CARBOLIC ACID INJECTIONS IN THE TREATMENT OF PILES.

The purpose of this article is briefly to been inflamed, and caused much suffering direct the attention of the Profession to for months. The external, several in the value of carbolic acid as a remedial number, situated at the junction of the agent in the radical cure of haemor- skin and mucous membrane, were of rhoids. The frequency of the disease long standing, small, hard, projecting and the great dread of patients generally like vegetations and exceedingly sensi- to submit to any form oftreatment which tive ; these were removed with the scis- will subject them to a painful operation sors ; warm anodyne fomentations were and confinement to bed for two or three ordered locally to allay the tenderness, weeks, induces me to mention this simple and the following laxative: R. —Mag- method, which, in the great majority of nesise carb., 38s; magnesiee sulph., jjij; cases, will supersede the knife, ligature, potass® bitartrat, sulphur sublimed, aa nitric acid, and clamp, heretofore the gss. M. Ft. Pulv. S. a teaspoonful in usual remedies where there is considera- half glass of water once or twice daily if ble dilatation of the haemorrhoidal veins. necessary. The external trouble was Patients, rather than submit to an op- relieved in a few days, but at each evac- eration, content themselves with the uation, or in the act of coughing, an in- use of various cathartics, laxatives, flamed haemorrhoid would protrude and and astringent and anodyne unguents, cause acute pain, to return which I was which, without effecting a cure, fre- called several times. For several days quently give little or no relief. A tem- she declined to have anything done, porizing treatment, under which the assigning as a reason that a former phy- disease is usually aggravated, and finally sician who had treated her father ad- the victims, under the impression that vised her never to submit to an operation, the general practitioner of surgery does as it would be dangerous. The laxatives, not understand the treatment of the dis- unguents, suppositories, etc., etc., having ease, or that it is too insignificant to failed to give relief, and being assured elicit his special study and attention, that the operation was simple, without fall into the hands of advertising spe- danger or much suffering, and that it cialists, who promise a certain cure would give speedy relief, she consented. without the use of the knife, ligature or On the 27th of November, 1876, I caustic. The inconvenience and suffer- directed her to sit over hot water and ing caused by enlarged or inflamed allow the pile to protrude through the hemorrhoids, and the ready relief given, external sphincter; I then penetrated may be inferredfrom the following cases: the pile with the needle of the hypo-

Mrs. , aged twenty-six; married dermic syringe and injected ten drops six years; occupation seamstress,sewing of a mixture of equal parts of carbolic on a machine; spanoemic; has for a long acid and glycerine; the pile was then time been suffering from habitual con- returned ; the pain was not severe, and stipation ; she has had piles for ten soon subsided without any medication ; years—her father and other members of next day she was much better; the pile the family having suffered in like man- did not protrude; the fifth day after the ner—a hereditary disease; she had ex- injection she was discharged cured. ernal and internal piles, which had She then resumed her usual avocation. 4 Carbolic Acid Injections in the Treatment of Piles. I ordered her a teaspoonful, three times 6th of October, Clinic day, bo was again daily, of the elixir of the phosphates of presented to the united classes and dis- iron, quinine and strychnia as a tonic, charged. Ho suffered very little from gentle out-door exercise and good nour- the injection, and I was agreeably sur- ishing food. After treatment she be- prised at the rapid cure. Ho had two came pregnant—a primipura—and was relapses of dysentery and malarial fever confined without any return of the dis- at intervals of about two and three ease. Several years ago I treated her weeks after the last injection, but no brother for the same disease, who in- return of the piles. Ho was retained forms me that he has had no return. in the hospital until the latter purt of Lewis Everson, German, aged 45; la- November as assistant nurse in the borer; was admitted into the Louisville ward, to give him time to recuperate City Hospital in July, 1877, with acute his health, and to observe the result of dysentery and intermittent fever. The his cuse. He had no further rectul latter part of August he was transferred trouble. His fover was controlled by to the surgical ward to be treated for sulphate of cincbonidia; after the par- frost-bite of the two great toes, which oxysms were interrupted he was ordered had been frosted two winters previous. ferrum dialysatum twenty drops three The toes were removed by a member of times a day at meal time, sulphate cin- tho Surgical Staff 31st of August. chonidia five grains three times a day When I took charge of the ward, Sep- after eating, and special diet. While in tember 1st, I found him weak, debili- the surgical ward tho attacks of dysen- tated and feeble, still suffering from tery were treated as follows: 14.—Bis- recurrent attacks of dysentery and muth subcarb., ; saccharuted pepsin, intermittent fever, and hoemorrhoids morph, sulph., grs. ij. M Ft. which were much aggravated by the Pulv. No. viij. S. one powder every inflamed condition of the rectum and two or four hours pro re nata; anodyne frequent straining at stool. By the 27th injections to control the straining; diet of September he had partially recov- chiefly boiled sweet milk, with one table- ered from his complication of diseases, spoonful of wheat flour added to each and was anxious to have something pint. This case I consider an excellent done for the piles, which came down test of tho value and efficacy of tho car- when he walked or was at stool. There bolic acid treatment in hjemorrhoids. were four large internal hemorrhoids, Here was a man who had been pros- which, when protruded, formed a nodu- trated with a complication of diseases, lar circle around the mucous mem- enfeebled, amcmic, his system poisoned brane of the rectum. with malaria, who, for more than two On the 29th of September, in presence years, had been suffering with ulcerated of the medical classes, I injected two of frosted toes, and laboring under all the the hemorrhoids with tho following: inconveniences of an impecunious man. Carbolic acid, ji; aque distillat, ji; The advantages of this treatment over glyceiin, ji. M. Of which ten or the ligature are made manifest by com- twelve drops were injected into each parison. August 31, the day before I took of two piles. On the 1st of October I charge of the surgical ward, a patient examined him, and found that the two about the same age had been ligatured injected piles had contracted and ulmost for piles; the ligatures came away from disappeared; I then injected the two the sixth to the tenth day, but he suf- remaining ones with the same injection, fered much pain ; tho ulcers left after and equal quantity as before; by the the separation of the ligatures healed Carbolic Acid Injections in the Treatment of Piles. 5 slowly, and he did not recover for at operation is completed. The acid acts least two or three weeks after the patient as an astringent, antiseptic and anti- I operated on a month later was well phlogistic. No inflammation occurred and doing duty in the ward. For the in either of the cases referred to; but injection of haemorrhoids, carbolic acid should it occur, use opiate suppositories, has been combined with sweet oil or hot fomentations to the anus, keep the glycerine. At first I used carbolic acid patient quiet and nourish with extract and glycerine, equal parts, but I found of beef and milk for a few days; give this combination too thick to flow freely quinine and tr. ferri mur. if indicated. through the needle of the ordinary After recovery the patient should be ad- pocket hypodermic syringe. By having vised to avoid constipation, drastic pur- a needle made longer and larger in cali- gatives, to use nourishing diet—meats, bre it would answer the purpose very vegetables, cereals and fruits—a mixed well. When I used equal parts of water diet, but not too great a variety at any and glycerine with the carbolic acid the one meal; it should be partly of a -laxa- solution flowed easily through the com- tive character. If the bowels are slug- mon hypodermic needle. Where the gish, aid peristaltic action by drinking a haemorrhoids are recent and the walls of teaspoonful of common table salt in half the veins not thickened, I use equal a pint of water one hour before breakfast, parts of the carbolic acid, glycerine and or the same quantity of some of the distilled water, shake well for one or natural laxative mineral waters; these two minutes and you have a clear, uni- are both prophylactic and curative; the ” form solution. Where the haemorrhoids “ Tamar Indien will act well where are of longer standing, the walls of the the patient can afford to buy them. An veins thickened and the connective excellent, pleasant and palatable laxative tissue infiltrated with plastic material, in the treatment of piles or habitual the result of adhesive inflammation, I constipation is the compound liquorice use two parts of the acid and one each powder of the “ Prussian Pharma- of the glycerine and distilled water. copoeia;” viz.: R.—Fol. senna pulv.,

Before operating, the patient’s bowels gij ; radix liquorice pulv., ; foeniculi should be evacuated by a mild laxative sem. (German) pulv., ; sulphurus —magnesia or castor oil answers the depurati, gi; sacchara alb. pulv., purpose very well, aided, if necessary, M. S. a teaspoonful in a wine glass of by a warm water enema—then direct water pro re nata. the patient to sit over a tub of warm There are many other laxatives which water to relax the sphincters and pro- the peculiarities of each case will sug- trude the piles; draw from ten to twenty gest. Rubbing the abdomen once or drops of the acid solution, according to twice daily with salt and water, and the size of the tumors, into the hypo- kneading thoroughly with- the hands dermic syringe, pass the point of the will often produce the desired result needle through the most prominent part without any internal medication, pro- of the hajmorrhoid well into the cavity, vided the patient can be convinced of then slowly inject the fluid, and hold it the efficacy of this kind of manual for a minute or two before withdrawing. manipulation, and is not too indolent A few drops of blood will flow from the and indifferent to faithfully carry it out. puncture, which is readily arrested by System has much to do in relieving pressing over it a dossil of cotton wool; constipation; have a regular hour of the after the injection is completed return day to go to stool, lay aside all else, the pile within the sphincter and the punctually attend to this duty, and the Carbolic Acid Injections in the Treatment of Piles.

peristaltic action of the intestinal canal dilated, accompanied with general con* will keep time as accurately as tho works gestion, givo such, laxatives, tonics, and of a twenty-four hour clock, provided alteratives as each cose suggests. Lo- the good house-wife winds it up daily cally use enemas of water, or water and at the appointed hour. In cases of glycerine, or muciluge incorporated with general debility give some of tho bitter persulphato or perehloridoof iron, or the tonics with iron in some form; plenty vegetable astringents, udding in pain- of sunlight, well ventilated apartments, ful cases an anodyne of hyoscyamus, suitable clothing and open air exercise. belladonna, stramonium or opium. If For patients of sedentary habits or in- there iB much tendorness and irritubility, door life prescribe a journey to the enemas of subnitrato or subcarbonate mountains, hunting, fishing, or a visit of bismuth or carbolic acid in mucilage to some of the watering places, lay or glycerine and water will have a study and brain work and sedentary happy effect, to which an opiate may be habits aside, seek cheerful society and added when indicated. The enemas recreation, forgot the old infirmity and should be small, not rnoro than ono or it will forget you. Pationts are prone two ounces, if largo tho distension of the to neglect little things which, if looked rectum will cause peristaltic action and to, will keep them well; they must be discharge of tho enema. Cotton wool impressed with the fact that tho body saturated with a solution of the persul- is like a piece of complex machinery, phate of iron has a good effect, especially nicely adjusted and adapted in all its in bleeding piles. Tho injection into parts for its work; but to keep it so, it the cavity of the diluted veins of a so- must bo daily watched and cared for. lution of the persulphate or perchloride A few words in regard to the general of iron or ergot is dangerous, a portion treatment of piles. The special treat- of the cohgulum formed may at uny time ment of individual cases must be gov- be detached, carried into tho circulation erned by the causes; these are local or and produce embolism. Of luto years temporary and'constitutional or organic; I have generally used theso various of the former we have drastic purga- local remedies alone or combined, in the tives, habitual constipation, dysentery, form of suppositories by incorporating constant riding on horseback, standing, with cocoa butter ten or fifteen grains or sitting in a constrained posture, por- to each suppository, and direct one to tal congestion, pregnancy, etc.; of the bo used two or three times a day as re- latter, organic disease of the stomach, quired. If tho patient can not readily liver, heart, or lungs, abdominal tumors introduce the suppository, order a sup- which interfere with venous circulation. pository syringe, which can bo passed In the former a radical cure may be ex- into the anus, and deposit it at the pected, in tho latter only temporary proper place. I have never been partial relief, or if cured, other branches of the to the nitric acid treatment; in the flat hemorrhoidal veins will, from continu- variety of hemorrhoids with broad base, ance of the cause, become dilated and thickening of the mucous membrane reproduce the disease. Where the cause and enlargement of the mucous papillae, is local, and the veins not too much dis- it might be used with advantage, but tended, general treatment with injec- whero the veins are much distended and tions of hot or cold water, according to the tumors well defined, I would not use the feelings of the patient, is all that is it; the ligature is much to be preferred. necessary. Where the disease is of In external piles, where they are pedieu- longer standing, and the veins much lated with small base or like vegetations, Carbolic Add Injections in the Treatment of Piles. 7 clip them off with scissors or scalpel; other surgical cases, and are in them- where they are tense with large base, selves, neither dangerous nor fatal. Any soft and fluctuating, puncture and press surgeon ofgood common sense and judg- out the blood; where they are hard and ment who is posted in his department, firm from thickening of the vein walls is as competent, yes, more competent, to and blood-clot, lay open ttith a bistoury treat this class of cases than the great and press out the blood clot, then apply mass of specialists who flood the country compresses; if tender and inflamed, use and cities with their fulsome circulars hot fomentations and a T bandage. If guaranteeing a certain cure, and certify- the walls of the veins and connective ing that no patient has ever died in tissue havh, from repeated inflammatory their hands—never died—for the good action, become consolidated and form reason that a patient about to die of hardened ridges or tumors, incise the some organic complication is always ad- skin and dissect out the hardened tis- vised to go home and recuperate for tues, then close the wound and dress to death; the so-called doctor of secret get union by first intention. This treat- remedies, known only to himself, has ment has been much more satisfactory the fat fee in his pocket, the deluded than the local use of leeches for deple- and confident patient never returns, or tion and astringent unguents. This is if too feeble to leave, he is abandoned very briefly an outline of my treatment to his fate. for haemorrhoids prior to the use of the That there is a wide-spread prejudice carbolic acid injection. I have had no against the surgeon’s treatment of piles experience as yet in the treatment re- among the populace and even doctors, commended by Mr. H. A. Reeves, of the I am sorry to say, can not be denied London Hospital, which he calls “ the This is probably due; first, to the old- immediate cure”; it consists in punctur- time treatment of excision by the knife ing the pile to the base with a conical- and application of the actual cautery, pointed wire heated to a dull red heat; to arrest htemorrbago, which has long the number of punctures are governed since been abandoned. Second. The by the size of the pile. ethics of the Profession prevent the sur- The common diseases of the rectum, geon from advertising in the secular viz., fistula, fissure, ulcer, and piles, the press and by circulars, giving certificates latter by far the most frequent, from and names of prominent patients cured, some one of which few persons in a life- which reach the populace. Third. The time escape, have, from some unaccount- general practitioners, whose time is ab- able reason, been considered the oppro- sorbed in the study and treatment of bria of surgery. Why should this be medical cases, do not advise their pa- so? Why is it that the last two inches of tients to consult the regular surgeons. the nether extremity of the alimentary Fourth. The advertising specialists are canal, a plain piece of tubular anatomy, bold and confident, if they do learn closed by two small muscles, always what they know at the expense of the ready to open at nature’s call, supplied patient. They guarantee a cure with- and nourished by the inferior hsemor- out the use of the knife, ligature, or rhoidal artery and connecting veins, caustic, consultation free, and fifty, one should be the prey of advertisers and hundred or two hundred dollars in ad- specialists? The diseases are readily vahce, or negotiable notes. This means recognized by digital or specular exam- business; it is the charm; it fixes the ination, very amenable to treatment, patient; no knife, no ligature, no cautery, much more easily cured than many secret remedies, known only to the ad- 8 Carbolic Acid. Injections in the Treatment of Piles. vertiser; the old Indian dodge—money spect, stating that ho wished to see an and in advance, never returned, cure or no article on tbo uso of carbolic acid cure. From these and other causes not sweet oil in the treatment of piles. 1 necessary to mention, the mass of rectal stated that I had not read the article re? diseases are treated outside of the regu- ferred to, but I had seen the treatment and lar Profession. The patients pay enor- briefly mentioned in other journals, mous fees, are satisfied in the belief that that I had, for more than a year, been the regular surgeons know nothing of using the acid and glycerine. He then the remedies used, and that a mystery stated he was a regular physician, had enshrouds the outlet of the rectum un- practiced in Kentucky for scvoral years, known to ordinary mortals. had been unable to attend to general For two or three years past the injec- practice, his means were well nigh ex- tion of carbolic acid and oil or glycerine hausted, had a family to support. In to has been extensively used as a secret looking around to find sorao way remedy. In portions of Illinois, Indi- make a support, he heard of this secret IIo ana, Tennessee, Kentucky, and other remedy for the treatment of piles. the States, the right to use it in a prescribed consulted some of his friends about territory has been sold for sums of propriety of giving fifteen hundred dol- money varying from five to fifteen hun- lars for the secret remedy and a specified dred dollars, each purchaser being sworn territory to operate in. Among those to secrecy. Doctors, farmers, trades- friends was a prominent practitioner of men, and sharpers, who could raise the this city, who advised the invalid doctor “ wherewith,” have left their legitimate to make the purchase. The purchase business and gone forth, armed with a was made, the contract drawn, the hypodermic syringe and a bottle of car- papers duly signed, the secret imparted, bolic acid and sweet oil to slay the rec- the territory assigned, and when the tal piles and gobble up a golden fortune. victimized doctor reached the field of The discovery of valuable gold mines operation, he learned, to his astonish- in the rectum is of comparatively recent ment, that the secret was public prop date; the hypodermic syringe is more erty. The object of his inquiry of m« easily wielded than the pick and the was to get sufficient evidence against the shovel; no danger of Indians there and party in this city who had sold the al- no scalps lost. Only a few days ago a leged secret remedy, to institute suit for prominent druggist informed mo that obtaining money under false pretenses an illiterate countryman, in Kentuck and compel the return of the money. jeans, purchased bis outfit and inquired Now if a regular practitioner, whose if the oil would pass through the hypo- locks have been silvered in the service, dermic needle. When asked what use who claims to observe the proprieties he would make of the hypodermic of the profession, who is tenacious for syringe and acid oil mixture, he replied : its honor, will volunteer such advice, •‘Gwine to practice medicine; right smart will encourage such arrant quackery, sprinkling of piles whar I live.” A sad what can the profession hope for? If case of this territorial selling deception men of influence sanction advertisers came under ray own observation: A few and secret nostrums, what becomes of months ago an intelligent-looking gen- medical ethics? This man is a teacher tleman, in delicate health, a stranger to of medicine; what an ignoble example me, called at my office and inquired for to place before the rising generation of a certain number ofBraith waite's Retro- doctors. O temporal O moresII