did. I found everything that had been described to be just so in regard

to the Staff and Institution.

Gratefully yours, J.M. ELAM, Flat Rock, Scott Co., Va.

DOUBLE VARICOCELE AND STRICTURE OF URETHRA.

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

_Gentlemen_--I have taken treatment from you for several months for nervous debility, and although I am not quite fully cured as yet, I have been greatly benefited, and believe, if I had come to you before I was duped and swindled by different quacks and was more dead than alive, I would to-day be a thoroughly well man.

I have also been to your Institute twice for surgical operations, and cannot too highly praise the Hotel, or the skill and care of the attending surgeons and nurses. They are gentlemen in every way and the Invalids' Hotel is just as represented.

I shall advise all suffering from chronic diseases to go to you for relief, as I have never seen any one there who was not cured or greatly benefited.

Very truly yours, CHRISTIAN HANSON, Austin, Mower Co., Minn.

INDIGESTION, CONSTIPATION, VARICOCELE.

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

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

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

BAD VARICOCELE.

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

_Gentlemen_--Having been operated upon at the Invalids' Hotel and Surgical Institute for the radical cure of a bad varicocele, from which I had suffered for eight years, I desire to express my thanks to you for your kindness and skill. And I would advise all persons, needing surgical or medical treatment, to go to the World's Dispensary Medical Association.

Respectfully yours, WILLIAM H. DELLINGER, Vincennes, Knox Co., Ind.

VARICOCELE.

Cambridge, Furnas Co., Nebr.

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

_Gentlemen_--With great gratitude toward your most valuable Institute, I feel indebted to you for the cure of varicocele. I was troubled ten years with this annoying disease, caused, I think, by being thrown from a horse. My case was of a very obstinate character. I was treated by a leading specialist of Omaha, Nebr., without success and without being in the least benefited. I expended the neat little sum of $500, and then sank back in despair, losing all hopes of a cure. I had previous to my treatment in Omaha noticed a little hand or Memorandum Book of the World's Dispensary, and again one came to my notice. I mustered up courage to write to you, and in June, 1892, I visited your Institute for treatment. I was treated by the best skilled surgeons and given best attention by experienced nurses. I met a number of patients while under treatment troubled with various and complex diseases, who expressed their gratitude to the Faculty of the Invalids' Hotel and Surgical Institute. The operation performed was rendered painless, owing to local applications previously applied. After the operation, which was about 11 o'clock, A.M., I rested until 12, noon, and responded to the dinner call as usual. I was required to remain but ten days, then returned home, a distance of some twelve hundred miles. I wore a neat fitting support for about six months, and then abandoned it and have gone as nature created me. Oh, what a relief. I had worn a "suspensory" for about six years. I have had no return of former trouble, it being now about two years since the operation.

To any suffering with varicocele I must say, "don't delay, but place yourself under treatment at the Invalids' Hotel and Surgical Institute, Buffalo, N.Y., and you will say as I do, 'The half has never been told.'" With earnest wishes for your future success, I am,

Yours truly, E.L. Brown

VARICOCELE.

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

_Gentlemen_--I wish to inform you of the success of your treatment of me for varicocele on the left side and its attendant weakness, etc. I am now happy to say that through the agency of your surgical skill and the efficacy of your medicine, I am healthy, strong, and a perfect man. I suffered for about two years previous to the operation with acute pain in the parts, and continued mental anxiety. I desire to express my entire satisfaction that, during the ten days that I remained in the Invalids' Hotel, I never experienced such uniform kindness and attention as I did from the attending surgeon and from all the attachees, and that I recommend all persons similarly afflicted to consult you, and they can be sure to find the way to happiness.

Respectfully yours, D.E. RIGHETTI, Cayucos, San Luis Obispo Co., Cal.

VARICOCELE

OF TWENTY YEARS' STANDING--CURED "WITHOUT PAIN.

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

_Gentlemen_--I take great pleasure in recommending the Invalids' Hotel and Surgical Institute. After trying my home physicians without obtaining any permanent relief, and growing constantly worse, I went to this famous Institution and submitted to an operation for varicocele. This was a perfect success, and soon I felt like a new man, and as strong as I ever did. I feel that nothing I could say would do justice to this renowned Institution. In every way, it is kept in advance of the age. The staff of physicians and nurses spare no pains to make the visit of every one pleasant as well as beneficial in the highest degree. I would urge all sufferers afflicted as I was, or with any chronic disease, to avail themselves, without delay, of the skillful treatment to be obtained of the specialists of the World's Dispensary Medical Association, for I am confident that they will receive all the benefit that can be obtained from medical or surgical treatment and care.

Yours truly, CHAS. H. BOYLE, Fort Benton, Choteau Co., Montana.

VARICOCELE.

SPENT $500 WITH OTHER DOCTORS TO NO PURPOSE.

Bryson, Jack Co., Texas.

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

_Gentlemen_--I had been troubled with varicocele for nine years, and had given up ever being cured. After spending $500.00, with medical quacks I then went to the World's Dispensary Medical Association as a last resort. One of their skillful surgeons performed an operation upon me which was entirely painless. I conversed with several other patients, who had the same disease. They seemed happy to know that there was such an Institution that could relieve suffering humanity. The surgeons and nurses were so good and kind to us and gave us the best of attention and even the patients had a very fraternal feeling toward each other.

Your Institution is finely equipped and has the best of accommodations. Accept my thanks.

Yours truly, A.D. Bryson

A BAD CASE.

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

_Gentlemen_--I have been cured of an almost life-long difficulty by the skill of your specialist, and heartily thank you for the successful manner in which the operation was performed in my case. The result is complete and perfect relief, and as time advances I can each day more fully appreciate the value of your Institution. The time spent there I shall never forget, as it was a time of extreme pleasure to me. The operation was _perfectly painless_ and did not confine me to my bed, and this taken with the extreme kindness of every one connected with the Institution, made the time pass in a very happy manner.

I consider your Hotel first-class in every respect, and would heartily advise all sufferers from chronic ailments to visit you before giving up their cases as hopeless.

Respectfully yours, H.C. DECKER, Dresbach, Winona Co., Minn.

VARICOCELE-CAUSED FROM STRAIN.

Montague, Sussex Co., N.J.

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

_Gentlemen_--In reply to your inquiry concerning my treatment, I cheerfully give you the following testimonial: "I was troubled for many years with a very bad varicocele, which I received when a boy while jumping. The complaint troubled me exceedingly. I tried almost every known means to effect a cure, but with no avail, for the more I doctored the more aggravated became the disease. After thus suffering for many years and knowing of the fame your Institution had attained in curing such diseases, I at last consulted your specialist in that class of diseases--was operated upon and returned home in ten days, a sound and well man. I can recommend your Institution to all suffering humanity as the most home-like, your nurses the most attentive and specialists the most skillful the world can offer. May you long be the benefactors of mankind."

Yours truly, F.L. Van Etten

VARICOCELE.

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

_Gentlemen_--The result of your operation, performed one year and a half ago for a case of varicocele of twelve years' standing, and which had troubled me very much, has cured me entirely. I am thankful to God that He put it into my mind to visit your Surgical Institute. I cannot recommend your skill too highly.

Yours truly, ED. H. MAHNKEN, Smithton, Pettis Co., Mo.

VARICOCELE.

Medora, Billings Co., N. Dak.

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

_Gentlemen_--Having been operated upon at the Invalids' Hotel and Surgical Institute, Buffalo, N.Y., for the radical cure of a varicocele on the left side from which I suffered four years, I take pleasure in certifying to the speedy and certain relief afforded, and the painless operation, as performed by the surgeon of the World's Dispensary Medical Association. Ten days from the time of the operation I returned home permanently cured.

I desire to express my thanks to the Medical Staff for their skill and attention.

Gratefully yours, Geo. O. Reid

A STRONG ENDORSEMENT.

_To whom it may concern_:

This is to certify that I took treatment at the Invalids' Hotel and Surgical Institute, Buffalo, N.Y., and I was cured of a chronic trouble that had been maltreated by other physicians. While there I saw a man who had been cured by the specialists, who had before been given up to die by the best doctors in Troy, N.Y. Of course, the case must have been a very stubborn one. I afterwards saw a man here, in Georgia, die, who, if he had been in Pierce's Surgical Institute under the treatment and care of his skilled doctors and nurses, I know would have most assuredly got well. Why? Because it was only a cage of _stone in the bladder_, and they are easily cured at Dr. Pierce's Surgical Institute. I think almost any chronic disease can be cured there, if taken in time, judging from my observations while an inmate of that Institution.

H.E. BANKSTON, Barnesville, Pike Co., Ga.

* * * * *

HYDROCELE,

OR DROPSY OF THE SCROTUM.

This malady consists of a collection of water in the _tunica vaginalis_, or membranous sac which contains the testicles. It may affect either one or both sides. In health the sac-like covering, or investing membrane, of the testicle secretes a limpid fluid which lubricates its inner surface. When secreted in excess, it accumulates and constitutes _hydrocele_.

The tumor commences at the bottom of the scrotum and grows very gradually, while hernia, or rupture, with which it is often confounded, progresses from above downwards and makes its appearance suddenly.

We were recently consulted by an aged gentlemen, whose disease a distinguished surgeon had pronounced _double hernia_. On examining the enlargement, we found the disease to be dropsy of the scrotum, complicated with varicocele.

CAUSES. Injuries from blows or bruises are among the most common causes of this disease. It may also result from inflammation of the testicle or from excited action in those parts. It has been known to result from stricture of the urethra, or water-passage, and also from local irritation along that passage.

HYDROCELE.

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

_Dear Sirs_--In answer to inquiries will say, that any person afflicted as I was, I would advise them not to listen to any ordinary doctor, but leave at once for the Invalids' Hotel and Surgical Institute, Buffalo, N.Y., where he could get the best of treatment and attendance that money could procure. The table also is loaded with the best of fruits, vegetables, and the finest meats of the markets.

Respectfully, H.H. WILLIAMS, St. Augustine, Florida.

HYDROCELE.

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

_Gentlemen_--Without solicitation, but simply to aid suffering humanity, I take pleasure in recommending your place to any suffering from Hydrocele.

I was cured in a short time, after having the Hydrocele for eighteen years. Your new process is painless, no knife being used and is certain, sure and safe. With many good wishes of success, I am,

Yours truly, DAVID FLYNN, (Engineer, S.F. & W. Ry.,) Way Cross, Ware Co., Ga.

HEMATOCELE OR RUPTURED VEINS.

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

_Gentlemen_--I was afflicted with Hematocele of large size, caused by an injury, for which home-treatment gave me no relief.

Hearing of your Invalids' Hotel I went there and had an operation performed for its cure. I have the greatest confidence in your Specialists, as the operation was a perfect success. It was perfectly painless, and I was able to go home in less than two weeks with the cure complete. I take pleasure in certifying to the good work you are doing.

With the best of feeling toward the Invalids' Hotel, I am,

Yours truly, DON PARKER, P.O. Box 155, Oakfield, Genesee Co., N.T.

HYDROCELE WITH VARICOCELE.

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

_Gentlemen_--About five years ago, having been a patient at, the Invalids' Hotel and Surgical Institute and undergone a painless operation for the cure of hydrocele and varicocele--which was performed to my entire satisfaction. I desire to express my thanks to the Medical Stuff for their skillful treatment of my case. Two weeks from the time of the operation I returned home, radically and permanently cured.

I recommend all similarly afflicted to consult the World's Dispensary Medical Association.

Yours truly, DANIEL HUNTINGTON, Huron, Beadle Co., So. Dak.

TWENTY-TWO YEARS' STANDING--UNSUCCESSFULLY TREATED BY OTHERS.

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

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

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

* * * * *

THE URINARY ORGANS:

THEIR ANATOMY, PHYSIOLOGY AND PATHOLOGY.

By reference to Fig. 1 the reader will get a good understanding of the relative positions of the kidneys, bladder, and adjacent organs.

THE KIDNEYS.

It is hardly necessary to discuss the minute structure of these organs in a book intended for the non-professional reader.

The function of the kidneys is to remove certain waste materials from the blood. As fast as excreted by the kidneys, the urine passes through the ureters, of which there are two,--one leading from each kidney, into the bladder. The ureters are lined with a continuation of the mucous membrane, reflected from the bladder upwards, and this lining also extends to the cavities of the kidneys.

Calculi or gravel, and stones, forming, as they sometimes do, in the kidneys, and passing down through these delicate and sensitive canals, cause excruciating pain. The symptoms of renal calculi passing from a kidney to the bladder are, as already indicated, severe cutting pain in the loins, and along the ureter, attended with considerable fever. A very rough stone, such, for instance, as a mulberry calculus, passes with considerable difficulty, and the patient is often suddenly seized with excruciating agony in the loins and in the groin, the pain also shooting down into the testicle of the corresponding side, often causing it to retract. There is usually, also, sympathetic pain shooting down the thigh. We have seen patients roll on the floor in the greatest agony, cold sweat meanwhile pouring down their faces, when thus suffering. The patient may also vomit violently, through nervous sympathy. The urine is apt to be bloody, and there is a constant desire to pass it. There is pain in the end of the penis, and also in the lower portion of the abdomen.

THE BLADDER.

This is a sac, or reservoir, to receive and hold the urine as it comes from the kidneys through the ureters. Its walls are partly composed of muscle, and partly of a lining mucous membrane. The muscular coating is external, and it is by its contraction that the urine is expelled. When empty, the bladder shrinks down to a small size, as compared with its distended condition. When filled, it is capable of holding about one pint. If it is distended by the retention of urine much beyond this capacity, the muscular coats lose their force, and often the urine cannot be passed naturally. In health, when the bladder becomes filled and distended, there is a consequent desire to empty it by passing water.

The voiding of the urine should not be attended with the slightest pain or disagreeable sensations, and the desire to pass it should not be frequent. When there is frequent desire to pass it, or when its passage is attended with pain, there is irritation, or inflammation, in the coats of the bladder, or in the urethra. This may arise from an excessively acid or irritating condition of the urine, as well as from various other causes. Gonorrhea, or clap; stricture of the urethra, which impedes the free flow of the urine; enlargement or inflammation of the prostate gland; gravel, and stone in the bladder, are all capable of creating a frequent desire to pass water. Whatever the unhealthy condition may be which gives rise to this troublesome symptom, it calls for prompt and skillful treatment, for the most trivial affections of these organs often pass into those that are exceedingly intractable, if not incurable.

THE EXAMINATION OF THE URINE. The urine itself, when subjected to microscopical or chemical examination, as we shall hereafter more fully explain, offers the best means of determining the exact nature of these distressing affections. When normal, the urine is of a pale straw-color, and throws down no deposits on cooling. In passing it no difficulty or pain should be experienced, and it should spurt from the urethra in a full, round, and regular stream, until the bladder is entirely emptied. If the stream is forked, checked, or interrupted in any way before the bladder is completely emptied, it is evidence that something is wrong. Stricture of the urethra, prostatic disease, and gravel, or stone in the bladder, are all capable of producing obstruction to the free flow of the urine.

HOW SLIGHT AILMENTS BECOME DANGEROUS DISEASES. As we have before stated, the mucous membrane lining the bladder is reflected upwards into the ureters, lining these canals. By reason of this continuity of mucous surfaces, patients suffering from urethral, prostatic, and bladder affections, often die from disease of the kidneys. It must not be supposed that because stricture of the urethra does not co-exist with _Brights_ disease, that the latter may not have been caused by the obstruction in the urethra due to stricture. Pulmonary consumption, for instance, often begins in the form of nasal catarrh, but, by the continuity of the mucous membrane, it travels, so to speak, into the throat, or pharnyx; from the pharnyx into the larnyx, and then into the lung structure itself. The disease is transferred from the nose into the lung tissue. What occurs in the nasal, laryngeal, and pulmonary tract of mucous membrane, happens, also, in the urinary tract. A gonorrhea, which is a specific acute inflammation of the urethral canal, leaves behind it a slight gleet, or chronic inflammation of the mucous membrane of the urethra. This may give little inconvenience for a number of years, but gradually it culminates in a stricture, or, implicating the prostatic portion of the urethra, occasions inflammation of the prostate gland, and, perhaps, enlargement of this organ. This gradually gives rise to cystitis, or inflammation of the bladder. From the bladder, the disease travels up the ureters into the kidneys, and finally _Brights_ disease is established in these organs.

The mucous membrane lining the bladder also extends through the urethra. Throughout the interior of the body, whether it be in the stomach, lungs, or other parts, this lining mucous membrane serves as a protection to the parts beneath, just as the skin on the exterior of the body serves as a protection to the sensitive true skin and the tissues underneath it.

THE CAUSE OF CERTAIN DISTRESSING SYMPTOMS. Close to the neck of the bladder is a triangular space, on which the mucous membrane is smoother, and devoid of folds, or rugae, and which is far more sensitive and vascular than other portions of the mucous membrane lining this organ. It is called the _trigone vesical_. This _trigone_ is the most depending part of the bladder. If there be stone in the bladder, it naturally gravitates and rests on this sensitive space, so that, when the bladder is empty, the foreign body occasions inconvenience, until the urine, trickling down through the ureters, and intervening between the mucous membrane and the stone, serves as a temporary protection to the mucous surface. Hence the pain becomes less as the urine is secreted, until the water is again passed, and the intervening fluid thereby removed, when the stone again presses upon, and irritates, the sensitive _trigone_, by coming into more immediate contact with it. The greater ease with patients afflicted with stone experience in a recumbent position in bed, or on a sofa, compared with being in an erect posture, is easily explained. The foreign body, when the patient is standing, walking, or riding, falls by its own gravity on this sensitive spot; when in a recumbent position, it rolls away from this sensitive _trigone_ into the back part of the bladder, where the mucous membrane is less sensitive; consequently, the patient suffering from stone in the bladder is more easy at night, whereas, one suffering from prostatic disease, whether it be inflammation of the prostate gland, or enlargement of that organ, is usually worse in bed.

HOW BLADDER DISEASES COME TO BE CONFOUNDED WITH OTHER DISEASES. The bladder is largely supplied with blood-vessels, lymphatics, and nerves, given off from the same systems that supply the rectum or lower bowel, and in females the uterus or womb, and the ovaries. This accounts, in a great measure, for the symptoms of bladder disease in those afflicted with piles, or other diseases of the lower bowel, or of diseases of the uterus or womb in the female. We have frequently been consulted by patients who had erroneously supposed themselves to be suffering from disease of the bladder, or of the prostate gland, but whom we found, on examination, to be suffering from hemorrhoids, or piles. In these cases, by removal of the pile tumors, the frequent desire to urinate, and all pain in the region of the bladder, are promptly relieved. Sometimes, ulcers located in the rectum, give very little unpleasant sensation in the bowel, but produce pain in the bladder, with frequent desire to urinate. Enlargement of the uterus, the womb, or displacements of that organ, as prolapsus, or anteversion, and all capable of producing symptoms of bladder disease. A frequent desire to urinate and more or less sharp pain in the region of the bladder are usually experienced in these cases. Disease of the bladder, in like manner, often produces an apparent disease of other organs through sympathy, and without great care in diagnosticating each case, the _effect_ may be taken for the _cause_, and the patient treated for a disease which does not really exist.

THE URETHRA.

The urethra, in the male, is the canal extending from the bladder to the end of the penis, through which the urine is passed. This canal starts from the base of the bladder, passes through the prostate gland, and, entering the penis, continues of about uniform size along the under part of the penis until it reaches the glans, or head of that organ, where it expands somewhat into a bulb-like fossa, or cavity, and becomes reduced again at the orifice. At a short distance from the bladder it receives the outlets of the seminal ducts. The urethra is a most delicate and sensitive canal, and is surrounded by tissues of like delicacy, and is lined with a mucous membrane which is highly vascular, and filled with sensitive nerves. The introduction of any instrument into this canal is to be undertaken only when absolutely required, and when necessary. It should be so skillfully and carefully effected that no pain or irritation can result. The slightest awkwardness is liable to cause an unnoticeable injury, which may result in a false passage, or an effusion of plastic lymph around the canal, which, organizing, forms the most troublesome kind of organic structure. By proper and early treatment all danger and pain is avoided, and a cure effected in a very short time. In an extensive practice, in which we yearly treat thousands of cases, we have never yet failed to give perfect and permanent relief from stricture, or disease of the prostrate gland, without the necessity of using cutting instruments of any kind, when we have been consulted before injury to the urethra has been produced by the improper use of instruments. Having specialists who devote their entire time and attention to the study of these diseases, we are able to relieve and cure a large number painlessly and speedily, in which the awkward manipulations of physicians or surgeons, whose hands, untrained by constant and skillful use, not only fail to effect any benefit, but set up new, or aggravate existing, disease.

This subject will receive a more full and complete consideration in another part of this treatise.

THE PROSTATE GLAND.

The prostate is a gland of about the size and shape of a large chestnut, lying just in front of the bladder, and surrounding the urethra. The size of the prostate gland varies considerably with the age of the person. In early life it weighs but a few grains. As puberty approaches it becomes larger, and in the adult weighs from half an ounce to an ounce. In old age it enlarges considerably, and sometimes presses upon the bladder so as to impede the flow of urine. This condition is often confounded with stricture, gravel, or stone in the bladder, by inexperienced physicians. Hypertrophy, or enlargement of the prostate gland, is not an unfrequent disease in the adult or middle-aged man. Being in close contact with the bladder, when it enlarges it encroaches on the bladder, pressing on it, and it has the effect of interfering with the function of urination. As before indicated, enlargement or hypertrophy of the prostate gland, is often confounded with stricture, gravel, and stone in the bladder, by inexperienced physicians, and treated accordingly. The true condition of this gland is readily determined by an examination through the rectum or lower bowel, the finger of the expert surgeon being able to determine at once whether it is enlarged or not.

THE DANGER OF BAD TREATMENT. In disease of the prostate gland, as well as in inflammation of the kidneys and bladder, stricture of the urethra, and many other forms of urinary disease, the use of stimulating diuretics, and the much-advertised "kidney cures," "buchus," and similar preparations, which largely increase the flow of urine, simply aggravate, and do positive harm. In fact, the most difficult cases that we have had to deal with have been those that, through such treatment, either taken on their own account or prescribed by inexperienced physicians, have been rendered so much worse as to make their cases very intractable, and tedious to relieve and cure.

REQUIRE NICELY ADAPTED TREATMENT. As we have heretofore indicated, there is no class of diseases that require nicer adaptation of medicines to each individual case, than those of the urinary organs. Medicines which, in one stage of these diseases are beneficial and curative, in another stage are often exceedingly injurious. Hence it is that we claim it to be impossible for any one to put up any set prescription, or proprietary medicine, that will meet the wants of a large percentage of this class of cases. The only rational course to be pursued is to examine carefully each case as it is presented; find out the exact condition and stage of the disease with which the patient is afflicted, and then prescribe for it such special medicines as are nicely and exactly adapted to the patient's condition. These, in many cases, will have to be changed from time to time, to suit the ever-changing condition of the disease, as it is modified by the treatment. Not only have the manufacturers of "buchus," "kidney cures," etc., committed grave errors by prescribing stimulating diuretics for almost all kidney and bladder diseases, under the impression that, as the patient passes only a small quantity of urine at a time, the kidneys should be stimulated to secrete more, but physicians in general practice have been very prone to commit the same error in their practices. When the bladder and kidneys are in a weak and diseased condition, incapable of efficient action, the bladder being already unable to dispose of the diminished quantity of urine secreted, it is simply outrageous practice to administer medicines calculated to stimulate the kidneys to perform more work. By being thus forced, these organs become seriously diseased. It would appear most unreasonable to whip and spur a horse already jaded from overwork. Common sense would dictate rest, which always does good; but, as the bladder is weak, the doctor whips up the kidneys with drugs, thus endeavoring to force them to secrete more urine, and thereby the poor, crippled bladder, which is incapable of disposing of even the diminished quantity secreted, is actually made to do more work in a diseased and feeble condition, than it would perform in a sound, strong, and healthy state. The results of this pernicious practice are _Bright's_ disease of the kidneys, cystitis or inflammation of the bladder, and numerous other grave maladies.

* * * * *

KIDNEY DISEASE.

Diseases of the kidneys are generally very slow in their inception, coming on gradually and manifesting no special symptoms of their presence until they have assumed a formidable character. For this reason they are the more dangerous. Simple derangement of the urinary secretion is no evidence of disease of these organs, as changes in the color, quantity and specific gravity of the urine are often produced by changes of temperature, active or sedentary habits, mental emotion, and sometimes by articles of diet, or drink, as well as by the use of different drugs.

The existence of disease of the kidneys in the early stages can only be positively determined by a microscopical and chemical examination of the urine, which reveals to us the presence of casts, epithelia, blood, pus, etc. The microscope informs us not only of the presence of disease, but very often of the particular portion of the kidney in which it is located, as well as of the stage which the disease has reached. We are also aided by chemistry in determining the exact abnormal condition of the kidneys by the detection of albumen, sugar, etc. These examinations, by aid of the microscope and chemical re-agents, should never be neglected by the physician. Without them his diagnosis, or judgment of the patient's condition, is simply guess-work. With them he is enabled to base his treatment upon certain and positive knowledge of the patient's real and true condition.

The usual symptoms of chronic disease of the kidneys, but which vary materially with the age, constitutional peculiarities and temperament, are weakness in the small of the back, pains in the region of the loins and groins, numbness of the thigh on the side of the affected kidney (for often only one organ is affected), high-colored and often scalding urine, many times depositing a sediment, sometimes white or milky urine, bloody urine, frequent desire to pass the urine, partial impotency, pains in the testicles and shooting into the loins, suppression or inability to pass the urine, gravel, stone in the bladder, dropsical swellings, swelling of the testicles, irritability and pain in the bladder, mucous and sometimes seminal discharges oozing from the urethra.

WHEN THE BLADDER IS AFFECTED the prominent symptoms usually complained of are irritability of the bladder, accompanied by a frequent desire to urinate, inability to retain more than a small quantity of urine, and this for a short time only, pain in the region of the bladder, extending into the back, thighs, etc., hot scalding sensations in passing the urine, sediment in the urine, and sometimes bloody urine. The appetite is usually diminished, there is a depression of spirits, the urine is often passed only by drops, and is irregular in quantity and quality, frequent inability to pass the urine at all, in males partial impotency, with dull disagreeable pain in the testicles and irritation of the urethra, attended with mucous and sometimes seminal discharges oozing from the urethra. Some of these symptoms may be present as the result of functional or organic disease of other organs than the kidneys or bladder, and to distinguish them with positive certainty is impossible without the aid of a microscopical and chemical examination of the urine.

* * * * *

BRIGHT'S DISEASE.

This affection may appear in either an acute or chronic form. The acute form is frequently a complication, or sequel of scarlet fever, diphtheria, cholera, typhoid fever, erysipelas or measles, and is frequently developed by intemperance. The acute form of the disease is very rapid in its progress, often destroying life by uraemic poisoning--the retention of urea in the system.

The symptoms of the acute form are diminution or suppression of urine, dry skin, chills, thirst, pains in the loins, and a general dropsical, puffy condition of the system, especially manifesting itself in the earlier stages under the eyes, but gradually showing itself in the oedema, or swelling of the feet, and lower extremities generally. Unless promptly relieved, the patient dies of coma (stupor), or from convulsions. No person should be so rash as to attempt the treatment of this dangerous affection without the aid of the best medical skill that can be procured.

IT IS THE CHRONIC FORM OF BRIGHT'S DISEASE that we propose principally to discuss in this article. True Bright's disease of the kidneys is an insidious and most fatal form of organic disease.

We venture to assert that less than one per cent. of those who imagine they have "Bright's," have this disease at all. We find that most of those who, as one of our Faculty puts it, _insist upon having_ Bright's disease, base their "diagnosis" upon the ever-changing condition of the urinary secretion, and especially upon the copiousness of the deposit; whereas, in true Bright's, deposits of any kind are rarely met with. Perhaps the form of deposit most commonly mistaken for Bright's disease, is that known to medical men as the _urates_. When the urates are in excess they form a heavy pinkish deposit of a flocculent nature within from five to thirty minutes after the urine has been passed--that is, after it has been passed sufficiently long to cool. To prove that the deposit is urates, heat the specimen to the temperature of the blood, when the deposit in question will disappear. Excess of urates has now been definitely traced, in the majority of instances, to functional torpidity of the liver.

Another common form of deposit is that in which the reaction of the urine, instead of being acid, as in health, is either neutral or alkaline, and in which the earthy phosphates are precipitated for this reason. The earthy phosphates, when thrown down by a neutral or an alkaline condition of the urine, appear as a heavy white deposit, which, though usually devoid of clinical significance, is certainly calculated to frighten timid patients who read of the "terrible ravages of Bright's" in the advertisements of various popular "kidney cures." To prove that the precipitate is phosphatic in its nature, add a few drops of vinegar and it will disappear; whilst, if, after the vinegar has been added, the specimen be brought to the boiling point, not only both the urates and phosphates remain in solution, but there is only one single substance known to pathological chemistry that can form a deposit under these conditions--and that substance is albumen, which, if present in quantity, is always indicative of serious disease.

The papers are filled with the plausible but unwarranted statements of the manufacturers of various "kidney cures," who anxiously desire that every one should be impressed with the idea that all their troubles arise from kidney disease in order to sell large quantities of their medicines. In many cases the unfortunate patient is rendered much worse by the use of remedies that are not suited to his condition, and which will not cure the real trouble with which he is affected.

Daily we are consulted by persons in whose cases these errors have been made. In reality, true Bright's disease is not a common affection, and nine out often individuals who think that they suffer from it, or the early stages of the trouble, in fact have something more curable. In some cases it is an affection of the liver, which forces an excretion of unnatural salts by the kidneys, and thus renders the urine acrid and irritating, or they may be suffering from some other disease, such as a deformity or enlargement of certain glands, as the prostate; unnatural position of the organs, as with women who suffer from weakness, the uterus pressing forward on the bladder and urethra, and thus showing every evidence of disease in the urinary canal. It is as common for persons to suffer from deformity of the urinary canal as from misshapen limbs, or from noses and ears not of proper size and proportion.

The urinary canal, from the bladder outward, is narrow and delicate. Any disease or injury therein is liable to result in gradual contraction, which may be manifested long years after the cause has been forgotten, or has disappeared. These affections, to the inexperienced, or the physician who is not particularly alert and cautious in his diagnosis, are liable to cause error, and he will pronounce a given case Bright's disease, when in reality there is some simple cause for the irritation of the urinary canal, and the pains in the kidneys, etc., all of which frequently result from a slight damming up of the flow of water, and the prevention of free expulsion from the system of the salts of which the body is relieved by the kidneys. They cannot work under pressure. When, from any cause, the flow of water is checked, and, as it were, dammed up so that a slight pressure is put upon the kidneys below, their secretion is most materially interfered with, and the many trains of symptoms that usher in disease of the kidneys, appear.

The true, and only sure way to relieve these conditions, as can be understood by any one, is to remove the real cause. The use of any medicine that stimulates the kidneys to an irritable action, under such pressure, is to be avoided, as it only makes the trouble worse, increases the amount of water that is dammed up, and results in more serious manifestations of constitutional disease; whereas, by merely relieving the choked outlet, the flow of water becomes free, and the kidneys are speedily restored to their natural condition. This is well illustrated by the following:

Case 113,396.

As recorded at the Invalids' Hotel. L.C.K., farmer, age 41, married. For a period of nearly ten years, as a result of slight injury, he had suffered from cloudy and unhealthy-looking water, with some burning on passing it; frequent calls to urinate; swelling of the limbs, loss of energy and strength; headache, etc.; gradually there appeared severe pain in the back, at times recurring with a sense of fullness in the abdomen. For a period of nearly eight years he had been constantly treated by physicians at his home, all of whom had investigated his case. He had made several long journeys to consult the manufacturers of a much-advertised "kidney cure," who, after pretending to examine his urine, scientifically (none of the proprietors are physicians), assured him that, without the shadow of a doubt, his disease was Bright's, and that he might be cured by their "kidney cure," which was for sale at all drug stores. For a period of eighteen months he steadily took this "cure," which, he states, he is sure aggravated his disease, as, although his sufferings at times were less, he felt that he was not improving in the least, and that his disorder was not being properly controlled. His home physician went with him on several occasions, consulted with the owner of the proprietary medicine, and was equally mistaken in his diagnosis. After consulting many doctors, all of whom assured him they could give him treatment that would prolong his life somewhat, and make his condition comfortable, but that no treatment would affect his cure, he was induced, by reading our article, heretofore referred to, to consult us. A very thorough examination of the case was made, which resulted in finding two contractions of the urethra, which admitted only the smallest sized probe, and which, necessarily, prevented the free flow of the urine. These were speedily removed, when, much to the surprise of his family physician, who accompanied him, over thirty-seven ounces of fluid were drawn from the bladder. This gave him immediate and perfect relief. The pains and aches in the region of the kidneys, the weakness and tenderness, and the many other uncomfortable symptoms with which he was troubled, all disappeared. From a feeble and irritable invalid, in a few weeks he was converted into a happy and cheerful man. The symptoms of congestion and irritability of the kidneys gradually disappeared, and in thirty days after visiting us he writes that he feels himself entirely sound and well. This gentleman states that he will be pleased to correspond with any one who wishes to learn the particulars of his case, and his full name and address will be furnished to any inquirer.

Bright's disease when fully established is characterized by degeneration of the kidneys. Submitted to examination, after death by this disease, these organs present various appearances. Hence, the degeneration that characterizes the disease has been designated as waxy degeneration. Some pathologists contend that the disease consists of several different renal maladies, all of which, however, agree in the one ever-present symptom of a more or less albuminous condition of the urine.

As to the causes of kidney disease, it may be said that any thing which will give rise to a greater or less degree of congestion of the kidney will induce either a temporary albuminous condition of the urine, or a true Bright's disease of the kidneys. Suppression of perspiration, by exposure to cold and wet, want of cleanliness, deficiency of nutritious diet, liver disease, certain poisons in the system, as of scarlet fever, measles, erysipelas or diphtheria, taken in conjunction with sedentary habits, bad air, excessive mental labor or worry, may each occasion an albuminous urine, and finally result in Bright's disease, but of all causes that appear to produce this disease, none are so prolific as intemperance. A scrofulous diathesis, or habit of body, may strongly predispose to the disease, and chronic kidney disease frequently follows acute rheumatism and the practice of masturbation. In some instances the chronic form of Bright's disease follows an acute attack, but is more often developed slowly and insidiously without any known cause.

THE SYMPTOMS of this fatal malady generally appear so gradually that they excite but little or no concern until it has reached its more advanced and dangerous stages. Frequently, a puffy, watery or flabby condition of the face, particularly under the eyes, is the first symptom noticed, and the patient may observe that his urine is diminished in quantity. The urine is sometimes abundant, but generally more scanty than in health, is acid in its reaction, and generally of a low specific gravity. The countenance is generally somewhat pale and bloodless, which, taken with the dropsical condition of the system, and the constant albuminous condition of the urine, points the expert specialist to Bright's disease of the kidneys. Various circumstances and conditions may give rise to the temporary presence of albumen in the urine, and, although albumen may be temporarily absent from the urine even when Bright's disease exists, yet this is not common. There are certain indirect symptoms which point clearly and almost unmistakably to the presence of this disease. These are deep-seated pain or weakness in the back, gradual loss of flesh, red, brown, or dingy urine, more or less drowsiness, and as the disease advances, a smothering sensation, or difficulty in breathing, with dropsical puffiness or swelling. Occasional attacks of nausea and vomiting are common; pains in the limbs and loins, which are often mistaken for rheumatism. Irregularity of the bowels is also common. The skin becomes harsh and dry, not perspiring even under active exercise. Sometimes these symptoms are years in their development, being very obscure at first, and in some cases the disease has been known to prove fatal without the patient having experienced any extraordinary symptoms. With those whose systems are enfeebled by want, intemperance, exposures or disease, as scrofula or syphilis, the first symptoms usually observed will be a frequent desire to urinate, occasional attacks of diarrhea, flatulency, dropsical swelling of the face, especially under the eyes, and afterwards of the extremities, paleness and increasing debility. Stupor, apoplexy and convulsions are the forerunners of a fatal termination.

Microscopical and chemical examinations of the urine are the only reliable means of diagnosis, and should be often repeated. (See Urinary Signs, in Appendix.) As albumen is often present in the urine without the existence of Bright's disease, it is impossible, except by the aid of the microscope, to distinguish true Bright's from other affections of the kidneys. In both purulent urine, and that containing blood, albumen will be found by the usual tests, but in smaller quantity than in Bright's disease. Albumen, with disintegrated epithelia, hyaline, and large granular casts, as well as waxy casts, are peculiar to, and characteristic of, this disease.

In the treatment of this malady, our specialist's experience has been very great, and attended with marvelous success. Of course, after the substance of the kidney has degenerated and broken down, and become destroyed to any great extent, a cure is impossible. But that we now possess remedies of great value, and specific power over this terrible disease, we have the most positive evidence in the remarkable success attended in its treatment. Most cases that are curable can be managed successfully at a distance, the necessary medicines being sent either by mail or express. Our specialists have cured many in this way who were so bloated from dropsical effusion as to weigh twenty-five to forty pounds more than usual. In our Sanitarium, where we have had the advantage of our Turkish baths and other appliances, we have cured some cases in which the removal of the dropsical effusion reduced the patient's weight sixty pounds.

We cannot, In conclusion, too strongly condemn the general resort to strong diuretics so often prescribed by physicians for all forms of renal maladies, but which, by over-stimulating the already weak and delicate kidneys, only aggravate and render incurable thousands of cases annually. Not less harmful are the many advertised "kidney cures," "kidney remedies," "buchus," and kindred preparations. They all contain powerful, stimulating diuretics, and, while they may appear for a short time to do good, invariably render the case worse and far more difficult to cure. The cases of Bright's disease reported cured by these preparations are cases of far less dangerous maladies, made to appear, by exaggerated accounts of them, as true Bright's disease. The use of these general, ready-made or proprietary remedies in any case of true Bright's disease is hazardous in the extreme. In no disease is there greater necessity for treatment nicely adapted to the exact condition of the patient (which should always be carefully ascertained by microscopical and chemical examinations of the urine) than in this. As it is a disease that runs a slow course, there is always time to send samples of the urine for examination by expert specialists, and no other physician than a specialist of large experience should be entrusted with the treatment of a malady so dangerous in its character, and in the diagnosis and treatment of which general practitioners commit such frequent, and often fatal, errors. (SEE TESTIMONIALS.)

DIABETES. (POLYURIA AND GLYCOSURIA.)

There are two essentially different varieties of this disease, one of which is called _Diabetes Insipidus_, or _Polyuria_, and the other _Diabetes Mellitus_, or _Glycosuria_. The first is characterized by an increase in the amount of urine excreted, and yields readily to proper treatment. The second is characterized by the presence of sugar in the urine, and under ordinary treatment often proves fatal.

The _causes_ are obscure, and are therefore not very well understood by the profession.

SYMPTOMS. A notable increase of the quantity of urine excreted is the first symptom which attracts the patient's attention. Frequently, several quarts, or even gallons, of urine are daily excreted, and it is paler than natural. The patient experiences extraordinary thirst, and has an almost insatiable appetite, though at the same time he loses flesh and strength. The tongue may be either clammy and furred or unnaturally clean and red. The bowels become constipated, and a peculiar odor is observed in the patient's breath and exhales from his body. The skin becomes harsh, dry, and scurfy. There are dizziness, headache, dejection, lassitude, and not unfrequently blindness, caused by cataract, is developed in one or both eyes. The intellect is blunted, and, as the disease progresses, the emaciation and debility increase, and pulmonary diseases develop; or, perhaps, an uncontrollable diarrhea sets in, and the patient dies from exhaustion.

In this disease, as in Bright's, we have many medicines that produce specific curative effects, enabling our specialists to treat it with greatly increased success. The disease is readily diagnosticated, or determined, by chemical examination of the urine, so that we have been enabled to treat this class of cases very successfully at a distance, and without personal examinations. Great attention should be paid to the diet in these cases. It should be highly nutritious, but anything of a sweet or starchy nature must be avoided.

The following articles are wholesome and afford sufficient variety, viz.: of animal food--beefsteak, game, poultry, fish, eggs, cheese, cream, butter; of vegetables--spinach, dandelion greens, turnip tops, watercresses, lettuce, celery, and radishes; of drinks--tea, coffee, claret, water, brandy and water, beef-tea, mutton-broth, or water acidulated with tartaric, nitric, citric, muriatic, or phosphoric acid. The _forbidden_ articles are oysters, crabs, lobsters, sugar, wheat, rye, corn or oatmeal cakes, rice, potatoes, carrots, bests, peas, beans, pastry, puddings, sweetened custards, apples, pears, peaches, strawberries, currants, etc., also beer, sweet wines, port, rum, gin, and cider. (SEE TESTIMONIALS.)

CHRONIC INFLAMMATION OF THE BLADDER. (CHRONIC CYSTITIS.)

This affection, also called _catarrh of the bladder_, is an inflammation of the mucous lining of this organ. It may occur at any period of life, but it oftenest appears in the aged, and is usually associated with some obstruction to the flow of urine.

CAUSES. It may be due to colds, injuries, irritating diuretics, injections, extension of disease from the kidneys or adjacent organs, intemperance, severe horseback riding, recession of cutaneous affections, gout, rheumatism, etc.; but it more frequently results from stricture of the urethra, enlarged prostate gland, gravel, and gonorrhea. It is also caused by an habitual retention of the urine, and sometimes results from masturbation or self-abuse.

SYMPTOMS. There is an uneasy sensation in the bladder, and heaviness and sometimes pain and weakness in the back and loins. The urine is scanty, and, although there is a desire to void it frequently, it is passed with difficulty. If allowed to stand, it deposits more or less mucus, which is sometimes mistaken for semen. As the disease progresses, the quantity of the mucus increases. It is very viscid, and adheres to the sides of the vessels, so that if an attempt be made to pour it out, it forms long, tenacious, ropy threads. Sometimes the quantity of mucus is so great that on exposure to cold the whole mass becomes semi-solid, and resembles the white of an egg. The excreted urine is alkaline, acrid, exhales a strong odor of ammonia, and soon becomes exceedingly fetid. Sometimes the urine becomes so thick that great difficulty is experienced in expelling it from the bladder. Nocturnal emissions, impotency, and loss of sexual desire are apt to ensue. Occasionally there will be a spasmodic contraction of the bladder, with straining and a sensation of scalding in the urethra, and sometimes the patient is unable to urinate.

When ulceration occurs in the progress of the disease, as it is apt to in its advanced stages, blood will occasionally be seen in the urine. In the advanced stages of the disease the system becomes greatly debilitated, emaciation supervenes, with hectic fever, nervous irritability and, finally, death.

TREATMENT. A strict observance of the rules of hygiene is essential to a cure. We must ascertain the cause if possible, remove it, and thus prevent it from perpetuating the disease. The various causes and conditions involved in different cases demand corresponding modifications of treatment; hence, it is useless for us to attempt to teach the non-professional how to treat this complex disease. We have succeeded in curing many severe cases without seeing the patient, being guided in prescribing by indications furnished by microscopical and chemical examinations of the urine. (See Urinary Signs in Appendix.) In fact, nearly all cases can be cured at their homes, and without a personal examination being made. In the worst cases, we have found it best to have our patients at our institution, where we can wash out the bladder with soothing, healing lotions, and thus make direct applications to the diseased parts. (SEE TESTIMONIALS.)

GRAVEL.

When the solid constituents of the urine are increased to such an extent that they cannot be held in solution, or when abnormal substances are secreted, they are precipitated in small crystals, which, if minute, are called _gravel_. Another cause of the precipitation of these salts is a stricture of the urinary canal which, by interfering with the free expulsion of all the fluid from the bladder, results in the retention of a portion, which gradually undergoes decomposition. Salts from the urine are thus precipitated in the same way that they are thrown down in urine which is allowed to stand in a vessel. Any one can illustrate this, by allowing a small quantity of the urinary secretion to stand for a few days either in an open or a closed bottle. Soon a white, flaky deposit will be observed, which will become more and more dense, and finally fine grains will be seen precipitated at the bottom of the bottle. Similar grains, lodging in the folds of the bladder, gradually increase in size, by the precipitation of more salts around them, and ultimately become a source of much irritation. When of large size, they are termed _calculi_ or stones. When these formations occur in the kidneys they are termed _renal calculi_; when in the bladder, _vesical calculi_. There are several varieties of gravel, each depending upon different conditions of the system for its formation. The two prominent varieties are the red, containing uric acid, and the white, or phosphatic, gravel.

SYMPTOMS. When the deposits are in the kidneys, there is pain in the back and loins, occasionally cutting and severe; sometimes it darts down the course of the ureter to the bladder, and extends even to the thighs. When the deposits are in the bladder, there is a frequent desire to urinate, with a bearing-down, straining pain; also a cutting or scratching sensation in the urethra during micturition. In the male, intense pain is often experienced at the end of the penis. When the urine is voided in a vessel and allowed to settle, a gravelly deposit is seen, generally of a red or a white color, and the particles varying in size.

TREATMENT. These urinary deposits indicate a general derangement of the system, as well as a local disease. Nutrition is imperfect and some of the excretory organs are not properly performing their functions, or, perhaps, some portion of the body is being too rapidly wasted. Very frequently we find these gravelly formations as the result of a rheumatic or a gouty diathesis. It is also a well-known fact that torpidity of the liver throws an excessive amount of work on the kidneys. These organs then, in part, perform the function of the liver, and hence unnatural activity is required of them, and the secreting of such substances as uric acid, which precipitates readily and gives rise to severe irritation of the urinary canal.

In order to treat these cases rationally and successfully, it is first necessary to ascertain by microscopical and perhaps chemical examinations, the character of the deposit. By such an examination, the exact condition of the system which gives rise to these abnormal products may be definitely determined, and the remedies to be employed indicated. As the non-professional are not qualified to make such examinations, it would be useless for us to suggest specific treatment for the various forms of this affection.

Samples of the urine may be sent to us with a brief description of the symptoms experienced, and the proper medicines to cure can be returned by mail or express. Our specialists are treating, with uniform success, large numbers of cases in this way. (SEE TESTIMONIALS.)

STONE IN THE BLADDER.

Few affections to which the human flesh is heir are more painful than this terrible affliction. The cutting operation heretofore required to remove it, is considered one of the most dangerous operations that the surgeon is ever called upon to perform.

The death of the Emperor Louis Napoleon, of France, from an operation for the removal of a stone, at the hands of surgeons renowned for their skill, gave new impetus to the efforts of surgeons to invent some method that would be less dangerous than that which has been heretofore commonly employed. The cutting operations have been the rule. Of these the operation by median-section is the safest, and is most commonly employed for the removal of stones that are not too large, while the lateral operation is used where the stone is more than about one inch in its smallest diameter.

As will be seen by the consultation of any hospital record, the deaths in these various operations have been, in adults, from one in three to one in every four cases--a very large percentage, and sufficient to deter any sufferer from undergoing an operation except for the relief of a condition which is in itself worse than death. Even when this alarming death-rate is explained to sufferers, they willingly undergo the operation, feeling that they would rather die than longer continue in their pain and anguish.

Our specialists, not satisfied with the results of these operative measures, in their studies of the disease endeavored to perfect some other means by which these foreign bodies could be removed from the bladder without such great danger and pain. The operation by crushing, and removal without cutting, appeared to them to present the most practicable advantages, and they therefore devote their entire time to the improvement of this method for the removal of stone.

The method of crushing was first invented by a French surgeon many years ago; but, owing to his crude instruments, and the difficulty that was experienced in expelling the pieces of stone, the operation was seldom employed by surgeons. The improvements in these methods at the hands of Bigelow and Sir Henry Thompson, with those that have been made by our specialists, have resulted in our being able to present to sufferers with this disease, a means of cure which is, we are assured, the most successful known to modern medical science.

There have been so far in the history of the treatment of this malady by the new method of cure, one hundred and twenty-odd cases operated upon at the hands of prominent surgeons, all of which were with less perfect methods than that of our specialists, and there were but four deaths in this large number. By the advantages which are the result of further improvements by our specialists, we can assure you that this mortality is even less in our hands; in fact, approaches, as near as possible, to a perfect method of cure.

We think that in a moderately healthy subject, one in which the kidneys are not badly diseased as the result of irritation from the calculus, the operation is almost absolutely safe. The method consists in the crushing of the stone, and its removal from the bladder by means of small silver catheters attached to an apparatus which gently and perfectly removes, by suction, all the pieces which are thrown to the bottom of the bladder. This operation has now been performed in our institution in a very large number of cases with uniform success, and the cures have been effected in from six to eight weeks without a single unpleasant symptom arising during their progress. By this method it is not necessary to remove the entire calculus at one operation, if it is a large one. By the old cutting operation this was required, as the bleeding was great, and what was to be done had to be done immediately, or the patient would die from the _hemorrhage_. With the new method a part of the large calculus, or when several exist, one or two of them, may be removed at a time, after which the patient can rest and gain strength for the second; or, if necessary, for the third operation.

The largest stone removed by us in this way was one weighing between seven and eight hundred grains, for which three operations were required. It is necessarily performed under a mild anæsthetic, which prevents suffering and secures the perfect relaxation of the patient. In the case in which this large amount of stone was removed we feel certain that a cure could not possibly have resulted from a cutting operation, as the heart was seriously affected, and the physical condition of the patient so low, as the result of years of suffering, that death would have occurred while undergoing the operation. By carefully pursuing the new method, and not prolonging the sittings more than a few minutes each time, the entire stone was evacuated. The health of the patient constantly improved during the interval of three operations, which covered a space of seven weeks. This stone was as large as a hen's egg.

Small calculi or gravel are readily removed in a few moments' time by the new method. In no case is there any bleeding. Instead of a large, gaping wound being left after the operation, from which secondary hemorrhage may take place, or poisoning result from the irritation of decomposing urine, the parts are left in a healthy state with the surface unbroken. The stone, a constant source of irritation, is removed, and the health is speedily restored.

When it is impossible for the patient to visit us, a careful examination of the urine is made, and if gravel have been passed, these are carefully examined also. An idea of the composition of the stone is arrived at by this means, and treatment is directed to dissolve it. Success has commonly followed this method of treatment, when the stone has not been very large. With the gradual reduction of the size of the stone the irritation subsides, and the general health of the patient improves. (SEE TESTIMONIALS.)

CHRONIC ENLARGEMENT OF THE PROSTATE GLAND. (HYPERTROPHY.)

The prostate gland lies just in front of the base of the bladder, and surrounding the urethra, or urinary canal. Enlargement, therefore, of this body, if it be of considerable extent, causes it to encroach and press upon the base of the bladder, and to more or less constrict the urinary canal near the base or outlet of the bladder. The enlargement may be only slight, or the dimensions of the gland may be increased from the size of a large chestnut, its normal dimension, to the volume of a pullet's egg, or even to the size of an orange.

Hypertrophy of the prostate generally arises from causes which operate in a slow and permanent manner. Whatever has a tendency to produce a determination of blood to, and an engorgement of, this organ, is capable of producing the affection, an augmented flow of blood to the the part having the effect to increase the nutrition. Among the most frequent causes of this affection, are excessive venery, masturbation, disease of the bladder, stricture of the urethra, horseback exercise, gonorrhea, and the employment of strong, stimulating diuretics. Some of the worst cases that we have had to deal with have occurred in old men, and, in fact, the malady is more common to those advanced in life; but it is frequently produced in those of middle age by the causes enumerated.

Among the earliest symptoms of the disease is an uneasy feeling in the region of the base of the bladder. There is a more frequent desire to urinate than usual, and, in the course of time, this frequency becomes more urgent; still no particular notice may be taken of it, it being considered as "only a slight inconvenience." After several months, or it may be years, the discomfort increases, and nightly calls to empty the bladder become habitual. By and by the patient begins to find the discomfort of getting out of his warm bed very troublesome; still no notice to taken of it. He does not consider it worth his while to consult a doctor for "such a trifle." In the course of time the patient is obliged to get out of bed twice during the night instead of once. Afterwards, the calls become still more frequent and urgent; the inconvenience more evident; finally, pain is substituted for inconvenience, and then the doctor is consulted. Unless a specialist of experience be consulted, the bladder will most probably be examined, and medicine will be prescribed only to excite the kidneys to secrete more urine, which does harm instead of good; the disease slowly, but surely progressing. Patients often write us that they have had something wrong with the bladder for a number of years, having to urinate more frequently than they ought; sometimes having to do so three and four times during the night; in extreme cases even every half hour or so, and that they are not able to pass it freely, but only in small quantities, and attended with much pain. These symptoms are not always constant, but let up for a few weeks and then appear again. Things go on in this way for a year or two, perhaps, when the passage of the urine is completely shut off for several hours, and the patient is in great agony until the bladder is relieved by the use of the catheter. After such instrumental relief, for a day or two the urine may be natural again, coming at first, perhaps, in very small quantities, but by and by more freely. Then, after a week or two intervening, there may be another complete stoppage, attended, as before, with intense suffering, which will have to be again relieved by the use of an instrument.

The foregoing is a fair account of the usual progress of the disease and its symptoms. As the prostate gland becomes more irritated and inflamed from the natural progress of the disease, or from the irritation caused by the passage of instruments, or the employment of strong, harsh, stimulating diuretics, the urine becomes cloudy, and still later is found to have deposited during the night in the chamber utensil a quantity of thick, tenacious, and usually offensive mucus. There is apt to be more or less discomfort in the rectum, or lower bowel, produced by the pressure of the enlarged prostate upon it. Rarely, the first intimation of a large prostate occurs through a sudden retention of the urine, and the patient being under the impression that there was nothing wrong with the organ previously. Closely questioned, however, the information is elicited that there has been a long train of mild symptoms, similar to those that we have described, preceding the attack of retention of the urine. This shows the importance of early attention and proper treatment when such symptoms are manifested. However slight the inconvenience experienced, it should not be neglected. The disease should be brought under control at the outset by skillful and nicely-adapted treatment. Usually before a person suffers from toothache, the decay occasioning it has been gradually progressing without pain for from five to eight years. Just as the decay of the tooth may be arrested by the early attention of the dentist, so may prostatic disease by early attention be not only promptly relieved, but permanently cured.

Disease of the prostate being slow in its inception and progress, is also slow to yield even to the most skillful treatment. Being slow to develop, patients rarely seek assistance until the organ has become so large as to be seldom restorable to a size where mechanical means can be wholly dispensed with for relieving the bladder. Most surgeons are too much in the habit of depending on the catheter for the relief of the patient, and usually instruct the sufferer how to use it, telling them that this, the catheter, is to be their only doctor for life. Great as is the relief afforded by the catheter, which has often saved life, yet it is a fact that its frequent and prolonged use often renders disease of the prostate very intractable and often wholly incurable. Frequent use of the catheter, without any treatment to prevent the further enlargement of the diseased gland, or to reduce its size, permits the part to go on enlarging, and, besides, the constant use of the catheter irritates the prostatic portion of the urethra, causing thickening of the lining membrane, and sooner or later a more or less complete organic stricture of this canal, depending upon thickening of the lining mucous membrane, as well as upon the encroachment of the gland itself upon this canal. Besides, when the use of the catheter is once commenced, even when the enlargement is not very great, it is with the utmost difficulty that we have been able to induce patients to leave off its use. The bladder, becoming accustomed to its use, refuses to obey the will without this help. The irritation set up in the parts by the friction of the catheter causes inflammation and exudation in the lining membrane. This extends to the structure of the prostate itself and increases the hypertrophy or enlargement. It will, therefore, be seen how important it is to early resort to treatment to relieve the first manifestations of this affection. A disease of so delicate a nature, and one so often confounded with other maladies by inexperienced physicians, should only be intrusted for treatment to expert specialists of large experience in the management of this and kindred maladies.

* * * * *

STRICTURE OF THE URETHRA.

Stricture of the urethra generally results from some specific disease of the urethra, but may be caused by sexual excesses, exposure, or strain, or by the practice of masturbation or self-abuse. It runs a course varying in time from a few days to many weeks or months, during which time the patient is often unaware of the real cause of his sufferings.

Commonly, the attention is first called to a stricture by a slight discharge, or smarting sensation, or the appearance of an undue amount of mucous deposit in the urine. Occasionally, some difficulty in starting the water, or a diminution in the size and force, or a twisting of the stream as it flows, is the first symptom. This passive stage is of variable duration. When skillful treatment is instituted at this stage of the disease, a speedy cure is easily effected without pain or danger. Any exposure, improper use of instruments, or irritating cause, may speedily give rise to the alarming symptoms due to closure of the urethra, from which fatal consequences may suddenly ensue.

This condition is illustrated in Fig. 2, which shows the hard and tough stricture which surrounds the soft mucous membrane that lines the urinary canal. When irritated or inflamed, as the result of a cold or other cause, the mucous membrane becomes swollen and thickened, and, as the stricture will not yield and enlarge, the result is that the urethra is almost completely closed, and it becomes impossible to pass the urine. Great pain is experienced, and the surgeon has to be called to draw off the urine with a catheter, which, at best, is a very difficult and painful operation, when the urethra is so irritable and constricted.

TREATMENT. In the earlier stages of the malady, relief is given by the skillful use of instruments for dilating the canal, or, where this fails by the operation of urethrotomy, for which we employ an improved and ingenious instrument, by which the stricture is readily and almost painlessly divided.

IMPROVED METHODS. Our surgeons have operated upon many hundreds of bad cases by a very ingenious and almost painless method, that requires no use of bougies in the after-treatment. This saves the patient an immense amount of pain and annoyance, and enables him to go home almost immediately after the operation.

The ordinary after-treatment, by dilatation with bougies, is very tedious, and often more painful than the operation itself, so that our peculiar method of treatment has been hailed with joy by those familiar with the old and unnecessarily-painful systems of treatment. Besides, our more improved method has been followed by far more perfect cures in every case operated upon.

In many of the cases coming under our observation and treatment, there have been several strictures, as illustrated in Fig. 3, which shows the urethra constricted at three different points, besides a congenital contraction at its mouth or meatus.

SPERMATORRHEA not infrequently results from stricture of the urethra, even when the affection is quite slight. Our attention was first called to this subject by the consideration of the numerous cases in which epileptic convulsions or "fits," and other serious diseases of the nervous system in children, have resulted from an unnatural contraction of the prepuce or foreskin, constituting what is termed _phimosis_.

Every surgeon of experience has met with many of these cases of reflex irritation. It occurred to us, that, inasmuch as these contractions of the foreskin give rise to nervous diseases of an alarming nature, may not an unnatural narrowing of the urethral canal, which must have exactly the same effect in retarding the flow of the urine, give rise to irritable nervous affections in adults. May not unnatural irritation and excitement of the sexual organs, so set up, cause loss of semen to occur during sleep, and consequent nervous and general debility?

It is a well recognized fact that the urethral canal should bear a certain definite and proportionate size to that of the penis, just as the length of the arm should naturally bear a certain proportion to the length of the body. In the case of some parts of the body, disproportionate development of the part may not give rise to anything further than unsightliness; but when we find the small size of the urethra retarding the free passage of the urine, then we may expect, if this condition is long continued, to find more or less irritation of the urethra and, perhaps, of the bladder, also. When there is a contraction of the urethra at its external orifice, or at any point along its course, unnatural pressure is put upon the urinary canal behind the constricted portion, and these parts must bear an undue strain during the passage of the urine.

It is a well established fact that improper diet, cold, exposure, and over-work exert a very powerful modifying influence upon the urinary secretion, frequently causing an acrid and irritating condition of this fluid. This condition, when associated with a contracted urethra, must result in irritation of the mucous membrane lining this canal back of the stricture, if long continued or frequently repeated. As an illustration, we have a hose pipe from which, by means of a small nozzle, water is expelled a considerable distance, but a great tension is put upon the hose behind the nozzle. If the pressure is increased greatly the hose will burst; but, if the small nozzle be replaced with a larger one, the projection of the stream will be quite as great, but all undue tension of the pipe is overcome and the danger of bursting is done away with. We have, in an unnaturally contracted urethra, a favorable condition for the development of disease in the urinary canal and adjacent parts of the generative organs. Irritation is set up in the urethra behind the stricture by undue strain in passing water, and the frequent reoccurrence of acrid urine, as the result of any of the causes we have already mentioned, this irritation keeps gradually increasing. It will be felt more during the periods when the urine is acrid, but may pass unnoticed even at such times. The seminal sacs and the prostate and Cowper's glands communicate with the deeper portions of the urethra by means of canals or ducts, lined with mucous membrane which is continuous with the urethral mucous membrane. Hence we can readily see that not only by reflex nervous irritation are those parts debilitated, through the contraction of the urethra, but the affection is apt to extend by continuity of the mucous membrane, and thus become more and more manifest, through symptoms of disease of the testicles, prostate gland and seminal vesicles, and these disorders become more and more seated the longer the morbid condition of the urethra is allowed to run on, until there may be an entire loss of the sexual functions, occurring at an age when there should be present the most vigorous manhood. From no other cause can we explain the common prevalence of disease of the deeper portions of the urethral canal and bladder, many times confounded with other diseases of the urinary and generative organs.

The following is the history of a case that fully illustrates the foregoing statements:

CASE 112,289. MR. O.C.E., SINGLE, 32 YEARS OF AGE.

He applied to us suffering from entire loss of the sexual function, with great nervous debility, and there was a thin slimy discharge from the urethra, and the usual symptoms of melancholia and weakness. He had lost all taste for business, and was extremely nervous, from the fact that he was engaged to be married, and felt that his condition would not permit it. On examination a contraction of the urethra was found at the point shown in Fig. 4, which had probably been present for years. He stated that he never had been just right in those parts, but had lived a virtuous life, had never had any venereal disease, and, hence, the true nature of his trouble had not been suspected. With the removal of the stricture there was an immediate improvement in his condition, which became more and more rapid, as his system gained strength and reaction became manifest. At the end of two months he wrote that he felt sound and well, and that he had experienced the most wonderful improvement in every way. His vital strength was fully restored, and he was most profoundly grateful.

Chronic inflammation of the bladder, sometimes called catarrh of the bladder, an affection that is elsewhere herein fully treated of, and chronic inflammation of the kidneys, and true Bright's disease, as well as prostatic disease, are all liable to result from strictures of the urethra. Hence, it behooves one suffering from this malady to have it promptly and skillfully treated.

FALSE PASSAGES. In very rare cases of impassable stricture, or in which fistulous openings, or false passages, have formed, through which the urine flows or dribbles away, we have resorted to the operation of perineal section with the most gratifying results. The cases requiring this operation are rare ones, in which death must generally result but for the relief afforded by the operation.

DANGEROUS USE OF INSTRUMENTS. The worst and most dangerous cases of stricture with which we have met, in a long and extensive experience, were rendered thus by the careless or unskillful use of bougies, catheters, or sounds. Many surgeons and physicians are most recklessly careless or unskilled in the use of these most dangerous instruments, as the many cases of false passage or stricture of the most painful and dangerous kind, caused or aggravated by their ignorant or improper use, sorrowfully testify.

DELAY DANGEROUS. By proper treatment of stricture in its early stages, all danger and pain are avoided, and a cure is effected in a very short time. In an extensive practice, in which we yearly treat hundreds of cases, we have never yet failed to give perfect and permanent relief from stricture, or diseased prostate or urethra, without the necessity of cutting instruments of any kind, when we have been consulted before injury of the urethra has been produced by improper use of instruments. Having specialists who devote their entire time to the study and cure of these diseases, we are thereby enabled to attain the highest degree of skill in the management of these cases.

GREAT SKILL REQUIRED. The urethra is a sensitive and delicate canal, and is surrounded by tissues the most delicate, and lined with mucous membrane which is highly vascular and filled with sensitive nerves. The introduction of any instrument is to be undertaken only when absolutely required, and, when necessary, it should be so skillfully and carefully effected that no pain or irritation can result. The slightest awkwardness is liable to cause an unnoticeable injury, which results in false passage or an effusion of plastic lymph around the canal, and as it organizes, the formation of the most troublesome organic stricture. The attention not only of sufferers, but also of the profession, is called to the remarkable success of our operation, perineal section, by which a cure of extremely bad cases of impassable stricture and false passages, or urinary fistulas, is effected in from thirty to forty days, and with very little suffering. That we have been successful in such cases must be considered as conclusive evidence that no case of stricture, false passage, or urinary fistula, is beyond the reach of our skill.

* * * * *

TESTIMONIALS.

In a practice embracing the treatment of a vast number of cases of diseases of the Urinary Organs, it has been our good fortune to effect many remarkable cures. The experience gained in this field of practice has made our specialists skilled experts, and hence hundreds consult them as a last resort. In fact we seldom get a case, in this line, that has not been the rounds of the home physicians before applying to us for relief and cure. The cures, therefore, which we shall introduce here are the more remarkable because of the failure, in nearly every case, of other medical men to benefit or cure. They are not the every-day, ordinary cases met with in the general practitioner's rounds, but complicated, obstinate ones, which had generally been given up as hopeless before coming to us.

CASE 4A-3431. "WASTED TO A SHADOW." BLEEDING FROM KIDNEYS. A SEVERE CASE.

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

_Gentlemen_--I think it my duty to write to you concerning my case. In the year 1886 I was seized with inflammation of the bladder and passed nothing but thick blood, owing to heavy work, and I consulted a doctor and he said there was no cure for such a bad case; but he gave me medicine and it relieved me at the time I used it; and I took 16 bottles and I got worse and wasted to a shadow. I quit taking the medicine, and other complaints came, as rupture in the spermatic cord, for which I applied to you and soon got relief. And in 1891 the bladder disease made its appearance, and I wrote to the Invalids' Hotel and Surgical Institute and got no reply as our mails were stopped on account of snow drifts. I sent for the best doctor in Listowell and I still got worse, and he said I might live three or four weeks, but there was no stoppage of the disease. And I got so weak that I had to support myself by the furniture in my room; and I wasted down to 100 lbs. in two weeks; and I applied to your Institute and I received my medicine in a few days, and in two weeks I began to gather strength and now I am hearty and well and my weight is 145 lbs. I feel so thankful to the Medical Association and its Staff of skilled men. It is 15 months since I quit taking your medicines and no signs of the disease returning.

Yours gratefully, THOMAS S. BAILEY, Dorking, Wellington Co., Ont.

CASE 23A-877. INFLAMMATION OF THE BLADDER, WITH OTHER COMPLICATIONS. SUFFERED EXCRUCIATING PAIN IN URINATING.

For many years I suffered with inflammation of the Prostrate Gland and Bladder. It became gradually worse and I endured extreme pain, so much so that I was laid up for weeks at a time, and almost gave up in despair. I was persuaded to go to the Invalids' Hotel and Surgical Institute. I have never regretted following this advice. While there I submitted to an operation by their specialist. This was entirely painless and the result perfectly satisfactory. I left in a short time delighted, and have since been strong and well. I cannot speak in too high praise of this famous Institution; the rooms are large and pleasant, the food the very best, the attendants kind and attentive and the staff of physicians skillful and of large experience. I highly recommend all invalids to the World's Dispensary Medical Association. I feel confident that all the benefit to be derived from medical treatment is to be received at this Institution.

Yours truly, GEO. W. HEFFNER, Chicago, Ills.

CASE 2A-103. INFLAMMATION OF BLADDER, COMPLICATED WITH KIDNEY DISEASE.

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

_Gentlemen_--Having been a patient in your Invalids' Hotel for several weeks, I take great pleasure in telling other sufferers of my treatment which I received under your efficient staff of physicians, surgeons and nurses, and I will say with clear conscience that every care and comfort was given me that could be wished for. I am sure that your Institution is far in advance of the age, and would wish that every invalid could avail himself of the treatment that I received in your most excellently kept Invalids' Hotel. I cheerfully give this as my testimonial to individuals, friends and sufferers. My health is so fully restored that I look upon life with pleasure and comfort, whereas before I was a suffering, nervous invalid, unable to sleep and much of the time in torment. Wishing you success,

I am your friend and well wisher, M. MANHEIM, Georgetown, S.C.

CASE 859,143. BLADDER, RECTAL, KIDNEY AND LIVER DISEASE. "ENTIRE URINARY ORGANS ONE MASS OF SORES." "DESPAIRED OF CURE."

My disease was caused by the roughness and exposure incidental to the life of a miner, working in the gold mines of California and Montana. I had much of the time to work in water, with my clothes wet, which finally brought on a severe pain In my kidney, which ere long completely prostrated me. I employed and was treated by six different physicians, the best I could obtain in my section of country, and who while seeming to understand the nature of my disease, yet gave me no remedy that afforded me any real relief. I grew worse under the treatment of them all. The pain in the kidney left me, but immediately located in the bladder. My bladder became very painful and commenced to ulcerate and fill up. It seemed from the excruciating agony I suffered, that there must have been an abscess in either the kidney or bladder, and from the large amount of pus discharged at one time, it appeared to me that my kidneys, bladder and the entire urinary organs were one mass of sores and pus mixed with blood. I had to use injections of laudanum daily in the lower bowels to ease the pain and live. Was reduced by long suffering, looking for each day to be my last. I felt that no human power on earth could help me. No language can describe, and God only knows, the agony I suffered. From what I have already written, you may form some faint conception of my physical condition at the end of six years' treatment by the best medical aid I could get in the section where I was living. I also used for some time (with no benefit), "Warner's Safe Cure," and in fact, tried every means that I could hear of, but to no permanent relief. Such was my condition when I was led finally to consult and be treated by your Association, though I had but faint hope of obtaining any relief from any one. With the very best description I could give in writing of my case, and all the information you got from me, you would not undertake the case until you were further informed, and for which caution I sincerely thank you. You wrote me--"we are at a loss to definitely determine your condition. We have an opinion based upon the facts before us, but we feel that we must have a personal examination." In the condition I was then in, I could not have been kept alive to reach the first railroad station, which was only six miles from my house, and much less to travel to Buffalo. Indeed I wrote you, that if you would cure me for nothing, I was unable to go to you. In reply, you then advised me to take your "Special Remedies" until I could improve sufficiently to go to Buffalo for examination. Now this frank answer of yours, removed every doubt from my mind, and convinced me that you were _honorable physicians_. On March 10th, 1883, I began taking your "Special Remedies," as you prescribed them, and at the end of three years' constant treatment, I was improved sufficiently to go to Buffalo to your Institute, where I was examined as you required of me. When I reached your Institute, I was there carefully examined and received a month's treatment. When I reflect on my condition and my suffering when I first began to use your specifics, and see what I am now, I feel that no words can too glowingly express my gratitude to your Association for the physical benefits you have conferred upon me by your treatment of my despaired-of case.

SAMUEL C. TRACY Platteville, Wis.

DOUBLE VARICOCELE AND STRICTURE OF THE URETHRA.

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

_Gentlemen_--I have taken treatment from you for several months for nervous debility, and although I am not quite fully cured as yet, I have been greatly benefited, and believe, if I had come to you before I was duped and swindled by different quacks and was more dead than alive, I would to-day be a thoroughly well man.

I have also been to your Institute twice for surgical operations, and cannot too highly praise the Hotel, or the skill and care of the attending surgeons and nurses. They are gentlemen in every way and the Invalids' Hotel is just as represented.

I shall advise all suffering from chronic diseases to go to you for relief, as I have never seen any one there who was not cured or greatly benefited.

Very truly yours, CHRISTIAN HANSON, Esq. Austin, Mower Co., Minn.

CASE 23A-890. DISEASE OF THE URINARY ORGANS.

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

_Gentlemen_--I feel it my duty to give my testimonial in behalf of your grand Institution. I had an operation performed at your place two years ago for the relief of a very painful disease of urinary passage, and, thanks to your skill, I was cured, and have enjoyed the best of health since. I earnestly recommend your Institution to all who are suffering, and still further let me thank you for the kindness I received at the hands of everybody connected with the Institution. I am,

Respectfully yours, FRANK A. EMPSALL, P.O. Box 980, Pittsfield, Berkshire Co., Mass.

CASE 2A-208. RETENTION OF URINE. SUFFERED INTENSE PAIN.

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

_Dear Sirs_--To your favor of the 20th ult., would say that I can only speak in the highest terms of your Institution. After suffering for ten or twelve years with retention of the urine, and bladder difficulties, I can say that I found immediate relief at your hands. When going to your place, about six years ago, I was suffering with intense pain, loss of appetite, and unable to eat a good meal. I now weigh 170 lbs., do a good day's work and feel well in every respect. I am only too glad that I am able to praise your Institution, and can highly recommend it to any one who is suffering as I was. With great respect, I remain.

Yours very truly, P.J. HAMILL, Utica, N.Y.

CASE 80,115. ENLARGED PROSTATE AND CHRONIC CATARRHAL INFLAMMATION OF BLADDER.

Several years ago I had occasion to become an inmate of the Invalids' Hotel and Surgical Institute, No. 683 Main Street, Buffalo, N.Y. I was afflicted with an enlarged prostate and chronic Inflammation, or catarrhal condition of the bladder. I was largely benefited by the treatment I received there, and had I remained a little longer, as I was advised to do by the doctor who attended me, I should have fully recovered. I was so nearly cured that I did not think it necessary to remain longer, as I supposed nature would do for me what remained to be done, to effect a perfect cure. My business was urgent. I could not well remain longer. In this I made a mistake, I should have remained longer. I was seventy-two years old at the time. I bear willing testimony to the ability of the medical staff and the interest the doctors take in the welfare of their patients. The nurses and all the subordinates were very kind and seemed to vie with each other to contribute to the pleasure and happiness of the inmates of the Institute. One will find the Institute equipped with all the improvements known to modern science, for the promotion and restoration of health. It is impossible to do justice to its merits in a short article of this kind. Persons must go there and see and judge for themselves, of the wonders of this extraordinary medical establishment. If they cannot recover their health there, in my Judgment, it is of no use to go elsewhere.

ABRAHAM SCHELL, Knight's Ferry, Cal.

CASE 820,804. OBSTINATE AND COMPLICATED DISEASE.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

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

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

CASE 520,425. COMPLICATION OF DISEASES.

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

ANDREW HOLES, Moorhead, Minn.

CASE 654,500. DISEASE OF KIDNEYS AND OTHER COMPLICATIONS CAUSED BY EXPOSURE AND MALARIA.

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

_Gentlemen_--Having spent a short period of time at the Invalids' Hotel and Surgical Institute, No. 663 Main Street, Buffalo, N.Y., I must say I found it fully equal in every respect to the claims made for it by the proprietors. It was filled with invalids who were under the care of a corps of physicians and surgeons and the fact that all the sick people appeared to be improving, and that they were both cheerful and hopeful, and that they all spoke well of the Institution and of its doctors, was calculated to inspire confidence in one who went there himself to be treated. The greater number of these cases, as far as I was able to learn, were chronic and of a complicated character. They represented a wide range of the States and Territories of the Union, and had in each exhausted the resources of the home physicians. Having myself been treated by your Faculty for a complication of troubles induced by exposure and malaria, I feel that I owe my restoration to health to your skill and devotion, at a time when I was unable to perform labor and was much discouraged, and had failed to obtain relief elsewhere. You are at liberty to make any use you may desire of this communication.

Very respectfully yours, J.W. DEAN, Chariton, Putnam Co., Mo.

CASE 620,230. DIABETES AND INFLAMMATION OF BLADDER, GIVEN UP BY HIS HOME DOCTORS AS SURE TO DIE IN A FEW WEEKS. RESTORED TO ACTIVE WORK ON HIS FARM.

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

_Gentlemen_--I received your kind letter the 12th, and was glad to hear from you and have no objection to your making use of my name in any way to help the sick and suffering, for I know what it is to be sick. I was sick for seven years; could not do anything; was visited by seven doctors and was treated by four, and was given up to die by one of the best doctors of Russellville. He said I could not live longer than fall. He treated me for Sugar Diabetes, while the rest said I had inflammation of the bladder. After giving up all hopes of being cured at home, a friend got me to write to Dr. Pierce's Institution and after corresponding: awhile I decided to go and be treated. I was there one month and I never was cared for or treated more kindly by any one. No parents could have been better to their sick children. I cannot speak too highly of the Institution, and I believe I would have been in my grave to-day if I had not gone and been treated.

I feel great pleasure in expressing to you my sincere thanks for the cure that has been effected in my case, by your very skillful treatment, whereby I am now entirely and I trust permanently cured from a dangerous disease, which had defied the utmost skill of all former medical attendants for the past five years, and from which I had despaired of being: relieved. I am happy to state that my health is so good since taking the month's course of treatment at your Institute, and, the home treatment since my return, that I am now able to carry on the work of my farm.

I would cheerfully recommend all persons requiring medical or surgical aid to consult you at the earliest possible opportunity, as I know by personal experience that the facilities cannot be surpassed for treatment of all classes of chronic diseases.

Most gratefully yours, J.D. PARKS, Homer, Logan Co., Ky.

P.S.--I have always recommended my neighbors to your Institution and was the cause of F.M. Brasher taking treatment, who was cured after two doctors gave him up. J.D.P.

CASE 820,426. COMPLICATION OF DISEASES. A GRATEFUL PATIENT'S WORDS OF PRAISE.

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

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

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

"_A question of life or death!_"

CASE 2A-107. STONE IN BLADDER. CASE SIMILAR TO THAT OF COL. ELLIOTT F. SHEPARD, WHO DIED IN NEW YORK WHILE UNDERGOING AN OPERATION.

_Gentlemen_--I am seventy-seven years of age and have resided in Erie for sixty-two years, and for thirty-six years have been an elder in the First Presbyterian Church. During four or five years I suffered from a painful affection of the bladder; the severity permitted neither freedom from pain by day nor calm repose by night. Meanwhile, I consulted leading physicians and visited numerous health resorts. Neither time, means nor effort were spared that I might be free from pain. Relief came unexpectedly. A signal act of Providence, that should be acknowledged daily, brought your Institution to my notice, though I had then no acquaintance with any one connected with it. With me it was a question of life or death. Up to last March I was in a condition of unendurable torture. I knew that at my age, after the months of pain already borne, that any operation would be serious, perhaps fatal. Accordingly, I arranged my temporal affairs and carefully "set my house in order." On the 13th of March last, I started for Buffalo to your Institution. Still uninformed as to the cause of my trouble, I submitted to a searching examination, as to my habits, constitution, parentage, the age and cause of death of my parents, and other facts, from which a tolerable biography could have been prepared. All was kindly intended. Their aim was to locate my ailment and then to determine my ability to undergo an operation. Having found a stone in the bladder, they advised that it be crushed and extracted. By a strange coincidence as this was announced, I learned of Col. Elliott F. Shepard's death under an operation for the same disease. He was many years my junior, and seemingly far better able to undergo the operation. Still, in my desperation, I determined to go on. During five days, I was under treatment for the coming operation. On the 18th of March the stone was crushed and extracted. It was a complete success. Of the consideration, tenderness and skill of the surgeon and his assistants, I cannot too strongly speak. Of the gentle and assiduous nurses, the system and completeness of the whole establishment, as it moved along as one harmonious whole, in all its departments, I cannot sufficiently express my admiration. I am now relieved of a state of torture, and restored to health and happiness equal to any period of my life. This I say with sincerity and emphasis. Since then I have gained twenty-two pounds in flesh. I wish my words could reach the ear of every one similarly affected, throughout our land, to banish all doubts and take advantage of the science, skill and pleasant surroundings so happily blended in your Institution, for the removal of pain and the mitigation of distress.

DAVID S. CLARK, Erie, Pa.

CASE 520,123. STONE IN BLADDER. 1200 GRAINS OF STONE REMOVED WITHOUT CUTTING. PASSED BLOOD IN GREAT QUANTITIES FROM THE BLADDER. DOCTORS AT HOME (AS USUAL) DISCOURAGED HIM FROM COMING TO US.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

_Gentlemen_--I am glad to make public the wonderful cure that you accomplished in my case. For ten years I was a sick man, and during three years I suffered so much that life was a burden. My business had to be given up and the torments were something that could not be described. Every little while I had to urinate, and each time suffered a spasm of pain, like a knife thrust; the use of a catheter was painful and often it took long and painful trials before the water could be drawn off. I passed blood, in quantities at times. When I went to your place we had given up hope of a cure, and relief was all that I looked for. My doctors at home discouraged me. I spent four weeks in your Invalids' Hotel, and now at the age of sixty-seven years am sound and hearty as any one, work from five in the morning until seven at night. I manage a large and active business and enjoy life. I cannot express my high praise of your Institution. Your doctors are skillful and the nurses all kind and good. All understand their business and attend to it. I came home a new man and cannot say enough for your praise, and to express my thanks for the wonderful cure and comfort I have enjoyed.

Yours, JAMBS VINE, SR.

P.S.--You removed a stone that weighed over 1200 grains from my bladder, without cutting. The operation gave me complete relief. While there and since, I have seen a great many skillful cures done by you.

J.V., SR., St. Catherines, Out.

CASE 620,610. STONE IN BLADDER--WEIGHT 530 GRAINS--SUCCESSFULLY REMOVED WITHOUT CUTTING. NEIGHBORS TOLD HIM HE WOULD BE "BROUGHT HOME IN A BOX."

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

_Gentlemen_--Seeing the picture of the Invalids' Hotel and Surgical Institute in our local newspapers, called to my mind the treatment I received there in 1887. I had been suffering for ten or twelve years with bladder trouble, and our home physicians did not seem to understand the cause or the trouble, and I finally corresponded with your faculty, and their advice was to come and have an examination. I had been a great sufferer and was so weak that I could hardly walk from the hotel to the depot, and those who saw me start said that I would be brought home in a box. Soon after my arrival an examination revealed a stone in my bladder. After a few days' treatment to strengthen up the system, the stone was taken out, weighing 530 grains. Four or five others were afterwards taken out of smaller size, and I am still alive. Will soon be seventy-six years old, and I cannot speak too highly of the care and attention I received from the physicians and nurses while there. Everything that was provided was of the best; good food, glean apartments; and no better place can be found for treatment of the many diseases they advertise to cure.

Anyone suffering from bladder or kindred trouble can find relief at the Invalids' Hotel, Buffalo, N.Y.

Respectfully, C.A. CHURCH, New Berlin, N.Y.

CASE 620,258. STONE IN THE BLADDER--GREAT SUFFERING FOR YEARS--HEART-FELT GRATITUDE.

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

I would not be a true man If I did not acknowledge at this time (as I should have done long ago), with words of gratitude, the wonderful relief I received at your Institution five years ago. It affords me the greatest pleasure to say to you and to the world at large, that the treatment and operation I received at your Institution was an entire success and a miraculous cure. After twenty-five long years of suffering such as few people endure, caused from exposure while in the military service of the United States, I contracted kidney and bladder disease, which shortly afterwards resulted in the formation of a calculus or stone. I experimented with medicines. Special Prescriptions, etc., from some of the most eminent physicians in the world, in fact everything that promised relief and help for my kidneys was used, but received no relief, until the bladder discomfort became unendurable. As a last resort, knowing full well that life with me would be very short unless I could receive immediate relief, I went to your famous Institute, where I was treated and operated upon and a large stone was removed from the bladder. The old method of cutting, which is so dangerous, was not employed, but the new and painless process of crushing; this process was an agreeable surprise to me, no pain and no risk, as in the old method of cutting. From the day of the operation I began to improve, and in a few weeks thereafter I returned home to my wife, family and friends, a well and happy man, and I have spent the last five years with ease, comfort and pleasure--a living, walking testimonial for your renowned Institute. Believe me, when I say that words fail me to express to you my sincere gratitude for your marvelous and almost miraculous cure effected in my case. I feel sure no invalid could receive more skillful and kindly attention anywhere in the world. I would urge every sufferer to take treatment at the Invalids' Hotel and Surgical Institute, believing it to be the most skillful, and feel sure that it is the most advanced of the age.

Sincerely and gratefully yours, WM. H. MILLER, Stoyestown, Somerset Co., Penna.

CASE 720,402. STONE IN BLADDER ONE AND A HALF INCHES IN DIAMETER SUCCESSFULLY REMOVED WITHOUT CUTTING OR PAIN.

From severe exposure when in the army, I brought upon myself an acute attack of rheumatism, from which I suffered terrible pain. Following this I began to be troubled with my bladder and kidneys. For three years I experienced considerable discomfort. There was severe burning and scalding, and urination caused much pain. I passed two pieces of gravel and became convinced that I had stone in the bladder. Was examined by my home physician, who said there was no stone. I was not satisfied, however, and went to the Invalids' Hotel and Surgical Institute. I was examined by their specialist. After an injection of cocaine and carefully cleansing out the bladder, a stone was found about one inch and a half in diameter, probably similar in its composition to the pieces already passed. I was advised to have it operated upon and removed, which I arranged to do. The process used was their new and painless one of crushing, no knife or other cutting instrument being employed. The stone was readily grasped by the crusher and reduced to small fragments. The evacuator was then introduced and the stone entirely removed. After a few weeks' careful attention my health was entirely restored and I was able to leave for home. I take great pleasure in making public my wonderful cure. I could not speak in too high praise of those who took charge of my case, nor recommend too highly this famous Institution. It is about three years since I was operated on, and pave not felt any bad effects since.

THOS. DALTRY, Huntington, Huntington, Co., Ind.

CASE 820,539. GRAVEL OR STONE WITH CHRONIC KIDNEY AND BLADDER DISEASE. CURED NINE YEARS AGO AFTER BEING GIVEN UP TO DIE.

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

In 1884, at the age of fifty-four years. I was prostrated with Kidney and Bladder complaint and told by the best physicians that I was but ten days out of the grave. I applied to your Institute for help and received treatment, and now after nearly nine years am in comparatively good health. All this time I have been able to do much work and to oversee my farm. Two stones or gravel were passed while under home treatment. No further formations have developed. The many cases I have recommended to you have all been more than satisfied with the results of their treatment. I wish to thank you for the great benefit and care I received at your hands.

Yours truly, ORVILLE THOMPSON, Avoca, Steuben Co., N.Y.

CASE 859,612. A STRONG ENDORSEMENT.

_To whom it may concern:_

This is to certify that I took treatment at the Invalids' Hotel and Surgical Institute, Buffalo, N.Y., and I was cured of a chronic trouble that had been maltreated by other physicians. While there I saw a man who had been cured by the specialists, who had before been given up to die by the best doctors in Troy, N.Y. Of course, the case must have been a very stubborn one. I afterwards saw a man here, in Georgia, die, who, if he had been in Pierce's Surgical Institute under the treatment and care of his skilled doctors and nurses, I know would have most assuredly got well. Why? Because it was only a case of _stone in the bladder_, and they are easily cured at Dr. Pierce's Surgical Institute. I think almost any chronic disease can be cured there, if taken in time, judging from my observations while an inmate of that Institution.

H.E. BANKSTON, Barnesville. Pike Co., Ga.

CASE 820,260. COMPLICATION OF DISEASES.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

_Gentlemen_--It is now about six months since I discontinued your treatment, and as I have had no return of the old symptoms, I consider it unnecessary to take more medicine. When I visited your Institution some two years ago, I had but faint hopes of ever being restored to health, as I was suffering from a complication of diseases. My case was an unusually obstinate one, yet I am satisfied that a cure could have been accomplished in half the time, had I been able to follow your directions in regard to diet more closely. I hereby tender you my sincerest thanks for the kind treatment received while at your Institution. Those days will always be the happiest in my memory. I will close by giving your faculty my sincere thanks, and hope success will crown your business.

Yours very gratefully, J.F. RITTER, Medford, Jackson Co., Oreg.

Stricture, the result of injury from falls and accidents, is particularly difficult of permanent cure. The following gratuitous recommendations are from cases belonging to this class who entirely approve of the publication, with full name, photo-gravure and address.

CASE 820,507. STRICTURE CURED AFTER MANY OPERATIONS BY OTHER SURGEONS HAD PROVEN TO BE FAILURES.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

I would state that I am an architect, fifty-two years of age, that about seventeen years ago I fell from a scaffold, a distance of eighteen feet, across a beam, striking upon the perineum. A physician was immediately called and I was treated by him for about eight or ten weeks. A catheter was introduced into the bladder, but caused such intense pain and anguish that it had to be withdrawn. It was tried again but could not be introduced on account of the lacerations in the urethra, caused by the violence used. A consultation was held and an operation recommended. An anæsthetic was used and a cut made through the perineum from the outside into the bladder. A catheter was inserted into the bladder, tied in place and left in position for about eight weeks. After eight or nine weeks the catheter was removed, but it was four or five weeks before the wound in the perineum healed. After a few months I began to have a urinary difficulty, and symptoms of urethral stricture. This condition continued until the urethra was entirely closed, and it was impossible to make water. A physician attempted to pass a catheter, but could not do so. He continued to treat me by the process of dilation for five or six months. I began to feel more comfortable, but the symptoms of stricture would manifest themselves again. I then went to a hospital at Toronto. There I was treated also by the dilating method. The treatment was continued for about four weeks, but became so very painful, and there was so much irritation in the urethra, that it was impossible to endure it longer. They then called an electrical specialist and he began treatment by electrolysis. In about three weeks I went home, but in a short time the stricture again manifested itself; the contraction was very marked, and micturition very difficult. It grew gradually worse and I could not receive any comfort or benefit. I returned to Toronto to take further treatment from the electrical specialist. During the operations of dilation of the urethra, I passed some gravel. After four weeks treatment I returned home, but in about two months was as bad as ever, and last October went back to Toronto and was again treated by the electrical method. The doctor had much difficulty in inserting the smallest catheter, and it caused intense pain and suffering. The last time he attempted to insert a catheter, there seemed to be something give way, and a large amount of pus and fluid passed from the rectum. The physician told me an abscess had formed. I returned home and tried to keep as comfortable as possible, but could not micturate with any degree of satisfaction or comfort. I gradually began to grow worse and there was a return of the stricture with inflammation of the bladder. In March, 1892, there began to be formed gravel in the bladder. They would at times obstruct the flow of urine entirely. I kept going from bad to worse, until the urethra appeared to be entirely closed. The physician I called found it impossible to pass a catheter Into the bladder, and advised me to go to some hospital where I could receive proper treatment, and where proper appliances for this class of cases were used, as he felt satisfied nothing could be accomplished for me at home. I then came to the Invalids' Hotel and Surgical Institute in Buffalo to receive treatment, and the treatment has been so successful that the urethral stricture as well as the gravel have been removed. After I returned home I felt as if a great load had been lifted from my shoulders. I have no irritation at all as I used to have, and I can keep my water for six or seven hours without any trouble, and the water seems to be clear and free from sediment of any sort, and in general I feel as I never expected to again. The doctors here were dumb-founded at the short time I was in getting fixed at your Institution, and feel ashamed to ask any questions as to treatment. Many months have passed and I continue well and active in my profession. Any one I can send the way of your Institution you may be sure I shall do so, and thanking you personally for your kind and successful treatment of my case,

I remain ever your well-wisher, ARCHIE RITCHIE, Architect, Mount Forest, Ont.

GRATEFUL LETTER FROM A PROMINENT ARCHITECT.

TO THE WORLD'S DISPENSARY MEDICAL ASSOCIATION:

_Gentlemen_--It is again with the greatest of pleasure that I write you after twelve months since I was treated in your Institution, to add to my former testimonial. With the blessing of good health I have been able to attend to my business as well as ever, and have the greatest of comfort in every respect, and feel about ten years younger than I was when I came to your Institution for treatment, and I have still again to thank you, gentlemen, for the kind and courteous attention I received from every one I came in contact with in your Institution, while under treatment, and shall ever remember my visit to your Hotel with pleasure, and shall advise any one suffering under the same trouble, with whom I may come in contact, to come to your valuable Institute for treatment, where they can have the best of attention and skill. Again thanking you, gentlemen, for what you have done for me, I hope that your Institute may long be kept up to minister to suffering humanity. God bless your staff of physicians, and may success attend you, is the wish and prayer of ever your well-wisher and grateful patient,

ARCHIBALD RITCHIE, Mt. Forest, P.O., Ont.

[_See Mr. Ritchie's former communication, on page 857._]

CASE 2A-126. PAINFUL IMPEDIMENT TO THE ACTION OF URINARY ORGANS.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

This is to certify that I have been to the Invalids' Hotel and Surgical Institute, at Buffalo, N.Y., for treatment, and cannot speak in too high terms of the staff of physicians and surgeons, or of the treatment which I received. I consider the Hotel one of the best in the country, the table being excellent, and the treatment the very best to be found in the land. It is a most pleasant place to stay. The attention which is given by the nurses could not be better. As surgeons I think your specialists possess the finest skill that can be found. Any person suffering should not delay, but go at once and be treated and get well. You are at liberty to use this endorsement in any way that will do the most good.

With gratitude, I remain, EDWARD COMPTON, Chillicothe, Ill.

CASE 620,380. STRICTURE, THE RESULT OF INJURY--CURE PERMANENT.

The stricture, which resulted from an injury, had been greatly aggravated by uric acid crystals which were continually forming in the urine. Patient had rheumatism, causing this acid state of the system. He had been a great sufferer for many years, continually experiencing the nervousness, smarting, pain and burning, with occasional attacks of urethritis, common to the malady in this form. This made the stricture almost unbearable, and he was practically incapacitated for his labor at the time that treatment was undertaken in our Institution. He had been to the Hot Springs and in the care of other physicians with no satisfactory results. The relief of the stricture by our new and painless method was followed by very great improvement in his condition, after which appropriate remedies for the rheumatism were administered, and the result was a very gratifying and satisfactory relief from his difficulty. Patient afterwards embarked in business as a proprietor of a hotel of his own, and has been ever since very active in carrying on the business, and extremely successful. The stricture showed no tendency to recur, as is commonly the case where it is cured by other methods than employed by us. Many years elapsed from the time that it was treated before the testimonial appended was written.

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

_Dear Doctors_--I want to thank you, but words cannot express my gratitude, for your treatment white at your Institution, but I will say for the benefit of persons afflicted with stricture, that I was entirely cured by you, and after several years have not seen any signs of its returning.

Yours truly, FAY SAWDY, Proprietor Hotel Sawdy, Earlville, Madison Co., N.Y.

CASE 551,864, URETHRAL STRICTURE--NASAL CATARRH--CURED IN TWENTY DAYS--A PREVIOUS OPERATION BY A NASHVILLE (TENN.) SURGEON UTTERLY FAILED.

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

In September, 1886, I was examined by one of your able staff of physicians and was found to be suffering with a bad form of nasal catarrh and with two strictures in the urethra (water passage). After a few days' general treatment, I was operated upon and turned over to be cared for by the nurse, from whom I received all the attention that was necessary. To my utter astonishment I was dismissed in twenty days from the Surgical Institute, cured of the stricture. I had been operated on by one able surgeon of Nashville, Tenn., and was worse after the operation than before. I have never had a symptom of the stricture since I was dismissed from the Invalids' Hotel and Surgical Institute, and have been in better health than ever before in my life.

Very truly, S.A.D. SMITH, Laurel Hill, Tenn.

CASE 820,201. STRICTURE OF THE URETHRA OF THREE YEARS' STANDING--COULD PASS URINE ONLY IN DROPS AND WITH GREAT PAIN.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

_Gentlemen_--Wishing to add my testimony as to your great skill in surgery, I will say that I suffered with stricture of the urethra, due to an injury, for about three years. It became so bad that at times I could pass water only in drops and with great pain. I went to a doctor here, who used sounds which helped me for a time, but in less than six weeks I was worse than ever. Hearing of your place, I came to you and had a painless operation performed, and have ever since been thoroughly cured. I experience no trouble or pain. It is three years since I had the operation, and the cure has proved permanent. You have my deepest gratitude.

Yours truly, FRANK BRENDELL, Olean, Catt. Co., N.Y.

CASE 820,472. COMPLICATED AFFECTION OF NERVOUS SYSTEM AND URINARY ORGANS.

_To the afflicted with chronic Diseases:_

It is with great pleasure that I refer to the successful treatment, together with the kind care and attention received at the hands of the professional staff, both physicians and nurses, of the world-renowned Invalids' Hotel and Surgical Institute. In every way It verifies their statement--"Not a hospital but a pleasant remedial home," and as such I add my name to the thousands who know and recommend it to the afflicted. Not only was this true in my own case, but in many which came under my observation while there, so I say to the afflicted--visit them if you can and if your case (no matter of what character) is Within human skill, you will never have to regret it.

Very sincerely yours, EDWARD J. ARCHER, Plainwell, Mich.

CASE 520,408. STONE IN THE BLADDER.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

_Gentlemen_--For six years I had been a great sufferer from stone in the bladder. The discomfort increased, until it almost became unbearable. Hearing of the universal success of the specialist at the Invalids' Hotel and Surgical Institute, in similar cases, I went there and submitted to an operation. The method employed was their new and painless one of crushing, no knife or cutting instrument being used. I felt no pain afterward, there was no fever, and I could have gone home the day after. The operation was witnessed by one of my friends, who says it was very artistic and done with skill. It was a complete success, for I have not been troubled in the least, although nearly seven years have passed.

I feel that I cannot speak in too high praise of this renowned Institution and its staff of skilled physicians. No invalid need fear to place himself under the skillful treatment and kindly care to be received there, for I am confident that all the benefit known to medical science, can be obtained at the Invalids' Hotel and Surgical Institute.

ROBERT WORTHINGTON, Staunton, Fayette Co., Ohio.

CASE 114,747. NERVOUS DEBILITY, DYSPEPSIA, KIDNEY AND LIVER DISEASE--CURED.

WORLD'S DISPENSARY MEDICAL ASSOCIATION:

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

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

With many good wishes and thanks for my cure,

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

CASE 790,698. DIABETES CURED BY HOME TREATMENT.

_To whom it may concern_:

This is to certify that for a number of years I was a constant sufferer, and what was many times termed a hopeless victim of that terrible disease, diabetes. The symptoms were indeed alarming; my strength being so completely exhausted that my walking from room to room was attended with difficulty. My nerves were in a constant tremor, and in fact no other words than that, "I was completely out of fix all over," will express my condition. Having purchased a bottle of Dr. Pierce's Favorite Prescription for my daughter, and in looking over the directions of the accompanying circular and finding my own case so thoroughly described, I decided at once to give his special home treatment a trial, which I did during the three months that followed. This proved to be all that was required for the restoration of my usual health, and during the four years which have since elapsed I have had not the slightest reason for believing otherwise than that a perfect cure has been effected, and can most heartily recommend Dr. Pierce's medicines and treatment to any or all who may be suffering with kidney complaint in any form.

Very sincerely yours, MRS. MARY A. WOODRUFF, Columbus Junct., Louisa Co., Ia.

CASE 795,590. INCONTINENCE OF URINE--CURED BY SPECIAL HOME TREATMENT.

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

_Dear Sir_--I consider myself duty-bound to you and suffering humanity to acknowledge the benefit that I have received from your treatments. From babyhood till I was twenty years old I was continually bothered with a weakness of the muscles of the bladder, that gave me much trouble, both by night as well as day. I doctored with several physicians and tried all patent medicines, but could not get any relief until I took your medicine about six months, and now I am sound and well. It has been over two years since I quit taking your medicine, and have had no symptoms of the disease returning.

Yours most gratefully. Miss MOLLIE RICHMAN. North Cove, Pacific Co., Wash.

CASE 4A-2,226. BRIGHT'S DISEASE AND GRAVEL CURED BY SPECIAL HOME TREATMENT.

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

_Dear Sir_--You have my thanks and best wishes for your success, as you cured me of what the doctors here called Bright's Disease and Stone in the Bladder. They did me no good, so I concluded to write to you, which I did, and am happy to say your medicine worked like a charm. God and myself only know how I suffered. I lost fifty-six pounds of flesh in six weeks and I thought my time had come, but when I commenced taking your medicine, in three days I saw a change for the better was taking place, and in one month I considered myself cured. I am still in good health and can do as hard a day's work as any man. Again I thank you. Your charges were reasonable and any one suffering as I was should write you at once.

Any person writing to me must send stamped addressed envelope if wanting an answer.

J.W. THOMPSON, St. John, Whitman Co., Wash.

CASE 2A-223. INFLAMMATION OF THE BLADDER. RETENTION OF URINE.

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

_Gentlemen_--I had been a terrible sufferer for many years with Bladder trouble. I had experienced the greatest discomfort, and tried in vain to find relief. I was persuaded to go to the Invalids' Hotel and Surgical Institute, I went and while there submitted to a course of treatment that gave me relief, and was entirely satisfactory. Three years have elapsed and I continue well. I take the greatest pleasure in making public my cure. No sufferer going there can fail to receive all the benefit to be derived from medical treatment. The staff of physicians are skillful and of large experience; the attendants kind and attentive, and the Institution, in all its appointments, not to be excelled in the country. I had been told by other physicians, Jealous at your success, not to go to your place, but I am now more than pleased that I disregarded their advice.

E.A. BROWN, Corfu, N.Y.

* * * * *

RUPTURE. (BREACH OR HERNIA.)

By the term _Hernia_, we mean a tumor, which is formed by the displacement of the intestines, the omentum (covering of the bowels), or both, and which protrudes from the abdominal cavity. The most common varieties are _umbilical, inguinal_ and _femoral_ hernia. Children are most subject to umbilical, males to inguinal, and females to femoral, hernia.

CAUSES. These are either _predisposing_ or _exciting_. Any thing which occasions general or local muscular debility, as dropsy, pregnancy, abscesses, wounds, obstructions to natural evacuations, etc., is a predisposing cause of hernia. The exciting cause is pressure applied to the contents of the abdomen, as straining in evacuating the bowels and bladder, lifting heavy weights, or violent physical exertion.

SYMPTOMS. The only characteristic symptom of hernia is the presentation of an elastic, or doughy tumor of variable size, which either gradually or suddenly makes its appearance. There is flatulence, uneasiness, and sometimes pain in the abdomen.

Sharp and dull pains frequently recurring and confined to the locations where ruptures appear should receive attention. Examination will not infrequently reveal a small enlargement. If a hernia, this will usually disappear after a night's rest and may not be again noticed until the next day, or for several days. On coughing, with the finger applied to the enlargement, a sensation of an impulse (succussion), or slight additional protrusion will be felt

The trouble appears at any time of life, an analysis of seventy thousand cases indicating that it is most common in debilitated persons, and that there is a constant decrease in the frequency of the affection from the first to the thirteenth year, after which rupture is more and more frequently met with as age advances.

INGUINAL HERNIA (see Fig. 1) is more common than all other forms of rupture. It is more frequently met with in men, and when severe there is usually a mass of intestine which falls into the scrotum and has an evil effect, by pressing upon the testicle. The protrusion follows the spermatic vessels and hence it usually appears low down in the abdomen and on one or both sides of the pubic bone.

FEMORAL HERNIA (see Fig. 2), most common in women of mature life, is felt as a lump below the strong ligament in the groin which forms the line of separation between the thigh and the abdomen. On its outer side and close to it can be felt the beating or pulsation of the large artery of the thigh.

UMBILICAL HERNIA (see Fig. 3) appears at or near the navel and is most common in children. It may be present from birth, or it may result from fretting and crying at any period of childhood.

Sufferers from any form of rupture are constantly subject to the danger of strangulation. This occurs when, from any cause the free return of the contents of the protruded part of the intestine is prevented. It is an accident of a serious nature, inasmuch as nearly fifty per cent. die if not carefully operated upon, and with the most skillful treatment, one in four cases terminates in death.

Every individual should guard against rupture by maintaining, by proper exercise, diet, and rest, a condition of vigor and tonicity of the muscular system.

When debilitated, all strains and exertions should be care fully avoided until the health is built up, and the relaxation overcome.

TREATMENT. The palliative treatment of hernia is by _reduction_ and _retention_. Reduction consists in returning the protruding intestine to its proper place through the opening by which it escaped. This is accomplished either by manipulation or by a surgical operation. Retention is effected by wearing a mechanical appliance called a _truss_.

As soon as the tumor protrudes, or the "bowel comes down," the patient should assume the recumbent posture, with his shoulders and feet elevated. The patient or an attendant should grasp the hernia, and with gentle, but gradually increasing pressure upon the tumor attempt to replace it. At the same time let the patient knead the bowels upward by pressing upon the integument, so that the intestine may, as far as possible, be pushed away from the point of protrusion. Sometimes the contraction of the muscular fibres at a point where the hernia makes its exit is so great that the tumor cannot be replaced. In this case the system should be relaxed with lobelia (not given in doses to produce vomiting), and as soon as the patient is thoroughly under its influence, the manipulations may be resumed. When there is any difficulty experienced in putting back the "breach," or rupture, professional assistance should be promptly summoned. After the reduction of the rupture, a truss should be properly adapted, applied, and constantly worn, to prevent the protrusion of the intestine.

Of the latter instruments there are several hundred varieties for sale throughout the country. With the exception of about one-half dozen forms, which embody the true principles of a proper truss, they are, without exception, harmful. Unless proper support be given to the walls of the abdomen, and that without constant pressure, a truss does harm; then, too, the shape of the pad must be such as to avoid pressure where it is not required; otherwise, as in the case where a small ring is worn upon a finger, there is a gradual loss of strength and a depression formed in the healthy tissue, which can be plainly seen and felt. In this way trusses do harm, and such evil consequences may follow the _improper_ application of a _good_ truss.

SURGICAL TREATMENT. When the hernia has become strangulated and cannot be returned by manipulation, a surgical operation is necessary. Whenever the necessity for such a procedure is apparent, it should be performed _immediately_, for the greater the delay the greater the liability to fatal results. The operation consists in cutting down upon the strangulated bowel, thus relieving it of its constriction and facilitating its replacement. It is a delicate operation, and must be skillfully performed. After the operation, the patient requires appropriate hygienic treatment.

THE RADICAL CURE. A small percentage of cures will follow the proper use of a good truss, and the advertisements of the so-called rupture cures are founded upon such cases. These impostors pretend that the use of some vaunted salve, ointment, or styptic lotion, applied on the outside, will heal and cure the deep-seated separation of the muscular fibres. The truss in these cases is the curative means in the small number that are relieved, and for it but few dollars should be charged instead of the exorbitant prices demanded by these impostors.

Improvements in surgery in this age of wonders, have kept apace with the advances in electricity and other branches of science. Diseases and deformities which only a few years ago were considered incurable are now overcome and cured with certainty and without risk or suffering. Especially is this true with reference to hernia or rupture.

Our specialists have devoted much attention to the radical cure of rupture, or breach, with the most gratifying results. Formerly we employed and advocated the use of the injection treatment only. This method was tested and brought to a most efficient and practical stage, so that we now apply it in the treatment of over eighty percent. of the cases that are presented at our Institution. This plan of cure, as used by us, is a great advance over that of any similar one in use, throughout the country. Our fluid is much more safe in its effects, never gives rise to the troublesome abscesses and inflammation that is common to the use of the injection fluids that have been advised on the Heatonian method. The fluid we use is a bland and healing agent, which produces an exudation behind the cords that surround the inguinal rings, and forms a well defined truss pad of moderate size in such position that the rupture cannot pass by it and appear externally. It causes also an adhesive inflammation limited to the hernial sac, that completely closes it.

This treatment is rendered _entirely painless_ by the use of a solution which is injected underneath the skin with a fine hollow needle attached to a small syringe, and which tends to produce complete local anæsthesia, or loss of feeling so that the procedure is thoroughly and carefully carried out without any risk or discomfort.

The needle used by us for the treatment of the hernia is so perfected that any possible injection of the fluid into the abdominal cavity, or upon the coating of the intestine, is an impossibility, and in no way can an injection be made into a blood vessel or nerve so as to produce any discomfort or trouble. We thus avoid all the risks that pertain to the usual plan of injection.

There is a small percentage of cases, as before stated, in which this form of treatment is not likely to give a permanent cure, from the fact that the omentum or intestine has become adherent externally, to the sac, or in the scrotum, to the coverings of the testicle. This makes the complete replacement of the rupture without cutting an impossibility, and in such cases even where the hernial opening is closed, treatment by injection only would not result in a permanent cure.

Our aim is to treat all cases of rupture that we undertake in such a manner that _by no possibility can the deformity return_. We therefore have for the cure of these cases another method, by which with our local anæsthetic fluid, we are able to perform a surgical operation without any distress whatever to the patient. The greatest risk of the old operation for rupture was the danger of general anæsthesia with chloroform or ether, or some similar agent. The great majority of individuals cannot bear the inhalation of the large quantities of these anæsthetics necessary to secure loss of feeling without consequent nausea, and at times an effect upon the heart that often results seriously. The risk from the anæsthetic is much greater than from the surgical procedure. By our method, this risk is entirely done away with. The pain dispelling fluid enables our operator to pursue his method WITHOUT GIVING THE PATIENT ANY PAIN OR DISCOMFORT WHATEVER. During the operation he is in full possession of all his faculties, and can assist in any way desired by coughing, or straining, in order, at any time, to complete the protrusion of the rupture and show its entire extent of surface when the sac is laid bare. We then replace the rupture completely; suture the sac so that the rupture will have no pocket into which to descend, and then firmly unite the rings by a plan that we have invented, and BY WHICH THEY ARE MADE MORE STRONG AND FIRM THAN IN THEIR ORIGINAL STATE.

Early in our experience, and while using the plan of treatment that is usually employed for the radical cure of rupture, we had occasional relapses of the difficulty, but since using our improved method we have had no such trouble. We can assure our patients that there is less risk of the appearance of the rupture at the point where the operation is performed than there is of a new breach forming. The success of this treatment has been invariable. None of the plans of treatment that we pursue for the cure of rupture tend to keep the patient in bed more than a few hours. There is little or no pain, after either of our plans of treatment, and out of the many hundreds which we have treated and perfectly cured, in no instance have we had any inflammation or serious manifestation--there being no fever or general reaction. It is a matter of great surprise to our patients, who undergo our treatment for the radical cure of rupture, that by our varied methods, the object is accomplished with so little discomfort and with no pain whatever.

From two to three weeks' personal attention of our specialist, is usually all that is required even in the worst cases.

NO TRUSS IS NEEDED AFTER OUR TREATMENT. WE CONSIDER A CASE CURED ONLY WHEN THE PATIENT IS ABLE TO DO WITHOUT A TRUSS OR SUPPORT IN ALL THE USUAL WALKS AND VOCATIONS OF LIFE.

* * * * *

TESTIMONIALS.

The testimonials that we append are but a small number out of the great mass that we have received. A very large percentage of individuals who have been treated by us for rupture desire that their disability be held a matter of sacred confidence and with all such we take pleasure in guarding their confidence with the greatest care. Others are quite willing that their experience may be made public in this manner for the benefit of similar sufferers.

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.

A LOCOMOTIVE ENGINEER

TESTIFIES TO HIS CURE OF RUPTURE. THE CONSTANT JAR OF A LOCOMOTIVE IS ONE OF THE SEVEREST TESTS THAT CAN BE APPLIED TO A RECENTLY CURED CASE.

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

_Gentlemen_--After suffering a number of years from a painful Rupture, I went to the Invalids' Hotel and Surgical Institute, at Buffalo. While there, I submitted to an operation which was not painful. It was done without chloroform, ether or any dangerous anæsthetic. Under the skillful treatment of your specialists and the very close and kind attention of your nurses, in less than a month, I left the Institution feeling like a new man. I have every reason to believe that the Hernia will never return, and that I am permanently cured. It it a great relief to go without a truss.

Very respectfully, F.W. FROST, Rotterdam June, Schenectady Co., N.Y.

A LOCOMOTIVE ENGINEER'S

ADVICE TO SUFFERERS FROM RUPTURE. THE CONSTANT JAR OF A LOCOMOTIVE IS ONE OF THE SEVEREST TESTS THAT CAN BE APPLIED TO A RECENTLY CURED CASE. THROW AWAY TRUSSES.

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

_Gentlemen_--I am an engineer--running an engine on the Western Division of the Fitchburg Railroad. I had a severe case of double Hernia; still, have always worked along with them until this winter. One side was of twenty-five years' standing--the other of about eight years. This winter I was laid up sick with pneumonia; in coughing so much, which of course was made necessary by that terrible disease, I strained myself so that after getting up from my sick-bed, I was not able to go to work, as I could get no truss that would hold the rupture. I was talking with Brother Stagg one day. He asked me "why I did not go to the Invalids' Hotel and Surgical Institute, at Buffalo, N.Y., and get cured?" I went, and in three weeks was cured, so that I could dispose of my truss entirely.

I wish to say this comes from me direct; it was my own proposition that this letter be made public.

Yours respectfully, F.S. AUCHENPAUGH, Rotterdam, N.Y.

RUPTURE FROM BOYHOOD.

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

_Gentlemen_--I am glad to say that I was cured at the World's Dispensary Medical Association after suffering from boyhood until the age of twenty-five from a hernia, or rupture, by a treatment of twenty days. It is now five years since I was cured, and can say that I was permanently cured. You have my most sincere gratitude for your skillful operation and the good care received in your Institution while there. I can recommend your nurses and physicians most highly, and I think your Institution unequaled in this country.

Yours truly, ALBERT SAUVAIN, Silverton, Marion Co., Oreg.

HERNIA--LEFT INGUINAL--PRESENT EIGHT YEARS WITH NERVOUS PROSTRATION.

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

_Gentlemen_--I take greatest pleasure in making public the most wonderful cure I received at the Invalids' Hotel and Surgical Institute of Buffalo.

I had suffered severely for eight years with a left inguinal hernia; had tried many physicians and medicines, but found only temporary relief. I was greatly run-down, and my nervous system considerably shattered. My friends persuaded me to go to the Invalids' Hotel and Surgical Institute. While there I was operated on by their specialist, and in a few weeks began to gain strength and energy so that I could return home, and have since felt entirely well.

Words could not do justice to my feeling in regard to this institution. There is no place like it for medical aid, and I would urge all invalids to go there, feeling confident that they could no where receive more skillful treatment or more kind attention and care.

Respectfully, A.J. KIDDER, North Yam Hill, Yam Hill Co., Oreg.

HERNIA. CURED SEVERE PAIN.

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

_Dear Sirs_--Your favor received and found that you would like to have me give you a testimony of my case I will say in reply that I was treated at the Invalids' Hotel and Surgical Institute, for Hernia on the left side. It was not large but it gave me severe pain while working. I wore a truss but it did not relieve the pain very much. I read in the paper one night your advertisement and a week after I started for the Invalids' Hotel, and took the treatment for rupture and went home sound and happy, like a new man, and I can work harder than ever and can assure anyone interested that it is no humbug.

With the best wishes, JOHN H. RIEMER, Zion, Wis.

P.S.--If any one would like to inquire about my case give them my full address and I will inform them about it, if they enclose return stamped and addressed envelope for reply. J.H.R.

"SOUND AS A DOLLAR."

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

_Gentlemen_--Am greatly pleased to report that the operation for the radical cure for rupture received at your Institution in May, 1889, has proved entirely successful. I am sound as a dollar. My case was an extremely troublesome and dangerous one. Many times I required the assistance of a surgeon to reduce it. No truss would hold it a whole day. My two weeks' stay with you was worth thousands of dollars to me. Will gladly answer any inquiry and would advise any one suffering from hernia to take the radical cure.

Very truly yours, B.F. HOOK, Holmesville, Holmes Co., Ohio.

RUPTURE, DYSPEPSIA OR INDIGESTION, AND KIDNEY DISEASE.

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

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

RUPTURE.

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

_Gentlemen_--About four years ago, when working on a scaffold it gave way, and I fell a few feet and the strain and jar caused a rupture in the right side. I did not pay very much attention to this until I noticed that it was enlarging. It finally grew so that I could not work. I used several kinds of trusses that did me no good.

I went to the Invalids' Hotel and Surgical Institute, and submitted to an operation which was entirely painless and proved most satisfactory in every respect. Since then I have been well and able to do hard work for a man of my age (72). I feel no inconvenience from the rupture.

I take pleasure in recommending the Institute to all who are in need of help. I can highly recommend the physicians and nurses and the kind attention I received while there. I am now well and sound as ever.

Yours truly, HENRY KEIFER, Spring Green, Sauk Co., Wis.

HERNIA AND PILES CURED WITHOUT PAIN.

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

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

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

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

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

HERNIA OR RUPTURE.

LARGE PROTRUSION OF SIXTEEN YEARS' STANDING.

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

_To the afflicted_: For sixteen years I was troubled with Hernia, caused by heavy lifting. It was on the right side and the protrusion sufficient to extend into the scrotum. I purchased trusses, but none of them could be worn with comfort, and I suffered very much. I concluded to go to the Invalids' Hotel and Surgical Institute and see if I could not obtain relief. While there I submitted to an operation. The result was entirely satisfactory. The pain in my back subsided; my general health began to tone up, and in a short time, thanks to the skill of their specialist and the kind attention of their nurses, I felt like a new man. I take pleasure in highly recommending the Institution to all the afflicted. I feel confident that all the benefit to be derived from medical or surgical treatment is to be received at the Invalids' Hotel and Surgical Institute.

Yours respectfully, M.G. HARTZELL, Deadwood, So. Dakota.

DOUBLE RUPTURE.

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

_Gentlemen_--It is with much pleasure that I write you this testimonial of the wonderful cures you have performed for me.

In the year 1883, I became ruptured on the _left_ side. I immediately wrote you (having heard of your fame in curing all kinds of diseases) for your terms of treatment which I received by return mail, you also stating you were positive you could cure me. Through unavoidable circumstances I was unable to come to your Institution until December, 1886. During this time I had tried wearing a truss, which only made it worse, and very much aggravated my complaint as it was impossible to hold the rupture in its place. However I arrived at the Invalids' Hotel on December 8th, 1886. On being examined by one of your staff, I was pronounced a bad case, but by your mode of treatment you could cure it. I was therefore, operated upon by one of your specialists, without any cutting however and comparatively little pain, by your scientific method, and in thirty days returned home cured. The time I had to remain there, I believe, was much longer than most persons treated for the same complaint.

Since then I have worked very hard sometimes (my occupation being that of a farmer,) so much so that I became ruptured on the _right_ side three years ago,--the other side remaining perfectly sound without any protection. I considered myself very unfortunate in being in this position again, fortunate in knowing where to go for relief, and very soon was back in your Institution where I was successfully treated and perfectly cured and am to-day a sound man and able to do any kind of work on my farm.

I write this testimonial for the sake of suffering humanity, and wish you to use it in any way that the greatest number of persons may read it. As for myself, I would not be in the condition I once was and not know of your Institution for all I could see. I not only recommend your Institution for the complaint of which I was cured but for all chronic diseases or anything requiring a skillful surgical operation, believing your Staff of Physicians and Surgeons to be second to none anywhere. Your nurses and attendants, and every accommodation, also, being all that is necessary to make your Institution everything that its name implies--a complete Invalids Hotel and Surgical Institute.

Respectfully yours, DAVID HARTLEY, P.O. Box 84, Wyoming, Out.

P.S.--I have also received much benefit from taking your "Golden Medical Discovery" for dyspepsia and liver complaint, and being broken down generally. A few bottles worked wonders, and I have been well ever since, and that was quite a number of years ago.

D.H.

RUPTURE.

A GRATEFUL PATIENT'S WORDS OF PRAISE.

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

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

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

STRANGULATED RUPTURE OR BREACH

IN A CHILD TWO YEARS OLD, CURED.

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

_Dear Sirs_--Our boy is, since the operation, quite well and healthier than ever before, so that I presume, the rupture, or a part of it, may have existed since his birth. Even that small lump in the groin has, as much as I can feel by touching, completely disappeared. I take this opportunity of expressing my heart-felt thanks for the kind and christian-like treatment my wife and boy experienced from you and the nurses. God bless you and let you live long for the welfare of suffering men. Dr. Pierce's Invalids' Hotel of Buffalo, N.Y., deserves to be recommended to every sufferer of whatever disease. Eight years ago I underwent a successful operation, saving my body a member. The dangerous outgrowth, which made the operation a necessity, never returned. In regard to your specialist, I wish to remark, that his skillful way of performing operations reminded me very much of Bernard von Langenbeck, professor of surgery in the University of Berlin, where I was a student. He is just as tender and sympathetic with his patients as that famous director of the Prussian Royal Clinical Hospital has been. As to the medicines of Dr. Pierce, I recommended them to members of my congregation, who told me that they did them good. Dr. Bastian, of Dansville, N.Y., a druggist, told me that your medicines are bought by the same persons again and again. I consider this to be the best recommendation. A medicine which is of no effect will not be bought a second time by the same person.

Yours, REV. RICHARD KRAUSE, Portway, N.Y.

Mrs. Mary Krause, the mother of the little boy whose case is above reported, writes: "In respect to your medicines I can only say that they have done me and others much good, especially when I suffered with chronic catarrh and doctored with your physicians. I shall never forget the kind treatment I received from your physicians and nurses during the time I had to stay in your house, while our Herman had to go through that dangerous operation which was necessary to cure his strangulated rupture. I can recommend your Institute and medicines to all suffering people."

HERNIA OR RUPTURE

OF FOURTEEN YEARS CURED "SOUND AS A DOLLAR."

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

_Dear Sirs_--In reply to yours of the 29th ult., in which you kindly make inquiry in regard to my physical condition, I would say, that I am now, I think, as sound as a dollar, and consider that after I had bad fourteen years of suffering with Hernia, and being cured as I was last winter at your Institute, makes me under great obligations to the science and skill of the World's Dispensary Medical Association.

Very respectfully yours, ROBERT GALLAND, Orangeville Mills, Barry Co., Mich.

IRREDUCIBLE HERNIA.

PRESENT FROM BOYHOOD--PROTRUSION OF ENORMOUS SIZE.

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

_Gentlemen_--I take pleasure in reporting that I have not worn the truss for a long period, and that I have been at work steadily at my business of binding and printing, running a large establishment, for over four years, without any trouble whatever from the rupture. It has remained permanently and perfectly cured. You will remember my case as a most severe one. I am a man of sixty years of age, and the disease had been the source of serious discomfort to me since childhood. The protrusion was the size of a man's head, and could not be replaced. I was forced to give up all exercise, and suffered much at my daily work from inconvenience and pain. Any injury upon the protrusion, which could not always be protected, was followed with much discomfort, and my general health was seriously affected. The passage of the food through the confined intestines was a painful process often times, and kept me in great misery. I am thankful to state that since your operation the rupture has remained sound and well, and I have been relieved of all difficulty of the kind. I now enjoy excellent health, and am at my business daily from twelve to sixteen hours, and on my feet constantly, yet without any manifestations whatever of the re-appearance of the rupture. You have my most sincere gratitude for the skillful operation and the good care received in your Institution while there. I can recommend your nurses and physicians most highly, and think your Institution is unequaled in this country.

With many good wishes, I am, Very truly yours, DANIEL NITSCHKE, 2067 Franklin Ave., Toledo, Ohio.

COMPLICATION OF DISEASES.

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

ANDREW HOLES, Moorhead, Minn.

HERNIA OR RUPTURE OF 11 YEARS' STANDING.

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

_Gentlemen_--Allow me to express my thanks to you for the attention and benefits received at the hands of your skillful staff of surgeons and nurses. I had been a sufferer from Hernia for eleven years and tried everything, but was no better. I finally went to the Invalids' Hotel and Surgical Institute, and am now entirely cured and enjoy splendid health. I heartily recommend yours to be the most skillful treatment of the age.

With best wishes, LEWIS CRIST, No. 67 Frankston Ave., Pittsburgh, Pa.

RUPTURE,

AGGRAVATED BY OCCUPATION AS A LOCOMOTIVE ENGINEER--COULD NOT BE HELD IN PLACE--AFTER TREATMENT SUBJECTED TO THE TRYING TEST OF THE CONSTANT JAR OF THE LOCOMOTIVE YET PROVES RELIABLE.

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

_Gentlemen_--It has long been my desire to make a statement of my cure for the benefit of all those persons who have suffered in like manner. I had a rupture that was very large and difficult to hold in place. Trusses of all kinds were tried. They were painful and would not hold it. The rupture would come down constantly when at my engine and give me fearful pain. I was cured at the Invalids' Hotel and Surgical Institute, Buffalo, N.Y., by a treatment that is safe and certain. My cure has been permanent, although I have worked steadily.

Yours sincerely, JAMES M. KEACH. No. 68 Bissell Ave., Buffalo, N.Y.

FEMORAL HERNIA.

This patient, aged thirty-four years, was always delicate; suffered from malarial fever each year for ten years past. The hernia was caused by lifting her father, who was on his sick-bed, during five different times, causing terrible suffering. The hernia was treated by our Specialist, and in eighteen days the lady was able to return home.

She reports:

_Gentlemen_--I am grateful to you for a permanent cure of the hernia, and happy to inform you that I have felt no signs of rupture since I was at your Institution.

Respectfully yours, Miss MATTIE V. THOMAS, Albion, Noble Co., Ind.

"A LIVING DEATH FOR YEARS."

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

_Gentlemen_--In the hope that some sufferer from hernia may be induced to take your treatment for that disease, I send you this certificate, containing a synopsis of my case and cure of the same. My life was a living death for years. I had almost lost all hope of ever being cured, and was plunged in despair, as I had tried so many trusses, appliances and remedies, each one in successive repetition, a failure. In January and February of the year '89, I entered your Institution for treatment, my malady being an inguinal hernia on the right side, of twenty years' standing--from childhood. I was then impressed with the feeling that it was my last chance, and that it would be my last effort, and to be candid I had very little hope that a cure would be effected. To me my condition seemed appalling, as I dare not eat, drink, laugh, exercise or perform any of the functions of life without having to reduce my rupture, frequently as often as forty or fifty times _per diem_, while on occasions the reduction would occupy hours of untold agony. No truss or appliance that I could get would retain the rupture, and I had tried all sorts as fast as they came to my knowledge. Marvelous as it may appear to all sufferers from this distressing affliction, I was discharged from your Institute in thirty days, a well and sound man, and only from memory and the record do I know that I was ever ruptured. I have at times since performed some of the hardest kinds of work for long periods, but no sign of weakness has ever appeared. I do not consider the necessary operation performed as attended with any danger; it is no comparison to the chances a person takes who in the daily walks of life is tortured with a rupture.

While an inmate of your Institution, I was accorded the kindest and most considerate treatment from all members of your staff and employees with whom I came in contact. I consider the appointments and cuisine of the establishment as perfection. You are at liberty to make the fullest and freest use of this testimonial you may see fit in your judgment, and I will cheerfully answer any communication from any sufferer referred to me for more explicit testimony.

I am, Sincerely yours, HENRY WOOD. Mason Valley, Nev.

* * * * *

CROUP, MEMBRANOUS AND SPASMODIC.

Every family should be made acquainted with the symptoms and treatment of this disease. Especially is this true in the case of those living remote from a physician. From the lack of this knowledge on the part of parents, many a little one has perished before medical assistance could be obtained. In some of its forms its progress is very rapid, and, unless relief is obtained in a few moments, or hours at the most, death ensues.

There are several quite distinct pathological conditions of the vocal and respiratory organs which have, in popular parlance, been designated as croup. But two of these are worthy of consideration here. These are _true_ or _membranous_ croup, in which a false, semi-organized membrane is formed, and _spasmodic croup_. Both may result fatally, but the former is much the more dangerous.

MEMBRANOUS CROUP is supposed to originate in the trachea, from which, as it progresses, it often extends upward to the larynx, and downward to the bronchial tubes. It is the result of severe inflammation of the mucous membrane, and is characterized by the formation of a false membrane, which covers or lines the inner surface of the true structure (see Fig. 1). It is formed of a coagulable, semi-fluid exudation from the mucous membrane. On being brought to the surface and into contact with the inspired air, this substance grows thick and tough, or leathery, as we find it. It is the obstruction in the respiratory canal which this foreign matter causes that gives rise to the labored breathing, and the ringing, brassy cough, together with the crowing or whistling inspiration characteristic of croup. Before recovery can take place this membrane must be detached and expelled. The cough is nature's effort to accomplish this work.

The formation of this adventitious membrane in the larynx is attended with more danger than when it is confined to the trachea. In most cases in which the disease has had a very speedily fatal termination, an examination has shown that the larynx was its chief seat.

SYMPTOMS. True croup is generally preceded by what is known as "a cold." The child coughs, sneezes, and is hoarse. It is the hoarseness and the peculiar _character_ of the cough which indicate the tendency to croup. This has been already described. In addition, the child is restless, fretful and feverish. The disease makes rapid strides. Finally the cough ceases to be loud and barking, and is very much suppressed; the voice is almost gone; the face is very pale; the head thrown back; the nostrils dilated and in perpetual motion, the pulse at the wrist very feeble, great exhaustion, more or less delirium, and, finally, death comes to the relief of the little sufferer. Convulsions sometimes occur in the last stages, and soon terminate fatally.

TREATMENT. No time should be lost in commencing treatment. Hot fomentations should be applied to the throat and upper portions of the chest. The free inhalation of steam should be employed early. The following treatment has been found very effectual in membranous croup, and is recommended by the highest authorities: Yellow subsulphate of mercury, or turpeth mineral, three to five grains, depending upon the age of the child, for one dose. If it does not cause vomiting in fifteen minutes, give a second dose. This, however, is seldom necessary. If the turpeth mineral cannot be obtained, sulphate of copper or sulphate of zinc may be given instead, as directed under the head of Emetics, in