Other surgeons prefer rapid dilatation, and insert probes of the largest size into the duet at the first sitting, this being usually performed under ether.
Electrolysis in stricture of the laery mai canal found rapidly effective in a. series of cases in Whieh probing extend ing over a long period had failed to afford relief. Its advantages are: ab sence of pain, no bleeding, and antiseptic action. Three milliampitres should not be exceeded; and the sittings two min utes. The positive pole is a -flat sponge applied to the nape of the neck. The canal, after withdrawal of the probe, is washed out with a. 4-per-cent. solution of protargol. L. L. Alia] (N. Y. Med. Jour., Oct. 20, 1900).
In intractable cases—as, for example, when the stricture is bony—two pro cedures have been practiced: the removal of the lacrymal gland and the oblitera tion of the lacrymal sac. The former of these has been modified by de Wecker, who excises the little lobules and the emissary ducts from both the subsidiary and main lacrymal glands.
Number of cases in which lacryination persisted after daeryoeystitis, although the nasal duct and tear-passages gener ally were restored to their normal con dition. In some instances of this kind the writer has observed an hypertro phied carunele the removal of which has cured the lacryination. So long as the eanaliculi are intact a large carunele has little bearing on lacrymation. The puucta dip into the lams at a point ex ternal to the earuncle. If, however, the canaliculus has been incised to admit the passage of probes, the opening is carried inward, and the pressure of the earuncle may be sufficient to block it by pressing the walls into contact with one another. In these patients the removal of the projecting part of the earunele sufficed to occasion cessation of lacry 'nation. The excision can be readily performed under cocaine. Atigi6ras (La
Clinique Opht., June 25, 1902).
Obliteration of the sac is but little practiced at present, but is best accom plished by means of the galvanocautery. If a fistula remain after abscess of the lacrynial sac, it may be healed by apply ing the galvanocautery to its freshened edges.
Syrupus lactucarii, 1/2 to 2 flui drachms.
Tinctura lactucarii, 10 to 60 minims.
Poisoning by Lactuearium. — Lactu earium is a feeble narcotic poison. When taken in overdose the symptoms are sim ilar to those of opium poisoning. In the treatment of poisoning by lactuca rium the same measures that are used in opium poisoning are indicated: the stomach should be evacuted if possible; the patient should be roused and kept moving; apomorphine, ammonia, coffee, douche, atropine, amyl-nitrite, aitificial respiration, and electricity may then be used.
Therapeutics.—Lactucarium is chiefly used in slight irritation of the larynx to allay nervous irritability and in cases , where there is an idiosyncrasy against opium. The syrup is used in cough mixtures for children and delicate sub jects. Aubergier's syrup and paste are active, uniform, and palatable. Lactucin may be used as an hypnotic and sedative in the dose of 1 to 2 grains.
LACTITCARIUM.—Lactucarium is the concrete milk-juice of Lactuca virosa, of the family Composita,, a wild variety of lettuce growing in Europe. It occurs in irregular, brown lumps, which are wax-like internally when cut, and pos sess a narcotic odor and a bitter taste. It is soluble in alcohol, ether, and partly soluble in water. Lactucarium contains 58 per cent. of lactucerin (white, crystal line, and soluble in alcohol), lactucin (bitter principle in fine, white scales, and soluble in alcohol and 80 parts of water), and lactucic acid.
Preparations and Doses. — Lactuca rium, 5 to 60 grains.