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 [pg 548]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.

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 [pg 549]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 [pg 550]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.

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 [pg 551]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.

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. [pg 552]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 [pg 553]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 [pg 554]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, [pg 555]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 [pg 556]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, [pg 557]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, [pg 558]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 [pg 559]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 [pg 560]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 [pg 561]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 [pg 562]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 [pg 563]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 [pg 564]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. [pg 566]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.

[pg 567]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 [pg 568]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.

[pg 569]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 [pg 570]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 [pg 571]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 [pg 572]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 [pg 573]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.

[pg 574]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 [pg 575]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 [pg 576]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 [pg 577]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 [pg 578]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.

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, [pg 579]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.

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 [pg 580]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.

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 [pg 581]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 [pg 582]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 [pg 583]lower bowels, frequently degenerate into cancerous disease. We have the eminent authority of J. Hughes Bennett, of Edinburg, and many other close observers, for saying that benign or ordinary tumors often degenerate into real cancerous disease, and our own extensive observation convinces us that this is not infrequently a result of neglected rectal disease, as piles, fistulæ and fissures. How important, then, to give prompt attention and skillful treatment to disease of these parts. When the ordinary palliative treatment, with ointments and with laxative agents to keep the bowels soluble, does not completely and perfectly subdue the malady, lose no time in securing the most skillful appliances, that every vestige of the affection may be promptly removed. We have treated many thousands of cases with uniform success, and our patients write to us expressing the greatest degree of satisfaction, and recommending our method most highly.

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

ANAL FISTULA. (FISTULA IN ANO.)

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

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

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

Causes The causes are a constitutional predisposition, constipation, piles, or the presence of foreign bodies in the rectum, causing an [pg 584]abscess or ulcer. Some authors have contended that fistula always originates from an ulcer in the rectum, which gradually makes its way through the cellular tissue to the surface. Others contend that the cause of this disease consists in an abscess, which burrows in the tissues and makes its exit into the rectum, or through the skin, or both. No doubt it may originate in both ways. It can readily be seen that when an internal opening is once established, the foeces which enter into it must sooner or later work their way to the surface, burrowing through those parts which offer the least resistance, until a place of exit is reached.

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

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

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

The use of the knife is becoming obsolete, and has, to a great extent, given way to other measures which are equally successful. Indeed, other means will succeed in cases in which the knife fails or is for any reason inapplicable. One great objection to the knife is not only the [pg 585]dread which patients entertain of it, but the great liability of its use to result in paralysis of the sphincters of the anus, the consequence of which is loss of control over the bowels; and another is that it sometimes entirely fails to result in cure. By the means which we employ, these objections are entirely overcome, and, while the general system is being renovated, the fistula is healed, without any complications.

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

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

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

TESTIMONIALS.

While we have a great cloud of witnesses testifying to the efficacy of our treatment of the diseases described in this volume, yet for lack of space we can here introduce only the few following:

"LIVER COMPLAINT."

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

J.H. May, Esq.

Gentlemen—In the year 1889 I was taken with disease which the doctors called "liver complaint." I tried three different doctors. They did me no good. They tried about one year; I was not able to work for two years. At last I thought I would try Dr. Pierce's medicines, and I wrote to Dr. Pierce, and he wrote to me to take his "Golden Medical Discovery," and I bought two bottles, and when I took it, I saw it was improving me, and I got five more, and before I had taken all I was well, and I haven't felt the symptoms since. I had a continued hurting in my bowels for about two years. I feel as if the cure is worth thousands of dollars to me.

Yours truly,
J.H. MAY,
Potts' Station, Pope Co., Ark.

DYSPEPSIA AND WOMB DISEASE.

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

Mrs. Ransom.

Dear Sirs—When first taking Dr. Pierce's Favorite Prescription I was nervous and would have sour stomach and distress after eating, and when I would rise after stooping over everything would turn dark before me and I would feel dizzy. I suffered a great deal of pain at each monthly period. I took one bottle and a half of the "Favorite Prescription," one teaspoonful three times a day, and the "Pellets" as directions called for. I gained in health and strength so rapidly that I have been able to work very hard the past summer, and my back never troubles me; and when I have my monthly periods I never feel the least bit of pain. In fact I consider myself in excellent health.

Very truly yours,
MRS. INEZ V. CARR RANSOM,
Panama, Chaut. Co., N.Y.

INFLAMMATION OF LIVER.

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

T.J. Bentley, Esq.

Gentlemen—I was taken sick with inflammation of the liver and could get no relief from the doctors of this place—Randolph, N.Y. I was induced to use Dr. Pierce's Golden Medical Discovery, and "Pleasant Pellets," and after using five bottles of the medicine, I regained my health, and now I am a well man. I weighed 185 pounds before taken sick, and I was reduced to 135 pounds in sixty days' time. I suffered greatly from headache, pain in my right shoulder, poor appetite, constipation and a sleepy feeling all the time. My health is now very good, and I weigh 170 pounds, and I am able to do a good day's work without any trouble at all. Thanks to these valuable medicines.

Yours truly,
THOMAS J. BENTLEY,
Randolph, Catt. Co., N.Y.

[pg 587]LIVER DISEASE AND DYSPEPSIA.

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

Mrs. Hart.

Dear Sirs—I am enjoying excellent health. After taking a bottle of Dr. Pierce's Golden Medical Discovery and several bottles of "Pellets," I am a different person. Only weighed 119 pounds when I began taking your medicine, now weigh 160. My symptoms were pain under the left shoulder, distress after eating, headache, dizziness, constipation, and, in fact, my system was "out of sorts generally." I tell every one your medicine has done more for me than any other.

I remain, yours truly,
MRS. CHARLES H. HART,
San Ardo, Monterey Co.,
California.

LIVER COMPLAINT AND CATARRH.

Wm. King, Esq.

Dear Sirs—After suffering for several years with nasal catarrh and liver complaint, and having become greatly reduced in health, as a last resort I placed myself in your hands for treatment. My improvement began almost immediately after entering your institution. I was enabled to leave at the end of one month, having experienced great benefit. The treatment was continued at home for a few months, after which my cure was complete. At the present time, I am able for office work, and feel that I am completely cured of the catarrh and have but little if any trouble with my liver. I shall lose no opportunity to recommend your institution or your medicines to the afflicted. I do most unhesitatingly recommend chronic sufferers to visit your institution or take your remedies at home.

Sincerely yours,
WILLIAM KING,
Rose Bud,
Pope Co., Ills.

A COMPLICATED CASE OF STOMACH, LUNG, AND UTERINE DISEASE.

Mrs. Rademaker.

Dear Sirs—Some six years ago I was taken sick with chills; I would have a very bad chill and then I would begin to sweat and vomit; I had no appetite; I had the catarrh very bad; I had inward troubles of different kinds; my back ached all the time; I had sores gather and break inside; I had a lung trouble; I was very bad off; I could sit up only long enough to have my bed made; my husband sent for our family doctor; he came three times a week for three months; I was not so well at the end of three months as when he first came, but kept growing worse; he gave me up to die, and said I had consumption. I had heard of Dr. Pierce's medicines doing a good deal of good, so I made up my mind to try them. I sent and got one bottle of "Favorite Prescription" and one bottle of "Golden Medical Discovery"; also one bottle of "Pellets," and commenced taking them. In a few days I commenced to gain, and In two weeks' time I could sit up most all day, and in five weeks' time I could do my work with the help of two small girls. After taking four bottles of "Favorite Prescription," six bottles of "Discovery," and three of "Pellets," I was well enough to get along without any medicine. I can do a good day's work, and I owe my life to Dr. Pierce. With God's will and the use of Dr. Pierce's medicine I am still alive and well.

Yours respectfully,
Mrs. CLARA A. RADEMAKER,
Addison Point, Washington Co., Me.

LIVER COMPLAINT AND DROPSY.

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

Mrs. Dennis.

Gentlemen&