Lichen strophulosus is a variety peculiar to infants. Dermatologists recognize several subdivisions of this species, but the general characteristics are the same in all. The pimples are much larger than in the other forms of lichen, of a vivid red color and the duration of the eruption is limited to two or three weeks.
Lichen urticatus is also an infantile affection and begins with inflammation, which is soon succeeded by the eruption. In a few days the pimples shrink, the redness disappears, and the skin has a peculiar bleached appearance. The eruption is attended by an intense itching sensation and, if the skin is ruptured, a small quantity of blood is discharged and a black scab formed. This variety of lichen is very obstinate and of long duration.
Lichen tropicus, popularly known as prickly heat, is an affection which attacks Europeans in hot climates. It is characterized by the appearance of numerous red pimples of an irregular form, distributed over those portions of the body usually covered by the clothing. It is attended with a fierce, burning, itching sensation, which is aggravated by warm drinks, friction of the clothing, and the heat of the bed. The eruption indicates a healthy condition of the system; its suppression or retrocession is an unfavorable symptom, denoting some internal affection such as deranged nutrition.
In lichen planus, as the term indicates, the pimples are flattened. There is no sensation of itching or formation of scabs. The pimples are solitary and have an angular base, and the fresh pimples formed appear on the spaces between the former eruptions. This affection usually attacks some particular region, such as the abdomen, hips, or chest. Instances are recorded in which it has appeared on the tongue and the lining membrane of the mouth. Sometimes it appears in patches, but even then, the margin of each pimple can be discerned.
Lichen pilaris and lividus are modifications of lichen simplex, the former being so named to describe the location of the pimples, i.e., surrounding the minute hairs which cover the body, especially the lower limbs. The term lichen lividus indicates the dark purplish hue caused by a torpid circulation and the consequent change of arterial into venous blood before leaving the pimples. Lichen circinatus is a modified form of lichen circumspectus. The pimples in the center of the circular patch subside and a ring is formed which gradually increases in size. When the rings become broken or extend in regular forms, the affection is termed lichen gyratus.
CAUSES. Constitutional debility predisposes the system to this eruption. The exciting causes are irritation of the skin, strumous diathesis, dentition, and any violation of hygienic rules. Although lichen is not a fatal disease, yet it tends to reduce the vitality of the system.
IMPETIGO. (Crusted Tetter or Scall.) Impetigo is a term applied to an inflammation of the skin, more severe and energetic in its character than the preceding affection. We have found the predominating characteristics of eczema and lichen to be the presence of exudation in the former, and the absence of it in the latter.
Impetigo is marked by the formation of yellow pus, which raises the cuticle into pustules. There is a slight swelling, redness, and the pus gradually dries up, forming an amber-colored crust, a representation of which is given in Colored Plate I, Fig. 5. It soon falls, leaving the skin slightly inflammed, but with no scar. The pustules are sometimes surrounded by a cluster of smaller ones.
The varieties of impetigo are designated according to the distribution of the pustules. Impetigo figurata, is characterized by the appearance of large clusters upon an inflamed and swollen surface, generally upon the face, but sometimes upon the scalp. This form is represented in Colored Plate I, Fig. 4. In impetigo sparsa the pustules are scattered over the whole body.
CAUSES. The predisposing cause of impetigo is nutritive debility, and the exciting causes are irritation, impure air, and errors of diet.
GUTTA ROSACEA is a progressive disease, and its successive stages of development mark the several varieties, such as gutta rosacea, erythematosa, papulosa, tuberculosa, pustulosa, according as they are characterized by redness, pimples, tubercles, or pustules. This affection is attended with heat, itching, and throbbing. The pustules contain serous lymph, which exudes if the cuticle be broken, and forms a crust at the summit of the pustule.
This eruption often appears on the face of persons addicted to intemperate habits, and has thus received the name of "rum blossom."
CAUSE. It is essentially a chronic affection, and depends upon constitutional causes.
SCABIES. (Itch.) This disease is characterized by a profuse scaliness of the skin, by an eruption of pimples, vesicles, and, in rare instances, of pustules. Its prominent feature is an intense itching, so aggravating that, in many instances, the skin is torn by the nails. Unlike other diseases of the skin, it is not due to inflammation, but is caused by animalculae, or little parasites, termed by naturalists the acarus scabiei. This minute animal burrows in the skin, irritating it, and thus producing the scaliness and itching. The vesicles are comparatively few in number, and contain a transparent fluid. The pustules are only present in the severest forms or when the skin is very thin and tender. It is then termed pustular itch.
The parts usually affected are the hands, flexures of the joints, and the genital organs. Cases are recorded, in which scabies appeared upon the face and head, but they are of rare occurrence. The activity of the animalculae, is modified by the vitality of the victim. In persons of a vigorous constitution, they will rapidly multiply, and, in a few days after their first appearance, will be found in almost every part of the body.
Scabies is not confined to any age or sex, but chiefly affects persons of filthy habits. This disease can only be communicated by contact, or by articles of clothing worn by an infected person. There are certain indications which predispose the system to infection, such as robust health, a hot climate, and uncleanliness.
TREATMENT. In all the varieties of eczematous affections, except scabies, the treatment of which will hereafter be separately considered, remedies employed with a view to the removal of the constitutional fault are of the greatest importance. The eruption upon the skin is but a local manifestation of a functional fault, which must be overcome by alterative remedies. All the excretory organs should be kept active. To open the bowels, administer a full cathartic dose of Dr. Pierce's Pleasant Pellets. Afterwards they should be used in broken doses of one or two daily, in order to obtain their peculiar alterative effects. The use of Dr. Pierce's Golden Medical Discovery is also necessary to secure its constitutional remedial benefits. As a local corrective to relieve the itching and disagreeable dryness of the skin, add half an ounce of blood-root to half a pint of vinegar, steep moderately for two hours, strain and paint the affected parts once or twice daily with the liquid. Every night before retiring, apply glycerine freely to all the affected parts, or dissolve one drachm of oxalic acid in four ounces of glycerine and anoint the skin freely. The white precipitate ointment, obtainable at any drug store, is an excellent application is most forms of eczema. A tea, or infusion, of black walnut leaves, applied as a lotion to the affected parts, has also proved beneficial. The surface of the body should be kept clean by frequent bathing, and thus stimulating its capillary vessels to healthy activity. The eczematous surfaces should not be bathed frequently, and never with harsh or irritating soaps. All varieties of eczematous affections, except scabies, are only temporarily relieved by external applications, while the radical cure depends upon a protracted use of alterative, or blood-cleansing medicines. Therefore, we would again remind the reader of the necessity of keeping the bowels regular, and removing all morbid taints of the blood and faults of the secretory organs by the persistent use of Dr. Pierce's Golden Medical Discovery. The successful treatment of scabies, or common itch, generally requires only local applications, for the object to be obtained is simply the destruction of the little insects which cause the eruption. Happily, we possess an unfailing specific for this purpose. Numerous agents have been employed with success, but Sulphur enjoys the greatest reputation for efficacy, and, since it is perfectly harmless, we advise it for this class of disease. Take a quantity of pulverized sulphur and mix with sufficient vaseline or lard to form an ointment. Having first divested the body of clothing, anoint it all over freely, and rub the ointment thoroughly into the pores of the skin while standing before a hot fire. The application should be made at night before retiring, and the patient should wear woolen night-clothes or lie between woolen blankets. In the morning after the application, the patient should take a warm bath, washing the skin thoroughly and using plenty of soap. This treatment should be repeated two or three times to be certain of a perfect eradication of the disease. After this course of treatment, the wearing apparel as well as the bed-clothes should be thoroughly cleansed, as a precaution against a return of the disease.
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The prominent features, eruption, and itching of eczematous affections are purely local. Erythematous affections are, however, remarkable for their symptoms of constitutional disorder. Each of these affections is preceded by intense febrile excitement and nervous debility. In brief, the local manifestations are simply signs of general internal disorders; hence, the treatment should be directed to the restoration of the system. This group includes erythema, erysipelas, and urticaria.
ERYTHEMA. A vivid and partial flushing of the face is produced by a superficial inflammation of the skin, termed erythema. There are many stages of this disease, from the instantaneous transient flush caused by emotional excitement, to the protracted inflammation and swelling of erythema nodosum.
The affection is characterized by a flush which is at first a bright vivid scarlet, but which changes to a deep purplish tint. There is a slight elevation of the skin, sometimes accompanied by itching. In the second stage of development, the flush subsides, the skin has a yellowish or bruised appearance, and a few minute scales are formed. In erythema papulosum, a fine representation of which is given in Colored Plate III, Fig. 18, there is an eruption of red pimples or pustules. The prominent feature of erythema nodosum, a variety of erythema which affects those portions of the skin exposed to the sun, is the appearance of a large swelling, usually lasting four or five days and attended by constitutional symptoms, such as nausea, fever, languor, and despondency. The disease is associated with the symptoms incident to a disordered nervous system and sometimes results fatally, in other cases, it terminates in melancholy and mania.
CAUSES. The predisposing causes of erythema are constitutional debility, changes of climate and temperature, and irritating food or medicines. Locally, it may be produced by friction and the heat of the sun.
ERYSIPELAS. There are few adult persons in this country who have not, by observation or experience, become somewhat familiar with this disease. Its manifestations are both constitutional and local, and their intensity varies exceedingly in different cases. The constitutional symptoms are usually the first to appear, and are of a febrile character. A distinct chill, attended by nausea and general derangement of the stomach is experienced, followed by febrile symptoms more or less severe. There are wandering pains in the body and sometimes a passive delirium exists. Simultaneously with these symptoms the local manifestations of the disease appear. A red spot develops on the face the ear, or other part of the person. Its boundary is clearly marked and the affected portion slightly raised above the surrounding surface. It is characterized by a burning pain and is very sensitive to the touch. It is not necessary for the information of the general reader that we should draw a distinction between the different varieties of this malady. The distinctions made are founded chiefly upon the depth to which the morbid condition extends, and not on any difference in the nature of the affection.
Suppuration of the tissues involved is common in the severer forms. Should the tongue become dark and diarrhea set in, attended with great prostration, the case is very serious, and energetic means should be employed to save life. A retrocession of the inflammation from the surface to a vital organ is an extremely dangerous symptom.
The disease is not regarded as contagious, but has been known to become epidemic.
URTICARIA. (Hives, or Nettle-Rash.) This word is derived from urtica, signifying a nettle; it is a transient affection of the skin, indicated by a fierce, burning, itching sensation and a development of pustules, or white blotches of various forms. A representation of this eruption is given in Colored Plate III, Fig. 17. It is appropriately named nettle-rash, from its resemblance to the irritation caused by the sting of a nettle. There is the same sharp, tingling sensation and a similar white wheal or blotch, caused by the muscular spasm of the corium, a layer of the skin.
Urticaria may be either acute or chronic. Acute urticaria is always preceded by febrile symptoms and the attack is indicated by a sudden congestion of the skin, followed by a slight swelling or elevation of the affected part. When the congestion subsides, the skin has a bruised appearance. In chronic urticaria, the febrile symptoms are absent.
CAUSES. The exciting causes of urticaria are gastric disorder, irritation of the mucous membrane, or a sudden nervous shock. The predisposing causes are conceded to be assimilative and nervous debility. Hence, it frequently accompanies purpura or land scurvy and rheumatism. The skin in some persons is so susceptible to irritation that urticaria can be kindled at any moment by excitement, as an animated conversation, or by the simple pressure of the hand.
TREATMENT. The proper treatment for simple erythema consists in applying to the affected parts a little lime-water, or sweet-oil, or glycerine, with the use of warm baths and mild cathartics. This is generally sufficient to effect a cure, if followed up with the persistent use of Dr. Pierce's Golden Medical Discovery taken three times a day.
In erysipelas a hot bath, with warm, sweating teas, or, better still. Dr. Pierce's Compound Extract of Smart-weed may be given to favor sweating. The whole person should be frequently bathed with warm water rendered alkaline by the addition of saleratus or soda. The whole should be moved by a full dose of the "Pleasant Pellets." Fluid extract of veratrum viride, in doses of a drop or two every hour will best control the fever. The specific treatment, that which antidotes the poison in the blood, consists in administering fifteen-drop doses of the tincture of the muriate of iron in one teaspoonful of the "Golden Medical Discovery," every three hours. As a local application, the inflamed surface may be covered with cloths wet in the mucilage of slippery elm. A preparation of equal parts of sweet oil and spirits of turpentine, mixed and painted over the surface, is an application of great efficacy.
For urticaria, the "Pleasant Pellets" should be administered in sufficient doses to move the bowels, the skin bathed with warm water rendered alkaline by the addition of common baking soda or saleratus, and, if there be any febrile symptoms, a little tincture of aconite or veratrum may be administered in one drop doses once each hour. In the chronic form of the disease, the diet should be light, unstimulating, and easily digested, the skin kept clean by frequent bathing, and fresh air and outdoor exercises freely taken. The somewhat protracted use of Dr. Pierce's Golden Medical Discovery will result in the greatest benefit in this form of disease.
The distinguishing feature of this group of cutaneous affections is the formation of bullae, or blebs, which are defined as "eminences of the cuticle, containing a fluid."
HERPES is an inflammation of the skin in which the eruption appears in patches of a circular form. On the second day, minute, transparent vesicles appear and gradually develop, becoming opalescent. On the succeeding days, they shrink and produce reddish brown scabs, which soon become hard and fall off, leaving deep, purplish pits. In adults, these vesicles sometimes terminate in painful ulcers, caused by an irritation of the eruption. By some practitioners, herpes is regarded as a purely nervous disorder, from the fact that it is frequently accompanied by severe neuralgic pains. These pains are not constant, but occasional, and do not appear at any definite stage of the disease. Sometimes they precede and accompany the eruption. Other instances are recorded in which they remained many years after the disease had disappeared. The local and constant pain of herpes is a severe burning, prickling, itching sensation, which remains after the scabs fall.
The three general forms of this disease are herpes zoster, phlyctoenodes and circinatus.
In herpes zoster, or shingles, the clusters of vesicles encircle one-half of the body, frequently at the waist; hence, it has received the name of zona or girdle. The vesicles often develop into bullae, and sometimes ulcerate. In herpes phlyctoenodes, the vesicles are small, round, and irregularly distributed over the face, neck, arms, and breast. This form is accompanied by febrile symptoms and offensive excretions.
In herpes circinatus, or ringworm, the vesicles appear in circular patches, or rings. This is the mildest form of herpes, and is not attended by symptoms of constitutional disorder. The various forms of herpes are represented in Colored Plate I, Fig. 3.
CAUSES. Herpes is not contagious. It is caused by vicissitudes of heat and cold, violent emotions, excessive exertion, irritation of the skin, and a general atony of the system.
MILIARIA is the name given to an eruption of vesicles which are larger than those of eczema, but smaller than the bullae of herpes. At first, the serum contained in the vesicles is perfectly transparent, and reflects the red tint of the underlying skin, hence the name miliaria rubra. But gradually it becomes milky and opalescent, hence, the term miliaria alba. The vesicles of miliaria are generally solitary, and appear on those portions of the body most liable to become heated and to perspire. The eruption is preceded by chills, languor, slight fever, intense thirst, a sharp prickling sensation of the skin, and profuse perspiration. The vesicles soon desiccate and are replaced by a new crop.
CAUSES. Miliaria is almost universally an accompaniment of febrile disease, and all disorders in which there occurs a profuse perspiration. The causes to which it may be traced in each instance are improper diet, impure air, burdensome clothing, or strong emotions.
PEMPHIGUS is a peculiar eruption which appears upon the limbs and abdomen. The affected part is of a bright red color, and, in a few hours, small vesicles appear containing a transparent fluid. The vesicles soon develop into bullae, entirely covering the inflamed portion. The fluid becomes opaque and in a few hours escapes. The patch is then covered with a yellow scab. Pemphigus may be either acute or chronic. The acute form is subdivided according to the degree of inflammation, as pemphigus pompholyx in which it is severe, and pemphigus benignus, when it is mild. The bullae of pemphigus are illustrated in Colored Plate III, Fig. 19.
CAUSE. Pemphigus is always caused by a vitiated state of the system.
RUPIA is indicated by an eruption as large as a chestnut containing a watery fluid, which desiccates into a yellowish-brown crust. A fine representation of rupia vesicles in both stages of development, is given in Colored Plate II, Fig. 13.
TREATMENT. In all forms of herpes, the administration of a small dose of Dr. Pierce's Pleasant Pellets, with the use of his "Golden Medical Discovery" in one to two teaspoonful doses three times a day, will be followed by the happiest results. The skin should be kept clean by the use of the sponge-bath, rendered alkaline by the addition of common baking soda or saleratus. The portion of the body covered by the eruption, should be bathed with a solution of sulphate of zinc, one ounce to a pint of water.
Miliaria is generally associated with certain febrile diseases, and its proper treatment consists in overcoming the febrile and other constitutional symptoms which accompany the disease. A hot foot-bath and small doses of tincture of aconite, say one drop in water each hour, will suffice to remove the fever. If the stomach and bowels are in a vitiated condition, as they are apt to be, a mild cathartic dose of "Pellets" should be given.
The treatment of pemphigus should consist in frequent alkaline sponge-baths, and in covering the affected parts with poultices of slippery elm, which should be kept moist with vinegar, The constitutional treatment should embrace the persistent use of the "Golden Medical Discovery." When the disease occurs in children, it is most generally dependent upon deficient nutrition, and special attention should be given to the diet of the patient, which should be nutritious. Fresh air and outdoor exercise ought not to be neglected.
The proper treatment of rupia does not differ from that suggested for pemphigus.
NERVOUS AFFECTIONS OF THE SKIN.
In nervous affections of the skin, the natural sensibility may be increased, diminished, or perverted. These morbid impressions arise from the nervous system. Although there are several varieties of these affections, yet, being of minor importance, we shall omit their consideration and only speak of one of them in this work.
PRURIGO affects the entire surface of the body and imparts to the skin a parched, yellowish appearance. It is characterized by pimples, and an intense burning, itching sensation. Rubbing and scratching only irritate the skin, which becomes covered with thin black scabs. A good representation of prurigo may be seen in Colored Plate II, Fig. 6. The itching sensations are sometimes caused by chilling the body, by violent exercise, and heat; allowing the mind to dwell upon the affection aggravates it. Prurigo is recognized under two forms; vulgaris, which is a mild form, and senilis, which chiefly occurs in old age, and is more severe. The external genital parts of females are frequently affected with this disease, and it is aggravated by menstruation and uncleanliness.
This affection may be due to a vitiated condition of the blood, and is common among those who are greatly debilitated. It is frequently occasioned by uncleanliness, intemperance, the use of unwholesome food, or by an impure atmosphere.
TREATMENT. To allay the itching, take glycerine, one ounce, add to it one drachm of sulphite of soda, and one ounce of rose-water, and apply this to the affected parts. A solution made with borax, two drachms, and morphine, fire grains, dissolved in six ounces of rose-water, makes an excellent lotion to allay the itching. If the disease be severe, it will be necessary to correct the vitiated condition of the blood by a protracted use of Dr. Pierce's Golden Medical Discovery, and to aid its effects, give one "Pleasant Pellet" every day, not to operate as a cathartic, but only to exert an alterative influence.
(SCALY SKIN DISEASES.)
Differences of opinion exist with regard to the proper classification of these affections. We shall briefly consider alphos, which is sometimes confounded with lepra.
ALPHOS, which from its Greek derivation signifies white, is characterized by circular, slightly raised white spots. These eruptions vary in size from one line to two inches in diameter, and may be scattered over the entire surface of the body, although they most frequently appear upon the elbows and knees. Alphos may consist of a single tubercle, or of large clusters constituting patches. The scales vary in color and thickness. In Colored Plate III, Figs. 14 and 15, are fine illustrations of alphos. When a person begins to recover from this affection, the scales fall off, leaving a smooth red surface, which gradually returns to its natural color.
This disease is more liable to occur in winter than in summer, although in some cases the reverse holds true. It may disappear for a time, only to return again with renewed vigor. It is not regarded as contagious.
TREATMENT. Thorough and protracted constitutional treatment is required to overcome this disease. Dr. Pierce's Golden Medical Discovery should be taken internally and also applied locally to the affected parts. To every other bottle of the "Discovery" which is taken, one-half ounce of the iodide of potash may be added. One or two of the "Pellets" taken daily will prove a useful adjunct to the "Discovery."
Locally, we have sometimes applied a lotion made of oxide of zinc, one-half drachm; benzoic acid, two drachms; morphine, five grains; glycerine, two ounces. Tincture of the chloride of iron, one drachm in one ounce of glycerine, makes an excellent local application. Whatever the local treatment may be, however, we chiefly rely upon the persistent use of the best alteratives, or blood-cleansing medicines.
AFFECTIONS OF THE HAIR-FOLLICLES.
FAVUS (Scald Head) is a disease peculiar to the hair-follicles, and is indicated by the formation of small yellow crusts, having the form of an inverted cup. The eruption has a very offensive odor. When it appears in isolated cups, it is termed favus dispersus, but it often occurs in large clusters, as represented in Colored Plate II, Fig. 12, and is then termed favus confertus. It generally affects the scalp, but sometimes extends to the face and neck.
CAUSE. Favus is caused by nutritive debility, which results in a perverted cell-growth.
SYCOSIS (Barber's Itch) is an inflammatory affection of the hair follicles of the face. The prominent features of the disease are redness and the formation of scales. It is peculiar to males. It has received various names, according to its predominating characteristics, such as sycosis papulosa, tuberculosa, and fungulosa. Colored Plate II, Fig. 10, is a line illustration of sycosis as it appears on the cheek.
CAUSES. Various causes induce the appearance of sycosis. The general causes are nutritive debility, vicissitudes of heat and cold, and an exhausted state of the nervous system. It may also result from various chronic diseases, such as syphilis and dyspepsia.
COMEDONES, or grubs, are due to a retention of the sebaceous matter in the follicles. The sebaceous substance undergoes a change, becoming granular and somewhat hardened. It gradually extends to the mouth of the follicle, where it comes in contact with the atmosphere, and assumes a dark color, as represented in Plate II, Fig. 8. This fact, together with its peculiar form when squeezed out of the skin, has caused it to be termed grub. They often appear in great numbers on the face of persons whose circulation is not active, or those who are of a particularly nervous temperament. Stimulating baths and friction will prove very efficacious in removing these cylinders of sebaceous matter. If they are allowed to remain, they will produce an irritation of the skin causing an inflammatory disease known as acne, or stone-pock.
ACNE OR STONE-POCK. In the earliest stage of congestion, acne is characterized by minute hardened elevations of the skin, as shown in Plate II, Fig. 9, and is termed acne punctata. As the affection progresses, a bright red pimple, Plate II, Fig. 11, appears, having a conical form, hence the name acne coniformis. The pimple develops into a pustule containing yellow "matter," and is then known as acne pustulosa. This is followed by a thickening of the tissues, termed acne tuberculata. When the thicker skin is removed, it leaves a deep scar, hence the term acne indurata.
CAUSES. The remote cause of acne is nutritive debility. The immediate causes are rapid growth, anaemia, improper food, errors of hygiene, mental exhaustion, and various chronic diseases.
TREATMENT. The treatment of favus or scald-head should be commenced by shaving the hair off close to the scalp and washing the head thoroughly with soap and water. In some severe cases, it may be necessary to soften the incrustations with poultices, following these with a free use of soap and water. Having thus exposed the scalp and thoroughly divested it of incrustations, apply to it the ointment of iodide of sulphur, which may be procured at any good drug store. It should be gently rubbed over the parts night and morning. The scalp ought to be kept perfectly clean throughout the treatment. Instead of the foregoing, the following may be applied: Take oxalic acid, ten grains; creosote, twenty drops; water, two ounces; mix. Half an hour after using this lotion, anoint the head freely with butter or lard; it will add greatly to the efficacy of the treatment. But while local applications will relieve many skin diseases and mitigate suffering, we cannot too strongly impress upon the minds of our readers the importance, in this as in all other chronic diseases of the skin, of perseverance in the use of the best alteratives. In this class of agents Dr. Pierce's Golden Medical Discovery stands pre-eminent. Its efficacy may be increased in this disease by adding to each bottle one ounce of the acetate of potash, and, when thus modified, it may be administered in the same manner as if no addition had been made to it.
The Treatment of Sycosis should be essentially the same as that suggested for favus, and it will result in prompt relief and a permanent cure.
Treatment of Acne. In the treatment of this, as in that of other diseases, we should seek to ascertain the cause, and, when possible, remove it. Outdoor exercise, a spare, unstimulating diet, and perfect cleanliness are of the first importance. The affected parts should be bathed with warm water and Castile, or, what is better, carbolic soap. Washing the face in cold water generally aggravates the disease. As a local application to the pustules, we have used with good results the following lotion: Oxide of zinc, twenty grains; morphine, five grains; glycerine, two ounces: mix. First having washed the affected parts thoroughly, apply this compound. Our chief reliance, however, as in the preceding diseases, should be upon the persistent use of alteratives and mild cathartics or laxatives.
FURUNCULAR AFFECTIONS. (BOIL-LIKE AFFECTIONS.)
Under this head properly belong boils, carbuncles, and styes.
BOILS. These annoying affections are hard, prominent, circumscribed, inflamed, suppurating tumors, having their seat in the cellular tissue beneath the skin. They vary in size from a pea to a hen's egg, and may occur on any part of the body. The color of a boil varies from deep red to mahogany. It is painful, tender, advances rapidly to maturity, becomes conical, and finally bursts and discharges bloody "matter." Through the opening, and filling the cavity, may be seen a piece of sloughing cellular tissue which is called the core. In from four to fifteen days, it is all expelled and the sore rapidly heals. The causes are an impure condition of the blood, which generally arises from imperfect action of the liver or kidneys.
TREATMENT. Spirits of turpentine applied to a boll in its earliest stage will almost always cause it to disappear; but when suppuration has commenced it should be favored by the application of poultices. Next purify the blood to prevent subsequent returns to other parts of the body. For this purpose take Dr. Pierce's Golden Medical Discovery. One or two "Pleasant Pellets" each day will aid in the cure.
These are more violent, larger, and more painful than boils, which they resemble. They may spring from several small pimples which extend deep into the tissues, and on the surface frequently several small vesicles appear and break. They may discharge, through one or several openings, a thin acrid, bloody, or dark-colored fluid. They most frequently appear upon the back of the neck, back, back part of the limbs, and under the arms. Their presence is evidence of a depressed condition of vitality. These tumors vary in size from one-half an inch to six inches in diameter, and rapidly proceed to a gangrenous condition, a grayish slough being detached from the healthy tissue.
TREATMENT. Invigorate the system by every possible means. The bitter tonics, such as Golden Seal, Gentian, or Willow, together with quinine and iron should be used. Nutritious diet, pure air, etc., are necessary. Purify the blood to remove the causes of the disease. For this purpose, give the "Golden Medical Discovery" in as large doses as can be borne without acting too freely on the bowels. Anodynes may be necessary to overcome the pain. Poultices are useful to encourage the separation of the dead from the living tissues. Antiseptic dressings are beneficial, of which carbolic acid is to be preferred; yeast, however, may be employed.
Sometimes powerful caustics or free incisions are productive of gratifying results, if followed by appropriate dressings, but these extreme measures should only be resorted to by the direction of a physician.
For a considerable time after the urgent symptoms have subsided, the "Golden Medical Discovery" should be used, to purify and enrich the blood, and the bitter tonics and iron may be alternated with it, or be used conjointly to good advantage.
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It is estimated that about one fifth of the human family are afflicted with scrofula. A disease so prevalent and so destructive to life, should enlist universal attention and the best efforts of medical men in devising the most successful treatment for its cure. It varies in the intensity of its manifestation, from the slightest eruption upon the skin (scrofulous eczema), to that most fatal of maladies, pulmonary consumption.
THE SCROFULOUS DIATHESIS. The existence of a certain disposition or habit of body designated as the scrofulous or strumous diathesis, is generally recognized by medical practitioners and writers as a constitutional condition predisposing many children to the development of this disease. Enlargement of the head and abdomen, fair, soft and transparent or dark, sallow, greasy or wax-looking skin, and precocious intellect are supposed to indicate this diathesis.
The characteristic feature of this disease, in all the multifarious forms that it assumes, is the formation of tubercle, which, when the malady is fully developed, is an ever-present and distinguishing element.
Tuberculous is therefore almost synonymous with scrofulous, and to facilitate an acquaintance with a large list of very prevalent maladies, we may generalize, and classify them all under this generic term. As tubercle is frequently spoken of in works treating on medicine and surgery, playing, as it does, a conspicuous part in an important list of diseases, the reader may very naturally be led to inquire:
WHAT IS TUBERCLE? As employed in pathology, the term is usually applied to a species of degeneration, or morbid development of a pale yellow color, having, in its crude condition, a consistence analogous to that of pretty firm cheese. The physical properties of tubercle are not uniform, however. They vary with age and other circumstances. Some are hard and calcareous, while others are soft and pus-like. The color varies from a light yellow, or almost white, to a dark gray.
It is almost wholly composed of albumen united with a small amount of earthy salts, as phosphate and carbonate of lime, with a trace of the soluble salts of soda.
The existence of tubercular deposits in the tissues of the body, which characterizes scrofula, when fully developed, must not, however, be regarded as the primary affection. Its formation is the result of disordered nutrition. The products of digestion are not fully elaborated, and pass into the blood imperfected, in which condition they are unable to fulfill their normal destiny—the repair of the bodily tissues. Imperfectly formed albuminous matter oozes out from the blood, and infiltrates the tissues, but it has little tendency to take on cell-forms or undergo the vital transformation essential to becoming a part of the tissues. Instead of nutritive energy, which by assimilation produces perfect bodily textures, this function, in the scrofulous diathesis, is deranged by debility, and there is left in the tissues an imperfectly organized particle, incapable of undergoing a complete vital change, around which cluster other particles of tubercular matter, forming little grains, like millet seed, or growing, by new accretions of like particles, to masses of more extensive size. As tubercle is but a semi-organized substance, of deficient vitality, it is very prone to disintegration and suppuration. Being foreign to the tissues in which it is embedded, like a thorn in the flesh, it excites a passive form of inflammation, and from lack of inherent vital energy it is apt to decompose and cause the formation of pus. Hence, infiltration of the muscles, glands, or other soft parts with tuberculous matter, when inflammation is aroused by its presence, and by an exciting cause, give rise to abscesses, as in lumbar or psoas abscesses. When occurring in the joints, tubercles may give rise to chronic suppurative inflammation, as in white swellings and hip-joint disease. Various skin diseases are regarded as local expressions of, or as being materially modified by, the scrofulous diathesis, as eczema, impetigo, and lupus. The disease popularly known as "fever-sore" is another form of scrofulous manifestation, affecting the shafts of the bones, and causing disorganization and decay of their structure. Discharges from the ear, bronchitis, chronic inflammation of the intestinal mucous membrane, and chronic diarrhea are frequently due to scrofula, while pulmonary consumption is unanimously regarded as a purely scrofulous affectation. Scrofula shows a strong disposition to manifest itself in the lymphatic glands, particularly in the superficial ones of the neck. The most distinguishing feature of this form of the disease is the appearance of little kernels or tumors about the neck. These often remain about the same size, neither increasing nor diminishing, until finally, without having caused much inconvenience, they disappear. After a time these glands may again enlarge, with more or less pain accompanying the process. As the disease progresses, the pain increases, and the parts become hot and swollen. At length the "matter" which has been forming beneath, finds its way to the surface and is discharged in the form of thin pus, frequently containing little particles or flakes of tubercular matter. During the inflammatory process there may be more or less febrile movement, paleness of the surface, languor, impaired appetite, night sweats, and general feebleness of the system. The resulting open ulcers show little disposition to heal.
SYMPTOMS. There is a train of symptoms characteristic of all scrofulous disease. The appetite may be altogether lost or feeble, or in extreme cases, voracious. In some instances there is an unusual disposition to eat fatty substances. The general derangement of the alimentary functions is indicated by a red, glazed or furrowed appearance of the tongue, flatulent condition of the stomach, and bloated state of the bowels, followed by diarrhea or manifesting obstinate constipation. Thirst and frequent acid eructations accompany the imperfect digestion. The foul breath, early decay of the teeth, the slimy, glairy stools, having the appearance of the white of eggs, and an intolerable fetor, all are indicative of the scrofulous tendencies of the system.
CAUSES. Scrofula may be attributed to various causes. Observation has shown that ill-assorted marriages are a prolific source of scrofula. Both parents may be not only healthy and free from hereditary taints, but robust, well-formed physically, perfectly developed, and yet not one of their children be free from this dire disease. It may present itself in the form of hip disease, white swelling, "fever-sore" suppurating glands, curvature of the spine, rickets, ulcers, pulmonary consumption, or some skin disease, in every case showing the original perversion of the constitution and functions. Scrofula is hereditary when the disease, or the diathesis which predisposes to its development, is transmitted from one or both parents who are affected by it, or who are deficient in constitutional energy, showing feeble nutrition, lack of circulatory force, and a diminished vitality. All these conditions indicate that a few exposures and severe colds are often sufficient to produce a train of symptoms, which terminate in pulmonary or other strumous affections. Whatever deranges the function of nutrition is favorable to the development of scrofula, therefore, irregularities and various excesses tend to inaugurate it. Depletion of the blood by drastic and poisonous medicines, such as antimony and mercurials, hemorrhages and blood-letting, syphilis, excessive mental or physical labor, as well as a too early use and abuse of the sexual organs, all tend to waste the blood, reduce the tone of the system, and develop scrofula.
Scrofula may be the consequence of insufficient nourishment, resulting from subsisting upon poor food, or a too exclusively vegetable diet, with little or no animal food.
Want of exercise and uncleanliness contribute to its production. It is much more prevalent in temperate latitudes, where the climate is variable, than in tropical or frigid regions. The season of the year also greatly influences this disease, for it frequently commences in the winter and spring, and disappears again in the summer and autumn months.
TREATMENT. The skin should be kept clean by means of frequent baths. These assist the functional changes which must take place on the surface of the body, permit the stimulating influence of the light and air and facilitate the aeration of the blood, as well as the transpiration of fluids through the innumerable pores of the skin. All exposure to a low temperature, especially in damp weather, and the wearing of an insufficient amount of clothing should be avoided. Then the food should be generous and of the most nourishing character. Steady habits and regular hours for eating and sleep must be observed, if we would restore tone and regularity to the functions of nutrition. Moderate exercise in the open air is essential, in order that the blood may become well oxygenated, that the vital changes may take place. It is no doubt true that the occasion of the prevalence of scrofula among the lower classes may be ascribed to frequent and severe climatic exposures, irregular and poor diet, or want of due cleanliness. Every well-regulated family can avoid such causes and live with a due regard to the conditions of health. The proper treatment of scrofula is important, because we meet with its symptoms on every side, showing its slow actions upon different parts of the body and its influence upon all the organs. After this disease has been existing for an indefinite length of time, certain glands enlarge, slowly inflame, finally suppurate, and are very difficult to heal. These sores are very liable to degenerate into ulcers. All of these symptoms point to a peculiar taste of the blood, which continually feeds and strengthens this morbid outbreak. All authors agree that the blood is not rich in fibrinous elements, but tends to feebleness and slow inflammation, which ends in maturation. Thus we may trace back this low and morbid condition of the blood to debility of the nutritive organs, defective digestion, which may be induced by irregular habits, a lack of nourishing food, or by the acquirement of some venereal taint.
The matter that is discharged from these glands is not healthy, but is thin, serous, and acrid; a whey-like fluid containing little fragments of tuberculous matter, which resembles curd. The affected glands ulcerate, look blue and indolent, and manifest no disposition to heal. We have thus traced this disorder back to weak, perverted and faulty nutrition, to disordered and vitiated blood, the products of which slowly inflame the glands, which strain out unhealthy, irritating, poisonous matter. The medicines to remedy this perverted condition of the blood and fluids must be alteratives which will act upon the digestive organs and tone the nutritive functions, thus enriching and purifying the blood. As this affection is frequently a complication in chronic diseases, it is eminently proper for us to refer to a few considerations involved in its general treatment.
An alterative medicine belongs to a class which is considered capable of producing a salutary change in a disease without exciting any sensible evacuation. In scrofula, remedies should be employed which will improve digestion and also prevent certain morbid operations in the blood.
It is well known to medical men that nearly all medicines belonging to the class of alteratives, are capable of solution in the gastric and intestinal secretions, and pass without material change, by the process of absorption, through the coats of the stomach and intestines, as do all liquids, and so gain an entrance into the general circulation; that these same alteratives act locally to tone and strengthen the mucous surfaces, and thus promote and rectify the process of digestion before being absorbed; that alterative medicines, when in the blood, must permeate the mass of the circulation, and thus reach the remote parts of the body and influence every function; that these medicines, while in the blood, may combine with it, reconstruct it, and arrest its morbid tendencies to decomposition.
We should use those alteratives which give tone to the digestive and nutritive functions, in order to curtail the constant propagation of scrofula in the system; which alter and purify the blood through the natural functions, thus reconstructing it; and which check the septic, disorganizing changes which are evinced by the irritating and poisonous matter discharged from the ulcers.
These are the three ways in which medicines operate upon the nutritive functions and the blood.
Thus alteratives may be specifics, in so far as they are particularly useful in certain disorders, and the combination which has been made in Dr. Pierce's Golden Medical Discovery, excels all others with which we are acquainted, for scrofulous diseases, particularly in fulfilling the foregoing indications. It works out peculiar processes in the blood, not like food, by supplying merely a natural want, but by strengthening the nutritive functions and counteracting morbid action, after which operations it passes out of the system by excretion.
From what has been said upon the importance of blood medicines and their modes of action, the reader must not infer that we account for all diseases by some fault of the humors of the body, for we do not. But that scrofula, in its varied forms, results from imperfect nutrition and disorders of the blood, is now universally conceded. It is for this reason that neither time nor pains have been spared in perfecting an alterative, tonic, nutritive, restorative, and antiseptic compound, to which Dr. Pierce has given the name of "Golden Medical Discovery." Not only is it an alterative and a nutritive restorative, acting upon the secretions, but it opposes putrefaction and degenerative decay of the fluids and solids. Hence its universal indication in all scrofulous diseases. It will intercept those thin, watery discharges which are the result of weakness, degeneration, and putrescent decay of the blood, perpetuated by a low grade of scrofulous inflammation. By an adult it can be taken in doses of from one to two teaspoonfuls three or four times per day.
The bowels should be properly regulated. When constipation exists one or two of Dr. Pierce's Pleasant Pellets taken daily, will fulfill the indication. The patient ought not to neglect to carry out all the hygienic recommendations heretofore given. The treatment of running sores is very simple. Cleanse them every day with Castile-soap and water, being careful not to rub or touch the surface of the sores. Use a clean sponge or a piece of clean muslin and saturating it with the warm water, hold it a few inches above the affected part, and squeeze out the fluid, allowing the cleansing stream to fall gently upon the open sore. After thoroughly cleansing the sore, apply to it Dr. Pierce's All-Healing Salve. 25 cents in postage stamps sent to us will secure a box by return post if your druggist does not have it in stock.
Hip-joint disease, also known as Coxalgia, is frequently a scrofulous affection of the hip-joint. It usually attacks children, but may occur at any period of life. The causes of this affection are imperfectly understood, yet all the indications point to a scrofulous state of the system. Dampness, cold, improper diet, severe injuries from blows or falls are all numbered among the exciting causes which are conducive to the establishment of this disease.
THE SYMPTOMS are usually developed gradually; at first there is severe pain in the knee, but finally it is located in the hip-joint. Occasionally it is noticed in the hip and knee at the same time. As the disease progresses, the general health becomes impaired, there is wasting of the muscles, wakefulness, disturbed sleep, high fever, profuse and offensive perspiration, the hair falls out, and there is an inability to move the limb without producing excruciating pain. Frequently pus will be formed and discharged at different points, and the limb will become greatly emaciated. Since pain in the knee-joint may mislead as to the location of the disease, to determine the seat of the affection, place the patient in a chair and percuss the knee lightly, by giving it a slight blow with the knuckle; if the hip be affected, the pain will be readily felt in that joint; if it be simply neuralgia of the knee-joint, it will excite no pain whatever. If the disease be allowed to progress and dislocation of the joint takes place, the affected limb becomes shortened.
TREATMENT. The treatment of this disease should consist in rest for the hip-joint, cleanliness of the person and plenty of fresh air and light, a nutritious diet and the use of tonics and sustaining alterative, or blood-cleansing medicines. Dr. Pierce's Golden Medical Discovery has, unaided by other medicines, cured many cases of this disease. This class of medicines should be persistently employed, in order to obtain their full effects. It is a disease which progresses slowly and which is not easily turned from its course, and its fatality should warn the afflicted to employ the best treatment.
Many poor, unfortunate victims know too well, from sad experience, that the course of treatment frequently recommended and employed by physicians and surgeons is ineffectual, and cruel; they deplete the system, apply locally liniments, lotions, iodine, and hot applications; confine the patient in bed and strap his hips down immovably, thus preventing all exercise; then they attach that cruel instrument of torture, the weight and pulley, to the diseased limb.
After many years of practical experience in the treatment of hundreds of cases, we have developed a system of treatment for this terrible malady which is based upon common sense. Instead of depleting, we, by proper constitutional treatment, strengthen and fortify the system. We do not confine the patient in bed, but permit him to go around and take all necessary exercise. We adjust an ingeniously devised and perfectly fitting appliance or apparatus, by which a gentle extension of the limb is maintained, thereby relieving the tension of the muscles, and preventing the friction and wearing of the inflamed surfaces of the joint, which, without the use of our new and improved appliance, are a source of constant irritation. The appliances required in the successful treatment of this disease are numerous and varied in their construction, and require skill and experience on the part of the surgical mechanic as well as on the part of the surgeon, to take accurate and proper measurements of the diseased limb, and to construct the appliances so that they will be adapted to the various requirements of different cases. There are no definite rules for taking these measurements, and only a thorough examination of the case can indicate to the eye of the experienced surgeon what measurements are required, and what kind of an appliance is suitable for each individual case. At the Invalids' Hotel and Surgical Institute these measurements are all taken by the surgeon in person, and each appliance is constructed under his immediate supervision. It is utterly impossible for physicians who have but a limited experience in the treatment of such cases to take correct measurements and send off for an apparatus which fulfills the requirements of the case.
In the light of our vast experience at the Invalids' Hotel and Surgical Institute, we feel that we cannot too strongly urge the employment of a suitable apparatus for supporting the hip-joint, giving it perfect rest, and enabling the patient to exercise and get the outdoor air. As much of the pain in this disease is due to the pressure of the head of the femur, or thigh-bone, in the acetabulum, or socket, steadily-applied mechanical extension, to relieve the inflamed and sensitive joint of the pressure, is of the greatest importance. By such application the patient is enabled to move about without pain, while the joint is kept perfectly at rest—a condition favorable to the reduction of inflammation within it. The surgeon specialist of the Invalids' Hotel and Surgical Institute is frequently sent for to visit cases of this disease hundreds of miles away and by the employment of suitable apparatus he has been enabled, in scores of cases, to relieve the suffering at once. In cases in which the head of the thigh bone, or the bony socket of the joint has become so diseased as to cause it to ulcerate and break down, all portions of diseased bone should be thoroughly removed by a surgical operation. If this be neglected or delayed, a fatal termination of the disease may be expected. Parents should not put off the employment of a competent specialist in this terrible, distressing, and fatal disease. As treated by general practitioners, it very often proves fatal; or, after causing intense suffering for a series of years, if the active condition of the disease subsides, the patient is left with a ruined and broken constitution, a result which more prompt and earlier relief would have prevented.
The records of practice at the Invalids' Hotel and Surgical Institute abound in reports of cases, demonstrating the fact, that by careful and judicious management, hip-joint disease in its earlier stages, may be promptly arrested, and that cures may be effected even when the bony structure of the joint is seriously diseased.
White Swelling, otherwise known as Hydrarthrus, or Synovitis, more frequently affects the knee-joint than any other part. The joints of the elbow, wrist, ankle, or toes, may, however, be affected with this disease, but we shall speak of it in this connection as affecting only the knee-joint. Synovitis may be acute or chronic. The latter form is sometimes induced by blows, sprains, falls, etc., or from exposure to cold; more frequently it is the result of rheumatism or scrofula.
THE SYMPTOMS of this affection are generally slow in their appearance, being sometimes months in manifesting themselves. The joint at first presents only a slight degree of swelling, which gradually increases. Pain is soon felt, mild at first, but augmenting until it becomes severe. The skin has a smooth, glistening appearance, and there is an increased amount of heat in the parts. The affected limb becomes wasted, and is sometimes permanently flexed. There is more or less fever about the body, impairment of the digestive organs, and sleeplessness. The pulse is low but quick, and night-sweats and diarrhea often appear. Under this irritation, the patient is liable to waste away and finally die.
A post-mortem examination reveals the effects of the disease upon the parts attacked. The cartilages of the joint are soft, the synovial membrane is thickened, the ligaments are inflamed and often destroyed, the synovial fluid is increased in amount, sometimes normal in appearance, at others thick and viscous. If the bones be diseased, their articular extremities may be distended and fatty matter deposited in them. The conditions depend upon the form, severity, and duration of the disease.
Synovitis may be considered under three heads; Rheumatic, Scrofulous, and Syphilitic.
Rheumatic Synovitis may arise from exposure to cold, from some injury, or from intemperance in eating. The beginning of the disease may be distinctly marked, or it may come on so gradually that the time of its commencement cannot be noted. The pain is of a dull, steady character, and less severe in the night. This form of the disease sometimes terminates favorably, but in scrofulous systems it is liable to end in the destruction of the joint. It is more common in early life, rarely occurring after the thirtieth year.
Scrofulous Synovitis, or Tuberculosis of the Knee-joint, when of a chronic character, shows a wasting of the limb, and the swelling is of a pulpy consistence. This form of the disease is more liable to occur in children, though occasionally it is met with in adults. But little pain accompanies this form, although the limb is liable to become permanently affected. In its earlier stages this disease may be checked.
Syphilitic Synovitis is the result of syphilis. The pain is more severe during the night. It, however, generally terminates unfavorably, especially in scrofulous constitutions.
THE TREATMENT of white swelling should be both constitutional and local. Alterative medicines are indicated to purify the blood. Doctor Pierce's Golden Medical Discovery is unequaled for this purpose.
As local treatment, in the active stage of the disease, the knee-joint should be steamed, and hot fomentations applied. This should be followed by applications over the joint of solid extract of stramonium or belladonna, mixed with glycerine. The joint should be wrapped in cotton or wool to keep it uniformly warm. If there are openings about the joint, discharging pus, syringe them out once a day with Castile soap-suds, which may be improved by adding a little bicarbonate of potash (common saleratus). See that the bowels are kept regular, and that the diet is nourishing.
Cases of this disease which have been treated at the Invalids' Hotel and Surgical Institute with uniform success might be cited to the extent of filling a very large number of pages like these. When treated by a skilled specialist, this otherwise formidable and dangerous disease is readily amenable to treatment, and good and serviceable limbs can be promised, even in the extreme cases in which amputation is usually advised by general practitioners and surgeons, who desire the glory that they imagine they will receive by performing a capital operation.
Rickets is a scrofulous disease, in which there is derangement of the entire system, and it finally manifests itself in disease of the bones. It is characterized by a softening of the bony tissue, due to a deficiency of earthy or calcareous matter in their composition. It appears to be a disease incident to cold, damp places, ill-lighted and imperfectly ventilated rooms, and it especially attacks those who are uncleanly in their habits.
THE SYMPTOMS of rickets are severe pains in the bones, especially during the night, febrile excitement and profuse perspiration, paleness of the face, a sallow and wrinkled appearance of the skin, and derangement of the digestive organs. After a time the body becomes emaciated, the face pale, and the head unusually large. The bones become soft and unable to support the body; various distortions appear; the extremities of the long bones are enlarged, while the limbs between the joints are very slender. Rickets is a disease peculiar to childhood, though it may not be developed until a more advanced period of life. It rarely proves fatal, unless the lungs, heart, or other vital organs, become involved. In some instances the softening and other symptoms continue to increase until every function is affected, and death ensues.
Post-mortem examinations of those who have died of rickets have disclosed morbid changes in the brain, liver, and lymphatic glands. The lungs are often compressed or displaced, and the muscles of the body become pale and wasted. Sometimes the bones are so soft, on account of the deficiency of the calcareous deposit, that they can be easily cut with a knife.
TREATMENT. The use of Dr. Pierce's Golden Medical Discovery is indicated in this affection. It is a disease usually developed during childhood, in consequence of insufficient exercise, deprivation of the sunlight, low, innutritious diet, and lack of cleanliness. Therefore, it is essential to obviate all known causes, and, at the same time supply the patient with food rich in those elements which the system seems to demand. Under any plan of treatment the general directions given for the hygienic management of scrofula should be followed. We might cite many cases that have entirely recovered from this disease, under our advice and the use of "Golden Medical Discovery." We shall merely say, for the encouragement of the afflicted, that this form of scrofula yields readily to this medicine.
OLD SORES. (CHRONIC ULCERS.)
Under this head we may properly consider that class of affections known as Fever-sores, Running-sores, Ulcers, etc. These sores have common characteristics, yet each possesses certain peculiarities, which have led to their division into irritable, indolent, and varicose. These peculiarities are not constant, one form of ulcer often changing into another. One feature common to all, however, is their slowness in healing, which has sometimes led to the belief that they are incurable. Another popular notion is that their cure is detrimental to the health of the patient. With equal propriety we might say that it is dangerous to cure diarrhea, dysentery, consumption, or cancer. As a result of these erroneous impressions, many people suffer from chronic ulcers for years, and even for a life-time, without attempting to obtain relief. Chronic ulcers usually appear upon the lower extremities. The depth and appearance of the ulcer depend upon its character and the thickness of the tissues where it is situated. Fig. 2 shows a chronic ulcer, or fever-sore, as it appears upon the ankle.
THE IRRITABLE ULCER is painful and tender, the slightest injury causing it to bleed. It is of a dark purplish hue, and filled with spongy, sensitive granulations. It discharges a thin, bloody matter which is sometimes very fetid and acrid, and excoriates the tissues if it comes in contact with them. The edges of this species of ulcer are shelf-like and ragged, and turn inward. The adjacent structures are red and swollen. Very often they are attended by severe constitutional disturbances, such as chills, fever, and great nervous prostration and irritability.
IN THE INDOLENT ULCER the edges are not undermined, but turned outward, and are rounded, thick, glossy, and regular. The granulations are broad, flat, pale, insensible, and covered with a grayish, tenacious matter. The surrounding parts are not very sensitive, but the limb on which it is located is apt to be swollen. This is the commonest form of ulcer, and often remains for years.
VARICOSE ULCER. This species of ulcer occasions a swollen or enlarged condition of the neighboring veins, which are very much enfeebled. It almost invariably appears below the knee, and may be either indolent or irritable. It is generally sensitive to the touch, and sometimes excessively painful. Knots of superficial veins may often be seen beneath the skin.
As we have before remarked, these various species of ulcers are merely modifications of one form of chronic sore. The patient may assert that he enjoys excellent health, but if we question him closely, we find that the sore irritates him, and that there is sufficient constitutional disturbance to prevent the healing powers of nature from effecting a cure.
TREATMENT. The cure of these sores is necessarily slow, and who ever expects to obtain immediate relief will be disappointed.
Constitutional treatment is of the utmost importance, and should, therefore, be thoroughly and persistently applied. The nutritive system, especially the absorbents, should be kept active, as these are the channels by which the broken-down tissue surrounding the sore is replaced by that of a higher grade of vitality. For this purpose, the best alteratives or blood cleansing remedies are required. If secretion and excretion are not normally performed, the blood becomes poisoned by the absorption of unhealthy "matter" from the sore, and various constitutional disturbances occur. If, at any time during treatment, constitutional disturbances are manifested by fullness or disagreeable sensations in the head, nausea, pain, cough, chills, or fever, a thorough cathartic should be given. If the patient be robust, a repetition of the same once a week will be very beneficial. Dr. Pierce's Golden Medical Discovery, and "Pellets" will be productive of the best results.
The local treatment should depend upon the character of the ulcer. If the sore be irritable or painful, soothing applications, such as warm poultices or steaming in a vapor of bitter herbs, as hops, boneset or smart-weed or water pepper, will be found highly beneficial. A poultice of powdered slippery elm is also very soothing, and hence well adapted to this purpose. If the ulcer be indolent, a stimulating application is necessary. The hardened, callous state of the edges should be removed by alkaline applications. A strong solution of saleratus, or even a caustic, prepared by boiling the lye from hard-wood ashes to the consistence of syrup, will prove of great utility. One or two applications of the latter are generally sufficient.
The foregoing course of treatment is intended to put the open sore or ulcer in what is known to surgeons as a healthy condition—a condition most favorable for the healing process.
But the open surface of the sore needs something more. It needs the cleansing or antiseptic and soothing influence of such a dressing as is found in Dr. Pierce's All-Healing Salve. If your dealer in medicines does not have this Salve in stock, 25 cents in stamps sent to World's Dispensary Medical Association, Buffalo, N.Y., will secure a box of this unequaled dressing. It will be sent to your address by return post. Therefore, do not allow the dealer to put you off with some inferior preparation. If he has not the All-Healing Salve in stock you can easily obtain it by sending to us as above directed.
No matter how good the local dressing applied to the open sore, or ulcer, do not discontinue the internal use of the "Golden Medical Discovery" until the affected parts are completely healed.
By the term necrosis we mean mortification, or the state of a bone when it is deprived of life. Dunglison says: "This condition is to the bone what gangrene is to the soft parts." It is popularly known as fever-sore, there being no distinction made between this species of sore and those ulcers which affect only the soft tissues of the body. When any part of a bone becomes necrosed, it is treated as a foreign body. Nature makes an effort for its removal, and at the same time attempts to replace it with new and healthy materials. In consequence of this process, the dead portion is often inclosed in a case of new, sound bone, termed the involucrum; when this is the case the dead portion is termed the sequestrum. If, however, it be superficial, and separate from the parts beneath, it is called an exfoliation. This healing process, by which the involucrum is formed, cannot be completed while the dead portion remains. Hence, numerous openings are made through the involucrum, to permit the escape of the sequestrum. When a surgical operation is performed for the removal of the necrosed bone it is called sequestrotomy. The instruments which our specialists usually employ for this practice are represented in Figs. 3, 4, and 5.
CAUSES. Fever-sore may be due to inflammation, injuries, working in phosphorus, or from the inordinate and protracted use of mercury.
SYMPTOMS. The pain frequently commences in the night, and all the different stages succeed, until, finally, the result is frequently mortification or death. The entire bone, or only a part of it, may be affected; the parts become swollen, "matter" forms, and unless it be artificially evacuated, it will in time work its way out through a fistulous opening. As the disease progresses, the adjacent tissues become thickened and numerous openings are formed, which communicate with the bone, and often with each other, so that a probe may be passed from one to another, as represented in Fig. 6, copied from a drawing by Dr. Howe. The discharge from fever-sores varies in character, and usually has a fetid odor. The surgeon can readily distinguish between healthy and unhealthy bone by the use of a probe. The pus discharged in necrosis contains minute particles of bone, which may be felt by rubbing it between the fingers. Sometimes large pieces present themselves at the openings. The general health is seriously impaired, and the patient becomes debilitated, anaemic, and hectic.
TREATMENT. The process of repair is necessarily tedious, and nature should be assisted to remove the old bone and promote the formation of the new. An alterative course of treatment is indicated and must be persistently followed. Give Dr. Pierce's Golden Medical Discovery and Pleasant Pellets in sufficient doses to keep the bowels regular. However, all efforts to heal the sores, as long as dead bone remains, will prove fruitless. The sores should he throughly cleansed with injections of an alkaline solution, after which bandages, moistened with glycerine, may be applied. If they emit a fetid odor, add a few drops of carbolic acid to the glycerine. The dead bone can be but slowly removed by suppuration, therefore time, and, indeed, sometimes life itself, may be saved by removing it with surgical instruments. In the operation of sequestrotomy, the surgeon must exercise great judgment. Carelessness may prolong the disease and subsequently necessitate another operation, or, perhaps, an amputation.
Usually the dead bone is easily removed by the skilled specialist surgeon, and, when thoroughly taken out, the parts readily heal and the patient rapidly recovers. The removal, therefore, of the dead bone which is a constant source of irritation, and the cause of protracted suffering, should not be delayed, for very rarely indeed can it be removed at all without the assistance of the surgeon. Besides, delay often results in the loss of the limb, and not unfrequently occasions the death of the patient. Under the influence of a reliable local anaesthetic, carefully applied, the operation of removing the decayed and offensive bone is speedily and painlessly performed, the use of chloroform or ether not generally being required.
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If the following letters had been written by your best known and most esteemed neighbors they could be no more worthy of your confidence than they now are, coming, as they do, from well known, intelligent and trustworthy citizens, who, in their several neighborhoods, enjoy the fullest confidence and respect of all who know them.
Out of thousands of similar letters received from former patrons, we have selected these few at random, and have to regret that we can find room only for this comparatively small number in this volume.
RAW SORES FROM KNEE TO ANKLE.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Dear Sirs—My little boy, Amasa Claude Peck, was severely stricken with what the doctors called erysipelas. We had employed two doctors for months without any effect, until he commenced taking your Dr. Pierce's Golden Medical Discovery. Two bottles effected a cure. His leg was raw from his knee to his ankle; it has never broken since, which has been several years. The same medicine also did great things for my now deceased husband in a case of erysipelas of long standing. Respectfully yours,
MRS. A.B. PECK, Ranger, Eastland Co., Texas.
My daughter Mrs. Jennie Rice, was cured of catarrh in her head by using the "Discovery" with Dr. Sage's Catarrh Remedy. She derived great benefit from your medicines and gives the privilege of using her name.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, NO. 663 Main St.. Buffalo, N.Y.:
Dear Sirs—Ten or twelve years ago I had a combination of diseases. Our family physician said I was bloodless and there was no hopes of my recovering. My mother advised me to consult you, which I did. After one month's treatment I was on foot again; it was truly astonishing how speedily I found relief after taking your preparations. I have also used your "Favorite Prescription" and "Golden Medical Discovery," which proved very beneficial.
MRS. ADDIE R. KNIGHT, Carapeake, Gates Ce., North Carolina.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—I am glad to say that the use of your medicine has saved me many doctors' bills, as I have for the past eleven years been using it for the erysipelas and also for chronic diarrhea, and am glad to say that it has never failed. I have also recommended it to many of my neighbors, as it is a medicine worth recommending.
I give you the privilege of using my name
Yours truly, JOSEPH SMITH Mineral Point, Tuscarawas Co., O
BLOOD AND KIDNEY DISEASE.
DR. R.V. PIERCE, Buffalo, N.Y.:
Dear Sir—I had been an invalid for nineteen years and had all the doctors in our country prescribe for me, but they could not say just what ailed me. When I wrote you giving the history and symptoms, you diagnosed my case as disease of the blood and kidneys, and advised me to try your "Golden Medical Discovery" and "Pellets" and I feel confident your medicines saved my life, and I hope all sufferers from kidney and blood diseases will try your valuable medicine.
Respectfully yours, T.H. EDMUNDSON, Postmaster, Home, Marshall Co., Kans.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, 663 Main St., Buffalo, N.Y.
Gentlemen—About five years ago I was taken with a discoloration of the skin on my legs and arms, which in a short time terminated in the most aggravated eczema. My sufferings were intense, and no relief did I experience, until I commenced the use of your preparations. I have taken five bottles of the "Golden Medical Discovery," and more than that number of the "Pellets," and believe that I am entirely cured. I never feel the least itching, or burning, which was at one time so unbearable. My appetite and digestion are splendid, and, although I will be seventy years old my next birthday, I am as hearty and strong as most men of fifty.
Very truly yours, JOSEPH P. DELANO, Warsaw, Richmond Co., Va.
Mr. G. MILTON SYDNOR, Druggist, of Warsaw, Richmond Co., Va., writes: "My friend, Mr. J.P. Delano, has requested me to write you in confirmation of his statement, which I cheerfully do. I know Mr. Delano well personally, and can testify to the correctness of his statement.
His case of eczema was the worst that I had ever seen. I saw him often during the time he was afflicted, as he came to my store often after medicine. He purchased the "Discovery" and "Pellets" from me, and has been one of the strongest champions of your medicines, and thus aided me very much in their sale. I am quite sure that he has been the means of my selling several dozens of that preparation."
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—I was troubled with boils for thirty years. Four years ago I was so afflicted with them that I could not walk. I bought Dr. Pierce's Pleasant Pellets, and took one "Pellet" after each meal. The boils soon disappeared and have had none since. I have also been troubled with sick headache. When I feel the headache coming on, I take one or two "Pellets," and am relieved of it."
Respectfully yours, WILLIAM RAMICH, Minden, Kearney Co., Neb.
A TERRIBLE SKIN DISEASE.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Dear Sirs—I had been troubled with skin disease all my life. As I grew older the disease seemed to be taking a stronger hold upon me. I tried many advertised remedies with no benefit, until I was led to try your "Golden Medical Discovery." When I began taking it my health was very poor; in fact, several persons have since told me that they thought I had the consumption. I weighed only about 125 pounds. The eruption on my skin was accompanied by severe itching. It was first confined to my face, but afterwards spread over the neck and head, and the itching became simply unbearable. This was my condition when I began taking the "Discovery." When I would rub the parts affected a kind of branny scale would fall off.
For a while I saw no change or benefit from taking the "Discovery," but I persisted in its use, keeping my bowels open by taking the "Pellets," and taking as much outdoor exercise as was possible, until I begun to gain in flesh, and gradually the disease released its hold. I took during the year somewhere from fifteen to eighteen bottles of the "Discovery." It has now been four years since I first used it, and though not using scarcely any since the first year, my health continues good. My average weight being 155 to 160 pounds, instead of 125, as it was when I began the use of the "Discovery."
Many persons have reminded me of my improved appearance. Some say I look younger than I did six years ago when I was married. I am now forty-eight (48) years old, and stronger, and enjoy better health than I have ever done before in my life. Yours truly,
BAD CASE OF ECZEMA OR SALT-RHEUM.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—I was troubled with eczema, or salt-rheum, seven years. I doctored with a number of our home physicians and received no benefit whatever. I also took treatment from physicians in Rochester, New York, Philadelphia, Jersey City, Binghamton, and received no benefit from them. In fact I have paid out hundreds of dollars to the doctors without benefit. My brother came to visit us from the West and he told me to try Dr. Pierce's Golden Medical Discovery. He had taken it and it had cured him. I have taken ten bottles of the "Discovery" and am entirely cured and if there should be any one wishing any information I would gladly correspond with them. If they enclose return stamped envelope.
Very truly yours, MRS. JOHN G. FOSTER, 83 Chapia Street, Canandaigua, N.Y.
ERYSIPELAS AND WOMB DISEASE.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, 663 Main St., Buffalo, N.Y.:
Gentlemen—I am forty-eight years old, and have had four children. Three years ago the doctor said I had womb trouble, which was accompanied with backache and a tired and miserable feeling all over; left side hurt me very much, and could not lie on that side, and the doctor said it came from affection of the spleen; had a great deal of headache; was costive, and suffered terribly from erysipelas; it nearly set me crazy, so great was the burning and itching; sometimes experienced severe burning in the stomach. I took twelve bottles of your medicines, six bottles of Dr. Pierce's Golden Medical Discovery and the same amount of his "Favorite Prescription." Was using them for about six months, and can say that they did their work well. I have ever since felt like another person, and do not think I can say enough in their praise. I have no more weakness, and all evidence of erysipelas has disappeared.
Respectfully yours, MRS. SARAH E. WHITE, Kennon, Belmont Co., Ohio.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—About four years ago my daughter, Helen G. Harris, was afflicted with Eczema in a distressing form. She tried medicines too numerous to mention, but they did no good. I told her that I would write to Dr. Pierce, which I did, and after a few months' use of his medicines she was entirely cured. I believe your medicines unequaled.
MRS. JNO. H. RICHARDSON, a widow living near Wakefield, Va., a few years ago, was in extremely bad health, and used your proprietary medicines with entire success.
Respectfully yours, THOMAS HARRIS, Wakefield Station, Sussex Co., Va.
SALT-RHEUM—FLESH CRACKED OPEN AND BLED.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—It gives me pleasure to express my faith in the virtue of Dr. Pierce's Golden Medical Discovery. Having suffered for three years from salt-rheum and after having been unsuccessfully treated by a good physician, I began the use of the "Discovery." The humor was in my hands. I was obliged to keep a covering on them for months at a time, changing the covering morning and night. The stinging, burning and itching sensation would be so intense that at times it seemed as if I would go crazy. When I bent the fingers the flesh would crack open and bleed. It is impossible for me to describe the intense pain and suffering which I endured night and day. After taking six bottles of the "Discovery" I was entirely cured.
Respectfully yours, MISS LOTTIE CLARK, River Falls, Pierce Co., Wis.
INVETERATE SKIN DISEASE WORLD'S DISPENSARY MEDICAL ASSOCIATION, 663 Main St., Buffalo, N.Y.:
Gentlemen—I desire to state that I am perfectly well and very thankful to you for curing me. The medicines which I used for two months only have effected a perfect and permanent cure of my case. My face looks as well as ever.
I was six weeks under treatment at the Invalids' Hotel and Surgical Institute, and I got first-class accommodation.
The case was a strange one. The pimples did not break out on my chin where I had let my beard grow, they broke out on my cheeks, forehead and nose. A doctor in San Francisco told me it was blood poison and said it was very hard to cure it. I think if it were blood poison it would run all through my system. When I first felt the disease coming on in winter—my face used to be very cold. I worked under the sun fourteen years every summer. I wore no hat—nothing but a skull cap. I thought I was sun-proof. The doctor in San Francisco stopped the disease for one year but it came back again. I had it for five years. It came on from hard work and exposure in the sun.
When my face would break out in the fall it got so itchy, and then little pimples would break out on my face, nose and forehead. I think parasites were in my face. If I would drink a glass of beer, I would feel the effects of it in my face, and tobacco would affect me just the same. My face, nose and forehead would be spotted all over like a "fiddler's note book," every fall for five years. I never saw a case like mine. The doctor said if I would get tanned with the sun I would be all right.
In the kind of work I had to do, I could wear no hat.
Respectfully yours, MICHAEL ALLEN, Oro Fino, Siskiyou Co., Cal.
CURES BROWN SPOTS.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, NO. 663 Main St., Buffalo, N.Y.:
Gentlemen—I can say that my health is better now than for the last fifteen years. I cannot say what my disease was, but I was as spotted as a leopard with brown spots; I was so miserable and nervous, and could not sleep. I took Dr. Pierce's Golden Medical Discovery one year, and the brown spots all disappeared and I am well. Have not taken any medicine in two years. I think the "Golden Medical Discovery" a splendid medicine for stomach, liver and skin disease. I got no help from the other doctors. I used only the "Golden Medical Discovery."
Yours truly, MRS. WILLIAM JOHNSON, P.O. Box 188, Owosso, Shiawassee Co., Mich.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, No. 663 Main St., Buffalo, N.Y.:
Dear Sirs—I was sick eight long years with the scrofulous humor and I used Dr. Pierce's Golden Medical Discovery and it cured me. I used five bottles and I have used it since for other troubles. It has helped me wonderfully, in fact cured me, and I recommend it to all my friends
Yours most gratefully, MRS. MARY E. NICHOLS Bay Shore, Suffolk Co., N.Y.
"HEART-RENDING TO BEHOLD".
Terrible Suffering from Skin Disease.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—My baby when about three months old began to have little sores come out on his face; did not amount to much until six months old, then they began to spread all over his face and head until his face, head and ears were one solid sore. Our family physician was summoned at the early stages of the disease and tried everything he knew of for the cure of the same, but nothing did him any good. The disease baffled the skill of the doctor in every way, and I was advised by friends to try certain remedies, which I did, with very little effect. The child by this time was a heart-rendering sight to behold, and suffered unknown agonies with the torturing itching and burning of the sores, and so things ran on until my brother, who resides in Buffalo, visited me. As soon as he saw the child he advised me to have him treated at the Invalids' Hotel and Surgical Institute in Buffalo. I wrote to them stating my baby's case, asking them if they could help him, and they thought they could, so began their treatment at once by using salves externally and medicine internally and as soon as they began their treatment the child began to improve and continued so until he was entirely cured in six months' time. He is now two years and six months old and is as tough as any child you ever saw; weighs thirty-five pounds and is perfectly well, thanks to Dr. Pierce and his wonderful medicines.
Yours truly, MRS. A.L. PAYNE, Box 147; Oxbow, Jefferson Co., N.Y.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, 663 Main St., Buffalo, N.Y.
Gentlemen—About four years ago I took scrofula, and did everything that doctors and others prescribed, but only got worse. Several abscesses formed about my neck and breast, discharging a quantity of matter. I got so weak I could scarcely walk about the house. I read all the medical works I could get hold of, and, among the rest, read some of your works. You described my case, and recommended Dr. Pierce's Golden Medical Discovery with his "Pleasant Pellets." So I procured some and commenced using them and soon began to mend. In six months my sores were all healed up, and in twelve months I was entirely well. I am forty-five years old and believe I am as stout as I ever was in my life. I used about one dozen bottles of the "Golden Medical Discovery" with the "Pellets," and used nothing else after I began using your medicines. So I must give your medicine all the praise for curing me, and I am bound to recommend it.
Yours truly MRS. BELLE SWEENEY, Flat Top, Mercer Co., W. Va.
CONVERGENT STRABISMUS. INSTANT AND PAINLESS CURE.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—I am happy to certify to your skill. I had been afflicted with badly crossed eyes from my birth, and my sight was impaired, and I was badly disfigured. By a painless operation my eyes were instantaneously restored to a proper position and my sight much improved.
Your Hotel and skillful surgery merit every recommendation.
Yours truly, DAVID CRANE, Spring Creek, Warren Co. Pa.
SCROFULOUS SORE EYES.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, 663 Main St., Buffalo, N.Y.:
Gentlemen—When I was two years old my eyes broke out in little white pimples and itching all the time in the mornings; when I awakened my eyes would have to be washed open; I could not see and when they were washed open the corruption would run down my face and drop off. I have tried all of our physicians and their medicine did me no good. A physician attended them from Ellicott City and did them no good. He said it was the running scrofula in the eyelids and could never be cured; it had continued fourteen years, and I had given up all hopes of ever being cured until I saw your advertisement of the "People's Common Sense Medical Adviser," and I sent and got one, and I saw a great deal in it about the eyes. I wrote to you about them and you prescribed for me. Now my eyes are quite well. Some advised me to wear glasses, but you said not. I have been a great sufferer but am glad to say you did me all the good that I have received.
Respectfully yours, MISS VIRGINIA M. GARDNER, Mayo, Anne Arundel Co., Md.
WEAK AND SORE EYES.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—After taking Dr. Pierce's Golden Medical Discovery for four weeks, at a cost of only $1.50, I am more than pleased to announce that my eyes are perfectly well and strong as ever. I doctored and fussed with quack medicines for about one year and a half and found no relief. Finally I consulted your "Medical Adviser" and found a case similar to mine so I wrote and got a speedy reply. I followed directions, which resulted in a speedy cure as above.
Yours truly, JOHN CASSERLY, JR., Westline, Redwood Co., Minn.
RUNNING SCROFULOUS SORES.
DR. R.V. PIERCE: Dear Sir—When about three years old I was taken with mumps, also had fever, finally I had that dreaded disease Scrofula. The most eminent physicians in this section treated me to no avail. I had running scrofulous sores on left side of neck and face. I was small and weakly when eight or nine years old, and in fact was nearly a skeleton. Six bottles of Dr. Pierce's Golden Medical Discovery wrought marvelous changes. Although the sores were healed in eight months, I did not quit taking it until I was sure it had been entirely routed from my system. The only signs left of the dreadful disease are the scars which ever remind me of how near death's door I was until rescued by the "Discovery." I am now eighteen years old and weigh 148 pounds; and have not been sick in five years.
Respectfully, HARVEY M. HOLLEMAN, Wilmington, Newbern & Norfolk Railway Co., Wilmington, New Hanover Co., N.C.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
Gentlemen—My daughter who is now 18 years of age was attacked with a severe pain and swelling in her ankle, which soon caused her to have high fever. We employed some of the best physicians in this locality who pronounced it rheumatism, did everything for her they could do, but she kept getting worse from day to day, and in about five weeks after she was first taken sick her ankles and legs came open and discharged a lot of yellow matter and finally slivers of bones came out of the openings in her ankles. All the doctors we consulted said that we would have to have an operation performed on her and have the dead bones taken out, or else she could not get well, with the exception of one of the doctors who said that if her health could be improved the dead bones would come out and be replaced with new ones, for the dead pieces would brake loose from the sound bone and come out through the opening with the matter; but he could not do anything to improve her health.