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bleeding is severe, or at longer intervals when it is only slight.

Hamamelis V., (Witch Hazel,) will in nearly all cases arrest the bleeding at once. It should be applied to the parts and taken internally at the same time. Drop doses to be put on the tongue once in fifteen or twenty minutes.

An infusion of the Hamamelis may be taken internally in doses of half a teaspoonful, and the same injected into the bowel with excellent effect.

The most effectual way, and the best for obtaining permanent relief from Piles when the tumors have become hard, and remain all the time so as to pass out of the anus at every evacuation, being constantly more or less tender and painful, and often becoming inflamed, is to have them taken off. But never let that be done with a knife. The bleeding would, in such a case, be very excessive, and most likely fatal. The history of knife operations for the excision of Pile tumors is written in blood, and the tombstone stands as a monument of condemnation of the practice. No trustworthy surgeon will at this day attempt it.

But however dangerous may be the knife operation, there is no danger at all to be apprehended from removing the tumors by a ligature. To accomplish this, take a soft cork about three-fourths of an inch in diameter, and one inch long—make a hole through the center from end to end, about one-eighth of an inch in diameter—cut crucial grooves in the top of the cork about an eighth of an inch deep, bevel down the lower end nearly to an edge, make a cord of saddler's silk, three fold twisted together and waxed, about eight or ten inches long, double this in the middle and pass the loop down through the cork out at the sharp end, the two loose ends of the string being out at the grooved end. Make a strong hickory stick about three-sixteenths of an inch in diameter, and just long enough to pass across the square end of the cork. Now have the patient protrude the Pile tumors as far out as possible, being placed on his knees with the head bent to the floor, pressing out firmly as if to evacuate the bowels. Let the tumors be dried as much as possible by gently pressing a soft, dry cloth to them; then let the loop of the string projecting from the flattened end of the cork, be pushed on over the largest tumor, and held down at its base, while an assistant places the stick in one of the grooves, ties the two ends of the cord firmly down over the stick, or toggle, by a square bow knot; then turn the stick round once, twice, or more, until the pressure upon the tumor is sufficient to strangulate it perfectly, and prevent the string from slipping off. Care should be taken to keep the cord down to the base of the tumor while it is being tied and tightened, as in many cases the base is much the larger part of the tumor, and the cord tends to slip up. After the ligature is applied and tightened, apply arnicated water to the parts, and a large, warm poultice of superfine slippery elm bark, wet so as not to be too soft and slippery, on the face of which Arnica may be put. Keep it on with a T bandage. The patient must be put to bed and kept quiet until the ligature and tumor come off, which will be in about six or seven days, sometimes sooner. Once a day the "toggle" must be turned part, or the whole of a circle or more, to tighten the cord as the patient can bear. This will be very painful from beginning to end of the ligating, but any, even the most sensitive, patient can bear it. The patient must have quite warm hip baths two, three, or more, times a day, or as often as the pain is severe, the poultice being replaced after each bath, and kept constantly on.

If there are several tumors protruding, apply ligatures to two of the largest, when these are removed, the others will disappear.

Injections of mucillage of slippery elm should be carefully used to move the bowels daily, or at least once in two days. Let the diet be of corn or oat meal mush, or rice. As the tumor gradually sloughs off, the surface heals, so that, though the base where the ligature was applied, may have been an inch or more across it, there will not be a raw surface of over an eighth of an inch in diameter, to which Calendula Cerate should be applied. The patient must keep quiet for a few days longer. Though this is a painful operation, it is not in the slightest degree dangerous. I have effected complete and permanent cures by this mode in numerous instances.

Sea-Sickness.

Nux Vomica should be used once in about four hours, for twelve hours before sailing, as a preventive to sea-sickness.

If, however, symptoms, such as dizziness or blur before the eyes, and headache, begin to come on, a dose of Nux should be taken, followed in an hour with Pulsatilla.

If the nausea comes on, Ipecac and Arsenicum should be taken alternately between the paroxysms of vomiting, should that symptom appear.

If practicable, the patient should lay still upon the back until the sickness passes off. I have removed sea-sickness immediately in several instances with Pulsatilla alone, and the last time I had an opportunity to prescribe for this affection I gave Podophyllin. It removed all the symptoms in a few minutes. That is the only time I ever tried it, but from the provings I am satisfied it is one of the best remedies.

Asiatic Cholera.

I was practicing in Cincinnati during the prevalence of Cholera in the years 1849, and 1850, and in Northern Ohio in 1854, and had abundant opportunity to observe and treat it. The disease generally begins with a diarrhœa, which may continue for several days, or only a few hours before other symptoms set in, such as vomiting, then cramping in the stomach and muscles of the legs, arms, hands and feet, followed by cold sweats, great prostration, restlessness, excessive and burning thirst, drinks being immediately rejected. These symptoms continue, the patient sinking rapidly into collapse, when the skin looks blue and shriveled, the eyes sunken, the surface covered with a cold, clammy sweat, the extremities, nose, ears, tongue and breath cold, the voice hollow and unnatural. This condition continues from two to eight or ten hours, the patient regularly failing, sometimes becoming delirious before he dies.

In some cases the vomiting and diarrhœa set in simultaneously, and the other symptoms follow, as above described, in rapid succession. In others the cramping may be the first symptom, the others following it.

In a large proportion of cases, the disease takes the course first described above, the diarrhœa, called the premonitory symptoms, or sometimes cholerine, coming on several hours, if not a day or more, before any other symptoms.

The diarrhœa is not usually painful, hence the patient may not be alarmed so as to attend to it until the more dangerous symptoms appear. It begins in some cases with pain and some griping, the discharges rather consistent, having a bilious appearance, so that the patient supposes it to be an ordinary bilious diarrhœa, which is not dangerous, his fears being thus quieted. But however the diarrhœa begins, it becomes sooner or later, copious, watery, and light colored, (rice water) painless but rapidly prostrating.

TREATMENT.

In the early stages of the diarrhœa, Veratrum, taken about twice as often as the evacuations occur, will frequently arrest it in a few hours, especially if the patient lies down and keeps quiet. But if not, and it increases in frequency, or becomes more copious, or any sickness is felt at the stomach, the patient should, at once, be laid upon a bed and strong tincture of Camphor should be given in drop doses, once in five minutes, for one hour or more, and as the symptoms abate, once in ten, fifteen or twenty minutes, for six or eight hours.

A teaspoonful of the Camphor tincture may be put into a tumbler of cold water, ice water if at hand, and the water agitated until it becomes clear, giving a teaspoonful of this camphorated cold water as a dose, stirring the water each time. I think this is better than to give the pure tincture. After the patient becomes quiet and easy, Veratrum should be given in alternation with Camphor, a dose in four to six hours for several days, or oftener if he feels any symptoms like a threatened return of the disease. These two medicines serve as prophylactics (preventives) of Cholera.

If, however, the disease continues in spite of the Camphor and Veratrum, in the first instance, or later, (as the Camphor may be given in many cases with success in the advance stage,) you must resort to other remedies.

If vomiting comes on with burning in the stomach give Ipecac and Arsenicum in alternation as often as the vomiting occurs, and if the diarrhœa continues give Veratrum between the doses of the other two, in a violent case, as often as every ten to fifteen minutes, and at longer intervals when the disease is slow in its progress. If the vomiting and diarrhœa, or either, occur with a kind of explosion, the vomiting ceasing suddenly for the time, after the first gush, or the discharges from the bowels are involuntary, Secale is the specific remedy.

For the cramping, Cuprum and Veratrum are the remedies to be given alternately.

If, however, the cramping comes on as the first symptom, which is sometimes the case, the patient being suddenly seized with it before any other alarming symptoms occur, Camphor is the great remedy, and in this case it may be given in doses of double or treble the quantity before directed.

If he sinks into the collapse and lies quiet, indifferent to everything, the pulse sinking, or he is pulseless, Carbo Veg. will sometimes arouse and restore him, hopeless as the case appears. It should be given once in half an hour until the pulse begins to rise. If, however, instead of being quiet he is restless and thirsty, give Arsenicum in alternation with Carbo Veg., repeating the dose as above directed. In some cases, after all the active symptoms cease, the patient will become quiet and drop to sleep, and instead of the pulse rising, as it will if he is recovering, it sinks, or does not appear if he has been pulseless, and the breathing becomes irregular and feeble—he is sinking. If aroused, he sinks back into the stupor in a few moments as before. Laurocerasus is a specific for this condition. It should be given once an hour until he is aroused.

If, however, besides the stupor, the head is hot, the face red, the breathing oppressed, the pulse slow and sluggish, Opium is to be used, and may be given in alternation with Laurocerasus.

For the irritation of the brain, and furious delirium that sometimes sets in after the cessation of cholera symptoms, Secale and Belladonna in alternation will prove specific.

Let the patient have warm or cold drink as he prefers, and let his covering be light or plentiful as is most agreeable. As soon as he gets easy, and the vomiting and purging cease, and his pulse begins to return, keep him quiet as possible, let the room be darkened and everything still, so that he may go to sleep, which he is inclined to do, this being the surest restorer. I am quite sure I have known several patients carried off by a return

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