Chapter XXXVI: Introduction (6)

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

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

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

ELONGATION OF THE UVULA.

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

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

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CHRONIC LARYNGITIS.

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

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

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

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

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CONSUMPTION.

PHTHISIS PULMONALIS.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Professor Flint says that consumption sometimes terminates in recovery, and that his observations lead him to the conclusion that the prospect of recovery is more favorable in cases characterized by frequent hemorrhages. Drs. Ware and Walshe are also led to the same conclusion.

Professor J. Hughes Bennett, of Edinburgh, has thoroughly investigated the subject, and adds his testimony to that of others, citing numerous cases that have resulted in perfect recovery. If such testimony is not sufficient, we may mention the following, whose names are well known and respected in professional circles, and all of whom declare that consumption is a curable disease. The list includes Laennec, Andral, Cruveilhier, Kingston, Presat, Rogée, Boudet, and a host of others.

No farther back than 1866, on page 145, of the proceedings of the Connecticut Medical Society, we find "Observations, Ante-mortem and Post-mortem, upon the case of the late President Day by Prof. S.G. Hubbard, M.D., New Haven," from which we learn that Jeremiah Day, LL. D., who was for twenty-nine years President of Yale College, was, while a mere youth, a victim of pulmonary consumption. During his infancy and boyhood his vitality was feeble. He entered Yale College as a student in 1789, "but was soon obliged to leave the institution on account of pulmonary difficulty, which was doubtless the incipient stage of the organic disease of the lungs which subsequently developed itself." He remained in feeble health for two years, but returned to college, and graduated in 1797. For the next six years his lung difficulties were quite severe, and he repeatedly bled in large quantities, but he had so far recovered in 1803, as to accept a Professorship. He was afterwards chosen President of the college, which office he held for many years, in the enjoyment of good health. He died from "old age," as we are told, in 1867, aged 94 years.

Statistics show that under the improved methods of treating this disease, the mortality, as compared with previous years, has been greatly reduced. Clinical observation proves that injuries to the lungs are not so fatal as was once supposed.

TREATMENT. The earlier the treatment of this disease is undertaken, the greater is the probability of success. The reason of this is obvious; at first the disease is general or constitutional, but as it advances, by the deposit of _tubercular matter_, it becomes both constitutional and local. Hence the treatment must be both _general_ and _local_. The occurrence of certain prominent and distressing symptoms, either from the natural progress of the disease, or from complications with other affections, often renders it difficult, even for physicians, to determine how far their treatment should be general and how far local.

Treating the symptoms instead of the general disease, or treating the constitutional disease without regard to the symptoms which arise from it, is an error into which many physicians have fallen. The constitutional affection, the local manifestations and complications, and the circumstances and individual peculiarities of the patient, must all be carefully considered; bearing in mind all the while, that tubercular matter is the product of a morbid action, which, in every case, must exist before its deposition in the lungs, or any other tissue, can take place.

In every case in which curative treatment is to be instituted, the hearty and persistent co-operation of both patient and friends is absolutely necessary; and the treatment, which is both hygienic and medical in character, should have in view the following aims:

(1.) The avoidance of the causes concerned in the production and perpetuation of the disease.

(2.) The restoration of healthy nutrition, in order to stop the formation of tuberculous matter.

(3.) The arrest of the abnormal breaking down of the tissues, and the prevention of emaciation.

(4.) The relief of local symptoms, and the complications arising from other diseases.

The fulfillment of the first indication, the avoidance of causes, is of the utmost importance, for if they have been sufficient to _produce_ the disease, their continued operation must certainly be sufficient to _perpetuate_ it. A single individual is very often subjected to the operation of several of the causes already enumerated, some of which, in consequence of circumstances and surroundings, are unavoidable. Of these, the one most difficult to overcome is climate; _i.e._ the frequent variations of temperature.

Upon the subject of climate much has been written. But that which is best adapted to the cure of consumption, is that which will enable the patient to pass a certain number of hours every day in the pure open air, without exposure to sudden alterations of temperature. There are very few persons who change their place of residence, except as a last resort, when the disease is in the last stage. It is then productive of little or no good. This is one reason why so many people having consumption die in Florida, and other warm countries. If a change of climate is to be effected at all, it should be made early.

The most powerful stimulant to health is well-regulated exercise. It assists the performance of every function, and is of paramount importance to promote good digestion and proper assimilation, conditions essential for recovery. It should not, however, be carried beyond the powers of endurance of the individual, so as to exhaust or fatigue. Everything that can invigorate should be adopted; everything that exhausts should be shunned.

To fulfill the second indication, to restore healthy nutrition, requires not only a proper diet, both as regards quantity and quality, but demands that the integrity of the organs concerned in the process of digestion and assimilation, shall be maintained at the highest standard of perfection possible.

That the diet be sufficient in quantity should be obvious to all. It is also necessary that it be nutritious, and that it should contain carbonaceous elements. Food of a starchy or saccharine character is apt to increase acidity, and interfere with the assimilation of other elements, therefore, articles, rich in fatty matters, should enter largely into the diet. The articles of food best adapted to the consumptive invalid are milk, rich cream, eggs, bread made from unbolted wheat-flour, and raised with yeast, cracked wheat, oatmeal, good butter, beef, game, and fowls. These contain the necessary elements for assimilation. Oily food is of great importance, and the beef eaten should contain a good proportion of fat. Plenty of salt should always be eaten with the food, and a desire for it is often experienced. Over-eating should be avoided, lest the stomach be induced to rebel against articles of diet rich in important elements.

Derangement of the process of nutrition requires careful attention, and, if necessary, correction. For this purpose, nothing can excel Dr. Pierce's Golden Medical Discovery. It increases the appetite, favors the nutritive transformation of the food, enriches the blood, and thus retards the deposition of tubercular matter. It is so combined that, while it meets all these indications, it relieves or prevents the development of those distressing symptoms so common in this disease.

The "Golden Medical Discovery" is adapted to fulfill the third indication in the management of this disease, which is to check the abnormal breaking down and waste of tissues, which constitute such a prominent feature in this malady. The antiseptic properties of the "Discovery" are unmistakably manifested in preventing such abnormal decomposition. The emaciation, excessive expectoration, profuse perspiration, diarrhea, and hectic fever, common to consumption, are all due to a too rapid disintegration and waste of the tissues. It is in this condition of the system that this medicine, by its powerful antiseptic properties, manifests its most wonderful curative ability. When, as in this disease, the vital forces of the system have, in a degree, lost their restraining influence over the processes of disintegration, waste, and decay, which goes on so rapidly that nutrition cannot compensate for the loss to the system, then it is that the "Golden Medical Discovery," by its antiseptic influence, checks this rapid waste of the tissues, and thus arrests the disease. To the lack of employment of such a remedy in the treatment of consumption, the unparalleled fatality of the disease is largely due. In their anxiety to improve digestion and nutrition, and thus build up the tissues, physicians often lose sight of the no less important indication of restraining the destructive waste going on in the system, which overbalances the supplies furnished by absorption. The gradually increasing emaciation and loss of strength render perpetuity of the organism impossible.

The fulfillment of the fourth indication, to relieve local symptoms, and the complications with other diseases, is often attended with no little difficulty.

_The Cough_ is a secondary symptom, arising from the irritation caused by the tubercular deposits. Medicated inhalations may give temporary relief, but cannot cure it. They strike at the branches of the disease, while the root is left to flourish and develop new branches.

Expectorants have been employed to a great extent, and the theories, which have been advanced in favor of their use, are sometimes very ingenious. That they modify the cough, we do not attempt to deny; but it is usually at a great expense, for they derange the stomach and interfere with digestion and assimilation.

Improvement of the general health is always attended with amelioration of the cough. If the patient did not cough at all, the lungs would soon fill up with broken-down tissue, and death from suffocation would result. Irritation of the nerves supplying the lungs sometimes occurs, and causes the patient to cough immoderately, when it is not necessary for the purpose of expectoration. This condition is readily controlled by Dr. Pierce's Golden Medical Discovery, which exerts a decidedly quieting and tonic influence upon the pneumogastric nerve, which, with its ramifications, is the one involved. An infusion of the common red clover, in tablespoonful doses, will also be found a valuable adjunct in overcoming this condition.

_Hoemoptysis_. Hemorrhage from the lungs is generally sudden and unexpected in its attack, though sometimes preceded by difficulty of breathing, and a salty taste in the mouth. Although it _very rarely_ destroys life, it often occasions alarm. Common table salt, given in one-fourth to one-half teaspoonful doses, repeated every ten or fifteen minutes, is generally sufficient to control it. Ligatures applied to the thighs and arms, sufficiently tight to arrest the circulation of blood in the veins, but not tight enough to impede it in the arteries, is a useful proceeding. Ergot, in teaspoonful doses of the fluid extract, hamamelis, and gallic acid, all are valuable for this purpose.

_Night-sweats_ can only be regarded as a symptom of weakness, and are to be remedied by an improvement of the general health. Bathing in salt water is sometimes attended with good results. The practice of giving acids for this symptom can only be regarded as irrational. It may arrest the sweating, but it will do harm in other ways. Belladonna, given at bed-time, is an effectual remedy.

_Frequency of the pulse_ is generally a prominent symptom in this disease. It sometimes points to a condition of sufficient importance to require a remedy. Although the "Golden Medical Discovery" is combined to meet this condition, its value may be greatly enhanced by adding one-half to one teaspoonful, according to the urgency of the case and the frequency of the pulse, of the fluid extract of _Veratrum Viride_ to each bottle. The benefit of this, when persisted in, will be apparent in the amelioration of all the symptoms, and in the general improvement. This fluid extract can be had at any drug store.

_Diarrhea_ is sometimes a troublesome symptom, and particularly so in the latter stages of the disease. It is generally due to acidity of the alimentary canal, to which the treatment must be directed. Great care should be taken in the selection of the diet to improve the quality and avoid everything which disagrees with the patient. Improve digestion by every possible means. Carbonate of soda and rhubarb, in the form of a syrup, are sometimes excellent. The Compound Extract of Smart-weed, in small doses, will generally diminish the frequency of the discharges.

_Derangement of the Liver_ is often a complication requiring attention, and the timely relief of which goes very far in ameliorating the general condition of the patient. The "Golden Medical Discovery" is generally sufficient to relieve this complication. Its influence, however, may be considerably increased in this direction by the use of Dr. Pierce's Pleasant Pellets, according to the directions which accompany them. They should only be taken in the smallest doses, one or two "Pellets "every day, just enough to produce a natural movement of the bowels each day.

_Uterine Derangements_. In the female, derangement of the menstrual function is generally an early complication of consumption, if indeed it does not occur at the outset. It deserves early attention, and, in addition to the remedies already advised, Dr. Pierce's Favorite Prescription is so compounded as to meet the requirements of this condition, and at the same time exert a favorable influence upon the constitutional disease.

The numerous reports of cures of well-developed cases of Consumption to be found in the back portion of this little treatise must be sufficient, it seems to us, to convince the most skeptical of the wonderful power which Dr. Pierce's Golden Medical Discovery exercises over this terribly fatal malady. As will be noted, many of the cases there reported had long been unsuccessfully treated with cod liver oil emulsion and all the other usual remedies employed by the profession and were fast running down. "Golden Medical Discovery" aroused the stomach and liver, and started all the nutritive functions into action, whereby digestion and nutrition were promoted and both the strength and flesh steadily built up. The reader will bear in mind, that most of the cases hereinafter reported, were pronounced Consumption by their attending physicians as well as by us. It cannot be said, therefore, that we exaggerate the malady and that the cases were merely bad, lingering coughs. Thousands, whose maladies have been pronounced genuine Tubercular Pulmonary Consumption, (Phthisis Pulmonalis) by eminent physicians have been _perfectly_ and _permanently_ cured by the use of Dr. Pierce's Golden Medical Discovery. It can, therefore, no longer be doubted that this wonderful compound is far superior as a remedy for Consumption to cod liver oil, compound Hypophosphites, and the many other agents so highly extolled, and so generally prescribed for this fatal malady by even the more progressive and advanced of the medical profession of our day. Read the letters received from grateful patients who have been cured and note how many commend the use of "Golden Medical Discovery," as a "last resort," after their home physicians had exhausted all their skill and resources in vain.

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CHRONIC BRONCHITIS.

This is a subacute or chronic form of inflammation of the mucous membrane of the bronchial tubes, of a very persistent character and variable intensity. There are few diseases which manifest a greater variety of modifications than this.

SYMPTOMS. The symptoms of this disease vary greatly with its violence and progress. Cough is always present, and is very often the first symptom to attract the patient's attention. It is usually increased by every slight cold, and with each fresh accession becomes more and more severe, and is arrested with greater difficulty. The cough is always persistent, sometimes short and hacking, at other times deep, prolonged, and harsh. Sometimes it is spasmodic and irritating and particularly so when it is associated with affections of the larynx, or with asthma, involving irritation of the branches or the filaments of the pneumogastric nerve.

When the chronic follows the acute form of the disease, or follows inflammation of the lungs, the expectoration may be profuse from the first, and of a yellowish color and tenacious character. When the disease arises from other causes, the expectoration is generally slight at first, and the cough dry or hacking. This may continue some time before much expectoration occurs. The expectorated matter is at first whitish, opaque, and tenacious, mixed sometimes with a frothy mucus, requiring considerable coughing to loosen it and throw it off. As the disease progresses, it becomes thicker, more sticky, of a yellowish or greenish color, mixed with pus, and sometimes streaked with blood. In the latter stages, it becomes profuse and fetid, and severe hemorrhage may occur. Sometimes the cough and expectoration disappear when the weather becomes warm, to appear again with the return of winter, which has gained for it the appellation of _winter cough_. The sufferers feel as if something was bound tightly round them, rendering inhalation difficult. Soreness throughout the chest is often a persistent symptom, especially when the cough is dry and hard. Behind the breast-bone there is experienced a sense of uneasiness, in some cases amounting to pain, more or less severe.

As the disease progresses, the loss of strength is more and more marked, the patient can no longer follow his usual employment, his spirits are depressed, and he gradually sinks, or tubercular matter is deposited in the lungs, and consumption is developed.

TREATMENT. Thorough attention to hygiene, with the avoidance of the causes concerned in the production and perpetuation of the disease, is necessary. The patient must be protected from the vicissitudes of the weather by plenty of clothing; flannel should be worn next to the skin, with a pad of flannel or buckskin over the chest, and the feet should be kept warm and dry. Exercise in the open air is essential. When the weather is so cold as to excite coughing, something should be worn over the mouth, as a thin cloth, handkerchief, muffler, or anything which will modify the temperature of the atmosphere before it comes into contact with the mucous lining of the lungs. Good ventilation of sleeping-rooms is all-important; not that the air should be cold, but that it should be as pure as possible.

The diet must be nutritious, cabonaceous, and of sufficient quantity. Beef, milk, rich cream, plenty of good butter, eggs, fish, wheat bread from unbolted flour, supply the appropriate alimentary substances for perfect nutrition and the maintenance of animal heat.

To overcome the modified form of inflammation in the bronchial tubes, all sources of irritation should be avoided, as the inhalation of dust, or excessively cold air. It is in the cure of severe and obstinate cases of this disease that Dr. Pierce's Golden Medical Discovery has achieved unparalleled success, and won the highest praise from those who have used it. Its value will generally be enhanced in treating this complaint by adding one-half a teaspoonful of the fluid extract of _Veratrum Viride_ to each bottle. This can be added by any respectable druggist. Especially should it be thus modified if the pulse be accelerated so as to beat ninety or a hundred times in a minute. The "Golden Medical Discovery" should be taken in teaspoonful doses, repeated every two hours. When the cough is dry and hard, with no expectoration, it arises from irritation of some of the branches of the pneumogastric nerve, which this remedy will relieve. It may, however, be aided by inhaling the hot vapor of vinegar and water, or vapor from a decoction of hops, to which vinegar has been added.

The use of Dr. Pierce's Golden Medical Discovery should be _persisted_ in, taking it in frequent doses, every two or three hours, and keeping up its use until the disease yields and is perfectly stamped out. Do not expect a formidable disease of perhaps weeks' or months' duration to be _speedily_ cured. Chronic diseases are generally slow in their inception and development and can only be cured by gradual stages. Perseverance in treatment is required. Many invalids do not possess the strength of purpose--the will power--to continue the use of the "Golden Medical Discovery" long enough to receive its full benefits. It is worse than useless for such to commence its use, for without persistency it cannot be expected to cure such obstinate maladies as chronic bronchitis.

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ASTHMA.

PHTHISIC.

One of the most distressing ailments with which the human family is afflicted is asthma. Its symptoms are not to be mistaken. Suddenly and without apparent provocation the patient experiences the greatest difficulty in breathing. When warning is given, there is usually a sense of fullness in the stomach, flatulence, languor, and general nervous irritability. The countenance is a picture of anxiety and horror. The difficulty of breathing increases and the struggle for air commences. Windows and doors are thrown open, fans used, and, utterly regardless of consequences, the sufferer passes the whole night in exposure and torture, even though the temperature be below zero. Fearing suffocation, the patient dare not lie down; he rushes to the window for air, rests his head upon a table or chair, or upon his hands, with the elbows upon the knees, jumps up suddenly and gasps and struggles for air. The eyes are prominent and the veins of the forehead distended with blood; sometimes the bowels are relaxed. The urine is colorless and is passed in copious quantities. This symptom indicates great excitement of the nervous system. The voice is hoarse, articulation difficult, breathing limited, noisy and wheezy. The _wheezing_ is pathognomonic of the disease. It can only be confounded with croup, and then only in the young. In croup there is pain and difficulty in swallowing, fever and cough, which are usually absent in asthma. A severe paroxysm of asthma is very distressing to witness, and one unused to it might well suppose the sufferer to be in his last agonies. No definite limit can be assigned to the duration of the attack or of the disease. It may last but a few minutes, may endure for hours, or with slight remission continue for days. The condition of the patient may be for years as changeable as the pointings of the weather-vane. In fact, the atmosphere has much to do with the disease. With every approaching storm, with every cloud of dust, even the dust from sweeping a room, with every foul odor, and, in some more sensitive organizations, with even the perfume of flowers, a paroxysm is provoked. Truly he is a "child of circumstances," a veritable football upon the toes of every atmospheric disturbance.

UNPARALLELED SUCCESS.

Persons affected with asthma or phthisic are numerous. With such an amount of suffering in our midst is it not a marvel, if not a disgrace, that the medical profession of to-day endorse the opinions of a half century ago and pronounce it incurable, rather than make stupendous and laudable efforts to discover plans of medication that will result in certain and permanent cure? Almost single handed we undertook this field of investigation, and we take pleasure in reporting that our labors have been crowned with success. The large experience furnished us has led to the discovery of remedies for this distressing malady of more than ordinary efficacy. Through the agency of these means we have been enabled to cure hundreds, who had suffered untold tortures for twelve, fifteen, or twenty-five years. Some whom we have been successful in curing had suffered from childhood to middle and even old age. The treatment of asthma, or phthisic, still continues to be a prominent specialty at the Invalids' Hotel and Surgical Institute.

NATURE OF THE DISEASE.

As to the exact pathological condition in this malady, opinions differ. Some physicians consider it a disease of the nervous system, others, of the blood, others, of the bronchial tubes, while not a few believe it to be dependent upon some disease of the stomach, heart, liver, kidneys, or due to urinary affections, or "female weakness." Respecting all these diseases of special organs, it is evident that any complication, and particularly one that is debilitating or causes irritation of the nervous system will increase its severity. This important fact we keep constantly in view in our treatment, and prescribe remedies to remove all complications.

In heart disease there is often dyspnoea, or difficult breathing, but this is not of the nature of asthma, or phthisic. The condition of the lungs is readily understood. There being an obstruction to the free passage of the blood through the heart, any excessive muscular exertion, or anything, in fact, which increases the action of the heart, is very apt to produce congestion of the lungs, and then the blood becomes surcharged with carbonic acid, which causes increased efforts to take more air into the lungs.

A NERVOUS DISEASE. A sudden fright, unfavorable news, grief, loss of property, etc., circumstances which affect the mind and nervous system, almost invariably throw the phthisical into a paroxysm. Nervines are demanded, particularly if the case be a chronic one, and we see that they are carefully and properly prepared and supplied, and in such a form as to be exactly fitted to the temperament and constitution.

POPULAR REMEDIES USED FOR SELF-TREATMENT OF ASTHMA.

There are numerous remedies that may be used to _relieve paroxysms_ of asthma. Among them we will notice a few that are most frequently employed by the profession. They can be easily and inexpensively prepared by any patient or druggist:

1. Equal parts of the tinctures of lobalis capsicum and skunk cabbage root. _Dose_.--Take a half teaspoonful in a little water every ten or fifteen minutes until relieved.

NOTE.--This is an antispasmodic and relaxant. In considerable quantities it will produce sickness at the stomach and perhaps vomiting. It should not be used when there is disease of the heart.

2. Chloroform. _Dose_.--A small quantity (say thirty drops), may be poured upon a handkerchief or napkin, held about one inch from the nostrils and the vapor inhaled. It is quite unnecessary to use this until insensibility follows; in fact, such an effect would be hazardous to life in the hands of the inexperienced.

3. Sulphuric ether. _Dose_.--The same as No. 2, and with the same precaution. Either of them should be used promptly upon the beginning of the paroxysm.

4. Take four ounces of stramonium leaves and strip from the stems, rubbing between the hands to partly pulverize. To this add one ounce of saltpetre, finely powdered. _Dose_.--Place a half teaspoonful upon a very hot shovel. Inhale the rising smoke. If the first few inspirations cause coughing, the smoke should not be evaded as the coughing incites deeper inspiration.

5. Stramonium and saltpetre as in No. 4. Dampen with water and make into balls or cones. These are more easily handled and are fired in the same way as the powder and used in the same way.

6. Take of sunflower leaves, stramonium leaves, mullein leaves, one ounce each; of lobelia leaves, half an ounce; of powdered nitre, one ounce; and benzoic acid, two drams. Mix thoroughly. _Dose_.--A pipeful, to be smoked the same as tobacco.

7. A cup of hot coffee or several of hot water. This is especially effective in cases arising from checked perspiration, from rheumatism, etc.

These recipes are given to the public as being the principal agents employed by the medical profession throughout the world. It must be distinctly understood that they are not _curative_ but merely _palliative_, and used to relieve paroxysms. We object to them wholly and unqualifiedly because they contain NARCOTICS. It is a fundamental principle in our treatment not to use this class of remedies. They stupefy the brain, debilitate the nervous system, and have, in not a few instances, formed an unfortunate appetite and habit, most difficult to overcome. We are of the opinion that one of the chief reasons why this malady has been considered incurable is the fact that physicians have almost universally relied upon narcotic drugs. With such medication a cure is the exception. A cure can only be effected under such circumstances when the _powers of nature are sufficient to overcome both the_ NARCOTIC _and the_ DISEASE. That they will _relieve_ we do not deny, but _they will never cure_. It reminds us of an old country doctor who advised a lady to smoke tobacco to cure acid dyspepsia. She followed the prescription for over thirty years and at last accounts was not cured yet. In all seriousness we ask would any other remedy except a narcotic or stimulant be used with such persistency for anything like this length of time? Is it not apparent that such agents form a habit which is often worse than the disease, and yet fail to effect a cure? We appreciate the necessity for relief, and do not blame sufferers for availing themselves of any means for this purpose. But they should not be satisfied with relief only, but should look about for such a system of medication as will rid them of the disease completely and permanently. If a week's or a month's exemption is a "foretaste of heaven," how incomparable are the comforts and happiness to be derived from a life-time immunity?

MILLIONS OF DOLLARS

are annually spent upon the advice of physicians, in traveling expenses, and hotel bills, by sufferers from asthma, or phthisic, in seeking a change of climate that will be advantageous. It is the last expedient of the doctor who is annoyed by the continued complaint of his unrelieved patient, and can only be made available by the wealthy. In some instances the change is beneficial, but to be effectually so a permanent change of residence is required. Most patients are unable or unwilling to do this. In some cases change only affords temporary relief, the attacks returning after a few months. Even the wealthy dislike to take such chances. The less opulent cannot think of such methods, and hence are compelled to bear their sufferings as best they can. In the majority of instances the "change of climate" is only an illusion, or only temporarily beneficial at best. We can tell them a better way, and if they are wise they will follow it.

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HAY ASTHMA, OR HAY FEVER.

This affection, known also as Hay Catarrh, Hay Fever, or Rose Cold differs but little in its manifestations, from coryza, or cold in the head, save in its _inciting cause_, and in its element of periodicity. In this latitude there are persons who, during summer or early fall, are invariably attacked with acute congestion or inflammation of the upper air-passages, giving rise to sneezing, watery discharges from the nose and eyes, difficult respiration, fever, and general prostration. These symptoms are supposed to be induced by the inhalation of pollen or odors from grasses or flowers, which at that time are supposed to give off certain exhalations of an Irritating character. Unless arrested by medical treatment, the disease lasts until cool weather, or the occurrence of a hard frost rids the atmosphere of the exciting influence.