Scrofula (part 2)

Gentlemen—In January of '90 took the "grippe," went to work before I was well, was caught in a rain which gave me a very bad relapse, resulting in lung fever and complete prostration; was on my bed two months, and when I did get out, the strength to walk any more than just a few rods did not come back. My family doctor and two prominent physicians of Sioux City, did me no good. Late in the fall I got a bottle of Dr. Pierce's Golden Medical Discovery, which quieted my trembling nerves and gave me an appetite to eat. I then concluded to try the Doctor, personally. Up to this time I was in a pitiable condition. Sometimes I could not sleep until I felt almost wild, then sleep so much I would be stupefied. I could not digest any food and my whole system was wasting and failing fast. I doubt if any one who saw me expected me to get well. I took the treatment sent me by the World's Dispensary Medical Association for more than a year. The medicine never gave me any distress as other medicines had done before. I began to improve from the start, but the change from one extreme to the other was like the growth of a child.

To any one suffering from nervous prostration I would say, "don't be impatient." It takes a long time for weakened nerves to grow strong. I have at last become strong and well, thanks to the Giver of all good and the grand Institution at Buffalo. I nave since married a noble-hearted young woman, and when I am playing with our sweet, healthy, baby girl, I give way to the thought that at last the long, Bad chapter of my life is ended; at such times her merry laugh sounds like a song of triumph of life over death.

Gratefully yours,
W.S. NICHOLSON,
Willow Creek, Clay Co., Iowa.

Diseases of the Heart.

Diseases of the heart are classified as either functional or organic We shall dwell only briefly upon purely functional derangements of the heart; as increased, or excited action, defective, or enfeebled action, and irregular action.

Increased action of the heart, indicated by palpitation, or increased number of the beats, may be caused mechanically, as by distention of the stomach, which, by preventing the descent of the diaphragm, excites the action of this organ. Or it may be a sympathetic disturbance produced through the nervous system; thus the emotions and passions may suddenly arouse the heart to excessive action; or the presence of worms in the intestines, improper food, and masturbation, may be the cause. The use of tea, tobacco, and alcoholic drinks excites the heart. We have found that the excessive use of tobacco is very frequently the cause of functional derangement of this organ. Deficiency of the blood, as in anæmia, may be the cause of palpitation of the heart.

Functional disturbance of the heart's action is manifested by palpitation, irregularity, intermissions, a rolling or tumbling movement, and a feeling as if the heart were in the throat. These symptoms often give rise to great apprehension, anxiety, fear, and depression of mind.

Treatment. The curative treatment of functional derangement of the heart must have reference to the causes producing it. If it is in consequence of indigestion, the appetite and digestion should be improved by observing regularity in the time of taking the meals, and eating very easily-digested food. The use of strong tea, coffee, tobacco, and spirits, should be interdicted, and regular exercise, rest, and sleep should be enjoined.

In all cases, the domestic management should include daily bathing, exercise in the open air, regular habits, and the avoidance of all causes which tend to excite the heart's irregularity.

The remedial treatment of these functional affections ought to be confided to some experienced physician, as the remedies are not within the ordinary reach of all families, nor if they were, would they have sufficient experience and knowledge to select and properly administer them.

Organic Disease of the Heart.

By organic disease we mean disease pertaining to the structure of the heart itself, in contradistinction to functional disease, which has reference merely to the action of the heart. The heart is subject to various organic diseases, but we have only space to consider, in the briefest manner, those which are the most common. It is essential that the reader should have some knowledge of the anatomy and functions of the various parts of the heart in order that its diseases and their effects may be comprehended; therefore the anatomy and physiology of this organ, given in Part I, Chapter VII, of this work, should be carefully studied.

It is very evident that any disease which affects the structure and function of any part of the heart must, necessarily, give rise to certain modifications of the pulse, sounds, etc. It is through the observation and study of these modifications and changes that we arrive at a correct diagnosis as to the precise location and character of the disease.

Fig. 1. Pond's Sphygmograph.

Until within comparatively recent years, physicians were very much in the dark regarding diseases of the heart. Now, however, with a thorough knowledge of the anatomy, physiology, and pathology of the heart and the parts surrounding it, and with the aid of instruments which modern ingenuity has given us, we are able to diagnosticate with precision the slightest lesions of any part of this important organ, and, knowing their nature, to map out an appropriate course of treatment. With the aid of the stethoscope, invented by Laennec and improved upon by Camman, we are able to distinguish the slightest deviation from the normal sounds, and, by noting the character of the sound, the time when it occurs, the area over which It is heard most distinctly, and the direction in which it is transmitted, to locate the lesion which produces it. By the aid of the sphygmograph, first invented by Herrisson, and afterward improved upon by Ludwig, Vierordt, Marey, and lastly by Pond, of our own country, the pulsations at the wrist are registered, and thus made perceptible to the eye.

We herewith give a cut, Fig. 1, of Pond's instrument, and two tracings made by it. The first is a healthy tracing, and the second indicates enlargement, technically called hypertrophy, of the heart

Pericarditis, or inflammation of the membranous sac which surrounds the heart, may be either acute or chronic. The symptoms in acute pericarditis are made up from co-existing affections, and are frequently associated with articular rheumatism, Bright's disease of the kidneys, or pleuritis The intensity of the pain varies in different individuals. The action of the heart is increased, the pulse is quick, and vomiting sometimes takes place. When this disease is developed in the course of rheumatism, it is known as rheumatic pericarditis, and is almost always associated with endocarditis. In some cases acute pericarditis is very distressing, in others it is mild. The fatality is not due so much to the disease itself, as to co-existing affections. When it does not prove fatal, it sometimes becomes chronic.

In chronic pericarditis, pain is seldom present. The heart is generally more or less enlarged, its sounds are feeble, the first being weaker than the second.

Endocarditis, or inflammation of the membrane lining the cavities of the heart, is one of the most frequent forms of heart disease. It is almost invariably associated with acute rheumatism, or some of the eruptive fevers, as small-pox, scarlet fever, etc., and is due to the irritation of the unhealthy blood passing through the heart. The disease is generally attended with little or no pain, and, consequently, if the attending physician be not on the alert, it will escape his observation. When associated with acute rheumatism, the disease is only in rare instances directly fatal, but in the great majority of cases it leaves permanent organic changes, which sooner or later develop into valvular affections, and these may eventually destroy life. When the disease occurs, however, as the result of pyæmia (blood-poisoning produced by the absorption of decomposing pus or "matter") or of diphtheria, or when it is associated with any other septic conditions, it constitutes a very grave element. Collections of matter formed on the membrane lining the heart and covering its valves, are liable to be detached and carried by the circulation to the brain, spleen, or liver, where they plug up some artery, and thus cause death of the parts which it supplies with blood.

Chronic endocarditis generally occurs in rheumatic subjects, unassociated with any acute disease, It may exist without any marked symptoms, except, perhaps, a sense of oppression and uneasiness in the chest, with palpitation. It produces a thickening and hardening of the membrane lining the heart, and generally causes a retraction, adhesion, and degeneration of some of the valves of the heart, thus bringing on valvular disease.

Valvular Lesions are, as we have seen, very frequently the result of endocarditis. They are of two kinds. First, those which prevent the valves from flapping back close to the walls of the ventricles, or arteries, thus diminishing, to a greater or lesser extent, the size of the valvular orifices, and offering an obstruction to the free flow of blood through them; and which consist of a thickening and retraction, or adhesion of the valves, chalky deposits, morbid growths, etc. Secondly, those which prevent complete closure of the valves, and thus permit a return of the blood into the cavity from which it has just been expelled. These latter consist of retractions, perforations, and partial detachments of the valves, chalky deposits around the base of the valves and in them, and rupture of the chordæ tendineæ.

These two forms of lesions are usually co-existent, one generally being more extensive than the other. Thus, the regurgitation may be slight, and the obstruction great, or vice versa. The symptoms and disturbance of the circulation are altogether dependent upon the location and form of the lesion, or lesions. Each valvular lesion has its characteristic sound, or murmur, which is heard at a particular period in the cycle of the heart's action, and it is, as before stated, from these sounds, from tracings of the pulse, and from the many other indications, that we arrive at a diagnosis. Thus, in obstruction of the orifice at the junction of the aorta with the left ventricle, one of the most frequent of valvular lesions, a murmur, generally harsh in character, is heard with the first sound of the heart, with greatest intensity directly over the normal position or the aortic semilunar valves. This is conveyed along the large arteries, and may be heard, less distinctly, over the carotids. In the sphygmographic tracing, the line of ascent is less abrupt than in the normal tracing (Fig. 2), and not nearly so high, and it is rounded at the top. In aortic regurgitation, the line of ascent is similar to that of the healthy tracing, but the line of descent is very sudden. The left side of the heart is almost invariably the primary seat of these affections, but in the latter stages of their course, the right side also is liable to become involved, and, as a consequence, there then exists great disturbance of the venous circulation, with a damming back of the blood in the veins, and passive congestion of the liver, kidneys and brain, followed by dropsy, albumen in the urine, etc.

Fig. 2. The above is a representation of a tracing of a healthy pulse as made with the Sphygmograph.

Hypertrophy of the Heart consists of a thickening of the muscular walls of this organ. It may be confined to one portion of the heart, or it may affect the entire organ. The affection has been divided into the following three forms: Simple hypertrophy, in which there is an increase in the thickness of the walls of the heart, without any augmentation in the capacity of the cavities, and which is usually the result of chronic Bright's disease, or great intemperance; eccentric hypertrophy, in which there is an increase in the thickness of the walls of the heart, together with increase in the capacity of the cavities, and which is generally the result of some valvular lesion; and concentric hypertrophy, in which there is an increase in the thickness of the walls of the heart, with a decrease in the capacity of the cavities. Valvular lesions, obstructions in the large arteries, or, in fact, any thing which calls upon the heart to constantly perform an undue amount of labor must, necessarily, produce hypertrophy of its muscular walls, just as the undue amount of labor which the blacksmith's arm is called upon to perform produces hypertrophy of its muscles. With this condition, the pulse is hard and incompressible, and the line of ascent in the sphygmographic tracing (Fig. 3) is higher than in health.

Fig. 3.

Dilatation of the Heart is a condition which is closely allied to hypertrophy of the heart, and which consists of an increase in the capacity of the cavities of the heart, with diminished contractile power. In simple dilatation, there is an increase in the capacities of the cavities, without any marked change in the walls of the organ. It is usually the result of some disease which has produced great muscular prostration, and which has interfered materially with nutrition. More frequently, however, dilatation is the result of valvular lesions, and is associated with hypertrophy, there being an increase in the thickness of the walls with a diminution of the contractile power. The hypertrophy from valvular lesions goes on increasing until it reaches a certain stage, when dilatation commences, the two conditions then being associated.

Atrophy of the heart is the opposite to hypertrophy, and signifies a wasting away of the muscular substance, and a diminution in the thickness of the walls of the heart. Its power is diminished in proportion to the degree of atrophy.

Fatty Degeneration of the heart consists in the deposition of particles of fat within the sarcolemma (the sheath which invests the fibrils), which are substituted for the proper muscular tissue. If the fatty degeneration exists to any extent the muscular walls present a yellowish color, and the heart is soft and flabby. This may be confined to one ventricle, or it may affect the inner layer of fibres, the outer layer remaining unchanged. Degeneration of the left ventricle occasions feebleness of the pulse. Difficulty in breathing is one symptom of this disease, especially when the right ventricle is affected. There is pallor, feeble circulation, cold extremities, and frequently dropsy. Fatty degeneration is more liable to occur in corpulent persons, and between the ages of forty and fifty years.

Angina Pectoris, also termed neuralgia of the heart, might be included among the diseases of the nervous system, but as it is usually associated with a derangement in the action of the heart, it may be properly considered in this connection. The pain varies in intensity, sometimes being very acute, at others assuming a milder form. The action of the heart is more or less disturbed. The beats are irregular, at times being strong, while again they are feeble. A feeling of numbness is experienced in those parts to which the pain penetrates. These paroxysms usually continue but a few minutes, although they sometimes last several hours. Persons suffering from angina pectoris are liable to sudden death. It is connected with ossification, or other organic changes of the heart. Usually these paroxysms, if the life of the patient continues, become more and more frequent. The danger is not to be measured by the intensity of the pain, but by the co-existing organic disease. Although it is not absolutely certain that organic disease is present in all cases of angina pectoris, yet the exceptions are so rare that when the signs of organic disease cannot be detected, it may be inferred that angina is not the real affection, or that the existing lesions escape observation. Those who suffer from this disease are, in the great majority of cases, of the male sex, and rarely under the age of forty.

Treatment. In the foregoing consideration of organic diseases of the heart, we have omitted to speak of their remedial management, for the obvious reason that unprofessional readers are unable to correctly distinguish between the various diseases of this vital organ; and it would, therefore, be useless for us to attempt to instruct them as to the medicinal treatment of the different cardiac affections.

In the vast majority of instances, diseases of the heart are not necessarily speedily fatal. Persons have been known to live twenty years or more with very extensive organic disease of this organ.

It is very important, however, that a correct diagnosis be made in the early stages of these diseases, in order that an appropriate course of hygiene and treatment may be adopted, which will check their progress. While we cannot cure extensive organic diseases of the heart, we can check their progress, and prolong life, and render the condition of the subject comparatively comfortable. Since we are able to diagnosticate with the utmost precision the various affections of the heart, and since the discovery of certain specific medicines which exert most beneficial effects, we are enabled to treat this class of maladies with the most gratifying results. Thus we have seen a case in a very advanced stage of the disease, with the breathing so difficult that the subject had been compelled to remain almost constantly in the sitting posture, in the greatest agony, for so long a time that immense bed sores had formed on the seat; in which the dropsy had become so extensive that the skin of the legs had burst open; and yet this patient, through the influence of a specific course of treatment, was speedily relieved, and enabled to live in a comparatively comfortable condition for many months.

One afflicted with heart disease should abstain from the use of all kinds of stimulants, tobacco, and whatever tends to lower vitality. His life should be an even one, free from all excitement of any kind whatsoever. He should avoid severe physical exertion, and everything which causes the heart to beat with undue frequency.

There are certain symptoms, the result of chlorosis (the green sickness), a deficiency of blood, dyspepsia, uterine disease, and certain nervous affections, which may simulate those of real organic disease, but the physician of education and experience, with a trained ear, is able to detect the difference speedily.

Sore Mouth. (Stomatitis.)

Stomatitis, or inflammation of the mucous membrane of the mouth, may include the entire surface of the gums, tongue, and cheeks, or appear only in spots. Vesicles are formed, having swollen edges and a white or yellow center, which finally ulcerate. When mild, the affection is confined to these parts.

If the inflammation is acute, the mouth is dry and parched, or as is more frequently the case, the flow of saliva is abundant and acrid, and, when swallowed, irritates the stomach and bowels, producing fever, diarrhea, griping pains, and flatulency. The tongue is either coated white or red, and is glossy, and the sense of taste is considerably impaired. Digestion and nutrition are then disturbed, and the patient becomes rapidly emaciated.

Thrush, or Canker, is that form of stomatitis in which white ulcers locate on the inner side of the upper lip, the tongue, or roof of the mouth; the irritation which they cause not only interferes with eating, but produces fever, together with the symptoms previously mentioned.

Apthæ, or follicular inflammation, is distinguished by very painful little ulcers, single or in clusters, scattered over the surface of the tongue and lining of the mouth. Sometimes it is complicated with little lumps in the tongue. These form ulcers and denote scrofulous inflammation. Fissures and cracks in the tongue indicate derangement of the stomach.

The Causes of stomatitis, in nursing infants, are unhealthy milk, or effete matter, which, for lack of proper care and cleanliness, accumulates upon the nipple. In older children, improper diet, irritants, debility of the digestive functions, or hereditary syphilitic taint, disorder the blood and induce local inflammation.

Treatment. Locally, use a wash of golden seal or gold thread sweetened with maple-sugar, and rendered slightly alkaline with borax or saleratus. Also use a very weak, alkaline tea, or one of slippery-elm flour, to obviate the acridity of the secretions. If the sores do not heal, constitutional treatment may be required, as the use of the Golden Medical Discovery. The family physician should be consulted if the sore mouth resists all these remedial measures.

Nursing Sore Mouth. (Stomatitis Materna.)

During the period of nursing, and sometimes in the latter months of pregnancy, women are liable to a peculiar variety of sore mouth. The soreness is sometimes so great that, although the appetite may be ravenous, the patient cannot eat. When this condition extends to the stomach and bowels, symptoms of a very grave character appear, and the disease, by interfering with the process of nutrition, causes emaciation and debility, and in extreme cases, death. It is a strange affection, nearly always disappearing upon weaning the child, though this course is not absolutely necessary. It appears to depend upon a hepatic, or gastric derangement, in connection with a vitiated condition of the blood, but how this is brought about is unknown.

Symptoms. The disease sometimes comes on suddenly, at others more slowly. The fact that the woman is either pregnant or nursing, is of importance in forming a diagnosis. At first there is a severe, scalding sensation of the tongue, mouth, and fauces, with pain, which is sometimes intense. The color of the tongue is often pink, or a light red, while the mouth is generally of a deeper hue. This stinging, biting sensation is accompanied by a profuse, watery discharge from the mouth, which seems extremely hot and acrid, causing excoriation whenever it comes in contract with the face or chin. The appetite is good, sometimes ravenous, but food or drinks, except of the blandest character, occasion such intense pain that the patient avoids their use. Ulceration occurs after a little time. The bowels are generally constipated, but when the disease extends to the stomach or intestines, diarrhea occurs. There is generally anæmia, debility, and impairment of the vital powers.

Treatment. The indications for treatment in this affection are to overcome the vitiated condition of the blood, and to sustain the vital powers. The remedies for this purpose are alteratives, antiseptics, and tonics. Give the Golden Medical Discovery, the value of which may be greatly enhanced by adding one-half ounce of the fluid extract of baptisia to each bottle, in doses of a teaspoonful four times a day. Chlorate of potash, half an ounce in a pint of water, used as a wash and gargle, is of great value. A teaspoonful of the same may be swallowed several times a day. This will not interfere with other medicines. As a tonic, the tincture of the muriate of iron, in five to ten-drop doses, diluted with water, may be taken three or four times daily. Quinine, in one or two-gram doses, should be given with the iron if the debility be extreme. When there is great acidity of the stomach, which may be known by heart burn, saleratus may be taken in water, to neutralize it, but should not be drunk within an hour of the time for taking other medicines. If constipation exists, use the Pleasant Pellets. This course of treatment, thoroughly carried out, will seldom fail to effect a perfect cure, without weaning the child, yet this latter course may sometimes become advisable to promote the recovery of the patient. Should the treatment advised not produce the desired result, a skillful physician's services should be secured, as he may, in individual cases, distinguish other important indications which may enable him to modify the treatment to advantage.

Diarrhea, Cholera Infantum, or Summer Complaint, and Dysentery.

These diseases are usually considered separately by medical writers but, as they are closely related, a simple diarrhea not unfrequently running into a cholera infantum or a dysentery, we shall consider them together.

Diarrhea is an affection characterized by unnaturally frequent evacuations from the bowels of a liquid of morbidly soft consistency. It may be simple or inflammatory, and acute or chronic.

A diarrhea is said to be bilious when the discharges are composed principally of serum, highly colored with yellow or green bile; catarrhal, when they are of a semi-transparent, mucous character; serous, when the dejections are thin and watery, sometimes mixed with blood, bile, or ingesta.

The symptoms of the affection are usually at first those of indigestion, a fullness of the stomach, flatulency, and colicky pains. The pains, which precede each evacuation, are intermittent in character. There may be an unpleasant sinking sensation in the abdomen, and, with the discharge, exhaustion, a feeble pulse, and a cool skin. In the inflammatory variety, there is more or less fever.

Cholera Infantum, or summer complaint, is a disease peculiar to the warm season, and more prevalent in cities, and among those children who do not nurse at the breast. It is characterized by great irritability of the stomach, and persistent vomiting and purging, the discharges from the bowels being copious and watery, and sometimes containing specks of curd, yellowish-green matter, and mucus. The limbs of the little sufferer are usually drawn up, indicating pain in the bowels, and there is great prostration with cold extremities. The invasion may be so sudden, and the disease so violent as to destroy life in a few hours.

Dysentery, also known as bloody-flux, consists of an inflammation of the mucous membrane of the large intestine, with ulceration of the affected surfaces. The disease is accompanied with much nervous prostration, and is distinguished by severe pains in the abdomen of a griping nature, followed by frequent scanty and bloody stools, and much straining. Occasionally the attack is ushered in with a chill and aching pains in various parts of the body, with copious fecal dejections. In other cases the attack is preceded by loss of appetite, a sense of uneasiness with dull pains in the abdomen, and weariness. The disease, like diarrhea, may be either acute or chronic.

The Causes of these affections of the bowels are many and varied. They may be brought on by exposure to cold and wet, or by improper and indigestible articles of food, such as unripe fruits, salads, pastries, and, in fact, anything which interferes with the normal operations of the digestive apparatus. One of the most fertile sources of diarrhea in infants, and of cholera infantum, is the administration of unsuitable food, the ill effects of which are greatly increased by exposure to heat or cold. Uncleanliness, and the inhalation of impure air, are prolific causes Of these diseases. Epidemics have been supposed to be due to some peculiarity in the condition of the atmosphere, or to some impalpable germ of a vegetable or animal nature.

Treatment. In the treatment of these diseases, one should first endeavor to ascertain the cause of the trouble, and then, if possible, effect its removal. Attention should be given to the hygienic surroundings of the individual afflicted; if he reside in a miasmatic district, or in a location in which the atmosphere is contaminated by the decomposition of animal or vegetable matter, or filled with noxious gases, his abode should be changed. A pure, dry air is most beneficial in these cases.

Only the least irritating and most easily digestible articles of food should be taken. Healthy cow's milk is slightly alkaline, but that of cows fed on slops is usually acid, and unfit for infants. It is, therefore, well to test all milk with blue litmus paper before feeding it to young children. If found to be strongly acid, that is if it turns the paper red, it should be rejected, but if only slightly so, sufficient lime water may be added to render it slightly alkaline. For adults and older children, the diet should consist of such starchy foods as arrow-root, sago, corn starch, and rice, and of ripe grapes, freed from the skins and seeds, peaches, and boiled milk, or milk and lime water. In some cases the animal broths are beneficial, especially mutton broth. To quench the thirst, crust coffee, rice coffee, and lemonade, in small quantities, may be taken.

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

At the onset of an attack of diarrhea or dysentery, if there be reason to believe that the intestinal tract contains irritating matter, a dose of castor oil, with a few drops of anise oil added to render it palatable, should be administered. After all irritating ingesta have been removed, Dr. Pierce's Compound Extract of Smart-weed should be given in doses proportionate to the age of the patient, and the severity of the case. Being composed of the extract of smart-weed, or water pepper, Jamaica ginger, camphor, and genuine French grape brandy, it exerts a most wonderful effect not only in those diseases but in cholera morbus and intestinal colic. It allays the irritation and inflammation of the affected mucous surfaces, and soothes the nervous system. In the great majority of cases, the above course of treatment will be found sufficient, but in the more severe forms of these diseases additional remedies may be required.

In dysentery, accompanied with severe pain and straining, injections of starch water and laudanum, from two to four ounces of the former to from twenty to fifty drops of the latter should be used.

Hot fomentations applied to the abdomen are beneficial. If the discharges contain much blood, a flannel cloth moistened with the spirits of turpentine should be laid over the lower part of the abdomen, and kept there until slight irritation is produced.

Lime water, bicarbonate of soda, bicarbonate of potash (saleratus), chalk, and the subnitrate of bismuth are valuable agents to correct the secretions, and allay irritation of the diseased mucous surface. The above-named preparations of soda, potash, and bismuth may be taken in doses of from five to twenty grains every few hours.

Blackberry root and cranesbill (Geranium Maculatum), in the form of fluid extract or infusion, are beneficial in acute cases in which the discharges are profuse and watery, and in the chronic forms of these affections.

In cholera infantum subnitrate of bismuth should be given in doses of from five to ten grains at intervals of from two to four hours. If the discharges are very profuse, the fluid extract of cranesbill may be administered in from two to ten-drop doses alternately with the bismuth. The camphorated tincture of opium (paregoric) is required in doses of from two to twenty drops, depending upon the age of the child and the severity of the case, if there is much pain, but great caution should be exercised in administering the preparations of opium to children. A single drop of laudanum given to a young infant has caused convulsions, coma, and death in more than one instance. To check the vomiting of cholera infantum, mild irritation over the stomach is sometimes effectual. For this purpose a weak mustard plaster, or a cloth moistened with turpentine, may be laid over the stomach for a few minutes at a time. If the child is old enough to suck pellets of ice, these are beneficial, or a piece can be wrapped in a cloth and sucked.

Colic.

Colic is a term applied to griping pains in the abdomen, which are sometimes accompanied with nausea and vomiting. The derangement is recognized in several forms, some of which we shall briefly describe.

Bilious Colic. This may be the result of a morbid condition of the liver.

Symptoms. It is characterized by severe pain occurring in paroxysms, which may be relieved by pressure upon the bowels. The pulse is quick, the tongue coated, and the skin harsh and dry; there is headache, impaired appetite, acrid taste in the mouth, thirst, nausea, attended with vomiting and general chilliness, followed by febrile symptoms.

Cause. It may be induced by exposure to cold, in consequence of which the circulation is impeded, the pores of the skin obstructed, and all of the vitiated matters having to be expelled through the liver, stomach, and intestines. It may also be due to malaria in the atmosphere. It most commonly occurs during the autumn, after a season of hot weather.

Flatulent Colic. Flatulent or "wind" colic is one of the results of indigestion.

Symptoms. A sense of fullness in the pit of the stomach, attended with pain, which is transferred from one part of the bowels to another. There is fever, a quick pulse, nausea, and the presence of gas; by the latter feature it may be detected from the other forms.

Causes. Cold or atmospheric changes, the eating of unripe fruits, uncooked vegetables and those articles of diet which ferment easily, are the principle causes.

Painter's Colic. This form is also known by various names, such as colica pictonum, saturnine, or lead colic. Those persons who are engaged in the manufacture of lead, and painters, are the most frequent victims of this affection.

Symptoms. Impaired appetite, fetid breath, thickly coated tongue, obstinate constipation, a dry skin, scanty urine, languor, severe pain in the umbilical region, and general derangement of the functions of the system.

Causes. From the term applied to this form, the cause may be inferred. It is induced by the absorption of lead through the lungs, stomach, and skin.

Treatment. The indication to be fulfilled in bilious colic is to relieve the intestinal spasm. This may be done by drinking freely of a decoction of yam-root, or dioscorea villosa, which is an effectual remedy in this affection. If this be not at hand, the spasm may be relieved by administering freely of Dr. Pierce's Extract of Smart-Weed. If the stomach be irritable, a tablespoonful of laudanum and one of tincture of lobelia, in four ounces of starch water, administered as an injection, is effectual. If simple means do not promptly arrest the attack, no time should be lost in summoning the family physician.

In flatulent colic, the treatment should depend upon the cause. If it be occasioned by cold, a teaspoonful or two of the Extract of Smart-weed, in warm water or catnip tea, repeated a few times, will be sufficient. If it result from overloading the stomach, a dose of the Pleasant Pellets will answer the purpose. If the pain in the abdomen is severe, apply hot fomentations. Assist the action of physic, by giving an injection of senna and catnip tea, or if the stomach is very sour, take internally some mild alkali, such as common saleratus.

In painters' colic, the following cathartic mixture is an effectual remedy: sulphate of magnesia (epsom salts), twelve ounces; nitrate of potassa (saltpeter), half an ounce; sulphuric acid, one drachm; boiling water, one quart. Of this remedy give a teaspoonful every thirty minutes or every hour, until the bowels move. An injection of some diaphoretic tea, or of alum water, is a good remedy. Castor oil and molasses, containing a teaspoonful of spirits of turpentine, will add to the efficiency of an injection. If the colic be not promptly relieved, a physician should be employed. To eliminate the lead from the system, and thus prevent a return of the colic, or other injurious effects, two drachms of iodide of potassium should be added to a bottle of the Golden Medical Discovery, and a teaspoonful of this taken four times a day.

Jaundice. (Icterus.)

This affection is generally regarded as a symptom of disordered liver, since it frequently occurs during the progress of diseases of that organ. When the disease imparts a greenish tinge to the skin, it is termed green jaundice, and, when it imparts a blackish color, it is known as black jaundice. Jaundice is undoubtedly due to the presence of biliary elements in the blood.

Causes. In consequence of the varied conditions from which it arises, Professor Da Costa has aptly remarked: "With the recognition of jaundice, the difficulty in diagnosis may be said to begin." He considers the causes of jaundice to be (1) diseases of the liver; (2) disease or the bile ducts; (3) diseases remote from the liver, or general disease leading to a disorder of that viscus; (4) certain causes acting upon the blood.

Symptoms. It is characterized by a yellowish color of the skin and of the white of the eyes. The skin is usually dry and harsh; if it be moist, the linen will be tinged yellow from the perspiration. The tongue is coated yellow, the mouth is dry, and the appetite impaired; there is headache, nausea, and sometimes vomiting; there is pain in the abdomen after eating, and in the region of the liver, and it is also felt in the right shoulder, and between the shoulder-blades. In severe cases, there is fever, accompanied with chills, despondency and loss of flesh. The stools are generally of a light clay color, and very offensive; the urine is thick and yellow. When the disease terminates fatally, there is delirium followed by stupor.

Treatment. The first step should be to eliminate from the system, as speedily as possible, all noxious materials. For this purpose, the spirit-vapor bath should be used. If the urine is scanty or voided with difficulty, take acetate of potash or queen of the meadow. These may be taken in connection with the Golden Medical Discovery and Purgative Pellets, the efficacy of which has already been described in the treatment of chronic inflammation of the liver. They are indeed valuable agents in this disease, since they increase the action of all the excretory glands, and rapidly remove those matters, which, if retained, would poison the system.

In some cases, acids are of great value; good hard cider or hydrochloric acid and the acid bath are frequently valuable agents.

In other cases the employment, both internally and externally, of alkalies in addition to the Golden Medical Discovery answers the purpose much better.

Again, there are persons who, in addition to alteratives and baths, require tonics. In the treatment or this affection, whatever may be the nature of the case, the use of alteratives must not be forgotten, for without them, the auxiliary treatment with acids, alkalies, and tonics, will not produce the desired effect.

The employment of drastic remedies is sometimes resorted to; but, although they may give temporary relief, the patient soon relapses into his former condition, while if the treatment above given be adopted, the recovery will be permanent.

Gall-Stones. (Biliary Calculi.)

These are concretions found in the gall-bladder or bile duct, and vary from the size of a pea to that of a hen's egg. There may be no indication of their existence in the gall-bladder until they begin to pass through the duct.

Causes. The formation of gall-stones is undoubtedly due to an unhealthy condition of the bile. Corpulent persons, and those indulging in over-stimulating diet, or in the habitual use of fermented drinks, are most liable to be troubled by them.

Symptoms. The patient is suddenly seized with excruciating pain in the right side. After a time it subsides, but is again renewed with as great severity as before. There is nausea, with vomiting, which is often excessive and severe. The pulse is sometimes slower than is natural, the extremities are cold, there is great exhaustion, together with perspiration and spasmodic contraction of the abdominal muscles. As soon as one stone has passed through the duct into the intestine, immediate relief is experienced until another commences to pass, and the larger the concretion, the greater is the pain. If the stools be washed, the gall-stones may be seen floating on top of the water.

Treatment. This consists chiefly in relieving the patient of pain and vomiting during the passage of the gall-stones. Hot fomentations made with stramonium leaves and lobelia, and applied over the painful parts, are beneficial. Small doses of lobelia may be taken, but not in sufficient quantities to produce vomiting. Doses of opium should also be taken; this anodyne must, however, be used with care. Gelseminum is often useful. Chloroform, ether, or the spirit vapor-bath generally allays the pain. Carbonate of soda, dissolved in water, often relieves the vomiting.

These distressing symptoms are apt to recur until the removal of all the gall-stones is effected. To aid in removing them, take the Golden Medical Discovery rather freely for a day or two, and continue its use with lobelia, in doses sufficiently large to produce nausea, but not vomiting. From four to eight ounces of sweet oil may be given, and, if the bowels do not respond within three hours, repeat the dose, and the gall-stones will generally be evacuated. To prevent the formation of these concretions take the Golden Medical Discovery, together with alkaline drinks made with carbonate of soda. Tone and energy will thereby be imparted to the liver, the free flow of bile will be insured and the subsequent formation of gall-stones prevented.

Intestinal Worms.

We have not the space to discuss the numerous theories which have been offered to account for the presence of these parasites in the human body. We shall enumerate the principal species, describe the symptoms indicating their presence, and indicate the proper remedies.

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

(1.) The round worm, termed by naturalists, ascaris lumbricoides, varies from six inches to a foot in length, and resembles the common earth-worm. It infests the small intestines, and seldom migrates into the stomach or large bowel. Instances are recorded, however, in which it has crept upward in the esophagus, larynx, nostrils, and eustachian tube; but their presence in these parts is of comparatively rare occurrence, and is generally caused by some local irritation which compels their migration. The fact that they have been found in the peritoneal sac, gave rise to the opinion that they perforate the intestine; but careful observations have proved that they can only escape through openings made by ulcers.

This species has been found in adults, but is more common in children from three to twelve years of age. The number of this species existing in a human body is variable. Sometimes only two or three are found. At other times a hundred, and even twice that number, are voided in a few days.

(2.) The ascaris vermicularis, thread, pin, or seat-worm, is round, very slender, and about half an inch in length. The habitation of this species is the rectum, and they are often found matted together in the excrement. They are very active, even after ejection, and have been known to cause great local irritation by entering the vagina and urethra. Their presence is an occasional cause of masturbation. It is impossible to estimate the number of these parasites that may exist in the human rectum. Great numbers, sometimes, are voided at a single evacuation.

(3.) The tricocephalus dispar is a third variety of the round worm, and is said to infest the bodies of almost every species of mammalia. As its name indicates, the upper portion of its body is slender, hair-like, and terminates at the lower extremity in a thick, spiral portion. It is from one to two inches in length, and is found attached by its head to the mucous membrane of the cæcum, and, in rare instances, in the colon and small intestine. They are rarely numerous.

Tæceniæ or tape-worms, are hermaphrodites, of a flat, ribbon-like form, and are composed of numerous segments, each of which is provided with a complete set of generative organs, and contains ova for the production of thousands of individuals. Some authors have supposed that each segment, or joint, is a distinct individual, but the existence of one head for the whole precludes this theory. There are two species of tæniæ developed in the human intestine; the tænia solium and the tænia lata.

(4.) The tænia solium is the species commonly found in America and all the countries of Europe, except France, Russia, and Switzerland. In France, both species are found, but the tænia lata seems to be indigenous to Russia and Switzerland.

The tænia solium varies in length from four or five to thirty, thirty-five, or even forty feet. The head is hemispherical and armed with a double row of twenty or thirty hooklets. The genital organs are alternate and placed upon the outer edges of each segment. It inhabits the small intestine, and is usually solitary.

(5.) The tænia lata, or broad tape-worm, is distinguished by the greater breadth of its segments, and the location of the genital organs, which are found in the centre of each segment. Its small elongated head is unarmed, and has a longitudinal fissure on each side. It usually attains a greater length than the tænia solium.

Symptoms. The symptoms which the long worms occasion, are frequently somewhat obscure. Thirst, irregular appetite, colicky pains, excessive flow of saliva, enlargement of the abdomen, itching of the nose, pallor of the face, offensive breath, disturbed sleep, and grinding of the teeth, all are common symptoms. Occasionally, convulsions and other nervous affections are produced by the presence of the ascaris lumbricoides, but generally they produce less constitutional disturbance than the other varieties. The passage of this species of worms from the bowels, or their ejection from the stomach, is the only positive evidence of their presence. The ascaris vermicularis, thread, pin, or seat-worm, gives rise to most of the symptoms produced by the long worms, but in addition produces intense itching at the anus, and, not unfrequently, an eruption upon that part. The itching is particularly distressing at night. When the little sufferer is well covered, the warmth occasioned by the bed-clothes causes these little parasites to crawl out upon the anus, and produces such paroxysms of itching and pain as to cause the child to kick the covering oft and lie naked. The persistent manifestations of a disposition to lie naked, should excite the parents' suspicions of seat-worms, and lead them to investigate all the symptoms. By examining the child's stools the worms may he found adhering to the feces, and they may also be seen on the anus. Thousands of children suffer untold agony from these little seat-worms, which are left unmolested to torment them, because the parents are unfamiliar with the meaning of the symptoms manifested, and therefore pay no heed to them. We have been thus particular in describing the symptoms indicating the presence of these pestiferous parasites, in order that they may be readily detected.

The Symptoms produced by the tape-worm are dizziness, ringing in the ears, increased secretion of saliva, indigestion, ravenous appetite, sharp abdominal pains, and emaciation. The only positive sign of the presence of these parasites, is the passage of pieces of them in the feces. The nervous and other symptoms produced by the ordinary long worms are also caused by the tape-worm.

Causes. Careful observations have proved that there are certain causes which favor the generation or development of intestinal worms. Among others, we may mention fatty or farinaceous articles of food, gormandizing, constant exposure to a moist atmosphere, and sedentary habits.

It is now generally conceded that the development of tape-worms is due to the swallowing of an egg or germ-cell, which is contained in many kinds of animal food, and which the process of cooking has failed to destroy. People living near low marshes, lakes, or the seacoast, are liable to tæniæ.

Treatment. The expulsion of the ascaris lumbricoides may be very easily and pleasantly effected. Santonin is an effectual remedy for this variety of worms. For a child three years old, take santonin, six grains; podophyllin, one grain; white sugar, thirty grains; mix, triturate, and divide into twelve powders, and give one every three or four hours, until they act upon the bowels; or take santonin, ten grains; white sugar, twenty grains; mix, triturate, and divide into ten powders, and give one every night at bed-time, and after giving two or three in this way, administer a mild cathartic. As santonin is almost entirely tasteless, if not combined with other medicines which are unpalatable, no difficulty will be experienced in administering it to children. By reference to the article on anthelmintics in this volume, other valuable vermifuges may be selected, and directions found for their employment.

In the removal of thread or pin-worms, anthelmintic medicines taken into the stomach are of little or no value. An injection of a strong solution of salt, is a very efficient remedy. A teaspoonful of turpentine in half a pint of milk makes a good injection. Strong coffee has been recommended as an injection. The anus should be well anointed with vaseline, lard, oil, or fresh butter, after each movement of the bowels. Whatever injection or remedy is used, it should be followed by the application of some ointment to the anus, otherwise they will continue to deposit their eggs about that orifice and multiply there.

Various remedies have been used to destroy tape-worms. Among others we may mention the old and time-honored remedy, which consists of two or three ounces of the oil of turpentine, taken in castor oil or some aromatic tincture.

A decoction made by boiling two or three ounces of freshly powdered pomegranate bark in a pint of water was used by the ancients, and is now highly recommended as a remedy.

Some American physicians have used an emulsion of pumpkin seeds with marked success.

Twenty or thirty grains of the extract of male fern, followed by a cathartic is highly recommended for the destruction and removal of tæniæ.

Trichina Spiralis.

In 1835, Owen discovered a peculiar parasite, which sometimes infests the human body, and is termed the trichina spiralis. The presence of these parasites has given rise to morbid conditions of the system, followed by the most serious results. They are developed in the alimentary canal, and then perforate its tissues and enter the muscles. Twelve trichinæ have been found in a section of human muscle only one-twelfth of an inch square and one-fifth of an inch in thickness.

The early symptoms of trichinæ are very uncertain, being the same as those of some other disease. The patient complains of severe pain in the abdomen and is troubled with diarrhea. When the trichinæ pass into the muscles, they occasion great suffering. There are sharp pains in the muscles, the perspiration is profuse, and the patient becomes exhausted.

Cause. Nearly every case of trichinæ, which has been brought to the notice of the profession, has been attributed to the eating of raw or improperly cooked pork. The parasites can only be detected with a microscope.

Treatment. The impossibility of removing the trichinæ after they have passed into the muscles is apparent; and, as yet, no special remedy has been recommended to remove them from the alimentary canal. The only safety lies in prevention. Hence raw or imperfectly cooked pork should never be eaten.

Dyspepsia.

It is generally conceded that a multitude of human ailments arise from indigestion, and in its various forms it taxes the skill of the physician to prescribe the proper remedies. It is undeniable that the closest intimacy exists between happiness and good digestion. A healthy digestion aids materially in making a cheerful disposition, and the "feast of reason and flow of soul" is due as much to the functional integrity of the stomach as to a strong and generous mental organization. Dr. Johnson severely said: "Every man is a rascal as soon as he is sick." We all know that a morbid condition irritates the individual and excites sarcastic and disagreeable remarks. And, likewise, an irritable temper and, suddenly aroused passions may not only turn and disturb the stomach, but even poison the secretions. Anxiety, excitability, fear, and irritability frequently cause the perversion of physiological processes.

The slightest functional disturbance of the stomach deranges, more or less, all the succeeding operations of digestion and tends to the vitiation and impairment of the delicate processes of nutrition. Dyspepsia may commence and proceed so insidiously as not to excite the suspicion of friends, although the patient generally desires active treatment, such as cathartics, emetics, and medicines to act upon the liver. When the disease becomes confirmed, it presents some of the following symptoms: Weight, uneasiness, and fullness in the region of the stomach, attended by impatience, irritability, sluggishness, anxiety, and melancholy; there is impairment of the appetite and taste, also sourness, flatulency, and, perhaps, frequent attacks of colic, loss of hope, courage, and energy; apathy, drowsiness, and frightful dreams are also symptoms common in the different stages of this disease. There are, furthermore, the accompanying symptoms of a coated tongue, bitter taste in the mouth, unpleasant eructations, scalding of the throat from regurgitation, offensive breath, sick headache, giddiness, disturbed sleep, sallow countenance, heart-burn, morbid craving after food, constant anxiety and apprehension, fancied impotency, and fickleness. The subjects of dyspepsia frequently imagine that they require medicines to act upon the liver, desire active treatment, are endlessly experimenting in diet, daily rehearse their symptoms, and are morbidly sensitive.

Causes. Overtasking the body or mind, overloading the stomach, the use of improper food, such as stale vegetables and meat, unripe fruits, indigestible articles, improperly prepared food, irregular meals, disorderly habits, the use of alcoholic stimulants, loss of sleep, masturbation irritability of temper, anxiety, or grief may all give rise to indigestion. If the functions performed by the skin are embarrassed by cold, tight clothing, or lack of cleanliness, the nutritive changes cannot properly take place throughout the body, and consequently the digestive functions are embarrassed, as the revolutions of a water-wheel are impeded by the backset of the water. When food is not thoroughly masticated, it is not properly mixed with saliva of the glands of the mouth, and is not prepared for digestion by the acids of the stomach.

Whatever diminishes the general strength, impairs the health, or encroaches upon the functions of life, also hinders the perfect solution of food and disturbs in a measure the function of digestion. Whatever diminishes the normal amount of the digestive secretions or perverts their quality, deteriorating their solvent properties, is a cause of dyspepsia. This should be borne in mind in selecting remedies.

Treatment. The hygienic treatment consists in the regulation of the daily habits, proper selection and preparation of the food, cultivation of cheerfulness, diversion of the mind, and cleanliness of person. We cannot give particular directions as to the kind of diet, as there are no established rules for guidance. Generally, a dyspeptic knows best, from experience, what articles of diet can be taken with the least injury. The directions applicable to the condition of one patient, are not suited to those of another. In dyspepsia, animal food is, as a rule, preferable. Foods rich in starchy matter often ferment and produce distress. Sometimes alkalies may be given with beneficial effect, when there seems to be an excess of acid in the gastric secretions.

In some cases, the digestive fluids are weak and fermentation results, giving rise to flatulency and belching. An antiseptic, which may be prepared by mixing a teaspoonful of hydrochloric acid with four ounces of water, of which a teaspoonful may be taken after each meal, will prove beneficial to check the fermentation and aid digestion. The addition of one or two drops of a mixture of one part of carbolic acid and six of glycerine, to the above solution of hydrochloric acid improves its antiseptic properties. Or, Dr. Pierce's Golden Medical Discovery will stop undue fermentation, and from its tonic and invigorating effect upon the lining membranes of the stomach will generally overcome the indigestion. Some people are afraid to take it, when suffering from indigestion, because it has a sweet taste. But the sweet is not saccharine, or sugar sweet, but an entirely different sweet principle which prevents fermentation instead of promoting it.

Acidity of the stomach and the attendant irritation may be allayed by the following mixture: Calcined magnesia, one drachm; refined sugar, one drachm; subnitrate of bismuth, one-half drachm; oil of cajeput, ten drops. The dose is half a teaspoonful an hour after every meal. Any dispensing druggist can put it up.

It is frequently difficult to prevent the patient from over-distending the stomach, and thus impairing the tone of the muscular coats and prolonging the process of digestion.

In consequence of debility, over-exertion, anxiety, or chronic inflammation of the stomach, there is not a proper secretion, in quantity or quality, of digestive solvents, and it matters not whether it be a deficiency of the fluids of the stomach, or of the intestines, or of the pancreas and liver, the result is indigestion. The question of what important agent is lacking, naturally presents itself to the physician. Is it pepsin, the active principle of the gastric juice, which converts proteids into peptone, that is wanting, or is there a deficiency of pancreatin? Of course the principle which is lacking should be supplied; but has the physician the remedial agents properly prepared, and ready for prescribing? The specialist, having more cases of dyspepsia to treat than the general practitioner, is more likely to have the latest and most approved remedies applicable to loss of appetite, indigestion, impoverished blood, imperfect assimilation, and all diseases arising from faulty nutrition. In ordinary practice, the physician's time is divided in his consideration of acute, chronic, surgical, and obstetrical cases; in fact, much of it is occupied in riding to reach his patients. His attention is continually diverted from one class of cases to another, effectually preventing investigation in any particular direction. His patronage does not warrant him in the outlay of time required for the investigation of particular diseases, and the expense necessary to obtain the latest and best remedial agents for their treatment. In the multiplicity of his cares and arduous duties by night and by day, obstinate chronic cases become an annoyance to him, and whenever he can be otherwise professionally employed, he avoids them, disliking to undertake their treatment.

With plenty of time for scientific investigation, ample facilities to meet the demands upon his skill, and each succeeding case presenting some new phase, the treatment becomes a matter of absorbing interest to the specialist, and each success inspires greater confidence. We not only use in the treatment of indigestion, solvent remedies, like pepsin, which act only upon proteids, but also other remedies of recent discovery, which exert a remarkable curative influence in diseases of the digestive organs.

The chemistry of digestion and of life is becoming better understood. Any of the free acids may serve to dissolve a precipitated phosphate; but it is only the investigating therapeutist and experienced practitioner who understands which of them is the most and which is the least efficacious. Alkalies may dissolve lithic deposits, but who, unless he be an experienced physician, can detect the fault of nutrition which leads to their formation, or rightly interpret the symptoms indicating it? These simple illustrations of the complications which attend dyspepsia, are mentioned merely to show that they must be anticipated and taken into account in the treatment.

The number of cases of dyspeptic invalids treated by the staff of the Invalids' Hotel and Surgical Institute within file past few years, is so large as scarcely to be credited by those unacquainted with the prevalence of this disease. For this reason we have taken unusual pains to investigate the causes of the disease, and have spared no expense to provide the most approved digestive solvents, and stomachic tonics, which invigorate the mucous membrane of the stomach, and materially assist in reducing the food to a liquid condition. Some of these, without being purgative, increase the activity of the liver, and stimulate the intestinal secretions, two very important indications which should be fulfilled by remedies which cause no real depression. The recent important discoveries made in obtaining the active principles from indigenous plants, has opened the way to the use of a few of the most important of these remedial agents, hitherto almost wholly unknown to the medical profession, and the encouraging results attending our practice have amply repaid us for the investigation and originality in our treatment of this affection.

A careful chemical and microscopical examination of the urine often discloses the actual morbid conditions which perpetuate this functional disease.

Chronic Diarrhea.

On account of the frequency and importance of chronic diarrhea, we deem it worthy of special consideration. It is frequently the sequel of the acute form of the affection. The urgent and severe symptoms of acute diarrhea are often abated, but the disease is not completely cured. The bowels are left in an irritable condition, perhaps in a state of chronic ulceration, which perpetuates morbid discharges.

The most noticeable symptom is the tendency to frequent and unhealthy discharges from the intestines. The evacuated matter varies much in appearance and character in different cases. The precise location of the morbid conditions which give rise to the discharges, as well as to their extent, modifies the color, consistency, and ingredients of the stools. Most frequently they are dark colored and of very offensive odor. They are of a more liquid character than is natural, except when, as is sometimes the case, periods of constipation alternate with periods of unnatural looseness. Tormina, or griping, is usually present, but not so severe as in the acute affection. Tenesmus, or straining, often accompanies it. The appetite is impaired, there is general debility, and the patient is nervous and irritable. The complexion becomes sallow, the skin dry and rough, the tongue dark colored, and the body emaciated.

The affection may be the sequel of neglected or badly treated acute diarrhea, may arise from the injudicious use of powerful purgative medicines, may result from dissipation, unwholesome food, bad air, absence of light, long continued exposure to dampness and cold, overwork, and extreme mental anxiety. Sometimes it is associated with other diseases, such as Bright's disease of the kidneys, scurvy, or some of the various forms of scrofulous disease.

The more prominent symptoms are so apparent and so characteristic that the most unskilled may be able to decide whether the patient has chronic diarrhea; but to determine in what portion of the intestinal canal the affection is chiefly seated, to decide upon the extent of its ravages, to ascertain what peculiar shade or type the affection has taken on, to investigate its complications and modifications, to ferret out its producing or aggravating causes, and above all, to nicely and skillfully adjust remedies to meet the depraved conditions, is by no means an easy task, even for the educated and experienced physician. It should be borne in mind that this is a dangerous malady, and one which should not be trifled with or neglected. Its tendency is to corrode and destroy the bowels, a process which if unchecked, must sooner or latter result in death. There is little tendency to spontaneous recovery, nor is a removal of the exciting cause often followed by recovery. The disease becomes so firmly seated, and the powers of life so debilitated, that nature cannot rally.

Treatment. A warm, salt bath, several times a week, taken at bed-time, is beneficial. Flannel should be worn next to the skin, and the sleeping-room should be warm and well ventilated.

As will be seen from testimonials hereinafter inserted, Dr. Pierce's Golden Medical Discovery has achieved great success in curing chronic diarrhea. Its use should be persisted in for a considerable time to strengthen and tone up the bowels. To relieve the discharges, take Dr. Pierce's Compound Extract of Smart Weed, as needed from time to time.

Chronic Inflammation of the Liver.

(Chronic Hepatitis.)

This is what is ordinarily termed liver complaint, torpid liver, and bilious disorder.

Under this head may be considered all those chronic affections known as congestion, induration, and enlargement of the liver, and which result in deficient action, functional derangement, morbid secretion of bile, and various chronic affections.

Symptoms. Owing to the liability of other organs to become diseased during the progress of chronic affections of the liver, great precision in diagnosis is required to determine, by the symptoms, the organ which is primarily diseased and those secondarily affected. This requires not only familiarity with the signs of a complicated disease, but also thorough anatomical knowledge of the diseased organ, of the morbid changes which occur in its structure, and their influence on its own functions, as well as on those of other organs.

The symptoms may differ according to the circumstances, temperament, sex, age, or constitution of the individual, and the complications of the disease. The local indications are fullness of the right side, thus denoting congestion of the liver; a dull, heavy pain, which is increased by pressure or by lying on the left side; a sense of fullness, weight, and oppression about the stomach; an aching in the right shoulder-blade; a dull, disagreeable pain in the shoulder-joint, which may extend down the arm, and which is sometimes felt in the wrist and joints of the hand Not unfrequently the complexion becomes pale and sallow, and there is puffiness under the eye, headache, a bitter taste in the mouth, tongue coated white or covered with a brown fur, and hardness of the gums; there is frequent sighing, a hacking cough, fever, restlessness, and loss of sleep; sometimes an unnatural, greasy appearance of the skin, at others, it is dry and harsh, has scaly or branny eruptions, pimples, dark blotches, and troublesome itching. The urine is frequently scanty and high-colored, but variable as to quantity and appearance; it often produces a scalding sensation when voided, and, if allowed to stand, deposits a sediment which sometimes contains albumen. The pulse is very slow, particularly when the elements of the bile are not eliminated from the blood. The pulsations of the heart are easily quickened, and palpitation is excited if the subject be low and anæmic. There is depression of spirits, and a decided tendency to be discouraged and despondent. The functional powers of the stomach are impaired; there is loss of appetite, or it becomes capricious; uneasiness is felt in the region of the stomach, oppression, sometimes nausea and water-brash, or there is indigestion, flatulency, and acid eructations; the bowels become irregular, usually constipated, and occasionally subject to obstinate diarrhea attended with colicky pains; the stools are of a light clay color, sometimes hard and dark, again thin and very offensive, and occasionally green or black. As the disease progresses, during the day the circulation is sluggish, the feet and hands are cold, but at night the pulse is accelerated, and a burning sensation is felt in the palms of the hands and the soles of the feet.

The foregoing symptoms are not all present in one case, nor are any two cases alike in every respect. They vary according to the organs most implicated in the hepatic derangement. Thus, when chronic inflammation of the liver is associated with heart disease, the subject may have palpitation, excessive or defective action of the heart, attended with more or less pain and shortness of breath. If the lungs be specially influenced, then, in addition to the ordinary hepatic symptoms, there may be a dry cough, asthma, hurried respiration, bronchitis, hoarseness, and pain in the chest. If the stomach be the sympathizing organ, the tongue is coated white or brown, there is nausea, loss of appetite, flatulency, acidity, dyspepsia, fullness, and oppression, amounting, sometimes, to pain in the stomach after taking food; the food ferments and gives rise to eructations and various other manifestations of disorder. If the bowels are morbidly influenced by this affection, there is constipation or diarrhea, griping pain, distension of the abdomen, piles, and pain just within the points of the hips, thus indicating irritation of The colon. If the brain or nervous system sensitively responds, there is headache, dizziness, disturbed sleep, depression of spirits, peevishness, capriciousness, lack of energy, irritability, and congestive symptoms. When the skin is involved the surface is dry, harsh, and scaly, displaying dark "moth-spots," blotches, or numerous little sores, and the countenance has a dull, tawny look. If the kidneys be disturbed by it, there may be pain and a sensation of weight in the back, while the urine may be scanty and high-colored, or abundant, pale, and limpid, frequently charged with sedimentary products of disease, and voided with difficulty. If the womb be implicated in this chronic affection, the menstrual function may be deranged, and result in an excessive or a deficient monthly flow, and be followed by profuse leucorrhea.

The preceding allusion to the complications of chronic inflammation of the liver shows the necessity of clearly distinguishing between the symptoms of this disorder and those reflected by the organs which sympathetically respond. To discriminate more effectually, and place the correctness of the diagnosis beyond doubt, we make a chemical and microscopical examination of the urine, and thereby detect the morbid products which it contains, and direct our attention to the diseased organs furnishing them. These examinations together with a complete history of the case, enable us to make a correct and definite diagnosis of the disease, and the extent to which it has affected the other organs.

Before entering upon the consideration of treatment, let us briefly enumerate the functions of the liver: First, it removes matter, which, if allowed to remain in the blood, would become noxious and unfit it for the further support of the body. Secondly, by secreting bile, it furnishes to the digestive organs a fluid which assists in converting the food into chyle, stimulates the intestine to action, and then is itself transformed and absorbed with the chylous products, after which it circulates with the blood and assists in nutrition until, becoming injurious and pernicious, it is re-secreted and re-elaborated to serve again, as described.

For its growth and nourishment, the liver is furnished with blood by the hepatic artery; but for the purpose of secretion and depuration, it is abundantly supplied with venous blood by the portal system, which is made up of veins from the spleen, stomach, pancreas, and intestines. This impure, venous blood, surcharged with biliary elements, which must be withdrawn from it, is freely poured into the minute network of this glandular organ. In a healthy condition of the liver, the carbonaceous elements of the blood are converted into sugar, and the constituents of the bile are liberated by the liver, and set apart for further duties. When it fails to eliminate these noxious elements from the blood, it is itself thoroughly vitiated by them.

Treatment. Food must be rich in carbon in order that it may build up the tissues and keep the body warm, but carbonic acid, the result of the combustion, must be removed from the blood, or death will ensue. So bile is necessary to digestion, nutrition, and life; yet, if it be not separated from the blood by the secreting action of the liver, it will as surely poison the system and destroy life as carbonic acid. Although the constituents of the bile exist in the blood, they must be removed in order that the blood may be rendered more fit to support the body, while the secreted bile is destined to assist in digestion, and the mysterious process of nutrition. Therefore, we should induce a secretion of bile, and restore the normal activity of the liver. This should be done, not by administering stimulants, but by relieving it of all contingent embarrassments as far as possible. Would any one think of giving to a weak, debilitated man large portions of brandy to enable him to work? Does not every one know that, when the unnatural stimulus is removed, he fails? Apply this principle in the treatment of the liver. When harsh, unnatural stimulants and "bile-driving" medicines are administered for a time and then withheld, the liver relapses into a more torpid and debilitated condition than before treatment was begun. Is not this true of nine-tenths of all who suffer from this malady, and have recourse to this class of remedies?

Then how can we remedially fulfill the preceding indications? We answer in the language of a distinguished author and standard medical writer, "by using a class of agents which should never be overlooked in the treatment of long-standing liver diseases, chiefly addressed to the blood and denominated 'alteratives.'"

Alteratives, tonics, and restorative catalytics are required not only in diseases of the liver, but in a large number of ailments in which the blood becomes charged with morbid materials. The active remedial properties of the most efficient agents of the above classes of medicine now known, are scientifically combined in the "Golden Medical Discovery," which acts especially upon the blood, and hence influences the system generally. It is also powerful in eliminating those morbid humors which are afterwards subjected to excretion through various organs.

Its action is radically different from most medicines employed in chronic diseases, for the reason, that what is usually prescribed, is something corrosive. Unless the disease be temporary, it may return with increased violence.

We have been very minute in the description of the remedial properties of the "Golden Medical Discovery," and have relied upon the reason and intelligence of our patrons, believing that they can, in a degree, understand why we deem it so applicable to the system. It does not debilitate the liver by over-stimulation, nor irritate the stomach and bowels by disturbing the delicate processes of digestion, neither does it act with severity upon the blood, but it operates so gently, insensibly, and yet with so much certainty, that it excites the surprise and admiration of the patient.

From the careful detail of its various properties, there is abundant reason for its favorable action upon all of the excretory organs, which co-operate in the removal of morbid materials from the system. If, however, the bowels are unusually sluggish or obstinately constipated, it is advisable, in conjunction with the "Golden Medical Discovery," to use the "Pleasant Pellets," which are also powerfully alterative, besides being mild and unirritating in their operation. They are the natural assistants of the "Discovery," working harmoniously together. They should be taken in small doses, and their use perseveringly followed, until the bowels are properly regulated by the use of the "Discovery" alone.

It has been customary to resort to powerful drastic cathartics, followed by bitters prepared in dilute alcohol. The habit is unscientific, for it is well known that alcohol deranges the functions of the digestive organs and depraves the blood, besides creating a morbid appetite. It has been repeatedly demonstrated that the use of such bitters has led to a life of drunkenness, with all the woe and untold misery which attend it.

Medicines to be strictly remedial, should exert a tonic influence upon all the vital processes. Those organs which are contiguous to the liver, or connected by sympathy with it, should be assisted in the performance of their functions. Persons who are habitually subject to "bilious" attacks are pleased to find that the use of the "Discovery" and "Pellets" furnishes immunity from such onsets, and prevents their usual recurrence. Thus these remedies are preventive as well as curative.

What we have thus far recommended for the treatment of this chronic affection is within the reach of every family. Patients laboring under this disease, when complicated with other affections, require special consideration and treatment, and all such are counseled to employ only those physicians whose experience and success entitle them to confidence. Health is one of the greatest of blessings, and how to restore it when lost, is a question of vital importance.

Having successfully treated thousands of invalids who have suffered from this chronic affection, we possess abundant evidence of the curability of the disease, but we have only space to publish a few letters from persons who have been under our care, or who have used our medicines, purchased from druggists.

Constipation. (Costiveness.)

Health depends very largely upon the regularity of the bowels. There should be proper alvine evacuations every day. There are few persons who have not suffered at some period of their lives from constipation of the bowels. Inattentive to the calls of nature, or a neglect to regularly attend to this important duty, sooner or later, produces disastrous results. Furthermore, it is essential to the comfort of every individual, for, when this function is not performed, there is derangement of the mental as well as of the bodily organs.

Constipation, or costiveness, as it is sometimes termed, is a functional derangement of the large intestine. This intestine is about five feet in length, and consists of the cæcum, colon, and rectum. It serves as a temporary reservoir for the excrementitial residue of alimentary matter, and for the effete materials excreted by the glands contained in its mucous coats. It is distinguished as the large intestine, because of its great size.

Habitual constipation produces many derangements, resulting from sympathy, irritation, or mechanical obstruction. By referring to Figs. 4 and 9, the reader may observe the anatomical relations which the large intestine sustains to the other abdominal organs. The ascending colon arises in the cæcum (Fig. 4), at the lower part of the abdomen, and passes over the kidney on the right side, where it begins a circuitous route around the abdominal cavity, comes in contact with the inferior surface of the liver, proceeds behind and below the large curvature of the stomach, emerges on the left side, and passes downward in front of the left kidney, where it dips into the pelvic cavity, and ends in the rectum.

If fecal matters are retained until they are decomposed, great injury follows, since the fluid portions are absorbed, conveyed into the blood, and, of necessity, corrupt it with their impurities. In this way, constipation may be the source of general derangement, but such disorder is seldom attributed to the torpid state of this intestine. There is little doubt but that it thereby imposes a great tax upon the functions of the liver, and, frequently, the fault is attributed to that organ instead of the large intestine. Sometimes the blood becomes so charged with fecal matter that its odor can be detected in the breath of the subject.

An overloaded condition of the large intestine may cause inflammation of the liver or dropsy of the abdomen. When the colon is distended, it becomes a mechanical impediment to the free circulation of the blood in other organs, and causes congestion of the portal system, predisposing to chronic inflammation or cirrhosis of the liver. This latter is a structural affection, and may, in turn, give rise to abdominal dropsy. In a word, the accumulation of feces in the colon irritates both the large and small intestines, thus causing congestion of the bowels, liver, or stomach.

The protracted presence of feculent matter deadens the sensibility of the intestine, so that great stimulation is required to provoke it to action. The contents become dry, solid, knotty, and hard, and very difficult to evacuate. If drastic, irritating physic be taken, only temporary relief is afforded, and it must be repeatedly resorted to, and the dose increased, to obtain the desired effect.

Symptoms. One diagnostic symptom of a loaded state of the colon, is an abundant secretion of urine, as limpid as water. The direct symptoms relate to the hardness of the feces and the great difficulty of voiding them. The influence of constipation upon the functions of the liver, is indicated by the sympathy displayed between that organ and the mind. The patient manifests apprehension, mental depression, taciturnity, and melancholy, all indicative of hypochondriac dejection, induced by constipation.

We have treated patients, who, from this cause, had renounced their bright hopes, lost their buoyant spirits, and, becoming subject to superstitious fears, had given themselves up, night and day, to devotions and penance. It often happens that the victims of this deep dejection and morbid feeling of self-abasement, are persons not only of good moral character, but of high religious attainments, and their painful exhibitions of fear, distrust, and gloom, originate in physical rather than in spiritual causes. It is interesting to witness this strange perversion of the imagination, this morbid debasement of the religious faculties, and dejection of mind, due to causes disturbing the functions of the liver and other vital organs.

Young girls, as they approach the age of puberty, seem possessed with the idea that the unfrequent action of the bowels is a desirable habit. They do not associate with the duty a proper regard for health, but consider it as an inelegant and repugnant practice. The consequence is, that at this susceptible period, constipation, induced by neglect, arouses a latent hepatic or pulmonary disease which has been lurking in the system.

How many girls illustrate the truth of this statement by their complaints of dizziness, throbbing pain in the forehead and temples, flushing of the face, transient flushes of heat over the body, while at the same time the extremities are cold. At other times, they manifest the evils of such a course by their stupor, drowsiness, and deep sleep, although upon arising in the morning, they are still tired and unrefreshed.

The constipated condition of the bowels, often leads to congestion of the uterus and leucorrhea, followed by uterine debility, prolapsus, excessive menstruation, anteversion or retroversion of that organ. The infrequency of the habit, incorrectly supposed to be desirable by a young woman, becomes nearly, if not quite disastrous to all her desires and bright prospects. Complications arise, and neither the inexperienced girl nor her solicitous and afflicted parents know where to look for remedial aid. If they seek an asylum from these sufferings, they find many private institutions, where flattering expectations of speedy recovery are aroused. At such institutions, these uterine disorders are generally treated merely as local diseases, while the causes are overlooked, and, consequently, a permanent cure is not effected. Having spent nearly all the money at her command, the patient returns home utterly disheartened. After such failures, many of these unfortunate individuals have applied to us and received treatment, and by persistently following our directions, have in due time been restored to health, amid all the comforts of home, and among friends, who rejoiced with them in the unexpectedly favorable turn of affairs, accomplished at a comparatively trifling expense.

We have seen infants, and also young children, in whom constipation was obstinate. It therefore seems that it is often hereditary. In some persons, this affection continues from childhood, with but little variation, until bleeding pile tumors are developed. Habitual constipation of the bowels for a long period of years will generate a class of diseases, which are often very serious in their results.

Causes. We have already alluded to a sense of false modesty which prevents a response to the calls of nature, and we may mention other reasons, equally trifling, which deter many from fulfilling its demands. Some are in the habit of temporarily postponing their visits to the water closet, until, when they do go, they find themselves unable to evacuate the bowels. Sometimes the closet is a damp, uncomfortable out-house, situated at a distance from the dwelling, or the access is too public, and, hence, there is an unwillingness to visit it at the proper time. Some appear to be too indolent to attend to this duty. Others are too energetic, and think they cannot take the time, until they have finished some self-imposed task or attended to a pressing engagement.

Inactive life and sedentary occupations are also causes of constipation. Active exercise promotes all the bodily functions, and helps to regulate the bowels. Those who are engaged in literary pursuits, find that mental occupation determines the blood to the brain, thus drawing it from the extremities; the temperature falls below the natural standard, and there is almost invariably congestion of the bowels. The inmates of boarding-schools, factory girls, seamstresses, milliners, employés in manufacturing establishments, and all who sit and toil almost unremittingly twelve hours in the day, do not get sufficient exercise of all the muscles of the body, and are often troubled with obstinate constipation.

Food prepared according to the modern modes of cookery, is one of the causes which favors the developement of this derangement. People live too exclusively upon bolted wheat flour. The branny portion of a kernel of wheat consists of various nutritive elements, with more than five times the amount of phosphate of lime contained in fine bolted flour. Those who daily use boiled cracked wheat are not troubled by constipation. There is no dryness or hardness of the feces, and the bowels are evacuated without discomfort.

Treatment. Prevention is always better than cure; hence, a few hygienic directions may not be amiss. Do not disregard the intimations of nature, but promptly respond to her calls. If there is constipation, overcome it by establishing the habit of making daily efforts to effect a movement of the bowels. Taking regular exercise by walking, and lightly percussing or kneading the bowels for five minutes daily, help to increase their activity. The habit of early rising favors the natural action of the bowels. Drinking a glass of water on rising exerts a beneficial influence. The food should be such as will excite the mucous secretion of the large intestines, and arouse its muscles to action. For this purpose, there is no one article that excels coarsely-cracked boiled wheat. Graham bread, mush, cakes, gems, and all articles of diet made from unbolted wheat flour are valuable auxiliaries, and may be prepared to suit the taste. Take the meals at stated hours; be punctual in attendance, regular in eating, and thoroughly masticate your food. Irregularity in the intervals between eating, disturbs the functions of the intestine. The use of ripe fruits, such as apples, pears, grapes, figs, and prunes, in proper quantities, is sometimes very beneficial. Trivial or unimportant as these hygienic suggestions may appear, yet were they observed, constipation, as well as most of the diseases incident to it, would be obviated. A large proportion of the cases will yield to the foregoing hygienic treatment without the employment of medicines. Should it be necessary, however, to employ an aperient to relieve the constipation, Dr. Pierce's Golden Medical Discovery will act most congenially, and will be followed by no constipating reaction, which invariably occurs when drastic cathartics are employed. Its operation is mild, bringing about a healthy action by promoting the biliary and other secretions, thus aiding nature in establishing normal functional activity in the bowels. Recourse should be had to it before employing any thing more strongly cathartic. However, should it prove too mild in its aperient effects, small doses of Dr. Pierce's Pleasant Pellets may be employed daily to assist it. Unlike other cathartics, they produce a secondary tonic effect upon the bowels, which renders their influence more lasting than that of other purgatives. We cannot too strongly discourage the injurious custom which many people have of frequently scouring out their bowels with strong cathartics. It is a bad practice, and cannot fail to do injury. The greatest benefit is derived, not from cathartic doses, but from taking only one or two of the "Pellets" per day, or enough to keep the bowels regular, and continuing their use for several weeks, in connection with Dr. Pierce's Golden Medical Discovery, strictly carrying out the hygienic treatment heretofore advised.

The medical treatment of individual cases sometimes involves many considerations relative to the particular circumstances and complications presented. The peculiar susceptibility of the constitution, as well as the diseases incident to constipation, must be taken into account. Symptomatic derangement should not be treated as primary, although it is by inexperienced physicians. If the patient be afflicted with uterine disease, piles, nervous affections, falling of the lower bowel, or fistula, they should be treated in connection with this disease. For these reasons, we would advise our readers to submit all complicated cases, or those that do not yield to the course heretofore advised, to a physician of large experience in the management of chronic diseases, and not assume the great responsibility and the dire consequences which are very liable to arise from the improper treatment of such cases. We have been called upon to treat thousands of cases of this troublesome affection, and as a result of our vast experience, and in consequence of our original and improved methods of diagnosis, it is not generally necessary that we should see and examine the patient in person. We can almost always determine the exact nature of the patient's malady, and its stage of advancement, without seeing the subject in person.

Piles. (Hemorrhoids.)

There are few maladies more common than this, and few which are more annoying. Piles consist of tumors formed within the rectum and about the anus, by dilatation of the hemorrhoidal veins and thickening of their walls. Sometimes, when attended by considerable inflammation, or when the attacks are very frequent, there is thickening of the adjacent cellular and mucous tissues.

There are two general forms of this disease, the external or blind piles, in which the tumors are outside the anus, and the internal or bleeding piles, in which the tumors are formed within the sphincters, although after their formation they may protrude. The external piles are commonly made up of thick tissues; upon one side, the skin forms the covering, while on the inner surface is the mucous membrane of the bowel. It is this surface which is most tender and irritable and liable to inflammation. The internal form of the disease is situated from a half an inch to two and a half inches above the sphincter muscle of the anus. The tumors are usually round, oval or cylindrical in form. They may be scattered over the surface of the bowel, or clustered together. The illustrations (Figs. 1 and 2) show the two forms of the disease. The two protruding tumors in Fig. 2, illustrate the usual form of prolapsing internal piles, whilst the one highest up in the bowel shows the form most commonly met with. It is seldom that one pile tumor is found alone, there usually being two or three, and sometimes as many as five or six, in a cluster. Fig. 3 shows the manner of distribution of the veins in the rectal region. The small venous loops, or bulb-like terminations of the veins H. i., are the points at which the piles most frequently occur.

Fig. 1. Swollen External Piles.

Causes. Whatever tends to favor an undue accumulation of blood in the hemorrhoidal veins predisposes to piles. For this reason the affection is frequently a result of diseases of the heart and liver, which cause an obstruction in the circulation of the blood through the portal vein. Mechanical pressure from tumors in the abdomen, pregnancy, or an enlarged or misplaced uterus, is not infrequently a cause of the disease, by keeping the hemorrhoidal veins over-distended. Those diseases which provoke much straining, as stricture, inflammation or enlargement of the prostate gland, and stone in the bladder are also active causative agents. The most common cause of all, however, is constipation; and persons of indolent, sedentary and luxurious habits of life are the ones most frequently affected with this derangement. The following are also prolific causes of piles, viz.: pelvic tumors, violent horseback exercise, indigestion, pregnancy, habitual use of drastic cathartics, diarrhea, dysentery, sitting on heated cushions, long-continued standing posture, diseases of the liver, worms, the wearing of tight corsets, eating highly seasoned or indigestible food, and the use of alcoholic stimulants. No age is exempt from piles, nor is the disease peculiar to either sex. Aside from the serious inconvenience and pain which are experienced with most forms of piles, there is a tendency to fistula, and to cancer in the rectal region. It is important, therefore, that the disease should not be allowed to run on unchecked.

Fig. 2. Piles: internal and protruding.

Symptoms. The most common symptoms at first are slight uneasiness, such as a little soreness or itching at the verge of the anus, and at times lancinating pains. These sensations are more severe as a rule if the bowels are constipated. If the piles are external they frequently become inflamed, swollen and painful, and in some instances they suppurate, which usually results in relief. When internal piles have increased to any considerable extent, or have become inflamed, they produce not only itching at the extremity of the bowel, pain in the back, etc., but also a sensation of fullness in the rectum, as though some foreign body were present, and, on action of the bowels, there is a sensation as though a portion of the fæces had not been expelled. When the internal piles become large, they frequently come down with fæcal matter from the bowel, as illustrated in Fig. 2, and this prolapsus becomes more and more marked with the progress of the disease, until, in many cases, the tumors are forced down at each action of the bowels, causing excruciating pain until they are properly replaced. Usually, in the early stages, they recede spontaneously; however, after a time it becomes necessary for the sufferer to press them back, but in some instances this is impossible. Frequently during the protrusion one of the hemorrhoidal veins gives away, and this is followed by a free escape of blood, and ulceration may ensue. Not infrequently with this disease the patient loses strength and flesh, and the face becomes pale and puffy, assuming a waxy appearance. Many times there is nausea, with vertigo. Is consequence of the relaxation, the bowel may descend when on the feet, or with some extra muscular effort, especially when stooping. These symptoms may not all be present in one person, and, indeed, sometimes are somewhat obscure; when such is the case, an examination by a competent physician will always determine the true character of the complaint at once.

Fig. 3. H. i. Internal hemorrhoidal veins. H. m. Middle hemorrhoidal veins. H. e. External hemorrhoidal veins. S. i. Internal sphincter muscle, S. e. External sphincter muscle.

Treatment. Notwithstanding the well established fact that piles are readily cured by the appropriate treatment, hundreds of thousands of people suffer untold tortures from them because of the popular impression that they cannot be cured. All cases are not, however, amenable to the same form of treatment, for various unhealthy conditions of the system are often concerned in their production and perpetuation, and must, of necessity, be remedied by appropriate treatment, before a cure of the piles can be expected. It will, therefore, become apparent that the avoidance of causes is of paramount importance. Some of these causes are external, and wholly under the control of the patient, while others depend upon diseases that are curable; it frequently happens that while other diseases are being remedied, the piles disappear Without any special attention.

Diseases of the urinary apparatus, as stricture of the urethra, enlargement of the prostate gland, and stone in the bladder, dysentery, diarrhea, and constipation,—all cause piles, by the irritation, and determination of blood, which they induce; these difficulties must be removed by appropriate treatment.

Some years since, we ascertained that we were using in our practice remedies which, in addition to other virtues, possessed a direct specific influence upon the vessels concerned in the formation of piles. These agents enter into the composition of Dr. Pierce's Golden Medical Discovery, which, consequently, will be found exceedingly efficacious in the treatment of this disease. This remedy, therefore, in removing the disease upon which the piles depend, as a congested or torpid liver, constipation, etc., and in exciting a direct curative control over the piles themselves, exerts a double influence. It may be aided, when the bowels are badly constipated, by the use of Dr. Pierce's Pleasant Pellets, taken in the morning, to secure a regular and easy evacuation of the bowels each day. All stimulating food and alcoholic drinks should be abstained from. The cold bath is beneficial in these cases, provided there is not great debility. The affected parts should be bathed frequently with cold water, and, if prolapsus exists, it is well to inject a little cool water into the rectum, and allow it to remain a few minutes. As a soothing, astringing and healing application to the affected parts we prepare an Ointment that has acquired great fame for the prompt relief which it affords in all ordinary cases. This we do not sell through druggists but can send by mail, on receipt of price, $1.00 per large box, postage prepaid. The persistent use of this Ointment, at the same time keeping the bowels regular by the use of "Golden Medical Discovery," with an occasional laxative dose of "Pellets," will generally cure all ordinary cases of piles.

The Radical Cure of Large Pile Tumors. In cases in which the tumors have become indurated and very large it is impossible to effect cures by the foregoing or any other medical treatment. Various methods have been in use by the profession for the relief of the most severe cases. The most common is excision with the knife or scissors. Reference to the large vessels, shown in Fig. 3, which are affected in this disease, will at once show the sufferer the dangers of this method. The sudden removal of a tumor, which is connected with one or more of the large hemorrhoidal veins, is sure to be followed by severe hemorrhage, and many times painful ulceration, and a fatal result. To avoid this it has been the practice of many physicians to apply caustics or to burn off the base of the tumors with a red-hot iron. A more barbarous and painful method could not be devised. When it is considered that in many cases, this severe and painful treatment is followed by ulceration, and occasionally by the developement of cancer, the matter should be carefully weighed before any such dangerous procedure is attempted. Another common method of treatment is to crush the base of the pile with a clamp, and then cut off the tumors with scissors. After this it is also necessary to apply the hot iron to prevent hemorrhage. Formerly, applications of nitric acid were in common use by physicians as a means of cure, but it was found that while this treatment would give temporary relief, yet in no severe case would it effect a cure. By what we term palliative treatment alone more cures are effected than by the old process of treatment with nitric acid. Still another form of treatment is strangulation of the pile by means of a ligature, and this is often more painful than the application of hot irons, inasmuch as in cutting off the return flow of blood from the piles, a large tumor is left for days fully distended and extremely painful. It does not slough off for a considerable time, and we have seen the strongest men suffer intensely, to whom the use of scissors in removing the tumors was a positive relief in comparison with the torture of the ligature. A treatment that has been highly recommended by some physicians and condemned by others, is the process of injection with carbolic acid. This method of treatment is not very painful but, unfortunately, it is dangerous. The injection of the tumors with a fluid which causes coagulation of the blood, and which does not completely shut off the return current of the circulation through the tumors, has proved fatal in a small percentage of cases. The clots which are formed by this treatment become detached and are carried into the general circulation and conveyed to the liver, lungs and even to the brain, where, by plugging up the vessels of those organs, they cause abscesses which terminate life. Serious inflammation of the veins is another accident which often follows the injection of carbolic acid. This treatment is, therefore, now seldom resorted to except by physicians who do not appreciate its dangers.

A More Successful Method. Fortunately for suffering humanity, a method of treatment has been perfected and thoroughly tested in our institution, in which all such trouble and danger as above described are avoided. This consists in bringing down the tumors, cleansing them and making application, of certain chemical preparations, that cause the tumors to speedily shrivel up, and in a very short time, say ten to fourteen days, disappear entirely. These treatments and applications cause no pain whatever, for by first applying a weak solution of cocaine to the parts they are speedily rendered entirely insensible, so that the most sensitive, nervous lady experiences not the slightest suffering from the application of our remedies.

Having now at our command means so positively certain in their action upon pile tumors, we do not hesitate to say that the very worst cases, no matter of how long standing, can be promptly cured, if we can only have the patient for a few days under our personal care. Considering the very distressing character of pile tumors, it is a great boon that we have at last found safe, painless, and positively certain means for their cure. The news will be hailed with joy by a large class of sufferers.

Probably no other discovery in modern science is destined to be the means of conferring greater blessings on a large class of sufferers than that of a painless and positive method of curing the largest pile tumors in the brief time required by our system of treating them.

It seems to us that there is no longer an excuse for any one to endure the tortures inflicted by pile tumors, provided the afflicted one can command the little time and moderate amount of means necessary to secure the treatment indicated. Piles are not only in and of themselves very painful and annoying, but often greatly aggravate and even cause other grave and painful affections, and should, therefore, not be neglected. When large, they never get well without proper treatment. We have seen many cases in which the long train of diverse and distressing symptoms caused by piles led the sufferer, and even the family physician, to suppose that other diseases existed, but all of which annoying symptoms were speedily dispelled by the cure of the piles. We have no doubt that neglected piles, fistulæ, and other morbid conditions of the lower bowels, frequently degenerate into cancerous disease. We have the eminent authority of J. Hughes Bennett, of Edinburg, and many other close observers, for saying that benign or ordinary tumors often degenerate into real cancerous disease, and our own extensive observation convinces us that this is not infrequently a result of neglected rectal disease, as piles, fistulæ and fissures. How important, then, to give prompt attention and skillful treatment to disease of these parts. When the ordinary palliative treatment, with ointments and with laxative agents to keep the bowels soluble, does not completely and perfectly subdue the malady, lose no time in securing the most skillful appliances, that every vestige of the affection may be promptly removed. We have treated many thousands of cases with uniform success, and our patients write to us expressing the greatest degree of satisfaction, and recommending our method most highly.

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

Anal Fistula. (Fistula in Ano.)

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

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

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

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

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

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

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

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

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

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

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

Testimonials.

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

"Liver Complaint."

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

J.H. May, Esq.

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

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

Dyspepsia and Womb Disease.

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

Mrs. Ransom.

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

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

Inflammation of Liver.

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

T.J. Bentley, Esq.

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

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

LIVER DISEASE AND DYSPEPSIA.

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

Mrs. Hart.

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

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

LIVER COMPLAINT AND CATARRH.

Wm. King, Esq.

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

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

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

Mrs. Rademaker.

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

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

Liver Complaint and Dropsy.

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

Mrs. Dennis.

Gentlemen—About two years ago I was confined to my bed for several weeks with liver complaint. I became dropsical, my limbs swelled to twice their usual size and I could scarcely move them. I commenced using Dr. Pierce's Golden Medical Discovery; one bottle helped me so I could sit up; two bottles gave me strength enough to be able to do part of my household work; six bottles cured me, and to-day I am enjoying good health. The "Medical Discovery" should be in every household, and in gratitude for what it has done for me I have recommended it to many friends. For nine years I have suffered from deafness, and while taking the "Discovery" my hearing became much improved.

Very truly yours,
MRS. I.C. DENNIS,
Burson. Calaveras Co., Cal.

Indigestion, Constipation, Varicocele.

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

Mr. Hodges.

Dear Sirs—In regard to my condition of health, will say, although I am not entirely well, yet I have received much and lasting good from your treatment. My digestion was improved greatly, so that little trouble is experienced after eating; my liver seems to act reasonable well, and my bowels are much better. My varicocele I consider entirely cured, as I have not used the bandage for one half day for more than six months, and do not experience any inconvenience from that source.

Yours truly,
HARLAN HODGES,
Keota, Keokuk Co., Is.

Case of Chronic Diarrhea Cured by Home Treatment.

Mrs. Gwin.

At the time the case was first submitted to us the bowels were moving six or eight times a day. In addition to the diarrhea, the patient had suffered from indigestion and womb trouble for eight years. There was almost continual pain from the top of the head to the hips and through the shoulders. There was weakness, soreness and numbness in the arms, hands, back and hips; the bladder was irritable, urine being passed frequently, or occasionally scanty, dark, thick, with a brick-dust deposit. There was a dragging sensation in the region of the womb. Menstruation was irregular, and she had frequent trembling spells lasting for hours. There was difficulty in fixing the attention, even for a sufficient length of time to write a brief letter. In fact, she was so weak and nervous she could scarcely write at all. Sleeplessness was a prominent feature of the case. The principal diet consisted of light bread and hot milk; could not use Graham bread. A course of special treatment was supplied to her about the first of January, 1890, but soon after commencing the treatment she had an attack of pneumonia. In due time the treatment was resumed, and then followed an attack of the epidemic influenza, or grip, so that, although the treatment was carried on at intervals during a year, there were but few occasions when our specialist had what he considered full control of the case. A year after the case was discharged the following communication was received:

February 15, 1893.

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

Gentlemen—I should have written sooner, but I waited to see if there would be any return of my old disease. After suffering over eight years with severe chronic diarrhea, you have cured me; I have had no return of it for over a year. It is with gratitude I write to you to tell you the great good you have done me, for I am sure I would have been in my grave before this had it not been for your treatment; My stomach troubles me very little any more. Occasionally I use a bottle of "Golden Medical Discovery" and a bottle of "Pellets." Hoping that the kind Father may spare your lives for many years to do good to suffering humanity,

I am, Very gratefully yours,
MRS. R.S. GWIN,
Peck's Run, Upshur Co., W. Va.

Liver Complaint, Dyspepsia, and Constipation.

Cured by Home Treatment.

J. Fleener.

Received his first disability in the war; complains of getting very weak; bowels move only in three or tour days; stomach so painful that nothing passes through it digested; back so weak cannot sit up; had the first attack of dyspepsia fifteen years ago, and has spent hundreds of dollars trying to get well; kidneys badly affected, urine highly colored, and burns in passing; has pains around the heart and fluttering sensations at times, says: "I am not able to travel; all the doctors have given me up as beyond medical aid."

Reports after two months' treatment: "I am happy to say that I am almost well; suffer with no pain in my stomach after eating; my appetite is good; my bowels move once a day and very often twice a day, and the urine is natural; do not have that dizziness in the head any more: rest well at night and feel rested in the morning. Have gained flesh all the time; weigh 178 pounds, and work every day on the farm. Have taken no medicine from any other physician, and give you and your medicine all the credit for the health I now enjoy. My wife has taken your "Golden Medical Discovery" for goitre (thick neck). She has taken it for about six weeks and she is getting better."

JOHN FLEENER, Brooklyn, Indiana.

Dyspepsia.

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

G.R. Kenyon, Esq.

Gentlemen—Your letter was received, and I am glad to say that I am perfectly well, and have been since I took your last medicine. I think I am better than I ever was, if such a thing could be. I am twenty pounds heavier than I ever was before, weighing 155 pounds. I have not had a pain or an ache since, for which fact I am thankful to you for looking after my case as promptly as you did, as, in looking over your catalogue of diseases, I thought that I had every thing ailing me that was in the book. I have told dozens if they were sick to call on you. With my best wishes, and hoping that all of your patients will receive as much benefit as I did, I remain,

Very truly yours,
GEORGE R. KENYON
Batavia, Ill.

Dyspepsia.

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

J.P. McAdams, Esq.

Gentlemen—"A few of my symptoms were: Heartburn and fullness after eating, sometimes pain in my bowels, headache, poor appetite and bad taste in my mouth. At night I was feverish, with hot flushes over skin. After taking Dr. Pierce's Golden Medical Discovery I was relieved of all these symptoms, and I feel perfectly well to-day."

Very truly yours,
J.P. MCADAMS,
Elon College,
North Carolina.

Obstinate and Complicated Disease.

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

John H. Smith, Esq.

Gentlemen—Yours of July 12th to hand. I am only too glad to comply with your request. Having suffered for many years with a complication of diseases and feeling conscious that they were rapidly making serious inroads upon my constitution, and that I was speedily becoming unable and incapacitated to attend to my ordinary business. I resolved, after reading a number of testimonials from your patients, to place myself under your treatment at the Invalids' Hotel and Surgical Institute. With heart-felt gratitude I can truthfully say I am relieved of my trouble. I most cheerfully and earnestly recommend this Institution to all who are afflicted with chronic and painful diseases, no matter of what nature. During my stay there I saw some wonderful cures and surgical operations.

Yours truly,
JOHN H. SMITH,
Deckertown, Sussex Co., N.J.

COMPLICATION OF DISEASES.

Andrew Holes, Esq.

Without solicitude or hope of pecuniary reward, with heart-felt gratitude and a desire to aid my fellow-man to health and happiness, allow me to state, that as an inmate for more than a month of the Invalids' Hotel and Surgical Institute at No. 663 Main Street, Buffalo, N.Y., I feel warranted in its highest recommendation. While there I saw and talked with a great number of people who came there as a last resort, to be cured of almost every chronic disease to which flesh is heir, and they were unanimous in their praise of the Institution and the skilled specialists who constitute its professional staff.

ANDREW HOLES,
Moorhead, Minn.

Nervous Debility, Dyspepsia, Kidney and Liver Disease—Cured.

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

B.V. Wright, Esq.

Gentlemen—I take pleasure in informing you that the treatment you gave me for the relief of an affection of the spine and nervous system, disease of the digestive organs, kidneys and liver, has been entirely successful. I had feared that my health was gradually being undermined, prior to entering your institution, and I can testify to the perfect appointment that you have, the excellent apparatus for the administration of electrical and other massage treatment and baths. My relief was most satisfactory, and the cure has remained permanent.

I take pleasure in recommending your institution to the afflicted, believing that you have the very best treatment for chronic diseases known, and I have had an opportunity to satisfy myself, from conversation with other invalids in your Institution, of the care and skillful treatment that you administer, and its excellent effects. I believe that it is fully abreast of the times, and equal to any institution in the world. With many good wishes and thanks for my cure, I remain,

Yours truly,
B.V. WRIGHT,
Graniteville, Middlesex Co., Mass.

Prolapsing Piles (Hemorrhoids), Asthma, Torpid Liver and Constipation.

Cured at the Age of 62—Now 73 Years of Age—and Continues in Good Health.

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

Mrs. Plummer.

Dear Doctors—It is with the greatest pleasure that I add my own experience to that of the many that you have cured. I am now seventy-three years of age, and enjoy very good health for my years, and as you can see by the photograph I send you, time has dealt very considerately with me so far as my activity and enjoyment of life are concerned. To this I feel that in large measure my thanks are due to you, for eleven years ago when I was sixty-two years of age you treated the pile tumors so successfully. They had been the source of greatest discomfort. I think that they were caused first by chronic diarrhea, which had troubled me many years prior to their appearance. I was also afflicted with asthma, torpid liver and constipation. These conditions produced in time some pile tumors that were the source of much suffering, and seemed to continually annoy me. As is usual with such difficulties, I believe, I would be free from discomfort for a time, and then the piles would get sensitive and irritable, come down at stool, and gave rise to severe pain that seemed to affect my general health. The nervous symptoms that resulted from their presence were such as to lead me to fear that I would break down in health unless they were relieved. From information obtained from others who had been relieved at your hands, I applied to your institution, and can thankfully assert that the tumors were permanently cured, as it has been eleven years since your specialist treated me, and I have had no trouble of the kind, and for an old lady I am pretty well. I had such good treatment and nice care at your institution that I cannot express in my testimony the thanks that I owe you. Wishing you every success in the treatment of others, and that you may be able to relieve the sufferings of many hundreds as you have mine,

I remain. Very respectfully and thankfully yours,
MRS. MOSES PLUMMER, Groton, Caledonia Co., Vt.

Biliousness, Constipation, Bad Cough.

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

George Wilder, Esq.

Gentlemen—Some twenty-five years since I was feeling very miserable all summer; I was very bilious; sometimes my bowels would not move once in sixty to seventy hours, and then almost impossible. I would take some bitters, which would help to move the matter, but as soon as the bitters were gone, I had to buy more or I would be as bad as before, and sometimes worse; but none of them appeared to do me any good except to move the bowels, until thirty years since a druggist called my attention to your "Golden Medical Discovery," and before I had taken half a bottle of the "Golden Medical Discovery," I felt much better, and by the time I had taken all, I could eat three hearty meals per day and had not felt so well for a long time. Soon after I was called to do a job some miles from home, and one night the old lady there was speaking about her daughter (Mrs. Brooks) who had been under the doctor's care for about five months and did not get any better, and I learned by asking a few questions that she had no appetite and no ambition to do anything. Then I told her what the "Golden Medical Discovery" had done for me. The next day the old lady drove down to her daughter's and got Mr. Brooks to send to Rutland, ten miles away, for two bottles of the "Golden Medical Discovery," and the next day when the doctor came and was about to take his leave, Mr. Brooks told the doctor he did not want him any more at present, and would send for him, if necessary. I saw the old lady about ten days later and her daughter was improving, and Mr. Brooks had great faith in the "Golden Medical Discovery," and had not sent for the doctor, but had gone to Rutland for more of the "Golden Medical Discovery." When I commenced taking the "Golden Medical Discovery" I thought I was going into consumption, as I had a cough for three years or more and my weight decreasing. My weight before taking the "Golden Medical Discovery" was 133 pounds; last March it was 147 pounds, and I give the credit to the "Discovery,"

GEORGE I. WILDER,
East Wallingford, Rutland Co., Vt,

Liver Disease.

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

Mrs. Bosworth.

Gentlemen—I suffered greatly for thirteen years. Not one moment during that time had I rest from pain or weakness. I consulted six of our best physicians, taking medicines from each for a good long time. I became completely discouraged, as I had been many times before. A letter from the World's Dispensary Medical Association with questions to be answered, fell into my hands; these I carefully answered. As soon as a letter could go and come I received another saying I had the Liver Disease. I could hardly believe it, for it had never entered my mind that that was my trouble. I read the pamphlet sent me in the next mail, describing my feelings much better than I could myself. I accepted their advice, strictly followed it. I found complete relief in taking the "Golden Medical Discovery." For years I could not ride a mile nor walk to my nearest neighbor's without feeling worse for it, and most of the time could not go at all. The day this picture was taken I rode eighteen miles, walking up and down two long hills. To the afflicted and discouraged I would say consult the World's Dispensary Medical Association; accept their advice, strictly follow it, and if there be help for you I believe you will find it in so doing.

Respectfully yours,
MRS. HELEN C. BOSWORTH,
Money Creek,
Houston Co., Minn.

Dyspepsia,

And Other Complications.

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

Stephen Ogden, Esq.

Gentlemen—In reply to yours of the 7th instant, I would say that I can cheerfully recommend your medicines, as I have tried them and found them just as represented. I am enjoying splendid health at the present time.

Yours truly,
STEPHEN OGDEN,
Twin Mound,
Douglas Co.,
Kansas.

Dyspepsia and Constipation.

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

Miss. Helfer.

Gentlemen—I have been troubled with dyspepsia and constipation for the last six years, and have tried all medicines that I could think of; and I got so low in health that I thought I would once more try the "Golden Medical Discovery" and Dr. Pierce's Pleasant Pellets. After taking it for three months I began to feel better, especially the gas and sour rising off my stomach at night. Formerly it was a terrible distressed feeling, could not rest nor sleep. I am very thankful to the World's Dispensary Medical Association, and thankful to God who put the great power in your medicine that cured me. I will say a good word for your medicines to all friends I meet. With many thanks, I remain,

Respectfully.
Miss M.A. ELIZABETH HELFER,
Moreton Farm, Monroe Co., N.Y.

Complication of Diseases.

A Grateful Patient's Words of Praise.

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

William Henkel, Esq.

Gentlemen—Having been in your Institution as a sufferer from two distinct chronic diseases of years' standing, and having been placed under the charge of your specialists, I was speedily relieved of my afflictions. The Invalids' Hotel is a place as much like home as it is possible for such an institution to be. The physicians and surgeons are all expert specialists and thoroughly efficient; the nurses are very competent, attentive and kind; and, in fact, the whole personnel of the Invalids' Hotel endeavor to do their best to make the patients feel like being at home. I always felt while there as if I was one of the family. I gladly recommend your Institution to all persons who are afflicted with any kind of chronic disease, for from my own experience I know the professional staff will do all which they promise to do. Please accept my thanks for the speedy benefits and perfect cure of my diseases, and I think your Institution is worthy of the highest endorsement.

Yours truly,
WILLIAM HENKEL,
No. 1917 Congress Street,
St. Louis, Mo.

Dyspepsia and General Debility.

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

Rev. A.H. Mevs.

Gentlemen—Having suffered for a number of years with dyspepsia, torpid liver and general debility, and having tried several physicians with little or no benefit, I resolved, as a last resort, to consult your specialists at the World's Dispensary. Being advised by them to use Dr. Pierce's Golden Medical Discovery, I did so, and after using several bottles, I feel entirely restored to health. Now, I take great pleasure in recommending your medicines to suffering humanity everywhere.

Yours very gratefully,
REV. A.H. MEVS,
Friar's Point,
Coahoma Co.,
Mississippi.

"Liver Complaint."

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

J. Gaughan, Esq.

Gentlemen—When I commenced taking "Golden Medical Discovery," I was suffering badly from "Liver Complaint." I had been out of health for three years. I suffered terribly from "heart-burn," had bad coat on tongue, and was often troubled with diarrhea. Three bottles of the "Discovery" cured me. Had I not commenced taking it when I did, I should have been dead long ago. You have my heartfelt gratitude for my cure.

Yours truly, JAMES GAUGHAN,
Braidwood, Will Co., Ill.

P.S.—There are lots of people here whom I have recommended to use your Golden Medical Discovery," and each and every one says it is a good medicine. One woman in particular, told me she was getting better every day by the use of your medicines.

J.G.

Nervous Dyspepsia.

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

Mrs. Taylor.

Gentlemen—I had a dead aching in my head and down the back of my neck and in my left ear, and my tongue was so stiff at night and dry, and I had no taste, or appetite to eat anything. I also had such a dead aching in the small of my back; it just felt as if I would break, and such aching between my hips. I had been having the "change of life," and if I worked hard I got a pain between my shoulders and a kind of aching in the abdomen. I doctored a good deal and never got any relief. I was very nervous. I took two bottles of Dr. Pierce's Golden Medical Discovery and two of his "Favorite Prescription," and I am perfectly cured.

MRS. ELLEN TAYLOR,
Clarion, Clarion Co.,
Pennsylvania.

Dyspepsia.

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

Rev. Prosser.

Dear Sirs—I was a great sufferer from dyspepsia, and I had suffered so long that I was a wreck; life was rendered undesirable and it seemed death was near! but I came in contact with Dr. Pierce's Golden Medical Discovery and "Pellets." I took twelve bottles of the "Discovery," and several bottles of the "Pellets," and followed the hygienic advice of Dr. Pierce, and I am happy to say it was indeed a cure, for life is worth living now. A thousand thanks for your treatment. I enclose my photo.

Yours respectfully,
REV. CHAS. PROSSER,
Mount Carmel,
Northumberland Co. Pa.

Liver Disease.

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

Mrs. Winter.

Dear Sirs—It is with pleasure that I tell you what your "Discovery" has done for my mother. She was in poor health for a long time, coughing and weak, and thought she had consumption; she had such palpitation of the heart and could not rest at night because of the palpitation sometimes, and then the right arm pained her so at times that she hardly knew what to do; If we would put on hot applications, it would drive it to the heart, and the doctor did her no good; so finally, as a last resort, we happened to get hold of some of Dr. Pierce's pamphlets and were constrained to write to him and send a small bottle of urine for examination. He immediately wrote back, saying it was liver trouble, and to take the "Golden Medical Discovery" according to directions. She took it for two months, when the pain in her arm gradually left her and she could comb her own hair, and began to be more cheerful, for she was melancholy before. The palpitation grew less and less, and she rested at night, and is now doing her own work for a family of five, and is sixty-one years old.

I have taken delight in recommending to others this wonderful medicine for heart and liver trouble; she took a dozen bottles to effect the desired end.

Respectfully yours,
Miss LU WINTER,
Dakota, Winona Co., Minn.

Torpid Liver, Suppressed Menstruation.

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

Mrs. Fitzgerald.

Gentlemen—I had suffered so much for years from "Liver Complaint" that I did not care whether I got well or not, but my husband urged me to take your "Golden Medical Discovery." I had not had my courses for six months; after I had taken your medicine about two months, I was well.

When one of my daughters with a baby two weeks old was in so much pain that she could not rest day or night, I went to her as quickly as I could, and commenced giving her your "Favorite Prescription." The next morning the pains were all gone. She said, "oh, mother, I would have died if you had not come. I do feel so good." Your medicine makes people feel like they wanted to live. There is a woman at Verdi who had several children who died with consumption of the bowels and chronic diarrhea. She had another one who was going the same way. The doctor said it was bound to die. I went there and gave it five drops of Dr. Pierce's Extract of Smart-Weed, and increased the dose every time its bowels moved, until I got to a half teaspoonful. The next morning the child was almost well. That woman says I saved her baby's life.

I could write a week and not tell half the good your medicines have done through my hands. Two weeks ago, a young man at my house was taken with cholera morbus. He thought he was surely going to die, but as quickly as I could get some hot water, I put hot applications on his stomach and bowels, and gave him a few doses of your Extract of Smart-Weed. He got well immediately. MRS. MARY ISABELL FITZGERALD. Reno, Washoe Co., Nev.

Liver Disease and Nervous Dyspepsia.

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

I. Rhue, Esq.

Gentlemen—I was weak, nervous, dizzy, with a fainting sensation when walking; could not walk any distance, always feeling hungry but always felt bad; after eating felt as though my victuals were sticking in my throat; could not rest well at night; I was not well all winter. In 1891 took sick and quit work; in March doctored with three different doctors with very little benefit for a good deal over a year, then began taking your "Golden Medical Discovery." Took ten bottles of that, and one bottle of your "Pleasant Pellets," and steadily improved all the time I was taking your medicine and have worked all this summer; did not work for two years.

My case was liver disease and nervous dyspepsia of which your medicine has cured me, for which receive my sincere thanks.

Respectfully yours,
ISRAEL RHUE,
Morrisdale Mines, Clearfield Co., Pa.

Torpid Liver.

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

Gentlemen—From early childhood I have suffered from a sluggish liver with all the disorders accompanying such a condition. Doctors' prescriptions and patent medicines I have used in abundance; they only afforded temporary relief. I was recommended to try Dr. Pierce's Pleasant Pellets. I did so, taking three at night and two after dinner every day for two weeks. I then reduced the dose to one 'Pellet' every day and continued this practice for two months. I have in six months increased in solid flesh, twenty-six pounds. I am in better health than I have been since childhood. Drowsiness and unpleasant feelings after meals have completely disappeared.

Respectfully yours,
U.S. Inspector of Immigration, Buffalo, N.Y.
John H.M. Berry

Liver Disease, Constipation.

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

Mrs. McDaniel.

Dear Sir—I enclose you my photograph as you requested; also, state that I have taken your "Pellets" and "Golden Medical Discovery" for chronic "liver complaint" attended with constipation of the bowels, and after using six bottles of "Discovery" and same of "Pellets," I am greatly benefited. You can use my name in advertising your medicines and I can warrant them to do all you claim for them.

Respectfully yours,
Mrs. M.F. McDANIEL,
Bee Branch,
Van Buren Co., Ark.

Torpid Liver, Dyspepsia, Nervous and General Debility.

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

J.F. Hudson, Esq.

Dear Sirs—Having suffered severely, for a long time, from a torpid liver, indigestion, constipation, nervousness and general debility, and finding no relief in my efforts to regain my health, I was induced to try your "Golden Medical Discovery" and "Pleasant Pellets."

Under this treatment I improved very much, and in a few months was able to attend to my professional duties.

I now feel very grateful for the benefits I have received from the use of your valuable medicines, and recommended them to many of my friends and neighbors.

Respectfully yours,
J.F. HUDSON,
Witcherville, Sebastian Co., Ark.

"Troublesome Complaints."

WORLD'S DISPENSARY MEDICAL ASSOCIATION, NO. 683 Main Street, Buffalo, N.Y.:

Miss Cheney.

Gentlemen—After using five bottles of Dr. Pierce's Golden Medical Discovery, four bottles of Dr. Pierce's Favorite Prescription, and about half-a-dozen packages of his "Pellets," I am convinced that I am thoroughly cured of that dread disease, known as dyspepsia, and other troublesome complaints.

Very sincerely yours,
MISS HATTIE L. CHENEY,
Sac City,
Sac County, Iowa.

Liver and Kidney Disease.

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

Mrs. Ray.

Gentlemen—Your kindness to me I can never forget, I cannot express half my feelings of gratefulness to you. I had despaired of ever getting well.

I had been in bad health twenty years—liver and kidneys, all out of order and aches all through me; numb hands and cold feet. Everything I ate distressed me, bowels constipated, was very nervous, depressed and despondent; in fact I can't express half my bad feelings to you. When I first wrote to you, I thought I would not live to get an answer from you.

I have taken twenty bottles of "Golden Medical Discovery" and "Pellets." My health is now very good. You have my honest recommendations to all sufferers.

Thankfully yours,
MRS. REBECCA RAY,
DeAnn, Hempstead Co., Ark.

Liver and Kidney Disease.

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

G.W. Sweeney, Esq.

Gentlemen—I was for years hardly able to go about. I suffered from liver and kidney trouble, six different Doctors treated me during that time but could do me no good. I give your "Medical Discovery" the praise for my cure.

Then, too, my wife had a bad case of Asthma which was cured by the use of that wonderful blood-purifier.

Yours truly,
GEO. W. SWEENEY,
Haydentown, Pa.

Torpid Liver.

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

Mrs. Bransford.

Gentlemen—I can truthfully say that I believe your "Golden Medical Discovery" saved my life. When I began your treatment two years ago, I had been given up by the Doctor, and my friends had lost all hope of my recovery. I had suffered for years with torpid liver; I had chronic pleurisy and catarrh in a very bad form, attended with hemorrhages—was confined to my bed two months. In a few days after beginning your medicine I could perceive a slight change for the better; in three months I felt almost like a new person.

Yours very gratefully,
MRS. MAGGIE E. BRANSFORD,
Williamsburg, W. Va.

Dyspepsia, Uterine Disease.

Mrs. Martin.

MRS. J.A. MARTIN, of Cleburne, Texas, had not had good health since the birth of her child, eight years before; had a headache with burning and throbbing sensations; and a hurting in her stomach; there was a dead aching and gnawing or drawing of the stomach as she described it; sharp pain in the stomach extending to her right breast and shoulder. Weighed in health 125 pounds, but was reduced to 95 pounds; was weak; could scarcely walk at all, was sick at stomach a great deal; when her monthly sickness came on had much pain and the sickness of the stomach remained until menstruation stopped. She writes:

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

Gentlemen—"I have taken about six bottles of your 'Golden Medical Discovery' and 'Favorite Prescription,' and am glad to say that I feel better and stouter than I have felt in a long time. I can work all day now and not be tired at night. My head don't trouble me now. When I commenced the use of the medicine I weighed 89 pounds, and to-day I weigh 98 pounds. I feel better than I have for months."

Dyspepsia and Consumption.

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

Mrs. Ferguson.

Dear Sir—I was not able to do my work for nearly two years, and I tried four different doctors and grew worse all the time. Then I began on your medicine and took twelve bottles of "Golden Medical Discovery" and one of "Favorite Prescription," and am able to do my work and feel as well as I have felt in years. Physicians called my disease Dyspepsia and Consumption.

Respectfully yours,
MRS. R. FERGUSON,
Ink. Shannon Co., Mo.

Dyspepsia, Costiveness.

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

Mrs. Wickline.

Gentlemen—I suffered a great deal with headache and dizziness in my head and costiveness. My food would sour on my stomach and I would spit it up. I also suffered with my back a great deal; in fact, I was entirely broken down. Had different doctors but none seemed to do me any good and I began to take your medicine—the "Golden Medical Discovery."

I have been enjoying better health since I have taken your medicine than I had for years before. I have recommended it to my friends; I believe it to be the best medicine in the world. My sister has taken more of your medicine than I have; her husband has also taken it; she thinks there is no medicine in the world so good as Dr. Pierce's.

Yours truly,
MRS. MAGGIE WICKLINE,
Box 95, Pulaski City, Pulaski Co., Va.

Dyspepsia of Fifteen Years.

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

Mrs. Strawderman.

Gentlemen—Dr. Pierce's Golden Medical Discovery and "Favorite Prescription" cured me of dyspepsia after fifteen years' suffering. I doctored a great deal without receiving any benefit. About four years ago my attention was called to Dr. Pierce's Favorite Prescription, which was highly recommended for dyspepsia and I used three bottles of "Prescription" and eight bottles of "Golden Medical Discovery," and they have done me more good than all other medicines I ever used.

Yours truly,
MRS. ANGELINE STRAWDERMAN,
Philippi, Barbour Co., W. Va.

Dyspepsia, Shortness of Breath.

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

W. Goodwin, Esq.

Gentlemen—I was in bad health when I commenced your treatment; I was troubled with my stomach, and with shortness of breath. Everything I ate distressed me. I lost flesh and strength and became very nervous and despondent. I took eight bottles of "Golden Medical Discovery," and six bottles of "Pellets," and they cured me.

I would advise all suffering people to go under your treatment.

Respectfully yours,
WRIGHT GOODWIN,
Gaylord, Beaufort Co., N.C.

Dyspepsia in Its Worst Form.

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

E. Dieterly, Esq.

Gentlemen—Only those who have had dyspepsia in its worst forms know what it really can be. What such a case needs I have found in your kindly encouragement, and your "Golden Medical Discovery."

Although I can now claim, if any one can, that I have a cast iron stomach, I always keep your "Golden Medical Discovery" and the "Pellets" on hand when settling down from an active summer's vacation, to quiet student life.

I heartily recommend these medicines to every one whose suffering is of the nature that mine was.

Yours truly,
ERVIN DIETERLY,
Gettysburgh, Pa.

Dyspepsia and "Female Weakness."

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

Mrs. Hutchinson.

Gentlemen—Words fail to describe my sufferings before I took your "Golden Medical Discovery" and "Favorite Prescription." I could not walk across the room without great suffering, but now I am able to do my own work, thanks to your wonderful medicines, I am a well woman. I suffered all the time with a weight in the bottom of my stomach, and the most severe bearing-down pains, low down, across me, with every step I attempted to take. I also suffered intense pain in my back and right hip. At times I could not turn myself in bed. My complexion was yellow, my eyes blood-shot, and my whole system was a complete wreck. I suffered greatly from headaches, and the thought of food would sicken me. Now I can eat anything, and at anytime. My friends are all surprised at the great change in me. Every one thought I would not live through the month of August. Two of my neighbors are using your medicines, and say they feel like new beings.

Truly yours,
MRS. ANNIE HUTCHINSON,
Cambridge, Dorchester Co, Md.

Indigestion and Nervousness.

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

Mrs. Livingston.

Gentlemen—I am a woman of fifty-six years of age. Had been troubled with Indigestion for three years, which, I think, resulted from "change of life" and overwork. An eminent physician informed me I had no organic disease. But I had distress after eating and was troubled with gas in parts affected, an unpleasant taste in my mouth in the morning. I was weak and nervous and had to live on a very light diet. After taking your "Golden Medical Discovery" I was relieved of these symptoms. I believe the results warrant me in recommending it to others.

Yours respectfully,
MRS. CHARLES LIVINGSTON,
Livingston,
Grant Co., Wis.

Indigestion and Torpid Liver.

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

E.M. Seavolt, Esq.

Gentlemen—I can heartily recommend your "Golden Medical Discovery" to any one who is troubled with indigestion and torpid liver; I was that bad it was about chronic with me. All the other medicines could give me no relief; but at last, what came to my relief was that wonderful medicine, the "Golden Medical Discovery." I could scarcely eat anything—it would put me in terrible distress in my stomach; I had a dull aching and grinding pain in my stomach with pain in my right side and back, and headache, bad taste in my mouth; at night I was feverish and the soles of my feet burned.

I took four bottles of the "Discovery" and two vials of the "Pellets." I am well and hearty and can eat as well as any body can,—thanks to your "Discovery."

Yours truly,
E.M. SEAVOLT,
No. 427 Sandusky St.,
Mount Vernon, Knox Co., Ohio.

Disease of Stomach.

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

A. Lewis, Esq.

Gentlemen—Yours of the 4th instant was duly received. I take great pleasure in recommending to the public your system of home-treatment for chronic diseases. I am thankful to say I am in perfect health and have worked every day since I last wrote to you and have not taken a particle of medicine of any kind and am weighing about one hundred and eighty pounds. I have taken your "Golden Medical Discovery" with very satisfactory results, and "Pleasant Pellets" also.

Yours respectfully,
ARTHUR LEWIS,
Schoharie, Schoharie Co., N.Y.

Rheumatism.

What a Minister Says. Cured for $4.

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

Rev. W. Williams.

Gentlemen—In the fall of last year I suffered from rheumatism in my left shoulder and elbow. I tried a great many remedies, recommended to me by friends, but they all failed to afford relief. From that time I began Dr. Pierce's Golden Medical Discovery, until I felt that I was cured, was a period covering four or five months. While the attack lasted, I suffered a great deal, and could not dress or undress myself. Although I am 73 years old, I now regard my health as splendid. I had spent a great deal of money previously, in various kinds of medicine, but the "Discovery," from the day I commenced until I was well, cost only FOUR DOLLARS.

Accept my gratitude, and I beg to subscribe myself,

Sincerely yours,
Rev. WILSON WILLIAMS,
Trinity Station, Morgan Co., Ala.

Headache and Constipation.

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

Miss Wolfe.

Gentlemen—I suffered from loss of appetite, constipation, neuralgia, and great weakness, and had terrible attacks of sick headache very frequently; also nose bleed. My health was so poor that I was not able to go to school for two years. I took Doctor Pierce's Pleasant Pellets and "Golden Medical Discovery," and in a short time I was strong and well. Many friends are taking your medicines seeing what they have done for me.

Respectfully yours,
Miss BERTHA WOLFE,
Markham, Cattaraugus Co., N.Y.

As Liver Pills,

Nothing Can Compare with Dr. Pierce's Pleasant Pellets.

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

Mr. S. Baker, Sr.

There is nothing that can compare with Dr. Pierce's Pleasant Pellets, as Liver Pills, They have done me more good than any other medicine I have ever taken.

Respectfully yours,
SAMUEL BAKER,
No. 161 Summit Ave.,
Phillipsburg. N.J.

Ulceration of Bowels.

Severe Bleeding.

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

Aurelia Vanzile.

Gentlemen—My friends said I would never be any better, for I had ulceration of the bowels. By the time I had taken a bottle and a half of Dr. Pierce's Golden Medical Discovery, the bleeding had almost stopped. My appetite was good, nothing seemed to hurt me that I ate. My improvement was wonderful. Several years have passed and my cure is permanent.

Yours respectfully,
Mrs. AURELIA VANZILE,
Hamilton, Ind.

Bilious Attacks.

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

I.C. Seely, Esq.

Gentlemen—Nine years ago I was taken with severe pains in my stomach and bowels which the usual home remedies failed to relieve; after several days it passed off, leaving me very sore and weak but in the course of a few weeks it came on again. I called in a doctor—he treated me for biliousness; I occasionally went several months without any attack and then it would come more severe than ever; I could scarcely bear the weight of my clothes on my stomach and bowels. I grew thin, weak and despondent,—could do no work without bringing on terrible pain. Doctors treated me for catarrh of the head and stomach, indigestion, dyspepsia, but all was of no avail; the suffering gradually increased in severity and I despaired of any relief.

In 1892 I had a spell that was so severe I cramped from feet to neck. The Doctor said I must die—he couldn't do any thing for me. After about five weeks in bed I could again sit up, but the pain had settled in my right groin and limb. Relatives persuaded me to try "Golden Medical Discovery." Two thirds of the bottle was gone when I felt a change for the better; I had one very light attack after the first bottle; that has been seventeen months ago and I have had no more trouble. I have taken ten bottles of Dr. Pierce's Golden Medical Discovery and I am now well and able to support my family.

To any one with stomach and bowel trouble I will recommend Dr. Pierce's Medicine. I am never without it in the house.

I remain, yours,
I.C. SEELY, Lindsborg,
McPherson Co., Kans.

Dyspepsia—Constipation.

WORLD'S DISPENSARY MEDICAL ASSOCIATION, 653 Main St., Buffalo, N.Y.:

Mrs. A.L. Pierce.

Gentlemen—Three years ago I was suffering from constipation, distress in the stomach, bowels, feet and ankles bloated, kidney and heart trouble, loss of appetite, bad taste in the mouth, sour risings in the stomach, and indigestion. I was under the treatment of three physicians seven months. One gave me up to die. This was my condition when I was prevailed upon to take Dr. Pierce's Golden Medical Discovery and "Pleasant Pellets." I am well, your medicines have cured me permanently. Had I the power and language to herald to the whole world the good qualities of your medicines, I would most gladly do so, as they have saved my life and brought health and happiness to me.

Yours most sincerely,
MRS. A.L. PIERCE,
Stillwater, Penobscot Co., Me.

Sores in Mouth Due to Indigestion.

C.K. Turney, Esq.

CHAS. KELLOGG TURNEY, ESQ., a prominent contractor and builder, also well known as one of the accomplished singers at the Chautauqua Assembly, and who does business at Room 6, Bernard Block, Collinwood, Cuyahoga County, Ohio, writes:

"I was troubled with little watery blisters which would form on the under side of my tongue, and which proved very sore and troublesome. Becoming alarmed at the frequency of their appearance, and having much faith in Dr. Pierce and his associates, I wrote to them for advice. They recommended me to take Dr. Pierce's Golden Medical Discovery, which I did, and after using two bottles my trouble entirely disappeared."

Gained Thirteen Pounds; Catarrh of Stomach.

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

Mrs. Powell.

Gentlemen—Two years ago I was pale and emaciated, food fermented in my stomach. A physician pronounced my case "Catarrh of the Stomach," but he could not help me. I lived a month without solid food and when I tried to eat I would vomit. At this time I began taking Dr. Pierce's Pleasant Pellets, and in two weeks I was decidedly better. I am now in good health, and never felt better in my life. I have a better color, eat more, and have no distress after eating—having gained thirteen pounds since I began taking them.

Yours respectfully,
MRS. MARY POWELL,
Glen Eaton, Marshall Co., W. Va.

Chronic Diarrhea—Dyspepsia.

T.L. HALL, ESQ.

THOMAS L. HALL, of Creek, Westmoreland County, Pa., had chronic diarrhea, which his physician called dysentery. He had been troubled more or less for five years; had very severe attack fifteen months before writing us; had not been able to work steadily for twelve months. Food sometimes passed undigested; some days had three to six passages; had watery and sour risings from the stomach; backache; was drowsy upon rising in the morning; pain about the heart; itching all over body and limbs. He had three months' treatment at home—the special medicines being sent him by express. He writes that he "was greatly benefited by first week's treatment," but continued and "in three months was entirely well."

Dyspepsia—Loss of Flesh.

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

B. MAKSON, ESQ.

Gentlemen—Three years ago I commenced taking Dr. Pierce's Golden Medical Discovery; I weighed 140 pounds, and now I weigh 175 pounds, so you see how I have gained in health and weight. Dr. Pierce's Pellets are the best pills I ever took for the liver. All my friends say they do them the most good.

Respectfully yours, ROBERT MANSON,
West Rye, Rockingham Co., N.H.

Terrible Dyspepsia Cured.

MRS. LUKE COOK.

Mrs. LUKE COOK, of Grove, Newaygo Co., Michigan, writes:

"I had been ill for five years. My symptoms were pain in the stomach and bowels; could eat nothing but stale bread and tea or coffee. Meat and vegetables passed through the bowels undigested in about two hours, causing great pain. I was all "run-down." Tongue looked like a piece of raw meat. One doctor pronounced my case cancer of the stomach. I took treatment from five different physicians with but very little benefit—only temporary relief. I got so weak I could scarcely walk around, and suffered terrible agony. After taking fifteen bottles of Dr. Pierce's Golden Medical Discovery, I am well and able to do my own work, and frequently walk two miles and back the same day. I am now sixty-eight years old."

Indigestion, Catarrh, and Nervousness.

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

E.A. BALDWIN, ESQ.

Gentlemen—For a long time I was suffering from indigestion, catarrh and nervousness. I was so run down that I could not go to school, and, as the various remedies I tried did me no good, I applied to you, and was advised to try a course of special treatment. After taking only two months' medicines from your noble institution, I feel perfectly restored to health. I have, moreover, recovered my lost flesh, and I am pleased to say need no further medicines.

Yours truly,
E.A. BALDWIN,
Proctorsville, Windsor Co., Vermont.

General Debility, Malaria, Sick Headache.

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

"Mrs. J.H. Lansing"

Gentlemen—I am happy to say that your valuable medicine has been a great benefit to me. I was suffering from general debility, malaria and nervous sick headaches, and after my third child was born (a beautiful baby boy of ten pounds) I only recovered after a long illness; I barely gained strength enough in two years' time so that I was able to crawl about to accomplish the little housework that I had, by lying down to read many times each day; had sick headaches very often; and many pains and aches, all the time complaining of getting no better. I finally asked my husband to get a bottle of Dr. Pierce's Favorite Prescription, which he promptly did. After I had taken one bottle I could see a great change in my strength, and fewer sick headaches.

I continued taking the medicine until I had taken eight bottles—seven of the "Favorite Prescription" and one of the "Golden Medical Discovery." For some time past I have not used it, but I am now able to do the housework for myself, husband and two children (aged nine and five years). I also take in dressmaking, and enjoy walking a mile at a time, and I think it is all due to the medicine, for I know I was only failing fast before I commenced to take it. I take great pleasure in recommending the "Favorite Prescription" to all women who suffer from debility and sick headache.

Respectfully yours, MRS. J.H. LANSING,
Fort Edward, Washington Co., N.Y.

Malarial Fever.

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

Miss McConell.

Gentlemen—My little girl, eleven years old, took malarial fever and lay 22 days in fever. Our family doctor was tending her twice a day; she got no better; I sent unbeknown to the doctor and got one bottle of Dr. Pierce's Pellets, and one bottle of his "Golden Medical Discovery," and commenced to give them to her as directed; after taking the medicine three days, the fever began to go down, and the doctor came in and said: "what's the matter?" "Ida, you have no fever this morning," and laughed. Then I told him I had been giving Dr. Pierce's medicines. He didn't say a word—he was beaten. My oldest daughter is improving by taking Dr. Pierce's Favorite Prescription.

Yours respectfully,
MRS. ELIZABETH McCONELL,
Payne, Paulding Co., O.

General Dropsy.

Tapping and Medication Conquers the Disease after it had run 22 Years.

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

E.L. Waters, Esq.

Gentlemen—I wish to acknowledge that you have cured me of the worst dropsy that ever came within my knowledge, it having afflicted me twenty-two years. After I had suffered much from other surgeons without any cure being effected, and with only relief for a short time, you performed a not only painless but very scientific operation, and with medicine completed the cure. It is now five years since you treated me and no symptoms of the disease have shown themselves. I will also add that while with you at the Invalids' Hotel I received the best of care and attention from the well trained nurses in your employ, for all of which I feel grateful.

With respect and best wishes,
EDWIN L. WATERS, Athol Centre, Mass.

Reduced to a Skeleton.

Chronic Diarrhea—Dyspepsia Cared by Two Months' Special Home-Treatment.

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

J.T. Yerby, Esq.

Gentlemen—To all sufferers from chronic diseases I want to say that I suffered for six years, and was under fourteen different doctors in city and country. They could not reach my case; I was given up to die; my sufferings were indescribable; I could not retain food on my stomach; could not control my bowels at times; suffered great pain; could not sleep at night; I was reduced to a skeleton; in health I weighed 180; then only 111; I now weigh as much as I did before I was sick. I am sixty years old, but feel young and active; I owe it to the medicines you sent to me. After taking it two months I was out of bed attending to my work; my friends could hardly believe it was I when they would meet me out away from home. I consider my cure as almost miraculous.

Respectfully,
JOS. T. YERBY,
White Stone,
Lancaster Co., Va.

Chronic Diarrhea.

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

I.G. Hamilton, Esq.

Gentlemen—It is now nine years since I was afflicted with the above disease, which reduced me to a mere skeleton, and my friends had very little hope of my recovery. After trying different doctors, and many other remedies for a year, from which I received little or no benefit, I was advised to try Dr. Pierce's special treatment, which I did, and after two months I was a well, strong, healthy man, and have been ever since.

Yours, etc.,
ISAAC G. HAMILTON,
Baie Verte,
Westmoreland Co., N.H.

Dyspepsia or Indigestion.

Kidney Disease and Rupture.

A.N. Kingsley, Esq.

The following is from the widely-known and popular proprietor of the Kingsley House at Ashuelot, N.H.: "It may seem useless to add testimony to the overwhelming mass already given of the many remarkable cures performed at your Institution, but I deem it a pleasure and a duty to add mine to your long list as very remarkable. I had a rupture of twenty-seven years' standing, with hemorrhage of the kidney for six months, preceding my visit to your Institute, and was also troubled badly with indigestion, all of which ailments had reduced me in strength and flesh to a mere skeleton. Had been treated by many local physicians, who failed to do me any good. I could walk but a very short distance when I left my home on the 8th of July, 1892, for treatment at your Institution, with but little faith or hope of ever being any better. But through your skillful treatment I was able to return to my home on the 9th of August, 1892, and consider myself permanently cured, having had to take no medicine since. Considering my case almost a miracle, I cannot speak too highly of your Institute and skillful treatment, to which I feel that I am indebted for my continued existence. You are at liberty to refer to me, and to use this as you see fit.

Very respectfully, A.N. KINGSLEY,
Ashuelot, Cheshire Co., N.H."

Dyspepsia, Rheumatism, Nervous Prostration, Sleeplessness.

J.T. Townsend, Esq.

Mr. J.T. TOWNSEND, of Noah, Coffee County, Tenn., consulted us by letter. He was suffering from great nervous prostration; could not walk without tottering; was troubled greatly with inability to sleep; poor appetite; did not relish food; suffered much pain and stiffness in the joints; was overcome with neat working on a thresher, followed by persistent nausea, confusion of ideas, his memory being very defective.

After taking a single course of treatment, the medicines being sent by express, he writes as follows: "The medicine you sent me lasted me five weeks, and proved very beneficial indeed. I believe it, under God, was the means of saving me from a premature grave. When I received the medicine, I had just gotten rid of an attack of bilious fever, which left me in a deplorable condition. I was very week and nervous, but my improvement commenced with the first dose of your medicine, so by the time my medicine was out I felt better than I had for years, and now have no indication of a return of my trouble." A month later he writes: "I continue to enjoy the most perfect health. Every organ of my body, and every faculty of my mind, is in splendid condition, which makes life worth living. I have gained twenty-one pounds since I have been able to attend to business. Please accept my profound thanks for your promptness in sending me my medicines."

Nervous Debility.

Piles, Catarrh, Heart Symptoms.

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

J. Talbott, Esq.

Gentlemen—The effect of your remedies is little short of a miracle. My general make-up and appearance are astonishing; my cheeks rosy, eyes bright, circles nearly all gone from under eyes; am fleshier, stronger, more active, and an entirely different man. No piles, catarrh, heart trouble; no chills and fever; no despondency, no anything.

Yours truly,
JOHN TALBOTT,
Pennsylvania Agricultural Works,
York, York Co., Penn.

Dyspepsia and Catarrh

Cured by Special Home-Treatment.

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

B. Eberhardt, Esq.

Gentlemen—I am happy to inform you that my catarrh and dyspeptic symptoms have all vanished. I am no longer troubled with headache and stoppage of the nose, my stomach is in good order, and I enjoy three hearty meals daily without any bad feelings.

I have gained in almost every respect, particularly in weight and strength, since beginning the use of your specially prepared medicines. By continuing to follow your special hygienic rules, I believe no relapse will occur.

Yours respectfully,
BERTHOLD EBERHARDT,
N.E. Cor. 10th, and Callowhill Streets,
Philadelphia, Pa.

Indigestion, Constipation, and Uterine Disease.

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

Miss Joslyn.

Gentlemen—Some months ago I consulted your specialist concerning my health, which had at that time become very much impaired from the effects of uterine disease, indigestion and chronic constipation. I was also troubled with frequent attacks of nervous headache which rendered me very miserable.

A line of treatment was outlined by your specialist, which I followed closely, and I immediately began to improve under the use of the medicine advised. The benefits wore so marked that within two or three months I was able to discontinue the use of the medicine, and have since that time been enjoying good health. I attribute my cure to the use of your medicines, and I heartily thank you for the benefits received, as well as for the kind attention given me by your specialist.

Respectfully yours,
IDA M. JOSLYN, Groton, Conn.

Chronic Bronchitis and Dyspepsia.

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

A. Rosenberger, Esq.

Gentlemen—Several years ago I spent many dollars for medicine, but in vain, and expected to die with consumption. But hearing of your Invalids' Hotel and Surgical Institute, I visited you.

To your advice and treatment I owe my life and present good health.

Hoping-that you and your eminent faculty may be spared many years to cure the afflicted, I send you my best wishes.

Yours truly,
ALBERT ROSENBERGER,
La Otto, Noble Co., Ind.

A Complete Collapse.

From Stomach Troubles.

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

J.L. Warner, Esq.

Gentlemen—Fifteen years ago I felt the first effect of a diseased stomach. It was very light at first, but as time went on it gradually grew worse. I did not suffer much at first—say for the first five years; but after that it was continual suffering all the time (and growing worse all the time), until just two years ago, when I completely collapsed, and had to give up all thoughts of work. I have not done a day's work since, but am now ready to go to work again. During the last five years I have been doctoring with as many as six different doctors here and in San Francisco. I was with one specialist here in my city five months, but none of the doctors gave me even temporary relief. The main symptoms of my disease were that my food would sour on my stomach and give me an awful heart-burn. I would bloat and have sour risings, and an awful burning sensation in my chest which would bring the tears. I have felt many times that I would like to leave this world. In looking over the ads. in the San Francisco Examiner, I ran across yours—stating that any one who would send twenty-one one-cent stamps to the address given would receive The People's Common Sense Medical Adviser I did as requested, and read a copy, and I now owe my life and present good health to Dr. Pierce and his noble staff of physicians. I have now taken fourteen bottles of the "Golden Medical Discovery" and four bottles of the "Pleasant Pellets," and will say that I am entirely well of all my stomach troubles. Can sleep nine hours every night.

A word to those who are taking or contemplating taking this grand remedy. Do not give up with one or two bottles, but continue on, and it will cure you as sure as the sun shines above.

Gratefully yours, J.L. WARNER,
1005 Fourth Street, Sacramento, Cal.

NERVOUS DYSPEPSIA.

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

J. Smith, Esq.

Gentlemen—For over twelve years I was a great sufferer from nervous indigestion and acidity of the stomach. I tried some of the best doctors, both in England and this country, but did not find permanent relief until I went to the Invalids' Hotel and Surgical Institute. The medicine prepared for me by the specialist at this famous institution was so effectual that I feel that I am perfectly cured.

I cannot speak in too high praise of the Invalids' Hotel and Surgical Institute. The Staff of Physicians is skillful and of large experience, and the institution itself, in all its appointments, excellent and in advance of the age. I highly recommend it to all the afflicted, feeling confident that all the benefit to be derived from medical or surgical treatment can be had at that institution.

JOSEPH SMITH,
No. 200 Eighth Street, Olean, N.Y.

BAD CASE OF DYSPEPSIA,

Cured by Special Home-Treatment.

Mrs. Johnson.

Mrs. JOHANNA JOHNSON, of Big Springs, Union Co., South Dak., forty-six years old. A pain began in the stomach, a sort of cramp; extended to the chest, shoulders and arms, also affecting the spinal column opposite the location of pain; had a hard lump that felt like lead in the pit of her stomach. Pain was brought on sometimes by eating something that at other times she could eat with impunity. Attacks of pain lasted usually about three days. After the pain would leave, she was weak and sore. Sometimes attacks would come on every day.

Had two months' special treatment.

Reports five months afterwards as follows: "Since taking your medicine, I am a new person; at least I feel so. I have used only one-half of the last set of medicines, and think I will not need to continue. A lady similarly afflicted is trying some of my medicine, and will order from you direct. I am glad to know where to direct the sick, and where the most good can be had for one's money. I am feeling well, and can work as formerly."

Indigestion and Constipation.

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

O.F. Sinigar, Esq.

Gentlemen—I was troubled with chronic indigestion and constipation. Had to be constantly taking physic, and finally was compelled to resort to hot water injections regularly to move my bowels. This got to be a great drudge to me. I took treatment from the leading physicians of this part of the country for my stomach and bowel troubles, and spent over one hundred dollars in this way, but they did me no good whatever. I got so bad that I began to think my time on earth was short, and did not care if I lived or died. I had to stop work; everything was a burden to me, until at last I tried your Institution. I went there, and you said you could help me, and those words sounded so good to me, as I thought I never could get well again. After taking your special home-treatment for five months, I was in the enjoyment of perfect health. This was two years ago, and ever since my bowels have moved regularly, and I have not taken any medicine to make them move. I cannot find words in which to express my sincere thanks for the almost immediate relief. I received from your specialists, and will say I am now enjoying the very best of health.

Yours with respect,
ORWIG F. SINIGAR, No. 71 Feather St., Canton, Ohio.

Fistula in Ano, Piles, Prolapse of Rectum.

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

N.T. Roberts, Esq.

Gentlemen—For more than twelve years I have been a sufferer with a complication of rectal troubles; pile tumors, prolapsus and fistula in Ano. I have been under the treatment of our most skilled practitioners, by ligature, carbolic acid, constitutional treatment, change of climate and the celebrated Brinkerhoff treatment, and also tried all of the local guaranteed nostrums, from all of which I have been only temporarily relieved. The old troubles would in a short time return, and with seemingly renewed vigor. With fast failing health and terrible nerve prostration, I left home the 1st day of October last, to take a two weeks' trip, hoping for some temporary relief. On the trip I stopped over at Buffalo, and having several years before been in correspondence with the Infirmary, concluded to consult you. I did so with little hope of a beneficial result. From the manner in which I was received and the satisfactory diagnosis of my case, I placed myself under your treatment. On the 16th day of October you operated upon me with such complete and satisfactory success, that I am now a sound and happy man, and am confident that had I been treated by you ten years ago that I would now be twenty years younger in feeling and thousands of dollars better off. It affords me pleasure, doctors, to recommend the Invalids' Hotel and Surgical Institute to all of the afflicted, and to assure them of the most skillful treatment, honest and polite attention, and with the assurance of my kindest and most grateful remembrance,

I am, Yours truly,
N.T. ROBERTS, Pine Bluff, Ark.

Rectal Fistula.

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

Mrs. Lothrop.

Gentlemen—Having been a great sufferer for years and receiving little or no benefit from other physicians, I determined to try your Institution, and with grateful results.

Having a successful operation for a fistula (of five years' standing) without the knife, while other home-physicians advised me there were no other means. And my troubles are yielding slowly but surely; my general health is better than for twelve years—all of which I owe to Dr. Pierce, and his skillful physicians and surgeons.

Please accept my sincere thanks for the kindness shown me while an inmate by all connected with the Invalids' Hotel. I shall heartily recommend your Institution to all sufferers.

Yours gratefully,
MRS. M.B. LOTHROP,
Villa Park,
Orange Co., Cal.

Uterine and Rectal Disease.

Home Physicians Failed.

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

Mrs. Clawson.

To whom it may concern—I was greatly afflicted with Uterine and Rectal disease. My disease was of very long standing and had baffled the skill of our home physicians. I went to the Invalids' Hotel and Surgical Institute, and received treatment of their specialist. Under his skillful care and kind attention I soon regained my strength and felt that my former life and ambition were again restored to me. I cannot speak in too high praise of this famous Institution; the rooms are large and cheerful, the food of the very best, the nurses kind and attentive, and the staff of physicians and surgeons skillful and of large experience.

Yours respectfully,
MRS. CHAS. CLAWSON,
Middlesex, Yates Co, N.Y.

Rectal Fistula

With Blood-Poisoning, Cured by a Safe and Painless method. A Prominent Merchant Testifies to the Superior Methods Employed at the Invalids' Hotel and Surgical Institute.

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

J.F. Saton, Esq.

It is with pleasure that I testify to the cure of the Fistula, for which you treated me. I had suffered from it for a long time, and felt that it was likely to seriously undermine my health and poison my system. I had deterred having it treated from the fears of the cutting operation in common use by physicians in the large hospitals and by surgeons in general practice. My fears were grounded on the fatal results that had followed in cases in my knowledge. I am thankful that I placed my case in the hands of your experienced specialists for treatment. The result has been a perfect cure. The treatment of the blood-poison that you gave me was successful in eliminating it all from my system, and I have since enjoyed perfect health, and no recurrence whatever of the fistula. It has been now many years since I was cured, and I thank you most sincerely for the good results that were brought about in my case.

I can recommend your institution as one in which all the requirements of an invalid are fully met.

Yours truly,
J.F. EATON,
Auburn, Mo., Box 806.

Rectal Fistula and Nervous Prostration-Rupture.

M.L. Stigers, Esq.

To the afflicted public:

It becomes my pleasant duty to recommend the Invalids' Hotel, Buffalo, N.Y., as an Institution for the successful treatment of surgical cases and chronic ailments of every description. It is with especial pleasure that I recommend the surgeon-in-chief of the Hotel, who is a skilled surgeon, one who stands at the head of the profession. The appointments of the Hotel are excellent. I was afflicted with an Anal Fistula (a very bad one it proved to be). I went to the Invalids' Hotel for treatment. Was placed under the care of your surgeon, who treated my case with such skill, that the parts are healed soundly. I recommended a friend of mine, who had a rupture, to go to you for treatment. He did so and was soundly healed of his trouble. I will cheerfully answer all communications relative to my stay at the Invalids' Hotel, provided a stamp is enclosed for return postage.

Yours truly,
M.L. STIGERS,
Menlo, Iowa.

Anal Fistula.

Complicated Case of Heart Disease.

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

N.S. Johnson, Esq.

Gentlemen—I feel that it is my duty to suffering humanity to let them know of your great success with me. I had a chronic disease that I had suffered with for sixteen years, and last November, owing to a fall, the disease doubled on me. I was confined to my bed for months, and the best surgeons of our city attended me daily. I continually grew worse. After consultation they decided that the knife must be used, which is attended with great pain and danger. I wrote you and stated my case; you said you could entirely cure me without pain, also without the use of the knife. I determined to go to Buffalo. Arrived there the 18th of March, and on the 20th of April I was at home entirely cured, and have enjoyed better health than for years. You also treated my wife for heart trouble, and greatly benefited her. The thoroughness of your methods, preparing the system, etc., greatly adds to your success, as well as your skillful treatment. I shall ever hold the surgeons at the Invalids' Hotel and Surgical Institute as a green spot in my memory.

Yours respectfully,
N.S. JOHNSON, Bloomfield, Iowa.

Hernia and Piles Cured Without Pain.

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

J.J. App, Esq.

Gentlemen—I have been successfully treated at your institution for piles and also rupture of the left side.

Your institution is all it claims to be, and the treatment of my case was accomplished without pain and apparently any risk. Your method of using locally cocaine as an anæsthetic is such a decided improvement. I did not have to take any dangerous ether or chloroform, but had a small quantity of medicine injected that made the operation as painless as though it was being done on some one else. At the same time I knew everything and could see what was being done.

You have my kindest thanks for the good care and many attentions given me. Your nurses and physicians all give kind and skillful care.

Yours very truly,
J.J. APP,
Bolivar, Tuscarawas Co., Ohio.

Large Pile Tumors.

J.C. Bagley, Esq.

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

Gentlemen—I was afflicted with piles for many years, brought on by heavy lifting during the war. My suffering was extreme, and the pile tumors gradually increased in size, notwithstanding the fact that I tried many different kinds of treatment. After becoming physically incapacitated and unable to do any work at all, and after much hesitation, I visited your institution as the last resort. I am happy to state that my visit there has resulted in a complete and permanent cure. A year or more has now elapsed since I placed myself under the care of your specialist, and I wish to thank you most heartily, for the attention which I received while there, and for the cure which has been accomplished in my case. I cannot say enough in favor of you and your staff of physicians who gave every attention, and whose treatment has been so successful. All suffering has entirely vanished, and I have gained about 35 pounds in flesh.

Respectfully yours,
J.C. BAGLEY, Watts Flats, Chaut. Co., N.Y.

Large Pile Tumors; Chronic Inflammation of Bladder.

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

P. Crump, Esq.

I was troubled with piles for thirty years. These were very mild at first but gradually increased in severity, and I was unable to get anything which would relieve them. They gradually increased in size, and for a good many years past have caused me a great amount of pain. The tumors became of large size and protruded whenever I lifted anything heavy or strained in the least; also bled copiously at times. This, together with chronic inflammation of the bladder, with which I have also suffered for some years, rendered my life miserable. Physicians at home gave up my case as hopeless, and said that they did not think I could be benefited, and certainly not cured. I visited your Institution, hoping to obtain relief, but with very little faith, and am happy to say that the treatment which I obtained there has resulted in a permanent cure of the piles, and the inflammation of the bladder has been so greatly relieved that at present I have no suffering of any kind. The cure is complete and I feel like a new person. In fact I have not experienced such comfort in many years. I shall always appreciate the kindness and attention shown me by your staff of physicians, and also by the nurses in your Institution, and shall advise my afflicted friends to make you a visit.

Very respectfully,
PETER CRUMP, Dennison, Goodhue Co., Minn.

PILE TUMORS.

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

S.H. Crosby, Esq.

Since the spring of 1872, I have been troubled with pains in head, the result of sun-stroke while in the U.S. army, and pile tumor growth. For the last named disease I was treated at the Invalids' Hotel and Surgical Institute, in June of 1887, and the growth, as I believe, is killed, and the result has been a great benefit to my general health. I am quite comfortable and with strength to look after my little work and superintend the same, much better than before treatment, for which benefit please accept my thanks.

Yours respectfully,
S.H. CROSBY,
Manito, Mason Co., Ill.

Bad Case of Piles Cured by Home-Treatment.

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

Gentlemen—I received a few days ago a communication from you requesting a photo, of myself. I will say that I am sorry, but I have had no photograph of myself taken since I was a child, but will gladly give you a testimonial and I will answer by letter any skeptical ones that you refer to me, provided they send a return addressed and stamped envelope for reply.

Just one year ago, I was suffering untold agonies from internal piles and prolapsus of the rectum: my bodily pain was so great that the mental strain was almost more than I could stand. I was useless to myself and family and had about persuaded myself it would be better to take my life, and I think I should have done so had not a copy of the Common Sense Medical Adviser happened to fall into my hands. I was not certain just what my trouble was, at least what to call it. I began the Chapter treating on Pile Tumors, and then I realized just what my trouble was. I wrote you and received encouragement. I sent for a month's treatment and it was certainly the best investment I ever made. I received the medicines at noon—read the directions carefully and commenced at once to carry them out. I seemed better the next day. I suffered less, and in a few days there was a decided change for the better. I continued the medicine until I had taken all of it; I have not taken any since, except occasionally a few of Dr. Pierce's Pellets, just enough to act as a mild laxative. I am perfectly well. I was always more or less constipated all my life. I now understand that by keeping the bowels open and in good order, I could have avoided all of the suffering that I have gone through; my friends all think my recovery almost a miracle. I feel, Oh, so grateful to you, I shall never fail to speak a word in your favor to suffering humanity.

Respectfully,
Mrs. J.W. Heist
Fayette, Howard Co., Mo.

Piles and Chronic Diarrhea.

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

J.J. Bradford, Esq.

Dear Sir—I was a great sufferer for thirty years from piles, and take great pleasure in bearing testimony to the fact, that since you treated me, seven years since, I have not had a symptom of piles.

At the above stated period I had also been a sufferer from diarrhea, in its most aggravating form, for three and a half years, and I was completely and radically cured of that, also.

I beg to assure you, and your noble associates, of my lasting gratitude, and feel no hesitancy in expressing the opinion that but for your great skill in treating me, I should have been in my grave. I state for the benefit of all those who may be similarly afflicted that if they will place themselves in your hands, you will goon effect radical cures.

JOHN J. BRADFORD,
Augusta, Perry Co., Miss.

LARGE PILE TUMORS.

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

L.H. Esety, Esq.

Gentlemen—Allow me to thank you for the kind attention and skillful treatment I received while at your Institution for five weeks' treatment. I cannot speak too favorably of your Institution.

You have my best wishes for your continued success.

Respectfully yours,
L.H. ESTEY,
Hinsdale,
Cheshire Co., N.H.

Headache.

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

E. Vargason, Esq.

Gentlemen—I have used your medicines for a number of years, and know that they do for me all that is claimed for them. I am employed mostly at my desk, and not infrequently have an attack of the headache. It usually comes on in the forenoon. At my dinner I eat my regular meal, and take one or two of Doctor Pierce's Pleasant Pellets immediately after, and in the course of an hour my headache is cured and no bad effects. I feel better every way for having taken them—not worse, as is usual after taking other kinds of pills. Your "Pleasant Pellets" are worth more than their weight in gold, if for nothing else than to cure headache.

Very respectfully,
E. VARGASON,
Otter Lake, Lapeer Co., Mich.

DYSPEPSIA, NEURALGIA.

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

Miss Gwin.

Gentlemen—Before using your medicines, my food would not digest; then neuralgia set in, and I suffered severe pain through my sides, shoulders, breast and stomach. Bilious attacks were frequent; then my flesh began stinging and my heart began beating badly and making me so that I could not lift a chair, and all together threw me into a cramp and a numbness, and the family thought I was dying, and sent for another doctor who said it was hard to do anything for me; he visited me almost six years and did not help me; the pain was so great I had to scream; I said to my doctor, "can you give me something" and he said, "yes, but it will not do you any good." I told him he had not done me any good in six years, and I would quit him. I saw I was almost gone, very pale and weak and did not eat anything.

I began your "Golden Medical Discovery," and one-half bottle helped me so much I began work and improved fast; it helped me so I got 10 bottles. While using them my friends said when I quit I would be just as bad as ever. It has been five years and no need of a doctor yet, and I will say that I think it cannot be beat, and I will still believe in it, for if it had not been for the "Golden Medical Discovery" I would have been in my grave. Your medicines have helped my brother, and father is using it now and it is helping him.

I remain. Your true friend,
Miss C.B. GWIN, Cowardin, Bath Co., Va.

Bloating of Bowels, Caused by Liver Disease.

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

MR. G.S. WATRING

Gentlemen—My son, aged fourteen years, was taken with bloating of the abdomen; this would go down leaving the parts so sore he could scarcely stand. We had three different doctors to treat him, but he grew steadily worse. We then commenced giving him Dr. Pierre's Golden Medical Discovery, and after using it three days he commenced to improve. Last summer he had so fully recovered his health as to make a full hand in the harvest field. He took, in all, only six bottles of the "Golden Medical Discovery," and it saved his life.

Respectfully yours,
J.B. WATRING,
Lead Mine, Tucker Co., W. Va.

Nervous Dyspepsia; Uterine and Spinal Weakness.

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

MRS. NAY.

Gentlemen—I had nervous dyspepsia for twenty years, followed by uterine and spinal weakness with irritation of the same. In the Spring of 1890 I became so exhausted that I was compelled to keep to my bed with symptoms of paralysis in the lower limbs, and many other distressing symptoms. I accidentally obtained one of Dr. Pierce's Medical Advisers from a friend, and finding my ailments so well described therein, I wrote to Dr. Pierce for his advice, which he sent by return mail. For my recovery he requested me to use his "Golden Medical Discovery," his "Favorite Prescription," and his "Pleasant Pellets." He also gave me some directions for every-day living. These means accomplished my complete cure. I am thankful that we can have such reliable medicines brought into our homes without great expense.

Yours truly,
MRS. AMERICA NAY,
Volga, Jefferson Co., Ind.

Dyspepsia, Torpid Liver—Terrible Suffering.

MRS. O'BANNON

DR. R.V. PIERCE: Dear Sir—When I commenced your medicines, had headache all the time, indigestion, pain in my back and loins, soreness and stiffness in my joints, my limbs ached so I could not sleep at night: I could not lie in bed more than two or three hours any night; when I would lie my head on the pillow I would have to rise immediately to get breath, sit up and walk the floor very near all night. I could not eat anything that would digest; I would do the cooking for the family, but I was in so much pain the tears were in my eyes all the time I would get a meal ready. I would take one mouthful of bread and then go off and sit down and cry with hunger, but dare not eat any more, and then would have to vomit from that one mouthful of bread—I would have such weak spells I could not stand on my feet.

I had tried five doctors, they had done me no good; I had given up—never to take anything more, only to lull the pain. I had given up to die when I received a pamphlet and some papers from you. I decided to try once more and I have been improving ever since I commenced your treatment; my health is better than it has been for fifteen years; I weighed one hundred pounds when I began taking your medicines; now I weigh one hundred and thirty, as much as I ever weighed. I have taken ten bottles of "Favorite Prescription" and still more of "Golden Medical Discovery," and several vials of the "Pellets."

Your sincere friend, MRS. M.H. O'BANNON,
Lameta, Leake Co., Miss.