one week; and during these intervals, I scarcely feel any inconvenience of the kind, the nostrils being very rarely stopped up. This is a trouble of long standing, and for the removal of which I have tried more nostrums and "certain remedies than I can easily enumerate. I suffered from it long before I felt the difficulty in the throat, **** and this leads me to speak more particularly of the throat as it is.

If I take the slightest cold, which I easily do, my throat is decidedly sore, the tonsils seem inflamed, and there is soreness, apparently, at the top of the windpipe, and the follicles on the back part of the throat behind the palate are swollen and shining.

When I have no cold, there is no great soreness, but generally some slight irritation and heat. The follicles before mentioned do not entirely disappear, but remain, though less prominent, and far more pale in color.

There is a slight soreness about the swallow, or opening into the windpipe, and I very often find myself trying to swallow something, which seems to be lodged in that region. (The uvula had been removed two years before.-Author.)

I easily become hoarse, especially at night, when I much oftener feel such a relaxation of the muscles of the throat, and neck, and upper breast, as nearly destroys the power and tone of my vocal organs. I have naturally a clear, distinct tenor voice, and have always been accustomed to singing. But at these times, my voice is dry, husky and unnatural, and my utterance exceedingly difficult and prostrating, so much so, that I instinctively avoid occasions for speaking. The effort obliges me to summon all the energy I possess. This, indeed, is now my greatest trouble.

It is not so much soreness, or even hoarseness, as it is weakness,- --a feeling all about the throat and neck and upper part of the breast as though I had not the power to speak.

My mouth and throat, which used to be very hot and dry, particularly on waking in the morning, are now quite comfortable in that respect, and at times, especially

the day after I have preached, my voice has nearly its former power and elasticity, always being worse in the former than in the latter part of the day.'

Nearly the entire letter of this correspondent is given, the italics not being his. It will be read with interest by other clergymen, who will see in it much that coinoides with their own feelings and symptoms. This case was treated by correspondence, and I had for some months ceased to hear from him; but having steadily improved from the first week of his application, I supposed he was well. In sixteen months after his first letter, he called at my office for the first time. natural, breathing regular, the lungs perfectly sound, working fully, measuring two hundred and thirty-two cubic inches, which was some twenty inches more than his healthful standard.

Pulse

I understood him to say that he had preached regu larly for some nine months, missing but one Sabbath, and having been invited to the pastorate of several churches, he had called on me to advise him as to the locality which would be best suited to his case. I saw nothing which required medical advice, and trust he will live to labor usefully and long.

It would be interesting to invalids to read other letters, in which descriptions are given in the language of patients themselves, but perhaps enough has been said to enable persons to understand the general symptoms of the diseases treated of. But in reference to clergymen, I desire to say, that as a general rule, it is time and money thrown away, in cases of legitimate and uncomplicated throat-ail, to quit preaching, and go to the South, or across the Atlantic, or to some large city for they can be treated safely and successfully at home, in the continuation of their labors.

I have found, thus far, that in three cases out of four, a return to preaching is a necessary prescription, under suitable restrictions as to time, manner, amount, &c.

In all cases, without an exception, where preaching gives a stinging sensation, or a sharp, knife-like pain, or

requires a great effort, not one word should be uttered in public, until by previous careful training the parts are prepared for the exercise.

I have not found it necessary to take off the uvula once in any five hundred adult cases.

I have not seen in the last ten years exclusive practice in diseases of the air passages, one single adult case, where I thought the excision of the tonsils desirable. I believe their removal is unnecessary, and that in many cases it is a fatal error; not that the operation destroys life at once, but that it lays the foundation for the loss of life, by consumption of the lungs, I think is demonstrable.

I believe that in cases of actual consumptive disease, the removal of the tonsils hastens death.

I believe that in cases of incipient consumption, the removal of the tonsils fixes consumption on the lungs.

I believe that those who are of a consumptive family, or who from various causes are threatened with consumption, will precipitate consumption on the lungs by removing the tonsils; whereas, had they been permitted to remain, such a result would have been indefinitely postponed.

These sentiments are entertained on the ground of counter irritation. I have observed that those persons having consumptive symptoms, with scarce any tonsils at all, in consequence of their having shrivelled away, do more certainly die, than those who have enlarged tonsils, for they "bear the brunt" of colds, and through them colds pass from the system with comparative impunity. I trust the Profession will direct their observations to this point, for it has become so popular a practice that the first step, and one taken as a matter of course, is to remove them for any throat affection which presents itself. I know very well that such an operation is not critical, gives but little pain, and no noticea ble present inconvenience; but that their indiscriminate removal does generally lay the foundation for disastrous results, is a fact of which I at least am fully convinced, My plan is to reduce them when enlarged, and as nature

placed them there, it is rational to conclude that it was for some important, at least necessary purpose, and that there they ought to be permitted to remain in their integrity, unless some malignant or acute disease renders their immediate removal imperative. My views are, that it is better for a cold to settle anywhere else than on the lungs, that the tonsils are as a van-guard, and often withstand and bear back the enemy, and thus secure the lungs from attack, so that instead of removing them, every effort ought to be made to restore them to a healthful condition, in their place, especially as their removal sometime occasions suffering, and is not always unattended with danger. See page 309.

A CASE TO BE STUDIED.

On a cold November night, a gentleman was called to visit a neighbor in distress, and became thoroughly chilled, resulting in a cough, which gradually increased in violence, until it gave him no rest during the day, and he visibly declined in flesh; and when I first saw him, on the tenth of January following, he looked badly; but had no pain, appetite good, sleep sound, and felt as strong as he ever did. The moment he laid down in bed his cough ceased, and returned only on rising in the morning. Reading, conversation, any sudden or fast motion, going up stairs, entering a room, or going out of doors, all these things excited an irritating, dry cough; almost the only relief he could get would be in continued gentle motion out of doors.

I warned him of the serious nature of his ailment, and urged the use of appropriate means without delay; but, like persons generally, he could not be persuaded that it was any thing more than a cold-he felt perfectly well in every respect except the cough. He was only thirty, in the prime of life, had weighed more the previous summer than he ever did, had had a similar attack in Paris, eight years before, and felt sure it would, as that did, gradually wear off as spring advanced. But it did not wear off; in about six weeks he commenced

spitting blood, which continued almost daily for some weeks. The most competent physician in Philadelphia could not arrest it, and he wrote to me- I went to bed as usual on Monday evening, April 30th, and slept until about six o'clock next morning, when I began to cough, and it required considerable effort to bring any thing up; and while straining to do so, up came a spoonful of red blood; since then, and even now, I have been spitting blood at every expectoration it is not all blond, but mixed with the sputa. It has not weakened me any, I feel as strong as ever; and this morning, three days after, I have walked three miles, without any difficulty, but still I cough about every half hour, and it is dry, and the expectoration scanty, with quite dark blood. Pulse eighty, breathing easy, appetite good, sleep sound. I have no pains or aches any where."

:

His physician, the most accomplished auscultator in Philadelphia, advised him that "there is now a mucous rattle under the right clavicle, (collar bone,) and that the little patches of tubercles are beginning to soften, and about two inches of surface dissolved." This was April 19th; the first bleeding was March 1st.

This gentleman became steadily and gradually worse; the cough troubled him in the night as well as in the day; he steadily grew weaker, more wan in appearance, his gait became slow, measured and careful, as a misstep would bring cough or blood, or at least the fear of it; he was chilly; he had constant exhausting and drenching night-sweats, and the general remark was, he will not live long. Soon after he was stricken with an intense pain in the left thigh, which became endurable in a day or two, but left him limping at every step.

Under these circumstances, I advised him that it was not a case of consumptive disease, that all medicine was wholly useless, that the only hope of life was in the adoption of certain modes of life, and forms of exercise, in a locality favorable to certain contingencies. I assured him that I believed it was almost impossible for him not to get well, if he would rigidly and energetically carry out my views, and at once. I was impor