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Some Diseases of the Rectum and Their Treatment.

Reflex Effects and Neurasthenia. EDITOR MEDICAL WORLD:-The evil effect rectal diseases have on the general health are very much greater than the public, as well as many medical men, realize. There is an intimate relation between the nerves

of the rectum and the spinal cord, from which the rectum receives its supply direct, and any irritation in this organ will act as a little fuse, constantly irritating and affecting the entire nervous system; therefore, the sufferer goes on studying self-control, fighting hard to subdue the nervous symptoms which light up from time to time in spite of all he can possibly do, and not realizing that the little fuse lighted up at the distal end of the nerves is liable to an explosion at any time, thus wrecking seriously the nervous system, which succumbs to that dreaded state of nervous prostration. few symptoms leading up to this condition are melancholia, irritability, unusual worry, anticipation of some unusual unpleasantness, and permitting the ordinary things of life to worry him unreasonably, which he would not do if he were in his normal condition.

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Then, again, the constant irritation of the rectum from the different diseases affect that organ so frequently, causing an unnatural contraction, because the muscles are, like those of the eye, involuntary, and any irritation of them causes them to contract without the will of the patient, the same as we close the eye when we have an irritant in it. This contraction leads up to the most frequent cause of constipation, which in turn disturbs the stomach, kidneys and liver, and, in fact, every organ in the body, because the great sewer of the system is clogged and the accumulation of fecal matter is being absorbed and taken into the general system, thus disarranging the entire body.

Fissure of Anus.

Occasionally we are called upon to treat a patient whose bowels have not moved for several days, the condition being caused by an irritable fissure, which, in turn, produced the contraction. I had one case of this kind, in which I had to give a general anesthetic and break up the fecal mass with a curet before it could be removed. This patient had not had a bowel passage for over two weeks, all caused by an irritable

*Read Before the Northeastern District Medical Society of Kansas, October 27, 1914.

fissure, which in turn produced a contraction, and it took about thirty minutes to remove the accumulation of fecal material with the patient under a general anesthetic. While this is a very exceptional case, it demonstrates the possibilities of such conditions. I do not claim that all cases of constipation are caused by this trouble, but I know of several cases of constipation of several years' standing which have been cured by curing the fissures.

No one can appreciate unless he has experienced it, the great bodily change that takes place in one's feelings, or the refresht, soothed state on the entire system resulting from the relief of this distress in the rectum.

Frequently such sufferers say they are unfit to transact business successfully and that they are cross and irritable; and such people are often censured when they should not be because they cannot entirely overcome the irritating results of the diseased parts. I know one man, a butcher, who had to quit business owing to the fact that he had lost his customers because he would be so cranky they just quit him to trade with another who was more congenial when they went to purchase meats. He told me that it made him mad to have a customer ask for a drink of water.

Effects of Constipation.

Frequently we find evil effects on the digestiv system as a result of the irritation of the nervous system by the constipation and the general sluggish condition of the bowels; for when the bowels are clogged and only partially evacuated each day, it is only natural that the stomach should be affected, resulting in the loss of appetite, dull headache, sluggish circulation of the blood and a stupid, worn-out, emaciated condition which is frequently the state of health we find such patients in when presenting themselves for treatment. Then again we frequently have patients who are suffering with what we call reflex pains; that is, pain produced in one part of the body caused by irritation in another. For instance, irritation in the rectum will produce pain in the top of the head, across the shoulders, the back, hips and down the legs sometimes.

Itching Piles.

Our experience with treating rectal diseases is that 50% of the persons afflicted with rectal disease do not understand the

nature of the disease. They think that everything that gets wrong with the rectum is caused by piles. Piles form on the hemorrhoidal veins, while some of the other diseases have nothing to do with the veins or arteries. For instance, what the laity call itching piles are caused by a condition outside of the rectum and many think they are one and the same thing.

Internal and External Piles.

There are the arterial, venous and capillary hemorrhoids. The first are bright red in appearance and the venous are blue or purple and the capillary are dark. The arterial and capillary varieties have a tendency to bleed. The internal hemorrhoids have the power to increase in size, which they almost always do while being handled, making the operation more easy. The action is similar to that of the erectil tissue of the penis and clitoris. The internal hemorrhoids are attacht inside the sphincter ani and the external are outside this muscle. About all that is necessary to know is whether they are large or small and whether they are external or internal.

Treatment of Piles.

The surgical treatment of piles consist of removing the tumors. The manner in which that is done depends on the nature of the tumor and the opinion of the surgeon, whether they are cut away, cauterized away, strangulated with a snare, ligated and allowed to sluff off or dissected out or a combination of some of these. It depends on the way the surgeon sees fit to operate at the time.

This intense itching around the rectum is best treated by dividing the nerve fibers near the surface. I am a firm believer in the radical cure of piles. I mean, to remove them. The manner in which this is done depends on circumstances, but there are other ways and some prefer them. But the physician can secure larger fees if he has an anesthetic given and one or two extra physicians and a trained nurse or two around when the work is done. It looks more like something is being done; while if he uses a little local anesthetic, very quietly injects something into the hemorrhoids and tells his patient to return in the morning to be drest it doesn't seem like anything has been done. But let me remind you that before the next morning arrives he will change his opinion about what has been done.

The drugs that have been used for the treatment of hemorrhoids are many, but the specialist, the quack, the general physician and all who are skilful in the treatment of these conditions have thrown all aside for one; that one is carbolic acid, alone or in combination with something else, and the stronger the solution is in acid content the better. Never use it weaker than 40%. The common formula and the best is R Acidi carbolici

Ol. olivæ.....

:

.....equal parts

Sig. Inject enuf to cause the tumor to turn white; wipe the tumor with pure alcohol. Apply a soothing ointment, and the job is done.

It is sometimes a good thing to use a snare to choke the blood in the tumor while

injecting it, but not always necessary. One

or two only should be injected at one treatment. This form of treatment applies to internal piles. The external variety should be cut off and treated the same as any other wound.

Here is a favorite method and successful one; after surrounding the pile with the snare inject the solution; this will produce the anesthesia needed. Then make the circular cut of skin and mucous membrane and ligate the pile; then the tumor is snipt off and the stump treated same as any other wound.

I wish to here remark that with the ordinary injection plan the treatment sometimes has to be repeated as many as three times.

Rectal Fistula.

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Rectal fistula is not uncommon. are the complete variety which has two openings and the incomplete variety with only one opening; also the external and internal varieties. The treatment of these conditions consists of destroying the scar tissue surrounding the canal (or the pipe) and healing it by granulation. The destruction of this can be done by the use of the knife or by the injection of the carbolic acid solution, or iodin or others. It is well after the injection of the fistula to leave a little gauze in the opening to answer as a wick for drainage. Every canal must be treated alone or the work will not be a success, and I will here state that I have seen one case with one external opening and five internal openings. All must be attended to or the operation will be a failure. This injection of a fistula must be repeated every third day till cured. The following is Brinkerhoff's injection fluid:

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Fissure of the rectum is a small crack, usually situated just within the anus and seldom having a greater depth than the skin or mucous membrane, but sometimes it is much deeper. This condition is very painful and annoying. It is caused by constipation or anything that produces irritation of the rectum. In simple and mild cases the application of astringent lotions or ointment before and after defecation will usually effect a cure in a short time. Dilating the sphincter will

sometimes cure a fissure. Sometimes it must be cauterized and then treated by antiseptic powders, etc., until healed. Sometimes it is necessary to divide partially or entirely the sphincter muscle, but it is best not to divide the skin. This can be done with a tenotomy knife, but it requires a little skill to do it well.

After all these treatments or operations it is necessary to constipate the bowels for two or three days if we get the best and quickest results.

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EDITOR MEDICAL WORLD:-In one of your issues I noticed an article by a doctor explaining his methods of nourishing his typhoid patients, and his views were so peculiar about the amount of nourishment he would give a patient that I have to question whether or not what in his judgment

he would allow was sufficient to nurture one going thru this trying ordeal. Further, he stated that he had not lost a patient in seven years, altho he had been practising in a community in which that disease was very prevalent.

Everybody who is honest knows that we have no remedy which acts on typhoid any better than local treatments will accomplish in the treatment of diphtheria, yet who would dare, under the light of antitoxin treatment, to make any claims for our oldtime treatment in that dreaded disease of the throat? If we have no remedy that we can tie to in the treatment of typhoid fever, then some one who loses no patients should not boast of anything further than good luck, and even good luck sometimes deserts us, so that our good friend may possibly find in the next seven years that he will be a wholesale loser, his luck, meanwhile, having deserted him.

I heard an eminent physician say that he knew of no better remedy in the treatment of this disease than the elixir of lactated pepsin, because, as he said, people need a remedy if for no other reason than psychologic effect, and it might as well be one thing as another. Having satisfied

them on the medical side, it is well enuf to see what more can be done.

It has been my habit for years to believe that a patient cured of typhoid is not the only result that we seek for, but to aim to leave him in as good a condition as possible after the recovery. How many of our patients fed on milk and broths survive looking like a famin subject from India! And nothing is more responsible for this than an inadequate diet. I, like our good friend who fed his patients little more than water, have had good luck and gave a far more liberal diet.

I am so confident that a well-nourisht patient will survive a great many of the complications much better than a poorly nourisht one, that I would ask your readers to at least try a more rational and substantial diet than I claim for milk or broths. Many a doctor thinks it is very risky to allow a convalescent to eat baked apples, bread pudding, custard, rice custard, broths thickened with flour, cream of wheat, milk toasts, etc., while I give those as the regulation diet thruout and the only misgivings during convalescence is when I venture on cucumber pickles and pork chops.

Once in a case convalescing from typhoid, I remember a nurse being much blamed for a relapse because she had given the patient a small round cracker. It was my province later to operate and find out that the cracker did not do the damage, but the patient had developt an attack of cholecystitis with formation of pus. In draining the gall-bladder I did not find the cracker, nor do I believe the cracker had anything to do with it.

I believe further that many and many a time patients whom the doctors believe are having relapses, are suffering from complications dependent upon an attack of typhoid fever such as the above case, or a perforation of the bowels.

JOHN J. REYCRAFT, M.D.

Petoskey, Mich.

Iniquitous Contract Practise.

EDITOR MEDICAL WORLD:-Since you have given material aid in elevating the medical profession in various ways, do not forget contract practise in mining and lumber camps. The death rate in these camps in southwest West Virginia is very high, and especially is this so in regard to infants and children.

There should undoubtedly be some legislation in many states on this subject, and the A. M. A., state and county societies should take the matter

in hand at an early date. The way it is carried on in McDowell, Mingo and Logan Counties is no more nor less than the capitalization of state license and the profession thru prestige and a pull, mostly political. This is done by men who have comfortable incomes and don't have to do it. They secure the contract for the practise of several mines and farm it out to some serf, who is just out of college or who has failed in private practise, at from $75 to $125 a month, leaving them a net rake-off equal and in many cases greater than the salary paid the men who do the work.

That the work is inefficient no one doubts; at the same time the miners are paying a sum that would secure good service. If the miners were allowed to select their doctors annually and the companies prohibited from letting the work to any but the doctor doing the practise, it would cut out this serf professional work and necessarily lower the death rate in these camps. It's a shame that the profession stands for it and a crime on these unfortunate people, who have to stand for the graft of prestige and politics. Logan, W. Va. J. E. McDONALD.

Treatment of Bedsores and Burns.

EDITOR MEDICAL WORLD:-I have had considerable experience with severe bedsores and a burn, and found the use of an ointment, given below, to be quite satisfactory.

In one case, that of a woman who had been bedridden a year, it healed the bedsores promptly. I never use whisky or alcohol on the sores, as that would cause smarting. For cleansing I use water that has been boiled. Where sterilized gauze is not to be had I employ linen that has been scorcht on both sides.

After the washing have the sores thoroly dry. Cut a piece of linen larger than the sore. At each corner of the linen place a drop of pitch, which will adhere to the skin when applied. Any number of layers can be so applied. A little white petroleum jelly will soften the pitch and it can then be easily removed. The ointment is placed in the center of the linen patch.

The formula I use is as follows:

Antiphlogistin. . . .
White petrolatum..
Stearate of zinc.

Boric acid.

.2 ounces

1 ounce

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.2 drams

Mix the petrolatum, stearate of zinc and boric acid together and then mix in the antiphlogistin. If necessary, add a little more petrolatum.

The inflammation was quickly relieved by this ointment.

This treatment prevents scabbing over and leaves smooth surface. Even white petrolatum, with stearate of zinc and boric acid, will heal. JULIA R. LEEMAN. Denmark, Me.

EDITOR MEDICAL WORLD-As the year's work nears its end I find myself looking over my journals, and I think I will discard this one and that one, but when I come to MEDICAL WORLD I find myself saying, "Well, I can't get along without this one." So here is my old dollar, and I want this companion for another year at least. I have mislaid the April number or lent it, so send me the April number to complete my 1914 volume. I am inclosing $1.10 to cover cost of extra number. C. I. WELSH.

Clyde, Kan.

Pseudocyesis.

EDITOR MEDICAL WORLD:-I wish to report a case in my practise which occurred twenty-five years ago. While reading an article from Dr. É. W. Zook, of Dunlap, Ill. (September WORLD, page 366), I was so struck with the similarity of the two cases, that I concluded to write up my case. Twentyfive years ago, a young woman, 24 years of age, called on me saying she was in trouble and wisht me to help her out; said she had mist two periods. After questioning her for some length and failing to elicit any symptoms of pregnancy, I proposed to examin her, to which she freely consented. I examined her very thoroly, but could find no signs of pregnancy. On weighing the case carefully in my mind I concluded that her mental strain had caused her to cease to menstruate, and told her I did not think she was pregnant, and explained to her fully my diagnosis of her case, and told her to quit worrying and she would come around after a while. After talking with her for some time she seemed to be satisfied and said she guesst I was right, but she wanted to know just when she would come round. I told her I could not tell as to that. I told her that the condition of her mind acting on her nervous system had caused her menses to stop, and that she would have to dismiss the thought of her being pregnant before there could be any change. She finally went away after promising she would think no more about it.

Well, to make a long story short, she returned to me at the end of every month up to the eighth month with no change in her condition, saying she knew she must be pregnant or she would come round. I examined her every month and tried in every way to convince her of the true state of affairs, but she would go away seeming satisfied until the next month, then she would come again. This continued to the end of the eighth month; at that time I tried in every way to dissuade her, finally showing her that she was smaller in every way than when she first came (she had become very much emaciated by reason of worry and a lack of food). She went home as usual. At the end of the ninth month I lookt for her, but she did not come, but two weeks after she called and told me that at the end of the ninth month she came round normally.

In conclusion, will say I kept track of her for some months, and she was, so far as I could learn, a perfectly normal woman. She married in about a year and a year after gave birth to a healthly child. I have no knowledge of her since. I regard this as a most remarkable instance of the influence of the mind on the reproductiv organs. Franklin Grove, Ill.

W. C. SMITH, M.D.

445,

Electric Treatment of Menorrhagia. EDITOR MEDICAL WORLD:-On page November WORLD, Dr. H. H. Schultz asks suggestions regarding a severe menorrhagia. May I add one suggestion to the splendid ones the WORLD has given? Use galvanism.

Technic: A Goldspoon electrode is well wrapt with cotton and covered with a gold-beater's condum. Saturate with normal salt solution, lubricate with KY or any non-greasy lubricant, attach to the positiv pole of your battery and place in vagina in Douglas' cul de sac. Place the negativ pole, a large pad, on the abdomen, and turn on 15 to 45 milliamperes for fifteen or twenty minutes. Let the amount of your current be

limited by the tolerance of the patient. Give treatments on alternate days. Following the next regular period you will have one of the most grateful patients you have ever treated. This is not original. International Falls, Minn. M. E. WITHROW.

Intact Hymen at Childbirth.—Metz Auto. EDITOR MEDICAL WORLD:-I have recently had a case of obstetrics with the hymen intact. There was a hole in the hymen about the size of a lead pencil. The hymen had to be cut for about three inches before the twins could be born. The membrane was about as thick as a bladder. I report this case on account of its rarity.

Please let me hear from "the family" in regard to Metz autos. I want to try one and would like to find out all I can before buying. Write direct to FRANK NISBETT, M.D.

me.

Brookland, Ark.

The Climate of Florida.

EDITOR MEDICAL WORLD:-Anent all the discussion still going on in some of the medical journals, I would like to add my mite. One-half of my thirty-eight years has been spent in Florida, and the rest from Rhode Island in the east to Illinois in the west, and as far in the southwest as Arkansas and Oklahoma, with a residence of a few years in each of the several states mentioned, as well as Pennsylvania and New Jersey.

Without having any bias, I have never found a climate that I like as I do that of Florida, nor a climate in which, for the sake of health, I would rather my family of one girl and three boys should grow up, tho there are redeeming features about all the different climates I have tried.

There is much good land in Florida that will produce over $150 to the acre, as, for instance, the land around Hastings, the great potato town.

Here in our locality, east of the St. Johns River, the tubercular patient who is amenable to any form of treatment responds to climate readily, and by living here the year round adds several years to his life.

The worst enemy Florida has is the dishonest real estate agent, and he certainly has given us a black eye in the North. Nevertheless, the truth remains the same, that nowhere in the United States can the poor man make a living easier or on a smaller piece of "sand."

It should also be emphasized that no prospectiv settler should buy without personally investigating, nor buy land unless he has from $300 to $500 to "go on" till returns begin to come in.

I have no land to sell, but will be glad to answer questions from anyone. Welaka, Fla.

Pellagra.

D. C. MAIN, M.D.

EDITOR MEDICAL WORLD:-As I received several letters from different doctors about the pellagra patients I made mention of in August WORLD, page 331, Monthly Clinic, will answer them thru THE WORLD by report of cases. One died, lady about 65 years old. Had been sick for about eight years. She went deranged before she died.

Another case, man about 50 years old, says he never was well long at a time. Suffered at different times with stomachache, but for the last five years has been having an excoriation on back of hands like a sunburn, that would not heal very well.

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