OBSERVATIONS AND EXPERIENCES INVOLVING *1^EGTAI TT> IS EASES. IE2. ZF\ HO-YT, 3D. /teae sur- prised and shocked if they could be made acquainted with the figures ex- pressing the ratio of people whose lower intestine insists upon protruding itself into the outer world to the great moral and physical detriment of the unhappy victims. I speak of specific prolapsus arising from relaxed rectum or sphincter muscle, and not the nec- essary or contingent condition associ- ated with hemorrhoidal developments. What does the general practitioner be- hold when journeying upon the high- way of current authorities upon this condition ? The principle object of his vision is a red hot iron. How many cases would come under the direction of a specialist if he did not have any thing else to offer this class of sufferers but a local conflagration with its con- comitants of necessary anaethesia, pro- longed absence from business, possible ugly ulcerations, and almost uniform uncertainty ? Not one in five thousand. How much better is the spirit that is free from ostentation, that consoles the patient by methods that live in in simplicity, and instead of the terror arising with the smoke of local com- bustion, exhales the peace born of con- fidence, a confidence established by deeds that appeal to cultured minds, teaching its lesson of quiet accomplish- ments. 8 HOYT, RECTAL DISEASES Prolapsus is the easiest kind of a ease to overcome. By introducing a speculum furnished with a lateral slide, and then withdrawing the slide to line that marks the union of the mucus membrane and skin, there in- sinuates itself into this cylinder of the speculum a mass of sub-mucus tissue. By means of a long needle attached to a hypodermic syringe, inject about five to ten drops of a ten percent, solution of carbolic acid. The constriction enacted by the fenestral margins of the specu- lum confine the agent to this particular location, and it almost immediately en- ters into a chemical union which, be- coming absorbed, superinduces a con- dition of atrophy, thereby in reality shortening the rectum at this point. By making the circuit of the entire intestine in this way at intervals of about six days, 3rou will soon have overcome the relaxed condition and the prolapsus ceases to exist. This can be accomplished without pain, detention from business, interference of the func- tion, leaving the mucus membrane itself entirely intact. The first exam- ple I intend to describe in illustration of this process, is the case of a gentle- man whom you all know, and who died about six years subsequent to my pro- fessional relations with him. There has been such a flood of imaginations floating with the currents of newspaper sensationalism, ascribing his dissolu- tion as a direct result of correcting the rectal difficulty, that I am almost im- pelled to give his name, inasmuch as he was a public man, and freely talked of this experience during the balance of his life time. I was called to see HOYT, RECTAL DISEASEvS. 9 him February nth, 1881, by recom- mendation of the late I)r. John Gray. Upon examination I found a double lateral prolapsus of such a degree of instability, that standing only for a short time would cause the protrusion. As above explained I injected into the tissue above the sphincter muscle, be- ginning with the left. Even this so contracted the rectum that it never came out from that time. Yet, as a matter of judgment I acted upon the other side in about one month. This was all the treatment he ever received for this condition from that date. And even now his most intimate friends tell how he rejoiced over this success al- most daily, during the brief number of years of his existence. I wouid ask if there was anything in this experience to produce appoplexy after a lapse of half a dozen years. The next example is a case I have just completed. A gentleman about fifty, excellent gen- eral health, whose name is conspicu- ous at the head of a Broadway house, and introduced by his family physician, a member, I presume, of this society. I found him in a condition of almost helplessness, from the readiness to which the intestine would prolapse, a toneless mass of burdensome tissue. This is an example that would have delighted the disciples of topical com- bustion, yet, by dealing with the mal- ady as above explained, the result has been satisfactory and complete, attend- ing to his usual business all through the treatment, and now he is free from a perpetual apprehension, happy in an increased confidence he has in himself, also having gained many pounds in 10 HOYT, RECTAL DISEASES excess of his weight as registered dur- ing the depressing days of his chronic illness. The dilatation of the sphincter mus- cle is a remedial process that appears very simple of itself, yet its judicious application has a broader sphere than a superficial consideration would war- rant. There are many cases of ladies whose nervous systems are of that delicate and susceptible nature that any manifestation of a reflex action is sure to construct a range of symp- toms that tell of a disturbance difficult to correct, and especially profuse as to the volume of sufferings entailed. I will illustrate my meaning by a practical experience. In April, 1882, there walked into my office a lady of about thirty-three years of age, hand- some, rich, married, and in good gen- eral health. She proceeded to tell her story, and a “ tale she did unfold,” re- lating experiences she had had with nearly all the available physicians here and in Brooklyn, telling of many opera- tions endured, mentioning a galaxy of remedies she had tested, enumerating a wilderness of pains, and still suffering. She concluded her pathological auto- biography by boldly stating that if I should promise to do her any good, she would think me either a knave or a fool, as she had consulted gentlemen that knew all that was known upon this subject, and without result. I re- plied by politely asking her to promptly walk out into the street. Do you know, by returning impudence for impudence, commanded her confidence at once, and she came down from her lofty pinnacle of egotism, and proceeded to compro- HOYT, RECTAL, DISEASES 11 mise our differences. She was one of those fine cultured women, highly edu- cated, gifted with a large ability to enjoy or suffer, possessing a disposi- tion that was at times a perfect flower garden of angelic loveliness, magnetic, poetic, aesthetic, just the kind of a woman to ensnare the sentiment of any large-souled man, until she had un- loaded into his presence one of her cyclonic waves of pyroteclinical tem- per, and then he would hate her. All this proves that the most unsystematic of all systems is the nervous system. The local condition as manifested by her descriptive language, was one of almost constant tenesmus, delicate sore- ness, and an inability to have a move- ment of the bowels, which was only accomplished by taking a large amount of compound licorice root upon retiring, which responded the following morn- ing, leaving the patient so exhausted that she had to remain in bed all that day. And this had been going on for fifteen years. By forcing the function only about three times weekly, could she realize any comfort at all. Upon examination I found a sensitive spas- modic sphincter muscle, with its corre- lative condition of engorged sub-mucus tissue. It was tissue of this character that had been excised under the mis- taken impression of being hemorrhoids. Only in women of such fiery and eccen- tric temperaments have I ever found this particular manifestation, and that is the reason I elaborated her peculiar- ities so minutely, as it is safe to suspect a spasmodic sphincter whenever a high strung nervous woman tells of having obstinate constipation attended with 12 HOYT, RKCTAU DISEASES great exhaustion. Subsequent to a movement, the slightest eifort to exer- cise any extrusive force would cause the muscle to spasmodically contract, and thus it had misbehaved for all this time, obstinately refusing to surrender, and would have held to its wayward career until now, had not its conceit been overcome by dilatation, and in two days time the woman was well and remains so the present date. Another attractive specimen of ne- cessity for dilatation was the case of a lady about fifty years of age, in good general health, and very nervous. About four years since, she called upon me and related experiences arising from her condition, experiences realized in nearly every capital of the whole world, and varied enough in detail to form the subject matter of a Rider Haggard novel. Upon examination I discov- ered a hypertrophied sphincter muscle, so extensively thickened that it was impossible to have a natural movement of the bowels. For about twenty years, and by the advise of a physician in Rome, she had introduced into the rectum every night upon retiring, about eight inches of a large Roman candle, such as are used in the cathedrals there, and, during the following morning the relaxation had been so accomplished as to allow the movement after this taper had been withdrawn. The mus- cle was promptly dilated and from that time she discontinued the Roman ex- pedient, gained greatly in general health, and has been a much happier woman ever since. I will give a few words in description as to the best means of dilating this HOYT, RECTAL DISEASES. 13 muscle. In the books you are told to lay the patient on the back, with but- tock close down to edge of the 1x.*d, limbs flexed upon the abdomen,—a very awkward position in case of la- dies—then introduce the two thumbs, produce your traction. This idea is all covered with objec- tions. In the first place no one can command a sufficient amount ot force for the purpose, and besides the patient would extend the limbs just as soon as he is under the anesthesis, therefore requiring two assistants, besides the one giving the ether, consequently glamouring the occasion with so much useless pretense, and I do hate a redun- dancy ef effort. P»y laying the patient on the left side, back close to edge of bed, limbs flexed upon the abdomen, where they will remain—then intro- ducing the thumb of right hand, and the index finger of left hand, in this manner you can easily control the situation without seeming effort, and gain the desirable sentiment of using means that represent the emphasis of simplicity. I hardly deem it neces- sary to more than mention the subject of hemorrhoids, as this malady is so well understood by all practitioners, still as repetition is the only highway to skill, will say that any hemorrhoidal tumor, or any tissue of like consistency can be most satisfactorily obliterated by injecting into its substance a few drops of a solution of carbonic acid and gly- cerine, equal parts, diluted with six- times its volume of water. There is not a hemorrhoidal ease possible but what can be obliterated by this means, and I am at a loss to ex- 14 HOYT, RECTAL DISEASES. plain why so many cling to methods that carry so much havoc and suffer- ing. I have used this process in about five thousand (5000) instances during the past fifteen years, and I do not believe there could be devised a more simple and satisfactory treatment. If every college in the land would have this subject demonstrated by men of experience and learning, all other means would soon loose recognition. To those that do not subscribe to any de- parture from the religion of the Materia Medica, will find it hard to answer why a potentized medicine should remove a mass of tissue that has become—by incident forces—just as much a part of the general organiza- tion as any other feature of the human anatomy. Is it possible to wing a few pellets upon the medium of the arterial circulation, and whisper instruc- tions into its dynamanized senses, telling them to hesitate at those nerve centres that rule over this hemorrhoi- dal existence just long enough to constrict their offices of nourishment, thus absorbing the difficulty ? There are a multitude of experiences record- ed where results are attributed to medicinal action, while in reality it is a matter of coincidence. A person may have transient congestion, a con- dition self-limited to about ten days duration, the physician does not make an examination calling the case “ an attack of Piles.” Then the indicated remedy is exhibited the irritation ceases, when this medicine is promptly underlined as reliable for all herni- orrhoidal conditions. If there is one expression I would use with extra and HOYT, RECTAL DISEASES. 15 vigorous emphasis it is to never pre- scribe for a rectal difficulty without making an examination, for there is such a pandemonium of reflex symp- toms arising from this class of cases that it is always an easy matter to marry them—with perfect compatibil- ity—to the pathogenesis of nearly every remedy in the Materia Medica. There will always be hemorrhoidal cases as long as civilization exists, and hemorrhoidal veins remain unfurnished with valves. I have often been asked why there are not any valves in these vessels. To those that believe in the theory of evolution, I refer to that inscrutable and very distant past, when these bloodvessels were in a horizontal position, and that since they have become upright there has not elapsed a sufficient time for nature to fill this new demand as she surely will some- time during the incomprehensible future. The experience I will give in ex- ample of this treatment is not a hemorrhoidal one, but it caused me more sentimental satisfaction than any result I ever achieved. A young lady, about twenty-five, good general health, living in Fifth Avenue, and recom- mended by her physician. She was suffering from a hypertrophy of right wall of the rectum. An active disposition, fond of horse- back riding, traveling, society, but was incapacitated on account of this condition, as upon the slightest en- couragement the enlargement would become everted, presenting a smooth, glassy, spherical surface, quite dense in consistency, and about one and a 16 HOYT, RKCTAT DISEASES half inches in diameter. The young lady was very sensitive, refusing all treatment that told of pain, hence the reason for deferring any attempts to- wards removal for so many years. I began by injecting into the central substance about five drops of this solution, repeating every week, and at the end of one month the mass had disappeared, unattended with suf- fering, she being about the house as usual, the growth simply subsided by atrophy, and the surface was not even broken. This was two years ago, and she has since developed a sufficient amount of vigor to go around the world on horseback if necessary. To those that cling to the old super- stition about hemorrhoids being a golden vein, or avenue of escape for constitutional dyscrasies, I would ask if they really think the God of Nature would stoop to a compromise ? 36 West 27th St., New York.