drawn down and the clamp applied (Smith's in my opinion being After cutting off the pile the stump is seared with the the best). Paquelin cautery, an antiseptic dressing applied and patient put to bed. The dressings are changed on the following day and anus and rectum irrigated. An astringent holds the bowels in check until the third day. The patient suffers scarcely any pain except at first act of defecation and resumes his occupation on the 4th or 5th day after the operation. This operation is surer to cure, safer from the dangers of suppuration, is more cleanly and less painful and is no more liable to produce stricture or ulcer than the ligature method. Troublesome hemorrhage is never a complication in the after-treatment of the operation by the clamp and cautery method. The time consumed in the after-treatment by this method is 8 to 10 days less than by the ligature method, thus saving much time for the patient and trouble for the surgeon. The chief disadvantages of this method are that it requires skilled assistance and a special instrument, the clamp, the cautery being a necessary part of any general surgical outfit. I have selected from among a great many I have operated on by these methods three cases to illustrate the better the various points brought out in my necessarily hurried descriptions. Case I-Chas. W. age 41 years. Fisherman. When 18 years of age had an attack of malaria fever followed by obstinate constipation and later by hemorrhoids. The piles were for 10 years only troublesome when purgatives were taken. In 1880-8 he had chronic diarrhea for 18 months, during which time the piles greatly enlarged and became very troublesome. One and a half years before I was consulted, the piles were injected with carbolic acid by a rectal specialist. This proved a complete failure. On June 19, 1894, Iligated 7 piles, two being very high up. I used every precaution and tied each pile as skillfully as possible, the rectum was cleansed, an antiseptic dressing applied and patient put to bed. The usual after-treatment was followed. Four days after the operation the patient had a rise of temperature, reaching 103° on the fifth day. This was probably due to suppuration and constipation. The aftertreatment occupied 3 weeks, the patient being discharged on the 21st day. Five days later he returned complaining of severe rectal pain. An examination showed that only 3 piles had sloughed away, leaving 4 still securely tied. I then tried the excision method as above described, using cocaine as the anesthetic. The result was perfectly satisfactory, giving no after trouble at all, the patient suffering scarcely any pain and no special inconvenience. On the 2nd day after the excision operation the patient was again discharged. I saw and examined him. four months after and found him entirely well in every partic ular. Two years later I had a letter from him stating that he was in the best of health. Case II-W. O. Male. Age 31 years. Grocery clerk. Had for years suffered from constipation and attributed piles to straining at stool. When consulted had been troubled by hemorrhoids 3 or 4 months. He readily consented to the operation which I proposed. I used the clamp and cautery method and removed 5 piles. Iodoform gauze was packed into the rectum immediately after the operation and removed on the second day; at this time anus was dressed with aseptic cotton and a T bandage. The patient was given astringents to prevent defecation until the 3 day. Epsam salts was then given and had the desired effect. The first pain of any consequence was experienced during the first act of defecation, and then lasting only a few minutes. Suppuration was very slight causing no inconvenience. Patient made an uneventful recovery and was discharged cured on the 5th day. In this case all the piles were highly situated save one. Chloroform was the anesthetic used. This patient was seen 14 months after the operation and his anus and rectum were normal and healthy. Case III.-Mr. W., age 39, railroad engineer. When he first consulted me he had had externo-internal piles 6 months. On July 11, 1896, I removed threc piles by excising, using cocaine as the anesthetic. Just before the operation the rectum was well cleansed by enemas and the patient made to strain over a bucket of hot water to force down the piles. A piece of gauze soaked in diluted Monset's solution was packed into the rectum after the operation, and aseptic cotton and a T bandage were applied. These were permanently removed the following day. On the second day after operation patient was up and on the third day he returned to his work, suffering and having suffered no pain nor inconvenience save a slight soreness at the site of the operation. Eleven months after the patient shows a complete and perfectly satisfactory cure. case. While ambulance surgeon in the Charity Hospital, New Orleans, I once operated by the excision method on an Italian suffering from strangulated venous externo-internal piles. He was so completely and quickly cured he left the hospital two days later, before I could obtain a history of his This operation is a fair sample of the operations of this kind. I have never had any but the most pleasant results from the excision method, case III. being a typical one. In case I. the injection was tried by an expert and failed. Ligation failed. Simple excision was tried and cured promptly and permanently The clamp and cautery have acted nicely in thirteen cases for me, but since I have been using the excision method I have abandoned it altogether, save in high internal venous piles and capillary hemorrhoids. The excision method is much quicker, simpler and easier performed, is safer and in fact more satisfactory in every particular than the clamp and cautery. All in all the excision method is in my opinion much to be preferred to all other methods for the surgical treatment of externo-internal venous hemorrhoids. "A NEW METHOD OF DEALING WITH INOPERABLE CASES OF CANCEROUS AFFECTIONS OF THE UTERUS, WITH REPORT OF CASE."* BY W. L. ROBINSON, M.D., Danville, Va., Ex-President of the Medical Society of Virginia. I THANK you for the honor of this invitation to read a paper before you, the more so because I recognize the ability and advanced thought which has ever characterized your Society. Self indulgence would dictate rest in these salt breezes and I would be more than repaid for my dusty ride by listening to *Read before the North Carolina Medical Society June 8, 1897. your valuable papers and scientific discussions, but I hold that whatever is in a professional man's life work, that he finds. promises alleviation of human suffering or is helpful to his brethren, should be given honestly and promptly. The good results I have obtained in two cases of that hitherto doomed class, who either suffer hopelessly to the end or sleep from morphine till death liberates them and their friends from distress and agony, impels early publication. I have dared brave the criticism "that nothing is proven by the short history of these cases," in the hope that the quickened perceptions and untiring zeal of our profession may evoke something more than the verdict rendered to our past efforts of "Loves labor lost." The history of these two cases of carcinoma of the uterus, verified by the microscope will be brief and pointed. Mrs. R., white, of Pittsylvania County, Va., 64 years of age, mother of four children, was referred to me January 10, 1897. She had noticed a slight hemorrhage, alternating with offensive watery discharge from vagina for eight or ten months. Constant pain increasing as night approached which robbed her of sleep, broke down her vital forces, resulting in emaciation and despondency. Vaginal examination reveals an indurated, cupped cervix, excoriated only within the cervix and lower seg ment of the uterus-the induration extcnded on the left side to the bony pelvis, with firm peri uterin adhesions fixing the uterus immovably. Micturition painful and frequent. January 16th aided by Drs. Nelson, Harvie and others, I opened the abdomen supra pubically, ligated the ovarian vessels, severed the broad and round ligaments, then dealt with the uterine artery and sacro-uterine ligaments in like manner, thus relieving the tension which kept up the pain, proven by the fact that she has never suffered any pain, except during the healing of the incision from the day of operation. The incision healed promptly and on the eighth day following the operation I commenced injections of boiled alcohol, which I continued every third or fourth day for two months—the injections were made via the vagina by long needles into the uterine and peri-uterine tissue, commencing with 20 minims, safely increased to 100 at each sitting. Pulse was greatly accelerated, redness of face, full feeling about the head. Considerable pain was caused by the injections in the indurated tissues. Result of two months treatment, cessation of all discharges and odor, pain abolished, insomnia cured, appetite restored, spirits good, irritable bladder relieved and the indurated area much reduced. This condition existed late in April when I last heard from her. Case 2nd.-Hattie Lovelace, col'd, an intelligent and model patient-37 years old-referred to me December 1896. History of hemorrhage, offensive discharge, pain, emaciation, insomnia and loss of appetite had gradually increased for eleven months. Bladder irritation and rectal pressure annoying. The cervix was gone and a large raw, oozing surface existed-uterus immovable. The necrosed tissue exposed was touched lightly with the thermo-cautery, then operated as in preceeding case, followed by prompt healing of abdominal incision. from pain was prompt so far as tension was a factor. begun on the eighth day and continued as in first case. The relief This case was septic when she came into hospital. Even temperature, usually 103-pulse 120. The discharge was much slower in yielding than case I. The bladder trouble and rectal pressure disappeared in two months. The area of induration perceptibly diminished. The septic condition baffled my efforts for quite a while-the continued fever and septic diarrhoea were uncontrollable till I gave hypodermic injections of the antistreptococcic serum on 3rd and 4th February. The effect was so prompt that I could not doubt. In forty-eight hours the temperature came down to normal and did not return and in 5 days the diarrhoea had ceased to trouble her. Her vaginal discharge stopped and her husband reported so late as yesterday, June 5th, that there had been no return. She has had occasional disturbances with frequent but painless micturition, lasting only a few days. No return of fever or diarrhoea, appetite fine, condition comfortable, though she has not regained. flesh or strength as her general relief would warrant. I omitted to state that I used tannate of alcohol and Methyline Blue as topical applications to the granulated surface with marked benefit in diminishing discharge and producing healthy appearance. The needles were made to order, 6 inches long and small at he end for introduction into the tissues, but fortified near syringe |