Illustration:

For many years the founder of the Invalids' Hotel and Surgical Institute and World's Dispensary has devoted himself very closely to the investigation and treatment of chronic diseases. Some few specifics have, during this time, been developed for certain forms of chronic ailments, and given to the public, but they have not been lauded as "cure-alls," or panaceas, but only recommended as remedies for certain well-defined and easily recognized forms of disease. These medicines are sold through druggists very largely, and have earned great celebrity for their many cures. So far from claiming that these proprietary medicines will cure all diseases, their manufacturers advise the afflicted that, in many complicated and delicate chronic affections, they are not sufficient to meet the wants of the case. These must have special consideration and treatment by a competent physician and surgeon, the medicines and other remedial means required being selected and prepared with reference to each particular case.

In order to be able to offer those afflicted with chronic ailments the most skillful medical and surgical services, Dr. Pierce, many years ago, associated with himself several eminent physicians and surgeons, as the Faculty of the old and renowned World's Dispensary, the consulting Department of which is now merged with the Invalids' Hotel and Surgical Institute.

DIVISION OF LABOR.

In the organization of the medical and surgical staff of the Invalids' Hotel and Surgical Institute, several years ago, we assigned to one physician the examination and treatment of diseases of the nervous system; to another, surgical operations and the treatment of surgical diseases; a third had charge of catarrhal and pulmonary diseases and affections of the heart; a fourth attended to diseases peculiar to women; a fifth, to diseases of the eye and ear; a sixth, to diseases of the digestive organs; a seventh, to special surgical cases; to another we entrusted diseases of the urogenital organs; and to others, various other specialties. Now that our practice has become so very extensive as to require for its conduct a greatly increased number of physicians and surgeons. Thus four physicians and surgeons devote their undivided attention to the examination and treatment of diseases of the urinary and generative organs of men. Three physicians give their sole attention to diseases peculiar to women and three to those of the nasal organs, throat and chest, embracing all chronic diseases of the respiratory organs. Thus we have a full council of three and four physicians in these several specialties. In several other divisions we have two specialists. No case is slighted either in the examination or in the treatment. All doubtful, obscure or difficult cases are submitted to a council composed of several physicians and surgeons. Skilled pharmaceutists are employed to compound the medicines prescribed. For the purpose of enabling us to conduct our extensive correspondence (for we have an extensive practice en every part of the United States and Canada, as well as in Great Britain from our London branch), graphophones are employed, to which replies are dictated, recording the words of the speaker. Afterwards the letters are written out in full, generally on a type-writing machine, which prints them in a plain, legible style. These machines are operated as rapidly as a person can think of the letters which compose a word, each operator thus accomplishing the work of several copyists. This system, by which we are enabled to correspond with our patients as rapidly as we can talk, has been rendered necessary by the growth of our business, which has attained immense proportions, giving rise to so large a correspondence that a dozen physicians cannot possibly conduct it all and give each patient's case careful attention, without the employment of graphophones and all other facilities which modern invention has given us. By the adoption of these various means, we are enabled to fully meet the demands of the afflicted, and give every case the most careful attention.

Illustration: Faculty
Faculty of Invalids' Hotel and Surgical Institute in Session.—Council-room.

As many persons, particularly young ladies and gentlemen, having catarrh or almost any other chronic disease, especially if of the urogenital organs, are very sensitive and fearful that somebody will know that they are afflicted and employing medical treatment, precautions are taken that none who consult us may incur the least risk of exposure. Although none but the most honorable and trustworthy gentlemen are employed as assistants, yet as a guarantee of perfect security to our patients, that every communication, whether made in person or by letter, will be treated as sacredly confidential, each professional associate, clerk, or assistant, is required to take a solemn oath of secrecy. Great care is also taken to send all letters and medicines carefully sealed in plain envelopes and packages, so that no one can even suspect the contents or by whom they are sent.

ADVANTAGES OF SPECIALTIES.

By thorough organization and a perfect system of subdividing the practice of medicine and surgery in this institution, every invalid consulting us is treated by a specialist—one who devotes his undivided attention to the particular class of diseases to which his or her case belongs. The advantage of this arrangement must be obvious. Medical science offers a vast field for investigation, and no physician can, within the limit of a single life-time, achieve the highest degree of success in the treatment of every malady incident to humanity. A distinguished professor in the medical department of one of our universities, in an address to the graduating class, recently said: "Some professional men seem to be ashamed unless they have the character of universal knowledge. He who falls into the error of studying everything will be certain to know nothing well. Every man must have a good foundation. He must, in the first place, be a good general practitioner. But the field has become too large to be cultivated in its entirety by any individual; hence the advantage of cultivating special studies in large towns, which admit of the subdivision of professional pursuits. It is no longer possible to know everything; something must be wisely left unknown. Indeed, a physician, if he would know anything well must be content to be profoundly ignorant of many things. He must select something for special study, and pursue it with devotion and diligence. This course will lead to success, while the attempt to do everything eventuates unavoidably in failure. Let there be single hands for special duties." Our institution is the only one in this country in which these common-sense-ideas are thoroughly carried out. The diversified tastes and talents of physicians cause each to excel in treating some one class of diseases, to which he devotes more attention and study than to others. One medical student manifests great interest in the anatomy, physiology, pathology, and treatment of diseases of the eye. He becomes thoroughly familiar with all the minutest details relative to that organ and its diseases, and so thoroughly qualifies himself in this branch of knowledge that he is able to cure an inflammation or other affection of the eye in a very short time. Another student is more interested in some other class of diseases, for the study of which he has a liking, and neglects to inform himself in the ophthalmic branch of medical and surgical science. If after engaging in the practice of his chosen profession, he is consulted by persons suffering from diseases of the eye, he tortures them with unnecessary and oftimes injurious applications, clumsily and carelessly made, and, as the result of such unskillful treatment, the inestimable blessing of sight may be sacrificed.

Illustration: A Corner in Printing Department.
A Corner in Printing Department.—World's Dispensary.

The great majority of physicians allow acute maladies, diseases of children, and the practice of midwifery, to engross most of their time and attention. They manifest an absorbing interest in everything that relates to these subjects, and devote little or no time to acquiring an intimate knowledge of the great variety of chronic maladies which afflict mankind. They acquire skill and reputation in their favorite line of practice, but are annoyed if consulted by one suffering from some obscure chronic affection, usually turn the invalid off with a very superficial examination, and, perhaps, only prescribe some placebo,^[6] apparently indifferent as to the result, but really desiring thus to conceal their lack of familiarity with such diseases. The specialist, the treatment of chronic diseases being his vocation, is equally annoyed if consulted by those suffering from acute diseases, but does not pursue the inconsistent course of assuming to treat them. He refers them to those of his medical brethren whose daily dealings with such cases make them, in his way of thinking, more competent than himself to render valuable service to such sufferers. He recognizes the fact that no man is likely to succeed in any line of study or business for which he possesses no talent or relish, nor does he believe in being a "jack-at-all-trades and master of none."

ADVERTISING.

Having thoroughly qualified himself for the practice of some particular branch of the healing art, the specialist sees no impropriety in acquainting the public with his ability to relieve certain forms of suffering. He believes that medical men should possess equal rights with other business men, and that any code of medical ethics which would deprive him of any of the sacred rights guaranteed to all by the liberal laws of the country, is professional tyranny, and merits only his contemptuous disregard. Nor does he display any false modesty in the manner of making known his skill. He maintains that he has an undoubted right to place his claim to patronage before the public by every fair and honorable means. He recognizes the display of goods in the merchant's show-windows as no less an advertisement and in no better taste than the publication of a card in the newspaper. So, likewise, he regards the various devices by which the extremely ethical physician seeks to place himself conspicuously before the public, as but so many ways of advertising, and as not more modest than the publication of cures actually performed, or than his announcement through the public press of his professional resources for treating certain maladies.

The physician who expresses a "holy horror" of the "advertising doctor," liberally bestowing upon him the epithet of "quack," announces himself a graduate, talks learnedly and gives notice to the public in some way that he is ready to serve them. He endeavors to impress upon the mind of the patient and family his skill, frequently exaggerates as to the extent of his practice, rides furiously about when he has no professional calls, keeps up business appearances by driving several horses, or joins influential societies. He may make a great display in style, manner, dress, pretensions, writing for the newspapers, exhibiting literary pedantry, referring to the superior facilities afforded by some particular school or society to which he belongs; or by editing and publishing a medical journal, ostensibly for the advancement of medical science, but practically to display titles or professorships, to publish reports which flatteringly allude to cases he has treated, the number of capital surgical operations he has performed, or the distinguished families he is treating. All these are but modes of advertising professional wares; in short, are artful, though not refined, tricks, resorted to for private announcement. We say to all such adventurers in modern advertising diplomacy, that these indirect, clandestine methods are not half so candid and honorable as a direct public statement of the intentions and proposals of a medical practitioner, who thereby incurs an individual responsibility before the law and his fellow-men.

No good reason has ever been assigned why any well educated physician, trained in the school of experience until he becomes proficient in medical skill, may not publish facts and evidence to disclose it, especially when these are abundant and conclusive. The following extracts from an able article by the Rev. THOMAS K. BEECHER embodies a sound view of the subject of medical advertising. He says:

* * "I am glad that the doctor cured him; I am glad that the doctor put it in the paper that he could cure him. And if any doctor is certain that he can cure such diseases and don't put it in the paper, I am sorry. What a pity it would have been had this doctor come to town with his wealth of science and experience and gone away leaving him uncured! What a pity it would have been if he had been so prejudiced against advertising as to read the responsible certificate of the doctor and give him the go-by as a quack! What are newspapers for, if not to circulate information? What more valuable information can a newspaper give than to tell a sick man where he can be cured? If a man has devoted his life and labor to the study of a special class of diseases, the necessity of his saying so becomes all the more pressing. His duty to advertise becomes imperative.

"When I was in England, I found on all the dead walls of London, placards, declaring that Dean Stanley, Chaplain to the Prince of Wales, would preach at such a place; that his grace the Archbishop (I think) of Canterbury would preach at another time and place; again, that an Oxford professor would preach. In short, religious notices were sprinkled in among the theater bills, and the highest church dignitaries were advertised side by side with actors, singers, and clowns. Of course, I was shocked by it, but in a moment I bethought me—if it be all right and dignified to hire a sexton to ring a bell when the minister is going to preach, it is all the same to silence the bell and hire a bill-sticker to tell the same news, the essential thing being to tell the truth every time. The remedy for the lying advertisements is for honest men to tell the truth. 'When iniquity cometh in like a flood, then the spirit of the Lord lifts up the standard.' A really able man, whatever be his gifts, makes a great mistake if he fail to use those gifts through want of advertising."If a physician possesses knowledge that enables him to remedy diseases heretofore regarded as incurable, what virtue or modesty is there to "hide his light under a bushel"? In this free country the people think and act for themselves, and hence all have a deep concern in the subject of health. The strong popular prejudice against the doctors who advertise is due to the fact, that by this method so many ignorant charlatans are enabled to palm off their worthless services upon the uneducated and credulous; but the practice of such imposition should not cause a presumption against the public announcement of real skill, for the baser metal bears conclusive evidence that the pure also exists.

Every step in scientific investigation, every proposition which relates to the interest and happiness of man, every statement and appeal involving a valuable consideration, must be submitted to the scrutiny and judgment of individual reason; for every person has the right to form his own conclusions, and justify them by experience. Those claims which are only supported by empty assertion are very doubtful. Misty theories vanish before the sun of truth. He who renders professional services cannot be successful, unless he be sustained by real merit.

TREATING PATIENTS WHO RESIDE AT A DISTANCE.

We can treat many chronic diseases as successfully without as with a personal consultation, as our vast experience enables us to correctly determine the malady from which the patient is suffering, from a history of the symptoms, and answers to questions furnished. We have not seen one person in five hundred of those whom we have cured.

Some may suppose that a physician cannot obtain, through correspondence, a sufficiently accurate idea of the condition of a patient to enable him to treat the case successfully; but a large experience in this practice has proved the contrary to be true, for some of the most remarkable cures have been effected through the medium of correspondence. In most long-continued cases, the patient has thought over his symptoms hundreds of times. The location of every pain, whether acute or mild, constant or occasional, and the circumstances under which it occurs, have been carefully noted. He has observed whether he had a rush of blood to the head, was feverish or chilly, whether troubled with cold hands and feet, whether full of blood, or pale and bloodless; and he states these matters with accuracy and common sense when writing to us, for he has a very good, if not a professional, knowledge of the relative importance of these symptoms. So in regard to digestion, he states what kinds of food agree with him, or whether he is troubled with excessive acidity or a flatulent condition of the stomach. He also informs us whether his tongue is coated and bilious, or clean and healthy, and gives many other particulars too various to enumerate, by which we are enabled to gain a perfect understanding of the case. If his description be not sufficiently complete to enable us to obtain a definite understanding of the case, he is requested to answer a list of important questions which are sent him. The people are far more intelligent in these matters than physicians are generally willing to admit. A patient is often confused while being personally examined by a physician, and gives imperfect or incorrect answers. After he has left the presence of the physician, he finds that he has failed to enumerate many of the most important symptoms. In consulting by letter, the patient is not embarrassed, he states the exact symptoms, and carefully reads over the letter to see if it is a complete and accurate description of his sufferings. In this way he conveys a much better idea of the case than if present in person, and subjected to the most thorough questioning and cross-examination. The timid lady and nervous young man write just as they feel; and one important reason why we have had such superior success in treating intricate and delicate diseases, is because we have obtained such true and natural statements of the cases from these letters, many of which are perfect pen-pictures of disease. As bank-tellers and cashiers, who daily handle large quantities of currency, can infallibly detect spurious money by a glance at the engraving or a touch of the paper, so the experienced physician, by his great familiarity with disease, becomes equally skilled in detecting the nature and extent of a chronic malady from a written description of its symptoms.

URINARY SIGNS.

A careful microscopical examination and chemical analysis of the urine is a valuable aid in determining the nature of many chronic diseases, particularly those of the nervous system, blood, liver, kidneys, bladder, prostate gland and generative organs. This important fact is not overlooked at the Invalids' Hotel and Surgical Institute, where an experienced chemist is employed to make such examinations and report the result to the attending physicians. Medical authors, professors, and practitioners of all schools, admit and even insist upon the importance of such examinations in diagnosticating diseases. Many practitioners neglect to take advantage of this invaluable aid, while others fear that if they attach much importance to such examinations they will be ranked with "uroscopian" or "water" doctors, a class of enthusiasts who claim to be able to correctly diagnosticate every disease by an examination of the urine. Persons consulting us and wishing to avail themselves of the advantages afforded by these examinations can send small vials of their urine by express. The vials should be carefully packed in saw-dust or paper and enclosed in a light wooden box. All charges for transportation must be prepaid, and a complete history of the case including the age and sex of the patient, must accompany each package, or it will receive no attention. This saves valuable time by directing the examination into the channels indicated, thus avoiding a lengthy series of experiments. As we are daily receiving numerous vials of urine, every sample should, to prevent confusion, be labeled with the patient's name.

Illustration: Binocular Microscope
Binocular Microscope used at the Invalids' Hotel and Surgical Institute.

Illustration: Fig. 1.
Fig. 1.

There is a natural, definite proportion of the component elements of every solid and fluid of the human body. These proportions have been reduced to definite standards, a deviation from which affords evidence of disease. Thus, there being a fixed standard in a normal proportion of the elements of the blood, any deviation from it, as in anÆmia, leucocythÆmia, etc., indicates disease. So also the standard proportion of the urinary elements being known, any considerable change, either in quantity or quality of its parts, bears unmistakable evidence of disease. The invention of the microscope has provided increased facilities for detecting diseases by examination of the urine. By the aid of this wonderful instrument, we are enabled to discover with absolute certainty the various urinary deposits characteristic of different maladies; thus in Fig. 1, A represents in a general way the sediment of abnormal urine as seen under the microscope. In division B is represented oxalate of urea upon precipitation by oxalic acid. Nitrate of urea is represented in division C. A deficiency of urea in the urine, with albumen and casts present, is a most important guide in the diagnosis of Bright's disease. The average quantity of urea present during health is 21.57 parts in 1,000. The microscopic examination of the urine, notwithstanding the distaste, and even contempt, which many physicians manifest for such investigations, is pursued at the Invalids' Hotel and Surgical Institute, with inestimable benefit to our patients. It has revealed the existence of many serious affections, which, with all our other modes of investigation, we might have been unable to detect. It has also thrown light upon many obscure chronic diseases.

Illustration: Fig. 2.
Fig. 2.

We have already spoken of the marked changes effected in the urine by a derangement of the digestive functions. It is a matter of surprise that physicians generally pay so little attention to the urine when dyspepsia is suspected, since all admit that an examination of that excretion furnishes unmistakable evidence of the nature and complications of the disease. In this way we are many times enabled to determine whether the indigestion is caused by congestion or functional disease of the liver or kidneys or by nervous debility. And when such cases are treated in accordance with the indications furnished, increased success attends our practice. In Fig. 2 highly magnified urinary deposits, which indicate impairment of the digestive functions, are represented. The crystals are composed of oxalate of lime and appear in the different forms shown in the five sections, of octahedral, decahedral, round and dumb bell shapes. The latter are formed in the kidneys, and are sometimes discovered adhering to casts.

Illustration: Fig. 3.
Fig. 3.

INVALUABLE AIDS IN DETERMINING DISEASES OF THE KIDNEYS AND BLADDER.

Illustration: Fig. 4.
Fig. 4.

The various forms of gravel, Bright's disease of the kidneys, hÆmaturia, inflammation of the kidneys and bladder, diabetes, and other functional and organic diseases of the urinary organs effect characteristic changes in the urine, thus enabling us to distinguish them with certainty and exactness. Some of the various microscopical appearances of the urinary deposits in diseases of the kidneys and bladder, are represented in Fig. 3. In division A is represented pus and mucus, with decomposition, indicating suppuration somewhere along the urinary tract. In B pus globules are alone represented. In the division marked C are shown blood corpuscles as they are arranged in blood drawn from a vein or artery. D represents the same separated, as they always are when present in the urine. In E highly magnified oil globules are represented. If present in the urine, they indicate disease of the kidneys. In F are represented epithelial cells, the presence of which in large numbers is indicative of diseases of the mucous lining of the urinary organs.Fig. 4 represents the microscopic appearance of phosphates in the urine. These are present in great quantity in cases of nervous debility and kindred affections. By attaching the camera lucida to the microscope we can throw an image of these urinary deposits upon paper. By the art of the engraver this may be faithfully traced, and thus we are enabled to produce an accurate representation of them. Some of the beautiful crystalline deposits shown in Fig. 4 represent less than a millionth part of a grain, yet their forms are delineated with geometrical precision. Earthy phosphates are often mistaken for pus and also seminal fluid. Phosphates are always found in decomposed urine, otherwise they indicate brain affections, acute cystitis, etc. Experience has taught us that the voiding of urine loaded with phosphates is a forerunner of cystitis, or enlargement of the prostate gland, or both. In fact, persons so affected are "prone to serious consequences from mild attacks of almost any and every acute disease."

Illustration: Fig. 5.
Fig. 5.

Fig. 5 represents the microscopic appearance of mixed urinary deposits. In division A is represented fermentation spores as they appear in diabetic urine. Pasteur asserts that the germs of this fungus get into the urine after it has been passed. Urates appear in division B. These indicate waste of flesh, as in fevers, consumption, prolonged physical efforts, etc. Division C pictures urates of ammonia. These appear in alkaline decomposition of the urine; it is isomeric with uric acid in acid urine. In division D is represented urate of soda, which is present in the tissues of persons suffering from gout. The crystals shown in division E consist of the same salt.

Illustration: Fig. 6.
Fig. 6.

In Fig. 6, division A, is represented purulent matter as it appears in the urine. The formation of pus in different parts of the genitourinary system is accompanied by the appearance of pus corpuscles in the urine. When fat globules, represented in division B, are found in the urine, they indicate fatty degeneration. In division C are representations of the cells found in the urine of persons suffering from cystitis or other inflammatory diseases.

Illustration: Fig. 7.
Fig. 7.

Fig. 7, divisions A and B, represent different forms of cystine. Fortunately this substance is rarely found in the urine. When present however it indicates liability to, or the actual presence of, a calculus or stone in the bladder. In division C is a representation of the deposits seen in the urine of those who are greatly debilitated. In division D are seen epithelial cells mixed with mucus.

Illustration: Fig. 8.
Fig. 8.

In Fig. 8, division A, are represented the caudated cells from the deep structure of the bladder. The cells represented in division B are amyloid concretions, found where there is an enlarged prostate gland.

Fig. 9 represents the appearance of spermatozoa as seen in the urine. When present, they afford indisputable evidence of the escape of semen in the renal excretions.

We might add many other illustrations of urinary deposits and state their several indications, but a sufficient number has been introduced to show the importance and practical value of microscopic examinations of the urine in revealing obscure diseases.

Although the microscope is of inestimable value in examining the renal excretion, it does not entirely supersede other valuable instruments and chemical re-agents in determining constitutional changes. By the urinometer we determine the specific gravity of the urine; by the use of litmus its acid or alkaline reaction, is ascertained; while various chemicals, when added to it, produce certain specific changes, according to the morbid alterations which it has undergone by reason of disease. By the application of heat, or the addition of a few drops of nitric acid, the albumen, which is invariably present in Bright's disease of the kidneys, is coagulated. By the employment of other re-agents we may determine the presence of sugar—a characteristic of diabetic urine. And thus we might mention almost innumerable chemical tests by which the several changed conditions of the urine, characteristic of different diseases, may be ascertained with absolute certainty.

THE MOST EMINENT MEDICAL AUTHORITIES ENDORSE IT.

Dr. Eberle, a distinguished allopathic author, thus writes: "Whatever may be the disease, the urine seldom fails in furnishing us with a clue to the principles upon which it is to be treated."

Dr. Braithwaite also says: "We can arrive at a more accurate knowledge respecting the nature of diseases from examining the urine than from any other symptom."

Golding Bird, whose writings are regarded as sound and practical by the most learned of the medical profession, says: "The examination of the urine in disease is now regarded as one of the most important aids in diagnosis, and which it would be injurious alike to the welfare of the patient and the credit of the practitioner to avoid."

Illustration: Fig. 9.
Fig. 9.

The eminent Dr. F. Simon writes as follows: "From the physical and chemical state of the urine, the attentive and observing physician may obtain a great quantity of information for ascertaining and establishing a diagnosis. More than all other signs, the correct examination of the sediment is of importance to the physician. * * * For the medical man it is the compass which guides him in the unlimited chaos of disease and its treatment; for the patient it is the thermometer of his condition, the premonitory indication of the decrease or aggravation of his malady; and for the healthy man it is the regulator of his diet and his life. Every one is aware of the variations of the barometer, and we know that the fluctuations of the column of mercury are closely associated with the variable conditions of the atmosphere; so, to the practical observer, variations of the urine, as well as the elements composing it, point out with certainty the changes in health, and the condition of the organs."

While we recognize the importance of examining the urine as an aid in distinguishing diseases, and have made this old German method of diagnosis a special study, yet we do not claim that all diseases can be unmistakably distinguished by such examinations alone. We take a conservative position and have no confidence in that class of ignorant fanatics whose pet hobby is "uroscopy."

From every person who solicits our professional services, we require explicit answers to numerous important questions, that we may know the age, sex, vocation, etc., as well as the prominent symptoms manifested.

CONSULTATIONS BY LETTER.

Formerly, we published in this book a very extensive list of questions to be answered by those consulting us, but a large experience has convinced us that beyond requiring answers to a few leading questions, which we still retain, it is better to let the patient describe the malady in his or her own way and language. After receiving and considering such a history, if we do not fully understand the patient's malady, we will ask such further questions as may be necessary. The patient should, however, in addition to writing name, post-office, county, and state, plainly, state the name of the town containing the nearest express office. Next give age, sex, whether married or single, complexion, height, present and former weight, if known, and occupation. State also if you have been a hard worker, and whether it is necessary for you to labor hard now, how long you have been out of health, and from what particular symptoms you suffer most. Follow this with a history of your case in your own language. If you find in this volume an accurate description of your disease, state the page and paragraph where it occurs.

FREE CONSULTATION.

We now make no charge for consultation by letter, but, instead of the one dollar formerly charged by us as a consultation fee, as we are desirous of making our facilities for treatment known to invalids far and near, we request that all persons writing to us for advice send us the names of all those within the circle of their acquaintance who are in any way in need of medical or surgical treatment for chronic diseases. If convenient, send the list on a separate piece of paper.

CHARGES MUST BE PREPAID.

Should you send a vial of urine for analysis, about a cupful will do, and all express charges on it must be prepaid. All liquids are excluded from the mails, when discovered, and yet we have received hundreds of samples through the mails safely when put in homoeopathic or other very small vials, well corked and carefully packed in a light tin can or wooden box, or in a light pine stick bored out hollow, the vial being carefully packed in sufficient saw-dust or blotting paper to absorb all liquid should the vial get broken. Letter postage, that is, two cents for each one ounce or fraction thereof, must be paid upon these sealed packages. Send the first urine that is passed after rising in the morning.

RELIABLE MEDICINES.

Next in importance to a correct understanding of the patient's disease, is the possession of reliable remedies for its treatment. Many of the medicines employed by physicians engaged in general practice are prepared from old drugs that have lost all their medicinal virtues, and hence are utterly useless and ineffectual. Many vegetable extracts are inert, because the plants from which they are produced were not gathered at the proper time. To give the reader an idea of the great care which we exercise in the selection and preparation of our medicines, he is requested to read under the head of "The Preparation of Medicines," in "The People's Common Sense Medical Adviser."

OUR TERMS FOR TREATMENT

require the payment of monthly fees, in advance, which entitles the patient to medicines specially prepared for and adapted to his or her particular case, and to all necessary attention and advice. Our fees for treatment are moderate, varying according to the nature and requirements of each particular case, and will be made known at the time of consultation.

WHY OUR FEES ARE REQUIRED IN ADVANCE.

We receive applications from strangers residing in all parts of America, and even in foreign countries, and it is not reasonable to suppose that credit could be dispensed so indiscriminately. It would not be a correct business transaction for a merchant to send a barrel of sugar or a roll of cloth to a stranger living hundreds of miles away, to be paid for when used. Our knowledge and medicines constitute our capital in business, and an order upon that capital should be accompanied with an equivalent. Some applicants refer us to their neighbors for a testimonial of their integrity. We cannot spare the time or employ assistants to make such inquiries for the sake of trusting any one. Should credit be thus indiscriminately given, there would necessarily be losses, and, to compensate for these, and the extra expense incurred by the employment of assistants, our fees would have to be much larger, thereby imposing the burden upon those who do pay. Instead of following this method of procedure, we place professional services within the reach of all, so that a greater number may be benefited. Many invalids say that they have paid large sums of money to medical men for treatment without obtaining relief. Unfortunately our land is cursed with quacks and unprincipled practitioners, who seek no one's good but their own, and it is a defect in our law that it permits such swindlers to go unpunished. Not so reprehensible is the family physician who fails, because his limited and varied practice does not permit him to become proficient in treating chronic diseases.The following beautiful sentiment of Hood truthfully expresses the sacredness of the physician's trust:

"Above all price of wealth
The body's jewel. Not for minds or hands profane
To tamper with in practice vain.
Like to a woman's virtue is man's health;
A heavenly gift within a holy shrine!
To be approached and touched with serious fear,
By hands made pure and hearts of faith severe,
E'en as the priesthood of the One Divine."

We are in regular practice, responsible for what we say and do, and cordially invite those who desire further evidence of our success in curing chronic diseases to come to the Invalids' Hotel and Surgical Institute and satisfy themselves of the truthfulness of our statements.

We are warranted in saying that our responsibility and disposition for fair dealing are known to many of the principal mercantile houses, as well as to all prominent American editors. We also refer to our present and former patients, one or more of whom may be found in almost every hamlet of America. To all who are under our treatment we devote our highest energies and skill, fully realizing that an untold blessing is conferred upon every person whom we cure, and that such cures insure the permanency of our business. On the contrary, we realize how unfortunate it is for us to fail in restoring to health any person whom we have encouraged to hope for relief. We are careful, therefore, not to assume the treatment of incurable cases, except when desired to do so for the purpose of mitigating suffering or prolonging life; for we never wish to encourage false hopes of recovery.

TERMS FOR BOARD AND TREATMENT AT THE INVALIDS' HOTEL AND SURGICAL INSTITUTE

are moderate, varying with the nature of the case and the apartments occupied. At times so great is the number applying to avail themselves of the skill of our Faculty, and the advantages which our institution affords, that we are unable to receive all applicants. To be sure of securing good apartments, it is well to engage them sometime ahead, and make an advance payment of fifty dollars or more upon them, which will be refunded in case acute sickness or any similar cause should prevent the patient from occupying them at the time specified. Complete terms for treatment and board can be arranged only when personal application for entrance to the institution is made, and the nature and extent of the disease and the necessary treatment fully determined by personal examination of the case. If satisfactory terms and arrangements cannot at that time be agreed upon, or if the case be deemed incurable, any advance payments that have been made to secure good apartments will be promptly refunded.

SPECIAL ADVICE.

Those coming here to consult us personally, should bring the money to pay for our services and for board and care while remaining here, in the form of drafts on New York City, Boston or Chicago, and not in the form of checks on a local or home bank. Such drafts can be purchased in the home bank by paying a small amount for the exchange. If more convenient, post office orders payable at Buffalo post office will do.

VISITING PATIENTS WHO RESIDE AT A DISTANCE.

We are frequently asked to visit patients residing hundreds of miles away, that we may personally examine their cases, or perform difficult surgical operations. We can seldom comply with such requests as the time of our professional Staff is generally very fully occupied.

TO PHYSICIANS

wishing to consult us in intricate cases of chronic diseases under their treatment, we desire to say that we shall, as in the past, take pleasure in responding to their solicitations. We have all the necessary instruments and appliances required in executing the most difficult surgical operations, and, as we have had much experience in this department, we are always ready and able to assist physicians who do not practice operative surgery. In this age of railways and telegraphs medical and surgical aid can be summoned from a distance and promptly obtained.

OUR MEDICINES

as put up for sale through druggists, are not recommended as "cure-alls," or panaceas, but only as superior remedies for certain common and easily-recognized diseases. They are our favorite prescriptions, improved and perfected by long study and a vast experience in the treatment of chronic diseases, and have gained world-wide celebrity and sale. We are well aware that there are many chronic diseases that can only be successfully treated and cured by careful adaptation of remedies to each individual case. This is especially true of the ever-varying and delicate diseases of the kidneys and bladder. It is not less so with reference to nervous debility, involuntary vital losses, with which so many young and middle-aged men are afflicted; and we may also include in this list epilepsy or fits, paralysis or palsy, obstinate gleety discharges, and many other chronic and delicate ailments of which our staff of physicians and surgeons cure annually many thousands of cases, but for which we do not recommend any of our put-up, ready-made, or proprietary medicines.

NO RELATIONSHIP WITH HUMBUGS.

Had our put-up or proprietary medicines, as sold by druggists the world over, been adapted to all classes and forms of chronic diseases, there would have been no necessity for our organizing a competent staff of physicians and surgeons to act as experts in the treatment of difficult, obscure, and complicated cases of chronic diseases. That we keep constantly employed, in our Buffalo and London institutions, eighteen medical gentlemen, with such helpers as chemists, clerks, etc., is indisputable proof that the medicines we offer for sale through druggists should not be classed with the humbug nostrums recommended to cure everything. They are the outgrowth of our vast and extended practice in the treatment of chronic diseases; are well-tried, world-famed, and honest medicines. They are not unduly puffed and lauded, but simply recommended for such diseases as are easily recognized and which they are known to cure.

NOT CONFINED IN PRESCRIBING

Our physicians, in the treatment of cases consulting us, prescribe just such medicines as are adapted to each particular case. They are not confined in the least to our list of a few put-up or proprietary medicines (valuable as they are when applicable to the case) but resort to the whole broad range of the materia medica, employed by the most advanced physicians of the age. They are not hampered by any school, ism or "pathy."

OUR MEDICINES PREPARED WITH THE GREATEST CARE.

The medicines employed are all prepared in our own Laboratory by skilled chemists and pharmacists, and the greatest care is exercised to have them manufactured from the freshest and purest ingredients. Our Faculty probably employ a greater number and variety of native roots, barks, and herbs, in their practice then are used in any other invalids' resort in the land. Using vast quantities of these indigenous medicines, we can afford and do not neglect to have them gathered with great care, at the proper seasons of the year, so that their medicinal properties may be most reliable. Too little attention is generally paid to this matter, and many failures result from the prescribing of worthless medicines by physicians who have to depend for their supplies upon manufacturers who are careless or indifferent in obtaining the crude plants and roots from which to manufacture their medicines for the market. While depending largely upon solid and fluid extracts of native plants, roots, barks, and herbs, in prescribing for disease, yet we do not use them to the exclusion of other valuable curative drugs and chemicals. We aim to be unprejudiced and independent in our selection of remedies, adopting at all times a rational system of therapeutics. This liberal course of action has, in a vast experience, proved most successful.

WORLD'S DISPENSARY MEDICAL ASSOCIATION,
663 MAIN STREET, BUFFALO, N.Y.