ing power to the free return of the venous blood, and knowing that belladonna is extensively used in America during the last days of gestation for dilating the os uteri, I, as she was then suffering a good deal from the bleeding internal pile, put her on two minim doses of the fluid ext. belladonna, ter die. A cure was effected in less than a week. I, however, continued the belladonna to the period of her accouchment, and I certainly think it facilitated her labour.

For the external pile the grease which runs from the hot bearings and eccentrics in the engine-room of a steamer when under steam, will be found an unfailing remedy. Chemically considered, it is rather complex in composition, and may be presumed to be a combination of the fatty acids and oil, used as lubricating materials, with the oxides of the more oxidisable metals exposed to friction. By the bearings are meant the fixtures in which the shaft works. They are made of brass and lined, to a certain extent, with a patent metal, composed of copper, tin, and antimony, or of zinc, lead, antimony, and platinum. The shaft is formed of wrought iron, and the brass is composed of copper, zinc, and tin. The bulk, however, of the metals oxidised, judging from a rough analysis I made, is formed of the copper and lead. There was hardly a trace of zinc, and none at all of the others found in a drachm of the ointment.

66 save

As the liquefied grease drips from the bearings, it is caught in a all," and on cooling is fit for use. It should be mixed with one-eighth its bulk of lard. It then forms an ointment of a pale blue colour, the efficacy of which is so well-known to the stokers that they treat, sub rosa, nearly all the cases of piles that occur on board ship. A chief stoker of my acquaintance told me he had treated successfully over fifty patients. He used it indiscriminately for all kinds of piles. From my own experience, I can only vouch for its utility in cases of the external or intermediate varieties; but lately I treated a stoker with it whose anus was festooned with marisco, without putting him on the list or getting him excused from duty. He was rid of his garnitures in about a fortnight. It proved equally efficacious in the case of a jockey from the United States, who suffered from the internal, fleshy, and external piles during a number of years, and who had to resign his occupation in consequence. It is needless to say this man had numberless remedies recommended, but cui bono? His occupation was gone, and could not be pursued until the ointment gave their congé to his unwelcome guests.

For the varieties of internal hemorrhoids which come under the third heading, the castor-oil and belladonna, administered by the mouth, and the ointment applied locally, will usually suffice. How the ointment acts I can only conjecture, but can recommend it with confidence as safe, efficacious, and productive of but very little pain. It will, I think, be generally found that if nature dispenses afflictions to the human race with her left hand, she showers their panacea on us with her right; and if she sends sickness and disease in our midst, she also places their remedies within our reach, and leaves us to find them. To the Bolivians, for their various calenturas, she has given the Calisaya. If the bothriocephali find a commodious habitat in the dura ilia of the vassals of Theodorus, or perhaps in those of his sable majesty himself, has not nature drawn up a process of ejectment in the flowers of the Brayera Anthelmintica, which will not endanger the life of a bailiff to serve? Do not the natives of the West Coast of Africa, when suffering from dysentery, find its specific in the fruit of the banana, prepared secundum artem, and found growing in the greatest profusion? and could she be less bountiful to stokers? No; if she permits the heat of the stokehold to festoon the anus of the stoker, she also prepares in an impromptu laboratory, in which the shaft and bearings, converted into a pestle and mortar, rub up the lubricating materials, and by means of heat, friction, and the atmosphere, produce an unguent calculated to remove his questionable decorations-one which, to use the language of an enthusiastic stoker whom it recently quit of such appendages, "is worth its weight in gold!"-Medical Press and Circular, June 10, 1868, p. 497.

LVIII.-11

60.-EXTRACTION OF A SEWING NEEDLE FROM THE RECTUM 5 DAYS AFTER IT HAD BEEN SWALLOWED.

Case under the care of Mr. HULKE, at Middlesex Hospital.

Slender, flexible, though strong objects, as small fish-bones, commonly enough traverse the alimentary canal when swallowed and are voided per anum; the same not uncommonly happens when a pin is swallowed. Needles frequently pierce the walls of the canal, and produce grave results. An instance of this, where a needle pierced the aorta and gave rise to fatal hemorrhage, was reported not long since from this hospital.

In the following case, however (for which we are indebted to Mr. Thomas Flower, Senior House Surgeon), the needle did not cause any inconvenience till it reached the rectum, where its arrival was marked by extreme pain. A man, aged 37, came to the out-patient room January 17th, 1868, stating that five nights before, while drinking a pot of beer, he felt something scratch his throat, but he had not thought anything more of it. He complained now, however, of pain in the lower bowel, so severe that he compared it to a stake being thrust into him. It had come on suddenly the night before, without any assignable cause. No fissure on the verge of the anus or other cause calculated to produce such suffering could be seen, but at the depth of the forefinger what was at first thought to be a pin could be just felt. sphincter ani was so spasmodically contracted and the examination so painful, that the foreign body could not be removed without chloroform, under the influence of which a slender three-bladed urethral speculum was passed, and a sewing-needle with a loop of thread was removed with forceps. One end of the needle was sticking in the gut, while the other end was free and directed upwards. A little soreness continued for a few days, after which no more inconvenience was felt. -British Medical Journal, July 4, 1863, p. 7.

The

61.-ON SOME NEW METHODS OF TREATING DISEASES OF THE CAVITIES OF THE NOSE.

By Dr. J. L. W. THUDICHUM.

I. The Medical Lantern.

Those who have tried sunlight for the inspection of the nose or larynx, and compared it with the light given out by oil-lamps specially adapted to the operation, and provided with complicated condensers, must have come to the conclusion that the latter are relatively useless. At all events, my own practice soon made me dissatisfied with such arrangements as Tobold's lamp-instruments which I found top-heavy and unstable, and whose horizontal beam of light did not satisfy my demands for inspection, much less my requirements for illumination during operations. I therefore established a platform before the window of my consulting room, in order to be able to utilise sunlight, thrown into the room by means of a heliostat, on all practicable occasions. Some diagnoses and operations which I had opportunities of making by the aid of this light, and which I am convinced could not have been made with the aid of an oil-lamp, however artfully devised, caused me to construct the following adaptation of Drummond's light to medical purposes :

A small lantern carries the arrangements which are required for the production of the spirit-oxygen-lime light. The glass spirit-lamp is screwed into the bottom of the lantern, in order that the level of the spirit may be always accessible to the eye. The rest of the arrangements, including an annular ditch round the burner, to be filled with water intended to cool the burner, are inside the lantern. The oxygen is supplied from an iron bottle underneath the lantern, in which it is contained under pressure produced by the condensation in it of several atmospheres of gas. A delicate screw-valve, moved by a lever, easily regulates the flow of gas. The bottle and lantern are fixed to a stand, being a brass rod screwed in a heavy circular iron plate.

Any position can be imparted to the lantern by means of the ball-and-socket joint on its attached side, and the screw sliding clamp, which fixes it to the rod. The light passes through a system of condensers in front of the lantern, and can be brought to a focus at any desired distance by the sliding arrangement of the bottom of the lantern which carries the light. The instrument, including the compressed gas, is manufactured and sold by Mr. John Orchard, optician, of Kensington.

The lantern in this form is eminently practical. It is easily lighted: a match inflames the spirit, the lime is fixed by its side, the oxygen is turned on, and within a minute or two a splendid beam of light is projected from the condensers. The direction of the beam is readily adapted to the requirements of the operator. For laryngoscopy and rhinoscopy he carries the concave mirror on his forehead over a screen, which, as the light comes from above, can be so adjusted as to completely protect the eye from any incident rays, and leave it all its pupillary space for the inspection of the illuminated cavities. The lamp is put out as easily as it is lighted: the oxygen is turned off; the lime-cylinder buried in lime-powder in a suitable receptacle; the spirit extinguished by a brass cap which fits into the water-ditch. The amount of gas in the bottle can always be controlled by a pressure gauge to be screwed on to the top of it. A full reserve bottle is always kept in store, and an empty bottle is at any time refilled by the maker. I pronounced this apparatus (which I exhibited last year at a conversazione at the Royal College of Physicians, and which I have now tried on many occasions during nearly two years), to be perfect, and greatly to be recommended to the profession, particularly for application in hospitals, but quite as suitable for the consulting room of either physician or surgeon.

II. Rhinoscopy and Nasal Specula.

Hitherto the inspection of the nasal cavities from the side of the pharynx, choanoscopy, has been practised much more systematically than that through the nostrils. This has asisen through the impetus given to laryngoscopy, of which rhinoscopy was considered to be a mere appendix. But the neglect of what, in contradistinction from posterior rhinoscopy or choanoscopy, I will term anterior rhinoscopy, is mainly due to the remarkable circumstance, that there were no proper specula by means of which this operation could have been accomplished. The only speculum I could find in the shops bore the name of Liston, and was not suitable for my purpose. I therefore constructed a series of specula to suit many cases and requirements, and ultimately retained the following forms as highly practical:

Two valves are held together by a spring, and when compressed form a canal of oval bore, about in. in length. The valve which expands the ala is from in. to in. longer than the valve which is placed against the septum. This latter inner valve should never be long enough to reach the sensitive part of the mucous membrane of the septum. It follows from this that each nostril requires its own speculum. There must therefore be for each case a right and a left speculum. As the nostrils of different persons vary greatly in size, different sizes of pairs of specula must be at hand in practice. The speculum is inserted into the nostril while closely compressed; the moment the spring is liberated the nostril is fully expanded, and if the operator now draws the spring, which serves also as handle, upwards, the cavity of the nose can be fully inspected. The speculum; therefore, is designed exclusively to expand the atrium or membrano-cartilaginous part of the nostril; if it were allowed to enter beyond this, and to reach the isthmus formed by the unyielding cartilaginous septum and the nasal margin of the ascending branch of the upper maxillary bone, it would cause pain, and narrow by its own thickness this small passage. The new specula, several sets of which have been made for me by Messrs. Weiss, cause no pain, widen the atria to the utmost extent, and admit of the introduction through them, into any part of the nose, of instruments necessary for slight, delicate or severe operations.-Lancet, Aug. 22, 1868, p. 243.

62.-ON THE OPERATION FOR NASAL POLYPI.

By Dr. J. L. W. THUDICHUM.

The operation for nasal polypi, as hitherto practised in all countries, consisting as it did in the tearing out of these growths by means of a pair of forceps, has always, and more particularly when I was obliged to perform it myself, appeared to me one of the most barbarous proceedings of surgery. The bruising and general injury to the nose were very great; one or other of the shell bones was mostly broken; the bleeding was always profuse; and the suffering of the patient was so extreme that it required the greatest energy on his part and on that of the operator to enable him to endure to the end. Very commonly the patient and operator had the mortification of finding the polypi to grow a second and a third time, or to relapse even more frequently than that; many persons who had had one taste of the operation dreaded its repetition, and kept their polypi. The operation could not be ameliorated so long as the instrument used for it filled the entire introitus of the nose-so long as the blades of the forceps, however thin they might be, had to be opened in a narrow and unyielding canal-so long as the objects to be seized could not be seen at the time of seizure. A usual result of the proceeding was that small polypi were jammed up into the narrow parts of the cavity, and were thus made the certain origin of subsequent growths, or so-called relapses. In almost all cases the sense of smell, which had been only impaired by the polypi, became totally lost after the operation. I therefore threw aside the forceps altogether, and endeavoured to apply the electro-caustic method, which had not heretofore been used for this operation, and was rewarded with the most perfect success. Indeed, operations in the nasal cavity may now be made to vie in delicacy with operations upon the eye, and the opprobrium so acutely felt by most surgeons with whom I have had an opportunity of conversing, is now removed from this chapter of science, and from this drawer of the surgical armamentarium.

Besides the medical lantern and the specula it requires the following apparatus:

1. Platinum-wire, loop-carrier and pully, with handle. The loop-carrier must be so thin that, while it is in the nostril, the eye can see the interior of the nasal cavity. It is therefore made of two very thin gilt brass tubes, isolated from each other by a layer of unspun silk wound round the tubes and varnished with shellac. The part of the loop-carrier which during the operation remains outside the nose is so bent aside or downwards that it is neither in the way of the eye nor in that of other instruments. This loopcarrier is fixed in the conducting handle, which bears the windlass. The handle and windlass which I used are copied from Middledorpf's instrument, made by Pischel of Breslau, exhibited in the last London Exhibition, and now in the possession of St. Thomas's Hospital.

2. An electrical battery of five large Grove's elements, mounted in the best style, with platinum plates and gilt incorrodible connexions. The power yielded by such a battery is sufficient to make any necessary length of platinum wire white-hot; it is serviceable for all other electro-caustic operations which occur in surgical practice; and such a battery has therefore, at St. Thomas's Hospital, taken the place of the much too powerful and unwieldy, and in the working much less economical, instrument supplied with the Exhibition instruments from Breslau.

3. Connector and conductors. Formerly, wherever the electro-cautery was applied the services of a special assistant were required to establish the connexion and let the current pass. This was so highly inconvenient that I had an instrument made by the aid of which the operator could at any time make and interrupt connexion by means of his foot. In the engraving the right foot of the operator is in the act of pressing down the button fixed in the end of the board on which the battery stands, and on the under-side of which the circuit is by this action established. A spring in connexion with this button is made of such strength that the mere weight of the foot does not bear it

down; it is necessary to put the foot strongly on the button in order to establish connexion.

We will now suppose everything to be arranged; the lantern burns brightly, and the mirror fixed over the shade before the eyes of the operator throws a brilliant light into the nasal cavity of the patient; the head of the patient is resting against the assistant, who steadies himself by means of his left hand on the back of the chair, and with his right holds the speculum upwards, resting his thumb gently on the patient's forehead; the loop of soft platinum-wire is introduced into the carrier, and connected with the windlass; it has been white-hot a moment before, and is now cool again. Everything is ready, and the operation proceeds. The platinum loop is passed over the polypus; it is then constricted round its pedicle by means of the windlass; connexion is made with the foot, and after a slight hissing noise indicating the burning off the pedicle of the polypus, the growth, mostly yet attached to the platinum, can be withdrawn from the nose entire. There is usually no bleeding, and the place where the polypus was attached is marked by a white stripe or spot. The patient has suffered some irritation from the instrument, and perhaps been obliged to sneeze, but after the use of his pocket handkerchief is quite ready to proceed to the extraction of the next polypus.-Lancet, Sept. 5, 1868, p. 307.

63.-ON THE TREATMENT OF CORYZA, OR NASAL CATARRH, BY A TOTAL ABSTINENCE FROM LIQUID."

By Dr. C. J. B. WILLIAMS.

[Dr. Williams in the article " 'Coryza," published in the Cyclopædia of Practical Medicine in 1833, after giving the usual treatment by aperients, diaphoretics, and diluents, adds:]

"It is the acrimony of this discharge (from the pituitary membrane) which reacts on the membrane and keeps up the inflammation and its accompanying disagreeable symptoms. On this circumstance depends the efficacy of a measure directly opposed to that just noticed, but to the success of which we can bear decided testimony-we mean a total abstinence from liquids." "This method of cure operates by diminishing the mass of fluid in the body to such a degree that it will no longer supply the diseased secretion." The coryza begins to be dried up about twelve hours after leaving off liquids; from that time the flowing to the eyes and fulness in the head become less and less troublesome; the secretion becomes gelatinous, and between the thirtieth and thirty-sixth hour ceases altogether. The whole period of abstinence needs scarcely ever to exceed forty-eight hours."— British Medical Journal, June 6, 1868, p. 554.

URINARY ORGANS.

64.-ON LITHOTRITY.

By Sir HENRY THOMPSON, Bart.

[The history of the instruments employed in lithotrity is interesting. The instrument in present use is a great improvement upon the original one of Civiale. It is due in part to Sir Henry Thompson's own design, and in part to Messrs. Weiss.]

In what respect does it differ from others? In this, that it enables you to operate in less time, and with less movement or shock to the bladder, than any other instrument; and time, you know, is a matter of importance. It makes a good deal of difference to a patient whether you retain in his bladder an instrument for three minutes or for one minute. If you pass a bougie