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inch or so of the lower bowel. Probably there is a congenital weakness of the muscular coat of these veins in most cases. There is usually a history of haemor- rhoids in other members of the family, and the trou- l)Ie, as a rule, develops early in life. But there are other factors which divide themselves into two groups; first, any cause of obstruction to the return of blood ihrough the inferior hsemorrhoidal plexus ; and, sec- ondly, any cause of local irritation. In the first group come a sluggish liver with engorgement of the veins of the portal system,_ heart disease, pregnancy, and most common of all, a loaded bowel in chronic constipation and with prolonged sitting or standing. In the second come every kind of septic irritation — want of cleanli- ness after defaecation. and local mechanical irritation, such as chafing, bumping, etc. Many cases of piles, even when very large, do not Purchase Lithium Carbonate require operation for their cure, and others, when first seen, are not in a Buy Eskalith state to permit of operation, although it \yill ultimately be nec- essary. Order Lithium Carbonate Online The first step in treatment is to Eskalith 450 Mg relieve any engorgement from within by gentle laxatives and bod- ily exercise. The piles and surrounding parts should be washed over three times daily, first with soap and water, and then with an antiseptic lotion — e. g., bichlor- ide solution, one to one thousand. The piles should Eskalith Cr 450 then be reduced within the anus if possible, but with- Buy Lithium Carbonate Online out force, and the patient should lie down for a while. This procedure should be carried out every morning, Eskalith Cr after the bowels have been moved, and at night just before going to bed. It often brings about a cure, and if not, it greatly improves the prospects for success of an operation. The writer is opposed to ligation or cau- terization, and holds Whitehead's classical operation to be the best. Laxatives should b" given four days be- fore the operation, combined with enemata, in order to make sure that the bowel is empty. In order to con- trol the anus properly during operation, it is well in all cases to stretch the sphincter with the thumbs. Lithium Eskalith But if spinal analgesia Lithium Carbonate Online is employed such stretching is not necessary. 2. Hysteria. — Savill, from a study of the disorder, concludes: I. Hysteria consists of an instability or un- due irritability of all the nervous and reflex centres throughout the body, and particularly those of the vaso- motor and sympathetic systems. 2. Hysterical paralysis or tremor and many other hysterical phenomena are produced by vascular changes in .the nervous system and elsewhere. 3. The essential defect in the nervous system upon which the hysteria depends is inborn and inherent — that is to say, the reflex centres in hysterical subjects are throughout life more unstable than those of other people. The general measures directed to the improvement of the nervous irritability may consist of rest, isolation from home surroundings, food, massage, electricity, hydrotherapy, and psychotherapy or hypno- tism. Of all the various measures, rest is of the great- est value in allaying irritability of the nervous system. All sources of peripheral irritation must be removed. Complete rest of the body can be obtained only in bed. .\bundance of sleep is essential, and it is sometimes justifiable to administer hypnotics. Removal from the conditions under which the disease arose is almost as indispensable as rest. It is often necessary not only to remove the patients from home, but to forbid any let- ters Eskalith Er to be written or received. As much easily assimi- lable food as the patient can take improves the nutri- tion of the nervous system and of the body generally. To increase the power of assimilation, such increase in the amount of food shoidd be associated with massage. Massage also soothes the nervous system. As a rule, no drugs should be given, except an occasional aper- ient or dose of bromide for sleeplessness. Electricity is of considerable use. especially in those cases where a rigid rest cure cannot be given. Static electricity is more useful than the galvanic or faradic forms. Hydro- JulJ 13, 1907.] PITH OF CCRREXT LITERATURE. 87 therapy is not much used in England, hut it undouht- edly acts powerfully on the neurovascular system. Un- der psychotherapy may be included all kinds of persua- sion, suggestion (autosuggestion and heterosuggestion) and hypnotism. The object is to cultivate the will and control of the patient over her unruly emotions Buy Lithium Carbonate and un- stable reflex centres. Anmioniuni bromide is the writer's sheet anchor for allaying the irritability of the reflex centres. Apc^morphine is the best remedy for the prompt cure of severe hysterical convulsions. The writer has also had a certain amount Lithium Carbonate Buy of success with vasoconstrictors Generic Lithium Carbonate (ergot), vasodilators (pilocarpine), and remedies acting on the blood (calcium salts) in cases where there is noticeable irregularity in the vaso- motor regulator mechanism. Educational and other prophylactic measures are of great value.

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