VOL. XXI.

TERMS:

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Address THE MEDICAL SUMMARY,

No. 9

vests the malady with peculiar interests. We who live now have many reasons to be thankful, and not the least of these reasons is the possession of adequate resources of relief and cure.

The control of hyperpyrexia is perfect, typhomania and intestinal hemorrhage have been robbed of their terrors.

We remember Wood for utilizing turpentine, Liebermeister for his iodine treatment, Wunderlich for the splendid showing he gave to the mild chloride, and Bartholow for his carbolic acid and iodine. The Brand method is new; it may have its objectionable features for the country practitioner. Simplification is needless. Our success or failure is a step forward or backward, and depends wholly on how and what we choose to treat our case. In the light of modern pathology we cannot mistake the cause.

Bacterial processes, fermentative processes, ulcerative process, the tripod of intestinal lesions on which it rests, stop these processes and the case is cured. Just as we treat an ulcer of the integument, so should the lesion of Peyer's glands be treated.

Can this be done? We believe it can. How? It is accomplished by intestinal antiseptics, judiciously and vigorously pushed. We believe the sulphocarbolates are the best. They speedily arrest the morbid processes, bring about reduction

of temperature and reduce danger from hemorrhage to a minimum. The precaution must be taken to have them pure. The maximum daily dose is large.

The writer relies principally on the sodium salt. Perhaps it is best to combine and give in capsule or tablet.

MORPHINE VS. VERATRUM ET AL IN ECLAMPSIA.

Like invasions of cholera and la grippe the discussion of certain maladies recurs with commendable regularity. This will continue till investigation tires, or till every aspirant for reportorial honors has had his say.

A recent writer of unbounded enthusiasm affirms that there is but one remedy for puerperal eclampsia. Morphine is the one remedy.

Admitedly, morphine is esteemed by many as such a remedy. One has only to turn to the pages of our journal literature for the current year to learn that not only morphine, but veratrum, chloral and bleeding, respectively, is the remedy above all others.

This is as it should be. These agents divide the honors. Each writer exploits the remedy that has seemed to be the best in his hands. For our own part we like chloroform for the paroxysm, and believe there is nothing better.

To treat the interval we choose Norwood's tincture every time, given in small doses (say eight or 10 drops) hypodermically. We believe 99 cases in 100 will yield, and are not much in doubt about results in the other one. But, we insist that the preparation of veratrum must be Norwood's tincture.

The reader perceives that we are enthusiastic. This is because our confidence is so great, and our confidence is so great because we have had such splendid success with our remedy.

Further, we believe that Norwood's possesses claims over other remedies suggested that any one can prove who cares to take the trouble to investigate.

We believe it is an error to liken its results to the results of bleeding-they have nothing in common. The patients condition after treatment by Norwood's is perhaps more natural and better than after treatment by any of the other proposed remedies.

CYSTITIS.

A rational plan of treating cystitis is to cauterize the lining membrane of the bladder with an ounce of a solution of nitrate of silver. Take two grains to the ounce of water, inject into bladder, let remain a minute or so and then draw off by same catheter, which has remained in place. Internally administer three grains of salol every three hours, or three drops of carbolic acid every three hours until the urine shows the characteristic cloudy appearance; also five drops of the oil of wintergreen, in capsules, till effect. A practitioner of much experience writes: "I do not know why, but sometimes I think rheumatism, or the cause of rheumatism (uric acid diathesis), has somewhat to do with inflamed bladders, and the salicylic acid in the oil of wintergreen seems to remedy, to some extent, this trouble.

NOTE.

To those receiving a copy of the SUMMARY not having seen it before, we would say, look it over, and if you like it send in your subscription. Remember, that the SUMMARY deals with the needs of everyday work of physicians; that it is a journal for, by and with the profession; that it has been successfully published for almost 21 years; that the classification of its reading matter is considered supurb.

Original Communications.

Brief and practical articles, SHORT and PITHY reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the SUMMARY must be contributed to it exclusively. The editor is not responsible for the views of contributors.

Write only on ONE SIDE of the paper.

THE NON-SURGICAL

IT

TREATMENT OF

HEMORRHOIDS.

BY MILTON P. CREEL, M. D.

T is very erroneous to believe that by surgical means alone we can successfully treat hemorrhoids. This view is entertained by many medical men, but some of the greatest medical observers take an entirely opposite view. Among these I will mention Struempell, who has a chapter on the treatment of hemorrhoids in his work on practice, and Loomis has also a chapter on this subject in his work.

According to the best observers the cause of hemorrhoids is, frequently repeated stasis in the veins in the affected part. We very often see patients who suffer with constipation and who lead a sedentary life suffer with hemorrhoidsthese being very fruitful causes of the disease. Cirrhosis of the liver and other hepatic diseases and diseases of the heart are causes of hemorrhoids, and I could enumerate other causes. What I have said relative to the causative factors, however, has been to show that we could not look to surgery for the removal of the

causes.

In the treatment of cases of hemorrhoids which come to us we should studiously look into the case to ascertain the causative factors and endeavor to correct them.

Constipation will be found one of the most constant factors in these cases. To correct the constipation we will be most successful if we put the patient on a rational diet and give some simple laxative often enough to evacuate the bowel. The cure, I believe, in constipation must come from diet, but certain drugs help us by evacuating the bowels until the patient has taken the diet long enough to effect a cure of the constipation in that way.

These patients-those who lead sedentary lives-must be told to take regular and systematic exercise, as upon this, as much as anything, will depend the successful issue of their disease. It has been common with the profession to use a great variety of salves and ointments in the treatment of hemorrhoids. Some of these are dangerous; some contain narcotics, others are irritants, and nearly all of them are greasy and produce results of an unsatisfactory character. Still, some of the popular remedies unquestionably do a great deal of good.

For some time, however, I have ceased giving these greasy salves and have depended entirely upon anusol suppositories. These suppositories are composed of anusoli, zinc oxide, balsam Peru, oil theobromæ and creatin ointment. These ingredients, I think, compose the best suppository and the most successful means of treating hemorrhoids at the disposal of the profession.

I direct my patient to insert one of these suppositories in the rectum every night before retiring, but in those cases where the condition is attended with a great deal of pain I have the suppositories used night and morning. In cases where the condition is very aggravated it is best that they be used every eight hours.

When

These patients should, if we would get speedy results, occupy the recumbent position. In this way we get results which are far more satisfactory. there is protrusion of the hemorrhoids from the margin of the anus, we can get more favorable results by introducing a suppository not only in the rectum, but by squeezing one up between our fingers and smearing it all over the protruding hemorrhoidal tumors.

These suppositories give almost instant relief, and the piles usually disappear very rapidly, and when the patient will adhere to my instructions pertaining to diet, exercise and other matters, he generally makes a recovery speedily.

In this article I am not to be understood to say that no cases of hemorrhoids need of necessity call for surgical assistance. I am sure that cases which have not been properly treated, and which have been in existence a long time, will

sometimes require surgical means of relief. But I have never seen a case in my practice which called for surgical means of relief. In fact, I rely with the utmost confidence upon other than surgical means of relief, and this reliance is based on the outgrowth of 20 years' experience. Besides my experience, I could quote the opinion of other able men in our profession who hold substantially the same views.

Below I give in outline a few clinical reports which seem to demonstrate the value of the treatment I have here advocated. These cases are, however, only a few of the great many cases treated on the lines here laid down:

Mrs. L., age 31 years. This lady, a teacher by occupation, had been troubled with hemorrhoids at intervals for the past two years. She suffered with constipation and took but little exercise. I had her to eat liberally of fruits and such foods as would leave debris in the intestinal canal. For a week a laxative was taken often enough to evacuate her bowels. After a week she did not have to take any drugs. I had her introduce an anusol suppository every night on going to bed. She persevered in this treatment and took proper diet and exercise, and at the end of a month she had ceased altogether to have hemorrhoids, her bowels were regular and she has now gone several months without anything like her old trouble.

been

Mr. S. O., age 29 years, had troubled with piles for several weeks, the pain being almost insufferable when he applied at the office. I had an anusol suppository introduced into the rectum and smeared one of the squeezed suppositories over the protruding piles. This gave him relief at once, and I heard no more of the case until he came to the office a week later, He felt well, he said, in every way, but I had him to use laxatives and adhere to a proper diet, and he has had no further recurrence of his trouble in several months.

Mr. J. S., age 37 years. He was subject to piles for 10 years, and on regulated diet and anusol supppositories he made a complete recovery in two weeks and has had no recurrence.

Mrs. S. H., age 39 years has been a sufferer, in fact almost an invalid, from piles for eight years. On the same treatment as in the above case she got along so well that she had no trouble after the fourth week.

H. S., age 49 years, an intemperate man, who suffered also with cirrhosis, was put on anusol suppositories. On these he got along comfortably. He would use them only when attacks came on, and when these were relieved he would cease to use anything.

Central City, Ky.

SEASONABLE POINTERS.

BY B. W. SWAYZE, M. D.

HE season of the year in which croup, diphtheria and allied diseases appear is approaching; in fact, a few "skirmish line" cases have already appeared, but the vast majority of cases will come when winter's cold begins to make us close up our houses and start our fires going; when the house air becomes contaminated by fumes of fuel-gas from improperly constructed, constructed, placed and dampered stoves and heaters of all grades and styles, from the "odorless" coal-oil stove to the "guaranteed gastight" heater in the cellar.

Add to these sources of contamination of breathing air the product of combustion from gas flames and oil lamps, and we find much if not the cause of many of our winter diseases. The constant assault upon our systems and constitutions by these home-made foes, both by day and by night, cannot but in time often shorten and break down the resisting forces within us so kindly provided by Nature, and as soon as the equilibrium is disturbed there appears a rapid breakdown of health-"grippoid" symptoms, pneumonias and other symptoms dependent upon a disordered and poisoned blood.

So often have I entered the homes of my patients, be they well-to-do or poor, and have been met by a wave of foul air as soon as I opened the door, yet upon inquiry or exclamation the inmates declare they "smell nothing." The well-to-do

man's house I find is more prone to be subject to fumes from coal fires, lamps, etc., than the poor man's home, from the simple fact that the former has taken pains to effectually cut off all ventilation to a great extent by equipping his doors and windows with the latest approved weather stripping, preventing leakage of foul air and heat outward and the ingress of fresh air. The poor man, however, must put up with houses in which many panes of glass are missing from the windows, and one can always see daylight around the doors, while often as much as an inch of space is between the bottom of the door and the sill.

Try as he will, by stuffing cloths and papers about his windows and doors, he cannot prevent an active circulation of air and its consequent discharge or exchange of foul ail for pure.

I have observed that most of the illness among the poor comes from indiscretions in eating and clothing throughout the whole year, generally, but particularly during the fall and winter. Lack of proper food and clothing, with absence of great variety of the former during the winter as compared with the balance of the year, together with ignorance of many of the common laws of health and hygiene, as shown by lack of personal cleanliness, dirty clothes, soiled diapers from young children lying in corners, food left standing on tables from one meal to the next, all act to lower the tone of the system and, with close air, tend greatly toward producing the diseases of the chest and thorax such as we are called upon to treat during the winter.

The remedy lies in the doctor endeavoring to educate his patrons to better living and higher standards of health. We can do much more to keeping diphtheria, croup, etc., from that home by explaining to its inmates the paramount value of God's pure life-giving air, cleanliness of person and apparel and judicious eating, and be doing them our full duty, than to wait until disease has appeared and then quarantine and clean up afterwards, or squirt antitoxins" into their flesh, and, if by chance they die from "heart failure," say "we did our best and the results rest with God."

Fresh air, therefore, is my first requisite in the sick room all the year around. While I have often thrown the windows wide open at times for immediate and rapid change of air, yet in most cases I make provision for constant circulation of air by inserting a board, some six or eight inches wide and the length to correspond with the width of the sash, immediately under the lower sash, which will rest upon it, leaving space between the upper and lower sashes where they pass each other; or by drawing in the blinds or shutters and leaving the windows open. In either case direct draught is prevented and ventilation is assisted.

Oil lamps, when needed for light, are placed in adjoining rooms or hallways where their light is shed into the room, while much of their odor is carried away. Oil stoves for heating purposes are of the devil's own suggestion, I believe, and unless the most scrupulous care is taken with them they will odorize to beat the

cars.

I believe we best serve humanity in sickness or health when we can assist Nature to effectively resist disease by natural and simple means than to rush to a medication of the body, often paralyzing oar efforts toward restoration. Yet, I believe in drugs and their employment, but not so much as a curing agent in themselves as I do as an ally or helper to Nature in ridding herself and the system of the drags that hold her or embarrass her. My dosages differ greatly now from what they did eight or nine years ago, and I no longer pile it in in shovelfuls according to the rule in most college courses, but take a medium and sometimes a minimum dosage and repeat as needed; yet, I am not a "homeo" by any means, having graduated from Jefferson.

Try a few of these suggestions, working them out to your best individual practice, for no one can make a rule that applies to all, but these are things which I have worked out for myself to a great extent, yet probably many SUMMARY readers will exclaim, "Like father, like son," as they may have read the articles on similar subjects from the pen and experience of my father, Dr. Geo. B. Swayze, of Philadelphia.

Berwick, Pa.