Further experience I think will show that cocaine will not answer in enucleation of the eyeball. In one case in which, beside the drops on the conjunctiva, I injected with a hypodermic syringe four minims three separate times deep into the socket behind the eyeball, so great was the pain that I was obliged to give bromide of ethyl before severing the optic and ciliary nerves. In the practice of others I have seen the same thing occur five times in six operations. The sixth was on one of those sturdy plethoric individuals, who, I believe, would not have winced had the whole operation been done without anaesthetic of any sort. Another case may be mentioned in which the cocaine did not relieve the pain of operation. A syphilitic patient had iritis from which both pupils were closed and undilatable. There was much congestion, and as the case was steadily getting worse in spite of vigorous specific treatment combined with atropine drops, I decided on doing an iridectomy. A four per cent. solution of cocaine was used four times at intervals of a few minutes. This time I operated on the right eye, and although I succeeded in doing the operation, the patient complained a great deal of pain. A few days later, when operating on the other eye, the experience was the same. At a subsequent operation he asked for chloroform, which was administered satisfactorily. In conclusion, from the foregoing and many other cases, I am of the opinion that for iridectomies either in acute glaucoma or when there is much inflammation from any cause, or for enucleations, cocaine will not entirely blunt the pain of operation. But that, combining, as it does, efficacy, ease of administration and rare need of assistants, with absolute safety, for the vast majority of operations on the eye it is simply perfect. VOLUNTEER PAPERS. RECTAL MEDICATION. BY D. W. CATHELL, M.D., Baltimore, Md. The proximity of the rectum to the seat of so many important diseases, and the fact that it is a closed cavity with decided absorbing power, make it rational to suppose that if, as Liebig states, "A solution of salt, in the proportion of one part to eighty of water injected into the rectum, will disappear completely in the course of an hour -so completely that an evacuation at the end of that time will be found to contain no more than the usual quantity," and if, "The fluid extract of rhubarb may be detected in the urine about an hour after being injected into the rectum," it is logical to infer that the insertion into that cavity, of remedies for the cure of its own diseases and those of neighboring parts may be pursued with success, and I am quite sure that all who have seen the excellent effects that follow the injection of twenty or twenty-five grains of chloral, in an ounce of water, into the rectum of a patient suffering with obstinate nausea or vomiting, as in pregnancy, or in various affections requiring a few hours of good sleep can never wholly doubt the efficacy of rectal medication. The directness in action of certain remedies administered by the rectum, compared with the same when administered by the mouth and compelled to run the gauntlet of the whole alimentary canal and risk decomposition or change, with all the incompatibles they may meet, is obvious, and accounts for the occasional success of remedies administered by the bowels after failing by the stomach. Medication by rectal suppository, is simple, direct and cleanly, and if the case and the remedy are logically suited, is also very efficacious, besides leaving the stomach free for food or whatever else is indicated. I shall not enter into a consideration of the entire subject of rectal medication at this time, or consider the action of quinia, ergot, assafetida, tannic acid, santonine, elaterium, podophyllin, aloes, or other articles suitable for use in this manner. Nor shall I attempt to offer anything novel, but shall ask your earnest attention to this convenient and effective method of availing ourselves of Morphia and Belladonna, two of the most valuable articles of the pharmacopeia. I would first ask attention to the use of sulphate of morphia in rectal suppository, in a large class of ailments of the pelvic organs and the higher abdominal viscera, that are characterized by increased sensibility and irritability, especially when connected with decreased action of the skin, and increased action of the mucous membranes of these parts. Over many of these cases it has wonderful influence, and has the important advantage that it never causes an intolerable dryness of the throat, as seen in many who are using belladonna. I would also ask attention to the use of Extract of Belladonna in rectal suppository for quite a number of ailments of the pelvic organs and abdominal viscera that are characterized by abnormal sensibility and irritability, especially when connected with increased action of the skin, in many of which cases it has the important advantage over morphia, that it has but little, if any, tendency to constipate; indeed the continued use of belladonna, in this way, has a strong tendency to overcome and cure existing constipation. Lastly, I would ask particular attention to a combination of the two, morphia and belladonna, in rectal suppository in numerous painful affection of the rectum, the urinary organs, the genital apparatus, the higher abdominal viscera, and even of the sacral and sciatic nerves. Although these two agents are well known physiological antagonists, they, when used together, in suppository, either establish a new property or antagonize each other's bad effects, rather than their good ones, for not only can the desirable therapeutical effects of each be unmistakably perceived when used together by the rectum, but that their ill effects are softened and sensibly diminished by combining them, seems equally clear; for example, in cases characterized by great pain and colliquative sweating, the pain is relieved with a degree of promptness that proves the action of the morphia, while the sweating is benefited to a degree that shows that the belladonna has also been active, each appearing to allow the good effects of the other while lessening its own bad ones. I believe the combination of these two drugs in rectal suppository to be especially useful, and shall briefly mention a few of the cases on which this belief is founded: . To avoid prolixity, I here state that I have, in all cases, resorted to whatever other treatment seemed to be demanded, in conjunction with the suppositories. Ulceration of the Prostate Gland.-J. W. B-, a gentleman of fine physique, aged 36, came under my care in August, 1877, suffering with hæmaturia, vesical tenesmus, dysuria, mucus, pus and other indications of a lesion of the bladder with which he had been suffering about two years. Inability to pass a sound through the prostatic portion of the urethra, exquisite sensitiveness of the prostate on rectal touch, etc., pointed to that rare and serious disease, ulceration of the prostate. This opinion was shared by several other members of the profession, among them the late Dr. Samuel D. Gross, who confirmed the diagnosis and emphasized the gravity. Other forms of treatment had failed and the patient had been brought by colliquative sweats, vesical tenesmus, frequent micturition, nausea, loss of sleep, etc., to a point at which his recovery was believed to be impossible, and his death was hourly expected. The stomach being no longer able to tolerate the anodynes his sufferings. demanded, the following suppository was devised: R Morphiæ Sulph. gr ; Belladonnæ Ext. gr. 4 ; Glycerine jelly suf. to make a fifteen grain One of this strength to be inserted into the rectum every six hours. Their good effect on the sweat, the tenesmus, and the frequent micturition was at once perceptible; composure of the mind and sleep followed, and it was soon possible to inject carbolized water into the urethra and bladder. Under the constant use of this treatment, improvement continued, and after a few months he was convalescent. He is to-day a stout, healthy man, with simply a slight irritability of the bladder and frequent urination, whenever he over-exercises or contracts cold. The undoubted value of that combination in this case, impressed me strongly, and I have since resorted to it, whenever suitable cases present themselves. An Italian ship captain, aged 59, came under my care in August, 1884. He had been suffering for about ten days with vesical tenesmus and increasing irritability of the bladder, the result of cold, exposure and prolonged anxiety, consequent on a stormy voyage. He was now suffering with a sense of great fulness in the perineum, smarting and distress about the neck of the bladder, a scalding sensation in the urethra and a perpetual desire to pass water, which had robbed him of sleep and taken away both appetite and strength. Anodynes, diluents, fomentations, etc., were used for three days with indifferent results; I then ordered a dozen rectal suppositories, each containing half a grain of morphia, and three-quarters of a grain of belladonna, one to be inserted every six hours. Improvement was immediately noticeable, and in four days thereafter, although not completely recovered he was able to rejoin his vessel and assume command. Senile Hypertrophy of the Prostate, frequent and painful Micturrition, etc.-A. Ba pattern-maker, aged 67, consulted me in March, 1881. He had suffered for three or four years with uneasiness about the neck of the bladder, with frequent and urgent desire ⚫ to urinate, which had increased, till now the intervals were generally not more than half an hour, and never over an hour. Urination was accompanied with difficulty, tenesmus, and unusual muscular effort. He also suffered with neuralgic tests, insomnia, etc. Anal exploration by the finger revealed a prostate enlarged to the size of a guinea egg, with a probability that the muscular coat of the bladder was also very much hypertrophied. In conjunction with some minor remedies, diluents, etc., a rectal suppository, similar to the one given in my first case, was ordered to be inserted at 9 o'clock in the morning, at 3 in the afternoon, and at 9 o'clock at night, daily. Under their influence the pain and tenesmus were speedily relieved, the intervals between the acts of urination were increased to two or three hours, and after a few days he was able to sleep five hours without arising. He remained under my observation for about six weeks, during all of which period he was kept comfortable, that too, after the first week by a suppository morning and night only. I then lost sight of him until I heard of his death, about two years after he begun this treatment. On making inquiry of his relatives, I ascertained that he died of |