action of pathogenic organisms. It is a decided 
 cell stimulant throughout the entire organism, promotes 
 glandular activity, assists assimilation and the reconstruction 
 of disintegrated cell structure. The dose must be. regulated 
 to the needs of the individual, and should be pushed to but 
 little less than the point of toleration. This will be evidenced 
 by a feeling of fullness in the head, throbbing of the cerebral 
 arteries and headache. It should be continued for at least 
 two to four weeks, according to condition of patient. 
 
 Bearing in mind that in a drug habitue all the digestive 
 organs are sluggish and lack functional activity, one of the 
 first indications is to relieve them and promote normal action. 
 By so doing the gradually decreasing morphine energy will 
 not cause such rapid nor so marked an effect and discomfort. 
 By this means, in addition to the remedies employed, the mild 
 discomforts which in the aggregate would amount to positive 
 suffering, are reduced to the minimum. 
 
 The improvement in patients of this class, by a prelimi- 
 nary course of treatment, is well marked, and has I believe a 
 considerable influence on the treatment proper. In giving 
 directions for the administration of the following remedies, 
 and rules to be followed in conducting the treatment to a suc- 
 cessful issue, many of the points already brought out in a 
 general way, will be repeated. If the details should seem 
 unnecessarily explicit to any one, let him remember that the 
 minutest details are sought for by many whose experience, 
 
DRUG ADDICTION. 1 79 
 
 or powers of perception or conception are less, or whose 
 desire to be sure they are right before they go ahead, is 
 stronger in them, than in him who is disposed to criticise. 
 
 Exercise. 
 
 During preparatory as well as during the treatment 
 proper, no unnecessary demands should be made on the 
 patient's energy or upon that of any organ, for although the 
 organism may have practically been restored to a proper bal- 
 ance by the different remedies employed, it will have sufficient 
 need for its reserve forces, and they must therefore not be 
 squandered on useless exercise or unnecessary worriment. 
 Exercise is best taken when the absence of morphine is felt, 
 as the change of position or moving about has a tendency to 
 relieve the mind of the thought which then is uppermost. 
 After each dose of morphine a fictitious energy is felt and it 
 is at this time that the patient will express desire for activity, 
 but if this is done the comfort and ease secured by the drug 
 will be of but short duration, and the want of stimulation is 
 felt earlier than if the opposite course is pursued. 
 
l8o DRUG ADDICTION. 
 
 Typical Methods of Treatment. 
 
 IMPORTANT. 
 
 Do not begin treating a patient for drug addiction until 
 after you have read every word of the chapter on Drug 
 Addiction. Two to five readings will be of proportionate 
 benefit. It will give you a broader view of the subject, 
 details will be impressed upon your mind which you will 
 otherwise overlook, and you will be the better prepared to 
 meet emergencies as soon as their appearance is made. I 
 shall not consider it necessary to repeatedly refer to the impor- 
 tance of watching the three vulnerable points — the brain, 
 heart and stomach. Specifics for the alleviation of symp- 
 toms due to perversion of the nervous and circulatory cen- 
 ters cannot be indicated as positively as for those due to 
 hyperacidity of the stomach, and in addition to such as are 
 mentioned throughout the several treatments and general 
 consideration of the subject, let the practitioner remembei 
 that the entire materia medica is at his command. Heart and 
 brain tonics and sedatives respond with much the same activ- 
 ity in a patient tinder treatment for drug addiction, as for 
 any other disease, and the same good judgment should be 
 exercised according to indication. For hyperacidity and the 
 symptoms due to this condition we are better prepared to 
 specialize, for but one remedy need be considered — Bicarbon- 
 ate of Soda. Bear it in mind always. 
 
 It is impossible, except at the risk of tiresome repetition, 
 to give the minute details under each treatment. All methods 
 of treatment should be considered as being but parts of the 
 whole, being but different routes converging toward the 
 same goal. In lieu of personal experience, the best substi- 
 tute is a thorough understanding of the knowledge that may 
 be gained by careful study of the subject. 
 
DRUG ADDICTION. l8l 
 
 A Gradual Reduction Treatment. 
 
 An Excellent Method of Reducing the Drug and Sus- 
 taining the Nervous and Circulatory System. 
 
 This method of treatment illustrates the principle of 
 restoring and sustaining the nervous and circulatory system 
 in advance of withdrawing the morphine to an extent that is 
 noticed by the patient, and if intelligently administered, 
 varied according to the requirements of each patient, the last 
 fraction of a grain of the drug can frequently be withdrawn 
 before the patient is aware of the fact that he is free of its 
 influence. 
 
 Special attention is directed to the necessity of avoiding 
 too rapid reduction. Frequently failures result in overesti- 
 mating the beneficial action of the remedies employed, after 
 an observance of the apparent smooth course of the treat- 
 ment. Failures are to be guarded against equally as much 
 on account of their psychic effect on the patient, as for lost 
 time, labor, etc., as patients who have lost confidence are in 
 most instances not desirable ones. 
 
 Preliminary treatment as previous outlined must not 
 be neglected. It is of fully as much importance as that which 
 is to follow ; indeed upon it often depends the success of the 
 issue and the permanency of the cure. 
 
 After attention to the preliminary treatment the quantity 
 of drug consumed is reduced to the amount absolutely neces- 
 sary to sustain the patient without suffering. The well- 
 known custom of patients to fill themselves up with morphine 
 before taking a cure, must be borne in mind, and for a few 
 days but little is done besides the preliminaries, except to 
 allow the morphine which the patient has stored within him- 
 self to expend its force, and ascertain the quantity required. 
 Absolute control of the patient's morphine supply must be 
 obtained, with the full assurance, that any demand will be 
 supplied when needed. Under this reduction, the heart 
 
1 82 DRUG ADDICTION. 
 
 sometimes becomes weak, but a few doses of strychnine or 
 hydrastin, will remedy this. The principal point to bear in 
 mind is, to keep the patient on as small an amount as will 
 keep him in comparative comfort, and yet not reduce it to 
 such an extent, that he will be miserable before the hour for 
 the next dose. The interval between doses, should vary from 
 four to five hours, preferably before meals and bed-time. 
 Appetite and rest will be better if so given. It is useless to 
 expect a patient to either eat or sleep when he feels the want 
 of morphine, and nothing conduces to a rapid and easy cure, 
 as a good appetite and restful, refreshing sleep. When the 
 patient is ready for the beginning of the regular treatment, 
 the quantity of morphine absolutely required per day, is care- 
 fully noted, and from 1-6 to 1-4 of this quantity is given at a 
 dose, hypodermatically, four times a day, thus giving him 
 2-3 of, or the whole usual quantity in a day. The best method 
 of regulating this is to make a solution of morphine in dis- 
 tilled water, thirty-two grains to the ounce, each fifteen 
 minims of which will equal one grain. To illustrate; if a 
 patient requires four grains of morphine per day, he would 
 receive from ten to fifteen minims of this solution, four times 
 a day, which would give him either two-thirds or one grain 
 at a dose. Never give more than is required, and never 
 reduce it unless it can be done without the patient noticing the 
 difference. 
 
 As a nerve reconstructive and tonic, the following solu- 
 tion is given hypodermatically, at the same time as the mor- 
 phine solution is given : 
 
 ^ Strychnine, alkaloid gr. 1-4. 
 
 Atropine Sulphate gr. 1-6. 
 
 Sparteine Sulphate gr. iij. 
 
 Hydrastine Muriate gr. vj. 
 
 Aqua Destil fl. § J- 
 
 Mix. Sig. 
 
 Inject fifteen or twenty minims, according to condition 
 
DRUG ADDICTION. 1 83 
 
 of patient, four times daily, at the same time as the morphine 
 is given. Regulate the dose according to effect, maintaining 
 at twenty minims, if no contra-indications appear. 
 
 Continue the morphine solution in same quantity as 
 used at the beginning, for eight or ten days, until the patient 
 feels perfectly comfortable, and has no wish for stronger 
 doses. This feeling should always prevail, but if reduction 
 is begun too early, the patient will complain. Eight to ten 
 days is usually the earliest time that a reduction is attempted. 
 The first reduction is made by giving the doses each one 
 minim less than formerly ; not reducing each dose one minim 
 less than the preceding one, but one minim less than was 
 given before the reduction was made, thus giving the patient 
 four minims per day, less than before. If this is borne well, 
 a similar reduction can be made in three or four days there- 
 after, and so on, until the dose that was given at the beginning 
 is reduced by one-third. Now make another solution, con- 
 taining half the quantity of morphine used in the former, and 
 double the dose, less one minim. Thus if the patient was 
 receiving ten minims of the solution containing one grain 
 for each fifteen minims, he would now receive nineteen 
 minims of a solution, containing one grain to each thirty 
 minims. 
 
 Continue on this solution until the patient is sustained 
 well, and reduce by one minim, each third or fourth day, 
 until the patient receives but one-half of the dose he received 
 at the beginning of the second solution. Now make another 
 solution, just half as strong as the one just discontinued and 
 double the dose in minims, less one, and by similar reductions, 
 reduce until the patient receives but 1-120 of a grain, when 
 the treatment can be discontinued. Use the tonic all along 
 in full doses, gradually increasing them if well borne, toward 
 the latter part of the treatment. Do not inform the patient 
 when the last dose of morphine is given, but give several 
 injections of water for a few days, before informing him 
 that he has taken no morphine for a certain time. 
 
184 DRUG ADDICTION. 
 
 Inspire confidence in the patient, assure him of relief if 
 he needs it, and never reduce to such an extent that the 
 reduction will be felt. Watch the secretions and keep them 
 as nearly normal as possible. Treat all complications as indi- 
 cated and give plenty of good wholesome food. See refer- 
 ence to diet elsewhere. If hypnotics are needed, as will be 
 in some cases. Bromidia cannot be excelled. This treatment 
 is slow, covering in certain cases, several months, but its 
 success is certain, and all disagreeable features are avoided. 
 It is best adapted to sanatorium work, or in cases where the 
 physician can be in constant attendance. 
 
 A Gradual Reduction Treatment 
 Without Hypodermatic Injections. 
 
 The following is a method of treatment that will give 
 satisfactory results in selected cases, under proper super- 
 vision. It is sometimes difficult to satisfy one accustomed to 
 the syringe mania by administering morphine by the mouth. 
 In certain cases however the change can be made by reducing 
 the amount injected, and giving the quantity taken from it, 
 by the mouth, and slowly increasing the proportions until 
 the full dose is taken internally. Frequently a larger quan- 
 tity will be required when taken by the mouth than by hypo- 
 dermatic injection, but this is of little consequence. 
 
 A number of reports have come to me stating that these 
 formulae were used for self treatment with the most satis- 
 factory results. 
 
 After a course of preliminary treatment, the treatment 
 proper is instituted. By the method of gradual reduction as 
 hereafter detailed, each succeeding dose of the drug is les- 
 sened in a manner that is frequently imperceptible. During 
 ;his process, the Tonic Compound builds up and supports 
 

 6 IV. 
 
 fl. 
 
 5 iss-ij 
 
 fl. 
 
 o ss - 
 
 fl. 
 
 o iij. 
 
 fl. 
 
 5 vj. 
 
 DRUG ADDICTION. 1 85 
 
 the nervous system. The drug Jamaica dogwood, an ingredi- 
 ent in the Opiate Compound, deserves special mention as 
 a substitute for morphine or opium. The fluid extract of this 
 drug would often give as good results as opium prepara- 
 tions, if prescribed in their stead for the relief of pain, and 
 in the treatment for opium addiction, its use is very often 
 attended with the happiest results, satisfying the craving 
 quite considerably. 
 
 The Opiate Compound. 
 
 If Morphine Sulphate. . . q. s., 
 
 Sodium Bromide 
 
 Ext. Jamaica Dogwood. . 
 
 Ext. Viburnum Prunif . . . 
 
 Elix. Ammon. Valerianate. 
 
 Elix. Aromatic. q. s. ad. . . . 
 Mix. Sig. One teaspoonful three to five times daily. 
 
 The quantity of morphine in this compound will depend 
 on the amount consumed by the patient. Sufficient of the 
 drug is to be taken and added to the other ingredients so that 
 each drachm of the compound will contain the quantity 
 usually taken at one dose. Thus if a patient were taking J^ 
 grain doses of morphine, the quantity required would be ^ 
 grain for each drachm of the six ounce mixture, or twenty- 
 four grains. The method by which reduction is best and 
 most conveniently accomplished, is as follows : Prepare two 
 bottles of the above compound and add the morphine to one 
 of them. As each teaspoonful is taken from the bottle con- 
 taining the opiate, the bottle is replenished with a teaspoon- 
 ful of the bottle without the opiate. When the bottle with- 
 out the opiate is empty, another one is prepared and the pro- 
 cess continued, no more morphine being added. 
 
 The intervals at which the doses are to be taken, should 
 be the same as were formerly observed between doses of the 
 drug, gradually increasing the interval between them, accord- 
 ing to the necessity of the patient. After several bottles of 
 
1 86 DRUG ADDICTION. 
 
 this size have been emptied, and the dose thereby increased 
 to an infinitesimal quantity, the same compound without the 
 opiate should be continued for a few bottles more. In con- 
 nection with the above, the following compound is adminis- 
 tered. It is known as 
 
 The Tonic Compound. 
 
 1^ Tr. Nux Vomica, 
 
 Fl. Ext. Passiflora Incarnata, 
 
 Fl. Ext. Avena Sativa aa. fl. § j. 
 
 Tr. Hydrastis Canadensis, 
 Fl. Ext. Erythroxylon Coca, 
 
 Fl. Ext. Cinchona Comp aa fl. 5 ij. 
 
 Elix. Aromatic, or Syrup, .q. s. ad. fl. § xl j- 
 
 Mix. Sig. One to two teaspoonfuls every four to six 
 hours. 
 
 Continue this compound, with the other, during the 
 entire period of treatment. The time required to effect a cure 
 naturally depends on the condition of the patient. No one 
 should begin this treatment, unless plenty of time can be 
 given to it. It is a gradual reduction cure, and cannot be 
 completed according to any fixed schedule. If the patient is 
 in circumstances that will allow the employment of a more 
 rapid mode, there is no reason why it should not be adopted, 
 but to the person to whom careful attention to the treatment 
 will not prove laborious, and who has sufficient confidence 
 in himself and his physician to expect a cure and follow direc- 
 tions, the treatment is admirably adapted. The symptoms 
 due to the withdrawal of the drug, are very often practically 
 absent, but will be present in a certain percentage of cases, 
 and entire freedom from them should not be promised. They 
 are never severe and can easily be overcome by a little forti- 
 tude. A moderate degree of stimulation, brandy, champagne, 
 or electricity will often relieve the unpleasant symptoms. 
 Attention to the heart and respiration must not be overlooked, 
 and irregularities met according to indications. 
 
DRUG ADDICTION. 1 87 
 
 Systematic Gradual Reduction 
 
 The Use of the Alkaloids oe Hyoscyamus. 
 
 The value of the alkaloids of hyoscyamus in the treat- 
 ment of opium or morphine addiction is incontrovertible ; the 
 hydrobromate of hyoscine, and hydrobromate and sulphate of 
 hyoscyamine being most frequently employed. During the 
 past year the discussion of the value of hyoscine and its 
 various salts has been occupying a somewhat prominent 
 place in many medical periodicals, and has received atten- 
 tion from some of the most eminent therapeutists. 
 
 Naturally, when men like Hare, and others in the same 
 class, recognize the value of a drug and deem it of sufficient 
 importance to contribute to medical literature on the subject, 
 interest is promptly awakened, and as a result, hyoscine is 
 receiving the attention its peculiar virtues merit. 
 
 Those of the profession who have either of the former 
 editions of this work have been acquainted with the action 
 of this drug for several years, as I mentioned it and gave 
 directions for its administration in my first edition, published 
 in 1900. 
 
 The following formulae will serve as a guide for the 
 treatment of opium or morphine addiction, using hyoscya- 
 mine in combination with other well known remedies. 
 
 It was contributed by a physician whose experience with 
 this combination has been large and satisfactory. 
 
 Injection No. i. 
 
 I£ Morphine Sulphate gr. vj orq.s. 
 
 Codeine gr. vj. 
 
 Caffeine gr. xij. 
 
 Aqua Dest fl- o J- 
 
 Mix. Inject twenty minims four times a day, before 
 meals and at bed-time. 
 
1 88 DRUG ADDICTION. 
 
 Injection No. 2. 
 
 3> Hyoscyamine Sulphate gr. iss. 
 
 Aqua Dest fi. % j. 
 
 Mix. Each two minims equals 1-160 gr. 
 For directions see later. 
 
 Injection No. 3. 
 
 I£ Strychnine Sulphate gr. 2-5. 
 
 Aqua Dest . fl. % j. 
 
 Mix. For directions see later. 
 
 Before retiring at night, give patient two compound 
 cathartics and three grains of blue mass, together with his 
 usual dose of morphine. Next morning the bowels should 
 move, and if this does not occur, a large enema is given, 
 which will start a copious stool. After the bowels have 
 moved, not before, give twenty minims of No. 1, and one 
 minim of No. 2 at once, injected into the arm or leg. He 
 will now take breakfast and pass the time in any pleasant 
 manner, until time for the second injection, which is given 
 just before dinner. The third injection is given before sup- 
 per, and the fourth at bed-time, about ten P. M. Never let 
 patient sleep during the day. Before retiring, a few mild 
 cathartic pills are given, sufficient to cause another move- 
 ment the next morning. The second day, the quantity of No. 
 1, is reduced by one minim, but he is given two minims of 
 No. 2 and two minims of No. 3. Follow this course through 
 the day, and at night give sufficient cathartic pills or calomel 
 to insure a good movement the following morning. Follow 
 this course every night, as free movement of the bowels is 
 necessary, and never start the injections in the morning, 
 until the bowels are moved. The third day, reduce No. 1 by 
 one minim, and increase No. 3 by one minim, No. 2 being 
 given same as before, two minims. No. 2 is never increased 
 or decreased from now on, but as No. 1 is decreased, No. 3 
 is increased. Decrease No. 1 by one minim each day, and 
 
DRUG -ADDICTION. 189 
 
 increase No. 3 by one minim each clay. When No. 1 has 
 been reduced to ten minims, some signs of disturbance 
 usually appear, for which asafoetida, in six gr. doses, is given 
 five or six times during the day. If the kidneys do not act 
 freely, sweet spirits of nitre may be given. If the reduction 
 seems to be made too rapidly, reduce it more slowly, always 
 increasing No. 3 in the same proportion as No. 1 is decreased. 
 When the reduction has reached the point where only one 
 minim of No. 1 is given, it may be discontinued entirely, 
 still giving two of No. 2 and twenty minims of No. 3. Now 
 give a large dose of epsom salts and observe the inky black 
 material that passes. At night a hypnotic may be required 
 and Bromidia is administered in half to one drachm doses. 
 Continue No. 2 and No. 3 for a few days, two minims of 
 No. 2 and twenty of No. 3. Supply abundant nourishment, 
 beef tea and cereals, prepared foods, and assist digestion by 
 bitter tonics, gentian, quassia, columbo, and give three or 
 four times a day, one drachm of Tr. cinchona compound. 
 This latter may be begun as soon as the morphine is stopped. 
 Supply reconstructive treatment, hypophosphites, iron and 
 protonuclein as needed, gradually decrease the quantities of 
 No. 2 and No. 3, and give the injections at longer intervals, 
 or the No. 2 may be dropped, and the strychnine may be 
 given by the mouth. Caution the patient in regard to his 
 bowels and advise regular habits. 
 
 Note: — In injection No. 1, sufficient morphine is added 
 so that 20 minims will represent the usual quantity taken at 
 each dose. 
 
lQO DRUG ADDICTION. 
 
 A Forty-Eight Hour Cure. 
 
 For Opium or Its Alkaloids, Cocaine or Chloral. 
 
 The Use; of Hyoscine. 
 
 The following formulae are those employed by the 
 majority of the quick cure institutes, although some may be 
 slightly altered in appearance for the purpose of deceiving 
 those to whom the ready made solutions are sold. The 
 cases that are adapted to this treatment, are the young, 
 recent and vigorous addict in middle life. The less quantity 
 of opium or morphine taken, or the shorter the period during 
 which it has been taken, the quicker and more certain the 
 cure. Do not employ this treatment for old, feeble or 
 debilitated cases. 
 
 Formula No. 1. 
 
 IJ Hyoscine Hydrobromate gr. ss. 
 
 Tr. Rhus Tox., 
 
 Tr. Apis Mellificata aa TTL v. 
 
 Sol. Acid Boracic, 2 % fl. 5 j. 
 
 Mix. Sig. Use Hypodermatically. 
 
 Maximum dose Tit x. 
 
 Minimum dose TTL v. 
 
 Use according to directions which follow. 
 
 Formula No. 2. 
 
 1^ Hyoscine Hydrobromate gr. J /g. 
 
 Strychnine Nitrate gr. j. 
 
 Nitro-Glycerine gr. %. 
 
 Fl. Ext. Avena Sativa fl. % ij. 
 
 Elix. Aromatic q. s. ad. fl. 5 vj. 
 
 Mix. Sig:. One drachm everv four to six hours. 
 
DRUG ADDICTION. 19 l 
 
 Directions for Use. 
 
 Prepare your patient by giving him a saline cathartic, 
 magnesia sulphate or citrate. Be sure to have the bowels 
 thoroughly moved before beginning the treatment. Then 
 give a hot bath, an alcohol sweat if possible. A vapor bath 
 cabinet is useful for the purpose. Let the patient abstain 
 from his accustomed drug until the craving becomes urgent, 
 when you will give Five minims of formula No. I. Wait fif- 
 teen minutes and give Five minims more. Wait thirty 
 minutes and give Ten minims more. The patient will now 
 complain of a dryness in the throat and will fall asleep, 
 which will continue three or four hours. (Should these 
 symptoms appear after the second dose, after the thirty 
 minute wait, a dose of Five minims, will probably be suffi- 
 cient to cause sleep. If it does not, give another Five minim 
 dose after fifteen minutes.) 
 
 On awakening, the patient will complain of feeling 
 dizzy, his face will be flushed and the pupils largely dilated. 
 About four hours after the last dose, or when he awakes, 
 give another dose of Ten minims. From now on, when 
 awake, the patient will pick at the bed clothes, grasp at 
 imaginary things, will find bugs, say funny things, may 
 swear or pray, sing or cry, etc. Do not be alarmed at this, 
 as it shows that the patient is under the influence of the 
 remedy, undergoing the denarcotizing process. From now 
 on, give only sufficient doses to maintain this condition for 
 a period of twenty-four hours. As the patient now passes 
 out from under the influence of the remedy, he will either 
 ask for his accustomed drug, or he will renounce it and joy- 
 fully proclaim his freedom. 
 
 Should this renunciation not be complete, ask the 
 patient whether he has a craving for his accustomed drug. If 
 the answer be "Yes," the denarcotizing process was not con- 
 tinued long enough, and it must at once be resumed in such 
 doses as are required, and the semi-intoxicated condition 
 maintained for another twelve hour period. Stop the treat- 
 
J 92 DRUG ADDICTION. 
 
 ment again until patient becomes rational and be again 
 governed by his answer. 
 
 If he declares himself free from the craving, he will 
 have no further desire for the drug, and you will commence 
 giving formula No. 2. 
 
 But few cases will require more than thirty-six hours of 
 the denarcotizing treatment, while many will be cured in 
 from eighteen to twenty-four hours. 
 
 During the treatment with formula No. 1, the patient 
 will vomit large quantities of bile, which must not be stopped. 
 
 Each "time bile is vomited, the patient will feel better, as 
 it is by the action of the liver, that most of the waste pro- 
 ducts which are thrown off are eliminated. The heart's 
 action usually remains about normal, but should it become 
 weak, or in your judgment require it, give a hypodermatic 
 injection of either nitro-glycerine or strychnine nitrate. The 
 former is indicated when the body is cold. The average dose 
 of the former is 1-100 grain, and of the latter 1-30 grain. 
 Should the tongue become dry, the breath fetid or perspira- 
 tion profuse, no alarm need be felt. There is also in some 
 cases sneezing, gaping, free salivation, and an unpleasant 
 odor, which may become nauseating to the attendant. Should 
 the respiration become slightly accelerated, no notice need 
 be taken of it, but should it become labored, a dose of 1-4 
 to 1-2 grain of morphine may be given. This will not now 
 retard the treatment but will soon correct the breathing, when 
 the treatment can be continued in smaller doses. 
 
 During the treatment, give the patient all the cold water 
 he wants and plenty of good rich milk. Diet is referred to 
 elsewhere. 
 
 The Use oe Formula No. 2. 
 
 After the craving has been removed, and the patient 
 has renounced the drug, give one drachm of formula No. 2, 
 and repeat the same dose every four hours, gradually chang- 
 ing to six hours, as the patient becomes stronger. This 
 should be continued for from three to six days, according to 
 the individual need of the patient. 
 
DRUG ADDICTION. 193 
 
 The most common complaint after being cured of the 
 opium or morphine addiction is insomnia, and experience 
 teaches that sleep brought about without the use of hypnotics, 
 is most beneficial to the patient. Cold, warm or tepid baths 
 may be employed, after which a cold compress may be placed 
 across the abdomen and held there by means of an oiled silk 
 bandage. If drugs are required, I advise the use of Bro- 
 midia, (Battle & Co.,) in half to one drachm doses. 
 
 During the period of active medication, and for a few 
 days afterward, the patient should be undressed and con- 
 fined to his room, allowing him to sit up or lie down as he 
 pleases. A nurse should be in constant attendance. Baths 
 should be given daily in temperature as pleases the patient 
 best, or which gives the best quieting results. Hot baths 
 are usually the best. Should the bowels not move at least 
 once in two days, a saline should be given as required. 
 Should there be diarrhoea, if necessary give bismuth, sub- 
 nitrate or subgallate as needed. After a few days the patient 
 regains his appetite and takes on flesh rapidly. In adminis- 
 tering these remedies, use the graduations on your hypo- 
 dermatic syringe as a gauge for formula No. I, and gradu- 
 ate or medicine glass for formula No. 2. This treatment is 
 heroic, but not dangerous in properly selected cases. 
 
 In speaking to the patient before commencing this 
 treatment, it will be best to avoid mentioning the semi- 
 intoxication which the remedy produces, as some will object 
 to it. It should however be borne in mind that it is the 
 presence of this condition which makes it possible to abruptly 
 withdraw the drug without the infliction of much suffering, 
 just as it is possible to perform surgical operations painlessly 
 under the influence of ether or other anaesthetic. It is always 
 best to inform the friends of the patient, if they will see 
 his condition, that such will be the effects of the treatment, 
 thus showing that vou are familiar with its action. 
 
194 DRUG ADDICTION. 
 
 A Rapid Reduction Treatment. 
 
 For Opium or Its Alkaloids. 
 
 This is an admirable method of treatment and one which 
 will show a large percentage of cures in curable cases. The 
 quantity taken or the length of time that the addiction has 
 been present, makes but little difference in the final results, 
 as it has been shown that cases taking upwards of one 
 hundred grains of morphine a day have recovered as quickly 
 and as easily as those whose daily consumption equals but 
 two to ten grains. 
 
 All cases are adapted to this treatment except the feeble 
 and debilitated, especially if over sixty years of age. The 
 treatment must be given under the physician's direction, or 
 that of a good nurse, and the patient should be seen several 
 times a day. In giving this treatment, no special course is 
 outlined for the patient to pursue, but he can either go to 
 bed, lounge about or spend part of the time in the open air. 
 He should not attempt to do any work, nor exercise anv 
 more than possible. The more exercise that is taken, the 
 more the tissue waste, and the consequent call for more 
 frequent stimulation. No morphine should be given after 
 the treatment is begun, unless absolutely required, as will be 
 shown by extreme nervous prostration. The greater portion 
 of cases will not require any of their accustomed drug dur- 
 ing the time they are under treatment, but are fully sus- 
 tained by the remedy. 
 
 Formula No. i. 
 
 I£ Powd. Ext. Cannabis Indica gr. iv. 
 
 Res. Podophyllum gr. iij . 
 
 Atropine Sulphate gr. ^. 
 
 Strychnine Nitrate gr. 1-3. 
 
 Mix. Ft. Caps, or Pil No. xvj. 
 
 Sig. One pill or capsule with each dose of the follow- 
 ing preparation. 
 
DRUG ADDICTION. 195 
 
 Formula No. 2. 
 
 ]> Fl. Ext. A vena Sativa fl. 5 j. 
 
 Fl. Ext. Passiflora Incarnata, 
 
 Bromidia, (Battle & Co.,) aa fl. § iss. 
 
 Spt. Ammonia Aromatic, 
 
 Syr. Lactucarium Virosa aa fl. q ij. 
 
 Mix. Sig. Four drachms as directed hereafter. 
 
 Directions for Using. 
 
 The night before commencing the treatment, allow the 
 patient to take his usual dose of opium or morphine, and 
 also give a ten grain dose of calomel, triturated well with the 
 same amount of sugar of milk. 
 
 This will start the liver to action, which is highly neces- 
 sary. In the morning, after the bowels have moved, let him 
 have his usual dose of drug and in one-half hour, commence 
 the treatment by giving one pill or capsule of formula No. 1, 
 and four drachms, (one-half ounce) of formula No. 2. 
 Give both together as though it were only a single prepara- 
 tion. Repeat this dose every three hours until twelve to 
 fourteen doses have been taken. Then give a dose every 
 six hours, until three to six more have been given, or as 
 may be required. 
 
 After the twelfth or fourteenth dose, give one-half to 
 one drachm of Fl. Ext. Passiflora Incarnata every two, three 
 or four hours, according to the nervous condition of the 
 patient, and continue until twelve to fifteen doses have been 
 eiven. Do not eive the Passiflora until formula No. 2 is 
 being taken at six hour intervals, when it should be given 
 between doses of same. 
 
 Should there be excessive nervousness, Fl. Ext. Avena 
 Sativa in doses of twenty drops and upward every three 
 hours, will be of excellent service. 
 
 Should the bowels become inactive, keep them moving 
 with calomel and small doses of podophyllum The patient 
 will feel relieved after each passage. 
 
I96 DRUG ADDICTION. 
 
 After the Passiflora (and Avena Sativa if necessary,) 
 has been taken for thirty-six to forty-five hours, gradually 
 stop it, and when the doses have been reduced by ten minims 
 each dose until none is required, the treatment will have 
 been completed. Should insomnia be persistent, and the 
 means before mentioned fail, half to one drachm doses of 
 Bromidia, should be given. This preparation has a peculi- 
 arly effective action on these cases, as patients awake with- 
 out the usual dullness experienced by the use of the com- 
 mercial bromides and chloral. 
 
 If during the treatment, the patient should become more 
 nervous or weak than is thought to be safe by the physician 
 in charge, small doses of morphine, (1-4 to 1-3 gr.) may be 
 administered every fifteen, twenty or twenty-four hours. 
 This will ease the patient, but the treatment must then be 
 continued somewhat longer, at least thirty hours after any 
 of the drug has been given. 
 
 Never begin the treatment until the bowels have moved 
 and the alimentary tract is clear of all irritating substances. 
 Should nausea come on at any time give warm water and in- 
 duce emesis ; it will add to the comfort of the patient. Hot, 
 cold or vapor baths may be given, as best borne by the pa- 
 tient. Should the heart become weak, or drop below fifty 
 per minute, give digitalin or nitro-glycerine ; the latter if the 
 body is cold. 
 
 Persons too weak and debilitated to take this treatment, 
 should be given the one next mentioned. 
 
DRUG ADDICTION! 197 
 
 A Gradual Reduction Treatment. 
 
 Specially Recommended for Weak and Debilitated 
 Subjects. For Opium or Its Alkaloids. 
 
 This is a very effective method of treatment, and as 
 above stated is especially valuable in old, weak and debili- 
 tated cases. It can also be employed in the treatment of 
 strong and vigorous cases, but these are usually anxious for 
 a treatment that cures more quickly. It is also an excellent 
 treatment for those who wish to be their own patients as 
 well as their own physicians ; for self-treatment. While it has 
 been called a Gradual Reduction treatment, it is not always 
 that the accustomed drug will be called for, and consequently 
 the cure becomes in such cases a comparatively rapid one. 
 No opium or morphine should ever be given during the 
 treatment, unless absolutely required. When a patient is well 
 sustained by the treatment and no drug is required, the cure 
 is usually effected in less than six days, while in those who 
 have the need of it, and who take small doses as occasion 
 demands, may prolong the treatment to twenty or even thirty 
 days. 
 
 The immediate and constant attention of a physician or 
 nurse is not required during the administration of this treat- 
 ment, but one or two daily visits should be made by the 
 physician. Especially is this true if the case is treated on 
 the gradual reduction plan, as the physician should have 
 absolute control of the morphine supply of the patient, and 
 at his visits should administer the necessary amount. It is 
 hardly necessary to add that the visits of the physician 
 should be at stated intervals and that punctuality is an im- 
 portant feature. 
 
 The patient should not work during treatment, but it is 
 not essential that he be confined to the house. The direc- 
 
I98 DRUG ADDICTION. 
 
 tions should be carefully followed, especially the instructions 
 relative to the reduction of the doses of the accustomed drug. 
 The formulae are as follows : 
 
 Formula Xo. 1. 
 
 I£ Tr. Belladonna lvs fl. 3 viij-xij. 
 
 Fl. Ext. Hyoscyamus fl. 5 vij. 
 
 Fl. Ext. Prickly Ash bark fl. 3 iv. 
 
 Glycerine.. C. P fl. % iij. 
 
 Syrup Simple q. s. ad. fl. 5 ix. 
 
 Mix. Sig. One drachm every three hours as directed 
 hereafter. 
 
 Note. Increase or decrease the belladonna, according 
 to effect. Moderate dryness of the throat and dilatation of 
 the pupil being indicative of sufficient dosage. 
 
 Formula Xo. 2. 
 
 R Fl. Ext. Passiflora Incarnata, 
 Fl. Ext. Avena Sativa, 
 
 Tr. Xux Vomica aa fl. "% j. 
 
 Tr. Hydrastis Canadensis fl. % ij. 
 
 Tr. Cinchona Comp q. s. ad. fl, 5 vj. 
 
 Mix. Sig. One drachm every three, four or six hours, 
 as directed. 
 
 Directions for Use. 
 
 Nearly all morphine, opium or laudanum addicts use 
 more of the drug than is actually required to keep them 
 comfortable. For a period of three or four days ask your 
 patient to reduce the quantity of the drug to the lowest 
 amount that will sustain him without suffering. Give him 
 during this time, one drachm doses of formula No. 2 every 
 four hours. 
 
 After three or four days of this treatment, during which 
 time the drug is often very much reduced, before retiring at 
 night, give him a ten grain dose of calomel, triturated well 
 with a like quantity of sugar of milk. This will stimulate 
 the liver to action which is highlv necessarv in the treatment 
 
DRUG ADDICTION. 199 
 
 of these addictions. The following morning, after the 
 bowels have moved, begin with formula No. i, one drachm 
 every three hours, and give formula No. 2 every three, four 
 or five hours, according to the nervous condition of the 
 patient. 
 
 Formula No. 1 should be given every three hours, night 
 and day, although one dose may be omitted if the patient 
 sleeps and awakes without a strong craving. If the craving 
 be strong on awakening, no dose must be omitted. If the 
 patient is nervous, restless, afraid or melancholy, formula 
 No. 2 should be given every three hours, alternated with No. 
 1. No. 2 may be continued night and day as -may be 
 required. It is a tonic to the motor nerves and sedative to the 
 sensory. 
 
 Some patients, generally the young and vigorous, or 
 those who used but small quantities of opium or morphine, 
 will be able to discontinue the use of it as soon as the 
 administration of formula No. 1 is begun. In these cases 
 where none of their accustomed drug is taken during the 
 treatment, continue the treatment for Sixty hours, after 
 which reduce each dose by ten minims until none is taken. 
 Formula No. 2 may be given in full doses while formula No. 
 1 is being reduced, if patient shows signs of increasing ner- 
 vousness, or if not, it may be reduced in the same manner. 
 Formula No. 2 may be continued as a supportive for a period 
 of a week after formula No. 1 is discontinued, in full doses 
 three times a day. 
 
 Gradual Reduction. If a patient is not perfectly sus- 
 tained by the treatment as above given, but manifests a crav- 
 ing for his accustomed drug, a small dose of morphine may 
 be given once in ten, fifteen or twenty hours. Begin with 
 about one-third of the usual quantity taken at once, and 
 reduce every succeeding dose by one-sixth to one-third. Do 
 not repeat unless absolutely necessary for the fair comfort 
 of the patient. Continue the treatment, in same manner as 
 outlined above, until the patient has taken none of his drug 
 for sixty hours when you will reduce the medicine as above. 
 
200 DRUG ADDICTION. 
 
 It is apparent that the less morphine given during the 
 treatment, the quicker the cure. 
 
 If, when the remedy is being reduced, a desire for the 
 drug should appear, do not give it at once, but return to the 
 full doses of the remedies and continue thus for twenty to 
 thirty hours longer, when the reduction process may again be 
 begun. For weakness or irregularity of the heart, or should 
 it drop to less than fifty, give digitalis, strychnine or nitro- 
 glycerine, as indicated. The bowels will generally remain 
 open, but should constipation be present, it must be over- 
 come by the use of calomel, podophyllin or sodium phos- 
 phate. Dark, inky passages will occur in the latter stages of 
 the treatment, and will greatly relieve the patient. For 
 insomnia, if the bath and wet pack will not relieve, half to 
 one drachm doses of Bromidia should be employed as 
 required. Baths may be used as before mentioned under the 
 former treatments. 
 
DRUG ADDICTION. 201 
 
 The Mattison Method of Treating 
 Morphinism. 
 
 Dr. J. B. Mattison, of Brooklyn, N. Y., who has devoted 
 thirty years of his life to the treatment of drug addiction, 
 has published a monograph on the subject, the essentials of 
 which are contained in the following extract. 
 
 In offering his method which he terms the American 
 method, in contrast to the cruel and torturing sudden and 
 rapid reduction methods of Levinstein, Erlenmeyer, and other 
 European specialists, he claims both originality and success, 
 and places his method in advance of any yet presented. 
 
 His method is a mean between two extremes — avoiding 
 the painful ordeal of abrupt disuse, and the tiresome delay 
 of prolonged decrease, — and is based on the power of certain 
 remedial resources to subdue abnormal reflex action, and 
 secures largely, two cardinal objects — minimum duration of 
 treatment and maximum freedom from pain. 
 
 It consists in producing a certain degree of nervous 
 sedation and consequent control of reflex irritation, by means 
 of the bromides, more specifically the bromide of sodium. 
 
 In obtaining the effects of this drug, he secures the 
 influence of the continued administration of it, giving it 
 twice in twenty-four hours, at regular intervals, so as to 
 keep the blood continually charged with it. A most import- 
 ant difference exists between the effect of this mode of using 
 it, and that of the single dose, or two or three doses given 
 so nearly together as to form practically one dose. In the 
 former case the system is constantly under the bromide in- 
 fluence, while in the other it is nearly free a large portion 
 of the time, due to the drug being eliminated. 
 
202 DRUG ADDICTION. 
 
 As the desired action of the continual administration of 
 this drug is somewhat remote, four to six days usually 
 elapsing before there is decided evidence in this direction, 
 much more desirable results are secured by its employment 
 for several days prior to complete discontinuance of the 
 opium — meanwhile gradually reducing the opiate — than if 
 the withdrawal be abrupt, and then reliance placed on the 
 bromide. 
 
 In the former instance the maximum sedative effect is 
 secured at the time of maximum nervous disturbance from 
 the opium removal, and its counteracting and controlling 
 power is much in excess of that to be had from its adminis- 
 tration after the nervous irritation has set in. 
 
 The bromide of soda is preferred for the reason that it 
 is more agreeable to the taste, more acceptable to the stomach, 
 causes the least cutaneous eruption, and much less muscular 
 prostration than either the bromide of potassium or bromide 
 of lithium. 
 
 As all the bromides in powder form, or in strong solu- 
 tion, are somewhat irritant, sometimes causing emesis and 
 always delaying absorption, it should be given largely diluted, 
 never with less than six or eight ounces of cold or carbonated 
 water, and in the larger doses, giving one drachm of water 
 for each grain of the salt. 
 
 To secure the requisite degree of sedation within a 
 limited time, it is essential that the bromide of sodium be 
 given in full doses. Failure is often due to non-observance of 
 this point. The initial dose consists of ten grains, twice 
 daily, at 10 A. M. and 10 P. M., increasing the amount 
 twenty grains each day — giving the second day twenty grains 
 at each dose, the third day thirty grains at each dose, the 
 fourth day forty grains at each dose, and continuing thus in 
 proper cases, until the maximum dose of one hundred grains, 
 twice a day, is reached. 
 
 During this time the usual opiate is gradually reduced, 
 so that on the tenth day it will be entirely abandoned. A de- 
 crease of one-fourth to one-third of the usual daily quantity 
 
DRUG ADDICTION. 203 
 
 is often made at the outset, experience having proved that 
 habitues are almost always using an amount in excess of 
 their need, and this reduction causes little or no discomfort. 
 
 Later, the opiate withdrawal is more or less rapid, 
 according to the increasing sedation, the object being to meet 
 and overcome the rising nervous disturbance by the growing 
 effect of the sedative. 
 
 In patients who are weak and anemic, a tonic course of 
 treatment will be advantageous in advance of the treatment 
 for morphinism, in connection with goed food and hygienic 
 measures. 
 
 Patients may have attempted to reduce their daily 
 allowance before coming for treatment, and in such cases 
 the usual large reduction at the outset is omitted. The con- 
 dition of others may be such that no reduction will be allow- 
 able for two or three days, until a part of the bromide action 
 has been secured. With all patients this rule governs. Each 
 case is a law unto itself ; and the length and amount of the 
 bromide giving and consequent rate of opiate decrease is 
 determined entirely by individual peculiarity, as shown both 
 before and during treatment. 
 
 If surprise should be expressed or objection made 
 regarding the large doses of bromide given, it must never be 
 forgotten that we are not to be governed in the giving of 
 any remedy by mere minims or grains, but by the effect pro- 
 duced. Again, one result of opium addiction is a peculiar 
 non-susceptibility to the action of other nervines, necessitat- 
 ing their more robust giving to secure the desired effect. 
 
 Given in the manner described, no unusual effect is 
 noticed before the fourth or fifth day. Then an increasing 
 drowsiness appears which deepens into slumber more or less 
 profound, to such an extent sometimes that it is difficult to 
 remain awake. With this is an aversion to exercise, not 
 solely due to muscular weakness but also to mental lassitude. 
 Sometimes the hypnotic effect is not very decided. 
 
 The bromic breath is sometimes noticed. There may be 
 acne, but this is usually absent. The renal secretions are 
 
204 DRUG ADDICTION. 
 
 often largely increased, and when this occurs, indicating 
 rapid elimination, the sedative effect is not so well marked. 
 
 Patients with serious lesion of the heart, lungs, or kid- 
 neys, should not be treated by this method, and debilitated 
 patients should always receive the tonic course previously 
 referred to. 
 
 Having secured the desired sedation and reached the 
 point where all opiates are discontinued, the reflex symptoms 
 are met by codeine. 
 
 As a rule this drug is not needed during the period of 
 decrease, although exceptionally, a dose or two may be 
 required the ninth or tenth day. When its active use is begun 
 it is given in doses of one or two grains, every three to five 
 hours, by the mouth or hypodermatically, and this is con- 
 tinued for eight to twelve days, gradually lessening the dose 
 or increasing the interval, till no longer required. 
 
 The salt of codeine usually given is the sulphate, muriate 
 or phosphate. 
 
 There is always insomnia after the discontinuance of 
 the opiate. This Dr. Mattison overcomes by trional, twenty 
 to thirty grains for men, and twenty grains for women, at 
 7 P. M., on the tongue, aided if necessary, by ten grains more 
 in three hours. It may be followed by hot water or milk. 
 This may be necessary for eight or twelve nights. 
 
 For the relief of unrest or neuralgia he gives cannabis 
 indica in doses that seem large, but he assures us that he 
 has given them to hundreds of men and women without pro- 
 ducing toxic effects that gave him any anxiety. He gives of 
 Cannabis Indica, thirty to sixty minims of Parke, Davis & 
 Co.'s or Squibb's fluid extract, or one to four grains of solid 
 extract. Small doses are exciting while large doses are seda- 
 tive, quieting and harmless. 
 
 He also uses the Turkish baths for restlessness and 
 neuralgia. Warm baths are worthless ; hot baths useful. For 
 diarrhoea, when it occurs, he gives hot water enemas, zinc 
 sulphocarbolate, fluid extract of coto, bismuth or tannopin, 
 and if all fail, a full dose of opium by the mouth or bowel. 
 
DRUG ADDICTION. 20$ 
 
 This always controls it, gives a full night's rest and the 
 diarrhoea seldom returns. 
 
 He also recommends galvanism, nitro-glycerine and 
 bicarbonate of soda in the same manner as mentioned under 
 a method of treatment previously given. In case of collapse, 
 which he says has never occurred to any of his patients, he 
 would give immediately a full dose of morphine. The indi- 
 cations for this would be irregular pulse, livid skin, faint- 
 ness and pallor. 
 
 Dr. Mattison advocates the discontinuance of the syringe 
 as soon as treatment is begun, or at least within a few days, 
 and substituting therefor the giving of morphine by the 
 mouth. This removes the fascination that patients seem to 
 have for the syringe and prolongs the effect of the mor- 
 phine. The acme of effect is reached earlier by the hypo- 
 dermatic method, but it also disappears earlier, while by the 
 mouth the effect is slower but more persistent. 
 
 Patients injecting six or eight times a day will do well 
 on four doses by the mouth. 
 
 The patient is not informed as to the decrease of the 
 opiate nor of the actual time when it is entirely stopped. 
 
 During the decrease patients are informed that if the 
 amount allowed is not sufficient, more will be given on appli- 
 cation. This being the case, no motive exists for secret 
 taking, and inspires confidence. 
 
 After treatment is completed and the patient free from 
 the use of the opiate, months must elapse before the system 
 is restored to its normal status. Premature return to physical 
 or mental work will imperil the prospect of permanency, and 
 should be avoided. 
 
206 DRUG ADDICTION. 
 
 Relapses. 
 
 The general impression seems to prevail that any cure 
 for opium addiction, that is not at once positive and perma- 
 nent, is not worthy of recognition, and to the relapses that 
 occasionally occur, is in a great measure due the unmerited 
 condemnation that has been placed on any treatment for 
 this addiction, by many men of the profession. This is 
 undoubtedly an error. Are not all physicians familiar with 
 the relapses that occur after an apparent cure of typhoid, 
 catarrhal or other fevers ? Are not surgeons frequently called 
 upon to operate a second or even a third time on cases in 
 which apparently no doubt existed as to the outcome of the 
 first ? Because a certain line of treatment in which you have 
 unbounded confidence fails to perform the work expected of 
 it in an isolated case, do you forever condemn it and refuse 
 to use it again ? 
 
 To condemn any treatment because its action is not uni- 
 formly satisfactory, is to condemn all the means at the com- 
 mand of the physician, the surgeon and obstetrician. If one 
 trial fails, pursue the rational course that is followed in any 
 case, if after convalescence from any disease, the patient 
 should have a relapse. Failures and relapses are not always 
 attributable to the treatment employed, as patients, during 
 treatment and after a cure, are often responsible for the 
 failure to obtain results that are in every respect satisfactory. 
 
 An important factor in determining the permanency of 
 a cure, is the cause that was responsible for the formation of 
 the habit. It will be necessary to consider this point 
 thoroughly, as if the same conditions which caused the patient 
 to resort to the use of morphine are still present, there will 
 be a strong temptation to seek relief in its narcotic effects 
 again. Special attention should therefore be given to the 
 removal of the cause underlying the first resort to the drug. 
 
DRUG ADDICTION. 
 
 207 
 
 In a certain number of cases, an occasional craving will mani- 
 fest itself from no determinable cause, unless it be the occa- 
 sional mental reference which the patient makes to the 
 buoyant state in which he existed while under the effect of 
 the narcotic, contrasted with the present state of imperfect 
 nerve control. Even after a cure has been effected, some- 
 times for several months after, the patient will not feel 
 entirely comfortable, even though there be nothing present 
 that could properly be termed a craving; it is a peculiar 
 loneliness, absent mindedness, lack of energy that at times 
 makes its appearance, and the patient cannot help imagining 
 the delightful sense of relief that he could obtain bv just a 
 single dose of morphine. For this reason a change of scene, 
 change of occupation, travel, amusement, in fact any diver- 
 sion, will be of material assistance to the patient. There is a 
 peculiar feature in this connection; the seventh month after 
 the cure seems to be the hardest one to endure, and all cured 
 patients, unless they are absolutely free from all traces of the 
 habit, should undergo a tonic course of treatment from the 
 sixth to the end of the seventh month. 
 
 Another frequent cause for a relapse is insomnia. With 
 insomnia, a weakness of the heart is frequently noticed, and 
 when this is the case, the weakness or irregularity must be 
 met with such drugs as digitalin, sparteine, strychnine, caff- 
 eine or cactus. The relief of the cardiac irregularities is often 
 followed by refreshing sleep. 
 
 If this is not present or after it has received attention, 
 the insomnia will usually yield to the use of hypnotics, baths 
 or wet pack. As a hypnotic suitable for these cases, nothing 
 excels Bromidia, (Battle & Co.) The action of this prepara- 
 tion is especially advantageous in the nervousness and ex- 
 haustion frequently met with, especially in those above middle 
 age. The dose should be from fifteen drops, frequently re- 
 peated, increased to one teaspoonful if needed. It is frequently 
 beneficial to change hypnotics on different nights. Do not 
 forget the baths, with cold pack on abdomen if insomnia 
 is persistent. 
 
208 DRUG ADDICTION. 
 
 Diet. 
 
 The capricious appetite of persons addicted to the use 
 of opium or its alkaloids, is often entirely destroyed unless 
 special attention is directed toward the selection of food, 
 especially toward the latter end of the treatment, and for 
 some time following the cure. 
 
 Sometimes the appetite returns with such force that there 
 is danger of over-eating, and on this account special direc- 
 tions should be given to avoid it. When too much food is 
 taken, even though the appetite demands it, it is usually fol- 
 lowed by gastric disturbances and, almost without exception, 
 a craving for the accustomed drug. 
 
 During the treatment it is a good practice to avoid all 
 solid food, limiting the diet to liquids, prepared foods and 
 fruits, as hereafter outlined. 
 
 Exception may be made when one of the methods of 
 gradual reduction or home treatment is employed, whereby 
 the treatment is extended over a period of two or three 
 months. In these cases the patient is more gradually brought 
 away from the influence of the drug, and the system restored 
 in advance of entire withdrawal. 
 
 When a method of treatment is employed in which the 
 physician or nurse are in constant attendance, as in sanator- 
 ium or hospital practice, when a rapid cure is desired, or in 
 any case in which the appetite fails, and the stomach becomes 
 irritable and rebellious, often accompanied with nausea and 
 vomiting, a careful dietetic regimen must be followed. 
 
 Liberal doses of bicarbonate of soda, especially when 
 there is hyperacidity, lime water, and charcoal will often 
 relieve the more urgent symptoms. I am particularly partial 
 to soda, and as previously stated, place much reliance on it. 
 
DRUG ADDICTION. 2O0 
 
 For extreme irritability of the stomach, external applications 
 of mustard, chloroform, or ice will sometimes relieve. Inter- 
 nally cocaine may have to be resorted to, and if all this fails, 
 a full dose of the accustomed drug may be required to tide 
 over a critical period. 
 
 A strict milk diet, for several days or a week, will often 
 overcome the more prominent symptoms, yet some patients 
 are unable to take milk in the necessary quantities, either on 
 account of an aversion to it or because it produces bowel 
 irregularities. Taken fresh, it will cause diarrhoea in some, 
 while others will be constipated if it is taken boiled. 
 
 Ordinarily, when no special gastric disturbances are 
 present or threatened, fruit and fruit juices are beneficial; 
 vegetables boiled, and seasoned, are allowed; bread, plain or 
 toasted, biscuits and cereals may be taken as desired, due 
 regard being observed as to quantity. 
 
 Beef tea, prepared either from prime lean beef, or a good 
 extract of the same, is grateful and nourishing. It may be 
 used within proper bounds. Food should be taken whenever 
 its need is felt, but eating to the limit of capacity is always 
 prohibited. 
 
 The prepared foods form an agreeable and nourishing 
 diet for persons undergoing treatment for drug addiction. 
 My experience has been that a solution of many of the per- 
 plexing problems relative to diet, will be found in their 
 employment. 
 
 When the exclusive milk diet disagrees or is not palat- 
 able, such foods as Horlick's malted milk, Eskay's albumen- 
 ized food, Mellin's food or Wampole's milk food should be 
 employed. These foods are nutritious, tax the digestive 
 organs but little, furnish a large amount of nourishment in 
 comparison to the quantity taken, and are quite palatable. 
 
 Bovinine is also an excellent food, in many cases prefer- 
 able to beef extracts, beef broths and similar products. When 
 well borne, an unusual amount of nourishment is derived 
 from a small quantity of this preparation. 
 
210 DRUG ADDICTION. 
 
 Oysters and clams, to those fond of this food, are 
 usually acceptable, and when prepared with plenty of rich 
 milk, form excellent diet. 
 
 During treatment for Inebriety patients are usually not 
 troubled on account of a lack of appetite, nor rebellion of the 
 stomach, but on the contrary, frequently eat more and feel 
 better than before. 
 
INEBRIETY. 211 
 
 INEBRIETY. 
 
 Chronic Alcoholism. 
 
 A lengthy discussion as to whether the excessive use of 
 alcoholic stimulants is a disease or a habit, is at this time 
 unnecessary, as the medical profession is now practically a 
 unit in conceding - that while the occasional indulgence in the 
 use of alcoholic liquors as a beverage may properly be 
 termed a habit, it speedily becomes, through unwise indul- 
 gence, so pronounced, as to constitute actual disease, mani- 
 fested by certain morbid phenomena. To the laity these 
 phenomena are not always apparent and their opinions are 
 formed by the impressions conveyed to their minds by the 
 occasional or frequent sight of an intoxicated person, in 
 whom they see personified all that is wicked and immoral, 
 wholly ignorant of the pathological changes that have taken 
 place in that delicate structure, the nervous system of the 
 inebriate. Again, the temperance advocate and total 
 abstainer are strong in their declarations that drunkenness is 
 a mean, low and disgraceful habit, from which any ordi- 
 nary person can free himself by the exercise of his will power 
 alone, while their deductions are offset by those of the vic- 
 tim himself, who maintains that he is afflicted with a high- 
 born, aristocratic disease, of uncertain nervous origin, for 
 the temporary relief of which alcoholic beverages have 
 proved themselves a sovereign remedy. 
 
 Among the laboring classes, those whose position in life 
 calls for an expenditure of vital force which their plain and 
 often innutritious diet fails to furnish, the habitual use of 
 stimulants is frequqently due to their discovery that alcohol 
 will supply to them the stimulus needed to enable them to 
 
212 INEBRIETY. 
 
 accomplish a greater amount of work than they would other- 
 wise he able to perform. The step from a custom of this 
 sort to confirmed inebriety, is short, indeed. 
 
 Among the higher classes, the desire for alcohol is often 
 the abnormal craving of an impaired and degenerate nervous 
 system for something that will stimulate and support, in 
 order that it may perform its functions without pain or 
 friction. 
 
 The desire for alcoholic stimulants is undoubtedly to a 
 certain extent hereditary; a virgin fountain fed from an 
 impure and tainted spring. 
 
 This heritage of depraved blood is a horrible endow 
 ment, but something from which unborn multitudes cannot 
 escape, for shall not the sins of the father be visited upon the 
 children even unto the third and fourth generation? What 
 a dreadful heritage ! What a frightful possession ! 
 
 The careless and unthinking multitude drink daily, 
 perhaps because the primary effect to them is pleasing, or 
 perhaps because it temporarily satisfies a craving which they 
 have never stopped to analyze, and in the very face of the 
 fact that they almost daily see the death of some person, cut 
 off in the prime of life, either from chronic alcoholism, or 
 some one of the many disorders to which it gives rise. 
 
 In the indiscriminate use of alcoholic liquors physicians 
 assume a responsibility for which they would hesitate to 
 answer, and for which they would dread to be held account- 
 able. While alcohol has in some forms of disease an apparent 
 therapeutic value, physicians should exercise greater care 
 and discrimination in advising its use, as habits of inebriety 
 are not infrequently directly traceable to a physician's pre- 
 scription. Then, too, it should not be forgotten that unques- 
 tionable therapeutic authorities hold that alcohol is abso- 
 lutely destitute of curative power, but is always a profound 
 nerve and tissue poison, producing first an exhilarating 
 effect which is later followed by a state of depression, to 
 counteract which a further supply is necessary. Any thera- 
 
INEBRIETY. 213 
 
 peutic effect which has ever been claimed for alcohol can 
 be obtained by the administration of other drugs, the action 
 of which is better understood and better controlled, and 
 which are certain not to leave the patient in a state of nerve 
 hunger for which alcohol is the only remedy, and which the 
 patient will not be slow to discover. 
 
 Drunkenness is seen in two forms, thus establishing 
 the theory that it may exist as a psychological disease of the 
 mind, or as a well defined physiological abnormality of the 
 nervous system. 
 
 As an example of the first form we have the periodical 
 drinker who wavers between two extremes ; either abstaining 
 entirely for an indefinite period, or neglecting everything, 
 and doing nothing but drink, drink, drink until he becomes 
 so sick that he is compelled to desist. His spree always 
 winds up in this manner, and the thought of being sick and 
 his desire of becoming well, changes the current of his 
 thoughts, and when he recovers he will not drink again until 
 he begins to think of it again. These cases are primarily 
 psychological and it is not until they get the thought of 
 drink thoroughly riveted in their minds, that the inhibitory 
 power of the will is paralyzed, and the first drink is taken. 
 In a short time he feels new life and energy, every cell in 
 his body becomes buoyant and produces a feeling of exhil- 
 aration which he cannot contain, and he continues to drink 
 until he is no longer able to do so. 
 
 In the other form of drunkennesss, where the shattered 
 nervous system demands a continual stimulation or suffers 
 collapse, the condition is entirely different from the former. 
 
 The continual drinker never gets sick from the use of 
 liquor, but from the lack of it. Without his customary 
 "bracer," an individual, who perhaps holds the destiny of 
 nations in his hands, is utterly unfit to perform the slightest 
 portion of his daily duty, or unable to write his own name. 
 
 This form of drunkenness is usually a subsequent stage 
 of the former. Periodical stimulation, repeated with inter- 
 
214 INEBRIETY. 
 
 missions that in many cases steadily grow shorter, in time 
 tend to produce the nervous state which characterizes the 
 second form. When this condition is not produced, as is 
 often observed in men who have indulged in numerous 
 periodical debauches, the nerve centres of the individual 
 have acquired by inheritance; constitutional perfection per- 
 haps ; a resistance sufficient to prevent the degenerative 
 changes from taking place. It is this nerve resistance which 
 saves every moderate or periodical drinker from that condi- 
 tion in which stimulants are continually demanded, and 
 which limits the disease to a psychological one, with more 
 or less constitutional manifestations. The man who can drink 
 or leave it alone, usually drinks. He will drink whenever 
 he thinks of liquor if he has the opportunity. That he does 
 not become a habitual drunkard is not due to his will power, 
 but to his inherited resistance, a condition which he cannot 
 understand but which nevertheless enables him to do without 
 stimulants if occasion demands it, and yet does not suffer 
 from the lack of them. In him who has less of this nerve 
 resistance, the disease gradually progresses and steadily 
 there is developed the nerve center degeneration which makes 
 a stronger demand for stimulation, renders the mind less 
 firm and consequently more easily influenced by the morbid 
 craving, and constant stimulation becomes a necessity. To 
 overcome this craving, treatment must be directed to the 
 reparation of the shattered nerves and impaired vital organs, 
 which brings us to this part of the subject. 
 
INEBRIETY, 215 
 
 TREATMENT. 
 
 If the periodical excessive indulgence in stimulants 
 were entirely psychological, drug treatment would necessarily 
 be useless. This is, however, not the case. It is psycho- 
 logical, or practically so, in such persons who can by their 
 own efforts discontinue the use of liquor. In these cases all 
 that is necessary is to prevent the thoughts in this direction 
 from controlling the individual and obtain his promise to 
 avoid his former associates, to remain away from places 
 where liquor is sold, and if possible, with promise of reward, 
 give him an object to be attained by the fulfillment of his 
 promise. In the young this can often be brought about by 
 the promise of such objects as they desire or will appreciate, 
 while in the older, promises of employment or position in 
 society may be made conditional upon their abstinence. 
 Change of surroundings or occupation is frequently of 
 benefit in this connection. 
 
 In the more advanced cases, where in addition to the 
 psychological phase we have beginning degeneration of the 
 nerve and vital forces, more than moral suasion is necessary. 
 
 It is not considered possible, by the use of any combina- 
 tion of drugs imaginable, to change the cell arrangement of 
 any individual in such a manner as to remove the possibility 
 of his becoming addicted to the use of alcoholic stimulants, 
 or to forever destroy the taste for it after it has once been 
 established, without the aid and co-operation of the person 
 directly concerned. No one, no matter what treatment he 
 has taken, no matter what the claims that are made for it, 
 can remain cured unless by the practice of total abstinence. 
 The taste of liquor, and the desire for it, in the majority of 
 cases, once foreign, can easily be acquired primarily, and 
 very much more easily if after a long term of gratification 
 of this craving, after a temporary cessation, it is again 
 encouraged. Full consent and willingness on the part of 
 
2l6 INEBRIETY. 
 
 the patient is therefore an indispensable requirement. Treat- 
 ment for this addiction can only assist the individual who 
 has a desire to be freed from its grasp, and make it possible 
 for him to gain the mastery. 
 
 The essentials in the treatment of inebriety are Elimi- 
 nation, Nutrition, Suggestion, Reconstruction, and when 
 required, Rest. 
 
 For elimination the mercurials are sometimes used, but 
 salines seem to be more satisfactory. Large quantities of 
 water should be combined with them so that the emunctories 
 which have failed in their physiologically appointed work, 
 the congested brain, liver, stomach, intestinal tract, mucous 
 membranes and skin are to be relieved and stimulated to their 
 proper functions. 
 
 Nutrition. In the treatment of inebriety the patient is 
 not so apt to lose his appetite as in the treatment of other 
 addictions, and a strong nutritious diet can usually be main- 
 tained with benefit. If the appetite is capricious or the 
 stomach disordered by solid foods, beef tea, milk, cereals, or 
 the prepared foods previously mentioned under Diet in Drug 
 Addiction may be given. 
 
 Suggestion consists chiefly in cheering up the patient, 
 assuring him that he will be cured and relieved from the need 
 of stimulants, and impressed with the thought that he will 
 not be compelled to stop drinking, but that he will be strong 
 and manly, and will be able to conquer the desire, and keep 
 it away from him. 
 
 Reconstruction is begun with the beginning of treat- 
 ment. The method by which this is accomplished varies 
 with the treatment employed, but as a general rule a few 
 weeks preparatory treatment will be of benefit. 
 
 Rest, if necessary, sleep, change of surroundings, hypo- 
 phosphites, beef, wine and iron, strychnia compounds, 
 calisaya cordials, egg phosphates and tissue building reme- 
 dies are indicated for this purpose. 
 
INEBRIETY. 217 
 
 After elimination of effete material from the tissues, 
 toning up and improving nutrition, and reconstructing the 
 forces of a weakened heart and nervous system, the real 
 treatment begins. 
 
 The question is often asked, is a sanatorium necessary 
 for the successful management of cases of inebriety, or can 
 a home treatment be successfully employed. The answer 
 is a qualified one. Every physician in general practice and 
 in connection with it, can cure a certain class of selected 
 cases without confining the patient and without recourse to 
 asylum methods. Generally speaking, the only cases that 
 require sanatorium treatment are those who have no good 
 home in which they can be taken care of, or no one to attend 
 to their wants and wait on them, or those so thoroughly 
 wrecked by liquor that they are unable to follow the physi- 
 cian's instructions, and who need an overseeing hand to 
 keep them under restraint. 
 
 Various methods of treatment for inebriety have been 
 devised, and many remedies have been brought forward as 
 specifics, but the true specific has never yet been discovered 
 and never will be. No single remedy or combination of 
 remedies will cure all cases. Differently tempered and con- 
 stituted persons require different treatment. Inebriety 
 must be treated as any other disease; with an ultimate and 
 well defined object in view, and meeting indications en route 
 as good judgment and experience may dictate. 
 
 Quick cures for drug and liquor addiction have in recent 
 years appeared in considerable numbers, and while many 
 of the profession have chosen to condemn these without a 
 trial, others have taken them up and used them with consid- 
 erable success. The Quick Cure method is best adapted to 
 sanatorium work, as the treatment is vigorously applied and 
 requires almost constant attention from physician or nurse. 
 It is adapted to the treatment of persons who are continually 
 under the influence of liquor, not necessarily intoxicated, 
 and who have in many cases not sufficient self control to 
 
2.1 8 INEBRIETY. 
 
 permit them to make up their minds as to whether they wish 
 treatment or not. 
 
 Similar treatments to the following are frequently adver- 
 tised to the profession, which if not identical with this, are 
 not sufficiently different to merit the investigation and ex- 
 pense necessary to ascertain their exact composition, if such 
 is at all possible. Hyoscine Hydrobromate is the only drug 
 that produces the symptoms as outlined under the Forty 
 Eight Hour Cure for morphine addiction, and many of 
 the advertised remedies produce these without variation. 
 
 After attending to the preliminaries the patient is placed 
 on the following formula and an effort made to lessen the 
 quantity of liquor taken. It should be continued from ten 
 days to two weeks. 
 
 Formula A. 
 
 T$ Hyoscine Hydrobromate gr. 1-20. 
 
 Strychnine Nitrate gr. j. 
 
 Tr. Hydrastis Canad, 
 
 Tr. Valerian aa fl. § iiss. 
 
 Tr. Capsicum fl. § ss. 
 
 Tr. Cinchona Comp q. s. ad. fl. § viij. 
 
 Mix. Sig. Two drachms every four to six hours. 
 
 Under this treatment the patient will usually be able to 
 get along with a much less quantity of liquor than was his 
 custom, will improve in appearance and general health and 
 will be in condition to receive 
 
 Formula B. 
 
 I£ Hyoscine Hydrobromate gr. j. 
 
 Sol. Boracic Acid, 2 per cent fl. § ij. 
 
 Mix. Sig. Five to ten minims hypodermatically. 
 
 Directions for use. The directions given for the use of 
 Formula One, under the Forty-Eight Hour Cure for Mor- 
 phine and Opium, will apply to the use of this formula in the 
 
INEBRIETY. 219 
 
 treatment of inebriety. They are practically of the same 
 composition. Formula A is discontinued when Formula B 
 is begun, but is resumed again as hereafter directed. 
 
 Treatment with Formula B should be continued for 
 from four to six days, but it is not essential to continue it 
 through the night, but may be discontinued about 10 P. M, 
 and resumed in the morning. After four days' treatment, 
 before resuming in the morning, ask the patient whether a 
 desire for drink is present, and as long as the answer is 
 "Yes," continue the treatment. When the answer is "No," 
 the treatment may be discontinued. 
 
 This class of patients frequently manifest more or less 
 destructive inclinations, and should they become unmanage- 
 able, they should be placed under restraint. If great ner- 
 vousness occurs they should be quieted with morphine in 
 doses of 1-4 to 1-2 gr. This will not retard the treatment, 
 as they are not addicted to morphine, and besides, they are 
 taking the morphine antidote. After a short sleep they will 
 awake refreshed and the treatment can be resumed. Should 
 the pulse rise to ioo or over, do not crowd the treatment ; 
 wait a short time and it will be reduced. Continue then, in 
 smaller doses, if deemed best. Occasionally a patient will 
 be met with who requires but half the ordinary doses, while 
 others require more than the usual. It is well therefore to 
 use the remedy according to effect. The semi-intoxicated 
 state should be maintained in a moderate degree throughout 
 the treatment, except during the night, as before noted, 
 always regulating the doses by the effects of the preceding 
 one. These patients do not as a rule vomit during the 
 treatment and retain their usual appetite. The same general 
 rules as to baths, nurses and confinement of patient, given 
 under the before mentioned opium treatment, apply to cases 
 of this nature. After the desire for liquor has been removed, 
 and the patient regained his normal mental condition, he 
 may be allowed to occupy his time about the house or go out 
 walking, care being taken that he does not become fatigued. 
 
220 INEBRIETY. 
 
 Now Formula A is again commenced and continued for sev- 
 eral weeks longer, or as needed. 
 
 This treatment is a very successful one, having cured 
 cases who were "graduates" of renowned institutions. It 
 should not be used except under sanatorium facilities, or 
 in apartments adapted for the purpose. For general use, by 
 physicians in general practice or who do not devote any 
 special attention to the treatment of this class of cases, the 
 following methods are more suitable, and better adapted to 
 their facilities. 
 
 The Ideal Inebriety Cure. 
 
 For Liquor, Wines and All Alcoholic Beverages. 
 
 A treatment adapted to all cases. No special facilities 
 required. This treatment is recommended in all cases where 
 the patient is willing to be cured, such as come within the 
 reach of the physician in general practice, who usually has 
 neither the time nor facilities at his disposal, which are neces- 
 sary for the correct administration of the treatment pre- 
 viously mentioned. The time required to effect a cure varies 
 from ten to twenty days, according to the length of time the 
 patient has been addicted to drink, the quantity consumed 
 and his physical condition. The habitual tippler, the indi- 
 vidual who drinks three to thirty times a day without becom- 
 ing intoxicated, but whose physical condition demands a 
 constant and oft repeated "bracer," requires more treatment 
 than the person who indulges in a periodical debauch and 
 perhaps for a month afterwards does not touch liquor. 
 Carry one of the latter class over the time during which he 
 
INEBRIETY. 22 £ 
 
 would become intoxicated and the greater part of the battle 
 will be won. 
 
 The "sickening process" has always been a closely 
 guarded secret in the treatment of inebriety. By this is 
 meant the part of the treatment directed toward impressing 
 the patient that liquor and his system are becoming antago- 
 nistic to each other. This is not accomplished through the 
 medium of the regular treatment, but by the secret substitu- 
 tion of an emetic at the proper time. This emetic is usually 
 Apomorphine. 
 
 This drug is given at the usual time for a hypodermatic 
 injection, and is substituted for it. The patient is, of course, 
 not informed of this change. When it is given in this man- 
 ner, and a drink of liquor shortly afterward, the patient will 
 attribute the resulting emesis to the treatment and will 
 become convinced that the treatment is doing its work. 
 Sooner or later he will, however, begin to doubt that he is 
 being benefited, and he will have a desire to see whether he 
 still cannot retain his customary beverage. In this wish he 
 should be gratified as much as possible, but it should be 
 arranged that the drink will be taken at about the time when 
 it is customary to give a hypodermatic injection, and apo- 
 morphine again substituted. The result will of course be as 
 disastrous as the first attempt, and there is usually no further 
 doubt on his part. Should there be, the same procedure is 
 repeated. Two or three times is usually sufficient. The 
 patient should have sufficient confidence in the physician 
 not to drink during the treatment, unless when allowed to do 
 so, but he may, of course, furnish his own whiskey. 
 
 Formula A. 
 
 1^ Hypo. Tablets Gold and Sodium 
 
 Chloride aa gr. i-io. 
 
 Sig. One tablet injected hypodermatically three times 
 daily, at intervals of six to eight hours. 
 
222 INEBRIETY. 
 
 Formula B. 
 
 ^ Atropine Sulphate gr. 1-3. 
 
 Strychnine Nitrate gr. 1-2. 
 
 Fl. Ext. Erythroxylon Coca, 
 
 Tr. Cinchona Compound aa fl. § iss. 
 
 Glycerine, C. P q. s. ad. fl. § iv. 
 
 Mix. Sig. One drachm every four hours, during 
 waking hours. 
 
 In order to facilitate the cure the patient should be 
 willing to quit work a few weeks while taking treatment, but 
 it is not necessary to confine him to the house. Moderate 
 exercise is beneficial. Formula B can be entrusted to the 
 patient, but it must be taken regularly. 
 
 At the most convenient time during the day the patient 
 should call upon the physician for his hypodermatic injection 
 of Formula A, the time being so arranged to suit both 
 physician and patient. At breakfast, after noon and in the 
 evening will usually be convenient. The intervals, as stated, 
 should be from six to eight hours. Should the patient be- 
 come very nervous or show signs of delirium, stop the 
 treatment and give 1-4 grain of morphine sulphate to quiet 
 him. Resume the treatment as soon as thought advisable 
 and continue it for a period of ten to twenty days, or until 
 the patient expresses himself as feeling free from the desire 
 or need of liquor. During the first part of the treatment, 
 three or four days, small quantities of liquor may be allowed. 
 Usually one-half ounce, three or four times a day. This 
 applies only to the continual drinker, and not to the period- 
 ical, as the latter can well do without it. After four days of 
 treatment, in all cases, at one of the regular calls for a 
 hypodermatic injection, ask him whether he has a desire for 
 liquor. The continual drinker will probably say he has, and 
 if he has been taking some in small doses, tell him you would 
 like to see him take a good big drink, such as he was accus- 
 tomed to take. If he has not taken liquor during the treat- 
 ment, this remark will be omitted, but whether he says he has 
 
INEBRIETY. 223 
 
 a desire or not, tell him you would like to see whether the 
 treatment is acting properly, whether it is strong enough or 
 whether it has already produced an antagonism in his system 
 toward liquor. 
 
 Now, instead of giving him the usual injection of For- 
 mula A, substitute i-io grain of Apomorphine, and follow it 
 within a few minutes with the drink. Never give the drink 
 first, as something might occur which would delay or pre- 
 vent the giving of the apomorphine, and he would thus find 
 no untoward effect from the liquor. If the apomorphine is 
 given first and the drink delayed too long, so that nausea 
 occurs before the liquor is given, it can be attributed to 
 another cause. Due attention should be paid to these details 
 and to have everything ready. Have a basin or vessel con- 
 veniently hidden near by, so that the patient will not know 
 that you made preparations for what will occur, and wait for 
 developments. If the dose was large enough, free emesis 
 will occur in a short time. Should it not cause vomiting, 
 merely nausea, tell him that the treatment is acting all right 
 and that after a few days more treatment, he can probably 
 not retain liquor but would have to vomit. In a few days 
 repeat the experiment, taking precaution to give somewhat 
 of a larger dose, regulating it according to the effect pro- 
 duced by the former dose. Tartar Emetic is sometimes used 
 for this purpose, mixing it with the liquor, but this allows 
 the patient to form the opinion that you have drugged his 
 liquor, and thus his confidence in you will be shaken. By 
 the other method he may furnish his own liquor. Caution 
 him not to drink unless in your presence. Examine his 
 heart after he has taken the drink and tell him that it must 
 be carefully watched when he takes a drink, as it might 
 need immediate attention. Impress upon him that should 
 he drink while away from you, his heart might suddenly 
 need attention and as you would not be at hand the results 
 might be unpleasant. The reason for these admonitions 
 are obvious. 
 
224 INEBRIETY. 
 
 After he has been thoroughly sickened several times 
 he will probably refuse to touch liquor, even the smell or 
 sight of it is likely to produce nausea. Do not hesitate to 
 make him extremely sick; the nearer death he will think 
 himself, the more certain the cure. 
 
 Both formulae are given in conjunction during the ten 
 to twenty day period, but after the disgust for liquor has been 
 firmly established, and the patient seems to be getting along 
 well without the use of stimulants, the injections may be 
 discontinued, but the remedy, Formula B, should be con- 
 tinued for a week or more afterward. After the sickening 
 process is begun, all liquor should be discontinued. The 
 bowels usually remain normal, but if constipated, use sodium 
 phosphate, plenty of it ; nothing else, except all the water he 
 can drink. After a cure, do not fail to impress your patient 
 with the necessity of avoiding the association of intemperate 
 companions, the frequency of saloons or bar-rooms, and 
 never to touch, taste or handle. Tell him that as he once 
 acquired the taste and desire for liquor, he can do so again, 
 but as he is free from it now, he should assert his manhood 
 and conquer his bitterest enemy. 
 
 This treatment, properly administered to a person willing 
 to be cured, who will co-operate with the physician and obey 
 instructions, will do wonderful work, and cannot be too 
 highly recommended. 
 
INEBRIETY. -225 
 
 A Home Cure for Inebriety. 
 
 There is more or less of a demand for a treatment for 
 habitual drunkenness, which can be taken or administered 
 without the direct supervision of a physician, but it is evident 
 that such a treatment can at best only assist an individual 
 who will make an honest effort to overcome the recurrent 
 desire for stimulants. In this connection a few words may 
 be said in reference to the numerous home cures which are 
 advertised as specifics for drunkenness. Some of these, the 
 majority perhaps, are said to be capable of eradicating the 
 desire for liquor and establish an antagonism against it, 
 without the consent or even knowledge of the person to 
 whom it is administered. These claims are in direct opposi- 
 tion to the teachings of the best authorities on diseases of the 
 nervous system and entirely contrary to the experience of 
 physicians who have made the treatment of chronic alcohol- 
 ism a special study and treated hundreds of cases. It is 
 quite probable that the majority of these claims are fraudu- 
 lent, and in many instances devised to ensnare the unfortunate 
 wives and children of drunkards, and extract from them 
 the little means they manage to possess. Any drug which 
 can so affect the nervous structure of a person that a desire 
 and craving for liquor can be eradicated without the consent 
 or assistance, or even against the will of the person to whom 
 it is given, must be powerful indeed; probably poisonous, 
 and if so, dangerous. Some of them are however claimed 
 to be "entirely harmless." and this statement I will not dis- 
 pute. It is probably true. 
 
 The following method of treatment commends itself to 
 the ordinary cases of habitual drunkenness, and will afford 
 substantial assistance to any one possessed with an honest 
 desire to be freed from the craving for stimulants, and who 
 
226 INEBRIETY. 
 
 will make an effort in that direction. To the person who is 
 unable to make up his mind whether or not he wishes to quit, 
 its action will serve no purpose. The more moderate the 
 drinker and the less quantity consumed during the intermis- 
 sion between the periodical debauch, the easier will be the 
 cure. This treatment is not as powerful nor as rapid as the 
 foregoing, consequently the hardened inebriate, the one who 
 is unable to control himself or exercise any will power, will 
 make better progress under the former. As a preliminary to 
 either of the preceding treatments, it is of value. 
 
 Formula A. 
 
 I£ Atropine Sulphate gr. ss. 
 
 Strychnine Nitrate gr. j . 
 
 Tr. Capsicum fl. o ij 
 
 Tr. Pulsatilla , fl. •"> iij. 
 
 Fl. Ext. Erythroxylon Coca. 
 
 Tr. Hydrastis Canadensis aa fl. 5 ij. 
 
 Tr. Serpentaria fl. ;> j. 
 
 Tr. Cinchona Compound fl. % iij. 
 
 Elixir Aromatic q. s. ad. fl. § xij. 
 
 Mix. Sig. Two drachms before each of the three daily 
 meals. 
 
 Formula B. 
 
 B Fl. Ext. Passiflora Incarnata fl. § iij. 
 
 Fl. Ext. Avena Sativa fl. § ij. 
 
 Elixir Aromatic q. s. ad. fl. § vj. 
 
 Mix. Sig. One drachm at 9 A. M., 3 P. M. and before 
 retiring, or about 9 P. M. 
 
 Continue both formulae for four to eight weeks, accord- 
 ing to the progress of the case. Patients need not stop work 
 during treatment. 
 
INEBRIETY. 22/ 
 
 Other Methods of Treatment for 
 
 Inebriety. 
 j 
 
 In the following pages other and well known methods 
 for treating inebriety will be detailed, all of which are cred- 
 ited with sufficient merit to warrant their use. Some of 
 them have had their origin and are successfully employed 
 in the practice of physicians of the highest professional 
 attainments, men who have given the subject much study 
 and attention, and whose objects in giving them to the pro- 
 fession at large is none other than to encourage more 
 thorough investigation and attain more definite results. 
 
 Bellevue Hospital Treatment. 
 
 Over four thousand cases of acute alcoholism are 
 received in Bellevue Hospital, N. Y., every year. A certain 
 percentage of these express a sincere desire to be relieved 
 from the tendency they have to indulge in periodical 
 debauches, and to such the following treatment is given. It 
 is the result of ten years' experience in the care of these cases. 
 
 After the effects of an acute attack of alcoholism have 
 disappeared, the following hypodermatic injection is given. 
 Each dose contains : 
 
 R Strychnine Nitrate gr. 1-15. 
 
 Atropine Sulphate gr. 1-300. 
 
 Distilled Water 1U x. 
 
 Mix. Sig. Inject three times a day, the first day of 
 treatment. 
 
228 INEBRIETY. 
 
 The second day the following is given. Each dose 
 contains : 
 
 I£ Strychnine Nitrate gr. 1-20. 
 
 Atropine Sulphate gr. 1-200. 
 
 Distilled Water Vt{ x. 
 
 Mix. Sig. Inject three times a day for the second day 
 of the treatment. 
 
 Internally, patients are given in connection with the 
 injections, the following, each dose containing: 
 
 I£ Tr. Cinchona Comp T)\ xv. 
 
 Tr. Capsicum 1T\, ss. to j. 
 
 Tr. Solanum Carolin Tl\ ij. 
 
 Bitter Wine of Iron q. s. ad. fl. 5 j. 
 
 Mix. Sig. One drachm three times daily. 
 
 Nourishment. One-half to one glass of milk, (hot or 
 peptonized,) alternating with hot beef tea or broth, every 
 two hours. 
 
 Hypnotic. Used first and second nights if needed. 
 
 I£ Potassium Bromide gr. xxxij. 
 
 Chloral Hydrate gr. xvj. 
 
 Tr. Valerian fl. 5 j- 
 
 Water q. s. ad. fl. 5 iv. 
 
 Mix. Sig. Hypnotic. One ounce at a dose, repeated 
 as needed. 
 
 The stomach is washed out if necessary, to remedy any 
 catarrhal disturbance, and they are given an abundance of 
 nourishment. Two days of this treatment usually finds them 
 with the desire for liquor gone, and they are discharged with 
 the following- mixture, and directed to report weekly. 
 
INEBRIETY. 229 
 
 ^ Tr. Columbo A- o J • 
 
 Tr. Capsicum HI xv. 
 
 Apomorphine gr. 1-3. 
 
 Tr. Nux Vomica fl. 5 j. to iss. 
 
 Tr. Cinchona Comp q. s. ad. fl. § iv - 
 
 Mix. Sig. One drachm in water after the three daily 
 meals. This is continued one month, when he may discon- 
 tinue taking this preparation, but he is kept supplied with 
 it, and directed to begin taking it the minute he feels a 
 desire for liquor, and report at once. He is then again given 
 the hypodermatic injections as before. 
 
 By this many persons are reclaimed and sent out with 
 confidence in themeslves and hope for the future, with a 
 staff upon which to lean in case of weakness. 
 
 The same treatment is also employed in treating mor- 
 phine addiction, but in these cases it must be continued 
 much longer and sometimes must be modified by adding 
 bromides or gradually reducing the morphine. The house 
 surgeon reported one case in which the morphine was stopped 
 immmediately, although thirty grains were taken daily. The 
 patient did not suffer in the least. From an article by Dr. 
 C. L. Dana, New York. — In the "Post Graduate." 
 
 Note : — Having ' seen the same treatment outlined in 
 another medical journal in which the dose of strychnine in 
 the first formula was given as 1-50 grain, and the dose of 
 Tr. Solanum in the third formula as Tit xij., I wrote to Dr. 
 Dana, and was informed by him that the formulae as I have 
 given them here are correct. J. D. A. 
 
230 INEBRIETY. 
 
 A "Whiskey Cure Institute 1 ' 
 Treatment. 
 
 The following formulae were obtained from a physician 
 who was for a number of years connected with a high priced 
 "Institute," located in New York. 
 
 On reception of patient, he was given a thorough bath 
 and sweat, similar to the well known Turkish baths. This 
 was followed by a thorough evacuation of the bowels and 
 flushing of the colon with three quarts of water as warm as 
 could be borne. This usually left the patient in a relaxed 
 condition, when the following hypodermatic injection was 
 given : 
 
 I£ Strychnine Nitrate gr. 1-40. 
 
 Atropine Sulphate gr. 1-200. 
 
 Aqua Destil q. s. to dissolve. 
 
 Mix. Sig. Give this quantity at each injection, three 
 times a day for four days, twice a day for eight days and 
 once a day for four days. 
 
 Together with this, the following pill : 
 
 I£ Quinine Sulphate gr. lxxx. 
 
 Zinc Oxide gr. lxxx. 
 
 Powd. Capsicum gr. lxxx. 
 
 Strychnine Sulphate gr. j. 
 
 Acid Arsenious gr. 1-3. 
 
 Mix. Ft. pil No. xl. 
 
 Sig. One pill, three times a day, alternating with 
 hypodermatic injection. This is given throughout the treat- 
 ment. The pill is best given half an hour before the usuai 
 time for meals; the injections midway between meals and 
 retiring, while given three times daily, midway between 
 meals when given twice, and a few hours after breakfast 
 when given once. 
 
INEBRIETY. 231 
 
 If patient cannot sleep the following is given : 
 
 1^ Tr. Aconite Root n\ v. 
 
 Tr. Capsicum fl. 5 ss. 
 
 Tr. Opium Deodorized, 
 
 Fl. Ext. Hyoscyamns. 
 
 Chloral Hydrate. 
 
 Potassium Bromide aa 5 ij. 
 
 Peppermint Water q. s. ad. fl. 5 iv. 
 
 Mix. Sig. One-fourth to one-half ounce at bed-time. 
 Use as little as possible, and dilute freely with water. 
 
 If patient becomes much excited or borders on delirium 
 tremens, the following is useful : 
 
 IJ Hyoscine Hydrobromate gr. 1-200 to 1-100 
 
 Hypodermatically. 
 Repeat pro re nata. 
 Patients receive abundant nourishment, soups, broths, 
 beef tea, milk, milk foods, peptonized milk, and plenty of 
 water in which sodium phosphate has been dissolved in the 
 proportion of one drachm to the pint. 
 
 (Remarks. — As a hypnotic, in the treatment of inebriety, 
 nothing excels the well known Bromidia. Its action is 
 prompt and it leaves no unpleasant after effects. J. D. A. ) 
 
232 INEBRIETY". 
 
 Another " Institute" Cure. 
 
 In the State of Indiana there is in operation a sanitarium 
 dedicated to the cure of drunkenness and nervous diseases, 
 in which the following line of treatment is followed : 
 
 After a preliminary treatment such as was detailed in 
 the foregoing' treatment, the patient is placed in a room and 
 supplied with a bottle of good liquor with instructions to 
 help himself to as much as he wishes. At this time the 
 treatment is begun and the patient receives, four times daily, 
 a hypodermatic injection of the following composition: 
 
 I£ Chloride of Gold and Sodium gr. 1-10. 
 
 Strychnine Nitrate gr. 1-40. 
 
 Mix. 
 
 In connection with the above he receives the following : 
 
 ^ Chloride of Gold and Sodium gr. xij. 
 
 Ammonium Muriate gr. vj. 
 
 Strychnine Nitrate gr. j. 
 
 Atropine Sulphate gr. 1-4. 
 
 Fl. Ext. Cinchona Comp fl. § iij. 
 
 Fl. Ext. Erythroxylon Coca fl. % j. 
 
 Glycerine fl. ."> j . 
 
 Distilled Water fl. 5 j. 
 
 Mix. Sig. One drachm every two hours while awake. 
 The physician in charge sees the patient four times a 
 day and increases the doses of gold and strychnine in the 
 injection until the symptoms show that the patient is receiving 
 all he can bear. The first day the patient usually drinks 
 heavily of the whiskey left with him, but during the second 
 day he begins to lose his desire for it. He will usually refuse 
 to take any by the third or fourth day. The treatment is 
 continued from three to six weeks, increasing or lessening 
 the doses according to the symptoms produced, always giving 
 
INEBRIETY. 233 
 
 the gold and strychnine to the "limit." The atropine causes 
 the pupil to be dilated, with some dimness of vision and a 
 slight irregularity of the gait in walking. 
 
 The strychnine causes a twitching of the muscles, 
 especially of the neck and jaws, and headache ensues. The 
 gold causes a red, irritating eruption to appear in the course 
 of a week or two. It appears all over the body. Regard 
 for these symptoms will indicate the dosage. 
 
 The theory of this treatment effecting cures is as fol- 
 lows : 
 
 The powerful poisons given disturb the nerves so pro- 
 foundly that the desire for liquor is lost in the same manner 
 as sometimes occurs after a fit or an attack of certain dis- 
 eases. This breaks the tyranny of the habit and enables the 
 patient to start on a career of total abstinence without any 
 feeling of distress from the lack of his stimulant. If he 
 begins tippling, he will soon acquire the taste and desire 
 again. The periodical drinker is said to be the most likely 
 to relapse and fall back into his old habits. 
 
 (Remarks. The dose of gold and sodium chloride in 
 these prescriptions is undoubtedly too large to be safe, and 
 much larger than is necessary for the production of its physi- 
 ological effect. Doses of this size would undoubtedly in the 
 majority of cases, produce gastro-enteritis, vomiting, digest- 
 ive disturbances and reduce the oxidizing power of the red 
 biood corpuscles to a point approximating if not exceeding 
 the danger point. The best authorities on therapeutics do 
 not advise its administration in larger doses than 1-10 to 1-8 
 grain. J. D. A.) 
 
234 INEBRIETY. 
 
 Dr. C. F. Chapman of Chicago, desirous of becoming 
 acquainted with the methods employed in Gold Cure Insti- 
 tutions, obtained a position in one of them for this purpose. 
 He found that as a "Tonic" they used a preparation of the 
 same composition as the formula just given, with the addi- 
 tion of Aloin, gr. j, and Hydrastin, gr. ij. Dose, one 
 drachm every two hours from 7 A. M. to 9 P. M. In con- 
 nection with this, the patient received an injection contain- 
 ing 1-40 gr. Strychnine Nitrate at 8 A. M., 12 M., 4 and 8 
 P. M. This quantity was gradually increased until strych- 
 nine effect was very well marked. Combined with the 
 strychnine solution, the patient was given three drops of the 
 following solution. 
 
 B Gold and Sodium Chlor gr. iiss. 
 
 Aqua Destil fl. 5 j- 
 
 Mix. Draw three drops of this solution into the 
 syringe containing the strychnine solution. The mixture 
 produces a beautiful golden color, to which the attention of 
 the patient is called for its psychic effect. It leaves a yellow 
 stain on the skin after the needle has been removed. Dr 
 Chapman has had experience in 300 cases with the treat- 
 ment outlined, with good success. Remarks. When such 
 large doses of the Gold and Sodium Chloride are success- 
 fully administered by a reputable physician, it may seem 
 unwarranted to criticise, yet Prof. Waugh does not hesitate 
 tc do so in his comments on the treatment. It may possibly 
 be that the physical condition of a person addicted to the 
 excessive use of stimulants, counteracts the effects of the 
 gold salt to a certain extent, thus rendering the system 
 immune to small doses. At any rate, the doses are very 
 large, and if used, its action should be closely observed. 
 
 Prof. W. F. Waugh, of Chicago, has also employed the 
 foregoing treatment, in a modified form. For the twelve 
 grains of Gold and Sodium Chloride, he substitutes one 
 grain of Bichloride of Mercury, giving 1-48 gr. of this drug 
 
INEBRIETY. 235 
 
 to the dose. Instead of giving strychnine hypodermatically 
 he advises the use of the alkaloid caffeine, dissolved in dis- 
 tilled water by the addition of sodium salicylate. This drug 
 greatly assists the solubility of caffeine. From one to six 
 grains are given hypodermatically four times a day. If the 
 patient's means permit it, he uses mandragorine instead of 
 atropine, in case the dose of that drug is not sufficient in the 
 tonic, the former being more efficient and less unpleasant. 
 If in a few days the patient's appetite for liquor does not 
 weaken, apomorphine is added to the liquor or given hypo- 
 dermatically, beginning with 1-30 grain and gradually in- 
 creasing it to 1-10 grain. 
 
 An important part of his treatment now follows. For 
 the free flushing of the emunctories, the following prepara- 
 tion is used. 
 
 E Potassium Acetate o iv. 
 
 Potassium Bromide gr. xl. 
 
 Potassium Nitrate gr. xv. 
 
 Potassium- Carbonate gr. xx. 
 
 Mix. Dissolve the above in one or two quarts of car- 
 bonated water, (plain soda as dispensed by druggists) and 
 let the patient drink this quantity every day. The differ- 
 ence in the quantity of carbonated water used depends on 
 the capacity of the patient. 
 
 The diet should be non-stimulating, plenty of fruit 
 juices, vegetable acids and milk, but no rich foods or condi- 
 ments. This treatment is continued until the patient is well 
 and strong and able to depend upon himself. 
 
2^6 INEBRIETY. 
 
 Another Gold Cure. 
 
 The following - treatment for inebriety is employed in a 
 certain institution near New York City, under the super- 
 vision of a well known physician. Although the "gold 
 cures" were looked upon as fraudulent when they first 
 appeared, it is worthy of note that the drug is used and 
 relied upon in some of our best institutions, and may be said 
 to be one of the most important factors in effecting cures. 
 
 In detailing his method of treatment, the doctor as- 
 sumes that the patient is sober on his arrival at the institu- 
 tion and directs treatment as follows. 
 
 Four times a day, inject hypodermatically, a solution 
 containing 1-30 grain Strychnine Nitrate to ten minims of 
 distilled water. Begin by giving five minims and note 
 results. If five do not produce physiological effects, gradually 
 increase the dose to ten. If the patient is willing to 
 remain any length of time necessary for a cure, not wishing a 
 "rush cure"' this dose of strychnine nitrate is never exceeded. 
 The first day the patient receives about four grains of calo- 
 mel, half an hour after breakfast, and half an hour before 
 dinner a liberal dose of sulphate of magnesia. If the bowels 
 do not respond liberally in three or four hours, repeat the 
 salts. If the patient becomes irritable, hankers after a drink 
 or complains of a bad taste in the mouth, repeat the calomel, 
 This may be done any time during the treatment. 
 
 Tonic. 
 
 B Gold and Sodium Chlor gr. ss. 
 
 Tr. Gentian fl. 3 x. 
 
 Tr. Cinchona Comp fl. 3 iv. 
 
 Tr. Columbo fl. 3 iv. 
 
 Tr. Hydrastis Canad fl. 3 x. 
 
 Glycerine q. s. ad. fl. o ly - 
 
 Mix. Sig. One drachm four times a day. 
 
INEBRIETY. 237 
 
 If the patient insists on drinking' after a day or two, 
 give him a small drink at the usual time for receiving the 
 injections. After doing this once or twice, add 1-20 to 1-15 
 grain of apomorphine to the strychnine solution and inject. 
 This usually has the desired effect. If the patient is very 
 nervous, the following mixture is given. 
 
 3$ Sodium Bromide gr. xv. 
 
 Chloral Hydrate gr. v. 
 
 Tr. Hyoscyamus gtt. xx. 
 
 Elix. Aromatic q. s. ad. fl. 5 j. 
 
 Aiix. Sig. Take at a dose. Repeat as required. 
 
 Occasionally a patient will be found who, though com- 
 pelled to vomit after an injection containing apomorphine. 
 will persist in drinking. These cases are given milk punches 
 and beef tea, and an injection containing in each dose. 
 Strychnine Nitrate, gr. 1-20; Atropine Sulphate, 1-100, and 
 Morphine Sulphate, gr. 1-4. This is repeated every four 
 hours and the stomach soon rebels, and the trouble is over. 
 Never attempt to break off liquor too rapidly, or delirium 
 tremens may ensue, but use judgment and be guided bv 
 the condition of the patient. Keep a close watch over him 
 for the first four days. Feed good, advise moderate exer- 
 cise, promote cheerfulness and encourage the patient. 
 
238 INEBRIETY. 
 
 Dr. Matchette's Cure for Chronic 
 Alcoholism. 
 
 The following treatment for persons addicted to the 
 use of whiskey has been used for more than twenty years 
 in the institution of the originator of the same, Dr. A. C. 
 Matchette, Bourbon, Ind., according to an article written 
 by him and published in a medical journal, several years ago. 
 So successfully has this treatment been employed in the 
 various institutions under his supervision, that only about 2 
 per cent, of failures have been recorded, and these have been 
 among patients who refused to submit to the full treatment. 
 In the experience of Dr. Matchette, cures are more easily 
 effected when a number of persons take the treatment at 
 once, as it enables them to find companions who are in 
 sympathy with them, spurs them on to do their best toward 
 assisting the treatment by creating a friendly rivalry between 
 themselves, and prevents the solitude more or less experi- 
 enced by a single patient under treatment. 
 
 On entry of a patient he receives a thorough hot bath, 
 if necessary he is given a cathartic, using the Comp. 
 Cathartic Pill, Imp. 
 
 He is then put on the following injection : 
 
 J$ Hydrastine Sulphate gr. ij. 
 
 Aqua Destil fl. % j. 
 
 Mix. Filter. 
 
 Sig. Inject from five to six minims into the arm four 
 times daily, increasing the quantity to twenty or twenty-five 
 minims within the first fortnight, if well borne, and then 
 continue until cured. * 
 
 The first ten to twenty-five days he receives also, if 
 nervous and broken down, the following : 
 
INEBRIETY. 239 
 
 1^ Fl. Ext. Kola. 
 
 Fl. Ext. Celery. 
 
 Fl. Ext. Valerian. 
 
 Fl. Ext. Gentian. 
 
 Fl. Ext. Cinchona Rub. 
 
 Fl. Ext. Cannabis Indica. 
 
 Fl. Ext. Erythrox, Coca. 
 
 Fl. Ext. Cypripedium aa fl. § j. 
 
 Mix. Sig. One teaspoonful every two hours. 
 
 If necessary, on account of digestive inactivity, add to 
 the above, Pure Pepsin, § ss., and Hydrastine Muriate, 3 ss. 
 
 The above is alternated with the following for four or 
 five days, then the time between the doses of the following 
 are lengthened as found best. 
 
 1$ Hydrarg, Bichlorid gr. iv. 
 
 Sodium Bromide 5 ij. 
 
 Potassium Bromide ^ iss. 
 
 Potassium Iodide 5 iij. 
 
 Ammonium Chloride 3 iij. 
 
 Water Oj. 
 
 Mix. Sig. One-half teaspoonful every two hours, 
 taken in a strong decoction of coca leaves. 
 
 Treatment is to be continued until the patient is dis- 
 charged cured, usually in about three weeks. During the 
 first 12 to 72 hours the patient is furnished with a generous 
 quantity of the best liquor, until he declines to use it, which 
 is often within the first day. Some will be determined to 
 continue the use of liquor, and boast of such determination, 
 but they are usually the first to refuse it. Others will say 
 little but will tenaciously cling to their flask, making one 
 effort after another to retain a drink, until finally, sometimes 
 after vomiting twenty times or more, they come to the con- 
 clusion that they have enough. 
 
24O INEBRIETY. 
 
 The treatment must not be discontinued when the 
 patient refuses liquor, even if the taste or smell of it causes 
 vomiting, but it must be continued until the physician has 
 determined that the cure is complete. Vast differences exist 
 in patients and each case must be treated according to the 
 particular demands thereof, varying the remedies employed 
 as indicated. These variations cannot be defined or fully 
 described, but tbe physician treating a number of patients 
 will observe them, and experience will improve and mature 
 his judgment. The variations found will usually depend 
 on age, weight, physical condition and ability to bear the 
 treatment either lighter or heavier, as the case may be. 
 Good nourishment is necessary, using cereals, prepared foods, 
 milk, etc. Cheerful associations are highly beneficial and 
 should be encouraged as much as possible. 
 
 (Remarks. — In the hypodermatic injection given, instead 
 of increasing the dose to 20 or 25 minims, I would suggest 
 that stronger solutions of the drug be procured. An injec- 
 tion of 25 minims is quite bulky. The dose of Cannabis 
 Indica is rather large, in the second prescription, and as this 
 is a dangerous drug its action should be watched, and modi- 
 fied accordingly. T. D. A.) 
 
ACUTE ALCOHOLISM. 24.I 
 
 Treatment for Acute Alcoholism. 
 
 It is frequently very important that a person under the 
 influence of alcoholics should become sober as soon as pos- 
 sible. Business affairs may be neglected or social engage- 
 ments forgotten during the period of indulgence, and it often 
 devolves upon friends of the habitual drunkard to assist 
 him to the possession of an unclouded brain and clear intel- 
 lect, and see to it that his appearance at least is respectable. 
 
 If he has recently drank intoxicants, the first indication 
 is an emetic. This may be accomplished by drinking freely 
 of warm water, tickling the fauces with a feather or intro- 
 ducing the forefinger as far down the throat as possible. 
 Should these measures fail, sulphate of zinc, twenty grains 
 dissolved in half a glass of warm water, should be given. 
 If this is not at hand a teaspoonful of mustard will prove 
 an excellent substitute. Tartar emetic by the mouth or 
 apomorphine hypodermatically may have to be used if all 
 else fails. After free emesis, the vegetable acids, especially 
 lemon juice, will prove grateful and beneficial. 
 
 If he has not drank recently and the liquor has circu- 
 lated through his system, emetics are of no value. Here 
 the Muriate of Ammonia, 20 to 30 grains, dissolved in half 
 a glass of water, will give splendid results, as will also ounce 
 doses of freshly prepared Liq. Ammon. Acetate. Either of 
 these remedies may be repeated in half an hour or less. 
 
 As the emetics will only relieve the stomach of its con- 
 tents, and as the intoxicated person is always under the 
 influence of alcoholics which have been absorbed, the prepara- 
 tions of ammonia just mentioned should be administered 
 after the stomach has been emptied. 
 
 Another method by which the effects of alcoholics can 
 quickly be dispelled is the hypodermatic injection of 1-3 to 
 1-2 gr. Morphine Sulph. It may be combined with 1-15 
 or even 1-8 of Strychnine Nitrate. After a short nap, the 
 person can be awakened with his senses comparatively nor- 
 mal. A thorough sweating will facilitate matters consid- 
 erably. 
 
2^2. TOBACCO ADDICTION. 
 
 TOBACCO ADDICTION. 
 
 As in other addictions, the person desiring to free him- 
 self from the use of tobacco must exercise his will power to 
 the full extent. 
 
 No remedy will cure any one so thoroughly that the 
 habit may not again be easily acquired, although if ordinary 
 efforts are made to avoid tobacco for several months, it will 
 be comparatively easy to let it alone thereafter. 
 
 On account of the numerous remedies advertised to the 
 laity by different firms, there is a certain, although limited, 
 demand made upon physicians for medicine of this character. 
 The following formula is a good one, and if left to the 
 patient entirely, if he makes an effort to use it regularly and 
 does not force tobacco on himself, will cure seventy-five per 
 cent, of cases. To those who require additional treatment, 
 add sufficient Tartar Emetic to the remedy, or give it sepa- 
 rately, to sicken them. Formula : 
 
 R Atropine Sulphate gr. 1-8. 
 
 Tr. Quassia, 
 
 Tr. Columbo aa fl. 5 '}• 
 
 Tr. Humulus. 
 
 Sp. Vini Rect aa fl. 5 ss. 
 
 Aqua q. s. ad. fl. § iv. 
 
 Mix. Sig. Teaspoon ful every three hours while awake. 
 
 If for chewing, let the patient have fine cut (no plug) 
 two or three times a day for a few days. The atropia causes 
 dryness of the mouth and fine cut usually disgusts them. If 
 not, use the Tartar Emetic. 
 
 If for smoking, allow a short smoke several times daily, 
 not more than one- fourth of a cigar, to be re-lit when another 
 smoke is taken. If a cigar smoker, give him a strong pipe; 
 this will not be as pleasant as a cigar. After a few days 
 stop smoking altogether, but if there is difficulty in stopping, 
 use the emetic as directed. 
 
TOBACCO ADDICTION. 243 
 
 The following is the formula of a well known proprie- 
 tary remedy in tablet form, which is recommended for both 
 Alcohol and Tobacco. Formula : 
 
 I> Gold and Sodium Chlor gr. j. 
 
 Strychnine Nitrate gr. 1-3. 
 
 Nitro Glycerine gr. 1-10. 
 
 Quassin gr . iss. 
 
 Atropine, alk o- r . 1-10. 
 
 Oleores Capsicum gr. vj. 
 
 Tr. Digitalis gtt. xl. 
 
 Mix with any suitable excipient and make Twenty pills 
 or tablets. Sig. One tablet or pill before each meal. 
 
 The above directions regarding the use of tobacco apply 
 to this treatment. 
 
 Another formula, somewhat similar to the above. 
 Iy Gold and Sodium Chlor gr. iv. 
 
 Strychnine Nitrate gr. ij. 
 
 Nitro Glycerine gr. ss. 
 
 Ext. Digitalis fid Tt\ xx. 
 
 P'ulv. Capsicum gr. xxv. 
 
 Salicin o-r r 
 
 Cinchonidin. Sulph gr. c. 
 
 M. Ft. Pil No. 100. 
 Sig. One before meals. 
 
 Continue using tobacco in somewhat reduced quantity 
 for a few days, then make an effort to stop it. Continue 
 treatment until free from the desire for tobacco. 
 
 Another formula for Tobacco Addiction : 
 
 PJ Apomorphine Muriate gr. iv. 
 
 Ac. Muriatic Dil fl. 3 ij. 
 
 Tr. Nux Vomica fl. % ss. 
 
 Aqua Dest q. s. ad. fl. % viij. 
 
 Mix. Sig. One half to one teaspoonfnl every two 
 hours. 
 
244 GOITRE. 
 
 GOITRE. 
 
 A thoroughly reliable treatment for this obstinate affec- 
 tion will undoubtedly be appreciated by the majority of 
 physicians. The following formulae, if properly and persis- 
 tently used, will cure all ordinary cases of goitre and benefit 
 all others. I have used this treatment in numerous cases 
 with entire satisfaction, effecting cures which have remained 
 permanent for several years. 
 Injection Fluid No. I. 
 
 R Pure Carbolic Acid fl. 5 ss. 
 
 Aqua Destil fl. 5 j. 
 
 Ft. Solution and add 
 
 Pure Glycerine fl. 5 ss. 
 
 Shake well and add 
 
 Tr. Iodine fl. •" ij. 
 
 Mix. 
 
 Injection Fluid No. 2. 
 
 IJ Iodoform gr. xl. 
 
 Pure Glycerine fl. 5 iij. 
 
 Mix thoroughly in a glass mortar and pour into a 
 colored bottle. 
 
 Local Application. 
 
 Ik Tartar Emetic 5 ss. 
 
 Aqua Destil fl. % ss. 
 
 Ft. Solution and add 
 
 Tr. Iodine fl. % iij. 
 
 Tr. Benzoin Comp fl. o ij. 
 
 Mix. 
 
 For treating all varieties of goitre except cystic, vas- 
 cular and exopthalmic. With a hypodermatic syringe inject 
 one to five minims of injection fluid No. 1 into the substance 
 of the goitre once each week. With the same instrument 
 inject from two to ten minims of injection fluid No. 2 into 
 
GOITRE. 245 
 
 the substance of the goitre once each week. Commence 
 with fluid No. 2 three days after commencing with fluid No. 
 i, and alternate with them, not using one of them in less 
 than three days after using the other. It is not necessary 
 to plunge the needle deep into the enlarged gland, but be 
 sure it has entered before injecting. Insert the needle, 
 instruct the patient to swallow ; if properly introduced the 
 needle will follow the goitre in its upward movement. If the 
 patient is under twenty years of age, one to four minims 
 (according to age), of No. 1 will be sufficient. Where the 
 patient is older, and especially if of long standing, it will in 
 some cases be necessary to use the maximum dose of both 
 fluids. If the goitre is bilateral inject one side at one time 
 and the other side at the next time, alternating in this man- 
 ner until cured. 
 
 The local application is used at the same time. Instruct 
 the patient to paint the skin covering the goitre twice a day 
 until considerable vesication is produced, then once a day or 
 as necessary to keep up considerable irritation. 
 
 CYSTIC GOITRE. 
 
 Evacuate the contents of the cyst with the hypodermatic 
 syringe, and then inject into the cavity about five to eight 
 minims of injection fluid No. 1, and allow it to remain. 
 Repeat twice a week until cured. 
 
 These cases usually get well in from two to six weeks. 
 Use the local application same as in the other varieties. 
 
 VASCULAR GOITRE. 
 
 In treating this form of the disease use the local appli- 
 cation same as in the other varieties. Every eight days inject 
 from two to five minims of injection No. 2 into the substance 
 of the goitre, and every eight days inject from one to five 
 minims of injection No. 1 into the tissues just beneath the 
 skin covering the goitre, and not into the substance of the 
 gland as in other varieties. Make an injection every four 
 days, alternating with the two fluids. 
 
246 GOITRE. 
 
 Remarks : — In preparing the formulae add the different 
 ingredients in the order named, and in preparing No. 1 add 
 the iodine slowly, shaking constantly. In using injection 
 No. 2 pour into a small bottle the desired amount and add 
 an equal quantity of pure water and shake well before filling 
 the syringe. This is done to dilute it so it will pass through 
 the needle. If you use a larger needle this will not be 
 necessary. These injections should be prepared freshly as 
 often as ever}- four weeks. Keep the needle clean, smooth, 
 sharp and free from rust. Always see that the air is out of 
 the syringe before injecting. In case there is no improve- 
 ment in four weeks, don't become discouraged and quit, as 
 the enlargement may disappear very rapidly after it begins 
 to be reduced. The average time required varies from eight 
 to twelve weeks. Don't imagine that because the treatment 
 is simple, that it is without merit, but give it a fair trial, and 
 you will be more than pleased. 
 
 Other Remedies for Goitre. 
 
 The Chloride of Ammonium Treatment. This 
 method of treatment was first suggested on account of the 
 well known absorptive action of the Chloride of Ammonium, 
 when used in the treatment of enlarged glands, either parotid 
 or lymphatic ; the local action of the Red Iodide of Mercury 
 being no doubt largely contributory to the good results often 
 obtained. The directions for treatment are as follows : 
 
 The Chloride of Ammonium should be given in eight 
 or ten grain doses, three times daily, and continued for weeks 
 o,r months. Locally use an ointment containing Red Iodide 
 of Mercury, grs. x to xx to the ounce of Vaseline, rubbed 
 well over the whole surface of the goitre once a day until 
 slight vesication appears. Discontinue then and repeat when 
 the vesication produced by the former application has disap- 
 peared. This may require two or three weeks. It should be 
 noted that this ointment should not be applied to the vesicated 
 
GOITRE. 24/ 
 
 surface, or where any abrasion of the skin exists, on account 
 of its powerful action constitutionally. As an alternating 
 remedy the Iodide of Potassium in five grain doses, three 
 times a day, may be given one week out of every four. Con- 
 tinue in this manner until satisfactory results are obtained. 
 
 Dr. Chavette's Goitre Remedy. 
 The following prescription was used for many years by 
 Dr. Chavette, of Chicago, with such success that he gained 
 both fame and fortune. 
 1$ Zinc Sulphate, 
 
 Acid Salicylic aa ij. 
 
 Iodoform, 
 
 Acid Boracic aa 5 iij. 
 
 Acid Oleic o viij. 
 
 Mix and keep at boiling heat for four hours, then pour 
 off the liquid and after cooling, bottle and cork well. 
 
 Sig. Apply to the enlarged gland with slight friction, 
 twice daily until slight desquamation occurs, after which 
 apply once daily until the enlargement is entirely reduced. 
 Cures effected by this method are said to be permanent. 
 
 Fucus Vesiculosus. This is a remedy that has at vari- 
 ous times been brought forward as a remedy for Goitre, 
 indeed Dr. R. N. Foster, of Chicago, claims it to be the only 
 remedy that he has ever known to cure Goitre. The drug 
 is very likely to deteriorate, and many preparations' of it 
 are unreliable. The dose varies according to the prepara- 
 tion used and should be taken according to dosage given for 
 the particular preparation employed. It should only be pur- 
 chased from the most reliable parties. 
 
 Electric Treatment. The treatment of Goitre by 
 cataphoresis is a safe and very often effectual means by 
 which goitre can be cured. A strong solution of potassium 
 iodide is applied to the tumor on a well wetted pad, attached 
 to the cathode of a galvanic battery. The positive pole may 
 
248 GOITRE. 
 
 be placed at the back of the neck or other convenient locality. 
 The opposite side of the tumor is a good location for the 
 positive pole. A current, from five to fifteen milliamperes, 
 is to be used. The treatment should be given every other 
 day, unless the parts become too tender, and should con- 
 tinue about fifteen minutes at a time. 
 
 The action of the electric current is to liberate the iodine 
 from the iodide of potassium, and the iodine being an electro 
 negative body is repelled from the cathode or negative pole, 
 as like poles repel and unlike poles attract. The potassium, 
 being electro positive, remains on the negative electrode while 
 the iodine is passed toward the positive electrode, and if the 
 action were continued long enough the free iodine would be 
 found on the positive electrode. Proof that it is absorbed 
 can also be shown by simply reversing the electrodes. Free 
 iodine will at once appear under the positive electrode where 
 the negative formerly was applied, and on reversing again to 
 the first position the iodine at once disappears. Change of 
 current will produce the same effect without removing the 
 electrodes. 
 
 This treatment causes no discoloration of the skin other 
 than the hyperaemia produced by the current. This treat- 
 ment should be continued until the growth of the gland is 
 sufficiently reduced. The improvement is not rapid but 
 will in many cases prove satisfactory. Persons with goitre 
 are usually acquainted with the usually accepted theory that 
 goitre is incurable, and any means that shows a reduction 
 will in the majority of cases be willingly continued. Diminu- 
 tion in size is usually first noticed by the patient on account 
 of the collar worn, and the measurement sometimes recom- 
 mended is entirely unnecessary. The patient will notice a 
 reduction before the tape line would indicate it. 
 
NASAL CATARRH. 249 
 
 NASAL CATARRH 
 
 Acute and Chronic. 
 
 There is no dearth of literature on Catarrh. Medical 
 text books and the periodical publications which give space 
 to the consideration of this disease are abundant evidence 
 that the authors of the former and editors of the latter are in 
 a measure endeavoring to cater to the evident demand for 
 information on the subject. 
 
 To any careful observer, and all physicians should be 
 such, it must be apparent that catarrhal diseases of the 
 Nose and Throat, with their consequences, complications 
 and reflex disturbances are responsible for many of the ills 
 that flesh is heir to, and that the intelligent treatment of 
 them becomes an absolute necessity to any physician who 
 assumes the responsibility of accepting a case for treatment. 
 The large and remunerative practice so generally enjoyed 
 by physicians who give special attention to the diseases of 
 the Nose and Throat is evidence sufficient that this class of 
 affections can be made to play a most important part in the 
 practice of every physician who gives them somewhat more 
 ihan passing attention. 
 
 Probably no part of the human body has been so abused 
 and maltreated as the upper air passages. Every malodor- 
 ous irritant, sold under the guise of an antiseptic powdet, 
 has been blown, syringed, douched and sprayed into these 
 cavities, until physicians have become discouraged and do 
 not hesitate to assert that Catarrh cannot be cured. 
 
25O NASAL CATARRH. 
 
 There seems to be a prevailing opinion in the minds of 
 many of the profession that the correct treatment of these 
 diseases implies the use of certain expensive and elaborate 
 apparatus, and the possession of more than an ordhmry 
 degree of skill to use them properly, so that the outcome in 
 many instances has been that the general practitioner has 
 allowed his cases to drift to the specialist, if indeed he has 
 not had the magnanimity to direct them there. 
 
 By a moderate amount of study and diligent practice, 
 by perserverance in the use of the methods at hand, the gen- 
 eral practitioner may overcome many imaginary difficulties 
 that seem to stand between him and success, and he will be 
 richly rewarded for his time and labor so spent. 
 
 The instruments that we may class under the list of 
 those strictly necessary are: a good lamp with reflector or a 
 condenser, a head mirror, a nasal speculum, a tongue depres- 
 sor and a laryngeal mirror. As time passes and the practi- 
 tioner becomes more skillful in their use and more bold in his 
 undertakings, other more elaborate instruments may be 
 added, but of these we will speak later on. 
 
 Acute Rhinitis. 
 (Cold in the Head.) 
 
 This condition is so common as to almost warrant an 
 omission of the symptoms here, but we will mention them in 
 passing. Frontal headache, general malaise, nose discharg- 
 ing a thin and irritating secretion which is responsible for 
 the excoriation that you will observe on the upper lip and 
 lower part of the nose. Breathing through the nose is im- 
 possible and much of the general indisposition is due to this 
 fact ; it prevents restful sleep. The throat feels parched and 
 irritated and the tongue is usually heavily coated, due mostly 
 to the mouth breathing. 
 
 A saline laxative will usually somewhat improve the 
 general feeling, while, internally a tablet containing the fol- 
 lowing, will to some extent control the local symptoms. 
 
NASAL CATARRH. 25 1 
 
 iy Quinine Sulph gr. ss. 
 
 Ext. Belladonna lvs gr. 1-8. 
 
 Camphor Monobrom gr. j. 
 
 Caffeine Citrat gr. ss. 
 
 M. Ft. tablet or capsule No. j . 
 
 Sig. One every two or three hours according to require- 
 ments. 
 
 For speedy relief, local treatment is undoubtedly greatly 
 superior to internal medication, but both can be used to 
 advantage. 
 
 On inspection the interior of the nose will be found to 
 be congested and swollen and a simple method of relieving 
 this congestion at once suggests itself — the use of cocaine. 
 For this purpose a two per cent, or four per cent, solution is 
 used. A pledget of cotton about the size of the nostril is 
 saturated with the solution and placed within the nose and 
 well up to, and pressing against the turbinates, and allowed 
 to remain there for a period of ten minutes. When it is 
 removed, the mucous membrane which ten minutes before, 
 was so red and angry looking, will now be seen to be dry, 
 pale and shrunken and your patient will be able to breathe 
 through the nose. The effects of cocaine will usually dis- 
 appear in about thirty minutes, when the symptoms will 
 again return. In order to prolong the effect of the cocaine, 
 the interior of the nose should be sprayed with a four per 
 cent, solution of antipyrine, which will maintain the cocaine 
 effect for a period of five to eight hours, and will be fol- 
 lowed by no reaction, but rather a decided improvement. 
 
 The temporary smarting which is produced by the four 
 per cent, solution of antipyrine, will pass away very quickly, 
 but antipyrine should never be used in as strong as four per 
 cent, solution without the previous application of cocaine. 
 
 In the pharynx and larynx, much stronger solutions of 
 antipyrine may be used without discomfort. 
 
252 NASAL CATARRH. 
 
 Never apply cocaine solution inside the nose with an 
 atomizer, as in that case there is always danger of the patient 
 swallowing an unknown quantity as almost invariably a por- 
 tion of the fluid reaches the pharynx. Again, cocaine applied 
 to the pharynx nearly always causes a feeling of dryness 
 and the presence of a foreign body, and may even cause 
 nausea and vomiting in extremely susceptible persons. Ni- 
 trate of silver has much the same effect and it may be said 
 to be a general rule never to use cocaine or nitrate of silver 
 in the pharynx, except in atrophic pharyngitis ; in which the 
 latter is of value. 
 
 A patient under treatment by the cocaine and antipyrine 
 solutions, should be instructed to present himself in about 
 six hours. Antipyrine may now be applied in a one per cent. 
 or two per cent, solution and should be followed by a 
 thorough spraying of a solution of aromatic antiseptics pro- 
 tected by an oily substance, as the following : 
 
 I£ Menthol gr. x. 
 
 Ol. Eucalyptol nx vj. 
 
 Camphorated Alboline, 3 to 5 % . . . fl. § iv. 
 M. Sig. Spray into nose three or four times a day. 
 
 For the excoriated spots inside the nose, as well as those 
 on the external parts, calomel, thinly dusted over them, will 
 hasten their repair as well as afford immediate relief. 
 
 This treatment will usually conquer an acute attack of 
 this sort in twenty-four to thirty-six hours. Should the 
 conditions demand it, the cocaine on cotton applications may 
 be repeated once or twice before the spray is given. Should 
 the circumstances of the patient be such as to render it 
 impossible for him to call at the office for frequent repeti- 
 tions of the treatment, an oil atomizer with sufficient solu- 
 tion may be given him with directions for use, together with 
 the following powder which is to be used as a snuff suffi- 
 ciently often to secure relief from excessive secretion and 
 nasal stenosis. 
 
NASAL CATARRH. 253 
 
 K Menthol grs. ij. 
 
 Magnesia Carbonate, light grs. x. 
 
 Cocaine Muriate grs. viij. 
 
 Saccharnm Lact •> uj- 
 
 M. Make an impalpable powder. 
 Sig. Use as a snuff as directed. 
 
 By the use of this preparation nasal stenosis may be 
 relieved for an indefinite time, and therein lies the danger 
 that it may lead to the formation of cocaine addiction. A 
 moderate use of cocaine for a short time is never dangerous 
 in this particular, but in order to prevent the patient from 
 using the above powder after the acute symptoms have sub- 
 sided, supplv the powder yourself in small quantities only, 
 and never tell the patient that he is using cocaine. Tn this 
 manner you have complete control of the supply and can 
 use proper precautions. 
 
 Chronic Nasal Catarrh. 
 
 For the purpose of considering this disease in as plain 
 and easily understood a manner as possible, we will make the 
 following divisions : 
 
 Simple Chronic Rhinitis, Hypertrophic Rhinitis, Atro- 
 phic Rhinitis. 
 
 Simple Chronic Rhinitis. 
 
 This condition may be said to be present when there is 
 a chronic inflammatory congestion of the nasal mucous 
 membrane, with but few if any, structural changes. It is 
 usually due to recurrent attacks of acute rhinitis which may 
 be due to the habits of the individual or constitutional 
 disease. Bathing in cold water, sleeping in rooms with too 
 much ventilation, inhalation of dust or irritating substances 
 are a frequent cause of this condition, as well as are dis- 
 eases of the stomach and constipation. 
 
254 NASAL CATARRH. 
 
 The chief and only symptom of Simple Chronic 
 Rhinitis is a profuse secretion of mucus, or sometimes when 
 of long standing, muco-pus. 
 
 Examination will reveal a nasal membrane more or less 
 congested, with here and there spots of yellowish or whitish 
 mucus. The epithelium may be abraided in spots or some- 
 times extensively, due perhaps as much to the frequent 
 attempts at relieving the nose of the accumulation of mucus 
 as to the disease itself. In the vault of the pharynx and 
 posterior nares where there is more glandular tissue, there 
 will be more swelling than anteriorly, and the secretions will 
 be found to be more tenacious. 
 
 Treatment: — The nose should be cleansed of the dry 
 secretions by the use of an alkaline wash which may be used 
 twice a day. The well known Dobell's solution may be 
 used for this purpose or if the patient dislikes the carbolic 
 acid odor, other alkaline and antiseptic agents may be 
 employed. These are furnished by all pharmaceutical 
 houses in tablet form. It should be borne in mind, however, 
 that carbolic acid has not only an antiseptic action in the 
 Dobell's solution, but that it is decidedly sedative in its 
 action. On this account, unless the odor of the acid is decid- 
 edly obnoxious to the patient, this solution is to be preferred 
 to many others which though more elegant, are vastly 
 inferior to this old and valuable remedy. The formula of 
 Dobell's solution, although familiar to most physicians, will 
 here be given. 
 
 I£ Sodium Bicarb. 
 
 Sodium Biborat aa 5 j. 
 
 Acid Carbolic 5 ss. 
 
 Glycerine fl. 5 j- 
 
 Aqua q. s. ad. Oij. 
 
 Mix. 
 
 The alkalies render the mucous secretions more fluid, 
 the carbolic acid acts both as an antiseptic and a sedative, 
 while the glycerine is added to increase the specific gravity 
 
NASAL CATARRH. 255 
 
 to nearer that of the normal secretions. No matter what 
 the composition of a. nasal douche may be, it will be irritat- 
 ing if the specific gravity is much more or much less than 
 that of blood serum. It is well therefore to bear in mind 
 that when tablets are used to form solutions for douching the 
 nose, glycerine to the amount of an ounce to the quart should 
 be added. Dobell's solution should not be used freshly 
 prepared, but should be allowed to stand for a week or ten 
 days and filtered. It is then that its bland and sedative 
 action is most marked. 
 
 The best method of using solutions of this kind is by 
 means of an atomizer. Direct the patient to point the noz- 
 zle slightly downward while using, as to point it upward as 
 the majority will do unless properly instructed, will often 
 cause severe pain in the ethmoidal sinuses. Direct the 
 patient to insert the nozzle fully one-half inch and to point 
 it toward the lower part of the ear. The head should be 
 tilted slightly backward when using the atomizer. The soft 
 rubber ear syringe may be used for the purpose of cleansing 
 the nasal passages, but as these are usually found with a tip 
 more than two inches long, it is well to cut them down to 
 about an inch. By this method more solution is wasted than 
 by the use of the atomizer and the results are not as satisfac- 
 tory, but under certain circumstances their use is justified, 
 notably among those whose nasal membrane is so sensitive 
 as to cause excessive sneezing or nausea. The douche or 
 spray should be used twice or three times daily. 
 
 Locally, the use of the Iodine-Glycerine solution should 
 be applied two or three times a week. The application 
 should be made to the floor of the nose and the naso-pharynx 
 or to all the affected parts. The formula for this solution is : 
 
 5 Iodine resub grs. x. 
 
 Potassium Iodide grs. xxx. 
 
 Glycerine fl. % ij. 
 
 Mix. 
 
256 NASAL CATARRH. 
 
 In preparing this solution the Iodide of Potassium and 
 the Iodine should be rubbed together in a mortar and the 
 glycerine added slowly. After an application of this solu- 
 tion the Menthol-Alboline spray, formula of which is given 
 under Acute Rhinitis may be used. It acts as a protective 
 and prevents too rapid evaporation of the iodine. 
 
 The discharge of mucus is usually thinner and more 
 watery after an application of the Iodine-Glycerine solu- 
 tion and the patient should be instructed not to blow the 
 mucus out through the nose, but to draw it back and expec- 
 torate it. Under this treatment, these cases usually recover 
 in from six to eight weeks. 
 
 Hypertrophic Rhinitis. 
 (Chronic Hypertrophic Catarrh.) 
 
 A certain number of cases of simple chronic rhinitis 
 are always neglected until they have developed into Hyper- 
 trophic Rhinitis, and will then for the first time be brought 
 to the notice of the physician. Here, on examination, a 
 different clinical picture reveals itself. Structural changes 
 in various degrees of development will now be noticed, a 
 proliferation of all the normal mucous membrane making 
 it of increased size and therefore called hypertrophic. The 
 glandular structures in the posterior nares and turbinated 
 bodies are also enlarged, subject to the same influences as 
 the membranes more anteriorly. The secretions are now 
 thick and tenacious, which with the enlarged membrane and 
 swollen turbinates completely occlude the air passages, caus- 
 ing difficult breathing, giving the voice a nasal twang and 
 causes the patient to become concerned about himself. 
 
 The parts most frequently involved are the inferior 
 turbinated bodies, which are more or less covered with 
 erectile tissue which is easily engorged and consequently 
 increased in size. For the reduction of this engorgement 
 the galvano cautery is frequently recommended and used, 
 but it must be said, often to the decided disadvantage and 
 
NASAL CATARRH. 
 
 '■i>7 
 
 discomfort of the patient, and not permanently removing 
 the disease. In chromic acid we have a remedy that in 
 many cases will prove itself superior to the cautery, and one 
 that is not attended with its dangers. It has also the advan- 
 tage of being more easily within the reach of the general 
 practitioner, for whose benefit these lines are written. For 
 the purpose of removing the hypertrophy of the anterior 
 portion of the inferior turbinates, the following technique 
 should be followed: The patient should receive local 
 treatment for the active inflammatory symptoms, similar to 
 that advised for simple chronic rhinitis, and after these have 
 subsided the procedure will be thus : The side of the nose 
 upon which the operation is to be performed should be 
 cocainized with a pledget of cotton saturated with a 4% 
 solution of cocaine. This pledget should be brought into 
 close contact with the hypertrophied tissue which is to be 
 removed, and allowed to remain fully twenty minutes. At 
 the end of this time the cotton will be removed and the 
 membrane will be found to be bleached and lying closely 
 in contact with the bone. A few fibres of cotton should now 
 be wrapped about the end of a probe and dipped first into 
 the cocaine solution and afterward into powdered cocaine. 
 This probe is then pressed rather firmly along the line of 
 the proposed application to be made with chromic acid. 
 After a few minutes of this pressure and rubbing along the 
 line of the proposed application, the membranes are ready for 
 the action of the chromic acid, and if properly cocain- 
 ized, little or no pain should be felt. There are several 
 methods by which chromic acid may be applied. Several 
 chromic acid applicators are in the market, the best of 
 which are probably the Bosworth and Sajou. Instrument 
 dealers can furnish these and their mode of action is evident 
 on inspection. For all practical purposes the cotton on 
 probe method is all that can be desired. A few fibers of 
 cotton should be wrapped closely about the end of a probe 
 and slightly moistened. A small quantity of coarsely pow 
 
258 NASAL, CATARRH. 
 
 dered chromic acid should now be placed on a piece of 
 glass, a glass slide answers very well, and the cotton tipped 
 end of the probe turned in it until considerable of the acid 
 is entangled in the cotton. The area to be cauterized is 
 then carefully dried, to prevent the acid from dissolving 
 and spreading to adjacent areas. The end of the probe with 
 the acid, firmly pressed against the parts, is then drawn 
 back and forth against the parts until the increased resist- 
 ance indicates that the tissues have been cauterized through 
 to the bone. The probe is now withdrawn and a few 
 moments are allowed for the acid to complete its work. The 
 patient now inclines his head forward, over a basin, and the 
 nose is sprayed with Dobell's solution to neutralize any 
 excess of acid which may remain in the nose. The spraying 
 should be so carefully conducted that all of the fluid flows 
 forward into the basin, and not backward into the pharynx, 
 as chromic acid is somewhat poisonous. Should a portion 
 of the fluid pass into the pharynx, carrying acid with it, free 
 douching should be resorted to and the patient instructed 
 to refrain from swallowing. This operation is usually fol- 
 lowed by considerable swelling of the operated area and 
 some degree of nasal stenosis will be present on this account 
 and the formation of the scabs. The scab usually comes 
 away within a week and smaller ones form ; sometimes once, 
 sometimes twice. When they have disappeared, if there is 
 no further hypertrophy, the nose remains open and unob- 
 structed. The after treatment consists of keeping the parts 
 clean with Dobell's solution, and if pain or stenosis should 
 require it the snuff before mentioned may be employed. 
 
 Hypertrophies of the posterior portion of the inferior 
 turbinated bodies are best removed by the use of the snare, 
 either the Jarvis or Bosworth. In this operation cocaine 
 must not be used, as it would shrink the part to be grasped 
 by the wire loop so much as to make it impossible. By 
 a little delicate manipulation the operator will be able to 
 grasp in the loop as much of the hypertrophied tissue as is 
 
NASAL CATARRH. 2jl) 
 
 desired to be removed, and by a rapid ringer pressure will be 
 able to retain it until the set screw can be set upon it. By 
 a few turns of the screw the wire loop is tightened until 
 there is no danger of slipping. After a few minutes rest 
 the screw is gradually turned, usually about one-half turn 
 at a time. Allow a rest of a few minutes after each half 
 turn and continue until the hypertrophy is freed from its 
 attachments. The attaching of the loop is really the only 
 painful part of the operation and as soon as it is well tight- 
 ened there is but trifling pain. There is usually but trifling 
 hemorrhage, but the patient should not be allowed to leave 
 the office for half an hour so as to be conveniently near 
 should a severe hemorrhage occur. 
 
 For the purpose of checking hemorrhage, should it 
 occur, pressure should be applied to the bleeding vessels. 
 A probe should be wrapped with sufficient absorbent cotton 
 to form a wedge shaped plug, two inches long and suf- 
 ficiently large to fill the interior of the nose. Saturate the 
 plug dripping wet with pure Hydrozone and thrust it along 
 the floor of the nose until the pharynx is reached. Place 
 the finger on the cotton in the nose and withdraw the probe, 
 allowing the finger to remain on the cotton, under slight 
 pressure, until the ebullition of the gas which forms, has 
 subsided. Support this plug with another so that the entire 
 space is thoroughly filled with the cotton. By the addition 
 of the peroxide to the clot in the nose the latter is hardened 
 and increased in size which assists the cotton in forming 
 pressure. It is however not the cotton nor the peroxide that 
 suppresses the hemorrhage, but the clot which forms firmly 
 about the cotton and extends into the bleeding vessel. This 
 plug may be carefully removed in from six to twelve hours. 
 In cases where the hemorrhage was unusually severe sev- 
 eral minutes should elapse between each slight movement 
 of the plug, and if a drop of blood appears, the cotton 
 already without the nose should be clipped off and a fresh 
 Hydrozone plug inserted against the stump of the old one. 
 
260 NASAL CATARRH. 
 
 Never use Monsell's solution or Monsell's salt inside 
 the nose. It is frequently recommended in medical jour- 
 nals, but is painful and very irritating. With the Hydro- 
 zone used as herein described, any nasal hemorrhage can be 
 checked, even though the plugging may have to be repeated 
 several times. As before said, severe hemorrhage is rare, 
 but as it is the unexpected occurrences which cause the 
 trouble it is best to have a remedy at hand. The after treat- 
 ment is the same as after chromic acid cauterization — clean- 
 liness. 
 
 Atrophic Rhinitis. 
 
 Atrophic catarrh, sometimes called Dry Catarrh, is 
 characterized by the formation of dry scabs and crusts, or 
 a thin watery discharge when it occurs in scrofulous per- 
 sons. These scabs, crusts and discharges usually emit a 
 fetid and offensive odor. In scrofulous cases the disease is 
 termed ozsena. This form of catarrh is usually developed 
 by neglecting to treat hypertrophic catarrh, and is essentially 
 a death of the tissues, the tissues being crowded to death by 
 the engorgement and enlargement present in the latter dis- 
 ease. There is but little possibility of confounding this 
 stage of the disease with any other. The nose is now not 
 pressed for space. There is no swelling, no engorgement, 
 no hypertrophy. There is no interference with the breath- 
 ing except that which is caused by the scabs or crusts 
 present, the posterior wall of the pharynx will be seen to be 
 dry and glistening, the sense of smell is interfered with and 
 sometimes destroyed, there is pain in the frontal sinuses, 
 the patient is irritable and very sensitive to atmospheric 
 changes. The odor escaping from the nostrils of persons 
 affected with this disease is sometimes beyond description 
 and must be imagined, rather than an attempt made to 
 describe it. Our words of encouragement which we were 
 able to express to patients suffering under the forms of 
 catarrh previously detailed, must now cease, for unfortu 
 
NASAL CATARRH. 261 
 
 nately the cure of this disease is rarely fully accomplished. 
 The fetor of the breath and the foul smelling discharges can 
 usually be easily and quickly corrected, and if the treatment 
 is persisted in, much good will be accomplished, and in 
 some cases an apparent cure will result. The indications 
 for treatment are two- fold; cleanliness and stimulation. 
 The former may be secured by the use of the antiseptic 
 wash before mentioned, Dobell's solution, although occa- 
 sionally it will be necessary to first remove the crusts and 
 scabs by means of the forceps. If the removal of these 
 formations is attended with much difficulty, a preliminary 
 spraying with Hydrozone, 50 %, will be of assistance. 
 As the pharynx is most frequently involved when this dis- 
 ease exists to any extent, the cleansing should be thor- 
 oughly done and extended into this part of the air passages. 
 For the purpose of reaching the pharynx a post nasal 
 syringe is best adapted, and after introducing the nozzle 
 behind the velum palati, the stream should be thrown into 
 the vault of the pharynx with considerable force. For the 
 purpose of stimulating the atrophied mucous membranes, 
 and increasing their vascularity, increasing the secretions 
 and promoting new growth, various remedies have been 
 brought forward, the most prominent of which are Nitrate 
 of Silver, Galangal Root, powdered, Salicylic Acid and 
 Potassium- Bromide. In my experience the first mentioned 
 is alone worthy of recognition. It may be employed either 
 in solution or by means of the powder blower. Any good 
 instrument will answer the purpose, and yet for general con- 
 venience and cleanliness the DeVilbiss, with several extra 
 reservoirs, is perhaps the one to be preferred. The tube 
 and reservoirs are of metal and can thus be easily cleansed. 
 If applied in solution the applications are made by means 
 of the cotton tipped probe, in sufficient strength to produce 
 momentary smarting. The strength may vary from five to 
 thirty grains of the Silver Nitrate to the fluid ounce of 
 distilled water. 
 
21)2 NASAL CATARRH. 
 
 For use in the powder blower the Nitrate of Silver 
 should be used in strength sufficient to produce the same 
 effect as in solution, momentary smarting. As a diluting 
 agent starch may be used and the strength may vary from 
 ten to thirty grains to the ounce of starch. Stearate of Zinc 
 is a very desirable vehicle for the body of a snuff, as it is 
 very light and extremely tenacious. As it is lighter and 
 more bulky than starch, two drachms may be used instead 
 of one ounce of starch. These stronger applications should 
 be made by the physician twice or three times each week, 
 while for the home use of the patient he should be given a 
 preparation containing about three grains of the Nitrate of 
 Silver to the ounce of Starch or two drachms Stearate of 
 Zinc. Directions should be given to use it as a snuff at 
 bedtime, each night. An important part of the treatment 
 of Atrophic Rhinitis is the wearing of cotton plugs or cylin- 
 ders in the nose, so placed inside the nose as to take the 
 place, to a large extent, of the atrophied turbinated bodies. 
 Their presence excites the atrophied mucous membrane to 
 renewed action, so that the dried secretions are washed 
 away in the increased discharges, and the fetid odor cor- 
 rected. The air passing through and around these cylinders 
 becomes warmed, moist and free from dust and enters the 
 lungs as if it had passed through a health}- nose. If the 
 pharynx presents an atrophied condition these cylinders of 
 absorbent cotton should be sufficiently long to extend the 
 entire length of the nasal floor and project somewhat from 
 the posterior nares. These cylinders are easily made by 
 loosely wrapping absorbent cotton about a smooth probe 
 until it has assumed the desired shape and bulk, when it may 
 be slipped off the probe and introduced into the nose, or it 
 may be introduced with the probe and slipped off afterward. 
 The patient may be taught how to make these cylinders and 
 instructed to introduce a fresh one as soon as the old one is 
 removed by the use of the handkerchief. As the secretions 
 are absorbed by the cotton the breathing becomes more dif- 
 
NASAL CATARRH. 263 
 
 ficult, and when it seems filled a fresh one should be inserted. 
 Note that these cylinders are to be loosely wrapped, so as 
 to allow free breathing through them. If worn constantly 
 the improvement will be immediately noticed. When the 
 pharynx is involved, in addition to allowing the cotton cylin- 
 ders to extend slightly beyond the posterior nares, applica- 
 tions of Nitrate of Silver in solution, grs. v to xv to the 
 ounce of distilled water, should be made to the atrophied 
 mucous membrane, three times a week, to stimulate the 
 atrophied glands to increased secretion and induce renewed 
 growth in the atrophied structures. 
 
 Internally, to increase secretions and lessen reflex irri- 
 tability, the following mixture may be used to advantage : 
 
 ^ Potassium Bromide 3 iv. 
 
 Potassium Iodide 5 iss. 
 
 Ext. Glycyrrhiza 5 iss. 
 
 Aqua q. s. ad. fl. 5 iv. 
 
 M. Sig. Teaspoonful before each meal. 
 
 Additional Formulae. 
 
 The formula given for Dobell's solution is a somewhat 
 modified form of the official preparation, which is as follows : 
 I£ Sodium Bicarbonate. 
 
 Sodium Biborate aa 5 ij. 
 
 Acid Carbolic gtt. xxiv. 
 
 Aqua q. s. ad. Oj. 
 
 Mix. 
 
 A great many modifications of this formula frequently 
 appear in medical periodicals, all of which practically answer 
 the purpose for which they are intended, although the one 
 given under Simple Chronic Rhinitis is perhaps the most 
 popular and has the advantage of having a specific gravity 
 practically the same as blood serum. 
 
264 NASAL CATARRH. 
 
 Instead of using cocaine in the form of a snuff it is per- 
 missible to combine it in the form of an ointment. It is 
 useful in Simple Chronic Rhinitis and in Hypertrophic 
 Rhinitis, but should be used with caution ; not dispensing 
 more than one-fourth or one-half ounce at a time and never 
 allowing the patient to know that cocaine is being used. It 
 should not be continued any longer than the time required 
 to treat the patient as heretofore outlined, and it should only 
 be considered as an adjunct, as a palliative, and not as a 
 curative agent. The following formula will be found pleas- 
 ant and effective in allaying irritability and temporarily 
 reducing the engorgement and hypertrophy : 
 
 I? Cocaine Muriate gr. xij. 
 
 Thymol gr. viij. 
 
 Menthol gr. xij . 
 
 White Petrolatum 3 iv. 
 
 Mix. 
 
 Sig. Apply a piece the size of a pea, well up into the 
 nostril. Repeat once or twice daily. 
 
 In the treatment of Simple Chronic Rhinitis, the 
 strength of the Iodine, Iodide of Potassium and Glycerine 
 mixture can be varied according to the requirements of the 
 patient. The formula given is usually a good one to begin 
 with and as soon as the patient becomes accustomed to this 
 strength and it no longer causes smarting when applied, the 
 strength of the Iodine and Iodide of Potassium may be 
 increased to as much as thirty grains of the former and 
 ninety grains of the latter to the ounce of glycerine. 
 
 The following formula may be used alternately with 
 the Iodine-Iodide of Potassium solution, especially when the 
 lower portion of the pharynx is involved : 
 
 ^ Fl. Ext. Hydrastis Canaden fl. 3 iv. 
 
 Glycerine q. s. ad. fl. § ij. 
 
 Mix. 
 
NASAL CATARRH. 265 
 
 After the local treatment by the physician is discon- 
 tinued, the patient should be instructed to continue the use 
 of the atomizer with the alkaline and antiseptic solution for 
 a month or more. Thorough cleansing of the nose and 
 pharynx, twice a day should be insisted on, and the follow- 
 ing ointment used afterward. This ointment is perfectly 
 harmless, even if continued indefinitely : 
 
 ^ Menthol gr. j. 
 
 Thymol gr. ii j . 
 
 Bismuth Sub Carbonate gr. xv. 
 
 Oil Gaultheria gtt. ij. 
 
 White Petrolatum 5 j • 
 
 Mix thoroughly. 
 
 Apply to nostril after using atomizer. 
 
 A Stimulating Powder. 
 
 I£ Acid Boracic 3 iv. 
 
 Sulphur lact 3 ij. 
 
 Fl. Ext. Calendula gtt. xxx. 
 
 Mix. Triturate well in a mortar and spread on paper 
 and allow it to dry. Triturate again and bottle. Apply 
 with powder blower. 
 
 In preparing solutions of Nitrate of Silver always use 
 distilled water, as the salts of calcium, potassium, etc., found 
 in water combine with it and render it less efficacious. 
 
 If the treatment of these commoner affections of the 
 upper air passages will be faithfully followed, any practi- 
 tioner can confidently expect to realize results fully as sat- 
 isfactory as those obtained by the specialist, bearing in mind 
 always that the specialist is nothing more than a physician 
 who has acquired a thorough knowledge of his subject, and 
 what is perhaps more to the point, has the courage to put 
 his knowledge to a practical application. 
 
266 NASAL GROWTHS. 
 
 Other Nasal Abnormalities. 
 
 The physician who has become thoroughly acquainted 
 with the treatment of the Catarrhal conditions of the air 
 passages, has but a short step to make to be able to handle 
 successfully some of the minor surgical conditions that are 
 frequently met with in a practice devoted largely to the 
 treatment of diseases of the nose and throat. These will 
 occupy our attention briefly. 
 
 Nasal Polypi. 
 
 A very frequent cause of nasal stenosis and difficult 
 breathing is nasal polypi, of which there are three varieties : 
 mucous, fibrous and cystic. The most common varieties 
 are the mucous and the fibrous. The cystic, which is noth- 
 ing more than a thin bladder like sac, filled with a thin 
 watery substance, is extremely rare. Polypi are easily rec- 
 ognized. They are usually somewhat paler in color than 
 the mucous membrane, and are pedunculated. The mucous 
 polypus is soft, gelatinous and increases in size in damp 
 weather. The fibrous polypus is harder, more firm and on 
 section shows a more solid structure than the mucous. They 
 are a frequent cause of reflex disturbances, the most notable 
 of which is asthma. Many asthmatic cases recover entirely 
 after the removal of nasal polypi. These growths are easily 
 removed, so easily in fact that it is surprising to learn of the 
 number of physicians who would not hesitate to amputate a 
 limb or curette a uterus, and yet refer cases of nasal polypi 
 to the nose and throat specialist. 
 
 A polypus is devoid of any sensibility, but its attach- 
 ment is often extremely sensitive, and therefore their 
 removal should not be attempted without the use of cocaine. 
 The instrument used is the wire snare, of which several 
 styles are in the market, and which have previously been 
 referred to in this chapter. If the polypus is small it should 
 
NASAL GROWTHS. 267 
 
 be encircled and slightly compressed by the wire before the 
 cocaine is applied, as if this is not done, the polypus will 
 often disappear under the influence of the cocaine. Their 
 removal is accomplished in the same manner as detailed 
 under the removal of the hypertrophied tissue from the tur- 
 binates. If the parts are not thoroughly cocainized there 
 will usually be considerable sneezing on the part of the 
 patient, greatly to the annoyance of the operator and possible 
 harm to the tissues, especially after the snare has been partly 
 tightened. The removal of polypi is usually attended with 
 but little loss of blood and under proper anesthesia is not 
 painful. After these growths have been removed and the 
 nose cleared, the stumps should be dusted with powdered 
 pepsin, caroid or papoid, that the tissue devitalized by the 
 pressure of the snare may be digested and the surface freed 
 from dead or partly dead fragments. It has been claimed 
 that applications of strong solutions of pepsin or the other 
 digestants mentioned have the power to digest polypi, but 
 this statement is not borne out by experience. Polypi are 
 usually recurrent but repeated removal and proper attention 
 to the stumps will after a time render the patient free from 
 these growths. After the removal of them, other conditions 
 if present should be treated as indicated. The removal of 
 polypi is often only the first step in the treatment of the 
 various forms in which catarrh appears. 
 
 Fibroma. 
 
 Fibrous tumors are sometimes met with in the naso- 
 pharyngeal region, and when found should be promptly 
 removed. Fibromata, as indicated by their name, are tough 
 fibrous growths with considerable vascularity. 
 
 Their removal is best accomplished by the galvano- 
 cautery snare, with its wire at a red heat. The operation 
 should not be attempted with the ordinary snare as the best 
 steel wire usually breaks, and the hemorrhage is quite pro- 
 fuse. The hot wire acts as a hemostat and thus adds another 
 feature to its value. Cocainize thoroughly. 
 
268 NASAL INSTRUMENTS. 
 
 Instruments. 
 
 In the fore part of this chapter we referred to a few 
 instruments that are absolutely necessary for the purpose of 
 making even a most superficial examination of the nose or 
 throat. These and others will now be more fully considered. 
 
 Instruments for Making Examinations. 
 
 The Lamp. When the office is supplied with gas, the 
 adjustable Gas Bracket with Argand Burner is a very desir- 
 able light, or the Boekel-Mackenzie Laryngoscope with 
 Mirror Bar and Mirror may be used. With the former the 
 head mirror is used while with the latter the mirror is 
 attached to the bar and lamp, thus leaving the head of the 
 operator free. The latter instrument can also be obtained 
 for use on an oil lamp for which purpose the lamp known as 
 the "Student," is best adapted. 
 
 Head Mirror. While this instrument is not used in 
 connection with the Laryngoscope previously mentioned, 
 every physician doing work along this line should be sup- 
 plied with one. Examinations may often be made by sun 
 light and when this is possible it is always most satisfactory. 
 A number of different styles of head mirrors and bands are 
 ir? the market, all of which are practically the same. Electric 
 lights with mirror attached are in the market, and are a con- 
 venient article. See portable electric light outfit in section 
 on Rectal Diseases. 
 
 Nasal Specula. The most desirable instrument for 
 dilating the nostril is one that is self-retaining, thus leaving 
 both hands of the operator free. Several of this kind are 
 in the market, the best of which are probably Potter's, 
 Bosworth's, Frankel's, Goodwillie's, or Folsom's, all of 
 which are similarly constructed and have their advocates. 
 
 Several different Specula should be bought to meet the 
 requirements of different cases. 
 
NASAL, INSTRUMENTS. 269 
 
 Tongue Depressors are found in various shapes and 
 styles, all of which practically answer the purpose. The 
 ordinary fenestrated instrument which folds and is thus 
 easily tucked away and carried is all that can be desired. 
 
 Laryngeal Mirrors are made in different sizes and sev- 
 eral should be purchased. 
 
 Operating Instruments. 
 
 Snares. The general principle of all snares is alike. 
 Some are more elaborate than others but have no practical 
 advantage over the simpler forms. As an all-around instru- 
 ment the Bosworth snare is a perfect success. The Hooper, 
 Jarvis and the Wright may also be mentioned. The latter 
 is a more complicated affair, and instead of a nut for tight- 
 ening the snare, it has a small lever, which on being pressed, 
 slips a serated attachment over a retaining point, one notch 
 at a time. It also can be folded. 
 
 Gaevano-Cautery. Any instrument house can fur- 
 nish these instruments in scores of different designs and 
 styles, depending largely on the amount which the physician 
 wishes to invest. The Galvano-Cautery, while as before said 
 is often used injudiciously, is nevertheless a desirable instru- 
 ment, and in proper hands will accomplish much good. A 
 follicular pharyngitis will almost invariably follow the free 
 use of the cautery, and treatment should be instituted at the 
 first symptom. 
 
 A Compressed Air Apparatus may be added for office 
 work, also the necessary Nebulizers, Vaporizers and Atom- 
 izers. A liberal supply of applicators, probes, retractors, 
 post-nasal syringes, powder blowers, etc., etc., should be 
 kept on hand. 
 
 Other instruments will be required from time to time 
 as the physician proceeds with his work, depending entirely 
 on the particular cases he may be called upon to treat. 
 
27O DISEASES OF WOMEN. 
 
 DISEASES OF WOMEN 
 
 Non-Surgical Treatment. 
 
 The treatment of diseases of women will forever con- 
 stitute an important and considerable portion of the practice 
 of the general practitioner, and if special attention is given 
 to this class of cases, the additional financial returns that will 
 accrue will amply repay any physician for the extra time and 
 thought devoted to them. 
 
 In considering this subject it should be understood that 
 the necessary surgical means, often so successfully resorted 
 to in cases in which surgery is undoubtedly indicated, are 
 not under-estimated or discouraged, but the fact remains 
 that after one or two successful operations on the female 
 generative organs have taken place in any locality, there will 
 be the usual rush for operations and it will continue unin- 
 terruptedly until one or more sudden deaths effectually quell 
 the onslaught. Under such circumstances the physician 
 is apt to be carried on with the swell of the tide and begins 
 to think that after all, surgery is the only remedy. The 
 gynecologist is never consulted in these cases until after 
 the patient has been ineffectually treated by one or more 
 general practitioners, and it is for the latter class of physi- 
 cians to decide whether the gynecologist is to be consulted 
 or not. On the treatment given by the family physician, 
 or some other physician in general practice, depends largely 
 the future course of the woman afflicted with diseases pecu- 
 liar to her sex, and it is therefore important that sufficient 
 attention should be given the subject to at least treat them 
 with intelligence and the best means known to the profes- 
 
DISEASES OF WOMEN. 2.JI 
 
 sion. When the indication for surgery is unmistakable, 
 no time should be lost in obtaining the necessary operation, 
 but when the indication for this is not clear or entirely 
 absent, much good can be accomplished by other remedial 
 means. 
 
 The conditions met with in an ordinary practice of this 
 kind are Dysmenorrhoea, Leucorrhoea, Vaginitis, Pruritus, 
 Prolapse, Ulcerations, Irritability of the Bladder, Backache, 
 Bearing-down feeling. Ovaritis and Pain. 
 
 Examination of women in whom this condition of 
 affairs exists will almost invariably reveal enlargement of the 
 womb, either hard, or soft and flabby, thickening of the 
 mucous membranes, inflamed and engorged when in the 
 earlier stages and hardened and tough in the latter stages, 
 and thickening of the peritoneal coverings and adhesions, 
 the latter being at times noticeable through the vaginal 
 walls and demonstrable in surgical cases. 
 
 Similar conditions occurring in other parts of the body 
 would at once call for a remedy that strangely is but seldom 
 seen recommended in the treatment of female diseases. The 
 remedy is Iodine. This drug is the best at our command 
 to increase. tissue waste and absorption of all hypertrophied 
 or indurated mucous membranes and combined with other 
 remedies that may be indicated, the results are often sur- 
 prising. The following can confidently be relied on and is 
 especially indicated where there is leucorrhoea, back-ache, 
 dysmenorrhoea or amenorrhoea, irritability of the bladder 
 and pain. 
 
 1^ Iodine, resublimed gr. xl. 
 
 Potassium Iodide gr. lxxx. 
 
 El. Ext. Nux Vomica. 
 El. Ext. Belladonna. 
 
 Tr. Cantharides aa fl. 5 ij. 
 
 Aqua q. s. ad. fl. % ij. 
 
 Mix. Dissolve the Iodine in a solution of the Iodide of 
 Potassium in the water, and add to the other ingredients. 
 
2J2 DISEASES OF WOMEN. 
 
 Let stand a week or ten days, filter, and it is ready for use 
 Dose, ten to fifteen drops, in water, three times a day, 
 preferably before meals. 
 
 When the leucorrhoea, back-ache and irritability of the 
 bladder disappear the treatment should be changed and only 
 the iodine and potassium iodide need be given. Use the 
 same quantities as above given, in two ounces of water, dose 
 being the same. Continue this until the enlargement and 
 thickening of the membranes also disappears or reaches 
 the limit of improvement. When amenorrhoea is the prin- 
 cipal symptom, the Iodine and Iodide of Potassium mixture 
 need only be given fifteen days prior to the time for men- 
 struation. It will prove itself an efficient emmenagogue 
 whenever a remedy of this sort is indicated. Instead of add- 
 ing all water, syrup or simple elixir may be added to im- 
 prove the taste. By adding vehicles of this sort the above 
 formula may be increased to eight ounces, when the dose 
 would be one drachm. 
 
 If the patient requires a sedative, Hyoscyamus or Vi- 
 burnum, or both may be added to the above, or Tr. Gentian 
 Comp., should the appetite need stimulation. In order to 
 obtain the best results it will be necessary to continue this 
 treatment for from six months to a year, according to the 
 gravity of the case. Iodine promotes absorption as is well 
 known, but it is essentially a slow process. Under this treat- 
 ment the entire system is benefited, especially when the 
 menstrual flow is retarded as it relieves the system of the 
 effete material which is allowed to accumulate. 
 
 Iodine stimulates to glandular activity and consequently 
 the ovaries are influenced by it. The glands in the mucosa 
 of the uterus as well as the numerous pelvic glands are also 
 stimulated to their normal action. 
 
 Iodine is usually better borne than the large doses of 
 Iodide of Potassium which would be necessary to obtain the 
 required amount of Iodine, and does not retard the diges- 
 tion as does the Iodide, and in fact in many cases the appe- 
 
DISEASES OF WOMEN. 273 
 
 tite is materially increased. Where small fibroids of the 
 uterus are known to exist, Iodine administered in connec- 
 tion with Ergot will sometimes cause them to be passed 
 with the menstrual flow. The Ergot should not be com- 
 bined with the Iodine, but should be given at an interval of 
 an hour or two after the latter. The dose depends upcn the 
 preparation employed, whether fluid extract, solid extract 
 or ergotin, and the physician may be guided in this matter 
 by the customary dosage of the preparation employed. 
 
 In cases of prolapse, ulceration, erosion of the cervix, 
 leucorrhoea, pruritus or small polypi the following wafer will 
 be found an exceptionally good remedy. They do not cause 
 any burning or stinging when introduced into the vagina 
 and are decidedly antiphlogistic. In cases where there is 
 much ulceration with oedema or polypi the discharges will 
 be found to contain more or less shreds of mucous mem- 
 brane or the polypi, and the patient should be informed of 
 this fact in order that she may not be frightened when she 
 notices it. The formula is as follows : 
 
 I£ Powd. Zinc Sulphate gr. xxx. 
 
 Powd. Jequerity Seed 3 iij. 
 
 Powd. Acacia 3 j. 
 
 Powd. Acid Boracic 3 x. 
 
 Aqua q. s . 
 
 Mix. Divide into 60 wafers, or compress into 60 flat 
 tablets. 
 
 Rub the powdered ingredients together in a mortar 
 until intimately mixed and add sufficient water to make a 
 mass of about the same consistency as a pill mass. Roll 
 the mass on a tile and cut into sixty pieces. Flatten each 
 piece into the shape of a coin and set aside to dry. Wafers 
 made by this process harden more solidly than when made 
 by compression of the dry powder, and therefore will not 
 dissolve as quickly; a desirable point. 
 
 Directions. Direct the patient to take a douche of hot 
 
2/4 DISEASES OF WOMEN. 
 
 water and after an interval of half an hour, insert a wafer 
 into the vagina, well up against the womb. Allow it to 
 remain three days, then take another douche. Wait twenty- 
 four hours and repeat the process and continue thus through- 
 out the time required, as long as relief and improvement is 
 obtained. 
 
 It should not be inferred that this treatment will cure 
 all cases of prolapse of the uterus, but by the tonic and 
 astringent action of this remedy the vaginal walls will become 
 less lax and shrunken and will thus afford a better support 
 for the womb. The sole cause for prolapse is often the pre- 
 viously mentioned engorgement and enlargement, which 
 being relieved will allow the womb to assume its normal 
 shape and position. 
 
 In simple leucorrhoea, vaginitis or pruritus the follow- 
 ing astringent powder will be found of the highest value : 
 
 H Powd. Alum. 
 
 Powd. Boracic Acid. 
 
 Powd. Sodium Biborate aa % xvj. 
 
 Acid Carbolic fl. 3 iiss. 
 
 Oil Gaultheria fl. 3 ss. 
 
 Mix. 
 
 Mix the Carbolic acid with the Oil and add the other 
 ingredients. If there is much fetor of the discharge Potas- 
 sium Permanganate may be added in the proportion of gr. 
 xv to gr. xxx to the pound. 
 
 Sig. One to two heaping teaspoon fuls to a pint of hot 
 water. Use as a douche once or twice daily. For the pur- 
 pose of douching the ordinary small vaginal tubes furnished 
 with syringes are practically worthless. Use a fountain 
 syringe of at least one quart capacity, with a dilating nozzle 
 ris shown in the following illustrations. 
 
DISEASES OF WOMEN. 
 
 -/b 
 
 m 
 
 
 The "Niagara Spray" Dilating Nozzle. (Closed). 
 With and without return flow. 
 
 By means of this instrument the vagina is thoroughly 
 dilated, folds of the mucous membrane which enclose and 
 retain secretions are opened and the antiseptic cleansing 
 douche distributed to all parts of the vagina. An additional 
 advantage is gained by not having the openings in the tube 
 in contact with the vagina. By means of the dilators the 
 
2/6 
 
 DISEASES OF WOMEN. 
 
 ■V ■■■■ 
 
 The "Niagara Spray" Dilating Nozzle. (Open). 
 With and without return flow. 
 
 vaginal membrane is at all times from three- fourths to 
 one inch distant from the outlet of the tube, thus allowing a 
 forcible contact of the douche against the vagina. Douches 
 given with the ordinary small tube cannot compare in 
 effectiveness with the thorough cleansing and medication 
 possible with this spray. 
 
 By means of the return flow attachment, a thorough 
 douching can be given in bed, or without soiling the clothing. 
 
DISEASES OF WOMEN. 277 
 
 Pruritus. 
 
 The obstinacy of this symptom warrants a somewhat 
 more extended consideration. When it is present the urine 
 should always be carefully examined, as it is known to be a 
 frequent symptom of Diabetes. 
 
 If no constitutional cause can be ascertained the fol- 
 lowing remedies will in many instances give relief. The 
 formulae given for Pruritus Ani may also be employed. 
 
 Applications of tar water to which one per cent, of 
 chloral hydrate and acetic acid have been added should be 
 used as a lotion to the vulva, morning and evening. Also 
 the following ointment : 
 
 T£ Menthol gr. xlv. 
 
 Olive Oil gtt. xv. 
 
 Lanoline 3 iss. 
 
 Mix. Apply after the lotion above mentioned. 
 Or 1^ Potassium Bromide. 
 
 Acid Salicylic aa gr. xv. 
 
 Glycerole of Starch 3 v. 
 
 Calomel gr. vj. 
 
 Powd. Ext. Belladonna gr. iij. 
 
 Mix. 
 
 Or IJ Acid Carbolic 3 j. 
 
 Morphia Sulphate gr. x. 
 
 Acid Boracic 3 ij. 
 
 Vaseline iiss - 
 
 Mix. 
 Or 1^ Cod Liver Oil. 
 Oil of Tar. 
 
 Lanoline aa 3 ijss. 
 
 Silver Nitrate gr. vj. 
 
 Mix. 
 
 Electricity, both Faradic and Galvanic current, is some- 
 times employed with good results. 
 
2/8 TAPE WORMS. 
 
 TAPE WORMS. 
 
 In man the normal habitat of the parasite of the genus 
 Tenia, commonly known as the Tape Worm, is in the small 
 intestine, where it flourishes under all normal or abnormal 
 physical conditions, its spontaneous expulsion rarely if ever 
 occurring. The symptoms of a person harboring one of these 
 unwelcome guests are sometimes serious and at others less 
 troublesome. There may be any of the following symptoms : 
 loss or increase of appetite, melancholia, nausea, vomiting, 
 colic, insomnia, headaches from intestinal irritation, etc. The 
 only certain indication of the existence of the worm is the 
 passage with the stool of the links or sections of the worm, 
 which appear and are often described by patients as pieces of 
 gristle. 
 
 Tape Worm Specialists. 
 
 The medical profession is largely responsible for the 
 existence and success of the gentry known as "Tape Worm 
 Specialists." This class of practitioners, who are often 
 irregulars and non-graduates, are frequently permanently 
 located in the large cities, or are of the itinerant order and 
 travel from one section to the other. 
 
 It is a great mistake on the part of the general profes- 
 sion to ignore the symptoms produced by tape worms, or 
 to refuse to attempt to treat persons thought to have one or 
 more of them, for the reason that itinerants and charlatans 
 deal with these parasites. If the profession would devote 
 some attention to these cases and treat them intelligently, 
 the presence of the "Tape Worm Specialist" would become 
 exceedinsflv rare. 
 
TAPE WORMS. 279 
 
 THE REMEDY. 
 
 When physicians desire to administer medicines for the 
 removal of tape worms they are often at a loss to know what 
 to prescribe, use inferior drugs, and often fail in their efforts. 
 The following remedy was obtained from a physician who 
 used it with a great deal of success, claiming that when good 
 drugs are used the remedy was practically a specific. In 
 my own practice I have had occasion to use the remedy and 
 I feel safe in asserting that seventy-five per cent, of all cases 
 will be permanently relieved, passing the worm entire, while 
 others will receive temporary relief, and can be treated again 
 in about ninety days. Treatment should not be repeated 
 earlier than ninety days after a treatment has been given, 
 or until sections of the worm pass in the feces. It requires 
 about this period for a worm to become full grown. Should 
 sections pass from a patient after a worm or part of one has 
 been removed, it is an indication, that a second worm is 
 present, and treatment may be given within a week or two. 
 The formula is 
 
 I£ Oleoresin Male Fern, (Squibb) 3 iij. 
 
 Fl. Ext. Kamala 5 ij. 
 
 Chloroform gtt. x. 
 
 Croton Oil gtt. iij. 
 
 Castor Oil q. s. ad. % ij. 
 
 Mix. 
 
 This quantity is to be divided into two portions of one 
 ounce each and taken as directed in the following paragraph. 
 
 Before administering the remedy a saline aperient should 
 be taken. Saline, because these cause a copious secretion of 
 fluids from the entire intestinal tract. This effusion taking 
 place from the surface where the head of the worm rests, 
 protected by dense mucus, loosens the mucus and washes it 
 away, thus allowing the remedy to come into contact with 
 the head. Otherwise it would pass over it without direct 
 contact and would not cause the head to pass. 
 
280 TAPE WORMS. 
 
 The saline should be given about thirty-six hours before 
 the remedy is to be given, and in the meantime the patient 
 should eat as little as possible. The less eaten the better. One 
 dose of the remedy should be given at about 7 A. M., and the 
 second, two hours later. The worm will come with the 
 cathartic action of the remedy. When the worm is known 
 to be passing the patient must sit over a vessel containing 
 warm water, about the normal temperature of the body, the 
 anus being in the water. The worm will pass more easily 
 by this method as the change in temperature, when the vessel 
 is not used causes the worm to make an effort to remain 
 inside. When the worm is dead this is of course not neces- 
 sary, but they are not always dead when passed. 
 
 Tannate of Peujetierinf, is a remedy that is largely 
 used and strongly recommended for the purpose of removing 
 tape worms. Pelletierine is the active principle of Pome- 
 granate. The following formula will prove effective : 
 
 I£ Pelletierine Tannate gr. iv. 
 
 Oleoresin Male Fern n\, xxx. 
 
 Chloroform Tl\ v. 
 
 Syr. Acacia 3 j. 
 
 Mix. After a saline and fasting as before directed, take 
 the above at one dose, preferably in the morning. A half 
 glass of milk should be taken immediately afterward. After 
 two hours take a brisk cathartic, preferably castor oil. 
 
 The following formula combines three of the most 
 prominent remedies for the removal of tape worms and 
 deserves mention. 
 
 1^ Ethereal Ext. Pomegranate. 
 
 Ethereal Ext. Male Fern aa gr. vii j . 
 
 Kousoo Flowers, Powd 3 v. 
 
 Honey 3 v. 
 
 Mix. Divide this quantity into three doses and take 
 
tape; worms. 281 
 
 one dose every fifteen minutes until three are taken. The 
 usual fasting rules are to be observed. Two hours after the 
 last dose, follow with two ounces or more of castor oil. 
 
 Salicylic Acid has been highly spoken of as a remedy 
 for the removal of tape worms, although it is not generally 
 used by the most successful practitioners in this line. This 
 may be due to its not being generally known. Dr. Carnet, 
 of Connecticut, claims to obtain excellent results from its use. 
 He allows, the patient to eat as usual and gives eight grains 
 of salicylic acid every hour until forty grains are taken. 
 After the last dose a laxative dose of castor oil is given. 
 The worms are said to pass alive and are usually passed 
 entirely. So common and cheap a remedy deserves a trial. 
 
282 ALOPECIA. 
 
 ALOPECIA. 
 
 Baldness may be considered physiological when it occurs 
 in persons well advanced in years, but when young or middle- 
 aged persons are thus affected it may well be termed an 
 abnormal condition. 
 
 The etiology of baldness is not by any means clear. 
 Trophic disturbances of the nervous supply of the occipito- 
 frontalis muscle have been declared to be the cause, but this 
 is so vague that it is equivalent to acknowledging ignorance 
 in the matter. The exclusion of light and air due to continual 
 wearing of the hat has been offered as a possible cause, but 
 the large majority of policemen, coachmen and men 
 employed out-doors and who wear head coverings as many 
 hours in twenty-four as any one, have an average supply of 
 hair. 
 
 A popular belief is that mental labor, continual anxiety 
 or occupations requiring acuteness of vision have some influ- 
 ence in connection with the loss of hair, but a large percent- 
 age of teachers, musicians, bankers and literary workers 
 have no use for hair restorers. The wearing of the ordinary 
 stiff hat, which fits the head closely and possibly interferes 
 with the proper blood supply of the scalp is perhaps a factor 
 in those who become bald, or possibly in those who have a 
 predisposition to baldness through heredity or otherwise, but 
 it can scarcely be termed a cause per se. The strongest argu- 
 ment in its favor is that so very few women become bald. 
 Unless lost through fever or some systemic disease, there is 
 scarcely a woman under fifty years of age, who has not the 
 usual quantity of hair. The parasite theory is perhaps the 
 one which finds most favor, probably for the reason that it 
 offers an explanation which cannot well be disproved. 
 
ALOPECIA. 283 
 
 Taking it as a premise that when baldness begins under 
 forty, or particularly when persons twenty or thirty years of 
 age become affected, it is abnormal, the conclusion must be 
 that proper treatment will frequently benefit ; either in arrest- 
 ing the loss or restoring the hair. Prof. Lassar has had good 
 success with the treatment which follows, as have also others 
 who have used it. Dr. Bernheim, of this city, a former stu- 
 dent of Prof. Lassar's, has obtained beneficial results in about 
 a dozen cases. The treatment must be patiently persisted in, 
 diligently applied and results not expected too early. 
 
 Prof. Lassar's Treatment. 
 
 First, the scalp should be shampooed every day for eight 
 weeks, and after that, every other day, or three times a week, 
 for eight weeks more, with tar soap, made by adding 40 
 parts of birchwood, or preferably beechwood tar, to 60 parts 
 of soap mixture. Ordinary tar soap is too weak to be effect- 
 ive. The shampooing must be done thoroughly, for not less 
 than ten minutes, after which the soap should be washed off 
 first with warm water, gradually coming to cool or even cold 
 water. The hair and scalp should then be dried by patting it 
 with a cloth or tissue paper. The scalp should next be 
 rubbed with the following: 
 
 I£ Mercuric Chloride, Corros gr. xv. 
 
 Glycerine, 
 
 Cologne Spts aa fl. § iij. 
 
 Water fl. % x. 
 
 Mix. 
 
 Apply to scalp with soft woolen cloth and rub for five 
 minutes. After this rub the skin dry for another five minutes 
 with a solution of 
 
 I£ Beta Napthol gr. xv. 
 
 Absolute Alcohol fl. g vij. 
 
 Mix. 
 
284 ALOPECIA. 
 
 After this, use as freely as possible, a hair oil as follows : 
 
 I£ Acid Salicylic gr. xxx. 
 
 Tr. Benzoin 3 j. 
 
 Neatsfoot Oil fl. 5 iijss. 
 
 Mix. 
 
 Sig. Rub generous portions of the oil into the scalp for 
 five minutes. 
 
 The idea of this procedure is to remove, by means of the 
 soap, all dirt, dust, etc. The mercuric solution is readily 
 taken up by the hair follicles and seems to have a special 
 tendency to stimulate the growth of hair. The napthol alco- 
 hol dries, removes fatty substances and disinfects the scalp 
 and prepares the pores for the absorption of the hair oil. 
 Neatsfoot oil is recommended as it seems to be better 
 absorbed and assimilated than a vegetable oil. Lanolin might 
 also be used. 
 
 This treatment is equally effective in alopecia areata, and 
 in all cases, where the process of destruction has not gone too 
 far, certainly will stop the hair from falling out, so that the 
 hair still in possession will at least be retained . 
 
 Treatment by Lactic Acid. 
 
 In giving the following treatment as a remedy for pre- 
 mature baldness, I shall quote it as written by a physician 
 whose experience it narrates. 
 
 "During my college days I was severely troubled with 
 headaches, the pain being mostly on the top of my head ; from 
 that time on my head became dry and full of dandruff, and 
 my hair came out until I was very bald. For five years I had 
 my head shaved twice a week, but no favorable results came 
 about, and I gave it up. I then tried crude petroleum and 
 thorough massage to the scalp every day for more than a 
 vear, with negative results. Since then I have used a dozen 
 remedies, but to no good effect. 
 
ALOPECIA. 285 
 
 "About a year ago I hit upon an application in which I 
 had but little faith, though I used it two or three times a 
 month. Now I have hair enough to comb and part it as of 
 yore. 
 
 "There is still a patch upon the extreme top of my head 
 that is covered with very fine hairs, yet this patch is steadily 
 growing smaller. 
 
 "The remedy that has done the work consists of a 
 twenty-five per cent, solution of. lactic acid in water. Rub 
 this into the scalp every day until it causes pustulation. Then 
 it is to be left off until the pustules disappear. Then it is to 
 be used again in the same manner. After the hair began 
 to grow I omitted the pustulating remedy and used 
 
 B Lactic Acid fl. § j. 
 
 Quinine Sulphate gr. xx. 
 
 Glycerine fl. § ss. 
 
 Water q. s. ad. fl. 5 iv. 
 
 Perfume to suit. 
 
 "Mix by putting the quinine into the acid, making a clear 
 solution, before adding the glycerine and water. Apply this 
 to the hair as an ordinary dressing every day. While in the 
 last formula the percentage of lactic acid is the same as in the 
 former, the addition of the quinine and glycerine prevents 
 the extreme irritation of the scalp. This irritation, I believe, 
 is of great importance at the beginning of the treatment. 
 This remedy does even more than grow hair. It restored the 
 original dark color of my hair after I was as gray as a 
 badger. (I have passed the 50 mark). 
 
 "Don't expect results in a month. Try it a year before 
 you register any complaints." 
 
286 ENURESIS. 
 
 ENURESIS. 
 
 The successful treatment of enuresis, especially the noc- 
 turnal form, is often attended with considerable difficulty. 
 In the majority of cases, no pathological changes can be 
 determined, and when present, they do not as a rule indicate 
 the curative course of treatment. 
 
 Bed-wetting is said to be due to several causes : Irrita- 
 bility of the bladder, relaxation of the sphincter muscle of 
 the bladder, or spasmodic contraction of the bladder. Treat- 
 ment directed toward the relief of either or all of these con- 
 ditions with the remedies they would suggest, is usually 
 unproductive of good results. Occasionally a cure will be 
 effected, but the average results are not such as will earn 
 for the practitioner a reputation for special skill in the treat- 
 ment of the condition. 
 
 The drug that will give the best results in a large per- 
 centage of cases, disregarding the cause, which can but sel- 
 dom be correctly determined, is Rhus Aromatica, the Sweet 
 Sumach that grows throughout the Eastern section of this 
 country. The bark of the root is the part used. 
 
 The dose of the fluid extract is one drachm or less, and 
 of the solid extract up to ten grains, yet full doses are seldom 
 necessar)', nor conducive to the best results. 
 
 As the patients are usually children, the doses need not 
 exceed ten to fifteen minims of the fluid extract, or two 
 grains of the solid. 
 
 In combination with nux vomica its selective action in 
 this condition is strengthened and results more satisfactory. 
 
 As a dose for a child four to eight years old, the follow- 
 ing formula will be eligible : 
 
 M Ext. Rhus Aromatica gr. ij. 
 
 Ext. Nux Vomica gr. %. 
 
 Mix. Ft. Tablet No. i. 
 
HYDROCELE. 287 
 
 Sig. Give one such after supper and at bedtime. If no 
 improvement is noticed in a week, increase the number of 
 lablets to four a day, giving them in addition in the morning 
 and at noon. Continue treatment one month after an appar- 
 ent cure. 
 
 Little or no fluids should be taken after 6 P. M., and 
 during the day an effort should be made to retain the urine 
 as long as possible without inconvenience or injury. 
 
 In old men, when prostatic troubles cause urinary diffi- 
 culties, these tablets, giving six to ten a day, in combination 
 with fluid extract of Pichi, in drachm doses, four times a 
 day, will be found an excellent treatment. 
 
 hydrocele. 
 
 The Radical Cure. 
 
 The radical cure of hydrocele should not be performed 
 in persons over sixty years of age, and never when the 
 patient is subject to dropsical symptoms. 
 
 In younger patients, when free from such complications, 
 this treatment should be employed, as a temporary incon- 
 venience will render the patient free from annoyance for the 
 rest of his life. 
 
 The operation should be performed in this manner : 
 
 The sac is punctured in the usual manner and about 
 one-half of the fluid is withdrawn. The canula is then ele- 
 vated and two drachms of a saturated solution of bichloride 
 of mercury in glycerine is injected through it and mixed 
 with the remainder of the fluid. After one minute, the whole 
 of the fluid is withdrawn, special attention being directed 
 toward its entire removal. Very little pain is experienced 
 and the patient can usually move about immediately after 
 the operation. Patient need not be confined to bed, but for a 
 few days should remain quiet, and in a week he will be well. 
 
288 HYDROCELE. 
 
 The bichloride acts as its own antiseptic, yet instruments 
 should be perfectly clean. 
 
 Note: — Do not use equal parts of a saturated solution 
 of bichloride of mercury, in water, and glycerine, but a sat- 
 urated solution of bichloride in glycerine. 
 
 ANOTHER METHOD. 
 
 After withdrawing all the fluid in the sac, inject into it a 
 mixture of Lloyd's Specific Thuja and glycerine, one half 
 drachm of the former to one and one-half drachm 
 of the latter. This quantity is used in hydroceles 
 from which one pint of fluid has been removed. When larger 
 or smaller, use proportionate quantities of this compound. 
 After injection, the scrotum must be manipulated so as to 
 bring the fluid into contact with the entire sac. There will 
 be swelling and inflammation for a few days, but little pain, 
 and in four or five days the patient will be well. 
 
 Prof. Wyeth, of N. Y., used thirty minims of pure car- 
 bolic acid, injected into the sac, after all the fluid had been 
 withdrawn. The advantages claimed for carbolic acid are 
 certainty of action, freedom from pain and the mild degree 
 of inflammation produced. In fifty cases treated by Prof. 
 Wyeth, only two were not cured by the first injection. 
 
 Considering the effects of carbolic acid, as mentioned in 
 another part of this volume, its employment in hydrocele 
 is in line with modern practice. Its anesthetic action in burns 
 and open wounds can easily be demonstrated and when intro- 
 duced into the scrotum its action is similar. To insure per- 
 fect results the fluid should all be withdrawn, so that the acid 
 will not be diluted, as diluted acid is painful and is absorbed. 
 
 Tr. Iodine, so often recommended for the radical cure 
 of hydrocele, is an extremely irritating and painful agent, 
 and is not used to any great extent at this time. In as much 
 as other remedies can be employed which are in all respects 
 preferable to iodine, there remains but little justification for 
 its use. 
 
VARICOCELE. 289 
 
 VARICOCELE. 
 
 Its Treatment. 
 
 The following modification of the well known ligation 
 treatment for varicocele is a decided improvement over it, 
 and can be relied upon in every particular; it is curative, 
 safe, not painful and the operation requires but little time for 
 its performance. 
 
 With the patient standing, so as to distend the veins, 
 crowd them to the scrotal wall and pass a needle armed 
 with an elastic ligature, through both scrotal walls, behind 
 the vein, excluding the vas deferens and cord. The vas 
 deferens can be readily distinguished by its tough cord-like 
 touch. It is found back of the cord. When this has been 
 done, let the patient lie down and by proper manipulation, 
 empty the veins of all the blood, and tie, including the vein 
 and skin in the loop, tight enough so that the ligature will 
 cut its way out. Dress with a simple antiseptic dressing. 
 
 To carry the elastic ligature through, the best method 
 is to thread the needle with a silk ligature which has attached 
 to it the rubber ligature, and pull it through after the needle 
 has been removed. In order that the rubber ligature may not 
 pass through entirely thus making another passage of the 
 needle necessary, attach an artery forceps to the end of it. 
 When the ligature is in place, tighten it by passing both ends 
 of the ligature through a tongue-tie and when tight enough 
 keep in place by grasping the ligature with the artery forceps. 
 Pass a silk ligature between the tongue-tie and artery forceps 
 and tie tight. The rubber ligature is not tied into a knot, but 
 is held together by a silk ligature. Use only the very best 
 quality of rubber ligature, and see that it is perfect before 
 using. The skin and vein will be cut through in the course 
 of a week without inconvenience to the patient. There is no 
 sloughing and barely forms a scab. Enclose as little skin in 
 the ligature as possible. The operation is extremely simple, 
 yet highly satisfactory. 
 
29O URETHRAL STRICTURE. 
 
 URETHRAL STRICTURE. 
 
 Treatment by the Solvent Method. 
 
 By reason of the persistent advertising of this method 
 by the irregular specialists, considerable interest has been 
 aroused and many inquiries have been received concerning it. 
 
 The idea of this treatment has evidently been derived 
 from the knowledge that diphtheritic and other false mem- 
 branes are dissolved and destroyed by the digestive ferments. 
 
 The passage of casts from the urethra, sometimes of 
 considerable size and formation, after treatment by this 
 method, would seem to warrant hope of benefit from its use- 
 
 The following formula may be used for this purpose : 
 
 It Ext. Hyoscyamus gr. ss. 
 
 Ext. Calendula gr. j. 
 
 Carica papaya gr. j. 
 
 Powd. Elm gr. v. 
 
 Mix. Form into one bougie and place into the con- 
 stricted portion of the urethra. 
 
 Prior to the introduction of the bougie the stricture 
 should be dilated. If difficulty be experienced in the intro- 
 duction of the sound, the injection of a few drops of fluid 
 extract of hyoscyamus will cause relaxation and facilitate its 
 passage. Use a bougie each night. 
 
 The following formula is offered for the same purpose, 
 also for acute or chronic gonorrhoea. This ointment is 
 penetrating, owing to the alboline ; germicidal, owing to the 
 mercury and silver ; a solvent for the fibrous exudate, due to 
 the pepsin and caroid. 
 
URETHRAL STRICTURE. 2yl 
 
 The formula : 
 
 J£ Yellow Oxide of Mercury gr. xx. 
 
 Oxide of Silver 5 ij. 
 
 Oleic Acid o j. 
 
 Powd. Scale Pepsin 5 iv. 
 
 Powd. Caroid o iv. 
 
 Alboline % ij • 
 
 Lanolin o ij- 
 
 Water § ij . 
 
 Mix as follows : Dissolve the oxides of mercury and 
 silver in the oleic acid and albolene. To do this it is neces- 
 sary to triturate the oxides in a large mortar dry, then add 
 oleic acid, and continue the trituration till the mass begins to 
 stiffen ; then add the albolene quickly, and the trituration 
 must be continued till a uniform paste is obtained. Then add 
 the lanolin, and rub it well into the mixture. Finally, having 
 dissolved the pepsin and caroid in the water, and filtered it 
 through a funnel lightly plugged with absorbent cotton, (this 
 is necessary, as the caroid has grit in it), add this aqueous 
 solution to the salve in the mortar, and triturate the whole 
 till it is a uniform, creamy paste. These details are impor- 
 tant, and any departure will result in a lumpy, uneven mass, 
 that is not only inelegant, but much inferior therapeutically. 
 By means of an applicator, introduce into the urethra, at 
 the point desired, half to one drachm of the remedy. For 
 stricture, an application twice or three times a week will be 
 sufficient, while for acute and chronic gonorrhoea, applica- 
 tions should be made night and morning. 
 
 Dr. T. W. Williams informs me that he has often 
 observed the passage of casts from the urethra, following- 
 applications of citrine ointment in the treatment of prostatic 
 disease, described in the latter portion of this work. 
 
 The applications can be best made with the Urethral 
 Applicateur described in Dr. Williams' article just men- 
 tioned. 
 
2Q2 MEDICAL MELANGE. 
 
 MEDICAL MELANGE. 
 
 Practical and Helpful. 
 
 It is often the little things that cause us the most worry 
 and anxiety. Hundreds of good practical suggestions are 
 yearly published in medical journals, but are frequently lost 
 sight of in the mad scramble to learn the latest development 
 in Prof. Scientific' s pathological researches ; to become 
 acquainted with the latest classification of microbes, or indeed 
 to be the first in any locality to experiment on some unfor- 
 tunate individual with the latest product of some German 
 paint or dye factory. A well developed and misbehaving 
 corn on the last quarter of an inch of a man's anatomy often 
 causes him more annoyance and genuine discomfort than a 
 double complete inguinal hernia, and a wart or mole on the 
 face of a society belle, will, if removed, be responsible for 
 more recommendations of your skill than if you had repaired 
 the lacerated cervix with which she suffers in the privacy of 
 her home. 
 
 THE SOLAR CAUTERY. 
 
 The rays of the sun when properly focused are known 
 to be irritant and caustic, destroying tissue and igniting 
 inflammable material. 
 
 As a therapeutic agent the solar cautery is not generally 
 employed, and yet some physicians, especially dermatologists 
 and cosmetic specialists use it quite extensively and to good 
 effect. For the purpose of focusing the rays properly at a 
 convenient distance, a lens of ten to twelve dioptric power is 
 preferable. Several lenses should be procured, each of dif- 
 ferent power. Some lenses will not focus as well as others, 
 and care should be used in selecting them. For some reason 
 
MEDICAL MELANGE. 293 
 
 or other a blue glass, medium tint, seems to act better when a 
 great deal of tissue is to be destroyed. Some claim that the 
 blue light is antiseptic and kills parasites and microbes 
 quicker than a colorless lens. Small growths of the skin, 
 such as warts, moles or a capillary aneurism can be removed 
 by one treatment and without much pain. The pain will be 
 proportionate to the tissue destroyed. To prevent pain a 
 local anesthetic is employed, usually cocaine in four per 
 cent, solution. Eucaine, chloretone or strong carbolic acid 
 may also be used. The anesthetic is applied to the growth to 
 be removed and the growth covered with a piece of asbestos 
 cloth with a small hole in the centre, just large enough to 
 allow the growth to be treated through the hole without 
 injuring the surrounding parts. Paper may be used for this 
 purpose, but it frequently ignites and causes annoyance and 
 delay. After an application of a few seconds more anesthetic 
 may be applied, and thus repeated until the treatment is com- 
 pleted. Warts are usually not sensitive until the deeper 
 structures are reached, and small warts may be burnt level 
 with the skin without any material discomfort. A wart will 
 smoke and sizzle, but a mole will not, but the latter will form 
 a blister and the application must be continued a little beyond 
 forming a blister. If one treatment is not sufficient, as can 
 be seen after a week or ten days, the treatment must be 
 repeated. Continue the application until you have burnt level 
 with the skin when treating warts ; and a trifle longer than to 
 raise a blister when treating moles. If the patient complains of 
 pain continue as long as he keeps still, then apply more anes- 
 thetic and continue. If the burn is not too deep there will be 
 no scar following this treatment. In Epithelial cancers, if 
 seen early, this treatment is strongly recommended and will 
 frequently arrest the disease. Burn deep, without regard for 
 the scar that will take its place. This disease is not treated 
 for its cosmetic effect. Corns can easily be cured by the solar 
 cautery. Pare away the calloused skin and make several 
 strong applications. A little soreness follows but it kills the 
 corn. Repeat until entirely relieved. 
 
2«J4 MEDICAL MELANGE. 
 
 WARTS may also be removed by the following 
 method, which is more applicable when these excrescences 
 are multiple or confluent. 
 
 R Sulphur Sub '. 5 v. 
 
 Cone. Acetic Acid fl. 3 iiss. 
 
 Glycerine fl. 5 ij. 
 
 Mix. This paste is applied to the warts either with a 
 brush or spread over them on small pieces of linen. This 
 is done at night and washed off in the morning. Repeat the 
 application thus for several days. Under this treatment warts 
 become blue, shrivel up and drop off. 
 
 AN EXTERNAL REMEDY FOR RESPIRATORY 
 DISEASES. 
 
 One of the oldest remedies in use to-day is the one of 
 which the formula is here given. It is of doubtful origin, 
 but highly spoken of by such eminent practitioners as Aitkin, 
 Stokes and Graves, to say nothing of the lesser lights who 
 are using it in their daily routine of work with excellent 
 results. 
 
 T£ Spts. Turpentine fl. § iij. 
 
 Acid Acetic fl. 5 iv. 
 
 Yolk of Egg One. 
 
 Rose Water fl. 3 iiss. 
 
 Oil of "Lemon fl. 3 j. 
 
 Mix. First rub the yolk of egg, the water and the 
 acetic acid together in a mortar until an intimate mixture 
 results, then add the spirits of turpentine and shake vigor- 
 ously; lastly add the oil of lemon. In bronchitis, asthma, 
 congestion of the lungs, pleurisy and even in phthisis this 
 remedy cannot be too strongly recommended. The chest and 
 neck should be sponged with it morning and evening. It not 
 only acts beneficially on account of its counter irritant action, 
 but the remedv is absorbed and acts as a direct stimulus. It 
 
MEDICAL MELANGE- 295 
 
 produces more or less redness of the surface, but its beneficial 
 action does not seem to depend on the degree of redness pro- 
 duced, hence my conclusions that it is absorbed. Its action 
 on the kidneys, by which the flow of urine is increased, is 
 quite marked; the noticeable odor of turpentine in the urine 
 being an evidence of this fact. In simple swelling of the 
 tonsils and inflammation of the throat, so often met with in 
 children, it should be applied to the neck and a flannel band- 
 age applied. In bronchitis and congestion, the entire neck 
 and chest should be rubbed with it. In asthma, its daily 
 use, when paroxysms are frequent, is indicated, and during 
 the paroxysms especially an application should be made. The 
 great relief and entire dissipation of the paroxysm which I 
 have so often seen follow an application of this remedy, is 
 sufficient to stamp it as one of our best. In the dyspnoea 
 acompanying pneumonia, pleurisy and phthisis its application 
 will almost invariably afford relief. Other treatment is not 
 interfered with and can be piven as indicated. 
 
 USES OF CARBOLIC ACID. 
 
 Carbolic acid, besides being one of our best antiseptics, 
 and in many cases to be preferred to bichloride of mercury, , 
 has other uses which make it worthy of special mention. It 
 is the only drug that combines cauterant, anesthetic, antisep- 
 tic and antiphlogistic properties. 
 
 The most astonishing use of carbolic acid* is its applica- 
 tion, pure and undiluted, to open surfaces, abscess cavities, 
 freshly exposed tissues and burns. When carbolic acid is 
 thus applied pure and undiluted, it is a perfectly harmless 
 agent. Its application to burns, where the skin has been 
 destroyed and the tissues injured, and the victim suffering 
 intense pain, will almost immediately cause the pain to cease. 
 
 It should be applied with a feather or camel's hair brush. 
 If thus applied there is absolutely no absorption, as the acid 
 
296 MEDICAI, MELANGE. 
 
 forms with the serum of the blood an impervious albuminate, 
 which renders absorption impossible. This covering also 
 excludes the air and acts as an anesthetic to the injured nerve 
 filaments. If the covering thus formed should become dis- 
 turbed by the removal of bandages, another application 
 should be made. This treatment was originated as far as can 
 be ascertained by Dr. Ben. H. Brodnax, of Brodnax, La., and 
 was favorably commented upon by Dr. O. H. Allis, of Phila- 
 delphia, Pa., who also read a paper on the subject before the 
 Philadelphia Medical Society, extracts of which were later 
 published by the Philadelphia Polyclinic. Dr. Allis says : "It 
 will strike many of you with astonishment when I say that 
 it would be safer to pour a gallon of pure carbolic acid into a 
 purulent thoracic cavity than to pour into it a gallon of water 
 into which a single ounce of carbolic acid had been placed. I 
 will go further and say that excess of the strong acid in a 
 cavity, such as an abscess cavity, or upon exposed tissues, as 
 a burn or a fresh wound, does no harm, while excess of a 
 dilute solution, if left in a cavity or used over an extensive 
 raw surface, will be promptly followed by dangerous, if not 
 fatal toxic effects." It requires some courage to apply strong 
 carbolic acid to a raw, glaring, quivering wound, but prompt 
 and excellent results will immediately follow the application. 
 It should be applied thoroughly, all over the wounded sur- 
 face, up to the very margin of the uninjured portion, and a 
 light cotton dressing applied. No other local treatment is 
 required in these cases, and nothing better nor safer can be 
 obtained. The acid to be used must be the full strength, not 
 the acid to which five or ten per cent, of glycerine has been 
 added to maintain solubility, but the liquid resulting from 
 heating the crystals. 
 
 For the purpose of liquefying carbolic acid, it should 
 never be heated in any other manner than in a water bath, 
 with the cork removed. The vapor is inflammable and may 
 explode if brought into contact with the naked flame. After 
 being liquefied it will remain so, if kept at a temperature 
 of 105 F. 
 
MEDICAL MELANGE. 297 
 
 TO ABORT BOILS, carbolic acid should be injected 
 into the centre of the boil, two or three drops being sufficient 
 to do the work. Use the pure acid fearlessly. There is no 
 pain and no danger. 
 
 For hypodermatic or deep injection, it is impossible to 
 prevent crystalization in the syringe and needle, unless the 
 instruments are kept warm. After filling a syringe, place 
 it into hot water a few minutes, and inject quickly. A good 
 syringe will not admit water, even if immersed. 
 
 LANCING A FELON can be painlessly accomplished 
 by dipping the finger into a twenty per cent, solution of car- 
 bolic acid and allowing it to remain there for a few minutes. 
 Wait half an hour before lancing. No pain will be felt. 
 
 ANTIDOTES. The best antidote to carbolic acid is 
 Alcohol. The action of carbolic acid may be arrested at any 
 stage by the application of alcohol. If accidentally swal- 
 lowed, alcohol is the remedy. Glycerine also partakes of this 
 property to some extent, but is not as active as alcohol. 
 Acetic acid is even better than glycerine ; it will destroy the 
 odor of carbolic acid, and if applied to the white surface 
 caused by its contact with the skin, will, by gently rubbing 
 the part, restore its natural color in a short time. 
 
 Carbolic acid is also a valuable addition to cocaine solu- 
 tion intended for hypodermatic injection. It renders absorp- 
 tion less liable, aids anesthesia and preserves the solution. 
 The usual proportion in solutions of this kind is eight drops 
 to the ounce. 
 
298 MEDICAL MELANGE. 
 
 FLEXIBLE SPLINTS. 
 
 The flexible splint, if well made and of good material, 
 has much to commend it. It conforms perfectly to the part 
 to which it is applied, is comfortable to the patient, and by 
 is rigidity assists in perfect union being obtained. The fol- 
 lowing formulae are the best obtainable for the purpose : 
 
 J^ Powd. Gum Shellac J xvj. 
 
 95 % Alcohol fl. 5 xxiv. 
 
 Sodium Biborate. 
 
 Castor Oil aa 3 ij . 
 
 Mix. Dissolve the shellac in the alcohol and add the 
 other ingredients and shake well. 
 
 Old woolen cloth is the best material for making splints. 
 Apply the solution to one side with a paint brush and dry 
 before a hot fire. Then apply a second coat to the same side 
 and dry as at first. Take two pieces thus prepared and place 
 the two coated sides together and unite them firmly by press- 
 ing them with a hot iron. When ready to use a splint thus 
 prepared, dip it in hot water or heat before a fire until pliable. 
 Shape the splint by holding it in place until it sets. Line it 
 with cotton and apply it, keeping it in place with the ordi- 
 nary bandage. The same splint can be used over and over 
 again until too much soiled. 
 
 A SECRET FORMULA. 
 
 The following formula was sold by a Western physician 
 for four dollars. He called it "Chydde's Solution." 
 
 J£ Liquor Soda-silicate fl. 3 xvj. 
 
 Dextrine % x. 
 
 Venice Turpentine % j. 
 
 Alcohol fl. § iv. 
 
 Acid Boracic 5 j. 
 
 Mix. It is used in the same manner as the other. 
 
MEDICAL MELANGE. 299 
 
 PAINLESS TOOTH EXTRACTION. 
 
 Physicians are frequently called upon to extract teeth 
 for the relief of pain, and to such the following formula will 
 commend itself. If properly injected there is really but little 
 pain experienced. It is very similar in appearance and odor 
 to a well known proprietary article sold to dentists at $1.00 
 per ounce. 
 
 I£ Cocaine Muriate gr. xx. 
 
 Ac. Carbolic, cryst gr. xxiv. 
 
 Gum Camphor gr. xxiv. 
 
 Alcohol, 95 °/o q. s. ad. 5 j. 
 
 Mix. Inject three minims of this mixture deeply into 
 the gum on the inner and outer side of the tooth, and apply 
 all around it a piece of cotton wet with the solution. Allow 
 it to remain three to four minutes, incise the gum freely and 
 extract. Always pull outward when extracting teeth, no 
 matter in what direction the tooth points. 
 Another, for local application : 
 
 IJ Oil Gauitheria fl. 3 ij. 
 
 Chloral Hydrate o ij. 
 
 Chloroform. 
 
 Sulphuric Ether aa fl. 3 j. 
 
 Oil Cloves fl. 3 iv. 
 
 Alcohol fl. 3 xij. 
 
 Mix. 
 
 Apply by means of cotton saturated with the solution. 
 Allow it to remain five minutes. Protect surrounding tissues 
 by placing dry cotton about the inner and outer side of the 
 tooth. 
 
 CHLORAL— CAMPHOR. 
 
 When Chloral Hydrate and Gum Camphor are mixed in 
 equal parts and triturated in a mortar, a heavy, oily liquid 
 results which is a veritable cure-all. A pledget of cotton 
 saturated with it and placed in the cavity of a decayed tooth 
 will almost immediatelv relieve the pain of tooth-ache ; 
 
300 MEDICAL MELANGE. 
 
 applied along the nerve trunks in neuralgia the relief is 
 almost immediate and quite lasting; painted over the abdo- 
 men, especially in the region of the ovaries, it relieves the 
 pain of dysmenorrhoea and ovarian neuralgia. By the addi- 
 tion of Carbolic acid its value is increased and is applicable 
 to many other diseased conditions. When Carbolic Acid is 
 added, use equal parts of each; Gum Camphor, Chloral 
 Hydrate and Carbolic Acid crystals. It is a sterling remedy 
 for all external sores and ulcers, chancres or syphilitic sores, 
 suppurating cavities, or to stimulate granulations of indolent 
 ulcers. It may be diluted one half to one third and used in 
 sore throat with a brush, and to ulceration of the cervix or 
 mucous patches. The compound containing the acid is less 
 painful but even without it the mixture is not severe. For 
 the purpose of dilution olive oil or a hydro-carbon oil should 
 be used. 
 
 "Success requires not something new 
 To win applause and recognition, 
 But doing that which others do, 
 Beyond their range of competition." 
 
DRUGS USED. 3 QI 
 
 DRUGS USED. 
 
 As pure and reliable drugs are of necessity essential to 
 success, considerable care should be exercised in their selec- 
 tion. 
 
 When fluid extracts are purchased, original packages 
 should be secured if possible, and as all of the principal phar- 
 maceutical firms supply packages of as low as four ounces, 
 there is little excuse for using drugs of unknown or uncer- 
 tain quality. 
 
 Tinctures made from standardized or physiologically 
 tested extracts are entirely reliable. 
 
 Chemicals, especially those of a delicate or unstable 
 nature, should be selected with due regard as to their purity, 
 and deterioration guarded against. Those made by Merck, 
 Mallinckrodt or other reliable chemists are to be preferred 
 to the inferior commercial salts often found in the shops. 
 
 Carbolic acid, either Mallinckrodt's Gilt Label, or 
 Merck's Dry Crystals, is fully as effective and reliable as 
 Calvert's English product, and much less expensive. 
 
 Peroxide of Hydrogen is such an unstable and variable 
 article that specimens purchased in the open market are fre- 
 quently devoid of any cleansing or stimulating properties, or 
 may even be irritating and injurious. 
 
 Marchand's Hydrozone and Medicinal Peroxide of 
 Hydrogen, the former of thirty volumes and the latter of 
 fifteen volumes strength, are superior preparations and have 
 given me better results than any similar preparation. 
 
302 SECRET SYSTEMS EXPOSED. 
 
 SECRET SYSTEMS EXPOSED. 
 
 The Medical Profession has for all time past been con- 
 sidered somewhat of a "pasture green" for the scheming 
 individual representing a company who had a "Secret Sys- 
 tem" for sale. Many physicians have been severely imposed 
 upon by this smooth tongued gentry and have been induced 
 to pay exorbitant sums for the "secret" and the exclusive 
 right to use the same in a certain limited territory. Many of 
 these secret systems possess merit, and it is not on the 
 account of worthlessness or misrepresentation that objection 
 to this method of doing business is made, but on account of 
 the unreasonable fees which are asked for and received, being 
 in most cases prohibitive and practically limiting the field to 
 the few whose income warranted the outlay, and which there- 
 fore was already above the average. This method of fur- 
 nishing information is also not in accord with the broad spirit 
 of the medical profession, nor with the liberality which char- 
 acterized the fathers of medicine to whom we are all greatly 
 indebted. While a great deal of this sort of business was 
 carried on by personal representation, the advertising pages 
 of many medical journals carried advertisements bringing 
 secret systems of this class to the notice of the profession, 
 instances of which can probably be recalled by anyone. 
 Through the courtesy of a number of professional friends 
 and the outlay of considerable cash, the author is enabled 
 to place before the profession the majority of the better 
 known systems of this kind. That they possess some merit 
 is evident from their composition, whether to a greater or 
 lesser degree than many of the more familiar combinations of 
 remedial agents, depends perhaps on the degree of skill with" 
 which they are applied. 
 
SECRET SYSTEMS EXPOSED. 303 
 
 If their introduction here will assist in satisfying a 
 curiosity known to exist among medical men, and in a meas- 
 ure lift the sombre robe that clothes some of the secrets and 
 mysteries connected with the healing art, the objects for 
 doing so will have been accomplished. 
 
 The Triumph System of Treating Drug and 
 Other Addictions. 
 
 Several years ago a representative of this concern 
 located in Knoxville, Tenn., canvassed this and other states 
 in the interest of the following Secret Systems for the Treat- 
 ment of Drug and Other Addictions, which was sold to physi- 
 cians at figures varying from $10.00 cash to $50.00 or more 
 in installments and commissions. 
 
 This is a fair specimen of what is sold to physicians 
 under agreements of secrecy, although it must be acknowl- 
 edged that this system is somewhat above the average of 
 those usually offered. It is not very well adapted to the use 
 of the physician in general practice, but rather to those having 
 special facilities for the care and treatment of patients. 
 
 It must be borne in mind that no system or method of 
 treatment is so complete that it will yield perfect results in all 
 cases, nor so inflexible that no changes or variations may be 
 made to meet the indications present. In giving it here in 
 its most essential parts, I am not stamping it with my 
 approval, nor in fact the contrary, but more especially as an 
 addition to our information along these lines of practice. 
 The more general knowledge on these subjects at our com- 
 mand, the better are we able to successfully cope with the 
 various phases of drug, liquor and other addictions. 
 
304 SECRET SYSTEMS EXPOSED. 
 
 The following extract contains all the essentials of the 
 method. 
 
 THE WHISKEY CURE. 
 Injection Hypoclermatically. 
 
 I£ Strychnine Nitrate gr. 85-100 
 
 Atropine Sulphate gr. 40-100. 
 
 Sol. Boracic Acid 2 % fl. § j. 
 
 Mix. 
 
 Details. Take six two drachm vials, marked from No. 1 
 to No. 6, and into each of them put 100 minims of the above 
 formula. 
 
 Leave vial No. 1 as it is, without any additions. To 
 each of the others add nitrate of strychnine, in the form of 
 hypodermatic tablets, as follows : 
 
 To vial No. 2 add five 1-40 gr. tablets. 
 
 To vial No. 3 add ten 1-40 gr. tablets. 
 
 To vial No. 4 add twenty 1-40 gr. tablets. 
 
 To vial No. 5 add thirty 1-40 gr. tablets. 
 
 To vial No. 6 add forty 1-40 gr. tablets. 
 
 Commence the treatment with No. 1 and continue for 
 three or four days. If toxical effects are not produced try 
 vial No. 2 for three or four days, and so on with the other 
 numbers until you get the effect. 
 
 Or, you can work this way : one or two doses of No. 1, 
 then one or two doses of No. 3, then one or two doses of 
 No. 2, then one or two doses of No. 1, skipping backward 
 and forward this way. Do not use vial No. 5 and No. 6 
 until as a last resort as the best results are obtained by the 
 use of vials No. 1 to No. 4. If the toxic effect is not pro- 
 duced by the time No. 4 is reached, return again to No. 1 
 and proceed in same manner as before. Don't expect toxic 
 effect for four or five days, viz : twitching of the muscles, 
 stiffness of the jaws, dryness of the throat, etc. As soon as 
 you reach this point, go back to No. 1 and use that only. 
 You can maintain the toxic effect by using the weakest solu- 
 tion, and the least medicine given a patient is always best. 
 
SECRET SYSTEMS EXPOSED. 305 
 
 THE DOSE. The dose of each of these vials is five 
 minims, hypodermatically, and a dose should be given at 
 8 A. M., 12 M., and 4 and 8 P. M. Cards should be given 
 each patient with the number of vial and time marked 
 thereon. 
 
 On the fourth day of the treatment, ask your patient 
 if he has a desire for whiskey. Of course some will say 
 "yes." Don't be alarmed at this. Tell them that you don't 
 see how it is as you are sure the medicine has taken effect or 
 is about to do so as it usually does about this time. Then 
 tell them you want to see them take a drink so as to note 
 the effects, and send them out to purchase some whiskey, as 
 you don't want to furnish it to them, as they might think it 
 was drugged. This must be done at one of the regular 
 times for a hypodermatic injection, and in place of it you 
 will substitute 1-10 gr. Apomorphine, giving it immediately 
 before the whiskey. Repeat this once a day until the taste 
 and smell of whiskey is disgusting to them. 
 
 Never increase the dose of any one of the vials, on 
 account of the Atropine contained therein, but if a stronger 
 effect is required, pass from one vial to the other as directed. 
 
 Continue the regular treatment for three weeks or more 
 after the taste and smell of liquor is distasteful or disgusting 
 to the patient, according to the demands of each case. Cases 
 of Delirium Tremens can be best handled by using No. 1 
 vial with 1-250 gr. of Hydrobromate of Hyoscyamine added 
 to each dose. 
 
 WHISKEY TONIC. 
 
 ^ Acid Muriatic, Free C. P gr. 2048. 
 
 Calcium Phosphate gr. 768. 
 
 Magnesia Phosphate gr. 1024. 
 
 Hydrastis Canadensis gr. 256. 
 
 Quinine Muriate gr. 256. 
 
 Strychnine Nitrate gr. IOJ4- 
 
 Pulsatilla gr. 256. 
 
 Aromatic Menstrum q. s. ad. Cong. j. 
 
306 SECRET SYSTEMS EXPOSED. 
 
 Exhaust the Hydrastis and Pulsatilla with sufficient 
 dilute alcohol, add the other ingredients secundum artem, 
 and add an aromatic elixir to make one gallon. The finished 
 product should contain 20 % of alcohol. 
 
 Dose. One teaspoonful every four hours, to be taken 
 between the hypodermatic injections, at 6 and 10 A. M., 
 2, 6 and 10 P. M., if patient is awake first and last hour. 
 After the hypodermatic injections are discontinued, continue 
 the use of this tonic for a few weeks, twice a day, adding 
 1-60 grain Strychnine Nitrate to each teaspoonful. 
 
 Before starting the treatment, obtain the full consent 
 and confidence of the patient, and have him stop all work 
 and worry for a few days. This should be observed in the 
 treatment of all addictions. 
 
 The maximum doses must be reached gradually and 
 when the toxic effects become evident they should be reduced. 
 Should an antidote become necessary give plenty of whiskey 
 and chloral hydrate. It is always necessary to exercise good 
 judgment with patients, watching for idiosyncrasies and 
 observing the action of the heart, &c. Begin treatment with 
 caution, especially the nervous, weak and wornout patients. 
 When patients refuse liquor the Atropine in the injection may 
 be withdrawn, and 1-60 grain doses of Picrotoxine substi- 
 tuted. If this causes copious perspiration it should be with- 
 drawn. Warm baths should be taken every two or three 
 days. The bowels should be kept moving with calomel, 
 ipecac and soda. Small quantities of liquor may be given 
 patients the first day or two, but then should be discontinued. 
 
 Remarks. Some discretion should be used in the selec- 
 tion of whiskey patients. Examine each case closely before 
 treatment, especially the action of the heart and nervous 
 system that you may note with benefit to yourself the changes 
 that will be produced by the action of the remedies used. 
 Question them particularly as to why they drink, whether 
 for the love of the taste of it or for the effect produced. If 
 the former vou need not hesitate to take the case and guaran- 
 
SECRET SYSTEMS EXPOSED. 307 
 
 tee a cure, for you will make the taste and smell, even the 
 thought of it, disgusting to them. If they drink for the 
 effect, don't fail to give the treatment faithfully and don't 
 omit the apomorphine as directed, repeating each day until 
 the taste is gone and it becomes nauseating to them. Whether 
 they drink for the taste or effect, give the apomorphine as 
 directed. . 
 
 THE OPIUM AND MORPHINE CURE. 
 
 Hypodermatic Injection. Same as for whiskey, viz: 
 vials No. 1 to No. 6, given every four hours, adding to each 
 injection 1-200 grain of Hydrobromate of Hyoscyamine. 
 Continue from one to three weeks or longer as the case 
 demands. 
 
 Also, take Two Four ounce bottles and fill with the 
 Opium and Morphine Tonic, (see formula below) and num- 
 ber them No. 1 and No. 2. Bottle marked No. 1 is left as 
 it is, but to bottle No. 2 add three-fourths of the amount of 
 morphine taken by the patient in one day, either hypoder- 
 matically or by the mouth. 
 
 Give the patient a teaspoonful of No. 2 four times a day, 
 between the injections, and replace each dose taken from 
 No. 2 with one teaspoonful of No. 1. This is the best sys- 
 tem of gradual reduction that can be obtained. After 
 finishing these two bottles, continue the injections as before, 
 and the following 
 
 OPIUM AND MORPHINE TONIC. 
 
 ty Hydrastis Canadensis, 
 Avena Sativa, 
 
 Pulsatilla aa 5 viij. 
 
 Cinchona Rubrum 5 xv j ■ 
 
 Nux Vomica, 
 
 Xanthoxylum Berries aa % i j . 
 
 Powd. Capsicum % ss. 
 
 Dilute Alcohol q. s. 
 
 Aromatic Menstrum q. s. ad. Cong. j. 
 
308 SECRET SYSTEMS EXPOSED. 
 
 Exhaust the drugs by percolating with sufficient dilute 
 alcohol and add an aromatic elixir, to make one gallon. The 
 finished product should contain 20 % alcohol. 
 
 Dose. One teaspoonful every Four hours. 
 
 The morphine patient cannot be trusted and the attend- 
 ing physician and nurse should always be on the alert, 
 examining the pupils of the eye frequently. If you can keep 
 them without using the drug for a week you may be assured 
 of success. Tell them that you will reduce them gradually, 
 but do not tell them when you give them their last dose. 
 When the change is made from bottle No. 2 containing the 
 morphine, they will not know the difference but will think 
 they are taking another bottle of the same. Any emergencies 
 that may arise should be treated as in any other case. Never 
 increase the hypodermatic injections; if you want larger 
 doses pass from one vial to the other as directed. 
 
 TOBACCO CURE. 
 
 For the cure of the habit of either chewing or smoking- 
 tobacco we give the following formula : 
 
 I£ Hypodermatic solution, same as 
 
 in whiskey treatment 5 ^2. 
 
 Tr. Plantago Major 3 y^. 
 
 Tr. Avena Sativa 3 34. 
 
 Mix. Sig. Give three drops each time a person feels 
 like taking a chew or a smoke, and after each meal, asking 
 the patient to assist you by lessening the number of chews 
 or cigars each day. 
 
 Give also five minims from vials No. 1 to No. 4, hypo- 
 dermatically three times a day. In nine to fourteen days 
 the taste and smell of tobacco will become disgusting. Stop 
 the use of tobacco entirely and continue the use of the first 
 formula above mentioned by simply touching the tongue 
 with the solution whenever the desire comes on, if it does at 
 all, or three to six times a day for a while, even if no desire 
 is noticed. 
 
SECRET SYSTEMS EXPOSED. 309 
 
 The Whiskey Tonic may also be given for a week or 
 ten days, a teaspoonful three times a day. If after the ninth 
 day the patient still persists in chewing or smoking, give 
 1-10 grain apomorphine after a chew or a cigar, and con- 
 tinue this once a day, at the time for the regular injections. 
 
 CIGARETTE CURE. 
 
 Begin the treatment by giving hypodermatic injections 
 from vials No. 1 to No. 4 every four hours, adding to each 
 dose 1-40 grain of Picrotoxine. Continue this until patient 
 sweats copiously. Then have an attendant give the patient 
 a hot sponge bath, or steam, cooling him off gradually, with 
 a shower, rubbing until dry. 
 
 Use now the following formula hypodermatically, two 
 to' four times a day. 
 
 3$ Whiskey Injection fl. 3 ij. 
 
 Tr. Cannabis Indica TU v. 
 
 Mix. Sig. Five to ten minims hypodermatically, as 
 above directed, using your judgment in individualizing your 
 case, the dose to be used and the number of them per day. 
 Continue these injections at least three to four weeks. Give 
 also at the same time the following formula : 
 
 I£ Whiskey Tonic fl. 5 v. 
 
 Tr. Avena Sativa fl. § j. 
 
 Mix. Sig. One teaspoonful three to four times a day. 
 If patient becomes very nervous use the following formula : 
 
 J£ Thein, (Merck) gr. viij. 
 
 Acid Boracic gr. ij. 
 
 Aqua Destil fl. 5 j. 
 
 Mix. Sig. Inject from Five to Ten drops as often as 
 required, as your discretion indicates. 
 
 The hypodermatic injections are usually given at 8 A. 
 M., 12 M., and 4 and 8 P. M. The tonic at 6 A. M. and 
 between the injections. The number of cigarettes should be 
 decreased by 1-2 or 1-3 each day, and in four or five days 
 discontinue them entirely. If the patient stubbornly persists 
 
310 SECRET SYSTEMS EXPOSED. 
 
 in smoking give him the usual dose of Apomorphine 
 immediately after lighting a cigarette, and continue this 
 daily until he becomes disgusted with them. The entire 
 treatment should consume from four to six weeks. 
 
 REMARKS — The alkaloids mentioned in this system 
 can be purchased from first class drug houses, in hypoder- 
 matic tablets. No crude or commercial drugs, or tablets, 
 or triturations should ever be used hypodermatically. Sharp 
 & Dohme, of New York and Baltimore, are at present the 
 only house listing the Hydrobromate of Hyoscyamine. 
 
 The Keeley System. 
 
 The following formulae were given me by a physician 
 who was formerly employed in a Keeley Institute, with the 
 assurance that they are correct. The same formulae are 
 published in a small booklet published by a physician in the 
 West, which corroborates the statement made by the physi- 
 cian giving them to me. I give them here for what they 
 may be worth, assuming no responsibility for whatever 
 results may follow their use. 
 
 On entering the institute the patient is given a mixture 
 containing the following : 
 
 I? Gold and Sodium Chloride gr. xxx. 
 
 Strychnine Nitrate gr. iv. 
 
 Atropine Sulphate gr. j. 
 
 Glycerine fl . % ij. 
 
 Fl. Ext. Cinchona Comp . .q. s. ad. fl. 5 xv j- 
 
 Mix. Sig. One teaspoonful in water three times a day. 
 In addition to the above, the patient receives a hypoder- 
 matic injection of strychnine nitrate, in doses that will 
 produce its physiological effect. 1-60 grain additional will 
 usually be all that is required, but it can be used as necessary. 
 
SECRET SYSTEMS EXPOSED. 3 11 
 
 R Solution. 
 
 I£ Acid Boracic g r - iv - 
 
 Aqua Dest A. o ij- 
 
 Mix and bring to boiling point and add 
 
 Strychnine Nitrate gr. ss. 
 
 Cool and filter and bring up to 2 ounces by adding 
 Aqua Dest. Color red with Tr. Cudbear. Dose Five to 
 Ten minims hypodermatically. This is begun when patient 
 is sober and continued during the treatment. Give an injec- 
 tion every four hours. 
 
 T Solution. 
 
 ^ Acid Boracic gr- xx - 
 
 Aqua Destil A. 5 j. 
 
 Them Muriate gr. viij. 
 
 Mix. Filter. Bring the water and boracic acid to 
 boiling point before adding the Thein Muriate. 
 
 Dose. Five to Ten Minims every four hours, by hypo- 
 dermatic injection. This is the "sobering up" solution. 
 
 P. Solution. 
 
 3$ Pilocarpine Muriate gr- viij. 
 
 Acid Boracic gr- xx - 
 
 Aqua Destil A. o j- 
 
 Mix in same manner as previous solution. 
 Dose Five to Six minims. This is used in the tobacco 
 treatment, or to produce sweating at any time should the 
 skin become too dry. It causes some nausea. 
 
 M Solution. 
 
 Magendie's solution of Morphia. 
 For nervousness during liquor treatment, as necessary. 
 
 If the desire for liquor does not disappear in a few days, 
 atropine sulphate is given hypodermatically in sufficient 
 doses to produce its full physiological effect. 
 
312 SECRET SYSTEMS EXPOSED. 
 
 The strychnine solution is colored red, as shown in 
 formula ; the atropine solution is left colorless, solution 
 being made with distilled water ; the apomorphine solution is 
 kept in a blue bottle. When the patient's appetite for liquor 
 does not disappear, in connection with the strychnine and 
 atropine solutions, he receives in addition an injection from 
 the blue bottle. 
 
 In the language of the inmates of the institution, this 
 arrangement of the colors, red, white and blue, has been 
 termed the "barber pole" and whenever the apomorphine 
 solution was used, the patient was said to have received the 
 barber pole. 
 
 The formula of the apomorphine solution is as follows : 
 
 Add 1-20 grain Apomorphine to Eight minims of "T" 
 solution and Four minims of "R" solution. 
 
 Inject this hypodermatically and follow with a drink of 
 whiskey. 
 
 This will sicken them and will render the taste and 
 smell nauseating to them. Give this at a regular injection 
 hour. 
 
 When the desire foriiquor has been gone for several 
 days, the following internal treatment is gradually substi- 
 tuted for the first formula. They may be alternated for a 
 few days, before discontinuing the first formula entirely. 
 
 INTERNAL TREATMENT. 
 
 I£ Ext. Cinchona, solid gr. xl. 
 
 Grd. Gentian Root § ij. 
 
 Powd. Capsicum gr. xx. 
 
 Mix and boil in Four pints of water for Twenty min- 
 utes, and add 
 
 Glycerine fl. % iij. 
 
 Remove from the fire and add Grd. Bitter Orange Peel, 
 5 ss. Let stand until cool, and strain. Color with Caramel. 
 Sig. One teaspoonful every 2 hours in 1-2 glass of 
 water. 
 
SECRET SYSTEMS EXPOSED. 313 
 
 After cure, continue same four times a day for a few 
 weeks. 
 
 If patient wants whiskey, (first request) precede by a 
 full dose of Calomel. If he persists give 1-20 grain Apo- 
 morphine with each drink. 
 
 FOR ALCOHOLIC GASTRITIS. 
 
 J£ Pepsin Sacch gr. el. 
 
 Bismuth Sub Nitrate gr. c. 
 
 Powd. Capsicum gr. xx. 
 
 Mix. Ft. Pulv. No. xx. 
 Sig. One every four hours. 
 
 FOR NEURASTHENIA. 
 
 ^ Tr. Cinchona Rub fl. § ij. 
 
 Fl. Ext. Kola fl. I ij. 
 
 Fl. Ext. Scutellaria ' fl. § j. 
 
 Elixir Aromatic q. s. ad. fl. % vj. 
 
 Mix. Sig. One teaspoonful in 1-2 glass of water four 
 times a day. 
 
 Also "T" solution. Five to Seven minims four times a 
 day. 
 
 KEELEY TOBACCO TREATMENT. 
 
 Inject Three to Five minims of "P" solution every other 
 day, and Five to Seven minims of "T" solution four times 
 a day. Also the following formula: 
 
 I£ Fl. Ext. Calumba fl. 5 ss. 
 
 Tr. Quassia fl. % ss. 
 
 Sp. Vini Rect fl. § ss. 
 
 Aqua q. s. ad. fl. § iv. 
 
 Mix. Sig. One teaspoonful every two hours. 
 
3 14 SECRET SYSTEMS EXPOSED. 
 
 Tri-Elixiria. 
 
 As a treatment for drug addiction, more especially 
 opium and morphine, the Tri-Elixiria remedies have been 
 rather extensively advertised in medical periodicals, and on 
 this account inquiries as to their composition are occasionally 
 received. 
 
 Personally, knowledge of this treatment is limited to but 
 one patient who applied to me for treatment, after spending 
 some time at the sanatorium in Memphis, Tenn., where the 
 treatment was employed under the direction of those inter- 
 ested in its manufacture and sale. 
 
 This patient, a physician, coming to me for treatment 
 for a mild form of morphine addiction, is sufficient evidence 
 of the failure of the treatment through which he had just 
 passed. 
 
 In regard to Mandragora, the drug upon which they 
 seem to place chief reliance, the following comment is made, 
 quoted from the U. S. Dispensatory : "Mandragora is a per- 
 ennial European plant with a spindle-shaped root, which is 
 forked beneath, and is therefore compared with the human 
 figure. In ancient times, this root was supposed to possess 
 magical virtues, and was used as an amulet to promote 
 fecundity. It was much used by the ancients with a view 
 to its narcotic effects. It is unknown as a remedy in the U. 
 S." This last statement is open to question, as in Prof. 
 Waugh's excellent work, "The Treatment of The Sick," the 
 following statement is made: "Mandragorine (Alk.,) sup- 
 posed to be the active principle in the Keeley cure for alco- 
 holism. Dose : Gramme, 0.00025 ; grain, 1-250, cautiously 
 increased, hypodermically." Mandragorine is also mentioned 
 in an article written by Prof. Waugh in 1894, on the treat- 
 ment of alcoholism. He says "Decidedly, mandragorine 
 
SECRET SYSTEMS EXPOSED. 
 
 M5 
 
 excels atropine — the former being less unpleasant and more 
 efficient." 
 
 Mandragorine is the alkaloid of Mandragora Officinalis, 
 first isolated by Crouzel. It resembles atropine in its action 
 but it is not indentical with it. It dilates the pupil. 
 
 The literature of the company contains the statement 
 that in order that physicians may prescribe Tri-Elixiria 
 intelligently, the component parts of the remedy are made 
 known, and are as follows : The absence of the definite 
 quantity of "Mandragora Off.'*' in the formula, is, in the 
 light of the appended extract from the Alkaloidal Clinic, 
 quite significant. 
 
 The formula : 
 
 B 
 
 Rhubarb, (F. E.,) . . 
 
 
 TTl iv. 
 
 Prickley Ash, (F. E.,).... 
 
 TTl iv. 
 
 Colombo, (F. E.,) 
 
 TTL V. 
 
 Hops, (Elixir,) 
 
 
 TTL ix. 
 
 Lactucarium, (Elixir 
 
 ,) 
 
 TTl vj. 
 
 Celery, (Elixir,) .... 
 
 
 TTl viij. 
 
 Brew 
 
 
 TTl viij. 
 
 Gentian, (F. E.,) . . . 
 
 
 TTl v. 
 
 Scull Cap.', (F. E.,) . 
 
 
 Til iij- 
 
 Valerian, (F. E.,) . . . 
 
 
 TTl V. 
 
 Licorice, (F. E.,) . . . 
 
 
 TU "J- 
 
 Ammonia, (Mur.,) . . 
 
 
 g r - ij- 
 
 Hydrastia, (Mur.,) . 
 
 
 gr. 1-16 
 
 Mandragora Off. (E: 
 
 ct.,) . . . 
 
 . . .q. s. 
 
 Dose. One teaspoonful in 1-4 glass of water eight times 
 a day, for opium and its preparations, as Morphine. Lauda- 
 num, etc., and for other drug addictions. 
 
316 SECRET SYSTEMS EXPOSED. 
 
 The Mandragorine Fake. 
 
 The following- is clipped from the Alkaloidal Clinic : 
 
 We have received a number of requests for information 
 as to Mandragorine ; and as we are originally responsible for 
 the attention paid to this alkaloid, we herewith give some 
 pointers as to it. 
 
 Benjamin Ward Richardson made some experiments 
 with mandragorine and stated that there were certain differ- 
 ences between its action and that of atropine. A very acute 
 observer who had studied this matter while taking the Keeley 
 treatment for alcoholism came to the conclusion that man- 
 dragorine was the agent used hypodermically, as the effects 
 corresponded with those described by Richardson. Inquiry 
 failed to find any mandragorine in the country ; in fact the 
 only supply we could obtain was a small lot of the man- 
 dragora root discovered in a country drug store, from which 
 we had the alkaloid extracted and made up into tablets. This 
 we believe is the only mandragorine that has been in 
 America during the past ten years. 
 
 We corresponded with Merck in relation to a supply, but 
 found that it could only be obtained by special arrangement, 
 since there was no call for it and none was prepared for the 
 trade. This would run the cost into hundreds of dollars, 
 more than the importance of the article justified, especially 
 as mandragorine is simply a mixture of atropine and hyos- 
 cine, and not in fixed or invariable proportions. As it is an 
 easy matter to mix these agents to suit ourselves in prescrib- 
 ing, it did not seem advisable to import the "mandragorine." 
 In the mean time the matter has been taken up by a number 
 of the dealers in secret methods of treating alcohol and drug 
 habits, probably because the general and medical public 
 knows nothing about mandragorine and cannot procure it. 
 This offers the desirable situation of non-secrecy and impos- 
 sibility of obtaining a supply except through the exploiters; 
 and under this very ethical arrangement the usual morphine 
 may be dispensed as a cure for the morphine habit, cocaine 
 
SECRET SYSTEMS EXPOSED. 317 
 
 to cure the cocaine habit, alcohol to cure the whiskey 
 habit, etc. 
 
 If any one desires to use "mandragorine" he may give 
 hyoscine gr. 1-100 with atropine gr. 1-250, and he will have 
 it, without the expense. The advertisements tendering this 
 alkaloid are to be placed on a par with those offering "red 
 lava flower," "halish sativa," etc. 
 
 In order to learn whether any one was really buying 
 mandragorine, we wrote to the leading purveyors of alka- 
 loids, asking if they could supply it. We append the only 
 reply received. The deduction is obvious. 
 
 "New York, July 16th, 1903. 
 
 "We are in receipt of your favor of the nth inst., and in 
 reply would say that we are not in a position to furnish 
 mandragorine. In this connection we would mention that 
 some years ago a certain investigator believed he had dis- 
 covered in atropa mandragora a new alkaloid which he 
 named "mandragorine." Subsequent investigations, how- 
 ever, have proved this supposedly new alkaloid to be a mix- 
 ture in which hyoscyamine predominates — practically impure 
 hyoscyamine. Trusting that the above information will be 
 of interest to you, we are, 
 "Faithfully yours, 
 
 "Merck & Co." 
 
 The "Husa" Swindle. 
 
 A few years ago, the medical profession was considera- 
 bly interested in an article that was being widely quoted by 
 medical journals, regarding the discovery by a physician 
 from Texas, of a plant which had the power to neutralize the 
 poisons communicated to persons bitten by all kinds of 
 venomous serpents and reptiles, and which also enabled any 
 physician to cure the opium or morphine habit in short 
 
318 SECRET SYSTEMS EXPOSED. 
 
 order. This drug he called "Husa," and its origin was said 
 to be in the everglades of Florida. Samples of the crude 
 drug could not be obtained, but the doctor kindly consented 
 to supply a liquid preparation of it at a fancy price. The 
 interest manifested in it, culminated in a scientific investi- 
 gation, and analysis being made by Prof. John Uri Lloyd, 
 of Cincinnati, whose report was read at a joint meeting of 
 the Cincinnati Chemical Society, and the Cincinnati Academy 
 of Pharmacy, from which his deduction is quoted : "To sum 
 up, 'Husa' is a liquid containing large amounts of morphine 
 sulphate, some salicylic acid, some alcohol, water, glycerine 
 and coloring matter, probably burnt sugar. I would define 
 'Husa' as follows — A solution of morphine to be adminis- 
 tered under the name of 'Husa,' and only by physicians. It 
 is sold to physicians at the rate of ten dollars for about two 
 hundred and thirty-four grains of morphine. Until I am 
 furnished with a new plant, containing morphine to the 
 extent found in these experiments, I shall accept that 'Husa' 
 is a concoction." The medical profession has been imposed 
 upon so much, that, it is well to investigate closely all "new 
 and startling discoveries" before investing anything in them. 
 
 The Ideal Hernia Cure. 
 
 This treatment is at present being advertised in several 
 medical journals, the formula being a secret one. Physicians 
 desiring knowledge of the secret are obliged to send ten 
 dollars to the Ideal Chemical Co. of St. Paul, and in return 
 receive a small folder containing the formula and directions 
 for its use. together with a hypodermatic syringe. 
 
 The following extract from their pamphlet, kindly 
 loaned to me by one who purchased it from the above firm, 
 gives all the leading points of the treatment. It will be 
 noticed by all who are even only fairly informed on this 
 subject, that nothing new is offered. True, the formula 
 
SECRET SYSTEMS EXPOSED. 319 
 
 may differ from others, yet there are hundreds of compounds 
 that will cure hernia if properly injected. 
 
 I have investigated many of the secret methods adver- 
 tised to physicians and it is indeed seldom that anything is 
 offered that is new or original, or of any more advantage 
 to the physician than formulae and methods which are 
 published in practical medical journals and books on the 
 subjects. 
 
 Details of Treatment. The day previous to the operation, 
 administer a large dose of sulphate of magnesia, to thor- 
 oughly clean the intestinal tube. Everything being favorable, 
 place the patient in bed, having the head and shoulders low, 
 and the pelvis slightly raised. Explore the inguinal canal 
 and rings thoroughly and see that the hernia is completely 
 reduced. Now invaginate the scrotum with the forefinger 
 of the left hand and locate the external ring, then with the 
 thumb of the same hand press from above downward on the 
 integument directly over the external ring. The integument 
 and tissues being firmly held between the forefinger and 
 thumb, the needle is pressed down beside the thumb until 
 the point reaches just below and under the arch of the 
 external ring. The instrument is now lowered and the point 
 slipped under the arch of the external ring and passed up 
 the canal in the sub serous areolar tissue until it reaches the 
 internal ring. The fluid is then slowly distributed over the 
 interior of the canal and around the margins of the ring 
 as the instrument is withdrawn. 
 
 A compress is now applied over the side of the hernia 
 and a figure 8 bandage applied around the body and thigh 
 of the affected side, enjoining positive rest for two days. 
 From five to fifteen drops of the solution should be injected 
 at each treatment, and should be repeated once a week until 
 assured of the proper formation of plastic material to warrant 
 a permanent cure. The truss commonly used may be worn 
 during the interim. It is seldom necessary to give more 
 than six treatments to secure satisfactory results, and in 
 cases of children one or two treatments may be sufficient. 
 
320 SECRET SYSTEMS EXPOSED. 
 
 The formula is : 
 
 Glycerole of Tannic Acid grs. xc. 
 
 Glycerine fl. 5 j. 
 
 Mix. 
 
 Of this solution take two drachms, and add Alcohol, 
 one drachm, and Tr. Cantharides, one drachm. Mix all and 
 shake thoroughly. 
 
 Note. There is no official preparation known as 
 Glycerole of Tannic Acid, but the composition of Glycerite 
 of Tannic Acid is approximately 90 grs. to the ounce of 
 glycerine. The formula is obscure as written and appears 
 to be another example of non secrecy combined with 
 impossibility. — J. D. A. 
 
 Excelsior Hernia Fluid. 
 
 The following is the formula of the Excelsior fluid for 
 the treatment of hernia. It was formerly sold as a secret 
 formula, but like many others, was disclosed and given to 
 the profession. 
 
 I have not used this compound but would not hesitate 
 to do so. From its composition it evidently possesses merit. 
 
 1^ Sulphate of Zinc gr. x. 
 
 Carbolic Acid TT\, vj. 
 
 Guaiacol n\, xv. 
 
 Lloyd's Spec. Tr. Thuja 3 j. 
 
 Fid. Ext. White Oak 3 ij. 
 
 Oil of Cinnamon TTL ij. 
 
 Glycerine 3 ij. 
 
 Water q. s. ad. 5 j. 
 
 Mix. 
 
 Dissolve the sulphate of zinc in the water, add the 
 glycerine, carbolic acid, oil of cinnamon and guaiacol. Mix 
 thoroughly and add the remaining ingredients. Let stand 
 for a week, with frequent agitation, after which filter through 
 paper. 
 
SECRET SYSTEMS EXPOSED. 32 I 
 
 Dr. Coffevs System of Treating 
 
 Rectal Diseases. 
 
 The following set of formulae was kindly furnished me 
 by a physician located in the middle West, who informs me 
 that this secret system was sold throughout his section at 
 prices varying from $350 to $1200, under an agreement of 
 secrecy. 
 
 As quite a number of physicians have made inquiry 
 regarding this treatment. I am pleased to be able to furnish 
 the information desired. 
 Hemorrhoidal Fluid. 
 
 R Campho-Phenique 3 vj. 
 
 Naphthalin 5 j. 
 
 Morphia Sulph gr. x. 
 
 Pulv. Hydrastis gr. xl. 
 
 Acid Carbolic 3 iv. 
 
 Mix. Let stand ten days, then filter. 
 Sig. Inject four to six minims, according to size of 
 hemorrhoid. 
 
 For Healing Ulcers and Fistulae. 
 
 R Gum Camphor gr. xx. 
 
 Morphia Sulph gr. xx. 
 
 Xaphthalin gr. xx. 
 
 Pulv. Hydrastis gr. xl. 
 
 Acid Carbolic 3 iv. 
 
 Vaseline * ij . 
 
 Mix. Make an ointment. 
 
 Note. C Carbolic acid cannot be incorporated with vas- 
 eline in this proportion so as to remain in permanent sub- 
 division, but separation, due to crystalization, will take place. 
 Adeps lanum. fresh lard or suet should be substituted for 
 the vaseline. — J. D. A.) 
 
3^2 SECRET SYSTEMS EXPOSED. 
 
 For Healing After Piles Have Sloughed Off. 
 I* Linseed oil, 
 
 Sweet oil, 
 
 Rosin, 
 
 Mutton Tallow . aa § iv. 
 
 Yellow Wax % iij . 
 
 Mix by melting all together and strain through a thin 
 cloth, and stir until cool. 
 
 For "Ease" when piles are painful, Cocaine, two grains 
 to the ounce of vaseline, is recommended. 
 
 For Hemorrhage, the use of Monsell's Solution is 
 advised. 
 
 After injection of piles the tumors are painted with a 
 solution composed of eight grains of morphine, and one 
 ounce each of Tr. Opii and Olive oil. 
 
 THE SLANDAIS PILE TREATMENT. 
 
 Sold to the profession some years ago under an agree- 
 ment of secrecy. First, 
 
 I£ English Rosin i lb. 
 
 Creolin, 
 
 Oil Gaultheria aa fi . 3 iv. 
 
 Melt together and when cooling divide into blocks half 
 the size of a hen's egg. 
 
 Second. Add a tablespoonful of Sodium Biborate and 
 a teaspoonful of Carbolic Acid to three pints of water. Use 
 hot and bathe the pile tumors for ten minutes. 
 
 Third. After bathing the piles place a shovel full of 
 wood ashes into a chamber, also one block of the first named 
 remedy, and place a live coal against it. While it burns 
 have the patient sit on the chamber and allow the smoke to 
 come in direct contact with the piles. The medicinal prop- 
 erties are conveyed in the smoke. Repeat four or five times 
 in twenty- four hours, until cured. After bathing, dry the 
 piles before taking the smoke treatment. 
 
SECRET SYSTEMS EXPOSED. 323 
 
 The Brinkerhoff System. 
 For Piles and Other Rectal Diseases. 
 
 Hemorrhoidal Fluid. 
 
 This secret formula is frequently seen reported to be 
 one ounce of carbolic acid, eight grains of chloride of zinc 
 and five ounces of olive oil. Any one who has seen the 
 compound as prepared by its manufacturers, who still supply 
 it, knows that this is not the correct formula. By tests the 
 percentage of carbolic acid is evidently much larger, and 
 the oil used is undoubtedly sperm oil. 
 
 I obtained some of this fluid indirectly, several years 
 ago, and I noticed that it was slightly colored with per- 
 manganate of potassium. On standing for some time this 
 color fades, due to the oxidization which takes place. 
 Judging from its action when injected, and its action on 
 mucous membrane generally, it is probably a fifty to sixty- 
 five per cent solution of carbolic acid in sperm oil. The elder 
 Brinkerhoff had a formula patented which he claimed was 
 that of his pile injection, but this is a most glaring deception. 
 The following was taken from the records of the patent 
 office in Washington : 
 
 "Take a quantity of sperm oil, place it in a dish at a 
 temperature of twenty-four degrees F., and add strong 
 carbolic acid to the oil until white feathery crystals begin 
 to form, stirring all the while." 
 
 The impossibilities in these directions appear in every 
 line. 
 
 Sperm oil at twenty-four degrees F. is a solid body, 
 almost as hard as a stone, as is also pure carbolic acid. 
 
 If an acid were used in which a sufficient quantity of 
 water or glycerine was present to keep it liquid, it would 
 not mix with sperm oil at any temperature. The intent to 
 deceive is therefore apparent. 
 
324 SECRET SYSTEMS EXPOSED. 
 
 The following is his treatment for Fistula : 
 
 1^ Dist. Ext. Hamamelis fl. 5 v. 
 
 Liq. Ferri Subsulph fl. 3 j. 
 
 Acid Carbolic, Cryst gr. ij . 
 
 Glycerine fl. 5 ij . 
 
 Mix. For Fistula in ano inject ten to fifteen drops deep 
 into the fistula, and press the track of the fistula with the 
 finger to force the fluid in more deeply. 
 
 In cases of Rectal Ulcer he gives the following treat- 
 ment : To an ounce and a half of water add half a teaspoon- 
 ful of starch and half a teaspoonful of the formula above 
 given, and inject into the rectum every night. Sometimes 
 he orders an injection of starch into the rectum in the morn- 
 ing after the bowels have moved. 
 
 His system, as applied to Fissure of the Anus, is this : 
 Once or twice a month the ulcer is cleaned and a solution of 
 nitrate of silver, 40 grains to the ounce, is applied to it. 
 Between these treatments the patient uses a morning and 
 evening treatment himself. Each morning he is to evacuate 
 the bowels, then inject into the rectum luke warm water, and 
 afterwards insert a little ointment consisting of three grains 
 of carbolic acid and eight grains of sulphur to the ounce of 
 vaseline or lard. For evening treatment he uses the ulcer 
 treatment, in the manner above given under Rectal Ulcer. 
 
 Alternating with the above treatment for Fissure, he 
 applies the following ''Fissure Compound" : 
 
 B Ac. Carbolic 3 iv. 
 
 Oil Sweet Almonds 3 ij. 
 
 Mix. 
 
 Sig. Apply with cotton tipped probe, lightly along the 
 track of the fissure. 
 
SECRET SYSTEMS EXPOSED. 325 
 
 Dr. Armstrong's "Vril." 
 
 Also Known as Po-pi-na, Mastico, Golden Manna, and The 
 Great Cell Irritant. 
 The formula of this preparation is as follows, obtained 
 from the originator. It has been advertised for several years 
 in a number of medical journals, and is furnished on receipt 
 of two dollars. In his advertisements, Dr. Armstrong makes 
 some astonishing statements, and repeats them without 
 reserve in his letters to inquirers. 
 
 ^ Coarse Wheat Bran, browned O j. 
 
 Soluble Citrate of Iron o iij. 
 
 Sugar, granulated ij _n j- 
 
 Mix. Sig. One heaping teaspoonful morning, noon 
 and night. Best taken in milk or cream, q. s. 
 
 If patient is under forty-five years old and not very 
 feeble, give one and one-half teaspoonful doses. 
 
 The bran is to be browned in an oven same as coffee. 
 It must be moderately coarse. The coarse particles are best 
 obtained by sieving the fine particles out and using what 
 
 remains. 
 
 When extra cell irritation is desired, instead of the 
 citrate of iron, citrate of iron and ammonia may be used in 
 same quantity. The preparation is also made in the form 
 of small blocks, of which the following is the formula : 
 
 B Gum Tragacanth 5 j ■ 
 
 Citrate of iron and Ammon, 
 
 Tannin '■ • -aa 5 iij. 
 
 Light Brown Sugar o x ij- 
 
 Oil of Orange '. A. * ss. 
 
 Coarse Wheat Bran, browned O v. 
 
 Alcohol O j 
 
 Water q. s. 
 
 Place the Gum tragacanth in sufficient water to dissolve 
 
326 SECRET SYSTEMS- EXPOSED. 
 
 it so as to make the solution of the consistency of cream. 
 Add the iron and tannin to this and mix. Knead the bran 
 into this and make a mass, adding the alcohol in which the 
 oil of orange has been dissolved, with the sugar and sufficient 
 water to make a mass the consistence of dough. Roll out 
 the mass to the thickness of 1-4 to 1-3 inch and cut into 
 blocks one inch square. Dust with powdered sugar and 
 box. Dose, one to two. The bran must not be used fine, 
 nor made fine during manipulation. 
 
 Quoting from a letter written to me, the doctor says : 
 ''I enclose the formula which I used for many years. 
 I put it up in paper boxes, mahogany colored, with gilt 
 letters, as a great cure for consumption and all chronic 
 diseases. I always give other remedies with it but only for 
 appearance, as this formula does all the work. It irritates 
 the great lining of the alimentary canal. I have cured many 
 bed-fast, hopeless cases of consumption, too feeble to rise 
 up in bed, wasted to the greatest extreme, hectic, etc. In 
 many cases they would get out of bed in three to five days 
 and walk about the house and were cured in two or three 
 months. It loosens cough and rapidly builds up. The 
 feebler the patient, the more marked and rapid the gain. It 
 does not cure all cases of consumption, but vastly more 
 than all things known to science, so also with women and 
 children and all 'conditions of debility. I have known it to 
 cure a woman of cancer of the breast in twenty days. It 
 was an open, discharging, painful cancer. A young woman 
 with consumption had not raised her head from the pillow 
 for months, and had taken but three tablespoonfuls of food 
 in four days previous to taking this cell irritant, and in 
 seven days after beginning it, she went out riding and ate 
 three fair meals a day. In convalescence, after fevers or 
 child-birth, where the patient is low, with dry and black 
 tongue, it is grand. No matter what the disease, unless flux 
 or cancer of the stomach, instead of drugs which often kill, 
 give this and in most cases it will put them on their feet in 
 a few days. There is too much calomel and opium given 
 
SECRET SYSTEMS EXPOSED. 327 
 
 in states of low vitality; they destroy what little vitality 
 remains, Instead, this gives prodigious vigor so quickly. 
 
 "In many diseases apparently beyond the reach of human 
 skill, when all hope is gone, if the patient can swallow, give 
 this remedy and you will be astonished and delighted and 
 save many lives. In consumption, if the cough does not 
 yield to this remedy, give one drop of peppermint oil on 
 sugar, three times daily, before meals. In all cases except 
 consumption, use alternate extension and flexion of all the 
 muscles, ten minutes each day." 
 
 I have not used this compound, nor do I credit the 
 statements made in its favor. It is given here as a striking 
 example of the extraordinary claims that can be made for 
 a common remedy for the purpose of exciting interest and 
 promoting its sale. 
 
 A large illustrated circular, the size of a small news- 
 paper, accompanied these formulae, and contained many 
 beneficial results follow its use, I would be pleased to hear 
 of them.— T. D. A. 
 
3 2 9 
 
 GENITO - URINARY 
 SPECIALTIES. 
 
 Contributed By T. W. Williams, M. D., 
 Milwaukee, Wis. 
 
 NON SURGICAL TREATMENT OF THE PROSTATE. 
 
 Affections of the prostate are more common than is 
 generally supposed. I have frequently been consulted by 
 patients for supposed stricture, bladder or kidney troubles 
 which upon examination proved to be enlargement of the 
 prostate. In his "Clinical Lectures on Diseases of the Uri- 
 nary and Generative Organs," Sir Henry Thompson asserts 
 that a digital examination of men over fifty-five will disclose 
 the fact that at least one-third have more or less enlargement 
 of the prostate. It is, in fact, a disease almost peculiar to 
 middle and advanced life. 
 
 The points of special clinical importance in reference to 
 the anatomy of the prostate are, that when the fore finger 
 is introduced well up into the rectum the healthy prostate 
 is felt in the median anterior line as a body about one and 
 a half inches long and nearly as broad, lying about an inch 
 and a half beyond the internal sphincter ani. The vesiculae 
 seminales lie beyond it, with the vasa efferentia opening 
 into that portion of the urethra surrounded by it. In all 
 chronic urinary troubles the practitioner should not fail to 
 make a digital examination of the prostate, as it will often 
 yield valuable diagnostic indications. 
 
 The two principal factors in the production of pros- 
 tatic diseases are previous gonorrhoea and sexual abuse. 
 What Hufeland terms "moral onanism," or that continued 
 state of erethysm of the sexual system produced by the mind 
 
330 GENITO-URINARY. 
 
 dwelling upon lewd objects, — frequently prolonged excite- 
 ment of the organs without physiological gratification, — in 
 fact an)- cause inducing congestion or plethora of the gland, 
 lays the foundation for future chronic enlargement. Gon- 
 orrheal inflammation affects the prostate iri much the same 
 way that it does the testicle, but much more frequently, 
 although seldom recognized on account of its location. Con- 
 sequently those who have been much addicted to venereal 
 indulgence in their younger days, become the victims of 
 prostatic disease in later life. The hypertrophy may be 
 either acute or chronic. The acute form is usually a result 
 of extension of the urethral inflammation of gonorrhea and 
 need not engage our attention' for the purpose of this essay. 
 Chronic enlargement may be due to a simple increase in the 
 size of the gland, from previous inflammation, or congestion 
 from erotic excitement; or it may, and frequently does, 
 arise from scrofulous calcareous, or tubercular deposits in 
 its' substance ; and finally it may be due simply to growth 
 from increased nutrition following an increased blood sup- 
 ply, accompanied by narrowing of the return veins. After 
 death, in this latter form, an enlargement of the blood vessels 
 similar to that in abnormal growths, has been observed. We 
 are usually able, by careful investigation, to diagnose the par- 
 ticular form of enlargement with which we have to deal. 
 
 The degree of trouble arising from enlarged prostate 
 depends upon its character. The lateral lobes may be greatly 
 enlarged without producing much inconvenience; but even 
 £ ver)'' slight enlargement of the median lobe, forming as it 
 does the floor of the prostatic portion of the urethra, will 
 produce more or less urinary troubles. I have sometimes 
 found an enormous enlargement of the lateral lobes in 
 patients who had experienced hardly any symptoms refer- 
 able to the prostate ; but on the other hand I have frequently 
 had patients who had become regular "urinary cranks," in 
 whom the enlargement of the median lobe could scarcely be 
 detected by the most careful digital examination. The reason 
 is that the slightest elevation of the floor of the prostate acts 
 
PROSTATE)— DR. Wltl/IAMS. 33I 
 
 as a dam to hold the water back, necessitating stronger 
 expulsive efforts, and eventually more or less vesical tenes- 
 mus. 
 
 Most of the evils resulting from hypertrophy, as Dr. 
 Godlee has pointed out, "depend upon the fact that the 
 bladder is never emptied; it is essential, therefore, that the 
 patient's power in this respect should be ascertained with- 
 out delay by catheterization, and if it be discovered that a 
 certain amount of residual urine remains, he should be taught 
 to pass the instrument himself, and directed to do so once a 
 day. Secondly, cystitis has often been caused by setting up 
 putrefaction of the urine." Urinary retention is very apt to 
 produce cystitis, not only on account of decomposition of the 
 urine, but from infection conveyed into the bladder by cathe- 
 terization. The odor of the urine in chronic prostatic disease 
 is quite characteristic, on account of ammoniacal decomposi- 
 tion. 
 
 The prominent symptoms are: Difficulty in emptying 
 the bladder, the urine escaping in driblets ; a frequent desire 
 to pass water, especially nights and mornings ; the charactei 
 of the urine is usually unchanged, and there may be some 
 slight pain before passing it, but usually none afterwards. 
 These are the premonitory signs of hypertrophy; later, the 
 patient finds it difficult to hold water ; the desire to pass it is 
 imperative, and must be immediately attended to. It is no 
 unusual mistake for physicians whose attention has not been 
 particularly called to the subject to ascribe these symptoms 
 to bladder or kidney troubles and prescribe accordingly. 
 
 Chronic Prostatitis is one of the most frequent causes 
 of sexual and urinary troubles in men of all ages, particularly 
 between twenty-five and forty-five. Its symptoms resemble 
 those of stone in the bladder. These are : A frequent desire 
 to urinate, a feeling of weight and heat in the perineum, and 
 a pain extending the whole length of the passage. At times 
 a few drops of blood will follow the water, or the water will 
 be bloody from rupture of the peripheral vessels, and gener- 
 ally the patient suffers from frequent nocturnal emissions. 
 
33 2 GENITOURINARY. 
 
 The urine is cloudy, and deposits a muco-purulent mass 
 after standing awhile. It is frequently met with as a sequel 
 of gleet which has extended to the prostatic portion. There 
 is also more or less complaint in regard to the urine, which 
 feels hot, with a slight smarting or stinging sensation after 
 passing; and there is often a feeling as if the bladder was not 
 entirely evacuated, which is true, as a very slight enlarge- 
 ment of the floor or middle portion of the gland, as previously 
 remarked, interferes with the complete emptying of the blad- 
 der, and causes the last drop to dribble away after the stream 
 of urine has ceased. 
 
 Hyperaesthesia of the Prostate is a condition frequently 
 encountered among young and middle aged men. Its princi- 
 pal symptom is the oozing out of a thin transparent mucus, 
 resembling the white of an egg, sufficient to keep the meatus 
 moist and sticky. In traveling over the alkali plains some 
 years ago, I noticed that all the mares in the party suffered 
 from a similar discharge from drinking the alkaline waters, 
 and plains-men informed me that as a result of the continual 
 "spewing," they became weak and emaciated. The glairy, 
 mucous secretion that oozes out as a result of sexual desire 
 in both sexes, seems to be of the same character — a product 
 of the glands of Bartholine in the female, of the prostate in 
 men — seemingly a provision of nature for "oiling up the 
 machinery" preparatory to the first act in the transmission of 
 life. The discharge itself is quite innocent in character, being 
 simply an increased secretion of the gland ; but it is usually 
 very annoying, and alarms the patient who mistakes it for 
 seminal fluid. A peculiarity of prostatorrhea, as the trouble 
 is usually called, is that on straining at stool, large quantities 
 of this discharge will escape, amounting sometimes to a table- 
 spoonful or more. After prolonged ungratified sexual 
 excitiment, to which the trouble is almost wholly due, it will 
 mingle with the urine, sometimes to such an extent as to give 
 it a milky appearance. Such symptoms are very alarming 
 to the laity as a rule, and render them an easy prey for the 
 
PROSTATE — DR. WILLIAMS. 333 
 
 quack, who has no difficulty, usually, in convincing his vic- 
 tim that he is suffering from a bad case of spermatorrhea ; 
 and still less in speedily relieving him of it by the use of the 
 following injection, two or three times a day: 
 
 3£ Zinc sulphate gr. xv. 
 
 Morphine sulphate gr. ij- 
 
 Rose Water fl. o V J- 
 
 A small quantity of this solution, about a drachm, is to 
 be injected twice a day by the physician, with a small hard 
 rubber syringe having a silver nozzle long enough to reach 
 the prostate, drop by drop, the process taking about five 
 minutes. Or the bulb catheter syringe, described further on, 
 may be used. 
 
 Prostatorrhea, not being a germ disease, yields readily 
 to mild astringent washes, like the above, followed by a 
 urethral crayon of similar composition, with the addition of 
 hydrastis, once a day until the cure is complete. Give five 
 grains mono-bromid of camphor three times a day as an 
 antaphrodisiac. 
 
 Excellent results are obtained in prostatorrhea from 
 local applications of argyrol ointment, 30 grains to the ounce, 
 made with Williams' Urethral Applicateur, elsewhere 
 described. 
 
 Acute Congestion of the Prostate is an alarming acci- 
 dent of hypertrophy to which sufferers with the latter affec- 
 tion are subject as the result of indiscretions in diet, drink- 
 ing, exposure to cold, or other apparently trivial causes. 
 Its symptoms are: sudden and complete retention of urine, 
 accompanied by bloody urine. An increased temperature, 
 quick pulse, and more or less pain and uneasiness- in the 
 region of the bladder. If the urine is not speedily evacu- 
 ated through the catheter, putrefaction ensues, the tongue 
 becomes dry and covered with a brown coat, the pulse 
 becomes faster and weaker, and the patient sinks into a 
 typhoid condition, which may end fatally. Old men are 
 more liable to these attacks than young men. 
 
334 GENITOURINARY. 
 
 The treatment of such cases is conducted upon general 
 principles. A brisk saline cathartic should be administered 
 at once, (a teaspoonful each of Epsom and Glauber salts 
 dissolved in a glass of warm water is best), and a hypoder- 
 mic injection of ]/\ grain sulph. morphia, repeated if neces- 
 sary in half an hour, administered. Internally I give ^4 
 grain solid extract hyoscyamus, which has a special action 
 on the neck of the bladder, or its equivalent of the fluid 
 extract, or alkaloid, hyoscyamine, every hour until the 
 patient is brought under the influence of the combined 
 opiates, greatly facilitating the introduction of the soft 
 catheter. It is of the utmost importance to prevent decom- 
 position of the urine as the chief danger of congestion is due 
 to this cause. For this purpose, the urine must be evacuated 
 and the bladder washed out with an antiseptic alkaline solu- 
 tion. The following answers the purpose admirably : 
 
 R Sodium Carb 5 ij . 
 
 Acid Boracic 5 j . 
 
 Sodium Chorid 3 ij. 
 
 Aqua O ij. 
 
 M. Filter. 
 
 SPECIFIC TREATMENT. In the treatment of dis- 
 eases of the prostate gland, I have obtained the most satisfac- 
 tory results from the local application of medicaments 
 directly to the prostatic portion of the urethra. Practical 
 experience has demonstrated that the use of escharotics for 
 this purpose should be discouraged on account of their liabil- 
 ity to leave hardened cicatrices, which interfere with the 
 normal functions of the organs. The local treatment consists 
 of alterative and antiphlogistic applications directly to the 
 prostate by means of the Urethral Applicateur hereafter 
 described, once or twice a week, followed during the intervals 
 by the specific local and internal treatment, to be described 
 presently. As an antiphlogistic alterative application, I have 
 found nothing superior to the combination of Ung. hydrarg. 
 
PROSTATE- — DR. WIU<IAMS. 335 
 
 per nit. and cocaine. It is prepared by rubbing up ten grains 
 of cocaine with four ounces of the mercurial preparation. 
 
 I have used this preparation in my special practice for 
 a number of years with the most gratifying results. I employ 
 the Urethral Applicateur, charging the reservoir with the 
 particular ointment decided on for the case. [See note at the 
 end of this article] . 
 
 Passing the instrument down to the prostatic portion of 
 the urethra, the ointment is deposited by a turn of the screw 
 plunger. I then withdraw the instrument, and the patient 
 goes about his business, as the operation causes no suffering, 
 and only a slight smarting, which passes off in a few minutes. 
 I. repeat these operations about once a week, sometimes twice, 
 and it is seldom necessary to continue them longer than from 
 six to twelve weeks. The effect is not only gratifying, but 
 immediate. Patient and physician are not discouraged by 
 waiting too long for tangible results. I have often had 
 patients apply for treatment who had been under the care of 
 physicians of unquestionable skill for months without appre- 
 ciable benefit. In nearly all there was more or less trouble 
 of one kind or another with the urine. Yet frequently a 
 single application to the prostate has made a marked change 
 in lessening the urinary trouble, and checking seminal emis- 
 sions. 
 
 I follow the mercurial application in twenty-four or 
 thirty-six hours, with a local application of a fresh solution 
 of the adrenals of the sheep, (suprarenal capsules), every 
 other day, applying it with a catheter syringe, and also 
 administer a five grain tablet of desiccated suprarenals three 
 or four times a day, alternating it in most cases with a five 
 grain tablet of desiccated prostate gland, or thyreoid, if of 
 strumous origin, as explained later on. In using the adrenal 
 solution, all that is necessary is a urethral syringe, with a 
 silver nozzle of sufficient length to reach the bladder ; an 
 ordinary soft catheter with a bulb attached, like that of a 
 "dropper," but larger, answers every purpose. Such a 
 syringe is easily extemporized by cutting off half the nozzle 
 
33^ GENITOURINARY. 
 
 of a soft rubber ear syringe, inserting a piece of glass tube 
 and passing over this a soft catheter, about six inches long. 
 The catheter is carried down until it enters the bladder, 
 and then is withdrawn until its point lies midway the pros- 
 tatic portion of the urethra, and the solution, to the extent 
 of from thirty drops to a drachm, is pressed out into the 
 canal drop by drop, allowing time for complete saturation of 
 the canal, or from ten to fifteen minutes. This briefly out- 
 lines the specific treatment, which will afford speedy and 
 permanent relief in the large majority of all cases of genuine 
 prostatic diseases, whether the symptoms are due to hyper- 
 trophy, acute or chronic inflammation; otherwise the case is 
 handled on general principles, according to the indications 
 present, stimulating the liver, if inactive, and keeping the 
 bowels open at the same time with a teaspoonful of sodium 
 phosphate dissolved in a half pint or more of warm water 
 every night on retiring, and looking after the digestive 
 organs if impaired. Xo other laxative meets these indica- 
 tions in prostatic diseases quite as well as the phosphate of 
 soda. 
 
 In conjunction with the general course of treatment out- 
 lined above, I prescribe in most cases, rectal suppositories 
 and urethral crayons composed of one ounce each of Euro- 
 phen. Aristol and Sulphonal to 28 ounces of cocoa butter. 
 with 2 ounces beeswax to give the requisite degree of firm- 
 ness, moulded into 35 grain rectal cones and 15 grain crayons. 
 A crayon and a suppository are used alternately every 
 twelve hours, and give us the specific alterative effects of 
 these drugs on the enlarged gland, combined with an anal- 
 gesic effect without the disadvantages attendant upon the 
 local application of the original preparations of iodoform 
 and iodine. 
 
 K Cocoa Butter ( Huyler's") 5 xxviij. 
 
 Bee's Wax. white 5 ij. 
 
 Europhen. 
 
 Aristol, 
 
 Sulphonal aa 5 i. 
 
PROSTATE — DR. WILLIAMS. 337 
 
 Melt the cocoa butter in a water bath with the wax; 
 stir in the europhen, aristol and sulphonal ; stir until it cools 
 down to a point at which it begins to thicken but still runs 
 freely, and pour into suppository moulds of sufficient size 
 to form thirty-five to forty grain suppositories, and set on ice 
 to cool. When removed from the moulds, they are dusted 
 with lycopodium and each one is wrapped in waxed paper. 
 Keep in a cool place as they melt at body temperature. 
 
 The urethral crayons are moulded from the same mass, 
 with the addition of one-half ounce hydrastine hydrochlo- 
 rate (Merck) to the above quantity. The crayon moulds 
 are bored out so as to form crayons about three inches long, 
 three-sixteenths of an inch in diameter at the large end, 
 tapering to a point. The materials entering into them render 
 these suppositories and crayons quite expensive, but they 
 are indispensable in the specific treatment of prostatic dis- 
 eases. 
 
 The solution of the suprarenals of the sheep is pre- 
 pared by macerating six grains of the powdered desiccated 
 gland in a teaspoonful of distilled water for two minutes, 
 and straining. It should be prepared fresh for each case 
 and used immediately, as it deteriorates rapidly. When 
 properly prepared its immediate effect is to blanch red and 
 inflamed mucous membranes in one minute, as may be 
 witnessed in its application to the eye in conjuctivitis. 
 Applied every other day to the prostate gland, in conjunc- 
 tion with the other treatment given, the entire gland eventu- 
 ally shrinks, contracts and shrivels up, with a marked amel- 
 ioration of all the symptoms. 
 
 In all chronic cases of prostatic disease, the mucous 
 membrane of the bladder is in a condition of sub-acute 
 inflammation, with more or less urinary derangement, alka- 
 line or ammoniacal urine, etc. Diuretic treatment is very 
 important in such cases, not only on account of the urinary 
 trouble, but to keep the urine in an aseptic condition. Diu- 
 retic preparations with a special tendency to the bladder 
 should be used. For this purpose I employ the following 
 
33& GENITOURINARY. 
 
 tablet, which can be prepared as a special formula by any of 
 the manufacturing pharmacists. I may add that it is one of 
 the best all around "Kidney Pills" extant. 
 
 I£ Buchu, 
 
 Para-Formaldehyde, 
 Potassium Nitrate, 
 
 Triticum Repens aa gr. j . 
 
 Tr. Digitalis V(l j. 
 
 Oil Juniper TTt ss. 
 
 Mix. Ft. one coated tablet or pill. 
 
 Sig. One or two according to the exigencies of the 
 case, to be taken every four or six hours, with a glass of 
 water. 
 
 RECAPITULATION. 
 
 After the diagnosis of the case is established, the blad- 
 der having been evacuated and washed out if necessary, 
 apply the per nitrate ointment (Ung. Hydrarg. Nitratis, or 
 Citrine Oint. U. S. P.) at once and commence the internal 
 treatment. Direct the patient to commence immediately with 
 the rectal suppositories, using one by the bowel every night 
 at bedtime. The third day after the operation, he is to use 
 in addition, at bedtime, a urethral crayon, repeating it every 
 other night. Put him on the kidney pills at once and direct 
 him to use one of the adrenal, or one of the prostatic tablets, 
 between the times of taking the kidney pills, alternating 
 them, taking a prostatic tablet one time and an adrenal the 
 next. He should call the next day after the application of 
 the per nitrate ointment, for an application of the solution 
 of the suprarenals, and every other day thereafter. Once a 
 week will be often enough for the per nitrate applications. 
 
 If you have reasons to suspect that the hypertrophy is 
 of strumous origin, or that state of heredity predisposing to 
 goitre, enlarged glands of the neck, etc., substitute five 
 grain tablets of the thyreoid extract from the sheep, for the 
 desiccated prostate gland extract. It is your sheet anchor 
 
PROSTATE DR. WILLIAMS. T)39 
 
 in such cases, but quite useless in prostatic enlargements 
 from any other cause. All of the animal extracts used are 
 from the Armour laboratories. 
 
 This is the regular routine treatment, but the experi- 
 enced physician, taking it as a basis, will no doubt be able to 
 modify and vary it, according to the necessities and circum- 
 stances of each individual case. Specific instructions to 
 cover all possible points that may arise in practice would 
 swell this article to the proportion of a large volume. 
 
 This article does not include the surgical treatment of 
 the prostate gland, which should be a dernier ressort. After 
 all other means have failed, life may be prolonged in com- 
 parative comfort, even in men between sixty and seventy, 
 by extirpation of the gland. 
 
 This operation has been carried to such perfection in 
 late years, as to involve comparatively little danger of life. 
 I very much prefer the perineal route, as practiced by Dr. 
 Alexander, of New York, to the English supra-pubic opera- 
 tion. 
 
 Note. — In my article published in the second edition of 
 this work I advised the use of the Lallemande porte caus- 
 tique for making local applications to the prostate, but since 
 then I have perfected the urethral applicateur, which is much 
 to be preferred, and which is fully described in the following 
 chapter on, "A New Method of Treating Disease of the Male 
 Urethra." 
 
34° GENITOURINARY. 
 
 A NEW METHOD OF TREATING DISEASE OF THE 
 MALE URETHRA. 
 
 The paucity of suitable surgical appliances for treating 
 the male urethra has always been an obstacle to the advance 
 of genito-urinary surgery. Since Lallemande's port cans- 
 iique was brought to the attention of the profession in 1836, 
 there has been little substantial improvement along this line. 
 
 Lallemande's instrument consists of a catheter-like 
 canula, provided with a caustic carrier as its name implies, 
 in which was an elongated depression, or cup which could 
 be drawn into the canula covering, during its introduction, 
 and projected when the portion of the urethra was reached 
 which was to be operated on, and turned around once or 
 twice, so as to bring the caustic in contact with all parts of 
 the membrane. The cup was first filled with crystals of 
 silver nitrate and held over a spirit lamp until they were 
 fused into a solid mass. 
 
 With this caustic-carrier, Lallemande cauterized the 
 caput gallinaginis about once a week, and claimed for it the 
 most brilliant results in spermatorrhea and impotence. Sub- 
 sequently his instrument was adopted for other cauterant 
 applications to the deep urethra and prostate gland. A cer- 
 tain amount of tactile dexterity, acquired only by practice, is 
 required to handle the instrument successfully, and even 
 when this is acquired, it is rather difficult to limit the cauter- 
 ant action at will. 
 
 Other operators have failed to secure the wonderful 
 results obtained by Lallemande with his method, which is 
 possibly due to the fact that he, as the inventor of the 
 method, was an enthusiast unable to analyze results with 
 impartiality. Being also the only physician of renown in his 
 time who made a specialty of sexual weakness, as a natural 
 consequence, as Dr. Vecki remarks, people of the wealthy 
 
.MALE URETHRA DR. WILLIAMS. 34 l 
 
 class afflicted or imagining themselves afflicted with sexual 
 debility, flocked to him from far and near ; and as the larger 
 proportion of those seeking medical advice for functional 
 forms of this ailment are psychically impotent, it is possible 
 that Lallemande's fame, combined with the great renown of 
 his method, exerted a greater curative influence upon these 
 neurasthenics than his porte caustiquc. 
 
 The slow and painstaking physicians of Germany, dis- 
 appointed in being unable to secure Lallemande's brilliant 
 results, rejected his method entirely; nevertheless, most 
 genito-urinary surgeons admit the value of cauterization in 
 spermatorrhea and impotence due to organic changes in the 
 prostatic urethra, although we now possess a better instru- 
 ment than the porte caustique, in Williams' Urethral Appli- 
 cateur, and a superior agent to lunar caustic, in argyrol and 
 nitrate of mercury. Cauterization by Lallemande's method, 
 especially if unskillfully performed, was frequently followed 
 by dysuria and bloody urine for two or three days, and some- 
 times the inflammation was so intense as to render ice bags 
 to the perineum, dieting, bathing and a regular antiphlogistic 
 regimen necessary. With the pernitrate of mercury oint- 
 ment, as herein recommended, the pain is slight, lasting only 
 a tew minutes, and there is no dysuria after the first passage 
 of water; while an application of even a strong ointment of 
 the silver preparation known as argyrol, is absolutely pain- 
 less. 
 
 One serious objection to the application of solid sdver 
 nitrate to the ejaculatory ducts and colliculus seminalis, is 
 its tendency to form chemical combinations with the tissues, 
 and unless great care is exercised, it is liable to make too 
 deep a burn, which results in the formation of cicatrical tis- 
 sue. This accident produces a patulous condition of the 
 ducts, aggravating rather than removing spermatorrhoea. 
 
 I have met with very few cases in which protargol, or 
 some of the other silver preparations, or the ointment of 
 pernitrate of mercury, U. S. P., has not given equally sjood. 
 
342 GENITOURINARY. 
 
 if not better results than nitrate of silver, without its disad- 
 vantages. 
 
 I attribute this to the fact that the oleaginous nature of 
 the preparation limits its caustic action to the surface of the 
 tissues, which are usually, as shown by the endoscope, 
 in a hyperaemic, swollen or granular condition. By thus 
 acting upon the surface of the engorged tissue, its morbid 
 irritability is changed, and a healthy contraction excited in it 
 which causes it to empty itself, become paler, and retain 
 a tonic, energetic action until its normal condition is 
 restored by subsequent soothing, healing and astringent 
 applications. 
 
 I employ it almost exclusively in operations on the deep 
 uicthra. 
 
 The latest of these silver preparations, argyrol, contain- 
 ing 30 % of silver, bids fair to supersede all the others. A 
 10 % ointment of this preparation may be substituted for the 
 pernitrate of mercury ointment. Prepare as follows : 
 
 ^ Argyrol grs. xlviij . 
 
 Lanum 3 vj. 
 
 Olive Oil 3 ij. 
 
 Mix. Ft. Unguent. 
 
 I commenced using the pernitrate as a local antiphlogis- 
 tic and cauterant about 1882. [See the Therapeutic 
 Gazette, June, 1885]. At that time and until recently I used 
 Lallemande's porte caustique for making the application, by 
 filling the cap with the ointment instead of with fused silver 
 nitrate. The principal objection to the porte caustique for 
 this purpose is that it does not hold a sufficient quantity of 
 the ointment for the various purposes of such an instrument. 
 
 More recently, however, I devised a Urethral Appli- 
 cateur, which I have not only found very much better for 
 this purpose, but also for treating disease of the urethra 
 generally, enabling us to make any kind of medicinal appli- 
 cation to that canal as readily as if it were an external mem- 
 brane. 
 
MALE URETHRA DR. WILLIAMS. 
 
 343 
 
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 The instrument is represented by the subjoined cut. It 
 consists of a silver or heavily plated catheter-stem, about 
 seven inches long, closed at the distal extremity, and per- 
 forated with 1-32 holes, which screws into a hard-rubber 
 reservoir, or cup to contain the medicament. A hard-rubber 
 
344 GENITOURINARY. 
 
 plunger screws into the top of the reservoir and forces the 
 ointment through the catheter. It is introduced into the 
 urethra as far back as the neck of the bladder, so as to cover 
 the prostatic, or deep urethra and colliculus seminalis. While 
 steadying the instrument with the thumb and forefinger of 
 the left hand on the projecting rim of the reservoir, the 
 physician by making a turn of the screw plunger, causes the 
 extrusion of the medicament. The instrument is turned 
 around in the canal once or twice to spread the ointment 
 before withdrawing the catheter. 
 
 Cauterant, antiphlogistic, analgesic and astringent appli- 
 cations in the form of ointments, are readily applied to the 
 colliculus seminalis and deep urethra, in chronic urethritis, 
 stricture, gleet, spermatorrhea, premature emissio seminis in 
 coitus, dribbling of urine from loss of contractility of the 
 canal, prostatitis, etc. For cauterizing the ejacnlatory ducts 
 and caput gallinaginis, it is preferable to Lallemande's porte 
 caustique. Acute gonorrhoea and non-specific urethritis can 
 be most effectually treated by first deadening the sensitive- 
 ness of the canal by injecting a few drops of a one or two 
 per cent, solution of Beta-eucaine or cocaine, then passing 
 the catheter stem, anointed with carbolized sweet oil, down 
 to the prostate, and extruding the medicament as the instru- 
 ment is slowly withdrawn, thus spreading it over the entire 
 urethral surface. This not only brings it in contact with 
 every part of the affected membrane, for a longer time than 
 injections, but keeps the inflamed, granulated, mattering 
 surfaces separated. — a sine qua non in facilitating the healing 
 process. 
 
 The Applicateur gives much better results in urethral 
 disease than injections or crayons. With it we can accom- 
 plish more in chronic cases in three or four weeks, than we 
 can by the ordinary methods in vogue in as many months. 
 It affords a wide choice of remedial agents. There is 
 scarcely any cauterant. antiphlogistic, analgesic, astringent, 
 stimulant or healing application that we cannot administer to 
 die urethra as readilv as if it were situated externally. Ung. 
 
MALE URETHRA DR. WILLIAMS. 345 
 
 hydrarg. nitrat., (preferable as a cauterant to nitrate silver), 
 Ung. hydrarg., oxide of zinc, subnitrate of bismuth, bole 
 Armenian (supposed to be the basis of "Injection Brou," 
 and to act by depositing an astringent earthy sediment on the 
 canal which keeps its folds separated), hydrastis, cocaine, 
 morphia, sulphate of zinc, adrenalin chloride, (i-iooo) aris- 
 tol, iodoform, iodine, salol, ichthyol, protargol,— in fact any 
 and all of the ingredients usually employed in the numerous 
 urethral crayons on the market, can be more effectually and 
 safely applied with this instrument in the form of oint- 
 ments, using lantim (Merck) and olive oil, Ya of the former 
 to Y A of the latter, as a vehicle,' the adhesiveness of which 
 retains the remedy in direct contact with the diseased mem- 
 brane for a long time, during which the latter is separated 
 and distended, affording the best opportunity for the exer- 
 cise of its gonococicide properties. 
 
 In the treatment of Stricture of the Urethra, also, the 
 Applicateur furnishes a valuable addition to the genito- 
 urinary surgeon's armenatarium. I have observed that if the 
 applications of the Ung. hydrarg. pernit. are repeated every 
 other day for a while, the patient begins to pass numerous 
 shreds in the urine, caused by the deadening and peeling off 
 of the epithelial layer of the mucous membrane. In a few 
 instances complete casts of the prostatic urethra have been 
 "shed" in this way, much to the alarm of the patient. Thus 
 it is possible with this instrument to repair a diseased urethra 
 by giving it a new lining, as it were, and to enlarge the 
 calibre of a strictured portion, not only by the absorption of 
 the layer of organized lymph deposited beneath its surface, 
 but also by repeatedly reaming out the passage, so to speak, 
 by causing the disorganization of one almost imperceptible 
 layer of tissue after another. In none of my cases, so far, 
 have I observed the least untoward result from this process. 
 
 By turning the Applicateur around once or twice, and 
 giving the screw plunger a backward turn, the little ointment 
 remaining on the tube will never noticeably affect the anterior 
 passage. 
 
34-6 GENITOURINARY. 
 
 Lavage of the urethra with water as hot as it can be 
 borne, impregnated with some mild antiseptic, before using 
 the Applicateur, is good practice, especially in acute cases. 
 The deeper creases and mucous cavities are thus thoroughly 
 cleansed and the ointment has a more direct action. The 
 catheter stem of the Applicateur, attached to a rubber bulb, 
 makes a good syringe for urethral lavage. Fill the bulb, 
 pass the stem down to the neck of the bladder, and slowly 
 inject the water which wells up around the stem and flows 
 out at the meatus. Repeat the operation several times. 
 Avoid injecting the bladder, but should some of the fluid 
 enter it, it will do no particular harm ; there is, however, no 
 danger of this, unless the stem is carried too deep. 
 
 I will add a few approved formulae of the different 
 ointments which I have found best adapted for the purposes 
 indicated. 
 
 FORMULAE. 
 
 No. i. K Ung. hydrarg. nitrat. U. S. P. . 5 j. 
 
 Cocaine, 
 
 Morphia sulph aa. gr. ij. 
 
 Mix and rub together thoroughly in a glass mortar. 
 Preferable to nitrate silver as a cauterant of the ejaculatory 
 ducts and colliculus seminalis in spermatorrhea, impotence 
 and chronic urethritis, with premature emission in coitus, 
 dribbling of urine, frequent desire to urinate, etc. 
 
 No. 2. 1^ Beechwood creosote fl. 3 ss. 
 
 Lanum (Merck) 3 vj. 
 
 Olive oil 5 ij. 
 
 Morphia sulph gr. ij. 
 
 Mix. 
 
 In gleet, urethral ulcers and chronic urethral troubles. 
 
 No. 3. 1? Ung. hydrarg, U. S. P. 
 
 Ung. bismuth oxide aa § ss. 
 
 Morphia sulph gr. ij. 
 
 Mix. In gonorrhea and gleet. 
 
FORMULAE — DR. WILLIAMS. 347 
 
 No. 4. I? Fl. Ext. Belladonna, 
 
 Fl. Ext. Hyoscyamus aa 3 ss. 
 
 Olive oil 5 ij- 
 
 Lanum (Merck) o vj. 
 
 Mix. In chordee, tenesmus urina, and dysuria. 
 
 No. 5. ty Iodine gr. xx. 
 
 Alcohol A- 3 ss - 
 
 Glycerine A- ^ ij- 
 
 Lanum (Merck) o ]■ 
 
 Mix. Rub the iodine first with alcohol and glycerine, 
 and then with the wool fat until thoroughly mixed. 
 In hypertrophy of the prostate, as a resolvent. 
 
 No. 6. 1^ Pyoktanin (Blue) gr. x. 
 
 Lanum (Merck) 5 vj. 
 
 Olive oil 5 ij. 
 
 Mix. In acute and sub-acute gonorrhea. 
 
 No. 7. fy Largin (Merck) gr. xx-xxx. 
 
 Lanum (Merck) 5 vj. 
 
 Olive oil 5 ij. 
 
 Mix. Twice daily in acute and sub-acute gonorrhea. 
 
 No. 8. Iy Ichthargan (Merck) gr. ss. 
 
 Glycerin 3 ij. 
 
 Lanum (Merck) 3 vj. 
 
 Mix. Twice daily in acute and sub-acute gonorrhea. 
 
 Nos. 6, 7 and 8 should not be exposed to the light. 
 
 * 
 
 No. 9. ty Zinc Sulphate gr. ij. 
 
 Lead acetate gr. iv. 
 
 Bole Armenian gr. viij. 
 
 Morphia sulph gr. ij. 
 
 Glycerine 5 ij. 
 
 Lanum (Merck) 5 vj. 
 
 Mix. An excellent application in sub-acute gonorrhea, 
 after subsidence of the inflammatory stage, twice daily. 
 
34& GENITOURINARY. 
 
 No. 10. K Thiosinamine (Merck) gr. xx. 
 
 Ether, sulphuric q. s. 
 
 Glycerin 5 i j . 
 
 Lanum (Merck) 5 vj. 
 
 Add sufficient ether to the thiosinamine to dissolve it, 
 and rub with the glycerin and purified wool fat until thor- 
 oughly mixed. 
 
 Used as a local application every two or three days, as a 
 resolvent in stricture and hypertrophy of the prostate gland. 
 
 All urethral troubles progress more satisfactorily when 
 some suitable internal treatment is combined with the local 
 applications. In gonorrhea and gleet and their sequelae, I 
 have never found anything to equal a capsule of sandal oil, 
 oil of cubebs, gurjun balsam, and benzoic acid, one or two 
 to be taken three or four times a day. It is a good plan to 
 take a digestive tablet in connection with these, or any oily 
 capsules, as it aids their digestion and absorption. The 
 digestive, pepsin, is too bulky for incorporation into the cap- 
 sule. 
 
 These capsules can be prepared by any competent phar- 
 macist, or in quantity by manufacturing pharmacists. 
 
 As Varicocele, Hydrocele and Hemorrhoids are fre- 
 quently associated with Urethral and Prostatic diseases, and 
 indeed often exist as causal complications, a brief consid- 
 eration of these abnormalities will not be out of order. 
 Beginning with Varicocele, Hydrocele and Hemorrhoids will 
 follow in order. 
 
VARICOCELE — DR. WILLIAMS. 349 
 
 VARICOCELE. 
 
 This is one of the most frequent causal complications of 
 spermatorrhea and impotence with which we have to deal. 
 
 Varicocele is a dilated and torturous state of the sper- 
 matic veins. It generally occurs in the young, and is almost 
 always confined to the left side, because the left vein is larger 
 than the right, and more indirect in its course ; but mainly 
 because it opens into the renal vein at a right angle, thus 
 preventing a free flow of the blood. Whatever may be the 
 cause, the fact is that the walls of these veins give way, 
 become relaxed, as it were, and distended, bulging out in 
 places into little pouches, giving the vessels, when full of 
 blood, a knotty appearance. The whole vein, in old cases, 
 is dilated, enlarged, tortuous, cordy and knotty, feeling when 
 taken in hand like a bundle of angle worms. The disease 
 is one very prevalent, and although it has been known to 
 exist for years without any serious results, in the majority 
 of instances it results in wasting of the testicle, spermator- 
 rhea and impotence, and sooner or later impairs the general 
 health by nervous irritation, inducing dyspepsia, dragging 
 sensations in the groins, lumbago, pain in the back, general 
 depression of the system, despondency, gloomy forebodings, 
 etc. The irritation produced in the generative organs by 
 variococele acts as both an exciting and continuing cause of 
 spermatorrhea, and retards its cure. If the disease is only 
 slight, and does not affect the general health, it will usually be 
 sufficient to use such palliative treatment as may be necessary 
 to relieve the weight and dragging sensations and produce 
 contraction of the enlarged veins. 
 
 This consists in wearing a pelvic appliance constructed 
 on the principle of an elastic truss, with two soft pads to 
 
350 GENITO-URINARY. 
 
 exert a moderate pressure upon the cords at the external 
 abdominal ring, and thus relieve the weight of the superin- 
 cumbent column of blood. We do not expect to effect 
 a radical cure of the varicocele in this way, but to overcome 
 its annoying symptoms, so that it shall not interfere with the 
 cure of the seminal trouble invariably associated with it. 
 
 The only radical cure, however, for varicocele, is by a 
 slight operation, which consists of ligating the diseased 
 veins. This is done subcutaneously, without the loss of a 
 drop of blood, and without interfering with the spermatic 
 artery or vas deferens, or injuring the testicle itself. I have 
 operated upon several hundred cases with the best results, 
 a permanent cure being affected in five days, during which 
 time the patient has to remain under the doctor's care, 
 although not confined to bed. 
 
 The technique of the operation is as follows : Grasp the 
 scrotum on the affected side, the patient standing, and care- 
 fully separate the varicose veins from the artery and vas 
 deferens, with the balls of the fingers, pushing the vas 
 deferens, which is easily distinguished by its hard, cordy 
 feel, and the artery, recognized by its pulsations, inwardly, 
 and keeping them separated by the thumb and finger of the 
 left hand. Then pass a curved needle, threaded with a 
 strong silk cord through the scrotum, between the vein and 
 the separated vas and artery, and draw the ligature through. 
 
 The hold on the scrotum is now removed and the 
 patient directed to lie on the operating chair. Then by taking 
 the scrotum in the hands, leaving the ligature in the wound, 
 you can bring the openings on each side of the scrotum, 
 through which the needle passed, exactly opposite each other. 
 Then pass the needle back from behind forward, through the 
 same holes, but the needle, which should be curved, is made 
 to return on the opposite side of the veins to that traversed 
 in its first passage, which encloses the veins in a loop, where 
 it is drawn through. The two ends of the cords are now 
 tied firmiv with a single knot, and then tied in a tight double 
 knot over a cork, and the operation is complete. The pain is 
 
varicocele; — dr. wiujams. 351 
 
 sharp and sudden, but only for a few seconds, as the parts 
 are speedily deadened, and the use of chloroform is unneces- 
 sary, and even objectionable, its after effects being more dis- 
 agreeable than those of the operation. The point of ligation 
 is about two-thirds the length of the scrotum from the bot- 
 tom ; i. e., at the bottom of the upper third of the bag. 
 
 I am in the habit of having patients come to my office 
 for the operation, and returning home. They are directed 
 to keep quiet, but are not confined to the bed. On the fifth 
 day, by which time there is thorough union of the inner coats 
 of the veins at the point of ligation, effecting occlusion of the 
 mass of veins; the ligature is removed, and the wound 
 dressed with antiseptic gauze. The operation is followed by 
 some swelling and soreness of the testicle, for which nothing 
 more is required than a cooling lead and laudanum lotion, 
 but care must be exercised that the bowels are kept open 
 daily with some saline laxative. Complete absorption 
 of the mass is effected in about a month, during which 
 time a suspensory is worn. Great care must be used not to 
 include either the artery or vas deferens in the ligature. This 
 has happened to me once or twice with the result of final 
 atrophy of the testicle. 
 
 This operation effects a complete and radical cure of 
 the varicocele, and it is often advisable for its psychical effect 
 upon the patient, aside from any absolute surgical necessity. 
 Patients with varicocele .are generally monomaniacs on the 
 subject, and are reduced to a state of hypochondria by worry- 
 ing about their condition. The moment they are operated on 
 they drop this pall of gloom and anxiety like an acursed 
 mantle and regain their natural moods. I have had them 
 come hundreds of miles, fully determined to submit to cas- 
 tration ; but after being operated on for varicocele, they 
 would return in that normal state of mind that impels a man 
 to matrimony. 
 
 The mere occlusion of the varicose veins does not, how- 
 ever, remove the relaxed and elongated scrotum. To effect 
 
352 GENITOURINARY. 
 
 this very desirable object and avoid the necessity of wearing 
 a suspensory, the following extension of the operation is 
 employed. 
 
 After having separated the varicose veins from the rest 
 of the cord, as already described, and passing the ligature 
 through the scrotum, the latter is slit up in front about one 
 and a half inches above, and the same distance below the 
 puncture laying open the tunica vaginalis testis and exposing 
 the cord. Or this may be done first, and the veins isolated 
 and ligated afterwards. This method is best with inexperi- 
 enced operators, as they can then more easily separate the 
 veins. I, however, prefer separating them first. The lower 
 end of the slit is then brought up and attached to the upper 
 end of the slit, by a suture; the slit then appears to run 
 horizontally across the scrotum, instead of perpendicularly. 
 The cut edges of the wound are next united by interrupted 
 sutures, and the ends of the ligating cord brought outside and 
 left about three inches long. This has the effect of shortening 
 the scrotum, so that it forms a natural suspensory for the 
 testicles. As in the former operation, the sutures and cord 
 are removed from the fifth to the sixth day, according to the 
 condition of adhesion. Neither operation is attended with 
 any special danger or serious after effects, if properly per- 
 formed, and gives that perfect satisfaction accorded all suc- 
 cessful surgical procedures. 
 
HYDROCELE — DR. WILLIAMS. 353 
 
 HYDROCELE. 
 An Occasional Complication of Sexual Debility. 
 This is one of those nondescript diseases that comes, no 
 man knoweth whence. It is simply an accumulation of 
 serous fluid in the tunica vaginalis and its treatment is so 
 simple that it scarcely rises to the dignity of a specialty. In 
 fact, all that is necessary is to evacuate the fluid, of which 
 there is usually ten or twelve ounces, with a trocar, and, 
 after withdrawing the trocar, inject into the sac, through 
 the canula, an irritating fluid that will set up sufficient 
 inflammation to destroy the secreting function of the mem- 
 brane. For this purpose a variety of substances, from milk 
 or salt water, to iodine and carbolic acid, have been success- 
 fully employed. Iodine seems to be the favorite with most 
 surgeons, from a half drachm to a drachm, mixed with an 
 equal quantity of alcohol or water being thrown into the 
 sac. But in my experience it often fails to cure, especially 
 in old cases, with thickened membrane. Any of the hernial 
 fluids may be used in the same way. Whatever fluid is 
 employed, after injecting, the bag should be taken between 
 the hands and massaged, as a washerwoman would wash a 
 dishcloth, to bring the fluid in contact with all parts of the 
 membrane. The operation is followed by considerable swell- 
 ing and soreness for a week or ten days, the more the better, 
 and after it subsides, the cure is usually complete. How- 
 ever, if the fluid accumulates again, the operation must be 
 repeated. The formula which follows is one of the most 
 satisfactory fluids for hydrocele, for the reason that it pro- 
 duces little or no pain at the time of the injection, although 
 it gets in its work about the third day. 
 1$ Guaiacol, 
 
 Creosote aa. TH, i j . 
 
 Zinc Sulphate gr. ij. 
 
 Ext. Hamamelis, Dist, 
 
 Glycerine, C. P aa fl. 3 j. 
 
 M. Sig. After evacuating, inject into the sac, and 
 
354 GENITOURINARY. 
 
 knead the scrotum between the knuckles so as to ensure its 
 reaching the upper part of the cavity. The following for- 
 mula is a good one, in my experience. 
 
 I£ Carbolic Acid n\ xc. 
 
 Ext. Hamamelis, Dist., 
 
 Distilled water aa fl. 5 vj. 
 
 M . Sig. Of this mixture take 20 minims ; tinct. iodine, 
 20 minims ; fluid extract, quercus alba, 20 minims ; glycerine, 
 20 minims; distilled water sufficient to make 4 drachms. 
 Inject the whole of it into the sac, massage, and squeeze it 
 out. 
 
 The after treatment consists simply in keeping quiet a 
 few days, and suspending the scrotum until the swelling and 
 soreness subside. 
 
 HEMORRHOIDS. 
 
 This subject is considered here by reason of the frequent 
 association of hemorrhoids with sexual debility as a compli- 
 cation, and a frequent cause of spermatorrhea from trans- 
 mitted irritation. For this reason they frequently require 
 the attention of the Genito-Urinary specialist. 
 
 Much has been written in medical books about the 
 causes of hemorrhoids; biologists assert that it is a weak 
 spot left in the evolution of man from a four footed animal, 
 and that it never occurs among the lower animals, — the 
 lapsus natura consisting in the fact that the superior hemor- 
 rhoidal veins become constricted where they pass through 
 slits or openings in the muscular wall, obstructing the pas- 
 sage of the blood, etc. It is true that hemorrhoids frequently 
 result from mechanical pressure on the veins, as in preg- 
 nancy ; but it is incorrect to say that constipation is one of 
 the most prolific causes of hemorrhoids. Constipation rarely 
 
HEMORRHOIDS DR. WILLI AMS. 
 
 355 
 
 produces hemorrhoids, which are the direct result of obstruc- 
 tion of the portal circulation, of which constipation, as well 
 as piles, is a symptom. The congestion and torpidity of the 
 biliary circulation which causes constipation also causes piles 
 by damming up and obstructing the passage of the blood 
 through the hemorrhoidal veins. 
 
 If my theory is correct, that hemorrhoids are simply a 
 painful manifestation of obstruction located in the portal 
 system, there is never any actual necessity for operating, 
 although the relief is more prompt if we open the largest of 
 the tumors and turn out the clot of black blood we shall find 
 there in external and constricted internal piles. 
 
 "A Bad Case of Piles." 
 
 In this illustration eight tumors 
 are shown in a cluster around the 
 anus. Usually, however, there are 
 not more than two or three. 
 
 TREATMENT. 
 
 The quickest and easiest method of getting rid of hem- 
 orrhoids is a slight operation which I prefer to the injection 
 treatment. 
 
 My method is as follows : Apply a piece of cotton satu- 
 rated with a io % solution of eucaine or cocaine to the tumor 
 
356 GENITOURINARY. 
 
 until its sensibility is deadened. Now slit up a few of the 
 largest tumors with a lancet and turn the clot out; then 
 swab out with equal parts of 95 % carbolic acid and glycer- 
 ite of tannin; follow this with an alcohol swabbing; apply 
 a sterile pad of cotton or gauze, kept in place by a T bandage. 
 
 For the purpose of destroying sensibility, the following 
 modification of Schleich's infiltration anesthetic solution' 
 which can be injected around and over the tumor, will per- 
 fectly anesthetize the part and any amount of manipulation 
 or cutting can be done without inflicting the least pain. 
 
 U Cocaine Hydrochlorate gr. iss. 
 
 Morphine Sulphate gr. ss. 
 
 Sodium Chloride gr. iij. 
 
 Acid Boracic gr. v. 
 
 Aqua Destil fl. 5 iiiss. 
 
 Mix. 
 
 In using this and similar solutions, remember that it is 
 not to be injected under the skin, but into the skin, just 
 below the epidermis. Less than a minim of the fluid so 
 injected produces a white welt, about ^4 i ncn i n diameter, 
 which indicates complete anesthesia of the part thus 
 blanched. Injections are continued until the surface to be 
 operated upon is entirely devoid of sensibility. If thrown 
 into the skin, where the peripheral sensory nerves terminate, 
 they are immediately paralyzed by absorbing it. 
 
 Twelve hours before the operation, administer one to 
 two teaspoonfuls of sodium phosphate in a pint of warm 
 water so as to move the bowels freely before operating. 
 Proper antiseptic precautions are to be used throughout, of 
 course. No special after treatment or further operative 
 measures are necessary, even in the worst cases, although it 
 is best for the patient to be quiet for a day or so. The wound, 
 which gives no further trouble and speedily closes, must be 
 kept scrupulously clean by frequent changes of dry absorb- 
 
HEMORRHOIDS DR. WILLIAMS. 357 
 
 ent dressings. After the operation, the patient is to use the 
 sodium phosphate every morning before breakfast, to unload 
 the portal system, until the cure is complete, usually in ten 
 to fourteen days. The same object can be attained by the 
 use of the following preparation : 
 
 I£ Flowers of Sulphur, 
 
 Cream of Tartar, 
 
 Powdered Sugar equal parts by weight. 
 
 Mix. One or two teaspoonfuls in a glass of water 
 before breakfast. 
 
 The above is the formula of an English itinerant doctor, 
 who travelled about the country several years ago, and 
 acquired a great reputation for his wonderful success in 
 speedily relieving and permanently curing the worst cases 
 of piles. I have frequently prescribed it myself for internal 
 or bleeding piles, and can testify to its intrinsic merits in 
 both acute and chronic cases. 
 
35 S 
 
 The Albright Wire Spring Truss. 
 
 Manufactured from Highest Grade Material Only. 
 Equipped with any St}de of Pads, Single or Double, Right 
 or Left. Sizes, 30 to 44. 
 
 The following prices are Net, F. O. B., Philadelphia, 
 Pa., in lots of One Dozen or Less. Orders for One Dozen 
 or More, will be shipped Prepaid any where in the U. S. 
 
 Single Trusses. 
 
 No. 1. Hard Rubber Front Pad, Hard Rubber 
 
 Ball and Socket Rear Pad . . Perdoz., $21x0 
 
 No. 2. Kid Water Front Pad, Hard Rubber 
 
 Ball and Socket Rear Pad . .Perdoz., 22.80 
 
 No. 3. Kid Water Front Pad, Kid Eall and 
 
 Socket Rear Pad ..... Per doz., 24.60 
 
 No. 4. Automatic Spring Front Pad, Hard Rub- 
 ber Ball and Socket Rear Pad, Perdoz., 31.80 
 
 No. 5. Automatic Spring Front Pad, Kid Ball 
 
 and Socket Rear Pad . . . Perdoz., 33.60 
 
 Double Trusses. 
 
 Any of the above combinations will be supplied at 
 Double the Price of the Single Truss. 
 
 The " BILTWELL " Truss, a New Style Wire Spring 
 Truss, encircles the body similar to the old style steel band 
 spring truss, but more desirable and more comfortable. 
 With Hard Rubber Pads . . . .Perdoz., $42.00 
 With Automatic Spring Pads 63.60 
 
 Wire Spring Trusses should retail at $5.00 to $6.00 for 
 Single, and S10.00 to S12.00 for Double. 
 
 The circumference of the patient's body, on a line with 
 the hernia, is the size of the truss required. 
 
359 
 
 INDEX. 
 
 Abscess, Rectal 47 
 
 Acid Carbolic, Uses of 295 
 
 in hemorrhoids . . .' 23 
 
 addiction- 
 Cocaine 162 
 
 DlONIN 176 
 
 Double 176 
 
 Drug 162 
 
 Morphine 162 
 
 Opium 162 
 
 Tobacco ." : 242 
 
 Alcoholism, Acute 241 
 
 Chronic ". 211 
 
 ALOPECIA 282 
 
 Treatment , 283 
 
 ANAL DISEASES 74 
 
 " Eczema 80 
 
 " Fissure 57 
 
 Fistula 45 
 
 " Pruritus 74 
 
 Anesthesia, Local Si- 83 
 
 Anus, Diseases of 74 
 
 Applicateur, Urethral 343 
 
 Armstrong's Vril 325 
 
 Baldness 282 
 
 Bed Wetting 286 
 
 Boils, To abort , 297 
 
 Brinkerhoff's Speculum 19 
 
 " Rectal Treatment 323 
 
 CANCER 137 
 
 Causes — 
 
 Predisposing 138 
 
 Primary 137 
 
 Traumatic 139 
 
 Diagnosis 140 
 
 Differential 141 
 
 Pathology 139 
 
360 INDEX. 
 
 Remedies — 
 
 Arsenious Acid 146 
 
 Formulae 147- 150 
 
 Protonuclein 158 
 
 Sodium Ethylate 160 
 
 A^egetable 155- 157 
 
 Zinc Salts 150 
 
 Formulae 151- 155 
 
 Treatment 142 
 
 Caustic 144 
 
 Constitutional 143 
 
 Internal 157 
 
 Local 143- 144 
 
 Varieties — 
 
 Carcinoma Cutis 141 
 
 Deep-Seated 141 
 
 Papillomatous 141 
 
 Superficial 140 
 
 Carbolic Acid, Uses of 295 
 
 Antidotes for 297 
 
 CATARRH, NASAL 249 
 
 Acute Rhinitis 250 
 
 Treatment 251 
 
 Chronic Rhinitis 253 
 
 Atrophic 260 
 
 Treatment 261 
 
 Hypertrophic 256 
 
 Treatment 257 
 
 Simple 253 
 
 Treatment 254 
 
 Cautery, Solar 292 
 
 Chloral-Camphor 299 
 
 Cigarette Cure 309 
 
 COCAINE SOLUTIONS 81 
 
 Schleich Formulae 82 
 
 " Modified 356 
 
 With Suprarenal Extract 83 
 
 Coffey's Rectal System 321 
 
 Colon, Flushing the ! 92 
 
INDEX. 361 
 
 CONSTIPATION 87 
 
 Enemas 9 1 
 
 Flushing the Colon 9 2 
 
 DILATATION OF THE SPHINCTERS 69 
 
 " without Anesthesia 71 
 
 " in Fissure 62 
 
 Dilators, Rectal 73 
 
 " Vaginal 275- 276 
 
 diseases- 
 anal 7 A 
 
 Genito-Urinary 329 
 
 Rectal 7 
 
 Of Women 270 
 
 DRUG ADDICTION 162 
 
 Abstinence Symptoms 17 1 
 
 Treatment of 172 
 
 Dionin 176 
 
 Double Addiction 176 
 
 Treatment of 176 
 
 Heroin 176 
 
 Modes of Withdrawal. 167 
 
 Gradual Reduction 167 
 
 Rapid Reduction 17° 
 
 Sudden Withdrawal 169 
 
 Relapses 206 
 
 Treatment 164 
 
 Diet during 208 
 
 Exercise during 179 
 
 Preparatory 177 
 
 Triumph System 3°7 
 
 Typical Methods 180 
 
 Forty-Eight Hour Cure 190 
 
 Gradual Reduction 181, 184. 187, 197 
 
 Mattison Method 201 
 
 Rapid Reduction ' 194 
 
 DRUGS USED 301 
 
 ECZEMA, ANAL 80 
 
 Treatment 80 
 
 Enemas 91 
 
 ENURESIS 286 
 
 Examination, Rectal 16 
 
 Felon, Lancing a 297 
 
 Fibroma, Nasal 267 
 
362 INDEX. 
 
 FISSURE, ANAL and RECTAL 57 
 
 Diagnosis 57 
 
 Symptoms 57 
 
 Treatment 58 
 
 Agnew's 60 
 
 Dilatation of Sphincters 62 
 
 Local 58 
 
 Monroe's 59 
 
 FISTULA, ANAL and RECTAL 45 
 
 Cause 0? 45 
 
 ; Classification oe 45 
 
 Diagnosis 46 
 
 . Symptoms 46 
 
 Treatment , 48 
 
 Candler's 50 
 
 Constitutional 56 
 
 Ligature : 49 
 
 . Local 52 
 
 Mason's 55 
 
 Surgical «... 48 
 
 Varieties 45 
 
 Flexible Splints 298 
 
 Fluids — 
 
 Hemorrhoidal 26, 32, 321, 323 
 
 Hernial 109, 128, 318, 320 
 
 Flushing the Colon '. 92 
 
 GENITO-URINARY DISEASES 329 
 
 Hydrocele 287, 353 
 
 Prostatic Diseases 329 
 
 Congestion, Acute 333 
 
 Hyperesthesia 332 
 
 Hypertrophy •••,■•• 330 
 
 Prostatitis, Chronic 331 
 
 Urethral Diseases 290, 340 
 
 Stricture 290, 345 
 
 Applicateur 343 
 
 Urethritis 291, 344 
 
 Varicocele 289, 349 
 
 GOITRE 244 
 
 Cystic 245 
 
 Vascular • 245' 
 
 Remedies for 244, 246 
 
 Treatment .-. 244 
 
 GYNECOLOGY, Non-Surgical .-. ."...,. 270 
 
INDEX. 
 
 363 
 
 26 
 28 
 
 HEMORRHOIDS • ■ ■ • 13. 354 
 
 Definition of : : ; I3 
 
 Description oe l * 
 
 1 ^ 
 Division of ° 
 
 External I4, I5 ' 3S 
 
 Sub-division of . 14 
 
 Internal ; I4 ' IS 
 
 Sub-division of 
 
 Mixed M 
 
 Injection of 29 
 
 Carbolic Acid • • • • 23 
 
 Internal Hemorrhoids I& 
 
 External ••'"'• 
 
 Injection Fluids 
 
 Agnew's 
 
 Author's • 2 ? 
 
 Brinkerhoff's ...... 3 3 
 
 Coffey's ;■•■ 321 
 
 Eliot's ;■■ 6 9. 
 
 ■ Hoyt's 34 
 
 Mason's ; ' ; 33 
 
 Monroe's 3 
 
 Overall's : " 33 
 
 Rorick's 34 
 
 Shuford's • ■ ■ ■ ' 33 
 
 Treatment • • ■'•, l6, 355 
 
 After Injection • • 30. 31. 40 
 
 Palliative ; ; • 38 " 39 
 
 HERNIA 95 
 
 Definition of • • • • ■ ■ • 95 
 
 Inguinal ■ 95 
 
 Direct • I23 
 
 Oblique • • 
 
 Needle ■ • 
 
 Syringe 
 
 Treatment • Il6 
 
 Injection Method • 95 
 
 Directions — 
 General : l5 
 
 Special ,:■:■: I22 
 
 Direct I24 
 
 Double I21 
 
 Femoral • • : J * 
 
 122 
 102 
 102 
 
364 INDEX. 
 
 Oblique 124 
 
 Umbilical 125 
 
 Rapid Method 126 
 
 HERNIAL FLUIDS— 
 
 Excelsior 320 
 
 Fidelity 130 
 
 Heaton's 129 
 
 Ideal 318 
 
 Miller's 131 
 
 Provost's 132 
 
 Robinson's 131 
 
 Souder's 128 
 
 UNIVERSAL No. r no 
 
 UNIVERSAL No. 2 in 
 
 Walling's 130 
 
 Warren's 129 
 
 Heroin 176 
 
 HYDROCELE 287- 353 
 
 Ideal Hernia Cure 318 
 
 INEBRIETY 211 
 
 Alcolholism, Acute 241 
 
 Chronic 211 
 
 Analysis of 213 
 
 Treatment 215 
 
 Bellevue Hospital 227 
 
 Gold Cure 236 
 
 Home Cure 225 
 
 Ideal Cure 220 
 
 Institute Cures 230, 232 
 
 Keeley Cure 310 
 
 Matchette's Treatment 238 
 
 Rapid Method 218 
 
 Secret Methods 303 
 
 Triumph System 303 
 
 Inguinal Hernia 95 
 
 Injection Treatment — 
 
 Hemorrhoids 16 
 
 Hernia 95 
 
 Instruments, Nasal 268 
 
 Rectal 84- 86 
 
 Trritable Ulcer 57 
 
 Keeley System, The 310 
 
 Local Anesthesia 81- 83 
 
 Mandragorne Fake, The 316 
 
INDEX. 365 
 
 MEDICAL MELANGE 292 
 
 Carbolic Acid, Uses of 295 
 
 Chloral-Camphor 299 
 
 Flexible Splints 298 
 
 Painless Tooth Extraction 299 
 
 Respiratory Diseases — Remedy 294 
 
 Solar Cautery 292 
 
 Morphine Addiction 162 
 
 NASAL CATARRH 249 
 
 " Fibroma ' 267 
 
 Instruments 268 
 
 Polypi 266 
 
 O'Neil's Speculum 20 
 
 Opium Addiction I0 2 
 
 Polypus, Nasal 266 
 
 Rectal 66 
 
 PROLAPSE, RECTAL 63 
 
 Treatment — 
 
 Complete 65 
 
 Partial 64 
 
 Prostatic Diseases 329 
 
 Pruritus — 
 
 Anal 74 
 
 Treatment 75 
 
 Palliative yy 
 
 Vulval 277 
 
 RECTAL DISEASES 7 
 
 Abscess 47 
 
 Dilatation 69, 71 
 
 Dilators y^ 
 
 Examination 16 
 
 Fissure '. 57 
 
 Fistula 45 
 
 Instruments 84- 86 
 
 Polypus 66 
 
 Prolapse 63 
 
 Reflexes 67 
 
 Specula IQ - 2 o 
 
 Ulcer 41 
 
 Rsctum, Diseases of 7 
 
 Blood supply of. 14 
 
o 
 
 V> INDEX. 
 
 Rrflex Irritation 67 
 
 " Symptoms in Ulcer 41 
 
 Respiratory Diseases, Remedy 294 
 
 Rhinitis, Acute 250 
 
 " Atrophic 260 
 
 " Chronic 253 
 
 " Hypertrophic 256 
 
 SECRET SYSTEMS EXPOSED 302 
 
 Armstrong's Vril 325 
 
 Brinkerhoff's 323 
 
 Coffey's 321 
 
 Excelsior Hernia Cure 320 
 
 Ideal Hernia Cure 318 
 
 Keeley's 310 
 
 Slandais Pile 322 
 
 Tri-Elixiria 314 
 
 Triumph 303 
 
 Solar Cautery 292 
 
 Speculum, Brinkerhoff's 19 
 
 " O'Neil's 20 
 
 Pratt's Dilating 73 
 
 Sphincters, Dilatation of 69 
 
 Splints, Flexible 298 
 
 Spray, Niagara ,. 275- 276 
 
 Stricture, Urethral 290, 345 
 
 Swindle, The Husa 317 
 
 Systems, Secret 302 
 
 TAPE WORMS 278 
 
 TOBACCO ADDICTION 242 
 
 Treatment 242- 243 
 
 KEELEY Remedy 313 
 
 Triumph Remedy 308 
 
 Tooth Extraction — Painless 299 
 
 Tri-Elixiria 314 
 
 TRUSSES 103, 133 
 
 Fitting of 133 
 
 Illustration of 106 
 
 Pads for 105 
 
 " selection of 134 
 
 " size of 135 
 
 Why They Fail 134 
 
 Price-Ltst of 358 
 
INDEX. 367 
 
 ULCER- 
 irritable 57 
 
 Rectal 41 
 
 Examination for 42 
 
 Symptoms of 41 
 
 Treatment 42 
 
 Home 43 
 
 Office 43 
 
 Urethral Diseases '. 290, 340 
 
 Stricture 290, 345 
 
 Vaginae Dilators 275- 276 
 
 " Pruritus 277 
 
 Varicocele 289, 349 
 
 Vril, Armstrong's 325