It is generally conceded that a multitude of human ailments arise from indigestion, and in its various forms it taxes the skill of the physician to prescribe the proper remedies. It is undeniable that the closest intimacy exists between happiness and good digestion. A healthy digestion aids materially in making a cheerful disposition, and the "feast of reason and flow of soul" is due as much to the functional integrity of the stomach as to a strong and generous mental organization. Dr. Johnson severely said: "Every man is a rascal as soon as he is sick." We all know that a morbid condition irritates the individual and excites sarcastic and disagreeable remarks. And, likewise, an irritable temper and, suddenly aroused passions may not only turn and disturb the stomach, but even poison the secretions. Anxiety, excitability, fear, and irritability frequently cause the perversion of physiological processes.

The slightest functional disturbance of the stomach deranges, more or less, all the succeeding operations of digestion and tends to the vitiation and impairment of the delicate processes of nutrition. Dyspepsia may commence and proceed so insidiously as not to excite the suspicion of friends, although the patient generally desires active treatment, such as cathartics, emetics, and medicines to act upon the liver. When the disease becomes confirmed, it presents some of the following symptoms: Weight, uneasiness, and fullness in the region of the stomach, attended by impatience, irritability, sluggishness, anxiety, and melancholy; there is impairment of the appetite and taste, also sourness, flatulency, and, perhaps, frequent attacks of colic, loss of hope, courage, and energy; apathy, drowsiness, and frightful dreams are also symptoms common in the different stages of this disease. There are, furthermore, the accompanying symptoms of a coated tongue, bitter taste in the mouth, unpleasant eructations, scalding of the throat from regurgitation, offensive breath, sick headache, giddiness, disturbed sleep, sallow countenance, heart-burn, morbid craving after food, constant anxiety and apprehension, fancied impotency, and fickleness. The subjects of dyspepsia frequently imagine that they require medicines to act upon the liver, desire active treatment, are endlessly experimenting in diet, daily rehearse their symptoms, and are morbidly sensitive.

Causes. Overtasking the body or mind, overloading the stomach, the use of improper food, such as stale vegetables and meat, unripe fruits, indigestible articles, improperly prepared food, irregular meals, disorderly habits, the use of alcoholic stimulants, loss of sleep, masturbation irritability of temper, anxiety, or grief may all give rise to indigestion. If the functions performed by the skin are embarrassed by cold, tight clothing, or lack of cleanliness, the nutritive changes cannot properly take place throughout the body, and consequently the digestive functions are embarrassed, as the revolutions of a water-wheel are impeded by the backset of the water. When food is not thoroughly masticated, it is not properly mixed with saliva of the glands of the mouth, and is not prepared for digestion by the acids of the stomach.

Whatever diminishes the general strength, impairs the health, or encroaches upon the functions of life, also hinders the perfect solution of food and disturbs in a measure the function of digestion. Whatever diminishes the normal amount of the digestive secretions or perverts their quality, deteriorating their solvent properties, is a cause of dyspepsia. This should be borne in mind in selecting remedies.

Treatment. The hygienic treatment consists in the regulation of the daily habits, proper selection and preparation of the food, cultivation of cheerfulness, diversion of the mind, and cleanliness of person. We cannot give particular directions as to the kind of diet, as there are no established rules for guidance. Generally, a dyspeptic knows best, from experience, what articles of diet can be taken with the least injury. The directions applicable to the condition of one patient, are not suited to those of another. In dyspepsia, animal food is, as a rule, preferable. Foods rich in starchy matter often ferment and produce distress. Sometimes alkalies may be given with beneficial effect, when there seems to be an excess of acid in the gastric secretions.

In some cases, the digestive fluids are weak and fermentation results, giving rise to flatulency and belching. An antiseptic, which may be prepared by mixing a teaspoonful of hydrochloric acid with four ounces of water, of which a teaspoonful may be taken after each meal, will prove beneficial to check the fermentation and aid digestion. The addition of one or two drops of a mixture of one part of carbolic acid and six of glycerine, to the above solution of hydrochloric acid improves its antiseptic properties. Or, Dr. Pierce's Golden Medical Discovery will stop undue fermentation, and from its tonic and invigorating effect upon the lining membranes of the stomach will generally overcome the indigestion. Some people are afraid to take it, when suffering from indigestion, because it has a sweet taste. But the sweet is not saccharine, or sugar sweet, but an entirely different sweet principle which prevents fermentation instead of promoting it.

Acidity of the stomach and the attendant irritation may be allayed by the following mixture: Calcined magnesia, one drachm; refined sugar, one drachm; subnitrate of bismuth, one-half drachm; oil of cajeput, ten drops. The dose is half a teaspoonful an hour after every meal. Any dispensing druggist can put it up.

It is frequently difficult to prevent the patient from over-distending the stomach, and thus impairing the tone of the muscular coats and prolonging the process of digestion.In consequence of debility, over-exertion, anxiety, or chronic inflammation of the stomach, there is not a proper secretion, in quantity or quality, of digestive solvents, and it matters not whether it be a deficiency of the fluids of the stomach, or of the intestines, or of the pancreas and liver, the result is indigestion. The question of what important agent is lacking, naturally presents itself to the physician. Is it pepsin, the active principle of the gastric juice, which converts proteids into peptone, that is wanting, or is there a deficiency of pancreatin? Of course the principle which is lacking should be supplied; but has the physician the remedial agents properly prepared, and ready for prescribing? The specialist, having more cases of dyspepsia to treat than the general practitioner, is more likely to have the latest and most approved remedies applicable to loss of appetite, indigestion, impoverished blood, imperfect assimilation, and all diseases arising from faulty nutrition. In ordinary practice, the physician's time is divided in his consideration of acute, chronic, surgical, and obstetrical cases; in fact, much of it is occupied in riding to reach his patients. His attention is continually diverted from one class of cases to another, effectually preventing investigation in any particular direction. His patronage does not warrant him in the outlay of time required for the investigation of particular diseases, and the expense necessary to obtain the latest and best remedial agents for their treatment. In the multiplicity of his cares and arduous duties by night and by day, obstinate chronic cases become an annoyance to him, and whenever he can be otherwise professionally employed, he avoids them, disliking to undertake their treatment.

With plenty of time for scientific investigation, ample facilities to meet the demands upon his skill, and each succeeding case presenting some new phase, the treatment becomes a matter of absorbing interest to the specialist, and each success inspires greater confidence. We not only use in the treatment of indigestion, solvent remedies, like pepsin, which act only upon proteids, but also other remedies of recent discovery, which exert a remarkable curative influence in diseases of the digestive organs.

The chemistry of digestion and of life is becoming better understood. Any of the free acids may serve to dissolve a precipitated phosphate; but it is only the investigating therapeutist and experienced practitioner who understands which of them is the most and which is the least efficacious. Alkalies may dissolve lithic deposits, but who, unless he be an experienced physician, can detect the fault of nutrition which leads to their formation, or rightly interpret the symptoms indicating it? These simple illustrations of the complications which attend dyspepsia, are mentioned merely to show that they must be anticipated and taken into account in the treatment.

The number of cases of dyspeptic invalids treated by the staff of the Invalids' Hotel and Surgical Institute within file past few years, is so large as scarcely to be credited by those unacquainted with the prevalence of this disease. For this reason we have taken unusual pains to investigate the causes of the disease, and have spared no expense to provide the most approved digestive solvents, and stomachic tonics, which invigorate the mucous membrane of the stomach, and materially assist in reducing the food to a liquid condition. Some of these, without being purgative, increase the activity of the liver, and stimulate the intestinal secretions, two very important indications which should be fulfilled by remedies which cause no real depression. The recent important discoveries made in obtaining the active principles from indigenous plants, has opened the way to the use of a few of the most important of these remedial agents, hitherto almost wholly unknown to the medical profession, and the encouraging results attending our practice have amply repaid us for the investigation and originality in our treatment of this affection.

A careful chemical and microscopical examination of the urine often discloses the actual morbid conditions which perpetuate this functional disease.

CHRONIC DIARRHEA.

On account of the frequency and importance of chronic diarrhea, we deem it worthy of special consideration. It is frequently the sequel of the acute form of the affection. The urgent and severe symptoms of acute diarrhea are often abated, but the disease is not completely cured. The bowels are left in an irritable condition, perhaps in a state of chronic ulceration, which perpetuates morbid discharges.

The most noticeable symptom is the tendency to frequent and unhealthy discharges from the intestines. The evacuated matter varies much in appearance and character in different cases. The precise location of the morbid conditions which give rise to the discharges, as well as to their extent, modifies the color, consistency, and ingredients of the stools. Most frequently they are dark colored and of very offensive odor. They are of a more liquid character than is natural, except when, as is sometimes the case, periods of constipation alternate with periods of unnatural looseness. Tormina, or griping, is usually present, but not so severe as in the acute affection. Tenesmus, or straining, often accompanies it. The appetite is impaired, there is general debility, and the patient is nervous and irritable. The complexion becomes sallow, the skin dry and rough, the tongue dark colored, and the body emaciated.

The affection may be the sequel of neglected or badly treated acute diarrhea, may arise from the injudicious use of powerful purgative medicines, may result from dissipation, unwholesome food, bad air, absence of light, long continued exposure to dampness and cold, overwork, and extreme mental anxiety. Sometimes it is associated with other diseases, such as Bright's disease of the kidneys, scurvy, or some of the various forms of scrofulous disease.The more prominent symptoms are so apparent and so characteristic that the most unskilled may be able to decide whether the patient has chronic diarrhea; but to determine in what portion of the intestinal canal the affection is chiefly seated, to decide upon the extent of its ravages, to ascertain what peculiar shade or type the affection has taken on, to investigate its complications and modifications, to ferret out its producing or aggravating causes, and above all, to nicely and skillfully adjust remedies to meet the depraved conditions, is by no means an easy task, even for the educated and experienced physician. It should be borne in mind that this is a dangerous malady, and one which should not be trifled with or neglected. Its tendency is to corrode and destroy the bowels, a process which if unchecked, must sooner or latter result in death. There is little tendency to spontaneous recovery, nor is a removal of the exciting cause often followed by recovery. The disease becomes so firmly seated, and the powers of life so debilitated, that nature cannot rally.

Treatment. A warm, salt bath, several times a week, taken at bed-time, is beneficial. Flannel should be worn next to the skin, and the sleeping-room should be warm and well ventilated.

As will be seen from testimonials hereinafter inserted, Dr. Pierce's Golden Medical Discovery has achieved great success in curing chronic diarrhea. Its use should be persisted in for a considerable time to strengthen and tone up the bowels. To relieve the discharges, take Dr. Pierce's Compound Extract of Smart Weed, as needed from time to time.

CHRONIC INFLAMMATION OF THE LIVER.

(CHRONIC HEPATITIS.)

This is what is ordinarily termed liver complaint, torpid liver, and bilious disorder.

Under this head may be considered all those chronic affections known as congestion, induration, and enlargement of the liver, and which result in deficient action, functional derangement, morbid secretion of bile, and various chronic affections.

Symptoms. Owing to the liability of other organs to become diseased during the progress of chronic affections of the liver, great precision in diagnosis is required to determine, by the symptoms, the organ which is primarily diseased and those secondarily affected. This requires not only familiarity with the signs of a complicated disease, but also thorough anatomical knowledge of the diseased organ, of the morbid changes which occur in its structure, and their influence on its own functions, as well as on those of other organs.

The symptoms may differ according to the circumstances, temperament, sex, age, or constitution of the individual, and the complications of the disease. The local indications are fullness of the right side, thus denoting congestion of the liver; a dull, heavy pain, which is increased by pressure or by lying on the left side; a sense of fullness, weight, and oppression about the stomach; an aching in the right shoulder-blade; a dull, disagreeable pain in the shoulder-joint, which may extend down the arm, and which is sometimes felt in the wrist and joints of the hand Not unfrequently the complexion becomes pale and sallow, and there is puffiness under the eye, headache, a bitter taste in the mouth, tongue coated white or covered with a brown fur, and hardness of the gums; there is frequent sighing, a hacking cough, fever, restlessness, and loss of sleep; sometimes an unnatural, greasy appearance of the skin, at others, it is dry and harsh, has scaly or branny eruptions, pimples, dark blotches, and troublesome itching. The urine is frequently scanty and high-colored, but variable as to quantity and appearance; it often produces a scalding sensation when voided, and, if allowed to stand, deposits a sediment which sometimes contains albumen. The pulse is very slow, particularly when the elements of the bile are not eliminated from the blood. The pulsations of the heart are easily quickened, and palpitation is excited if the subject be low and anÆmic. There is depression of spirits, and a decided tendency to be discouraged and despondent. The functional powers of the stomach are impaired; there is loss of appetite, or it becomes capricious; uneasiness is felt in the region of the stomach, oppression, sometimes nausea and water-brash, or there is indigestion, flatulency, and acid eructations; the bowels become irregular, usually constipated, and occasionally subject to obstinate diarrhea attended with colicky pains; the stools are of a light clay color, sometimes hard and dark, again thin and very offensive, and occasionally green or black. As the disease progresses, during the day the circulation is sluggish, the feet and hands are cold, but at night the pulse is accelerated, and a burning sensation is felt in the palms of the hands and the soles of the feet.

The foregoing symptoms are not all present in one case, nor are any two cases alike in every respect. They vary according to the organs most implicated in the hepatic derangement. Thus, when chronic inflammation of the liver is associated with heart disease, the subject may have palpitation, excessive or defective action of the heart, attended with more or less pain and shortness of breath. If the lungs be specially influenced, then, in addition to the ordinary hepatic symptoms, there may be a dry cough, asthma, hurried respiration, bronchitis, hoarseness, and pain in the chest. If the stomach be the sympathizing organ, the tongue is coated white or brown, there is nausea, loss of appetite, flatulency, acidity, dyspepsia, fullness, and oppression, amounting, sometimes, to pain in the stomach after taking food; the food ferments and gives rise to eructations and various other manifestations of disorder. If the bowels are morbidly influenced by this affection, there is constipation or diarrhea, griping pain, distension of the abdomen, piles, and pain just within the points of the hips, thus indicating irritation of The colon. If the brain or nervous system sensitively responds, there is headache, dizziness, disturbed sleep, depression of spirits, peevishness, capriciousness, lack of energy, irritability, and congestive symptoms. When the skin is involved the surface is dry, harsh, and scaly, displaying dark "moth-spots," blotches, or numerous little sores, and the countenance has a dull, tawny look. If the kidneys be disturbed by it, there may be pain and a sensation of weight in the back, while the urine may be scanty and high-colored, or abundant, pale, and limpid, frequently charged with sedimentary products of disease, and voided with difficulty. If the womb be implicated in this chronic affection, the menstrual function may be deranged, and result in an excessive or a deficient monthly flow, and be followed by profuse leucorrhea.

The preceding allusion to the complications of chronic inflammation of the liver shows the necessity of clearly distinguishing between the symptoms of this disorder and those reflected by the organs which sympathetically respond. To discriminate more effectually, and place the correctness of the diagnosis beyond doubt, we make a chemical and microscopical examination of the urine, and thereby detect the morbid products which it contains, and direct our attention to the diseased organs furnishing them. These examinations together with a complete history of the case, enable us to make a correct and definite diagnosis of the disease, and the extent to which it has affected the other organs.

Before entering upon the consideration of treatment, let us briefly enumerate the functions of the liver: First, it removes matter, which, if allowed to remain in the blood, would become noxious and unfit it for the further support of the body. Secondly, by secreting bile, it furnishes to the digestive organs a fluid which assists in converting the food into chyle, stimulates the intestine to action, and then is itself transformed and absorbed with the chylous products, after which it circulates with the blood and assists in nutrition until, becoming injurious and pernicious, it is re-secreted and re-elaborated to serve again, as described.

For its growth and nourishment, the liver is furnished with blood by the hepatic artery; but for the purpose of secretion and depuration, it is abundantly supplied with venous blood by the portal system, which is made up of veins from the spleen, stomach, pancreas, and intestines. This impure, venous blood, surcharged with biliary elements, which must be withdrawn from it, is freely poured into the minute network of this glandular organ. In a healthy condition of the liver, the carbonaceous elements of the blood are converted into sugar, and the constituents of the bile are liberated by the liver, and set apart for further duties. When it fails to eliminate these noxious elements from the blood, it is itself thoroughly vitiated by them.

Treatment. Food must be rich in carbon in order that it may build up the tissues and keep the body warm, but carbonic acid, the result of the combustion, must be removed from the blood, or death will ensue. So bile is necessary to digestion, nutrition, and life; yet, if it be not separated from the blood by the secreting action of the liver, it will as surely poison the system and destroy life as carbonic acid. Although the constituents of the bile exist in the blood, they must be removed in order that the blood may be rendered more fit to support the body, while the secreted bile is destined to assist in digestion, and the mysterious process of nutrition. Therefore, we should induce a secretion of bile, and restore the normal activity of the liver. This should be done, not by administering stimulants, but by relieving it of all contingent embarrassments as far as possible. Would any one think of giving to a weak, debilitated man large portions of brandy to enable him to work? Does not every one know that, when the unnatural stimulus is removed, he fails? Apply this principle in the treatment of the liver. When harsh, unnatural stimulants and "bile-driving" medicines are administered for a time and then withheld, the liver relapses into a more torpid and debilitated condition than before treatment was begun. Is not this true of nine-tenths of all who suffer from this malady, and have recourse to this class of remedies?

Then how can we remedially fulfill the preceding indications? We answer in the language of a distinguished author and standard medical writer, "by using a class of agents which should never be overlooked in the treatment of long-standing liver diseases, chiefly addressed to the blood and denominated 'alteratives.'"

Alteratives, tonics, and restorative catalytics are required not only in diseases of the liver, but in a large number of ailments in which the blood becomes charged with morbid materials. The active remedial properties of the most efficient agents of the above classes of medicine now known, are scientifically combined in the "Golden Medical Discovery," which acts especially upon the blood, and hence influences the system generally. It is also powerful in eliminating those morbid humors which are afterwards subjected to excretion through various organs.

Its action is radically different from most medicines employed in chronic diseases, for the reason, that what is usually prescribed, is something corrosive. Unless the disease be temporary, it may return with increased violence.

We have been very minute in the description of the remedial properties of the "Golden Medical Discovery," and have relied upon the reason and intelligence of our patrons, believing that they can, in a degree, understand why we deem it so applicable to the system. It does not debilitate the liver by over-stimulation, nor irritate the stomach and bowels by disturbing the delicate processes of digestion, neither does it act with severity upon the blood, but it operates so gently, insensibly, and yet with so much certainty, that it excites the surprise and admiration of the patient.

From the careful detail of its various properties, there is abundant reason for its favorable action upon all of the excretory organs, which co-operate in the removal of morbid materials from the system. If, however, the bowels are unusually sluggish or obstinately constipated, it is advisable, in conjunction with the "Golden Medical Discovery," to use the "Pleasant Pellets," which are also powerfully alterative, besides being mild and unirritating in their operation. They are the natural assistants of the "Discovery," working harmoniously together. They should be taken in small doses, and their use perseveringly followed, until the bowels are properly regulated by the use of the "Discovery" alone.

It has been customary to resort to powerful drastic cathartics, followed by bitters prepared in dilute alcohol. The habit is unscientific, for it is well known that alcohol deranges the functions of the digestive organs and depraves the blood, besides creating a morbid appetite. It has been repeatedly demonstrated that the use of such bitters has led to a life of drunkenness, with all the woe and untold misery which attend it.

Medicines to be strictly remedial, should exert a tonic influence upon all the vital processes. Those organs which are contiguous to the liver, or connected by sympathy with it, should be assisted in the performance of their functions. Persons who are habitually subject to "bilious" attacks are pleased to find that the use of the "Discovery" and "Pellets" furnishes immunity from such onsets, and prevents their usual recurrence. Thus these remedies are preventive as well as curative.

What we have thus far recommended for the treatment of this chronic affection is within the reach of every family. Patients laboring under this disease, when complicated with other affections, require special consideration and treatment, and all such are counseled to employ only those physicians whose experience and success entitle them to confidence. Health is one of the greatest of blessings, and how to restore it when lost, is a question of vital importance.

Having successfully treated thousands of invalids who have suffered from this chronic affection, we possess abundant evidence of the curability of the disease, but we have only space to publish a few letters from persons who have been under our care, or who have used our medicines, purchased from druggists.

CONSTIPATION. (COSTIVENESS.)

Health depends very largely upon the regularity of the bowels. There should be proper alvine evacuations every day. There are few persons who have not suffered at some period of their lives from constipation of the bowels. Inattentive to the calls of nature, or a neglect to regularly attend to this important duty, sooner or later, produces disastrous results. Furthermore, it is essential to the comfort of every individual, for, when this function is not performed, there is derangement of the mental as well as of the bodily organs.Constipation, or costiveness, as it is sometimes termed, is a functional derangement of the large intestine. This intestine is about five feet in length, and consists of the cÆcum, colon, and rectum. It serves as a temporary reservoir for the excrementitial residue of alimentary matter, and for the effete materials excreted by the glands contained in its mucous coats. It is distinguished as the large intestine, because of its great size.

Habitual constipation produces many derangements, resulting from sympathy, irritation, or mechanical obstruction. By referring to Figs. 4 and 9, the reader may observe the anatomical relations which the large intestine sustains to the other abdominal organs. The ascending colon arises in the cÆcum (Fig. 4), at the lower part of the abdomen, and passes over the kidney on the right side, where it begins a circuitous route around the abdominal cavity, comes in contact with the inferior surface of the liver, proceeds behind and below the large curvature of the stomach, emerges on the left side, and passes downward in front of the left kidney, where it dips into the pelvic cavity, and ends in the rectum.

If fecal matters are retained until they are decomposed, great injury follows, since the fluid portions are absorbed, conveyed into the blood, and, of necessity, corrupt it with their impurities. In this way, constipation may be the source of general derangement, but such disorder is seldom attributed to the torpid state of this intestine. There is little doubt but that it thereby imposes a great tax upon the functions of the liver, and, frequently, the fault is attributed to that organ instead of the large intestine. Sometimes the blood becomes so charged with fecal matter that its odor can be detected in the breath of the subject.

An overloaded condition of the large intestine may cause inflammation of the liver or dropsy of the abdomen. When the colon is distended, it becomes a mechanical impediment to the free circulation of the blood in other organs, and causes congestion of the portal system, predisposing to chronic inflammation or cirrhosis of the liver. This latter is a structural affection, and may, in turn, give rise to abdominal dropsy. In a word, the accumulation of feces in the colon irritates both the large and small intestines, thus causing congestion of the bowels, liver, or stomach.

The protracted presence of feculent matter deadens the sensibility of the intestine, so that great stimulation is required to provoke it to action. The contents become dry, solid, knotty, and hard, and very difficult to evacuate. If drastic, irritating physic be taken, only temporary relief is afforded, and it must be repeatedly resorted to, and the dose increased, to obtain the desired effect.

Symptoms. One diagnostic symptom of a loaded state of the colon, is an abundant secretion of urine, as limpid as water. The direct symptoms relate to the hardness of the feces and the great difficulty of voiding them. The influence of constipation upon the functions of the liver, is indicated by the sympathy displayed between that organ and the mind. The patient manifests apprehension, mental depression, taciturnity, and melancholy, all indicative of hypochondriac dejection, induced by constipation.

We have treated patients, who, from this cause, had renounced their bright hopes, lost their buoyant spirits, and, becoming subject to superstitious fears, had given themselves up, night and day, to devotions and penance. It often happens that the victims of this deep dejection and morbid feeling of self-abasement, are persons not only of good moral character, but of high religious attainments, and their painful exhibitions of fear, distrust, and gloom, originate in physical rather than in spiritual causes. It is interesting to witness this strange perversion of the imagination, this morbid debasement of the religious faculties, and dejection of mind, due to causes disturbing the functions of the liver and other vital organs.

Young girls, as they approach the age of puberty, seem possessed with the idea that the unfrequent action of the bowels is a desirable habit. They do not associate with the duty a proper regard for health, but consider it as an inelegant and repugnant practice. The consequence is, that at this susceptible period, constipation, induced by neglect, arouses a latent hepatic or pulmonary disease which has been lurking in the system.

How many girls illustrate the truth of this statement by their complaints of dizziness, throbbing pain in the forehead and temples, flushing of the face, transient flushes of heat over the body, while at the same time the extremities are cold. At other times, they manifest the evils of such a course by their stupor, drowsiness, and deep sleep, although upon arising in the morning, they are still tired and unrefreshed.

The constipated condition of the bowels, often leads to congestion of the uterus and leucorrhea, followed by uterine debility, prolapsus, excessive menstruation, anteversion or retroversion of that organ. The infrequency of the habit, incorrectly supposed to be desirable by a young woman, becomes nearly, if not quite disastrous to all her desires and bright prospects. Complications arise, and neither the inexperienced girl nor her solicitous and afflicted parents know where to look for remedial aid. If they seek an asylum from these sufferings, they find many private institutions, where flattering expectations of speedy recovery are aroused. At such institutions, these uterine disorders are generally treated merely as local diseases, while the causes are overlooked, and, consequently, a permanent cure is not effected. Having spent nearly all the money at her command, the patient returns home utterly disheartened. After such failures, many of these unfortunate individuals have applied to us and received treatment, and by persistently following our directions, have in due time been restored to health, amid all the comforts of home, and among friends, who rejoiced with them in the unexpectedly favorable turn of affairs, accomplished at a comparatively trifling expense.

We have seen infants, and also young children, in whom constipation was obstinate. It therefore seems that it is often hereditary. In some persons, this affection continues from childhood, with but little variation, until bleeding pile tumors are developed. Habitual constipation of the bowels for a long period of years will generate a class of diseases, which are often very serious in their results.

Causes. We have already alluded to a sense of false modesty which prevents a response to the calls of nature, and we may mention other reasons, equally trifling, which deter many from fulfilling its demands. Some are in the habit of temporarily postponing their visits to the water closet, until, when they do go, they find themselves unable to evacuate the bowels. Sometimes the closet is a damp, uncomfortable out-house, situated at a distance from the dwelling, or the access is too public, and, hence, there is an unwillingness to visit it at the proper time. Some appear to be too indolent to attend to this duty. Others are too energetic, and think they cannot take the time, until they have finished some self-imposed task or attended to a pressing engagement.

Inactive life and sedentary occupations are also causes of constipation. Active exercise promotes all the bodily functions, and helps to regulate the bowels. Those who are engaged in literary pursuits, find that mental occupation determines the blood to the brain, thus drawing it from the extremities; the temperature falls below the natural standard, and there is almost invariably congestion of the bowels. The inmates of boarding-schools, factory girls, seamstresses, milliners, employÉs in manufacturing establishments, and all who sit and toil almost unremittingly twelve hours in the day, do not get sufficient exercise of all the muscles of the body, and are often troubled with obstinate constipation.

Food prepared according to the modern modes of cookery, is one of the causes which favors the developement of this derangement. People live too exclusively upon bolted wheat flour. The branny portion of a kernel of wheat consists of various nutritive elements, with more than five times the amount of phosphate of lime contained in fine bolted flour. Those who daily use boiled cracked wheat are not troubled by constipation. There is no dryness or hardness of the feces, and the bowels are evacuated without discomfort.

Treatment. Prevention is always better than cure; hence, a few hygienic directions may not be amiss. Do not disregard the intimations of nature, but promptly respond to her calls. If there is constipation, overcome it by establishing the habit of making daily efforts to effect a movement of the bowels. Taking regular exercise by walking, and lightly percussing or kneading the bowels for five minutes daily, help to increase their activity. The habit of early rising favors the natural action of the bowels. Drinking a glass of water on rising exerts a beneficial influence. The food should be such as will excite the mucous secretion of the large intestines, and arouse its muscles to action. For this purpose, there is no one article that excels coarsely-cracked boiled wheat. Graham bread, mush, cakes, gems, and all articles of diet made from unbolted wheat flour are valuable auxiliaries, and may be prepared to suit the taste. Take the meals at stated hours; be punctual in attendance, regular in eating, and thoroughly masticate your food. Irregularity in the intervals between eating, disturbs the functions of the intestine. The use of ripe fruits, such as apples, pears, grapes, figs, and prunes, in proper quantities, is sometimes very beneficial. Trivial or unimportant as these hygienic suggestions may appear, yet were they observed, constipation, as well as most of the diseases incident to it, would be obviated. A large proportion of the cases will yield to the foregoing hygienic treatment without the employment of medicines. Should it be necessary, however, to employ an aperient to relieve the constipation, Dr. Pierce's Golden Medical Discovery will act most congenially, and will be followed by no constipating reaction, which invariably occurs when drastic cathartics are employed. Its operation is mild, bringing about a healthy action by promoting the biliary and other secretions, thus aiding nature in establishing normal functional activity in the bowels. Recourse should be had to it before employing any thing more strongly cathartic. However, should it prove too mild in its aperient effects, small doses of Dr. Pierce's Pleasant Pellets may be employed daily to assist it. Unlike other cathartics, they produce a secondary tonic effect upon the bowels, which renders their influence more lasting than that of other purgatives. We cannot too strongly discourage the injurious custom which many people have of frequently scouring out their bowels with strong cathartics. It is a bad practice, and cannot fail to do injury. The greatest benefit is derived, not from cathartic doses, but from taking only one or two of the "Pellets" per day, or enough to keep the bowels regular, and continuing their use for several weeks, in connection with Dr. Pierce's Golden Medical Discovery, strictly carrying out the hygienic treatment heretofore advised.

The medical treatment of individual cases sometimes involves many considerations relative to the particular circumstances and complications presented. The peculiar susceptibility of the constitution, as well as the diseases incident to constipation, must be taken into account. Symptomatic derangement should not be treated as primary, although it is by inexperienced physicians. If the patient be afflicted with uterine disease, piles, nervous affections, falling of the lower bowel, or fistula, they should be treated in connection with this disease. For these reasons, we would advise our readers to submit all complicated cases, or those that do not yield to the course heretofore advised, to a physician of large experience in the management of chronic diseases, and not assume the great responsibility and the dire consequences which are very liable to arise from the improper treatment of such cases. We have been called upon to treat thousands of cases of this troublesome affection, and as a result of our vast experience, and in consequence of our original and improved methods of diagnosis, it is not generally necessary that we should see and examine the patient in person. We can almost always determine the exact nature of the patient's malady, and its stage of advancement, without seeing the subject in person.

PILES. (HEMORRHOIDS.)

There are few maladies more common than this, and few which are more annoying. Piles consist of tumors formed within the rectum and about the anus, by dilatation of the hemorrhoidal veins and thickening of their walls. Sometimes, when attended by considerable inflammation, or when the attacks are very frequent, there is thickening of the adjacent cellular and mucous tissues.

There are two general forms of this disease, the external or blind piles, in which the tumors are outside the anus, and the internal or bleeding piles, in which the tumors are formed within the sphincters, although after their formation they may protrude. The external piles are commonly made up of thick tissues; upon one side, the skin forms the covering, while on the inner surface is the mucous membrane of the bowel. It is this surface which is most tender and irritable and liable to inflammation. The internal form of the disease is situated from a half an inch to two and a half inches above the sphincter muscle of the anus. The tumors are usually round, oval or cylindrical in form. They may be scattered over the surface of the bowel, or clustered together. The illustrations (Figs. 1 and 2) show the two forms of the disease. The two protruding tumors in Fig. 2, illustrate the usual form of prolapsing internal piles, whilst the one highest up in the bowel shows the form most commonly met with. It is seldom that one pile tumor is found alone, there usually being two or three, and sometimes as many as five or six, in a cluster. Fig. 3 shows the manner of distribution of the veins in the rectal region. The small venous loops, or bulb-like terminations of the veins H. i., are the points at which the piles most frequently occur.

Illustration: Fig. 1. Swollen External Piles.
Fig. 1. Swollen External Piles.

Causes. Whatever tends to favor an undue accumulation of blood in the hemorrhoidal veins predisposes to piles. For this reason the affection is frequently a result of diseases of the heart and liver, which cause an obstruction in the circulation of the blood through the portal vein. Mechanical pressure from tumors in the abdomen, pregnancy, or an enlarged or misplaced uterus, is not infrequently a cause of the disease, by keeping the hemorrhoidal veins over-distended. Those diseases which provoke much straining, as stricture, inflammation or enlargement of the prostate gland, and stone in the bladder are also active causative agents. The most common cause of all, however, is constipation; and persons of indolent, sedentary and luxurious habits of life are the ones most frequently affected with this derangement. The following are also prolific causes of piles, viz.: pelvic tumors, violent horseback exercise, indigestion, pregnancy, habitual use of drastic cathartics, diarrhea, dysentery, sitting on heated cushions, long-continued standing posture, diseases of the liver, worms, the wearing of tight corsets, eating highly seasoned or indigestible food, and the use of alcoholic stimulants. No age is exempt from piles, nor is the disease peculiar to either sex. Aside from the serious inconvenience and pain which are experienced with most forms of piles, there is a tendency to fistula, and to cancer in the rectal region. It is important, therefore, that the disease should not be allowed to run on unchecked.

Illustration: Fig. 2. Piles: internal and protruding.
Fig. 2. Piles: internal and protruding.

Symptoms. The most common symptoms at first are slight uneasiness, such as a little soreness or itching at the verge of the anus, and at times lancinating pains. These sensations are more severe as a rule if the bowels are constipated. If the piles are external they frequently become inflamed, swollen and painful, and in some instances they suppurate, which usually results in relief. When internal piles have increased to any considerable extent, or have become inflamed, they produce not only itching at the extremity of the bowel, pain in the back, etc., but also a sensation of fullness in the rectum, as though some foreign body were present, and, on action of the bowels, there is a sensation as though a portion of the fÆces had not been expelled. When the internal piles become large, they frequently come down with fÆcal matter from the bowel, as illustrated in Fig. 2, and this prolapsus becomes more and more marked with the progress of the disease, until, in many cases, the tumors are forced down at each action of the bowels, causing excruciating pain until they are properly replaced. Usually, in the early stages, they recede spontaneously; however, after a time it becomes necessary for the sufferer to press them back, but in some instances this is impossible. Frequently during the protrusion one of the hemorrhoidal veins gives away, and this is followed by a free escape of blood, and ulceration may ensue. Not infrequently with this disease the patient loses strength and flesh, and the face becomes pale and puffy, assuming a waxy appearance. Many times there is nausea, with vertigo. Is consequence of the relaxation, the bowel may descend when on the feet, or with some extra muscular effort, especially when stooping. These symptoms may not all be present in one person, and, indeed, sometimes are somewhat obscure; when such is the case, an examination by a competent physician will always determine the true character of the complaint at once.

Illustration: Fig. 3.
Fig. 3. H. i. Internal hemorrhoidal veins. H. m. Middle hemorrhoidal veins. H. e. External hemorrhoidal veins. S. i. Internal sphincter muscle, S. e. External sphincter muscle.

Treatment. Notwithstanding the well established fact that piles are readily cured by the appropriate treatment, hundreds of thousands of people suffer untold tortures from them because of the popular impression that they cannot be cured. All cases are not, however, amenable to the same form of treatment, for various unhealthy conditions of the system are often concerned in their production and perpetuation, and must, of necessity, be remedied by appropriate treatment, before a cure of the piles can be expected. It will, therefore, become apparent that the avoidance of causes is of paramount importance. Some of these causes are external, and wholly under the control of the patient, while others depend upon diseases that are curable; it frequently happens that while other diseases are being remedied, the piles disappear Without any special attention.

Diseases of the urinary apparatus, as stricture of the urethra, enlargement of the prostate gland, and stone in the bladder, dysentery, diarrhea, and constipation,—all cause piles, by the irritation, and determination of blood, which they induce; these difficulties must be removed by appropriate treatment.

Some years since, we ascertained that we were using in our practice remedies which, in addition to other virtues, possessed a direct specific influence upon the vessels concerned in the formation of piles. These agents enter into the composition of Dr. Pierce's Golden Medical Discovery, which, consequently, will be found exceedingly efficacious in the treatment of this disease. This remedy, therefore, in removing the disease upon which the piles depend, as a congested or torpid liver, constipation, etc., and in exciting a direct curative control over the piles themselves, exerts a double influence. It may be aided, when the bowels are badly constipated, by the use of Dr. Pierce's Pleasant Pellets, taken in the morning, to secure a regular and easy evacuation of the bowels each day. All stimulating food and alcoholic drinks should be abstained from. The cold bath is beneficial in these cases, provided there is not great debility. The affected parts should be bathed frequently with cold water, and, if prolapsus exists, it is well to inject a little cool water into the rectum, and allow it to remain a few minutes. As a soothing, astringing and healing application to the affected parts we prepare an Ointment that has acquired great fame for the prompt relief which it affords in all ordinary cases. This we do not sell through druggists but can send by mail, on receipt of price, $1.00 per large box, postage prepaid. The persistent use of this Ointment, at the same time keeping the bowels regular by the use of "Golden Medical Discovery," with an occasional laxative dose of "Pellets," will generally cure all ordinary cases of piles.

The Radical Cure of Large Pile Tumors. In cases in which the tumors have become indurated and very large it is impossible to effect cures by the foregoing or any other medical treatment. Various methods have been in use by the profession for the relief of the most severe cases. The most common is excision with the knife or scissors. Reference to the large vessels, shown in Fig. 3, which are affected in this disease, will at once show the sufferer the dangers of this method. The sudden removal of a tumor, which is connected with one or more of the large hemorrhoidal veins, is sure to be followed by severe hemorrhage, and many times painful ulceration, and a fatal result. To avoid this it has been the practice of many physicians to apply caustics or to burn off the base of the tumors with a red-hot iron. A more barbarous and painful method could not be devised. When it is considered that in many cases, this severe and painful treatment is followed by ulceration, and occasionally by the developement of cancer, the matter should be carefully weighed before any such dangerous procedure is attempted. Another common method of treatment is to crush the base of the pile with a clamp, and then cut off the tumors with scissors. After this it is also necessary to apply the hot iron to prevent hemorrhage. Formerly, applications of nitric acid were in common use by physicians as a means of cure, but it was found that while this treatment would give temporary relief, yet in no severe case would it effect a cure. By what we term palliative treatment alone more cures are effected than by the old process of treatment with nitric acid. Still another form of treatment is strangulation of the pile by means of a ligature, and this is often more painful than the application of hot irons, inasmuch as in cutting off the return flow of blood from the piles, a large tumor is left for days fully distended and extremely painful. It does not slough off for a considerable time, and we have seen the strongest men suffer intensely, to whom the use of scissors in removing the tumors was a positive relief in comparison with the torture of the ligature. A treatment that has been highly recommended by some physicians and condemned by others, is the process of injection with carbolic acid. This method of treatment is not very painful but, unfortunately, it is dangerous. The injection of the tumors with a fluid which causes coagulation of the blood, and which does not completely shut off the return current of the circulation through the tumors, has proved fatal in a small percentage of cases. The clots which are formed by this treatment become detached and are carried into the general circulation and conveyed to the liver, lungs and even to the brain, where, by plugging up the vessels of those organs, they cause abscesses which terminate life. Serious inflammation of the veins is another accident which often follows the injection of carbolic acid. This treatment is, therefore, now seldom resorted to except by physicians who do not appreciate its dangers.

A More Successful Method. Fortunately for suffering humanity, a method of treatment has been perfected and thoroughly tested in our institution, in which all such trouble and danger as above described are avoided. This consists in bringing down the tumors, cleansing them and making application, of certain chemical preparations, that cause the tumors to speedily shrivel up, and in a very short time, say ten to fourteen days, disappear entirely. These treatments and applications cause no pain whatever, for by first applying a weak solution of cocaine to the parts they are speedily rendered entirely insensible, so that the most sensitive, nervous lady experiences not the slightest suffering from the application of our remedies.

Having now at our command means so positively certain in their action upon pile tumors, we do not hesitate to say that the very worst cases, no matter of how long standing, can be promptly cured, if we can only have the patient for a few days under our personal care. Considering the very distressing character of pile tumors, it is a great boon that we have at last found safe, painless, and positively certain means for their cure. The news will be hailed with joy by a large class of sufferers.

Probably no other discovery in modern science is destined to be the means of conferring greater blessings on a large class of sufferers than that of a painless and positive method of curing the largest pile tumors in the brief time required by our system of treating them.

It seems to us that there is no longer an excuse for any one to endure the tortures inflicted by pile tumors, provided the afflicted one can command the little time and moderate amount of means necessary to secure the treatment indicated. Piles are not only in and of themselves very painful and annoying, but often greatly aggravate and even cause other grave and painful affections, and should, therefore, not be neglected. When large, they never get well without proper treatment. We have seen many cases in which the long train of diverse and distressing symptoms caused by piles led the sufferer, and even the family physician, to suppose that other diseases existed, but all of which annoying symptoms were speedily dispelled by the cure of the piles. We have no doubt that neglected piles, fistulÆ, and other morbid conditions of the lower bowels, frequently degenerate into cancerous disease. We have the eminent authority of J. Hughes Bennett, of Edinburg, and many other close observers, for saying that benign or ordinary tumors often degenerate into real cancerous disease, and our own extensive observation convinces us that this is not infrequently a result of neglected rectal disease, as piles, fistulÆ and fissures. How important, then, to give prompt attention and skillful treatment to disease of these parts. When the ordinary palliative treatment, with ointments and with laxative agents to keep the bowels soluble, does not completely and perfectly subdue the malady, lose no time in securing the most skillful appliances, that every vestige of the affection may be promptly removed. We have treated many thousands of cases with uniform success, and our patients write to us expressing the greatest degree of satisfaction, and recommending our method most highly.

Reports of a few cases, selected at random from the large number which we have cured, are given below to illustrate our success in curing them.

ANAL FISTULA. (FISTULA IN ANO.)

This disease is more dangerous than piles, though, after once formed, not so painful. It sometimes commences with intense itching about the anus, accompanied with a little discharge; or the first symptom may be a painful abscess, like a boil, which finally breaks. The soreness then in a measure subsides, leaving a fistulous opening, with a continuous discharge of matter. This unnatural opening, with its constant drain upon the system, sooner or later is certain to ruin the health or develop consumption or other maladies, and destroy life.

Fistula in Ano may exist in three conditions: First, complete fistula—when the opening is continuous from the cavity of the rectum or bowel to the surface of the skin, so that liquids, gases, etc., escape; secondly, internal incomplete fistula, when the opening extends from the inside of the rectum into the tissues surrounding it, but not through the skin. A few cases of this kind exist, while the sufferers are unconscious of the nature of the difficulty, supposing it to be piles or some trouble—they know not what. Thirdly, external, incomplete fistula, when the opening extends through the skin into the tissues around the rectum, but does not enter the bowel.

Other complications, such as pendulous tits or projections, from one-fourth to one and a half inches in length, are attendant upon fistula. Two or more openings may appear in the skin, all communicating with the same sinus, or opening into the rectum. Sometimes only a small external opening is seen, while a large abscess exists internally. In any case, the discharge is not only reducing to the system, but it is disgusting and offensive.

Causes The causes are a constitutional predisposition, constipation, piles, or the presence of foreign bodies in the rectum, causing an abscess or ulcer. Some authors have contended that fistula always originates from an ulcer in the rectum, which gradually makes its way through the cellular tissue to the surface. Others contend that the cause of this disease consists in an abscess, which burrows in the tissues and makes its exit into the rectum, or through the skin, or both. No doubt it may originate in both ways. It can readily be seen that when an internal opening is once established, the foeces which enter into it must sooner or later work their way to the surface, burrowing through those parts which offer the least resistance, until a place of exit is reached.

Diagnosis. The disease may be suspected, if there has been an abscess in the parts involved, or if the patient has been subject to pain in the rectum, and the parts are tender, tumid, or indurated. When the fistula opens externally, the linen will be moistened and soiled with pus, or a bloody fluid, and when the tract is large, the foeces may pass through it. A careful exploration with a probe, passed into the external opening while the finger is in the rectum, generally reveals the direction of the tract; but, sometimes, in consequence of the tortuous course of the canal, the probe cannot he made to follow it. When the fistula is incomplete, and opens internally, the probe is passed into the rectum and directed outwards, when it may be felt externally. In such cases, a tumor, caused by the contents of the fistula, may generally be seen protruding near the anus, and the pain will be considerably increased during defecation, by the foeces passing into it and disturbing its walls. The examination should be made with the greatest possible care, for it is attended with more or less pain.

Treatment. When constitutional derangement exists, it must be rectified, or any treatment will be liable to result in failure. The comfort of the patient may be greatly promoted by attention to the bowels, keeping their contents in a soluble condition, and the liver active, so as to prevent congestion of the rectum and adjacent structures. This can best be done by careful attention to hygiene, and the use of "Golden Medical Discovery" and "Pellets," in sufficient quantities to produce the above named effects.

A radical cure, however, cannot be accomplished except by surgical means, for which we have the knife, ligature, caustic, stimulating injections, etc., which may be varied to suit the emergency, but which should never be employed except by a competent surgeon. Constitutional conditions materially influence the cure, no matter what procedure is adopted; the greater the constitutional derangement and the poorer the general health, the longer is the cure delayed. The great secret of our success in treating this disease consists in applying appropriate constitutional treatment at the same time.

The use of the knife is becoming obsolete, and has, to a great extent, given way to other measures which are equally successful. Indeed, other means will succeed in cases in which the knife fails or is for any reason inapplicable. One great objection to the knife is not only the dread which patients entertain of it, but the great liability of its use to result in paralysis of the sphincters of the anus, the consequence of which is loss of control over the bowels; and another is that it sometimes entirely fails to result in cure. By the means which we employ, these objections are entirely overcome, and, while the general system is being renovated, the fistula is healed, without any complications.

Fistula is much more common than has generally been supposed. It is apt to be associated with pulmonary diseases. Heretofore, it has been supposed that to heal the fistula, during the progress of the lung affection, would result in fatal consequences, and the patient has been left to suffer and die under the combined influence, of the two diseases. Observation, based upon an extensive experience in the management of such diseases, has proved that supposition to be fallacious in every respect, and we would urge all persons afflicted with fistula to have the affliction cured, no matter what complications may exist. The fact underlying this erroneous opinion is, that when grave constitutional troubles have co-existed the use of the knife has resulted in failure, and the fistula has refused to heal.

Having had ample facilities for observing the relative merits of the various methods of treating this complaint, in hundreds of eases, in our own practice and that of others, we feel justified in saying that the plan which we have adopted is far superior to that in general use. The local treatment which we employ depends upon the nature of the fistula; in some instances the ligature is best, in others caustics, and again injection, etc., while still others require a combination of two or more methods, or a modification of them.

In cases in which it is impossible for the patient to come to our hotel for a radical and speedy cure of the fistula, we employ constitutional treatment, with, the use of a medicated crayon, which is similar in shape to a small slate pencil. This crayon is made of gelatine with the remedial agents thoroughly incorporated through it, and in an easily soluble form. They are very flexible and readily used, and where the fistulous track is sufficiently large to admit of their insertion, the most decided improvement invariable follows their application. One is oiled and gently introduced into the track every two or three days, and by its solution the unhealthy tissues which line the track are removed. They are thrown off, and a healthy action is induced. With careful constitutional treatment, decided improvement soon follows, and the discharge is gradually lessened. The most satisfactory improvement occurs in the general health and strength of the patient, and gradually the fistula closes. Sometimes it is necessary to pursue this course of treatment for many months, but the result obtained is sufficient reward for the trouble. A large percentage of cures follow this treatment, and we recommend it when it is impossible for the patient to leave home, or when the general health is greatly reduced by severe constitutional disease.

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ids' Hotel and Surgical Institute, where experienced chemists are employed to make such examinations and report the result to the attending physicians. Persons consulting us and desiring to avail themselves of the advantages afforded by these examinations, can send a sample of their urine by express. The bottle should be thoroughly cleansed and should contain from two to four ounces of that first passed after arising in the morning. It should be carefully packed in saw-dust or paper and inclosed in a light wooden box. All express charges must be prepaid through and a complete history of the case, including the age and sex of the patient, should accompany every package, or it will receive no attention. This saves valuable time by directing the examination into the channels indicated and thus avoiding a lengthy series of experiments. As we are daily receiving numerous bottles of urine, every sample, to prevent confusion, should be labeled with the patient's name. By the postal regulations, all liquids are excluded from the mails, unless packed in accordance with our printed directions, which will be sent free on request being received for them.

WE AIM TO CURE,

not merely to palliate as is so often done by practitioners in dealing with these distressing maladies. We do not prescribe coca mixtures, whiskey, malt extracts, so-called celery compounds or other nerve stimulants, which only spur the already weakened nervous system on as a man would urge his jaded horse to renewed efforts when the animal should be refreshed by proper food and rest. Neither have we any faith, in lasting good resulting from prescribing such nerve sedatives as put the nerves to sleep and so, by simply blunting sensibility, delude the patient into the false belief that he is being benefited.

To effect a radical cure of the weakness, the nerve centres must be restored to a normal condition by improving the nutrition of the nerve cells. To do this the causes of the difficulty must be understood and any local weakness or disease of any organ, be it the liver, kidneys, lungs, stomach, rectum, bladder, or generative organs, must be understood, properly treated and overcome. The desire for alcoholic stimulants is a most common and dangerous tendency of the disease. To gratify the morbid appetite for stimulants is to do the patient lasting injury.

IMPOVERISHED BLOOD.

In some cases the nervous affection is the result of an impure, or impoverished, condition of the blood. In such cases the use of Dr. Pierce's Golden Medical Discovery has, in the great majority of cases, resulted in an immediate benefit and gradually in a permanent restoration of the nerve centres to a normal condition. This remedy, particularly if assisted by the use of Dr. Pierce's Pleasant Pellets, when constipation is present, unloads the liver, and their combined action tends to remove from the blood the poisons which it is the function of the liver to take from that fluid. The cells of the brain, after performing their function, throw into the blood certain poisonous materials which it is the function of the liver to remove. If this is not done, the cells become clogged, and can only be restored to a natural and healthful condition by increasing the activity of the liver. This treatment gives rise to an immediate improvement, and a continuance of the remedies results in a gradual toning up of the nervous system and relief from the unpleasant symptoms.

"FEMALE WEAKNESS."

Many women suffer from nervous prostration, or exhaustion, owing to congestion of the uterus and ovaries, caused by over-indulgence; again by overwork, the strain of too many household cares, or too frequent childbirths. In these cases, the use of Dr. Pierce's Favorite Prescription is of the greatest benefit, tending to restore the uterus and ovaries to a normal condition. Its wonderful restorative effects, tonic and nerve invigorating properties, especially adapt it to the cure of these cases. Digestion and assimilation of food are promoted by its use. When the liver or blood is not in healthful condition, as previously referred to, the "Golden Medical Discovery" should be used in conjunction with the "Prescription." If menstruation be scanty, Dr. Pierce's Pellets will have a beneficial influence in increasing the flow, and overcoming the headache and congestion of internal organs that is the result of scanty menstruation, especially if their use be accompanied with full doses of Dr. Pierce's Compound Extract of Smart-Weed.

LOCAL CAUSES.

In the great majority of cases, when nervous prostration has made its appearance at intervals, with periods of prolonged good health intervening, but in which, as a rule, slight excesses, over-exertion or the attacks of some acute disease, produces a nervous exhaustion, we have found that local derangement is the cause of the whole trouble. This cause may often be readily removed and a perfect and permanent restoration of the health will follow.

In Men, we have often found a varicocele to be the cause of nervous prostration. In others rupture, or urethral stricture, sometimes of a character so mild as hardly to give serious inconvenience, has been the cause.

In Women,, ulceration of the uterus, stricture of the cervix, congestion or other diseases of the ovaries, such as cysts, abscesses, etc., inflammation of the Fallopian tubes, characterized with more or less periodical discomfort and attacks of leucorrhea, or "whites," are common causes.

In all cases in which the nervous disease depends upon local causes, we find that the relief of the local source of irritation, which tends to reduce the general health and interfere with perfect nervous tone, is all that is necessary to give the invalid a perfect restoration to health, vigor and activity. It is like removing the burden from a tired horse who has fallen prostrate under an excessive load. The removal of the burden puts the individual under a favorable condition for the immediate restoration to health and strength, and permanent relief is only a matter of a few days' or weeks' time, with appropriate nourishment and restorative nerve tonics.

ALCOHOL, OPIUM AND TOBACCO

affect different individuals according to their several susceptibilities. Some are able to withstand, with apparent impunity, an amount of these that can not be tolerated by others without great injury. No one, however, is wholly proof against these unwholesome agents which are in such common use. The sad results of their excessive use are seen in thousands of cases of shattered nerves and wasted vigor. The excessive use of tea and coffee is also a prolific cause of nervous affections.

Happily, we have now at our command remedies which exercise a most potent controlling influence over the acquired, morbid appetite for these narcotics and stimulants. Of course we have to depend, to some extent, upon the will power of the patient, but where this is not wholly lost, we have in all our later experience, been able to realize a degree of success which has been alike gratifying to both physician and patient.

THE INVALIDS' HOTEL AND SURGICAL INSTITUTE SPECIALLY EQUIPPED FOR THE CURE OF NERVOUS AFFECTIONS.

Private institutions, well supplied with the numerous and costly aids to the work of the specialist treating nervous diseases, are now a recognized necessity. Physicians and sufferers alike appreciate this fact.Public hospitals do not answer this purpose, owing to the fact that they are more especially intended for the alleviation of the sufferings of the poor, and the greater part of the work done is in affording relief from acute diseases and emergencies requiring surgical aid. Attention is thus detracted from delicate nervous affections and is almost wholly engrossed in caring for sufferers from other diseases and injuries. Besides, association with the charity cases that abound in such places and the evidences of suffering present on every hand, are enough to prevent all improvement in sensitive and sympathetic invalids.

Perfect equipment is an important part of the battle in the cure of nervous affections.

ELECTRICITY IN NERVOUS AFFECTIONS.

Illustration: Fig. 4. Our large 40 cell Galvano-Faradic Battery with Switch-board.
Fig. 4. Our large 40 cell Galvano-Faradic Battery with Switch-board.

Electrical applications, to be beneficial, require, on the part of the attendant, a technical knowledge of the highest character with costly apparatus and special appliances. There can be little doubt that electricity is convertible into nerve force.

Illustration: Fig. 5. Our Franklin, or Static Electricity, Machine.
Fig. 5. Our Franklin, or Static Electricity, Machine.

In treating cases in the Invalids' Hotel, a large variety of batteries, dynamos and other electrical appliances are brought into use. These consist of cell batteries, such as is illustrated by Fig. 4, dynamos, operated by power, Franklin, or static electrical machines illustrated in Fig. 5, and other electrical apparatus, the choice of the particular machine or battery being determined by the nature of the case.

CARE AND SKILL REQUIRED.

Electricity, like other powerful agencies, in order to prove remedial must be used of proper strength and in proper quantity. The potential, or strength, as well as the volume, or amount, of current has to be carefully measured for that purpose. To accomplish this, we employ an instrument called a galvanometer, or amperemeter, illustrated in Fig. 6, which indicates the exact amount of current being applied. For the want of such instruments to measure the current, physicians often fail to get beneficial results, as they are not able to administer either the proper quantity or quality of current. Ofttimes, for like reasons, their hap-hazard way of employing this powerful agent does positive injury to the patient.

Illustration: Fig. 6. The Galvanometer, or Amperemeter.
Fig. 6. The Galvanometer, or Amperemeter.

Of course, in treating cases at a distance, we cannot avail ourselves of all the great variety of apparatus brought into use at our Invalids Hotel, yet we have some forms of machines well adapted for home use, and so simple that, by sending plain printed directions with the machines, our patients are able to use them effectively without the aid of the physician. Especially is this true in the milder forms of nervous disease, and when great exactness and nicety of application is not so important. We show in Fig. 7 and Fig. 8, two forms of such batteries which are often furnished our patients for use at their homes. Many times, after cases are under treatment here for a while, we are able to educate them in the use of the battery so that by taking one of these home with them they can continue the treatment with good results after leaving the Institution.

ORGANIC, OR ANIMAL, EXTRACTS AS REMEDIES.

The experience of Pasteur, Brown-Sequard, and our own specialists, in the use of extracts of nerve substance and of certain glands and organs by hypodermic or subcutaneous injection of these fluids, has, in a vast number of cases, been most gratifying to both physicians and patients. Many wonderful cures have thus been obtained. Injected subcutaneously these animal extracts are immediately assimilated and we are often able to stop, at once, the progress of disease and turn the tide towards recovery. Thus the cells receive the special stimulants upon which their life and activity depend.

Illustration: Fig. 7. A small Battery for home use.
Fig. 7. A small Battery for home use.

The animal extracts employed in our Institution are all scientifically and carefully produced in our chemical laboratory under the direct supervision of an experienced chemist, and are believed to be superior in quality. They are turned out fresh, as wanted, which is important, as all such preparations, no matter how carefully made and put up, deteriorate with age.

These extracts are made from the glands and organs of the lower animals, as from the brain, spinal cord, heart, testicles, ovaries and some other organs and parts of bullocks, rabbits, guinea pigs and other animals. That they possess properties which exert most potent tonic, or invigorating, influences upon those organs and parts of the human system corresponding to the organs and parts of the lower animals from which they have been extracted, no longer admits of doubt. In cases of partial and even complete impotency, especially in elderly men, attended with nervous exhaustion, most astonishingly favorable results are obtained by our specialists through the administration of our extracts obtained from the nerve tissue of the spinal cord, associated with the use of the expressed juices from animal testes. We do not, however, prescribe these extracts to the exclusion of other well tested remedial agents, but do regard them, especially in the more confirmed and obstinate cases, as among our most positive curative agents.

Illustration: Fig. 8. A small Battery for home use.
Fig. 8. A small Battery for home use.

We must confess that when first proclaimed by Brown-Sequard as Valuable remedial agents, we regarded the use of these extracts with good deal of skepticism, but experience is, after all, the best teacher and we were forced, after numerous successful tests, to admit their great efficacy. We have always endeavored to keep up with the vanguard of the army of medical reform, and so took early occasion to introduce these agents into our practice and made preparations to produce them in our laboratory.

From an article written by an eminent specialist in nervous diseases, and recently published in the New York Medical Journal, we extract the following:

"Organic beings possess the power of assimilating from the nutritious matters they absorb the peculiar pabulum which each organ of the body demands for the development and sustenance. The brain, for instance, selects that part which it requires, the heart the material necessary for its growth and preservation, and so on with the liver, the lungs, the muscles, and the various other organs of the body. No mistake is ever committed. The brain never takes liver nutriment, nor the liver brain nutriment; but each selects that which it requires. There are, however, diseased conditions of the various organs in which this power is lost or impaired, and, as a consequence, disturbance of function, or even death itself, is the result."

"Now, if we can obtain the peculiar matter that an organ of the body requires

and inject it directly into the blood, we do away with the performance of many vital processes which are accomplished only by the expenditure of a large amount of vital force."

"Let us suppose a person suffering from an exhausted brain, the result of

excessive brain-work. Three hearty meals are eaten every day, but, no matter how judiciously the food may be arranged, the condition continues. Now, if we inject into that person's blood a concentrated extract of the brain of a healthy animal, we supply at once the pabulum which the organ requires. Then, if under this treatment the morbid symptoms disappear, we are justified in concluding that we have successfully aided Nature in doing that which, unassisted, she could not accomplish."

"That is the system. I believe it is applicable not only to the brain, but to all

the other organs of the body."

The writer of the above is, very probably, a little over sanguine in his opinion that the plan of treatment will prove efficacious in all organic diseases, but certainly, from our experience, we can endorse his belief as to its great efficacy in many forms of organic weakness, especially those of the generative organs, nervous system, heart and some other parts of the body. We believe that we are placing a conservative estimate upon the remedial value of these animal juices, or extracts, when we say that they are destined to fill an important place in the curative resources of the specialist in chronic diseases.

Under the head of epilepsy, also in connection with our consideration of locomotor ataxia, we shall have occasion to refer to the use of these extracts as applicable to the cure of those maladies.

Most cases of nervous diseases that come to us, for examination and treatment, do so after having tried, without success, treatment by baths, enforced seclusion, as well as unskillfully applied electrical treatment and massage. Prolonged medication has frequently aroused digestive disorders and made the patient hate the sight of the medicine bottle. In such cases our improved methods, as applied in the Institution and also prescribed for patients at a distance, enable our specialists to give relief and effect cures with a minimum of medicine. They also enable us to treat many cases of nervous diseases heretofore regarded as almost hopeless, such as locomotor ataxia, paralysis, epilepsy and spinal affections, with a degree of success which has been very gratifying alike to physicians and patients.

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There is no ill to which flesh is heir that is the source of a greater degree of discomfort to the human race than headache. The farmer, housewife, banker, merchant and laborer seem to be equally prone to the affliction and all who suffer have a great number of days rendered uncomfortable and unhappy by the presence of this most unpleasant affection. Pain is the warning finger of disease—the threatening indication of coming trouble. In headache, we have an indication that the system is subjected to some strain or injurious impression. It may be that the eyes have been overworked or the brain unnaturally taxed; or that the nervous and physical systems have not been properly refreshed by sufficient sleep, and have used up the residue of reserve power. Many suffer from headache only after they have been subjected to sudden changes of temperature and have taken cold; others only when the bowels have become inactive, the liver torpid and the blood vitiated with retained poisons.

All appreciate the discomfort that results from this malady and earnestly seek for permanent relief.

Headaches may be divided in two classes: (1) those due to the presence of poisons in the blood, and (2) those due to irritation of various organs, as of the eyes, stomach, liver, and intestines.

Of the first form, or variety, of headache, influenza, or grip, and acute "cold in the head," are the most common causes. These give rise to most excruciating pain. There is congestion, followed by inflammation in the nasal passages and cavities communicating therewith. The membranes of these passages throw out a thin, watery, irritating discharge, which gradually thickens and becomes pus-like and offensive in character, if the disease continues.

Poisonous matters are absorbed from the affected surfaces into the blood. These poisons, circulating in the blood, produce great irritation of the nerve cells, so much so, that the severity of the attack is felt in the nervous centres, the brain and spinal cord, with pain varying from the most acute and sharp, to a dull, numb ache. The temples, eyes, neck and small of the back, are in their order, the usual locations of greatest pain. Such attacks vary in frequency and severity. One attack is usually followed by an early recurrence, which may be more or less severe, while the period of active pain varies from a few hours to several days. Such attacks leave an exhausted state of the nerve centres and general weakness of the system that often lasts for weeks and may permanently impair the system, except such results be prevented by appropriate treatment. Every recurrence of the attack leaves the system in a worse condition, until profound nervous prostration; ensues.Malarial headache, sometimes termed "brow ague," is a common form of the malady with those residing in malarial regions. The pain rapidly develops, usually over one eye. It lasts from five to ten hours, and is often of frightful intensity.

Other forms are rheumatic and gouty headache; usually a heavy aching pain appearing on the approach of storms, but at times almost continuous, made worse by improper diet.

UrÆmic headache is due to kidney disease, and alcoholic to direct irritation of the brain membranes from the use of alcoholic beverages. The latter is accompanied with much irritation of the stomach and intestines.

Headaches of a similar character result from the presence in the blood of an excess of the active principles of coffee and tea.

Overindulgence in these agents, as with alcohol, affects the nerve cells and membranes, often causing severe attacks of headache.

Nervous headache is another common affliction. This seems to arise from several causes, such as impoverished blood and exhaustion from overwork of the brain. Hysterical headache is not uncommon. There is a severe kind of headache, the attacks of which appear first at early puberty and continue at intervals more or less frequent in women up to the change of life and in men to about the fortieth year.

The periodical headache is usually preceded by yawning, chilliness, languid, exhausted feelings, in others by peculiar emotional or mental activity. This is followed by unusual drowsiness, in which the night's rest is broken by dreams, and from which the patient awakes tired. Gradually, during the day, the headache develops, beginning in the eyes or bones over them. It gets more and more severe, shooting into the jaws and neck or extending to the back of the head and spine. As the pains get most severe, nausea or vomiting, often repeated, follow, in which the contents of the stomach, with mucus and bile, is ejected. The whole paroxysm lasts from five hours to two or even three days.

Neuralgic headache is a common variety; often the pain is not confined to the head, in fact neuralgia may affect almost any part of the system.

NEURALGIA.

Neuralgia is an affection of the nerves, of which the chief symptom is pain. This is of variable intensity and character. It follows the course of the affected nerve and its branches, and occurs in paroxysms, of agonizing pain with periods of intermission during which the pain may be very slight, and cause but little discomfort.

The severe pain is described as lancinating, cutting, tearing, burning, boring and pressing. Patients use different words in describing the attacks, and there is probably a difference in the character of the pain, though in a severe paroxysm one is scarcely able to make a very nice distinction. We have known cases in which the pain occurred suddenly and overwhelmed the patient's fortitude by its severity and unexpected onset. Between the paroxysms there may be less severe pain, which is then more frequently of an aching, burning or pricking character. In some, paroxysm after paroxysm succeed each other with almost lightening-like rapidity, and even in the intervals the pain is very intense. At another time there is only one sharp sting of pain, which attacks recur several times an hour or day, or may be absent for days or months. An extended freedom from all pain is rare in a patient very much affected. The first attacks in all forms of neuralgia are often comparatively light, and the severity of the pain gradually increases as the attacks multiply. We have frequently had patients unacquainted with anatomy, map out the distribution of a nerve very perfectly, simply describing the portion of the body in which the pain was experienced. For convenience, the neuralgia has been named with reference to the nerve most seriously attacked; lumbago to the spasms of pain affecting the small of the back; tic-douloureux is a term applied to neuralgia of the fifth nerve, that supplying the side of the face, with branches to the eyes, jaw, and teeth. Neuralgia of the testicles, ovaries, stomach, heart, are frequently met with. That affecting the large nerve supplying the thigh and leg is termed sciatica. These nerve affections often prove a most grave disorder, rendering the life of the sufferer a burden.

Treatment. Contrary to opinions frequently expressed by members of the medical profession, we find that most cases present some removable, or remediable, cause for attacks of headache and neuralgia. The temporary relief that is obtained by the use of "headache powders," various bromide combinations, caffeine and other anodyne and narcotic medicines, is sometimes necessary in order that the excruciating sufferings may be borne for the time, but as a rule such remedies only react unfavorably by interfering still further with the natural restoration of the affected organs, or protract the removal of the cause of the disease. Hence, the next attack is usually earlier in its appearance and more severe and lasting when such agents are employed.

The great majority of headaches and neuralgias are due to the presence of poisons in the blood. This may be due to affections of the blood-making, or blood-purifying organs.

For the correction of inactive blood-making glands, or a lack of purification of the blood, due to such cause, the use of Dr. Pierce's Golden Medical Discovery is particularly beneficial. It has no equal in its direct effect upon the liver, the great purifying organ of the body. Through this natural gateway, it removes from the system poisonous materials which are the waste from the nerve cells. The accumulation of these waste materials irritates the cells and causes them to cry out with pain. The blood, being properly purified by the use of "Golden Medical Discovery" supplies to the nerves, and to the nerve cells, what they crave—a healthy and rich blood that furnishes proper nourishment. Hence the headache disappears, and the neuralgic pains are overcome.

When the liver is engorged and torpid, the intestines become overloaded with fecal matters that putrefy and give rise to gases and consequent distention. Deleterious poisons are formed and absorbed by the blood from such hardened and irritating lumps in the intestines. When the bowels are thus constipated, Dr. Pierce's Pleasant Pellets are necessary as an adjunct to the "Golden Medical Discovery." The "Pellets" remove from the intestinal canal all irritating materials and thus enhance the alterative, or blood-cleansing, action of the "Golden Medical Discovery."

In women, when there is a nervous affection, dependent upon some unnatural state of the ovaries or uterus, and complicated with an imperfect or unnatural circulation in those parts, we have noted that most satisfactory results invariably follow the use of Dr. Pierce's Favorite Prescription. This agent improves the tone of the nervous system, and by its direct restorative tonic effects, lessens, or overcomes, any congestion of the womb or its appendages, regulates menstruation and promotes a condition of health and vigor.

In a vast experience, our specialists have thoroughly tested a great many specific remedies which we prescribe for home-treatment, sending the necessary remedies to our patients by express or mail, carefully adapting them to each individual case. Many sufferers have been, by a brief course of our home-treatment, relieved permanently from excruciating sufferings that had been a source of annoyance and loss of time for many years prior to the use of our remedies.

Our treatment is intended to effect permanent cures. We do not use those narcotics and compounds of antipyrine and other similar agents which are very depressing in their effects, and, like morphine and other preparations of opium, give only temporary relief, and interfere with the action of the heart, but we use treatment that builds up the system, removes the cause of the difficulty and restores the nervous system and all the organs of the body to a normal and healthful condition.

In some cases we advise treatment in our Institution, where we have every facility in the way of electrical appliances and many other aids that can only be employed by the personal attention of a skillful physician. These aids are more fully described under the head of nervous exhaustion and a reference is also suggested to what we have to say under the heads of paralysis and locomotor ataxia.

Headaches or neuralgic pains, due to local irritations, as uterine disease, stricture, neurotic or nerve tumors, pressure of trusses, eye strain from weakened eye muscles, or lenses that need the help of proper spectacles, require for a permanent cure the removal of the cause. Sciatic neuralgia, one of the most common and painful forms of nerve irritation, is particularly amenable to treatment by the modern means of cure used in our practice at the Invalids' Hotel.We find, as a rule, that severe headaches and neuralgias are but the forerunners of more serious conditions, and are therefore deserving of special attention. They should be corrected as early as possible, before any organic changes have occurred.

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PARALYSIS OR PALSY;

, it is most generally dependent upon deficient nutrition, and special attention should be given to the diet of the patient, which should be nutritious. Fresh air and outdoor exercise ought not to be neglected.

The proper treatment of rupia does not differ from that suggested for pemphigus.

NERVOUS AFFECTIONS OF THE SKIN.

In nervous affections of the skin, the natural sensibility may be increased, diminished, or perverted. These morbid impressions arise from the nervous system. Although there are several varieties of these affections, yet, being of minor importance, we shall omit their consideration and only speak of one of them in this work.

Prurigo affects the entire surface of the body and imparts to the skin a parched, yellowish appearance. It is characterized by pimples, and an intense burning, itching sensation. Rubbing and scratching only irritate the skin, which becomes covered with thin black scabs. A good representation of prurigo may be seen in Colored Plate II, Fig. 6. The itching sensations are sometimes caused by chilling the body, by violent exercise, and heat; allowing the mind to dwell upon the affection aggravates it. Prurigo is recognized under two forms; vulgaris, which is a mild form, and senilis, which chiefly occurs in old age, and is more severe. The external genital parts of females are frequently affected with this disease, and it is aggravated by menstruation and uncleanliness.

This affection may be due to a vitiated condition of the blood, and is common among those who are greatly debilitated. It is frequently occasioned by uncleanliness, intemperance, the use of unwholesome food, or by an impure atmosphere.

Treatment. To allay the itching, take glycerine, one ounce, add to it one drachm of sulphite of soda, and one ounce of rose-water, and apply this to the affected parts. A solution made with borax, two drachms, and morphine, fire grains, dissolved in six ounces of rose-water, makes an excellent lotion to allay the itching. If the disease be severe, it will be necessary to correct the vitiated condition of the blood by a protracted use of Dr. Pierce's Golden Medical Discovery, and to aid its effects, give one "Pleasant Pellet" every day, not to operate as a cathartic, but only to exert an alterative influence.

ALPHOUS AFFECTIONS.

(SCALY SKIN DISEASES.)

Differences of opinion exist with regard to the proper classification of these affections. We shall briefly consider alphos, which is sometimes confounded with lepra.

Alphos, which from its Greek derivation signifies white, is characterized by circular, slightly raised white spots. These eruptions vary in size from one line to two inches in diameter, and may be scattered over the entire surface of the body, although they most frequently appear upon the elbows and knees. Alphos may consist of a single tubercle, or of large clusters constituting patches. The scales vary in color and thickness. In Colored Plate III, Figs. 14 and 15, are fine illustrations of alphos. When a person begins to recover from this affection, the scales fall off, leaving a smooth red surface, which gradually returns to its natural color.

This disease is more liable to occur in winter than in summer, although in some cases the reverse holds true. It may disappear for a time, only to return again with renewed vigor. It is not regarded as contagious.

Treatment. Thorough and protracted constitutional treatment is required to overcome this disease. Dr. Pierce's Golden Medical Discovery should be taken internally and also applied locally to the affected parts. To every other bottle of the "Discovery" which is taken, one-half ounce of the iodide of potash may be added. One or two of the "Pellets" taken daily will prove a useful adjunct to the "Discovery."

Locally, we have sometimes applied a lotion made of oxide of zinc, one-half drachm; benzoic acid, two drachms; morphine, five grains; glycerine, two ounces. Tincture of the chloride of iron, one drachm in one ounce of glycerine, makes an excellent local application. Whatever the local treatment may be, however, we chiefly rely upon the persistent use of the best alteratives, or blood-cleansing medicines.

AFFECTIONS OF THE HAIR-FOLLICLES.

Favus (Scald Head) is a disease peculiar to the hair-follicles, and is indicated by the formation of small yellow crusts, having the form of an inverted cup. The eruption has a very offensive odor. When it appears in isolated cups, it is termed favus dispersus, but it often occurs in large clusters, as represented in Colored Plate II, Fig. 12. and is then termed favus confertus. It generally affects the scalp, but sometimes extends to the face and neck.

Cause. Favus is caused by nutritive debility, which results in a perverted cell-growth.

Sycosis (Barber's Itch) is an inflammatory affection of the hair follicles of the face. The prominent features of the disease are redness and the formation of scales. It is peculiar to males. It has received various names, according to its predominating characteristics, such as sycosis papulosa, tuberculosa, and fungulosa. Colored Plate II, Fig. 10, is a line illustration of sycosis as it appears on the cheek.

Causes. Various causes induce the appearance of sycosis. The general causes are nutritive debility, vicissitudes of heat and cold, and an exhausted state of the nervous system. It may also result from various chronic diseases, such as syphilis and dyspepsia.

Comedones, or grubs, are due to a retention of the sebaceous matter in the follicles. The sebaceous substance undergoes a change, becoming granular and somewhat hardened. It gradually extends to the mouth of the follicle, where it comes in contact with the atmosphere, and assumes a dark color, as represented in Plate II, Fig. 8. This fact, together with its peculiar form when squeezed out of the skin, has caused it to be termed grub. They often appear in great numbers on the face of persons whose circulation is not active, or those who are of a particularly nervous temperament. Stimulating baths and friction will prove very efficacious in removing these cylinders of sebaceous matter. If they are allowed to remain, they will produce an irritation of the skin causing an inflammatory disease known as acne, or stone-pock.

Acne or Stone-pock. In the earliest stage of congestion, acne is characterized by minute hardened elevations of the skin, as shown in Plate II, Fig. 9, and is termed acne punctata. As the affection progresses, a bright red pimple, Plate II, Fig. 11, appears, having a conical form, hence the name acne coniformis. The pimple develops into a pustule containing yellow "matter," and is then known as acne pustulosa. This is followed by a thickening of the tissues, termed acne tuberculata. When the thicker skin is removed, it leaves a deep scar, hence the term acne indurata.

Causes. The remote cause of acne is nutritive debility. The immediate causes are rapid growth, anÆmia, improper food, errors of hygiene, mental exhaustion, and various chronic diseases.

Treatment. The treatment of favus or scald-head should be commenced by shaving the hair off close to the scalp and washing the head thoroughly with soap and water. In some severe cases, it may be necessary to soften the incrustations with poultices, following these with a free use of soap and water. Having thus exposed the scalp and thoroughly divested it of incrustations, apply to it the ointment of iodide of sulphur, which may be procured at any good drug store. It should be gently rubbed over the parts night and morning. The scalp ought to be kept perfectly clean throughout the treatment. Instead of the foregoing, the following may be applied: Take oxalic acid, ten grains; creosote, twenty drops; water, two ounces; mix. Half an hour after using this lotion, anoint the head freely with butter or lard; it will add greatly to the efficacy of the treatment. But while local applications will relieve many skin diseases and mitigate suffering, we cannot too strongly impress upon the minds of our readers the importance, in this as in all other chronic diseases of the skin, of perseverance in the use of the best alteratives. In this class of agents Dr. Pierce's Golden Medical Discovery stands pre-eminent. Its efficacy may be increased in this disease by adding to each bottle one ounce of the acetate of potash, and, when thus modified, it may be administered in the same manner as if no addition had been made to it.

The Treatment of Sycosis should be essentially the same as that suggested for favus, and it will result in prompt relief and a permanent cure.

Treatment of Acne. In the treatment of this, as in that of other diseases, we should seek to ascertain the cause, and, when possible, remove it. Outdoor exercise, a spare, unstimulating diet, and perfect cleanliness are of the first importance. The affected parts should be bathed with warm water and Castile, or, what is better, carbolic soap. Washing the face in cold water generally aggravates the disease. As a local application to the pustules, we have used with good results the following lotion: Oxide of zinc, twenty grains; morphine, five grains; glycerine, two ounces: mix. First having washed the affected parts thoroughly, apply this compound. Our chief reliance, however, as in the preceding diseases, should be upon the persistent use of alteratives and mild cathartics or laxatives.

FURUNCULAR AFFECTIONS.

(BOIL-LIKE AFFECTIONS.)

Under this head properly belong boils, carbuncles, and styes.

Boils. These annoying affections are hard, prominent, circumscribed, inflamed, suppurating tumors, having their seat in the cellular tissue beneath the skin. They vary in size from a pea to a hen's egg, and may occur on any part of the body. The color of a boil varies from deep red to mahogany. It is painful, tender, advances rapidly to maturity, becomes conical, and finally bursts and discharges bloody "matter." Through the opening, and filling the cavity, may be seen a piece of sloughing cellular tissue which is called the core. In from four to fifteen days, it is all expelled and the sore rapidly heals. The causes are an impure condition of the blood, which generally arises from imperfect action of the liver or kidneys.

Treatment. Spirits of turpentine applied to a boll in its earliest stage will almost always cause it to disappear; but when suppuration has commenced it should be favored by the application of poultices. Next purify the blood to prevent subsequent returns to other parts of the body. For this purpose take Dr. Pierce's Golden Medical Discovery. One or two "Pleasant Pellets" each day will aid in the cure.

CARBUNCLE. (ANTHRAX.)

These are more violent, larger, and more painful than boils, which they resemble. They may spring from several small pimples which extend deep into the tissues, and on the surface frequently several small vesicles appear and break. They may discharge, through one or several openings, a thin acrid, bloody, or dark-colored fluid. They most frequently appear upon the back of the neck, back, back part of the limbs, and under the arms. Their presence is evidence of a depressed condition of vitality. These tumors vary in size from one-half an inch to six inches in diameter, and rapidly proceed to a gangrenous condition, a grayish slough being detached from the healthy tissue.

Treatment. Invigorate the system by every possible means. The bitter tonics, such as Golden Seal, Gentian, or Willow, together with quinine and iron should be used. Nutritious diet, pure air, etc., are necessary. Purify the blood to remove the causes of the disease. For this purpose, give the "Golden Medical Discovery" in as large doses as can be borne without acting too freely on the bowels. Anodynes may be necessary to overcome the pain. Poultices are useful to encourage the separation of the dead from the living tissues. Antiseptic dressings are beneficial, of which carbolic acid is to be preferred; yeast, however, may be employed.

Sometimes powerful caustics or free incisions are productive of gratifying results, if followed by appropriate dressings, but these extreme measures should only be resorted to by the direction of a physician.

For a considerable time after the urgent symptoms have subsided, the "Golden Medical Discovery" should be used, to purify and enrich the blood, and the bitter tonics and iron may be alternated with it, or be used conjointly to good advantage.

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SCROFULA.

It is estimated that about one fifth of the human family are afflicted with scrofula. A disease so prevalent and so destructive to life, should enlist universal attention and the best efforts of medical men in devising the most successful treatment for its cure. It varies in the intensity of its manifestation, from the slightest eruption upon the skin (scrofulous eczema), to that most fatal of maladies, pulmonary consumption.

The Scrofulous Diathesis. The existence of a certain disposition or habit of body designated as the scrofulous or strumous diathesis, is generally recognized by medical practitioners and writers as a constitutional condition predisposing many children to the development of this disease. Enlargement of the head and abdomen, fair, soft and transparent or dark, sallow, greasy or wax-looking skin, and precocious intellect are supposed to indicate this diathesis.

The characteristic feature of this disease, in all the multifarious forms that it assumes, is the formation of tubercle, which, when the malady is fully developed, is an ever-present and distinguishing element.

Tuberculous is therefore almost synonymous with scrofulous, and to facilitate an acquaintance with a large list of very prevalent maladies, we may generalize, and classify them all under this generic term. As tubercle is frequently spoken of in works treating on medicine and surgery, playing, as it does, a conspicuous part in an important list of diseases, the reader may very naturally be led to inquire:

What is Tubercle? As employed in pathology, the term is usually applied to a species of degeneration, or morbid development of a pale yellow color, having, in its crude condition, a consistence analogous to that of pretty firm cheese. The physical properties of tubercle are not uniform, however. They vary with age and other circumstances. Some are hard and calcareous, while others are soft and pus-like. The color varies from a light yellow, or almost white, to a dark gray.

It is almost wholly composed of albumen united with a small amount of earthy salts, as phosphate and carbonate of lime, with a trace of the soluble salts of soda.

The existence of tubercular deposits in the tissues of the body, which characterizes scrofula, when fully developed, must not, however, be regarded as the primary affection. Its formation is the result of disordered nutrition. The products of digestion are not fully elaborated, and pass into the blood imperfected, in which condition they are unable to fulfill their normal destiny—the repair of the bodily tissues. Imperfectly formed albuminous matter oozes out from the blood, and infiltrates the tissues, but it has little tendency to take on cell-forms or undergo the vital transformation essential to becoming a part of the tissues. Instead of nutritive energy, which by assimilation produces perfect bodily textures, this function, in the scrofulous diathesis, is deranged by debility, and there is left in the tissues an imperfectly organized particle, incapable of undergoing a complete vital change, around which cluster other particles of tubercular matter, forming little grains, like millet seed, or growing, by new accretions of like particles, to masses of more extensive size. As tubercle is but a semi-organized substance, of deficient vitality, it is very prone to disintegration and suppuration. Being foreign to the tissues in which it is embedded, like a thorn in the flesh, it excites a passive form of inflammation, and from lack of inherent vital energy it is apt to decompose and cause the formation of pus. Hence, infiltration of the muscles, glands, or other soft parts with tuberculous matter, when inflammation is aroused by its presence, and by an exciting cause, give rise to abscesses, as in lumbar or psoas abscesses. When occurring in the joints, tubercles may give rise to chronic suppurative inflammation, as in white swellings and hip-joint disease. Various skin diseases are regarded as local expressions of, or as being materially modified by, the scrofulous diathesis, as eczema, impetigo, and lupus. The disease popularly known as "fever-sore" is another form of scrofulous manifestation, affecting the shafts of the bones, and causing disorganization and decay of their structure. Discharges from the ear, bronchitis, chronic inflammation of the intestinal mucous membrane, and chronic diarrhea are frequently due to scrofula, while pulmonary consumption is unanimously regarded as a purely scrofulous affectation. Scrofula shows a strong disposition to manifest itself in the lymphatic glands, particularly in the superficial ones of the neck. The most distinguishing feature of this form of the disease is the appearance of little kernels or tumors about the neck. These often remain about the same size, neither increasing nor diminishing, until finally, without having caused much inconvenience, they disappear. After a time these glands may again enlarge, with more or less pain accompanying the process. As the disease progresses, the pain increases, and the parts become hot and swollen. At length the "matter" which has been forming beneath, finds its way to the surface and is discharged in the form of thin pus, frequently containing little particles or flakes of tubercular matter. During the inflammatory process there may be more or less febrile movement, paleness of the surface, languor, impaired appetite, night sweats, and general feebleness of the system. The resulting open ulcers show little disposition to heal.

Symptoms. There is a train of symptoms characteristic of all scrofulous disease. The appetite may be altogether lost or feeble, or in extreme cases, voracious. In some instances there is an unusual disposition to eat fatty substances. The general derangement of the alimentary functions is indicated by a red, glazed or furrowed appearance of the tongue, flatulent condition of the stomach, and bloated state of the bowels, followed by diarrhea or manifesting obstinate constipation. Thirst and frequent acid eructations accompany the imperfect digestion. The foul breath, early decay of the teeth, the slimy, glairy stools, having the appearance of the white of eggs, and an intolerable fetor, all are indicative of the scrofulous tendencies of the system.

Causes. Scrofula may be attributed to various causes. Observation has shown that ill-assorted marriages are a prolific source of scrofula. Both parents may be not only healthy and free from hereditary taints, but robust, well-formed physically, perfectly developed, and yet not one of their children be free from this dire disease. It may present itself in the form of hip disease, white swelling, "fever-sore" suppurating glands, curvature of the spine, rickets, ulcers, pulmonary consumption, or some skin disease, in every case showing the original perversion of the constitution and functions. Scrofula is hereditary when the disease, or the diathesis which predisposes to its development, is transmitted from one or both parents who are affected by it, or who are deficient in constitutional energy, showing feeble nutrition, lack of circulatory force, and a diminished vitality. All these conditions indicate that a few exposures and severe colds are often sufficient to produce a train of symptoms, which terminate in pulmonary or other strumous affections. Whatever deranges the function of nutrition is favorable to the development of scrofula, therefore, irregularities and various excesses tend to inaugurate it. Depletion of the blood by drastic and poisonous medicines, such as antimony and mercurials, hemorrhages and blood-letting, syphilis, excessive mental or physical labor, as well as a too early use and abuse of the sexual organs, all tend to waste the blood, reduce the tone of the system, and develop scrofula.

Illustration: Fig. 1. A Scrofulous Tumor
Fig. 1. A Scrofulous Tumor

Scrofula may be the consequence of insufficient nourishment, resulting from subsisting upon poor food, or a too exclusively vegetable diet, with little or no animal food.

Want of exercise and uncleanliness contribute to its production. It is much more prevalent in temperate latitudes, where the climate is variable, than in tropical or frigid regions. The season of the year also greatly influences this disease, for it frequently commences in the winter and spring, and disappears again in the summer and autumn months.

Treatment. The skin should be kept clean by means of frequent baths. These assist the functional changes which must take place on the surface of the body, permit the stimulating influence of the light and air and facilitate the aeration of the blood, as well as the transpiration of fluids through the innumerable pores of the skin. All exposure to a low temperature, especially in damp weather, and the wearing of an insufficient amount of clothing should be avoided. Then the food should be generous and of the most nourishing character. Steady habits and regular hours for eating and sleep must be observed, if we would restore tone and regularity to the functions of nutrition. Moderate exercise in the open air is essential, in order that the blood may become well oxygenated, that the vital changes may take place. It is no doubt true that the occasion of the prevalence of scrofula among the lower classes may be ascribed to frequent and severe climatic exposures, irregular and poor diet, or want of due cleanliness. Every well-regulated family can avoid such causes and live with a due regard to the conditions of health. The proper treatment of scrofula is important, because we meet with its symptoms on every side, showing its slow actions upon different parts of the body and its influence upon all the organs. After this disease has been existing for an indefinite length of time, certain glands enlarge, slowly inflame, finally suppurate, and are very difficult to heal. These sores are very liable to degenerate into ulcers. All of these symptoms point to a peculiar taste of the blood, which continually feeds and strengthens this morbid outbreak. All authors agree that the blood is not rich in fibrinous elements, but tends to feebleness and slow inflammation, which ends in maturation. Thus we may trace back this low and morbid condition of the blood to debility of the nutritive organs, defective digestion, which may be induced by irregular habits, a lack of nourishing food, or by the acquirement of some venereal taint.

The matter that is discharged from these glands is not healthy, but is thin, serous, and acrid; a whey-like fluid containing little fragments of tuberculous matter, which resembles curd. The affected glands ulcerate, look blue and indolent, and manifest no disposition to heal. We have thus traced this disorder back to weak, perverted and faulty nutrition, to disordered and vitiated blood, the products of which slowly inflame the glands, which strain out unhealthy, irritating, poisonous matter. The medicines to remedy this perverted condition of the blood and fluids must be alteratives which will act upon the digestive organs and tone the nutritive functions, thus enriching and purifying the blood. As this affection is frequently a complication in chronic diseases, it is eminently proper for us to refer to a few considerations involved in its general treatment.

An alterative medicine belongs to a class which is considered capable of producing a salutary change in a disease without exciting any sensible evacuation. In scrofula, remedies should be employed which will improve digestion and also prevent certain morbid operations in the blood.

It is well known to medical men that nearly all medicines belonging to the class of alteratives, are capable of solution in the gastric and intestinal secretions, and pass without material change, by the process of absorption, through the coats of the stomach and intestines, as do all liquids, and so gain an entrance into the general circulation; that these same alteratives act locally to tone and strengthen the mucous surfaces, and thus promote and rectify the process of digestion before being absorbed; that alterative medicines, when in the blood, must permeate the mass of the circulation, and thus reach the remote parts of the body and influence every function; that these medicines, while in the blood, may combine with it, reconstruct it, and arrest its morbid tendencies to decomposition.

We should use those alteratives which give tone to the digestive and nutritive functions, in order to curtail the constant propagation of scrofula in the system; which alter and purify the blood through the natural functions, thus reconstructing it; and which check the septic, disorganizing changes which are evinced by the irritating and poisonous matter discharged from the ulcers.

These are the three ways in which medicines operate upon the nutritive functions and the blood.

Thus alteratives may be specifics, in so far as they are particularly useful in certain disorders, and the combination which has been made in Dr. Pierce's Golden Medical Discovery, excels all others with which we are acquainted, for scrofulous diseases, particularly in fulfilling the foregoing indications. It works out peculiar processes in the blood, not like food, by supplying merely a natural want, but by strengthening the nutritive functions and counteracting morbid action, after which operations it passes out of the system by excretion.

From what has been said upon the importance of blood medicines and their modes of action, the reader must not infer that we account for all diseases by some fault of the humors of the body, for we do not. But that scrofula, in its varied forms, results from imperfect nutrition and disorders of the blood, is now universally conceded. It is for this reason that neither time nor pains have been spared in perfecting an alterative, tonic, nutritive, restorative, and antiseptic compound, to which Dr. Pierce has given the name of "Golden Medical Discovery." Not only is it an alterative and a nutritive restorative, acting upon the secretions, but it opposes putrefaction and degenerative decay of the fluids and solids. Hence its universal indication in all scrofulous diseases. It will intercept those thin, watery discharges which are the result of weakness, degeneration, and putrescent decay of the blood, perpetuated by a low grade of scrofulous inflammation. By an adult it can be taken in doses of from one to two teaspoonfuls three or four times per day.

The bowels should be properly regulated. When constipation exists one or two of Dr. Pierce's Pleasant Pellets taken daily, will fulfill the indication. The patient ought not to neglect to carry out all the hygienic recommendations heretofore given. The treatment of running sores is very simple. Cleanse them every day with Castile-soap and water, being careful not to rub or touch the surface of the sores. Use a clean sponge or a piece of clean muslin and saturating it with the warm water, hold it a few inches above the affected part, and squeeze out the fluid, allowing the cleansing stream to fall gently upon the open sore. After thoroughly cleansing the sore, apply to it Dr. Pierce's All-Healing Salve. 25 cents in postage stamps sent to us will secure a box by return post if your druggist does not have it in stock.

HIP-JOINT DISEASE.

(COXALGIA.)

Hip-joint disease, also known as Coxalgia, is frequently a scrofulous affection of the hip-joint. It usually attacks children, but may occur at any period of life. The causes of this affection are imperfectly understood, yet all the indications point to a scrofulous state of the system. Dampness, cold, improper diet, severe injuries from blows or falls are all numbered among the exciting causes which are conducive to the establishment of this disease.

The Symptoms are usually developed gradually; at first there is severe pain in the knee, but finally it is located in the hip-joint. Occasionally it is noticed in the hip and knee at the same time. As the disease progresses, the general health becomes impaired, there is wasting of the muscles, wakefulness, disturbed sleep, high fever, profuse and offensive perspiration, the hair falls out, and there is an inability to move the limb without producing excruciating pain. Frequently pus will be formed and discharged at different points, and the limb will become greatly emaciated. Since pain in the knee-joint may mislead as to the location of the disease, to determine the seat of the affection, place the patient in a chair and percuss the knee lightly, by giving it a slight blow with the knuckle; if the hip be affected, the pain will be readily felt in that joint; if it be simply neuralgia of the knee-joint, it will excite no pain whatever. If the disease be allowed to progress and dislocation of the joint takes place, the affected limb becomes shortened.

Treatment. The treatment of this disease should consist in rest for the hip-joint, cleanliness of the person and plenty of fresh air and light, a nutritious diet and the use of tonics and sustaining alterative, or blood-cleansing medicines. Dr. Pierce's Golden Medical Discovery has, unaided by other medicines, cured many cases of this disease. This class of medicines should be persistently employed, in order to obtain their full effects. It is a disease which progresses slowly and which is not easily turned from its course, and its fatality should warn the afflicted to employ the best treatment.Many poor, unfortunate victims know too well, from sad experience, that the course of treatment frequently recommended and employed by physicians and surgeons is ineffectual, and cruel; they deplete the system, apply locally liniments, lotions, iodine, and hot applications; confine the patient in bed and strap his hips down immovably, thus preventing all exercise; then they attach that cruel instrument of torture, the weight and pulley, to the diseased limb.

After many years of practical experience in the treatment of hundreds of cases, we have developed a system of treatment for this terrible malady which is based upon common sense. Instead of depleting, we, by proper constitutional treatment, strengthen and fortify the system. We do not confine the patient in bed, but permit him to go around and take all necessary exercise. We adjust an ingeniously devised and perfectly fitting appliance or apparatus, by which a gentle extension of the limb is maintained, thereby relieving the tension of the muscles, and preventing the friction and wearing of the inflamed surfaces of the joint, which, without the use of our new and improved appliance, are a source of constant irritation. The appliances required in the successful treatment of this disease are numerous and varied in their construction, and require skill and experience on the part of the surgical mechanic as well as on the part of the surgeon, to take accurate and proper measurements of the diseased limb, and to construct the appliances so that they will be adapted to the various requirements of different cases. There are no definite rules for taking these measurements, and only a thorough examination of the case can indicate to the eye of the experienced surgeon what measurements are required, and what kind of an appliance is suitable for each individual case. At the Invalids' Hotel and Surgical Institute these measurements are all taken by the surgeon in person, and each appliance is constructed under his immediate supervision. It is utterly impossible for physicians who have but a limited experience in the treatment of such cases to take correct measurements and send off for an apparatus which fulfills the requirements of the case.

In the light of our vast experience at the Invalids' Hotel and Surgical Institute, we feel that we cannot too strongly urge the employment of a suitable apparatus for supporting the hip-joint, giving it perfect rest, and enabling the patient to exercise and get the outdoor air. As much of the pain in this disease is due to the pressure of the head of the femur, or thigh-bone, in the acetabulum, or socket, steadily-applied mechanical extension, to relieve the inflamed and sensitive joint of the pressure, is of the greatest importance. By such application the patient is enabled to move about without pain, while the joint is kept perfectly at rest—a condition favorable to the reduction of inflammation within it. The surgeon specialist of the Invalids' Hotel and Surgical Institute is frequently sent for to visit cases of this disease hundreds of miles away and by the employment of suitable apparatus he has been enabled, in scores of cases, to relieve the suffering at once. In cases in which the head of the thigh bone, or the bony socket of the joint has become so diseased as to cause it to ulcerate and break down, all portions of diseased bone should be thoroughly removed by a surgical operation. If this be neglected or delayed, a fatal termination of the disease may be expected. Parents should not put off the employment of a competent specialist in this terrible, distressing, and fatal disease. As treated by general practitioners, it very often proves fatal; or, after causing intense suffering for a series of years, if the active condition of the disease subsides, the patient is left with a ruined and broken constitution, a result which more prompt and earlier relief would have prevented.

The records of practice at the Invalids' Hotel and Surgical Institute abound in reports of cases, demonstrating the fact, that by careful and judicious management, hip-joint disease in its earlier stages, may be promptly arrested, and that cures may be effected even when the bony structure of the joint is seriously diseased.

WHITE SWELLING

White Swelling, otherwise known as Hydrarthrus, or Synovitis, more frequently affects the knee-joint than any other part. The joints of the elbow, wrist, ankle, or toes, may, however, be affected with this disease, but we shall speak of it in this connection as affecting only the knee-joint. Synovitis may be acute or chronic. The latter form is sometimes induced by blows, sprains, falls, etc., or from exposure to cold; more frequently it is the result of rheumatism or scrofula.

The Symptoms of this affection are generally slow in their appearance, being sometimes months in manifesting themselves. The joint at first presents only a slight degree of swelling, which gradually increases. Pain is soon felt, mild at first, but augmenting until it becomes severe. The skin has a smooth, glistening appearance, and there is an increased amount of heat in the parts. The affected limb becomes wasted, and is sometimes permanently flexed. There is more or less fever about the body, impairment of the digestive organs, and sleeplessness. The pulse is low but quick, and night-sweats and diarrhea often appear. Under this irritation, the patient is liable to waste away and finally die.

A post-mortem examination reveals the effects of the disease upon the parts attacked. The cartilages of the joint are soft, the synovial membrane is thickened, the ligaments are inflamed and often destroyed, the synovial fluid is increased in amount, sometimes normal in appearance, at others thick and viscous. If the bones be diseased, their articular extremities may be distended and fatty matter deposited in them. The conditions depend upon the form, severity, and duration of the disease.Synovitis may be considered under three heads; Rheumatic, Scrofulous, and Syphilitic.

Rheumatic Synovitis may arise from exposure to cold, from some injury, or from intemperance in eating. The beginning of the disease may be distinctly marked, or it may come on so gradually that the time of its commencement cannot be noted. The pain is of a dull, steady character, and less severe in the night. This form of the disease sometimes terminates favorably, but in scrofulous systems it is liable to end in the destruction of the joint. It is more common in early life, rarely occurring after the thirtieth year.

Scrofulous Synovitis, or Tuberculosis of the Knee-joint, when of a chronic character, shows a wasting of the limb, and the swelling is of a pulpy consistence. This form of the disease is more liable to occur in children, though occasionally it is met with in adults. But little pain accompanies this form, although the limb is liable to become permanently affected. In its earlier stages this disease may be checked.

Syphilitic Synovitis is the result of syphilis. The pain is more severe during the night. It, however, generally terminates unfavorably, especially in scrofulous constitutions.

The Treatment of white swelling should be both constitutional and local. Alterative medicines are indicated to purify the blood. Doctor Pierce's Golden Medical Discovery is unequaled for this purpose.

As local treatment, in the active stage of the disease, the knee-joint should be steamed, and hot fomentations applied. This should be followed by applications over the joint of solid extract of stramonium or belladonna, mixed with glycerine. The joint should be wrapped in cotton or wool to keep it uniformly warm. If there are openings about the joint, discharging pus, syringe them out once a day with Castile soap-suds, which may be improved by adding a little bicarbonate of potash (common saleratus). See that the bowels are kept regular, and that the diet is nourishing.

Cases of this disease which have been treated at the Invalids' Hotel and Surgical Institute with uniform success might be cited to the extent of filling a very large number of pages like these. When treated by a skilled specialist, this otherwise formidable and dangerous disease is readily amenable to treatment, and good and serviceable limbs can be promised, even in the extreme cases in which amputation is usually advised by general practitioners and surgeons, who desire the glory that they imagine they will receive by performing a capital operation.

RICKETS. (RACHITIS.)

Rickets is a scrofulous disease, in which there is derangement of the entire system, and it finally manifests itself in disease of the bones. It is characterized by a softening of the bony tissue, due to a deficiency of earthy or calcareous matter in their composition. It appears to be a disease incident to cold, damp places, ill-lighted and imperfectly ventilated rooms, and it especially attacks those who are uncleanly in their habits.

The Symptoms of rickets are severe pains in the bones, especially during the night, febrile excitement and profuse perspiration, paleness of the face, a sallow and wrinkled appearance of the skin, and derangement of the digestive organs. After a time the body becomes emaciated, the face pale, and the head unusually large. The bones become soft and unable to support the body; various distortions appear; the extremities of the long bones are enlarged, while the limbs between the joints are very slender. Rickets is a disease peculiar to childhood, though it may not be developed until a more advanced period of life. It rarely proves fatal, unless the lungs, heart, or other vital organs, become involved. In some instances the softening and other symptoms continue to increase until every function is affected, and death ensues.

Post-mortem examinations of those who have died of rickets have disclosed morbid changes in the brain, liver, and lymphatic glands. The lungs are often compressed or displaced, and the muscles of the body become pale and wasted. Sometimes the bones are so soft, on account of the deficiency of the calcareous deposit, that they can be easily cut with a knife.

Treatment. The use of Dr. Pierce's Golden Medical Discovery is indicated in this affection. It is a disease usually developed during childhood, in consequence of insufficient exercise, deprivation of the sunlight, low, innutritious diet, and lack of cleanliness. Therefore, it is essential to obviate all known causes, and, at the same time supply the patient with food rich in those elements which the system seems to demand. Under any plan of treatment the general directions given for the hygienic management of scrofula should be followed. We might cite many cases that have entirely recovered from this disease, under our advice and the use of "Golden Medical Discovery." We shall merely say, for the encouragement of the afflicted, that this form of scrofula yields readily to this medicine.

OLD SORES. (CHRONIC ULCERS.)

Under this head we may properly consider that class of affections known as Fever-sores, Running-sores, Ulcers, etc. These sores have common characteristics, yet each possesses certain peculiarities, which have led to their division into irritable, indolent, and varicose. These peculiarities are not constant, one form of ulcer often changing into another. One feature common to all, however, is their slowness in healing, which has sometimes led to the belief that they are incurable. Another popular notion is that their cure is detrimental to the health of the patient. With equal propriety we might say that it is dangerous to cure diarrhea, dysentery, consumption, or cancer. As a result of these erroneous impressions, many people suffer from chronic ulcers for years, and even for a life-time, without attempting to obtain relief. Chronic ulcers usually appear upon the lower extremities. The depth and appearance of the ulcer depend upon its character and the thickness of the tissues where it is situated. Fig. 2 shows a chronic ulcer, or fever-sore, as it appears upon the ankle.

Illustration: Fig. 2. A Chronic Ulcer.
Fig. 2. A Chronic Ulcer.

The Irritable Ulcer is painful and tender, the slightest injury causing it to bleed. It is of a dark purplish hue, and filled with spongy, sensitive granulations. It discharges a thin, bloody matter which is sometimes very fetid and acrid, and excoriates the tissues if it comes in contact with them. The edges of this species of ulcer are shelf-like and ragged, and turn inward. The adjacent structures are red and swollen. Very often they are attended by severe constitutional disturbances, such as chills, fever, and great nervous prostration and irritability.

In the Indolent Ulcer the edges are not undermined, but turned outward, and are rounded, thick, glossy, and regular. The granulations are broad, flat, pale, insensible, and covered with a grayish, tenacious matter. The surrounding parts are not very sensitive, but the limb on which it is located is apt to be swollen. This is the commonest form of ulcer, and often remains for years.

Varicose Ulcer. This species of ulcer occasions a swollen or enlarged condition of the neighboring veins, which are very much enfeebled. It almost invariably appears below the knee, and may be either indolent or irritable. It is generally sensitive to the touch, and sometimes excessively painful. Knots of superficial veins may often be seen beneath the skin.

As we have before remarked, these various species of ulcers are merely modifications of one form of chronic sore. The patient may assert that he enjoys excellent health, but if we question him closely, we find that the sore irritates him, and that there is sufficient constitutional disturbance to prevent the healing powers of nature from effecting a cure.

Treatment. The cure of these sores is necessarily slow, and who ever expects to obtain immediate relief will be disappointed.

Constitutional treatment is of the utmost importance, and should, therefore, be thoroughly and persistently applied. The nutritive system, especially the absorbents, should be kept active, as these are the channels by which the broken-down tissue surrounding the sore is replaced by that of a higher grade of vitality. For this purpose, the best alteratives or blood cleansing remedies are required. If secretion and excretion are not normally performed, the blood becomes poisoned by the absorption of unhealthy "matter" from the sore, and various constitutional disturbances occur. If, at any time during treatment, constitutional disturbances are manifested by fullness or disagreeable sensations in the head, nausea, pain, cough, chills, or fever, a thorough cathartic should be given. If the patient be robust, a repetition of the same once a week will be very beneficial. Dr. Pierce's Golden Medical Discovery, and "Pellets" will be productive of the best results.

The local treatment should depend upon the character of the ulcer. If the sore be irritable or painful, soothing applications, such as warm poultices or steaming in a vapor of bitter herbs, as hops, boneset or smart-weed or water pepper, will be found highly beneficial. A poultice of powdered slippery elm is also very soothing, and hence well adapted to this purpose. If the ulcer be indolent, a stimulating application is necessary. The hardened, callous state of the edges should be removed by alkaline applications. A strong solution of saleratus, or even a caustic, prepared by boiling the lye from hard-wood ashes to the consistence of syrup, will prove of great utility. One or two applications of the latter are generally sufficient.

The foregoing course of treatment is intended to put the open sore or ulcer in what is known to surgeons as a healthy condition—a condition most favorable for the healing process.

But the open surface of the sore needs something more. It needs the cleansing or antiseptic and soothing influence of such a dressing as is found in Dr. Pierce's All-Healing Salve. If your dealer in medicines does not have this Salve in stock, 25 cents in stamps sent to World's Dispensary Medical Association, Buffalo, N.Y., will secure a box of this unequaled dressing. It will be sent to your address by return post. Therefore, do not allow the dealer to put you off with some inferior preparation. If he has not the All-Healing Salve in stock you can easily obtain it by sending to us as above directed.

No matter how good the local dressing applied to the open sore, or ulcer, do not discontinue the internal use of the "Golden Medical Discovery" until the affected parts are completely healed.

FEVER-SORE. (NECROSIS.)

By the term necrosis we mean mortification, or the state of a bone when it is deprived of life. Dunglison says: "This condition is to the bone what gangrene is to the soft parts." It is popularly known as fever-sore, there being no distinction made between this species of sore and those ulcers which affect only the soft tissues of the body. When any part of a bone becomes necrosed, it is treated as a foreign body. Nature makes an effort for its removal, and at the same time attempts to replace it with new and healthy materials. In consequence of this process, the dead portion is often inclosed in a case of new, sound bone, termed the involucrum; when this is the case the dead portion is termed the sequestrum. If, however, it be superficial, and separate from the parts beneath, it is called an exfoliation. This healing process, by which the involucrum is formed, cannot be completed while the dead portion remains. Hence, numerous openings are made through the involucrum, to permit the escape of the sequestrum. When a surgical operation is performed for the removal of the necrosed bone it is called sequestrotomy. The instruments which our specialists usually employ for this practice are represented in Figs. 3, 4, and 5.

Illustration: Fig. 3. Hand drill for boring bone.
Fig. 3. Hand drill for boring bone.

Illustration: Fig. 4. The osteotrite, for enlarging openings and cutting carious bone.
Fig. 4. The osteotrite, for enlarging openings and cutting carious bone.

Illustration: Fig. 5. Gouge forceps for excavating bone.
Fig. 5. Gouge forceps for excavating bone.

Causes. Fever-sore may be due to inflammation, injuries, working in phosphorus, or from the inordinate and protracted use of mercury.

Symptoms. The pain frequently commences in the night, and all the different stages succeed, until, finally, the result is frequently mortification or death. The entire bone, or only a part of it, may be affected; the parts become swollen, "matter" forms, and unless it be artificially evacuated, it will in time work its way out through a fistulous opening. As the disease progresses, the adjacent tissues become thickened and numerous openings are formed, which communicate with the bone, and often with each other, so that a probe may be passed from one to another, as represented in Fig. 6, copied from a drawing by Dr. Howe. The discharge from fever-sores varies in character, and usually has a fetid odor. The surgeon can readily distinguish between healthy and unhealthy bone by the use of a probe. The pus discharged in necrosis contains minute particles of bone, which may be felt by rubbing it between the fingers. Sometimes large pieces present themselves at the openings. The general health is seriously impaired, and the patient becomes debilitated, anÆmic, and hectic.

Illustration: Fig. 6. Necrosis of the tibia. A common probe is passed through the sinuses, or openings.
Fig. 6. Necrosis of the tibia. A common probe is passed through the sinuses, or openings.

Treatment. The process of repair is necessarily tedious, and nature should be assisted to remove the old bone and promote the formation of the new. An alterative course of treatment is indicated and must be persistently followed. Give Dr. Pierce's Golden Medical Discovery and Pleasant Pellets in sufficient doses to keep the bowels regular. However, all efforts to heal the sores, as long as dead bone remains, will prove fruitless. The sores should he throughly cleansed with injections of an alkaline solution, after which bandages, moistened with glycerine, may be applied. If they emit a fetid odor, add a few drops of carbolic acid to the glycerine. The dead bone can be but slowly removed by suppuration, therefore time, and, indeed, sometimes life itself, may be saved by removing it with surgical instruments. In the operation of sequestrotomy, the surgeon must exercise great judgment. Carelessness may prolong the disease and subsequently necessitate another operation, or, perhaps, an amputation.

Usually the dead bone is easily removed by the skilled specialist surgeon, and, when thoroughly taken out, the parts readily heal and the patient rapidly recovers. The removal, therefore, of the dead bone which is a constant source of irritation, and the cause of protracted suffering, should not be delayed, for very rarely indeed can it be removed at all without the assistance of the surgeon. Besides, delay often results in the loss of the limb, and not unfrequently occasions the death of the patient. Under the influence of a reliable local anÆsthetic, carefully applied, the operation of removing the decayed and offensive bone is speedily and painlessly performed, the use of chloroform or ether not generally being required.

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for so???o??? xual intercourse, and, hence, its presence has been considered evidence of virginity. Its absence, however, must not be considered a conclusive evidence of sexual intercourse, for, as Dr. Dunglison says, "many circumstances of an innocent character may occasion a rupture or destruction of this membrane. It is often absent in children soon after birth; while it may remain entire after copulation. Hence, the presence of the hymen does not absolutely prove virginity; nor does its absence prove incontinence, although its presence would be prima facie evidence of continence."

Sometimes this membrane, when not imperforate, is so thick and strong as to render sexual intercourse impossible, and requires a cutting operation to open the vagina. Several such cases have been operated upon at the Invalids' Hotel and Surgical Institute.

It occasionally happens that the hymen is entire, or imperforate, at birth. This may not be discovered before puberty. But when this period arrives and the menstrual discharge takes place into the vagina, the female will suffer from the retention and accumulation of this secretion, and ultimately a tumor or a protrusion of the membrane which closes the vagina will occur, giving rise to severe pain and other serious symptoms. The retained menstrual fluid, increasing in quantity at every monthly period, dilates the womb as well as the vagina, and even the Fallopian tubes become distended, presenting at length an urgent necessity for relief.

Treatment. This condition admits of relief only by operative surgery. The operation consists in dividing the hymen by a crucial incision, thus allowing the accumulated fluid to be discharged, after which the vagina is cleansed by syringing it with warm water.

Absence of the Ovaries. Let us suppose the case of a young woman who has fully reached the period of puberty without having menstruated. All the organs which we have described, are manifestly developed, she is healthy, vigorous, robust, and able to exercise freely or to engage in laborious occupations. But we notice that her voice is not sweetly feminine, nor is her presence timid, tender, and winning; there is wanting that diffident sexual consciousness, which gently woos, and, at the same time, modestly repels, and tends to awaken interest, curiosity, and desire. Considering also that she has never manifested any inclination to menstruate, we are irresistibly led to the conclusion that the ovaries are wanting; the delicate mustache upon the upper lip, the undeveloped breasts, the coarse features, and her taste for masculine pursuits, all concur in this diagnosis. Thus we account for the harshness of the voice, fitted for command rather than to express the mellow, persuasive cadences of love. Such a malformation cannot be remedied.

Retention and Suppression from Morbid Conditions of the Blood. Non-appearance, as well as suppression of the menses, may result from an abnormal state of the blood. The first condition which demands our attention under this head is plethora. In robust, plethoric females the menses are sometimes very tardy in their appearance, and every month the attempt to establish this function is attended with pain in the head, loins, and back, chilliness, nausea, and bloating of the abdomen. Sometimes there is intolerance of light or sound, and cerebral congestion, amounting almost to apoplectic symptoms. The pulse is full and strong, the blood abundant and surcharged with red corpuscles. Such persons may be accustomed to luxurious living, and there is evidently a predisposition to abnormal activity of the alimentary functions.

Treatment. We may briefly suggest that such subjects should engage in laborious physical exercise in order to expend the surplus of vitality, and should lessen the daily amount of food taken, and use that which is light and unstimulating. We should also prevent the determination of blood to the head, by keeping it cool and the feet warm, and by increasing the flow of blood to the extremities. The volume of the circulation may be diminished by acting upon the natural outlets, such as the skin, kidneys, and bowels. The proper means and appliances for quickening the circulation of the blood are indicated, and friction upon the surface, bathing, the daily use of such cathartics as Dr. Pierce's Pleasant Pellets, and, finally, the use of some general uterine stimulant, such as Dr. Pierce's Favorite Prescription, will generally prove successful in cases of amenorrhea resulting from plethora.

Retention and Suppression from AnÆmia. To describe the condition of the patient whose blood is low and deprived of the richness, warmth, and bloom, it once possessed when it kindled admiration and enthusiasm in others, is but to give a picture of a numerous class of female invalids. It is sad to see beauty fading, vigor waning, and Bright's disease or consumption slowly wasting the blood and consuming the vital cells, until the spirit can no longer dwell in its earthly abode and death claims the skeleton for dust.

Chronic Decline, with its attendant anÆmia, may be induced by bad habits, destitution, or constitutional depravity. Sickly forms, wrecks of health, address our senses on every side. All these subjects evidently once had a capital in life, sufficient, if properly and carefully husbanded, to comfortably afford them vital stamina and length of days. Alas! they have squandered their estate, perchance in idleness and luxurious living, or have wasted it in vanities or misdirected ambition. Having become bankrupts in health, there is necessarily a failure of the menstrual function, and then follows a panic. All the blame of the insolvency and general derangement, is unjustly attributed to the non-performance of the duties of the uterus. Thus, this organ is altogether dependent Upon the general health for its functional ability, yet frequently treatment is instituted to compel menstruation, regardless of the condition of the system. Thus the enfeebled uterus is wrongfully held responsible for general disorder, because it ceases to act, when by acting it would further deplete the blood and thus materially contribute to the already existing chronic decline.

No matter what are the causes of this decline, whether they are the follies of fashion, the effect of indolence, debility in consequence of insufficient food, perversion of nutrition by irregular habits, lack of exercise, or the taking of drastic medicines, the result is anÆmia and amenorrhea.

Treatment. We would suggest in such cases a nutritious diet, increased exercise, cleanliness, regular habits, hard beds, and useful employment. The diet may be improved by animal broths, roasted meats, fresh beef, mutton, chicken, or eggs, and the dress should be comfortable, warm, and permit freedom of motion. The patient should indulge in amusing exercises, walking, swinging, riding, games of croquet, traveling, singing, percussing the expanded chest, or engage in healthful calisthenic exercises. The hygienic treatment of this form of amenorrhea, then, consists in physical culture, regular bathing, and the regulation of the bowels, if constipated, as suggested in this volume under the head of constipation.

The medical treatment should be directed to enriching the blood, improving nutrition, toning up the generative organs, and the health of the whole system. This requires the employment of uterine and general tonics, and Dr. Pierce's Favorite Prescription, which is sold by druggists, happily combines the properties required. It improves digestion, enriches the blood, exercises a tonic and gently stimulating effect upon the uterus and ovaries, and thus promotes the function of menstruation. It is not a strong emmenagogue, but operates slowly, yet surely, and in accordance with physiological laws, being eminently congenial in its effects upon the female system, and, hence, not liable to do harm. There is danger in employing active driving medicines, besides, no emmenagogue, however powerful, can establish the menstrual function so long as the system is in a debilitated condition and the blood reduced. The restorative effects of the "Favorite Prescription" should be secured by administering it regularly, in from one to two teaspoonful doses, three or four times a day, for several weeks, and as the system is built up and those symptoms appear which indicate a return of the menses, their visitation may be encouraged by the use of hot foot and sitz-baths, and free doses of Dr. Pierce's Compound Extract of Smart-weed. But the latter should only be used when symptoms of approaching menstruation are manifested. By following out this course of treatment, a soft flush will gradually take the place of the pallor of the cheeks, the appetite will return and the health will be restored.

Acute Suppression of the Menses may be caused by strong emotions, as excessive joy, or by violent excitement of the propensities, as intense anger, sudden fright, fear, or anxiety. Suppression may result from sudden exposure to cold, immersion of the hands or feet in cold water, drinking cold water when the body is heated, sitting on the cold ground or damp grass, or from a burn or wound. It is not uncommon for women to labor in the heated wash-room, pounding, rubbing, and wringing soiled linen, thereby overtaxing the delicate physical system. While feeling tired and jaded, all reeking in perspiration, they rinse and wring the clothes out of cold water and hang them upon the line with arms bare, when the atmosphere is so freezing that the garments stiffen before they finish this part of the task. Is it any wonder that acute suppressions occur or that inflammations set in?

The symptoms which naturally follow are a quick pulse, hot skin, thirst, fever, headache, and dizziness, and the inflammation may locate in the ovaries, uterus, lungs, bowels, brain, or other parts. No matter what organs are attacked the menses are suppressed. The suppression can generally be attributed to an adequate cause, resulting in constitutional disturbance. The severity and duration of the attack and the power of the constitution to resist it, must determine the gravity of the consequences.

Treatment. As acute suppression of the menses is due to derangement of the circulation of the blood, caused by taking cold, by violent excitement of the propensities or excessively strong emotional experience, the prominent indication is to secure its speedy equalization. Give a hot foot, a warm sitz, or the spirit vapor-bath and administer full doses of Dr. Pierce's Compound Extract of Smart-weed, to produce free perspiration. Dr. Eberle, a very celebrated medical author, says that he used the Extract of Smart-weed in twenty cases of amenorrhea, and affirms, "with no other remedy or mode of treatment have I been so successful as with this." Our experience in the use of the Extract has been equally satisfactory. Should this treatment not establish the function, Dr. Pierce's Favorite Prescription should be given three times a day until the system is invigorated, say for twenty-eight days, when the above course may be repeated, and generally with success. Should the case be complicated with inflammation of the lungs, brain, or other vital organs, manifesting alarming symptoms, the family physician should be called. The treatment should be active and suited to the indications of each particular case. When the disease becomes chronic, the active stage of symptoms having passed, and it continues to linger without making the desired improvement, all the means suggested for the treatment of suppression from anÆmia should be employed. Their use will be followed by the most gratifying results. It should be borne in mind, however, that when we have suggested any treatment in this volume, it is generally such as the family may institute and apply, and does not, by any means, represent the variety or extent of the remedial resources which we employ when consulted in person or by letter. We refer our readers to only a few of the safe and reliable remedies which we have prepared and placed within their reach, and give them just such hygienic advice as we think will best serve their interests.

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