The Ordinary Xerography Cattery, supplied for burning artistic wood designs, has proven a most efficient and reliable instrument for the clamp and cattery hemorrhoid operation. The idea was suggested to me as a novel feature to the operative technique and I extended my experience with several such outfits, over a series of sixty clamp and cattery operations performed either in hospitals or in private dwellings. I not only found the cattery useful in hemorrhoid operations, but equally so in cauterizing the stump of an extirpated appendix. Its reliability was so certain that on several occasions I ventured to operate without the added assurance of carrying a Jacqueline cattery with me. During warm weather I had no trouble in any way with the instrument, but in cold weather or when the operating room was chilly, the benzine became so cold that it would not volatilize quickly enough to supply the proper amount of ignition to the platinum tip and necessitated wrapping the glass bottle benzine-container with a warm wet cloth or warming it on a steam radiator for a few minutes. On one occasion the hole in the platinum tip became tilled with some sand or foreign substance which was easily washed out under water. The platinum tip is much smaller than the tip supplied with the ordinary surgical instrument and will not permit so long a contact with the mass to be burned, but with judgment it may be reapplied oftener to procure satisfactory cauterization. I can recommend it as a good substitute to those who do not care to purchase the more expensive Jacqueline cattery, in the hope that the instruments necessary to the performance of the clamp and cattery operation may be cheaply supplied.

Fig. 69. Modified Jacqueline cattery

Galvani-puncture Treatment of Hemorrhoids. In discussion of the subject of local anesthesia, Kelsey of New York, in an article in The Medical Record of December 14, 1912. describing his personal experience in the use of local anesthesia in various affections of the anal ring, gives an especially interesting description of his galvanometer-puncture treatment of hemorrhoids. The treatise is as follows:

*' Since substituting weak solutions of eucalypti and cocaine. both used hypodermic ally or under the mucous membrane. I have had no occasion to change the form of anesthetic. Quinine and urea I had great hopes from until I was discouraged by Wyeth bad results and abandoned it without any fair trial. It has always been rather a weakness of my own in surgical practice when I found a good thing to hold to it until I was sure of a better, which will explain why I have never yet performed a Whitehead operation for hemorrhoids and never expect to do so.

"Whatever surgery of the rectum is done under eucalypti must be done without any very decided stretching of the sphincter. It is both useless and dangerous to try to overcome the sensitiveness of the whole anus by injecting an anesthetic subcutaneously to an extent which will permit of stretching the muscle. I tried it in the early days of cocaine and spent hours of anxiety over the untoward results though, fortunately, never having a fatal accident. This constitutes the first decided limitation to this method of treatment. Whatever is done must be either on the skin, as in fistula or fissure, or through a speculum, as in hemorrhoids, or polyp, which cannot be extruded by straining. Were it not for this all of the minor surgery of the rectum could be done as well by local as by general anesthesia.

"It is this inability to properly dilate the sphincter which makes the treatment with local anesthesia inapplicable to any but the simplest forms of fistula, for the ordinary fistula cannot be operated upon with precision and success unless the sphincter be first paralyzed. Where the sinus is straight and without branches, where there is one opening on the skin and one on the mucous membrane and the surgeon can satisfy himself that this is the condition, local anesthesia and operations in one's office work most satisfactory. Where this is not the case and the sinus is tortuous and bifurcated the attempt to cure in this way will generally be a failure.

"And while upon this point it has often seemed to me that there is a way of curing fistula without any operation at all, which has never been tried out as it might be. I refer to the treatment of curettage, draining, and stimulating to healthy action which would be used on any old sinus not connected with the rectum. By it I have occasionally had successful results which have greatly surprised me and this not only in simple cases, but in cases so extensive that I have hesitated to inflict the injury necessary to secure a cure with the knife. Perhaps it is because a patient with fistula is usually willing to be operated upon and an operation is easier for the surgeon, while one with hemorrhoids is generally unwilling, that this method has not been more generally used. Or it is possible that the method is more common with the general practitioner than I am aware.

"Another condition to which attention may be called is slight laceration through the sphincter from parturition -cases in which it is only necessary to freshen the edges of the laceration and bring the ends of the muscles together by a few sutures. It is not long since I traveled a considerable distance to do just this little thing upon a lady of wealth and position whose life was that of a semi-invalid from icon pertinence, after three or four failures to effect a cure with all the advantages of general anesthesia. Whether she would try once more or not depended entirely upon whether she must take ether or not, and hence I had small chance to choose. There was nothing remarkable in the fact that the operation was successful with eucalypti, the wonder being that it had not been successful before, as the tear was only through the sphincters.