After doctoring her three months she was reduced to a mere skeleton and had to be tended to like a mere baby and have her feet elevated, or else she would scream with pain. We commenced giving her Dr. Pierce's Golden Medical Discovery. After using it for one month we could see, for the first time, that she was getting no worse, and after using about five bottles her health began to improve a little; but she still suffered with pain and could not have her feet down until she had taken twelve bottles. When she had taken fifteen bottles—she began to walk on crutches, and later with a cane, for about two or three months, when she could walk without a crutch or cane. The diseased bones gradually came out in pieces, some of them an inch to two inches long and one-fourth of an inch thick; the sores healed as soon as the last dead bone was out. She is now a strong healthy young lady as her photograph plainly shows.

Respectfully yours, D.R. SCHROER. Holstein, Warren Co., Mo.

GENERAL DECLINE, RUNNING SORE ON LEG.

Fort Coulonge, Pontiac Co., Quebec.

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

Gentlemen—Thanks be to God, and you, I have the best of health since I have taken your special medicine and one bottle of "Favorite Prescription." I was as weak as any person could be without dying, and I am as healthy as any person can be to-day, and I have gained ten pounds since, and a great many people remark to me how much better I look.

Also, I can mention to you another person who was cured by your "Golden Medical Discovery." His name is John McCoy. For near two years he never walked. He suffered from a running sore on his leg, and after using twelve bottles, he could walk all right and is well to-day The doctors wanted to have it taken off. You say in your letter you would like to have a photograph. I have none and there is no photograph gallery in this village or I would have one taken.

Yours truly, Mrs Isaac Brady

ECZEMA.

DR. R.V. PIERCE, Buffalo, N.Y.:

Dear Sir—When I was married I weighed 125 pounds. I was taken sick with a disease which my doctor said was eczema. He failed to do me any good, and I fell away to 90 pounds. I had dyspepsia so bad that I could not eat anything. My husband got me "sarsaparillas" and "cures" and "bitters," and nothing did me any good. Finally he got two bottles of Dr. Pierce's Golden Medical Discovery. I began using it, and, thank God and you, I improved; now I weigh 140 pounds, and my skin is as smooth as a baby's. My husband says I look younger than I did the first time he saw me. I have better health than ever, and I owe it all to you. It is a miracle that I am cured. I cannot say too much about the medicine.

Very respectfully, Rebecca F. Gardner

"FEVER SORES" OR INDOLENT ULCERS—DROPSY AND TORPID LIVER.

Dr. R.V. PIERCE, Buffalo, N.Y.:



Dear Sir—I write in regard to your great "Golden Medical Discovery." I cannot be thankful enough to you for what it has done for me. As a result of the grippe I had dropsy, and ulcers formed on my legs with a most intolerable itching at night after going to bed. My circulation was very poor and liver inactive. I feel perfectly well since I took the medicine. The old sores on my legs are all healed up, and I feel like a new man. I highly recommend your "Golden Medical Discovery" to any inquiring person, for it has saved my life.

Yours very truly, FRED. PESTLINE, Alexander, Genesee Co., N.Y.

RUNNING SORE.

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



Gentlemen—It pleases me to state that I had a running sore up on my neck, and had it operated upon three times, and still it was not cured. I was also run down very much. There was a decided change after using Dr. Pierce's Golden Medical Discovery. I took a few bottles and was soon cured Later my husband had a lump behind his ear; he tried your medicine, and one bottle cured him. I shall always recommend your medicines.

Yours respectfully, MRS. L. KOHN, No. 618 E. 16th St., New York City.

"OLD SORES" ON LEGS.

Alexander, N.C.

DR. R.V. PIERCE, Buffalo, N.Y.:

Dear Sir—Your "Golden Medical Discovery" has proven a blessing to me. It was recommended to me by Rev. P.A. Kuykendall. I have been a sufferer with old sores on my legs for four years. I used three bottles of it, and my legs are sound and well and my health is better than it has been for some time. I had THE best doctors of this country treat my case and they failed to effect a cure.

Yours respectfully, J.N. Kery Kendall

HIP-JOINT DISEASE.

PHYSICIANS FAIL TO BENEFIT.

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



Gentlemen—At the age of eight years I became afflicted with "Hip-joint Disease." For a year I suffered as much as it was possible for a human being to suffer. My physicians told me I would have to wait patiently, but my father procured me some of Doctor Pierce's Golden Medical Discovery, and I found my falling health restored.

I can cheerfully say that I believe I owe my life to the use of that valuable medicine.

Your true friend, EDWARD J. RUSH, Elizabeth, Harrison Co. Ind.

HIP-JOINT DISEASE CURED.



MISS MARY E. RIDGLEY, of Gales Creek, Washington Co., Oregon, when only three years old, had lameness in one of her lower limbs but the use of liniment and Dr. Pierce's Pellets relieved her, and she got better. When six years old the trouble developed into hip-joint disease, so pronounced by her physician. She lost the use of the limb. Was three months under the doctors, but got no better. She complained of great pain in the limb, especially in the knee and hip. The limb wasted away, becoming small and short, and her back became crooked. She had no appetite; was very weak. Hip and knee were very tender to the touch. Physician's treatment not helping her, her mother began to give her "Golden Medical Discovery." Four months afterwards she wrote Dr. Pierce as follows: "She is growing fast, and never complains of any pain or ache. She sleeps well, and eats heartily. Her leg has filled up, and is as big as the other. She plays around all day with the other children. Everybody is astonished to see how she has improved."

In the margin we print Miss Ridgley's picture as she appears twelve years after this treatment, at the age of eighteen. The young lady herself, writes Dr. Pierce as follows: "Your medicines are worth their weight in gold. I was cured of hip-joint disease by the "Golden Medical Discovery" and "Pellets," and I feel sure that they can cure the worst cases if given a chance."

HIP-JOINT DISEASE OF 11 YEARS' STANDING.

P.O. Box 128, Gagetown, Tuscola Co., Mich.

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

Gentlemen—When I began taking your medicines I was in bed, nothing would relieve me, my hip being swelled seemingly ready to burst. When I began to take Dr. Pierce's Golden Medical Discovery and "Pellets," the swelling gradually decreased; when I had taken one bottle I was able to be up. I don't know how long I will remain well, but I am satisfied that it is the medicine that did the work: I take it right along; as long as I can keep the way I am now, I am satisfied. I have recommended your remedies, and will continue to do so.

Yours truly, H.F. Giron

THICK NECK (GOITRE).

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



Gentlemen—I am willing and pleased to have you publish anything I have written in regard to the cure of my little son of Goitre (that a surgeon of N. Adams said could never be cured).

I do hope that by so doing some little one may escape the misery my little one suffered for over a year until I began the use of the "Golden Medical Discovery." I followed your directions found in the little book around the bottles. Before the first bottle was gone, he could eat and sleep without that coughing and choking that, before the use of the "Discovery," was impossible.

The tumor began to lessen in size, and after the third bottle I would never have known he ever had a tumor there. He is now hearty and healthy. Sleeps as good as any child and is full of life. He does not take anything to prevent a return, and has not for over a year.

I have one of your Common Sense Medical Advisers, and found it worth five times what I gave for it; I have helped others to get it and the "Medical Discovery" and "Favorite Prescription" have brought relief to many through me I use the "Prescription" off and on; it has given me strength; I think I should have been an invalid long ago without it.

Every one here knows the truth of this letter, and I would tell it to the world if I could. Respectfully,

MRS. ANNIE SUMNER, Heartwellville, Bennington Co., Va.

THICK NECK (GOITRE),

NERVOUS DEBILITY AND WEAKNESS CURED.



Miss ELLA A. HOUGHTON, of Theresa, Jefferson Co., N.Y., was cured of Thick Neck, Nervous Prostration, Weakness and a complication of ailments by Dr. Pierce's "Discovery" and "Favorite Prescription." She says: "My health is now as good as it was before I was sick. The swelling (goitre) has all gone from my neck. I don't have any bad feelings. My gratitude for the benefit I have received from your treatment has induced me to recommend you to all whom I know to be sick." "I have known of two or three middle aged ladies residing near here, who have been cured by your 'Favorite Prescription.'"

GOITRE CURED.

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



Dear Sirs—I can say that your medicine has done its work well in the case of my sister, Miss Rachel Mann. She is entirely well of Goitre and throat trouble. I am glad to say that we can recommend your medicines very highly.

Very truly yours, MARY J. MANN, for sister Rachel Mann, Romola, Center Co., Pa.

CARBUNCLES LARGE AS HEN'S EGGS!

EIGHT OR TEN YEARS AFFLICTED. TWO BOTTLES ONLY, CURE.

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



Gentlemen—For about eight or ten years my father was laid up with carbuncles, the worst that I ever saw. He tried everything he heard of, and his doctor did everything he could for him, but nothing did him any good. Had six or seven carbuncles at a time, as large as a hen's egg; he got so weak and suffered so much he could not walk a step. It was in the summer of '72 or '73 that he had his bed put in the middle of his chamber and got on it to die. No one expected him to get well. Looking over the newspapers, he saw your "Golden Medical Discovery" advertised, and the good it had done. There was not any sold then in the country, so he sent to Richmond—forty-five miles—and got a bottle. When he began to take it he was nearly covered with carbuncles—little and big together. Before he had taken half-a-bottle they began to go away. Before he had taken two bottles he was entirely cured, and he has never been bothered with them since. Every time he sees any sign of them, he gets a bottle of "Golden Medical Discovery" and it cures them. My father, Col. T.U. Fogg, lives in West Point, King William Co., Va. He is now seventy-eight years old, and enjoys good health.

Yours truly, Mrs. NANNIE GOULDMAN, Beulahville, King William Co., Va.

* * * * *



THICK NECK. (GOITRE.)

Thick neck, or goitre, also sometimes called bronchocele, consists of an enlargement of the thyroid gland, which lies over and on each side of the trachea, or windpipe, between the prominence known as "Adam's apple" and the breast bone. The tumor gradually increases in front and laterally, until it produces great deformity, and often interferes with respiration and the act of swallowing. From its pressure on the great blood-vessels running to and from the head, there is a constant liability to engorgement of blood in the brain, and to apoplexy, epilepsy, etc. When the enlargement once makes its appearance, it continues to increase in size as long as the person lives, unless appropriate treatment be resorted to. It never disappears spontaneously. These tumors are much larger than those not familiar with them would suppose from their outward appearance, as they extend under and are bound down by the muscles on each side of the neck, so that they become embedded in the cellular tissues underneath, while the sides of the neck retain, to a considerable extent, their round and even appearance, whereby the real magnitude of the tumor is not apparent. Figure 7 represents the appearance of the neck of a person afflicted with this disease. The form of protuberance varies materially with different persons, that shown in the engraving being the shape which it ordinarily assumes.



The causes of the affection are not well understood. The use of snow-water, or water impregnated with some particular saline or calcareous matter, has been assigned as a cause. It has also been attributed to the use of water in which there is not a trace of iron, iodine, or bromine. A writer in a Swiss journal, Feuilles d' Hygiene, states that the disease is often due to an impeded circulation in the large veins of the neck, from pressure of the clothing, or from the head being bent forward, a position which is often seen in school children, when the muscles of the back of the neck have become fatigued.

TREATMENT. We have obtained wonderful results by a new method of treatment, which consists in the employment of electrolysis in conjunction with other therapeutic means. There is scarcely a case in which this treatment, properly carried out, will not effect a radical cure. It is attended with no danger whatever.

Those who are afflicted with this disease and unable to avail themselves of special treatment, cannot do better than to take Dr. Pierce's Alterative Extract, or Golden Medical Discovery, and apply to the skin over and around the tumor, night and morning the following solution which may be prepared at any drug store: iodine, one drachm; iodide of potassium, four drachms; dissolve in three ounces of soft water. Apply to the tumor twice a day, with a feather or hair pencil.

MUMPS. (PAROTITIS.)

This is an inflammation of the parotid glands and generally occurs in childhood. It is often epidemic, and is manifestly contagious. It usually, though not always, appears on both sides of the neck at the same time.

SYMPTOMS. An external, movable swelling, just below and in front of the ear, near the angle of the jaw, is the prominent symptom. The enlargement is not circumscribed, but hard and painful, and attended with more or less fever, derangement of the secretions, and difficulty in swallowing. The swelling increases until the fourth and fifth day, when it gradually diminishes, and by the eighth or tenth is entirely gone. Sometimes the disease is accompanied by swelling of the breasts in the female, or the testicles in the male.

TREATMENT. Usually but little treatment is necessary. Exposure to cold should be avoided. If severe or painful, with febrile symptoms, a hot foot-bath and small doses of the "Compound Extract of Smart-Weed," in some diaphoretic infusion, to induce sweating, together with small doses of aconite, will produce good results. If swelling of the testicles threatens (which seldom happens except on taking cold), resort should be had to mild cathartics, the spirit vapor-bath, stimulating liniments to the neck, and warm fomentations to the part attacked If delirium occurs, a physician should be summoned.

INFLUENZA, OR LA GRIPPE.

This is an infectious disease, characterized by depression, and usually associated with a catarrhal condition of the mucous membrane. It may affect the respiratory organs or the intestinal canal. There is a marked liability to serious complications, of which pneumonia is the most dangerous. The disease is evidently due to a specific virus of great infectiveness, and is more active and contagious at certain seasons and under certain conditions of the atmosphere. By some it has been supposed that it is due to a miasma in the air, but the character of its infection indicates that the true virus is of a germinal nature.

Uncomplicated cases recover, but in the aged and in the delicate we may see fatal results, due usually to the profound depression or the high temperature to which the individual is subjected. There is much redness and swelling of the mucous membranes of the nose and throat—a bronchitis—and a catarrhal state of the stomach and intestines. These may all be present, or the disease may center upon one particular portion of the animal economy, and manifest its ravages there alone.

SYMPTOMS. The attack usually resembles an ordinary catarrh of cold. In some cases the nasal catarrh is absent, or very mild, and the infection invades the general system, with much fever. A very striking manifestation of the disease is the severe nervous troubles which are present at the outset, consisting of headache, pain in the back and legs, and a general soreness of the muscles and bones as if bruised or beaten. The pulse is usually feeble and small—intermittent. The disease may center in the brain, producing delirium. Mental disorders are not uncommon, and there is usually following the disease more or less inaptitude for mental work and a tendency to depression of spirits. In many cases there is a severe diarrhea, and the individual suffers much from pain and discomfort in the abdomen. This is a gastro-intestinal irritation, and apparently favors an early recovery, and usually there are less severe sequels in such cases.

The most dangerous complication is pneumonia. These cases may follow bronchitis, or the grip may begin with well-characterized symptoms of this disease, for which see the chapters upon this trouble. The sputa may not be rusty until after several days. The crisis is usually slow, and a considerable proportion recover, the disease frequently showing a sudden change for the better, and the patient being up and around in a few days. Cases complicated with pneumonia are the most indefinite in their symptoms, and require the closest attention.

TREATMENT. In every case the disease must be regarded as a dangerous one, and the patient be confined to bed and indoors until all fever has disappeared, otherwise sudden and serious manifestations are liable to appear at any time. The patient must be well fed and nourished from the outset. The bowels should be acted upon by mild laxatives, such as castor oil or Dr. Pierce's Pleasant Pellets, using from one to three. It is also of advantage afterward to move them twice each day, by the injection of warm water, to which has been added a teaspoonful of table salt to each pint. This injected into the rectum, using the water slightly tepid, or cool if the patient is feverish, will tend to soften the actions from the bowels and favor the escape of poisonous matter. The cool water has also a soothing effect upon the fever and nervous system. If the fever is high, and there is delirium, small doses of aconite, with water, should be used every half hour or hour, but all depressing agents of this kind must be used with caution, as profound prostration sometimes develops. Warm baths, repeated frequently, and followed by hot lemonade, are of the greatest benefit in reducing the feverish condition and quieting the patient. The bed should be warmed after these are administered and the patient given hot lemonade to bring on free action of the skin, kidneys, and bowels. Where the pulse is weak, the free use of stimulants, as wine, coffee, tea, and brandy or whiskey, are required, as the great danger of the disease is a depression of the heart. In severe bronchitis, pneumonia, and other complications, appropriate treatment should be applied.

* * * * *



ACUTE NASAL CATARRH.

Acute Nasal Catarrh, or cold in the head, is an acute inflammation of the mucous membrane lining the nasal passage which may confine itself to these parts or extend to the pharynx, larynx, and air-passages below, or affect the auxiliary sinuses or cavities communicating with the nasal passages.

The most frequent cause of cold in the head is exposure to sudden changes in temperature, or draughts of cool air, without taking proper precaution to protect the body so as to prevent the rapid radiation of animal heat. In most cases there is an inherited tendency or acquired weakness, which frequently may be associated with a scrofulous condition of the whole system, that render these points less resistant, and consequently invite the morbid changes which result from exposure and cold. Acute Catarrh also occurs during the initial stage of such eruptive diseases as measles, typhus, typhoid, erysipelas, etc.

Seldom do we meet with an otherwise healthy individual, who is subjected to a frequent cold in the head. Impure blood, inherited scrofulous taints, enfeebled circulation, debility, either general or nervous, are all advance agents, inviting catarrhal disease, and preventing rapid recovery from an acute attack, so that a low grade of Chronic Catarrh is generally the sequence.

SYMPTOMS. The attack is visually ushered in by a chill, or chilly sensation, feeling of lassitude, followed by a slight fever. These symptoms are not as distressing as the sense of fullness about the eyes and frontal region, and prickling dry heat, with more or less obstruction in the nostrils. A few hours later follows a copious, acrid watery discharge, which gradually becomes thick and yellow. Often the inflammatory action may extend to the orifice of the eustachian tube, causing obstruction with temporary deafness, or ringing in the ears. Severe facial neuralgia may be caused by the pressure from the swollen parts upon the branches of sensitive nerves.

TREATMENT. In the mild forms of acute catarrh, or coryza, only simple treatment is required. A hot foot-bath on retiring at night, with a full dose of Dr. Pierce's Compound Extract of Smart-weed, to produce free perspiration will generally break up the attack. Should the discharge from the nostrils continue, Dr. Sage's Catarrh Remedy should be freely used four to six times each day, until the symptoms are controlled. In case the bowels do not act, a full dose of Dr. Pierce's Pleasant Pellets may he taken at bed-time. Avoidance of exposure to cold, and light vegetable diet, are advisable. In the more severe attacks, especially when complicated by laryngeal or bronchial symptoms, the most decisive measures should be employed. The Compound Extract of Smart-weed should be taken freely, together with hot drinks, or a hot general bath. The patient should be warmly covered in bed to encourage a continued perspiration, to equalize the circulation, and subdue the inflammation. Dr. Pierce's Golden Medical Discovery should be taken in teaspoonful doses four times each day in all cases that are complicated or protracted.

Individuals suffering from frequent colds will do wisely to fortify their systems by taking a few bottles of the "Golden Medical Discovery" to improve nutrition, purify the blood, and thus aid nature in overcoming such inherited tendency or required weakness as may be their misfortune to possess. Remember frequent attacks of Acute Catarrh prepare fertile soil for the chronic form which oftentimes is so loathsome and destructive.

* * * * *



CHRONIC NASAL CATARRH.

OZAENA.

In consequence of repeated attacks of acute catarrh, or "cold in the head," as it is usually termed, the mucous membranes of the nose and the air-passages of the head become permanently thickened, the mucous follicles or glands diseased, and their functions either destroyed or very much deranged. Although chronic catarrh is most commonly brought on in the manner above stated, it sometimes makes its appearance as a sequel of typhoid fever, scarlet fever, measles, or other eruptive fevers, or shows itself as a local manifestation of scrofulous or syphilitic taints in the system.

Injury to the nose may result in a displacement of one or more of the bony structures, setting up a chronic inflammation with catarrh at that point. In the early stages of the disease, the patient may be annoyed with "only a slight dropping into the throat," as many express it, the amount of the discharges from the air-passages of the head at this stage of the disease being only slightly in excess of health. In some cases the discharge is thick, ropy, and tough, requiring frequent and strong efforts in the way of blowing and spitting, to remove it from the throat, in which it frequently lodges. In other cases, or in other stages of the same case, the discharge is thin, watery, acrid, irritating, and profuse. The nose may be "stopped up" from the swollen and thickened condition of the lining mucous membrane, so as to necessitate respiration through the mouth, giving to the voice a disagreeable nasal twang. From the nature of the obstruction in this condition, it is useless for the sufferer to endeavor to clear the passage by blowing the nose; this only tends to render a bad matter worse, by increasing the irritation and swelling of the already thickened lining membrane. The swelling of the mucous membrane does not in all cases become so great as to cause obstruction to respiration through the affected passages. In some cases, the patient suffers from head ache a great portion of the time, or experiences a dull, heavy, disagreeable fullness or pressure in the head, with a confusion of his ideas, which renders him quite unfit for business, especially such as requires deep thought and mental labor. Memory may be more or less affected, and the disposition of those who are otherwise amiable is often rendered irritable or morose and despondent. The mental faculties suffer to such an extent in some cases as to result in insanity. The sense of smell is in many cases impaired, and sometimes entirely lost, and the senses of taste and hearing are not unfrequently more or less affected.

OZAENA. The ulcerous or more aggravated stage of the disease, from the offensive odor that frequently attends it, is denominated Ozaena.

The secretion which is thrown out in the more advanced stages of chronic catarrh becomes so acrid, unhealthy, and poisonous, that it produces severe irritation and inflammation, which are followed by excoriation and ulceration of the delicate membrane which lines the air-passages in the head. Although commencing in this membrane, the ulceration is not confined to it, but gradually extends in depth, until it frequently involves all the component structures of the nose—cartilage and bone, as well as fibrous tissues. As the ulceration extends up among the small bones, the discharge generally becomes profuse and often excessively fetid, requires the frequent use of the handkerchief, and renders the poor sufferer disagreeable to both himself and those with whom he associates. Thick, tough, brownish incrustations, or hardened lumps, are many times formed in the head, by the evaporation of the watery portion of the discharge. These lumps are sometimes so large and tough that it is with great difficulty that they can be removed. They are usually discharged every second, fourth, or fifth day, but only to be succeeded by another crop. Portions of cartilage and bone, or even entire bones, often die, slough away, and are discharged, either in large flakes, or blackened, half-decayed, and crumbly pieces; or, as is much more commonly the case, in the form of numerous minute particles, that escape with the discharge and are unobserved. It is painfully unpleasant to witness the ravages of this terrible disease, and observe the extent to which it sometimes progresses. Holes are eaten through the roof of the mouth, and great cavities excavated into the solid bones of the face; in such cases only the best and most through treatment will check the progress and fatal termination of the disease.

COMPLICATIONS.

Catarrh, or ozaena, is liable to be complicated, not only by the system, blood, and fluids, suffering from scrofulous or other taints, as has already been pointed out, but also by an extension of the diseased conditions to other parts beyond the air-passages of the head.

Occasionally deformities of the septum or other internal structures also polypi or tumors, are sources of constant irritation and accelerate catarrhal disease.

DISEASE OF THE THROAT. The acrid, irritating and poisonous discharge, which, in some stages of disease, almost constantly runs down over the delicate lining membrane of the pharynx (throat), is liable to produce in this sensitive membrane a diseased condition similar to that existing in the air-passages of the head. The throat may feel dry, husky, and at times slightly sore or raw; or, from the muco-purulent discharge that is almost constantly dropping down over its surface, the patient may feel very little inconvenience from the disease of the throat until it is far advanced—the moistening and lubricating effect of the matter that drops on the surface tending to blunt the sensibility of the parts. (See pharyngitis for symptoms and treatment.)

THE EXTENSION OF THE DISEASE TO THE LARYNX. The larynx, situated directly below the pharynx (throat), is subjected to the influence of the same irritation from acrid and poisonous discharges dropping into the throat from the head. More or less of it is removed by hawking and spitting, but some remains and is drawn into the larynx, or still lower into the trachea (windpipe), with the inspired air. Thus the disease creeps along the continuous mucous surfaces of the air-passages, the acrid poisonous discharge arousing in its track the irritation, inflammation, ulceration, and thickening of the lining membrane which characterize the disease in other portions of the air-passages. The symptoms and treatment of laryngitis will be found under its appropriate classification.

BRONCHITIS AND CONSUMPTION. We have already detailed the manner in which the throat, larynx, and trachea, in succession, become affected from catarrh, or ozaena. By the same process of extension, the bronchial tubes, and lastly, the parenchyma, or substance of the lungs, in their turn, become diseased, and bronchitis and consumption are firmly established. Tightness in the chest, with difficulty of breathing; soreness; darting, sharp, or dull, heavy pain, or a prickly, distressing sensation, accompanied with more or less cough and expectoration—are evidences that the bronchial tubes have become affected, and they should admonish the sufferer that he is now standing on the stepping-stone to CONSUMPTION, over which thousands annually tread, in their slow journey to the grave.



DEAFNESS. By means of a small canal, called the eustachian tube, an air-passage and communication between the throat and middle ear is formed. (See Fig. 8.) This passage is lined by a continuation of the mucous membrane which covers the throat and nasal passages. The catarrhal inflammatory process, by continuity of surface, follows the mucous membrane, thickening its structure, until the eustachian tube is closed, and the beautiful mechanism of the internal ear is rendered useless. While the thickening of the mucous membrane is going on, and the passage is gradually becoming closed (and the process sometimes extends through several years), the patient will occasionally, while blowing the nose, experience a crackling in one or both ears, and hearing becomes dull, but returns suddenly, accompanied with a snapping sound. This may be repeated many times, until, finally, hearing does not return, but remains permanently injured. In other cases the hearing is lost so gradually that a considerable degree of deafness may exist before the person is really aware of the fact. Either condition is often accompanied with noises in the head of every conceivable description, increasing the distress of the sufferer. The delicate bones of the ear are sometimes detached from their articulations, the drum is ulcerated and perforated, and through the orifice thus made, the bones or small spiculae may escape with the thick, purulent, and offensive discharge.

CLOSURE OF THE TEAR DUCT. The lachrymal duct, or passage (tear duct), which, when in a healthy condition, serves to convey the tears from the eye into the nose, may be closed by the same inflammatory and thickening process which we have already explained. This condition is usually attended with watery and weak eyes, the tears escaping over the cheeks, and sometimes producing irritation and excoriation. The nasal branch of the ophthalmic nerve sometimes participates in the ulceration going on in the head, so that the eyes are sympathetically affected. They sometimes become congested or inflamed, and sharp pain in the eyeballs may be experienced.

INDIGESTION, DYSPEPSIA, ETC. A large portion of the acrid, poisonous, purulent discharge, which drops into the throat during sleep, is swallowed. This disturbs the functions of the stomach, causing weakness of that organ, and producing indigestion, dyspepsia, nausea, and loss of appetite. Many sufferers complain of a very distressing "gnawing sensation" in the stomach, or an "all gone," or "faint feelings," as they often express it.

SYMPTOMS. Dull, heavy headaches through the temples and above the eyes; indisposition to exercise; difficulty of thinking or reasoning, or concentrating the mind upon any subject; lassitude; indifference respecting business, lack of ambition or energy; obstruction of nasal passages; discharges voluntarily falling into the throat, sometimes profuse, watery, acrid, thick and tenacious, mucous, purulent, muco-purulent, bloody, concrete blood and pus, putrid, offensive, etc. In others, a dryness of the nasal passages: dry, watery, weak, or inflamed eyes; ringing in the ears, deafness, discharge from the ears, hawking and coughing to clear the throat, ulcerations, death and decay of bones, expectoration of putrid matter, spiculae of bones, scabs from ulcers leaving surface raw, constant desire to clear the nose and throat, voice altered, nasal twang, offensive breath, impairment or total deprivation of the sense of smell and taste, dizziness, mental depression, loss of appetite, nausea, indigestion, dyspepsia, enlarged tonsils, raw throat, tickling cough, difficulty in speaking plainly, general debility, idiocy, and insanity.

All the above symptoms, as well as some others which have been previously given, and which it is not necessary here to repeat, are common to this disease in some of its stages or complications; yet thousands of cases annually terminate in consumption or chronic bronchitis, and end in the grave, without ever having manifested one-half of the symptoms enumerated.

VARIETIES. People often suppose that there are a great many varieties or species of catarrh. This is an error. The nature of the disease is the same in all cases, the symptoms only varying with the different stages of the disorder, and the various complicated conditions which are liable to arise, and which have already been pointed out.

CAUSES. Anything which debilitates the system, or diminishes its powers of evolving animal heat and withstanding cold or sudden changes of atmospheric temperature, and other disease-producing agencies, renders the individual thus enfeebled very liable to catarrh. Among the most common debilitating agencies are a scrofulous condition of the system, or other impurities of the blood, exhaustive fevers, and other prostrating acute diseases, or those badly treated; exhaustive and unnatural discharges, intemperance, excessive study, self-abuse, adversity, grief, want of sleep, syphilitic taints of the system, which may have been contracted unknowingly, or may have been inherited, having perhaps been handed down even unto the third or fourth generation, to an innocent posterity from infected progenitors; too sudden rest after great and fatiguing exercise, and living in poorly-ventilated apartments. These are among the most fruitful causes of those feeble, deranged, or impure conditions of the system to which catarrh so frequently owes its origin. Although the immediate or exciting cause is generally repeated attacks of "cold in the head," which, being neglected or improperly treated; "go on from bad to worse," yet the predisposing or real cause of the disease is in the majority of cases, an enfeebled, impure, or otherwise faulty condition of the system, which invites the disease, and needs only the irritation produced in the nasal passages by an attack of cold, to kindle the flame and establish the loathsome malady. Some people are convinced with difficulty that there exists in their system a weakness, impurity, or derangement of any kind, which permitted the disease to fasten itself upon them. They may not feel any great weakness, may not have any pimples, blotches, eruptions, swellings, or ulcers, upon their whole person; in fact, nothing about them that would, except to the skilled eye of the practical and experienced physician, indicate that their system is weakened or deranged with bad humors; and yet such a fault may, and GENERALLY DOES, exist. As an ulcer upon the leg, or a "fever-sore," or an eruption upon the skin, may be the only outward sign of a fault in the system, so frequently chronic catarrh is the only sign by which a bad condition of the system manifests itself in a manner that is perceptible to the sufferer himself, or to the non-professional observer. The finely-skilled physician, whose constant practice makes his perceptive faculties perfect in this direction, would detect the constitutional fault, as an experienced banker detects a finely-executed and dangerous bank-note which the unpracticed eye would pronounce genuine.



TREATMENT. If you would remove an evil strike at its root. As the predisposing or real cause of catarrh is, in the majority of cases, some weakness, impurity, or otherwise faulty condition of the system, in attempting to cure the disease our chief aim must be directed to the removal of that cause. The more we see of this odious disease, the more so we the importance of combining; with the use of a local, soothing and healing application, a thorough and persistent internal use of blood-cleansing and tonic medicines.

As a local application for healing the diseased condition in the head, Dr. Sage's Catarrh Remedy is beyond all comparison the best preparation ever invented. It is mild and pleasant to use, producing no smarting or pain, and containing no strong, irritating, or caustic drug, or other poison. Its ingredients are simple and harmless, yet when scientifically and skillfully combined, in just the right proportions, they form a most wonderful and valuable healing medicine. Like gunpowder, which is formed of a combination of saltpeter, sulphur, and charcoal, the ingredients are simple, but the product of their combination is wonderful in its effects. The Remedy is a powerful antiseptic, and speedily destroys all bad smell which accompanies so many cases of catarrh, thus affording great comfort to those who suffer from this disease.

The reader's mind cannot be too strongly impressed with the importance of combining thorough constitutional with the local treatment of this disease. Not only will the cure be thus more surely, speedily, and permanently, effected, but you thereby guard against other forms of disease breaking out, as the result of humors in the blood or constitutional derangement or weakness.

In curing catarrh and all the various diseases with which it is so frequently complicated, as throat, bronchial, and lung diseases, weak stomach, catarrhal deafness, weak or inflamed eyes, impure blood, scrofulous and syphilitic taints, the wonderful powers and virtues of the "Golden Medical Discovery" cannot be too strongly extolled. It has a specific effect upon the lining mucous membranes of the nasal and other air passages, promoting the natural secretion of their follicles and glands, thereby softening the diseased and thickened membrane, and restoring it to its natural, thin, delicate, moist, healthy condition. As a blood-purifier, it is unsurpassed. As those diseases which complicate catarrh are diseases of the lining mucous membranes, or of the blood, it will readily be seen why this medicine is so well calculated to cure them.

The "Golden Medical Discovery" is the natural "helpmate" of Dr. Sage's Catarrh Remedy. It not only cleanses, purifies, regulates, and builds up the system to a healthy standard, and conquers throat, bronchial, and lung complications, when any such exist, but, from its specific effects upon the lining membrane of the nasal passages, it aids materially in restoring the diseased, thickened, or ulcerated membrane to a healthy condition, and thus eradicates the disease. When a cure is effected in this manner it is permanent. The system is so purified, regulated, and strengthened, as to be strongly fortified against the encroachments of catarrh and other diseases. The effects of the "Golden Medical Discovery" upon the system will be gradual, and the alterative changes of tissue and function generally somewhat slow. They are with however, less complete, radical, and lasting; and this constitutes its great merit. Under its influence all the secretions are aroused to carry the blood-poisons out of the system, the nutrition is promoted, and the patient finds himself gradually improving in flesh; his strength is built up, his lingering ailments dwindle away, and by and by he finds his whole person has been entirely renovated and repaired he feels like a new man—a perfect being.



THE CLOTHING. With most persons suffering from chronic nasal catarrh, there is a great disposition to take cold, even slight cause being sufficient to produce an acute attack, which greatly aggravates the chronic affection and operates to render it permanent. To obviate the bad effects that are liable to result from this predisposition, great attention should be paid to the clothing, that it thoroughly protects the person from sudden changes of temperature. For more particular and practical suggestions in regard to this matter, the reader is referred to the article on Clothing, in Part Two, Chapter II, of "The People's Common Sense Medical Adviser."

THE DIET has an important influence with this disease, as with consumption and many other chronic ailments. It should be largely composed of those articles rich in the non-nitrogenized or carbonaceous elements. Fat meats, rich, sweet cream, good butter, and other similar articles of food, should comprise a large part of the diet. These elements, which are prolific in the production of animal heat counteract the predisposition to take cold, and thus become most valuable remedial agents—not less essential than the medical treatment that has been advised. The patient, suffering from chronic catarrh, should study well the hygienic teachings to be found in Part Two of "The People's Common Sense Medical Adviser," and govern himself accordingly.

TREATMENT OF COMPLICATIONS. There are various complications of this disease that require modifications of the treatment to meet them successfully. The rules cannot be made that would enable non-professional readers to vary the treatment to suit peculiarities of constitution, or complications of the disease. When consulted, either the person or by letter, we have been able to so modify the treatment as to be adopt it to peculiar individuals which rejected the ordinary treatment, and have thus cured hundreds who had otherwise failed to find relief.



TIME REQUIRED IN EFFECTING A CURE. Reader, if you suffer from chronic nasal catarrh, do not expect to be very speedily cured, especially if your case is one of long standing. Unprincipled quacks and charlatans, who possess no knowledge of disease, or medicine either, and whose sole design is to palm off upon you a bottle or two of some worse than worthless strong, caustic solution, irritating snuff, or drying "fumigator," "dry up," "annihilator," "carbolated catarrh cure," "catarrh specific," or other strong preparation, will tell you that the worst cases can be speedily cured by these unreasonable means. It is true that such strong, irritating, and drying preparations will many times suddenly arrest the discharge from the nose, but the thickened or ulcerated condition of the lining mucous membrane, which really constitutes the disease, is not removed by such treatment, and the discharge soon comes on again. Besides, there is danger attending the employment of such strong, irritating, or drying preparations. The disease, by their use, is frequently driven to the throat, bronchial tubes, lungs, or brain, and thus a bad matter is made worse. Not less irrational and unsuccessful is the plan of treating the disease with inhalations of "carbolized iodine," and other drags, administered through variously-devised pocket and other inhalers. Such treatment may mask or cover up catarrh for a time; but, by reason of the constitutional nature of the disease, it cannot effect a perfect and permanent cure. Dr. Sage's Catarrh Remedy, on the other hand, cures the disease on common-sense, rational, and scientific principles, by its mild, soothing, and healing properties, to which the disease gradually yields, when the system has been put in perfect order by the use of "Golden Medical Discovery." This is the only perfectly safe, scientific, and successful mode of acting upon and healing it. Without, we trust, being considered egotistical, we can say that this opinion is based upon a large experience and a perfect familiarity with the nature and curability of the disease. For many years our whole time and attention has been given to the study and cure of catarrh and other chronic diseases treated of in "The People's Common Sense Medical Adviser." Cases of catarrh have been treated by thousands, and our medicines for the cure of this loathsome disease, and of other chronic diseases, have met with an extensive sale in all parts of the United States, and have found their way into many foreign countries. The universal satisfaction with which their use has been attended, and the grateful manifestations received from the cured, have afforded one of the greatest pleasures of our lives. Scarcely a mail arrives that does not bring new testimony of cures effected by the treatment here recommended.

DIRECTIONS FOR USING DR. SAGE'S CATARRH REMEDY.

To prepare the medicine ready for use, put the whole quantity of powder contained in the package, as put up for sale, into a bottle; pour into it one pint of cool, soft water. Rain water or melted snow is good. Ordinary lake, river, well or spring water will do if only slightly hard. Cork the bottle tightly and shake it thoroughly, after which allow it to stand six or eight hours to settle. Two of the ingredients of which the remedy is composed do not entirely dissolve, but their medicinal properties are completely and speedily extracted and taken up by the water. These settlings have lost their medicinal properties and should not be allowed to enter the nasal cavity. It should be kept tightly corked, not allowing it to freeze in winter, or be kept where it is very warm in summer. This we term the "Catarrh Remedy Fluid."

Use the fluid, prepared according to the above directions, not less than three or four times a day, the last time just before retiring, in the following manner: Without shaking the bottle to roll the fluid, pour out a teaspoonful or more into the hollow of the hand, hold it there until warmed; first gently, and afterwards forcibly, snuff the fluid up one nostril and then the other, until the nose is well filled and it passes back into the throat. No fears need be entertained that it will produce strangling or any unpleasant effect in thus using it, for, unlike any other fluids (simple tepid water not excepted), it does not produce the slightest pain or disagreeable feeling, but, on the contrary, leaves such a cooling, pleasant sensation that its use soon becomes a pleasure rather than a task. In a few minutes after thus using the remedy, it should be blown out gently (never forcibly), to clear the nose and throat of all hardened crusts and offensive accumulations, if any such exist. Never blow the nose violently, as it irritates the passages and counteracts, to some extent, the curative effects of the remedy. This process should be repeated until the remedy has been thoroughly applied two or three times, not blowing it out the last time of using it, but retaining the medicine in contact with the affected parts for a considerable length of time. No harm can result if the fluid be swallowed, as it contains nothing poisonous or injurious.

A BETTER WAY. The manner of using Dr. Sage's Catarrh Remedy, advised above, is somewhat imperfect and not nearly so thorough a mode as the one to which the reader's attention will now be directed.

In a very large number of bad cases of catarrh, or those of long standing, the disease has crept along and extended high up in the nasal passages, and into the various sinuses or cavities, and tubes communicating therewith. The act of snuffing the fluid carries it along the floor of the nose and into the throat, but does not carry it high enough, or fill the passages full enough, to reach all the chambers, tubes, and surfaces, that are affected with the disease.

The fluid may seem, from the sensation produced, to pass high up between the eyes, or even above them, but it does not. It is only a sensation transmitted to these parts by nerves, the filaments of which are distributed to that portion of the mucous membrane which the fluid does not reach, just as a sensation is transmitted to the little finger by a blow upon the elbow.

Now, in order to be most successful in the treatment of catarrh, it is necessary that the remedy should reach and be thoroughly applied to all the affected parts. This can be accomplished in only one way, which is by hydrostatic pressure. The anatomy of the nasal passages, and the various chambers and tubes that communicate therewith, is such that they cannot be reached with fluid administered with any kind of syringe or inhaling tube, or with any instrument, except one constructed to apply it upon the principle above stated. Such an instrument is Dr. Pierce's Nasal Douche.

By the use of this instrument, the fluid enters every portion of the air-passages of the head by its own weight, no snuffing being required.

DIRECTIONS FOR USING DR. SAGE'S CATARRH REMEDY WITH THIS INSTRUMENT.



To cleanse out the passages previous to applying the Catarrh Remedy fluid, take one quart of soft water, add to it two large tablespoonfuls of common salt, and shake it up occasionally until all is dissolved. Before use heat it until blood warm, or, in other words, until it gives a pleasant, mild warmth to the inserted finger. Put the reservoir on a shelf, or hang it up, so that it will be a little higher than the head: fill the reservoir with salt and water, pressing the tube between the thumb and finger so as to prevent the fluid from escaping through it; introduce the nozzle at the end of the tube into one nostril, pressing it in far enough to close the entrance of the passage so that no fluid can escape by the side of the tube, breathe through the mouth, avoid swallowing, and allow the fluid to flow. The soft palate, by the act of breathing through the mouth, is elevated so as to completely close the passage into the throat, and thus the fluid is made to flow up one nostril in a gentle stream, to pass into and thoroughly cleanse all the sinuses, or cavities, connected with the nasal passages, and to flow out of the other nostril. The douche should not be employed unless both nostrils are open and the flow is free. If the head is "stopped up," snuff up the warm liquid from the hand occasionally, until the passages are open and you can breathe freely through both nostrils.

Do not forget that the instrument will not work properly unless you breathe through the mouth and avoid swallowing while the fluid flows.

Fill the reservoir a second time with the simple salt and water, and, inserting the nozzle into the nostril out of which the fluid flowed on using it the first time, pass the current through in the opposite direction; that is, so that it will flow out of the nostril into which it flowed the first time of using it.

After having thus thoroughly cleansed the passages, fill the instrument half full or more with the "Catarrh Remedy Fluid," prepared as heretofore directed, and warmed to a moderate temperature, and pass this through the nose in the same manner as directed for the salt water. The salt water is not curative, but is milder than simple water, and is, therefore, preferable for cleansing the passages.

On first commencing the use of the instrument, it is best to hang it only a very little higher than the forehead, but after using it a few times, put it up about as high as the length of the tube will admit.

Let no one entertain any feeling of timidity on commencing the use of this instrument, as its operation is perfectly simple and harmless, and, with the fluids which we recommend, is never attended with any strangling, choking, pain, or other disagreeable sensations. The medicine should be applied with the Douche at least twice a day, in the morning and at night on retiring. There is no advantage in using the medicine oftener than three times a day, when used with the instrument, but a sufficient quantity should be used each time to medicate all the diseased parts. If any remains in the Douche it may be poured back into the stock solution for subsequent use, but a liquid that has once passed through the nasal cavity contains the germs of the disease and must not be used a second time.

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NASAL POLYPUS.

The term Nasal Polypus is usually given to a variety of growths which are met with in the nasal passages far more frequently than any other tumors. They are thus designated because of their fancied resemblance to the aquatic polypus. They occur singly, or in clusters, as illustrated in Fig. 13. In the early stages the mucous membrane is swollen and irregularly dilated, presenting a rough and mottled appearance not unlike chronic catarrh with which they are usually associated. Gradually these mound-like tumors enlarge, usually becoming pendulant, and presenting a grayish opaque glistening surface, similar to the pulp of a grape. Occasionally they become massive at the point of attachment, and assimilate a warty or cauliflower growth. The latter variety is better supplied with blood vessels and presents a red or dark pink surface and may bleed on slight irritation. The favorite location is beneath or behind the middle or superior turbinated bodies, oftentimes nearly or quite concealed. However, no portion of the mucous membrane lining the upper air passages is exempt. Sometimes they grow from the roof of the nostril and pharnyx in pendulous masses, assuming the shape of the cavities, filling the entire nostril and upper portion of pharnyx. The mucous membrane covering the turbinated bodies may become dilated and swollen, finally developing by catarrhal processes into a polypus at that point. (See H, Fig. 13.)



CAUSES. Nothing definitely is known regarding their causation. They are generally supposed to originate in some constitutional derangement, impairing the nutrition of the mucous membranes. Other cases are closely associated with chronic nasal catarrh, and frequent attacks of cold in the head.

SYMPTOMS. These may vary considerably in different cases due to the character and location of the polypus. In the early stages before the tumor is well developed, the symptoms may be those of nasal catarrh, and the diagnosis of polypus be possible only after a personal examination by a skillful specialist. Neither is the size of the polypus always in proportion to the severity of the symptoms. The nasal discharge is generally increased and of a variable character. As the tumors enlarge they cause a sense of fullness and weight between and below the eyes, with more or less headache and facial neuralgia. There is partial or complete obstruction of one or both nostrils. In some cases the obstruction changes from one nostril to the other when lying down; the stoppage generally being on the side toward the pillow. A polypus located at the junction of the nasal passages and throat by force of gravity always causes obstruction to the lower nasal cavity when lying down. Polypi often attain considerable size and by pressure upon and displacement of the surrounding structures occasion hideous facial deformity. Changes in the weather often aggravate the symptoms. By blowing the nostril the tumor sometimes may be forced forward, so that it may be seen a short distance from the anterior opening of the nostril. The voice is often affected, being muffled or harsh in tone, similar to that which accompanies a cold in the head. Respiration may be considerably embarrassed, due to the obstruction in the nasal passages, and the patient necessarily resorts to mouth breathing. In advanced cases the Larnyx is usually much congested, being constantly irritated, not only reflexly through the nervous system, but directly by the inspired air, and excoriating discharges dropping in the throat from behind the palate. Thus it is plain to understand how chronic Pharyngitis, Laryngitis, Bronchitis, and Asthma may result from a small polypus in the nasal cavity.

TREATMENT. In mild cases correcting the constitutional derangement may check the morbid process in the nostrils and cause absorption of the polypus growth. For this purpose Dr. Pierce's Golden Medical Discovery is unequaled. The removal of the polypus may sometimes be accomplished by snuffing powdered blood-root. When these measures fail it is necessary to seek surgical assistance. After the removal of the polypus Dr. Sage's Catarrh Remedy should be used to prevent a recurrence.

OUR OPERATION FOR NASAL TUMORS.

Having operated with unvarying success upon a very large number and variety of nasal tumors at the Invalids' Hotel and Surgical Institute we are positively assured that the means and methods which we employ are neither severe or dangerous; no pain, consequently no shock; recovery rapid and permanent. Many forms of injection and local treatment are in use for the removal of nasal polypi, none of which have proven to be curative; recurrence of the tumor many times following such treatment. Many cases have presented themselves after having been treated by the heroic method of seizing the polypus with a pair of forceps and forcibly tearing it loose, bringing with it segments of healthy tissue, leaving bone exposed, and a ragged, uneven surface of diseased membrane. It is much easier to properly treat a case from the beginning than to undertake it in such a rendition.

Owing to the fact that these nasal tumors grow directly from the lining membranes it is necessary not only to thoroughly remove the tumor but to treat the diseased membrane at the point from which the polypus springs; otherwise another tumor may develop at the same point. The nasal passage having been thoroughly anaesthetized, or benumbed, by the use of cocaine, the nasal speculum is introduced, and by means of reflected light from the head mirror worn by the operator, the interior of the nostril is brought into view. (See Fig. 9, p. 479.)

Often the attachment of the growth is entirely hidden behind the irregular bony structures of the nostril so that it requires the skill of an expert specialist, deft in the manipulation of these parts, to operate properly.

Many styles and shapes of delicately devised instruments are necessary to completely remove the growth without doing injury to the adjacent structures. By our newly devised operation the tumor is at once removed, without pain, and with the loss of only a few drops of blood. Further, because the tumor is entirely removed and the base properly treated there is not the offensive discharge for a long time afterward and the danger from infection and blood-poison to which the patient is subjected in other forms of treatment.

In conclusion we would say that we claim for our operation the following points that are worthy of the careful consideration of every one who may be so unfortunate as to require the services of a specialist for the removal of growths in the nasal or upper air passages.

1st. Our operation is absolutely painless.

2d. No chloroform or ether is required.

3d. We insure perfect removal of growth.

4th. There is no injury to other adjacent structures.

5th. The operation is bloodless.

6th. The recovery is rapid.

7th. There is no slough to produce pus that may be absorbed and cause blood-poisoning.

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DEFORMITY OF THE NASAL SEPTUM.

In health the nasal septum is a bony or cartilaginous plate, as shown in A, Fig. 14, dividing the nasal passages into two cavities of the same size and shape. This plate or partition is also a support to which the flexible structures which form the tip of the nose are attached. In early life the septum is flexible and may be bent or doubled by injury to the nose; but owing to its elasticity usually resumes its natural position and shape. After maturity any dislocation or change in this bony plate usually remains permanent unless some means are employed for its correction. In a limited number of cases supposed to be chronic nasal catarrh, we have found upon examination that one or both nasal cavities were more or less obliterated and obstructed by the deformed and thickened septum. (See A, Fig. 15.) Many of these cases date from an injury to the external parts, causing only bleeding from the nose and a slight pain for a short time. Chronic inflammation develops at the point where the bone is bent or cracked, resulting in thickening, often producing nodules or spur-like projections which not only interfere with nasal breathing, but also act as irritants to the adjacent delicate membranes and produce many of the symptoms common to nasal catarrh.



Among other common causes are unequal or imperfect development of the nasal bones, due to an inherited strumous tendency and local ulcerative disease, weakening or destroying the bone.

SYMPTOMS. The location and extent of the deformity of the nasal septum necessarily gives opportunity for a variety of symptoms. In aggravated cases the nose appears to be bent toward one side. In the earlier stages there is an excess of mucous secretion, often dropping into the throat from behind the palate. The discharge is variable as in nasal catarrh with more or less difficult nasal breathing, the stoppage changing from one nostril to the other. Sneezing and frequent attacks of nose bleed are often common symptoms. The tendency of the disease is to extend backward often causing headache, deafness, roaring in the ears and post-nasal disease which results in a chronic sore throat, the latter disease often being the one for which the patient seeks advice. If allowed to progress uninterruptedly the throat gradually becomes more irritable, associated with an annoying cough, and the voice becomes harsh and has a nasal tone. The general health is impaired, the nervous system excitable; laryngitis, asthma, and lung disease become complications, which render the existence of the individual miserable.

TREATMENT. In mild cases where the deformity is slight, and the obstruction is not a constant symptom, the nasal cavities should be cleansed (See treatment of nasal catarrh) after inhaling dust, and special attention given to the prompt treatment of cold in the head. Should there be irritability, sneezing, or a constant discharge, it is advisable to use Dr. Sage's Catarrh Remedy as directed on p. 483 to soothe the excitability and lessen the inflammatory action in and about the thickened and deformed septum. As an auxiliary to promote the absorption of the thickened tissues and restore them to a healthy activity, a number of bottles of the "Golden Medical Discovery" should be taken while using the local treatment. Any dormant condition of the liver or digestive tract may be corrected by taking Dr. Pierce's Pleasant Purgative Pellets. In advanced cases after the structures are so diseased and thickened that it renders local treatment hopeless, only surgical interference can prove curative.

OUR PAINLESS OPERATION.

By the application of a few drops of a solution of cocaine in the nostril, at the point to be treated, we are now able to produce such local anaesthesia as to render the operation entirely painless without the administration of either chloroform or ether. This is an important consideration as many are adverse to taking chloroform or ether, and now that we possess an agent that produces, locally, complete insensibility to pain, we are very glad to dispense with their use in all such minor operations. There is no pain caused even by the application of the cocaine to deaden the sensibility of the part. Many examinations of the upper air-passages heretofore very annoying and even painful to the patient and sometimes unsatisfactory, are rendered entirely painless, and carried out with a thoroughness that would be impossible without the use of this wonderful agent. Not only in surgery of the nose and throat, but alike in other departments, our surgeon-specialists employ the same local anaesthetic in all minor operations, none of which are attended with the least pain.

Our specialists were among the first surgeons in this country to employ this newly-discovered anaesthetic. We regard it as a great boon to our patients, and never withhold it in any case where it can be employed to prevent suffering. Its use is attended with no danger, nor is it followed by bad or disagreeable results.

OUR OPERATION.



The nostrils being the entrance to and the beginning of the air passages no dexterity and skill can be spared in treating and properly correcting any deformity that may exist. Mutilation of these sensitive structures is sure to be followed by serious reflex symptoms in adjacent parts.

Consequently cases of this nature should only be entrusted to the care of a competent and experienced specialist. Our resources and appliances are unlimited and seldom do we use the surgeon's knife in a case of this nature.

As in the treatment of other pathological growths in the upper air passages the rhinoscope is indispensable. The parts can only be brought into the view of the operator by means of this instrument and sets of mirrors to reflect light on all sides of the deformed and hidden parts.

By our operation both nasal cavities are restored to their normal size and contour (compare Figs. 14, 15), unhealthy and diseased tissues are removed, and free nasal respiration established.

All treatments are carried out under strict aseptic precautions, thus reducing the danger from absorption of poisonous secretions to the minimum. By our skillful and ingenious management of these cases we never have had a single patient manifest any serious symptoms after operation. In such cases we consider this the only safe, practical, and permanent cure. Every year hundreds pass out of existence the victims of incurable disease of the air-passages resulting from morbid nasal conditions, who might be saved by proper and timely treatment.

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PHARYNGITIS AND POST-NASAL CATARRH.



Simple chronic pharyngitis seldom exists alone and uncomplicated; most cases being the result of previous existing disease of the nasal or post-nasal passages. Many cases are associated with hypertrophy, or enlargement, of the tonsils. Usually the disease is located in the upper part of the pharynx, or throat, behind and above the uvula and soft palate, and is thus hidden from view when looking into the throat through the mouth. When not associated with nasal catarrh the common symptoms are dropping of tenacious mucous in the throat, causing a constant desire to hawk and spit; sense of dryness in this region; cough and expectoration on rising in the morning, which is due to the irritability of the throat, and may invade the lower air-passages. The throat may be studded with red and thickened patches of its mucous membrane. Respiration may be embarrassed, the voice affected and the general health gradually decline. The membrane above and behind the palate is angry, reddened, thickened and roughened, as represented in G, Fig. 16.

TREATMENT To rationally treat a disease, attack the cause. Therefore, in an uncomplicated case of post-nasal disease of the pharynx the medicine should be applied at this point. For this purpose we recommend the regular and continuous use of Dr. Sage's Catarrh Remedy administered preferably by means of the post-nasal syringe as illustrated in Fig. 16.

The efficacy of Dr. Sage's Catarrh Remedy as a curative agent in catarrh of mucous membranes is unequaled if the medicine be properly and thoroughly applied. The Catarrh Remedy fluid should be prepared as directed in the pamphlet which accompanies the medicine. Warm enough of the medicine to fill the syringe twice. After the syringe is filled with the warm medicine, introduce the curved tip behind the soft palate, holding the syringe as seen in Fig. 16, then incline the head forward over a wash bowl and empty the syringe by pressing the plunger quickly. The medicine will immediately come in contact with the diseased surfaces and pass out through the nostrils, thoroughly medicating, disinfecting and cleansing the upper part of the throat and the posterior region of the nostrils. Two syringes of the medicine should be used for each treatment, and two or more applications made every day until a cure is effected.

At the same time the local treatment is being used, Dr. Pierce's Golden Medical Discovery should be taken to act through the blood upon the diseased tissues.

The Catarrh Remedy may be administered by means of the Nasal Douche, if the case is complicated by nasal catarrh. Should tumors or deformities exist, it is advisable to consult a specialist.

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ENLARGED TONSILS.

Chronic enlargement of the tonsils, as shown in Fig. 17, A A, is an exceedingly common affection. It is most common to those of a scrofulous habit. It rarely makes its appearance after the thirtieth year, unless it has been imperfectly cured. Both tonsils are generally, though unequally enlarged. A person affected with this disease is extremely liable to sore throat, and contracts it on the slightest exposure; the contraction of a cold, suppression of perspiration, or derangement of the digestive apparatus being sufficient to provoke inflammation.

CAUSES. Repeated attacks of quinsy, scarlet fever, diphtheria, or scrofula, and general impairment of the system, predispose the individual to this disease.

SYMPTOMS. The voice is often husky, nasal or guttural, and disagreeable. When the patient sleeps, a low moaning is heard, accompanied with snoring and stentorian breathing, and the head is thrown back so as to bring the mouth on a line with the windpipe, and thus facilitate the ingress of air into the lungs. When the affection becomes serious it interferes with breathing and swallowing. The chest is liable to become flattened in front and arched behind, in consequence of the difficulty of respiration, thus predisposing the patient to pulmonary disease. On looking into the throat, the enlarged tonsils may be seen, as in the Fig. 17. Sometimes they are so greatly increased in size that they touch each other.



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

(1.) To remedy the constitutional derangement.

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

The successful fulfillment of the first indication may be readily accomplished by attention to hygiene, diet, clothing, and the use of Dr. Pierce's Golden Medical Discovery, together with small daily doses of his "Pleasant Pellets." This treatment should be persevered in for a considerable length of time after the enlargement has disappeared, to prevent a return.

To fulfill the second indication, astringent gargles may be used. Infusions of witch-hazel or cranesbill should be used during the day. The following mixture is unsurpassed: iodine, one drachm; iodide of potash, four drachms; pure, soft water, two ounces. Apply this preparation to the enlarged tonsils twice a day, with a probang, or soft swab, being careful to paint them each time. A persevering use of these remedies, both internal and local, is necessary to reduce and restore the parts to a healthy condition.

Sometimes the enlarged tonsils undergo calcareous degeneration; in this case, nothing but their removal by a surgical operation is effectual. This can be readily accomplished by any competent surgeon. We have operated in a large number of cases, and have never met with my unfavorable results.

The method we adopt at the Invalids' Hotel and Surgical Institute for the removal of diseased tonsils is, like other minor operations, painless. The patient is not required to take chloroform or ether. When the enlarged gland is once thoroughly removed the disease seldom returns.

ELONGATION OF THE UVULA.

Chronic enlargement, or elongation of the uvula or soft palate, as shown at B in Fig. 17, may arise from the same causes as enlargement of the tonsils. It subjects the individual to a great deal of annoyance by dropping into or irritating the throat. It causes tickling and frequent desire to clear the throat, also change, weakness and loss of voice, and often gives rise to a very persistent and aggravating cough. Constriction of the throat, cough and difficult breathing are more prominent symptoms in complicated cases.

TREATMENT. The treatment already laid down for enlarged tonsils, with which affection, elongation of the uvula is so often associated, is generally effectual. When it has existed for a long time, and does not yield to this treatment it may be removed by any competent surgeon.

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CHRONIC LARYNGITIS.

This is of much more frequent occurrence than the acute form, and is often associated with tubercular affections, and constitutional syphilis. It is characterized by an inflammatory condition, ulceration, or hardening of the mucous membrane of the larynx, most frequently the latter. There is also a chronic form, known as follicular laryngitis, or clergymen's sore throat, to which public speakers are subject.

THE CAUSES of chronic laryngitis are various, as prolonged use of the vocal organs in reading or speaking; using them too long on one pitch or key, without regard to their modulation; improper treatment of acute diseases of the throat; neglected nasal catarrh; the inordinate use of mercury; syphilis; repeated colds which directly cause sore throat, injuries, etc. It is also frequently due to tubercular deposits, and in these cases it generally terminates in consumption.

SYMPTOMS. The affection often comes on insidiously. There is soreness of the throat, noticeable particularly when speaking, and immediately thereafter; a "raw" and constricted feeling, leading to frequent attempts to clear the throat, in order to relieve the uneasy sensation. The voice becomes altered, hoarse, and husky, and there is a slight, peculiar cough, with but little expectoration. At first, the matter expectorated is mucus, but as the disease advances, and ulceration progresses, it becomes muco-purulent, perhaps lumpy, bloody, or is almost wholly pure pus. The voice becomes more and more impaired, and is finally lost. In the latter stages, it resembles consumption, being attended with hectic fever, night-sweats, emaciation, cough, profuse expectoration, and sometimes hemorrhage.

TREATMENT. The patient should avoid using his voice as much as possible. At the same time, attention should be paid to the diet, the bathing, and the clothing. Every thing should be done that is calculated to build up and improve the general health. Dr. Pierce's Golden Medical Discovery is well adapted to remove morbid states of the disease, in consequence of its direct action on the mucous membranes of the air-passages, and its efficacy in allaying irritation of the laryngeal, pharyngeal, and pneumogastric nerves. It should be perseveringly employed. Iodine inhalations, administered with the pocket inhaler, illustrated by Fig. 3, and the application of tincture of iodine to the forepart of the neck, are efficacious in many cases. Inhalations of chloride of ammonia, administered with a steam-atomizer, Fig. 11, in the form of spray, are frequently of great benefit. Perseverance is necessary, and the afflicted are cautioned against discontinuing the treatment too soon, for the disease is very liable to return.

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CONSUMPTION.

PHTHISIS PULMONALIS.

By this we understand a constitutional affection, characterized by a wasting away of the body, attended by the deposition of tubercular matter into the lung tissue. Hence the appellations, Phthisis Pulmonalis; Pulmonary Tuberculosis; Tubercular Consumption. Tubercles may form in other organs and result in a breaking down of their tissues, but the employment of the term Consumption in this article is restricted to the lungs. The general prevalence, the insidious attack, and the distressing fatality of this disease, demand the special attention and investigation of every thinking person. It preys upon all classes of society. Rich and poor alike furnish its victims.

Some idea of its prevalence may be formed when we consider that, of the entire population of the globe, one in every three hundred and twenty-three persons annually dies of consumption. It may not be definitely known just what proportion of all the deaths in this country and Europe occurs from this one disease. Those who have gathered statistics differ somewhat, some claiming one-fourth, while others put the ratio at one-sixth, one-seventh, and even as low as one-ninth. A fair estimate, and one probably very near the truth, would be one-sixth or one-seventh of the whole number. In New York City, for five consecutive years, the proportion was three in twenty. In New England, about twenty thousand annually succumb to this destroyer, and in the State of New York as many more. These figures may appear to be exaggerations, but investigations of the subject prove them to be the simple truth. Epidemics of cholera, yellow fever, and other diseases of similar character, so terrible in their results, occasion wide-spread alarm, and receive the most careful considerations for their prevention and cure, while consumption receives scarcely a thought. Yet the number of their victims sinks into insignificance when compared with those of consumption. Like the thief in the night, it steals upon its victim unawares. In a large proportion of cases, its approach is so insidious that the early symptoms are almost wholly disregarded; indeed, they excite but little, if any, attention, and perhaps for a time disappear altogether. Thus the patient's suspicions, if they have been aroused, are allayed and appropriate measures for his relief are discontinued. This may be the case until renewed attacks firmly establish the disease, and before the patient is fully aware of the fatal tendency of his malady, he is progressing rapidly towards that "bourne from which no traveler returns."

As has already been stated, consumption is a constitutional disease, manifested by feeble vitality, loss of strength, emaciation—symptoms which are too often classed under the name of general debility, until local symptoms develop, as cough, difficult breathing, or hemorrhage, when examination of the chest reveals the startling fact that tubercular deposits have been formed in the lungs. Invalids are seldom willing to believe that they have consumption, until it is so far advanced that all medicine can do is to smooth the pathway to the grave. Another characteristic of this disease is hope, which remains active until the very last, flattering the patient into expectation of recovery. To the influence of this emotion, the prolongation of the patient's life may often be attributed.

NATURE OF THE DISEASE. It is an error to suppose that the disease under consideration is confined to the lungs. "Pulmonary Consumption," as has been remarked, "is but a fragment of a great constitutional malady." The lungs are merely the stage where it plays its most conspicuous part. Every part of the system is more or less involved, every vital operation more or less deranged; especially is the nutritive function vitiated and imperfect. The circulation is also involved in the general morbid condition. Tubercles, which constitute a marked feature of the disease, are composed of unorganized matter, deposited from the blood in the tissue of the lungs. They are small globules of a yellow, opaque, friable substance, of about the consistency of cheese. After their deposition, they are increased in size by the accretion of fresh matter of the same kind. They are characteristic of all forms of scrofulous disease.

The most plausible theory in regard to them is, that they are the result of imperfect nutrition. Such a substance cannot be produced in the blood when this fluid is perfectly formed. It is an unorganized particle of matter, resulting from the imperfect elaboration of the products of digestion, which is not, therefore, properly fitted for assimilation with the tissues. The system being unable to appropriate it, and powerless to cast in off through the excretory channels, deposits it in the lungs or other parts of the body. There it remains as a foreign substance, like a splinter or thorn in the flesh, until ejected by suppuration and sloughing of the surrounding parts. It might be supposed by some that when the offending matter was thus eliminated from the lungs, they would heal and the patient recover; but, unfortunately, the deposition of tubercular matter does no cease. Owing to the morbid action of the vital forces, it is formed and deposited as fast or faster than it can be thrown off by expectoration. Hence arises the remarkable fatality of pulmonary consumption.

CAUSES. The causes of consumption are numerous and varied, but may all be classed under two heads, viz: Constitutional, or predisposing, and local, or exciting. Of just what tubercular matter consists, is still a subject of controversy, but that its existence depends upon certain conditions, either congenital or acquired, is generally conceded; and one of these conditions is impaired vitality. Constitutional predisposition must first give rise to conditions which will admit of the formation of tubercular matter, before any cause whatever can occasion its local deposition. It must modify the vitality of the whole system, when other causes may determine in the system thus impaired, the peculiar morbid action of which tubercular matter is the product. The general division of causes into predisposing and exciting, must ever be more or less arbitrary. Individuals subject to predisposing causes may live the natural term of life and finally die of other disease. Indeed, when predisposing causes are known to exist, they should constitute a warning for the avoidance of other causes. Again, among the so-called exciting causes, some may operate in such a manner, with some individuals, as to predispose them to consumption, and the result will be the same as if the disposition had been congenital. The causes which in one individual are exciting, under other circumstances and in other individuals, would be predisposing, because they act so as to depress the vitality and impair the nutritive processes.

THE PREDISPOSING CAUSES, then, are hereditary predisposition, scrofula, debility of the parents, climatic influences, sedentary habits, depressing emotions, in fact, anything which impairs the vital forces and interferes with the perfect elaboration of nutritive material.

THE EXCITING CAUSES are those which are capable of arousing the predisposing ones into activity, and which, in some instances, may themselves induce predisposition; as dyspepsia, nasal catarrh, colds, suppressed menstruation, bronchitis, retrocession of cutaneous affections, measles, scarlatina, malaria, whooping-cough, small-pox, continued fevers, pleurisy, pneumonia, long-continued influence of cold, sudden prolonged exposure to cold, sudden suspension of long-continued discharges, masturbation, excessive venery, wastes from excessive mental activity, insufficient diet, both as regards quantity and quality, exposure to impure air, atmospheric vicissitudes, dark dwellings, dampness, prolonged lactation, depressing mental emotions, insufficient clothing, improper treatment of other diseases, exhaustive discharges, tight lacing, fast life in fashionable society, and impurity and impoverishment of blood from any cause. This list might be greatly extended, but the other causes are generally in some manner allied to those already named.

SYMPTOMS. The symptoms of consumption vary with the progress of the disease. Writers generally recognize three stages, which so gradually change from one to the other that a dividing line cannot be drawn. As the disease progresses, new conditions develop, which are manifested by new symptoms. Prior to the advent of pulmonary symptoms, is the latent period, which may extend over a variable length of time, from a few months to several years; and, indeed, may never be developed any farther. Until sufficient tubercular matter has been deposited in the lungs to alter the sounds observed on auscultation and percussion, a definite diagnosis of tubercular consumption cannot be made, even though there may have been hemorrhage. Nevertheless, when we find paleness, emaciation, accelerated and difficult breathing, increased frequency of the pulse, an increase of temperature, and general debility coming on gradually without any apparent cause, we have sufficient grounds for grave suspicions. These are increased if tenderness under the collar-bone, with a slight, hacking cough is present. These symptoms should be sufficient to warn any individual who has the slightest reason to believe that he is disposed to consumption, to lose no time in instituting the appropriate hygienic and medical treatment, for it is at this stage that remedies will be found most effective. Unfortunately, this period is too apt to pass unheeded, or receive but trifling attention; the patient finds some trivial excuse for his present condition, and believes that he will soon be well. But, alas for his anticipations! The disease goes onward and onward, gradually gaining ground, from which it will be with great difficulty dislodged.

The cough now becomes sufficiently harassing to attract attention, and is generally worse in the morning. The expectoration is slight and frothy; the pulse varies from ninety to one hundred and twenty beats in a minute, and sometimes even exceeds this. Flushes of heat and a burning sensation on the soles of the feet and palms of the hands are experienced. A circumscribed redness of one or both cheeks is apparent. These symptoms increase in the afternoon, and in the evening are followed by a sense of chilliness more or less severe. The appetite may be good, even voracious; but the patient remarks that his food "does not seem to do him any good," and, to use a popular expression, "he is going into a decline." As the strength wanes the cough becomes more and more severe, as if occasioned by a fresh cold, in which way the patient vainly tries to account for it. Expectoration increases, becomes more opaque, and, perhaps, yellow, with occasionally slight dots or streaks of blood. The fever increases, and there is more pain and oppression of the chest, particularly during deep respiration after exercise. Palpitation is more severe. There may now be night-sweats, tire patient waking in the morning to find himself drenched in perspiration, exhausted, and haggard. Bleeding from the lungs occurs, and creates alarm and astonishment, often coming on suddenly without warning. The hemorrhage usually ceases spontaneously, or on the administration of proper remedies, and in a few days the patient feels better than he has felt for some time previously. The cough is less severe, and the breathing less difficult. Indeed, a complete remission sometimes occurs, and both patient and friends deceive themselves with the belief that the afflicted one is getting well.

After an indefinite length of time, the symptoms return with greater severity. These remissions and aggravations may be repeated several times, each successive remission being less perfect, each recurrence more severe, carrying the patient further down the road toward the "dark valley." Now the cough increases, the paroxysms become more severe, the expectoration more copious and purulent, as the tubercular deposits soften and break down. The voice is hollow and reverberating, the chest is flattened, and loses its mobility; the collar-bones are prominent, with marked depression above and below. Auscultation reveals a bubbling, gurgling sound, as the air passes through the matter in the bronchi, with the click, to the air cells beyond. Percussion gives a dull sound or if there are large cavities, it is hollow, and auscultation elicits the amphoric sound, as of blowing into a bottle. Hectic fever is now fully established; the eye is unusually bright and pearly, with dilated pupils, which gives a peculiar expression; the paroxysms of coughing exhaust the patient, and he gasps and pants for breath. The tongue now becomes furred, the patient thirsty, the bowels constipated, and all the functions are irregularly performed. Another remission may now occur, and the patient be able to resume light employment, for an indefinite length of time, which we have known to extend over three or four years, when the symptoms again return.

If the patient is a female, and deranged or suppressed menstruation has not marked the accession of pulmonary symptoms, the flow now becomes profuse and clotted, or is scanty and colorless, sometimes ceasing altogether. In the male, the sexual powers diminish, and copulation is followed by excessive and long-continued prostration. From this time onward, the progress of the disease is more rapid. The liver and kidneys are implicated. In addition to the pallor, the complexion becomes jaundiced, giving the patient, who is now wasting to a mere skeleton, a ghastly look. The urine is generally copious and limpid, though occasionally scanty and yellow. The pulse increases to one hundred and thirty or one hundred and forty beats in the minute, and is feeble and thread-like. The cough harasses the patient so that he does not sleep, or his rest is fitful and unrefreshing; whenever sleep does occur, the patient wakes to find himself drenched with a cold, clammy perspiration. The throat, mouth, and tongue now become tender, and occasionally ulcerate. Expectoration is profuse, purulent, and viscid, clinging tenaciously to the throat and mouth, and the patient no longer has strength to eject it. The hair now falls off, the nails become livid, and the breathing difficult and gasping; the patient has no longer strength to move himself in bed and has to be propped up with pillows, and suffocates on assuming the recumbent position. Drinks are swallowed with difficulty. Diarrhea takes the place of constipation. The extremities are cold, swollen, and dropsical; the voice feeble, hollow, grating, husky, the patient gasping between each word; the respiration is short and quick. A slight remission of these symptoms occurs. The patient is more comfortable, lively, cheerful, and perhaps forms plans for the future. But it is the last effort of expiring vitality, the last flicker of the lamp of life, the candle burns brilliantly for a moment, and with one last effort goes out, and death closes the scene.

The duration of the active stage of consumption varies from a few weeks to several years, the average time being about eighteen months.

Cough is always a prominent symptom throughout the entire course of the disease, varying with its progress.

Expectoration, at first scanty, then slightly increased, colorless, frothy, and mucous, is also a characteristic. After a time it becomes opaque, yellow, and more or less watery; then muco-purulent and finally purulent, copious, and viscid. When tubercular matter is freely expectorated, with but little mucus, it sinks in water. This symptom continues to the very last.

Haemoptysis (bleeding from the lungs) may occur at any stage of the disease, often being the first pulmonary symptom noticed, again being delayed until late; and there are cases in which it does not happen at all. It seldom occurs in any other disease.

Night-sweats may occur at any stage, though they are rarely experienced until the disease is pretty well established, and are very exhausting.

Hectic Fever generally occurs soon after the pulmonary symptoms are developed, and increases in intensity with the progress of the disease. There are usually two paroxysms in twenty-four hours, one of which occurs towards evening and is followed by night-sweats.

Dyspnoea (difficult breathing) is at first slight, except after exertion, amounting to only a sense of oppression; but it becomes more and more severe as the disease advances, until the very last, when it is agonizing in the extreme.

Aphthae, sometimes extending to the pharynx and larynx, generally occurs towards the last. The mouth and throat become so very sore and tender that nourishment and medicine are taken with difficulty.

Emaciation and Debility are characteristic of the disease. They fluctuate as the disease advances or is retarded, increasing to the very last.

Auscultation and Percussion constitute valuable means of diagnosis from the time tubercular matter begins to be deposited to the very last, and, when correctly practiced, reveal the extent and progress of the disease. As a knowledge of the sounds elicited can only be acquired by practical experience with proper instruments, they will not be described here. The only diseases with which consumption is likely to be confounded are general debility in the early stage, bronchitis, chronic pleurisy, chronic pneumonia, and abscess in the lungs, after the advent of pulmonary symptoms.

CURABILITY. Notwithstanding the prevailing opinion that consumption is incurable, there exists ample, incontrovertible evidence to the contrary. Its curability is established beyond the shadow of a doubt. Individuals have recovered in whom there was extensive destruction of pulmonary tissue, and, indeed, entire destruction of one lung. Numerous instances are on record in which persons have suffered from all the symptoms of confirmed consumption, and have regained their health and subsequently died of other diseases. The case of the late Dr. Joseph Parish, of Philadelphia, affords a striking example of this kind. In early life, he manifested all the symptoms of confirmed consumption, including frequent hemorrhages, yet he fully regained his health, and, after a very useful life, died at an advanced age of another disease. Post-mortem examination revealed the existence of cicatrices, or scars, in his lungs where tubercular matter had been deposited. Dr. Wood, in his Practice of Medicine, mentions another instance of a medical gentleman in Philadelphia, who in early life suffered from consumption with haemoptysis, from which he recovered, and afterwards died, at an advanced age, of typhoid fever, when the knife revealed the presence of cicatrices. Post-mortem examinations of individuals who have died of other diseases, have revealed, in numerous instances, the presence of consumption at some period of their existence. In these cases the lungs were perfectly healed by cicatrization, or by the deposit of a chalky material. A French physician made post-mortem examinations of one hundred women, all of whom were over sixty years of age, and who had died of other diseases, and in fifty of them he found evidences of the previous existence of consumption.