TREATMENT. The treatment should consist in the employment of those

remedial agents advised in intermittent fever, the Golden Medical

Discovery and quinine being taken during the remission of symptoms.

During the height of the fever, tincture of aconite maybe given and an

alkaline sponge-bath administered with advantage. As in intermittent

fever, should the course of treatment here advised not promptly arrest

the disease, the family physician should be summoned.

CONGESTIVE FEVER. (PERNICIOUS FEVER.)

This is the most severe and dangerous form of malarial fever. It may be

either intermittent or remittent in character. In some instances the

first paroxysm is so violent as to destroy life in a few hours, while in

others it comes on insidiously, the first one or two paroxysms being

comparatively mild. It is frequently characterized by stupor, delirium,

a marble-like coldness of the surface, vomiting and purging, jaundice,

or hemorrhage from the nose and bowels. In America this fever is only

met with in the Mississippi valley, and in other localities where the

air contains a large quantity of malarial poison.

TREATMENT. This fever is so dangerous that a physician should be

summoned as soon as the disease is recognized. For the benefit of those

who are unable to obtain medical attendance, we will say that the

treatment should be much the same as in intermittent fever, but more

energetic. Quinine should be taken in doses of from five to fifteen

grains every two or three hours. If it be not retained by the stomach,

the following mixture may be administered by injection: sulphate of

quinine, one-half drachm; sulphuric acid, five drops; water, one ounce;

dissolve, and then add two ounces of starch water.

CONTINUED FEVERS.

The symptoms of these fevers do not intermit and remit, but _continue_

without any marked variation for a certain period. They are usually

characterized by great prostration of the system, and are called

_putrid_ when they manifest septic changes in the fluids, and

_malignant_ when they speedily run to a fatal termination. _Typhoid_ and

_typhus_ fevers belong to this class. We shall not advise treatment for

these more grave disorders which should always, for the safety of the

patient, be attended by the family physician, except to recommend some

simple means which may be employed in the initial stage of the disease,

or when a physician's services cannot be promptly secured.

TYPHOID FEVER. (ENTERIC FEVER.)

In typhoid fever there is ulceration of the intestines and mesenteric

glands. This diseased condition of the bowels distinguishes this fever

from all others, and is readily detected by sensitiveness to pressure,

especially over the lower part of the abdomen on the right side. The

early disposition to diarrhea is another characteristic symptom of it,

and there is also no intermission of symptoms as in intermittent fever.

The disease comes on insidiously, with loss of appetite, headache,

chilliness, and languor. It is usually a week or more before the disease

becomes fully developed.

CAUSE. Typhoid fever is a specific form of fever developed from the

action of a specific germ upon a susceptible system. The poison of

typhoid fever is eliminated mainly through the bowels. The germs of

typhoid can maintain life for months in water, and thus it happens that

ponds, lakes, rivers and streams which receive sewage can spread the

germs of typhoid fever. Well water often swarms with these poisonous

germs. In some cases it has been found that privies, though twenty or

forty feet away from a well, have yet drained into it--through a clay

soil covered with gravel--and carried the germs to those drinking the

water from the well. Next to water, milk is the most prominent carrier

of contagion. Milk is apt to get infected with the germs if cooled in

tanks of water which may receive drainage from outhouses and barns.

TREATMENT. Scientific support has been given the treatment by cold tub

baths (70° Fahrenheit) and it is advised by many physicians. Experience

has proved that sponge baths and tub baths are of the utmost importance,

when the temperature of the patient is at or above 102.5° Fahrenheit.

Every three hours the tub bath is given for twenty minutes at 70°

Fahrenheit. These may be tepid at first, gradually cooling to 70°.

Frictions are applied to patient in the bath, and he is wrapped in

blankets when taken out to avoid danger of chill, and then given a warm

drink or stimulant. Treatment should be directed by an experienced

physician to suit the symptoms. The evacuations from the bowels should

be thoroughly disinfected with chloride of lime or carbolic acid, that

they may not convey the disease to others. All the sewerage and drain

pipes in the house should likewise be disinfected.

SCARLET FEVER. (SCARLATINA.)

This fever takes its name from the scarlet color of the eruption on the

surface of the body. Sometimes it is comparatively mild, and is then

called _Scarlatina Simplex_; when it is accompanied by a sore throat, it

is termed _Scarlatina Anginosa_; and when the disease is of a low,

putrid type, it is called _Scarlatina Maligna._ This disease has three

distinct stages: (1), the stage of invasion; (2), the stage of eruption;

and (3), the stage of desquamation. In the first stage there is pain in

the head, increased heat of the skin, redness and soreness of the

throat, and sometimes nosebleed, diarrhea, or vomiting. The average

duration of this stage is twenty-four hours. The eruptive stage

generally begins on the second day, though sometimes it is delayed

longer, and the scarlet rash rapidly diffuses itself over the whole

body. The redness is vivid and has been compared to the appearance of a

boiled lobster. The stage of eruption reaches its maximum of intensity

on the third day, and it is important that it does not recede. Redness

of the tonsils and throat is one of the early symptoms which precedes

any cutaneous eruption. The tongue also is finely spotted with numerous

red points which mark its papillae, presenting an appearance which has

been compared to that of a strawberry.

The thirst is urgent, there is no appetite, and vomiting and mild

delirium are common. This stage continues from four to six days, and

sometimes longer. Desquamation (scaling off of the skin) commences at

the decline of the eruption, in the form of minute, branny scales. The

duration of this stage is indefinite, and may end in five or six or may

continue ten or twelve days.

If the inflammation in the throat is very severe, it may terminate in an

abscess, which may also occur in the glands of the neck, and sometimes

the inflammation extends to the lips, cheeks, and eyelids. Gangrene

within the throat occurs in rare instances. The disease is easily

communicated, and usually develops in two to five days after exposure.

It occurs most frequently in the third and fourth years of life. There

is no other disease so simple, and yet so often liable to prove fatal,

as scarlet fever; and for this reason we shall advise the attendance of

the family physician.

Domestic treatment may be given as follows, until a physician can be

obtained: Catnip, pennyroyal, or pleurisy-root tea, containing one

teaspoonful of the Extract of Smart-weed, may be given, to drive the

rash to the surface. Cold drinks are suitable to allay the thirst,

nausea, and fever. The sick-room should be kept at a temperature of

about 65° Fahr., and fresh air admitted freely. The patient ought not to

be overloaded with bed-clothes; and the skin should be sponged over

twice daily with tepid water, different parts being exposed

successively, and carefully dried with soft cloths. Soda may be added to

the water, but no soap should be used. The diet should consist of milk,

extract of beef, and soups. Injections may be employed to relieve

constipation, but purgatives should be avoided. We repeat that this

disease is one which requires the attendance of the family physician,

and great care should be exercised during recovery, that no bad results

may follow.

SMALL-POX. (VARIOLA.)

Small-pox is produced by a specific poison, which is reproduced and

multiplied during the progress of the disease. It is contained in the

pustules, and in the excretions and exhalations of affected individuals.

It is established after a period of incubation varying from nine to

thirteen days after infection.

There are two varieties of this disease, known as _confluent_ and

_distinct_ variola; in the former, the vesicles run together, in the

latter, they are separate.

This fever has three stages. The first is that of _invasion_, distinctly

marked by a chill or a series of chills, which alternate with flushes of

heat. In this stage the tongue becomes coated, there is also nausea and

vomiting, pain in the limbs, back, and particularly in the loins, the

latter symptom being of diagnostic importance. This stage continues

about two days, and if the symptoms are light, it may be expected that

the disease will be comparatively mild, and of the _distinct_ variety.

_The stage of eruption._ The eruption begins to appear on the skin,

generally on the third day following the attack, though in the throat

and mouth may be discovered round, whitish, or ashy spots, several hours

previous to the appearance of vesicles on the surface of the body. These

are first seen on the face and neck, then on the trunk and upper

extremities, and, lastly, on the lower extremities. The eruption at

first appears in the form of small, red or purple spots, which change

the texture of the skin by becoming more hard, pointed, and elevated. On

the fifth day of the eruption they attain their full size, being

softened and depressed in the center, and hence are called

_umbilicated_. Now a change takes place, and the vesicles fill with

"matter" and become pointed, and there is a rise in the fever.

_The stage of suppuration_ commences thus: the pulse quickens, the skin

becomes hotter, and in many cases of the confluent variety, swelling of

the face, eyelids, and extremities occurs. Frequently there is passive

delirium in this stage, and if diarrhea sets in, it is an unfavorable

sign. The duration of this stage of the eruption is four or five days.

_The stage of desication_, or of the drying of the pustules, commences

between the twelfth and fourteenth day of the disease. In the confluent

variety, patches of scab cover all the space occupied by the eruption,

and the skin exhales a sickening odor.

THE TREATMENT should have reference to the determination of the eruption

to the surface. If there is thirst, allow cold drinks, ice-water, or

lemonade. Bathing the surface with cold water, breathing plenty of fresh

air, using disinfectants in the room, and taking antiseptic medicine

internally, are proper. Add one part of carbolic acid to six parts of

glycerine, mix from two to three drops of this with an ounce of water,

and of this preparation administer teaspoonful doses frequently. A few

drops of carbolic acid and glycerine may be rubbed up with vaseline, and

the surface anointed with it to prevent pitting. The malady is so grave

that it should be intrusted to the care of the family physician.

VARIOLOID. (MODIFIED SMALL-POX.)

Varioloid is a modified form of small-pox. There is less constitutional

disturbance, and very little or no pitting of the skin. Varioloid

generally occurs in persons who have not been fully protected by

vaccination. A person suffering from this modification of the disease

may, by contagion, communicate to another genuine small-pox. The

_treatment_ is the same as that recommended in variola.

VACCINIA. (COW-POX.)

The important discovery of vaccination is due to Dr. Jenner, who

ascertained that when the cow was affected by this disease and it was

then communicated to man, the affection was rendered very mild and

devoid of danger, and at the same time it proved a very complete

protection against small-pox. Like most other valuable discoveries

introduced to the world, it encountered bitter prejudice and the most

unfair opposition. Now its inestimable value is generally known and

admitted.

In a few cases, in which the quality of the vaccine virus was

deteriorated, its effect is only to slightly-modify small-pox, and then

the disease resembles that caused by inoculation. The operation of

infecting the blood with the _kine virus_ is called _vaccination_. All

that we know is that when the cow becomes affected with this disease,

and it is then transferred to man, it loses its severity and serves as a

protection against small-pox. In a great majority of cases this

protection is absolute, and only in a very few does it leave the subject

susceptible to small-pox, materially modified. The protection it affords

against small-pox is found to diminish after the lapse of an indefinite

number of years, and hence it is important to be re-vaccinated once or

twice, for instance, after an interval of five years. Between the second

and third months of infancy is the best period for vaccination, and the

place usually selected is the middle of the arm above the elbow-joint.

CHICKEN-POX. (VARICELLA.)

Chicken-pox is an eruptive disease, which affects children, and

occasionally adults. It is attended with only slight constitutional

disturbance, and is, therefore, neither a distressing nor dangerous

affection. The eruption first appears on the body, afterwards on the

neck, the scalp, and lastly on the face. It appears on the second or

third day after the attack, and is succeeded by vesicles containing a

transparent fluid. These begin to dry on the fifth, sixth, or seventh

day. This disease may be distinguished from variola and varioloid by the

shortness of the period of invasion, the mildness of the symptoms, and

the absence of the deep, funnel-shaped depression of the vesicles, so

noticeable in variola.

TREATMENT. Ordinarily very little treatment is required. It is best to

use daily an alkaline bath, and, as a drink, the tea of pleurisy-root,

catnip, or other diaphoretics, to which may be added from one-half to

one teaspoonful of the Extract of Smart-weed. If the fever runs high, a

few drops of aconite in water will control it.

MEASLES. (RUBEOLA.)

This is generally a disease of less severity and importance than the

other eruptive fevers, but it is sometimes followed by serious

complications. The stage of invasion is marked by the symptoms of a

common cold, sneezing, watery eyes, a discharge from the nostrils, a dry

cough, chilliness, and headache. This stage may last four days. Then

follows an eruption of red dots or specks, which momentarily disappear

on pressure. On the fourth day of the eruption the redness of the skin

fades, the fever diminishes, and the vesicles dry into scales or little

flakes. The eyes may be inflamed and the bowels may be quite lax at this

stage.

TREATMENT. The great object in the treatment is to bring out the

eruption. To effect this, sweating teas are beneficial. The free use of

the Extract of Smart-weed is recommended, and the skin should be bathed

every day with tepid water. Sometimes when warm drinks fail to bring out

the eruption, drinking freely of cold water and keeping warmly covered

in bed, will accomplish the desired result.

FALSE MEASLES (_Rose Rash_) is an affection of very little importance

and may be treated similarly to a case of ordinary measles.

ERYSIPELAS.

There are few adult persons in this country who have not, by observation

or experience, become somewhat familiar with this disease. Its

manifestations are both constitutional and local, and their intensity

varies exceedingly in different cases. The constitutional symptoms are

usually the first to appear, and are of a febrile character. A distinct

chill, attended by nausea and general derangement of the stomach is

experienced, followed by febrile symptoms more or less severe. There are

wandering pains in the body and sometimes a passive delirium exists.

Simultaneously with these symptoms the local manifestations of the

disease appear. A red spot develops on the face, the ear, or other part

of the person. Its boundary is clearly marked and the affected portion

slightly raised above the surrounding surface. It is characterized by a

burning pain and is very sensitive to the touch. It is not necessary for

the benefit of the popular reader that we should draw a distinction

between the different varieties of this malady. The distinctions made

are founded chiefly upon the _depth_ to which the morbid condition

attends, and not on any difference in the _nature of the affection_.

Suppuration of the tissues involved is common in the severer forms.

Should the tongue become dark and diarrhea set in, attended with great

prostration, the case is very serious, and energetic means must be

employed to save life. A retrocession of the inflammation from the

surface to a vital organ is an extremely dangerous symptom. The disease

is not regarded as contagious, but has been known to become epidemic.

TREATMENT. The treatment during the initial stage of this disease should

correspond with the general principles laid down for the treatment of

fever. The spirit vapor-bath, with warm, diaphoretic teas, or the

Compound Extract of Smart-Weed may be given to favor sweating. The whole

person should be frequently bathed in warm water rendered alkaline by

the addition of saleratus or soda. The bowels should be moved by a full

dose of the Purgative Pellets. Fluid extract of aconite in small and

frequent doses will best control the fever. The specific treatment,

which should not be omitted, consists in administering doses of ten

drops of the tincture of the muriate of iron in alternation with

teaspoonful doses of the Golden Medical Discovery, every three hours. As

a local application, the inflamed surface may be covered with cloths wet

in the mucilage of slippery elm. Equal parts of sweet oil and spirits of

turpentine, mixed and painted over the surface, is an application of

unsurpassed efficacy.

DIPHTHERIA.

This is an exceedingly grave, constitutional disease characterized by a

rapid breaking down of the powers of life, together with a peculiar

affection of the throat, in which a disposition to the formation of

false membranes is a prominent feature. The formation of these

membranes, however, is not limited to the throat, but may occur on

mucous surfaces elsewhere.

CAUSE. Infection with the specific germ of the disease by contagion or

inoculation. It can be carried in milk or water, and the germs can

attach themselves to furniture, walls, clothing, etc. A person with

chronic diphtheretic sore throat can infect children or susceptible

persons with the disease in its most acute type by kissing. All persons

with sore throat should avoid kissing--as this disease is commonly

spread in this way.

SYMPTOMS. The symptoms vary in different cases. In some the disease

comes on gradually, while in others it is malignant from the first. The

throat feels sore, the neck is stiff and a sense of languor, lassitude,

and exhaustion pervades the system. Sometimes a chill is experienced at

the outset. Febrile disturbance, generally of a low, typhoid character,

soon manifests itself. The skin is hot; there is intense thirst; the

pulse is quick and feeble, ranging from 120 to 150 per minute. The

tongue is generally loaded with a dirty coat, or it may be bright red.

The odor of the breath is characteristic, and peculiarly offensive, and

there is difficulty in swallowing and sometimes in breathing. Vomiting

is sometimes persistent. If we examine the throat, we find more or less

swelling of the tonsils and surrounding parts, which are generally

bright red, and shining, and covered with a profuse, glairy, tenacious

secretion. Sometimes the parts are of a dusky, livid hue, and, in rare

instances, pallid. The false membrane, a peculiar tough exudation, soon

appears and may be seen in patches, large or small, or covering the

entire surface from the gums back as far as can be seen, its color

varying from a whitish yellow to a gray or dark ashen tint. When it is

thrown off, it sometimes leaves a foul, ulcerating surface beneath. The

prostration soon becomes extreme, and small, livid spots may appear on

the surface of the body. There may be delirium, which is, in fatal

cases, succeeded by stupor, or coma. The extremities become cold;

diarrhea, and in some cases convulsions, indicate the approach of death.

Sometimes the patient dies before the false membrane forms.

TREATMENT. The extremely dangerous character of this disease demands

that the services of a skillful physician be obtained at once; and that

his efforts should be aided by the most thorough hygienic precautions,

good fresh air, bathing, and a supporting diet. Prior to the arrival of

the physician, lose no time in using plenty of good brandy or whiskey to

offset the extremely weakening effect of the disease. The employment of

alcoholic stimulation in this disease is almost always used by

physicians. Control the vomiting and allay the thirst by allowing the

patient to suck small pieces of ice every five or ten minutes. Hot

fomentations or spirits of turpentine should be applied to the throat.

If the physician does not take charge of the patient by this time, the

use of permanganate of potash, triturated, in strength of one grain to

the ounce, in a mixture of fine sugar of milk and gum acacia, and blown

over the parts with an insufflater every few hours, brings the best

results if thoroughly carried out; or the throat can be swabbed out with

the following mixture: chlorate of potash, four drachms; tincture of

muriate of iron, three drachms, syrup of orange, two ounces; water

sufficient to make four ounces; administered every two or three hours.

Inhaling steam or lime-water from a steam atomizer is especially good.

The use of blisters, caustics, active purges, mercurials, or bleeding,

should be condemned. Throughout the whole course of the disease the

strength must be supported by the most nourishing diet, as well as by

tonics and stimulants. Beef tea, milk, milk punch, and brandy should be

freely administered. A competent physician should be called in as early

as possible. The general results of the treatment with antitoxin, if

given on the first, second or third day of the disease, are usually

favorable. There are rarely any immediately bad results from the

injections, and the published testimony of careful observers would tend

to prove that recovery has followed its use in a larger percentage of

cases than under former methods of treatment.

QUINSY. (TONSILLITIS.)

This is an acute inflammation of the tonsils, which generally extends

to, and involves adjacent strictures, and is attended with general

febrile disturbance. Its duration varies from four to twenty days. It

sometimes terminates by a gradual return to health (resolution); or by

the formation of "matter" within the gland (suppuration.) When this

latter is the case, the swelling sometimes becomes so great before it

breaks as to require lancing.

CAUSES. It most frequently results from a cold. In some persons there is

a predisposition to it, and the individual is liable to recurring

attacks. Persons of a scrofulous diathesis are more liable to it than

others.

SYMPTOMS. Difficulty of swallowing, soreness, and stiffness of the

throat, are the first monitions of its approach. There is fever, quick,

full pulse, and dryness of the skin; the tongue is furred, and the

breath offensive. The tonsils are intensely red, swollen, and painful,

the pain often extending to the ear. Sometimes but one tonsil is

affected, though generally both are involved. In severe cases the

patient cannot lie down, in consequence of the difficulty of breathing.

TREATMENT. In the early stage of the disease, the spirit vapor-bath is

invaluable. The sweating which it produces should be kept up by the use

of the Compound Extract of Smart-weed in some diaphoretic infusion. Hot

wet-packs to the throat, covered with dry cloths, are useful. The

inhalation of the hot vapor of water or vinegar, or peppermint and

water, is beneficial. A carthartic should be given at night. When the

disease does not show a disposition to yield to this treatment, the

services of a physician should be obtained. When pus, or "matter," is

formed in the tonsil, which may be known by the increased swelling and

the appearance of a yellowish spot, the services of a physician will be

required to lance it.

ENLARGED TONSILS.

[Illustration: Fig. 147.

_A A._--Enlarged Tonsils. B.--Elongated

Uvula.]

Chronic enlargement of the tonsils, as shown in Fig. 147, _A A_, is an

exceedingly common affection. It is most common to those of a scrofulous

habit. It rarely makes its appearance after the thirtieth year, unless

it has existed in earlier life, and has been imperfectly cured. Both

tonsils are generally, though unequally enlarged. A person affected with

this disease is extremely liable to sore throat, and contracts it on the

slightest exposure; the contraction of a cold, suppression of

perspiration, or derangement of the digestive apparatus being sufficient

to provoke inflammation.

CAUSES. Repeated attacks of quinsy, scarlet fever, diphtheria, or

scrofula, and general impairment of the system, predispose the

individual to this disease.

SYMPTOMS. The voice is often husky, nasal or guttural, and disagreeable.

When the patient sleeps, a low moaning is heard, accompanied with

snoring and stentorian breathing, and the head is thrown back so as to

bring the mouth on a line with the windpipe, and thus facilitate the

ingress of air into the lungs. When the affection becomes serious, it

interferes with breathing and swallowing. The chest is liable to become

flattened in front and arched behind, in consequence of the difficulty

of respiration, thus predisposing the patient to pulmonary disease. On

looking into the throat, the enlarged tonsils may be seen, as in the

figure. Sometimes they are so greatly increased in size that they touch

each other.

TREATMENT. The indications to be carried out in the cure of this malady

are:

(1.) To remedy the constitutional derangement.

(2.) To remove the enlargement of the tonsil glands.

The successful fulfillment of the first indication may be readily

accomplished by attention to hygiene, diet, clothing, and the use of the

Golden Medical Discovery, together with small daily doses of the

Pleasant Purgative Pellets. This treatment should be persevered in for a

considerable length of time after the enlargement has disappeared, to

prevent a return.

To fulfill the second indication, astringent gargles may be used.

Infusions of witch-hazel or cranesbill should be used during the day.

The following mixture is unsurpassed: iodine, one drachm; iodide of

potash, four drachms; pure, soft water, two ounces. Apply this

preparation to the enlarged tonsils twice a day, with a probang, or soft

swab, being careful to paint them each time. A persevering use of these

remedies, both internal and local, is necessary to reduce and restore

the parts to a healthy condition.

Sometimes the enlarged tonsils undergo calcareous degeneration; in this

case, nothing but their removal by a surgical operation is effectual.

This can be readily accomplished by any competent surgeon. We have

operated in a large number of cases, and have never met with any

unfavorable results.

ELONGATION OF THE UVULA.

Chronic enlargement or elongation of the uvula, or palate, as shown at

B, Fig. 147, may arise from the same causes as enlargement of the

tonsils. It subjects the individual to a great deal of annoyance by

dropping into and irritating the throat. It causes tickling and frequent

desire to clear the throat, change, weakness, or entire loss of voice,

and difficulty of breathing, frequently giving rise to the most

persistent and aggravating cough.

TREATMENT. The treatment already laid down for enlarged tonsils, with

which affection, elongation of the uvula is so often associated, is

generally effectual. When it has existed for a long time and does not

yield to this treatment, it may be removed by any competent surgeon.

ANÆMIA.

When the blood contains less than the ordinary number of red corpuscles,

the condition is known as _anæmia_, and is characterized by every sign

of debility. A copious hemorrhage, in consequence of a cut, or other

serious injury, will lessen the quantity of blood and may produce

anæmia. After sudden blood-letting, the volume of the circulation is

quickly restored by absorption of fluid, but the red corpuscles cannot

be so readily replaced, so that the blood is poorer by being more

watery. This is only one way in which the blood is impoverished.

The blood may be exhausted by a drain upon the system, in consequence of

hard and prolonged study. Severe mental employment consumes the red

corpuscles, leaving the blood thin, the skin cool and pale, and the

extremities moist and cold.

Anæmia may arise from lack of exercise, or it may be occasioned by

mental depression, anxiety, disappointment, trouble, acute excitement of

the emotions or passions, spinal irritation; in fact, there are many

special relations existing between the red corpuscles of the blood and

the various states of the mind and the nervous system. The latter

depends directly upon the health and quantity of these red corpuscles

for its ability to execute its functions.

Anæmia may arise in consequence of low diet, or because the alimentary

organs do not properly digest the food, or when there is not sufficient

variety in the diet. No matter how anæmia is occasioned, whether by

labor and expenditure, by hemorrhages, lead poisoning, prolonged

exposure to miasmatic influences, deprivation of food, indigestion,

imperfect assimilation, frequent child-bearing, or lactation, the number

of the red corpuscles in the blood is materially diminished.

The diagnostic symptoms of anæmia are pallor of the face, lips, tongue,

and general surface, weakness of the vital organs, hurried respiration

on slight exercise, swelling or puffiness of the eyes, and a murmur of

the heart, resembling the sound of a bellows.

This disorder of the blood tends to develop low inflammation, dropsical

effusion, tubercular deposits, Bright's disease, derangements of the

liver, diarrhea, leucorrhea, and is a precursor of low, protracted

fevers. This condition of the blood predisposes to the development of

other affections, providing they are in existence, and often it is found

associated with Bright's disease, cancer, and lung difficulties.

TREATMENT. (1.) Prevent all unnecessary waste and vital expenditure.

(2.) Place the patient under favorable circumstances for recovery, by

regulating the exercise and clothing entertaining the mind, and

furnishing plenty of pure air.

(3.) Prescribe such a nutritious diet as will agree with the enfeebled

condition of the patient.

(4.) Regular habits should be established in regard to meals, exercise,

recreation, rest, and sleep.

(5.) The use of tonics and stimulants, as much as the stomach will bear,

should be encouraged. Bathe the surface with a solution of a drachm of

quinine in a pint of whiskey.

(6.) Iron, in some form, is the special internal remedy in anæmia.

Meantime, it is proper to treat the patient with gentle, manual

friction, rubbing the surface of the body lightly and briskly with the

warm, dry hand, which greatly stimulates the circulation of the blood.

Anæmia occurs more frequently in the female than in the male, because

her functions and duties are more likely to give rise to it.

APNOEA.

Apnoea, or short, hurried, difficult respiration, is occasioned by

certain conditions of the blood. When anything interferes with the

absorption of oxygen, or the elimination of carbonic acid, the blood is

not changed from venous to arterial, and becomes incapable of sustaining

life. This morbid condition is termed _asphyxia_. We often read of

persons going into wells where there are noxious gases, or remaining in

a close room where there are live coals generating carbonic acid gas and

thus becoming asphyxiated, dying for want of oxygen.

Deficiency of oxygen is the cause of apnoea, and sometimes the red

corpuscles themselves are so few, worn out, or destroyed, that they

cannot carry sufficient oxygen, and the consequence is that the patient

becomes short of breath, and when a fatal degeneration of the corpuscles

ensues, he dies of asphyxia. Many a child grows thin and wan and

continues to waste away, the parents little dreaming that the slow

consumption of the red corpuscles of the blood is the cause which is

undermining the health. Sometimes this disease is the result of

starvation, irregular feeding, improper diet, want of care, and, at

other times, want of fresh air, proper exercise, and sunlight.

TREATMENT. The first essential to success in the treatment of this

disease, is the removal of the exciting cause. Exercise in the outdoor

air and sunlight, with good, nutritious food, and well-ventilated

sleeping apartments, are of the greatest importance. The bitter tonics,

as hydrastin, with pyrophosphate of iron, should be employed to enrich

the blood and build up the strength.

LEUCOCYTHÆMIA.

This term is used to designate a condition in which there is an excess

of colorless blood-corpuscles. In health, the colorless corpuscles

should exist only in the proportion of one, to one or two hundred of the

red corpuscles. These colorless corpuscles increase when there is

disease of the lymphatic glands, but whether this is the cause of their

increase or perversion is not known.

They have been found abundant in the blood in diseases of the spleen and

of the liver. Diarrhea usually attends this complaint, together with

difficult breathing, loss of strength, gradual decline, fever,

diminution of vital forces, and finally death. The recovery of a

well-marked case of this disease is very doubtful. Its average duration

is about one year.

DROPSIES.

_Transudation_ is the passage of fluid through the tissue of any part of

the body without changing its liquid state, while _exudation_ means,

medically, the passage of matter which coagulates and gives rise to

solid deposits. When transudations are unhealthy, they may accumulate in

serous cavities or in cellular structures, and constitute _dropsy_.

Exudation is the result of inflammation, and the product effused

coagulates and becomes the seat of a new growth of tissue. Exosmosis

means the passage of fluid from within outward, and is a process

constantly taking place in health; while transudation takes place

because the blood is watery and the tissues are feeble and permeable,

permitting the serum and watery elements of the blood to pass into

certain cavities, where they accumulate.

The cause of dropsies may be low diet, insufficient exercise,

indigestion, hemorrhages, wasting diseases, in fact, any thing which

impoverishes the blood and increases the relative amount of serum. The

tardy circulation of blood in the veins, or its obstruction in any way,

is a condition highly favorable to the development of dropsy.

General dropsy is called _anasarca_, and is readily distinguished by

bloating or puffiness of the skin all over the body. This condition is

also called _oedema_. The skin is pale, yields under the finger without

pain, and preserves the impression for some time. The oedema usually

appears first in the lower extremities, next in the face, and from

thence extends over the body.

General dropsy is commonly due to an impoverished condition of the

blood, and this may be the result of _albuminuria_, a disease of the

kidneys. Albuminuria is frequently the sequel of scarlatina. Hence, the

utmost care should be taken against exposure of a patient recovering

from scarlatina, and the same caution should be exercised during

convalescence from measles, erysipelas, and rheumatism. Dropsies may be

general, as in anasarca, or local, as dropsy of the heart, called

_cardiac_ dropsy: dropsy of the peritoneum, the serous membrane which

lines the abdominal cavity, called _ascites_; dropsy of the chest,

called _hydrothorax_; dropsy of the head, called _hydrocephalus_; dropsy

of the scrotum, called _hydrocele_.

Dropsy is not, therefore, of itself a disease, but only the symptom of a

morbid condition of the blood, kidneys, liver, or heart. Thus disease of

the valves of the heart, may obstruct the free flow of blood and thus

retard its circulution. In consequence the pulse grows small and weak,

and the patient cannot exercise or labor as usual, and finally the lower

limbs begin to swell, then the face and body, the skin looks dusky, the

appetite is impaired, the kidneys become diseased, there is difficulty

in breathing, and the patient, it is said, dies of dropsy, yet dropsy

was the result of a disease of the heart, which retarded the circulation

and enfeebled the system, and which was actually the primary cause of

death.

TREATMENT. Dropsy being only a symptom of various morbid conditions

existing in the system, any treatment to be radically beneficial must,

therefore, have reference to the diseased conditions upon which the

dropsical effusion, in each individual case, depends. These are so

various, and frequently so obscure, as to require the best diagnostic

skill possessed by the experienced specialist, to detect them. There

are, however, a few general principles which are applicable to the

treatment of nearly all cases of dropsy. Nutritious diet, frequent

alkaline baths to keep the skin in good condition and favor excretion

through its pores, and a general hygienic regulation of the daily

habits, are of the greatest importance. There are also a few general

remedies which may prove more or less beneficial in nearly all cases. We

refer to diuretics and hydragogue cathartics. The object sought in the

administration of these is the evacuation of the accumulated fluids

through the kidneys and bowels, thus giving relief. Of the diuretics,

queen of the meadow, buchu, and digitalis generally operate well. As a

cathartic, the Purgative Pellets accompanied with a teaspoonful or two

of cream of tartar, will prove serviceable. Beyond these general

principles of treatment it would be useless for us to attempt to advise

the invalid suffering from any one of the many forms of dropsy. The

specialist skilled by large experience in detecting the exact morbid

condition which causes the watery effusion and accumulation, can select

his remedies to meet the peculiar indications presented by each

individual case. Sometimes the removal of the watery accumulation by

tapping becomes necessary, in order to afford relief and give time for

remedies to act. We have found it necessary to perform this operation

very frequently in cases of _hydrocele_, and also quite often in cases

of abdominal dropsy. The chest has also been tapped and considerable

quantities of fluids drawn off, and this has been followed by prompt

improvement and a final cure.

CASES TREATED.

CASE I. A Canadian gentleman, aged 68, applied at the Invalids

Hotel and Surgical Institute, for examination and treatment.

He had been dropsical for over two years, and had become so

badly affected as to be unable to lie down at night. His legs

were so filled with water and enlarged as to render it almost

impossible for him to walk, and there was a general anasarca.

The least exertion was attended with the greatest difficulty

of breathing. He had been under the treatment of several

eminent general practitioners of medicine in Canada but found

no relief. They were unable to discover the real cause of his

ailment, but to the specialist who has charge of this class of

diseases at our institution, and who annually examines and

treats hundreds of such cases, it was at once apparent that

the dropsy was caused from a weakened condition of the heart,

which rendered it unable to perform its functions. He was put

upon a tonic and alterative course of treatment, which also

embraced the use of such medicines as have been found to exert

a specific, tonic action upon the muscular tissues of the

heart. He improved so rapidly that in less than two months he

was able to lie down and sleep soundly all night. The bloating

disappeared, his strength improved, and in three month's more

he was discharged perfectly cured.

CASE II. A man aged 42, consulted us by letter, stating that

he was troubled with general bloating which had made its

appearance gradually and was attended by general debility and

other symptoms which have been enumerated as common to general

dropsy. He had been under the treatment of several home

physicians without receiving any benefit; he had steadily

grown worse until he felt satisfied that if he did not soon

get relief he could not live very long. He was requested to

send a sample of his urine for examination, as we had

suspicions, from the symptoms which he gave, that the cause of

his dropsy was _albuminuria_, or Bright's disease of the

kidneys. On examination of the urine, albumen in very

perceptible quantities was found to be present. We had, about

this time, come into possession of a remedy said by very good

authority, to be a specific in degeneration of the kidneys

when not too far advanced, and we determined to test it upon

this well-marked case. We accordingly prescribed it, together

with other proper tonics and alteratives, at the same time

giving the patient important hygienic advice, which must be

complied with if success is attained in the management of this

very fatal malady. Our patient gradually improved, and in a

few months' time was restored to perfect health, which he has

continued to enjoy ever since. From our subsequent experience,

embracing the treatment of quite a large number of cases of

Bright's disease of the kidneys, we are satisfied that it is,

in its early stage, quite amenable to treatment.

CASE III. A man aged 35, single, consulted us for what he

supposed to be enlargement of the testicles. The scrotum was

as large as his head, and it was with difficulty that he could

conceal the deformity from general observation. The disease

was immediately recognized by the attending surgeon as

hydrocele. The liquid was promptly drawn oft by tapping, and a

stimulating injection was made into the scrotum to prevent

re-accumulation. We mention this case only because it is one

among a very large number who have consulted us supposing that

they were suffering from enlargement of the testicles, cancer,

or some other morbid growth within the scrotum, when a slight

examination has shown the affection to be hydrocele, a disease

which is speedily cured by tapping, with a little after

treatment. The operation is perfectly safe and almost entirely

painless.

CASE IV. A lady, aged 24, consulted us by letter enumerating a

long list of symptoms which clearly indicated abdominal

dropsy, resulting from suppression of the menses. A

well-regulated, hygienic treatment was advised, and medicines

to restore the menstrual function by gradually toning up and

regulating the whole system, were forwarded to her by express.

After four months' treatment, perfect recovery resulted. Cases

like this latter are very common and generally yield quite

readily to proper management. No harsh or forcing treatment

for restoring the menstrual function should be employed, as it

will not only fail to accomplish the object sought, but it is

also sure to seriously and irreparably injure the system. The

most difficult cases which we have had to deal with, have been

those which had been subjected by other physicians to the

administration of strong emmenagogues in the vain effort to

bring on the menses.

RHEUMATISM.

Prominent among constitutional diseases is the one known as

_rheumatism_. It is characterized by certain local symptoms or

manifestations in fibrous tissues. This term has been applied to

neuralgic affections and to _gout_, but it differs from each in several

essential particulars. Rheumatism may be divided into (1) _Acute_, (2)

_Chronic_, (3) _Muscular_.

ACUTE ARTICULAR RHEUMATISM. Acute articular rheumatism implies an

affection of the articulations or joints. It usually commences suddenly;

sometimes pain or soreness in the joints precedes the disclosure of the

disease. The symptoms are pain in the joints, tenderness, increased

heat, swelling and redness of the skin. The pain varies in its intensity

in different oases, and is increased by the movement of the affected

parts. Swelling of the joints occurs, especially those of the knee,

ankle, wrist, elbow, and the smaller joints of the hands and feet. The

swelling and redness are generally in proportion to the acuteness of the

attack. Acute articular rheumatism is always accompanied with more or

less fever. Sweating is generally a prominent symptom, being strongly

acid and more profuse during the night. The appetite is impaired, the

tongue is coated, the bowels are constipated, or there is diarrhea.

THE DURATION OF THIS DISEASE. Unlike fevers, its course is marked by

fluctuations; frequently after a few days the pain subsides, the fever

disappears, and convalescence is apparently established, when, suddenly,

all the symptoms are renewed with even greater intensity than before.

This disease rarely proves fatal, unless the heart is involved.

CAUSES. Rheumatism is frequently supposed to be occasioned by a

suppression of the functions of the skin, and is generally attributed to

the action of cold upon the surface of the body. But this acts only as

an exciting cause. It is a disease of the blood. This form of rheumatism

usually occurs between the age of fifteen and thirty, and prevails most

extensively in changeable climates. Acute articular rheumatism seldom

terminates in the chronic form.

CHRONIC ARTICULAR RHEUMATISM. Articular rheumatism, in the subacute or

chronic form, is frequently observed in medical practice. The symptoms

are pain and more or less swelling of the joints, although not of as

grave a character as in acute rheumatism. There is frequently an absence

of increased heat and redness. As in the acute form, the different

joints are liable to be affected successively and irregularly, until,

after a time, the disease becomes fixed in a single joint, and the

fibrous tissues entering into the ligaments and tendons are liable to be

affected. The appetite, digestion, and nutrition are often good, and, in

mild cases, patients are able to pursue their daily vocations. The

disease is supposed to be the same as in the acute form, but milder,

and, strange to say, more persistent. A diseased condition of the blood

is supposed to be involved in both instances, but this morbid state is

less extended, and, at the same time, more obstinate in the chronic than

in the acute form. Sub-acute articular rheumatism is not always chronic,

and may disappear in a shorter time than in the acute form. Chronic

articular rheumatism is not generally fatal, but there is danger of

permanent deformities.

MUSCULAR RHEUMATISM. This affection is closely allied to _neuralgia_,

and may properly be called _myalgia_. It exists under two forms, acute

and chronic. In acute muscular rheumatism, there is at first a dull pain

in the muscles, which gradually increases. When the affected muscles are

not used the pain is slight, and certain positions may be assumed

without inducing it constantly; but in movements which involve

contraction of the muscles the pain is very violent. In some cases, the

disease is movable, changing from one muscle to another, but usually it

remains fixed in the muscle first attacked. The appetite and digestion

are not often impaired, and there is no fever. The duration of this form

of rheumatism varies from a few hours to a week or more.

In subacute or chronic muscular rheumatism, pain is excited only when

the affected muscles are contracted with unusual force, and then it is

similar to that experienced in the acute form. The chronic form is more

apt to change its position than the acute. The duration of this form is

indefinite. In both the acute and chronic forms some particular parts of

the body are more subject to the affection than others.

The muscles on the posterior part of the _neck_ are subject to rheumatic

affection. It is termed _torticollis_ or _cervical_ rheumatism in such

cases, and should be distinguished from ordinary neuralgia. When the

muscles of the loins are affected, it is commonly known as _lumbago_. In

case the thoracic muscles are affected, it is known as _pleurodynia_. In

coughing, sneezing, and the like, the pain produced is not unlike that

in pleuritis and intercostal neuralgia.

One of the most marked features of muscular rheumatism, is the

cramp-like pain, induced by the movements of the affected muscles,

whereas the pain is slight when those muscles are uncontracted. This

feature is very serviceable in distinguishing muscular rheumatism, or

myalgia, from neuralgic affections. Another trait which distinguishes

muscular rheumatism from neuralgia, is that the former is characterized

by great soreness, while the latter is not. There is also a distinction

between inflammation of the muscles and muscular rheumatism. In the case

of the former, there is continued pain, swelling of the parts,

occasional redness, and the presence of more or less fever, which

conditions do not exist in the latter. Persons subject to rheumatism of

the muscles, are apt to suffer from an attack, after exposure of the

body to a draught of air during sleep, or when in a state of

perspiration.

TREATMENT OF ACUTE RHEUMATISM. Administer the spirit vapor-bath to

produce free perspiration, which should be maintained by full doses of

the Compound Extract of Smart-weed. The anodyne properties of the latter

also prove very valuable in allaying the pain. Tincture or fluid extract

of aconite root may also be employed, to assist in equalizing the

circulation, and also to secure its anodyne action. Black cohosh seems

to exert a specific and salutary influence in this disease, and the

tincture or fluid extract of the root of this plant may be

advantageously combined with the aconite. Take fluid extract of

aconite-root, thirty drops; fluid extract of black cohosh, one drachm;

water, fifteen teaspoonfuls; mix. The dose is one teaspoonful every

hour. The whole person should be frequently bathed with warm water,

rendered alkaline by the addition of saleratus or soda. The painful

joints may be packed with wool or with cloths wrung from the hot

saleratus water, and the patient kept warm and quiet in bed. The acetate

of potash taken in doses of five grains, well diluted with water, every

three or four hours, is very valuable in acute rheumatism. Its alkaline

qualities tend to neutralize the acid condition of the fluids of the

system, and it also possesses diuretic properties which act upon the

kidneys, removing the offending blood-poison from the system through

these organs. If the joints are very painful, cloths wet with the

Compound Extract of Smart-weed and applied to them, and covered with hot

fomentations, very frequently relieve the suffering. The majority of

cases yield quite promptly to the course of treatment already advised,

if it is persevered in. The disease, however, sometimes proves obstinate

and resists for many days the best treatment yet known to the medical

profession.

TREATMENT OF CHRONIC RHEUMATISM. The general alkaline baths recommended

in the acute affection are also valuable in the chronic. The spirit

vapor-bath, the Turkish, as well as the sulphur vapor-bath, are all

worthy of a trial in this obstinate and painful disease. Alternatives

are a very valuable class of agents in chronic rheumatism. The following

mixture, in teaspoonful doses three times a day, in alternation with the

Golden Medical Discovery, has proved very successful in this disease:

acetate of potash, one ounce; fluid extract of black cohosh, one ounce;

fluid extract of poison hemlock, two drachms; simple syrup, six ounces.

This thorough alterative course, if well persevered in, together with

the use of alkaline and vapor-baths, will generally prove very

successful. The specialist, however, dealing with chronic diseases

exclusively, will occasionally meet with a case which has been the

rounds of the home physicians without benefit, that will tax his skill

and require the exercise of all his perceptive faculties to determine

the exact condition of the patient's system, upon which the obstinacy of

the disease depends. When this is ascertained, the remedies will

naturally suggest themselves, and the malady will generally yield to

them. But, although the treatment of this disease has entered largely

into our practice at the Invalid's Hotel, and has been attended by the

most happy results, yet the cases have presented so great a diversity of

abnormal features, and have required so many variations in the course of

treatment, to be met successfully, that we frankly acknowledge our

inability to so instruct the unprofessional reader as to enable him to

detect the various systemic faults common to this ever-varying disease,

and adjust remedies to them, so as to make the treatment uniformly

successful. If the several plans of treatment which we have given do not

conquer the disease, we can not better advise the invalid than to

recommend him to employ a physician of well-known skill in the treatment

of chronic diseases. If such a one is not accessible for personal

consultation, a careful statement of all the prominent symptoms, in

writing, may be forwarded to a specialist of large experience in this

disease, who will readily detect the real fault, in which the ailment

has its foundation. Particularly easy will it be for him to do so, if he

be an expert in the analysis of urine. A vial of that which is first

passed in the morning, should be sent with the history of the case, as

chronic rheumatism effects characteristic changes in this excretion,

which clearly and unmistakably indicate the abnormal condition of the

fluids of the body upon which the disease depends.

* * * * *

DISEASES OF THE SKIN.

ECZEMATOUS AFFECTIONS.

Eczematous affections constitute a very important class of skin

diseases, the prominent characteristics of which are _eruption_ and

_itching_. They are progressive in character, passing through all the

successive stages of development, from mere redness of the skin to

desquamation, or thickening of the cuticle. The affections belonging to

this group are _eczema, psoriasis, pityriasis, lichen, impetigo, gutta

rosacea,_ and _scabies_, or _itch_. A careful examination of each of

these diseases shows it to be a modified form of eczema, and, therefore,

they demand similar treatment.

ECZEMA. (_Humid Tetter, Salt-rheum, Running Scall_, or _Heat Eruption_.)

The term _eczema_ is used to designate the commonest kind of skin

diseases.

In this disease, the minute blood-vessels are congested causing the skin

to be more vascular and redder than in its natural state. There is an

itching or smarting in the affected parts. The skin is raised in the

form of little pimples or vesicles, and a watery lymph exudes. Sometimes

the skin becomes detached and is replaced by a crust of hardened lymph,

or it may be partially reproduced, forming _squamæ_, or scales. There

are three stages of this disease; the inflammatory, accompanied by

swelling, and the formation of pimples or vesicles; that of exudation,

which is succeeded by incrustation; and that of desquamation, in which

the skin separates in little scales and sometimes becomes thickened.

Rarely, if ever, does the disease pass through these successive stages,

but it is modified by its location and the temperament of the patient.

The many varieties of eczema are designated according to their

predominating characteristics. Thus, when pimples or vesicles are

abundant, it is termed, respectively, _eczema papulosum_ and _eczema

vesiculosum,_ a fine illustration of which may be seen in Colored Plate

I, Fig. 1. Again, when characterized by the eruption of pustules, it is

termed _eczema pustulosum_, a representation of which may be seen in

Plate I, Fig. 2; and, when the prominent feature is the formation of

scales, it is termed _eczema squamosum_.

Eczema may be general or partial; in other words, the eruption may

appear in patches or be distributed over the entire surface of the body.

The latter form often appears in infants, but rarely occurs in adults.

Two or more varieties of the eruption may be associated, or one form may

gradually develop into another.

[Illustration: Plate I.

Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5.]

Infants and young children are peculiarly subject to this disorder, and,

if the disease be not promptly arrested, it will assume the severest

form and eventually become chronic. The muscles are soft, the eyes are

dull and expressionless, and the little sufferer experiences the most

excruciating torments. Frequently the whole body is covered with patches

of eczema, the secretions are arrested, and, where the scales fall off,

the skin is left dry and feverish.

Eczema has no symptoms proper, since the morbid feelings are due to

constitutional debility, of which eczema is the result. The _signs_ of

eczema are redness, heat, an itching or smarting sensation, the

formation of pimples or vesicles, exudation, incrustation, the

separation of the cuticle into scales and a gradual thickening of the

skin.

CAUSES. Three forms of constitutional derangement predispose the system

to eczema; nutritive, assimilative, and nervous debility. In the former,

there is a diminution of nutritive power, so that the patient becomes

weak and emaciated. Assimilative debility is indicated by an impaired

digestion and a consequent suppression, or an abnormal state of the

secretions. Eczema occasioned by nervous debility, is accompanied by all

the morbid conditions incident to irritation and exhaustion of the

nervous system. Eczema may be excited by a violation of the rules of

hygiene, as undue exposure, or sudden transition from heat to cold,

deficient or excessive exercise, impure air, or improper clothing.

PSORIASIS. Psoriasis may be defined as a _chronic form of eczema_. The

transition of the last stage of eczema into psoriasis is indicated by a

tendency of the inflamed, thickened, scaly skin to become moist when

rubbed. It usually appears in patches on various portions of the body.

The skin is parched and highly discolored. The hairs are harsh and

scanty. The patient is constantly tormented by an unbearable itching

sensation and, if the skin is rubbed, it exudes a viscous or sticky

fluid. These are the characteristic signs of psoriasis. It generally

appears on the flexures, folds and crooks of the joints, the backs and

palms of the hands, the arms, and the lower portions of the legs.

PITYRIASIS. (_Branny Tetter_, or _Dandruff_.) This affection is a mild

form of psoriasis, from which it may be distinguished by a more

superficial congestion or inflammation of the affected parts, the

absence of swelling, and the formation of smaller scales, having the

form and appearance of _fine bran_. It generally appears on the scalp,

sometimes extends over the face, and, in rare instances, affects the

entire surface of the body. The signs peculiar to this disease are

slight inflammation, itching, and the formation of minute scales.

CAUSES. Pityriasis is caused by nutritive debility, and is often

associated with erysipelas, rheumatism, and bronchitis.

LICHEN. (_Papular Rash_.) Lichen is a term used to designate an eruption

of minute conical pimples, which are more or less transparent, red, and

occasion great annoyance. The eruption is attended with a severe, hot,

prickling sensation, as if the flesh were punctured with hot needles.

The pimples contain no pus, but if opened, they exude a small quantity

of blood and serum. This disease more frequently occurs between the ages

of twelve and fifty, but occasionally appears during dentition, when it

is called "tooth rash." The lichen pimples are sometimes dispersed

singly over the skin and gradually subside, forming a minute scale,

corresponding in position with the summit of the pimple. When the

pimples appear in clusters, there is a diffused redness in the affected

part, and, if they are irritated, minute scabs will be formed. Lichen

generally appears on the upper portion of the body, as on the face,

arms, hands, back, and chest.

The various forms of lichen are designated according to their causes,

signs, location, manner of distribution, and the form of the pimples.

_Lichen Simplex_ is the simplest form of this disorder, and is indicated

by the appearance of minute pimples, which, when the distribution is

general, are arranged like the blotches of measles. Sometimes the

eruption is local and bounded by the limits of an article of clothing,

as at the waist. In eight or ten days, the cuticle separates into minute

scales, which are detached and thrown off; but a new crop of pimples

soon appears and runs the same course, only to be succeeded by another,

and thus the affection continues for months and even years.

_Lichen circumscriptus_ is an aggravated form of _lichen simplex_, and

is characterized by a circular arrangement of the pimples. The

circumference which marks the limit of the patch is sharply defined.

This form of lichen usually appears on the chest, hips, or limbs, and is

not unfrequently mistaken for ringworm.

_Lichen strophulosus_ is a variety peculiar to infants. Dermatologists

recognize several subdivisions of this species, but the general

characteristics are the same in all. The pimples are much larger than in

the other forms of lichen, of a vivid red color and the duration of the

eruption is limited to two or three weeks.

_Lichen urticatus_ is also an infantile affection and begins with

inflammation, which is soon succeeded by the eruption. In a few days the

pimples shrink, the redness disappears, and the skin has a peculiar

bleached appearance. The eruption is attended by an intense itching

sensation and, if the skin is ruptured, a small quantity of blood is

discharged and a black scab formed. This variety of lichen is very

obstinate and of long duration.

_Lichen tropicus_, popularly known as _prickly heat_, is an affection

which attacks Europeans in hot climates. It is characterized by the

appearance of numerous red pimples of an irregular form, distributed

over those portions of the body usually covered by the clothing. It is

attended with a fierce, burning, itching sensation, which is aggravated

by warm drinks, friction of the clothing, and the heat of the bed. The

eruption indicates a healthy condition of the system; its suppression or

retrocession is an unfavorable symptom, denoting some internal affection

such as deranged nutrition.

[Illustration: Plate II.

Fig. 6. Fig. 7.

Fig. 8. Fig. 9.

Fig. 10. Fig. 11.

Fig. 12. Fig. 13.]

In _lichen planus_, as the term indicates, the pimples are flattened.

There is no sensation of itching or formation of scabs. The pimples are

solitary and have an angular base, and the fresh pimples formed appear

on the spaces between the former eruptions. This affection usually

attacks some particular region, such as the abdomen, hips, or chest.

Instances are recorded in which it has appeared on the tongue and the

lining membrane of the mouth. Sometimes it appears in patches, but even

then, the margin of each pimple can be discerned.

_Lichen pilaris_ and _lividus_ are modifications of lichen simplex, the

former being so named to describe the location of the pimples, _i.e._,

surrounding the minute hairs which cover the body, especially the lower

limbs. The term _lichen lividus_ indicates the dark purplish hue caused

by a torpid circulation and the consequent change of arterial into

venous blood before leaving the pimples. _Lichen circinatus_ is a

modified form of _lichen circumspectus_. The pimples in the center of

the circular patch subside and a ring is formed which gradually

increases in size. When the rings become broken or extend in regular

forms, the affection is termed _lichen gyratus_.

CAUSES. Constitutional debility predisposes the system to this eruption.

The exciting causes are irritation of the skin, strumous diathesis,

dentition, and any violation of hygienic rules. Although lichen is not a

fatal disease, yet it tends to reduce the vitality of the system.

IMPETIGO. (_Crusted Tetter_ or _Scall_.) Impetigo is a term applied to

an inflammation of the skin, more severe and energetic in its character

than the preceding affection. We have found the predominating

characteristics of eczema and lichen to be the presence of exudation in

the former, and the absence of it in the latter.

Impetigo is marked by the formation of yellow pus, which raises the

cuticle into pustules. There is a slight swelling, redness, and the pus

gradually dries up, forming an amber-colored crust, a representation of

which is given in Colored Plate I, Fig. 5. It soon falls, leaving the

skin slightly inflammed, but with no scar. The pustules are sometimes

surrounded by a cluster of smaller ones.

The varieties of impetigo are designated according to the distribution

of the pustules. _Impetigo figurata_, is characterized by the appearance

of large clusters upon an inflamed and swollen surface, generally upon

the face, but sometimes upon the scalp. This form is represented in

Colored Plate I, Fig. 4. In _impetigo sparsa_ the pustules are scattered

over the whole body.

CAUSES. The predisposing cause of impetigo is nutritive debility, and

the exciting causes are irritation, impure air, and errors of diet.

GUTTA ROSACEA is a _progressive_ disease, and its successive stages of

development mark the several varieties, such as _gutta rosacea,

erythematosa, papulosa, tuberculosa, pustulosa_, according as they are

characterized by redness, pimples, tubercles, or pustules. This

affection is attended with heat, itching, and throbbing. The pustules

contain serous lymph, which exudes if the cuticle be broken, and forms a

crust at the summit of the pustule.

This eruption often appears on the face of persons addicted to

intemperate habits, and has thus received the name of "_rum blossom_."

CAUSE. It is essentially a chronic affection, and depends upon

constitutional causes.

SCABIES. (_Itch_.) This disease is characterized by a profuse scaliness

of the skin, by an eruption of pimples, vesicles, and, in rare

instances, of pustules. Its prominent feature is an intense itching, so

aggravating that, in many instances, the skin is torn by the nails.

Unlike other diseases of the skin, it is not due to inflammation, but is

caused by animalculæ, or little parasites, termed by naturalists the

_acarus scabiei_. This minute animal burrows in the skin, irritating it,

and thus producing the scaliness and itching. The vesicles are

comparatively few in number, and contain a transparent fluid. The

pustules are only present in the severest forms or when the skin is very

thin and tender. It is then termed _pustular itch_.

The parts usually affected are the hands, flexures of the joints, and

the genital organs. Cases are recorded, in which scabies appeared upon

the face and head, but they are of rare occurrence. The activity of the

animalculæ, is modified by the vitality of the victim. In persons of a

vigorous constitution, they will rapidly multiply, and, in a few days

after their first appearance, will be found in almost every part of the

body.

Scabies is not confined to any age or sex, but chiefly affects persons

of filthy habits. This disease can only be communicated by contact, or

by articles of clothing worn by an infected person. There are certain

indications which predispose the system to infection, such as robust

health, a hot climate, and uncleanliness.

TREATMENT. In all the varieties of eczematous affections, except

scabies, the treatment of which will hereafter be separately considered,

remedies employed with a view to the removal of the constitutional fault

are of the greatest importance. The eruption upon the skin is but a

local manifestation of a functional fault, which must be overcome by

alterative remedies. All the excretory organs should be kept active. To

open the bowels, administer a full cathartic dose of Dr. Pierce's

Pleasant Pellets. Afterwards they should be used in broken doses of one

or two daily, in order to obtain their peculiar _alterative_ effects.

The use of Dr. Pierce's Golden Medical Discovery is also necessary to

secure its constitutional remedial benefits. As a local corrective to

relieve the itching and disagreeable dryness of the skin, add half an

ounce of blood-root to half a pint of vinegar, steep moderately for two

hours, strain and paint the affected parts once or twice daily with the

liquid. Every night before retiring, apply glycerine freely to all the

affected parts, or dissolve one drachm of oxalic acid in four ounces of

glycerine and anoint the skin freely. The white precipitate ointment,

obtainable at any drug store, is an excellent application is most forms

of eczema. A tea, or infusion, of black walnut leaves, applied as a

lotion to the affected parts, has also proved beneficial. The surface of

the body should be kept clean by frequent bathing, and thus stimulating

its capillary vessels to healthy activity. The eczematous surfaces

should not be bathed frequently, and never with harsh or irritating

soaps. All varieties of eczematous affections, except scabies, are only

temporarily relieved by external applications, while the _radical cure_

depends upon a protracted use of alterative, or blood-cleansing

medicines. Therefore, we would again remind the reader of the necessity

of keeping the bowels regular, and removing all morbid taints of the

blood and faults of the secretory organs by the persistent use of Dr.

Pierce's Golden Medical Discovery. _The successful treatment of

scabies_, or common itch, generally requires only local applications,

for the object to be obtained is simply the destruction of the little

insects which cause the eruption. Happily, we possess an _unfailing

specific_ for this purpose. Numerous agents have been employed with

success, but _Sulphur_ enjoys the greatest reputation for efficacy, and,

since it is perfectly harmless, we advise it for this class of disease.

Take a quantity of pulverized sulphur and mix with sufficient vaseline

or lard to form an ointment. Having first divested the body of clothing,

anoint it all over freely, and rub the ointment thoroughly into the

pores of the skin while standing before a hot fire. The application

should be made at night before retiring, and the patient should wear

woolen night-clothes or lie between woolen blankets. In the morning

after the application, the patient should take a warm bath, washing the

skin thoroughly and using _plenty of soap_. This treatment should be

repeated two or three times to be _certain_ of a _perfect eradication_

of the disease. After this course of treatment, the wearing apparel as

well as the bed-clothes should be thoroughly cleansed, as a precaution

against a return of the disease.

* * * * *

ERYTHEMATOUS AFFECTIONS.

The prominent features, eruption, and itching of _eczematous_ affections

are purely local. _Erythematous_ affections are, however, remarkable for

their symptoms of constitutional disorder. Each of these affections is

preceded by intense febrile excitement and nervous debility. In brief,

the local manifestations are simply signs of general internal disorders;

hence, the treatment should be directed to the restoration of the

system. This group includes _erythema, erysipelas_, and _urticaria_.

ERYTHEMA. A vivid and partial flushing of the face is produced by a

superficial inflammation of the skin, termed _erythema_. There are many

stages of this disease, from the instantaneous transient flush caused by

emotional excitement, to the protracted inflammation and swelling of

_erythema nodosum_.

The affection is characterized by a flush which is at first a bright

vivid scarlet, but which changes to a deep purplish tint. There is a

slight elevation of the skin, sometimes accompanied by itching. In the

second stage of development, the flush subsides, the skin has a

yellowish or bruised appearance, and a few minute scales are formed. In

_erythema papulosum_, a fine representation of which is given in Colored

Plate III, Fig. 18, there is an eruption of red pimples or pustules. The

prominent feature of _erythema nodosum_, a variety of erythema which

affects those portions of the skin exposed to the sun, is the appearance

of a large swelling, usually lasting four or five days and attended by

constitutional symptoms, such as nausea, fever, languor, and

despondency. The disease is associated with the symptoms incident to a

disordered nervous system and sometimes results fatally, in other cases,

it terminates in melancholy and mania.

CAUSES. The predisposing causes of erythema are constitutional debility,

changes of climate and temperature, and irritating food or medicines.

Locally, it may be produced by friction and the heat of the sun.

[Illustration: Plate III.

Fig. 14.

Fig. 15.

Fig. 16.

Fig. 20.

Fig. 17.

Fig. 19.

Fig. 18.]

ERYSIPELAS. There are few adult persons in this country who have not, by

observation or experience, become somewhat familiar with this disease.

Its manifestations are both constitutional and local, and their

intensity varies exceedingly in different cases. The constitutional

symptoms are usually the first to appear, and are of a febrile

character. A distinct chill, attended by nausea and general derangement

of the stomach is experienced, followed by febrile symptoms more or less

severe. There are wandering pains in the body and sometimes a passive

delirium exists. Simultaneously with these symptoms the local

manifestations of the disease appear. A red spot develops on the face

the ear, or other part of the person. Its boundary is clearly marked and

the affected portion slightly raised above the surrounding surface. It

is characterized by a burning pain and is very sensitive to the touch.

It is not necessary for the information of the general reader that we

should draw a distinction between the different varieties of this

malady. The distinctions made are founded chiefly upon the _depth_ to

which the morbid condition extends, and not on any difference in the

_nature of the affection_.

Suppuration of the tissues involved is common in the severer forms.

Should the tongue become dark and diarrhea set in, attended with great

prostration, the case is very serious, and energetic means should be

employed to save life. A retrocession of the inflammation from the

surface to a vital organ is an extremely dangerous symptom.

The disease is not regarded as contagious, but has been known to become

epidemic.

URTICARIA. (_Hives, or Nettle-Rash._) This word is derived from

_urtica_, signifying a nettle; it is a transient affection of the skin,

indicated by a fierce, burning, itching sensation and a development of

pustules, or white blotches of various forms. A representation of this

eruption is given in Colored Plate III, Fig. 17. It is appropriately

named nettle-rash, from its resemblance to the irritation caused by the

sting of a nettle. There is the same sharp, tingling sensation and a

similar white wheal or blotch, caused by the muscular spasm of the

corium, a layer of the skin.

Urticaria may be either acute or chronic. Acute urticaria is always

preceded by febrile symptoms and the attack is indicated by a sudden

congestion of the skin, followed by a slight swelling or elevation of

the affected part. When the congestion subsides, the skin has a bruised

appearance. In chronic urticaria, the febrile symptoms are absent.

CAUSES. The exciting causes of urticaria are gastric disorder,

irritation of the mucous membrane, or a sudden nervous shock. The

predisposing causes are conceded to be assimilative and nervous

debility. Hence, it frequently accompanies purpura or land scurvy and

rheumatism. The skin in some persons is so susceptible to irritation

that urticaria can be kindled at any moment by excitement, as an

animated conversation, or by the simple pressure of the hand.

TREATMENT. The proper treatment for simple erythema consists in applying

to the affected parts a little lime-water, or sweet-oil, or glycerine,

with the use of warm baths and mild cathartics. This is generally

sufficient to effect a cure, if followed up with the persistent use of

Dr. Pierce's Golden Medical Discovery taken three times a day.

In _erysipelas_ a hot bath, with warm, sweating teas, or, better still.

Dr. Pierce's Compound Extract of Smart-weed may be given to favor

sweating. The whole person should be frequently bathed with warm water

rendered alkaline by the addition of saleratus or soda. The whole should

be moved by a full dose of the "Pleasant Pellets." Fluid extract of

veratrum viride, in doses of a drop or two every hour will best control

the fever. The specific treatment, that which antidotes the poison in

the blood, consists in administering fifteen-drop doses of the tincture

of the muriate of iron in one teaspoonful of the "Golden Medical

Discovery," every three hours. As a local application, the inflamed

surface may be covered with cloths wet in the mucilage of slippery elm.

A preparation of equal parts of sweet oil and spirits of turpentine,

mixed and painted over the surface, is an application of great efficacy.

_For urticaria_, the "Pleasant Pellets" should be administered in

sufficient doses to move the bowels, the skin bathed with warm water

rendered alkaline by the addition of common baking soda or saleratus,

and, if there be any febrile symptoms, a little tincture of aconite or

veratrum may be administered in one drop doses once each hour. In the

chronic form of the disease, the diet should be light, unstimulating,

and easily digested, the skin kept clean by frequent bathing, and fresh

air and outdoor exercises freely taken. The somewhat protracted use of

Dr. Pierce's Golden Medical Discovery will result in the greatest

benefit in this form of disease.

BULLOUS AFFECTIONS.

The distinguishing feature of this group of cutaneous affections is the

formation of _bullæ_, or blebs, which are defined as "eminences of the

cuticle, containing a fluid."

HERPES is an inflammation of the skin in which the eruption appears in

patches of a circular form. On the second day, minute, transparent

vesicles appear and gradually develop, becoming opalescent. On the

succeeding days, they shrink and produce reddish brown scabs, which soon

become hard and fall off, leaving deep, purplish pits. In adults, these

vesicles sometimes terminate in painful ulcers, caused by an irritation

of the eruption. By some practitioners, herpes is regarded as a purely

nervous disorder, from the fact that it is frequently accompanied by

severe neuralgic pains. These pains are not _constant_, but

_occasional_, and do not appear at any definite stage of the disease.

Sometimes they precede and accompany the eruption. Other instances are

recorded in which they remained many years after the disease had

disappeared. The local and constant pain of herpes is a severe burning,

prickling, itching sensation, which remains after the scabs fall.

The three _general_ forms of this disease are _herpes zoster_,

_phlyctoenodes_ and _circinatus_.

In _herpes zoster_, or _shingles_, the clusters of vesicles encircle

one-half of the body, frequently at the waist; hence, it has received

the name of _zona_ or _girdle_. The vesicles often develop into bullæ,

and sometimes ulcerate. In _herpes phlyctoenodes_, the vesicles are

small, round, and irregularly distributed over the face, neck, arms, and

breast. This form is accompanied by febrile symptoms and offensive

excretions.

In _herpes circinatus_, or _ringworm_, the vesicles appear in circular

patches, or rings. This is the mildest form of herpes, and is not

attended by symptoms of constitutional disorder. The various forms of

herpes are represented in Colored Plate I, Fig. 3.

CAUSES. Herpes is not contagious. It is caused by vicissitudes of heat

and cold, violent emotions, excessive exertion, irritation of the skin,

and a general atony of the system.

MILIARIA is the name given to an eruption of vesicles which are larger

than those of eczema, but smaller than the bullæ of herpes. At first,

the serum contained in the vesicles is perfectly transparent, and

reflects the red tint of the underlying skin, hence the name _miliaria

rubra._ But gradually it becomes milky and opalescent, hence, the term

_miliaria alba_. The vesicles of miliaria are generally solitary, and

appear on those portions of the body most liable to become heated and to

perspire. The eruption is preceded by chills, languor, slight fever,

intense thirst, a sharp prickling sensation of the skin, and profuse

perspiration. The vesicles soon desiccate and are replaced by a new

crop.

CAUSES. Miliaria is almost universally an accompaniment of febrile

disease, and all disorders in which there occurs a profuse perspiration.

The causes to which it may be traced in each instance are improper diet,

impure air, burdensome clothing, or strong emotions.

PEMPHIGUS is a peculiar eruption which appears upon the limbs and

abdomen. The affected part is of a bright red color, and, in a few

hours, small vesicles appear containing a transparent fluid. The

vesicles soon develop into bullæ, entirely covering the inflamed

portion. The fluid becomes opaque and in a few hours escapes. The patch

is then covered with a yellow scab. Pemphigus may be either acute or

chronic. The acute form is subdivided according to the degree of

inflammation, as _pemphigus pompholyx_ in which it is severe, and

_pemphigus benignus,_ when it is mild. The bullæ of pemphigus are

illustrated in Colored Plate III, Fig. 19.

CAUSE. Pemphigus is always caused by a vitiated state of the system.

RUPIA is indicated by an eruption as large as a chestnut containing a

watery fluid, which desiccates into a yellowish-brown crust. A fine

representation of rupia vesicles in both stages of development, is given

in Colored Plate II, Fig. 13.

TREATMENT. In all forms of herpes, the administration of a small dose of

Dr. Pierce's Pleasant Pellets, with the use of his "Golden Medical

Discovery" in one to two teaspoonful doses three times a day, will be

followed by the happiest results. The skin should be kept clean by the

use of the sponge-bath, rendered alkaline by the addition of common

baking soda or saleratus. The portion of the body covered by the

eruption, should be bathed with a solution of sulphate of zinc, one

ounce to a pint of water.

Miliaria is generally associated with certain febrile diseases, and its

proper treatment consists in overcoming the febrile and other

constitutional symptoms which accompany the disease. A hot foot-bath and

small doses of tincture of aconite, say one drop in water each hour,

will suffice to remove the fever. If the stomach and bowels are in a

vitiated condition, as they are apt to be, a mild cathartic dose of

"Pellets" should be given.

_The treatment of pemphigus_ should consist in frequent alkaline

sponge-baths, and in covering the affected parts with poultices of

slippery elm, which should be kept moist with vinegar, The

constitutional treatment should embrace the persistent use of the

"Golden Medical Discovery." When the disease occurs in children, 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.

* * * * *

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]

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.]

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. ]

[Illustration: Fig. 4.

The osteotrite, for enlarging openings and cutting carious bone.]

[Illustration: 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.]

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.