of scrofulous diathesis without the provocation of any previous dis ease in the anus or rectum. It commences not far from the anus, and usually announces its approach by itching, or pain, or uneasiness, although in some cases no unpleasant symptom is experienced until it begins to discharge its purulent matter, and then this discharge may be the only evidence of its existence. So long as it has but one opening it is called incomplete, but when the abscess has proceeded so far as to penetrate the rectum, or any other cavity, it is said to be complete. The annexed cut, figure 103, represents a complete fistula Sometimes it has several openings into the rectum or other

in ano.

Fig. 108.

parts, and the canal is in some cases so complete as to have a lining almost like the mucous membrane. I once had a case of fistula which opened perfect communication between the rectum and the urethra, so that at stool some of the fluid portion of the fæces passed out of the mouth of the penis. When the abscess is active, large quantities of purulent matter issue therefrom, especially at stool when it is pressed by the descending fæces. When much inflammation is present the affection is terribly painful.

COMPLETE FISTULA IN ANO.

In all cases of fistula, the blood should receive the first attention of the physician, and the knife should be the last resort, because if the latter be employed, it still remains necessary to purify the blood, or the fistula, or an abscess of some kind will return. It would consequently seem the more sensible plan in all cases, to have suitable blood-treatment at the outset. This may suffice to cure the difficulty. If it does not, neither time nor money will have been unnecessarily wasted, because the constitutional treatment cannot be safely dispensed with, however successful the operation. I have succeeded in curing fistula in ano, with blood-purifying medicines alone, after noted surgeons had expressed a decided opinion that nothing but the knife could possibly remove the local affection.

Stricture of the Rectum

Is an annoying and generally painful affection which may result from neglected or badly treated piles, local inflamination, bungling operations for fistula, or any thing which causes an abrasion or great

Irritation in the lining of the canal. The stricture may consist of a thickening of the walls of the rectum, causing a partial obliteration of the canal; adhesion of some portions of the walls, after the healing of abrasions or abscesses; or it may be caused by indolent tumors forming therein, or remaining after a severe attack of piles. Stricture of the rectum is a most troublesome difficulty, because it obstructs the passage of the excrementitious matter, and in some cases to such a degree as to prove fatal. The symptoms attending stricture in this locality are-difficulty in passing faces even when they are soft and pliable: passage of fæces in small fragments, sometimes stresked with blood; and, when caused by thickening of the walls of the rectum, the expulsion of narrow flattened fæces. In a case of stricture of the rectum, both constitutional and local treatment are necessary, and the patient cannot do better than to rely wholly upon the advice of the physician in whom he may entertain confidence. In cases living at a distance, the author can give such directions as will enable the patient to administer the necessary local treatment himself, or herself.

Falling of the Rectum:

The technical name given to this troublesome affection is prolapsus ani. It consists of a falling or protrusion of the bowels, In some cases of this kind the lining of the rectum protrudes constantly; and in others it only descends at stool. Neglected piles are usually the immediate cause of this difficulty; but in nearly all cases there is great weakness, and in some complete paralysis of the sphincter muscle, or that ring-like muscle which encircles the anus, and which in health closes the orifice at all times except when the excrementitious matters are being expelled. In a case of prolapsus ani the falling of the bowels should be returned carefully by manipulation, and the use of some soothing ointment, or common oil, to soften the swollen and congested parts while they are being placed back Then a pile compresser (see page 911), should be adjusted, and treat ment at once adopted calculated to strengthen the sphincter muscle, stimulate healthful circulation in the lining of the rectum, and to remove whatever may be the inciting cause.

Ulceration of the Bowels.

Ulcerations are liable to take place in any part of the body when any thing like a scrofulous or a syphilitic taint exists in the system.

These ulcerations may occur in the intestines, giving rise to a multitude of painful symptoms. Of course, any thing which so far affects the intestinal canal as to interfere with the free discharge of fecal matter must, unless removed, ultimately prove fatal. It is necessary to take food into the system daily, and it is equally as necessary to have a diurnal removal of that which is innutritious, and also of the waste secretions which are cast into the intestinal reservoir, called the colon. It is practically no worse to have ulcerations of the mouth and of the canal called the oesophagus, leading to the stomach, so that a person cannot easily take nourishment, than to have those ulcers in the fecal sewers, causing by their presence the waste matters-the ashes and clinkers-to be disposed of with difficulty. In all cases of ulceration of the bowels, if inflammation attends it, there are sensations of heat or pain; tenderness on pressure; and copious discharges of ulcerous matter mixed with blood, which usually passes off at stool, preceding or mixing with the fæces. The latter symptom occurs if the ulceration be not attended with inflammation.

As it is not possible for ulceration to take place in any part of the system unless the blood is badly affected with impurity, the predis. posing cause points with unerring directness to the remedy, which lies in the entire renovation of the vascular fluids. In my practice, in the treatment of this class of invalids, I aim directly at the blood, and usually my advice and medicines are successful. An interesting case is presented in the extracts of letters, see page 594.

Intestinal Worms.

It is not pleasant to think of, but a fact that must be stated in this chapter, that the human family, in a state of civilization, is apt to be wormy, and that the residence of these worms is usually in the stomach or intestines. The wild men of the forest, uncontaminated by civilization, are not subject to them, which may easily enough be accounted for. They live so naturally, that their vascular fluids and animal fibres are too healthy to encourage the presence of parasites. Long thread-worms, round and white, from one to two inches in length; knots and balls of pin-worms, little fellows almost requiring the microscope to see the smallest specimens; long, round worms, from two to fourteen inches in length, sometimes pale, and at others a deep red; liver-worms, an inch or over in length, flat, with all the

various colors of the bile, thrown off from the gall bladder; and tapeworms, flat in shape, in complexion usually white, jointed like so many small pumpkin seeds attached with a thread, and in length sometimes twenty feet, are found in the intestines of men, women, and children. The most common afflictions of this character are pinworms, which infest the rectum, pay visits to the anus, and create an unendurable itching by their pranks. To the microscopic world the rectum is as large as the State of New York, and these pinworms are as formidable as boa constrictors, while they twist and flounder about more actively than the huge creatures alluded to.

The same rule that governs trichina appertains to intestinal worms, so far as their generation and encouragement in the body is concerned. All such vermin can only exist in systems wherein the blood is sufficiently impure to nourish them with its corruption. It is plain, therefore, that the only way in which they can be permanently exterminated is by making the blood too pure for them. Restore the purity of the blood, and they will die out by actual starvation; for it is not the waste matters of the system, but the unwholesome secretions of the mucous membrane which feed them.

TREATMENT OF DISEASES PRESENTED IN THIS CHAPTER.-AS I have in each essay given appropriate suggestions as to the best course to be pursued for the successful management of the diseases under consideration, it would be mere repetition to present them here. I will therefore refer readers who are affected with any of them, to the chapter on the Treatment of Disease, page 574. This chapter will be found interesting and suggestive. Before concluding the author will simply remark, that he does not claim by any means to have treated upon all the chronic diseases which are found to affect the liver, stomach, and bowels. It seems hardly necessary to occupy space with more than those commonly met with in medical practice. Invalids having symptoms leading them to suppose that they are affected with any of them, or with other chronic diseases of these organs, are at liberty to present their cases to the author in person or by letter,

CHAPTER IV.

ACHES AND PAINS.

Fall the aches and pains that afflict a few people, were distributed among the many, there would be one constant ache apiece for every body, including the domestic animals of the household. There are as many heart-aches among young misses, as there are headaches among the matrons; and as many back-aches among dissipated young men, as there are brainaches in the counting-rooms of opulent merchants, or the offices of overworked lawyers. There are, in brief, acres of aches on either side of life's pathway. It is necessary to walk a line as narrow as a crack to avoid them.

Then, of pains, how many of them are so concentrated, so doubledistilled, that one person could spare enough to set a whole family in contortions, and not cease himself to make involuntary grimaces at the contented cat under the table, or the complaisant dog on the door-step; nor hesitate to wish he had been born feline or canine. Considering, therefore, the quantity and concentrated quality of the pains, and the variety of the aches which afflict humanity, the author shrinks from any attempt in this chapter to circumvent many of them, and will consequently content himself to speak of less than half a dozen of those most commonly met with in every-day life, while promising to give his attention unremittingly in practice to the alleviation of aches and pains of every description.

Bilious Headache.

Had I not recently heard of a child just born out West without a visible head-the mouth, breathing passages, and eyes being located in the chest-I should start out in this essay with the unqualified statement that nobody ever lived without sometime having had