A
TREATISE
ON
THE VENEREAL DISEASE.
By JOHN HUNTER.
PHILADELPHIA:
PRINTED AND SOLD BY PARRY HALL, No. 149, IN CHESNUT
STREET NEAR FOURTH STREET.
M.DCC.XCI.



THE
CONTENTS.
INTRODUCTION.
SECT. I. Of sympathy, page 1
Sect. II. Of morbid actions being incompatible
with each other, 2
Sect. III. Of the comparative powers of differ-
ent parts of the body — from situation — from
structure, 4
Sect. IV. Of parts susceptible of particular dis-
eases, 5
Sect. V. Of inflammation, 6
Sect. VI. Of mortification, 7
PART I.
CHAP. I. Of the venereal poison, 9
Sect. I. Of the first origin of the poison, 9
Sect. II. Began in the human race and in the
parts of generation, 10
Sect. III. Of the nature of the poison, 11
Sect. IV. Of the greater or less acrimony of the
poison, 12
Sect. V. Of the poison being the same in gonor-
rhœa and in chancre, 13
Sect. VI. Of the cause of the poisonous quality
— fermentation — action, 17
CHAP. II. The mode of venereal infection, 21
CHAP. III. Of the different forms of the disease, 22
Sect. I. Varieties in different constitutions, 23
CHAP. IV. Of the lues venerea being the cause of other dis-
eases, 24
PART

THE CONTENTS.
PART II.
CHAP. I. Of gonorrhœa, 27
Sect. I. Of the time between the application of
the poison and effect, 29
Sect. II. Of the difficulty of distinguishing the
virulent from the simple gonorrhœa, 30
Sect. III. Of the common final intention of sup-
puration not answering in the present dis-
ease, 32
Sect. IV. Of the venereal gonorrhœa, 38
Sect. V. Of the seat of the disease in both
sexes, 38
Sect. VI. Of the most common symptoms, and
the order of their appearance, 41
Sect. VII. Of the discharge, 44
Sect. VIII. Of the chordee, 46
Sect. IX. Of the manner in which the inflam-
mation attacks the urethra, 47
Sect. X. Of the swelled testicle, 50
Sect. XI. Of the swellings of the glands from
sympathy, 54
Sect. XII. Of the diseases of the lymphatics in a
gonorrhœa, 56
Sect. XIII. Short recapitulation of the varieties
in the symptoms, 56
CHAP. II. Of the gonorrhœa in women, 58
Sect. I. Of the proofs of a woman having this
disease, 61
CHAP. III. Of the effects of the gonorrhœa on the constitu-
tion in both sexes, 62
CHAP. IV. Of the cure of the gonorrhœa, 63
Sect. I. Of the different modes of practice —
evacuants — astringents, 67
Sect. II. Of local applications — different kinds
of injections — irritating — sedative — emolli-
ent — astringent, 70
CHAP. V. Of the cure of gonorrhœa in women, 76
CHAP. VI. Of the treatment of the constitution in the cure
of gonorrhœa, 77
CHAP. VII.

THE CONTENTS.
CHAP. VII. Of the treatment of occasional symptoms of go-
norrhœa, 81
Sect. I. Of the bleeding from the urethra, 81
Sect. II. Of preventing painful erections, 81
Sect. III. Of the treatment of the chordee, 81
Sect. IV. Of the treatment of the suppuration
of the glands of the urethra, 82
Sect. V. Of the treatment of the affection of the
bladder from gonorrhœa, 83
Sect. VI. Of the treatment of the swelled testi-
cle, 83
Sect. VII. Of the decline and termination of the
symptoms of gonorrhœa, 85
CHAP. VIII. Observations on the symptoms which often re-
main after the disease is subdued, 87
Sect. I. Of the remains of the disagreeable sen-
sations excited by the original disease, 88
Sect. II. Of a gleet, 91
Sect. III. Of the cure of gleets — constitutional-
ly — locally, 93
Sect. IV. Of the remaining chordee, 97
Sect. V. Of the continuance of the irritation of
the bladder, 98
Sect. VI. Of the remaining hardness of the epi-
didymis, 98
PART III.
CHAP. I. Of diseases supposed to arise in consequence of
venereal inflammation in the urethra of
men, 100
Sect. I. Of strictures, 102
CHAP. II. Of a permanent stricture, 103
Sect. I. Of the bougie, 106
Sect. II. Of the treatment of the permanent
stricture, 107
Sect. III. Of the cure of stricture by ulceration,
112
Sect. IV. Of the application of a caustic to
strictures, 116
CHAP. III.

THE CONTENTS.
CHAP. III. Of strictures in women, 120
Sect. I. Of the cure of strictures in women, 121
Sect. II. Of the gleet in consequence of a stric-
ture, 121
CHAP. IV. Of stricture attended with spasmodic affection,
122
CHAP. V. Of some circumstances attending the use of bou-
gies — their figure and composition, 124
Sect. I. Of a new passage formed by bougies, 126
CHAP. VI. Of diseases in consequence of a permanent stric-
ture in the urethra, 131
Sect. I. Of the enlargement of the urethra, 132
Sect. II. Of the formation of a new passage for
the urine, 132
Sect. III. Of inflammation in the parts sur-
rounding the urethra, 139
Sect. IV. Of the treatment of the inflammation
in the surrounding parts, 141
Sect. V. Of the effects of inflammation in the
surrounding parts upon the constitution, 143
Sect. VI. Of fistulæ in perinæo, 144
Sect. VII. Of the operation for fiftulæ in peri-
næo, 145
CHAP. VII. Of some other affections of the urethra, 149
Sect. I. Of the spasmodic affections of the ure-
thra, 149
Sect. II. Of the cure of spasmodic affection of
the urethra, 150
Sect. III. Of the paralysis of the urethra, 152
Sect. IV. Cure of the paralysis of the urethra,
153
Sect. V. Of caruncles or excrescences in the
urethra, 153
Sect. VI. Of the cure of the excrescence or
caruncle, 154
CHAP. VIII. Of the swelled prostate gland, 154
Sect. I. Of the treatment of the swelled prostate
gland, 160
CHAP. IX. Of the disease of the bladder, particularly from
the before-mentioned obstructions to the
urine, 161
Sect. I.

THE CONTENTS.
Sect. I. Of the treatment where the actions of
the urethra and bladder do not exactly al-
ternate, 164
Sect. II. Of the paralysis of the bladder from ob-
struction to the passage of the urine, 164
Sect. III. Of the cure of the paralysis of the
bladder from obstruction arising from pres-
sure or spasm, 167
CHAP. X. Of a suppression of urine, and operations for the
cure of it, 168
Sect. I. Of allowing a catheter to remain in the
urethra and bladder, 175
Sect. II. Of the increased strength of the blad-
der, 176
Sect. III. Of the distension of the ureters, 177
Sect. IV. Of irritability in the bladder independ-
ent of obstructions to the passage of the
urine, 178
Sect. V. Of the cure of simple irritability of
the bladder, 178
Sect. VI. Of a paralysis of the acceleratores
urinæ, 179
CHAP. XI. Of the discharge of the natural mucus of the
glands of the urethra, 180
Sect. I. Of the discharge of the secretions of the
prostate gland and vesiculæ seminales, 180
CHAP. XII. Of impotence, 182
Sect. I. Of impotence depending on the mind, 183
Sect. II. Of impotence from a want of proper
correspondence between the actions of the
different organs, 186
CHAP. XIII. Of the decay of the testicle, 190
PART IV.
CHAP. I. Of chancre, 195
Sect. I. Of the phymosis and paraphymosis, 201
CHAP. II. Of chancres in women, 204
CHAP. III. General observations on the treatment of chan-
cres, 205
Sect. I. Of the destruction of a chancre, 208
b Sect. II.

THE CONTENTS.
Sect. II. Of the cure of chancres — local appli-
cations, 209
Sect. III. Of the treatment of phymosis in con-
sequence of or attended with chancre, 214
Sect. IV. Of the common operation for the
phymosis produced by chancres, 214
Sect. V. Of the constitutional treatment of phy-
mosis, 216
Sect. VI. Of the treatment of the paraphymo-
sis from chancres, 217
Sect. VII. Of the cure of chancres by mercury
given internally, 218
CHAP. IV. Of the cure of chancres in women, 222
CHAP. V. Of some of the consequences of chancres, and the
treatment of them, 223
Sect. I. Of dispositions to new diseases during
the cure of chancres, 224
Sect. II. Of ulcerations resembling chancres, 225
Sect. III. Of a thickening and hardening of
the parts, 227
Sect. IV. Of warts, 227
Sect. V. Of excoriations of the glans and pre-
puce, 229
PART V.
CHAP. I. Of bubo, 231
CHAP. II. Of buboes in women, 240
CHAP. III. Of the inflammation of buboes, and the marks
that distinguish them from other swellings
of the glands, 242
CHAP. IV. General reflections on the cure of buboes, 247
Sect. I. Of resolution of the inflammation of
the absorbents on the penis, 250
Sect. II. Of the resolution of buboes in the
groin, 250
Sect. III. Of the resolution of buboes in wo-
men, 251
Sect. IV. Of buboes in other parts, 252
Sect. V. Of the quantity of mercury necessary
for the resolution of a bubo, 252
Sect. VI.

THE CONTENTS.
Sect. VI. Of the treatment of buboes when they
suppurate, 254
CHAP. V. Of some of the consequences of buboes, 256
PART VI.
CHAP. I. Of the lues venerea, 262
Sect. I. Of the nature of the sores or ulcers pro-
ceeding from the lues venerea, 264
Sect. II. Of the matter from sores in the lues
venerea compared with that from chancres
and buboes, 267
Sect. III. Of the local effects arising from the
constitution considered as critical — symp-
tomatic fever, 274
Sect. IV. Of the local and constitutional forms
of the disease never interfering with one
another, 276
Sect. V. Of the supposed termination of the lu-
es venerea; in other diseases, 277
Sect. VI. Of the specific distance of the venere-
al inflammation, 278
Sect. VII. Of the parts most susceptible of the
lues venerea - of the time and manner in
which they are affected — what is meant by
contamination, disposition and action —
summary of the doctrine, 279
CHAP. II. Of the symptoms of the lues venerea, 289
Sect. I. Of the symptoms of the first stage of
the lues venerea, 292
Sect. II. Experiments made to ascertaln the pro-
gress and effects of the venereal poison, 298
Sect. III. Of the symptoms of the second stage
of the lues venerea, 300
Sect. IV. Of the effects of the poison on the
constitution, 302
CHAP. III. General observations on the cure of the lues ve-
nerea, 304
Sect. I. Of the use of mercury in the cure of
the lues venerea, 307
Sect. II.

THE CONTENTS.
Sect. II. Of the quantity of mercury necessary
to be given, 313
Sect. III. Of the sensible effects of mercury up-
on parts, 315
Sect. IV. Of the action of mercury, 317
Sect. V. Of the different methods of giving
mercury — externally — internally, 319
Sect. VI. Of the cure of the disease in the se-
cond or third stage, 325
Sect. VII. Of local treatment, 328
Sect. VIII. Of abscesses — exfoliation, 329
Sect. IX. Of nodes on tendons, ligaments and
fasciæ, 330
Sect. X. Of correcting some of the effects of
mercury, 331
Sect. XI. Of the form of the different prepara-
tions of mercury when in the circulation, 334
Sect. XII. Of the operation of mercury on the
poison, 337
Sect. XIII. Of gum guaiacum, and radix sarsa-
parillæ, in the venereal disease, 339
CHAP. IV. Of the effects remaining after the disease is cured,
and of the diseases sometimes produced by
the cure, 341
Sect. I. General observations on the medicines
usually given for the cure, 343
Sect. II. Of the continuance of the spitting, 348
CHAP. V. Of preventing the venereal disease, 349
PART VII.
CHAP. I. Of diseases resembling the lues venerea, which have
been mistaken for it, 350
Sect. I. Of diseases supposed to be venereal pro-
duced by transplanted teeth, 362
INTRODUCTION.

INTRODUCTION.
TWO motives have induced me to publish the following
treatise. In the first place, I am not without hope, that
several new observations, contained in it, will be deemed wor-
thy of the public attention; in the next place, I am desirous
to have an opportunity of shewing from whom some opinions,
that have made their way into the medical world, originated.
But, as much of the theory, which will often be referred to
in the course of this work, is peculiar to myself, it seems ne-
ceffary to give an introductory explanation of some parts of it,
in order that the terms used may be the more intelligible to
the reader.
I. OF SYMPATHY.
I DIVIDE sympathy into two kinds; universal and partial.
Universal sympathy is, an affection wherein the whole con-
stitution sympathises with some sensation or action. Partial
sympathy is, an affection wherein one or more distinct parts
sympathise with some local sensation, or action.
The universal sympathies are different in different diseases;
but those that occur in the venereal disease are principally two;
the symptomatic fever, and the hectic fever. The symptoma-
tic fever is an immediate effect of some local injury, and sel-
dom takes place in the venereal disease in any great degree un-
der any of its forms, except in the case of a swelled testicle,
which is itself an instance of a partial sympathy; the symptoma-
tic fever here, therefore, is an universal sympathy arising from
a partial one. The hectic fever is an universal sympathy with
a local disease, which the constitution is not able to overcome.
This takes place oftener and in a greater degree in the lues
venerea than in any other form of the disease.
I divide partial sympathy into three kinds; the remote, the
contiguous, and the continuous. The remote is, where there
appears to be no visible connection of parts from whence we
B can

2 INTRODUCTION.
can account for such effects, as in the case of pain of the shoul-
der in an inflammation of the liver. The contiguous is, that
which appears to have no other connection than what arises
from vicinity or contact of separate parts; an instance of which
we have, in the stomach and intestines sympathising with the
integuments of the abdomen. The continuous is, where these
is no interruption of parts, and the sympathy runs along from
the irritating point, as from a centre, which is the most com-
mon of all sympathies. We have an example of this in the
spreading of inflammation.
II. OF MORBID ACTIONS BEING INCOMPATIBLE
WITH EACH OTHER.
THE venereal disease is not only suspected to be present in
many cases, where the nature of the disorder is not well mark-
ed, but it is supposed that it can be combined with other dis-
eases, such as the itch and the scurvy: thus we hear of pocky
itch, and of scurvy and the venereal disease combined; but
this supposition appears to me to be founded in error. I have
never seen any such cases, nor do they seem to be consistent
with the principles of morbid action in the animal œconomy.
It appears to me, beyond a doubt, that no two actions can take
place in the same constitution, nor in the same part, at one
and the same time. No two different fevers can exist in the
same constitution, nor two local diseases in the same part at
the same time; yet as the venereal disease, when it attacks the
skin, bears a resemblance to those symptoms which are vulgar-
ly called scorbutic, they are often supposed to be mixed and to
exist in the same part.
What has been called a scorbutic constitution, is no more
than a constitution very susceptible of an action producing
eruptions on the skin, whenever an immediate cause takes place;
and there are some parts of the body more susceptible of this
than others, in which therefore a slighter immediate cause is
sufficient to excite the action; but the easy susceptibility, with
respect to one disease, is not a reason why a constitution should
not likewise be susceptible of other diseases. A man may have
the pox and the small-pox at the same time; that is, parts of
his body may have been contaminated by the venereal poison,
and the small-pox may take place, and both diseases may ap-
pear

INTRODUCTION. 3
pear together, but not in the same parts. If both were con-
sequences of fever, and each followed the fever nearly about
the same time, it would be impossible for each to have its re-
spective eruption, even in different parts, at the same time;
two fevers, antecedent to thefe different diseases, cannot be
co-existent.
From this principle, I think I may fairly put the following
queries. Does not the failure of inoculation, and the power
of resitsting many infections, sometimes arise from the person's
having, at the same time, some other disease, and therefore be-
ing incapable of a new action? Does not the great difference
in the time, from the application of the cause, to the appear-
ance of the effect, in many cases, depend upon the same prin-
ciple? It has been sometimes observed, that the puncture in the
arm has shewn no sign of inflammation in fourteen days after
the application of the variolous poison. Has there not been
another disease in the constitution at the time of inoculation?
Does not the cure of some diseases depend upon the same prin-
ciple? The suspension, or cure of a gonorrhœa by a fever,
may be an instance of this.
Let me illustrate this principle still further, by one of many
cases which have come under my own observation. On Thurs-
day, the fifteenth of March, one thousand seven hundred and
seventy-five, I inoculated a gentleman's child; in whose arms
it was observed, I made large punctures. On the Sunday fol-
lowing, he appeared to have received the infection; a small
inflammation or redness appearing round each puncture, and
a small tumour above the surface of the skin having been ob-
served. On the twentieth, and the twenty-first, the child was
feverish; but I declared that the fever was not variolous, as
the inflammation had not at all advanced since the nineteenth.
On the twenty-second, a considerable eruption appeared, which
was evidently the measles; upon this the sores on the arms ap-
peared to go back, becoming less inflamed. On the twenty-
third, he was very full of the measles; the punctures on the
arms being in the same state as on the preceding day. On the
twenty-fifth, the measles began to disappear. On the twenty-
sixth, and twenty-seventh, the punctures began again to look
a little red. On the twenty-ninth, the inflammation increased,
and there was a little matter formed. On the thirtieth, he was
seized with fever. The small-pox appeared at the regular time,
went

4 INTRODUCTION.
went through its usual course, and terminated favourably. In
like manner, it may be observed, that the venereal disease makes
its appearance at different periods after infection. Is not this
explicable on the same principle?
III. OF THE COMPARATIVE POWERS OF DIFFER-
ENT PARTS OF THE BODY — FROM SITUATI-
ON — FROM STRUCTURE.
WE shall have occasion to observe, that the parts affected
assume the morbid action more readily, and continued more
rapidly, when near to the source of the circulation than when
far from it; for the heart exerts its influence upon the different
parts of the body in proportion to their vicinity to it; and the
more distant that the parts are the weaker are their powers.
This is, perhaps, better illustrated by disease than by any
actions in health; for in health we have no comparative trials,
as no two parts of the machine, at unequal distances from the
heart, can be thrown into equal action, and therefore no con-
clusions can be drawn. It may be observed, that all the vital
parts are near the heart.
In diseases we see mortification, arising from debility in the
extremities, oftener than in other parts, more especially if the
person is tall; the heart not propelling the blood to these distant
parts with equal force. In such a state of constitution, those
who labour under a hemiplegia, are often found to die at last,
from a mortification in the extremities of the paralytic side.
In some of these cases the arteries give way, and allow of an
extravasation of the blood, and therefore we may reasonably
suppose, that they are proportionally weak in health. We
also find, that such extravasation commonly begins in the ex-
tremities. This principle is not only evident in these two dis-
eases, but also in every disease that can affect an animal body.
It appears in the readiness with which diseases come on, and
proceed in parts distant from the source of the circulation, and
also in the steps towards a cure.
Parts differ not only in their powers, in proportion as they
are nearer or further from the heart, but likewise according
to their peculiar strufture, whereby they vary as much in the
progress of morbid actions as in the operations of health.
An

INTRODUCTION. 6
An animal body is composed of a variety of substances, as
muscle, tendon, cellular membrane, ligament, bone, nerve,
&c. We have therefore an opportunity of observing the com-
parative progress of diseases in them, and their comparative
powers of performing a cure; and we find that they differ
very much from one another in those respects. How far these
differences take place in all diseases, I have not been able to
determine; but should suppose, that in specific diseases, as
scrofula and cancer, there is in general no difference in the
mode of action in any of the structures*, these diseases pro-
ducing the same specific effects in all the parts that are capa-
ble of being affected by them; but in diseases arising from ac-
cident, a great difference in the degrees of action takes place;
the parts from such a cause being allowed to act according to
their natures, which observation holds good also in the venere-
al disease. This difference appears to be chiefly in the degrees
of strength and weakness in resisting morbid action. The less
the natural powers of action are in any particular structure of
parts, the less they are able to resist disease; therefore bone,
tendon, ligament, and cellular membrane, go through their
morbid actions more slowly than muscle or skin; and this
principle is applicable to the venereal disease.
IV. OF PARTS SUSCEPTIBLE OF PARTICULAR
DISEASES.
THERE are some parts much more susceptible of specific
diseases than others. Poisons take their different seats in the
body as if allotted for them. Thus we have the skin attacked
with what are vulgarly called scorbutic eruptions, and many
other diseases; it is also the seat of the small-pox and the measles;
the throat is the seat of the hydrophobia and the hooping-cough.
The scrofula attacks the absorbent system, especially the glands.
The breasts, testicles, and the conglomerate glans, are the
seat of cancer. The skin, throat, and nose, are more readily
affected by the lues venerea  than the bones and periosteum,
which, on the other hand, suffer sooner than many other parts,
particularly the vital parts, which perhaps are not at all sus-
ceptible of the disease.
V. OF
* Here it is to be understood, that we do not include those parts which have a great-
er tendency to specific diseases than what many others have; as the lymphatics to the
scrofula, the breast to the cancer.

6 INTRODUCTION.
V. OF INFLAMMATION.
I CONSIDER common inflammation to be an increased ac-
tion of the smaller vessels of a part, joined with a peculiar
mode of action, by which they are enabled to produce the fol-
lowing effects; to unite parts of the body to each other; to
form pus; and to remove parts of the solids. These effects
are not produced by a simple increase of action or enlargement
of the vessels, but by a peculiar action, which is at present
perhaps not understood,
These three effects of inflammation I have called, distinct
species of inflammation. That which unites parts I have call-
ed, the adhesive inflammation; that which forms pus, the sup-
purative inflammation; and that which removes parts, the sup-
perative inflammation.
In the adhesive inflammation the arteries throw out coagu-
lable lymph, which becomes the bond of union. This how-
ever is not simply extravasated, but has undergone some change
before it leaves the arteries, since in inflamed veins it is
found lying coagulated upon the internal surface of the vessel,
which could not have happened if simply extravasated. In
the suppurative inflammation a still greater change is produced
upon the blood before it is thrown out by the arteries, where-
by it is formed into pus; which change is probably similar to
secretion. In the ulcerative inflammation, the action of the
arteries does not remove the parts; that office is performed
by the absorbent vessels which are brought into action.
In the two first species of inflammation there must be a
change in the disposition and mode of action of the arteries;
for the suppurative species cannot be considered as simply an
increase of the action of the adhesive, as its effects are totally
different; but in the third species there is probably no change
of action in the arteries from that of the second; the action
only of the absorbents being superadded, by which solid parts,
and of course, the arteries themselves are removed.
VI. OF

INTRODUCTION. 7
VI. OF MORTIFICATION.
MORTIFICATIONS are of two kinds, one preceded by in-
flammation, the other not; but as the cases of mortifications,
which will be mentioned in this work, are all of the first kind,
I shall confine my observations to that species.
I consider inflammation as an increased action of that power
which a part is naturally in possession of. This increased ac-
tion, in healthy inflammations at least, is probably attended
with an increase of power: but in inflammations, which ter-
minate in mortification, there is no increase of power. On
the contrary, there is a diminution of power, which, joined
to an increased action, becomes the cause of mortification, by
destroying the balance which ought to subsist between the pow-
er and action of every part.
If this account of mortifications be just, we shall find it no
difficult matter to establish a rational practice; but before we
attempt this, let us just take a view of the treatment hitherto
recommended, and see how far it agrees with our theory.
It is plain from the common practice, that the weakness has
been attended to; but it is as plain, that the increased action
has been overlooked; and therefore the whole aim has been to
increase the action with a view to remove the weakness. The
Peruvian bark, confectio cardiaca serpentaria, &c. have been
given in as large quantities as the case appeared to require, or
the constitution could bear; by which means an artificial or
temporary appearance of strength has been produced, while it
was only an increased action. The cordials and wine, upon
the principle on which they have been given, are rationally
administered; but there are strong reasons for not recommend-
ing them, arising from the general effect which all cordials have
of increasing the action without giving real strength; and the
powers of the body are afterwards sunk proportionally as they
have been raised; by which nothing can be gained, but a great
deal may be lost; for in all cases, if the powers are allowed
to sink below a certain point, they are irrecoverable.
The local treatment has been as absurd as the constitutional.
Scarifications have been made quite to the living parts, that
stimulating and antisceptic medicines might be applied to them,
such

[8] INTRODUCTION.
such as turpentines, the warmer balsams, and sometimes the
essential oils. Warm fomentations have been also applied as
congenial to life, but warmth always increases action, and stimu-
lants are improper where the actions are already too violent.
Upon the principles here laid down, the bark is the only
medicine that can be depended upon, as it increases the powers
and lessens the action. Upon many occasions opium will be
of singular service by lessening the action, although it does not
give real strength. I have seen good effects from  it, both
when given internally in large doses, and when applied to the
part. To keep the parts cool is proper, and all the applicati-
ons should be cold. The above-mentioned practice is to be
kept in view in mortifications that happen in the venereal
disease.
PART

[9]
PART I.
CHAPTER I.
OF THE VENEREAL POISON.
THE Venereal Disease arises from a poison; which, as
it is produced by disease, and is capable of again pro-
ducing a similar disease, I call a morbid poison, to distinguish
it from the other poisons, animal, vegetable, and mineral.
The morbid poisons are many, and they have different
powers of contamination. Those, which infect the body, ei-
ther locally or constitutionally, but not in both ways, I call
simple. Those, which are capable of affecting the body, both
locally and constitutionally, I call compound. The venereal
poison, when applied to the human body, possesses a power of
propagating or multiplying itself; and as it is also capable of
acting both locally and constitutionally, it is a compound mor-
bid poison. Like all such poisons, it may be communicated
to others in all the various ways in which it can be received,
producing the same disease in some one of its forms.
I. OF THE FIRST ORIGIN OF THE POISON.
THOUGH the first appearance of this poison is certainly
within the period of modern history, yet the precise time and
manner of its origin has hitherto escaped our investigation;
and we are still in doubt, whether it arose in Europe, or was
imported from America. I shall not attempt to discuss this
question; and those who wish to examine at length the facts, au-
thorities and arguments brought in favour of the latter opini-
on, may consult Astruc; and for the former a short treatise*
C published
* Intitled, "A Dissertation on the Origin of the Venereal Disease; proving that it
was not brought from America, but began in Europe from an epidemical Distemper.
Translated from the original Manuscript of an eminent Physician. London, printed for
Robert Griffiths, 1751."

10 OF THE VENEREAL POISON.
published in one thousand seven hundred and fifty-one, with-
out a name. The author of this treatise appears to have con-
sidered the subject very fully, and as far as reasoning goes on
a subject of this kind, proves that the disease was not brought
from the West-Indies. Not contented with this, he goes on
to account for its first rise in Europe: but in this he is not
equally successful. The subject is a difficult one; and the
want of a sufficient number of facts leaves too much room
for conjecture.
We shall not therefore enter further into this question; nor
is it material to know at what period, and in what country,
this disease arose; but we may in general affirm, that as ani-
mals are not naturally formed with disease, or so as to run
spontaneously into morbid actions; but with a susceptibility of
such impressions as produce such actions, diseases must always
arise from impressions made upon the body: and as man is
probably susceptible of more impressions, that become the im-
mediate cause of disease, than any other animal, and is besides
the only animal which can be said to form artificial impressions
upon himself, he is subject to the greatest variety of diseases.
In one of those self-formed situations, therefore, the impres-
sion most probably was given, which produced the venereal
disease.
II. IT BEGAN IN THE HUMAN RACE, AND IN
THE PARTS OF GENERATION.
IN whatever manner it arose, it certainly began in the hu-
man race; as we know no other animal that is capable of be-
ing infected with this poison. It is probable too, that the
parts of generation were the first affected: for, if it had taken
place in any other part of the body, it might probably never
have gone further than the person in whom it first arose; and
therefore never have been known; but, being seated in the
parts of generation, where the only natural connection takes
place between one human being and another, except that be-
tween the mother and child, it was in the most favourable si-
tuation for being propagated: and, as we shall find hereafter
in the history of the disease itself, that no constitutional effect
of this poison can be communicated to others, we are led of
necessity to conclude that its first effects were local.
III. OF

OF THE VENEREAL POISON. 11
III. OF THE NATURE OF THE POISON.
WE know nothing of the poison itself, but only its effects on
the human body. It is commonly in the form of pus, or united
with pus, or some such secretion, and produces a similar mat-
ter in others, which shows that it is most generally, although
not necessarily, a consequence of inflammation. It produces,
or excites therefore, in most cases, an inflammation in the
parts contaminated; besides which inflammation, the parts so
contaminated have a peculiar mode of action superadded, dif-
ferent from all other actions attending inflammation; and it is
this specific mode of action which produces the specific qua-
lity in the matter. It is not necessary, that inflammation
should be present to keep up this peculiar mode of action, be-
cause the poison continues to be formed long after all signs of
inflammation have ceased. This appears from the following
facts: men having only what is called a gleet or healing chan-
cre, give the disease to sound women: and many venereal go-
norrhœas happen without any visible signs of inflammation.
In women, the inflammation is frequently very slight, and
often there is not the least sign of it; for they have been
known to infect men, though they themselves have had no
symptoms of inflammation, or of the disease in any form.
Therefore the inflammation and suppuration, when present,
are only attendants on the peculiar mode of action; the degree
in which they take place depending more on the nature of the
constitution than on that of the poison.
The formation of matter also, though a very general, is
not a constant attendant on this disease; for we sometimes find
inflammation produced by the venereal poison, which does not
terminate in suppuration; such inflammation I suspect to be
of the erysipelatous kind. It is the matter produced, whether
with or without inflammation, which alone contains the poi-
son; for without the formation of matter, no venereal poison
can exist. Therefore a person having the venereal irritation in
any form not attended with a discharge, cannot communicate
the disease to another. To communicate the disease therefore,
it is necessary that the venereal action should first take place;
that matter should be formed, in consequence of that action;
and that the matter should be applied to a sound person or part.
That

12 OF THE VENEREAL POISON.
That the venereal disease is to be propagated only by matter,
is proved every day by a thousand instances. Married men
contract the disease, and not suspecting that they have caught
it, cohabit with their wives, even for weeks. Upon disco-
vering symptoms of the disease, they of course desist; yet in
all my practice I never once found, that the complaint was
communicated under such circumstances, except where they had
not been very attentive to the symptoms, and therefore continu-
ed the connection after the discharge had appeared. I have gone
so far as to allow husbands, while infected, but before the ap-
pearance of discharge, to cohabit with their wives in order to
save appearances, and always with safety. I could carry this
still further, and even allow a man, who has a gonorrhœa, to
have connection with a sound woman, provided that great care
be taken to clear all the parts of any matter, by first syring-
ing the urethra; making water; and washing the glans.
The matter, which is impregnated with this poison, when
it comes in contact with a living part, irritates that part, and
inflammation is the common consequence. It must be applied
either in a fluid state, or rendered fluid by the juices of the
part to which it is applied. There is no instance where it has
given the infection in the form of vapor, as is the case in ma-
ny other poisons.
IV. OF THE GREATER OR LESS ACRIMONY
OF THE POISON.
VENEREAL matter must in all cases be the same; one
quantity of matter cannot have a greater degree of poisonous
quality than another; and, if there is any difference, it is on-
ly in its being more or less diluted, which produces no differ-
ence in its effects. One can conceive, however, that it may
be so far diluted as not to have the power of irritation. Thus
any fluid taken into the mouth, capable of stimulating the nerves
to taste, may be so diluted as not to be tasted. But if the
poison can irritate the part, to which it is applied to action, it
is all that is required; the action will be the same, whether
from a large or small quantity, from a strong or a weak
solution.
We find from experience, that there is no difference in the
kind of matter; and no variation can arise in the disease from
the

OF THE VENEREAL POISON. 13
the matter's being of different degrees of strength; for it ap-
pears, that the same matter affects very differently different
people. Two men having been connected with one woman,
and both catching the disease, one of them shall have a violent
gonorrhœa or chancre, while the other shall have merely a
slight gonorrhœa. I have known one man give the disease to
different women, and some of the women have had it very se-
verely, while in others it has been very slight. The same rea-
soning holds good with regard to chancres. The variations of
the symptoms in different persons depend upon the constitution
and habit of the patient at the time. What happens in the
inoculation of the small-pox strengthens this opinion. Let the
symptoms of the patient, from whom the matter is taken, be
good or bad; let it be from one, who has had a great many
pustules, or from one, who has had but few; let it be from
the confluent or distinct kind; applied in a large quantity or a
small one; it produces always the same effect. This could
only be known by the great numbers that have been inoculated
under all these different circumstances.
V. OF THE POISON BEING THE SAME IN
GONORRHŒA AND IN CHANCRE.
IT has been supposed by many, that the gonorrhœa and the
chancre arise from two distinct poisons; and their opinion
seems to have some foundation, when we consider only the
different appearances of the two symptoms, and the different
methods of cure; which, with respect to the nature of many
diseases, is too often all we have to lead our judgment. Yet,
if we take up this question upon other grounds, and also have
recourse to experiments, the result of which we can absolutely
depend upon, we shall find this notion to be erroneous.
If we attend to the manner in which the venereal poison
was communicated to the inhabitants of the islands of the South
Seas, there are many circumstances which tend to throw light
upon the present question. It has been supposed, as no men-
tion is made of a gonorrhœa at Otaheite, that it must have been
the chancre that was first introduced into that island; and that
of course nothing but a chancre could be propagated there;
for as no gonorrhœa had been communicated, no such disease
could take place. But if we were to reason upon all the pro-
bable

14 OF THE VENEREAL POISON.
bable circumstances, attending the voyages to that part of the
world, we should conclude the contrary; for it was almost im-
possible to carry a chancre so long a voyage without its destroy-
ing the penis; while we know from experience, that a gonor-
rhœa may continue for a great length of time. It is mention-
ed in Cook's voyage, that the people of Otaheite, who had
this disease, went into the country and were cured; but when
it became a pox, it was then incurable. This shows, that the
disease, which they had, must have been a gonorrhœa; for we
know that it is only a gonorrhœa that can be cured by simple
means: and further, if it had been a chancre, and they had
been acquainted with the means of curing it, they could also
have cured the lues venerea.
Wallis left Plymouth in August 1766, and arrived at Ota-
heite in July 1767, eleven months after his embarkation; and
if none of his men had the disease when he sailed, there was
hardly a possibility of their contracting it any where afterwards
in the voyage. This appears to be too long for a gonorrhœa
to last. But let us suppose even that Wallis carried it thither
in his ship, one or two of his crew having the disease. As he
staid there five weeks, it was very possible, even very proba-
ble, that such person or persons might have communicated it
so quickly as to have become the cause of contamination of
the whole crew of his ship; but as this did not happen, it is
a presumptive proof that Wallis  did not carry it thither.
Bougainville left France in December 1766; but he touched
at several places where some of his people might have got the
disease. The last of which place was Rio de la Plata, which he
left in November 1767, and arrived at Otaheite in April 1768,
five months after. This interval of time agrees better with the
usual continuance of the disease, than the length of Wallis's
voyage, and therefore from this circumstance it becomes
more probable, that Bougainville carred it thither. Besides,
it is likely that he could guard his people less against the dis-
ease than Wallis; for Wallis could have his choice of men at
his first setting out, which was all that was necessary to pre-
vent his carrying the disease with him, for he ran no risk of
contracting it afterwards: but although Bougainville had the
same advantage at first, yet he had it not afterwards, for his
men were in the way of infection in several places, and he had
no opportunity of changing them, and probably no great chance 
of

OF THE VENEREAL POISON. 15
of having them cured. The circumstance of the disease be-
ing found by Bougainville at Otaheite soon after his arrival, is
a kind of proof that he carried it thither himself; for I ob-
served before, that if Wallis had carried it by one man only,
this man could in a very few days have so far propagated it,
as to have spread it through the whole ship's crew; and as
Bougainville arrived at the island ten months after Wallis,
there was a sufficient time for the inhabitants of the whole
island to have been infected, and the ravages of the disease must
have been evident to them immediately upon their arrival.
Bougainville remained only nine days at the island of Otaheite,
and observed nothing of the disease till some weeks after his
departure, when it was found that several of the crew were in-
fected, which most probably must have happened in conse-
quence of the poison being carried there by some of his own
people. It is also mentioned by Cook, that the Otaheiteans
ascribed the introduction of the disease to Bougainville; and
we can hardly suppose that they would be so complaisant to our
countrymen as to accuse Bougainville, when they must have
known whether the disease was imported by Wallis or not,
especially as they had no reason to be partial  in favour of the
people who accompanied the latter. But as we find in Cook's
last voyage, that the disease in every form is now there, and
as we have no new intelligence of a gonorrhœa being since in-
troduced, we must suppose that every form of the disease has
been propagated from one root, which most probably was a
gonorrhœa.
If any doubt still remain with respect to the two diseases be-
ing of the same nature, it will be removed by considering that
the matter produced in both is of the same kind, and has the
same properties; the proofs of which are, that the matter of a
gonorrhœa will produce either a gonorrhœa, a chancre, or the
lues venerea; and the matter of a chancre will also produce
either a gonorrhœa, a chancre, or the lues venerea.
The following case is an instance of a gonorrhœa producing
a lues venerea. A gentleman twice contracted a gonorrhœa,
of which he was cured both times without mercury. About
two months after each he had symptoms of the lues venerea;
those in consequence of the first infection, were ulcers in the
throat, which were removed by the external application of
mercury; the symptoms in consequence of the second, were
blotches

16 OF THE VENEREAL POISON.
blotches on the skin, for which also he used the mercurial
ointment, and was cured. With regard to the lues venerea
proceeding from chancres, instances occur so frequently to
every one's observation, as to require no further proof here.
Since then it appears, that the gonorrhœa and chancre are
the effects of the same poison, it may be worthy of inquiry,
to what circumstances two such different forms of the disease
are owing.
To account for these two very different effects of the same
poison, it is only necessary to observe the difference in the
mode of action of the parts affected when irritated, let the ir-
ritation be what it  may. The gonorrhœa always proceeds
from a secreting surface*, and the chancre is formed on a non-
secreting surface; and in this last, the part to which the poi-
son is applied, must become a secreting surface before matter
can be produced. All secreting surfaces in the body being
probably similar, one mode of application only is necessary to
produce this disease in them all, which is by the poisonous
matter simply coming in contact with them. But to produce
the chancre, the venereal matter may be applied in three dif-
ferent ways; the first and most certain is by a wound, into
which it may be introduced; the second is by applying the
matter to a surface with a cuticle, and the thinner that is it
allows the matter to come more readily to the cutis; and the
third is by applying the matter to a common sore already
formed.
The poison then being the same in both cases, why do they
not always happen together in the same person? For one
would naturally suppose, that the gonorrhœa, when it has ap-
peared, cannot fail to become the cause of a chancre; and
that this, when it happens first, must produce a gonorrhœa.
Although it does not often happen so, yet it sometimes does;
at least there is great reason to believe so. I have seen cases
where a gonorrhœa came on, and in a few days after in some;
in others as many weeks, a chancre has appeared: and I have
also seen cases where a chancre has come first; and in the
course
* By secreting surfaces I mean all the passages for extraneous matter, including also
the ducts of glands, such as the mouth, nose, eyes, anus, and urethra; and by non-secreting
surfaces, the external skin in general. To which I may add a third kind of surface,
leading from the one to the other, as the glans penis, prolabium of the mouth, the in-
side of the lips, the pudendum; which surfaces partaking of the properties of each, but
in a less degree, are capable of being affected in both ways, sometimes by being excited
to secretion, and at other times to ulceration.

OF THE VENEREAL POISON. 17
course of its cure, a running and pain in making water have
succeeded. It may be supposed that the two diseases arose from
the original infection, and only appeared at different times;
and their not occurring oftener together would almost induce
us to believe it was so, since the matter is the same in both,
and therefore capable of producing either the one or the other.
I suspect that the presence of one irritation in these parts
becomes in general a preventive of the other. I have already
observed, that the two parts sympathise in their diseases; and
it is possible that that very sympathy may prevent the appear-
ance of the real disease; for if an action has already taken
place which is not venereal, it is impossible that another should
take place till that ceases; and it is probable that this sympa-
thy will not cease while the cause exciting it exists; and there-
fore when both happen in the same person at the same time, I
suspect that either the urethra never had sympathised with the
chancre, or if it did at first, that the sympathy had ceased, and
then the venereal matter might stimulate the parts to action.
VI. OF THE CAUSE OF THE POISONOUS QUA-
LITY — FERMENTATION — ACTION.
AS the consideration and explanation of this point will throw
some light upon the disease, and cure, I may be allowed to
dwell a little upon it. It has been supposed by some, that the
poisonous quality of the matter arises from a fermentation taking
place in it as soon as it is formed. But whether this poison-
ous quality arises from that cause; or whether the animal body
has a power of producing matter according to the irritation
given, whereby the living powers, whenever irritated in a par-
ticular manner, produce such an action in the parts as to gene-
rate a matter similar in quality to that which excited the ac-
tion, is what I am now to consider.
In the examination of this subject I shall confine myself to
the gonorrhœa. In support of either of the two opinions, it
must be supposed that the venereal matter has by its specific pro-
perties, a power of irritation beyond common matter. I have
already observed, that it has the power of exciting inflamma-
tion even on the common skin, and of forming a chancre,
which power is not possessed by common matter. In the first
opinion it must be supposed, that there is no specific inflamma-
D tion

18 OF THE VENEREAL POISON.
tion or suppuration produced by the application of the venereal
matter, but only a common inflammation and suppuration, and
that the matter capable of producing these effects acts as a fer-
ment upon the new-formed matter, rendering it venereal as
soon, or nearly as soon, as it is formed; and as there is a suc-
cession of secretions, there immediately follows a succession of
fermentations. Now, let us see how far this idea agrees with
all the variety of phænomena attending the disease. First, it
may be asked, what becomes of this ferment in many cases
where the suppuration does not come on for some weeks after
the irritation and inflammation have taken place? In such cases
we can hardly suppose the original venereal matter to remain,
and to act as a ferment. Secondly, when there is a cessation
of the discharge and no matter formed, which sometimes hap-
pens for a considerable time, and yet all the symptoms recur,
what is it that produces this fermentation a second time? No-
thing can, but a new application of fresh venereal matter.
When, for example, the irritation is translated to the testicle
and the discharge is totally stopped, as often happens, what
becomes of the virus; and how is a new virus formed when
the irritation falls back upon the urethra? Thirdly, if the
poisonous quality were produced by fermentation taking place
in the matter already formed, it would not be an easy matter
to account for the symptoms ever ceasing; for, according to
my idea of a ferment, it would never cease to act if new mat-
ter were continually added; nor could any thing possibly check
it but a substance immediately applied to the part, which could
stop or prevent the fermentation in the new matter. But as
the venereal inflammation in this species of the disease is not
kept up beyond a certain time, the production of the poison
cannot depend on fermentation. Fourthly, if it depended on
a fermentation in the secreted matter, all venereal cases would
be alike, nor would one be worse than another, except from a
greater or smaller number of fermenting places. Upon this
supposition also all cases would be equally easy of cure; for
the fermentation would be equally strong in a slight case as in
a bad one. It can only be fermentation in the matter after it
has left the vessels.
When the venereal matter has been applied  to a sore, so as
to irritate, it produces a venereal irritation and inflammation.
But even this does not always take place; for the common
matter

OF THE VENEREAL POISON. 19
matter from the sore may remove the venereal matter applied
before it can affect the sore, so as to produce the venereal in-
flammation and suppuration there. This experiment I have
made several times, and have only once produced the venereal
inflammation. But if the venereal matter were capable of act-
ing as a ferment, then it would in all cases produce venereal
matter, without altering the nature of the sore.
The effects, produced by the venereal poison, appear to me
to arise from its peculiar, or specific irritation, joined with the
aptness of the living principle to be irritated by such a cause,
and the parts so irritated acting accordingly. I shall therefore
consider it as a poison, which by irritating the living parts in
a manner peculiar to itself, produces an inflammation peculiar
to that irritation, from which a matter is produced peculiar to
the inflammation. Let us consider how far this opinion agrees
with the various phænomena attending the disease.
First, the venereal matter having a greater power of irritat-
ing than common matter, conveys more the idea of irritation
than of fermentation. Secondly, its producing a specific dis-
ease with specific symptoms and appearances, shows that it has
a specific power of irritation, the living powers necessarily
acting according to that irritation. Thirdly, the circumstance
of the inflammation having its stated time of appearance and
termination, is agreeable to the laws of the animal œconomy
in most cases, as it is a circumstance that takes place in other
diseases that have a crisis; and when the disease is longer of
duration in some than in others, it is because they are much
more susceptible of this kind of irritation, and there may be
perhaps other concurrent circumstances. Fourthly, the vene-
real inflammation being confined to a specific distance, is more
agreeable to the idea of a specific irritation, than that of a
fermentation. Fifthly, we have a further proof of this opinion,
from the appearance of the disease being translated from one
part of the body to another, as in the case of the swelled testicle,
in which the discharge is often stopped or otherwise affected.
Sixthly, the discharge often stops from the constitution being
attacked by a fever, and returns after some days or weeks, or
not at all, according to the continuance of the fever. Now
we can plainly see, why the fever should put a stop to the dis-
charge, as the disposition, produced by it in a part, is very
different from that disposition which formed the matter; and
we

20 OF THE VENEREAL POISON.
we can plainly see, why the same disposition to form matter
should often return; but how that return should be venereal,
upon the principles of fermentation, we do not see. Seventh-
ly, the production by art of an irritation of another kind, which
is not specific, removes the specific irritation; now an irrita-
tion of another kind cannot prevent the fermentation from
going on, but may destroy the venereal irritation. Eighthly,
the circumstance of particular parts of our body being much
more readily irritated than others by the venereal poison, when
in the constitution, shows that it arises from an irritation, and
that of a particular kind. Ninthly, we know of no other ani-
mal that is susceptible of the venereal irritation; for repeated
trials have shewn that it is impossible to give it to a dog, a
bitch, or an ass*. It is much easier to suppose, that a dog or
an ass is not susceptible of many irritations of which the hu-
man body is susceptible, as we find to be the case in all other
specific diseases, and most poisons, than that the matter of the
human body is susceptible of a change, of which that of the
dog or ass is not.
This argument is still further suppported by comparing the
venereal poison with other morbid poisons. The animal poi-
son, productive of the hydrophobia, seems to be produced by
a particular irritation affecting certain parts, which shows, that
if the body, or any part of the body, is irritated, it takes a
disposition to act in a peculiar manner, and that this mode of
action is capable of secreting such juices as will throw another
animal into the same action. In the hydrophobia, the throat
and its glands are particularly affected; and how the saliva
should become of such a nature from the same kind of matter
being either carried into the constitution, or perhaps only by
the general sympathy of the constitution with a local affection,
and more particularly with the parts about the throat, is not
easily to be accounted for, without a supposition either that the
absorbed poison circulating can produce a specific constitutional
action capable of affecting the throat and glands there, just as
the poison of the small-pox affects the skin, or that the circulat-
ing
* I have repeatedly soaked lint in matter from a gonorrhœa, chancre, and bubo, and
introduced it into the vagina of bitches, without producing any effect. I have also in-
troduced it into the vagina of asses, without any effect. I have introduced it under the
prepuce of dogs without any effect. I have also made incisions and introduced it under
the skin, and it has only produced a common sore. I have made the same experiments
upon asses, with the same result. 

THE MODE OF VENEREAL INFECTION. 21
ing poison has power to affect or irritate the glands of the mouth
only, or that those parts only are capable of immediately sym-
pathising with the part irritated, as the muscles of the lower
jaw are when they produce the locked jaw.
If this theory be just, it explains why epidemical diseases,
arising from particular seasons, particular constitutions of air,
&c. irritate in such a manner, as to produce a fever, the effluvia
of which shall irritate in the same manner. For it is not in the
lead material how the original irritation arises, it is only ne-
cessary that there should exist in the animal a power of acting
according to the stimulus, given by that irritation.
CHAPTER II.
THE MODE OF VENEREAL INFECTION.
EVERY infectious disease has its peculiar manner of being
caught, and among mankind there is generally something
peculiar in the way of life, or some attending circumstance,
which exposes them at one time or other to contract such dis-
eases, and which, if avoided, would prevent their propagation.
The itch, for instance, is generally caught by a species of civi-
lity, the shaking of hands; therefore the hand is most com-
monly the part first affected. And as the venereal poison is
generally caught by the connection between the sexes, the parts
of generation commonly first suffer. From this circumstance
people do not suspect this disease, when the symptoms are any
where else, while they always suspect it in every complaint of
those parts.
In the lower class of people, one as naturally thinks of the
itch when there is an eruption between the fingers, as we do
in young men of the venereal disease from the genitals being
affected: but as every secreting surface, whether cuticle or not
cuticle, (as was explained before) is liable to be infected by
the venereal poison when it is applied to it, it is possible for
many other parts besides the genitals to receive this disease.
Therefore it appears in the anus, mouth, nose, eyes, ears, and,
as

22 OF THE DIFFERENT FORMS OF THE DISEASE.
as has been said, in the nipples of women who suckle children
affected by it in their mouths; which children have been in-
fected in the birth from the diseased parts of the mother.
CHAPTER III.
OF THE DIFFERENT FORMS OF THE
DISEASE.
THE venereal poison is capable of affecting the human
body in two different ways; locally, that is, in those
parts only to which it is first applied; and constitutionally, that
is, in consequence of the absorption of the venereal pus which
affects parts while diffused in the circulation.
Between the first and second kind, or the local and consti-
tutional*, certain intermediate complaints take place in the pro-
gress of absorption; these are inflammations and suppurations
forming what are called buboes, in which the matter is of the
same nature with that of the original disease.
When the matter has got into the constitution, and is circu-
lating with the blood, it there irritates to action. There are
produced from that irritation many local diseases, as blotches
on the skin, ulcers in the tonsils, thickening of the periosteum
and bones.
The local or first kind is what I have called immediate, arising
immediately upon the application of the venereal pus. Of this
kind there are two sorts seemingly very different from one an-
other. In the first there is a formation of matter without a
breach in the solids, called a gonorrhœa. In the second there
is a breach in the solids, called a chancre. Neither of these
two ways, in which the disease shows itself, is owing to any
thing peculiar in the kind of poison applied, but to the differ-
ence in the parts contaminated.
The readiness with which the parts run into violent action,
in this species of inflammation, is greater or less according to
the
* I have called this form of the disease, constitutional: yet it is not strictly so, for
every complaint in consequence of it is truly local, and is produced by the simple appli-
cation of the poison to the parts.

OF THE DIFFERENT FORMS OF THE DISEASE. 23
the nature of the parts affected; which perhaps does not arise
from any specific difference in the parts, but is according to the
common principle of sensibility and irritability; for we find
that the vagina is not so much disposed to inflammation in this
disease, as the urethra is in the same sex, because it is not so
sensible. However it is possible, that there may be some specific
disposition to irritation and inflammation in the urethra in man;
and what would incline me to think so is, that this canal is sub-
ject to be more frequently out of order than any other, pro-
ducing a great variety of symptoms.
I. VARIETIES IN DIFFERENT CONSTITUTIONS.
THIS disease, when it appears in the form either of a go-
norrhœa or a chancre, differs very much in the violence of its
symptoms in different people. In some it is extremely mild,
in others extremely violent. When mild, it is generally simple
in its symptoms, having but few, and those of no great extent,
being much confined to the specific distance; but when violent,
it becomes more complicated in its symptoms, having a greater
variety, and extending itself beyond the specific distance. This
does not arise from any variety in the specific virtue of the
poison, but from a difference in the disposition and mode of
action of the body, or parts of the body; some being hardly
susceptible of this or any irritation, others being very suscepti-
ble of it, and of every other irritation, so as readily to run
into violent action.
The venereal irritation however does not always follow
these rules; for I have known young men, in whom a sore
from common accident has healed up readily, yet the irrita-
tion attending a gonorrhœa has been violent, and a chancre
has inflamed and spread itself with great rapidity, and even
has mortified. On the other hand, I have known young men
in whom a sore from common violence has been healed with
great difficulty, yet, when they had contracted a gonorrhœa
or chancre, the disease has been mild and easily curable.
In particular people it is either mild or severe for the most
part, uniformly. In the first stated dispositions it is not in-
variably so, but then I believe there is some indisposition at
the time. I have known several gentlemen who had their go-
norrhœas so slight in common, that they frequently cured
themselves;

24 LUES VENEREA, CAUSE OF OTHER DISEASES.
themselves; but it has so happened, that a gonorrhœa has
been remarkably severe, and has obliged them to apply for as-
sistance, but then they were soon attacked with the symptoms
of a fever, and when the fever has gone off, the symptoms
of the gonorrhœa have immediately become mild. I may
now also observe, that when the disease is in the form of a
lues venerea, different constitutions are differently affected, in
some its progress is very rapid, in others it is very slow.
CHAPTER IV.
OF THE LUES VENEREA BEING THE
CAUSE OF OTHER DISEASES.
EVERY animal may be said to have natural tendencies to
morbid actions, which may be considered as predispos-
ing causes, and these may be called into action whenever the
immediate cause takes place, which may be such as to have
no connection with these tendencies, and cannot therefore be
considered as the cause of the disease. One disease excites
another, and therefore is supposed to be the sole cause of it,
as slight fevers, or colds, small-pox, and measles, become fre-
quently the immediate cause of scrofula, and certain derange-
ments of the natural actions of the body often bring on the
gout, agues, and other diseases; but these diseases will be al-
ways more or less according to the constitution and parts;
and the constitutions will differ according to circumstances,
which may be numerous; two of these, however, will be
local situation, and age.
In this country, the tendency to scrofula arises from the
climate, which is in many a predisposing cause, and only re-
quires some derangement to become an immediate cause and
produce the whole disease.
The venereal disease also becomes often the immediate
cause of other disorders, by calling forth latent tendencies to
action. This does not happen from its being venereal, but
from its having destroyed the natural actions, so that the mo-
ment

LUES VENEREA, CAUSE OF OTHER DISEASES. 25
ment the venereal action and disposition is terminated, the
other takes place; and I have seen, in many cases, the ten-
dency so very strong, that it has taken place before the vene-
real has been entirely subdued; for by pursuing the mercurial
course the symptoms have grown worse; but by taking up the
new disposition, and rendering it less active than the venereal,
the venereal has come into action anew; and these effects have
taken place alternately several times. In such cases it is a
lucky circumstance when the two modes of treatment can be
united; but where they act in opposition it is very unfortunate.
If the venereal disease attacks the lungs, although that dispo-
sition may be corrected, consumption may ensue; and in like
manner where the bones are affected, or the nose, scrofulous
swellings or fistula lacrymalis may be the consequence, though
the disease may have been cured.
Many of the diseases arising from this source appear to be
peculiar to such causes, and seem to be formed out of the con-
stitution, the disease, and method of cure; it is therefore dif-
ficult to say of what nature such a disease may be; but it will
in general have a particular tendency from the constitution;
and if we are acquainted with the general tendency of a con-
stitution, we are to suspect that as the strongest cause, and
that the disease will partake more of it than the other. In
this country these complaints have most commonly a scrofu-
lous tendency, and are often truly scrofulous, the disease par-
taking more of that disposition than any other.
Parts have also their peculiar tendency to diseases, which
are stronger than those of the constitution at large, and when
injured they will of course fall into the morbid action arising
from such tendencies, therefore, when parts have had their
natural actions destroyed by a venereal irritation, those ten-
dencies will be brought into action; and therefore the diseases
arising from the tendencies of such parts are to be kept in
view. They will be assisted likewise by local situation, and
age.
In particular countries, and in young people, the tendency
of scrofula will be predominant; therefore buboes in them will
more readily become scrofulous. In old people they may
form cancers; and when in parts of the body which have a
particular tendency to cancer, that disease will more readily
take place.
E The

26 LUES VENEREA, CAUSE OF OTHER DISEASES.
The want of knowledge and of attention to this subject,
has been the cause of many mistakes; for whenever such ef-
fects have been produced in consequence of the venereal dis-
ease, it has immediately been blamed, and not only as a cause,
but it has been supposed to be the disease itself. This is an
inference natural enough for those who cannot see that a vari-
ety of causes are capable of producing one effect, or in other
words, that where the predisposing cause is the same, a vari-
ety of immediate causes may produce the same action. It
shows great ignorance, however, to suppose the venereal dis-
ease can be both the predisposing and immediate cause.
When the venereal disease attacks the urethra, it often be-
comes itself the predisposing cause of abscesses, and many
other complaints; when it attacks the outside of the penis,
forming chancres, they often ulcerate so deep as to communi-
cate with the urethra, producing fistula in the urethra, and
often continued phymoses.
In describing diseases which, like the venereal disease, ad-
mit of a great variety of symptoms, we should keep a middle
line, first giving the most common symptoms of the disease in
each form, then the varieties which most commonly occur,
and last of all the most uncommon; but it will not be easy
to take notice of every possible variety. Therefore, when a
variety occurs not mentioned, it is not to be supposed that the
author is leading his readers astray, or is unacquainted with
the disease at large. If his general principles are just, they
will help to explain most of the singularities of the disease.
PART

[27]
PART II.
CHAPTER I.
OF GONORRHŒA.
WHEN an irritating matter of any kind is applied to a
secreting surface, it increases that secretion, and
changes it from its natural state (whatever that may be) to
some other. This, in the present disease, is pus.
When this takes place in the urethra, it is called a gonor-
rhœa; and as it arises from the matter being applied to a non-
cuticular surface, which naturally secretes some fluid, it is of
no consequence in what part of the body this surface is; for,
if in the anus, it will produce a similar discharge there, and
a similar effect on the inside of the mouth, nose, eyes, and
ears. It is conceived by some, that gonorrhœas may take
place without the above-mentioned immediate cause; that is,
that they may arise from the constitution; if so, they must be
similar to what is supposed to be a venereal ophthalmia. But
from the analogy of other venereal affections proceeding from
the constitution, I very much suspect the existence of either
the one or the other; for when the poison is thrown upon the
mouth, throat, or nose, it produces ulcers, and not an in-
creased secretion like a gonorrhœa. But we never find an
ulcer on the inside of the eye-lids in those ophthalmiæ; and
gonorrhœas in the urethra are too frequent to proceed from
such a cause.
Till about the year 1753, it was generally supposed, that
the matter from the urethra, in a gonorrhœa, arose from an
ulcer or ulcers in that passage; but from observation it was
then proved that this was not the case.
It may not be improper to give here a short history of the
discovery that matter may be formed by inflammation without
ulceration. In the winter of 1749, a child was brought into the
room, used for dissection, in Covent Garden; on opening of
whose

28 OF GONORRHOEA.
whose thorax a large quantity of pus was found loose in the
cavity, with the surface of the lungs and the plura furred over
with a more solid substance similar to coagulable lymph. On
removing this from those surfaces, they were found entire.
This appearance being new to Dr. Hunter, he sent to Mr.
Samuel Sharp, desiring his attendance; and to him it also ap-
peared new. Mr. Sharp, afterwards, in the year 1750, pub-
lished his Critical Inquiry, in which he introduced this fact,
"That matter may be formed without a breach of substance;"
not mentioning whence he had derived this notion. It was
ever after taught by Dr. Hunter in his lectures. We, howe-
ver, find writers adopting it without quoting either Mr. Sharp
or Dr. Hunter. So much being known, I was anxious to
examine whether the matter in a gonorrhœa was formed in
the same way. In the spring of 1753, there was an execu-
tion of eight men, two of whom I knew had at that time very
severe gonorrhœas. Their bodies being procured for this par-
ticular purpose, we were very accurate in our examination,
but found no ulceration. The two urethras appeared merely
a little blood-shot, especially near the glans. This being ano-
ther new fact ascertained, it could not escape Mr. Gataker, ever
attentive to his emolument, who was then attending Dr. Hun-
ter's lectures, and also practising dissection under me. He
published soon after, in 1754, a treatise on this disease, and
explained fully, that the matter in a gonorrhœa did not arise
from an ulcer, without mentioning how he acquired this know-
ledge; and from that time successive writers have repeated the
same doctrine. Since the period mentioned above, I have
constantly paid particular attention to this circumstance, and
have opened the urethra of many who at the time of their
death had a gononhœa, yet have never found a sore in any;
but always observed that the urethra near the glans was more
blood-shot than usual, and that the lacunæ were often filled
with matter. I have indeed seen an instance of a sore a little
within the urethra; but this sore was not produced by any
ulceration of the surface, but from an inflammation taking
place, probably, in one of the glands, which produced an
abscess in the part, and that abscess opened its way into the
urethra. The very same sore opened a way through exter-
nally at the frænum, so that there was a new passage for the
urine. Indeed the method of curing a gonorrhœa might have
shown

OF GONORRHOEA. 29
shown that it could not depend upon a venereal ulcer; for
there is hardly an instance of a venereal ulcer being cured by
any thing but mercury, escharotics excepted. We know,
however, that most gonorrhœas are curable without mercu-
ry; and what is still more, without any medical assistance;
which, I believe, is never the case with a chancre. This
doctrine, that a gonorrhœa does not depend on ulcers, was
first taught publicly by Dr. Hunter, at his lectures, in the
year 1750; but he did not attempt to account for it.
I. OF THE TIME BETWEEN THE APPLICATION
OF THE POISON AND EFFECT.
IN most diseases there is a certain time between the appli-
cation of the cause, and the appearance of the effect. In
the venereal disease this time is found to vary considerably,
owing probably to the state of the constitution when the in-
fection was received. Each form of the disease also varies in
this respect; the gonorrhœa and chancre being earlier in their
appearance after contamination than the lues venerea, and of
the two former the gonorrhœa appearing sooner than the chan-
cre. In the gonorrhœa the times of appearance are very dif-
ferent; I have had reason to believe that in some the poison has
taken effect in a few hours, while in others it has been six
weeks; and I have had examples of it in all the intermediate
periods; so far however as we can rely upon the veracity of
our patients, and farther evidence we cannot have, six, eight,
ten, or twelve days would appear to be the most common pe-
riod, though it is capable of affecting some people much soon-
er, and others much later. I was informed by a married gen-
tleman, who came from the country, and left his wife behind
him, that in a frolic he went to a bagnio and had connection
with a woman of the town. The next morning he left her,
and he had no sooner got to his lodging than he felt a moisture
of the part, and upon inspection he found a beginning gonor-
rhœa, which proved a very troublesome one. I was told by
another gentleman, that he had been with a woman over night,
and in the morning the gonorrhœa appeared; the same hap-
pened to him twice. I was informed by a third gentleman,
that the discharge appeared in six-and-thirty hours after the ap-
plication of the poison. In the above-mentioned patients the
infection

30 OF GONORRHOEA.
infection must have arisen from the poison applied at those stat-
ed times, as neither of these patients is supposed to have had an
opportunity of receiving the infection for many weeks before.
These assertions from men of veracity, and where there
could be no temptation to deceive, not even an imaginary one,
are sufficient evidences. On the other hand, upon equally
good authority, I have been informed that six weeks after the
application had passed, before any symptom appeared, the
patient had strange and uncommon complaints preceding the
running, such as an unusual sensation in the parts, with most
of the other symptoms of gonorrhœa except the discharge.
He had the same complaint about twelve months afterwards,
and then it was four weeks from the application of the poison
before it appeared, giving for some part of that time the for-
mer disagreeable sensations; but from his late experience he
suspected what was coming. From this I am inclined to be-
lieve that it seldom or never lies perfectly quiet so long, and
that the inflammatory state may take place for some considera-
ble time before the suppurative; and in these cases there is less
disposition for a cure, as the very disposition which forms a
running is in general a salutary one, and is an intermediate step
between the disease, which is the inflammation, and the cure;
for in the time of suppuration a change has taken place in the
vessels producing the formation of matter. If this change
should never take place, it is not certain what would be the
consequence; whether the inflammation would go off without
suppuration, as in many common inflammations, I have not
been able to determine, but should suspect that it would conti-
nue much longer than usual, because the parts have not com-
pleated their actions; and I also suspect that such cases always
arise from some peculiarity of constitution.
II. OF THE DIFFICULTY OF DISTINGUISHING THE
VIRULENT FROM THE SIMPLE GONORRHOEA.
THE surface of the urethra is subject to inflammation and
suppuration from various other causes besides the venereal poi-
son; and sometimes discharges happen spontaneously when no
immediate cause can be assigned; such may be called simple
gonorrhœas, having nothing of the venereal infection in them;
though those persons that have been formerly subject to viru-
lent

OF GONORRHOEA. 31
lent gonorrhœas are most liable to them. It is given as a dis-
tinguishing mark between the simple and the virulent gonor-
rhœa, that the simple comes on immediately after copulation,
and is at once violent; whereas the virulent comes on some
days after, and gradually. But the simple is not in all cases a
consequence of a man's having had connection with women,
it does not always come on at once, nor is it always free from
pain. On the other hand we see many venereal gonorrhœas
that begin without any appearance of inflammation; and I have
been very much at a loss to determine whether they were ve-
nereal or not; for there are a certain class of symptoms com-
mon to almost all diseases of the urethra, from which it is dif-
ficult to distinguish the few that arise solely from the specific
affection. I have known the urethra sympathise with the cut-
ting of a tooth* producing all the symptoms of a gonorrhœa.
And this happened several times in the same patient. The ure-
thra is known to be sometimes the seat of the gout†. I have
known it the seat of the rheumatism. The urethra of those
who have had venereal complaints, is more apt to exhibit symp-
toms similar to gonorrhœa, than the urethra of those who have
never had any such complaint; and it is generally in conse-
quence of the parts having been hurt by that disease, that the
simple gonorrhœa comes on; which, perhaps, is also a reason
why they are in some measure similar. A discharge and even
pain attacks the urethra, and strange sensations are every now
and then felt in these parts, which may be either a return of the
symptoms of the venereal disease without virus, may arise as it
were spontaneously, or may be a consequence of some other
disease. When it happens in consequence of some former ve-
nereal gonorrhœa it is seldom constant, and may be called a
temporary gleet, ceasing for a time and then returning; but in
such cases the parts seldom swell; the glans does not change
to the ripe cherry colour, nor does it sweat a kind of matter.
Such a complaint, as a discharge without virus, is known to
exist by its coming on when there has been no late connection
with women, and likewise by its coming on of its own accord
where there had never been any former venereal complaint, nor
any chance of infection. From its commonly going off soon,
both in those who have had connection with women, and in
those
* Nat. Hist. of Teeth, pt. II. p. 126. † Essays and Obs. Phys. and Liter, of
Edin. v. III. p. 425.

32 OF GONORRHOEA.
those who have not, it becomes very difficult in many cases to
determine whether or not it is venereal; for it is often thought
venereal when it really is not so; and on the other hand it may
be supposed to be only a return of the gleet, when it is truly
venereal; but perhaps this is not so material a circumstance as
might at first be supposed. These diseases, when they are a
consequence of former venereal complaints, may be considered
only as an inconvenience intailed on those who have had the
venereal gonorrhœa; no certain cure for them is known;
they are similar to the fluor albus in women.
III. OF THE COMMON FINAL INTENTION OF
SUPPURATION NOT ANSWERING IN THE
PRESENT DISEASE.
WHEN a secreting surface has once received the inflamma-
tory action, its secretions are increased, and visibly altered.
Also when the irritation has produced inflammation and an ul-
cer in the solid parts, a secretion of matter takes place, the in-
tention of which in both seems to be to wash away the irritat-
ing matter; so that it is the end of irritations to produce their
own destruction, like a mote in the eye which by increasing
the secretion of tears is itself washed away. But in inflamma-
tions arising from specific or morbid poisons, this effect cannot
be produced; for although the first irritating matter be wash-
ed away, yet the new matter formed has the same quality with
the original; and therefore upon the same principle, it would
produce a perpetual succession of irritations, and of course se-
cretions, even if there were no other cause for the continuance
than its own matter. But the venereal inflammation is not kept
up by the pus which is formed; but like many other specific
diseases, by the specific quality of the inflammation itself. This
inflammation, however, it would appear, can only last a li-
mited time; the symptoms peculiar to it vanishing of themselves
by the parts becoming less and less susceptible of irritation.
This circumstance is not peculiar to this particular form of the
venereal disease; it is perhaps common to almost every disease
that can affect the human body. From hence it will appear,
that the consequent venereal matter has no power of continu-
ing the original irritation; and indeed if this were not the case
there would be no end to the disease.
As,

OF GONORRHOEA. 33
As the living principle in many diseases is not capable of con-
tinuing the same action, it also loses this power in the present,
when the disease is in the form of a gonorrhœa, and the effect
is at last stopped, the irritation ceasing gradually. This cessa-
tion will vary according to circumstances; for if the irritated
parts are in a state very susceptible of such irritations, in all pro-
bability their actions will be more violent and continued long-
er; but in all cases the difference must arise from the difference
in the constitution, and not from any difference in the poison
itself.
The circumstance of the disease ceasing spontaneously, only
happens when it attacks a secreting surface, and when a secre-
tion of pus is produced; for when it attacks a non-secreting
surface, and produces its effects there, that is an ulcer; the
parts so affected are capable of continuing the disease, or this
mode of action for ever, as will be taken notice of when we
shall hereafter consider chancre. But this difference between
spontaneous and non-spontaneous cure, seems to depend more
on the difference in the two modes of action, than on the dif-
ference in the two surfaces; for when the disease produces an
ulcer on a secreting surface, which it often does from the con-
stitution, as on the tonsils, it has no disposition to cure of it-
self; nor in the urethra, in a recent case, if ulcers are formed
there, would they heal more readily than when formed in any
other part.
The common practice proves these facts. We every day see
gonorrhœas cured by the most ignorant; but in chancre, or
the lues venerea, more skill is necessary. The reason is obvi-
ous: gonorrhœa cures itself, whilst the other forms of the dis-
ease require the assistance of art.
It sometimes happens that the parts which become irritated
first, get well, while another part of the same surface receives
the irritation, which continues the disease, as happens when it
shifts from the glans to the urethra.
From this circumstance of all gonorrhœas ceasing without
medical help, I should doubt very much the possibility of a per-
son getting a fresh gonorrhœa while he has that disease; or of
his increasing the same by the application of fresh matter of its
own kind. And this observation holds in all the forms of the
disease; for it has been proved, that the application of the mat-
ter from a gonorrhœa to a bubo does not in the least retard
F the

34 OF GONORRHOEA.
the cure of that bubo; nor does the matter of a chancre applied
to a bubo, nor the matter of a bubo applied to a chancre, pro-
duce any bad effect; though if venereal matter is applied to a
common sore, it will often produce the venereal irritation.
By all which I am led to believe, that the venereal matter form-
ed in a gonorrhœa does not assist in keeping up that gonor-
rhœa; for it is only an application of matter, the poison and
effects of which are exactly similar to the effects upon the so-
lids already produced; and that nothing could increase or con-
tinue the effect but something that is capable of increasing the
disposition of the parts themselves for such inflammation, or
of making them more susceptible of it. We find besides, that
a gonorrhœa may be cured while there is a chancre, and vice
versa: now if fresh venereal matter were capable of keeping
up the disease, no gonorrhœa could ever get well, while there
is this supply of venereal matter*. From all this it is reason-
able to suppose, that such a surface of an animal body is not
capable of being irritated by its own matter; nor is it capable
of being irritated beyond a certain time; and therefore if fresh
venereal matter were continued to be applied to the urethra of
a man having a gonorrhœa, that it would just go off as soon
as if no such application had been made, and get as soon well
as if great pains had been taken to wash its own matter away.
The same reasoning holds good in chancres.
I carry this idea still further, and assert that the parts become
less susceptible of the venereal irritation; and that not only a
gonorrhœa cannot be continued by the application of either its
own or fresh matter; but that a man could not get a fresh go-
norrhœa, nor a chancre, if he applied fresh venereal matter to
the parts when the cure is nearly completed, and continued the
application ever after, or at least at such intervals as were with-
in the effect of habit. I can conceive that in time the parts
may become so habituated to this application as to be insensible
of
* When treating of pus, in my lectures, I observed that I was inclined to believe that no
matter, of whoever kind, can produce any effect upon the part that formed it: nor do
I believe that the matter of any sore, let it be what it will, ever does or can do any hurt
to that sore; for the parts which formed the matter are of the same nature, and cannot
be irritated by that which they produced, except extraneous matter is joined with it. The
gland which forms the poison of the viper, and the duct which conveys it to the tooth,
are not irritated by the poison: and it would appear from Abbé Fontana's experiments,
that the viper cannot be affected by its own poison. Vide Traté fur le Vénin de la Vi-
pere, par M. F. Fontana, vol. I. page 22. If what I have now advanced is true, wip-
ing, or washing away matter under the idea of keeping the parts clean, is in every case
absurd.

OF GONORRHOEA. 35
of it; for by a constant application, the parts would never be
allowed to forget this irritation, or rather never become unac-
customed to it; and therefore this supply of fresh matter could
not affect the parts so as to renew the disease till they first re-
covered their original and natural state; and then they would
be capable of being affected again.
This opinion is not derived from theory only, but is found-
ed on experience and observation. A man immediately after
having suffered a gonorrhœa, shall have frequent connections
with women of the town, and that for years successively, without
being infected; yet a fresh man shall contract it immediately from
the very same woman; and if the first mentioned man were to be
out of the habit of this irritation for some time, he then would
be as easily infected as the other. Where this habit is not so
strong as to prevent altogether the parts from being affected, still
it will do it in part; and it is a strong proof of this, that most
people have their first gonorrhœa the most severe, and the suc-
ceeding ones generally become milder and milder till the dan-
ger of infection almost vanishes.
This seems to be explained by the following facts. A mar-
ried man who had had a communication with his wife only for
several years, slept with a woman with whom he had formerly
cohabited. She gave him a severe gonorrhœa, and declared
that she was not conscious of being diseased. He put himself
and her under my care; and while they were going on with
their cures they still continued their intercourse, which I readily
allowed. He got well, and it was supposed she got well also.
The intercourse was continued between them for many months
after, without any mischief received on his side, or any suspi-
cion of remaining disease on hers.
At last this connection was broken off, and she formed ano-
ther attachment: she no sooner formed this new attachment,
than she gave her new lover a gonorrhœa; she now flew to me
for a cure, and declared that she had no connection but with
the two gentlemen before-mentioned; and therefore that the
present disease must be the same for which I had attended her
formerly. Her second lover was not a patient of mine; but I
gave her medicines which she very much neglected taking.
Her lover continued his connection, as the first had done, for
several months after he had got well, without any further infec-
tion from her; but unfortunately her first lover returned about
a twelve-

36 OF GONORRHOEA.
a twelve-month after; and thinking himself secure, as she liv-
ed in peace with the present, renewed his acquaintance with her,
and but once, the consequence however was, a gonorrhœa.
Had the woman the gonorrhœa all this time? And what was
the reason those gentlemen did not catch the disease, except
that the acquaintance had been interrupted for some time; was
it the effect of habit by which the parts lost their susceptibility
of that irritation?
The case of a young woman from the Magdalen hospital is a
striking proof of this, as far as circumstances can prove a fact.
She was received into that house, and continued the usual time,
which is two years. The moment she came out she was pick-
ed up by one who was waiting for her with a post-chaise to
carry her off immediately. She gave him a gonorrhœa.
This opinion of parts being so habituated to this irritation as
hardly to be affected by it, is strengthened by observing, that in
the gonorrhœa the violent symptoms shall often cease, and the
disease shall still continue, spinning itself out to an amazing
length, with no other symptoms than a discharge; yet that dis-
charge shall be venereal. This I have frequently seen; and the
following is an abstract of a singular case of this kind.
A gentleman had connection with a woman of the town, and
received a venereal gonorrhœa in the beginning of April 1780.
He, at first, could hardly believe it to be venereal, as he had
kept the woman in the country, where she had scarcely ever
been out of his sight; but the violent pain in making water,
great running, chordee, and swelled testicle, convinced him
that it was venereal. When the cure was going on tolerably
well, and he had got the better of one swelled testicle, the other
began to swell; however, all the symptoms gradually disappear-
ed, except the chordee, hardness of the epididymis, and a small
gleet which was slimy. On the 12th of June he went into the
country; while he was in the country the chordee went off,
and the hardness of the epididymis entirely disappeared, but still
a slimy gleet remained, although but trifling.
September the first, he married a young lady, and endea-
vouring to enter the vagina, he found great difficulty, which
brought on a return of the chordee, and an increased discharge.
On the 10th, she began to complain of heat, and pain, and of
a difficulty and frequency in making water, and when she made
water there was forced out some matter; she had also a dull hea-
vy

OF GONORRHOEA. 37
vy pain, and a sense of weight at the bottom of her belly, and
round her hips, with great soreness of the parts when she sat;
these symptoms had been preceded by an itching about the ori-
fice of the vagina.
By taking a mercurial pill, and rubbing the parts with mer-
curial ointment, in about eight days the violence of the symp-
toms abated. They were now allowed to cohabit, but whene-
ver they came together, the pain which she suffered was exces-
sive. The parts were washed with a solution of corrosive sub-
limate and sugar of lead, and anointed with mercurial ointment,
which applications being continued for some time, the soreness
went off. He was treated medically, and afterwards all was
well.
Here was a venereal gonorrhœa contracted about the begin-
ning of April; all the symptoms had disappeared by the first of
June, and there only remained some of the consequences, such
as chordee, hardness of the epididymis, and a discharge of a lit-
tle slimy mucus, which could only be observed in the morning.
In a short time the chordee and hardness in the epididymis had
entirely gone off, and merely the small discharge of mucus which
appeared only in the morning remained; yet three months after
he communicated the disease to his wife.
I was consulted in the following case by the surgeon who at-
tended: July 13th, 1783, a person had connection with a wo-
man of the town: the 30th, that is seventeen days after, a go-
norrhœa came on, which was violent. He took mercurial pills
and gentle purges; in twelve days the violent symptoms abated,
and about the 4th of September the discharge was stopped. The
9th it began to appear again, but only lasted a few days; and
would come and go in this way sometimes every two days; oft-
en six or seven days. On the 28th of September he had con-
nection with his wife, while he had a small discharge. The 9th
of October he had connection again, and three days after she
complained of heat in making water, with a discharge and other
symptoms of gonorrhœa which were violent. About the latter
end of October her complaints were almost removed; some only
of the symptoms appearing and disappearing till January 1784,
when he had connection with her to try whether she could give
it him, viz. three months after the second connection, and in
fourteen days after this he had all the symptoms of a gonorrhœa.
April 29th he was not perfectly well, having a discharge with
a pain

38 OF GONORRHOEA.
a pain in the perinæum, and she also had a discharge. If this
last attack in January 1784, in him was a gonorrhœa, then of
course she must have had it; and also of course he must have lost
his in the intermediate time, between the 9th of October 1783,
and January 1784; for if he had had it also then, it could not
have produced any effect upon him.
It was impossible to say whether they had now the infection
or not, for any trials upon themselves would prove but little,
except one of them only had it so as to infect the other; but
if both had it, no alteration could take place in either; as it
could not be ascertained whether they had the disease or not,
and as there were suspicious symptoms in both, when joined
with all the circumstances, I agreed with the attending surgeon,
it was most prudent to treat them as if actually affected with a
gonorrhœa.
If it is true, as is asserted in the voyage round the world, that
the venereal disease was carried to Otaheite, it shows that it can
be long retained after all ideas of its existence have ceased; and
when it is retained for such a length of time it is most probably
in the form of gonorrhœa*.
In like manner, a venereal bubo, if it could be kept a consider-
able time between the point of suppuration and resolution, would
become indolent from habit, continue in that point of suspension,
and remain perhaps almost incurable; such I think I have seen.
IV. OF THE VENEREAL GONORRHOEA.
IN treating of the seat, extent, and symptoms of gonorrhœa,
I shall begin with such particulars as are constant or most fre-
quent, and take them as much as possible in the order they be-
come less so; for there is considerable variety in different go-
norrhœas.
V. OF THE SEAT OF THE DISEASE IN BOTH SEXES.
THE seat of this disease, in both sexes, is commonly the
parts of generation. In men it is generally the urethra; tho'
it sometimes takes place on the inside of the prepuce and sur-
face of the glans. In women it is the vagina, urethra, labia,
clitoris, or nymphae.
The
* Vide page 14.

OF GONORRHOEA. 39
The disease has its seat in these parts from the manner in
which it is caught. But if we were to consider the surface of
contact simply in men, we should naturally suppose that the
glans penis, or the orifice of the urethra, would be the first, or
indeed the only parts affected; yet most commonly they are not;
for though there are cases where the glans is affected, and where
the disease goes no further, I believe, it seldom attacks the ori-
fice of the urethra, without passing some way along that canal.
How far it ever can be said to affect the prepuce only, I am
not quite certain, although I believe it sometimes happens: for
I have seen inflammation there, as well with, as without, a dis-
charge from the urethra, which appeared to me to be venereal.
I have seen in such cases the inflammation extending into the
loose cellular membrane of the prepuce, and producing a phy-
mosis; and this inflammation I suspect to be of the erysipela-
tous kind.
When the disease attacks the glans, and other external parts,
as for instance the prepuce, it is principally about the root of
that body, and the beginning of the prepuce, the parts where
the cuticle is thinnest, and of course where the poison most rea-
dily affects the cutis; but sometimes it extends over all the glans
and also the whole external surface of the prepuce. It produ-
ces there a soreness or tenderness, with a secretion of thinnish
matter, commonly without either excoriation or ulceration. I
am not certain, however, that it does not sometimes excoriate
those parts; for I once saw a case, where almost the whole cu-
ticle was separated from the glans. The patient assured me that
it was venereal; and, from the particular circumstances, which
he related, I had no reason to think his opinion ill founded.
He never had had any such complaint from connection with wo-
men before that time. Perhaps the difease begins oftener on
those parts than is commonly imagined; but, being defended by
a cuticle, they are but little susceptible of this kind of irritation;
and this may be the reason why a permanent effect is not produ-
ced, and why it is often so slight as not to be observed. When
the glans or prepuce, or both, suffer the venereal inflammation,
it often rests there and goes no further, not being attended with
a discharge of matter, nor with pain in the urethra. This the
following case illustrates.
A young gentleman, from Ireland, slept with a woman at
Bristol; and a fortnight afterwards he had intercourse with ano-
ther

40 OF GONORRHOEA.
ther woman in London, which last happened to be on a Mon-
day, and on the Tuesday, or the day following, he observed a
discharge from the end of his penis when covered with the pre-
puce. On the Saturday following he applied to me. Upon
examination, I found that the running came from the inside of
the prepuce, near to the glans; and the corona glandis, as also
that part of the prepuce behind it, appeared to be in a tender
and excoriated state, and covered with matter. He told me he
had once had a gonorrhœa before; and upon being asked if it
was in the same place, he said it was. Not being certain how
far this might be venereal, I made the following inquiry; whe-
ther he had been subject to such excoriations before he had visit-
ed women? And his answer was, that he never had; and that
he had not this complaint always after coition, but only twice,
as has been above-mentioned; which, being uncommon, in-
clined him to suppose the effect to be venereal.
I suspect, that, when the prepuce swells in a gonorrhœa of
the urethra, producing a phymosis, which is often the case, it
arises from the same disease having affected its inside, and that,
not being sufficient to produce ulceration, it goes no further.
It seems probable that this inflammation is of the erysipelatous
kind; a circumstance very necessary to be known in the cure.
The urethra is the part in which this form of the venereal dis-
ease is most frequent; and, although the inflammation, attend-
ing the disease in this part, has many of the common symptoms
of inflammation, yet it can hardly be called inflammatory, when
moderate, at least it does not constantly produce all the effects
of common inflammation, though there is a tendency towards
it. The parts seldom have all the characteristic symptoms; for
there is no throbbing sensation; there is but little pain, except
from the irritation of the urine and distension of the parts; the
inflammation seldom goes deeper than the surface; and we
have therefore rarely any tumefaction or thickening of the parts.
It should rather seem to be an error loci on the surface of the
urethra, like a bloodshot eye.
The secretion of pus with so little inflammation, is perhaps
owing to these parts being naturally in a state of secretion;
therefore the transition from an healthy to a diseased secretion
is more easily produced. It sometimes happens, however,
that the parts do inflame considerably, and the inflammation
goes deep into the cellular, or rather reticular membrane of
the

OF GONORRHOEA. 41
the corpus spongiosum urethræ, especially near the glans.
Sometimes it extends further along the corpus spongiosum
urethræ, producing tumefaction, that is, an extravasation of
the coagulable lymph, which is the common cause of chor-
dee. It may be observed in general, that in most cases when
suppuration is produced, there is a decrease of inflammation.
The inflammation in the reticular membrane of the surrounding
parts would appear not to be always confined to the adhesive
stage; for in those parts we have sometimes suppurations, es-
pecially in the perinæum, which suppurations I suspect to be in
the glands, as will be taken notice of hereafter.
The gonorrhœa does not always attack an urethra other-
wise found; nor does it always attack an urethra the relative
parts of which are always sound. Thus we have people con-
tracting this disease while they are affected with strictures,
swelled prostate gland, as also diseased testicles, or such tes-
ticles as very readily run into diseases; by which the malady
becomes more complicated and requires more attention in the
method of cure. Sometimes such diseases are relieved by
the gonorrhœa, at other times increased.
VI. OF THE MOST COMMON SYMPTOMS, AND
THE ORDER OF THEIR APPEARANCE.
ALTHOUGH the irritation must always begin first, yet it is
not certain which of the symptoms, in consequence of that
irritation, will first appear; for any one may appear singly
without the others, though this is rarely the case. The first
symptom, when carefully attended to, is generally an itching at
the orifice of the urethra; sometimes extending over the
whole glans*, a little fulness of the lips of the urethra; the
effects of inflammation is next observable, and soon after a
running appears; the itching changes into pain, more par-
ticularly at the time of voiding the urine; there is often no
pain till some time after the appearance of the discharge,
and other symptoms; and in many gonorrhœas there is hard-
ly any pain at all, even when the discharge is very consider-
able; at other times the pain, or rather a great degree of
soreness will come on long before any discharge appears.
C There
* These symptoms are most carefully observed by those who are under apprehensions
of having the disease, and therefore are attentive to every little sensation about those parts.

42 OF GONORRHOEA.
There is generally at this time a greater fulness in the
penis, and more especially in the glans, although it is not
near so full as when erected, being rather in a state of half
erection. Besides this fulness, the glans has a kind of tran-
sparency, especially near the beginning of the urethra, where
the skin is distended, being smooth and red, resembling a ripe
cherry, this is owing to the reticular membrane at this time be-
ing loaded with a quantity of extravasated serum, and the vessels
filled with blood. Near the beginning of the urethra there is
in many cases an evident excoriation, which is marked by
the termination of the cuticle all round; the surface of the
glans also is often in an half excoriated state, which gives it a
degree of tenderness, and there ouses out from it a kind of
matter, as has been before observed. The canal of the ure-
thra becomes narrower, which is known by the stream of the
urine being smaller than common; this proceeds from the
fulness of the penis in general, and from the internal mem-
brane of the urethra being swollen by the inflammation, and
also from its being in a spasmodic state.
Besides these changes, the fear of the patient, whilst void-
ing his urine, assists in diminishing the stream of urine. The
stream, as it flows from the urethra, is generally much scat-
tered and broken as soon as it leaves the passage, which is
owing to the internal canal having become irregular, and is
not peculiar to a venereal gonorrhœa, but common to eve-
ry disease of the urethra that alters the exact and natural fi-
gure of the canal, even although the irregularity is very far
back, as we find in many diseased prostate glands.
There is frequently some degree of hæmorrhage from the ure-
thra. This I suppose arises from the distension of the vessels,
more especially when there is a chordee, or a tendency to one.
There are often small swellings observable along the lower
surface of the penis in the course of the urethra. These, I sus-
pect, are the glands of the urethra so enlarged as to be plainly
felt on the outside. They inflame so much in some cases as to
suppurate; and according to the laws of ulceration, the matter
is brought to the skin, forming one, two, or more abscesses
along the under surface of the urethra, and some of these break-
ing internally form what are called internal ulcers. I have ob-
served in several cases a tumor on the under side of the penis
where the urethra is, which would swell at times very conside-
rably,

OF GONORRHOEA. 43
rably, even to the size of a small flattened nut, inflame, and
then a gush of matter flowing from the urethra, would almost
immediately subside. The discharge has continued for some
time, gradually diminishing till it has entirely gone off and the
tumor has been almost wholly reduced; yet after some months
it has swelled in the same manner again, and terminated in the
same way. How far these tumors, and the matter they dis-
charge, are really venereal when they appear first, may be doubt-
ful; and it is difficult to determine this, from the patients in
general having recourse to medicine immediately; but in their
subsequent attacks they are certainly not venereal, for they cure
themselves.
I have suspected these tumors to be the ducts, or lacunæ of the
glands of the urethra distended with mucus from the mouth of the
duct being closed, in a manner similar to what happens to the
duct leading from the lachrymal sack to the nose; and in con-
sequence of the distension of the ducts or lacunæ, inflammation
and suppuration come on, and ulceration takes place, which
opens a way into the urethra; but this opening soon closes up
and occasions a return. Cowper's glands have been suspect-
ed to inflame, and hardness and swelling have been felt exter-
nally very much in the situation of them, which coming to sup-
puration have produced considerable abscesses in the perinæ-
um. These tumors break either internally or externally, and
sometimes in both ways, making a new passage for the urine,
called fistulæ in perinæo.
A soreness is often felt by the patient all along the under side
of the penis, owing to the inflamed state of the urethra. This
soreness often extends as far as the anus, and gives great pain
principally in erections; yet it is different from a chordee, the
penis remaining straight.
Erections are frequent in most gonorrhœas. Those arising
from the irritation at the time, often approach to a priapism,
especially when there is the above-mentioned soreness, or when
there is a chordee.
Priapisms often threaten mortification in men; and I have
seen an instance of it in a dog. The erection never subsided,
and the glans penis could not be cvoered by the prepuce, from
the swelling of the bulb. The penis mortified and dropped, off;
the bone in it was denuded, and an exfoliation followed. As
opium

44 OF GONORRHOEA.
opium is of great service in priapism, there is reason to suppose
the complaint is of a spasmodic nature.
VII. OF THE DISCHARGE.
THE natural slimy discharge from the glands of the urethra
is first changed from a fine transparent ropy secretion to a wa-
tery, whitish fluid; and the natural exhaling fluid of the ure-
thra, which is intended for moistening its surface, and which
appears to be of the same kind with that which lubricates ca-
vities in general, becomes less transparent; and both these se-
cretions becoming gradually thicker, assume more and more
the qualities of common pus. In some cases of gonorrhœa,
the glands that produce the slime which is secreted in conse-
quence of lascivious ideas, are certainly not affected; for I have
seen cases, when after the passages had been cleared of the ve-
nereal matter by making water, the pure slime has flowed out
of the end of the penis, on such occasions. When this mat-
ter is more in quantity than what lubricates the urethra, it is
forced out of the orifice by the peristaltic action of that canal,
and appears externally*.
The matter of gonorrhœa often changes its colour and con-
sistence, which is owing to the disposition of the parts which
form it; sometimes from a white to a yellow, and often to a
greenish colour. These changes depend on the increase or de-
crease of the inflammation, and not on the poisonous quality
of the matter itself; for any irritation on these parts, equal to
that produced in a gonorrhœa, will produce the same appear-
ances; and the changes in the colour of the matter are chiefly
observable after it has been discharged upon a cloth, and become
dry. The appearance upon the cloth is of various hues; in the
middle the matter is thicker or more in quantity, and it is there-
fore generally of a deeper colour; the circumference is paler,
because the watery or serous part of the matter has spread fur-
ther, and at the outer edge of all it is darkest; this last appear-
ance is owing to its being only water with a little slime, in
which some of the tinge is suspended, which when dry gives a
transparency
* That the urethra has considerable powers of action, is evident in a vast number of
instances; and that action is principally from behind forwards. We find that a bougie
may be worked out by the action of the urethra. This action I believe is often inverted,
as in spasmodic stranguries.

OF GONORRHOEA. 45
transparency to the part, that takes off from the white colour of
the linen. It is very probable that there is a small extravasa-
tion of red blood in all the cases where the matter deviates from
the common colour, and to this the different tinges seem to be
owing. As this matter arises from a specific inflammation, it
has a greater tendency to putrefaction than common matter from
a healthy sore, and has often a smell seemingly peculiar to itself.
As it should appear that there is hardly a sufficient surface of
the urethra inflamed to give the quantity of matter that is often
produced, especially when we consider that the inflammation
does in common go no further than two or three inches from
the external orifice, it is natural to suppose that the discharge
is produced from other parts, the office of which is to form mu-
cus for natural purposes, and which are therefore more capable
of producing a great quantity upon slight irritations, which
hardly rise to inflammation. These parts I have observed, are
the glands of the urethra. In many cases where the glands have
not been after death so much swelled as to be felt externally;
and where I have had an opportunity of examining the urethra
of those who have had this complaint upon them, I have always
been able to discover, that the ducts or lacunæ leading from
them have been loaded with matter, and were more visible than
in the natural state; I have observed too, that the formation of
the matter is not confined to these glands entirely, for the inner
surface of the urethra is commonly in such a state as not to suf-
fer the urine to pass without considerable pain; and therefore
most probably this internal membrane is also affected in such a
manner as to secrete a matter.
This discharge in common cases should seem not to arise
much further back in the urethra than where the pain is felt,
although it is commonly believed that it comes from the whole
of the canal, and even from Cowper's glands and the prostate,
not even what are called the vesiculæ seminales*. But the
truth of this I very much doubt. My reasons for supposing
that it comes only from the surface where the pain is, are the fol-
lowing. If the matter arose from the whole surface of the ure-
thra, and from the glands near the bladder, there would certain-
ly be many other symptoms than do actually occur; for instance,
if
* Those bags are certainly not reservoirs for the semen. The difference between the
contents of them and the semen gave me the first suspicion of this; and from several ex-
periments on the human body, as also a comparative view of them in other animals, I
have been abk to prove that they are not.

46 OF GONORRHOEA.
if all the parts of the urethra beyond the bulb, or even in the
bulb, were affected so as to secrete matter, that matter would
be gradually squeezed into the bulb as the semen is, and from
thence it would be thrown out by jerks; for we know that no-
thing can be in the bulbous part of the urethra, without stimu-
lating it to action, especially when in a state of irritation and
inflammation. In such a state we find that even a drop of urine
is not allowed to rest there; and also if an injection of warm
water only is thrown into the urethra as far as the bulb, the
musculi accelerators are uneasy till they act, and throw it out.
Hence it is natural to suppose that, if the membranous and bul-
bous part of the urethra, with the vesiculæ seminales, prostate
and Cowper's glands, assisted in forming the matter, whenever
it collected in the bulb it would probably be immediately thrown
forwards by the muscles above-mentioned, and we should be
sensible of it every moment of the day. But such symptoms
are seldom observed. Sometimes indeed a spasmodic contrac-
tion of these muscles occurs, which may probably arise from
this cause, though it is more frequently felt immediately after
the urine is discharged.
When the inflammation is violent, it often happens that some
of the vessels of the urethra burst, and a discharge of blood ensues,
which is in greater quantity at the close of voiding urine. This
however happens at other times, and generally gives tempora-
ry ease. Sometimes this blood is in small quantity, and only
gives the  matter a tinge, as I observed when treating of the co-
lour of the discharge. The erections of the penis often stretch the
part so much as to become a cause of an extravasation of blood.
This extravasation generally increases the soreness at the time
of emptying the bladder, and in such a state of parts the ure-
thra is usually sore when pressed, yet the bleeding diminishes
the inflammation, and often gives ease.
VIII. OF THE CHORDEE.
THE chordee appears to be inflammatory in some cases,
and spasmodic in others; we shall treat first of the inflamma-
tory chordee.
When the inflammation is not confined merely to the sur-
face of the urethra and its glands, but goes deeper and affects
the reticular membrane, it produces in it an extravasation of
coagulable

OF GONORRHOEA. 47
coagulable lymph, as in the adhesive inflammation, which
uniting the cells together, destroys the power of distension
of the corpus spongiosum urethræ, and makes it unequal in
this respect to the corpora cavernosa penis, and therefore a
curvature takes place in the time of erection, which is called a
chordee. The curvature is generally in the lower part of the
penis, arising from the cells of the corpus spongiosum ure-
thræ having their sides united by adhesions. Besides this ef-
fect of inflammation, when the chordee is violent, the inner
membrane is I suppose so much upon the stretch, as to be in
some degree torn, which frequently causes a profuse bleeding
from the urethra that often relieves the patient, and even some-
times proves the cure. As chordee arises from a greater degree
of inflammation than common, it is an effect which may and oft-
en does remain when all infection is gone, being merely a con-
sequence of the adhesive inflammation.
IX. OF THE MANNER IN WHICH THE INFLAM-
MATION ATTACKS THE URETHRA.
IN what manner the disease extends itself to the urethra, is
a question not yet absolutely determined. I suspect that it is
communicated, or creeps along from the glans to the urethra,
or at least from the beginning or lips of the urethra to its inner
surface; because it is impossible to conceive, that any of the
venereal matter from the woman can get into the canal during
coition, although the contrary is commonly asserted; it is im-
possible at least that it can get so far as the common seat of the
disease, or into those parts of the urethra where it very often
exists, that is, through the whole length of the canal. The fol-
lowing case amounts almost to a proof of this opinion.
A gentleman, on whose veracity I have an entire confidence,
when in Germany, where he had not lain with a woman for ma-
ny weeks, sat in a necessary-house some time. Upon arising
he found something that seemed to give the glans penis a little
sharp pull, and he found a small bit of the plaister of the necessa-
ry-house sticking to it. He paid no further attention to it at
that time than merely to remove what stuck to his penis; but
five or six days after, he observed the symptoms of a clap which
proved a pretty severe one. The only way for accounting for
this is, that some person who had a clap had been there before
him,

48 OF GONORRHOEA.
him, and had left some venereal matter upon this place, and
that the penis had remained in contact with it a sufficient time
for the matter to dry.
When the disease attacks the urethra it seldom extends fur-
ther than an inch and an half, or two inches at most, within
the orifice, which distance appears to be truly specific, and
what I have called the specific extent of the inflammation*.
As the cause of a gonorrhœa is commonly an inflamma-
tion, it is accompanied with pain and the formation of mat-
ter. In such a state neither the sensations of the patient, nor
the actions of the parts themselves are confined to the real seat
of the disease. In consequence of the neighbouring parts
sympathising, a variety of symptoms are produced, many of
which do not exceed what might arise from an irritable state;
an uneasiness partaking of soreness and pain, and a kind of
weariness, are every where felt about the pelvis: the scrotum,
testicles, perinæum, anus and hips, become disagreeably sen-
sible to the patient; and the testicles often require being sus-
pended; and so irritable are they indeed in such cases, that
the least accident or even exercise, which would have no
such effect at another time, will make them swell. The glands
of the groin are often affected sympathetically, and even swell
a little, but do not come to suppuration. When they inflame
from the absorption of matter they in general suppurate. I
have seen cases where the irritation has extended so far as to
affect with real pain the thighs, the buttocks, and the abdomi-
nal muscles, so that the patient has been obliged to lie quiet in
an horizontal position. The pain has at times been acute, and
the parts have been very sore to the touch; they have even swel-
led, but the swelling has not been of the inflammatory kind;
for notwithstanding a visible fulness, the parts have been rather
soft. I knew one gentleman who never had a gonorrhœa, but
that he was immediately seized universally with rheumatic pains.
This had happened several times. The blood at such times is
generally free from the inflammatory appearance, and therefore
we may suppose that the constitution is but little affected.
When
* It is to be here remarked, that specific diseases, among which I shall reckon such
as arise from mordid poisons, have their specific distance or extent as one of their proper-
ties; but this can only take place where the constitution is not susceptible of erysipe-
las, or any other uncommon mode of action; for where there is an erysipelatous dis-
position no bounds are set to the inflammation.

OF GONORRHOEA. 49
When the gonorrhœa (exclusive of the affections arising from
sympathy) is not more violent than I have described, it may be
called common or simple venereal gonorrhœa; but if the pati-
ent is very susceptible of such irritation, or of any other mode of
action which may accompany the venereal, then the symptoms
are in proportion more violent. In such circumstances we
sometimes find the irritation and inflammation exceed the spe-
cific distance, and extend through the whole of the urethra.
There is often also a considerable degree of pain in the perinæum,
and a frequent, though not a constant, symptom is a spasmodic
contraction of the acceleratores urinæ, which is always attend-
ed with contractions of the electores muscles. Whether these
spasms arise from a secretion of matter, which being collected
in the bulbous part of the urethra produces uneasiness, and ex-
cites contractions in order to its own expulsion, like the last
drops of urine, I have not been able to determine. I have seen
such spasms in the time of making water, from the urine irri-
tating the parts in its passage through the urethra, and throw-
ing the musculi acceleratores into contractions, so that the wa-
ter has come by jerks. This kind of inflammation sometimes
is considerable, goes deep into the cellular membrane, and produ-
ces tumefaction without any other effect. In other cases it goes
on to suppuration, often becoming one of the causes of fistulæ
in perinæo. I have sometimes, as I have already observed,
suspected Cowper's glands to be the seat of such suppurations;
for I have observed externally, circumscribed swellings in the
situation of those glands. The small glands likewise of the bul-
bous part of the urethra may be affected in a similar manner;
and the irritation is often extended even to the bladder itself.
When the bladder is affected it becomes more susceptible of
every kind of irritation, so that very disagreeable symptoms are
often produced; it will not allow of the usual distension, and
therefore the patient cannot retain his water the ordinary time,
and the moment the desire of making water takes place, he is
obliged instantly to make it with violent pain in the bladder,
and still more in the glans penis, exactly similar to what hap-
pens in a fit of the stone. If the bladder be not allowed to dis-
charge its contents immediately, the pain becomes almost into-
lerable; and even when the water is evacuated there remains
for some time a considerable pain, both in the bladder and
H glans;

50 OF GONORRHOEA.
glans; because the very contraction of the muscular coat of
the bladder becomes a cause of pain.
The ureters, and even the kidnies sometimes sympathise,
when the bladder is either very much inflamed, or under a
considerable degree of irritation; however this but rarely hap-
pens. I have even reason to suspect that the irritation may
be communicated to the peritonæum by means of the vas de-
ferens. This suspicion receives some confirmation from the
following history. A gentleman had a gonorrhœa which was
treated in the antiphlogistic way. The discharge being in
some degree stopped, a tension came upon the lower part of
the belly on the right side just above Poupart's ligament,
but rather near to the ilium; there was hardness and soreness
to the touch, this soreness spread over the whole belly, pro-
ducing rigors every third day, with a low pulse, which to
me indicated a peritonæal inflammation, arising, in my opi-
nion, from the vas deferens of that side being affected in its
course through the belly and pelvis.
When the inflammation, or perhaps only the irritation,
runs along the whole surface of the urethra, attacks the blad-
der, and even extends to the ureters and the kidnies so as to
cause a disagreeable sensation in all these parts, the disease is
generally very violent, and I suspect is something of the ery-
sipelatous kind; at least it shows an irritable sympathising habit.
This disease sometimes produces very uncommon symptoms.
A gentleman had a gonorrhœa, and when the inflammatory
symptoms were abating, the urethra lost both the involunta-
ry and voluntary powers of retaining the urine. His water
came away involuntarily, nor could he stop it. I advised
him to do nothing, and to wait for some time, as probably
the method of cure might be more disagreeable than the dis-
ease itself, although it was very troublesome to him when in
company. The complaint gradually lessened, and in time
went entirely off.
X. OF THE SWELLED TESTICLE.
A VERY common symptom attending gonorrhœa is a swel-
ling of the testicle. This, I believe, like the affection of the
bladder, and many of the symptoms mentioned before, is only
sympathetical, and not to be reckoned venereal, because the
same

OF GONORRHOEA. 51
same symptoms follow every kind of irritation on the urethra,
whether produced by strictures, injections, or bougies. It may
be observed here, that those symptoms are not similar to the
actions arising from the application of the true venereal matter,
whether by absorption or otherwise; for they seldom or ever
suppurate, and when suppuration happens, the matter produc-
ed is not venereal.
The testicles seem as it were, in many cases, rather to be
acting for the urethra, than for themselves, which is an idea ap-
plicable to all sympathies. Thus the swelling and inflammation
appears suddenly, and as suddenly disappears, or in a few mi-
nutes goes from one testicle to the other; the affection depend-
ing upon the state of the urethra, and not at all upon the part
itself. A part however of the testicle, the epididymis, assumes
all the characters of inflammation, remaining swelled even for
a considerable time after the inflammation has subsided.
The first appearance of swelling in the testicle is generally a
soft pulpy fulness of the body of the testicle, which is tender to
the touch; this increases to a hard swelling, accompanied with
considerable pain. The hardest part is generally the epididymis,
and principally that portion of it which is at the lower end of
the testicle, as may be distinctly felt; the hardness and swelling
however often run the whole length of that body, and form a
knob at the upper part. The spermatic chord is likewise often
affected, and more especially the vas deferens, which is thick-
ened and sore to the touch. The veins of the testicle sometimes
become varicose. I have seen such a state of veins accompany
a swelling of the testicle in two instances. A pain in the small
of the back generally attends inflammations of the testicle of all
kinds, with a sense of weakness of the loins and pelvis. The
bowels generally sympathise with most complaints of the testicle,
in some by cholicky pains, in others by an uncommon sensa-
tion both in the stomach and intestines. Sickness is a common
symptom, and even vomiting; the powers of digestion by this
means are impaired, and a disposition for the accumulation of
air takes place, which is often very troublesome. Here we
have from the testicles a chain of sympathies, as we had in con-
sequence of the irritation running along the whole urinary pas-
sages; first the testicle is affected from the urethra, then the
spermatic chord, the loins, intestines, stomach, and from thence
in some measure the whole body.
In

52 OF GONORRHOEA.
In a case of swelled testicle I have known the buttocks
swell, but the swelling was not of the inflammatory kind, and
in making water pain was felt in that part. Whether this
symptom arose from the swelling of the testicle, or from the
same common cause, that is the gonorrhœa, is not easily de-
termined, although the latter supposition is the most probable.
It has been asserted, but without proof, that in cases of swel-
led testicles in consequence of a gonorrhœa, it is not the testicle
that swells, but the epididymis. The truth is, it is both the one
and the other. Any man that is accustomed to distinguish be-
tween a swelling of the whole testicle, and that of the epididy-
mis only, will immediately be sensible, that in the hernia hu-
moralis the whole testicle is swelled; the testicle assumes the
same shape that it does from other causes, where we know from
being obliged to remove it, that the whole has swelled. The
pain is in every part of the testicle. I have seen such swellings
suppurate on the sore part, and have known several instances of
adhesions between the tunica albulginea and vaginalis, from
such causes. This has only been discovered after death, or in
the operation for a partial hydrocele; such changes could not
have taken place if the body of the testicle had not been in a
state of inflammation. This inflammation of the testicle most
probably arises from its sympathising with the urethra, and in
many cases it would appear to arise from what is understood by
a translation of the irritation from the urethra to the testicle:
thus a swelling of the testicle coming on shall remove the pain
in making water, and suspend the discharge; which shall not
return till the swelling of the testicle begin to subside; or the
irritation in the urethra first ceasing shall produce a swelling of
the testicle, which shall continue till the pain and discharge re-
turn; thus rendering it doubtful, which is the cause and which
is the effect. I have nevertheless known cases where the tes-
ticle has swelled, and yet the discharge become more vio-
lent; nay, I have seen instances where a swelling has come
on after the discharge had ceased, yet the discharge has return-
ed with violence, and remained as long as the swelling of the
testicle. Sometimes the epididymis only is affected, sometimes
the vas deferens, and at other times only the spermatic chord,
producing varicose veins; no reason can be assigned why one
of these parts is affected more than another, and indeed the im-
mediate cause in all is as yet unknown. For although an acti-
on

OF GONORRHOEA. 53
on in the urethra is the remote cause, yet it is still impossible
to say whether it be the cessation of that action that is the cause
of the swelling in the testicle, or the swelling in the testicle the
cause of the cessation. It is described as arising from an irri-
tation taking place in the mouths of the vassa deferentia. Were
this the cause, it ought in general to affect both testicles at the
same time: but I have seen this complaint happen as often
where the inflammation has gone no further back in the ure-
thra than about an inch and a half, or two inches, as where it
has extended further; and the circumstance of the swelling shift-
ing suddenly from one testicle to the other, shews it to arise
from some other principle in the animal œconomy.
A strangury often attends such cases of sympathy, and more
frequently when the running stops, than when it is continued
along with the swelling of the testicle; indeed any sudden stop-
ping of the discharge gives a tendency to a strangury.
As singular circumstance as any respecting the swelling of the
testicle is, that it does not always come on when the inflamma-
tion in the urethra is at the height. I think it oftener happens
when the irritation in the urethra is going off, and sometimes
even after it has entirely ceased, and when the patient conceives
himself to be quite well.
I may be allowed to remark, that swellings in the testicle in
consequence of venereal irritation in the urethra, subject it to
a suspicion that every swelling of this part is venereal; but from
what I said of its nature when it arises from a venereal cause,
which was, that it is owing to sympathy only, and from what I
shall now say, that it is never affected with the venereal disease
either local or constitutional, as far as my observation goes,
it is to be inferred that such suspicions are always ill-founded.
This perhaps is an inference to which few will subscribe.
I have known the gout produce a swelling in the testicle of
the inflammatory kind, and therefore similar to the sympathe-
tic swelling from a venereal cause, having many of its characters.
Injuries done to the testicle produce swellings, but they are dif-
ferent from those above-mentioned, being more permanent, hav-
ing the disease or cause in the part itself. Cancers and the scro-
fula produce swellings of the testicle, but these are generally
slow in their progress, and not at all similar to those arising from
an irritation in the urethra.
XI. OF

54 GONORRHOEA.
XI. OF THE SWELLINGS OF THE GLANDS
FROM SYMPATHY.
SINCE our knowledge of the manner in which substances
get into the circulation, and our having learned that many
substances, especially poisons, in their course to the circula-
tion, irritate the absorbent glands to inflammation and tume-
faction, we might naturally suppose such swellings, accompa-
nying complaints in the urethra attended with a discharge, to
be owing to the absorption of that matter, and therefore if it
be a venereal discharge, that they must also be venereal. But
we must not be too hasty in drawing this conclusion; for
we know that the glands will sometimes swell from an irri-
tation at the origin of the lymphatics, where no absorption
could possibly have taken place. They often swell and be-
come painful upon the commencement of inflammation, be-
fore any suppuration has taken place, and subside upon the
coming on of suppuration; because when the suppuration be-
gins, the inflammation abates. I have known a prick in the
finger with a clean sewing needle, produce a red streak all
up the fore-arm, pain along the inside of the biceps muscle,
a swelling of the lymphatic glands above the inner con-
dyle of the humerus, and also of the glands of the arm-pit,
immediately followed by sickness and a rigor, all which howe-
ver have soon gone off. As it should therefore appear,
that the absorbent system is capable of being affected as well
by irritation, as by absorption of matter, in all diseases of
this system arising from local injuries attended with matter, one
must always have these two causes in view, and endeavour if
possible to distinguish from which the present affection proceeds.
For in those arising from an irritating surface in consequence
of poison, especially the venereal, it is of considerable conse-
quence to be able to say from which of the two it arises; since
it sometimes happens, although but seldom, that the glands of
the groin are affected in a common gonorrhœa with the appear-
ance of beginning buboes, but which I suspect to be similar to
the swelling of the testicle, that is, merely sympathetic; the
pain they give is but very trifling, when compared to that of
true venereal swellings arising from the absorption of matter;
and they seldom suppurate. However, there are swellings of
these

OF GONORRHOEA. 55
these glands from actual absorption of matter in gonorrhœa, and
which consequently are truly venereal; and as it is possible to
have such, they are always to be suspected. As they have some-
times arisen upon a cessation of the irritation in the urethra, simi-
lar to the swelling of the testicle, it has been supposed that the
matter was driven as it were into them by unskilful treatment.
From our acquaintance with the absorbing system, we know that
the matter can go that way; but we also know that we have
no method of driving it that way; and if we had, there is no
reason why more should not be formed in the urethra. This
therefore does not account for the cessation of secretion of mat-
ter in that part.
It is difficult to say, what is the nature of those sympathetic
diseases. They are not venereal, for they subside by the com-
mon treatment of inflammation without the use of mercury;
and I have known an instance of a swelled testicle from a vene-
real gonorrhœa, that suppurated, and was treated by my advice
as a common suppuration, and healed without a grain of mer-
cury being given. Neither can they be called truly inflamma-
tory, having rarely any of the true characters of inflammation,
such as thickening of the parts, symptomatic fever, or fizy
blood, except in swellings of the testicle and glands. The swel-
ling of the testicle has several peculiarities attending it; it is oft-
en very quick in its increase, and not being of the true inflam-
matory disposition, it requires less time for the removal of the
inflammation; but even where it appears to have more of the
true inflammatory action, we find that the removal of the in-
flammation and tumefaction take place more rapidly than when
proceeding from other causes. A swelled testicle in conse-
quence of the radical cure in the hydrocele does not subside af-
ter inflammation is gone, in as many weeks, as the swelled testi-
cle in consequence of its sympathy with other parts, does in
days; and probably the reason of this is, that it arises from
sympathy; for an inflammation arising from real disease in a
part, or from an external injury, as in the hydrocele, must al-
ways last either till the disease be removed, or the injury repair-
ed; but that from sympathy will vary as the cause varies, which
may happen very quickly; for we find a testicle swell in a few
minutes, and in a little time subside; and also the swelling
move suddenly from one testicle to the other. These sympathies
are often peculiar to constitutions, and even to temporary con-
stitutions,

56 OF GONORRHOEA.
stitutions, in so much as to be in some degree epidemic; for
there is often such an influence in the atmosphere as predisposes
the body to this kind of irritation; and bodies so predisposed
require only the immediate cause to produce the effect.
XII. OF THE DISEASES OF THE LYMPHATICS
IN A GONORRHOEA.
ANOTHER symptom, which sometimes takes place in go-
norrhœa, is a hard chord leading from the prepuce, along
the back of the penis, and often directing its course to one of
the groins, and affecting the glands. There is most com-
monly a swelling in the prepuce at the part where the chord
takes its rise. This happens sometimes when there is an ex-
coriation and discharge from the prepuce or glans, which
may be called a venereal gonorrhœa of these parts. Both
the swelling in the groin, and the hard chord, we have rea-
son to suppose arise from the absorption of pus, and there-
fore that they are the first steps towards a lues venerea; but
as that form of the disease seldom happens from a gonorrhœa,
I shall not take any further notice of it in this place. How-
ever, I may remark, that from this observation of the lues
venerea being seldom produced from a gonorrhœa, it should
appear that a whole surface, or one only inflamed, does not
readily admit of the absorption of the venereal poison; and
therefore, although the venereal matter lies for many weeks in
the passage, and over the whole glans, it seldom happens that
any absorption takes place. I have seen a case where blood has
been discharged from the urethra, and the above-mentioned
symptoms have come on. I at first suspected that the absorp-
tion had taken place where the vessel gave way; but as this
symptom rarely happens, even where there has been a consi-
derable discharge of blood, I am inclined to think that wounds
are also bad absorbing surfaces, especially when I consider that
few morbid poisons are absorbed from wounds.
XIII. SHORT RECAPITULATION OF THE VARIE-
TIES IN THE SYMPTOMS.
FROM what has been advanced above, it must appear that
the variety of symptoms in a gonorrhœa, and the difference of
them

OF GONORRHOEA. 57
them in different cases, are almost endless. I shall now reca-
pitulate a few of the most material or common varieties. The
discharge often appears without any pain, and the coming on
of the pain is not at any stated time after the appearance of the
discharge. There is often no pain at all, although the discharge
be considerable in quantity, and of a bad appearance. The
pain often goes off, while the discharge continues, and will
sometimes return again. An itching in some cases is felt for
a considerable time, which sometimes is succeeded by pain;
though in many cases it continues to the end of the disease.
On the other hand, the pain is often troublesome, and consi-
derable even when the discharge is trifling or none at all. In
general, the inflammation in the urethra does not extend be-
yond an inch or two from the orifice; sometimes it runs all
along the urethra to the bladder, and even to the kidnies, and
in some cases spreads into the substance of the urethra, produc-
ing a chordee. The glands of the urethra inflame and often
suppurate; and I suspect that Cowper's glands sometimes do the
same. The neighbouring parts sympathise, as the glands of the
groin, the testicle, the loins, and pubes, with the upper parts
of the thighs and abdominal muscles. Sometimes the disease
appears soon after the application of the poison, as in a few
hours, at other times not till after six weeks. It is often not
possible to determine whether it is venereal, or only an acci-
dental discharge arising from some unknown cause.
It may not be improper to mention here, that I have seen
a chancre on the prepuce produce a pain in the urethra in mak-
ing water; which most probably depended upon a sympathy si-
milar to that by which the application of venereal matter to the
glans produces a discharge from the urethra, as was observed above.
If the application of venereal matter to the glans can produce
a discharge from the urethra, it is possible that any acrid mat-
ter, though not venereal, may have a similar effect. The dis-
charge from the vagina in cases of what is called fluor albus, is
sometimes extremely irritating, in so much as to excoriate the
labiæ and thighs; and the following history shows that it may
sometimes produce effects similar to venereal matter.
Mr. and Mrs.- have been married these twenty years
and upwards. She has for many years past been at times trou-
bled with the fluor albus. When he has connection with her
at such times, it generally, although not always, produced an
I excoriation

58 OF GONORRHOEA.
excoriation of the glans and prepuce, and a considerable dis-
charge from the urethra, attended with a slight pain. These
symptoms commonly take a considerable time before they go off,
whether treated as a gonorrhœa or as a weakness. Is this a
new poison? And does it go no further because the connecti-
on takes place only between two? What would be the conse-
quence, if she were to have connection with other men, and
these with other women? Such cases, as far as I have seen,
have only been in form of a gonorrhœa, they have not pro-
duced sores in the parts; nor, as far as I know, do they ever
produce constitutional diseases.
CHAPTER II.
OF THE GONORRHOEA IN WOMEN.
THE venereal disease in the form of gonorrhœa in women,
is not so complicated as in men; the parts affected are
more simple, and fewer in number. But it is not so easily
known in them as it is in men, because the parts commonly
affected in women are very subject to a disease resembling the
gonorrhœa, called fluor albus; and the distinguishing marks,
if there are any, have not yet been completely ascertained.
A discharge simply from these parts in women, is less a proof
of the existence of the venereal infection than even a dis-
charge without pain in men; therefore in general little or
no attention is paid to it by the patient herself, and we oft-
en find the venereal virus formed in those parts without any
increase of the natural discharge. The kind of matter gives
us an assistance in distinguishing the two diseases; for it often
happens that the discharge in the fluor albus puts on all the
appearance of the venereal matter; and an increase of the
discharge is no better mark by which we can distinguish the
one from the other. Pain, or any peculiarity in the sensa-
tions of the parts, is not a necessary attendant upon this com-
plaint in woman, therefore not to be looked for as a distin-
guishing symptom.
The

OF GONORRHOEA. 59
The appearance of the parts often give us but little infor-
mation, for I have frequently examined the parts of those
who confessed all the symptoms; such as increase of discharge,
pain in making water, soreness in walking, or when they
were touched, yet I could see no difference between these and
sound parts. I know of no other way of judging in cases where
there are no symptoms sensible to the person herself, or where
the patient has a mind to deny having any uncommon symptoms,
but from the circumstances preceding the discharge; such as
her having been connected with men supposed to be unsound,
or her being able to give it to others; which last circumstance
being derived from the testimony of another person, is not al-
ways to be trusted to, for very obvious reasons. Thus a wo-
man may have this species of the venereal disease without know-
ing it herself, or without the surgeon being able to discover it,
even on inspection. It may appear very strange, that a disease
which is so violent and well marked in men should be so obscure
in women: but when we consider that this poison generally pro-
duces symptoms according to the nature of the parts affected by
it; it becomes an easy matter to account in some measure for
this difference.
When we attend to the manner in which this disease is con-
tracted by women, it is evident that it must principally attack
the vagina, a part that is not endowed with much sensation, or
action of any kind. While it is confined to the vagina it may
be compared to the same disease on the glans penis in men. In
many cases however it extends much further, and becomes the
cause of disagreeable feelings, producing a considerable soreness
in all the parts formed for sensation, such as the inside of the
labia, nymphæ, clitoris, carunculæ myrtiformes, the orifice of
the meatus urinarius, and often affecting that canal in its whole
length. Those parts are so sore in some cases, as not to bear
being touched; the person can hardly walk; the urine gives
pain in its passage through the urethra, and when it washes the
above-mentioned parts, which can hardly be avoided; such
symptoms are not much increased at one time more than ano-
ther, excepting at the time of making water, and then princi-
pally in those who have the urethra affected; for as these parts
are less exposed to circumstances of change, the increased ir-
ritation arising from such change of parts must necessarily in
this sex be less; but in men, the urethra, which is the part most
commonly

60 OF GONORRHOEA.
commonly affected, has great sensibility, is capable of violent
inflammation, is often distended with a stimulating fluid, and
the body of the penis, urethra, and glans, stretching the passage
with erections, always produce an increase of the symptoms,
especially of the pain.
But as this disease frequently attacks parts more sensible
than the vagina, and which are more susceptible of inflamma-
tion, as has been observed, under such circumstances women
have nearly the same symptoms as men; a fulness about the
parts, almost like an inflamed tonsil, a discharge from the ure-
thra, violent pain in making water, and great uneasiness in
sitting from pressure on those parts.
The bladder sometimes sympathises, producing the same symp-
toms as in men, and it is probable that the irritation may be com-
municated even to the kidnies. It has been asserted that the ova-
ria are sometimes affected in a similar manner to the testicles in
men. I have never seen a case of this kind, and I should very
much doubt the possibility of its existence; for we have no in-
stance in other diseases of the ovaria sympathising with those
parts, or at least producing such symptoms as would enable us
to determine that they did. That there do however uncom-
mon symptoms now and then occur should appear from the
following case.
A lady had all the symptoms of a venereal gonorrhœa, such
as a discharge, pain and frequency in making water, or rather
a continued inclination to void it, and a heaviness approaching
to pain about the hips and loins. The uncommon symptom
in this case, was great flatulence in the stomach and bow-
els; this last symptom was most probably a sympathy with
the uterus. There may possibly be sympathies therefore with
the ovaria.
The inflammation frequently goes deeper than the surface of
the parts; often running along the ducts of the glands, and af-
fecting the glands themselves so as to produce hard swellings
under the surface of the inside of the labia, which sometimes
suppurate, forming small abscesses, opening near the orifice of
the vagina. These are similar to the inflammations and sup-
purations of the glands in the urethra in men. The different
surfaces or parts which the disease attacks, make no distinction
in the disease itself. It is immaterial whether it is a large or
small surface: in one case the parts are more susceptible of this
irritation

OF GONORRHOEA. 61
irritation than in another, but the method of cure may be
more complicated.
It sometimes happens, that the venereal matter from the va-
gina runs down the perinæum to the anus, producing a gonor-
rhœa or chancres there.
How far the gonorrhœa in women is capable of wearing it-
self out, as in men, I cannot absolutely determine; but am
much inclined to believe that it may; for I have known many
women who have got rid of a violent gonorrhœa without hav-
ing used any means to cure it; and indeed the great variety of
methods of cure employed in such cases, all of which cannot
possibly do good, though the patients get well, seems to con-
firm this opinion. One circumstance, which appears as curi-
ous as any, is the seeming continuance of the disease in the va-
gina for years; at least we have reason to believe this, as far as
the testimony of patients can be relied on; and this long conti-
nuance of it, without wearing itself out as it does sometimes in
men, is probably owing to its being less violent in the vagina.
I. OF THE PROOFS OF A WOMAN HAVING
THIS DISEASE.
IT may be asked, what proof there is of a woman having a
gonorrhœa when she is not sensible of having any one symptom
of the disease, and none appears to the surgeon on examination?
In such a case the only thing we can depend upon is, the testi-
mony of those whom we look upon as men of veracity. Such
men have asserted that they have been infected by a woman in
the situation above-described, having had no connection for some
months with any other woman. From this evidence it is rea-
sonable to suppose, that the disease has been caught from such
women; and it should seem to put it beyond a doubt, when the
same woman gives the disease in this way to more than one man.
The case of the woman giving the disease to two men alternate-
ly at an interval of twelve months each time*, which gives a
space of at least two years for the continuance of the disease,
proves that its communication is almost the only criterion of
its presence. The case too of a young woman at the Magdalen
hospital†, confirms the same opinion. Yet all this does not
amount to an absolute proof; for a sound woman may have had
a con-
* See page 35. † See page 36.

62 OF GONORRHOEA.
a connection with a man who had a gonorrhœa, or a man with
chancres, and soon after, that is perhaps within forty-eight
hours, she may have admitted the embraces of a sound man.
In such a case it is  very possible that he may receive the infec-
tion from that matter which was lodged in the vagina by the
unsound man, and yet the woman may not catch the disease;
for the matter may be washed away before it irritates the vagi-
na, and this woman may be suspected of having a gonorrhœa,
and apparently with great justice. A repetition of these cir-
cumstances may be the cause of many women appearing to have
the disease for years, without really having it. Again, I have
seen a bubo come on at a time when the patient was not sensi-
ble of any disorder till that appeared. This one would think
is an absolute proof that there may be a gonorrhœa and the pa-
tient not be conscious of it; but even this is not altogether
without fallacy; for there may have been an absorption of ve-
nereal matter deposited in the vagina by some infected man,
which may not have produced any initation in that part.
CHAPTER III.
OF THE EFFECTS OF THE GONOR-
RHOEA ON THE CONSTITUTION
IN BOTH SEXES.
THE disease I have been describing, both in men and
women, is local, and generally confined to the part af-
fected; yet it sometimes happens that the whole constitution
is more or less affected by it. Thus we find, before there is
any appearance of matter from the parts, that some patients
complain of slight rigors: these are most considerable when
the suppuration is late in taking place. A remarkable in-
stance of this happened in a gentleman who had the infection
twice*. The first time he assured me, that it was six weeks
between the time it was possible for him to have contracted
the disease, and its appearance; and that for a considerable
part
* The case is mentioned before, page 37.

OF GONORRHOEA. 63
part of that time he had often been indisposed with slight ri-
gors, attended with a little fever and restlessness, for which
he could assign no cause; nor was he relieved by the usual
remedies prescribed in such cases. A violent gonorrhœa came
on and these symptoms went off, which appeared to me to
explain the case. The second time it was a month from the
time of infection before the gonorrhœa appeared, and for
some weeks of that time he was subject to a similar indispo-
sition, which went off as before, when the running came on.
Here it would appear that we have something of a suppu-
rative fever, which, perhaps, often happens in this disease;
but the inflammation being small, and the fever therefore in-
considerable, it is commonly little noticed by the patient.
The above gentleman not suspecting any such complaint in
the first attack, had connection with his wife as usual, and
was afraid, when the disease appeared, that he might have
given it to her; but she never complained, which is a strong
circumstance in confirmation of the principle laid down above,
that it cannot be communicated but by matter.
These constitutional sympathies from local specific diseases,
are the same from whatever cause they proceed; they are
the sympathetic effects of irritation or of violence, and it is
probable that all remote sympathies are, at least in this respect,
similar; for if they were similar to their cause, it is most pro-
bable that they would produce in the constitution the same
kind of disease that gave rise to them.
CHAPTER IV.
OF THE CURE OF THE GONORRHOEA.
FROM the idea, which I have endeavoured to give of the
venereal disease in general, namely, that in whatever form
it appears, it always arises from the same cause, it might be
supposed, that, since we have a specific for some of the forms
of the disease, this specific should be a certain cure for every
one; and therefore that it must be no difficult task to cure the
disease

64 OF GONORRHOEA.
disease when in the form of inflammation and suppuration up-
on the secreting surfaces of any of the ducts or outlets of the
body: but from experience we find the gonorrhœa the most va-
riable in its symptoms, while under a cure; and the most un-
certain, with respect to its cure, of any of the forms of this
disease; many cases terminating in a week, while others con-
tinue for months, under the same treatment.
The only curative object is, to destroy the disposition and
specific mode of action in the solids of the parts, and as that is
changed, the poisonous quality of the matter produced will al-
so be destroyed. This effects the cure of the disease, but not
always of the consequences.
I have already observed, that this form of the disease was
not capable of being continued beyond a certain time in any
constitution; and that in cases where it was violent, or lasted
long, it is owing to the parts being very susceptible of such ir-
ritation, and readily retaining it. As we have no specific me-
dicine for the gonorrhœa, it is fortunate that time alone will
effect a cure: it is therefore very reasonable to suppose, that
every such inflammation ceases of itself; yet although this ap-
pears to be nearly the truth, it is worthy of consideration, whether
medicine can be of any service in this form of the disease. I
am inclined to believe it is very seldom of any kind of use, per-
haps not once in ten cases; but even this would be of some
consequence, if we could distinguish the cases where it is of ser-
vice, from those where it is not. Upon the idea that every go-
norrhœa cures itself, I gave certain patients pills of bread,
which were taken with great regularity. The patients always
got well, but some of them, I believe, not so soon as they would
have done, had the artificial methods of cure been employed.
The methods of cure hitherto recommended, and still follow-
ed by different people of the profession, are of two kinds. They
consist either of internal remedies, or local applications; but
in whichsoever of these two ways this disease is to be treated,
we are always to pay more attention to the nature of the con-
stitution, or to any attending disease in the parts themselves, or
parts connected with them, than to the disease itself.
The nature of the constitution is principally to be learned
from the local effects; for the local effects of this poison are
so different in different people as to require great variety of
treatment; but this has been too little attended to, every one
endeavoring

OF GONORRHOEA. 65
endeavouring to attack the immediate symptoms, as if he had a
specific for a gonorrhœa.
The first thing to be considered is, the nature of the inflam-
mation, whether violent or mild, whether common or irrita-
ble; yet even when this is ascertained, we have not in all cases
the cure in our power; for I have already observed, that some
people are very susceptible of this irritation, who are as it were
insensible to others; and on the contrary, many are easily af-
fected by common inflammation, who are insensible to this.
These last are rather uncommon dispositions, and the cure be-
ing always easy, they demand little attention. When the symp-
toms are violent, but of the common inflammatory kind,
which is to be collected from the attending circumstances, par-
ticularly the extent of the inflammation not exceeding the spe-
cific distance, the local mode of cure may be either irritating or
soothing. Irritating applications in the present case may be at-
tended with less danger than in the irritable inflammation*, and
may alter the specific action; but to produce this effect it must
be greater than the irritation from the original injury. The
parts would afterwards recover of themselves, as from any other
common inflammation. After all, however, I believe the sooth-
ing plan is the best at the beginning. If the inflammation be
great, and of the irritable kind, no violence is to be used in
the cure, for it will only increase the symptoms, unless we
know that the great degree of inflammation arises entirely from
a susceptibility of this irritation, and that there is no general
irritability in the constitution, which seldom can be ascertain-
ed. In cases where the symptoms run high, nothing should be
done that may tend to stop a discharge, either by internal or
external means, for nothing would be gained thereby; as we
may stop the discharge and not put an end to the inflammation.
The constitution is to be altered if possible, by remedies adapt-
ed to each disposition, with a view to alter the actions of the
parts arising from such dispositions, and reduce the disease to its
K simple
* It is very difficult to give clear ideas of distinctions in disease, when they are not
marked by something permanent as to time, space, &c. I have used the term irritable
inflammation, because I think this kind of inflammation takes place more in weak irri-
table habits than in others: it appears to be guided by no law that I am acquainted with.
It may be called an ill-formed inflammation, as not going through the usual process to a
natural termination, but continuing with little variation; and if such inflammation were
to take place in the cellular membrane, it would rather produce an œdematous swelling
than such as arises from the extravasation of coagulable lymph, which takes place in what
I would call the true inflammation.

66 OF GONORRHOEA.
simple form. If the constitution cannot be altered, nothing is
to be done but to allow the action to wear itself out.
When the inflammation has considerably abated, and the
disease only remains in a mild form, its cure may be attempt-
ed either by internal remedies, or local applications. If a
local cure be attempted, violence is still to be avoided; be-
cause it may bring back the irritation. At this period gen-
tle astringents may be applied with a prospect of success; or
if the disease has begun mildly, and there are no signs of an
inflammatory disposition, either of the common kind or the ir-
ritable; in order to get rid of the specific mode of action
quickly, an irritating injection may be used, which will
increase the symptoms for a time, but when it is left off they
often abate, or wholly disappear. In such a state of parts,
astringents may be used; for the only thing to be done, is
to procure a cessation of the discharge, which is now the prin-
cipal symptom.
In those cases where the itching, pain, and other uncom-
mon sensations are felt for some time before the discharge ap-
pears, I should be inclined to recommend the quieting or
soothing plan instead of the irritating, with a view to bring
on the discharge, as that effect is a step towards a resolution
of the irritation; but how far it would really be the proper
plan, I cannot absolutely say, not having had experience
enough in such cases. One thing however, I think I may
assert from reasoning, that to use astringents would be bad
practice, as they would rather tend to prevent the discharge
from taking place, which might prolong the inflammation
and protract the cure. In cases of stricture, or in cases of
diseased testicles, I believe astringents should not be used, for
we find in either case, while the discharge lasts, both com-
plaints are relieved; therefore in such cases we should pro-
ceed with more caution than when all the parts are otherwise
sound. If we had a specific for venereal  gonorrhœa, it would
still be a question, whether this specific could cure the irrita-
tion, before the full action had taken place?
I. OF

OF GONORRHOEA. 67
I. OF THE DIFFERENT MODES OF PRACTICE —
EVACUANTS — ASTRINGENTS.
THE internal remedies commonly recommended in a gonor-
rhœa may be divided into evacuants and astringents. The eva-
cuants are principally of the purgative or diuretic kind, and
these not confined to any particular medicines; for every prac-
titioner supposes that he is in possession of the best. Some
use mercurial evacuants, while others carefully avoid mercury
in every form. The neutral salts have been given from the idea
of their being cooling. Some of the profession have kept prin-
cipally to diuretics, perhaps with two views, as evacuants act-
ing upon the urinary passages mechanically, to wash off the vene-
real matter, or as specifics for the latter purpose: nitre has been
given with this view; besides, it has been supposed to lessen
inflammation; but its virtues in this way I very much doubt.
Under these different modes of treatment the patients always get
well, and the cures are ascribed by each practitioner to his own
method of treatment.
To keep the body open in most cases, even when the patient
is in other respects in health, must, no doubt, be proper; but
what idea can we form of an irritation produced all along the
intestinal canal, curing a specific inflammation in the urethra?
Yet there are cases where a brisk purge has been of service,
and even in some has performed a cure. But I suspect that in
such cases the disease had been continued by habit only, and
that this practice would not have succeeded in the beginning.
A gentleman had a gonorrhœa, all the symptoms of which con-
tinued for two months, and by taking at once ten grains of ca-
lomel, which purged him most violently, he was almost imme-
diately cured. The calomel could not have acted specifically,
but by a kind of derivation, that is, an irritation, produced in
one part, curing one that subsisted in another; but even if it
should be granted, that in some constitutions purges have the
power of making the solids less susceptible of this irritation, it
cannot be supposed they will have this effect in every case: in
some constitutions they might debilitate, increase irritability, and
of course increase the symptoms. These contrary effects must
take place in different constitutions in which a medicine has no
specific action. On the supposition of the cure being promote-
ed

68 OF GONORRHOEA.
ed by an evacuation from the blood, what service can purging
out some of the blood in form of a secretion from one part do,
to an inflammation of another part? On such a supposition,
would not a sweat, or an increase of saliva by chewing tobacco,
or stimulating the nose by snuff, all tend equally to cure a go-
norrhœa? But humours having been considered as the univer-
sal cause of every disease, especially those in which pus was
formed or a discharge produced, and purging having been sup-
posed to be the cure for humours, purgatives were of course
made use of in this disease; and as the patients have always
been cured, the practice became generally established.
Those who recommended mercury in this form of the disease,
did it most probably from the opinion that this medicine was a
specific for the venereal disease in all its forms. On this suppo-
sition we can see some reason for their practice, as it would be
absorbed from the intestines, circulate through the inflamed ves-
sels of the urethra, and thereby destroy the venereal irritation.
Here we can only suppose it to act by its specific virtue; but
I doubt very much of mercury having any specific virtue in this
species of the disease, for I find that it is as soon curable with-
out mercury as with it; and where this medicine is only used
as a purge, or purged off the next day, and therefore allowed
to act merely upon the bowels, I cannot conceive that it could
have any more effect upon the venereal inflammation in the ure-
thra, than an irritation in the bowels arising from any other
purgative. So little effect indeed has this medicine upon a go-
norrhœa, that I have known a gonorrhœa take place while un-
der a course of mercury sufficient for the cure of a chancre.
Whether the gonorrhœa arose from the same infection that pro-
duced the chancre I cannot say, nor can it be easily determined
in such cases. Men have also been known to contract a gonor-
rhœa when loaded with mercury for the cure of a lues venerea,
the gonorrhœa nevertheless has been as difficult of cure as in
ordinary cases.
A gentleman committed himself to my care on the 27th of
June, for the cure of two chancres and a bubo. I dispersed the
bubo, but as he disliked the unction, I was obliged to substitute
mercurius calcinatus daily instead of it, giving two grains in the
evening and one in the morning. About the middle of July
his mouth became sore, and the mercury was left off; we be-
gan its use again in a week, and he appeared to be quite well of
his

OF GONORRHOEA. 69
his venereal complaints. I however continued the use of mer-
cury, keeping his mouth sore, and on the 16th of August, while
in this state, he had connection with a woman, both on that
and the following evening, and in five days after, a gonorrhœa
appeared, and proved to be very violent.
The same general observations may be made with regard to
the effects of diuretics considered as evacuants.
It is possible that specific medicines taken into the constitu-
tion, (if we had such) and passing off by urine, might act upon
the urethra in their passage through it. The balsams and tur-
pentines pass off in this way, and become specifics for many ir-
ritations in the urinary passages; but how far medicines which
have the power of affecting particular parts when sound, or when
under diseases peculiar to those parts, have also the powers of
affecting a specific irritation in these parts, I know not; but do
not believe they have any considerable powers in this way. It
is possible, however, that they may remove any attending irri-
tation, although not the specific one. Diuretics have never-
theless their advantages, for if they produce a greater quantity
of water, they do good; but I believe this had better be effect-
ed by simple water, or water joined with such things as will en-
courage the patient to drink a good deal, as tea, syrups of capil-
laire, orgeate, and the like.
Astringents, although often given, yet have always been con-
demned by those who have called themselves the judicious and
regular practitioners; because, according to them, there is some-
thing to be carried off, and if that is not carried off, a lues ve-
nerea is to be the consequence. This reasoning is not just, and
therefore the question to be considered is, do they, or do they
not assist us in the cure of the gonorrhœa? I believe they do
not in any case lessen the venereal inflammation; but certainly
they often lessen the discharge. As that effect however does
not constitute a cure, it is not necessary to produce it.
I can conceive that a combination of astringents, especially
the specific astringents of those parts, as the balsams, with any
other medicine which may be thought to be of service, may
help to lessen the discharge in proportion as the inflammation
abates; and this I have often seen, as will be explained more
at length hereafter.
II. OF

70 OF GONORRHOEA.
II. OF LOCAL APPLICATIONS — DIFFERENT
KINDS OF INJECTIONS — IRRITATING - SE-
DATIVE - EMOLLIENT - ASTRINGENT.
LOCAL applications may be either internal to the urethra,
external to the penis, or both; all of which will in many ca-
ses be necessary. The internal, applied to the urethra, should
seem the most likely to cure this species of disease, by com-
ing immediately in contact with the diseased parts; for if
they have any power of action, whatever that be, it must be
in opposition to the venereal irritation; therefore we might
suppose that most irritations that are not venereal would tend
to cure; but certainly this is not universally the case. If,
on the contrary, the applications are such as quiet irritation,
they must also be of service.
Local applications to the urethra may be either in a solid
or fluid form, each of which has its advantages and disad-
vantages. A fluid is only a temporary application, and that
of very short duration, and is similar to the washing of a sore,
which is, I believe, in most cases unnecessary; for I ima-
gine that matter, from any sore whatever, is always such as
cannot stimulate that sore into any action; it can be of no
consequence therefore whether the matter is allowed to lie
upon it or not; but it being removed the medicines are allow-
ed to come in contact with the inflamed surface. I appre-
hend it is only in this way that the removal of it can be of ser-
vice. The solid applications may remain a long time, and
are similar to the dressings in the case of a wound. When
the parts are not so much inflamed as to prevent the use of
them, they would appear to have an advantage over the fluid
applications by continuance; but they in general irritate im-
mediately, in consequence of their solidity alone. These ap-
plications must be in the form of a bougie; but I should be
inclined to suppose, that the less use is made of bougies when
these parts are in an inflamed state, the better; although I
cannot say that I ever saw any bad effect from them in any
case, when applied with caution.
Fluid applications to the inside of the urethra are common-
ly called injections, and like the internal remedies, are with-
out number; every practitioner thinking, or wishing to make
the

OF GONORRHOEA. 71
the world  think, that his own is the best. But as every ve-
nereal inflammation is frequently removed under the use of in-
jections of various kinds, (which were observed with respect
to internal medicines) have we not here a strong corroborating
circumstance in favour of an opinion, that every such com-
plaint will in time cure itself? I think however it appears
from practice, that an injection will often have almost an im-
mediate effect upon the symptoms, and that therefore they
must have some powers; and yet the kind of injection which
would have the greatest specific powers, I believe is not yet
known: if an injection has no specific powers, it must be ve-
ry uncertain in its effects, and can only be of service as far as
it may be adapted to a peculiarity of constitution or parts.
As injections are only temporary applications, it becomes ne-
cessary to use them often, especially in cases where they are
found to be of service; they should therefore be applied as
often as convenient, perhaps every hour, or even oftener;
but this must be regulated in some measure by the kind of in-
jection; for if it be irritating, it will not be proper to use
it so often, as it may be productive of bad consequences.
Many injections immediately, or at least soon after the ap-
plication, remove the symptoms, and prevent the formation of
matter, which has given rise to the notion of their shutting up
the disease, and driving it into the constitution; but this suppo-
sed mode of producing a constitutional complaint, is the reverse
of what really happens; for I have already endeavoured to
prove, that matter is the only substance in which the poison is
contained, and that the formation of the poison is inseparable
from the formation of matter; therefore if we can prevent the
one, the other cannot take place, and of course there can be no
room for absorption; so that there can neither be any power of
infecting the constitution in the same person, nor of communi-
cating the infection to others*.
When the discharge is an effect of present inflammation, it
may be stopped by injections, though the inflammation still con-
tinue in some degree, and may afterwards be removed without
the discharge ever reappearing. But I believe that by this prac-
tice little is gained, for the effect of the inflammation is not the
disease which we wish to remove. However, we find that the
same method which stops the discharge, also removes the in-
flammation,
* Vide page 12, what was said in the method of contracting the lues venerea.

72 OF GONORRHOEA.
flammation, although not always, and only I believe when the
inflammation is slight.
I shall divide injections according to their particular effects
upon the urethra, into four kinds, the irritating, sedative,
emollient, and astringent. The specific, I believe, is not yet
discovered, although a mercurial injection, in some form or
other, is by most people supposed to be possessed of such a pow-
er, and of course this mineral makes part of many of the injec-
tions now in use.
Irritating injestions, of whatever kind, I suspect, in this
disease act upon the same principle, that is, by producing an irri-
tation of another kind, which ought to be greater than the ve-
nereal, by which means the venereal is destroyed and lost, and
the disease is cured, although the pain and discharge may still
be kept up by the injection. Those effects, however will soon
go off when the injection is laid aside, because they arise only
from its irritating qualities. In this way bougies, as well as
many injections, may be supposed to perform a cure; and al-
though they increase the symptoms for the time, they never can
increase the disease itself, any more than the same injection
which would produce the same symptoms if applied to the ure-
thra of a sound man can communicate the disease. Most of
the irritating injections have an astringent effect, and prove sim-
ply astringent when mild, their irritating quality depending
chiefly upon their strength.
As irritating injections do not agree with all inflammations
arising from the venereal poison*, it may be asked in what cases
are the irritating injections to be used with advantage? This
I have not been able to determine absolutely; but I think ir-
ritating injections should never be used where there is already
much inflammation, especially in constitutions which cannot
bear a great deal of irritation, as a previous knowledge of the
disease in the same person sometimes teaches us; nor should
they be used where the irritation has spread bevond the speci-
fic distance; nor where the testicles are tender, nor where up-
on the discharge ceasing quickly they have become sore; nor
where the perinæum is very susceptible of inflammation, and
especially if it formerly has suppurated; nor where there is a
tendency in the bladder to irritation, which is known from the
patient
* For I have already remarked, that the inflammation varies according to the con-
stitution.

OF GONORRHOEA. 73
patient having had for some time a frequency in making water.
In such cases I have not succeeded with them; they not only
do no good, but they often do harm; for I have seen them
make the inflammation spread further in the urethra*; and I
think I have had reason to suspect that they have been the cause
of abscesses in perinæo. But in cases that are mild, and in
constitutions that are not irritable, injections often succeed, and
remove the disease almost immediately. The practice however
ought to be attempted with caution, and not perhaps till milder
methods have failed: two grains of corrosive sublimate dissolv-
ed in eight ounces of distilled water, are nearly as good an in-
jection as any of the kind. But an injection of only half this
strength may be used, where it is not intended to attempt a cure
so quickly. If, however, the injection, even in that propor-
tion, gives considerable pain in its application, or if it occasi-
ons a great increase of pain in making water, it should be di-
luted.
Sedative injections will always be of service in cases where
the inflammation is considerable, not by lessening the disease
itself, but by lessening the diseased action, which always allows
the natural actions of the part more readily to take place; they
are likewise very useful in relieving the painful feelings of the
patient. Perhaps the best sedative we have is opium, as well
when given by the mouth or anus, as when applied to the part
affected in the form of an injection. But even opium will not
agree, or act as a sedative in all constitutions or parts; on the
contrary, it often has opposite effects, producing great irritabi-
lity. Lead may be reckoned a sedative, so far as it abates
inflammation, while at the same time it may act as a gentle
astringent. Fourteen grains of saccharum saturni, in eight
ounces of distilled water, make a good sedative astringent
injection.
The drinking freely of diluting liquors may perhaps be con-
sidered as having a sedative effect, as it in part removes some
of the causes of irritation, rendering the urine less stimulating,
either to the bladder, when the irritation is there, or to the
urethra in  its passage through it; and it is possible that dilut-
ing may lessen the susceptibility of irritation. The vegetable
mucilages of certain seeds and plants, and the emollient gums
L are
* It is however to be remarked, that this symptom is not always to be attributed to
the injection, for it often happens when none has been used.

74 OF GONORRHOEA.
are recommended; but I suspect that this practice is founded on
a mechanical notion, and that none of them are of much ser-
vice. I believe the advantage arises chiefly from the quantity
of water that is drunk, and that if the water be joined with any
thing, spirits excepted, that can induce the patient to drink free-
ly, the purpose is fully answered. I have, however, been in-
formed by some patients, that they have thought that when the
liquids they drank were impregnated with mucilaginous sub-
stances, they have less uneasiness in making water.
Emollient injections are the properest applications where the
inflammation is very great. They are most probably useful by
first simply washing away the matter, and then leaving a soft
application to the part; in which way I can conceive them to
be of singular service, by lessening the irritating effects of the
urine. Indeed practice proves this, for we often find that a
solution of gum arabic, milk and water, or sweet oil, will
lessen the pain and other symptoms, when the more active in-
jections have done nothing, or have seemed to have done harm.
It very often happens that the irritation is so great at the ori-
fice of the urethra, that the point of the syringe cannot be suf-
fered to enter; when this is the case nothing should be done in
the way of injection till the inflammation abate. Emollients
may likewise be used externally in form of fomentation.
The astringent injections can only act by lessening the dis-
charge. They can have no specific effect upon the inflamma-
tion; but as they must affect the actions of the living powers,
it is possible they may alter the venereal disposition. They
should only be used towards the latter end of the disease, when
it has become mild, and the parts begin to itch. But this should
be according to circumstances, and if the disease begins mildly,
they may be used at the very beginning; for by gradually les-
sening the discharge without increasing the inflammation, we
complete the cure, and prevent a continuation of the discharge,
called a gleet. Injections of this kind very probably stimulate
in such a way as to make the vessels of the part contract, and
probably hinder the act of secretion. We can hardly suppose
that they act chemically by coagulating the juices. They will
have an irritating quality if used strong, which in some mea-
sure destroys their astringency, or rather make the parts act con-
trary to what they would do from the application of a simple
astringent. Thus they often increase the discharge instead of
lessening

OF GONORRHOEA. 75
lessening it, by which means the disease also may be cured, in
the same way as by irritating injections, that is, by altering the
disposition of the inflammation. When more mild, they oft-
en stop the discharge, without however in all cases hastening
the cure; for the inflammation may still continue even longer
than it otherways would have done if the tendency to secretion
had not been stopped. I have already observed, that a surface
that discharges has assumed the complete action of the disease,
which is one step towards a cure or termination. However, it
sometimes happens, that an astringent injection will cure a slight
irritation in a very few days. My experience has not taught
me that one astringent is much better than another.
The astringent gums, as dragon's blood, the balsams, and
the turpentines dissolved in water; the juices of many vegeta-
bles, as oak bark, Peruvian bark, tormentil root, and perhaps
all the metallic salts, as green, blue, and white vitriols; the
salts of mercury, and also alum; probably all act much in the
same way; although we may assert that they do not always act
equally well in every gonorrhœa, for on our changing the in-
jection we sometimes succeed after several others have been tried
in vain.
The external applications are generally poultices, and fo-
mentations; but they can be of little service, except when
the external parts, such as the prepuce, glans, and orifice of
the urethra, are in some degree inflamed; the last indeed is
almost always more or less affected.
When the glands of the urethra are so much swelled so as
to be felt externally, the application of mercurial ointment to
the part may be proper, but most probably this will be of
more service after the inflammation has subsided. Indeed mer-
curial ointment is often applied to all the external surface of
those parts when in a state of inflammation, with an emolli-
ent poultice over it. I am not perfectly satisfied of the utility
of this practice.
CHAP-

76 OF GONORRHOEA.
CHAPTER V.
OF THE CURE OF GONORRHOEA
IN WOMEN.
IN women the cure of the gonorrhœa is nearly the same as
in men; but the disease itself is milder, and the secondary
symptoms less numerous in women. This arises from there not
being so many parts to be affected, and from those parts not be-
ing either of so great extent, or so liable to inflammation;
Hence the cure becomes more simple.
When the disease is in the vagina only, it is easily cured. In-
jections are the best means that can be used, and, after the use
of them, it may be proper to anoint the parts, as far up as pos-
sible, with mercurial ointment*, and also to wash the external
parts often with the injection.
If the inflammation has attacked the urethra, injections there
cannot be so conveniently used, as it is almost impossible for the
patient to throw an injection into that canal.
The injections, recommended in the cure in men, are equal-
ly serviceable here; but they may be made doubly strong, as
the parts of women are not nearly so irritable as the common
seat of this disease in men.
If what I have said of the disease in women be just, we must
see that it will be a difficult thing to say, with any degree of
certainty, when the patient is well; because, whenever the symp-
toms have ceased, the surgeon and the patient will naturally sup-
pose the cure to be complete: but a new trial of those parts
may prove the contrary; or in cases, where the disease has ne-
ver affected the urethra, but only the vagina, and still more
where no symptoms have ever been observed, it will be more
difficult to fix the date of the cure; but general experience
must direct the practitioner.
When the inflammation runs along the ducts of the glands,
whether those of the mouth of the vagina, or urethra, or affects
the glands themselves, the same method is to be followed; in
particular, the mercurial ointment is to be freely applied to the
parts. If the inflammation on the mouths of the ducts is so great
as
* How far mercurial ointment assists in the cure I have not been able to determine; the
use of it arises more from a kind of practical analogy than real experience in such cases.

OF GONORRHOEA. 77
as to shut them up, the duct and glands will suppurate, and
form abscesses: in such cases it will be necessary to open them,
or enlarge the opening already formed, and dress the abscess as
a chancre or bubo.
In the case of a simple running, the constitutional treatment
will be taken notice of hereafter; but if any suppuration follow,
the constitution is to be treated as in chancres and buboes;
for most probably absorption will take place, and its effects
must be guarded against.
CHAPTER VI.
OF THE TREATMENT OF THE CON-
STITUTION IN THE CURE OF
THE GONORRHOEA.
IN the cure of the gonorrhœa, the constitution is in some
cases to be as much attended to as the parts affected, if
not more; but in general this is not necessary. The know-
ledge of the constitution is to be obtained in a great measure
from the local symptoms, and as far as the constitutional treat-
ment can be made similar to the local, they should correspond.
We find in many strong plethoric constitutions, where
both the powers and actions are great, that the symptoms are
violent. These constitutions have generally a strong tenden-
cy to fever of the inflammatory kind; and probably the most
distinguishing mark of such a constitution is that of the symp-
toms not extending beyond the specific distance. Many me-
dicines, which might be of service in another constitution,
will often prove hurtful here, in so much as to increase the
very symptoms they were meant to relieve. I have seen even
opiate clysters, though they relieved at first, yet in the end
produce or increase fever, and by that means increase all the
symptoms. I have seen the balsam  capivi, given in such ca-
ses, increase the inflammatory symptoms, probably by stop-
ping the discharge in part, which appears to be salutary. The
treatment of such a constitution, when affected with this dis-
ease, consists chiefly in evacuations, the best of which are
bleeding

78 OF GONORRHOEA.
bleeding and gently purging. To live sparingly, and above
all to use little exercise, is necessary; for although such a treat-
ment does not lessen the venereal irritation, yet it lessens the
violence of the inflammation, and allows the parts to relieve
themselves. In this kind of constitution, therefore, the dis-
ease is in the end soonest cured, as there is not a tendency to
a continued inflammation.
In the weak and irritable constitution, the symptoms are
frequently very violent, arising from great action in the parts,
and often extend beyond the specific distance; the inflamma-
tion running along the urethra, and even affecting the bladder.
Instead of evacuations, which would rather aggravate the
symptoms than relieve them, the constitution should be strength-
ened, and thus it will be less susceptible of irritation in general.
I have seen patients whose constitutions were such, that
they were never sure of twenty-four hours health, where the
inflammation has been both considerable, and extensive. I
have seen evacuations tried, and the symptoms increased; but
as soon as the bark was given freely, they have become al-
most immediately mild; and without using any other medi-
cine the patients have soon recovered. The medicine here
acted upon the constitution, destroyed the irritability, gave the
parts a true and healthy sense of the venereal irritation, and
brought the inflammation to that state in which it ought to
be in a healthy subject, whereby the constitution was enabled
to cure itself.
So capricious sometimes is this form of the disease in its
cure, that the accession of an accidental fever has stopped the
discharge, the pain in making water has ceased, and the go-
norrhœa has finally terminated with the fever. In others I
have seen all the symptoms of the gonorrhœa cease on the ac-
cession of a fever, and return when the fever has been subdu-
ed. In some I have seen a gonorrhœa begin mildly, but a se-
vere fever coming on, and continuing for several days, has
greatly increased the symptoms, and on the fever going off,
the gonorrhœa has also gone off. Although a fever does not
always cure a gonorrhœa, yet as it possibly may, nothing should
be done while the fever lasts; and if it continues after the
fever is gone, it is then to be treated according to the symptoms.
Unfortunately there are cases where no known method les-
sens the symptoms; evacuations have produced no abatement,
the

OF GONORRHOEA. 79
the strengthening plan has been as unsuccessful; sedatives and
emollients have procured no relief; and time alone has per-
formed the cure. In such cases the soothing plan I believe
is the best, till we know more of the disease. Astringents
should not be used, their action upon the inflamed parts being
uncertain, for they often do not lessen the inflammation or
the pain, although they may perhaps lessen the discharge.
The turpentines, especially the balsam capivi, and Canada bal-
sam, lessen the disposition of the parts to form matter, which
effect has always a salutary appearance; but as they have not
at the same time the power of lessening the inflammation, they
can be of little service.
Besides the various effects arising from the difference of con-
stitution in the gonorrhœa, we find that it is considerably affect-
ed by the patient's way of life, during the inflammatory state,
and also by other diseases attacking the constitution at the same
time. But this is common to all other diseases: for when-
ever we have a local disease, in which light I have consider-
ed a gonorrhœa, it is always affected by whatever affects the
constitution. Most things that hurry, or increase the circu-
lation, aggravate the symptoms, such as violent exercise, drink-
ing too much of strong liquors, eating strong indigestible
food; some kinds of which act specifically on these parts, there-
by increasing the symptoms more than simply heating the bo-
dy, such as peppers, spices and spirits.
From what has been said in general, it must appear that a
gonorrhœa is to be cured in the same way as every other in-
flammation; and it must also appear, that all the methods
used are only to be considered as correctors of irritation in ge-
neral, and of disordered circulation. In cases that have begun
mildly, where the inflammation has been but slight, or in those
cases where the violent symptoms above taken notice of have
subsided, such medicines as have a tendency to lessen the discharge
may be given along with the local remedies before-mentioned.
The turpentines I believe are the most efficacious; cantharides;
the salts of some metals, such as of copper, and lead, and also
of some earths, as alum, are strongly recommended as astrin-
gents when given internally.
Whatever methods are used for the cure, locally or consti-
tutionally, it is always necessary to have in view the possibility
of some of the matter being absorbed, and afterwards appearing
in

80 OF GONORRHOEA.
in the form of a lues venerea; to prevent which, I should be
inclined to give small doses of mercury internally. At what
time this mercurial course should begin is not easily ascertained,
but if the observation be just, that a disposition once formed is
not to be cured by mercury, but that mercury has the power
of preventing a disposition from forming, as was formerly ex-
plained, we should begin early and continue it to the end of the
disease, till the formation of venereal matter ceases, and even
for some time after. The mercurial ointment may be used
where mercury disagrees with the stomach and intestines.
This practice appears to be more necessary it the discharge
has continued a considerable time, and especially if the treat-
ment has been simply by evacuants, for in the former case there
is a greater time for absorption, and in the latter we may sup-
pose a greater call for it, such medicines having no effect in
carrying off the virus.
To prevent a lues venerea being produced by absorption, a
grain of mercurius calcinatus taken every night, or one at night
and another in the morning, may be sufficient; but should be
continued in proportion to the duration of the disease.
The success of this practice in any particular case can never
be ascertained, because it is impossible to say when matter has
been absorbed, except in cases of buboes; and where it is not
known to be absorbed, it is impossible to say that there would
have been a lues venerea if mercury had not been given, as ve-
ry few are infected from a gonorrhœa, although they have tak-
en no mercury. It is, however, safest to give mercury, as we
may reasonably suppose it will often prevent a lues venerea, as
it does when given during the cure of a chancre or bubo, where
we know, from experience, that without it the lues venerea
would certainly take place.
CHAP-

OF GONORRHOEA. 81
CHAPTER VII.
OF THE TREATMENT OF OCCASIONAL
SYMPTOMS OF THE GONORRHOEA.
AS the following symptoms are only occasional consequen-
ces of a venereal gonorrhœa, being the effects of an irri-
tation on the urethra, and therefore not venereal, they are to
be treated in the same manner as if they had arisen from any
other cause.
I. OF THE BLEEDINGS FROM THE URETHRA.
IT has been already observed, that when the inflammation is
violent, or spreads along the urethra, there is frequently a dis-
charge of blood from the vessels of that part. In such bleed-
ing, the balsam capivi, given internally, has been of service;
and it may be supposed that all the turpentines will be equally
useful. I have not found any good effects from astringent
injections; and in some cases, have suspected that they have
been the cause of this complaint. They always go off in the
usual time of the cure of the gonorrhœa.
II. OF PREVENTING PAINFUL ERECTIONS.
OPIUM, given internally, appears to have great effects in
preventing painful erections in many cases. Twenty drops of
tinctura thebaica, taken at bed-time, has procured ease for a
whole night. The cicuta likewise seems to have some powers
in this way.
III. OF THE TREATMENT OF THE CHORDEE.
IN the beginning of this complaint, bleeding from the arm
is often of service, but it is of more immediate service to
take away blood from the part itself by leeches; for we oft-
en find by a vessel giving way in the urethra, and a consider-
able hæmorrhage ensuing, that the patient is greatly relieved.
Relief will often be obtained by exposing the penis to the steam
of hot water. Poultices likewise have beneficial effects;
M and

82 OF GONORRHOEA.
and both fomentations and poultices will often be assisted in
removing inflammation by the addition of camphor. Opium
given internally is of singular service, and if it be joined
with camphor the effect will be still greater; but opium in
such cases acts rather by lessening the pain than by removing
the inflammation, though by preventing erections it may be
said to obviate the immediate cause of the complaint.
When the chordee continues after all other symptoms are
gone, little or nothing in the way of evacuation seems to be
necessary, the inflammation being subdued, and a consequence
of it only remaining, which will cease gradually by the absorp-
tion of the extravasated coagulable lymph; therefore bleed-
ing in this case can be of no use. Mercurial ointment appli-
ed to the parts will promote the absorption of the extravasated
coagulable lymph; for experience has shown that mercury
has considerable powers in exciting absorption; the friction
itself also will be of use. In one case considerable benefit
seemed to result from giving the cicuta, after the common me-
thods of cure had been tried. Electricity may be of service.
This symptom is indeed often longer in going off than ei-
ther the running or pain, but no bad consequences arise from
it; its declension is gradual and uniform, as happens with
most consequences of inflammation.
In relieving the chordee, or the remains of it which ap-
pear to arise from spasm, I have known the bark of great ser-
vice. Evacuations, whether from the parts, or from the
constitution, generally do harm.
IV. OF THE TREATMENT OF THE SUPPURA-
TION OF THE GLANDS OF THE URETHRA.
SUPPERATIONS in the glands of the urethra are to be
treated as chancres. Therefore mercury ought to be given,
as will be explained hereafter.
Should a suppuration take place in Cowper's glands, it
demands more attention; the abscess  must be opened freely,
and early, as the matter if confined may make its way either
into the scrotum or urethra, whence would arise bad conse-
quences. Here also mercury must be given, and perhaps as
freely as in a bubo. In short, the treatment should be the
same as in a venereal ulcer; and in this respect it will differ
from

OF GONORRHOEA. 83
from the treatment of those abscesses which arise in conse-
quence of stricture.
V. OF THE TREATMENT OF THE AFFECTION
OF THE BLADDER FROM GONORRHOEA.
WHEN the disease extends as far as the bladder, it produc-
es a most troublesome complaint, from which however bad
consequences seldom arise. But I suspect that it sometimes
has laid the ground-work of future irritation in that part,
which has proved very troublesome, and even dangerous.
Opiate clysters, if nothing in the constitution forbid the
use of them, procure considerable temporary relief. The
warm bath is of service, although not always; and bleeding free-
ly, if the patient is of a full habit, often does good. Leeches
also applied to the perinæum have good effect; but in many
constitutions bleeding will rather do harm; and we should be
cautious in  making use of this evacuation, for it has been al-
ready observed, that many of these cases are rather from sym-
pathy than inflammation. As this affection of the bladder
often continues for a considerable time, producing other sym-
pathies in the neighbouring parts, and is not in the least mi-
tigated by the methods commonly used, I would recommend
the following trials to be made use of in such cases. An opi-
ate plaister to be applied to the pubes or the small of the back,
where the nerves of the bladder take their origin; a small blister
on the perinæum, which is of service in irritations of the blad-
der arising from other causes.
VI. OF THE TREATMENT OF THE SWELLED
TESTICLE.
WHEN the testicle sympathises either with the urethra or
bladder, and is inflamed, rest is the best remedy; the horizon-
tal position of the body is the easiest, as such a position is the
best for a free circulation. If the patient cannot submit to an
horizontal position, it is absolutely necessary to have the testi-
cle well suspended. Indeed the patient will be happy in having
recourse to that expedient as soon as he is acquainted with the
ease which it affords.
In

84 OF GONORRHOEA.
In this complaint perhaps no particular method of cure can be
laid down. It is to be treated as inflammation in general, by
bleeding and purging, if the constitution requires them, and by
fomentation and poultices. Bleeding with leeches has often been
of service. This we cannot well account for, as the vessels of
the scrotum have but little connection with those of the testicle.
As I do not look upon the swelling of the testicle to be ve-
nereal, mercurials, in my opinion, can be of no service in these
cases while the inflammation continues, but are useful when
that is gone, and the induration only remains.
Vomits have been recommended in such cases, and are some-
times of service. I have known a vomit remove the swelling
almost instantaneously. The effects of the vomit most proba-
bly arise from the sympathy between the stomach and the testi-
cle. Opiates are of service, as they are in most irritations of
those parts. When such swellings suppurate, which they sel-
dom do, they require only to be treated as common suppura-
tions, and mercury need not be given.
In the history of this disease I observed, and indeed it has
been observed by most writers, that when a swelling comes up-
on the testicle in consequence of a gonorrhœa, the running
ceases; or when the running ceases, the testicle swells; but
which is the cause, or which is the effect, has not yet been as-
certained. It has been also observed, that when the running
returns, the testicle then showed the first symptoms of recove-
ry; so that by the testicle having lost its sympathising action,
the action is restored to the urethra. And here also it has not
yet been ascertained, which is the cause, or which is the effect;
but from a supposition that the cessation of the discharge in the
urethra is the cause of the swelling, it has been attributed to
the mode of treatment of that irritation, and by some to in-
jections.
It has been advised by many, and attempted by some, to
procure a return of the running; but the methods used have
hardly been founded upon any sound principle. Mr. Brom-
field appears to have been the first who recommended a treat-
ment suitable to this theory, which was to irritate the urethra
to suppuration again, by introducing bougies. I have not seen
that benefit that could have been wished, or that the first idea
might induce us to expect, from this practice. Some have gone
further; by recommending the introduction of venereal matter
into

OF GONORRHOEA. 85
into the urethra; but this appears to be only conceit, and is
founded upon a supposition that such swellings arise only from
venereal irritations; but I have already observed that they are
produced by other causes.
It is generally a long time before the swelling of the testi-
cle entirely subsides, although it does so more quickly at first
than swellings of this part arising from other causes. Before
it becomes less, it generally becomes softer, commonly on the
anterior surface; and by degrees the whole becomes perhaps
softer than natural, and then it diminishes.
It is still much longer (sometimes even years) before the epi-
didymis returns to its natural state; sometimes it is never re-
duced to its natural size and softness. However this is of no
great consequence, as no inconvenience results from a continu-
ance of the hardness simply; though sometimes perhaps such
testicles are rendered totally useless. I never had an opportu-
nity of examining the testicle of one that was known to have
this complaint; but have examined testicles where the epididy-
mis has had the same external feel, and where the canal of the
vas deferens has been obliterated. But this I suspect to seldom
happen, for there are people who have both testicles swelled,
and notwithstanding discharge their semen as before.
It is in this stage of the complaint that resolvents may be of
service, such as mercurial friction joined with camphor. Like-
wise we may usefully apply fumigations with aromatic herbs in
order to stimulate the absorbents to take up the superfluous mat-
ter. Electricity has been in some cases of singular service.
VII. OF THE DECLINE AND TERMINATION OF
THE SYMPTOMS OF GONORRHOEA.
THE decline of the disease is generally known by an abate-
ment of some or all of the above-mentioned symptoms. The
pain in the part becomes less, or terminates in an itching simi-
lar to what is felt in the beginning of many gonorrhœas, and
at last entirely goes off. The sense of weariness about the loins,
hips, testicles, and scrotum, is no longer felt, and the trans-
parent cherry-like appearance of the glans penis gradually dis-
appears. These are the most certain signs of an abatement of
the disease.
The

86 OF GONORRHOEA.
The running becomes less, or if it does not diminish, be-
comes first whiter, then of a paler colour, and gradually ac-
quires a more slimy and ropy consistence, which has always
been considered as the most certain sign of an approaching cure.
When the running becomes more slimy it is then changed from
matter to the natural fluid which lubricates the passage, and al-
so to that fluid which appears to be preparatory to coition; but
it is often very inconstant in its appearances, arising frequent-
ly from different modes of living, exercise, or other causes.
It very often happens that all the symptoms shall totally disap-
pear, and the patients shall think themselves cured, and yet the same
symptoms shall come upon them anew, commonly indeed mild-
er than at first, though in some cases as violent, or even more
violent; and this takes place sometimes at a considerable di-
stance of time. I have known the symptoms return a month
after every appearance of the disease had been removed. How-
ever in such cases they seldom last long. How far this second
attack is to be looked upon as truly venereal, has not as yet
been ascertained. Nothing can prove it absolutely to be vene-
real but the circumstance of having given it to a sound person.
What may be the case with those in whom it has returned soon
after the going off of the symptoms, I will not pretend to say;
but I should very much suspect that where the patient has con-
tinued well for a month, a return cannot be venereal. This
is only conjecture; and if we were to reason upon it, we might
easily reason ourselves into a belief of its being venereal; for
if the parts can fall back again into one mode of action, that
of inflammation and suppuration, there can be no reason why
they should not fall back again into the specific mode of action.
However, as the common effect of irritation is suppuration,
and as the specific suppuration requires a peculiar irritation, it
is easier to conceive that the parts may fall into the common
mode of action, than in both. It is possible, however, that in
such cases, it is only the venereal action may be only suspend-
ed, similar to what happens between the contamination and
complete appearance of the disease.
In women returns of the symptoms are more frequent than
in men, particularly of the discharge; which being similar to
the fluor albus, and frequently taken for that disease, gives less
suspicion, although they are perhaps equally virulent as those
in men.
The

OF GONORRHOEA. 87
The distinction between a gonorrhœa and a gleet is not yet
ascertained, for the inflammation subsiding, the pain going off,
and the matter altering, are no proofs that the poison is de-
stroyed. It is no more necessary there should be a continuance
of the inflammation to produce the specific poison, than there
should be a continuance of the inflammation to produce the
gleet, as will appear evident from two cases before related*.
The first of these cases shows that the inflammation is not
necessary to the existence of the venereal poison; and on the
contrary, the inflammation may exist after the matter discharg-
ed has ceased to be venereal. I have known cases where the
inflammation and discharge have continued for twelve months,
and with considerable violence: in the mean time a free inter-
course with women has not communicated the disease. How-
ever, this is not an absolute proof that there is no virus in the
discharge.
CHAPTER VIII.
OBSERVATIONS ON THE SYMPTOMS
WHICH OFTEN REMAIN AFTER
THE DISEASE IS SUBDUED.
IT often happens after the virus is destroyed, and the vene-
real inflammation removed, that some one, two, or more
of the symptoms shall continue, and perhaps prove more ob-
stinate than the original disease itself. Some of these symp-
toms should continue through life, and even new ones shall
sometimes arise as soon as the first have subsided. All these
symptoms are commonly imputed by the patients themselves,
and what is still worse, by some of the profession. to the ori-
ginal disease having been ill treated. But certainly so far as
we are yet acquainted with the disease and method of cure,
this is not true; for the methods of treatment, though nume-
rous, may be said to be very similar; and we shall find these symp-
toms not to be consequences of any one mode of treatment,
but
* Vide page 36 and 37.

88 OF GONORRHOEA.
but that they happen indiscriminately after them all. Yet I
can conceive that many constitutions, and particular parts,
often require one mode of treatment in preference to ano-
ther, and probably require modes that we are not as yet ac-
quainted with; but if thefe peculiarities of constitution, or
parts, are not yet known, which must often be the case, the prac-
titioner is not to be rashly accused of ignorance.
In the introduction I observed, that the venereal disease is
capable of calling into action such susceptibilities as are remark-
ably strong, and peculiar to certain constitutions, and coun-
tries; and that as the scrofula is predominant in this country,
some of the effects of gonorrhœa may partake of a scrofulous
nature.
The symptoms which continue after the virus is gone, do
not owe their continuance to the specific qualities of the vi-
rus, but to its effects upon the parts, such as inflammation
and its consequences; for the same degree of inflammation,
arising from any other cause, would leave most of the same
effects. But I suspect that the continuance of the discharge,
called a gleet, is an exception to this; for we find that it is
often cured by the same mode of action which would produce
the other symptoms, that is, inflammation; and we find in
general that a discharge brought on by violence of no speci-
fic kind, does not last longer than the violence, even although
the cause has been continued for some time, as is often the
case during the use of bougies.
The first of the continued symptoms may be reckoned the
remains of the disagreeable sensation excited by the original
disease.
The second, the discharge called a gleet.
The third, the chordee.
The fourth, the irritable state of the bladder.
The fifth, the increase and hardness of the epididymis.
I. OF THE REMAINS OF THE DISAGREEABLE
SENSATIONS EXCITED BY THE ORIGINAL
DISEASE.
THE disagreeable sensations which continue in the urethra
and glans, happen most frequently when the bladder has sym-
pathised with the urethra during the disease; for then there are
often

OF GONORRHOEA. 89
often the remains of the old shooting pains in the glans, or on
its surface, which take their rise from the bladder. These,
however, commonly go off, seldom being the forerunners of
any bad symptoms, and therefore are not to be considered as
part of the disease, but merely a consequence; yet they are
often very troublesome, and teazing to the patient, keeping his
mind in doubt, whether he is cured or not, which makes him
frequently become the dupe of ignorant or designing men.
As these remaining sensations vary considerably in their na-
ture, perhaps no one method of treatment will always be proper.
I have known a bougie, introduced a few times, take off en-
tirely the disagreeable sensation in the urethra; and I have
known it do no good. Gentle irritating injections used occa-
sionly will often alleviate in some degree those complaints. A
grain of corrosive sublimate to eight ounces of water makes a
good injection for this purpose; but all such applications are in
general no more than palliatives.
I have known the use of hemlock relieve the symptoms ve-
ry much, and in some cases entirely cure them; while in ma-
ny others it has not had the least effect.
A blister applied to the perinæum will entirely cure some of
the remaining symptoms, even when they extend towards the
bladder, as will be explained hereafter. Indeed it appears to
have more effect than any other remedy. A blister to the small
of the back will also give relief, but not so effectually as when
applied to the perinæum.
The following cases are remarkable instances of this. A
Portuguese gentleman, about twenty-five years of age, had con-
tracted a venereal gonorrhœa, of which he was cured; but
two years after many of the symptoms still continued, and even
with considerable violence. The symptoms were the following;
a frequency in making water, and when the inclination came
on he could not retain it a moment; a straining, and pain in
the bladder after voiding it; a constant pain in the region of
the bladder; a shooting pain in the urethra, which extended
often to the anus; strange sensations in the perinæum; a sense
of weariness in the testicles; and if he at any time pressed his
thighs close together, the pain or sensation in the perinæum
was excited. It was supposed at Lisbon that he had the stone,
and he came over to London for a cure of that disease. He
was examined, but no stone was found. He was ordered to
N wash

90 OF GONORRHOEA.
wash the external parts every morning with cold water, which
he did for a fortnight, but found no benefit. I was consulted,
and informed of all the above-mentioned circumstances. As a
staff had been passed, there could be no stricture; however, I
thought it was possible there might be a diseased prostate gland,
and therefore examined him by the anus; but found that gland
of its natural size and firmness. As there was no visible alter-
ation of structure any where to be found, I looked upon the
disease as only a wrong action of the parts, and therefore or-
dered a blister to be applied to the perinæum, which being kept
open only a few days, all the symptoms were entirely removed.
He retained his water as usual; all the disagreeable sensations
went off; and the blistered part was allowed to heal. About a
fortnight after, he got a fresh venereal gonorrhœa, which
alarmed him very much, as he was afraid it might bring back
all his former symptoms, which however did not return, and
he was soon cured of the gonorrhœa. He staid in London
some time after, without any relapse.
Another case, was that of a gentleman's servant in the
country. He had, from a venereal cause, a disagreeable
sensation whenever he made water, also a running, and some
degree of chordee; which symptoms he had laboured under for a
considerable time. He had gone through a course of mercu-
ry which lasted two months, on a supposition that the vene-
real virus not being destroyed, but without benefit. He had
after that been bled, used powders of gum arabic and traga-
canth, and taken calomel in small doses, with no better success.
He then had recourse to injections and bougies of all kinds,
but with no better success. On the ground of the symptoms
not being venereal, but only wrong actions of the parts, a blis-
ter was applied upon the perinæum, repeated and kept open
six days, upon which the symptoms totally disappeared, and
had not recurred a twelvemonth afterwards.
This practice is not only of service where there has been a
preceding gonorrhœa, but I have found it remove, almost im-
mediately, suppressions of urine from other causes, where the
turpentines and opium, both by the mouth and anus, had
proved ineffectual, and when the catheter had been necessarily
introduced twice a day to draw off the water. But of this
more fully hereafter.
Electricity

OF GONORRHOEA. 9l
Elctricity has been found to be of service in some cases,
and therefore may be tried either in the first inftance, or when
other means have failed.
II. OF A GLEET.
WHATEVER method has been had recourse to in the cure
of the venereal inflammation, whether injections have been
used or internal medicines, (mercurials, purgatives, or astrin-
gents) it often happens that the formation of pus shall con-
tinue, and prove more tedious and difficult of cure than the
original disease. For as I have already observed, the vene-
real inflammation is of such a nature as to go off of itself, or
to wear itself out: or, in other words, it is such an action
of the living powers as can subsist only for a certain time.
But this is not the case with a gleet, which seems to take its
rise from a habit of action which the parts have contracted,
and as they have no disposition to lay aside this action, it of
course is continued; for we find in those gonorrhœas, which
last long, and are tedious in their cure, that this habit is
more rooted than in those which go off soon.
This disease, however, has not always the disposition to
continue, for it often appears to stop of itself, even after every
method has been ineffectually used. It is most probable, that
this arises from some accidental changes in the constitution,
not at all depending upon the nature of the disease itself.
I have suspected that there was something scrofulous in
some gleets. We find frequently that a derangement of the
natural actions of a part will be the cause of that part faillng
into some new disease, to which there may be a strong ten-
dency in the constitution. We find that a cold falling on the
eyes produces a scrofulous weakness in those parts, with a
considerable discharge. There are often scrofulous swellings
in the tonsils from the same cause.
This opinion of the nature of some gleets is strengthened
by the methods of cure, for we find that the sea-bath cures more
gleets than the common cold bath, or any other mode of bath-
ing. I have never yet tried the internal use of those medi-
cines which are generally given in the scrofula; but I have
found sea-water diluted, and used as an injection, cure some
gleets, though it is not always effectual.
A gleet

92 OF GONORRHOEA.
A gleet is generally understood to arise from a weakness;
this certainly gives us no idea of the disease, and indeed there
is none which can be annexed to the expression. By mecha-
nical weakness is understood the inability to perform some action,
or sustain some force. By animal weakness the same is under-
stood. But when the expression is applied to the animal's
performing an uncommon, or an additional action, I do not
perfectly understand it.
Upon this idea of weakness depended in a great measure the
method of cure; but we shall find that the treatment, founded
on this idea, is so far from answering in all cases, that it oft-
en does harm, and that a contrary practice is successful.
A gleet differs from a gonorrhœa, first in this, that though
a consequence of it, it is perfectly innocent with respect to in-
fection. Secondly, when it is a true gleet it is generally dif-
ferent in some of the constituent parts of the discharge, which
consists of globular bodies floating or wrapt in a slimy mucus
instead of a serum. But the urethra is so circumstanced as
easily to fall back into the formation of pus, and this com-
monly happens upon the least increase of exercise, eating or
drinking indigestible food, or any thing which increases the
circulation or heats the patient. The virus, however, I be-
lieve does not return; but of this I am not certain, for
there are cases that make it very doubtful, as was before ob-
served.
I am inclined to suspect that a gleet arises from the surface
of the urethra only, and not from the glands; for I have ob-
served in several instances, that when the passage has just been
cleared, either by the discharge of urine, or by the use of an
injection, a lascivious idea has caused the natural slime to flow
very pure, which I do suppose would not have happened if the
parts secreting the liquor, had assisted in forming the gleet.
A gleet is supposed to be an attendant upon what we call a
relaxed constitution; but I can hardly say that I have observed
this to be the case; at least, I have seen instances where I should
have expected such a termination of a gonorrhœa, if this had
been a general cause, but did not find it; and I have seen it in
strong constitutions, at least in appearance, in every other re-
spect. Gleets do not in all cases arise from preceding gonor-
rhœas, but sometimes from other diseases of the urethra. A
stricture in the urethra is, I believe, almost always attended
with

OF GONORRHOEA. 93
with a gleet. It sometimes arises also from a disease in the
prostate gland.
When a gleet does not arise from any evident cause, nor can
be supposed to be a return of a former gleet in consequence of
a gonorrhœa, a stricture, or diseased prostate gland is to be sus-
pected; and inquiry should be made into the circumstances of
making water, whether the stream is smaller than common —
whether there be any difficulty in voiding it — and whether the
calls to make it are frequent. If there should be such symptoms,
a bougie, of a size rather less than common, ought to be used,
which, if there is a stricture, will stop when it reaches it; and
if it passes on to the bladder with tolerable ease, the disease is
probably in the prostate gland, which should be next examined.
But more fully of both these complaints hereafter.
III. OF THE CURE OF GLEETS — CONSTITU-
TIONALLY — LOCALLY.
AS this discharge has no specific quality, but depends upon
the constitution of the patient, or nature of the parts themselves,
there can be no certain or fixed method of cure; and as it is
very difficult to find out the true nature of different constituti-
ons, or of parts, it becomes equally difficult to prescribe with
certainty the medicines that will best suit this disease; for so
great is the variety in constitutions, that what in one case proves
a cure, will in another aggravate the complaint.
There are two ways of attempting the cure of this com-
plaint, constitutionally, or locally.
Medicines, taken into the constitution with a view to the
cure of gleet, may be supposed to act in three ways, as speci-
fics*, strengtheners, and astringents.
The specific power of internal medicines upon those parts is
not very great, however we find that some of them, such as
the balsams, turpentines, cantharides, are of use, especially in
slight cases. I think I have been able to ascertain this fact,
that when the balsams, turpentines, or cantharides are of ser-
vice they are almost immediately so; therefore if upon trial
they are not found to lessen, or totally remove the gleet in five
or
* It may be necessary to remark here, that by specific I do not mean a specific for the
disease, but only such medicines as act specifically on the parts concerned, as the turpen-
tines, cantharides, &c.

94 OF GONORRHOEA.
or six days, I have never continued them longer. And even
where they have either lessened or totally removed the gleet in
that time, it will often recur upon leaving them off, and there-
fore they should be continued for some time after the symptoms
have disappeared. I have known cases where the gleet has dis-
appeared immediately upon the use of the balsam capivi, and
recurred upon the omission of it; and I have also seen where
that medicine has kept it off for more than a month, and yet
it has recurred immediately upon laying it aside, and stopped
again as quickly, when the patient has returned to it. In such
cases the other methods of cure should be tried. The balsams
may either be given alone, or mixed with other substances so
as to make them less disagreeable.
The general strengtheners of the habit need only be given
when the parts act merely as parts of that habit. The whole be-
ing disposed to act properly, these parts are also disposed to act in
the same way. By general strengtheners are here meant, the
cold bath, sea-bath, the bark and steel. Astringents taken into
the constitution have no great powers, and if they had, they
might be very improper, as any thing that could act with powers
in the constitution equal to what would be necessary here, might
very much affect many natural operations in the animal œconomy.
The astringent gums, and salt of steel, are commonly given.
The second mode of cure is by local applications; these may
be divided into four, which are, specifics, astringents, irritat-
ing medicines, and such as act by derivation.
The specifics applied locally, we may reasonably suppose
will have greater effects than when given internally, because
they may be applied stronger than can safely be thrown into the
circulation. Of this I think I have had experience.
The astringents commonly used are, the decoction of the
bark, white vitriol, alum, and preparations of lead. The aqua
vitriolica cœrulea, of the London Dispensatory, diluted with
eight times its quantity of water, makes a very good astringent
injection. The same observations that I made on the specifics
are applicable to the astringents; I believe that they act nearly
in the same manner, and have the same effect. What their
mode of action is it is difficult to say.
When either of these methods have been used, and have had
the desired effect, they should be continued for a considerable
time after the symptoms have disappeared, and the time must
be

OF GONORRHOEA. 95
be in proportion to the duration of the complaint, or the fre-
quency of its returns. If it has been of a long standing, we
may be sure that the disposition for such a complaint is strong;
and if it has returned frequently, upon the least increase of cir-
culation, we may expect the same thing to happen again; there-
fore to correct the bad habit, it is necessary to continue the me-
dicines a considerable time.
Irritating applications are either injections or bougies, sim-
ple, or medicated with irritating medicines; violent exercise
may be considered as having the same effect. Such applications
should never be used till the other methods have been fully tri-
ed and found unsuccessful. They differ from the foregoing by
producing at first a greater discharge than that which they are
intended to cure; and the increased discharge may or may not
continue as long as the application is used. It becomes there-
fore necessary to inquire how long they are to be used to pro-
duce a cure of the gleet. That time will generally be in pro-
portion to the violence used, and the nature of the parts which
form the matter; and according to the disposition being strong
or weak joined to its duration, and the greater or less irritabi-
lity of the parts. If the parts are either weak or irritable, or
both, an irritating injection should not be used; if strong, and
not irritable, it may be used with safety. In this last case, if it is
an injection that stimulates very considerably, perhaps it may
be sufficient to use it twice or thrice a day. I knew a gentle-
man who threw into the urethra, for a gleet of two years stand-
ing, Goulard's extract of lead undiluted, which produced a
most violent inflammation, but when the inflammation went
off, the gleet was cured. Two grains of corrosive sublimate
to eight ounces of water are a very good irritating injection.
If it is a gleet of old standing, it may require a week or
more to remove it, even with an irritating injection; and if
the injection is less irritating, so as to give but little pain,
and to increase the discharge in a small degree, it may require
a fortnight. But one precaution is very necessary respecting
the use of irritating injections; it should be first known if pos-
sible, that they will do no harm. To know this may be dif-
ficult in many cases, but the nature of the parts is to be as-
certained as nearly as possible, that is, whether they had ever
been hurt before by such treatment; whether they are so sus-
ceptible of irritation, as that the irritation may be expected to
run

96 OF GONORRHOEA.
run along the urethra and produce symptoms in the bladder; for
in such cases irritating applications do not answer, but on the
contrary, often produce worse disorders than those which they
were meant to cure.
Bougies may be classed with the irritating applications, and
in many cases they act very violently as such. They appear
to be more efficacious than injections, but they require longer
time to produce their full effect. A simple, or unmedicated
bougie, is in general sufficient for the cure of a gleet, and re-
quires a month or six weeks application before the cure can be
depended on. If bougies are made to stimulate otherwise than
as extraneous bodies, then a shorter time will generally be suf-
ficient; probably the best mode of medicating them, would be
by mixing a little turpentine, or a little camphor with the com-
position, so as to act specifically on the parts; but great care
should be taken not to irritate too much.
The size of the bougie should be smaller than the common,
and need only be five or six inches long, as it seldom happens
that a greater extent of the urethra has the disposition to gleet;
but no harm will arise from passing a bougie of the common
length through the whole extent of the urethra.
In the cure of a gleet, attempted by means of the bougie,
we have no certain rules to direct us when it should be left off;
as the discharge will often continue as long as the bougie is
used. If upon leaving off the bougie after the use of it for se-
veral weeks, the running ceases, then we may hope there is a
cure performed; but if it should not be in the least diminish-
ed, it is more than probable that bougies will not effect a cure,
and therefore it is hardly necessary to have recourse to them
again. Yet if the gleet is in part diminished, it will be right
to begin again, and probably it may be proper to increase the ir-
ritating quality of the bougie, in order to suit it to the dimi-
nished irritability of the parts.
The fourth mode of cure is by sympathy, or by producing
an irritation in another part of the body, which shall destroy
the mode of action in the urethra.
I knew a case of obstinate gleet attended with very disagree-
able sensations in the urethra, especially at the time of making
water, removed entirely by two chancres appearing upon the
glans. The patient had taken all the medicines commonly re-
commended, and had applied the bougie, without effect.
A gentleman

OF GONORRHOEA. 97
A gentleman informed me, that he had cured two persons
of gleets, by applying a blister to the underside of the urethra;
and I have known several old gleets, after having baffled all
common attempts, cured by electricity. All these different
methods of cure alter the disposition of the part.
In whatever way the cure is attempted, rest or quietness in
most cases is of great consequence; for, as I have observed,
exercise is often a cause, not only of its continuance, but of
its increase and return. But this idea is not to be too rigidly
adhered to, especially in cases which have been treated unsuc-
cessfully; as I have known some that have got immediately
well by riding on horseback after long disuse of that exercise.
Regularity and moderation in diet should be particularly at-
tended to; for irregularities of this kind either hinder the cure
or bring on a return of the disease.
Intercourse with women often causes a return, or increase
of gleet, and in such cases it gives suspicion of a fresh infecti-
on; but the difference between this, and a fresh infection is,
that here the return will follow the connection so close, as to
be almost immediate, and that circumstance joined with the
other symptoms will in general ascertain the nature of the
discharge.
The cure of the gleet in women is nearly the same as in
men, except in the use of what I have called specifics to the
parts; for as the gleet in women is principally from the vagi-
na, I believe that this part is not more affected by the turpen-
tines than other parts are; but as the vagina is less irritable than
the urethra in men, the astringents which are applied to it may
be considerably stronger. Neither can we use the bougie in
cases of gleet in the vagina; and when the gleet is only from
the urethra, I imagine it is hardly ever attended to in women.
IV. OF THE REMAINING CHORDEE.
THIS symptom, I have already observed, often remains af-
ter every mark of the true virus is removed, and may or may
not be an attendant on any of the other continuing symptoms.
Mercurial ointment, applied to the part, may be of service,
and if joined with camphor, its powers will be increased. I
have known electricity cure a chordee of long standing. If
it is the spasmodic chordee that remains, bark should be given.
O V. OF

98 OF GONORRHOEA.
V. OF THE CONTINUANCE OF THE IRRITA-
TION OF THE BLADDER.
THE irritation of the bladder sometimes continues after eve-
ry other symptom is ceased, and it may be an attendant upon
all, or any of the other continuing symptoms; it seldom lasts
with the same violence, although it is often very troublesome.
When this irritation is kept up with the same violence, the
bladder itself may be suspected of being diseased; or it may
arise from its connection with other parts, such as the urethra,
or prostate gland; for a stricture in the urethra coming on
will prove the cause of its continuance, and a disease in the
prostate gland will do the same.
Neither of these diseases will probably follow the gonorrhœa
so closely as to keep up this irritation, though perhaps they
may have been taking place prior to the gonorrhœa, and so
contribute to its increase, and continuance; which may pro-
bably be ascertained by a history of the patient preceding the
present complaint; however, before the bladder itself is attempt-
ed to be cured, a bougie should be passed, and if no stricture
is found, then the prostate gland should be examined, as shall
be described.
When the disease is in the bladder only, I think the pain is
principally at the close of making water, and for a little while
after. The cure of this symptom consists in opiate clysters,
cicuta, bark, sea-bathing, and I should be inclined to recom-
mend the application of a blister to the perinæum in men.
How far opiate clysters can affect the bladder in women as they
do in men, I am not certain.
VI. OF THE REMAINING HARDNESS OF THE
EPIDIDYMIS.
THIS symptom I have observed remains long after every
other symptom is removed, and may continue even for life,
but seldom or ever any bad consequences happen from it, if
the vas deferens is not rendered impervious; and not even then
if it is only in one testicle, the other being equal to all the
purposes of generation. As this is the case, we must at once
see, that no certain method of resolution is yet known. The
application

OF GONORRHOEA. 99
application of the steam of hot water with camphor, may be
tried, especially in such cases as are not disposed to be perma-
nent; and the scrotum may be rubbed with mercurial oint-
ment joined with camphor. But, in most cases, this practice
will prove too tedious, or rather too inefficacious to be long
persisted in.
PART

[ 100 ]
PART III.
CHAPTER I.
OF DISEASES SUPPOSED TO ARISE IN
CONSEQUENCE OF VENEREAL IN-
FLAMMATION IN THE URE-
THRA OF MEN.
THE gonorrhœa produces, or at least is supposed to pro-
duce, besides those disorders already mentioned, many
others which are totally different from the original disease.
How far they do all or any of them arise in consequence of
this disease, is not clear; but as they are diseases of the ure-
thra, and are both numerous and important, I mean to treat
fully of them in this place. If any of these diseases arise
from a gonorrhœa, they are most probably not the conse-
quences of any specific quality in the venereal poison, but are
such as might be produced by any common inflammation in
those parts, as was observed of the continued symptoms.
In this investigation we shall find some of the complaints
arising out of each other, so that there is frequently a series
of them. Thus a stricture of the urethra produces an irrita-
ble bladder, a frequent desire to make water, increased strength
of the bladder, a dilatation of the urethra between the blad-
der and stricture, ulceration, fistulæ in perinæo, dilatation of
the ureters and enlargement of the pelvis of the kidneys, be-
sides other complaints that are sympathetic, such as swellings
of the testicle, and of the glands in the groin. I shall treat
of the disease of those parts in the older in which they most
commonly arise.
It may be observed that most of these diseases, especially
diminution of distensibility in the bladder, attack men advanc-
ed beyond middle age, although many, if not all of them, are
at times found in younger subjects, and the circumstance of
their

SUPPOSED CONSEQUENCES, &c. 101
their appearing at this period arises probably in some degree
from a long habit of an unnatural mode of life producing ma-
ny diseases, such as gout; for certainly such complaints do
not so frequently take place among the more uncivilized nations.
The most frequent disease in the urethra is an obstruction
to the passage of the urine; it happens both in young and old,
although most frequently in the latter. Before I begin to treat
of this subject, I shall, for the better understanding of the
whole, make some observations on the use of this passage in its
natural state.
It may first be observed, that the urethra in man is employ-
ed for two purposes. On this occasion I may be allowed to
make the following general remark, that nature has not been
able to apply any one part to two uses with advantage, as might
be illustrated in many instances in different animals. The ani-
mals whose legs are both for swimming and walking, are not
good at either, as seals, otters, ducks, and geese. The ani-
mals also whose legs are intended both for walking and flying,
are but badly formed for either, as the bat. The same ob-
servations are applicable to fish, for the flying fish neither swims,
nor flies well; and whenever parts intended for such double func-
tions are diseased, both are performed imperfectly. This is im-
mediately applicable to the urethra, for it is intended as a canal
or passage, both for the urine, and the semen. The urine re-
quires the simplest of all canals, and of no greater length than the
distance from the bladder to the external surface, as we find
the urethra in women, birds, the amphibia, and fish; but the
passage for the semen in the quadruped required to be a com-
plicated canal, and of a length capable of conveying the se-
men to the female, provided with many additional and neces-
sary parts, as the corpus spongiosum urethræ, musculi accele-
ratores, Cowper's glands, prostate glands, and vesiculæ semi-
nales. As all these parts are to serve the purpose of genera-
tion, and as the diseases of this canal are principally seated
in them, we at once see how much the urinary organs must
suffer from a connection with parts so numerous, and so liable
to disease; and what adds to the evil is, that the actions of the
urinary organs are constant, and absolutely necessary for the
well-being of the machine, whereas the evacuation of the se-
men takes place only during a certain portion of life, is then
only occasional, and never essentially necessary to the exist-
ence

102 SUPPOSED CONSEQUENCES
ence of the individual. The force of this observation is at once
seen by making the comparison between the inconvenience
that attended the expulsion of the urine in the male, and in
the female.
The canal of the urethra is liable to such diseases as are ca-
pable of preventing in some degree the passage of the urine
through it; and in some of these diseases the passage at last be-
comes completely obstructed. In all cases there is a diminu-
tion of the size of the canal, but in different ways. There are
five modes of obstruction, four of which are diseases of the pas-
sage itself, the fifth is a consequence of the diseases of other
parts. Three of the former are a lessening of the diameter of
the passage; the fourth an excrescence in the passage; the fifth
arises from the sides being compressed, which may be done
either by exterior contiguous swellings, or by a swelling of the
prostate gland.
I. OF STRICTURES.
THE three first I shall now consider, of which the first is the
true permanent stricture arising from an alteration in the struc-
ture of a part of the urethra. The second is a mixed case,
composed of a permanent stricture and spasm. The third is the
true spasmodic stricture. Most obstructions to the passage of
the urine, if not all, are attended with nearly the same symp-
toms, so that there are hardly sufficient marks for distinguish-
ing the different causes. Few take notice of the first symptoms
of a stricture till they have either become violent, or have been
the cause of other inconveniences; for instance, a patient shall
have a considerable stricture without observing that he does not
make water freely; he shall even have, in consequence of a
stricture, a tendency to inflammation, and suppuration in the
perinæum, and not feel any obstruction to the passage of his
urine, nor suspect that he has any other complaint than the in-
flammation in the perinæum. In all of these obstructions the
stream of water becomes small, and that in proportion to the
obstruction; but this symptom, though probably it is the first,
is not always observed by the patient. In some the water is
voided only in drops, and then it cannot escape notice; in others
the stream of urine is forked, or scattered; under such circum-
stances the passage should be examined with a bougie; and if
one

OF GONORRHOEA. 103
one of a common size passes with tolerable ease, the fifth cause
of obstruction is to be suspected, which will most probably be
found to be a swelled prostate gland; for any other cause that
can produce a compression of the sides of the urethra, sufficient
to obstruct the urine, will be known to the patient, such as a
tumor forming any where along the canal, or an inflammation
along its sides. If therefore neither of these are known to ex-
ist, the prostate gland should be examined, as will be describ-
ed hereafter.
The spasmodic obstruction will commonly explain itself when
the symptoms are well investigated; for the obstruction arising
from this cause will not be permanent. These obstructions, but
more particularly that from a permanent stricture, is generally
attended with a discharge of matter or a gleet. This is often
considered by the patient as the whole disease, and he applies to
the surgeon for the cure of a gleet. The surgeon often perse-
veres in attempting the cure of this disease; but no success at-
tending him, at last other symptoms are observed, and a stric-
ture is suspected either by the surgeon or patient. In diseases of
this passage, and also of the prostate gland and bladder, there is
commonly an uneasiness about the perinæum, anus, and lower
part of the abdomen, and the person can hardly cross his legs
without pain.
CHAPTER II.
OF THE PERMANENT STRICTURE.
IN the permanent stricture* the patient seldom complains till
he can hardly procure a passage for the urine; and fre-
quently has a considerable degree of strangury, and even other
symptoms that happen in stone and gravel, which are there-
fore too frequently supposed to be the causes of the complaint.
The disease generally occupies no great length of the passage;
at least in most of the cases that I have seen, it extended no
further in breadth than if the part had been surrounded with
a piece
Vide plate I, fig. I.

104 SUPPOSED CONSEQUENCES
a piece of packthread; and in many it had a good deal of that
appearance. I have however seen the urethra irregularly con-
tracted for above an inch in length, owing to its coats, or in-
ternal membrane, being irregularly thickened, and forming a
winding canal.
A stricture does not arise in all cases from an equal contrac-
tion of the urethra all round, but in some from a contraction of
one side, which probably has given the idea of its having aris-
en from an ulcer on that side. This contraction of one side
only, throws the passage to the opposite side, which often ren-
ders it difficult to pass the bougie. The contracted part is
whiter than any other part of the urethra, and is harder in its
consistence. In some few cases there are more strictures than
one. I have seen half a dozen in one urethra; some of which
were more contracted than others; and indeed many urethras
that have a stricture have small tightnesses in other parts of
them. This we learn from successive resistance felt in passing
the bougie.
Every part of the urethra is not equally subject to strictures,
for there appears to be one part which is much more liable to
them than the whole of the urethra besides, that is about the
bulbous part. We find them however sometimes on this side
of the bulb, but very seldom beyond it. I never saw a stric-
ture in that part of the urethra, which passes through the pro-
state gland; and the bulb, besides being the most frequent seat of
this disease, has likewise the strictures formed there of the worst
kind. They are generally slow in forming, it being often se-
veral years from their being perceived before they become ve-
ry troublesome.
The same stricture is not at all times equally bad; for we
find that in warm weather it is not nearly so troublesome as in
cold: these changes are often very quick, a cold day, even an
hour of cold weather, shall produce a change in them; and
the same stricture is almost always worse in winter than in sum-
mer. However, this observation is not free from exceptions;
I knew one case that was always worse in the summer. There
are other circumstances besides cold that make a stricture worse.
A gentleman who had an ague, always found the stricture in-
creased during the fit. It is also increased by drinking, vio-
lent exercise, and by the retention of urine after an inclination
to void it has been felt. This last cause is often so great as to
produce

OF GONORRHOEA. 105
produce a total stoppage for a time. It is sometimes rendered
much worse by a small calculus passing from the bladder, of
the formation of which this stricture was probably the cause.
The calculus not passing will produce a total stoppage of urine,
the cause of which can hardly be known at the time; and if
known, it could not be remedied without an operation*.
It is impossible to say what is the cause of that alteration in
the structure of the urethra which diminishes the canal: it has
been ascribed to the effects of the venereal disease, and often to
the method of cure; but I doubt very much if it commonly,
or even ever, arises from these causes; yet as most men have
had venereal complaints some time or other, it is natural to
ascribe the stricture to them; and therefore it may be very dif-
ficult to refute this opinion. Many reasons however can be
given why we should suppose that it is not commonly a conse-
quence of a venereal inflammation. Strictures are common
to most passages in the human body; they are often to be
found in the œsophagus; in the intestines, especially the rec-
tum; in the anus; in the prepuce producing phymosis; in the
lachrymal duct producing the disease called the fistula lachry-
malis, where no disease had previously existed. They some-
times happen in the urethra where no venereal complaint has
ever been. I have seen an instance of this kind in a young
man of nineteen, who had had the complaint for eight years,
and which therefore began when he was only eleven years of
age. It was treated at first as stone, or gravel. He was of
a scrofulous habit, the lips thick, the eyes sore, a thickened
cornea of one eye, and the general habit weak. This stricture
was in the usual place, about the membranous part of the ure-
thra. I have seen an instance of a stricture in the urethra of
a boy of four years, and a fistula in perinæo in consequence
of it. They are as common to those who have had the go-
norrhœa slight, as those who have had it violently.
I knew a young gentleman who had a very bad stricture.
He had had several gonorrhœas, but they were so slight that
they seldom lasted a week; nor in any of them did the pain
extend beyond the frænum; but the stricture was about the
membranous part. Cases of this kind occur every day. They
are never found to come on during the venereal inflammation,
nor for some time after the infection is gone. There has been
P thirty,
* Vide plate III.

106 SUPPOSED CONSEQUENCES
thirty, and sometimes forty years, between the cure of a gohor-
rhœa and the beginning of a stricture, the health being all that
time perfectly good. If they arose in consequence of the ve-
nereal inflammation, we might expect to find them of some
extent, because the venereal inflammation extends some way;
and we should also expect to find them most frequent in that
part of the urethra which is most commonly the seat of the
venereal disease. But I remarked before, that they are not so
frequent there as they are in other parts of the urethra.
It is supposed by many, that strictures arise from the use of
injections in the cure of gonorrhœa; but this opinion appears
to be founded in prejudice; for I have seen as many strictures
after gonorrhœas, that have been cured without injections, as
after those cured with them.
Such modes of accounting for strictures give no explana-
tion of those where there has been no previous gonorrhœa, or
where the gonorrhœa has not been cured by injections; and
indeed if we consider the mode of cure of strictures, we must
see that an injection is a mild application to the urethra, com-
pared to a bougie; yet a bougie has never been supposed, or
known to be the cause of a stricture. Further, some have in-
jected by mistake very irritating liquors, such as the undiluted
extract of lead, and caustic alkali, without giving the least ten-
dency towards a stricture, although they produced violent in-
flammation, and even sloughing of the internal membrane of
the urethra.
By many they have been supposed to have arisen from the
healing of ulcers in the urethra; but as I never saw an ulcer
in these parts, except in consequence of a stricture, and as I
do not believe there ever is an ulcer in the case of a common
gonorrhœa, I can hardly subscribe to that opinion.
I. OF THE BOUGIE.
The bougie, with its application, is, perhaps, one of the
greatest improvements in surgery which these last thirty or for-
ty years have produced. When I compare the practice of the
present day with what it was in the year 1750, I can scarcely
be persuaded that I am treating the same disease. I remem-
ber, when about that time, I was attending the first hospitals
in

OF GONORRHOEA. 107
in this city, the common bougies were either a piece of lead*
or a small wax candle; and although the present bougie was
then known, yet a due preference was not given it, or its
particular merit understood, as we may see from the publica-
tions of that time.
Daran was the first, who improved the bougie and brought
it into general use. He wrote professedly on the diseases for
which it is a cure, and also of the manner of preparing it; but
he has introduced so much absurdity in his descriptions of the
diseases, the modes of treatment, and of the powers and com-
postion of his bougies, as to create disgust. However, this
absurdity has been much more effectual in introducing the bou-
gie into universal use, than all the real knowledge of that time,
directed by good sense, could have been. Such extravagant
recommendations of particular remedies are not at all times
without their use. Inoculation would have still been practised
with caution, had it not been for the enthusiasm of the Suttons.
Preparations of lead would not have been so universally appli-
ed if they had not been recommended by Coulard in the most
extravagant terms; nor would the hemlock have come into
such general use if its true merits only had been held forth.
Improvements are often over-rated; but they come to their
true value at last: Sutton has told  us, that the cold regimen,
in extreme, is infinitely better than the old method; but from
general practice we have learned that moderation is best, which
is all we yet know.
When Daran published his observations on the bougie, eve-
ry surgeon sat to work to discover the composition, and each
conceived that he had found it out, from the bougies he had
made producing the effects described by Daran. It never oc-
curred to them that any extraneous body, of the same shape
and consistence, would do the same thing.
II. OF THE TREATMENT OF THE PERMANENT
STRICTURE.
THE cure of the permanent stricture is, I believe, to be ac-
complished only by local applications. Mercury has been giv-
en
* When lead was used in place of bougies, it has happened that a piece of the end
has broken off in the bladder, which has been dissolved by injecting quicksilver. I at
first suspected that quicksilver could not come in contact with lead, while in water, so
as to dissolve it, but upon making the experiment I found it succeded.

108 SUPPOSED CONSEQUENCES
en upon the erroneous supposition of its being venereal; but
without success. The cure is either a dilatation of the con-
tracted part, or a destruction of it by ulceration, or escharotics.
The dilatation is performed by the bougie; and this is seldom
or ever more than a temporary cure; for although the passage
may be dilated sufficiently for the urine to pass, yet there is al-
ways the original tendency to contraction, which generally re-
curs sooner or later*. The ulcerative process is also affected
by a bougie, and the destruction by escharotics, is by means
of caustics. It often happens in strictures, that the passage is
so diminished as hardly to allow any water to pass, producing
often a total stoppage; nor will a bougie immediately pass;
and if it can be made to pass; yet no water follows it when
withdrawn. In such cases therefore we must have recourse to
the means that afford a temporary relief; such as the warm
bath, which counteracts the effects of cold, and quiets any
spasms that may have taken place in the parts, and clysters
with opium, which still have more effect. Producing an eva-
cuation by stool, often lessens the spasm, for a spasmodic sup-
pression of urine frequently arises from a constipation, even
where there is no stricture.
The cure by dilatation is, I imagine, principally mechani-
cal when performed by bougies, the powers of which are in ge-
neral those of a wedge. However, the ultimate effect of them
is not always so simple, as that of a wedge upon inanimate mat-
ter; for pressure produces action of the animal powers, either
to adapt the parts to their new position, or to recede by ulcera-
tion, which gives us two very different effects of a bougie, and
of course two different intentions in applying them; one to pro-
duce dilatation, the other ulceration; which last is not always so
readily effected.
It generally happens, as has been already observed, that the
disease has gone considerable lengths before application has been
made for a cure, and therefore the stricture has become consi-
derable,
* In cases of stricture, when a patient applies for relief, it may often be proper to in-
quire into the history of the case, previous to the passing of a bougie; especially to in-
quire if he ever used bougies before; if he has, then to inquire into the result; if they
passed readily, or if they did not pass the stricture at all: if the first, then nothing fur-
ther need be asked; but if the laft, then inquire if he or his surgeon observed that they
were gaining ground with the bougie, viz. If the bougie went further in before it was left
off than at first; if so, then to ask him how far. If they have visibly gained ground with-
out getting through the stricture, I am afraid that the use of the bougie must not be pur-
sued, because it is most probable that a new passage has been formed, which makes the
passing of the bougie into the stricture impossible.

OF GONORRHOEA. 109
derable, in so much that it is often with great difficulty that a
small bougie can be made to pass. If the case is such as will readi-
ly admit the end of a small bougie to pass, let it be ever so small,
the cure is then in our power. It often happens however, that
the stricture is such, as will resist the passing of a small bougie
at first, and even after repeated trials. Yet it is necessary to
persevere with a small bougie, for sometimes it happens that the
passage through the stricture is not in a line with the urethra
itself, which of course obstructs the bougie; such strictures I
suspect are not equally placed all round so as to throw the small
passage remaining into the centre of the canal.
In many cases where the stricture is very considerable, much
trouble is given by occasional spasms, which will either resist
the bougie altogether, or only let a very small one pass; though
at another time they will admit one larger. In such cases I
have been able to get the point of the bougie sometimes to en-
ter, by rubbing the perinæum externally with the finger of one
hand while I pushed the bougie on with the other. This,
though it does not always succeed, yet is worth trying. Whe-
ther it alters the position of the stricture so as to give entrance
to the point of the bougie, or by sympathy removes the spasm,
I will not absolutely determine; but, I believe, it rather acts
by sympathy. In such cases of spasm in the stricture, I have
often succeeded by letting the bougie remain a little while close
to the stricture, and then pushing it on; this mode so often suc-
ceeds that it should always be attempted when the bougie does
not pass, or only passes occasionally. This will be mentioned
more fully when we shall consider the spasmodic stricture.
The spasm may probably be taken off by dipping the glans
penis into cold water, which succeeds sometimes in the com-
mon strangury, but this cannot be so easily done while a bou-
gie is in the passage.
In cases of a permanent stricture, though the bougie does not
at first pass, yet after repeated trials it will every now and then
find its way, which helps to render a future trial more certain
and easy. It however too often happens that the future success
does not immediately depend upon passing the bougie once or
twice; for it shall pass to-day and not to-morrow; and this un-
certainty shall last for weeks, notwithstanding every trial we can
make. Yet I may observe, that in general its introduction be-
comes

SUPPOSED CONSEQUENCES
comes gradually less difficult, and therefore in no case should
we despair of success.
It is imagined by some that the best time for trial in these ca-
ses is just after making water, as the passage is supposed to be
clear and more in a straight line; but this is not confirmed by
practice.
It is not an easy matter in cases where the passage is very
small, to know whether the bougie has entered the stricture or
not; for such slender bougies as must generally be used at first,
bend so very easily that the introducer is apt to think it is pas-
sing while it is only bending. A surgeon, however, should in
general first make himself acquainted with the situation of the
stricture by a common sized bougie, and afterwards make use
of a smaller one, and when he comes to the stricture push gent-
ly, and for a little time only. If the bougie has passed further
into the penis, he will know how far it has entered the stric-
ture by taking off the pressure from the bougie; for if it recoil
he may be sure that it has not passed, at least has not passed far
but only bent; for the natural elasticity of the bougie, and the
direction of the passage having been altered by it, will force it
back again. But if it remain fixed and do not recoil, he may
be sure that it has entered the stricture. In using a very small
bougie, however, these observations are not so applicable, for
it may be bending, or bent, without being perceptible. It oft-
en happens that a bougie will enter only a little way, perhaps
not more than one-tenth of an inch, and then bend if the pres-
sure be continued. To determine whether this be the case, it
is necessary to withdraw the bougie and examine its end; if the
end be blunted we may be sure the bougie has not entered in the
least, but if it be flattened for an eighth or tenth of an inch, or
grooved, or have its outer waxy coat pushed up for that length,
or if there be a circular impression made upon the bougie where
the stricture is, or only a dent on one side, both of which last
I suspect arise from spasm at the time, we may then be sure that
it has passed as far as these appearances extend. It becomes
then necessary to introduce another exactly of the same size and
in the same manner, and to let it remain as long as the patient
can bear it, or convenience will allow; and by repeating this
we may overcome the stricture. Sometimes we can judge of its
having entered the stricture, by pulling it gently out; for if it
stick a little at the first pull, we may be certain it has entered;
but

OF GONORRHOEA. 111
but the appearance of the bougie itself will give the best infor-
mation*. In such cases I have always directed my patient to
preserve the bougie for my inspection, exactly in the same form
it was when it was withdrawn; but when it passes with ease
this nicety is not necessary.
The time that each bougie should remain in the passage,
must be determined by the feelings of the patient; for it should
never give pain, if possible. To go beyond this point is to
destroy the intention, to increase the very symptoms that are
meant to be relieved, and to produce irritation, which for a
time renders the further application of the bougie improper.
While the bougie is passing, if the patient feel very acutely,
it should not be left in the urethra above five, or at most ten
minutes, or not so long, if it give great pain; and each time
of application should be lengthened so gradually, as to be in-
sensible to the feelings of the patient, and the irritability of the
parts. I have known it days, nay in many patients weeks, be-
fore they could allow the bougie to remain in the passage ten
or even five minutes, and yet in time they have been able to
bear it even for hours, and at last without any difficulty. The
best time to let it remain in the passage is when the patient
has least to do; or in the morning, while he is in bed, pro-
vided he can introduce it himself.
The bougie should be increased in size, according to the fa-
cility with which the stricture dilates, and the ease with which
the patient bears the dilatation. If the parts are very firm, or
very irritable, the increase of the size of the bougie should be
slow, gradually stealing upon the parts, and allowing them to
adapt their structure to the increased size. But if the sensibility
of the parts will allow of it, the increase of the size of the bou-
gie may be somewhat quicker, though never more quick than
the patient can bear with ease. The increase should be conti-
nued till a bougie of the largest size passes freely; nor should
this
* It may be remarked, that there are some lacunæ (Vide plate I, fig. 2.) near, and
also a little way beyond the glans penis, which often stop the bougie, and give at first
the idea of a stricture. I have known them taken for such; and when the bougie stops
so near to the glans this is to be suspected, and therefore we should vary the direction
of the point of the bougie, bearing it against the underside of the urethra. When the
bougie stops in one of those lacunæ, I think that the patient appears to have more pain
than from a real stricture. The valvular part of the prostate gland formed by disease
(Vide plate IV.) very often obstructs the bougie, and is taken for a stricture by those
who are not well acquainted with the different obstructions in this canal; and by those
who are, it is a means of discovering disease in this part; and indeed in a natural state
of parts I think I can ascertain when I come to this part with a bougie.

112 SUPPOSED CONSEQUENCES
this be laid aside till after three weeks, or a month, in order
to habituate the dilated part to its new position, or to take off
the habit of contracting from the part as much as possible; but,
as was observed before, the permanency of this cure can seldom
be depended upon.
Instead of proceeding with the caution recommended, it has
been practised with success for a time, to force a common siz-
ed bougie through a stricture that only allowed a small one to
pass. This, I suppose, either tore the stricture or weakened
it by stretching it suddenly so as to render it unable to recover
its contractile power for a considerable time after. I have seen
where this has produced good effects, and for a time removed
the permanent stricture, and prevented spasm. This is a prac-
tice, however, which I have never tried; having always pre-
ferred the mild treatment where I could pass a bougie.
I have known the passing of the bougie remove, almost im-
mediately, a swelling of the testicle, which had arisen from the
stricture; therefore such a symptom should not prevent the use
of the bougie.
In cases of strictures, where the bougie is used, the patient
is commonly in other respects well, and is with difficulty per-
suaded to restrain from his common habits, often making too
free in eating, drinking, and exercise; which are all in many cases
pernicious, more especially where inflammation and suppura-
tion have taken place. It is therefore the duty of the surgeon
to restrict the patient for some time within certain bounds, till
he finds by trials what the parts are capable of bearing with-
out producing inflammation.
III. OF THE CURE OF STRICTURE BY
ULCERATION.
THE cure of a stricture by means of ulceration is likewise
effected by a bougie. This method may be employed both in
cases where a bougie will, and where it will not pass. In the
first case there is not the same necessity for ulceration as in the
second, because where a bougie will pass there is no immedi-
ate danger arising from the stricture, which may therefore be
dilated, as has been described. But if this method should be
preferred to a slow dilatation, which allows the parts time to
adapt themselves to their new position, the stricture may be
destroyed

OF GONORRHOEA. 113
destroyed by producing ulceration in the parts, especially if
they are not irritable, but admit of considerable violence.
When this is intended, the bougie should be introduced as
far into the stricture as possible, and the size of it increased as
fact as the sensations of the patient can well bear. This will
produce ulceration in the part pressed, which is a more lasting
cure, because more of the stricture is destroyed than when the
parts are simply dilated. I believe, however, there are few
patients that will submit to this practice; and indeed few will
be able to bear it; for I have seen it bring on violent spasms
on the part, which have produced suppression of urine, and
proved very troublesome. Therefore as there is no absolute
necessity in such cases for pursuing this method, I do not re-
commend it as a general practice, although there have been
cases in which it has succeeded. Where this method is to be
practised, it might probably be right to accustom the passage
to a bougie for some time before such violence is used.
If the smallest bougie, which can possibly be made, cannot
be made to pass by some degree of force, dilatation becomes
impracticable, and it is necessary that something else should be
done for the relief of the patient; for the destruction of the
stricture must be effected. In many cases it may be proper to
attempt this by ulceration of the part; for we find from expe-
rience, that a stricture may be removed by the simple pressure
of a bougie. This effect must arise from the irritation of ab-
sorption being given to the diseased part, which from the stric-
ture not being an originally formed part, nor having the pow-
er of resistance, equal to the original one, is more suscepti-
ble of ulceration, and thereby is absorbed. The bougies which
are only to produce ulceration in consequence of their being
applied to the stricture, need not be so small as in the former
cases, as they are not intended to pass; and by being of a com-
mon size they will also be more certain in their application to
the stricture. The force, applied to a bougie, in this case
should not be great; for a stricture is the hardest part of the
urethra; and if a bougie is applied with a considerable de-
gree of pressure, and left in the passage, it sometimes happens
that the end of it slips off the stricture before there is time for
ulceration, and makes its way into the substance of the cor-
pus spongiosum by the side of the stricture; and if the pres-
sure be continued still longer, it will make a new passage be-
Q yond

114 SUPPOSED CONSEQUENCES
yond the stricture in the corpus spongiosum urethræ*. This
more readily happens if the stricture be in the bend of the ca-
nal, as in such cases the bougie can hardly be applied exactly
to it, not having the same curve. Such mischief I have seen
more than once; and sometimes the bougie has been pushed
so far as to make its way into the rectum.
It often requires a considerable time before the whole is so
far ulcerated as to admit the bougie, and this tires the patient
and almost makes him despair of a cure. In this process great
attention should be paid to the seeming progress of the cure;
for if it appears to the surgeon that he is gaining ground by the
bougie passing further in, and yet the patient does not make wa-
ter better in the least, then he may be sure that he is forcing a
new passage†.
When the stricture has so far yielded to these means as to ad-
mit a small bougie, the dilatation is to be made as in the for-
mer case where a bougie passed at first. Whenever a bougie
of a tolerable size, passes with case, and the parts and patient
have become accustomed to it, it is no longer necessary that the
surgeon should continue to pass it; the patient may be allowed
to introduce bougies himself; and when he can do it readily,
the business may be trusted to him, as he can make use of them
at the most convenient times, so that they may be applied, lon-
ger at a time and oftener, the surgeon only attending occasion-
ally. This practice of the patient under a surgeon's eye, by
which he is taught how to pass them, becomes more necessary,
as strictures are diseases that commonly recur; therefore no
man, who has ever had a stricture, and is cured of it, should
rely on the cure as lasting, but should be always prepared for a
return; and should always have some bougies by him. He
should not go a journey, even of a week, without them; and
the number should be according to the time he is to be absent,
or to the place whither he is going; for in many parts of the
world he cannot be supplied with them. The bougies for such
purpose should be of different sizes, as it is uncertain in what
degree the disease may return.
Bougies, in all cases, from their shape, and from the action
of the parts, readily slip out, whereby the cure is retarded;
but
* Vide plate II, fig. 4.
† This makes it necessary in all cases of strictures where bougies will not pass, to be
very particular in our inquiries, whether the patient has used bougies formerly; and whe-
ther there may not be reason to believe that they had taken a wrong direction.

OF GONORRHOEA. 115
but it is much worse when they pass into the bladder; which
can only take place in cases where the stricture is in some mea-
sure overcome. The consequence of a bougie passing into the
bladder must at once appear in its fullest force to every one;
it subjects the patient in most cases to be cut as for the stone;
and indeed if it is either not soon thrown out, or cut out, it
becomes the basis of a stone. A young man was cut for a bou-
gie only a fortnight after it had passed into the bladder; and
it was almost wholly crusted over with calculous matter. Bou-
gies have been known to be forced out of the bladder along
with the water by the action of that viscus, and in several folds.
It is probable that the bladder in a natural state has not power
sufficient to perform such an action; but we shall show that in
cases of strictures, where the resistance to the passing of the wa-
ter is very much increased, the strength of the bladder becomes
proportionably greater. This happens principally in strictures
of long standing.
Such accidents are often observed before the outer end of
the bougie has got beyond the projecting part of the penis, but
even then it is difficult of extraction. I have succeeded in
some of these cases by fixing the bougie in the urethra some
way below its end; for instance, in the perinæum, by pres-
sing against it with one hand, and pushing back the penis up-
on the bougie with the other hand; then laying hold of the
penis upon the bougie, removing the pressure below, and draw-
ing the whole up; and by performing these two motions alter-
nately, I have been able to lay hold of the end of it. Howe-
ver, this does not always succeed, for when the bougie is either
small, or becomes soft, it will not admit of the penis being
pushed down upon it without bending; or if the thick end of
the bougie has got beyond the moveable, or projecting part
of the penis, then this mode of treatment becomes impractica-
ble. I have succeeded in these last cases with the forceps for
extracting the stone out of the urethra; but if it has got into
the bend of the urethra, this practice will also fail; and in
such a state it would be most adviseable to pass a catheter down
to it, and cut upon that; and probably the above-mentioned
forceps introduced through the wound might then lay hold of
its end; or by cutting a little further, so as to expose some part
of the bougie, it might be easily extracted, without the neces-
sity

116 SUPPOSED CONSEQUENCES
sity of cutting into the bladder. This part of the operation,
however, would be very difficult in a fat or lusty man.
To prevent the inconveniency of the bougie coming out, or
the mischief of its passing in, it is necessary to tie a soft cot-
ten thread round that end of the bougie which is out of the ure-
thra, and then round the root of the glans. This last part
should be very loose, for an obvious reason; and the project-
ing part of the bougie should also be bent down upon the pe-
nis, which makes it both less troublesome, and more secure.
IV. OF THE APPLICATION OF CAUSTIC TO
STRICTURES.
WHEN a bougie can readily pass, there is no necessity for
using any other method to remove the stricture: but there are
too many cases where a bougie cannot be made to pass, or so
seldom that it cannot be depended upon for a cure. This
may arise from several causes. First, the stricture may be so
tight as not to allow the smallest bougie to pass. Secondly,
the orifice in the stricture may not be in a line with the ure-
thra, which will make it uncertain, if not impossible, to pass
a bougie. Thirdly, there may be no passage at all, it having
been obliterated by disease, and the urine passed by fistulæ in
perinæo.
The first very rarely occurs, for if the passage in the stric-
ture be in a line with the general canal, a small bougie will
commonly pass; and although it may not readily do so
upon every trial, it will be sufficient to make way for another
bougie which is all that is wanted.
The second case, where the canal is not in a line with the
common passage, may arise from three causes. First, when
the stricture is in the bend of the urethra, although the pas-
sage through it may be in the centre of the canal, yet as the
bougie cannot have the exact curve, it will be very uncertain
in its application. Secondly, from an irregularity in the for-
mation of the stricture, which may throw the passage to one
side, even in the straight part of the urethra; and thirdly, from
ulceration having taken place, producing fistulæ in perinæo
which often make the canal irregular in its course.
The third case where the application of the caustic may be
necessary, is where there is no passage at all, which happens
from

OF GONORRHOEA. 117
from ulceration and abscesses in the perinæum opening external-
ly; and in the healing of them the passage is often closed
up entirely. In all the above-mentioned cases I have succeed-
ed with the caustic beyond expectation.
If the obstructions are any where between the membranous
part of the urethra and the glans, where the canal is nearly
straight, or can easily be made so by the introduction of a straight
instrument, it becomes an easy matter to destroy them by cau-
stic; but if beyond that, it becomes then more difficult; how-
ever at the beginning of the bend of the urethra the obstruc-
tion may be so far removed as to admit of the passing of a
bougie, or at least to procure a tolerably free passage for the
urine. I have seen several cases where it was thought ne-
cessary to follow this practice, and it succeeded so well that
after a few touches with the caustic the bougie could be passed,
which is all that is wanted. The success in these cases was
such as would incline me to have recourse to this practice ve-
ry early: indeed whenever I could not pass a small bougie
through the stricture. I look upon the caustic as a much sa-
fer method than using pressure with a bougie, for the reason
before-mentioned, that is, on account of the danger of mak-
ing a new passage, without destroying in the least any part
of the obstruction.
Most of the strictures I ever examined after death, appeared
to have been in the power of such treatment; however, I have
seen one or two cases, where the contraction was of some
length and irregular, which would have puzzled me if I had at-
tempted to cure with the caustic; because I should have been
apt to suspect that I was making a new passage by my gaining
ground, and yet not relieving the patient by the removal of the
symptoms.
I have often tried this practice in strictures where there were
also fistulæ in the urethra, and where the water came through
different passages. Such cases were not the most favourable;
yet I succeeded in the greater part of them, that is, I overcame
the stricture and could pass a bougie freely. I have seen seve-
ral cases of fistulæ of these parts, where the natural passage was
obliterated by the stricture, in which I have succeeded with the
caustic, and the fistulous orifices have readily healed.
It does not happen always in cases of obstruction to the pas-
sage of the urine, that when the obstruction is removed by the
caustic,

118 SUPPOSED CONSEQUENCES
caustic, and the water of course passes freely, a bougie will al-
so pass. This I apprehend arises from the caustic not having
destroyed the stricture in a direct line with the urethra, so that
a bougie cannot catch the sound urethra beyond. But this ap-
pears to me of little consequence, as it is as much in the power
of the bougie to prevent a return at this part as if it passed on
to the bladder; for if the water flows readily, it is certain that
the caustic has gone beyond the stricture, although it may not
be in a direct line, and that the only risk of a return of ob-
struction will be at the old stricture; but as a bougie can now
pass beyond that part, it does as much good as if it passed
into the bladder; for I have known several cases where the bou-
gie appeared to have the same effect as if it had passed on to the
bladder.
The application of the caustic need not be longer than a mi-
nute, and it may be repeated every day, or every other day,
allowing time for the slough to come off. But there are other
causes that may prevent the repetition of the caustic, besides
waiting for the separation of the slough; for sometimes the use
of it brings on irritation, inflammation, or spasm in the part,
which frequently occasions a total suppression of urine for a time,
against which all the means, used commonly on such occasions
to procure relief, must be employed, and we must wait till these
symptoms are gone off. If the patient can make water imme-
diately after the application it will be proper; as it will wash
away any caustic that may have been dissolved in the passage,
which if left would irritate the parts. A little water injected
into the urethra will answer the same purpose.
About the year 1752, I attended a chimney-sweeper labour-
ing under a stricture. He was the first patient I ever had un-
der this disease. Not finding that I gained any advantage af-
ter six months trial with the bougie, I conceived that I might
be able to destroy the stricture by escharotics*; and my first at-
tempt was with red precipitate. I applied to the end of a bou-
gie some salve, and then dipped it into red precipitate. This
bougie I passed down to the stricture; but I found that it brought
on considerable inflammation all along the inside of the passage,
which I attributed to the precipitate being rubbed off in passing
the bougie. I then introduced a silver cannula down to the
stricture,
* Having lately looked over some authors on this disease, I find that this is not a
new idea.

OF GONORRHOEA. 119
stricture, and through this cannula passed the bougie with pre-
cipitate as before. Not finding, however, that the patient
made water any better, and not as yet been able to pass the
smallest bougie through the stricture, I suspected that the pre-
cipitate had not sufficient powers to destroy it. I therefore
took a small piece of lunar caustic and fastened it on the end of
a wire with sealing wax, and introduced it through the cannu-
la to the stricture. After having done this three times, at two
days interval, I found that the man voided his urine much more
freely. Upon the application of the caustic a fourth time, my
cannula went through the stricture*. A bougie was afterwards
passed for some little time till he was perfectly well.
Having succeeded so well in this case, I was encouraged to
apply my mind to the invention of some instrument better suited
to the purpose than the above-mentioned, which I have in some
degree effected, although it is not yet perfectly adapted to all
the situations of stricture in the urethra. The caustic should
be prevented from hurting any other part of the canal; which
is best done by introducing it through a cannula to the stric-
ture, making it protrude a little beyond the end of the cannula,
by which it acts only upon the stricture. The caustic should
be fixed in a small portcrayon. It is necessary to have a piece
of silver the length of the cannula, with a ring at one end,
and a button at the other of the same diameter with the can-
nula forming a kind of a plug, which should project beyond
the end of the cannula that enters the urethra, by which means
it makes a rounded end; or the portcrayon may be formed
with this button at the other end. The button being intro-
duced into the cannula, it should be passed into the urethra, and
when it reaches the stricture the silver plug should be withdrawn,
and the portcrayon with the caustic introduced in its place;
or, if the plug and portcrayon are on the same instrument, then
it is only withdrawing the plug, and introducing the portcray-
on with the caustic. This plug, besides giving a smooth round-
ed end to the cannula, answers another good purpose, by pre-
venting the cannula from being filled with the mucus of the
urethra, as it passes along, which mucus would be collected in
the end of it, dissolve the caustic too soon, and hinder its ap-
plication to the stricture†.
* Wiseman had the same idea, but probably the clumsy way in which he attempted
to put it in execution might be the reason why he seems not to have pursued it.
† Vide plate II, fig. I.

120 SUPPOSED CONSEQUENCES
If the stricture be in the bend of the urethra, the cannula
may be bent at the end also; but it becomes more difficult to
introduce a piece of caustic through such a cannula, for the
plug and portcrayon must also be bent at the end, which can-
not be made to pass through the straight part of the cannula;
but this I have in some measure obviated by having the can-
nula made flexible, except at the end where it is to take the
curve*.
After the bougie can be made to pass, the case is to be treated
as a common stricture, either by dilating it slowly, or by quick-
ly increasing the size of the bougie, and thus continuing the
ulceration.
There are sometimes more strictures than one; but it sel-
dom happens that they are all equally strong. One only be-
comes the object of our attention. The smaller ones may, how-
ever, be sufficient to hinder the passing the cannula to that
which is to be destroyed by the caustic. When that is the
case, those small strictures are to be dilated with bougies, as in
common, till they are sufficiently large to allow the cannula
to pass.
CHAPTER III.
OF STRICTURES IN WOMEN.
OBSTRUCTIONS to the urine in women, I believe, ge-
nerally arise from stricture, although not always; for I
have known them produced by compression from some adja-
cent swelling; and they are common in uterogestation, as also
in dropsical or scirrhous ovaria. But such causes are common-
ly known long before this effect is produced, by which the sup-
pression is easily accounted for. It may also arise from excre-
scences as in men.
How far a stricture, in the urethra of this sex, is really
a consequence of a venereal inflammation, I am not certain;
but should suppose it is not; and for stronger reasons still than
those
* Vide plate II, fig. 2 and 3.

OF GONORRHOEA. 121
those which I gave in speaking of the cause of strictures in men;
for I can say, that none of the strictures that I have seen in wo-
men, have arisen in consequence of this disease; at least I had
no reason to believe that they did; and I have observed before,
that in most women, who have the venereal disease in the form
of a gonorrhœa, it seldom attacks the urethra. Therefore if
we find a stricture in a woman, who has had the disease, we are
not to impute it to that, at least till we can ascertain the ure-
thra was affected; and even then it will remain doubtful.
Strictures are not near so common in women as in men.
This may be owing to the great difference there is in the length
of the two canals; but more especially to the canal in women
being more simple, and intended only for one purpose. The
stricture in women does not produce such a variety of symp-
toms, or so much mischief, as in men, there not being so ma-
ny parts to be affected.
I. OF THE CURE OF STRICTURES IN
WOMEN.
THE cure of strictures in the urethra of women is similar
to that in men: but it is rather more simple from the simpli-
city of the parts. There is, however, an inconvenience at-
tending the passing the bougie in women, that does not occur
in men, which is, that in most cases it must be passed for them,
it being hardly possible for a woman to introduce a bougie her-
self. The confinement of the bougie is also more difficult, for
although it can easily be prevented from going into the blad-
der by bending the outer end down upon the mouth of the va-
gina; yet it is very difficult to prevent them from slipping out.
It will be necessary to have a bandage of the T kind passing
down between the labia over the bend of the bougie.
It appears to me that the caustic would answer extremely
well in such cases, and therefore I should prefer it to the bou-
gie, both for convenience and efficacy.
II. OF THE GLEET IN CONSEQUENCE OF A
STRICTURE.
I HAVE already observed, that it happens generally, if not
always, that there is a gleet when there is a stricture in the ure-
R thra.

122 SUPPOSED CONSEOUENCES
thra. This I suppose to arise from the irritation produced in
the urethra beyond the stricture, by the urine in its passage dis-
tending this part too much, which distension is increased by
the increased strength of the bladder. This symptom often leads
us to the knowledge of a stricture, or at least gives a suspi-
cion of such a disease; and when a stricture is known to be the
cause, no attempts should be made to cure the gleet, for it is
generally cured when the stricture is removed; but if it still re-
mains it may be cured as recommended in the common gleet,
as probably arising from a cause different from a stricture.
CHAPTER IV.
OF STRICTURE ATTENDED WITH
SPASMODIC AFFECTION.
THERE are very few strictures that are not more or less
attended with spasm; but some much more than others,
the spasm being in some cases more the disease than the stric-
ture itself. But real strictures are attended with occasional con-
tractions, which make the passing of the urine much more dif-
ficult at one time than another. In all the cases that I have seen
of this kind, when not attended with spasms, the disease is not
formidable; but when the parts are in a spasmodic state, the
symptoms are as violent as in the simple stricture.
As this is a mixed case, it has all the characters both of the
permanent and spasmodic stricture; for the urethra in such cir-
cumstances is in a state similar to what it is in the true spasmo-
dic kind, being very irritable, giving great pain in passing of
the bougie, and often rejecting it altogether; as will be taken
notice of when we shall treat of that disease.
Upon considering this subject we should at first hardly be dis-
posed to believe that the spasm in the urethra is in the strictured
part, which can scarcely be supposed capable of contraction;
and it might therefore naturally be referred to the sound part
of the urethra, as being brought on by the waters not flowing
freely. If this is a just mode of accounting for it, we must
suppose

OF GONORRHOEA. 123
suppose that the contraction is behind the stricture, that being
the only part dilated by the water; and such urethras being ve-
ry irritable, that part may contract so as to stop the flowing of
the water altogether. But some circumstances that occur in
practice, giving reason to believe that such strictures have the
power of contraction; for we find the bougie grasped by the
stricture when allowed to remain some time. And the circum-
stance of the strictured parts refusing the bougie at times is al-
so a proof of the same.
There is sometimes this singular circumstance attending these
cases, that when there arises a gonorrhœa, or any other dis-
charge of matter from the urethra, or an increase of an old
gleet, the passage becomes free, and allows the urine to pass as u-
sual; but such relief is uncertain and only temporary; for when-
ever the discharge ceases the spasmodic affection returns. I
think it is probable that it is only the spasm that is affected by
the discharge, and not the real stricture. Two remarkable ca-
ses of this kind fell under my observation, which I shall now
relate.
A gentleman had for a long time a complaint in the urethra
attended with a stricture, which was supposed to be originally
from a venereal complaint. It was often attended with a dis-
charge which always produced a slight fever on its coming on;
but while the discharge lasted, the difficulty in making water
was relieved, and that in proportion to the greatness of the
discharge; and whenever he got a fresh gonorrhœa the same
thing happened.
Another gentleman had a difficulty in making water, suppo-
sed to arise from a stricture. It was generally attended with
such a running as is common to strictures; but when that dis-
charge was much increased, then the stricture was less in pro-
portion. During this complaint he contracted two different
infections, both of which relieved him of the stricture for the
time.
As this is a mixed disease, it may be thought proper to treat
it with bougie for the real stricture, and for the other to use
the method hereafter recommended for the cure of spasm.
It sometimes happens in these mixed kinds, that a bougie
does not immediately pass, but is rejected by the spasm; yet by
letting it lie in the urethra almost close to the stricture for ten,
fifteen, or twenty minutes, you will often make it pass. This
is

124 SUPPOSED CONSEQUENCES
is as it were stealing upon it, and the water will often flow al-
though the bougie is not attempted to be passed on. It is of-
ten relieved by gentle irritating injections.
CHAPTER V.
OF SOME CIRCUMSTANCES ATTEND-
ING THE USE OF BOUGIES — THEIR
FIGURE AND COMPOSITION.
IN cases of strictures, where a bougie is used as a wedge, not
as a stimulant, and where the stricture is so far overcome
as to let a bougie pass on, the question is, whether it may be
better to pass the bougie through the whole length of the ure-
thra, so that the end of it shall be in the bladder, or only to
pass it through the stricture a little way, so that its end shall re-
main in the urethra. Nothing but experience can determine
this question; and, perhaps, in such cases we seldom make a
fair trial, generally pushing the bougie on to the bladder; though
if we observe the consequences of the bougies not passing in
those cases, where they either cannot pass far beyond the stric-
ture, or not at all, we find no inconvenience arising from this
circumstance, except when they are applied with too much
force, so as to make a new passage. Th common idea is, that
it will be more hurtful to allow the end of the bougie to lie in
the urethra than in the bladder; but this seems to be more
founded in theory than practice.
Some people have such a quantity of calculous matter in their
urine, or so great a disposition in their urine to deposit its cal-
culous matter, that it only requires the presence of an extrane-
ous body in the bladder to become an immediate cause of stone;
for I have observed in some, that the end of a bougie cannot
remain in the bladder a few hours without being covered with
a crust of calculous matter. Such people I have generally advi-
sed to use as much exercise as all other circumstances will allow.
Bougies, when first introduced, often produce sickness, and
sometimes even fainting. I have seen a patient become sick,
the

OF GONORRHOEA. 125
the colour leave his face, a cold sweat come on, and at last a
deliquium; but all these effects soon go off, and seldom return
upon a second or third trial. They at first produce an irrita-
tion on the urethra, which gives pain in the time of making wa-
ter, but goes off on repetition. They produce a secretion of
pus in those cases, where there was none, and generally in-
crease the discharge where there is one previous to the applica-
tion of them; but this effect gradually ceases.
It frequently happens, that swellings in the lymphatic glands
of the groin arise from the use of bougies; but I never saw them
advance to suppuration. As in most of such cases there is a
discharge of matter previous to the bougie being passed, they
can hardly be owing to the absorption of matter, but must arise
from sympathy.
When treating of the stricture, I observed that it was often
the cause of a swelling in one or both testicles; and further,
that the passing of a bougie often removed that complaint. I
may now observe, that a very common consequence of the pas-
sing a bougie is a swelling of the testicle. This also arises from
sympathy, and like the swelling of the glands, is a common
effect of all irritations of the urethra.
It may not be improper here to add some observations on the
figure and composition of bougies. They ought to be about
two inches longer than the distance between the glans and the
stricture, or more if they can pass freely, so as always to allow
an inch to bend upon the glans, and another to pass beyond the
stricture. The thickness should be according to the size of the
stricture; at first, such as will pass with a small degree of tight-
ness, and this should be gradually increased as the contracted
part enlarges. But when the urethra has become of the natu-
ral size, the bougie need not be further increased, but its use
still continued, as has been observed.
With regard to the shape, they should not taper from end to
end when very small, but should be nearly of an equal thick-
ness till within an inch of their smallest end, after which they
should taper to a point, forming a round wedge fitted to pass in-
to the stricture; and this form gives them greater strength than
when made to taper from one end to the other.
The consistence ought to vary according to the nature of the
case, and size of the bougie. If the stricture be near the glans,
a stiff bougie may be used, and the whole may be made to ta-
per

126 SUPPOSED CONSEQUENCES
per gradually, because a short bougie will always have suffici-
ent strength for any pressure that is necessary; but if the stric-
ture be deeper seated, as about the bulb, where the passage be-
gins to take a curve, the bougie must be a little thicker in its
body to support the necessary pressure. If the stricture be any
where in the bend of the urethra, or near the bladder, the bou-
gie should be very flexible, (although this is contrary to our ge-
neral position) because in this case it must bend in order to adapt
itself in the curve of the passage, which it ought to do with
ease; for when it bends with difficulty it does not make its pres-
sure upon the stricture, but upon the back part of the urethra,
and therefore does not enter so easily; which circumstance makes
it more difficult to enter a stricture near the bladder, than near
the glans. In the composition of the bougie the consistence is
the most material thing to be considered; the medical proper-
ties, as far as known, being of little consequence. The ma-
terials of which they are commonly made, are wax, oil, and
litharge. The litharge gives them smoothness, and takes off
the adhesive quality which they would have if made of wax and
oil only. A composition which answers well, is three pints of
oil of olives, one pound of bees wax, and a pound and an half
of red lead, boiled together upon a slow fire for six hours.
I. OF A NEW PASSAGE FORMED BY BOUGIES.
THE greatest evil arising from the improper use of the bou-
gie, and the most dangerous is, where it makes a new pas-
sage*. I mentioned before that this generally arose from an
attempt to produce ulceration by the application of the end of
the bougie to the stricture in cases where a bougie could not
pass; for in those cases where a bougie passes there can be no
danger of such an effect.
This new passage is seldom carried so far as to produce ei-
ther an increase of the present disease, or a new one, although
sometimes this happens; yet it prevents the cure of the ori-
ginal disease, for it renders both the application of the bou-
gie and caustic to the stricture so uncertain, that a continu-
ance of either is dangerous, as it may increase the mischief
and at last produce very bad consequences.
This
* Vide plate II, fig. 4.

OF GONORRHOEA. 127
This new passage is generally along the side of the old one,
when in that part of the urethra which is on this side of the
bend, and it is made in the spongy substance of the urethra;
but when it is made at the beginning of the bend, then it pas-
ses on in a straight line through the body of the urethra, about
the beginning of the membranous part, going through the cel-
lular substance of the perinæum towards the rectum. When
the new passage is made between the glans and the bend of
the urethra, it may take place on either side of the canal equal-
ly, in the spongy substance of the urethra, between the canal
and the skin of the penis, or scrotum; and it may be between
the canal and the body of the penis. The situation of it will
make some difference in the operation necessary for the cure
of this complaint.
When a new passage is made, I know of no other method
of cure but to open the part externally; and the opening must
be made in that part of the urethra which is most convenient
for coming at the stricture; regard being had to the other ex-
ternal parts, such as the scrotum. If the stricture be before
the scrotum, the new passage will be there also, and therefore
the operation must be made of course before that part; but if
the stricture is opposite to the scrotum, the bottom of the new
passage may also be opposite to this part; but if the new pas-
sage is of a considerable length, its bottom or termination may
be in the beginning of the perinæum; and in either situation
the operation must be begun behind the scrotum, or indeed may
be made a little way into it. But if the stricture and new pas-
sage are in the perinæum, then the operation is to be per-
formed there.
The method of performing this operation is as follows. Pass a
staff, or any such instrument, into the urethra as far as it will go,
which will probably be to the bottom of the new passage; and
that we may be certain is beyond the stricture. Feel for the
end of the instrument externally, and cut upon it, making the
wound about an inch long, if the disease be before the scrotum;
and an inch and an half, or more, if in the perinæum. If the
new passage be between the urethra and the body of the penis,
then you will most probably get into the sound urethra before
you come to the instrument or new passage; if so, it is not
necessary to go further in order to get into the bladder, as we
may be certain that this part of the urethra is behind the stric-
ture.

128 SUPPOSED CONSEQUENCES
ture. Having proceeded so far, take a probe, or some such
instrument, and introduce it into the urethra by the wound;
and pass it towards the glans, which will be passing it forwards
towards the stricture. If it meet with an obstruction there, we
may be certain it is the stricture, which is now to be got
through, and which will afterwards be easily enlarged. To
complete the operation, withdraw the probe, and introduce
in the room of it a hollow cannula forwards to the stricture;
then take another cannula and introduce it from the glans
downwards till the two cannulas oppose each other, having the
stricture between them; an assistant laying hold of the urethra
on the outside, between the finger and thumb, just where the
two cannulas meet, to keep them in their places; then through
the upper cannula introduce a piercer, which will go through
the stricture, and pass into the lower cannula; this done, with-
draw the piercer, and introduce a bougie into the same can-
nula, in the same way, being careful that it passed into the low-
er cannula, then withdraw the lower cannula, and the end of
the bougie will appear in the wound; lay hold of the bougie
there, and withdraw the upper cannula over the bougie, leaving
the bougie in the urethra; now the lower end of the bougie is
to be directed into the urethra leading on to the bladder, and
pushed on to that viscus. It may be further necessary to lay the
whole of the new passage open, that it may all heal up; for it
is possible that this new passage may often receive the bougie,
to be applied in future, which would be troublesome, and might
prove an obstruction to the cure.
If the new passage be between the skin and the canal of the
urethra, after cutting down to the instrument, you must go
further on in search of the natural canal, and, when you have
found it, introduce a probe into it towards the glans to find
the stricture; and when this is done, go on with the operation
as above described.
The bougie must be left in the passage, and as it may be
found difficult afterwards to introduce another readily into the
bladder, the longer the first is allowed to remain, so much the
more readily will the second pass. I am not yet certain but
that it would be better to push on the hollow cannula at first, and
keep it there for some days, at least till the inflammation is over
and the parts have adapted themselves to that body, which will
make a bougie pass more easily afterwards. The bougies must
be

OF GONORRHOEA. 129
be gradually increased in size, and continued till the wound is
healed up.
The first case of a new passage, formed by a bougie, which
I ever saw, was at the hospital of the third regiment of guards,
about the year 1765. A young soldier who had a stricture,
for the cure of which he had bougies regularly passed for near
half a year without any relief. The bougie had gone further
than at first by two inches, and therefore seemed to have gain-
ed ground on the stricture. This seemed to justify the conti-
nuance of the practice; but it being suspected that there was
something more than was then understood, I was consulted,
and without foreseeing what was really the case, I proposed that
an opening should be made into the urethra where the obstruc-
tion was, and carried further back if necessary, in search of
the sound urethra. This was accordingly done in the follow-
ing manner: the grooved staff was first passed as far down as
it could go, which was to the bottom of the new passage; the
scrotum was pulled up upon the penis, when the end of the
staff was prominent towards the skin a little way above the pe-
rinæum, and there an incision was made on the end of the
staff about an inch long: this disengaged the end of the staff,
which was pushed out at the wound; then search was made
for the other orifice which led to the bladder, on a supposition
that that orifice was the stricture; but none being to be sound,
we tried to trace it by blowing with a blowpipe into the bottom
and lower part of the wound; but no orifice could be observ-
ed. We then began to suspect, that we were not in the ure-
thra. To determine if we had been in the urethra, I began to
dissect with care the parts at the bottom of the wound, and
laid bare the musculi acceleratores. I then made an incision
into the body of the urethra and came to the true canal, which
was easily discovered. When this was done we passed a probe
on to the bladder, then withdrew, turned, and passed it from
this wound towards the glans penis, but found that it went not
much more than two inches that way, and then stopped. This
struck us with a new idea of the case; for we were now sure
that the end of the staff had not been in the urethra, but in a
new passage made in the spongy part of the urethra, for two
inches beyond the stricture. We now passed a staff from the
glans down the urethra, and another up from the last wound,
to see at what distance the ends of the two instruments were,
S which

130 SUPPOSED CONSEQUENCES
which would give us the length of the stricture. We found,
by taking hold of the urethra between the finger and thumb on
the outside, that the two ends were close together. What was
to be done next was our consideration; it immediately struck
us that we might force our way through the stricture with safe-
ty. The gentleman, who assisted me in the operation, passed at
blowpipe one-fifth of an inch in diameter (being not sufficient-
ly furnished with instruments) from the wound forwards to the
stricture; and then I took a silver cannula, open at both ends,
which had an iron piercer longer than itself, and passed it down
to the stricture from the glans; and now the end of the cannu-
la opposed the end of the blowpipe, and they were almost close
upon one another. They were kept in this position, with the
finger and thumb applied on the outside of the penis, like splints
on a broken bone. I then introduced the piercer and pushed
it on, which went through the stricture into the hollow of the
blowpipe. Great care was taken not to push too forcibly, left
the two ends of the hollow tubes should slip by one another,
which they would do if not held firmly, as actually happened
twice in this case; but we succeeded the third time. I then
pushed on the cannula through the stricture, and with it push-
ed out the blowpipe. The next object was to pass a hollow
bougie along the urethra to the bladder, to do which the small
end of it was introduced into the cannula, which being pushed
on forced out the cannula at the wound; we then passed a di-
rector into the orifice of the urethra, leading on to the bladder,
and put the end of the bougie into the groove of the director,
and pushed it along the groove to the bladder; and before we
withdrew the director we turned it round with its back to the
bougie, that the end of the bougie might not stop against the
end of the groove, and so be pulled out again. After all this
was done, one stitch was made in the urethra, but the exter-
nal wound in the skin was left for the passage of the urine, that
it might not insinuate itself into the cellular membrane. We
dressed the wound superficially, and applied the T bandage,
which was slit to go on each side of the scrotum, and just where
it came to the scrotum we tied the two ends together, which
supported the scrotum and kept it forwards on the penis; and
the two ends that came from this knot on each side of the scro-
tum were tied to the circular part that came round the body.
The patient had some slight fever for a day or two, and the
urine

OF GONORRHOEA. 131
urine came partly through the bougie and partly by the side of
it through the wound. A swelling of one testicle came on,
likewise a swelling of the glands of the groins, pain in the bel-
ly, sickness, and at times vomiting, all which symptoms were
owing to the sympathy, and entirely went off in five or six
days. The water, in nearly the same time, came entirely by
the natural passage. The bougie was changed from time to
time till the cure was completed.
CHAPTER VI.
OF DISEASES IN CONSEQUENCE OF A
PERMANENT STRICTURE IN THE
URETHRA.
STRICTURES in the urethra produce almost constantly
diseases in the parts beyond them; that is, in the part of
the urethra between the stricture and the bladder. They bring
on in most cases a gleet, as has been described, and often a
considerable distension of the part of the canal beyond the stric-
ture; also inflammation and ulceration, and in consequence
of them diseases in the surrounding parts, as in Cowper's
glands, the prostate, and the surrounding cellular membrane,
forming abscesses there, and at last ulceration, for the purpose
of making a new passage for the urine. The bladder is also
often affected, and sometimes the ureters, with the pelvis of
the kidneys, and in some cases the kidneys themselves. All
these are effects of every permanent obstruction to the urine;
some of them are methods which Nature takes to relieve the
parts from the immediate complaints; such are the increase of
the urethra beyond the stricture, and the enlargement of the
ureters and pelvis of the kidneys, which are only to be consi-
dered as the parts accommodating themselves to the immediate
consequences of the obstruction, which is the accumulation of
urine. Of these complaints I shall take notice in their order.
I. OF

132 SUPPOSED CONSEQUENCES
I. OF THE ENLARGEMENT OF THE URETHRA.
THE urethra beyond the stricture I have observed is enlarg-
ed, because it is more passive than the bladder, and yields to the
pressure of the urine. It is naturally passive while the bladder
is acting, by which means it becomes distended in proportion
to the force with which the bladder acts, and the resistance of
the stricture. Its internal surface often becomes more irregu-
lar and fasciculated. It is also more irritable, the distension
becoming often the immediate cause of spasms in that part;
and these spasms are most probably excited with a view to coun-
teract the effort produced by the action of the bladder.
II. OF THE FORMATION OF A NEW PASSAGE
FOR THE URINE.
WHEN the methods recommended above for the removal
of stricture have either not been attempted, or have not suc-
ceeded, Nature endeavours to relieve herself by making a new
passage for the urine, which, although it often prevents im-
mediate death, yet if not remedied is productive of much in-
convenience and misery to the patient through life. The mode
by which Nature endeavours to procure relief is by ulceration
on the inside of that part of the urethra, which is enlarged and
within the stricture. The ulceration commonly begins near or
close to the stricture, although the stricture may be at a consi-
derable distance from the bladder; therefore we must suppose
that there is some circumstance besides the distension of the
urethra by the urine, which determines the ulceration to a
particular part. This circumstance most probably arises imme-
diately out of its vicinity to the stricture, and may be called
contiguous sympathy. The stricture is often included in the
ulceration, by which it is removed, the disease cured, and a
stop sometimes put to the further ulceration: but unluckily this
is not always the case. We may observe that this ulceration
is always on the side next to the external surface, as is com-
mon in abscesses.
As this ulceration does not arise from preceding inflamma-
tion; and as it cannot be said that the urine acts exactly as an
extraneous body, because it is in its natural passage, we find
that

OF GONORRHOEA. 133
that there is but very little inflammation of the adhesive kind
attending these ulcerations. We must allow, however, that the
urine produces the ulcerative disposition here, like matter on
the inside of an abscess, although not so readily.
Whenever, therefore, the internal membrane and substance
of the urethra are removed by absorption, the water readily
gets into the loose cellular membrane of the scrotum and penis,
and diffuses itself all over those parts, not having been previ-
ously united by the adhesive inflammation: and as the urine has
considerable irritating powers when applied to the common
cellular membrane, the parts inflame and swell. The presence
of the urine prevents the adhesive inflammation from taking
place; it becomes the cause of suppuration wherever it is dif-
fused, and the irritation is often so great, more especially in
cases where the urine has been allowed to become very stale,
that it produces mortification first in all the cellular membrane,
and afterwards in several parts of the skin; all of which, if
the patient lives, will slough away, making a free communica-
tion between the urethra and external surface, and produce
fistulæ in perinæo.
We may observe however, that the want of the adhesive in-
flammation in these ulcerations appears to be peculiar to that
part of the urethra which lies between the membranous part
and the glans penis; for we find from experience, that when
this process takes place further back, as in the prostate gland,
that a circumscribed abscess is generally formed. This may arise
from the difference in texture of the cellular membrane of the
parts, the first admitting of the diffusion of the urine very rea-
dily from the looseness of its texture, the other producing ad-
hesions before the urine is allowed to pass; which adhesions
afterwards exclude it.
It sometimes happens that the urine gets into the spongy
substance of the body of the urethra, and is immediately dif-
fused through the whole, even to the glans penis, producing
mortification of all those parts, as I have more than once seen.
When the urine has made its way into the cellular mem-
brane, although the ulceration of the urethra is in the perinæ-
um, yet it generally passes easily forward into the scrotum,
that part being composed of the loosest cellular membrane in
the body. When the seat of the ulceration is in the membran-
ous or bulbous part of the urethra, and the pus and urine have
found

134 SUPPOSED CONSEQUENCES
found their way to the scrotum, there is always a hardness ex-
tended along the perinæum to the swelled scrotum, which is
in the tract of the pus.
Ulceration cannot be prevented but by destroying the stric-
ture; but when the water is in the cellular membrane, which
is the state we have been describing, the removal of the stric-
ture will in general be too late to prevent all the mischief, al-
though it will be necessary for the complete cure: therefore
an attempt should be made to pass a bougie, for perhaps the
stricture may be included in the ulceration, (as was mentioned
before) and thereby allow a bougie to pass. When this is the
case, bougies must be almost constantly used to procure as free
a passage forwards in the right way as possible. Where the
bougie will not pass, I am afraid that the caustic, as described in
the case of a stricture, in many cases would be too slow in its
operation, and in others it cannot be tried, as the situation
of the stricture is often such as will not admit of it.
While we are attempting the cure of the stricture, every
method is to be used that removes inflammation, particularly
bleeding. Great relief may be obtained by exposing the parts
to the steam of hot water; but this is merely a palliative cure.
The warm bath, opium, and the turpentines, given by the
mouth, and also by the anus, will assist in taking off any spas-
modic affection; but all these are too often insufficient, and
therefore immediate relief must be attempted, both to unload
the bladder, and prevent any further effusion of urine into the
cellular membrane. This must be done by an operation, which
consists in making an opening into the urethra somewhere be-
yond the stricture, and the nearer to the stricture the better.
The method of performing the operation is first to pass a
director or some such instrument into the urethra, as far as
the stricture; then to make the end of the instrument as pro-
minent externally as possible so as to be felt, which in such a
case is often difficult, sometimes impossible. If it can be felt
it must be cut open, and the incision carried on a little further
towards the bladder, or anus, so as to open the urethra beyond
the stricture; this will be sufficient to allow the urine to
escape, and to destroy the stricture. If the instrument cannot
be felt at first by the finger, we must cut down towards it
which will bring it within the feel of the finger, and afterwards
proceed as above directed.
If

OF GONORRHOEA. 135
If the stricture in the urethra be opposite to the scrotum, it
being impossible to make the opening there, it must be made
in the perinæum, in which case there can be no direction giv-
en by an instrument, as one cannot be made to pass so far;
therefore we must be guided by our knowledge of the parts.
The opening being made, the stricture is to be searched for as
described in the operation, in cases where a false passage has
been made, by passing a probe from the wound forwards, to-
wards the glans. The other steps of the operation will be
nearly the same. In whichsoever way the operation is perform-
ed, a bougie must be introduced, and the wound healed up
over it. In my opinion a catheter answers this purpose better.
Great attention should be still paid to the inflammation which
arises in consequence of the urine having been diffused in the
cellular membrane, as before described. Where the inflamma-
tion is attended with suppuration and mortification, it will be
necessary as well in this case, as in that where no operation is
required, to scarify the parts freely, to give an opening both
to the urine and pus. Where mortification has taken place in
the skin, the scarifications should be made in the mortified parts,
if it can be done with equal advantage, and this with a view
to prevent irritation.
In total suppressions of urine, from whatever cause, the urine
should never be allowed to accumulate, and should either be
drawn off frequently, or a catheter should be kept continually
in the urethra and bladder; because we should on no account
allow the bladder to be distended beyond an easy state; for if
it be, it always brings on debilitating and alarming symptoms,
as paralysis of that viscus. In many suppressions of urine, as
in cases of strictures, it becomes impossible to draw off the wa-
ter. In some cases where the urethra is ulcerated, and the
urine gets into the cellular membrane of the penis, and pre-
puce, so as to distend them much, producing a phymosis, it
becomes impossible to find the orifice of the urethra. The fol-
lowing case illustrates most of the preceding doctrines.
A gentleman of a scrofulous habit had often had venereal
gonorrhœas, which being severe, commonly produced swellings,
or knobs along the urethra; upon which account he was ad-
vised to avoid this disease as much as possible. When in the
country, in November 1782, he was attacked with a slight cold
or fever, and a small discharge from the urethra, which he
could

136 SUPPOSED CONSEQUENCES
could not determine to be venereal. In this state he sat out
for London, but was seized on the road with a suppression of
urine, which detained him two days at an inn. On his arrival
in London, I found him feverish. He spoke to me only of a
discharge from the urethra; but as I did not conceive that the
fever could arise from that cause, I desired him to be easy on
that account. He was taken with a shivering fit, which made
us suspect it might terminate in an intermittent, and we waited
for the result. He still complained of the discharge, and men-
tioned a soreness in the perinæum, both when he made water
and when he pressed it externally. On examining the perinæ-
um, I found a fulness there, from which I suspected a stric-
ture, and inquried particularly how he made water in com-
mon; he declared very well, which led me from the true cause.
This swelling was regarded as the effect of an inflammation,
either in consequence of the fever, the disposition of the part,
or both, increased by fitting in a postchaise for several days.
The part was fomented and poulticed; and leeches were ap-
plied several times. He had another shivering fit three days
after the first, which, if his disease had been an intermittent,
would have constituted a quartan; but he had another some
hours after, which made us give up our suspicions of an inter-
mittent. We now began to suspect that matter was forming
in this part, although I could never feel any thing like a fluc-
tuation; nor was the pain of the throbbing kind, or so acute
as we commonly find it in the suppurative inflammation. What
in some degree surprised me was, that the swelling came for-
ward along the body of the penis towards the os pubis while
it seemed to be diminishing in the perinæum. He now began
to find a difficulty in making water, with a frequent desire,
which increased till there was a total suppression. I pressed on
the lower part of the belly to determine whether or not the
urine was secreted and accumulated in the bladder; but I could
not find any fulness; nor did he then feel pain on such pres-
sure; however, about twenty-four hours after, he began to
complain of a great desire to make water, and a pain in the
lower part of his belly; and the hand being placed there, a
fulness of the bladder was readily felt. It was now clear
that the water should be drawn off; but as I still suspected
mischief in the urethra as a cause in his complaint, I took the
necessary precautions. I provided myself with catheters and
bougies

OF GONORRHOEA. 137
bougies of different sizes, and to be as much upon my guard as
possible, I introduced a bougie of a small size first, and found
a full stop about the bulbous part of the urethra: I then took
a smaller one, which passed but with difficulty. I afterwards
passed a small catheter on to the stricture, where it stopped;
but as it was absolutely necessary the water should be drawn off,
I used more force than I otherways would have done: it went
on, but with difficulty, and I was not certain whether it was
in the natural passage, or was making a new one. When
the bougie had gone so far as certainly (if I was in the right
passage) to have entered the bladder, I found that no water
came, I therefore pressed on the lower part of the belly, and
the water immediately came out through the catheter; whence
it appeared that the bladder had lost its power of contraction.
The water was drawn off three times every day, that is, every
eight hours, to give as much ease to the bladder as possible; but
still it was necessary to press the belly to assist the discharge of
the urine; and it was upwards of a fortnight before the blad-
der began to recover its power of contracting. The swelling
in the perinæum still continued, advancing along the body of
the penis, and spreading a little on the pubes, it seemed to ex-
tend along the projecting part of the penis, and at last filled
the whole cellular membrane of the prepuce, but did not in
the least affect the scrotum. This swelling appeared to be ow-
ing to the urine having found its way into the cellular mem-
brane of the perinæum, and from thence proceeding along the
side of the penis. When the prepuce became much loaded
with water, a very considerable phymosis took place, which
made the introduction of the catheter into the orifice of the
urethra very uncertain; so much did the swelled prepuce pro-
ject over the glans. I was obliged to squeeze the water back
into the body of the penis, and introduce the finger, and feel
for the glans, and on this finger introduce the catheter; and
in a few minutes I generally found the orifice.
The nature of the case was now plain; for ulceration had
taken place beyond the stricture, and the swelling had arisen
from the urine having insinuated itself into the cellular mem-
brane of the perinæum; and as the urine escaped from the ure-
thra, it was pushed forwards where the cellular membrane was
loosest, till it got to the very end of the prepuce as before-
mentioned.
T By

138 SUPPOSED CONSEQUENCES
By this time he was become extremely low and irritable;
his pulse quick and small; his tongue brown, dry, and con-
tracted; his appetite gone, with great drought, bad sleep, and
the first stages of a dilirium coming on. This discovery of the
true state of the case gave a change to the mode of treatment.
Instead of evacuations to lessen inflammation, bark and cordials
were given, with as much food as his stomach would bear.
Their effects on the constitution were almost immediate; and
he began to recover, although but slowly. I made two punc-
tures in the phymosis at the extremity, with a view both to take
off the tension, and to evacuate the urine from the cellular
membrane, between the penis and the skin.
Blisters began to form on the skin of the penis; and at last
mortification took place in several parts, especially on the pre-
puce, which I divided at the mortified parts, and thereby the
glans became exposed, so that the catheter could now be intro-
duced easily.
Upon squeezing the swelling from the perinæum forwards
along the penis, I could force out at the mortified parts, air,
water, and some matter. The cellular membrane under the
skin was almost wholly mortified. When bounds were set to
the mortification, the sloughing cellular membrane began to se-
parate; and a good deal was cut away to keep the parts clean,
and to allow of a freer vent for the matter. Now that separa-
tion was taking place, I was clear that no more water from
the bladder could insinuate itself any further into the surround-
ing cellular membrane; therefore it was not necessary to pass
the catheter any more; and the patient was allowed to make
water whenever he had a call; which when he did, the water
came both ways, through the urethra, and through the cellular
membrane, at the openings where the skin had sloughed off.
As the sloughs separated, they came forwards from behind, at
the side of the scrotum, so that I could draw them out; and
when most of the mortified cellular membrane was removed, I
saw a part, about the size of a sixpence, of the tendinous co-
vering of the corpus cavernosum dead, which was also allow-
ed to slough off. Most of the water now came through the
sore. The parts became more painful; he was more restless,
and one morning he had a shivering fit. I endeavoured to
pass a bougie down the sore, between the skin and penis, but
could not; in the evening of the same day a gush of matter
and

OF GONORRHOEA. 139
and blood came out of the sore, which immediately relieved
him; and he began to mend again, and continued to do so,
both in the parts and his general health, the water coming both
ways, but often varying in quantity between the two passages;
more and more, however, came the right way, till at last the
new passage closed up entirely.
While the external parts were healing, I passed a bougie
occasionally, to keep the passage clear and open. To find
out the situation of the internal opening, I ordered the patient
to press on different parts of the perinæum while he was mak-
ing water; by which means he found that by pressing upon a
particular spot he could stop the water from flowing through
the new passage. He was directed, however, not to press too
hard, for fear of forcing together the sides of the natural pas-
sage. Upon erections, the penis was bent to the side that had
suffered; but in time the parts gradually recovered their na-
tural form.
III. OF INFLAMMATION IN THE PARTS SUR-
ROUNDING THE URETHRA.
INFLAMMATION, caused by the distension and irritation of
the urethra, often extends considerably further than the surface
of that canal; for the surrounding parts become the seat of in-
flammation, the situation of which will commonly be accord-
ing to the situation of the stricture, producing the disten-
sion. Thus we find the inflammation affecting the prostate
gland, the membranous part of the urethra, the bulb, and proba-
bly Cowper's glands, with other parts of the urethra between
the bulb and the glans. But inflammation in the surrounding
parts of the urethra is not always a consequence of distension
or stricture; it arises often from other irritations in this canal,
such as violent gonorrhœas, and very irritating injections.
When inflammation attacks these parts it is of the true adhe-
sive kind; and therefore when suppuration takes place an ab-
scess must be formed, unless the inflammation be resolved.
The matter, according to a general principle in abscesses, points
externally; when the seat of the abscess is either in the pro-
state gland, membranous part, or in the bulb, the matter will
point in the perinæum; for the abscess may be formed for-
wards in the scrotum, or before it, according to the situation
of the stricture. The

140 SUPPOSED CONSEQUENCES
The seat of these abscesses is generally so near the inner sur-
face of the urethra, that the partition between them often gives
way, and they open internally, as frequently happens in an ab-
scess by the side of the rectum, so that the matter is at once dis-
charged by the urethra, or carried back into the bladder to be
discharged with the urine. When the internal opening only
takes place, I believe it is owing to the ulceration on the inner
surface of the urethra, as has been already described; and in these
cases also the stricture is sometimes involved in the abscess and
ulceration, by which means the water will find a free passage for-
wards; but the urine has also a free passage into the abscess, which
we may suppose retards its healing, and often becomes the cause
of its opening externally; but here from the adhesive inflam-
mation having taken place, the urine cannot insinuate itself in-
to the surrounding cellular membrane, so as to produce the
consequences mentioned in treating of the way in which Na-
ture endeavours to relieve herself. In such cases we find that
upon pressing the abscess externally, the matter is squeezed into
the urethra, and so out by the glans. It sometimes happens,
that a catheter can be introduced into the opening of such an
abscess, by which means it can be washed by injecting some-
thing through the catheter, whereby probably it may be sooner
healed. It more frequently happens, that such abscesses open
both internally and externally, discharging themselves both ways.
These ulcerations and suppurations, of both kinds, are to be
considered as efforts of Nature; or to speak more physiologi-
cally, as a natural consequence arising from such irritation, by
which as the urine cannot pass by the old passage, a new one is
made to prevent further mischief.
Both these diseases when they open externally, if not proper-
ly treated, often lay the foundation for the complaint common-
ly called the fistula in perinæo; which is owing to the bottom
of the abscess having a less disposition to heal than the exter-
nal parts. It may be further supposed, that the urine passing
into the abscess by the inner orifice, and making its escape
by the external, keeps up a constant irritation in the sore,
which in some measure may prevent a union of the sides, and
rather dispose them to form themselves into a hard callous sub-
stance, whose inner surface of which loses the disposition to
union, and assumes the nature of an outlet.
But it is more than probable, that the cause which prevents
these

OF GONORRHOEA. 141
these abscesses from healing, depends upon their first action often
continuing in full force, that is, a diseased state of the inter-
nal parts, as will be further illustrated when we shall treat on
the fistula in perinæo. They often heal up at the orifice in
the skin, especially if the water has a free passage forwards;
but if the internal opening is not perfecty consolidated, some
water will insinuate itself into the old sore, become the cause
of fresh inflammations and suppurations in the surrounding
parts, which frequently open externally in different places, not
following the old canal, although they sometimes communi-
cate with it and form branches, as it were, from the princi-
pal trunk. I have seen the scrotum, perinæum, and inside of
the thigh, full of openings which were the mouths of so many
sinuses leading to the first formed abscess. When the abscess
opens only externally, which is seldom the case, it is to be
considered as a common abscess.
When these inflammations arise from stricture, the difficulty
in making water is increased in the time of the inflammation,
which is  generally so great as to compress the sides of the ure-
thra together for some way; besides the stricture itself will be-
come tighter from being inflamed. Inflammation in these
parts, even when it does not arise from a stricture, brings on
a suppression of urine; but in such cases a bougie or catheter
can be passed; the last of which, in cases of obstruction aris-
ing from contiguous swellings, as tumors, inflammations, and
swelled prostate gland, is the proper instrument, as the sides of
the urethra would be pressed together immediately upon with-
drawing the bougie, by which the urine would be as much as
ever prevented from following.
IV. OF THE TREATMENT OF THE INFLAMMA-
TION IN THE SURROUNDING PARTS.
THE inflammation of these parts is to be treated like other
inflammations. Resolution is much to be wished for; but it
is almost impossible it should take place where stricture is
the cause. When the stricture is removed, either by ulcera-
tion or a bougie, we have only the inflammation to contend
with; but this seldom happens, for the inflammation is but
too often accompanied with suppuration.
When suppuration takes place, the sooner the abscess is
opened

142 SUPPOSED CONSEQUENCES
opened externally the better, as that may in some cases be the
means, though seldom, of preventing its opening internally;
yet it may prevent the inner opening from becoming so large
as it otherways might be. The opening externally should
be large; and if the stricture is not involved in the suppuration,
then it must be destroyed; because there can be no cure while
the water passes through the new opening. I have succeeded
with the caustic even in strictures of long standing.
When the stricture will admit of the passage of a bougie
through it, it is to be kept almost constantly in the urethra, and
to be withdrawn only at the time of making water; this will
allow the urine to pass more freely through the urethra, with-
out escaping through the sore. The sore must be healed from
the bottom.
Hollow bougies are recommended in such cases, after the
stricture is destroyed, to prevent the urine passing through the
wound. This instrument admits of a constant dribbling of urine
through it; but the bougie may be occasionally stopped up, and
the urine permitted to pass when there is a desire to make wa-
ter. It becomes under certain circumstances the worst instru-
ment possible; for if its canal is not of a size sufficient to let
the water pass as freely as the contraction of the bladder requires,
the water will pass easily by the side of the bougie to the abscess,
and not getting forwards beyond the stricture, flow out at the
abscess: to avoid this effect as much as possible, the hollow
bougies should be as large as the strictured part will allow, and
its sides should be as thin as possible, that its passage may be
the larger. The elastic gum has these two properties in a high-
er degree than the spiral wire covered with waxed cloth. But
as I doubt very much that the passage of the urine may be an
hinderance to the healing of the sore, I am the less solicitous
about such practice; for we find, that, after lithotomy the parts
heal very readily; and, even in this operation, the external
parts which are not diseased heal up very readily. I suspect
that the want of disposition to heal arises from the strictures not
being sufficiently subdued, or the deeper parts not being in a
healthy state.
When these suppurations are left to themselves, and no me-
thod tried to remove the stricture, and of course nothing in-
troduced into the urethra, the stricture sometimes closes en-
tirely, so that no water can pass forwards through the urethra;
and

OF GONORRHOEA. 143
and therefore before any attempt can be made to heal the fistu-
lous orifices, a passage must be made through the united parts.
This cannot be done with a bougie; and if this union of the
parts is before the bend of the urethra, which most common-
ly it is, nothing but the caustic can be applied with any pros-
pect of succecs, as we shall mention more fully in treating of
the fistula in perinæo.
V. OF THE EFFECTS OF INFLAMMATION IN THE
SURROUNDING PARTS UPON THE CON-
STITUTION.
THE effects which these attempts to form a new passage for
the urine have upon the constitution, are very considerable;
much more so than what one would at first expect. Those cases
appear to be most formidable, which begin by ulceration on
the inner surface of the urethra, and where the water diffuses
itself into the cellular membrane of the scrotum and penis.
Those where the inflammation is circumscribed are more of
the true abscess, and therefore do much less mischief to the
parts than when the urine is diffused in the cellular membrane.
In these last, if not soon relieved, the patient sinks, and a mor-
tification comes on. If before the patient sinks, a separation
of the slough takes place, this separation performs the operation
of opening, and the patient may recover. We should not, I
believe, wait for such separation of the mortified part, but make
an opening early, upon the first knowledge of a diffusion of
water into the cellular membrane; and we should be guided as
to situation by introducing a staff into the urethra on to the
stricture. But in some cases this cannot be done, for when
the urine gets into the corpus spongiosum, it produces mortifi-
cation of all these parts, and renders the whole so indistinct that
often no urethra can be found.
The effects, that the circumscribed inflammation has upon
the constitution, is generally not so serious as the above, for
mortification as seldom takes place in this as in abscesses in ge-
neral. When the abscess is from the bulb backwards, there is
generally a smart sympathetic fever, because the abscess will be
of considerable size before it gets to the skin of the perinæum,
and is generally attended with great pain; but this pain goes off
by the formation of the matter, especially if opened early.
As

144 SUPPOSED CONSEQUENCES
As there is a great disposition to violent action, attended
with great weakness in such cases, more especially in those of
the first kind, it is adviseable to give the bark early, and in con-
siderable quantity; but I apprehend it is necessary to give along
with it sudorifics, as some of the preparations of antimony,
there being generally a good deal of fever. The bark gives
strength, and also in some degree lessens irritability; but it
should be assisted by other medicines.
VI. OF FISTULÆ IN PERINÆO
IT often happens that the new passages for the urine do not
heal on account of the stricture not being removed; and even
when the stricture is removed, they frequently have no dispo-
sition to heal. In both cases they become fistulous, and pro-
duce fresh inflammations and suppurations, which do not al-
ways open into the old sore, but make new openings exter-
nally. These sometimes arise from the first external openings
not being sufficiently large, so that they heal up long before
the bottom, or long before the diseased urethra; and even
when the external opening has been made as large as possible,
it will often heal sooner than the bottom, and become fistu-
lous at last.
It is very common for these diseases to affect the constitution,
so as to bring on complaints of an intermittent kind. I have
seen several affected with regular agues, where the bark has
produced no effect; but whenever the obstruction has been got
the better of, or the fistulous orifice opened and in a state of
healing, these complaints have entirely gone off.
To cure this disease, it is necessary first to make the natu-
ral passage as free as possible, that no obstruction may arise from
that quarter; and sometimes this alone is sufficient; for the
urine, finding a free passage forwards, is not forced into the
orifice, and the fistulæ healed up. The bougie may bring on
an inflammation on the urethra at this part, and produce adhe-
sions there; but if this effect is not produced early, the bougie
will rather do harm if applied too often, and too long at a time,
as will be more fully explained. But the dilatation of the stric-
ture is not always sufficient; it is often necessary to perform an
operation on the fistulæ, when they alone become the obstacle
to the cure, which I shall now describe.
VII. OF

OF GONORRHOEA. 145
VII. OF THE OPERATION FOR FISTULÆ IN
PERINÆO.
WHEN the before-mentioned treatment is not sufficient for
the cure of the new passages, a method should be followed
similar to that used in the cure of a fistulæ in other parts, by
laying them freely open to the bottom, and even making the
orifice in the urethra a fresh sore if possible. This will be
difficult in many situations of the internal orifice; and the mode
of opening, and other circumstances attending the operation,
will vary according to the situation.
That as little of the sound part of the inner surface of the
urethra may be opened as possible, and that the diseased part
may be fully exposed, it is necessary to be well directed to the
inner orifice, for which we have commonly two guides, one is
a staff introduced into the urethra as far as is thought necessa-
ry, or as far as it will go, (which will only be to the stricture,
where the stricture still exists, or it may pass on to the bladder
in cases where the stricture has been destroyed;) the other guide
is a probe passed into the fistulous orifice. The probe should
be first bent, that it may more readily follow the turns of the
fistula, and introduced as far as possible; if it could be made
to meet the staff, so much the better, as then the operator could
cut just what is necessary. If the fistula is tolerably straight,
so as to admit the passing a director, it is the best instrument
for operating upon. If neither the probe nor the director can
be made to pass on to the staff, we must open as far as they
go, and begin searching anew after the remainder of the passage
with the same instrument, and pursue it till the whole fistulous
canal is laid open. If there are any sinuses, they are to be laid
open if possible; but it frequently happens that they cannot be
followed by the knife, some running along the penis where the
scrotum is attached, others passing on towards the pubes round
the penis, while others are about the membraneous part of the
urethra. In such cases some degree of violence may be used,
and I have several times introduced my finger into these sinu-
ses, and have torn the parts so as to produce a considerable in-
flammation, by which means they often suppurate, granulate,
and unite.
U If

146 SUPPOSED CONSEQUENCES
If the situation of the internal orifice is opposite to the scro-
tum, it will be difficult to get to it, but I imagine we may use
great freedom with the external parts, whatever they are, for
they are generally in a state of callosity. However this requires
judgment.
In cases where the disease is before the membraneous part
and the stricture is not removed, a staff cannot be made to pass
on to the inner orifice. In such the fistulous opening must be
followed by introducing a probe or director into it, and by dila-
tation upon the instrument till the urethra beyond the stricture
is found; and then a probe must be passed on towards the glans,
to meet the end of the staff at the stricture; similar to what is
done in the operation where a false passage has been made by
the mismanagement of the bougie. The stricture must then be
destroyed, and a bougie passed, as was recommended in that
operation.
If either the ulceration, or the abscess, is formed in or near
the prostate gland, then probably the stricture is near that part.
In that case a staff muft be passed as far as possible, and a probe
or director introduced into the external orifice, and the opera-
tion is to be directed accordingly. The difference of the ope-
ration in this case from the former will be, that we shall most
probably be obliged to cut into the urethra on both sides of
the stricture, therefore more of the canal muft be exposed.
As this operation is the opening of all the fistulous canals,
and also the destruction of the stricture, if there has been one,
an instrument can afterwards, in every case, be passed into the
bladder. It will most probably always be proper to introduce
an instrument into the bladder, and keep it there almost con-
stantly, so as to preserve the passage of the urethra in a regu-
lar form, while the openings made are healing; and probably
the catheter will be by much the best instrument, because it is
not necessary to be withdrawn whenever the necessity to make
water comes on, which a bougie must; and its introduction
again is often not practicable, for its end will be apt to get into
the wounds.
In such cases as require a hollow cannula to be left in the
bladder for the purpose of drawing off the water, whether a ca-
theter or hollow bougie, it is absolutely necessary it should be
fixed there, or else it will in common come out by the acti-
ons of the part. To effect this, it is necessary to fix that end
of

OF GONORRHOEA. 147
of the instrument out of the penis to some part of the body that
is the least moveable: what will answer extremely well is the
common belt-part of the bag-truss, with only two thigh-straps
fixed behind and made to tie or buckle before; and two or
three very small rings or short tapes fixed to those straps; where
they pass between the thigh and scrotum they should not be at
a great distance from one another, where they are fixed behind
to the belt, for otherways they are much altered in tightness
by the motion of the thigh. If they have a flat spring in them
so much the better*.
The common bag-truss for the scrotum answers extremely
well, first by fixing two or three rings on each side of it along
the side of the scrotum, and with a piece of small tape the
ring of the cannula can be fastened to any one of those rings
that is most convenient for its situation.
Whatever instrument is used for the purpose of keeping the
passage clear and open while the sores are healing, whether the
sores are in consequence of this operation, or in consequence
of the causes of the fistulæ, which I  have described, there is a
limited time in many cases, for its continuance; for if conti-
nued beyond a certain period, it frequently acts contrary to
what was intended: at first it often assists the cure, but towards
the last it may obstruct the healing of the sores by acting at
the bottom of the wound as an extraneous body. Therefore,
whenever the sores become stationary, I would advise the with-
drawing of the instrument, and the introducing it only occasi-
onally. The catheter will probably be still the best instrument
for this purpose, as it will pass more readily, and draw off the
water at the same time: however, I have often used a bougie,
and by great care have passed it with success; and probably
it will be proper to use it every now and then, even when all
is healed, in order to determine whether or not the passage is
free from the disease.
The sore and the wound are to be at first dressed down to the
bottom as much as possible, which will prevent the re-union of
the parts just divided, and make the granulations shoot from
the bottom so as to consolidate the whole by one bond of union.
When the urethra has suffered so much, that abscesses have
formed beyond the scrotum, the patient should ever after take
great care to avoid a fresh gonorrhœa, for he seldom, in that
                                                      case,
Mr. Vanbutchell's springs would answer very well.

148 SUPPOSED CONSEQUENCES
case, escapes a return of the same complaints; and indeed, if
he is not careful in many other respects, he is liable to returns
of the same disease. If, notwithstanding this precaution, he
should contract a gonorrhœa, every thing heating is to be
carefully avoided, particularly irritating injections.
The following case shows that keeping extraneous bodies in
the urethra prevents wounds made into that canal from healing.
A man, aged twenty-six, came into St. George's Hospital,
March 2, 1783. He had laboured under a fistula in perinæo
for near two years, arising from a stricture, attended with great
pain and difficulty in making water. Four fistulous orifices
were to be observed in the perinæum and scrotum. The small-
est bougie could not be made to pass into the bladder after re-
peated trials. The caustic was then applied, but without success.
The operation for the fistula in perinæo was performed, Sep-
tember 19. A catheter was first introduced as far as it would
go, as a director, and all the sinuses were laid open to that ca-
theter, which exposed near an inch in length of that instru-
ment; then the catheter was in part withdrawn to expose that
part of the urethra which was laid bare. The blood being
sponged off, the orifice in the stricture was next searched for,
and when found it was dilated. The catheter was now push-
ed on to the bladder, although with some difficulty, and the
end of it was then fastened to a roller which went round the
thighs; and the wound was distended with lint. He took an
anodyne draught after the operation, and another at night.
September 20, he had some pain in the head from the opiates,
his pulse was natural, and he had slept tolerably well. On the
21st day the catheter slipped out, and the second introduction
of it gave considerable pain. The anodyne was repeated. Oc-
tober 1. The catheter was still to be felt by introducing a probe
into the wound. From this time to the 25th, nothing materi-
al happened, excepting a piece of lint, of the first dressing,
coming away through the urethra. November 20. The wound
having for some time been stationary, and shewing no disposi-
tion to heal, I conceived that the catheter was now acting as
an extraneous body at the bottom of the wound, and therefore
desired that it might be withdrawn, and passed occasionally;
and no sooner was the wound free from it but it put on a heal-
thy look; and by the tenth of December no urine came through
the wound, but passed tolerably well through the urethra; and
on

OF GONORRHOEA. 149
on the 12th the wound was quite healed, and his water came
from him rather in a full stream, and without pain, although
we could never pass either catheter or bougie afterwards, pro-
bably from the new and old passages being irregular.
CHAPTER VII.
OF SOME OTHER AFFECTIONS OF
THE URETHRA.
THE substance of the urethra is muscular, and it is there-
fore capable of contracting its canal, similar to an intes-
tine, so as to shut it up entirely. This makes it subject to dis-
eases peculiar to muscle in general; which is indeed the only
proof we have of its being muscular.
I. OF THE SPASMODIC AFFECTIONS OF THE
URETHRA.
IN a sound state of parts these muscles are never excited to
violent actions, acting simply as sphincter muscles; but when
irritated they are capable of acting violently, as is best seen in
some cases upon the first use of injections the urethra often re-
fusing the injection entirely. This seems rather to be a salu-
tary motion to hinder things from getting into the bladder;
but there are often spasmodic contractions of these muscular
fibres in different parts of the canal, shutting up the passage
and obstructing the course of the urine, often not allowing a
drop to pass. That this also is owing to spasm upon the mus-
cular fibres is evident, because a large bougie will sometimes
pass when it is at the worst. When the contraction is near
the bladder it is called a strangury, and is often produced in a
sound state of parts by irritating medicines, the power of which
fall upon these parts, as cantharides; and when this part is in
an irritable state, the spasm may be brought on by a vast num-
ber of things, such as most of the peppers, fermented liquors
of all kinds, violent exercises, &c.
The

150 SUPPOSED CONSEQUENCES
The urethra in cases of spasmodic stricture is more irritable
than in the true stricture, which irritation indeed is in a great
measure the cause of the spasm. Spasmodic strictures often
bear so strong a resemblance to the cramp, that one would be
apt to attribute them to the same cause as that which produces
cramp. In such cases the spasm also goes off by tickling the
part, similar to the removal of cramp.
In all cases of very irritable urethras, where spasm very rea-
dily take place, the patient should never long retain his urine
when he has an inclination to void it; for I have seen cases where
this alone has brought on the spasm; and indeed these parts,
when in perfect health, will be thrown into a spasmodic affec-
tion, if the urine is too long confined in the bladder; while at
the same time a certain fulness of the bladder, or a small degree
of retention of the urine will make the bladder contract with
more force; and the urethra will for the same reason relax more
freely; therefore in cases, where there is a tendency to stran-
gury, there is seldom any harm in waiting a little after the in-
clination comes on.
I may be allowed here to caution surgeons who have not had
opportunities of seeing many of these cases, when they meet
with permanent strictures which are becoming troublesome, at-
tended with frequency in making water, and a difficulty in pas-
sing it often threatening strangury, not to advise, or rather not
to allow, their patients to take long journeys either on horse-
back or in carriages, more especially in the winter. I have
known many patients labouring under such complaints taken ill
in the middle of a journey, and obliged to stop for days upon
the road, and who have continued in misery the remainder of
the journey; and after having arrived at the place of their de-
stination, have been laid up for months, and have suffered from
most of the before-mentioned complaints.
II. OF THE CURE OF SPASMODIC AFFECTION
OF THE URETHRA.
IT may be not improper to premise, that in diseases of the
actions only of the urethra and bladder, whether spasmodic, and
proceeding from too great irritability, or paralytic, (although
two opposite diseases) irritations on other parts have often won-
derful effects equally diminishing the action in the one, and in-
creasing

OF GONORRHOEA. 151
creasing it in the other. The proof of this will appear when we
treat of the irritable and paralytic urethra and bladder; for in
either part, and in either case, we find blisters applied to the
lower part of the small of the back, or the perinæum, as also
many other applications to this part, often produce great
effects*.
As spasm simply is not an alteration of structure, but is on-
ly a diseased or preternatural action arising from some irritation,
it may be made to cease instantaneously. In whatever part of
the urethra the spasm is, if time will allow, it is proper to try
internal medicines, and also external applications, to remove
it. The internal medicines that may be said to act immediately
are opiates and turpentines†, given either by the mouth or the
anus; but they are more immediate in their effects in the form of
clyster, especially the opium. Bark is often had recourse to in
spasmodic affections, in which it is thought to be of service;
but in such affections of the urethra I think I have seen it fre-
quently do harm.
The external applications are the steam of warm water with
spirits, the pediluvium, the warm bath, bladders of warm water
applied to the perinæum, and similar applications. The crumb
part of a new baked loaf, warm from the oven, applied to the
perinæum, has been found to give ease.
I have known a blister, applied to the loins, in a great mea-
sure remove the spasm from the urethra; it is equally effectual
when applied to the perinæum. But in most cases these methods
are too tedious; therefore when the case has been of some stand-
ing, before assistance has been called for, and requires imme-
diate relief, recourse should be had to the catheter or bougie
immediately.
If the contraction is near the bladder, the catheter will an-
swer best; but in most cases the bougie will be sufficient, and
is a much safer instrument; for in many hands the catheter is
a very dangerous one, requiring a dexterity only to be ac-
quired by a thorough knowledge of the course of that canal,
and
* That the parts concerned in the expulsion of the urine (as the bladder and urethra)
sympathise strongly with the skin of the perinæum, I believe is commonly supposed,
from applications being often made to that part in cases of stoppages of urine.
A gentleman who had no complaint in these parts, had a small fistula at the side of the
rectum, for which he often had occasion to sit over the steam of warm water and vine-
gar; and this application to the perinæum never failed of making him void his urine.
† Dr. Home, in his experiments on this medicine, found that large doses brought on
the strangury in women.
Strangury is the frequent effect of turpentine taken for some time.

152 SUPPOSED CONSEQUENCES
and a habit of passing it. The bougie has likewise this advan-
tage, that in many cases, where the part spasmodically affected
will not allow it to pass, it may be allowed to lie close to the
stricture; for it is not always necessary for the bougie to pass
through the constricted part; for a bougie, which has only
passed a very little way into the urethra, has sometimes been
effectual, if suffered to stay there till the desire of making wa-
ter is perceived.
In such cases, even when the bougie passes into the bladder,
it is necessary to let it stay in the passage till the inclination to
make water comes on. If the water does not follow on the
first attempt, it will be proper to make another; or if only
part follows the bougie, it will be necessary to introduce it
again. This circumstance of the water following the bougie
with more certainty, if it is allowed to stay till the inclination
comes on, is a proof that the disposition in the bladder to con-
tracting, removes in some degree the disposition to contrac-
tion in the urethra.
Some attention is necessary with respect to the passing of
the bougie in these cases; for the urethra being more irritable
than common, it often resists the bougie before it reaches the
true spasmodic part. When this is the case, force is not to be
used; but we should rather wait a little with patience, and then
make another attempt to push it on. Dipping the end of the
penis in very cold water often removes the spasm, and the wa-
ter flows immediately and freely.
In most cases there is an uneasy sensation at the end of the
penis, which leads the patient to rub those parts, and some-
times, though rarely, during the friction, the water will pass.
Gentle irritating injections, thrown in only a little way, often
give ease. They may be supposed to act in a manner some-
what similar to a bougie that does not pass, and by irritating
one part of the urethra to produce a relaxation in the other.
They act in some cases as a preventive.
III. OF THE PARALYSIS OF THE URETHRA.
IN opposition to the foregoing disease, there is the want of
power of contraction of the urethra; but this is not so fre-
quent a case as the former. This disease is attended with
symptoms contrary to those of the foregoing; the bladder is
hardly

OF GONORRHOEA. 153
hardly allowed to be filled so as to give the stimulus of reple-
tion; but the water dribbles away insensibly as fast as secreted
by the kidneys; or if the bladder is filled so as to receive the
stimulus for expulsion, then it immediately takes place, and
the water flows, if the person does not act with the musculi
acceleratores; but sometimes in such cases the power of con-
traction of these muscles is lost, and then the water will flow,
whether the person will or not, there being little or no power
of retention. There is great difference in the degrees of vio-
lence of this disease.
IV. CURE OF THE PARALYSIS OF THE URETHRA.
IT is to be cured by stimulants, as a blister to the loins, of
a blister to the perinæum. It may be useful to immerse the feet
in cold water. Tincture of cantharides, taken internally, fif-
teen or twenty drops once or twice a day, according to their
effects, are of singular service in some cases.
A man came to St. George's hospital with this complaint.
I ordered him the before-mentioned medicine, and it had such
an effect as to bring on the contrary disease, or a spasmodic
affection of the urethra, so that he could not make water when
he had the inclination; but an injection of opium removed
this complaint, and he was then well. In this case a few drops
less, probably would have effected a cure without any incon-
venience.
V. OF CARUNCLES OR EXCRESCENCES IN
THE URETHRA.
STRICTURES are not supposed to be the only causes of ob-
struction to the passage of urine in this canal; excrescences or
caruncles are likewise mentioned by authors as happening fre-
quently. From the familiarity with which they talk of them,
and the few instances in which they really occur, one would
suspect that this cause of obstruction was originally founded in
opinion, and not observation, and afterwards handed down as
matter of fact. If caruncles had been at first described from
actual examination of cases, the language would have accorded
with the appearances, and they would have been considered as
seldom the causes of obstruction compared with strictures. How-
X ever

154 SUPPOSED CONSEQUENCES
ever, they do sometimes happen, although but rarely. I have
in all my examinations of dead bodies seen only two, and these
were in very old strictures, where the urethra had suffered con-
siderably. They were bodies rising from the surface of the ure-
thra like granulations, or what would be called polypi in other
parts of the body. It is possible they may be a species of in-
ternal wart; for I have seen warts extend some way into the
beginning of the urethra, having very much the appearance of
granulations. Most probably it will not be possible in the liv-
ing body to distinguish caruncles, excrescences, or risings in the
urethra, from a stricture; for I cannot conceive that they can
produce any new symptoms, or peculiar feel to the examiner.
VI. OF THE CURE OF THE EXCRESCENCE OR
CARUNCLE.
I SHOULD very much suspect that this disease is not to be
cured by the bougie; at least dilatation in such cases is not to
be attempted, as there is no contraction. If therefore the bou-
gie is of any use, it must be in making the carnosity ulcerate
from its pressure, which probably may be done by a large bou-
gie pressing upon it with considerable force. But if this should
not have the desired effect, I should certainly recommend or
use the caustic, if the parts are so situated as to admit of the
application; and from such practice I should not doubt of a
cure. But the difficulty lies in distinguishing the disease from
the true stricture; for although authors talk of caruncles as
common, and give us the method of treatment, yet they have
not told us how we are to distinguish them from strictures.
I have never met with a caruncle in women.
CHAPTER VIII.
OF THE SWELLED PROSTATE GLAND.
ANOTHER disease of the parts surrounding the urethra,
which is often very formidable, is a swelling of the pro-
state

OF GONORRHOEA. 155
state gland. This is of more serious consequence than any of
the former causes of obstruction, because we have fewer me-
thods of cure, for we cannot destroy it as we do the stricture,
nor can Nature relieve herself by forming new passages; we
have, however, often the means of temporary relief in our
power, which is not the case in the stricture; for most com-
monly we can draw off the water by the catheter.
The swelling of the prostate gland is most common in the
decline of life. The use of this gland is not sufficiently known
to enable us to judge of the bad consequences that attend its
diseased state, abstracted from swelling. Its situation is such,
that the bad effects of its being swelled must be evident, as it may
be said to make a part of the canal of the urethra, and there-
fore when so diseased as to alter its shape and size, it must ob-
struct the passage of the urine. When it swells it does not
lessen the surface of the urethra at the part like a stricture; on
the contrary, it rather increases it; but the sides of the canal
are compressed together, producing an obstruction to the pas-
sage of the urine, which irritates the bladder, and brings on all
the symptoms in that viscus that usually arise from a stricture or
stone. From the situation of the gland, which is principally
on the two sides of the canal, and but little, if at all, on the
fore part, as also very little on the posterior side, it can only
swell laterally, whereby it presses the two sides of the canal
together, and at the same time stretches it from the anterior
edge or side to the posterior, so that the canal, instead of be-
ing round, is flattened into a narrow groove. Sometimes the
gland swells more on one side than the other, which makes an
obliquity in the canal passing through it.
Besides this effect of the lateral parts swelling, a small por-
tion of it, which lies behind the very beginning of the urethra,
swells forwards like a point, as it were, into the bladder, act-
ing like a valve to the mouth of the urethra, which can be seen
even when the swelling is not considerable, by looking upon
the mouth of the urethra from the cavity of the bladder in a
dead body. It sometimes increases so much as to form a tu-
mor*, projecting into the bladder some inches. This projec-
tion turns or bends the urethra forwards, becoming an obstruc-
tion to the passage of a catheter, bougie, or any such instru-
ment; and it often raises the sound over a small stone in the
bladder,
* Vide plates IV and VI.

156 SUPPOSED CONSEQUENCES
badder, so as to prevent its being felt. The catheter should
for this part be more curved than is necessary for the other parts
of the urethra. In such cases I have frequently passed first a
hollow elastic catheter till it has reached this point, and after-
wards a stilet or brass-wire properly curved so as to go over the
prostate gland. The advantages of this method are, that if the
hollow catheter passes, no more is necessary; and, if it does
not, the curved wire will pass along the hollow bougie much
easier both to the surgeon and patient than it would have done
if it had been introduced at first with the hollow bougie over it;
for it would endeavour to adapt the urethra to the curve:
whereas, when introduced afterwards, the stilet acts only on
the inside of the hollow bougie, which the patient hardly feels.
A gentleman had been often sounded for a stone, and yet
no stone could be found; but it afterwards appeared that there
was a stone, which, together with the swelling of the prostate
gland, had been the cause of his death.
John Doby, a poor pensioner in the Charter-house, had
been several years afflicted with the stone in the bladder, and
was relieved from all the symptoms by an enlargement of this
part of the prostate gland, preventing the stones from falling
down upon the neck of the bladder and irritating those parts.
A twelvemonth after that the symptoms of the stone had gone
off, he was attacked with a strangury, to relieve which, many
ineffectual attempts were made both with the bougie and cathe-
ter; but it soon proved fatal. Upon examination of the parts
in the dead body, the prostate gland was found enlarged to a
size six times greater than what it is in common, and the ure-
thra, passing through it, was a slit about an inch and half in
length, the two sides of which were close together, the upper
end towards the pubes and the lower towards the rectum. This
slit was formed by the sides of the prostate gland only swelling,
and the right side was the most enlarged, having its surface next
the urethra rounded or convex, and the left side was exactly
fitted to it, having its surface hollowed in the same proportion.
The small projecting point of the gland was so much enlarged
as to come forwards into the cavity of the bladder and fill up
entirely the passage at the neck of it. The bladder itself was
very much enlarged and thickened in its coats, and contained
above twenty stones, most of them lying behind the projecting
process of the prostate gland, and the rest lodged in small sacs,
made

OF GONORRHOEA. 157
made by the internal membrane being pushed some little way
between the fasciculi of muscular fibres.
The prostate gland when swelled, generally becomes firmer
in its consistence. The effects of these swellings are very con-
siderable, for they squeeze the sides of the urethra close together,
and the projecting point hinders in some degree the urine from
entering the passage, and in many cases stops it entirely. Fur-
ther, the increased firmness of the substance of the gland hin-
ders it from yielding to the force of the urine, so that little or
none can pass. It will be unnecessary to relate the particular
symptoms which this disease occasions; they are such as arise
from any stoppage of urine, producing an irritable bladder.
When a difficulty in making water takes place, a bougie is
the instrument which the surgeon will naturally have recourse
to, and if he finds the passage clear, which he often will, in
such cases he may very probably suspect a stone. If search is
made and no stone felt, he should naturally suspect the prostate
gland, especially if the sound or instrument used meets with a
full stop, or passes with some difficulty just at the neck of the
bladder. He should examine the gland. This can only be
done by introducing the finger into the anus, first oiling it well,
placing the fore part of the finger towards the pubes; and if
the parts, as far as the end of the finger can reach, are hard,
making an eminence backwards into the rectum, so that the
finger is obliged to be removed from side to side, to feel the
whole extent of such a swelling, and it also appears to go be-
yond the reach of the finger, we may be certain the gland is
considerably swelled, and is the principal cause of those symp-
toms.
I have known cases where the common catheter has been
pushed through the projecting part of the gland into the blad-
der, and the water then drawn off; but in one patient the bleed-
ing from the wound passed into the bladder and increased the
quantity of matter in it. The use of the catheter was attempt-
ed a second time, but, not succeeding, I was sent for. I pas-
sed the catheter till it came to the stop, and then suspecting that
this part of the prostate projected forwards, I introduced my
finger into the anus, and found that gland very much enlarged.
By depressing the handle of the catheter, which of course rais-
ed the point, it passed over the projection; but unfortunately
the blood had coagulated in the bladder, which filled up the
holes

158 SUPPOSED CONSEQUENCES
holes in the catheter so that I was obliged to withdraw it,
and clear it repeatedly. This I practised several days; but sus-
pecting that the coagulum must in the end kill, I proposed cut-
ting him as if for the stone; but he died before it could be
conveniently done, and the dissection, after death, explained
the case to be what I have now described.
In some of those cases where this part of the gland swells
into the bladder in form of a tumor, the catheter has been
known not to bring off the water at times when it appeared to
have passed; and upon the death of the patient when the parts
have been examined, it was imagined that the catheter, in the
living body, had made its way into the tumor so as to have been
buried in it at those times*.
From the knowledge of the above-mentioned facts, when-
ever I find the urine does not flow immediately upon introduc-
ing the catheter into the bladder, I have pushed it on and de-
pressed the handle so as to reach the fundus of the bladder with
the end of the catheter, and have always succeeded. For the
more ready introduction of the instrument, a catheter made
flexible at the point only for about an inch, is perhaps best, as
it is more under the command of the hand than when wholly
flexible.
If the bougie be used, it should be first warmed and then ve-
ry much bent at the point, and allowed to cool in this position,
and passed quickly with the concave side upwards, before it
loses the bend in its passage. But the bougie does not answer
so well as the catheter, because upon withdrawing the bougie
the sides of the gland soon close again. I have known where
the water has passed by the side of the bougie with more free-
dom than when it was pulled out, because the bougie gave a
straightness to this part of the canal, which it had not when
the bougie was withdrawn. The following case is a strong in-
stance of the inconveniences arising from such a disease of the
prostate gland.
A gentleman was attacked with a suppression of urine; a ca-
theter could not be passed, but a bougie relieved him. He con-
tinued well for five years; but the same complaint returning,
the bougie could not be passed, and the disease was supposed
to be a stricture. A catheter however passed, although with a
good deal of difficulty; and the bougie, though often tried,
could
* Vide plate VI.

OF GONORRHOEA. 159
could not be passed, excepting once, just after using the cathe-
ter. I was sent for, and tried the bougie with as little success,
and was obliged to have recourse to the catheter. I passed it
with great ease, and the water was drawn off. The late Mr.
Tomkyns, who had Daran's bougie, was  called; but he was
not more successful, and was obliged to have recourse to the
catheter; but such violence was used as to cause a good deal
of blood to come from the urethra, and after all it did not suc-
ceed. I was again consulted, and passed the catheter, but with
much more difficulty than before, which made me believe that
the passage had been a good deal torn. Upon taking out the
catheter I passed a large bougie into the bladder with great ease;
this I allowed to remain for three days, and he made water to-
lerably freely by the side of it. The moment I drew out the
bougie I attempted to pass another, but did not succeed, al-
though I gave it the natural bend of the passage. Upon with-
drawing those bougies that did not pass, I observed that all of
them had a bend at the point, contrary to the direction of the
passage; this made me suspect, that the place which stopped the
bougie was on the posterior surface, and that by being pushed
on, it bent forwards into the passage, and of course the point
turned back. I therefore took a thick bougie; and, before I
introduced it, I bent the point almost double, so that it could
not catch at the posterior surface of the urethra, where I sup-
posed the stop to be: this point of the bougie rubbed all along
the anterior and upper surface of the urethra, by which means
it avoided catching on the posterior surface, and it passed with
great ease into the bladder. He made water by the side of the
bougie, as before. He had been for some time troubled with fits
of an intermittent, which at first were very irregular, but be-
came afterwards more regular. In one of the cold fits, the
bougie, being in the urethra, gave him great pain, and oblig-
ed him at last to pull it out, on which he had immediate ease.
The sensation was as if it stretched the passage too much, and
it seemed to come out with difficulty. This looks as if there
was a contraction of the urethra, as well as of the vessels of
the skin, in the cold fit; so that this disposition runs deep.
By giving the bougie this bend, he was able for the future to
pass them with great ease. I may just observe, that by intro-
ducing the finger into the anus, I found the prostate gland
much enlarged.
Many

160 SUPPOSED CONSEQUENCES
Many patients, while labouring under any of the before-
mentioned diseases of the urethra, and sometimes even after
they have been cured of them, find great pain in throwing for-
wards the semen, having a sensation as if it scalded. This
arises from the very irritable state which the muscles of this
part are in, giving great pain by their own action.
I. OF THE TREATMENT OF THE SWELLED
PROSTATE GLAND.
THE methods, practised in the above cases, afforded only
temporary relief; yet such must be had recourse to in order to
prevent the consequences of retaining the urine too long. As
a temporary relief from pain, as also to remove spasm, opiate
clysters should be thrown up once or twice a day. A certain
cure, I am afraid, is not yet discovered.
I have seen hemlock of service in several cases. It was giv-
en upon a supposition of a scrofulous habit. On the same
principle I have recommended sea-bathing; and have seen
considerable advantages from it, and, in two cases, a cure of
some standing.
In one case in which I was consulted, the surgeon had found
that burnt sponge had reduced the swelling of the gland very
considerably.
This disease, like the stricture, produces complaints in the
bladder; but in this the bladder is more irritable, perhaps from
the cause being nearer to that viscus.
Diseases of the vesiculæ seminales are very familiarly talked
of; but I never saw one. In cases of very considerable indu-
ration of the prostate gland and bladder, where the surrounding
parts have become very much affected, I have seen these bags
also involved in the general disease; but I never saw a case
where it appeared that they were primarily affected.
In a case of a swelled prostate gland, with symptoms of an
irritable bladder, in a young gentleman about twenty years of
age, Mr. Earle tried a blister to the perinæum; but not find-
ing the desired effect, and conceiving a greater irritation and
discharge to be necessary, he passed a seton in the direction of
the perinæum. The orifices were about two inches distant
from each other. The symptoms of irritability in the bladder
began to abate, and in time went entirely off. Upon exami-
nation

OF GONORRHOEA. 161
nation of the prostate gland, from time to time, it was found
to decrease gradually till it was nearly of the natural size. The
seton was continued some months, and upon its being with-
drawn the symptoms began to return. It was advised to in-
troduce it again; which was accordingly done, but without
the former good effect.
CHAPTER IX.
OF THE DISEASES OF THE BLADDER,
PARTICULARLY FROM THE BE-
FORE-MENTIONED OBSTRUC-
TIONS TO THE URINE.
ALL the diseases of the urethra, as also the diseases of the
prostate gland, I have now treated of; and shall next
consider the effects of them upon the bladder; as also the dis-
eases of that viscus, independent of affections of the urethra.
The disease of the bladder arising from obstruction alone, is
increased irritability, and its consequences, by which the blad-
der admits of little distension, becomes quick in its action, and
thick and strong in its coats. But prior to the description of
the effects of the diseases of the urethra on the bladder, it will
be necessary for the better understanding of the whole, to make
some remarks upon those diseases of the two parts, in which
we find that each affects the other; and these I shall consider
without having any regard to the cause, but only the general
effects when they are diseased. It may be observed, that every
organ in an animal body is made up of different parts, the func-
tions or actions of which are totally different from each other,
although all tend to produce one ultimate effect. In most, if
not in all, when perfect, there is a succession of motions, one
naturally arising out of the other, which in the end produces
the ultimate effect; and an irregularity alone in these actions
will constitute disease, at least produce very disagreeable effects,
and often totally frustrate the final intentions of the organs.
I may be allowed also to premise, that the natural width of
the urethra gives such a resistance to the force or power of the
Y bladder

162 SUPPOSED CONSEQUENCES
bladder in expelling the urine, as is easily overcome by the na-
tural action of the bladder; but when the canal is lessened, ei-
ther by stricture, spasm, swelled prostate gland, or any other
means, this proportion is lost, by which means the bladder finds
greater difficulty than natural, and is of course thrown into an
increased action to overcome the resistance, which becomes a
cause of the irritability and increased strength of this viscus in
such diseases.
It is to be understood, that in a sound state of these two
parts, the bladder and urethra, the contraction of the one pro-
duces a relaxation of the other, and vice versa; so that their
natural actions are alternate, and they may be considered as an-
tagonist muscles to one another. Thus when the stimulus of
expulsion of the urine takes place in the bladder, which im-
mediately produces contractions in it, the urethra relaxes, by
which means the urine is expelled from the bladder and allow-
ed to pass through the urethra; and when the action ceases in
the bladder, the urethra contracts again like a sphincter mus-
cle*, for the purpose of retaining the urine which flows into
the bladder from the kidneys till it gives the stimulus for ex-
pulsion again. But in many diseases of these two parts, this
necessary alternate action is not regularly kept up, the one not
obeying the summons of the other. This irregularity arises
perhaps oftener from disease in the urethra, than in the blad-
der; for the action of the urethra depends upon the actions of
the bladder; and if it is not disposed to obey the notices of
the bladder, then there must be an irregularity as to time,
which produces very troublesome symptoms.
We find in many diseases of the urethra, such as strictures
and spasms, as also in diseases of certain parts belonging to this
canal, such as the prostate, and Cowper's glands, that there is
a greater disposition in this canal for contraction, than com-
mon, so that when the bladder has begun to act, the water is
not allowed to flow, the urethra not immediately relaxing;
and the moment such a symptom takes place, every other pow-
er takes the alarm, and is brought in to assist the bladder, such
as straining violently with the abdominal muscles, and muscles
of
* It may be remarked, that many sphincter muscles have two causes of action; one
which may be called involuntary, depending on the natural uses and actions of the parts;
the other is voluntary, where a greater degree of action can be produced by the command
of the will: and when a diseased action takes place, it is probably of this voluntary ac-
tion, for it is an increased action over the natural, which the voluntary is.

OF GONORRHOEA. 163
of respiration, from all which there is violent pain in the parts
immediately concerned, especially in the glans penis.
This disease has different degrees of violence. When slight,
the distance in time between the contraction of the bladder,
and the relaxation of the urethra is but short, only giving a
momentary pain and straining, before the urethra relaxes, and
the water flows according to the dilatation of the urethra, which,
in many of these cases, is but very small. In others the dis-
tance of time is very long, many straining for a considerable
time before a drop will come; and what does come is often
only in drops; and sometimes before the whole urine can be
expelled in this way, the spasm of the urethra comes on again,
and there is a full stop, which gives excruciating pain for a
while; but at last the bladder is as it were tired, and ceases to
act. But as the urine in such cases is seldom all discharged,
and often but a very little of it, the symptoms soon recur; and
in this way, with a call to make water perhaps every hour
out of the four and twenty, the patient drags on a miserable
life.
The bladder, in all cases of obstruction, whether constant,
as in the permanent stricture, or swelled prostate gland, or on-
ly temporary, as in the spasmodic stricture, is generally kept
distended, but much more so in the permanent stricture; and
when the irritation of fulness comes on, which is very frequent,
the contraction of that viscus becomes violent, in proportion
to the resistance: the sympathetic contraction of the muscles of
the abdomen takes place, and is also violent, yet the water at
such times shall only dribble, and be discharged in small quan-
tity; and in the spasmodic stricture often not a drop shall pass,
so that the bladder is never entirely empty; and what does
pass is no more than what is sufficient to take off the irritation
of fulness; by which means these actions become more fre-
quent, and consequently there is almost always a constant ooz-
ing of urine from the penis between the times of making wa-
ter. This however is not always the case, for the bladder
sometimes is so irritable as not to cease acting till it has eva-
cuated the whole water; and even then it is not at ease. but
still strains though there is nothing to throw out, the action of
the bladder becoming a cause of its own continuance.
In all such affections of the bladder there is a sensation of
pain and itching combined in the glans penis.
If

164 SUPPOSED CONSEQUENCES
If the symptoms are more urgent than what can be account-
ed for upon the supposition of a stricture or disease of the pro-
state gland, a stone is to be suspected.
I. OF THE TREATMENT WHERE THE ACTIONS
OF THE URETHRA AND BLADDER DO NOT
EXACTLY ALTERNATE.
THE cure, where the disease arises from spasm alone, con-
sists in removing the disposition to over-action in the urethra,
and the irritable disposition of the bladder when the urethra does
not obey it. Perhaps opiate clysters, as a temporary means of
relief, are the very best medicines that can be administered. I
have known a blister to the loins, or to the perinæum, remove
the spasm, in a great measure, from the urethra.
When the circumstance of the ultimate actions of these parts
not being regular arises from stricture, swelled prostate gland,
or any mechanical obstruction to the urine, then that cause
must be removed, as has been fully described in the treatment
of these diseases.
II. OF THE PARALYSIS OF THE BLADDER
FROM OBSTRUCTION TO THE PASSAGE
OF THE URINE.
WE may observe that the bladder is a part easily deprived
of its power of contraction; for we find in many debilitating
diseases and long illnesses from any cause, as fever, gout, and
considerable local diseases which debilitate, that the bladder oft-
en becomes paralytic, and the water must be drawn off. We
may also observe when the bladder has been distended consi-
derably, from whatever cause, so as to have its contractile pow-
er destroyed, that there is a considerable extravasation of blood
from the inner surface of the bladder, so that the water which
is evacuated is often extremely bloody. I have seen in cases
where the patient has died with this obstruction upon him, that
the inner membrane of the bladder has been almost black, be-
ing loaded with extravasated blood, but this symptom of bloo-
dy urine goes off, as the bladder acquires again its powers of
action.
In

OF GONORRHOEA. 165
In the diseases of the urethra, before described, when not
properly, or in time, attended to, and in cases of stricture,
where Nature has not been able to relieve herself, the water
must of course be retained in the bladder, which is perhaps al-
ways productive of another disease, that is, the loss of the pow-
er of contraction of that viscus. Although this one effect, the
retention of urine, arises from very different causes, as before
related, yet immediate relief must be given in all of them,
which can only be affected by the evacuation of the water. Ac-
cording to the nature of the obstruction, the mode of evacua-
tion will be different, and will be of two kinds, one by the na-
tural passage by means of an hollow tube, the other by an ar-
tificial opening made into the bladder.
If the causes of suppression are either spasmodic affections of
the urethra, a swelled prostate gland, inflammation in the sur-
rounding parts of the urethra, or tumors pressing upon it, as
happens in pregnant women, immediate relief may be procur-
ed by means of a catheter, because under such circumstances a
catheter will most probably pass, the sides of the canal being
merely forced together by spasm, or external pressure.
A bougie, although it will also pass under such circum-
stances, will not answer so well, because a bougie must be with-
drawn before the water can flow, which will allow the cause of
the obstruction to exert again its full force; and if the spasm
should now exist, yet the bougie will not answer, unless there
be a power of action in the bladder; for it is with difficulty
that the urine can be made to pass through the urethra, by pres-
sing the abdomen only.
When the catheter is passed, it will be necessary to make the
patient strain with his abdominal muscles, as also with his mus-
cles of respiration, to squeeze out the water, the bladder hav-
ing no power of contraction, and even this will not be suffici-
ent, for it will be necessary to press on the region of the pubes
with the hand to make the water flow.
In cases where there is a considerable degree of debility in
the bladder, or in those cases where there is a considerable stran-
gury and of long standing, and where a small quantity of urine
in the bladder gives the stimulus of fulness to that viscus, which
is always attended with considerable urgency to make water;
and where only very small quantities are evacuated, the blad-
der not being emptied at each time of making it, and when a
catheter,

166 SUPPOSED  CONSEQUENCES
catheter, either rigid or flexible, can with readiness be passed,
the question is, What is the best way upon the whole to eva-
cuate the water? There are three ways in which it can be done,
one, by allowing the parts to do their own business as much
as they can, and this at first sight might be supposed to be the
very best; but it is in some cases the very worst; for the fre-
quency of the inclination to make water arising from the water
not being wholly evacuated each time, the evacuation not rea-
dily taking place, increases the effort, and for a few minutes pro-
duces excruciating pain, keeping up a considerable and almost
constant irritation in all those parts, which few can bear. Ano-
ther method is, to draw off the water each time with a catheter,
but this in many cases is next to impracticable; for supposing the
operation to be performed only twice or three times in the day,
we shall find that this is oftener than what should be done. The
third method is, to leave the catheter almost constantly in the
bladder.
Which of these three methods is likely to give, on the whole,
the least irritation must depend upon circumstances attending
different cases. Where the frequency and the urgency is great,
and the flowing of the water difficult, either the second or the
third is to be pursued; and when the symptoms are such that
a catheter must be passed very often, I believe it had better be
left in, only taking it out occasionally. I think this is support-
ed by observation and experience.
It sometimes happens in cases of swelled prostate gland, that
the catheter cannot be passed without the utmost difficulty, and
when this has been the case I have left it in the bladder, for fear
of not being able to pass it again, and continued it there till
the bladder has sufficiently recovered its tone, which is known
by its being able to throw the urine through the catheter; after
which that instrument may be withdrawn.
If the spasm, in such cases as arise from that cause, should
still continue after the bladder has recovered its tone, we must
continue the use of the catheter. But it often happens that the
spasm leaves the urethra before the bladder recovers its power
of contraction, the disease becoming then simply a paralysis of
that viscus.
One of the first symptoms of the bladder beginning to regain
its power of contraction is, the sensation of fulness, or an in-
clination to make water, and when that sensation comes on the
patient

OF GONORRHOEA. 167
patient should be allowed to make water, but not to force it, for
that circumstance alone will bring on the spasm if the urethra is
not very ready to dilate. I have seen however in some cases, that
slight sensation is not altogether to be depended upon, for it
required a little retention more effectually to stimulate the blad-
der to action, and then the water has passed more freely.
The spasmodic contraction of the urethra does not appear to
give up its action simply upon the stimulus or inclination to
make water, and not till the bladder begins to have the power
of contraction; for in cases where the bladder is paralytic, and
yet sensible of the stimulus arising from being full, as it does
not contract, the urethra does not relax, and the water cannot
be made to pass.
It would appear, that, as the bladder recovers of the paraly-
sis, it is not able to contain so much water as usual. There-
fore the patients are obliged to make water often, and of course
in small quantities.
III. OF THE CURE OF THE PARALYSIS OF THE
BLADDER, FROM OBSTRUCTION ARISING
FROM PRESSURE OR SPASM.
THE removal of the causes of the paralysis of the bladder
was fully described when we were treating of the diseases which
produce that complaint, and the immediate relief, when the
bladder is rendered inactive, has just now been considered; the
paralysis itself is therefore the only remaining thing to be at-
tended to. In this disease there are often contrary indications
of cure, for a spasm is very different from a paralysis; and if
the suppression is from spasm, and that still continues, then what
may be good for the paralysis, may be bad for the spasm. As
in such cases the water can be drawn off, the bladder should be
first attended to. Stimulants and strengtheners are useful; blis-
ters to the loins to rouse the bladder to action, and blisters to
the perinæum, to take off the spasm from the urethra, often
succeed. Electricity is sometimes of singular service, when
applied in such cases to the perinæum. Through the whole of
the cure the urine must be drawn off frequently, because the
bladder should not be allowed to be distended, which other-
ways would be the consequence; and the sensation arising from
the distension of that viscus is a very oppressive one.
A gentleman

168 SUPPOSED CONSEQUENCES
A gentleman was at times attacked with a difficulty in mak-
ing water, which he paid no attention to, as it had always gone
off; but at last he was taken so bad as to be obliged to have
recourse to the catheter, which afforded only a temporary relief.
The spasm continued, and I was sent for. When I passed the
catheter, I was obliged to press the lower part of the abdomen
to squeeze out the water, for the bladder appeared to give but
little assistance. I ordered a blister to the loins, which gave
some power of contraction to the bladder, and took off some
of the spasm in the urethra, but still he was very little relieved.
I then directed a blister to be applied to the perinæum, which
immediately removed his complaint.
CHAPTER X.
OF A SUPPRESSION OF URINE — AND
OPERATIONS FOR THE CURE OF IT.
IN cases of total suppression of urine arising from strictures,
or other causes where a catheter cannot be passed, and
where every other method recommended is impracticable, an
artificial opening must be made into the bladder for the evacu-
ation of the water. There are three places where this open-
ing may be made, and each has had its advocates. This ope-
ration has not been considered in all its circumstances in dif-
ferent patients, so as to direct the young surgeon in the varie-
ty of cases that may occur; for under some circumstances the
operation is more advisable in one place than another; and
indeed it may sometimes be next to impossible to perform it
in a particular part.
The opening may be made first in the perinæum, where we
now cut for a stone; secondly, above the pubes, where cutting
for the stone was formerly practised; and thirdly, from within
the rectum, where the bladder lies in contact with the gut.
The first question which naturally occurs, is, Which of those
situations is the most proper for the safety of the patient, the
evacuation of the water, and the conveniency of operating,
when

OF GONORRHOEA. 169
when no particular circumstance forbids either of the situ-
ations?
On the first view of the subject, one would be apt to pre-
fer that above the pubes, or from the rectum, as the bladder
is nearer to either, and the parts more adapted to an operation
than from the perinæum, where we must cut at random. These
two situations, although the most proper in this respect, under
certain circumstances, yet may become the most improper, for
they are subject to greater changes than the perinæum.
The reasons that may render it very improper above the pu-
bes are, the persons being very fat, or the bladders not distend-
ing sufficiently so as to rise above the pubes, which is common
enough in diseases of those parts.
In very fat people it will be found that the substance to be
cut through may be three, or four inches, which will not on-
ly make the operation very unpleasant, but often improper; for
such thickness of parts will make the swell of the bladder very
obscure and uncertain; in many the bladder is so diseased as
to allow of but little distension, and in such the symptoms of
fulness come on very early, perhaps when there is only a few
ounces of water collected. But if the retention has been for
some considerable time, as twenty-four hours, then we may sup-
pose that the bladder has allowed of distension to a much great-
er degree, which may in some cases be ascertained by introduc-
ing the finger into the rectum.
But where the bladder distends, and the parts are so thin that
it can be plainly felt above the pubes, I see no material objec-
tion to this situation; and it has this advantage over the ope-
ration by the rectum, that a catheter can more easily be intro-
duced, and kept in, which will be necessary to be done till the
cause is removed.
It may be necessary here to mention some precautions respect-
ing the keeping the instrument in the bladder; as also the best
kind to be used. It must be a hollow tube, and should reach
as far as the posterior surface of the bladder, for upon the con-
traction of that viscus its anterior part recedes backwards and
downwards from the abdomen towards its fixed point, which
may draw the bladder off from the tube. But as the distance
between the skin of the abdomen and posterior surface of the
bladder cannot be exactly ascertained, the cannula may be ei-
ther too long, or too short; if too long, its end may press up-
Z on

170 SUPPOSED CONSEQUENCES
on the posterior surface of the bladder and produce ulceration
there, and in time work its way into the rectum. To avoid
this mischief, as also the inconveniences arising from its being
too short, and the bladder slipping off from its end, I would
recommend the tube to be made with a curve, and to lie with
its convex side on the posterior part of the bladder, which be-
ing a large surface, and following nearly the same curve as
the cannula, less mischief is to be expected. The openings
into the cannula may be made on the concave side.
It would probably be both safer and easier for the patient,
to have the curved end of the catheter introduced into the ure-
thra from the bladder. The passing of it into the urethra is
very practicable; and we know that such a body lying in the
urethra is not productive of any mischief. A common cathe-
ter passed in this way enters so far as to bring the handle al-
most flat to the belly, at most only a little bolster between the
catheter and belly is necessary, and then with a piece of tape
fixed to the handle of the catheter it might be fastened to the
body, or a short catheter might be made with ears to fix the
tape to*. In cases where the cannula has remained in the ure-
thra some time, the artificial passage will become in some de-
gree permanent, so that it may be taken out occasionally, and
cleaned from any stony matter that may be attached to it. To
avoid this part of the operation it has been recommended to
have two cannulas, one within the other, that by drawing out
the inner it might be cleaned, and again introduced; but in
most cases it will also be necessary to withdraw the outer one,
as its external surface will contract a crust.
The second method, or puncture by the anus, will more
commonly admit of being performed than that above the pubes;
for it does not require that distension of bladder which the other
does, therefore not so often impracticable from that cause; and
perhaps the only obstacle here is a swelled prostate gland. In
many of these cases of diseases of the urethra, the prostate
gland is very much swelled, which I can conceive may make
the proper place for the puncture very uncertain; for the pro-
state gland, in such cases, will be pressed down towards the
anus,
* Where this operation is performed in consequence of a stricture, I have conceived
that by passing a catheter into the urethra from the bladder till it comes to the stricture,
and then passing another straight cannula from the glans down the urethra, that the two
may nearly meet, only having the stricture between them; and a piercer may be passed
down and forced into the end of the one from the bladder, and afterwards either a bougie
or hollow catheter introduced.

OF GONORRHOEA. 171
anus, before the bladder, and will be the first thing felt by the
finger. Care must therefore be taken to distinguish the
one from the other, which can only be done by getting the
finger beyond the prostate gland, which may not be practica-
ble; and if practicable, it may not be an easy matter to dis-
tinguish the one from the other, as a thickened and distended
bladder may seem to be a continuation of the same tumor.
However, if the objections given to the performing of it above
the pubes exist, I should prefer operating by the rectum; for al-
though the probability of succeeding here may not be apparently
greater than above the pubes, yet the chances are in its favour.
I must however observe here, that the objections which I
have started, are only raised in my own mind from my know-
ledge of the diseases of those parts, and not from cases of sup-
pression of urine under all the before-mentioned circumstances
having occurred to me in practice.
A case of a total suppression of urine arising from stricture,
where no instrument could be passed by the natural passage,
and where a puncture was made into the bladder, from the
rectum, with success, is related in the Philosophical Transac-
tions, by Dr. Hamilton of Kings-Lynn in Norfolk*.
What led Dr. Hamilton to do it here, was a difficulty which
was found in passing the clyster-pipe into the rectum, which
induced him to introduce his finger into the anus, and he found
the bladder so prominent in the rectum as to give the hint of
performing the operation there.
The man was put into the same position as in the operation
for the stone, and a trochar was introduced upon the finger
into the anus, and thrust into the lower and most prominent
part of the tumor, in the direction of the axis of the bladder,
and upon withdrawing the piercer the water flowed out through
the cannula.
A straight catheter was then introduced through the cannu-
la, lest the orifice in the bladder should be drawn off from
the cannula.
Then the cannula was pulled out over the catheter, which
was left in till the whole water was evacuated, and was then
withdrawn.
The bladder, notwithstanding this perforation, retained the
water as usual, till the inclination to make it came on; and
when
* Philosophical Transactions for the Year 1776, vol. 66, page 573.

172 SUPPOSED CONSEQUENCES
when he performed the action of making water, the orifice in
the bladder seemed to open, and it rushed out by the anus.
This continued about two days, when the water began to find
its natural passage, and a bougie was introduced into the blad-
der, through the urethra, which gave a free passage for the
water, and of course less came by the anus; so that on the
sixth day after the operation the whole came by the natural
passage. The man continued the use of the bougie till the
stricture was dilated.
Dr. Hamilton further remarks, that in those cases of sup-
pression of urine, in general, he has found that calomel and
opium, in large doses, answer better than any thing he has
tried. He is convinced, from repeated trials, that the speci-
fic efficacy is in the calomel, as large doses of opium alone
have proved ineffectual; but he does not say that calomel alone
will answer. He orders ten grains of calomel with two of
opium, to be repeated in six hours if it has not answered in
that time; and he says he has seldom been obliged to give a
third dose.
This method of tapping the bladder was first suggested by
Mons. Fleurant, surgeon to the Charité, at Lyons, in the year
1750. The operation was performed at that time, and an ac-
count of it was afterwards published by Mons. Pouteau, in
1760, with the history of the cases, in all which the opera-
tion was performed by Mons. Fleurant. The propriety of
performing the operation in this part occurred to him in a
manner similar to that before-related of Dr. Hamilton; for
in introducing the finger into the rectum to examine the state
of the bladder in a case where he was going to puncture in
the perinæum, he found the bladder so prominent there, and
so much within the reach of his instrument that he immediate-
ly altered his intention, and performed it in this part. He ve-
ry readily drew off the water, and kept the cannula in, with a
T bandage, till the urine came the right way, and then with-
drew it, and all terminated well. But there was a good deal
of trouble on account of the cannula being left in on going to
stool, as also from the constant dribbling of the water through
it, all of which was prevented in Dr. Hamilton's case, by re-
moving the cannula immediately upon the evacuation of the
water. This was productive of another good effect, which
was the retention of the urine till the stimulus of fulness was
given,

OF GONORRHOEA. 173
given, and then it passed through the artificial as it would
through a natural passage. Should this be a constant effect in
consequence of performing the operation here, I think it must
be owned to be an unexpected circumstance which at first could
not have been imagined*.
In another patient of Mons. Fleurant's, the cannula was kept
in the anus and bladder thirty-nine days, without any incon-
veniency; so that the objection to this part of the operation
cannot be material. Pouteau mentions one case where he per-
formed this operation, in the year 1752, and the man died†.
He says, I was called to visit a poor man suffering under a re-
tention of urine, so obstinate and violent that it had already the
symptoms of what is called a reflux of urine into the blood;
and the complaint had continued more than three days. An
empiric, to whose care he had been entrusted, after having ve-
ry improperly given him the most powerful diuretics, had like-
wise the rashness to search him. It appears probable, that these
attempts, which were made without success, must have increas-
ed the mischief. A catheter could not be passed into such parts
by unskilful hands, without increasing the inflammation. I
only made three slight efforts to effect a passage into the blad-
der by the urethra, which appeared to be much diseased, as
well by the effusion of blood, as the extreme pain these at-
tempts produced. I determined at once to do as before, and
plunged my trochar by the rectum into the bladder. The suc-
cess was exactly the same; the bladder was entirely emptied,
and I allowed the cannula to remain there a whole night and
a day, during which time the urine flowed without intermissi-
on. Every thing went on without any accident which could
be supposed connected with the operation; and death, which
happened next day, was entirely independent of it.
One must suppose with Pouteau, that the death of the pa-
tient could not have arisen from this operation, but from the
preceding diseases.
The bags called vesiculæ seminales, and the hæmorrhoidal
vessels, have been mentioned as parts in danger of being wound-
ed in the operation, and thereby proving troublesome; but if
either of them are wounded, no inconvenience can arise. To
avoid the vesiculæ seminales, it is recommended to perforate
high
* A history, with a description of this operation, is published by Mr Reid, surgeon,
of Chelsea, in 1778.                                      '  , 9
† Pouteau Melanges de Chirurgie, printed at Lyons, 1760, page 506, 507, and 508.

174 SUPPOSED CONSEQUENCES
high up, and directly in the middle of the bladder, between
the two sides; and this situation is, at the same time, the one
where the hæmorrhoidal vessels are the smallest, and therefore
it is of less consequence if they are wounded.
It must appear from the following case, sent me by a gen-
tleman, that a communication being kept up between the blad-
der and rectum, is only inconvenient, and not so much so as
might be expected.
"With respect to the sailor who passed his urine by the
rectum, I have examined the few papers by me, but cannot
find the particular remarks I made; however, as the case was
singular, I recollect the man told me, that a few years before,
(this was at Madras hospital, in December 1779) he had the
venereal disease, very bad and long; that the urine came by
the anus, but this passage healed up, and it came by the penis,
and continued to do so till he caught the disease again, when
the urine found its way a second time by the anus, and came
that way for years. When he first came under my care, in the
hospital at Bombay, February 1779, he felt no uneasiness or
inconvenience from this manner of passing his urine; whene-
ver he had an inclination to make water he sat down. I often
made him lie upon his breast, with his legs drawn up, and the
stream came through the anus with great force."
In other cases, in consequence of abscesses forming between
the bladder and rectum, where they have not healed up, there
has been a reciprocal passing of the contents of these cavities
from the one to the other.
It only remains to speak of the puncture in the perinæum.
An obstruction to the urine taking place in the natural passage
prevents us from introducing an instrument in most of those ca-
ses, and deprives us of all the advantages we could receive
from it as a guide in the operation; yet there may be cases
of stricture, where by cutting into the urethra, beyond the stric-
ture, the water will flow; but this must be done without any
guide or direction, and requires a nice and accurate knowledge
of the parts; or if the obstruction arises from the valvular pro-
jection of the prostate gland, a staff may be passed as far as
this projection, and cut upon as for the stone, the surgeon on-
ly making a smaller incision, using a small gorget, or, in the
room of that, a trochar of a particular form might be run along
it into the bladder; for although the staff does not enter the
bladder,

OF GONORRHOEA. 175
bladder, yet the distance to pass through without this guide is
but small. If this cannot be done, a small and deep incision
may be made in the perinæum, with an imposthume lancet to-
wards the bladder; the point of the trochar is to be introduced
by this, the surgeon passing at the same time the fore finger
of the other hand into the anus, which will be a guide both
for the direction of the instrument, as also to avoid its point
passing into the rectum. With these precautions the error
cannot be great.
I must own, however, that I have not seen cases enough to
enable me to give all the varieties that commonly happen, and
of course to give all the advantages and disadvantages of each
method.
I. OF ALLOWING A CATHETER TO REMAIN IN
THE URETHRA AND BLADDER.
IN cases of debility of the bladder, and where a catheter
passes with difficulty, or with great uncertainty, and in cases
where it must be used frequently, and for a length of time, it
will be necessary to keep an instrument in the urethra and blad-
der, so as to allow the water to pass through it freely. A
common catheter, or one made of the elastic gum is perhaps
the best instrument; but it must be fixed in the canal; this
will be best done by its outer end being tied to some external
body, as I shall now describe. When the catheter is fairly in
the bladder, the outer end is rather inclined downwards, near-
ly in a line with the body. To keep it in this position we may
take the common strap or belt-part of a bag-truss, with two
thigh-straps either fixed to it or hooked to it, and coming round
each thigh and forwards by the side of the scrotum, to be fast-
ened to the belt where the ears of the bag are usually fixed.
A small ring or two may be fixed to each strap just where it
passes the scrotum or root of the penis; and with a piece of
small tape the ends of the catheter may be fixed to those rings,
which will keep it in the bladder. A bit of a rag about four
or five inches long, with a hole at the end of it, passed over
the exterior end of the catheter, and the loose end allowed to
hang in a bason, placed between the thighs, will catch the
water which cannot disengage itself from the catheter, and keep
the

176 SUPPOSED CONSEQUENCES
the patient dry; or if another curved pipe is introduced into
the catheter, it will answer the same purpose.
Under such treatment the bladder will never be allowed to
be distended; and when the patient wants to have the bladder
in some degree emptied, he has only to strain with his abdo-
minal muscles, by which means he will be able to throw out a
great deal at each time.
As the bladder begins to recover its actions, the patient will
find that an inclination to make water will come on, and at
those times he will also find that the water will come from him
without straining with the abdominal muscles; when this takes
place readily the catheter may be taken out, and it will be found
that he will be able in future to make water of himself. If it
is necessary to keep in the catheter a considerable time, it will
be the cause of a great deal of slime and mucus being formed
in the urethra and bladder; but I believe this is of no conse-
quence. I have known a catheter kept in this way for five
months without any inconveniency whatever.
In all cases where it is necessary to keep an extraneous body
for a considerable time in the bladder, whether in an artificial
passage or the natural one, it will be proper a few days after its
first introduction to withdraw it and examine whether it is in-
crusting, or filling up in its cavity with the calculous matter of
the urine. If, after remaining in the bladder for some days,
it has contracted none, we need be under no apprehensions of
its doing it; but if, as frequently happens, it should have col-
lected a considerable quantity, then it will be necessary to have
it occasionally withdrawn and cleaned. The best method pro-
bably of doing this is to put it in vinegar, which will soon dis-
solve the stony matter.
II. OF THE INCREASED STRENGTH OF THE
BLADDER.
THE bladder, in such cases as have been described, having
more to do than common, is almost in a constant state of irri-
tation and action; by which, according to a property in all
muscles, it becomes stronger and stronger in its muscular coats;
and I suspect, that this disposition to become stronger from re-
peated action, is greater in the involuntary muscles than the
voluntary; and the reason why it should be so, is, I think,
very

OF GONORRHOEA. 177
very evident; for in the involuntary muscles the power should
be in all cases capable of overcoming the resistance, as the power
is always performing some natural and necessary action; for
whenever a disease produces an uncommon resistance in the
involuntary parts, if the power is not proportionably increased,
the disease becomes very formidable; whereas, in the voluntary
muscles, there is not that necessity, because the will can stop
whenever the muscles cannot follow; and if the will is so dis-
eased as not to stop, the power in voluntary muscles should not
increase in proportion.
I have seen the muscular coats of the bladder near half an
inch thick, and the fasciculi so strong as to form ridges on the
inside of that cavity*; and I have also seen the fasciculi very
thin, and even wanting in some parts of the bladder, so that a
hernia of the internal coat had taken place between the fasci-
culi, and formed pouches†. These pouches arise from the thin
parts not being able to support the actions of the strong; as
happens in ruptures at the navel, or rings of the abdomen.
III. OF THE DISTENSION OF THE URETERS.
IT sometimes happens that the irritation from the distension
of the bladder, and the difficulty in throwing out its contents,
is so great, that the urine is prevented from flowing freely into
that viscus from the ureters, which become thereby preterna-
turally distended. The pelvis of the kidneys, and infundibula
are also enlarged; but how far this dilatation of the ureters and
pelvis is really owing to a mechanical cause, I am not so clear;
or whether it is not a disposition for dilatation arising out of
the stimulus given by the bladder. In some cases of long stand-
ing, where the bladder was become very thick, and had been
for a long time acting with great violence, it had affected the
mamillæ, so that the surface of these processes produced a mat-
ter, and perhaps even the secreting organs of the kidneys, so
A a that
* This appearance was long supposed to have arisen from a disease of that viscus: but
upon examination I found that the muscular parts were sound and distinct; that they
were only increased in bulk in proportion to the power they had to exert; and that it was
not a consequence of inflammation, for in that case parts are blended into one indistinct
mass.
† This is perhaps the cause of the stone being often found in a pouch formed in the
bladder: for the bladder in cases of stone is often very strong, which arises from the vio-
lent contraction of that viscus, caused by the irritation of the stone on the sides of it;
and also from the stone being often opposed to the mouth of the urethra in the time of
making water.

178 SUPPOSED CONSEQUENCES
that the urine secreted was accompanied with a pus, arising from
the irritation being kept up in all these parts.
The urine in the above cases is generally stale, even before
it is thrown out of the bladder, which when joined with the
circumstance of the linen being constantly kept wet, by the al-
most continual discharge of urine, becomes very offensive, and
it is hardly possible to keep the patient sweet.
IV. OF IRRITABILITY IN THE BLADDER INDE-
PENDENT OF OBSTRUCTIONS TO THE PAS-
SAGE OF THE URINE.
ANOTHER disease of the bladder, connected with the present
subject, is, where that viscus becomes extremely irritable, and
will not allow of its usual distension. The symptoms of this
disease are very similar to those arising from obstructions to the
passage of the urine in the urethra, but with this difference,
that in the present disease the urine flows readily, because the
urethra obeys the summons and relaxes; however, there is oft-
en considerable straining, after the water is all voided, arising
from the muscular coat of the bladder still continuing its con-
tractions.
This irritability of the bladder often arises from local causes,
as a stone, cancer, or tumors forming on the inside, all which
produce irritability of this viscus. In such cases the straining
is violent, for the cause still remains which continues to give
the stimulus of something to be expelled, and the bladder con-
tinues to contract till tired, as in the cases of simple irritabili-
ty: and then there is a respite for a time; but this respite is
of short duration, for the urine is soon accumulated.
This disease will in the end be fatal, by producing an hectic
fever.
V. OF THE CURE OF SIMPLE IRRITABILITY OF
THE BLADDER.
WHEN the symptoms arise from  irritability alone, and not
from a stone, or any local affection, the nature of the com-
plaint may not at first be so obvious; temporary relief may,
however, be procured by opium, which is most effectual in
slight and recent cases; and if it be applied as near to the part
as

OF GONORRHOEA. 179
as possible, its effects will be more evident; and therefore it
may be given by clyster as well as by the mouth.
I should, however, be inclined to rely on a blister applied
to the perinæum, or to the lower part of the small of the back,
or upper part of the sacrum, if more convenient, than to any
other method of cure.
In all cases, where there is an irritation of the bladder, the
patient should never endeavour to retain his water beyond the
inclination to make it. It hurts the bladder and increases its
irritability; and indeed I am apt to think that this circumstance,
even in sound parts, is often a predisposing cause of disease in
this viscus and its appendage, the urethra; for I have known
several cases where it has brought on the spasmodic stricture in
the urethra, in sound parts; and it is frequently an immedi-
ate cause of strangury in those who have either a stricture, or
a disposition to spasms in those parts.
A gentleman, in perfect health, from retaining his urine be-
yond the inclination, in the play-house, had all the symptoms
of an irritable bladder brought on, which continued for seve-
ral years, rendering him miserable.
VI. OF A PARALYSIS OF THE ACCELERATORES
URINÆ.
IN many irritations of the bladder, the urethra not only re-
laxes directly on the stimulus to make water being felt in that
viscus, as has been described, but a paralysis sometimes takes
place in the voluntary muscles of those parts, so that the will
cannot command them to contract to hinder the inconveniences
that may attend an immediate evacuation of that fluid. If we
attempt to stop the water, which is an act of the will, it is
vain; the acceleratores will not obey, and the water flows.
A blister applied to the perinæum will have considerable ef-
fects in removing this complaint.
CHAPTER

180 SUPPOSED CONSEQUENCES
CHAPTER XI.
OF THE DISCHARGE OF THE NATU-
RAL MUCUS OF THE GLANDS OF
THE URETHRA.
THE small glands of the urethra, and Cowper's glands,
secrete a slimy mucus, similar to the white of an egg not
coagulated. This seldom appears externally, or flows from the
urethra, but during the indulgence of lascivious thoughts, and
is seldom or never attended to, excepting by those who are un-
der apprehensions either of a gonorrhœa coming on, or ima-
gine the last infection is not gone off entirely, and are therefore
kept in constant terror by this natural discharge. They often
find it in such quantity as to leave spots on the shirt, but with-
out colour; and often after toying, the lips of the urethra are
as it were glewed together by it, from its drying there, which
appearances alarm the mind of the patient without cause. Al-
though this is only a natural discharge, and is secreted, at such
times, under the same influence which naturally produces it,
it must be owned, that it is commonly much increased in those
cases of debility arising from the mind, which is probably not
easily to be accounted for. It would seem that the contest be-
tween the mind and the body increases this secretion, for it
cannot be considered as a disease of the parts.
I. OF THE DISCHARGE OF THE SECRETIONS
OF THE PROSTATE GLAND AND VESICULÆ
SEMINALES.
THIS complaint is imagined to be the consequence of the ve-
nereal disease in the urethra; but how far this is really the case
is not certain; though most probably it is not. It is a discharge
of mucus by the urethra which generally comes away with the
last drops of urine, especially if the bladder is irritable; and
still more at the time of being at stool, particularly if the pati-
ent be costive; for, under such circumstances, the straining or
actions of the muscles of those parts are more violent. It has
generally been supposed that this discharge is semen; and the
disease

OF GONORRHOEA. 181
disease is called seminal weakness: but it appears from many
experiments and observations, that the discharge is undoubted-
ly not semen. It is only the mucus secreted either by the pro-
state gland, by those bags improperly called vesiculæ seminales,
or both; and it may not be improper to give here the distin-
guishing marks between these two fluids. First, we may ob-
serve the discharge in question is not of the same colour with
the semen, and is exactly of the colour of the mucus of the pro-
state gland, and of those bags. It has not the same smell, and in-
deed it hardly has any smell at all. The quantity, evacuated at one
time, is often much more considerable than the evacuation of
semen ever is; and it happens more frequently than it could
possibly do were the discharge semen. It is a disease that oft-
en attacks old men, where one can hardly suppose much se-
men to be secreted; and we find that those, who are affected
with this disease, are no more deficient in the secretion and
evacuation of the semen, in the natural way, than before they
had the disease. If the mind be at ease, this shall take place
immediately after a discharge of semen, as well as before,
which could not be the case were it semen. Further, if those
that labour under this complaint, are not connected with wo-
men, they are subject to nocturnal discharges from the imagi-
nation, as persons are who are perfectly sound; and indeed
most patients, when made acquainted with these circumstances,
become very sensible that it is not the semen.
It is not clear what the diseased state of the parts is upon
which this discharge depends; whether there is a larger secre-
tion of this mucus than natural, or whether it is entirely ow-
ing to a preternatural, uncommon action of those parts; and
if this last why these parts should be put into action when the
bladder, rectum, and abdominal muscles are thrown into action
to expel their contents, is not easily explained. It is plain that
the most violent actions of these parts are necessary to produce
this evacuation; for it does not come with the first of the urine,
nor, in general, with an easy stool.
As it was thought to be a seminal discharge, it was imagin-
ed to arise from a weakness in the organs of generation; and
as frequent discharges of the semen in the natural way general-
ly weaken, it was therefore imagined that this discharge must
also weaken very considerably; and the imagination will ope-
rate so strongly as to make the patients believe they really are
weakened.

182 SUPPOSED CONSEQUENCES
weakened. Whether the cause of such a discharge is capable
of weakening, I will not pretend to say; but I believe that the
discharge simply does not. Fear, and anxiety of mind may
really weaken the patient. In the cases I have seen of this kind,
the mind has been more affected than the body.
From my own practice, I can hardly recommend any one
medicine, or way of life, for removing this complaint. In
one case I found considerable benefit from giving hemlock in-
ternally.
The idea, that has been formed of the disease, leads to the
practice generally recommended, such as giving strengthening
medicines of all kinds; but I never saw any good effects from
any of them; and I should rather be inclined to take up the
soothing plan to prevent all violent actions. Keeping the body
gently open will in some degree moderate the discharge, and
probably may effect a cure in the end.
CHAPTER XII.
OF IMPOTENCE.
THIS complaint is by many laid to the charge of Onanism
at an early age; but how far this is just, it will in many
cases be difficult to determine; for, upon a strict review of this
subject, it appears to me to be by far too rare to originate from
a practice so general.
How far the attributing to this practice such a consequence,
is of public utility, I am doubtful, particularly as it is follow-
ed most commonly at an age when consequences are not suffi-
ciently attended to, even in things less gratifying to the senses;
but this I can say with certainty, that many of those, who are
affected with the complaints in question, are miserable from
this idea; and it is some consolation for them to know that it
is possible it may arise from other causes. I am clear in my
own mind, that the books on this subject have done more harm
than good.
In the cases of this kind that have come under my care, al-
though the persons themselves have been very ready to suppose
that

OF GONORRHOEA. 183
that the disease has arisen from the cause here alluded to; yet
they did not appear to have given more into the practice than
common; and in particular, the worst case I have ever seen
was where but very little of this practice had ever been used,
much less than in common among boys.
Nothing hurts the mind of a man so much as the idea of in-
ability to perform [w]ell the duty of the sex. If his scrotum
hangs low it makes him miserable; he conceives immediately
that he is to be rendered incapable of performing those acts in
which he prides himself most. It is certain, that the relaxa-
tion or contraction of the scrotum, is in some degree a kind
of sign of the constitution; but it is of the constitution at large,
not of those parts in particular. Nurses are so sensible of the
contraction of that part being a sign of health in the children
under their care, that they take notice of it. The relaxation
of it in them cannot be supposed to arise from inability to per-
form those acts at one time more than another. The face is
one of the signs of the constitution, and has as much to do
with those peculiar acts as the scrotum. However, we must
allow that this part is much more lax than what we should con-
ceive was intended by Nature, even in young men who are well
in health; but as this is very general, I rather suspect that it
arises from the circumstances of the part being kept too warm,
and always suspended, the muscles hardly ever being allowed
to act, so that they have less force. How far it is the same
in those countries where the dress does not immediately sus-
pend those parts, I have not been able to ascertain. Warmth
appears to be one cause; for we find that cold has generally
an immediate effect; but this is perhaps owing to its not being
accustomed to cold, which if it were, it might possibly become
as regardless of it as it is of warmth. What the difference is
in this part, in a cold and warm climate, all other circum-
stances the same, I do not know. But whatever may be the
cause, if it is really in common more lax than intended by
Nature, it is of no consequence as to the powers of genera-
tion. The testicles will secrete whether kept high or low.
I. OF IMPOTENCE DEPENDING ON THE MIND.
AS the parts of generation are not necessary for the exist-
ence or support of the individual, but have a reference to
something,

184 SUPPOSED CONSEQUENCES
something else in which the mind has a principal concern, a
complete action in those parts cannot take place without a per-
fect harmony of body and of mind; that is, there must be both
a power of body, and disposition of mind; for the mind is
subject to a thousand caprices, which affect the actions of
these parts.
Copulation is an act of the body, the spring of which is in
the mind; but it is not volition; and according to the state of
the mind so is the act performed. To perform this act well,
the body should be in health, and the mind should be perfect-
ly confident of the powers of the body; the mind should be
in a state entirely disengaged from every thing else; it should
have no difficulties, no fears, no apprehensions; not even an
anxiety to perform the act well; for even this anxiety is a
state of mind different from what should prevail; there should
not be even a fear that the mind itself may find a difficulty at the
time the act should be performed. Perhaps no function of the
machine depends so much upon the state of the mind as this.
The will, and reasoning faculty, have nothing to do with
this power; they are only employed in the act, so far as vo-
luntary parts are made use of; and if they ever interfere,
which they sometimes do, it often produces another state of
the mind which destroys that which is proper for the perform-
ance of the act; it produces a desire, a wish, a hope, which
are all only diffidence and uncertainty, and create in the mind
the idea of a possibility of the want of success, which destroys
the proper state of mind, or necessary confidence.
There is perhaps no act in which a man feels himself more
interested, or is more anxious to perform well, his pride being
engaged in some degree, which, if within certain bounds,
would produce a degree of perfection in an act depending upon
the will, or an act in voluntary parts; but when it produces a
state of mind contrary to that state, on which the perfection
of the act depends, a failure must be the consequence.
The body is not only rendered incapable of performing this
act, by the mind being under the above influence, but also by
the mind being perfectly confident of its power, but conscious
of an impropriety in performing it; this, in many cases, pro-
duces a state of mind which shall take away all power. The state
of a man's mind, respecting his sister, takes away all power. A
conscientious man has been known to lose his powers on find-
ing

OF GONORRHOEA. 185
ing the woman, he was going to be connected with, unex-
pectedly a virgin.
Shedding tears arises entirely from the state of the mind, al-
though not so much a compound action as the act in question;
for none are so weak in body that they cannot shed tears; it is
not so much a compound action of the mind and strength of
body, joined, as the other act is; yet if we are afraid of shed-
ding tears, or are desirous of doing it, and that anxiety is kept
up through the whole of an affecting scene, we certainly shall
not shed tears, or at least not so freely as would have happened
from our natural feelings.
From this account of the necessity of having the mind inde-
pendent, respecting the act, we must see that it may very often
happen that the state of mind will be such as not to allow
the animal to exert its natural powers; and every failure in-
creases the evil. We must also see from this state of the case,
that this act must be often interrupted; and the true cause of
this interruption not being known, it will be laid to the charge
of the body, or want of powers. As these cases do not arise
from real inability, they are to be carefully distinguished from
such as do; and perhaps the only way to distinguish them is, to
examine into the state of the mind respecting this act. So
trifling often is the circumstance which shall produce this in-
ability, depending on the mind, that the very desire to please
shall have that effect, as in making the woman the sole object
to be  gratified.
Cases of this kind we see every day; one of which I shall
relate as an illustration of this subject, and also of the method
of cure.
A gentleman told me, that he had lost his virility. After
above an hour's investigation of the case, I made out the fol-
lowing facts: that he had, at unnecessary times, strong erecti-
ons, which showed that he had naturally this power; that the
erections were accompanied with desire, which are all the na-
tural powers wanted; but that there was still a defect some-
where, which I supposed to be from the mind. I inquired, if
all women were alike to him, his answer was, no; some wo-
men he could have connection with, as well as ever. This
brought the defect, whatever it was, into a smaller compass;
and it appeared that there was but one woman that produced
this inability, and that it arose from a desire to perform the act
B b with

186 SUPPOSED CONSEQUENCES
with this woman well; which desire produced in the mind a
doubt, or fear of the want of success, which was the cause of
the inability of performing the act. As this arose entirely from
the state of the mind, produced by a particular circumstance,
the mind was to be applied to for the cure; and I told him that
he might be cured, if he could perfectly rely on his own power
of self-denial. When I explained what I meant, he told me
that he could depend upon every act of his will, or resolution;
I then told him, if he had a perfect confidence in himself in
that respect, that he was to go to bed to this woman, but first
promise to himself, that he would not have any connection
with her for six nights, let his inclinations and powers be
what they would; which he engaged to do; and also to let
me know the result. About a fortnight after, he told me,
that this resolution had produced such a total alteration in the
state of his mind, that the power soon took place: for instead
of going to bed with the fear of inability, he went with fears
that he should be possessed with too much desire, too much pow-
er, so as to become uneasy to him, which really happened;
for he would have been happy to have shortened the time;
and when he had once broke the spell, the mind and powers
went on together; and his mind never returned to its former
state.
II. OF IMPOTENCE FROM A WANT OF PRO-
PER CORRESPONDENCE BETWEEN THE AC-
TIONS OF THE DIFFERENT ORGANS.
I LATELY observed, when treating of the diseases of the
urethra and bladder, that every organ in an animal body, with-
out exception, was made up of different parts, whose func-
tions, or actions, were totally different from each other, al-
though all tending to produce one ultimate effect. In all such
organs, when perfect, there is a succession of motions, one na-
turally arising out of the other, which in the end produces the
ultimate effect; and an irregularity alone, in these actions,
will constitute disease, at least will produce very disagreeable
effects, and often totally fruftrate the final intention of the or-
gan. I come now to apply this principle to the actions of the
testicle and the penis; for we find that an irregularity in the ac-
tions of these parts sometime happens in men, producing im-
potence:

OF GONORRHOEA. 187
potence: and something similar, probably, may be one cause
of barrenness in women.
In men, the parts subservient to generation may be divided
into two, the essential, and the accessory. The testicles are
the essential; the penis, &c. the accessory. As this division
arises from their uses or actions in health, which exactly cor-
respond with one another; a want of exactness in the corre-
spondence, or susceptibility of those actions, may also be di-
vided into two: where the actions are reversed, the accessory
taking place without the first or essential, as in erections of the
penis, where neither the mind, nor the testicles, are stimulated
to action; and the second is where the testicle performs the ac-
tion of secretion too readily for the penis, which has not a cor-
responding erection. The first is called priapism; and the se-
cond is what ought to be called seminal weakness.
The mind has considerable effect on the correspondence of
the actions of these two parts; but it would appear in many in-
stances, that erections of the penis depend more on the state of
the mind, than what the secretion of the semen does; for ma-
ny have the secretion, but not the erection; but in such, the
want of erection appears to be owing to the mind only.
Priapism often arises spontaneously, and often from visible
irritation of the penis, such as the venereal gonorrhœa, espe-
cially when violent. The sensation of such erections is rather
uneasy than pleasant, nor is the sensation of the glans at the
time similar to that arising from the erections of desire, but
more like to the sensation of the parts immediately after coi-
tion. Such as arise spontaneously are of more serious conse-
quence than those from inflammation, as they proceed, proba-
bly, from causes not curable in themselves, or by any known
methods.
The priapism arising from inflammation of the parts, as in
a gonorrhœa, is attended with nearly the same symptoms; but
generally the sensation is that of pain, proceeding from the
inflammation of the parts. It may be observed, that what is
said of priapism, is only applicable to it, when a disease in it-
self, and not as a symptom of other diseases, which is fre-
quently the case.
The common practice in the cure of this complaint is to or-
der all the nervous and strengthening medicines, such as bark, va-
lerian, musk, camphor, and also the cold bath. I have seen good
effects

188 SUPPOSED CONSEQUENCES
effects from the cold bath; but sometimes it does not agree
with the constitution, in which cases I have found the warm
bath of service. Opium appears to be a specific in many
cases; from which circumstance I should be apt, upon the
whole, to try a soothing plan.
Seminal weakness, or a secretion and emission of the se-
men without erections, is the reverse of a priapism, and is by
much the worst disease of the two. There is great variety in
the degrees of this disease, there being all the gradations from
the exact correspondence of the actions of all the parts to the
testicles acting alone; in every case of the disease there is too
quick a secretion and evacuation of the semen. Like to the
priapism, it does not arise from desires and abilities, although
when mild it is attended with both, but not in a due propor-
tion; a very slight desire often producing the full effect.
The secretion of the semen shall be so quick that simple thought,
or even toying shall make it flow.
Dreams have produced this evacuation repeatedly in the
same night; and even when the dreams have been so slight,
that there has been no consciousness of them when the sleep
has been broken by the act of emission. I have known cases,
where the testicles have been so ready to secrete, that the least
friction on the glans has produced an emission: I have known
the simple action of walking or riding, produce this effect, and
that repeatedly, in a very short space of time.
A young man, about four or five and twenty years of age,
not so much given to venery as most young men, had these
last-mentioned complaints upon him. Three or four times in
the night he would emit; and if he walked fast, or rode on
horseback, the same thing would happen. He could scarce-
ly have connection with a woman, before he emitted, and in
the emission there was hardly any spasm. He tried every sup-
posed strengthening medicine, as also the cold bath, and sea-
bathing, but with no effect. By taking twenty drops of laud-
anum, on going to bed, he prevented the night-emissions; and
by taking the same quantity in the morning, he could walk or
ride, without the before-mentioned inconvenience. I directed
this practice to be continued for some time, although the dis-
ease did not return, that the parts might be accustomed to this
healthy state of action; and I have reason to believe the gen-
tleman is now well. It was found necessary, as the constitu-
tion

OF GONORRHOEA. 189
tion became more habituated to the opiate, to increase the
dose of it.
The spasms, upon the evacuation of the semen, in such ca-
ses are extremely slight, and a repetition of them soon takes
place; the first emission not preventing a second; the consti-
tution being all the time but little affected*. When the testi-
cles act alone, without the accessory parts taking up the ne-
cessary and natural consequent action, it is still a more melan-
choly disease; for the secretion arises from no visible or sen-
sible cause, and does not give any visible or sensible effect, but
runs off similar to involuntary stools, or urine. It has been
observed that the semen is more fluid than natural in some of
these cases.
There is great variety in the diseased actions of these parts,
of which the following case may be considered as an example.
A gentleman has had a stricture in the urethra for many
years, for which he has frequently used a bougie, but of late
has neglected it. He has had no connection with woman for
a considerable time, being afraid of the consequences. He
has often in his sleep involuntary emissions, which generally
awake him at the paroxysm; but what surprises him most is,
that often he has such, without any semen passing forwards
through the penis, which makes him think that at those times
it goes backwards into the bladder. This is not always the
case, for at other times the semen passed forwards. At the
time the semen seems to pass into the bladder, he has the erec-
tion, the dream, and is awakened with the same mode of action,
the same sensation, and the same pleasure, as when it passes
through the urethra, whether dreaming or waking. My opi-
nion is, that the same irritation takes place in the bulb of the
urethra without the semen, that takes place there when the se-
men enters, in consequence of all the natural preparatory steps,
whereby the very same actions are excited as if it came into the
passage; from which one would suppose that either semen is
not secreted, or if it be, that a retrograde motion takes place
in the actions of the acceleratores urinæ; but if the first be
the case, then we may suppose that in the natural state the ac-
tions of those muscles do not arise simply from the stimulus of
the
* It is to be considered that the constitution is commonly affected by the spasms only,
and in proportion to their violence, independent of the secretion and evacuation of the
semen. But in some cases even the erection going off without the spasms on the emission,
shall produce the same debility as if they had taken place.

190 SUPPOSED CONSEQUENCES
the semen in the part; but from their action being a termination
of a preceding one making part of a series of actions. Thus they
may depend upon the friction, or the imagination of a friction
on the penis, the testicles not doing their part, and the spasm
in such cases arising from the friction and not from the secretion.
In many of those cases of irregularity, when the erection is
not strong, it shall go off without the emission; and at other
times an emission shall happen almost without an erection; but
these arise not from debility, but affections of the mind.
In many of the preceding cases, washing the penis, scro-
tum, and perinæum, with cold water, is often of service; and
to render it colder than we find it in some seasons of the year,
common salt may be added to it, and the parts washed when
the salt is almost dissolved.
CHAPTER XIII.
OF THE DECAY OF THE TESTICLE.
IT would appear from some circumstances, that the parts of
generation are not to be considered as necessary parts of
the animal machine, but only as parts superadded for particu-
lar purposes; and therefore only necessary when those parti-
cular purposes are to be answered; for we may observe, that
they are later of coming to maturity than any other parts, and
are more liable to decay. Thus far in their natural properties
they are different from most other parts of our body, the teeth
only excepted, which are similar in some of those circumstances.
The testicles appear to be more subject to spontaneous dis-
ease than any other part of the body; but what is the most sin-
gular thing of all, is the wasting of those bodies. One or
both testicles shall wholly disappear, like to the thymus gland,
or membrana pupillaris, &c. in the infant. This we do not
find in any parts of the body which are essential to its œconomy;
excepting the parts are of no further use, and might become
hurtful in the body, as in the instance of the membrana pupil-
laris; but the testicles do not undergo this change, as if in
consequence

OF GONORRHOEA. 191
consequence of an original property stamped upon them, as
is the case of the thymus gland, whenever the age of the per-
son is such as to render them useless; but are liable to it at
any age, and therefore the disposition is in the testicles them-
selves, independent of any connection with the animal œco-
nomy. An arm, or leg may lose its action, and may waste
in part, but never wholly.
Testicles have been known to waste in cases of rupture,
probably from the constant pressure of the intestine. Mr.
Pott has given us cases of this kind. I have seen, in the hy-
drocele, the testicle almost wasted to nothing, probably from the
compression of the water; but in all these the causes of wast-
ing are obvious, and would probably produce similar effects in
other parts of the body under the same circumstances; but a
testicle without any previous disease wastes wholly; or at other
times it inflames, either spontaneously, or from sympathy
with the urethra, becomes large, and then begins to subside,
as in the resolution of common inflammation of the body, but
does not stop at the former size, but continues to decay till it
wholly disappears. The following cases are instances of this.
Case I. A gentleman about nine years ago had a gonor-
rhœa, with a bubo, which suppurated. A swelling of one of
the testicles came on, for which he used the common methods
of producing resolution, and seemingly with success. All the
other symptoms being removed, he thought himself quite well;
but some time after, he found that the testicle, which had been
swelled, was become rather smaller than the other, which made
him now pay attention to it; this decrease continued till it
wasted entirely. For some years past there has been no ap-
pearance of a testicle. He is not in the least different in in-
clination, or powers, from what he was before.
Case II, communicated by Mr. Nansan. "A gentleman,
aged about eighteen, who never had any venereal complaint,
has had two different attacks of the same nature, one in each
testicle. February 3, 1776, after skating a few hours, with-
out having, to his knowledge, received any injury from it, he
was seized with a violent pain and inflammation of the left
testicle, which in a few days increased much in size. A sur-
geon being sent for, followed the usual treatment in such cases
of inflammation. In about six weeks, the inflammation and
swelling gradually subsided, some hardness only remaining. A
mercurial

192 SUPPOSED CONSEQUENCES
mercurial plaister was now applied, which, after being worn
for some time, was left off. The testicle ever since has con-
tinued gradually to decrease, and is no larger than a horsebean;
indeed the body of the testicle is quite decayed, nothing remain-
ing but what seems part of the epididymis. It appears to have
no sense of pain, except when pressed, and is very hard and
uneven on its surface. The spermatic chord is not in the least
affected. October 20, 1777, he was seized in the same man-
ner in the right testicle without any apparent cause, whereupon I
was applied to. He was immediately bled, took an opening mix-
ture, after that a saline mixture with tartar emetic; and a fomen-
tation and embrocation of spiritus mindereri, and spiritus vini,
was used. On the 27th, a cataplasm was applied of linseed meal
and aqua vegeto-mineralis. This treatment was persisted in till
about the middle of November. The inflammation went off, and
the testicle seemed much in the natural state. On December
19, I was applied to again; it seemed to be growing hard,
and decreasing in size, much in the same manner as the other
had done, which made him very unhappy. I ordered him
some pills with calomel and tartar emetic, in hopes of increas-
ing the secretion of the glands in general, and making some
change in the testicle. At first this method seemed to be of
service, but soon lost its effects, and the testicle began to de-
crease just as the other did." Mr. Adair and Mr. Pott were
consulted with me, but nothing could be thought of that could
give any hopes of success. I advised him to employ the parts
in their natural uses, as much as inclination led him; but all
was to no purpose, the testicle continued to decrease till not a
vestige was left.
Case III, communicated by Dr. Cothom, of Worcester. "A
young man, aged sixteen, was suddenly seized with great cold-
ness and shivering, attended with frequent rigors. During
this paroxysm, which continued three hours, his pulse was
small and contracted, and so exceedingly quick that the strokes
of the artery were with difficulty counted. This period was
succeeded by an intense heat, and a strong, hard, full pulse,
on which account he was copiously bled; and a dose of cool-
ing physic was immediately administered, and a clyster thrown
up to promote its more speedy effects. In the evening the
bleeding was repeated. All this day he complained of excru-
ciating pain in his loins, and the side of his belly descending
down

OF GONORRHOEA. 193
down into the scrotum. On examining the part affected, I
saw an appearance of inflammation in the groin of the left
side, and a great tension about the ring of the abdominal mus-
cles, with an enlargement of the testicles. These parts were
now ordered to be fomented with a discutient fotus strongly
impregnated with crude sal ammoniac, and to be bathed with
spiritus mindereri, and spiritus volat. aromat. before the ap-
plication of each stupe; and he was directed to take six grains
of the pulv. antimonialis, with fifteen grains of nitre every
three hours; his food to be thin gruel, with fruit and lemon-
juice, and his drink barley-water with sugar and nitre. Not-
withstanding this antyphlogistic plan of frequent cooling phy-
sic, anodynes, three emetics, and thirteen blood-lettings, the fe-
ver continued, and the pain, inflammation and tumor increased
till the eighth day, including the first day of seizure; when
seeing no hope of discussing the tumor, the testicle being near-
ly as large as a child's head, I attempted by emollient fotuses,
and maturating cataplasms, to bring it to suppuration. On the
10th, a fluctuation was perceptible; and on the 12th, much
more so, the scrotum having then put on a livid appearance.
I used every possible argument for permission to open it, but
he being now quite easy, would not admit it. On the 15th,
the patient was again attacked with rigors, coldness and shiver-
ing, succeeded by a great feverish heat, which soon terminated
in a profuse sweat, yet no pain attended this paroxysm. In
the evening, however, the tumor was so prominent that I was
of opinion it would open spontaneously before morning, when
I hoped to obtain his consent to enlarge the aperture; but this
not happening, and all intreaties, relating to the necessity of
an incision, proving ineffectual, I contented myself with giv-
ing the bark with elixier of vitriol. From this time, after every
paroxysm of fever, the testicle was obferved to decrease. Not
being permitted to make an incision, and his strength and ap-
petite continuing good, I began to entertain hopes of success
without it, and advised him to persist in the use of the tonic
and antiseptic plan, with the addition of stupes wet with the
decoction of bark, to be constantly applied; by which means,
at the end of thirty days from the first seizure, the pus was to-
tally absorbed. The testicle then appeared to be of the size of
an hen's egg, and was as hard as a schirrus. I directed it to
be rubbed, night and morning, with equal parts of the unguent.
C c mercur.

194 SUPPOSED CONSEQUENCES, &c.
mercur. fort. and liniment. volat. camphorat. and ordered, in-
ternally, some mercurial alteratives, with a decoction of bark.
By these aids his night-sweats, and every other disagreeable
symptom, gradually abated; he gathered strength, flesh and
spirits, very fast, and the diseased  testicle went on constantly
decreasing, though very slowly, for near twelve months; at
the expiration of which time there was no other appearance
of it than a confusion of loose fibres, obvious to the feeling,
in the upper part of the scrotum. About a month ago
the patient consented to my examining it. Of the testicle
there was not the least vestige, neither could I perceive the
tunica vaginalis on that side in the groin; but upon the os
pubis, and a little under it, I could embrace with my fingers
and thumb the chord, and distinguish the vessels, which were
without the least degree of hardness or schirrosity; and if I
pressed one in particular, I gave him exquisite pain for a mo-
ment. He is in perfect health, of a strong, robust constitu-
tion, and has fine healthy children; the only change which
he has perceived in the constitution has been a propensity to
grow fat, which neither temperance, nor violent exercise on
horseback, daily, with little rest, will prevent."
PART

[195]
PART IV.
CHAPTER I.
OF CHANCRE.
I HAVE been hitherto speaking of the effects of this poison,
when applied to a secreting surface and without a cuticle;
of the intention of Nature in producing these effects, and of all
the consequences, both real and supposed. I now mean to ex-
plain its effects when applied to a surface that is covered with a
common cuticle, as the common skin of the body, which on
such a surface will be found to be very different from those I
have been describing. But I may be allowed here to remark,
that the penis, the common seat of a chancre, is, like every
part of the body, liable to diseases of the ulcerative kind; and
from some circumstances, rather more so than other parts; for
if attention is not paid to cleanliness, we have often excoria-
tions, or superficial ulcers, from that cause; also, like almost
every other part that has been injured, these parts, when once
they have suffered from the venereal disease, are very liable to
ulcerate anew. Since then this part is not exempted from the
common diseases of the body, and as every disease in this part
is suspected to be venereal, great attention is to be paid in
forming our judgment of ulcers here.
Venereal ulcers commonly have one character, which how-
ever is not entirely peculiar to them, for many sores that have
no disposition to heal, (which is the case with a chancre) have
so far the same character. A chancre has commonly a thick-
ened base, and although in some the common inflammation
spreads much further, yet the specific is confined to this base.
The future, or consequent ulcers are commonly easily distin-
guished from the original, or venereal, which will be describ-
ed hereafter.
It is an invariable effect, that when any part of an animal
is irritated to a certain degree, it inflames and forms matter,
the

196 OF CHANCRE.
the intention of which is, to remove the irritating cause. This
process is easily effected when it is on a surface whose nature
is to secrete; but when on a surface whose nature is not to se-
crete, it then becomes more difficult, for another process must
be set up, which is ulceration. This is not only the case in
common irritations, but also in specific irritations from morbid
poisons, as the venereal disease and small pox. The variolous
matter, as well as the venereal, produces ulcers on the skin;
but when it affects secreting surfaces, a diseased secretion is the
consequence; and this is different in different parts; on the
tongue, inside of the mouth, uvula and tonsils, the coagulable
lymph is thrown out in form of sloughs, somewhat similar to
the putrid sore throat; but in the fauces and all down the œso-
phagus, a thickish fluid, in appearance like matter, is secreted.
When the irritation is applied to a surface whose cuticle is
thin, and where there is a secretion naturally, as the glans pe-
nis, or inside of the prepuce, there it sometimes only irritates,
so as to produce a diseased secretion, as was described; but
this is not always the effect of such irritation on such surfaces.
They are often irritated to ulceration, and producing a chancre.
The poison has, in general, either no disposition, or not suf-
ficient powers to blister or excoriate the common skin; for if
it did, the symptoms most probably would be at first nearly the
same, if not exactly so, with a gonorrhœa; that is, a discharge
of matter from a surface, without a cuticle, newly inflamed;
for it is reasonable to suppose, that the poison would produce
on that excoriated surface a secretion of matter, which would
be at first a gonorrhœa, and which, very probably, would af-
terwards fall into the second mode of action or ulceration, and
then become a chancre.
There are three ways in which chancres are produced; first,
by the poison being inserted into a wound; secondly, by be-
ing applied to a non-secreting surface; and thirdly, by be-
ing applied to a common sore. To whichever of these three
different surfaces it is applied, the pus produces its specific in-
flammation and ulceration, attended with a secretion of pus.
The matter, produced in consequence of those different modes
of application, is of the same nature with the matter applied,
because the irritations are the same in both.
The poison much more readily contaminates, if it is appli-
ed to a fresh wound, than to an ulcer, in this resembling the
inoculation

OF CHANCRE. 197
inoculation of the small pox. Whether there are any parts of
the skin, or any other part of the body, more susceptible of
this irritation than others, in consequence of local application,
is not yet ascertained.
This form of the disease, like the first, or gonorrhœa, is ge-
nerally caught on the parts of generation, in consequence of a
connection between the sexes; but any part of the body may
be affected by the application of venereal matter, especially if
the cuticle is thin.
I have seen a chancre on the prolabium, as broad as a six-
pence, caught the person did not know how*. The penis, and
particularly the prepuce, being the parts most commonly affect-
ed by this form of the disease, are so constructed as to suffer
much from it, especially when they are very susceptible of such
irritation; for the construction alone produces many inconve-
niences, besides considerable pain, while under the disease, and
in general retards the cure.
The chancre is not so frequent an effect of the poison as the
gonorrhœa; and I think very good reasons may be assigned
for it, although there are more modes than one of catching it,
as I just now mentioned; but the parts in two of them, to
wit, the wound, and the sore, are seldom in the way of being
infected; therefore when it is caught it is commonly by the
same mode of application with that of the gonorrhœa; but as
the cuticle cannot be affected by this poison, this covering act-
ing as a guard to the cutis, it is often prevented from coming
in contact with it; and indeed it is almost surprising that the
cutis should be affected by it, where it has such a covering,
excepting about the glans, the inside of the prepuce, or other
parts of the body, where this covering is thin. The propor-
tion which the cases of gonorrhœa bear to those of chancre is
as four or five to one.
When it is caught in men, it is generally upon the frænum,
glans penis, prepuce, or upon the common skin of the body
of the penis; and sometimes on the forepart of the scrotum;
but I think most frequently on the frænum, and in the angle
between the penis and glans. Its affecting these parts arises
from the manner in which it is caught, and not from any spe-
cific
* That this sore was a chancre I made no doubt, for besides its diseased appearance,
he had a bubo forming in one of the glands under the lower jaw, on the same side.
It is most probable that his own fingers were the conveyers.

198 OF CHANCRE.
cific tendency in these parts to catch it more than others: and
its affecting the frænum, &c. more frequently than the other
parts of the penis arises from the external form of this part,
which is irregular, and allows the venereal matter to lie undis-
turbed in the chinks; by which means it has time to irritate,
and inflame the parts, and to produce the suppurative, and ul-
cerative inflammation in them. But as this matter is easily
rubbed off from prominent parts, by every thing that touches
them, it is a reason why such parts in general so often escape
this disease.
The distance of time between its application, and its effects
upon the part is uncertain; but, upon the whole, it is rather
longer in appearing than the gonorrhœa; however this depends
in some measure on the nature of the parts affected. If it be
the frænum, or the termination of the prepuce into the glans,
that is affected, the disease will in general appear earlier; these
parts being more easily affected than either the glans, common
skin of the penis, or scrotum; for in some cases where both
the glans and prepuce were contaminated from the same applica-
tion of the poison, it has appeared earlier on the prepuce.
I have known cases where the chancres have appeared twen-
ty-four hours after the application of the matter; and others
where it has been seven weeks. A remarkable case of this
kind was in a gentleman who had not touched a woman for se-
ven weeks, when a chancre appeared. That this was a vene-
real chancre was proved, by his having had the lues venerea
from it, and being under a necessity of taking mercury. An
officer in the army had a chancre which appeared two months
after he had had any connection with a woman. After the last
connection he marched above an hundred miles, when the chan-
cre broke out, and only gave way to mercury.
This, like most other inflammations which terminate in ul-
cers, begins first with an itching in the part; if it is the glans
that is inflamed, generally a small pimple appears full of mat-
ter, without much hardness, or seeming inflammation, and
with very little tumefaction, the glans not being so readily tu-
mefied from inflammation as many parts are, especially the
prepuce; nor are the chancres attended with so much pain or
inconvenience as those on the prepuce; but if upon the fræ-
num, and more especially the prepuce, an inflammation more
considerable than the former soon follows, or at least the ef-
fects

OF CHANCRE. 199
fects of the inflammation are more extensive and visible. Those
parts being composed of a very loose cellular membrane, afford
a ready passage for the extravasated juices; continued sympa-
thy also more readily takes place in them. The itching is
gradually changed to pain; the surface of the prepuce is in
some cases excoriated, and afterwards ulcerates: in others a
small pimple, or abscess appears, as on the glans, which forms
an ulcer. A thickening of the part comes on, which at first,
and while of the true venereal kind, is very circumscribed, not
diffusing itself gradually and imperceptibly into the surround-
ing parts, but terminating rather abruptly. Its base is hard,
and the edges a little prominent. When it begins on the fræ-
num, or near it, that part is very commonly wholly destroy-
ed, or a hole is often ulcerated through it, which proves ra-
ther inconvenient in the cure, and in general it had better, in
such cases, be divided at first.
If the venereal poison should be applied to the skin, where
the cuticle is more dense than that of the glans penis, or fræ-
num, such as that upon the body of the penis, or fore part of
the scrotum, (parts which are very much exposed to the appli-
cation of this matter) then it generally appears first in a pim-
ple, which is commonly allowed to scab, owing to its being
exposed to evaporation. This scab is generally rubbed off, or
pushed off, and one larger than the first forms. I think there
is less inflammation attending these last, than those on the fræ-
num and prepuce, but more than those upon the glans.
When the disease is allowed to go on, so as to partake of
the inflammation peculiar to the habit, it becomes in many
instances more diffused, and is often carried so far, as to pro-
duce disagreeable symptoms, as phymosis, and sometimes pa-
raphymosis, greatly retarding the cure; but still there is a
hardness peculiar to this poison, surrounding the sores, especi-
ally those upon the prepuce.
When these ulcers are forming, and after they are formed,
or in the state of inflammation, it is no uncommon thing for
the urethra to sympathise with them, and give a tickling pain,
especially in making water; but whether or not there is ever
a discharge in the urethra from such a cause I will not deter-
mine; but if a discharge never takes place but when the disease
really attacks the urethra, it would make us suppose that this
sympathy is not really inflammatory; or if it is carried so far
as

200 OF CHANCRE.
as to produce inflammation, yet that it is not of the specific
kind. However it is possible in those cases where there is a
gonorrhœa preceded by a chancre, that this gonorrhœa may
arise from sympathy, and is not a disease proceeding from the
original contamination, nor from the matter of the chancre.
That the sensation in the urethra, in those instances where
there is no discharge, is from sympathy, and not from the
urethra being attacked with the disease at the time that the
matter laid the ground-work for the chancre, is evident from
the following observation. I have seen it happen more than
once, when the seat of the chancre had broke out a second
time, and where no new or fresh infection had been caught,
that the patient complained of the same tickling or slight pain
in the urethra before any discharge had taken place in the be-
ginning ulcerations. From the same connection of parts I have
seen a chancre coming upon the glans absolutely cure both a
gleet and an irritation all along the passage of the urethra. So
great was the previous irritation in this case, that I suspected a
stricture; but on passing a bougie found none.
In consequence of the urethra sympathising with the chan-
cre, the testicles and scrotum will further sympathise with the
urethra, and become affected. I have seen this sympathy ex-
tend over the whole pubes, and so strong that touching the
hairs gently on the pubes has given disagreeable sensations, and
even pain.
In speaking of the local, or immediate effects of the vene-
real disease, I mentioned that they were seldom wholly speci-
fic, and that they partook both of the specific and the constitu-
tional inflammation; and therefore it is always very necessary
to pay some attention to the manner in which chancres first
appear, and also to their progress; for they often explain the
nature of the constitution at the time. If the inflammation
spreads fast, and considerably, it shows a constitution more
disposed to inflammation than natural. If the pain is great, it
shows a strong disposition to irritation. It also sometimes hap-
pens that they begin very early to form sloughs; when this is
the case they have a strong tendency to mortification.
These additional symptoms mark the constitution and direct
the future mode of treatment.
When there is a considerable loss of substance, either from
sloughing or ulceration, a profuse bleeding is no uncommon
circumstance,

OF CHANCRE. 201
circumstance, more especially if the ulcer is on the glans; for
it would appear that the adhesive inflammation does not suffi-
ciently take place there to unite the veins of the glans so as to
prevent their cavity from being exposed, and the blood is al-
lowed to escape from what is called the corpus spongiosum
urethræ. The ulcers, or sloughs, often go as deep as the
corpus cavernosum penis, where the same thing happens.
I. OF THE PHYMOSIS AND PARAPHYMOSIS.
THESE diseases arise from a thickening of the cellular mem-
brane of the prepuce, in consequence of an irritation capable
of producing considerable and diffused inflammation, which,
when it does happen, is generally in consequence of a chancre
in this part. This irritation, however, and inflammation, some-
times attacks the prepuce, even when the disease is in the
form of what I suspect to be a gonorrhœa of the glans and pre-
puce*, sometimes even in the common gonorrhœa, but most
frequently of all from a chancre in the prepuce. When this
disease or tumefaction takes place in consequence of a chancre,
I suspect that there is an irritable disposition in the habit; for
it is plain there is more than the specific action, the inflamma-
tion extending beyond the specific distance.
It may be observed here, that the prepuce is no more than
a doubling of the skin of the penis when not erected, for then
it becomes too large for the penis, by which provision the
glans is covered and preserved when not necessary to be used,
whereby its feelings are probably more acute. When the pe-
nis becomes erect, it in general fills the whole skin, by which
the doubling forming the prepuce in the non-erect state is un-
folded, and is employed in covering the body of the penis.
The diseases called phymosis and paraphymosis being a thick-
ening of the cellular membrane of this part, they will com-
monly be in proportion to the inflammation and distensibility
of the cellular membrane of the part. The inflammation oft-
en runs high, and is frequently of the erisypelatous kind; be-
sides, in such parts where the cellular membrane is so very
loose, the tumefaction is considerable, and the end of the pre-
puce being a depending part, the serum is accumulated in it,
which, in many inflammations, is allowed to pass from the in-
D d flamed
* See page 39, where this gonorrhœa is mentioned.

202 OF CHANCRE.
flamed to some more depending part, as in an inflammation of
the leg or thigh, where the foot commonly swells or becomes
œdematous in consequence of the descent of the serum extra-
vasated above.
A natural contraction of the aperture of the prepuce is very
common, and so strong in some, that those under such con-
struction of parts have a natural and constant phymosis. Such
a state of parts is often attended with chancres, producing ve-
ry great inconveniences in the time of the cure; and in those
cases of considerable diffused inflammation, a diseased phymo-
sis, similar to the other, unavoidably follows; and, whether
diseased or natural, it may produce the paraphymosis simply by
the prepuce being brought back upon the penis; for this tight
part acting as a ligature round the body of the penis, behind
the glans, retards the circulation beyond the ligature, produc-
ing an œdematous inflammation on the inverted part of the
prepuce. When the paraphymosis takes place in consequence
of a natural tightness only, although attended with chancres,
yet it has nothing to do with the constitution, this being only
accidental; however, in either case, a paraphymosis is to be
considered as in some degree a local violence.
This natural phymosis is so considerable in some children as
not to allow the urine to pass with ease, but in general be-
comes larger and larger, as boys grow up, by frequent endea-
vours to bring it over the glans, by which the bad consequences,
that would otherways ensue in it when affected with disease,
are often prevented.
This part of the prepuce, although in most men it is loose
enough to produce no inconvenience in a natural state, yet it
sometimes contracts without any visible cause whatever, and
becomes so narrow as to hinder the water from getting out,
even after it has got free of the urethra, so that the whole ca-
vity of the prepuce shall be filled with the urine, and give
great pain. The cases that I have seen of this kind have been
principally in old men.
When the prepuce is in its natural position it then covers
entirely the glans, and is commonly a little loose before it; but
when it begins to swell and thicken, more and more of the skin
of the penis is drawn forwards over the glans, and the glans at
the same time is pushed backwards by the swelling against its
end. I have seen the prepuce projecting from such a cause
more

OF CHANCRE. 203
more than three inches beyond the glans, and its aperture
much diminished.
The prepuce often becomes in some degree inverted by the
inner skin yielding more than the outer, having a kind of neck
where the outer skin naturally terminates. From the tightness
and distension of the parts in a state of tumefaction it becomes
impossible to bring it back over the penis, so as to invert it,
and expose the sores on the inside.
Such a state of the prepuce is very often productive of bad
consequences, especially when the chancres are behind the
glans, for the glans being between the orifice of the prepuce
and the sores, it there fills up the whole cavity of the prepuce
between the chancres and opening, and often so tightly that the
matter from the sores behind cannot get a passage forwards be-
tween the glans and prepuce, by which means there is an ac-
cumulation of matter behind the corona glandis, forming an
abscess which produces ulceration upon the inside of the pre-
puce; this abscess opens externally, and the glans often pro-
truding through the opening, throws the whole prepuce to the
opposite side, the penis appearing to have two terminations.
On the other hand, if the prepuce is loose, wide, and is ei-
ther accustomed to be kept back in its sound state, or is pulled
back to dress the chancres, and is allowed to remain in this
situation till the above tumefaction takes place, then it is call-
ed a paraphymosis; or if the prepuce is pulled forcibly back
after it is swelled, it is then brought from the state of a phy-
mosis, as before-described, to that of a paraphymosis.
This last-described situation of the prepuce is often much
more troublesome, and often attended with worse symptoms
than the former, especially if it should have been changed
from a phymosis to a paraphymosis. The reason of which is,
that the aperture of the prepuce is naturally less elastic than
either the internal inverted part, or the external skin; there-
fore, when the prepuce is pulled back upon the body of the
penis, that part grasps it tighter than any other part of the skin
of the penis, and more so in proportion to the inflammation;
the consequence of which is, the swelling of the prepuce is di-
vided into two, one swelling close to the glans, the other be-
hind the stricture or neck. This stricture is often so great as
to interrupt the free circulation of the blood beyond it, which
also assists in increasing the swelling, adds to the stricture, and
only

204 OF CHANCRE.
often produces a mortification of the prepuce itself, by which
means the whole diseased part, together with the stricture, is
sometimes removed, forming what may be called a natural
cure*.
In many cases the inflammation not only affects the skin of
the penis, in which is included the prepuce, but it attacks the
body of the penis itself, often producing adhesions, and even
mortification in the cells of the corpora cavernosa, either of
which will destroy the distensibility of those parts ever after,
giving the penis a curve to one side in its erections. This
sometimes takes place through the whole cellular substance of
the penis producing a short and almost inflexible stump.
The adhesions of those cells do not proceed from venereal
inflammation only; they are often the consequences of other
diseases, and sometimes they take place without any visible
cause whatever.
A gentleman, sixty years of age, who has been lame with
the gout these twenty years past, has for these eighteen months
had the penis contracted on the left and upper side, so as to
bend that way very considerably in erections, which erections
are more frequent than common.
Query: Is the gout the cause of this, by producing adhesi-
ons of the cells of one corpus cavernosum, so as not to yield
to, or allow of the influx of blood on that side? And is the
irritation of the gout the cause of the frequency of the erections?
CHAPTER II.
OF CHANCRES IN WOMEN.
WOMEN are subject to chancres, but from the simplici-
ty of the parts the complaint is often less complicated
than in men. For in this sex we have only the disease and con-
stitutional
* A young man came into St. George's Hospital, with a paraphymosis in consequence
of chancres on the inside of the prepuce. All the parts before the stricture, formed by
the prepuce, mortified and dropped off. I ordered nothing but common dressings, and
it healed very readily, and he left the hospital cured of the local complaint. Whether or
not absorption had taken place, previous to the mortification, I do not know, as I never
heard more of him.

OF CHANCRE. 205
stitutional affection, no inconvenience arising from the forma-
tion of the parts.
When the matter is introduced into the vagina or urethra,
it there irritates a secreting surface, as I described when treat-
ing of the disease in general, and of women in particular; but
when it is lodged in the inside of the skin of the labia or nym-
phæ, those parts are often only affected with gonorrhœa; but
like the glans penis in men, they are also capable of ulceration;
ulcerations are generally more numerous in women, because
the surface upon which they can form is much larger. We
find them on the edge of the labia, sometimes on the outside,
and even on the perinæum.
Ulcers that are formed on the inside of the labia, or nym-
phæ, are never allowed to dry or scab; but on the outside they
are subject to have the matter dry upon them, which forms a
scab, similar to those on the body of the penis or scrotum.
The venereal matter from such sores is very apt to run down
the perinæum to the anus, as in a gonorrhœa, and excoriate
the parts, especially about the anus where the skin is thin, and
often produce chancres in those parts.
Chancres have been observed in the vagina, which I suspect
not to have been original ones, but to have arisen from the
spreading of the ulcers on the inside of the labia.
This form of the disease, like the gonorrhœa, both in wo-
men and in men, is entirely local, the constitution having no
connection with it but sympathetically, and I believe much
more seldom in this than in the former.
CHAPTER III.
GENERAL OBSERVATIONS ON THE
TREATMENT OF CHANCRES.
THE inflammation from the venereal poison, when it pro-
duces ulceration, generally, if not always, continues till
cured by art, which I observed was not the case with the go-
norrhœa. It will perhaps not be an easy task to account for
this

206 OF CHANCRE.
this material difference in the two kinds of disease; but I am in-
clined to think that, as the inflammation in the chancre spreads,
it is always attacking new ground, which is a succession of irri-
tations, and is the cause that it does not cure itself.
Chancres, as well as the gonorrhœa, are perhaps seldom  or
never wholly venereal; but are varied by certain peculiarities
of the constitution at the time. The treatment therefore of
them, both local and constitutional, will admit of great varie-
ty; and it is upon the knowledge of this variety, that the skill
of the surgeon principally depends. On this account the con-
comitant symptoms are what require particular attention. Mer-
cury is the cure of the venereal symptoms abstractedly consider-
ed: but there is no one specific for the others, the treatment
of which must vary according to the constitution. From hence
we must see that no one kind of medicine, joined with mercu-
ry, will be likely to succeed in all cases, although the different
pretended secrets are of this kind: some cases not requiring any
thing except mercury, others requiring a something besides, ac-
cording to their nature, which in many cases it will not be an
easy matter to find out, from the appearances of the chancre
itself, but which must be discovered by repeated trials.
Probably from the before-mentioned circumstances it is,
that a chancre is in common longer in healing than most of
the local effects from the constitutional disease, or lues venerea;
at least longer than those in the first order of parts; and this
is found to be the case notwithstanding that the cure of a chan-
cre may be attempted both constitutionally, and locally, while
the lues venerea can in common only be cured constitutionally.
It is commonly some time before a chancre appears to be affect-
ed by the medicine. The circulation shall be loaded with mer-
cury for three, four, or more weeks before a chancre shall be-
gin to separate its discharge from its surface, so as to look red,
and show the living surface; but when once it does change,
its progress towards healing is more rapid. A lues venerea
shall in many cases be perfectly cured before chancres have
made the least change.
Upon the same principle some attention should be paid to
internal medicines; and it should be considered, whether
weakening, strengthening, or quieting medicines should be
given; for sometimes one kind, sometimes another, will be
proper.
Chancres

OF CHANCRE. 207
Chancres admit of two modes of treatment; the object of
one, is to destroy, or remove them by means of escharotics,
or by extirpation; that of the other, is to overcome the venereal
irritation by means of the specific remedy for that poison.
I have endeavoured to show that chancres are local com-
plaints; this opinion is further confirmed by their being de-
stroyed or cured by merely a local treatment. But in chan-
cres, as well as in a gonorrhœa, it has been disputed whether
mercury should ever be applied locally to them or not; some
have objected to it, while others have practised it, and proba-
bly the dispute is not yet generally settled.
Upon the general idea which I have endeavoured to give of
the venereal disease, it can be no difficult task to determine
this question.
It is to be observed that in the cure of the chancres we have
two points in view, the cure of the chancre itself, and the pre-
venting of a contamination of the habit.
The first, or the cure of the chancre, is to be effected by
mercury applied either in external dressings, or internally
through the circulation, or in both ways. The second object,
or preservation of the constitution from contamination is to be
obtained, first by shortening the duration of the chancre, which
shortens the time of absorption, and also by internal medicine,
which must be in proportion to the time that the absorption
may have been going on.
If the power of a chancre to contaminate the constitution, or
which is the same thing, if the quantity absorbed is as the size
of the chancre, and the time of absorption, which most proba-
bly it is, then whatever shortens the time must diminish that
power, or quantity absorbed; and if the quantity of mercury
necessary to preserve the constitution is as the quantity of poi-
son absorbed, then whatever lessens the quantity absorbed must
proportionally preserve the constitution. For instance, if the
power of a chancre to contaminate the constitution in four
weeks is equal to four, and the quantity of mercury necessary
to be given internally, both for the cure of the chancre and
the preservation of the constitution, is also equal to four, then
whatever shortens the duration of the chancre must lessen in the
same proportion the quantity of the mercury; therefore if local
applications along with the internal use of mercury will cure
the chancre in three weeks, then only three-fourths of the mer-
cury

208 OF CHANCRE.
cury is necessarily wanted internally. Local applications there-
fore, so far as they tend to shorten the duration of a chancre,
shorten the duration of absorption, which also shortens the ne-
cessity of the continuance of an internal course of mercury, all
in the same proportion. For example, if four ounces of mer-
curial ointment will cure a chancre and preserve the constitu-
tion in four weeks, three ounces will be sufficient to preserve
the constitution if the cure of the chancre can be by any other
means forwarded so as to be effected in three weeks. This is
not speculation, but the result of experience, and the destruc-
tion of chancres confirms it.
I. OF THE DESTRUCTION OF A CHANCRE.
THE simplest method of treating a chancre is by destroying
or extirpating it, whereby it is reduced to the state of a com-
mon sore or wound, and heals up as such. This only can be
done on the first appearance of the chancre, when the surround-
ing parts are not as yet contaminated; because it is absolutely
necessary that the whole diseased part should be removed, which
is done with difficulty when it has spread considerably. It
may be done either by incision or by caustic. If the chancre
appears upon the glans, touching it with the lunar caustic is
preferable to incision, because the hæmorrhage by such a mode
would be considerable, from the cells of the glans.
The common sensation of the glans is not very acute, there-
fore the caustic will give but little pain. The caustic to be
used should be pointed at the end like a pencil, that it may on-
ly touch those parts that are really diseased; this treatment should
be continued till the surface of the sore looks red and healthy after
having thrown off the last sloughs; after it has arrived at this
state, it will be found to heal like any other sore produced by
a caustic.
If the sore is upon the prepuce, or upon the common skin
of the penis, and in its incipient state, the same practice may be
followed with success; but if it has spread considerably, it is
then out of the power of the caustic, when only applied in this
slow manner, to go so deep as to keep pace with the increas-
ing sore; but it is very probable that the lapis septicus may an-
swer very well in such cases. When this cannot be conveni-
ently used, incision will answer the purpose effectually.
I have

OF CHANCRE. 209
I have taken out a chancre by dissection, and the sore has
healed up with common dressings. However, as our know-
ledge of the extent of the disease is not always certain; and as
this uncertainty increases as the size of the chancre, it becomes
necessary, in some degree, to assist the cure by proper dres-
sings, and therefore it may be prudent to dress the sore with
mercurial ointment. From such treatment there is but little
danger of the constitution being infected, especially if the
chancre has been destroyed almost immediately upon its appear-
ance, as we may then reasonably suppose there has not been
time for absorption. But as it must be in most cases uncertain
whether there has been absorption or not, this practice is not
always to be trusted to; and from that circumstance perhaps
never should; and therefore even in those cases where the
chancre has been removed almost immediately, it would be
prudent to give some mercury internally; the quantity of which
should be proportioned to the time and progress of the sore;
but if it has spread to a considerable size before extirpation,
then mercury is absolutely necessary, and perhaps not a great
deal is gained by the extirpation.
II. OF THE CURE OF CHANCRES — LOCAL AP-
PLICATIONS.
THE cure of a chancre is a different thing from its destruc-
tion, and consists in destroying its venereal disposition; which
being effected, the parts heal of course as far as they are ve-
nereal.
Chancres may be cured in two different ways, either by ex-
ternal applications or internal, through the circulation. The
same medicine is necessary for both these purposes, that is,
mercury.
I have shown that a gonorrhœa and a chancre have so far
the same disposition, as to form the same kind of matter; yet
I have also observed that mercury has no more power in curing
the gonorrhœa than any other medicine; and therefore it
might be supposed that mercury would have no effect in the
present complaint; but we find that in a chancre it is a speci-
fic, and will cure every one that is truly venereal; but as other
dispositions take place, so other assistance is often necessary, as
will be taken notice of in the history of the cure.
E e The

210 OF CHANCRE.
The action of this medicine must be the same in whatever
way it is given, for its action must be upon the vessels of the
part, in one way acting only externally, in the other internally*.
For external local  applications, mercurial ointments are the
common dressings; but if the mercury were joined with watry
substances instead of oily, by mixing with the matter the ap-
plication would be continued longer to the sore, and would
prove more effectual. This is an advantage that poultices have
over common dressings. I have often used mercury rubbed
down with some conserve in the room of an ointment, and it
has answered extremely well. Calomel used in the same way,
and also the other preparations of mercury mixed with muci-
lage or with honey, answer the same purpose. Such dressings
will effect a cure in cases that are truly venereal; but perhaps
we seldom have a constitution quite free from some morbid
tendency.
Some will have an indolent disposition, to counteract which
it will be right to join with the mercury some warm balsam in
a small proportion, or as much red precipitate as will only
stimulate without acting as an escharotic; and sometimes both
may be necessary.
Calomel mixed with some salve, or any other substance which
will suspend it, is more active than common mercurial oint-
ment, and in such cases as require stimulating applications, it
will answer better.
Many other applications are recommended, such as soluti-
ons of blue vitriol, verdigrease, calomel, with the spiritus nitri
dulcis, and many others.
But as all of these are only of service in remedying any pe-
culiar disposition of the parts, having no specific power on the
venereal poison; and as such dispositions are innumerable, it
becomes almost impossible to say what will be effectual in every
disposition; some will answer in one state of the sores, some
in another. It may be found oftentimes that the parts affect-
ed are extremely irritable; in such cases it will be necessary
to
* This is well illustrated by the application of some medicines locally to parts whose
actions are immediate and visible; and by throwing the same medicine into the constitu-
tion, the same immediate and visible effect is produced; for instance, if ten grains of
ipecacuanha is thrown into the stomach of a dog, it will, in a short time, make him vo-
mit, from its local application to that viscus; and if a solution of five grains is thrown
into a vein, it will produce vomiting before we can conceive it to have got to the vessels
of the stomach. The same effects are produced from an infusion of jalap thrown into
the veins, that are commonly produced when taken into the stomach and bowels.

OF CHANCRE. 211
to mix the mercury with opium, or perhaps preparations of
lead, as white or red lead, to diminish the action of the parts.
The oftener the dressings are shifted the better, as the mat-
ter from the sore separates the application from the diseased
parts, by which means the effects are lost or diminished. Three
times every day, in many cases, is not oftener than necessary,
especially if the dressings are of the unctuous kind, for they do
not mix, like watry dressings, with the matter, so as to impart
some of their virtues to it, which would in a proportional de-
gree affect the sore.
Chancres after having their venereal taint corrected, often
become stationary, and having acquired new dispositions, in-
crease the quantity of disease in the part, as will be taken no-
tice of hereafter. When they become stationary only, they
may often be cured by touching them slightly with the lunar
caustic. They seem to require that the surface which had been
contaminated, or the new flesh which grows upon that surface
should be either destroyed or altered before it can cicatrise;
and it is surprising often how quickly they will heal after be-
ing touched, and probably once or twice may be sufficient.
III. OF THE TREATMENT OF PHYMOSIS IN
CONSEQUENCE OF, OR ATTENDED WITH
CHANCRE.
FROM the history which I have given of the disease, we
must see that a phymosis may be of two kinds, one natural with
the disease superadded, the other brought on by disease. The
first may be increased by the disease; but if otherways it is not
so troublesome as the other. Such phymoses as arise from the
disease, I have observed, depend upon the peculiarity of the
constitution. In either case it is often not practicable to apply
dressings to the chancres on the inside of the prepuce.
A phymosis should be prevented, if possible; therefore up-
on the least signs of a thickening of the prepuce, which is
known by its being retracted with difficulty and pain, the pa-
tient should be kept quiet; if in bed so much the better, as in
an horizontal position the end of the penis will not be so de-
pending, but may be kept up. If confinement in bed cannot
be complied with, then the end of the penis should be kept up
to the belly if possible, but this can hardly be done when the
person

212 OF CHANCRE.
person is obliged to walk about; for the extravasated fluids de-
scending and remaining in the prepuce, contribute often more
to render the prepuce incapable of being drawn back than the
inflammation itself.
When the diseased phymosis completely takes place, the same
precautions may be followed; but as the sores cannot be dress-
ed in the common way, we must have recourse either to dres-
sings in forms of injections, or the operation for the phymosis.
If we use injections only, they should be often repeated as they
are only temporary applications.
The dressings in form of injections should be mercurial, ei-
ther crude mercury rubbed down with a thick solution of gum
arabic, which will assist in retaining some of the injection be-
tween the glans and prepuce; or calomel with the same, and a
proportion of opium. In the proportion of these no nicety is
required; but if a solution of corrosive sublimate is made use
of as an injection, some attention is to be paid to its strength.
About one grain of this to an ounce of water will be as much
as the sensation of the part will allow the patient to bear; and
if this gives too much pain it may be lowered by adding more
water.
After the parts are as well cleaned as possible with this injec-
tion, it will be necessary to introduce other mercurial applica-
tions of some kind to remain there till the parts want cleaning
again, which will be very soon; such as are mentioned before
will answer this purpose very well; but I have my doubts about
the propriety of using any irritating medicines or injections in
such cases.
As often as he voids his urine, the patient may wash the
parts, by pressing the orifice of the prepuce together, so as to
oblige the water to run back between the prepuce and glans:
immediately after this the patient should use the mercurial ap-
plications, otherways this operation of washing may do harm,
as it will be washing away the former application of mercury;
but in many cases the parts are so sore as not to allow of this
practice.
A poultice of linseed meal alone, or of equal parts of this
and bread should be applied. This poultice is to be made with
water, to which one-eighth of laudanum has been added. But
previous to this, and immediately after the cleaning, it would
be very proper to let the penis hang over the steam of hot wa-
ter

OF CHANCRE. 213
ter, with a little vinegar and spirits of wine in it, which is the
neatest way of applying fomentations.
The oftener this is practised the better; for thus a mercurial
application is kept in contact with the diseased parts a greater
number of the hours out of the twenty-four, than otherways
could be were the matter allowed to lie on the parts.
When to the above-mentioned symptoms a bleeding of the
chancre is added, I do not know a more troublesome complaint,
because here the cells or veins have no great disposition for con-
traction*. Oil of turpentine gives the best stimulus for the
contraction of vessels of all kinds; but where bleeding arises
from an irritable action of the vessels, which is sometimes the
case, then sedatives are the best applications. Whatever is
used in such a state of the prepuce must be injected into the
part.
When in consequence of the treatment the inflammation
begins to go off, and the chancres to heal, it will be necessary
to move the prepuce upon the glans as much as they will allow
of, to prevent adhesions which sometimes happen when there
have been chancres on both surfaces opposite to each other.
Indeed the practice here recommended is such as will in gene-
ral prevent such consequences.
If this has not been properly attended to, and the parts
have grown together, the consequences may not be bad; but
it must be very disagreeable to the patient, and a reflection up-
on the surgeon.
I have seen the opening into the prepuce so much contract-
ed from all these internal ulcers healing and uniting, that there
was hardly any passage for the water. If the passage in the pre-
puce so contracted be in a direct line with the orifice of the
urethra, then a bougie may be readily passed; but this is not
always the case: it often happens that they are not in a direct
line, therefore an operation becomes necessary. The opera-
tion consists in either slitting up part of the prepuce, or remov-
ing part of it, but as these parts have become very indistinct
from the adhesions, either the slitting it up, or removing part
of it, becomes a difficult operation. Whenever the urethra is
discovered,
* I suspect that where chancres bleed profusely, the blood comes either from the
glans, when there are chancres there, or from the spongy substance of the urethra where
the chancre has begun about the frænum, for we seldom see profuse bleedings from the
prepuce when its inside is the seat of the chancre and can be exposed; but indeed in such
cases the inflammation is not violent.

214 OF CHANCRE.
discovered, or can be found out by a bougie, that is to be in-
troduced, and its application repeated till the passage becomes
free and has got into the habit of keeping so.
I observed formerly that this tumefaction sometimes produc-
ed a confinement of the matter formed by the chancre, and
that while this effect lasted no subsiding of the inflammation
or tumefaction could take place; that therefore those diseases
continued to exist, and that the part thus circumstanced came
under our definition of an abscess; that is, the formation of
matter in a state of confinement. Although it never has been
considered in this light, yet the necessary treatment shows it to
be such. This consists in laying it open from the external ori-
fice to the bottom where the matter lies, as in a sinus, or fistula,
so as to discharge it. However the intention annexed to this
practice was not to allow of the discharge of the matter of the
sore, but to admit of the application of dressings to it, for it
has been recommended and practised, where there was no par-
ticular confinement of matter, which I have not found to be
necessary, merely for that purpose, as we are in possession of
an internal remedy; and if the opening produces no other
good, but the allowing of the application of dressings it is not
so material, because the sores may be washed with an injection,
through a syringe.
IV. OF THE COMMON OPERATION FOR THE
PHYMOSIS PRODUCED BY CHANCRES.
THE common operation for the phymosis is slitting the pre-
puce nearly its whole length, in the direction of the penis; but
even this is sometimes thought not sufficient, and it is directed
to cut the prepuce in two different places, nearly opposite to one
another. When it was thought proper to be done in this way,
it was imagined that it was seldom necessary to cut the whole
length of the prepuce. It will in some degree depend on cir-
cumstances, which practice is to be followed. If it is a natu-
ral phymosis without tumefaction, and the chancre is near the
orifice of the prepuce, which in such cases it most probably
will be, as the glans is not denuded in coition so as to have
chancres deeper seated, then it may be necessary only to go as
far as the chancres extend.
From

OF CHANCRE. 215
From the common situation of the chancre, this disease of
the phymosis arises more commonly from the tumefaction of
the parts; and from the idea I have endeavoured to give of
the inconveniences arising from this phymosis, where the
chancres are placed behind the corona, producing a confine-
ment of the matter behind the glans, slitting open the prepuce
a little way cannot be sufficient, for in such cases it must be
exposed to the bottom, or no good can arise from the operation.
Although this operation will not take off the tumefaction of
the prepuce so as to allow it to be brought back, yet it will
allow of a free discharge of the matter, and also in some cases it
will allow of dressings being applied to the sores; but not in
all, for the tumefaction will not allow more of an inversion
of the prepuce than before, and in such the sores cannot have
dressings applied to them.
In many cases it will be found that so violent an operation
is improper; for it often happens that while the inflammation
is so very considerable, there is danger of increasing it by this
additional violence, of which mortification may be the conse-
quence; while on the other hand there are cases where a free-
dom given to the parts would prevent mortification, so that
the surgeon must be guided by the appearances, and other cir-
cumstances. Besides these reasons for and against the opera-
tion arising from the disease itself, it will not always be con-
sented to by the patients themselves, for some have such a dread
of operations that they will not submit to cutting instruments;
however in those cases where the matter is confined, it will be
absolutely necessary to have an opening somewhere for the dis-
charge of it. This is often produced by the ulcerative process
going on on the inside, which makes an opening directly through
the skin, laterally, which affords a direction for the surgeon;
therefore the opening may be made directly into the cavity of
the prepuce, through the skin, on the side of the penis, by a
lancet; or a small caustic may be applied there, for which the
lapis septicus is the most convenient.
The opening will allow of the discharge of the matter, and
also admit any proper wash to be thrown in. But this open-
ing should not be a large one, as in many cases the conse-
quence of this lateral opening proves very troublesome; for,
from the tumefaction of the prepuce, the glans is squeezed on
all sides, and rather more backwards upon the body of the pe-
nis,

216 OF CHANCRE.
nis, than in any other direction, by which means it is often
forced through this opening, whereby the glans is directed to
one side, and the prepuce to the opposite, having a forked ap-
pearance. Besides, this state of the parts tightens the skin of
the penis round the root of the glans, acting there somewhat
like a paraphymosis, and sometimes makes the whole prepuce
mortify and drop off, which is often a lucky circumstance; but
if this is not the consequence, then amputation of the prepuce
becomes necessary; however this should not be done till all
inflammation is gone off, and the chancres are cured, when pro-
bably the tumefaction of the prepuce will have considerably
subsided.
A mortification of the prepuce is sometimes a consequence
of chancres, when attended with violent inflammation, even
without any previous operation; and I have seen cases where
the glans and part of the penis have mortified, while the pre-
puce has kept its ground. But I should suspect in all such
cases, that there is some fault in the constitution, and that the
inflammation is of the erisypelatous, not of the true suppura-
tive kind.
I have seen the mortification go so far as to remove the whole
of the diseased prepuce, and the parts have put on so favour-
able an appearance, that I have treated it as a common sore,
and no bad consequences have happened. In this case the dis-
ease performed what is often recommended in other diseases of
this part, that is circumcision; but this is not always to be
trusted to, for if absorption of the venereal matter has taken
place, previous to the mortification, a lues venerea will be the
consequence, although the parts heal very readily.
V. OF THE CONSTITUTIONAL TREATMENT OF
PHYMOSIS.
IN those cases where violent inflammation has attacked the
seat of a chancre, producing phymosis, as before-described, and
often so as to threaten mortification, a question naturally oc-
curs, What is to be done? Is mercury to be given freely to
get rid of the first cause? Or does that medicine increase the
effect while it destroys the cause? Nothing but experience can
determine this. I should incline to believe, that it is necessary
that mercury should be given, for I am afraid our powers to
correct

OF CHANCRE. 217
correct such a constitution, while the first cause subsists, are
weak. However, on the other hand, I believe the mercury
should be given sparingly; for if it assists in disposing the con-
stitution to such symptoms, we are gaining nothing, but may
lose by its use. I therefore do suppose that such medicines, as
may be thought necessary for the constitution, should be given
liberally, as well as the specific. Bark is the medicine that
probably will be of most general use; opium in most cases of
this kind will also be of singular service. The bark should be
given in large quantities, and along with it mercury, while the
virus is still supposed to exist. Or if the inflammation has
arisen early in the disease, they may be then given together so
as to counteract both diseases, and not allow the inflammation
to come to so great a height as it would otherways do if mer-
cury was given at first alone. This inflammation may be so
great in many cases, or be so predominant, that mercury may
increase the disposition and therefore become hurtful. Where
this may be supposed to be the case bark must be given alone.
VI. OF THE TREATMENT OF THE PARAPHY-
MOSIS FROM CHANCRES.
A PREPUCE in the state of inflammation and tumefaction,
and which has been either kept back upon the body of the pe-
nis while inflaming, or pulled back when inflamed, seldom
can be again brought forwards while in this state, therefore
becomes also the subject of an operation, which consists in di-
viding the same part, as in the phymosis, only in a different
way, arising from its difference of situation; the intention of
which operation is to bring the prepuce, when brought for-
wards, to the state of a phymosis that has been operated upon.
This operation becomes more necessary in many cases under
this disease than under the phymosis, because its consequences
are generally worse; since, besides the real disease, viz. in-
flammation, tumefaction, ulceration, &c. there is a mechani-
cal cause producing its effects, by  grasping the penis, which
can of itself produce inflammation where the prepuce is natu-
rally tight, as has been observed. From whatever cause it arises
it often produces mortification in the parts between the stric-
ture and the glans if it is not removed. This removal some-
times happens naturally by the ulceration of the strictured part;
F f but

218 OF CHANCRE.
but an operation is generally necessary; and it is more trou-
blesome than in the former case, because the swelling on each
side of the stricture covers or closes in upon the tight part and
makes it difficult to be got at.
The best way appears to be to separate the two swellings as
much as possible where you mean to cut, so as to expose the
neck, then take a crooked bistory which is pointed, and pass-
ing it under the skin at the neck divide it; no part of the two
swellings on the sides need he divided, for it is the looseness
of the skin in these parts which admits of their swelling.
When this is done the prepuce may be brought forwards over
the glans; but as this disease arose from chancres which may
require being dressed, and as the state of a phymosis is a very
bad one for such treatment, it may be better now that the stric-
ture is removed, to let it remain in the same situation till the
whole is well.
If the paraphymosis has arisen from a natural tightness of
the prepuce, and its being forced back from accident, then no
particular treatment after the operation is necessary, but to go
on with the cure as recommended in chancres. It is indeed
probable that in consequence of the violence produced by the
position of the prepuce, as also by the operation, a considera-
ble inflammation may ensue; but as this will be an inflamma-
tion in consequence of violence only, local treatment for the
inflammation will be sufficient.
But if it is a paraphymosis in consequence of a diseased phy-
mosis, then the same mode of treatment becomes equally ne-
cessary as was recommended in the phymosis attended with
considerable inflammation; and probably rather more attenti-
on is necessary here, as violence has been added to the former
disease.
VII. OF THE CURE OF CHANCRES BY MERCURY
GIVEN INTERNALLY.
WHILE chancres are under local treatment, as before-de-
scribed, it is necessary to give mercurials internally, both for
the cure of a chancre and the prevention of a lues venerea;
and we may reasonably venture to affirm, that the venereal
disposition of chancre will hardly ever withstand both local
and internal mercurials.
In

OF CHANCRE. 219
In cases of chancres where local applications cannot easily
be made, as in cases of phymosis, internal mercurials become
absolutely necessary; and more so than if they could be con-
veniently and freely applied externally. However, even in
such cases, internal mercurials will in the end effect a cure;
so that we need seldom or ever be under any apprehension of
not curing such a disease.
In every case of a chancre, let it be ever so slight, mercu-
ry should be given internally; even in those cases where they
were destroyed on their first appearance. It should in all cases
be given the whole time of the cure, and continued for some
time after the chancres are healed; for as there are perhaps
few chancres without absorption of the matter, it becomes ab-
solutely necessary to give mercury to act internally, in order
to hinder the venereal disposition from forming.
How much mercury should be thrown into the constitution
in the cure of a chancre, for the prevention of that constitu-
tional affection, is not easily ascertained, as there is in such
cases no disease actually formed so as to be a guide, it must be
uncertain what quantity should be given internally. It must in
general be according to the size, number, and duration of the
chancres. If large, we may suppose that the absorption will
be proportioned to the surface, and if long continued, the ab-
sorption will be according to the time; and if they have been
many, large, and continued long, then the greatest quantity is
necessary.
The circumstances therefore attending the chancre must be
the guide for the safety of the constitution, especially in those
cases where some stress in the cure is laid upon the external
remedy.
The mercury given to act internally must be thrown in ei-
ther by the skin or stomach, according to circumstances.
The quantity in either way should be such as may in com-
mon affect the mouth slightly; which method of giving mer-
cury will be considered hereafter.
When the sore has put on a healthy look, when the hard
basis has become soft, and it has skinned over kindly, it may
be looked upon as cured.
But in very large chancres it may not always be necessary to
continue the application of mercury either for external or inter-
nal action till the sore is healed; for the venereal action is
just

220 OF CHANCRE.
just as soon destroyed in a large chancre as it is in a small one;
for every part of the chancre being equally affected by the mer-
cury, is equally easy cured. But the skinning is different; for
a large sore is longer in skinning than a small one. A large
chancre therefore may be deprived of its venereal action long
before it is skinned over; but a small one may probably skin
over before the venereal poison is entirely subdued. In the
[l]atter case, both on account of the chancre and constitution,
it will be erring on the safe side to continue the medicine a lit-
tle longer, which will most certainly in the end effect a cure:
for we may reasonably suppose that the quantity of mercury ca-
pable of curing a local effect, although assisted by local applica-
tions, or of producing in the constitution a mercurial irritation
sufficient to hinder the venereal irritation from forming, will
be nearly as much as will cure a slight lues venerea.
I have formerly laid it down as a principle, that no new ac-
tion will take place in another part of the body, however con-
taminated, whilst the body is under the beneficial operation of
mercury; but there are now and then appearances which occur
under the cure that will at first embarrass the practitioner.
I have suspected that the mercury flying to the mouth and throat
has sometimes produced sloughs in the tonsils, and these have
been taken for venereal. The following cases in some degree
explain this.
A young gentleman had a chancre on the prepuce, with a
slight pain in a gland of one groin, for which I ordered mercu-
rial ointment to be rubbed into the legs and thighs, especially
on the side where the gland was swelled, and the chancre to be
dressed with mercurial ointment. While he was pursuing this
course the chancre became cleaner, the hardness at the base
went off, and the pain in the groin was entirely removed.
About three weeks after the first appearance of the disease, he
was attacked with a sore throat, and on looking into the mouth
I found the right tonsil with a white slough which appeared to
be in its substance, with only one point yet exposed. From
my mind being warped by the opinion that these complaints pro-
ceeded from the chancre, I immediately suspected that it was
venereal; and the only way I could account for this seeming
contradiction in one part healing while another was breaking
out, was, that the healing sore was treated locally as well as
constitutionally,

OF CHANCRE. 221
constitutionally, while the tonsil, or the constitution at large,
was only treated constitutionally, which was insufficient.
Soon after this another gentleman was under my care for ve-
nereal scurffs, or eruptions on his skin, for which he used mer-
curial friction till his mouth became sore; and in this state he
continued for three weeks, in which time the eruptions were
all gone, discolourations being left only where the eruptions
had been, yet at the end of three weeks a slough formed in
one of the tonsils, exactly as in the former case. This made
me doubtful how far such cases were venereal. I ordered the
friction to be left off, to see what course the ulcers would take;
the slough came out and left a foul sore: I waited still longer,
and in a day or two it became clean and healed up.
The first-mentioned case I did not see to an end; but I
learned that the patient continued the mercury and got well;
and the ulcer in the throat was supposed to be venereal; but
from the circumstances of the other case I now very much
doubt of that.
It is more than probable that these effects of mercury only
take place in constitutions that have a tendency to such com-
plaints in the throat. I know this to be the case with the last-
mentioned gentleman; and it is also probable that there may
be an increased disposition at the time, either in consequence
of the mercury, or some accidental cause. I have reason to
suppose that mercury in some degree increases this disposition,
which I shall further take notice of when treating of the cure
of the lues venerea.
In the cure of chancres I have sometimes seen, when the
original chancre has been doing well, and probably nearly
cured, that new ones have broken out upon the prepuce, near
to the first, and have put on all the appearance of a chancre;
but such I have always treated as not venereal. They may be
similar to some consequences of chancres, which will be taken
notice of hereafter.
As swellings of the absorbed glands take place in consequence
of other absorptions besides that of poisons, we should be care-
ful in all cases to ascertain the cause, as has been already de-
scribed; and here it may not be improper still to observe fur-
ther, that in the cure of chancres, swellings of the glands shall
arise, even when the constitution is loaded with mercury suffi-
cient for the cure of the sores; but then the mercury has been
thrown

222 OF CHANCRE.
thrown into the constitution by the lower extremity; and
therefore there is great room for suspicion that such swellings
are not venereal, but arise from the mercury: for a real bubo,
from absorption of venereal matter, if not come to suppuration,
will give way to mercury rubbed into the leg and thigh. In
such cases I have always desisted from giving the mercury in
this way when I could give it by the mouth.
CHAPTER IV.
OF THE CURE OF CHANCRES IN
WOMEN.
THE parts generally affected with chancres in this sex, are
more simple than in men, by which means the treatment
in general is also more simple; but in most cases they require
nearly the same, both in the local application of mercury, and
in throwing it into the constitution. It may be supposed how-
ever, that it will be necessary in many cases to throw into the
constitution more mercury than in men; because in general
there are more chancres, and the surface of absorption of
course larger.
As it is difficult to keep dressings on the female parts, it is
proper they should be washed often with solutions of mercury;
perhaps corrosive sublimate is one of the best, as it will act as
a specific, and also as a stimulant when that is wanted; but in
chancres that are very irritable, the same mode of treatment
as was recommended in men is to be put in practice. After-
wards the parts may be besmeared with a mercurial application,
either oily or watry, to be frequently repeated according to the
circumstances of the case.
If the ulcers should have spread, or run up the vagina,
great attention should be paid to the healing of them; for it
sometimes happens that the granulations contract considerably
so as to draw the vagina into a small canal; at other times the
granulations will unite into one another and close the vagina
up altogether; therefore in such cases it will be necessary to
keep

OF CHANCRE. 223
keep some substance in the vagina till the sores are skinned, for
which purpose probably lint may be sufficient.
CHAPTER V.
OF SOME OF THE CONSEQUENCES OF
CHANCRES, AND THE TREATMENT
OF THEM.
AFTER the chancres have been cured, and all venereal
taint removed, it sometimes happens that the prepuce
still retains a considerable degree of tumefaction, which keeps
up the elongation and tightness which it acquired from the dis-
ease, so that it cannot be brought back upon the penis to ex-
pose the glans.
For this perhaps there is, in many cases, no cure; how-
ever it is necessary to try every possible means. The steam of
warm water, fomentations with hemlock, and also fumigations
with cinnabar, are often of singular service in this case.
But if the parts still retain their size and form, it may be
very proper to remove part of the overgrown prepuce; how
much, must be left to the discretion of the surgeon. I should
suppose, that all that part, which projects beyond the glans
penis, may be cut away.
The best way of removing it is by the knife; but great care
should be taken to distinguish first the projecting prepuce from
the glans. When this is perfectly ascertained, the penis being
held horizontally, an incision may be made on the upper sur-
face, and followed down with caution; because if the incision
should be too near the glans there may be danger of cutting it.
The parts may be allowed to heal with any common dres-
sings, as it is to be considered as a fresh wound; however it
will not heal so readily as a fresh wound made in an entirely
sound part, because the operation consists in taking away only
a superfluous part of a diseased whole; and what is left is dis-
eased, but not so as to produce any future mischief.
Some care may be necessary in the healing of the parts; for
it is very possible that the cicatrix may contract, and still form
a phy-

224 OF CHANCRE.
a phymosis. This will be best prevented by the patient him-
self if he brings the prepuce often back upon the penis; but it
should not be attempted till the part is nearly healed; and it
is to be performed with great care, and slowly.
I. OF DISPOSITIONS TO NEW DISEASES DURING
THE CURE OF CHANCRES.
CHANCRES, both in men and women, often acquire new
dispositions in the time of the cure, which are of various kinds,
some of which retard the cure, as described, and, when the parts
are cured, leave them tumefied and indolent, as in the enlarg-
ed prepuce. In others a new disposition takes place, which
prevents the cure or healing of the parts, and often produces
a much worse disease than that from which it arose. They al-
so become the cause of the formation of tumors on these parts,
which will be taken notice of hereafter.
Such new dispositions take place oftener in men than in wo-
men, probably from the nature of the parts themselves. They
seldom or never happen but when the inflammation has been
violent, which violence arises more from the nature of the parts
than the disease, and therefore belongs more to the nature of
the parts or constitution than to the disease. However, I can
conceive it may also take place where the inflammation has
not been violent.
In general they are supposed to be cancerous, but I believe
they seldom are; although it is not impossible that some may
be so.
Of this kind may be reckoned those continued and often in-
creased inflammations, suppurations, and ulcerations, becom-
ing diffused through the whole prepuce, as also all along the
common skin of the penis, which becomes of a purple hue;
the cellular membrane every where on the penis being very
much thickened so as to increase the size of the whole con-
siderably.
The ulceration, on the inside of the prepuce, will sometimes
increase and run between the skin and the body of the penis,
and eat holes through in different places till the whole is re-
duced to a number of ragged sores. The glans often shares
the same fate till more or less of it is gone; frequently the
urethra at this part is wholly destroyed by ulceration, and the
urine

OF CHANCRE. 225
urine is discharged some way further back. If a stop is not
put to the progress of the disease, the ulceration will continue
till the parts are entirely destroyed. I suspect that some of
these cases are scrofulous.
As this is an acute case, immediate relief should be given,
if possible; but as it may arise from various peculiarities in the
constitution, and as these peculiarities are not at first known,
no rational method can be here determined. The decoction of
sarsaparilla is often of service in such cases, but requires to be
given in large quantities. The German  diet-drink* has been
of singular service; I knew a case of this kind cured by it,
after every known remedy had been tried. The extract of
hemlock is sometimes of service. I have known sea-bathing
cure these complaints entirely. A gentleman came from Ire-
land with a complaint of this kind, and after having tried eve-
ry common, and known method, without effect, as sarsaparil-
la, hemlock, German diet-drink: and after having used a great
variety of dressings, (which were all at last laid aside, and opi-
um only retained to quiet the pain) he bathed in the sea and
got well. It may be sometimes necessary to pass a bougie, to
hinder the orifice of the urethra from closing or becoming too
small in the time of healing in such cases.
II. OF ULCERATIONS RESEMBLING CHANCRES.
IT often happens that after chancres are healed, and all the
virus gone, the cicatrices ulcerate again, and break out in the
form of chancres.
Although this is most common in the seat of the former
chancres, yet it is not always confined to them; for sores oft-
en break out on other parts of the prepuce; but still they ap-
pear to be a consequence of a venereal complaint having been
there, as they seldom attack those who never had gonorrhœa
or chancres. They often have so much the appearance of chan-
G g cres,
* The following formulas have been much recommended as diet-drinks. Take of
crude antimony, pulverized, tied up in a bit of rag; pumice-stone, pulverized, tied up
in the same, of each one ounce; China-root, sliced; sarsaparilla-root, sliced and bruis-
ed, of each half an ounce; ten walnuts, with their rinds, bruised; spring-water, four
pints; boiled to half that quantity; filter it, and let it be drank daily in divided doses.
Take sarsaparilla, Saunders-wood, white and red, of each three ounces; liquorice
and mezereon, of each half an ounce; of lignum, rhodium, guaiacum, sassafras, of each
one ounce; crude antimony, two ounces; mix them and infuse them in boiling water,
ten pints, for twenty-four hours; and afterwards boil them to five pints, of which let
the dose be from a pint and an half to four pints a day.

226 OF CHANCRE.
cres, that I am persuaded many are treated as venereal that are
really not such: they differ from a chancre in general by not
spreading so fast, nor so far; they are not so painful, nor so
much inflamed, and have not those hard bases that the venere-
al sores have, nor do they produce buboes. Yet a malignant
kind of them, when they attack a bad constitution, may be
taken for a mild kind of chancre, or a chancre in a good con-
stitution.
Some stress is to be laid upon the account that the patient
gives of himself: but when there is any doubt, a little time
will clear it up. I have seen the same appearances after a go-
norrhœa; but that more rarely happens. It would appear that
the venereal poison could leave a disposition for ulceration of
a different kind from what is peculiar to itself. I knew one
case where they broke out regularly every two months, exact-
ly to a day.
As they are not venereal their treatment becomes difficult;
for the cure consists more in preventing a return, than in the
healing up of the present sores.
They require particular attention; for although they are not
dangerous, they are often troublesome, keeping the mind in
suspence for months.
I have tried a great variety of means, but with little success,
yet they have in general got well in the end. In the follow-
ing case, the lixivium saponarium produced a speedy cure.
A gentleman had three sores broke out on the prepuce,
which had very much the appearance of mild chancres. As I
was doubtful of their nature, I waited some time, and only or-
dered them to be kept clean. As they did not get well, seve-
ral things were tried. Mercurial dressings were applied, but
they always produced considerable irritation, and it was neces-
sary to leave them off. The mercurius calcinatus was given
by way of trial, and to secure the constitution, but the sores
continued the same. They were eat down with the lunar cau-
stic, which appeared to have a better effect than any other thing
tried; but still they were not healed at the end of five months.
I ordered forty drops of the lixivium saponarium to be taken
evey evening and morning in a bason of broth. After using
it three days he observed a considerable alteration in the sores,
and in six they were perfectly skinned over. He had formerly
had such sores often, which had always been treated as vene-
real;

OF CHANCRE. 227
real; but he began to doubt whether they really were so
from their getting so soon well in the present instance by the
lixivium.
I knew a gentleman who had these sores breaking out and
healing again for years. By bathing in the sea for a month or
two they healed up and never afterwards appeared.
III. OF A THICKENING AND HARDENING OF
THE PARTS.
IN some cases the parts do not ulcerate, but appear to thick-
en and become hard or firm; both the glans and prepuce seem
to swell, forming a tumor or excrescence from the end of the
penis, in form a good deal like a cauliflower, and, when cut
into, showing radii running from its base, or origin, towards
the external surface, becoming extremely indolent in all its
operations. This gives more the idea of a cancer than the first,
being principally a new-formed substance. However, it is not
always a consequence of the venereal disease; I have known
it to arise spontaneously.
This disease appears to be a tumor of so indolent a kind,
that I do not know any medicine that stands the least chance
of performing a cure. I have amputated them, and have also
seen the same thing done by others, from the idea of their be-
ing cancerous, and the remaining part of the penis has heal-
ed kindly.
In most of these cases a considerable part of the penis must
be removed. Immediately after the amputation, a suitable ca-
theter should be introduced into the urethra; for if no such
precaution is made use of, the consequences must be trouble-
some; for the first dressings become cemented to the orifice
by the extravasated blood, and prevent the patient's making
water, which must be attended with obvious inconveniences.
This was the case with a patient whose penis I amputated.
IV. OF WARTS.
ANOTHER disposition, which these parts acquire from the
venereal poison, is the disposition to form excrescences, or cu-
taneous tumors, called warts. This disposition is strongest
where the chancres were; and indeed chancres often heal into
warts;

228 OF CHANCRE.
warts; but perhaps the parts acquire this disposition from the
venereal matter having been long in contact with their surfaces;
for it often happens after gonorrhœas, where there had been
no chancres; and probably it is only in those cases where the
venereal matter had produced the venereal stimulus upon the
glans and prepuce, forming there what may be called an in-
sensible gonorrhœa.
A wart appears to be an excrescence from the cutis, or a
tumor forming upon it, by which means it becomes covered
with a cuticle, which like all other cuticles, is either strong
and hard, or thin and soft, just as the cuticle is which covers
the parts from whence they arise. They are radiated from
their basis to the circumference, the radii appearing at the sur-
face pointed or granulated, much like granulations that are
healthy, except that they are harder, and rise above the sur-
face. It would appear that the surface, on which each is form-
ed, has only the disposition to form one, because the surround-
ing and connecting surface does not go into the like substance;
thus a wart once begun does not increase in its basis, but rises
higher and higher. They have an increasing power within
themselves; for, after rising above the surface of the skin, on
which they are not allowed to increase in breadth at the basis,
they swell out into a round thick substance, which becomes
rougher and rougher.
This structure often makes them liable to be hurt by bodies
rubbing against them; and often from such a cause they bleed
very profusely, and are very painful.
These excrescences are considered by many not as simply a
consequence of the venereal poison, but as possessed of its spe-
cific disposition, and therefore they have recourse to mercury
for the cure of them; and it is asserted that such treatment
often removes them. Such an effect of mercury I have never
seen, although given in such a quantity as to cure in the same
person recent chancres, and sometimes a pox.
As these substances are excrescences from the body, they
are not to be considered as truly a part of the animal, not be-
ing endowed with the common or natural animal powers, by
which means the cure becomes easier. They are so little of
the true animal, and so much of a disease, that many trifling
circumstances make them decay; an inflammation in the natu-
ral and sound parts round the wart will give it a disposition to
decay;

OF CHANCRE. 229
decay; many stimuli applied to the surface will often make
them die. Electricity will produce action in them which they
are not able to support; an inflammation is excited round
them, and they drop off.
From this view of them, the knife and escharotics must ap-
pear not always necessary, although these modes will act more
quickly than any other in many cases, especially if the neck is
small. In such formed warts perhaps a pair of scissars is the
best instrument; but where cutting instruments of any kind are
horrible to the patient, a silk thread tied round their neck will
do very well; but in whichsoever way it is separated, it will
be in general necessary to touch the base with caustic.
Escharotics act upon warts in two different ways, namely
by deadening a part and stimulating the remainder; so that by
the application of escharotic after escharotic, the whole decays
tolerably fast; and it is seldom necessary to eat them down to
the very root, as the basis or root often separates and is thrown
off. This however is not always the case, for we find that
the root does not always separate, and that it will grow again;
therefore in such cases it is necessary to eat down lower than
the general surface to remove the root.
Any of the caustics, such as the lapis septicus, as also the
metallic salts, such as the lunar caustic, blue vitroil, &c. have
this power. The rust of copper and savine leaves mixed are
one of the best stimulants.
After they have been to appearance sufficiently destroyed,
they often rise anew, not from any part being left, but from
the surface of the cutis having the same disposition as before.
This requires a repetition of the same practice, so as to take off
that surface of the cutis.
V. OF EXCORIATIONS OF THE GLANS AND
PREPUCE.
IT very often happens that the surface of the glans and in-
side of the prepuce excoriate, becoming extremely tender, and
then a matter oozes out. The prepuce in such cases often be-
comes a little thickened, and sometimes contracts in its orifice,
both which circumstances render the inversion of it difficult and
painful. Whether this complaint ever arises from a venereal
cause

230 OF CHANCRE.
cause is not certain, as it often takes place where there never
has been any venereal taint.
This disease is in the cutis; and under such a disposition it
has no power of forming a good cuticle. It is very similar to
a gonorrhœa in this part, but is not venereal.
Drawing the prepuce back, and steeping the parts in a solu-
tion of lead, often takes off the irritation, and a sound cuticle
is formed. Spirits diluted often produce the same effect; the
unguentum citrinum of the Edinburgh Dispensatory, lowered
by mixing with it equal parts of hogs-lard, is often of singular
service in such cases; but there are cases which bid defiance to
all our applications, in which I have succeeded by desiring
the person to leave the glans uncovered, which produced the
stimulus of necessity for the formation of a natural cuticle.
PART

[231]
PART V.
CHAPTER I.
OF BUBO.
A KNOWLEDGE of the absorbing system, as it is now
established, gives us considerable information respecting
many of the effects of poisons, and illustrates several symptoms
of the venereal disease, in particular the formation of buboes.
Prior to this knowledge we find writers at a loss how to give
a true and consistent explanation of many of the symptoms of
this disease. The discovery of the lymphatics being a system
of absorbents, has thrown more light on many diseases than
the discovery of the circulation of the blood; it leads in many
cases directly to the cause of the disease.
The immediate consequence of the local diseases, gonorrhœa
and chancre, which is called bubo, as also the remote or lues
venerea, arise from the absorption of recent venereal matter
from some surface where it has either been applied or formed.
Although this must have been allowed in general ever since the
knowledge of the disease and of absorption, yet a true solution
of the formation of bubo could not be given till we had ac-
quired the knowledge of the lymphatics being the only absorb-
ents. Upon the old opinion of absorption being performed by
the veins, the lues venerea could have easily been accounted
for, because it could as readily be produced by the absorbing
power of the veins, if they had such, as by the lymphatics;
but the difficulty was to say how the bubo was formed. There
they seemed to be at a loss to account for this disease, yet they
sometimes expressed themselves as if they had some idea of it,
although at the same time they could have no clear notions of
what they advanced; nor could they demonstrate what they
said from the knowledge of the parts and their uses.
Buboes are by some imputed to the stopping of a gonorrhœa,
or as they expressed it, driving it to the glands of the groin,
conformably to the idea they had of the cause of the swelling
of the testicle. But this is not just, for we know of no such
power

232 OF BUBO.
power as repulsion; and if it was driven there it could not be
by stopping the formation of matter, but by increasing the ab-
sorption, of which they had no idea.
When we examine the opinion of authors concerning the
formation of bubo, prior to the knowledge of the power of ab-
sorption in the lymphatics, we shall find them making use of
terms which they could not possibly understand. For instance,
Heister says, "They are of two kinds, one venereal, and the
other not;" but he does not say that the venereal arises only
from impure coition.
Astruc says, page 326, that some buboes arise immediately
from impure coition, and these he calls essential; others from
suppressed gonorrhœa, or a small discharge, or from chancres
of the penis, and these he calls symptomatic; lastly, that they
arise spontaneously without any immediate previous coition, and
are a pathognomonic sign of a hidden pox.
In page 327 he shows the impossibility of this last happen-
ing from what we now call or understand by a lues venerea;
but in page 328 he explains what he calls a latent lues venerea,
which is local affection produced as he supposes from a lues ve-
nerea; but which most probably never yet happened; and if
ever they had arisen from such a cause, even the absorption of
their matter could not produce a venereal bubo, as will be ex-
plained. In short, as he understood not the true absorbing
system, his ideas are become now unintelligible*.
We find Cowper, Drake, and Boerhaave, as well as Astruc,
speaking of the vitiated lymph not passing the glands, therefore
inflaming them; also of the inspissated lymph passing either by
the circulation of the blood, that is, from the constitution to
these glands, (an opinion held by some to this day) or by a
shorter course, viz. The lymphatic vessels which go to the in-
guinal glands. They also speak of the swelling of the in-
guinal glands, or venereal buboes, from the contagion being
communicated by the resorbent lymphatics. Drake even
speaks more pointedly, and if we consider him no further, he
would almost make us believe that he knew that the lym-
phatics were the absorbents; but as he has no such ideas
when treating of those vessels expressly, we are not to give him
credit for it. His words are, "The venereal bubo may very
likely
* The above extracts are from the English edition, published in the year 1754, page
326.

OF BUBO. 233
likely take its rise from some parts of the contagious matter of
claps sucked up by the lymphatic of the penis, and thence im-
ported to the inguinal glands where they deposit their liquor;
and thence it well behoves the surgeon to be as early as may
be in the opening of such tumors, before, by the exporting ves-
sels of that class, the poison is carried further into the blood,
which very probably may be the case where such tumor ariseth
immediately upon the stopping of a gonorrhœa, as does the
hernia humoralis; but when the same appears some months af-
ter that was removed, we are to suppose as in cases of other
poisons laying hold of the blood, by the strength of Nature it
is thrown forth, either by means of the lymphatics of the
blood-vessels themselves, if not spewed out of the nervous tubes,
as Wharton surmised, and deposited in these emunctories."
Here he compares it to the formation of a hernia humora-
lis, which plainly shows that he understood neither of them.
Even so late as the year 1748, we do not find any new ideas
on this subject: Freke says, "By sealing up the mouths of the
glands of the urethra, the poison is thence by the ducts lead-
ing to the inguinal glands conveyed to them."
In the year 1754, eight years after Dr. Hunter having pub-
licly taught his opinion of the lymphatics being a system of
absorbents, we find a treatise on this disease by Mr. Gataker,
where as little new is advanced on this subject, as in any of the
former.
When we come so low down as the year 1770, in an abridge-
ment of Astruc by Dr. Chapman, (second edition) in which he
introduces his own knowledge and ideas, we find the absorbing
power of the lymphatics brought in as a cause of the formation
of buboes; but by this time the knowledge of the lymphatics
being the system of absorbents was in this country generally
diffused.
The doctrine of absorption being now perfectly understood,
we have only to explain the different modes in which it may
take place.
The venereal matter is taken up by the absorbents of the part
in which it is placed; and although the absorption of the mat-
ter and the effects after absorption are the same, whether from
the matter of the gonorrhœa or chancre, yet I shall divide the
absorption into three kinds, according to the three different
H h surfaces

234 OF BUBO.
surfaces from which the matter may be absorbed, beginning
with the least frequent.
The first and most simple is where the matter either of a
gonorrhœa or chancre has only been applied to some sound sur-
face, without having produced any local effect on the part, but
has been absorbed immediately upon its application. Instances
of this I have seen in men, and such are perhaps the only in-
stances that can be depended upon; for it is uncertain in many
cases, whether a woman has a gonorrhœa or not. I think
however I may venture to affirm that I have seen it in women,
or at least there was every reason to believe that they had nei-
ther chancre, nor gonorrhœa preceding, as there was no local
appearance of it, nor did they communicate it to others who
had connection with them.
It must be allowed that this mode of absorption is very rare;
and if we were to examine the parts very carefully, or inquire
of the patient very strictly, probably a small chancre might be
discovered to have been the cause, which I have more than
once seen. For when we consider how rarely it happens from
a gonorrhœa, in which the mode of absorption is similar, we
can hardly suppose it probable that it should here arise from
simple contact, the time of the application of the venereal mat-
ter being commonly so very short. We might indeed suppose
the frequency to make up for the length of time, which we
can hardly allow, for the same frequency should give the
chance of producing it locally. Therefore very particular at-
tention should be paid to all the circumstances attending such
cases.
There is however no great reason why it should not happen,
and the possibility of it lessens the faith that is to be put in the
supposition, that the disease may be years in the constitution
before it appears; for whenever it does appear in a lues vene-
rea, its date is always carried back to the last local affection,
whether gonorrhœa or chancre, and the latter connections are
never regarded.
The second mode of absorption of this matter is more fre-
quent than the former, and it is when the matter applied has
produced a gonorrhœa; and it may happen while the complaint
is going on, either under a cure or not. Some of the matter
secreted by the inflamed surfaces having been absorbed and car-
ried into the circulation, produces the same complaints as in
the

OF BUBO. 235
the former case, by which means a person gives himself the
lues venerea.
The third mode is the absorption of the matter from an ul-
cer, which may either be a chancre or a bubo. This mode is
by much the most frequent; which, with many other proofs,
would show that a sore, or ulcer, is the surface most favour-
able for absorption. Whether ulcers in every part of the body
have an equal power of absorption I have not been able to de-
termine; but I suspect that an ulcer on the glans is not so
good a surface for absorption as one on the prepuce, although
I have seen both buboes and the lues venerea arise from the
former, but not so often as from the latter.
To these three methods may be added a fourth, absorption
from a wound; which I have already remarked is, perhaps,
not so frequent as any of the former.
As the venereal poison has the power of contaminating
whatever part of the body it comes in contact with, it conta-
minates the absorbent system, producing in it local venereal
complaints. It is hardly necessary to observe, that what is now
commonly understood by a bubo is a swelling taking place in
the absorbing system, especially in the glands, arising from the
absorption of some poison, or other irritating matter; and
when such swellings take place in the groin, they are called
buboes, whether from absorption or not, but are most com-
monly supposed to be venereal, even although there has been
no visible preceding cause. This has been so much the case,
that all swellings in this part have been suspected to be of this
nature; femoral ruptures, and aneurysms of the femoral arte-
ry have been mistaken for venereal buboes.
I shall call every abscess in the absorbing system, whether
in the vessels or the glands, arising in consequence of the ab-
sorption of venereal matter, a bubo.
This matter when absorbed from either of the four different
surfaces, which are common surfaces, wounds, inflamed sur-
faces, and ulcers, is carried along the absorbent vessels to the
common circulation, and in its passage often produces the spe-
cific inflammation in these vessels; the consequence of which
is the formation of buboes, which are venereal abscesses, ex-
actly similar in their nature and effects to a chancre; the on-
ly difference being in size. As the absorbents with the glands
are immediately irritated by the same specific matter which has
undergone

236 OF BUBO.
undergone no change in its passage, the consequent inflamma-
tion must therefore have the same specific quality, and the
matter secreted in them be venereal*.
As this system of vessels may be divided into two classes,
the vessels themselves, and their ramifications and convoluti-
ons, called the lymphatic glands, I shall follow the same divi-
sion in treating of their inflammations.
Inflammation of the vessels is not nearly so frequent as that
of the glands. In men, such inflammations, in consequence
of chancres upon the glans or prepuce, generally appear like
a chord leading along the back of the penis from the chancres.
Sometimes they arise from the thickening of the prepuce in
gonorrhœas, that part in such cases being generally in a state
of excoriation, as was described when I treated of that form
of the disease. These chords often terminate insensibly on the
penis, near its root, or near the pubes; at other times they
extend further, passing to a lymphatic gland in the groin: this
chord can be easily pinched up between the finger and thumb,
and it often gives a thickness to the prepuce, making it so stiff
at this part as to make the inversion of it difficult, it not im-
possible, producing a kind of phymosis.
I think I have observed this appearance to arise as frequent-
ly from the gonorrhœa, when attended with the before-men-
tioned inflammation and tumefaction of the prepuce, as from
chancres; which, if my observation is just, is not easily ac-
counted for. I have observed that absorption is more com-
mon to ulcers than inflamed surfaces; or at least the formation
of a bubo in the gland, and its effects in the constitution, are
more common from an ulcer; but it may be remarked, that
the inside of the prepuce, from whence this chord appears to
arise, is in an excoriated state. It is possible that this effect
may arise from the lymphatics sympathising with the inflamma-
tion of the urethra; but I believe the affection is truly vene-
real; or it is possible that even the absorption of the coagula-
ble lymph, which was produced from the venereal inflamma-
tion, and which is the cause of the tumefaction, may have the
power of contamination, as appears to be the case in the
cancer.
The
* I do not know how far this reasoning will hold good in all cases of poisons; for I
very much suspect that the bubo, that is sometimes formed in consequence of inoculation
of the small pox, does not produce variolous matter. The natural poisons, in producing
buboes, certainty do not form a poison similar to themselves.

OF BUBO. 237
The thickening, or the formation of this hard chord, pro-
bably arises from the thickening of the coats of the absorbents,
joined with the extravasation of coagulable lymph, thrown in
upon its inner surface, as in inflamed veins.
This chord often inflames so much as to suppurate, and
sometimes in more places than one, forming one, two, or
three buboes, or small abscesses in the body of the penis.
When this is going on, we find in some parts of this chord a
circumscribed hardness; then suppuration takes place in the
centre, the skin begins to inflame, the matter comes nearer to
it, and the abscess opens like any other abscess.
I have seen a chain of these buboes, or little abscesses, along
the upper part of the penis through its whole length.
This may be supposed to be exactly similar to the inflam-
mation and suppuration of a vein after being wounded and ex-
posed.
Inflammation of the glands is much more frequent than the
former, and arises from the venereal matter being carried on
to the lymphatic glands; the structure of which appears to be
no more than the ramifications and reunion of the absorbent
vessels, by which means they form these bodies.
From this structure we may reasonably suppose that the
fluid absorbed is in some measure detained in these bodies, and
thereby has a greater opportunity of communicating the disease
to them than to the distinct vessels, where its course is perhaps
more rapid; which may account for the glands being more fre-
quently contaminated.
Swellings of these glands are common to other diseases, and
should be carefully distinguished from those that arise from the
venereal poison. The first inquiry should be into the cause, to
see if there is any venereal complaint at some greater distance
from the heart, as chancres on the penis, or any preceding dis-
ease on the penis; to learn if mercurial ointment has been at
all applied to the legs and thighs of that side; for mercury ap-
plied to those parts, for the cure of a chancre, will sometimes
tumefy the glands, which has been supposed to be venereal.
We should further observe, if there be no preceding disease
in the constitution, such as a cold, fever, &c. the progress of
the swelling with regard to quickness is also to be attended to,
as also to distinguish it from a rupture, lumber abscess, or
aneurysm of the crural artery.
Perhaps

238 OF BUBO.
Perhaps these bodies are more irritable, or more susceptible
of stimuli than the vessels. They are certainly more suscepti-
ble of sympathy; however we are not yet sufficiently acquaint-
ed with the use of these glands to be able to account satisfacto-
rily for this difference.
It would appear in some cases, that it is some time after the
absorption of the venereal matter before it produces its effects
upon the glands; in some it has been six days at least. This
could only be known by the chancres being healed six days be-
fore the bubo began to appear; and in such cases it is more
than probable that the matter bad been absorbed a much longer
time before; for the last matter of a chancre most probably is
not venereal; and indeed it is natural to suppose that the poi-
son may be as long before it produces an action on the parts,
when applied in this way, as it is either in the urethra, or in
forming a chancre; which I have shown to be sometimes six
or seven weeks.
The glands, nearest to the seat of absorption, are in general
the only ones that are attacked, as those in the groin, when
the matter has been taken up from the penis in men. In the
groin, between the labia and thigh, and the round ligaments,
when absorbed from the vulva, in women. I think there is
commonly but one gland at a time that is affected by the ab-
sorption of venereal matter, which if so, becomes in some sort
a distinguishing mark between venereal buboes and other dis-
eases of these bodies. We never find the lymphatic vessels,
or glands, that are second in order, affected; as those along
the iliac vessels, or back; and I have also seen when the dis-
ease has been contracted by a sore, or cut upon the finger, the
bubo come on a little above the bend of the arm, upon the in-
side of the biceps muscle; and in such where the bubo has
come in that part none has formed in the arm-pit, which is the
most common place for the glands to be affected by absorption.
But this is not universal, although common, for I was in-
formed by a gentleman who contracted the disease in the be-
fore-mentioned way, that he had buboes both on the biceps
muscle, and in the arm-pit. Another case of this kind I have
heard of since; why it is not more common is perhaps not ea-
sily explained.
It might be supposed that the matter was weakened, or
much diluted by the absorptions from other parts by the time
it

OF BUBO. 239
it gets through these nearest ramifications, and therefore has
not power to contaminate those which are beyond them; but
it is most probable that there are other reasons for this. I
once suspected that the nature of the poison was altered in these
glands as it passed through them, which was the reason why
it did not contaminate the second or third series of glands;
and also why it did not affect the constitution in the same way
as it did the parts to which it was first applied; but this expla-
nation will not account for the next order of glands to suppu-
rating buboes not being affected by the absorption of venereal
matter. It appears to me that the internal situation of the
other glands prevents the venereal irritation from taking place
in them; and this opinion is strengthened by observing when
one of these external glands suppurates and forms a bubo, which
is to be considered as a large venereal sore or chancre, that the
absorption from it, which must be great, does not contaminate
the lymphatics or glands next in order, by the venereal matter
going directly through them.
If this be true, then the skin would seem to be the cause of
the susceptibility of the absorbents to receive the irritation.
Whether the skin has the power inherent in itself, or acquires
it from some other circumstances, as air, cold, or sense of
touch, is not easily ascertained; but whichever it be, it shows
that the venereal matter of itself is not capable of irritating,
and that it requires a second principle to complete its full effect,
that is, a combination of the nature of the poison and the in-
fluence of the skin, and that influence must be by sympathy,
and therefore weaker than if acting in the same part, that is,
the skin itself; which perhaps is the reason why the venereal
matter does not always affect those vessels and glands, while it
always does the skin, if inserted into it.
The situation of buboes arising from the veneread disease in
the penis, are in men, in the absorbent glands of the groin:
if a gonorrhœa is the cause of a bubo, one groin is not exempt-
ed more than the other, both may be affected; but if a bubo
arises in consequence of a chancre, then the groin may be ge-
nerally determined by the seat of the chancre; for if the chancre
is on one side of the penis, then the bubo will commonly be
on that side; however, this is not universally the case, for I
have known instances, although but few, where a chancre on
one side of the prepuce, or penis, has been the cause of a bu-
bo

240 OF BUBO.
bo on the opposite side, which, if arising from that chancre, is
a proof that the absorbents either anastomose, or decussate each
other. If the chancre be on the frænum, or on the middle of
the penis, between the two sides, then it is uncertain which
side will be affected.
The situation of the glands of the groin is not always the
same, and therefore the course of the absorbent vessels will vary
accordingly. I have seen a venereal bubo which arose from a
chancre on the penis, a considerable way down the thigh; on
the contrary, I have seen it often as high as the lower part of the
belly, before Poupart's ligament, and sometimes near the pubes,
all of which three situations may lead to some variations in the
method of cure, therefore it may be proper to attend to them.
As the disease most commonly arises from copulation, the
situations of buboes are generally in the groin; but as no part
of the body, under certain circumstances, is exempt from this
disease, we find the nearest external glands between the part of
absorption, and the heart, every where in the body share the
lame fate with those of the groin, especially if external.
CHAPTER II.
OF BUBOES IN WOMEN.
THE same diseases in the absorbents in consequence of the
absorption of the venereal matter, take place in this sex
as well as in men. I never saw but one case where the absor-
bent vessels were diseased; but this is nearly in the same pro-
portion as in men, when I consider the proportion the number
of the one sex bears to that of the other who apply to me for
a cure of the venereal disease in any form. The case was a
gonorrhœa with violent itching and soreness when the patient
sat or walked; but she had very little pain in making water.
When I examined the parts, I could see no difference between
them and sound parts, excepting that the left labium was swel-
led, or fuller than the other, and a hard chord passed from the
centre of that labium upwards to the os pubis, and passed on
to

OF BUBO. 241
to the groin of the same side, and was lost in a gland as high
as Poupart's ligament. It was not to be felt but by pressing
the parts with some force, and it gave considerable pain upon
pressure.
The swelling of the labium appeared to be somewhat similar
to the swelling of the prepuce in similar cases in men, so that
they would appear to arise from the same cause.
One would naturally suppose that what has been said of this
complaint in the lymphatic glands in men, would be wholly ap-
plicable to women; and also that nothing peculiar to women
could take place; but the seat of absorption is more extensive in
this sex, and the course of some of the absorbents is also differ-
ent, from whence there are three situations of buboes in wo-
men, two of which are totally different from those in men, and
these I suspect to be in the absorbents.
The third situation of buboes in this sex is similar to that in
men, and therefore they may be divided into three, as in men.
When buboes arise in women where there is no chancre, it
is more difficult to know whether they are venereal or not
than in men; for when they arise in men without any local
complaint, it is known that no such complaint exists, and
therefore the bubo cannot be venereal, excepting by immedi-
ate absorption; but in women it is often difficult to know
whether there be any infection present or not; and therefore
in order to ascertain the nature of the bubo, attention must be
paid to its manner of coming on, progress, and other cir-
cumstances.
When chancres are situated forwards, near to the meatus
urinarius, nymphæ, clitoris, labia, or mons veneris, then we
find that the matter absorbed is carried along one or both of
the round ligaments, and the buboes are formed in those liga-
ments just before they enter the abdomen, without, I believe,
ever going further. These buboes I suspect not to be glandu-
lar, but inflamed absorbents; and if so, it strengthens the
idea that it is only an external part that can be affected in
this way.
When the chancres are situated far back, near the perinæum,
or in it, the matter absorbed is carried forwards along the an-
gle, between the labium and the thigh, to the glands in the
groin, and often in this course there are formed small buboes
in the absorbents, similar to those on the penis in men, and
I i when

242 OF BUBO.
when the effects of the poison do not rest here, it often pro-
duces a bubo in the groin as in men.
CHAPTER III.
OF THE INFLAMMATION OF BUBOES,
AND THE MARKS THAT DISTINGUISH
THEM FROM OTHER SWELLINGS OF
THE GLANDS.
THE bubo commonly begins with a sense of pain, which
leads the patient to examine the part, where a small hard
tumor is to be felt*. This increases like every other inflamma-
tion that has a tendency to suppuration; and, if not prevented,
goes on to suppuration and ulceration, the matter coming fast
to the skin.
But we find cases, where they are slow in their progress,
which I suspect either arises from the inflammatory process be-
ing kept back by mercury, or other means; or being retarded
by a scrofulous tendency, such a disposition in the parts not so
readily admitting the true venereal action.
At first the inflammation is confined to the gland, which is
movable in the cellular membrane; but as it increases in size,
or as the inflammation, and more especially the suppuration,
advances, which in all cases produce rather a common than a
specific effect, the specific distance is exceeded; the surround-
ing cellular membrane becomes more inflamed; and the tumor
is more diffused. Some buboes become erisypelatous, by which
means they are rendered more diffused and œdematous, and do
not readily suppurate, a circumstance often attending the eri-
sypelatous inflammation.
To ascertain what a disease is, is the first step in the cure;
and when two or more causes produce similar effects, great at-
tention
* It must be remarked here that whenever a person has either a gonorrhœa or a chan-
cre, he becomes apprehensive of a bubo; and as there are in the gonorrhœa, and some-
times in the chancre, sympathetic sensations in or near the grion, they are suspected by
the patient to be beginning buboes, and the hand is immediately applied to the part; and
if he feels one of the glands, although not in the least increased, the suspicions are con-
firmed from a belief that he has no such parts naturally.

OF BUBO. 243
tention is necessary to distinguish one effect from another, so
as to come at the true cause of each.
The glands of the groin, from their situation, are liable to
suspicion, for besides being subject to the common diseases,
they become exposed to others by allowing whatever is absorb-
ed to pass through them; and as the rout of the venereal poi-
son to the constitution is principally through them, and being
oftener ill from this cause than any other, they often are sus-
pected of this disease without foundation.
To distinguish, with certainty, the true venereal bubo from
swellings of those glands arising from other causes, may be ve-
ry difficult. We must, however, examine all circumstances,
to ascertain in what the bubo differs from the common dis-
eases of those glands, whether in the groin or elsewhere; in
which examination the apparent causes are not to be neglected.
I have already given the character of the venereal bubo in ge-
neral terms; but I shall now be more particular, as the two
are to be contrasted.
The true venereal bubo, in consequence of a chancre, is
most commonly confined to one gland. It keeps nearly its
specific distance till suppuration has taken place, and then be-
comes more diffused*. It is rapid in its progress from inflam-
mation to suppuration and ulceration. The suppuration is
commonly large for the size of the gland, and but one abscess.
The pain is very acute. The colour of the skin where the in-
flammation attacks is of a florid red.
It may be observed, that the buboes in consequence of the
first mode of absorption, viz. where no local disease has been
produced, will always be attended with a greater uncertainty of
the nature of the disease than those attended or preceded by a
disease in the penis; because a simple inflammation and sup-
puration of these glands are not sufficient to mark it to be ve-
nereal; but as we always have this disease in view when the
glands of the groin are the seat of the disease, the patient runs
but little risk of not being cured, if it should be venereal; but
I am afraid that patients have often undergone a mercurial
course when there has been no occasion for it.
It will perhaps be difficult to find out the specific difference
in the diseases themselves; but I think that such buboes as arise
without
* It may be observed here, that the glands and surrounding parts being dissimilar, in-
flammation, does not so readily become diffused as when it takes place in a common part.

244 0F BUBO.
without any visible cause are of two kinds, one similar to those
arising from chancres or gonorrhœa; that is, inflaming and sup-
purating briskly. These I have always suspected to be venere-
al; for although there is no proof of their being so, yet from
these circumstances there is a strong presumption that they are.
The second are generally preceded and attended with slight
fever, or the common symptoms of a cold, and they are gene-
rally indolent and slow in their progress. If they are more
quick than ordinary, they become more diffused than the vene-
real, and may not be confined to one gland. When very slow
they give but little sensation; but when more quick the sen-
sation is more acute, though not so sharp as in those that are ve-
nereal; and most commonly they do not suppurate, but often
become stationary. When they do suppurate it is slowly, and
often in more glands than one, the inflammation being more
diffused, and commonly small in proportion to the swelling.
The matter comes slowly to the skin, not attended with much
pain, and the colour is different from that of the other, being
more of the purple. Sometimes the suppurations are very con-
siderable but not painful.
Now let us see what other causes there are for the swelling
of these glands besides venereal infection, to which I have ascrib-
ed one of the modes of swelling; for there must be other causes
to account for the other modes of it.
The first thing to be attended to is, whether or not there
are any venereal complaints; and if not, this becomes a strong
presumptive proof that they may not be venereal, but proceed
from some unknown cause. If the swelling is only in one
gland, very slow in its progress, and gives but little or no pain,
it is probably merely scrofulous; but if the swelling is consi-
derable, diffused and attended with some inflammation and pain,
then it is most probable that there is a constitutional action con-
sisting in slight fever, the symptoms of which are lassitude, loss
of appetite, want of sleep, small quick pulse, and an appear-
ance of approaching heftic. Such swellings are slow in their
cure, and do not seem to be affected by mercury, even when
very early applied.
A gentleman had all the symptoms of a slight fever; the
pulse a little quick and hard, loss of appetite, and of course loss
of flesh; a listlessness and a sallow look. While he was in
this state, a swelling took place in the glands of one of the
groins.

OF BUBO. 245
groins. He immediately sent for me, because he imagined it
to be venereal. From the history of the case I gave it as my
firm opinion it was not; in this he had not much faith. The
swellings were not very painful; and, after having acquired a
considerable size, they became stationary. To please him, I
gave him a box of mercurial ointment, to be rubbed on the
leg and thigh only of the side affected, that it might have a suf-
ficient local effect, and as little go into the constitution as pos-
sible; but it did not appear to be of any service to the swel-
lings in the groin, they remaining stationary, and almost with-
out pain. His friends became uneasy, and sent their surgeons
to him, who, without knowing he was my patient, and of
course without knowing my opinion, imagined that the disease
was venereal, and talked of giving mercury. With respect to
the cure, I thought he should go to the sea and bathe.
Allowing the chance of the disease being venereal or not
venereal, to be equal, I reasoned upon that ground. His pre-
sent want of health could not be supposed to arise from any ve-
nereal cause, as it was prior to the swelling in the groin, and
therefore though the swelling might be venereal, he was not
at present in a condition to take mercury, as a sufficient quan-
tity of that medicine, for the cure, might kill him; and if it
should not be venereal, that still a greater quantity of mercury
must be given than what was necessary if it were venereal; be-
cause its not giving way readily would naturally make the sur-
geon push the mercury further; and, besides this disagreeable
circumstance, the disease in the groin might be rendered more
difficult of cure. But by going to the sea, his constitution
would be restored; and if the disease in the groin proved to
be venereal, he would be in a proper condition to go through
a mercurial course, and by that means get rid of both diseases
by the two methods. But if I should be right in my opinion,
that there was nothing venereal in the case, then he would get
well by the sea-bathing alone.
These arguments had the desired effect; he went directly to
the sea, and began to recover almost immediately. About a
fortnight after a small suppuration took place in one of the
glands. I directed that a poultice should be made with sea-
water and applied; and, in case of the breaking of the abscess,
that it should not be further opened, but poulticed till healed.
In six weeks he came back perfectly recovered in every respect.
The

246 OF BUBO.
The above-mentioned appearance, with the constitutional
affections, I have seen take place when there were chancres;
and I have been puzzled to determine whether it was sympa-
thetic, from a derangement of the constitution, or from the
absorption of matter.
I have long suspected a mixed case; and I am now certain
that such exists. I have seen cases where the venereal matter,
like a cold or fever, has only irritated the glands to disease,
producing in them scrofula, to which they were predisposed.
In such cases the swellings commonly arise slowly, give but
little pain, and seem to be rather hastened in their progress if
mercury is given to destroy the venereal disposition. Some
come to suppuration while under this resolving course; and
others, which probably had a venereal taint at first, become so
indolent that mercury has no effect upon them, and in the end
get well either of themselves or by other means; which, I
imagine, may have induced some to think that buboes are ne-
ver venereal. Such cases require great attention, that we may
be able to determine them properly; and I believe, this re-
quires in many cases so nice a judgment, that we shall be oft-
en liable to mistakes.
Buboes are undoubtedly local complaints, as has been ex-
plained.
How far the lymphatic glands are to be considered as guards
against the further progress of this or any other disease caught
by absorption, is not easily determined. We must however
allow that they cannot prevent the poison from entering the
constitution, in cases where it produces buboes; for whenever
it affects these glands in its course, it produces the same dis-
ease in them which is capable of furnishing the constitution
with an increased quantity of the same kind of poison.
CHAPTER

[247]
CHAPTER IV.
GENERAL REFLECTIONS ON THE
CURE OF BUBOES.
FROM what has been offered on the history of buboes, it
will be needless here to enter into a discussion of the opi-
nion of their being a deposit from the constitution, and of the
conclusion drawn from this opinion, that they ought not to be
dispersed; for, according to this theory, to disperse them
would be to throw the venereal matter upon the constitution.
But if this were really the case, then there would be no occa-
sion for the use of mercury, provided that the bubo be allowed
to proceed, as it would prove its own cure; but even those
who were of this opinion, were not satisfied with the cure
which they supposed Nature had pointed out, but gave mercu-
ry, and in very large quantities. From the same history of a
bubo I have also endeavoured to show that there are several
buboes which are not in the least venereal, but scrofulous;
and that there are also buboes which appear to be only in part
venereal; or perhaps only a gland disposed to scrofula brought
into action by the venereal irritation, similar to what happens
often from the matter of the small pox in inoculation. There-
fore, prior to the speaking of the method of cure, the true ve-
nereal bubo is to be distinguished from the others, if possible.
When it is well ascertained to be venereal, resolution is cer-
tainly to be attempted, if the bubo be in a state of inflamma-
tion only. The propriety of the attempt depends on the pro-
gress which the disease has made. If it be very large, and
suppuration appears to be near at hand, it is probable that re-
solution cannot be effected; and if suppuration has taken place,
I should very much doubt the probability of success, and an
attempt might now possibly only retard the suppuration, and
protract the cure.
The resolution of those inflammations depends principally
upon mercury, and almost absolutely upon the quantity that
can be made to pass through them; and the cure of them, if
allowed to come to suppuration, depends upon the same cir-
cumstances. The quantity of mercury, that can be made to
pass

248 OF BUBO.
pass through a bubo, depends principally upon the quantity of
external surface for absorption beyond the bubo.
Mercury is to be applied in the most advantageous manner,
that is, to those surfaces by an absorption from which it may
pass through the diseased gland: for the diseases there being de-
stroyed, the constitution has less chance of being contaminated.
The powers of mercury may often be increased from the man-
ner in which it is applied. In the cure of buboes, it should
always be made to pass into the constitution by the same way
through which the habit received the poison; and therefore to
effect this, it must be applied to the mouths of those lymphatics
which pass through the diseased part, and which will always
be placed on a surface beyond the disease.
But the situation of many buboes is such as not to have much
surface beyond them, and thereby not to allow of a sufficient
quantity of mercury being taken in in this way; as for in-
stance, those buboes on the body of the penis arising from
chancres on the glans or prepuce.
These two surfaces are not sufficient to take in the necessary
quantity to cure those buboes in its passage through them;
therefore whenever the first symptoms of a bubo appear, its
situation is well to be considered, with a view to determine if
there be a sufficient surface to effect a cure, without our hav-
ing recourse to other means. It is first to be observed, whe-
ther the absorbent vessels, on the body of the penis, are affect-
ed, or the glands in the groin. If the disease be in the groin,
it must be observed in which of the three situations of the bubo,
before taken notice of, it is; whether on the upper part of
the thigh and groin, on the lower part of the belly before Pou-
part's ligament, or near to the pubes. If they are on the body
of the penis, this shows that the absorbents, leading directly
from the surface of absorption, are themselves diseased. If in
the groin, and on the upper part of the thigh, or perhaps a
little lower down than what is commonly called the groin, then
we may suppose it is in the glands common to the penis and
thigh. If high up, or on the lower part of the belly, before
Poupart's ligament, then it is to be supposed that those absorb-
ents, that arise from about the groin, lower part of the belly,
and pubes, pass through the bubo; and if far forwards, then
it is most probable that only the absorbents of the penis and
skin about the pubes, pass that way. The knowledge of these
situations

OF BUBO. 249
situations is very necessary for the application of mercury for
the cure by resolution, and for the cure after suppuration has
taken place.
The propriety of this practice must appear at once, when we
consider that the medicine cannot pass to the common circula-
tion without going through the diseased parts; and it must pro-
mote the cure in its passage through them; while at the same
time it prevents the matter, which has already passed, and is
still continuing to pass into the constitution from acting there,
so that the bubo is cured and the constitution preserved.
But this practice alone is not always sufficient; there are
many cases in which mercury by itself cannot cure. Mercury
can only cure the specific disposition of the inflammation; and
we know that this disease is often attended with other kinds of
inflammation besides the venereal.
Sometimes the common inflammation is carried to a great
height, at other times the inflammation is erisypelatous, and, I
suspect, often scrofulous. We must, therefore, have recourse
to other methods.
Where the inflammation rises very high, bleeding, purging,
and fomenting, are generally recommended. These will cer-
tainly lessen the active power of the vessels, and render the in-
flammation more languid; but they can never lessen the speci-
fic effects of this poison, which were the first cause, and are
still in some degree the support of the inflammation. Their
effects are only secondary; and if they reduce the inflamma-
tion within the bounds of the specific, it is all the service they
can perform. If the inflammation be of the erisyplatous
kind, perhaps bark is the best medicine that can be given; or
if it be suspected to be scrofulous, hemlock, and poultices made
with sea-water may be of service.
Vomits have been of service in resolving buboes, even af-
ter matter has been formed in them, and after they have been
nearly ready to burst; this acts upon the principle of one irri-
tation destroying another; and sickness and the act of vomiting
perhaps give a disposition for absorption. A remarkable in-
stance of this kind happened in an officer who had a bubo at
Lisbon. It came to fair suppuration, and was almost ready to
burst. The skin was thin and inflamed; and a plain fluctuation
felt. I intended to open it, but as he was going on board a ship
for England on the day following, I thought it better to defer it.
K k When

250 OF BUBO.
When he went on board, he set sail immediately; and the
wind blew so very hard that nothing could be done for some
days, all which time he was very sick, and vomited a good
deal; when the sickness went off, he found the bubo had disap-
peared, and it never afterwards appeared. When he came to
England, he went through a regular course of mercury.
I. OF RESOLUTION OF THE INFLAMMATION OF
THE ABSORBENTS ON THE PENIS.
THE surface beyond the seat of the disease in this case, that
is all that part of the penis before the bubo, is not large enough
to take in a quantity of mercury sufficient to prevent the effects
of absorption, and therefore recourse is to be had to other
means; yet this application should by no means be neglected,
and this surface, small as it is, should be constantly covered
with mercurial ointment, which will assist in the cure of the
local disease. It may be disputed whether any medicine can
pass through diseased lymphatics, so as to have any effect up-
on them, but I judge from experience that it certainly can.
As this surface is too small, and as it is necessary that a larger
quantity should be taken in, it becomes proper to give it either
by the mouth, or by friction on some larger surface; this is ne-
cessary to prevent the lues venerea, as well as to cure the parts
themselves. The quantity cannot be determined; that must be
left to the surgeon, who must be directed by the appearances
of the original complaint, and the readiness with which the
disease gives way.
The same method is to be followed in women; but as there
is a larger surface in this sex, more mercury may possibly be
absorbed; and there should be a constant application of oint-
ment to the inside, and outside of the labia.
II. OF THE RESOLUTION OF BUBOES IN THE
GROIN.
THE inflammation of the glands is to be treated exactly up-
on the same principle with the other; but we have in general
a larger surface of absorption, so that we can make a greater
quantity of mercury pass through the diseased parts.
It

OF BUBO. 251
It will be proper to apply the mercury according to the situ-
ation of the inflamed gland. If the bubo be in the groin, ac-
cording to our first situation, then it is necessary to rub the
mercurial ointment upon the thigh. This surface will in ge-
neral absorb as much mercury as will be sufficient to resolve
the bubo, and to preserve the constitution from being contami-
nated by the poison that may get into it; but if resolution does
not readily take place, then we may increase the surface of
friction, by rubbing the ointment upon the leg.
But if the bubo be on the lower part of the belly, that is,
in the second situation, then the ointment should be rubbed
also upon the penis, scrotum, and belly; and the same, if the
bubo should be still further forwards; for probably those glands
receive the lymphatics from all the surfaces mentioned as well
as from the thigh and leg.
The length of time for continuing the frictions must be de-
termined by circumstances. If the bubo gives way, they must
be continued till it has entirely subsided, and perhaps longer,
on account of the cause of it, a chancre, which may not yield
so soon as the bubo. If it still goes on to suppuration, the
frictions may, or may not be continued; for I do not know
for certain if any thing is to be gained by their continuance in
this state.
The quantity, here recommended, may affect the mouth;
and this effect must also be regulated according to circumstances.
III. OF THE RESOLUTION OF BUBOES IN WOMEN.
WHEN treating on the seat of buboes in women, I observed
that two situations were peculiar to them, the others similar
to those in men.
In the treatment of buboes in women some attention should
be paid to their situation, for on that depends, in some degree,
the method of resolution and cure when they suppurate. The
first was in the round ligament, the second between the labi-
um and thigh, and the third in the groin.
In the first and second situations, especially the first, the sur-
face of absorption, beyond the bubo, is by much too small to
be depended upon for receiving a sufficient quantity of mercu-
ry to produce resolution; but in the second, that is, between
the labia and thigh, the mercury may be rubbed in all about
the

252 OF BUBO.
the anus and buttock, as all the absorbents of those parts pro-
bably pass that way; we know at least that they do not pass
into the pelvis by the anus, but go by the groin. Other means
of introducing mercury must be recurred to, as is recommend-
ed in the case of men; but still it will be proper to rub in on
these surfaces as much as possible.
In the situations common to both sexes, we have a larger
field; yet, as they are divisible into three, the same observa-
tions hold good, and a similar mode of practice is to be fol-
lowed in women as in men.
IV. OF BUBOES IN OTHER PARTS.
AS venereal buboes arise from other modes of application
of the poison besides coition, they are to be found in different
parts of the body; but more frequently in the hands. They
arise in the arm-pit from wounds in the hands or fingers being
contaminated by venereal matter, and reduced to a chancre.
In such cases it becomes necessary that the ointment should be
rubbed on the arm and fore-arm; but this surface may not be
sufficient, therefore we must apply it in another way, or to
other parts, to produce its effects upon the constitution.
I have seen a true venereal chancre, on the middle of the
lower lip, produce a bubo on each side of the neck under the
lower jaw, just upon the maxillary gland. By applying strong
mercurial ointment to the under lip, chin, and swellings, they
have been resolved.
V. OF THE QUANTITY OF MERCURY NECESSA-
RY FOR THE RESOLUTION OF A BUBO.
THE quantity of mercury, necessary for the resolution of a
bubo, must be proportioned to the obstinacy of the bubo; but
care must be taken to stop short of certain effects upon the con-
stitution. If it be in the first situation, and yields readily to
the use of half a dram of mercurial ointment, made of equal
parts of quicksilver and hogs-lard, every night, and the mouth
does not become sore, or at most only tender, then it will be
sufficient to pursue this course till the gland is reduced to its
natural size; and this probably will be a good security for the
constitution, provided the chancre, which may have been the
cause

OF BUBO. 253
cause of the bubo, heals at the same time. If the mouth is
not affected in six or eight days, and the gland does not readily
resolve, then two scruples, or a dram, may be applied every
night; and if there be no amendment, then more must be rub-
bed in; in short, if the reduction is obstinate, the mercury
must be pushed as far as can be done without a salivation.
If there be a bubo on each side, then there cannot be so
much mercury applied locally to each; for the constitution
most probably could not bear double the quantity which is ne-
cessary for the resolution of one. But in such cases we must
not so much attend to the soreness of the mouth as when there
is but one; however, we must allow the buboes to go on to
suppuration, rather than affect the constitution too much by
the quantity of mercury; and therefore, when there are two
buboes, they are more likely to suppurate than where there is
only one.
In the second and third situation of buboes, if we find that
most probably a sufficient quantity of mercury does not pass
through them for their resolution, it may be continued to be
thrown in by the leg and thigh to act upon the constitution, as
has been already observed. The quantity admitted in this way
must be greater than would be necessary if the whole could be
made to pass through the bubo. The mouth must be affected,
and that in proportion to the state and progress of the bubo.
This method of resolving buboes occurred to me at Bellisle,
in the year 1761, where I had good opportunities of trying
it upon the soldiers; and I can say with truth, that only three
buboes have suppurated under my care since that time, and
two of these were in one person, where a small quantity of
mercury had considerable effects on the constitution, and there-
fore a sufficient quantity could not be sent through the two
groins for their resolution; but in both cases the suppurations
were small in comparison to what they threatened to be.
Many buboes, after every attempt, remain swelled without
either coming to resolution or suppuration, but rather become
hard and scirrhous. Such, I apprehend, were either scrofu-
lous at first, or became so when the venereal disposition was
removed. The cure of them should be attempted by hemlock,
sea-water poultices, and sea-bathing, as will be further taken
notice of.
VI. OF

254 OF BUBO.
VI. OF THE TREATMENT OF BUBOES WHEN
THEY SUPPURATE.
AFTER every known method has been used, buboes can-
not in all cases be resolved, but come to suppuration. They
then become more an object of surgery, and are to be treated
in some respects like any other abscess. If it be thought pro-
per to open a bubo, it should be allowed to go on thinning the
parts as much as possible. The great advantage arising from
this is, that these parts having become very thin, lose the dis-
position to heal, which gives the bottom of the abscess a better
chance of healing along with the superficial parts; by this
means too, a large opening is avoided, and the different modes
made use of for keeping the skin from healing, till the bottom
is healed, become unnecessary.
It may admit of dispute, whether the application of mer-
cury should be continued or not through the whole suppura-
tion. I should be inclined to continue it, but in a smaller
quantity; for although the parts cannot set about a cure till
opened, yet I do imagine that they may be better disposed to
it; and I think that I have seen cases where suppuration took
place although under the above-mentioned practice, that were
very large in their inflammation, but very small in their sup-
puration, which I imputed to the patient's having taken mer-
cury in the before-mentioned way, both before and while sup-
puration was going on.
It has been disputed more in this kind of abscess than in
others, whether it should be opened or allowed to burst of it-
self; and likewise whether the opening should be made by in-
cision or caustic.
There appears to be nothing in a venereal abscess different
from any other to recommend one practice more than another.
The surgeon should in some degree be guided by the patient.
Some patients are afraid of caustic, others have a horror of
cutting instruments; but when it is left wholly to the surgeon,
and the bubo is but small, I suppose, a slit with a lancet will
be sufficient; in this way no skin is lost.
But when a bubo is very large, in which case there is a
large quantity of loose skin, perhaps the caustic will answer bet-
ter, both on account of its destroying some skin, and because
the

OF BUBO. 255
the destruction is attended with less inflammation than what at-
tends incision. If done by a caustic, the lapis septicus is the
best*; but it is not necessary to open every bubo, and perhaps
it may be difficult to point out those where opening would be
of service or necessary.
The bubo is to be dressed afterwards according to the nature
of the disease, which, I have already observed, is often so com-
plicated as to baffle all our skill. The constitution at the same
time is to be attacked with mercury, either by applying it in-
ternally or externally; if externally, it should be applied to
that side, and beyond where the bubo is, as before directed in
treating of the resolution of buboes; for it may have some in-
fluence on the disease in its passing through the part.
Mercury, in these cases, answers two purposes; it assists the
external applications to cure the buboes, and it prevents the
effects of the constant absorption of the venereal matter from
the sore.
How far it is necessary to pursue the mercurial course with
a view to prevention, it is not possible to determine; but it
may be supposed that it is necessary to give the same quantity
to prevent a disease that would cure one that has already taken
place. It will be necessary to continue the course till the bubo
is healed, or till it has for some time lost its venereal appear-
ance; but it may be difficult to ascertain this last fact; there-
fore we must have recourse to experience, not theory, and con-
tinue the course in general till the whole is healed, and even
longer, especially if the bubo heals very readily; for we find
in many cases that the constitution shall be still tainted after
all; however, some restrictions are here necessary; for I have
already observed, that it often happens, that buboes assume
other dispositions besides the venereal, which mercury cannot
cure, but will even make worse. It is therefore very necessary
to ascertain the distinction; which will be taken notice of.
CHAPTER
* I once opened two buboes in the same person, one immediately after the other.
The first was with the lapis infernalis, which gave him considerable pain, and therefore
he would have the other opened with a lancet, as the pain would only be momentary.
But it was great, and the soreness continued long, while there was no pain in the other,
deadened by the caustic, after it bad done its business.

256 OF BUBO.
CHAPTER V.
OF SOME OF THE CONSEQUENCES
OF BUBOES.
I FORMERLY observed, that the venereal disease is ca-
pable of bringing latent dispositions or susceptibilities into
action. This is remarkably the case with buboes; and I be-
lieve the disposition is more of the scrofulous kind than any
other. Whether this arises from the buboes being formed in
lymphatic glands, or not, is probably not easily determined.
It sometimes happens, that these sores, when losing, or en-
tirely deprived of the venereal disposition, form into a sore of
another kind, and most probably of various kinds. How far
it is a disease arising from a venereal taint, and the effects of a
mercurial course jointly, is not certain; but most probably
these two have some share in forming the disease. If this idea
of it were just, it would become a specific disease, and be re-
duceable to one method of cure; but I should suspect that ei-
ther the constitution or the part hath some, if not the princi-
pal, share in it; that is, the parts fall into a peculiar disease
independent of the constitutional disease or method of cure;
for if it arose out of the two first entirely, we might expect
to meet with it oftener. So far as the constitution or the part
has a share in forming this disease, it becomes more uncertain
what the disease is, because it must in some degree partake of
the constitution or nature of the part.
Such diseases make the cure of the venereal affection much
more uncertain, because when the sore becomes stationary, or
the mercury begins to disagree, we are ready to suspect, that
the virus is gone; but this is not always the case; the virus is
perhaps only less powerful than the new-formed disease, and as
it were lies dormant, or ceases to act, and when the other be-
comes weaker, the venereal influence begins to show itself
again.
The proper treatment, in such cases, is to attack the pre-
dominant disease; but still the difficulty is to find out the dis-
ease, and to know when it is or is not venereal. The follow-
ing case explains this difficulty very well.
A gen-

OF BUBO. 257
A gentleman had a very large venereal bubo, which was
opened. He took a great deal of mercury for about two months,
but, I suspect, not in sufficient doses, which produced a mer-
curial habit. The bubo had no disposition to heal, and I was
consulted. From the account he gave me, I suspected that he
had then too much of a mercurial habit to receive at this time
any further good from that medicine. I therefore advised him
to use a good nourishing diet for near a month; after that I
put him upon a brisk mercurial course by friction; and the
parts put on a better appearance. This course he continued
for near two months, and then the sore, although much mend-
ed, began to be stationary, I did now conceive that the vene-
real action was destroyed, and therefore immediately left off
the mercurial course and put him upon a milk diet, and sent
him into the country. But not gaining much ground, he had
a strong decoction of the sarsaparilla with mezereon given him,
which, although continued for above a month, produced little
or no effect. I also gave him the cicuta as much as he could
bear, with the bark almost the whole time, without effect: new
sinuses formed, which were opened, and the sore became ex-
tremely irritable, with thickened lips. The dressings were
poultices made with the juice of hemlock, sea-water, opium,
and a gentle solution of lunar caustic; but nothing seemed to
affect it. I suspected scrofula, and therefore proposed he should
bathe in the sea; but this then could not be done. These dif-
ferent treatments, after mercury had been left off, took up about
four months without the least benefit. Being doubtful whe-
ther there might not be still something venereal in the sore,
especially as appearances were growing worse, and it was now
four months since he had taken any mercury, I was inclined
to try it once more, and sent him two portions of ointment,
half an ounce each, to rub in in two nights. He had caught a
little cold, and therefore did not rub in the mercury the two
evenings as ordered; and called upon me the third day and told
me he was much better; the sore now became easy, the watry
or transparent inflammation began to subside; the lips became
flatter and thinner; and the edges of the sore began to heal.
I then desired him not to rub in the ointment, but wait a lit-
tle. In eight or ten days the sore had contracted to three
quarters of its former size, and had all the appearance of a heal-
ing sore.
L l Query:

258 OF BUBO.
Query: What conclusions should be drawn from this case?
I think the following; that the virus may be gone, although
the sore has no disposition to heal: therefore we are not to
look upon the not healing of a bubo as a sign of the presence
of the original disease. Secondly; that the sarsaparilla, meze-
reon, cicuta, and the bark, will not succeed in all such cases;
and thirdly, that some of these diseases are capable of wearing
out the unhealthy disposition of themselves, and that we should
not be too ready to attribute cures to our treatment; for if the
mercury had been rubbed in, and the same effects had still tak-
en place, I should then have certainly pursued the mercury with
vigor, and attributed the cure to it; but I should not have
rested here: I should have related the case, as an instance of
the disease continuing after repeated courses of mercury, and
should have contended that it is necessary in such cases, where
the mercury appeared to lose its power, and even do harm, to
wait, and season the constitution to strength, and the loss of
the mercurial habit; and that even four months are sometimes
necessary for this purpose; after which we must begin again to
give mercury.
A gentleman had a common gonorrhœa, which was severe.
I gave him an injection of a grain of corrosive sublimate in
eight ounces of water, with a few mercurial pills. After hav-
ing continued the injection for ten, or twelve days, without
any visible benefit, I gave it as my opinion that it would be of
no service to continue it any longer; and therefore desired he
would be quiet for a little time. About this time a swelling in
each groin took place, and supposing them to be venereal, I
ordered mercurial ointment to be rubbed into both the legs and
thighs to resolve them if possible. He appeared to be less un-
easy about the buboes than he was about the gonorrhœa; but
I told him that the cure of that complaint would be insensibly
involved in the resolution of the buboes. I spoke too confi-
dently of my power, with respect to the resolution of the bu-
boes, for they both suppurated; although the suppuration was
small in comparison to the magnitude of the buboes when they
first inflamed. The frictions were left off.
While we were attempting to resolve the buboes, he got
well of the gonorrhœa. The skin, covering the buboes, be-
came thin; they were both opened, one with a caustic, the
other with a lancet; he then was ordered to rub in mercury
again

OF BUBO. 259
again on the thighs and legs for their cure. They began soon
to look well, and to close fast, but when about half healed they
became stationary. I suspected that a new disease was forming.
On continuing the frictions a little longer, they began to in-
flame and swell anew, and a suppuration took place about half
an inch above each of the first suppurations, which broke into
the first. I left off the mercury immediately upon their in-
flaming, and said that now a new disease had formed. I or-
dered poultices made with sea-water to be applied, and also a
decoction of sarsaparilla to be taken; but this appeared not to
be sufficient for the cure of this new disease. I then ordered him
to go into the tepid sea-bath every evening, the heat of the water
to be about ninety degrees. By the time he had been in the
bath four times, the inflammation and swelling had very much
abated, and the first sores, or original buboes, were beginning
to heal. He went on with the bathing every everting for about
three weeks, when the sores rather began to look worse; I then
suspected that the venereal disposition was become predominant;
and I ordered the friction as before. In about a fortnight the
first buboes healed, but the second suppurations were not yet
healed; then I supposed it to be entirely the new-formed dis-
ease, and he went into the country, where I desired he might
go into the open sea every day, as he then could have an op-
portunity, which he did, and got perfectly well, and has con-
tinued so.
This case plainly shows that there was another disposition
formed besides the venereal, and which was put into action by
the venereal irritation.
I have seen some buboes most exceedingly painful and ten-
der to almost every thing that touched them, and the more
mild that the dressings were, the more painful the parts became.
In some the skin seems only to admit the disease; ulcera-
tion going on in the surrounding skin, while a new skin forms
in the centre, and keeps pace with the ulceration, forming an
irregular sore like a worm-eaten groove all round. This, like
the erisypelatous inflammation, as also some others, appears
to have only the power of contaminating the parts that have
not yet come into action: and those that have already taken
it seem to lose the diseased disposition, and heal readily.
In some they spread to an amazing extent, as the following
ease shows, the circumstances of which are very remarkable.
A young

260 OF BUBO.
A young gentleman, aged eighteen years, in consequence
of a venereal infection, had two buboes, which were both
opened. They were treated in the usual manner, and at first
put on a favourable appearance; but, when they were nearly
healed, they began to ulcerate at their edges, and spread in all di-
rections, rising above the pubes almost to the navel, and descend-
ing upon each thigh. His nights became restless, and his ge-
neral health was affected. A great variety of medicines were
tried, particularly mercury in different forms, with little or no
effect. Extract of hemlock did more good than any thing else,
and was taken in unusual quantities. An ounce was swallow-
ed in the course of the day for some time, which was afterwards
increased to an ounce and an half, two ounces, and even two
ounces and an half. It produced indistinct vision and blind-
ness, loss of the voice, falling of the lower jaw, a temporary
palsy of the extremities, and once or twice a loss of sensation;
and notwithstanding he was almost every night in a state, as it
were, of complete intoxication from the hemlock, his general
health did not suffer, but, on the contrary, kept pace in its
improvement with the ulcers. They could not however be
healed by the hemlock; and among many other things, Æthi-
ops mineral, and Plummer's pill were liberally given, seeming-
ly with advantage. Recourse was had to the hemlock from
time to time. A great many different kinds of dressings were
made trial of, none of which were found to exceed dry lint.
The ulcers were nearly all healed, after having tormented him
upwards of three years, when committing some irregularities
in diet, and the sores getting worse, he returned to the extract
of hemlock, which he had for some time laid aside, and of
himself swallowed in the course of the morning ten drams.
This quantity was only the half of what he had formerly taken
in twenty-four hours, but his constitution had been gradually
habituated to the medicine. The ten drams produced great
restlessness and anxiety; he dropt insensible from his chair, fell
into convulsions, and expired in two hours.
To return to the cure of buboes: where they only become
stationary and appear to have but little disposition to spread,
(which is most common) and where perhaps a sinus or two
may be found running into them from some other gland, I
have often seen them give way to hemlock, and sooner than to
any thing I am acquainted with, especially if joined to the bark. 
If

OF BUBO. 261
If the hemlock is applied both internally and externally it an-
swers better.
Sarsaparilla is often of singular service here, as well as in
other cases arising seemingly from the same cause; and I have
seen sea-bathing of great service, as also sea-water poultice.
At the Lock Hospital they use goldrefiners water as an ap-
plication, which is of service in some cases. Dr. Fordyce re-
commends the juice of oranges to be drunk in large quantities,
which I have seen good effects from in some cases. The me-
zereon is in some instances of singular use.
PART

[262]
PART VI.
CHAPTER I.
OF THE LUES VENEREA.
THE lues venerea, I have already observed, arises in con-
sequence of the poisonous matter being absorbed and car-
ried into the common circulation. This form of the disease,
which I have called the constitutional*, would appear to be
much more complicated, both in the different ways in which
it may be caught, and in its effects when caught, than either
a gonorrhœa or chancre. It generally arises from the local
complaints, before taken notice of, the matter being absorbed
and carried into the constitution. The matter, however, ap-
pears to be capable of being taken into the constitution by sim-
ple application, without first having produced either of the be-
fore-mentioned local effects, as I observed in treating of the
formation of the bubo; but this seems to be only when it is
applied to some particular parts of our body, such as may be
called a half internal surface, as the glans penis. I think it is
not capable of being received by the absorbents of the sound
skin; but this is matter only of opinion.
It may likewise be received into the constitution by being
applied to common ulcers, although not necessarily rendering
these ulcers themselves venereal; also by wounds, as has been
observed; but, I believe, always previously producing ulcera-
tion in the wound.
Many other modes of infection have been supposed, but, I
believe, erroneously; such suppositions most probably having
taken
* The term constitutional is, perhaps, not strictly a proper term; for by constitutional
disease strictly, I would understand that, in which every part of the body is acting in one
way, as in fevers of all kinds, either sympathetic or original; but the venereal poison ap-
pears to be only diffused through the circulating fluids, and, as it were, to force certain
parts of the body to assume the venereal action, which action is perfectly local, and
takes place in different parts in regular succession of susceptibilities; there are but few
parts therefore acting at the same time; and a person may be constitutionally affected in
this way, and yet almost every function may be perfect.

OF THE LUES VENEREA. 263
taken their rise from ignorance or deceit, two great sources
of error in this disease.
It is most likely that contamination takes place about the
beginning of the local complaints, especially when that is a
chancre; for there is in most cases less chance of its happening
afterwards, because the patient commonly flies to medicine,
which generally becomes a prevention of contamination. For
if it could take place through the whole time of the cure, we
should have the parts contaminated at different periods, com-
ing into action at different times, each according to its stated
time, although in similar parts both in their nature and other
circumstances; but as these similar parts do not vary much in
the time of coming into action, it is reasonable to suppose that
they were contaminated at, or near, the same time, and there-
fore that no contamination takes place in the time of the cure,
although we may suppose that the power of absorption is equal-
ly strong then as at any other time.
In cases of contamination from a gonorrhœa, where no mer-
cury has been taken, we might expect this irregularity in si-
milar structures; but as contamination so seldom takes place
in this way, we have not a chance of great variety from such;
however, it would be worth while to ascertain the matter,
which, from a great many cases, might be done.
Without being very exact in ascertaining the different pro-
portions in those who have the lues venerea originating from
the three several modes above-described, I think we may ven-
ture to say from general practice or experience, that where
one contracts it from the first cause, that is, where no local
effects have been produced, an hundred have it from the se-
cond, or gonorrhœa; and where one has it from the second,
an hundred have it from the third, or chancre; and, perhaps,
not one in five hundred who have connection with venereal
women, have it in the first way, and not one in an hundred
have it from the second; while not one in an hundred would
escape it from the third, if the means of prevention were not
made use of in the common method of cure of the chancre.
I. OF

264 OF THE LUES VENEREA.
I. OF THE NATURE OF THE SORES OF ULCERS
PROCEEDING FROM THE LUES VENEREA.
IN consequence of the blood being contaminated with real
venereal pus, it might naturally be supposed, that the local
effects arising thereform would be the same with the original
which produced them; but from observation and experiment
I have reason to believe that this is not so.
In considering this subject, we may first observe, that local
effects, from the constitution, are all of one species, that is
ulcers, let the surface upon which they appear be what it will,
whether the throat or common skin; which is not the case in
the local application of the matter in gonorrhœa and chancre;
for there I observed, that it produced effects according to the
nature of the surfaces. Now if the matter, when in the con-
stitution, were to act upon the same specific principles with that
which is applied, we should have gonorrhœas when it attacks
a canal; sores or chancres when it attacks other surfaces; but
it has never been yet known to produce a gonorrhœa from the
constitution, though this has indeed been suspected. For some
gonorrhœas, the origin of which has not been clear, and which
have not easily given way to the common methods of cure,
have been supposed to have arisen from the constitution.
Whenever the disease affects the mouth and nose, it has always
been looked upon as producing a true chancre; yet even here
I find that such ulcers in their first appearance are very diffe-
rent from chancres. The true chancre, I observed, produces
considerable inflammation, which of course brings on quickly
suppuration, attended often with a great deal of pain; but the
local effects, from the constitution, are slow in their progress,
attended with little inflammation, and are seldom or ever pain-
ful, except in particular parts. However, this sluggishness in
the effefts of the poison is more or less according to the na-
ture of the parts which become diseased; for when the tonsils,
uvula, or nose, are affected, its progress is rapid, and the sores
have more of the chancre in their appearance than when it af-
fects the skin; yet I do not think that the inflammation is so
great in them as in chancres that are ulcerating equally fast.
It has been supposed that even all the secretions from the con-
taminated blood could be affected so as to produce a like poison
in

OFTHE LUES VENEREA. 265
in them; and as the parts of generation are thrown in the way
of receiving it, when fresh contracted, so they still lie under
the censure of having it returned upon them from the consti-
tution. Hence it has been supposed that the testicles and vi-
siculæ seminales may be affected by the disease; that the semen
may become venereal, may communicate the disease to others,
and, after impregnation, may even grow into a pocky child:
but all this is without foundation; otherways, when a person
has the lues venerea, no secreting surface could be free from
the state of a gonorrhœa, nor could any sore be other than
venereal. Contrary to all which, the secretions are the same
as before; and if a sore is produced by any other means in a
sound part, that sore is not venereal, nor the matter poisonous,
although formed from the same blood.
The saliva in the case of a mad dog, being a natural secre-
tion rendered poisonous, may be brought as an argument in
contradiction to this theory; yet it is easily accounted for, and
might be produced rather as an argument in support of it. In
the dog, there is an irritation peculiar to the hydrophobia in the
salivary glands; but the other and natural secretions of the
same dog are not capable of giving this infection, because they
are not susceptible of the same specific irritation.
The breath and sweat are supposed to carry along with them
contagion. The milk of the breast is supposed to be capable
of containing venereal poison, and of affecting the child who
sucks it; but there are several reasons which overturn these
opinions. First, we find that no secretion is affected by this
poison, excepting where the secreting organs have been pre-
viously affected by venereal inflammation or irritation, or its
specific mode of action. Again, if they were contaminated so
as to produce matter similar to that of an ulcer in the throat,
such matter would not be poisonous, nor possess a power of
communicating the disease, as will be explained more fully
hereafter. Further, true venereal matter, even when taken
into the stomach, does not affect either the stomach or consti-
tution, but is digested; as was evident in the two following
cases.
A gentleman, who had chancres which discharged largely,
used to wash the parts with milk in a tea-cup with some lint,
and generally let the lint lie in the cup with the milk. A lit-
tle boy in the house stole the milk and drank it: but whether
M m or

266 OF THE LUES VENEREA.
or not he swallowed the lint was not known. No notice was
taken of this by the gentleman, either to the family or the boy;
and attention, unknown the family, was paid to the boy even
for years, but nothing happened that could give the least sus-
picion of his having been affected either locally in the stomach
or constitutionally.
A gentleman had a most violent gonorrhœa, in which both
the inflammation and the discharge were remarkably great.
He had also a chordee, which was very troublesome at night.
In order to cool the parts, and keep them clean, he had a
small bason of milk by the bed-side, in which, when the chor-
dee was troublesome, he got up and dipped or washed the pe-
nis. This operation he frequently repeated in the night. Un-
der such complaints he allowed a young lady to sleep with
him. Her custom was to have by her bed-side a bason of tea
to drink in the morning before she got up; but unfortunately
for the lady, she drank one morning the milk instead of the
tea. This was not known till she got up, which was five or
six hours afterwards. I was sent for directly, and in the mean
time she endeavoured to vomit, but could not. I ordered ipe-
cuanha, which proved slow in its operation. She vomited,
but it was more than eight hours after drinking the milk and
water, and what came up was nothing but slime, mucus, or
water, the milk being digested. I was attentive to what might
follow; but nothing uncommon happened, at least for many
months.
It is also supposed, that a fœtus, in the womb of a pocky mo-
ther, may be infected by her. This I should doubt very much,
both from what may be observed of the secretions, and from
finding that even the matter from such constitutional inflamma-
tion is not capable of communicating the disease. However,
one can conceive the bare possibility of a child being affected in
the womb of a pocky mother, not indeed from the disease
of the mother, but from a part of the same matter which con-
taminated the mother and was absorbed by her; and whether
irritating her solids to action or not, may possibly be conveyed
to the child, pure as absorbed; and if so it may affect the child
exactly in the same way it did or might have done the mother.
This idea has been carried still further; for it has been suppos-
ed that such a contaminated child could contaminate the breasts
of a clean woman by sucking her; the possibility of which will
be

OF THE LUES VENEREA. 267
be considered presently. We may observe, that even the blood
of a pocky person has no power of contaminating, and is not
capable of giving the disease to another even by inoculation;
for if it were capable of irritating a sound sore to a venereal
inflammation, no person that has this matter circulating, or
has the lues venerea, could escape having a venereal sore when-
ever he is bled or receives a scratch with a pin, the part so
wounded turning into a chancre. For if venereal matter had
been on the point of the lancet, or on the point of the pin, the
punctures must become chancres.
II. OF THE MATTER FROM SORES IN THE LUES
VENEREA COMPARED WITH THAT FROM
CHANCRES AND BUBOES.
WHEN the matter has affected the constitution, it from
thence produces many local effects on different parts of the bo-
dy, which are in general a kind of inflammation, or at least
an increased action occasioning a suppuration of its own kind.
It is supposed, that the matter, produced in consequence of
these inflammations, similar to the matter from a gonorrhœa
or chancre, is also venereal and poisonous. This I believe till
now has never been denied; and, upon the first view of the sub-
ject, one would be inclined to suppose that it really should be ve-
nereal; for first the venereal matter is the cause; and again the
same treatment cures both diseases; thus mercury cures both
a chancre and a lues venerea; however this is no decisive proof,
as mercury cures many diseases besides the venereal. On the
other hand there are many strong reasons for believing that
the matter is not venereal. There is one curious fact which
shows it is either not venereal, or if it be, that it is not capa-
ble of acting in some respects on the same body or same state
of constitution as that matter does, which is produced from a
chancre or gonorrhœa. The pus from these latter, when ab-
sorbed, generally produces a bubo, as has been described; but
we never find a bubo from the absorption of matter from a
pocky sore; for instance, when there is a venereal ulcer in the
throat, we have no buboes in the glands of the neck; when
there are venereal sores on the arms, or even suppurating
nodes on the ulna, there are no swellings of the glands of the
arm-pit; although such will take place if fresh venereal matter
is

268 OF THE LUES VENEREA.
is applied to a common sore on the arm, hand, or fingers.
No swelling takes place in the glands of the groin from either
nodes or blotches on the legs and thighs. It may be suppos-
ed that there is no absorption from such sores; but I think we
have no grounds for such supposition. Its mode of irritation,
or the action of the parts affected is very different from what
happens in the chancre, gonorrhœa or bubo, being hardly at-
tended with inflammation, which in them is generally violent.
It might be supposed that a constitution truly and universal-
ly pocky, is not to be affected locally by the same species of
matter; but from the following experiments it would appear
that matter from a gonorrhœa or chancre is capable of affect-
ing a man locally that is already poxed; and that matter from
pocky sores, arising from the constitution, has not that power.
A man had been affected with the venereal disease a long
time, and had been several times salivated, but the disease still
broke out anew. He was taken into St. George's Hospital,
affected with a number of pocky sores; and before I put him
under a mercurial course, I made the following experiment:
I took some matter from one of the sores upon the point of a
lancet, and made three small wounds upon the back where the
skin was smooth and sound, deep enough to draw blood. I
made a wound similar to the other three, with a clean lancet,
the four wounds making a quadrangle; but all the wounds heal-
ed up and none of them ever appeared afterwards.
This experiment I have repeated more than once, and with
the same result. It shows that a pocky person cannot be af-
fected locally with the matter proceeding from the sores pro-
duced by the lues venerea. But to see how far real venereal
matter was capable of producing chancres on a pocky person,
I made the following experiment.
A man, who had venereal blotches on many parts of his
skin, was inoculated in sound parts with matter from a chan-
cre, and also with matter from his own sores. The wounds
inoculated with the matter from the chancres became chancres;
but the others healed up. Here then was a venereal constitu-
tion capable of being affected locally with fresh venereal mat-
ter. This experiment I have likewise repeated more than once,
and always with the same effect.
I ordered a person, at St. George's Hospital, to be inocu-
lated with the matter taken from a well marked venereal ulcer
on

OF THE LUES VENEREA. 269
on the tonsil, and also with matter from a gonorrhœa, which
produced the same effects as in the preceding experiment; that
is, the matter from a gonorrhœa produced a chancre, but that
from the tonsil had no effect.
A woman, aged twenty-five, came into St. George's Hos-
pital, August 21, 1782, with sores on her legs, and blotches
over her body. Her husband gave her the venereal disease,
December 1781. Her symptoms then were a discharge from
the vagina, and a small swelling of the glands of the groin,
which were painful. She had taken some pills, supposed to
be mercurial. February 1782, about three months after being
infected, the discharge stopped; but the swelling, which had
been gradually increasing ever since its first appearance, had
now suppurated. She applied some ointment to it which was
brought to her by her husband, and in two months it got well,
that is, in April 1782. After the bubo got well, a discharge
from the vagina came on, for which she took more of the
same pills she had taken before. After this time blotches came
out over her whole body; some about her legs, under her
arms, and upon her nipples, ulcerated.
Twins, which she brought forth at eight months, in March
1782, at the time the bubo was healing, had blotches upon
them at their birth, and died soon after.
Another girl, about two years old, whom she suckled, was
also covered with blotches when she came to the hospital.
To ascertain whether her secondary ulcers were infectious,
that is, whether the matter of them would have the specific ef-
fects of venereal matter, she was inoculated with some matter
from one of her own ulcers, and with some matter of a bubo
of another person where mercury had not been used. This
was done, September 18, 1782. September 19, the puncture,
where she was inoculated with her own matter, gave her pain
three hours from the time of inoculation, and the day follow-
ing inflamed a little. The other had not then inflamed at all.
September 20, both the punctures had suppurated and had
the appearance of a small-pox pustule; they spread considerably,
and were attended with much inflammation. That from her
own matter healed with common poultices, and ointments
without mercury; but the other, although treated in a similar
way, continued in the same state, attended with much pain
and inflammation.
September

270 OF THE LUES VENEREA.
September 22, the child was inoculated with some matter
from one of its own ulcers, and with some common pus. The
punctures both inflamed in a small degree, but neither of them
suppurated.
The mother and the child went into the ward appropriated
to salivation, October 21, 1782. The child took no mercury.
It was supposed that its gums became a little sore; and the
blotches got well.
During the time that the mother was using mercury, the
ulcer from inoculation began to get well, and all her venereal
symptoms disappeared. What shall we say to this case? Were
the blotches venereal? There was every leading circumstance
to make us think so; and our opinion was strengthened by the
method of cure. If they were venereal, my opinion that the
constitutional appearances of the disease do not produce matter
of the same species that produced them, is confirmed. If they
were not venereal, then we have no absolute rule by which to
judge in such cases.
It has been supposed and asserted from observation, that ul-
cers in the mouths of children from a constitutional disease,
which constitutional disease has been supposed to be derived
from the parent, have produced the same disease upon the nip-
ples of women who had been sucked by them; that is, the
children were contaminated either by their mothers or fathers
having the disease in form of a lues venerea, of which I have
endeavoured to show the impossibility. If, however, it were
possible to contaminate once in this way, it would be possible
to contaminate for ever.
How far the observations, upon which the before-mention-
ed opinion is founded, have been made with sufficient accuracy
to overturn those which I made with a view to ascertain the
truth, I know not. But, from a more accurate investigation
of some of those cases, which were by most of the faculty call-
ed venereal, they appeared evidently not to be such. To say
what they were, would lead us into the consideration of other
diseases. The following case may lessen our faith in the histo-
ries of such as have been supposed to be venereal.
Before I describe the case, I shall first mention some of the
circumstances leading to it.
A child was supposed to have infected its nurse with the ve-
nereal disease. The parents had been married about twelve
years,

OF THE LUES VENEREA. 271
years, when this child was born. The father was a very fond
husband, and the mother a mild and most affectionate woman.
The father had a venereal gonorrhœa two years before he mar-
ried, that is, fourteen years before the birth of the child. About
nine months after marriage they had a child, and afterwards a
second, both of which were extremely healthy at birth, and
still continue so. The mother fell into a weakly state of health
and miscarried of her third child at the end of five months.
The fourth child was born at seven months, but was puny,
weak, and had hardly any cuticle when born. It was imme-
diately after birth attacked with a violent dysentery. It died
in a few days and was opened by me. The whole skin was
almost one excoriated surface. The intestines were much in-
flamed and thickened.
With her fifth child, from great care, she went eight months,
and it was now hoped that she might go the full time, and also
that this child might be more healthy than the former. When
she was delivered, the child was very thin, but free from any
visible disease.
Some days after birth it became blistered in a vast number
of places on its body, which blisters were filled with a kind of
matter, and, when they broke, discharged a thinnish pus. The
inside of the mouth was in the same condition. Bark was given
to the nurse. Bark, in milk, was given to the child by the
mouth; and it was fomented with a decoction of bark; but,
in about three weeks after birth, it died.
Some weeks after the death of the child, the nurse's nipple,
and the ring around the nipple, inflamed, and sores or ulcers
were formed with a circumscribed base*. They were poulticed,
but without benefit. She also complained of a sore throat;
but the sensation, she complained of, was so low in the throat
that no disease could be seen. A swelling took place in the
glands of the arm-pit but they did not suppurate. She applied
to a physician, and according to the account which she gave,
he pronounced that her disease was venereal, and that she had
given suck to a foul child; and he ordered ten boxes of mer-
curial ointment to be rubbed in on her legs and thighs, eight
of which had been used, when I saw her; and then her mouth
was become extremely sore.
These
* She had but one breast that gave milk.

272 OF THE LUES VENEREA.
These circumstances came to the ears of the family, and an
alarm took place. The husband went from surgeon to surge-
on, and from physician to physician, to learn, if it was possible
for him to have the disease for fourteen years, and never to have
perceived a single symptom of it in all that time: or if it was
possible he could get children with the disease now, when the
two first were healthy. He also wanted to know, if it was pos-
sible for his wife to have caught the disease from him under
such circumstances; and also, if she could breed children with
this disease, although she herself never had a single symptom
of it. If we take all the above-mentioned circumstances as
facts, the conclusion is, that it was impossible there could be
any thing venereal in the case; but as they could not be ab-
solutely proved to be facts, there must remain a doubt in the
mind, a something still to be proved.
Now let us consider the result of the case. The nurse's
mouth was become extremely sore from the mercury when I
first saw her. I desired that Mr. Pott might see her along
with me; and it was the opinion of us both, that the sores
on the nipple, and around it, were not venereal; but it was
alledged, that, as she had taken mercury, their not having a ve-
nereal appearance now was owing to that cause. The bark was
given, as also the sarsaparilla, but the sores did not heal, nor
did they become worse; nor was the mouth better by leaving
off the mercury. I ordered the hemlock, but that appeared
to have no effect. In the mean time eruptions broke out on
the skin. The skin of the hands and fingers peeled off; the
nails of both fingers and toes separated; and sores formed
about their roots, which were all supposed (by many) to be
venereal. But some of them appearing, while the constitution
was full of mercury, and others disappearing without any fur-
ther use of that medicine, I judged that they were not venereal.
We suspected that her mode of living was such as contributed
greatly to the continuance of her first complaint, and gave rise
to the new ones; for she looked dejected and sallow. She was
desired to go into an hospital, which she did. As soon as
she got into a warm bed, and had good wholesome food, she
began to mend, and in about five or six weeks she had become
fat and almost well; the sore only about the root of the nail
of the great toe had not healed; but that appeared now to be
owing to the root of the nail being detached, therefore acting as
an

OF THE LUES VENEREA. 273
an extraneous body. She came out of the hospital before this
toe had got well; and, returning to her old poor mode of liv-
ing, she had a return of the soreness in the mouth; however,
she mended at last without the use of more mercury.
This case I shall further consider when on diseases resem-
bling the venereal.
The following case will further prove that we often suspect
complaints to be venereal when they really are not.
A gentleman had for some time blotches on his skin. The
face, arms, legs and thighs, were in many places covered with
them; and they were in their different stages of violence. In
this situation he applied to me; and I must own they had a
very suspicious appearance. I asked him what he supposed
these blotches were? he said he supposed them to be venereal.
I asked him when he had a recent venereal complaint? he told
me not for above twelve months. I then asked him how long
he had had the blotches? and the answer was, above six
months. As this was a sufficient time for making observations
upon them that might ascertain better than the mere appear-
ance what they were, I asked him if any of the blotches, that
came first, had disappeared in that time? and he said many; I
desired to see where those had been; and on examination I
found only a discoloured skin, common to the healing of su-
perficial sores. I then declared to him that they were not ve-
nereal, for if they had arisen from that source, none of them
would have disappeared. He now informed me that he had
been taking mercury; and this information obliged me to have
recourse to further inquiries; and I therefore asked him, whe-
ther, while he was taking mercury, many of the first got well?
the answer was, yes. And was the cure of those imputed to
the mercury? The answer was again in the affirmative. I
then asked him, if, while he was taking the mercury, which
appeared to have cured some, those, that now remained, arose?
Yes. My next question was, how long had he taken mercu-
ry? He said, for six months. I then declared they were not,
nor ever had been venereal. I asked him, what was now the
opinion of his surgeon? He said, that his opinion still was,
that they were venereal, and that he should go on with the
mercury. I advised him to take no medicines whatever; to
live well, avoiding excess, and to come to me in three weeks;
which he did, and then he was perfectly well, only the skin
N n was

274 OF THE LUES VENEREA.
was stained where the blotches had been. He now asked me,
what he was next to do? I told him he might go to the sea
and bathe for a month. This he did, and returned well and
healthy, and has continued so.
III. OF THE LOCAL EFFECTS ARISING FROM
THE CONSTITUTION CONSIDERED AS
CRITICAL — SYMPTOMATIC FEVER.
HOW far the eruptions or local effects of this disease, arising
from the constitution, are an effort of Nature to clear herself
of this disease, is not certain. I observed, that a gonorrhœa
might be produced by a general law in the animal œconomy,
by which it endeavours to relieve itself of the irritation by pro-
ducing a discharge; and that in chancres a breach is made in
the solids for the same purpose, although this purpose is not an-
swered in either; Nature not having a provision against this
poison. But how far a similar attempt takes place in a lues
venerea, I do not know; and if it was upon the same princi-
ple, the same reason might be expected to be given, why the
constitution is not capable of relieving itself in the present in-
stance that I gave, when treating of the primary affections, be-
cause in this as it was in the other, the matter formed might
be supposed to be venereal; and therefore by being absorbed by
the very surface which produced it as in a chancre, it might
keep up the constitutional disease. If this were really the case,
it would be very different from many other specific diseases;
for the reason why many specific diseases cure themselves, is that
the irritation cannot last beyond a stated time; and also that
in many, the patient is never susceptible of the same disease a
second time, as in the small-pox. If this was not the case, a
person once having the small-pox, would always have them;
for according to one supposition, that absorption of its own
pus keeps up the disease; and according to another, that the
irritation never wears itself out, the patient would either never
be free, or have them repeated for ever; for his own matter
would give the disease a second time, a third time, and so on*.
But the venereal matter, when taken into the constitution,
produces
* This circumstance alone is a strong proof that people cannot have the small-pox twice,
at least at any distance of time between, if they had fair eruptions the first time; for if
the constitution was not so altered as not to be susceptible of this irritation a second time,
a person would have them immediately upon the going off of the first.              

OF THE LUES VENEREA. 275
produces an irritation which is capable of being continued in-
dependent of a continuance of absorption; and the constituti-
on has no power of relief, therefore a lues venerea continues
to increase. This circumstance is perhaps one of the best dis-
tinguishing marks of the lues venerea, for in its ulcers and
blotches it is often imitated by other diseases, which not hav-
ing this property will therefore heal and break out again in
some other part. Diseases in which this happens, show them-
selves not to be venereal; however, we are not to conclude,
because they do not heal of themselves and give way only to
mercury, that therefore they are venereal, although this cir-
cumstance, joined to others, gives a strong suspicion of their
being such.
When the parts are contaminated by the venereal poison,
we commonly find fever, restlessness, or want of sleep, and
often headach; but I believe that these symptoms are rather
peculiar to the disease, when the second order of parts, the
periosteum and bones, are affected, although they are sometimes
sound of the first. Do these symptoms arise from the local ir-
ritations affecting the constitution? And are they merely sym-
pathetic? Whatever the immediate cause may be, they never
go off till the local irritations are removed. This fever at first
has much the appearance of the rheumatic fever; and after a
time it partakes a good deal of the nature of the hectic.
These symptoms often take place independent of, or unat-
tended by, any local action; and when that is the case it be-
comes very uncertain what the disease is; for in cases, not ad-
mitting of clear proof, we must rest on the concurrence of cir-
cumstances. Many of these symptoms give way to mercury.
This is probably the only concurring circumstance attending
this complaint that is any proof of its being venereal*. It ra-
ther, however, appears to militate against this idea, that, for
the most part, a [muc]h smaller quantity is sufficient for the cure
of such symptoms than what is necessary for the cure of local
complaints. But, if mercury always cured them, it would
not be very material what they are called. It is worthy of
consideration, however, how far the venereal poison, when in
the constitution, does or does not always produce local effects.
That it in general does, we are certain; but whether it is ever
a cause
* Here it is to be understood, that the circumstance of a previous gonorrhœa or chan-
cre is not to be considered as strong evidence. 

276 OF THE LUES VENEREA.
a cause of constitutional symptoms, simply, such as loss of
appetite, wasting, debility, want of sleep, and fever, at last
becoming hectic, is uncertain; and it is also uncertain, whether
it is ever capable of producing local actions from irritations on-
ly without an alteration of the structure of the parts irritated,
as cough, secretion from the lungs, purging, headach, sick-
ness, pains in different parts of the body, like rheumatic pains,
but not from an alteration of the structure of the part taking
place, as beginning nodes. If such effects take place, we must
in such a case rely entirely on the history of the disease, and
pronounce according to probability. Such complaints come
oftener under the management of the physician than the surge-
on, to whom I would recommend a particular attention to this.
The fever in consequence of the venereal irritation, like
most other fevers, deranges the constitution, which thereupon
suffers agreeably to its natural tendency. It is capable of pro-
ducing glandular swellings in many parts of the body, and pro-
bably many of the nodes that arise in the time of this fever,
may proceed from the fever, and similar to every such effect,
from whatever cause, it does not partake of the disease which
produced it, for it is not venereal: it only takes place in con-
stitutions very susceptible of such action where the predisposing
cause is strong, and probably at seasons most fitted to produce
it, only waiting the immediate cause to put them into action,
such will and do go away of themselves when the predisposing
cause ceases, such as season.
IV. OF THE LOCAL AND CONSTITUTIONAL
FORMS OF THE DISEASE NEVER INTER-
FERING WITH ONE ANOTHER.
I OBSERVED, when treating of the gonorrhœa and chan-
cre, that, when occuring in the same person, the one neither
increases the symptoms, nor retards the cure of the other.
And it may also be observed, that the chancre or gonorrhœa,
and the constitutional form of the disease, meeting in the same
person, do not interfere with each other, either in their symp-
toms or cure.
To explain these effects more fully, let me observe, that if
a man has a gonorrhœa, and a chancre appears some days af-
ter, the chancre does not either increase or diminish the gonor-
rhœa.              

OF THE LUES VENEREA. 277
rhœa. Again, if a man has either a gonorrhœa, a chancre,
or both, and a lues venerea ensue in consequence of either of
these, neither the gonorrhœa nor chancre is affected by it. If
a man has a lues venerea and gets either a gonorrhœa, or chan-
cre, or both, neither of them affects the lues venerea, nor are
their symptoms the worse. Nor is the cure of either, singly,
retarded by the presence of the other; for a gonorrhœa is as
easily cured when there are chancres, as when there are none,
even although the chancres are not attempted to be cured; and
a chancre may be cured locally independent of the gonorrhœa.
Further, a gonorrhœa, chancre, or both, may be as easily
cured, when the constitution is poxed either by them, or pre-
vious to their appearance, as when the person is in perfect
health; but the chancre has this advantage, that the constitu-
tion cannot be cured without its end being likewise cured.
The gonorrhœa and chancre indeed so far influence one ano-
ther, as the one can be in some degree a cause of prevention
of the other, as has been already observed; but I believe that
this circumstance does not affist in the cure of either: yet I
could conceive it might, each acting as a derivator to the other,
without increasing its own specific mode of action.
V. OF THE SUPPOSED TERMINATION OF THE
LUES VENEREA IN OTHER DISEASES.
THIS disease seldom or ever interferes with other disorders,
or runs into, or terminates in any other, although it has been
very much accused of doing so; for, a termination of one dis-
ease in another, as I understand the expression, must always
be a cure of the one terminated; but the venereal disease ne-
ver terminates till the proper remedy is applied, and therefore
never can run into any other disease.
That venereal complaints may be the cause of others, I think
is very probable. I have seen a chancre the immediate cause
of an erisypelatous inflammation; but the venereal malady did
not terminate in the erisypelatous inflammation; for if it had,
the chancre would have been cured; nor was the erisypelatous
inflammation venereal; the chancre only acted here as a com-
mon irritator, independently of the specific quality of the dis-
ease as a cause. I have known a venereal bubo become a scro-
fulous sore as soon as the venereal poison was destroyed by mer-
cury;

278 OF THE LUES VENEREA.
cury; this was not a venereal terminating in a scrofulous affec-
tion; for in such a view the scrofula must have cured the vene-
real. The venereal disease would seem only to partake of the
nature of such disorders as the constitution was previously dis-
posed to, and may excite into action the causes of these disor-
ders. The same observation and mode of reasoning holds equal-
ly good with respect to other diseases. The common symp-
toms, however, of the lues venerea, though in some degree
according to the constitution, are not so much so as either in
the chancre, or the gonorrhœa; for the lues venerea is attend-
ed with very little inflammation, which in general partakes
much more of the nature of the constitution than any other
diseased action.
VI. OF THE SPECIFIC DISTANCE OF THE VE-
NEREAL INFLAMMATION.
I HAVE already observed, that many specific diseases, as al-
so those arising from poison, having their local effects confin-
ed to certain distances, which I have called their local specific
distance; and it would appear from observation, that the ve-
nereal irritation and inflammation, of whatever kind it may be,
is guided by this principle; for it seldom extends far beyond
the surface that receives it; the neighbouring part not having
a tendency to sympathise, or run easily into this kind of in-
flammation. This is the reason why we find a gonorrhœa for
weeks confined to one spot in the urethra in men, and for
months to the vagina in women, not extending further in ei-
ther. In chancres also the inflammation is confined to the seat
of the sore without becoming so diffused as when from common
accidents. As a further proof of this fact, we find it is also
confined to the glands of the groin, in cases of buboes, till
matter is formed in them; which matter acts as a common ir-
ritator, and the specific is in some degree lost, and then the
inflammation becomes somewhat more diffused, as happens in
common inflammation. We also see that the same thing hap-
pens in venereal ulcers when they arise from the constitution;
their size is at first but small, and they are merely local; but
as the disease increases, the size increases, but still they remain
circumscribed, not becoming diffused. Perhaps all poisons and
specific diseases agree in this property of having their inflam-
mation

OF THE LUES VENEREA. 279
mation limited and circumscribed in a manner peculiar to them-
selves; for we find that the inflammation of the small-pox,
measles and chicken-pox, is each circumscribed in its own way.
From hence it must appear, that the human body in general is
not so susceptible of specific irritations as it is of the common,
or what may be called the natural. But we must also consider,
that the common inflammation in very healthy constitutions
has its specific distance, although not so determined or circum-
scribed as is that of the specific in such constitutions; there-
fore we may reasonably suppose, that such healthy constitutions
are the furthest in disposition from the inflammatory action;
and we may also suppose still more so from the specific. What
would appear to strengthen this idea is, that when the consti-
tution is such as readily goes into inflammation, the more readi-
ly does the inflammation spread, every part being susceptible
of such action; and we find that in many the specific also spreads,
although not in so great a degree, from which we may suppose
that the specific is always a more confined mode of action. I
have suspected that when the body was disposed to increase the
inflammation beyond the specific distance, it was of the erisy-
pelatous kind, as was mentioned before, and which is to be
attended to in the cure.
VII. OF THE PARTS MOST SUSCEPTIBLE OF THE
LUES VENEREA — OF THE TIME AND MANNER
IN WHICH THEY ARE AFFECTED — WHAT IS
MEANT BY CONTAMINATION, DISPOSITION
AND ACTION — SUMMARY OF THE DOCTRINE.
WHEN I assigned the causes for so great a difference in the
effects of the same poison upon two different surfaces, as form-
ing the gonorrhœa and chancre, I then said I did not know
whether similar surfaces in every part of the body were equal-
ly susceptible of this irritation, having but few comparative
trials of the direct application of the poison to other parts be-
sides those of generation. But it would appear that some parts
of the body are much less susceptible of the lues venerea than
others; and not only so, but many parts, so far as we know,
are not susceptible of it at all. For we have not yet had every
part of the body affected; we have not seen the brain affected,
the heart, stomach, liver, kidneys, nor other viscera; although
such

280 OF THE LUES VENEREA.
such cases are described in authors. But as there are different
orders of parts respecting the times of the disease appearing,
and as the person commonly flies to relief upon the first or
second appearances, it may be supposed that the whole disease
in the parts actually affected is cured before the other parts have
had time to come into action, which will therefore be cured
under the state of a disposition only, if we can conceive that a
cure can take place before parts have come into action. But
if the parts visibly affected are cured, while those only disposed
are not, and afterwards come into action, they would form a
second order respecting time; and if these again are cured, and
other parts under a disposition should come into action, such
would form a third order of parts respecting time. The lungs
have been believed to have been affected with the venereal dis-
ease, both from the circumstances preceding the complaint,
and from the complaint itself being cured by mercury; and
their being affected when the other viscera are not, may arise
from their being in some degree an external surface, as will
be explained hereafter.
It is this form of the disease therefore that gives us the com-
parative susceptibility of parts both for disposition and action.
For we must suppose that all parts are equally and at once ex-
posed to the action of the poison; but though there may be
various degrees of susceptibility, it will be sufficient for prac-
tice to divide them into two, under the following appellations
of first in order, and second in order, to which we may add
the intermediate.
Whether the parts that are really first affected are naturally
more easily affected by this kind of irritation, or that some
other circumstance which belongs to these parts is the cause,
cannot be absolutely determined; but from the matter atten-
tively considered, it would appear to be owing to something
foreign to the constitution, and also not depending on the na-
ture of the parts themselves; for if we take a view of all the
parts, that are first affected by this disease, when arising from
the constitution, which I shall suppose are the parts most sus-
ceptible of it, we shall see that in the recent state of the disease
these parts are subject to one general affection, while there are
similar parts of the body not affected by this disease, and not
subject to this general affection. Probably the parts second in
order may naturally be as susceptible of the irritation as those
first

OF THE LUES VENEREA. 281
first in order; but not being under the influence of an irritat-
ing cause, they are later in coming into action; and there are
also probably other causes in the nature of the parts themselves,
such as being indolent in all their actions, and of course indo-
lent in this, therefore later in coming into action. However,
it is not universally the case that the parts which I have called
first in order are always so; on the contrary, we find that this
order is inverted in some cases, although but rarely. We
cannot suppose that this difference arises from any active power
in the poison, nor any particular direction of it, but from pro-
perties in the parts themselves; for it may be allowed us to
suppose, that when this matter has got into the circulation, it
acts on all parts of the body with equal force; that is, it is not
determined to any one part more than another by any general
or particular power in the animal machine; nor is the nature
of the poison such as will fall more readily on one part of the
body than another, when they are all in similar circumstances.
That some parts therefore are more readily affected by it than
others, owing to circumstances which are no part of the ani-
mal principle, nor of the poison; and also that some parts of
the body have a greater tendency to be irritated by it than
others, must be allowed.
The parts that are affected by this form of the disease when
in its early stage or appearance, which I have called first in or-
der, are the skin, tonsils, nose, throat, inside of the mouth,
and sometimes the tongue*. When in its later state, the pe-
riosteum, fasciæ, and bones, come into action, and these I call
second in order of parts. Perhaps the bones come into action
from the membrane being affected.
That we may be able to account in some measure for these
similar effects as to time in dissimilar parts, such as the skin and
the tonsils, two very different kinds of parts, let us consider
in what circumstance they agree, and why they are more sus-
ceptible of this irritation than those parts that probably are
naturally as much so, although they do not receive it so rea-
dily, such as the periosteum, fasciæ, and bones.
O o The
* The tongue is very subject to have ulcers formed on it, especially on its edge.
They are seldom very large, nor are they often either very foul or have a hard basis:
these are commonly supposed to be venereal; but I believe they seldom are. I do not
know whether I am, or not, acquainted with the distinguishing marks. I never saw
but one that I suspected to be either venereal or cancerous from its foul look and its hard
basis. It gave way readily to mercury, therefore I supposed it to be venereal.

282 OF THE LUES VENEREA.
The most remarkable circumstance, perhaps, to which the
external surface is exposed, and to which the internal is not,
is cold, or a succession of different degrees of cold. For we
may observe in general, that the atmosphere in which we live
is colder than the human body* in its usual temperature, there-
fore the skin, &c. is continually exposed to a cold greater than
what the internal parts are; and we find that all those parts
which are most exposed to this, admit of being much more ea-
sily affected, or come more readily into action in this disease
than the others.
It is certain that cold has very powerful effects on the ani-
mal œconomy. It would at least appear to have great powers
of disposing the body for receiving the venereal irritation, and
going readily on with it.
From this idea we may account for several circumstances
respecting this disease, as the mouth, nose, and skin, being the
most frequently affected, because they are rendered most sus-
ceptible of it from the causes before-mentioned, and for the
same reason come very readily into action. If this be a true
solution, it also accounts for those second in order being af-
fected; for if the poison has contaminated parts which are
both first in order of susceptibility and time of coming into ac-
tion, it is natural to suppose that those parts which are most
predisposed, as the external surfaces, shall come first into ac-
tion; the parts exposed to cold, in the next degree, forming
the second in order, come next into action, such as bones, pe-
riosteum, &c. but even in them it is not in every bone alike,
or every part alike in any one bone; for it appears first in those
that are in some measure within the power of being affected by
sympathy from application of cold to the skin: we find that
when the deeper seated parts, or the parts second in order come
into action, such as the periosteum or bones, it is first in these
that are nearest the external surface of the body, such as the pe-
riosteum or bones of the head, the tibia, ulna, bones of the nose,
&c. nor does it affect these bones on all sides equally, but first on
that side next the external surface. However, it would appear that
in the bones there is another cause, besides the vicissitudes of wea-
ther, why this disease should attack them; for the periosteum of
bones, or bones themselves, are not liable to be diseased on all
parts
* It is to be understood, that this cannot hold good as an universal principle it can
only take place in the temperate and frigid zone; for in the torrid the heat of the sur-
rounding atmosphere is sometimes greater than that of the human body,

OF THE LUES VENEREA. 283
parts in proportion to the distance from the skin, the periosteum
which covers the ancles, or many of the joints being as near
the external surface as many other parts of the periosteum or
bones that are affected. The nature of the bones themselves,
which are covered by that periosteum, are somewhat different;
they are softer in their texture, therefore they would seem to
be affected in proportion to their nearness to the skin and hard-
ness of the bones jointly; which would incline us to believe,
that the bones are more easily affected, and rather have some in-
fluence upon the periosteum in this disease, than the periosteum
upon them; and this susceptibility in the hard bones would ap-
pear to be in proportion to their quantity of earth and exposure
to cold combined.
It may be objected to this theory, that the fore-part of the
tibia, &c. cannot be really colder than the back-part; but
then it may be supposed, that it is not necessary that the part
should be actually cold, but only within the power of sympathy.
For a part that is not actually cold is capable of being affected
from its sympathising with a cold part in the same manner as
if actually cold; although perhaps not in so great a degree, and
therefore requires a longer time to come into action than if it
were actually cold. We find, for example, that when the skin
is actually cold, the muscles underneath are thrown into alter-
nate action, so that we tremble, or our teeth chatter with cold,
and yet it is possible that these muscles may not be colder at
this time than any other; although it is most probable that they
are really colder*, which will assist the power of sympathy.
So far as cold can affect the actions of parts, so far also will
the sympathising part be affected in proportion as it is nearer to
the parts actually cold; therefore the deeper seated parts in the
venereal disease are later in coming into action.
The actual cold parts come first into action, then those that
are less so, and next those that are nearest in sympathy, and
so on, except the parts first in order of susceptibility have been
only partially cured, and then their recurrence may correspond
with the action of those that are second in order of suscepti-
bility, and all the parts will come into action together. What
would seem to strengthen this opinion is, the different effects
that arise from different climates: in warm climates the dis-
ease seldom or ever arises to such a height as in cold climates;
it
* See Philosophical Transactions, vol. 68, part I, page 7.

284 OF THE LUES VENEREA.
it is more slow in its progress, and much more easy to cure,
at least if we may give credit to the accounts we have receiv-
ed of the disease in such climates.
Whether the difference in the time of appearance between
the superficial and deeper seated parts in warm climates is the
same as in cold ones, I do not know; but from the above theory
it should not be so great in the warm as in the cold climates.
Besides the causes already mentioned, it would appear that
there are others by which the lues venerea may be brought
sooner into action than it otherways would be if left entirely
to the nature of the constitution; for I think I have seen cases
where fever has brought it into action when the disposition
had been previously formed. Like most other diseases to which
there is a susceptibility or disposition, we find that any distur-
bance in the constitution shall call it forth: scrofula, gout, and
rheumatism are often called forth in this way.
Having said that the deeper seated parts of the body come
into action later than those that are superficial, I shall now ob-
serve, that when the lues venerea has been cured so far as on-
ly to remove the first actions, but not to eradicate the disposi-
tion in the deeper seated parts, as has been explained, under
such circumstances of the disease it never attacks again the ex-
ternal, or the parts that were first affected, but only the deep-
er seated parts which are second in order of time. The reason
is, that the deeper seated parts had not been affected at the
time of the cure of the first. The following cases, selected
from a great number of similar ones, will illustrate the doc-
trines we have laid down.
In January 1781, A. B. had connection with a woman, and
two days after perceived an itching in the glans: at the end
of four days he found chancres upon the prepuce. He took
about twenty grains of calomel, and then applied to a surgeon,
under whose care he remained three months, that is till April.
He thought himself nearly well, and went into the country,
taking a few pills with him, and at the end of another month
believed himself perfectly cured. Three months after, that is in
August, he caught cold, and had considerable fever, for which
James's powders were given. Soon after this spots of a cop-
per colour appeared upon his legs and he had violent pains in
his shin bones. By the order of a country surgeon, he rub-
bed in about an ounce of mercurial ointment, and had a slight
spitting;

OF THE LUES VENEREA. 285.
spitting; the pain ceased, the spots disappeared, and in a month
he again conceived himself to be well. This was in October
1781. In June 1782, he had the influenza: about a fortnight
afterwards his left eye inflamed, and he had a pain in his head,
and a noise in his ears. Five days afterwards his throat became
sore. Three weeks after the inflammation of his eye, several
pustules made their appearance near the anus. These symp-
toms remained till the 21st of August, when he came into St.
George's Hospital. He rubbed in strong mercurial ointment
till his mouth became sore; he sweated very much; the pain
in his head remained, but the complaint in his eye, and about
the anus, together with the sore throat, were totally removed.
It appears that, in this case some additional power was re-
quired to dispose the body more readily to exhibit venereal
symptoms. That cold has a strong power of this kind we have
allowed, which appears in this case to have been the first im-
mediate cause; but a fever seems to have been equally effectu-
al in producing the second return of the symptoms.
Here was the venereal disposition in the constitution from
April 1781, the time he was cured of the local complaint, till
June 1782, fourteen months after; and then it reappeared ele-
ven months after that, which periods might have been longer,
if it had not been called forth by the two circumstances of cold
and fever.
Let us consider how far this case corresponds with the opi-
nion of the action being easier of cure than the disposition.
The first aftion, that is, the chancres, were perfectly cured by
the quantity of mercury he took at first, for they never recur-
red; but the venereal matter had produced the disposition in
the constitution, which was not cured by the same quantity of
mercury, for blotches appeared three months after; but all the
parts that had taken on the disposition at that time had not
then come into action; therefore only the parts which had come
into action were cured by the second cource of mercury; and
the other parts which had not yet taken on the action, went
on with the disposition till the influenza (which happened ele-
ven months after) brought them into action. The first class of
pocky appearances were perfectly cured by the second course of
mercury, as the local had been cured by the first; for they ne-
ver reappeared, not even with the second. The second set of
pocky symptoms, we have observed, appeared to be perfectly
cured

286 OF THE LUES VENEREA.
cured by the third course of mercury. How far there may be
a third set of pocky symptoms to come forth, time can only
tell.
This case further proves that sometimes the second set of
symptoms appear first, and the first second; and also shews the
difference in times between the first pocky appearances after
the healing of the local, and between the second appearance of
the symptoms after the healing of the first.
A gentleman had a chancre in May 1781: in the same
month next year, 1782, he had a gonorrhœa; and, in May
1783, he had a sore throat. He had no connection with any
woman from September 1782, till May 1783, which was about
a fortnight before his throat became sore, and had had no im-
mediate local complaints.
When I saw the throat first, I said it was not venereal;
and he being rather of an hectic habit, was desired to go to
Bristol. When at Brislol, an ulcer appeared at the root of
the uvula, which made him immediately come back to London.
When I saw this ulcer I said it was venereal. He now went
through what I supposed was a sufficient course of mercury,
and all the venereal symptoms appeared to be cured*. He
went into the country about the month of August; and about
the beginning of January 1784, viz. four months after the sup-
posed cure, he felt a pain, together with a swelling, in his shin
bones, for which he went through a course of mercury which
removed both the pain and the swelling.
In this case we have every reason to suppose that the dispo-
sition had taken place in the bones, or their coverings, from
the same cause that affected the uvula; but the uvula suffered
first, being of the first order of parts. Whether this was really
the case or not, we must allow that in the parts second in or-
der, the disposition, and not the action, did exist at the time
when the disease in the uvula came into action, as also at the
time when he went through a course of mercury sufficient to
cure the uvula; we must also allow that the disposition was not
removed by the quantity of mercury which was capable of re-
moving the disease in the uvula. From all which I would draw
the following inferences in confirmation of the preceding doc-
trine;
* I may remark here, that only the venereal ulcer got well by the mercury, for the
former excoriation of the throat continued, but was afterwards cured by bark and sarsa-
parilla.

OF THE LUES VENEREA. 287
trine: first, that the parts about the throat are capable of as-
suming the action sooner than the bones. Secondly, it is pro-
bable that mercury can cure the action only, and not the dis-
position; and thirdly, that the venereal pus is not present in
the circulation while the secondary actions take place; for if
it were, the parts first in order would stand an equal chance of
being again contaminated, and of coming into action a second
time; supposing the venereal matter still to exist in the con-
stitution after the parts first thrown into action are absolutely
cured. So as to contaminate the parts that are second in order
of action, we should certainly have the parts first in order take
on the disease a second and even a third time, and so on, while
the second or third in order would be going on and only coming
into their first action; and therefore we might have those that
are first in order, and those that are second in order, in action
at the same time. This might be carried still further, for as
it is possible for the parts first in order of susceptibility to have
the disease a second time, while the parts second in order are
under the influence of the first infection, those first in order
may be contaminated a second time from a new or fresh infec-
tion; which would be a lues venerea upon a lues venerea, a
case which certainly may happen. If the matter does really
continue in the constitution, it would be natural to suppose that
the parts most easily affected by it would remain so long as the
poison remained. It may indeed be alledged, that parts which
have already been accustomed to this irritation and cured, are
rendered by that means less susceptible of it.
If the poison were still capable of circulating after its visible
effects were cured, then mercury given in the time of a chan-
cre can be of little service, as it can only assist in the cure of
the chancre, but cannot preserve the constitution from infec-
tion, which does not agree with experience; for practice in-
forms us, that not one in fifty would escape the lues venerea if
the chancre were only cured locally; so that mercury has the
power of preventing a disposition from forming, and therefore
is necessary to be given while we suppose absorption going on,
or while there is matter that may be absorbed.
Mercury, prior to the action, will not remove the dispositi-
on, and of course will not hinder the action coming on after-
wards; however, it is possible, and most probable, that the
medicine while it is present will hinder the action taking place;
so

288 OF THE LUES VENEREA.
so that no venereal complaints will take place under the course
of mercury, although the parts may be contaminated.
This is not peculiar to the venereal disease, but common to
many others, and in some it may be reversed, for there are
diseases whose disposition can be cured, and therefore the ac-
tion prevented by such medicines as would rather increase the
action if given in the time of it.
The parts first affected are more easily cured, according to
our present method, than the parts second in order. A part
once perfectly cured is never irritated again by the same stock
of infection, though probably some other parts in the consti-
tution are still under the venereal irritation. If the facts stated
be just, the circumstance of the disease appearing to leave the
parts first attacked, and attacking the secondary parts, is easily
accounted for. It is no more than the first parts being cured
while the secondary are not, and of course going on with the
disease, the first remaining well.
If this mode of accounting for these circumstances be just,
it proves two things; first, a former assertion, that this disease,
in the form of lues venerea, has not the power of contaminat-
ing parts, not already under its influence, even in the same con-
stitution; secondly, that the venereal poison is not circulating
in the blood all the time the disease is going on in the constitu-
tion; so that most probably the poison only irritates when just
absorbed, and is soon expelled or thrown out in some of the
secretions.
The above account of the lues venerea may be reduced to
the following heads.
First, that most parts, if not all, that are affected in the lues
venerea, are affected with the venereal irritation at the same
time.
Secondly, the parts exposed to cold are the first that admit
the venereal action; then the deeper seated parts, according
to their susceptibility for such action.
Thirdly, the venereal disposition, when once formed in a
part, must necessarily go on to form the venereal action.
Fourthly, that all parts of the body, under such disposition,
do not run into action equally fast, some requiring six or eight
weeks, others as many months.
Fifthly,

OF THE LUES VENEREA. 289
Fifthly, in the parts, that come first into action, the disease
goes on increasing without wearing itself out, while those that
are second in time follow the same course.
Sixthly, mercury hinders a disposition from forming, or in
other words, prevents contamination.
Seventhly, mercury does not destroy a disposition already
formed.
Eighthly, mercury hinders the action from taking place al-
though the disposition be formed.
Ninthly, mercury cures the action.
These principles being established, the facts respecting the
cure are easily accounted for.
CHAPTER II.
OF THE SYMPTOMS OF THE LUES
VENEREA.
WHEN the venereal matter has affected the constitution
in any of the ways before-mentioned, it has the whole
body to work upon, and shows itself in a variety of shapes;
many of which putting on the appearance of a different disease,
we are often obliged to have recourse to the preceding history
of the case before we can form any judgment of it. Probably
the varieties in the appearances may be referred to the three
following circumstances; the different kinds of constitutions;
the different kinds of solids affected; and the different dispo-
sitions which the solids are in at the time: for I can easily
conceive, that a peculiarity of constitution may make a very
material difference in the appearance of the same specific com-
plaint; and I am certain, that the solids, according to their
different natures, produce a very different appearance when at-
tacked with this disease; and I can also easily conceive, that a
different disposition, from the common, in the solids at the
time, may make a considerable difference in the appearances.
The difference of the constitution, and of the same parts at
different times, may have considerable effects in the disease
P p with

290 OF THE LUES VENEREA.
with respect to its appearing sooner, or later. This I am cer-
tain of, that the different parts of the body produce a very
considerable difference in the times of appearance of this
disease. That it appears much sooner in some parts than
in others, is best seen where different parts are affected in
the same person; for I have already endeavoured to show that
it is most probable all the parts affected are contaminated near-
ly at the same time. This difference in the times is either ow-
ing to some parts being naturally put into action more easily
by the poison than others, or they are naturally more active
in themselves, and therefore probably will admit more quickly
the action of every disease that is capable of affecting them.
When on the general history of the lues venerea, I divided
the parts into two orders, according to the time of their ap-
pearance; I also observed that the first were commonly the
external parts, as the skin, nose, tonsils; and that the second
were more internal, as the bones, periosteum, fasciæ, and
tendons.
The time, necessary for its appearance, or for producing its
local effects in the several parts of the body, most readily affected,
after it has got into the constitution, is uncertain; but in general
it is about six weeks; in many cases, however, it is much later,
and in others much sooner. In some cases it appears to pro-
duce its local effects within a fortnight after the possibility of
the absorption of the matter. In one case a gentleman had a
chancre, and a swelling in the groin came on, and within the
before-mentioned time he had venereal eruptions all over the
body. He could not impute this to any former complaint, yet
there is a possibility of its having arisen from the first mode of
catching the disease, by simple contact, at the time he got the
local or chancre, which might extend the time to a week or
more, although this is not probable. In another case, three
weeks after the healing of a chancre, eruptions broke out all
over the body, and this happened only a fortnight after leaving
off the course of mercury that cured the chancre. The effects
on other parts of the body, that are less susceptible of this irri-
tation, or are slower in their action, are of course much later
in appearing; and in those cases where both orders of parts are
contaminated, it is in general not till after the first has made its
appearance for a considerable time, and even perhaps after it
has been cured; for while the parts first in order of action were
contaminated

OF THE LUES VENEREA. 291
contaminated and under cure, the second in order are only in
a state of contamination, and go on with the disease afterwards,
although it may never again appear in the first.
From this circumstance of the parts, second in order, com-
ing later into action, we can plainly see the reason why it shall
appear in them, although the first in order may have been cur-
ed; for if the external parts, or first in order, have been cured,
and the internal, or second, such as the tendons, bones, peri-
osteum, &c. have not been cured, then it becomes confined
solely to these parts. The order of parts may sometimes be in-
verted; for I have seen cases where the periosteum, or bone,
was affected prior to any other part; whether in the same case
it might in the end have affected the skin, or throat, I will not
pretend to say, as it was not allowed to go on; but it is possible
that the second order of parts may be affected without the first
having ever been contaminated.
Its effects on the deeper seated parts are not like those pro-
duced in the external, and the difference is so remarkable as to
give the appearance of another disease; and a person accustom-
ed to see it in the first parts only, would be entirely at a loss
about the second.
The parts which come first into action go on with it, pro-
bably on the same principle, much quicker than the others;
and this arises from the nature of the parts, as has already been
observed.
Each succeeding part, that becomes affected, is slower and
slower in its progress, and more fixed in its symptoms when
produced; this arises also from the natural disposition of such
parts, all their actions being slow, which indolent action may
be assisted by the absence of the great disposing cause, that is
cold. I should, however, suspect that warmth did not contri-
bute much to their indolence of action, for if it did, it would
assist in the cure, which it appears not to do, these parts being
as slow in their operations of restoration as they are in their
actions of disease. We may also observe, that similar parts
come sooner into action, and appear to go on more rapidly
with it, as they are nearer the source of the circulation. It ap-
pears earlier on the face, head, shoulders, and breast, than on
the legs, and the eruptions come sooner to suppuration in the
before-mentioned parts*.
The
* See Introduction.

492 OF THE LUES VENEREA.
The circumstance of its being very late in appearing in some
parts, when it had been only cured in its first appearances, as
mentioned, has made many suppose that the poison lurked some-
where in the solids; and others, that it kept circulating in the
blood for years.
It is not, however, easy to determine this point; but there
can be no good reason for the first hypothesis, as the lurking
disposition never takes place prior to its first appearance; for
instance, we never find that a man had a chancre a twelve-
month ago, and that it broke out after in venereal scurfs upon
the skin, or ulcers in the throat. The slowness of its pro-
gress is only when the parts, less susceptible of its irritation,
have been affected by it.
I. OF THE SYMPTOMS OF THE FIRST STAGE
OF THE LUES VENEREA.
THE first symptoms of the disease, after absorption, appear
either on the skin, throat, or mouth. These differ from one
another according to the nature of the parts affected. I shall
therefore divide them into two kinds, although there appears
to be no difference in the nature of the disease itself.
The appearance on the skin I shall call the first, although
it is not always the first appearance; for that in the throat is
often as early a symptom as any. The appearances upon the
skin generally show themselves in every part of the body, no
part being more susceptible than another, first in discoloura-
tions, making the skin appear mottled, many of them disap-
pearing, whilst others continue, and increase with the disease*.
In others it will come on in distinct blotches, often not ob-
served till scurfs are forming; at other times they appear in
small distinct inflammations, containing matter and resembling
pimples, but not so pyramidal, nor so red at the base.
Venereal blotches, at their first coming out, are often at-
tended with inflammation, which gives them a degree of trans-
parency, which I think is generally greater in the summer,
than in the winter, especially if the patient be kept warm. In
a little time this inflammation disappears, and the cuticle peels
off in the form of a scurf. This sometimes misleads the patient,
and the surgeon, who look upon this dying away of the inflam-
mation
* This is not peculiar to this disease, it often takes place in the small-pox.

OF THE LUES VENEREA. 293
mation as a decay of the disease, till a succession of scurfs un-
deceives them.
These discolourations of the cuticle arise from the venereal
irritation, and are seldom to be reckoned a true inflammation,
for they seldom have any of its characteristics, such as tume-
faction and pain; but this is true only on those parts most ex-
posed; for in parts well covered, and in parts constantly in
contact with other parts there is more of the true inflammatory
appearance, especially about the anus.
The appearance of the parts themselves next begins to alter,
forming a copper coloured, dry, inelastic cuticle, called a scurf;
this is thrown off, and new ones are formed. These appear-
ances spread to the breadth of a sixpence or shilling, but sel-
dom broader, at least for a considerable time, every succeed-
ing scurf becoming thicker and thicker, till at last it becomes
a common scab, and the disposition for the formation of mat-
ter takes place in the cutis under the scab, so that at last it
turns out a true ulcer, in which state it commonly spreads, al-
though but slowly.
These appearances arise first from the gradual loss of the
true sound cuticle; the diseased cutis having lost the disposi-
tion to form one; and, as a kind of substitute for this want of
cuticle, an exudation takes place, forming a scale, and after-
ward becoming thicker, and the matter acquiring more con-
sistence, it at last forms a scab; but before it has arrived at
this stage, the cutis has given way, and ulcerated, after which
the discharge becomes more of a true pus. When it attacks
the palms of the hands and the soles of the feet, where the
cuticle is thick, a separation of the cuticle takes place, and it
peels off, a new one is immediately formed, which also sepa-
rates, so that a series of new cuticles takes place from its not
so readily forming scurfs as on the common skin. If the dis-
ease is confined to those parts, it becomes more difficult to de-
termine whether or not it be venereal; for most diseases of
the cutis of these parts produce a separation of the cuticle at-
tended with the same appearances in all, and having nothing
characteristic of the venereal disease.
Such appearances are peculiar to that part of the common
skin of the body which is usually exposed; but when the skin
is opposed by another skin, which keeps it in some degree
more moist, as between the nates, about the anus, or between the
scrotum

294 OF THE LUES VENEREA.
scrotum and the thigh, or in the angle between the two thighs,
or upon the prolabium of the mouth, and in the arm-pits, the
eruptions never acquire the above-described appearances, and,
instead of scurfs and scabs, we have the skin elevated, or, as
it were, tumefied by the extravasated lymph into a white, soft,
moist, flat surface, which discharges a white matter. This may
perhaps arise from there being more warmth, more perspirati-
on, and less evaporation, as well as from the skin being thin-
ner in such places. What strengthens this idea still more is,
that in many venereal patients I have seen an approach towards
such appearances on the common skin of the body; but this
has been on such parts as were covered with the clothes; for
on those parts of the skin, that were not covered, there was
only the flat scurf; these, however, were redder than the
above-described appearances, but hardly so high.
How far this is peculiar to the venereal disease, I know not.
It may take place in most scurvy eruptions of the skin. From
a supposition of this not being venereal, I have destroyed them
at the side of the anus with caustic, and the patient has got
well; however, from my idea of the disease that every effect
from the constitution is truly local, and therefore may be cured
locally; a cure effected by this treatment does not determine
the question.
This disease, on its first appearance, often attacks that part
of the fingers upon which the nail is formed, making that sur-
face red which is seen shining through the nail; and, if allow-
ed to continue, a separation of the nail takes place, similar to
the cuticle in the before-described symptoms; but here there
cannot be that regular succession of nails as there is of cuticle.
It also attacks the superficies of the body which is covered
with hair, producing a separation of the hair. A prevention
of the growth of young hair is also the consequence while the
disease lasts.
The second part, in which it appears, is most commonly the
throat, sometimes the mouth and tongue. In the throat, ton-
sils, and inside of the mouth, the disease generally shows itself
at once in the form of an ulcer without much previous tume-
faction, so that the tonsils are not much enlarged; for when
the venereal inflammation attacks these parts, it appears to be
always upon the surface, and it very soon terminates in an
ulcer.
These      

OF THE LUES VENEREA. 295
These ulcers in the throat are to be carefully distinguished
from all others of the same parts. It is to be remarked, that
this disease when it attacks the throat, always, I believe, pro-
duces an ulcer; although this is not commonly understood;
for I have seen cases where no ulceration had taken place, call-
ed, by mistake, venereal. It is therefore only this ulcer that
is to be distinguished from other ulcers of thefe parts. This
species of ulcer is generally tolerably well marked, yet it is per-
haps in all cases not to be distinguished from others that attack
this part, for some have the appearance of being venereal, and
what are really venereal resemble those that are not. We have
several diseases of this part which do not produce ulceration on
the surface, one of which is common inflammation of the ton-
sils, which often suppurates in the centre, forming an abscess,
which bursts by a small opening, but never looks like an ulcer
begun upon the surface as in the true venereal; this case is
always attended with too much inflammation, pain, and tume-
faction of the parts to be venereal; and if it suppurates and
bursts, it subsides directly, and it is generally attended with
other inflammatory symptoms in the constitution.
There is another disease of these parts, which is an indolent
tumefaction of the tonsils, and is peculiar to many people whose
constitutions have something of the scrofula in them, producing
a thickness in the speech. Sometimes the coagulable lymph
is thrown out on the surface, and called by some ulcers, by
others sloughs, and such are often called putrid sore throats.
Those commonly swell to too large a size for the venereal;
and this appearance is easily distinguished from an ulcer or loss
of substance; however, where it is not plain at first sight, it
will be right to endeavour to remove some of it; and if the
surface of the tonsil is not ulcerated, then we may be sure it is
not venereal. I have seen a chink filled with this, appearing
very much like an ulcer; but upon removing the coagulable
lymph, the tonsil has appeared perfectly sound. I have seen
cases of a swelled tonsil where a slough formed in its centre,
and that slough has opened a passage out for itself; and when
it has been as it were sticking in this passage it has appeared
like a foul ulcer.
The most puzzling stage of the complaint is, when the slough
is come out, for then it has most of the characters of the ve-
nereal ulcer; but when I have seen the disease in its first stages,
I have

296 OF THE LUES VENEREA.
I have always treated it as of the erisypelatous kind, or as
something of the nature of a carbuncle.
When I have seen them in their second stage only, I have
been apt to suppose them venereal; however, no man will be
so rash as to pronounce what a disease is from the eye only,
but will make inquiries into all the circumstances before he
forms a judgment. If there have been no preceding local symp-
toms within the proper date, he will suspend his judgment and
wait a little to see how far Nature is able to relieve herself. If
there has been any preceding fever, it will be still less probable
that it is venereal. However, I will not say of what nature
such cases are, but only that they are not venereal, as they
are often believed to be. I have seen a sore throat of this kind
mistaken for venereal, and mercury given till it should affect
the mouth, which when it did, it brought on a mortification
on all the parts concerned in the first disease. It would there-
fore appear that this species of the sore throat is aggravated by
mercury.
There is another complaint of those parts which is often ta-
ken for venereal, which is an ulcerous excoriation, where the
ulceration or excoriations run along the surface of the parts,
becoming very broad and sometimes foul, having a regular
termination, but never going deep into the substance of the
parts as the venereal ulcer does. There is no part of the in-
side of the mouth exempted from this ulcerous excoriation;
but I think it is most frequent about the root of the uvula, and
spreads forwards along the palatum molle. That such are not
venereal, is evident from their not giving way in general to
mercury; and I have seen them continue for weeks without
altering, and a true veneraal ulcer appear upon the centre of
the excoriated part.
The difference between the two is so strong that there can
be no mistake; patients have gone through a course of mercury
which has perfectly cured the venereal ulcers, but has had no ef-
fect upon the others, which have afterwards been cured by bark.
The true venereal ulcer in the throat is perhaps the least li-
able to be mistaken of any of the forms of the disease. It is
a fair loss of substance, part being dug out as it were from the
body of the tonsil, with a determined edge, and is commonly
very foul, having thick white matter adhering to it like a slough,
which cannot be washed away.
Ulcers

OF THE LUES VENEREA. 297
Ulcers in such situations are always kept moist, the matter
not being allowed to dry and form scabs, as in those upon the
skin; the matter is carried off the ulcers by deglutition, or the
motion of the parts, so that no succession of scurfs or scabs can
take place, as on the skin.
Their progress is also much more rapid than on the common
skin, ulceration taking place very fast.
Like most other spreading ulcers, they are generally very
foul, and for the most part have thickened or bordered edges,
which is very common to venereal or cancerous sores, and in-
deed to most sores which have no disposition to heal, whatever
the specific disease may be.
When it attacks the tongue it sometimes produces a thicken-
ing and hardness in the part; but this is not always the case,
for it very often ulcerates as in the other parts of the mouth.
They are generally more painful than those of the skin; al-
though not so much so as common sore throats arising from
inflamed tonsils.
They oblige the person to speak thick, or as if his tongue
was too large for his mouth, with a small degree of snuffling.
These are the most common symptoms of this stage of the
disease; but it is perhaps impossible to know all the symptoms
this poison produces when in the constitution. I knew a gen-
tleman who had a teasing cough, which he imputed to it; for
it came on with the symptomatic fever and continued with it,
and by using mercury both disappeared.
There are inflammations of the eyes which are supposed to
be venereal; for after the usual remedies against inflammation
have been tried in vain, mercury has been given on the sup-
position of the case being venereal, and sometimes with success,
which has tended to establish this opinion. But if such cases
are venereal, the disease is very different from what it is when
attacking other parts, from the constitution, for the inflamma-
tion is more painful than in venereal inflammation proceeding
from the constitution; and I have never seen such cases attend-
ed with ulceration, as in the mouth, throat and tongue, which
makes me doubt much of their being venereal.
Q q
II. EX-

298 OF THE LUES VENEREA.
II. EXPERIMENTS MADE TO ASCERTAIN THE
PROGRESS AND EFFECTS OF THE VENE-
REAL POISON.
TO ascertain several facts relative to the venereal disease,
the following experiments were made. They were begun in
May 1767.
Two punctures were made on the penis with a lancet dipped
in venereal matter from a gonorrhœa; one puncture was on
the glans, the other on the prepuce.
This was on a Friday; on the Sunday following there was
a teasing itching in those parts which lasted till the Tuesday
following. In the mean time, these parts being often examin-
ed, there seemed to be a greater redness and moisture than usu-
al, which was imputed to the parts being rubbed. Upon the
Tuesday morning, the parts of the prepuce where the puncture
had been made were redder, thickened, and had formed a speck;
by the Tuesday following, the speck had increased and discharg-
ed some matter, and there seemed to be a little pouting of the
lips of the urethra, also a sensation in it in making water, so
that a discharge was expected from it. The speck was now
touched with lunar caustic, and afterwards dressed with calomel
ointment. On Saturday morning, the slough came off; and
it was again touched, and another slough came off on the Mon-
day following. The preceding night the glans had itched a
good deal, and on Tuesday a white speck was observed where
the puncture had been made; this speck, when examined, was
found to be a pimple full of yellowish matter. This was now
touched with the caustic, and dressed as the former. On the
Wednesday, the sore on the prepuce was yellow, and therefore
was again touched with caustic. On the Friday both sloughs
came off; and the sore on the prepuce looked red, and its basis
not so hard; but on the Saturday it did not look quite so well,
and was touched again; and, when that went off, it was al-
lowed to heal up, as also the other, which left a dent in the
glans. This dent on the glans filled up in some months, but
for a considerable time it had a bluish cast.
Four months afterwards the chancre on the prepuce broke
out again; and very stimulating applications were tried; but
these seemed not to agree with it, and nothing being applied,
it

OF THE LUES VENEREA. 299
it healed up. This it did several times afterwards, but always
healed up without any application to it. That on the glans
never did break out; and herein also it differed from the
other.
While the sores remained on the prepuce and glans, a swel-
ling took place in one of the glands of the right groin. I had
for some time conceived an idea that the most effectual way to
put back a bubo was to rub in mercury on that leg and thigh,
that thus a current of mercury would pass through the inflam-
ed gland. There was a good opportunity of making the ex-
periment. I had often succeeded in this way, but now want-
ed to pat it more critically to the test*. The sores upon the
penis were healed before the reduction of the bubo was attempt-
ed. A few days after beginning the mercury in this method,
the gland subsided considerably. It was then left off; for the
intention was not to cure it completely at present. The gland
some time after began to swell again, and as much mercury
was rubbed in as appeared to be sufficient for the entire reduc-
tion of the gland; but it was meant to do no more than to cure
the gland locally, without giving enough to prevent the con-
stitution from being contaminated.
About two months after the last attack of the bubo, a little
sharp pricking pain was felt in one of the tonsils in swallowing
anything; and, on inspection, a small ulcer was found, which
was allowed to go on till the nature of it was ascertained, and
then recourse was had to mercury. The mercury was thrown
in by the same leg and thigh as before, to secure the gland more
effectually, although that was not now probably necessary.
As soon as the ulcer was skinned over, the mercury was left
off, it not being intended to destroy the poison, but to observe
what parts it would next affect. About three months after,
copper coloured blotches broke out on the skin, and the form-
er ulcer returned in the tonsil. Mercury was now applied the
second time for those effects of the poison from the constitution,
but still only with a view to palliate.
It was left off a second time, and the attention was given to
mark where it would break out next, but it returned again in
the same parts. It not appearing that any further knowledge
was to be procured by only palliating the disease a fourth time
in
* The practice in 1767, was to apply a mercurial plaister on the part, or to rub in
mercurial ointment on the part, which could hardly act by any other power than sympathy.

300 OF THE LUES VENEREA.
in the tonsil, and a third time in the skin, mercury was now
taken in a sufficient quantity, and for a proper time, to com-
plete the cure.
The time the experiments took up, from the first insertion
to the complete cure, was about three years.
The above case is only uncommon in the mode of contract-
ing the disease, and the particular views with which some parts
of the treatment were directed; but, as it was meant to prove
many things, which, though not uncommon, are yet not at-
tended to, attention was paid to all the circumstances. It proves
many things, and opens a field for further conjectures.
It proves first, that matter from a gonorrhœa will produce
chancres.
It makes it probable that the glans does not admit the vene-
real irritation so quickly as the prepuce. The chancre, on the
prepuce, inflamed and suppurated in somewhat more than three
days, and that on the glans in about ten. This is probably
the reason why the glans did not throw off its sloughs so soon.
It renders it highly probable, that to apply mercury to the
legs and thighs, is the best method of resolving a bubo; and
therefore also the best method of applying mercury to assist in
the cure, even when the bubo suppurates.
It also shows that buboes may be resolved in this way, and
yet the constitution not safe; and therefore that more mercury
should be thrown in, especially in cases of easy resolution,
than what simply resolves the bubo.
It shows that parts may be contaminated, and may have the
poison kept dormant in them while under a course of mercury
for other symptoms, but break out afterwards.
It also shows that the poison, having originally only conta-
minated certain parts, when not completely cured, can break
out again only in those parts.
III. OF THE SYMPTOMS OF THE SECOND STAGE
OF THE LUES VENEREA.
THIS stage of the disease is not so well marked as the former;
and, as it is of more importance, it requires all our discern-
ment to determine what the disease is.
The parts less susceptible of this irritation are such as are more
out of the way of the great exciting cause, which is the exter-
nal

OF THE LUES VENEREA. 301
nal air, as has been before-related. And they begin to take
on the venereal action whether it may or it may not have
produced its local effects upon the external or exposed surfaces;
and they even go on with the action, in many cases, after
these surfaces first affected have taken on the action and have
been cured, as has been already observed. These deeper seat-
ed parts are, the periosteum, tendons, fasciæ, and ligaments;
however, what the parts affected may be when the disease is in
this stage, is not always certain; I have known it produce to-
tal deafness, and some of those cases to end in suppuration, at-
tended with great pain in the ear, and side of the head. Such
cases are generally supposed to arise from some other cause;
and nothing but some particular circumstance in the history of
the case, or some symptom attending it, can lead the surgeon
to the nature of the complaint.
When these deeper seated parts become irritated by this poi-
son, the progress is more gradual than in the first; they have
very much the character of scrofulous swellings, or chronic
rheumatism, only in this disease the joints are not so subject to
it as they are in the rheumatism. We shall find a swelling
come upon a bone when there has been no possible means of
catching the infection for many months, and it will be of some
size before it is taken notice of, from having given but little
pain. On the other hand, there shall be great pain, and pro-
bably no swelling to be observed till some time after. The
same observations are applicable to the swelling of tendons,
and fasciæ.
As these swellings increase by slow degrees, they show but
little signs of inflammation. When they attack the perioste-
um, the swelling has all the appearance of a swelling of the
bone, by being firm and closely connected with it.
The inflammation, produced in these later stages of the dis-
ease, can hardly get beyond the adhesive, in which state it con-
tinues growing worse and worse, and when matter is formed
it is not true pus, but a slimy matter. This may arise in some
degree from the nature of the parts not being in themselves
easily made to suppurate; and, when they do suppurate, the
same languidness still continues, in so much that this matter is
not capable of giving the extraneous stimulus, so as to excite
true suppuration or ulceration, even after the constitution is
cleared

302 OF THE LUES VENEREA.
cleared of the original cause, and then the disease is probably
scrofulous. Some nodes, either in the tendons or bones, last
for years before they form any matter at all; and in this case
it is doubtful whether they are venereal or not, although com-
monly supposed to be so.
I have already observed, that the pain in the first stages of
this disease is much less than might be expected, considering
the effects produced by the poison. The disease being very
slow and gradual in its progress, its giving little pain may be
accounted for. An ulcer in the throat causes no great pain;
and the same may be said of blotches on the skin, even when
they become large sores.
When the periosteum and bones become affected, the pain
is sometimes very considerable, and at other times there is hard-
ly any. It is not perhaps easy to account for this. We know
also that the tendinous parts, when inflamed, give in some cases
very considerable pain, and that of the heavy kind, while in
others they will swell considerably without giving any pain.
These pains are commonly periodical, or have their exacer-
bations, being commonly worst in the night. This is common
to other aches or pains, especially of the rheumatic kind, which
the venereal pains resemble very much.
When the pain is the first symptom, it affords no distinguish-
ing mark of the disease, it is therefore often taken for the
rheumatism.
IV. OF THE EFFECTS OF THE POISON ON THE
CONSTITUTION.
THE poisonous matter, simply as extraneous matter, pro-
duces no change whatever upon the constitution, and whatever
effects it has depend wholly upon its specific quality as a poi-
son. The general effects of this poison on the constitution are
similar to other irritations, either local or constitutional. It
produces fever, which is of the slow kind; and when it conti-
nues a considerable time it produces what is called a hectic
disposition, which is no more than an habitual slow fever aris-
ing from a cause which the constitution cannot overcome.
While this exists, it is impossible that any thing salutary can
go on in such a constitution. The patient loses his appetite,
or

OF THE LUES VENEREA. 303
or even if his appetite is good, loses his flesh, becomes restless,
loses his sleep, and looks sallow*.
In the first stage of this disease, before it begins to show it-
self externally, the patient has generally rigors, hot fits, head-
achs, and all the symptoms of an approaching fever.
These symptoms continuing for some days, and often for
weeks, show that there is some irritating cause which works
slowly upon the constitution. It is then supposed to be what-
ever the invention or ingenuity of the practitioner shall call it;
but the venereal eruptions or nodes upon either the periosteum,
bones, tendons, or other parts, appearing, show the cause, and
in some degree carry off the symptoms of fever and relieve the
constitution for a little time, but they soon recur.
These constitutional complaints, however, are not always to
be found; the poison stimulating so slowly as hardly to affect
the constitution, unless it be allowed to remain in it a long
time.
There are a number of local appearances, mentioned by au-
thors, which I never saw, such as the fissures about the anus,
&c. There are also a number of diseases, described by authors
as venereal, especially by Astruc and his followers, which are
almost endless. The cancer, scrofula, rheumatism, and gout,
have been considered as arising from it, which may be in some
measure true; but they are with them the disease itself, and all
their consequences, as consumption, wasting from want of nou-
rishment, jaundice, and a thousand other diseases, which hap-
pened many years before the existence of the lues venerea, are
all attributed to it.
There is even at this day hardly any disease the practitioner
is puzzled about, but the venereal comes immediately into his
mind; and if this became the cause of careful investigation, it
would be productive of good, but with many the idea alone
satisfies the mind.
CHAPTER
* This kind of look, although arising entirely from a harrassed constitution, is always
supposed to be peculiar to a venereal one. This idea, however, does not arise from the
look only, but from the leading symptoms.

304 OF THE LUES VENEREA.
CHAPTER III.
GENERAL OBSERVATIONS ON THE
CURE OF THE LUES VENEREA.
IT has been observed before, that there are three forms of
the venereal infection, gonorrhœa, chancre, and the lues
venerea, which various forms I have endeavoured to account
for. As they all three arise from the same poison, and as the
two first depend only on a difference in the nature of the parts,
and the lues venerea on another circumstance which has been
explained, it would be natural to suppose that one medicine,
whatever it be, would cure all the forms of this disease. But
we find from experience, that this does not hold good; for one
medicine, that is mercury, cures only the chancre and the lues
venerea, and the gonorrhœa is not the least affected by it;
and what is still more remarkable is, that the two, which it
cures, are in no respest similar, while the gonorrhœa, which
it does not cure, is similar in some respects to the chancre,
which it does cure.
It may be remarked in general, that there is not only a dif-
ference in the form of the disease, but also in the modes of
cure, and in the times necessary for the cure of the different
forms of the disease, even when the same medicines cure. The
gonorrhœa, in its cure, is the most uncertain of the three, the
chancre next, and the lues venerea the most certain, although
cured by the same medicine which cures the chancre.
A gonorrhœa in some cases shall be cured in six days, and
in others require as many months; which, with regard to time,
is about the proportion of thirty to one. A chancre may be
sometimes cured in two weeks, and often requires as many
months; which is in the proportion of four to one. The lu-
es venerea in general may be cured in one or two months;
which is only two to one. This calculation shows the regula-
rity and irregularity, as to time, in the cure of each form of
the disease.
I have formerly observed, that indispositions of the body
often affect this disease very considerably, more especially the
gonorrhœa and the chancre.
When

OF THE LUES VENEREA. 303
When an increase of symptoms takes place in a gonorrhœa,
from an indisposition of body, nothing should be done for the
gonorrhœa, the indisposition of body being only to be attended
to; because we have no specific for the gonorrhœa, and in time
it cures itself. But this practice is perhaps not to be followed
in a chancre, or lues venerea. It may be necessary in those
to continue the mercury, although perhaps more gently; for
the mercury is a specific that cannot be dispensed with, because
neither the chancre nor lues venerea are cured by themselves,
but always increase.
This form of the venereal disease I have divided into two
stages. When in the parts most susceptible of the disease,
which I have called the first order of parts, and which appear
to be the superficies only; the lues venerea is perhaps subject
to less variety than either the gonorrhœa or chancre, and its
mode of cure is of course more uniform; although the disease
be less easily ascertained, at least for some time. In the se-
cond order of parts the lues venerea becomes more complicated,
and its cure still less to be depended upon.
The cure of this form is much more difficultly ascertained
than either of the two former, they being always local, and
their effects visible, become more the object of our senses, so
that we are seldom or ever deceived in the cure; although at
the same time the cure is often more tedious and difficult; for
whenever the symptoms of the gonorrhœa or chancre have en-
tirely disappeared, in general the patient may look upon him-
self as cured of them; but this is not the case in the lues ve-
nerea.
A lues venerea is the effects of the poison having circulated
in the blood till it has irritated parts so as to give them a vene-
real disposition, which parts sooner or later assume the vene-
real action, according to the order of their susceptibility.
When the venereal matter is circulating, I have supposed
that certain parts are irritated by it, and that a vast number of
other parts escape, as is evidently the case with the chancre;
for in the case of a chancre the whole glans, prepuce and skin
of the penis, have had the matter applied to them, yet only one
or more parts are contaminated or irritated by it, all the others
escaping; and we often see in the lues venerea, that when the
parts contaminated assume the action, it is confined to them
without affecting other parts, although the disease be allowed
R r to

306 OF THE LUES VENEREA.
to go on for a considerable time without any attempt to a cure;
and also, if these parts are imperfectly cured, the disease re-
turns only in them; therefore these effects, although arising
from the constitution, are in themselves entirely local, similar
to the gonorrhœa and chancre, and like them may be cured
locally; and the person may still continue to have the lues ve-
nerea, although not in these, yet in other parts, because there
may be many other parts in the same body that are under the
venereal disposition, although they may not yet have assumed
the venereal action. To cure the local and visible effects of
the disease we must attack it through that medium by which it
was communicated, that is, the blood, without however con-
sidering the blood itself as diseased, or containing the poison,
but as the vehicle of our medicine, which will be carried by
it to every part of the body where the poison was carried,
and in its course it will act upon the diseased solids. This
practice must be continued some time after all symptoms have
disappeared; for the venereal action may to appearance be
stopped, and symptoms disappear, and yet all return again, the
venereal action not being completely destroyed. If the medi-
cine were also a cure for the disposition in the parts second in
order, and could prevent their coming into action, it would
be necessary to continue it somewhat longer on their account;
but this is not the case, for the visible effects, symptoms, or
appearances, in the first order of parts, give way to the treat-
ment, while the parts that have only acquired the disposition,
and are still inactive, afterwards assume the action and conti-
nue the disease. This deceives the surgeon and leaves the
ground-work for a second set of local effects in the parts se-
cond in order; but I have asserted, that what will cure an ac-
tion will not cure a disposition; if so, we should push our
medicine no further than the cure of the visible effects of the
poison, and allow whatever parts may be contaminated to come
into action afterwards.
The parts that first assume the venereal action are easiest of
cure; and I have suspected that those effects of the disease be-
ing external, were in some degree assisted in their cure by the
local action of the medicine, which evidently passes off through
those parts.
Wnen the disease has attacked the parts second in order of
susceptibility, it generally happens that they are more difficult
of

OF THE LUES VENEREA. 307
of cure than the former; therefore, when they are affected at
the same time with the former, and are cured, we may be sure
that the first will be also cured. From hence, as it would ap-
pear that the parts most susceptible of the disease are also easiest
of cure, it follows that the parts least susceptible of the disease
are also most difficult of cure; and I believe that this is seldom
or ever reversed, therefore, those second in order of suscepti-
bility have this advantage, that we have the local complaints
for our guide to judge of the whole; and in such we have on-
ly to continue the treatment till they all vanish, being certain
that the cure of the first, if there are any, will be involved in
those of the second.
As the second are attended with more tumefaction or swel-
ling than the first, it becomes a question, whether the mercu-
rial course should be continued till the whole has subsided.
But I believe it is not necessary to continue the method of
cure till the whole tumefaction disappears; for as those local
complaints cannot contaminate the constitution by reabsorption,
and as the venereal disposition and action from the constituti-
on can be cured while the local effects still remain, even where
the tumefaction forming nodes on the bones, fasciæ, &c. is
carried the length of suppuration, there can be no occasion for
continuing the course longer than the destruction of the vene-
real action. But this effect of our medicine is not easily known,
therefore it will be necessary to pursue the method of cure till
the appearances become stationary, and probably a little longer
to destroy the whole action of the disease. From these circum-
stances it would appear that the venereal irritation, when in
this stage of the disease, is easier of cure than the effects of
that irritation, such as the tumefaction.
I. OF THE USE OF MERCURY IN THE CURE OF
THE LUES VENEREA.
MERCURY in the lues venerea, as in the chancre, is the
great specific, and hardly any thing else is to be depended up-
on. It is necessary that we should always consider well the
effects of this medicine, both on the constitution at large, and
the disease for which it is given. The effects of mercury on
a constitution will always be as the quantity of mercury in that
constitution; and when the same quantity affects one constitu-
tion

308 OF THE LUES VENEREA.
tion more than another, it is in the proportion of the irritabi-
lity of that constitution, to the powers of mercury, entirely in-
dependent of any particular preparation, or any particular mode
of giving it.
With regard to the preparations of the medicine, and the
modes of applying it, we are to consider two things; first, the
preparation and mode that is attended with the least trouble or
inconvenience to the patient; and second, the preparation and
mode of administering it that most readily conveys the necessa-
ry quantity into the constitution.
Nothing can show more the ungrateful or unsettled mind of
man, than his treatment of this medicine. If there is such a
thing as a specific, mercury is one for the venereal disease in
two of its forms; yet mankind are in pursuit of other specifics
for the disease, as if specifics were more common than dis-
eases; while at the same time they are too often contented with
the common mode of treating many other diseases for which
they have no specific; and these prejudices are supported by
the Public, who have in their minds a dread of this medicine,
arising from the want of knowledge of our predecessors in ad-
ministering it; and many of the present age, who are equally
ignorant, take the advantage of this weakness.
Mercury in the constitution acts on all parts of the machine,
cures those which are diseased, affecting but little those that are
sound. Mercury is carried into the constitution in the same
way as other substances, either externally by the skin, or in-
ternally by the mouth: it cannot, however, in all cases, be
taken into the constitution in both ways; for sometimes it hap-
pens that the absorbents on the skin will not readily receive it,
at least no effect will be produced, either on the disease or con-
stitution, from such application; when this is the case it is to
be considered as a misfortune, for then it must be given inter-
nally by the mouth, although possibly this mode may be very
improper in other respects, and often inconvenient. On the
other hand it sometimes happens that the internal absorbents
will not take up this medicine, or at least no effect is produc-
ed either upon the disease or constitution; in such cases it is
right to try all the different preparations of the medicine; for
it will sometimes happen that one preparation will succeed when
another will not. I have never seen a case where neither ex-
ternal

OF THE LUES VENEREA. 309
ternal nor internal applications of mercury were not absorbed;
such a case must be miserable indeed.
I may just observe here, that many surfaces appear to ab-
sorb this medicine better than others; and most probably all
internal surfaces and sores are of this kind; for when we find
that thirty grains of calomel rubbed in on the skin has no more
effect than three or four taken by the mouth, it becomes a kind
of proof that the bowels absorb it best; also, when dressing a
small sore with red precipitate produces a salivation, it shows
that sores are good absorbing surfaces, especially too when we
know that the lues venerea generally arises from a chancre.
A patient with a stump which produced too much granula-
tions, was dressed with ointment containing a large proportion
of red precipitate; the sore was about the size of a crown piece.
It very nearly brought on a salivation, and the patient was
obliged to leave it off.
A mulatto woman had upon her leg a very bad ulcer, which
was about the breadth of two palms; it was dressed with red
precipitate mixed with common ointment, which soon threw
her into a violent salivation.
A lady, in the month of December 1782, was burnt over
the whole breast, neck, and shoulders, as also between her
shoulders, on which parts deep sloughs were formed. The
sores at first healed nearly up, and tolerably well for burns;
but they broke out anew and then became more obstinate. Se-
ven months after the accident she came to London, with very
large sores extending across the breast, and upon each side to
the shoulders; they were extremely tender and painful. They
continued to heal for some time after she came to London;
but she became ill, having been affected with extreme irritabi-
lity, loss of appetite, sickness, and throwing up of her food
and medicines. At this time the sores again began to spread,
and became very large. After having been two months in
town with little advantage, I tried warmer dressings, as basili-
con to some parts, to see if any advantage would arise from
such treatment, and it was found that these parts healed rather
faster than the others; but the soreness was so great, even from
the mildest dressings, that they could only be used in part. I
next tried red precipitate mixed with the ointment; and, that
it might increase the pain as little as possible, I ordered only
ten grains to two ounces of the ointment. This appeared to
agree

310 OF THE LUES VENEREA.
agree better with the sores than the ointment alone; and we
were happy in having found a dressing which both hastened on
the cure, and was easier than the former. But about the fourth
or fifth dressing from beginning the use of the precipitate, she
began to complain of her gums; the next day began to spit,
and by the seventh or eighth day the mouth was so sore, and
the spitting so considerable, that upon considering the case we
began to suspect that it might proceed from the red precipitate
in the dressing. The gums, inside of the cheeks, and the
breath, were truly mercurial.  We immediately left off this
dressing, except to a small corner, and had recourse to the former
dressings. In a few days the effects of the mercury abated, and
the sores looked more healthy than ever, and we again began
to dress part of the sores with the ointment containing preci-
pitate, which still agreed with them. When the mouth first
became affected, she had not used much above one half of the
ointment; and by the time we had discovered the cause, about
three fourths of it had been expended in dressings, so that there
was not quite ten grains of precipitate applied; and although
this took up seven or eight days, and the ointment must have
been soon removed from the sore by the discharge, yet a con-
siderable spitting was produced, which lasted above a month.
It is hardly to be conceived that above a grain or two could
really be taken into the constitution; for when we consider the
particles of precipitate were covered with ointment, and a vast
discharge of matter, so as soon to remove this small quantity
from the sore, we can hardly admit the possibility of more be-
ing absorbed; if this idea of the quantity taken in is just, to
what must we attribute the great susceptibility to the effects of
the medicine? Was it the irritable state of the patient at the
time? For the state of the constitution appeared to me to be
that in which the locked jaw often takes place; and I often had
this disease in my mind. The patient afterwards got well by
the use of an ointment in which pitch was an ingredient. All
this tends to show that sores and internal surfaces absorb better
than the skin.
Besides the practicability of getting the medicine into the
constitution in either way, it is proper to consider the easiest for
the patient, each mode having its convenience and inconveni-
ence, which arises from the nature of the constitution of the
parts to which it is applied, or from certain situations of life of
the

OF THE LUES VENEREA. 311
the patient at the time. It is therefore proper to give it in that
way which suits these circumstances best.
To explain this further, we find that in many patients the
bowels can hardly bear mercury at all, therefore it is to be giv-
en in the mildest form possible; also joined with such other
medicines as will lessen or correct its violent local effects, al-
though not its specific ones on the constitution at large.
When it can be thrown into the constitution with propriety
by the external method, it is preferable to the internal, because
the skin is not nearly so essential to life as the stomach, and
therefore is capable in itself of bearing much more than the sto-
mach; it also affects the constitution much less; many courses
of mercury, which are absolutely necessary, would kill the pa-
tient if taken by the stomach, proving hurtful both to the sto-
mach and intestines, even when given in any form, and join-
ed with the greatest correctors: on the other hand, the way of
life will often not allow it to be applied externally. It is not
every one that can find convenience to rub in mercury, there-
fore they must take it by the mouth if possible. To obviate the
inconvenience often arising from the visible effects of mercury,
many preparations have been invented; but any preparation of
mercury producing an effect different from the simple effects of
mercury in that constitution, such as sweating, or an increas-
ed discharge of urine, must be supposed either not to act as
mercury, or the substance with which it is compounded pro-
duces this effect; but if its peculiar effects are less than usual,
I should very much suspect that the mercury is acting in part
as a compound, and not entirely as mercury.
Mercury, like many other medicines, has two effects, one
upon the constitution and particular parts, which is according
to its mode of irritation, independent of any disease whatever.
The other is its specific effects upon a diseased action of the
whole body, or of parts, whatever the disease be, and which
effects are only known by the disease gradually disappearing.
The first becomes an object of consideration for the surgeon,
as it is in some measure by them he is to be guided in giving
this medicine so as to have its specific effects sufficient for the
cure of the disease.
Whatever injury mercury may do to the constitution it is by
its visible effects, and thence the pretended art in avoiding those
visible effects has been too much the cause of great imposition.
The

312 OF THE LUES VENEREA.
The part upon which its effects are most likely to fall, is the
part that is in most cases attempted to be avoided, or guarded
against, and that is the mouth. I believe that we are not pos-
sessed of any means of either driving the mercury to the mouth,
or of preventing it from attacking that part. Cold and warmth
are the two great agents mentioned by authors; we find them
recommending the avoiding of cold, for fear the mercury should
fly to the mouth, as if warmth was a prevention; while others,
and even the same authors, when talking of bringing the mer-
cury to the mouth, recommend warmth, as if cold were a pre-
ventive. This being the case, we may reasonably suppose that
neither the one nor the other have any material effect.
In giving mercury in the venereal disease, the first attention
should be to the quantity, and its visible effects in a given time;
which when brought to a proper pitch, are only to be kept up,
and the decline of the disease to be watched; for by this we
judge of the invisible or specific effects of the medicine, which
will often inform us that some variation in the quantity may
be necessary.
The visible effects of mercury are of two kinds, the one on
the constitution, the other on some parts capable of secretion.
In the first it appears to produce universal irritability, making
it more susceptible of all impressions; it quickens the pulse,
also increases its hardness, producing a kind of temporary fe-
ver; but in many constitutions it exceeds this, acting as it were
as a poison. In some it produces a kind of hectic fever, that
is, a small quick pulse, loss of appetite, restlessness, want of
sleep, and a sallow complexion, with a number of consequent
symptoms; but by the patient being a little accustomed to the
use of it, these constitutional effects commonly become less, of
which the following cases are strong instances.
A gentleman rubbed in mercurial ointment for the reducti-
on of two buboes. He had only rubbed in a few times when
it affected his constitution so much that it was necessary to leave
it off. He was seized with feverish complaints of the hectic
kind, a small quick pulse, debility, loss of appetite, no sleep,
and night sweats. He took the bark, with James's powder,
and asses milk, and got gradually rid of these complaints. As
the buboes were advancing, it was necessary to have recourse
to mercury again; and I told him that now it would not pro-
duce the same effects so quickly, nor so violently as before.
He

OF THE LUES VENEREA. 313
He rubbed in a considerable quantity without his constitution
or mouth being affected; but the buboes suppurating, I order-
ed it to be left off a second time; and when they were opened
he had recourse to the ointment again for the third time, and
without producing any disagreeable effects. The buboes took
on a healing disposition for a while and then became stationary,
showing that a new disposition was forming. He was directed
to leave off the ointment and to bathe in the sea, which he did,
and the buboes began to heal. In about three weeks, how-
ever, it was thought necessary to use more friction, and when
he began, which was the fourth time, it had almost an imme-
diate and violent effect upon his mouth; he left off again
till his mouth became a little better, and then returned to the
mercury a fifth time, and was able to go on with it.
A stout healthy man used mercurial friction for a bubo till
it affected his mouth; it further brought on very disagreeable
constitutional complaints, such as loss of appetite, watchfulness,
sallow complexion, lassitude from the least exercise, and swell-
ed legs; and although various means were used to reconcile
the constitution to it, yet it continued to act as a poison.
Mercury often produces pains like those of the rheumatism,
and also nodes which are of a scrofulous nature, from thence
it has been accused of affecting the bones, "lurking in them,"
as authors have expressed it.
It may be supposed to be unnecessary to mention in the pre-
sent state of our knowledge, that it never gets into the bones in
the form of a metal, although this has been asserted by men of
eminence and authority in the profession; and even the defec-
tions of dead bodies have been brought in proof of it; but my
experience in anatomy has convinced me that such appearances
never occur. Those authors have been quoted by others;
imaginary cases of disease have been increased; the credulous
and ignorant practitioner misled, and patients rendered mi-
serable.
II. OF THE QUANTITY OF MERCURY NECESSARY
TO BE GIVEN.
THE quantity of mercury to be thrown into the constitution
for the cure of any venereal complaint, must be proportioned
to the violence of the disease. Two circumstances are, how-
S s ever

314 OF THE LUES VENEREA.
ever, to be strictly attended to in the administration of this me-
dicine; which are, the time in which any given quantity is to
be thrown in, and the effects it has on some parts of the body,
as the salivary glands, skin, or intestines. These two circum-
stances, taken together, are to guide us in the cure of the dis-
ease; for mercury may be thrown into the same constitution
in very different quantities so as to produce the same ultimate
effect; but the two very different quantities must be also in dif-
ferent times; for instance, one ounce of mercurial ointment,
used in two days, will have more effect upon the constitution
than two ounces used in ten; and to produce the same effect
in the ten days, it may perhaps be necessary to use three ounces
or more.
The effects, on the constitution, of one ounce, used in two
days, are considerable, and also its effects upon the diseased
parts; therefore a much less quantity in such a way, will have
greater effects; but if these effects are principally local, that
is, upon the glands of the mouth, the constitution at large not
being equally stimulated, the effect upon the diseased parts must
also be less, which is to be determined by the local disease not
giving way in proportion to the effects of the mercury on some
particular parts.
If it is given in very small quantities, and increased gradu-
ally so as to steal insensibly on the constitution, its visible ef-
fects are less, and it is hardly conceivable how much may at
last be thrown in, without having any visible effect at all*.
These circumstances being known, it makes mercury a
much more efficacious, manageable, and safe medicine, than
formerly it was thought to be; but unluckily its visible effects
upon some particular parts, such as the mouth, and the intes-
tines, are sometimes much more violent than its general effect
upon the constitution at large; therefore a certain degree of
caution is necessary, not to stimulate these parts too quickly,
as that will prevent the necessary quantity being given.
The constitution, or parts, are more susceptible of mercury
at first than afterwards; if the mouth is made sore, and allow-
ed to recover, a much greater quantity may be thrown in a se-
cond
* To give an idea of this, ten grains of the ointment used every day, during ten days,
affected a gentleman's mouth. The ointment was of equal parts of mercury and hogs-
lard. But by means of omitting the ointment occasionally, and returning to the use of
it, he at last rubbed in eighty grains every night for a month, without having his mouth,
or any of the secretions visibly affected.

OF THE LUES VENEREA. 315
cond time, before the same soreness is produced; and indeed
I have seen cases where it could not be reproduced by as much
mercury as possibly could be thrown in. Upon a renewal of
the course of mercury therefore, the same precautions are not
necessary as at first. We are, however, every now and then
deceived by this medicine, it being hardly possible to produce
visible effects at one time; and afterwards the mouth, and in-
testines, shall all at once be affected.
Mercury, when it falls on the mouth, produces in many
constitutions violent inflammation, which sometimes terminates
in mortification. The constitutions, in which this happens,
I suspect are of the erisypelatous kind, or what are called
the putrid; therefore in such, greater caution is necessary.
Mercury in general, that is, where it only produces its common
effects, seldom or never does any injury to the constitution.
It should seem only to act for the time, and to leave the con-
stitution in an healthy state. But this is not always the case,
for probably mercury can be made to affect every constitution
very materially, being capable of producing local diseases, as
has been mentioned; and also capable of retarding the cure of
chancres, buboes, and certain effects of the lues venerea, after
the poison has been destroyed.
III. OF THE SENSIBLE EFFECTS OF MERCURY
UPON PARTS.
THE sensible effects of mercury are generally an increase of
some of the secretions, a swelling in the salivary glands, and
increase of saliva; and increase of the secretion of the bow-
els, which produces purging, and an increase of the secretion
of the skin, producing sweat, also often an increase of the se-
cretion of urine. Sometimes one of these secretions only is
affected, sometimes more, and sometimes all of them together.
But the effects upon the mouth are the most frequent.
Mercury often produces headaches, and also costiveness,
when its action on other parts become sensible, especially up-
on the glands of the mouth.
When the mercury falls upon the mouth, it does not affect
all parts of it equally, sometimes attacking the gums, at other
times the cheeks, which become thickened, and ulcerate, while
the

316 OF THE LUES VENEREA.
the gums are not in the least affected, as appears by the pati-
ent being capable of biting any thing hard.
Mercury, when it falls upon the mouth, and parts belong-
ing to the mouth, not only increases the discharge of those
parts, but it brings on great tumefaction, which is not of the
true inflammatory kind, where coagulable lymph is thrown out,
but rather resembling erisypelatous tumefaction. The tongue,
cheeks, and gums swell, and the teeth become loose; all which
effects are in proportion to the quantity of mercury given, and
susceptibility of the parts for such irritation. It produces great
weakness in the parts, in which ulceration easily takes place,
especially if they are in the least irritated, which is often done
by the teeth, and even mortification sometimes ensues. How
far it produces similar effects when it falls on other parts, I
do not know. The saliva, in such cases, is generally ropy, as
if principally from the glands affected. The breath acquires a
particular smell.
As mercury generally produces evacuations, it was natural-
ly imagined that it was by this means it effected a cure of the
venereal disease; but experience has taught us, that in curing
the venereal disease by this medicine, evacuations of any kind,
produced by it, are not at all necessary; and this might have
been supposed, as similar evacuations, produced by other me-
dicines, are of no service; therefore it was reasonable to ima-
gine that these evacuations, when produced by mercury, were
also of no service; except when we could suppose the evacua-
tion, produced by the mercury, was not the same with that pro-
duced by other medicines, but that it was a specific evacuation;
that is to say, a discharge carrying off the venereal poison by
its union with the mercury; and therefore the faster the mer-
cury went off, the sooner would the poison be carried out of
the constitution. But this is not found to be the case in prac-
tice; on the contrary, evacuations produced by the medicine
retard the cure, especially if the secretory organs are too sus-
ceptible of this stimulus; for then the quantity which is neces-
sary, or sufficient for the cure of the disease, cannot be taken
in, the effects of the medicine upon particular parts being great-
er than the patient can bear; and the quantity of mercury to
be thrown into the constitution must be limited and regulated
according to the quantity of evacuation, and not according to
the extent of the disease. On the other hand, if it is given
with

OF THE LUES VENEREA. 317
with care, so as to avoid violent evacuation, any quantity may
be thrown in sufficient for the cure of the disease.
Certain evacuations may be supposed to be a mark of the
constitutional effests of mercury; but they are not to be entire-
ly depended upon, the secretions being only a proof of the sus-
ceptibility of some parts to such a stimulus; however, it is pro-
bable that in general they are a good gauge of its constitution-
al effects. Some have gone so far as to suppose that quantity
of mercury alone, without any sensible effects, is sufficient for
the cure of the disease; and this is in some degree the case, but
not completely so, for we have no good proof of its affecting
the constitution but by its producing an increase of some of
the secretions.
IV. OF THE ACTION OF MERCURY.
MERCURY can have but two modes of action, one on the
poison, the other on the constitution; we can hardly suppose
it to act both ways. If mercury acted upon the poison only,
it might be supposed to be in two ways, either by destroying
its qualities by decomposing it, or by attracting it and carrying
it out of the constitution. If the first were the action of mer-
cury, then we might reasonably suppose that quantity alone
would be the thing to be depended upon; if the second, that
the quantity of evacuation would be the principal circumstance.
But if it act upon the principle of destroying the diseased
action of the living parts, counteracting the venereal irritation
by producing another of a different kind, then neither quanti-
ty alone, nor evacuation, will avail much; but it will be quan-
tity joined with sensible effects that will produce the quickest
cure, which from experience we find to be the case. But al-
though the effects, that mercury has upon the venereal disease,
are in some degree in proportion to its local effects on some of
the glands, or particular part of the body, as the mouth, skin,
kidneys, and intestines, yet it is not exactly in this proporti-
on, as has been mentioned. When mercury disagrees as it
were constitutionally, producing great irritability and hectic
symptoms, this action or irritation is not a counter irritation
to the venereal disease, but is a constitutional irritation, hav-
ing no effect on the disease, which continues to increase.
Mercury, loosing its effects upon the disease by use, gives a
proof

318 OF THE LUES VENEREA.
proof that it neither acts chemically, nor by carrying off the
poison by evacuation, but by its stimulating power.
The effects will always be in proportion to the quantity in a
given time, joined with the susceptibility of the constitution to
the mercurial irritation. These circumstances require the mi-
nutest attention; and in order to procure its greatest action with
safety, and to procure this in the most effectual way, it must
be given till it produces local effects somewhere, but not too
quickly, that we may be able to throw in a proper quantity;
for local effects produced too quickly prevent the sufficient
quantity being thrown in for counteracting the venereal irrita-
tion at large. I have seen cases where the mercury very rea-
dily acted locally, and yet the constitution was hardly affected
by it, for the disease did not give way.
A gentleman had a chancre which he destroyed with cau-
stic, and dressed the sore with mercurial ointment. He had al-
so a small uneasiness in one of his groins, which went no fur-
ther, but which showed an absorption of the poison. The
chancre soon healed, and he rubbed in about two ounces of
mercurial ointment. He began this course with small quan-
tities, that is, a scruple at each rubbing, and increased it;
however it soon affected his mouth, and he spit for about a
month. Two months after he had a venereal ulcer in one of
his tonsils. Here was a considerable sensible effect from a small
quantity of mercury, which proved ineffectual, because its spe-
cific effects, as I apprehend, were not in proportion to its sen-
sible effects; the salivary glands being too susceptible of the
mercurial irritation.
On the other hand, I have seen cases, where quantity did
not answer till it was given so quickly as to affect the constitu-
tion in such a manner as to produce local irritation, and con-
sequently sensible evacuations, which is a proof that the local
effects are often the sign of its specific effects on the constitution
at large, and shows the susceptibility of the diseased parts, to
be affected by the medicine, is in proportion to the effects of it
upon the mouth. Its effects are not to be imputed to evacua-
tion, but to its irritation, therefore mercury should be given,
if possible, so as to produce sensible effects upon some parts of
the body, and in the largest quantity of mercury that can be giv-
en to produce these effects within certain bounds; and that
these sensible effects should be the means of determining how
far

OF THE LUES VENEREA. 319
far the medicine may be pushed, in order to have its best effects
upon the disease without endangering the constitution. The
practice here must vary according to circumstances; and if the
disease is in a violent degree, less regard must be had to the
constitution, and the mercury is to be thrown in in larger quan-
tities; but if the disease be mild, it is not necessary to go be-
yond that rule, although it is better to keep up to it on pur-
pose to cure the disease the sooner.
If the disease is in the first order of parts, a less quantity of
mercury is necessary than if it were in the second order of
parts, and had been of long standing, with its first appearances
only cured, and the venereal disposition still remaining in the
secondary parts. To cure the disease, whether in chancre, bu-
bo, or lues venerea, probably the same quantity of mercury is
necessary; for one sore requires as much mercury as fifty sores
in the same person, and a small sore as much as a large one;
the only difference, if there is any, must depend upon the na-
ture of the parts affected, whether naturally active or indolent.
If there be any material difference between the recent and con-
stitutional, which, I apprehend, there is, it may make a differ-
ence in the quantity. I do conceive that the recent are up-
on the whole more difficult to cure; at least they commonly re-
quire longer time, although not always.
Having thus far premised these general rules and observati-
ons, I shall now give the different methods of administering
mercury.
V. OF THE DIFFERENT METHODS OF GIVING
MERCURY EXTERNALLY—INTERNALLY.
PREVIOUSLY to the giving of mercury, it is very proper
to understand, as much as possible, the constitution of the pa-
tient with regard to this medicine, which can only be known
in those who have already gone through a mercurial course;
but as many of our patients are obliged to undergo this treat-
ment more than once, it becomes no vague inquiry; for as
there are many who can bear this medicine much better than
others, it is very proper that this should be known, as it will
be a direction for our present practice. I think that few con-
stitutions alter in this disposition; although I knew one case
which admitted of a considerable quantity at one time without
being

320 OF THE LUES VENEREA.
being visibly affected; but about a twelve month after, the pa-
tient was affected with a very little.
When mercury is given to cure the lues venerea, whatever
length we mean to go in the sensible effects of it, we should
get to that length if possible, and we should keep up to it. For
we shall find it difficult to bring its effects to that standard again
if we allow it to get below it. If the mercury should get be-
yond what we intended, we should be very much upon our
guard in lowering it; and should probably begin to give it
again before its effects are reduced to the intended standard:
for the same quantity now will not operate so powerfully as
before; insomuch that what at first produced greater effects
than was intended, will not be sufficient afterwards.
Mercury is best applied externally in form of an ointment.
Unctuous substances keep it divided, attach it to surfaces, and
do not dry; it may also be supposed that they become a vehicle
for the mercury, and carry it through the absorbents to the ge-
neral circulation; for it is probable that oil is as easy of ab-
sorption as watry substances.
If the symptoms are mild in the first order of parts, and the
patient not accustomed to mercury, or it is known that he can-
not bear the medicine in great quantity, and it is intended to
conduct the cure by almost insensible means, it is proper to
begin with small quantities. One scruple, or half a dram, of
an ointment made of equal parts of quicksilver and hogs-lard,
rubbed in every night for four or six nights will be sufficient
to begin with. If the mouth is not affected, the quantity may
be gradually increased till two or three drams are rubbed in at
each time; but if the first quantity has affected the mouth, we
may be almost certain that the glands of the mouth are very
susceptible of the mercurial stimulus; therefore it will be pro-
per to wait two or three days till that effect begins to go off.
When we begin the second time, the quantity may be gra-
dually increased, at least a scruple every time, till two drams
or more are rubbed in each night, which may be done with-
out affecting the patient very considerably a second time, as has
been already observed.
If all the symptoms gradually disappear, there is no more
to be done but continue this practice for a fortnight longer by
way of security.
This

OF THE LUES VENEREA. 321
This method, steadily pursued, will cure most recent cases
of lues venerea; but it is not sufficient if the disease has been
merely kept under by slight courses of mercury; a greater
quantity becomes necessary, from a kind of habit the constitu-
tion has acquired, by which it is rendered less susceptible of
the mercurial stimulus.
If the disease should return in the second order of parts, we
may be certain the same quantity of mercury will not be suffi-
cient to cure them, their action being slow under the venereal
irritation, therefore require more than what had been first given.
I may be allowed to remark, that where the venereal symp-
toms have been ulcers in the mouth or throat, I have suspect-
ed that the mercury being brought to the mouth, and the saliva
being impregnated with it, and acting as a mercurial gargle,
cured those parts locally; and that the constitution has remain-
ed still tainted; the mercurial action in it having been much
inferior to what it was in the mouth. Perhaps something simi-
lar may take place in eruptions of the skin where the mercury
passes off by sweat; for we know that sulphur will cure the
itch by passing off in perspiration. If these are facts, then it
may in some degree account for the local symptoms in the first
order of parts being easier of cure than those in the second.
The manner of living under a mercurial course need not be
altered from the common, because mercury has no action upon
the disease which is more favoured by one way of life than an-
other. Let me ask any one what effect eating a hearty dinner,
and drinking a bottle of wine can have over the action of mer-
cury upon a venereal sore, either to make it affect any part
sensibly, as falling upon the glands of the mouth, or prevent
its effect upon the venereal irritation? In short, I do not see
why mercury should not cure the venereal disease under any
mode whatever of regimen or diet.
I own, however, that I can conceive cold affecting the ope-
rations of mercury upon the venereal disease; it is possible that
cold may be favourable to the venereal irritation, and there-
fore contrary to that produced by mercury; and there is some
show of reason for supposing this; for I have before asserted
that cold was an encourager of the venereal irritation; and
therefore keeping the patient warm may diminish the powers
of the disease while under the cure.
T t Mercury,

322 OF THE LUES VENEREA.
Mercury, given internally, is in many cases sufficient, al-
though in general it is not so much to be depended on as the
external application; therefore I would not recommend it, or
give it in cases where the disease has not been sufficiently cured
by former courses of mercury. It is the most convenient way
of giving this medicine; for many will swallow a pill who do
not choose to rub the body with the ointment; indeed there
are many circumstances in life which make this mode of in-
troducing it into the constitution the most convenient; but, on
the other hand, there are many constitutions that cannot bear
mercury given internally. When these two circumstances
meet in the same patient it is unfortunate.
Mercury taken internally, often produces very disagreeable
effects upon the stomach and intestines, causing sickness in the
one, and griping and purging in the other.
If it be found necessary to give it internally, and it disagree
either with the stomach or intestines, or both, even in the most
simple preparation, its effects, whatever they are, must be cor-
rected or prevented, by joining with the mercury other medi-
cines. If it affect the stomach only, the mercury may be join-
ed with small quantities of the essential oils, as the essential oil
of cloves, or camomile flowers, which will in many cases take
off that effect. If it disagree both with the stomach and bow-
els, which I believe arises either from the mercury meeting
with an acid in the stomach, by which part of it is dissolved,
forming a salt, or from being given in the form of a salt, both
of which will generally purge and become the cause of their
own expulsion. There are two ways of obviating these effects;
the first is, by preventing the salt from forming; the second,
by mitigating its effects on the intestines if forming, by taking
off their irritability. To prevent the salt from forming, the
best way is to join the mercury with alkaline substances, either
salts, or earths; and when given in a saline state, it may be
joined with opium, or some of the essential oils.
To prevent the formation of the salt, take of the preparati-
ons of mercury, such as mercurius calcinatus, mercurius fuscus,
or calomel, forming them into pills, with the addition of a small
quantity of soft soap, or any of the alkaline salts; the alkaline
salt also prevents the pill from drying: or instead of these a
calcareous earth may be joined with the mercury, such as chalk
or crabs eyes: upon this principle is the mercurius alkalizatus,
which

OF THE LUES VENEREA. 323
which is crude mercury rubbed down with crabs-eyes. But
these substances add considerably to the bulk of the medicine,
no less than twenty grains being necessary for a dose; which
contains seven grains and a half of crude mercury. The mer-
curius calcinatus, rubbed with a small proportion of opium,
makes an efficacious pill, and in general agrees well both with
the stomach and bowels. Opium has long been joined with
mercury to cure the venereal disease. By some as much has
been attributed to the opium as the mercury; however, opium
should be given with care, for it is not every constitution with
which it agrees, often producing irritability, in some lassitude
and debility, in others spasms.
If the mercury is not given in the above manner, but in the
form of a salt, or the salts are allowed to form, then it should
be joined with one third of opium, and a drop of the oil of
cloves, or camomile, which will make it agree with the stomach,
and prevent its purging; or, if it is found still to disagree both
with the stomach and bowels, compound it still further, by
joining with the mercury the alkaline salts, the opium, and
some essential oil.
A grain of mercurius calcinatus made into a pill, with the
addition of such medicines as the stomach or bowels may re-
quire, may be given every night for a week; and if in that
time it has not affected the mouth, it may be repeated evening
and morning; and after the patient has been accustomed to the
medicine, and it is found not to fall much upon the mouth, it
may be increased to two grains in the evening, and one in the
morning.
The same directions hold equally good either with the mer-
curius fuscus, or calomel; but it requires more of these last
preparations of mercury to have the same medicinal effect upon
the disease, than of the before-mentioned; perhaps the propor-
tion of their effects are about two, or three, to one. Why
this should be the case is probably not easily accounted for, the
quantity of mercury being very nearly the same in a given
weight in both, for in eight grains of calomel there are seven
grains of crude mercury. Three grains of these preparations
appear only equal to one of the mercurius calcinatus. The
crude mercury given in the same quantities with either of the
former appears the least efficacious of all; for fifteen grains of
crude

324 OF THE LUES VENEREA.
crude mercury rubbed down with any mucilage, seems only
equal to one or two of the mercurius calcinatus.
The corrosive sublimate, which is a salt capable of stimulat-
ing violently, is generally given in solution in common water,
brandy, or some of the simple waters, and has been used with
she appearance of considerable success. It would appear that
it removes ulcers in the mouth, as soon, if not sooner than
any of the other preparations; but this I suspect arises from its
application to these parts in its passage to the stomach, acting
upon them locally as a gargle; however, from experience, it
appears not to have sufficient powers over the venereal irrita-
tion; in recent cases only removing the visible local effects,
without entirely destroying the venereal action; for many more
have been found to relapse after having taken this preparation,
than from many of the others; which is owing to its passing ve-
ry readily off by the skin. Besides, it disagrees much more with
the stomach and intestines, than any of the other preparations.
A grain of this medicine dissolved in about an ounce of some
fluid, is generally the dose, and increased according as it agrees
with the bowels, and according to its effects upon the mouth,
and disease.
As corrosive sublimate contains an acid, and as you must be
guided by the effects of the acid on the bowels, the quantity
of mercury you can give in this form is necessarily smaller than
in the other preparations. Ward's drop, containing less acid,
can be given in larger quantity, and is more efficacious on that
account. Perhaps any of these preparations united with a scru-
ple of gum guaiacum may have more effect than when given
alone; since guaiacum is found to have considerable effects on
the venereal disease.
This practice, continued for two months, will in general
cure a common lues venerea; but here it is not meant that any
time should be specified. After all the symptoms of the dis-
ease have disappeared, this course should be continued at least
a fortnight longer; but if the symptoms disappear very sudden-
ly, as they often do, perhaps within eight or ten days, proba-
bly from the medicine going off by those surfaces where the
disease appears, the medicine should be continued three weeks,
or perhaps a month longer, and the dose increased. In such
cases the visible local effects appeared to be cured, while a ve-
nereal disposition remains in the parts.
Various

OF THE LUES VENEREA. 325
Various are the preparations of mercury recommended for
internal use, while practitioners have generally been satisfied
with but one for external application. Every practitioner finds
some one of the preparations answering better to appearance
in some one case than another, which call the balance in favour
of that medicine in his mind; or others finding the bad effects
of a particular preparation at some one time, have generally
condemned that preparation; not to mention that deceit is oft-
en practised in the cure of this disease. One would naturally
suppose that the simplest preparation is the best, that which is
easiest dissolved in the animal juices, does least mischief to the
stomach, or general health, and is least disturbed or hinder-
ed in its operations; for we can hardly suppose that any sub-
stance joined with mercury, which alters either its chemical or
mechanical properties out of the body, can add to its power
in the body, except a substance which had a similar power when
acting alone. The preference generally given to the ointment
shows this; and if we could find a preparation still more sim-
ple than the ointment, that preparation should be used in pre-
ference to the crude mercury.
VI. OF THE CURE OF THE DISEASE IN THE
SECOND OR THIRD STAGE.
IN the more advanced stages of the disease the mercurial course
must be pushed further. The greatest quantity of that medi-
cine that the patient can bear at a time, is to be thrown in and
continued with steadiness till there is great reason to suppose the
disease is destroyed. It will not be possible, in such cases, to
prevent the mouth from being considerably affected, the quan-
tity of mercury necessary to be thrown in for the cure of these
stages of the disease being such as will in most cases produce
that effect.
Before the disease has advanced so far, the patient most pro-
bably has taken mercury, and it is proper to inquire how he
has been affected by it, and what quantity of it he can bear,
which will in some degree direct us in the quantity now to be
begun with. If the patient has not taken mercury for a consi-
derable time, and is easily affected by it, which is the case that
admits of the least quantity, it will be necessary to begin cau-
tiously, regulating the quantity according to circumstances;
but

326 OF THE LUES VENEREA.
but if the person has taken mercury lately, although easily af-
fected by it, more freedom may be used on returning to it, be-
cause it will have less power on his mouth, as also on the dis-
ease; again, if the person has been taking mercury very late-
ly, and is with difficulty affected by it, which is the case that ad-
mits of the greatest quantity, then it may be administered free-
ly so as to affect the constitution in the proper time. If the
mercury is brought to the mouth in six or eight days, and a
considerable soreness is produced in twelve, it will in general
be a good beginning. In such cases the constitution is if possible
to be surprized by the medicine so as to produce its greatest ef-
fects, but with such caution as to be able to keep up these ef-
fects by quantity.
Mercurial friction will answer better than mercury given in-
ternally; for in this way we are surer of throwing in a larger
quantity in a given time, than could be taken internally with-
out hurting the stomach.
The quantity of mercury applied in this way should be un-
der certain circumstances, in an inverse proportion to the sur-
face on which it is applied, and the surface should be complete-
ly covered with the ointment; for half an ounce of mercurial
ointment rubbed in upon a given surface, will have nearly the
same effect as one ounce rubbed in on the same surface; there-
fore one ounce to have double the effect should have double the
surface. The quantity of ointment must therefore be adapted
to the quantity of surface, for on a certain extent of surface no
more than a determined quantity of ointment can be applied so
as to be absorbed; and applying a greater quantity would be
useless; and if the quantity of surface is greater, the same pro-
portion of ointment cannot be diffused so as to employ fully all
the absorbents. Every surface which is used may therefore
have its full quantity of ointment, but certainly should not have
more, if we are to attribute the effects of the mercury to the
quantity.
It has most probably been always the practice to rub the
mercury well in, as it is termed; but I suspect that this arose
rather from an idea of the surface being porous like a sponge,
than of absorption being performed by the action of vessels; and
it is probable that this action in the vessels producing absorp-
tion may be rather disturbed than excited by friction.
How

OF THE LUES VENEREA. 327
How long the course is to be followed is not to be exactly
ascertained, it may be thought proper to continue it till the lo-
cal appearances, as nodes, have subsided; but I suspect that this
is hardly necessary, except they give way readily; for in such
cases the local complaints, or tumefaction, &c. generally re-
quire a longer time to be removed than the venereal action;
and local applications must be of service, especially if such tu-
mefactions are obstinate.
The manner of living under such a severe course, which is
in every respect weakening, is to be particularly attended to;
the patient must be supported, and the local effects of the me-
dicine in the mouth preventing his taking many kinds of nou-
rishment, especially such as are of a solid form; fluids must
form his only nourishment, and these should be such as will
become solid after they are swallowed; milk is of this kind.
An egg beat up with a little sugar, and a little wine; sago, sa-
lep, &c. form a proper diet. In many cases wine and bark
must be given through the whole course. Sugar is perhaps one
of the best restoratives of any kind we are acquainted with,
when a constitution has been very much debilitated by long
fasting, from whatever cause, whether from the want of food
when in health, or in the time of disease, or where the food
has not been allowed to answer the constitutional waste, as in a
course of mercury, and when the disease or course of mercury
is gone, then sugar will restore such constitution probably bet-
ter than any thing else.
Although it is not a common opinion, and therefore not a
common practice to give sugar entirely with this view, yet
there are sufficient proofs of its nutritive quality over almost
every other substance. It is a well-known last, that all the
negroes in the sugar-islands become extremely lusty and fat in
the sugar-cane season; and they hardly live upon any thing
else. The horses and cattle that are allowed to feed upon them
all become fat. The hair of the horses becomes fine. Birds
who feed upon fruit never eat it till it becomes very ripe, when
it has formed the greatest quantity of sugar, and even then only
on such as furnish the largest quantity of sugar. Insects do the
same; but we cannot have a stronger instance of this fact than
in the bee. Honey is composed of sugar, with some other
juices of plants, with a little essential oil; but sugar is the
principal ingredient. When we consider that a swarm of bees
will

328 OF THE LUES VENEREA.
will live a whole winter on a few pounds of honey, keep up
a constant heat about ninety-five or ninety-six degrees, and the
actions of the animal œconomy equal to that heat, we must al-
low that sugar contains perhaps more real nourishment than
any other known substance.
We see too that whey is extremely fattening, which is the
watry part of the milk, containing neither the oil nor the co-
agulable matter; this arises principally from the sugar it con-
tains; for being composed of the watry part it holds all the
sugar of the milk in solution. If the milk is allowed to be-
come sour it is not so fattening, because it is the sugar which
is become sour.
Although the nutritive qualities of sugar have not been so
generally known as to introduce it into universal practice, yet
they have not entirely escaped the notice of practitioners. Mr.
Vaux, from observing the negroes in the West Indies growing
fat in the sugar-season, has been induced to give it in very
large quantities to many of his patients, and with very good
effects. Honey is perhaps as good a mode of taking this sub-
stance as any; sweetening every thing that is either eat or
drank, whether by sugar in honey, or sugar alone, is proba-
bly immaterial; yet it is probable that the other ingredients in
honey may add to its nutritive quality.
VII. OF LOCAL TREATMENT.
IF the local effects have gone no further than inflammation
and swelling, either of the soft or hard parts, most probably no
local treatment will be necessary, for the treatment of the con-
stitution will, in general, remove them entirely.
It sometimes, however, happens that the local complaints
will not give way, but the parts remain swelled in an indolent
and inactive state, even after there is every reason for suppos-
ing the constitution is perfectly cured. In such cases the con-
stitutional treatment is to be afficted by local applications of
mercury to the part, either in the form of a plaster or oint-
ment. The latter is by much the best mode. If these are not
sufficient, as often happens, we must endeavour to destroy this
disposition by producing an inflammation of another kind. I
have seen a venereal node which gave excruciating pain, cur-
ed by an incision only being made down to the bone the whole
length

OF THE LUES VENEREA. 329
length of the node; the pain has ceased, the swelling has de-
creased, and the sore healed up kindly, without taking a grain
of mercury. Blisters have been applied to nodes with success;
they have removed the pains and diminished the swellings; so
far furnishing a proof, that local treatment may assist mercury
in many cases.
This treatment has not only been used to assist mercury in
those cases where the medicine did not appear to be equal to
the disease, but it has been used at the commencement of the
cure, and even before mercury had been applied; but it was
still thought necessary to go through the same mercurial course
as if nothing had been done to the local complaints.
It may be asked, What advantage arises from the incision
or application of the blister? The advantage is immediate relief
from violent pains; and as there are two powers acting, it is
natural to suppose the cure will be more speedy.
After all the above-mentioned trials, it may happen that the
local effects shall still remain, forming as it were a new dis-
ease, which mercury may increase, and therefore other me-
thods of cure may be tried, as will be described hereafter.
VIII. OF ABSCESSES — EXFOLIATION.
WHEN an abscess forms in a node in the periosteum, the
bones are generally affected and make part of the abscess.
Great attention should be paid to them, for suppurations
in them are not like suppurations in common abscesses, they
are seldom produced from the true suppurative inflammation,
and therefore are slow in their progress, rarely producing true
matter, but a mucus something resembling slime, which lies flat
upon the bone. This circumstance makes it difficult to deter-
mine when suppuration has taken place; and in many cases to
detect matter, even where it is formed. Another circumstance,
which renders the presence of matter in such cases doubtful, is,
that the progress of the disease is generally checked very early
by the use of mercury. This matter is often reabsorbed dur-
ing a mercurial course; and it is proper, particularly in an
early state of the complaint, to give it this chance; but if the
absorption does not take place, and the complaint is in an ad-
vanced state, it must be opened.
U u The

330 OF THE LUES VENEREA.
The surgical treatment of the parts under such circumstances
is the same as in other diseases of these parts; opening with
great freedom is absolutely necessary; for the more parts are
exposed, the more inclinable they are in general to heal, and
still more so here; for violence assists in destroying the vene-
real disposition. No skin covering a bone should be removed-
from an abscess, especially in the lower extremities.
If the abscess is opened freely, and an exfoliation takes
place, which is generally the case, it is to be treated as any
other exfoliation. Exfoliations succeed much better here than
in many other cases, because the disease from which they pro-
ceed can generally be corrected, which is not the case in ma-
ny diseases of bones where exfoliation takes place. Cases,
however, sometimes occur in which, after the venereal dispo-
sition has been corrected, another disease takes place in the
bone, the nature of which will be explained when we shall
consider the effects remaining after the disease is cured, and
the disease sometimes produced by the cure.
IX. OF NODES ON TENDONS, LIGAMENTS,
AND FASCIÆ.
THE observations, made on the nodes of the periosteum
and bones, are applicable to swellings and suppurations of the
ligaments and faciæ; but it is still more difficult to ascertain the
presence of matter in them than in the former.
When a thickening only of the ligaments or fasciæ is the
consequence of the disease, it is very obstinate, as in many cases
the diseased part may be cleared of all venereal taint and still
the swellings remain. Blisters may often be applied here with
success; but if they fail, then it will be absolutely necessary to
make an incision into the part, to excite a more vigorous action;
for although the complaint has nothing venereal in it, nor is
any contamination to be feared from it in future, yet as it
leaves often very obstinate and disagreeable swellings, which
neither give way to medicine nor time, it is proper to use eve-
ry means for their removal.
X. OF

OF THE LUES VENEREA. 331
X. OF CORRECTING SOME OF THE EFFECTS
OF MERCURY.
FORMERLY, when the management of mercury was not
so well understood, nor its effects in this disease so well known
as they are at present, it was generally supposed to act by eva-
cuation from the salivary glands, and was therefore always
given till that evacuation took place; and, as its effects in the
cure were imagined to be in proportion to the quantity of this
evacuation, it was pushed as far as possible, without endanger-
ing suffocation. From this treatment it often happened in
those constitutions which were very susceptible of the mercu-
rial irritation, and in which the medicine produced much more
violent effects on some particular secretions than could be wish-
ed, that recourse was obliged to be had to medicines correct-
ing the effects of mercury; as these effects were often an hin-
drance to its being given in sufficient quantities for the cure
of the disease.
I mentioned, when treating of the effects of mercury, that
the sensible increase of the secretions, produced by it, were in
the following order: first of saliva, then sweat, then urine, and
often of the mucus of the intestines, producing purging; I
also observed, that when any of those secretions became too
violent, the hand of the surgeon was tied up till they were mo-
derated. Attempts have been made to lessen those effects in
two ways, either by the destruction of its power on the body
in general, or by its removal, but neither of these means have
succeeded. It never has once been thought necessary to at-
tempt to lessen its powers on the organs of secretion, so as still
to retain the same quantity in the constitution, or even to
throw in more, which, if it could be effected, would be some-
times of great service; but as we are not yet acquainted with
powers sufficient for these purposes, we are obliged to observe
great caution in our mode of giving the medicine.
I have endeavoured to show that this medicine need not be
given with a view to procure those evacuations; and that it
may be given in any quantity without increasing either of those
secretions in any evident degree; however, after every pre-
caution, we may still be deceived, and the medicine will eve-
ry now and then produce greater effects than were intended.
It

332 OF THE LUES VENEREA.
It is very necessary therefore to seek for a preventive of the
effects of mercury, when likely to be too violent; or to reme-
dy those effects when they have already taken place.
The common practice when mercury produced violent ef-
fects upon the intestines, was to counteract these effects; but
this was not done with a view to retain the mercury in the con-
stitution, but to relieve the bowels that were suffering by the
action of the medicine: whereas the proper practice would be
to stop its progress here, as in every other outlet, that more
mercury may be retained in the constitution.
Although these increased secretions arise from the constitu-
tion's being loaded with mercury, yet there is no danger in
stopping them, for they do not arise from an universal disposi-
tion becoming a local, or critical one; and therefore if such
an action be checked or stopped in one place, it must necessa-
rily fall upon some other; but it is from the part being more
susceptible of this irritation than any other, and the quantity
now in the constitution being equal to the susceptibility of the
part; and therefore, though its effects are stopped here, it does
not break out any where else, every other part being capable
of supporting this quantity, and of remaining unaffected till
more is thrown in.
When the mercury attacked the salivary glands, it increased
that secretion so much as in some cases to oblige practitioners to
administer such medicines as were thought likely to remove this
new complaint. This susceptibility of the glands of the mouth,
and the mouth in general, to be easily put into action by this
medicine, was generally supposed to arise from a scorbutic con-
stitution, to which most complaints of the mouth are attribut-
ed. I am of opinion that scrofulous people, and those of a
lax and delicate habit, are more subject to have it fall on the
mouth than those of a contrary temperament.
Purges were given upon a supposition that mercury could be
carried off by the evacuation produced by them, and they were
repeated according to the violence of the effects of the medi-
cine, and the strength of the patient: but I can hardly say that
I have ever seen the effects of mercury upon the mouth lessen-
ed by purging; whether it arose spontaneously, was produced
by purging medicines, or even when arising from the mercury
itself. As this method was not found sufficient for the remov-
al of the complaint, other medicines were tried; sulphur was
supposed

OF THE LUES VENEREA. 333
supposed to be a specific for the removal of the effect of mer-
cury. Whether this idea arose from practice or reasoning, is
not material*; but I think I have seen good effects from it in
some cases. If we can suppose purging of any service, purg-
ing with sulphur would answer best, as it would exert its ef-
fects both as a purge and a specific.
Sulphur certainly enters the circulation as sulphur, because
our sweat and urine smell of it; if it does not combine with the
mercury and destroy its properties as mercury, it is possible,
agreeably to the opinion of those who first thought of giving it
with this intention, that it may so combine as to form æthiops
mineral, or something similar; for we know that the æthiops
mineral, however formed, does not in general salivate. It is
possible too, that sulphur may act as a contrary stimulus to
mercury, by counteracting the effects of it in the constitution.
Sulphur has even been supposed to hinder the mercury from
entering the circulation. Upon the whole, as these prepara-
tions of sulphur and mercury are still supposed to have good
effects, and as I think I have seen good effects in other cases,
we must either allow that they enter the circulation, or that
their whole effects are on the stomach and intestines, with which
the rest of the body sympathises. The good effects from sul-
phur in lessening or altering the immediate effects of mercury,
can only take place when that medicine is really in the consti-
tution; therefore a distinction is to be made between such as
arise immediately from mercury, and one continued from habit,
after the mercury has been evacuated from the constitution; a
case that sometimes happens, and which will be taken notice
of in its proper place.
The taste in the mouth, from the use of mercury, has been
known to go off, and not be perceived for a fortnight, and the
same taste has recurred; this I am informed has happened twice
to one gentleman from the first quantity of mercury taken. To
account for this is not easy; in whatever way it happens, it is
a curious fact.
When the mercury has fallen upon the mouth and throat,
washing those parts with opium has often good effects; for opium
takes off irritability, and of course the soreness, which is one
means
* Sulphur, united with any of the metals, probably destroys their solubility in the
juices, or at least their effects in the circulation; none of the cinnabars act either as
sulphur, or mercury. Crude antimony, which is regulus and sulphur, has no effect.
Arsenic, when joined with sulphur, has no effect; nor has iron.

334 OF THE LUES VENEREA.
means of lessening the secretion. A dram of tinctura thebaica
to an ounce of water, makes a good wash, or gargle*.
When the mercury falls upon the skin, it is neither so dis-
agreeable nor so dangerous as when it falls upon the mouth;
however, it may often happen that it will be proper to check
such a discharge, both upon account of its being troublesome
and of its lessening the effects of the medicine in the constitu-
tion by carrying it off. The bark is, perhaps, one of the best
correctors of this increased secretion.
When the medicine attacks the kidneys and increases the
secretion of these glands, it is not so troublesome as when it pro-
duces sweating, though it is possible that it may carry off the
mercury too soon; but as we have but few medicines that can
lessen that secretion, in most cases it must be allowed to go on.
The bark may in such cases be given with advantage.
When the mercury falls upon the bowels it proves often more
dangerous and troublesome than in any of the former cases,
especially the two last; but it is, perhaps, most in our power
to prevent or palliate. Opium should be given in such quan-
tities as to overcome the complaint, and I believe will seldom
fail of removing all the symptoms.
XI. OF THE FORM OF THE DIFFERENT PREPA-
RATIONS OF MERCURY WHEN IN THE
CIRCULATION.
IT would appear from reason, and many circumstances, that
mercury must be in the state of solution in the juices of the body
before it can act upon the venereal disease, and indeed before it
can act upon any other disease. That mercury is in a state of
solution in our juices and not in the state of any preparation of
mercury, that we know of, is very probable from the follow-
ing facts.
First, crude mercury, every salt of mercury, and calx of mer-
cury, is soluble in the spittle, when taken into the mouth, by
which means it is rendered sensible to the taste; from thence
it must appear that it is capable of solution in some of our
juices.
Secondly,
* My using opium in this way was from analogy; finding that opium quieted the
bowels when a purging came on in consequence of mercury: I tried it by way of gargle
to the mouth, and found good effects from it, but not equal to those which it produced
in the bowels.

OF THE LUES VENEREA. 335
Secondly, crude mercury, when divided into small parts by
gum arabic, &c. so as to be easier of solution when taken into
the stomach, generally purges; but crude mercury taken with-
out such division has no such powers, not being so readily dis-
solved in the juices of the stomach. The simple calx of mer-
cury has the same effects, purging, and much more violently,
from being, I suppose, readier of solution in the animal juices;
for if it only purged from its union with the acid which happen-
ed to be in the stomach, it most probably would not purge more
than crude mercury; although it is very probable that the calx
is easier of solution in a weak acid, than even the crude mer-
cury.
Thirdly, every preparation of mercury producing the same
effect in the mouth, and also having one and the same effect
in the constitution, shows that they must all undergo a change,
by which they are reduced to one particular form. We can-
not say what that form is, whether it is the calx, the metal,
or any other that we are acquainted with; but it is probable
that it is not any of them, but a new solution in the animal
juices peculiar to the animal itself. This is rendered still more
probable by this circumstance, that every preparation of mer-
cury put into the mouth, undergoes the same change, and the
spittle has the same taste from every one of them. If every
different preparation of mercury had the same properties in the
constitution that it possesses out of it, which we must suppose
if it enters and continues in the same form, in that case the
venereal poison must be eradicated in as many different ways
as there are preparations. Crude mercury would act mecha-
nically, by increasing the weight and momentum of the blood;
the calx would act like brick-dust, or any other powder that
is heavy; the red precipitate would stimulate by chemical pro-
perties in one way, while the corrosive sublimate would act in
another, and the mercurius flavus in a third; this last would
most probably vomit as ipecacuanha does, which vomits whe-
ther thrown into the stomach or circulation.
Fourthly, all the preparations of mercury, when locally ap-
plied, act always in one way, that is, as mercury; but some
have also another mode of action, which is chemical, and
which is according to the specific nature of the preparation.
The red precipitate is a preparation of this kind, and acts in
both these ways; it is either a stimulant or an escharotic.
To

336 OF THE LUES VENEREA.
To ascertain whether this opinion of mercury being in so-
lution in our juices was just, I made the following experiments
upon myself. I put some crude mercury into my mouth, as
a standard, and let it stay there, working it about, so as to
render it easier of solution, till I tasted it sensibly; I then put
into my mouth the mercurius calcinatus, and let it remain till
I perceived the taste of it, which was exactly the same; but I
observed that it was easier of solution than the crude mercury.
I tried calomel in the same way, and also corrosive sublimate,
after being diluted with water, and the taste was still the same.
It was some time before I perceived the taste of the crude mer-
cury in my mouth. I tasted the calx and calomel much soon-
er. The corrosive sublimate had at first a mixed taste, but
when the acid was diluted it had exactly the same taste with
the former; all these different preparations producing the same
sensation or taste in the mouth.
From the effects of these experiments it would appear, that
the mercury in every one of them was dissolved in the spittle,
and reduced to the same preparation or solution.
To try whether mercury in the constitution would produce
the same taste in the mouth, I rubbed in mercurial ointment
upon my thighs till my mouth was affected, and I could plain-
ly taste the mercury; and, as far as I could rely upon my
memory, the taste was exactly the same as in the former ex-
periments.
I allowed some time for my mouth to get perfectly well and
free from the taste; I then took calomel in pills till it was af-
fected again in the same way. I afterwards took mercurius
calcinatus, and also corrosive sublimate. All these experiments
were attended with the same result; the mercury in every form
producing the same taste, which was also exactly the same as
when the several preparations were put into the mouth.
From the above experiments it must appear, that when
mercury produces evacuation by the mouth, it certainly goes
off in that discharge; and from thence we may reasonably con-
clude, that when other evacuations are produced from the me-
dicine when in the constitution, as purging, sweating, or an
increased flow of urine, that it also goes off by these evacua-
tions, which become outlets to the mercury.
From the above experiments it appears to be immaterial
what preparation of mercury is used in the cure of this disease,
provided

OfF THE LUES VENEREA. 337
provided it is of easy solution in our juices, the preparations
easiest of solution being always the best.
XII. OF THE OPERATION OF MERCURY ON THE
POISON.
MERCURY may be supposed to act in three different ways
in curing the venereal disease. First, it may unite with the
poison chemically, and decompose it, by which means its powers
of irritation may be destroyed; secondly, it may carry it but
of the constitution by evacuation; or thirdly, it may produce
an irritation in the constitution which counteracts the venereal
and entirely destroys it.
It has been supposed that mercury acts simply by its weight
in the circulating fluids; but of this we can form no adequate
idea; and if it were so, other substances should act on this
disease in proportion to their weight, and of course many of
them should cure it; but from experience we find, that such
bodies as have considerable weight, as most of the metals, have
no effect on this disease. We have no proof of mercury act-
ing by a decomposition of the poison from any of the conco-
mitant circumstances.
Mercury certainly does not cure the venereal disease by
uniting with the poison and producing an evacuation. For in
those cases where mercury is given in such a way as to produce
considerable evacuations, or in those constitutions where eva-
cuations are easily excited by mercury, its effects upon the dis-
eased action are the least; and the same evacuations produced
by any other means have not the least effect on the disease.
Whether the mercury be supposed to carry off the circulat-
ing poison, or to decompose it, in neither way could it pro-
duce, when locally applied, any effect on a venereal inflam-
mation or sore arising from the constitution; for as long as
any of the poison existed in the circulation, none of them
could be healed by local applications, the circulation constant-
ly carrying the poison to them; but we find the contrary of
this to be true; for a venereal sore, arising from the constitu-
tion, may be cured locally.
The last or third of our modes of action of mercury, seems
to me the most probable, and for many reasons. First, because
the disease can in many cases be cured by raising a violent sti-
X x mulus

338 OF THE LUES VENEREA.
mulus of another kind; and perhaps if we could raise such a
constitutional irritation without danger, as we often can in lo-
cal cases, we might cure the venereal disease in the same man-
ner, and in one quarter of the usual time. Secondly, we find
that mercury acts as an universal stimulus, causing great irrita-
bility in the constitution, making the heart beat faster, and ren-
dering the arteries more rigid, so as to produce a hard pulse,
as has been already observed. It may further be said to pro-
duce a disease, or a peculiar or unnatural mode of action in a
certain degree. The following case will illustrate this. A
gentleman had electricity recommended to him for some com-
plaint he had. The electricity was applied, but without any
visible effect. Besides the complaint for which he used elec-
tricity, he had a venereal one, for which he was first put under
a course of mercury, and while under it, the electricity was
applied for the former complaint; but he had become so irrita-
ble, that he could not bear the shocks of one half their former
strength; but the most curious part of the case was, that the
shocks had a much greater effect on the disease than what they
had before when twice as strong, and he now got cured. This
gave the surgeon a hint, and having another occasion to use
electricity,  also without effect, he put the patient under a gen-
tle course of mercury, and then found the same effects from the
electricity as in the former case, and the patient also got well.
The powers of mercury upon the constitution appear to be
as the quantity of mercury and the susceptibility of the consti-
tution to be affected with it, without any relation to the disease
itself; and we find that the power of mercury upon the disease
is nearly in the same proportion. This fact gives us an idea
of the irritation of mercury upon the constitution, and conse-
quently an idea of administering it, and of the cure of any
disease for which it is a remedy.
As we find that a given quantity of mercury produces dou-
ble effects in some constitutions to what it does in others; al-
so, that in those cases it produces its effects upon the disease,
we are led to believe that it is this effect upon the constitution
which cures the disease; and therefore if it did not produce
this effect it would also not have performed a cure. I have
already observed, that the cure does not go on exactly in pro-
portion to the visible effects upon the constitution, except
quantity in the medicine is joined with it; which, if true,
would

OF THE LUES VENEREA. 339
would incline us to believe that there was something more
than simply a constitutional stimulus, which most probably is
a peculiar specific effect, which is not regulated entirely by its
visible effects, either constitutional or local, although they ap-
pear to have some connection.
This fact being known, obliges us to be more liberal in giv-
ing mercury in those constitutions where it makes but little im-
pression, than in those which it easily irritates; although in
these last we must not be entirely regulated by its local effects,
nor depend upon a commonly sufficient quantity, but be ruled
by the sensibility of the constitution, and quantity joined; for
in those where the constitution appears to be very susceptible
of the mercurial irritation, where small quantities produce con-
siderable local effects, it is still necessary to have quantity, al-
though it is not so necessary to take the quantity in general that
is supposed to be sufficient. We must be guided by the three
following circumstances, the disappearance of the disease, the
quantity of irritation produced, and the quantity of the medi-
cine taken.
XIII. OF GUM GUAIACUM, AND RADIX SARSA-
PARILLÆ IN THE VENEREAL DISEASE.
I HAVE hitherto only recommended mercury in the cure of
the venereal disease; and indeed it is the only medicine to be
depended upon. However, as both the guaiacum and sarsapa-
rilla have been recommended as powerful remedies in this com-
plaint, I took a favourable opportunity of trying their compa-
rative powers in the venereal disease upon the same person.
The guaiacum* I found had considerable specific power over
the disease, consequently it may be of service in slight cases
where it may be inconvenient or improper to give mercury on
account of some other disease. These cases, however, I have
not yet ascertained; or it may be given in those cases where it
is apprehended that the quantity of mercury necessary to sub-
due the disease would be too much for the constitution to bear;
cases which sometimes occur. The sarsaparilla appeared to
have no effect at all.
I shall
* The lignum guaici was imported by the Spaniards from Hispaniola, as a cure for the
venereal disease, in the year 1517, having been given to one of them by a native.

340 OF THE LUES VENEREA.
I shall relate exactly the case in which their comparative
powers were tried. A man came into St. George's Hospital
with venereal sores over almost his whole body: there were
many excrescent sores in the arm-pits, some of which were about
the size of an half-penny; there were the same appearances
about the anus, between the buttocks, along the perinæum, be-
tween the scrotum and thigh, where those parts come in con-
tact with one another. Those upon the skin in general had the
common appearance. I ordered a poultice of the gum guaia-
cum to be applied to the sores in the right arm-pit; also a
poultice of a strong decoction of sarsaparilla and oatmeal mix-
ed, to be applied to the left arm-pit. These poultices were
changed every day for a fortnight; the excrescent sores in the
right arm-pit were entirely healed, and become even with the
skin, and covered with a natural skin, although somewhat dis-
coloured; the sores in the left arm-pit, which were poulticed
with sarsaparilla, were rather worse than when the poultice was
first applied, as indeed were all the sores, except those in the
right arm-pit. I then ordered the poultice of guaiacum to be
applied to the left arm-pit, which was done, and the sores there
also got well in a fortnight. I was now perfectly convinced
that the gum guaiacum had cured these eruptions locally.
I next wished to see what effect the gum guaiacum would
have upon the remaining sores when given internally, that is,
those about the anus, scrotum, and on the skin in general. The
patient began with half a dram three times every day, which
purged him; but this was prevented by joining it with opium.
In about four weeks all the eruptions were cured, and he was
allowed to stay in the hospital some time longer, to see if he
would continue well; but about a fortnight after he began to
break out anew, and in a very short time was almost as bad as
ever. I began a second time the gum guaiacum internally,
but it had lost all its powers, or rather the constitution was no
longer affected by it. He was put under a course of mercury,
apd cured.
CHAPTER

OF THE LUES VENEREA. 341
CHAPTER IV.
OF THE EFFECTS REMAINING AFTER
THE DISEASE IS CURED, AND OF
THE DISEASES SOMETIMES PRODUC-
ED BY THE CURE.
IN treating of the local effects of the venereal disease, the go-
norrhœa and chancre, as also the bubo, I observed that
after the virus was destroyed, there remained in many cases
some of the same symptoms, and particularly after the gonor-
rhœa. It was also observed, that, though all the symptoms
were entirely cured, yet they were liable to break out again.
A gleet will appear, sometimes attended with pain, so as to
resemble a gonorrhœa; after chancres there will be sores re-
sembling them; and buboes after the virus is gone, will not
heal, but spread. In the lues venerea, the same thing often
happens, especially if the inflammation and suppuration have
been violent in the parts. These cases puzzle considerably;
for it is difficult to say when the venereal virus is absolutely
gone. In such doubtful cases the treatment to be followed be-
comes more undetermined.
Such complaints are more common in the tonsils than in
any other part; for we often find that while a mercurial course
is going on, and the ulcer on the tonsils healing, or even heal-
ed, they shall swell, become excoriated, and the excoriations
shall sometimes spread over the whole palatum molle, which
renders the nature of the disease doubtful. I believe these ex-
coriations, as well as such other appearances of disease as come
on during the use of mercury, are seldom or never venereal.
In all such cases I would recommend not to continue the mer-
cury longer than what appears sufficient for overcoming the
original venereal complaints, not considering those changes
in the case as venereal. The bark is often of service here,
and may be given either with the mercury, or after the mercu-
rial course is over.
It often happens that venereal abscesses will not heal up, al-
though they have gone a certain length towards it; for while
the venereal action remained in the part, the mercury disposed
that

342 OF THE LUES VENEREA.
that part to heal; but under that course the constitution and
part had acquired another disposition, proceeding from a vene-
real and mercurial irritation affecting a particular habit of bo-
dy, or part, at the time, which new disposition differs from
the venereal, mercurial, and natural, being a fourth dispositi-
on arising out of all the three. I suspect however that it de-
pends chiefly on the constitution; because if it was owing to
the other two, we should always have the same disease; and
what makes this opinion more probable is, that it differs
in different people, at least it is not cured in all by the same
means. The constitution being predisposed, the other two be-
come the immediate causes of action. As soon as the venereal
irritation is destroyed by the mercury, or becomes weaker than
the other two, then the effects of the others take place. While
the venereal action prevails, the mercury is of service, and the
sore continues healing; but when it is lessened to a certain de-
gree, or destroyed, the mercury not only loses its powers,
but becomes a poison to the new disposition that is formed;
for if mercury is continued, the sore spreads, it should there-
fore be immediately left off.
Some of the sores, formed in this way, not only resist all
means of cure, but often inflame, ulcerate, and form hard cal-
lous bases, so as to put on the appearance of a cancer, and are
often supposed really to be so.
We find also that new diseases arise from the mercury alone.
The tonsils shall swell where no venereal disease has been be-
fore, the periosteum shall thicken, and also probably the bones,
and the parts over them shall become œdematous and sore to
the touch; but as these complaints arise while under a mercu-
rial course, they are not to be reckoned venereal, but a new
disease, although they are too often supposed to be venereal,
and on that account the mercury is pushed as far as possible.
In such cases if the complaints for which the mercury was giv-
en are nearly cured, and the medicine has been continued a suf-
ficient time after to complete the cure of those complaints,
then of course it should be left off; and if there be any doubt,
it should be left off rather sooner than if no such complaint had
taken place, because it is probably producing a worse disease
than the venereal; and if after the cure of these complaints
from the mercury, the venereal disease begins again to come
into action, mercury must be given a second time, and now
the

OF THE LUES VENEREA. 343
the constitution will be better able to bear it, especially if at-
tention has been paid to the restoring the strength of it. Those
diseases of the tonsils and periosteum, I suspect have something
scrofulous in them.
Besides, local complaints, arising from the combined action
of the mercury, the disease, and the constitution, there is some-
times a constitutional effect, which is a weakness, or debility,
a langour, want of appetite, frequent sweats threatening hec-
tic; but these happen mostly in those constitutions with which
mercury disagrees. These complaints, local as well as consti-
tutional, arise in some measure from weakness. They are dif-
ficult of cure, whether arising from a venereal chancre, bubo,
or the lues venerea. Strengthening medicines are of the most
service: the bark is of great use, though in general not suffi-
cient, as it can only more or less remove the weakness, the
specific qualities still remaining. What these are, is, I believe,
not yet known; but I suspect that many partake of the scro-
fula; and this opinion is strengthened by their frequently giv-
ing way to sea-bathing*.
I. GENERAL OBSERVATIONS ON THE MEDI-
CINES USUALLY GIVEN FOR THE CURE.
A DECOCTION of the woods, among which are common-
ly included guaiacum and sarsaparilla, is one of the first medi-
cines in the cure, and many of the cases yield to it, which gives
them the credit of curing the venereal disease, while such dis-
eases were supposed to be venereal. The sarsaparilla was often
given alone, and was found to produce nearly the same effect.
The good effects of it in one case gave it some reputation†. A
diet-drink discovered at Lisbon was also of considerable ser-
vice; and as it cured cases similar to those cured by the sar-
saparilla, it was imagined that the diet-drink consisted princi-
pally of a decoction of this root. This was still on the suppo-
sition that all those cases were venereal; but it was observed
at last that those medicines did not cure this disease till mercu-
ry
* In a case of an ulcerated rib from a venereal cause, and five nodes on the shin-bone,
of twelve months standing, a deep salivation of six months was undergone, after fruitless
attempts by gentle friction. None of the sores were healed by the mercury, and the pa-
tient was ordered to bathe in the sea, and take the bark. In three or four months the
sores all healed up very kindly; but the side last of all.
†See London Medical Essays, a case published by Mr. Fordyce, now Sir William
Fordyce.

344 OF THE LUES VENEREA.
ry had been given, and in tolerably large quantity. This was
sufficient to lead some thinking minds to doubt whether they
were venereal, or not; and their being cured by different me-
dicines ought to produce a conviction of their being different
from the venereal disease, and that they are themselves of dif-
ferent kinds.
The mezereon has also been found to be of service in some
symptoms of the lues venerea, such as nodes of the bones; but
their being venereal was taken for granted. The mezereon is
seldom given in venereal ulcers in the throat, or blotches on
the skin, which of all the venereal symptoms are the most cer-
tain, and the most easy of cure; yet it was conceived that it
removed such symptoms as are the most difficult of cure; but
all those cases in which the mezereon has been given with suc-
cess, plainly appear not to have been venereal.
When the hemlock came into fashion in this country, it
was given in almost every disease, and of course was tried in
some of those complaints consequent to the venereal disease;
and some of these it was found to cure, so that it now stands
upon the list of remedies. Velno's vegetable sirup has had
similar effects in some of these cases; and opium appears also
to have many advocates. Opium, like the sarsaparilla, and
mezereon, was supposed by its first introducers to cure the lu-
es venerea*, but, like the sarsaparilla, it appears to have no
effect till mercury has done its best, or its worst†. It has cer-
tainly considerable effects in many diseases, both in such as are
consequent to the venereal disease, and others arising from
other causes.
It has been long a favourite medicine of mine, not only as
relieving pain, for that is its common effect, but as a medicine
capable of altering diseased actions, and producing healthy ones.
In all sores attended with irritability, a decoction of poppy-
heads, made into a poultice, is an excellent application. Bleed-
ing sores that do not arise from weakness, but from irritability,
have the bleeding stopped immediately by this application. Mr.
Pott is, I believe, the first who showed the world its use in
mortifications. My first mode of applying it for the cure of
diseases was locally, in which I found it had most salutary ef-
fects in some cases, and it was ordered afterwards internally
upon
* See Medical Communications, vol. I, page 307.
† See a pamphlet published by Mr. Grant.

OF THE LUES VENEREA. 345
upon the same principle, and it was also found to have salutary
effects in this mode. In two cases that had been long suspected
to be venereal, its effects were very remarkable; and, by its
having cured them, it confirmed me in my opinion that they
were not. But when I was informed that they cured the vene-
real disease in the army in America by opium, I then began to
question myself, whether I had formed a right judgment of the
nature of those two cases which were cured by opium. To as-
certain whether opium would cure the lues venerea or not, I
made the following trial at St. George's Hospital.
A woman was taken into the hospital with blotches on her
skin, which had arrived to the state of scabs, with well-mark-
ed venereal ulcers on both tonsils. A grain of opium was or-
dered to be taken the first night, two the second, and so on,
increasing a grain every night, unless something should arise
to forbid it. This was closely followed till the nineteenth
night, when she was ordered a dose of physic as she had
become costive, and the opium was omitted. On the 20th
she began again, and continued increasing the dose, as before,
till it amounted to thirty grains, no alteration being produced
in the sores, except what arose from the loss of time, whereby
they were rather worse. I concluded, that if she had taken
mercury to affect the constitution as much as the opium did,
the venereal disease must have been nearly cured, or at least
much lessened; but as that was not the case, it convinced me
that the opium had no effect whatever on the venereal disease.
I then put her under a course of mercury, by friction, and in
a short time it affected her mouth; the sores soon began to look
better, and they went on healing without interruption, till the
disease was cured. I may just observe, the inconvenience from
the opium was not considerable; for although it kept her quiet,
she was not constantly dosing.
Luke Ward was admitted into St. Bartholomew's Hospital,
January 12, 1785; his complaint was an ulcer in the throat
of three months standing, which, both from its appearance,
and the symptoms which preceded it, seemed to be venereal.
He was ordered two grains of opium twice a day, which he took
a few days, without any other effect than that of sleeping better
at night than usual, when the dose was increased to two grains
three times a day. His throat now gave him less pain; but
upon inspection was not found to be at all mended. After two
Y y days

346 OF THE LUES VENEREA.
days the dose was increased to three grains thrice a day; from
this quantity he felt little or no inconvenience: he complained
of being a little drowsy; his eyes were rather inflamed, and
his face rather flushed. He continued to take this quantity for
five days, and then it was increased to three grains four times
a day. Next morning the redness and heat of his face was
much increased, and had extended over his whole skin; he
complained of pain in his head. His pulse was full and strong;
he was bound in his body, and his belly was tense and painful.
The opium was omitted, and such remedies as the present symp-
toms seemed to require were given, but without effect; all his
symptoms continuing to increase till he died, which was on the
fourth day after; during this time the ulcer increased much,
and the discharge of saliva was so great as to resemble a slight
salivation.
This case proves, in the first place, that the opium had no
effect upon the ulcer in the throat; and, in the next that it is a
medicine capable of producing very violent effects on the skin,
requiring therefore great caution in the mode of administer-
ing it.
John Morgan was admitted into St. Bartholomew's Hospital
with an ulcerated leg. The common applications were tried
for seven weeks, at the end of which time he was in every re-
spect worse, having no sleep from constant pain, and he was
sinking very fast. Two grains of opium were given every two
hours, for  twenty-three days; it made him hot and costive,
and his pulse became strong and full, but without sleep or abate-
ment of pain. The dose was increased to four grains every
two hours in the day, and eight grains every two hours during
the night. The effects were costiveness, retention of urine,
loss of appetite, an inflammatory disposition, no sleep, with-
out any amendment of the ulcer. On the third day of taking
the last mentioned quantities, he awoke from a short sleep, de-
lirious, and continued so for twelve hours, when it left him
very weak, sick at his stomach, and with a low pulse. In
three or four hours the delirium returned and continued forty-
eight hours; the pulse, on its return, immediately rose, and
his strength returned to a very great degree. When it went
off he fell into a sound sleep for about eight hours, and awoke
very tranquil, though weak; no more opium was given, and
the leg in the space of a month healed.
In

OF THE LUES VENEREA. 347
In the first twenty-three days he took twenty-four grains a
day; for the last three days he took seventy-two grains a day.
In twenty-six days he took seven hundred and sixty-eight,
which is nearly two ounces of opium.
Sarsaparilla, from the comparative experiment made with it
and the guaiacum, it would appear to have no effect upon the
venereal irritation itself, and therefore can be of no service till
that irritation is destroyed; and as mercury is the antidote to
that poison, and becomes one of the causes of the complaints
for which sarsaparilla is useful, therefore mercury is not only
necessary to destroy the poison, but also assists in forming the dis-
eases we are now treating of.
It is easy to conceive it in many cases to be of use in pre-
venting the formation of the disease arising from mercury.
When given along  with the mercury it is often joined with the
gum guaiacum, or the wood of the guaiacum, which we know
will have some effect.
The sarsaparilla is generally given in form of a decoction,
three ounces to three pints of water, boiled down slowly to a
quart, and the half or whole is drunk every day, generally at
three different times, often at meals. It is sometimes ground to
a powder and taken every day with the same effect; but I should
prefer the extract made into pills, as the easiest way of taking
this medicine.
In many of these cases I have seen good effects from the
hemlock, of which the following is an instance; and I would
further refer the reader back to the observations given of this
medicine when treating of the disease produced in consequence
of a bubo, page 260.
A poor woman had undergone repeated salivations, which
had always relieved the most pressing symptoms; but after that
she was afflicted more or less for three or four years, ulcers
broke out in her nose, and all over her face, with what is cal-
led a true cancerous appearance. The sores became soon ve-
ry deep, and gave very considerable pain. Mercury, sarsapa-
rilla, and bark were given, without effect; the sore getting dai-
ly worse, the parts affected were ordered to be held over the
steam of a decoction of hemlock every four hours, and as much
extract to be taken internally as the patient could bear. She
had sleep, and was free from pain the first night; and in a few
days the sores put on a healing appearance. She lost her nose
and

348 OF THE LUES VENEREA.
and one side of her mouth; but in six weeks time every part
was skinned over. She remained well for three months, when
the disease returned with redoubled violence and soon destroy-
ed her.
II. OF THE CONTINUANCE OF THE SPITTING.
IT sometimes happens that the spitting continues after there is
every reason for supposing the mercury is entirely out of the
constitution. As it is only a continuation of an action, or an
effect of mercury having been in the constitution, it is neces-
sary to distinguish it from the original, or from the immedi-
ate effect of mercury; since on this distinction rests the method
of cure. Such constitutions have been generally supposed scor-
butic; and where there is a great susceptibility of the mercuri-
al stimulus in these parts, the salivation will continue for months
after the mercury has been completely removed; but this me-
dicine not being given now in quantity sufficient to produce
such violent effects on the salivary glands, these cases seldom
occur.
In such cases I would recommend strengthening diet, and
strengthening medicine. Sea-bathing is one of the best restor-
atives of relaxed habits, especially after mercury. Mead's
tincture of cantharides is supposed to be of service in those cases.
The alveolar processes have sometimes become dead, and ex-
foliations have taken place; and this alone has kept up a dis-
charge of saliva. When this happens, we must wait till sup-
puration takes place, and extract the loose pieces, after which
the salivation will subside.
I have seen part of the jaw exfoliate from this cause. In
most cases the teeth are loose; and in many they drop out.
CHAPTER

OF THE LUES VENEREA. 349
CHAPTER V.
OF PREVENTING THE VENEREAL
DISEASE.
AS diseases in general should not only be cured, but, when
it is possible, prevented, it will not be improper to show,
as far as we know, how that may be done; for in this disease
we can with more certainty prevent infection, its origin being
known.
Preventives are previous or immediate applications, and may
be divided into various kinds; as those that will not allow the
venereal matter to come in contact with the parts; those which
wash it off before it stimulates; and those which will act che-
mically and destroy the poison.
Oils rubbed on a dry part, stick to it and prevent any thing
that is watry from coming in contact with it; and as the vene-
real poison is mixed with a watry fluid, it is not allowed to
touch the part.
Every thing which has a power of mixing with the venereal
matter, and removing it from the part to which it is applied,
may prove a prevention. Caustic alkali is the best for this
purpose; it unites with the matter, forming a soap, and is
then easily washed off.
It is possible this union with the alkali may destroy the poi-
son; the alkali must be much diluted, or it will excoriate.
Lime-water would make a good wash.
If both these methods were put in practice, there would be
still more security.
Corrosive sublimate in water, about a grain or two to eight
ounces, has been known to prevent the catching of the disease.
PART

[350]
PART VII.
CHAPTER I.
OF DISEASES RESEMBLING THE LUES
VENEREA, WHICH HAVE BEEN
MISTAKEN FOR IT.
THERE is probably no one disease to which some other
may not bear a strong resemblance in some of its ap-
pearances or symptoms, whereby they may be mistaken for
each other. The situation of a complaint also may mislead the
judgment. A lump, for instance, in the breast of a woman,
may resemble a cancer so much as to be mistaken for one, if
all the distinguishing marks of cancer are not well attended to.
An ulcer on the glans penis, or in the throat, and nose, creates
a suspicion of the venereal disease. Even the way in which a
disease is caught becomes a cause of suspicion. The fluor al-
bus in women sometimes produces a simple gonorrhœa in men.
Drinking out of the same cup, with a venereal patient, was
formerly supposed to be capable of communicating the lues ve-
nerea; but this notion is, I believe, now exploded. Of late
years a new mode of producing the venereal disease is supposed
to have arisen; this is by the transplanting of a tooth, from the
mouth of one person into the mouth of another. That such
practice has produced disease, is undoubted; but how far it has
been venereal, remains to be considered.
Diseases which resemble others, seldom do it in more than
one or two of the symptoms; therefore, whenever the nature
of the disease is suspected, the whole of the symptoms should
be well investigated, to see whether it agrees in all of them
with the disease it is suspected to be, or only in part. This
observation seems to be more applicable to the venereal dis-
ease than any other; for there is hardly any disorder that has
more diseases resembling it in all its different forms than the
venereal

DISEASES RESEMBLING, &c. 351
venereal disease; and when a disease resembles the venereal in
some of its symptoms, but not at all in others, then those other
symptoms are to be set down as the specific or leading ones of
the disease to which it belongs; the resembling symptoms to
the venereal being only the common ones. But if a disease
is suspected to be venereal, though it is not perfectly marked,
yet if it resembles the venereal in most of its symptoms, it must
be supposed to be venereal, that being the most probable, al-
though it is by no means certain; for probably the venereal
can hardly be demonstrated in any case, especially in the form
of the lues venerea, from its not having the power of con-
tamination.
Although the venereal disease keeps its specific properties
distinct in its several forms, yet its symptoms are in appearance
common to many other diseases, and in that light it cannot be
said to have any one symptom peculiar to itself. For instance,
every symptom of the venereal disease, in form of a gonorrhœa,
may be produced by any other visible irritating cause; and
often without any cause that can be assigned; even buboes and
swelled testicles, which are symptoms of this disease, have fol-
lowed both stimulating injections and bougies, when applied to
the urethra of a sound person; and indeed these two symp-
toms, when they do arise from a venereal cause, in many
cases, are only symptomatic, not specific, but more especially
the swelled testicle.
Sores on the glans penis, prepuce, &c. in form of chancres,
may, and do arise without any venereal infection; although
we may observe that they are in general a consequence of
former venereal sores which have been perfectly cured.
The symptoms produced from the infection, when in the
constitution, are such as are common to many other diseases;
viz. blotches on the skin are common to what is called scorbutic
habits; pains common to rheumatism, swellings of the bones,
periosteum, fasciæ, &c. to many bad habits, perhaps of the scro-
fulous and rheumatic kind. Thus most of the symptoms of the
venereal disease, in all its forms, are to be found in many other
diseases; therefore we are led back to the original cause, to a
number of leading circumstances, as dates, and its effects upon
others from connection when only local, joined with the pre-
sent appearances and symptoms before we can determine abso-
lutely what the disease truly is; for all these taken together,
may

352 DISEASES RESEMBLING
may be such as can attend no other disease. However, with
all our knowledge, and with all the application of that know-
ledge to suspicious symptoms of this disease, we are often mis-
taken, often calling it venereal when it is not; and sometimes
supposing it to be some other disease when it is venereal.
Rheumatism, in many of its symptoms, in some constitutions,
resembles the lues venerea; the nocturnal pains, swelling of
the tendons, ligaments, and periosteum, and pain in those swell-
ings, are symptoms both of the rheumatism and the venereal
disease, when it attacks those parts: I do not know that I ever
saw the lues venerea attack the joints, though many rheumatic
complaints of those parts are cured by mercury, and therefore
supposed to be venereal.
Mercury, given without caution, often produces the same
symptoms as rheumatism; and I have seen even such supposed
to be venereal, and the medicine continued.
Other diseases shall not only resemble the venereal in appear-
ance, but in the mode of contamination, proving themselves to
be poisons by affecting the part of contact, and from thence pro-
ducing immediate consequences similar to buboes; also remote
consequences similar to the lues venerea.
As errors in forming a judgment of a disease lead to errors
in the cure, it becomes almost of as much consequence to avoid
a mistake in the one as in the other; for it is nearly as dan-
gerous in many constitutions to give mercury where the disease
is not venereal, as to omit it in those which are; for we may
observe, that many of the constitutions which put on some of
the venereal symptoms, when the disease is not present, are those
with which mercury seldom agrees, and commonly does harm.
I have seen mercury given in a supposed venereal ulcer of the
tonsils, produce a mortification of those glands, and the patient
has been nearly destroyed.
When treating of the lues venerea, and giving the symptoms
and general appearances of the disease, I related some cases
which appeared to be venereal, though they really were not;
and I shall now refer the reader to these, as it will be unne-
cessary to give them again here, although if they had not been
formerly taken notice of, this would have been a very proper
place.
As the diseases in question are various, and not to be reduced
to any system or order that I am acquainted with, I shall con-
tent

THE LUES VENEREA. 353
tent myself with relating the cases, and thereby put it in the
power of others to judge for themselves, if they should not be
inclined to adopt the conclusions I have drawn from them.
On the 28th of July, 1776, a gentleman, when in the West
Indies, scratched the end of his finger with a thorn. On the
31st he opened an abscess on the shoulder of a negro woman
who had the yaws, and had been long subject to such abscesses
in different parts of the body, and to incurable ulcerations af-
terwards. At the instant after the operation, he perceived a
little of the matter upon the scratch, and exclaimed that he was
inoculated. On the 2nd of August, he amputated a boy's fin-
ger, of thirteen years of age, for a sore resembling worm-eat-
en wood. The scratch on his finger did not heal, but from
time to time threw off whitish scales: this appearance alarmed
him, and he rubbed in mercurial ointment very freely. Not-
withstanding this, in the month of September, a painful inflam-
ed tumor appeared on the second joint of the finger, which was
soon followed by several others on the back of the hand, in the
course of the metacarpal bone of the fore-finger. He still con-
tinued the mercurial friction, but without effect, for the tu-
mors daily multiplied; and by the month of November extend-
ed to within a small distance of the axilla. They did not go on
to suppuration at this time. About the end of November he
began to be affected with severe nocturnal pains in different parts
of the body, but especially along the tibia and fibula, with fre-
quent severe headachs, which continued to increase to an al-
most intolerable degree for five months, though he used mer-
curial friction, with decoction of sarsaparilla every day in great
quantity.
In the month of May 1777, a scabby eruption appeared in
different parts of the body, especially the legs and thighs, and
the before-mentioned tumors ulcerated; but this was followed
by a remission of the nocturnal pains.
He never could bring on a salivation, though his mouth
was constantly tender, even for months. The ulcerations be-
came daily worse, and a voyage to England was thought the on-
ly resource. He arrived in London the 1st of August, and by
the advice of Dr. William Hunter and Sir John Pringle he
began again a course of mercury and sarsaparilla, with a milk
diet. I was called in, and judging that two thirds of a grain
of mercurius calcinatus, every day, was too small a dose, if it
Z z were

354 DISEASES RESEMBLING
were judged to be venereal, it was ordered to be gradually in-
creased to five grains; and he continued this course till No-
vember, when all the sores were perfectly cured.
He now discontinued the mercury, and remained free from
all symptoms of the disorder, except some nodes on the tibia,
and rheumatic pains on exposure to cold, until about twelve
months ago, when he began to have an uneasiness in swallow-
ing, a rawness in the throat, and a discharge of viscid mucus
from that and the posterior nostrils, all of which still continue.
The following observations may be made on the above case:
There can be little doubt that the disease was the yaws.
The yaws are a disease that resembles the venereal in several of
its symptoms, as well as in the manner in which it is most
commonly communicated. It differs, however, in some es-
sential particulars. The yaws have a regular progress, after
going through which they leave the constitution in an healthy
state, at least free from that disease; it being sufficient for the
cure that the patient be put in a state favourable to general
health. Thus, a negro labouring under the disease must do
little or no work, be kept clean, and have a better diet than
usual. Under these circumstances, he commonly gets well in
from four to nine months; although the unfavourable cases
will continue much longer. Various medicines are given for
the cure, but it is not clear that any of them do good. Mer-
cury has considerable power over the disease, without being a
specific for it. If given early it will either check the progress
of the disease, or perhaps even heal up all the sores on the
skin; but nothing is gained by this, for the disease soon breaks
out anew. Some practitioners of medicine in the West Indies,
are of opinion that interrupting the course of the disease by
mercury is productive of no other evils than those of loss of
time, and an imperfect cure; others affirm, that it is often the
cause of what they call the bone-ach. Towards the end of the
disease it is generally allowed that mercury may be given safe-
ly, and even with advantage. It is probable the long continu-
ance of the disease being above fourteen months, and also the
pains in the bones in the present case, were owing to the very
early and free use of mercury. It may be allowable to add,
that the yaws do not differ more from the venereal disease in
curing themselves, than in this circumstance, that, like the
small-nox, they affect none a second time.
A gentle-

THE LUES VENEREA. 355
A gentleman applied to me for the cure of chancres, seat-
ed on the attachment of the prepuce to the penis, and also on
the frænum. Mercury was used chiefly by friction, in order
to affect the constitution; it was also applied to the sores, in
order to affect them locally. The cure of the chancres went
on gradually and without interruption; and in about five weeks
they were perfectly healed. He almost immediately had con-
nection with a woman, and long before we could suppose the
mercury had all got out of his constitution. In a very few
days after the first connection, the prepuce began to be chop-
ped all round on the edge of its reflection. He continued his
connection, and upon its growing worse he applied to me, and
I found the chops very deep, and the prepuce there so tight
and sore that he could not bring it back upon the penis. The
question now was, whether this was venereal or not? The
sores themselves did not appear to be so; but more was to be
taken into the account than simply appearances. It was first
to be considered, whether it might possibly be a return of his
former complaint. This could not be the case, because the
sores were not in the same parts. It was next to be question-
ed, was it possible for this part of the prepuce to have been
contaminated at the same time with the former, and the poi-
son not to have come into action till now, having been pre-
vented by the course of mercury, which had not cured the dis-
position? This could not be well answered, although not pro-
bable, because the poison appeared to come too soon into ac-
tion after the leaving off of the medicine; for I did suppose
there was still a great deal of mercury in the constitution. Was
it then possible for him to have caught it from the woman?
This, I supposed, could not have been the cause of these chops,
whatever effect this connection might have to render them ve-
nereal hereafter; for they appeared too soon after it, especi-
ally as he had mercury in his constitution at the time, and as
the parts had been accustomed to the application of venereal
matter but a very little time before. Although, from all cir-
cumstances taken together, I was convinced the case was not
venereal, yet an apprehension arose in his mind concerning
the possibility of having given it to the lady, as he had con-
nection after the first appearance of the sores. I was equally
convinced of the impossibility of the one as of the other, there-
fore desired him to rest easy on that head. He went immedi-
ately

356 DISEASES RESEMBLING
ately into the country, and nothing being done for those chops,
they got perfectly well. In less than a fortnight after this con-
nection, the lady became a little indisposed with a slight fever;
and a swelling came in one of her groins. I watched the pro-
gress of this swelling, which was slow, and I did not believe
it to be venereal. It at last formed matter and broke, and a
poultice was applied to it. Instead of ulcerating or spreading,
it rather had a healing disposition, and in about six weeks it
was perfectly well. While it was healing, scurfy eruptions
came out on the skin, some on the face and thighs, but more
especially on the hands and feet, where the cuticle peeled off.
Upon the first appearance of these, I was a little staggered;
but as the sore was healing, I was unwilling to give credit to
the appearance, and therefore begged that nothing might be
done; and they all got well.
From the general outline of these cases, one would natural-
ly have said, they were venereal; but the particular circum-
stances being all investigated, and the whole taken together,
led me to suppose that they were not, and the event proved
that to be the case.
The following case was communicated by Mr. French of
Harpur street.
"June the 9th, 1782, a gentleman applied to me for an
ulcer which was seated on the glans penis, attended with ex-
cessive pain. Knowing him to be an intemperate man, and
learning from himself, that during a state of intoxication he
had been connected with a woman, I judged the complaint to
be venereal. He was now in a feverish state and unfit for the
exhibition of mercury; I therefore prescribed for him decoction
of bark, with elixir of vitriol and tinctura thebäica, proporti-
oned to his pain. I directed him to abstain from every kind
of fermented liquor; to live chiefly upon milk, and to wash
the ulcer with a liniment composed of equal parts of oil of
almonds and aqua sapphirina.
"About the 17th of the same month, some check having
been given to the fever, the sore looking cleaner, and his pain
having abated, I ordered him small doses of the argentum vi-
vum and extract of hemlock.
"July the 4th, finding the mercurial course disagree, I or-
dered three grains of the extract of hemlock to be taken two
or three times a day, and the decoction of bark to be taken as
before,

THE LUES VENEREA. 357
before, with twenty drops of tinctura thebäica, which was gra-
dually increased to sixty, at bed-time.
"The ulcer had spread very much during the mercurial
course, and had now destroyed half the glans penis.
"October 1st, Mr. Hunter was consulted, and ordered the
patient to add the powder of sarsaparilla to the decoction of
bark, to take laudanum freely, and wash the sores with tinctu-
ra thebäica. Soon after beginning this course, the remainder
of the glans penis sloughed off; the parts gradually healed;
and health was restored.
"There were two other symptoms in this case which de-
serve to be taken notice of; a considerable enlargement of the
scalp on the right side of the os frontis, and on the left parie-
tal bone, attended with excessive pain; and vibices resembling
the sea-scurvy on the inside of the left tibia, both of which
disappeared in the course of the cure.
"Some months after, the tumor in the head returned, and
several abscesses were formed, which were opened, and the
cranium found carious to a great extent. On account of the
pain, he has for some months past taken two hundred and for-
ty drops of laudanum, and six grains of opium daily. These
sores healed up, and others broke out in different parts of the
head, which also got well; and in June 1785, there was on-
ly one large ulcer in the angle of the right eye."
A lady was delivered of a child on the 30th of September
1776. The infant being weakly, and the quantity of milk in
the mother's breasts abundant, it was judged proper to procure
the child of a person in the neighbourhood to assist in keeping
the breasts in a proper state. It is worthy of remark, that the
lady kept her own child to the right breast, the stranger to the
left. In about six weeks the nipple of the left breast began to
inflame, and the glands of the axilla to swell. A few days
after, several small ulcers were formed about the nipple, which,
spreading rapidly, soon communicated and became one ulcer,
and at last the whole nipple was destroyed. The tumor in the
axilla subsided, and the ulcer in the breast healed in about three
months from its first appearance. On inquiry, about this time
the child of the stranger was found to be short breathed; had
the thrush; and died tabid, with many sores on different parts
of the body. The patient now complained of shooting pains
in different parts of the body, which were succeeded by an
eruption

358 DISEASES RESEMBLING
eruption on the arms, legs, and thighs, many of which be-
came ulcers.
She was now put under a mercurial course, with a decocti-
on of sarsaparilla. Mercury was tried in a variety of forms,
in solution, in pills internally, and externally in the form of
ointment. It could not be continued above a few days at a
time, as it always brought on fever or purging, with extreme
pain in the bowels. In this state she remained till March 16,
1779, when she was delivered of another child in a diseased
state. This child was committed to the care of a wet nurse,
and lived about nine weeks. The cuticle peeling off in vari-
ous parts, and a scabby eruption covering the whole body.
The child died.
Soon after the death of the child, the nurse complained of
headach and sore throat, together with ulceration of the breasts.
Various remedies were given to her, but she determined to go
into a public hospital, where she was salivated, and after some
months she was discharged, but not cured of the disease. The
bones of the nose and palate exfoliated, and in a few months
she also died tabid.
Of the various remedies tried by the lady herself, none suc-
ceeded so well as sea-bathing. About the month of May she
began a course of the Lisbon diet-drink, and continued it with
regularity about a month, dressing the sores with laudanum, by
which treatment the sores healed up; and in September she was
delivered of another child, free from external marks of disease,
but very sickly; and it died in the course of the month.
About a twelvemonth after, the sore broke out again,
and although mercurial dressings and internal medicines were
given, remained for a twelvemonth, when they began again to
heal up.
The following cases being all derived from one stock, show
as much as possible, that new poisons are rising up every day,
and those very similar to the venereal in many respects, although
not in all; therefore it is the want of similarity that becomes
the criterion to judge by, and not the similarity. The parents
of the child, who is the subject of the following history, were
and are to all appearance healthy people. The child was weak-
ly when born; and the mother having little or no milk, when
it was three weeks old she gave it to a nurse whose milk was
then seven months old, and was giving suck to her own child.
The

THE LUES VENEREA. 359
The foster-mother allowed her own to suck the right breast,
while the other sucked the left.
The nurse observed that the skin of the foster-child began to
peel off; but no rawness or soreness took place except about
the anus, where it looked as if scalded. The same kind of
peeling took place on the lips, but they did not appear to be
sore, although the people in the country said it was the thrush.
The inner surface of the mouth and tongue appeared sound.
In a fortnight after her receiving the child it died, and then she
allowed her own child to suck both breasts for three weeks; at
the end of which she came to town to nurse a gentleman's child.
She gave suck to this second child; but after being in town
about ten or eleven days, she did not feel herself perfectly well;
which made them suppose that the new mode of life, confine-
ment in town, and probably better living, might not agree with
her, and she went into the country and took the gentleman's
child with her. About three or four days after she went to the
country, for instance, about a fortnight after she took this child,
and five weeks after the death of the first child, her left nipple,
which the first nursed child had always sucked, began to be sore,
so that she could not let the child suck it. This ulcer on the
nipple became extremely painful; and in a day or two erup-
tions came out on her face, and soon after all over her body,
but most on her legs and thighs. They continued coming out
for about a fortnight, and had at first very much the appear-
ance of the eruptions of the small-pox, on the third day of their
eruption were attended with fever, universal uneasiness, and
great pain.
Two or three days after the eruption on the skin appeared,
one of the glands of the arm-pit began to swell, and formed
matter, and was opened within a fortnight after its first appear-
ance, and healed almoft directly. Some of the eruptions in-
creased fast and become very broad sores, nearly of the size of
a half-crown, especially on the legs and thighs, and were co-
vered with a broad scab; many remained small and only ap-
peared like pimples. About a fortnight after the first appear-
ance of the eruption, some began to die away; and in four
weeks more after this appearance, a foul ulcer attacked the left
tonsil.
The surgeon in the country, from all these circumstances,
finding he could not get any ground by the before-mentioned
treatment.

360 DISEASES RESEMBLING
treatment, determined to give her the solution of corrosive sub-
limate, of which he gave half a grain in solution night and
morning; in about a week there seemed to be a stop put to the
swelling of the ulcers, and the discharge to be somewhat lessen-
ed, the ulcer in the throat putting on a better appearance.
It was at this period I first saw her, which was about six
weeks after the first appearance of the eruption, and a fortnight
after the appearance of the ulcer in the tonsil. The eruptions
were then very much as before-described; but the ulcer in the
tonsil was clean and healing. From the history of the case I
did conceive it not to be venereal; I therefore desired that all
medicines might be left off, which medicines could only have
been taken for a fortnight at most, because it was after the appear-
ance of the ulcer on the tonsil the mercury was given, which
was only of a fortnight's standing when I saw her. She soon
after recovered.
After being well for some time, she again applied to the sur-
geon in the country, an abscess having formed where the com-
plaint first began in the breast, attended with fresh eruptions on
the face.
The abscess was opened, and it healed up in a few days, and
upon taking some cooling physic the eruptions disappeared. She
has continued very well ever since, without any other bad ef-
fect than the total loss of her nipple. This case was certainly
understood to be venereal.
About five days after the appearance of the eruption on the
nurse, the gentleman's child was taken away and given to a
healthy woman of a florid complexion, aged twenty-four years,
and who had lain in with her first child eleven months when
she became wet nurse to this child. After a few days she ob-
served eruptions on the child's head, not unlike those already
described on the first nurse which it had sucked. Its mouth soon
after became excoriated, so that it sucked with difficulty. Af-
ter a short time those eruptions on the head became dry and
peeled off, others appeared on the face, knees and feet, but
wholly unlike the former, as the first maturated, while the
latter appeared only cutaneous, peeling off and leaving a cir-
cumscribed spot of a light dun colour, which continued increas-
ing for five weeks. These eruptions continued nearly three
months from their commencement, at which period the child
was extremely emaciated; but no particular treatment was in-
dicated,

THE LUES VENEREA. 361
dicated, so no medicine was exhibited, and in a few weeks af-
ter it came to London and got perfectly well.
The second nurse, a few days after giving suck to the child,
had blotches appear on her left breast, precisely the same with
those on the first nurse; with this difference only, that they
were fewer in number, and attended with a greater degree of
phlegmonous inflammation. They continued, and increased
in size for seven or eight days; then the nipple of the same
breast became ulcerated; the ulceration spreading so much as
to endanger the loss of it; her thighs now became diseased, and
afterwards her legs.
She suckled this child about twelve weeks. The disease
seemed no longer to increase, and in twelve or fourteen days
after this entirely disappeared, without her taking any medicine,
except a few ounces of the decoction of the bark. The only
application to the breast was unguentum simplex.
The milk at this time became so small in quantity, that they
were under the necessity of providing a third wet nurse for the
child, and the second returned to the country. Her own child
being weaned, she had no further occasion for the milk, and
in a few days it wholly disappeared; but by way of amusing the
child when peevish, she allowed it to take the nipple, which
had been diseased, in its mouth; the consequence was, that
in a few days this child also became diseased in like manner
with the former. She now applied to an eminent surgeon for
assistance, who not being acquainted with the history, suppos-
ed it venereal, and ordered a colourless medicine, supposed,
from circumstances, to be the solution of sublimate, sixteen
grains to half a pint of water; the dose a table-spoonful. She
took this medicine as directed, and also gave it to her husband
and child; the child a tea-spoonful only at a time. While
taking this medicine she got well.
The third wet nurse, like the former, was in a short time
affected, but the blotches in this case were still fewer in num-
ber, the disease appearing to lose considerably in its power, as
each fresh infection became less malignant than the former.
She got well without taking any medicine.
A a a I. OF

362 DISEASES RESEMBLING
I. OF DISEASES SUPPOSED TO BE VENEREAL
PRODUCED BY TRANSPLANTED TEETH.
SINCE the operation of transplanting teeth has been prac-
ticed in London, some cases have occurred in which the vene-
real infection has been supposed to be communicated in this
way; and they have been treated accordingly; nor has the
method of cure tended to weaken the suspicion: yet, when all
the circumstances attending them, both in the mode of catch-
ing the disease, and in the cure when they have been treated
as venereal, are considered, there is something in them all
which is not exactly similar to the usual appearance of the ve-
nereal disease when caught in the common way; especially too
when it is considered that some of the cases were not treated
as venereal, and yet were cured; and therefore, the cures of
the others which appeared to be from mercury, are not clear
proofs of their having been venereal*.
I believe that I have seen most, if not all the cases of this
kind which have occurred, and have attended some of them.
In all of them the time of local affection, after the insertion of
the tooth, has been almost regularly a month, which is too
long for the venereal to take effect at a medium; and where
they have produced constitutional symptoms, those again have
either followed the local too close for the venereal, or too re-
gular as to time. But it may be advanced, that a disease has
been produced probably as bad in its consequences as the vene-
real. That a disease has been formed in this way is certain.
The first case of this kind which came under my care, was
a lady who had one of the bicuspidati transplanted. The trans-
planted tooth fastened very well. About a month after, she
danced till five or six o'clock in the morning, caught cold, and
had a fever in consequence, which lasted near six weeks. In
this time ulceration in the gum and jaw took place, though it
was then not known. And when she was beginning to recover,
it was found that not only the gum and socket of this tooth
were
* It is to be remarked here that I do not, in the present case, lay any stress at all on
my opinion of the lues venerea not having the power of contamination; and I believe we
must allow if the disease were venereal, it must have been contracted from a lues venerea
in the person from whom the tooth was taken; for chancres are not common in the
mouth, and they would be seen on examination. I believe few discharges similar to go-
norrhœa take place there.

THE LUES VENEREA. 363
were diseased, but also those of the teeth next to it. The two
teeth were taken out, and the sockets of both afterwards exfo-
liated; but the parts were very backward in healing. This
backwardness gave rise to various opinions, the principal of
which was, that it was venereal. In the mean time a rising
appeared upon one of the legs, which was of the indolent node
kind; this was also suspected by some to be venereal, or rather
was a corroborating circumstance of the former opinion; but
I gave it as my opinion that it was not. I desired she might
go to the sea and bathe, which she did, and got perfectly well,
both in the jaw and leg, and has continued so ever since.
The second case of this kind I have seen was also in a young
lady: the transplanted tooth fastened extremely well, and con-
tinued so for about a month, when the gum began to ulcerate,
leaving the tooth and socket bare. The ulcer continued, and
blotches appeared upon the skin, and ulcers also in the throat.
The disease was treated as venereal, the complaints gave way
to this course, but they recurred several times after very severe
courses of mercury: however, she at last got well.
The only observation I can make on this case is, that the
symptoms recurred after continued courses of mercury, much
oftener than is usual in venereal cases; and I had my suspici-
ons all along that it was scrofulous.
The third case was of a gentleman, where the transplanted
tooth remained, without giving the least disturbance, for about
a month, when the edge of the gum began to ulcerate, and the
ulceration went on till the tooth dropped out. Some time after,
spots appeared almost every where on the skin; they had not
the truly venereal appearance, but were redder, or more trans-
parent, and more circumscribed. He had also a tendency to
a hectic fever, such as restlessness, want of sleep, loss of appe-
tite, and headach. After trying several things, and not finding
relief, he was put under a course of mercury, and all disease
disappeared according to the common course of the cure of the
venereal disease, and we thought him well; but some time
after, the same appearances returned, with the addition of swel-
ling in the bones of the metacarpus. He was now put under
another course of mercury more severe than the former, and
in the usual time all the symptoms again disappeared. Seve-
ral months after, the same eruptions came out again, but not
in

364 DISEASES RESEMBLING
in so great a degree as before, and without any other attendant
symptoms. He a third time took mercury, but it was only
ten grains of corrosive sublimate in the whole; and he got
quite well. The time between his first taking mercury, and
his being cured, was a space of three years.
Query: Could this case be venereal? The two first courses
of mercury removing the eruptions, would seem to prove it
was; but the third course also removing them, which consist-
ed of only ten grains of corrosive sublimate, would seem to
prove that it could not be venereal; for if it had, the appear-
ances which returned after the second course, in which a con-
siderable quantity of mercury had been given, would not have
yielded to ten grains.
The fourth case was that of a young lady who had a tooth
transplanted, and about the same distance of time after it as
mentioned in the former cases, the gum began to ulcerate, and
the ulceration was making considerable progress. The surgeon
who was first consulted desired mercury to be given immedi-
ately. I was afterwards desired to see her, and advised that
mercury should not be had recourse to, that we might ascer-
tain the nature of the case; for if she took mercury and got
well, it would be adding one more to the number of the sup-
posed venereal cases arising from such a cause. I recommend-
ed drawing the tooth, that we might see what effects would be
produced by the removal of the first cause.
The tooth was drawn, and the gum healed up as fast as any
common ulcer, and has ever since continued well.
This case requires no comment. I may, however, be allow-
ed to observe, that if the lady had gone through a course of
mercury, she would have, in all probability, also got well; for
the tooth, in the time necessary for compleating the course of
mercury, would have dropped out; and if this had really hap-
pened, we need not hesitate in affirming, that it would have
been considered as venereal.
The fifth case was that of a young lady, eighteen years of
age, who had one of the incisores transplanted, which fastened
very well; but six or seven weeks after the operation, an ul-
ceration of the gum took place, the tooth was immediately or-
dered to be removed, and the bark was given without any other
medicine, and she got well in a few weeks.
The

THE LUES VENEREA. 365
The sixth case was that of a gentleman, aged twenty-three,
a native of one of the West India islands, who had the two front
incisores transplanted; and about the same time after the ope-
ration, as in the former cases, an ulceration of the gums took
place, which increased to a very great degree, and the edges
of the gum sloughed off. An eminent surgeon was consulted,
who ordered the bark, and the patient, without taking any other
medicine, got well, in nearly the same time as the ladies in
cases four and five, who had the teeth taken out. The gums
recovered themselves perfectly, but were considerably shorter.
If we take some of the above cases, and consider them as
they at first appeared, we shall almost pronounce them to have
been venereal. If we take the others, we shall pronounce them
absolutely not to be venereal; and if we consider every cir-
cumstance relating to those probably venereal, we shall, as far
as reasoning goes, conclude that they were not venereal. The
first case that appeared at the time to be venereal, is the second
of those before related; but as I did not attend the lady through
the whole of the cure, I can say less upon it; she certainly
had the symptoms recur oftener than they do in venereal cases
in common, where the disease is attended with no ambiguity,
and took more than the usual quantity of mercury; there is
therefore in this case something not clearly understood, because
it does not exactly agree with venereal cases in general in all
its parts.
The fourth case was similar in its recurring, and in the
quantity of mercury that appeared to be necessary to remove
the symptoms.
The most serious effects of the transplanting of a tooth hap-
pened to a young lady, and are related in the Medical Trans-
actions by the late Sir William Watson.
The dentist being alarmed at the first appearance, desired me
to go and see her upon his own account. The edge of the gum
had just then begun to ulcerate. As I did not know well what
was best to be done, I desired him to make a strong solution
of corrosive sublimate, and let the mouth be often washed with
it, and also to apply some lint, soaked in it, to the part; but
as this did not stop its progress, she applied to Sir William
Watson, to whose account of the case I must refer the reader,
and from that account I must take my materials to reason up-
on.

366 DISEASES RESEMBLING
on. However, I may remark, that the case appears to have
been supposed at last to have been venereal, whatever might
have been the first opinion, and for the two following reasons;
first, from the mode of catching the disease being possible; and
secondly, from its not giving way to medicines which are of
no service in the venereal disease; and this opinion appears to
have been confirmed by the disease giving way to mercury.
But the case itself, abstracted from the mode of catching it,
and even the mode of cure, does not perfectly agree with the
common attending circumstances of the venereal; nor has that
attention been paid to the necessary circumstances sufficient to
determine it to be venereal.
The progress of the ulceration in the mouth, which was the
first symptom, was by much too rapid for a venereal ulcer in
common; for it must be considered, if venereal, simply as a
chancre, or local affection.
Now let us trace the progress of the disease into the consti-
tution. "About this time," viz. when the local disease was
making such rapid progress, "blotches appeared in her face,
neck, and various parts of the body; several of these became
ulcerated painful sores*." Now this date of the constitutional
affections following the local, is by much too soon to be ve-
nereal; we know if a lues venerea arises either from a gonor-
rhœa or chancre, it does not appear in common till about six
weeks, often much later, but seldom sooner. I do not count
much upon the circumstance of there being no swelling of the
lymphatic glands of the neck, forming buboes, as that is not
a constant symptom attending the venereal matter getting into
the circulation, although it should be allowed to have some
weight, especially where other circumstances do not perfectly
agree. The appearances from the constitution, when they did
take place, were much more violent and rapid in their progress
than any venereal blotches I ever saw: we know in the lues
venerea that they are months before they arrive at the stage of
scabs; also the pain attending those sores did not in the least
correspond with the lues venerea. Venereal blotches hardly
give any sensation, or at least very little; but after all, mercu-
ry cured this disease, whatever it was: twenty-eight grains of
calomel, made into fourteen pills, was taken, probably, in ten
or
* Medical Transactions, vol. 3, page 328.

THE LUES VENEREA. 367
or twelve days; for it was directed she should take one or two
each day, as the bowels would allow; but although tinctura
thebäica was given, they purged so much as made it necessary
to give no more in this way; but although so little mercury
was taken, and had also run off considerably by the bowels, yet
"The ulceration of her mouth and cheeks did not spread, but
were less painful and of a milder appearance; the blotches in
her face and body grew paler, and such of them as had ulce-
rated healed apace and no new ones appeared. Unguent cœru-
leum fortius" was therefore directed "to be well rubbed into
her legs and thighs twice a day, in small doses;" lest it should
be determined to the bowels. "In about ten or twelve days
her griping and purging returned with violence, the ointment
was therefore discontinued; at this time the blotches were all
gone; the ulceration in her face and body were completely
healed, and those of her mouth nearly so."
The only remark I have to make on the cure is, that the
quantity of mercury was not sufficient to cure chancres on the
penis, making such rapid progress as those did in her mouth;
nor could the same quantity of mercury cure venereal sores on
the skin, which had made such rapid progress as they did in
this case; and if we take in the effect this had upon her health,
with the termination of the whole, I think we should pronounce
it not venereal; for the specific circumstances, if it was vene-
real, were just as uncommon as the mode of catching it.
Many of these cases, suspected of being venereal, I have
seen occasionally; and although the patients recovered while
under a course of mercury, yet on account of the want of at-
tention in the practitioners to the very circumstances that would
decide the disease to be either venereal or not, I pass them over
unnoticed.
After having considered the cases themselves of those who
had the teeth transplanted, let us also consider the persons from
whom the teeth were taken; for I cannot help thinking that
this will throw some light upon the subject. Let me suppose
that the young girls from whom the teeth were taken really had
the lues venerea, and that the teeth were of course also infect-
ed, which is a supposition most unfavourable to my real opi-
nion, it appears to me, that even in this case there can be no
difference between the gums of the girl from whom the tooth
was

368 DISEASES RESEMBLING
was taken, and the gums of the person who received it: if the
ulceration took place in the last from contamination, would
not the socket in the girl from whom the tooth was taken like-
wise have ulcerated? But this did not happen in any of them.
I have here supposed the teeth capable of being contaminated;
although I believe we have never yet seen them have this disease
primarily, but only in consequence of its breaking out some-
where else, in the mouth, throat, or nose, and spreading to
them; but still, if they are capable of having the disease, and
communicating it to others, it becomes very extraordinary that
those people should have hit upon the few teeth that probably
were ever so contaminated.
When we consider that the girls from whom the teeth were
taken, had not the least appearance of disease at the time, and
had none when the disease broke out in the person who receiv-
ed the teeth, it becomes strange that it should break out in the
receivers, and not in the giver.
It is also singular, that an ambiguity should follow this dis-
ease in all its stages; in the mode of its being caught, the ap-
pearance, and the cure.
Let us sum up all the arguments in favour of the disease not
being venereal.
First; two patients, whose cases were similar to the others
in their origin, recovered without medicine.
Secondly; they who seemed to be cured by mercury, had
not a treatment exactly similar to those who were indisputably
poxed.
Thirdly; I consider it as impossible for parts to have the
power of contaminating, which are not themselves diseased.
Fourthly; the parts contaminating were never known to
have been contaminated themselves.
But it must be nearly the same thing to those who want to
have teeth transplanted, whether my reasoning is just or not;
for a disease in consequence of the operation most certainly has
taken place; and in some cases this has been worse, or cured
with more difficulty, than the lues venerea in common; and
whatever the disease may be, I yet know of no mode of preven-
tion, except the drawing of the tooth early, and that has been
tried in one case only, and in that case was successful.
From

THE LUES VENEREA. 369
From this account many may be deterred from having this
operation performed; in that light no evil can arise, except the
mortification which arises from a reflection, that no relief is to
be had in cases of bad teeth: but it is to be remembered, that
this is a publication of all the unsuccessful cases, which is the
very reverse of what is generally practised in medical books;
and they are mentioned upon no other principle than that the
disease, when it happens, may not be improperly managed.
It may be asked, what is this disease? There is more diffi-
culty in answering what it is, than what it is not. I should
say that a sound tooth transplanted may occasion such an irrita-
tion as shall produce a species of disease which may be follow-
ed by the local complaints above-mentioned.
I cannot conclude without intimating, that undescribed dis-
eases, resembling the venereal, are very numerous; and that
what I have said is rather to be considered as hints for others
to prosecute this inquiry further, than as a complete account
of the subject.
THE END.
Bbb

Plate I.
Fig. 1.
Fig. 2.
Thackara & Vallance Sculp.

EXPLANATION
OF THE
PLATES.
PLATE I.
FIGURE I.
THE penis, slit open, showing a stricture in the urethra,
about two inches from the glans. The stricture is but
slight.
AA. The cut surface of the corpus spongiosum urethræ.
BB. The canal of the urethra, in which may be observed the
orifices of the lacunæ.
C. The stricture.
FIGURE II.
THE penis slit open for about three inches, to show the la-
cunæ, which become occasionally an obstruction to the passage
of the bougie.
AA. The corpus spongiosum urethra.
BB. The internal surface of the canal of the urethra, pointing
to the orifice of two of the lacunæ.
C. A bristle introduced into a lucuna.
D. The end of the bougie introduced into the remaining part
of the urethra.

PLATE II.
Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

PLATE II.
FIGURE 1.
THE urethra opened in two different places, one before
the stricture, the other behind: the one before, is through
the body of the penis; the other behind, is upon the anterior
surface of the membraneous part, and a bougie passes from the
one opening to the other.
AA. The crura penis and bulbous part of the urethra all
blended together by inflammation and suppuration, which
has taken place in many parts.
BB. The prostate gland in a diseased state.
CC. The cut edges of the bladder.
D. The urethra behind the stricture very much enlarged; ir-
regular on the surface in consequence of ulceration.
EE. The cut surface of the corpus cavernosum penis.
FF. The cut surface of the corpus spongiosum urethræ.
GG. The bougie passing from the sound to the unsound part
of the urethra.
H. A small bougie in the new passage.
TWO cannulas, for applying caustic to strictures in the
urethra.
FIGURE II.
A straight silver cannula, with the plug projecting beyond
the termination of the cannula, making a rounded end; at the
other end of the wire is a small portcrayon in which is repre-
sented a piece of caustic.
FIGURE III.
A flexible cannula, for applying the caustic to strictures in
the bend of the urethra. The wire, with the small portcrayon
is pushed out beyond its end.
FIGURE IV.
A piece of silver wire, with the plug at the end, to be in-
troduced into the cannula, as in Figure II.

Plate III.
Thackara & Vallance Sc.

PLATE III.
THE bladder and penis of a person who died of a mortifica-
tion of the bladder in consequence of a stricture and
stone in the urethra. In this plate not only the stricture is re-
presented, but the thickened coats and fasciculated inner sur-
face of the bladder; as also the small stone which acted as a
valve, or plug; besides which, a cannula is introduced from
the glans down to the stricture, showing the practicability of
destroying it with caustic.
AA. The bladder, cut open, showing its coats a little thick-
ened, and its inner surface fasciculated.
B. The body of the penis.
CC. The corpus spongiosum urethra, cut open through its
whole length exposing the urethra.
D. The prostate gland divided.
E. A silver cannula introduced into the urethra, through which
the caustic is passed on to the stricture.
F. Points out the stricture, with the stone laying above, so as
entirely to prevent the passage of urine.

Plate IV.
Thackara & Vallance, Sc.


PLATE IV.
AN enlarged prostate gland, particularly the valvular pro-
cess, which has increased inwards, into the bladder, in
form of a tumor, in consequence of which the water passed
with difficulty, which became the cause of the increased thick-
ness of the bladder.
A. The prostate gland.
B. The projecting part passing into the cavity of the bladder.
CC. A bristle in the urethra, to show it is above this tumor.
D. The cut edge of the bladder, which shows its increased
thickness*.
* The preparation, from which this drawing was made, I was favoured with by Mr.
Gunning, and which is in his possession.
Ccc

Plate V.
Thackara & Vallance Sculpt.


PLATE V.
A Kidney, whose ureter, pelvis, and infundibula, are ve-
ry considerably enlarged in consequence of a stricture
in the urethra.
A. The substance of the kidney, which is become very thin.
BB. The infundibula much enlarged.
C. The pelvis very much enlarged.
D. The ureter increased more than ten times its natural size.

Plate
F. Smither

PLATE VI.
THE valvular part of the bladder so increased as to form a
considerable tumor, projecting into the cavity of the
bladder. The prostate is also enlarged. This tumor had been
the occasion of several severe suppressions of urine, and had
often been the cause of a failure in drawing off the water with
the catheter, by that instrument, most probably, passing into
its substance so deep as to hinder the urine entering its open-
ings. The dark line, passing along the tumor from the ure-
thra, was probably made by this means, but now collapsed.
AA. The cut surface of the prostate gland.
BB. The inner sides of the prostate gland projecting inwards.
C. The tumor.
D. The cavity of the bladder.



INDEX.
A.
ABSCESSES near the urethra; their treatment, 140. In the perinæum are very
apt to return on contracting a fresh gonorrhœa, 148. Venereal, when obstinate,
their treatment, 342.
Absorbents on the back of the penis; inflammation of, 236. Resolution of, 250.
Absorption of matter, how prevented in a gonorrhœa, 80. Of venereal matter is of
three kinds, 233.
Action; the meaning of, 279. Easier cured than disposition, 285.
Actions, morbid, incompatible with each other, 2.
Animals; some are not susceptible of venereal irritation, 20.
B.
Balsams; their use in gleets, 94.
Bark; its use in mortifications, 8. In gonorrhœa, 78. In gleet, 94. In mortifica-
tions arising from a diffusion of urine in the cellular membrane of the scrotum and pe-
rinæum, 144. In phymosis, 217.
Bladder, affected in a gonorrhœa, 49, 60. Affections of the; treatment of, 83, 98.
Its strength increased in stricture, 115. Diseases of the, from obstruction to the urine,
161. Its increased irritability, ibid. And urethra contract and relax alternately,
162. Inconveniences which arise when these actions do not take place regularly, 163.
Their treatment, 164. Paralysis of the, from obstruction to the passage of the urine,
ibid. Paralysis of the; its cure when it arises from obstruction owing to pressure or
spasm, 167. Puncture of the, above the pubes, 169. Puncture of the, by the rec-
tum, 170. Puncture of the, in the perinæum, 174. Of the increased strength of
the, 176. Irritability of the, independent of obstructions to the passage of urine, 178.
Simple irritability of the; its cure, ibid.
Bleeding; its use in gonorrhœa, 77. In chordee, 81.
Bleedings, from the urethra; their treatment, 81. From chancres; treatment of, 200.
Blisters applied to the perinæum; their use in removing disagreeable sensations which
remain after the cure of a gonorrhœa, 89. Their use in strangury, 90. In gleet, 97.
In spasmodic affections of the urethra, 151. In paralysis of the urethra, 153. In
paralysis of the bladder, 167. In spasmodic affections of the urethra accompanied by
a paralysis of the bladder, 168. In simple irritability of the bladder, 178. In para-
lysis of the acceleratores muscles, 179. In nodes, 329.
Blood of a person having the lues venerea will not communicate the disease to a sound per-
son by inoculation, 267.
Blotches, venereal, described, 292.
Body; parts of the; their comparative powers, 4. Their powers greater the nearer they
are to the heart, ibid. And weaker the more distant they are, ibid. Their structure
produces a difference in their powers of action, 5. Their susceptibility of particular
diseases, ibid. No one part of the, applied by Nature to two purposes, with advan-
tage; instances of this in different animals, 101.
Bougainville's voyage; a passage from, 14.
Bougies; their use in gonorrœa, 70, 84. In gleet, 95, 96. Different kinds of, 107.
Their use in strictures, 108. Directions for passing them, 109, 152. Frequently
stop in the lacunæ of the urethra, 111. Sometimes form a new passage on the side of
the urethra, 113, 126. Sometimes slip into the bladder and occasion the patient to
be cut as for the stone, 115. Mode of extracting them when a part still remains in
the urethra, ibid. Affect many parts by sympathy, 125. Hollow; their use in stric-
ture, 142. How introduced where the prostate gland is enlarged, 158, 159.
Bubo;

INDEX.
Bubo; theory of its formation, 231. Mistakes of authors relative to this subject, 232,
233. Situation and description of, 235. May be formed in the lymphatics or lym-
phatic glands, 236. How distinguished from other swellings, 237. Of the time be-
tween the application of the venereal matter and the formation of, 238. In the right
groin when occasioned by chancres generally arises from those situated on the right side
of the penis, 239. In women, its division, 241. Of the inflammation of, 242.
Marks which distinguish it from other swellings of the glands, ibid. General reflecti-
ons on its cure, 247. Of the resolution of, ibid. Is attended with different disposi-
tions which must be treated accordingly, 249. Resolution of; the use of vomits in,
ibid. In the groin; of the resolution of, 250. In women; of the resolution of, 251.
Indifferent parts of the body; treatment of, 252. Resolution of; the quantity of
mercury necessary for, ibid. Is more likely to suppurate if there is one in each groin
than when single, 253. Sometimes becomes schirrous; its treatment, ibid. Its treat-
ment when it suppurates, 254. Mercury is to be given during the suppuration of,
ibid. Method of opening it, ibid. Consequences of, 256. Degenerates sometimes
into a sore of the scrofulous kind, ibid. 259. In some they spread to an amazing ex-
tent, 259. Its treatment when it becomes stationary, 260.
C.
Calculous matter frequently attaches itself to the ends of bougies, when left in the blad-
der, 124. Frequently fills up the cavity of the catheter, when kept a long time in
the bladder, 176.
Camphor; its use in chordee, 82.
Caruncles in the urethra, 153. Their cure, 154.
Case of a child under inoculation attacked with the measles, 3. Of a gentleman, prov-
ing that a gonorrhœa may produce a lues venerea, 15. Of a young woman from the
Magdalen Hospital, showing that a gonorrhœa may continue two years, 36. Of a
gentleman, where a gonorrhœa continued a length of time without losing its virulence,
ibid. Of a gentleman, proving the same, 37. Of a man, where the cuticle of the
glans came off, 39. Of a young gentleman, where the gonorrhœa was confined to the
glans, 40. Of a gentleman, showing how the venereal matter is communicated to the
urethra, 47. Of a woman having a fluor albus, and communicating a disease similar
to gonorrhœa, 37. Of a gentleman cured of a gonorrhœa almost immediately by tak-
ing ten grains of calomel, 67. Of a gentleman under a course of mercury contracting
a gonorrhœa, 69. Of a gentleman, showing the use of blisters applied to the perinæ-
um in removing disagreeable sensations which remain after the cure of a gonorrhœa,
89. Of a gentleman's servant, showing the same, 90. Of a chimney-sweeper cured
of a stricture by the application of lunar caustic, 118. Of a gentleman relieved in a
stricture by a gonorrhœa, 123. Of a gentleman, shewing the same, ibid. Of a sol-
dier, where a new passage was made along the side of the urethra by a bougie, 129.
Its treatment and cure, 129, 130. Of a gentleman where a mortification took place
in the cellular membrane of the penis from urine diffused into it, 135. Of a man in
St. George's Hospital, showing that keeping extraneous bodies in the urethra prevents
wounds made into that canal from healing, 148. Of a man in St. George's Hospital,
cured of a paralysis of the urethra, 153. Of John Doby, a poor pensioner in the
Charter-House, who died from a suppression of urine occasioned by a swelled prostate
gland, 156. Of a gentleman, showing the inconveniences arising from a swelling of
the prostate gland, 158. Of a gentleman, showing the use of blisters applied to the
perinæum in spasmodic affections of the urethra accompanied with a paralysis of the
bladder, 168. Of a total suppression of urine relieved by a puncture in the bladder
through the rectum, 171. Two instances of the same, 172, 173. Of a sailor, where
the urine passed from the bladder into the rectum, 174. Of a gentleman, who was
impotent with respect to one woman only, 185. Of a young man cured of a seminal
weakness by opium, 188. Of a gentleman, where the semen paged into the bladder
at the time of emission, 189. Of a gentleman, where one of the testicles wasted en-
tirely, 191. Of a gentleman, showing the same, ibid. Another instance of the
fame, 192. Of a gentleman, where seven weeks elapsed between the application of
the venereal poison and the appearance of a chancre, 198. Of a gentleman, where
the penis was bent to one side at the time of erection, 204. Of a gentleman, showing
that mercurial frictions sometimes occasion ulcers on the tonsils which have the ap-
pearance of venereal ulcers, 220. Another case, showing the same, 221. Of a gen-
tleman, with a spreading ulcer of the prepuce cured by sea-bathing, 225. Of a gen-
tleman

INDEX.
tleman cured of ulcerations resembling chancres, by the lixivium saponarium, 226.
Of a gentleman, who had a swelling in the groin suspected to be venereal, 244. Of
an officer at Lisbon, where a bubo was resolved, though it contained matter, by sea-
sickness, 249. Of a gentleman, where a bubo degenerated into a sore of the scrofu-
lous kind, 257. Of a gentleman, who had a gonorrhœa and two buboes, where a
new disposition formed besides the venereal, 258. Of a boy who swallowed some ve-
nereal matter without any ill consequences, 265. Of a lady who met with the same
accident, 266. Of a child who was supposed to infect its nurse with the lues venerea,
270. Of a gentleman, proving that venereal complaints are often supposed to exist
when they really do not, 273. Of a man having the lues venerea, showing that the
superficial parts, or those first in order, may come into action and be cured; while
those parts which are second in order have only the disposition; but that they after-
wards may come into action and be cured as those first in order were, 284. Of a gen-
tleman, showing the same, 286. Of a lady who was salivated by a small quantity of
red precipitate applied to sores, 309. Of a gentleman, showing the effects of mercury
on the constitution, 312. Another instance of the same, 313. Of a gentleman, show-
ing that the effects of mercury on the constitution are not sufficient for the cure of the
lues venerea, it requiring its specific effects on the poison, as well as its sensible effects
on the constitution, 318. Of a gentleman, showing that the efficacy of electricity in
the cure of diseases may be increased by mercury, 338. Of a man in St. George's
Hospital having the lues venerea, where a comparative trial was made of the effects of
guaiacum and sarsaparilla, 340. Of a woman in St. George's Hospital having the lues
venerea, where the cure was attempted by opium, but without success, 345. Of Luke
Ward, in St. Bartholomew's Hospital, showing the inefficacy of opium in the lues ve-
nerea, and that it may sometimes act as a poison, ibid. Of J. Morgan, in the same
hospital, showing the use of opium in the cure of an ulcerated leg, 346. Of a woman,
where hemlock was of use in venereal sores which had put on a cancerous appearance,
347. Of a gentleman infected with the yaws, 353. Of a gentleman having a disease
resembling the lues venerea, 355. Of a gentleman having a similar complaint, 356.
Of a lady infected with a disease similar to the lues venerea, by the transplanting of a
tooth, 362. Another instance in a young lady, 363. Another in a gentleman, ibid.
Cases of a lady, two children and a wet nurse, infected with a disease resembling the lues
venerea, 357. Of three children and three wet nurses having similar complaints, 358.
Of diseases resembling the venereal disease, from transplanted teeth, 362, 363, 364,
365.
Catheter in the urethra; mode of fixing it, 146. Observations on the use of the, ibid.
How introduced into the bladder when the prostate gland is enlarged, 157. Of allow-
ing it to remain in the urethra and bladder, 175.
Caustic; its use and application in stricture, 116, 117, 118, 143. Description of an
instrument for conveying it to strictures in the urethra, 119.
Chancre; its poison the same as in gonorrhœa, 13. Description of, 195, 198. Pro-
duced in three ways, 196. May attack any part of the body, 197. Not so frequent
an effect of the venereal poison as the gonorrhœa, ibid. Its seat, ibid. Of the distance
of time between the application of the venereal poison and the appearance of, 198.
May produce a gonorrhœa by sympathy, 200. An instance of its curing a gleet, ibid.
Its variation from constitution, ibid. 205. Sometimes occasions a profuse bleeding,
200. Of, in women, 204. Observations on the treatment of, 205. The constitu-
tion to be attended to in the cure of, 206. Is a local complaint, but may infect the
constitution by the absorption of its matter, 207, 209. May be destroyed in two ways,
by excision or caustic, 208. Its cure, 209. Local applications in, 210. Is attend-
ed by particular dispositions which must be considered in the cure, ibid. Its cure by
mercury given internally, 218. Of the quantity of mercury necessary in the cure of,
219. A kind of false one takes place sometimes after the cure of the true chancre,
222, 225. Consequences of; their treatment, 223. Of dispositions to new diseases
taking place during the cure of; their treatment, 224.
Chord on the back of the penis; explanation of that appearance, 236. Its treatment, 250.
Chordee; its cause, 41, 46. In some cases inflammatory, in others spasmodic, ibid.
Its treatment, 81. The use of opium in, 82. The use of camphor in, ibid. 97. The
use of electricity in, 97. The use of bark in spasmodic, ibid.
Civilization; a disadvantage attending it, 101.
Climate; its effects on the lues venerea, 283.
Cold; its effects upon stricture, 104. Upon the urethra, 159. Its effects in disposing
different parts of the body to receive the venereal irritation, 282. Applied to the skin,
affects the deeper seated parts by sympathy, 283.
Ddd Constitution,

INDEX.
Constitution, scorbutic, of, 2. Its treatment in the cure of gonorrhœa, 77. Effects of
inflammation in the perinæum and scrotum upon the, 143. To be attended to in the
cure of chancre, 206. How infected by the matter of a chancre, 207.
Contamination; the meaning of, 279.
Cook's voyage; a passage from, 13.
Copulation; of the requisites necessary for performing that act well, 184.
Corrosive sublimate; mode of giving it in the lues venerea, 324.
Cough, may be occasioned by the lues venerea, 297.
Cowper's glands, affected in a gonorrhœa, 43, 49. Suppuration of, how treated, 82.
Cuticle; cracking of the, a symptom of the lues venerea, 293.
D.
Diet-drinks; formulæ for, 225. Lisbon; its use in the lues venerea, 343.
Disease, venereal; its different forms, 22. Varieties in different constitutions, 23.
Specific, observes a specific distance or extent, 48. A number of diseases said to be
venereal which are not, 303. Of the time necessary for the cure of its different forms,
304. Of its prevention, 349.
Diseases, epidemic; an observation on them, 21.
Disposition; the meaning of, 279. More difficult of cure than action, 285.
E.
Electricity; its use in chordee, 82. In a swelled testicle, 85. In a gleet, 97. In
paralysis of the bladder, 167. In venereal warts, 229. Its powers on diseases in-
creased by mercury, 338.
Epididymis; state of, in a swelled testicle, 52, 85, 98.
Erections; painful, how prevented, 81.
Escharotics; their use in destroying strictures in the urethra, 118. In destroying
warts, 229.
Eyes; inflammation of, doubtful if ever venereal, 297.
Experiments made to prove that matter from sores in the lues venerea will not affect a
person locally who has the lues venerea; but that matter from a gonorrhœa or chancre
will, 268. Made to ascertain the progress and effects of the venereal poison, 298.
Conclusions drawn from those experiments, 300. Made to prove that mercury and its
preparations are dissolved in the animal juices, 336.
F.
Fermentation; the venereal poison does not arise from, 17.
Fever, symptomatic; of, 1. Hectic; of, ibid. No two different fevers can exist at
the same time, 2. Suppurative sometimes takes place in a gonorrhœa, 63. Its ef-
fects on gonorrhœa, 78. Brings the lues venerea into action, 284.
Fistula in perinæo; its cause, 144. The occasion of aguish complaints, ibid. Its
cure, ibid. Description of the operation for, 145.
Fluor albus sometimes communicates a disease similar to the gonorrhœa, 57.
Fœtus in utero, may be infected with the lues venerea by the matter which infected the
mother, 266. But not from the effects of that matter upon the mother, 270.
G.
Glands, absorbent; swellings of, from sympathy, 54. Affected singly by the venereal
poison, 238. Those which are second in order are not affected by the venereal poison;
the reason of this, 239. Swellings of, how distinguished from buboes, 242.
Gland, prostate; swelling of, 154, 155. Its effects on the canal of the urethra, 155,
156. Sometimes prevents a stone in the bladder being felt, 155. Mode of detecting
it, 156. Its treatment, 160. The use of hemlock in, ibid. The use of burnt sponge
in, ibid. Of the discharge of the secretion of, 180. Mucus of; the distinction be-
tween it and semen, 181.
Glands

INDEX.
Glands of the groin affected by sympathy in a gonorrhœa, 48, 54, 55. Of the urethra;
their suppuration, how treated, 42, 82. Of the groin affected sympathetically by
the use of bougies, 124, 125, 131.
Gleet; its cause, 91. Its cure, 93. Balsams; their use in, ibid. Injections to be
used in, 95. The use of blisters in, 97. The use of electricity in, ibid. Its treat-
ment in women, ibid. Attends upon stricture, 103, 131. In consequence of a stric-
ture, its cure, 121. Cured by a chancre; an instance of, 200.
Gonorrhœa may produce a lues venerea, 15. Does not arise from ulcers in the urethra,
27. Appears sometimes the day after receiving the infection, 29. May be cured
without mercury, 29, 67. Virulent and simple; difficult to distinguish them, 30.
Frequently cures itself, 33, 64, 71. Cannot be increased by the application of fresh
matter, 34. The first the severest; the succeeding ones generally milder; facts seem-
ing to prove this, 35. Frequently continues a long time without losing its virulence,
36, 86. Its seat in both sexes, 38. Often confined to the glans, 39. Its symptoms,
41. Affects Cowper's glands, 43. Of the discharge in, 44. A variety of symptoms
produced by sympathy in, 48. Uncommon symptoms in, 50. Its effects on the con-
stitution in both sexes, 62. Its cure, 63. No specific medicine for, 63, 64. Dif-
ferent modes of practice in, 67. As soon cured without mercury as with, 68. May
be contracted by a person under a course of mercury, 69. How affected by fever, 78.
Treatment of occasional symptoms of, 81. And gleet; the distinction between them
not yet ascertained, 86. Symptoms of, remaining after the disease is subdued, 87.
Supposed consequences of, 100. Does not in general occasion stricture, 105. Some-
times relieves a stricture, 123. May be produced by a chancre sympathetically, 200.
Gonorrhœa in women, 58. Not easily distinguished from fluor albus, ibid. The parts
affected, 59. Uncommon symptoms in, 60. Wears itself out in women as well as
men, 61. Proofs of its existence in women, ibid. Its continuance, ibid. May ex-
ist without the patient knowing it, 62. Its cure, 76.
Guaiacum; its use in the lues venerea, 343, 347.
Gum guaiacum, its effects in the lues venerea, 339, 347.
H.
Hæmorrhage, from chancre; the use of oil of turpentine in, 213.
Hemlock; its use in swellings of the protstate gland, 160. In what is called a seminal
weakness, 182. In spreading ulcers of the prepuce, 225. An instance of its being
taken in very large quantities, 260. Its use in buboes, ibid. In lues venerea, 344,
347.
Hernia humoralis; symptoms of, 52.
Hydrophobia; observations on that disease, 20, 265.
I.
Ialap; its effects on the stomach when thrown into the veins, 210.
Impotence; its causes, 182. Depending on the mind, the cause of, 183. From a want
of proper correspondence between the actions of the different organs, 185.
Infection, venereal; the mode of, 21.
Inflammation, of, 6. Division of, into adhesive, suppurative, and ulcerative, ibid. Pro-
duces matter without ulceration, 27. How it attacks the urethra in gonorrhœa, 47.
A case showing this, ibid. Venereal; observes a specific distance, or extent, 48. Ir-
ritable; what it is, 65. In the parts surrounding the urethra; its treatment, 139,
141. In the perinæum and scrotum, its effects on the constitution, 143.
Injections; different kinds of, used in gonorrhœa, 70. To be used very often, 71.
Their effects, 72. In what cases they are improper, ibid. To be used in gleet, 95.
Instrument; description of one for conveying caustic to strictures in the urethra, 119.
Inoculation; queries relative to that operation, 3. Case of a child under inoculation
attacked with the measles, ibid.
Ipecacuanha; its effects on the stomach when thrown into the veins, 210.
Irritation, specific; produced by the venereal poison, 19. Venereal, can be kept up
but a certain time in gonorrhœa, 33, 64. Venereal parts become so habituated to, as
hardly to be affected by it, 36. Venereal, takes place more readily in those parts ex-
posed to cold, 282.
L.

INDEX.
L.
Lead; its use in gonorrhœa, 73. In gleet, 95. In the bladder how removed, 107.
Living; mode of, under a course of mercury, 321, 327.
Lixivium saponarium; its use in ulcerations resembling chancres, 226.
Lues venerea; never combined with the itch or scurvy, 2. And small-pox may appear
at the same time, but not in the same parts, ibid. Produced by a gonorrhœa, 15.
The cause of other diseases, 24. The different ways in which it is communicated,
262. Of the nature of the sores or ulcers proceeding from the, 264. Does not con-
taminate the different secretions, 264, 265. Sores in the; the matter from, compared
with that from chancres and buboes, 267. Sores in the; the matter of, not venereal,
ibid. A person having the, may be affected locally by the application of matter from
a gonorrhœa or chancre, 268. Of the local effects arising from the, considered as
critical, 274. Of the symptomatic fever in the, ibid. Of the local and constitution-
al forms of the disease never interfering with one another, 278. Of its supposed ter-
mination in other diseases, 277. Of the specific distance of the venereal inflammati-
on in the, 278. Of the parts most susceptible of the, 279. Of the time and manner
in which the parts are affected in the, ibid. Summary of the doctrine on the, ibid.
Parts affected in the, are divided into two orders, namely, first in order of parts and
second in order of parts, 280, 305. Takes place more readily in those parts which
are exposed to cold, 282. Is brought into action by fever, 284. Symptoms of the,
289. Of the time necessary for its appearance, 290. Of the symptoms of the first
stage of, 292. Of the symptoms of the second stage of, 300. Of the effects of the
poison, on the constitution in the, 302. General observations on the cure of the, 304.
The poison in the, circulates with the blood; but its effects are local and may be
cured locally, 305, 306. The parts first in order are easier of cure than those second
in order, 306. Of continuing mercury while the swelling of the parts second in order
still continues, 307. Of the use of mercury in the cure of, ibid. Preparation of
mercury and mode of applying it in the, 308. Of the quantity of mercury necessary
to be given in the cure of the, 313. Of the length of time mercury should be conti-
nued for the cure of the, 324. Of the cure of the, in the second or third stage, 325.
Of the local treatment in the, 328. Of the effects remaining after its cure, and of
the diseases sometimes produced by the cure, 341. General observations on the me-
dicines usually given for the cure of, 343. Of the continuance of the spitting in, 348.
Of diseases resembling the, which have been mistaken for it, 350. Supposed to be
communicated by the transplanting of a tooth, ibid.
Lymphatics; diseases of in gonorrhœa, 56.
M.
Matter of a sore, not pernicious to that sore, 34. Venereal, may be taken into the sto-
mach without producing any bad consequences, 265, 266.
Mercury, unnecessary in the cure of a gonorrhœa, 67. Combined with mucilage prefer-
able to oily substances when used externally, 210. Sometimes produces ulcers on the
tonsils, which are taken for venereal, 220. When rubbed into the thigh for the cure
of a chancre sometimes occasions swelling of the glands of the groin, 221. How to be
used in the resolution of buboes, 248, 251. Of the quantity necessary for the resolu-
tion of buboes, 252. To be used during the suppuration of buboes, 254. Appears
sometimes to lose its power on the body, 257. Of the use of, in the cure of lues ve-
nerea, 307. Preparation of, and mode of applying it in the lues venerea, 308. The
most convenient way of introducing it into the constitution, 310. Its action, 311,
317. Its effects on the constitution, and parts capable of secretion, 312, 338. Ne-
ver gets into the bones in the form of a metal, 313. Of the quantity necessary to be
given for the cure of the lues venerea, 313, 318, 326. Its effects on the mouth, 315.
Of its sensible effects upon parts, ibid. Does not act by evacuation, 316, 337. Of
the different methods of giving mercury externally and internally, 319, 322. When
mixed with the saliva may act as a gargle upon ulcers in the throat, 321. Mode of
living under a course of, ibid. Of the different preparations of, and their combination
with other medicines, 322, 325. Of the length of time it should be continued for the
cure of the lues venerea, 324. Of correcting some of the effects of, 331. Of the form
of the different preparations of, when in the circulation, 334. Is dissolved in the
animal juices, 335. Of the operation of, on the venereal poison, 337. Increases the
efficacy of electricity in the cure of diseases, 338.
Mercurius

INDEX.
Mercurius calcinatus; its use in preventing a lues venerea from a gonorrhœa, 80. In
the lues venerea, 322.
Mezereon; its use in the lues venerea, 344.
Mortification takes place in the extremities of tall people, and why, 4. Of two kinds,
7. Its cause, ibid. Its treatment hitherto in part improper, ibid. Its cure, ibid.
The use of the bark in, 8. The use of opium in, ibid. In consequence of the diffu-
sion of urine into the cellular membrane of the scrotum; its treatment, 135.
N.
Nails; separation of the, a symptom of the lues venerea, 294.
Nodes, venereal; description of, 301. Treatment of, 328. The use of blisters in, 329.
Of abscesses in consequence of, ibid. Of exfoliation in consequence of, 330. On
tendons, ligaments, and fasciæ; their treatment, ibid.
Nurses, who suckle children, supposed to have the lues venerea; how affected, 270.
O.
Onanism; how far pernicious to the constitution, 182.
Opium; its use in mortifications, 8. In priapism, 43. In  gonorrhœa, 73. In chor-
dee, 82. In stricture, 108. In spasmodic affections of the urethra, 151. In simple
irritability of the bladder, 178. Its use in seminal weakness, 188. In phymosis, 217.
In the lues venerea, 323, 344. In soreness of the mouth from mercury, 333. An
instance of its being given in very large quantities, 346.
P.
Paralysis of the urethra, 152. Its cure, 153. Of the bladder from obstruction to the
passage of the urine, 164. Of the bladder; its cure when it arises from obstruction
owing to pressure or spasm, 167. Of the acceleratores urinæ; its cure, 179.
Paraphymosis; its cause, 201. Natural; description of, ibid. 202. From disease; de-
scription of, 203. From chancres; the treatment of, 217. Operation for, 218.
Phymosis; its causes, 201. Natural; description of, ibid. 202. From disease; de-
scription of, 203. Its treatment when produced by or attended with chancre, 211.
Produced by chancres; the common operation for, 214. Of the constitutional treat-
ment of, 216.
Poison, venereal; its origin doubtful, 9. Began in the human race, and in the parts of
generation, 10. Its nature, 11. Its effects, ibid. Propagated by matter, 12, 63.
Its action, 12. Its greater or less acrimony, ibid. It affects very differently differ-
ent people, 13. The same in gonorrhœa as in chancre, ibid. How communicated
to the inhabitants of the South Sea islands, ibid. Produces different forms of the dis-
ease; how this happens, 16. The cause of its poisonous quality, 17. Does not arise
from fermentation, ibid. Its effects arise from a specific irritation, 19. Affects the
body in two different ways, locally and constitutionally, 22. Of the time between
the application and effect, 29. Applied to a sore will often produce the venereal ir-
ritation, 34. May be absorbed in three different ways, 233. When absorbed may
affect the lymphatics themselves, or the lymphatic glands, forming buboes in each,
235. Of the time between its application and the formation of a bubo, 238. Af-
fects but one gland at a time, ibid. Never affects the glands which are second in or-
der; the reason of this, 239. Sometimes only irritates the glands to disease, produc-
ing in them scrofula, 246. Experiments made to ascertain the progress and effects of
the, 298. Of its effects on the constitution in the lues venerea, 302. Circulates
with the blood in the lues venerea; but its effects are local and may be cured locally,
305, 306. Of the operation of mercury on the, 337.
Poisons, morbid; divided into simple and compound, 9. New, are rising up every
day, 358.
Prepuce; contraction of the, operation for, 213. Mortification of; its treatment, 216.
Tumefaction and elongation of, after the cure of chancre; its treatment, 223. Ex-
coriations of the prepuce and glans; their treatment, 229.
Priapism; its effects in a dog, 43. The use of opium in, 44. Its cause, 187. Its
cure. ibid.
S.

INDEX.
S.
Salivation, occasioned by a sore being dressed with red precipitate, 309.
Sarsaparilla; its use in spreading ulcers of the prepuce, 225. In buboes, 261. In the
lues venerea, 339, 343, 347.
Scrofula; observations on, 24,25, 88, 91.
Scrotum; relaxation of the; the cause of, 183.
Sirup; Velno's vegetable; its use in the lues venerea, 344.
Skin, seems to be the cause of the susceptibility of the absorbents to receive venereal ir-
ritation, 239.
Small-pox; matter immaterial from what subject taken, 13. The reason why a person
cannot be infected twice with the, 274.
South Sea islands; inhabitants of, how infected with the lues venerea, 13.
Strangury; the use of blisters in, 90. Its cause, 149.
Stricture; different kinds of, 102. Permanent; description of, 103. Affected by
cold, 104. Its cause, 105. Common to most passages in the body, ibid. In gene-
ral not the effect of venereal complaints, ibid. Its cure by dilatation, 108. Use of
bougies in, ibid. Frequently attended with spasms, 109. Its cure by ulceration,
112. Occasions an increase in the strength of the bladder, 115. The use and appli-
cation of caustic to, 116, 143. In women; observations on, 120. In women; its
cure, 121. Attended with spasmodic affection, 122. Sometimes relieved by a go-
norrhœa, 123. Spasmodic; its treatment, ibid. Permanent; diseases in conse-
quence of, 131. Bad effects of travelling in, 150.
Sugar; one of the best restoratives of any kind we are acquainted with, 327.
Sulphur; its use in correcting some of the effects of mercury, 332, 333.
Suppression of urine; how relieved, 165. Operations for the cure of, 168.
Suppuration; of its not answering the common final intention in a gonorrhœa, 28.
Surfaces; secreting and non-secreting, what they are, 16. Of the best, for absorption,
309.
Sympathy; division of, into universal and partial, 1. Partial, divided into remote,
contiguous, and continuous, 2. Between the urethra and the cutting of a tooth; an
instance of it, 31. Occasions a variety of symptoms in gonorrhœa, 48. In gonor-
rhœa occasions swellings in the testicles, 50, 84; and in the absorbent glands, 54.
Sometimes cures a gleet, 96. Occasions affections of many parts during the use of
bougies, 125, 131. Between the skin and deeper seated parts of the body when cold
is applied to the former, 283.
System, absorbent, affected in two ways; by irritation and the absorption of matter, 54.
Discovery of; its use in medicine, 231.
T.
Teeth; transplanting of, supposed to communicate the lues venerea, 350. Of diseases
supposed to be venereal produced by, 362. Produces a disease which sometimes is
more difficult of cure than the venereal, 368.
Testicle; swelling of the, arises from sympathy in gonorrhœa, 50, 84, 200. Swelled;
symptoms of, ibid. Swelling of, is not venereal, 53, 84. Swelling of, sometimes
produced by the gout, 53. Swelled; its treatment, 83, 84. The use of vomits in,
84. Affected sympathetically from the use of bougies, 125, 131. Of the decay of
the, 190.
Tongue; ulcers of the, are seldom venereal, 281.
Tonsils, venereal; ulcers of the; description of, 295. Tumefaction of, ibid. Exco-
riation of, 296, 341.
Turpentine, oil of; its use in hæmorrhage from chancre, 213.
V.
Vesiculæ seminales; their use, 45. Are seldom diseased, 160. Of the discharge of the
secretion of, 180. Mucus of; the distinction between it and semen, 181.
Viper; an observation on its poison, 34.
Vomits; their use in a swelled testicle, 84. In resolving buboes, 249.
U. 

INDEX.
U.
Ulcers, venereal; of the nature of, 264. Of the tonsils; description of, 295.
Ureter and kidney, affected in a gonorrhœa, 50. Of the distension of the ureters, 177.
Urethra; ulcers in the, not produced in a gonorrhœa, 27, 106. A short history relative
to that subject, 29. An instance of its sympathising with the cutting of a tooth, 31.
Is sometimes the seat of the gout and rheumatism, ibid. Its action, 43. What parts
of the, furnish the matter in a gonorrhœa, 45. Bleeding of, 46. How affected by
inflammation, 47. Bleedings from; their treatment, 81. Suppuration of its glands;
how treated, 82. Observations on its uses, 101. Obstructions of; the different
kinds of, 102. Parts of the, most subject to stricture, 104. Lacunæ of, a bougie
frequently stops in them, 111. Different kinds of obstructions which take place in
that canal, 116. Sometimes a new passage is made along the side of the urethra by
bougies; the treatment and cure of that accident, 127. Enlargement of, 132. In-
flammation of the parts surrounding the; treatment of, 139, 141. Abscesses near
the; their treatment, 139, 140. Spasmodic affections of the, 149. Their cause,
ibid. Their cure, 150. Paralysis of, 152; its cure, 153; the use of cantharides
in, ibid. And bladder contract and relax alternately, 162. Inconveniences which
arise when these actions do not take place regularly, 163. Their treatment, 164.
Mucus of; of the discharge of, 180.
Urine; a new passage formed for the, 132. The mischief it occasions by being diffused
into the cellular membrane of the scrotum and neighbouring parts, 133. Description
of an operation to prevent it, 134, 135. To be drawn off frequently in suppressions
of, 135, 168. Suppression of; how relieved, 165. Suppression of; operations for
the cure of, 168. Suppression of; the use of calomel and opium in, 172. Should
never be retained a length of time in the bladder, 179.
W.
Warts, venereal; their treatment, 229.
Weakness, seminal; its cause, 188. The use of opium in, ibid. Its cure, 190.
Y.
Yaws; case of a gentleman infected with the, 353. Description of the, 354.