WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--I had catarrh in the head for years, and trouble with my

left lung at the same time. You put so much faith in your remedies that

I concluded to try one bottle or two, and I derived much benefit

therefrom. I used up three bottles of Dr. Sage's Catarrh Remedy, five

bottles of your "Golden Medical Discovery," and in four months I was

myself again. I could not sleep on my left side, and now I can sleep and

eat heartily. So long as I have your medicines on hand I have no need of

a doctor; I do not think my house in order without them.

Yours truly,

A.H. Heard

A DEBT OF GRATITUDE.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: Prof. W. Hausner, Famous Mesmerist.]

_Gentlemen_--Some ten years ago I suffered untold agony from chronic

nasal catarrh. My family physician gave me up as incurable, and said I

must die. At this time I weighed 110 pounds. My case was such a bad one,

that every day, towards sunset, my voice would become so hoarse I could

barely speak above a whisper. In the morning my coughing and clearing of

my throat would almost strangle me. By the use of Dr. Sage's Catarrh

Remedy in three months I was a well man; the cure has been permanent,

and I now weigh 148 pounds.

Yours truly, PROF. W. HAUSNER,

Ithaca, Tompkins Co., N.Y.

CATARRH, DEAFNESS AND OTHER COMPLICATIONS.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: M.C. Weaver, Esq.]

_Gentlemen_--I take pleasure in announcing to you that I have been

greatly benefited by your medicines; my trouble began with nasal catarrh

and extended to my throat and ears; my bowels were inactive and my

general health became impaired; my worst trouble, however, was dullness

of hearing. I had an uncomfortable, bad feeling in my ears--akin to

earache; I had a watery discharge from the nose; I had to hawk and spit

a great deal at times; my mind was greatly affected also and had a great

deal of pain in the head. Upon advice of friends to try your medicines I

resolved to do so. Have used six bottles of your "Golden Medical

Discovery" and two bottles of Sage's Catarrh Remedy. The pain in my head

is gone and my health is greatly improved and am working every day,

something I could not do before. My appetite is good.

Yours truly,

MORRIS C. WEAVER,

No. 171 E. Genesee St., Buffalo, N.Y.

BRONCHIAL DISEASE.

Clifford, Susquehanna Co., Penna.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--The doctors said I had bronchitis, and I doctored with five

different physicians before taking your medicines. My throat would bleed

from three to five times a day--half a dozen mouthfuls perhaps--as fresh

as if you had cut your finger, and I was in a generally weakened state

although able to be about the house, but the least exertion would make

me tremble. Finally I purchased one of Dr. Pierce's Common Sense Medical

Advisers, and read it a good deal, and so was induced to take your

medicines. I took in all seven bottles of the "Golden Medical

Discovery," one of the "Favorite Prescription," and one bottle of Dr.

Sage's Catarrh Remedy, and some of the "Pellets," and they did

everything for me--more than anything else I ever tried. In about six

months' time I was well. Now, my throat does not trouble me unless I

take cold. It has been about six years since I took your medicines, and

I think they cured me.

I think there are no medicines equal to your medicines, and would

recommend them to all suffering ones.

Yours truly,

Mrs. Lewis Johnson

CATARRH.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: D. Miner, Esq.]

_Gentlemen_--I had the catarrh in the head for about fifteen years; my

head was always stopped up and I had pains almost constantly. My nose

would run, and stuff would fall into my throat whenever I would lie

down, and at other times it seemed dry and crusty, and then my head

would become stopped up and I would suffer again.

I used cubebs and glycerine for a long time; they only relieved me while

I was using them. I used several other kinds of stuff, but I received no

benefit from them. I had nearly given up in despair. At last I came

across one of your advertisements of Dr. Sage's Catarrh Remedy in one of

your Memorandum Books, and I thought I would try it. It is the grandest

thing on earth. I was thankful to God I found something at last to stop

my suffering. May God bless you, dear friends, for saving my life.

I used your medicine about eight weeks: it only took two bottles to cure

me sound and well after all the rest had failed.

Yours truly,

DAVID MINER,

Bridgeport, Marion Co., Ind.

CHRONIC NASAL CATARRH.

HALF A DOZEN BOTTLES OF DR. SAGE'S CATARRH REMEDY WITH DR. PIERCE'S

GOLDEN MEDICAL DISCOVERY CURES PERMANENTLY A BAD CASE OF CHRONIC NASAL

CATARRH.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, NO. 663 Main St., Buffalo, N.Y.:

[Illustration: N.M. Hodges.]

_Gentlemen_--I was suffering from chronic catarrh, and bought a

half-dozen bottles of your Dr. Sage's Catarrh Remedy, also some of Dr.

Pierce's Golden Medical Discovery to purify my blood and I am happy to

say I am permanently cured of that disease.

Years after this letter was written Mr. Hodges informs us that his cure

has remained permanent.

Yours truly,

N.M. HODGES,

Laketown, Rich Co., Utah.

CHRONIC NASAL CATARRH. STARTED WITH LA GRIPPE.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: E.W. Thomas, Esq.]

_Gentlemen_--I think it is time I reported my case to you, as it is five

months since I began using your medicines. I have taken five bottles of

Dr. Sage's Catarrh Remedy, and used it with Dr. Pierce's Golden Medical

Discovery. I have no signs of catarrh now, and can say I never felt

better in my life, then while taking your medicine. Two years later Mr.

Thomas says: I nave not been troubled with catarrh since taking the

"Catarrh Remedy." I am a tenor singer and my voice almost left me when I

had the catarrh but now my voice has come back. Yours respectfully,

E.W. THOMAS,

Box 18, Garden City, Miss.

CATARRH AND OTHER COMPLICATIONS.

North Berne, Fairfield Co., Ohio.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--My health is good. I am restored from weak eyes, weak

stomach, catarrh, also female trouble. I took two bottles of Dr.

Pierce's Golden Medical Discovery, one bottle of Dr. Sage's Catarrh

Remedy. It took wonderful effect. I have recommended your medicines a

great deal, and have done a great deal of work for you. I have been the

cause of selling quite a quantity of medicine in this county, and I will

do all I can for you.

Yours truly,

Sarah Campfield

CATARRH OF EIGHT YEARS' STANDING.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: E.M. Baily, Esq.]

_Gentlemen_--I write this to let you know that I am well of that disease

called catarrh of the head. Three years ago this fall I had catarrh in

its worst form, till from three gills to one and one-half pints of

corruption would be expectorated in twenty-four hours.

Then I noticed your advertisement. Six months after taking your

medicines I thought it too soon to tell you, but I can now say that my

money was well spent in buying your medicine, for it resulted in a

permanent cure. The catarrh was of eight years' standing.

Yours respectfully,

EDWARD M. BAILEY,

Taggart, Harrison Co., Mo.

DREADFUL COUGH. ABSCESS OF LUNG.

Brookeland, Sabine Co., Texas.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: F. Berryman, Jr.]

_Gentlemen_--Seven years ago I was on the verge of the grave, with what

the physician pronounced an abscess of the right lung. It lingered on

for three years. During that time my side discharged large quantities of

pus and I had a dreadful cough. I was so weak that I could not walk

fifty yards without being completely exhausted. I had taken every kind

of medicine that was recommended for similar maladies, such as cod liver

oil, sarsaparillas, iron tonic and syrup of hypophosphites, without any

relief. I was about discouraged when I commenced taking Dr. Pierce's

Golden Medical Discovery. I took six bottles and it completely restored

me to health. The discharge stopped from my side, and the cough has

ceased. I am now able to follow my profession, which is a teacher of

penmanship. I can walk ten miles any day without the least worry. If any

one doubts this statement they can write me and I will verify the above

statement.

Trusting that this may be the means of assisting some one else who is

suffering untold miseries, as I did before using the "G.M.D."

I am, fraternally thine,

F. Berryman, Jr.

CATARRHAL DEAFNESS.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: S.P. Gray, Esq.]

_Gentlemen_--I was nearly deaf on the right side of my head. I used

three or four bottles of Dr. Pierce's Golden Medical Discovery and four

bottles of Dr. Sage's Catarrh Remedy with the Nasal Douche, in the first

trial. Cold weather coming on I had to stop, as I could not use the

Injector in freezing weather, but I was greatly benefited. Along towards

spring I found it was coming back, from taking cold, and, after several

trials of other remedies, I again began the use of your medicines,

taking two bottles of the "Golden Medical Discovery" and three bottles

of Dr. Sage's Catarrh Remedy, and I feel safe in believing I am cured as

I feel no signs of its return. My health is very good for a man of 74

years of age and I am satisfied that Dr. Pierce's Medicines did it. I

recommend them whenever I have a chance.

Yours respectfully,

S.P. GRAY,

Graham, Nodaway Co., Mo.

BRONCHITIS. LIVER COMPLAINT.

318 E. 83rd St., New York City, N.Y.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--I am extremely sorry not to have informed you sooner of the

magnificent result I obtained from your most valuable medicines. When,

sometime ago, I consulted you in regard to my affliction, bronchitis, I

was indeed fearing the worst. But I had so much confidence in your

medicines, which I had previously used for colds and liver complaint

with good results, that I strictly followed your kind advice and

continued taking it until I was assured of perfect health. I took five

bottles of your Dr. Pierce's Golden Medical Discovery, using the

"Pellets" combined as directed, and _the effect was magical_. I am now

healthy and hearty. Heartily thanking you for your kind advice and

assistance, I remain, gentlemen.

Yours most respectfully,

Paolo Bedesing

LINGERING COUGH.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.

_Gentlemen_--I contracted a cough during the winter of 1889 and tried

many different kinds of cough medicines, but none did me any good. I at

last became alarmed, and wrote to Dr. R.V. Pierce to know if he could

prepare a medicine that would cure me, and I was advised to try his

"Golden Medical Discovery," which I did, and am glad to say that only

two bottles cured me after letting the cough run on from the winter of

1889 until the spring of 1893.

Yours respectfully,

MORGAN. C. LILLY,

Holston, Washington Co., Va.

NERVOUS DEBILITY AND CATARRH.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: Mrs. Hoffman.]

_Gentlemen_--I have enjoyed good health since I took your treatment. I

suffered intense agony for five months, and after taking one month's

medicine I found very much relief--so much I was surprised.

Many thanks for the good your medicines have done me, and my prayers are

that God may help you in your good work, and that you may live long and

prosper.

Yours respectfully,

MRS. ALICE HOFFMAN,

Box 183, Clarksville, Butler Co., Iowa.

NERVOUS DEBILITY AND CATARRH.

Big Piney, Pulaski Co., Mo.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--I was treated by you eleven years ago for nervous debility

and chronic catarrh of eight years' standing and of a very aggravated

nature. I was considered near my grave by many of my friends when I

commenced treatment.

I used eight months' special treatment, after while I used some 12 or 15

bottles of your Sage's Catarrh Remedy, and have had excellent health

ever since.

Yours truly,

B.P. Dake.

CURE OF DEAFNESS DUE TO CATARRH.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: T.J. Williams, Esq.]

_Gentlemen_--For several years I was troubled with catarrh and deafness

of the right ear--the hearing becoming more and more defective until I

could scarcely hear at all. There was a constant ringing, roaring noise

in my ear, and finally the disease assumed a very painful form.

The ear became very sensitive to the touch, and the pain and

inflammation extended into the eustachian tube and down into the throat.

I could scarcely sleep at night, and during the day I suffered

constantly.

I finally decided to consult Dr. Pierce, and acting under his advice, I

began the use of "Golden Medical Discovery" and Sage's Catarrh Remedy by

means of Dr. Pierce's Nasal Douche.

I soon began to improve and after using three bottles each of the above

named remedies the pain and soreness left my ear, my hearing returned

and I considered myself completely cured, and indeed there has been no

recurrence of the trouble since.

Sincerely yours, T.J. WILLIAMS,

Byrneville, Harrison Co., Ind.

ASTHMA AND CATARRH.

[Illustration: G. Berner, Esq.]

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--For some months I suffered from a shortness of breath and

dryness in the throat which usually came on at night, and these symptoms

gradually became aggravated until it was impossible for me to procure

enough sleep so that I could perform my daily duties about the farm.

Deriving no relief from such treatment as I was taking I came to your

Institution, was examined by your specialist, who pronounced my case

asthma, complicated with nasal catarrh. After using the special

medicines which he prepared for me for a few days I commenced to feel

better, the shortness of breath gradually disappearing; the paroxysms of

asthma were less frequent and not so severe.

After taking only two months' treatment I was completely restored to my

previous good health, and for five months it has not been necessary for

me to use any medicine, and I feel that I am perfectly well. I give you

this testimonial in order that others who are similarly afflicted may

know of your skill in treating cases of this nature, and seek relief

from your Institution.

Respectfully,

GOTTLIEB BERNER,

Cheektowaga, Erie Co., N.Y.

ASTHMA COMPLICATED WITH BRONCHITIS.

[Illustration: T.E. Stanton, Esq.]

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

_Gentlemen_--It is five weeks to-day since I was at your place for

medical treatment for a bronchial and asthmatic difficulty; it had got

so bad that it was hard work for me to breathe if I moved around any; I

have sat up many a night for when I laid down I could not get my breath.

I had six different doctors to aid me--all the good they did me was to

get my money. Can say, of a truth, that you have done mo more good than

all other doctors. One doctor said I would not live two years; that is

four years ago and I am yet alive. I am sure I am now on the safe road

to recovery with your treatment.

Yours, etc.,

T.E. STANTON,

Manlius, Onondaga Co., N.Y.

ASTHMA, OR PHTHISIC.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: A.F. Buttles.]

_Gentlemen_--In gratitude to yourselves as well as to give my fellow

sufferers the benefit of my experience I wish to say, that immediately

after receiving your courteous reply to my letter, describing the

difficulty in breathing after any extra exertion, I began taking Dr.

Pierce's Golden Medical Discovery, and before I had finished the first

bottle I was greatly relieved.

I have taken less than one-half dozen bottles, and although the disease

was of about three years' standing, I can now do as big a day's work as

any of my neighbors and as many of them, for all of which I am indebted

to the "Golden Medical Discovery."

Yours respectfully,

AVERY F. BUTTLES.

Norden, Keyapaha County, Nebr.

NASAL POLYPI.

WORLD'S DISPENSARY MEDICAL, ASSOCIATION, Buffalo, N.Y.:

[Illustration: G.H. Bailey, Esq.]

_Gentlemen_--It is with pleasure that I can testify to your skillful

operation in removing a number of nasal tumors.

I had been a great sufferer from acute headaches, caused by the tumors,

for years.

I cannot speak too highly of the benefit I received at your Institution

the two months I stayed with you. I feel sure of a permanent cure as I

do not have the headaches as formerly.

Yours respectfully,

GEORGE H. BAILEY,

Hinsdale, Cheshire Co., N.H.

ASTHMA CURED.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: Mrs. Kyker.]

Gentlemen--My wife was afflicted with asthma for twenty years: as she

grew older she grew worse. Her case was treated by three eminent

doctors, but all failed; they told me there was no cure for it.

Discouraged as I was, I resolved to try Dr. Pierce's Golden Medical

Discovery; she used five bottles and two vials of your "Pleasant

Pellets," which has made a permanent cure. She has gained twenty pounds

in weight since the cure was effected.

Yours truly,

D.R. KYKER,

English, Cocke Co., Tenn.

COMPLICATION OF DISEASES.

A GRATEFUL PATIENT'S WORDS OF PRAISE.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, 663 Main Street, Buffalo, N.Y.

[Illustration: W. Henkel, Esq. ]

_Gentlemen_--Having been in your Institution as a sufferer from two

distinct chronic diseases of years' standing, and having been placed

under the charge of your specialists, I was speedily relieved of my

afflictions. The Invalids' Hotel is a place as much like home as it is

possible for such an institution to be. The physicians and surgeons are

all expert specialists and thoroughly efficient; the nurses are very

competent, attentive and kind; and, in fact, the whole _personnel_ of

the Invalids' Hotel endeavor to do their best to make the patients feel

like being at home. I always felt while there as if I was one of the

family. I gladly recommend your Institution to all persons who are

afflicted with any kind of chronic disease, for from my own experience I

_know_ the professional staff will do all which they promise to do.

Please accept my thanks for the speedy benefits and perfect cure of my

diseases, and I think your Institution is worthy of the highest

endorsement.

Yours truly,

WILLIAM HENKEL,

No. 1917 Congress Street,

St. Louis, Mo.

LUNG TROUBLE.

WORLD'S DISPENSARY MEDICAL ASS'N, Buffalo, N.Y.:

[Illustration: Mrs. Sunderland.]

_Gentlemen_--When I commenced taking your medicines, eighteen months

ago, my health was completely broken down. At times I could not even

walk across the room, without pains in my chest. The doctor who attended

me said I had lung-trouble and that I would never be well again. At last

I concluded to try Dr. Pierce's medicines. I bought a bottle of "Golden

Medical Discovery," took it and soon commenced to feel a little better,

then you directed me to take both the "Golden Medical Discovery" and the

"Favorite Prescription," which I did. Altogether I have taken eighteen

bottles of "Golden Medical Discovery," twelve of the "Favorite

Prescription" and five vials of "Pellets." I am now almost entirely well

and do all my work without any pain whatever, and can _run_ with more

ease than I could formerly _walk_.

Yours truly,

MRS. CORA L. SUNDERLAND,

Chaneyville, Calvert Co., Md.

ASTHMA, OR PHTHISIC.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: Mrs. Owen.]

_Gentlemen_--For six or seven years I have been a great sufferer from

asthma, being for weeks so I had to sit in my chair night and day; and

to all people suffering with the disease, I am glad to recommend your

medicines of which I have taken only a few bottles. I now call myself

cured, for I have not had asthma for a long time.

Yours respectfully,

MRS. EMILY OWEN,

Hinsdale, Cheshire Co., N.H.

NERVOUS PROSTRATION FOLLOWING GRIP.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:

[Illustration: W.S. Nicholson, Esq.]

_Gentlemen_--In January of '90 took the "grippe," went to work before I

was well, was caught in a rain which gave me a very bad relapse,

resulting in lung fever and complete prostration; was on my bed two

months, and when I did get out, the strength to walk any more than just

a few rods did not come back. My family doctor and two prominent

physicians of Sioux City, did me no good. Late in the fall I got a

bottle of Dr. Pierce's Golden Medical Discovery, which quieted my

trembling nerves and gave me an appetite to eat. I then concluded to try

the Doctor, personally. Up to this time I was in a pitiable condition.

Sometimes I could not sleep until I felt almost wild, then sleep so much

I would be stupefied. I could not digest any food and my whole system

was wasting and failing fast. I doubt if any one who saw me expected me

to get well. I took the treatment sent me by the World's Dispensary

Medical Association for more than a year. The medicine never gave me any

distress as other medicines had done before. I began to improve from the

start, but the change from one extreme to the other was like the growth

of a child.

To any one suffering from nervous prostration I would say, "don't be

impatient." It takes a long time for weakened nerves to grow strong. I

have at last become strong and well, thanks to the Giver of all good and

the grand Institution at Buffalo. I nave since married a noble-hearted

young woman, and when I am playing with our sweet, healthy, baby girl, I

give way to the thought that at last the long, Bad chapter of my life is

ended; at such times her merry laugh sounds like a song of triumph of

life over death.

Gratefully yours,

W.S. NICHOLSON,

Willow Creek, Clay Co., Iowa.

* * * * *

DISEASES OF THE HEART.

Diseases of the heart are classified as either _functional_ or _organic_

We shall dwell only briefly upon purely _functional_ derangements of the

heart; as _increased_, or excited action, _defective_, or enfeebled

action, and _irregular_ action.

Increased action of the heart, indicated by palpitation, or increased

number of the beats, may be caused _mechanically_, as by distention of

the stomach, which, by preventing the descent of the diaphragm, excites

the action of this organ. Or it may be a _sympathetic_ disturbance

produced through the nervous system; thus the emotions and passions may

suddenly arouse the heart to excessive action; or the presence of worms

in the intestines, improper food, and masturbation, may be the cause.

The use of tea, tobacco, and alcoholic drinks excites the heart. We have

found that the excessive use of tobacco is very frequently the cause of

functional derangement of this organ. Deficiency of the blood, as in

anæmia, may be the cause of palpitation of the heart.

Functional disturbance of the heart's action is manifested by

palpitation, irregularity, intermissions, a rolling or tumbling

movement, and a feeling as if the heart were in the throat. These

symptoms often give rise to great apprehension, anxiety, fear, and

depression of mind.

TREATMENT. The curative treatment of functional derangement of the heart

must have reference to the causes producing it. If it is in consequence

of indigestion, the appetite and digestion should be improved by

observing regularity in the time of taking the meals, and eating very

easily-digested food. The use of strong tea, coffee, tobacco, and

spirits, should be interdicted, and regular exercise, rest, and sleep

should be enjoined.

In all cases, the domestic management should include daily bathing,

exercise in the open air, regular habits, and the avoidance of all

causes which tend to excite the heart's irregularity.

_The remedial treatment_ of these functional affections ought to be

confided to some experienced physician, as the remedies are not within

the ordinary reach of all families, nor if they were, would they have

sufficient experience and knowledge to select and properly administer

them.

ORGANIC DISEASE OF THE HEART.

By organic disease we mean disease pertaining to the structure of the

heart itself, in contradistinction to _functional_ disease, which has

reference merely to the _action_ of the heart. The heart is subject to

various organic diseases, but we have only space to consider, in the

briefest manner, those which are the most common. It is essential that

the reader should have some knowledge of the anatomy and functions of

the various parts of the heart in order that its diseases and their

effects may be comprehended; therefore the anatomy and physiology of

this organ, given in Part I, Chapter VII, of this work, should be

carefully studied.

It is very evident that any disease which affects the structure and

function of any part of the heart must, necessarily, give rise to

certain modifications of the pulse, sounds, etc. It is through the

observation and study of these modifications and changes that we arrive

at a correct diagnosis as to the precise location and character of the

disease.

[Illustration: Fig. 1.

Pond's Sphygmograph.]

Until within comparatively recent years, physicians were very much in

the dark regarding diseases of the heart. Now, however, with a thorough

knowledge of the anatomy, physiology, and pathology of the heart and the

parts surrounding it, and with the aid of instruments which modern

ingenuity has given us, we are able to diagnosticate with precision the

slightest lesions of any part of this important organ, and, knowing

their nature, to map out an appropriate course of treatment. With the

aid of the stethoscope, invented by Laennec and improved upon by Camman,

we are able to distinguish the slightest deviation from the normal

sounds, and, by noting the character of the sound, the time when it

occurs, the area over which It is heard most distinctly, and the

direction in which it is transmitted, to locate the lesion which

produces it. By the aid of the sphygmograph, first invented by

Herrisson, and afterward improved upon by Ludwig, Vierordt, Marey, and

lastly by Pond, of our own country, the pulsations at the wrist are

registered, and thus made perceptible to the eye.

We herewith give a cut, Fig. 1, of Pond's instrument, and two tracings

made by it. The first is a healthy tracing, and the second indicates

enlargement, technically called hypertrophy, of the heart

PERICARDITIS, or inflammation of the membranous sac which surrounds the

heart, may be either acute or chronic. The symptoms in acute

pericarditis are made up from co-existing affections, and are frequently

associated with articular rheumatism, Bright's disease of the kidneys,

or pleuritis The intensity of the pain varies in different individuals.

The action of the heart is increased, the pulse is quick, and vomiting

sometimes takes place. When this disease is developed in the course of

rheumatism, it is known as rheumatic pericarditis, and is almost always

associated with endocarditis. In some cases acute pericarditis is very

distressing, in others it is mild. The fatality is not due so much to

the disease itself, as to co-existing affections. When it does not prove

fatal, it sometimes becomes chronic.

In chronic pericarditis, pain is seldom present. The heart is generally

more or less enlarged, its sounds are feeble, the first being weaker

than the second.

ENDOCARDITIS, or inflammation of the membrane lining the cavities of the

heart, is one of the most frequent forms of heart disease. It is almost

invariably associated with acute rheumatism, or some of the eruptive

fevers, as small-pox, scarlet fever, etc., and is due to the irritation

of the unhealthy blood passing through the heart. The disease is

generally attended with little or no pain, and, consequently, if the

attending physician be not on the alert, it will escape his observation.

When associated with acute rheumatism, the disease is only in rare

instances directly fatal, but in the great majority of cases it leaves

permanent organic changes, which sooner or later develop into valvular

affections, and these may eventually destroy life. When the disease

occurs, however, as the result of pyæmia (blood-poisoning produced by

the absorption of decomposing pus or "matter") or of diphtheria, or when

it is associated with any other septic conditions, it constitutes a very

grave element. Collections of matter formed on the membrane lining the

heart and covering its valves, are liable to be detached and carried by

the circulation to the brain, spleen, or liver, where they plug up some

artery, and thus cause death of the parts which it supplies with blood.

Chronic endocarditis generally occurs in rheumatic subjects,

unassociated with any acute disease, It may exist without any marked

symptoms, except, perhaps, a sense of oppression and uneasiness in the

chest, with palpitation. It produces a thickening and hardening of the

membrane lining the heart, and generally causes a retraction, adhesion,

and degeneration of some of the valves of the heart, thus bringing on

valvular disease.

VALVULAR LESIONS are, as we have seen, very frequently the result of

endocarditis. They are of two kinds. First, those which prevent the

valves from flapping back close to the walls of the ventricles, or

arteries, thus diminishing, to a greater or lesser extent, the size of

the valvular orifices, and offering an obstruction to the free flow of

blood through them; and which consist of a thickening and retraction, or

adhesion of the valves, chalky deposits, morbid growths, etc. Secondly,

those which prevent complete closure of the valves, and thus permit a

return of the blood into the cavity from which it has just been

expelled. These latter consist of retractions, perforations, and partial

detachments of the valves, chalky deposits around the base of the valves

and in them, and rupture of the chordæ tendineæ.

These two forms of lesions are usually co-existent, one generally being

more extensive than the other. Thus, the regurgitation may be slight,

and the obstruction great, or _vice versa_. The symptoms and disturbance

of the circulation are altogether dependent upon the location and form

of the lesion, or lesions. Each valvular lesion has its characteristic

sound, or murmur, which is heard at a particular period in the cycle of

the heart's action, and it is, as before stated, from these sounds, from

tracings of the pulse, and from the many other indications, that we

arrive at a diagnosis. Thus, in obstruction of the orifice at the

junction of the aorta with the left ventricle, one of the most frequent

of valvular lesions, a murmur, generally harsh in character, is heard

with the first sound of the heart, with greatest intensity directly over

the normal position or the aortic semilunar valves. This is conveyed

along the large arteries, and may be heard, less distinctly, over the

carotids. In the sphygmographic tracing, the line of ascent is less

abrupt than in the normal tracing (Fig. 2), and not nearly so high, and

it is rounded at the top. In aortic regurgitation, the line of ascent is

similar to that of the healthy tracing, but the line of descent is very

sudden. The left side of the heart is almost invariably the primary seat

of these affections, but in the latter stages of their course, the right

side also is liable to become involved, and, as a consequence, there

then exists great disturbance of the venous circulation, with a damming

back of the blood in the veins, and passive congestion of the liver,

kidneys and brain, followed by dropsy, albumen in the urine, etc.

[Illustration: Fig. 2.

The above is a representation of a tracing of a healthy

pulse as made with the Sphygmograph.]

HYPERTROPHY OF THE HEART consists of a thickening of the muscular walls

of this organ. It may be confined to one portion of the heart, or it may

affect the entire organ. The affection has been divided into the

following three forms: _Simple hypertrophy_, in which there is an

increase in the thickness of the walls of the heart, without any

augmentation in the capacity of the cavities, and which is usually the

result of chronic Bright's disease, or great intemperance; _eccentric

hypertrophy_, in which there is an increase in the thickness of the

walls of the heart, together with increase in the capacity of the

cavities, and which is generally the result of some valvular lesion; and

_concentric hypertrophy_, in which there is an increase in the thickness

of the walls of the heart, with a decrease in the capacity of the

cavities. Valvular lesions, obstructions in the large arteries, or, in

fact, any thing which calls upon the heart to constantly perform an

undue amount of labor must, necessarily, produce hypertrophy of its

muscular walls, just as the undue amount of labor which the blacksmith's

arm is called upon to perform produces hypertrophy of its muscles. With

this condition, the pulse is hard and incompressible, and the line of

ascent in the sphygmographic tracing (Fig. 3) is higher than in health.

[Illustration: Fig. 3.]

DILATATION OF THE HEART is a condition which is closely allied to

hypertrophy of the heart, and which consists of an increase in the

capacity of the cavities of the heart, with diminished contractile

power. In simple dilatation, there is an increase in the capacities of

the cavities, without any marked change in the walls of the organ. It is

usually the result of some disease which has produced great muscular

prostration, and which has interfered materially with nutrition. More

frequently, however, dilatation is the result of valvular lesions, and

is associated with hypertrophy, there being an increase in the thickness

of the walls with a diminution of the contractile power. The hypertrophy

from valvular lesions goes on increasing until it reaches a certain

stage, when dilatation commences, the two conditions then being

associated.

ATROPHY of the heart is the opposite to hypertrophy, and signifies a

wasting away of the muscular substance, and a diminution in the

thickness of the walls of the heart. Its power is diminished in

proportion to the degree of atrophy.

FATTY DEGENERATION of the heart consists in the deposition of particles

of fat within the _sarcolemma_ (the sheath which invests the fibrils),

which are substituted for the proper muscular tissue. If the fatty

degeneration exists to any extent the muscular walls present a yellowish

color, and the heart is soft and flabby. This may be confined to one

ventricle, or it may affect the inner layer of fibres, the outer layer

remaining unchanged. Degeneration of the left ventricle occasions

feebleness of the pulse. Difficulty in breathing is one symptom of this

disease, especially when the right ventricle is affected. There is

pallor, feeble circulation, cold extremities, and frequently dropsy.

Fatty degeneration is more liable to occur in corpulent persons, and

between the ages of forty and fifty years.

ANGINA PECTORIS, also termed _neuralgia of the heart_, might be included

among the diseases of the nervous system, but as it is usually

associated with a derangement in the action of the heart, it may be

properly considered in this connection. The pain varies in intensity,

sometimes being very acute, at others assuming a milder form. The action

of the heart is more or less disturbed. The beats are irregular, at

times being strong, while again they are feeble. A feeling of numbness

is experienced in those parts to which the pain penetrates. These

paroxysms _usually_ continue but a few minutes, although they sometimes

last several hours. Persons suffering from angina pectoris are liable to

sudden death. It is connected with ossification, or other organic

changes of the heart. Usually these paroxysms, if the life of the

patient continues, become more and more frequent. The danger is not to

be measured by the intensity of the pain, but by the co-existing organic

disease. Although it is not absolutely certain that organic disease is

present in all cases of angina pectoris, yet the exceptions are so rare

that when the signs of organic disease cannot be detected, it may be

inferred that angina is not the real affection, or that the existing

lesions escape observation. Those who suffer from this disease are, in

the great majority of cases, of the male sex, and rarely under the age

of forty.

TREATMENT. In the foregoing consideration of organic diseases of the

heart, we have omitted to speak of their remedial management, for the

obvious reason that unprofessional readers are unable to correctly

distinguish between the various diseases of this vital organ; and it

would, therefore, be useless for us to attempt to instruct them as to

the medicinal treatment of the different cardiac affections.

In the vast majority of instances, diseases of the heart are not

necessarily speedily fatal. Persons have been known to live twenty years

or more with very extensive organic disease of this organ.

It is _very important_, however, that a correct diagnosis be made in the

early stages of these diseases, in order that an appropriate course of

hygiene and treatment may be adopted, which will check their progress.

While we cannot cure extensive organic diseases of the heart, we _can_

check their progress, and prolong life, and render the condition of the

subject comparatively comfortable. Since we are able to diagnosticate

with the utmost precision the various affections of the heart, and since

the discovery of certain specific medicines which exert most beneficial

effects, we are enabled to treat this class of maladies with the most

gratifying results. Thus we have seen a case in a very advanced stage of

the disease, with the breathing so difficult that the subject had been

compelled to remain almost constantly in the sitting posture, in the

greatest agony, for so long a time that immense bed sores had formed on

the seat; in which the dropsy had become so extensive that the skin of

the legs had burst open; and yet this patient, through the influence of

a specific course of treatment, was speedily relieved, and enabled to

live in a comparatively comfortable condition for many months.

One afflicted with heart disease should abstain from the use of all

kinds of stimulants, tobacco, and whatever tends to lower vitality. His

life should be an even one, free from all excitement of any kind

whatsoever. He should avoid severe physical exertion, and everything

which causes the heart to beat with undue frequency.

There are certain symptoms, the result of _chlorosis_ (the green

sickness), a deficiency of blood, dyspepsia, uterine disease, and

certain nervous affections, which may simulate those of real organic

disease, but the physician of education and experience, with a trained

ear, is able to detect the difference speedily.

SORE MOUTH. (STOMATITIS.)

Stomatitis, or inflammation of the mucous membrane of the mouth, may

include the entire surface of the gums, tongue, and cheeks, or appear

only in spots. Vesicles are formed, having swollen edges and a white or

yellow center, which finally ulcerate. When mild, the affection is

confined to these parts.

If the inflammation is acute, the mouth is dry and parched, or as is

more frequently the case, the flow of saliva is abundant and acrid, and,

when swallowed, irritates the stomach and bowels, producing fever,

diarrhea, griping pains, and flatulency. The tongue is either coated

white or red, and is glossy, and the sense of taste is considerably

impaired. Digestion and nutrition are then disturbed, and the patient

becomes rapidly emaciated.

THRUSH, OR CANKER, is that form of stomatitis in which white ulcers

locate on the inner side of the upper lip, the tongue, or roof of the

mouth; the irritation which they cause not only interferes with eating,

but produces fever, together with the symptoms previously mentioned.

APTHÆ, or follicular inflammation, is distinguished by very painful

little ulcers, single or in clusters, scattered over the surface of the

tongue and lining of the mouth. Sometimes it is complicated with little

lumps in the tongue. These form ulcers and denote scrofulous

inflammation. Fissures and cracks in the tongue indicate derangement of

the stomach.

THE CAUSES of stomatitis, in nursing infants, are unhealthy milk, or

effete matter, which, for lack of proper care and cleanliness,

accumulates upon the nipple. In older children, improper diet,

irritants, debility of the digestive functions, or hereditary syphilitic

taint, disorder the blood and induce local inflammation.

TREATMENT. Locally, use a wash of golden seal or gold thread sweetened

with maple-sugar, and rendered slightly alkaline with borax or

saleratus. Also use a very weak, alkaline tea, or one of slippery-elm

flour, to obviate the acridity of the secretions. If the sores do not

heal, constitutional treatment may be required, as the use of the Golden

Medical Discovery. The family physician should be consulted if the sore

mouth resists all these remedial measures.

NURSING SORE MOUTH. (STOMATITIS MATERNA.)

During the period of nursing, and sometimes in the latter months of

pregnancy, women are liable to a peculiar variety of sore mouth. The

soreness is sometimes so great that, although the appetite may be

ravenous, the patient cannot eat. When this condition extends to the

stomach and bowels, symptoms of a very grave character appear, and the

disease, by interfering with the process of nutrition, causes emaciation

and debility, and in extreme cases, death. It is a strange affection,

nearly always disappearing upon weaning the child, though this course is

not absolutely necessary. It appears to depend upon a hepatic, or

gastric derangement, in connection with a vitiated condition of the

blood, but how this is brought about is unknown.

SYMPTOMS. The disease sometimes comes on suddenly, at others more

slowly. The fact that the woman is either pregnant or nursing, is of

importance in forming a diagnosis. At first there is a severe, scalding

sensation of the tongue, mouth, and fauces, with pain, which is

sometimes intense. The color of the tongue is often pink, or a light

red, while the mouth is generally of a deeper hue. This stinging, biting

sensation is accompanied by a profuse, watery discharge from the mouth,

which seems extremely hot and acrid, causing excoriation whenever it

comes in contract with the face or chin. The appetite is good, sometimes

ravenous, but food or drinks, except of the blandest character, occasion

such intense pain that the patient avoids their use. Ulceration occurs

after a little time. The bowels are generally constipated, but when the

disease extends to the stomach or intestines, diarrhea occurs. There is

generally anæmia, debility, and impairment of the vital powers.

TREATMENT. The indications for treatment in this affection are to

overcome the vitiated condition of the blood, and to sustain the vital

powers. The remedies for this purpose are alteratives, antiseptics, and

tonics. Give the Golden Medical Discovery, the value of which may be

greatly enhanced by adding one-half ounce of the fluid extract of

baptisia to each bottle, in doses of a teaspoonful four times a day.

Chlorate of potash, half an ounce in a pint of water, used as a wash and

gargle, is of great value. A teaspoonful of the same may be swallowed

several times a day. This will not interfere with other medicines. As a

tonic, the tincture of the muriate of iron, in five to ten-drop doses,

diluted with water, may be taken three or four times daily. Quinine, in

one or two-gram doses, should be given with the iron if the debility be

extreme. When there is great acidity of the stomach, which may be known

by heart burn, saleratus may be taken in water, to neutralize it, but

should not be drunk within an hour of the time for taking other

medicines. If constipation exists, use the Pleasant Pellets. This course

of treatment, thoroughly carried out, will seldom fail to effect a

perfect cure, without weaning the child, yet this latter course may

sometimes become advisable to promote the recovery of the patient.

Should the treatment advised not produce the desired result, a skillful

physician's services should be secured, as he may, in individual cases,

distinguish other important indications which may enable him to modify

the treatment to advantage.

DIARRHEA, CHOLERA INFANTUM, OR SUMMER COMPLAINT, AND DYSENTERY.

These diseases are usually considered separately by medical writers but,

as they are closely related, a simple diarrhea not unfrequently running

into a _cholera infantum_ or a dysentery, we shall consider them

together.

DIARRHEA is an affection characterized by unnaturally frequent

evacuations from the bowels of a liquid of morbidly soft consistency. It

may be simple or inflammatory, and acute or chronic.

A diarrhea is said to be bilious when the discharges are composed

principally of serum, highly colored with yellow or green bile;

catarrhal, when they are of a semi-transparent, mucous character;

serous, when the dejections are thin and watery, sometimes mixed with

blood, bile, or ingesta.

The symptoms of the affection are usually at first those of indigestion,

a fullness of the stomach, flatulency, and colicky pains. The pains,

which precede each evacuation, are intermittent in character. There may

be an unpleasant sinking sensation in the abdomen, and, with the

discharge, exhaustion, a feeble pulse, and a cool skin. In the

inflammatory variety, there is more or less fever.

CHOLERA INFANTUM, or summer complaint, is a disease peculiar to the warm

season, and more prevalent in cities, and among those children who do

not nurse at the breast. It is characterized by great irritability of

the stomach, and persistent vomiting and purging, the discharges from

the bowels being copious and watery, and sometimes containing specks of

curd, yellowish-green matter, and mucus. The limbs of the little

sufferer are usually drawn up, indicating pain in the bowels, and there

is great prostration with cold extremities. The invasion may be so

sudden, and the disease so violent as to destroy life in a few hours.

DYSENTERY, also known as _bloody-flux,_ consists of an inflammation of

the mucous membrane of the large intestine, with ulceration of the

affected surfaces. The disease is accompanied with much nervous

prostration, and is distinguished by severe pains in the abdomen of a

griping nature, followed by frequent scanty and bloody stools, and much

straining. Occasionally the attack is ushered in with a chill and aching

pains in various parts of the body, with copious fecal dejections. In

other cases the attack is preceded by loss of appetite, a sense of

uneasiness with dull pains in the abdomen, and weariness. The disease,

like diarrhea, may be either acute or chronic.

THE CAUSES of these affections of the bowels are many and varied. They

may be brought on by exposure to cold and wet, or by improper and

indigestible articles of food, such as unripe fruits, salads, pastries,

and, in fact, anything which interferes with the normal operations of

the digestive apparatus. One of the most fertile sources of diarrhea in

infants, and of _cholera infantum_, is the administration of unsuitable

food, the ill effects of which are greatly increased by exposure to heat

or cold. Uncleanliness, and the inhalation of impure air, are prolific

causes Of these diseases. Epidemics have been supposed to be due to some

peculiarity in the condition of the atmosphere, or to some impalpable

germ of a vegetable or animal nature.

TREATMENT. In the treatment of these diseases, one should first endeavor

to ascertain the cause of the trouble, and then, if possible, effect its

removal. Attention should be given to the hygienic surroundings of the

individual afflicted; if he reside in a miasmatic district, or in a

location in which the atmosphere is contaminated by the decomposition of

animal or vegetable matter, or filled with noxious gases, his abode

should be changed. A pure, dry air is most beneficial in these cases.

Only the least irritating and most easily digestible articles of food

should be taken. Healthy cow's milk is slightly alkaline, but that of

cows fed on slops is usually acid, and unfit for infants. It is,

therefore, well to test all milk with blue litmus paper before feeding

it to young children. If found to be strongly acid, that is if it turns

the paper red, it should be rejected, but if only slightly so,

sufficient lime water may be added to render it slightly alkaline. For

adults and older children, the diet should consist of such starchy foods

as arrow-root, sago, corn starch, and rice, and of ripe grapes, freed

from the skins and seeds, peaches, and boiled milk, or milk and lime

water. In some cases the animal broths are beneficial, especially mutton

broth. To quench the thirst, crust coffee, rice coffee, and lemonade, in

small quantities, may be taken.

Rest is important in these diseases. In severe cases, the patient should

be kept in bed.

At the onset of an attack of diarrhea or dysentery, if there be reason

to believe that the intestinal tract contains irritating matter, a dose

of castor oil, with a few drops of anise oil added to render it

palatable, should be administered. After all irritating ingesta have

been removed, Dr. Pierce's Compound Extract of Smart-weed should be

given in doses proportionate to the age of the patient, and the severity

of the case. Being composed of the extract of smart-weed, or water

pepper, Jamaica ginger, camphor, and genuine French grape brandy, it

exerts a most wonderful effect not only in those diseases but in cholera

morbus and intestinal colic. It allays the irritation and inflammation

of the affected mucous surfaces, and soothes the nervous system. In the

great majority of cases, the above course of treatment will be found

sufficient, but in the more severe forms of these diseases additional

remedies may be required.

In dysentery, accompanied with severe pain and straining, injections of

starch water and laudanum, from two to four ounces of the former to from

twenty to fifty drops of the latter should be used.

Hot fomentations applied to the abdomen are beneficial. If the

discharges contain much blood, a flannel cloth moistened with the

spirits of turpentine should be laid over the lower part of the abdomen,

and kept there until slight irritation is produced.

Lime water, bicarbonate of soda, bicarbonate of potash (saleratus),

chalk, and the subnitrate of bismuth are valuable agents to correct the

secretions, and allay irritation of the diseased mucous surface. The

above-named preparations of soda, potash, and bismuth may be taken in

doses of from five to twenty grains every few hours.

Blackberry root and cranesbill (_Geranium Maculatum_), in the form of

fluid extract or infusion, are beneficial in acute cases in which the

discharges are profuse and watery, and in the chronic forms of these

affections.

In _cholera infantum_ subnitrate of bismuth should be given in doses of

from five to ten grains at intervals of from two to four hours. If the

discharges are very profuse, the fluid extract of cranesbill may be

administered in from two to ten-drop doses alternately with the bismuth.

The camphorated tincture of opium (paregoric) is required in doses of

from two to twenty drops, depending upon the age of the child and the

severity of the case, if there is much pain, but great caution should be

exercised in administering the preparations of opium to children. A

single drop of laudanum given to a young infant has caused convulsions,

coma, and death in more than one instance. To check the vomiting of

_cholera infantum_, mild irritation over the stomach is sometimes

effectual. For this purpose a weak mustard plaster, or a cloth moistened

with turpentine, may be laid over the stomach for a few minutes at a

time. If the child is old enough to suck pellets of ice, these are

beneficial, or a piece can be wrapped in a cloth and sucked.

COLIC.

_Colic_ is a term applied to griping pains in the abdomen, which are

sometimes accompanied with nausea and vomiting. The derangement is

recognized in several forms, some of which we shall briefly describe.

BILIOUS COLIC. This may be the result of a morbid condition of the

liver.

SYMPTOMS. It is characterized by severe pain occurring in paroxysms,

which may be relieved by pressure upon the bowels. The pulse is quick,

the tongue coated, and the skin harsh and dry; there is headache,

impaired appetite, acrid taste in the mouth, thirst, nausea, attended

with vomiting and general chilliness, followed by febrile symptoms.

CAUSE. It may be induced by exposure to cold, in consequence of which

the circulation is impeded, the pores of the skin obstructed, and all of

the vitiated matters having to be expelled through the liver, stomach,

and intestines. It may also be due to malaria in the atmosphere. It most

commonly occurs during the autumn, after a season of hot weather.

FLATULENT COLIC. Flatulent or "wind" colic is one of the results of

indigestion.

SYMPTOMS. A sense of fullness in the pit of the stomach, attended with

pain, which is transferred from one part of the bowels to another. There

is fever, a quick pulse, nausea, and the presence of gas; by the latter

feature it may be detected from the other forms.

CAUSES. Cold or atmospheric changes, the eating of unripe fruits,

uncooked vegetables and those articles of diet which ferment easily, are

the principle causes.

PAINTER'S COLIC. This form is also known by various names, such as

_colica pictonum, saturnine_, or _lead colic_. Those persons who are

engaged in the manufacture of lead, and painters, are the most frequent

victims of this affection.

SYMPTOMS. Impaired appetite, fetid breath, thickly coated tongue,

obstinate constipation, a dry skin, scanty urine, languor, severe pain

in the umbilical region, and general derangement of the functions of the

system.

CAUSES. From the term applied to this form, the cause may be inferred.

It is induced by the absorption of lead through the lungs, stomach, and

skin.

TREATMENT. The indication to be fulfilled in _bilious_ colic is to

relieve the intestinal spasm. This may be done by drinking freely of a

decoction of yam-root, or _dioscorea villosa_, which is an effectual

remedy in this affection. If this be not at hand, the spasm may be

relieved by administering freely of Dr. Pierce's Extract of Smart-Weed.

If the stomach be irritable, a tablespoonful of laudanum and one of

tincture of lobelia, in four ounces of starch water, administered as an

injection, is effectual. If simple means do not promptly arrest the

attack, no time should be lost in summoning the family physician.

In _flatulent_ colic, the treatment should depend upon the cause. If it

be occasioned by cold, a teaspoonful or two of the Extract of

Smart-weed, in warm water or catnip tea, repeated a few times, will be

sufficient. If it result from overloading the stomach, a dose of the

Pleasant Pellets will answer the purpose. If the pain in the abdomen is

severe, apply hot fomentations. Assist the action of physic, by giving

an injection of senna and catnip tea, or if the stomach is very sour,

take internally some mild alkali, such as common saleratus.

In _painters'_ colic, the following cathartic mixture is an effectual

remedy: sulphate of magnesia (epsom salts), twelve ounces; nitrate of

potassa (saltpeter), half an ounce; sulphuric acid, one drachm; boiling

water, one quart. Of this remedy give a teaspoonful every thirty minutes

or every hour, until the bowels move. An injection of some diaphoretic

tea, or of alum water, is a good remedy. Castor oil and molasses,

containing a teaspoonful of spirits of turpentine, will add to the

efficiency of an injection. If the colic be not promptly relieved, a

physician should be employed. To eliminate the lead from the system, and

thus prevent a return of the colic, or other injurious effects, two

drachms of iodide of potassium should be added to a bottle of the Golden

Medical Discovery, and a teaspoonful of this taken four times a day.

JAUNDICE. (ICTERUS.)

This affection is generally regarded as a symptom of disordered liver,

since it frequently occurs during the progress of diseases of that

organ. When the disease imparts a greenish tinge to the skin, it is

termed _green jaundice,_ and, when it imparts a blackish color, it is

known as _black jaundice._ Jaundice is undoubtedly due to the presence

of biliary elements in the blood.

CAUSES. In consequence of the varied conditions from which it arises,

Professor Da Costa has aptly remarked: "With the _recognition_ of

jaundice, the difficulty in diagnosis may be said to begin." He

considers the causes of jaundice to be (1) diseases of the liver; (2)

disease or the bile ducts; (3) diseases remote from the liver, or

general disease leading to a disorder of that viscus; (4) certain causes

acting upon the blood.

SYMPTOMS. It is characterized by a yellowish color of the skin and of

the white of the eyes. The skin is usually dry and harsh; if it be

moist, the linen will be tinged yellow from the perspiration. The tongue

is coated yellow, the mouth is dry, and the appetite impaired; there is

headache, nausea, and sometimes vomiting; there is pain in the abdomen

after eating, and in the region of the liver, and it is also felt in the

right shoulder, and between the shoulder-blades. In severe cases, there

is fever, accompanied with chills, despondency and loss of flesh. The

stools are generally of a light clay color, and very offensive; the

urine is thick and yellow. When the disease terminates fatally, there is

delirium followed by stupor.

TREATMENT. The first step should be to eliminate from the system, as

speedily as possible, all noxious materials. For this purpose, the

spirit-vapor bath should be used. If the urine is scanty or voided with

difficulty, take acetate of potash or queen of the meadow. These may be

taken in connection with the Golden Medical Discovery and Purgative

Pellets, the efficacy of which has already been described in the

treatment of chronic inflammation of the liver. They are indeed valuable

agents in this disease, since they increase the action of all the

excretory glands, and rapidly remove those matters, which, if retained,

would poison the system.

In some cases, acids are of great value; good hard cider or hydrochloric

acid and the acid bath are frequently valuable agents.

In other cases the employment, both internally and externally, of

alkalies in addition to the Golden Medical Discovery answers the purpose

much better.

Again, there are persons who, in addition to alteratives and baths,

require tonics. In the treatment or this affection, whatever may be the

nature of the case, the use of _alteratives_ must not be forgotten, for

_without_ them, the auxiliary treatment with acids, alkalies, and

tonics, will not produce the desired effect.

The employment of drastic remedies is sometimes resorted to; but,

although they may give temporary relief, the patient soon relapses into

his former condition, while if the treatment above given be adopted, the

recovery will be permanent.

GALL-STONES. (BILIARY CALCULI.)

These are concretions found in the gall-bladder or bile duct, and vary

from the size of a pea to that of a hen's egg. There may be no

indication of their existence in the gall-bladder until they begin to

pass through the duct.

CAUSES. The formation of gall-stones is undoubtedly due to an unhealthy

condition of the bile. Corpulent persons, and those indulging in

over-stimulating diet, or in the habitual use of fermented drinks, are

most liable to be troubled by them.

SYMPTOMS. The patient is suddenly seized with excruciating pain in the

right side. After a time it subsides, but is again renewed with as great

severity as before. There is nausea, with vomiting, which is often

excessive and severe. The pulse is sometimes slower than is natural, the

extremities are cold, there is great exhaustion, together with

perspiration and spasmodic contraction of the abdominal muscles. As soon

as one stone has passed through the duct into the intestine, immediate

relief is experienced until another commences to pass, and the larger

the concretion, the greater is the pain. If the stools be washed, the

gall-stones may be seen floating on top of the water.

TREATMENT. This consists chiefly in relieving the patient of pain and

vomiting during the passage of the gall-stones. Hot fomentations made

with stramonium leaves and lobelia, and applied over the painful parts,

are beneficial. Small doses of lobelia may be taken, but not in

sufficient quantities to produce vomiting. Doses of opium should also be

taken; this anodyne must, however, be used with care. Gelseminum is

often useful. Chloroform, ether, or the spirit vapor-bath generally

allays the pain. Carbonate of soda, dissolved in water, often relieves

the vomiting.

These distressing symptoms are apt to recur until the removal of all the

gall-stones is effected. To aid in removing them, take the Golden

Medical Discovery rather freely for a day or two, and continue its use

with lobelia, in doses sufficiently large to produce nausea, but not

vomiting. From four to eight ounces of sweet oil may be given, and, if

the bowels do not respond within three hours, repeat the dose, and the

gall-stones will generally be evacuated. To prevent the formation of

these concretions take the Golden Medical Discovery, together with

alkaline drinks made with carbonate of soda. Tone and energy will

thereby be imparted to the liver, the free flow of bile will be insured

and the subsequent formation of gall-stones prevented.

INTESTINAL WORMS.

We have not the space to discuss the numerous theories which have been

offered to account for the presence of these parasites in the human

body. We shall enumerate the principal species, describe the symptoms

indicating their presence, and indicate the proper remedies.

There are five species of intestinal worms, sufficiently common to merit

a description.

(1.) The round worm, termed by naturalists, _ascaris lumbricoides_,

varies from six inches to a foot in length, and resembles the common

earth-worm. It infests the small intestines, and seldom migrates into

the stomach or large bowel. Instances are recorded, however, in which it

has crept upward in the esophagus, larynx, nostrils, and eustachian

tube; but their presence in these parts is of comparatively rare

occurrence, and is generally caused by some local irritation which

compels their migration. The fact that they have been found in the

peritoneal sac, gave rise to the opinion that they perforate the

intestine; but careful observations have proved that they can only

escape through openings made by ulcers.

This species has been found in adults, but is more common in children

from three to twelve years of age. The number of this species existing

in a human body is variable. Sometimes only two or three are found. At

other times a hundred, and even twice that number, are voided in a few

days.

(2.) The _ascaris vermicularis_, thread, pin, or seat-worm, is round,

very slender, and about half an inch in length. The habitation of this

species is the rectum, and they are often found matted together in the

excrement. They are very active, even after ejection, and have been

known to cause great local irritation by entering the vagina and

urethra. Their presence is an occasional cause of masturbation. It is

impossible to estimate the number of these parasites that may exist in

the human rectum. Great numbers, sometimes, are voided at a single

evacuation.

(3.) The _tricocephalus dispar_ is a third variety of the round worm,

and is said to infest the bodies of almost every species of mammalia. As

its name indicates, the upper portion of its body is slender, hair-like,

and terminates at the lower extremity in a thick, spiral portion. It is

from one to two inches in length, and is found attached by its head to

the mucous membrane of the cæcum, and, in rare instances, in the colon

and small intestine. They are rarely numerous.

_Tæceniæ_ or _tape-worms,_ are hermaphrodites, of a flat, ribbon-like

form, and are composed of numerous segments, each of which is provided

with a complete set of generative organs, and contains ova for the

production of thousands of individuals. Some authors have supposed that

each segment, or joint, is a distinct individual, but the existence of

one head for the whole precludes this theory. There are two species of

_tæniæ_ developed in the human intestine; the _tænia solium_ and the

_tænia lata_.

(4.) The _tænia solium_ is the species commonly found in America and all

the countries of Europe, except France, Russia, and Switzerland. In

France, both species are found, but the tænia lata seems to be

indigenous to Russia and Switzerland.

The _tænia solium_ varies in length from four or five to thirty,

thirty-five, or even forty feet. The head is hemispherical and armed

with a double row of twenty or thirty hooklets. The genital organs are

alternate and placed upon the outer edges of each segment. It inhabits

the small intestine, and is usually solitary.

(5.) The _tænia lata_, or broad tape-worm, is distinguished by the

greater breadth of its segments, and the location of the genital organs,

which are found in the centre of each segment. Its small elongated head

is unarmed, and has a longitudinal fissure on each side. It usually

attains a greater length than the _tænia solium_.

SYMPTOMS. The symptoms which the long worms occasion, are frequently

somewhat obscure. Thirst, irregular appetite, colicky pains, excessive

flow of saliva, enlargement of the abdomen, itching of the nose, pallor

of the face, offensive breath, disturbed sleep, and grinding of the

teeth, all are common symptoms. Occasionally, convulsions and other

nervous affections are produced by the presence of the _ascaris

lumbricoides,_ but generally they produce less constitutional

disturbance than the other varieties. The passage of this species of

worms from the bowels, or their ejection from the stomach, is the only

positive evidence of their presence. The _ascaris vermicularis_, thread,

pin, or seat-worm, gives rise to most of the symptoms produced by the

long worms, but in addition produces intense itching at the anus, and,

not unfrequently, an eruption upon that part. The itching is

particularly distressing at night. When the little sufferer is well

covered, the warmth occasioned by the bed-clothes causes these little

parasites to crawl out upon the anus, and produces such paroxysms of

itching and pain as to cause the child to kick the covering oft and lie

naked. The persistent manifestations of a disposition to lie naked,

should excite the parents' suspicions of seat-worms, and lead them to

investigate all the symptoms. By examining the child's stools the worms

may he found adhering to the feces, and they may also be seen on the

anus. Thousands of children suffer untold agony from these little

seat-worms, which are left unmolested to torment them, because the

parents are unfamiliar with the meaning of the symptoms manifested, and

therefore pay no heed to them. We have been thus particular in

describing the symptoms indicating the presence of these pestiferous

parasites, in order that they may be readily detected.

_The Symptoms_ produced by the tape-worm are dizziness, ringing in the

ears, increased secretion of saliva, indigestion, ravenous appetite,

sharp abdominal pains, and emaciation. The only positive sign of the

presence of these parasites, is the passage of pieces of them in the

feces. The nervous and other symptoms produced by the ordinary long

worms are also caused by the tape-worm.

CAUSES. Careful observations have proved that there are certain causes

which favor the generation or development of intestinal worms. Among

others, we may mention fatty or farinaceous articles of food,

gormandizing, constant exposure to a moist atmosphere, and sedentary

habits.

It is now generally conceded that the development of tape-worms is due

to the swallowing of an egg or germ-cell, which is contained in many

kinds of animal food, and which the process of cooking has failed to

destroy. People living near low marshes, lakes, or the seacoast, are

liable to _tæniæ_.

TREATMENT. The expulsion of the _ascaris lumbricoides_ may be very

easily and pleasantly effected. Santonin is an effectual remedy for this

variety of worms. For a child three years old, take santonin, six

grains; podophyllin, one grain; white sugar, thirty grains; mix,

triturate, and divide into twelve powders, and give one every three or

four hours, until they act upon the bowels; or take santonin, ten

grains; white sugar, twenty grains; mix, triturate, and divide into ten

powders, and give one every night at bed-time, and after giving two or

three in this way, administer a mild cathartic. As santonin is almost

entirely tasteless, if not combined with other medicines which are

unpalatable, no difficulty will be experienced in administering it to

children. By reference to the article on anthelmintics in this volume,

other valuable vermifuges may be selected, and directions found for

their employment.

In the removal of thread or pin-worms, anthelmintic medicines taken into

the stomach are of little or no value. An injection of a strong solution

of salt, is a very efficient remedy. A teaspoonful of turpentine in half

a pint of milk makes a good injection. Strong coffee has been

recommended as an injection. The anus should be well anointed with

vaseline, lard, oil, or fresh butter, after each movement of the bowels.

Whatever injection or remedy is used, it should be followed by the

application of some ointment to the anus, otherwise they will continue

to deposit their eggs about that orifice and multiply there.

Various remedies have been used to destroy tape-worms. Among others we

may mention the old and time-honored remedy, which consists of two or

three ounces of the oil of turpentine, taken in castor oil or some

aromatic tincture.

A decoction made by boiling two or three ounces of freshly powdered

pomegranate bark in a pint of water was used by the ancients, and is now

highly recommended as a remedy.

Some American physicians have used an emulsion of pumpkin seeds with

marked success.

Twenty or thirty grains of the extract of male fern, followed by a

cathartic is highly recommended for the destruction and removal of

tæniæ.

TRICHINA SPIRALIS.

In 1835, Owen discovered a peculiar parasite, which sometimes infests

the human body, and is termed the _trichina spiralis_. The presence of

these parasites has given rise to morbid conditions of the system,

followed by the most serious results. They are developed in the

alimentary canal, and then perforate its tissues and enter the muscles.

Twelve trichinæ have been found in a section of human muscle only

one-twelfth of an inch square and one-fifth of an inch in thickness.

The early symptoms of trichinæ are very uncertain, being the same as

those of some other disease. The patient complains of severe pain in the

abdomen and is troubled with diarrhea. When the trichinæ pass into the

muscles, they occasion great suffering. There are sharp pains in the

muscles, the perspiration is profuse, and the patient becomes exhausted.

CAUSE. Nearly every case of trichinæ, which has been brought to the

notice of the profession, has been attributed to the eating of raw or

improperly cooked pork. The parasites can only be detected with a

microscope.

TREATMENT. The impossibility of removing the trichinæ after they have

passed into the muscles is apparent; and, as yet, no special remedy has

been recommended to remove them from the alimentary canal. The only

safety lies in prevention. Hence raw or imperfectly cooked pork should

never be eaten.

* * * * *

DYSPEPSIA.

It is generally conceded that a multitude of human ailments arise from

_indigestion_, and in its various forms it taxes the skill of the

physician to prescribe the proper remedies. It is undeniable that the

closest intimacy exists between happiness and good digestion. A healthy

digestion aids materially in making a cheerful disposition, and the

"feast of reason and flow of soul" is due as much to the functional

integrity of the stomach as to a strong and generous mental

organization. Dr. Johnson severely said: "_Every man is a rascal as soon

as he is sick._" We all know that a morbid condition irritates the

individual and excites sarcastic and disagreeable remarks. And,

likewise, an irritable temper and, suddenly aroused passions may not

only turn and disturb the stomach, but even poison the secretions.

Anxiety, excitability, fear, and irritability frequently cause the

perversion of physiological processes.

The slightest functional disturbance of the stomach deranges, more or

less, all the succeeding operations of digestion and tends to the

vitiation and impairment of the delicate processes of nutrition.

Dyspepsia may commence and proceed so insidiously as not to excite the

suspicion of friends, although the patient generally desires active

treatment, such as cathartics, emetics, and medicines to act upon the

liver. When the disease becomes confirmed, it presents some of the

following symptoms: Weight, uneasiness, and fullness in the region of

the stomach, attended by impatience, irritability, sluggishness,

anxiety, and melancholy; there is impairment of the appetite and taste,

also sourness, flatulency, and, perhaps, frequent attacks of colic, loss

of hope, courage, and energy; apathy, drowsiness, and frightful dreams

are also symptoms common in the different stages of this disease. There

are, furthermore, the accompanying symptoms of a coated tongue, bitter

taste in the mouth, unpleasant eructations, scalding of the throat from

regurgitation, offensive breath, sick headache, giddiness, disturbed

sleep, sallow countenance, heart-burn, morbid craving after food,

constant anxiety and apprehension, fancied impotency, and fickleness.

The subjects of dyspepsia frequently imagine that they require medicines

to act upon the liver, desire active treatment, are endlessly

experimenting in diet, daily rehearse their symptoms, and are morbidly

sensitive.

CAUSES. Overtasking the body or mind, overloading the stomach, the use

of improper food, such as stale vegetables and meat, unripe fruits,

indigestible articles, improperly prepared food, irregular meals,

disorderly habits, the use of alcoholic stimulants, loss of sleep,

masturbation irritability of temper, anxiety, or grief may all give rise

to indigestion. If the functions performed by the skin are embarrassed

by cold, tight clothing, or lack of cleanliness, the nutritive changes

cannot properly take place throughout the body, and consequently the

digestive functions are embarrassed, as the revolutions of a water-wheel

are impeded by the backset of the water. When food is not thoroughly

masticated, it is not properly mixed with saliva of the glands of the

mouth, and is not prepared for digestion by the acids of the stomach.

Whatever diminishes the general strength, impairs the health, or

encroaches upon the functions of life, also hinders the perfect solution

of food and disturbs in a measure the function of digestion. Whatever

diminishes the normal amount of the digestive secretions or perverts

their quality, deteriorating their solvent properties, is a cause of

dyspepsia. This should be borne in mind in selecting remedies.

TREATMENT. The hygienic treatment consists in the regulation of the

daily habits, proper selection and preparation of the food, cultivation

of cheerfulness, diversion of the mind, and cleanliness of person. We

cannot give particular directions as to the kind of diet, as there are

no established rules for guidance. Generally, a dyspeptic knows best,

from experience, what articles of diet can be taken with the least

injury. The directions applicable to the condition of one patient, are

not suited to those of another. In dyspepsia, animal food is, as a rule,

preferable. Foods rich in starchy matter often ferment and produce

distress. Sometimes alkalies may be given with beneficial effect, when

there seems to be an excess of acid in the gastric secretions.

In some cases, the digestive fluids are weak and fermentation results,

giving rise to flatulency and belching. An antiseptic, which may be

prepared by mixing a teaspoonful of hydrochloric acid with four ounces

of water, of which a teaspoonful may be taken after each meal, will

prove beneficial to check the fermentation and aid digestion. The

addition of one or two drops of a mixture of one part of carbolic acid

and six of glycerine, to the above solution of hydrochloric acid

improves its antiseptic properties. Or, Dr. Pierce's Golden Medical

Discovery will stop undue fermentation, and from its tonic and

invigorating effect upon the lining membranes of the stomach will

generally overcome the indigestion. Some people are afraid to take it,

when suffering from indigestion, because it has a sweet taste. But the

sweet is not saccharine, or sugar sweet, but an entirely different sweet

principle which prevents fermentation instead of promoting it.

Acidity of the stomach and the attendant irritation may be allayed by

the following mixture: Calcined magnesia, one drachm; refined sugar, one

drachm; subnitrate of bismuth, one-half drachm; oil of cajeput, ten

drops. The dose is half a teaspoonful an hour after every meal. Any

dispensing druggist can put it up.

It is frequently difficult to prevent the patient from over-distending

the stomach, and thus impairing the tone of the muscular coats and

prolonging the process of digestion.

In consequence of debility, over-exertion, anxiety, or chronic

inflammation of the stomach, there is not a proper secretion, in

quantity or quality, of digestive solvents, and it matters not whether

it be a deficiency of the fluids of the stomach, or of the intestines,

or of the pancreas and liver, the result is indigestion. The question of

what important agent is lacking, naturally presents itself to the

physician. Is it _pepsin_, the active principle of the gastric juice,

which converts proteids into peptone, that is wanting, or is there a

deficiency of _pancreatin_? Of course the principle which is lacking

should be supplied; but has the physician the remedial agents properly

prepared, and ready for prescribing? The specialist, having more cases

of dyspepsia to treat than the general practitioner, is more likely to

have the latest and most approved remedies applicable to loss of

appetite, indigestion, impoverished blood, imperfect assimilation, and

all diseases arising from faulty nutrition. In ordinary practice, the

physician's time is divided in his consideration of acute, chronic,

surgical, and obstetrical cases; in fact, much of it is occupied in

riding to reach his patients. His attention is continually diverted from

one class of cases to another, effectually preventing investigation in

any particular direction. His patronage does not warrant him in the

outlay of time required for the investigation of particular diseases,

and the expense necessary to obtain the latest and best remedial agents

for their treatment. In the multiplicity of his cares and arduous duties

by night and by day, obstinate chronic cases become an annoyance to him,

and whenever he can be otherwise professionally employed, he avoids

them, disliking to undertake their treatment.

With plenty of time for scientific investigation, ample facilities to

meet the demands upon his skill, and each succeeding case presenting

some new phase, the treatment becomes a matter of absorbing interest to

the specialist, and each success inspires greater confidence. We not

only use in the treatment of indigestion, solvent remedies, like pepsin,

which act only upon proteids, but also other remedies of recent

discovery, which exert a remarkable curative influence in diseases of

the digestive organs.

The chemistry of digestion and of life is becoming better understood.

Any of the free acids may serve to dissolve a precipitated phosphate;

but it is only the investigating therapeutist and experienced

practitioner who understands which of them is the _most_ and which is

the _least_ efficacious. Alkalies may dissolve lithic deposits, but who,

unless he be an experienced physician, can detect the fault of nutrition

which leads to their formation, or rightly interpret the symptoms

indicating it? These simple illustrations of the complications which

attend dyspepsia, are mentioned merely to show that they must be

anticipated and taken into account in the treatment.

The number of cases of dyspeptic invalids treated by the staff of the

Invalids' Hotel and Surgical Institute within file past few years, is so

large as scarcely to be credited by those unacquainted with the

prevalence of this disease. For this reason we have taken unusual pains

to investigate the causes of the disease, and have spared no expense to

provide the most approved digestive solvents, and stomachic tonics,

which invigorate the mucous membrane of the stomach, and materially

assist in reducing the food to a liquid condition. Some of these,

without being purgative, increase the activity of the liver, and

stimulate the intestinal secretions, two very important indications

which should be fulfilled by remedies which cause no real depression.

The recent important discoveries made in obtaining the active principles

from indigenous plants, has opened the way to the use of a few of the

most important of these remedial agents, hitherto almost wholly unknown

to the medical profession, and the encouraging results attending our

practice have amply repaid us for the investigation and originality in

our treatment of this affection.

A careful chemical and microscopical examination of the urine often

discloses the actual morbid conditions which perpetuate this functional

disease.

CHRONIC DIARRHEA.

On account of the frequency and importance of chronic diarrhea, we deem

it worthy of special consideration. It is frequently the sequel of the

acute form of the affection. The urgent and severe symptoms of acute

diarrhea are often abated, but the disease is not completely cured. The

bowels are left in an irritable condition, perhaps in a state of chronic

ulceration, which perpetuates morbid discharges.

The most noticeable symptom is the tendency to frequent and unhealthy

discharges from the intestines. The evacuated matter varies much in

appearance and character in different cases. The precise location of the

morbid conditions which give rise to the discharges, as well as to their

extent, modifies the color, consistency, and ingredients of the stools.

Most frequently they are dark colored and of very offensive odor. They

are of a more liquid character than is natural, except when, as is

sometimes the case, periods of constipation alternate with periods of

unnatural looseness. Tormina, or griping, is usually present, but not so

severe as in the acute affection. Tenesmus, or straining, often

accompanies it. The appetite is impaired, there is general debility, and

the patient is nervous and irritable. The complexion becomes sallow, the

skin dry and rough, the tongue dark colored, and the body emaciated.

The affection may be the sequel of neglected or badly treated acute

diarrhea, may arise from the injudicious use of powerful purgative

medicines, may result from dissipation, unwholesome food, bad air,

absence of light, long continued exposure to dampness and cold,

overwork, and extreme mental anxiety. Sometimes it is associated with

other diseases, such as Bright's disease of the kidneys, scurvy, or some

of the various forms of scrofulous disease.

The more prominent symptoms are so apparent and so characteristic that

the most unskilled may be able to decide whether the patient has chronic

diarrhea; but to determine in what portion of the intestinal canal the

affection is chiefly seated, to decide upon the extent of its ravages,

to ascertain what peculiar shade or type the affection has taken on, to

investigate its complications and modifications, to ferret out its

producing or aggravating causes, and above all, to nicely and skillfully

adjust remedies to meet the depraved conditions, is by no means an easy

task, even for the educated and experienced physician. It should be

borne in mind that this is a dangerous malady, and one which should not

be trifled with or neglected. Its tendency is to corrode and destroy the

bowels, a process which if unchecked, must sooner or latter result in

death. There is little tendency to spontaneous recovery, nor is a

removal of the exciting cause often followed by recovery. The disease

becomes so firmly seated, and the powers of life so debilitated, that

nature cannot rally.

TREATMENT. A warm, salt bath, several times a week, taken at bed-time,

is beneficial. Flannel should be worn next to the skin, and the

sleeping-room should be warm and well ventilated.

As will be seen from testimonials hereinafter inserted, Dr. Pierce's

Golden Medical Discovery has achieved great success in curing chronic

diarrhea. Its use should be persisted in for a considerable time to

strengthen and tone up the bowels. To relieve the discharges, take Dr.

Pierce's Compound Extract of Smart Weed, as needed from time to time.

CHRONIC INFLAMMATION OF THE LIVER.

(CHRONIC HEPATITIS.)

This is what is ordinarily termed _liver complaint, torpid liver, and

bilious disorder_.

Under this head may be considered all those chronic affections known as

congestion, induration, and enlargement of the liver, and which result

in deficient action, functional derangement, morbid secretion of bile,

and various chronic affections.

SYMPTOMS. Owing to the liability of other organs to become diseased

during the progress of chronic affections of the liver, great precision

in diagnosis is required to determine, by the symptoms, the organ which

is _primarily_ diseased and those secondarily affected. This requires

not only familiarity with the signs of a complicated disease, but also

thorough anatomical knowledge of the diseased organ, of the morbid

changes which occur in its structure, and their influence on its own

functions, as well as on those of other organs.

The symptoms may differ according to the circumstances, temperament,

sex, age, or constitution of the individual, and the complications of

the disease. The local indications are fullness of the right side, thus

denoting congestion of the liver; a dull, heavy pain, which is increased

by pressure or by lying on the left side; a sense of fullness, weight,

and oppression about the stomach; an aching in the right shoulder-blade;

a dull, disagreeable pain in the shoulder-joint, which may extend down

the arm, and which is sometimes felt in the wrist and joints of the hand

Not unfrequently the complexion becomes pale and sallow, and there is

puffiness under the eye, headache, a bitter taste in the mouth, tongue

coated white or covered with a brown fur, and hardness of the gums;

there is frequent sighing, a hacking cough, fever, restlessness, and

loss of sleep; sometimes an unnatural, greasy appearance of the skin, at

others, it is dry and harsh, has scaly or branny eruptions, pimples,

dark blotches, and troublesome itching. The urine is frequently scanty

and high-colored, but variable as to quantity and appearance; it often

produces a scalding sensation when voided, and, if allowed to stand,

deposits a sediment which sometimes contains albumen. The pulse is very

slow, particularly when the elements of the bile are not eliminated from

the blood. The pulsations of the heart are easily quickened, and

palpitation is excited if the subject be low and anæmic. There is

depression of spirits, and a decided tendency to be discouraged and

despondent. The functional powers of the stomach are impaired; there is

loss of appetite, or it becomes capricious; uneasiness is felt in the

region of the stomach, oppression, sometimes nausea and water-brash, or

there is indigestion, flatulency, and acid eructations; the bowels

become irregular, usually constipated, and occasionally subject to

obstinate diarrhea attended with colicky pains; the stools are of a

light clay color, sometimes hard and dark, again thin and very

offensive, and occasionally green or black. As the disease progresses,

during the day the circulation is sluggish, the feet and hands are cold,

but at night the pulse is accelerated, and a burning sensation is felt

in the palms of the hands and the soles of the feet.

The foregoing symptoms are not all present in one case, nor are any two

cases alike in every respect. They vary according to the organs most

implicated in the hepatic derangement. Thus, when chronic inflammation

of the liver is associated with _heart_ disease, the subject may have

palpitation, excessive or defective action of the heart, attended with

more or less pain and shortness of breath. If the _lungs_ be specially

influenced, then, in addition to the ordinary hepatic symptoms, there

may be a dry cough, asthma, hurried respiration, bronchitis, hoarseness,

and pain in the chest. If the _stomach_ be the sympathizing organ, the

tongue is coated white or brown, there is nausea, loss of appetite,

flatulency, acidity, dyspepsia, fullness, and oppression, amounting,

sometimes, to pain in the stomach after taking food; the food ferments

and gives rise to eructations and various other manifestations of

disorder. If the _bowels_ are morbidly influenced by this affection,

there is constipation or diarrhea, griping pain, distension of the

abdomen, piles, and pain just within the points of the hips, thus

indicating irritation of The colon. If the _brain_ or _nervous system_

sensitively responds, there is headache, dizziness, disturbed sleep,

depression of spirits, peevishness, capriciousness, lack of energy,

irritability, and congestive symptoms. When the _skin_ is involved the

surface is dry, harsh, and scaly, displaying dark "moth-spots,"

blotches, or numerous little sores, and the countenance has a dull,

tawny look. If the _kidneys_ be disturbed by it, there may be pain and a

sensation of weight in the back, while the urine may be scanty and

high-colored, or abundant, pale, and limpid, frequently charged with

sedimentary products of disease, and voided with difficulty. If the

_womb_ be implicated in this chronic affection, the menstrual function

may be deranged, and result in an excessive or a deficient monthly flow,

and be followed by profuse leucorrhea.

The preceding allusion to the complications of chronic inflammation of

the liver shows the necessity of clearly distinguishing between the

symptoms of this disorder and those reflected by the organs which

sympathetically respond. To discriminate more effectually, and place the

correctness of the diagnosis beyond doubt, we make a chemical and

microscopical examination of the urine, and thereby detect the morbid

products which it contains, and direct our attention to the diseased

organs furnishing them. These examinations together with a complete

history of the case, enable us to make a correct and definite diagnosis

of the disease, and the extent to which it has affected the other

organs.

Before entering upon the consideration of treatment, let us briefly

enumerate the functions of the liver: _First_, it removes matter, which,

if allowed to remain in the blood, would become noxious and unfit it for

the further support of the body. _Secondly_, by secreting bile, it

furnishes to the digestive organs a fluid which assists in converting

the food into chyle, stimulates the intestine to action, and then is

itself transformed and absorbed with the chylous products, after which

it circulates with the blood and assists in nutrition until, becoming

injurious and pernicious, it is re-secreted and re-elaborated to serve

again, as described.

For its growth and nourishment, the liver is furnished with blood by the

hepatic artery; but for the purpose of secretion and depuration, it is

abundantly supplied with venous blood by the portal system, which is

made up of veins from the spleen, stomach, pancreas, and intestines.

This impure, venous blood, surcharged with biliary elements, which must

be withdrawn from it, is freely poured into the minute network of this

glandular organ. In a healthy condition of the liver, the carbonaceous

elements of the blood are converted into sugar, and the constituents of

the bile are liberated by the liver, and set apart for further duties.

When it fails to eliminate these noxious elements from the blood, it is

itself thoroughly vitiated by them.

TREATMENT. Food must be rich in carbon in order that it may build up the

tissues and keep the body warm, but carbonic acid, the result of the

combustion, must be removed from the blood, or death will ensue. So bile

is necessary to digestion, nutrition, and life; yet, if it be not

separated from the blood by the secreting action of the liver, it will

as surely poison the system and destroy life as carbonic acid. Although

the constituents of the bile exist in the blood, they must be removed in

order that the blood may be rendered more fit to support the body, while

the secreted bile is destined to assist in digestion, and the mysterious

process of nutrition. Therefore, we should induce a secretion of bile,

and restore the normal activity of the liver. This should be done, not

by administering stimulants, but by relieving it of all contingent

embarrassments as far as possible. Would any one think of giving to a

weak, debilitated man large portions of brandy to enable him to work?

Does not every one know that, when the unnatural stimulus is removed, he

fails? Apply this principle in the treatment of the liver. When harsh,

unnatural stimulants and "bile-driving" medicines are administered for a

time and then withheld, the liver relapses into a more torpid and

debilitated condition than before treatment was begun. Is not this true

of nine-tenths of all who suffer from this malady, and have recourse to

this class of remedies?

Then how can we remedially fulfill the preceding indications? We answer

in the language of a distinguished author and standard medical writer,

"by using a class of agents which should never be overlooked in the

treatment of long-standing liver diseases, chiefly addressed to the

blood and denominated '_alteratives._'"

_Alteratives, tonics_, and _restorative catalytics_ are required not

only in diseases of the liver, but in a large number of ailments in

which the blood becomes charged with morbid materials. The active

remedial properties of the most efficient agents of the above classes of

medicine now known, are scientifically combined in the "Golden Medical

Discovery," which acts _especially_ upon the blood, and hence influences

the system generally. It is also powerful in eliminating those morbid

humors which are afterwards subjected to excretion through various

organs.

Its action is radically different from most medicines employed in

chronic diseases, for the reason, that what is usually prescribed, is

something corrosive. Unless the disease be temporary, it may return with

increased violence.

We have been very minute in the description of the remedial properties

of the "Golden Medical Discovery," and have relied upon the reason and

intelligence of our patrons, believing that they can, in a degree,

understand why we deem it so applicable to the system. It does not

debilitate the liver by over-stimulation, nor irritate the stomach and

bowels by disturbing the delicate processes of digestion, neither does

it act with severity upon the blood, but it operates so gently,

insensibly, and yet with so much certainty, that it excites the surprise

and admiration of the patient.

From the careful detail of its various properties, there is abundant

reason for its favorable action upon all of the excretory organs, which

co-operate in the removal of morbid materials from the system. If,

however, the bowels are unusually sluggish or obstinately constipated,

it is advisable, in conjunction with the "Golden Medical Discovery," to

use the "Pleasant Pellets," which are also powerfully alterative,

besides being mild and unirritating in their operation. They are the

natural assistants of the "Discovery," working harmoniously together.

They should be taken in small doses, and their use perseveringly

followed, until the bowels are properly regulated by the use of the

"Discovery" alone.

It has been customary to resort to powerful drastic cathartics, followed

by bitters prepared in dilute alcohol. The habit is unscientific, for it

is well known that alcohol deranges the functions of the digestive

organs and depraves the blood, besides creating a morbid appetite. It

has been repeatedly demonstrated that the use of such bitters has led to

a life of drunkenness, with all the woe and untold misery which attend

it.

Medicines to be strictly remedial, should exert a tonic influence upon

all the vital processes. Those organs which are contiguous to the liver,

or connected by sympathy with it, should be assisted in the performance

of their functions. Persons who are habitually subject to "bilious"

attacks are pleased to find that the use of the "Discovery" and

"Pellets" furnishes immunity from such onsets, and prevents their usual

recurrence. Thus these remedies are _preventive_ as well as _curative_.

What we have thus far recommended for the treatment of this chronic

affection is within the reach of every family. Patients laboring under

this disease, when complicated with other affections, require special

consideration and treatment, and all such are counseled to employ only

those physicians whose experience and success entitle them to

confidence. Health is one of the greatest of blessings, and how to

restore it when lost, is a question of vital importance.

Having successfully treated thousands of invalids who have suffered from

this chronic affection, we possess abundant evidence of the curability

of the disease, but we have only space to publish a few letters from

persons who have been under our care, or who have used our medicines,

purchased from druggists.

CONSTIPATION. (COSTIVENESS.)

Health depends very largely upon the regularity of the bowels. There

should be proper alvine evacuations every day. There are few persons who

have not suffered at some period of their lives from constipation of the

bowels. Inattentive to the calls of nature, or a neglect to regularly

attend to this important duty, sooner or later, produces disastrous

results. Furthermore, it is essential to the comfort of every

individual, for, when this function is not performed, there is

derangement of the mental as well as of the bodily organs.

Constipation, or _costiveness_, as it is sometimes termed, is a

functional derangement of the large intestine. This intestine is about

five feet in length, and consists of the cæcum, colon, and rectum. It

serves as a temporary reservoir for the excrementitial residue of

alimentary matter, and for the effete materials excreted by the glands

contained in its mucous coats. It is distinguished as the _large_

intestine, because of its great size.

Habitual constipation produces many derangements, resulting from

_sympathy, irritation_, or _mechanical obstruction_. By referring to

Figs. 4 and 9, the reader may observe the anatomical relations which the

large intestine sustains to the other abdominal organs. The ascending

colon arises in the cæcum (Fig. 4), at the lower part of the abdomen,

and passes over the kidney on the right side, where it begins a

circuitous route around the abdominal cavity, comes in contact with the

inferior surface of the liver, proceeds behind and below the large

curvature of the stomach, emerges on the left side, and passes downward

in front of the left kidney, where it dips into the pelvic cavity, and

ends in the rectum.

If fecal matters are retained until they are decomposed, great injury

follows, since the fluid portions are absorbed, conveyed into the blood,

and, of necessity, corrupt it with their impurities. In this way,

constipation may be the source of general derangement, but _such_

disorder is seldom attributed to the torpid state of this intestine.

There is little doubt but that it thereby imposes a great tax upon the

functions of the liver, and, frequently, the fault is attributed to that

organ instead of the large intestine. Sometimes the blood becomes so

charged with fecal matter that its odor can be detected in the breath of

the subject.

An overloaded condition of the large intestine may cause inflammation of

the liver or dropsy of the abdomen. When the colon is distended, it

becomes a mechanical impediment to the free circulation of the blood in

other organs, and causes congestion of the portal system, predisposing

to chronic inflammation or cirrhosis of the liver. This latter is a

structural affection, and may, in turn, give rise to abdominal dropsy.

In a word, the accumulation of feces in the colon irritates both the

large and small intestines, thus causing congestion of the bowels,

liver, or stomach.

The protracted presence of feculent matter deadens the sensibility of

the intestine, so that great stimulation is required to provoke it to

action. The contents become dry, solid, knotty, and hard, and very

difficult to evacuate. If drastic, irritating physic be taken, only

_temporary_ relief is afforded, and it must be repeatedly resorted to,

and the dose increased, to obtain the desired effect.

SYMPTOMS. One diagnostic symptom of a loaded state of the colon, is an

abundant secretion of urine, as limpid as water. The direct symptoms

relate to the hardness of the feces and the great difficulty of voiding

them. The influence of constipation upon the functions of the liver, is

indicated by the sympathy displayed between that organ and the mind. The

patient manifests apprehension, mental depression, taciturnity, and

melancholy, all indicative of hypochondriac dejection, induced by

constipation.

We have treated patients, who, from this cause, had renounced their

bright hopes, lost their buoyant spirits, and, becoming subject to

superstitious fears, had given themselves up, night and day, to

devotions and penance. It often happens that the victims of this deep

dejection and morbid feeling of self-abasement, are persons not only of

good moral character, but of high religious attainments, and their

painful exhibitions of fear, distrust, and gloom, originate in

_physical_ rather than in spiritual causes. It is interesting to witness

this strange perversion of the imagination, this morbid debasement of

the religious faculties, and dejection of mind, due to causes disturbing

the functions of the liver and other vital organs.

Young girls, as they approach the age of puberty, seem possessed with

the idea that the unfrequent action of the bowels is a desirable habit.

They do not associate with the duty a proper regard for health, but

consider it as an inelegant and repugnant practice. The consequence is,

that at this susceptible period, constipation, induced by neglect,

arouses a latent hepatic or pulmonary disease which has been lurking in

the system.

How many girls illustrate the truth of this statement by their

complaints of dizziness, throbbing pain in the forehead and temples,

flushing of the face, transient flushes of heat over the body, while at

the same time the extremities are cold. At other times, they manifest

the evils of such a course by their stupor, drowsiness, and deep sleep,

although upon arising in the morning, they are still tired and

unrefreshed.

The constipated condition of the bowels, often leads to congestion of

the uterus and leucorrhea, followed by uterine debility, prolapsus,

excessive menstruation, anteversion or retroversion of that organ. The

infrequency of the habit, incorrectly supposed to be desirable by a

young woman, becomes nearly, if not quite disastrous to all her desires

and bright prospects. Complications arise, and neither the inexperienced

girl nor her solicitous and afflicted parents know where to look for

remedial aid. If they seek an asylum from these sufferings, they find

many private institutions, where flattering expectations of speedy

recovery are aroused. At such institutions, these uterine disorders are

generally treated merely as local diseases, while the causes are

overlooked, and, consequently, a permanent cure is not effected. Having

spent nearly all the money at her command, the patient returns home

utterly disheartened. After such failures, many of these unfortunate

individuals have applied to us and received treatment, and by

persistently following our directions, have in due time been restored to

health, amid all the comforts of home, and among friends, who rejoiced

with them in the unexpectedly favorable turn of affairs, accomplished at

a comparatively trifling expense.

We have seen infants, and also young children, in whom constipation was

obstinate. It therefore seems that it is often hereditary. In some

persons, this affection continues from childhood, with but little

variation, until bleeding pile tumors are developed. Habitual

constipation of the bowels for a long period of years will generate a

class of diseases, which are often very serious in their results.

CAUSES. We have already alluded to a sense of false modesty which

prevents a response to the calls of nature, and we may mention other

reasons, equally trifling, which deter many from fulfilling its demands.

Some are in the habit of temporarily postponing their visits to the

water closet, until, when they do go, they find themselves unable to

evacuate the bowels. Sometimes the closet is a damp, uncomfortable

out-house, situated at a distance from the dwelling, or the access is

too public, and, hence, there is an unwillingness to visit it at the

proper time. Some appear to be too indolent to attend to this duty.

Others are too energetic, and think they cannot take the time, until

they have finished some self-imposed task or attended to a pressing

engagement.

Inactive life and sedentary occupations are also causes of constipation.

Active exercise promotes all the bodily functions, and helps to regulate

the bowels. Those who are engaged in literary pursuits, find that mental

occupation determines the blood to the brain, thus drawing it from the

extremities; the temperature falls below the natural standard, and there

is almost invariably congestion of the bowels. The inmates of

boarding-schools, factory girls, seamstresses, milliners, employés in

manufacturing establishments, and all who sit and toil almost

unremittingly twelve hours in the day, do not get sufficient exercise of

all the muscles of the body, and are often troubled with obstinate

constipation.

Food prepared according to the modern modes of cookery, is one of the

causes which favors the developement of this derangement. People live

too exclusively upon bolted wheat flour. The branny portion of a kernel

of wheat consists of various nutritive elements, with more than five

times the amount of phosphate of lime contained in fine bolted flour.

Those who daily use boiled cracked wheat are not troubled by

constipation. There is no dryness or hardness of the feces, and the

bowels are evacuated without discomfort.

TREATMENT. Prevention is always better than cure; hence, a few hygienic

directions may not be amiss. Do not disregard the intimations of nature,

but promptly respond to her calls. If there is constipation, overcome it

by establishing the habit of making daily efforts to effect a movement

of the bowels. Taking regular exercise by walking, and lightly

percussing or kneading the bowels for five minutes daily, help to

increase their activity. The habit of early rising favors the natural

action of the bowels. Drinking a glass of water on rising exerts a

beneficial influence. The food should be such as will excite the mucous

secretion of the large intestines, and arouse its muscles to action. For

this purpose, there is no one article that excels coarsely-cracked

boiled wheat. Graham bread, mush, cakes, gems, and all articles of diet

made from unbolted wheat flour are valuable auxiliaries, and may be

prepared to suit the taste. Take the meals at stated hours; be punctual

in attendance, regular in eating, and thoroughly masticate your food.

Irregularity in the intervals between eating, disturbs the functions of

the intestine. The use of ripe fruits, such as apples, pears, grapes,

figs, and prunes, in proper quantities, is sometimes very beneficial.

Trivial or unimportant as these hygienic suggestions may appear, yet

were they observed, constipation, as well as most of the diseases

incident to it, would be obviated. A large proportion of the cases will

yield to the foregoing hygienic treatment without the employment of

medicines. Should it be necessary, however, to employ an aperient to

relieve the constipation, Dr. Pierce's Golden Medical Discovery will act

most congenially, and will be followed by no constipating reaction,

which invariably occurs when drastic cathartics are employed. Its

operation is mild, bringing about a healthy action by promoting the

biliary and other secretions, thus aiding nature in establishing normal

functional activity in the bowels. Recourse should be had to it before

employing any thing more strongly cathartic. However, should it prove

too mild in its aperient effects, small doses of Dr. Pierce's Pleasant

Pellets may be employed daily to assist it. Unlike other cathartics,

they produce a secondary tonic effect upon the bowels, which renders

their influence more lasting than that of other purgatives. We cannot

too strongly discourage the injurious custom which many people have of

frequently _scouring_ out their bowels with strong cathartics. It is a

bad practice, and cannot fail to do injury. The greatest benefit is

derived, not from cathartic doses, but from taking only one or two of

the "Pellets" per day, or enough to keep the bowels regular, and

continuing their use for several weeks, in connection with Dr. Pierce's

Golden Medical Discovery, strictly carrying out the hygienic treatment

heretofore advised.

The medical treatment of individual cases sometimes involves many

considerations relative to the particular circumstances and

complications presented. The peculiar susceptibility of the

constitution, as well as the diseases incident to constipation, must be

taken into account. Symptomatic derangement should not be treated as

primary, although it is by inexperienced physicians. If the patient be

afflicted with uterine disease, piles, nervous affections, falling of

the lower bowel, or fistula, they should be treated in connection with

this disease. For these reasons, we would advise our readers to submit

all complicated cases, or those that do not yield to the course

heretofore advised, to a physician of large experience in the management

of chronic diseases, and not assume the great responsibility and the

dire consequences which are very liable to arise from the improper

treatment of such cases. We have been called upon to treat thousands of

cases of this troublesome affection, and as a result of our vast

experience, and in consequence of our original and improved methods of

diagnosis, it is not generally necessary that we should see and examine

the patient in person. We can almost always determine the exact nature

of the patient's malady, and its stage of advancement, without seeing

the subject in person.

PILES. (HEMORRHOIDS.)

There are few maladies more common than this, and few which are more

annoying. Piles consist of tumors formed within the rectum and about the

anus, by dilatation of the hemorrhoidal veins and thickening of their

walls. Sometimes, when attended by considerable inflammation, or when

the attacks are very frequent, there is thickening of the adjacent

cellular and mucous tissues.

There are two general forms of this disease, the external or blind

piles, in which the tumors are outside the anus, and the internal or

bleeding piles, in which the tumors are formed within the sphincters,

although after their formation they may protrude. The external piles are

commonly made up of thick tissues; upon one side, the skin forms the

covering, while on the inner surface is the mucous membrane of the

bowel. It is this surface which is most tender and irritable and liable

to inflammation. The internal form of the disease is situated from a

half an inch to two and a half inches above the sphincter muscle of the

anus. The tumors are usually round, oval or cylindrical in form. They

may be scattered over the surface of the bowel, or clustered together.

The illustrations (Figs. 1 and 2) show the two forms of the disease. The

two protruding tumors in Fig. 2, illustrate the usual form of prolapsing

internal piles, whilst the one highest up in the bowel shows the form

most commonly met with. It is seldom that one pile tumor is found alone,

there usually being two or three, and sometimes as many as five or six,

in a cluster. Fig. 3 shows the manner of distribution of the veins in

the rectal region. The small venous loops, or bulb-like terminations of

the veins H. _i_., are the points at which the piles most frequently

occur.

[Illustration: Fig. 1.

Swollen External

Piles.]

CAUSES. Whatever tends to favor an undue accumulation of blood in the

hemorrhoidal veins predisposes to piles. For this reason the affection

is frequently a result of diseases of the heart and liver, which cause

an obstruction in the circulation of the blood through the portal vein.

Mechanical pressure from tumors in the abdomen, pregnancy, or an

enlarged or misplaced uterus, is not infrequently a cause of the

disease, by keeping the hemorrhoidal veins over-distended. Those

diseases which provoke much straining, as stricture, inflammation or

enlargement of the prostate gland, and stone in the bladder are also

active causative agents. The most common cause of all, however, is

constipation; and persons of indolent, sedentary and luxurious habits of

life are the ones most frequently affected with this derangement. The

following are also prolific causes of piles, viz.: pelvic tumors,

violent horseback exercise, indigestion, pregnancy, habitual use of

drastic cathartics, diarrhea, dysentery, sitting on heated cushions,

long-continued standing posture, diseases of the liver, worms, the

wearing of tight corsets, eating highly seasoned or indigestible food,

and the use of alcoholic stimulants. No age is exempt from piles, nor is

the disease peculiar to either sex. Aside from the serious inconvenience

and pain which are experienced with most forms of piles, there is a

tendency to fistula, and to cancer in the rectal region. It is

important, therefore, that the disease should not be allowed to run on

unchecked.

[Illustration: Fig. 2.

Piles: internal and protruding. ]

SYMPTOMS. The most common symptoms at first are slight uneasiness, such

as a little soreness or itching at the verge of the anus, and at times

lancinating pains. These sensations are more severe as a rule if the

bowels are constipated. If the piles are external they frequently become

inflamed, swollen and painful, and in some instances they suppurate,

which usually results in relief. When internal piles have increased to

any considerable extent, or have become inflamed, they produce not only

itching at the extremity of the bowel, pain in the back, etc., but also

a sensation of fullness in the rectum, as though some foreign body were

present, and, on action of the bowels, there is a sensation as though a

portion of the fæces had not been expelled. When the internal piles

become large, they frequently come down with fæcal matter from the

bowel, as illustrated in Fig. 2, and this prolapsus becomes more and

more marked with the progress of the disease, until, in many cases, the

tumors are forced down at each action of the bowels, causing

excruciating pain until they are properly replaced. Usually, in the

early stages, they recede spontaneously; however, after a time it

becomes necessary for the sufferer to press them back, but in some

instances this is impossible. Frequently during the protrusion one of

the hemorrhoidal veins gives away, and this is followed by a free escape

of blood, and ulceration may ensue. Not infrequently with this disease

the patient loses strength and flesh, and the face becomes pale and

puffy, assuming a waxy appearance. Many times there is nausea, with

vertigo. Is consequence of the relaxation, the bowel may descend when on

the feet, or with some extra muscular effort, especially when stooping.

These symptoms may not all be present in one person, and, indeed,

sometimes are somewhat obscure; when such is the case, an examination by

a competent physician will always determine the true character of the

complaint at once.

[Illustration: Fig. 3.

H. _i._ Internal hemorrhoidal veins. H. _m._ Middle

hemorrhoidal veins. H. _e._ External hemorrhoidal

veins. S. _i._ Internal sphincter muscle, S. _e._ External

sphincter muscle. ]

TREATMENT. Notwithstanding the well established fact that piles are

readily cured by the appropriate treatment, hundreds of thousands of

people suffer untold tortures from them because of the popular

impression that they cannot be cured. All cases are not, however,

amenable to the same form of treatment, for various unhealthy conditions

of the system are often concerned in their production and perpetuation,

and must, of necessity, be remedied by appropriate treatment, before a

cure of the piles can be expected. It will, therefore, become apparent

that the avoidance of causes is of paramount importance. Some of these

causes are external, and wholly under the control of the patient, while

others depend upon diseases that are curable; it frequently happens that

while other diseases are being remedied, the piles disappear Without any

special attention.

Diseases of the urinary apparatus, as stricture of the urethra,

enlargement of the prostate gland, and stone in the bladder, dysentery,

diarrhea, and constipation,--all cause piles, by the irritation, and

determination of blood, which they induce; these difficulties must be

removed by appropriate treatment.

Some years since, we ascertained that we were using in our practice

remedies which, in addition to other virtues, possessed a direct

specific influence upon the vessels concerned in the formation of piles.

These agents enter into the composition of Dr. Pierce's Golden Medical

Discovery, which, consequently, will be found exceedingly efficacious in

the treatment of this disease. This remedy, therefore, in removing the

disease upon which the piles depend, as a congested or torpid liver,

constipation, etc., and in exciting a direct curative control over the

piles themselves, exerts a double influence. It may be aided, when the

bowels are badly constipated, by the use of Dr. Pierce's Pleasant

Pellets, taken in the morning, to secure a regular and easy evacuation

of the bowels each day. All stimulating food and alcoholic drinks should

be abstained from. The cold bath is beneficial in these cases, provided

there is not great debility. The affected parts should be bathed

frequently with cold water, and, if prolapsus exists, it is well to

inject a little cool water into the rectum, and allow it to remain a few

minutes. As a soothing, astringing and healing application to the

affected parts we prepare an Ointment that has acquired great fame for

the prompt relief which it affords in all ordinary cases. This we do not

sell through druggists but can send by mail, on receipt of price, $1.00

per large box, postage prepaid. The persistent use of this Ointment, at

the same time keeping the bowels regular by the use of "Golden Medical

Discovery," with an occasional laxative dose of "Pellets," will

generally cure all ordinary cases of piles.

THE RADICAL CURE OF LARGE PILE TUMORS. In cases in which the tumors have

become indurated and very large it is impossible to effect cures by the

foregoing or any other medical treatment. Various methods have been in

use by the profession for the relief of the most severe cases. The most

common is excision with the knife or scissors. Reference to the large

vessels, shown in Fig. 3, which are affected in this disease, will at

once show the sufferer the dangers of this method. The sudden removal of

a tumor, which is connected with one or more of the large hemorrhoidal

veins, is sure to be followed by severe hemorrhage, and many times

painful ulceration, and a fatal result. To avoid this it has been the

practice of many physicians to apply caustics or to burn off the base of

the tumors with a red-hot iron. A more barbarous and painful method

could not be devised. When it is considered that in many cases, this

severe and painful treatment is followed by ulceration, and occasionally

by the developement of cancer, the matter should be carefully weighed

before any such dangerous procedure is attempted. Another common method

of treatment is to crush the base of the pile with a clamp, and then cut

off the tumors with scissors. After this it is also necessary to apply

the hot iron to prevent hemorrhage. Formerly, applications of nitric

acid were in common use by physicians as a means of cure, but it was

found that while this treatment would give temporary relief, yet in no

severe case would it effect a cure. By what we term palliative treatment

alone more cures are effected than by the old process of treatment with

nitric acid. Still another form of treatment is strangulation of the

pile by means of a ligature, and this is often more painful than the

application of hot irons, inasmuch as in cutting off the return flow of

blood from the piles, a large tumor is left for days fully distended and

extremely painful. It does not slough off for a considerable time, and

we have seen the strongest men suffer intensely, to whom the use of

scissors in removing the tumors was a positive relief in comparison with

the torture of the ligature. A treatment that has been highly

recommended by some physicians and condemned by others, is the process

of injection with carbolic acid. This method of treatment is not very

painful but, unfortunately, it is dangerous. The injection of the tumors

with a fluid which causes coagulation of the blood, and which does not

completely shut off the return current of the circulation through the

tumors, has proved fatal in a small percentage of cases. The clots which

are formed by this treatment become detached and are carried into the

general circulation and conveyed to the liver, lungs and even to the

brain, where, by plugging up the vessels of those organs, they cause

abscesses which terminate life. Serious inflammation of the veins is

another accident which often follows the injection of carbolic acid.

This treatment is, therefore, now seldom resorted to except by

physicians who do not appreciate its dangers.

A MORE SUCCESSFUL METHOD. Fortunately for suffering humanity, a method

of treatment has been perfected and thoroughly tested in our

institution, in which all such trouble and danger as above described are

avoided. This consists in bringing down the tumors, cleansing them and

making application, of certain chemical preparations, that cause the

tumors to speedily shrivel up, and in a very short time, say ten to

fourteen days, disappear entirely. These treatments and applications

cause _no pain whatever_, for by first applying a weak solution of

cocaine to the parts they are speedily rendered entirely insensible, so

that the most sensitive, nervous lady experiences not the slightest

suffering from the application of our remedies.

Having now at our command means so positively certain in their action

upon pile tumors, we do not hesitate to say that the very worst cases,

no matter of how long standing, can be promptly cured, if we can only

have the patient for a few days under our personal care. Considering the

very distressing character of pile tumors, it is a great boon that we

have at last found safe, painless, and positively certain means for

their cure. The news will be hailed with joy by a large class of

sufferers.

Probably no other discovery in modern science is destined to be the

means of conferring greater blessings on a large class of sufferers than

that of a painless and positive method of curing the largest pile tumors

in the brief time required by our system of treating them.

It seems to us that there is no longer an excuse for any one to endure

the tortures inflicted by pile tumors, provided the afflicted one can

command the little time and moderate amount of means necessary to secure

the treatment indicated. Piles are not only in and of themselves very

painful and annoying, but often greatly aggravate and even cause other

grave and painful affections, and should, therefore, not be neglected.

When large, they never get well without proper treatment. We have seen

many cases in which the long train of diverse and distressing symptoms

caused by piles led the sufferer, and even the family physician, to

suppose that other diseases existed, but all of which annoying symptoms

were speedily dispelled by the cure of the piles. We have no doubt that

neglected piles, fistulæ, and other morbid conditions of the lower

bowels, frequently degenerate into cancerous disease. We have the

eminent authority of J. Hughes Bennett, of Edinburg, and many other

close observers, for saying that benign or ordinary tumors often

degenerate into real cancerous disease, and our own extensive

observation convinces us that this is not infrequently a result of

neglected rectal disease, as piles, fistulæ and fissures. How important,

then, to give prompt attention and skillful treatment to disease of

these parts. When the ordinary palliative treatment, with ointments and

with laxative agents to keep the bowels soluble, does not _completely

and perfectly_ subdue the malady, lose no time in securing the most

skillful appliances, that every vestige of the affection may be promptly

removed. We have treated many thousands of cases with uniform success,

and our patients write to us expressing the greatest degree of

satisfaction, and recommending our method most highly.

Reports of a few cases, selected at random from the large number which

we have cured, are given below to illustrate our success in curing them.

ANAL FISTULA. (FISTULA IN ANO.)

This disease is _more dangerous_ than piles, though, after once formed,

not so painful. It sometimes commences with intense itching about the

anus, accompanied with a little discharge; or the first symptom may be a

painful abscess, like a boil, which finally breaks. The soreness then in

a measure subsides, leaving a fistulous opening, with a continuous

discharge of matter. This unnatural opening, with its constant drain

upon the system, sooner or later is certain to ruin the health or

develop consumption or other maladies, and destroy life.