Dr. Houston, of Dublin, strongly recommends the application of strong Nitric Acid to bleeding piles, but particularly to that soft, red, strawberry-like elevation, which he names a vascular tumour of the rectum, and which the acid removes, by the production of a slough of its surface. The surface to be acted upon must be soft, and free from any coating of cuticle, such as is apt to form on it by persistent prolapsus. To ensure the full effect of the caustic, the parts should be dried, and cleared of all mucous and other adherent fluids. " Let the patient," observes Dr. Houston, "strain at the night chair, so as to bring the tumours fully into view, and while they are so down, let him lean over the back of a chair, so as fully to expose the parts. Let a piece of wood, cut in the shape of a spatula, be dipped in the acid, and then, with as much of the acid adhering to it as it will carry without dripping, let it be rubbed on the tumour to the extent required; the due effect of the acid on the part is shown by its changing it to a greyish white colour. The prolapsed parts should then be pushed back within the sphincter, the patient put to bed, and an opiate administered. The pain, which is sharp and burning at first, goes off in two or three hours. If the tumours be old and firm, a second or third application may be necessary." He details many cases illustrative of its efficacy and safety. Mr. Lee§ employed it with success in other forms of hAemiorrhoidal tumours. He advises the use of the strongest acid, in order rapidly to destroy the vitality of the part. The surrounding parts should be carefully protected. Much valuable information on this remedy and its mode of application will be found in Mr. H. Smith's work on Haemorrhoids (Lond. 1860).

vols. xxiii and xxvi. § Lond Journ. of Med., Jan. 1849.

* Op. cit, p. 299.

Dis. of Urinary Organs, p. 111.

Dub. Journ. of Med. Sciences,

1893. In Syphilis, The Internal Use Of Nitric Acid Was First Advocated By Dr

Scott,* of Bombay, in 1796. On his recommendation it was employed by Kellie, Rollo, Cruickshank, Bed-does, Hammick, Ferriar, Albers, Hoist, and others, in the primary form of the disease, and they all reported in the highest terms of its efficacy. Mr. Pearson, however, gave it a fair trial; his testimony was, on the whole, adverse to its employment; and in the hands of others it was also found to fail. It has consequently fallen into comparative disuse, at least in the primary form. In Secondary or Constitutional Syphilis, however, particularly in that met with in the tropics, it is a most valuable remedy. In old debilitated constitutions, in those who have been subjected to long mercurial courses, in Syphilitic Rheumatism, and in Syphilitic Eruptions, Nitric Acid may be given with every prospect of speedy relief and eventual cure. I have seen the greatest benefit result from its use, in doses of ex. thrice daily, in decoction of Sarsaparilla. Ulcers may, at the same time, be dressed with Liq. Plumb. Subacet. or other mild stimulants; all mercurial salts should be carefully avoided, and a light animal diet allowed. This treatment is highly spoken of by Dr. Graves. In syphilitic affections of the bone and periosteum, it is inferior in efficacy to the Iodide of Potassium. To Chancres, at their first appearance, the strong Nitric Acid is advised by Mr. Bransby Cooper, as the most effectual caustic to destroy and decompose their surface. All forms of Secondary Syphilis are benefited by the use of Nitric Acid baths (fl. oz. j. - fl. oz. ij. to each bath).

1894. In Chronic Hepatitis, when a scorbutic or strumous habit contra-indicates the use of Mercury, and when large quantities of that mineral have been previously taken without effecting a removal of the disease, the symptoms will frequently be ameliorated or subdued by dilute Nitric Acid, in doses of evj. - x. in Decoct. SarsAe. thrice daily. If persevered in, it will produce a slight soreness of the mouth, which may be taken as a sign that it has been carried to a sufficient extent. Sponging the body and the surface of the liver particularly, with dilute Nitro-hydrochloric Acid, may be advantageously employed at the same time. (See Nitro-hydrochloric Acid.)

1895. In Cholera, Nitric Acid, largely diluted with any demulcent vehicle, has occasionally been used with apparent benefit. Sir James Macgrigor published a favourable report of its influence in the Cholera of India; and Mr. Hope recommends it, conjoined with Opium, in the Cholera of temperate climates. When largely diluted and sweetened, it may be used as an ordinary drink in this disease.

* Duncan's Annals, 1796, vol. i pp. 373 - 383. Duncan's Annals for 1802.

Edin. Med. and Surg. Journ. vol. xxvi. p. 41.