restore her general health; and to restrain the bleeding, cold water, containing lead, zinc, and other astringents, was injected twice a day: she was also confined to the sofa. The treatment was persevered in for a month, with the effect of improving her health, but not relieving the pain in the bowel, or diminishing, in any sensible degree, the hemorrhage. It was, therefore, determined to apply nitric acid to the morbid tissue. The bowels having been thoroughly freed, and the mucous membrane made to descend by the administration of an enema, concentrated nitric acid was applied to the diseased part, which was afterwards smeared with oil, and the intestine replaced. An opiate was administered; the patient experienced but slight pain after the operation, and slept well at night. On the third day she had some castor oil; when the bowels acted she felt some smarting, but no hemorrhage occurred. She was directed to inject four ounces of cold water, containing eight grains of sulphate of zinc, night and morning. In rather more than a fortnight all local disease had disappeared by the use of tonics, attention to the bowels, and taking exercise, she regained her health, the leucorrhoea ceased, and the catamenia reappeared at proper intervals.

Internal hemorrhoids; the patient upwards of eighty years of age; successful treatment by nitric acid; irritability of the bladder; phosphatic urine.

A gentleman, upwards of eighty years of age, applied to me, in 1854, complaining of a sense of fulness in the rectum, and a constant desire to defecate: he stated that whenever he visited the closet he lost a small quantity of blood, and that a protrusion of the bowel took place; he experienced no difficulty in returning it,. but it often descended when he walked. He had tried several forms of mechanical appliances to retain the bowel in its position, but they failed in the intention, and only occasioned him uneasiness and annoyance. Making an examination, I found two hemorrhoidal tumors prolapsed: their surfaces were florid and granular, and one tumor was slightly ulcerated; the lower part of the intestinal canal was loaded with scybala; the pouch of the rectum was much dilated, and appeared to have little power of

contracting. The prostate gland was indurated and slightly enlarged; his urine was alkaline and thick. I first directed attention to unloading the bowel, which was effected by aperients and enemata; and afterwards restoring tone to it, by the administration of small doses of strychnia, and the use of astringent injections. These objects being accomplished, but the bowel continuing to descend, and my patient being much troubled by the sense of fulness in the rectum, I applied the concentrated nitric acid to the hemorrhoidal excrescences; the pain it occasioned was so slight that no confinement was necessary. On the third day after the operation, the bowels were moved by medicines, and their action was attended with considerable smarting: each succeeding day this was less, and in ten days all inconvenience from the hemorrhoidal disease was removed, and he has had no return of it since. On several occasions, the irritability of the bladder has tormented him much, the urine at these times depositing a large quantity of phosphate of ammonia, forming a tenacious mass adhering to the bottom of the chamber utensil. This condition was relieved by the administration of small doses of morphia and nitric acid, and washing out the bladder with water slightly acidulated with the same acid. This gentleman continued under my care till his death, in Nov. 1857. By washing out the bladder more or less frequently as the condition of the urine necessitated, by the use of aperients and tonics as occasion required, he was able to pass the time very comfortably, and to take exercise when the weather permitted.

Internal hemorrhoids; excessive pain; treated with nitric acid.

Mrs., æt. thirty-three, married; the mother of four children, the youngest three years old, of delicate constitution, has always suffered during her pregnancies from enlargement of the veins, and oedema of the legs; the bowels at those periods were particularly obstinate. . She has always been of costive habit, and has had constant recourse to purgatives, chiefly salines: during the period of gestation, she has also suffered from external piles. In 1848, she began to experience aching, weight, and fulness in the rectum; hemorrhage occurred at intervals, increasing in quantity as time rolled on. Pain in the bowel became very distressing.

When I was consulted (1850), she had not been able to leave the house for some weeks, and had been confined to the couch, feeling easier in the prone position. She was pale, nervous, and debilitated; the menstrual secretion had been scanty, and occurred at lengthened intervals: she complained of acute pain in the rectum, increased to a violent degree at stool, followed by hemorrhage of an arterial character. Her skin was dry, tongue flabby and furred, pulse small, urine scanty and high colored; appetite bad; it had previously been capricious, sometimes voracious; she had pain at the epigastrium, and flatulence; the abdomen was hard, and dulness on percussion in the course of the colon existed. Examining the rectum, it was found loaded with indurated fæces: on the right side, about three quarters of an inch from the margin of the anus, were two excrescences, each about the size of a fourpenny piece; their surfaces were florid and granular in appearance, and bled freely on the slightest touch. I proposed applying the concentrated nitric acid to the morbid tissues; but, it being necessary to unload the bowels and get the constitution into a better state, the following remedies were prescribed, and the patient ordered to remain in bed:

R Pilula Hydrargyri, gr. iij; Pulveris Ipecacuanhæ comp., gr. v; Extracti Glycyrrhizæ, q. s. ; ut fiant pil. ij, hora somni sumendæ.

R Pulveris Rhei, gr. xviij; Sodæ Potassio Tart., 3iss; Confectionis Aromatici, gr. x; Essentiæ Cinnamomi, vj; Aquæ Cinnamomi, 3iss. M. fiat haustus, primo mane sumendus.

& Decoct. Hordei, 3xix; Olei Ricini, 3j. M. fiat enema.

The remedies acted freely in the morning, attended with pain in the rectum and a considerable discharge of florid blood.

R Potassæ Citratis, 3j; Potassæ Nitratis, gr. xxx; Tincturæ Serpentariæ, ziv; Aquæ, 3vss. M. fiat mist.; sumat cochl. ij, ampla ter die.

The pills, draught, and enema were administered four times, the abdomen became soft, and the general health somewhat better; but the pain in the bowel continued, and hemorrhage occurred at each action of the bowels, which the injection of cold water failed to check.

On the seventh day after I first saw her I introduced a speculum ani, and touched the raised and granulated mucous membrane with

the strong nitric acid, using a piece of lint on the end of a probe: smarting was experienced at the time, but this soon subsided; an enema of four ounces of starch and thirty minims of liquor opii sedativus having been injected into the bowel. Ten grains of Dover's powder were administered at bedtime. She passed a tranquil night; on the third day the bowels were moved by a dose of castor oil, smarting was experienced at the time: she was directed to inject twice a day four ounces of water and eight grains of sulphate of zinc. In ten days the sloughs had separated, and the ulcerated surfaces nearly healed. The bowels were kept open by castor oil. In a few days more she was quite free from the local malady, but was still pale and weak.

The following draught was prescribed :

R Ferri Ammonio Citratis, gr. v; Potassæ Bicarb., gr. xij; Magnesiæ Sulph., 9j; Aquæ, 3xj; Syrupi, 3j. M. fiat haustus in actu effervescentiæ cum succi limonis cochl. amplo bis in die sumendus.

This medicine was continued for several weeks, and she went out every day for a walk, or in her carriage if the weather was unfavorable. Her health became better than it had ever been; the menstrual function was performed regularly, and was natural in quantity.

Internal hemorrhoids preceded by dysentery; great loss of blood; stricture of urethra. Hemorrhoids treated with nitric acid.

Major J, a tall, fine man, of a naturally good constitution, but impaired by a long residence in India and active military service; had suffered several times from dysentery; for seven years had had piles, frequently lost considerable quantities of blood, the bleeding at times continuing for half an hour: defecation was always attended with pain and much straining, the pain being aggravated when the fæces were bulky and indurated; the bowel slightly descended at stool, but returned by muscular contraction. He had had various remedies prescribed, as lenitive electuary and sulphur, copaiba, Ward's paste, etc., but without benefit. No examination of the bowel had been made by the several surgeons he had consulted. His countenance and con

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junctivæ were slightly yellow; tongue covered with a creamy fur ; skin dry; appetite moderate; had flatulence, and frequently felt fulness and pain at the epigastrium after eating; urine highcolored, and voided in a small stream, with some straining; slight tenderness over the liver on pressure; no enlargement of it indicated by percussion; pulse feeble and irritable. By examination after the action of the bowels, the mucous membrane being prolapsed, a florid granular surface, from which blood freely oozed, was observed; it was about the size of a shilling, and slightly raised from the surrounding tissue; it was very painful when touched the finger introduced into the rectum did not detect any tumor. The treatment adopted was at first small doses of mercury with chalk, and extract of taraxacum; aperients every second morning; subsequently tonics, with nitric acid, and various preparations of iron: enemata of cold water were used; afterwards astringent fluids. Examination of the urethra detected a stricture, through which a No. 3 catheter was passed with some difficulty; the introduction of instruments twice a week was had recourse to, the size being gradually increased, till the natural calibre of the urethra was restored. By perseverance in the remedies, his general health was much improved, the countenance became clear, the pain in the region of the liver subsided; but though feeling much better, the bleeding from the rectum continued. Having given medical treatment a fair trial without much benefit to the local disease, I deemed the application of nitric acid advisable. The bowels having been freely moved by extract of colocynth and blue pill taken at night, and an enema administered the following morning, the florid granular surface of the pile was exposed by a speculum, and freely touched with strong nitric acid, chalk and water being subsequently used to neutralize the excess of acid, and prevent injury to the surrounding tissue. After the operation, a dose of laudanum was administered. On the third day, the bowels were moved by castor oil; for some days subsequently he experienced smarting when at stool, but the pain gradually lessened. He was directed always to use enemata of cold water after defecating. It is now four years since I attended this patient, and he has not had the slightest return of any of the symptoms from which he previously suffered.