CARBOLIC ACID INJECTIONS IN THE TREATMENT OF PILES. 
The purpose of this article is briefly to 
direct the attention of the Profession to 
the value of carbolic acid as a remedial 
agent in the radical cure of haemor- 
rhoids. The frequency of the disease 
and the great dread of patients generally 
to submit to any form of treatment which 
will subject them to a painful operation 
and confinement to bed for two or three 
weeks, induces me to mention this simple 
method, which, in the great majority of 
cases, will supersede the knife, ligature, 
nitric acid, and clamp, heretofore the 
usual remedies where there is considera- 
ble dilatation of the haemorrhoidal veins. 
Patients, rather than submit to an op- 
eration, content themselves with the 
use of various cathartics, laxatives, 
and astringent and anodyne unguents, 
which, without effecting a cure, fre- 
quently give little or no relief. A tem- 
porizing treatment, under which the 
disease is usually aggravated, and finally 
the victims, under the impression that 
the general practitioner of surgery does 
not understand the treatment of the dis- 
ease, or that it is too insignificant to 
elicit his special study and attention, 
fall into the hands of advertising spe- 
cialists, who promise a certain cure 
without the use of the knife, ligature or 
caustic. The inconvenience and suffer- 
ing caused by enlarged or inflamed 
hemorrhoids, and the ready relief given, 
may be inferred from the following cases: 
Mrs. , aged twenty-six; married 
six years; occupation seamstress,sewing 
on a machine; spanoemic; has for a long 
time been suffering from habitual con- 
stipation ; she has had piles for ten 
years—her father and other members of 
the family having suffered in like man- 
ner—a hereditary disease; she had ex- 
ernal and internal piles, which had 
been inflamed, and caused much suffering 
for months. The external, several in 
number, situated at the junction of the 
skin and mucous membrane, were of 
long standing, small, hard, projecting 
like vegetations and exceedingly sensi- 
tive ; these were removed with the scis- 
sors ; warm anodyne fomentations were 
ordered locally to allay the tenderness, 
and the following laxative: R.—Mag- 
nesise carb., 38s; magnesiee sulph., jjij; 
potass® bitartrat, sulphur sublimed, aa 
gss. M. Ft. Pulv. S. a teaspoonful in 
half glass of water once or twice daily if 
necessary. The external trouble was 
relieved in a few days, but at each evac- 
uation, or in the act of coughing, an in- 
flamed haemorrhoid would protrude and 
cause acute pain, to return which I was 
called several times. For several days 
she declined to have anything done, 
assigning as a reason that a former phy- 
sician who had treated her father ad- 
vised her never to submit to an operation, 
as it would be dangerous. The laxatives, 
unguents, suppositories, etc., etc., having 
failed to give relief, and being assured 
that the operation was simple, without 
danger or much suffering, and that it 
would give speedy relief, she consented. 
On the 27th of November, 1876, I 
directed her to sit over hot water and 
allow the pile to protrude through the 
external sphincter; I then penetrated 
the pile with the needle of the hypo- 
dermic syringe and injected ten drops 
of a mixture of equal parts of carbolic 
acid and glycerine; the pile was then 
returned ; the pain was not severe, and 
soon subsided without any medication ; 
next day she was much better; the pile 
did not protrude; the fifth day after the 
injection she was discharged cured. 
She then resumed her usual avocation. 4 
Carbolic Acid Injections in the Treatment of Piles. 
I ordered her a teaspoonful, three times 
daily, of the elixir of the phosphates of 
iron, quinine and strychnia as a tonic, 
gentle out-door exercise and good nour- 
ishing food. After treatment she be- 
came pregnant—a primipura—and was 
confined without any return of the dis- 
ease. Several years ago I treated her 
brother for the same disease, who in- 
forms me that he has had no return. 
Lewis Everson, German, aged 45; la- 
borer; was admitted into the Louisville 
City Hospital in July, 1877, with acute 
dysentery and intermittent fever. The 
latter part of August he was transferred 
to the surgical ward to be treated for 
frost-bite of the two great toes, which 
had been frosted two winters previous. 
The toes were removed by a member of 
tho Surgical Staff 31st of August. 
When I took charge of the ward, Sep- 
tember 1st, I found him weak, debili- 
tated and feeble, still suffering from 
recurrent attacks of dysentery and 
intermittent fever, and hoemorrhoids 
which were much aggravated by the 
inflamed condition of the rectum and 
frequent straining at stool. By the 27th 
of September he had partially recov- 
ered from his complication of diseases, 
and was anxious to have something 
done for the piles, which came down 
when he walked or was at stool. There 
were four large internal hemorrhoids, 
which, when protruded, formed a nodu- 
lar circle around the mucous mem- 
brane of the rectum. 
On the 29th of September, in presence 
of the medical classes, I injected two of 
the hemorrhoids with tho following: 
Carbolic acid, ji; aque distillat, ji; 
glyceiin, ji. M. Of which ten or 
twelve drops were injected into each 
of two piles. On the 1st of October I 
examined him, and found that the two 
injected piles had contracted and ulmost 
disappeared; I then injected the two 
remaining ones with the same injection, 
and equal quantity as before; by the 
6th of October, Clinic day, bo was again 
presented to the united classes and dis- 
charged. Ho suffered very little from 
the injection, and I was agreeably sur- 
prised at the rapid cure. Ho had two 
relapses of dysentery and malarial fever 
at intervals of about two and three 
weeks after the last injection, but no 
return of the piles. Ho was retained 
in the hospital until the latter purt of 
November as assistant nurse in the 
ward, to give him time to recuperate 
his health, and to observe the result of 
his cuse. He had no further rectul 
trouble. His fover was controlled by 
sulphate of cincbonidia; after the par- 
oxysms were interrupted he was ordered 
ferrum dialysatum twenty drops three 
times a day at meal time, sulphate cin- 
chonidia five grains three times a day 
after eating, and special diet. While in 
the surgical ward tho attacks of dysen- 
tery were treated as follows: 14.—Bis- 
muth subcarb., ; saccharuted pepsin, 
morph, sulph., grs. ij. M Ft. 
Pulv. No. viij. S. one powder every 
two or four hours pro re nata; anodyne 
injections to control the straining; diet 
chiefly boiled sweet milk, with one table- 
spoonful of wheat flour added to each 
pint. This case I consider an excellent 
test of tho value and efficacy of tho car- 
bolic acid treatment in hjemorrhoids. 
Here was a man who had been pros- 
trated with a complication of diseases, 
enfeebled, amcmic, his system poisoned 
with malaria, who, for more than two 
years, had been suffering with ulcerated 
frosted toes, and laboring under all the 
inconveniences of an impecunious man. 
The advantages of this treatment over 
the ligature are made manifest by com- 
parison. August 31, the day before I took 
charge of the surgical ward, a patient 
about the same age had been ligatured 
for piles; the ligatures came away from 
the sixth to the tenth day, but he suf- 
fered much pain ; tho ulcers left after 
the separation of the ligatures healed Carbolic Acid Injections in the Treatment of Piles. 
5 
slowly, and he did not recover for at 
least two or three weeks after the patient 
I operated on a month later was well 
and doing duty in the ward. For the 
injection of haemorrhoids, carbolic acid 
has been combined with sweet oil or 
glycerine. At first I used carbolic acid 
and glycerine, equal parts, but I found 
this combination too thick to flow freely 
through the needle of the ordinary 
pocket hypodermic syringe. By having 
a needle made longer and larger in cali- 
bre it would answer the purpose very 
well. When I used equal parts of water 
and glycerine with the carbolic acid the 
solution flowed easily through the com- 
mon hypodermic needle. Where the 
haemorrhoids are recent and the walls of 
the veins not thickened, I use equal 
parts of the carbolic acid, glycerine and 
distilled water, shake well for one or 
two minutes and you have a clear, uni- 
form solution. Where the haemorrhoids 
are of longer standing, the walls of the 
veins thickened and the connective 
tissue infiltrated with plastic material, 
the result of adhesive inflammation, I 
use two parts of the acid and one each 
of the glycerine and distilled water. 
Before operating, the patient’s bowels 
should be evacuated by a mild laxative 
—magnesia or castor oil answers the 
purpose very well, aided, if necessary, 
by a warm water enema—then direct 
the patient to sit over a tub of warm 
water to relax the sphincters and pro- 
trude the piles; draw from ten to twenty 
drops of the acid solution, according to 
the size of the tumors, into the hypo- 
dermic syringe, pass the point of the 
needle through the most prominent part 
of the hajmorrhoid well into the cavity, 
then slowly inject the fluid, and hold it 
for a minute or two before withdrawing. 
A few drops of blood will flow from the 
puncture, which is readily arrested by 
pressing over it a dossil of cotton wool; 
after the injection is completed return 
the pile within the sphincter and the 
operation is completed. The acid acts 
as an astringent, antiseptic and anti- 
phlogistic. No inflammation occurred 
in either of the cases referred to; but 
should it occur, use opiate suppositories, 
hot fomentations to the anus, keep the 
patient quiet and nourish with extract 
of beef and milk for a few days; give 
quinine and tr. ferri mur. if indicated. 
After recovery the patient should be ad- 
vised to avoid constipation, drastic pur- 
gatives, to use nourishing diet—meats, 
vegetables, cereals and fruits—a mixed 
diet, but not too great a variety at any 
one meal; it should be partly of a -laxa- 
tive character. If the bowels are slug- 
gish, aid peristaltic action by drinking a 
teaspoonful of common table salt in half 
a pint of water one hour before breakfast, 
or the same quantity of some of the 
natural laxative mineral waters; these 
are both prophylactic and curative; the 
“ Tamar Indien ” will act well where 
the patient can afford to buy them. An 
excellent, pleasant and palatable laxative 
in the treatment of piles or habitual 
constipation is the compound liquorice 
powder of the “ Prussian Pharma- 
copoeia;” viz.: R.—Fol. senna pulv., 
gij ; radix liquorice pulv., ; foeniculi 
sem. (German) pulv., ; sulphurus 
depurati, gi; sacchara alb. pulv., 
M. S. a teaspoonful in a wine glass of 
water pro re nata. 
There are many other laxatives which 
the peculiarities of each case will sug- 
gest. Rubbing the abdomen once or 
twice daily with salt and water, and 
kneading thoroughly with- the hands 
will often produce the desired result 
without any internal medication, pro- 
vided the patient can be convinced of 
the efficacy of this kind of manual 
manipulation, and is not too indolent 
and indifferent to faithfully carry it out. 
System has much to do in relieving 
constipation; have a regular hour of the 
day to go to stool, lay aside all else, 
punctually attend to this duty, and the Carbolic Acid Injections in the Treatment of Piles. 
peristaltic action of the intestinal canal 
will keep time as accurately as tho works 
of a twenty-four hour clock, provided 
the good house-wife winds it up daily 
at the appointed hour. In cases of 
general debility give some of tho bitter 
tonics with iron in some form; plenty 
of sunlight, well ventilated apartments, 
suitable clothing and open air exercise. 
For patients of sedentary habits or in- 
door life prescribe a journey to the 
mountains, hunting, fishing, or a visit 
to some of the watering places, lay 
study and brain work and sedentary 
habits aside, seek cheerful society and 
recreation, forgot the old infirmity and 
it will forget you. Pationts are prone 
to neglect little things which, if looked 
to, will keep them well; they must be 
impressed with the fact that tho body 
is like a piece of complex machinery, 
nicely adjusted and adapted in all its 
parts for its work; but to keep it so, it 
must bo daily watched and cared for. 
A few words in regard to the general 
treatment of piles. The special treat- 
ment of individual cases must be gov- 
erned by the causes; these are local or 
temporary and'constitutional or organic; 
of the former we have drastic purga- 
tives, habitual constipation, dysentery, 
constant riding on horseback, standing, 
or sitting in a constrained posture, por- 
tal congestion, pregnancy, etc.; of the 
latter, organic disease of the stomach, 
liver, heart, or lungs, abdominal tumors 
which interfere with venous circulation. 
In the former a radical cure may be ex- 
pected, in tho latter only temporary 
relief, or if cured, other branches of the 
hemorrhoidal veins will, from continu- 
ance of the cause, become dilated and 
reproduce the disease. Where the cause 
is local, and the veins not too much dis- 
tended, general treatment with injec- 
tions of hot or cold water, according to 
the feelings of the patient, is all that is 
necessary. Where the disease is of 
longer standing, and the veins much 
dilated, accompanied with general con* 
gestion, givo such, laxatives, tonics, and 
alteratives as each cose suggests. Lo- 
cally use enemas of water, or water and 
glycerine, or muciluge incorporated with 
persulphato or perehloridoof iron, or the 
vegetable astringents, udding in pain- 
ful cases an anodyne of hyoscyamus, 
belladonna, stramonium or opium. If 
there iB much tendorness and irritubility, 
enemas of subnitrato or subcarbonate 
of bismuth or carbolic acid in mucilage 
or glycerine and water will have a 
happy effect, to which an opiate may be 
added when indicated. The enemas 
should be small, not rnoro than ono or 
two ounces, if largo tho distension of the 
rectum will cause peristaltic action and 
discharge of tho enema. Cotton wool 
saturated with a solution of the persul- 
phate of iron has a good effect, especially 
in bleeding piles. Tho injection into 
the cavity of the diluted veins of a so- 
lution of the persulphate or perchloride 
of iron or ergot is dangerous, a portion 
of the cohgulum formed may at uny time 
be detached, carried into tho circulation 
and produce embolism. Of luto years 
I have generally used theso various 
local remedies alone or combined, in the 
form of suppositories by incorporating 
with cocoa butter ten or fifteen grains 
to each suppository, and direct one to 
bo used two or three times a day as re- 
quired. If tho patient can not readily 
introduce the suppository, order a sup- 
pository syringe, which can bo passed 
into the anus, and deposit it at the 
proper place. I have never been partial 
to the nitric acid treatment; in the flat 
variety of hemorrhoids with broad base, 
thickening of the mucous membrane 
and enlargement of the mucous papillae, 
it might be used with advantage, but 
whero the veins are much distended and 
the tumors well defined, I would not use 
it; the ligature is much to be preferred. 
In external piles, where they are pedieu- 
lated with small base or like vegetations, Carbolic Add Injections in the Treatment of Piles. 
7 
clip them off with scissors or scalpel; 
where they are tense with large base, 
soft and fluctuating, puncture and press 
out the blood; where they are hard and 
firm from thickening of the vein walls 
and blood-clot, lay open ttith a bistoury 
and press out the blood clot, then apply 
compresses; if tender and inflamed, use 
hot fomentations and a T bandage. If 
the walls of the veins and connective 
tissue havh, from repeated inflammatory 
action, become consolidated and form 
hardened ridges or tumors, incise the 
skin and dissect out the hardened tis- 
tues, then close the wound and dress to 
get union by first intention. This treat- 
ment has been much more satisfactory 
than the local use of leeches for deple- 
tion and astringent unguents. This is 
very briefly an outline of my treatment 
for haemorrhoids prior to the use of the 
carbolic acid injection. I have had no 
experience as yet in the treatment re- 
commended by Mr. H. A. Reeves, of the 
London Hospital, which he calls “ the 
immediate cure”; it consists in punctur- 
ing the pile to the base with a conical- 
pointed wire heated to a dull red heat; 
the number of punctures are governed 
by the size of the pile. 
The common diseases of the rectum, 
viz., fistula, fissure, ulcer, and piles, the 
latter by far the most frequent, from 
some one of which few persons in a life- 
time escape, have, from some unaccount- 
able reason, been considered the oppro- 
bria of surgery. Why should this be 
so? Why is it that the last two inches of 
the nether extremity of the alimentary 
canal, a plain piece of tubular anatomy, 
closed by two small muscles, always 
ready to open at nature’s call, supplied 
and nourished by the inferior hsemor- 
rhoidal artery and connecting veins, 
should be the prey of advertisers and 
specialists? The diseases are readily 
recognized by digital or specular exam- 
ination, very amenable to treatment, 
much more easily cured than many 
other surgical cases, and are in them- 
selves, neither dangerous nor fatal. Any 
surgeon of good common sense and judg- 
ment who is posted in his department, 
is as competent, yes, more competent, to 
treat this class of cases than the great 
mass of specialists who flood the country 
and cities with their fulsome circulars 
guaranteeing a certain cure, and certify- 
ing that no patient has ever died in 
their hands—never died—for the good 
reason that a patient about to die of 
some organic complication is always ad- 
vised to go home and recuperate for 
death; the so-called doctor of secret 
remedies, known only to himself, has 
the fat fee in his pocket, the deluded 
and confident patient never returns, or 
if too feeble to leave, he is abandoned 
to his fate. 
That there is a wide-spread prejudice 
against the surgeon’s treatment of piles 
among the populace and even doctors, 
I am sorry to say, can not be denied 
This is probably due; first, to the old- 
time treatment of excision by the knife 
and application of the actual cautery, 
to arrest htemorrbago, which has long 
since been abandoned. Second. The 
ethics of the Profession prevent the sur- 
geon from advertising in the secular 
press and by circulars, giving certificates 
and names of prominent patients cured, 
which reach the populace. Third. The 
general practitioners, whose time is ab- 
sorbed in the study and treatment of 
medical cases, do not advise their pa- 
tients to consult the regular surgeons. 
Fourth. The advertising specialists are 
bold and confident, if they do learn 
what they know at the expense of the 
patient. They guarantee a cure with- 
out the use of the knife, ligature, or 
caustic, consultation free, and fifty, one 
hundred or two hundred dollars in ad- 
vahce, or negotiable notes. This means 
business; it is the charm; it fixes the 
patient; no knife, no ligature, no cautery, 
secret remedies, known only to the ad- 8 
Carbolic Acid. Injections in the Treatment of Piles. 
vertiser; the old Indian dodge—money 
in advance, never returned, cure or no 
cure. From these and other causes not 
necessary to mention, the mass of rectal 
diseases are treated outside of the regu- 
lar Profession. The patients pay enor- 
mous fees, are satisfied in the belief that 
the regular surgeons know nothing of 
the remedies used, and that a mystery 
enshrouds the outlet of the rectum un- 
known to ordinary mortals. 
For two or three years past the injec- 
tion of carbolic acid and oil or glycerine 
has been extensively used as a secret 
remedy. In portions of Illinois, Indi- 
ana, Tennessee, Kentucky, and other 
States, the right to use it in a prescribed 
territory has been sold for sums of 
money varying from five to fifteen hun- 
dred dollars, each purchaser being sworn 
to secrecy. Doctors, farmers, trades- 
men, and sharpers, who could raise the 
“ wherewith,” have left their legitimate 
business and gone forth, armed with a 
hypodermic syringe and a bottle of car- 
bolic acid and sweet oil to slay the rec- 
tal piles and gobble up a golden fortune. 
The discovery of valuable gold mines 
in the rectum is of comparatively recent 
date; the hypodermic syringe is more 
easily wielded than the pick and the 
shovel; no danger of Indians there and 
no scalps lost. Only a few days ago a 
prominent druggist informed mo that 
an illiterate countryman, in Kentuck 
jeans, purchased bis outfit and inquired 
if the oil would pass through the hypo- 
dermic needle. When asked what use 
he would make of the hypodermic 
syringe and acid oil mixture, he replied : 
•‘Gwine to practice medicine; right smart 
sprinkling of piles whar I live.” A sad 
case of this territorial selling deception 
came under ray own observation: A few 
months ago an intelligent-looking gen- 
tleman, in delicate health, a stranger to 
me, called at my office and inquired for 
a certain number of Braith waite's Retro- 
spect, stating that ho wished to see an 
article on tbo uso of carbolic acid and 
sweet oil in the treatment of piles. 1 
stated that I had not read the article re? 
ferred to, but I had seen the treatment 
briefly mentioned in other journals, and 
that I had, for more than a year, been 
using the acid and glycerine. He then 
stated he was a regular physician, had 
practiced in Kentucky for scvoral years, 
had been unable to attend to general 
practice, his means were well nigh ex- 
hausted, had a family to support. In 
looking around to find sorao way to 
make a support, he heard of this secret 
remedy for the treatment of piles. IIo 
consulted some of his friends about the 
propriety of giving fifteen hundred dol- 
lars for the secret remedy and a specified 
territory to operate in. Among those 
friends was a prominent practitioner of 
this city, who advised the invalid doctor 
to make the purchase. The purchase 
was made, the contract drawn, the 
papers duly signed, the secret imparted, 
the territory assigned, and when the 
victimized doctor reached the field of 
operation, he learned, to his astonish- 
ment, that the secret was public prop 
erty. The object of his inquiry of m« 
was to get sufficient evidence against the 
party in this city who had sold the al- 
leged secret remedy, to institute suit for 
obtaining money under false pretenses 
and compel the return of the money. 
Now if a regular practitioner, whose 
locks have been silvered in the service, 
who claims to observe the proprieties 
of the profession, who is tenacious for 
its honor, will volunteer such advice, 
will encourage such arrant quackery, 
what can the profession hope for? If 
men of influence sanction advertisers 
and secret nostrums, what becomes of 
medical ethics? This man is a teacher 
of medicine; what an ignoble example 
to place before the rising generation of 
doctors. O temporal O moresII