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ARMY MEDICAL LIBRARY
FOUNDED 1836
WASHINGTON. D.C

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          HOMCEOPATHIO   BOOKS
Published by Rademacher & Sheek, 239 Arch St., Philadelphia.
  The  Homoeopathic  Materia  Medica,  arranged  Systematically  and
Practically by A. Teste, M. D.  Translated from the French, by Charles J. Hem-
pel, M.D.  634 pages.  1854.  Bound $2 50.
  Diseases of Females and Children and their Homoeopathic Treat-
ment, by  Walter Williamson, M. D.,  Professor of Materia Medica and  Thera-
peutics in  the Homoeopathic Medical College of Pennsylvania. Second improved
and enlarged edition.  Containing also a full description  of the dose of each
medicine.  (Over 250 pages.)  1854.  Bound 75 cents.
  The Parent's Guide.  Containing the Diseases of Infancy and  Childhood
and their Homoeopathic Treatment. To which is added a Treatise on the Method
of rearing  Children from their earliest Infancy; comprising the essential branches
of Moral and Physical  Education.   By J. Laurie, M. D.  Edited, with  Additions,
by Walter Williamson,  M. D., Professor of Materia  Medica and Therapeutics in
the Homoeopathic Medical College of Pennsylvania.  (460 pages.) 1854.  Bound
$1 00.
  The  Homoeopathic  Treatment  of Indigestion, Constipation, and
Haemorrhoids, by William Morgan, Member of the Royal College of Surgeons
of England.  Edited with notes and annotations, by A. E. Small, M. D., Professor
of Physiology and Medical Jurisprudence in the Homoeopathic Medical College
of Pennsylvania, and  one of the  Consulting  Physicians  of the  Homoeopathic
Hospital in Philadelphia.   (166 pages.)  1854.  Bound 75 cents.
  The Sides of the  Body and Drug- Affinities. Homoeopathic Exercises
by C.  von  Boenninghausen, M.D.  Translated and edited by Charles J. Hempel,
M.D.  1854.  Paper cover, 25 cents.
  The  Hand-Book  to Veterinary Homoeopathy,  or the Homoeopathic
Treatment of Horses, Cattle, Sheep, Dogs, and Swine, by John Rush, Veterinary
Surgeon. From  the London edition.  With numerous additions from the Seventh
German edition  of Dr.  F. E.  Guenther's Homoeopathic Veterinary, translated by
Jacob F. Sheek, M. D.  (150 pages.)  1854.   Bound 50 cents.
  The  Homoeopathic  Treatment of Acute and  Chronic Diseases,
by Emilius Kreussler, M.D.  Translated from the German, with important Addi-
tions and Revisions, by Charles J. Hempel, M.D.  (190 pages.)   1854.  Bound
75 cents.
  Manual of Homoeopathic Practice, for the use of Families and private
individuals.  By A. E. Small, A. M., M. D., Professor of Physiology and Medical
Jurisprudence in the Homoeopathic Medical College of Pennsylvania, etc. (835
pages.)  1854.   Bound $2 00.
  Hering, Dr.  C, Domestic Physician, revised with additions from the author's
manuscript of the Seventh German Edition.  Containing also a Tabular Index of
the medicines and the diseases in which they are used. Fifth American Edition.
(509 pages.)  1851.  Bound, $2 00.
  [£~r- Dr. C. Bering's Domestic Physician is also to be had of  the subscribers
in German (eighth edition,) French (second edition,) and Spanish.
  Caspari's Homoeopathic  Domestic Physician, edited by F. Hartmann,
M. D., "Author of the Acute  and Chronic  Diseases."   Translated from the
eighth German edition, and enriched by a Treatise on Anatomy and Physio- 
       Homoeopathic Books Published by RADEMACHER & SHEEK.

logy,  embellished with  30 illustrations by W. P. Esrey, M. D.  With additions
and a preface by C. Hering, M. D.  Containing also a chapter on Mesmerism
and Magnetism ; directions for patients living some distance from a homoeopathio
physician, to describe their symptoms; a Tabular Index of the medicines and the
diseases in which they are used; and a Sketch of the Biography of Dr. Samuel
Hahnemann, the Founder of Homoeopathy. (475 pages.)  1861.  Bound, $1 00,
  Materia  Medica  of American  Proving*.  By  C. Hering,  M. D., J.
Jeanes, M. D., C. B. Matthews, M. D., W. Williamson, M. D., C.  Noidhard, M.D.,
S. R. Dubs, M. D., C. Bute, M. D.  Containing the Provings of: Acidum benzoi-
cum, Acidum fluoricum, Acidum oxalicum, Elaterium, Eupatorium perfoliatum,
Kalmia  latifolia, Lobelia  inflata, Lobelia cardinalis,  Podophyllum  peltatum,
Sanguinaria canadensis and Triosteum  perfoliatum.    Collected  and  arranged
by the American Institute of Homoeopathy.  With a Repertory by W. P. Esrey,
M.D.   Second Thousand.  (300 pages.)  1853. Bound, $1.
  Laurie, Dr.  J., Elements  of  Homoeopathic  Practice  of Physic.  Second
American  edition,  enlarged and improved, by A. Gerald Hull, M. D., and an
Appendix  on  Intermittent Fever, by J. S. Douglas, A. M., M. D.  1853.  939
large  8vo. pages.  Bound, $3 00.
  The Philadelphia  Journal of Homoeopathy.  Edited by William A.
Gardiner, M. D.,  Professor of Anatomy in the Homoeopathio Medical College
of Pennsylvania, and  Alvan E. Small, A.M., M.D., Professor of Physiology and
Medical Jurisprudence  in the Homoeopathic  Medical College of Pennsylvania;
assisted by the following contributors : Drs. B. F. Joslin, A. H. Okie, J. P. Dake,
P. P. Wells, J. H. Henry, J. Beakley, W. E. Payne, C. Dunham, James Kitchen,
W. S. Helmuth, S. R. Dubs, G. Lingen.   Published Monthly by Rademacher &
Sheek, 239 Arch st., Phila.  Price  per  volume of 12 monthly numbers, free of
postage, $3 00.
  [£^= The third volume  of the Philadelphia Journal,  commenced in April,
1854.  The first two volumes can be furnished at $4 in numbers, or  bound, at
$5.  On the 1st of March, 1855, at which  time three volumes will be complete,
they will be furnished to new subscribers,  handsomely bound, at $8 00.
                       ---------*_»----------

                           COW  POX  VIETJS.
  The great benefits resulting to mankind from  the discovery of vaccination,
renders it  imperative upon every one to preserve the original purity  of the art,
as well as  the advantages to be derived from the practice.
  In order to effect this, great care should  be exercised  in reference to the
virus employed.  That taken from the arms of children, vaccinated from matter
that has run through many subjects, is, in our mind, far less reliable  than  that
whose pedigree is perfectly knowii.
  That the necessity of resorting to virus of doubtful  quality  may be oviated,
the subscribers have made arrangements  for being supplied from Europe with
the genuine  Cow-pox virus.  It comes  in little glass  tubes, containing three
drops.  The manner of using the virus from these  tubes, is to break the end of
the tube above the matter, and then by introducing a small needle into the tube,
enough will adhere to vaccinate one child.   The manner of applying it, is to
place it on the skin from the needle, and then with the point of  a lancet make a
little irritation beneath it; the absorbents will imbibe it, and in about fourteen
days it will attain its crisis, and from this, good fresh matter can  be obtained.
Price per tube, $1 50, sent free to any part of the United States.
                                     RADEMACHER & SHEEK,
                                            239 Arch  street, Philadelphia. 
THE
HOMEOPATHIC   GUIDE,
                IN ALL DISEASES

^                     DP TT7P
^      URINABY AND SEXUAL ORGANS^

                INCLUDING THE DERANGEMENT8 CAUSED BY

            ©nanism anfo  Stsnal  (femes;

     WITH A STRICT REGARD TO THE PRESENT DEMANDS OF
                  MEDICAL SCIENCE,

             AND ACCOMPANIED BY AN APPENDIX
                     ON THE USE OF

         ELECTRO-MAGNETISM

             IN THE TREATMENT OF THESE DISEASES,
                        BI
                WM. GOLLMANN, M.  D.
           TRANSLATED, WITH ADDITIONS,
                        BY
                CHAS. J. HEMPEL, M. D.
    Fellow and Corresponding Member of the Honwvopathic 5^tdi«J College of Peonsylvania-r
         Honorary Member of the Hahnemann Socictjficrf ifcnc^Ejj <w. &c. *": -
                          ■' O ir./ _**-•/"|AJ ,'" i* ,. i,'
Mm:   ■
            PHILADEIJPHIA
PUBLISHED BY RADEMACHER & SHEEK, NcT "239TECH
     NEW YORK :—WILLIAM RADDE, 322 BROADWAY
                  1855. 
y**4

Entered according to Act of Congress, in the year 1854, by

       RADEMACHER &  SHEEK,
V
4
In the Office of the Clerk of the District Court of the United States, in and for the Eastern
                     District of Pennsylvania.                         »
________________________________    J
I
King & Baird, Printers, Sansom Street. 
EDITOR'S   PREFACE.
   Gollmann's work commends itself to the profession, as one
of sterling merit in more than one sense.  In the first place,
it does not deal in unmeaning, incoherent symptoms, but  is,
throughout,  adapted to the  present  demands of  medical
science as respects diagnosis, pathology, and a description of
all the characteristic pathognomonic signs of disease.  And^in
the second place, the work is complete; it omits no important
or interesting fact, and presents such a classification of the
diseases of which it treats, as the rational mind can at once
accept as philosophical and satisfactory.

   Such a work as Gollmann's will be particularly serviceable
to the few superficial and one-sided symptomatists still lagging
behind the great body of homoeopathic physicians, who are
constantly and earnestly pressing forward towards  the goal
of scientific  truth in the treatment of disease.  It will con-
vince the reader, provided conviction can at  all  be impressed
upon his mind, that disease is something more than a mere
agglomeration of symptoms, and  that morbid conditions of
the  system  may arise, where  the  highest exercise of the
reasoning  faculty has to be  brought into  play, in order to
determine the real  quality of a group  of  apparent pheno-
mena.  How could we  ever succeed  in  successfully treating 
i
EDITOR'S PREFACE.
 the various forms of secondary and tertiary syphilis, includ-
 ing  almost every variety  of  disorganisation of the various
 tissues, if we did not first  take the trouble to trace these
 disorganisations to their first causes, by means of the reason-
 ing  faculty guided  by the Ariadnean thread of physiology
 and  pathology?  Let any physician  undertake to  treat  a
 syphilitic ulceration  of the throat, syphilitic tubercles, exan-
 thems, bone-pains, or syphilitic caries and necrosis, syphilitic
 iritis, syphilitic epilepsy, or syphilitic cachexia, according to
 mere symptoms, and  then  see where  such treatment would
 lead him. Why, the  treatment could not even be commenced.
 The symptomatic treatment of all such diseases is radically
 impossible.   Scarcely any of the  symptoms which  charac-
 terise these diseases, have  been reproduced in  our provings
 upon the  healthy.   In  the numerous  cases of mercurial
 poisoning,  recorded  in  the  books, a  few  disorganisations
 similar  to  those  above named, have indeed, been  observed,
 but they are  far, very far, from being  sufficiently numerous
 to serve as a  basis for a strict symptomatic treatment. If the
 treatment of  these affections is not conducted according to
 reason, but simply according to the law of outward or appa-
 rent similarity, which is  a mere perception on  the plane of
 sense, it will  not only remain nugatory, but the poison will
 run its triumphant career until  the organism falls a victim to
 its virulence.  I  am well aware that  there  are still  a few
ignorant pretenders  in the homoeopathic school, who reject
 the existence  of all secondary and tertiary forms of the syphi-
 litic  disease; in corroboration of this statement, I may here
 allude  to a writer in  the  Philadelphia Journal of Homoeo-
pathy,  a certain Adolphus Lippe,  who, with  a ridiculous
boldness, asserted that there was no such a thing as secon-
dary or  tertiary syphilis.   Homoeopathic  physicians  are 
EDITOR'S PREFACE.                   V
getting to be ashamed of the childish assumptions of such
scribblers, and,  thanks to the  more  enlightened  teachings
emanating from  individual physicians,  from well-organised
homoeopathic  colleges, and from  the  liberal portion  of the
alloeopathic brotherhood, the time is fast approaching, when
homoeopathy will no longer be a separate and distinct system
of medical treatment, but  the true formula of therapeutics,
to which all  medical truths  will tend  as  naturally  as the
rivers converge in their common reservoir, the ocean.

   Attention is directed to the appendix, on  the use of electro-
magnetism in the treatment of sexual diseases.  I am enabled
to corroborate, from  personal experience, all that Gollmann
says, in praise of this  great agent, and my friend,  Doctor
D. D. Smith, of this city, who  is in the habit of combining
electro-magnetism with homoeopathic treatment, and, for this
purpose, uses electro-magnetic  lockets, batteries,  &c, of his
own  contrivance, is  constantly obtaining the most brilliant
results from the  use of electro-magnetism in sexual diseases,
of any form or degree of intensity.

   In  Gollmann's work, the  symptomatic indications  for the
 use of particular remedies have been omitted.  I have sup-
 plied them in the present translation, and trust that they will
 prove an acceptable and useful addition  to the original.

                       CHARLES  J. HEMPEL, M.  D.,
         ~    ~                  m   /        54 Bond Street.


     New York,  Sept., 1854. 
»J
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:'     &
AUTHOR'S  PREFACE.
  In  giving this work to the public, the author was neither
actuated by the desire of enriching the  book-trade, nor by
the vain glory of being  heard in the vast forum of science.
He was simply moved by the deep  conviction acquired by
years of observation and experience, in  the  exclusive treat-
ment  of diseases of the sexual and urinary organs, that these
diseases very frequently destroy all domestic happiness ;  that
they cause deep bodily and mental suffering, and prepare for
the sufferer a  sad and  distressing future.
   Experience has likewise convinced him, that a satisfactory
knowledge of  the origin  and spread of these diseases, and of
the physiological, anatomical  and  morphological relations of
the organs which  are the seat  of the  sexual and  urinary
functions,  will  afford to  rational and  enlightened laymen
the most certain  means of putting a stop to  the spread  of
these affections.
   The  author does not mean to imply, however, that he wrote
this work for. laymen  only ;  on the contrary,  he feels confi-
dent, that physicians will likewise derive essential advantages
from this  work, inasmuch as regard has  been  had to all the
demands of modern science, and all the  recent physiological,
 chemical, and pathologico-anatomical discoveries, have  been
used  as a basis in the  composition of this treatise.
   The author has, therefore,  deemed it his duty, with consci- 
viii               author's preface.
entious care and an independent, critical judgment, to combine
his own experience, with the knowledge contained in the best
and  most  recent writings  concerning the treatn^'nt of this
disease;  he mentions, with gratitude, the  names of Ricord,
Sigmund,  Zeisl,  Wallace,  Waller,  Cazenave,  Eebra,  and
others, who have shed such brilliant  light  on the nature and
treatment of  syphilitic diseases, and  whose thorough investi-
gations  and  observations  in  this respect, have constantly
served as a basis for his own studies.
   This acknowledgment, of course, only applies to the scien-
tific  diagnosis, etiology  and prognosis of these  diseases, not
to the treatment.  The treatment recommended by the author,
is strictly homoeopathic, and,  on this account, differs  consi-
derably,  from that proposed by the above-mentioned authors.
In describing the treatment,  all those remedies have been
recommended, which, according to  his notes,  had  been of
essential service  to  the author in the management of  these
affections.  The intelligent reader will at once  perceive, that
these remedies have  been selected with a certain discrimina-
tion, and with a strict regard to the  actual  forms of the
disease;  whereas, less  efficient remedies, or  such  as  only
referred  to particular symptoms,  have been  omitted.   The
particular  indications of these few specific remedies had to
be left to the judgment of the  attending physician, who has
to determine what remedies ought  to be used in every special
case. It  is only in diseases where a layman who is sufficiently
versed in  homoeopathy, might safely prescribe for himself,
without  the  interference of a physician,  that the principal
symptomatic indications have  been  given.  The manner in
which these remedies are to be administered, on such  occa-
sions, will  be found briefly indicated in the subsequent  intro-
duction. 
                  author's preface.                  ix
  Xhe author  has deemed  it  expedient to commence  the
work with an account of the anatomical structure, and of the
physiological functions of  the  sexual and urinary organs.
Considering the high  rank,  which chemistry and  the  micro-
scope occupy in modern medicine, the author deemed a chemi-
cal analysis of  the healthy urine, and a microscopical account
of the spermatozoa which play such an important part in the
function of propagation, indispensable.
   After furnishing these anatomical and physiological details,
which are equally important and interesting to the physician
and layman, the author enters upon the description of the
various diseases.   The arrangament which has been followed
by him in this  respect,  requires a short explanation.
   The  author  deemed  it expedient to commence this work
with a description of the sexual diseases, because they occur
more frequently,  and are more varied,  than  others.  These
diseases are naturally divided into two classes, one of which
is composed of the diseases which are communicated  by con-
tact  generally by being inoculated during the  sexual act
by means of a virulent matter; the second class comprises
the  diseases emanating from mechanical causes, congenital
malformations, sexual excesses of all kinds.
   In the first division, we have treated all such diseases  as
owe their immediate  origin to an impure colt; our classifica-
tion  of  these  diseases differs somewhat from  the views  of
other authors.  Such  diseases  as cannot be  inoculated by
means of a contagium, have been ranged under the head of
simple venereal diseases.   These cases have been described
by Sigmund, as syphilitic  blennorrhagia.  To  this class  of
diseases belong the various cases of gonorrhoea, with their
direct and indirect consequences. 
X
author's  preface.
   The second class of this extensive group of diseases, com-
prises those forms of disease which are endowed with an inocu-
lable poison.   These forms of disease are known under the
name of ulcerous  syphilis, termed primary syphilis, as long
as the poison has not infected the general organism.  From
the moment when  the poison loses its  local  action, and, by
infecting  the  blood,  developes constitutional symptoms,  an
essential difference is perceived between these  two  forms of
disease.  The disease now becomes a general or constitutional
syphilis, which is again distinguished in secondary and terti-
ary  syphilis,  each  of which is  characterised  by striking
appearances.
  The third class is  composed of sexual diseases which can-
not be traced to a contagium, but which have a great influence
on the happiness of mankind, and either weaken or destroy
the sexual power.  Onanism  and sexual excesses, which are
the most frequent causes of these diseases, have  been dilated
upon with particular care, and we recommend this chapter to
the attention of our non-professional readers as a means of
guarding against a host of distressing maladies.
  The diseases of  the urinary organs form the  last  part of
the work.
  The work has been enriched with an appendix on electro-
magnetism, which has  recently  played such an  important
part in sexual diseases, and which we ourselves have employed
in so many cases with distinguished success. In this appendix
we have furnished a brief outline of the efficacy of this agent,
and  of  our method  of using it;  a method, from  which we
have  derived the  most brilliant  results in the  treatment of
sexual diseases.
  In publishing this work, we have only thought of the weal 
                  author's preface.                   xi
of our fellow-beings, and we shall deem ourselves sufficiently
rewarded for our trouble, if our efforts should contribute in
some slight degree to a limitation of diseases which so seri-
ously impair the welfare of human society.
August, 1853. 
 
INTRODUCTION.
   In order to facilitate the use of this work, we have deemed
it appropriate, for the benefit of laymen, to furnish  a few
indications concerning the use of the agents which are recom-
mended  in this work, including rules for a repetition of the
dose, and for the alternate exhibition of two  or  more drugs.
   Taking it for granted, that both laymen and physicians are
acquainted with the rules according  to which homoeopathic
medicines have to be selected, and more particularly with the
fundamental law, that a remedial agent, in order to be homoeo-
pathic to a disease, must be capable  of  producing in the
healthy organism, a train  of symptoms, similar  to  those of
the disease, we will at once pass  over  to  the  practical  rules
concerning the exhibition of the drug.
   As regards the dose, we never go above the sixth or seventh
potency.  From the commencement of our practice, we have
had every reason  to prefer this attenuation  to any other.
We never  adhere  to one drug, if it is evident that no cure
can be expected from it.  If  one drug fails us, we resort to a
second, and even third.   It seems to us a reprehensible prac-
tice, to adhere to the exclusive use of  one drug,  if this drug
evidently has  no effect on the condition of the patient.   In
obstinate cases, we  do not hesitate to combine surgical means
with the  homoeopathic treatment. 
xiv                   introduction.
   Strict regard has to be had to the mental condition of the
patient.   In  some cases, the  choice  of  an  otherwise  ap-
propriately indicated  remedy, is determined by the moral
condition of the patient.   If the patient is  disposed to low-
ness of spirits, we recommend Aurum;  if to religious melan-
choly, Veratrum ; if to a weeping mood, Pulsatilla, Ignatia,
Sepia; if of an  irritable  disposition, Bryonia,  and if  very
nervous,  Coffea.
   Diet and regimen, are of particular importance under homoeo-
pathic treatment.  The patients ought to abstain from stimu-
lants, spices, fat, and flatulent food, tea, coffee, wine, and all
other  spirituous drinks.   Indigestible  food, or food whicn
oppresses  the  stomach, such  as goose, duck,  pork, heavy
farinaceous diet, pastry, etc., have likewise to be avoided.
   The success of a homoeopathic  treatment is very much
interfered with by every thing  that  excites  and disturbs the
mind,  such as  depression of  spirits,  books, company, or
theatrical representations that excite the senses.
   A cure is promoted  by cheerful surroundings,  in the coun-
try,  or in some  open and pleasant part of the  city; by
moderate bodily exercise, and  abstinence  from mental exer-
tions.  The repetition of the dose depends entirely upon the
nature of the case.  Dangerous and intensely-acute diseases,
which run a rapid course, require a much more frequent repe-
tition  of  the  dose than chronic diseases  that  run  a   slow
course.
   These few indications will probably suffice ; in difficult or
doubtful  cases, a physician will have to be consulted. 
                  SECTION  I.

  ANATOMICAL AND PHYSIOLOGICAL DESCRIPTION OF THE URINARY AND
            SEXUAL ORGANS OF THE HALE AND FEMALE.

   The urinary and sexual organs are so  closely related to
 each other, both as  respects  their original development  and
 the union of their secretory ducts, that, although performing
 vastly different functions, they may, nevertheless, be treated
 anatomically as one set of organs.  The same organ which
 serves as an outlet to the urine secreted by the kidneys, is
 likewise designed to carry,  with a feeling of the highest
 sexual  delight, the  fructifying  semen  of the male into the
 vagina  of the  female, through which it is transmitted to the
 inner organs  of generation  and gestation, where, after a
 period of forty weeks, the future man,  the lord of creation, is
 developed in a most, marvellous manner out of a drop of the
 male spermatic fluid.

                    The Urinary Organs.
  They  consist of pairs of  glandular  organs which secrete
 the  urine ;  of their  excretory  canals, the  kidneys  and
 ureters,  and of a single hollow organ  in which  the urine
 collects, and which  is termed bladder, which discharges its
 contents through the urethra.

                    I.  The  Kidneys.
  The kidneys are  two  glandular  bodies  situated in   the
lumbar  region, and designed to secrete  the urine.   The right
kidney is somewhat lower than the left, to accommodate  the
right lobe  of  the  liver, which  is situated above  it.  Both
kidneys  are surrounded by  a fatty,  loose cellular tissue,
which keeps them in place.  In shape  they resemble a bean,
the outer border being convex, the inner concave; the latter 
10
the  kidneys.
is provided with a fissure, where the renal vessels  enter the
organ, on which account this fissure is termed the gate of the
kidneys or hilus renalis. The structure of the parenchyma of
the kidney is very curious.  If a longitudinal incision is made
into the kidney, a whitish triangular substance  is discovered
with  the naked eye,  around  which  we perceive  another
substance of a brown-red coldr.
  Former anatomists termed  the whitish mass the medullary,
and the brown-red  substance the cortical substance of the
kidneys.  But, thanks to the microscope, we now know that
the so-called  medullary substance  consists of  an infinite
number of delicate tubes  termed  the  tubes of Bellini; and
that the cortical substance is  simply a net-work of vessels,
formed by the tortuous convolutions of microscopic twigs of
the renal artery,  and  designated  as  the tubes of Ferrein.
These tubes give origin  to  the tubes of Bellini, in  whose
interior the urine is secreted.   The number of these tubes is
enormous,  but gradually decreases  in consequence of these
tubes uniting at acute angles  two by two, until their number
is reduced to two hundred, which form a sort of triangular
pyramid, known under the name of pyramid or cone of Mal-
phighi.  There are about ten or fifteen of such cones in each
kidney, with rounded apices  termed papillse, and converging
towards the  hilus  of this organ.   The papillae,  which are
the excretory ducts of the  Malpighian cones, are surrounded
by short, membranous cups  or infundibula, four or five of
which are united into  a common cup or calyx,  which calices
unite  again in  their turn  to form the pelvis of  the kidney.
The pelvis terminates  in the ureter which  enters  the cavity
of the bladder.
   The supra-renal  capsules  are  two  spongy,  glandular
organs of  a yellowish-brown color, without excretory ducts.
They are situated in the upper  end of each kidney, which
is  covered  by them as by a  cup.   Their  object  is as yet
unknown. 
THE  URETERS.—THE BLADDER.
11
                    II.  The Ureters.
   These are two cylindrical membranous canals conducting
the urine from the pelvis of the kidney to the bladder.  They
pass from the pelvis of the kidney to the  inferior and poste-
rior portion  of the  bladder,  which  they  enter,  passing
obliquely through its muscular and mucous  coat.  They are
of the size of a goose-quill, but they are extremely dilatable,
as  is seen  in  various  cases  of  retention  of urine,  in  the
passage of calculi from the  kidneys, pressure occasioned by
tumors, and difficult urination.

                   III. The Bladder.
   This is the largest of all reservoirs in the human organism
containing secretions.   Its  size varies with  the  age, sex, or
habits of a  person, or  according to the disease with which the
organ is affected.  The female  bladder  is  larger than  the
male, which is supposed to be owing to the circumstance, that
the former  is more liable  to distention from the more fre-
quent retentions of urine  to which the  female is  exposed.
But there  is another  reason why women void the urine less
frequently than men; it is this, men drink more  than women.
As regards  age, old people have a larger bladder than young
persons; the former, owing  to a  blunted sensibility, do  not
feel the want of urinating  as often as the latter, and hence
they are enabled to retain the urine much longer than young
people.  This leads to  an increased distention of  the bladder.
So  far as habit has an  influence on the size of the bladder, it
may be said that the bladder of those who are in the habit of
retaining their urine as long as possible, is  larger than that
of persons who discharge it  frequently, as  soon as the least
desire to urinate is felt.   Morbid conditions of the bladder
may either  occasion a considerable distention of this organ,
as in retention of urine, or  else an excessive contraction, so
that not even  a few drops  of urine can be retained in  the
bladder.   When  the bladder is full, it can be distinctly felt
above  the symphysis pubis as high up as the navel.   Only
the upper and posterior portion of  the bladder is covered by 
12
THE  URETHRA.
the peritoneum, so that only the lower portion of the organ
can  be cut into  without  injuring  the peritoneal covering.
Posteriorly, the bladder is bounded by the rectum in the
male, and by the uterus in the female.   To the lower surface
of the bladder in the male  are attached the seminal vesicles
and the excretory ducts carrying the semen from the testicles
to the vesicles.   The  superior extremity of the bladder is
attached to the umbilicus by means of  the urachus, a strong
fibrous band arising from  the obliteration of  the umbilical
vesicle, a canal that is  found only in the foetus.
  The internal surface of the bladder shows numerous  folds
of the mucous membrane, which assume a smooth appearance
when distended;  moreover, we discover numerous muscular
bundles,  forming  prominences or trabecula, and determining
the  contractile power of the bladder.
  At the lower extremity of the bladder we see  three orifices,
those of  the ureters and the opening of the bladder  into the
urethra.   This portion of  the  bladder  is termed the neck of
the  bladder.
  The bladder is composed of three coats.  The outer coat is a
continuation of the peritoneum, and is, therefore, a serous sac
covering the bladder only  partially, as  stated before; the
middle or  muscular  coat  is composed  of  longitudinal and
circular muscular fibres, which cross each other.  The third
coat is a thin mucous membrane, which dips into the urethra.
Besides these  various  parts,  the bladder is furnished  with
numerous nerves and blood-vessels.

                   IV. The  Urethra.
  The urethra is  the  excretory canal of the bladder, and is
solely formed of the cellular and mucous tissues  of this organ.
  The male urethra differing essentially from the female, they
have to be described separately.
  The male urethra is a canal of from six to eight inches
long, and  from two  to three lines wide, but can be suf-
ficiently  dilated to admit of the  passage of instruments of
four lines  in  size in  operations  for stone  in  the bladder. 
THE  urethra.
13
The urethra commences  at the neck  of  the  bladder, passes
obliquely  through the prostate  gland forwards  and down-
wards, takes a semi-lunar curve under the symphysis pubis,
ascends forwards  and upwards, and, from the root of  the
penis, courses  onwards to the tip of the glans along the bot-
tom of the furrow formed by the juxta-position of the corpora
cavernosa.  It is  appropriately divided into  three portions,
1st, the prostatic portion, which extends from  the neck of the
bladder to the  outer edge of the prostatic gland, and which
contains the so called caput gallinaginis  or  verumontanum,
an oblong triangular fold of the mucous  membrane; 2d, the
membranous portion, about three-fourths of an inch in length,
narrow, very little dilatable, and not surrounded by the pros-
tate gland or the corpora cavernosa; 3d, the cavernous portion
of the urethra, which is surrounded by the corpora cavernosa,
and the lower  part of which, forming  an enlargement in con-
sequence of its being enclosed by the corpora cavernosa, is
termed the bulbus of the urethra.  The lower  wall of this por-
tion of the urethra is somewhat depressed, on which account,
the introduction of the  catheter is  frequently impeded, and,
if conducted with  undue force, occasioning the much dreaded
perforations of the  perinseum.   When  empty, the mucous
rrfembrane of  the cavernous  portion is  arranged  in  folds,
which accounts for its extreme dilatability.   Previous to the
urethra reaching its external orifice, the lower side of this
canal expands into the so called fossp, navicularis, in which
the first phenomena of gonorrhoea develope themselves.
  The female  urethra is only one inch and a half in length,
and has neither a prostatic portion, nor  corpora cavernosa.
Females are without the prostate gland.  The female urethra
is wider than the male; it can be dilated to  six lines.   This
shortness  and  dilatability of the female urethra accounts, in
some  respects, for the less  frequent  occurrence of stone in
females, and for  the  facility with which  stone is  taken from
the female  bladder  without the  operation of lithotomy.
For the same reason it  is much easier and  much less dan-
gerous to introduce the  catheter into the  female urethra. 
14
the  urinary secretion.
The female urethra extends in the pelvic cavity downwards
and forwards, forming a slightly convex curve, then courses
along the mesian line  of the  anterior wall of the vagina,
passes forwards under the symphysis pubis, between the crura
of the clitoris, and ends between the labia minora, a few lines
in front of, and above the orifice of the vagina.

                  The Urinary Secretion.
   The blood is conducted  to the  kidneys by their arteries,
and,  after passing  through a  multitude of  ramifications,
arrives at the cortical substance, where it is first transformed
into venous blood which the renal veins carry to  the inferior
vena cava, and afterwards  into urine, which  passes from the
cortical substance into  the tubes of Bellini of the medullary
substance and oozes from the orifices of the  papillae,  as may
be  distinctly seen by  pressing  upon  the   latter  with the
finger.  From  the  papillae  the urine is received  into the
infundibula, the  calices, and lastly  into the  pelvis of the
kidney, whence, by its own weight, and  by the movements
of the diaphragm during respiration, it  is  pushed forward
into  the ureters, and finally collects in the bladder which
expels its contents as often as the desire for it is felt.
   The evacuations of the  bladder  take  place  in  a  similar
manner as those of the bowels.   Under the  influence of the
will the transverse fibres of the membranous portion of the
urethra become relaxe^, in consequence of which  a  similar
relaxation takes place with the fibres of the sphincter vesicae,
and  the orifice of the bladder is  opened.   Shortly  after, the
transverse muscular fibres of the  bladder compress it  from
all sides ; a similar compression is  made by the longitudinal
fibres from  the  apex  to  the  fundus.   These  contractions
which take place with great uniformity and  regularity,  and
are assisted by the  voluntary action of the  abdominal mus-
cles,  drive  the  urine towards  the orifice  of the bladder,
through which  it passes into the urethra which is attached
to the bladder like a moveable  tube to a syringe, and, being 
the  urinary secretion.
15
a  contracted  and  continuous canal of uniform  dimensions,
discharges the urine in a single, coherent stream.
   The force with which the urine is expelled, is  about  equal
to the  force that would be required to burst  the bladder, if
the urine should be prevented, by some mechanical  obstacle,
from being expelled.
   The immediate expulsion of the urine is effected by means
of the muscular contractions of the bladder.  But the con-
tractions themselves are brought about by the action of the
nerves, a great many of which are distributed over the walls,
and more especially over the  neck of the bladder; they pro-
ceed from the spinal marrow, and the absence or deficiency
of this nervous action causes  paralysis of the bladder  and a
consequent inability on the part of  this organ to perform its
contractions.
   One of the principal causes  which excites the  muscular
activity of the bladder, is the urine ; it is the most natural
and the most frequent cause of its contractions.   It  stimu-
lates the walls of the bladder.  According to the quantity
and quality of the urine, its  stimulating effects  are more or
less speedily  perceived by the bladder.  This depends like-
wise more or less upon the sensitiveness of the inner surfaces
of the  bladder, and upon the fact, whether one  is  in the
habit of holding the  urine as long  as possible, or of voiding
it as soon as the least desire  for it is felt.
   In young persons this sensitiveness is greater  than  in old
age.  The contractions of the bladder  in  the young  are much
more vigorous and rapid than in old people.   In females the
sensitiveness  seems likewise  less, for the reason, probably,
that a feeling of modesty impels them to hold  the urine as
long as  possible.   Individuals who lead a  sedentary life;
literary men who, while their attention is riveted to scientific
subjects, lose sight  of the  indications of the  bladder, are
enabled to hold the urine a long time on account of  a dimi-
nished sensitiveness of the inner surfaces of  this organ.
   The forcible retention of the urine in the bladder, contrary
to the natural desire of voiding it, may be productive of incal- 
16
the  urinary secretion.
culable mischief.   The full bladder crowding upon the adjoin-
ing organs, a variety of  distressing  feelings are excited  in
consequence ;  stinging pains are experienced in the urethra,
perinaeum, and at the neck of the bladder; anxiety, palpita-
tion of the heart, sweat, and even fainting fits are experienced,
and the emission of the urine, if it is finally to be accom-
plished, becomes exceedingly difficult,  or even a dangerous
retention  of urine sets in.  It is said that  the celebrated
astronomer, Tycho de Brahe, perished at the table of  Queen
Christina of Sweden, in consequence of suppressing a natural
desire of voiding  the  urine.
   Foreign bodies in the  bladder,  such as  stone, coagula, a
piece  of a probe,  diseases  of  the prostate gland, hypertrophy
of this organ, strictures of the urethra, spasms of  the neck
of the bladder, irritate this portion of the bladder, increase
the sensitiveness and multiply the contractions of this organ.
The same effect is produced by inflammation of the bladder,
irritation  of  the  bladder by foreign substances, which the
urine  derives from the  circulatory fluid, by the internal and
external  use  of Cantharides; such causes may  occasion  a
continual desire to urinate, without a drop of urine being dis-
charged.
   The irritability of the bladder may be increased, and fre-
quent  contractions  of  this  organ may be  occasioned  by
various other diseases, such as painful  haemorrhoids, diseases
of the rectum, cancer or polypus of the uterus, etc.
   The rapidity of the flow of urine differs according to the
age and constitution of the individual.  In old  people the
flow is slower than in young persons.  In stricture of the
urethra the stream is frequently interrupted, and  the dis-
charge of the urine takes place drop by drop.   If the stream
rushes onward to  a distance,  we may regard this as a sign of
strength.
   The size  of the stream depends upon the width of the
urethra and  upon its  dilatability.  In young persons the
stream is larger  than in old people.  During an erection the
stream is thinner, because the tension  of the urethra  prevents 
           PHYSICAL PROPERTIES OF THE URINE.        17

its full dilatation, and, besides, alters its course.  If the pre-
puce covers the glans  too tightly, the  urine accumulates in
the fossa navicularis, before being discharged.
  Towards the close of an emission of urine, when the blad-
der is nearly emptied, the flow of  urine slackens, and the
stream stops, afterwards reappears more feebly and for a little
while,  again  intermits  and  again  makes  its  appearance.
These last contractions of the bladder are performed partly
by the muscular fibres of the bladder, partly by the muscles
of the perinaeum.  The dribbling which takes  place in some
cases towards the end  of the emission,  which had been other-
wise satisfactory as respects vigor and continuance, depends
upon a deficiency of muscular action.
  The urinary secretion of the female differs somewhat from
that of  the  male.   The female urethra being shorter, the
stream  which  it  discharges is less  vigorous.   The  labia
minora direct  it downwards, and, in  order to prevent the
wetting the external pudendum and  the thighs, females have
to spread their lower limbs more than males during  the act
of micturition.  The stream being  moreover larger,  females
are able to accomplish it in a much  shorter time than males.
The greater width of  the urethra may likewise be the cause
of the more sudden  and involuntary emission of urine in the
case of females under the impulse of  fright, fear,  or in con-
sequence of tickling, etc.

               Physical Properties of the Urine.
   The  urine  of the female contains  more water  and more
saline particles than that of the male.  In return the male
generally secretes a larger quantity of urine than the female.
Females  are  less subject to diseases  of the urinary organs
than males.
   The  urine  which is  secreted  within  twenty-four  hours,
weighs from three to five pounds.  This quantity varfes more
or  less  according  to  the  quantity of liquid  that a  person
drinks in that period of time.   Beverages which contain car-
bonic acid increase the secretion of urine;  spirituous drinks 
18         PHYSICAL PROPERTIES OF  THE URINE.
diminish it.  Various  plants, and even  nutrient vegetables,
such as parsley, potatoes, beer, and such drugs as  colchi-
cum,  digitalis,  turpentine, saltpetre, bicarbonate  of soda,
cream  of  tartar, cantharides, etc., promote the secretion of
urine by virtue of their specific action upon the kidneys.   In
the winter season, and  in cold climates, more urine is secreted
within  twenty-four hours  than  in warm  climates where the
cutaneous exhalation is more abundant.   This shows that the
action  of the skin and that of the  kidneys are in alternate
relation to each other.  Children emit  a large quantity of
urine,  which is pale and clear as water.   Old  people  secrete
a comparatively smaller quantity of urine, which is darker,
and contains a good deal of urate and phosphate of lime.
  In diseases, the secretion of urine may either be decreased
or increased, or even  entirely suppressed.  In diabetes mel-
litus the urine is not only  secreted in an excessive quantity,
but it  likewise contains  a good deal of saccharine  matter "
which  may be obtained from  the urine in the shape of crys-
tals by evaporating the liquid.  In diabetes insipidus, and in
pulmonary phthisis, the urinary secretion is likewise increased;
in fevers, in diseases of the  liver and heart, and more parti-
cularly in dropsy, it is diminished, and in cholera and disor-
ganizations of the kidney it is entirely suppressed.
  The color of healthy urine is of a pale or  orange yellow.
In  the morning the urine is generally  darker,  more satu-
rated ; this darker color is occasioned by the  uroxanthin, a
coloring matter of urine.   In fevers, in diseases of the liver,
in  arthritis  and  rheumatism,  etc., the  urine  frequently
assumes a  red-brown,  dark-yellow,  greenish,  or some other
color,  and deposits a quantity  of  sediment.  The normal
chemical constituents of the urine are sometimes increased,
at other times decreased in disease.   In  nervous diseases, in
violent nervous  pains,  hysteria, megrim, the urine is gene-
rally paMe and reacts less as an acid.
  Several kinds of food and drugs modify the color of the
urine.   Beets,  the fruit of  the cactus  opuntia,  campeachy
wood,  Peruvian balsam, cochineal, madder, impart a reddish 
PHYSICAL  PROPERTIES  OF THE URINE.         19
color to urine; rhubarb tinges it yellow;  indigo and Prussian
blue tinge it greenish and blue.
  Urine, which is clear and transparent in health, is apt to
become cloudy and turbid in disease.   This cloudiness of the
urine  is partly owing to the anomalous chemical constituents
of the urine, partly to the  admixture of organic substances,
such as: mucus,  albumen, fat, blood, semen, pus, etc.
   The odor of  recently-voided urine is peculiarly aromatic,
and not very disagreeable.  After  standing for a while, and
cooling, it  loses  this odor, and assumes  the characteristic
smell of urine.   Afterwards, according as  the urine is more
or less  disposed to become decomposed, the smell changes  to
sour,  and finally becomes ammoniacal and fetid.
   In  hysteria and other'nervous affections, urine has no  odor ;
in  Bright's disease,  which is  generally  accompanied  with
dropsy, and where the urine contains a good deal of albumen,
it smells  like broth ; in diabetes mellitus it  has  at first  an
insipid smell which, after the sugar  begins  to  ferment,
changes to the  odor of  alcohol;  in  blennorrhoea of the
bladder and in  retention of urine, it has an offensive smell
as soon as it is emitted.
   The  ordinary  smell of urine is likewise altered by certain
kinds of  food  or drugs.   Asparagus, cabbage,  cauliflower,
impart a very unpleasant smell to urine ; turpentine,  rosin,
balsam of  copaiva  or other kinds  of balsam, give it the odor
 of violets ;  juniper berries,  valerian, garlick, castoreum, musk,
 impart to  the urine the odor which is peculiar to these sub-
 stances.
   A peculiar and not  very  frequent phenomenon  is the
 shining of the urine.  In  one case this  shining was observed
 in the winter-season immediately after  the urine had been
 voided; it shone for half a minute like a fire-fly, after which
 the luminous appearance  diminished.  In  another case the
 urine was observed to shine after  it touched the wall  or the
 soil; in some  cases this  phenomenon has been observed  for
 two  or three minutes in succession.  This  shining of the urine
 is a natural property of this fluid in the case of the civit-cat, 
20
THE  SEXUAL  ORGANS.—MALE.
the iltis, and  other animals.  This  shining probably results
from the presence of phosphorous nitrogen, arising from the
deoxydation of phosphoric acid and carbon contained in the
urine.
   The chemical  constituents  of  the  urine in its normal or
morbid state,  and the various  changes which this fluid under-
goes, will not be described in this work, which was not designed
to convey this sort of information.

                    The Sexual Organs.
   These organs are similar, in their arrangement, to the uri-
nary organs.  Their destination is not, like that of the other
viscera, to preserve the individual, but to propagate the spe-
cies.   Their constituent parts are:  a gland which secretes
the semen,  and   its excretory  duct;  a  reservoir  which
receives and matures  the semen, and  a canal  going  to the
surface of the body.  The division  of the sexual  organs into
external, middle and internal,  is not applicable to both sexes ;
for that portion of the male organs,  which corresponds to the
internal female organs, is situated  outside of the abdominal
cavity.  It  would be more appropriate to class  the  sexual
organs under  two heads, organs of generation and organs of
fecundation ;  the former prepare the seminal fluid, the latter
perform  the function of fecundation during  the sexual act.
The male organs of generation  are  the  testicles,  spermatic
duct and  seminal vesicles;  the female  organs  are: the ova-
ries, Fallopian tubes and uterus. The male organs of fecun-
dation are:  the penis; and the  female organs: the vagina
and vulva.

              I.  The Male Sexual  Organs.
   The testicles, which secrete the semen, are the most essen-
tial portion  of the organs of generation ; they determine the
sexual character  of the man ; their  loss annihilates his gene-
rating faculty, and either renders nugatory, or effaces all his
other sexual attributes.  They are attached to the spermatic
chords, and lie close together in the bottom of the scrotum, 
         SEMINAL DUCTS',  OR, VASA DEFERENTIA.        21

the right one  a little higher than the left;  they consist  of
the testicle properly speaking, and of the epidydimis.
  The testicle has an ovoid, somewhat flattened shape.  It is
not quite perpendicular, its upper extremity being somewhat
turned forwards and outwards, its lower extremity backwards
and downwards,  its anterior border somewhat downwards,
and its posterior upwards.
   The epidydimis is laid alongside the posterior border of the
testis like a clasp ;  its larger, upper  extremity is termed the
globus major,  and its thinner, lower extremity, which unites
with the vas deferens, is termed the  globus minor or cauda.
   The testicle is surrounded by a fibrous membrane which
determines the shape of the testicle,  and, from its inner sur-
face sends off a number of processes which dip into the sub-
stance  of the testicle, and  divide  it into several hundred
lobules, each of which is composed of several exceedingly con-
voluted  seminiferous tubuli.   These  tubuli are  about T}5 of
an inch  in  diameter; they are  united by cellular tissue and
blood vessels,  and  constitute the parenchyma of the testicle.
This parenchyma  is very soft,  and has the appearance of
yellow or grey marrow deposited between the above-mentioned
processes of the surrounding membrane.   The marrow is com-
posed of the seminiferous  tubuli or ducts of which  about 800
have been counted,  and the united length of which amount to
about 850 to  2500 feet.

     II.  The  Seminal Ducts ;  or, Vasa Deferentia.
    These are to the organs of generation what the ureters are
 to the bladder.  Each vas deferens extends from  the cauda
 of the epidydimis,  of which it  forms the continuation, to  the
 seminal vesicle of  the  same  side.  At first it forms a convo-
 luted duct, after which it passes upwards in a direct course
 along the posterior part of the spermatic cord, and along the
 spermatic canal to the internal abdominal ring.   From  the
 ring it  is reflected inwards  to the  side of the fundus of the
 bladder, and  descends  along its posterior surface, crossing the
 direction  of  the ureter to the inner border of the vesicular 
22
SPERMATIC cord.—vesicul^e semimales.
seminalis, approaching that of  the  opposite side.   It  is
through  this open triangular space, where the bladder and
the rectum meet, that the bladder has to be cut into from the
perinaeum in the operation of lithotomy.  The vas deferens
terminates at  the base of the prostate gland by uniting with
the duct of the vesicula seminalis, aad constituting the  ejacu-
latory duct.
  The structure of this canal is remarkable on account of the
thickness of its parietes, which is so great that the canal can
be easily felt in the spermatic cord.

               III. The Spermatic Cord.
   It  is  composed of  arteries, veins, lymphatics,  nerves, the
excretory duct of the vesicle, and  the investing  tunics.  It
commences at the internal abdominal ring, where the vessels
of which it is composed, converge, and passes obliquely along
the spermatic canal;  the cord then  escapes  at the external
abdominal ring, and descends through the scrotum to the pos-
terior border of the testicle.   The left cord is somewhat longer
than  the right, and permits the left testicle to descend a little
lower than the right.   It is covered by a smooth fibrous mem-
brane which it has in common with the external  tunica vagi-
nalis testis.   This  membrane extends through the inguinal
canal down to the  bottom of the scrotum, in  the shape of a
cylindrical bag which is enlarged below,  and  lines the sper-
matic cord and testicle of one side, without, however, forming
a cavity; but, by its  internal  surface it adheres  to the sper-
matic cord,  and is  united to the  testicle by  means  of  the
tunica vaginalis.   Externally  the cord is surrounded by a
 thin  muscular expansion capable  of elevating the scrotum
 towards the abdominal ring.

              IV. The Vesicula Seminales.
    These are two lobulated  and  somewhat pyriform  bodies
 situated on the under surface of  the base of the bladder, and
 converging towards the base of the prostate gland.   They
 are  about  two inches in length.  Their upper surface is in 
prostate  gland.—cowper's glands.
23
contact with the base of the bladder; the under side rests on
the rectum.  Each vesicula is formed by the convolutions of
a single tube, which gives off several irregular coecal branches.
It is enclosed in a dense fibrous membrane, and is constricted
beneath the prostate gland into a small excretory duct.  The
vas deferens, somewhat enlarged and  convoluted,  lies along
the inner border of each vesicula, and is included in its  fibrous
investment.  It communicates with the duct  of the vesicula,
and forms the ejaculatory duct.   This is about three quar-
ters of an inch in length, and  running  forward, first between
the base  of the prostate and  the  isthmus, and  then through
the tissue of the verumontanum, opens upon the mucous mem-
brane  of the urethra, near its fellow of the opposite side, at
the anterior extremity of that  process.

                V. The Prostate Gland.
   This gland resembles a Spanish chesnut  both in size and
form.  It surrounds the commencement of the urethra for  a
little more  than an inch  of its extent, and is situated upon
the rectum, through which it may be felt with the finger.   It
consists  of three  lobes, two  lateral  and a  middle  lobe or
isthmus,  which are united together by a firm  celular mem-
brane  that surrounds the whole gland.  Its surface is smooth.
The mucous membrane of the urethra being continuous with
that of the excretory ducts of the gland, an  inflammation of
the urethra may spread onward to, and involve the gland.

                  VI.  Cowper's  Glands.
   These are two  small lobulated  and somewhat compressed
glands of the  size of  peas.  They are  situated in front of,
and close behind the  prostate gland, above the corpus spon-
giosum of the penis, to which they are attached by strong
fibres.  They consist of small lobules and vesicles,  the excre-
tory ducts of which unite into a larger duct three-fourths of
an inch in length,  and opening upon the lower surface of the
urethra.
   Their  destination is  scarcely any better known  than  that 
24
THE  PENIS.
of the prostate gland;  and, on account of their small size,
they are not of much practical importance.

                     VII.  The Penis.
   The penis is the medium of sexual union between the male
and female.  The urethra being the canal through which the
male  semen is  discharged into the internal sexual organs  of
the female: it  is one of the constituent parts of the male
organs of generation.  If the  urethra  had no other destina-
tion than merely to facilitate  the  escape of the urine from
the bladder, a simple orifice at the surface of the body, as  in
the female, would be sufficient.   Next to  transmitting the
semen, the penis discharges another very important mechani-
cal function, viz: to excite the  sexual tone in the female
organs.   This exaltation of the female  organs is an essential
condition for  the reception  of  the semen by the female.
Hence the penis has to be  so arranged as not only to be
capable  of erection  but also of elongation.   Otherwise  it
could not possibly exercise  its sexual stimulation either by
pressure  or friction.   The penis is provided with three dila-
table bodies by means of which this purpose is accomplished.
The entire penis  is  covered by the skin, and, at its root,  is
suspended to  the mons veneris  by a suspensary ligament.
The  skin is  continuous with that of the mons veneris  and
scrotum,  and with the skin of the  adjoining parts.  It is  a
thin skin, and is united  to the subjacent parts by means of a
loose cellular tissue which is capable of  dilatation and exten-
sion.  At the  anterior  extremity of the penis the  skin  is
reflexed inwards as far  as the fossa behind the glans;  this
reflexed  portion of the  skin changes to mucous membrane,
and is reflexed back again over  the glans.  This anterior
portion of the outer skin covering the glans is thinner, very
delicate,  and provided  with  a looser  cellular tissue; it  is
termed the foreskin  or  prepuce,  and generally covers,  and
even  overhangs the  tip of  the  glans, although it  can be
drawn back as far as the groove behind the glans.  The pre-
puce is composed of the  outer skin, and the subjacent mucous 
THE  PENIS.                     25
 membrane; these two parts are separated by loose cellular
 tissue.   In front, opposite  the orifice of the urethra in the
 glans, the foreskin has a roundish slit of  different size; the
 posterior half of the prepuce is composed of its inner layer,
 which is always more closely adhering and tighter than the
 outer skin or layer,  and  is  united to the glans  except in the
 middle, where it is attached by the frsenulum to the urethra.
 On the inner side of the internal layer we have from two to
 three rows of follicular glands," which secrete a fatty, thick,
 strong-smelling  substance of a white-yellow color, the abnor-
 mal accumulation of which, especially with a tight prepuce,
 sometimes  occasions  inflammatory  symptoms, with  small
 ulcers on the glans,  balannorrhoea, which might be mistaken
 for syphilis by uninformed persons.   If the prepuce is so
 long  that it hangs  beyond the glans like a tube, and if the
 foreskin is moreover so  tight that it  cannot be drawn  back
 over  the glans, we  term this  condition phymosis, which, in
 consequence of  impurities  accumulating behind the prepuce,
 or in consequence of an excessive secretion from the follicles,
 may lead to a painful inflammation of the mucous membrane,
 an inconvenience which Turks and Jews endeavor to prevent
 by circumcision.   The suspensory  ligament of the penis is
 composed  of a bundle of strong fibres, of a triangular, flat
 shape, going from the symphysis pubis to the root  of  the
 penis.
  The corpora cavernosa of the penis on its dorsum or sides,
 are composed of an exceedingly composite tissue  of blood-
 vessels anastomosing with wide orifices; they are surrounded
by a firm, fibrous membrane, sending processes into the tissue,
by means of which it is divided into meshes within which the
blood-vessels are embedded.  There are two corpora caver-
nosa,  one on the right, and  the other on the left side, arising
posteriorly by two roots from the inner borders of the ascen-
ding rami of the  ischia.  In  front of  the  symphysis pubis
both become enveloped in a fibrous covering, and, by a  ver-
tical, fibrous septum, are  divided into two halves.  Inferiorly,
where they unite, a shallow  furrow is  formed, through which
                           3 
26        THE female sexual organs.—0VARIA.

the urethra courses.   The anterior extremity of the  corpora
cavernosa forms a truncated cone which is surrounded by the
glans.   Superiorly another furrow is formed, through which
the dorsal vein of the penis, two arteries and  nerves  course.
The distribution of the blood-vessels in the corpora cavernosa
is' different from that in other parts,  and  is principally calcu-
lated to admit of a speedy transmission of the fluid from the
arteries into the veins.  The glans forms the  anterior extre-
mity of  the penis,  and somewhat  represents  a truncated
cone, the  apex of which  contains the orifice of the urethra.
Behind the glans we discover a furrow, termed corona glandis.
The surface  of the glans is covered  by a  delicate mucous
membrane, which is richly provided, with follicles in the region
of the  corona.   The tissue of the glans  is  spongy, erectile,
like that of the corpora cavernosa.  The  glans seems to  be  a
continuation and enlargement of the corpora cavernosa.

                The Female  Sexual  Organs.
                       I.  OVARIA.
  The  ovaria are to the female that which the testes are to
the male:  germ-preparing organs, and,  therefore, the  most
essential portions of the organs of generation.  Their shape
and structure remind one of the testes,  and, indeed, the
ancients  called them  the female testes.  They are two oval
bodies, somewhat compressed from before backwards, and not
quite as large as the  testes.   They  are  situate horizontally
in  the entrance of the small  pelvis, in  a fold of the broad
ligaments, behind the  Fallopian tubes, one  on each  side of
the uterus. They are of a whitish color with a reddish tinge ;
previous  to pubescence their  surface  is smooth, but  after
menstruation, conception or  parturition,  it becomes cracked.
Immediately previous to the  first menses  their size is the
largest;  as the female advances  in age, their  size and shape
becomes  altered; they become  thinner, harder, more  elon-
gated,  and in old women they shrink up to one third of  their
original volume.
   The ovaries are connected to  the upper  angles  of the 
THE  UTERUS.
27
uterus at each side by means of a rounded cord, the ligament
of the ovary.  By the opposite extremity they are connected
by another and  a shorter ligament to the fimbriated extre-
mity of the. Fallopian tube.
  Each ovary is composed of a firm, whitish, shining fibrous
covering which is intimately connected with the peritonaeum ;
and  of  an internal substance  composed of a number  of
blood-vessels and dense cellular tissue, the  parenchyma  of
the ovary.   This parenchyma contains from twelve to twenty
perfectly  closed  membranous sacs, the  G-raafian vesicles,
each  of which is composed  of  three  parts: 1, the  vesicle
properly speaking which is about three lines in diameter ; its
outer firm envelope adheres to the parenchyma, and.its fluid
interior contains  a number of small granules which accumu-
late near the surface on the vesicle and constitute the ovisacs
or receptacles of 2, the human ovum, which is scarcely visible
to the unarmed eye.  The peripheral portion of the ovum is
composed of  albumen,  the  inner portion of the yolk, with
numerous larger and  smaller granules.  In this  yolk, but
somewhat near  the  surface,  we find  3, the so-termed ger-
minal vesicle  discovered by  Purkinge;  it  is transparent,
rounded, surrounded by a  very delicate  envelope and con-
taining in its interior  a clear  fluid,  in  which we  observe
through the  microscope the germinal spot discovered  by
Wagner.

                   II.  The Uterus.
  This is a single hollow organ,  in which the development of
the foetus takes  place.   It has  an oblong, pyriform  shape.
Its  broad,  thick  fundus is  directed upwards, its flat,  cylin-
drical neck downwards.   The lowest portion of the neck pro-
jects forwards into the vagina, and is the  vaginal portion  of
the uterus.  The posterior surface of the body of the  uterus
is flatter  than the posterior, and the  broad ligaments are
attached to the sides.   The round ligaments are real prolon-
gations of the substance of the  womb, emanating from the
sides  of the fundus in the shape  of rounded cords enclosed in 
28
THE  UTERUS.
the anterior layer  of the broad ligaments, extend through
the inguinal canal to the external pubic region, and are lost
in the superficial fascia.
   In proportion to the  size of the  organ, the cavity of the
uterus is small; in females who have not yet borne children,
the shape of this cavity resembles a triangle whose sides are
bent inwards.   The basis of the triangle  corresponds to the
fundus of the uterus.   At the  angles of the basis are the
orifices of the Fallopian tubes.   The summit of the triangle
represents  an elongated narrow  canal with two openings,  an
upper one, the interior orifice, and a lower one, the exterior
orifice of the womb.  In virgins the exterior orifice is a trans-
verse slit;  but  in  females who had  children, the orifice is
rounded.
   The substance of the uterus is composed of three  layers.
The outer layer, which is a duplicature of the peritonaeum, is
only seen on the fundus  and body of the organ; the inner
layer is a mucous membrane continuous with that of the Fal-
lopian tubes, and forming within the neck of the uterus two
or three  longitudinal folds, from which smaller folds  branch
off on the  sides, the whole of which resemble the stem and
winged extremity of a feather, and  are  termed  arbor vitse.
Between the little  folds we perceive larger  mucous glands
which are  very frequently of the shape of rounded,  closed,
prominent  vesicles,  and  in this condition  are termed ovula of
Xaboth.  In the uterine cavity proper, the mucous membrane
is without any folds and is dotted with small shaggy flocks
and innumerable, tubular, perpendicular follicles acquiring a
considerable  development  during pregnancy.   The  middle
layer constitutes the hard genuine substance of the uterus.
   The size, shape, position and condition of the uterine cavity
undergo numerous  modifications in the different  ages of the
female.   The uterus of a  young woman is two  and a half
inches long; it has a breadth of sixteen  lines at  the  fundus,
and of  only nine lines  at the neck.  After parturition the
uterus loses  forever its virginal condition,  and, on account
of the relaxation of its  ligaments, descends somewhat in the 
FALLOPIAN  TUBES.—VAGINA.
29
pelvic cavity.   This  likewise takes  place transitorily during
every monthly period.
  The pressure which is exercised upon the adjoining organs
by the impregnated uterus, accounts for the derangements of
the alvine  and urinary functions, the difficulty of breathing,
the jaundice, the  swelling and numbness of the feet, the dis-
tension and hardness  of  the abdomen, and the consequent
tendency of carrying the upper part of the body backward.
  The most remarkable changes of form take place  in the
neck  and vaginal portion of the uterus.  Having been once
distended by pregnancy,  the external orifice  of the  uteru>
never again assumes its flattened shape with the transverse
split, but becomes rounded, with the lips standing apart, and
the margins notched inconsequence of the lacerations which
the external uterine  orifice  suffers during a first parturition,
and which impart to it a cartilaginous consistence.

              III.   The Fallopian Tubes.
  These tubes  are given  off from  the upper portion  of the
uterus, and  extend  to  the sides of the small pelvic cavity.
They  are five inches in length.  Enclosed in the broad liga-
ments, they at first run in a straight line, and afterwards form
an outward  curve with fringed  or fimbriated extremities, as
if they had been bitten off.  The fringes, when erect, form a
funnel-shaped space, which embraces the ovary at the moment
when  an ovum  escapes from a Graafian vesicle.  The ovum
passes through the tube  into the  uterus, in whose cavity it
either disappears by absorption, or is changed to a foetus.  In
rare  cases  it  happens that the  ovum remains within the
tube, and is there transformed into a foetus.   This kind of
pregnancy is termed Fallopian pregnancy, which always ter-
minates unfavorably.

                   IV.   The Vagina.
  The vagina is a canal which leads from the uterus  to the
external pudendum and receives the penis during co'it.   It is
dilatable and membranous, from five to six inches  long, and 
30
the  external pudendum.
fifteen to twenty lines wide, and situated between the bladder
and rectum.   Its course is slightly downwards and forwards,
corresponding to the axis of the small pelvis in which it is
imbedded.   The upper extremity forms a circular cul-de-sac,
embracing the neck of the uterus, and  somewhat larger pos-
teriorly; the anterior  extremity forms a  longitudinal  split,
terminating in the external pudendum.   Its position be£ween
the rectum  and bladder,  and its proximity to the urethra,
explains how one  and the same  cause may affect all  these
parts  together;  how, for  instance,  a violent and  continued
pressure of the head of the  child during labor may cause a
sloughing  of these parts,  and a consequent recto  or vesico-
vaginal fistula.
  The walls of the vagina are  about one line in thickness,
dilatable and relaxed, and are composed of two closely inter-
woven membranes.   The  outer membrane is a firm cellular
membrane,  traversed by a numerous network of veins; the
internal membrane is a delicate mucosa, continuous with that
of the uterus and that of the labia minora.  On the anterior
wall  of the vagina,  this  mucous  membrane forms on both
sides  of a  longitudinal sutsure numerous transverse  rugae,
more  particularly at the entrance  of  the  vagina.   These
rugae  disappear  more  and more by co'it  and  parturition.
The mucous membrane is  furnished with a multitude of folli-
cles.   Near the entrance the  vagina is surrounded by circular
muscular fibres, termed constrictor vaginae; these fibres start
from the lower side of the  symphysis  pubis, and coalesce
with the constrictor ani.  Numerous blood-vessels and nerves
course along with the vagina.

             V.  The External Pudendum.
  First, we notice  the so called mons veneris, which is a
prominence situated in front of the  symphysis pubis, is com-
posed of adipose cellular tissue, and covered with frizly hair.
  The labia majora are two  thick membranous folds, consti-
tuting the  sides of the external  pudendum.   They commu-
nicate with the integuments of the  mons  veneris and  those 
the  external pudendum.
31
of the perinaeum;  at the posterior  extremity, close  to  the
entrance of the vagina, there is a small depression, termed
the fossa  navicularis.   Externally the  labia majora  consist
of a delicate, rather hairy skin, continuous with that of the
thighs and pubic  region;  the inside  covering resembles a
mucous membrane, is thin and smooth, reddish in young, and
pale in old age.  Both  the  outer and inner sides enclose a
loose adipose cellular tissue  and a number of mucous follicles
opening on the inner side.  In the virgin both lips are closely
united, forming a  longitudinal slit;  after frequent co'it  and
parturition, they remain permanently separated  more or less
by the labia minora, which protrude between the former.
  The labia minora or nymplix, likewise constitute two mem-
branous folds, emanating from the labia majora.   Posteriorly
they are closer together than anteriorly; externally they ter-
minate in a cock's-comb-shaped, indented, free margin. They
consist of  a delicate, red mucous membrane, richly provided
with nerves, and hiding between its  external and  internal
layers a loose cellular tissue and a number of mucous glands.
At the anterior and superior extremity, each lip divides into
two crura, the lower ones of which unite with the clitoris, and
and the  upper  ones of which,  above  the  clitoris, coalesce,
forming a  sort of cap or prepuce.
   It is only in females in whom they do  not protrude,  that
the labia minora have the rosy color of a mucous membrane;
if protruding, they become drier, harder, assume a brown color,
and, if the sexual organs are abused, they sometimes become
so relaxed that they hang down like  flaps of an inch in width.
Among the women of  the  Hottentots  and Bosjemans, they
are  from  six  to eight inches long, and have  been described
by travellers  as aprons.  Among certain tribes of northern
Africa, they are habitually so long that they have to be
cut off.
   The clitoris is a  body that  resembles the male penis.  It
consists of two corpora cavernosa, has a glans,  prepuce and
double fraenulum, but no meatus urinarius.  The clitoris is
Bituated below the anterior commissure  of the labia minora, 
32
THE  EXTERNAL PUDENDUM.
and  is  covered by  the prepuce.  It arises by two crura
from the ascending rami of the ischia, to each of which an
erector  muscle  is attached;  the  corpora cavernosa unite
under the symphysis pubis, terminating in the glans of the
clitoris which  reaches beyond the prepuce in the shape  of a
roundish body of the size of a pea.   Superiorly the clitoris
is  united to the symphisis pubis by means of a fraenulum,
and interiorly  to the labia minora by means of another fre-
nulum.
   This  portion  of  the  pudendum  is richly endowed  with
nerves and  vessels,  and is the principal seat  of the thrill
during co'it.
   In the southern climate the clitoris is larger than in the
temperate and frigid zones.   Among the women of Abys-
sinia, among the Mendingas and Ibbos, its  size is so conside-
rable that it is a popular usage to clip off a part of it.  When,
after the conversion  of  the Abyssinians to Christianity, the
circumcision of the  women was abolished  as  a remnant of
paganism, the men rebelled against this innovation, and  the
opposition was not appeased until a surgeon was sent by the
propaganda  from Rome, who  declared the restoration of  the
former custom necessary.
   Among our  own women the clitoris is sometimes so large
that  a belief  in the  existence of hermaphrodites has been
suggested by this abnormal size; that is to say, female sexual
organs with  a  male penis, a  malformation which has  induced
an unnatural satisfaction of the sexual instinct between two
women.  In the case of a woman  of thirty-five years, the
clitoris had the size of the penis of a boy  of two years, and
was capable of erection  and abnormal sexual satisfaction; in
another case the clitoris had the ordinary thickness, but four
times its  natural  length; all the  other  characters of  the
female pudendum were preserved in their natural form.  la
this case the clitoris was an  hindrance to sexual intercourse,
and was amputated with success.
   The triangular space  between the clitoris, meatus urinarius,
and labia minora, is termed the vestibule of the vagina. 
     PHYSIOLOGY OF  SEXUAL FUNCTIONS.—SEXUAL  ACT.   33

  The meatus urinarius forms a small, pad-shaped ring, and
is situated below the clitoris  and above the entrance  to the
vagina.
  In virgins, the greater portion of the vaginal orifice which
is covered by the labia, is closed by the hymen.   This hymen
consists of two folds of the  mucous membrance,  and has
various shapes; generally it  is semi-lunar, with a concave
margin.   Sometimes it is circular,  covering the whole orifice,
with a perforation in the centre.' Very seldom the vagina is
closed entirely, which  would  prevent the  discharge  of the
menstrual blood.  Generally the hymen is torn during the
first sexual embrace, and its remnants are termed the myrtle-
shaped warts.   In some cases, however, the hymen remains
intact  after repeated  intercourse, and I  myself have been
obliged in the case  of  a primipara, to separate the hymen
with the knife during the act of parturition.

            Physiology of the Sexual Functions.
  The highest object of the sexual functions is the propaga-
tion of the species.   This  is  effected by the sexual act and
consequent fecundation.

                  I. The Sexual Act.
  The object of the sexual act on  the part of man is, to dis-
charge the semen into the sexual  organs  of the  female, and
on  the part  of woman  to receive the  seminal  fluid.  The
sexual delight which precedes the act, increases in proportion
as the contact of the sexual  organs becomes more intimate.
By merely touching the mammrc,  both the mammae and the
penis sometimes become erect, the woman experiences shoot-
ing stitches in the mammae and abdomen, palpitation of the
heart,  trembling, chills; excitable  or debilitated females are
even seized with convulsions.  The penis  and  the tissue of
the clitoris become erect, and the constrictor muscle  of the
vagina dilates its orifice and changes it to a rounded opening.
On  inserting  the  penis  into the vagina,  the nerves  of  the
clitoris are first touched by the glans, and the sexual delight 
34
FECUNDATION.
is  increased; passing onward under  the clitoris, the glans
penetrates  with  some difficulty between  the prominences  of
the vestibule, the dorsum of the penis comes in contact with
the glans oL^clitoris, and the whole space of the vagina  is
filled up by the penis.
  In virgins the sexual delight is increased even by the pain
which the tearing of the  hymen causes;  the narrowness and
the pleasant temperature of the vagina, its prominences here
and there, and the rhythmical contractions of the constrictor
vaginae, facilitate the delightful friction  of the  penis; the
voluntary movements of the penis, and the involuntary action
of the erector muscles, increase the excitement to the highest
degree, which terminates in the male with the emission of the
semen, and in the female after the penis had been withdrawn
from the vagina, or the penis has become relaxed. By means
of the vaginal  friction, the orifice of the womb may possibly
be opened so that the semen is enabled to reach the  interior
of the womb, but in most cases it flows back  again out of the
vagina.
  The emission takes place  involuntarily by the contraction
of the  ejector muscles; after the emission is terminated the
stimulation of the nervous tissues generally ceases, as well  as
the afflux of blood to  the arteries of the penis;  the blood
again flows backwards through  the veins, and the penis
becomes relaxed.   The  erection of the clitoris likewise ceases.
  This sexual orgasm  is  frequently succeeded by languor,
drowsiness,  sadness, irritable mood;  hence  the proverb:
" omne animal post co'itum  triste," after coit every animal
feels out  of humor.

                   II.   Fecundation.
  In order that fecundation or conception may take place, it
is necessary that the ovum should actually be touched by the
semen, and not merely by the seminal aura; and, secondly,
that the semen should contain a sufficient number of sperma-
tozoa.  We will  now proceed to consider these elements and
laws of conception more in detail. 
THE  MALE SEMEN.
35
                    The  Male  Semen.
  On coming out of the urethra,  the male  semen consists of
a thin  fluid which is soon succeeded by a fluid of more  con-
sistence, and forms a mixture of the secretions of the testicles,
spermatic ducts,  seminal vesicles,  Cowper's glands,  of the
prostatic  fluid, and probably of the mucus of the urethra.
As was said above, the semen consists of a thin milky, and of
a thick, viscid  and albuminous portion.  If the  semen is
exposed to the air, the fluidity of these elements increases, and
a more intimate commingling takes place.   The semen spreads
a peculiar odor, has an alkaline reaction; its chemical consti-
tuents are water, mucus, albumen, natrum, phosphate and
muriate of lime, phosphorus, and a peculiar animal substance,
termed spermatine.  If the  semen is seen through the micro-
scope, we  discover floating in it small filiform bodies which
have been termed spermatozoa.  They  exist in every kind of
animal semen, and are so  characteristically shaped, that  their
presence is a sure indication of the character of the fluid.  In
the spermatozoa of the human semen, one extremity is large,
the head,  to which is attached a thread-shaped prolongation,
the tail; their length is from ^ to ^ of a line.
  If magnified to three or four hundred times their original
size, in the recent semen,  they move  about very briskly in
every direction ;  they agitate their tails,  and even avoid small
obstacles  in their course.  Gradually their movements become
slower, and finally cease altogether. The duration and liveli-
ness of these movements depend upon the strength of the indi-
vidual from whom the semen came.   The strength or debility
of these spermatozoa indicates a higher or lower  degree of
fecundating power.  They first show themselves at the age of
pubescence, and  probably disappear again with the complete
extinction of  the  sexual  power.   Their  complete absence
indicates  an inability on the part of man to fecundate the
female  ovum. 
36
THE  FEMALE  OVUM.
                    The Female Ovum.
  The ovaries, the artificial removal or the destruction of which
by disease is just as surely followed by sterility as the removal
of the testicles in the male, contain from  12 to  20 ovula
which we have described previously-  In little girls the ovaries
are very small and light, but  towards  the  period  of pubes-
cence they increase rapidly in size and weight; at the critical
period termed the  period of involution, when the menstrual
flow ceases, they, together with the ovula, disappear.  Each
menstrual period  is characterized by an increased determina-
tion of blood towards  the ovaries, which is  particularly  per-
ceptible round the ovum  that has reached the highest degree
of maturity and which then reddens, swells and escape from its
capsule.   This little ovum is seized by the fimbriated  extremity
of the Fallopian tube and conducted to the  uterus wherfce  it
escapes with the menstrual blood.  After the escape of the
ovum the ruptured vesicle becomes  cicatrised, and forms a
yellowish  spot  which  Wagner  terms  the germinal spot.
Formerly when  the physiology of the  female functions  was
yet little understood,  it was supposed  that this  yellow  spot
was a sign of  previous fecundation;  but this  spot is seen  in
girls who had  never conceived; for a little  ovum is detached
at each menstruation, and after its escape, leaves this yellow
spot.
   The first menses generally make their appearance towards
the fourteenth year, and the menstrual discharge ceases again
between the forty-fifth and fiftieth year.  It is a most impor-
tant function in the  female organism ; irregularities as  to
time  and  quantity induce  a variety  of disturbances.   The
menstrual blood  is dark and  does not  readily coagulate;
during  its discharge  the mucous membrane of the uterus is
renovated.
   Before we pass to an examination of the difficult  and inter-
esting question, how and where  the  semen comes  in contact
with  the ovum, it may not be out of place to  describe the
interesting experiments of artificial fecundation of the eggs of 
THE  FEMALE  OVUM.
37
frogs that have been instituted by Spallanzani, Prevost and
Dumas.   Spallanzani  watched the  fecundating process as
carried on by frogs in  and out of the water.  At the instant
when the female wants  to lay her  eggs, the male spirts a
clear fluid upon  them, by which means fecundation  takes
place.   Having covered the legs of the male with oil-silk, the
eggs remained unfecundated, and a sufficient quantity of the fluid
was found adhering to the oil-silk leggins, to enable him to col-
lect some of it by means of a fine painter's brush.  Every egg
which he touched .with this fluid, became fecundated.   This
experiment was repeated  by Prevost and Dumas, and it was
found that this direct fecundation was always accompanied by
the presence of spermatozoa.   This  fact puts an end to the
formerly prevailing opinion that  fecundation was  effected by
a seminal aura.   Semen  and ova have been placed so near to
each other, that the latter had to be touched by  the seminal
exhalation; but  no  fecundation took place, and was, on the
other hand,  effected immediately as soon  as actual contact
between the seminal fluid and the ovum had taken place.  If
the spermatozoa are  motionless,  consequently dead ;  or if
they are sickly, or imperfectly developed, in such a case they
are of  no use as fecundating agents, and, if this should be
the condition of the human  spermatozoa, the male semen is
 unfit to carry on the process of fecundation, and  sterility
 ensues.
    Let us now enquire where the process of fecundation takes
 place in the human subject.  Numerous experiments and inves-
 tigations have recently shown that it is in the ovaries that the
 semen comes in  contact with the ovum and that the first germ
 cf the  future man is  formed.   It is only among the inferior
 animals that  the eggs are detached  from their original abode
 previous to fecundation;  among  the higher  species the male
 semen  goes to the ovum while yet lodged in the ovary.  On
 this account fecundation is most readily effected shortly pre-
 vious to the menstrual period; for the ovum may have escaped
 from its vesicle, and is perhaps on its way to  the  uterine
 cavity,  meeting  the semen half way.  Starting from this sup- 
38
THE  FEMALE  OVUM.
position it has been laid down as a rule that, in order to avoid
fecundation,  no intercourse with the female should be  had
eight days before, nor eight days after the menstrual period.
   The supposition that the fecundating process takes place
in the ovary,  is fortified  by the following  reasons:  1. If
animals are  killed shortly after  conception, semen is  found
in the ovaries ;  2. The eggs of birds only reach the period of
maturity gradually, and  the  ova  of mammalia do not pene-
trate the uterine cavity until some time after the accomplish-
ment of the  sexual act, when the semen could no longer be
fresh and possessed of fecundating power;  3. Pregnancy may
.take place beyond the uterine cavity; 4. If shortly  after the
sexual act the Fallopian  tubes are tied, no fecundation takes
place.
   Formerly the process of fecundation was accounted for in
a different manner.   The  doctrine was, that a seminal  aura
penetrated through the uterine cavity and the Fallopian tubes
to the ovaries,  where  it effected the process of fecundation.
This being accomplished, the fecundated ovum was conveyed
into the uterine cavity for the purpose of further development.
This opinion was undoubtedly very ingenious, but  erroneous.
Fecundation is  only effected when both the male and female
seminal secretions meet at one and the same moment.   But
this can only be  accomplished when the  semen is  healthy,
and the penis  sufficiently erect to introduce the semen  into
the uterus.   If the ovum is not sufficiently developed, if the
tubes are  closed, if the neck  of the uterus is either closed or
deviating  from  its normal axis, if  the vagina is  obstructed,
etc., fecundation is impossible.
   From these facts which  have been abundantly established
by modern physiologists, we  infer that the procreation of a
new human  being requires as a  necessary condition   the
immediate contact of the semen and the ovum.
   The next question is, to ascertain what part the semen  and
the ovum respectively  take in the act of fecundation.
   To solve this question, a  multitude of hypotheses have been
resorted to.  It  was  supposed that the semen of the male 
THE  FEMALE  OVUM.
39
 being composed of all the  constituent parts  of the body, it
 furnished  the  first elements  towards the formation of the
 different organs  and tissues of the  new being.  Or  it was
 believed that the semen itself, together with the spermatozoa,
 after undergoing a number 6f transformations, formed the
 new man,  or, at any rate, the principal portion of this new
 man, namely,  the nervous system.   Another  opinion was,
 that the semen was a living fluid, and that it excited life and
 developments in a female germ, the ovum.
   In regard to the product of the ovary, opinions were equally
 diversified.  Some said  that  a vesicle was filled with semen
 which, like the semen of  the male, consisted  of the original
 elements of the various constituent organs of the body; others
 taught that the ovum was transformed into a receptacle for the
 Bpermatozoa to which it  furnished sustenance;  some again
 supposed that  some unorganized substance that had the pro-
 perties  of  gelatine, was  the cause of life by exciting motion.
 Finally, according to  the opinion  of modern physiologists,
 such  as Valentin, Joh. Mueller, Wagner,  Bischoff, BrUcke,
 etc., the ovum, after being  detached from the ovary, derives
from the semen the property of developing itself further in the
 uterus,  and evolving a  new being endowed  with life, and
 resembling both the father and the mother.
   If  a  perfect commingling of the  seminal  secretions takes
 place, it is just as impossible for either the male or female  to
 prevent conception, as it is otherwise impossible to determine
 the physical or moral qualities of the foetus.   Some  of the
 ancients, physiologists and physicians, among whom we dis-
 tinguish, Anaxagoras, Aristoteles, Hippocrates, fancied that
 the right testicle  and ovary furnished  the elementary consti-
 tuents of the boy, and the corresponding left organs those  of
 the girl.  If this were so, it must certainly be possible, during
 intercourse,  to cause either the left or right organs to be
 principally active ; but this seems impossible so far  as we
 know.  But the  opinion itself is erroneous;  for we know  of
 men who, after losing one testicle, procreated both male and
 female children;  and so in regard  to women:  with one ovary 
40
THE  FEMALE  OVUM.
only, boys and girls indifferently were  the  result of concep-
tion.   Similar results were experimentally obtained  in  the
case of rabbits.
  It is likewise beyond the power of the  male  or female to
determine by volition the number of ova that are to be fecun-
dated.   In the case of man, one ovum is the rule ; but there
are cases where two, three, and even four and  five children
were born at one birth.
  Nevertheless, the physical and moral qualities of the fetal
child are not entirely beyond the reach of the parents' influ-
ence.   Such an influence is however exercised only gradually.
The condition of the foetus depends upon the moral state of the
parents during the sexual act, and upon a  certain  degree of
activity which is required to secure  the proper performance
of the act.   It is past all doubt that the vitality of the child
is more or less proportionate to the vigor  and  cheerfulness,
or to the indifference and  unwillingness which were displayed
during coit.  Excessive sexual intercourse  results  in the pro-
creation of weakly children, whereas  healthy  and vigorous
children are the consequences of a  moderate  and rational
enjoyment of the sexual pleasur?.  Too frequent co'it, exces-
sive sexual passion, and  even premature  marriage, are pre-
judicial to child-bearing.  To secure  the  highest  degree of
fecundity, the husband should be about ten years  older than
the wife.   The fecundity  of the human female is greatest up
to the age of twenty-six years, that of the  human  male up to
thirty-three.  An active  mode of life and bodily exercise
favor conception, even among those who are obliged  to live
poorly, although want and starvation diminish the number of
births proportionally to the high price of  food.  In warm
climates and along the coast, conception  takes place  more
readily than in  colder  climates.  Some nations  are distin-
guished in this respect.  The fecundity of the Jewish  females
was known  even to  the  Egyptians; negro women conceive
more readily than white women; the Slavish race is, in this
respect, superior to the Germanic nations.  There are years
when  the number  of births  is much  less  than in  others. 
THE  FEMALE  OVUM.
41
After an earthquake it was observed that for two  years  the
women  ceased to  bear children.*   After  a war or an epi-
demic disease  the number of births is generally much greater
than ordinarily.
   Conception  generally  takes  place  when  the  semen  is
retained after coit.  However,  this is not by any means  a
rule.    Some  women  can  tell  immediately  after  the  act
whether conception has  taken  place ; others know it only
some days  after by a series  of peculiar sensations, such as
vertigo, nausea, vomiting, colic, aversion to certain kinds of
food and to sexual intercourse.
   Conception depends upon both external and  internal  cir-
cumstances.   The greatest number  of  pregnancies generally
occurs during the months of May and June.  Ardent women
are said to conceive more readily in winter, colder women in
summer.  Indifference or aversion to intercourse is an obstacle
to conception, although  it  has  happened  that  women have
conceived during sleep, and even after rape.

          * This might have been the result of fright.—Ed.
4 
                SECTION  II.

 OF THE DISEASES OF THE SEXUAL AND URINARY ORGANS.

  In the preceding section the anatomy and physiology of
the urinary and  sexual organs have been explained.   We
have seen that  these organs perform exceedingly important
functions in the human organism, and that the urinary organs
in particular are necessary to the preservation of  life  and
health, for  they eliminate  all such constituents  of the blood
as are  no longer serviceable to the reproduction of the tis-
sues, and which, if retained in the blood,  would cause disease  ;
hence we infer  that the preservation and healthful condition
of these organs are essentially necessary to the normal condi-
tion of the organism.  We have likewise seen that the sexual
organs subserve the purpose of procreation, and that their high
object can only be accomplished by preserving them in health
and strength,  and enabling them to  perform their  peculiar
process of secretion readily and without the least hindrance.
   In   the  following  sections we intend to  describe  and
explain the various disturbances  to  which the  functions of
these organs are liable, and to  indicate the remedies which
are capable of restoring  them to a state of health in the
quickest, safest, pleasantest  and most lasting manner.   We
shall likewise point  out to  the reader  the rules and principles
by the observance of which a derangement of  their functions
may be avoided.
   We  shall have to examine the diseases of  these organs in
a twofold point of view.   Some of these diseases arise  from
causes which are of  a general character and have nothing to
do with syphilitic contagion ; but by far the  larger number
is the result of  syphilitic infection which is communicated by
one sex  to  the other during the sexual act, and by which 
HISTORY  OF SYPHILIS.
43
the highest  earthly delight is  not only  converted  into a
source of loathsome and  distressing  disease, but which like-
wise results  in the procreation of an  unhealthy,  miserable
offspring.  We will begin our work with the treatment of the
more  important  class,  the syphilitic diseases, premising a
short  indication of their probable origin and their  successive
development in the different periods of  the  world's history.
   The  first  historical  investigations  of this  disease were
instituted  from religious motives.  Venereal diseases were
represented as a punishment from God for  sexual  transgres-
sions.   At  a  later period,  these investigations  assumed a
political character, and served to gratify national antipathies.
The French  termed the syphilitic disease " mal de Naples,"
the Italians  " mal  Francese,"  the Germans  "Franzosen."
Oviedo, a Spaniard, derived  the  disease from the American
Indians, as if to palliate the  cruelties which had been  perpe-
trated by his countrymen against the aborigines of America.
   Science is  interested in these historical  investigations of
the origin and spreading of the disease ; for a knowledge of
these  facts may facilitate the  treatment, and suggest  correct
views  concerning the  infectious character of the malady.
Let us therefore cast a  glance at its history.
   The history  of  syphilis may be divided into three periods ;
the first extends to  the end of the fifteenth century,  or  the
epidemic  of  1495;  the second  extends from  this period to
the time when  Fernel made  the  discovery that syphilis is a
specific poison ; and the third period extends to the present
day.
   It is an established  fact that  the origin of the venereal
disease is  lost in the remotest  antiquity.  It seems super-
fluous  to repeat  in this place  the  various  contradictory
opinions in reference to this  matter.   The first allusions to
venereal discharges  are contained in the books of Moses.  As
regards genuine  syphilis, it is not by any means  impossible
that this disease, like glanders and small pox, may  have been
transmitted to  man  by  the brute creation.  It is well known
that many diseases are ingrafted upon the human species by 
44
HISTORY  OF SYPHILIS.
animals, and are afterwards developed among  mankind as a
disease peculiar  to  them.  It is  not therefore, improbable
that syphilis has a  similar origin, which is somewhat con-
firmed by the derivation of the term syphilis from the Greek
words, sys, swine, an&phileo, to love.
  Besides the allusions to a contagious discharge from the
urethra,  contained  in the books  of Moses,  we find similar
allusions in the  writings of the ancient Greek physicians,
from which the existence of syphilis may be  inferred.  Hip-
pocrates mentions ulcers of the sexual  organs, pustules of
the penis,  and  a considerable  number of  other  affections
arising from the progressive development of syphilis.
  Celsus describes every variety of chancre  with or  without
phimosis, the indurated Hunterian chancre,  and the phage-
denic chancre.
  Galen describes a case of gonorrhoea  contracted by coit.
Avicenna gave  a detailed  account of ulcers  of the penis
which resemble perfectly the modern chancre.  Michael Scott
relates cases of disease which were communicated to men  by
unclean females'and vice versa, and  which produced symp-
toms  which  resembled  exactly the  modern   constitutional
syphilis.
  W. Saliceto, Lanfranc and their disciples describe ichorous,
virulent  or so-called acrid discharges inducing a variety of
affections of the sexual organs and genuine buboes. A detailed
account of  syphilis  is also found in the  work of W.  Becket
who communicates the rules laid down for the prostitutes of
the city  of Winchester, according to  which  every diseased
woman, if caught in the exercise of her trade, was  fined one
hundred  shillings.  These  facts go  to  show  that  ancient
authors were  as well acquainted  with syphilis as with the
other maladies which they describe ;  only they did not know
that the syphilitic disease was derived  from a specific poison.
They were unacquainted with the mode in  which the poison
was communicated, and they were particularly unacquainted
with  the constitutional  consequences of primary syphilis.
With the elder physicians constitutional  syphilis was a form 
HISTORY  OF SYPHILIS.
45
of lepra.  Syphilis existed in the  earliest ages, but its cha-
racter was not yet known.
  In 1494 the epidemic broke  out.  Some twenty different
nations were invaded  by it.   In  Germany the disease had
been unknown previous to  this time.  The morals  of the
people were rigid, and prostitution was rare.   Morever, there
was little intercourse between  the different  German states.
This was different in  other  countries, especially in  Italy:
a wide-spread commerce on the sea, luxurious living,  shame-
less  immorality,  and the celibacy of the priests naturally
spread the disease far and wide.
   The  campaign  of Charles VIII.  of France was  one  of
the chief causes  of the spread of the epidemic; hence its
name morbus gallicus, or French  disease.   In the month  of
August,  1494, Charles invaded  Italy with a well appointed
army,  for the purpose of chastising Pope Alexander VI. who
was opposed to his pretensions, and  of conquering the king-
dom of Naples, which  had fallen  to him as an  inheritance.
The soldiers carried off an immense booty, but at the same
time the syphilitic disease.  They termed it souvenir or mal
de Naples, in which city it had existed previous to the arrival
of the French, and where it exercised the greatest ravages
among them.  The assertion that the disease was brought by
the Spaniards from America, is without any foundation; for
it was  first in 1495 that  a  Spanish army was sent to Italy,
consequently one year after the character of the disease had
already been established.
   In  Germany the spread of  the  disease  was  principally
attributed to  the lansquenets,  a  military rabble, who were
constantly ready to sell their life and  blood to  the  highest
bidder.  With what frightful rapidity syphilis spread in  an
army,  was sufficiently demonstrated in  the last wars.  It was
not to be wondered that syphilis should have spread through-
out Europe in the fifteenth  century, when the whole conti-
nent was traversed by  military hosts; nor  that physicians
should have begun to suspect the connection between primary
and secondary syphilis.  One reason why this knowledge was 
46
HISTORY  OF SYPHILIS.
so tardily obtained, was the fact that physicians were ashamed
of treating  ulcers of the sexual organs, and  left this dirty
business to quacks of every description.
  The same confusion which prevailed as  respects the origin
of syphilis, likewise prevailed in regard to the mode in which
the disease was transmitted.   It was believed that the disease
might  be  transmitted by the atmosphere, and that it might
be introduced into and carried out of a convent through the
lattice-door  in the  parlor.   Fallopius fancied that  the  dis-
ease might be communicated  by the holy water into which a
syphilitic  patient had  dipped his finger.   Only an obscure
idea was had of the syphilitic poison.
  It was not until the year 1556 that Fernel showed that the
syphilitic  disease  originated in some specific cause emanating
from some affected individual, and acting upon one in health.
He deserves the credit of having opposed  the opinion that
the disease was communicated by the atmosphere.  Forsaking
the belief in astrological, cosmic or teleological ideas, which
prevailed  in his time, he  succeeded in describing with great
correctness the mode of transmission of the syphilitic disease.
He teaches that it is contagious, and that  contagion is indis-
pensable to  its transmission.  Contagion  cannot take place
without actual contact,  and  the most frequent contact  is
during sexual intercourse.  With a  master's hand  Fernel
describes the symptoms by which the contagion is recognised,
likewise  the secondary  or constitutional  symptoms.  Even
after a lapse of three hundred years, Fernel's picture of the
syphilitic  disease is still true, and the recent  additions have
only served to make it appear still more so.
  Fernel's doctrines were perfected and confirmed by John
Hunter and Carmichael, but the  most scientific works  on
syphilis, in which the disease is discussed with all  the light
which modern science has shed upon every form of knowledge,
emanate from the pen of Ricord of Paris, Simon of Hamburg,
Sigmund  of Vienna, Waller of Prague, etc. 
GONORRHOEA.
47
             First Series of Syphilitic Diseases.

  It is peculiar to these diseases to arise either directly or
indirectly from an impure coit, and  to  be transmitted  to
other persons by some  specific contagion,  somewhat in  a
similar manner to the inoculation of the small-pox.   Hence it
is that these diseases first break out  on the sexual organs,
and, by means  of the lymphatic system, are thence carried
through the whole organism.  Generally the chancre either
breaks out on the integuments of the  penis, where the  skin
had been excoriated,  or  in some  part  where  the  delicate
epidermis had  been injured, as  on the  glans  penis, on the
mucous membrane of the pudendum, on the labia, etc.
  We will distinguish this  larger group of diseases into two
divisions,  1st, simple  venereal diseases, and 2d, venereal  or
syphilitic  diseases properly speaking.

             I.  Simple Venereal Diseases.
  These  are  diseases which have not  the specific syphilitic
character, and do not induce constitutional syphilis by pene-
trating the  general organism.   Among  these  diseases we
number gonorrhoea and  blennorrhoea, together with all the
accessory  and secondary affections belonging  to  these dis-
charges, female gonorrhoea and common leucorrhoea.

             II.   Gonorrhoea  of the Male.
  By gonorrhoea we understand  a violent inflammation of the
mucous membrane of the urethra, with a discharge of puru-
lent mucus.
  The course of this disease is generally as follows:—From
two to five days after an impure  coit, the patients generally
experience a peculiar  itching at the tip of the penis, which,
during an erection, increases  to a real pain.  This pain is
aggravated during  an emission  of urine.  In  two or three
days more, the orifice of  the urethra becomes red, swollen
and  moist.   Frequently a tension and  drawing  are expe- 
48
GONORRHOEA.
rienced at this  period in the spermatic cord, the testes, the
inguinal region.   After urinating, a slight burning pain is
experienced, which increases from  day to day.  The swelling
and  redness  of the urethra likewise increases, and  a dis-
charge, which is at first inconsiderable and is generally clear
and viscid, takes place from the urethra, and causes the sides
of the orifice to adhere.  The linen looks stained,  the glans
swells more  or  less, becomes hot,  red, and is  painful during
a walk.  The erections are distressing, and are particularly
frequent at night,  disturbing sleep.   On the eighth day, and
sometimes earlier, the discharge increases, becomes thicker,
of a yellowish-white color,  milky.   The inflammatory symp-
toms gradually increase in violence  and extent.  The pain
during  urination and during erections, reaches the highest
degree of violence, and is  no longer confined to the forepart
of the penis,  but extends over the  whole organ.  On account
of the inflammation, the urethra becomes contracted;  hence
the stream of urine is no longer full and large, but divided.
The discharge assumes a greenish-yellow tint, becomes thick,
profuse, and has a peculiar, disagreeable odor.   When sitting
the patient experiences pain, and the perinaeum even is some-
times swollen in consequence of the inflammation of  Cowper's
glands.
  This  second  stage of gonorrhoea generally commences on
the seventh  or  eighth  day, and continues for eight days or
a fortnight.   It is of great importance  in the treatment of
the disease, that the first and  second stages  should not be
confounded.
  In the stage  of  decrease the first sign of improvement is,
that the emission of urine and  the erections are less painful,
and finally become altogether  painless;  only the discharge
continues, and changes to a whitish, viscid, thready secretion.
The redness at  the orifice of the urethra, and the swelling of
the glans disappear.   If these symptoms  should  continue
for awhile, without being accompanied by pain, we term them
secondary gonorrhoea or gleet.
  Whatever cause is capable of inducing an inflammation of 
GONORRHOEA.
49
the urethra, may likewise cause a gonorrhoeal discharge. This
need not necessarily be the result of an impure coit.  New
wine, unfermented  beer, stimulating  spices, a cold, exposure
of the organs to the wind while urinating, frequently cause a
gonorrhoeal discharge which runs the same course as, and is
similar to, genuine  gonorrhoea.
   As  regards  the disposition  to  gonorrhoea,  it generally
occurs  among young  people.   Persons  with  a long and
narrow prepuce are more easily infected than those whose
prepuce  glides loosely over the glans, or in whom the glans
is not at all covered by this  organ.   In such cases the glans
is much  less sensitive, and hence less liable to the action of
the gonorrhoeal poison.   Among  the nations where  circum-
cision is  practised, gonorrhoea is  much less frequent than
among us.
   A  gonorrhoeal  discharge  may  likewise  be  induced   by
mechanical or  chemical causes, by a natural predisposition,
climate, a peculiar structure  of the sexual organs, and  by
constitutional debility.
   Among the mechanical causes of gonorrhoea, we may men-
tion the introduction of the catheter or of a bougie  into the
urethra,  mechanical injuries of the mucous membrane of this
canal, calculi or other foreign bodies in the urethra, etc.
   Among the chemical causes we note injections of irritating
substances, abuse of spirits, spices, salt food, asparagus and
beer.
   As regards predisposition, persons  of a plethoric habit, with
blond hair, a fine white color, and a  delicate frame, are more
easily tainted than those who do not possess these qualities.
   In regard to climate,  it may be  stated,  that gonorrhoea
occurs more frequently in a warm than in a cold climate.
   So far as the structure of the organs is concerned, a large
penis, a  wide urethra  lined with a thick mucous membrane,
repeated infections,  strictures, or   disorganizations  of  the
mucous tissue, facilitate the gonorrhoeal contagion.
   The forms of constitutional irritation which predispose one
more  particularly to gonorrhoea,  are cutaneous eruptions, 
50
GONORRHOEA.
scrofula, tubercles,  gout,  rheumatism  and piles.   Onanism
and venereal excesses  may likewise  cause  a  discharge from
the urethra without any other infectious contact.
   The most frequent cause of gonorrhoea is  an impure coit.
Even if the co'it was not completed, and the penis was simply
brought in contact with a diseased pudendum, infection may
take place.  It must not be imagined, however, that a specific
or so termed virulent discharge is indispensable to effect this
result.  A  gonorrhoeal discharge may be induced by excessive
sexual intercourse, even among married persons, by an imper-
fectly executed or an excessively prolonged coit;  by having
intercourse during the menstrual period, or  during the last
months of pregnancy, when  the ordinary vaginal discharge
becomes quite considerable, and sometimes very acrid, or  by
ulceration of the neck  of the womb.
   It  is a remarkable  fact, that some men can  have sexual
intercourse with women who  have the whites, without being
affected by this discharge, whereas  other  men  are at  once
infected by these same persons.   This must be owing to the
fact, that some men are not susceptible to this kind of infec- ■■
tion, whereas  others are so to an extraordinary degree.   I
have known cases, and other authors  have had a similar expe-
rience, that several men in succession had intercourse with
the same girl, and that some of them were infected, others,
on the contrary, remained  intact.  There are likewise cases
where a gonorrhoeal discharge took place  without  the least
symptom of discharge or ulceration being perceptible in the
girl, even after the strictest examination by a physician.
  It may likewise happen that women had been infected by a
man, and that previous to  any discharge having yet made  its
appearance, they communicated the disease to the next cus-
tomer.
  A gonorrhoea which  had developed itself after intercourse
with a perfectly healthy woman, is frequently more obstinate
and more unyielding to treatment than  a genuine syphilitic
discharge.   It is therefore necessary to  be acquainted with 
GONORRHOEA.
51
the rules, by the observance of which a gonorrhoeal infection
can be prevented.
   To this end every unnatural excitement should be avoided,
before and during an embrace.   Stimulation by means of
spices or spirits, unnatural means of producing sexual excite-
ment during  the  act, excessive  enjoyment of the sexual
pleasure,  etc., are sometimes sufficient to excite a gonorrhoeal
discharge.
   It is an established  fact that the preservation of a man's
health, especially in the full vigor of manhood, requires  the
enjoyment of sexual intercourse.  Complete abstinence from
all intercourse is sometimes followed by dangerous diseases,
especially  in healthy  and vigorous  men.   Considering that
there are  many men  in large cities, who  do  not get  mar-
ried because they either have not the means of supporting a
family, or because they do not find any one  whom they desire
to marry, prostitutes seem to be a  necessary evil for the time
being.  The following rules should be observed during sexual
intercourse with a prostitute:  the  act should be accomplished
in as short a time as possible, and, immediately after the ejacu-
lation of the semen, the penis should be withdrawn, because
it is a well-known fact that the susceptibility of the organ to
the reception of the contagion is much increased.
   After the coit  the  penis should  at once be washed with a
solution of soap, and the urine should be voided, because by
this means the morbid matter which might  have adhered to
the parts, would again be easily expelled.
   Some grease the penis with a fatty substance previous to
its introduction into the vagina; by this means the pores of
the skin  are obstructed, and the poison is prevented from
penetrating into the  parts.  The  safest preventive is un-
doubtedly the condom or guards.
   Any  other  preventives, many  of which have  been an-
nounced  with a great flourish, are either  useless  or  even
injurious.  Injections  are particularly to  be avoided;  they
simply serve to carry the gonorrhoea^ matter which may have
been left in the urethra, still farther along in this canal.   By 
52
GONORRHOEA.
observing the rules which we have  indicated, infection  will
be prevented in most cases.
  The treatment of gonorrhoea  embraces, 1, a regulation  of
the mode of life, and 2, the therapeutic treatment.   A  suit-
able regime is  indispensable  to a cure.   If gonorrhoeal pa-
tients could be kept at home, in a horizontal position, upon a
horse-hair mattrass, chronic gonorrhoea would become a  very
rare disease.
  Let the patient, therefore, remain as quiet as possible ; let
him avoid all  violent exercise, such  as  dancing, riding  on
horseback, and likewise every kind of excitement, especially
of a sexual nature.  The food and beverages he uses, should
be  without any  irritating  influence,  especially  as long  as
symptoms  of inflammation remain  visible.   He should eat
little, and what little he does  eat,  should  be easily digestible.
Stool should be had every day.  Cleanliness is indispensable
to a successful cure.   The linen and the  rags which are tied
round the parts,  should be changed frequently;  the penis and
the organs generally should be carefully cleansed with  tepid
or cold water, and the adhering matter washed off.  In wash-
ing the parts, all violent friction  should  be strictly avoided.
If  the linen should adhere  to  the  orifice of the urethra, it
should never be torn off by force,  but  should first be loosened
by soaking it with warm water.  If the lips of the orifice should
be glued together, and the patient should wish to void urine,
 care must be had first to  free the orifice by moistening it
 with saliva;  otherwise  the forcible  passage  of the  stream
 through the orifice  might cause irritation, pain, and even a
 little hcemorrhage from ruptured capillaries.
    In case of inflammatory  irritation, tepid local and general
 baths are to be used, both for purposes of cleanliness, and in
 order to alleviate the pain and inflammation.  But cold baths
 should be resorted to  as soon as the inflammatory symptoms
 have been subdued, or  even  from the commencement, if no
 inflammatory symptoms should at all be present. Water may
 be drank in quantity, for the purpose of securing a less pain-
 ful emission of urine, and diminishing the naturally irritating
i 
GONORRHOEA.
53
properties of this fluid.  Patients who are obliged to be about
on  account of business, will  do well to  wear a  suspensory.
Jjet us now  speak of the medical treatment of this disease.
  In gonorrhoea, as well as in any other disease, the homoeo-
pathic treatment has decided advantages over the allopathic.
However, it is not my intention to mention the large number
of remedies which have been recommended  by homoeopathic
physicians, many of them with extravagant- praise.  I  shall
simply mention such remedies as have proved efficient in the
many cases that I have been called upon to treat.  They are
the following, together with the symptomatic indications.
  Agnus castus is particularly adapted to a  yellow purulent
discharge from the urethra, after the inflammatory symptoms
have subsided for the most part, and in cases of gleet, accom-
panied by want of erections and deficient sexual desire.
  Argentum nitricum is useful when the emission of urine is
accompanied by burning, and if a sensation is experienced as
though the urethra  were closed, and the last portion of the
urine remained behind in the urethra; it is also indicated by
dragging pains in the  urethra, cutting  along the urethra as
far  as .the anus,  feeling of soreness  in the urethra even  after
micturition, haemorrhage  from  the  urethra, painful tensive
erections, discharge of mucus from  the urethra.
  Balsamum copaiv. is indicated by smarting pain,  burning
and itching in the urethra before and after micturition, swell-
ing and  inflammation  of  the  orifice of the  urethra, painful
soreness  of the urethra,  and  purulent discharge from the
same.
  Cannabis: Smarting pain in the  urethra between the acts
of micturition, constant urging to urinate, burning and sting-
ing in the  urethra, at the corona glandis, and in the  outer
parts  of  the prepuce, erections with tensive pains, titillation
in the urethra, glueing together of the orifice of the urethra
by a moisture which becomes visible on compressing the glans.
  Cantharides: Cutting in the urethra during and after mic-
turition ; yellowish discharge, which leaves a yellow stain on
the linen, and increase of the discharge in secondary gonor- 
54
GONORRHOEA.
rhcea; this  agent frequently cuts short  the  disease  when
given as soon as the first signs of inflammation become appa-   .
rent.                                                      ~>
   Capsicum: Burning  at  the orifice  of  the urethra before,
during  and after  micturition, painfulness of the urethra to
contact, cutting pain in the urethra between the acts of mic-
turition, pricking as with pins in the forepart of the urethrav
thick, purulent, yellow discharge.
   Cocculus: Tensive, aching pain in the orifice of the urethra^
between the acts of  micturition, itching  stinging in the fore- *
part of the urethra.
   Ferrum: Discharge  of mucus from  the urethra  after a
cold.
   Mercurius solubilis: Burning pain of the urethra when
touching the penis, inflammation of the orifice of the urethra,
swelling of the forepart   of  the urethra with  suppuration
between the glans  and prepuce, redness and  heat   of  the
urethra, with  painfulness  of  the same when touching it  or
when walking, accompanied by a raging pain in the forehead,
a feeble stream of the urine, itching and stinging in the fore-
part of the urethra, throbbing in the  same, and  a greenish,
painless discharge, especially  at  night, or a slight secretion
of moisture from the forepart  of the urethra.
   Mezereum: Stinging, titillating pain  at the urethra and
discharge of a  little moisture; tearing and drawing through
the  whole of the urethra, commencing  at  the perinaeum;
painful soreness of the  urethra when  touching  it, or partly
before,  and partly during micturition, and discharge of a
watery  mucus from the urethra during exercise.
   Nux vomica: Pressive pain at the  orifice of the urethra
between the acts of micturition, accompanied  by a feeling of
shuddering; sharp  pressure, as with  a  cutting  or sticking
instrument in the forepart of the urethra,  at  the bladder,
neck of the  bladder, perinaeum,  rectum, anus, as if  cutting
flatulence were endeavoring to issue  from all  these  parts;
accompanied by  contractive  pains in the forepart  of  the
urethra between the acts  of  micturition, and  discharge  of 
GONORRHOEA.
55
 mucus from the urethra depending upon haemorrhoidal affec-
 tions.
   Petroselinum: Tingling and pressure in the urethra in the
 region of Cowper's glands, especially early in the morning in
 bed,  abating when standing or sitting; drawing and pressure
 in  the  navicular  fossa, secretion of a milky fluid  from the
 urethra which can be  pressed out; glueing together of the
 urethra  by mucus, discharge of a  yellow, glutinous  matter
 from the urethra.
   Pulsatilla: Contraction of the urethra and thin stream of
 the urine, discharge  of blood  from the urethra,  swelling of
 the testes  and inflammation of the  eyes  caused by suppres-
 sion of gonorrhoea.
   Mercurius corrosivus:  Inflammation of the meatus urina-
 rius,  itching in the front part of the urethra,  smarting pain
 during  micturition, and stitches to and  fro in the urethra,
 with  a discharge which is at first thin, afterwards  thickly.
   Sulphur: Burning in  the forepart of  the  urethra, inter-
 nally and  externally, pains in the urethra at the commence-
 ment of gonorrhoea, redness and inflammation of  the meatus
 urinarius,  thin stream  of the urine,  itching in  the  middle
 of the urethra, constant desire to urinate, tearing  and sting-
 ing  in  the  urethra  between the acts of micturition, cut-
 ting in the urethra before and during stool, and  stitches  in
 the forepart of the urethra.
   Thuja:  Burning in the urethra; burning, piercing stitches
 near the orifice  of the  urethra  between the acts  of micturi-
 tion, sensation in the urethra  as if  a  drop would run out  of
 it, drawing, cutting pain in the urethra especially when walk-
 ing, stitches in the urethra from behind forwards between the
 acts of micturition, jerking pain in the urethra, and a watery,
 copious discharge.
 \_Dose.—During the  acute  or inflammatory stage, the tinct-
tures  or lower  attenuations  or  lower triturations may be
administered, one  grain three times a day, or  one-third of a
drop three  times a day, in a spoonful of water or on a little
sugar; after the inflammatory symptoms have been subdued, 
56
BALANNORRHCEA.
or in the gleetish form of the disease, the middle and higher
attenuations may be resorted to, one drop morning and night,
and, if  a  decided improvement is perceived, only one dose
every night before retiring.  This remark applies to all the
remedies and diseases mentioned in this section  of the work,
as far as Syphilitic diseases proper.]

          Balannorrhoea, balanitis, balanoposthitis.
  By balanorrhoea we  understand  an inflammation and a
purulent secretion  on the surface of the glans and on the
inner side of the prepuce,  a  condition which may arise from
gonorrhoeal infection as well as from the action of non-conta-
gious irritating causes.
  This secretion emanates  from the follicular glands situated
behind the corona glandis and which, even in health, secrete
a cheesy, strong-smelling substance.
  The disease generally runs the following course: at first
the patients experience a slight smarting or burning on the
surface  of the glans or in the prepuce.  The parts, especially
the glans, are hot, of a rose  color or a bright carmine red-
ness, somewhat swollen, sensitive  to pressure and especially
to the rubbing of the clothes when walking.  The follicular
secretion is very much increased;  it soon becomes purulent,
thick, greenish-yellow.  The  pus  is discharged  on each side
of the fraenulum in large tenacious drops.   The  margin of
the prepuce is swollen, bright-red,  somewhat distended ; both
it and the folds  of the prepuce are constantly filled with pus
which sometimes dries  up, forming  small crusts of a  dirty
yellow color, and causing the prepuce to adhere to the linen.
The inner surface of the prepuce has an intensely bright-red
color.  Upon  this inner surface as  well as  upon the glans,
we  soon notice erosions of the mucous membrane having a
red or grayish-red color, and readily becoming gangrenous
and inducing violent incidental affections, such as phymosis,
paraphymosis, which will  be  described bye  and bye.  The
flat little ulcers are not syphilitic, and are caused by the
acridity of the secreted matter.   In most cases they remain 
BALANNORRHCEA.
57
unchanged for a week or a fortnight, after which the cure is
rapidly effected.
  A benign balannorrhoea frequently occurs in children, but
principally in individuals with  a long prepuce which is not
entirely drawn  behind  the glans during  coit,  on which
account the  pus which  has penetrated between it and the
glans  is enabled to remain without being disturbed.   How-
ever, balannorrhoea may likewise occur when the prepuce is
short  or even entirely wanting.  Circumcised  persons are
free from it almost  entirely.   This secretion  is not conta-
gious.
   The venereal  or  contagious balannorrhoea  is contracted
during coit.   It is of rare  occurrence, notwithstanding that
the surface of the glans is  sooner exposed to the contagious
pus than the urethra.
   This circumstance may be owing to the peculiar nature of
the epithelium of the glans,  and to the fact that  the pus
adheres to it but a short time, and is then wiped off again.
It generally shows itself sooner than  gonorrhoea, sometimes
one or two hours, but in most  cases  from three to six days
after an impure coit.
   In regard to  preventive means, the same rules should be
followed that we have  laid down in treating of gonorrhoea;
cleanliness, washing  the parts with  soap  and water  after
intercourse,  and  all the  other precautionary  rules are
indispensable.
   In regard  to regime and diet, the same rules have to be
followed that have been mentioned for gonorrhoea.
  ' Of the remedies used the  following were found the most
efficient: Acidum Nitricum,  Cannabis, Capsicum, China,
 Cinnabaris,   Mercurius  solubilis,  Mczereum,  Nux vomica,
Pulsatilla,  Sabina,  Stannum, Sulphur, and  Thuja.   The
following are the symptomatic indications :
   Acidum Nitricum: Balannorrhoea with small vesicles in the
orifice of the uretha,  on the inner surface, and  at the margin
of the prepuce; they soon break, suppurate, and form  chan-
crous ulcers; or with brown,  painful, lentil-sized spots on 
58
BALANNORRHOEA.
the glans, excavated ulcers on the glans, with elevated, lead-
colored,  sensitive  margins ;  flat,  clean  little ulcers at the
corona glandis, secreting  a  strong-smelling matter;   flesh-
colored excrescences at the corona glandis, secreting a fetid
humor and bleeding when  touched ; itching of the prepuce,
and  humid spots  on its inner  surface, and sharp stinging
pains in  the same.
   Cannabis:  The glans is  covered with  small bright-red
spots, which are lighter than the glans itself when the glans
is  as red as the prepuce;  redness and dampness behind the
corona  glandis;   itching under the  prepuce,  and  at  the
fraenulum ; swelling of the glans and  penis, like a sort of
painless  erection;  dampness  round the  corona glandis; con-
stant burning of the prepuce and glans.
   Capsicum : Constant pressure and prickling in the glans ;
fine itching, stinging of the glans as if bit by mosquitoes.
   China: Burning in the glans, and creeping and pressure in
the urethra and anus ;  itching of the glans, especially in the
evening  in bed;  twitching pain between the glans and pre-
puce during  a  walk;  tearing pain in  the left side of the
prepuce, and in the left testicle; fine pricking at the  fraenu-
lum as with pins.
   Cinnabaris: Burning, stinging,  itching of  the  corona
glandis ;  itching  pain  in the fossa behind the glans,  with
exudation of pus of  a nauseous sweetish  smell; tearing
stitches  in the glans;  small red spots on  the glans; or red
shining little  dots  or readily-bleeding  warts on the prepuce.
   Mercurius  solubilis: Burning around the glans, followed
by the breaking out of vesicles  on the  inner  surface of the
prepuce, which soon break and give rise to  small ulcers, with
itching stinging in the glans  after pressure; tearing stitching
pain in the fore-part  of  the  glans, extending  through the
whole penis as far as  behind the anus, and sometimes even
as far as the groins; vesicles on the fore-part of the glans, on
tlje upper surface, and at the sides, penetrating and spreading,
 and  discharging  an acrid humor; suppuration  between the
 glans and prepuce,  with  swelling  of the  fore-part of the 
BALANNORRHOEA.                   59
urethra, which looks red and feels  hot, and is very painful
when touched or during exercise;  ulcers on the glans and
prepuce,  with  a cheesy, lardaceous bottom,  and  a  hard
margin ; swelling of the glans and  prepuce; tingling at the
fraenulum and  scrotum; fine  red eruption on the outer, and
cracks  and rhagades  on the inner  surface of the  swollen
prepuce.
   Mezereum:  Itching, tearing and twitching tearing in the
glans;  fine prickling stitches in the penis  and at the tip  of
the glans; tearing drawing at the corona glandis, with secre-
tion of a  quantity of yellowish smegma in that region, and
inflammatory redness  of the prepuce which exhibits excoria-
tions, accompanied by a feeling of soreness in  the glans and
prepuce.
   Nux vomica:  Smarting and burning itching  of the glans,
copious  secretion of  smegma behind  the  corona glandis;
smarting itching of the inner side of the  prepuce, especially
towards evening.
   Pulsatilla:  Smarting and  corrosive itching of the glans
under the prepuce;  agreeable titillation of the  glans, accom-
panied by a discharge of a colorless mucus ;  constrictive pain
behind  the  glans; itching, smarting pain of the inner  and
upper'portion of the prepuce; finely stinging itching in the
prepuce when sitting or lying.
   Sabina:  Burning soreness of the glans when touching it;
dark redness of  the glans; painfulness of the prepuce,  and
inability to press it  back behind the glans; occasional turns
of pain at the fraenulum.
   St annum:  Burning pain in the glans, followed by urging
to urinate; burning prickings in  the glans.
   Sulphur:  Swelling, redness and  coldness of the prepuce
and glans, accompanied by stitches in the  penis.
   Thuja:  Burning  itching, with a  feeling  of  soreness  and
stitches in  the  glans;  titillating  sensation between the pre-
puce and glans; violent stitches in the glans near the urethra,
which are  always accompanied  by an urging to urinate, the
urine  passing off in drops, the  stitches  are at  times very 
60        erections.—satyriasis  and  priafism.

violent, and at other times they disappear altogether;  red
spots and erosions on the corona glandis, which become moist
and suppurate; flat, unclean, red ulcers, with burning pain at
the corona glandis; dampness of the glans, with acutely-pain-
ful  stitches in the interior of the  prepuce, and  smooth, red
excrescences in the region where  the prepuce adheres to the
body of the penis.

    Affections which accompany Gonorrhoea and Blennorrhoea.
  These accessory affections are  in direct relation with the
gonorrhoeal discharge.  They  are   either caused by it, or
supervene by  chance.   We will  mention these accessory
affections  seriatim,  give  a brief description of  their phe-
nomena,  and  indicate  the remedies  by which they are
removed.

                      I.  Erections.
  These are present in almost every case of gonorrhoea, and
frequently cause the most  violent  pains.  They always aggra-
vate the  inflammatory condition.   They  are  more  painful
during a  first attack of gonorrhoea than  in those who had
been several times attacked with this disease.
  The patient should not only observe  the rules which have
been laid  down for  the cure of  gonorrhoea,  but he should
guard  against  every mental or bodily excitement, and  more
particularly against lascivious fancies.   He should never feel
of his  parts;  eat very little supper or none at all;  sleep on
a horse-hair mattrass;  not lie on  his back;  void the  urine
frequently, even  at  night, in order to  avoid every possible
pressure and irritation of  the seminal vesicles.
  The principal remedies will be found to be Capsicum and
 Cantharides, or one of the remedies mentioned for gonor-
rhoea,  to be selected in accordance  with the symptoms.

               II. Satyriasis and Priapism.
   Satyriasis (or a frantic desire for coit in the male) and
priapism, (or a painful erection of  the penis,) are conditions 
      CHORDEE.—HEMORRHAGE FROM THE  URETHRA.    61

of the parts where the erections never cease, and are accom-
panied by  an excessive degree of sexual excitement.  For
such conditions  we recommend  cold  hip-baths, cold  water
bandages round the parts, and the internal use of Agaricus,
Petroselinum, Cantharides, Acidum phosphoricum, Opium
and Hyoscyamus.

                      III. Chordee.                     ^
   On account of  the violent inflammation, the longitudinal
muscles of the urethra and the erector muscles are not put
upon the stretch simultaneously.   The patients  complain of
a sensation as though the penis were curved by force.  This
curvature  or twisting  actually takes  place;  sometimes the
penis is bent downwards,  sometimes upwards, and at other
times laterally.   These phenomena of an intensely-developed
inflammation may extend even to the corpus spongiosum.  If
this inflammation is not subdued in season, it may terminate
in some chronic disorganisation, thickening, indurations and
adhesions.  If adhesions have taken  place, a cure can no
longer be expected.  The chordee then remains a permanent
condition of the parts, coit is more or less painful, and some-
times even impossible.
   Among the lower classes, the custom still prevails here and
there to beat the penis, in order to remove  the chordee; they
place the concave side upon a table, and strike the convex por-
 tion with their fist; it need scarcely be told, that this violent
 proceeding sometimes results in distressing consequences.
   Suitable means for the cure of this affection are cold baths
 and hip baths, vapor-baths, the use of the north-pole of the
 magnet, the internal use of Capsicum, Cantharides, Chamo-
 milla and Pulsatilla.

           IV.  Hemorrhage from the Urethra.
    In very violent inflammations, a discharge of blood may be
 useful, for it has been observed, that the inflammatory symp-
 toms abated afterwards, and that even  the  chordee  ceased.
 Excessive haemorrhage is undoubtedly hurtful, and should be 
62
PROSTATITIS.—DYSURIA.
arrested.  The patient should be kept in a horizontal posture,
the penis should be compressed; cold water or ice should be
applied to  the penis, and internally the following remedies
should be resorted  to:  Acidum nitricum, Argentum nitri-
cum,  Cantharides.  [I have found  Aconite useful in many
cases, Ed.]

         V. Inflammation of Cowper's Glands.
  This is indicated  by a pain and swelling of the perinaeum.
It should be subdued as soon as possible, for it is apt to ter-
minate in inflammation.  If the  suppuration has already set
in,  it must be promoted,  and means  afforded for the pus
to escape, lest an urinary fistula should develope itself.
  As soon  as  the  first signs of  inflammation  make  their
appearance, we should administer Mercurius  solubilis, Sul-
phur or Thuja.

VI. Prostatitis, Inflammation of the Prostate Gland.
  This inflammation commences  with a sensation of pressure
and heat in the perinaeum, towards the neck of  the bladder
and rectum.  The patients complain of  a continual and pain-
ful urging to pass urine and stool; likewise of a sensation as
if some foreign body had lodged in the rectum.   The pain
increases with every attempt to  satisfy the urging, which is
either fruitless or results  in a very scanty discharge.  This
inflammation very frequently runs a chronic course.
  In acute  cases the following  remedies are indicated :  Aco-
nite, Belladonna, Bryonia, Cannabis, Mercurius solubilis,
Phosphorus, Thuja; they have to be selected  in accordance
with the symptoms.

                     VII. Dysuria.
  This  is  invariably present in  every case of gonorrhoea,
where the posterior  portions of the urethra are affected.  We
give, according to the symptoms, Cantharides, Copaiva, Mer-
curius solubilis, Thuja.
  If the urinary tenesmus should continue and a dangerous 
PRURITUS.—ECZEMA.
63
result should have to be apprehended, the catheter may have
to be introduced.   The operation should be performed with
great caution, lest a false passage should be made.

       Affections which may occur without Gonorrhoea.
   There is a class of affections which sometimes accompany
the gonorrhoeal discharge, but may likewise occur in connec-
tion with, or without any other morbid conditions. These are

      I.  Pruritus Glandis,  itching of the Glans.
   Sometimes  the patients complain of an intolerable itching
of the glans which induces such a violent scratching that the
itching parts and those which surround them, are frequently
rendered sore  by the scratching.  This itching consists in an
increased irritability of the parts, is  sometimes  extremely  \
obstinate, and is apt to recur.   It not only occurs during  and   \
after the existence of gonorrhoea, but also in cases  where   !
neither gonorrhoea nor ulcers had existed, and where the parts  /
had indeed never been affected by any disease.
   I  have employed with the  greatest success, Antimonium
crudum,  Causticum, Arsenic, Calcarea sulph.
   The itching  may likewise be  experienced  by females who
have the whites or  even by such as are perfectly healthy, or
even by girls of the most unexceptionable conduct during or
after the menses.   The same remedies which have been men-
tioned previously, will  help in the case of females.

           II.  Eczema, Herpes Preputialis.
   This troublesome vesicular eruption may affect both sexes
either with or  without a syphilitic taint.   In the male  these
vesicles are located on  the prepuce and glans, in the female
on the labia majora and  minora.  The  inexperienced physi-
cian  might easily mistake  them for incipient  chancre.  It is
therefore of the greatest importance to  be  well  acquainted
with them.   Sometimes the prepuce looks red in one or more
places, the redness extending over a larger or smaller space.
Generally the  patients are not aware  of the  disease  until 
 64            OEDEMA PR2EPUTII.—PHYMOSIS.

 their attention is directed to it by the itching of the red and
 swollen parts.  The fully developed vesicles are of the size of
 a pin's head, never larger.
   Generally several of these vesicles  are  clustered together,
 sometimes they run into each other.  By using one or the
 other of the following remedies, which have  to be selected
 with  reference to the totality of the  perceptible symptoms,
 these vesicles generally dry up and disappear after the  lapse
 of from  four to five days,  after which the itching ceases:
 Acidum phosphoricum, Petroleum, Thuja.  If these vesicles
 break out previous to the monthly period, we  may add: Ve-
 ratrum,  at other times Mercurius  sol.

   III. (Edema preputii,  swelling of the Prepuce.
   Gonorrhoea is sometimes accompanied by a swelling of the
 prepuce caused by infiltration and  exudation of a serous  fluid.
 If this swelling is opened, a clear, and sometimes  a  bloody
 serum is  discharged, frequently in  large quantity.   The pre-
 puce looks dark-red, hot, inflamed, and the swelling is some-
 times so  considerable that it looks like a bladder distended by
 air or water.  In the former  case,  Cannabis and Sulpur are
 the remedies, in the latter Merc. sol.

                     IV.  Phymosis.
  This affection is closely related to the last-named condition,
 and is frequently caused  by it.   It  is   a contraction or con-
 striction  of  the prepuce in front of the glans, so  that  it is
 either  impossible or extremely difficult  to  pull the prepuce
 over the  glans.   It  arises from an inflammation of the sub-
 cutaneous cellular tissue of the prepuce, in which a quantity
 of serum  is deposited.   The external layer of the prepuce
 has the usual color, is smooth, shining; the internal mucous
membrane is of a rose color, transparent, the prepuce is con-
siderably swollen, and the glans is likewise enlarged.  These
 circumstances sufficiently account  for  the impossibility of
 denuding the glans.
  Phymosis never takes place without balannorrhoea;  out of 
paraphymosis.
65
every ten  cases of balannorrhoea, one  is  generally accom-
panied by phymosis.  Generally only such men are affected
by this disease as are troubled with a long and narrow pre-
puce even during health.   Among  circumcised persons this
disease is impossible.
  Sometimes the swelling  and inflammation of the prepuce
increase so rapidly that gangrene  may set in.  The prepuce
forms a large, long, dark brown-red bulbous  swelling  at the
extremity of the penis ; its borders are enlarged like thick
lips, cracked and so narrow that only a small portion  of the
secreted  pus, which is generally thin,  and sometimes  thick,
and of a green-yellow color, can flow out; the remainder  of
the pus collects behind the  corona glandis, where it  forms an
indistinctly fluctuating swelling.
  The pain is very acute.   In some cases the remaining por-
tion of the integuments  of  the penis, as far as  the root, and
even the  skin of the scrotum and of the inguinal region, are
involved  in the inflammation.
  Among the homoeopathic remedies with which this affection
should be treated, we distinguish :  Merc, sol., Rims t. Thuja,
Cannabis, Cinnabaris, Sulphur and Viola tri-color.  If these
remedies should not effect a  cure, it  may be  necessary  to
make slight incisions into  the prepuce, for  the  purpose  of
allowing  the  fluid  to  escape;  in  extremely difficult  cases,
when gangrene threatens, it may be necessary to remove the
long and unyielding prepuce with the knife.

                   V.  Paraphymosis.
  In this affection the constriction of the prepuce takes place
behind the glans.   The prepuce is generally  inverted, and
the outer skin is more or less covered by the inner membrane.
If the constriction is not speedily removed, the  inflammation
soon reaches  a  dangerous height, and  invades  the  whole
penis.
  We  treat  this disease with Cannabis, Sabina, Mercurius
sol, and, in dangerous cases, we may have to resort  to the
operation. 
66
GONORRHOEAL BUBOES.
                 Sequelae  of Gonorrhoea.

  Beside the accessory or secondary affections of gonorrhoea,
of which we have treated in the preceding chapters, we have
a series of  affections which are the sequelae of gonorrhoea, to
which they owe, more or less, their origin.
  The sequelae of gonorrhoea may be  divided into two classes,
those which arise from a metastasis of gonorrhoeal inflamma-
tion to other organs,  and secondly, those which are charac-
terised by disorganizations  or functional derangements of the
organs that are sympathetically affected during the course of
gonorrhoea.

 Affections  caused by  a Metastasis of the  Gonorrhoeal Inflam-
                  mation of other Organs.
I.   Glandular  swellings in  the Groin, Gonorrhoeal
                         Buboes.
   These swellings  occur in many  cases of gonorrhoea.   In
most cases  of violent gonorrhoea the inguinal glands are more
or less sensitive, even if not much swollen or inflamed.  At
first they  constitute  moveable little tumors  of  the size of
beans, rather hard, painful  when walking.   At this stage it
is still possible to scatter  them  by treatment.   By neglect
they become inflamed, grow larger, and then form the buboes
properly speaking.
   These buboes may either be  the result of con-sensual or
sympathetic irritation, or they may be an indication of genu-
ine syphilis.   These  two forms of bubo  require to be distin-
guished with great care.  We will here describe  the former
variety; the second  form will be treated of in the chapters
on primary syphilis.
  In the case of a gonorrhoeal bubo, the cellular tissue which
surrounds  the gland,  first  begins to  swell.   Gradually  this
swelling increases, suppuration sets in, the skin becomes  red,
the patients experience a drawing and tension  in the inguinal
region, pressure on the  tumor causes pain,  walking beccmes 
gonorrhoeal buboes.
67
more troublesome;  finally the swelling grows softer, the skin
over the swelling breaks, and a thick yellow pus, or a thin
yellowish fluid is discharged, with disks of pus floating in it.
   These glandular swellings supervene in the first fortnight,
while the gonorrhoeal  inflammation is still confined to the
region of the  navicular fossa.   They are caused by the pus
being absorbed by the lymphatics of the penis, which carry
it  to the glands where it  causes an inflammation.   The de-
velopment of buboes is hastened by much bodily exercise or
fatiguing efforts during the inflammatory stage of gonorrhoea.
   As regards the treatment of buboes, during the early stage
of inflammation and swelling, the patient  should  remain as
quiet as possible, and take  one of the  following remedies:
Aconite,  Belladonna, Carbo anim., Lycopod., Merc, sol.,
Phosph., Rhus t., Thuja.
   \_Aconite,  more  particularly, if  the inflammation  is very
acute, and accompanied by fever;
   Belladonna, after the fever begins to decline, and a sub-
acute stage of the inflammation has developed itself;
   Mercurius sol., if the swelling is  neither red nor very sore,
and has developed itself very slowly ;
   Rhus tox., when the tumor is as hard as stone, and almost
insensible;
   Lycopod. and  Thuja, if the tumor has become  chronic
after one or more of the other remedies had been used.]
   If the increased  redness  and the presence of fluctuation
should  lead us to infer that pus has been formed, the suppu-
rative process should be hastened by the application of warm
poultices ;  internally one of the following remedies which are
physiologically related to the morbid process, may be given:
Belladonna,  Hepar sulph.,  Merc,  sol.,  Silicea.   If the  in-
flammation and the pain should be very violent, and the tumor
should  not break voluntarily, the patient  will derive great
relief  from the tumor  being lanced. 
  68     cystitis.—epididymitis blennorrhaqica.

      II.  Cystitis, Inflammation of the  Bladder.
    This disease  is  not very  frequent.   It  arises from  the
  mucous membrane of the neck of the bladder,  or  even the
  bladder, being invaded  by the gonorrhoeal inflammation.  It
  is generally accompanied with  inflammation  of the prostate
  gland.  The patients complain of  distressing pains  in the
  region of the  bladder,  causing a good  deal of oppressive
  anxiety and spreading to  the adjoining parts, the perinaeum,
  anus, testicles, loins.  The pains, and the anguish are still
  increased by the violent urinary tenesmus, in consequence of
  which  the urine can only be  discharged in drops.  These
  phenomena  are  of course accompanied by violent fever, the
  patients spend  sleepless  and  distressing nights, and  lose
  strength  and  flesh.  The urine  is turbid,  and deposits  a
  bloody and purulent sediment.
    A very strict  diet is here rendered necessary by the inten-
  sity of the inflammation.  The following remedies may  be
  exhibited: Aconite, Acidum phosphor.,  Bryonia, Staphys.,
  Tart, emet., and Veratr.
    [The principal remedies are undoubtedly Aconite and  Can-
  tharides, which  may be  used alternately, in tincture  form,
  two or three drops of the Aconite, and one drop of Cantha-
  rides,  in  separate tumblerfuls  of water,   a tablespoonful of
  each solution every half hour  alternately, until the dangerous
  and distressing symptoms have abated, after which the medi-
  cines may be continued at longer intervals, every hour or two
  hours.  If, after the subsidence of  all the acute symptoms,
  some strangury  should still remain,
    Nux vomica  or Pulsatilla may be resorted to, and  then
  again Aconite or Cantharides, or both in alternation,  until
'  the cure is completed.]

  III.   Epididymitis Blennorrhagica,  Acute Inflamma-
                 tion of  the Epididymis.
    This disease is one of  the most frequently-occurring  com-
  plications of gonorrhoea, and,  on account  of the cause whence 
epididymisis blennorrhagica.
69
it springs, one of the most important.  It is either caused by
the  spread  of the gonorrhoeal inflammation  along  the eja-
culatory canal and  the  vas  deferens, so  that the spermatic
cord is  simultaneously invaded by the inflammatory  process,
or by sympathy, in which case these last-mentioned organs
are not affected.  Many contend that  such an inflammation
may be  caused by a sudden  suppression of the gonorrhoeal
discharge.   This opinion is contradicted by other authorities
of the highest standing.  Ricord especially asserts  that the
best  preventive of  inflammation of  the testes  is  a speedy
removal of the gonorrhoeal discharge ;  and that this inflam-
mation  occurs most frequently in cases  where  the gonorrhoea
had not been treated at all. Orchitis  frequently occurs simul-
taneously with gonorrhoea, but most frequently in  the last
stage of the disease.
   Orchitis is more readily superinduced  when the following
conditions  occur :  excessive  afflux  of venous blood to the
testes,  relaxation  of the scrotum,  large size of the  testes,
frequent voluntary or involuntary emissions of semen, sexual
excitement,  or else unnatural abstemiousness, efforts  and irri-
tations of the neighboring parts by standing, walking, riding,
vesical calculi, constipation, colds, mechanical injuries such as
blows, contusions, etc.  Improper medical treatment, such as
irritating injections, may likewise occasion this disease.
   It  generally runs the  following course: after the gonorr-
hoea  has continued for  a while, the patient experiences  a
sensation of pressure and heaviness either immediately in the
testes, or first in the region of the kidneys, groins, perinaeum.
The pain increases, particularly if the testicle is left to its
weight, or by standing; and, if it  reaches a high degree, it
extends to the thigh, abdomen and small of the back.   Col-
icky  pains set in, accompanied  by urinary difficulties ; even
the peritoneum may be  invaded.  Sometimes  the spermatic
cord swells to such a degree  that it becomes constricted, and
phenomena resembling those  of incarcerated hernia,  develope
themselves.   If the disease is violent, there  is  always some
fever.   The sensitiveness of  the affective parts is sometimes 
70           epididymisis blennorrhagica.
so great that the least contact of the parts causes the patients
to faint away.
   The disease runs a very  rapid course, and an appropriate-
treatment removes it in a few days.
   The treatment is both prophylactic and curative.  The pro-
phylactic treatment prescribes a strict avoidance of all sexual
excitement from the moment that  the gonorrhoea first shows
itself, and of every exposure or influence that might give rise
to orchitis.  The patient should wear  a suitable suspensory
until one or two weeks after the gonorrhoea has ceased.
   The internal treatment is to be conducted with one or more
of the following remedies :
   Aconite:  Contusive pain in the testicle, with fever.
   Acidum nitricum: Swelling and inflammation of the testes,
whence the  pain travels to  the abdomen through the sperma-
tic cords; the testicle is painful to contact, with tearing in
the spermatic cord.
   Acidum phosphoricum: Aching pain in both testes, worse
when  waking or when touching the parts;  burning tearing in
the left testicle, and burning  in  the  prostate  gland,  with
frequent erections.
   Ammonium  carbon.:  Strangling pain  in  the testes  and
spermatic cords, with sensitiveness of  the testes to contact
and involuntary erections;  seminal emissions preceded by a
drawing and strangling sensation in the testes.
   Argentum nitricum: Contusive  pain,  with enlargement
and hardness of the right testicle.
   Arsenicum:  Crampy cutting colic  darting  through  the
abdominal ring and the perinaeum, considerable  swelling of
the testicles, phenomena resembling those  of incarcerated
hernia.
   Aurum:  Swelling of the lower part of the right testicle,
with  an  aching pain when  touching  or rubbing the  part;
aching tensive pain in the right testicle, as if contused.
   Baryt acet.: Frequently recurring and disappearing swell-
ing of the testicles.
   Belladonna: Tearing in  the left spermatic cord, especially 
EPIDIDYMISIS BLENNORRHAGICA.
71
in the evening, in bed, previous to falling asleep ;  drawing in
the spermatic  cord  during the acts of  micturition; long
stitches in the testicle which is drawn up.
  Bismuth: Aching pain in the right  testicle, worse when
touching the part.
   Cannabis: Tensive pain in the spermatic cord and con-
traction of the scrotum, or contractive sensation in the scro-
tum when standing; sensation of pressure in the testicles, or
a pulling sensation.
   Cantharides: Drawing pain in the spermatic cord  during
micturition, with swelling of the scrotum.
   Capsicum: Drawing pain in  the spermatic cord, and a
crampy pain in the testicle  during and some time after mic-
turition.
   tausticum: Aching  pain in the testicles, stitches  in  the
right testicle.
   China: Painful swelling of the spermatic cord and testicle,
especially of the  epididymis; tearing  pain  in the left  tes-
ticle and in  the left side of the prepuce, a crampy-contractive
pain in the testicles and urethra,  especially in the evening.
   Clematis: Swelling of both  testes; ascending pain  in  the
testicle and  spermatic cord.
   Cocculus: Stitching pain in one or the other testicle; vio-
lent pains in both testicles as if bruised, especially  during
contact; drawing pain in the testicles.
   Colocynthis :  Continual violent drawing  in the left testicle,
painful twitching of the testes, they are drawing up.
  Ignatia:  Pressure in the testicles ;  severe strangling sen-
sation  in  the testicles, in the evening after lying down in
bed.
  Iodium:  Swelling and induration  of the testes  and pros-
tate gland.
  Ipecacuanha : Twisting,  drawing pain in the testicle.
  Marum verum: Descension of the  right spermatic cord
towards the abdominal ring, with a sensation as if the sper-
matic  cord  were  pressed;  crampy  sensation  deep  in  the
abdomen, which extends to the testicles  as if they had been 
72
EPIDIDYMISIS BLENNORRHAQICA.
violently pressed upon ; the integuments  of the left  testicle
feel sore when touched, as if a pain had invaded them, start-
ing from the root of the penis.
  North-pole of the magnet: Cutting and sharp drawing in
the testes; sharp stitches in the left testicle ; strangling pain
in the right testicle; sharp drawing and  cutting in the tes-
ticles.
  South-pole of the magnet:  Tearing  in the spermatic cord;
pain in the spermatic cord, early in the  morning, while the
testicle  is hanging down relaxed, as if the cord were pulled
upon;  the testicle is painful when touched;  slow, fine,  pain-
ful drawing in the spermatic  cord;  swelling of the testicles,
and  a tearing, strangling  jerk in  the same;  at night the
testes are spasmodically drawn up.
  Manganum aceticum: Aching, drawing pain  in  the  sper-
matic cord, as if drawn up, and in  the testicles, with a feel-
ing of weakness in the parts.
  Magnes.:  Swelling  of the  epididymis, and simple pain in
the same when touching it, or during motion.
  Mercurius solub.:  Paroxysmal drawing in the spermatic
cord; sensitiveness of the swollen testicle, which, however, is
not painful; feeling of coldness in the testes; itching in the
right  testicle; crampy, tearing pain,  commencing  between
the testes, afterwards penetrating into the penis and causing
a good deal of  itching ; drawing pain  in the testicles and in
the groin; drawing with pressure,  the drawing  being the
most distressing.
  Mezereum: Painless swelling of  the left testicle, which
had been swollen in former times.
  Nux vomica: Heat in the testes; stitches in the same;
contractive pain in the testicles.
  Oleum anim.: Alternate swelling of one or the other tes-
ticles, with pain when touched.
  Pulsatilla: Swelling of  the right spermatic cord and tes-
ticles, with  a tensive  pain.   Drawing pains, and  drawing
tensive pains pass out of the  abdomen through the spermatic
cord into the testicles which are relaxed.  The right  testicle 
EPIDIDYMITIS  BLENNORRHAGICA.
73
is  drawn  up and  swollen, with a tensive pain, whereas the
left testicle is hanging down relaxed.   The testes and  sper-
matic cords are  painful and swollen, with  discharge  of  pros-
tatic  fluid; tearing pain  in  the  te'stes; the  testicles  hang
down very loosely, with tensive, drawing pains  passing out
the abdomen into the testicles through the spermatic cord.
   Rhododendron: Distressing pain in the testicles, especially
in the epididymis, when touching the parts; the testicles are
drawn up and swollen; contusive pain of the testes.
   Spigelia: Stitching  pain in one testicle; itching  stinging
in the left testicle; itching stitch in the right  testicle and in
the penis  from behind forward; burning stitch in the  right
testicle and in the penis.
   Spongia  marina:  Painfulness  and swelling of the  sper-
matic cord ;  long dull stitches proceeding from the spermatic
cord and  striking into the testes;  painful aching swelling of
the testes and spermatic cords ; the testicle is painful  when
touched;  crampy, strangulating, contusive pain in the  right
testicle.
   Staphysagria:  Violent, drawing-burning stitches from the
right spermatic cord to the right  testicle  through the abdo-
minal  ring, when  sitting, walking  or  standing, most violent
when stooping;  aching pain  in the left testicle, aggravated
by walking and by contact or friction;  drawing  and tearing
in the right testicle, with pressure, as if it.were forcibly com-
pressed.
   Sulphur: Pressure and tension in the spermatic cords and
testicles;  slow tingling in the testicles, all day;  sometimes a
slight  buzzing is experienced in the thighs, whence it passes
to the testes, after which it recommences as before, more vio-
lently ; vibratory sensation in the testicles and other organs.
   Thuja:  Burning  stitches  with pressure from  below up-
wards, through the scrotum and spermatic cord ;  drawing and
stitching in the  spermatic cords and in  the testicles; aching
pain in the testicles, as if contused, when walking or sitting.
   Zincum:  Frequent  drawing in the  testes, following the
course of the spermatic cord.  Painfulness and  swelling of
                             6 
74
OPTHALMIA GONORRHCEICA.
the testes.   Drawing pricking pain in the testes, worse when
sitting or stooping.

             IV.  Ophthalmia  Gonorrhceica.
   This affection arises from the  metastasis of the gonorrhoeal
discharge to the eye,  the  discharge remaining either  unal-
tered, or becoming less, or entirely -suppressed.  This disease
occurs more  frequently among  men than women, and gene-
rally  affects one  eye  only.   The conjunctiva is not much
affected,  the disease  generally develops itself slowly.   In
blepharophthalmitis  gonorrhceica  the  redness and  swelling
of the conjunctiva are generally very moderate; the secre-
tion is of the same quality as in the  common blennorrhoea of
the eyes, but less in  quantity, and the pain is less likewise.
   In the very acute  and rapidly-developed form of ophthal-
mia gonorrhceica,  we  distinctly observe  three stages.  The
first stage sets in with a violent, burning itching especially*
at the margins of  the lids and in the canthi, accompanied by
a profuse flow of acrid tears, and considerable photophobia ;
the conjunctiva  is uniformly  reddened,  and  the  lids, espe-
cially the upper  ones, swell  considerably.   In  the region
where the conjunctiva  passes from the  lids to the eyeball,  a
good deal of  vascular engorgement takes place.   Towards
the end of this stage,  which generally is  of  short duration,
the tears become rnore  turbid.   These phenomena are accom-
panied by fever, dulness of the head, coated tongue and vio-
lent thirst.
   In a few days the  second stage commences with consider-
able swelling  of the conjunctiva;  at first a whitish  yellow
mucus, to which the tears with  which it is mixed, impart  a
watery consistence, is secreted; it speedily increases in quan-
tity and thickness,  assumes a greenish  tint  after a while,
and, in flowing down the cheeks, either  inflames or corrodes
them.  The upper lid sometimes swells to the  size of a hen's
egg, the lower lid is  less  swollen.  The pains become ex-
tremly acute, and from  the eye and its  surrounding parts
spread over  the whole  head.   The  conjunctiva  which looks 
OPTHALMIA  GONORRHCEICA.
I o
red as far as the cornea, forms a pad-shaped elevation around
the cornea, covering its margins,  and penetrating even as a
dark-red mass between the lids which become everted in con-
sequence, especially the lower.   There is a profuse secretion
of  mucus  from the conjunctiva,  the inflammation speedily
invades the cornea whose  interstices  become distended even
in a few hours, and which assumes an uniformly grayish or
yellowish appearance.
   The fever, in the  second stage, is of course  worse; the
raging pain causes sleeplessness, and even delirium.
   If  this stage is not  arrested by artificial means, the third
stage sets in, and with it  a complete disorganization of the
cornea by suppuration.  In consequence of this destruction the
eye frequently breaks  and the whole of  the  contents of the
interior eye are discharged ;  or else ulcerations of the cornea
take place here and there.
   When the third stage has set in, the pains in and around
the eye decrease,  the  mucus becomes less,  more watery, yel-
lowish-white, less  corrosive; the  swelling of the eyelids and
of the conjunctiva decreases, the whites  begin  to reappear,
and the phlyctaenae of  the cornea  dry up.  The fever ceases
entirely, but  all sorts of  disorganizations  remain, such  as :
prolapsus of the iris,  adhesions of the iris and cornea, sta-
phyloma, leucoma, disturbances of the visual power, dimness
of the lenticular capsule,  adhesions of the capsule to  the
margin of the pupil.
   The course of  this  disease varies according to  the consti-
tution of the patient.  In young and  robust  persons  it is
rapid, in old and debilitated individuals it runs a slow course.
   The causes  of ophthalmic gonorrhoea are—1, direct poison-
ing of the eye with gonorrhoeal matter ;  2, metastasis of the
gonorrhoeal discharge  to the eye after complete suppression or
considerable decrease of the  discharge ; and 3,  spreading  of
the inflammation to the conjunctiva as to a homogeneous tissue.
   The opinions of authors  respecting this  disease vary a good
deal.   St. Yves and Plenk  consider metastasis as the only
cause of the disease.   Richter, Beer, Walther, Dupuytren, 
76
OPTHALMIA GONORRHCEICA.
Schcen, Himly,  attribute only the  more acute form of this
disease to metastasis; Howard, Foot, Spangenberg,  Ritter,
Benedict, Lawrence and others, on  the  contrary, derive  it
from some local infection;  Ricord likewise denies ever having
seen it take place after suppression of the original discharge.
  It is conceded that the more acute  forms of gonorrhceic
ophthalmia are caused by the gonorrhceic poison getting into
the eye; this accounts for the  fact that  men  are more fre-
quently attacked by the  disease than women, and that only
one eye,  principally the right  one, is generally affected; for
the patients are in the habit of touching  the diseased  parts
with the  right hand, and afterwards rubbing with it the right
eye for the purpose of stopping the itching which they may
happen to experience.
   Suppression  of  gonorrhoea  is undoubtedly the least fre-
quent cause of ophthalmia gonorrhceica.
   The prognosis in this  disease is generally very unfavor-
able.   The visual power  can only be preserved by a suitable
treatment being instituted  from the  commencement.  If the
inflammation should be far advanced, the cornea'considerably
affected,  interstitially distended,  covered with  phlyctaenae,
considerable disturbances of the visual power can scarcely be
prevented.  It is therefore advisable, according to Ricord,  to
look upon every case of ophthalmia which takes place simul-
taneously with gonorrhoea as a malignant form of inflamma-
tion, and to institute a treatment accordingly.
   As regards treatment, the use of specific  remedies should
be accompanied by the observance of the strictest cleanliness.
   Even  in  the  lesser  forms of the disease, the affected eye
should be used as little  as possible, and should be protected
by a screen against the light.
   In the commencement of the disease Aconite  is an excel-
lent remedy; in the lighter forms it alone frequently effects a
cure.
   In violent inflammation, with burning pains,  copious dis-
charge of mucus,  one or more from  among  the following
remedies should be used:  Arg.  nit.,  Belladonna, Calomel, 
OPTHALMIA  gonorrhceica.
77
Cannabis,  Carbo veget. Euphrasia, Graphites, Hepar sulph.,
Lycopod., Merc, sol., Nitric acid, Mercurius corrosivus, Sul-
phur, Tart, emet., Thuja, Verat. alb.
   In inveterate cases Tussilago petasites has been found use-
ful.  In cases where the iris had  become affected, which is
frequently the  case when matter gets into  the  eye, China,
Colchicum,  Euphorbium, Sulphur  and Terebinth., will  be
found efficacious remedies.
   [The principal remedies are undoubtedly Aconite, Acidum
nitricum and the mercurial preparations, especially Mercurius
prsecipitatus ruber, corrosivus, dulcis and acetatus.
   Aconite, when the inflammation is very acute, and the pains
in the eye and in the region of  the  eyebrows agonizing, cut-
ting, throbbing, burning, with excessive sensitiveness  to  the
light;  after the acute pains have been subdued  by Aconite,
and this agent does not  seem any  longer to act in the case,
we may resort to
   Belladonna, for  aching, sore  pains, with  sensitiveness to
the light, dilated pupils, frontal  headache;  or
   Euphrasia, when the  inflammation is  accompanied by a
profuse secretion of tears ;
   Acidum nitricum, when the anterior chamber seems filled
with a  dirty-looking pus, as  if  the eye  would  become  dis-
organized.
   The mercurial preparations may be used  in the following
order:  corrosivus, dulcis, ruber,  and lastly, acetatus,  for
symptoms  of disorganization, opacity or  ulceration of  the
cornea, opacity of the lens, distortion of the  pupil.  If symp-
toms of iritis develope themselves  during  the acute attack,
Aconite  in alternation with Mercurius corrosivus are invalu-
able agents;  of the Aconite, mixing  three  or four drops of
the saturated tincture of the root in  a tumblerful of  water,
and giving the corrosive mercury in grain doses  of the third
trituration.] 
78
GONORRHOEA OF TnE MOUTH.
   V. Gonorrhoea of the Buccal and Nasal Cavities.
   It is supposed that the gonorrhoeal  matter may be carried
to the nasal cavity by means of the pocket-handkerchief, and
that in consequence inflammation of and  discharge from the
nostrils may take place.  It appears, however, that this form
of the disease occurs very seldom.  It has only been observed
by few authors.   At first  the  symptoms  are like those of a
common catarrh; afterwards the mucous membrane swells, and
the discharge becomes purulent and profuse.
   Actual  gonorrhoea  has  likewise  been  noticed  from the
buccal  cavity.  Such  cases  are  related by Petrosi, of Kiel,
and  Sigmund, of Vienna; both  men  and women have  had
their mouths infected with the gonorrhoeal disease by bring-
ing  these parts  in  contact  with the contagious matter.—
Petrosi relates as follows:  A young man was attacked with
gonorrhoea of the urethra, and,  in consequence  of applying
his mouth to the diseased  pudendum,  the buccal cavity like-
wise became diseased.  Already on  the  following  day he
experienced a pain about the lips and gums.  On the fourth
day  the  mucous  membrane  of the lips  and buccal  cavity
became  intensely red; the  motions  of the mouth  became
painful;  the  gums were  interstitially distended, receding
from the  teeth,  readily bleeding, and the secretions from
the buccal cavity  were  more copious.  Afterwards a copious,
purulent, tenacious  and ropy secretion, with  aphthous exu-
dations  under the tongue, and  painful  deglutition  set in.
Professor  Sigmund, indeed,  admits that, in most cases, the
gonorrhoeal  disease of the mouth arises from the poisonous
matter of the same  person being brought in  contact with
the lips ; however, he mentions  cases where the disease was
caused by introducing  the diseased penis into the mouth of
another person,  or  by licking the affected pudendum with
the tongue.   Sigmund  not  believing it possible  that human
degeneracy could reach this low  level, an experienced prosti-
tute  afforded him an opportunity of being an unseen witness 
gonorrhoea of the rectum.
79
of such an act perpetrated by an old frequenter of haunts of
vice.
  The strictest cleanliness  is likewise required for a success-
ful treatment of nasal and  buccal  gonorrhoea.  The internal
treatment of the  gonorrhoeal  inflammation  of  the mucous
membrane of the nose and mouth requires the use of Aurum,
Calcarea, Ilepar sulph., Pulsatilla,  Phosphorus, Mercurius
corrosivus, Sulphur and Thuja.
  \Aurum, when the discharge  from the nose  is very offensive
and  the  internal parts of  the  nose  feel very sore.  If this
should not help, resort to
  Hepar sulphuris, especially if the discharge is of an acrid
and  excoriating nature; if thin  and ichorous,  burning,
  Arsenic may be  given ;• or, if attended with swelling, inflam-
mation, soreness of the nostrils,
  Mercurius corrosivus and Sulphur in alternation.]

             VI. Gonorrhoea  of  the  Rectum.
  This form of gonorrhoea may be  caused by an unnatural
gratification of the sexual instinct, or in the case of females,
by the gonorrhoeal matter flowing from the vagina downwards
along the perinaeum into the anal fissure;  in any case, the
disease is caused  by direct  contact of the poison.   In the
case of females, where it is caused by  self-infection, the skin
around the anus is generally inflamed, excoriated, secreting a
turbid, purulent fluid.  In large  cities it is  rather frequent,
particularly among prostitutes  and  men given to Sodomitic
habits.
  Cleanliness and one or more  of  the following remedies" will
cure the disease:   Aconite, Argentum, Aurum,  Belladonna,
Calcarea, Jgnatia, Merc, sol, Natr. mur., Nux  vom., Phos-
phorus, Sepia and Sulphur.
  [Aconite, for burning, shooting pains, with soreness  and
inflammation.
  Mercurius, for stitching pains, with  purulent discharge.
  Nux vomica and Sulphur, when  the  symptoms  are  com-
plicated  with haemorrhoids,  strictures of the rectum,  etc. 
80
gonorrhoeal rheumatism.
 Generally, the same medicines will cure the disease that are
 indicated by the character of the gonorrhoeal discharge.
   For metastatic gonorrhoea of the rectum, Pulsatilla, Mer-
 curius corrosivus, and Tussilago petasites will be found most
 efficacious.]

 VII.  Gonorrhoeal   arthritis,  rheumatism,  articular
   inflammation,  swelling   of  the  knee,   arthritis
   blennorrhoica, rheumatismus  gonorrhoicus, gonitis
   gonorrhoica, gonocele,  etc.
   Gonorrhoeal arthritis is one of the  sequelae of  gonorrhoea,
 which was formerly overlooked and is  denied even now  by
 many.   Its existence is admitted, however, by such men  as
 Astley  Cooper, Graves, Simon, Eisenmann, Lawrence, Cu-
 mano, Holscher, Rayer, Rostan, Sigmund, Hebra, etc.  Even
 Ricord,  who denies the existence of this disease,  admits that
 in persons who are subject  to  rheumatism,  gonorrhoea may
 induce a gonorrhoeal arthritis or rheumatism.   Casenave has
 shown, however, that an articular rheumatism which happens
 to supervene  during gonorrhoea, has to be carefully distin-
 guished from gonorrhoeal rheumatism.  Articular rheumatism
 which happens to supervene  during the existence of gonorr-
 hoea  rarely occurs at  a period when  gonorrhoeal arthritis
 generally sets  in, namely, about the fourth, fifth, or sixth
 week of gonorrhoea; in most cases the rheumatism is already
 existing  previous to the gonorrhoeal infection taking place.
 In gonorrhoeal arthritis the pain is generally seated  in the
 knee, sometimes in the  elbow and in the  tarsal joint; in rheu-
 matism,  on the contrary, every joint, even  the muscles, are
 affected;  it is either  shifting  from joint to joint, or else
 seated.
  Gonorrhoeal articular  rheumatism  is  generally located  in
 the knee-joint, and is distinguished from  gonorrhoeal arthritis
by a  much more intense reaction which is  almost entirely
 wanting in the latter.   Articular rheumatism leaves the go-
norrhoeal discharge almost entirely unaltered; in gonorrhoeal
arthritis  it is either lessened  or suppressed. 
          SUPPURATION  OF THE PROSTATE GLAND.        81

   With proper treatment the disease lasts from three to four
 weeks. According to the symptoms, one or more from among
 the following list of remedies will have to be selected : Aco-
 nite,  Bryonia, Mercurius sol, Nux vom., Pulsat., Rhus t.,
 Rhododendron, Sulphur,  Tussilago petasites;  electro-mag-
 netism is an admirable remedy in this  disease.
   [Aconite, if  the swelling develops itself suddenly, with all
 the symptoms of an acute inflammation, intense burning  and
 lancinating or  tearing  pains, excessive  tenderness to  the
 touch, etc.
   Bryonia  may be substituted for  Aconite when the acute
 stage has subsided, and the pains have  moderated; or it may
 be given in alternation with Aconite.
   Mercurius sol. will be found suitable, if the original  dis-
 charge was of a syphilitic character, or some intensely-acting
 mercurial preparation may be employed.
   Pulsatilla is useful when  the knee-joint is the principal
 seat  of the disease,  with  deep-seated soreness and aching
 pains  in the joints.
   Rhus. tox. and Rhododendron  may  be  resorted, to, if  the
 pains  are mitigated by motion, and  the inflammatory symp-
 toms are very slight, the  swelling is large  and hard.]

               Gonorrhoeal  Disorganizations.
   L- Chronic inflammation and suppuration  of the
                   prostate  Gland.
   If an  acute  inflammation of the prostate gland is  not
 speedily scattered,—and  it is but too frequently the case that
 the aid of a physician is only sought when this  disease  has
 already reached its acme,—it generally terminates in suppu-
ration, or  passes into the chronic form.
   Generally the patients first complain of  a painful pressure
 in the  perinaeum, and which is at  first felt only during an
 emission of urine or semen, but afterwards becomes continu-
 ous, and  is always worse during the above-mentioned emis-
sions.  At a later  period  the pain  increases  to  a burning,
 extending to the glans and even downwards to the testicles 
82        suppuration of the prostate gland.
and thighs.   From the urethra an albuminous, colorless, ropy
fluid is discharged, which  sometimes closes the orifice of the
urethra, is secreted more copiously after an emission of semen,
urine or after stool, and is particularly increased during a con-
stipated state of the bowels  by pressing upon the prostate
gland, by excesses in drinking or sexual pleasures, by taking
cold or by physical exertions ; the pains  are likewise  aggra-
vated at such periods.
   Under the operation of these same  causes, the urging to
urinate is likewise more violent, the  irritation extends to the
bladder, the  urine is expelled by fits and starts;  it is mixed
with mucous flocks, the  stream  is sometimes divided, and a
little  urine constantly remains  behind in the bladder,  of a
dark  color,  a pungent  ammoniacal  odor,  and  causing an
increased  irritation of the organ.  In  order to be sure  of a
correct diagnosis, the parts should be explored simultaneously
with the finger  through the rectum, and with the catheter
through the urethra.   The prostate gland becomes variously
disorganised, at times only swollen, at others harder or softer;
at times again its tissue is  altered,  or  there  are  adhesions
between the prostate and the surrounding parts.
   The existence of suppuration  may be  inferred from a  con-
stant desire to urinate, pain when urinating, and the presence
of tenacious  mucous and pus in the urine.  In such a case,
the constitutional  irritation is quite considerable; there are
frequent chills, febrile motions, and even delirium.  In  the
perinaeal region  a dull, painful throbbing is experienced.
   The suppurative process is either going on in the body of
the gland, or in the surrounding cellular tissue.
   The abscess generally opens  into the urethra;  sometimes
the discharge is accomplished by means  of the catheter.  The
dangerous symptoms speedily disappear after  the  discharge
of the  pus, which is drawn off by the catheter.  The pus may
likewise discharge into  the bladder or rectum.  In the former
case the pus is expelled together with the urine; in the latter
case, blood and pus flow out of the rectum.  After the break-
ing of  the abscess, no  matter in what direction, the  morbid 
          suppuration  of  the prostate gland.        83

phenomena, especially the  retention of urine,  subside, and
perfect recovery soon takes place.
   If the pus cannot be discharged, which takes place in case
the substance of the gland  is affected, the consequences may
be very distressing.
   The  following remedies will be found the most suitable in
chronic inflammation and suppuration of the prostate gland:
Arg. nitr., Aurum, Arsen.,  Acid, nitr., Carbo. anim., Calcar.,
Capsic, Cannab., Conium, Iodine, Lycopod., Merc, sol, Nux
vom., Pulsat., Rhodod.,  Sal ammoniacum, Silieea, Sulphur,
Spongia,  Thuja, Tussilago petasites and Uva ursi.
   [Thuja is one  of the most efficient remedies for hypertropb}r,
engorgement and infiltration of the prostate  gland, also sup-
puration ; in a case of suppuration of this gland, reported by
Trinks, the exhibition of Thuja was followed  by an increase
of the  pains and of the urging to urinate, and by the protru-
sion of haemorrhoidal tumors, with violent burning pains; the
disease was cured completely and in a short time by the binnio-
dide of potash.
   Arsenicum  may be resorted to if the patient  feels very
much debilitated by  the  disease; if  the disease threatens to
assume  a malignant form, and a foul ichor is discharged from
the gland, with fetid colliquative diarrhoea, foul urine, etc.
   Mercurius  sol,  if the urine contains shreds of  mucus,
or deposits a chalk-like, purulent sediment,  and  a heavy,
aching  pain  is  experienced in the perinaeal  region.   The
other mercurial  preparations may  prove serviceable,  if the
soluble  mercury should fail.
   The  biniodide of potash has  been  mentioned previously as
an important agent in suppuration of the prostate gland.
   Iodine may prove  serviceable in induration or subsequent
atrophy of the gland.
   Silieea may be used in chronic suppuration of the gland,
with heat and  soreness in the gland, discharge of pus with the
urine or stool, urging to urinate, costiveness.] 
84
strictures  of  the urethra.
            II. Strictures of the Urethra.
  By strictures of the urethra we understand a diminution of
the transverse diameter of this  canal, owing  to some morbid
alteration of its tissue.
  The most frequent  cause  of  strictures of the urethra is
gonorrhoea.  This form of blennorrhoea, which does not arise
from an ulcer, and has the character of a genuine  catarrhal
inflammation of the mucous membrane of the urethra,  yields
to proper treatment, even in  its most acute forms,  in two or
three weeks, without leaving  a  trace behind. After  such a
treatment the mucous membrane resumes its former elasticity
and dilatability, as if no discharge had ever existed.
  But most  patients, especially young people, are prevented
by a feeling of ill-timed  modesty, from applying to a trust-
worthy physician, and  prefer  submitting to the  improper
treatment of some quack.  The discharge remains uncured,
and strictures, inflammations of the  kidneys or  bladder, are
the consequence.   If quacking  remains inefficient, a  physi-
cian is applied to.   In the  meanwhile the  inflammation of
the mucous  membrane becomes  chronic, and an exudation
takes place in  its  tissue, in consequence of  which the ure-
thra becomes  narrower,  and the free emission  of urine is
prevented.
  After  syphilitic or virulent  gonorrhoea strictures  of  the
urethra  are quite common.  This is  owing to the pressure of
a syphilitic ulcer in the urethra, from which the pus  is  dis-
charged.   Such ulcers are generally  seated on one side  of the
inner wall of  the  urethra, and leave a cicatrix  even  in  the
most  fortunate cases.  This  cicatriced tissue is constantly
disposed  to contractions which likewise lead to strictures, but
different  from those which result from a common  gonorrhoeal
discharge.
  Another cause of stricture is the varicose  engorgement of
the blood-vessels  of the  mucous membrane  of the urethra.
The engorged  vessels form prominences in the urethra, gener-
ally in the region of the neck of the  bladder, in consequence 
strictures  of the  urethra.
85
of which the urethra becomes narrower and the emission of
urine is sometimes rendered impossible.
   Strictures are sometimes, but  less frequently, induced by
tubercles  in the sub-mucous cellular tissue  of the urethra.
With reference to the above mentioned  causes we distinguish
spasmodic, organic or continuous and mixed strictures.
   1.  Spasmodic strictures are said to result from anomalous
contractions of the organic and animal  muscular fibres of the
urethra.  This form of stricture  is doubted by some.  It is
said to occur principally in irritable individuals, haemorrhoidal
subjects, and in persons suffering with  chronic inflammation
of the prostate gland.
   2.  Organic strictures are the real strictures of the urethra,
the treatment of which requires our most particular attention.
   This class of strictures has likewise  been divided into sevi
eral  varieties, based upon pathological distinctions :
  a. Inflammatory strictures, which develope themselves even
during  the  course of  an acute  gonorrhoea.  The  mucous
membrane is swollen  throughout  its  whole extent, owing to
which the space of the urethral  canal is diminished and  the
discharge of urine is less and even entirely prevented.  This
kind of stricture  disappears together  with  the gonorrhoea
under proper treatment.
  b. Membraneous strictures, arising from the formation of
folds or valves in the mucous membrane.
  c.  Fleshy  strictures, caused by  a  partial swelling of  the
lining membrane.
  d. Fibrous or cartilaginous strictures, caused by cicatrized
wounds, ulcers, fissures,  etc.
  e.  Varicose  strictures,  arising from  engorgement of  the
blood-vessels coursing along the  inner walls of the urethra,
especially in the region of the neck of the bladder.
  3. By mixed strictures we mean such as arise from a spas-
modic  condition and  an  organic ulceration  of the tissues
They may likewise be caused by the  insertion of a bougie
through a  contracted portion of the  urethra.  Riding  on 
86
STRICTURES  OF THE  URETHRA.
horseback, forced marches, excessive  drinking  and venereal
abuse may likewise lead to such complications.
  As regards locality, the whole canal may be constricted so
as to form a narrow tube.  Spasmodic strictures  are  always
seated in the membranous portion, for this is the only portion
of the urethra which is surrounded by muscular fibres.
  Organic strictures  are most frequently located five or six
inches from the internal orifice of the urethra, directly under
the symphysis pubis, at  the junction of  the spongy with the
membranous portion.   They occur less frequently at the ter-
mination of  the navicular fossa, or in the prostatic portion.
  Let us now  pass to the phenomena of a stricture.   Soon
after  the termination of an  improperly treated gonorrhoea
drops of mucus  are  discharged from the urethra, which  are
only  seen in the morning, when  the orifice is found  closed
with the  mucus.   The bed-linen and the shirt exhibit  dirty
yellow stains.  This  kind of  discharge  is generally  termed
" goutte militaire,"  and  is not infectious.  Such discharges
from the urethra always point to incipient strictures.
  Another sign by which the existence of stricture is known,
is the thinness of the stream, always accompanied with an
increased slowness of the stream which ceases to form a curve,
but comes down in a rather perpendicular direction.
  The shape of the stream is likewise altered; first it becomes
flat,  and  finally divides  into several branches, which  are
twisted about one another like a cork-screw.   Sometimes the
stream scatters all around on leaving the urethra; at last the
urine comes off in drops  and very  slowly.
  The urging  to  urinate is  constant,  and is  particularly
troublesome at night.   The urine is discharged with  great
trouble;  the patient  has  to press both  his hands upon his
knees or upon some  other hard object near  by; during  such
efforts the face and neck turn  red, tears flow out  of the eyes,
and  in  more  inveterate  cases the  patients are sometimes
obliged to assume  a position, when urinating, as if  they
would go to stool.  If this condition  lasts any length of time,
hernia and  prolapsus of the  rectum are apt  to take place. 
STRICTURES OF THE  URETHRA.
87
Such  efforts  are always accompanied by  great  pain.  This
pain is of various kinds, prickling, stinging, burning, itching
and more or less acute;  it excites a sensation of heat, which
sometimes increases to a burning, as with a red-hot iron, and
is so distressing that the patients  refrain from  urinating as
long as they can in order not to excite the pain.  In conse-
quence of being retained in this  manner, the urine becomes
more acrid, and causes erosions, soreness, rhagades and ulcer-
ations behind the stricture.   At first  the dysuria is only felt
during  an  emission of urine; after a  while it continues  even
after the emission.
  Not only  the  emission of the urine, but  also that of  the
semen causes pain, which is sometimes so  violent that  the
patients dread sexual intercourse and frequently  avoid it alto-
gether.  According to the statements of some  patients, the
pain  which is experienced  during an  emission  of semen is
more acute than that which an emission of urine causes.
  In the course of the disease an inability to retain the urine,
or incontinence  of urine, sets in.   This incontinence may be
complete or partial.  If partial, a small quantity of urine is
discharged  involuntarily drop by drop after every urinary
emission ;  the clothes get wet, and, after awhile, a fetid odor
is spread in spite of the utmost cleanliness.  This dribbling
of the urine is  caused by a quantity of urine* accumulating
behind the stricture in a kind of sacculated enlargement, and
flowing  off  through  the  stricture by its  own gravitation.
Complete incontinence is  much more distressing and incon-
venient.  In this case the enlargement extends to the  neck
of  the  bladder, on  which account the  bladder  is unable to
retain  the  urine which passes  off continually  and  involun-
tarily.   Such unfortunate patients have to wear a receiving
vessel fastened  to the parts.
   The most horrible accompaniment of strictures is retention
of  urine,  which  really endangers life.  Inasmuch  as  this
affection  may likewise arise from other causes, we will recur
to it in a special section.
   The alterations which occur in the  quantity and quality of 
88
STRICTURES  OF THE  URETHRA.
the urine in strictures, require to be examined.  The quantity
of the urine does not differ much from that of the urine in a
normal state of health.  It is lessened  if  the  patients,  in
order  to avoid the necessity  of  emitting it on account  of
the great pain, endeavor to diminish the  natural  quantity
of the urine by  diminishing the  quantity of the  beverage
which  they are in the habit  of  drinking.   This,  however,
does not diminish  the urinary tenesmus; for, owing to the
diminution of the quantity of the beverage, the urine becomes
more  salt and  irritating than it was  formerly.   The  urging
is more frequent, very painful; stranguary sets  in,  and the
urine is discharged in  drops.
  The quality of the urine is altered in this, that it contains
a greater amount of salt  and  ammonia  than in its  healthy
condition; it is moreover  mixed with pus and mucus; after
standing  for a time, a cloudy, dirty white  precipitate goes
down, and a pungent, disagreeable,  ammoniacal odor ema-
nates from the  urine.
  Beside these symptoms, an exploration of the urethra by
means of the catheter completes the certainty of  our diagno-
sis as to  the existence of a stricture.
  This exploration  may either be instituted with inflexible,
metallic,  or with flexible, soft catheters, termed bougies.  We
omit a description of the mode in which the catheter is to be
introduced; physicians may consult surgical works in refer-
ence to this subject, and laymen will probably not venture on
such an operation, which requires  a good deal of dexterity
and practical experience.   This same remark applies  to the
various forms and the materials of probes.
  We will simply state in  this place, that a catheter or bou-
gie is to  be introduced, if  we desire to find out the  number,
locality,  length, form  and condition  of the  strictures, and
that the  thickness of the  bougie should  be  proportionate  to
the size of the stream.
  The course of a stricture is very irregular; it  may be
shortened or  prolonged by  natural  disposition, a  suitable
mode of life,  and by various diseases.   The stricture is gene- 
STRICTURES  OF THE  URETHRA.            89
rally made worse by errors in diet, an exciting mode of life,
and by venereal excesses.  A  stricture  never gets well  of
itself, but is always  disposed  to terminate in a  complete
closing of the urethra, and consequent  retention  of urine.
To prevent this result, a seasonable  treatment is absolutely
necessary.
   The prognosis is generally doubtful, especially if a suitable
treatment is  not  instituted in  season.   It likewise depends
upon the  seat and the condition of the stricture.  The nearer
it is to the outer portion of the urethra, the more recent, the
more dilatable, the less extensive and contracted the stricture,
the sooner it  is removed.   Complications and constitutional
derangements increase the difficulty and  render  the progno-
sis less favorable.
   In regard to treatment, I do  not think that homoeopathic
physicians will be  able  to  dispense with  mechanical means.
Spasmodic strictures  can indeed  be removed  by internal
treatment  permanently and  without pain;  likewise other
kinds of stricture, provided the disorganization of the mucous
membrane is not too far advanced; in such a case  the  spe-
cific remedial  virtues  of our drugs may yet succeed  in effect-
ing a resolution of the morbid alterations  of the tissue of the
urethra.   But if the disorganization has assumed a fibrous
character, manual interference is indispensable.
   In the treatment of spasmodic strictures, and of the lighter
forms of swelling  of the mucous membrane of the urethra,
the following remedies will be found the most suitable, accord-
ing  as  the symptoms may require: Agaricus,  Agr. nitr.,
Argilla, Belladonna,  Bismuth,  Camphora,  Clematis,  Con.
mac, Silieea, Kali,  Petrol, Digit., Iodium,  Nitric acid,
Opium, Stramon.,  Terebinth, Thuja.  (Cantharides, Mercur.
sol. and Sulph. should not be omitted.—Ed.)
   [The principal remedies for spasmodic strictures, with their
symptomatic indications, are:
   Aconite: with inflammatory fever; constant and  distress
ing urging to urinate, with inability to pass any urine. 
90
STRICTURES  OF THE  URETHRA.
   Cantharides: For similar symptoms, with discharge of a
few drops of blood instead of urine.
   Belladonna: For frequent urging, the urine looking natural
or gold-colored, with cerebral congestion, and costiveness.
   Camphor a:  Strangury, burning of the urine, thin stream.
   Digitalis : Continual desire to urinate, emitting only a few
drops each time, with sensation as  if the bladder were too
full; or pressing and burning in the middle of the urethra as
if too narrow.
   Argentum nitricum: Burning urine, pain in the  urethra
as if swollen and closed.
   Nux vomica: Painful, ineffectual desire to urinate.
   Opium: Spontaneous interruption  of the  stream  when
urinating; or complete suppression of the urinary secretion.
   Terebinthina: Dysuria, also complete suppression of urine,
also with painful erections.
   Thuja:  Difficult micturition; the stream  is arrested half
a dozen times before the urine  is entirely voided.]
   In organic strictures, a surgical operation is  unavoidable.
Before,  however,  resorting  to it, we  have  to distinguish
between strictures-which allow  the urine  and the instruments
to pass, and such as  do not,  or only with  great  difficulty.
This second variety will be discussed more fully in the article
on retention of urine, section of the diseases of the  urinary
organs.   For the present we will simply mention the various
operations which are employed  with  success for the purpose
of effecting the dilatation  of the contracted urethra.   They
are
   1. Simple dilatation;
   2.  Cauterization; and
   3. Incision.

                      1.  Dilatations.
   This method is the one which is most generally employed,
and which I likewise prefer, for it has never  failed me in my
practice which  has been pretty extensive.  Some employ for
this purpose metallic, others  flexible  bougies.   The bougie 
STRICTURES  OF THE  URETHRA.
91
may either be left in  the  urethra  for a longer period, (per-
manent dilatation,) or a momentary introduction  may suffice
(temporary dilatation).  I  prefer the use  of  elastic bougies
made of caoutchouc and gutta percha.
   The size of the bougie should be  proportionate to the size
of the stream.  At first thin  bougies  should  be used, and
their size should be gradually increased.  Holding the bougie
as we do a common writing pen, we cautiously introduce it
into the urethra.   It  may  happen that, before reaching  the
stricture, the bougie is arrested by a  fold of the  mucous
membrane, or by  one  of the  mucous follicles situated along
the lower wall of the urethra.  In such a case the  bougie
is to be drawn back, and the penis  to be pulled forward
for the purpose of removing the obstacle.   If the stricture
is reached,  we endeavour to work  the  bougie through  the
narrow opening;  if we do  not  succeed, a thinner bougie has
to be tried.   We must not  lose courage, if we find it  hard to
overcome the difficulty;  with skill and perseverance we shall
finally gain our object.  If, after passing the bougie into  the
narrow opening,  the  obstacle remains  nevertheless  uncon-
quered, we have to attribute the difficulty to the windings of
the stricture.   This  new  obstacle is overcome by turning
the bougie irregularly in different directions, until we finally
succeed in penetrating the bladder.
   In order to be  perfectly satisfied whether the  bougie has
really penetrated the stricture, we hold it quite loosely between
the fingers; if the stricture is passed, the bougie will  remain
in its place; if it  is simply bent in the  urethra, its elasticity
will cause it to bound back again.
   If  the  canal should be  very narrow, it  is sometimes  an
advantage to inject sweet almond oil into the urethra.
   The bougie may be introduced once or  twice a day.   At
every new trial, the bougie which had been used last, and had
been  introduced with  ease, has to  be used  again, and to be
left five or ten minutes in the urethra, before we replace it by
one of larger size.
   The length of  time during which the bougie  should  be 
92            STRICTURES  OF THE  URETHRA.
      allowed to remain in the urethra,  depends upon the patient's
      own feelings.   Some  bear the presence of the bougie for an
      hour;  very  irritable  and  sensitive  persons are  frequently
      made sick, if the bougie is left too long.   This sensitiveness
      decreases however after repeated trials.
         At the commencement of the treatment, the bougies should
      not be changed without great caution.   Bougies of larger size
      should only be used  after  a  considerable dilatation of  the
    ,  stricture has  taken place.  The  operation of  the bougie is
J&tij  materially aiMested by a few doses of Belladonna,  Clematis
      or Thuja.
         After  using the bougie and  the  suitable remedies for  about
      three weeks, the  patient is generally cured, and the stricture
      together with  all the  diffiulties  in voiding urine, removed.
      However it is  not well  to discontinue  the use  of the bougie
      immediately;  on the contrary, it is advisable to continue the
      use thereof for sometime longer.
         In the case  of sensitive and irritable persons, who  suffer
      much pain  from  the introduction  of the bougie, one or two
      days should be allowed to elapse before another introduction
      of the bougie is  attempted, until  the parts have become less
      irritable. If, in  spite of all care and trouble,  we should not
      succeed, upon  a  first  trial, in introducing  a  bougie, were it
      ever  so  thin,  the  introduction  of  the instrument may be
      attempted while  the patient is' in a tepid  bath.  Sometimes
      we will find it more easy to introduce a bougie of larger than
      one of a smaller  size.
         The dilatation of the urethra by means of  a bougie has
      several  advantages.   1st, a mechanical enlargement of the
      stricture; and 2d, a restoration  of the depressed vitality of
      the urethral mucous membrane, an increased activity of the
      reproductive system, and consequent absorption of the adven-
       titious growth.
         The symptoms are likewise favorably altered by the use of
       the bougie.  Even  after  its  first introduction, the  urine  is
       voided with more ease, and the patient is very much relieved.
         As the stricture is  more dilated, the  stream increases in 
STRICTURES  OF ME  URETHRA.
93
size, the urine is voided in less time, and the last drops even
are properly expelled by the bladder, instead of the former
dribbling.
   On first introducing the bougie, the  mucous discharge is
somewhat increased; but it decreases in proportion as the
stricture dilates, and finally ceases altogether.
   The urging to urinate disappears already after a few trials.
This  enables the  patient to have a quiet rest  at night, by
which means the general health is improved and the cure faci-
litated.
   The efforts which  the patient had to make, in order to void
the urine, and the pain which he experienced during micturi-
tion  or during  an  embrace, decrease likewise after several
introductions of the  bougie.  The dribbling of the urine, and
the ischuria likewise disappear, provided, however, the  latter
disease did not arise from any other cause.
   The urine becomes clearer after awhile; it is no  longer
mixed with blood  and mucus, loses its  pungent, ammoniacal
odor, and the sediment gradually disappear.
   We have to devote a few remarks to permanent dilatation ;
which, though less  desirable than  the  temporary dilatation,
may nevertheless  be rendered necessary now and then by
circumstances.   This is particularly necessary when the phy-
sician is prevented from seeing his patient every day.  For
the permanent dilatation we generally use an elastic catheter.
The instrument is introduced in the same  manner as  the
bougie, and, after having penetrated the stricture, it  is fas-
tened to the abdomen by means of a thin string, and left in
this position until the next day, so that it can be easily moved
to and  fro in the  stricture.  Next  day we  use a catheter  a
little  larger in size,  and which it is difficult  to pass through
the stricture.  Every second or third day we select a catheter
of a  somewhat larger size, until the urethra has acquired its
normal diameter.  The outer orifice of the  catheter is closed
by means of a  little tampon which the patient removes him-
self when he desires to void urine.   If  the  physician should
be unable to see his patient every day, or if the patient should 
94            STRICTURES OF THE  URETHRA.
live at a distance, the  patient may introduce the bougie him-
self after being shown  how.

                    2.  Cauterization.
   Without having the least desire to say a word in favor of
this method, we do not deem ourselves  authorized to omit it,
were it for no other reason than because it is not long since
it was  universally practised.   This method of treatment may
be traced as far back as Ambrosius Pare, towards the middle
of the sixteenth century.  Two hundred years after this period
it was  superseded by the method  of dilatation,  until revived
again by Hunter about the middle of the last century.   Du-
camp is the one who has most distinguished himself in  the
treatment of strictures by cauterization.  Owing to his efforts
and example, it became almost the exclusive method of treat-
ment of strictures of the urethra during a period of ten years
from 1820 to 1830.   It was soon found, however, that  this
method did not obviate the liability to relapses caused by  the
contracting cicatrix.   On  this account it was opposed  by a
number of modern physicians, and finally had  to  give way
again to the method of dilatation.
   The  caustic is applied in the following manner.  After
having explored the locality and extent of the stricture,  the
caustic is applied by means of a canula of gum elastic, platina,
gold or silver, to the end of which a little capsule of platina
filled with liquid nitrate of silver is attached.   A tod is riveted
to the cap&ule, by means  of which it can be moved to and fro,
and turned about.  At its extremity,  or  on the  sides,  the
canula  has openings through which the caustic is brought in
contact with the stricture.   To the canula is  attached a gra-
duated scale marked with figures, by which we can ascertain
how far  the  capsule has  penetrated  in the urethra.  The
caustic remains in contact with the stricture for half a minute
or a whole minute, after which the rod with the  capsule,  and
finally, the whole instrument is withdrawn.  On the second
and third day,  bougies  are introduced for  the purpose of
dilating the canal and facilitating the coming off of the scurf. 
STRICTURES  OF THE  URETHRA.
95
This proceeding is repeated every three or four days until the
obstacle is entirely removed.   To complete the cure, bougies
are used in order  to secure a proper dilatation of the urethra,
and this method  is continued until the wound is completely
cicatrized.

  3. Scarification,  Operations with  Cutting Instruments.
   This method is as old  as any of the former.   Ambrosius
Pare likewise resorted to it, and employed for his purpose an
instrument which he termed queue de ret.   Later  surgeons
employed for this purpose trocarts; Amussat  invented an
urethratome and  scarificators.   Modern surgeons,  such  as
Diondi,  Dieffenbach,  Pauli,   Stafford,  Tanebon, Despiney,
Martial, Duynerris and Ricord, have contrived various instru-
ments  for the division of strictures.  The most simple instru-
ment is undoubtedly that  of Ricord consisting of a  tube con-
taining a stiletto  with a small blade, which can be pushed out
ad  libitum.
  Before this instrument can  be employed, the  stricture has
to be sufficiently  dilated by means of bougies, to  admit  of the
passage of the instrument.  The  instrument, closed and well
oiled, is passed through the stricture, and the stiletto with its
blade having been pushed forward, the stricture is divided
several times, from  before backwards, and  from behind for-
wards.   To prevent  the premature adhesions of the incisions,
bougies have to  be introduced.  The  operation has  to be
repeated until the difficulty is entirely removed,
   On  account  of the many inconveniences consequent upon
this operation, among which the hemorrhage  which  some-
times accompanies it, and is sometimes quite considerable, is
not by any means one of  the least troublesome,  it, as well as
the treatment by cauterization, has been abandoned by most
physicians, so much more as its results are not more promising
than those of the method of  dilatation.  It is only resorted
to now-a-days in the case of valvular  strictures, or  such as
are located in the anterior portion of the urethra. 
96
FLUOR ALBUS.
       Gonorrhoea of the female, fluor albus, leucorrhoea.
   Leucorrhoea is an affection of the female organs analogous
to the gonorrhoea of the male, and,  by many physicians, is
looked upon as  a variety of syphilis.  This, however, is no
more true than  that every form of gonorrhaea is a syphilitic
disease.
   The female organs are much more frequently affected with
blennorrhoea than  the male,  probably because the mucous sur-
face of the former  is  more  extensive, and the inflammatory
irritation may invade  several  organs.   On this account four
varieties of female gonorrhoea have been adopted:  1, urethri-
tis, inflammation of the urethra;  2, vulvitis, inflammation of
the vulva ; 3, vaginitis,  inflammation of the vagina; 4, uteri-
tis, inflammation of the  uterus.  We will define each of these
four varieties more in detail, as soon as the course of female
gonorrhoea generally shall have been treated of.
   A few days after an impure coit, a heat, burning and draw-
ing are experienced in  the  parts; the mucous membrane is
drier than usual, and very sensitive, and of a dark red color
either throughout its whole extent or only in some of its parts.
The large, and afterwards the small labia begin to swell.  The
rubbing of the clothes in walking causes a pain ; the pains dur-
ing micturition are still more  distressing, particularly when the
last  drops flow over the inflamed  mucous membrane.  Soon
after, the patient complains of pains in the small of the back,
especially when sitting.  A sense of tension, tickling,  and
very frequently an  irresistible desire for an  embrace, a real
nymphomania set  in.    Coit is,  however, painful.  Many
women experience, moreover, a languor, a tearing in the ex-
tremities, especially in the thighs,  and colicky pains.  These
phenomena  generally cease  after the  appearance of the dis-
charge.  This is at first watery, yellowish, turbid, and some-
times mixed with  blood, and leaves  a grayish stain  on the
linen.  Afterwards the discharge assumes  a dark yellow,
greenish color, becomes  thick, has an offensive smell, and is
so copious that it flows  down the  thigh on walking or rising 
FLUOR ALBUS.
97
from a seat.  When the inflammation decreases, the discharge
becomes whitish, milky, sometimes very thick,  cheesy, and
flocculent.   At first the mucous membrane looks red, and is
marked  with roundish spots or streaks,  which  afterwards
change to erosions.  After the disease has lasted for a time,
the follicles begin to swell and become  prominent, imparting
an uneven  and granular feel to the mucous membrane.   At
the commencement of the menses the pain gets worse, and the
discharge increases a good deal.   During the menstrual flow,
however, the pains abate, and reappear again as before, after
the cessation of the menstrual periods.
  As regards the causes, and disposition to female gonorrhoea,
the remarks we have offered concerning  this disease in the
male, are likewise applicable to  the female.   Every cause
which is capable of causing an inflammation of the mucous
membrane is likewise capable of causing an inflammation with
a mucous discharge in the pudendum.  The habitual exposure
of  the  female  parts  to the atmospheric air  increases their
liability to disease.  Hence leucorrhoea may be caused  by a
variety of» influences, and may affect every age.    There are
even cases where a copious  discharge  of mucous from the
pudendum  has been observed in infants during their passage
from the womb into the light of day.   It frequently happens
that girls are attacked with leucorrhoea during the period of
dentition, accompanied with considerable  pain;  also  during
the course  of many eruptive diseases, scrofula, etc.
  Blennorrhoea of the pudendum may arise from a variety
of irritating causes, from  onanism, premature sexual inter-
course, especially when  the vulva is too small, excessive
sexual intercourse, mechanical injuries, foreign bodies in the
vagina,* such as the pessary.   It is quite common, even among
perfectly healthy women, that they should have a  leucorrhoeal
discharge shortly before  and shortly after the period.    A

  * Some time ago I treated a girl of  17 years for leucorrhoea, which had
been caused by the girl having rubbed the vagina for a considerable period
of time with a carrot, which had been introduced for that purpose into the
vagina. 
98
URETHRITIS.
similar discharge takes place during  the last weeks of preg-
nancy and at the critical age when the menses are about  to
stop.   In large cities most women are troubled with leucor-
rhoea to  some extent, which is probably attributable to the
weather,  to their  mode of dressing and living, to  excessive
reading, to sedentary habits and other circumstances.  Coffee
with milk is likewise supposed capable of causing leucorrhoea.
  Gonorrhoea may likewise  be caused by an infectious  con-
tagion, without, however, being syphilitic, and without causing
chancrous ulcers.    In the case of  the female  it is indeed
more difficult than in the case of  the male, to ascertain the
contemporaneous existence  of syphilitic  ulcers and the leu-
corrhoeal discharge, hence a mistake is not so very difficult.
  The infection of the gonorrhoeal  contagion generally takes
place during coit.   It may likewise take place  by the female
parts being barely touched by the  diseased  penis.  In order
to be perfectly certain of the true nature of  the discharge in
the case of females, it is absolutely necessary to explore the
parts by means  of  a  speculum;  otherwise the  physician
might be left in the dark and miss  the cure.
  Before we proceed to the treatment of leucorrhoea, we will
consider  each of the four forms  of leucorrhoea distinguished
with reference to the particular seat of the disease.

                      I. Urethritis.
  If the  inflammation is located  in  the urethra, it is  first
revealed  to us by itching, pain, swelling of the orifice of the
urethra, urging to urinate.   It  scarcely ever exists by itself,
and is generally accompanied by inflammation of the labia
and the vagina.   It is readily recognized by the drops of pus
which are seen at the orifice of the  urethra.   Immediately
after voiding urine or washing  the parts, the traces of the
inflammation  have to be looked  for  on the  linen which  the
patients wear on their persons.  We  see on  the shirt small,
isolated,  opaque spots of a  yellowish-green  color.  In order
to be perfectly sure of the character of the  disease, we have
to institute an examination per  speculum, and by the touch. 
VULVITIS.
99
 For this  purpose the index-finger  is introduced into  the
 vagina, and the urethra is compressed from behind forwards
 and upwards, by which means a yellowish, thick mucus is
 pressed out of the orifice of the urethra.

                       II. Vulvitis.
   This inflammation  is recognized  even after a superficial
 examination of the parts, and is the same as the balanorrhoea
 of the male.  If the inflammation is  very acute, the swelling
 of  the  labia  sometimes encroaches  upon  the  orifice of  the
 vagina.  The  small labia  are oedematous;  they constitute a
 thick,  bluish-red,  shining,  disk-shaped  swelling, and  are
 covered with a number of erosions; likewise the clitoris and
 its surrounding parts.  The labia majora are tense, dark-red
 and very prominent.   The contact of the urine causes much
 pain, and  the introduction  of the  speculum  is impossible.
 The follicles are swollen, and constitute more or less consider-
 able prominences which sometimes  terminate in suppuration,
 constituting the so-called abscessus pudendi.  When the labia
 are intensely inflamed, the warmth of the bed becomes intoler-
 able, fever sets in, and the  patient is tormented by thirst and
 sleeplessness.   On examining the parts, we discover a viscid,
 purulent fluid  of  a specific odor, which sometimes dries up in
 the hair of the pudendum, forming a thick, crusty covering.
 Sometimes this secretion is so acrid that the external surface
 of the labia majora, the perinaeum, anus, and even the thighs
 become inflamed,  excoriated, and likewise secrete a purulent
 fluid.
  Corpulent women are particularly predisposed to this kind
 of leucorrhoea.  Such patients find it troublesome to walk;
 their sexual instinct is  generally more active, but the sexual
 act itself is painful.  In the  case of little girls, leucorrhoea is
 either the result of some internal disease, or more frequently
 of mechanical  injuries, touching, rape. Andrieux de Brionde
 states that  newly-married women frequently experience sting-
ing pains in the pudendum the first days after their marriage,
which he attributes to an unusual desire for sexual intercourse. 
100                    vaginitis.
Onanism is a frequent cause of the disease.  As long as this
vice is indulged in, the disease will of course continue.  The
most  careful watching,  the  most serious  exhortations, even
punishment, are frequently insufficient to  stop this vile prac-
tice.   Durand Tarvel relates the case of a girl of nine years
whose clitoris was removed by the knife, in order to stop this
destructive habit.  The operation was very painful.  In order
to arrest the haemorrhage,  the  actual  cautery was applied;
but scarcely had  the wound been healed when  the child
resumed its former habits.

      III. Vaginitis.  Inflammation of the Vagina.
   This  disease is more frequent than inflammations of the
external parts.  It is generally accompanied with blennorrhoea
of the labia.   The inflammation is either seated in the super-
ficial  mucous membrane, or in the mucous  follicles or bursae;
if very acute, the whole substance of the  mucous membrane
and the subjacent sub-mucous  cellular tissue may be invaded.
   In  such a case women sometimes complain  of pain in the
pelvis, heat, and sense of weight in this region;  intense heat
in the  vagina, pains which frequently strike  td  the renal
regions; all these symptoms  are  worse during a  walk,  at
stool, and when voiding the urine.   The sexual desire is gene-
rally  more  intense, and may be gratified  without pain, pro-
vided the inflammation  is not too  acute.  The mucus is dis-
charged in quantities.  Either the whole vagina  or only a
portion  thereof may be affected.  If the follicles are princi-
pally  invaded, we distinguish  a  number of  miliary granula-
tions with the finger.  In every case of this  kind the mucous
membrane is  redder than usual,  partially denuded of  its
epithelium,  and covered with small, superficial ulcers.   A
mucus which is  frequently mixed  with blood,  and  pus  are
secreted; this secretion has an acid reaction, and leaves yel-
low or yellowish green spots on the linen. 
                        UTERITIS.                    101


     IV. Uteritis.   Inflammation  of the Uterus.
  The catarrhal inflammation of the uterus is the most obsti-
nate form of leucorrhoea, and the most distressing in its con-
sequences.  It is accompanied with considerable derangements
of the menstrual functions, violent haemorrhages, difficult con-
ception, degeneration of the fetus, disposition to miscarriage,
and even complete sterility and obliteration of the Fallopian
tubes, as is frequently observed in prostitutes.   This inflam-
mation is recognized by redness and dryness of the neck of
the uterus.   The neck is covered with a whitish,  thick, adher-
ing mucus, secreted from the  internal  orifice of  the womb or
from all the surrounding  parts.  The patients  complain of
heaviness and drawing in  the pelvis and small  of the back,
and, on sitting down, frequently experience  a burning pain.
Erosions soon develope themselves  round  the os tincae, with
superficial, uneven ulcerations, which  are  covered here and
there with whitish patches of dead epithelium.   Sometimes,
and particularly  in  the case of prostitutes who  do  a large
business, inflammation  spreads  to the inner surface  of  the
uterus, the Fallopiant ubes, the ovaries and the peritonaeum ;
in such a case life may be  endangered by the inflammation.
  In treating female gonorrhoea homoeopathically, we have to
consider  the seat  and  extent of the disease, the accessory
symptoms which happen to  accompany  it, and  the  general
condition of the patient.   Accordingly, we may have to  use
one or more of the subsequent list of medicines, either alone
or in alternation, or  several medicines in a successive series ;
the selection of the  remedy  will of course depend upon the
symptoms  and state of the  disease.  We will  relate these
remedies in  alphabetical  order, and mention the group of
symptoms to which each medicine is specifically adapted.
  Acid.  nitr.: Flat ulcers in the vagina as if covered with a
yellow pus ; with a burning, itching pain and leucorrhoea. Dis-
charge of a flesh-colored mucus from the vagina.   Swelling at
one side  of the vagina.  (This remedy is particularly adapted
to chronic vaginitis.) 
102
uteritis.
  Acidum phosphor.:  Leucorrhoea before  and  after  the
menses, with burning in the urethra.
  Acidum sulphur.: Milky, transparent leucorrhoea, painless,
but sometimes smarting and mixed with blood, acrid, copious
and erosive.
  Aconitum: Leucorrhoea, with slight tingling  in the parts
which is not disagreeable.
  Arsenicum: Smarting, gnawing leucorrhoea, causing a sore-
ness of the parts  with which it comes  in contact; when
standing the discharge drops down, accompanied with emis-
sion of flatulence.   Redness of the  parts.
  Aurum: Profuse leucorrhoea which  excoriates  the  peri-
naeum,  and the internal sides of the  thighs, with vesicular
eruption on the parts and back, labor-like pains in the abdo-
men as  if  the menses would make their appearance.
  Belladonna: Violent dragging towards  the sexual parts as
if every thing would issue from the abdomen, worse when
walking and sitting bent; she feels  easier  when sitting erect.
Bloating of the abdomen, followed by contraction of the same,
and by  discharge of white mucus from the vagina, violent
stitches  in the pubic region and the inner parts, at every step
she makes, (vaginitis.)
  Bryonia: Black,  hard  pustule  on  the  swollen  labium.
Swelling of the labia majora.  Increase of the discharge which
had been decreasing, (vulvitis.)
  Calcarea: Burning,  jerking leucorrhoea  previous  to  the
menses, flowing out like milk.   Smarting between the genital
organs arid thighs.   Pressure in the vagina, and tubercles on
the labium.
  Cannabis: Cutting between  the  labia during micturition.
The orifice of the urethra is closed with a  drop of pus.   Vio-
lent sexual desire with swelling of the vagina.   The discharge
causes a smarting of the parts which it  touches, (urethritis.)
  Cantharides: Copious, debilitating leucorrhoea, with pains
in the kidneys and a distressing feeling in the pelvis, accompa-
nied with a languid,  sallow complexion, depression of spirits, 
UTERITIS.
103
swelling of the neck of the uterus.   Burning and itching of
the pudendum, (chronic uteritis.)
   Chamomilla: Yellow, smarting leucorrhoea from the vagina.
Acrid, smarting,  watery discharge from  the  vagina, with
smarting, burning as if the parts were excoriated.
   Crocus: Leucorrhoea accompanied by paroxysms  of acute
stitches from the pudendum to the right thigh, as if a knife
were thrust into these parts every now and then, suddenly,
gradually penetrating into the parts, and with  increasing
pain.
   Graphites : Profuse leucorrhoea in the vagina and painful
pressing towards the pudendum.
   Ignatia:  Violent crampy pressure in the uterus,  followed
by purulent, corrosive leucorrhoea.  Chronic leucorrhoea with
excited sexual desire.  Swelling of the clitoris  with weakness
of the remaining  portion of the pudendum; coolness  of the
body, and uterine spasms.  (Chronic uteritis.)
   Kreasotum: Bloody,  flesh-colored,  yellow  or yellowish-
white, leucorrhoea, having a foul smell, especially early in the
morning, after rising.   Acrid discharge, with  itching of the
pudendum ; jerking, smarting pain in the external parts, and
weakness of the legs.   (Vagina, &c.)
   Lamium:  Copious  leucorrhoea, coming  off in drops, with
smarting in  the pudendum.
   Lycopodium:  Copious, bloody or milky leucorrhoea, coming
 off in paroxysms,  worse  before the full moon, with burning in
 the vagina.   (Vaginitis.)
   Mercurius solubilis: Mild  leucorrhoea, of  a pale, yellow
 color, and a sickly, sweetish odor.   Discharge of flocks, pus
 and mucus,  of the size of hazle nuts.  Purulent leucorrhoea,
 which does not drop, of a green color, causing a smarting in
 the anterior portions of the ptidendum,  which obliges  the
 patient  to  scratch, especially in  the  evening  and at night;
 the scratching is followed  by a violent burning.   Corrosive
 leucorrhoea with long, lasting itching of the labia, especially
 shortly before the menses.   Pressing in the pudendum, after
 which the patient has to void a quantity of urine.  Swelling 
104
UTERITIS.
of the follicles of the labia.  Swelling and inflammation of
the internal vagina, as if raw and sore.   (Vaginitis and vul-
vitis.)
  Mezereum: Albuminous  leucorrhoea.   Mucous  discharge
from the urethra and vagina.
  Natrum muriaticum:  Greenish leucorrhoea, passing off
profusely during a walk, with itching of the pudendum ; the
discharge is  preceded by  contractive colic, and a pressing
downwards.  Aversion to an embrace.  Discharge  of  blood
after an embrace, followed  by a feeling of ease, and finally,
irritable and peevish mood.   Painful pressing towards the
pudendum.
  Nux vomica: Painless discharge of yellow mucus from the
vagina.  Discharge of fetid  mucus from the vagina.  Burning
in the  pudendum, with violent sexual desire. Gnawing, itch-
ing eruption on the  pudendum.  Swelling of the inner vagina,
with burning pain, rendering contact intolerable.  (Vaginitis.)
  Phosphorus:  Leucorrhoea with stitches from the vagina to
the uterus.   Aversion to coit.   Leucorrhoea  instead of the
menstrual discharge ; milky leucorrhoea early in the  morning
when walking.   (Uteritis.)
  Platina: Leucorrhoea, with pinching in the  abdomen, fol-
lowed by pressing downwards in both groins, alternated by
pressure in the pudendum, and increased discharge of blood.
Painless, not disagreeable pressure in the lower portion of the
pudendum, preceded  by a voluptuous  tingling in the parts.
Painless sensitiveness, and  continual  pressure in the inner
parts, and in the region of the mons veneris, accompanied with
an almost unceasing  internal chill,  and feeling  of  coldness
externally to the hands.  Gnawing soreness, as  if excoriated,
on the left side of, and near the pudendum.  Voluptuous  ting-
ling in the pudendum, accompanied by a similar, though less
perceptible sensation;  oppressive anxiety and  palpitation of
the heart, followed  by a painless, not disagreeable pressure
in the pudendum, with a languid feeling, and stitches in the
fore part of the  head.  (Uteritis.)
  Pulsatilla: Painless leucorrhoea; discharge  of a  thickish 
UTERITIS.
105
milk-colored  mucus, which is especially perceptible on lying
down.  Milky leucorrhoea with swelling of the labia.  Leucor-
rhoea with burning pain.  Acrid, thin leucorrhoea.  Burning,
stinging pain in the labia  and vagina.   Cutting pain at the
os tincae.  (Vaginitis.)
   Sabina: Discharge of mucus and  blood  from the vagina,
with labor-like pains.  Sharp stitches in the posterior portion
of the vagina.   Habitual leucorrhoea of the consistence  of
starch,  yellowish, ichorous, fetid, accompanied  with painful
discharge of blood, almost every fortnight, having a foul smell
like old serum.   Copious, milky leucorrhoea, causing an  itch-
ing.  Itching of the sexual organs.  Increased sexual delight
during  coit.   Discharge of blood between  the  periods,  with
sexual excitement. (Vaginitis and vulvitis.)
   Sepia:  Leucorrhoea, with itching  in  the vagina.  Watery
leucorrhoea.   Discharge of blood after  an embrace, or  only
when walking.   Itching of the pudendum.
   Stannum:   Discharge  of  transparent  mucus  from  the
vagina, with  smarting.             *
   Mercurius  corrosivus:  Pale-yellow  discharge  from  the
vagina, of a  nauseous sweetish  smell.   Pressure  at the  os
tingae during coit.
   Sulphur:  Profuse leucorrhoea.   Smarting, burning,  thin
leucorrhoea,  especially  early in  the morning  after  rising.
Yellow, excoriating discharge  from the vagina, accompanied
with palpitation  of the heart and  heat in the face during
motion, and  followed by burning in  the abdomen.  Burning
of the external pudendum, accompanied by blisters.  Violent
itching of the clitoris.
   Thuja: Leucorrhoea from one period to the. other; it is
mild and  leaves yellowish-green stains on the linen.  Mucous
discharge  from the urethra.   Contractive and pressing pain
in the pudendum when  sitting or rising from a seat.  Smart-
ing pain in the pudendum as if the parts were sore, especially
during  micturition.  Stinging in the pudendum when walk-
ing.  Whitish ulcer on the  inside  of the labia majora, first
causing a pain as if sore when touching  it, afterwards itching. 
106     TRUE  VENEREAL OR  SYPHILITIC  DISEASES.

Swelling of both labia, with burning pain only when walking
or touching the parts.  Smarting and itching of the puden-
dum, principally in the urethra when voiding urine, and e"ven
afterwards.  (Urethritis and  vulvitis.)
   Zincum: Discharge of thick mucus, especially after stool.
Constant yawning, with pinching in the abdomen previous to
the discharge. Excited sexual desire, especially at night, with-
out lascivious dreams.  Terrible desire for self-gratification.

            True Venereal or Syphilitic Diseases.

   The essence of syphilitic diseases is as yet little known.
Pathologically we know that in its first stages it is an inflam-
mation of certain parts  of  the skin or mucous  membrane,
which runs  a course strikingly analogous to the  phenomena
caused by violent animal poisons,  such as  the poison of small
pox, dead bodies, etc.
   We have already stated that  the first symptoms of syphilitic
inflammation develope tffemselves  at the spot where the infec-
tious matter is first communicated to the organism.
   This inflammation consists in an inflammation of the folli-
cles, and in ulcerations  from which a lardaceous, contagious
matter is secreted.   At this stage the disease yields readily
to proper treatment.  If the parts round  the  ulcer have
already become hard, it is scarcely possible  to avoid a con-
stitutional disease.   Afterwards the inflammation spreads to
the next lymphatic  vessel and to  the  glands appertaining
thereto, and  in some cases,  produces a poisonous and infec-
tious secretion, even in  these  parts.  This is  the commence-
ment  of constitutional syphilis,  characterised  by  specific
inflammations of  the mucous  membrane  and the dermis in
remote parts, and, although  no longer capable of producing
contagious matter, yet still transmissible to the  succeeding
generation in congenital  syphilis.  This is  Ricord's view.
But Sigmund, of Vienna, and Waller, of Prague, have shown
that secondary syphilis is still able to infect  others, and to
develope in them  analogous phenomena.  It  is only at a later 
PRIMARY  SYPHILIS.
107
period that the syphilitic disease recedes from the dermis and
from the mucous membrane, and,  under the form of tertiary
syphilis, invades the  inner  tissues,  the fibrous membranes
and bones, where it manifests itself in the stage  of lentes-
cent inflammations, generally in  a circumscribed  space,  in
the shape of nodes, nodous excrescences, tophi, etc., form-
ing peculiar  and characteristic, but not contagious morbid
products.
   Accordingly,  considering the internal essence of syphilis,
we distinguish two  forms of this disease, 1, primary syphilis,
or the local  inflammation  produced by the  first and direct
tiction of the  contagious; and, 2, constitutional syphilis, where
the whole organism is under the  influence  of the  syphilitic
miasm, and  of which  we  again distinguish  two forms:  A,
secondary, and B, tertiary syphilis.

                     Primary Syphilis.
   Most  frequently  the syphilitic poison is  communicated
during coit, by the contact of a sound  part with one that is
diseased.  The infection takes place so much more readily as,
during this  sexual  orgasm,  the secretion of the  contagious
matter, and  its  absorption by  the healthy  organs, are con-
siderably increased.  In the majority of cases the primary
inflammation  affects the  mucous  membranes  of the sexual
organs, anus, mouth and  nipples.   It may  likewise occur in
the eye or nose, in consequence of syphilitic pus getting acci-
dentally to these parts.  The syphilitic poison may likewise be
transmitted to excoriated parts, wounds or sloughs.   Syphilitic
ulcerations are frequently seen in small wounds  on the fingers,
which happened to touch the  diseased organs of the  same indi-
vidual. Infection may take place  in dressing syphilitic ulcers
or  during  a  surgical  operation.   Sometimes  the  syphilitic
disease is communicated to the infant by the nursing mother,
and vice versa.  It may likewise be communicated during the
passage of the child through the vagina, or by kissing a per-
son, although in the latter  case,  the mouth  or tongue had
generally been infected by being  applied directly to the dis- 
108                PRIMARY  SYPHILIS.
eased organs.   The infectious matter may likewise be trans-
mitted by means of tumblers, glasses, spoons, tobacco-pipes,
syringes,  surgical instruments,  lancets,  water-closets, etc.
Prostitutes who do a large business, sometimes communicate
the disease without being themselves affected.  The poisonous
matter commingles with the vaginal mucus, without infecting
them, but is transmitted to  the next healthy customer.   By
washing  herself,  the  girl, whose  vaginal  mucous membrane
had  become thick and hardened by excessive use,  remains
free  from the disease.
  The principal forms of the primary syphilitic disease are
the primary ulcer or chancre, and the primarg inflammation
of the lymphatic vessels and glands in the neighborhood of the
chancre.

                        Chancre.
  From three to eight days after an impure coit or after con-
tagion has taken place, an  itching  and slight burning are
experienced at  the spot where  infection had taken place,
after which a small red spot comes  out, upon which a clear
vesicle of the size of a pin's head starts up, whose  contents
become turbid and purulent.   This vesicle breaks and gives
place to a small ulcer, with sharp, inverted edges; the open-
ing of the ulcer is narrower than  its base.  The place where
the ulcer is seated, is  somewhat hard and swollen.   The pus
is  grayish, bloody, and mixed up with remnants  of tissue.
Sometimes the  patients are not aware  of the trouble until
after the disease is completely developed.   This  is  particu-
larly the case with men who have  a  contracted prepuce, and
still  more with women  in whom the  infection first took place
in the vagina. A chancre may possibly develope itself on any
part of the body; it  is most frequently seated under the
glans, by the fraenulum, round the  corona glandis, on the
inner surface of the prepuce, on the  scrotum and at the anus,
less frequently in the urethra.  According to Professor  Sig-
mund's statement in the Vienna Mediz. Wochenschrift of the
12th of April, 1853, chancres in th^ urethra  are not near as 
CHANCRES.
109
uncommon as has been supposed.  Among 483  chancres, 47
were located in the urethra.   Chancres are likewise seen on
the lips, tongue, eye-lids, ears and fingers; in the female, on
the labia,  at the entrance of the vagina, in the interior of the
vagina, at the neck  of the  uterus, anus,  less frequently at
the nipples, lips, tongue, or in the buccal cavity.
   Taking the physiological and pathological character of the
chancre as a guide, we distinguish the superficial, indurated
and phagedenic primary syphilitic ulcer.
   The superficial  chancre  is confined to  the upper layer of
the skin, only a very small portion of its tissue being destroyed,
and the exudation round about being either entirely wanting
or only very trifling.
   The indurated  or  so-called  Hunterian chancre penetrates
through the whole thickness of the skin, the loss of substance
is quite considerable, and  a quantity of  matter is secreted
from the ulcer, which becomes  rapidly organized and forms
all around the ulcer a hard  node that can be  felt with  the
finger  and constitutes  the  principal characteristic  of  this
variety of the  disease.   It is  this variety of chancre which
is always  present in constitutional syphilis.
   The phagedenic or diphtheritic chancre is  principally de-
veloped in impoverished individuals who are at the same  time
affected with scrofula.  The ulcer is covered with  a  thick
gray layer of false  membranes, beneath  which the destruc-
tion of the tissues in  surface and depth goes on quite rapidly ;
the margins are thin, violet, brown, shaggy, rolled up;  the
secretion is thin, fetid; the cicatrization takes place much more
slowly, sometimes not till the ulcerative process has destroyed
a considerable extent of tissue by suppuration, both on  the
surface and in  depth; in some cases dangerous haemorrhage
even takes place.   The phagedenic  ulcer is  generally  very
painful;  on the other hand, the constitutional symptoms  are
very rare,  because the poison  seems to have  exhausted its
action by the violence of the local symptoms.   Supervening
buboes, if  ending  in suppuration, are disposed to assume the
same  character as the chancre. 
110
PRIMARY  SYPHILIS.
  In some cases the chancre becomes  gangrenous.   In such
a case  the destruction  of the tissues goes on at a rapid rate,
so that the whole glans is sometimes  destroyed  in  a short
period.  After the sloughing a simple ulcer remains which is
easily healed.
  The treatment must be conformable to the form of the
ulcer.  Whereas a simple chancre is sometimes cured in from
two to three weeks without any signs of constitutional syphi-
lis, the indurated chancre, even under  the most careful allo-
pathic  treatment, never gets well without symptoms of consti-
tutional syphilis supervening after five or six weeks of treat-
ment.  Under homoeopathic treatment, which may last from
six  to  eight weeks before a cure is  perfected,  the consti-
tutional disease  is generally prevented.  The treatment has
to be  continued until every trace of  induration has  disap-
peared.  The  ulcer  frequently heals without  the induration
having been entirely removed round the cicatrix; if this is
not accomplished to the last vestige,  constitutional syphilis
will pretty certainly develope itself.
  The treatment of the phagedenic chancre has likewise to
be continued for some time.
  In any variety of chancre the internal treatment has to be
accompanied with the utmost cleanliness.   The ulcer should
be kept  covered with  lint  dipped in  water, and should  be
repeatedly cleansed during the day.  A linen rag moistened
with cold water  may be placed on the ulcer, and the penis
wrapt up in a  linen bandage.  Moreover, the penis should be
supported by a  suspensory, to  prevent the pressure of the
blood,  by which  the cure would be  retarded.
  Among the remedies to be employed for the cure of chancre,
I mention particularly Acidum nitricum, the specific effect
of which has  scarcely ever  disappointed me.  I  have found
it particularly  indicated by the following conditions:  chancres
of the  orifice of the urethra, prepuce, margin  of the prepuce ;
chancres  with bloody,  fetid,  ichorous pus;  small chancres
without inflamed borders, with flat  edges ;  considerable swell-
ing of the  glans, of the meatus  urinarius, which are  of a 
CHANCRES.
Ill
dark-red color and puffed up; small vesicles in the meatus, on
the inner surface and margin  of the  prepuce, which  soon
break, suppurate and form  chancres ;  deep ulcer at the corona
glandis, with elevated, lead-colored, extremely sensitive edges ;
flat little ulcers at the  corona  glandis, which look  clean, but
secrete a strong-smelling matter; itching  of the prepuce and
damp places on its  inner  surface; burning of the inflamed
and swollen prepuce, the inside of which is denuded of the
epidermis and covered with small little ulcers, secreting an
ichor that has  a pungent, nauseous odor,  and stains the
linen like bloody pus;  simple  flat chancre in  the vagina, it is
covered with yellow pus and  burns and  itches;  and lastly,
inflammation of the vagina and labia majora.
   Accordingly, Acidum nitricum  will be  found particularly
adapted to simple chancre, chancre in the meatus  urinarius
and in the vagina.
   Arsenicum: Gangrenous ulcers with bloody edges, corro-
sive pus ; ulcers with copious secretion of watery, fetid ichor ;
painless  ulcers with hard  edges;  lardaceous, stinging chan-
crous ulcers  with white places in the middle  of the ulcer;
Gangrenous  chancre  on the  glans  and prepuce;  sudden
gangrene of  the penis.
   Accordingly Arsenicum  will be found  adapted  to phage-
denic, gangrenous chancres, and accordingly to the indurated
chancre  of Hunter.
   Argentum nitricum :  Little ulcers on the prepuce, the tips
of  which are at first covered with pus, and which gradually
spread  in  extent and become  covered  with  a  tallowy or
lardaceous substance ;  swelling  and knotty hardness of the
urethra,  inflammation  and  pains  in  the  urethra, priapism,
dysuria,  haematuria.   (Chancre in the urethra.)
   Aurum muriaticum:  Chancres of the  scrotum, with  fetid,
ichorous pus.
   Calcarea carbon: Chancres on  the lower surface of the
penis;  chancres with  burning pain, having  the form of
rhagades.
   Carbo vcg.: Readily bleeding chancres with secretion of
ichor. 
112
PRIMARY  SYPHILIS.
   Caustieum:  Chancres with acrid, corrosive pus or a watery,
greenish secretion, with jerking pain, developed out of little
blisters, complicated with  gout, scurvy and cutaneous  erup-
tions, disposition to fungous formations. (Phagedenic chancre.)
  Hepar sulphuris: Readily bleeding chancres with  larda-
ceous edges and fetid secretion.
  Iodine:  Florid chancres  with  raised  edges   that  are
more or less shaggy, watery  secretion.
  Mercurius solubilis: Red chancre on the prepuce; spread-
ing and deeply penetrating ulcers on the glans and prepuce;
pale-red vesicles on the glans and prepuce, forming  small
ulcers after breaking;  readily bleeding chancres; distress-
ingly painful chancres, secreting  a  quantity of yellowish-
white fetid pus;  small  chancres  with  a cheesy bottom,
inverted, red edges; inflamed round chancrous ulcers with
swelling of the vagina; chancres with edges resembling raw
flesh; not very painful ulcers, sensitive  to  the  contact of
linen ; vesicles  at the forepart and on the side  of  the  glans,
spreading  and  penetrating  more and more  ; ulcers of the
glans and prepuce with cheesy, lardaceous  bottom  and hard
edges; a number of  small red vesicles at the tip of the glans
behind the  prepuce, breaking after a  fortnight and forming
little  ulcers, which secrete a  strong-smelling, yellowish-white
matter that stains  the linen ; afterwards  the larger  ulcers
bleed and  are  painful when touched, from which the whole
body  was  sympathetically affected; they  were round, their
edges looked raw and the bottom of the ulcers was covered
with a cheesy matter.
  Mercurius corrosivus: Chancres with ichor adhering  to
the bottom of the ulcer so firmly that  it cannot be  removed
by  washing; ulcers  with thin pus,  leaving stains upon the
linen as from melted tallow.
  Staphysagria : Smarting vesicles on the  inside of  the labia
majora, painful when touched ;  chancres with  fetid ichor.
  Sulphur: Chancres with lardaceous white spots and secre-
tion of fetid ichor; ulcers  covered with  scurfs, and looking
like itch-sores; chancres on the prepuce, resembling excoria- 
BUBOES.
113
tion3;  superficial chancres as if the skin  were excoriated ;
red ulcers with lardaceous bottom here and there, lined  with
a thin  matter that can be  easily removed ;  violently itching
ulcers, impeding one's walk;  torpid  ulcers complicated with
scrofula, scurvy, gout and cutaneous eruptions.
  Thuja:  Vesicles on the glans; erosions on  the  inner sur-
face of the prepuce, which secrete a humor and suppurate;
red spots on the prepuce; granular spots on the outer surface
of the prepuce, which change to ulcers, become covered with
scurfs, itch and burn ; pustules on the inside of the prepuce,
depressed in the centre, secreting a humor  and suppurating,
painful only when touched.  Burning pain  at the  corona
glandis: flat, itching ulcers surrounded with redness,  with
stinging pain  and unclean bottom.   Whitish chancres  with
hard  edges.   Chancres  with shaggy edges  and lardaceous
bottom.   Chancres  with  sharply circumscribed edges, and
clean,  flesh-colored bottom. Chancres with thin, fetid ichor.
  During the treatment of  primary syphilitic ulcers,  the
diet should be  strictly conformable to the  principles  of
homoeopathic  practice.   Impoverished individuals afflicted
with phagedenic chancres, have  to use a nutritious  diet.
Cleanliness is indispensable in every case.


  Primary Inflammation of the Neighboring  Glands.
                         Buboes.
  The inflammation and suppuration of lymphatic glands is
generally the first symptom of the  infection  of the  general
organism by the syphilitic poison.  The inguinal glands, with
the surrounding cellular tissue, are generally those that first
become affected, inflamed, indurated and then pass into the
stage  of suppuration.  Such swellings  are  termed buboes.
They generally arise from the contagious pus of the primary
ulcer being absorbed by  the lymphatic vessels.   One or more,
even four weeks generally elapse before  the  bubo  begins to
develope itself, sometimes after the chancre is healed.  Buboes
in the  groin occur most  frequently when the chancre is seated 
114
primary  syphilis.
at the orifice of the urethra or on the fraenulum.  They like-
wise accompany chancres  seated on the scrotum, external
pudendum, in the vagina, on the neck of the uterus, on  the
mons veneris, on the  inner and upper surface of  the thighs,
on  the  nates and  rectum.  Buboes  occur rarely in both
groins at the same time; this only takes place when chancres
exist on both sides of the penis.
   Primary ulcers  of  the lower lip and  of the tongue give
sometimes  rise to buboes  under  the chin,  generally in  the
corner of the jaw;  chancres  on the upper lip give rise to
buboes at the same place, or in front of the ear ;  chancres of
the wings of the nose and eye-lids, have buboes directly in
front of the  meatus auditorius externus, at the place  where
the lobule  adjoins it, in some cases  above  the malar  bone ;
chancres of the nipples give rise to  swellings of the axilliary
glands ; chancres on the fingers result in glandular swellings
on the inner side of the elbow joint, and  in the  axilla.
   The cause of primary not constitutional  buboes is, as we
said before,  the  absorption  of  the  pus secreted from  the
primary ulcer.  Such buboes develope themselves much more
readily and frequently when  the primary affection is slight;
the secretion of  pus is scanty and the inflammation not very
acute.   The development of the bubo does not depend upon
the size of the chancre.
   A swelling of the  inguinal glands may  be induced by
external causes,  such as a cold, violent or fatiguing exertions
of the lower extremities during work or by excessive walking,
dancing, etc.  Persons  who have to stand a good  deal, are
likewise  liable to  the development  of buboes.  They may
likewise  arise from  an excessive  enjoyment  of sexual  inter-
course, from errors in diet.  Women are  generally less liable
to buboes than men.
   If buboes and  chancres co-exist, the invasion  of constitu-
tional syphilis may be pretty certainly depended upon.   This
is probably the  reason why  buboes  are  regarded  by many
physicians as signs of constitutional syphilis.
   We  distinguish  three forms  of  the  primary bubo,  cor- 
buboes.
115
responding  somewhat  to the three varieties  of chancre;
acute, inflamed buboes, which generally terminate in suppu-
ration, after which  the pus escapes  from under the skin ;
indolent  or indurated  buboes running  a long course, and
characterized  by organized  exudations, which do not readily
suppurate, and phagedenic buboes.
   These three varieties of buboes only correspond to the three
forms  of chancre in so far as this, that they run a similar
course; but they are not necessarily related in this manner
that indurated buboes accompany indurated chancres, or pha-
gedenic buboes phagedenic  chancres.   Any variety of bubo
may supervene with any form of chancre.
   The  acute  bubo  sets in with  symptoms  of very violent
inflammation ; the pain and the swelling of the glands increase
very  rapidly.   The  surrounding  cellular  tissue  becomes
infiltrated with the inflammatory exudation, forming a large
and hard wall around  the immovable gland.   Shortly after,
the skin  over the tumour  becomes hot, a slight  redness
developes  itself in the middle, it becomes shining and very
sensitive.   The motion of the lower limb is very painful, and
the patients frequently complain of a tearing and  stitching
pain in the whole thigh of  the affected side.   If the bubo is
not scattered, the suppurative process first developes itself in
 the cellular tissue round the gland.  The pus which developes
 itself  round the tumor, gives rise to an oval, soft swelling, in
 the centre of the tumour;  the gland itself still continues to
 remain hard.   Afterwards the suppuration  likewise invades
 the gland. When the tumour is on the point of breaking the
 skin becomes pale, of a bluish-red color.  A violent inflam-
 mation of the inguinal glands is  sometimes  accompanied by
 oedema  of the labia majora, or in both sexes by oedema of
 the abdomen and of the internal surface of the thighs.  ^ Gen-
 erally fever supervenes, the patients complain of pain in the
 extremities,  coated tongue,  full  and hard  pulse, headache,
 thirst, etc.   When the pus begins to form,  chills seti n.   If
 the suppuration is completed, the fever abates, the pains grow
 less, and  the  motions of the  limb become less painful.   The 
116
primary  syphilis.
pus escapes  in one  or more places, generally where the skin
is thinnest, nearest  the centre.   The openings have shaggy,
red margins.   The pus is of the consistence of cream, and
has a greenish, or dark yellow color.
  The indolent  bubo  appears  as  frequently after primary,
particularly after indurated chancres, as after  constitutional
chancres arising from mucous tubercles (plagues muqueuses).
This bubo runs a characteristically slow course,  and does not
begin to  grow until  the chancre  is healed.   This  growth
takes place very slowly; the bubo is very little painful, and
feels hard.  The  skin over the swelling  is not altered either
in color or temperature;  it is moveable  over  the  rugged
tumour.   When quiet  the patients  are  without pain ; it  is
only when walking  or  sitting with  the  thighs  considerably
bent, or when pressing  upon the tumour, that a tension  and
drawing  are  experienced.   These buboes  are  much  larger
than the former variety, and frequently remain unaltered for
months, especially in the case of men.  Signs of an increased
vital  action in the tumor  develope  themselves  very  slowly.
The  skin becomes  hot and the patients  experience slight
stitches.   [The  suppurative process,  however, only takes
place in a  portion  of the glandular  tumor.   Small,  soft
places corresponding  to  the  single glands,  and, with  an
indistinct fluctuation, gradually make their appearance ; the
skin over these parts is at first of  a bright-red color, which
afterwards, but slowly, changes to a blue-red.   If the tumor
breaks in such a place, only a small quantity of thin, floccu-
lent  pus is discharged.  The opening  seldom  increases  to
any  great extent;  it looks like an unequal, corroded ulcer
of the size of a bean, with a dark-yellow, or gray-red  rugged
bottom;  the skin is undermined much farther, but is  thinner
only  round the  edges; only  a small  quantity  of  a  thin
yellowish fluid escapes.  It scarely ever  happens that the
entire glands are  changed to  pus ; at the bottom  of the
ulcer they generally constitute an uneven surface traversed
by ridges.  Between and by the  side of the glands  fistuke
with  indurated edges develope themselves in various direc- 
BUBOES.
117
tions, and frequently lead  to  the  secretion  of considerable
quantities of pus.
  The phagedenic bubo, as soon as it assumes  the condition
of an  ulcer, has the same properties  in  regard to shape,
spreading  and  healing,  as the  phagedenic  chancre.   It
developes itself just as frequently after indurated chancre, as
in consequence  of the simple  spread  of  the  disorganizing
phagedenic  chancre.   The  external and internal causes of
the phagedenic bubo are the same  as those of the phagedenic
chancre.  It commences with  a violent, erysipelatous inflam-
mation of the skin, which spreads rapidly both  in extent and
depth.  The patients complain  of violent pain in the tumor,
acute fever, the pulse i3 small and rapid, thirst intense, tongue
coated, there is restlessness and sleeplessness.   The skin over
the tumor soon assumes a livid or  dirty-yellow, brown color,
becomes gangrenous, sloughs, and the phagadenic chancre is
completely developed.
  In regard to the syphilitic bubo, we have to  observe three
things:  1st, to prevent its  development (prophylactic treat-
ment) ;  2d.  Scattering  the  existing tumor;  3d.  Healing of
the ulcer after suppuration has set in and a discharge of pus
has taken place.
  The prophylactic treatment implies, 1st, as rapid a cure as
possible of the primary chancre; 2d, prevention of the break
ing out  of new chancres in the neighborhood of the  former;
3d, perfect rest of the diseased parts.
  The two other  conditions  of the treatment are met by one
or more of the  following remedies, which have to be chosen
in accordance with the symptoms:  Calcar. carb., Clematis,
Copaiv.,  Dulcam., Graphites,  Kali carb., Lycopod.,  Merc.
sol, Natr. carbon., Nat. mur., Nitric acid., Nux vom.,  Phos-
phor.,  Phosphoric  acid,  Pulsatilla,  Sulphur,  Terebinth.,
Thuja.
  (The  principal remedies  for buboes  are: Mercuriws, sol,
Kali hydriodicum, Silieea, Culcarea carb., Acidum nitricum,
Graphites, Thuja.
  Mercurius sol may be used  as soon  as the bubo begins 
118             CONSTITUTIONAL  SYPHILIS.
to form;  if it should not suffice to prevent the development
of the bubo, we may resort to
   Kali hydriodicum,  which may also be  used  alternately
with Mercurius.
   Calcarea and Graphites are suitable for chronic buboe3,
of a torpid character.
   Acidum nitricum, if Mercurius had remained ineffectual,
the bubo continues to increase in size, and there is danger of
suppuration setting in.
   Thuja may be useful, if the syphilitic symptoms were mixed
up with condylomatous excrescences on the penis or round the
anus.)
   This last named remedy is particularly indicated in inci-
pient inflammation of the  inguinal glands, characterized by
stitching, drawing and tension in the groin, and slight swell-
ing  of the  inguinal glands.   For indolent buboes,  Acid.
phosphor., Arsen., Con.  macul, Ignat. and Sepia have been
found most efficacious.

                  Constitutional Syphilis.
   This disease developes itself sooner or later after the appear-
ance of the chancre and the absorption of the syphilitic poi-
son by the organism.
   The first  signs of constitutional syphilis generally make
their appearance some six weeks after the first breaking out
of the primary chancre in the shape of syphilitic cutaneous
eruptions which are sometimes accompanied by ulceration of
the tonsils and mucous membrane of the fauces, or even by
syphilitic bone-pains.   At a  later period ulceration of the
laryngeal and nasal mucous membrane supervene.
   After the poison has been absorbed  by the constitution, its
contagious properties are gradually diminished and disappear
entirely after  the constitutional disease is fully developed.
In general, in proportion as the syphilitic disease penetrates
the organism, its original character frequently becomes altered
to such an extent  that  it is  frequently exceedingly difficult
to diagnose  the  disease  and to distinguish it  from  other 
CONSTITUTIONAL SYPHILIS.
119
 equally penetrating disorganizing diseases, such as scrofulosis,
 tuberculosis, etc.
   It does not always follow that primary syphilis must neces-
 sarily be followed by the constitutional disease.  According
 to  statistical results, among  a hundred males  affected  with
 disease, from  25 to 48 become  constitutionally  diseased;
 and among  a  hundred females, from 45 to 55.  Moreover,
 the longer and  the more copious the secretion  of pus  from
 the primary chancre, the more certain is the constitutional
 disease.
    Climate  and  season have  considerable  influence on the
 development of constitutional syphilis.  In  the  temperate   '
 zone it is a  general rule that the syphilitic eruptions are most
 frequent during the extremes of temperature, extreme cold
 or extreme  heat.  In the damp and  cold season, particularly
 in spring and late in the fall, affections of the buccal and
 pharyngeal  mucous membrane  are most  frequent.   Cold,
 derangements of the cutaneous action, changes of the weather,
 damp swellings, etc., favor the development of constitutional
 syphilis.  Want or starvation,  violent emotions',  errors  in
 diet, irritations  of the  intestinal mucous membrane by arti-
 ficial articles of food or drink, abuse of spirits, excessive eat-
 ing, want of exercise in the open air, fatiguing labor, forced
 marches,  war, bivouacking, etc., excite the syphilitic dys-
 crasia.
    On the contrary, the constitutional  disease  can be put  off
 for  a long  time by rest, warmth, good clothes, suitable diet.
 These circumstances likewise favor the cure of the constitu-
 tional malady.
    Although constitutional  syphilis occurs more  frequently
  among women  than  among men, yet  it runs  a more  rapid
  course  among the former.   Pregnancy has a peculiar effect
  upon syphilis.  During pregnancy, and particularly during
  the second period, new forms of the disease  scarcely ever
  make their appearance.  Existing forms of the  disease  either
~ disappear of themselves or  readily yield to treatment.  Even
  when left to nature, they do not get worse  until after  partu- 
120
CONSTITUTIONAL SYPHILIS.
rition.   This is particularly applicable as regards affections
of the mucous membranes, skin, bones, glands, etc.   Vegeta-
tions at the anus or sexual parts generally disappear  of them-
selves towards the end of pregnancy, but exercise a  so much
more pernicious influence upon the fetus.
   The signs of constitutional syphilis have a peculiar charac-
ter, and on this  account,  are justly  considered a specific
malady.  For  instance,  it  is characteristic of this  disease,
only to affect certain organs, and even parts of organs, prin-
cipally  the mucous membrane of the  mouth, fauces,  nose,
rectum  and sexual organs;  the skin and its appendages, the
sub-cutaneous  cellular tissue;  the  lymphatic system; the
muscles and tendons; the brain and its  membranes; the
periosteum and the bones; the iris; the testicles and ovaries;
the liver.
   The constitutional disease is moreover distinguished by its
form  and  color.   The eruptions are generally of  a  copper
color, rounded, disposed to form arched groups, or  simple
arches, rings,  or serpentine lines, and  giving  rise to  exuda-
tions which dry up and form crusts.  Another peculiarity of
the disease  is,  rarely to  affect  only one  organ or tissue, but
several tissues  at the same time-
   The skin and mucous membranes, and the lymphatic glands,
are the most frequent seats of the constitutional disease in all
its various forms, degrees and stages.
   The  development of  the constitutional  symptoms  takes
place in two successive periods, termed by Ricord secondary
and tertiary syphilis.
   Although these two forms of the  constitutional syphilis
are not separated by any distinct lines of  demarcation, yet
this distinction seems to  be  very convenient, and is very gene-
rally recognized by physicians.   These two forms sometimes
co-exist at one and the same period. 
SECONDARY  SYPHILIS.
121
                    Secondary Syphilis.
  In  some cases,  the  first signs  of constitutional syphilis
appear during the existence of the primary chancre, especially
the Hunterian or  indurated form; generally, however, they
break out a few months, and in a few rare cases, several years
after the primary disease.
   Careful observation would probably  show that the  first
absorption of the poison by the general organism is accompa-
nied by a feverish reaction, termed syphilitic eruptive fever.
Afterwards it assumes all sorts of syphilitic inflammations and
ulcerations, growths, indurations,  etc.   The mucous  mem-
branes  are first invaded by these derangements, particularly
the mucous membrane of the mouth, fauces, and the adjoining
parts; afterwards the mucous membranes of the labia pudendi
and vaginae,  or the outer skin  in the  shape of eruptions,
termed syphilides; and finally  the eye, especially the iris,
causing iritis syphilitica.
   The first development of  constitutional syphilis is frequently
announced by paleness of the patient, swelling  of the  lym-
phatic  glands, especially  on the neck,  shifting pains of  an
apparently rheumatic or  neuralgic character,  various  cuta-
neous eruptions peculiar  to syphilis, falling off  of the  hair,
 iritis and febrile motions.
   This peculiar eruptive fever, generally precedes with  more
 or less  distinctness, the appearance of constitutional affections
 of the skin  and mucous  membranes.  The first sign  of a
 general  infection  of the organism is  a  feeling of  malaise
 throughout the body.   Aftenvards, a very violent headache
 is experienced, in  the  forehead, occiput, and sometimes over
 the whole head.   The patient complains of an aching,  burn-
 ing,  stinging pain, or a  pain  as if  the  head were  pressed
 together with an iron band, or split in two.  The pain becomes
 more and more intolerable, and a  variety of other symptoms
 supervenes, such as  heaviness and tearing in the shoulders,
 forearms, small of the back, legs and knees, excessive languor,
 restlessness,  sleeplessness, coated tongue, thirst, constipation, 
122               SECONDARY  SYPHILIS.
 hot  skin which is  constantly covered with a little  moisture,
 quick  and rapid pulse; the urine deposits a sediment.  The
 cervical glands  commence to swell.   The  cicatrices of the
 primary ulcers become darker, sensitive, they swell and grow
 larger and harder.  In bed the pains either diminish or dis-
 appear altogether, particularly after the appearance of the
 constitutional symptoms.   Recently Sigmund observed that
 the  first  appearance  of  the eruptive  fever is frequently
 attended with symptoms of jaundice, which seem to be refer-
 able to the ulterior development of the liver affection.

   I.  Syphilitic diseases of the Mucous Membranes.
   These diseases either appear in the  form of erythema and
 erosions of the mucous membrane of the mouth,  fauces, nasal
 cavity and sexual  organs, or  in  the shape of little blotches,
flat  tubercles (mucous  tubercles) of  these  membranes,  or
 finally, as deep-seated tubercles and ulcerous excavations of
 the same.

  Syphilitic  Erythemata   and Erosions of the Mucous
                       Membranes.
   These eruptions occur  most  frequently  on  the mucous
 membrane  of the  mouth  and fauces.   They constitute iso-
lated,  circumscribed,  dark-red or  copper-colored,  not  very
 elevated, inflamed spots  or  streaks  on the  mucous  mem-
brane,  especially on that  of  the  soft  palate, tonsils, uvula,
pharynx and larynx.   The  buccal cavity and the fauces
become hot, a difficulty of swallowing  and a burning sensa-
tion  in the fauces; hoarseness and pain when  talking are
experienced, the  patient coughs and hawks, the voice becomes
snuffling or jarring,  the mouth  and throat feel dry.  The
inner surface  of the lips and cheeks, the palate, tonsils, uvula,
the posterior  surface of  the  pharynx, look bluish-red, the
follicles are swollen and engorged with blood.  In the centre
of the  intensely-red spots  we  discover smaller insulated spots
of a grayish-white color, which, upon close  examination, are
found to be erosions. 
SYPHILITIC ERYTHEMATA.             123
  Similar derangements  are perceived on the mucous mem-
brane of the nasal cavity and of the sexual organs.  The nose
seems at first  affected  as in common catarrh, but the symp-
toms  are  really precursors  of  mucous  tubercles, or the so
called plaques muqueuses.  On  the internal layer of the pre-
puce, in the furrow behind the glans and round the meatus
urinarius, these tubercles generally form small rounded ero-
sions upon  a  bright copper-colored base, and flat margins
gradually disappearing  in the surrounding  membrane, and
secreting  a grayish, purulent, fetid fluid.  Similar phenomena
are seen  on the  mucous membranes of the  pudendum.  In
both sexes these erosions give rise to the formation of condy-
lomata.   At the anus,  rhagades  with  a  lardaceous bottom
frequently develope themselves.
   Among the remedies which are particularly adapted to this
form of the syphilitic disease, the  following are to be noticed:
Aconite, (also during the eruptive fever,) Anacardium, Arsen.,
Bellad., Aurum  mur.,  Bryon.,  Calcarea carbon., Cannab.,
Canthar., Copaiv., Crot.,Mercur. sol, Mercur. corros., Natrum
carbon., Nitri. acid,  Nux vom., Pulsat., Sulphur, Thuja.
Recently I have used Anthrakokali with advantage.
   [Acidum nitricum is an excellent medicine in this affection,
especially if the spots are dark-colored and disposed to bleed.
   Mercurius  sol. and corros.,  more particularly if no  mer-
curial preparations had as yet been employed.
   Aurum mur., if the syphilitic disease is complicated with
symptoms of mercurial poisoning, in which case,
   Sulphur may likewise prove serviceable, also Hepar sul-
phuris.
   Arsenic will help, if gangrenous symptoms set in, or bad-
looking scurfs cover the  spots.
   Kali hydriodicum is a most useful agent if  the eruption
shows a tendency to ulceration.] 
124
secondary  syphilis.
          3Iucous Tubercles, Plaques Muqueuses.
  These occur most frequently in females and children; in
men they are less frequently noticed on the sexual organs
and at the anus ; in both sexes they develope themselves most
frequently on the mucous membranes of the mouth and fauces.
These mucous tubercles being still possessed of contagious
properties and capable of developing by their secretion chan-
crous ulcers, they were for a long time looked upon as symp-
toms of primary syphilis.
  They consist in flat, circumscribed elevations of the mucous
membrane, which, together with its  follicles and the sub-
mucous   cellular  tissue,  is  engorged and  thickened,  and
secretes  a tenacious, purulent exudation of a peculiar and
extremely offensive odor.   Their size varies from that of a
millet-seed to the size of a dime.  Sometimes several of them
unite, forming irregularly-shaped, vaulted flakes. The smaller
ones have altogether a tuberculoid shape, are generally very
humid,  regularly rounded,  forming  truncated  cones, of a
brighter redness  in the centre than at the margin, and fre-
quently  are  united  in groups or regularly-shaped  rings,
especially on the glans, the  inner  surface of the cheeks and
lips, the curtain  of the palate, tongue, and at the roof of the
mouth.   The  surrounding  parts have a  bluish-red, or bright
copper color'.
   The  large  tubercles are raised about a line  above the
mucous  membrane, and either constitute perfectly round or
more or less  regularly oval, full, tense,  and, on their upper
surface, flattened elevations of the mucous membrane.  Their
color is a bright-red.  On their surface they are covered with
a thick, grayish-white layer of epithelium.
   As we stated  above, the  mucous tubercles  are rarely seen
on the sexual organs of the male, and generally only singly
or in ring-shaped groups.  They appear much more frequently
on the female parts,  the labia majora  and  minora,  at  the
entrance of the vagina, on  the upper portion of the interior
vagina, and  even on the vaginal  portion of the uterus.  At 
mucous tubercles.
125
the outer pudendum they occur either isolatedly or in crowds.
Flat tubercles are likewise seen very frequently at the anus,
even in children who had been abused for nefarious purposes.
   The most destructive action of these tubercles takes place
in the Schneiderian membrane.    On account of the itching
which they cause in  this part, the crusts  are scratched off,
which gives  rise to more obstinate  ulcerations  than in any
other  part.  In many cases  a portion of the wings of the
nose is destroyed, which  leaves  a  rugged surface  and the
Schneiderian membrane exposed.
   If mucous tubercles develope themselves in the interior of
the nose, the first symptoms are those of a catarrh which,
however, last much  longer  than  usual.   A tickling  and
burning in the  nose  are  experienced, and a watery fluid  is
secreted in great quantity;  gradually a sensation supervenes
as though  it were difficult for the  air to pass  through the
nose.  The patients fancy the nose is full of mucus, and they
blow  it quite  frequently.   The whole mucous membrane
becomes red, the faculty of smell  is  either diminished or
arrested.   Soon the tubercles  ulcerate and become  covered
with  a hard crust  of  irregular  shape,  varied thickness,
reddish-brown color,  and consisting of dried  nasal mucus,
blood and  disorganized exudations.  If proper means are not
speedily and vigorously brought  to  bear upon this affection,
the ulcers  increase in size,  grow larger and deeper, destroy
the mucous membrane and  the subjacent cellular tissue, per-
forate  the septum and cause caries or necrosis  of the nasal
bones, cartilages, cribriform  plate, etc.  A quantity of fetid,
greenish,   bloody  pus is  discharged from the nose, (ozaena
syphilitica;) the cartilages,  upper jaw, vomer and the inner
parts  of the nose  become  invaded, disorganised,  the hard
palate  is perforated,  the nose disfigured, the speech becomes
indistinct.    The  destructive process  which is going on in
these  spongy bones, may extend  to other  parts  of  the head
and vertebrae, and life may  become endangered.
   The following remedies have been found particularly useful
for this affection :— 
126               SECONDARY  SYPHILIS.
  Acid nitricum, Argent, nitr., Bryon., Calcar., Ignat., Pul-
sat., Rhus tox., Thuja.   If the tubercles  are seated in the
nose, the following medicines will be found most efficacious :—
  Acidum nitr., Acid, phosphor., Argent, nitr., Calcar. carb.,
Kali carb., Kreasot., Lycop., Mercur. corros., Pulsat., Rhus-
tox., Sepia, Staphys., Sassapar., Thuja.
  [Among these remedies the most important are undoubtedly
the mercurial preparations, and  if mercury had been  used
previously, and the symptoms are complicated with symptoms
of mercurial  poisoning, we may resort to Acidum nitricum,
Aurum muriaticum,  Kali hydriodicum and  Sepia, in the
order in which these remedies are here mentioned.]

Deep-seated tubercles and ulcerous excavations of the mucous
                       membranes.
  These ulcerations  are almost always preceded by a tuber-
culous  thickening  of the mucous membrane and the submu-
cous cellular  tissue.   The  ulcers always penetrate to a con-
siderable  depth, destroy the mucous  membrane  throughout
with great rapidity, and sometimes invade even the subjacent
tissues.   The ulcers are either isolated or in groups, rounded,
and have sharply circumscribed, unequal, vaulted, pad shaped,
and  sometimes undermined margins.   The bottom of the
ulcers is frequently  dotted with  granulations, and  like the
margins, covered with a grayish or yellow, creamy, papescent,
thick exudation.
  These ulcerations occur principally in the neighborhood  of
the fraenulum and on both sides  of the  glans.    They  may
perforate  the lower wall  of the urethra,  causing urinary fis-
tulae and strictures.   At the female pudendum they are
generally seated at  the  entrance  of  the vagina, the lower
commissure, in the rugae of the vagina, and on the vaginal
portion of the uterus.   On these parts they are apt to  form
abscesses which, if neglected, perforate the whole thickness of
the vagina, spreading to the rectum and urethra, and causing
recto-vaginal or urethro-vaginal fistulae.
   These ulcers occur moreover on the gums, in the nose, on 
                        BYPHILIDES.                    127

the tonsils, at the curtain of the palate, on the posterior wall
of the fauces, at the epiglottis and  in  the  larynx, causing
more or less  extensive  disorganizations  in these parts, and
frequently terminating fatally.
   The remedies  which have been mentioned  above for other
forms of secondary syphilis, will, especially at the commence-
ment, be found useful in  this disease, if chosen with reference
to the symptoms.
   If the destructive process should  have invaded the fauces
and larynx, we may add the following remedies to the above
mentioned list:—Arsenic,  Carbo veg., Natrum mur., and
Zinc. oxyd.

II.  Syphilitic  exanthems,  Syphilides,  Exanthemata
                      SYPHILITICA.
   The skin being a favorite seat of constitutional syphilis, it
is not to be wondered that it should develope upon this organ
a scries of diversified morbid processes and eruptions  which,
for convenience of treatment, require to be distinguished into
particular  classes.   We  shall adopt the  classification  of
the distinguished dermatologist Hebra, which, resting  upon a
pathologico-anatomical basis, is on this account to be  consid-
ered the most expedient  and useful.
   Syphilitic eruptions have the general features of all  other
exanthems, but they occur principally in the  shape of spots,
pimples, tubercles, and  fig warts.   Sometimes they bear a
striking  resemblance to particular eruptions, such as measles,
rubeolas,  varicellas,  lichen, psoriasis, variola,  etc.  In  this
case they may be distinguished by the following signs from
similar non-syphilitic diseases : The syphilides run  a charac-
teristically slow but uninterrupted course  which nothing can
arrest.  In most cases they come out in a definite number of
efflorescences, and this number remains  unchanged in their
ulterior developments.  Subsequent  efflorescences appear  at
the  same places where  the former  ones  had  dried up.
Syphiloid eruptions are  liable to  relapses,  but they always
reappear  at  the same  places.   Their color  is brown-red, 
128
SECONDARY  SYPHILIS.
resembling  the color of  copper  or raw ham.   Professor
Hebra does not look upon this brown color as a characteristic
sign of syphiloid eruptions.  According to his opinion, this
brown color arises from the  frequent  recurrence of  these
effloresences at the same places and the depositions of pigment
which  always  accompany the  eruptions.  From  a similar
cause,  other non-syphilitic eruptions might exhibit a similar
color, and this is indeed the case.  The color of  syphilides
need not always be brown-red; if the pigment is yellow, the
color of the eruption may be a  mixture of yellow and red.
It is a eertain fact, however, that the color of syphiloid erup-
tions is always characterised by a  sickly or dubious  appear-
ance, a sort of morbid discoloration.   The color alone  would
not be a safe guide of diagnosis, but in  conjunction with the
other signs, it becomes an important  symptom.
   In regard to form, syphiloid  eruptions prefer  a  circular
shape.  In the case of ulcerated eruptions of this class, the
circular form is truly characteristic;  first, they are  kidney-
shaped,  and  gradually assume  a semi-lunar,  and finally a
semi-circular form.
   Another  peculiarity of  syphilitic cutaneous  diseases  is
this, that they form  crusts in preference to  scales.  Such
scales  are generally thinner and drier than in non-syphilitic
diseases.   The crusts, on the contrary, are generally  thick,
large  and  deeply penetrating, and closely adhering  to  the
subjacent parts. New crusts continuing  to be added from day
to day to the former layer, they gradually acquire an  extra-
ordinary thickness  as in rupia.  Syphiloid eruptions prefer
such parts of the skin as are without adipose tissue, such as
the head, forehead, (corona venerea,) occiput, nose, tibia; as
a general rule  they develope themselves on parts where other
non-syphilitic  eruptions are  scarcely  ever  noticed.  They
become visible in the cold, and disappear during the warmth,
particularly the  roseola syphilitica.   This is  the contrary
with  non-syphilitic eruptions, which generally come out  in
warmth and disappear in the cold.  Syphiloid eruptions  do not
itch;  this is  another of their  peculiar  characteristics, and 
MACULE.                     129
reveals  the  syphilitic  character  of  many eruptions which
might otherwise  pass for non-syphilitic.   These eruptions
constitute the first  series of secundary syphilitic symptoms,
and are sometimes accompanied by ulceration of the tonsils
and pharyngeal mucous membrane, and in a few cases by bone-
pains.   Afterwards ulcerations of the  laryngeal and nasal
mucous membranes supervene.
  As regards the classification of syphilides, the former method
of arranging them under distinct heads with reference to their
original  or  typical forms, is exceedingly inconvenient and
impracticable; for these forms generally run into one another,
and  it frequently happens that several of them co-exist.
  Hebra views the various forms of syphilides as certain stages
of the syphilitic  disease upon the skin;  generally  it first
appears  in the shape of spots;  afterwards  it assumes  the
tuberculoid, then the squamous, fymatous, and other forms.
According to Hebra,  there are four or five positive periods
during which the various forms of the syphiloid cutaneous
disease gradually develope themselves.
  Consequently we  divide syphilides into
  Erythemata (maculse, syphilis cutanea maculosa ;
  Syphilis cutanea  nodosa;
  Syphilis cutanea  squamosa, psoriasis ;
  Syph. cutan. papulosa;
  Syphil. pustulosa, vesicles, blisters  pustules;
  Rupia syphilitica,  crusts ;
  Condylomata ;
  Syphilitic  affections of the hair  and nails ;


                 Maculse, spots, ephelides.
  This form  is the  most frequent  and comes out  first.  The
spots are separate,  bright red, sometimes, however, they are
very pale and only come out in the  cold.   Sometimes they
are raised like blotches.  Most ordinarily they appear on the
chest, neck, face, arms,  and in some  cases on the inner side
of the thighs, and in the neighborhood of .the sexual  organs; 
130
SECONDARY  SYPHILIS.
other parts of the body are likewise  liable to becoming the
seats of these spots.
  Not unfrequently they are  accompanied by difficulty  of
swallowing, burning and dryness of the throat.   They are
distinguished from non-syphilitic spots, such as  measles  or
rubeolae, by this, that these non-syphilitic eruptions never
become chronic, and generally disappear again after a period
of from .four to eight days.   If the eruptions last longer, we
may safely look upon them as syphilitic, roseola syphilitica.
  This  eruption  runs  a slow course, it is true, but never  of
five or six months; for previous  to this  it takes  the form  of
tuberculoid  syphilis.   At certain periods,  after   eating, for
instance, the spots grow larger.   After having stood for some
time, they generally grow paler, and  the  red color  usually
assumes a dirty gray, or gray-red tint.

Syphilitic cutaneous tubercles, flat tubercles or condylomata.
  These tubercles  are  either single and incoherent, or else
they form circular lines, or finally, they appear in groups  or
clusters.  Very  frequently  they  appear in  company  with
mucous tubercles,' principally  on the  scrotum, penis, mons
veneris, in the inguinal folds,  on the  perinaeum,  round the
anus, on the inside of the thighs, on the nape ef the neck,  in
the axillae, on the hairy scalp, in  the face, round  the mouth,
on the wings of the nose, on the  forehead,  between the toes,
and along the nails.  As a general rule, they only come out
in one or the other of these places, only in a very few cases
over the whole body.   I have only seen one  case of this kind,
at Professor Hebra's clinique for  cutaneous  diseases.
  The secretion which is discharged  by these tubercles,  con-
tinues in most cases contagious, not only for others, but also
for the adjoining portions of the  skin and mucous membrane
of the patient himself.   Generally they are of a bright copper-
red color, and almost always painless.   They develope them-
selves  slowly and remain unaltered for a  long  time.   Not
unfrequently an ulcer  forms on  the surface of the tubercle,
which becomes  covered with a hard crust that leaves a deep 
SQUAMiE.—LICHEN.
131
 cicatrix after  falling off.   If the  tubercles do not ulcerate,
 they usually become depressed and  flat, and assume a scaly
 form.

            Squamous syphilis, scales, psoriasis.
   Generally, this form arises from the tuberculoid form,  and
 sometimes from the spots.  The tubercles pass into large,
 irregularly-shaped, and sometimes confluent elevations of a
 bright  copper color; they are covered  with hard, readily-
 tearing scales, of a  dull white color.  As the  disease  pro-
 gresses, the eruption loses its bright color, and only the scales
 remain.  This usually takes place  in  the  face, in the hollow
 of the hand (psoriasis palmaris), and  on the soles of the  feet
 (psoriasis plantaris.)   In the palm of tin hand the  patient
 first sees brown-red spots ;  after a while, while washing him-
 self, the patient imagines he observes callous risings above
 these spots.   These risings are  scratched  off by  the patient;
 they come off  in the shape of scales, after a while the livid
 spots and risings return, are scratched off a second time, after
 which rhagades and  then ulcers form.  Ulcers are very  apt
 to arise from any form of syphilitic efflorescences.

                      Papulse,  lichen.
   We distinguish large and small papulae.   The small papulae
 constitute miliary, acuminated, hard  elevations on the skin,
 which are disposed  to pass into  suppuration  or  to assume
 the form of acne syplilitica.  These papulae generally form
 round, circular or arched groups of a bright-red copper color,
 and frequently come out in innumerable quantity.   The erup-
 tion of the papulae is  almost always preceded by  fever.  The
 exanthem may develope itself on every part of the  body,  but
 it  appears most frequently on the  extremities, back, nape of
the neck, shoulders, on the  parts adjoining the sexual parts,
 and  on the lower surface of the penis, less frequently in  the
face and on the neck.
   The large papulae  appear most frequently on the extremi-
ties,  shoulders, nape  of the neck, chest, forehead and  hairy 
132
SECONDARY  SYPHILIS.
scalp;  sometimes  on all these parts at one and  the  same
period.   Generally it remains  unaltered for several months.
Unless  arrested  by proper  treatment,  the eruption keeps
renewing  itself constantly.  Previous to the appearance  of
the papulre, small, reddish-yellow spots of a regularly round
shape  appear upon the skin, either singly, scattered over a
large space, or, more rarely in clusters.   Upon these spots
start up slowly and in a perpendicular direction, acuminated,
hard, globular, lenticular callosities, from one to two lines in
diameter, and of a bright copper color.  Soon they reach the
size of  a  pea, and are so closely crowded together that the
place where  they are located  constitutes  an elevation upon
the  skin.   In  some cases they constitute rings  of various
sizes raised above the skin, and generally of a rounded shape.
The open sides of the adjoining rings are sometimes in oppo-
site directions, so that, if the terminal points of the lines com-
municate, a  serpentine or wave-line is  formed.   Sometimes
the papulae form scales, under which ulcers are seldom wit-
nessed.
   The large papulae are  frequently accompanied  by ulcers in
the fauces, inflammation of the iris, papulous eruptions on the
mucous membranes of the sexual organs, especially the mucous
membrane of the glans.

         Syphilitic pustules, vesicles, blisters, bullse.
   Syphilitic vesicles  are an extremely rare disease; among
1000 cases scarcely one  occurs.  Prof. Hebra  who is at the
head of one of the most  extensive cliniques  of Europe for
cutaneous diseases, has  never  yet  seen such  a  case.   This
impartial observer maintains that herpes is never of syphilitic
origin; a syphilitic  eczema would not  cause any itching,
and would  gradually  terminate  in  ulceration; but  every
eczema does cause an itching,  hence it  cannot be syphilitic.
At all events the existence of this form is doubtful.
   This remark does not  apply to  the other syphilides with
liquid exudations, such as syphilitic pustules,  bullae, blisters,
pemphigus, ecthyma and impetigo pustulo-crustacea. 
BULLAE.
133
  Syphilitic  pustules  take the form of  acne syphilitica  in
young, robust,  plethoric persons, while the parts surrounding
the pustules are  of an  intensely bright-red color, and the
Becretion  of  pus takes place more rapidly.  The  larger pus-
tules, with a pit in the centre, marked by a small, black, dry-
ing-up point, can  scarcely be distinguished from variola, and
are on this account  termed variola syphilitica.   In children
who were infected by their nurses, they came out in the face,
on  the abdomen  and thighs, in the shape of  a superficial
ecthyma.  They soon break in these cases, forming bright-
yellow loosely adhering crusts. In old or young  impoverished
constitutions the  pustules develope themselves very slowly,
every  single pustule being surrounded by a light  blue-red,
livid tint.
   Syphilitic pustules are very apt to occur after other syphi-
lides, such as papulae or tubercles.
   Syphilitic variola is distinguished from genuine variola  by
this, that the former keeps breaking out anew in successive
intervals; that the crusts do not fall off at one  and  the same
period, and that  this process lasts longer than  in common
variola.   Except this, the pustules have the same shape and
size, and  cover the  same parts  of the body, as the common
variola.   They break out and  run their course without any
fever.   In some  cases, however, the pustules  are  so large
that they cannot be mistaken for small-pox.
   Syphilitic varicella  appears  most frequently in  the face,
on the abdomen, on the inner side of the thighs, and on the
legs, less frequently on the arms.   This eruption is generally
preceded by a violent fever,  on which   account  it  might
readily be confounded with varicella.   After the fever has
lasted two or three  days, spots  break out on several parts of
the body in succession ; they are  round, of a pale-red, seldom
of a bright-copper  color, and soon are raised above the skin
throughout their whole extent,  and, in their interior, contain
a bright-yellow of whitish fluid. 'Afterwards a copper-colored
circular areola forms around the pustules.
   The syphilitic pemphigus is generally noticed in children, 
134               SECONDARY SYPHILIS.
                                                        «
less frequently in full-grown persons.  It is composed of blis-
ters of the size of beans, and of  an irregular shape.   These
blisters generally break, leaving  ulcers which, by the matter
which continues to  exude, and by a want of cleanliness, form
crusts that frequently increase to an enormous size and con-
stitute the rupia syphilitica.   It is not necessarily the case,
however,  for  every  rupia  to be  preceded  by pemphigus.
The rupia may come on after any syphilitic ulcer.  Accord-
ing to  Hebra,  the pemphigus of  new-born  infants is not
necessarily syphilitic.  He  maintains  that pemphigus is a
disease  sui generis, that  it breaks  out in  other parts than
those which are generally selected  by the  syphilitic disease,'
and that  it attacks mostly small children who die from its
effects.   Successive breakings  out  do  not  take place in the
case of pemphigus;  in some cases  ulcers  appear  after the
blisters, in other cases they  are wanting.  The  pemphigus
of new-born infants always contains gae'lic acid according to
Dr. Schottin; that  of full-grown  persons never contains any.
  Pemphigus  is generally seated on  the  sexual  organs, on
the abdomen and extremities, less frequently in the palms of
the hands and on the soles  of the  feet.   It breaks out  in
superficial, bloch-shaped risings of the skin, of a bright cop-
per color; the blisters  are  surrounded by a copper-colored
or violet areola, and always leave yellow, transparent  crusts
behind.
  The next variety, impetigo pustulo-crustacea, is  frequently
seen accompanied with affections  of the mucous membrane  of
the nose and mouth.  The pustules are crowded together  in
large numbers, and  run into one  another.  Thick,  large
crusts form, with ulcers underneath that secrete a tolerably
large quantity of pus, and leave large scattered  cicatrices.
They mostly appear on  the  chest, neck, in the face, at the
eyebrows  and  on the forehead.   The pustules are  preceded
by  a  more or  less  bright  redness;  after  a while small,
rounded, purulent tips become visible  in  close proximity to
each other and running  into each other the more rapidly the
more  the  skin is inflamed.   The pustules which  are  filled 
RUPIA.                      135
with the purulent secretion, soon break,  the discharged pus
dries up to one or more greenish crusts  of large  size, thick,
not  much raised  above the skin, surrounded by a  copper-
colored areola and yielding to the pressure of the finger.
   The ecthyma is characterised by larger  pustules  than the
former.  The pustules are circular, conical, from three to four
lines in  diameter, and containing a thick,  green-yellow pus.
The areola which surrounds the pustules, is  of a  striking
copper-color, but not very hard.  The pustules soon break,
and become  covered with a brown, rounded, loosely-adhering
crust of uniform thickness, under which a superficial ulcer is
seated.  The ecthyma is mostly found on the hairy scalp, on
the parts round the  mouth and on  the forearms, but it may
likewise break out on any other part of the body, and spread
over a considerable  extent of  surface.  If the ecthymatous
pustules are very large, oval, they form a transition link with
the next following eruption, rupia syphilitica.

                    Rupia Syphilitica.
   The rupia frequently arises  from pemphigus or ecthyma,
but it  may likewise  break out without any of these forms
preceding it.  In the former case it arises  from blisters of a
regularly round shape, of  the  size of  beans, not very tense,
and surrounded by a copper-colored areola; they stand upon
a  swollen, indurated basis, and contain a dark-yellow,  puru-
lent  fluid, which changes to a brownish color.   The pus dries
up in the middle of the blister, and forms a small brown crust.
Round the crust the  epidermis  likewise rises in blisters filled
with a similar  brownish-red, purulent fluid;  these  likewise
dry up, thus  enlarging the  crust in extent, whilst its enlarge-
ment in  depth  is  promoted  by the  drying up  of  the recent
exudations in the interior of the pustules; by this means the
crust gradually acquires a conical or pyramidal shape.   The
crusts sometimes  increase to an  extraordinary size, but they
are not  very numerous; there are  at most from twelve to
twenty crusts scattered  over the whole  body.   They run a
very slow course,  and, on  account  of the secretion of pus 
136
SECONDARY  SYPHILIS.
which  is continually  going on under the crusts, undermine
the patient's constitution, so that, after a while, the patients
grow so feeble, that they are scarcely able to walk, the diges-
tive functions  are impaired,  and  a supervening  diarrhoea
hastens the final dissolution of the patient.
   The serpiginous and  perforating tubercles are related to
this form of syphilides.  Either of the former eruptions is
greatly disposed to destroy the  tissue of the  skin.  Either
commences  with  nodous swellings  extending into  the sub-
cutaneous  cellular tissue.  The  serpiginous  tubercles  are
large,  hard, and  have a pretty regular, round  shape.  Per-
forating tubercles only exist in small number, forming spheroi-
dal risings on the  skin, and penetrating to the sub-cutaneous
cellular tissue, where  they can be felt with the finger as hard
tumors.
   Serpiginous tubercles occur most frequently in the face, on
the nape of the neck, on  the head, forehead, shoulders  and
trunk, less frequently on the rest of the body, but never on
the borders or soles of the feet.  By successive growth they
may gradually spread over a large portion of the surface of
a part or of one  side of the trunk.   Serpiginous  tubercles
have  at first  a bright  copper-color  and  a  shining surface,
which  is never covered with scales.  Afterwards they become
inflamed, ulcers form  at their  tips and become covered with
a  thick, hard, conical,  brownish  or yellowish-gray,  firmly-
adhering crust. If the crust is detached, we discover a super-
ficial ulcer with a  grayish bottom, which is  speedily covered
with a new, softer, and less dark-colored crust.
   The perforating tubercles occur most frequently in scrofu-
lous individuals with a delicate, white  skin, generally  in the
face, on the cheeks, round the nose and lips, in front  of the
ear, on the legs, and  also on other parts of the  body.
   Both these forms of tubercles are greatly disposed to passing
into the form of ulcers;  those arising from perforating tuber-
cles frequently destroy the skin entirely.
   In few cases the perforating tubercles appear on  the nasal
wings  and  lips in groups of several  crowded together;  this 
CONDYLOMATA.
137
causes the surrounding parts to swell, and imparts to the
ulcer the appearance of lupus or cancer, with which they are
frequently confounded.  These  two eruptions  are the  most
dilatory in  breaking out  after  the primary syphilis; some-
times six, eight, ten and more years elapse before they make
their appearance.


Condylomata syphilitica, papules muqueuses, (Ricord,) tuber-
   cules syphilitiques plates, (Rayer,) pustules plates,  (Cul-
   lerier,) figwarts.

   The original  nature of  condylomata is not yet settled to
the  satisfaction of all  parties.   Some  consider  them of
syphilitic  origin, whereas others  maintain that they may exist
without any syphilitic taint.  This is likewise our  opinion ;
we have seen a number of condylomata which were evidently
non-syphilitic, inasmuch as  not  a trace of either primary or
secondary syphilis was perceptible in the organism.
   The condylomata are  either raised and acuminated, or
broad  and flat; .they  always arise from  morbidly enlarged
papillae of the  corion, which are  covered with a thickened
epidermis.
   We  generally distinguish two  kinds of figwarts, according
as they are seated upon a broad  or narrow basis.   The broad
condylomata are of syphilitic origin, the acuminated  condylo-
mata are  non-syphilitic, and may be caused by the irritating
action of  coit, by want of cleanliness, gonorrhoea or leucor-
rhoea, they  are  generally  more obstinate than those with a
broad  base.  Some maintain that the broad condylomata are
hypertrophied conditions of the skin, and that the acuminated
condylomata are parasites.
   Fricke and Hauck adopt another class of condylomata, the
subcutaneous, consisting  of condyloinatous  swellings in the
mucous and cuticular follicles.   Hauck says in this  respect:
"In  young individuals  with a delicate skin,  especially in
young females who  had been affected with  gonorrhoea, lcucor-
                            10 
138
SECONDARY  SYPHILIS.
rhoea, or with acuminated condylomata, but not merely with
chancre, we frequently notice on the internal surface of the
thighs down to the knees, on the outer  skin of the penis and
of the labia majora, on the mons veneris and on the abdomen,
but no  where else, small, rather hard and elastic, yellowish-
white elevations, of the size of a millet-seed, and about two
lines in height, somewhat smaller at the upper extremity which
is flat, and upon which a dark,  dot-shaped depression is visi-
ble.   On account of their external appearance, these  tuber-
cles were termed by Fricke syphilitic porcelain tubercles.
  Hauck discovered  the real  nature of  the  subcutaneous
figwarts by the following  experiment:   Placing both thumb-
nails  against the base of the cutaneous  elevation, he pressed
them  together from  above  downwards,  upon  which  the
thickened and whitish  sebaceous contents started in vermi-
cular  shape out of the opened follicle.  Upon  renewing the
pressure the small follicle was again opened, a small, whitish,
globular, compressed, crisp, sometimes pluri-lobular  growth,
started  out of the  interior, which was at once recognized as
an acuminated condyloma, adhering  by its root  to the  bot-
tom of the follicle, but being otherwise perfectly disconnected
from the surrounding parts.
  According  to Barensprung,  Simon,  Kraemer  and others
condylomata  constitute a degeneration of single  portions of
the skin, particularly of the  epidermis, the papillae  and the
hairy follicles.  Upon  some  circumscribed spot  the papillae
first grow  uniformly larger,  and the epidermis covering this
part  grows thicker, so that the original condyloma consti-
tutes a flat and smooth elevation upon the skin.   On portions
of the  skin which  are more remote from the  mucous mem-
branes,  particularly on the scrotum, the condylomata seldom
advance beyond this stage ; but  on parts which are nearer to
the mucous membrane, the development of the condylomata
takes place much more rapidly.   Towards the end the elon-
gated papilla  forms bulbous swellings; these give out shoots,
which in their turn give out other shoots, and in this way a
papillae which was simple at its base, is gradually transformed 
CONDYLOMATA.
139
into a tissue of numerous ramifications.  Every papillae con-
tains a blood vessel.
   The more extensive these condylomata become, the thinner
becomes the epidermis,  which,  however,  never  disappears
entirely.   In most cases the epidermis which  is thoroughly
pervaded  by fluid, resembles the epithelium of the mucous
membranes.
   The variety of the forms depends upon the shape and the ex-
tent of that portion of the skin which was originally diseased.
If this portion is small, acuminated, and if large, broad condy-
lomata arise from it.  At other times the variety of the forms
depends upon the manner in which the ramifications shoot
up, and upon the locality.   If these ramifications  shoot out
longitudinally, in  this case the  condyloma takes  the form
of a cone,  standing upon its pointed extremity; if they are
developed  in every direction  indiscriminately, the  condylo-
mata assume the  shape of raspberries; at the anus the con-
dylomatous growths like to accommodate  themselves to the
natural  folds of the skin, and being flattened on either side,
they assume the shape of a cock's comb.   If these growths
spread  over a large surface  in  every  direction, they form
cauliflower-shaped,  pedunculated,   fig-shaped,  mulberry-
shaped, fungous, grape-shaped, or other kinds  of condyloma-
tous excrescences.
   Condylomata, whether syphilitic  or non-syphilitic, most
frequently  attack persons who do not keep themselves clean,
on parts of the skin or mucous  membranes, where  two flat
surfaces from which corrosive secretions  ooze  out, come in
contact  with, or rub against  each other.   They occur more
frequently  on the female than on the  male parts.   We see
them on the labia majora and minora, at the entrance  of the
vagina,  in  the vagina, in the  rugae of  the vaginal  mucous
membrane, at the roof of the vagina, etc.   There are  cases
where the whole vagina is dotted with such comdylomata.  In
the male sex we see them in the  furrow behind the corona
glandis, on the glans, in the meatus  urinarius.    Favorite
localities of the condylomata, in both sexes, are the inner 
140
SECONDARY  SYPHILIS.
surface  of the  anus and the  surrounding parts,  and the
perinaeum ; here too they are more frequently in females than
in males.   They are likewise observed in  the corners  of the
mouth and lips, in the nose, mouth and fauces, in the external
meatus  auditorius, on the conjunctiva of the eye, upon the
skin of the inner side of the thighs, in the inguinal  folds, in
the axilla, and even, though rarely, on the fingers.

 Syphilitic  affections  of the  hair and nails.   Alopecia
         syphilitica and onychia maligna syphilitica.
   General or partial falling off  of the hair, especially on the
head, with furfuraceous  desquamation,  occurs  in  various
periods  of constitutional  syphilis, but most frequently as a
consequence of syphiloid  eruptions.   At first the  hair comes
out more abundantly only when combing it; afterwards the
hair not only comes out on the head, but also at the eyebrows,
eyelashes, whiskers and the sexual parts.   The skin on these
parts is  covered with thin,  whitish  or bright-yellow  scales,
which constantly form anew.   The whole  affected  portion of
the skin looks redder.   The hair which grows out in the place
of that which  had fallen off, is thinner, of a lighter color, it
remains small and  frizzles. In young persons it acquires again
its former consistence and rich growth as  soon as  the  consti-
tutional disease is  healed.  In old persons it remains thin and
small as  long  as  they live.  The  falling off of the  hair  is
promoted by the use of mercury.
   While the syphilitic diseases is running  into  the tertiary
form, the onychia  syphilitica is frequently added to the other
symptoms.  It is  especially the nodous  form  of cutaneous
syphilis that is disposed to invade the nails.   The patients
experience pains in the  fingers,  especially in the thumb ; the
least pressure is intolerable.  Afterwards a  small, semilunar
ulcer forms with its convex surface turned upwards ; the pain
and sensitiveness become exceedingly acute, the ulcer enlarges
in size, the whole root of  the nail  is affected and  the  nail  is
finally destroyed without  ever growing again.
   Onychia syphilitica invades the fingers as well as the toes, 
ALOPECIA.—ONYCHIA.
141
but principally the latter.   In most cases several  nails are
diseased;  it has happened that every nail  of the upper  and
lower extremities was destroyed.
  In conducting  the  treatment  of any of these secundary
eruptions  of the syphilitic  disease, the diet should  be  con-
stantly in accordance with the strictest homoeopathic treat-
ment.  What is of still more importance than the diet is this,
that the patient  should be kept in an uniform,  somewhat
elevated temperature.  In the warmer climate  of the South,
syphiloid eruptions  run a much  more rapid and more favor-
able course, and the cure is much more  readily accomplished
than in the  colder North.
   Among  the remedies  which  we  shall  mention  for the
syphilitic  dyscrasia, one or more, in alternation or succession,
will have to be prescribed in accordance with the symptoms-
We have to remember that the syphilides are disposed to pass
from one into another, and that  several  forms  frequently co-
exist.  The proper  mode of alternating the drugs,  their suc-
cession or the repetition of the dose, will have to be left  to
the discretion of the practitioner or the intelligent  layman.
   In  erythema,  roseola syphilitica, the following remedies
will be found most suitable: Antim. crud., Arnic, Arsen.,
Aurum, Bellad., Calc  carb.,  Cantharis.,   Chelid.,  Chin.
sulph., Clemat., Coccul, Copaiv.,  Crot. tigl, Lycop., Merc.
sol.,  Merc, corros., Mezereum,  Petrol, Phosphor., Tart.
emet.
   In nodous syphilis, flat condylomata,  we may use :  Antim.
crud., Aurum, Bovista, Carbo anim., Carbo veget., Caustic,
He par sulph., Kali carb., Ledum, Mer. sol., Nitr., Staphy.,
 Thuja.
   For  psoriasis  syphilitica we  recommend:  Baryt.  mur.,
 Copaiva,  Cuprum, Calc  carb.,  Calc acet., Hepar  sulph.,
 Kali- carb.,  Mezcr.,  Mercur., Natr.  carb. Nitr. acid.,
Plumbum, Graph., Gratiola.   (Also, Kali hydriodicum.)
   In papulous syphilis we use  with advantage : Agaric, Am-
nion, mur.,  Arsen., Aurum, Bovist, Caustic, Con., Copaiv.,
 Graphit., lod., Kali, carb., Kali hydriod., Ledum., Lycop., 
142
secondary syphilis.
Merc, Nat. carb., Nat. mur., Phosphor., Rhus, tox., Stra-
mon.,  Tabac, Tereb., Zincum.
   In pustulous syphilis, variola syphilitica, ecthyma syphili-
ticum, we have:  Acid, nitr., Antim. crud., Amm. mur.,
Argent, nitr., Arsen., Bellad., Baryt. carb., Bryon., Caustic,
Calc. carb., Canthar., Carbo. veg., Clemat., Coccul,  Copaiv.,
Crot., Dros., Evonyn.,  Graph., Hyos., Kali hydriod., Kali
carb., Merc, sol., Merc, corrosivus, Mezer., Natr. mur.,
Phosphor., Petrol, Ranunc bulb., Ranunc sceler.,  Rhus.
tox., Sassapar., Secale corn., Tabac,  Tereb.
   For  rupia  syphilitica the following  seven  remedies have
been found efficacious: Acid, mur., Arsen., Caustic, Crot.,
Dulcam., Rhus tox., Sabina.
   Condylomata are controlled with tolerable certainty by
Aurum,  Causticum, Phosphoric acid,  Merc, sol.,  Thuja.,
and Sabina.
   Alopecia syphilitica requires: Arsen.,  Calc. carb., Carbo.
veg.,  Graph.,  Hyper., lod., Kali carb., Lycop., Magnesia
carb.,  Mercur.,  Natr.  mur., Nitri  acid., Petrol, Phos-
phor.,  Selen., Sepia, Sulphur.
   To onychia syphilitica the following remedies are adapted :
Arsen., Antim. crud.,  Graphit., Hep. sulph.,  Kali carb.,
Lycop., Merc, sol., Nux vom., Petrol.
   (Among the above named remedies those which are printed
in fat type, have the nearest resemblance to the disease, and
may, as a general  rule, be tried first. In all syphilitic diseases
the Mercurial preparations occupy the first rank.   Acidum
nitricum  and Iodine, with  their  compounds, are  likewise
powerful anti-syphilitica, and  deserve  especial  attention in
the case  of mercurial  complications;  this remark  likewise
applies to Aurum and its compounds. Next to these we have
Silieea, Mezereum, Acidum phosphoricum, and the  class o f
remedies generally indicated for scrofulosis and tuberculosis.)

                III.  Iritis Syphilitica.
   This disease is intermediate between secondary and tertiary
syphilis, and  is by some authors reckoned among the former, 
iritis.
143
by others among the latter variety.   Ricord places it among
the forms of secundary syphilis.   We feel disposed to do the
same, for we have  often  met it in conjunction  with  roseola,
lichen and  other syphilides.   According to Helbert, about
four out of every hundred  patients  affected with  secundary
syphilis are attacked with iritis.  There are, however, syphil-
itic eye-diseases, and iritis  is one them, which  are evidently
forms of tertiary syphilis.   These diseases will be treated of
in detail in  the chapter on tertiary syphilis.
   We will now go into some details regarding secundary iritis.
   This  disease is characterized by a very violent inflamma-
tion of the membrane of Descemet, especially on the  anterior
surface of  the iris, which results  in dimness of the cornea,
yellowish or greenish discoloration of the iris, contraction or
distortion of the pupil, morbid dilatation  thereof (mydriasis),
excessive photophobia and nocturnal pains in the orbit.
   In most cases syphilitic iritis affects one eye only,  and has
all the properties and appearances of common iritis.
  In the commencement of the disease, the color of the iris
becomes duller, grayish, the smaller circle is less clearly dis-
tinguished from  the larger,  the radii are more or less effaced.
The pupil is moved with difficulty, more  or less contracted,
its shape is altered, angular. The cornea is somewhat dimmed
and on the inner surface we discover a few bundles of vessels.
   The whole of  the sclerotica is  filled with blood, of a rose
color; at  its juncture with the cornea we  perceive a dark-red,
more or less broad, violently inflamed, ring.   The  patients
complain of a drawing and a dull pressure in the eye, photo-
phobia, increased secretion of tears;  the sight is blurred as if
a gauze were before the eyes,
  After  a  while these changes  become more  intense and
spread.   The iris becomes more discolored, almost of a dirty-
red  color.  This change is  particularly distinct in  the case
of  gray  and  blue eyes;  blue eyes generally  change  to  a
greenish-red.   The surface of the iris is  lined by a  layer of
exudation of more  or less  thickness ;  this causes the iris to
swell, its free margin is thickened, and upon its anterior sur- 
144
secondary  syphilis.
face we discover globular elevations of a yellow or gray color.
The pupil is perfectly immovable, contracted and distorted.
In the substance of the iris we discover small extravasations
of blood, abscesses,  forming upon its anterior surface small,
rounded, yellow  elevations, and at its free  margin reddish-
yellow, roundish flocks or globular, pedunculated excrescenses,
termed condylomata of the  iris.   As the  disease progresses,
adheskms take place between the  iris and the lenticular cap-
sule.   If, in such a case, the pupil still remains open, it does
not look black but grayish.   At the bottom of the anterior
chamber we observe through the dim cornea a more or less
elevated layer of pus which is sometimes mixed with  blood.
As the disorganization progresses, the pain  increases in vio-
lence.   The  patient experiences violent,  constrictive, boring
pains  and stitches  spreading to  the temples, forehead and
even the cheeks.   The pains are worse  in the evening and at
night, so that the patients have scarcely ever any sleep.   If
the disease is not  speedily arrested, it may spread to the  other
membranes  of  the eye, causing  amaurosis, specks on the
cornea, stamphyloma, mydriasis, etc.   The lighter degrees of
iritis are speedily controlled by judicious treatment; but there
remains a tendency to  relapses, on which account the patients
have to observe great caution for some time to come.
   In treating the disease, we have above all things to protect
the eye from the light.   This is  done by wearing  a  green
screen before the eye, and by abstaining from any work that
might  strain the eye,  such  as reading  or writing.  It  may
even be  necessary to  keep  the patient constantly in a dark
room.
   Among the homoeopathic remedies the principal is Merc sol,
provided the  patient had not been drugged with mercury by
some allopathic physician.   If this should have been the case,
we have to give :  Acid, nitr., Aurum, Belladonna, Cannabis,
Carbo  veg.,  Crocus, Coffea,  Graphit.,  Hepar  sulph.,  Kali
carb., Lycop., Pulsat., Sulph., Thuja,  Veratr.
   [It is  doubtful whether such agents  as Crocus and Coffea
will be of any direct use in syphilitic iritis; the remedies from 
                    tertiary  syphilis.                145

which positive benefit may be  derived in this affection, are
Acidum nitricum, Mercurius solubilis and corrosivus, and, if
there should be intense pain in the frontal region, and rapid
distortion  of the pupil,  the saturated tincture of  the root of
Aconite.   It is well to use this agent in alternation  with
Mercurius corrosivus.]


                      Tertiary Syphilis.
   According to Ricord, the  symptoms of tertiary  syphilis
differ from those of  secundary syphilis  in this, that  they are
no longer transmissible to the fetus.  Ricord maintains that,
at this period, the syphilitic disease loses its specific character,
and  that it becomes a dyscrasia which is very much analogous
to scrofulosis.   The older the syphilis, and the longer it lasts,
the more it becomes divested  of its specific character.   Ter-
tiary symptoms are always preceded by primary and secondary
phenomena.  Physicians who  dispute this point, have cer-
tainly forgotten to institute a careful subjective and objective
analysis.
   Tertiary symptoms are much more formidable than the con-
ditions by which they were preceded, and are the more serious
the longer and more diversified had been the anti-syphilitic
cures which the patients had undergone.  The mercurial treat-
ment, especially, renders the tertiary symptoms  inveterate.
Mercury enfeebles the body, and the syphilitic disease is the
more frightful the more  debilitated the  constitution  in which
it  exercises its  ravages.
   Tertiary  symptoms  seldom  show themselves  under, six
months after the disappearance of the chancre.   This is the
shortest period.  As to  the period beyond which the action
of the syphilitic poison need no longer be  apprehended, it is
impossible  to determine it with any thing  like certainty.
Cases have occurred where the  syphilitic  disease broke  out
ten, fifteen, twenty years after the first infection;  but such a
long period rarely ever  elapses without the occasional super-
vention of suspicious symptoms.   There is always some little 
146
tertiary  syphilis.
trouble which  the patient overlooks on account of its insig-
nificance.   But suddenly the  disease  breaks out; a steady
pain is felt in  one of the tibiae, or a testicle begins to swell.
  Tertiary symptoms affect the sub-cutaneous and sub-mucous
cellular tissue, the fibrous,  osseous and cartilaginous tissues,
the muscles, nerves, parenchymatous  organs; in short, the
whole organism.
  Accordingly, we distinguish  affections of the sub-cutaneous
and sub-mucous tissue, of the cellular tissue, and of the lym-
phatic glands and vessels enclosed in it.
  Tertiary symptoms  of  the  fibrous  and  parenchymatous
organs.
  Syphilitic diseases of the periosteum and bones.
  Syphilitic affections of the muscles and tendons.
  Syphilitic affections of the eyes.
  Syphilitic affections of the nerves.
  Syphilitic affections of parenchymatous organs and syphilitic
cachexia.

I.  Tertiary  affections  of the Sub-cutaneous and Sub-
  mucous Tissue, the  Cellular Tissue, the Lymphatic
  Glands and Vessels.

Gummata Syphilitica,  Gummatose Tumors on the Skin and
               in Parenchymatous Organs.
  These tumors are located in the sub-cutaneous, sub-mucous
or interstitial cellular tissue. They are found more frequently
under the skin or under the mucous membranes than more
deep-seated.  They  are not often met with,' belong to the
remotest stage  or period of constitutional syphilis, and not
unfrequently  accompany syphilitic  cachexia.  They  run  a
slow course, and are liable to relapses.
  Gummata occur most  frequently under the scalp, the skin
of the neck, upper arms, legs, especially on the inside of the
thighs and legs, on  the  prepuce  and under the skin of the
penis and scrotum.  At first we observe a pea-shaped, round,
very hard, not very prominent swelling under the skin ; whose 
GUMMATA.
147
         color is not altered in the least.  These swellings are painless,
         and it is only during a change of weather that a slight, dull
         pain is experienced in the part where they are seated.  They
         increase slowly in size; sometimes a year elapses before they
         reach  the size of a hazel-nut.  They seldom occur singly, but
         are generally disposed  in a  row, like beads, from four  to six
         together.  For a long time  they remain hard, can be moved
         to and fro over the subjacent parts,  but their  upper sur-
         face firmly adheres to the skin.   These swellings frequently
         remain unaltered  for years.  Finally,  however, in one case
  a      sooner, in the other later, they become soft.  In the centre of
^k      the tumor pus begins to form, and this change keeps spreading
  »      to the circumference.   In   the meanwhile the gumma has
^»      formed adhesions with the adjoining parts, and is enclosed as
 N      in a kind of cyst.  The process of softening takes place in
  m      the interior of the cyst, and, after awhile, fluctuation is per-
         ceived through the walls of the cyst,  and becomes more and
         more distinct.  Gradually the formerly  hard gumma acquires
         the consistence of an abscess filled with pus.  The skin over
         the swelling, the color of which had remained  unaltered so
 ^      far, now changes to  a bluish copper-color, becomes  thinner,
         breaks, and a fetid ichor is discharged from the tumor.  This
         ichorous  exudation sometimes undermines the neighboring
         cellular tissue, forming widely-ramified  fistulous canals.  At
         this period, the discharge of ichor is generally accompanied
         with portions of organized  tissue.  The ulcerative  process
  ^      extends more and more, both in breadth and depth, the edges
- >^     of the  ulcer look suspicious.
 \J       Gummata of the sub-mucous  cellular tissue of the tongue
         deserve especial mention.   Syphilitic  tumors of the  tongue
         are frequently confounded with diseases of  an entirely dif-
         ferent  nature.   They have   been  mistaken for cancer and
         schirrus, and  have been cut  out.  These  sub-mucous gum-
         mata of the tongue develope themselves without the  patient
         being made aware of it by any symptom of pain.  The tongue
         becomes hard, knotty, either in one portion only or through-
        out its  whole extent.   The free motion of the tongue in  talk- 
148
tertiary  syphilis.
ing or chewing is of  course impeded.   These swellings may
be distinguished from cancer by the absence of the shooting
pains which are always felt in the latter.
  The most suitable remedy for these gummata  is undoubt-
edly Merc. sol. which  will always have  the desired  effect,
provided the  patient had  not  been drugged with allopathic
doses of calomel.   If this remedy should not suffice, one or
more of the following remedies will  have to  be  chosen:
Arsenic, Borax,  China, Mezer., Mecur. dulc, Plumb., Stra-
mon., Rhus tox., Ruta, Carbo anim., Aurum, Belladonna,
Acidum phosphor., Calcar. carbon., Graphit., Juglans.

               Symptomatic  Indications.
  [Arsenicum is particularly indicated  when the  suppurative
process  has already commenced, and symptoms  of  a malig-
nant character are  developed; the  pus is ichorous,  thin,
corrosive, foul, and the swelling has a livid appearance.
  China may be used after arsenic, if this should not help,
or in alternation with  it; and if neither arsenic nor china
should  make  any impression, and the character  of the pus
should remain unchanged, or if the tumor should  seem to be
perfectly torpid and hard,
  Carbo animalis may  be employed with great  advantage.
  Mercurius  dulcis may be given after  Mercurius  sol. had
been tried ineffectually.
  Rhus tox. is excellent when the swelling is hard as stone,
or when a commencement of  torpid inflammation  becomes
visible.
  Aurum may be tried after  Mercury,  in  case  this agent
should  not have any effect, or in case  mercury should have
been given previously, or by some  allopathic practitioner.
In such a case
  Nitri acidum,  Calcarea carbonica,  Acidum phosphoricum
and  Graphites  might  likewise  be given  with  advantage.
These remedies  are  likewise useful if the swelling does not
seem to be impressed in the least  by any* of the  previously
named remedies^ 
SARCOCELE.
149
   Belladonna is indicated when the swelling looks inflamed,
and is very tender and hot, or a throbbing is experienced in
the tumor.
   Juglans is indicated when the  swelling begins to feel sore,
or symptoms of ulceration  develope themselves.   In such a
case
   Mezereum, Calcarea  carb., and  Graphites will likewise
prove useful.]

     II.   Tertiary Affections of the Fibrous and
                 Parenchymatous organs.

Sarcocele syphilitica,  orchitis syphilitica, syphilitic swelling
                       of the testes.
   For a long time syphilitic sarcocele was looked upon as
identical with orchitis  arising from  gonorrhoea.   The differ-
ence  between these two  forms of orchitis was first  scientifi-
cally  and   thoroughly accounted  for by Astley Cooper,
Dupuytren, but  particularly by Ricord.  In speaking of this
disease we  shall adopt the masterly description by Ricord,
which is distinguished  by clearness and correctness ; without,
however, neglecting  the more recent observations and views
of Hamilton, Helot and Moore.
   According to  Ricord  syphilitic sarcocele which  has  also
been  termed albuginea syphilitica, because the tunica  albu-
ginea is  principally affected in  this disease, constitutes one
of the first and most frequent symptoms of tertiary syphilis.
It usually  affects one  side only,  although cases  occur where
both  testicles, or one  after the  other, are diseased.   There
are scarcely ever any  precursory symptoms ; now and then,
but in a few cases only, the patients complain of acute boring
pains in the loins, generally at night; sometimes  they com-
plain  of a painful pressure  in the region of  the kidneys, or
of a sensation as if a sticking instrument were thrust through
their  flesh.  In  some cases  the nocturnal appearance of the
pains denotes  an evidently syphilitic origin.  As a general
rule,  however,  the precursory symptoms are wanting; the 
150
TERTIARY syphilis.
testicle begins  to  swell without  the  patient being  at  all
aware of it.  Some, however, have their attention called to
the  approaching  trouble  by a sensation of  troublesome
tension and a dull pain in the  testicles prior to any appear-
ance  of swelling.  Most frequently  the alteration is unac-
companied by any striking phenomena, and developes itself
in the following manner: in the  testicle which is the  seat of
the disease, we  discover one  or more  indurated nodes; on
pressing the testicle we feel a small spot that is harder  and
less elastic than the other parts.   As the disease progresses,
this  induration  continues  to  spread.   In  many cases the
induration spreads round about like a circular belt; in other
cases several indurations make their appearance  successively
and  gradually coalesce until the whole testicle  has become
involved.
   In simple cases, where the sarcocele runs a regular  course,
the epididymis remains unaltered for a long period, and  can
be clearly distinguished from the testicle proper which either
preserves its  normal volume while the induration  is going
forwards, or  becomes hypertrophied.   But  even if the tes-
ticle  swells, the swelling never goes beyond certain  limits,
and this is another diagnostic sign of syphilitic sarcocele, for
in many other forms of disorganization  of the testes, such as
elephantiasis, fungous enlargement, this organ may acquire
an enormous size.
   The increase of the swelling in  syphilitic sarcocele takes
place with great regularity.  The testicle preserves its pear-
shaped form, the larger extremity being turned downwards,
and the elongated extremity upwards,  and the  longitudinal
diameter in the direction of the spermatic cord.   The syphi-
litic testicle feels harder than the other; the hypertrophy is
regular; the inequalities which we  discover with the  finger,
observe a certain regularity; they constitute a regularly pro-
gressive series of circular or zone-shaped  indurations.   As
soon as the swelling has reached  three or four times the size
of the original testicle, the epididymis is no longer perceptible
even upon close  examination; an oval swelling is all that we 
SARCOCELE.
151
discover; nevertheless the epididymis is not morbidly altered;
neither the epididymis  nor the vas deferens is involved  in
any degree in the process  of degeneration.
   This is a very important diagnostic sign; for degeneration
of  the epididymis or spermatic cord would constitute a most
unusual complication.   If the sarcocele  attains  a  certain
degree, the testicle loses in many cases the sensibility which
it possesses in the normal  state.
   The swelling is hard, firm, not elastic; if pressed upon by the
finger, the tumor conveys  the  sensation of a massive, fibro-
cartilaginous, unelastic  texture.   The  outer  skin appears
unaltered, keeps its natural color, remains cold, and can  be
moved  to and  fro  over the  swelling, to which  it does not
adhere.  Only in a few cases some of the veins of the scrotum
appear somewhat engorged.
   Sarcocele, after  it has  reached a certain stage, is some-
times  accompanied by  hydrocele of the tunica  vaginalis.
This seems to be purely  symptomatic, and  is unaccompanied
by  fever or by any general derangement of the functions.
  After the internal texture of the testicle has become disor-
ganized, the seminal  secretion gradually ceases,  especially if
both testes are  diseased.   The erections become less frequent
and finally disappear altogether.
  The  physical  properties of the  semen undergo striking
alterations in regard to  quantity  and consistence; the sper-
matozoa disappear, and, instead  of  semen, a transparent,
almost watery fluid is secreted.
  Syphilitic  sarcocele may last  months,  and even  several
years.   It never terminates in suppuration, nor  does it ever
transgress certain limits.  After reaching a  certain point, it
here remains for a  time, after which  resolution takes place.
This either takes place  spontaneously, or in consequence  of
adequate treatment.  Sometimes it happens that the testicle
grows  smaller  in  size;  the patients  consider  this a  good
omen, endeavor to hasten the  disease,  but unfortunately this
does not stop until the testicle has disappeared altogether.
  In such a case other phenomena, which are generally met 
152                TERTIARY SYPHILIS.
with in eunuchs, supervene; for instance, the whole organism
undergoes a  change, the whole  appearance and condition  of
the patient become altered, the voice loses its resonnance, etc.
  There  are cases where the disease takes a  different turn;
the swelling changes to a cartilaginous, fibrous and even osseous
tumor.   Ricord has seen several changes of  this  kind, and
I have come across two such cases in  my own  practice.
  Ricord has been  led to believe by some cases that, if the
vessels have  not become atrophied, syphilitic sarcocele may
terminate in simple resolution, and  that the organ may again
acquire its normal shape.   We saw a case of this kind in his
clinique; the patient died  of inveterate syphilis, but a few
months before his death, the testicle had resumed its natural
shape and consistence.
  According to Hamilton, syphilitic sarcocele only takes place
from one to six years after the  primary infection.  He dis-
tinguishes two forms of the  disease, the  simple  syphilitic
and the tuberculous syphilitic.   The former, he thinks, only
befalls robust  individuals, and is accompanied by secundary
and  tertiary  symptoms, such  as  papulae,  pustules, scales,
iritis, the lighter forms of ostitis and periostitis, etc. Accord-
ing to his statement the syphilitic tuberculous form is much
more frequent than the former from which it differs in many
essential particulars.
  The penetrating Rokitansky, whose impartial and faith-
ful investigations in pathological anatomy are  of inestimable
value for a  correct  knowledge of the  diseased tissues,  in
reference to  sarcocele,  says:  Chronic inflammation of the
tunica albuginea  and of  the  processes  which  it sends off
towards the inner parts, occasions in  rare cases only a con-
siderable  thickening of  the  fibrous membranes,  material
enlargement of the cellulo-fibrous tissue in the interior of the
testicle, hypertrophy, a morbid  hardness  of the testicle, and
finally atrophy."   In reference to  tuberculous syphilitic sar-
cocele, Rokitansky offers  the  following  remarks:  " Tuber-
culosis of the testicle principally  affects young  persons  in
consequence  of excessive  or  unnatural gratification of the 
SARCOCELE.
153
sexual passion; pathological a*natomy has not yet succeeded
m determining the connection of this disease with gonorrhoea;
in other words, the blennorrhoeic character of  the constitu-
tional disease and of the  tubercle have not yet been  proven,
and the theory, that syphilitic sarcocele is an effect of gonor-
rhoea,  lacks, in  our estimation, an  essential  foundation.
Tuberculosis  of the testis generally developes  itself  in  the
shape of nodes, from the size of a millet seed to that of a pea,
and coalescing  into a shapeless mass, which  scarcely  ever
terminates  in resolution, but almost always in  suppuration,
and  constitutes phthisis  of the testicle.   The  increase  of
volume depends upon the number of tubercles  and particu-
larly upon the  number of tuberculous groups,  the tumor
having an  uneven, knotty  surface.   The  tissue which  sur-
rounds the  tubercle and its vomica, feels thick and callous, is
dense, cartilaginous, resembling lard.
   As  in  the lungs and pleural cavities, tuberculosis of  the
testicle is frequently accompanied by inflammation  of  the
tunica albuginea leading to tuberculous deposits of a variety
of shapes."
   This shows  that tuberculosis  of  the testis  must  be  the
result of a deeply-penetrating action of the syphilitic virus,
and that there is an essential difference between gonorrhoeal
orchitis and syphilitic sarcocele.
   As regards the causes and developments  of syphilitic  sar-
cocele,  Ricord  considers  not  only  syphilis,  but  all other
influences which act upon the testicle,  as causes of this dis-
ease.  Whatever exercises an irritating and exciting influence
upon the testicles, may contribute to the development of sar-
cocele.  Gonorrhoea contracted during the course  of secondary
syphilis, may excite the disease.  Other  causes,  such as a
contusion of these parts, a blow, excessive abstinence or else
excessive indulgence, may likewise favor the development of
sarcocele during secondary or  tertiary syphilis.   Sometimes
the  syphilitic  dyscrasia  is  complicated with  a cancerous,
tuberculous,  scrofulous diathesis; in such  a case syphilitic
sarcocele is  likewise more easily developed.
                            11 
154                TERTIARY SYPHILIS.

  Syphilitic sarcocele is found complicated with  all sorts  of
disorganized secretions, such as : varicocele, hydrocele, which
is  quite  frequent;  acute and  chronic  gonorrhoeal orchitis,
simple orchitis, cysts and hydatids, and  other forms of disor-
ganizations.
  The prognosis  depends upon the  simple  or  complicated
nature of the disease.   The less complicated the trouble, the
sooner a gentle and rational treatment is  instituted, the less
the patient has been'subjecte'd to violent treatment: the more
favorable the prognosis.
  For syphilitic sarcocele, the following medicines have been
found  the  most  efficacious: Calcarea  carb., Carbo  veget.,
Aurum, Kali carb., Lycopod. and Spongia tosta.  But it may
likewise be necessary to use one or  more of the  following
remedies, according as they may be indicated  by existing
symptoms:
  Acid, nitr., Acid, phosph.,  Alumina,  Arsenicum, Bella-
donna, Baryt. mur.,  Clemat., China, Copaiva,  Euphor.,
Graphites,  Lycopod.,   Mercur. sol,  Mezerum,  Oleander,
Plumb, acet., Pulsat.,  Ranunc bulb., Rhodod.,  Rhus tox.
   (The symptomatic indications for  each  of these remedies
in particular imply a careful investigation and  an accurate
knowledge of the syphilitic disease from the  beginning.   In
no other way would it be possible to arrive at a knowledge of
the appropriate remedy in  a case where sarcocele is appa-
rently the  only symptom, and  may exist  unaccompanied  by
any characteristic constitutional phenomena.   An investiga-
tion  of the whole series  of   symptoms constituting  the
syphilitic disease, will then first lead us to such remedies as
Acidum nitricum, Clematis, Copaiva, Mercurius  sol, Mer-
curius corrosivus, Mezereum, which seem  to be  more  closely
related to the syphilitic virus.
   Arsenicum, China and Acidum phosphoricum, Plumbum
acet.,  if the general constitution seems to be broken down,
debilitated, the vital  fluids  seem  to be  tainted, or if the
disease had been hastened by excesses;
   Mercurius,  Clematis, Copaiv.,  Pulsatilla, if mismanaged 
         INDURATION OF THE CORPORA  CAVERNOSA.     155

gonorrhoea was either the immediate cause of the disease, or,
at any rate, had complicated and aggravated it;
   Belladonna,  if  symptoms  of  inflammatory congestion
develope themselves in the tumor;
   Graphites and Lycopodium, Oleander and Belladonna, if
the disease is complicated with general  scrofulosis, glandular
swellings,  chronic eruptions, as if it had grown worse  and
become more inveterate in consequence  of the  sudden sup-
pression of a cutaneous  eruption  by a cold, washes, etc.,  in
which latter case Baryta mur., Rhus tox., may be added  to
the last mentioned  drugs.)

      Induration of the corpora cavernosa of the penis.
   This is one of the least known and least frequent pheno-
mena of tertiary syphilis.
   To our knowledge Ricord  is the only author who has given
an exact  and  correct description of this disease.  He has
observed some eighty cases, and, although the disease is very
rare, yet he states  that some eight or ten cases  occur every
year in his private  or hospital practice.   In our own practice,
we have had a few cases of this disease to treat.
   The  induration  of  the  corpora  cavernosa  generally  de-
velopes  itself in the following manner: In one or in both
corpora cavernosa at the same  time, the patient discovers,
among other  symptoms of tertiary syphilis, a small, hard
body of the size of a grain of rice, which is, however, entirely
painless.  This hardness  increases  in  size,  either on  one
side, or on both sides at the  same time, and may occur in the
upper or lower portion or in the  sides of the penis.
   This disease runs a slow course, progresses very gradually,
and is painless; but in proportion as the disease progresses,
the  penis deviates from its straight line in the following man-
ner: If the induration is located on one side, the penis, if an
erection takes place, will necessarily be  turned  towards  the
diseased side, where the erectile  tissue has lost  its  dilatable
character; this kind of  erection, with the point  of  the penis
turned towards the inguinal  fold, has been termed, by Ricord, 
156
TERTIARY SYPHILIS.
inguino-crural erection.  If the induration is seated on the
dorsum of the  penis, the erection takes place upwards, the
penis forming a curve with the concavity upwards and the
glans turned towards the pubic arch.  Ricord likewise saw
the penis turned in other directions in consequence of an
induration of the cavernous bodies ; in some cases  he saw it
twisted like a ring.
   [This affection never terminates in suppuration, and is fre-
quently incurable.  It is Ricord's opinion, though he does not
give it as positive, that a violent gonorrhoea is, in most cases,
the cause of this disease.   In many cases  the primary cause
of the disease seemed to  have been an  act  of violence com-
mitted while the penis was erect.   He relates the case of a
young student of medicine, where the disease seems to have
resulted from a sudden apoplectic effusion of blood into the
substance of the cavernous bodies.   During a very violent
erection the young man experienced an acute pain, apparently
caused  by a  rupture  of the cells, after which an effusion of
blood  took place, and coagula formed in the bodies, which
could not be removed by  absorption.
   In this affection the following remedies will be found the
most suitable to palliate, if not to cure, the disease :
   Argent, nitr.  Copaiva,  Graphites, Hepar sulph., Mercur.
acet., Mezer., Sabina.
   In regard to symptomatic indications, we refer the reader
to our remarks in the preceding paragraphs.   The indications
in the present case are the same.  Not one of the remedies
above mentioned can be said to be homoeopathic to the disease
upon purely symptomatic grounds, for  an  induration of the
cavernous  bodies of the  penis has never been obtained  by
artificial drug-proving;  the  homoeopathicity of the remedy
to the disease  in  all  such disorganizations must  be traced
back to the original conditions, to the starting-point of the
disease, as well  as  to the starting-point of the drug-action ;
if these are alike, the remedy is homoeopathic, and, if a cure
be possible, and the  medicine  be  properly used, a cure will
undoubtedly  be effected.  All  such  disorganizations may, 
BONE-PAINS.
157
however, result from a complication of morbid miasms, syphi-
lis, scrofulosis, tuberculosis  and the like; and it may, there-
fore, be necessary to have recourse to more than one remedy
during the treatment.
   To the syphilitic and gonorrhoeal dyscrasia correspond the
mercurial preparations:  Argent,  nit.,  Copaiv.,  Mezer.,
Thuja, Sabina, Acid, nitric, Pulsat.,  Canthar., Cannabis.,
Aurum, Silieea, etc.
   To the  scrofulous  and  tuberculous dyscrasia: Calcarea,
Graphites, Lycop.,  Bellad.,  Arsenicum, Sulphur,  Hepar
sulph.,  China, Dulcamara,  etc.
   In the case of haemorrhage related above, the best remedy
would undoubtedly have been Aconite, for the excessive erec-
tion was undoubtedly the result of an excessive congestion of
the parts, and not the haemorrhage a result of the erection.]

III. Tertiary Affections of the Periosteum and Bones.
   These affections  manifest themselves  under four  different
forms, which, however, have to be regarded as different stages
and terminations of the inflammatory process, but not as dif-
ferent forms  of the syphilitic disease  in the bones.   These
affections generally constitute the following successive series
of phenomena; syphilitic bone-pains (dolores osteocopi,) pex-
ostoses,  exostoses and syphilitic necrosis and caries.

           Syphilitic bone-pains, dolores osteocopi.
   These pains may be  located in any portion of the osseous
tissue, in the  more deep-seated, as well as in the superficial
layers, in the flat or long bones,  in  the  articular extremities
as well as in the shafts, and finally in the periosteum.  There is
not a single spot in the whole body that may not be affected by
this pain.  As a general rule, however, these pains occur most
frequently in the superficial portions of the fibrous and osseous
systems.  Those portions of the bones which are less covered
by the muscles and are more exposed to the  open air, are
most  frequently  invaded by  syphilitic  pains.   Hence  they
occur more frequently in the  tibia, radius, humerus,  clavicle, 
158
TERTIARY SYPHILIS.
sternum and in the bones of the skull, than in the more deep-
seated bones.  As a general rule, the compact portions of the
bone  are  more  frequently invaded by the  pains than  the
spongy portions.
  Bone-pains  are to be numbered  among the remotest mani-
festations  of constitutional syphilis, and constitute in  the true
sense of the word tertiary phenomena.   There is no case on
record where bone-pains occurred, before five or six months
after  the  primary  chancre had elapsed.  They may  occur
even ten,  fifteen  or twenty and even  more years after  the
primary disease.
  Bone-pains are most frequently caused by a sudden change
in the weather.   Although a sudden change from warm to
cold weather favors  the development of bone-pains, yet  the
inverse transition from cold to warmth, if the bone-pains are
already developed, renders them much  more acute.   Hence
it is, that they are very much  aggravated when the patient
goes to bed and begins to get warm.  These nocturnal exacer-
bations of the bone-pains are exclusively attributable to the
influence of the warmth of the bed.  It is, therefore, wrong to
consider the nocturnal exacerbations of the bone-pains a char-
acteristic  sign of their syphilitic character, and to term them
dolores nocturni, as though they occurred preferably at night.
Ricord states in reference to this subject, that these pains are
felt at night only by  those who go to bed at night, and get
warm  in the bed;  but that  they  are not felt  by those who
spend  the night in carousing; such persons only feel  the
pains in the day time while they are in bed and exposed to
its warmth; in their  case  the  pains would have to be called
dolores diuturni.  But they deserve neither one nor the other
appellation, but simply increase by rest and the warmth of
the bed, whether this occurs in the day time or at night.
Ricord states, that  among the rich who spend the summer in
the country and the winter in the city, the bone-pains are felt
at night in the summer, and in the day time in  the winter;
the reason of this is quite simple: in the winter the rich spend
their nights in  social entertainments  and sleep  in  the  day 
BONE-PAINS.
159
time, whereas, in the summer, they sleep at night and spend
their days with fishing,  hunting, riding on horse-back, and
such like exercises.
  In most cases, if the patients go to bed in the evening, the
pains commence at eleven o'clock in the evening, and continue
until two  or three o'clock in the morning.
  Syphilitic bone-pains always begin with a disagreeable sen-
sitiveness. This gradually increases to a pain, until it finally
changes to a frightful torture.   It is peculiar to this pain to
become seated in one spot of the bone, and always to reappear
at the same place.  The pain is aggravated by the least pres-
sure, which is not the case when it is simply a rheumatic pain.
After  the pains have lasted  for a  time, they are not only
excited by the warmth of the bed, but they are felt in  the day
time as well as at night, except that they are aggravated by
rest. Syphilitic bone-pains may continue for a longer or shorter
period without  any alteration of the  bone in the region where
the pains are  seated, becoming  perceptible; they resemble
neuralgic pains.  Very  often, however, these pains  are  the
precursory symptoms of material changes of  the bones which
develope  themselves  speedily in some, and  more tardily in
other cases.  Many patients experience these pains for months
without perceiving any other  change  than a derangement of
the reproductive functions and an increasing emaciation.
   Syphilitic bone-pains  most  frequently terminate in perios-
tosis.
   The  treatment is  most  efficaciously conducted  by  the  fol-
lowing remedy:
  Calcarea carbonica, Carbo. animalis, Caustic, Croc, Fluor.
ac,  Kali carb., Laches., Lycopod., Magnes. carb., Mercur.
sol, Mezer., Natr. mur., Nux vom., Platin., Plumb., Plumb.
acet., Petrol, Phosphor., Pulsat., Rhododend., Staphys.
   [In regard to the special indications, we have to  observe,
that the  principal remedies  for this  disease, provided  the
patient had  not been saturated with mercury under allopa-
thic treatment,  are, 1, the mercurial preparations, Merc sol,
dulcis, corrosivus, ruber, acetatus, etc.; 2, the Hydriodate of 
160
TERTIARY SYPHILIS.
potash, if a good  deal of  mercury had  been used, in which
case it may be advisable to give the patient a few table-spoon-
fuls of an infusion of Sarsaparilla every  day; 3, Nitric acid,
and  some of its compounds, such as the Nitrate of potash.
In addition to  these  remedies, Fluoric  acid, Mezereum, and
Staphysagria may be employed, the two  last named remedies
more particularly, if the region where the pain is located feels
sore, as if ulcerated.
  Lachesis will be found useful, if the mercurial preparations
had  been employed to excess, or  if mercury remains ineffec-
tual under homoeopathic treatment.
  If there should be a complication with scrofulosis,  and the
patient should have been troubled in his  childhood with weak-
ness of the osseous .system, rickets and such like diseases, we
may select our medicines  accordingly, and use for instance,
Calcarea carb., Phosphor, and Phosphor, acidum,  Pinus syl-
vestris, likewise China and Arsenic, the two latter  more parti-
cularly if the constitution is shaken and requires building up.]

                   Periostitis syphilitica.
  After the syphilitic bone-pains have continued for a length
of time, alterations in the  tissue  of the  periosteum  begin to
take place.  The  periosteum becomes inflamed, and exuda-
tions become  distinctly  perceptible when pressing upon the
part.  The exuded matter at first looks  yellowish, of a gela-
tinous consistence, and, after a while, changes to a reddish or
brownish fluid mixed  with extravasated blood.
  Syphilitic periostitis generally developes itself in the region
where the pain had  been felt.   At this place we discover a
rather circumscribed  swelling of a greater or less  extent, and
with its base firmly adhering to the subjacent bone.  The skin
over this swelling is moveable,  and its color seems unaltered.
Gradually the swelling increases to the  size  of  a  pigeon's or
hen's egg.  The  swelling is  owing to   the presence of  the
exuded matter between the periosteum and the bone, and
resembling synovial fluid.
  The swelling on first developing itself, is rather firm; it 
EXOSTOSIS.
161
does not fluctuate, but, when  pressed  upon, does not impart
the sensation of a hard, resisting bone.  Such swellings may
increase to a considerable extent, but may likewise scatter
without leaving  a trace of their existence.  A complete dis-
persion can only take place provided  the exudation has not
terminated in an actual disorganization.  If no suitable treat-
ment is instituted previous to such a result, an  osseous degene-
ration (exostosis) is  very  apt  to  take place.   Such osseous
tumors arising from the consolidation of the plastic exudation,
are termed tophi.
   Periostitic inflammations resulting in exudations under the
periosteum resembling the synovial fluid, are termed gumma,
gummata.

                         Exostosis.
   These swellings are always  preceded by periostitis, and do
not develope themselves until the  bone-pains have lasted for
a time.  They run a very  slow course.  They arise  from an
osseous disorganization of the plastic exudation in periostitis,
a disorganization which takes place  in a similar manner as
the callus in the fracture of bones.  The morbid process com-
mences partially in the periosteum and in the superficial layer
of  the compact bony substance which is thickened  by  an
additional layer of osseous exudation between the bone and
the periosteum.   On its surface the exudation is cartilaginous;
the deeper layers exhibit an osseous consistence.  After the
exudation has lasted for  a time, it acquires  throughout the
consistence of bone,  and is of various thickness.   At first the
surface of the  swelling is rough, sometimes as  if covered with
warts; the older the swelling, and the more  it  acquires the
consistence of ivory, the more its surface becomes smooth and
even.
   These rather superficial exostoses are of various  shapes;
sometimes  they form  a flat,  extensive layer, resembling  a
simple distension or swelling  of the original bone; at other
times the exostoses constitute fusiform, pad-shaped, round or
prominent, knotty, and even pedunculated tumors. 
162
TERTIARY SYPHILIS.
   In other cases the exostosis commences in the interior of
the bony substance, or on the inner surface  adjoining the
diploe or marrow.   The exudation taking place within the
bony substance, the  bone  grows thicker  and  harder; the
tumor which encroaches upon,- and sometimes fills up entirely
the hollow interior, acquires the consistence of ivory, and, on
its outer surface, represents a flat, round elevation.   Some-
times, several of such exostoses are placed side by side, at
first isolated, but afterwards coalescing.  In the commence-
ment of  the disease, the patients do not complain of any pain
except the  bone-pains.   These  continue  often  for  a long
period before the exostosis shows itself, and abate as soon as
the bone begins to  swell.   The  exostosis never terminates in
suppuration, nor does it  even become carious.  It  either
remains unaltered during the patient's life-time, or a gradual
reduction is effected by suitable treatment, sometimes after
the tumor had been in existence for years.   An exostosis may
arise in  a locality where  it may give origin to a variety of
distressing secondary phenomena.  Large exostoses on the
lower extremities impede motion, and render it painful, inter-
fere with the functions of  the muscles and tendons, and may
lead to atrophy of the part.   Exostoses on the inner surface
of the skull may cause all  that  train of  phenomena  conse-
quent upon pressure of the brain and of its membranes such
as paralysis, spasms and so forth.
   The following remedies  will be found the most adequate to
the complete or partial reduction of syphilitic periostoses and
exostoses:
   Asafoetida, Aurum, Bryon., China, Conium, Mercur. sol,
Mezer., Phosphor., Ruta, Sabina, Sepia,  Silieea, Sulphur,
Stannum, Staphysagria,  Thuja.
   [To these remedies we should add the hydriodate of potash.
   Aurum, Phosphorus, and the phosphate of lime, also  Ruta,
seem to be particularly adapted to exostoses of  the cranium ;
the two last named remedies more particularly if the syphilitic
dyscrasia is  complicated by scrofulosis.
   Asafoetida, Mercurius, the Hydriodate of potash, Staphy- 
CARIES AND NECROSIS.
163
sagria and Silieea, will be found  particularly useful in exos-
toses of the long or hollow bones.
   Thuja  and Sabina refer more especially to a sycosic char-
acter of the tumor.
   Acidum nitricum and the hydriodate of potash are suitable
remedies  when we have reason to suspect a complication of
mercurial and syphilitic dyscrasia.
   The mercurial preparations are undoubtedly the principal
remedy for this* disorganization, and the treatment may safely
be commenced with them, provided mercury had not  been
previously administered in allopathic doses; and even then,
small homoeopathic doses  of  mercury, if judiciously adminis-
tered, may be of great use in this  disease.
   Ledum palustre may be given for hard tubercles and tophi
in the joints.  The mercurial preparations  are likewise  indi-
cated for this affection, if accompanied with arthritic pains
in the joints.
   Rhus tox. is another  remedy for swelling of bones, if the
parts are painful  and  the pain  is  worse  during  rest  than
during motion, with  a sense of paralytic numbness and weak-
ness in the parts.
   Sulphur has likewise been used with advantage for swelling
and curvature of the bones.]

              Syphilitic caries and necrosis.
   We have seen  that  syphilitic  periostoses and  exostoses
result from a specific inflammation of the periosteum  and of
the bone.   They may be considered as terminations of  peri-
ostitis and ostitis, in the one case in resolution, in the other
in induration.  A third termination of ostitis is suppuration.
This is the most pernicious, but fortunately the least frequent
of all the terminations of ostitis.   In compact bones, of low
vitality,  the  inflammatory  process  generally terminates in
exostosis, much less frequently in suppuration.
   In bones endowed  with  a higher degree of vitality, if the
patients are  sickly, and  the osseous system is  disposed to
inflammatory  conditions,  syphilis will more readily lead to 
1G4
TERTIARY SYPHILIS.
caries and necrosis.   Hence the spongy tissue of bones is
more easily attacked with caries and necrosis than the denser
tissue.
  The termination in suppuration takes place in the follow-
ing manner:  the diseased part is  exceedingly painful.   The
pains continue  day and night, only that at night  the pains
are much more violent.   The pain has the general  character
of just such a pain as is experienced previous to  the suppura-
tive  process  setting in.   First  it is aching, tensive, after-
wards throbbing, and increases in proportion as  the suppura-
tion  is drawing  near.  Soon after the  soft parts commence
to change, they coalesce  with the tumor.  At first this is cir-
cumscribed and resisting, afterwards it becomes fluctuating.
The  abscess  does not always  open in the region where the
part is  diseased; the pus may burrow downwards between
the  muscular  layers; the  skin   over  the  tumor  becomes
inflamed and  breaks spontaneously, unless opened,  in several
places.   At first fistulous abscesses form, all which lead to
the  denuded  bone.  Afterwards the pustules run together
into  a larger abscess, at the bottom  of  which  the  carious
bone either lies  exposed, or is partially covered by rapidly
suppurating,  lardaceous  layers,  and afterwards by adventi-
tious granulations.   The surrounding skin is quite 'red, and,
together with the subjacent parts, unites with  the bone in
one compact mass.   With the suppuration and destruction of
the soft  parts, the vitality of  the bone gets lost, the  calca-
reous portions are laid bare, so that the dead calcareous mass
alone remains.  This dead matter acts,  in  its  turn, like a
foreign body, and helps to keep  up the suppurative process.
But  there are cases where the suppuration  penetrates through
the osseous tissues, and the bony mass  becomes  decomposed.
In the one case the bones begin to die as soon as the destruc-
tion  of the soft parts commences;  in the other case the bone
becomes  ichorous, and is decomposed into larger or smaller
pieces.   The  former disorganization is termed  necrosis, the
latter caries.   These  two  disorganizations  are  frequently
found united. 
CARIES AND  NECROSIS.               165
   Although any part of the osseous system may be marked
by caries, yet  this  disorganization befalls principally  the
bones of the cranium, those of the face, and more particularly
the upper maxillary bones.   It occurs very rarely in the sub-
maxillary bone.  The palatine bones are frequently attacked.
In many cases the affection commences in the  corners of the
nose and the caries of the palatine bones is the result of the
affection of the adjoining soft parts, in consequence of which
the bones  become  denuded.   Very frequently  the carious
perforations  of the  the palatine bones are caused by per-
forating tubercles of the nasal bones.   The dental portion of
the maxillary  bones is  most frequently attacked  by caries.
The parts which constitute  the sockets  of the  teeth, swell,
and these more or less painful  swellings are  followed by
abscesses which raise  the soft  parts, and  the fetid odor of
caries emanates from the suppurating disorganization. After
the breaking  of the abscesses, the probe  soon  reveals  the
rough surface of a carious bone.  Afterwards, on examining
the teeth, it will be found that one tooth  alone cannot be
shaken, but that, upon endeavoring to shake several teeth
together, the whole dental portion of the jaw is moved.   If
this motion is distinctly perceptible, the bone is  dead, and
there is no hope remaining  of  preserving it or reducing it to
its normal condition.   The ascending processes of the palate-
bones generally remain free from caries ;  on the contrary the
nasal  cartilages are principally invaded by this disease;  the
vomer which has a denser tissue, becomes necrotic; the  nose
caves in, the  outer nasal bones are not destroyed, but  the
form of the nose becomes nevertheless altered.
   The bones of the cranium are likewise frequently attacked
by syphilitic caries and necrosis.
   Syphilitic caries and necrosis of the jaw leads to the loss
of teeth, indistinctness of speech  in consequence of the per-
foration of the palatine vault.
   If the disorganization affects the nose, the  loss of a few
cartilages may not be attended with any considerable incon-
venience.   But if the vomer and the other  cartilages  of  the 
166
TERTIARY SYPHILIS.
nose should be destroyed, the nose will cave in, and the shipe
of the face will become  considerably altered.  The destruc-
tive process likewise invades the septum; the nose forms only
one cavity; the Schneiderian membrane becomes altered and
covered with  a pseudo-plastic layer which secretes a peculiar,
fetid matter; some portions  of the  Schneiderian membrane
remain  sound.   The matter  which  is  secreted in  the  nose,
adheres; it is not expelled as  readily as  the common  nasal
mucus,  and  it  accumulates in  large quantity.   There  is a
secretion of  purulent, ichorous matter continually  going for-
ward, having a sickly, nauseous odor.
   Caries and necrosis of the skull-bones are likewise of fre-
quent occurrence.  This  condition  is  so much  the  more
important as it may lead to  dangerous  cerebral  affections.
If  the  external  plate is diseased,  the cerebral functions
remain undisturbed,  except  the pain.  But the  thing  is
different,  if  the tumor  is seated on  the  vitreous table;  in
such a case  violent  headache, vertigo, tremor,  numbness of
the  limbs, and, after a  period, semilateral paralysis of the
muscles of the face and remainder of  the head,  delirium and
epileptiform  convulsions  may  supervene.   Caries  of  the
frontal and parietal bones leads to inflammation and ulcera-
tion  of the  meningeal membranes.   Caries of the frontal
bones results in perforation  of the frontal  sinuses,  destruc-
tion of the cribriform plate and of the adjoining parts.
   In caries and necrosis the following remedies will be found
useful:
   Asafoetida,  Aurum,  Argentum  nitricum, Baryta carb.,
 Bellad., Bryonia, Calcarea carb.,  Caustic, China, Conium,
 Dulcam., Mercur. sol, Mezer., Nux vom., Phosphorus, Pulsat.,
 Rhus tox., Sabina, Silieea, Staphys., Sulphur.
   [To  this list we may add :
   Tartar emetic, frictions with which, upon the skull, have pro-
 duced caries of the skull-bones, and which may therefore be
 supposed possessed of curative virtues in this disease.
   Mercurius solub., has cured caries of the bones  in general, 
MUSCLES AND TENDONS.
167
and caries of the joints, of the auricula auris, and of the maxil-
lary bone in particular.
  Mezereum has cured caries of the bones.
  Calcarea phosphorata is useful in caries, also caries of the
skull.
  Aurum foliatum is a great remedy for caries of  the facial
bones, nasal bones and palate.
  Hepar sulphuris in caries of the hip-joint, or in caries pro-
duced by abuse of mercury, for which Aurum and Silieea will
likewise be found indicated.
  Silieea has cured caries of the humerus, jaw-bone, malar-
bone, tibia, and vertebrae.
   Calcarea carbon, is useful in caries of the vertebrae.
   Cistus canadensis has been found of great use in caries of
the lower jaw, and  of the  facial  bones; in  the latter case it
was used as an  infusion internally, and in the  shape  of a
poultice externally.
   China, Conium  and Sulphur are adapted  to mercurial,
scrofulous and syphilitic caries.
  Asafoetida will likewise be found useful  in  mercurial and
scrofulous caries, although this remedy is generally much less
valuable than is supposed.]

 IV.  Tertiary Affections of the Muscles and Tendons.
   Ricord terms these affections syphilitic contractions of the
muscles and tendons, and ranks them among the most curious
phenomena of tertiary  syphilis.  They are  exceedingly  rare,
and generally attack persons of  advanced age who had been
syphilitic and exposed to repeated rains and colds.
   The syphilitic affections of the muscles and tendons begin
with  pains which are very similar  to bone-pains, have  inter-
missions like these, and  are  generally made worse by the
warmth  of  the bed.   Being  considerably  aggravated by
motion, these pains have also been termed syphilitic rheu-
matism.   Even  after  the pains  have lasted only a short
period, a permanent contraction of the muscles  takes place.
The  distortion  of  the  limb  caused  by such  contractions, 
168
TERTIARY SYPHILIS.
developes itself very slowly.  In  general  the disease runs a
slow  course.  In  the region  where the pain is located, the
patient gradually experiences  a sort of rigidity, a difficulty of
motion, especially when attempting to stretch  the part; for
then  the  muscle feels  as  if it  were  contracted.  Little by
little  such a contraction really takes place; the limb remains
permanently bent.   The' contraction never takes place sud-
denly as  if caused  by some  sudden  nervous  derangement.
The starting-point of this  contraction is not to be sought in
the brain  or spinal column, but in the substance of the muscle
itself  and in  the  alteration which  the  tissue  undergoes.
Coagulable lymph exudes between the muscular fibres,  form-
ing after  a  longer or shorter period a fibrous, cartilaginous
and even  osseous disorganization, which results  in atrophy of
the part.  The skin covering these muscular disorganizations
is moveable, and not at all altered in appearance.  The neigh-
boring  lymphatic  glands frequently swell.  A change in the
weather causes pain in the muscular swelling.
  Such muscular disorganizations generally take place in the
flexor muscles of the forearm, in the muscles of the eye, in
the sterno-cleido-mastoideus muscles, in the posterior cervical
muscles, especially the  transversalis colli;  in the pectoralis
major, the gluteus maximus, and in the gastrocnemius mus-
cle.   These  muscles and  the corresponding  parts become
contracted.
  The tongue and lips are likewise liable to such contractions.
In the tongue the exudation generally takes  place in a por-
tion of the hypoglossus muscle «nly, very seldom in the whole
substance of the muscle. The  tongue is swollen, the  tumor is
hard  and  seated within  the substance of the tongue where it
constitutes a more or less  circumscribed, globular elevation,
which is exceedingly sensitive to motion.  Talking, chewing
and even swallowing are impeded.  This affection is frequently
confounded with cancer, not to the benefit of the patient.  In
this affection there are never any lancing pains, nor is the
surface of the tongue indurated or warty as in cancer.
  Syphilitic affections of the tendons are more frequent than 
MUSCLES  AND  TENDONS.              169
those of the muscles.  They are characterized  by circum-
scribed,  hard,  rounded  or irregularly-shaped thickenings
which  are  painful   only  at  the  commencement.   These
tendinous swellings  are likewise  occasioned by exudations
in the sheath or in the substance of the tendons, which at
first are  liquid, gradually become  organised, and afterwards
acquire a calcareous  consistence.   The  swelling constitutes
a perceptible prominence on the tendon, and, if  situated on
tendons adjoining the skin, as in the palm of the hand, in
the  wrist-joint, on the  tendo Achilles, the  skin  and  the
swelling  coalesce ; a few bunches only are perceptible to the
touch.
   For tertiary affections of the muscles and tendons,  the
following remedies will be found most appropriate :
   Angustura spur., Aconit., Alum., Ammon. carb., Acidum
nitr., Arsen. Ammon. mur., Bellad., Baryt.  carb., Berber.,
Coccul,  Crot., Caust.,  Colch., Carb. animalis, Euphorb.,
Euphras.,  Graphit.,  Guajac, Hyoscyamus,  Ignat., Indigo,
Kreosot., Laches., Lycop.,  Mercur.  sol, Natr.  mur., Nux
vom., Opium, Oleand., Plumb, acet.,  Petrol  Ranunc bulb.,
Rhus tox., Sabina, Secalc, Sarsap.,  Sepia,  Spigelia, Stra-
mon., Silieea, Spongia, Sulph.,  Thuja,  Veratr.,  Zincum.
   [Among this large  number of remedies we have to distin-
guish
   1.  Such as refer to purely syphilitic  condition.
   2.  Such as refer to syphilitic conditions complicated with
rheumatism.
   3.  Such as refer  to a complication of syphilis and scro-
fulosis ;  and
   4.  Such  as  correspond to  syphilis complicated  with
general  debility.
   Among the first class  we number Acidum  nitricum, Kali
hydriodicum, Mercurius sol,  Sabina,  Thuja; the two  last
named  particularly,  when the  affection can  be traced to
sycosis.
   To the second  class belong Aconite,  Belladonna,  Colclri-
cum, Guajacum, Mercurius solub., JSuxvom., S<pia, Sulphur;
                            12 
170
TERTIARY SYPHILIS.
 Aconite  and Belladonna being  principally  indicated when
 inflammatory  symptoms are present,  the  swellings feel hot
 and sore, and the least attempt  to extend the  parts causes
 pain.
   Guajacum is more particularly indicated when the posterior
 muscles of the legs are the seat of the  disease, with lancina-
 tions from the feet upwards.
   Mercurius,  when the parts are stiff  and ache, without the
 pain being very acute ;  the patient feels chilly when exposed
 to the least breath of air.
   Colchicum may be used if Aconite  seemed  indicated but
 did  not  produce  the desired  effect, or it may be given in
 alternation  with  Aconite, especially if the derangement was
 caused by exposure to wet or a draught of air; Rhus tox. is
 likewise indicated in this disease.
   Sepia and Sulphur are more particularly adapted to chro-
 nic forms of this disease.
   The third class comprises the following remedies : Aconite,
 Belladonna,  Baryt.  carb., Graphit.,  Lycopod.,  Sarsap.,
 Silic, Spongia and Sulphur.
   Belladonna, Spongia, and Sulphur  may be  used first in
 preference to  the other  medicines,  not  omitting,  however,
 the exhibition  of the mercurial preparations which  cannot be
 dispensed with in  any form of the disease.
   If the syphilitic affection is accompanied with a general
 sinking  or debility  of the constitution,  we may  use  the
 remedies  mentioned  in  the  fourth  division,  principally
 Arsenicum, Baryta, Carbo.  anim.,  China, Ignatia, Olean-
 der, Plumbum acet., Sepia,  Veratrum, although any of the
 other medicines may likewise be indicated.]

        V.  Tertiary Affections of the Eyes.
  Beside the iritis syphilitica which  Ricord numbers among
the secondary  affections of the eyes, he speaks of tertiary
affections of these organs, which have never been mentioned
before by any  author.
  Tertiary affections may either involve the eye  itself, or its 
affections  of the eyes.
171
 appendages, or the neighboring parts.  These affections may
 occur  alone without  any  other  part  of the body being
 diseased.  Ricord  treated  patients  for  diplopia in whom,
 after death, the muscles of the eye were found altered in the
 same manner as  other  muscles are.   Most patients whose
 eyes are affected in this manner have an excellent vision;
 but  as soon  as  they look upwards or  sideways, every thing
 appears   to  them  double; this  alteration  of  the visual
 functions occurs quite suddenly,  and ceases  again as soon
 as  the original  direction of the  eye is restored.  In some
 cases the muscles of the eye  were  contracted to such  an
 extent that the patient squinted.  Ricord treated one patient
 for  strabismus convergens, the outer  muscles  having their
 natural  mobility and  length.   According  to  this physician
 the most frequent  contractions occur in the inferior rectus
 muscle, in consequence of which the eyeball may  be  perma-
 nently drawn downwards out of its horizontal axis.
  Beside these contractions of the muscles of the eyes, there
 are alterations of the visual functions arising from syphilitic
 affections of the sclerotica.  This membrane may, like  the
 other fibrous portions of the  body,  undergo alterations  of
 tissue which exercise an important influence upon the shape
 and  functions of the eye.  Alterations of the  nervous struc-
 ture of  the  eye may likewise  lead to  amaurosis.   Ricord
 relates  several cases  of amblyopia occasioned by tertiary
 syphilis,  and the  same  author  gives  it as  his opinion that
 lenticular or capsular  cataract  may likewise arise from  the
 action of the syphilitic miasm upon the lens or its enveloping
 membrane.
  The following remedies may be of  use in the treatment of
 these affections of the  eye:
  Alum., Agaric, Ammon. carb., Arsenic, Aurum,  Baryt.
 carb., Bellad.,  Con.,  Digit.,  Euphorb., Graphit.,  Hyosc,
lod., Nitr. acid., Petrol, Pulsat., Secale, Stram., Veratr.
  [For contraction of  the muscles of the  eye, we may use:
Aconite,   Belladonna  and the  more penetrating mercurial
preparations such as Mercurius corrosivus,  dulcis, ruber. 
172
TERTIARY SYPHILIS.
  For disorganizations of the lens and membranes of the eye,
Belladonna, Arsenicum, Acidum nitr.,  Cannabis, Iodine,
may be given.
  For alterations of the nervous functions, we have Bella-
donna,  Conium, Digitalis, Hyoscyamus, Stramonium, Tussi-
cago 2>etasites.]

VI. Tertiary Affections  of the  Nerves and  Central
                    Nervous Organs.
  Syphilis may affect the brain and spinal marrow idiopathi-
cally.   Alterations of the meningeal membranes, after  the
bones of  the  cranium or of the vertebral  column have been
destroyed by syphilis, must necessarily affect the functions of
the brain  or spinal column, but these derangements would not
be idiopathic.   It is Ricord's opinion that the syphilitic poison
affects directly the nervous centres.  In the brain of persons
who had died of syphilis, he found tubercles which bore great
resemblance to syphilitic deposits in other parts of the body.
Such  tubercles in the brain or spinal marrow must  of course
produce marked alterations  in the cerebral or  nervous func-
tions  during the life-time of the patient,   And it  is indeed
true that the motor and sentient powers of syphilitic patients
are affected in a manner which can only be traced to syphilis.
  One  of the most  frequent disturbances  of both the motor
and sentient nerves  is  paraplegia.   Ricord gives it as his
opinion, that  syphilis is a very  frequent  cause  of general
paralysis  or paraplegia.  It is only recently, that the disco-
very was made, that syphilis may cause a  paralysis of the
seventh pair of nerves.   In the "Deutsche Klinik," Knorre
relates several cases of paralysis caused by syphilis, which he
treated in the Hamburgh hospital; among them two cases of
paralysis  of the facial nerve, and several cases of diplopia and
amaurosis.
  Epilepsy and catalepsy are likewise  caused by tertiary
syphilis.  Ricord relates the case of one of the most distin-
guished actors of Paris whom he treated some  years ago for
syphilitic epilepsy.   This gentleman had been treated in vain 
DISEASES OF  THE NERVES.
173
by a number of the most distinguished physicians of Paris;
Ricord undertook an anti-syphilitic course of treatment, and
removed the attacks in some months.
  We must not forget to mention  a  peculiar derangement of
the nervous system caused by syphilis, and which is undoubt-
edly noticed by every practitioner;  Ricord terms it syphili-
phobia.  This  is  one of the worst  forms of hypochondria.
Without a single sign of syphilis being perceptible any where
in the patient's constitution, he nevertheless fancies that he is
affected  with the disease.  This imaginary syphilis is a fixed
idea with such  patients ; it does not  leave them by day or by
night; the least spot, pustule, pain, is a symptom of syphilis.
Such patients are a perfect burthen  to themselves, to others,
and particularly to their  physician; they come to him  for
every little trifle, show him their tongues, ask him to examine
their private parts or the interior of the throat; the least red-
ness and secretion of mucous causes them great trouble, and
confirms them in  their apprehensions.   They examine them-
selves in the looking-glass,  look  at their  tongues, and feel
unhappy if they discover a few small papillae, or if the orifice
of the Stenonian duct excites their  attention. In this way they
go about, physicking themselves as advised  either by quacks
or physicians, until their constitution is ruined.
   We have found the following remedies the  most efficacious
in  derangements  of the nervous functions from syphilitic
causes:
   Acid,  nitr., Anacard.,  August.,  Arnica,  Arsenicum,
Bryon.,  China, Cocculus, Colchicum, Nux vom., Oleander,
Plumb., Plumb, acet, Sepia, Silieea, Stannum,  Zincum.
   [Anacardium will be  found particularly useful when  the
functions of the special  senses, and  the intellectual functions
are  impaired;
   Angustura  for  cramps,  spasms  of the  spinal  marrow,
especially when of a tetanic nature;
   Arnica, Arsenicum and China, when  the  patient com-
plains of debility, the flesh becomes flabby, looks sickly and 
174
TERTIARY SYPHILIS.
 sallow, the appetite is poor, sleep disturbed, the reproductive
 functions are declining;
   Nux vomica, for derangement  of the sentient  functions,
 numbness and creeping in the  extremities, spasmodic  twitch-
 ings, constipation, load at the stomach;
   Plumbum  acet.,  atrophied  condition  of the  extremities,
 paralysis, dulness of the mental powers;
   Iodine, for a similar condition as Plumbum.
   Zincum, general emaciation, colliquative discharges, chronic
 headache, sleeplessness.]

 VII.   Tertiary Affections  of the  Parenchymatous
            Organs and Syphilitic Cachexia.

   We have shown in the course of this work,  that  the  first
 tendency of syphilis is to the skin and mucous membranes ;
 as it progresses it invades the fibrous membranes, the  bones,
 muscles, tendons, and even nerves.   These  different organs
 are  liable to the most  horrible  disorganizations  from  the
 syphilitic virus, in  consequence of which  the  organism  is
 sadly and frightfully undermined.   But the  destructive  pro-
 cess goes much farther, and even invades the parenchymatous
 organs   of  the  interior  cavities.   Until  recently,  these
 syphilitic affections  of the inner  organs  were little heeded
 and even unsuspected.  And yet many deep-seated affections
 of the liver, larynx,  lungs, and even the heart and brain, are
 enkindled by the syphilitic poison.
  Professor Dittrich, of Erlangen, was the first who  instituted
 extensive inquiries into the syphilitic affections of the liver,
 and communicated the results of his inquiries in the "Prager
 Vierteljahrschrift."   According to his observations, the sub-
stance of the liver is never wholly, but only partially attacked
by the syphilitic process which consists in partially organized
 exudations caused by inflammatory action.   These inflamma-
tions are usually cured, only leaving cicatrices behind.  With-
out giving any further account of the distinguished pathologico
anatomical investigations of  the Professor,  we will simply 
cachexia.                     175
state  that  the further progress of  the  disease in the liver
leads to suppuration of this organ.
  Not only the liver, but also the spleen, kidneys  and even
the  thyroid   gland   are involved  in  this  process,  which
ultimately leads to dropsy and death.   Such  morbid altera-
tions of parenchymatous  organs constitute the  remotest forms
of constitutional syphilis.
  A syphilitic derangement of the liver announces itself  in
the first place by jaundice, bloating of the liver,  disposition
to diarrhoea and derangement of the digestive functions ; after-
wards the syphilitic  cachexia  which we  shall  describe  more
completely hereafter, develope themselves.   It is undoubtedly
true,  that the abuse  of mercury aggravates the  affections  of
the liver.   The  process  of exudation  which is going  on  in
the liver, excites  inflammations,  swellings and sanguineous
engorgements of the liver, and, if the  enveloping membranes
of  the  liver  are  inflamed,  a dangerous  local  or general
peritonitis may ensue.  A general syphilitic  cachexia winds
up the malady.  The skin becomes sallow,  livid or yellowish.
The fat vanishes, the muscles grow thinner, the strength fails,
and even  sight  and  hearing  grow  weaker; the  process  of
sanguification  is  altered,  and   a  state  of anaemia  and
hydraemia, with their consequences,  such as dropsy, etc.,
set  in.  The  blood-disks  are less  in number.   These pheno-
mena of  a disturbed reproduction of  the  blood  are accom-
panied by palpitation of the  heart, murmurs in the arteries,
and chlorotic symptoms.  In some  cases, intermittent  or
remittent fevers, disposition  to  sanguineous  extravasations
under the skin (scurvy, purpura haemorrhagica, etc.,) effusions
of  blood  into the  lungs,  bowels,  interior  of the bones;
atheromatous processes  in  the  larger  arteries and  lastly
dropsy supervene.
  Since his first communications, Professor Dittrich has pub-
lished a  new series  of observations,  and has  added  new
reasons for the confirmation of his views.
  The cases which came under his notice, were divided  by
him into  three  groups,  the  first  of  which  confirmed the 
176
TERTIARY SYPHILIS.
co-existence of an inflammatory process in the liver and loss
of substance of the vault of the palate and of the fauces.
   The second group  contained four cases without any appa-
rent affection of the fauces, but with sufficient symptoms of a
syphilitic diathesis  to permit  one to ascribe  the  affection of
the liver to the previous action of the syphilitic  virus.   He
likewise directs attention to the exudations into the substance
of the lungs, which were characterized by similar symptoms
as the exudations into the substance of the liver, whence the
Professor concludes that the pulmonary exudations  are like-
wise of syphilitic origin.
   In the third  group we have two cases where the exudative
process in the  liver, and the  transformation  of  the exuded
fluid  into pus, still exist in their original form.    From the
fact that  some portions  of the liver are already cicatrized,
whilst new  exudations  are  going on in other portions, the
Professor argues the chronic character of the exudation.
   Ricord has shown with a good deal of accuracy  that similar
morbid processes may be going on in the lungs.   A consider-
able number of post-mortem examinations have led him to the
opinion that there are pulmonary affections which have to be
charged upon the presence of syphilitic  tubercles.   It is  true
Ricord has arranged  this morbid process side by side with
syphilitic tubercles  or gummata  of  the outer skin.  These
adventitious growths  run the  same course in  the lungs as in
any  other portion of the body;  the swelling has the  same
form, runs the same course, and likewise terminates in suppu-
ration.   The patients raise pus, the same as in the last stage
of phthisis tuberculosa ; they grow thin, feeble, and  soon die
from this extreme derangement of the respiratory functions.
   A development of the  syphilitic tubercle may  involve the
neighboring parts.  For instance, if the palatine  vault or the
Schneiderian membrane should be affected, the adjoining bones
and  cartilages may become  involved in  the disorganization.
This  may lead to syphilitic  perichondritis and  to syphilitic
laryngitis and syphilitic phthisis of the larynx.  We have had
several cases of  this  destructive  malady to treat.   Porter, 
CACHEXIA.
177
Hasse, Albers, Jansen and  Rokitansky, all mention this dis-
ease, and Rokitansky moreover attributes it to the action  of
mercury.  According to Dittrich the laryngeal disease is not
a form of genuine primary perichondritis, but an affection that
first invades the soft parts, and gradually induces a syphilitic
stricture of the larynx (laryngosthenosis.)  A portion of the
exudation or even the whole of it, changes to a fibrous, callous
growth, encroaching  upon the internal space of the larynx.
Sometimes a portion of the exudation changes to pus, forming
ulcers of various shapes and  dimensions.    If a deep-seated
portion of the exudation, which is in contact with the carti-
lage of the larynx, should change to pus, the destruction  of
the cartilage and necrosis of  this organ become unavoidable,
and abscesses round  the laryngeal cartilages are the natural
result.
   Ricord states  that he  saw tubercles  in a heart, some  of
which were about to soften.   Similar tubercles were seen  in
the lungs of this  same individual, and on the skin some  of
the same kind of  tubercles were already softened.  There had
not been any symptoms of genuine tubercular phthisis in this
patient, previous to his contracting syphilis; it seemed, there-
fore, rational to attribute the presence of tubercles in his case
to the action of the syphilitic virus.
   Accordingly Ricord advises whenever we have to deal with
inexplicable, deep seated, mysterious, disguised derangements
of the functions,  and there  is  the  least  reason to suppose
that the  trouble  arises  from  syphilitic taint, to institute an
anti-syphilitic  treatment.   He  thinks that  if this  course
had  been  pursued,  a pretty fair number  of consumptive
patients might have been  saved.
   The following remedies either cure or palliate this disease:
   Acid,  nitr., Acid, phosph.,  Arsen., Alumina,  Bryon.,
Carbo. animal,  Carbo.  veget.,  Calcar. carb., China, Chin.
sulph.,  Iodine, Kali  carbon.,   Lactura  vicosa,  Lycopod.,
Mercur.  viv., Mercur.  sol,  Mercur. dulc,  Nux  moschat.,
Plumb.,   Plumb,  acet.,  Sabad.,  Secale,  Sepia,   Sulphur,
Thuja. 
178
TERTIARY SYPHILIS.
   [Particular indications for each  of these  remedies are of
course interesting and important, but the symptoms are so
various that it seems almost impossible to furnish a complete
list of the symptomatic characteristics to which each of these
remedies corresponds.  We will  therefore content  ourselves
with  the  principal outlines of each  remedy, and  refer the
reader to the symptomen-codex.
   Acidum nitricum: Signs of a general decomposition of
the  fluids;  scorbutic symptoms  in  the  mouth ;  ptyalism  ;
foul ulcers of the gums and tongue ;  bleeding of the gums  ;
ulcerative soreness of the hairy scalp ; falling off of the hair;
difficulty  of  hearing; humming  and roaring in  the ears;
ulceration  of the nose  with  yellow and fetid  discharge;
ulcers in the  throat with  putrid  smell from the mouth;
costiveness, with dampness and itching of the anus ; scraping
sensation  in  the  larynx  with dryness and hoarseness,  also
cough with expectoration of black coagulated blood ; weak-
ness of the extremities ; soreness  and lameness of the joints;
anxious dreams at  night; blotches  and  boils on  the skin;
sallowness of the  skin ; spasms and epilepsy.
   Phosphori acidum may  be used for  symptoms  similar
to  the  former,  especially when  there is a complication of
symptoms arising from loss of animal fluids, onanism;  the
joints are more particularly involved; humid, itch-like erup-
tions on the forehead, face, back, thighs; inveterate ulcers
secreting a bad pus, with  shaggy  borders  and a burning  and
stinging pain ; the  lungs seem  invaded by the   syphilitic
process, with dry cough, also bloody cough.
   Arsenicum:  General sinking of strength; bloating, as if
dropsical; scaly; also malignant eruptions  or ulcerations  ;
fetid diarrhoea, or exhausting  bloody diarrhoeic stools with
constant and distressing urging ;  pale face ; jaundiced color
of the skin ; trembling of the limbs ; arthritic and rheumatic
pains in the limbs diminished by moving the parts.
   Carbo veget. may be used, if Arsenic, should not procure
the relief intended,  and more particularly if symptoms of 
CACHEXIA.
179
dyspepsia, acidity of the stomach, palpitation of the heart,
are present.   In such a case
   Carbo animalis may be tried, instead of vegetabilis.
   Iodine corresponds to glandular disorganizations, atrophied
conditions of the extremities, mercurial complications.
   Mercurius sol and dulcis: disorganizations of the tonsils,
ulceration of  the throat,  mouth, skin, bone-pains, especially
in bed,  and more particularly about the skull, with excessive
painfulness of the hairy scalp; costiveness,  dry, hard, and
lumpy stool, urine depositing a chalk-like and purulent sedi-
ment.
   Plumbum acet:  Melancholy mood, emaciation,  debility,
anguish about the heart, flaccidity and paleness of the muscles,
hectic fever, ptyalism.
   Sulphur: Itch-like eruptions, ulcers on the  tibia, mercu-
rial complications, ptyalism, bleeding of the gums, tumors in
the joints of the arms and feet.
   Thuja: Syphilitic dyscrasia, characterized by condyloma-
tous excrescenses with a broad base, discharging  pus and
blood;  pressure in  the  region  of  the  bones, here and there,
accompanied by a pricking, scraping  sensation; headache as
if a button  were pressed against the skull.
  For syphilitic perichondritis,  the best remedies are: Bella-
donna, Hepar sulphuris, Drosera, Spongia, Causticum.
   Drosera and  Spongia are particularly adapted to  a dry,
spasmodic cough, principally troublesome  at night.
   Kali biehromicum, if the cough is accompanied with ulcera-
tive pains in the region of the larynx, and raising of pus from
the painful spot.
   Causticum, when  the weakness in  the larynx is  charac-
terized by permanent hoarseness and weakness of speech.] 
180
SYPHILIS OF  LITTLE CHILDREN.
                 Syphilis of little Children.
  Constitutional syphilis may be transmitted by the father or
mother to the fetus, but it is  very rare that infants are infected
by the mother during the passage of the child through  the
vagina.
  In congenital syphilis the  primary ulcers are wanting ; how-
ever,  the disease exercises  considerable  influence upon  the
fetus in the uterus, and a large number of syphilitic mothers
either miscarry or their children are still-born.  This is espe-
cially the case where both parents are affected by the disease.
The still-born infant exhibits all the traces of a deeply-rooted
syphilis.   Weakly children  born  at full term, or premature
children die either during or shortly after their expulsion from
the womb.  Many children tainted with  congenital syphilis
seem to be robust and healthy at  birth. A few days or weeks
elapse before syphilitic symptoms are perceived.   But at  the
expiration of two or three weeks, and in rare cases, of the second
month, the first signs of the disease make their appearance.
  Children affected with congenital syphilis, are uneasy even
a few days after their birth; they cry day and night, emaciate
very rapidly, their face looks old and  withered,  and their
eyes are sunken.   Soon after there appear in  the region of
the sexual organ, groins, on  the thighs, heels, buttocks, round
the anus, and even in the umbilical region, and sometimes all
over the  skin, circumscribed spots of a bright copper color,
rising speedily above the skin in the shape  of blotches, and
sometimes  running together, especially at  the  soles of  the
feet,  and covering them  entirely.   The  same  phenomenon
soon after developes itself on the  palms of the hands.  Simul-
taneously a papulous  eruption, which  afterwards  changes to
small, dirty-yellow pustules  surrounded with a broad areola,
breaks out on the chest, back, in  the face, and  on the hairy
scalp.   On the inflamed portions of the feet, hands and anus,
tuberculous elevations start up, which become  covered with
blisters resembling pemphigus ; these blisters change to exco-
riations and afterwards to deep ulcers, particularly between 
SYPHILIS OF LITTLE  CHILDREN.
181
the toes, on the heels, in the inguinal folds, at the perinaeum
and in the axillae.   At  the anus ulcerated rhagades develope
themselves.
   In  spite of the characteristic nature of these phenomena,
mothers seldom pay much attention to them unless they should
have become quite serious.  They generally look upon these
symptoms as common soreness, and employ such common domes-
tic remedies as the nurse or some old woman may advise. Some-
times the eruption disappears without any medical treatment.
Frequently, however, superficial ulcers in the corners of the
mouth and in the nose show themselves.  The child is attacked
with a discharge from the nose which at first looks like catarrh.
Gradually the discharge increases, the conjunctiva and espe-
cially the margin of the eyes, the Meibomian glands become
inflamed and  suppurate. The ulcers in the corners of the
mouth penetrate more deeply,  their edges become raised and
red.  The voice sounds  hoarse, thin  and  moaning.  Haemor-
rhage from the mouth and nose sets in ; the latter is frequently
stopped up with  crusts, by which  the  nursing is rendered
difficult; the breathing  is accompanied by  a slight rattling.
the head breaks out, and some of the lymphatic glands swell.
Ulcers  break out in the fauces, deglutition becomes painful,
the voice has a peculiar,  hoarse sound.  Such children seldom
live longer than one year, for the syphilitic disease becomes
complicated with acute tuberculosis of the brain.  If the child
does not perish in this manner, the  syphilitic cachexia deve-
lopes  itself.  The  child becomes chlorotic, the skin  assumes
a dirty gray-yellow color like wax, a complete state of anaemia
developes itself, the reproductive system is  prostrate, and the
child  dwindles  down to a skeleton.   Not unfrequently these
symptoms assume the form of scrophulosis,  or chronic hydro-
cephalus developes itself.  Congenital  syphilis in children,
generally runs a  very  rapid  course, and, unless  speedily
arrested by proper treatment, terminates fatally.
   If the infection dates  from the passage of the child through
the vagina, or if it took place while the child was nursing—the
former  is  supposed  to  take  place  during  slow labor—the 
182           SYPHILIS OF LITTLE  CHILDREN.
 above-mentioned eruption is principally seen on parts where
 the  skin  is  delicate and deprived of the cheesy covering,
 namely, the  neck and  the sexual parts;  the course of this
 form of the disease is the same as that of congenital  syphilis.
   Cazenave  does  not  admit  the  possibility of congenital
 syphilis.  He points out  the fact that there is perhaps not a
 single well authenticated case of syphilis communicated to the
 child during its  passage  through  the vagina.  He believes,
 however, in the possibility of syphilis being transmitted to a
 child by the influence of the milk, and while at the breast.
 Moreover, he thinks that  the disease is much more frequently
 inherited from the father than  from the mother.
   According to this same author, the syphilides of nurses are
 exceedingly injurious to children.
   In little children, affected with congenital syphilis, Wallace
 has seen a peculiar cutaneous disease, of which no mention has
 yet been made any where, and  which he describes as  follows:
   There appear  on various parts of the  body, especially on
 the back, isolated papulae of the size of peas and rather hard;
 they remain  unaltered for four or eight weeks, and then grow
 gradually to the size of a bean, never larger.  They are seated
 in the sub-cutaneous cellular  tissue, the skin over them is
 moveable, and  adheres  to the  eruption the  more intimately
 the larger it grows.  After a while a number of these little
 swellings  change to abscesses  which  break in  the  middle,
 discharging a  thick, dark, bloody pus,  and  then  becoming
 covered with a blackish scurf, beneath which they heal  very
 soon.  The  ulcerative  process  is accompanied with  loss of
 substance, and the  cicatrices retain for a long time a hard-
 ness and a blue-red, livid  color.
   There are generally from  fifty to one  hundred  papulae
which break  out  at various periods, so that they exist upon
the skin in  all their various stages.   Some  of them remain
small, others run the course just described,  all are isolated.
There is no pain or fever; only if the skin remains inflamed
after the falling off of the scurf,  some pain is experienced.
   The patients were all less than a year  old;  the eruption 
              SYPHILIS OF  LITTLE CHILDREN.          183

was accompanied by other syphilides, such as scales and pus-
tules, and  more particularly  flat tubercles.  Most of these  .
patients died in a  state of cachexia.
   Syphilis of little children has been investigated in Sweden
by a special board of physicians, with the following results :
   1.  There is no diagnostic  sign  by which a cutaneous dis-
ease, pustule or ulcer, when first showing itself on a nurse or
infant, could be tfaced to syphilis.
   2.  A syphilitic father may procreate a syphilitic child with-
out infecting  the mother.
   3.  We cannot  as  yet  admit that a nurse's  milk is  alone
capable of infecting an infant with syphilis.
   4. Nor can a nurse  be infected by  an infant tainted with
latent syphilis.
   5. Secondary syphilis is less  contagious than primary.
   6. A child which  is apparently healthy, when taken from
 a syphilitic nurse and transferred to a sound one, may  infect
 the latter.
   7. In case the life of the child should be jeopardized by
 feeding, a physician would not  be justified by the bare  sus-
 picion of syphilis in  the  child or nurse, in depriving it  of the
 nurse's milk.
   8. No law should  be enacted  to prevent a nurse from  volun-
 tarily nursing an infant which she knows to be syphilitic.
   9.  In  order to limit, if not to eradicate syphilis in foundling
 hospitals, every infant should have its own nurse.
   10. If a  child, whose parents  are  altogether unknown, is
 o-iven to a nurse, she ought to be warned against the possible
 danger of syphilis.
    11. Sores on the breasts should be attended to with great
 care, and, if possible, only such nurses should be engaged as
 have had children at the breast for some time.
    12. There is no precise period when the first signs of  con-
 genital syphilis first show themselves.
    13. On account  of  the  possibility  of relapses,  children
  that have been cured of syphilis, should be carefully watched
  for a year longer. 
184
SYPHILIS OF LITTLE CHILDREN.
   In treating children for syphilis, it is above all  of import-
ance that they should not be exposed any longer to the action
of the syphilitic virus.   If  the mother or nurse  is infected
with syphilis, some other healthy nurse has to be selected.
Cleanliness, which is of the utmost importance in  the case of
full grown syphilitic patients, is so much more important in
the case of little children.   These little patients should be
bathed  every day, and kept in  a uniform, somewhat more
elevated temperature.   If these conditions  are properly ob-
served,  the homoeopathic  treatment of congenital syphilis
will be found much more efficacious than the allopathic.   In
most cases, a few doses of Mercurius sol. will be sufficient to
free the little patients of their sufferings, and to  prevent all
consecutive disorders.  Only in  very  few cases it will be
found  necessary to resort  to other  remedies.  If no  cure
should be effected by a few doses of Merc, sol., Mercurius
prsecipitatus  ruber., Mercurius dulcis., ox Vivusmaj be tried.
If the child should improve in looks, the ulcers should  heal
and the little patient gain flesh, we may safely conclude  that
the syphilitic  disease has been  reached in  its fundamental
principles, and if some symptoms  should still remain linger-
ing in the  organism, we  have to  treat them in  accordance
with the homoeopathic law,  lisimilia  similibus."   If circum-
stances should render it impossible to engage  another  nurse,
the  sick mother or nurse has to  be  treated  simultaneously
with the child, and the same remedies will have to be given. 
HYDROCELE.
185
                SECOND SERIES.

        Non-Syphilitic Diseases of the Sexual Organs.

   The number of non-syphilitic diseases of the sexual organs
is likewise very great.  They occur as frequently and are as
injurious  to  the organism as  the syphilitic  diseases.   Not
only  do  they  make  terrible inroads upon both body and
mind, and even destroy them entirely;  they deprive man of
the noblest function which God has appointed him to perform,
the pro-creation of offspring, and of the  sweetest delights
 which a man can enjoy, namely the delights of pure and true
 love.
   A  great many derangements of the sexual organs  arise
from  depraved  sensuality and from the horrible practice of
self-abuse  to the pernicious consequences of which  upon
body  and  mind we shall devote particular attention.   But
there are  likewise other affections of these  parts which owe
their  origin to either causes, abnormal, social or constitutional
influences, an abnormal structure of the parts, and a variety
of other more or less evident circumstances.
   We will first treat of the latter class of diseases, and after-
wards of those which are the natural consequences of sexual
abuse, together with the most appropriate treatment for  their
removal.

                        Hydrocele.
   By hydrocele we understand an effusion of  serum into the
tunica vaginalis  testis, and  into  the spermatic  cord.   The
tunica vaginalis of the testes and spermatic cord is  a serous
membrane which, like other serous membranes, consists of
two layers between which  a little serum is  seated on  its
inner surface.   This  serous membrane  is  always moist,
smooth, lubricated, owing to the serous fluid which is exhaled
                            13 
186
HYDROCELE.
by the blood vessels and absorbed  again by the lymphatics.
If more serum is secreted than is absorbed by the lymphatics,
it accumulates between the layers of the tunica vaginalis.
   This excess of secretion is  most frequently owing to san-
guineous  congestion  and an  inflammatory irritation of the
tunica vaginalis, and  sometimes developes itself quite rapidly.
   Hydrocele  may occur at  every age, even in new-born
children,  but  it is most frequent  among the  young.  The
most ordinary exciting causes are:  constant riding on horse-
back, bruises,  contusions,  badly applied trusses,  inflamma-
tions of the urethra and testicles.
   The scrotum swells to the  shape of a pear, generally on
one side;  the swelling is elastic, and if percussed simultane-
ously on both sides, fluctuation is perceived in it.  The lower
portion of the scrotum swells first;  sooner or later the swel-
liag rises  towards the inguinal ring.  The size of the swelling
varies, at  first from  the  size of a  pear to that  of a fist.
According as there is more or less serum in the tumor, it is
either soft and elastic, or' hard and tense, so that it might
easily be  confounded with  sarcocele,  which is very apt to
happen  in hydrocele  of  long standing where the  tunica
vaginalis is considerably thicker than usual.
  In some cases the swelling spreads as far as  the middle of
the thighs and even the knees, and is distinctly seen through
the pantaloons.   The skin of  the scrotum remains unaltered
except that the blood-vessels become a little more prominent.
   Hydrocele is not a painful disease, and what pain there is,
is generally slight, and  caused by the  pulling of the sper-
matic cord, and the pressure upon the testicle.
  The safest diagnostic is the transparency of the swelling,
if,  in a dark  room, a light is held in  front  of it, and the
swelling is examined from behind.
   The fluid which is  contained in  the swelling, is generally
clear, yellowish, frequently contains a number  of crystals of
cholestearine,  smells of semen, and consists of a quantity of
water, albumen, phosphates, sulphates, and muriates.   Less
frequently the fluid is turbid, green, brownish, or deep brown. 
HYDROCELE.
187
If the fluid is mixed up with a good deal of blood, the  affec-
tion is termed hematocele.
   Of itself hydrocele is  not a dangerous  disease.  Persons
may have it for years without  feeling any pain.   But if the
swelling grows  to  a  very large size, pains in the spermatic
cord and renal region may be experienced.   On  account  of
the  enormous size of the swelling, the penis becomes very
short;  sometimes it  is entirely  concealed, and sexual inter-
course becomes impossible.   The discharge of urine is inter-
fered with, and the emission of semen is likewise impeded.
   Hydrocele of young people, if  of  recent origin, may be
cured by the following remedies:
   Calcarea carb.,  Conium, Digitalis, Dulcamara, Mercurius
sol., Spongia, Staphys.
   [Of these remedies Calcarea and Spongia may be  princi-
pally used, when there seems to be a scrofulous taint pervad-
ing the constitution, and the reproductive system is depressed,
as indicated by loss of appetite, debility, emaciation, dryness
of the skin.
   Conium is particularly suitable when the affection can be
traced to mechanical injuries, contusions, etc.
   Dulcamara,  when  it arises from a cold,  suppression  of
tetters, suppression of momentary or  habitual sweat  by ex-
posure to a draught of air, dampness, etc.
   3/crcurius sol,  if the patient  had  been troubled, when a
little child, with soreness  and swelling of the  sexual organs,
especially of the prepuce, if he is liable to feeling chilly and
taking  cold during damp weather, with  sore throat worse
during  empty deglutition; if the  hair is  dry, falls out, the
patient is  troubled with sour-smelling night-sweats, costive-
ness, the alvine evacuations being hard, dark-colored, lumpy.
   Digitalis may prove useful if there  is a  constant desire to
pass water, or if the patient had had water in the brain when
a child.]
   In  the  case of little children we may use Pulsatilla and
Rhus tox.  in  the  commencement of the disease,  and  after-
wards Carbo veg.,  Graph., Helleb. and Iodine. 
188
VARICOCELE.
   [Graphites is particularly useful  in such cases.  Iodine  is
adapted to a general scrofulous taint, characterized by glandu-
lar swellings, emaciation.  Helleborus when the child had
had water on the brain, or dropsy after scarlet fever.]
   In the case of plethoric individuals, we may have to use
Arsenic, China,  Ignatia or  Nux  vomica;  (Arsenic  more
particularly if the glans penis is inflamed and  swollen, and
Nux vomica if  the patient has a ravenous  desire for meat,
bowels are costive, and  the patient is troubled with piles, and
has an irritable disposition.)   If the disease is of long stand-
ing, or very extensive, we may try Ferrum, Silieea,  Sulphur
and Zincum.  In old people,  where absorption  has become
impossible,  tapping,  or even  extirpation  may  have  to be
resorted to.

                   Varicocele, Cirsocele.
   By varicocele we mean a morbid  dilatation of the veins  of
the spermatic cords and testicles.
   The causes of this somewhat frequent disease  are, in  some
respects anatomical, inasmuch as the veins of the spermatic
cords form long sinuosities, and  are so arranged that blood
has overcome its own gravitation, which is rendered still more
difficult by the absence of valves in  the veins.   Persons who
are naturally disposed  to varices  and piles, are  liable  to
varicocele.  Beside these mechanical causes,  the disease may
likewise be  caused  by  excessive sexual intercourse, and by
onanism,  owing to the  permanently  increasing congestion
which these practices determine to the sexual  organs.  Habit-
ual costiveness becomes  a mechanical cause of this disease,  in
consequence of the reflux of the venous blood being impeded
by the hard faeces which are lodged in the lower portion  of
the colon.   This explains the fact why the disease occurs
more  frequently on the left  side, where the left spermatic
vein passes under the  last portion of the colon.   In  a similar
manner a tumor in and  on the abdomen, or a large hernia  of
long standing, may produce varicocele by pressure upon the
spermatic cord.   Constant riding on horseback, and continual 
VARICOCELE.
189
standing during work, likewise favor the development of the
disease.   Badly applied trusses, venous congestions of the
abdomen, or of the portal system, swelling of the liver will
sometimes cause the disease.  A varicocele of considerable
size, which involves the inguinal canal, may be mistaken for
scrotal hernia.  Its slow disappearance in a horizontal, and
its equally slow return in an upright position constitute char-
acteristic differences between the two diseases.
  Varicocele is  characterised by the  following phenomena:
A soft,  knotty and elastic swelling extends from  the scrotum
to the inguinal ring;  the nodosities readily disappear under
pressure, but reappear again as rapidly.  The scrotum hangs
down relaxed; the affected side is longer ;  the more the dis-
ease progresses, the longer and the more relaxed  becomes the
scrotum.  The swelling decreases in a recumbent posture, it
increases after standing and walking, hence the swelling gen-
erally reaches its  largest  size  in  the  evening.    On pressing
upon  the scrotum, a sensation as of a bundle of worms  is
experienced.  The pains are, upon the whole, not very con-
siderable ; at  times  dull pains in the loins and kidneys, a
feeling of heaviness, malaise, drawing in the spermatic cord
and  testicles; shooting, colicky stitches  are  occasionally
experienced in these regions, especially when the sexual desire
is excited without an  opportunity being given of gratifying
it.   Such shooting stitches are generally experienced  when
dallying with  a handsome woman.   The patients feel easier
bv supporting the scrotum with the hand.  On the inner side
of the  thigh  which is in contact with the diseased testicle,
the patients generally perspire a good deal;  the  sweat which
is generally of a corrosive character, frequently  causes a
troublesome eczema  on the scrotum  and thigh, sometimes
spreading to the  perinaeum  and  anus. The affection  never
endangers life, but is troublesome and wears upon the spirits.
At times the  pains  become  more acute, strike  to the renal
region and thighs; walking is impeded. These  disagreeable
sensations in  the sexual parts  cause depression of spirits,
fretfulness, and hypochondria.   The patients are continually 
190
VARICOCELE.
 haunted by the idea of being affected by an incurable malady,
 are frequently driven to suicide by such thoughts.
   As we have  said, the disease  is not dangerous to life, nor
 is the sexual power necessarily affected by it.  Nevertheless,
 if the spirit should be much affected, and  the disease  should
 have attained a high degree of development, the treatment
 will have to be conducted with care and energy.
   Lighter cases of this  disease may yield  to  cold hip-baths,
 suspensaries, and to the abstaining from all influences which
 have a  tendency to promote a  congestion of blood to the
 parts, such as:  sexual intercourse,  riding  on  horseback,
 dancing, constant walking or  standing, warm baths, etc.  For
 the depression of spirits  we may use: Belladonna,  Calc. carb.,
 Caustic, Conium, Lycopod.,  Pulsat.,  Sepia,  Tart,  stib.,
 Veratrum.
   Varicocele of the  labia majora  is of less frequent  occur-
 rence.  It is less troublesome  than varicocele of the scrotum,
 and generally yields to a few doses of Lycopodium.
   [The medicines may be used in  the following order:
   Belladonna, if  the  patient suffers with symptoms of con-
 gestion in other parts, especially in the head, and the swelling
 feels hot, hard, with stitching and throbbing pains.
   Calcarea carb.,  may be given in alternation with, or after
 Belladonna,  especially if the sexual  instinct is  very much
 excited,  the skin and hair are  dry,  the bowels are costive.
  Lycopodium and Sepia may be used  in  the place of Cal-
 carea, if the sexual desire is depressed and the sexual power
 is likewise very weak.
  Pulsatilla is  particularly suited to individuals of a pleg-
 matic, melancholy disposition,  and who are  subject to gastric
 derangements, mucous diarrhoea, bad taste in the mouth, etc.,
in recent cases.
  Aconite  will be found  eminently  useful in  raising the
nervous energies of the affected part, and  dispelling the en-
gorgement  of the vessels.] 
MENSTRUATION.
191
         Derangements of the Menstrual Functions.
  Menstruation is an exclusive function of the sexual organs
of the human female, and a regular recurrence of this phe-
nomenon is of  great  importance to a  healthful condition of
her sexual  powers.   Derangements, irregularities or suppres-
sions of the menstrual functions are frequently the cause of
many diseases of the uterine system, and even of sterility.
  The appearance of the menses, together with other changes
in the female organism, is a sign  that the sexual system of
the female  is maturely developed.   In one climate the average
appearance of  the menses is about the fifteenth year, and
their cessation  from the forty-fifth to the  fiftieth.   In warm
climates, among the inhabitants of the southern region, the
menses both appear and and cease  at an earlier period.   The
appearance of  the menses is hastened  by the woman's  mode
of life, her morals, the use of highly seasoned food, and pre-
mature sexual intercourse.  If the menses are regular, they
ought to reappear every four weeks.  In a  state of health,
they last four days, sometimes from five to eight days.   As a
general rule, the menses  do not flow during pregnancy and
while the woman is nursing; in a very few cases, however, the
menses were known to have continued during pregnancy.
  This monthly discharge of blood, which is necessary to a
healthy female, is subject  to frequent derangements and
irregularities which require an appropriate medical treatment.
The menses are frequently preceded or accompanied by pains
in the sacral  region and  abdomen, drawing in the thighs,
stitches in  the  breasts, headache, vomiting and other nervous
symptoms.  During the menstrual flow the woman is  gene-
rally paler  than usual, tired, not disposed  to work; the eyes
are  somewhat  sunken, surrounded by blue margins.   Such
symptoms are of no importance, and do not require the  inter-
ference of  art; as soon  as the menses cease, the woman's
spirits become  brighter, and the desire for sexual intercourse
is restored. 
192
AMENORRHCEA.
  Suppression of the menses at a period when they ought to
flow with regularity, is a morbid condition of the organism,
termed amenorrhoea.
  This condition is characterised by a variety of troublesome
symptoms. About the  period when the menses ought to flow,
the patients frequently complain of violent pains in the small
of the back and loins, drawing and heaviness in the feet, more
frequent urging to urinate, malaise in the abdomen, irritable
mood, and hysteric  spasms.   Signs  of congestion in other
organs are frequently present,  such  as headache, vertigo,
buzzing in the ears or oppression of  the  chest, spitting of
blood, palpitation of the heart, cramps in the stomach, vomit-
ing, etc.   Even convulsions may set in; in the more favorable
cases the  nose bleeds.  Between these periodical paroxysms,
symptoms of plethora are frequently present,  the patients
feel heavy,  weary, their  sleep  is uneasy.   In many  cases
chlorotic  symptoms  gradually develope themselves and may
even terminate in dropsy.                        ,
  In amenorrhoea the  menses are retained from the first; an
accidental suppression of the menses  after  they  had made
their appearance, is termed menoschesis.
   The menstrual suppressions may either be  complete, where
there is no flow at all, or only partial, with scanty discharge.
   The menstrual  flow may be suddenly arrested by violent
emotions, such as fright, anger;  exposure of the feet, chest or
sexual parts  to  dampness, a  draught of air,  keen winds;
immoderate dancing;  leaving  off a  portion of the under-
clothes ;  suppression of sweat  on the feet;  coit  during the
menses; fever and other acute diseases.
   Scanty menstruation occurs in chlorotic females, affected
with leucorrhoea, or after considerable losses of  the animal
fluids, after severe diseases,  puerperal fevers, or in conse-
quence of deficient care and food.  It  has often been observed
that women of the age of thirty or forty suddenly gain flesh,
whereas,  at the same time, the menses flow more scantily, and
 even sterility sets in.  Diseases of the uterus,  ovaries and 
DYSMENORRHEA.
193
vagina may induce scanty menstruation or a  complete sup-
pression of the menstrual flow.
  Suppressed or scanty menstruation is generally accompa-
nied by congestions, hcemorrhages from the  nose,  mouth,
stomach, bowels, lungs, bladder, rectum, skin,  breasts, or
from existing ulcers.  The nervous system is likewise affected,
and we have hysteria, epilepsy, corea, catalepsy, spinal irrita-
tion, cardialgia, neuralgia,  somnambulism, mental  derange-
ments, paralysis, etc.  Disorganizations leading to consump-
tion, hectic fever and dropsy may likewise set  in.
  In investigating the  causes  of menstrual suppression, we
have to pay particular attention to the probable existence of
pregnancy.  The general  phenomena, such as  nausea, vomit-
ing, nervous derangements, congestions, etc., are  very much
alike in both conditions; the abdomen may even  bloat  con-
siderably.   Some women, especially when young, and recently
married, mistake  the  symptoms of amenorrhoea  for preg-
nancy.
  Dysmenorrhoea  is another form of menstrual irregularity.
It is a flow of the  menses accompanied with  much distress.
The discharge is not suppressed, but sometimes preceded for
several days ; and accompanied by acute distress.
   Sometimes  the  flow is excessively copious, and  almost
resembles  haemorrhage.  General debility,  anaemia,  dropsy
and sterility may arise  from  such a  state.
   For amenorrhoea the following remedies will be found most
suitable:
   Baryt.  carb., Belladonna,  Calcar.  carbon.,  Causticum,
Coeeulus,  Conium, Dulcam., Kali,  carb., Lycop., Magnes.
mur.,  Mercur. sol, Mezer., Natr.  mur.,  Pulsat., Sepia,
Spongia, Staphys.
   For menstrual suppression we give :  Arsen. alb., Alum.,
Con.,  Coccul, Ferrum, Ignat., Graphit., Natr.  mur., Nux.
vom., Platin., Plumb., Opium, Sepia, Sulphur.
   In  dysmenorrhoea the  following  medicines have proved
efficacious:
   Aeon., Antim. crud., Au.um., Bellad., Calc. carb., Carlo. 
194                  MENSTRUATION.
veg.,  Coccul,  Conium,   China, Graphit.,  Ipec,  Iodine,
3Iagnes. carb., Natrum, Natrum mur., Nux mosch, Phos-
phor., Pulsat., Stramon.,  Sulphur,  Veratr.
   I have derived particular benefit from  the alternate use of
China and Nux vom,
   In menorrhagia or excessive  menstruation, I have  given
with great success :
   Acid,  nitr., Aeon., Arnic,  Arsen.,  Bellad.,  Chamom.,
China, Crocus, Coccul, Ferrum, Ignat.,  Nux vom., Platina,
Sepia, Silieea, and Sulphur.
   [For the benefit of the reader we give  the following symp-
tomatic indications of the  principal remedies in this list:
   Aconite is  a great remedy for menstrual suppression  in
consequence of fright, exposure  to wet or  a  draught of air,
with soreness  all over, and particularly in  the lower part of
the abdomen ; oppression on  the chest, palpitation of  the
heart,  headache, dizziness,  buzzing in  the  ears; also  for
metrorrhagia, with burning sensation in the womb, the blood
is bright-red, the flow is accompanied with  chills and flushes
of heat, fainting  feeling, throbbing in the whole body, heavi-
ness of the lower limbs.
   Cocculus:  Premature menses, with distension  of the abdo-
men, contractive  cutting in the abdomen at every  movement
and when drawing  breath, sharp pressure  as from stones in
the distended  abdomen when sitting or moving, painfulness of
the distended  abdomen as from  an ulcer  ; amenorrhoea with
abdominal spasms, flatulence,  lameness,  anguish, oppression
of breathing, spasms in the chest, nausea with fainting sensa-
tion ;  painful menstruation with  copious discharge of coagula
and subsequent haemorrhoids ; suppression  or irregularity of
the menses, with  uterine spasms.
   Arsenicum : Painful menstruation, with  lancinations from
the rectum to the anus and pudendum,  or from the  pit of  the
stomach to the hypogastrium, weeping and moaning.
   Ignatia:  Scanty menstruation, with black blood, having
a putrid odor.
   3Iagnesia muriatica: Profuse menstruation, with pain in 
MENSTRUATION.                  195
the small of the back and thighs, also spasms in the ligaments
of the uterus.
   Nux vomica: Premature menses, more scanty than usual,
also with  nausea,  chilliness and fainting, which is sometimes
preceded by spasmodic movements  in the abdomen, and  fol-
lowed by a  sense  of  chilliness on rising  from bed; painful
menstruation, with contractive uterine spasms, a griping  and
digging sensation, with discharge of clots of coagulated blood.
   Ipecacuanha, in metrorrhagia, with nausea, faint feeling;
also,  after miscarriage.
  Pulsatilla, Amennorrhoea caused by a cold, with pale face,
spasmodic  tightness in the chest after the slightest emotion,
chilliness  even in summer;  amenorrhoea with  leucorrhoea,
vertigo, throbbing headache,  fulness and pressure in  the
stomach, drawing, aching pain in the uterus, painful micturi-
tion; painful menstruation, with cutting in the abdomen  and
uterus, pressure on the bladder, loss of appetite, discharge of
black and viscous blood: painful menstruation, preceded  and
accompanied by pleuritic stitches, which are excited by moving
the arms, drawing breath, and by  loud talking, and laming
the arm;  menstruation, with  thick and  black  blood,  dis-
charged by fits and starts.
  Sepia, premature  menses,  with  scanty flow, leucorrhoea
with stitches in the uterus, and itching in  the vagina.
  Sulphur  is  indicated, for  similar conditions as  Sepia,
especially if  the menstrual blood is thick, black, and so acrid
that it renders the thigh sore.
  Platina will be found serviceable for excessive menstru-
ation, with pressing from the  groins to  the genital  organs,
and  spasmodic labor-like pains in the abdomen ; dark blood,
which is partly fluid  and partly coagulated ;  metrorrhagia,
with  sexual  orgasm and desire for an  embrace; also, with
thirst, anorexia, sensation as if a ball were moving about in
the abdomen, pressing pains in the groins; also, with sensa-
tion as if  the body were growing larger in every direction.
   Crocus, metrorrhagia, the blood being dark and coagulated.
  Sabina, metrorrhagia, with  bright red  arterial blood. 
196
SELF-ABUSE.
   China, metrorrhagia, with drawing in the lower abdomen
and  thighs, sense of debility, bearing down pains  in  the
womb, sallow complexion, dizziness,  chilliness, stretching of
the limbs.
   Secale cornutum, metrorrhagia with bearing down pains,
resembling labor-pains.]
   There is one remedial agent which has helped me out in the
most  obstinate and  inveterate cases of amenorrhoea, where
every other means had failed.  This agent is electro-magnet-
ism,  which I have found to be one of the most efficient means
in many diseases of the sexual organs, and concerning which,
I offer more extensive remarks at the conclusion of the chap-
ter on the consequences of sexual excesses.
   I  have treated many cases  of amenorrhoea, accompanied
with considerable derangements of the sexual sphere, and of
the  organism generally.   These patients  had  been under
allopathic and  hydropathic  treatment, but without any suc-
cess.   Homoeopathic treatment seemed likewise inefficient,
and the application of  electro-magnetism was the only means
by which the  menses could be brought on, sometimes  after
a  few applications only.  The  organism was restored to its
normal condition,  the sexual desire  became  again active, the
patients looked better, and were enabled to  enjoy the exqui-
site delight of bringing forth healthy and strong children.
   In applying the apparatus, I introduced  one of the  poles
into the vagina,  and applied the  other • pole to the  small of
the back.  At first, I allowed the electric current to continue
for two minutes  only, and then added one  minute  at every
sitting, until  the application  lasted  fifteen  minutes,  after
which the menses soon made their appearance.

                      On  Self-Abuse.
   The desire to  propagate the  species, is  one of the most
sacred instincts  of the  human heart. This instinct, which
begins to be  felt  about   the period of  pubescence,  first
announces itself  by  a mysteriously magnetic attraction  of
the  senses  towards each   other.  This  attractive  force  is 
SEXUAL EXCESSES.                197
 sexual love, which, as it progresses, develops  sexual  desire.
 This  precious  gift, which  is  one of the first  means of pro-
 moting health and cheerfulness of mind, may, on the other
 hand, be so abused, as to destroy the organism, and become
 a source of torture and misery.
    The perverse genius of  man, misguided by  sensuality, has
 been led to the most pernicious abuses of the sexual appetite,
 and to the most revolting refinements of sexual lust.
    These  sexual  excesses  undermine  health, shorten life,
 destroy the happiness of families, incapacitate the male from
 the noble office of procreating offspring, and deprive woman
 of her beautiful mission of bearing children.
    Believing with Jean Jacques Rousseau, Montaigne, Kampe,
 Jean Paul and others, that a knowledge of the  devastating
 effects of vice is calculated to  excite an  aversion to vicious
, habits, and that many may be saved from  destruction, who,
 without  this knowledge, would  lose bodily strength, mental
 vigor and  contentment, by the  odious  practice of self-pollu-
 tion : we feel called upon to devote a chapter to this interest-
 ing subject.  We will first depict the frightful effects of sexual
 excesses, and afterwards endeavor to explain  the means  by
 which they may either be removed or alleviated.

                      Sexual  Excesses.
    Sexual excesses are almost'as ancient  as the human race.
 Man has, at all times, and among all nations, been given to
 refinements of sexual lust.  It seems, however, as though the
 ancient races had been more corrupt in this respect than the
 modern.   All such horrible violations of nature as pederasty,
 sodomism, etc., are  much  less  frequent among us than they
 were among the ancient Greeks, Romans, and the Orientals.
    Even the bible furnishes records of  the  sensuality of the
 Asiatic and African nations.   Suffice it to  mention the vices
  of Sodom and Gomorrha, the excesses of Ruben, Juda, and
  of Thomar, who may be  set  down  as  the  mother of prosti-
  tutes ;  of Potiphar, Absolom, and even of  the wise Solomon
 who  kept a harem of a thousand women. 
198                 SEXUAL EXCESSES.
   The  ancient Egyptians were celebrated  for  their sexual
 excesses.   The Lesbian love, which led to the extirpation of
 the  clitoris, a  practice which  is still prevalent in modern
 Egypt,  for the purpose of arresting this  abuse,  emanates
 from this region.  In our article on Lesbian love, we will be
 more explicit on this point.  According to Herodotus, the
 pyramid of  Cheops was  constructed by the lovers of the
 daughter of this king, as  a reward for her favors.   Of the
 wild excesses of Cleopatra whole volumes might  be filled.
   The temple of Isis in Egypt was the central locality of all
 the excesses of the priests.
   The ancient  Babylonians, Medes, and  Lydians were  cele-
 brated for their debauched manners, but the licentiousness of
 the Persian kings beats every thing that history has recorded
 in the shape of human immorality.  The most beautiful and
 most fascinating girls were sent to the Persian kings from
 every province of their vast  empire.   These girls had  to
 anoint themselves for twelve months with salves, balsams, and
 myrtle,  before they could be admitted  to the  honor of sharing
 a nightly debauch with their master.  Even their own daugh-
 ters and sisters became  the concubines of the Persian kings.
  There was a law in Babylon which obliged  every maiden in
 the country to expose herself to a stranger, once in her lifetime,
 in the temple of Venus.   The women of Carthage and Tyrus
 had to submit to a similar prostitution, and the money which
 they earned by this  degradation, was  their wedding-present.
 The  women of Lydia obtained their  bridal gift by similar
 means, and the women of Armenia were not  deemed fit to be
married until they had  been prostituted by some stranger in
the temple of Diana  Anaitis.  In  the temple of Belus at
Babylon, at Thebes in Egypt, and at Patares in Lydia, it was
the gods, or rather the priests, who honored the young maiden
with their favor, and there are yet devotees in Egypt, to whom
women expose themselves in public, in the belief that their
 conduct is well-pleasing to God.
  We are well acquainted with the debaucheries to  which the
 Greeks and Romans were addicted at the period when these 
SEXUAL EXCESSES.
199
nations had fallen from their high estate.  Who has not heard
of those bacchanalia during which young  girls, in a state of
intoxication, and singing  amorous  songs, half naked  and
dishevelled, committed the most horrible orgies  with the  men
disguised as satyrs and shamelessly exposed ?
   Sappho  rendered  herself famous, not  only by her songs,
but  also by her amorous excesses, and by the Lesbian vice
which she helped to spread.  The prostitute and  public dancer
Collytto, was Avorshipped in Athens as a goddess, under the
name  of  Venus  popularis.  She was honored by  nightly
orgies under the direction of  her priests.
   Public depravity was still worse in ancient Rome.   Caesar
bargained  away his virtue to Nicomedes, king of Bythinia,
who was designated as " the  husband of  all women, and as
the wife of all men."  Augustus was guilty of the blackest
crimes, and the  poet Ovidius was banished from the court of
Rome for no other reason than  because he had surprised  the
emperor in  the act of committing incest with his own daughter.
Every Roman lady, married or  unmarried, sought  the honor
of a debauch with the emperor.   They had  first to undress
themselves, in order to have all their secret charms or defects
examined, before they could be admitted to the imperial favor.
Caligula, whom nature, according to  Seneca's own statement,
had destined to show to the world what a monster on a throne
is capable of doing, committed incest with all his sisters, even
in the presence of his wife, and while eating his meal.   He
took off the married women in the presence of their husbands,
and, after having exposed them  in public, used any of them he
took a fancy to.   His palace was a  brothel, where the most
horrible vices were committed.  He boasted of being the king
of vice, and the most infamous excesses are charged upon him
and his companions.
   Messaline, wife of the  imbecile Claudius,  surpassed every
woman of her time  in  vile licentiousness.  Juvenal says  of
her :  " Dressed in vile  clothes, she entered her chamber  in a
public brothel, and, under the  name  of Lyciska, exposed
her  body that had  borne the magnanimous  Britannicus; 
200
SEXUAL EXCESSES.
 she was the last to leave the house in the morn;ng, not satiated
 but wearied."
   Nero  went even  so far as to  violate  the  person of  a
 vestal,  a crime which the superstitious  Romans would  not
 forgive their emperor Heliogabalus.
   The purifying influence of Christianity arrested  for some
 centuries theses excesses, but after this period lost all power
 of restraining the lusts of  either rich  or poor, laymen  or
 priests.  Monks  and nuns  were as much addicted  to  de-
 bauchery as the Greeks and Romans had been, so that Char-
 lemagne was obliged to issue the following edict:
   " We have been informed, to our  great horror, that many
 monks are addicted to debauchery and all sorts of vile abomi-
 nations, even to unnatural sins.  We forbid all such practices
 in the most solemn manner, and hereby make known that all
 monks who indulge in the gratification of such  lusts, will be
 punished by us so severely that no christian will ever care to
 commit such sins  again.  We command  our monks  to cease
 swarming about the country, and we forbid our  nuns to prac-
 tice fornication and intoxication.  We shall not allow them
 any longer to be  whores, thieves, murderers and  so-forth, to
 spend  their  time  in debauchery and  sing  improper songs.
 Priests  are  herewith forbidden to haunt  the  taverns  and
 market-places for the purpose of seducing  mothers  arid
 daughters, etc."
   This account of sexual excesses might be continued down
 to our time,  but it is useless to dwell upon such  statistics any
 further.  The facts which we have  related, are sufficient  to
 show that such excesses have prevailed among all nations and
 at all ages, and have been a prolific source of the  physical
 and moral deterioration of our race.
   Among the specific forms of a  depraved sexual appetite
 we distinguish pederasty, the Lesbian love and sodomy; these
 abominations are, fortunately,  rarely  indulged in  among
modern nations; but there  is one vice which  is  universally
prevalent now-a-days, and to which  we shall devote a good
 deal of attention, it is the vice of self-abuse or onanism. 
SEXUAL EXCESSES.
201
   Pederasty.  This vice, horrible as it is, was practised even
by the  most ancient  people.   Among  the  Hebrews,  whole
cities were addicted to it.  It is believed that  Sodom and
Gomorrah were  destroyed by fire and brimstone as a punish-
ment for this abominable practice.  In  Greece pederasty was
a religious art, and the most distinguished men, even Socrates,
whose minds soared far above the  common ideas and  habits
of the race, are said  to  have practised this  vice.  Greece,
Syria, Egypt, and the north of  Africa and Asia, are  known
as countries where sodomy is a native vice.  Prisoners  of the
Egyptian musulmans, bedouins or maures, have  to submit to
the infamous  familiarities  of their captors.    In  all  those
countries of Asia where Bramah is worshipped, there  exists
a class of young men  who make  it their business  to sell them-
selves  for such horrible purposes.  Among the  Christian
nations of modern times the  vice  of pederasty has become
nearly extinct.  In the middle ages it prevailed  to  a consid-
erable extent among the  Catholic priests; even Leo X and
Sixtus  IV. were suspected of indulging in  it.   Among  us
pederasty  is a  capital crime,  like murder; in 1750, two
pederasts were publicly burnt in Paris.  In the larger capitals
of Europe some refined rake may yet now and then be  found
anxious to buy the favors of a few handsome young reprobates
who are generally unacquainted  with the evil consequences of
this practice, such as fistulae, induration  and ulceration of the
rectum, and in  whom the last whisperings  of an  outraged
conscience are stifled by their  horrible depravity.
   The so-termed Lesbian love is a vice of a still more hideous
and degrading nature than pederasty.   If it be a horrible
practice for men to gratify  their lust in  filthy embraces, how
much  more disgusting is it to see women approach each other
for the purpose  of quieting their wild  desires by the most
unnatural intimacy.   It  seems  as  though sexual depravity
could  scarcely reach a lower level.
  This vice has  derived its  name from the island of Lesbos,
where it was practised by the celebrated poetess  Sappho.  In
                           14 
202                 SEXUAL  EXCESSES.
ancient Rome, it was likewise common ; and women who in-
dulged in it, were called by the Romans  "Tribades."
  Previous  to  the  first  French  revolution, there existed  a
society of women in Paris, who  numbered some of the first
ladies of the city among their number, and who made it their
business  to  practice  this vice in common.   As  if to  add
mockery to  their infamy, they termed themselves the society
of the " vestals."
  Sodomy was originally practiced by shepherds, who resorted
to this mode of gratifying their sexual passion with beasts,
for want of more natural opportunities.   Even  at this day,
sodomy is still practiced in Sicily, with goats.   According to
Blumenbach, the women  of Guinea have intercourse with
monkeys, and the Persians  resort to she-asses as  a cure for
coxalgia.

             Self-Abuse, and its  Consequences.

  Onanism, or  self-abuse, is a most pernicious vice, and  a
deplorable substitute for a natural gratification of  the sexual
passion.
  According to the bible this  vice was  first practiced by
Onan, from  whom it is named;  but  the Greeks and Romans
attribute it  to  the  artful Mercury, who invented it for the
benefit of Pan, who had lost his mistress,  the beautiful  Echo.
  It is an unfortunate  fact that, this vice can be traced to the
remotest antiquity, and that it has  been practiced by the
lowest as well as by the highest  classes of society.  It is  a
most  unnatural vice, resulting  in extinction of the conjugal
faculty, demoralization, and weakness of  the sexual powers.
  The effects of this vice are the more pernicious  the sooner
it is practiced.   In  our generation it is known even to tender
childhood.   Thousands are initiated in  such practices by
servants and nurses.   In  public and private schools  it  is
universally  prevalent.   How important  it is, therefore, for
parents and teachers, to watch the private conduct of  their
pupils. 
SEXUAL EXCESSES.
203
  The consequences of  this vice differ more or less according
to the age and sex of the patient.            '
   Previous to the age of pubescence, the effects  in both sexes
are pretty nearly alike  : momentary excitement, followed by
depression* of spirits, and finally by a more or less  complete
derangement of the nervous functions.
   The following is a tolerably accurate picture of the gradual
effects of this vice: After  having indulged in this practice
for a time, repeating it more  and  more  frequently until it
becomes a daily habit, the child, without being otherwise sick,
loses its bright complexion, which becomes  pale,  with a green-
ish tint, especially around the eyes, which are sunken, sur-
rounded by blue margins ; the lips  lose their vermillion hue.
 Careful observation reveals to us other important signs of the
 alteration of the child's  health.   The mind  is indolent, the
 child sits with the head inclined forward, staring  as if absorbed
 in deep thoughts,  without, however, looking at any thing, and
 started by a sudden question.  If told to do a thing, the child
 rises slowly from its seat, and all its motions  are  slow and
 heavy.  It is averse to  play, which  it loved formerly, prefers
 sitting quiet  and alone, becomes  obstinate, peevish, irritable,
 and cannot bear the least joke.  Children who are addicted to
 such habits,  like to be  in solitary places, where they can in-
 dulge their vicious propensities ; they like  to sleep late in the
 morning, and nevertheless feel unrefreshed and  heavy on get-
 ting up. Gradually every function, especially digestion, suffers
 more or less.   The tongue and teeth  are covered with phlegm,
 the least nourishment causes distress, colic, oppression, flatu-
lence.  The  child grows thin, and the mental  faculties are
weakened.    The power of  comprehension is  diminished, the
child is dull and taciturn, though unconsciously so. Such conse-
quences may  continue for years, to the end of life, even though
the practice of this vice had long been abandoned, and every-
thing had been done to  restore  the patient's health.   If  some
kind of sickness should  set in at this time, it is generally very
severe ; the least fever is apt to assume a typhoid form, and the
exhausted body speedily  succumbs to the ravages of disease. 
204                 SEXUAL EXCESSES.
  Sadly does the young life perish even before it  had begun
to bud, as a young  plant withers away at whose root a worm
had been gnawing.   All the  cares of sorrowing parents are
fruitless, the sources of their  highest  terrestrial happiness
are drained, and the state is deprived of useful and healthy
citizens.
  From this short but true picture  we may infer that  there
is no more degrading bondage than the  bondage of one's own
lusts.  The imagination is enkindled  by an impure fire.  It is
in vain that the patient tries to resist the power of habitual vice;
it torments him in his dreams, and in his waking hours.  And,
instead of enjoyment, it gives him disappointment and misery.
Self-abuse is the most certain road to the grave.  It not only
destroys the body, but likewise undermines the peace of the
soul; the  destruction is not accomplished all at once ;  slowly,
but most certainly,  the onanist  instils a  poison into his frame
that will inevitably lead to death.
  If this  vicious habit is continued beyond  the age of pube-
scence, the fountain of health is drained forever.  The mind
is weakened, the memory  gone, the  ideas become confused,
and the patients frequently are  seized with mania; they are
constantly restless, tormented by anguish and remorse, and
driven to  tears;  they are  subject  to frequent  attacks  of
vertigo;  their senses, especially sight and hearing, are weak-
ened ; their sleep, provided it  has not  entirely left  them, is
interrupted by uneasy dreams.   The body is  exhausted, its
growth is checked, the patients are tormented by violent pain,
such as headache, pains in the chest, pressure at the stomach,
colic; all complain of an indescribable lassitude in the limbs.
The face  is covered with itching pimples, pustules on the nose,
chest, thighs.    The sexual organs suffer  a good deal; some
lose all power of erection ; others lose  their semen from the
least excitement, or even at stool, while bearing down.  Others,
again, are afflicted with a constant flow of semen, termed sper-
 matorrhoea.  Robust persons are sometimes troubled with very
 painful erections.  Some lose their urine involuntarily, others
 are attacked with a most  painful retention of urine, or with 
SEXUAL EXCESSES.
205
violent burning at urinating. Many are attacked with swellings
of the testicles, pains in the penis and spermatic cord.  Most
of these unfortunates are impotent, either because they are no
longer capable of erections, or because the semen has lost all its
vivifying properties.  The functional derangements caused in
other organs, will be mentioned more particularly in the sequel.
   In women  the consequences  of  onanism are  somewhat
different from  what they are in men.  The object of this
vicious habit is the same in boys  as well  as in girls, viz.:
sexual excitement.  There is this difference, that girls do not
weaken themselves by the loss of the spermatic fluid, but by
the  excessive exaltation  of  the nervous system.  Nervous
prostration is therefore the first  effect of onanism in young
females,  and  is  characterized by  headache, depression of
spirits, obstinacy, sadness, indifference to worldly pleasures,
and  finally, melancholy and other forms of mental derange-
ment.  The senses become duller, especially the eyes,  which
are red and dim, with a staring look.
   In the  hospitals and lunatic  asylums, there is  a larger
number of females than males, under treatment for onanism.
This is an additional proof, that in the female, the mind and
nervous system are principally affected by onanism.
   This nervous derangement soon leads to a derangement of
the digestive system.   The patients grow thin.   All sorts of
spasmodic  symptoms develope  themselves, such as  spasms,
cardialgia, chorea, epilepsy, catalepsy, convulsions, etc.   All
the former charms of the young woman leave her, her faoe
looks sallow and thin, the skin is rough, dry, cracked, covered
with freckles and  pimples; the eyes look dim, the  lips are
pale and bluish,  the  teeth decay.  A  copious mucus is dis-
charged from  the  vagina, corroding the thighs, groins, and
perinaeum,  and  causing a most  distressing  hysteria.   The
internal organs  become  diseased, indurations and cancer of
the womb develope themselves, and the patients either die of
some such disease, or else pine away  from debility.
  Nevertheless, howsoever horrid the consequences of onan-
ism seem,  they may be prevented or removed by appropriate 
206
SEXUAL EXCESSES.
and timely treatment.  By and bye we shall explain in detail,
the means which we  employ for this purpose.   We will first
advert to the pernicious consequences of excessive sexual
intercourse, which are indeed less ruinous than the effects of
onanism, but  are likewise destructive of health.
  My readers will naturally inquire, At what age, and how
often, is it  proper to indulge, without injuring one's health ?
  It is not very  easy  to  answer this question,  but we will
nevertheless attempt it.
  As regards age, it is undeniable  that  sexual intercourse
ought not to be indulged in before the organism is fully devel-
oped, or the period of  pubescence has been reached.
  This may depend upon climate, geographical position, mode
of life, food, race, temperament.  All these causes may either
hasten or retard the  period of pubescence.
  In the countries between the tropics, females attain their
maturity much sooner than they do in the frigid or temperate
zones.  Some are known to have borne children at the age
of 13 or 14, and  at  the age  of 30  the menstrual  functions
cease.  In the countries of the temperate zones, pubescence
is reached by females  at the age of 14, and by  males at the
age of 17 or 18.   A few more years are required  to enable
them to reproduce their species.
   In former times all premature marriages were forbidden by
law.  Lycurgus forbade men to marry before  the age of 37,
and women before the age of 17.   According to Xenophon
and Plutarch these  laws were enacted for  the purpose of
raising a vigorous race.  Aristotle required the husband to
be 20 years older than his wife, in order that their fecundat-
ing powers might cease at the same period.   Among the old
Germans  no man was allowed to have  intercourse with a
woman before he  was 20 years old.   It is to this abstinence
that Julius Caeser attributes the strength and large size of
these people.
   Premature marriages have a pernicious  influence upon the
public health. The young people ruin themselves by untimely
intercourse, which is moreover carried on to excess, in conse- 
SEXUAL EXCESSES.
207
quence of the passions being uncontrolled by reason.   The
children springing  from such premature marriages, may be
fitly compared to hot-house plants, and lack inherent strength
and vigor.  It may be laid down as a tolerably certain rule,
that the male body is  not fully developed before the 20th or
25th year.  Previous  to this period, the semen is not secreted
in sufficient quantity, is not  sufficiently vivifying to generate
healthy life, and the children born of such imperfect parents,
are  weak,  sickly,  and scarcely ever attain the fulness of
strength and growth.
   If, in premature marriages, the man generally suffers more
than the woman, it is probably because the mother's weakness
is entailed on the foetus.
   On the other hand,  if premature  marriages  are extremely
hurtful and  dangerous, an  excessive delay in marrying  may
likewise become injurious to health.   Marriages between per-
sons of disproportionate ages are likewise attended with great
inconveniences.   The  propagating  faculty of one party  may
still exist, whilst it had become extinct in the other.  Sterility,
in such  cases, is simply accidental.   Young women may not
bear children to enfeebled old husbands, whereas husbands of
corresponding ages  and sexual powers, will  very speedily
gratify the fervent desires of their hearts, to lavish a mother's
cares upon  a tenderly-beloved infant.  An inevitable  conse-
quence of  marriages  between  persons  of disproportionate
ages, is the  physical weakness of the  children.  It has  also
been observed that the skin of young women who marry old
men, becomes loose and withered,  and breaks out in herpetic
eruptions.
  As regards the second question :  How often is  it proper
to indulge ivithout injury to  health ?  it is equally difficult to
return a general answer ;  for this depends, likewise, upon a
variety of circumstances, race, age, temperament, and individ-
ual idiosyncrasies.  History tells extraordinary feat3 of some
men in this respect.  Hercules is said to have impregnated fifty
girls in one night.   The Emperor Proculus boasted of having
impregnated a  hundred Sarmatian maidens  in a  fortnight. 
208                 SEXUAL  EXCESSES.
Pharos relates of a Moorish  prince, that he had intercourse
with forty women in three days.  A woman requested pro-
tection of the king of Arragon against the passion of  her
husband, who used her ten times every night.  The king con-
fined him, under penalty of death,  to  six times a day.  A
mountaineer  of the eastern  slope of the Pyrenees, married
eleven women in the space of fifteen years.  He  used them
so often and vehemently, that all these women died of severe
uterine  affections.   He was forbidden to marry  the twelfth
time.
   Such extreme  cases  are  rare.  As a general  rule, men
would be ruined by such excesses.   Physicians and physiolo-
gists of all ages, agree in opinion, that the loss of one ounce
of semen is more debilitating than the loss of forty ounces of
blood.   Hippocrates tells us that the male semen is composed
of all the fluids of  the body, and  is the most precious con-
stituent of the human organization.  By losing semen, man
loses vital spirit.   It  is not  to be wondered, therefore, that
the excessive loss of semen enervates the body.  It takes  a
long time  for the organism to  repair the loss of the seminal
fluid.  Twenty-four hours  after a  seminal  discharge,  the
seminal vesicles are again full, but  it takes a few additional
days, to impart to this semen vivifying properties of a healthy
nature.
   Pythagoras terms the semen the flower of the blood; his
disciple, Alcmeon,  considered the  semen a  portion  of the
brain; Epicurus looked upon  semen as a portion of the soul
and body, and exhorted his disciples  to take good care of this
fluid, in order to preserve both their  bodies  and their souls.
   All this shows that the most  distinguished  philosophers
have, at all times, looked upon  the  male semen as the most
precious secretion of the blood,  and have cautioned against
the  wasteful use of this fluid, as  something ruinous to the
mind as well as the body.
   As a general rule concerning the frequency of sexual inter-
course,  we may adopt  the maxim of Luther, that " twice a
week, or one hundred and four times a year,  hurts  neither 
SEXUAL EXCESSES.                209
me nor thee."  Celsus says:  " Coit should neither be prac-
ticed to excess, nor should it be entirely avoided.   If mode-
rately  enjoyed,  it  stimulates and  invigorates  the  body;
excessive  intercourse,  on the contrary,  destroys  the  body.
Excess depends not upon the frequency, but upon the  quality
of the act, upon  the age and temperament of the parties.
Coit will not  be  hurtful, if it be not succeeded  either by
lassitude or pain."
  This rule is likewise applicable to women, although women
are less exhausted  by intercourse than  men, and preserve
their strength better.
  Daily experience shows that a man will ruin himself by
excessive coit,  whereas we see prostitutes getting fat in spite
of their  dissolute life.   History, even, has  preserved  the
names of women who  had carried their licentious habits to
the highest degree without their  health being visibly affected
by  this  libertinage.  Quartilla,  a  Roman woman, boasted
of not  remembering having  ever  been  a virgin,  and  of
requiring the  use of  a  man at least  thirty times a day.
Lysisca  stood  the embraces of  fifty  robust men in succes-
sion.  Cleopatra entered in disguise the brothels of Rome, and
triumphed by twenty-five times over  the  bravest prostitutes.
In  one night  Messalina used one hundred and  sixty men,
without  being  satiated.   Bertrand Rival relates that during
the  first French revolution,  a beautiful  and modest  girl
was  ravished  by twenty-eight  hussars,  and that the  only
bad  effects  of  this violence, were a slight irritation of  the
vagina, and  a  few scratches, which  soon healed again.   On
another occasion, a prostitute accommodated  thirty soldiers
without  inconvenience.   Under  Theodorus' reign, a woman
killed twenty-two men by  sexual excesses.   A physician of
Paris relates the case of a woman of forty years old, who
had used a man ten times a day for the last twenty-two years,
and who still enjoyed good health.
   Women frequently  complain  that  their husbands do  not
satisfy them, but  men are seldom heard to complain of their
wives. 
210
SEXUAL EXCESSES.
  Such cases, however, are exceptions, and even these excep-
tions finally lead to important derangements.  The constant
irritation  of  the sexual parts finally relaxes the rectum so
that it  loses all contractile power;  an incurable diarrhoea
sets in,  and the dilapidated body perishes.   Excessive  coit
prevents conception, and leads to uterine diseases.
  We  will now devote a few paragraphs  to the so-called
aphrodisiacs, and show how far they may be  safely used, ami
which of them have to be avoided.   In spite of the warning
of physicians, numbers allow themselves to  be entrapped by
such nostra,  and to ruin themselves by the use of them.
  Among the means which excite the sexual instinct without
injuring health, we distinguish in the first place the influence
of a( pure and refined woman, and  secondly, electro-magnet-
ism.  He whose nerves are not  stimulated by the neighbor-
hood of a charming woman, or by the electro-magnetic current,
will likewise remain dull under the influence of spices, pills,
and potions,  or these things will at  most produce only a mo-
mentary effect, to  the  great prejudice of the organism.   To
these means  may be added vivid  descriptions of  the sensual
delights of  love,  erotic songs, or  pictures  embodying love-
scenes.   In the chapter on "impotence," we shall allude with
more minuteness to the  use of  electro-magnetism.   Some
vegetable preparations were likewise supposed to  be endowed
with aphrodisiac properties.   This applies  more  particularly
to the cryptogami, or the  so-termed akotyledones of modern
botanists.  Gourmands know very well that truffles,  mush-
rooms, ragouts, etc., are not eaten  alone because they tickle
the palate.
  Linnaeus relates that a variety of the orchideas (a species
of plants to  which  Dioscorides  already attributed  exciting
properties) stimulates the sexual instinct of the bulls of Dale-
caria.   Fishes, oysters, crabs, eggs, celery,  parsley, aspara-
gus, mustard, vanilla,  milk, figs, etc., are likewise supposed
to be endowed with aphrodisiac properties.
  The inhabitants of the  Orient excite  their sexual  passions
by opium, the use  of which we would advise  our readers, as 
SEXUAL EXCESSES.
211
 little as the momentary suspension to which some Englishmen
 are said to resort for the purpose of enjoying the pleasurable
 excitement of the sexual organs which this suspension is sup-
 posed to  procure.   It has  happened that such voluptuous
 sensualists were left to  perish, the attendants forgetting to
 cut them  down.
   Almost all  nations, but particularly  the  Orientals, have
 their peculiar aphrodisiaca, which shows  that the  sexual pas-
 sions are  highly esteemed everywhere.   We repeat, however,
 that  all such artificial excitements  of the sexual organ are
 extremely injurious  to  the organism.    The bangi  of  the
 Indians, and the maslac of the Turks, are said to be made of
 a species  of hemp.   If the Indians wish to enjoy voluptuous
 dreams, they take,  previous to retiring, a potion composed of
 bangi,  areca-nuts,  ambra  and musk.  To excite the sexual
 desire, the Chinese use a root which they term ginseng, and
 which is more valuable than silver.   The wine of ginseng has
 been introduced in Europe,  but it does not  seem to produce any
 great results, and may perhaps be made of a root, which is not
 the genuine ginseng.   For similar purposes the Chinese em-
 ploy a mollusk, termed holothuria, or biches de mer in France,
 which is found principally on the  Charlotte islands  and on
 other islands of the South  Sea.   This  mollusk is  dried and
 smoked, and brings a high price in  China.
  Beside ambra and musk, the animal kingdom gives us other  •
 excitants of the sexual organs, which are, however, dangerous
 to health  and even  to life.   One of the principal  ingredients
 of the so-called diablotins which are  used  in Italy and France,
 is Cantharides, or the Spanish fly.  These bonbons, the name
 of which is significant of their abominable nature, were not
 only used by enervated rakes for  the  purpose  of enjoying
 once more the delights of the sexual passions,  but they were
given to young girls who were intended as their victims, and
whose seduction was more easily  accomplished  after their
passions had been excited by such artificial means.
  These diablotins  were  introduced  at the courts of  Henry
III. and Charles IX., by the notorious Catharine  of Medicis. 
212
SEXUAL EXCESSES.
The bonbons which were used by Cardinal  Richelieu in his
latter days, and which became fashionable at the court of
Louis XV., appear to have derived their principal effect from
cantharides.   The premature death of the celebrated poet
Lucretius,  is attributed by his biographers, to a stimulant
which was  given to  him by his  mistress Lucilia.  The cele-
brated physician Ambrosius Pare", relates  the case of  a man
who died of hoemorrhage caused by a powder of cantharides
which was administered to him by  his lady-love.  A similar
death happened to  an old priest  who took a small  dose of
cantharides to  rouse the extinct sexual power.   The delete-
rious effects of  this drug may be inferred  from the following
sad occurrence: A young rake took it into his head to excite
the sexual  lust of  two old  male and female servants in the
family, and for this purpose he administered to them secretly
some  tincture  of  cantharides.   That  same evening  both
servants were seized with  such a wild desire that dangerous
haemorrhages ensued, of which the female servant suffered for
a long time after.
  Narcotic poisons, such as opium and stramonium, are like-
wise very dangerous  and equally deleterious in their effects
upon the organism.  Boerhaave relates the following case :—
An amorous  old fool had won the affections of a young girl.
In  order to excite  her passion  and enjoy her charms, he
administered to her,  after a copious repast,  a powder of
stramonium in a cup  of coffee.   The girl became intoxicated,
her eyes sparkled with  love, her face was  flushed, she sang
amorous doggerel,  lost all self-control, manifested an irresisti-
ble desire for sexual intercourse, took off her clothes, stared
at her old Adonis, finally trembled  while desirous of giving
herself up  to him, grated  her teeth, and  went into  spasms.
The enamored old  wretch went for a physician, who restored
her to health.  After taking her coffee, she had lost all con-
sciousness of what happened afterwards.
   The so-termed philtra, elixirs of love, played an important
part among the ancients.   This name was given to  certain
potions which were supposed to be  endowed with  the  power 
SEXUAL EXCESSES.
213
of either exciting or  destroying love in an individual.  But
even in modern times there are superstitious  people who be-
lieve that a person's love may be won and retained by some
charmed potion.  In Italy this faith is still prevalent  among
a great many.  The witty, but rather superstitious traveller,
William Mailer, relates, in reference to this subject:
   " The rendezvous of the  Roman  witches,  of whom there
are a great many among  the  young  and old women of the
city, is the ancient  forum, now-a-days called  campo-vecchio.
There they meet in the night, the largest and most  solemn
meeting taking place  in the night of St. John, when  they
appear in the form  of black cats with fiery eyes.   This trans-
formation is effected by means of some mysterious ointment the
principal ingredient of which is said to be the root of pimpi-
nella, and which is rubbed upon the whole body.   Who is not
reminded by  these witches  of the  Thessalian  sorceresses ?
These witches make brews which either excite love or  hatred,
exorcise absent persons  by  means  of magic formulas, and
raise storms.   Philtra were originally made in Naples.  Dur-
ing my short stay,  I saw several emaciated young men who
were supposed by the people of the city, to have been brought
to this  condition  by  elixirs of love.  People are, therefore,
very careful not to  give away their hair, because it is believed
that the spell  of love is fond of adhering to  the hair.  It is
supposed that in Rome the  people  are  more safe.   During
the carnival the bonbons which are thrown to one  by masked
persons, are generally avoided ; strangers are warned  against
accepting  them.    Female masks frequently exclaim to the
passer by :  " Eat the bonbon, do not be afraid, you  are not
handsome enough to make yourself uneasy about any  thing."
   Although it is undeniable that these various influences  tend,
by their narcotic  or  exciting  virtues, to lull the victim to
sleep, or to  excite the  sexual passions, and  facilitate the
nefarious scheme  of the  seducer:   there are,  on the  other
hand, natural agents which  exalt the sexual powers  without
injuring the  body.  We know, for instance,  that  the sexual
instinct of cats is  very much excited by Valeriana, or by the 
214
SEXUAL EXCESSES.
nepeta  cataria of Linnaeus.  Birds that are  fed  on foenu
Graecum,  buckwheat, and other kinds of seed, become very
much excited;  even  carps become  heated by rubbing musk
on their posterior parts.
  It is well known that the  exhalations of animals  are influ-
enced by the sexual act, and it was  therefore believed by the
ancients that such exhalations, being so intimately related to
the sexual functions, must likewise  exercise a powerful influ-
ence on man; the mucus which is  secreted  from the vagina
of the mare during the act, and which was termed by them
hippomanes, was supposed to be an  important agent.  There
are other animal secretions which likewise stimulate the sexual
power, for instance:  castoreum,  ambra,  zibeth, musk.  An-
cient physicians used to mix all these things in  their elixirs,
and even  corresponding human secretions were  added.  •

Diseases arising from an excessive development  of the Sexual
           Instinct, whether induced by artificial
                    or natural means.

                     I. Satyriasis.

  This disease is peculiar to men only, and is much less fre-
quent in our climate than nymphomania, which  is peculiar to
females, and is characterized by similar symptoms.
  The causes why this disease occurs  less frequently among
men than among  women,  are various.  Man  enjoys more
freedom than woman to gratify his sexual passion, he leads a
more active life, gets more tired by his labor, whereas woman,
especially in the higher walks of society, seems to live almost
exclusively for the purpose of indulging in sensations of every
kind.
  Satyriasis is characterized by the following  phenomena:
permanent erection, an excessive, insatiable desire for sexual
intercourse,  which  sometimes increases  to a  perfect frenzy.
The outbreak of the disease is generally preceded by frequent,
passing  erections, which occur either spontaneously  or at  the
sight of women.  The imagination  is continually tormented 
SATYRIASIS.
215
by lascivious images; sleep is  disturbed by dreams, and  by
frequent seminal emissions; the desire for sexual intercourse
is constantly increasing, and is  gratified  indiscriminately in
every shape and manner.  The patient  is attacked with  an
acute fever, the face looks fiery, the glistening eyes protrude
from their sockets, the mouth foams, the patient complains of
a burning thirst, becomes delirious, raves about the most
horribly lascivious things, and has  to be prevented by force
from indulging in the most abominable self-gratifications.  If
the patient is not  speedily relieved by adequate  treatment,
the sexual organs  become inflamed, gangrenous,  and death
terminates his horrible sufferings.
  This disease may be caused by excessive sexual intercourse,
onanism, aphrodisiac medicines, especially cantharides, fre-
quent reading of lascivious novels, irritations of the skin by
eruptions, flaggellations, excessive abstemiousness.  In respect
to this last point, the history of pastor Blanchet, narrated by
himself,  is very  remarkable.  Firmly struggling against the
sexual passions from his boyhood, he fled the other sex. But
being of a robust  constitution, he  was  attacked with satyri-
asis at the age of  32 years, and was almost driven to frenzy.
His health was restored by the moderate enjoyment  of the
sexual passion.
  The treatment should not only be medicinal, but the mind
of the patient has  likewise to be  acted  upon  by adequate
treatment.  The imagination of the patient should be quieted
by cautiously and gradually presenting to it images of female
purity and loveliness, and  the  mind should be  occupied  by
mechanical exercises or easy intellectual labor; mechanical
labor  has likewise to be resorted  to.  Other means of cure
are: cold baths, douches, cold hip-baths  several times a day,
moderate and cooling diet  and  drinks, sleeping on hard mat-
tresses.
  Among the remedies which are useful in this  disease, and
which have to be chosen with reference to the bodily as well
as to the moral symptoms,  we distinguish the following:
  Agaricus, Agnus castus, Anacardium, Antimonium eni- 
216
SEXUAL EXCESSES.
dum, Arnica, Asafoetida, Asparagus, Aurum,  Baryta car-
bon., Calcar. carbon.,  Camphora,  Cannabis,  Cantharides,
Causticum,  Chin, mur.,  Crocus,  Digitalis,  Ginseng,  Gra-
phites, Ignat., Kali carbon., Moschus, Nitric acid., Phospho-
rus, Stramonium.
  (The principal remedies among this list are,
  Asparagus, for sexual excitement, burning in the urethra,
the urine  being covered with a white pellicle, and depositing
a fatty substance on the sides of the vessel.
  Cantharides:  Frantic  sexual desire, with  priapism and
excessive pains.
  Digitalis:  Sexual  excitement, with frequent and painful
erections at night and in the day-time.
  Ginseng:  Sexual desires, with erections, lascivious dreams.
  3Ioschus:  Violent sexual  desire, also with nausea  and
vomiting after an embrace.
  These are  the only agents  that seem to have any positive
curative virtues in this  disease, and they will doubtless cure
every case that admits of  being cured.)

                   II. Nymphomania.

  This disease arises from the same causes as satyriasis ; such
as :  onanism, sexual excesses, etc.; if neglected, it generally
terminates in craziness.  The disease is  characterized by a
violent desire for sexual intercourse; such patients lose all
sense of shame, expose  themselves to others, and utter  the
vilest and most obscene speeches.
  This disease occurs most frequently at the period of pube-
scence.   Women endowed with an exquisite nervous sensi-
tiveness, or robust women, with a  profuse crop of dark hair,
dark and lively eyes,  expressive and animated features, and
well-developed sexual organs, such as :   a hard  and round
bosom,  well-marked hips, tall stature, a  large  pudendum, a
prominent clitoris, are  particularly predisposed for this dis-
ease.  All these attributes may, however, be wanting, and
nymphomania may nevertheless break out.  In  such cases 
nymphomania.
217
the disease  is generally caused by some eruption  near the
sexual organs, worms, ascarides in the vagina, etc.
  If nymphomania is fully developed, it  presents a group  of
most repulsive phenomena.  Such women assail every man
who comes near them, supplicate and excite him  by the most
shameless  requests  to  gratify their  passions.   Every  new
gratification increases the desire.   If men are not at hand  to
quiet  them, they resort to the most  horrible means of self-
gratification, which it is impossible to describe without shud-
dering.
  The treatment of this disease implies the regulation of the
diet and moral impressions of the patient. Exercise, employ-
ment, travelling, cold baths, cold douches, early rising from
bed, and absence of  all confinement in a room, are indispen-
sable  means of cure.  The reason of the patients has like-
wise to be appealed to.  Among the internal remedies, Platina
seems to have produced the best results.  A successful treat-
ment, however, requires that all the symptoms which do not
directly bear  upon the sexual sphere,  should  be carefully
investigated.   If the patients' eyes look  glassy, their  faces
are flushed, Belladonna and Conium are indicated.   In other
cases we may  employ  Aconite, Arsen., Canthar., Ferrum,
Ilyoscyam., Ignat., Phosphor., Pulsat., Sabina,  Sepia, Sili-
eea, Stramonium, Sulphur, and Veratrum album.
  [Aconite is an admirable remedy for nymphomania charac-
terized by a violent and  distressing titillating  sensation  in
the clitoris.
  Cantharis:  burning  in the  pudendum, violent itching  in
the vagina, pressing towards the genital organs.
  Hyoscyamus: nymphomania accompanied  with delirium,
loss of all shame, desire to expose one's self.
  Ignatia: nymphomania, with deep melancholy.
  Pulsatilla:  nymphomania with suppression of  the menses,
heat and weight in the  pudendum.
  Platina :  excessive titillation in the uterus.]
15 
218                 SEXUAL  EXCESSES.
III.  Involuntary  Seminal Emissions.  Spermatorrhoea.
  Spermatorrhoea is one of the most frequent, obstinate, and
disastrous consequences of  sexual  excesses, particularly  of
long-continued  onanism.  This weakness, which  only exists
in the case of man, poisons every pleasure,  and frequently
drives man to  craziness and suicide.  The disease  is quite
frequent now-a-days, but the phenomena which  characterize
it, are generally attributed to some derangement of  a cardi-
nal portion of the nervous  system, particularly the  spinal
marrow, although such nervous derangements are, generally
secondary, sympathetic affections.  Thanks to the microscope
and  to  a correct analysis of the urine, we find it  easy to
diagnose the disease; and we  are  likewise [enabled, by the
progress of science, to cure it, provided the patient is willing
to obey the instructions of his physician.
  Spermatorrhoea is the most  frequent cause of impotence,
concerning which Hippocrates  already remarks :  " This dis-
ease frequently occurs  among  the recently-married,  and  in
consequence of sexual excesses; thqre  is no fever, the appe-
tite remains good, but the  strength vanishes, and the  patients
grow thin. They complain of formication from the head down
the spine; semen  is lost  with  the urine,  and at stool, also
during  sleep, with  or  without  dreams, or  while riding  on
horseback, or during a walk.  The patients become impotent,
debilitated, the head feels  heavy, and they experience a buz-
zing in  the head.   If fever supervenes, the patients  die of
consumption, etc.
  The semen may  escape in a threefold manner:
  1. During stool, at the termination of an emission of urine,
during  sudden  motions, conversation with females, or while
reading lascivious novels or songs.
  2. At night, while dreaming, with or without  any particu-
lar  sensations,  frequently  only towards morning, when the
bladder and rectum are full;  in the more advanced stages of
the disease the semen  escapes  while  lying  on the  back, or
sleeping on the sofa.  Generally the patients wake during the 
SPERMATORRHOEA.
219
 emission, at other times the  loss is perceived only by the
 stains on the linen.
   3. The semen  is mixed up with  the  urine;  there is  no
 erection, nor  any peculiar sensation of pleasure.   This  is
 spermatorrhoea in the genuine sense of the term.  This is the
 most  dangerous form of spermatorrhoea, because it is not
 perceived until it has  developed its disastrous consequences in
 the organism.   In some cases several of these various forms
 of spermatorrhoea co-exist in the same individual;  but as a
 general rule, only one form exists at a time;  some  lose the
 semen with the urine  without having ever been troubled with
 emissions;  others lose semen during an exertion, but never
 with the urine; generally, however,  the influence upon the
 organism is the same  in these various cases.
   Besides the  above-mentioned causes of this disease, sexual
 excesses of various kinds, there are still other causes which it
 is important to investigate in order to regulate the treatment
 accordingly.
   Sometimes the disease arises from  the joint action of seve-
 ral causes, in which case it is difficult to ascertain the leading
 one.  Pathologically,  the phenomena of this disease  may  be
 divided into  two chief categories: an irritation of the lower
 portion of the  spinal marrow, and secondly, an irritation and
 chronic  inflammation  of the ejaculatory canals, and seminal
 vesicles.  As regards  the special causes, the following may
 be looked upon as the  principal ones  which  are instrumental
 in producing this disease :
   1. Gonorrhoea,   especially  chronic gonorrhoea.    This  is
 generally located  in  the posterior  portion of  the  urethra,
 where the seminal ducts terminate.   Hence the  necessity of
 removing, as soon  as possible, even the lighter forms of this
 disease.
  2. Irritating injections in the  urethra.  These injections,
if used to excess, or at improper  periods, or if too acrid, fre-
quently cause the inflammation of the mucous membrane  to
 extend to the posterior portion of the urethra.
  3. Strictures of the urethra.   Behind  the stricture the 
220
SEXUAL EXCESSES.
urethra generally enlarges, the mucous membrane is irritated
by the urine which collects in  the enlarged portion, an  in-
creased quantity of mucus is secreted, and the inflammation
generally spreads  to  the  more  deep-seated portions of  the
urethra. - While endeavoring to expel the urine, the orifices
of the seminal ducts become  relaxed, and the  involuntary
discharge of semen is facilitated thereby.
  4. Morbid conditions of the  rectum, such as obstinate con-
stipation, piles, painful fistulae of the anus, tumors, diarrhoea.
Some of these conditions  act mechanically in consequence of
the effort which is required during  stool;  others, like  the
piles, by communicating the irritation to the seminal vesicles.
  5.  Onanism.  This  is undoubtedly the most frequent cause
of spermatorrhoea.  This disastrous habit induces a constant
irritation of  the sexual organs, a more, frequent  and more
copious determination of  blood to these parts, which is alone
sufficient to cause  a loss of semen.  After  such  an irritation
has  lasted for  a  time, the internal sexual  parts become
weaker, relaxed, particularly the orifices of the seminal ducts,
in consequence of which the seminal fluid escapes  more easily.
  6. Sexual excesses with women.—These injurious  conse-
quences are of a three-fold kind: First, an increased secretion
of semen in consequence of  the frequent irritation  of the
sexual  parts;  secondly, relaxation of the  whole body,  and
particularly of the sexual organs ;  thirdly, irritation and even
chronic inflammation  of the seminal vesicles and the ejacula-
tory ducts, which may be inferred from  the suddenness with
which the semen is discharged, and from the pain by which
the  discharge  is accompanied.   The bad  effect is still in-
creased by retaining  the semen as long as possible, either for
the  purpose of  perpetuating the pleasurable excitement, or
from some other cause.   By this means the vesicles and the
ducts  become  distended, and  the orifices  of the  ducts  lose
their tone and  elasticity.
   7. Frequent excitation of the sexual instinct, without  sub-
sequent natural gratification,  either  by  lascivious books, or
by intimacies with females, except sexual intercourse.   In 
SPERMATORRHOEA.
221
consequence of this excitement, there  is a considerable rush
of blood to the sexual parts, the penis swells, becomes erect,
and such erections last much longer than during an embrace ;
a viscous  transparent fluid, the prostatic fluid, or even real
semen, is discharged  from the urethra; a violent throbbing
sensation is  experienced in  the  perinaeal  region,  the  face
becomes flushed, the heart beats more violently, and a fre-
quent repetition of such fruitless intimacies, brings on formi-
cation and  shooting  stitches in the  back.    The  immediate
consequence  of this exaltation is a relaxation of the seminal
vesicles, and of the orifices of the seminal ducts, which are
endowed with a similar but weaker  power as the sphincter
muscles of other orifices of excretory ducts.
   8.  Abstemiousness.  Excessive  abstemiousness may  like-
wise  be attended with involuntary seminal losses.  With many
persons, abstemiousness  is no  virtue,  because  they are not
tempted by enjoyment, and there is no virtue without tempta-
tion.  .There  are  men  who practice abstemiousness  from
religious motives, at  the expense of their health.   In a full-
grown young man, especially if  he  lives well, the  testicles
constantly secrete semen which ought  to be discharged from
time to time, proportionally to its quantity and the  rapidity
with which it is secreted.  If this discharge is  not effected
by coit,  the excess is got rid of by involuntary nocturnal
 emissions, the frequency of which  is proportionate to the
 quantity tof  semen  secreted.  As  long as these nocturnal
 emissions take place moderately, they afford a feeling of ease
 rather than  otherwise.   But it frequently happens that  these
 emissions take place  every night, especially if  the patient
 had been given to excessive intercourse previous to becoming
 abstemious.
   9. Diseases of the cerebellum and the spinal marrow.  We
 know by physiological experimentation that the  cerebellum
 and  the medulla oblongata are  in close relation to the sexual
 organs.   It has been  noticed  that a  disorganization of the
 cerebellum impairs the sexual functions, and that a  complete
 atrophy  of  the  cerebellum is  succeeded by  their  complete 
222
SEXUAL EXCESSES.
extinction.  Gall already directed attention to the fact that
the cerebellum is the seat of the sexual power.   In his crani-
ology we find  a number of cases going to show that certain
diseases of the brain, such as: inflammation, tumors, mechani-
cal injuries inflicted by a blow, concussion, etc., cause a violent
excitement of  the  sexual passion, and  consequent  seminal
emissions.
   Various  diseases of the spinal marrow are  still  more fre-
quent causes of spermatorrhoea, because  a flow of  semen is a
standing symptom of many such  spinal irritations, and con-
sequently increases  the debility. In these diseases the sexual
organs are deprived of the normal nervous influence which
they require for the healthy exercise  of their  functions.
Sometimes the semen is secreted in too large a quantity, but
too thin and not sufficiently vivifying.   The seminal vesicles
are overfilled;  the excretory ducts become relaxed, as is the
case with the sphincter vesicae  under similar circumstances;
the testicles hang down relaxed; shooting stitches are  experi-
enced in the spermatic cord ; the erections are either imperfect
or entirely wanting, and an unavoidable  consequence  of this
condition is impotence, tabes dorsalis, etc., of which mention
will be made hereafter.
   10. Excessive length of the prepuce, and consequent phy-
mosis, may likewise lead to involuntary emissions,  caused by
inflammation of the surface  of the glans, sensitiveness of the
glans, copious  accumulation of smegma  behind the  corona
glandis.  This sensation spreads from the glans to  the inner
parts, and causes involuntary emissions.  Such emissions are,
however, easily arrested.
   11. In a number  of cases an involuntary loss of semen is
hereditary.  We know this from actual observation.
   12. Excessive use of tea and  coffee likewise causes seminal
losses. It is true that both tea and coffee act powerfully upon
the kidneys, but their injurious effect upon the sexual organs
is not yet  proven,  although a number of persons who were
afflicted with  seminal losses,  have said  that  their  trouble
became much worse after the use of coffee or tea. 
SPERMATORRHOEA.
223
  13.  Aphrodisiaca, cantharides, violent  cathartics,  warm
and irritating injections, cause an increased flow of blood to
the pelvic organs and sexual parts, and consequently an irri-
tation of the seminal vesicles leading to seminal losses.  The
injurious effects of such agents have been described before,
and our readers are referred to those pages.
  14. In a former paragraph we alluded to intestinal ivorms,
and stated that  they were capable of irritating the sexual
organs.  It is especially ascarides which are capable of ex-
citing  spermatorrhoea, by causing a violent irritation of the
internal  sexual  organs,  in consequence  of their  irritating
action upon the nervous system generally. This circumstance
deserves particular notice from the fact that the presence of
such worms is easily overlooked;  whereas, if the cause were
properly noticed, its removal could easily be effected.
   15.  Besides the above-mentioned  causes,  there  are others
which  may give rise to  spermatorrhoea, such  as  riding on
horseback,  in consequence of  the continued pressure and
shaking of  the  genifal organs;  a sedentary mode of life
which is apt to induce constipation and an increased warmth
of the abdominal  organs by congestions of the portal system,
and lastly various idiosyncrasies which it is not always pos-
sible to account for upon physiological principles.   There are
cases  where patients  had  not felt well for  a time and  after-
wards were suddenly attacked with  copious nocturnal  emis-
sions, without any of the causes which we  have enumerated,
being present.  I have known a  case where a man who had
entered a  house  of  dubious character, was suddenly  seized
with a copious  loss of semen without erection, and without
the least  thrill,  merely from fright.   Many  persons are
attacked with seminal losses on looking down from a height,
or while fancying they are lying on the border of a  precipice,
or while balancing themselves on a swing.
  As regards the  phenomena which generally accompany
spermatorrhoea, we have to consider in the first place whether
the seminal losses take place in the day-time or at night.
  Nocturnal emissions are at first accompanied by  lascivious 
224
SEXUAL EXCESSES.
dreams, erections and pleasurable sensations.  As the trouble
increases these sensations grow less, and the loss of semen is
only revealed by the moisture or the stains on the linen.  At
first the emissions  occur less frequently, afterwards two  or
three times a week, then every night, and even  several times
in the night.  Gradually the semen loses its consistence, the
color and smell become altered, the spermatozoa diminish  in
number, the  semen is changed to a thin, transparent mucus,
and is sometimes mixed with blood.  When the disease has
reached this stage, a  soft  or fresh bed,  a full bladder  or
rectum, a little warm beverage,  rubbing the penis  against
the shirt, and such like trivial causes are sufficient to cause a
loss of semen.
  In  other cases the losses are  excited  by rather unusual
causes, such as fancies concerning the  copulation of certain
animals, flies,  snails, etc.   Afterwards  sleep is  disturbed by
frightful dreams, the  patients are attacked with nightmare,
and finally the emissions take place without any pleasurable
sensation;  on the contrary, they are"  painful.   It is such
emissions, as these that are peculiarly debilitating.
  In the day time the loss of semen generally occurs during
an  emission of urine  or  at  stool—there is  no erection and
no  thrill.   At  stool the  semen passes  off  while pressure  is
made upon the rectum;  in  such  cases  the  bowels  are gene-
rally constipated, and the cause of the loss is more or less  of
a mechanical nature.  Drops are discharged from the urethra
of a grayish-white color and a peculiar odor, which, under the
microscope, are found to contain spermatozoa.  If the seminal
fluid becomes altered, clear,  colorless, thin, without any pecu-
liar smell, the patient is generally without any suspicion.  In
such a case the spermatozoa have disappeared from the fluid.
  If the semen passes off during an emission of urine, the loss
occurs not  while the urine  is flowing out, but when the last
drop is about to be discharged; sometimes only now and then,
not with every emission of urine.   In most cases the seminal
loss occurs in the morning, when  the urine  is discharged for
the first time after  rising; the last drops of urine  are gene- 
SPERMATRROHCEA.
225
rally thicker,  viscous, ropy, adhere  to the  orifice of the
urethra, and  stain  the linen like starch.   If the urine  is
collected  in a goblet, it  becomes  somewhat turbid, and  at
the  bottom of the vessel we perceive small, rounded, trans-
parent little granular bodies of various shapes.
   If the seminal loss is accompanied by spinal irritation, the
urine deposits  in  the morning and forenoon a copious, light-
brown sediment;  it reacts like an acid, has  a  sickly odor,
is never  entirely clear, and shows  at  the surface a  fine,
opalescent greasy pellicle, which, after removal, is invariably
reproduced.
   In other cases a regular seminal emission is caused by the
sight of a girl, by dancing  with her, by some lascivious fancy
or scene, or by looking at some lascivious picture, by riding
on horseback or in a carriage, by hard walking, etc.  In such
cases the  erections and pleasurable sensations continue for a
time, but  disappear  entirely after the disease had lasted for
awhile.
  One of the  unavoidable consequences of this weakness  is
impotence.  The quality and consistence of the  semen become
altered, the spermatozoa either disappear or die, or are  so
weak that they lose all fecundating power.  Coit can only
be carried on imperfectly, in consequence of the semen being
expelled too soon.  Gradually the erections cease altogether,
owing to the increasing weakness of the  penis.
  The  disastrous consequences of excessive seminal  losses
will  not astonish any one who considers that the semen is the
most precious  and most concentrated secretion of the human
organism.  The production of  semen takes  place much more
slowly than that of  any other  secretion  in  the human body.
This is owing  to the length of the route which the semen has
to traverse, for all the seminal canals of the  testicles unite
into  a net-work, from which the fifteen or twenty coni vascu-
losi  Halleri pass into the larger extremity of the epididymis;
if all these seminal canals were extended in  one line, it would
be about  1,050,  and,  according  to the English anatomist,
Monro,  even 5,208 feet long.  This immense length  shows
* 
226
SEXUAL EXCESSES.
that it is not only difficult  for the semen to be reproduced,
but that  its excessive  use must be attended with disastrous
consequences to the general  organism.  All the functions are
affected, and the destruction of the body may even be caused
by such abuses.   No other  functions in the body affect  its
normal condition as much as do the sexual functions.   How-
ever, it is impossible to lay  down  rules in this respect which
admit of no exceptions.  Even the structure, constitution and
mode of life of certain persons do not seem to influence the
sexual  powers in the least.   Apparently weakly individuals
will sometimes bear considerable seminal losses without any
detriment to their general health, whereas, on the other hand,
robust  individuals are affected by a  trifling expenditure of
their seminal fluid.
  The effects upon the spinal marrow, which is deeply involved
in the sexual act, and still more in the practice of self-abuse,
are likewise very different in different individuals.  As soon
as the irritation of the spinal marrow passes certain bounds,
it becomes permanent and  has a  prejudicial influence upon
the sexual sphere as well as upon the whole body.  Volition
especially, is impaired by the extreme excitability  of the
nervous system; the activity of the voluntary muscles  is like-
wise affected to such an extent that all their-energy may be
lost and complete paralysis set in.  What  impairs the moral
and mental condition still more than the loss of the seminal
fluid, is a certain revelling in lascivious fancies, which is the
more dangerous the  more secretly it is indulged in, and the
younger  and feebler the persons who are addicted to such
excesses.   The  higher  functions of the soul are  almost
entirely destroyed  by them, and  all the  purer and nobler
thoughts  are constantly superseded  by the  imagery  of a
libidinous imagination; this  unnatural indulgence affects the
sensorium, the spinal marrow, digestion  and nutrition.  By
the time  the patient is  made aware  of  his error, all  these
phenomena have acquired a  more intense development. The
effect of these silent transgressions is the  more  formidable the
younger the culprit, and the weaker his  constitution and the 
SPERMATORRHOEA.
227
desire to discontinue his evil practices.  No abuse is fraught
with more destructive consequences than onanism.
  We  will now proceed  to point  out the consequences of
excessive seminal losses, and more  particularly their  debili-
tating influence on the various organs of the body, and above
all upon the nervous system.
  In the beginning of this work we made allusion to a state-
ment  emanating  from  Hippocrates, that  such  patients  eat
with an excellent appetite, and nevertheless grow thin.
  Indeed they do have a great  craving for food, and use it in
large quantity, fancying that this will repair their strength;
unfortunately the constant loss  of semen gradually diminishes
and finally destroys  the power of digesting the  food.  The
patients complain of weight in  the stomach, distress, restless-
ness ; the pulse becomes irregular, and cerebral congestions
set in, the patients incline to  perspire during the process of
digestion, they become drowsy,  unable to think or work; they
experience sour and fetid eructations, the stomach is distended
with gas, a rumbling, and colicky pains are experienced in  the
bowels, the stool becomes irregular, costiveness alternates with
diarrhoea; at  last the constipation becomes  permanent  and
keeps up the seminal loss.  These derangements continue to
grow worse; occasionally the patients feel a little better,  but
they do not seem  to appreciate  the real cause of their trouble,
or else they are too bashful to discover it to a physician. The
patients lose flesh, grow sensitive to the cold, have a yellowish
complexion, with blue circles around  the  eyes.   The tone of
of all the organs  of the body is depressed; the voice becomes
thinner, almost like that of a woman; the patient is taciturn,
and the consciousness  of being  the author of  his misery,
renders his speech timid and impairs his whole activity.   As
the emaciation increases, the skin becomes pale-yellow,  the
eyes retreat into  their sockets, the eyes grow dull, the mus-
cular energies  sink,  the patients grow weary from the least
exertion.  At  times a weakness of the lower limbs, bordering
upon paralysis sets  in.  In many cases the calves lose their
substance first, in consequence of which the  gait becomes
heavy, dragging, without energy. 
228
SEXUAL EXCESSES.
  Not all such patients grow thin, many of them retain their
good appearance, red cheeks and all the signs of health, but
they feel weak, and are tormented  by many distresses which
drive them to suicide.
  An almost constant symptom with which such patients are
affected is a constant desire for motion, notwithstanding that
they feel exhausted and distressed after every exercise.  The
patients experience a vehement desire  to change their places
all the time.
  In common cases the disease runs its course without any
fever, unless it should be  complicated with inflammatory dis-
eases.  The patients are seized  with irregular chills along the
spinal column, in the arms and legs;  soon after they  expe-
rience a sensation of warmth and throbbing in the perinaeum,
flushes of heat from the  chest to the head and on the sides
of the neck, morbid  contractions  of the  laryngeal  region
with  sudden stoppage of breath  as  if  a foreign  body had
lodged in this region.  The large vessels of  the neck  throb,
and, on auscultating this  region, we perceive the  so-termed
bruit de diable, as exists  in chlorotic  girls.  Sometimes  the
patients are attacked with palpitation of the heart on taking
the least exercise; the night's  rest is disturbed by a tumul-
tuous beating of the heart which either sets in spontaneously
or is preceded by heavy and disturbing  dreams.  The palpi-
tation of  the heart is increased by both agreeable  and disa-
greeable emotions.   The  patients are apt to  lose their breath
when  walking, running,  and  particularly  when  going up
stairs; a sense of emptiness, heaviness in the head  and buz-
zing in the ears are experienced. The patients are frequently
obliged to take breath and are liable  to taking cold;  pains
and shooting stitches in various parts of the chest and  back,
especially in the region of  the heart, often frighten the patient,
and a dry cough soon develops itself.  Pulmonary  phthisis  is
very  frequently the result of such disturbances.
   The constant loss of animal  fluids and the disturbed  diges-
tion lead to a deterioration of the blood.  The blood becomes
watery,  loses  part  of its  fibrine  and  albumen, the blood- 
SPERMATORRHOEA.
229
disks diminish  in  number,  the white globules increase  to
excess, and the  blood is less  coagulable.
  Beside these derangements of the digestive organs, of the
muscles, blood, lungs and heart, the nervous system is  parti-
cularly  affected.   The  cerebro-spinal axis,  as well as the
peripheral  nerves and the organs of the senses, are involved
in the disastrous effects of spermatorrhoea.
  The visual power is  particularly  weakened.   The pupil
dilates, short-sightedness and diplopia set in, black or shining
points hover before the eyes, even blindness may set in, the
eyes  are extremely sensitive to the  light.   If the  sperma-
torrhoea was caused by onanism, the look becomes unsteady,
erratic.  The hearing  loses its power of accurately distin-
guishing sounds; very often the patients lose  their hearing
entirely, and nevertheless they are troubled with a distress-
ing  sensitiveness to  unpleasant sounds, were  they ever so
trifling.  Various unpleasant noises are perceived  in the ears.
The taste is likewise altered; the tongue is constantly coated
with a thick phlegm, rendering the  mouth sticky  and pappy.
  In the extremities a  feeling of coldness is  experienced;
sometimes  a perfect loss of sensation takes place over a more
or less extensive region,  Sometimes the  loss of sensation
shifts  from one place to  another.   A  passing sensation of
burning and heat,  or a sensation as if cold air  were blowing
upon certain parts  of the body, or as if water were dropping
upon it, or as  if  an electric  aura  or  stroke  were passing
through it, are experienced.   The extremities are disposed to
go to sleep, or a formication is felt in the extremities, along the
back, in the lumbar region, on the thighs; the limbs suddenly
start especially  during sleep and shortly after falling asleep,
sometimes  even in the  day-time while  the  patients are ab-
sorbed in thought.
  Patients  affected with spermatorrhoea, generally become
languid, effeminate, pusillanimous;  the power  of volition  is
very much  weakened ; volition is readily excited, but it does
not  last, there is a  lack of firmness; the patient has the best
intentions,  but  is   unable  to carry  them out ;  in the  more 
 230                 SEXUAL EXCESSES.

 advanced  states of  the disease the  power  of  volition is
 entirely destroyed.  The patients become diffident, sensitive,
 capricious, irascible ; the least untoward event excites  their
 anger, but grave insults do not seem  to disturb  them, they
 are afraid of resenting them.  Towards the female sex such
 patients are cold,  they  avoid the society  of females  and
 scarcely dare look them in the face;  they prefer solitude, are
 sad, low-spirited, melancholy; they like to indulge in glow-
 ing  thoughts.   They are averse  to  any kind of work, they
 loathe life and often think of killing  themselves, nevertheless
 they are constantly tormented by a desire of recovering their
 health.  They are constantly thinking of  their condition;
 they observe the urine,  stool, watch  their digestion, and all
 the  other functions.   They show an indifference  to every
 thing, neglect their business, and are everlastingly tormented
 by the  thought of having lost their  virile powers.  Depres-
 sion of spirits and hope, joy and sadness alternate  in quick
 succession according as the involuntary losses of semen occur
 more or  less rapidly,  or according  as the patients are im-
 pressed with the idea of  either being better or worse.   If this
 fitfulness of spirits should be ascribed by  the patients  or
 those around them to any other cause but the true one, itself
 becomes either a source  of joy or  grief to them, especially
 on comparing the present with the  past.   The  memory is
 frequently impaired,  and, in persons  endowed with  higher
 intellectual powers, the flight of ideas is considerably embar-
rassed ; the imagination loses its  vivacity, and the acuteness
and discriminating power of  the reasoning faculty are weak-
ened.
  These symptoms, although they excite legitimate suspicions
of the existence of  the  disease, are however not sufficient to
remove all doubt in reference to it.   To obtain perfect cer-
tainty the physician has  to convince himself that there is an
actual loss of semen  and that the quality of the semen is
altered.   The stains on  the linen are positive  proofs  of the
seminal loss in the day-time and at night.  If, in consequence
of the long continuance  of the disease, or of the  debilitated 
SPERMATORRHOEA.
231
state  of the patient's constitution, the semen should have
become too thin and watery, the  recognition of the  disease
by  the stains  on the linen would be more  difficult.  The
difficulty of the diagnosis is greatest when the semen is dis-
charged with the urine.   This circumstance  is  so much the
more dangerous  as  the weakness  may continue in this way
for a long time without being perceived, and  as this unper-
ceived loss implies a more deep-seated relaxation of the semi-
nal vesicles and their excretory  ducts.   In such  doubtful
cases the urine  should be examined with great care, particu-
larly the last drops of the urine which will be  found distin-
guished by the following characteristic phenomena:  At the
bottom of a transparent vesicle we perceive small little globular
bodies or flocks, of a somewhat shining exterior; after filtering
the liquid, these flocks and  the spermatazoa remain behind
on the  filter.   Viewed with the unarmed eye, the globules
appear of  different sizes and numbers ; they do not  dissolve
even in boiling water.  Alcohol, nitric acid and a solution of
tannin cause them to coagulate like albumen.   Inasmuch  as
these phenomena likewise take place when the prostatic fluid,
which  sometimes is  discharged  together with the semen,
escapes alone,  the use of the microscope  is absolutely neces-
sary to establish a correct  diagnosis.  If the  alteration  of
the semen is  considerably advanced, these flocks disappear,
but the spermatazoa which are heavier than the urine, fall to
 the bottom of  the vessel.
   A valuable diagnostic is the constant formation of a num-
 ber of crystals of the oxalate of  lime in  the  urine.
   An examination of the semen by means of the microscope
 enlightens us concerning the quality and  numeral increase or
 decrease of the spermatozoa.  If the seminal loss had lasted
 a long time, the spermatozoa diminish in  number, are imper-
fectly developed, move about slowly or are quite motionless.
 Afterwards they shrink to  one-half or  one-third of their
 normal size.  If marasmus sets in, the spermatozoa disappear
 entirely, and in their stead we behold shining, roundish little
 bodies, which are probably the heads of the extinct  sperma- 
232
SEXUAL EXCESSES.
tazoa.   This kind  of semen is devoid of  all fecundating
power.  If  an  improvement  in  the condition of the patient
takes place,, the spermatozoa reappear in the semen, and their
reappearance encourages the hope of the ultimate restoration
of health and of the virile powers.
  As regards the treatment of this most important disease,
there is no doubt that it demands  the most  rigid attention,
both on the part of the physician and patient.   For, although
the ravages which  this disease causes in  the human system,
are deep-seated  and obstinate, yet, if the  treatment  is  con-
ducted  by  a  physician of  good sense and  endowed with
consciencious  patience, it may terminate  in most cases in
recovery.  I have treated a number of  patients who had
despaired of themselves,  but who not only  recovered their
spirits but their health and became happy fathers of a family.
Unfortunately, such patients are too often inclined to confide
themselves into  the hands of quacks, instead of applying to
some honorable physician, who  not only knows  how  to use
physical but likewise  suitable moral means of cure.   Con-
sidering the high  importance  of  this  disease,  I deem  it
proper to go into the treatment of this disease as extensively
as  space will  permit, without omitting any complications or
coincident affections.
   The first duty of the physician consists in obtaining from
the patient a confession  of his errors, and a firm promise
that he will abandon his evil practices.  Until this is" done no
treatment can be of any avail.  The patient must be given
to understand, and to this end the physician  should exert all
his eloquence and  persuasive powers, that no cure is possible
unless the patient obeys the advice of his medical friends with
the utmost conscienciousness.  Let  the  patient understand
that a cure is possible,  provided the  patients  subject  them-
selves to a rigorously systematic treatment.
   In the first place it is of the  utmost importance that the
pernicious practice of self-abuse should be  abandoned.  Next
the diet  has  to be regulated in  the manner which  will be
 described hereafter. 
                     SPERMATORRHOEA.                 233

   If the patient is troubled with nocturnal  emissions, all
 spices and stimulants have to be carefully avoided, especially
 in the evening;  all kinds  of spirits, wine, brandy, tea, coffee,
 have likewise to be given  up;  in  general the patient  should
 drink very little in  the evening, in order to keep the bladder
 tolerably empty.   Before  retiring to bed, the bladder and rec-
 tum  should  be  emptied of their contents, if  possible;  it is
 likewise well to void the urine  soon  after  rising.  Inasmuch
 as  the  emissions generally take  place towards morning, it is
 well to rise early, towards five o'clock; as a general rule it
 is injurious for such patients to sleep later in the morning, for
 the  lascivious  dreams  generally occur towards  day-break, if
 the  patients fall asleep again after waking.   The bed upon
 which the patient sleeps should not be too soft;  horse-hair or
 straw mattresses, or the recently-invented  hard elastic  bed,
 are far preferable to feather-beds.  The  patient should not
 sleep on his back, but on  the side.  Previous  to retiring the
 fancy should  not  be excited  by lascivious conversation or
 books.   All intimacy with the other sex in the evening-hours
 should be avoided;  in  general  any intercourse with females,
 which results in sexual excitement, without gratification, is
 hurtful at any time.  Body and mind should be occupied in
 an useful manner.   Exercise in the open air is advantageous
 even in the higher forms of the disease.   The  nature  of the
 diet, whether it  ought to  be light or nutritious, is to  be de-
 termined by  the attending  physician,  and  depends in  a
 measure upon the character of the disease.   If this should be
 chronic inflammatory, the  diet should consist  of light food,
 such as easily digested vegetables, light farinaceous  prepara-
 tions, little meat, fruit, etc.;  wine and beer, tea, coffee, should
 be avoided;  water,  a light lemonade, and effervescent  bever-
 ages may be used.   If  the patients should  be very much re-
 duced by the disease, nutritious food may be resorted to,  and
 even  a  little wine  or beer  may be  used,  but discreetly.
Bathing in  a river, and cold  baths  generally, shower-baths
and  wave-baths,  douche,  cold  hip-baths,  injections  of cold
water, are much to  be commended.   The  cure is likewise
                            1G 
234
SEXUAL EXCESSES.
promoted by gymnastic exercises, and  by residing  in the
country where the scenery is beautiful  and the  air healthy
and invigorating.
  The private  habits  of the patient should never be  lost
sight of,  and the ruinous consequences of self-abuse should be
continually kept fresh in his soul's memory.  In the case of
children, judicious punishments  may be  resorted to, to deter
them from such habits.
  This dietetic and moral treatment, which we deem of great
importance,  we accompany with the  internal use  of  Carbo
veget.,  Causticum,  China, Graphit., Petroleum, and  Phos-
phorus.
  [To these remedies  may be  added three agents, which I
have found of great efficiency in  the treatment of gastric,
nervous  and numerous  disorders arising from  the habit of
self-indulgence;  these agents are:  Aconite,  Mercury,  and
Nux vomica.
  Aconite is indicated by great nervous derangements, sudden
starting  at the least noise, fitful mood, depression of spirits,
apprehensions for the future, dizziness, intense frontal head-
ache, either every forenoon or constantly, dryness  of the
mouth,  coated  tongue,  distress  in the  pit of  the stomach,
vomiting of the ingesta, wakefulness at night, drowsiness in
the day-time, nightmare, copious  and exhausting  emissions
every night, costiveness.  This agent will be found of no use
in this disease, unless it is administered in the form of tinc-
ture, one or two  drops of the concentrated  tincture  in a
tumbler  full of water,  a teaspoonfull  every three or  four
hours, until a decided improvement sets in.
   Nux vomica may be  given, one dose of the  6th att. every
other night, if the patient complains of costiveness, bad taste
in the mouth, soreness of the stomach, distress after eating,
fulness in the pit of the stomach,  constipation.
   3Iercurius vivus  is adapted  to the  following symptoms:
pappy mouth, thinly coated tongue, altered taste, sallow com-
plexion, chilliness, great sensitiveness to the air, costiveness,
the alvine evacuations being composed of hard balls or lumps, 
SPERMATORRHOEA.
235
having a dark color.  Give a powder of the third trituration
every night.
   Carbo veget. will be  found  adapted to  constipation with
heartburn, acidity of the stomach, distress after eating, dis-
tension of the bowels.   If this agent should not relieve the
patient,
   Phosphorus may be  substituted, especially if the nervous
system seems to be very  much shattered, and the  patient
complains of oppression on the chest, tendency to cough, pains
in the chest.  This medicine may be used alternately with
   China, if the  patient is  very weak, the least exercise tires
him and he is troubled with a  ravenous craving for  food.]
   One of the most  efficient remedies in this disease is electro-
magnetism ;  indeed, I look upon it  as  indispensable in the
treatment of this  affection.  I commence  the  treatment by
first  inducing, with my hand, an electro-magnetic  current
along the  back  of  the  patient;  after* a time I substitute the
cylinder in the  place of the  hand  and lastly resort  to the
electro-magnetic baths.  The  passes have to be made along
the whole length of the spinal column.   Sometimes  I apply
one pole to the perinaeum, and the other one to the lumbar
region.  The current has to be induced very methodically.
The first applications should not last longer than five minutes ;
afterwards every application should be increased  by one or
two minutes, until  we gradually prolong it to about fifteen
minutes, after which every succeeding application is shortened
again by one minute.  Already after the first days of the
treatment  the  patient will  perceive an amelioration: his
apathy and his indifference to the enjoyments of life will be
succeeded  by a  feeling of ease  and physical well-being; the
seminal losses will either diminish or cease entirely, and all
the other morbid phenomena will gradually disappear, and the
appearance of the patient will mend considerably.   But even
if the improvement should be ever so striking, the treatment
should  not be discontinued all at once, for their affection is
disposed to return; it is therefore advisable to continue the
treatment  some  two  or three weeks even after the  patient 
236                 SEXUAL EXCESSES.
should seem perfectly restored; the diet should likewise be
continued, although, if desired, in a modified form.   It need
scarcely be remarked that  sexual intercourse  should be en-
joyed with moderation, and the vicious practice of self-abuse
should never be resumed.

      IV. Impotence  and Sterility of the Male.
   These two weaknesses, although differing in  form, resemble
each other in one respect: both arrest the faculty of propa-
gating the species.
   By impotence we mean an inability to exercise the act of
coit.   Impotence is  necessarily accompanied by  sterility.
In sterility coit may actually take place, but there is no con-
ception.  Generally speaking impotence applies to the male,
and sterility  to the female.
   Impotence may either be congenital or acquired ;  it may
continue only for a period,  or during a man's life-time.
  The causes of impotence and sterility of the male may be
general, local and relative.   The general causes refer to the
constitution, the composition of the blood  and the state of
the nervous  functions.   The ancient physicians were  only
acquainted with constitutional  causes, hence  their theories
concerning the  character of these  weaknesses were  incom-
plete and erroneous.  In modern times we  have discovered
an  increasing  number of particular conditions  which  bear
upon  the  development of  these  weaknesses,  and  we  have
succeeded in  establishing a line of demarcation between the
constitutional and local  causes.  These  investigations  have
led to  considerable  improvements in the treatment of these
weaknesses, to such an extent that we are now able to cure
a great many cases which had to remain uncured  heretofore.
   Among the constitutional causes we number diseases that
weaken the body with more or less rapidity, and  which result
in an alteration or actual toxication of the blood.  Onanism
is one of the most frequent causes of impotence.   The action
of the syphilitic virus  might likewise lead  to impotence in
the male; in the most favorable cases  this poison, if it does 
IMPOTENCE OF THE MALE.
237
not produce perfect  sterility,  yet destroys the life of the
fetus.
   The inability of procuring an  erection is one of the  most
frequent causes of impotence.  This inability is  frequently
the consequence of onanism  or of sexual excesses, especially
if they had been indulged in prematurely, or it may amount
to a sort of paralysis of these parts  caused by irritation of
the lower portion of the spine.
   Generally, excessive passion during the sexual act, and the
violent orgasm of the parts caused by this fierce vehemence,
are  the main  causes of sterility in  the male;  on the  other
hand,  a certain timidity in performing  the act, or a certain
fear that it might not be  adequately performed, may lead to
temporary impotence.
   If the desire for an embrace is entirely wanting, all inter-
course between the sexes becomes impossible.   This perfect
suppression of all desire sometimes exists in persons  addicted
to intense mental  labor, or leading a secluded  and exceed-
ingly abstemious life.  Long abstinence from  sexual inter-
course has the same effect upon the sexual passion.
   Impotence is also  chiefly caused  by diseases of the brain
and spinal marrow arising from onanism and sexual excesses,
and  to which we shall refer more  in  particular  hereafter.
Diseases of the urinary and sexual organs, and  abdominal
affections likewise weaken the sexual functions.  Intoxication
is an obstacle to sexual intercourse.  It has been observed in
Holland that drunkards are frequently affected with  impo-
tence,  and  among  the  nations of the  north of Europe the
abuse of spirits has likewise led to an increase of this weak-
ness.
   The sexual power  is likewise  affected by the  age  of  a
person.  Old men generally become  impotent.   Some,  how-
ever,  preserve  their  virility to  the age of seventy, and
upwards, especially if they had been virtuous and sober men
in their youth.  Cato had a son at the  age of eighty ; Mas-
sinissa, King of  the  Numidians,  and  Abraham procreated
children at the age of ninety.   Self-abuse and premature 
238
SEXUAL EXCESSES.
excesses lead to a premature  cessation of  the  virile powers,
the semen loses its vitality, and the sexual act remains incom-
plete.  It is supposed that the excessive use of strong black
coffee and tea likewise cause debility of the sexual organs.
   The local  causes of  impotence may  be various,  either
purely physiological and  functional,  resulting  in alterations
of the secretions, or organic and congenital.  Malformations
of the sexual organs cannot be cured, and we  mention  them
simply for the sake of completeness, and in order to caution
patients against making any useless attempts at cure.
   A morbid alteration of  the seminal fluid is one of the chief
physiological causes of sterility.  The semen constitutes the
most  important fecundating agent  cm the part of the male,
and  its fecundizing virtues depend upon  the  presence  of a
large number  of  fully developed  spermatozoa.   If  these
spermatozoa  are diseased, or  entirely wanting, the semen
loses all power of fecundating the ovum.   Alterations of the
semen may occur in consequence of severe, debilitating dis-
eases,  of  imperfect restoration of the tissues either  from
deficient nutrition or imperfect digestion ;  or in consequence
of excesses of various kinds, continued losses of animal fluids
and more particularly of the seminal  fluid.   Sexual  excesses
render the renewal  and perfect elimination of the seminal
fluid impossible; for  although the  secretion of this fluid is
constantly going on in the testes, the epididymis, seminal
ducts and seminal vesicles do no longer contribute their share
to the perfect restoration of the quality of the  seminal  fluid.
In some persons the fluid is repaired slowdy, in others  more
rapidly.   The more frequently the  semen  is discharged, the
more slowly is it repaired. Hence,  in consequence of disease
or of excessive emissions the semen loses its consistence,
specific gravity,  odor, color, and scarcely stiffens the linen.
The microscope no longer shows a  super-abundance  of lively
spermatozoa.
   The loss of the testicles is another chief cause of  sterility.
As long as only one of the testicles is preserved, a sufficient
quantity of semen may still be secreted to carry on the  pro- 
IMPOTENCE OF  THE MALE.
239
cess of fecundation.   Even after the removal of both testicles
by an operation, a  sufficient quantity of semen may remain
in the vesicles for  a time, to effect the fecundation of the
female ovum ; for castration does not destroy the  faculty of
procuring an erection.  But after a certain period, the impo-
tence of the castrated individual becomes perfect.
  The retention of the testicles in the abdominal cavity is
another cause of impotence and  sterility of the male.  As a
general rule the  testicles do  not descend  into the scrotum
until the  fetus  has  reached the age  of  seven months; if
they do not descend at this period, the virile powers may
be  seriously  impaired  in after-life.    In  such cases  both
the internal and external organs are imperfectly  developed,
the sexual appetite is exceedingly feeble, and sterility is the
natural consequence.  Sometimes only one  testicle descends
and the other one remains in the abdominal cavity; or, in-
stead of two, three testicles are present.  Such irregularities
do not prejudice the sexual faculty.
  Diseases of the testicles constitute  a tolerably frequent
source of sterility.   We have already made mention of the
syphilitic sarcocele.  Cancer and the medullary sarcoma of
the testicles likewise extinguish the fecundating power.  These
disorganizations generally require to be removed by the knife,
and we therefore refer to works on surgery for the details of
such operations.
   Tuberculosis of the testicles completely  destroys the virile
power.  Very frequently this is  an  original disease;  it com-
mences in the epididymis, and thence spreads to the seminal
vessels and vesicles,  the prostatic gland and the  lymphatic
glands belonging  to the  sexual system.   Sometimes  the
disease spreads still farther.  It develops itself more particu-
larly in young men affected with tuberculous dyscrasia, and
addicted to sexual excesses or self-abuse.
   Impotence and sterility may likewise  be caused by diseases
of the prostate gland, of the seminal vesicles and  the ejacu-
latory ducts, and in general by whatever has a tendency to
weaken  the fecundating powers or organs, or to cause sper- 
 240                SEXUAL EXCESSES.

 matorrhoea; or by paralysis of  the  perinaeal  muscles which
 contribute to the ejaculation of the semen. •
   Malformations constitute mechanical causes of impotence.
 If congenital, the impotence is a permanent and irremediable
 defect.  But if merely acquired, or removable  by an opera-
 tion, the sexual  power may often be restored by adequate
 treatment.
   Among congenital malformations we distinguish—
   1. Smallness of the penis: All the rest of the organs being
 normally developed, the  penis  may  nevertheless  remain
 small—in consequence of various anomalous  influences—and
 therefore short, as is more or less the case in  hypospadiasis
 and in male hermaphrodites whose penis is not much larger
 than the clitoris of the female.  Evidently sexual intercourse
 is impossible when the male organs are shrunk to this diminu-
 tive size.
   A portion of the penis has sometimes to be removed by an
 operation.   In such  cases the power of fecundating  the
 female  ovum is not  always  destroyed, inasmuch  as  a mere
 ejaculation of the semen against the outer pudendum  is fre-
 quently sufficient to effect this result.
   2. Hypospadiasis  and epispacliasis: These defects  consist
 in fissures of the  penis or rather of the urethra.   Hypospa-
 diasis  is  much  more frequent  than  epispadiasis.  In  the
 former disease the fissure occurs below, in the  latter on  the
 dorsum of the  penis.  The extent of the fissure is various,
 especially in hypospadiasis.   In hypospadiasis the  fissure
 may extend  from the glans and involve only a portion of, or
 the whole urethra, and even the scrotum ; this malformation is
 accompanied by a corresponding diminution of  the size and
 shape of the penis resulting from the fissure and smallness of
 both the prepuce and glans.  In  the  higher forms of this
malformation the penis, by the complete absence of the  pre-
 puce, and the retreat of  the penis  into the fissure  of  the
scrotum, shrinks to the size of the clitoris, and, if the  fissure
of the scrotum should take the outward form of a vagina,
may lead one to mistake one sex for the other. 
IMPOTENCE OF THE MALE.
241
   In former times such malformations were termed herma-
 phrodites.  It was supposed that in such individuals both
 sexes coexisted.  In his legal medicine, Metzger mentions the
 name of Maria Dorothea Derrier, whom some physicians, such
 as Hufeland and Mursinna, maintained to be a female, and
 others, such as Stark, Martens, Marc, a male.  Malformations
 of this kind generally result in impotence.
   3. Atrophy of the penis is almost always accompanied with
 atrophy of the testes, and always  causes  impotence  and
 sterility.
   4. Apparent diminution of the size  of the  penis: This
 takes place in large scrotal herniae, sarcocele, hydrocele,  and
 may occasion impotence until the disorganization is removed.
   5. Phimosis or excessive length of the prepuce may like-
 wise lead to impotence.  If the prepuce is so long and narrow
 that it cannot be  drawn back over the glans, the ejaculation
 of the semen is impeded.  Circumcision  may restore the  fe-
 cundating faculty.
   Imperfect or suppressed erections constitute a mechanical
 obstacle to coit.  This weakness may result from abuse or in
 consequence of severe diseases.  It may likewise be owing to
 a sort of paralysis  of the  corpora  cavernosa, occasioned  by
 too frequent and  too constant compression of  the same, in
 consequence of which their excitability is impaired and even
 destroyed.  In such  cases  powerful  excitants, such as can-
 tharides, vanilla, beating with nettles, or  the use  of other
 aphrodisiaca have to be resorted to  in order to procure  an
 erection.   This weakness  is  radically cured by the applica-
 tion  of electro-magnetism, cold baths, douches, etc.  Another
 obstacle  to fecundation is an excessive erection of the penis,
 which results in a swelling  of the mucous  membrane of the
 urethra, and consequent difficulty of  ejaculating  the semen.
 A deviation of the erect penis  from the true line  likewise
 prevents'its approach to  the os tincae.  This  defect  arises
 from an extreme shortness  and tension  of the  suspensory
ligament of the penis, or of the fraenulum; or it may arise
from paralysis of one of the  corpora cavernosa, or the condi- 
242
SEXUAL EXCESSES.
tions may resemble that of chordee in gonorrhoea.  If the
fraenulum is too long, the glans is rather turned upwards, and
the penis is curved with the convex  side underneath;  if the
suspensory ligament is too short, the erect penis  may almost
touch the abdominal walls.
  The urethra may be closed up  entirely by tumors on the
penis,  indurations,  condylomata,  schirrous  tumors on the
glans, swellings of the prostatic gland, large calculi; such
difficulties  may give rise to impotence which could only be
cured by the removal  of the original obstacle.  Strictures of
the urethra may likewise impede the passage of the  semen
sufficiently to prevent fecundation.
  Obstruction^ of the excretory ducts, or an abnormal alte-
ration of their situation and direction may likewise lead to
impotence.  Injuries or extirpation  of  the spermatic duct or
the seminal vesicles by cutting into the bladder through the
rectum may lead to the same results.  The above-mentioned
obstructions cause  the semen to be  retained and to accumu-
late.   Generally this takes place  on one  side  only, the
seminal duct in the spermatic cord  and even the  epididymis
swell, and  a feeling of heaviness and a  dragging sensation
are experienced, known to science  by the  name  of sperma-
tocele.
   Congenital  malformations of the  sexual  organs causing
impotence  and sterility, cannot be removed by art.  If here
weaknesses result from  general  debility, weakness of the
sexual organs, abuse  of the sexual functions, they can be
cured, provided the patient sare in the hands of  intelligent
and experienced physicians.
   Homoeopathy possesses  a variety  of  agents  which have
been  used  with the  best  results  in these  affections.  The
proper selection of  the remedy in such cases depends, how-
ever,  upon a careful investigation of the general condition of
the patient and of all the symptoms characterising it.  By
and bye we will furnish a list of these remedies and of their
symptomatic indications.   Previously, however,  we  must
make mention of an agent of which we have seen the moi,t 
IMPOTENCE OF THE MALE.
243
beautiful results  in our practice, and which we have found
essentially to  favor the employment and action of homoeo-
pathic remedies;  we allude to  electro-magnetism.   The
negative pole  is  applied  to the sexual  organs or  to  the
perinaeum, and the positive pole to the lumbar vertebrae.  In
some cases we have  found  it advisable  to pass a  current
through the parts while the patient was taking a bath.  At
the close of the work  we shall go into details concerning our
mode of applying electro-magnetism, and we will now furnish
a list of the homoeopathic agents, of which we have success-
fully availed ourselves in the treatment of seminal weaknesses.
  Acidum muriaticum, in complete impotence, relaxation of
the penis,  complete absence of all erections and a sense of
weakness in the parts.
  Agnus  castus, for frequent emissions, aversion or indiffer-
ence to sexual intercourse, deficient erections.
  Argentum nitricum: Deficient sexual desire, shrivelling of
the genital organs.
   Camphora:  Weakness of the parts, want of sexual desire
and erections, coldness of the parts.
   Cannabis: Aversion to sexual intercourse, with coldness of
the genital organs.
   Colocynthis : Complete impotence, complete loss of sexual
desire.
   Conium maculatum:  Impotence, deficient  erections,  im-
perfect or  short-lasting erections.
  Ignatia amara: Impotence, with a feeling of weakness in
the  hips.
  Lycopodium:  Aversion to intercourse of  several years
standing,  with impotence.
  3Iagnesia carb.: Deficient erections, loss of sexual desire,
aversion to intercourse, no erection even when dallying with
a female.
   Selenium: Impotence, with desire for coit.
   Sulphur: Impotence, with amorous fancies.
 , Stramonium:  Complete impotence.
  Sabadilla: Relaxed  penis,  even with amorous fancies; 
244
SEXUAL EXCESSES.
insensibility  to  sexual excitement, averson to  dallying with
females, diminished sexual desire.
   Thuja: Indifference to female society.


              V. Sterility of the Female.

   Sterility occurs much  more frequently in the female than
in the male.  The causes of sterility in the female are as
various as those of impotence, and may likewise be  divided
into general, local, and relative causes.
   Among the general causes we distinguish more particularly
such as  relate to the whole body, and involve the composi-
tion of the blood and  the nervous energy, viz: debilitating
diseases.  Hence sterility of the female  frequently occurs
after sexual excesses, or  in consequence of onanism, in which
case it is accompanied by a whole series of phenomena which
have been  described  already in  the  chapter  on  onanism.
There  is a certain shape  and development of the female body
which  denote a disposition to sterility.   Such women are of
slender make, their extremities are coarse and angular, the
sound  of their voice is  rough  and hard,  the  mammae are
either  wanting  or imperfectly developed,  the  skin  has  a
darker hue and, is covered with hair in places where  they
generally exist in the male sex, as  on the upper lip, chin, etc.
Considerable fleshiness is likewise  a  frequent cause of  steri-
lity ; a lascivious disposition and excessive  intercourse like-
wise prevent  conception,  as is seen in the case of prostitutes.
Females  who marry either too young or too old, are likewise
apt to  be without children.   There is scarcely a woman who
is  entirely devoid of  sexual desire ; but even if  this were the
case, she might  yet  conceive, considering that the part she
performs in  the sexual  act, is of a  more  passive nature.
Women in whom the sexual passion  is  less active,  are  more
easily impregnated, than  women with strong sexual desires.
The same general diseases which cause impotence in the male,
lead to sterility in the female.   The same remark  applies to
the use of coffee, tea and other spirituous stimulants. 
STERILITY OF  THE  FEMALE.
245
  Among the  causes of sterility which are inherent in  the
condition of the parts, we  number  functional derangements,
diseases of the sexual  organs, congenital malformations and
anomalies preventing either the sexual act itself or the fecun-
dation of the  ovum.
  Diseases  of the ovaries, inflammation, dropsy, hydatids,
fibrous tumors, schirrous indurations and osseous  concretions
of the ovaries  lead to the  destruction of the ova, and conse-
quently produce sterility.
  If  all the ovula are destroyed, conception is, of course, no
longer possible.
  Not unfrequently  a copious  leucorrhoea is  the  cause of
sterility.   In such a  case it  is important to  ascertain the
exact locality of the  leucorrhoeal discharge ; for, if it arises
from  the walls of the vagina,  sterility is very  seldom the
result of it, unless the thick and sour mucus should interfere
with  the free  movements  of  the  spermatozoa.   If the  dis-
charge  arises  from the neck or cavity of the  uterus,  the
mucus is still  thicker, glassy  like albumen, stiffens the linen
and has an alkaline reaction.   After coming in contact with
this mucus, the movements of the spermatozoa  are  arrested
on  the spot.  This disease is frequently in the way of  con-
ception, but it can be removed.
   There are various  primary or consecutive diseases of the
uterus which are still  more frequent causes of sterility.   In
consequence of other diseases the direction of the uterus may
be  altered, so as to cause  retro  or anteversion of the uterus ;
the os tincae may deviate  from the normal line, so as to form
an angle with the body of the uterus;  prolapsus and inver-
sion of the uterus, destructive  ulcerations of the substance
of  the  uterus,  adventitious growths, such as : cysts, fibrous
tumors, polypi, osseous  concretions, tubercles,  cancer,  and
frequently recurring metrorrhagiae are more or less frequent
 causes  of  sterility.
   The absence of the menstrual flow is likewise a  cause of
 sterility, especially if this anomaly arises from diseases  of
 the ovaries.   We know that an ovum is secreted  at every 
 246                 SEXUAL  EXCESSES.

 menstruation, and this seems to  show that menstruation and
 formation of the ovula are intimately connected.  Generally
 women lose their  catamenia at the age of forty or forty-five
 years, and cease to bear children; only in a few cases women
 have still been impregnated after the cessation of the menses.
 If the  menses  cease prematurely  in  consequence of some
 violent emotion, a cold, etc., sterility is  very frequently tho
 consequence of  such  a suppression, and derangements of the
 general health set in, which  ordinarily point to diseases of
 the ovaries.
   It  is a general rule that, if  the first menses appear prema-
 turely,  they likewise  cease again at an early age.
   Sterility of the female is caused by a variety of malforma-
 tions, either of the external or internal organs.
   The  external  pudendum may either be  entirely wanting
 or only imperfectly developed. Some parts of the pudendum,
 such  as the labia or clitoris may be  too small; the entrance
 of the vulva may be  entirely  obliterated or  too -large.   The
 labia or clitoris  may,  on the  other  hand,  be  excessively
 lengthened, the  nymphae may be abnormally multiplied or
 too large  and long.
   The vagina may be completely or partially obliterated; it
 may form a cul-de-sac of various shapes and sizes, having its
 sacculated extremity somewhere in the interior of the vagina,
 or it may terminate in the urethra. It may likewise assume a
 hermaphroditical appearance,  the clitoris  being  enlarged to
 the size of the male penis, and the other parts being  compa-
 ratively smaller  than  in the natural state.  There may be two
 vaginae, or the vagina may be divided into two canals by an
 intermediate septum.  In  such a case the  uterus may either
 be  compound or single.  Such  a case has occurred to us
 some  time ago.    The speculum  penetrated  both  passages,
 and, in  each, showed an os tincae.
   Entire closure or  excessive narrowness of the  vagina is
probably a congenital defect in most cases, but may likewise
result from large ulcers and cicatrizations.   This defect may
either involve the whole  or  only a portion of  the  vagina. 
STERILITY OF THE FEMALE.
247
Sometimes a second hymen is discovered in  the  vagina, a
dense membrane which of course arrests the introduction  of
the semen.   Tumors  in  or  near the vagina, occasioning a
contraction of the organ, likewise impede  conception.
  Malformations  of the hymen, such as excessive hardness,
thickening, abnormal  growths or interstitial distentions of the
hymen, may likewise  oppose the fecundating process.
  Defects of the  uterus.  Sometimes the os  tincae is closed
by a membrane, by whieh means not only the introduction of
the semen but also the discharge of the menstrual blood is
prevented, so that its  accumulation in the  uterus and the
consequent swelling of this organ may simulate pregnancy.
The os tincae may likewise be  closed by plugs of mucus.  A
conical shape of the os tincae  is supposed to  render  sterility
unavoidable: in such  a case it is very long, pointed, and  its
orifice is scarcely perceptible.   The uterus  may likewise  be
entirely wanting.   In such cases the vagina generally termi-
nates like a  cul-de-sac, although  the  general health of the
patient may be excellent.   Generally such a defect is accom-
panied by a defect or an entire absence of the ovaries.
  Defects of the Fallopian tubes.  In  some cases  their fim-
briated extremities adhere to adjoining parts, in consequence
of which defect they are no longer able to embrace the ovary
and to receive the ovum after  it had become detached.  This
defect is either congenital or it  may arise from an inflamma-
tion of the peritoneum.   The tube may be very much con-
tracted, or it may be  closed at the  extremities  or in the
middle.  Such a defect is either congenital, or it results from
an  inflammation  of the tube,  or from an excessive secretion
of mucus in the tube, or  from tumors existing either in  or
near the tube.  If the tubes are entirely wanting, in such a
case the ovaries are likewise wanting.   The  tubes may like-
wise be temporarily obstructed or contracted  by mucus.
  Beside these  exceedingly  important causes of sterility,
which it is sometimes impossible to.remove, there are other
relative causes of sterility.
  By  relative  causes we understand a variety  of circum- 
248
SEXUAL EXCESSES.
stances, which in spite  of a perfect development of all the
organs, nevertheless prevent conception.   Such causes are,
for example, antipathy or antagonism between the married
partners; extreme differences of age,  constitution  and tem-
perament, as when a very old man is married to a very young
wife, or vice versa, a very old woman to a very young  hus-
band ;  or when a cold and phlegmatic husband  has a wife of
a very  ardent temperament.  Such causes are quite frequent,
although it is not always easy to  find them out.  There are
instances of sterility of  five,  ten  or twenty years  standing,
and where, after this period, conception  took  place in conse-
quence of a change in the outward relations of the married
partners.   Henry II.  had no children by the Duchess  of
Urbain for ten years.   When he was on the point of  separa-
ting from his wife, his friends advised him first to  consult
the celebrated Doctor Fernell.   " Will you make my wife a
child?" asked the King, smilingly.  " Sire," said the Doctor,
"you will  have  to do that,  but I will tell you how."   The
Doctor's advice being followed, the Queen indeed gave birth
to a child, and, on this occasion, made  the doctor a  present
of seventy thousand dollars, which was a very large  sum  at
that period.  Anna of Austria had been  married to Louis
XIV. for fifteen  years before she had a child.  Baudeloque
mentions  the case of a  high  personage  who could  not  have
any children either by his wife  or his mistresses.   After an
absence of two years from France, his wife became pregnant,
and gave birth to a boy.   After this, his  wife again remained
without children  for four years.  After another  absence from
France, his wife  again had a  child.  The  change of  climate
was evidently the cause of the change in the condition of the
uterus.  By Baudeloque's advice  he took  a journey out  of
France once a year, and by this means he  became the father
of eleven children, five boys and six girls.
   In former times, when sterility was  noticed much  more
than now-a-days, aversion of  one of the  married partners
against the other may have been a frequent cause of sterility.
In those times women frequently complained before a judge 
STERILITY OF  THE FEMALE.
249
that their husbands neglected  to  fulfil their  matrimonial
duties.   This  gave  rise  to  the enactment, particularly in
France, that the sexual  act had to be executed in the presence
of witnesses, in order that the ability of the husband might
be proved or disproved.
  This statute is said to have originated in the proposal made
by a certain rake who was accused of impotence, to hold  in-
tercourse with a female in the presence of witnesses, and to
prove to them that he was not afflicted with impotence.  This
proceeding became more or less general in the 16th century,
and the ecclesiastical tribunals resorted to it  by statute in all
doubtful cases.
  The lawyers, Guy de Chanliac and Vincent Tagereau, re-
late the following particulars in reference to this statute:—
  According to Chanliac, husband and wife are to lie by each
other in the  same  bed  for several  days and nights, in the
presence of an experienced matron, appointed for that pur-
pose by a physician employed by the authorities ; this matron
is to exhort both parties to caress each other, etc.,  and was to
give them some elixir, and to fumigate their parts  with some
ointment made of dry vine leaves; finally  she was to  report
to the physician what she had seen,  and this one related the
facts to the authorities.
  Vincent Tagereau, in his discourse  on impotence, states
that in the suit of Treasurer  de Bray, three physicians, three
surgeons, and three  midwives, acted  as jurors.  Both parties
having sworn  that they would honestly fulfil the matrimonial
duty without interposing any obstacles, and the jurors having
sworn that they would faithfully  relate what had passed  be-
tween the parties, these are conducted into a room where both
are carefully examined, from the vertex to the feet, in order
to ascertain whether there might be any natural obstacles to
the  sexual act; the  parts of the husband were washed with
tepid water, and the woman was  placed for a while in a tepid
bath.  After  this, husband and  wife lie together in the same
bed, the curtains are closed and the husband is requested to
fulfil the act.   In  one  or two  hours  the jurors  are either
                            17 
250
SEXUAL EXCESSES.
called or they come  of their own accord,  and examine the
female,  in  order to  find out whether the thing had been ac-
complished.  The  proceedings  are  communicated to the
ecclesiastical tribunal.
  It often  happens  that women who  had no.children by one
husband, have  children by another one, and vice versa, that
husbands whom their wives  accused of being unable to pro-
create children, have children  by other wives.   In 1653 the
Marquis de Langry married, at the age of  twenty-five years,
Lady Mary de Courtomier, fourteen  years old, and  for four
years they lived together on the best understanding.  In the
fifth year  the  lady charged  her husband with impotence.
Experts declared that  both parties were perfectly formed.
The lady,  however,  insisted upon her charge, and the mar-
riage, in spite of all the efforts  of the Marquis to  the con-
trary, was  declared null and void.   He afterwards married
Diana of Montault, by whom he had seven children.   Such
results have occurred and  will continue to occur very fre-
 quently.
   We do not  consider it necessary,  in order that conception
 may take  place, that  the thrill should occur  simultaneously
 in both parties, but it  is a settled fact that the nearer  to  the
 menstrual  period the sexual  act takes place, the more cer-
 tainly  the women will conceive, because an ovum is already
 detached  at this period, and is on its way to  the uterus.   It
 has likewise been observed  that  pregnancy takes place more
 readily after the parties have been separated for a while, or if
 they observe  due moderation in the exercise of their matri-
 monial functions.  Among the  orthodox  Jews the women
 generally bear many children,  probably  owing to the  fact
 that the husband is not allowed to have any intercourse with
 his wife for one fortnight after her menstruation.
    The treatment of this disease is  pretty much the same as
  that of impotence.  A careful  examination  of  both parties
  and absolute  confidence in the physician are  indispensable to
  a cure.   A variety of circumstances may sometimes operate
  to bring  about  such a condition, and unless  they are known, 
STERILITY OF THE FEMALE.
251
it is impossible to remove them by treatment, provided, how-
ever, that no malformations are in the way.
  The examination  has to embrace the whole history of the
parties  themselves,  and  even  of the parents ;  the sexual
organs have tojie subjected to a careful inspection.
  It would be impossible to indicate a suitable treatment for
every case of sterility; the  best method is to consult an in-
telligent and conscientious physician, who, after taking cog-
nizance of every circumstance bearing upon the case, will
be best able to remove the difficulty.
  We will mention a few general rules of treatment in order
to convince interested parties that a cure is often possible.
  One of the most frequent causes of sterility is weakness of
the sexual organs and of the sexual functions, accompanied by
general debility; the  former weakness generally arises from
abuse of the parts, the latter from sickness.
  To remove  the weakness of the organs, the patients will
have  to avoid for  a time every thing that might excite the
organs.  The  same diet will  therefore have to be observed in
sterility that has been  recommended for impotence.
  Homoeopathic agents and electro-magnetism  have likewise
proved very efficient in the treatment of sterility.   One pole
is applied to the parts, or  even introduced in the vagina: and
the other  to the spine, either in the  lumbar region  or  some-
times in the region of the medulla oblongata.'
  The moral condition of the patient is of great importance ;
with reference to such symptoms,  Baryta, Conium,  Dul-
camara, Platina, Sepia, or Sulphur, may be  administered.
[Conium  more  particularly when  the patient inclines  to
sadness and is easily moved to tears by little trifles, or is dis-
posed to feel vexed; Platinavihen the patient feels oppressed
with anxiety, or feels very cheerful one day, and low-spirited
the next;  Sepia, for great sadness, disposition  to find fault;
Sulphur, for despondency, irascible disposition, forgetful.]
  Congenital  malformations are generally  incurable.   If
sterility depends upon some local  cause, this  is frequently
removeable.  Diseases of the ovaries and uterus, and  more 
252
SEXUAL EXCESSES.
particularly leucorrhoea, can be cured  by proper treatment,
and the sterility caused by them, will likewise yield.
  For chronic ovaritis, which is  such a  frequent cause of
sterility, we give at times Cocculus, at others Ignatia, espe-
cially if the patients  complain of dull pains, in the pelvic
region.  If the disease is  of long standing, and the patients
complain of dull, burning pains deep in  the pelvis, Arsenicum
album is indicated.  If the inflammation had been caused by
sexual excesses or by onanism, China, in conjunction  with
electro-magnetism, will  prove useful.   If complicated  with
nymphomania, Platina, Sepia or Sulphur may be exhibited.
   Chronic affections of the uterus require : Arsenic, Cocculus,
Nux vomica, Platina and Sepia.
   [Arsenic, for schirrus and  carcinoma of the uterus, with
burning and  shooting pains, discharge of foul  and corrosive
sanguineous ichor;
   Cocculus for uterine spasms, amenorrhoea, indurations  of
the  cervix;
   Nux vomica: chronic congestions of the uterus, with burn-
ing   heat, heaviness,  sticking  and  pressure;  contractive
uterine  spasms, a  griping and digging  sensation, with dis-
 charge  of clots of  congealed blood;  pressure towards  the
 genital  organs,  early in the morning, in  bed, or during a
 walk in the open air, with  contraction  in  the hypogastrium;
 excessive  duration  of the menses, a constant flow, but  not
 very copious, or paroxysmal gushes of blood;
   Platina for uterine hysteria, with intolerable titillation in
 the   uterus, or  uterine  disorganizations with  symptoms  of
 putrescence ;
   Sepia, schirrous  disorganizations  of the cervix, discharge
 of a purulent, foul matter.] 
SPINAL IRRITATION.                253
                  VI.—Spinal Diseases.
   The spinal marrow is frequently involved in diseases of the
 sexual organs, especially when such  diseases arise from pre-
 mature or unnatural sexual excesses.
   Diseases of the spinal marrow manifest themselves either
 as  local affections, or in remote  parts, most  generally and
 first in the lower extremities, urinary bladder,  sexual parts,
 etc.   It is not our intention to furnish a complete treatise of
 diseases of the spine, and we  shall simply confine ourselves
 to such as are  intimately connected with the condition of the
 sexual organs, and either result from or give rise  to a derange-
 ment of the sexual functions.   It  is true, scarcely any spinal
 disease does  not exercise some influence on these functions,
 but there are some spinal  affections  that  are more immedi-
 ately related to the sexual sphere.

                   Spinal Irritation.
  A pain or soreness of the spine is a frequent accompani-
ment  of diseases  of  the  sexual  organs.   It is generally in
the lumbar and sacral region that the irritation of the spine
is seated.  It  is  accompanied by great excitability  of the
sexual organs,  erections, etc.   This irritation of  the  spinal
genital nerves is generally caused by hysteria,  sexual exces-
ses, onanism, leucorrhoea, carcinoma of the womb, gonorrhoea,
and urinary diseases.  This kind  of  irritation is pretty com-
mon among the higher classes, especially that portion whose
minds and bodies have been subjected to the perverse systems
of education prescribed by fashion;  it is  known under the
comprehensive  appellations of hypochondria and hysteria.
The symptoms are aggravated  by  disagreeable emotions,
luxurious living, stimulating drinks, menstrual derangements,
late rising, sleeping on the back, and sexual irritations.
  The treatment  is  regulated agreeably  to   the primary
causes  of this disease.   Among the general means by which
the disease is removed, we  distinguish: a strict diet, little or 
254
SEXUAL EXCESSES.
 no meat, no spirituous, beverages, coffee or tea, perfect avoid-
 ance  of all sexual irritations; frequent exercise  in which
 every part of  the  body is interested, regular and systematic
 gymnastic exercises,  country-air, travelling, short and  calm
 sleep, walking early in the  morning, bathing in rivers, sea-
 bathing, hydropathic treatment, the use of electro-magnetism.
   Of internal remedies  we recommend: Acid, nitr., Acid.
 phosphor., Arsenic,   Belladonna, Bryonia,  Calcar. carb.,
 Chamom., Coffea,  Colocynth.,  Cocculus, Conium, Causticum,
 Ferrum,  Graphites, Lycop.,  Nux vom.,  Opium,  Pulsat.,
 Rhus tox., Sepia, Sulphur, Veratr. alb.
   [The  selection of each particular agent depends in a mea-
 sure upon the constitutional symptoms which characterize the
 spinal irritation.
   Aconite is one of the most admirable  remedies for spinal
 irritation  characterized by soreness, lameness, weakness of
 the back, shooting, boring, twitching, wrenching or crawling
 pains, constant involuntary emissions, weakness of the sexual
 organs, deficient  erections, great sensitiveness of the organs
 to the touch.
   Acidum phosphoricum: Burning spot in  the small of  the
 back, drawing  and pressing  pain in the small of the back,
 hard  swelling  of the   spermatic cord, loss of  the sexual
 desire, frequent emissions.
   Calcarea carbonica: weakness of the back with great ner-
 vousness, excessive  sexual desire.
   Chamomilla:  Drawing  or  excessive   bearing-down  and
pressing  pain in  the  small of  the back, down the thighs,
sexual excitement with itching of the scrotum.
   Cocculus:  Laming and bruising  pain in  the small of  the
back,  tremor in the  back, itching of the scrotum, violent pain
in both testicles as if bruised, increased desire for coit.
   Conium: Stitches in  the small of the back, with drawing
through  the lumbar vertebrae when standing;  spasm in  the
back;  loss of  sexual desire; loss of semen after the least
sexual excitement.
  Lycopodium: Violent pain in the small of the back, with 
SPINAL IRRITATION.
255
stiffness,  chilliness,  loss of sexual desire, small,  cold penis
with inability to become erect.
   Nux vomica: Nightly pains in the small of  the  back;
beating pain in the  small of the back, with eructations  and
chills;  contractive pain in the small of the back; tense  and
sore feeling of the sacral and lumbar regions to the touch, or
pain  in the  small of the back and knees as if bruised  and
contused; sudden stitch  in  the  small of the back, when
endeavoring  to turn to one  side, with dull pain when sitting
perfectly  quiet; constrictive pain in  the  testicles, nocturnal
emissions, continued and painful erections.
   Opium: The sexual desire is violently excited, with lasci-
vious dreams and  emissions.
   Pulsatilla:  Aching pain in the small of the  back  as  if
weary ; stiffness and ulcerative pain in the small of the back ;
contractive pain through the  small of the back, or stitching
pain  in the  small of the back and abdomen, followed by a
creeping and drawing in the  head, accompanied  by vanish-
ing of sight  and hearing ; the back is painful and stiff as a
board; the right testicle  is drawn up and  swollen,  with swell-
ing and tensive pain of the spermatic cord, or drawing-tensive
pains from the abdomen through the spermatic cord into the
testicles which hang down low;  erections day  and night;
emissions with excited sexual desire.
   Rhus tox.: Pain in the small of the back as if  bruised or
contused,  when lying still,  or  sensation as if the part  were
pressed against a sharp edge; tympanitic  swelling of the
scrotum, with a good deal of  itching; violent sexual desire,
with emissions.
   Sepia: Weakness of the small of the back, with  increase
of the sexual desire, and painful and violent erections.
  Belladonna: Dull, distressing  drawing round  the  whole
pelvis ;  intense cramp-pain  in the  small of the back and the
os coccygis, relieved by standing and walking; lancinations
in the  testicles,  they are  drawn up;  nocturnal emissions
without erections;  perfect apathy when thinking of the other
sex.] 
256
SEXUAL EXCESSES.
                    Tabes dorsalis.
  This is a disease of the spinal marrow in  consequence of
which  the  muscular energy and  elasticity gradually  disap-
pear, and  which,  from  emaciation  of the long dorsal  and
lumbar muscles, gradually leads to general consumption  and
perfect paralysis.
  Both sexes are liable to this disease, but more particularly
young men.   It is  frequently overlooked  in  females,  on
account of the  greater delicacy with which  their  condition
has to be examined and inquired into.  It is either the direct
or indirect consequence of sexual excesses, bodily fatigue or
cold.  The disease is sometimes preceded for years  by symp-
toms of increased irritability and  relaxation of the sexual
organs  characterized by an inability to  perform the sexual
act,  and by frequent emissions even in the  day-time,  and
various other signs  of  a general  irritation  of  the spinal
marrow.
  This  disease  commences with an unusual disposition to
weariness  in  the lower limbs and back,  and an inability to
bear fatiguing exercise and to stand  or stoop for a long time.
After a while the muscular sensations become altered; when
walking the patient fancies that he is stepping on fur or wool,
and  that the floor  is shaking or soft; hence,  when walking,
he likes to stamp with the feet  against the floor.  Gradually
the patient loses the faculty of properly using his muscles
without looking; in the  dark, or while his eyes are closed,
he loses his  sense of equlibrium, staggers to and  fro,  and
frequently consults a physician  about his vertigo.  When the
dorsum of  the hand  is extended on the table, small bodies
placed in the palm of the hand, are no longer perceived  by
it; the patient is unable  to button up his coat; all his volun-
tary  motions  are performed hastily  and  in an  awkward
manner, because they are no longer directed by the muscular
sensibility and energy.   The gait becomes unsteady, stagger-
ing,  the knees  give  way  from before backwards; if once 
TABES DORSALIS.
257
under way the patient is  unable to arrest his steps without
holding on to something; hence he is unable to stop or to
turn about suddenly, and is  greatly  disturbed by trifling
obstacles.  At last he has to be supported in walking.   The
ischiatic processes and the iliac bones become prominent in
consequence of the emaciation  of the dorsal  and glutei mus-
cles.  Accompanying  symptoms are :  drawing and  shooting
pains, creeping in the  lower extremities and the back ; sensi-
tiveness of the skin  to  currents of air; relaxation of the
abdominal muscles,  bladder and rectum; paralysis of the
sexual organs; sweats and herpetic eruption on the perinaeum;
pains in the abdomen and chest,  dyspnoea, palpitation  of the
heart, etc.
   The treatment should aim above all things  at removing the
causes of this disease; hence  all physical excitation  of the
sexual organs, and all lascivious  fancies have to be carefully
avoided in order to allow the sexual organs  as much  repose
as  possible.  Spices,  and stimulating  food  and beverages
have to  be avoided.   The patient should sleep on a hard
mattress, on the side, rise  early, and never retain the urine
or stool.  In the first stage of the disease, gymnastic exer-
cises, if  carried on  moderately and discreetly,  may have
favorable results.  Country-air,  rural occupations, etc., are
likewise useful;  afterwards cold baths, shower-baths, washing
the chest, back and sexual organs with cold water,  vapor-
baths and douches on the sacral region  will be found emi-
nently useful.
   The diet should be nourishing  and light: milk, milk-soups,
jellies, venison, etc.;  whey should constitute a constant arti-
cle of the patient's diet.
   Internally the patient may use Aconite, Acidum phospho-
ricum,  Arsenicum,  Graphites and Lycopodium, especially
the three first named remedies,  in the order in which they
are  named.   The cautious use  of  electro-magnetism  is
attended with the best results. 
258        DISEASES  OF THE  URINARY ORGANS.
              Diseases of the Urinary Organs.
  These diseases frequently exist independently of syphilis
or derangements of the sexual functions.  They are gene-
rally painful, troublesome and dangerous diseases, the rather
that many patients  aggravate their condition by not apply-
ing to  a  physician in  season.  Syphilitic  diseases of  the
urinary organs and of the prostate gland having been treated
in the previous chapters, we have only to describe the symp-
toms and indicate  the treatment of such affections of these
parts as do not arise from a syphilitic cause.

                I.  Retention  of Urine.
  By retention of urine we understand an  inability to void
the urine.  This weakness  is a symptom of  many urinary
affections, and  is frequently painful  and attended with dan-
gerous consequences ; it may even endanger life, and should
be attended  to as soon as it is perceived.
  The causes of this disease may be divided  into two groups,
one of which embraces all those influences which neutralize
the contractile power of the bladder;  and the other, such as
prevent the emission of urine, although the contractile power
of the bladder is perfect.
  In describing the anatomy of the bladder, we showed that
it is provided with muscular fibres, which enable it to contract
whenever  an adequate stimulus  is acting upon it.   This con-
tractile power  of the bladder is one of its  chief means of
voiding the urine, for the  peritoneum and the  diaphragm are
only indirectly concerned in the emission of urine, and would
be unable, in  case  the  bladder were  paralyzed, to expel the
urine.   If the  bladder is no longer capable of contracting,
we say that  the bladder is paralyzed.   This is always accom-
panied by a  complete retention  of the urine.   If the contrac-
tile power of the bladder is only weakened, the retention of
urine will only be imperfect.
  Among the  diseases which lead to the retention  of urine,
we number:  diseases of the brain and spinal marrow; exces- 
retention of urine.               259
 sive distention of the muscular fibres of the bladder, which
 takes place whenever,  from carelessness,  forgetfulness,  or
 false modesty, the urine is retained in the full bladder beyond
 a certain period; violent inflammation of the bladder and of
 the  adjoining organs; catarrh of the  bladder;  inflammation
 of the peritoneum;  difficult  labor, during which the  head of
 the child remains for a long time wedged in the pelvis; fibrous
 or  schirrous  disorganization of  the  walls  of  the bladder;
 typhus and other acute fevers, during  which the patients lose
 their consciousness and allow the urine to accumulate in  the
 bladder and to remain in it beyond the normal period.
  During the course of the diseases which we have mentioned,
 the sentient nerves of the urinary bladder may become para-
 lyzed, in  consequence' of which the desire  to urinate would
 no longer be felt; or the will-power ceases  to influence  the
 muscles of the bladder,  as, for instance, in affections of  the
 brain and spinal marrow;  or the muscular fibres may have
 become so relaxed and atrophied that they are no longer able
 to perform  their functions with regularity.   In the former
 case the  patient  ceases  to be conscious of the necessity of
 voiding the urine, and the sphincter vesicae, after the bladder
 has  become full  and distended, loses  its controlling power,
 and  the  urine drops  out during motion, like  an overfilled
 vessel when agitated.  In the latter case, the bladder has no
 longer the muscular energy required for the expulsion of the
 urine.
  Complete retention of  the urine in the various diseases  of
 the kidneys, such as inflammation of the kidneys, Bright's
 disease, etc., oGCurs less  frequently.
  The second group of the causes of  retention we class me-
 chanical  obstacles which  impede the flow of  urine, although
 the bladder may be possessed of  its  full contractile  power.
 These obstacles act partially from without,  compressing the
urethra and the neck of the bladder, and thus preventing the
urine from  flowing out.   In  men the  urine may be retained
in the bladder by large  hernia,  swelling of the testes and
scrotum,  accumulation of the faeces in the rectum, or con- 
260         DISEASES OF THE URINARY  ORGANS.

striction of the penis by means of a cord which is tied round
the part by  some young men for the purpose of preventing
involuntary  discharges of urine in bed during sleep;  it was
not long since that we were called to such a case.
  In the case of women, retention of urine generally sets in
in the fourth month of pregnancy and during parturition; it
may likewise be caused by polypi  in the uterus ; fibrous tu-
mors and schirrus of the uterus;  changes in  the  position of
the uterus,  such as retroversion  or anteversion; curvature
and  prolapsus of this organ; or incrustation of a pessary in
the substance of the womb.
  Mechanical obstacles may likewise act  from  within, by
closing  the canal as with a plug.   This  may  be effected by
stone,  gravel, coagula, hydatids,  mucous  plugs, or foreign
bodies which had penetrated into the bladder, such as pieces
of bougies,  catheters,  pencils,  and  such like objects, which
children sometimes introduce into the urethra for  fun, and
which then glide forward into the bladder.
  Other mechanical obstacles are alterations of  the  tissue of
the urethra, such as  mucous valves at the neck of the blad-
der ; swelling of the prostate  gland; strictures; absence of
an orifice at the outer extremity of the  urethra; closing  or
constriction of the prepuce ; engorgements of the veins on the
neck  of the  bladder, which very frequently co-exist  with
haemorrhoidal tumors and varicocele.
  We  generally distinguish three degrees of  retention  of
urine,  and  designate  each degree by  a particular name;
1, dysuria,  the emissions of urine being  simply  difficult, with
or without  pain ; 2, strangury, the urine  being discharged
only in drops, in spite of the greatest efforts; and 3,  ischuria,
or complete inability to emit urine.
  The affection  commences in  various ways.   Sometimes it
sets in suddenly in all its intensity ; at other  times it is pre-
ceded by various kinds of distress, the stream is feebler and
thinner, or  the urine is  discharged in drops,  there  is a  fre-
quent  urging to urinate, and only a small  quantity of urine
is discharged each time. 
RETENTION OF URINE.
261
  If the  retention  is complete, the  patient experiences a
sense of  heaviness  in the  perineal region,  urging to stool
without inability to gratify it, acute pains above  the sym-
phisis pubus ; these pains  extend as far as the kidneys and
glans.   These symptoms are accompanied by a feeling as if
the thighs  had gone to sleep ;  the  pains are worse  when
walking,  coughing  or rising  from a  chair;  they abate on
stooping  forward, because then  the  abdominal muscles  are
relaxed.   There is a constant desire to pass urine, the patient
is constantly agitated and in motion.   All endeavors at void-
ing urine, are fruitless.   After a while, nausea  and an anx-
ious oppression of breath set in.  The face and eyes become
red, palpitation of the heart, fainting, sweat and vomiting
set  in.   The bladder fills more and more,  and rises up to the
pit  of the stomach,  forming a visible  tumor which  presses
upon  the  viscera.   Gradually the  urine  is absorbed  in the
circulation,  a violent fever, delirium and sopor develope them-
selves.  If the retention has reached this degree, death gene-
rally ensues either by inflammation of the bladder and other
abdominal viscera developing themselves, or also  in  conse-
quence of the rupture of the bladder and an effusion of urine
into the abdominal  cavity.  The urethra may likewise get
ruptured,  and an infiltration of  the  urine into the cellular
tissue may take place, causing inflammation, suppuration and
even gangrene; an  inevitable  consequence of this suppura-
tion are  urinary fistulae, several of which frequently make
their appearance in the neigborhood of the rupture.
  If the retention  takes place very gradually, an  enormous
quantity of urine may accumulate in the bladder ;  it may
even pass  upwards into the ureters, the pelvis of the kidneys,
and even enter the fine urinary ducts in these organs.
  Although it is not very difficult to diagnose a retention of
urine, yet an involuntary dribbling of urine  may  sometimes
be  mistaken for an  inability to retain  the  urine, whereas, in
reality, it is owing  to the fact that the bladder is overfilled,
and that  the urine flows out,  as it were, in a similar manner
as any other vessel would flow over when  agitated. 
262        DISEASES OF THE URINARY ORGANS.
   In order to establish a correct diagnosis, it will therefore
be necessary to institute a careful examination of the  case
by the following means: 1, palpation of the abdomen and of
the region of the bladder, in order to find out whether a firm
or fluctuating tumor has developed itself any where; 2, per-
cussion of the abdomen with the plessimeter, which, if the
bladder is full, will yield a  dull  and  faint sound  in  parts
where  a clear  bowel-sound is usually heard;  by means of
percussion we have it in our power to determine the size of
the  bladder  and to distinguish  it from  the  other  viscera.
3. An examination should be instituted from the rectum or
the vagina, in which case the examining finger will discover a.
tense swelling like a bladder, and 4, a catheter may be intro-
duced, which will at the same time alleviate  and frequently
remove the difficulty.
   It is of the utmost importance to ascertain the real cause
of the disease ; for unless we know the exact cause, it would
be impossible to effect a cure.
   If the retention should arise  from an accidental  delay in
not at once satisfying the desire to pass urine, a single intro-
duction of the catheter will  remove the trouble.  [I have
found that in such cases the application to  the bowels  of a
bandage dipped in cold water, causes an immediate  contrac-
tion of the bladder and consequent discharge of urine, with-
out resorting to the catheter at all.—Ed].
   In cases  of imperfect contraction  or  paralysis  of  the
bladder,  the  urine  has to  be drawn off  with  the  catheter
which is then allowed to remain for twenty-four hours in  the
bladder.   This treatment is frequently sufficient in imperfect
paralysis of the bladder such as it apt to occur in the case of
old people.
   The principal remedies for retention of urine arising from
complete or  partial  paralysis  of the bladder, are :  Acid.
nitr., Cannabis,  Cantharides,   Causticum,  Clematis,  and
Pulsatilla.
   [To these remedies may be added Aconite and Arsenicum,
especially if the patients are very nervous and  restless, tor- 
RETENTION OF URINE.
263
mented by anxiety, and the urine passes off in  drops, looks
dark, bloody, has a strong  odor.   Aconite is  particularly
suitable to hysteric females, or in cases arising  from taking
cold, a sudden fright, a strain.
   Cantharides may be given if the paralysis is  accompanied
by violent urging to  urinate, and if it remains as a conse-
quence of inflammation of the bladder or kidneys.
  Pulsatilla is more particularly adapted to females or per-
sons of mild and lymphatic temperament.]
  In desperate  cases electro-magnetism will be found  an
excellent  remedy.  We  apply it  in the  following manner:
A silver catheter is introduced into  the bladder for the pur-
pose of emptying it, and is allowed to remain in  the bladder;
a similar  catheter is introduced into the  rectum; both poles
of the  battery having been brought in contact with the extre-
mities  of  the catheters, the electric currents were  conveyed
to the  walls of  the  bladder.  By gradually increasing the
electric action,  fifteen applications  were frequently sufficient
to cure the disease completely.
  If the paralysis is caused by inflammation of  the  bladder,
a careful homoeopathic treatment will be found sufficient to
cure the disease without resorting to the introduction of the
catheter.   This  is a great advantage;  for not only  is the
introduction of the catheter under those  circumstances diffi-
cult, but it is well, if the  irritation which always accompanies
the introduction  of the instrument, can be avoided.  If fever
should be present, Aconite will be found sufficient to subdue
both the  fever  and the  disease, and  if  a  dull pressure or
burning  at  the  neck of the bladder  should  still remain
behind, Nux vomica  will remove these symptoms.  Other
symptoms may happen to require
   Arsenicum, Baryta carbonica, Belladonna, Bryonia, Can-
nabis,  Cantharides,  Capsicum, Carbo  veget., Helleborus
niger, Veratrum.
   Arsenicum: Great urging to urinate, the urine is burn-
ing, looks bloody.
   Belladonna:  Retention of  stool and  urihe; the  urine 
264        DISEASES OF THE URINARY ORGANS.

comes off in drops, of a natural color, or else of a gold-yellow
color.
   Cannabis : Paralysis of the bladder; the urethra is closed
with mucus and pus.
   Cantharides: The urging to urinate is accompanied with
great pain, icy-coldness of  the hands and feet.
   If the retention  is  owing to a spasmodic closing of the
neck of the bladder, one of the following  remedies has to be
chosen:
   Acidum phosphor.,  Arsenicum, Belladonna, Calcar. car-
bon., Carbo veg.,  Canthar.,  Conium,  Graphites, Helleborus
niger, Ignatia,  Lycopod., Nux vomica, Platina,  Pulsatilla,
Staphysagria, Sulphur, Zincum.
   [Aconite: Violent urging, anxiety, pain  in the region of
the bladder, congestion of blood to the head, redness of the
face.   If this remedy should not relieve, give
   Cantharides, especially if the pains are cutting and tear-
ing.
   Arsenic.: As if the bladder were too full.
   Ignatia: Sharp  pressure  on the  bladder as from  flatu-
lence.
   Nux vomica : Painful, ineffectual desire to urinate, without
fever.
   Pulsatilla: Ineffectual desire to urinate, in nervous,  hys-
teric females, or persons  of gentle and yielding  disposition.
   Sulphur: Inability to  urinate,  especially in children, who
are troubled with worms or have been deprived -of exercise.]
   If the -retention is owing to mechanical causes, they have
to be removed: hernia have to be reduced,  accumulations of
faeces,  tumors,  and  foreign  bodies  have to be  removed;
abnormal positions of the uterus  have to be remedied.  The
mechanical manipulations which  may be  required for such
purposes, are materially assisted by the  exhibition  of Aco-
nite, Arsenic,  Belladonna, Cocculus,  Ipecacuanha, Lauro-
cerasus, Nux vomica, Sulphur and Veratrum.
   [Aconite, Cocculus and Nux vomica are of peculiar benefit
in  hernia;  A'conite  more  particularly when  inflammatory 
URGING TO URINATE.               265
symptoms  are  present;  in  general Aconite, and  sometimes
Coffea, will  be found  indispensable  adjuvants  in  surgical
operations to quiet the  nervous  excitement and  subdue the
supervening inflammation.)
   If prolapsus of the uterus is  the  cause of the retention,
the same remedies that have been mentioned for hernia, will
be found useful, and  moreover:  Calcarea carb., Petroleum,
Platina and Pulsatilla.
   If  all  these remedies and manipulations  should fail in
removing  the retention,  and if the excessive distention of the
bladder should threaten a  rupture of this organ, in such a
case the bladder will have to be punctured with a trocar, the
instrument being introduced through the perinaeum, or above
the symphisis pubis or through the rectum, according as the
surgeon may deem advisable.
   Having saved the patient from immediate death,  we then
proceed to  remove the  cause of the  retention ; having  suc-
ceeded in this, we then heal  the wound as speedily as possible.
If the cause cannot  be  removed, the artificial passage for
the urine will have to be kept open ;  to meet  such an emer-
gency, it would be advisable to perform the operation above
the pubis, because a metallic instrument  could  easily be
retained in this region through which the urine might be dis-
charged.
   In  the  case of women the  operation may be  performed
either through the vagina or above the symphisis  pubis.


   C/  II.  TOO FREQUENT URGING  TO  URINATE.
   Although this trouble is not a disease properly speaking,
yet it is a very unpleasant weakness  to which old people are
more particularly liable.   A frequent urging to urinate, with
or without actual discharge of urine, is often experienced by
persons who  live in a good  deal of company or who lead  a
sedentary life.   The urging increases  more or less gradually,
but a resistance to the desire to  urinate is exceedingly dis-
tressing.  If the emission of urine is postponed too long, it
                            18 
266        DISEASES OF THE URINARY  ORGANS.

sometimes becomes impossible to emit a  single drop, and the
patient has  to press upon the bladder for a long  time, after
which the urine comes off first in drops and finally in a con-
tinuous stream.
  This abnormal desire to urinate may be perfectly painless,
but it is frequently accompanied  by a sense of heaviness in
the region of the bladder, a peculiar sensation of muscular
spasms in the perineal region, pains and burning in the neck
of the bladder, contractions of the anus,  and very frequently
a spasmodic, periodical urging  as  far as the glans where a
very unpleasant itching is experienced.   If the patient suc-
ceeds in voiding the urine, it first passes  off by fits and starts,
after  a  while  the stream  become  continuous, and  the last
drops are rather painful.  In other cases there are no pains,
and the patient  is only troubled with frequent urging which
is gratified without any pain being experienced.   The  affec-
tion generally developes itself gradually.   After it has lasted
for a while,  the patients begin to  feel  uneasy about it and
fancy that  they are affected with  some  more deep seated
trouble, such as gravel, stone, stricture of the urethra, etc.,
and the  physician has the  greatest trouble,  by means  of
explanations and  persuasive  eloquence, to   remove  these
apprehensions.
   The causes of  this trouble  may be  various.   One  cause
may be the extreme smallness of the bladder, which, being
unable to hold much urine, has to be emptied very frequently.
Some persons are in the habit of voiding the,urine as soon as
the least-desire for doing s*o is  felt; in this way the bladder
gradually loses the faculty of distension, so that  it becomes
unable to hold any considerable quantity of urine.  One of
the most frequent causes is  an  excessive  sensitiveness of the
neck  of the bladder, and  of the  sphincter vesicae.   This
portion of  the bladder being naturally  vascular  and richly
supplied with nerves, it is of course sensitive, and  this sen-
sibility admits of being considerably heightened by influences
calculated to induce a determination of  blood  to this region.
A cold, for  instance, especially when arising  from  exposure 
URGING TO URINATE.
267
of the feet, may give rise to an excessive urging to urinate;
every body may know that  a cold bath, or exposure of the
feet  to cold stones, increases the desire  to  urinate.  This
trouble is  likewise occasioned by the excessive  use  of tea,
black coffee, stimulating beverages  and spiced food; by an
inflammatory  irritation of  the  mucous  membrane  of the
bladder and urethra, by blennorrhoea of the urethra, irritating
injections,  strictures,  abuse of bougies, also by the presence
of stone and renal calculi; by habitual  costiveness, irregu-
larities of  the intestinal canal, irritations of the rectum by
piles, ascarides, etc.
   Females  are frequently subject to this trouble, in conse-
quence of  anomalous  menstruation; acuminated condylomata
in the interior  or on the outside of the  urethra, may like-
wise give rise to this affection.
   The  treatment should  of course  aim at  removing the
exciting cause, and regulating the diet.   Tea, coffee, stimu-
lating beverages, spiced food, have to be avoided; in general
the  patient  should not distend the  bladder by  too  much
liquid previous to retiring  to bed.   The  principal remedies
for this weakness will be found to be
   Acidum  nitr.,  Calcar.  carb.,  Cantharides,  Causticum,
Conium, Graphites, Kali carbon., Lycop., Natrum muriat.,
Pulsat., Sepia.
   [Aconitum will prove an  admirable remedy for this affec-
tion, if it  arises from  a cold or a sudden emotion, such as
fright.   If Aconite should not afford any relief,
   Dulcamara may be used, for similar causes.
   Cantharides will help, if the urging is painful, the pain is
cutting and tearing.
   Pulsatilla, if the weakness is accompanied by a  mucous
discharge from the urethra.   In chronic cases
   Sepia and Lycopodium may be used.] 
268        DISEASES OF THE URINARY ORGANS.


III. Incontinence  of Urine, Inability to retain the
                         Urine.
  The inability to  retain the urine, and  the constant invol-
untary dribbling of the urine is a much  more disagreeable,
troublesome «and  loathsome weakness than the former.  The
urine passes off in drops,  without any  urging,  sometimes
without any sensation, and without interruption, or else the
last-mentioned  affection  attains simply a higher  degree of
development and the  bladder fills to  such an extent that it
flows over, as it were.  In either case the  sphincter vesicae is
weakened or paralyzed, and the muscular  fibres of the body
of the organ act so much more vigorously or  alone.  If the
sphincter  is entirely paralyzed, the urine generally passes
out of the bladder as soon as it enters it.
  The disease  occurs  most frequently among old  people, or
among such persons  as had  grown old prematurely in con-
sequence of excessive  living; the weakness of the bladder
generally arises from excessive irritation of the spinal mar-
row, and may  often be considered a symptom of incipient
tabes dorsalis.   In middle-aged persons the trouble may set
in in consequence of diseases of the brain and spinal marrow,
hernia, injuries of the vertebrae,  fall  of  the perinaeum,  or
during excessive  intoxication, fainting, convulsions, and in
hysteric persons.  In  some cases  the  weakness commences
even in childhood.
  This disease is not dangerous, but exceedingly disagreeable,
loathsome;  the clothes are soaked with urine, and a pestife-
rous odor of urine surrounds the patient.   Such patients are
a burthen  to themselves and others, and have  to shun  all
company.   In  spite of  the  greatest  cleanliness   they  are
troubled with a burning and itching, redness  and soreness of
the parts moistened by the urine.
  A variety of this affection is nocturnal enuresis  or wetting
the  bed, which generally occurs among children,  but  some-
times also among full-grown people.  I  have treated girls
and young men of from seventeen to twenty years old for such 
incontinence of the urine.
269
a weakness.  It  arises from a relaxed  state of the bladder.
In  some  the  urine  escapes .involuntarily in consequence of
their sleeping too soundly.  Such persons have to be roused
two or three times  in the night, in order to accustom them
to regular emissions of the urine.   Others fancy that  they
are using the chamber, whereas, in reality, they are wetting
their  beds;  such persons  should likewise be  roused  very
frequently.   There   are  some  who  from  sheer laziness,
prefer wetting the bed to  getting up and using the chamber.
In  such  cases punishments or exposure  may  have to  be
resorted  to.
  The treatment  should  be conformable to the particular
causes of the weakness.   If it depends upon other diseases,
it will  disappear with them.   If the patients  are children,
they should  eat and  drink little at supper, and should be
made to  void urine previous to  going to bed.   Children should
never  sleep on  their  backs,  but always  on  their sides or
stomachs; for, in these positions, the urine is less apt  to  irri-
tate the bladder  and  bring on  contractions of this organ.
  In the case of girls, the trouble generally continues until
they get  married.
  If the weakness is  owing to  excesses,  these  have  to be
avoided,  and the weakness of the sphincter vesicae has to be
removed  by specific remedies.
  If the  weakness arises from paralysis of the sphincter, we
usually  apply  electro-magnetism with  great  success,  and
accompany  the  application of this agent  by  the  internal
exhibition of Carbo veg., Causticum, China, Conium, Natrum
muriat.,  Petroleum, Rhus tox., Sepia, Sulphur.
  [To  these remedies  we will add Aconite, Digitalis  and
Mercurius.
  Aconite is a great remedy for this weakness, in the case of
hysteric  females, when the urine is quite pale and watery, or
when the affection was caused  by a sudden fright, a cold, or
by previous, mismanaged inflammation.
  Digitalis, when the weakness is accompanied by irregularity
of the  heart's action, dizziness, sluggish pulse. 
270        DISEASES  OF THE  URINARY ORGANS.
    31ercurius, watery urine, frequent  urging in the day-time,
 costiveness, the stools being hard, lumpy, dark-colored.
    China, will be found useful if the trouble  was caused by
 excessive losses of animal fluids, onanism, sexual excesses.
    Carbo veget. may be resorted to when  children seem to be
 troubled with worms, or in case of acidity of the stomach
 alternating, or existing simultaneously with palpitation of the
 heart.
   Sulphur is one of the most  important  remedies  in this
 affection ; in the day-time there is a  constant desire  to void
 the urine, and the patient wets his bed every night.   I once
 treated  a young man  of sixteen years,  who had wetted his
 bed every night  two or three  times  for several years past ;
 the urethra had expanded into a sacculated swelling, and for
 several months past the patient had slept on hard boards, in
 spite of which the urine passed off  every  night.  He  was
 radically and permanently cured with eight powders  of the
 first centesimal trituration of Sulphur.]  If no cure should be
 possible, the patient will have to wear a  reservoir made of
 caoutchouc, into which the urine  may collect.

             VI.  Hematuria, Bloody Urine.
   This affection usually befalls persons of an advanced age,
 and men more frequently than women.  The blood which  is
 discharged together with the urine, may emanate from various
 portions of the uropoetic system, the  kidneys, ureters, blad-
 der and urethra.   This disease is scarcely ever an idiopathic
 disease, but generally a mere symptom of some other malady.
  The cause may be  general or local.
  Among the general or constitutional causes we distinguish
an  alteration  in the  composition of the  blood, as in scurvy,
purpura haemorrhagica, severe typhus, typhus  putridus ; or the
blood may be passed with the  urine in consequence  of  the
suppression of  regular discharges, such as  the  piles or cata-
menia.   Some  females, after their menstruation ceases, pass
blood with the urine.  According to  Peter Frank, one half
of those who  are troubled with bloody urine, are addicted to 
BLOODY URINE.
271
intoxication.   This trouble may also  be one of  the  conse-
quences of onanism and sexual excesses.
  The local causes of haematuria are various :  injuries  of the
kidneys,  bladder,  ureters, urethra, especially  by stone or
gravel; contusions and shocks in the  region  of the kidneys
or bladder by a fall or strain;  continual riding on horseback,
concussion of the body in a badly contrived vehicle, over bad
roads, full of ruts, violent exertions in raising a heavy load,
during severe labor, coit, or when vomiting ; forced marches;
abuse  of  violent cathartics or  aphrodisiaca, such  as  cantha-
rides or drugs that bring on  miscarriage; also vesicatories
applied to the region of  the kidneys or bladder, etc.
   Bloody urine is passed in nephritis, or in organic diseases
of the urinary  passages, gravel, stone,  cancer or medullary
sarcoma of the kidneys or bladder, ulcerations of the bladder,
varicose  disorganizations of  the  mucous membrane  of the
bladder, etc.
   In Bright's disease, especially in the commencement of the
malady, and  in  scarlatina, the  urine is likewise frequently
bloody.
   Haematuria is frequently preceded  by  congestions of the
organs from which the blood proceeds, characterized by such
symptoms as: heaviness, dull  pain, drawing in the  lumbar
region and other  symptoms of affections of  the  kidneys, if
the  blood proceeds from  the latter organ;  anomalous sensa-
tions  in  the  region of the bladder,  strangury, If the blood
flows from the bladder.
   If the bloody discharge is caused by  injuries in the region
of the kidneys or  bladder, or  by a fall  upon the perinaeum,
the  blood is generally pure and red provided there is no urine
in  the bladder at the time.   From  the appearance  of the
blood it is  impossible  to determine  with correctness  from
what organ the blood proceeds.  If the blood emanates from
 the kidneys or ureters,  the blood is generally mixed with
 urine, and the bloody discharge is generally accompanied  by
 the above-mentioned symptoms.  If the blood comes  from
 the bladder, the patient experiences a sense of fulness,  pres- 
272        DISEASES OF  THE URINARY  ORGANS.

sure, urging and a crampy feeling in that region, a burning
sensation in the urethra, erections, and if the haemorrhage
should be  considerable, the extremities  grow cold,  the face
pale, and fainting turns supervene.   In  such a case there is
no  intimate commingling of  the blood  and urine, and the
blood is deposited on the  bottom of  the vessel in flocks and
coagula.   Very frequently these coagula fill up  the bladder ;
and, by stopping the orifice, cause strangury and even  com-
plete retention of urine.   If the difficulty arises from  stone
in  the bladder, the  first urine is generally clear, but the
latter portion of the urine becomes bloody.
  The urine may continue bloody even after the cause of the
haemorrhage had been removed for some  days.  This is owing
to the fact that the dark-red fibrine of the coagula which had
become lodged in the bladder,  are gradually carried off by
the urine.   After this dark-red  fibrinous matter has  been
removed by the  urine, the remaining pale-red fibrine gene-
rally passes off in a vermicular form,  giving rise to the belief
that worms are discharged from the bladder.
  Bloody urine  is not always  painful.    In  some cases but
very little blood is passed, but sometimes the quantity  is so
considerable as  to endanger life, especially  if the haemor-
rhage set in suddenly and copiously.
  In treating this disease we have to consider the nature and
causes of  the disease.  All spirituous  beverages,  all  sub-
stances which tend to excite the sexual appetite and to bring
on miscarriage, all sexual  excesses, self-abuse,  etc., have to
be strictly avoided.  If the disease is not caused by inflam-
mation, but by  sedentary habits and by obstructions in  the
portal system, by suppression of piles or menses, the patient
should take frequent exercise in  the open  air  in order to
promote  the circulation, and to remove  the  abdominal  con-
gestions.   Stone in the bladder  and calculi in the urethra
have to be removed by a  surgical operation.
  Internally the following remedies have  to be given : Calcar.
carb., Cantharides, 3Iercur. sol, 3Iezereum and Pulsatilla.
  [In this list the most important agent  for the cure of this 
GRAVEL AND CALCULI.               273
 affection has  been omitted, and this is undoubtedly Aconite.
 I do not believe that any drug known to us is better able to
 remove obstructions in the portal system than Aconite,  and
 to cure the diseases which arise from such obstructions, among
 which bloody urine  is very  commonly met with.   The  dis-
 charges are generally attended with a burning and stinging
 sensation in the urethra, and the patient is apprehensive of
 evil consequences, looks frightened,  sallow.  It is likewise
 adapted to the bloody urine of  hysteric females, or when the
 discharge  arises  from suppression  of the  menses, haemor-
 rhoids, or  from a cold.   If there should be an intense,  dis-
 tressing and frequently-recurring  urging to  urinate, Cantha-
 rides may  be tried instead of the  Aconite, which, by the by,
 should be  given in the  form of tincture, and, after the  dis-
 tressing urging or the pains are relieved, and the urine  con-
 tinues slightly bloody, mixed with pus or mucus, Pulsatilla
 may be employed; these three agents will be found sufficient,
 to control  almost  every case of this disease.]

   V. Gravel and Calculi  in the  Urinary Passages.
   These are  little bodies which  are  precipitated  from  the
 urine  as it cools, and are deposited on  the bottom  of  the
 vessel.  Generally the deposit is composed of small crystals
 discernible  to the naked eye.  Sometimes  it  is a  fine pul-
 verized sediment; sometimes this sediment contains small
 calculi.
   Generally this  affection  is  the  first degree  of stone,  and
 accompanied by gout and rheumatism.
   Gravel forms in the kidneys, the finest canals in which  are
filled with it.   Very frequently gravel only consists  of urate
of ammonia,  with or without free  urea; its color  is gene-
rally red,  and the urine in which  it is  contained, mostly
reacts like  an acid.   There are several kinds  of gravel dis-
tinguished   from each  other  by  their color,  size,  number,
shape, surface, consistence, position  and  chemical constitu-
tion.   Beside red gravel, we have  gravel which is red-brown,
vellow, brown, gray-white  or  ash-colored.  The size  varies 
274        diseases  of the  urinary organs.

from the finest sand to that of a pea.   As regards the shape,
the larger grains of gravel are at times round, at others oval,
oblong,  compressed in various ways, pear-shaped, cylindrical,
cordiform, prismatic, etc.   Their surface is at times smooth,
at others facet-shaped, or rough  and uneven.  In regard to
consistence, we observe differences depending upon the chem-
ical  constitution;  at  times the gravel is soft like pap, at
others hard as stone.   Most frequently  gravel is  composed
of urate of ammonia, sometimes  of mere urea, or of ammo-
niacal phosphate of magnesia,  or  oxalate of lime.
   Some  individuals  are  predisposed  to the formation  of
gravel,  and  in  others this  predisposition  is  hereditary.
Parents  affected with  stone or  gout,  generally transmit  to
their children a disposition to gravel or stone.
   The arthritic diathesis  is closely related to the formation
of gravel in  the kidneys;  a paroxysm of gout is frequently
preceded by a discharge of gravel from the urethra.  Rayer
observed that among one  hundred gouty individuals ninety-
nine were at   the same time affected with gravel.  In chil-
dren scrofulosis and rickets seem to be allied to  the  forma-
tion  of stone.
   It has been observed  that  in some  regions  gravel and
stone occur  quite frequently,  whereas  they  are  almost
unknown in other  regions.  Some have  attributed the exist-
ence of these diseases in such regions  to the use of sour
cider and sour wine, of food containing  a large  quantity of
nitrogen, to the nature of the water  and to various other
causes.   But all these  causes likewise exist  in other  places
without being attended by the same consequences.
   The formation of gravel, especially of the  kind of  which
uric  acid is the chief  element, is  undoubtedly eminently due
to the mode  of life of  the individual.   It can be shown  by
experiment that a rich, nitrogenized dry food increases  the
quantity of  uric   acid  in  the urine,  whereas the contrary
results from the use of  simple, moderate food which contains
but little nitrogen. Gravel occurs therefore most frequently
among  those who  are addicted to rich living, to the use of 
gravel and calculi
275
meat,  strong wines, etc.   Patients  who  are affected with
gravel, generally feel worse after an excess  at dinner, whereas
moderate living renders the disease comparatively harmless.
There are  substances, such  as  cheese, which is an  indi-
gestible article, any how—whose nitrogen greatly contributes
to the formation of uric  acid.  Sour food and sour drinks
likewise  favor the development of gravel;  their acid passes
into the urine and thus favors the formation of uric acid.
   The formation  of gravel  is likewise promoted  by such
derangements of the urinary apparatus as impede the  emis-
sion of urine.  Among these diseases we number principally
weakness and paralysis of the bladder, swellings of the pros-
tatic gland,  strictures,  a  habit of  retaining the urine, rest,
late rising in the morning, and all such diseases as impede the
freedom  of motion, such as articular rheumatism, fractures of
bones, etc.   Women are less frequently  attacked by  this
disease than men.
   Patients who are afflicted with gravel, the chief constituent
of which is  an urate,  frequently  complain  of sour, rancid
eructations  after dinner, sometimes of  canine  hunger, flatu-
lence, costiveness, hypochondriac  mood; indiscretions  in
eating are followed by restless nights, a feeling of malaise in
the abdomen, drawing pains in the  shoulders and nape of the
neck.  The  vascular system  is irritated,  the  pulse  is full,
hurried,  there is headache and dizziness.  Frequently pains
are experienced in the lumbar region, and along the urethra;
the emission of  urine  is accompanied by  pains and spasms,
and  the urine contains a little blood together with the gravel.
Sometimes these symptoms  alternate  with  regular attacks of
gout  or  piles, during which the above-mentioned symptoms
abate; or else  the  gout and piles abate while  the urine
deposits  the red gravel, and, after a while, again reappear.
Sometimes  the  symptoms of gravel are  confined  to  local
affections of  the urinary organs, pains in the loins which are
aggravated by bodily exercise and by excesses; pains in the
region of the bladder, frequent urging to urinate, itching and 
 276        diseases of  the urinary  organs.

 pain of the orifice of the urethra, discharge of blood with the
 urine,  etc.
   If the basis of the gravel is a phosphate, the constitutional
 symptoms are more  deep-seated; the digestive  functions are
 impaired  much  more, the appetite  is entirely gone, the  sto-
 mach is distended by flatulence, costiveness alternates  with
 diarrhoea, the stools  are fetid.  Other symptoms  are :  general
 prostration,  a small, feeble,  and  sometimes hurried pulse,
 extreme irritability, emaciation, cachectic appearance  and
 depression of spirits.
   The prognosis in  gravel is most  favorable when  there is
 no hereditary disposition,  dyscrasia, or organic disease of the
 kidneys or other organs ;  and when the formation of gravel
 is restrained as much as possible by suitable diet, regime and
 the use of remedial agents.   The uriate  is more easily cured
 than  the phosphate which  generally  depends upon some
 organic disease.    Gravel composed of the phosphate of lime,
 is the worst form of gravel,  for it  is generally  accompanied
 by organic diseases of the mucous membrane of the kidneys
 or bladder, and by an increased secretion of mucus from these
 parts.
   The cure   of  this  affection is most materially assisted by
 strict diet, which is  sometimes sufficient to arrest the forma-
 tion of urates in the kidneys.  We know from experience
 that such patients had better abstain from the use of animal
 food, and confine themselves to refreshing drinks, and use
such bodily  exercise  as will  promote the action  of the skin.
 Robust persons who  had lived on meat principally, will often
 be able to arrest the  gravel-diathesis by confining themselves
 to vegetable diet exclusively.   All heavy food, such as cheese,
 heavy   farinacious compounds, food which is  disposed to
 engender  acids,  which contains a  good deal of saccharine
 matter, and  is consequently disposed to ferment, wines, more
 especially sour wines,  have to be  avoided.  The  cutaneous
 action  should be promoted  by  warm clothes, and frictions,
 by avoiding every kind of exposure to colds, by warm baths,
 shower-baths and by bodily exercise. 
STONE.
277
   The  following remedies  may be used internally :  Bella-
donna,  Cannabis,   Capsicum,   Colchicum,  Calcar.  carb.,
Lycopod., 3Iezereum, Sarsap., Uva ursi.
   [Belladonna may be given, if the urine looks gold-yellow,
the kidneys feel sore, warm, with sense of fulness and  con-
striction.
   Cannabis:  Inability to pass the urine, it looks bloody, the
urethra is filled with pus.
   Colchicum: The disease is complicated with chronic rheu-
matism,  gout.
   Sarsaparilla :  The patient had taken much mercury under
alloeopathic treatment, or the urine contains a good deal of
white, acrid and turbid matter, and is passed with a good
deal of tenesmus.
   Uva ursi: The urine contains blood and pus.]

                  VI.  Lithiasis,  Stone.
   This is* a more perfect degree of the former weakness;  a
stone arises from the  gradual combination of several  calculi
into one  coherent mass.
   Calculi are generally located in the pelvis of the kidneys,
in the calices  and in the medullary, very rarely in the corti-
cal substance.   They  are of various sizes  and  frequently
exist several together.   Sometimes these unite into one, are
of various shapes, round, oval, or without  any definite form,
rough or smooth, etc.   The  chemical composition influences
the form of these concretions, especially on their surface; the
oxalates  are  generally  provided with pointed elevations, the
phosphates have a rough, and the urates a smooth surface.
   The calculi frequently contain  a  nucleus of coagulated
blood, of urate of ammonia or oxalate of lime, around which
the remaining layers  of the concretion are concentrically
arranged.
   The causes of lithiasis are the same as  those of gravel.
By inducing chronic inflammations of  the  urinary passages
and catarrh of the bladder,  calculi favor the  developments of
the lithiatic disease ; for the  mucus which  is secreted in in- 
278        diseases  of the  urinary organs.
creasing  quantities, causes the calculi  to  adhere more and
more.
  Foreign bodies in the bladder are very apt to become the
nuclei of stones. Little fragments of pencils, needles, kernels,
hair, bougies, probes, etc., are known to have  become  such
nuclei.
  Calculi, like gravel,  are found in  various parts  of the
urinary organs.
  The phenomena of lithiasis are  almost the same as those
of gravel; only more developed and more intense, and more
frequently accompanied by distressing  and alarming symp-
toms.  Colica renalis frequently occurs, if one or more calculi
penetrate the orifice of the ureter and are pressed downwards
into the bladder.   This kind of colic may likewise be caused
by violent concussions,  movements, riding  in  a carriage  or
on horseback, coit, spirituous  beverages, diuretics, etc., very
frequently it occurs at periods when attacks of gout habitually
take place in the spring and fall.  The pains suddenly rise to
an intense height, causing even  convulsions.   They do not
remain confined to the lumbar region, but extend through the
abdomen towards  the bladder; this whole space sometimes
becomes so painful that the least  contact  causes  the patient
to scream.  Frequently the  pains  spread to the pubic and
sexual regions,  as far  as the  tip of the  glans.  They are
generally accompanied by retention  of urine and a painful
urging to urinate; amid violent tenesmus only a few drops of
red, black urine, which  is mixed with blood and  mucus, are
emitted.
  Beside colica renalis, lithiasis is frequently  complicated
with haematuria and nephritis.
  A stone in the bladder has to be removed by means of an
operation, either lithotomy or lithotrimy.  For a  description
of these  operations we  refer  the reader  to the  works on
surgery. 
CATARRH of the bladder.
279
  VII.  Catarrh,  or Blennorrhea of the  Bladder.
  This  chronic  affection  of  the  bladder very frequently re-
mains after an acute disease ; it is frequently caused by other
organic diseases of the bladder, prostate gland, or urethra;
or it may occur  as an idiopathic disease.
  The most essential symptom of this disease is the secretion
of a considerable quantity of mucus which is discharged from
the bladder together with the urine.  As long as the disease
remains in its first stage of  development,  the urine simply
appears  turbid,  and the mucus which is mixed  up with  the
urine, gradually  falls to the bottom of the vessel in the shape
of a whitish,  whitish-gray, transparent layer, whereas  the
urine above it clears up.   Very frequently the mucus  floats
about in the urine  in the  shape of  flocks  and filaments.   If
much mucus is secreted, which is more generally the case, the
urine becomes thick, the mucus is  frequently white, yellow,
green,  and may constitute  a  considerable  portion of  the
urine ; it goes  down as a tenacious, gelatinous, lumpy sub-
stance, which is  drawn out into ropy filaments upon the urine
being poured from one vessel into another.   At  first  the
urine preserves its acid reaction ; as  the mucus increases in
quantity, the reaction becomes alkaline : from being inodorous
its odor becomes ammoniacal  and offensive, and decomposition
takes place very rapidly.  Inasmuch as the mucus goes down
while the urine  is  in  the bladder, it  may happen that  the
urine which passes out first,  is clear, and that it is only the
last portions of the urine which is mixed with mucus.  Some-
times the urine  contains a little blood and albumen.
   The emission of urine generally takes  place  imperfectly.
Instead  of flowing in a rapid  and full  stream, the urine
passes out very  slowly.  Sometimes the stream is interrupted
suddenly, and after many vain  exertions, a plug of mucus is
expelled, after which  the urine flows out again more easily.
At night especially the patients are roused from sleep by a
desire to urinate;  very often they have to urinate every half 
280        diseases of the urinary organs.

or every quarter of  an hour -^ they feel a pain in the region of
the bladder, urethra and perinoeum.  The urinary emission is
frequently preceded by a spasm in the bladder which increases
while the last drop of urine is being pressed out, and then
disappears again.
   If the blennorrhoea lasts for a time, the general health of
the patient  becomes affected; the digestion is impaired, the
patients complain of constipation, pains  in the loins, they
have a cachectic look, grow thin, are attacked with fever in
consequence of not sleeping and  losing so much mucus ; the
lower  extremities become  oedematous,  and  general  dropsy
frequently sets in.
   In some rare cases paralysis of the bladder takes the place
of the spasm.   The  secretion of  mucus  remains unaltered,
the alkaline urine  flows continually, but  only in  drops and
involuntarily from  the distended  bladder;  very  frequently
symptoms of absorption  of the urine into the  general circu-
lation develope themselves,  and this condition may easily ter-
minate fatally.
   If the first symptoms of  the  disease  are  overlooked,  a
cure  becomes  much more  difficult. Season, climate and
regime have great influence upon this disease. In the summer
a cure takes place much more readily, but  a relapse is  always
a thing often to be  apprehended.
   The obstinacy of the disease renders the  prognosis some-
what doubtful, although no  actual danger  exists  except when
paralysis of the bladder takes place or the urine is absorbed
by the blood.   The causes of this affection are numerous and
varied.   Old people are  particularly liable to it.   Men are
more frequently affected  in this way than women, especially
leucophlegmatic, scrofulous and arthritic individuals ;  indivi-
duals addicted to an effeminate and luxurious mode of living,
and to sedentary habits,  to the use of spirits, or afflicted with
abdominal plethora, literary men, tailors, shoemakers,  etc.,
are particularly liable to catarrh of the bladder.  The  disease
is  quite frequent in  low districts, damp regions,  along the
sea-coast in Holland and England. 
catarrh of  the bladder.
281
   Among the exciting causes we notice
   a. Organic diseases of  the  bladder,  prostate gland  and
 urethra, which lead to an increased secretion of mucus in the
 bladder,  such as :   stone,  ulceration  and carcinoma  of  the
 bladder,  swelling of  the  prostate  gland,  scrictures  of  the
 urethra, etc.
   b. Irritation of the  mucous membrane of the bladder by
 acrid urine;
   c Mechanical and  chronic irritation  of the bladder by
 frequent introductions of the catheter, attempts at lithotrimy,
 irritating injections into the bladder, etc.
   d. Colds, and abnormal atmospheric  influences, such as
 cold and  damp air, low and marshy regions, etc.
   e. Piles  and  gout  are frequent  causes of catarrh of the
 bladder, especially of the male sex, who are frequently troubled
 with this  disease.
   Sexual excesses,  abuse of certain kinds of beverage, such
 as new beer, new wine, strong claret, the use of cantharides,
 turpentine, may likewise lead to this trouble.
   A radical cure is  seldom possible. An intelligent physician
 will therefore aim  at making the patient as comfortable as
 possible, and prolonging his life by a carefully regulated diet
 and regime.  Such  patients  should live in dry, high, sunny
 and airy  dwellings; they have  to  avoid  the damp  morning
 and  evening  air, and in  general every  kind of humidity.
 They ought to dry  their clothes well  by the  fire before put-
 ting them on ; it is  a good custom  for such patients to wear
 flannel next to the  skin in order to moderate the  action of
 the atmospheric air  upon this organ, and  promote the cuta-
 neous exhalation.
   The diet may  be  nourishing, but it should be moderate.
 Spiced, salt and  smoked food,  sour fruit, sour, fermenting
 beverages have to be avoided.   Fresh meat, vegetables that
 contain a good deal  of saccharine matter, water and  sugar, a
 little claret in water at dinner, and  farinaceous food may be
allowed.   Pure wine and spirituous beverages should be pro-
hibited.
                            19 
 282        diseases of  the urinary.organs.

   The urinary secretion should be a chief point of attention
 with  the  attending physician; if it is not perfectly regular,
 it will have to be regulated.   Before voiding the urine in the
 night, the patients should rise  and walk up and  down the
 room a few times in order to  prevent the mucus from going
 to the bottom of the bladder.  The habit to void  the urine
 kneeling,  should not be indulged in, inasmuch as it promotes
 the disease ; at any rate this  is  the  opinion of distinguished
 physicians.   If the stream  should  be suddenly interrupted,
 the patient  should  not  press hard, for a little shaking, or a
 change of position are sometimes sufficient  to  restore the
 flow.   If  the bladder should not be completely emptied, the
 remaining urine will  have to be  drawn off  by means of  a
 catheter, in order to prevent it from becoming alkaline  and
 irritating  the bladder still more.  Catheters made of caout-
 chouc  or  gutta  percha are  the best for this purpose.  The
catheter should not  be introduced too frequently, because  this
might likewise increase the irritation.
  In the first stage of the disease, especially when frequent
relapses take place, Mercurius sol., Belladonna and Pulsa-
 tilla will  be found  excellent palliatives, and in a  few rare
 cases Hyoscyamus.  In the further course of the disease we
 have to resort to Capsicum and  Helleborus.  If these reme-
 dies afford but temporary relief,  Carbo  veget. may  be tried.
 In  the  case of scrofulous  persons Conium, Dulcamara  and
 Staphysagria may be exhibited.  If spasms, urging to urinate
 and excessive sensitivenes of  the bladder supervene, Bella-
 donna,  Cannabis, Cantharides and Digitalis may prove  ser-
 viceable.  Colocynthis and Sabina will  be found suitable to
 arthritic patients.
   In very  chronic  cases Argentum,  Calcarea carbonica,
 Graphites,  Lycopod.,  Mangan.  acet.,  Magnesia  muriat.,
 Natrum carbon, may still  be of some  use. 
HYPERTROPHY OF THE  BLADDER.          283
 VIII.  Hypertrophy of the Bladder, Thickening of the
   Bladder, with dilatation or contraction of its cavity.
    Hypertrophy of  the  bladder  with dilatation  frequently
 developes itself imperceptibly,  so that  the  patient  is  not
 aware  of any trouble until the  urinary discharges are inter-
 fered with.   The distended bladder forms a painless globular
 swelling above the pubes.  Its  exact position and the fact
 that it is full of urine,  can be ascertained  by percussion.
 The urging to urinate is  experienced more frequently than
 usual,  the  emissions of urine become  troublesome, and  the
 stream is weaker.  The bladder is never completely emptied,
 and, after the urine is voided, the organ remains apparently
 distended  above the pubes, where  it is felt as a tense, some-
 what moveable body.  The urine, especially if the bladder is
 at the same time affected with chronic inflammation, is turbid,
 purulent, and has a strong ammoniacal odor.   The distended
 and hypertrophied bladder occasions a sense of heaviness in
 the pelvis, a pressure at the  perinaeum, on the rectum, diffi-
 culty of passing stool, a pressure on  the sacral nerves, a
 feeling  of numbness and even paralysis of the lower limbs.
   In hypertrophy of the bladder with contraction, the  organ
 scarcely holds a few ounces of urine, and  the  patient is
 unable to retain even a small quantity of this fluid; he has
 to  pass urine every few  minutes.   Even after  voiding the
 urine, the patient still feels as though the bladder were full.
 Even by means of the catheter but a small quantity  of urine is
 drawn off.   The urine is  turbid and has a strong  ammonia-
 cal odor.
   These two  forms  of  hypertrophy, although secondary
 affections, yet may cause other disturbances such as  catarrh
 of the bladder, inflammation and suppuration of the bladder,
 dilatation of the superior urinary passages, of the ureters,
pelvis of the kidneys, gangrene of  the mucous membrane of
the bladder  and peritonitis;  some  of  these conditions may
have a fatal termination. 
284        DISEASES OF THE URINARY ORGANS.

   The disease generally occurs among  older  people.  The
causes of hypertrophy of  the muscular fibres of  the bladder
are frequently recurring, catarrhal irritations of  the mucous
membrane of the bladder, stone in  the  bladder, mechanical
obstacles to the free emission of  urine  arising either  from
diseases  of  the prostate gland and  urethra, or from hyper-
trophy  or displacement of  adjoining  organs,  carcinoma or
prolapsus of  the  uterus,  etc.;  violent and  repeated gonor-
rhoea in  former years.
   The treatment can only be palliative.   The  causes of the
trouble,  catarrh  of  the  bladder,  swelling of  the  prostate
gland, strictures of the urethra, external tumors, have  to be
removed or palliated.
   The regimen  and diet should be the  same  as have  been
indicated for catarrh of the bladder.
   Calcarea carb.,  Carbo veget.,  Conium, Euphorbium,  Gra-
phites, Lycopodium, Sulphur and  Thuja may be adminis-
tered internally.
   [In selecting a remedy for this disease we  have to survey
the whole ground covered  by all the symptoms that can be
traced as having had any bearing upon the existing group of
morbid phenomena.  If we can trace any connection between
the disease  of the bladder and irregularities of  the heart's
action, Aconite and Digitalis may prove excellent palliatives;
if the affection  of the bladder seems  to be traceable to de-
rangements of the mucous and glandular systems, Mercurius
vivus and Calcarea carb. may be exhibited; if the vegetative
system seems especially disturbed, as manifested by derange-
ments of the digestive functions such  as acidity, heartburn,
costiveness, brick-dust or whitish sediment in the urine, Cal-
carea and  Carbo  veget. may prove  useful.  Mercurius and
 Thuja will be found serviceable  if the  hypertrophy seems
connected with  previous  syphilitic  or sycosic  diseases, dis-
eases of the prostate gland,  etc.] 
SPASM  OF THE  BLADDER.
285
              IX. Spasm of the Bladder.
  A spasm  of the bladder may either  be a mere symptom
characterising one of the above-mentioned diseases, or it may
be  an  idiopathic disease, of a  purely nervous  character,
without any organic alterations.
  In the latter case  it  generally sets in  suddenly.  The
patients, frequently towards the end of an urinary emission,
experience a  violent,  constrictive  pain in the  region  of
the  bladder, especially in the  perinaeum,  which extends
into the urethra,  and, in the male,  spreads  to the supe-
rior portion of  the penis towards  the glans;  sometimes
it  is accompanied by painful erections and extends to the
groins, testicles  and thighs.   Frequently it  is  accompanied
by painful tenesmus of the sphincter  ani, involuntary stool
and prolapsus  of  the  rectum.   The  perinaeum  and lower
region of the abdomen  are sensitive to pressure, hot and dis-
tended.  The pain which sets in in paroxysms, generally lasts
only a few minutes, never more  than from  fifteen to thirty
minutes.  It is  accompanied  by a painful urging to urinate
which cannot be satisfied.  When the spasm  abates, a full
stream of urine is frequently emitted.  On  account of the
excessive irritability of the bladder, it is extremely difficult
to introduce the catheter.  The urine  is generally clear and
paler than usual.   A violent spasm of  the bladder is accom-
panied  by anguish, restlessness,  trembling, general nervous
paroxysms,  cold  sweat, a small and  contracted  pulse  and
vomiting.
   This disease may attack persons of  any age  and of either
sex; females, and persons of middle age are  most frequently
subject to it.  Nervous, irritable, hypochondriac and hysteric
persons are  particularly predisposed for this affection.
  Exciting  causes are  emotions,  anger, mortification, exer-
tions of the  mind,  irritation of the urinary and  sexual organs
by cantharides,  diuretics,  new wine and beer; retention of 
286         diseases of the urinary organs.

acrid urine in the bladder; sexual excesses, colds, sitting on
damp, cold ground, etc.
  The treatment  of this disease has to aim at the removal of
the exciting cause; at the  same time we may prescribe- one
or more of the following remedies according to the symptoms ;
Acidum phosphor.,  Arsenicum, Belladonna, Calcar  carb.,
Cantharides, Carbo  veget., Conium, Graphites, Helleborus,
Ignatia, Lycopod., Nux vomica, Platina, Pulsatilla, Staph y-
sagria, Sulph air,  Zincum.
  [To these remedies may be added Aconite, when the spasm
is  caused by a cold, exposure to  dampness, suppression  of
sweat, or when it is a symptom of  hysteria.
  Among the  above-mentioned remedies,  Pulsatilla, Nux
vomica and Cantharides may be considered as chiefly adapted
to this affection.
  Nux vomica, when the spasm is' accompanied by a painful
desire to urinate.
  Pulsatilla, when the spasm is characterized by a constric-
tive sensation  in the region of the  bladder, tenesmus  of the
bladder, with involuntary discharge of a little urine.
  Cantharides, excessive urging to  urinate,  with cutting and
tearing pain in the region of the bladder.]
  It is a matter of course that the regime and diet  of the
patient should be regulated with great care, as in all  other
diseases of the urinary organs. 
SYPHILISATION.
2S7
                SYPIIILISATIOX.
  Before concluding  our remarks  concerning syphilis,  we
will allude to the method introduced in France of inoculating
the syphilitic poison for the purposes of arresting the ravages
of this  disease;  it has even  been asserted  that secundary
syphilis has been radically cured by this means.
  This  method of inoculating the syphilitic virus,  has  been
termed  syphilisation, and the  discussion  concerning this sub-
ject is not yet  closed.
  For this  reason we forbear expressing  a  critical opinion
about it, and content ourselves with giving the historical out-
lines of this method from the  commencement  to the present
period.
  On the 30th  of September, 1844, Dr. Auzias Turenne,
laid before  the French Academy of Sciences, a communica-
tion  that he had successfully  inoculated a monkey with the
syphilitic virus, and on the 5th of November, 1844, such a
monkey was exhibited before the Academy, and on the  20th
of November  another monkey  to the  Chirurgical  Society.
Dr. Auzias Turenne intended to show by his experiment that
the pus of a primary syphilitic  ulcer produced the same dis-
ease in animals  as well as in men, and that therefore the
opinion that syphilis is a disease which exclusively affects the
human race, is erroneous.
  By repeating these inoculations with  the syphilitic virus,
chancres finally ceased to be  reproduced, and this gave rise
to the theory  that  the animal was no longer susceptible to
the syphilitic disease, and that the same relation obtained in
the case of  this animal between its constitutional  condition
and the  syphilitic virus, as between the small-pox virus and
a vaccinated individual.  By transferring this  theory to man,
the conclusion  was  arrived  at, that repeated  inoculations of
the syphilitic virus  in man, produced the same insensibility
to its effects, as existed in the case of the monkey, and might
be resorted  to  as prophylactic means against  the  syphilitic 
288
SYPHILISATION.
contagion.  It was afterwards  supposed that  such  repeated
inoculations might likewise be  employed as curative means
where the syphilitic disease had actually broken out.
   On the 30th of June, 1851, the  following communication
from  Dr. Auzias Turenne was read before the Academy of
Sciences.
   " On  the 11th  of November, last year, I informed  the
Academy that I had  succeeded in discovering by experiments
upon  animals  a species of prophylactic inoculation against
syphilis, which I  have termed  syphilisation for the  reason
that the organism is impregnated with the syphilitic virus.  I
then  added that  experiments  on man  had induced  me  to
believe  that the same process would lead to the same results
in his case that I  had observed in the case of animals, and
I have  now to report that I have been unceasingly engaged
since that period in verifying the results of my theory.
   At  this period  experiments  concerning this  subject are
being instituted in large hospitals, and some of my statements
have already been confirmed.  Nevertheless I deem it proper
not to promulgate  the facts which have  been collected thus
far, until they have been confirmed by abundant testimony;
I will content myself with laying before the  Academy the
contents of a paper which was read on the 22d of May last
before the academy of Turin by Dr. Casimir Sperino.
   The author who was  surprised at the uniformity  of the
results which had been obtained by both of us, undertook to
repeat my experiments.  For this purpose he  selected fifty-
two prostitutes in his wards of  the hospital for  syphilitic
diseases, who were more or less affected either with primary
or secondary syphilis.  In these fifty-two cases the chancres
became  the less active the more  frequently they were repro-
duced in the same individual until it finally became  impos-
sible to  reproduce any.   There was  no exception to this
rule."
   Moreover it was found that serpiginous chancres, obstinate
ulcers of the fauces, fluctuating buboes, figwarts  and  other
more  dangerous syphilitic phenomena, would  yield to the 
SYPHILISATION.
289
action of the  syphilitic virus if properly  applied.  Neither
mercury nor iodine was used.   This method had  excited so
much  confidence in Turin that several  prostitutes presented
themselves  before Dr.  Sperino,  in  order to be  syphilised,
either for the purpose of being cured of  the disease, or of
being  protected  against  it.   " It frequently happens, says
Dr. Sperino, that patients who were averse to syphilisation,
now beg me  to subject them  to  this treatment."  It is
attended  only by a  few slight  inconveniences  which  can
easily  be  avoided.
   Sperino closes his report with the following remarks :  " The
question now  is whether those women who are no longer sus-
ceptible to the action of the syphilitic poison, remain so for
ever, or only for  a time ?   Whether  the cure of the primary
and  secondary syphilitic  disease will prove permanent and
radical ?  These  questions can  only be solved by time and
careful observations.
   So   far it is  a positive fact  that  all those patients who
were received in our hospital for the last  five months, and
who were saturated by me with the syphilitic virus, have not
only remained free, without an  exception, from  secondary
symptoms, but that their general health  steadily improved
from the moment when the first  acute chancre was produced
in them, up to the time when the treatment was concluded."
   " It is likewise certain that successive inoculations with the
syphilitic virus remove rapidly all the primary and secondary
syphilitic symptoms, and i\ seems to  me that such results are
sufficiently important  to claim our most  serious attention."
   Sperino's observations  have been  conducted with  remark-
able  tact  and  sagacity, and they show that no preconceived
opinions should deter  us from instituting similar experiments.
   We  will now communicate to  our  readers in 51  proposi-
tions the results of the method of syphilitic inoculation as ex-
plained by Dr. Auzias  Turenne, in  No.  48,  of  November,
1853; as to the value  of the statements contained  in these
51 propositions, we forbear expressing  any opinion  for  the
present. 
290                   SYPHILISATION.
  1. There is  but  one  syphilitic poison  although it  may
emanate from various sources; but its effects vary;  we may
therefore adopt several degrees of syphilitic toxication.
  2. An individual who is capable of resisting the action of
the lower  degrees of this poison, need not necessarily be
capable of resisting the higher degrees.
  3. All other  circumstances being  equal, the character of
the virus descends in degree the further the process  of syphi-
lisation is  carried, and  the more extensive the surface  from
which the virus is secreted and the larger the quantity.
  4. A poison which ceases to affect  one person, may still be
able to  affect  some other person who  is less thoroughly
syphilised, and particularly one who  had not yet been inocu-
lated at all.
  5. If  a  perfectly healthy individual is  inoculated with  a
poison of the higher degrees, the first chancre will be  very
considerable.  The subsequent chancres will  be less  active,
especially if the virus is taken from the same individual, and
the pus which is secreted by these subsequent  chancres, will
be of  an inferior quality.   The more frequently the process
of inoculation,is repeated in  the  same individual, the more
thoroughly  the  organism  becomes  impregnated  with  the
syphilitic virus.
  6. The virus  taken  from  an  individual that had  been
repeatedly inoculated,  acts with less intensity not only upon
the same individual, but likewise,  although  not to  the same
extent, upon others not yet inoculated.
  7. This virus of a less degree is  obtained by repeated inocu-
lations of the same individual  in a state of  health, and, after
the second or third inoculation of that same individual results
in the production  of  the most inveterate chancre,  viz: the
indurated or Hunterian variety.
  8. Those who believe  that,  at a certain  period, the chan-
crous  virus is no longer transmissible by inoculation, should
have considered the double cause of this want of transmissi-
bility. 
SYPHIILSATION.
291
  Namely, a.  The alteration which the chancrous virus under-
goes in consequence of the process of inoculation in the same
organism;  b.  The diminished  sensitiveness  of  the  organism
to the  homogeneous virus to be inoculated.   These two  cir-
cumstances lead to  a  perfect insensibility of the same indi-
vidual  to the action of its own virus.
  9. Every chancre has a  period of decrease during which
it can  be inoculated in every body in the same  degree  and
form.
  10.  All  inoculated  chancres have the same tendency to
cicatrise, and they do cicatrise provided its tendency is not
neutralised by some incidental influence.
  11.  Chancres of the largest dimensions, which are gene-
rally likewise of longest duration, require the most time to
accomplish the process of cicatrisation.
  12.  The extent and duration of the cicatrisation  may like-
wise be influenced by the locality of the chancre.
  13.  Chancres of the same date but of different  origin, in
one  and the  same  individuals, may, especially in  the com-
mencement, show entirely  different degrees of vitality  cor-
responding to the quality of the virus which had been  em-
ployed for the production of the chancre.
  14.  Two chancres of the  same origin  and date, in different
individuals, may exhibit different degrees of action inversely
proportionate to the syphilisation which had been effected in
them.
  15.  Later chancres  produced in the same person, may be
much  more considerable than former ones, if the virus which
caused them,  is more intense.
   16.  Even the weakest virus is  still capable  of affecting
persons who had never been syphilitic.
  17.  If a person ceases to be sensitive  to  the action of an
inferior virus, he may still be sensitive to the action  of a virus
of a higher degree.
  18.  This virus may then still  continue to produce two or
three  successive chancres in the same person.
   19.  If  a person  is inoculated with  a virus of  a higher 
292
SYPHILISATION.
degree than that  which is secreted  from  actually existing
chancres, the virus which is  obtained  from these new chan-
cres, is not, on this account, superior to the former virus.
  20. By thus renewing the production of chancrous virus
in the same person, we finally secure him completely against
all syphilitic contagion.
  21. The best and quickest mode of thoroughly impregna-
ting an individual with chancrous virus, consists in effecting
several successive inoculations with a very powerful  and con-
tinually  renewed virus ; this method  is, however,  attended
with pain,  and care has  to be had to  prevent the chancre
from becoming phagedemic.
  22. The following is the best mode of syphilising  a person
who had never yet been syphilitic:  a.  by means of a single
puncture pus of a lower degree is inoculated, after which the
same person is inoculated with his own virus every eight days,
and afterwards even still more frequently, until the person
ceases  to be any further affected  by it; b. afterwards the
inoculations are repeated on the same person with virus of a
higher quality and at shorter intervals.
  23. If a person is affected with chancre, the virus of this
chancre may be taken for the purpose of inoculation, and the
process may then be continued as described above.
  24. For persons affected with constitutional syphilis the
same process  is adopted  as  for those who  had never been
tainted  with syphilis,  with this difference, that virus of a
higher degree is substituted as soon as  the lower virus  ceases
to act.
  25. The puncture  should be as direct and  superficial as
possible,  so as  to  secure  the smallest  possible size of the
chancre.   The first chancrous pustule is exactly proportionate
in size to the solution of continuity effected by the puncture;
hence the more  direct  and superficial  the  puncture, the less
extensive the chancre.
  26. Syphilisation is a source of strength to the organism ;
it increases the appetite and the assimilative power of the
organism.   This method may likewise be  employed against 
SYPHILISATION.
293
other diseases ; we know from experience that it has  been
advantageously resorted to against cancer.
  27. Gonorrhoea and  phymosis are sometimes, not always,
symptomatic diseases ; these are prevented by syphilisation,
and they are cured in every case where the purely syphilitic
character of the  disease has not been replaced by an  irrita-
tion of a catarrhal character.
  28. They may be caused by an inferior virus as primary
symptoms, in which case they may be said to be a commence-
ment  of syphilisation;  or else  they may be  produced by a
superior virus in an organism previously tainted with syphilis.
  29. In the former case the inoculation may be successively
repeated on the same person; in both cases persons who are
not tainted, may be inoculated.
  30. Venereal excesses which limit the action of the poison
to a smaller number, likewise diminish its intensity.  In per-
sons who  had never been tainted, chancres spread with  great
rapidity.
  31. Chancres which  do  not cause  constitutional syphilis,
are a. such as are caused by an inferior virus, and are termed
primary chancres;  b. such as are produced in persons under-
going the process of syphilisation, and whose organisms have
been thoroughly impregnated with the syphilitic virus ; in the
former case the  germ  is deficient, in the latter the organic
susceptibility.
  32.  The secondary phenomena are caused by the constitu-
tional infection,  and are results  of the diminished quality of
the virus secreted by an indurated chancre.  These secondary
phenomena may be compared to the  multiplied chancres of a
person undergoing the process of syphilisation.
  33.  A person  affected with constitutional  chancre, cannot
be inoculated with virus  of an  inferior quality, although a
healthy person may be  inoculated with it.
  34.  Syphilisation not  being  a pathological condition,  it
cannot be effected or transferred by  injections of blood.
  35.  The infecting power of the chancrous virus is not pro-
portionate to the extent of the chancre. 
294
SYPHILISATION.
  36. The virus of a phagedenic chancre keeps its quality  as
lone as the chancre remains phagedenic.
  37. In order to control a phagedenic chancre by syphilisa-
tion, a virus of  a higher or lower quality than  that of the
chancre, has to  be employed.   A pus that can be readily
absorbed,  should be principally used.  A pus which is not
readily absorbed, assumes a phagedenic character; pus which
is readily absorbed, acts  as an anti-syphilitic prophylactic,
the more efficiently, the higher its quality or degree.
  38. The effect of this syphilitic pus is not always the same
in the different stages of the chancre from which the pus  is
secreted.
  39. After inoculation the chancre developes itself the more
rapidly the more thoroughly the individual had already  been
subjected  to the process of syphilisation.
  40. The  condition which, according to circumstances,  is
variously, and at certain periods, developed in certain  indi-
viduals who had remained free from constitutional syphilis,
disappears again in consequence of the successive modifica-
tions produced by subsequent chancre.
  41. In  order to remain perfectly free- from all  primary
symptoms of syphilis, it is necessary to subject one's-self  to
a thorough process of  syphilisation;  this process, however,
need not be carried to a very high degree if nothing else  is
desired than to be guarded against general syphilis.
  42.  Persons  thoroughly inoculated with  the  syphilitic
virus, are  no longer able to produce it; the source,  from
which  either  primary  or secondary  symptoms  spring,  is
drained.
  43. No constitutional symptoms  of syphilis  result from
syphilisation; on the contrary, if any such exist, they dis:
appear in consequence.
  44. A.  chancrous  cicatrix is just as susceptible to the
syphilitic  virus as any other part of the skin.
  45. Syphilisation is not effected locally; if one portion  of
the body is under  the  influence of the syphilitic virus, the
whole body is. 
SYPHILISATION.
295
  46. The prophylactic  effects of syphilisation are not tran-
sitory, nor are they idiosyncratic.
  47. Animals are  less  susceptible to the syphilitic virus
than men, although  not all of them in the  same degree.   A
dog, for instance, is less susceptible than a rabbit;  a rabbit
less than  a cat; a cat less than monkeys in general; we say
in general, for some monkeys are  more susceptible than cats.
  48. A man undergoing the process of syphilisation, passes
through these various  degrees of  susceptibility.
  49. The less an animal or man is naturally or  artificially
susceptible to the  syphilitic virus,  the more powerful  the
virus has  to be which we use for purposes o*f inoculation.   A
non-observance of this rule is the  cause of the frequent fail-
ures in attempting  to inoculate men  or animals, and of the
secondary symptoms which have been frequently developed
in men.
   50. The syphilitic virus  in  its  various degrees is  the best
standard by which the existing.susceptibility to the syphilitic
virus can  be measured.
   51. Syphilisation upsets  both practically and theoretically
all existing theories  concerning syphilis.   The opposition to
the doctrine of syphilisation is directly proportionate to the
amount of false theories which it does away with. 
296
ELECTRO-MAGNETISM.
                    APPENDIX.

On Electro-Magnetism and its Curative Virtues in various Diseases
  in General and against Sexual Diseases and their Consequences
  in particular, according to  the Method which i have followed
  in the Treatment of these Diseases for a number of  tears.
  Electricity  and  magnetism   are  physical forces which,
although they have been known from time immemorial, and
notwithstanding  the  astonished  progress of the  physical
sciences, still produce a great many inexplicable  and myste-
rious  phenomena.   The wonderful properties of the electro-
magnetic telegraph are known to every body, and demonstrate
in the most incontrovertible  manner the marvellous forces of
these  two imponderable  substances.   These forces, being
known even to the  physicians of the earlier ages, were em-
ployed already by them for therapeutic  purposes.
  The electrical machine and the Leyden battery  were the
first instruments of this kind that were employed for various
diseases, and even for the resuscitation of persons apparently
dead.   But the impracticable nature of an electrical machine
which could not be carried by  the physician from patient to
patient; the violent effects  of such a  machine and of the
Leyden battery soon  drove  electricity  out  of  the materia
medica, and caused it to be abandoned entirely.
  In  1790,  Professor  Galvani  of Bologna, discovered  that,
while  suspending frogs' legs, denuded of their integuments,
from  an iron railing by means of small copper  hooks, these
legs were  thrown into brisk convulsive twitchings as often  as
a current of  air  caused them  to  touch  the railing.   He
accounted for this phenomenon  by supposing a peculiar fluid
(a so-called animal electricity,) whom he located in the nerves
and which he supposed was transmitted by the metallic bodies
to the muscles at the moment when these came in contact with
the iron.
  Galvani's discovery led to a variety of investigations which,
however,  did  not advance the  knowledge of the cause  of 
ELECTRO-MAGNETISM.                297
these phenomena, until Volta, professor  at Pavia, repeated
Galvani's experiments with particular care, and became con-
vinced that the convulsions  were more particularly excited
when the conducting medium between  the nerves and mus-
cles  consisted of two metals, the surfaces of which  in those
places where they were in contact with each  other and with
the  legs of the frog, had to  be metallic throughout.  Volta
taught that the heterogeneous  metals  during their contact
become  charged  with opposite  electricities,  and that, after
completing the circuit by means of the muscles and nerves,
an electric  current, as  in the  case of  the Leyden  battery,
arises  which convulses the  legs of  the frog.   Electricity
obtained  in  this manner,  is  called,  electricity by  contact,
galvanism or Volta's electricity.
  Galvani's  discovery,  and  more particularly  Volta's, was
afterwards employed by physicians.   The use of these appa-
ratuses was at first complicated with a good many difficulties,
and  the knowledge of  the physicians  was not sufficient to
draw from these new sources all the benefit they might have
yielded.   Physicians, being unused to such new phenomena,
soon lost sight of them, and natural philosophers  were the
only ones who continued to investigate and apply them. The
gradual elucidation of the phenomena of electricity and gal-
vanism by means of the physical sciences is  too well known
to require any detailed  account of it in this place.   Latterly
medical  science  again became  intimately mixed up  with the
natural sciences, and electricity and  magnetism were  again
resorted  to for therapeutic purposes.  The fact that soft iron,
when surrounded by copper wire, and sufficiently insulated, is
rendered magnetic by passing through it a current of electri-
city, led  to the discovery of the electro-magnetic apparatuses
in which both forces are combined and  act together. Clever
mechanicians simplified  these  apparatuses so  as to render
them available for purposes of cure, and to induce physicians
to use them. Their expectations relative to the curative effects
of these  apparatuses, were surpassed in  every respect.
  For a  number of years I have instituted experiments with
                           20 
298
ELECTRO-MAGNETISM.
electro-magnetism,  both on men  and animals, and  I have
had abundant opportunities of verifying the extent of its
curative agency.   The  results which  I have obtained by
means of the method which I  am in the habit of pursuing,
are so striking that I cannot  forbear to give them  to  my
readers.  Previously, however, I deem it advisable to offer a
few hints concerning the mode  in which the electric principle
acts in the animal organism, even when  excited by external
applications.
  It is well known that at every contact of  heterogeneous
substances, or while different parts of the body are exposed
to different degrees of temperature, or during all chemical
processes, the electricity of the  body with  which these various
processes take place, is excited into  polar action;  hence it is
undeniable  that electricity plays  an important part in  the
living organism.  During the oxydation  or carbonization of
the  blood, during  the process  of digestion  and so  forth,
electricity exercises the  most important part.   It is certain
that many diseases, such  as rheumatism, gout,  etc.,  arise
simply  from the fact that the  electrical condition of the
part had been rendered abnormal by the  local  depression of
the temperature of the affected part.
  The  Italian naturalist,  Mateucci, has demonstrated the
existence of electricity in the living organism by numerous
experiments.  According to his doctrine, however, it is not
the  nerves  but  the muscles that are the vehicles  of  this
electric action.  He asserts that the nervous principle is still
enveloped in much mystery and is entirely distinct from elec-
tricity.  Dubois Raymond, however,  by  his experiments
which are described  in  his work on animal electricity, has
refuted Mateucci in  the most conclusive manner.   Dubois
Raymond proved by experiment  that  animal electricity is
contained in every part of the nervous system;  he shows that
the nerves are capable of producing all the known phenomena
of electricity, even  the deviation of  the magnetic needle by
means of a multiplicator.   He  further shows  that this elec-
trical action is not simply an indifferent adjunct but an essen- 
ELECTRO-MAGNETISM-                299
tial cause of the internal movements of the animal organism.
According to this  observer  the electrical  action is identical
with the hypothetical nervous fluid.
  Professor Hassenstein has  likewise shown that durino- life
a portion of the natural electricity of the animal body is con-
stantly excited into  polar  action.  According  to  him, the
central organs of the nerves are the immediate causes of this
action, and the nerves are its carriers and vehicles throughout
the whole organism.   The electric action which we see in the
muscles, is a consequence of that nervous action, and, there-
fore, depending upon the latter.
  We infer from  this incontestible fact that  this  electrical
action of  the  nerves must have  a definite polar direction.
This point  has likewise been demonstrated by Hassenstein
experimentally, and likewise that the polarity of this action
is unchangeable, whereas formerly it was  supposed that it is
changeable.   This electrical action differs in  different  indi-
viduals, but it remains nearly the same during  health in the
same person, and  within a period of  time  of about the  same
length.
  The whole surface  of the body is negatively electric;  this
electricity is most feeble in those parts which are nearest to
the central organs, and most intense  in parts which are  most
remote from them.  This fact  explains the character of the
polarity of the  nervous electricity, and shows  that the nega-
tive pole  is directed  towards the external, and the positive
pole towards the internal surfaces.   In this respect the ani-
mal body has to be looked upon as a  Voltaic pile, the surface
of the body constituting the negative, and the  central organs
the positive pole of the pile.   In the  same manner  as the
action  of these electricities which  now attract and then again
repel each other, is kept up in the pile in a  definite polar
direction, is  the electrical action maintained in the central
nervous organs  and in the nerves themselves as long as life
lasts.  This action ceases after death ; the electricities unite
and the central organs are no longer able  to separate them.
  From these preceding remarks we infer that  only a portion 
300
ELECTRO-MAGNETISM.
of the natural  electricity of the  organic body is  in  polar
action, and that another portion  remains latent.   Some of
this  latent  electricity  may, however, be  excited into  polar
action by external  stimuli, and this polarity may be altered
ad libitum according as the  negative pole is  applied to the
peripheral nerves and the positive  pole to the central organs,
or vice versa the negative  pole to  the central organs and the
positive pole to  the peripheral nerves.
  By applying the negative pole to the hand and the positive
pole to the  spine, the ensuing electrical induction  causes a
repulsion  of the homogeneous and  an attraction of the  oppo-
site electricities, and the polar direction  of these  attractions
and  repulsions is the opposite of  what it  is in the  original
bodies.   On the contrary, if the positive pole  be applied to
the hand, and the negative pole to the back or the forehead,
the electricity which is set free, will have the same polarity
as the natural electricity.  In the  former case the electrical
action originally existing in the nerves is  diminished, in the
latter case increased.   It is readily perceived that  in  what-
ever body a certain amount of electricity is excited into polar
action, its natural electrical action is increased when by some
adequate  stimulus, a larger amount of its electricity is excited
into a * corresponding  polar action.  On the  contrary, if a
portion of the  previously latent electricity is excited into a
polar action opposite to the polarity of the electricity  which
is already active in the part, a larger or less portion of the
latter is  necessarily neutralised, and  the natural electricity
of the body is weakened.   Hence the object which we seek
to attain  by acting upon the human body by means  of elec-
tricity, can only be:
   1.  To  exalt the  action of the electricity which is  already
active in  the nerves, or
   2.  To diminish this action.
   According to Hassenstein  either  of  these ends  may be
attained:
   a.  An increase  of electric action, by applying electricity 
ELECTRO-MAGNETISM.
301
of the same polarity as that which is originally active in the
part.
   b. A decrease of  electric action, by applying electricity of
an opposite polarity to that which is originally active in the
nerves.
   A physician is frequently called upon either to exalt or to
diminish the vital action, or to reduce it to its normal condi-
tion.   In every disease, no matter what its cause, the normal
vital action, and of  course the electric nervous action are dis-
turbed, there is either an abnormal more or less.
   In many diseases  the  metamorphosis of the tissues takes
place much more rapidly than in a state of health.  We know
that, during  every  chemical  process, and  hence during the
metamorphosis of the tissues, electricity is set free the more
copiously the more  energetically these chemical processes are
carried on; for it is probable that they are  determined by
electrical action.  If the metamorphosis be arrested, and the
chemical action consequently diminished, there is of course  a
corresponding decrease of electric action in the nerves.  This
shows how intimately the condition of the body in the various
diseases is connected with the electric  action of the nerves,
and what  an important  agent electricity is in the treatment
of disease.
   The curative action of both  electricity and magnetism is
increased  by uniting both forces in one apparatus as is done
in electro-magnetic batteries.
   We have now to  state  in what diseases  electro-magnetism
is of particular benefit to patients.  Numerous observations
instituted by ourselves and by other physicians, have abun-
dantly shown that,
   a. An increase of electric  nervous  action  is required  in
 the following diseases: hypochondria and hysteria,  anaesthe-
 sia, general and local  debility, weakness of the urinary and
 sexual organs, impotence, retention and suppression of the
 menses, weak stomach, constipation, weak eyes, hard hearing
 and deafness, paralysis of any kind. 
302
ELECTRO-MAGNETISM.
   b.  A  decrease of nervous  electric action, in the  following
 affections:  rheumatic and arthritic pains, nervous headache,
 rheumatic and nervous  toothache,  nervous pains in general,
 hyperaesthesia, rheumatic swellings, podagra, white swelling
 of the knee, spasmodic diseases of any kind, such as: cardial-
 gia, spasm of the chest, prosopalgia, epilepsy, catalepsy, cho-
 rea, cephalalgia, excessive sexual  excitement, nymphomania
 and satyriasis, suppression of milk, vertigo, fever and ague,
 profuse  menstruation.
   c A  local action  of  both  electricities,  when the nervous
 action is neither to be increased or decreased, and it is simply
 designed to  excite the  chemical  electric  action in  certain
 localities of the organism;  as in  the following affections:
glandular indurations, tumors,  excrescences, ulcers, schirrus,
 cancer,  fungus hsematodes,  fungus medullaris, gangrene,
primary syphilis,  strictures  of the urethra, fistula, dimness
 of the cornea,  leucorrhoea, cataract.
   My mode  of using electro-magnetism  is  based upon the
 doctrines of  Hassenstein and  Duchenne.   Having for years
 devoted myself exclusively to the treatment of sexual diseases,
 I have had frequent opportunities of employing Duchenne's
method  of localised galvanization,  together with Hassen-
 stein's method.  According  to Duchenne's method we arc
enabled  to electrify  on  the living  body, the  skin,  muscles
and nerves, alone and isolated from the adjacent tissues; in
other  words, to  localise the  curative  effects  of electricity,
and confine them to the skin,  muscles and nerves, according
 as the case may require.
   If we simply wish to electrify the skin, and the  terminal
extremities of the cutaneous nerves, we  apply dry conductors
to the dry portions of skin that we wish  to act upon.  The
course of the nerves has to be exactly known for this purpose.
The electric  action has likewise to be regulated, for it  may
be increased from a mere prickling  and  tingling to an intense
pain.
  These modifications are attained by means of the following
manipulations: 
ELECTRO-MAGNETISM.
303
           a.  With the electric hands.
           b.  With the electric conductors.
           c.  With metallic wires.
  a. With the electric hand.  One of the conductors is applied
to the sensitive part, for example, to the spinal  column, the
other conductor is held by the operator in  one hand, and
with the dry fingers of his other hand he makes  passes  over
the skin after it had first been dried.
   This  proceeding is resorted to in the case of very sensitive
patients who  cannot bear the direct action of even the slightest
degree  of electricity.
   b. Localised galvanization by means of metallic conductors,
is effected by applying one of them to a part somewhat remote
from the affected region,  and the  other one  dry to  a part
adjoining the affected part.
   c. Metallic wires are applied  in the same manner as the
conductors, except that, in the place of one of the conductors,
a metallic brush or broom  is used.
   The electric brush represents  the highest degree of localised
galvanism.   If it  is moved about, or the  skin is struck with
it,  this  proceeding  is  termed electrical flagellation; if the
brush is kept steadily at one spot, we term this the electrical
moxa.
   If we desire to  act upon a certain muscle without affecting
at the same time the superimposed tissues, Duchenne advises
to moisten all the tissues situated between the conductor and
the muscle in such a manner that the electrical current passes
rapidly through the moistened layers and reaches the muscle
without irritating  the  other layers.   In this way the  muscle
is alone excited into contractions.
   The  same process  is resorted  to  if we wish  to act upon
larger or smaller nervous trunks ; but the course of the nerve
has to be exactly known.
   We have not followed  this  method exclusively, but have
often  combined  it  with Hassenstein's.   In  applying  this
method, whenever the electric nervous action had  to  be in-
creased, as in  hypochondria and hysteria, general debility 
304
ELECTRO-MAGNETISM.
caused by onanism, involuntary  emissions, sexual excesses,
we apply the negative pole to  the  back, occiput, and  the
positive pole to the arms, legs, or abdomen.
   In impotence we apply the negative pole to the occiput or
back, the positive pole to the perinaeum.
   In local or general  debility we apply the negative pole to
the back, the positive pole to the  affected part.
 '  In suppression or  retention of the menses we  apply the
negative pole to the lower portion of  the back, in the lumbar
or sacral region, and the positive  pole to the inner pudendum,
even to the uterus.
   In paralysis the negative pole  is applied to  the  back, the
positive pole to the paralysed part.
   In diseases which require a diminution  of electric action,
such as spasmodic diseases, we apply the negative pole to the
affected part, and the positive pole to the back.
   In excessive sexual  excitement, nymphomania, satyriasis,
we apply the negative  pole to the hands, perinaeum, or abdo-
men, and the positive pole to the  back or occiput.
   In profuse menstruation the negative pole is applied to the
abdomen, or pubes, and the positive pole to the sacral region.
  The apparatuses which I use with the best effect  are those
of Neef, with modifications  and corrections by Steinberger,
according to my own indications ;  they are provided with a
scale  by means  of which  the  increase  or decrease  of the
electric action can be exactly regulated.  The pocket appara-
tuses constructed by this maker, are particularly commendable
both for their neatness and their correctness. 
~~/z£y
INDEX.
                                                          Page
Alopecia syphilitica,...................................................................  140
Arthritis blennorrhoica,..............................................................   SO
Balanitis,.................................................................................   56
Balannorrhoea,.........................................................................   56
Balanoposthitis..........................................................................   56
Bladder,...................................................................................   n
Bladder, catarrh of the,.............................................................  279
   "    blennorrhoea of the,.......................................................  279
   "    hypertrophy of the,........................................................  283
   "    inflammation of the........................................................   68
   "    spasm of the,...........................................................j- ••  285
Bone-pains, syphilitic,................................................................  *"
Buboes,....................................................................................  113
Buboes,  gonorrhoeal,..................................................................   66
Bulke.......................................................................................  132
Cachexia syphilitica,................................... ..............................  I'4
Caiculi, urinary,....................................•...................................  273
Caries syhilitica,.......................................................................  "o
Catarrh of the bladder,...............................................................  279
Chancre,................................................................................  108
Chordee,  ...............................................................................   61
Circocele..........:.......................................................................  188
Condylomata,............................................................................  130
Condylomata syphilitica,............................................................  l3'
Cystitis,...................................................................................   68
Disorganisations, gonorrhoeal,......................................................   SI 
306                           INDEX.
                                                                 PAflE
Dolores osteocopi...................................................................... 157
Dysuria....................................................................................  62
Eczema,...................................  ...............................................  63
Electro-magnetism,.................................................................... 296
Emissions,  seminal,................................................................... 218
Ephelides,................................................................................. 129
Epididymitis blennorrhagica,....,..,................................................  68
Erections,................................................................................  60
Erythemata, syphilitic,............................................................... 122
Exanthems, syphilitic,................................................................ 127
Excesses, sexual........................................................................ 197
Exostosis,................................................................................. 161
Eyes, tertiary affections of the,................................................... 170
Fecundation..............................................................................  34
Fibrous and parenchymatous organs, affections of,........................... 149
Figwarts,.................................................................................. 137
Fluor albus..............................................................................  96
Glans, inflammation of,...............................................................  56
Gonitis gonorrhoica,...................................................................  80
Gonocele,..................................................................................  80
Gonorrhoea of the buccal and nasal cavities,....................................  78
Gonorrhoea of the female,............................................................  96
Gonorrhoea of males,..................................................................  47
Gonorrhoea and blennorrhoea, affections 'which accompany,.................  60
Gonorrhoea of the rectum,............................................................  79
Gonorrhoea, sequelae of,..............................................................  66
Gravel,.................................................................................... 273
Gummata syphilitica,.................................................................. 146
Hematuria,............................................................................... 270
Haemorrhage from urethra,...........i..............................................  61
Hair and nails, syphilitic affections of the,....................................... 140
Herpes  prasputialis,...................................................................  63
Hydrocele,............................................................................... 185
Hypertrophy of bladder,............................................................. 283
Impotence of the male................................................................ 236
Incontinence of urine.................................................................. 268
Induration  of the corpora cavernosa,............................................. 155
Inflammation of the bladder,........................................................  G8 
                               INDEX.                           307
                                                                 Page
Inflammation of Cowper's glands..................................................  62
Inflammation  of the epididymis,...................................................  68
Inflammation of glans.................................................................  56
Inflammation of the knee, gonorrhoeal,...........................................  80
Inflammation of the prostate gland,................................................  62
Inflammation of the urethra,.......................................................  98
Inflammation of the uterus......................................................... 101
Inflammation of the vagina,......................................................... 100
Inflammation of the vulva,...........................................................  99
Iritis syphilitica,....................................................................... 142
Itching of the glans,...................................................................  63
Kidneys,...................................................................................   9
Leucorrhoea,..............................................................................  96
Lichen,................................................................................... 131
Lithiasis................................................................................... 277
Maculse............................................................................;....... 129
Menstrual derangements,............................................................ 191
Metastatic affections of gonorrhoea,................................................  66
Muscles and tendons, tertiary affections of the,.............................. 167
Necrosis syphilitica,................................................................... 163
Nerves, tertiary affections of the,.................................................. 172
Nymphomania,.......................................................................... 216
Oedema praeputii,.....................................................................  64
Onychia syphilitica,................................................................... 140
Ophthalmia  gonorrhceica............................................................. 174
Orchitis syphilitica,.................................................................... 149
Ovum,......................................................................................  36
Papulae,...................................................................................  131
Paraphymosis,............................................................................  65
Parenchymatous organs,  tertiary affections of,................................ 174
Periosteum and bones, tertiary affections of the,.............................  157
Periostitis syphilitica,.................................................................  160
Phymosis,................................................................................   64
Plaques muqueuses,................................................................... 124
Priapism,.................................................................................   60
Prostate gland, inflammation of the..............................................   62
Prostate gland, chronic inflammation and suppuration of, .................   81
Prostatitis,...............................................................................   62 
308                            INDEX.
                                                                   Pace
Pruritus glandis.........................................................................   63
Pustules,  syphilitic.................................................................... 132
Retention of urine,..................................................................... 258
Rupia syhilitica,........................................................................ 135
Sacocele syphilitica,................................................................... 1^9
Satyriasis,......................................................................... GO, 214
Scales, syphilitic,....................................................................... I3*
Self-abuse.......................................................................... 196,202
Semen,....................................................................................   35
Sexual functions, physiology of the,...............................................   3°
Sexual organs, male...............................................................  20-26
    "     "    female,............................................................  26-33
Sexual organs, non-syphilitic,  diseases of the,.................................  1°°
Spasm of the bladder,.................................................................  285
Spermatorrhoea,.........................................................................  218
Spinal diseases,........................................................................  253
Spinal irritation,.......................................................................  253
Spots,..................................................................................... 129
Sterility of the female,................................................................  244
Stone,....................,...............................................................  277
Strictures of the urethra,...........................................................   84
     "    Cauterisation of,.........................................................  94
     »     Dilatation of,..............................................................  90
     "     Scarifications of,.........................................................  95
Subcutaneous and submucous  tissue, tertiary affections of the,........... 146
Swelling of the prepuce,..............................................................  64
Syphilis,  constitutional................................................................ 118
Syphilis, history of,....................................................................  42
Syphilis of little children,........................................................... 180
Syphilis,  primary,...................................................................... 107
Syphilis,  secondary,................................................................... 121
Syphilis,  squamous.................................................................... 131
Syphilis,  tertiary.......................................................................  145
Syphilisation,............................................................................  287
Syphilitic diseases  of the mucous membranes,..................................  122
Tabes dorsalis,..........................................................................  256
Tubercles, cutaneous..................................................................  130
Tubercles, mucous,.....................................................................  124 
                               INDEX.                            309
                                                                  Page
Tubercles of mucous membranes, deep-seated,................................. 126
Ureters,...................................................................................  11
Urethra,...................................................................................  12
Urethritis,................................................................................  98
Urging to urinate,..................................................................... 265
Urinary and sexual organs, description of the,.................................   9
Urinary and sexual  organs, diseases of the,........,............................  42
Urine,......................................................................................  14
   "   physical properties of the,..................................................  17
Urine, bloody,.......................................................................... 270
Urine, retention  of,.................................................................... 258
Uteritis,................................................................................... 101
Vaginitis,................................................................................. 100
Varicocele,............................................................................... 188
Venereal diseases, simple,...........................................................  47
Vesicles, syphilitic,.................................................................... 132
Vulvitis,..........................................................•........................  99 
r  *
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