iVlVlMnV Vii I1'',"' ' '» ■ • • • >■•>. > fe*$^ ;;.v.-':■■■..■ $$P&^ -^ •.';;' :.;.;v.:,:; ^&it»*V4. ^V v V•?: v •: .■!?:■:■:•;;:;■. ,/. vr;-.}% / '., . /i■ v - - •. v.. /kP.w SURGEON GENERAL'S OFFICE LIBRARY, 0/ - %i „> J) N... 113, NO W.D. S. G.O. 5 \ 5* \\ "'■■-. .'' i. > ^ > fc^U* ,v 1 A . . / ^ \ V s / V « ■, «*■ v:. : — - 'J ^; if ?7 t t WW - TREATISE O If THE VENEREAL DISEASE, BY THE CELEBRATED AND INGENIOUS Mr. JOHN HUNTER, of London, A B R I P G E P By WILLIAM CURRIE. PHILADELPHIA: Printed /y CHARLES CIST, in Race-fireet, between Front and Second-flreets. MiDCCjLXXXVII. l *• * ■ ••-,- ., . ,. , ,. /£ *% * ( n t. * * . * PREFACE. CT^H E following Treat ife on the Vene^ real Difeafe, is an abridgment of the incomparable, but voluminous work of Mr. John Hunter, a celebrated anatomifl in London; who is confejfedly allowed to have done more towards the improvement of anatomy, phyfiology, and medical furgery, than any other man of the prefent or, perhaps, any former age. This abridgment, ffhort and imper- fect as it may appear,) will be found to contain more practical knowledge and real inf ruction, than any other produc- tion of the kind, hitherto publifhed. And, as the work from whence this is feletfed, is the refult of very exten- five experience, conducted by a man of fuperior talents; the editor thinks no apology necejfary for the prefent abridge * ment; [ iv ] rnent; efpedaily, as he is perfuaded it will, (on account of its fize and price,) contribute to diffufe a more correct know- ledge of the nature and cure of the different forms of that jufi fcourge of lawlefs embraces; than is to be expected from the work at large, or than is attainable from any other publication : and by this means correct the errors of practice, and thereby fave the lives and preferve the health of numbers, who may have the misfortune to contract the dif eafe through ignorance, or who might fuffer from improper treatment. Whether this abridgment is calculated to anfwer this dejirable purpofe, or not, mufi be left to the judgment of the difcerning. Trufiing fojely to its merit, the editor leaves it to its fate, and only afks for jufiice. CONTENTS. CONTENTS. Page. the venereal difeafe, - i Of the venereal gonorrhoea, - 10 Of the cure, - - v - 13 Of chancre, - - - * 24 The cure of fimple chancre, - 16 Of buboes, - - -36 Of the confirmed lues venerea, - 43 Of the cure of lues Venerea, - 48 Of the atlion of mercury, - - 50 Of the difeafes of the urethra, fuppofed to he derived from the venereal difeafe, - 58 Of the difeafes of the urethra, - 6 2 Of correclingfome of the effecls of mercury, 77 Of the form of the different preparations of mercury, when in the circulation, - 85 Of gum guaiacum and farfaparilla, in the venereal difeafe, - - 89 Of the effecls remaining after the difeafe is cured, and of the difeafes fometimes pro- duced by the cure, - 90 General obfervations on the medicines ufually given for the cure, - - 96 Some feletled cafes, to confirm part of what has been advanced in the preceding pages, 102 0F O F T H E VENEREAL DISEASE, THE venereal poifon is capable of affe<9> ing the human body in two different ways-----Locallyy that is, in thofe parts Only to which it is firft applied-^and conjfitutionallyf that is, in confequence of the abforption of the venereal pus, which affects the folids through the medium of the circulating fluids.' Between the firft and fecond, or the local and conftitutional, form of this difeafe, certain intermediate complaints take place-----In the progrefs of abforption there are inflammations and fuppurations, forming, what are called, buboes, in which the matter is of the fame nature with that of the original difeafe. When the matter has got into the conftitution and is circulating with the blood, it there irritates to action, and from that irritation are produced A many [ * ] many local affections; as, blotches on the fkin, ulcers in the tonfils, thickening of the periofteum and bones. The local, or firft. kind, may be called immediate, becaufe it arifes immediately upon the application of venereal pus.—Of this form v there are two forts, feemingly very different from each other, but not fo in fact. In the firft, there is a formation of matter without a breach in the folids, called a gonorrhoea. In the fecond, there is a breach or ulcera- tion in the folids, called a chancre. I am perfectly convinced, from numerous experiments and repeated obfervations of my own, that neither of thefe two ways in which the difeafe fhews itfelf, is owing to any thing peculiar in the kind of poifon applied, but to the difference in the nature, fituation and pro- perties of the parts contaminated. The readinefs with which the parts run into violent action, in this fpecies of inflam- mation, is greater or lefs according to the nature of the parts affected; which perhaps does not arife from any fpecifk difference in the [ 3 ] the parts themfelves, but is according to the common principle of fenfibility and irritabi- lity; for we find that the vagina is not fo much difpofed to inflammation in this difeafe, as the urethra is in the fame fex, becaufe it is not fo fenfible. However, it may be pofiible, there may be fome fpecific difpofition to irri- tation and inflammation in the urethra in man; and what inclines me to think fo, is, that its canal is perhaps oftener out of order than any other, producing a great variety of fymptoms. This difeafe, when it appears in the form either of a gonorrhoea or a chancre, differs very much in the violence of its fymptoms in different people—In fome it is extremely mild, in others extremely violent. When mild, it is generally fimple in its fymptoms, having but few, and thofe of no great extent, being much confined to a fpecific diitance, reaching from the orifice of the glans to an inch, an inch and an half, or perhaps two inches up the urethra. But when violent, it becomes more complicated in its fymptoms, having a greater variety, and extending itfelf beyond the fpecific diftance: this does not arife from any variety in the fpecific quality of the poifon, but from A 2 a dif- [ 4 ] a difference in the difpofition and mode of action of the body or parts of the body; fome being hardly fufceptible of this or any other irritation, others being very fufceptible of it and of every other irritation, fo as readily to run into violent action. The venereal irrita- tion, however, does not always follow thefe rules; for I have known young men, in whom a fore from common accident healed up rea- dily, yet the irritation attending a gonorrhoea would be violent, and a chancre would in- flame and fpread with great rapidity, and even mortify.—On the other hand, I have known young men in whom a fore from common vio- lence, has been healed with great difficulty, yet when they had contracted a gonorrhoea or chancre, the difeafe has been mild and eafily curable. In particular people it is either mild or fevere, for the molt part uniformly. In the firft ftated difpofitions it is not invariably fo, but then, I believe, there is fome indifpofition at the time, I have known feveral Gentlemen, who had their gonorrhoeas fo flight in common, that they frequently cured themfelves; but it has fo happened, that a gonorrhoea has been re- markably fevere, which baffling all their flrill, they [ 5 ] they have applied for afliitance; but then they were attacked with the fymptoms of a fever, and when the fymptoms of fever have gone off, the gonorrhoea immediately became mild. I may now alfo observe, that when the difeafe is in form of a lues venerea or pox, different conltitutions are differently affected, in fome its progrefs being very rapid, in others very flow. To account for the very different effects of the fame matter producing different forms of this difeafe, it is only neceflfary to obferve the difference in the mode of action of the parts affected when irritated, let the irritation be what it may. The gonorrhoea always proceeds from a fe- creting furface, and the chancre is formed on a non-fecreting furface , and in the latter, the part to which the poifon is applied myft be- come a fecreting furface before matter can be produced. All fecreting furfaces in the body being probably fimilar, one mode of application is probably fufflcient to produce this difeafe in them all; which is by the poifonous matter Amply [ 6 1 fimply coming in contact with them. But to produce chancre the matter may be applied three ways—to a wound-—to an excoriation of the cuticle—or to a furface where the cuticle is very thin. The effects produced by the venereal poifon, appear to arife from its pecu- liar or fpecific irritation, joined with the fufcep- tibility of the living principle, to be irritated by fuch a caufe, and the parts fo irritated acting accordingly. When an irritating matter of any kind is applied to a fecreting furface, it increafes that fecretion, and changes it from its natural ftate (whatever that be) to fome other, which in the prefent cafe is pus. Until about the year 1753 it was a re- ceived opinion, that the matter from the urethra in a gonorrhoea arofe from an ulcer or ulcers in that paffage; but from an accurate inflection of perfons after their deceafe, who were known to have the diforder at the time of their deceafe, it was about that time firft difcovered that this was not the cafe, but that it was produced by a vitiated fecretion. Whent [ 7 ] When a fecreting furface has once received the irritating action, its fecretions are increafed and vifibly altered; alfo, when the irritation has produced inflammation and an ulcer in the folid parts, a fecretion of matter takes place; the intention of which, in both, feems to be to wafh away the irritating matter 3 fo that irritations have a tendency to produce their own deftruction: like a mote in the eye, which, by promoting a fecretion of tears, is itfelf waffied away. But this fpecific irritation in gonorrhoea, is preferved and prolonged by the inflammation it produces.—It is however found, that this inflammation can only laft a limited time; the fymptoms peculiar to it vanifhing of them- felves, by the parts becoming lefs and lefs fufceptible of irritation. This cefifation will vary according to cir- cumftances, for if the parts are very irritable, their actions will be more violent and longer continued; but in all cafes it is an incon- teftible fact, that the difference mult arife from the difference in the conftitution, or ac- cording to the patient's regimen and conduct, and the care taken to relieve or cure the difeafe. In [ « 1 In many cafes, if by a proper regimen the' irritation of the inflamed ftate is carefully avoided, the gonorrhoea fpontaneoufly ceafes, the fymptoms of inflammation gradually abat- ing, the matter difcharged becoming of a thicker and more vifcid conflftence, as well as of a whiter colour; till at length the flow of it ceafes altogether; and whether it be thus cured fpontaneoufly, or by art, the difeafe often exifts without communicating any in- fection to the other parts of the body; becaufe while the urethra continues free from ulcera- tion, the abforbents have no command. But this circumftance, of the difeafe ceaf- ing fpontaneoufly, only happens when it at- tacks a fecreting furface, and when a fecre- tion of pus is produced; for when it attacks a non-fecreting furface and forms an ulcer there, the ulceration goes on, continually increafing and propagating other effects, by means of abforption, till it deftroys the patient's life, unlefs prevented by art. From this ftatement of the difeafe, it would be natural to expect, that whatever medicine would cure it in one form, would cure it in any form, and alfo all the varieties of every form; [ 9 ] form; but repeated experiments have taught us, that this does not hold good, efpecially in this difeafe. For mercury, which is found to be a fpecific for chancre and all its confe- quenCes, however varied, inftead of contri- buting to the cure of gonorrhoea, never fails to aggravate and prolong it; and has too often been the caufe of effects, much worfe than the difeafe for which it was employed to cure. Having premifed fufficient to give a ge- neral idea of the nature and character of this difeafe, I now proceed to confider in a more particular manner, the fymptoms peculiar to each form and modification. And firft— B Of [ io ] OF THE VENEREAL GONORRHCEA. THIS form of the difeafe generally makes its appearance within eight or ten days after the infection has been received; fome- times indeed it appears in two or three days, and at other times not in lefs than a fortnight.. Previous to the difcharge, the patient feels an itching, with a fmall degree of pain, a little diftance above the glans penis, in the urethra: afterwards a thin whitifh vifcid matter be- gins to difcharge from the canal, which ftains the linen, and occafions a fmall degree of ti- tillation, particularly in the time of making water; this gradually increafing, arifes gra- dually to a fenfe of fcalding and pain, chiefly felt about the extremity of the urinary paffage, where a flight degree of rednefs and inflam- mation likewife begins to appear. As the diforder advances, the pain, ardor urinas, and running increafe, while frefh fym- ptoms [ II 1 ptoms daily enfue. In men the erections be- come painful and involuntary, and are more , frequent and lafting than when natural. This iymptom is moft troublefome when the patient is warm in bed. The pain, which was at firft only felt towards the extremity, in many cafes proceeds and extends all the way up the urinary paifage; and in other cafes, the in- flammation fpreads even to the neck of the bladder. In thefe aggravated eircumftances it fometimes happens (but that is very rare) a more confiderable inflammation is occafioned in certain parts of the urethra; and fometimes even terminates in fuppuration cr ulcer, by which the venereal poifon is fometimes com- municated to the fyftem, and gives rife to a general lues. But difiections prove, that the difeafe commonly does exift without any ul- ceration of the urethra; fo that the difcharge which appears, is entirely of a vitiated mucus from the follicles of the urethra. In many cafes the heat of urine is fo great, that the patient dreads the making water, and though he feels a conftant incli- nation, yet it is rendered with difficulty, and .often only by drops. The chordee is often .extremely painful and frequent, and the run- B 2 ning [ 12 ] ning is copious, fharp, and of a bloody, brown or greenifh colour. These alterations in the colour and conflf- tence of the running are owing to the condi- tion and difpofition of the parts which form it, and this difpofition of the parts depends chiefly on the increafe or decreafe of the inflamma- tion, and not on the poifonous quality of the matter itfelf; for any irritation on the fame parts, equal to that produced by the irritation of the venereal matter, will produce the fame appearances. It often happens, after the fymptoms pecu- liar to gonorrhoea have been perfectly removed, that a mucous fluid continues to iffue from the urethra, and continues fo to do a long time, and fometimes for a great part of a perfon's life. This difcharge is denominated gonor- rhoea benigna or gleet. In fuch circumftances the matter difcharged rarely, if ever, contains any venereal poifon, notwithftanding it fometimes has a puriform appearance. This appearance in the matter of a gleet, which before had been of a lefs coloured kind, has been frequently miftaken for [ 13 ] for a frefh infection : But I am certain that fuch appearances may be brought on by per- haps various other caufes ; and particularly, by intemperance in venery and drinking concur- ring together. When it was the practice to employ mer- cury and draftic purgatives freely, at the com- mencement of the Virulent gonorrhoea, a gleet was a frequent confequence. Of the CUR E. THE chief circumftance to be attended to in the cure of the virulent gonorrhoea, is the inflamed ftate of the urethra, which may be confidered as infeparable from this form of the difeafe. And if what has already been advanced be true (as it certainly is) that the difeafe will always be cured fpontaneoufly in time, with- out medical afliftance, if not prevented by mifmanagement or intemperance, and that the whole of the infectious matter will be entirely difcharged ; all that is required of art, is to remove and prevent a return of that inflam- mation [ 14 ] mation which continues the difeafe, and ac- cafions all the troublefome fymptoms that ever attend it. The fole bufinefs, therefore, fhould be directed to take off the inflammation ac- companying the gonorrhoea, and this may for the moft part be performed by avoiding ex- ercife, by employing the antiphlogiftic regi- men, by abftaining entirely from fpirituous and fermented liquors, and by drinking plen- tifully of mild aqueous liquids. The fcalding, which is fo troublefome a fymptom, and which is occafioned by the paf- fage of the urine through the irritable and in- flamed paffage, fhould be remedied as foon as poflible. This is beft done by the liberal ufe of warm water, rendered palatable with the acid juices of ripe vegetables, and by the in- jection of tepid mucilaginous watery liquids, /deftitute of ftimulating particles-----oil of almonds—emulfion — milk and water, &c. Emollient clyfters would likewife be benefit cial, much more fo than the mildeft purga- tives ; but as coftivenefs always adds to the ir- ritability of the bladder and urethra, where clyfters are not fubmitted to, the fedative or quieting laxatives may be occafionally allowed, efpecially Glauber's fairs, foluble tartar, mag- nefia, [ 15 ] nefia, oleum ricini, lenitive electuary, &c. But every purgative of a draftic quality fhould be carefully prohibited, nor fhould any purgative be adminiftered oftener than merely neceffary to prevent or remove coftivenefs.—As for diu- retics, the inflamed ftate of the body render them abfolutely improper. In this ftate of the parts it has been advifed, to apply emollient fomentations and poultices to the body of the penis; but thefe feldom do good, and may do harm if applied hot. Com- preffes, dipt in cold lead water, feem better adapted to refift and prevent the increafed im~ pulfe of the fluids; and as the fymptoms de- pend, in a great meafure, on the increafed fenfi- bility of the urethra and contiguous parts, it will generally be found that opium will afford more relief than any thing elfe,. efpecially after the bowels have been emptied or blood has bee,* drawn from the patient, provided he is in a condition to bear the lofs of blood—a grain or two may therefore be given under fuch cir- cumftances at night, and half as much in the morning; and a filtered folution of the fame of tepid warmth, may be injected into the urethra frequently in the courfe of the day. When [ 16 ] When by thefe means the inflammation has confiderably abated, the difeafe only now re- maining in a mild form, it may be attacked either by internal remedies or local applica- tions. If it be attacked locally, violence is ftill to be avoided; becaufe as long as the difeafed parts remain very fufceptible of irri- tation, the inflammation may be brought back. At this period, however, gentle aftringents may be employed with a profpect of fuccefs; or if the difeafe has begun mildly and there are no figns of an inflammatory difpofition, either of the common or of the eryfipelatous kind, in order to get rid of the fpecific mode of action quickly, an irritating injection may be ufed, which will increafe the fymptoms for a time, but when it is left off they will often abate or wholly difappear. In fuch a ftate of the parts aftringents may be ufed, for the only thing neceffary to be done, is to procure a ceffation of the difcharge, which is now the principal fymptom. In cafes of ftricture or hernia humoralis, I believe aftringents fhould not be ufed; for we find in either cafe, while the difcharge lafts, both complaints are relieved. Many [ 17 ] Many injeclions remove the fymptoms foon, and prevent the formation of matter; and this has given rife to a notion of repelling and fhutting up the difeafe in the conftitution; but this is not the cafe, for my experiments teach that the venereal matter is the only fubftance in which the poifon is contained, and cannot be communicated without the formation of matter; therefore, if we can prevent the for- mation of the one, the other cannot take place, and of courfe there can be no room for ab- forption, fo that there can be no power of in- fecting the conftitution in the fame perfon, nor of communicating the infection to others. I shall divide injections, according to their particular effects upon the urethra, into four kinds-----the irritating, the sedative, the emollient and the astringent.—A fpecific one I am not acquainted with. Most of the irritating injections have an aftringent effect, and prove Amply aftringent when much diluted. Irritating injections fhould never be ufed where there is already much inflammation, efpecially in irritable con- ftitutions; nor fhould they be ufed where the irritation has fpread beyond the fpecific dif- C tance, [ *8 ] tance, which, as has already been faid, reaches about an inch and an half or two inches up the urethra; nor where the tefticles are tender; nor where there is a tendency in the bladder to irritation, which is known from a conftant inclination to make water. In fuch cafes I have found them do» harm ; they have fome- times increafed the inflammation, and in fome cafes produced abfceffes in perinaso; but have often fucceeded with them immediately in cafes that were mild, and in conftitutions lefs irritable. The following is equal to any of this clafs: Rec. Pulv. mere. fubl. corrofiv. gr. ii. Aq. pluv. vel rofar. unc. viii. M. But where that ftimulates confiderably, or induces an increafe of inflammation, it muft be weakened, and perhaps entirely omitted for a time. Sedative injections will always be of fervice in cafes where the inflammation is confiderable, by leffening the difeafed action of the parts, and by relieving the painful fenfations of the patient. Perhaps the beft fedative is opium, as well when given by the mouth or anus as when applied to the part affected in form of injection. [ 19 ] injection. But it has not this effect in all con- ftitutions or conditions of the parts; but on the contrary, adds to the irritation. Perhaps if thrown up the rectum with a common penis fyringe, it would anfwer better than any other way in cafes of great uneafinefs and irritation, unattended with the fwelling and throbbing which characterifes inflammation. The faccharum faturni acts both as a fedative and gentle aftringent, and may be employ- ed in the proportion of 14 grains, diffolved in 8 ounces of rofe water. The drinking freely of diluting liquors, may be confidered as having a fedative effect, as it in part removes fome of the caufes of irri- tation, rendering the urine lefs ftimulating, either to the bladder when the irritation is there, or to the urethra in its paffage through it; and it is poflible, that dilution may lefien the fufceptibility of irritation. Water with a folution of gums, or an infufion of mucilagi- nous vegetables, is in no refpect preferable to fimple water, becaufe it is only the water with which they are mixed that reaches the parts af- fected, or that can make any impreflion on the conftitution. Perhaps therefore lemonade, q 2 tamarind [ «> ] tamarind water, toaft and water, barley ptifan, &c. are equal to any other drink. Emollient injections are proper where the inflammation Sec. is very great: thefe may be compofed of milk and water, of frefh oil of almonds, or of the infufions of emollient and mucilaginous vegetables. Under fuch circum- ftances, more active injections might do harm. It very often happens, that the irritation at the entrance of the urethra is fo great, that the point of the fyringe can not be fuffered to enter: here it fhould not be attempted till the inflammation abates; this may be aflifted by emollient fomentations. The aftringent injections can only ad by leffening the difcharge, they can have no fpe- cific effect upon the inflammation; but as they mult affect the action of the living powers, it is poflible, they may alter the venereal difpo- fition. They fhould only be ufed towards the latter end of the difeafe, when it has become mild, and the parts begin to itch. But when the difeafe' has begun mild, they have been found ferviceable from the beginning, for by gradually leffening the difcharge without in- creafing [ 21 ] creafing the inflammation, we complete the cure, and prevent a gleet. Thefe ad by con- tracting the veffels of the urethra, and fupprefs fecretion. During the continuance of chordee, no violence is to be employed in the cure, but all irritation fhould be avoided; otherwife that fymptom will be aggravated: nor under fuch circumftances fhould any thing be done that may tend to fupprefs the running, either by internal or external means; becaufe that has no effect in removing the inflammatory irri- tation which gives rife to that fymptom; but the conftitution is to bealtered, if poflible, by remedies adapted to each difpofition, and with a view to alter the action of the parts arifing from fuch difpofition, and to reduce the difeafe to its fimple form. The moft fpeedy removal of the hernia humoralis or fwelled tefticle, which is only a fympathetic affection, is, by emollient fomenta- tions to the tefticles and penis, the application of emollient cataplafms, by clyfters, and when the inflammation has not increafed the action of the vafcular fyfterm fudorific anodynes, will [ 22 ] will be proper to be repeated occafionally after a mild laxative, &c. The ftrangury, which is a very common and diftrefling fymptom of a recent infection, may be occafioned either by a fpafmodic con- ftriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former cafe, the patient begins to void his urine with tolerable eafe; but as foon as it touches the inflamed urethra, a fudden fpafm takes place, and the urine is voided by fpurts, and fometimes by drops only. When the ftrangury is owing to an inflam- mation about the neck of the bladder, there is a conftant heat and uneafinefs of the part, a perpetual defire to make water, while the patient can only render a few drops : if this complaint continues any time, a tenefmus generally comes on. When the ftrangury is owing to fpafm, the beft treatment will be liberal dilution with mild aqueous drinks, and five or fix drops of laudanum taken every four or five hours, and and a larger quantity at bed-time. The pec- toral [ *3 ] total ptifan is a valuable drink in fuch eir- cumftances. Emollient fomentations may alfo be applied. When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding fhould be copioufly performed and repeated, according to the violence of the fymptoms. After bleeding, mild foftening anodyne clyfters fhould be adminiftered, if the patient will fubmit to them, or if that cannot be conveniently done, laxatives of caftor oil, or manna and Glauber's falts may be fubfti- tuted, and the patient may himfelf inject fome mild mucilaginous tea up the rectum, with a little crude opium diffolved in it, with a penis fyringe. In addition to thefe means, flannels, dipt into a decoction of emollient herbs, fuch as poppies, mallows, and chamomile flowers, fhould be frequently applied to the pubes, groins, penis, and perinasum. If the complaint does not give way to this method, or a total fupprefllon of urine fhould come on, the patient fhould be put into a warm t *4 ] warm bath which fhould reach as high as his ftomach, and when put to bed, the urine fhould be drawn off with a catheter. In this inflamed ftate, the furgeon will often find his utmoft fkill baffled, in attempt- ing to introduce the catheter, and when that is the cafe, it would be proper to try a bougie, or perhaps an operation may become necef- fary, as will be more fully fpecified in the latter part of this work, when treating of strictures. O F CHANCRE. TNSTEAD of proceeding to give an account J- of the fuppofed effects of gonorrhoea at prefent, I fhall defer that part of my fubject till I have finifhed both my account of the other local affection of the venereal difeafe, known by the name of chancre, and of the confirmed or conftitutional lues. By [ 25 ] By chancre I would be underftood to mean a fpreading venereal ulcer, with ragged, cal- lous, prominent edges, and unequal furface. This kind of ulcer may happen with or without a gonorrhoea. Thefe are commonly feated about the glans penis and infide of the pre- puce. They firft appear like a little blifter or blifters, with an inflamed circumference. This vefication feels hot and itchy before it breaks; afterwards it gradually degenerates into a foul obftinate ulcer, the bottom of which is commonly covered with a vifcid mucus, and the edges become hard and contracted. Sometimes the firft appearance refembles a fimple excoriation of the cuticle, which foon increafes to a corroding ulcer. Chancres partake both of a fpecific and conftitutional inflammation : hence, it is always necelfary to take notice of the manner and condition in which they firft appear, and alfo to their progrefs; for they often explain the nature of the conftitution at the time. If the in- flammation fpreads fait and diffufively, it fhews a conftitution preternaturally difpofed to in- flammation. If the pain is great, it fhews a ftrong difpofition to irritation. It alfo fome- times happens, that they begin very early to D form [ 26 ] form Houghs'; when this is the cafe, they have a ftrong tendency to mortification.----By thefe marks we may, in fome meafure, under- stand the future treatment. My obfervations convince me, that chancre never appears, in any degree, without im- mediately communicating more or lefs of the venereal poifon to the conftititution, by means of the abforbents; whereby it is conveyed into the circulating fluids. The CURE of Simple Chancre MAY be fhortened, by deftroying it by cauftic or excifion, while the blood is well charged with mercury. The earlier, after infection, it is deftroyed, the better: the whole difeafed part fhould be removed: the cauftic fhould only be applied to thofe parts that are really difeafed, and this treatment fhould be continued with a piece of cauftic, pointed like a pencil, till the furface of the fore looks red and healthy, after throw- ing off the laft flough ; after which it will heal like any other fore produced by cauftic. When [ 27 ] When the ulcer is large, it is out of the power of the cauftic; but if the fituation will allow, the difeafed parts may be cut out, or incifions may be made round it into the cel- lular membrane with good effect. Where this-method cannot be employed with proprie- ty, becaufe of the inflamed or painful ftate of the chancre, it fhould be frequently fomented with warm water or other emollients, and drelTed with the mild blue mercurial ointment, made of argentum vivum and hogs lard in equal parts; or if not inflamed, with equal parts of crude mercury and venice turpentine : but in moft cafes filling the ulcer every day or two with red precipitate and covering with the lead water poultice, or Goulard's cerate, is the moft effectual, though not the leaft painful, of any other application. If the chancre be deftroyed early, no other fymptoms will follow; but if matter has been abforbed, its effects will appear in other parts in form of lues, as will be more fully ex- plained when on that part of the fubject. When a chancre fixes on the internal fur- face of the prepuce, one of two very trouble- D 2 fome t 28 ] fome and diftrefllng fymptoms is generally the confequence—either a phymofis, or a para- phymofis; the firft fignifying fuch a conftric- tion of the prepuce over the glans, as hinders its retraction ; the laft is fuch a conftriction of the prepuce back of the glans, as hinders it from being brought forward. The phymofis and paraphymofis is a thick- ening of the cellular membrane of the prepuce, in confequence of the irritation produced by the chancre, attended with considerable and diffufed inflammation. In this condition it is often impracticable to apply dreflings to the chancre. A phymofis fhould therefore be prevented ifpoffible, and upon the leaft fign of a thick- ening of the prepuce, which is known by its being retracted with difficulty and pain, the patient fhould be kept quiet, and the penis kept up againft the belly with a linen fwath, becaufe if fuffered to hang down, the extra- vafated fluids defcending and remaining in the prepuce, contribute often more to prevent it from being drawn back, than the inflamma- tion itfelf. When [ 29 ] When the phymofis has taken place, the fame precaution may be followed; but as the fores cannot be dreffed in the common way, we mult either have recourfe to dreflings in form of injections, or lay open the prepuce by means of a knife. If injections only are employed, they fhould be frequently repeated, as they are only tem- porary applications. The dreflings in form of injections fhould be mercurial, either crude mercury rubbed down with a thick folution of gum Arabic, which will aflift in retaining fome of the in- jection between the glans and prepuce; or calomel and opium with the fame. In the proportion of thefe no nicety is re- quired. But where the fenfibility of the parts is not very acute, a weak folution of fublimate in water, half a grain to an ounce or two of water, will frequently be found proper propor- tions ; but if it encreafes the pain and attend- ing fymptoms it fhould be more diluted. In many cafes the prepuce and glans arc too much fwelled and too fore to admit of any [ 30 ] any injection; here a poultice made of bread and water, with an eighth part of laudanum, will be proper; but previous to this application, immediately after having cleaned the part, it would be proper to let the penis hang over the fteam of hot water, with a little vinegar and fpirits of wine in it, which is the neateft way of employing fomentations. When to the above mentioned fymptoms a bleeding of the chancre is added, I do not know a more troublefome complaint, becaufe here the cells or veins have no great difpofi- tion for contraction: the blood generally comes either from the glans, or from the fpungy fubftance of the urethra, where the chancre has begun about the frasnum. Oil of turpentine affords the belt ftimulus for the contraction of veffels of all kinds ; but where haemorrhage arifes from an irritable action of the veffels, which is fometimes the cafe, then fedatives, fuch as opium, is the belt application.-----Whatever is ufed in fuch a ftate of the prepuce, mult be injected into the part. Where [ 3> ] Where the chancres are in a healing con- dition on the glans or prepuce, the prepuce fhould be moved on the glans as much as it will allow, once or twice a day, to prevent adhefions. When the parts have fuppurated, the pus may be let out with an inftrument, or by the lapis fepticus applied on the part where the pus is collected. A mortification of the prepuce is fometimes the confequence of violent inflammation ; but fuch cafes are generally of the eryfipelas; and not of the phlegmonous or true fuppurative kind. When excrefcencies under the prepuce are numerous or large, it commonly becomes neceffary to divide the prepuce with the knife, in order to have room to apply fuitable dref- fings. In thofe cafes where violent inflammation has invaded the feat of the chancre, producing phymofis, and often fo as to threaten mor- tification, a queftion naturally arifes, what is to be done ? Is mercury to be given freely, to get rid of the firft caufe, or does that medicine increafe the effect, while it deftroys the caufe ? Nothing but [ 32 ] but experience can decide this. But I fhould incline to think it neceflary to give mercury; for I am afraid, our powers, to correct fuch a con- ftitution, while the firft caufe fubfifts, are but weak; but would give it fparingly, becaufe it aflifts in difpofing to fuch fymptoms, and might, if given liberally, do injury. I am therefore of opinion, that fuch medi- cines as may be thought neceflary for the conftitution, fhould be given along with the fpecific. Bark promifes to be of the moft ge- neral ufe ; and opium, administered at proper periods, will be of fingular fervice. By com- bining the bark with mercury, they will coun- teract both difeafes, the local and constitutional. When the inflammation is fo predomi- nant, that mercury may increafe the dif- pofition, bark must be given alone. In inflammations which have a tendency to mortification there remains an increafe of action, but a decreafe of power; and this is the caufe of the mortification, by destroying the balance which ought to fubfift between the power and the action of every part. Upon thefe [ 33 ] thefe principles the bark is the medicine on which we can place the moft dependence; be- caufe it increafes the powers and leffens the action at the fame time. Opium likewife, in many cafes, leffens the action, but has not the property of increafing real or permanent strength of the fyftem or of particular parts. When the stricture from the paraphymofis threatens mortification, an operation becomes necelfary. This operation is more difficult and trouble- fome than that for the phymofis ; becaufe the fwelling on each fide of the stricture covers or clofes in upon the tight part, and makes it difficult to be got at. The belt way is to feparate the two fwellings, caufed by the stricture, on each fide, as much as poflible, when you mean to cut, fo as to expofe the neck, then pafs a crooked bistoury which is pointed, under the fkin at the neck and divide it; no part of the fwellings on either fide of the stricture need be divided, for it is the laxity of the fkin in thefe parts which admits of their fwelling. It may be proper to let the prepuce remain in the fame fituation E after [ 34 ] after the operation, till the chancres are healed on it, or on the glans. If increafed inflam- mation fucceeds the operation, local treatment will be sufficient, fuch as fomentations, poul- tices, &c. Mercury fhould be employed in every cafe of chancre.—If given internally and cau- tioufly managed, it will feldom or never fail of curing the difeafe, even where local appli- cations are omitted. When employed to act internally, it fhould be continued the whole time of the cure, and for fome time after the chancres are healed, The quantity of mercury employed, fhould be in proportion to the fize of the ulceration j becaufe abforption is more copious from large than from fmall furfaces. Mercury employed to act internally, must be applied either to the fkin or taken into the ftomach, according to circumftances. The quantity, in either way, fhould be fuch as may affect the mouth (lightly. When the fore has put on an healthy afpect, when the hard hafis has become foft, and it has [ 35 ] has fkinned over kindly, it may be looked upon as cured. But in very large chancres it may not al- ways be neceflary to continue the employ- ment of mercury, either for external or internal action, till the ulcer is healed; becaufe the venereal action is juft as foon deftroyed in a large chancre as in a fmall one ; for every part of the chancre, being equally affected by the mercury, is equally eafily cured : But the fkinning is different, for a large fore is longer fkinning than a fmall one. When the mercurial courfe is -carried too high, or is too long continued, it will fome- times produce floughs and ulcerations in the tonfils, and enlarge the furface of ulcers, after the venereal virus is removed. Under fuch circumftances the cortex with decoctions of farfaparilla and mezereon are found the beft remedies. A gentleman whofe ulcerations were ag- gravated by mercurial dreflings, was cured by taking forty drops of lixivium tartari every evening and morning, in abafon of broth. E 2 OF [ 36 ] O F BUBOES. BUBOES, being an inflammation and tu- mefaction of the inguinal glands, may arife from various kinds of irritation. When the fibres are in a ftate of preternatural tone, called an inflammatory diathefis, they fre- quently arife from the external application of mercury. But as the moft frequent caufe is the abforption of venereal matter, I fhall con- fine my remarks to venereal buboes only. The venereal bubo is always caufed by the abforption of venereal matter, but this abforp- tion can not take place, unlefs the urethra, the epithelium or cuticle of the glans or pre- puce is abraded, unlefs introduced into a wound, &c. below the gland. Therefore, although the matter lies for many weeks in the urethra and over the glans penis, it feldom happens that any abforption takes place; and hence the reafon that a gonorrhoea fo feldom degenerates into a lues venerea, though the matter [ 37 ] matter of it and that of chancre are precifely the fame. When a bubo is afcertained to be venereal, refolution certainly ought to be attempted if it be in a ftate of inflammation only—If very large and suppuration begun, this can feldom be effected. Resolution is to be performed principally by mercury, and depends almost abfolutely on the quantity that can be made to pafs through the gland. And where fuppuration has come on, the cure depends upon the fame circum- stance. The quantity of mercury which can be made to pafs through the difeafed gland, depends greatly on the extent or size of the ex- ternal furface for abforption below the bubo: Hence it is neceflary to apply the mercurial ointment to the leg and thigh of the fide affect- ed, and alfo to the penis and fcrotum, that it may pafs through all the branches of the lym- phatics which lead to the affected gland; but nothing of the kind fhould be applied to the integuments of the gland itfelf, left by its irri- tation the intention of refolution be defeated. When local inflammation runs high, bleed- ing and lead water poultices, with the addition of [ 3» ] of a pafte made with opium and water, fhould accompany the application of the mercurial ointment. These poultices fhould always be applied cold. In this way they have very powerful effects, in diminifhing the action of the arte- ries of the part, while the mercury alters the ' fpecific irritation. But, if the conftitutional irritation is very great, that is, if the folids are in preternatu- ral tone, and the globules of the blood denfe and compact, evacuations and topical feda- tives fhould always precede the employment of mercury. On the contrary, in relaxed habits, the bark and a nutritive regimen, fhould be combined with mercury. Mercury, taken into the ftomach, cannot act immediately on the bubo ; the ointment fhould therefore always be preferred. In women, buboes are feated fometimes in the ligamentum rotundum ; fometimes be- tween the labium and thigh j and fometimes in the groin. When [ 39 ] When feated between the labium and fe- mur, the mercury, that it may pafs through it, fhould be rubbed about the perinaeum, nates and infide of the thigh, as all the abforbents of thofe parts appear to pafs that way ; at least, they do not pafs into the pelvis by the anus, but go by the groin. In the refolution of buboes, mercury fhould be pufhed as far as poflible, without inducing falivation. Half a drachm of ointment, made of equal quantities of crude mercury and frefh hogs- lard, has been generally sufficient to apply at a time ; and if the mouth does not become fore, but only tender, then pursuing this courfe, till the gland is reduced to its natural fize, will be sufficient, and will probably fecure the conftitution, provided the chancre, which o-ave rife to the bubo, heals at the fame time. If the mouth is not affefted in fix or eight days, then two fcruples or one drachm may be rubbed in along the courfe of the lympha- tics every night, till it accomplishes the pur- pofe. When [ 40 j When there are two buboes, the quantity of ointment fhould be proportionally greater. When the buboes are fo feated, or fo cir- cumstanced, that the mercury cannot be con- veyed to them through the lymphatics, it muft be employed either externally or internally, as may be moft proper, fo as to cure, by acting on the conftitution in general. And in fuch cafes, the mouth muft be affected. By following this method, I* have had but three buboes to fuppurate, fince the year 1761. But if they fhould come to suppuration, they are then to be treated in fome refpects like other abfceffes. When suppurated it will be belt to let the bubo break itfelf: but if that is not allowed, it fhould be permitted to go on thinning the parts as much as poffible before it is opened. The great advantage arising from this is, that thefe parts having become very thin, lofe the difpofi- tion to heal, which gives the bottom of the abfcefs a better advantage for healing with the superficial parts; by this means too large an opening [ 41 ] opening is avoided, and the different modes made ufe of for keeping the fkin from healing, till the bottom is healed, become unneceffary. I am of opinion that mercury fhould be con- tinued through the whole suppuration: for though the parts cannot become difpofed for a cure, till the abfcefs is opened and the pus let out; yet I think, they will have a greater ten- dency that way. The abfcefs may be opened by fimple inci- sion, in preference to any other way. After the abfcefs has been opened, mercu- ry fhould be employed in the fame manner as directed for the refolution, and for the fame reafon. In general, the fyftem fhould be kept charged with mercury till the bubo is healed; or, till it has for fome time loft its venereal or difeafed afpect. But venereal ulcers, fome- times, afliime other afpects and dispositions, different from venereal. In fome fuch cafes, when the fyftem has been much reduced by long confinement, and a tedious courfe of mer- cury, and the ulcers continue without fhewing any difpofition to heal, but perhaps even grow F worfe; [ 42 ] worfe; under fuch circumftances, in general, the moft effectual remedy is a light nourifh- ing diet, with frefh air and moderate exercife, to reftore and invigorate the conftitution. The bark and wine, or Huxham's tincture, will likewife contribute to the fame purpofe. And, as old fores of this kind, are generally covered with a glofly flough, fome degree of local sti- mulus will be always proper. An ointment formed of Precip. rub. two drachms, and Ba- filic. flav. one ounce, affords one of the best dreflings. When by the application of this ointment, the Houghs have all cast off and a proper pus is difcharged, the ulcer may after- wards be dreffed with lint, and covered with common cerate, fo as to exclude the air. Of [ 43 3 O F T H E Confirmed LUES VENEREA, I HAVE now finifhed my account and me- thod of treatment of thofe affections, in which the venereal poifon is fuppofed to be confined chiefly to the particular part by which it was received; and fhall next treat of the difeafe, in its confirmed ftate; that is, when the poifon is actually received into the bloodj and thereby conveyed to every part of the body. The firft fymptoms of this form of the difeafe, appear either on the fkin, throat, or mouth. It appears on the fkin, in dry fcabby erup- tions or pustules, covered with a yellow fcab, and moft numerous among the hairy parts. If the fcab is picked off, the fkin underneath appears of a reddifh brown or copper colour; the pustules are usually covered with a dry branny fcurf, or elfe with a hard dry fcab, of a tawny yellow colour. The parts of the F 2 throat [ 44 ] throat and mouth principally affected, are the tonfils, uvula, and fauces, from whence they often fpread to the offa nafi. In the fecond ftage of this difeafe, it affects the deeper feated parts, the. conglobate glands, the tendons, the fafciae, the ligaments, the pe- riosteum, and the fpongy parts of the bones. When thefe laft parts become irritated by this poifon, the progrefs of the fymptoms is more gradual than in the firft; and have very much the character of fcrofulous fwellings, or chronic rheumatism, When the periosteum is affected, the fwelling has the appearance of an enlarged bone; becaufe it is firm and clofely connected with it. All thefe fymptoms go'on increasing in violence, and additional ones continue to arife, till the miferable patients fall into an hectic and atrophy, and die miferably, unlefs preferved by the powers of medical art. Hard indolent fwellings, however, refem- bling venereal nodes, exoftofes, &c. fome- times arife independent of the venereal poifon, and may depend on a fcrofulous conftitution, We [ 45 ] We ought, therefore, to examine other fym- ptoms well, before we pronounce thefe to be venereal. When thefe fwellings are not owing to venereal poifon, they are very fel- dom painful, or have a great tendency to inflame or fuppurate; whereas thofe that are venereal, generally do, and if they lie upon a bone, generally bring on a caries. These carious ulcers are moft commonly met with on the ulna, tibia and bones of the cranium; and when accompanied with nocturnal pains, we need never hefitate in confidering them as venereal. These, then, are the principal and moft evident figns of the confirmed lues—there are others enumerated by authors ; but as they are more equivocal, fhall for the pre- fent be paffed over in filence. Being thoroughly convinced, that the cafe is venereal; before we apply our remedies, we fhould consider firft of all, whether it be of longer or fhorter date, and then the age, fex and conftitution of the patient—becaufe this difeafe is much more difficult to ma- page, when it has been of long continue ance [ 46 ] ance in weakly perfons, and in perfons la- bouring under any chronic difeafe, than in one of a found and healthy conftitution—Not becaufe two difeafed actions of a different nature can exist in the fame part, but becaufe the predominant action will operate with more violence, in confequence of the parts affected being more fufceptible of impref- fion by the weaker difeafed action. The more fymptoms that arife, and the more that they affect the bones, the more difficult will be the cure. The condition of the patient fhould al- ways be considered, before he enters on a courfe of the grand fpecific, mercury. It is fuperfluous to obferve, that it would be rafh and dangerous to administer mercury in an acute fever, in the hectic fever, derived from internal ulcers or abfceflfes, and in the laft stage of a confumption, except when in the laft mentioned cafes there is convincing evidence, that the hectic is derived from the lues. In many chronic difeafes, or morbid con- stitutions, mercury may be administered un- der certain limitations, with perfect fafety and advantage, efpecially in the fcrofula, the afthma, &c. If t 47 ] If the patient's strength has been much exhausted by labour, abstinence, or ficknefs, or any other caufe, the employment of mer- cury fhould be poftponed till by time, reft, and a nourifhing diet, it can be sufficiently restored. In the application of mercury to pregnant women and to infants, much caution will be requifite. Mercury fhould always be guardedly given to patients afflicted with the fcurvy, and to fuch as are subject to habitual diarrhcea or dyfentery. Where any of thefe diforders prevails, it fhould be cured, or at least alleviated, before the patient enters on a cure of the lues. ■ The patient's regimen fhould be in fome meafure conformable to his former habits; and if he has been accuftomed to live full and to drink free, the quantity of his aliments and drinks may be reduced with propriety, but not their quality: otherwife mortal diarrhoeas, palfies, or fome other difeafe of a debilitating nature, will be apt to be the confequence. It is [ 48 ] is however of much importance, to avoid all manner of excefs, and to avoid the common caufes of inflammation on the one hand, and thofe productive of putrefaction on the other—" In medio tutiffimus ibis." Of the CURE of the LUES VENEREA. TO cure the local and visible effects of the lues, we muft attack it through the medium by which it was communicated, that is the blood, without however confidering the blood itfelf, as a difeafed part, or containing the poifon, but as the vehicle of our medicine which will be carried by it to every part of the body, where the poifon was carried, and in its courfe it will act on the difeafed folids. With regard to the preparation of the medicine, and the modes of adminiftering or applying it, we are to confider two things. lit. The [ 49 ] ift. The preparation and mode that is attended with the least trouble or inconveni- ence to the patient; and, 2d. The preparation and mode of admi- niftering it, that moft readily conveys the neceffary quantity into the conftitution. And when in every form it acts locally, instead of generally, it will become neceflary to join fuch medicines with it, as will leffen or prevent its violent local effects, without affecting its fpecific ones on the constitution at large. When it can be thrown into the conftitu- tion with propriety, by external application, it is preferable to the internal, becaufe the fkin is not near fo effential to life as the fto- mach, and is therefore capable in itfelf of bearing much more than the ftomach; it alfo, in this way, affects the conftitution much lefs. The visible effect of mercury on the con- ftitution is, to produce universal irritability, that is, make it more Wceptible of all irri- G preflions; [ 5° ] preflions ; it quickens the pulfe, increafes its hardnefs, and produces a kind of tempo- rary fever, &c. Experiments prove that evacuations, pro- duced by mercury, retard the cure, especi- ally if the fecretory organs are too fufceptible of this stimulus, for then the quantity suffi- cient for the cure cannot be taken in. On the other hand, if given with care and judg- ment, fo as to avoid violent evacuation, any quantity may be introduced, fufficient for the cure of the difeafe. <•" OF THE ACTION of MERCURY. MERCURY can have but two modes of action—one upon the poifon ; the other on the conftitution. If C 5« 1 If it acted upon the poifon only, it might be fuppofed to be in two ways, either by destroying its qualities, by decomposing, or by attracting it, and carrying it out of the conftitution. If the firft were its action, the quantity alone would be the thing to be depended upon; if the fecond, the quantity of evacu- ation would be the object. But if it act upon the principle of de- stroying the difeafed action of the living parts, counteracting the venereal irritation, by producing another of a different kind, then neither quantity alone, nor evacuation, will avail much ; but it will be quantity, joined with fenfible effects, that will pro^ duce the quickest cure, which, from ex- perience, we find to be the cafe. Mercury lofing its effects upon the dif- eafe, by constant and habitual ufe, is a proof that it neither acts chemically, nor by carrying off the poifon by the excretions, but by its stimulating power, G 2 Thb [ 52 ] The belt preparation of mercury, for ex- ternal application, is made by triturating equal weights of crude mercury and hogslard to- gether, till perfectly incorporated, without any other addition. The preparations I employ for internal application, and which I believe to be equal, if not fuperior, to any other form, is, mer- curius calcinatus, calomel, and argentum vivum, incorporated with thick mucilage of gum arabic. Of the firft, I commonly give one grain, with a third of a grain of opium and a drop of agreeable effential oil, for one week or upwards; and if by that time, that quan- «? tity has not made a vifible alteration in the mouth or throat, I repeat the fame quantity twice a day, for another week; or till it gives evidence of having pervaded the fy- ftem; in which condition I endeavour to keep the fyftem, without bringing on a falivation, till all the fymptoms of the difeafe are removed. About three grains of calomel are equal in strength to one of mercurius calcinatus; and [ 53 ] and fifteen of crude mercury are equal to three of calomel. It has of late years, been the common practice, to give corrofive fublimate, in folu- tion ; but from many trials I have made with it, I am convinced it feldom performs a perfect and radical cure. It is true, it removes ulcers of the mouth fooner than any other preparation; but this I fufpect is, by its acting locally as a gargle. A grain, or lefs, diffolved in any agreeable liquid, particularly distilled fpirits, is the common dofe and form of adm^'ftering it. It paffes readily off by the fkin, owing to its being in the form of a diffusible stimulating fait; hence has considerable effect on fimple cuta- neous eruptions. But it difagrees more with the ftomach and bowels, than any other preparation; therefore, generally requires to be combined with opium, to abate their fenfibility. Gum guaiacum, in dofes of a fcruple, is fometimes a good auxiliary to thefe prepa- rations, efpecially in old debauched constitu- tions, Many [ 54 ] Many of the local affections, befides the application of mercury, require other assist- ance. Nodes have given way frequently to blif- tering, but oftener to an incifion down to the bone, through the periosteum—by thefe means the violence of pain, which is fo in- supportable to the patient, while warm in bed, is perfectly relieved. Venereal warts may be confidered as mere excrefcences from the cutis, and ought not to be confidered as a part of the animal, becaufe not endowed with the common or natural animal powers, for which reafon the cure becomes eafier—hence many trifling circumftances may occasion them to decay. Electricity will produce an action in them, which they are unable to fupport. An in- flammation excited round them, will often make them drop off.—Many stimuli applied to their furface, make them wither and die.— Any cauftic frequently applied, will deftroy them—or, where the oafe is flender, they may be cut off with a pair of fciffors, or by a waxed thread drawn fo tight, as to prevent the entrance of any fluid into them; and afterwards [ 55 ] afterwards their bafe fhould be touched with cauftic ; merely as a ftimulant, the ruft of copper and powder of Savine leaves is one of the belt. When the cauftic is employed to remove venereal excrefcences, they fhould not be applied over a large furface at once, left they induce inflammation, and do injury. When the bafes of excrefcences are large, a needle, with an eye in the point, armed with two pieces of waxed filk thread, fhould be thruft through the middle of it, at its bafe, with which each half is to be fur- rounded, and tightened clofe, increafing its tightness daily, till the whole drops off. When part of any gland, after suppura- tion, remains indurated, and cannot be brought to fuppurate, it will be proper to deftroy the indurated parts, by the repeated application of the lunar cauftic. Venereal ulcers of the mouth and throat, are best relieved by gargles made of vegeto- mineral water, and a weak folution of subli- mate, combined together. And when, by mif- management [ 56 ] management or other caufe, a falivation has taken place, a gargle of opium has good effect, by taking off forenefs and irritability on which the difcharge depends.—Laxatives and sudorific anodynes will likewife be proper in fuch cafes. From all the obfervations I have been able to make on the operation of different preparations of mercury in the human fyftem, I am of opinion, every preparation of that metal, when it acts on the circulation at all, becomes fpecifically the fame ; either before or after its entrance, fo that the lefs stimu- lating and more fimple the preparation is, in irritable temperaments, the better. Every preparation appears to act, by producing an irritation, which counteracts and destroys the venereal irritation. I shall conclude this part of my fubject with the following facts, in fupport of what I have advanced, reflecting the venereal virus in gonorrhoea and chancre, being the fame.-----Both gonorrhoea and chancre are very generally confequences of the fame re- mote caufe, that is, communication with an affected perfon of a different fex: from a fingle [ 57 ] fingle inftance of expofure to infection, a patient has contracted both thefe local forms of the difeafe. From the fame female, who it was afcer- tained beyond controverfy, had only a go- norrhoea, two different men were affected, one with gonorrhoea, the other with chancre ; and feveral in whom the affection had begun in form of gonorrhoea, have (in confequence of inflammation, terminating in an abfcefs and ulceration,) had it converted into a confirmed lues. To put the matter out of all difpiite, I * prevailed on more than one patient in an hofpital, to permit experiments to be tried on them in different ways, with matter in each form of the difeafe; all of which con- firmed the fact. H OF [ 5« ] OF THE DISEASES of the URETHRA; Suppofed to he derived from the VENEREAL DISEASE. BEFORE I enter upon this part of my subject, I deem it proper to give a fhort defcription of the urethra, &c in a found and healthy ftate, By the urethra, I understand that canal, by which the urine is conveyed out of the bladder. I consider all that part of the canal, con- tinued from the bladder and incumbent on the proftate gland, the neck of the bladder; and, at the termination of the neck of the bladder, the membranous part, called the urethra, has its origin. The mufcular fibres, which act as a fphincter, are implanted into the proftate gland: for, although what has formerly been called the neck of the bladder, after the expulfion of the urine, is more like a canal [ 59 J a canal than the body of the bladder, till the canal has arrived at the prostata, it has not the leaft power of refifting the efflux of the urine. The commencement of the urethra ap- pears to be truly membranous, but foon after it receives a covering, called corpus caver- nofum; the origin of this cavernous sub- stance is by much its largest part, both as to number of cells, as well as form; which is not unlike a pear, whofe bafis is next to the prostata, and is imperforate at its bafis: this fpongy or carvernous fubftance is con- tinued round the urethra, throughout its whole extent; and when it gets beyond the extremities of the corpora cavernofa penis, it becomes a cap to them, and forms what is called the glans penis; though its cells have not the leaft communication with the corpora cavernofa penis, but only with the corpora cavernofa urethral. The extremity of this canal has an aperture of an oblong fhape, for the exit of the urine and fperm. If we examine the internal furface of the urethra, after dividing its fuperior part, lodged in the fulcus between the corpora H 2 cavernofa [ 60 ] cavernofa penis, and continue the incifion quite through that part of the canal which is lodged within the proftate gland, till the neck of the bladder is laid open, we shall difcover a fort of caruncle, called caput gallinaginis, or veru montanum. This carun- cle has two or three orifices, opening into the cavity of the urethra, which are the ducts from the veficulas feminales, and are fo directed as to ferve as valves, to hinder the urine from entering when difcharged from the bladder, and are furniihed with fome fibres, which act as fphincters, to pre- vent the femen from efcaping, till wanted in time of coition. On each fide of the veru montanum, we obferve ten or twelve orifices, v/hich are the terminations of the excretory ducts from the proftate gland. If we blow, with a fmall pipe, on the inner furface of the urethra, obliquely to- wards the neck of the bladder, we may obferve the appearance of many femilunar valves, which cover the excretory ducts of the mucous glands, lodged in the caver- nous fubftance of the urethra: thefe ducts do [ 6> ] do not open into the urethra, immediately, on their being fent off from the glands; but, pafllng between its coats for fome fhort fpace, and advancing obliquely for- ward, terminate in the urethra, and are called lacunar : by the direction of thefe lacuna?, their orifices muft be always clofed during the difcharge of the urine ; and by this me- chanism, the orifices are not ftimulated at that time ; but the glands being acted on by the column of urine, difcharge their mu- cilage which, lubricating the internal furface of the urethra, prevents offence being given by the falts of the urine, which would otherwife happen from the great fenfibility of the internal membrane. « Near to the bulb of the urethra, we remark two lacunae, much more confpicuous than the reft, which are the openings of the excretory ducts, from two glands, com- monly called Cowper's glands, from the name of the difcoverer; they are fituated on the outfide of the urethra, and acted on by the mufcle, called accelerator urinas and feminis. The whole internal furface of the urethra is villous. The [ 62 ] The* urethra is a cylinder, as far as it is contained within the fulcus of the corpora cavernofa penis; but after that, it is extended towards the glans penis; its fides approach- ing each other, it becomes rather a flat tube, but remarkably depreffed jufi within the glans; which depreflion is called foffa navicularis; after that the canal terminates by a fort of oblong flit, called the orifice of the urethra. What we have now advanced may ferve to convey a general notion of the anatomy of the parts; the difeafes whereof we are about to treat. O F [ 63 ] of the DISEASES OF the URETHRA. THERE are five modes of obstruction, to which the urethra is fubject; four of which are difeafes of that canal itfelf, the fifth is the confequence of the difeafes of other parts. Three of the former modes are a leffen- ing of the diameter of the paffage; the fourth is an excrefcence in the canal; and the fifth is derived from contiguous exte- rior fwellings, or from a fwelling of the proftate gland. Strictures are known by the leffening of the diameter of the stream of urine. Sometimes the stream is forked or fcat- tered. Under fuch circumftances, if a bou- gie, of a common fize, paiTes with tolerable [ 64 ] eafe, the fifth caufe of obstruction is to be fufpected, which will moft probably be a fwelled proftAte gland. The spasmodic obstruction will com- monly explain itfelf, when the fymptoms are well investigated; for the obstruction arifing from this caufe, will not be perma- nent or constant, but will fometimes inter- mit or be abfent. The bougie, with its application, is per- haps one of the greatest improvements in furgery, which thefe laft thirty or forty years have produced. Formerly the bougies were either a piece of lead or a fmall wax candle. When lead was ufed in place of bougies, it has happened that a piece of the end has broken off in the bladder, which has been diffolved and brought away by injecting quicksilver into that vifcus, I suspected (a priori,) that quicksilver could not come in contact with lead, in water, fo as to diffolve it; but upon making the experiment found, it did. Daran t 65 ] Daran was the firft who improved and brought the bougie into general ufe. Many place great faith in certain com- positions of which the bougie is formed; but it is of no confequence what are the materials of its composition, becaufe any extraneous body of the fame shape and conflftence, will act in the fame manner. The permanent stricture is only to be cured by local applications. The cure is either a dilatation of the contracted part, or a destruction of it, by ulceration or efcha- rotics. The dilatation is effected by the bougie, but this is feldom permanent. The ulcerative process is alfo effected by the bougie; and the destruction by efcha- rotics, is by means of caustics. The bougie fhould be increafed in fize, according to the facility with which the stricture dilates, and the eafe with which the patient bears the dilatation. I The [ 66 ] The time each bougie fhould remain in the paffage, muft be determined by the feelings of the patient; for it fhould never give much pain: going beyond this point, is destroying the rational intention, and produces irritation; which for a time renders the further introduction of the bougie im- proper. When the ufe of it is firft com- menced, perhaps it fhould feldom be left in, more than from five to ten minutes at a time; till the irritation ceafes from habit. It fometimes happens, that fome patients cannot bear it to remain in the paffage for ten minutes together, at the end of feveral weeks; and yet in time, they come to bear it without much inconvenience, for hours. The belt time of introducing the bougie, is in the morning before the patient leaves his bed, or when he has no occasion to ufe exercife. Symptoms of inflammation, are to be pre- vented, by temperature and vegetable regi- men; but when they take place, by general and fedative evacuants, and the antiphlogistic regimen,—which consists in avoiding every thing [ 67 ] thing poffeft of irritating powers, and by emol- lient watry liquors copioufly drank, with a view of relaxing and diminifhing the action of the distended fibres and diluting the falts of the urine. If the smallest bougie which can be con- trived, with any degree of strength cannot pafs, dilatation becomes impracticable, and it becomes necelfary that fomething elfe be done for the relief of the patient. So circumstanced, the stricture is to be destroyed fome way or other. Here then the cauftic is the beft application. This may be performed, by fixing a lunar cauftic, in form of a flender pencil, to the end of a wire or fmall flexible probe, by means of melted fealing wax; which is to be paffed to the part moft affected with the stricture, through a fmall fllver cannula or catheter. The application of cauftic need not ex- ceed a minute at a time, and may be re- peated every day, or every fecond day, only allowing time for the (lough to come off, I 2 When [ 68 ] When this method excites inflammation and pain, which is fometimes the cafe, and fometimes a total fupprefiion of urine— the application is to be fufpended a while, and thofe effects removed by cool injec- tions of vegeto-mineral water, and a folu- tion of opium in water—fomentations to the region of the bladder—faline purga- tives, fucceeded by an anodyne draught at bed time, joined with thirty or forty drops of antimonial wine; but, if the inflamma- tory irritation comes to be communicated to the fyftem, anodynes will not be pro- per, till that circumstance has been re- moved by blood-letting, &c. To prevent thofe effects of the cauftic, the patient fhould make water, or inject warm milk and water into the urethra, to wafh out any part of the cauftic, that may have been diffolved. The cure of strictures, in the urethra of women, is similar to that in men. The bougie muft be prevented from paffing into the bladder of women, by bending part of it over the orifice of the vagina, and fhould be prevented from falling out, by [ 69 ] by the (T) bandage. The bougie fhould always be introduced for women, as it is almoft impracticable for them to do it themfelves—but happy for them, they have very feldom occafion for fuch an applica- tion, as the vagina, in females, is much of- tener the feat of the venereal difeafe, than the urethra. A composition, which anfwers very well for the conflftence of bougies, is the fol- lowing : ol. Olivar. lb. iij.—cerse flav. lb. j. minii lb. ifs. which are to be boiled to- gether over a flow fire for fix hours. The cure of the excrefcence, or caruncle in the urethra, is to be conducted in the fame manner as directed for the destruc- tion of impervious or contracted stricture, already defcnbed. In cafes of difeafed urethra, where the urine diffufes itfelf into the cellular mem- brane of the fcrotum and penis, unlefs foon relieved, the patient finks, and a mor- tification , comes on. If, [ 70 ] If, before he finks, a feparation of the flough takes place, this feparation performs the operation of opening, and the patient may recover. We fhould not however, I think, wait for fuch feparation of the mortified part, but make an opening early, upon the firft knowledge of a diffusion of the urine into the cellular membrane; and we should be guided as to situation, by introducing a staff into the urethra on to the stricture. As in fuch cafes there is great difpofi- tion to violent action, attended with great debility of the moving fibres, in the part locally affected, it is advifeable to give the bark early and liberally, accompanied with fuch medicines as have the property of acting on the perfpiratory veffels, fuch, as the faline draughts, Mindererus's fpirit, antimonial wine, or other antimonial pre- parations ; as there is generally a stricture on the furface, and considerable fever. The cortex gives strength, and alfo, in fome degree, leffens irritability, and by that meansj [ 7i ] means, leffens action.—Opium will often assist its effects. Abscesses fometimes take place in the urethra, in confequence of violent inflam- mation, and frequently break and difcharge on the outside of the perinseum or inferior part of the penis, through which the urine is difcharged, rendering. the wound callous and fistulous. In cafes of fistulous ulcers in the perine- um or penis, a bougie or the catheter, is almoft the only remedy neceflary to be em- ployed. By a proper and long continued ufe of either of thefe, the obstruction will be removed.—But I prefer the catheter for the moft part to the bougie, becaufe when neceflary to make water, the catheter need not be withdrawn.—-When the catheter is employed, it is to be fecured from coming out, by a fuitable contrivance. When the cure of the urehtra is effected, it will be known by the instrument pafling in without impediment, and by the urine following in full stream when withdrawn, and the orifice of the external fore is com- preffed. [ 72 3 If this preternatural opening does not now heal, in the courfe of a fhort time by fimple drefling, it will be found to be pre- vented by its edges having become callous, and by their being covered with a morbid production of the surrounding cuticle. Till this obstacle to the progrefs of the cure is removed, it is evident no advantage can be derived from any means which can be employed. We are, therefore, to attempt the deftruc- tion of the callous edges of the fore, as foon as it is found that the bougie or cathe- ter, after removing the obstructions in the urethra, have not proved altogether effectual. And the method of doing it, is this. The patient is to be placed on a table, in the fame posture as is ufed in the ope- ration for the ftone; and a staff being in- troduced into the urethra and pufhed gently along till it has paffed the opening; at which the urine is difcharged. In this fituation it is to be held firm by an afliftant, while the operator, intro- ducing [ 73 ] ducing a fmall probe, at the external open- ing of the ulcer; and cutting upon it in the courfe of the finus, is then to lay it open through its whole length; till it terminates in the urethra or in the bladder itfelf, if the fistula or finus reaches fo far. When there are more openings than one vifible externally; they muft all be laid open, in the fame manner. In fome instances, there are two or three finufes in the cellular membrane, leading from openings in the urethra; but in others, there are as many openings in the urethra, as there are finufes or fores, externally. This, however, is not a frequent occur- rence; but is a matter of importance, as the fame method of treatment anfwers equal- ly well in both cafes: for, whether the1 dif- ferent finufes originate from one common opening in the urethra or not, they ought all to be laid completely open, from one extre- mity to the other. The blood being fpunged off, the ori- fice in the stricture of the urethra is to be K fearched [ 74 ] fearched for, and when difcovered, is to be dilated. The catheter is then to be pufhed forward into the bladder, and fecured from coming out, and the wound to be diftended with lint. An anodyne may be given, after the ope- ration, and another at bed. time. The catheter or a bougie, as may be thought moft advifeable, is to be left in the urethra; unlefs fucceeding inflammation makes it neceflary to withdraw it, till the wound becomes stationary; then left it fhould prevent healing, it fhould be with- drawn, and only ufed occafionally. The fubftance of the urethra being muf- cular, it is subject to difeafes, peculiar to mufcles in general. In a paralyfis of the urethra, the bladder is hardly allowed to be filled fo as to give the stimulus of repletion, but the urine dribbles away infenfibly, as fast as fecreted by the kidneys. There [ 75 ] There is great difference in the degrees of violence of this difeafe. This complaint is to be cured by stimu- lants; as a blister to the loins, or to the perinaeum. Putting the feet in cold water may be ferviceable. Cantharides taken internally, fifteen or twenty drops of their tincture, twice a day, according to their effects, are of fingular fervice in many cafes. This fometimes brings on a fpafmodic affection of the urethra, but an emollient clyster with the addition of opium, foon relieves. Spices and fteel medicines are of fervice, and from what has been faid of the bark, fhould fuppofe it a good medicine. Electricity fometimes fucceeds----and wafhing the adjacent parts with cold water, may probably have a good effect. K 2 ' When [ 7« ] When carnofities are difcovered in the urethra, cauftic is the only remedy. Strictures are too often mistaken for carnofities and execrefcences, which are but rare occurences. A swelling, or induration of the pro- ftate gland, is often the proximate caufe of the ftrangury, and frequently prevents the catheter from entering the. neck of the bladder: fuch cafes require fmall bougies to bring on suppuration, &c, Involuntary feminal difcharges, are oc- casioned by relaxation, and preternatural irri- tability of the testicles and contiguous parts; and are fometimes to be cured by opium, given in fmall dofes, night and morning, twelve or fifteen drops of Tinct. Thebaic, at bed time, and half as many in the morning; aided by bark, cold bath, flefh brufh, and exercife in the open air. Oe [ 77 ] Of CORRECTING SOME OF THE EFFECTS of MERCURY. FORMERLY, when the management of mercury was not fo well understood, nor its effects in this difeafe fo well known, as they are at prefent, it was generally fuppofed to act by evacuation from the falivary glands, and was therefore always given, till that evacuation took place; and as its effects in the cure were imagined to be in proportion to the quantity of this eva- cuation, it was pufhed as far as poflible, with- out bringing on a danger of suffocation. From this treatment it often happened in thofe constitutions which were very fufceptible of the mercurial irritation, and in which the medicine produced much more violent ef- fects on fome particular fecretions than could be wifhed, that recourfe was obliged to be had to medicines, correcting the effects of mercury; as thefe effects were often [ 78 ] often an hindrance to its being given in suf- ficient quantities for the cure of the difeafe. I mentioned, when treating of the effects of the mercury, that the fenfible increafe of the fecretions produced by it, were in the following order; firft of faliva, then fweat, then urine; and often of the mucus of the intestines, producing purging. I alfo ob- ferved, that when any of thefe fecretions became too violent, that the hand of the surgeon was tied up, till they were mode- rated. Attempts have been made, to lef- fen thofe effects in two ways, either by the destruction of its power on the body in general, or by its removal, but neither of thefe means have fucceeded. It never has once been thought necef- fary to attempt to leffen its powers on the organs of fecretion, fo as ftill to retain the fame quantity in the conftitution, or even to throw in more, which if it could be effected, would be fometimes of great fervice; but, as we are not yet acquainted with power sufficient for thefe purpofes, we are obliged to obferve great caution in our mode of giving the medicine. I have en- deavoured to fhow that this medicine need not L 79 J not be given with a view to procure thofe evacuations, and that it may be given in any quantity, without increafing either of thofe fecretions, in any evident degree; however after every precaution, we may be still deceived; and the medicines will, every now and then, produce greater effects than were intended. It is very neceflary, there- fore, to feek for a preventive of the effects where they have already taken place. The common practice when mercury produced violent effects upon the inteftines, was to counteract thefe effects; but this was not done with a view to retain the mercury in the conftitution, but to relieve the bowels that were suffering by the action of the medicine; whereas the proper practice would be to ftop its progrefs here, as in every other outlet, that more mercury may be retained in the conftitution. Although thefe increafed fecretions arife from the conftitu- tion being loaded with mercury, yet there is no danger in stopping them: for they do not arife from an univerfal difpofition becoming a local or critical one; and therefore, if fuch an action be checked or stopped in one place, it muft necessarily fall upon fome other; but it is from the part being more fufceptible of this t 80 ] this irritation than any other, and the quan1 tity, now in the conftitution, being equal to the fufceptibility of the part, and, therefore, though its effects are flopped here, it does not break out any where elfe; every other part being capable of fupporting this quantity and of remaining unaffected till more is thrown in. When the mercury attacked the falivary glands, it increafed that fecretion fo much, as in fome cafes to oblige practition- ers to administer fuch medicines, as were thought likely to remove this new complaint. This fufceptibility of the glands of the mouth, and the mouth in general, to be eafily put into action by this medicine, was generally fuppofed to arife from a fcorbutic conftitution, to which moft complaints of the mouth are attributed. I am of opinion, that fcrofulous people, and thofe of a lax and delicate habit, are more subject to have it fall on the mouth, than thofe of a contrary temperament. Purges were given, upon a fuppofition that mercury could be carried off by the evacuation produced by them; and they were repeated according to the violence of the effects of the medicine, and the strength of [ 8i ] of the patient: but I can hardly fay that 1 ever have feen the effects of mercury upon the mouth, leffened by purging; whether it arofe fpontaneoufly, was produced by purging medicines, or even when arising from the mercury itfelf. As this method was not found fufficient for the removal of the complaint, other medicines were tried; sulphur was fuppofed to be a fpecific, for the removal of the effect of mercury. Whether this idea arofe from practice, or reafoning, is not material; but I think I have feen good effects from it, in fome cafes. If we can fuppofe purging of any fervice, purging with fulphur, would an- fwer best, as it would exert its effects, both as a purge and as a fpecific. Sulphur, certainly, enters the circulation as fulphur, becaufe our fweat and urine fmell of it; if it does not combine with the mercury, and deftroy its properties as mer- cury, it is possible, agreeably to the opi- nion of thofe, who firft thought of giving it with this intention, that it may fo com- bine, as to form sethiops mineral, or fomething fimilar; for we know, that the icthiops mineral, however formed, does L not [ 82 ] not in general falivate. It is poffible too, that fulphur may act as a contrary stimu- lus to mercury, by counteracting the effects of it in the conftitution. Sulphur has even been fuppofed to hinder the mercury from entering the cir- culation. Upon the whole, as thefe pre- parations of fulphur and mercury, are ftill fuppofed to have good.effects, and as I think I have feen good effects in other cafes, we muft either allow that they enter the circu- lation, or that their whole effects are on the ftomach, or inteftines, with which the reft of the body fympathifes. The good effects of fulphur, in leffening or altering the imme- diate effects of mercury, can only take place, when that medicine is really in the conftitution; therefore a distinction is to be made between fuch as arife immediately from mercury, and one continued from habit, after the mercury has been evacuated from the constitution; a cafe that fometimes happens. The tafte in the mouth, from the ufe of mercury, has been known to go off, and not be perceived for a fortnight, and the fame* [ 83 ] fame tafte has recurred; this I am informed, has happened twice to a gentleman, from ' the firft quantity of mercury taken. To account for this is not eafy; in whatever way it happens, it is a curious fact. Sulphur united with any of the metals, probably deftroys their folubility in the juices, or at leaft their effects, in the circu- lation; none of the cinnabars act either as fulphur, or mercury. Crude antimony, which is regulus of antimony and fulphur, has no effect. Arfenic when joined with fulphur, has no effect; nor has iron. When the mercury has fallen upon the mouth or throat, wafhing thofe parts with opium, has often good effects; for opium takes off irritability and of courfe, the fore- nefs, which is one means of leffening the fecretion. A drachm of Tinctura Thebaica to an ounce of water, makes a good wafh or gargle, My ufing opium, in this way, was from analogy, finding that opium quieted the bowels, when a purging came on, in con- fequence of mercury: I tried it by way of L 2 gargle, [ 84 ] gargle, to the mouth, and found good ef- fects from it; but not equal to thofe which it produced in the bowels. When mercury falls upon the fkin, it is neither fo difagreeable, nor fo dangerous as when it falls upon the mouth; however, it may often happen, that it will be proper to check fuch a difcharge, both on account of its being troublefome, and of its leffen- ing the effects of the medicine, in the con^ ftitution, by carrying it off. The bark is, perhaps, one of the best correctors of this increafed fecretion. When the medicine attacks the kid- neys, and increafes the fecretion of thefe glands, it is not fo troublefome as when it produces fweating, though it is possible that it may carry off the mercury too foon; but as we have but few medicines that can leffen that fecretion, in moft cafes it muft be allowed to go on. The bark may in fuch cafes be given with advantage. When the mercury falls upon the bow- els, it proves often more dangerous and troublefome than in any of the former cafes, [ 85 ] cafes, efpecially the two laft; but it i? perhaps more in our power to prevent or palliate. Opium fhould be given in fuch quantities, as to overcome the complaint, and I believe will feldom fail in removing all the fymptoms. OF THE FORM OF THE DIFFERENT PREPARATIONS O F MERCURY, WHEN IN THE CIRCULATIO N. IT would appear from reafon and many circumftances, that mercury muft be in a ftate of folution in the juices of the body, before it can act upon the venereal difeafe, and indeed, before it can aft upon any [ 86 ] any other difeafe. That mercury is in a ftate of folution in our fluids, and not in the ftate of any preparation of mercury, that we know of, is very probable, from the following facts. First, crude mercury, every fait of mer- cury, and calx of mercury, is foluble in the fpittle, when taken into the mouth, by which means it is rendered fenfible to the tafte; from thence it may appear, that it is capable of folution in fome of our juices. Secondly, crude mercury, when divided into imall parts by gum Arabic, &c. fo as to be eafier of folution when taken into the ftomach, generally purges ; but crude mercury taken, without fuch division, has no fuch powers, not being fo readily diffol- ved in the juices of the ftomach. The simple calx of mercury has the fame ef- fect, purging, and much more violently, from being, I fuppofe, readier of folution in the animal juices ; for if it only purged from its union with the acid, which hap- pened to lie in the ftomach, it moft pro- bably would not purge more than crude mercury, although it is very probable, that [ 87 ] the calx is eafier of folution in a weak acid, than even the crude mercury. Thirdly, every preparation of mercury producing the fame effect in the mouth, and alfo having one and the fame effect in the conftitution, fhows that they muft all undergo a change, by which they are reduced to one particular form. We cannot fay what that form is, whe- ther it is the calx, the metal or any other, that we are acquainted with; but it is pro- bable, that it is not any of them, but a new folution in the animal juices. This is rendered ftill more probable by this circum- stance that every preparation of mercury, put into the mouth, undergoes the fame change, and the fpittle has the fame tafte from every one of them. If every different preparation of mercury had the fame properties in the conftitution, that it had out of it, which we muft fuppofe, if it enters and continues in the fame form; in that cafe, the venereal poifon muft be eradicated, in as many different ways as there are preparations. Crude [ 88 ] Crude mercury would act mechanically* by increafing weight and momentum of the blood; the calx would act like brickduft, Or any other powder that is heavy; the red precipitate would stimulate, by chymical properties, in one way, while the corrofive fublimate would act in another, and the mercurius flavus in a third; this laft would moft probably vomit, as ipecacuanha does, which vomits, whether thrown into the cir- culation or ftomach. Fourthly, all the preparations of mer- cury, when locally applied, act always irt one way, that is, as mercury; but fome have alfo another mode of action, which is, chymical, and which is according to the fpe- cific nature of the preparation. The red precipitate is a preparation of this kind, and acts in both thefe ways ; it is either a ftimulant, or an efcharotic. From what has been faid, and from many experiments which I made on myfelf, for the purpofe of afcertaining the fact, it ap- pears to be immaterial, what preparation of mercury is ufed in the cure of the ve- nereal [ 89 J nereal difeafe, provided it is of eafy fo- lution in our juices; the preparations ea- fieft of folution, being the best. of GUM GUAIACUM, and SARSAPARILLA, IN THE VENEREAL DISEASE. IH A V E hitherto only recommended mercury, in the cure of the venereal difeafe; and indeed it is the only medicine to be depended upon. The Guaiacum, I have found, poffeffes fome power over the difeafe; confequently it may be of fervice in flight cafes, where it may be improper or inconvenient to give mercury, on account of fome other dif- eafe; thefe cafes, however, I have not yet M been t 9° 1 been able to afcertain; or it may be giveri in thofe cafes, where it is- apprehended, that the quantity of mercury, neceflary to fubdue the* difeafe, would be too much for the conftitution to bear; cafes, which fometimes occur. The farfaparilla appeared to have no ef- fect at all. of the EFFECTS remaining, AFTER THE DISEASE is CURED; AND OF THE DISEASES sometimes PRODUCED BY THE CURE. IN treating of the local effects of the ve- nereal difeafe, the gonorrhoea and chan- cre, as alfo the bubo, I obferved that after the virus was deltroyed, there remained in many cafes, fome of the fame fymptoms, end [ 9- ] and particularly after the gonorrhoea. It was alfo obferved, that though all the fymptoms were entirely cured, yet they were liable to break out again. A gleet will appear, fometimes attended with pain, fo as to refemble a gonorrhoea; after chancres there will be fores, refembling them; and buboes, after the virus is gone, will not heal, but fpread. In the lues venerea, the fame thing often happens, efpecially if the inflammation and fuppuration, have been violent in the parts. These cafes puzzle ^considerably, for it is difficult to fay when the venereal virus is gone. In fuch doubtful cafes, the treat- ment to be followed becomes more undeter- mined. * Such complaints are more common, in the tonfils, than any other part; for we often find, that while a mercurial courfe is going on, and, the ulcers on the tonfil healing, or even healed, they fhall fwell, become excoriated, and the excoriations fhall fometimes fpread over the whole pa- latum molle; which renders the difeafe doubtful. M 2 I believe [ 92 ] I believe thefe excoriations, as well as fuch other appearances of the difeafe, as come on during the ufe of mercury, are feldom or never venereal. In all fuch cafes, I would recommend, not to continue the mercury longer than what appears neceflary or fufficient, for overcoming the original venereal complaints; not confidering thofe changes in the cafe, as venereal. The bark is often of fervice here, and may be given either with mercury, or after the venereal courfe is over. It often happens, that venereal abfceffes will not heal up, although they have gone a certain length towards it; for while the venereal action remained in the part, the mercury difpofed that part to heal; but under that courfe, the conftitution and part had acquired another difpofition, proceeding from a venereal and mercurial irritation, af- fecting a particular habit of body or part, at the time, which new difpofition, differs from the venereal, mercurial and natural, being a fourth difpofition, arising out of all the three. I SUSPECT [ 93 ] I suspect, however, that it depends chief- ly on the conftitution; becaufe, if it was owing to the other two we fhould always have the fame difeafe; and what makes this opinion more probable, is, that it dif- fers in different people, at leaft it is not cured in all by the fame means. The con- ftitution being predifpofed, the other two become the immediate caufes of action. As foon as the venereal irritation is de- stroyed by the mercury, or becomes weaker than the other two, then the effects of the others take place. While the venereal ac- tion prevails, the mercury is of fervice, and the fore continues healing, but when it is leflened to a certain degree, or destroyed, the mercury not only lofes its powers, but becomes a poifon to the new difpofition that is formed: for if mercury is continued the fore fpreads; it fhould therefore, be im- mediately left off. Some of the fores, formed in this way, not only refift all means of cure, but often inflame, ulcerate, and form hard callous bafes; fo as to put on the appearance of a cancer, and are often fuppofed tq be n r We really lo. [ 94 ] We find alfo, that new difeafes arife from the mercury alone. The tonfils fhall fweH where no venereal difeafe has been before, the periosteum fhall thicken, and alfo pro- bably the bones, and the parts over them fhall become cedematous, and fore to the touch; but as thefe complaints arife, while under a mercurial courfe, they are not to be reckoned venereal, but a new difeafe; al- though they are too often fuppofed to be venereal, and on that account the mercury is pushed as far as poflible. In fuch cafes, if the complaints for which the mercury was given, are nearly cured, and the medicine has been continued a fuffi- cient time after, to complete the cure of thefe complaints, then of courfe, it fhould be left off; and if there be any doubt, it fhould be left off rather fooner than if no fuch complaint had taken place, becaufe it is probably producing a worfe difeafe than the venereal ; and, if after the cure of thefe complaints from the mercury, the ve- nereal difeafe begins again to come into action, mercury muft be given a fecond time, and now the conftitution will be better able to bear it, efpecially, if attention has been paid [ 95 ] paid to the restoring the strength of1 it. Thofe difeafes of the tonfils and perioste- um, I fufpedt, have fomething fcrofulous in them. Besides local complaints, arifing from the combined action of the mercury, the difeafe and the conftitution, there is fome- times a constitutional effect, which is a weaknefs, or debility, a languor, want of appetite, frequent fweats threatening hec- tic ; but thefe happen mostly in thofe con- stitutions, with which mercury disagrees. These complaints, local, as well as con- stitutional, arife in fome meafure from weaknefs. They are difficult of cure, whe- ther arifing from a venereal chancre, bubo, or the lues venerea. Strengthening medicines are of the moft fervice: the bark is of great ufe, though in general not fufficient, as it can only more or lefs remove the weaknefs, the fpecific qualities ftill remaining. What thefe are is, I believe, not yet known ; but I fufpect, that many partake of the fcrofula; and [ 96 ] and this opinion is strengthened, by their frequently giving way to fea-bathing. In a cafe of an ulcerated rib, from a venereal caufe, and five nodes on the fhin- bones, of twelve months standing, a deep falivation of fix months was undergone, af- ter fruitlefs attempts by gentle friction. None of the fores were healed by the mer- cury, and the patient was ordered to bathe in the fea, and take the bark. In three or four months the fores all healed up very kindly; but the fide laft of all. GENERAL OBSERVATIONS on the MEDICINES USUALLY GIVEN, FOR THE CURE. A DECOCTION of the woods, among which are commonly included guaia- cum and farfaparilla, is one of the firft medicines in the cure; and many of the cafes yield to it: and this gave them the credit [ 97 ] credit of curing the venereal difeafe, while fuch difeafes were fuppofed to be venereal. This farfaparilla was often given alone, and was found to produce nearly fimilar ef- fects. A diet drink, difcovered at Lifbon, was alfo of confiderable fervice ; and as it cured cafes fimilar to thofe cured by far- faparilla, it was imagined, that the diet drink confuted principally of a decoction of this root. This was still on the suppo- sition, that all thofe cafes were venereal; but it was obferved at laft, that thofe me- dicines did not cure this difeafe, till mer- cury had been given, and in tolerably large quantity. This was fufficient to lead fome thinking minds to doubt, whether they were venereal or not; and their being cured by different medicines, ought to produce a conviction of their being different from the venereal difeafe, and that they are them- felves of different kinds. The mezereon has alfo been found to be of fervice in fome fymptoms of the lues venerea, fuch as nodes of the bones; but their being venereal, was taken for granted. The mezereon is feldom given in venereal ulcers in the throat, or blotches on the N fkin, [ 98 ] fkin which, of all the venereal fymptorm, are the moft certain, and the moft eafy of cure; yet it was conceived, that it re- moved fuch fymptoms as are the moft dif- ficult of cure; but, from what I have feen of its effects, I am convinced that all thofe cafes* in which it has been given with suc- cess, have not been venereal. -i. Hemlock has been tried in fome fuch cafes, with apparent advantage ; but, like the farfaparilla; it appears to have no effect, till mercury has done its best or its worst. Opium has been long a favourite medi- cine of mine, not only as relieving • pain, for that is its common effect; but as a me- dicine, capable of altering difeafed actions, and producing healthy ones. In all fores, attended with irritability, a decoction of poppyheads, made into a poultice, is an ex- cellent application. Bleeding fores, that do not arife from debility and laxity, but from irritability, have the bleeding stopped im- mediately, by this application. Mr. Pott is, I believe, the firft who fhewed the world its ufe in mortifications. My [ 99 ] My firft mode of applying it was lo- cally, in which I found it had falutary ef- fects in fome cafes, and it was ordered in^ ternally afterwards on the fame principle, and in this way it was alfo found to have falutary effects. In two cafes, that had been long suspected to be venereal, its effects were very remarkable, but its having cured them, it confirmed me in my opinion, that they were not. But when I was inform- ed, that they cured the venereal difeafe in America by opium, I then began to qucf- tion myfelf, whether I had formed a right judgment of the nature of thofe two cafes, which were cured by opium. To afcertain, whether opium would cure the lues venerea or not, I made the following trial at St. George's hofpital, A woman was taken into the hofpital, with blotches on her fkin, which had ar- rived to the ftate of fcabs, and with well marked venereal ulcers on both tonfils. A grain of opium was ordered to be taken the firft night, two the fecond, and foon; increafing a grain every night, unlefs fome- thing fhould arife to forbid it. This was clofely followed, till the nineteenth night, N 2 when [ 100 ] when fhe was ordered a dofe of phyfic, as fhe had become costive, and the opium was omitted. On the twentieth fhe began again, and continued encreafing the dofe, as before, till it amounted to thirty grains, no alteration being produced in the fores, except what arofe from lofs of time. I concluded, that if fhe had taken mercury to affect the constitution, as much as the opium did, the venereal difeafe muft have been cured, or at leaft much leffened; but as that was not the cafe, it convinced me that opium had no effect whatever on the difeafe. I then put her under a courfe of mercury, by friction, and in a fhort time it affected her mouth, the fores foon began to look better, and they went on healing without interruption, till the difeafe was cured. She found very little inconvenience from the opium; it kept her quiet, but fhe was not particularly fleepy. Opium was afterwards tried on a man in the fame hofpital, gradually increafing the dofe till he took four grains, three times a day; whereby apoplectic fym- ptoms were brought on, and the patient loft his life by it. This [ ioi 1 This proves that it is a medicine, ca-' pable of producing very violent effects in the conftitution, requiring therefore,, great caution in the mode of adminiftering it. It was alfo tried on one Morgan, in the fame hofpital, with an ulcerated leg, in dofes of twenty-four grains, a day, for twenty-three days; and for the three laft days, he took feventy-two grains a day. This experiment went near to depriving him of life, without doing any remarkable fervice to his leg, however he efcaped; and, his leg healed in about a month after. the [ 102 I THE FOLLOWING CASES ARE SELECTED, TO CONFIRM PART OF WHAT HAS BEEN AD- VANCED IN THE PRECEDING PAGES: I. A GENTLEMAN twice contracted a gonorrhoea, of which he was cured, both times without mercury. About two months after each, he had fymptoms of the lues venerea; thofe in confequence of the firft infection were ulcers in the throat, which were removed by the external appli- cation of mercury; the fymptoms in confe- quence of the fecond were blotches on the fkin, for which alfo he ufed the mercurial ointment, and was cured. We have too many examples of chancres, producing the the lues. II. The gonorrhoea continued on a young woman, in the Magdalene hofpital two years, at the end of which, fhe gave the difeafe to ©ne, who had connection with her. This appears L io3 J appears to have been owing to the effects of habit, by which the parts loft their fufcep- tibility of the fpecific irritation. This opinion of parts being fo habitu- ated to this irritation, as hardly to be af- fected by it, is strengthened by obferving, that in the gonnorhcea, the violent fymptoms fhall often ceafe, and the difeafe fhall ftill continue fpinning itfelf out to an amazing length, with no other fymptoms than a dif- charge ; yet, that difcharge fhall be vene- real : this I have frequently feen. III. Great attention fhould be paid to the inflammation, which arifes in confequence of the urine, being diffufed in the cellular membrane. Where this inflammation is at- tended with suppuration and mortification, it will be neceflary (whether the cafe re- quires an incifion into the urethra, to re- move ftricture, or not,) to fcarify the parts freely, to give an opening both to the urine and pus.—Where mortification has taken place in the fkin, the fcanfications fhould be made in the mortified places, if it [ iut as I did not conceive that the fever could arife from that caufe, I defired him to be eafy on that account. I ordered for that night, fix grains of James's powder: his phyfician, faw him afterwards, and ordered for his fever what he thought proper. He O was [ id6 ] was taken with a fhivering fit, which made us fufpect it might terminate in an inter- mittent, and we waited for the refult. He ftill complained of the difcharge, and men- tioned a forenefs in the perinaeum, both when he made water, and when he preffed it externally. On examining the perinseumi I found a fulnefs there, from which I fuf- pected a stricture, and enquired particu-i larly, how he made water in common; he declared very well ; by which he led me off from the true caufe. We looked on this fwelling as proceeding from an inflamma- tion, either in confequence of the fever, the difpofition of the part, or both; increafed by fitting in a post chaife, for feveral days. The part was fomented, poulticed, and leeches applied feveral times. He had another fhivering fit, three days after the firft, which, if his difeafe had been an in- termittent, would have constituted a quartan; but he had another, fome hours after, which made sis give up our fufpicions of an intermittent. We now began to fufpect, that matter was forming, in this part, al- though I could never feel any thing like a fluctuation; nor was the pain of a throb- bing kind, or fo acute as we commonly find [ i°7 ] find it in the suppurative inflammation, What in fome degree furprifed me, was^ that the fwelling came forwards along the body of the penis, towards the os pubis, while it feemed to be diminifhing. in the peri- naeum. He now began to find a difficulty in making water, with a frequent defire, which increafed till there was a total fupprefllon, I preffed on the lower part of the belly, to fee if the urine was fecretcd and accu- mulated in the bladder, but I could not find any fulnefs, nor did he then feel pain on fuch preffure; however about twenty- four hours after, he began to complain of a vaft defire to make water, and a pain in the lower part of his belly; and on placing the hand there, a fulnefs of the bladder was readily felt. It was now clear that the water fhould be drawn off; but as I ftill fufpected mifchief in the urethra, as a caufe in his complaint, I took the neceflary precautions. I provided myfelf, with catheters and bougies, of different fizes, and to be as much upon my guard as poflible, I introduced a bougie of a fmall gzc firft, and found a full ftop, about the O % bulbous , [ io8 ] bulbous part of the urethra. I then took a fmall one, which paffed, but with diffi- culty. I afterwards paffed a fmall cathe- ter on to the stricture, where it stopped; but, as it was abfolutely neceflary the wa- ter fhould be drawn off, I ufed more force than I otherwife fhould have done; it went on, bur; with difficulty, and I was not certain whether it was in the natural paffage, or was making a new one. When I had got fo far, as to be in the bladder, (if I was in the right paffage,) I found no water come, I therefore preffed on the lower part of the belly, and the water immediately came out, through the cathe- ter, which fhewed that the bladder had loft its power of contracting. The water was drawn off, every eight hours; but ftill it was necelfary to prefs upon the belly, as before; and it was two weeks before the bladder recovered its power of contracting, in any degree. The fwelling now encreafed down the body of the penis, and made it evident, that it had arifen from the urine having insinuated itfelf into the cellular membrane of the perinaeum; and as the urine paffed out [ 109 ] out of the urethra, it was pufhed forward, where the cellular membrane was loofeft, till it got to the very end of the prepuce, and formed an enormous phymofis. By this time he was become extremely low and irritable—was apt to be fick and fainty on any motion, attended with total lofs of appetite, and great proftration of strength. The bark was now administered freely, with madeira wine, and cordial diet. Incifions were made through the integu- ments to the cellular membrane; and the prepuce deeply fcarified, from whence issu- ed bloody froth, and air. Blisters began to rife on the fkin, and in a short-time, the whole prepuce floughed off, leaving the glans bare. The whole penis was kept wrapt up in a foft cataplasm, made of a folution of opium in water, and thickened with white bread; having been previously fomented with a decoction of bark and chamomile flowers, with the addition of a little fpirit of wine. In a few weeks, all the mortified parts feparated, a great portion of the cellular membrane came away, and the patient recovered. F I N I S. *' 1 1 i i ERRATUM. Page 60, line 9, after the word feminales, in- fert the words improperly fo called, and then reading on to the word bladder, expunge the re- mainder of the paragraph% McdL.Hist; wz 5170 n?7 ^) V>K\ \ y v !