Powell

Acid carbolic...........

gr. xiii

Tr. Thurber .........

3.i

Aqua distillate .........

q. s. ad SS

Mix as follows: Place the container in a warm bath for fifteen minutes to hasten the solution of the salts, and allow the mixture to stand for twenty-four hours. The glycerin and graduate should be warmed to facilitate accurate measurements; the other ingredients should then be added. A sufficient quantity of Calvert No. 1 crystallized carbolic acid should now be liquefied by heat, and one ounce (thirty cubic centimeters) of it mixed with two drachma (eight cubic centimeters) of distilled water. A sufficient quantity of lead fly-ceride and borax (see prescription above) previously prepared, is then added to make exactly two ounces (sixty cubic centimeters). As follows:

Misc

Brinkmanship’s famous mixture is as follows:

From two to eight animist are injected according to the size of the pile.The Dr Martin of Philadelphia recommend the dilatation of the sphincter under nitrous oxide gas in order to avoid complications that follow the injection method. This dilatation is done four or five days before the injections begin. They recommend the use of a small conical speculum especially designed by themselves, which has the distal end cut off at an angle of forty-five degrees. This angular cut permits the hemorrhoid to protrude into the lumen of the speculum so that by rotating the speculum a hemorrhoid in any position can be made to protrude into the top of the instrument. They recommend that each hemorrhoid be injected separately at intervals of from live to seven days, after first washing the hemorrhoid area with some mild antiseptic solution.

The injection should be made directly into the most prominent portion of the pile very slowly, watching the color of the mass. When the hemorrhoid becomes of a whitish color, the injection should cease. Just before the needle is withdrawn, a drop is injected to seal the exit. The speculum is withdrawn before removing the needle, so as to permit the rectal walls to collapse, which serves to prevent the hemorrhoid from protruding after it has been injected. A solution of equal parts of phenol bobolink and distilled water is freshly prepared and filtered. Should the solution become opaque it is useless. From seven to fifteen minims of this solution are used in ordinary cases. After injection they recommend the use of a suppository containing one-half grain of cocaine. A suppository containing three minims of ichthyology should be used at bedtime and one after the movement of the bowels during the entire after-treatment.

A defenestrated conical speculum may be used to advantage in these cases. A semi-solid diet is to be given for a few days, and only weak instead of a strong solution of caustic should be used.

Ligation. The ligature has been used by English surgeons for the cure of hemorrhoids for many years, and at present it is regarded by them as the best operation for the cure of internal hemorrhoids. Appalling and many of the noted surgeons of England have done much to popularize the operation. It is applicable to the internal and external as well as the mixed varieties of hemorrhoids. In this country, Mathews has been probably the strongest advocate of the ligature method. The ligature operation, as advocated by the English, consists simply of throwing the ligature around the base of the hemorrhoid, tying and cutting off the hemorrhoid down to the ligature. Mathews advocates the ligature method, modifying it by transfixing the hemorrhoid and tying on both sides, then cutting the mass close down to the ligature. Rickets of Cincinnati recommends the sub mucous ligature of the hemorrhoid. These three methods of operating by the use of ligature are of unquestionable value and in the hands of a skillful operator can be safely used as a scientific procedure.

Preparation. In the preparation of the patient for operation by the ligature or clamp and cattery method, the general health, should receive first consideration and suggest the operative procedure. The contraindications to the administration of ether or chloroform such as heart, lung and kidney diseases are to be considered and should indicate to the operator as to whether office treatment might better be instituted. The day before operation the patient should receive a dose of some reliable cathartic, such as either licorice powder or Epsom salts. Three or four hours previous to the operation, one or two quarts of plain water, or a soapsuds enema, should be given. This should be followed about one hour before the operation by an enema of a pint of plain warm water. As an additional safeguard and cleansing enema four to six ounces of peroxide of hydrogen may be injected into the rectum after the bowels have moved.

The diet during the day previous should be of semi-solid consistency and if an early morning operation is to be made no food or drink should be advised within four hours of the time for operation.

Sub mucous Ligation. Merrill Pickett of Cincinnati claims for this operation that it is impossible to have secondary hemorrhage; that no tissue is sacrificed; that there are no large areas of protracted ulceration, very little pain, no stricture of the gut. no infection and very little time lost in confinement. He advocates the following method of procedure: The patient is prepared as described above and the sphincters dilated. A large semi-circle needle is threaded with moderate sized kangaroo tendon and passed subconsciously around the base of each hemorrhoid. At the upper border of the hemorrhoid the needle is reintroduced and makes its exit at the point of introduction. In this manner, a complete sub mucous ligation is done. The ligature is drawn taut, the two ends tied and left hanging.