rated; came home expecting me to do a supra-pubic cystotomy, but I succeeded in using the catheter, which had to be kept up for three weeks, after which time he could void his urine.

He was very much opposed to a cystotomy, and I told him of the relief that Mr. V. had received from castration.

After suffering greatly for two years he came to me last August, and said, "I want you to take my testicles out. told him that I could not guarantee him a cure by the operation, when he replied "That he felt confident that there was an intimate sympathetic connection between the prostrate and the testes, and that he would take all risk of disappointment should the operation fail of success."

He was admitted into the Home and Retreat, of this city, stood the operation well, and is now fully relieved of his former malady, the gland reduced in size, and urine voided at regular times without difficulty-Richmond Jour. of

Practice.

Treatment of Rectal Diseases.* The treatment of rectal diseases is a very large subject. When I selected When I selected this topic for a paper to be read before this intelligent body of physicians I did not expect to refer to the treatment of all rectal diseases. I shall only discuss the treatment of three of the most common-hemorrhoids, commonly called piles; fistula and irritable ulcer, commonly called fissure. On account of limited time I can only touch, as it were upon these three. The literature of rectal diseases has become very extensive during the last ten years, hence I do not expect to bring anything new before you What I may What I may say may benefit some present who have not the means of access to the publications upon this subject. There are many comprehensive and complete works before the public treating upon this class of diseases.

PREPARATORY TREATMENT OF

HEMORRHOIDS.

I believe, as a rule, we find a sluggish liver in patients who have piles. Therefore, I think it well to give calomel

•Prepared for the West Virginia State Medical Society.

Sig. One every hour, to be followed by one or two seidlitz powders.

If we desire a rapid result from seidlitz powders they should be given in as hot water as the patient can take.

The above prescription should be given three days before treatment. The night before treatment the patient should take one tablespoonful of castor oil. Give the oil as follows: Put tea cup in hot water for a few moments; when it is hot put one tablespoonful of whisky in it; on top of this put one tablespoonful of castor oil; on top of this, again, put one tablespoonful of whisky; now rinse the mouth with listerine, and then swallow contents of cup at one mouthful; rinse the mouth again with listerine. By taking the oil in this way no taste is noticed, and patients will not object to taking it.

One hour before operating have patient use an injection of one pint of warm water with one teaspoonful of boracic acid dissolved in it. A general bath may be taken the day before treatment.

EXTERNAL PILES-GRAPE VARIETY.

water.

External piles of the grape variety usually treat without an anesthetic. wash the parts well with soap and I usually use the tar soap (Packer's). I then saturate absorbent cotton with hydrogen dioxide and wash with this. I have the patient lie upon the side on which are the tumors, with his knees well drawn up towards the abdomen. A north light is the best We light for any surgical operation. may saturate cotton with a 20 per cent. solution of muriate of cocaine and press against the piles. This may, to some

extent, destroy sensation.

I now take a very sharp knife and make a vertical incision into the pile; sometimes I make a cross cut also. The blood-clot escapes, or by making slight pressure it will come out. I now syringe the cavity with hydrogen dioxide. This injection speedily controls the bleeding. It seems to be one of the effects of

No

hydrogen dioxide to control hemorrhage. I now press into the cavity iodoform gauze, covered with absorbent cotton, and fasten with a T-bandage. further attention, as a rule, is needed. After the second day the parts may be washed daily with boracic acid and water, or hydrogen dioxide. After the second day we should aim to have an action of the bowels each day. We may give a three-grain pill of cascara sagrada extract for that purpose.

EXTERNAL PILES OR TABS. About the only treatment of any serIvice for these are their removal. We may use the muriate of ocaine to anesthetize, or freeze them with ether spray. Then cut them off with a heavy bladed scissors. They should be dressed the same as the grape variety. Sometimes the stump will bleed quite freely after removal. This can be controlled by pressure. Apply the T-bandage tightly should there be much bleeding.

INTERNAL OR BLEEDING HEMORRHOIDS.

I use the same preparatory treatment as I do in the external variet.

Ligature.-Have patient under chloroform. Place him upon the side. Have one assistant hold legs. Introduce fingers into the rectum and stretch the sphincter. Catch each pile with any good pile-forceps, draw it well outside, with scissors separate it from the skin. Have needle threaded with strong silk or linen, pass it through base of tumors and tie each side as tightly as you can. Cut off top of tumor; be careful not to cut too close to ligature for fear it might slip off, allowing a dangerous hemorrhage to take place. This occurred to me once. Treat each tumor in the same way. We may then use bichloride of mercury, 1:5,000, as a wash, or hydrogen dioxide, 1:10. This may be used with a fountain syringe. Now press the remnant of the piles back into the rectum. Press iodoform gauze into rectum and apply externally. Over this place absorbent cotton and fasten with a T-bandage. This dressing should be changed about the third day, and the parts thoroly cleansed with the hydrogen dioxide. new dressing of the gauze and cotton should be applied. The patient should remain in bed and be kept quiet with

A

sulphate of morphine or McMunn's elixir of opium. The parts should now be dressed every second day. Upon the fifth or sixth day we should aim to have an action of the bowels. This can be accomplished with castor oil or one or two seidlitz powders. It requires from two to five weeks to produce a cure with the ligature.

Objections to the use of the ligature are first, severe pain; this is sometimes extreme. This can generally be controlled by the use of some opiate. The urine has often to be drawn by catheter. We may have septicemia and tetanus. Secondary hemorrhage may ensue when seventh to the twelfth day. As a rule, the ligatures come off; this is from the the treatment by the ligature is eminently successful.

should undergo the same preliminary The Clamp and Cautery.-The patient treatment as used when the ligature is made use of. Chloroform should be

given, the patient placed upon the side, atony produced, the piles drawn outside and dissected up so the clamp can be applied, the clamp applied and locked, the top of the tumors trimmed off with scissors and seared with the Paquelin cautery, or an iron at a red heat. After the searing the clamp may be loosened a little; if there is any bleeding tighten the clamp and again apply the hot iron. Each tumor may be treated in the same way. The dressing is the same as in the ligature treatment.

There has been a defect in the clamps until the introduction of Dr. Gant's, of Kansas City. I think his clamp is perfect. There is some danger of primary hemorrhage from the use of the clamp and cautery, but not as much now with the improved clamps as formerly. As a rule, the pain is not very severe. Occasionally we strike a case that requires large doses of morphine to control the excruciating suffering. I do not know the reason of this, unless it may be that we have an unusual supply of nerves in the piles, and the burning sets up the pain. This is mere conjection on my part.

I keep my patients in bed a few days, then allowing them to sit around in their room for a few days longer. We may have ulceration following this method

of treatment, as we may from any method. In that event we have a long, tedious convalescence. Ulceration here should be treated the same as ulceration elsewhere.

[This valuable article, by Dr. George J. Monroe, which appeared in the Lancet-Clinic, will be concluded next month, giving the carbolic injection method, with advantages and objections, ligature method, treatment for fissure, etc.]

WHILE the figures representing the deaths from preventable diseases are appalling in their magnitude, they fail to convey a just conception of the permanent injury resulting from these diseases in the multitude of cases which do not have a fatal termination.

The attention of sanitarians is now directed with great earnestness towards the discovery and removal of the causes of preventable diseases. The vast benefts which have already accrued from the application of preventive measures may be increased by further extending these

Yes, 8,495. No, 149.

Redemption Money.

Are you in favor of paper money being made redeemable in metallic money?

Yes, 3,372. No, 4,822.

Demonetization of Gold and Silver.

Are you in favor of the demonetization of both gold and silver and the substitution of full legal tender paper money, issued by the government? Yes, 2,198. No, 6,316.

Postal Savings Banks.

Are you in favor of a postal savings bank system?

Yes, 7,604 No, 779

Income Tax.

Are you in favor of what is commonly known as the income tax?

Yes, 7,888. No, 505.

Single Tax.

Are you in favor of the single tax as defined by Henry George?

Yes, 2,751. No, 3,363.

Socialism

Are you in favor of socialism as defined by Lawrence Gronlund?

Are you in favor of settling all leading po litical issues by a direct vote of the people, and of making this proposition an issue in the next presidential campaign?

Yes, 8,659. No, 305

Shall the greenbacks be retired?
Yes, 199. No, 9,032.

As might be expected, there are some surprises in the above vote. While postal savings banks receive a large vote in their favor, I do not understand the vote of 779 against them. Perhaps the negative voters were bankers, or voters who do not understand the arguments for and against (I do not know any arguments against, except that bankers would not like them).

The vote against paper money being made redeemable in metallic money is very encouraging. Money is not such by virtue of the material it contains, but by the authority that is behind it. The idea of redeeming one kind of a dollar in another kind of a dollar is ridicu lous. A dollar is not a dollar if it depends upon another dollar for its value; it is then only a token.

I might here announce that the book that I have mentioned a time or two, and which will likely be called "Rational Money," is now in the printer's hands, and will appear soon. It plants paper money firmly on a basis of facts in history, with incontrovertible argument and reasoning; "redemption " is not in a certain kind of metal,

but the multiple standard is fully worked out, explained and advocated. I feel that this book contains the best solution of the money question that has ever been presented-and it seems to be the final solution-the solution that civilization will finally be compelled to adopt before the question will be really settled. The manuscript has been prepared by one of the ablest scholars in this country, and the book will doubtless command the approval of the scholars of the country. I am anxious that this book should pass rapidly into the hands of thinking people, particularly doctors. This book will be the first of a series, issued quarterly, dealing with public questions in a progressive way. I have decided to make the price low, 15 cents per single number, or 50 cents per year (four numbers). To start the ball rolling, I will say that during April we will receive advance orders for 25c. for the yearly series, or ten cents for the money book alone. Please send immediately, and the money book will be sent to you as soon as it is out, which may be some time in April, or possibly not until May.

our

Referring again to the above vote, the almost unanimous vote for Direct Legislation is particularly encouraging. It speaks well for the progressiveness of the members of this organization. I have recently been surprised to learn that many prominent, intelligent and otherwise progressive men in Pennsylvanialeaders in public affairs-know practically nothing about this subject. Direct voting on measures, when the people demand that a measure shall be referred to the people, is what will drive the lobby from legislative halls, make the politicians seek pastures new, and thus purify our politics. But as heartily as I favor the Referendum, I do not think it wise to use it for National purposes until the people have had some years experience with it for local purposes in town, county, township, city and state matters. It is an improved instrument and will work wonders in purifying politics, as it has done in Switzerland; but a new instrument should be practiced with in a small way first. Our local politics, particularly in large cities, is notoriously corrupt. It is here that the Referendum will do its best and most needed work. See that your candidate for the next state legislature is acquainted with and committed to it. In most states it will have to be gotten by constitutional amendment.

be interesting to see the vote of other organizations on these same questions. In the majority of instances, I fear, the voter would admit that he knew little or nothing about the questions. Take the single tax for example. How many voters understand its principles ? Also, the proper redemption of money. Ask your preacher or lawyer what he knows about the Initiative and Referendum? Ask your congressman, governor or the state chairman of your political party, and note the answers. We need patriotic study of public questions by public men, by leaders and by all voters. Then the country will be safe; but until then we will be dominated by politicians, corporations, trusts and financiers..

The following are extracts from a letter from Dr. Ira Harris, of Tripoli, Syria:

"I am with you in everything you say. There is no doubt our country is run in the interest of the wealthy classes, and if it were not for men like you, I should feel very much like saying that the country is going to the dogs. But God has been with our people, and He will not let sordid motives ruin our dear land. Much you say is well known and cannot be disproved, especially what you say about the express companies. I was in the French postoffice here the other day. I saw a notice on the wall of a new arrangement for parcel post packages. They will receive a package weighing 11 pounds for every country in Europe except Russia, and every country in the postal union except United States and Russia, a package weighing 7 to 11 pounds. What a splendid thing it would be for us if we could get a package from United States by mail, and to send packages home in the same way.

"A short time ago I was going to Beirut. I was talking to the chief engineer of the steamer about typhoid fever, when he suddenly left me. Presently he returned with a number of THE WORLD and said I was much interested reading what this monthly says about typhoid; perhaps you would like to read it.' I told him I knew you, and asked how he came to get a copy. A friend of the ship's doctor had loaned it to him. So you see THE WORLD has friends in Egypt.

Practical Points.

SEE the page of Wm. N. Willis & Co. this month-entire page. So many of the WORLD readers were disappointed in not getting a Keen case when they reduced the price temporarily last summer that they have decided to reduce it again. cheap. They offer a new and special thing this This is your opportunity to get a good case very

month in the way of catheters-a soft catheter that will not spoil by age. Get a supply of them and give your patients the comfort that they make

(Continued over next leaf.)

The

C. F. TAYLOR, M. D.

Editor and Publisher

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of the heated term begin.

Under May's bright sun, the limp of the rheumatic grows less; in May's balmy air, obstinate catarrhs begin to clear up. Children play in the open air, and their cheeks become rosy and their faces happy. The doctor is not so necessary as in less happy times-but as a rule, he is glad of it. It gives him a chance to catch up lost rest, and to feel again that life is worth living. Also he can straighten up his book-keeping, if it has gotten behind, and give some attention to collecting, and thus he can make

receipt is given.

May, beautiful May. It is beautiful everywhere.

When travelers abroad ask what time in the year this country and that is the most beautiful, the answer is, May. Travelers wish that they could be everywhere in May-or rather, that there could be an endless succession of Mays. In this country more district, state and national medical societies meet in May than during any other month. This is not only on account of the beautiful weather, but chiefly because the general health is better during May than during any other month. A rest from the exertions of practice is needed after the winter and spring months, and May brings the

He can also get his medical magazines in order, write up his cases, and best and most important, he can arm himself for the coming heated season.

Review your experience of last summer; refresh your mind on important articles that have appeared in THE WORLD on summer diseases during the past few summers, and from these data plan your campaign. Write and tell us what your plan is, so your plan can be compared with that of others. This will be mutually helpful. Please do this immediately, so it will be in time for June is

sue.

The Advantage of Association. Instead of each man making his own shoes, hats and coats, and producing his own food and providing for shelter, it is found much better for one man to devote his entire attention to making shoes, another to making hats, others to making clothing, farming, building houses, etc., and each exchanging his product for what he needs of the products of others. This principle of division of labor is the chief difference between savage life and civilization. This principle permits certain individuals to devote themselves to the healing art.

This division has led to another stepthe association of those devoting themselves to the same line, for mutual help and benefit. For example, the science of medicine as we