Thomas Windsor Manchester ?-1745 (1845) LECTURES on the RATIONALE of SURGERY by JOHN HUNTER. VOL. 2.  1 Volume. 2nd. – Part. 2nd. (continued) Aphorism 848th. Hemorrhages. may depend on various causes either a Wound made in an Artery by external force, or by such a state of weakness being produced by a disease in the Coats of the Arteries themselves, as to render them incapable of withstanding the impetus of the blood. 849. When an Artery in health is divided there is a natural power of contractility in its Coats, that disposes its orifice to Close & prevent the future escape of Blood. 850. This contractile power is stronger in inverse proportion to the largeness of the Artery, in the larger Vessels it is not Equal to the business of restraining the Hemorrhage, & therefore renders the assistance of Art necessary. 851. Another natural cause of the restraining of an Hemorrhage & wch. we call the accidental, is the plugging up the mouth of the Vessel by coagulate Lymph. 852. Art is employed in restraining Hemorrhages in three ways 1st by increasing the Contractile power of the Arteries. 2nd by increasing the Coagulation & thus plugging up the Mouth. of the Vessel 3rd. 🜹 855. It is evident the artificial retardment of the motion of the Blood commonly takes place when the bleeding is from / an Extremity We have sufficient testimonies of the use of the retardment of the bloods motion in the stopping of Hemorrhage, when we see people faint who have suffered great losses of Blood, & that on the Syncope taking place the hemorrhage commonly ceases. + 857. If the actual Cautery is used, the Iron should be very thick and heated nearly to a red heat. 2 3rd by Compression of the sides of the Artery together near its mouth & thus rendering it impervious to blood. 853: The first intention (852.1.) we fulfill by the use of Stimulants & of these the most powerful is Oil of Turpentine. 854. The second intention (852.2) by such remedies as will forward the natural & produce an artificial Coagulation of the Animal Juices. 855. This Coagulation will be forwarded by the retardment of the Blood motion. 🜹. - 856. The substances forwarding the formation of the Coagulum, are spungy bodies, as lint, fur, agaric, flower, Cobwebs. &ca. – 857. The means productive of an Artificial Coagulation of the Animal Juices, are the application of matter which act chemically upon them, such will be the actual Cautery, concentrated Acids, boiling Water &ca. +. 858. The mechanical means of stopping Hemorrhage is by compression this is made by enclosing the Vessel near its Orifice in a ligature applied by the use either of the Tenaculum of needle. 859. The Tenaculum should only be used when we have sound & unossified Arteries, & those situated not in the Centre of a muscle but loose in the interstices of Muscles & in the Cellular membrane. 860. The use of the needle is to be preferred, where there is reason to suspect the Artery is not quite sound when it is situated in the middle of a Muscle. 861. When the Needle is used, a considerable portion of the circumjacent parts as muscular flesh, cellular Substance, Nerves &ca. is commonly included together with the Artery in the ligature which gives an additional support to the Artery when weak or suspected to be unsound. 🜹. 864. Of this the Millers case, whose Arm was torn off by the Wheel of a Mill at the Articulation with the Scapula is an ample testimony (see Cheselden’s Anatomy) So also the Case of a person sometime ago in the Middlesex Hospital. The Farmers are sensible of this for they divide the funis of the Calves & Lambs by tearing it in two. + 865. Of this Mr. Hunter is satisfied having several times tied the Nerves with the Artery & no ill consequence supervened. ☿ 866. In St. Georges Hospital a Boys thigh was Amputated for a disease of the Knee Joint, by repeated bleedings from the Stump which always stopped spontaneously the Patient was so much reduced, that at last he Sunk, upon examining the Limb after death, the Artery appeared sound, until within an inch of its termination in the Extremity of the Stump, where it was black & had lost its Elasticity. The Bleeding anew happens more frequently in the Radial or Ulnar Arteries than any other. – 3 862. The degree of tightness to which the ligature is to be drawn will be in proportion to the size of the Artery, & the quantity of surrounding parts enclosed in the ligature. 863. The ligature should be made thicker than is commonly done that a larger extent of surface of the Artery may be compressed. 864. An accidental method of stopping Hemorrhages is tearing the Vessel asunder, for in contused Wounds the bleeding of a Vessel is less than in incised. 🜹. 865. The disagreable & sometimes fatal Symptoms following the use of the needle, where it is necessary to compress the sides of an Artery together, do not arise from irritation produced by a Nerve being enclosed in a Ligature, but from some peculiarity of constitution. +. 866. It sometimes happens that after tying an Artery consequent on an Accident or Operation, that the Artery shall bleed afresh at some distant time, as one, two, or three days, or even when granulation is going on, this mostly happens in the large Vessels. ☿. 867. When it arises within two or three days it commonly is owing to some circumstances attending the Operation, as tying the ligature too loosely or too tight. 868. When this is not the Case ( ) & when Bleeding happens after Granulation has taken place it may be attributed to a diseased state of the Artery. 869. The Artery should be laid bare (if diseased) until the sound part comes in view, & there a ligature should be passed. 870. In some patients when granulation has taken place after a wound or a considerable surface is stripped of its integuments, (as after Amputation Φ 876 The thickening of the Cellular Substance wound the Artery & its being lined with tough Coagulum will make this Complaint resemble the real Aneurism, but in the latter the Coats of the Artery are always forming the Cyst in the former the Coats of the Artery are never dilated. 4 Amputation of a thigh) there will be a profuse bleeding from every point of the exposed surface. 871. This will occur in patients who are extremely debilitated & whose Vessels (even the smallest) want the power of contracting. 872. The term spurious Aneurism has been improperly applied to an Extravasation of Blood in the Cellular substance, which blood has escaped from a puncture through the coats of an Artery. 873. This may be either recent, or not recent. In both those will in general be necessity for performing the operation of the Aneurism. 874. In this Case as there is a lateral Wound in the Artery, the escape of the Blood will continue to go on because the Artery cannot contract itself longitudinally. & was it to contract circularly, There would be an obliteration. 875. Therefore there will be no natural Cure for the Accident, it must either kill, or the operation be performed. 876. In the non recent Spurious Aneurism the Wound in the Skin is healed, the Cellular substance has thickened & with some Coagulum of Blood formed a Cyst, into which Blood from the unclosed Wound in the Artery is continually effused, this must ultimately burst & destroy the Patient unless the Operation for the Aneurism is previously performed. Φ. 877. To this state ( ) the recent Spurious Aneurism must always proceed, unless it either destroys the Patient or the Operation is specially performed. 878. The Arteries are subject to two diseases. Ossification & weakness the latter will be the predisponent cause of a dilatation of the Coats ♁ 883. This has been supposed to happen & has been called the mixed Aneurism, but from Experiments similar to the following the Conclusion is to be made. Mr. Hunter laid bare the Carotid artery of a Dog, and afterwards thinned it with a knife even to transparency, no dilatation of the Vessel ensued, three weeks afterwards the animal was killed, & the Artery on which the experiment was made was not found the least dilated but thickened by the adhesive inflammation & the adhesion of the adjacent Cellular Substance. 884. The dilatation if an Aneurism takes place In the Arch of the Aorta will be upwards. In the Abdomen---Forwards. In the Carotid Artery---outwards. In the Axilla---downwards. In the Ham---backwards. In the Groin---forwards. In the Leg---uncertain. Hence absorption of bone so often arises from its making pressure against them. The Artery will continue to swell in that direction in which it first begins to tumefy & the lower part will be dilated more than the upper. 🜔^ 885. It may suffocate by pressing on the trachea, if the Carotid or the Aorta is the seat of the disease. Its pressure on the returning vessels may occasion dropsy &ca. if the Aorta in the abdomen is the diseased part it may burst inwardly, or if it produces 5 of an Artery to which alone the name of Aneurism should be given 879. The immediate cause of Aneurism is a disparity between the force of the bloods motion, & the powers of resistance, in the Artery. 880. Accident (as some violent Exertion of muscular power) may give rise to it, but it most commonly depends entirely upon some diseased state of the Coats of the Artery. 881. This is more probable because it is not unusual to find several Aneurisms in the same person from which it should, appear that the disease is a weakness & disposition to dilatation in the Arterial System. 882. Moreover the common seat of the Aneurism is in the large Arteries whose seats are less muscular than those of the smaller 883 An Aneurism we believe never takes place from a rupture or wound of some of the Coats of an Artery & a dilatation of the rest. ♁ 884. The dilatation of the Artery will always be to that side on which there is the least resistance from the surrounding parts if there is no resistance from the surrounding parts of either side it will then be in that direction in which the blood is most forcibly thrown, if these circumstances are equal on all sides, it is then uncertain in what direction the dilatation will be made. 885. The natural tendency of the disease is to destroy life, this is effected either by the tumor bursting & the Patient dying of the Hemorrhage, or by its enlargement so as to press upon some parts Essential to Life, & hinder their functions. 🜔^ 886. When the Operation for the Aneurism is proper, it should absorption of the Bones of the Spine it may swell outwardly & at length the Skin inflaming & sloughing & the Coats of the Artery undergoing the same change the Coagulum gives way & a fatal Hemorrhage Ensues. ♂ 887. By the first rule, all the Aneurisms of internal parts will of Course be excluded from the Operation. As to rule 2d. the only Arteries admitting of a question will be the femoral & the brachial, but success here is only to be doubted of, yet by no means improbable the other Arteries are either out of the way of operation or have. In the Aneurism of the Interosscal, Anterior & Posterior Tibial Arteries the operation cannot take place from the difficulty of taking up these Vessels, therefore recourse must be had to Amputation & also when a diseased state of the bones &ca. in any part is induced by a pressure of the Tumor. On the whole, this Aphorism will allow of the Operation if Rules 3. 4. 5 permit it in the following Arteries. In the Carotid above the Sternum. In any of the branches of the external Carotid. In the Subclavian when it has passed the Scalenic Muscle & in any of its branches. In the Crural after it has given off the Profundus, & In the Popliteal. Directions for the Operation. 1st. When the Tourniquet is applied, that is if possible between the Aneurism & the Heart, make a longitudinal Incision in the Course of 6 always be performed as early as possible, this rule will also extend to spurious Aneurism. 887. The Operation is proper 1st. When the dilated Artery can be included between the ligatures. 2nd. When there is a probability that the parts to whose support the Artery in question was subservient heretofore, will be still Nourished & supplied with blood. 3d. When it has done no mischief to surrounding. Parts as bones &ca. – 4th. Where it is distinct & Circumscribed, not connected with parts which may be incurable when Exposed, as bones &ca. 5th. When there is distinct Pulsation in the Tumor. 6th. When it is probable that there is no other Aneurism between it & the Heart. ♂. 888. Note continued. the Artery through the integuments & to a greater extent than that of the tumor, then cut it into the Aneurism & scoop out the Coagulable blood as well as Evacuate that which is fluid. The inferior Orifice will be most readily discovered as it will throw out some little blood of a venous colour, to discover the Superior the Tourniquet should be slackened. Tye the Artery at least one inch above the superior Orifice, the same caution is not necessary respecting the inferior. When the Tourniquet cannot be applied, the ligature may be passed both above and below the Tumor, before the incision into is [is] made, it is then to be laid open throughout its Extent. The Sac need not be cut but left to slough away; the dark colour of the Blood issuing from the inferior Orifice is caused by the Bloods taking & slow & retrograde motion which is explained by the annexed diagram. For Blood by having a slow motion or by stagnating will even in the Arteries acquire a dark hue, the older the Aneurism the more will the Coagulum approach to a brown Colour & the more recent the nearer will it be to the natural colour of Arterial blood. When an Aneurism forms, the Cellular substance thickens round it but being inelastic readily yields to distention. Aneurismal Cases. 1 A Young Man had a pain in the Calf of his Leg for two Years at length he received a blow on the Ham, after which a pulsation & Swelling soon appeared. The Operation was performed, every thing went on well to the 5th. day, when the Artery burst either from the upper ligature being applied too tight or too low, before the Tourniquet could be applied he lost as much blood as Occasioned his death. Upon dissection the Artery was found perfectly sound above the part where the ligature was made. 2 An Aneurism of the Crural Artery in the middle of the Thigh extended 5 or 6 Inches in length the Tumor being Oblong, the Operation was performed & the Patient in a short time recovered. 3 Mr. Martin had an Aneurism in the Popliteal Artery, the Operation was performed & he recovered the use of his Limb so perfectly as to be able to dance &ca. Remarks on the propriety of operating for the Aneurism of the 7 (Note continued.) Popliteal Artery in preference to Amputation. Whatever Objections are made to the Operation, the same must hold good against Amputation of the Limb. That one, so much insisted on of the disease being most commonly a disease of the Arterial System & not of the part in question only, if true militates equally against Amputation as against the Operation. If there is not only an Aneurism in the Ham, but another higher up as in the Femoral Artery, or in the Aorta, it is evident that Amputation of the Limb does not give the Patient a greater chance for his Life, than tying the Artery, but it not uncommonly, perhaps most commonly it happens, that whatever may be the general disposition of the Arterial System, yet the Actual dilatation shall only have taken place in one part, now if tying up & removing the diseased part can be accomplished the patient still retaining the use of his Limb, it is certain that the Operation must be highly preferable to Amputation, as the latter though it may preserve the patients life yet leaves him imperfect & mutilated. – 🜖 890 In treating of Gun shot Wounds it is observed that Contused & lacerated Wounds will not heal without Suppuration In wounds penetrating Cavities, if the Wound is made to heal without Inflammation & Suppuration it is then similar to any other simple Wound, But if the Suppurative Inflammation is to take place, it will be requisite to advert to the doctrine of Exposure of Cavities & of penetrating Gunshot Wounds, it must be evident also that if Extraneous bodies are introduced into the Cavity either by accident or intention & not removed the suppurative Inflammation will be necessary. 🜔🜹 891 A Poultice answers this description & the best manner of Preparing it, is to pour boiling Water into Linseed Meal & add as much oil or hogs lard as will keep it from drying, but Poultices cannot universally be had recourse to, & in lieu of them we use Lint dipped in Olive Oil. 8 888. In our treatment of Fresh Wounds it is necessary to consider. 1st. The nature of the part wounded 2nd. The management of an Hemorrhage should one arise 3rd. When the 1st. or 2nd. mode of union, is to be desired, or whether Suppuration is indicated. – 2 889. If the united parts are to be divided by the first mode of union, the indication will be bring them into Contact & retain them so This will be fulfilled by means of bandage & in some cases Sutures. 890. But when a part is to inflame & suppurate it is better to defer the application of Bandage, until after Inflammation has subsided. 891. Whenever a Wound is to go through either the adhesive or the suppurative inflammation, it is generally improper to use applications which will adhere to the wounded surface, become dry & which cannot be removed at the pleasure of the Surgeon, hence The use of dry Lint is extreemly improper. But if the substance to be applied is somewhat that is soft & moist, has no continuity of parts & which can with ease be removed on any Occasions it can do no injury. 🜔🜹 892. When a wound [is to go through either the adhesive] has suppurated & granulations are arising, if they do not readily Contract so as by their contraction to forward the formation of a Cicatrix it will be proper to employ the pressure of a bandage. 893. Abscess will be either Sound or Unsound. By the former we understand Abscess arising in healthy constitutions, or from some Specific disease. 894. The nature & treatment of sound Abscesses will be readily  9 understood from reconsidering the doctrines of the adhesive & suppurative Inflammation. 895. The Evacuations of the Matter contained in an Abscess is either obtained by the Abscess bursting of itself or by an Artificial Opening. Abscesses may be suffered to burst unless some particular circumstances require an Artificial opening. 896. The circumstances most generally requiring an artificial Opening is the danger arising from a long retention of the matter. 897. All Abscesses of the Abdomen Thorax, Brain, Eye & Joints should be opened Artificially & early. 898. When an Abscess is opened Artificially it will in general be necessary that the opening be large to prevent the future inconveniency of a Fistula. – 899. When an incision is made into an abscess, the wound should be so dressed as to prevent the reunion of the incised parts by the first or second mode of Union. 900. There are two methods of opening an Abscess Viz. a by Caustic b by Incision. Where no particular Circumstances (as the seat of the Abscess) forbid, the choice may be left to the patient. 901. Another circumstance indicating the Artificial opening of an abscess will be, its being of such a magnitude that the natural opening will not be sufficient for the discharge of the matter. 902. In determining the Size of our opening it is necessary to have regard to the present distension & future contraction of the ☽︎. 902. This Note is added to explain the text as I am not clear Whether I have there properly conveyed Mr. J. Hunters Ideas. “If the magnitude of the Abscess has produced only simple distention without considerable absorption (ulcerative or interstitial) of the parts in which it is seated it is not necessary to make a very large Opening, because when the distending fluid is removed the parts will immediately contract themselves, & discovering their original Situation the cavity will become obliterated, but if the Cavity has been made by ulceration & absorption of the parts in which the matter is lodged & not by simple distension of the surrounding parts then it will be necessary to make a larger & free Opening to prevent the inconveniency of a succeeding Fistula, because here the parts cannot Contract themselves to Obliteration of the Cavity but the cure must be Accomplished by Granulations. (See Fistula). 10 integuments. ☽︎. 903. The living principle will always be uneasy under extensive exposure & will therefore be powerfully excited to action. hence large openings in Abscesses, where the Contraction of the parts is not sufficient for the obliteration of the Cavity & consequently for the Cure, are always useful, because they are the means of exciting the Process of restoration. 904. Abscesses may be free from any specific disease, may arise in an healthy constitution, & yet certain Circumstances may retard their healing. 905. These may be. 1st. Peculiarities of situation 2nd The Stimulus of some deep seated foreign body, as a Ball, Splinter of Bone &ca. – The first causes of backwardness to heal we cannot alter. The second causes we must wait for the removal of, before we can hope for the healing of the Abscess. 906. When sores of any kind have a disposition to healing, the Surgeon has little to do, except to prevent any obstacles arising that may hinder the process of restoration. 907. If dry Lint is used to healing Sores it should be applied so as not to extend quite to their margin, if ointments are used they should be free from Stimulus. 908 – Amongst the Obstacles to the healing of a Sore will be. Intemperance. Neglect of rest, and The Granulations rising too high above the Surface 912. This will be best illustrated by considering the rupture of the [Tendo?] Achilles, it is generally affected when the Muscles of the leg become tired & unfit for voluntary motion as after long continued dancing, & therefore the Muscle will act involuntarily, hence the Cramp, &ca. by this acting very Violently & involuntarily they rupture the Tendon. In doing this the Patient feels little or no Pain in the Part, but seems to receive a blow on the Gastrocnemius Muscles & hears a Noise as of some Elastic body snapping in two. Inflammation &ca, may succeed, the Muscles may be squeezed out & the Ends of the Tendons approximated together & as much as can be retained so, When those Symptoms are removed no inconvenience can arise from suffering the Patient to walk if he himself has courage enough to do so, for there is no danger of the will throwing the Muscle into Action & Merely producing a further seperation of the divided Ends of the Tendon, for the will cannot now act upon the Muscle, but an involuntary action of the muscles may take place during sleep, & this is to be guarded against by a tight bandage round the calf of the Leg & making the Patient wear an high heeled Slipper or Sandal. The Bandage & Sandal are more particularly necessary by night, & whilst the patient sleeps, during the day time their use may Commonly be dispensed with; from the back of the Sandal a piece of Leather is to be Carried & fixed to the bandage or a Leather Strap Placed tight round the Calf. Where the Rupture happens no Bandage should be applied. 11 Surface of the sound Skin. 909. The latter obstacle is to be removed by pressure as that of a bandage, & by touching the Granulations with some Metallic Salt, as Vitriol of Copper, lunar Caustic &ca. – 910. New formed parts being weaker than Original parts, are less able to support the fatigues of the Offices of life than the latter; hence upon a slight stimulus being applied, they readily inflame & if that Inflammation is not removed, the suppurative & ulcerative Stages come on Rapidly, or mortification speedily takes place. 911. The absorption of new formed parts may be either a Ulcerative, or b Intersticial. 912. The Tendons of Muscles are sometimes ruptured & the Accident arises from causes similar to those of the broken Patella, the Muscle being in violent action at the same instant of time, that there is an unconquerable resistance made by the point to which the Tendon is attached. Note continued. The patient will find little Amendment during the first two months, but will after that period generally recover the use of his Limb. Keep the foot nearly at a right Angle with the Leg the Heel a little raised when the patient walks he should turn his Toe outwards & not attempt to bend his Knee. The Ankle & Foot will commonly swell considerably. About three weeks from the accident the roller & slipper may be left off, it may be asked when the Patient may attempt to use his Muscles We answer, whenever he feels a consciousness of a power to use them. Mr. Hunter broke his own Tendo Achilles in dancing, he is not clear, whether Cramp of the Muscles precedes the snapping of the Tendon, but it certainly immediately follows it. 916. The motions of the Shoulder joint are most difficultly restored after any Wound, or considerable injury of that Joint, because to some of them the gravity of the Arm is an obstacle, were it possible to cure a Wound of the shoulder joint with the Arm elevated, then the motion would be as easily restored as those of other Joints. – 12 913. In order to the Cure of this accident, the indications will be. 1st. to place the divided Ends of the Tendons as nearly as possible to their natural situation. 2nd. To take off or prevent Inflammation. 3rd To prevent the involuntary action of the Muscles. 914. It is unnecessary to forbid voluntary action of the Muscle because in the present state it will be no longer subservient to the Will. 915. Should the divided ends of the Tendon not be brought into contact, but remain at some distance asunder, the union will be accomplished by new formed substance & therefore the Tendon be somewhat lengthened the Muscle will however be thereby shortened & its power of contraction lessened, no inconvenience will ultimately take place, for the muscle (as in the Cases of Fractures of the Patella & Olecranon) will acquire new powers of contracting adapted to its necessities. 916. In Wounds connected with Joints, it is necessary to pay great attention to the Motion of the Joint, during the Cure if, there has been loss of substance without great care on the part of the Surgeon rigidity & loss of motion will be the Event. 917. After the Inflammation has entirely subsided, & the Cure is somewhat advanced, the joint should be gradually moved by the Surgeon from time to time, that the irritating matter may be elongated in a manner similar to the elongation of the coagulable Lymph in adhesions between the Lungs & the Pleura. – End of the Second Part.  13 We now come to treat of those Affections of the body which are the objects of Surgery, that may be more properly called diseases, that is, those Affections in which parts have no disposition for restoration, but only a disposition to destruction, & which disposition will continue to exist, until either it has worn itself out, or has destroyed the Patient, or is cured by Art, in short those affections for which there is no natural Cure. Inflammations whether arising spontaneously or from External violence, suppuration &ca. & all accidents (unless so much mischief is done either to a vital part or to the constitution that the functions of the body cannot go on) become themselves the causes of Restoration. These we have already inquired into so far as concerns the principle on which their different Phenomena depend, & have also considered the particular attentions by which we shall facilitate the natural process of healing in wch. in fact little is to be done except removing all the impediments to the natural Cure. But in diseases the present disposition is to be removed & a new one induced in its stead. –  14 It has been shewn that as irritation in health induces disease ( ) so irritating / in disease is to bring back Health. “This Aphorism generally hold good tho’ in some Cases of diseased irritability an objection may be made to it. “After some previous general remarks on indolence we come to particular diseases originating from that Cause. Tumors are those spoken of, but those only which originate from indolence are those meant to be explained.” the definition given of them indeed will apply to swellings from other causes than indolence, as Inflammation &ca. but the subsequent remarks will shew that Mr. Hunter when speaking of Tumors in that place had it only in view to treat of indolent swellings. 918. Diseases or unsound dispositions will be properly divided into the irritable & the indolent, or those in which there is a disposition to too great or too little action. 919. Either of these dispositions will be a hindrance to restitution of health, & must be changed before health can be restored. 920. It is easier in general to increase the disposition of a part to action than to abate it. 921. In the indolent diseased disposition there is neither sufficient power, nor sufficient excitement to action. In the irritable there is too great excitement without corresponding powers. 922. Again in diseased irritability, parts are impatient under any removal from a state of perfection, yet have no disposition to at about the process of restoration. This disposition may be ♀. 929. Caustics are not followed by so speedy or Extensive an Inflammation as the Knife, an incised wound in such circumstances has frequently for its Sequel, an Erysipelatous Inflammation. 15 either Simple or Connected with some specific disease as Syphilis Cancer, &ca. – 923. When simple we must have respect to the principle laid down ( ) but when complicated with some specific disease, both the specific & the irritable disposition require attention. 924 Diseased irritability may be local, or it may be a state of the constitution at large. 925. It appears in general to be passive requiring the application of some stimulus to bring it into action. 926. An encreased [action] degree of sensibility will generally accompany diseased irritability, the living & sensible principle commonly Sympathizing. 927. Inflammations with diseased irritability should not be hurried into suppurations, nor on the contrary should those means be used which lessen their powers, the indication being simply to lessen violence of action, not to diminish Powers. Opium may be properly used in Solution or mixed with emollient Poultices, for preperations of Lead see, ( ). 928 The diseased irritability of the Constitution is lessened by the use of the Bark & those means which encrease the strength. 929. When a suppuration has taken place in parts under this state, if an opening is to be made to discharge the matter, a caustic is to be employed in preference to the Knife, for incision has not here in general such favourable consequences as the other method. ♀. 930. Ulcers have sometimes a diseased irritability & when this ☍ 931. Some Ulcers which shew every sign of the greatest irritability &ca. will have their Symptoms unrelieved & often increased by mild dressings, but will grow easy under the use of the most powerful Stimulants as Ol. Terebinth, but we would first by Poultices with Opium. &ca. – 932 We meet with few constitutions which will not readily take on Inflammation, a Stimulus being applied to any part of the body in which there is no particular local affection, how far constitutional indolence may prevail, we have a proof in Scrophula. – 16 is the case the dressings should in general be of the mildest kind. 931. We cannot a priori always determine what application will assuage the pain & other Symptoms we must therefore change our dressings until we meet with one fulfilling that intention. ☍ 932. The unsound disposition with indolence, or the diseased indolent, may be either an affection of the constitution or of a part, the constitution will rarely be indolent in a great degree. 933. Specific diseases may give rise to or accompany indolence in parts, as the Syphilis, the Scrophula, & sometimes the Gout. 934. The common effect of indolence in parts is a thickening of them. the process of restoration in parts in a state of indolence is very slow. – 935. As the Extent & spreading of disease, in diseased irritable parts is great & rapid, so the disease of parts in a state of indolence is in general very circumscribed & rarely spreads to any considerable extent. 936. The thickning of Swelling of parts morbidly indolent is of 2 kinds Viz. 1st. Intersticial. 2nd Superadded. & Indolent swellings commonly go on to a considerable degree before any knowledge of them is communicated to the mind, But when very far advanced, some dull, heavy pain, with sickness will be produced, &ca. but this probably arises from the distention of the surrounding parts. 937. The Causes of indolent disposition arising in parts are 1st. The long Continued Action of Cold.  17 2nd. Violent actions terminating in weakness. 3 Pressure from Mechanical Causes. Indolence may be also spontaneous, arising without any visible or known cause. 930. The first Species (936) or intersticial thickening, is that in which no new or distinct parts are formed but there is simply a swelling or enlargement of the original Parts, as a Corn varices of Veins &ca. – 939. The Second (936) or diseased indolence with parts superadded is that in which new parts are actually formed distinct from the old. 940. The intention of Cure will be to encrease both actions and powers. In the intersticial thickening, as swelling generally consists in the disposition of Coagulable Lymph in the cellular substance &ca. We endeavour to procure a reabsorption of it, & to this end we employ those means which increase the action of the Absorbents as Mercury, pressure applied so as to stimulate fumigations &ca.. Care however is necessary not to excite the parts to greater action than they can support least mortification ensue. 941. When those thickenings cannot be removed by absorption (940) stimulating applications may induce a Cure, by exciting the Suppurative Inflammation in them, however their suppuration is with difficulty brought about, & when it has taken place, & Ulceration followed it, the Cure is not always easily obtained. 942. Abscesses have been divided into sound & unsound, of ∇ 944. The cure of Corns consists in obtaining a seperation from the cuticle, which may be brought about rather by leaving off the pressure, soaking the part often in warm water & keeping it always moist & defended by some proper Plaister, or by removing it at once, when a corn has been of long standing it is often difficult to remove by Excision, as a wound of the parts underneath is sometimes followed by Inflammation, & even Gangrene, but we may attempt it by removing the Pressure, soaking the part long in warm water, & then applying a blister to obtain a seperation of the Cuticle from the Cutis. 18 Sound Abscess an account has already been given, of those wch. are unsound, & which have a disposition to indolence, it will be better to speak when their common Cause & consequences. Scrophula & Fistula come under consideration. 943. Ulcers or Sores may have an indolent disposition and thence a backwardness to heal, when simple indolence is the cause we have recourse to those means which will excite the parts to action, as Turpentine, Balsams &ca. 944. Corns are an instance of indolence from pressure, the Cuticle thickens from the stimulus of necessity, & as it acquires thickness presses on the Skin & produces uneasiness & pain. ∇. 945 Various Veins are also an indolent thickening from pressure if the disease is not too extensive or the operation too hazardous, they may be dissected out, & the inconveniency thus removed. 946 Chilblains may be given as an instance of indolent thickening from cold. Though they have in them especially at first somewhat of an increased irritability. The constitutions most disposed to this kind of indolent thickening are the delicate & such as have but small Powers of generating heat. 947. Schirrus of a Gland may be offered as an Example of Violent action terminating in weakness, & acting as the Cause of an indolent thickening. 948. Of the spontaneous indolence ( ) proofs may be given, in the swelling of the Legs, so common in Barbadoes & sometimes 🜔 950. Of this kind are those swellings of the inguinal Glands which have been so often mistaken for venereal & for which people have even been salivated. Sometimes these enlarged Glands are so situated, that extirpation is difficult & to be undertaken with the greatest caution, this will be spoken to, when we come to Tumors & Scrophula to which two Articles they belong. ☽︎☉ 953. When we speak of indolent swellings being diffused we only speak as comparing them to Tumors, for indolent thickenings compared to swellings of parts from other causes are generally circumscribed. – 19 seen in this Country, & in the swelling of the Lymphatic Glands 949. Some indolent Swellings may require extirpation, as in encreasing their action in order to suppuration, they may be made to turn out Cancerous. 950. Lymphatic Glands may slowly, gradually & indolently tumify until they become of a size which may render extirpation necessary from their making pressure on some important part & disturbing its Œconemy, or from their occasioning deformity. 🜔 951. Wherever a cure can be obtained the indication will be the same, either to encrease the action of the absorbents, or to remove the part entirely. 952. In all indolent thicknings we should endeavour to ascertain whether they arise from the constitution or whether they are purely local (see Constitution local & original local). 953. Indolent swellings of parts will either be circumscribed or diffused, by the former we understand a Tumor (954, the latter we mean when we speak of thicknings of parts. ☽︎☉ 954. By the Term Tumor we mean a circumscribed substance produced by disease & differing in its nature & consistence from the surrounding parts. 955. Tumors may be divided into a. the Solid b. the Encysted. 956. The Solid (956.a.) may be subdivided into three Vizt. 1. The Intesticial.  20 2 The Superadded, or new formal Substances. 3 The mixed. 957 The 1st. or Intesticial (956) belongs to Scrophula. The 2d. or Superadded are entirely new formed substances, they take their rise from some fixed point from which they grow, as from a root which will be of different Sizes, they are perfectly circumscribed, are generally more detached than a Lymphatic Gland & they have no Coat. The 3d. or mixed consists of these Tumors called Wens. & Schirri, in which there is a mixture both of enlarged & original & of new formed Parts. 958. These differ very much in their appearance & consistence being only fatty Tumors, sometimes almost cartilaginous, when cut through they resemble somewhat a divided Lemon. 959. The 2d & 3d. Species will rarely if ever admit of any other treatment in order to a cure than extirpation. 960. Previous to the extirpation of any Tumor it is necessary that we enquire. 1st. What part it adheres to, or is connected with & its situation 2d. The manner in which it ought to be extirpated. 3d. Whether it is necessary to remove any of the surrounding parts with it. 961. The second Species ( ) may be of different degrees of hardness, may grow from a bone & be bony, or from a Tendon & be of a ligamentous firmness. 962. They may also be adherent to the Skin, to a Muscle &ca. & they 967. A Young Lady had a Tumor situated on the lower Jaw it became hard & almost bony. Mr. Hunter pared it away even to the Surface of the Jaw bone, but it arose again, when it had been pared off a second time & the Maxilla Cauterized the patient got well, the Tumor consisted of a thin Plate of bone forming a shell which contained a cartilaginous substance. A Young Woman had a Cartilaginous excrescence growing from the upper Jaw after the extraction of a Tooth, they were removed but grew again, after being a second time extirpated the Patient got well, these seem to occur most frequently in the Jaw bone or on the Tibia. In the 3d or mixed Calcareous Earth is sometimes deposited, they not unusually fall into a kind of suppuration without the surrounding part being affected, in removing them great caution is sometimes required. Mr. Hunter has dissected them off the temporal [Muscle] and Carotid Arteries & once laid the Trachea itself bare. 21 may be either superficial or deep seated. 963. The third may be loose under the Skin, or they may adhere to the Skin, they may be situated superficially or deep, upon Muscles, a Bone, or a large Blood Vessel &ca.. 964. If the surrounding parts are not diseased, they may be suffered to remain, they must be removed as far as the disease extends, for it must be a rule to remove the whole of the disease. 965. If a Tumor is loose & does not adhere to the Skin a longitudinal or crucial Incision, according as it is large or small, deep seated or superficial may be sufficient & then the Tumor may be raised from its bed & removed. 966. But if it is adherent to the Skin then a portion of the Integuments must also be removed, at least as large as the adhesion extends. 967. If it springs from a root originating from above, it is to be removed by the Saw, Pincers or Chisel, in this Case it may also be necessary to Cauterize that part of the Bone from which it Sprang. 968. If it is situated on any large Vessel &ca, great care will be required in the dissection of from its seat (see Note on 967). 969. If it be only a fatty Tumor not adhering & of a small Size a simple incision down to it will be found sufficient & then the Surgeon may squeeze it from its bed, with his Fingers. 970 When the third or mixed, very much enlarges they are not unfrequently productive of pain, however it does not prove acute, but is of a dull heavy kind & it depends on pressure upon parts more sensible. The Stomach sympathizes with the affection & ☉ 978. Hydatids. It is difficult to explain the manner in wch. these are formed, or to determine which are formed first the Exterior or interior ones. – Are they not Animals of the Polypi kind? – Remarks on particular Hydatids. Hydatids of the Brain are sometimes found & usually on the Plexus Choroides, these occasion no symptom peculiar to themselves & from their situation can admit of no Cure. Uterus & Ovaria. The fluid contained within the Hydatids found in those places is sometimes of a gelatinous nature, they are more detaches at first than afterwards, sometimes encrease to an enormous size occupying greatest part of the abdominal Cavity, & is then called encysted dropsy. It is to be distinguished from Ascites by the manner of attack, the Patient first feels a weight & swelling on one side, which as it grows larger rolls about, until at length encreasing gradually in size, it becomes fixed, & then the abdomen swells regularly & gradually, the health of the Patient is often little affected by it tapping is the Palliative Cure, & should be done with a large Trochar least the fluid be gelatinous, when large they will adhere to the Parieties of the Abdomen & then the operation is safer than at any other time, they are often made up of a number of cells, so that sometimes a Small quantity of fluid is only discharged by one Tapping, as this disease will certainly kill in the end, if it can be ascertained early, it would perhaps be right to make an incision through the whole length of the Tumor & Extirpate it entirely, Electricity has seemed 22 Sickness is not an unusual circumstance. 971. As is the pain so likewise is the Inflammation when it arises, that of the surrounding parts, these however are seldom much thickened. 972. As to endeavouring to induce in these Tumors the suppurative Inflammation, the Opinion given ( ) will now be applicable. 973. The encysted Tumors are substances contained in a coat wch. is either natural or acquired. 974. The natural are the Hydrocele; Dropsy of the Ovaria, Pericardium, Saccule Mucosi &ca. in which the contents are enclosed in a natural bag. 975. The contents of Encysted Tumors whose Tunic is acquired will be various in their consistence & natural Hydatids form a considerable Class of these Tumors. 976. Hydatids are collections of watry fluid enclosed in an adventitious bag, we do not know the cause, nature, or manner of their formation. 977. Every part of the body where there is cellular Substance, becomes the seat of Hydatids, but more commonly the Plexus Choroides of the Brain, Tunica Vaginalis of the Testicles forming a spurious kind of Hydrocele ( ). 978 They are of different Sizes, as they enlarge their Coats, thicken & become stronger, their Coats are but little Vascular, sometimes one large Hydatid will contain several smaller ones, one within another, they are often found in the Uterus, Kidnies, Liver, Thyroid Gland, Lungs &ca. but how ☉ of late to have been of very great service to one patient affected with this disease. Hydatids in the Kidnies. – Here they are generally situated between the External & Internall Lamella of the proper tunic of the Viscus, & are not out of the reach of relief. In the Liver. – They are most commonly found in the Substance sometimes they are discharged Externally, the bags making their way to the Peritoneum adhering to it. Inflammation & Suppuration coming on, the integuments ulcerate & the Hydatids are discharged. Mr. Hunter on opening a Woman found a great number of them enclosed in one common bag. In the Lungs. Sometimes they make their way into the Trachea & are coughed up. In the Thyroid Gland. They may become troublesome by impeding deglutition. They are found in the Cellular Substance in different parts of the Body. Especially in the neck & about the lips of Woman. – 🜔v 982. In this manner we suppose hair is formed which is found in tumors of the Ovaria. Mr. Hunter Once found an encysted tumor in a sheep, which contained a Ball of Wool, now it is probable this was thrown off from the interior surface of that tumor on which it had formerly grown. – 23 formed is unknown. 979. As to the Cure of Encysted tumors we can do little unless we can either procure a discharge of the contents & an obliteration of the Cavity of the Cyst, or an entire removal of the whole. 980. Tumors mat appear in parts whose they was not formed but into which they have made their way from some deeper part This Circumstance the Surgeon should consider when he is about to extirpate a Tumor. 981. If the Surgeon is not attentive to this circumstance he may be deceived, & operate ineffectually only removing a superficial appearance of disease & neglecting the deep seated cause of it & when probably some other tumor arising has driven the first into its present situation. 982. Some encysted Tumors are found to contain a quantity of hair the internal surface of these has taken on the natural disposition of the Cutis & Cuticle & thus given Room for the growth of hair. 🜔v. 983. The Carbuncle as to its ultimate Effect might have been classed with Mortification, as it produces a considerable sloughing of soft parts, but some characteristic appearances attend it, which would shew it to be a distinct disease & of a specific nature. 984 The predisposing Causes we cannot easily ascertain, It cannot be supposed to be owing to weakness as in general it arises not far from the source of the Circulation, & it does not commonly arise in weak parts, or in weak habits, its seat is commonly the  24 posterior part of the body, as the hinder part of the Neck, the Back &ca. 985. It begins with a considerable inflammation of the Skin approaching nearer the Erysipelatous than any other, the Skin is somewhat tumid but not prominent the part has a doughy feel. For a short time a pimple Arises, the Inflammation spreads rapidly and widely, & the Cellular Membrane to a considerable Extent, Mortifies; the Skin & Muscles still retaining their Life. 986. The Skin above has pimples which now Ulcerate, forming large holes, through which the sloughs of the cellular Membrane are thrown off, & as they come away leave large chasms which are loosely covered by the Skin, which is flaccid & hanging inwards, sometimes the matter discharges itself through an infinite Number of small holes. 987. The disease though it has its Progress chiefly in the Cellular membrane, seems to begin in the Skin, & the matter generated seems of a specific nature, which contrary to the course of all other matter tends inwards, & burrows in the cellular membrane, which wants power to resist its spreading, from a want of the adhesive Inflammation. 988. Should not free openings be made in the Infancy of the disease to give free Exit to the matter, & to prevent its spreading & diffusing itself through the Cellular Membrane. 989. The loose Skin remaining after the coming away of the sloughs of Cellular Substance should not be removed, as it will commonly in the end unite with the subjacent parts, & thus 🜔^ 995. (see Lord Ansons Voyage) Here the Constitution not having a power of supporting the new parts or Even the original reclaims at were the former & causes them to be absorbed. 25. greatly forward the cure, which if things go on well from this time proceeds as in a common sound Ulcer. – 990. Boils seem to be a species of Carbuncles but more of the adhesive Inflammation arising in the Circumjacent parts they do not spread. The cure of boils vulgarly so called is in fact a slough or mortified part thrown off. 991. The Aged & free Livers are most Subject to Carbuncles the Young to Boils. 992. Though the cellular membrane sloughs, yet suppuration freely goes on, in which matter is either furnished from living cells which are endeavouring to throw off the dead, or from cells which are themselves also about to die. 993. Carbuncles are sometimes local & sometimes seem connected with a diseased state of the System. 994. Bleeding is rarely proper, though at the beginning may be indicated sometimes, if there appears Symptoms of Inflammatory Diathesis. 995. A diseased state of the System as Scurvy, may occasion both intersticial, & ulcerative Absorption of new formed substances which we have shewn are weaker than the Original, hence in violent Scurvy, cicatrices have been known hastily to Ulcerate & even Calluses which formerly reunited broken bones become absorbed & the Ends of the bones loosened. 996. Tetanus. Or Locked Jaw is a disease which consists in an involuntary Contraction of voluntary muscles, sometimes it becomes an unnatural contraction of voluntary Muscles & Δ 996. Unnatural Contraction of Muscles is a Genus of disease wch. has many orders to it belongs tetanus, Cramp, Wry Neck, St. Vitus’s dance, Subsultus Tendinum, One of the kinds of Quincey, Ague, it bears some Analogy to Epilepsy & Catalepsy, though these are properly affections of the brain, it is not peculiar to the human Species, Horses, Monkeys, Stags &ca. are subject to Tetanus. – 1000. In this it is so similar to other Spasmodic Complaints which are very common in Warm Climates, but rarely felt in Cold ones. – ♀ 1001. These act upon the principles of producing weakness & an irritable state of the Nervous System. Locked Jaw has been often attributed to the Wound of a Nerve or Tendon, with respect to the former, the opinion seems quite erroneous, with respect to the latter, as Wounds of the Tendons do not heal readily, they induce an irritable & weak state of the System & this being present irritations which do not become sensible give rise to it. Upon that Principle it is, that it is known to follow large Wounds which have considerable Suppurations & which induce a weak & irritable state of the habit It does not arise here from Inflammation, for it does not take place until after Inflammation is gone off. Mr. Hunter is satisfied from his Experiments, that wounds of Nerves or the including a Nerve in a Ligature made upon an Artery have no particular Tendency to bring on locked Jaw which he has frequently found to take place where it was Evident no more was wounded. 26 then perhaps it becomes fatal. Δ. 997. When it affects the Muscles of the lower Jaw, it is called Locked Jaw, when it Extends to the anterior Muscles of the body it is called Emprosthotonos when the posterior Opisthotonos 998 The predisponent Causes will be whatever can render the habit weak & irritable. 999. Amongst these (998) Climate is a very powerful one. In hot Climates it is extreemly common, being produced by the slightest occasional causes & even sometimes arising Spontaneously. 1000. In Temperate Climates it is more rare, in very cold Climates it is unknown. 1001. Other predisponent causes may be fever, large suppurations, Wounds of Tendons, & ligamentous parts. ♀. 1002. The most trifling external injury may be the occasional cause of this Disease, even a Scratch or puncture, where neither Nerve nor Tendon are found to have suffered. 1003. It appears to be a disease of the nervous system & not of the Principle of Life, every circumstance appertaining to the latter commonly remain natural & unaltered, sometime after the attack of the disease. 1004. The Muscles of the lower Jaw seem more disposed to take on this Affection than any other Muscles, here the Disease commonly begins & soon spreads itself to other Muscles those whose Action is involuntary & necessary to Life then the Patient is destroy. 🜍 1005. Stupor. This Shews that the brain must be somehow affected, as it is neither Muscular, nor connected with Muscles, it is difficult to say how this affection of it is produced, is it from any compression on the Brain, induced by the Spasm of the Muscles of the Neck making pressure on the Jugular Veins, or is it from sympathy. 27 1005. It begins with a small degree of stiffness in the Muscles raising the lower Jaw, the patient finding a difficulty to open his mouth, at length the Jaw becomes less & less capable of being depressed, the muscles of the Eyelids are next affected, & the upper Eyelid falls more & more so that the Patient looks like a person going to Sleep, sometimes soreness of the mouth & Throat precedes, but this is only accidental, then the Muscles of the Head became affected; at first the head is held immediately Erect by the Spasm, then it is drawn backwards, the muscles of the Spine become nex Affected & the body of the Patient is bent [for] backward, then those of the Abdomen, the bowels are drawn inwards; the patient complains of a pain in the lower part of the Sternum, perhaps from the Diaphragm being affected; a difficulty of respiration from the spasm extending to the Diaphragm, Intercostal Muscles &ca. in which last an excruciating cramp-like pain is felt Universal convulsive motions of the Body sometimes attend like to Subsultus Tendinum. In other respects health seems to remain & the functions of the Body go on. The Spasms of the Involuntary Muscles, however increasing in violence & perhaps the heart also becoming similarly affected the Patient is cut off, sometimes Stupor produces his Death. 🜍. 1006. Should the patient live until the habit becomes accustomed to the disease it then wears itself out & at length the patient gets well, in general however it Kills before the System can be habituated to its Action. 1007. The disease does not always increase gradually & regularly  28 regularly as described (1005) but sometimes it will Extend itself suddenly from the Jaw over the whole body, so as to Excite unnatural contraction in the Muscles in general. When the Spasm confines itself to the Jaw the disease may be called Mild & then it does not prove fatal. 1008. The disease kills at different periods of time, but if the patient lives through the second or third Week from the Commencement of the complaint, the constitution becomes so much habituated to it, that it loses its power of destroying Life; then wears itself out. – 1009. The disease continues sometimes even Ten Weeks, a great part of the time remaining Stationary & at last the Patient gradually loses the Spasmodic Affection & his Muscles are resolved to a natural State. 1010. All Ages are subject to it, of Constitutions the delicate & relaxed are most liable to its attack. 1011. When it Kills the Muscles remain contracted until the contraction is removed by force, but when Art has relaxed than they do not contract again, no preternatural appearance presents itself upon dissection in any part of the body in general the disease kills suddenly. 1012. From considering what has been said, we are perhaps enabled to discover. – Why the Patient remains under the disease a long time without his general health being affected. Why the Disease kills – why it may Kill at different 🜺 1013 & 1014. Bark, Opium, Blister, Camphor, Bleeding, Warm bathing & a variety of other methods have been tried, wherever Mr. Hunter has seen the patient recover, the disease has seemed to have gone through its natural course, & to have worn out itself without his having had any reason to attribute anything to the power of Medicine. He recommends the Sugar Lead to be tried upon the principle of the known tendency of Lead to produce relaxation of Muscles & inability in them to contract. Externally as a substitute for change of Climate he recommends that the Patient should be put into a cold bath or an Ice house, he never saw a Patient die after the third Week. ☍ 1016. Cases of Locked Jaw. 1. A locked Jaw & Convulsions of the Muscles of the Arm from a compound fracture of the Radius. Heat & Perturbation of Mind encreased the Symptoms, he was always observed to be worse after drinking anything warm, or after warm External applications. Opium & Bleeding was tried he died the sixth day. 2. A Soldier received a Wound in his leg when it was nearly well a locked Jaw came on. Musk & Opium were tried for three Weeks, the patient finding no Change would take no more. He continued in the same state for Seven Weeks & more, & then began to mend, which he continued to do insensibly until he Recovered his health. – He took Bark & Port Wine during the whole of his illness his Wound healed long before, his Complaint left him. 3 A Soldier with a locked Jaw after using Musk, Opium, Camphor 29 periods, & why it [may] commonly cutts off the Patient suddenly. 1013. No internal remedy has been yet discovered that will cure or relieve this disease. 🜺 1014. External application have also been found ineffectual as Climate is one great predisposing Cause to the disease a change from the present to a colder might be tried. Electricity has once been found serviceable. 🜺 1015. As the indication of Cure must be to relax the present contractions of the Muscles, & to take off every disposition in other Muscles to unnatural Contractions, the internal use of Lead might probably deserve trial, as lead by inducing paralysis may cure one disease by producing another. – 1016. If the locked Jaw here follows a Wound in any part of the Body, the removal of the part wounded is not found to remove or lessen, the disease unless the Tetanus arises during the State of Inflammation in the Wound. For when the Inflammation & irritation of the part which received the injury is gone off, it must be evidently useless to remove it in case a locked Jaw should have come on, because whatever irritation was heretofore applied to the part is now taken away, & that is no longer the diseased part, nor can it now tend to cause or keep up the Spasm its Action on the System has been already produced & terminated ☍ Upon the whole from what has been related we may be justified in acceeding to the conclusion given in (1013 & 1006.). – 1017. Scrophula. is a disease which may be considered as constitutionally local ( ) it is not hereditary, as in other diseases so in this a susceptibility of the disposition for diseased Action & even the cold Bath & finding no relief left off all his Medicine, he took none for eight days, & then began gradually to mend. 4 A Young man had his thigh Amputated, had violent pain in it & frequent spasmodic Affection of the Muscles, 13th. day locked Jaw came on, 15th. became locked all over, 16th. he died. Opium Æther & Sweating were Employed; Muscles continued rigid after death, but when Relaxed by force did not contract again. – 5. A Sailor had a Tetanus affecting the Jaw & Muscles of the Spine, came on 2 Weeks after having received a Wound in his Wrist, during his Illness had Ischuria & Costiveness, both of which were relieved by a Clyster, Opium, Camphor, Bark, Steel, Cold Bathing were all tried, he lived some days had pain in his heart & great sense of oppression about that Organ having come on he died suddenly. 6 A Man had a locked Jaw, it was uncertain whether this disposition to it was induced by a Wound on the foot, or by a Wound of the Tongue, he died the 9th. day. The second day of his illness the Spasm extended to the Muscles of the Neck & Spine, the 4th. his Skin became exquisitely sore to the touch, his Eyelids did not open properly he had universal Spasm, & a degree of Stupor – 8th. his breathing was difficult & he had a pain in the lower part of the Sternum 9th. he died suddenly. – 7 Locked Jaw cam on after Trepang, Opium was freely given no visible good effect followed it, but after a fortnight the Patient mended gradually & got well. 8. Locked Jaw arose spontaneously after Nervous Fever, the 30 is all that can be inherited. ( ).. 1018. It is a specific disease, every process of which is marked with indolence & slowness of actions, whether it produces tumefaction, suppuration, or ulceration, all of which when the disease is true Scrophula go on with little or no pain. 1019. When it produces Swelling of a part the tumefaction encreases slowly, there is hardness with little pain or soreness, all the appearances of common inflammation are wanting no Resolution of the tumor take place a kind of suppuration is produced. 1020. When the Tumor becomes soft & suppurates, which it does very slowly & without pain, the matter very gradually makes its way to the External parts. 1021. The ulceration of the Integuments in order for the Evacuation of the matter is equally slow & tedious, the matter does not make a point as in healthy Abscesses but it stretches the Skin equally to some extent & renders it as far as it distends it, Shining of a Purplish hue, in this state the disease will sometimes remain stationary for months, when the Skin can no longer resist the [?ressure] of the matter it bursts & a fluid like a mixture of Curds & Whey is evacuated, there is rarely any common Pus when the Scrophula has gone on pure & unmixed with the Common Inflammation. 1022. When the Abscess has emptied itself it does not readily [??ll] up or suffer its Cavity to be obliterated but will often remain fistula the small hole through which the matter bursts remaining open. Patient took nothing but Port Wine & recovered. – 9 Locked Jaw arose in a Child of two years old after a scratch of a Finger by a Saw – died the 10th. day. – 10. Locked Jaw arose Spontaneously after Dysentery. – 🜔🜹 1028. It is not peculiar to the human Species, Several Quadrupeds, as Monkeys, some Birds, as Turkeys, are subject to the action of Scrophula. 31 1023. When Scrophulous Ulcers granulate, the granulations are large, soft, pointed appearing like a transparent glassy Substance their sensibility is little, the Margin of the Sore is loose flabby & turned inward, the Skin round about it has a purplish hue the granulations want the power of contracting ( ) so that the Ulcer will continue stationary, or at most its sore will be slowly diminished. 1024: The process of Cicatrization is equally difficult & tedious & when formed has not an healthy appearance. 1025. The disease seems to have a sedative effect upon the System diminishing all the actions of the parts which it invades. 1026. It has a power of producing in the parts, surrounding the part originally diseased a similar State, but it does not produce continued Sympathy in any great extent. 1027. The predisposing cause is a delicate & irritable constitution with weak powers of action. The parts most disposed to take on Scrophulous action are the Lymphatic Glands, especially those wch. are most Exposed to the influence of the atmosphere, as the Glands of the neck & lungs, “the Mesenteric Glands”. Joints particularly those of the Foot & Hand, ligaments, the soft Ends of Bones, in all which parts the strength & powers of restoration are but small. 1028. Persons between the Age of 15 & 40. of a fair Complexion & light hair, who do not appear to have the usual quantity of red Blood in their Vessels, & those who live in climates which are very changeable & irregular are most liable to this disease. 🜔🜹. 1029. Though it produces continued Sympathy to a small distance it has no power of affecting the Absorbents, nor is the disease capable of being communicated by them, it cannot like  32 the small Pox be communicated by innoculation. 1030. The Skin is rarely if ever originally & primarily affected by this disease, it may however fall into it from continued Sympathy. 1031. The Exciting causes will be external Violence especially if not very great, sudden application of, or unusual exposure to Cold, the use of Mercury. The slightest degree of external violence in habits predisposed to it (1026-27) will cause the part to take on a Scrophulous action. 1032. The Susceptibility of Scrophula in some Constitutions is so great that any complaint which deranges the habit for a time, as Fever, Syphilis, Small Pox &ca. will give occasion to a Scrophulous disposition & action. 1033. The appearances of Scrophula will vary according as different parts are affected, however it will always be found with one of the following circumstances. 1. A Circumscribed Tumor. 2. A Tumefaction more diffused 3. Suppuration without tumefaction. 1034. The circumscribed Tumors are chiefly Lymphatic Glands although they are sometimes found in the brain, breast, Uterus & Testicle. 1035. When the disease attacks a part which may suffer without much disturbance of the general health, we are often unacquainted with the nature of the disease, until a swelling in consequence of Suppuration appears, either in the part originally diseased, or in some other part to which the matter has made its way, the suppuration going on without inflammation & perhaps without pain ♂ 1042. A Fever has sometimes cured Scrophula & hence we might be led to think that Stimulating Remedies are indicated, but the Analogy will not hold good, for the disease is a specific one & will not go until it has worn itself out, until it has destroyed Life or is Cured by some specific. Should Lumbar & Hip Abscesses be opened? They are in themselves incurables possibly a chance for Life may be given to the Patient by opening them early that is as soon we are satisfied Absorption of the matter cannot be brought about. In some Scrophulous Abscesses we can obtain a Real Absorption of the fluid, it is always to be desired as the healing of them after ulceration has taken place is Accomplished with difficulty. – 33 1036. When the disease affects the Knee, the pain is more considerable than when the other parts are attacked & here somewhat of the true inflammation is mixed with it. 1037. Whenever the lower extremity is the seat of the disease, the Limb appears longer than the other, this is from the Patients particularly favouring that side & leaning on the other. 1038. Children are often lame for Months, & at length a swelling has appeared in the foot. When Scrophulous Abscesses appear about the fingers, hand or foot, the swelling sometimes does not subside even after the matter has been discharged. 1039. Lumbar Abscesses sometimes appear without any Previous pain, sometimes patients remember to have had pains in the loins in general however, if they have pain it is felt beyond the seat of the disease, as in the thigh, the Knee, or Foot, the Matter here very frequently presents itself in the thigh though formed in the Loins. 1040. Patients under 30 are most subject to this complaint it is produced by the common Exciting causes of Scrophula, it is to be distinguished from a disease of the Hip by attending to the motion of the Foot. 1041. Abscess in the joint of the Thigh is of the Scrophulous kind there is commonly a thickening of the soft Parts forming & surrounding the joint, the patient has a sense of weakness in the limb, wch. wastes & has its motions contracted. 1042. White Swelling is a term that may be applied to every Scrophulous swelling of a Joint, before the Skin becomes inflamed it is generally attended with an increase of Synovia, sometimes is truely Scrophulous & sometimes has a mixture of the common Inflammation. ♂.  34 1043. The common Pulmonary Consumption is generally a Scrophulous Affection of the Lungs. 1044. The Young, the fair & the delicate are most subject to it & the common Exciting Cause is Cold, it commences with tubercles in the lungs, swelling of the Glands of the neck often appear in the beginning, the disease increases slowly, the tubercles Suppurate & ulceration being formed, the patient becomes hectic & is at length destroyed. 1045 The Pulmonary Consumption is however seldom a purely Scrophulous affection it has generally somewhat of the common Inflammation mixed with it, as we know from this pain in the Chest, the quick hard Pulse &ca. – 1046. An Hemorrhage from the Lungs is not uncommonly the fore runner of pulmonary consumption but how far this has to do with Scrophula we cannot determine. 1047. The Testicle is also the seat of Scrophula As in its Actions upon other parts so here also its attack is scarcely known & its progress slow. 1048. It rarely occurs before the Age of Sixteen or in Old Age. 1049. The Breasts of Women also fall into this disease in which they will gradually, slowly, & with little pain swell to an Enormous Size.. 1050. The Scrophulous Testis (1047-1048) & Breast (1049) are to be distinguished from Cancer of those parts, by the want of Swelling in the Spermatic Chord & [Axillary] [inguinal] Glands, also by the abscence of local Sympathy, at least until the Skin is beginning  35 to be affected by the Suppuration. ( ). 1051. The indications of cure in Scrophula with respect to the constitution are. A. 1st: to give strength to the System. 2d: to Counteract the effects of Climate. 3d: the use of some Specific. with respect to a apart B. 1st: to produce resolution of the tumor or Absorption of matter if it has suppurated. or 2d: to Extirpate the disease if practicable. 1052. The indication (a.1) we endeavour to fulfill by means of bark & other tonic Remedies. The indication (a.2.) by changing the situation of the Patient, or if that cannot be done, by rendering the Systems less susceptible of the influence of the Climate in which the patient lives The indication (a.3) By the administration & application of such remedies as Experience has proved. 1053. If Climate cannot be changed which is to be desired & wch. should always be altered to a warmer & more regular; then we may lessen the susceptibility of the body by tonic Medicines. Cold bathing & the use of such Cloathing as will maintain on the surface of the body an uniform & equable heat, such as flannel which conducts heat from the body badly. 1054. Experience seems to have approved the powers of Sea bathing as the most powerful specific in every Scrophulous Complaint whether Hip Cases, white swellings. Consumptions &ca. & some + 1055. We consider Sea Bathing as a specific in Scrophula but we are also to consider under what circumstances it will Act most powerfully, for instance whether Sea bathing & a Cold Bath, Sea Bathing & a Tepid Bath, Sea Bathing & a Warm Bath, will best agree with our Patient, for we are not only to consider what will cure the specific disease but also what will best agree with the Patients Constitution. Some Persons cannot bear Cold bathing but will find themselves much refreshed by the tepid Bath, again others require the heat of the Warm bath to render Sea Water Agreable to their Constitutions, Again the season of the Year is to be considered for more additional heat will be required to be given to the water in the Winter than in the Summer, if the cold Bath cannot be endured. In the warm or tepid Bath the patient should remain 10 or 15 Minutes with the precaution of tempering the heat to the agreable degree. Sea Bathing may be employed in all Cases of Scrophula Even pulmonary Consumption. To prove that the Bath agrees with the patient he should feel a Glow of heat, & his Spirits be enlivened by its use, if these appearance are wanting after a 2d. or 3d. trial & the patient feels himself [cross out] chilly & enervated, some other degree of heat should be tried. In bathing the sores of Scrophulous Patients should always be uncovered. 36 Specific powers are also attributed to the fossil Alkali & Hemlock. 1055. Sea bathing is to be used with that degree of heat which is found most agreable to the System & followed by the greatest encrease of vigor & Spirits. + 1056. The means recommended (1052-1053-1054-1055) are most to be insisted on when there is greatest predisposition to the disease & the patient most disposed to the action of Exciting Causes. hence Children & Young persons stand more in need of them than those advanced in Life, also in irregular climates & in Winter more than in regular Climates or in Summer, for the Winter favours the Progress of Scrophula, therefore sea bathing & flannel Cloathing are more necessary in Winter than in Summer (It is a bad practice with Parents & Nurses to carry young children about in the cold with the extremities naked & exposed to the Atmosphere the bear cold ill & suffer from it more than those advanced in Life) 1057. We are not to expect a speedy Cure from any remedies used in the treatment of Scrophula, length of time being always required to give them Efficacy from 3 Months to 2 Years. 1058. Moderate Exercise is to be recommended & perhaps Vegetable diet may be employed with advantage. 1059. Mercury is in general improper in Scrophulous Complaints Bleeding is often necessary in Scrophulous Lungs to diminish the quantity of blood circulated through the Pulmonary Artery & proportion it to the quantity of unobstructed Lungs. 1060. As to the topical treatment where the disease admits of it &  37 it can be removed with propriety all at once, Extirpation is the best method. 1061. In the resolution of tumours, or the healing of Scrophulous Sores few topical application Except sea water & the Juice of Hemlock are of any advantage. 1062. Stimulating applications are generally injurious, Violence increases the action of the parts & at the same time does not cure but adds to the disease. 1063. When there is suppuration the Abscess should not be opened with a Knife in general they should be left to break of themselves. 1064. Variations in Age will often lend to the spontaneous Cure of the complaint, & this is most observable in Females. 1065. In scrophulous bones Exfoliation is tedious and obtained with difficulty, In those as in soft Parts every process of Exfoliation goes on not without difficulty. 1066. In Scrophulous Swellings sometimes only a White Curdy or Caseous matter is formed, indeed the parts being altered in their Structure & incapable of carrying on their functions lose their life, but do not putrefy, nor is there a disposition of parts immediately in contact to throw them off, themselves also being affected by continued Sympathy. 1067. Rickets may be defined 1st. a want of disposition in the Vessels of the Bones to form calcareous Earth arising from a weakness of a peculiar kind, or  38 2nd. too great & hasty absorption of Earth from the bone in proportion to the quantity formed by the Vessels. 1068. It is a disease of the Constitution & Originates in a weakness of a peculiar kind, for weakness in general does not produce Ricketty Complaints, although Rickets are always attended with weakness. The first Cause (1067-1) operates in the production of Rickets in Children, the second (1067-2) produces the disease in Adults. 1069. The Rickets in children are known by the bones becoming Enlarged, by their bending under the incumbent weight of the body & yielding to the ordinary Action of the Muscles so as to be thereby distorted. 1070. A certain Size in the Bones & a certain proportion of Earth should be present together as the Size of the bones is determined in adults it is impossible, the encrease of the bones in Size beyond their grown Subject. 1071. But in Children this is the Case, it is a known fact that during the time of growth, the enlargement of the bones is the greatest whilst the quantity of the Earth formed in them is the least, for the formation of Earth checks the growth of bone. 1072. The animal matter of the Bones is also altered, for it is found to be different from the Animal matter of Bones simply deprived of their Earth. 1073. The Rickets cannot produce an encreased growth of Bone in the Adult, but in other respects, as softness of the Bones 🜁 1077. If the bones of the Cranium have been affected, an irregular ossification may arise on the inside nearest the Brain & by its pressure induce morbid affections of that Viscus. On the concave side of incurved bones nature will sometimes form an additional quantity of bone in order to strengthen the Original. Of the softness of ricketty Bones a case occurred at Lime-house, when the Bones were as soft as Tendons. “It is necessary to add that Mr. Hunter considers the molities Opium as a species of Rickets, & that it is here described as in Adults. 39 & their inability to support weight & Muscular Motion, though the causes of rickets in the Infant & adult may be different tho’ effects will ultimately be the same. 1074. The general consequences of Rickets in parts supporting Weight are, that the Joints are obliged to form more Acute Angles. 1075. From what has been advanced, we are [without] enabled to understand why bones of the Inferior Extremities, are more frequently bent, than those of the Superior, & also why those of the superior themselves are sometimes bent, why the Bones are knocked. 1076. Why the disease affecting the Spine shall produce difficulty of breathing & other complaints of the Viscera & why it should render the pelvis distorted & labours difficult. – 1077. The bending of the bones & their [becoming] throwing an increase of weight upon a joint, gives rise to the Stimulus of necessity which excites a disposition in some parts to take on ossific Inflammation & to generate new bone hence irregular Exostoses, Anchyloses of the Joints &ca. – 🜁. 1078. From what has been said we also understand why bones bend in particular, & in different directions. 1079. For [in] this disease no certain remedy has yet been discovered. 1080. The disease is either a species of or allied to Scrophula & Sea Bathing seems to be what approaches nearest to a Specific remedy, as well as for Scrophula. 1089. Where the removal of the Tumors by Mechanical means is feasible & convenient it should be done by the Pincers, Chisel or saw 40 7081 The general indications of Cure are to give strength to the System, hence the Cold bath, Exercise, bark, & othe tonics may be advantageously employed. 7082 Exostosis, has probably somewhat in its native similar to Rickets, it is a growing out of a bone from a bone. 7083. It appears to be of two kinds 1. Constitutional 2. Local In the first a Similar disposition shews itself in almost every bone, in the latter perhaps only in a single bone. 7084. It has generally its seat near the heads of bones & therefore seems much connected with soft parts. 7085. The tumor sometimes arises all at once out of the Substance of the bone, sometimes very gradually. 7086. When near the Joints it sometimes produces lameness altering the direction of the Muscles & tendons. – 7087. It is peculiar to Youth & rarely appears in the more advanced Stages of Life. 7088. Though we know the [causes] Absorbents have a power of removing superfluous substances, even bony ones, yet we know not of any Medicine whose powers will either produce a removal of those Tumors, or a prevention of them. 7090. Fistula are of two kinds 1st. A passage for the discharge of pus &ca. from a diseased part 2d. An artificial opening or Canal in lieu of some natural one being obstructed. –  41 1091 It is the consequence of some parts being affected with disease, which they are not able to get the better of, although the fistula itself is seated in a sound part. 1092. The diseased part to which the fistula leads is always larger & more Extensive than the fistula itself. 1093. As the Fistula commonly opens in the Skin, & as the diseased parts is more deeply seated the lips of the Skin will be more tucked inwards (though sometimes the lips of the Orifice are turned outwards, so as to resemble a prolapsus Ani,) and the Orifice will be nearly filled up with loose fungus Granulations, which if destroyed, radily shoot up again. 1094. Whatever is the disease in the part to which the Fistula leads until the obstruction to its restoration is removed, or its disposition if Specific or unsound is changed no cure will be obtained. 1095. If the seat of the disease extends to or occupies a vital part, it will teize a patient & the constitution until hectic is induced & death succeeds. – 1096. The indication of cure in the 1st. Species of fistula (1090) will be 1st. the removal of whatever obstructs the healing of the Parts. & 2d. The inducing a new disposition in the diseased part. 1097. The second intention (1096) will be fulfilled by laying open the fistula or cavity, throughout its whole length & even carrying incision into sound parts that the mouth of the cavity may be as large or larger than the surface of its bottom, & that the whole  42 being exposed, a necessity for some New Process in consequence of the exposure may arise. 1098. non est inventus. 1099. The first indication of cure will consist in the removal of all foreign bodies or such as stimulate, as splinters of bone &ca. under the limitations heretofore given in cases of Gun shot wounds & diseases of Bones. 1100. If the parts in question have any powers of restoration, the consequence of (1097) this treatment, will be the Excitement of Inflammation Suppuration & ultimately granulation, which will at length fill up the cavity which is unnatural & cure it. 1101. In the second Species of Fistula the indication of cure will consist (1090) 1st. in opening again the natural Canal – or 2d in making some New one which will answer the purposes of the original one. 1102. In the first species there is a greater disposition to heal in the parts through which the fistula passes, than in the deeper seated parts, hence the disproportion of size (1091-1092-1097.). – 1103. We cannot simply from the appearance of a Fistulous Orifice determine its extent, we must therefore examine its depth, the seat & extent of the disease by some convenient instrument as a probe &ca. – 1104. Sometimes one diseased Cavity will have several openings leading to it, it is generally necessary to lay open the whole Cavity making it into one, & to induce a disposition to heal, at the bottom Φ 1108 A person had a Fistula in Ano for which he was cut, but the part still remained Fistulous upon a more accurate Examination it was found that the Sinus extended two inches above the Anus & then penetrated, above the orifice it continued its course along the Gut, for another Inch, the incision was then carried to the End & the Man got well. 43 bottom of that cavity. 1105. When Fistula & the parts they lead to are laid open the external parts should be kept from healing, until the deep seated ones have acquired a disposition for Restoration & the Ulcer can be healed from the bottom. 1106. These observations may be better understood by considering 1st. Fistula in Ano. 2d. Fistula in Perineo – 3d Fistula leading to Joints..4th. Fistula of the Lungs Liver &ca. 5 Fistula Lacrymalis 6th. Fistula of the Parotid Duct – 7th Fistula of Coopers Glands in the Female. – 1107. Fistula in Ano is the consequence of inflammation beginning two or three, or more inches higher up in the Cellular Substance, or the outside of the rectum, which going on to suppuration the matter descending commonly makes a point externally near the Anus & bursts but sometimes the rectum becomes so diseased that it will also give way & a breach be made in it opposite to where the Inflammation began. – 1108. The Cure (1097) will consist in laying open the whole Cavity making its External mouth equal to or larger than the Surface of any side of the Cavity & preventing the too early reunion of the lips of the Wound. Φ. (1106). 1109. Fistula in Perineo. there will often be several Sinuses whose mouths open Externally communicating with the fixed point of the disease, there it is right to treat if we can according to Rule given above, but before a Cure can be accomplished the diseased disposition in the parts must be changed, for instance ♃: 1110 As fistula in perineo will not get well though a Wound in the same part in Lithotomy easily heals, in the latter the external parts have not lost their disposition to healing, hence there is no obstacle to the Cure. – ♄ 1112. We take no notice of Amputation for Fistula in joints as it has nothing to do with the doctrines now before us. – 44 1110. Fistula in Perineo may have for its cause. Stricture in the Urethra, disease in the prostate Gland or membranous part of Urethra, the external Orifice cannot heal as long as the disease remains uncured. ♃. 1111. Fistula communicating with Joints will not heal because they communicate with parts whose powers of restoration are weak and making free openings only increase the disposition to disease, & the violence of the Hectic, neither can we Cure Fistula of the Lungs or Liver, because we cannot lay open the Cavity. 1112. In Cases therefore where we cannot have recourse to the treatment recommended (1097 &ca. we can[not] only endeavour to give power to the constitution by time & Strengthening Medicines. that if possible a natural Cure (though little to be expected) may be obtained. ♄. 1113. Fistula Lacrymalis is sometimes an Original local disease, sometimes a constitutional Local, a arising from Syphilis, Scrophula, &ca. 1114. From whatever cause the ductus ad nasum may become obstructed, whether from Inflammation or a disposition to contract similar to that which arises in other membranous canals (as the Urethra &ca.) forming stricture in it, the passage of the Lachrymal fluid is impeded; distention gives a stimulus to the Lachrymal Sac, which stimulus is also increased by the Salts in the Tears. hence Inflammation & Suppuration is produced, & the matter bursts through the Skin near the Eye. 1115. Through this new & unnatural opening the purulent matter  45 matter mixed with the Tears continues to flow until the Surgeon either dilates the natural Canal, or makes a new one, so that the tears may again have a passage into the nostril & then the fistula will heal. 1116. If the Obstruction in the natural passage is very great dilatation of it will rarely cure because we cannot in general destroy the disposition of the Canal to form strictures, & these recurring the disease will also return, so that most commonly a New & Artificial Canall into the nostrils must be formed. 1117. Fistula of the Parotid Gland, the duct from the Parotid Gland passing over the Masseter & Buccinator Muscles consequently lying very superficially is extreemly liable to be divided & the Saliva will flow outward from the end next the Gland, or suppuration from any cause whatever arising in the Duct & bursting externally a similar circumstance will take place. 1119. The Cure is performed by passing a Needle armed with a round ligature of Thread from without through the duct into the mouth & let the Thread remain there until the wound made by the needle has lost a disposition to heal, the External Wound we should suffer & encourage to heal. 1120. The ducts leading from Coopers Glands to the inner surface of the Vagina in Women are sometimes obstructed & a Sac will be formed Containing a slimy matter which will cause a distention or Enlargement of one of the labia to a prodigious size & produces the resemblance of an Hernia. 1121. An incision should be made into the tumor & the matter discharged, after which the incision should be suffered to heal.  46 1122. Then a second Crucial incision should be made into the Sac near to the natural opening of the duct, & this should be kept Open until it has lost all disposition for healing, & the mucus is discharged by it as formerly was by the natural passage. 1123. Unsound Abscesses. these are to be considered as two fold Viz. 1. those forming in a part 2. Abscesses of a part. 1124. In the first we have a collection of matter formed in the part where they appear, & in the second the matter is formed in some other part more or less distant & from thence makes its way to the part where it appears. 1125. Of the first we have instances in many Scrophulous suppurations in abscesses of the Joints &ca. 1126. Of the second we have instances in the Psoas Muscles & Hip Joint, which often present their matter in the thigh or Groin. 1127. Whether the latter burst, or are opened, the doctrine of Fistula will apply to them, nor will opening unsound Abscesses of a part be of Utility unless we can also induce in it a disposition to heal, or we have some foreign body to remove as Splinters of Bone &ca.. – 1128. Unsound Abscesses are generally caused by some Specific disposition as Scrophula, Lues Venerea &ca. or from a disposition to indolence either acquired or natural, that is Either in parts which have natural powers of healing but fall into a state of diseased indolence, or in parts which have natural but small powers of healing as in joints, ligamentous parts &ca. – ☉ 1132 By This definition, Glass, Metallic Salts, even Arsenic & a variety of Vegetable Substances as Crow figs. Hemlock, Opium &ca. are excluded from the Class of Poisons, also Honey, Particular kinds of Fish &ca. for three Reasons. 1st. Because these are not poisonous in the smallest Possible Quantity 2d. Because their action is not universal. 3d. Because their irritation is not specific but common. 47 1129. New formed parts as Cicatrices & Calluses are sometimes suddenly falling into the ulcerative & intersticial Absorption & the progress of the absorption will be uncommonly rapid as this arises from an unsound disposition in the Constitution, that disposition is to be removed or altered. 1130. We come now to Poisons (Poisons) especially the Animal & principally Morbid. 1131. But we can give no unexceptionable definition of poisons. 1132. The definition however which we can give & most free from Exception is A matter which produces a peculiar mode of irritation & affects the vital principle in a peculiar manner, when even used in the smallest possible quantity; & this without any relation to any known chemical or Mechanical powers, or by any common irritation. ☉. 1133. We know no substance in the mineral kingdom answering to this description, nor is there much poison of this nature in the Vegetable, but the Animal kingdom possesses it in great abundance. 1134. No secreted fluids are poisonous to the part secreting them but they will act as poisons on any other part of the Animal they belong to. 1135. Poisons answering our definition (1132) are of four kinds 1st. Those which act locally as the sting of a Cancer Itch &ca 2d. Those which have their effect on the Constitution, as Jail fever, hooping Cough &ca. - 3d. Those whose influence is upon the whole Nervous System, 1135 In the Animal Kingdom, some Animals as the bug & muskitoe & probably the, poison the part at the same time that they get their food from it. The Bugs, for instance poisons the part & produces an Extravasation of its Juices which it feeds upon. The leech after making a Wound poisons the Vessels of the part Wounded, so as to almost destroy their power of contracting, hence the Hemorrhage which often continues so long after a leech has been sucking which never follows other similar Wound 48. as the poison of the dog, of Indian poisoned Arrows &ca. 4th. Those whose powers are mixed as the Poison of the small Pox, Lues Venerea &ca. acting both locally & on the Constitution. 1136. We intend to consider Animal poisons only, & these are of two kinds, viz. 1. Natural 2. Morbid. 1137. The Natural are such as belong Originally & Naturally to the Animal possessing them & not depending upon any Preternatural affection or alteration in the Structure of any body or its path. 1138. The Natural has no power of propagating its effects beyond the individual its powers are exerted in poisoning. 1139. The morbid on the contrary depends on a preternatural action, or change of Structure in the Body communicating. 1140. But the morbid in general may be communicated by the body poisoned to other bodies & therefore may be propagated to many individuals; because the individual poisoned receives the same power of poisoning others as the Animal possessed by which it was poisoned. 1141. Some of the natural act locally only, as the Wasp, others both locally & constitutionally, as the Viper, Rattle Snake &ca. – 1142. Those acting on the constitution generally first produce local effects, before they are absorbed & affect the System. 1143. Pain in the part receiving the poison, red Streaks & swellings of the Lymphatic Glands in the course of absorption are sometimes preludes to rigors, Convulsions, general livid extravasations Swelling of the whole body & Death. ♀ 1151. Mr. Hunter suspects the Venereal poison militates a little against the general definition of poisons, in that he imagines its action depends on some measure in the quantity applied. Small Pox by inoculation between the time of its application & the time of its visible irritation requires 2 or 3 days Natural Small Pox 23 days – Measles 9 days. Cancer some Months – Itch time not ascertained. 49 1144. Inflammation is produced in the part of the adhesive kind (for the parts swell) which rarely terminates in suppuration tho sometimes pus is formed. 1145. The pus is of the common kind, when it does form, & it contains no poison, whereas when suppuration takes place in the morbid poisons, the pus itself is poisonous. 1146. All the natural poisons must come in Actual Contact with the part to be poisoned, some require to be inserted by a Wound in order that their influence may be [hastened] Exerted. 1147. Morbid poisons probably all arose at first from a [Wound] diseased state of the Body or of parts. 1148. Many are obliged to the power of Contamination for their continuance & that power destroyed would Cease to be known. 1149. In what they differ from the natural has been already shewn, they are like the natural communicated by contact & some of them in a state of Vapor. 1150. Those which arise spontaneously seem to be confined to the species of Animals in which they arise, as Cancer, Syphilis &ca. which are peculiar to the human Species & cannot be communicated to any other Animal. 1151. Morbid poisons applied to Animal Bodies have specific distances of time, between the time of applying the poison & the time of its producing irritation &ca. ♀. 1152. The natural poisons do not in general produce Extensive local Sympathy. 1153. Morbid poison being applied to a part, that part becomes  50 infected & diseased without a power of contaminating other parts by means of the absorbents, as in the Itch, or 1154. Morbid poisons being applied to a part, that part becomes diseased, & has a power of communicating the disease to other parts but not to the Constitution, as Cancer &ca. – 1155. When a part has the power of contaminating the System as the Small Pox. 1156. Of the action of some poisons, as Small Pox, Measles &ca. the constitution is sensible only once in the course of Life; of others it may have the action repeated. 1157. Cancer. is a disease produced by a morbid poison arising spontaneously in a part without our being able to account for the manner in which it is generated. 1158. It is a local disease which may produce a consequent similar local disease in another part but has never the power of infecting the Constitution. 1159. Some parts are more liable to the affections produced from difft. poisons than others, so the secretory Glands are most commonly the seat of Cancer. The breast & uterus in Women. The lips, external Nose, Pancreas, Pylorus, & Testicle are commonly seized with this disease. 1160. It is a poison of whose action the human Species are alone susceptible, Experiments have shewn us that it cannot be communicated to other Species of Animals. 1161. We find in parts affected with Cancer an indurated knotted feel with a kind of suppuration in the Centre, or an ulceration of the external surface attended with pain. 🝄 1169. “We may infer that cancerous Virus has no Power of infecting the blood or producing similar diseases in any part by means of the Blood.” “One Reason why Cancerous matter should not be able to act upon the system when Absorbed may be, that it is so slow in producing its Action that time cannot be sufficient for that purpose after its being absorbed, before it is thrown out of the body.” 51 1162. previous to a disposition to ulceration being formed the pain is dull & heavy but this disposition being produced, the pain becomes violent, giving a shooting burning sensation. 1163. The part affected has its functions destroyed, if a secretory Organ it loses entirely the power of Secretion. 1164. In its suppurating process the Cancers becomes adherent to the surrounding parts. The Skin becomes discoloured, smooth & shining & matter is formed, sometimes without much previous Inflammation 1165. When the Cancer is cut into previous to ulceration having taken place, there is sometimes found the appearance of a Cyst which contains an ill conditioned Serum, Blood, Curdly matter &ca. but seldom or never matter resembling good pus. 1166. The process of Cancer in all its stages & states is in general slow. 1167. When ulcerative Absorption has taken place, the integuments round the Ulcer, are tight & rigid, the Skin is tucked in at the edges & wrinkled into folds, an ill conditioned matter is discharged. 1168. The Lymphatic Glands in the Neighbourhood become indurated & Enlarged, sometimes soon, sometimes even before the Ulceration has taken place, & little Lumps are sometimes formed in the circumjacent Skin. 1169. It has a power of poisoning other parts, & of producing in them a similar disease, but it has no power of Contaminating the Constitution. 🝄. 1170. A Cancer of one part may produce Sympathetic swellings of the parts, but not true Cancer unless of Parts which are in the course of absorption.  52 1171. Constitutional effects as Hectic Fever &ca. may arise in Consequence of a patients labouring under a Cancer from the irritation the disease produces, but the affection of the Constitution will be only that, common to simple irritation, nor will there be anything specific or peculiar in the manner in which Cancerous irritation acts upon the System. – 1172. The time of life seems to be the powerful predisponent cause of Cancer, the Age which most strongly predisposes is from 40 to 60 it sometimes however appears Earlier tho’ rarely. 1173. The Exciting Cause. 1174. The parts most susceptible of the cancerous disposition seem to be those proper to the Sexes. 1175. Women are more susceptible of the Cancerous disposition than Men probably because they have more parts peculiar to Sex. 1176. Is there not another cause in the parts peculiar to Sex in Women at the given time of Life, undergoing a Change which renders them unfit for procreation. 1177. We know of no Medicine which will cure a Cancer. 1178. Arsenic is probably a specific for the Cancerous disposition but its powers are too weak to produce a Cure, nor will the System allow of its being introduced in sufficient quantity. 1179. Yet, a Cancer, if left to itself always kills, either by its constant irritation it exhausts the principle of Life, or by Producing continued or contiguous Sympathy, & thereby inducing a similar diseased affection in some part necessary to Life. 1180. Therefore Extirpation of the diseased part is always to be desired & if practicable always to be preferred before a consequent  53. cancerous affection has taken place any other part. 1181. We are always to consider not only the Original or first formed Cancer but also any part which may have been poisoned by matter absorbed from it, & which we call the Consequent Cancerous Affection. 1182. Nor can we always be certain that a consequent Cancer is not formed because ulceration & the formation of cancerous matter has not taken place for 1183. Coagulable Lymph which had been extravasated, in the thickening & induration, if absorbed will equally contaminate & poison the parts it is applied to, for whatever the fluid seperated in a part may be it will always possess the specific properties of the part from which it is secreted. 1184. The Consequent affection begins Either in the Lymphatic Glands or the Lymphatics themselves but a Cancer once formed whether Original or Consequent, there is no part contiguous to which it may not extend its action, even to bones. 1185. Hence Cancers should always be extirpated as Early as possible the Earlier they are removed the fairer prospect has the patient of future health. 1186. Previous to Extirpation it is always necessary to observe a. The common rules laid down touching the Extirpation of Tumors. b. Whether any Consequent is already formed & where. c. Though no Consequent cancer is Visible whethere there is just reason to believe a disposition for one is any where formed. 1187. In extirpation it must be an invariable rule to take away the whole of the disease. (1188 non est inventus) 1189. If the whole of the disease cannot be removed Extirpation  54 is not to be attempted. 1190. If the Tumor adheres to the Skin it should always be a rule to remove more Skin than the diseased part is adhering to that if possible, we may be sure of not only taking away the present diseased parts, but also of taking away any part in which it is probable from its Contiguity that a disposition for a consequent Cancer may be formed. 1191. The Consequent if left will be equally injurious & equally fatal with the Original Cancer, & though the Original be taken away, will itself contaminate other parts in the same manner & to the same degree as the Original & is equally incurable by any powers of Medicine. 1193. Notwithstanding all our Care the disease will sometimes appear again, even after we have removed all evidently diseased parts & these also which we are justified in suspecting. 1194. For, the slowness with which the Cancerous Virus sometimes acts may be a Cause of deceiving us, a disposition to a consequent disease may be formed in some part, which we can by no Signs whatever ascertain the Existence of. 1195. Nevertheless when the operation is admissible we ought always to endeavour at the Extirpation of a Cancer. 1196. Cancer must be distinguished from Scrophula & from indolent thickenings of all kinds which may be done, not only from its appearance, pain, &ca. but also from its acting as a poison on the neighbouring parts, which scrophula & simply indolent thickenings never do.  55 1197. It should also be distinguished from the Fungated Sore wch. though it is not a poison as it has already been considered as Cancerous may not improperly be noticed in this place. 1198 The fungated Sore is a specific disease entirely local & has no power of contaminating or poisoning parts, beyond the Extent of continued Sympathy & even this not widely diffused. 1199. It has its seat in every part of the body without Exception. 1200. It begins in a circumscribed Tumor partly solid or encysted is not for a time very painful, it gradually & not very hastily enlarges, the Skin becomes discoloured & at length burst & ulcerates 1201. A lose Spungy fungus of the colour of dark Cruor is then thrown out, which rises & enlarges faster than Escharotics can take it down, it bleeds easily from the surface of the fungus & its pain is Acute. 1202. It resembles Cancer in being absolutely incurable by Medicine & if left to itself destructive. 1203. But it differs from Cancer in not being poisonous, & in never producing either in the Lymphatics or Lymphatic Glands a similar affection. 1204. This disease kills without seeming to have done so much mischief as might be supposed admissable without destruction of life. 1205. Nothing can be done to relieve the patient, but extirpation in which we should be extreemly careful to remove every Atom of disease, otherwise the part will again take on the same Affection. 1206. Many diseased appearances on the face, which have been considered as Cancerous are only fungated Sores.  56 1207. In the extirpation of Cancer two methods have been Employed. Viz. 1st. the Knife or Excision 2d. The use of such means as produce the death of the whole of the diseased parts & the subsequent seperation of them from the second parts. 1208. Diseased as well as new formed Parts ( ) have much less power of preserving life & resisting Death than sound parts, hence we can conceive how the application of Arsenic to Cancers shall sometimes produce the destruction of the whole of the parts laboring under Cancer, without depriving the Circumjacent parts of life 1209. Chemical applications as the different Caustics ( ) have also been employed, but the powers of Arsenic are the greatest, the Caustics making less distinction in their action between ye sound & unsound parts, the latter Acting Chemically, Arsenic by its irritation & exciting an Action under which the diseased parts have not strength to live or subsist. 1210. If we employ the Knife we should always cut into sound parts, in general we can employ excision more universally than the other means. 1211. We should in the Course of the Cure of the Ulcer after the operation if any lumps arise, or any consequent Cancer appear it is right to remove them as soon as discovered. 1212. If a Cancerous disposition remain after the Operation the Wound either will not heal or the catrix will soon ulcerate afresh, or the consequent disease will make its appearance. 1213. It is necessary to take notice of some Cancerous Affections of particular parts.  57 1214. A Cancer of the Breast most commonly begins in a small Schirrous Lump, which is in general circumscribed; at other times it begins with a discharge of blood, or a kind of matter from the nipple, sometimes the Skin becomes diseased very Early being thickened, discoloured &ca. – 1215. The natural function of the breast is destroyed, it loses the power of secreting Milk, is painful &ca. – 1216. It should be amputated before there is any adhesion of the breast to the pectoral Muscle or ribs, & before the Glands in the Axilla become affected, or at least before these Circumstances take place in any great degree. 1217. We must be cautious in Examining the Axillary Glands sometimes when enlarged they may seem moveable but when we come to operate we may find a Chain of little diseased Glands extending beyond the reach of the Knife, & rendering our endeavours fruitless. 1218. If the Cancer of the breast is suffered to become irremediable the ulceration increases with a stiffness & tightness of the surrounding parts, the breathing becomes affected & is difficult & laborious. 1219. The Axillary Glands being universally & greatly Enlarged the return of the Lymph from the Arm is obstructed, hence an Oedema of the whole Arm, sometimes soft, sometimes hard, takes place. 1220. In some patients the integuments on that side of the body will become Oedematous, & even a paralytic affection of that side of the body on which the disease is situated may ensue.  58 1221. Consequent Cancers will be formed, at length the patient worn out for want of sleep, with pain & hectic from the constant irritation, until at length she sinks & end is put to her sufferings 1222. In this as in all other Cancerous affections the liberal & unlimited use of Opium is to be permitted. 1223. If Cancer is seated in the Testicle it should be removed before the spermatic Chord is thickened, or at least whilst so much of it is apparently undiseased without the abdominal ring as to have room for the performance of Castration & then we are justified in operating, though the success is uncertain. 1224. In the Cancer of the Testis the pain is more excruciating than in the breast; with regard to the Extirpation & the Administration of Opium the rules given will apply. 1225. In the Cancer of the Testis the consequent Cancer will be in the spermatic Chord, the absorbents of the Testicle pursuing its course. 1226. If the Scrotum is the Seat of Cancer, the consequent disease will be in the Inguinal Glands. 1227. In the Lips the disease begins with a thickening. It is to be removed by the operation for the Hare lip, in other respects the preceding general rules must be observed. 1228. It is not necessary to dwell on the particular Cancers of other parts, as the Eye, the Nose, the Uterus &ca. Extirpation when practicable should be early employed, when impracticable means of alleviating pain, can only be had recourse to.  59 1230 The Itch, is a specific disease produced by a morbid poison which being applied to the Skin occasions ulceration in it. 1231. The Itch is Contagious, the person infected with it being always able to communicate it to others in the same manner as he received it. 1232. Contact of parts is necessary to its being communicated in a state of Vapour it has no power of Contagion, & its powers of infecting are very weak & easily guarded against. 1233. Animalcula may exist in the Matter but not necessarily nor universally. 1234. Continued Sympathy produced by it is very little & contiguous Sympathy hardly ever takes place from its action it has no power of poisoning the System nor have the Absorbents ever been seen to be affected by it. 1235. Its most ordinary seat is where the cuticle is Thin, its first appearance is a small Vesicle containing a little fluid to this succeeds an Ulcer discharging pus, which in the recent state is very minute, but when of some standing considerably increases in breadth, so as to be sometimes as large as a Sixpence. 1236. The little Ulcers made by the Itch never heal Spontaneously, & when healed by Art they do not again break out nor do other ulcerations arise in the surrounding Skin. 1237. Its power of irritating is not very considerable, the surface of the body must be healed to be sensible of its irritation, the sensation it Occasions is Itching not Pain. 1238. Different remedies are found to be specific for the itch  60 Sulphur, Hellebore, Mercury, externally used are known to cure it, but Sulphur Ointment seems to be the most powerful remedy. 1239. A Mercurial Girdle has been known to Cure the disease even when Mercurial Ointment applied to the Skin has failed. Brimstone taken internally will sometimes Produce a Cure. The ☍. 1243. Men who have a gleet, after all inflammation is gone off may infect Women & Women Men. 61 The Venereal Disease. 1240. The Venereal disease is one of the most Morbid compound Animal poisons, & like other morbid Animal poisons may be communicated by the persons infected to others. 1241. It is always communicated in the form of or united with purulent matter, which shews that it originally arises from Inflammation. 1242. When communicated to a part it produces in general Inflammation; but its progress is attended with Symptoms Peculiar to itself & distinct from those of other Animal poisons. 1243. The presence of Inflammation is not however necessary to its Existence, an infected person may communicate it to others after all Inflammation has left him, as in the Case of a venereal Gleet. ☍ 1244. To produce infection the Venereal matter must be communicated in a fluid state, or in a state rendered immediately fluid by the Juices of the receiving part, in the form of a Vapour it cannot infect, nor can it be communicated without the presence of purulent matter. (1242). 1245. The poison first arose probably in the Genital parts in the intercourse between the Sexes. This intercourse is not however necessary, it may be communicated from other parts besides the Genitals, & Even when applied by means of other substances than living 🜔v 1245. A Gentleman by Passing a bougie that had been formerly used by him when he had a Clap, caught a Gonorrhea. 1247. Mr. Hunter has sometimes known Gonorrhea arise without any preceding inflammation & confessed himself very much puzzled concerning the nature of such a Case, if they were venereal it should seem this Aphorism will not universally hold good. 62 bodies. 🜔v 1246. Actual Contact with the part to be infected is however always necessary. 1247. Venereal matter applied to sound parts has generally the effect of producing inflammation, which is always of a specific kind. 1248. From what has been said it is evident those parts which are not naturally or Accidentally secreting surfaces cannot communicate the Venereal contagion. 1249. It may affect the body either locally or universally & therefore may be divided into two Genera viz. 1st. Genus. Original or immediately local. 2d. Genus Constitutional. 1250. The first Genus has two species seemingly different yet their ultimate effect is the same Vizt. 1st. without ulceration or breach in the Solids called a Clap or Gonorrhea. 2d. with a breach in the Solids, or solution of continuity called a Chancre. 1251. The Bubo or local consequent may follow either the first or second species of the first Genus & when suppurating differs in nothing from the Chancre except in size. 1252. When the infecting matter is applied to a secreting surface the first species will be produced, when to a non secreting Surface as the Skin covered with the cuticle, the 2d. species will arise; from  63. either of these a Gland in the line of absorption being affected the bubo or local consequent, will be brought on. 1253. All secreting surfaces in the human body having nearly the same mode of action will take up the infection from simple Contact & may any or either of them be the seat of the 1st. Species. 1254. The second species may be induced a by a Wound. b by application of the Matter to the Cuticle. C by application of the matter to a Sore. 1255. Secreting surfaces being natural as that of the Urethra & Nostrils &ca. or accidental as an Ulcer, whenever the Venereal Matter is applied to them increase their secretion to wash away the offending matter. 1256. But the further consequence of the application of Venereal matter to the Natural & Accidental secreting surface will be different, of the former it will in general only change the nature of the secreted fluid from the latter, it will first increase the quantity of secretion, & then producing for a time, a Gonorrhœa of the Sore, it will change the nature of the Sore from a common one to a Venereal one, & then the disposition to ulcerate will be increased & the sore be in every respect converted into a chancre of the 2d. species. – 1257. Whenever a part becomes infected with the Venereal Virus it takes on a new action, if it is a secreting or sine Cuticular Surface as above described the nature of the secretion will be changed, if on a secreting surface the ulcerative Absorption of the part will take place & the pus will be secreted. 1258. Some secreting surfaces seem more susceptible of the Venereal 🜍 1262 A Gentleman had Chancres many times, they always healed very readily but the slightest scratch from any accident he received always was extreemly difficult to heal, so that some are very susceptible of this Specific or Venereal Irritation tho highly so of any irritation. – 64 Venereal irritation than others, the urethra seems evidently distinguished to take it on. 1259. Absorption of Extraneous matter always goes on more readily from an Ulcer than from a fresh wound, or from a Canal, it must be evident then that the local consequent must more readily & frequently arise from the first than the second Species. 1260 The Venereal poison will be always the same in point of Strength or acrimony, it may indeed at one time be diluted through a larger quantity of Fluids than at another, but it will produce the effects of a poison in the smallest possible quantity. 1261. Yet it produces different effects in different subjects, in some it will cause the most violent in others the slightest affection, it is therefore evident the susceptibilities of different persons of its irritation must be very much. 1262. This (1261) will not be easily explained for the susceptability of venereal irritation will not be in proportion to the susceptability of other irritations. 🜍. 1263. The local consequent will differ nothing either in its nature or its ultimate Effects from the original local having the same power of poisoning other parts, or the constitution & the matter secreted in it being equally infectious as that of the 1st. or 2d. Species of the first Genus. 1264. A natural secreting surface cannot be affected by this poison, longer than a certain time for had it a power of keeping up a specific Action in the part longer than a certain time the duration of the disease would be endless, for fresh matter being continually secreted would be the cause of a still further secretion of similar 🜔🜹 1264. Parts lose their sensibility of the Stimuli applied to them, in the Urethra the nature of the Solids is not changed but only the mode of the Secretion, now in process of time the membrane becomes habituated to the presence of Venereal matter & is then no longer sensible of its Stimulus, which can now no more produce the specific disease & therefore the disease [always] decays & a natural Cure takes place (see Note 1265). 🜔 1265. When we consider the different methods different people have to curing the gonorrhœa & that all are successful many of whom cannot possibly have any specific action upon the part we may readily suppose in General the complaint goes off of itself. Cases. A Married Man, during several years had known no other Woman but his Wife, he at length lay with a Woman of the Town & caught a severe clap. The Woman who gave it to him was not sensible herself of the ailment she continued her connection with him for several months without perceiving any change. She then formed a new attachment & gave a Gonorrhœa to her second Lover, she had no marks whatever of the disease herself he continued his intercourse with her for sometime, but notwithstanding got cured the while at length the first lover Returned to her had connection with her only once & she clapped him again. 2 A Gentleman kept a Mistress who becoming clapped left him she applied to & was taken into the Magdalen hospital, where she was apparently cured, she continued in that Hospital 2 Years seemingly 65 similar matter & so on ad infinitum for it would still continue its secreting action. 🜔🜹. 1265. We are induced to believe this to be the case from knowing 1st. That all Gonorrhœas are cured without any Specific remedies. 2d. That a secreting surface will retain Venereal Matter after Inflammation is gone off & also a power of poisoning other parts for a considerable length of time without being sensible of the presence of Venereal matter or undergoing any morbid affection from its remaining in Contact with it. 3d. That the application of fresh Venereal matter may be applied to the secretory surface in question without increasing the present disease or even retarding the Cure 🜔. 1266 Note continued. ~ quite well & when discharged was picked up again immediately on her dismission by the Gentleman who had formerly kept her, to whom she nevertheless gave a severe gonorrhœa, he continued however to Cohabit with her & got quite well without interrupting his connection which at last he broke off. A Married Gentleman in the City took her into keeping & was immediately clapped by her he was likewise Cured although he continued his intercourse with her during the cure, his Mistress however left him & returned to her former lover whom she clapped the second time. These histories abundantly shew & serve to prove what has been advanced. Many more of the same kind could be adduced, moreover if the Venereal matter of a Gonorrhœa or a Chancre is applied to a Bubo, or that of a Bubo to a Chancre it will not in the least increase the disease or retard the Cure. If a Man continues to be intimate with a woman who has clapped him, & if he is cured & she not, still he will not receive fresh infection, that is provided he continues to cohabit with her but if he absents himself from her for sometime, that is until his Genital parts have recovered themselves & as it were lost the recollection of the Venereal Stimulus he will then get a fresh Gonorrhœa. This we see depends upon the force of habit, from being long accustomed to the Stimulus of Venereal Virus the parts lose their sensibility of it & cannot be irritated by it. thus in general if a Man gets several successive Claps the first will be the severest & they will become slighter & slighter every time, was a Man once clapped to continue during his Cure even so long afterwards his intercourse with Venereal Woman, it is extremly probable he would find it impossible to contract a fresh Venereal Gonorrhea (see habit 98) 🜖 1270. Where the pus discharged from Ulcers in the Urethra the Gonorrhea would not be cured without Mercury, which we [have] know is by no means the Case. – 66 1266. But this natural decay of the specific morbid action & spontaneous cure will only arise in natural secreting surfaces. wherever a chancre or Venereal Ulcer is formed no natural or spontaneous cure is ever effected, but the disease continues increasing in violence until it is cured by Art. 1267. The matter of a Gonorrhœa & Chancre is exactly similar & equally capable of poisoning other parts. A Gonorrhœa will produce in the same person a Chancre or a chancre, a Gonorrhœa, & both or either may produce a Constitutional disease, in general when the Chancre appears the Gonorrhœa goes off, & frequently the Gonorrhœa appearing the chancre will go off. It should therefore seem that one irritation cures the other, the two parts sympathizing with each other. 1268. It is extremly difficult to decide when the power of Contamination is entirely lost, persons sometimes retain a power of communicating the disease after not only inflammation but even the discharge has seemingly disappeared. 1269. If the Venereal poison is applied to a fresh Wound, or by means of any Wound, suppuration must in general first take place, before it can produce any effects on the body. 1270. The discharge from a Gonorrhœa is purulent but is very rarely attended with any Ulceration of the Urethra. 🜖. 1271. The local Consequent or bubo, sometimes neither Suppurates nor goes off by resolution, but becomes indolent & will 🜁 1272. We have seen the Chancre readily Cured in a person & he afterwards contracted a Gonorrhœa which was very severe and very difficult to remove. ∇ 1276. A Boy Eight years old swallowed some Milk & Water in which some Chancre had been bathed, with impunity; A Lady drank by mistake a bason of Milk & Water in which a Gentleman had washed his Chancre, it was near Eight hours after before she took an Emetic yet no bad consequence ensued. 67 frequently remain in that state notwithstanding the use of the most powerful remedies. 1272. Not only different person will be affected by the Venereal Virus in different degrees of violence (1261) but the same Remark will hold good with respect to different parts of the Body. 🜁. 1273. The second Genus or Constitutional ( ) takes place when the Venereal Virus is absorbed & carried into the Circulation. 1274. It may be communicated to the constitution by means either of Gonorrhœa or Chancres, sometimes although rarely from Venereal matter being applied to the surface at the body without Ulceration having previously taken place & sometimes from application of it to an Ulcer, without producing any change, but those two latter modes of infection are very Unfrequent. 1275. It may also be introduced into the System by poisoning a Wound, but there it must first produce inflammation & Suppuration in the same manner as inoculated Small Pox must produce Inflammation & suppuration in the place of incision before the constitution becomes infected. 1276. The Venereal Virus will not act as a poison applied to some parts of the body, it will have no effect upon the Stomach as has been proved by Experiment. ∇. 1277. The Venereal Virus cannot be taken in from the breath, sweat, saliva, milk or any other natural Secretion of a person labouring under the disease in its worst state. 1278. When the Venereal Virus is absorbed into the Circulation, it produces no change in the Blood, but has a power of producing local effects in different parts of the body, as blotches Ulcers, Nodes 1281. A Nurses breast inflamed & Ulcerated after suckling a child who had lately died. A Physician gave it as his opinion that the was Universal & that she had been giving suck to a pocky Child, but the event of the Case contradicted him Mercury did not mend the state of the sore, indeed New Sores broke out upon the breast while she was taking it, at length she left off Mercury & recovered by good diet & Country Air. 🜆. 1282. It has been supposed that if a pregnant Woman is poxed, the Infant in Utero must partake of the disease, if ever this is the Case, it can only happen from the original matter from a Sore being conveyed unaltered to the Child which is what we can hardly conceive to happen. 68 &ca. but it is certain the Venereal matter undergoes some change as the Ulcer &ca. so produced, that is from the constitution, have no poisonous quality, the matter from a Venereal constitutional Ulcer will not communicate Venereal infection nor will it differ in its powers from pus of common ulcers. 1279. The blood although the matter has been absorbed into the circulation will not communicate the disease to a second person nor are any of the secretions of a patient labouring under the 2d. Genus any ways infectious. 1280. The Venereal Virus then can never be communicated unless from a part, that labours under the 1st. Genus, or has an original local Complaint. 1281. It must be from hence evident, that the opinion that an infected Child unless it has its mouth or lips originally infected cannot communicate the disease to its Nurse, nor can the Milk of an infected Nurse communicate the disease to the Child. 1282. It is also most to be believed that a Child in Utero is never poxed, it may receive the infection in its passage through the Vagina &ca. & thus it may be locally & in the end universally effected. 🜆. 1283. Many Anomalous morbid appearances resemble the Venereal disease from which it is by no means easy to distinguish it by the Eye. 1284. The only unequivocal Criterions for assisting us in discriminating one from the other are. 1st. The Venereal Eruption, blotches, ulcer, or other  69 affection (Gonorrhœa excepted) whether originally local or constitutional ever disappears or is cured without the operation of Mercury its true & specific remedy. 2d. No Eruption, blotch, ulcer, or other affection that is truly Venereal will appear whilst the constitution is under the influence of Mercury. 1285. The same person may have both an Original local & a constitutional disease at the same time. Of the 1st. Genus a person may have both the first & second species at once & the first species or Gonorrhœa may be cured the Chancre or 2d. Species remaining notwithstanding & vice versa. 1286. So either or both species of the first genus may Exist together with the second or Constitutional & either or both Gonorrhœa & Chancre may be cured without the removal of the Constitutional disease. 1287. But the Chancre will not remain uncured when the 2d Genus is cured although the Gonorrhœa will yet continue to Exist 1288. [But the Chancre without will not remain un] The Constitutional as above noted almost always arises from some species of the first Genus but the Chancre or Gonorrhœa does not at all become altered or have its action awakened by Poxing the constitution. (1285) 1289. The specific local diseases have all their specific distance for action which they do not Exceed. So also the Venereal disease has its specific distance for local action [which they do not exceed] this is however not always the same Extent, being sometimes ♂. 1290. Mr. Hunter has proved this by a variety of Experiments on the dog, the Ass, the Bitch &ca. by soaking Lint in Venereal Virus from a Gonorrhœa & Chancres & introducing into the Vagina &ca. ♀ 1293. A Gentleman had blotches in his face which resembled Venereal ones & had been deem’d so by many Medicinal Men, he had also blotches in his Legs & Thighs, they continued for Six Months several of them having got well during that time & others broken out notwithstanding he took Mercury, he at length consulted Mr. J Hunter who judging of them according to his idea advanced in the Text, assured him they were not Venereal & advised him to leave off Medicines, to live well tho temperately & bath in the Sea if he chose it, in a few weeks he lost his complaints. A Nobleman labouring under some complaints which appeared to be Venereal (& which those who attended him assured him was so) consulted Mr. J. Hunter he was with much difficulty persuaded to leave off Medicines & take a sea voyage to change the Air, he followed this advice & was cured. When any disease affects the Genital parts, they are generally considered as Venereal, but Gonorrhœa, Sores in the Glans penis, Buboes may all arise without any Venereal infection, moreover there may be a variety of the morbid appearances that take place 70 affecting a small space; sometimes a larger one it is however always circumscribed, but when it spreads more widely than Common it has always a mixture of the Erysipelatous. 1290. The Venereal disease is peculiar to the human species other Animals not being susceptible of its irritation. ♂. 1291. Does the Venereal disease produce its effects by fermentation, or by producing a peculiar Action in the Solids? The Question is not easily determined. 1292. A Man who has got a pox may notwithstanding get a chancre or Gonorrhœa without increasing the Pox, it is evident then that when the habit is once infected with the Venereal poison, it cannot receive any addition from the absorption of fresh Venereal matter. 1293. Many diseases may imitate the appearance of Venereal but they arise, heal & break out again, a local disease from a pox never disappears until it is Cured, this then differs from other poisons never wearing itself out nor ever suffering the part to make a progress tow’rds a cure. ♀. 1294. When the Venereal Virus has been absorbed into the System it has in itself no particular tendency to produce affections of one part more than another but from some peculiarities in different parts of the body themselves, some parts will be more susceptible of the Venereal irritation than others & of course take on Venereal action soonest. 1295. One Cause which disposes parts to take on Venereal action readily is, Exposure to cold therefore it makes its appearances in in the constitutional disease or second Genus, which are common also to other diseases we are not therefore hastily to determine whether a disease is Venereal or not, but together with observing appearance, inform[ing] ourselves also of the history of the complaint previously. 🜋 1299. Thus the Tibia being of all bones most Exposed to the action of Cold is of all others most frequently affected. it may be objected that the tibia is actually colder than many parts which take on the disease before it, but we know whatever dispositions are formed in Bones they come into Action much more slowly than the soft parts. ☽︎☉ 1300. They are either not susceptible of the Venereal irritates or else they never come into the venereal action before the disease is totally Cured. 71 the more External parts of the body first, this reasoning is strengthened by observing. 1296. That the disease is found to prove much more speedy as well as much more violent in its action in cold than in warm Climates, in the latter it rarely arises to any great violence. 1297. The parts first in order of susceptibility are a. the Skin. b. the inside of the Mouth & throat &ca. c. the Tonsils 1298. The parts second in order of susceptibility are a. the Periosteum b the Fascia – c the Bones. 1299. The bones seem to be the more susceptible of it the more hard they are & the nearer the surface of the body, consequently the more exposed to the action of Cold 🜋 1300. Many of the internal parts are not liable (as far as experiment hath proved) to the venereal Action as the brain, the Stom: the Liver, the heart &ca. - ☽︎☉. 1301. The Lungs are sometimes the Seat of the Venereal disease although they are late in coming into action, perhaps their susceptibility of this irritation depends upon their being in some measure an External part. 1302. The Venereal Matter when taken into the constitution does not long continue in the Circulation, but produces its action on the parts susceptible of the disease & is then thrown off by some of the secretions as any other extraneous matter. 1303. It does not long continue circulating in the System we know this because the parts first in order may be cured & the parts second in order still remain uncured, yet the first parts will not again take on the diseased Action now were the Venereal matter 🝄 1303. Thus if a Man with Venereal blotches & also diseased bones is put under a course of mercury, the disease of the Skin may be cured that of the bones notwithstanding remaining the diseased action of the bones may continue to go on if he leaves of mercury but the disease will not again appear on the Skin. 1306. When a part has received a strong disposition fraction a cure sometimes cannot be effected until the disposition has actually gone into Action. A Man might suppose that those parts which are most susceptible of the Venereal irritation, would in the advanced Stages of the disease suffer the most violently, but this is not the case a part having gone fully into action loses the susceptibility of the irritation which it had at first. 🜔 1309. A Man who has a Gleet though he has connection with a venereal Woman, will not catch a fresh Gonorrhœa. 72 still circulating in the blood there would be no reson why the parts first in order should not again fall into disease. 🝄. 1304. Dispositions once formed will go on to action though some time may Elapse before that action appears (see 167) Parts having received the Venereal taint; will if left to themselves always go on to diseased action although the distance of time may be considerable. 1305. Hence we may understand why many parts of the different orders may be contaminated at the same time, but their diseased appearance may take place at different Periods. – 1306. Those parts which most readily fall into the specific Action are the first in going through a Cure. 1307. As a further proof that the Venereal matter becomes altered when taken into the Constitution, we may observe that an ulcer that is constitutional Venereal, on the application of venereal matter from originally & locally diseased parts will catch a Gonorrhœa & so take on the action of an original Sore, now the matter of one Constitutional Sore will not excite another Constitutional Sore. 1308. If the matter of a Gonorrhœa is applied to a chancre it will produce no new effect vice versa. Again the matter of one originally local sore or Chancre will not irritate another Chancre. 1309. A part which has lately been under the irritation of Venereal matter will not readily take on the same diseased Affection again. 🜔. 1310. The seat of the first species of the first Genus ( ) in Men is the Urethra; the surface of the glans penis, the internal surface of the proputium. ∇ 1318. Perhaps the changes of Colour in the discharge will [depe??] upon a small quantity of blood being extravasated & mixed with it: 73 1311, Its attack on the prepuce & glans Penis is generally at the root of the latter & the beginning of the preputium, here the cuticle is extreemly thin & the cutis is easily affected. 1312. It there produces itching, soreness & tenderness with a discharge of thin matter. 1313. When this part takes on the disease the Symptoms begin very early. Forty Eight hours have been the whole of the time elapsed between the Infection & the appearance of them. 1314. When the Urethra is the seat of the Clap, the inflammation generally has its place within an inch or an inch & half of the external opening. 1315. It mostly begins with a sense of itching at the end of the orifice & sometimes over the whole glans, the lips of the orifice will be unusually full & turned somewhat outwards. The Penis in general seems somewhat enlarged. Pain, heat & uneasiness in passing the Urine, sometimes preceded by & sometimes following the appearance of a running from the Urethra, the canal of the urethra fells inflamed, the Patient voids his urine with fear from the sense of the smarting & then the urine comes off in small or in divided streams. 1316. The Glands of the Urethra become inflamed & swollen, they become hard & may be felt on the underside of the Urethra. 1317. According to the period & the degree of inflammation the discharge becomes of different colours & different in consistence its Venereal virulency is however always the same. 1318. The matter if received upon cloth will be found to give it spots of variegated hues in the centre of the Spot the colour will be darker & paler in the circumference. ∇.  74 1319. The matter will have a Smell peculiar to itself which will be fœtid & disposed to putrefaction. 1320. The Symptoms & progress of the Complaint will differ very much according to the susceptibility of the parts & the degree & Extent of inflammation. 1321. The more violent the Inflammation &ca. the more commonly will it produce great extravasation of coagulable lymph Occasioning Cordee, Soreness of the whole length of the Urethra, Even to the Anus, producing a sensation like that of Chordee Inflammation & hardness of the Glans Penis. Hemorrhage from the Urethra, Various Sympathies. 1322. The running comes from the urethra & its glands & in general not high up, it does not come from the bulbous portion of the Urethra, otherwise it would be thrown out by Jerks & not run off in the manner it is known to do. 1323. On the Examination of patients after death which at the time of their dissolution laboured under this complaint, the ducts leading from the Glands have been found filled with matter. 1324. The inflammation penetrating very deep, Coopers Glands may inflame, suppurate, & produce an abscess which is frequently the cause of fistula in Perineo. 1325. [The inflammation penetrating very deep, Coopers glands] [may inflame, &] The cause of the Gonorrhœa of the Urethra must be a transition of the matter from the external part to the inner surface of that membrane although it is difficult to account for the manner in which it is introduced. 1326. It certainly can never be introduced, but 1326. We know it may be communicated this way. An Officer who had no intercourse with the female Sex for a considerable length of time when in Germany, went to a necessary the tube of which according to the custom of the country went tapering downwards, when he arose from his seat he found something sticking to his Penis upon taking it off he found it was a plaister from a sore which some other person using the necessary had left behind him in a few days after a gonorrhœa appeared. 75. the external part must always receive the venereal infection. 1327. Chordee is of two kinds Viz. 1st. The Inflammatory 2d. The simple spasmodic. 1328. The first is owing to an Extravasation of Coagulable Lymph in the reticular substance & in the Corpus Spongiosum generally in the lower part of the penis, this is much more obstinate & remains much longer than the spasmodic which is without extravasation & comes & goes at uncertain periods of time. 1329. The Hemorrhage arises from rupture of some Vessel of the Urethra, either by a Spasm, or giving way to the encreased violence of the circulation. The Hemorrhage is sometimes considerable & for the present relieves not unfrequently the violence of the Inflammation & its consequences. 1330. The parts that Sympathize with the Urethra will be a. the Testicle. b. the Bladder c. the Muscles of the Urethra & Penis. d. the Glands of the Groin. e. the Whole Pelvis f. the Loins. g. the Stomach h. the Whole Constitution. 1331. Sometimes there will be an Erysipelatous Eruption of the neighbouring parts. 1332. At different periods of the Gonorrhœa, the testicle will sometimes becomes swolen, this is never to be accounted a Venereal but 🜨 1339. The Inguinal Glands swell, it is to be doubled if they are sometimes Inflammatory but purely spasmodic. The swelling of the Testicle will sometimes arise suddenly in a few minutes & go off as readily requires [only] often less time for it to subside in by a great deal than the common swelling of the Testicle after the radical cure of the Hydrocele the swelling will sometimes change sides being similar as to the Gouty sympathy of the Testicle. 76 purely a sympathetic affection of the testicle, sympathizing with ye. Urethra. 1333. A swelling of the Testicle may arise from any Cause irritating the Urethra, even the passing a bougie has brought it on. 1334. It sometimes appears during the more inflammatory Stage of the gonorrhœa but more frequently when the inflammation has abated, & it is sometimes attended with an increased, sometimes with a stopping of the running. 1335. The complaint begins with a pulpy & softened feel of the Testicle a slight enlargement of it, & a sense of increased painfulness on the touch or pressure, its tumefaction then increases & it grows hard, especially the Epidydymis. 1336. Sympathy produces pain in the original seat of the Testicle the loins, nausea & sickness, even Vomiting loss of appetite, uneasiness in the Bowels &ca.. – 1337. The swelling of the Testicle is not peculiar to the gonorrhœa it is often produced by Gout, Cancer & Scrophula, although more slowly by the latter. 1338. When the bladder Sympathizes, Strangury & the common symptoms of Stone in the bladder will occur. 1339. The inguinal Glands swell from Sympathy, rarely terminate in suppuration & as well as the swolen testicle are often curable without Mercury which shews that they are not Venereal. 🜨 1340. The Muscles of the penis will Sympathize, & often undergo a Spasm producing sudden & involuntary erections of the Organ which are called Spasmodic. ☿. 1343. In one person---10 hours. Another---20 hours In many---36 hours D°.---2 Days D°.---6 Days. In a great number---12 Days In many---4 Weeks In some---6 Weeks. 🜔🜹 1345. In a boy the Gonorrhœa returned twice whilst he was cutting his Teeth. – 77 1341. Of the Loins, Pelvis, & Kidney sympathizing with the Urethra it is unnecessary to speak, further than noticing the facts that Pain of those parts often attends Gonorrhœa. 1342. When the whole Constitution sympathizes there will be slight rigors, heat & other mild Symptoms of general irritation. 1343. The distance between the time of infection & the appearance of the Symptoms, so far as can be ascertained is all the intermediate time between 10 hours & 6 Weeks, most commonly however within twelve days. ☿. 1344. The Gonorrhœa is not peculiar to the Venereal diseases a discharge from the Urethra, without heat &ca. has been known to accompany gouty & rheumatic affections of the body. 1345. It has moreover been known to Sympathize with cutting the teeth. 🜔🜹. 1346. The Urethra of a Patient who has once had the disease is ever after Extreemly liable to it. 1347. We should endeavour to distinguish a gleet from a Venereal Gonorrhœa, in the gleet the glans penis does not change color nor does it sweat a kind of pus as it does in the Venereal Gonorrhœa 1348. It often goes off spontaneously & then it makes a somewhat puzzling Case, it has no specific remedy. 1349. A Constitutional disease in the 2d. Genus is as we have above observed sometimes though not very often known to Arise from the first Species of the first Genus, whenever there is a kind of hard Cord arises, leading from the penis to the Glands in the groin absorption of the virus is always to be suspected & the Constitutional 1354 The Vagina is not a part very sensible to common irritation hence matter may remain. ♀ 1356 A Woman had a Bubo formed in the Groin without having the least of any preceding affection. – 78 Genus feared. 1350 This circumstance most usually Occurs in the gonorrhea of the Glands & Prepuce. The 2d. Genus has also followed an internal gonorrhea in which there was a rupture of a vessel & an hemorrhage from the urethra consequently an internal wound, but it is very rarely the virus is communicated to the System by means of a Wound. 1351. The seat of the first species of the first Genus in Women is the Vagina, Nymphe, Clitoris & Urethra. 1352 It is not so complicated in women as in men, its symptoms are much milder & it is still with more difficulty ascertained. 1353. Appearances will in general give little information nor will its Symptoms enable us to decide. 1354. We can only judge the Woman has the disease, if she has the common symptoms following her connection with an infected Man, or if she whilst labouring under these Symptoms gives the disease to some sound person. 1355. We cannot however always determine that a woman has a Gonorrhœa because she communicates infection to a Man as her genital parts may have a power of receiving & communicating the infection without having ever felt any Complaint herself, or may retain the power of poisoning after the gonorrhœa has been Cured. 1356 From this it must be evident that a Woman does not always, know whether she has or has not the disease. ♀. 1357. The common Symptoms of a Gonorrhœa in Women are  79 pretty similar to these in Men, as smarting in making water a Running from the Vagina, a disagreable Sensation of the External Parts as the Clitoris & Nymphæ a fullness of the Labia pain in walking & the complaint rarely having exacerbations except at the time of making water. 1358. Sometimes the discharge will run down from the Vagina to the Anus & produce exulcerations of the Perineum. 1359. When the disease goes on, as in (1358) it is very doubtful whether it will there spend its violence as in the Gonorrhœa in Men 1360. In both Sexes previous to the appearance of the discharge the constitution will sometimes become affected (as in 1342) & a strange & unusual sensation of the parts will be perceived. 1361. Gonorrhœa without infection may arise in both Sexes from Various Causes. (1344). 1362 Although a Gonorrhœa will sometimes cure itself ( ) & we have no Specific for the disease ( ) yet we can shorten its duration & lessen its Symptoms by proper remedies. 1363. These remedies are divided into internal & topical 1364. The internal ones are Either a. Evacuants – or b. Astringents. The topical ones are Either a. Injections.. or b. Bougies. 1365. Mercury is the Specific for the Venereal disease but it seems of no other use in the Gonorrhea, than with a view to the absorption of the Venereal matter in the part thereby preventing  80 preventing its affecting the constitution, but this we have observed rarely happens & we have no reason to believe Mercury has any Specific power on the Affection of the membranous part of the Urethra 1366. Keeping the bowels regular is necessary in health & therefore useful in this Complaint, tho purging is not generally serviceable yet we have seen a brisk purge entirely cure the affection in which case it must operate either by derivation or by Sympathy. 1367. Diuretics are so far useful as by their effects in the urinary secretion they may lessen the violence of the irritation. Water is the best but will generally require to be accompanied with some mucilaginous substance. 1368. Balsams & Turpentines may be their Specific Operation on the part affected produce also a change in its diseased action & consequently effect a Cure. 1369. Astringents (1364b). do not lessen the Venereal irritation, but they may prove of some service by lessening the quantity of the discharge. 1370. Topical Applications (1364) must either be fluid or Solid, the fluids are injections, the solids bougies. 1371. The effects of the solid must be more permanent as it can be kept longer in contact with the parts affected; however it produces so much irritation that in general their use is better omitted. 1372. Injections may be divided into a Irritating b Astringent  81 c Sedative d. Emollient injections. 1373. Injections curing Gonorrhœa suddenly have been supposed to lock up the poison & throw it into the Constitution, but this Opinion is erroneous – for 1374 The Effect of the Injection here is to stop the farther secretion of matter, if then this is accomplished, it is evident that injections must contribute rather to the prevention of the 2d. Genus than bringing it on, the common vehicle of the poison being matter. 1375. Injections may either take off the Inflammation & the consequent increased secretion, or they may stop the secretion without removing the Venereal Inflammation. 1376. The irritating Injections are mostly astringent when made Weaker & astringent injections when made stronger will act as irritating. 1377. Injections are irritating when they produce an irritation greater than that of the disease itself. 1378. Irritating injections are in general improper, where the Constitution is extremly irritable & the inflammation has spread beyond the Venereal point, when used in this case they have become the causes of Fistula in Perineo. 1379. Where the disease is milder they generally succeed sooner in removing the Symptoms, for they produce the Cure by giving an irritation greater than that given by the disease which being overcome by a greater Stimulus leaves the part. They must therefore be improper where the parts cannot without danger of increased mischief bear 🜍 1379. A proper injection for this purpose is a solution of Sublimate in water (weak) if it gives pain it may be still further diluted. 🜔 1381. When a secreting Surface has been inflamed, & the part has received a disposition to secrete, the compleat Action being taken on is a step tow’rds the Cure, we therefore see why Astringents by checking the secretion may sometimes produce a Cure. 82 a more powerful irritation than that already produced & present. 🜍 1380. Astringents may Cure a slight disease, they act by lessening the discharge, & as they produce an affection of the living Solids they may contribute to a Cure. 1381. They make the Vessels contract & lessen the discharge, however they often produce a lessening of the discharge only, without forwarding the Cure, nay they sometimes protract the Cure. 🜔. 1382. Emollients in violent inflammations are very useful washing away the stimulating matter & leaving the surface of the part Soft & smooth. 1383. Sedatives ( ) sooth pain & abate inflammation, Opium is undoubtedly the best & most general sedative, but does not agree universally. 1384. Sometimes the end of the Canal & of the Urethra at the Glands is contracted by Inflammation, which is a troublesome circumstance & indicates the Omission for the present of bougies or injections. 1385. Other topical means as Mercurial Ointment, medicated Poultices, Fomentations &ca. can do little good Except when the External parts are the seat of the disease, or unless the Glands of the Urethra are so swolen as to be perceptible externally in which case we may use Ung: Cerul: fort. 1386. In Hemorrhages from the Urethra we have seen benefit afforded by the internal use of Turpentine & Balsams, Injections are not only useless but hurtful here. 1387. Opium given internally has powerful effects in preventing painful Erections & soreness of the Penis.  83 1388. The Cordee is in the beginning relieved by bleeding from the System & still more by Leeches applied to the part, & we are the more encouraged to practice the latter as we have observed that a Spontaneous hemorrhage from the rupture of some vessel in the Urethra has removed Chordee; Medicated Poultices & Camphor internally, sometimes affords relief. 1389. Chordee often continues after inflammation of the parts has subsided, from the Coagulable Lymph remaining Extravasated, whatever then will tend to produce absorption of the lymph will carry it off Mercurial Ointment, Electricity, Friction & Cicuta are all found serviceable, the affection will however continue often, long after the complaints have ceased & then go off slowly. 1390. In the Spasmodic Chordee ( ) we have known Bark singularly useful. 1391. If the Glands of the Urethra suppurate they become of the nature & produce the effect of chancres, & as such they may be treated. 1392. When the bladder takes on the affections (1338) the complaint is rarely inflammatory but mostly Sympathetic. Bleeding is rarely useful, & is if employed at all, to be managed with caution & in general topically the Warm bath. Plasters of Opium to the Perineum & to the origin of the Nerves of the Bladder & Clysters with Opium will commonly succeed. 1393. This Symptom in general is not hazardous but it is to be suspected that it sometimes lays the foundation for future mischief. Δ 1396. Perhaps the Practice of employing Vomits arose from Relief having been given by a Vomit administred to cure a sickness in the Stomach caused by Inflammation of the Testicle. 84 1394 When the Testis is swoln (1333) Rest in an horizontal Position, with the common treatment of inflammatory affections is to be insisted on. 1396. Vomits have sometimes great power in carrying off this affection. Δ. 1397. It is not determined how far Mercury is useful in Cases of swelled Testicle, we have reason to believe it may sometimes be Efficacious after the Inflammation is over. 1398. Sometimes the Testis takes on the suppurative Inflammation & an Abscess is formed which however requires no Particular treatment, as it is not Venereal matter that is formed Mercury is unnecessary. 1399. When resolution takes place the swelling of the Testicle subsides but slowly when it diminishes it grows gradually softer especially in the forepart & which sometimes becomes even softer than natural. 1400. The Epidydymis however generally continues hard & it is to be suspected that in consequence of that circumstance the testis is sometimes rendered useless, yet in general no inconvenience is observed to arise from it. 1401. The cure of the Gonorrhœa in Women is still more simple than in Men, Washes & Injections are proper here also. When the Vagina is the seat of the complaint, the internal surface of it should be several times be greased as high as it can be reached by the finger with Mercurial Ointment. 1402. As the Vagina is less irritable & sensible than the Male  85 Urethra, the injections to be used for the former may be prepared of greater strength. 1403. If the Female Urethra is affected, injections will not be admissible, but Mercurial Ointment may be insinuated into that Canal as observed above, it is not easy to know when the Cure is compleated. 1404. Should the inflammation spread & affect Coopers Glands The Mercurial Ointment may have also be used, if they suppurate they are to be considered & treated as suppuratory Buboes. 1405. It is sometimes necessary to attend to the constitution in the Cure of Gonorrhœa. 1st. if the Constitution is strong & disposed to Fever, it may be right to bleed. 2d. if the Complaint should take place in a low weak irritable habit, & when the Inflammation has a disposition to diffuse itself (which sometimes it will even to the Bladder) then Evacuations will be hurtful, & the liberal use of Bark will be adviseable to destroy the diseased irritability. 1406. It is generally found that the Constitution disposed to fever & inflammation admits most easily of the gonorrhea being Cured. 1407. In some irritable Constitutions it has been observed that a fever arising the Symptoms have gone off & that when the fever has left the patient the local Symptoms have returned. Again in others the coming on of a Fever even when the disease was mild has increased the Gonorrhœa & the Fever again going off the Gonorrhœa ☍ 1409. It is difficult to say, if giving Mercury will always prove a preventitive to the second Genus, but it is the most sure means we know of at present & therefore to be advised, either the Mercurius Calcinatus, or Ointment are recommended 🜔🜹 1411. We have remarked that there is perhaps an impossibility of distinguishing between a Gleet & a Gonorrhea, we shall observe a case or two. Case 1 A Gentleman in April 1780 got a Gonorrhœa, Swelled Testicle &ca. in June all his Symptoms left him, except now & then a little discharge of slimy matter & mucus, Sept.1. he married & gave his Wife a clap. It is to be observed that he met with some difficulty in entering the Vagina & that perhaps from the force he exerted his inflammatory Symptoms returned. Case 2 A Gentleman had a Gonorrhea two Weeks after he lost every Symptom except a gleet he lay with & clapped his Wife. We know in some that the inflammation & running has been kept up even for 12 months & yet the patients have not clapped the Woman with whom during that time they have been connected. 86. Gonorrhœa has been cured. 1408. It is perhaps always right to have in view the possibility of absorption of Venereal matter into the habit especially whe the disease has been long standing. 1409. Altho’ Mercury has no specific Action on the Inflammation of the Urethra yet with a view to prevent the ill effects that may arise from venereal matter being absorbed into the System it is right to administer it, especially tow’rds the latter end of the Cure & when the process of absorption must be nearly at an end. ☍. 1410. We judge of the Gonorrhœas advancing to a Cure when the cherry colour of the Glans changes to a pale hue & other Symptoms also abate, as the running decreasing in quantity & becoming more slimy, Pain & tenderness of the penis going off. 1411. It often happens that the Symptoms will leave the patient he will continue well even for a month & then they shall return, but it is probable that they will not be found to be Venereal when they appear a second time. 🜔🜹. 1412. Strange sensations in the Urethra & Glans (especially when the bladder has been affected) will often be perceived by the Patient after the Gonorrhœa is gone off. These will sometimes be obstinate & troublesome & too commonly render the dissatisfied & credulous Patient the dupe of Quacks. 1413. An obstinate Gleet will sometimes be cured by means similar to these which gave rise to it. Viz. a New Inflammation. 1414. Among the Complaints which will remain after a Gonorrhœa is cured, are those (1411.1412) swelling of the Testicle & hardness  87 hardness of the Epidydymis, wasting of the Testicle, affections of the bladder, strictures in the urethra, Carbuncles, Fistula in Perineo Swelling of the prostate, paralysis of the Urethra & Paralysis of the Bladder. 1415. Gleet has nothing Specific in its Nature, nor can it produce in others a similar disease; it differs from Gonorrhea in a. That the true Gleet is never infectious. b. The discharge has its Globules, but the Globules swim in mucus not in Serum. 1416. It is incidental to all constitutions, the strong as well as the weak, it arises from various causes besides Gonorrhea. 1417. It sometimes goes of naturally but whether from some change taking place in the state of the parts which are the seat of the disease, or from the want of power to continue the discharge we do not determine. 1418. It generally takes its rise from an habit of action in the part & almost always accompanies strictures in the Urethra. 1419. We attempt to cure it by Art in three ways Viz. a. Constitutionally b Locally c Sympathetically. 1420. The Constitutional Cure may be divided into a Specific b Strengthening. 1421. Specific Medicines are Bals: Copais: &ca. if they do service it will generally be immediately perceived; but should no benefit be found for 5 or 6 Days they should be left off, should they relieve they should be persisted in for a length of time for if discontinued  88 discontinued the complaint will not uncommonly return. 1422. The strengthening Medicines act upon the disposition of the parts in question, or in common with that of the Habit in general. 1423. Medicinal applications, [cross out] may affect locally 1st. as Specific & these have more influence when applied locally than when by means of the System (1421). 2dly. As Astringents, as decoction of bark, solution of white Vitriol, Alum &ca. These produce their effects by causing a Peculiar tonic action in the parts, their use should be long persevered in to produce a Cure. 3dly. Local medicines may produce a Cure by the Violence they offer to the parts, but their use should be deferred until other methods have been tried they are followed by an increase of the discharge from the Urethra, of this kind are very stimulating injections as Solutions of Sublimate, & Bougies either simple or medicated. As to the time these should be employed of the injections are very irritating 2 or 3 times will be enough, if less irritating a Week or two. Simple bougies may be used 5 or 6 Weeks for bougies made irritating a much shorter time will suffice. 1424. The third general method is by means of Sympathy or Perhaps derivation, as a Gleets being cured by two Chancres being formed on the Glans Penis, or by applying a blister to the underside of the Urethra; or by Electricity &ca. – 1425. Uneasy sensations of the bladder & Urethra have been removed by blisters applied to the Perineum or loins, the use of Hemlock; injections of sublimate & other means, but blisters to the Perineum have 1425 Case. 1st: Sir Charles Bunburgs Servant had for a complaint of this kind consulted Dr. Warren. Messr. Pitt & Gunning without relief. Mr. Hunter applied a blister ad Perineum which soon cured him, it was kept open 6 Days. Case. 2d. A Portuguese Gentleman had for 2 Years after a Gonorrhœa, such uneasy sensations in his Urethra & bladder as to give Suspicion of a Stone. Mr. Hunter examined him per Anum as well as by sounding & found nothing unnatural, a blister was applied to the Perineum Which cured him almost immediately 2 Weeks after he got a fresh gonorrhœa but no Extraordinary circumstance attended it, nor dis his old Complaint return. 14 ☽︎ 1430. Case 1st A Surgeon had a Gonorrhea & Bubo, the testicle on one side Entirely disappeared. Case 2d. A Young Gentleman Aged 18, without any Clap had a spontaneous Inflammation of the Testis on one side it was wasted gradually to the size of an hone bean the spermatic chord unaltered, he had afterwards a similar attack upon the other Testis which continued wasting until not a trace of it was left. Case 3rd. By Dr. Atham late Worcester. A Gentleman had a fever, & an inflammation in the left Groin & Testis. The Testis suppurated, at length however the matter was 89. seemed imminently useful. 1426. In the Gleet. Rest in general should be recommended though sometimes the complaint has been removed by riding on Horseback, Regularity & Temperance are also generally necessary, though there are not wanting instances of the opposite effecting a Cure. 1427. In Women the Vagina is the seat of the Gleet the treatment recommended in Men will here also apply the use of bougies Excepted. 1428. Chordee remaining after the cessation of the other Symptoms. Rub the parts externally with Ung, Mer, joined with Camphor, Electricity may also be had recourse to. 1429. Hardness of the Epididymis after a swelling of the Testicle will sometimes remain through life without any ill consequences. Sometimes relief has been afforded by rubbing the Scrotum with Mercurial Ointment, sitting on the steam of warm Water &c. - 1430. The Testicles are subject to spontaneous diseases more than most (if any) other parts of the Body, like the teeth they are added only for particular purposes, & they will be (similar to the Thymus Gland or membrana pupillaris) sometimes wasted & at length entirely absorbed This may happen at any Age. ☽︎. 1431. This absorption of the Testicle will follow an inflammation of the Testis, Hydrocele, & hernia Scrotalis but sometimes will take place without any preceding disease at all. 1432. Obstruction to the free passage of the urine through the urethra may arise from different causes. Vizt. 1 Excrescences in the Canal reabsorbed & the testis continued to waste until not a vestige of it except a few loose fibres could be found. 90 2d. Tumor without the urethra pressing on its sides & hindering its free dilatation. 3d. Strictures of the Urethra. 1433. If when the urine passes off only in a small stream & with difficulty we pass a middling sized bougie & find we can introduce it with ease we have reason to suspect a tumor (1432 2). 1434. Caruncles or fleshy excrescences (1432 1) growing in the urethra are seldom though they are sometimes known to exist, Probably they are a kind of internal Wart. Ulcers in the urethra we have never met with. 1435. Strictures in the urethra (1432 3) are of 3 kinds. 1 Permanent – 2d. Spasmodic – 3 Mixed. 1436. All Canals whatever are subject to strictures consequently the Urethra is not exempt, & indeed this Canal is subject to them not particularly as the consequence of Gonorrhea because they frequently take place in the Urethra without any Venereal Symptom whatever preceding. 1437. The seat of the Gonorrhea is commonly very near the Orifice of the Urethra, the seat of the stricture is commonly in the membranous portion. 1438. They do not seem to arise from the use of injections nor do Bougies ever produce them. 1439. Ulcers in the Urethra have been supposed to be the Causes of strictures, but we have never met with such a Case. 1440. We do not understand properly the causes of Strictures in the Urethra any more than we understand why they should Occur in other Canals. 🜔^ 1446 This proves that the Urethra has something of a Muscular power. 91. 1441. When a Gleet remains obstinate & the urine flows in a smaller stream than common, or in divided Streams, or is Escerned wth. some difficulty there is reason to suspect a Stricture & we should Examine by passing a Bougie. 1442. Permanent Strictures may take place in the whole circumstance of the urethra making an annular stricture & opening the area of the Canal as though a piece of cord was drawn tight round the urethra, or they must Occupy one side of the urethra in which case the Contraction will not be circular, but only on one side & then the Area will not be so much diminished as in the other case but the general dilatation of the Urethra being resisted the figure of the Canal will be necessarily altered, the Extent of the strictures will also differ in length, more or less of the Urethra being occupied by them. 1443. The number of Strictures will be also different in different Urethra sometimes only one, sometimes 4. 5. or Six. 1444. The portion of Urethra in which the permanent Strictures takes place will be whiter & harder than the rest of the Canal. 1445. Permanent Strictures will continue to a great length of time even Years their formation & progress is slow they are generally for obvious reasons overlooked until they have become considerable. 1446. They are generally more troublesome in cold weather than in warm & therefore are worse in Winter than in Summer. 🜔^. 1447. Permanent stricture continuing for years, teizes the Patient & at length gives rise to the worst diseases irregular enlargements  92 in the Urethra, diseases of the Bladder, Fistula in Perineo &ca. 1448. To understand properly why these consequences should arise from strictures of the urethra as also the nature of spasmodic Stricture we should have a clear Idea of the Structure & functions of the bladder & Urethra. 1449. The Bladder is a Muscular bag & has a power of Contraction for expelling the Urine, it can contract itself to the smallest Size. – 1450. The Urethra is also a Muscular body & can contract itself so as to shut up its Canal entirely. 1451. In a natural & healthy state of both Urethra & bladder the following Circumstances must be present. 1st. The actions of the bladder & Urethra must be alternate, that is whilst the bladder is contracting itself to Expel the Urine it is necessary that the Urethra should dilate itself or become relaxed in order to admit of the free & regular Exit of the Urine. 2ndly. When the Bladder has ceased from acting then it is requisite that the urethra should contract itself to present the dribbling away of Urine whilst the Bladder is in a state of relaxation. 3rdly. The Area of the Urethra when dilated must bear a certain proportion to the force with which the bladder acts in the Expulsion of the Urine. 4thly. The disposition of the bladder to contract and the disposition of the Urethra universally to be dilated must take place in the same point of time & the strength of the disposition in ♁. 1453. The Muscular coat of the Urethra has by these irritations been made 1/4 of an Inch thick. The Stone in the Bladder also produces a similar state of it by acting & dilating irregularly it often becomes fasciculated hence Sacs are formed in which Calculi are sometimes lodged. 93 each must be always in a certain & exact proportion. One to the other. 1452. From considering what is advanced (1449-50-51) we readily foresee, [greater than] That as a resistance given to the actions of an muscular body greater than it can overcome, & that frequently repeated, either increases its susceptibility of a disposition to Act, or otherwise Produces [adhes] a destruction of its Muscular powers & so renders it Paralytic, if by the Urethra not receiving or being insusceptible of a disposition to relax when the bladder is contracting, or not relaxing & dilating in due proportion of time & to a proper size of Canal, either an increased irritability & susceptibility of action in the bladder must take place, or its muscular powers being destroyed & Paralysis must occur. 1453. The Urethra not dilating in due time or to a proper size (1451-4.) & resistance being thereby made to the action of the bladder the latter increases the violence of its action to overcome the resistence, & this resistence being repeated every time the bladder has a disposition to Act, the Viscus becomes thickened, for the bladder like other muscular parts increases in density from frequent action & for a time at least in strength, it also becomes more irritable. ♁. 1454. If the resistance made to the Bladder is so great that it cannot overcome it but continues a length of time until the Urethra is either spontaneously or artificially dilated & this unconquerable resistence often repeated the muscular power of the bladder is destroyed & a paralysis of that Organ Succeeds. – 1459. Sometimes matter has been discharged from the Kidnies, Perhaps from the irritation & this without finding any Ulcer on dissection. 94 1455. If in consequence of Inflammation, partial contraction [&ca.] of the urethra &ca. the upper part of the urethra loses its power of Contraction, A paralysis of its muscular powers takes place, the Urethra is paralysed & no Contraction of the Urethra attends the dilatation of the Bladder, & the urine is continually dribbling off. 1456. If the Area of an portion of the Canal of the Urethra is diminished by permanent strictures in the Urethra, or any Tumor compressing its sides, so that although the Urethra has a disposition, in due time to become dilated, yet the urine not being evacuated with speed proportionable to the force with which the bladder acts will induce an irritable bladder & a thickening of its Coats. 1457. The Urethra may receive a disposition to contract irregularly without alteration of its structure & that only in particular parts this constitutes the Spasmodic stricture (1435 2). 1458. The Urethra may be permanently dilated in particular parts & contracted in others, by this means its surface will be unequal & often rough. 1459. The state of the bladder may be rendered such by distension of it & resistance of its contraction that it cannot admit the influx of fresh urine by the Ureters & the distention & enlargement of them shall be continued even to the pelvis of the Kidney which shall itself also become distended. 1460. It frequently happens that there shall be not only a permanent stricture lessening the size of the Canal of the Urethra, but also in the same Urethra a disposition to spasmodic contraction, this  95 constitutes the mixed Stricture (1451 3). 1461. The Urethra has sometimes a disposition to contract & close its canal independent of any alteration of its structure & loses not the disposition when the bladder gets into action, this being in fact a spasm of the Urethra we call it Spasmodic Stricture. 1462. Another cause of obstruction to the free passage of the urine may be as swelling of the prostrate gland. 1463 The use of the prostrate Gland is not understood, from its making a part of the urinary canal, it is evident that a swelling of it must produce an alteration in the state of the Urethra. 1464. When it is enlarged it stretches the Urethra Anteriorly & Posteriorly & flattens & narrows it laterally, the small Portion at the back part of it will Act as a valve to the Canal hindering the free Egress of the Urine. 1465. When greatly enlarged little or no Urine will be voided & all the Symptoms of an irritable bladder will come on. 1466. When there is no Symptom of disease in the Urinary canal & we can find neither stricture nor stone we should be led to Examine the state of the Prostate Gland. 1467. Pass the finger in Ano as far as the first joint if an hardness is felt extending higher than the finger can reach we may believe it to be a disease of the Gland. 1468. We may find this disease in two Stages. Vizt. 1st. When the Obstruction is not so great but a bougie or Catheter may still be passed into the bladder. 8. 1469 A Gentleman laboured under a Complaint of this kind by forcing the Catheter into the Bladder an Hemorrhage ensued the blood coagulating stopped up the holes of the Catheter when afterwards introduced into the bladder the Urine could not be drawn off & the patient died. – 96. 2dly. When neither one or the other can be introduced. 1469. we have noticed (1464) that a small posterior portion of the prostrate projecting into the Urethra sometimes Acts as a Valve through this projecting substance, a catheter has been sometimes forced into the Bladder which has ultimately terminated in death. 8. 1470. Permanent Strictures in the urethra give rise also to Fistula in Perineo. Nature endeavours to get rid of the stricture by producing an Ulcer in the part it occupies. 1471. But this is not always the Case the Seat of the Ulceration will be not unfrequently between the Stricture & the Bladder, whichever is the Case the ulceration directs its course from within outwards to give an exit to the urine as ulceration in Abscess observes a similar course to give an exit to the pus, with this difference however, that in the present instance the progress is slow with little or no inflammation, hence the Urine will insinuate itself into the Cellular substance & Corpus Spongiosum of the Urethra, so that the openings formed in the skin shall not correspond with the openings in the Urethra. 1472 This latter remark however will in general hold good only when the seat of the stricture is before the membranous part of the urethra, [than] when more posteriorly, the Ulceration is more Regular & more similar to that of Common Abscess. 1473. By the insinuation of the Urine into the Cellular Substance Inflammation of a considerable Extent followed by suppuration or even Gangrene may be induced. – ♂ 1479. Mr. Hunter does not allow that the Vesicula Semilaries contain Semen 97 1474. The prostate Gland, Coopers Glands, the bulbous part of the Urethra as well as the cellular substance may partake of the suppuration & the matter point externally. 1475. When an Abscess forms in perineo from this cause there is generally a free passage for the urine into the abscess & both its Opening from the Urethra & its external opening will not unusually admit a Catheter into the cavity. 1476. As in other Fistula so in those of the Perineum, the Ulcer in the Skin has generally a stronger disposition to heal than that of the deeper seated parts, hence the external Orifice will sometimes close & then the Urine insinuating itself diffusively into the cellular substance of the surrounding parts will at length make its way through a number of Orifices formed by Ulceration in the Skin of the Perineum Scrotum & even inside of the Thighs which are commonly the mouths of an equal member of surfaces. 1477. Seminal Weakness is considered as a consequence of Gonorrhœa Virulenta. 1478. The disease which commonly goes by this name is a copious discharge of a Dreglike mucus at the end of making Urine & in straining at going to stool in which Case there is often a copious discharge of Mucus which is considered as semen. 1479. But in reality this is not semen but the liquor of the prostate gland & Vesicula Seminales. ♂. 1480. As a proof that this is no discharge of semen we observe that it is common to old Men & that those who are afflicted wth. it find no diminution either of their venereal desires or of their  98. powers, that the quantity evacuated is often more than the quantity of Semen the Patient emits, that to produce it in some violent efforts are required as straining at stool or evacuating the last drops of urine, & lastly that patients have been immediately after this discharge has come away able to emit a fresh & natural quantity of real Semen which had the first been really it would have been impossible to do. 1481. It generally preys much upon the mind & imagination of the patient & hence rather than from its proper effects on the constitution renders him weak & debilitated. 1482. But real involuntary discharges of semen, may attend some patients & this is a matter of serious consideration. 1483. The Organs of Generation like many other parts consist of two parts. 1st. Those whose Action is primary as the Testes. 2d. Those whose Action is secondary as the Penis. The actions of the second should always follow the Actions of the 1st. irregularity in this circumstance is productive of Disease. 1484. When the Penis takes on action without the disposition of the Testes for action being increased, we have involuntary Erection of the Penis which may be similar to Cordee, except that it is attended with no pain or at most with only a sense of uneasiness similar to that which we experience in the part after Coition. 1485. Involuntary Erections of the Penis may be spontaneous 🜋 1485. I should imagine that Mr. Hunter means in this place Erections of the Penis taking place without any libidinous Ideas being first Excited in the mind. 99 or may arise from visible irritation of the member as virulent Gonorrhœa. 🜋. 1486. These Erections are to be considered as Spasmodic affections of the Muscular powers of the penis & therefore similar in their nature to Spasm of any other muscular part. 1487. But the Penis may not only act without any corresponding disposition in the Testicles, but the Testes may also act without any corresponding action in the Penis. 1488. This is the reverse of the other disease, the semen will here be discharged in every even the slightest occasion, the least friction of the Glans Penis, as in walking will produce an Emission, without any erection of the Penis, so will the most simple thought in Venereal matters, a dream in the least degree lascivious &ca. & here the Semen runs off like Stools or urine. 1489. Caruncles (1438) we may attempt the of by Producing ulceration of the carnosity whether this can be done by the Bougie is doubtful, when it fails the Caustic should be used in the manner hereafter described in the treatment of strictures. 1490. The permanent stricture is to be cured either by a. Dilatation. or – b. Ulceration. 1491. The method (a) is by means of Bougies, in the use of which we must attend to certain directions here laid down. 1492. We are to be extreemly careful not to make a false or New passage by means of the bougie & we are also to ascertain if Possible whether any false passage for the Bougie has been  100. already made. 1493 If upon enquiry we learn from the patient that bougies have been already used & that ground was gained in the length of the bougie which was last introduced without however getting clear of the Stricture we have reason to fear a false passage is already made. 1494. Near the orifice in the glans Penis a bougie may by chance be thrust into the mouth of a Lacuna this should be attended to, because it scarcely happens that strictures so low down obstruct the passage of the bougie. 1495. We should first attempt to introduce a middling size bougie, if that will not pass we have recourse to a smaller and smaller until we come down to one of a minute size. 1496. The great inconvenience of using a small bougie is that it bends in the urethra & so doubles, we should in our introduction of the instrument endeavour to ascertain this, least we think that the bougie is advancing when it is only doubling 1497. When a bougie is introduced if it is doubling, it will generally recoil if the hand is removed, if it is really advanced into the Urethra the length that it seems to be it will not recoil if by taking away the hand we cease to push it forwards. 1498. When a bougie hesitates in its passage but does not Recoil we should stroak the perineum with one hand at the same time that with the other we gently push on the Instrument.  101 1499. sometimes an advantage is gained by giving the bougie (before it is introduced) the natural bend of the Urethra. 1500. If we can introduce the smallest bougie the cure of the Patient is generally in our hands as by increasing the size of the bougie in future introductions we can produce the necessary dilatation. 1501. We suffer the bougie to remain in the Urethra a longer, or shorter time according as the Patient can endure its pressure from 5 or 10 minutes to 2 or 3 hours & this we at first repeat daily until a large bougie can be easily passed & no obstruction to the stream of urine remains, we then pass it less frequently but as there is always a possibility of the complaint returning those therefore who have been afflicted with strictures should never pass any length of time without introducing a bougie. 1502. The most convenient season for using the bougie will be a little before bed time, or an hour or two before the Patient gets up in the Morning. 1503. If the weather is very cold the stricture may be more violent so as to prevent any urine passing off or the introduction of the smallest bougie hence we are to make use of such remedies as are temporary relaxants, as the warm bath, Clysters with opium, blisters to the Perineum &ca. – 1504. A Bougie sometimes cannot be introduced beyond the stricture the first time, in that Case we are to introduce it ♂ 1508. Formula for making bougies RS. Diachylon Shel lac. When bougies are introduced care should be taken to prevent the slipping into the bladder by tying thread or Narrow tape to the round their upper end & bending it over the Glans Penis. Some persons have such a disposition to form calcareous concretions that a bougie Cannot remain in their bladder a few hours without being incrusted with calcareous matter & persons should use a great deal of exercise. Mr. Bromfied cut a Bougie out of a young Mans bladder when it had remained two weeks & a large quantity of calcareous Earth had Crystalized upon it. In passing a bougie it may be stopped by a Lacuna draw it back in that case, turn it & you will avoid that orifice 102 gently as far as practicable into the Urethra & leave it there for sometime by several repetitions of this practice we may expect in general to get beyond the stricture. 1505. From an increase in the disposition of the urethra to contraction, it will sometimes happen that we may be able this day to pass a bougie & quite unable the next. 1506. The passage through the stricture is not always straight this we shall best judge of from the appearance of the bougie after it is withdrawn. 1507. The Bougie does not act in the cure of strictures simply as a wedge, that is in the manner it could do in a dead Urethra but it acts upon & produces a reaction of the living parts & the cure is accomplished either by the parts habituating themselves to the pressure or by intesticial Absorption being excited. 1508, We also proposed to Cure strictures in the Urethra by ulceration & this is effected either by the irritation of a large bougie continued until ulcerative absorption arises or by means of a caustic. ♂. - 1509. Although the stricture is not an originally forms and therefore being a weak part may without much difficulty be made to ulcerate, yet great care must be taken that the Bougie is not forced into the Corpus Spongiosum Urethra which has been done & the instrument pushed even through the cellular substance of the Rectum.  103 1510 It may not be useless to repeat the remark, that if in passing a bougie it seems to make considerable progress & at the same time to be confined by the stricture there is room to suspect there is a new Passage forced open. 1511. Of this as well as of suffering a bougie to slip into the bladder the Surgeon should ever be extreemly cautious. 1512. The Cure by Ulceration is (generally speaking) to be Confined to that part of the Urethra which is straight & then in Cases Strictures not readily yielding to the pressure of the bougie it may be properly had recourse to. 1513. The method of producing ulceration by means of the Caustic may be employed When the bougie cannot be passed & the stricture is in the straight part of the [cross out] Urethra. 1514. The following instruments are necessary. 1st A Silver Canula 2d A Stillet, one End of which solid like a blunt probe, the other made of Gold, like a port Crayon & in the [Gill??] a piece of caustic is to be fixed. 1515. In this Operation the Canula Enclosing the stillet with the probe end downwards is to be introduced up the urethra until the probe strikes against the stricture the stillet is then to be withdrawn & turning the end Armed with the Caustic downwards to be again introduced through the Canula until the Caustic comes in contact with the Stricture where it is to be held for a ☿ 1515. Mr. Hunter observes that in some cases of stricture in the Urethra he has succeeded by means of Caustic beyond all Expectation. In one Case where the Stricture was between the membranous part of the Urethra & the Glans Penis a few to with the caustic enabled him to pass a bougie. In two other Cases in which the stricture had produced Fistula in Perineo & one of which suffered no Urine to Pass by the Penis the Caustic produced a Cure He farther remarks that it is safer to use the caustic than to persevere too long in irritating the Stricture the bougie, as force in the latter case is so easily products of a new Passage. 1519. If it slips within the Urethra so that it cannot taken hold of by the finger or forceps endeavour by grasper the Penis tight in one hand to prevent its getting further towards the Bladder, & with the other hand gently draw the Penis forward then backwards, so as if possible to work the End of the bougie upwards until it comes within reach of the Forceps 104. minute or two & then removed, this process is to be repeated every other day until the intent is accomplished. ☿. 1516. The patient should make water immediately after the Stillet is withdrawn or else warm water should be gently injected to wash off any portions of caustic that may be left in the Urethra. 1517. A slight Ischuria sometimes follows this method of cure which rarely yields to the common remedies. 1518. The ill effects that may follow the use of bougies besides making falsa passages are 1st. That the first time or two that the bougie is introduced many patients will be affected with sickness & Syncope but this goes off of its own accord & does not return on subsequent Repetitions of the use of the bougie. 2d. a discharge of pus from the urethra when before there was none & an increase of that secretion when before existing this is however an effect of little consequence. 3d. An inflammation & swelling of the Testicle in which the common treatment is to be had recourse to. 4th A Sympathetic Swelling of the inguinal Glands 5th. A Bougie slipping into the Bladder may form an nucleus for stone, should it slip so far that it cannot be taken of in the urethra, it must be extracted by the operation of Lithotomy. 1520. The Bougie making a new passage is not in general Forceps or Fingers, should this be ineffectual the bougie must be fixed steadily in the Urethra, Cut down upon & Extracted. ♎︎ 1522. Pass a staff into the Urethra as far as it will go which will generally be to the bottom of the new passage & beyond the stricture; the feel for the end of the Instrument Externally & cut down into its groove, making a wound of an inch or an Inch & half long, carrying the incision a little way into the Scrotum, then take a probe & pass it through the wound into the Urethra to the Stricture if it meets with an Obstruction pass two Canulas one on each side of the Obstruction until they are brought as near to each other as possible, then thrust a piercer from within one Canula, through the obstruction into the other Canula & withdrawing it supply its place with a bougie, next remove the lower Cannula & the Bougie will appear in the Wound, next take out the upper Canula & introduce the bougie along the Canal of the Urethra into the Bladder, it may be right then to lay the new passage Open through the whole of its extent that all may heal together, & least the new passage should receive in future the end of the bougie & prove an hindrance to the Cure As it may be difficult to introduce a second bougie after withdrawing the first, the first should be suffered to remain in the bladder for some time or perhaps it may be better to use the first time a flexible Catheter afterwards the bougies should be increased in size & their use persisted in until a Cure is attained. 105 productive of new disease, as the mischief done is generally early discovered but will impede the Cure of the present. 1521 If the Bougie [making a new passage is not in go] has made its way through the Spongy body of the Urethra it will pass onwards towards the Rectum if in the membranous portion it will take another direction. 1522. The Remedy for or cure of the New Passage is to be performed by incision. ♎︎. 1523 In the performing of which it must be a principle that the Urethra is to be fairly incised beyond the extent of the Stricture. 1524. In the spasmodic Stricture if the Symptoms are urgent we must have recourse at once to the bougie or the Catheter, the bougie is the least hazardous & a large one can often be Easily passed & will then readily relieve the patient even when we cannot pass it, by carrying it as far as we can without force & then leaving it, the stimulus its presence gives to the Urethra will take off the stricture & permit the urine to flow. 1525. We may internally administer Opium & the Turpentines Camphor may relieve this Spasm as well as strangury produced by Cantharides. Externally we may use Fomentations – Warm Bath – Steams of warm Water Blisters to the Perineum or loins &ca. 1526. There will rarely be permanent strictures producing  106 urgent Symptoms without spasmodic Affections of the Urethra also taking place. In the mixed stricture we shall find sufficient directions for practice by attending to what has been advanced in the other two Species the permanent & Spasmodic. 1527. In endeavouring to relieve the [Spasm] Bladder rendered morbidly irritable we should observe the following directions 1st. We should endeavour to remove all obstructions to the ready exit of the Urine. 2d. We should instruct the patient never to suppress an inclination to make water. 3d. We should endeavour to relieve the present urgent Symptoms by giving opium internally Clysters &ca. and 4th. We should try the effects of new irritation as a blister to the Perineum or to the loins. 1528. In case of paralysis of the bladder the catheter should be often introduced to keep the bladder from being distended & when we are evacuating the urine, pressure should be made by the hand upon the Belly we should also apply blisters to the Perineum or to the loins & give stimulating medicines internally. 1529. In paralysis of the Urethra which is a more rare complaint [attended with discharges] a similar mode of treatment is to be adopted especially the application of a blister to the Perineum [or to the loins & give]. 1530. Hemlock has seemed to be serviceable in the complaint Catheters employed for drawing of Urine should be considerably curved at the end & should be introduced carefully yet with some expedition, a flexible Catheter is to be preferred 🝄 1534 As the Female Urethra is short & straight no obstacle will arise to the use of the Caustic but should Bougies be used it will be requisite to retain them in their proper place & situation by means of a T bandage. 107 attended with a discharge of the liquor of the Prostate Gland & Vesicula Seminalis falsely called Seminal weakness ( ) bark & other astringents & strengtheners are also adviseable. 1531 Involuntary erections of the Penis being a nervous & Spasmodic Complaint, Antispasmodic Remedies may with propriety be called in such as Warm & Cold Bathing, Opium &ca. – 1532. In cases of real seminal weakness ( ) Opium has afforded singular benefit & may be use both internally & externally that is applied to the scrotum. 1533. The Enlarged Prostate ( ) is mostly incidental to Old men although Young Men have sometimes been affected wth. it. 1534. No cure is known for this complaint, Hemlock & Sea bathing may be beneficial, as the disease may not impossibly be owing to Scrophula, Opiates & Clysters should be frequently thrown up to Relieve the pain & lessen the irritation. 1535. In strictures of the Female urethra we can more easily succeed by the use of Caustic than bougies from the difficulty of retaining the latter & from the impracticability of their being passed by the patient herself. 1536. When in consequence of obstruction to the Exit of the Urine nature has made New passages for that fluid by the ulceration of the urethra & the formation of fistula in Perineo, we are to attempt the cure by carrying in our minds the general principles of the treatment of Fistula & also what has been already 🜖 1537. As the External parts are generally in a very disease and callus state we are not to be very delicate or sparing on using the Knife upon them, but if possible proceed so far as to make the several openings into one & to cut the Urethra beyond the stricture if the seat of the stricture is not already destroyed by ulceration. – 108 already laid down concerning the cure of new passages formed by an unskillful introduction of the bougie. (1522). 1537. In the Cure the staff is to be introduced in the manner before described upon which we are to cut down into the urethra then from the Urethra we are to pass a probe or flexible director into the sinuses that lead from the opening into the urethra & lay them all open as far as we can follow them. 🜖 1538. An hollow bougie is then to be introduced in the manner before described into the Bladder & the wound healed over it but there is a disadvantage attending the rise of the hollow bougie, which is, that its bore in too small to admit of the exit of the urine in a velocity proportioned to the force with which the Bladder acts. ( ). § We have already considered the consequences of Venereal irritation applied to a secreting or sine Cuticular surface, we now proceed to consider its effects when the matter is applied to a non secreting or cuticular surface the primary effects of which constitution the second species of the first Genus ( ) or local disease. 1539. If any irritating matter is applied to a secreting surface & the irritation is carried to a certain degree, then a change of that Secretion & a discharge of pus or the suppurative inflammation must take place. [1540. (If any irritating matter is applied to a non secre-]  109 1540. Irritation to a certain degree applied to a non secreting surface, suppuration must also follow, but that must be proceeded by ulceration 1541. We see therefore that if venereal matter is applied to the Skin & its application continued a sufficient length of time, ulcerative absorption of a small portion of the Skin takes place, & a chancre is formed. 1542. We have shewn (1254) that there are three ways in which a chancre may be formed. 1543. The second species, like the first is generally caught in Coition; it is not so common as the first species, we calculate that the first species is contracted four times for once that the second is, for the cuticle in general prevents its action on the cutis until the Venereal matter is some how washed off. 1544. The prepuce & Glans penis is the ordinary seat of it but the most common is the Frænum or the Angle between it & the Glans & this from the irregularity of its Surface. 1545. The distance of time between the infection & the appearance of the chancre is uncertain, it generally however makes its appearance later than the Gonorrhea. 1546. We have known a chancre appear 36 hours after coition we have known 7 weeks elapse between the time of Coition & the time of ulceration, we have known also an interval of two Months. 1547. It begins with an itching of the parts affected; if its  110 seat is the Glans there is not much tumefaction, if on the Prepuce there is a little discharge from the beginning at least more so than when the Glans as being a laxer part, the parts ulcerate or a small pimple is formed, or a little abscess especially if the Glans is the seat of it, a little hardness round about the pimple or ulceration is noticed. 1548. Should the Chancre be situated on the body of the Penis it generally begins with a Pimple which breaks & being little attended to at first, Scabs, the Scab is then Picked or rubbed off & a larger one forms, here the inflammation is more considerable than if the chancre begins on the Glans, less however than if upon the prepuce; an hardness generally surrounds it. 1549 The Canal of the Urethra often sympathizes with the External parts so far at least as Smarting, itching, tingling. Whether a discharge will arise simply from this sympathetic affection, we do not affirm, possibly however, not all Gonorrhea which are preceeded by a Chancre are specific. 1550. The Sympathy of the neighbourings parts with the seat of the Chancre is sometimes so strong that even touching the hairs on the Pubis create uneasiness. 1551. The Chancre will be attended with more or less pain & Inflammation according to the peculiar habit & disposition of the Patient. 1552. The local disease will spread with greater or less violence  111. sometimes considerable & deep sloughs will form Early & there will be Gangrene of some extent. The Ulceration will sometimes Penetrate so deep as to open the canal of the Urethra. 1553. The Prepuce is only a doubling of the Skin of the penis that it may be loose & convenient for Erection. The Phymosis or stricture confining it over the end of the Glans so that it cannot be retracted is a frequent consequence of chancre. 1554. The Phymosis often preceeds the Paraphymosis & is in fact frequently the cause of the latter for in patients attempting to get the Skin back it will sometimes be made to slip behind the Root of the Glans & will then take on a Stricture Strangulating the glans. 1555. The Phymosis in some Patients so entirely purses up the end of the prepuce as even to prevent the Exit of the Urine after it has passed through the urethra. 1556. In this disease there is a thickening of the Cellular substance of the prepuce & often an adhesive is formed between it and the Glans. 1557. It has often for its cause a disposition of the Erysipelatous kind, accompanying the venereal inflammation. 1558. The Phymosis if severe produces such a swelling of the prepuce as shall press violently against the end of the glans, & if there are sores or chancres underneath it which is not uncommonly the case the matter issuing from them will be confined ♄ 1559. A Young Man with chancres had a paraphymosis he came into St. Georges Hospital, the entire Glans & all the diseased parts gangrened & sloughed away the patient [reco??] Φ. 1565 Lunar Caustic is recommended, as most convenient it should be pointed like a pencil & the Sores touched with it once or twice a day, until they assume the red & healthy appearance of a common healing ulcer. 112 confined from which & from the pressure on the penis, the worst consequences will ensue even a mortification of the Penis. 1559. The paraphymosis strangulating the Glans will if not relieved sometimes produce a gangrene of the part strangulated & even a seperation of the whole diseased part. ♄ 1560. In Women chancres are apt to be more numerous than in Men & to spread to a larger size because the surface they have to spread over is of greater Extent, In them the Perineum is more subject to Chancres than in Men, from the facility with which the matter in their chancres in the labia & &ca. runs down to that part. 1561. Chancres are frequently attended with some peculiarities independent of the specific affections, & therefore some variety in their treatment may be necessary consequently it is requisite to attend to concomitant circumstances whether local or of the Constitution. 1562. Two modes of local Cure of Chancre are practised the one by extirpation the other by altering the nature of the irritation. 1563. In extirpating the object is not only to cure the chancre but also to prevent any communication of the vines to the System. 1564. Two methods of extirpation have been practised one by the dissecting out of the Chancre the other by destroying the diseased part by means of Caustic. 1565. When the Glans is the seat of the Chancre the Caustic is undoubtedly preferable. Φ. 🜔v 1569. Mercury is applied either in the form of an Ointment or by means of a watery Vehicle, the latter from its ready mixibility with the animal fluids is probably most efficacious; but it should be a rule to change the application often, as any one dressing will have its Efficacy diminished as the sore becomes more or less habituated to its action. 113 1566. Chancres may be dissected off the prepuce &ca. with a Knife, whether dissection or Caustic is employed it is proper afterwards to dress the Sore with mercurial Ointment as by that means we destroy any venereal Infection which may remain. 1567. Extirpation is improper when the chancre is large. 1568. The other mode of local Cure is by means of altering the nature of the Ulcer (which is done by Mercurial Ointment) in which there is no destruction of parts but only a destruction of venereal irritation. 1569. Mercury although it does not cure the first species is a Specific for the Second. ( ) 🜔v. 1570. Chancres to their specific disposition will often have superadded either indolence or irritability. In the former Mercurials should be mixed with stimulating balsams, in the latter Mercurials should be mixed with Opium & the oftener the latter are dressed, the better. – 1571. If a patient with a phymosis cannot submit to keeping his bed (a circumstance to be desired) he should use a proper suspensory bandage. 1572. Between the pressure & Glans an injection should be thrown often prepared either of Calomel, Gum Arabic & Water, or of mercurial Ointment incorporated with Mucilage of Gum Arabic, with Water, between the times of injecting mercurial Ointment may be rubbed on the outside, sometimes a poultice of vegeto mineral water & linseed meal affords relief. ♀ 1573. Oil of Turpentine is the best Styptic we are acquainted with. 🜔🜹. 1577. Many have recommended us not to open the prepuce by one longitudinal incision the whole length of it, but to make two slits one on each side which they say will save the necessity of making so long a wound, but they have drawn this reasoning from the natural Phymosis, which will by no means apply to the Phymosis from disease, in which the prepuce is very much tightned & incapable of yielding & stretching as in the natural Phymosis. Whenever disease makes it necessary to operate the Prepuce should be slit up its whole length. 114 1573. An Hæmorrhage the consequence of ulceration will sometimes happen, & is an extremly troublesome Symptom. ♀ 1574. When the Inflammation abates more the prepuce of the Glans frequently to prevent adhesions which would subject the patient to a permanent inconvenience. 1575. Should it happen that an ulceration of both the surfaces of Glans & Prepuce has taken place, the we must endeavour to prevent adhesion by the frequent use of injections thrown between the Glans & the prepuce. 1576. If the preputium is drawn much over the Glans & Contractd. & the opening of the Urethra is in a straight line with the end of the prepuce pass a bougie into the canal in order to prevent the ill consequences of the passage of the Urine being obstructed by the preputium adhering to the end of the Glans & closing itself over the Orifice of the Urethra. 1577. In this latter case, or in case the orifice in the Urethra is not in a right line with the end of the preputium we must slit open the prepuce & expose the Orifice. 🜔🜹 1578. In many Cases the Operation of the Phymosis is not adviseable, as where the inflammation is violent, or there is much tendency to Gangrene as the additional Violence of the operation must tend to encrease both. 1579. When matter is collected & confined in any part from the adhesion of the prepuce to the Glans, a wound by a Launcet should be made & the matter discharged, or if the fears of the Patient ☿. 1582 It sometimes however happens that mercury encreases the tendency to Gangrene, under which circumstance Bark should be administred alone. 115. patient object to the lancet, a small caustic may be employed. 1580. Mortification sometimes takes place in Phymosis & we have seen cases in which the whole Prepuce has slough’d away 1581. Hence we may suspect a faulty constitution & that the Inflammation was of the Erysipelatous kind. 1582. In these Cases Bark should be administred with Mercury thereby attacking at once the Venereal infection & the Constitutional disposition. ☿. 1583. A necessity for performing the operation for the Phymosis will appear to arise 1st. When the prepuce is so contracted over the Orifice of the Urethra as to become the Cause of hindering the exit of the Urine. & 2ndly. When added to this inconvenience or without it the matter from chancre is concluded by the prepuce becomes confined & cannot be evacuated on applications made to the Chancre Without dividing the Prepuce. 1584. An Operation for the relief of the [Patient] Paraphymosis becomes oftener necessary than in the Phymosis & danger of Gangrene &ca. from this Stricture will more often occur. 1585. The Operation consists in drawing up the integuments as much as may be with the fingers & Thumb & then passing a crooked bistory through the most strictured part & bringing it through from within outwards. 1586. In consequence of the Inflammation of the prepuce in Phymosis or Paraphymosis it will be often much elongated &  116. thickened so as to be much inconvenience to the Patient. 1587. If by proper applications as the steam of warm water, the fumes of Cinnabar or hemlock fomentations, we cannot reduce the swelling, it will be right to perform circumcision. 1588. Or we should at least remove as much of the prepuce as projects beyond the Glans, taking care however not to include any part of the Glans in the extirpation of the prepuce, & in healing the wound we should direct the patient often to draw the prepuce up & down to prevent the cicatrix contracting & forming a phymosis or stricture over the end of the Glans. 1589. Warts are no sign of a Pox, they arise in Gonorrhœa from the discharge from the Urethra touching any of the neighbouring parts. Chancres heal into Warts, Warts have an increasing power in themselves, often bleed, & are frequently painful. 1590. Mercury has been employed for their use & it is asserted will remove them, but our Experience does not warrant us to Affirm this to be the Case. 1591. As being new formed parts it is evident that their powers of supporting action must be weak by exciting a strong action in them & the surrounding parts by means of Powerful Stimulants we may produce in them a disposition to decay as a a more violent action will be thus produced than they are able to support. 1592. Rust of Copper mixed with powdered Savine is found to  117 answer this purpose (1591). 1593. They may also be extirpated by means of ligature, Excision or Caustic, but it is often found that by what means so ever they are removed they will frequently sprout up a fresh, in this case a repetition of the former process is necessary. 1594. Although Chancres may in general be cured by the local means above described, yet the introduction of Mercury into the System is adviseable, & generally to be insisted on both as forwarding the Cure of the local disease & as counteracting the effects of the virus if absorbed into the System. 1595. As we have remarked (1556) some variety will be necessary in the mode of treating chancres according to the concomitant disposition of the constitution or the part & this internally as well as Externally thus if there is a disposition to indolence we join some stimulating Medicines as the balsams with Mercury, if to irritability Opium, bark, &ca. – 1596. The quantity of Mercury to be introduced into the constitution should be in proportion to the number of chancres, their size & the time they have continued, it will be right to produce a slight spitting as a criterion of the Mercury having Acted in the System. 1597. Mercury may be carried into the System either from the Stomach or the Skin; when all the hardness is become softened & the Sore is skinned over the cure may in general be supposed  118. to be accomplished. 1598. This rule should however be applied to a large rather than to a small Chancre for in the former the Virus must in general be destroyed before the chancre will heal, yet in the latter the sore will sometimes skin over before the venereal virus is destroyed. 1599. It is better for the most part to continue the Mercury for sometime after the Chancre is healed to prevent any further action of the Venereal Virus by means of the Constitution. 1600. Chancres in Women should be often washed with solutions of corrosive sublimate & mercurial Ointment should be applied to them. 1601. The quantity of Mercury thrown into the Constitution should be greater in them than in others because their Chancres are commonly larger & more numerous. 1602. When the Ulcers spread considerably, if the seat of them is in the Vagina some extraneous body as lint &ca, should be kept between its sides to prevent their Cohering & Straitning & Closing the passage through the Vagina, an accident that has been known to take place. 1603. New diseased dispositions not venereal may arise during the Cure of chancres & remain after the venereal virus is destroyed. 1604. In some there will be a diffused inflammation of a Purplish 1606. Mr. Hunter has once known them to break out in two Months, these new ulcerations do not always appear immediately where the original Chancres were situated by a very small distance from the Cicatrix. 119. Purplish hue, about the sore which will be ragged & assume a cancerous appearance, these have been commonly considered as Cancers, but for the most part are only Scrophulous. In others there is a swelling & hardness with an indolent disposition. 1605 freely used in these Cases has proved serviceable, the Lisbon diet drink has also been found of singular utility Extract of Hemlock has done service, so has Sea bathing, & Opium used externally, if the disease extends near to the orifice of the Urethra care should be taken to prevent its closing, by means of a bougie, Extirpation of the diseased part if indolent may sometimes be requisite. 1606. The Cicatrices of Chancres after all the Virus is eradicated will sometimes breakout again such are generally but falsly considered as Venereal, the cure of these Ulcerations is uncertain. 1607. We recommend Sea bathing as highly useful in this diseased affection having experienced its efficacy in such Cases. 1608. From whatever surface the Venereal poison is absorbed the effect is ultimately the same. 1609. The Constitution may be affected by Venereal Virus in four ways 1st. By Venereal matter applied to a surface & absorbed into the System without any previous local effects. 2d. By Gonorrhœa. 3d. By a Venereal Ulcer, whether Chancre or Bubo. 4th. By a Wound. 🜔 1609. Mr. Hunter calculates the proportions of infection in the 2d. way to the 1st. was 100 to 1 & the 3d. to the 2d. is as 100 to 1 also. 120 The most general way by far is the third, the first scarcely ever happens. 🜔. 1610. The Venereal Matter being taken up (1609) by the Absorbents may previous to any constitutional affection give rise to the bubo or local consequent. (1252, 1263). 1611. The Venereal Bubo may be divided into. a. That in which the Absorbent Vessel itself being contaminated is the seat of the disease. b. Where the Lymphatic Gland in the line of Absorption is the part affected. 1612. The first very rarely occurs, when it does it is known by a resemblance to an hard Chord running along the dorsum Penis & leading to a Gland. 1613. The hardness is occasioned by a thickening of the coats of the inflamed Vessels. The absorbent sometimes suppurates & form a chain of abscesses along the Penis similar to the Abscesses of Veins (543) when suppurating they are to be considered as chancres. 1614. The first species is so rare that it is not noticed in speaking generally of Bubo. (1252). 1615. In the second kind which we commonly Call bubo the Venereal Matter is carried by the absorbents to the nearest of the Lymphatic Glands. 1616. The Lymphatic Glands consist of a Convolution of Vessels construded so, as very much to favour the stay of Venereal Matter in them a sufficient time to produce their contamination. ♀ 1617. First in Order---Inguinal Second in Order---Glands of the back. It would appear from this that the matter is diluted in its passage, the more probable reason however is, that the second order are not so easily irritated as the first being deeper seated. – (1295). 121. 1617. The Lymphatic Glands nearest in order to the Source of the Matter are the parts affected, those of the second order scarce Ever. ♀ 1618. In Men the seat of the Bubo will be in the Lymphatic Gland of the Groin, but as to the situation of the Lymphatic Glands it is not always the same precisely & the nearest Lymphatic Gland will sometimes not be in the groin but just above pouparts Ligament near to the os pubis, that will sometimes be the seat of the bubo. 1619. In case the Bubo arises from Gonorrhœa the seat of the Tumor may be on either side, if from a chancre, the Bubo will form on the same side as the chancre, but if the chancre is in the middle of the Penis then the Bubo may arise at either side. 1620. In Women the surface of Absorption being larger than in Men there are three different Parts which a Bubo may occupy & that dependant on the site of the Chancre. 1621. If the chancre appears on the Labia or Nympha the Venereal matter will pass on when absorbed in the course of the Ligamentum Rotundum & just before that ligament enters the abdominal ring the bubo will form, but never within the ring. 1622. This Bubo we refer to the first kind not considering it as Glandular but as an inflammation of the absorbing Vessel only, & this strengthens our Opinion that deep seated & internal parts are not readily susceptible of the Venereal irritation & that a bubo can only be External. (1617). 1623. If the Chancre be situated further backwards, then the bubo will form between the labia & the Groin or as in Men in the Groin 1624. “To this because the surface of the Glans Penis approaches nearest to a secretory surface than that of the Prepuce. We see absorption goes on slowly from a secreting surface. 122 1624. Absorption of Venereal Matter goes one more readily from some surfaces than from others, e.g. it is much more frequently taken up from the Preputium than from the Glans Penis. 1625. The first notice given to the patient of the formation of a bubo, is a sense of pain in the part affected, in which upon Examination he feels an hard tumor. 1626. This Tumor is generally of the common inflammatory kind & often advances to Suppuration speedily. 1627. Sometimes the Tumor is more of an indolent disposition & will then be long in coming to maturation. 1628. When the Bubo is of the truly inflammatory kind [& often] [advances to suppuration speedily.] [1627. Sometimes the Tumor is more of an indolent disposition &] [will then belong in common to maturation.] [1628. When the Bubo] the pain attending the suppuration will be very considerable when of the indolent nature it will be less acute, more dull & heavy, a disposition to indolence especially prevails in Patients of Scrophulous dispositions. 1629. The inflammation of the bubo will however sometimes be found of the Erysipelatous kind & then though the pain may be considerable, the Inflammation will be considerable & the part oedematous. 1630. Inflammations & Swellings of the inguinal Glands are not always Venereal, great will be the difficulty however sometimes ♄ 1632. It is however doubtful whether we do not often meet with Cases in which the Venereal disposition is mixed with the Scrophulous. in this Case we are to attack the predominant disposition whether it be Scrophulous or Syphilitic. Case Colonel W. had a gonorrhea preceeded by Buboes which suppurated they were opened & for a time went on healing kindly but at length became Stationary. Mr. Hunter suspected that a New disposition was taking place therefore ordered sea bathing &ca. when the new disposition which was Scrophulous, abated, the Venereal disposition increased so that it was necessary to return to Mercury. ☉ If Buboes were critical deposits from the constitution why do they not arise in some other Glands as those of the Neck &ca. & not in the Sympathetic Glands of the Groin or always in the nearest to the source of Absorption; again if Critical why should it be necessary to administer Mercury when they form. 123. in ascertaining the nature of an inguinal bubo. 1631 If a Gland in the Groin swells without a visible Cause, is painful, & goes on to suppuration quickly, venereal matter should be suspected & Mercury given, as in cases of chancres. 1632. But if the Tumor has an indolent nature & is attended with a Cold & Feverish indisposition & arises without any visible cause we may for the most part consider it as Scrophulous. ♄. - 1633. Bubo’s both in Men & Women are entirely local & are no more connected with the Constitution than the preceding local affection of which they are the consequence. 1634. They are not critical deposits from the Constitution as has been some supposed. ☉. 1635. In order to the cure of Buboes, having first ascertained their being Venereal we have recourse to the exhibition of Mercury. 1636. We are always to desire the resolution of the bubo & to avoid suppuration for the Bubo when it forms matter is similar to a chancre & has equal powers of contaminating the System. 1637. It is necessary to observe that in the Cure of the bubo, Mercury should be employed, but as that will only destroy the specific disposition of the Gland, it is necessary to attend also to the nature of the concomitant inflammation whether common Scrophulous, or erysipelatous. 1638. In the first we have recourse to bleeding & Purging according to the violence of the Inflammation. For the second, or Scrophulous, Cicuta, Sea bathing &ca. ☍ 1639. A Gentleman had a suppuration considerably advanced, he went to sea & the Sea sickness he endured & the consequent vomiting caused an Absorption of the matter & the cure of the Abscess. 🜍 1641. Thus if a chancre in the prepuce preceded the bubo – the Mercurial ointment should be rubbed on the side of the Penis where the Chancre formed itself & on the inside of the Thigh, in the Scrotum & belly &ca. as the Lymphatics from those parts take their route through the Inguinal Glands. 1642. Of all the patients Mr. Hunter has had under his Care for 16 years past, only 3 have had buboes which suppurated, that is of those which applied to him at the commencement of the bubo. 124 For the third Bark. 1639. Vomiting has been known to produce resolution of the Bubo even when suppuration had taken place, acting upon the principle of resolution. Vomit also powerfully Excite the action of the absorbents. ☍ 1640 In the [course] Cure of the Bubo we can much increase the Powers of our Remedies by the manner of applying them, & it should be a Rule to endeavour to produce an Action of the Mercury on the part before we produce its action on the System. 1641. We should therefore cause Mercurial Ointment to be rubbed on the surface from which the Absorbents begin that pass through the affected part, & as near as possible the part from which the first absorption of the venereal matter took place, thus introducing the Mercury into the System by the same road which the Virus persued, & as it were making the Antidote tread on the heels of the Poison. 🜍. 1642. By the early use of Mercury in the manner recommended (1641). The suppuration of buboes will commonly be prevented but should they happen notwithstanding to form matter, or should the matter be formed before the Surgeon is consulted; Mercury should be used during the whole time of maturation though in a more moderate quantity than before as well as after the bubo is opened or has burst. 1643. If the bubo is to be opened by Art the Skin should be permitted to come exceeding thin before the Operation is Performed, that a disposition may have taken place prior to exposing the Abscess to heal from the bottom. 1644. The opening may be made Either by the Launcet or by Caustic 1646. Sir William Fordyce first recommended Orange & Lemon juice which Mr. Hunter has since prescribed to advantage. Gold beaters Water is in use at the lock Hospital & sometimes does service. ♃ 1647. Case A Gentleman has a bubo which was opened he used Mercury 2 Months, still the Ulcer continued without the least disposition to heal, Mr. Hunter considering his constitution as too much of a Mercurial one & therefore little Affected by that Remedy he left it off & confined him to Milk diet &ca. for sometime, he then returned to Mercury again & continued its use for 2 Months when the Ulcer became stationary, he then again discontinued it returned to the Milk & gave Cicuta, the Ulcer was sinuous. The sinuositus were laid open & the patient was sent to Sea he persued this plan 4 Months & returned home without benefit. Mercury was again ineffectually administred, the patient at last got well having left off all Medicines. 125 Caustic according to the inclination of the Patient, it should however be small. When left to the choice of the Surgeon, if the Skin is very loose he may use a Caustic, & the lapis Infernalis is to be preferred, if the Skin is not loose, the lancet is best as thereby none will be destroyed, the Wound is to be drest according to the nature of the discharge. 1645. Mercury should be thrown into the constitution during the whole of the time from the ulceration until after the healing of the bubo, or at least until the Bubo has lost its venereal appearance which the Experienced Surgeon alone will be able to determine. 1646. Some exceptions however to this, are found to arise, sometimes the bubo takes on a New diseased disposition which mercury increases, the sore will continue obstinately spreading & the more freely Mercury is administred, the more progress the Ulceration will make. In this Case we perhaps have a Scrophulous or Scorbutic habit to encounter, & we shall find benefit probably from the use of Hemlock & Sea bathing & from Orange & Lemon Juice. 1647. In some of these Cases we have found no Medicine of any Utility but the disposition at length has worn itself out & the Ulcer healed. ♃. 1648 Another Exception to the constant use of Mercury is that the patients Constitution may become so habituated to it, that it shall lose its power of acting as a specific, in this Case we should discontinue the Mercury for some Weeks & then have recourse to it again. 1649. As the Venereal disease may be communicated by other  126 means than coition, so buboes may be formed in other Glands as well as those in the vicinity of the parts of generation, if the infection was received on the Lip; the Bubo would be seated in the Neck, if Venereal matter was absorbed from an ulcer or wound in the Finger, we should find the Bubo in the Axilla. 1650. In the Cure of these the same principle is to be kept in view, as if they had formed in the Groin (1636-1640). 1651. Some uncertainty must prevail as to the precise Quantity of Mercury necessary to be used for the removal of buboes, where the resolution is obstinate the quantity of Mercury should be pushed so as to affect the Mouth in general we may begin with ½ dram of Ointment (prepared with Axunge & Mercury) & increase or diminish according as the bubo is affected by it. 1652. When the Venereal Virus has been absorbed into the habit, & the second Genus arises Variety of appearances are produced & these will be according to the following Circumstances. 1653. 1st. the time since it was Absorbed into the Constitution. 2d the peculiarities of the Constitution. 3d the different Solids affected by it. 4th. The different dispositions the solids were in when they first became affected with it. 1654. The time in which the second Appearances take place after the infection depends upon the nature of the constitution, at a medium the period is found to be 6 Weeks in some it is sooner ♄. 1654. A Case occurred in which almost the whole body was covered with general Eruptions within a fortnight after the breaking out of a Chancre. ☉ 1659. In some persons, Copper Coloured, dry Scurfs, or as it were Cuticles appear which are thrown off from time to time & spread at times to the size of a Sixpence. 127. in others later. ♄. 1655. The deep seated parts, or parts second in order of [succession] susceptibility (1298) do not always come later into action than the superficial parts (1297) as we have known the Periosteum to become diseased without any previous affection of the Skin or Throat. 1656. We have accounted for the reasonsy why parts shall fall into the Venereal Action after parts labouring under the same diseased action shall be cured (1303-1304). 1657. We have also shewn that Venereal matter does not continue circulating in the Blood for any length of time, that the secretions are not contaminated by the Venereal Matter, nor the Blood rendered Capable of communicating the infection to other persons but that after the absorption into the System it Circulates for a short time with the common mass of Fluids, gives a venereal disposition to the different solids having first undergone a change in its nature & is soon thrown out by the different excretions. 1658. In some the Eruption upon the Skin appears in distinct blotches not very observeable until Scurfs are forming upon them, at other times as small pimples with inflammation & the pimples filled with matter. ☉. 1659. The first appearance after Absorption is generally upon the Skin, throat or Mouth, the appearance in the throat often precedes the others. 1660. When Skin is opposed to Skin, as in Axilla &ca. the above described appearances never take place, but the Skin rises while  128 & smooth, & a whitish kind of matter is secreted & they attended with more pain than the former, whether this attends the disease in question only we will not pretend to determine. 1661. The hair falls off the parts that are attacked with it & so long as the disease continues the new hair cannot grow. The fingers are sometimes the seat of the disease & then the nails fall off. 1662. When the throat inside of the mouth & tongue are the seats of the Venereal Action, an Ulcer rapid in its progress but without much tumefaction is formed it is foul & has thickened or bordered Edges; but this is a circumstance attending all sores that have no disposition to heal. 1663. These Ulcers are painfull although much less so than a common inflammation of these parts, & oblidge the patient to speak thick & snuffle. 1664. The matter secreted upon them does not remain to form a Scab, but is washed off in swallowing. 1665. The Eye sometimes become the seat of disease & a venereal Ophthalmia is produced which with difficulty can be distinguished from the common Ophthalmia. 1666. When the disease has been affecting the constitution for sometime, then the parts second in order may shew the action of the Virus or the same Effect may occur when it had first appeared in the External part, & the diseased appearances there had been Cured. 1667. A total deafness is not uncommon at this time, now & then attended with pain & suppuration in the parts.  129. 1668. A Node often appears several months after any possible infection, the progress of this is very slow & the consequence of any suppuration is a very slimy matter instead of good pus. 1669. When the Periosteum &ca. becomes affected the Pain is very considerable but not always so. 1670. Nodes will sometimes continue several Years before they come to Suppuration, the inflammation being very slow. 1671. Venereal pains are periodical being more particularly Severe at night & in this respect they resemble the Rheumatic. 1672. The Effects of the Venereal disease upon the Constitution are similar to the effects of all other irritations whether locar or Costitutional. 1673. In some a slow kind of nervous fever with loss of appetite is produced, or there are Rigors, frequent hot fits head Achs. &ca. 1674. In the cure the disease may be considered as in two extreemes, not different in their nature but only as requiring a more mild or more severe treatment. 1675. In the first Genus our senses will generally inform as when a Cure is compleated but in the second Genus we labour under great difficulties as the Virus has circulated in the blood & we know the contaminated Solids only by their shewing a diseased action. 1676. The Effects arising from the constitution are local & may be cured locally, but as other parts may have received the Venereal disposition, although they have not yet come into action, we must attack the ☽︎ 1682. Mr. Hunter observes that a smaller quantity of Calomel is sufficient to Salivate by the Bowels than by the Skin, & again that using precipitate to Sores has salivated patients. 130. Blood, not as now containing the poison, but as the Vehicle carrying the specific through all the solids of the body, curing present diseased effects, & destroying dispositions which would have produced future ones. 1677. It is not clear whether those parts which have first been attacked are easier to Cure then those which took a diseased Action later. 1678. If parts are susceptible of Cure in proportion to their susceptibility of diseased action then the parts first in order must have their diseased disposition & action removed. 1679. The second in order may appear diseased when the first has been already cured, but the order is rarely reversed. 1680. Mercury is the true specific remedy for this disease & none other whatever can be depended on, when taken into the constitution it circulates with the juices cures those parts which are diseased & little affects those that are not. 1681. There are two modes of administring it Vizt. By the Stomach---By the Skin. 1682. Like other substances it is more readily absorbed from some surfaces than from others. ☽︎. 1683. In the administration of Mercury it is necessary to consider. a. The Constitution of the Patient. b. The quantity of Mercury necessary c. The proportion that will best agree wth. The Patient d. The mode of giving it.  131. e. The Regimen necessary to be observed by the Patient during his Mercurial Course. 1684. As to the constitution we should endeavour to learn whether it is very much disposed to irritability or indolence, if possible whether it is easily or difficultly affected with Mercury, & again the time the Constitution has been contaminated. 1685. With respect to the second circumstance belonging to the constitution we may in general take the History given us of the degree in which it has been affected by a given quantity of Mercury on any former occasion as a guide for our practice for it rarely happens that the Constitution Varies much in this particular. 1686. The quantity of Mercury to be given must be equal to the Violence of the disease but it becomes necessary at the same time to consider the period of time within which a given quantity is introduced into the System & the effects of that quantity on the Constitution. Thus one ounce of Mercurial Ointment rubbed into the Skin in two days will have more Effect on the constitution & secretions than two Ounces rubbed in within ten days. 1687. A large quantity of Mercury quickly introduced into the System, a sudden Alarm is given & its effects are rendered mostly local consisting in the unusual Excitement of some sensation. 1688. But if we introduce the Mercury slowly a very considerable quantity may be thrown in without visibly affecting the constitution. – ☿. 1694. All parts do not become Sore together but severally the lips may alone become thick & inflamed & the Cheeks or Gums become Sore. – 132 1689. From a knowledge of these circumstances we find Mercury a much larger & more manageable Remedy than it was formerly known to be. 1690. Mercury when first applied affects the System much more readily than when the patient has been sometime accustomed to its use we are therefore enabled by beginning with a small quantity & going on gradually to throw into the constitution a much larger quantity than could have otherwise been born by the Patient. 1691. If given with care so as to avoid Stimulating any secretory Part to Action, & thus producing Evacuation, any quantity of mercury may be introduced that the disease can require. 1692. The effects of Mercury are generally in the following order. 1st. On the salivary Glands – 2d. on the intestinal Glands. 3d. On the Skin 4th. on the Kidneys. 1693. These are affected sometimes singly, sometimes more than One, sometimes altogether. 1694. Soreness of the mouth most commonly though not always attends the increased action of the Salivary Glands ☿. 1695. Evacuations by any of the secretories are of no use in curing the disease, they only shew the susceptibility of the secretory Organ to be affected by the remedy, however they afford some Evidence of the constitutions being acted on by the Remedy. 1696. If the secretory Organs are too susceptible of the stimulus of the Mercury it will be difficult to Cure the disease because ♃. 1696 A Gentleman had a Chancre & a bubo he rubbed in Mercurial Ointment once, his mouth became affected, a slavering came on, the spitting was kept up for a month during which time the Chancre & Bubo got well, soon after his Throat became affected with the disease this Mr. Hunter attributed to the too great susceptibility of stimulus in the Salivary Glands which suffered the Mercury to be evacuated so fast, that it had not time or power to affect all the other parts of the System. 134. The Patient will not bear a sufficient quantity of the specific to be introduced into the Circulation. ♃. 1697. The too ready susceptibility of any secretory Organ should be obviated by proper astringents hereafter to be mentioned. 1698. Mercury can act only upon the constitution & upon the Poison. 1699. Upon the Poison either by destroying its properties & decomposing it, or By attracting it & carrying it out of the Circulation together with itself, or By counteracting the venereal irritation & producing a new & opposite irritation. 1700. If the latter conjecture is true then the readiest way of curing the disease must be, giving Mercury so as to produce visible effects on the disease yet in such a quantity as to produce a different disposition in the System. 1701. It should be given slowly so as to produce at length some local Effects, yet however in such manner that a quantity may be introduced into the System sufficient to cure the disease. 1702. As a general rule it is right & necessary to give Mercury in such quantities as shall produce good effects on the disease yet no ill ones on the Constitutions & to continue its exhibition until some local irritation is produced. 1703. Of the two modes of throwing Mercury into the constitution if the patients way of Life & circumstances renders it convenient that of rubbing it into the Skin is most Eligible & most certain ♀ 1709. Should it be found that purging has any effects in diminishing Salivation it might be right to give sulphur in sufficient quantities to act as a purgative. 135. in its effects. 1704 If the Patient has been unused to Mercury, he should begin with a scruple or half a dram of the Ointment prepared with & rub that quantity in every night for 4 or 6 nights & then he may increase the quantity to a drachm & so on gradually until two drams are rubbed in every night. 1705. If the Symptoms disappear gradually it will be right in general to continue the medicine a fortnight after their removal. 1706. When the mouth becomes affected by the mercury we must suspend its administration, until the soreness abates. 1707. If the Mercury runs off by any of the secretions they should be restrained no danger arises from checking a too violent secretion although that encreased secretion does not arise from the constitution. 1708. Sulphur has certainly been serviceable in diminishing too violent secretion by the Salivary Glands in what manner it produces this effect we do not determine, it can only act upon the mercury after the latter has got into the blood probably it is a kind of Antimercurial Stimulus. has it any powers of combining with the Mercury in the constitution. ☍ 1709. We should distinguish a Mercurial salivation from a Salivation which goes on from habit after the mercury is Evacuated 1710. purging had probably no power in diminishing a Mercurial Salivation. ♀. 1711. Sulphur certainly Enters the Blood unchanged & as Sulphur. ♄ 1716 Mercury cannot act in the body as it does not of it, all the preparations of it undergoes a change & after being taken into the System a New Combination peculiar to the animal body is formed & that is the same whatever may be the preparation of mercury employed. Did Mercury Act when in the System as it does in the Primæ viæ or applied Externally, the preparations would have different effects. e.g. Turboth Mineral when in the blood would act as an emetic in the same manner as Ipecacoanha does when thrown into the blood Vessels, but all the preparations of Mercury after they are dissolved in the Animal juices form one particular combination when dissolved in the Saliva they have all the same taste. Mr. Hunter held crude mercury in his mouth for sometime, it was very slow in giving the proper metallic taste to the saliva which shewed that it dissolved in the Mouth & gave the same taste. Calomel did the same. Corrosive sublimate held in the Mouth, for a time the acid taste was prevalent, but that going off the proper Mercurial taste similar to that of M. Cale: Argent. vis: &ca. took place; introduced by means of the skin into the System, they all have one common Effect, tho some are quicker in producing their Effect than others. – 136 1712. Should the Secretion by the bowels be violent we restrain it by opium which seldom fails in removing the irritation of those parts the violent action of Mercury on which, is by far more dangerous than on any of the other secretory organs. 1713. Mercurial sweatings or Evacuations by the Skin, we check with most success by the use of peruvian Bark. 1714. The encreased action of the Kidneys is not near so troublesome as the others, Bark may be given as it corrects; but it will sometimes go on whatever means are employed to check it. 1715. Mercury probably cures most of the Symptoms of the first stage locally, that is applied to the parts by means of some of the secretions, thus it probably cures the sore throat locally, the saliva loaded with Mercury proving an antivenereal Gargle, so also in Cutaneous affections, being applied to the skin by means of the sweat. 1716. Mercury cannot act upon the Venereal or any other disease but in a state of solution & that in the Animal juices. ♄. 1717. It is however certain that different preparations of Mercury will produce Effects upon the system & upon the secreting Organs at different periods of time & will affect different indviduals in different manners, & that those who are not cured by one preparation of mercury will by another therefore it is right to try different Preparations when the disease is obstinate. 1718. All the preparations of Mercury are readily voluble in Saliva. Mercurius Calcinatus is the most simple & easily dissolved  137 in the mouth, mixed with a quantity of opium it makes one of the most efficacious internal remedies. 1719. Calomel in proportion as to strength & its effects in the Constitution to Mercurius Calcinatus is as One to three. One Grain of calcined Mercury is equally powerful with 3 of Calomel 1720. Corrosive Sublimate is a powerful preparation of mercury its action in curing any diseased part is mostly local as being carried to them by means of some secreted fluid, it cures ulcers in the throat sooner than any Medicine, acting perhaps as a gargle. A cure by it however is not to be entirely depended upon as it does not seem to have any great powers in the constitution & relapses more frequently happen after a supposed cure by Corrosive Sublimate than by any other preparation of Mercury. 1721. For too small a quantity of Mercury only when we use sublimate can be introduced into the System, to effect a proper change of the constitution, it too readily passes off by the Skin &ca. – 1722. Crude Mercury divided with any substance by triture is the weaker of all the mercurial preparations. 15 Grains of it being only equal to one grain of mercurius Calcinatus. 1723. A Grain of Calcined Mercury may be taken [into] every night for five six or seven Nights, if no affection of the mouth is thereby produced the quantity may be increased. 1724. Either of these may be joined with Quaiacum ( ) in dose & will in general produce a cure of the Symptoms in one month. 1725. If the Symptoms diappear suddenly, for instance in the ☉ 1726 It is with this view probably that Mercurius is prescribed. – 138 first eight days, it will be still right to persist in the use of the remedy a considerable time, & even when the suppuration gradually decreases it will not be improper to persevere in the use of the Remedy for a fortnight afterwards & this whether the external or internal method is employed, for we should always consider the danger of having incurred a venereal disposition in parts not yet come into action. In this first Stage it is much easier to cure the Symptoms than to rid the constitution of the specific disposition. 1726. If Mercury is given internally either in a Saline form as sublimate, or formed into a salt by any acid it may meet with in the Stomach, regard is to be had to the irritation it may produce on the Stomach & Primæ Viæ. if they are disposed to irritability Opium & Essential Oil may be administred with it, or alkaline Medicines accompanying its Exhibition. ☉. 1727. In general if Mercury is properly administred the constitution may be cured in six Weeks. 1728 In the second or worst Stage as affections of the Periosteum, Tendons, Ligaments & Bones. a more severe course is to be pursued & mercury is often required to be given in the largest quantities that the patient can with saftey bear. 1729. Here we must begin with a large quantity at first, in order as it were to surprise the system & we should produce a sensible effect in 5 or 6 days & a soreness in the mouth in 12 days Here the quantity of Mercury to be employed will be so great that it is scarcely possible to prevent a Salivation.  139. 1730 In this Case more attention will be required to the Patients diet, as he will not be able to Eat solid food from the soreness of his mouth & yet will require his strength to be supported, Egged Wine, Sagoe &ca. will be proper viands. 1731. In our use of the mercury we are to observe that in this Stage it is easier to cure the constitution than the local disease & therefore it is not necessary to persist in the use of mercury until all the local Complaints are removed as the parts may remain in a diseased state after every Venereal disposition is destroyed. 1732. Topical remedies in this stage will be useful, as will readily be conceived from (1731). 1733. Previous to beginning the Mercurial Course we must make the same enquiries as are directed to be made preparatory to a less severe Course ( ) that is whether the patient has heretofore taken Mercury whether lately, or in what quantities. 1734. If he has lately taken Mercury (& this is to be considered as it were a continuation of a Course already begun we must begin with a large quantity as two drachms of Ointment, rubbing the same quantity of Ointment into the Skin every night, if the Patient can bear it, or even encreasing it to ʒiij. Or if he has heretofore borne a large quantity of Mercury without inconvenience, we may proceed with similar boldness. 1735. But if the Patient has not been used to mercury or is weak & irritable we must proceed with some Caution; One drachm ☽︎. 1738. We perhaps shall not be surprized at the length of time which may Elapse between a Venereal disposition being given to a Bone & the time of its action on the bone appearing for we see not only Venereal Virus is very slow in its Operation but that processes of all kinds in bones go on with tediousness & difficulty. ♂. 1739 Why does Mercurial Ointment cure Nodes? It cannot be by the Mercury acting locally by Contact, it must either be by the System, or by Sympathy. 140. of Ointment is as much as we should venture to employ. 1736. Mercury in any stage can only Cure the constitution by being absorbed into the System. This we must be aware of, & therefore if the surface of the Skin, will not absorb it, we must give it internally if the absorbents of the bowels will not take it up, no more than those of the Skin the Case of the Patient is really deplorable, & the Cure impossible. 1737. Some particular local affections in this Stage deserve attention as. a. Nodes 1738. If the affection of the Periosteum or bone has proceeded no further than inflammation & swelling, in general no particular application is necessary but the Venereal Virus only will require to be destroyed. ☽︎. 1739. Sometimes however it will be other wise, then they may be covered with Mercurial plaister or rubbed with the Ointments the latter is best. ♂. 1740. If these do not succeed we must try the effects if a new inflammation. Blisters applied round the Node have removed the pain & assisted the Cure. If Blisters fail an incision should be freely made in the diseased part that by the processes of Inflammation a new disposition may be formed in the parts, & the nature of a common sore produced. 1741. As parts may remain in a state of disease after the Venereal Virus is destroyed & the Constitution cured we may often very  141 safely leave the Nodes to time which will not uncommonly effect a Cure, but sometimes however a particular local treatment will be necessary. 1742. Nodes are often blended with Abscesses which seldom produce good matter, but generally a kind of slime or mucus which his flat on the bone & renders it difficult to determine whether there is a fluid underneath or of what kind. In this Case there is but little of the adhesive Inflammation. 1743. Inducing Violence of Action in the diseased parts, here facilitates their cure by destroying the present irritation, we should therefore make free openings. Exfoliation may more readily take place in bone affected with the Venereal disposition than any other diseased disposition, because here we have a specific remedy by which we can correct the present disposition. 1744. When a Node Occurs in a Tendon, if blistering does not relieve the tumor should be laid open as a ground work is laid for a very obstinate & disagreable Swelling which will neither yield to time nor Medicines & must therefore be attacked locally. 1745. As in the other Genus so here also New dispositions may be taken on by the parts affected which it may be difficult to distinguish from the Venereal disposition, & therefore may render it difficult to determine when the cure of the Venereal Virus is effected. 1746. To these new dispositions Mercury may be a poison increasing instead of lessening the evil. Many of them will take on a Cancerous ☿ 1746. A poor Woman in St. James’s Workhouse had Venereal complaints for which she underwent a course of Mercury, she had ulceration in her face which took on a new disposition seemingly Cancerous. Hemlock was applied internally & externally & she got well after having lost part of her Nose & part of her right cheek, in 12 months she relapsed. Hemlock & other means were tried in vain for she died of the complaint. ♃. 1747. One drachm of Opium dissolved in of water makes a very useful application to Venereal Ulcer. – ♀. 1749. Mr. Hunter has given powder of Sarsaparilla mixed with some farinaceous substances made into a pudding, that the patient might take it in very large doses. ♄. 1750. A Young Man had Venereal Eruptions & Ulcers in different parts of his body, under the Armpits on his Thighs. Scrotum &ca. some even of the size of a half penny a poultice of Gum Guaiacum Was applied to the right armpit & a poultice of Sarsaparilla To the left, removed every day, & continued for a fortnight, the sores in the right Armpit were cured, those in the left rather worse, left off the Sarsaparilla & applied the Guaiacum to the left which then healed in a fortnight. Gum Guaiacum ʒss joined with Opium was also given 3 times a day, by which means all the eruptions disappeared in a Month, he was allowed to stay in the Hospital 2 or 3 Weeks, after this seeming cure at the end of which time Eruptions again appeared 142 appearance. ☿. 1747. Ulcers in the mouth & throat often arise during the use of Mercury, these should be distinguished from Venereal Ulcers and treated with Bark, or Opium as Gargles. ♃. 1748. In some persons the long use of Mercury is followed by General debility of the constitution with all its effects as profuse sweatings an inclination to Hectic &ca. In this case the general strengthning plan is to be pursued Bark is useful but is no specific, Scrophula seems to have something to do in the present Case & this is rendered. the more probable by the disposition giving way 1749. Sarsaparilla has no power over the Venereal Virus, it is however very useful & seemingly specific, for many of the new dispositions taking place after the virus is destroyed. It may be of use in preventing the formation of [matter] such disposition & may be exhibited with Mercury. It is best taken in substance & in large doses or its Extract may be given. ♀. 1750. Guaiacum has some specific powers over the Venereal disease; how far these powers extend is not ascertained. We can however place no dependance on this remedy in serious Cases. Mercury is the only true & [useful] universal Specific, on it alone can we depend for it will cure in despight of every unfavourable concomitant circumstance, as irregularity in the patient, intemperance, Climate &ca. ♄ 1751. Hemlock is frequently of Utility in many of the new dispositions which form during or after the course of the Venereal disease Recourse was again had to the Guaiacum, that it had lost its powers. Mercury cured him. this shews that Guaiacum has some specific powers, though weak ones over the venereal disease. Mercury properly applied is the only true Specific. Mr. Hunter does not object to his Patients indulging in the usual diet or taking his usual Exercise, he may take the Sports of the Field by day & his Bottle of Wine at Night. 143. especially in such as from their appearance give cause to suspect cancer. 1752. A salivation will often go on from habit long after the Mercury is Eliminated from the System, it will sometimes remain for Months, though this is now rarely known to be the case, as the Mercury is seldom given in such manner as to produce violent Secretions by the salivary Glands, it is to be considered as a Gleet of those parts. 1753. Gargles prepared with peruvian Bark, Gargles of Opium, Sea bathing & good Air are beneficial. Dr. Mead used to recommend Tincture of Cantharides which may be tried. 1754. Sometimes the Alveolar processes of the teeth becoming [loose] diseased may be a cause of keeping up the spitting when this happens we cannot hope for a Cure until exfoliation has taken place. 1755. Prevention of the Venereal disease is effected by Applications Previous to or immediately after exposure to infection. 1756. Applications to be used previous to exposure are such substances as will not suffer the Venereal matter to come in contact with the Skin. 1757. Venereal matter being immiscible with oil, the part Exposed may be depended by anointing it with the most viscid Oil that can be conveniently had. 1758 Means to be employed after exposure are caustic Alkali properly diluted which will dissolve the Venereal Matter, or Goulards  144. – Extract of Lead which is a powerful coagulater of Animal juices & will coagulate the virus a Solution of Corrosive sublimate is also used & said to have succeeded when other means have been found inefficacious. – Finis.  145 Proposals for the recovery of drowned Persons. By Mr. J. Hunter Philosophical Transactions Vol: 66th. London 4to. 1st. Whilst an animal retains the powers though deprived of the motions of Life, the cause of that privation may be frequently removed; but when the powers of Life are destroyed, the action ceases to be recoverable. 2nd. Part of the living principle is in the Blood. 3d. The Stomach Sympathizes with every part of the Animal & every part with the Stomach, Cordials by their action on the Stomach excite universal motion & there is also a peculiar Sympathy between the heart & Lungs, many poisons, steams of phlogiston & Charcoal &ca. received into the Lungs the hearts motion instantly ceases & that much sooner than if the trachea had been tyed. From experiments anything salutary applied to the Lungs will restore the hearts action after it has been at rest for some time. Violent deaths are divided into 3 kinds. 1st. When only a stop is put to the action of Life in the Animal, not however by any irreparable injury to a Vital part. If this action be not restored in a certain time it will be irrecoverably lost. 2d. When an injury is done to a vital part. 3d. To when absolute death instantly takes place in every part as  146. is the case in Strokes of Lightening. Which of these three Deaths does the case of Drowning come under? probably the first. Here it first affects Respiration, then the Hearts motion. – Restore Respiration & Cure drowning. New born infants have been animated by blowing into their Lungs. Put the juice of Hone Radish, peppermint, Spt. Coma. Cervi into the Stomach & Anus. Avoid Phlebotomy & the fumes of Tobacco. Mr. Hunter has invented a Bellows to exhaust as well as to fill the Lungs & also a Syringe. –       INDEX Aphorism Page A Aneurism spurious---872---4 Aneurism---878---4 Abscesses---893---8 ___unsound---1123---46 B Bubo---1610---120 C Corns---944---18 Chilblains---946---18 Carbuncle---984---23 Coopers Glands obstructions of in Women---1120---45 Cancer---1157---50 Chordee---1327---75 ___cure of---1387---82 Chancre---1539---108 F Fistula---7090---40 ___in Ano---1107---43 ___in Perineo---1109,1475---43,97. ___Lachrymalis---1113---44 ___of the Parotid Gland---1117---45 ___communicating with Joints---1111---44 Fungated Sore---1198---55 G Gonorrhea---1310---72 ___cure---1362---79 H Hæmorrhages---848---1 I Indolence & Irritability---918---14 Itch---1230---59 Infection of the second order of Parts---1652---126 M Mercury mode of exhibiting---1680---130 ___ulcers in the mouth from---1747---142 N Nodes---1737---140 P Poisons---1130---47 Prostate enlarged---1533---107 Phymosis & Paraphymosis---1553---111 Prevention---1755---143 S Scrophula---1017---29 ___cure---1051---35 Seminal Weakness---1477---97 Salivation---1752---143 Strictures---1490---99 T Tendons ruptured---912---11 Tumors---955---19 Testicle swelling of---1332---75 ___cure---1394---84 Tetanus---996---25 U Urethra obstructions of---1432---89 ___strictures of---1435---90 ___cure---1490---99 V Veins Varicose---945---18 Venereal disease---1240---61 W Wounds---888---8 Warts---1589---108                  Thomas Windsor Manchester ?-1745 (1845) LECTURES on the RATIONALE of SURGERY by JOHN HUNTER. VOL. 2.  1 Volume. 2nd. – Part. 2nd. (continued) Aphorism 848th. Hemorrhages. may depend on various causes either a Wound made in an Artery by external force, or by such a state of weakness being produced by a disease in the Coats of the Arteries themselves, as to render them incapable of withstanding the impetus of the blood. 849. When an Artery in health is divided there is a natural power of contractility in its Coats, that disposes its orifice to Close & prevent the future escape of Blood. 850. This contractile power is stronger in inverse proportion to the largeness of the Artery, in the larger Vessels it is not Equal to the business of restraining the Hemorrhage, & therefore renders the assistance of Art necessary. 851. Another natural cause of the restraining of an Hemorrhage & wch. we call the accidental, is the plugging up the mouth of the Vessel by coagulate Lymph. 852. Art is employed in restraining Hemorrhages in three ways 1st by increasing the Contractile power of the Arteries. 2nd by increasing the Coagulation & thus plugging up the Mouth. of the Vessel 3rd. 🜹 855. It is evident the artificial retardment of the motion of the Blood commonly takes place when the bleeding is from / an Extremity We have sufficient testimonies of the use of the retardment of the bloods motion in the stopping of Hemorrhage, when we see people faint who have suffered great losses of Blood, & that on the Syncope taking place the hemorrhage commonly ceases. + 857. If the actual Cautery is used, the Iron should be very thick and heated nearly to a red heat. 2 3rd by Compression of the sides of the Artery together near its mouth & thus rendering it impervious to blood. 853: The first intention (852.1.) we fulfill by the use of Stimulants & of these the most powerful is Oil of Turpentine. 854. The second intention (852.2) by such remedies as will forward the natural & produce an artificial Coagulation of the Animal Juices. 855. This Coagulation will be forwarded by the retardment of the Blood motion. 🜹. - 856. The substances forwarding the formation of the Coagulum, are spungy bodies, as lint, fur, agaric, flower, Cobwebs. &ca. – 857. The means productive of an Artificial Coagulation of the Animal Juices, are the application of matter which act chemically upon them, such will be the actual Cautery, concentrated Acids, boiling Water &ca. +. 858. The mechanical means of stopping Hemorrhage is by compression this is made by enclosing the Vessel near its Orifice in a ligature applied by the use either of the Tenaculum of needle. 859. The Tenaculum should only be used when we have sound & unossified Arteries, & those situated not in the Centre of a muscle but loose in the interstices of Muscles & in the Cellular membrane. 860. The use of the needle is to be preferred, where there is reason to suspect the Artery is not quite sound when it is situated in the middle of a Muscle. 861. When the Needle is used, a considerable portion of the circumjacent parts as muscular flesh, cellular Substance, Nerves &ca. is commonly included together with the Artery in the ligature which gives an additional support to the Artery when weak or suspected to be unsound. 🜹. 864. Of this the Millers case, whose Arm was torn off by the Wheel of a Mill at the Articulation with the Scapula is an ample testimony (see Cheselden’s Anatomy) So also the Case of a person sometime ago in the Middlesex Hospital. The Farmers are sensible of this for they divide the funis of the Calves & Lambs by tearing it in two. + 865. Of this Mr. Hunter is satisfied having several times tied the Nerves with the Artery & no ill consequence supervened. ☿ 866. In St. Georges Hospital a Boys thigh was Amputated for a disease of the Knee Joint, by repeated bleedings from the Stump which always stopped spontaneously the Patient was so much reduced, that at last he Sunk, upon examining the Limb after death, the Artery appeared sound, until within an inch of its termination in the Extremity of the Stump, where it was black & had lost its Elasticity. The Bleeding anew happens more frequently in the Radial or Ulnar Arteries than any other. – 3 862. The degree of tightness to which the ligature is to be drawn will be in proportion to the size of the Artery, & the quantity of surrounding parts enclosed in the ligature. 863. The ligature should be made thicker than is commonly done that a larger extent of surface of the Artery may be compressed. 864. An accidental method of stopping Hemorrhages is tearing the Vessel asunder, for in contused Wounds the bleeding of a Vessel is less than in incised. 🜹. 865. The disagreable & sometimes fatal Symptoms following the use of the needle, where it is necessary to compress the sides of an Artery together, do not arise from irritation produced by a Nerve being enclosed in a Ligature, but from some peculiarity of constitution. +. 866. It sometimes happens that after tying an Artery consequent on an Accident or Operation, that the Artery shall bleed afresh at some distant time, as one, two, or three days, or even when granulation is going on, this mostly happens in the large Vessels. ☿. 867. When it arises within two or three days it commonly is owing to some circumstances attending the Operation, as tying the ligature too loosely or too tight. 868. When this is not the Case ( ) & when Bleeding happens after Granulation has taken place it may be attributed to a diseased state of the Artery. 869. The Artery should be laid bare (if diseased) until the sound part comes in view, & there a ligature should be passed. 870. In some patients when granulation has taken place after a wound or a considerable surface is stripped of its integuments, (as after Amputation Φ 876 The thickening of the Cellular Substance wound the Artery & its being lined with tough Coagulum will make this Complaint resemble the real Aneurism, but in the latter the Coats of the Artery are always forming the Cyst in the former the Coats of the Artery are never dilated. 4 Amputation of a thigh) there will be a profuse bleeding from every point of the exposed surface. 871. This will occur in patients who are extremely debilitated & whose Vessels (even the smallest) want the power of contracting. 872. The term spurious Aneurism has been improperly applied to an Extravasation of Blood in the Cellular substance, which blood has escaped from a puncture through the coats of an Artery. 873. This may be either recent, or not recent. In both those will in general be necessity for performing the operation of the Aneurism. 874. In this Case as there is a lateral Wound in the Artery, the escape of the Blood will continue to go on because the Artery cannot contract itself longitudinally. & was it to contract circularly, There would be an obliteration. 875. Therefore there will be no natural Cure for the Accident, it must either kill, or the operation be performed. 876. In the non recent Spurious Aneurism the Wound in the Skin is healed, the Cellular substance has thickened & with some Coagulum of Blood formed a Cyst, into which Blood from the unclosed Wound in the Artery is continually effused, this must ultimately burst & destroy the Patient unless the Operation for the Aneurism is previously performed. Φ. 877. To this state ( ) the recent Spurious Aneurism must always proceed, unless it either destroys the Patient or the Operation is specially performed. 878. The Arteries are subject to two diseases. Ossification & weakness the latter will be the predisponent cause of a dilatation of the Coats ♁ 883. This has been supposed to happen & has been called the mixed Aneurism, but from Experiments similar to the following the Conclusion is to be made. Mr. Hunter laid bare the Carotid artery of a Dog, and afterwards thinned it with a knife even to transparency, no dilatation of the Vessel ensued, three weeks afterwards the animal was killed, & the Artery on which the experiment was made was not found the least dilated but thickened by the adhesive inflammation & the adhesion of the adjacent Cellular Substance. 884. The dilatation if an Aneurism takes place In the Arch of the Aorta will be upwards. In the Abdomen---Forwards. In the Carotid Artery---outwards. In the Axilla---downwards. In the Ham---backwards. In the Groin---forwards. In the Leg---uncertain. Hence absorption of bone so often arises from its making pressure against them. The Artery will continue to swell in that direction in which it first begins to tumefy & the lower part will be dilated more than the upper. 🜔^ 885. It may suffocate by pressing on the trachea, if the Carotid or the Aorta is the seat of the disease. Its pressure on the returning vessels may occasion dropsy &ca. if the Aorta in the abdomen is the diseased part it may burst inwardly, or if it produces 5 of an Artery to which alone the name of Aneurism should be given 879. The immediate cause of Aneurism is a disparity between the force of the bloods motion, & the powers of resistance, in the Artery. 880. Accident (as some violent Exertion of muscular power) may give rise to it, but it most commonly depends entirely upon some diseased state of the Coats of the Artery. 881. This is more probable because it is not unusual to find several Aneurisms in the same person from which it should, appear that the disease is a weakness & disposition to dilatation in the Arterial System. 882. Moreover the common seat of the Aneurism is in the large Arteries whose seats are less muscular than those of the smaller 883 An Aneurism we believe never takes place from a rupture or wound of some of the Coats of an Artery & a dilatation of the rest. ♁ 884. The dilatation of the Artery will always be to that side on which there is the least resistance from the surrounding parts if there is no resistance from the surrounding parts of either side it will then be in that direction in which the blood is most forcibly thrown, if these circumstances are equal on all sides, it is then uncertain in what direction the dilatation will be made. 885. The natural tendency of the disease is to destroy life, this is effected either by the tumor bursting & the Patient dying of the Hemorrhage, or by its enlargement so as to press upon some parts Essential to Life, & hinder their functions. 🜔^ 886. When the Operation for the Aneurism is proper, it should absorption of the Bones of the Spine it may swell outwardly & at length the Skin inflaming & sloughing & the Coats of the Artery undergoing the same change the Coagulum gives way & a fatal Hemorrhage Ensues. ♂ 887. By the first rule, all the Aneurisms of internal parts will of Course be excluded from the Operation. As to rule 2d. the only Arteries admitting of a question will be the femoral & the brachial, but success here is only to be doubted of, yet by no means improbable the other Arteries are either out of the way of operation or have. In the Aneurism of the Interosscal, Anterior & Posterior Tibial Arteries the operation cannot take place from the difficulty of taking up these Vessels, therefore recourse must be had to Amputation & also when a diseased state of the bones &ca. in any part is induced by a pressure of the Tumor. On the whole, this Aphorism will allow of the Operation if Rules 3. 4. 5 permit it in the following Arteries. In the Carotid above the Sternum. In any of the branches of the external Carotid. In the Subclavian when it has passed the Scalenic Muscle & in any of its branches. In the Crural after it has given off the Profundus, & In the Popliteal. Directions for the Operation. 1st. When the Tourniquet is applied, that is if possible between the Aneurism & the Heart, make a longitudinal Incision in the Course of 6 always be performed as early as possible, this rule will also extend to spurious Aneurism. 887. The Operation is proper 1st. When the dilated Artery can be included between the ligatures. 2nd. When there is a probability that the parts to whose support the Artery in question was subservient heretofore, will be still Nourished & supplied with blood. 3d. When it has done no mischief to surrounding. Parts as bones &ca. – 4th. Where it is distinct & Circumscribed, not connected with parts which may be incurable when Exposed, as bones &ca. 5th. When there is distinct Pulsation in the Tumor. 6th. When it is probable that there is no other Aneurism between it & the Heart. ♂. 888. Note continued. the Artery through the integuments & to a greater extent than that of the tumor, then cut it into the Aneurism & scoop out the Coagulable blood as well as Evacuate that which is fluid. The inferior Orifice will be most readily discovered as it will throw out some little blood of a venous colour, to discover the Superior the Tourniquet should be slackened. Tye the Artery at least one inch above the superior Orifice, the same caution is not necessary respecting the inferior. When the Tourniquet cannot be applied, the ligature may be passed both above and below the Tumor, before the incision into is [is] made, it is then to be laid open throughout its Extent. The Sac need not be cut but left to slough away; the dark colour of the Blood issuing from the inferior Orifice is caused by the Bloods taking & slow & retrograde motion which is explained by the annexed diagram. For Blood by having a slow motion or by stagnating will even in the Arteries acquire a dark hue, the older the Aneurism the more will the Coagulum approach to a brown Colour & the more recent the nearer will it be to the natural colour of Arterial blood. When an Aneurism forms, the Cellular substance thickens round it but being inelastic readily yields to distention. Aneurismal Cases. 1 A Young Man had a pain in the Calf of his Leg for two Years at length he received a blow on the Ham, after which a pulsation & Swelling soon appeared. The Operation was performed, every thing went on well to the 5th. day, when the Artery burst either from the upper ligature being applied too tight or too low, before the Tourniquet could be applied he lost as much blood as Occasioned his death. Upon dissection the Artery was found perfectly sound above the part where the ligature was made. 2 An Aneurism of the Crural Artery in the middle of the Thigh extended 5 or 6 Inches in length the Tumor being Oblong, the Operation was performed & the Patient in a short time recovered. 3 Mr. Martin had an Aneurism in the Popliteal Artery, the Operation was performed & he recovered the use of his Limb so perfectly as to be able to dance &ca. Remarks on the propriety of operating for the Aneurism of the 7 (Note continued.) Popliteal Artery in preference to Amputation. Whatever Objections are made to the Operation, the same must hold good against Amputation of the Limb. That one, so much insisted on of the disease being most commonly a disease of the Arterial System & not of the part in question only, if true militates equally against Amputation as against the Operation. If there is not only an Aneurism in the Ham, but another higher up as in the Femoral Artery, or in the Aorta, it is evident that Amputation of the Limb does not give the Patient a greater chance for his Life, than tying the Artery, but it not uncommonly, perhaps most commonly it happens, that whatever may be the general disposition of the Arterial System, yet the Actual dilatation shall only have taken place in one part, now if tying up & removing the diseased part can be accomplished the patient still retaining the use of his Limb, it is certain that the Operation must be highly preferable to Amputation, as the latter though it may preserve the patients life yet leaves him imperfect & mutilated. – 🜖 890 In treating of Gun shot Wounds it is observed that Contused & lacerated Wounds will not heal without Suppuration In wounds penetrating Cavities, if the Wound is made to heal without Inflammation & Suppuration it is then similar to any other simple Wound, But if the Suppurative Inflammation is to take place, it will be requisite to advert to the doctrine of Exposure of Cavities & of penetrating Gunshot Wounds, it must be evident also that if Extraneous bodies are introduced into the Cavity either by accident or intention & not removed the suppurative Inflammation will be necessary. 🜔🜹 891 A Poultice answers this description & the best manner of Preparing it, is to pour boiling Water into Linseed Meal & add as much oil or hogs lard as will keep it from drying, but Poultices cannot universally be had recourse to, & in lieu of them we use Lint dipped in Olive Oil. 8 888. In our treatment of Fresh Wounds it is necessary to consider. 1st. The nature of the part wounded 2nd. The management of an Hemorrhage should one arise 3rd. When the 1st. or 2nd. mode of union, is to be desired, or whether Suppuration is indicated. – 2 889. If the united parts are to be divided by the first mode of union, the indication will be bring them into Contact & retain them so This will be fulfilled by means of bandage & in some cases Sutures. 890. But when a part is to inflame & suppurate it is better to defer the application of Bandage, until after Inflammation has subsided. 891. Whenever a Wound is to go through either the adhesive or the suppurative inflammation, it is generally improper to use applications which will adhere to the wounded surface, become dry & which cannot be removed at the pleasure of the Surgeon, hence The use of dry Lint is extreemly improper. But if the substance to be applied is somewhat that is soft & moist, has no continuity of parts & which can with ease be removed on any Occasions it can do no injury. 🜔🜹 892. When a wound [is to go through either the adhesive] has suppurated & granulations are arising, if they do not readily Contract so as by their contraction to forward the formation of a Cicatrix it will be proper to employ the pressure of a bandage. 893. Abscess will be either Sound or Unsound. By the former we understand Abscess arising in healthy constitutions, or from some Specific disease. 894. The nature & treatment of sound Abscesses will be readily  9 understood from reconsidering the doctrines of the adhesive & suppurative Inflammation. 895. The Evacuations of the Matter contained in an Abscess is either obtained by the Abscess bursting of itself or by an Artificial Opening. Abscesses may be suffered to burst unless some particular circumstances require an Artificial opening. 896. The circumstances most generally requiring an artificial Opening is the danger arising from a long retention of the matter. 897. All Abscesses of the Abdomen Thorax, Brain, Eye & Joints should be opened Artificially & early. 898. When an Abscess is opened Artificially it will in general be necessary that the opening be large to prevent the future inconveniency of a Fistula. – 899. When an incision is made into an abscess, the wound should be so dressed as to prevent the reunion of the incised parts by the first or second mode of Union. 900. There are two methods of opening an Abscess Viz. a by Caustic b by Incision. Where no particular Circumstances (as the seat of the Abscess) forbid, the choice may be left to the patient. 901. Another circumstance indicating the Artificial opening of an abscess will be, its being of such a magnitude that the natural opening will not be sufficient for the discharge of the matter. 902. In determining the Size of our opening it is necessary to have regard to the present distension & future contraction of the ☽︎. 902. This Note is added to explain the text as I am not clear Whether I have there properly conveyed Mr. J. Hunters Ideas. “If the magnitude of the Abscess has produced only simple distention without considerable absorption (ulcerative or interstitial) of the parts in which it is seated it is not necessary to make a very large Opening, because when the distending fluid is removed the parts will immediately contract themselves, & discovering their original Situation the cavity will become obliterated, but if the Cavity has been made by ulceration & absorption of the parts in which the matter is lodged & not by simple distension of the surrounding parts then it will be necessary to make a larger & free Opening to prevent the inconveniency of a succeeding Fistula, because here the parts cannot Contract themselves to Obliteration of the Cavity but the cure must be Accomplished by Granulations. (See Fistula). 10 integuments. ☽︎. 903. The living principle will always be uneasy under extensive exposure & will therefore be powerfully excited to action. hence large openings in Abscesses, where the Contraction of the parts is not sufficient for the obliteration of the Cavity & consequently for the Cure, are always useful, because they are the means of exciting the Process of restoration. 904. Abscesses may be free from any specific disease, may arise in an healthy constitution, & yet certain Circumstances may retard their healing. 905. These may be. 1st. Peculiarities of situation 2nd The Stimulus of some deep seated foreign body, as a Ball, Splinter of Bone &ca. – The first causes of backwardness to heal we cannot alter. The second causes we must wait for the removal of, before we can hope for the healing of the Abscess. 906. When sores of any kind have a disposition to healing, the Surgeon has little to do, except to prevent any obstacles arising that may hinder the process of restoration. 907. If dry Lint is used to healing Sores it should be applied so as not to extend quite to their margin, if ointments are used they should be free from Stimulus. 908 – Amongst the Obstacles to the healing of a Sore will be. Intemperance. Neglect of rest, and The Granulations rising too high above the Surface 912. This will be best illustrated by considering the rupture of the [Tendo?] Achilles, it is generally affected when the Muscles of the leg become tired & unfit for voluntary motion as after long continued dancing, & therefore the Muscle will act involuntarily, hence the Cramp, &ca. by this acting very Violently & involuntarily they rupture the Tendon. In doing this the Patient feels little or no Pain in the Part, but seems to receive a blow on the Gastrocnemius Muscles & hears a Noise as of some Elastic body snapping in two. Inflammation &ca, may succeed, the Muscles may be squeezed out & the Ends of the Tendons approximated together & as much as can be retained so, When those Symptoms are removed no inconvenience can arise from suffering the Patient to walk if he himself has courage enough to do so, for there is no danger of the will throwing the Muscle into Action & Merely producing a further seperation of the divided Ends of the Tendon, for the will cannot now act upon the Muscle, but an involuntary action of the muscles may take place during sleep, & this is to be guarded against by a tight bandage round the calf of the Leg & making the Patient wear an high heeled Slipper or Sandal. The Bandage & Sandal are more particularly necessary by night, & whilst the patient sleeps, during the day time their use may Commonly be dispensed with; from the back of the Sandal a piece of Leather is to be Carried & fixed to the bandage or a Leather Strap Placed tight round the Calf. Where the Rupture happens no Bandage should be applied. 11 Surface of the sound Skin. 909. The latter obstacle is to be removed by pressure as that of a bandage, & by touching the Granulations with some Metallic Salt, as Vitriol of Copper, lunar Caustic &ca. – 910. New formed parts being weaker than Original parts, are less able to support the fatigues of the Offices of life than the latter; hence upon a slight stimulus being applied, they readily inflame & if that Inflammation is not removed, the suppurative & ulcerative Stages come on Rapidly, or mortification speedily takes place. 911. The absorption of new formed parts may be either a Ulcerative, or b Intersticial. 912. The Tendons of Muscles are sometimes ruptured & the Accident arises from causes similar to those of the broken Patella, the Muscle being in violent action at the same instant of time, that there is an unconquerable resistance made by the point to which the Tendon is attached. Note continued. The patient will find little Amendment during the first two months, but will after that period generally recover the use of his Limb. Keep the foot nearly at a right Angle with the Leg the Heel a little raised when the patient walks he should turn his Toe outwards & not attempt to bend his Knee. The Ankle & Foot will commonly swell considerably. About three weeks from the accident the roller & slipper may be left off, it may be asked when the Patient may attempt to use his Muscles We answer, whenever he feels a consciousness of a power to use them. Mr. Hunter broke his own Tendo Achilles in dancing, he is not clear, whether Cramp of the Muscles precedes the snapping of the Tendon, but it certainly immediately follows it. 916. The motions of the Shoulder joint are most difficultly restored after any Wound, or considerable injury of that Joint, because to some of them the gravity of the Arm is an obstacle, were it possible to cure a Wound of the shoulder joint with the Arm elevated, then the motion would be as easily restored as those of other Joints. – 12 913. In order to the Cure of this accident, the indications will be. 1st. to place the divided Ends of the Tendons as nearly as possible to their natural situation. 2nd. To take off or prevent Inflammation. 3rd To prevent the involuntary action of the Muscles. 914. It is unnecessary to forbid voluntary action of the Muscle because in the present state it will be no longer subservient to the Will. 915. Should the divided ends of the Tendon not be brought into contact, but remain at some distance asunder, the union will be accomplished by new formed substance & therefore the Tendon be somewhat lengthened the Muscle will however be thereby shortened & its power of contraction lessened, no inconvenience will ultimately take place, for the muscle (as in the Cases of Fractures of the Patella & Olecranon) will acquire new powers of contracting adapted to its necessities. 916. In Wounds connected with Joints, it is necessary to pay great attention to the Motion of the Joint, during the Cure if, there has been loss of substance without great care on the part of the Surgeon rigidity & loss of motion will be the Event. 917. After the Inflammation has entirely subsided, & the Cure is somewhat advanced, the joint should be gradually moved by the Surgeon from time to time, that the irritating matter may be elongated in a manner similar to the elongation of the coagulable Lymph in adhesions between the Lungs & the Pleura. – End of the Second Part.  13 We now come to treat of those Affections of the body which are the objects of Surgery, that may be more properly called diseases, that is, those Affections in which parts have no disposition for restoration, but only a disposition to destruction, & which disposition will continue to exist, until either it has worn itself out, or has destroyed the Patient, or is cured by Art, in short those affections for which there is no natural Cure. Inflammations whether arising spontaneously or from External violence, suppuration &ca. & all accidents (unless so much mischief is done either to a vital part or to the constitution that the functions of the body cannot go on) become themselves the causes of Restoration. These we have already inquired into so far as concerns the principle on which their different Phenomena depend, & have also considered the particular attentions by which we shall facilitate the natural process of healing in wch. in fact little is to be done except removing all the impediments to the natural Cure. But in diseases the present disposition is to be removed & a new one induced in its stead. –  14 It has been shewn that as irritation in health induces disease ( ) so irritating / in disease is to bring back Health. “This Aphorism generally hold good tho’ in some Cases of diseased irritability an objection may be made to it. “After some previous general remarks on indolence we come to particular diseases originating from that Cause. Tumors are those spoken of, but those only which originate from indolence are those meant to be explained.” the definition given of them indeed will apply to swellings from other causes than indolence, as Inflammation &ca. but the subsequent remarks will shew that Mr. Hunter when speaking of Tumors in that place had it only in view to treat of indolent swellings. 918. Diseases or unsound dispositions will be properly divided into the irritable & the indolent, or those in which there is a disposition to too great or too little action. 919. Either of these dispositions will be a hindrance to restitution of health, & must be changed before health can be restored. 920. It is easier in general to increase the disposition of a part to action than to abate it. 921. In the indolent diseased disposition there is neither sufficient power, nor sufficient excitement to action. In the irritable there is too great excitement without corresponding powers. 922. Again in diseased irritability, parts are impatient under any removal from a state of perfection, yet have no disposition to at about the process of restoration. This disposition may be ♀. 929. Caustics are not followed by so speedy or Extensive an Inflammation as the Knife, an incised wound in such circumstances has frequently for its Sequel, an Erysipelatous Inflammation. 15 either Simple or Connected with some specific disease as Syphilis Cancer, &ca. – 923. When simple we must have respect to the principle laid down ( ) but when complicated with some specific disease, both the specific & the irritable disposition require attention. 924 Diseased irritability may be local, or it may be a state of the constitution at large. 925. It appears in general to be passive requiring the application of some stimulus to bring it into action. 926. An encreased [action] degree of sensibility will generally accompany diseased irritability, the living & sensible principle commonly Sympathizing. 927. Inflammations with diseased irritability should not be hurried into suppurations, nor on the contrary should those means be used which lessen their powers, the indication being simply to lessen violence of action, not to diminish Powers. Opium may be properly used in Solution or mixed with emollient Poultices, for preperations of Lead see, ( ). 928 The diseased irritability of the Constitution is lessened by the use of the Bark & those means which encrease the strength. 929. When a suppuration has taken place in parts under this state, if an opening is to be made to discharge the matter, a caustic is to be employed in preference to the Knife, for incision has not here in general such favourable consequences as the other method. ♀. 930. Ulcers have sometimes a diseased irritability & when this ☍ 931. Some Ulcers which shew every sign of the greatest irritability &ca. will have their Symptoms unrelieved & often increased by mild dressings, but will grow easy under the use of the most powerful Stimulants as Ol. Terebinth, but we would first by Poultices with Opium. &ca. – 932 We meet with few constitutions which will not readily take on Inflammation, a Stimulus being applied to any part of the body in which there is no particular local affection, how far constitutional indolence may prevail, we have a proof in Scrophula. – 16 is the case the dressings should in general be of the mildest kind. 931. We cannot a priori always determine what application will assuage the pain & other Symptoms we must therefore change our dressings until we meet with one fulfilling that intention. ☍ 932. The unsound disposition with indolence, or the diseased indolent, may be either an affection of the constitution or of a part, the constitution will rarely be indolent in a great degree. 933. Specific diseases may give rise to or accompany indolence in parts, as the Syphilis, the Scrophula, & sometimes the Gout. 934. The common effect of indolence in parts is a thickening of them. the process of restoration in parts in a state of indolence is very slow. – 935. As the Extent & spreading of disease, in diseased irritable parts is great & rapid, so the disease of parts in a state of indolence is in general very circumscribed & rarely spreads to any considerable extent. 936. The thickning of Swelling of parts morbidly indolent is of 2 kinds Viz. 1st. Intersticial. 2nd Superadded. & Indolent swellings commonly go on to a considerable degree before any knowledge of them is communicated to the mind, But when very far advanced, some dull, heavy pain, with sickness will be produced, &ca. but this probably arises from the distention of the surrounding parts. 937. The Causes of indolent disposition arising in parts are 1st. The long Continued Action of Cold.  17 2nd. Violent actions terminating in weakness. 3 Pressure from Mechanical Causes. Indolence may be also spontaneous, arising without any visible or known cause. 930. The first Species (936) or intersticial thickening, is that in which no new or distinct parts are formed but there is simply a swelling or enlargement of the original Parts, as a Corn varices of Veins &ca. – 939. The Second (936) or diseased indolence with parts superadded is that in which new parts are actually formed distinct from the old. 940. The intention of Cure will be to encrease both actions and powers. In the intersticial thickening, as swelling generally consists in the disposition of Coagulable Lymph in the cellular substance &ca. We endeavour to procure a reabsorption of it, & to this end we employ those means which increase the action of the Absorbents as Mercury, pressure applied so as to stimulate fumigations &ca.. Care however is necessary not to excite the parts to greater action than they can support least mortification ensue. 941. When those thickenings cannot be removed by absorption (940) stimulating applications may induce a Cure, by exciting the Suppurative Inflammation in them, however their suppuration is with difficulty brought about, & when it has taken place, & Ulceration followed it, the Cure is not always easily obtained. 942. Abscesses have been divided into sound & unsound, of ∇ 944. The cure of Corns consists in obtaining a seperation from the cuticle, which may be brought about rather by leaving off the pressure, soaking the part often in warm water & keeping it always moist & defended by some proper Plaister, or by removing it at once, when a corn has been of long standing it is often difficult to remove by Excision, as a wound of the parts underneath is sometimes followed by Inflammation, & even Gangrene, but we may attempt it by removing the Pressure, soaking the part long in warm water, & then applying a blister to obtain a seperation of the Cuticle from the Cutis. 18 Sound Abscess an account has already been given, of those wch. are unsound, & which have a disposition to indolence, it will be better to speak when their common Cause & consequences. Scrophula & Fistula come under consideration. 943. Ulcers or Sores may have an indolent disposition and thence a backwardness to heal, when simple indolence is the cause we have recourse to those means which will excite the parts to action, as Turpentine, Balsams &ca. 944. Corns are an instance of indolence from pressure, the Cuticle thickens from the stimulus of necessity, & as it acquires thickness presses on the Skin & produces uneasiness & pain. ∇. 945 Various Veins are also an indolent thickening from pressure if the disease is not too extensive or the operation too hazardous, they may be dissected out, & the inconveniency thus removed. 946 Chilblains may be given as an instance of indolent thickening from cold. Though they have in them especially at first somewhat of an increased irritability. The constitutions most disposed to this kind of indolent thickening are the delicate & such as have but small Powers of generating heat. 947. Schirrus of a Gland may be offered as an Example of Violent action terminating in weakness, & acting as the Cause of an indolent thickening. 948. Of the spontaneous indolence ( ) proofs may be given, in the swelling of the Legs, so common in Barbadoes & sometimes 🜔 950. Of this kind are those swellings of the inguinal Glands which have been so often mistaken for venereal & for which people have even been salivated. Sometimes these enlarged Glands are so situated, that extirpation is difficult & to be undertaken with the greatest caution, this will be spoken to, when we come to Tumors & Scrophula to which two Articles they belong. ☽︎☉ 953. When we speak of indolent swellings being diffused we only speak as comparing them to Tumors, for indolent thickenings compared to swellings of parts from other causes are generally circumscribed. – 19 seen in this Country, & in the swelling of the Lymphatic Glands 949. Some indolent Swellings may require extirpation, as in encreasing their action in order to suppuration, they may be made to turn out Cancerous. 950. Lymphatic Glands may slowly, gradually & indolently tumify until they become of a size which may render extirpation necessary from their making pressure on some important part & disturbing its Œconemy, or from their occasioning deformity. 🜔 951. Wherever a cure can be obtained the indication will be the same, either to encrease the action of the absorbents, or to remove the part entirely. 952. In all indolent thicknings we should endeavour to ascertain whether they arise from the constitution or whether they are purely local (see Constitution local & original local). 953. Indolent swellings of parts will either be circumscribed or diffused, by the former we understand a Tumor (954, the latter we mean when we speak of thicknings of parts. ☽︎☉ 954. By the Term Tumor we mean a circumscribed substance produced by disease & differing in its nature & consistence from the surrounding parts. 955. Tumors may be divided into a. the Solid b. the Encysted. 956. The Solid (956.a.) may be subdivided into three Vizt. 1. The Intesticial.  20 2 The Superadded, or new formal Substances. 3 The mixed. 957 The 1st. or Intesticial (956) belongs to Scrophula. The 2d. or Superadded are entirely new formed substances, they take their rise from some fixed point from which they grow, as from a root which will be of different Sizes, they are perfectly circumscribed, are generally more detached than a Lymphatic Gland & they have no Coat. The 3d. or mixed consists of these Tumors called Wens. & Schirri, in which there is a mixture both of enlarged & original & of new formed Parts. 958. These differ very much in their appearance & consistence being only fatty Tumors, sometimes almost cartilaginous, when cut through they resemble somewhat a divided Lemon. 959. The 2d & 3d. Species will rarely if ever admit of any other treatment in order to a cure than extirpation. 960. Previous to the extirpation of any Tumor it is necessary that we enquire. 1st. What part it adheres to, or is connected with & its situation 2d. The manner in which it ought to be extirpated. 3d. Whether it is necessary to remove any of the surrounding parts with it. 961. The second Species ( ) may be of different degrees of hardness, may grow from a bone & be bony, or from a Tendon & be of a ligamentous firmness. 962. They may also be adherent to the Skin, to a Muscle &ca. & they 967. A Young Lady had a Tumor situated on the lower Jaw it became hard & almost bony. Mr. Hunter pared it away even to the Surface of the Jaw bone, but it arose again, when it had been pared off a second time & the Maxilla Cauterized the patient got well, the Tumor consisted of a thin Plate of bone forming a shell which contained a cartilaginous substance. A Young Woman had a Cartilaginous excrescence growing from the upper Jaw after the extraction of a Tooth, they were removed but grew again, after being a second time extirpated the Patient got well, these seem to occur most frequently in the Jaw bone or on the Tibia. In the 3d or mixed Calcareous Earth is sometimes deposited, they not unusually fall into a kind of suppuration without the surrounding part being affected, in removing them great caution is sometimes required. Mr. Hunter has dissected them off the temporal [Muscle] and Carotid Arteries & once laid the Trachea itself bare. 21 may be either superficial or deep seated. 963. The third may be loose under the Skin, or they may adhere to the Skin, they may be situated superficially or deep, upon Muscles, a Bone, or a large Blood Vessel &ca.. 964. If the surrounding parts are not diseased, they may be suffered to remain, they must be removed as far as the disease extends, for it must be a rule to remove the whole of the disease. 965. If a Tumor is loose & does not adhere to the Skin a longitudinal or crucial Incision, according as it is large or small, deep seated or superficial may be sufficient & then the Tumor may be raised from its bed & removed. 966. But if it is adherent to the Skin then a portion of the Integuments must also be removed, at least as large as the adhesion extends. 967. If it springs from a root originating from above, it is to be removed by the Saw, Pincers or Chisel, in this Case it may also be necessary to Cauterize that part of the Bone from which it Sprang. 968. If it is situated on any large Vessel &ca, great care will be required in the dissection of from its seat (see Note on 967). 969. If it be only a fatty Tumor not adhering & of a small Size a simple incision down to it will be found sufficient & then the Surgeon may squeeze it from its bed, with his Fingers. 970 When the third or mixed, very much enlarges they are not unfrequently productive of pain, however it does not prove acute, but is of a dull heavy kind & it depends on pressure upon parts more sensible. The Stomach sympathizes with the affection & ☉ 978. Hydatids. It is difficult to explain the manner in wch. these are formed, or to determine which are formed first the Exterior or interior ones. – Are they not Animals of the Polypi kind? – Remarks on particular Hydatids. Hydatids of the Brain are sometimes found & usually on the Plexus Choroides, these occasion no symptom peculiar to themselves & from their situation can admit of no Cure. Uterus & Ovaria. The fluid contained within the Hydatids found in those places is sometimes of a gelatinous nature, they are more detaches at first than afterwards, sometimes encrease to an enormous size occupying greatest part of the abdominal Cavity, & is then called encysted dropsy. It is to be distinguished from Ascites by the manner of attack, the Patient first feels a weight & swelling on one side, which as it grows larger rolls about, until at length encreasing gradually in size, it becomes fixed, & then the abdomen swells regularly & gradually, the health of the Patient is often little affected by it tapping is the Palliative Cure, & should be done with a large Trochar least the fluid be gelatinous, when large they will adhere to the Parieties of the Abdomen & then the operation is safer than at any other time, they are often made up of a number of cells, so that sometimes a Small quantity of fluid is only discharged by one Tapping, as this disease will certainly kill in the end, if it can be ascertained early, it would perhaps be right to make an incision through the whole length of the Tumor & Extirpate it entirely, Electricity has seemed 22 Sickness is not an unusual circumstance. 971. As is the pain so likewise is the Inflammation when it arises, that of the surrounding parts, these however are seldom much thickened. 972. As to endeavouring to induce in these Tumors the suppurative Inflammation, the Opinion given ( ) will now be applicable. 973. The encysted Tumors are substances contained in a coat wch. is either natural or acquired. 974. The natural are the Hydrocele; Dropsy of the Ovaria, Pericardium, Saccule Mucosi &ca. in which the contents are enclosed in a natural bag. 975. The contents of Encysted Tumors whose Tunic is acquired will be various in their consistence & natural Hydatids form a considerable Class of these Tumors. 976. Hydatids are collections of watry fluid enclosed in an adventitious bag, we do not know the cause, nature, or manner of their formation. 977. Every part of the body where there is cellular Substance, becomes the seat of Hydatids, but more commonly the Plexus Choroides of the Brain, Tunica Vaginalis of the Testicles forming a spurious kind of Hydrocele ( ). 978 They are of different Sizes, as they enlarge their Coats, thicken & become stronger, their Coats are but little Vascular, sometimes one large Hydatid will contain several smaller ones, one within another, they are often found in the Uterus, Kidnies, Liver, Thyroid Gland, Lungs &ca. but how ☉ of late to have been of very great service to one patient affected with this disease. Hydatids in the Kidnies. – Here they are generally situated between the External & Internall Lamella of the proper tunic of the Viscus, & are not out of the reach of relief. In the Liver. – They are most commonly found in the Substance sometimes they are discharged Externally, the bags making their way to the Peritoneum adhering to it. Inflammation & Suppuration coming on, the integuments ulcerate & the Hydatids are discharged. Mr. Hunter on opening a Woman found a great number of them enclosed in one common bag. In the Lungs. Sometimes they make their way into the Trachea & are coughed up. In the Thyroid Gland. They may become troublesome by impeding deglutition. They are found in the Cellular Substance in different parts of the Body. Especially in the neck & about the lips of Woman. – 🜔v 982. In this manner we suppose hair is formed which is found in tumors of the Ovaria. Mr. Hunter Once found an encysted tumor in a sheep, which contained a Ball of Wool, now it is probable this was thrown off from the interior surface of that tumor on which it had formerly grown. – 23 formed is unknown. 979. As to the Cure of Encysted tumors we can do little unless we can either procure a discharge of the contents & an obliteration of the Cavity of the Cyst, or an entire removal of the whole. 980. Tumors mat appear in parts whose they was not formed but into which they have made their way from some deeper part This Circumstance the Surgeon should consider when he is about to extirpate a Tumor. 981. If the Surgeon is not attentive to this circumstance he may be deceived, & operate ineffectually only removing a superficial appearance of disease & neglecting the deep seated cause of it & when probably some other tumor arising has driven the first into its present situation. 982. Some encysted Tumors are found to contain a quantity of hair the internal surface of these has taken on the natural disposition of the Cutis & Cuticle & thus given Room for the growth of hair. 🜔v. 983. The Carbuncle as to its ultimate Effect might have been classed with Mortification, as it produces a considerable sloughing of soft parts, but some characteristic appearances attend it, which would shew it to be a distinct disease & of a specific nature. 984 The predisposing Causes we cannot easily ascertain, It cannot be supposed to be owing to weakness as in general it arises not far from the source of the Circulation, & it does not commonly arise in weak parts, or in weak habits, its seat is commonly the  24 posterior part of the body, as the hinder part of the Neck, the Back &ca. 985. It begins with a considerable inflammation of the Skin approaching nearer the Erysipelatous than any other, the Skin is somewhat tumid but not prominent the part has a doughy feel. For a short time a pimple Arises, the Inflammation spreads rapidly and widely, & the Cellular Membrane to a considerable Extent, Mortifies; the Skin & Muscles still retaining their Life. 986. The Skin above has pimples which now Ulcerate, forming large holes, through which the sloughs of the cellular Membrane are thrown off, & as they come away leave large chasms which are loosely covered by the Skin, which is flaccid & hanging inwards, sometimes the matter discharges itself through an infinite Number of small holes. 987. The disease though it has its Progress chiefly in the Cellular membrane, seems to begin in the Skin, & the matter generated seems of a specific nature, which contrary to the course of all other matter tends inwards, & burrows in the cellular membrane, which wants power to resist its spreading, from a want of the adhesive Inflammation. 988. Should not free openings be made in the Infancy of the disease to give free Exit to the matter, & to prevent its spreading & diffusing itself through the Cellular Membrane. 989. The loose Skin remaining after the coming away of the sloughs of Cellular Substance should not be removed, as it will commonly in the end unite with the subjacent parts, & thus 🜔^ 995. (see Lord Ansons Voyage) Here the Constitution not having a power of supporting the new parts or Even the original reclaims at were the former & causes them to be absorbed. 25. greatly forward the cure, which if things go on well from this time proceeds as in a common sound Ulcer. – 990. Boils seem to be a species of Carbuncles but more of the adhesive Inflammation arising in the Circumjacent parts they do not spread. The cure of boils vulgarly so called is in fact a slough or mortified part thrown off. 991. The Aged & free Livers are most Subject to Carbuncles the Young to Boils. 992. Though the cellular membrane sloughs, yet suppuration freely goes on, in which matter is either furnished from living cells which are endeavouring to throw off the dead, or from cells which are themselves also about to die. 993. Carbuncles are sometimes local & sometimes seem connected with a diseased state of the System. 994. Bleeding is rarely proper, though at the beginning may be indicated sometimes, if there appears Symptoms of Inflammatory Diathesis. 995. A diseased state of the System as Scurvy, may occasion both intersticial, & ulcerative Absorption of new formed substances which we have shewn are weaker than the Original, hence in violent Scurvy, cicatrices have been known hastily to Ulcerate & even Calluses which formerly reunited broken bones become absorbed & the Ends of the bones loosened. 996. Tetanus. Or Locked Jaw is a disease which consists in an involuntary Contraction of voluntary muscles, sometimes it becomes an unnatural contraction of voluntary Muscles & Δ 996. Unnatural Contraction of Muscles is a Genus of disease wch. has many orders to it belongs tetanus, Cramp, Wry Neck, St. Vitus’s dance, Subsultus Tendinum, One of the kinds of Quincey, Ague, it bears some Analogy to Epilepsy & Catalepsy, though these are properly affections of the brain, it is not peculiar to the human Species, Horses, Monkeys, Stags &ca. are subject to Tetanus. – 1000. In this it is so similar to other Spasmodic Complaints which are very common in Warm Climates, but rarely felt in Cold ones. – ♀ 1001. These act upon the principles of producing weakness & an irritable state of the Nervous System. Locked Jaw has been often attributed to the Wound of a Nerve or Tendon, with respect to the former, the opinion seems quite erroneous, with respect to the latter, as Wounds of the Tendons do not heal readily, they induce an irritable & weak state of the System & this being present irritations which do not become sensible give rise to it. Upon that Principle it is, that it is known to follow large Wounds which have considerable Suppurations & which induce a weak & irritable state of the habit It does not arise here from Inflammation, for it does not take place until after Inflammation is gone off. Mr. Hunter is satisfied from his Experiments, that wounds of Nerves or the including a Nerve in a Ligature made upon an Artery have no particular Tendency to bring on locked Jaw which he has frequently found to take place where it was Evident no more was wounded. 26 then perhaps it becomes fatal. Δ. 997. When it affects the Muscles of the lower Jaw, it is called Locked Jaw, when it Extends to the anterior Muscles of the body it is called Emprosthotonos when the posterior Opisthotonos 998 The predisponent Causes will be whatever can render the habit weak & irritable. 999. Amongst these (998) Climate is a very powerful one. In hot Climates it is extreemly common, being produced by the slightest occasional causes & even sometimes arising Spontaneously. 1000. In Temperate Climates it is more rare, in very cold Climates it is unknown. 1001. Other predisponent causes may be fever, large suppurations, Wounds of Tendons, & ligamentous parts. ♀. 1002. The most trifling external injury may be the occasional cause of this Disease, even a Scratch or puncture, where neither Nerve nor Tendon are found to have suffered. 1003. It appears to be a disease of the nervous system & not of the Principle of Life, every circumstance appertaining to the latter commonly remain natural & unaltered, sometime after the attack of the disease. 1004. The Muscles of the lower Jaw seem more disposed to take on this Affection than any other Muscles, here the Disease commonly begins & soon spreads itself to other Muscles those whose Action is involuntary & necessary to Life then the Patient is destroy. 🜍 1005. Stupor. This Shews that the brain must be somehow affected, as it is neither Muscular, nor connected with Muscles, it is difficult to say how this affection of it is produced, is it from any compression on the Brain, induced by the Spasm of the Muscles of the Neck making pressure on the Jugular Veins, or is it from sympathy. 27 1005. It begins with a small degree of stiffness in the Muscles raising the lower Jaw, the patient finding a difficulty to open his mouth, at length the Jaw becomes less & less capable of being depressed, the muscles of the Eyelids are next affected, & the upper Eyelid falls more & more so that the Patient looks like a person going to Sleep, sometimes soreness of the mouth & Throat precedes, but this is only accidental, then the Muscles of the Head became affected; at first the head is held immediately Erect by the Spasm, then it is drawn backwards, the muscles of the Spine become nex Affected & the body of the Patient is bent [for] backward, then those of the Abdomen, the bowels are drawn inwards; the patient complains of a pain in the lower part of the Sternum, perhaps from the Diaphragm being affected; a difficulty of respiration from the spasm extending to the Diaphragm, Intercostal Muscles &ca. in which last an excruciating cramp-like pain is felt Universal convulsive motions of the Body sometimes attend like to Subsultus Tendinum. In other respects health seems to remain & the functions of the Body go on. The Spasms of the Involuntary Muscles, however increasing in violence & perhaps the heart also becoming similarly affected the Patient is cut off, sometimes Stupor produces his Death. 🜍. 1006. Should the patient live until the habit becomes accustomed to the disease it then wears itself out & at length the patient gets well, in general however it Kills before the System can be habituated to its Action. 1007. The disease does not always increase gradually & regularly  28 regularly as described (1005) but sometimes it will Extend itself suddenly from the Jaw over the whole body, so as to Excite unnatural contraction in the Muscles in general. When the Spasm confines itself to the Jaw the disease may be called Mild & then it does not prove fatal. 1008. The disease kills at different periods of time, but if the patient lives through the second or third Week from the Commencement of the complaint, the constitution becomes so much habituated to it, that it loses its power of destroying Life; then wears itself out. – 1009. The disease continues sometimes even Ten Weeks, a great part of the time remaining Stationary & at last the Patient gradually loses the Spasmodic Affection & his Muscles are resolved to a natural State. 1010. All Ages are subject to it, of Constitutions the delicate & relaxed are most liable to its attack. 1011. When it Kills the Muscles remain contracted until the contraction is removed by force, but when Art has relaxed than they do not contract again, no preternatural appearance presents itself upon dissection in any part of the body in general the disease kills suddenly. 1012. From considering what has been said, we are perhaps enabled to discover. – Why the Patient remains under the disease a long time without his general health being affected. Why the Disease kills – why it may Kill at different 🜺 1013 & 1014. Bark, Opium, Blister, Camphor, Bleeding, Warm bathing & a variety of other methods have been tried, wherever Mr. Hunter has seen the patient recover, the disease has seemed to have gone through its natural course, & to have worn out itself without his having had any reason to attribute anything to the power of Medicine. He recommends the Sugar Lead to be tried upon the principle of the known tendency of Lead to produce relaxation of Muscles & inability in them to contract. Externally as a substitute for change of Climate he recommends that the Patient should be put into a cold bath or an Ice house, he never saw a Patient die after the third Week. ☍ 1016. Cases of Locked Jaw. 1. A locked Jaw & Convulsions of the Muscles of the Arm from a compound fracture of the Radius. Heat & Perturbation of Mind encreased the Symptoms, he was always observed to be worse after drinking anything warm, or after warm External applications. Opium & Bleeding was tried he died the sixth day. 2. A Soldier received a Wound in his leg when it was nearly well a locked Jaw came on. Musk & Opium were tried for three Weeks, the patient finding no Change would take no more. He continued in the same state for Seven Weeks & more, & then began to mend, which he continued to do insensibly until he Recovered his health. – He took Bark & Port Wine during the whole of his illness his Wound healed long before, his Complaint left him. 3 A Soldier with a locked Jaw after using Musk, Opium, Camphor 29 periods, & why it [may] commonly cutts off the Patient suddenly. 1013. No internal remedy has been yet discovered that will cure or relieve this disease. 🜺 1014. External application have also been found ineffectual as Climate is one great predisposing Cause to the disease a change from the present to a colder might be tried. Electricity has once been found serviceable. 🜺 1015. As the indication of Cure must be to relax the present contractions of the Muscles, & to take off every disposition in other Muscles to unnatural Contractions, the internal use of Lead might probably deserve trial, as lead by inducing paralysis may cure one disease by producing another. – 1016. If the locked Jaw here follows a Wound in any part of the Body, the removal of the part wounded is not found to remove or lessen, the disease unless the Tetanus arises during the State of Inflammation in the Wound. For when the Inflammation & irritation of the part which received the injury is gone off, it must be evidently useless to remove it in case a locked Jaw should have come on, because whatever irritation was heretofore applied to the part is now taken away, & that is no longer the diseased part, nor can it now tend to cause or keep up the Spasm its Action on the System has been already produced & terminated ☍ Upon the whole from what has been related we may be justified in acceeding to the conclusion given in (1013 & 1006.). – 1017. Scrophula. is a disease which may be considered as constitutionally local ( ) it is not hereditary, as in other diseases so in this a susceptibility of the disposition for diseased Action & even the cold Bath & finding no relief left off all his Medicine, he took none for eight days, & then began gradually to mend. 4 A Young man had his thigh Amputated, had violent pain in it & frequent spasmodic Affection of the Muscles, 13th. day locked Jaw came on, 15th. became locked all over, 16th. he died. Opium Æther & Sweating were Employed; Muscles continued rigid after death, but when Relaxed by force did not contract again. – 5. A Sailor had a Tetanus affecting the Jaw & Muscles of the Spine, came on 2 Weeks after having received a Wound in his Wrist, during his Illness had Ischuria & Costiveness, both of which were relieved by a Clyster, Opium, Camphor, Bark, Steel, Cold Bathing were all tried, he lived some days had pain in his heart & great sense of oppression about that Organ having come on he died suddenly. 6 A Man had a locked Jaw, it was uncertain whether this disposition to it was induced by a Wound on the foot, or by a Wound of the Tongue, he died the 9th. day. The second day of his illness the Spasm extended to the Muscles of the Neck & Spine, the 4th. his Skin became exquisitely sore to the touch, his Eyelids did not open properly he had universal Spasm, & a degree of Stupor – 8th. his breathing was difficult & he had a pain in the lower part of the Sternum 9th. he died suddenly. – 7 Locked Jaw cam on after Trepang, Opium was freely given no visible good effect followed it, but after a fortnight the Patient mended gradually & got well. 8. Locked Jaw arose spontaneously after Nervous Fever, the 30 is all that can be inherited. ( ).. 1018. It is a specific disease, every process of which is marked with indolence & slowness of actions, whether it produces tumefaction, suppuration, or ulceration, all of which when the disease is true Scrophula go on with little or no pain. 1019. When it produces Swelling of a part the tumefaction encreases slowly, there is hardness with little pain or soreness, all the appearances of common inflammation are wanting no Resolution of the tumor take place a kind of suppuration is produced. 1020. When the Tumor becomes soft & suppurates, which it does very slowly & without pain, the matter very gradually makes its way to the External parts. 1021. The ulceration of the Integuments in order for the Evacuation of the matter is equally slow & tedious, the matter does not make a point as in healthy Abscesses but it stretches the Skin equally to some extent & renders it as far as it distends it, Shining of a Purplish hue, in this state the disease will sometimes remain stationary for months, when the Skin can no longer resist the [?ressure] of the matter it bursts & a fluid like a mixture of Curds & Whey is evacuated, there is rarely any common Pus when the Scrophula has gone on pure & unmixed with the Common Inflammation. 1022. When the Abscess has emptied itself it does not readily [??ll] up or suffer its Cavity to be obliterated but will often remain fistula the small hole through which the matter bursts remaining open. Patient took nothing but Port Wine & recovered. – 9 Locked Jaw arose in a Child of two years old after a scratch of a Finger by a Saw – died the 10th. day. – 10. Locked Jaw arose Spontaneously after Dysentery. – 🜔🜹 1028. It is not peculiar to the human Species, Several Quadrupeds, as Monkeys, some Birds, as Turkeys, are subject to the action of Scrophula. 31 1023. When Scrophulous Ulcers granulate, the granulations are large, soft, pointed appearing like a transparent glassy Substance their sensibility is little, the Margin of the Sore is loose flabby & turned inward, the Skin round about it has a purplish hue the granulations want the power of contracting ( ) so that the Ulcer will continue stationary, or at most its sore will be slowly diminished. 1024: The process of Cicatrization is equally difficult & tedious & when formed has not an healthy appearance. 1025. The disease seems to have a sedative effect upon the System diminishing all the actions of the parts which it invades. 1026. It has a power of producing in the parts, surrounding the part originally diseased a similar State, but it does not produce continued Sympathy in any great extent. 1027. The predisposing cause is a delicate & irritable constitution with weak powers of action. The parts most disposed to take on Scrophulous action are the Lymphatic Glands, especially those wch. are most Exposed to the influence of the atmosphere, as the Glands of the neck & lungs, “the Mesenteric Glands”. Joints particularly those of the Foot & Hand, ligaments, the soft Ends of Bones, in all which parts the strength & powers of restoration are but small. 1028. Persons between the Age of 15 & 40. of a fair Complexion & light hair, who do not appear to have the usual quantity of red Blood in their Vessels, & those who live in climates which are very changeable & irregular are most liable to this disease. 🜔🜹. 1029. Though it produces continued Sympathy to a small distance it has no power of affecting the Absorbents, nor is the disease capable of being communicated by them, it cannot like  32 the small Pox be communicated by innoculation. 1030. The Skin is rarely if ever originally & primarily affected by this disease, it may however fall into it from continued Sympathy. 1031. The Exciting causes will be external Violence especially if not very great, sudden application of, or unusual exposure to Cold, the use of Mercury. The slightest degree of external violence in habits predisposed to it (1026-27) will cause the part to take on a Scrophulous action. 1032. The Susceptibility of Scrophula in some Constitutions is so great that any complaint which deranges the habit for a time, as Fever, Syphilis, Small Pox &ca. will give occasion to a Scrophulous disposition & action. 1033. The appearances of Scrophula will vary according as different parts are affected, however it will always be found with one of the following circumstances. 1. A Circumscribed Tumor. 2. A Tumefaction more diffused 3. Suppuration without tumefaction. 1034. The circumscribed Tumors are chiefly Lymphatic Glands although they are sometimes found in the brain, breast, Uterus & Testicle. 1035. When the disease attacks a part which may suffer without much disturbance of the general health, we are often unacquainted with the nature of the disease, until a swelling in consequence of Suppuration appears, either in the part originally diseased, or in some other part to which the matter has made its way, the suppuration going on without inflammation & perhaps without pain ♂ 1042. A Fever has sometimes cured Scrophula & hence we might be led to think that Stimulating Remedies are indicated, but the Analogy will not hold good, for the disease is a specific one & will not go until it has worn itself out, until it has destroyed Life or is Cured by some specific. Should Lumbar & Hip Abscesses be opened? They are in themselves incurables possibly a chance for Life may be given to the Patient by opening them early that is as soon we are satisfied Absorption of the matter cannot be brought about. In some Scrophulous Abscesses we can obtain a Real Absorption of the fluid, it is always to be desired as the healing of them after ulceration has taken place is Accomplished with difficulty. – 33 1036. When the disease affects the Knee, the pain is more considerable than when the other parts are attacked & here somewhat of the true inflammation is mixed with it. 1037. Whenever the lower extremity is the seat of the disease, the Limb appears longer than the other, this is from the Patients particularly favouring that side & leaning on the other. 1038. Children are often lame for Months, & at length a swelling has appeared in the foot. When Scrophulous Abscesses appear about the fingers, hand or foot, the swelling sometimes does not subside even after the matter has been discharged. 1039. Lumbar Abscesses sometimes appear without any Previous pain, sometimes patients remember to have had pains in the loins in general however, if they have pain it is felt beyond the seat of the disease, as in the thigh, the Knee, or Foot, the Matter here very frequently presents itself in the thigh though formed in the Loins. 1040. Patients under 30 are most subject to this complaint it is produced by the common Exciting causes of Scrophula, it is to be distinguished from a disease of the Hip by attending to the motion of the Foot. 1041. Abscess in the joint of the Thigh is of the Scrophulous kind there is commonly a thickening of the soft Parts forming & surrounding the joint, the patient has a sense of weakness in the limb, wch. wastes & has its motions contracted. 1042. White Swelling is a term that may be applied to every Scrophulous swelling of a Joint, before the Skin becomes inflamed it is generally attended with an increase of Synovia, sometimes is truely Scrophulous & sometimes has a mixture of the common Inflammation. ♂.  34 1043. The common Pulmonary Consumption is generally a Scrophulous Affection of the Lungs. 1044. The Young, the fair & the delicate are most subject to it & the common Exciting Cause is Cold, it commences with tubercles in the lungs, swelling of the Glands of the neck often appear in the beginning, the disease increases slowly, the tubercles Suppurate & ulceration being formed, the patient becomes hectic & is at length destroyed. 1045 The Pulmonary Consumption is however seldom a purely Scrophulous affection it has generally somewhat of the common Inflammation mixed with it, as we know from this pain in the Chest, the quick hard Pulse &ca. – 1046. An Hemorrhage from the Lungs is not uncommonly the fore runner of pulmonary consumption but how far this has to do with Scrophula we cannot determine. 1047. The Testicle is also the seat of Scrophula As in its Actions upon other parts so here also its attack is scarcely known & its progress slow. 1048. It rarely occurs before the Age of Sixteen or in Old Age. 1049. The Breasts of Women also fall into this disease in which they will gradually, slowly, & with little pain swell to an Enormous Size.. 1050. The Scrophulous Testis (1047-1048) & Breast (1049) are to be distinguished from Cancer of those parts, by the want of Swelling in the Spermatic Chord & [Axillary] [inguinal] Glands, also by the abscence of local Sympathy, at least until the Skin is beginning  35 to be affected by the Suppuration. ( ). 1051. The indications of cure in Scrophula with respect to the constitution are. A. 1st: to give strength to the System. 2d: to Counteract the effects of Climate. 3d: the use of some Specific. with respect to a apart B. 1st: to produce resolution of the tumor or Absorption of matter if it has suppurated. or 2d: to Extirpate the disease if practicable. 1052. The indication (a.1) we endeavour to fulfill by means of bark & other tonic Remedies. The indication (a.2.) by changing the situation of the Patient, or if that cannot be done, by rendering the Systems less susceptible of the influence of the Climate in which the patient lives The indication (a.3) By the administration & application of such remedies as Experience has proved. 1053. If Climate cannot be changed which is to be desired & wch. should always be altered to a warmer & more regular; then we may lessen the susceptibility of the body by tonic Medicines. Cold bathing & the use of such Cloathing as will maintain on the surface of the body an uniform & equable heat, such as flannel which conducts heat from the body badly. 1054. Experience seems to have approved the powers of Sea bathing as the most powerful specific in every Scrophulous Complaint whether Hip Cases, white swellings. Consumptions &ca. & some + 1055. We consider Sea Bathing as a specific in Scrophula but we are also to consider under what circumstances it will Act most powerfully, for instance whether Sea bathing & a Cold Bath, Sea Bathing & a Tepid Bath, Sea Bathing & a Warm Bath, will best agree with our Patient, for we are not only to consider what will cure the specific disease but also what will best agree with the Patients Constitution. Some Persons cannot bear Cold bathing but will find themselves much refreshed by the tepid Bath, again others require the heat of the Warm bath to render Sea Water Agreable to their Constitutions, Again the season of the Year is to be considered for more additional heat will be required to be given to the water in the Winter than in the Summer, if the cold Bath cannot be endured. In the warm or tepid Bath the patient should remain 10 or 15 Minutes with the precaution of tempering the heat to the agreable degree. Sea Bathing may be employed in all Cases of Scrophula Even pulmonary Consumption. To prove that the Bath agrees with the patient he should feel a Glow of heat, & his Spirits be enlivened by its use, if these appearance are wanting after a 2d. or 3d. trial & the patient feels himself [cross out] chilly & enervated, some other degree of heat should be tried. In bathing the sores of Scrophulous Patients should always be uncovered. 36 Specific powers are also attributed to the fossil Alkali & Hemlock. 1055. Sea bathing is to be used with that degree of heat which is found most agreable to the System & followed by the greatest encrease of vigor & Spirits. + 1056. The means recommended (1052-1053-1054-1055) are most to be insisted on when there is greatest predisposition to the disease & the patient most disposed to the action of Exciting Causes. hence Children & Young persons stand more in need of them than those advanced in Life, also in irregular climates & in Winter more than in regular Climates or in Summer, for the Winter favours the Progress of Scrophula, therefore sea bathing & flannel Cloathing are more necessary in Winter than in Summer (It is a bad practice with Parents & Nurses to carry young children about in the cold with the extremities naked & exposed to the Atmosphere the bear cold ill & suffer from it more than those advanced in Life) 1057. We are not to expect a speedy Cure from any remedies used in the treatment of Scrophula, length of time being always required to give them Efficacy from 3 Months to 2 Years. 1058. Moderate Exercise is to be recommended & perhaps Vegetable diet may be employed with advantage. 1059. Mercury is in general improper in Scrophulous Complaints Bleeding is often necessary in Scrophulous Lungs to diminish the quantity of blood circulated through the Pulmonary Artery & proportion it to the quantity of unobstructed Lungs. 1060. As to the topical treatment where the disease admits of it &  37 it can be removed with propriety all at once, Extirpation is the best method. 1061. In the resolution of tumours, or the healing of Scrophulous Sores few topical application Except sea water & the Juice of Hemlock are of any advantage. 1062. Stimulating applications are generally injurious, Violence increases the action of the parts & at the same time does not cure but adds to the disease. 1063. When there is suppuration the Abscess should not be opened with a Knife in general they should be left to break of themselves. 1064. Variations in Age will often lend to the spontaneous Cure of the complaint, & this is most observable in Females. 1065. In scrophulous bones Exfoliation is tedious and obtained with difficulty, In those as in soft Parts every process of Exfoliation goes on not without difficulty. 1066. In Scrophulous Swellings sometimes only a White Curdy or Caseous matter is formed, indeed the parts being altered in their Structure & incapable of carrying on their functions lose their life, but do not putrefy, nor is there a disposition of parts immediately in contact to throw them off, themselves also being affected by continued Sympathy. 1067. Rickets may be defined 1st. a want of disposition in the Vessels of the Bones to form calcareous Earth arising from a weakness of a peculiar kind, or  38 2nd. too great & hasty absorption of Earth from the bone in proportion to the quantity formed by the Vessels. 1068. It is a disease of the Constitution & Originates in a weakness of a peculiar kind, for weakness in general does not produce Ricketty Complaints, although Rickets are always attended with weakness. The first Cause (1067-1) operates in the production of Rickets in Children, the second (1067-2) produces the disease in Adults. 1069. The Rickets in children are known by the bones becoming Enlarged, by their bending under the incumbent weight of the body & yielding to the ordinary Action of the Muscles so as to be thereby distorted. 1070. A certain Size in the Bones & a certain proportion of Earth should be present together as the Size of the bones is determined in adults it is impossible, the encrease of the bones in Size beyond their grown Subject. 1071. But in Children this is the Case, it is a known fact that during the time of growth, the enlargement of the bones is the greatest whilst the quantity of the Earth formed in them is the least, for the formation of Earth checks the growth of bone. 1072. The animal matter of the Bones is also altered, for it is found to be different from the Animal matter of Bones simply deprived of their Earth. 1073. The Rickets cannot produce an encreased growth of Bone in the Adult, but in other respects, as softness of the Bones 🜁 1077. If the bones of the Cranium have been affected, an irregular ossification may arise on the inside nearest the Brain & by its pressure induce morbid affections of that Viscus. On the concave side of incurved bones nature will sometimes form an additional quantity of bone in order to strengthen the Original. Of the softness of ricketty Bones a case occurred at Lime-house, when the Bones were as soft as Tendons. “It is necessary to add that Mr. Hunter considers the molities Opium as a species of Rickets, & that it is here described as in Adults. 39 & their inability to support weight & Muscular Motion, though the causes of rickets in the Infant & adult may be different tho’ effects will ultimately be the same. 1074. The general consequences of Rickets in parts supporting Weight are, that the Joints are obliged to form more Acute Angles. 1075. From what has been advanced, we are [without] enabled to understand why bones of the Inferior Extremities, are more frequently bent, than those of the Superior, & also why those of the superior themselves are sometimes bent, why the Bones are knocked. 1076. Why the disease affecting the Spine shall produce difficulty of breathing & other complaints of the Viscera & why it should render the pelvis distorted & labours difficult. – 1077. The bending of the bones & their [becoming] throwing an increase of weight upon a joint, gives rise to the Stimulus of necessity which excites a disposition in some parts to take on ossific Inflammation & to generate new bone hence irregular Exostoses, Anchyloses of the Joints &ca. – 🜁. 1078. From what has been said we also understand why bones bend in particular, & in different directions. 1079. For [in] this disease no certain remedy has yet been discovered. 1080. The disease is either a species of or allied to Scrophula & Sea Bathing seems to be what approaches nearest to a Specific remedy, as well as for Scrophula. 1089. Where the removal of the Tumors by Mechanical means is feasible & convenient it should be done by the Pincers, Chisel or saw 40 7081 The general indications of Cure are to give strength to the System, hence the Cold bath, Exercise, bark, & othe tonics may be advantageously employed. 7082 Exostosis, has probably somewhat in its native similar to Rickets, it is a growing out of a bone from a bone. 7083. It appears to be of two kinds 1. Constitutional 2. Local In the first a Similar disposition shews itself in almost every bone, in the latter perhaps only in a single bone. 7084. It has generally its seat near the heads of bones & therefore seems much connected with soft parts. 7085. The tumor sometimes arises all at once out of the Substance of the bone, sometimes very gradually. 7086. When near the Joints it sometimes produces lameness altering the direction of the Muscles & tendons. – 7087. It is peculiar to Youth & rarely appears in the more advanced Stages of Life. 7088. Though we know the [causes] Absorbents have a power of removing superfluous substances, even bony ones, yet we know not of any Medicine whose powers will either produce a removal of those Tumors, or a prevention of them. 7090. Fistula are of two kinds 1st. A passage for the discharge of pus &ca. from a diseased part 2d. An artificial opening or Canal in lieu of some natural one being obstructed. –  41 1091 It is the consequence of some parts being affected with disease, which they are not able to get the better of, although the fistula itself is seated in a sound part. 1092. The diseased part to which the fistula leads is always larger & more Extensive than the fistula itself. 1093. As the Fistula commonly opens in the Skin, & as the diseased parts is more deeply seated the lips of the Skin will be more tucked inwards (though sometimes the lips of the Orifice are turned outwards, so as to resemble a prolapsus Ani,) and the Orifice will be nearly filled up with loose fungus Granulations, which if destroyed, radily shoot up again. 1094. Whatever is the disease in the part to which the Fistula leads until the obstruction to its restoration is removed, or its disposition if Specific or unsound is changed no cure will be obtained. 1095. If the seat of the disease extends to or occupies a vital part, it will teize a patient & the constitution until hectic is induced & death succeeds. – 1096. The indication of cure in the 1st. Species of fistula (1090) will be 1st. the removal of whatever obstructs the healing of the Parts. & 2d. The inducing a new disposition in the diseased part. 1097. The second intention (1096) will be fulfilled by laying open the fistula or cavity, throughout its whole length & even carrying incision into sound parts that the mouth of the cavity may be as large or larger than the surface of its bottom, & that the whole  42 being exposed, a necessity for some New Process in consequence of the exposure may arise. 1098. non est inventus. 1099. The first indication of cure will consist in the removal of all foreign bodies or such as stimulate, as splinters of bone &ca. under the limitations heretofore given in cases of Gun shot wounds & diseases of Bones. 1100. If the parts in question have any powers of restoration, the consequence of (1097) this treatment, will be the Excitement of Inflammation Suppuration & ultimately granulation, which will at length fill up the cavity which is unnatural & cure it. 1101. In the second Species of Fistula the indication of cure will consist (1090) 1st. in opening again the natural Canal – or 2d in making some New one which will answer the purposes of the original one. 1102. In the first species there is a greater disposition to heal in the parts through which the fistula passes, than in the deeper seated parts, hence the disproportion of size (1091-1092-1097.). – 1103. We cannot simply from the appearance of a Fistulous Orifice determine its extent, we must therefore examine its depth, the seat & extent of the disease by some convenient instrument as a probe &ca. – 1104. Sometimes one diseased Cavity will have several openings leading to it, it is generally necessary to lay open the whole Cavity making it into one, & to induce a disposition to heal, at the bottom Φ 1108 A person had a Fistula in Ano for which he was cut, but the part still remained Fistulous upon a more accurate Examination it was found that the Sinus extended two inches above the Anus & then penetrated, above the orifice it continued its course along the Gut, for another Inch, the incision was then carried to the End & the Man got well. 43 bottom of that cavity. 1105. When Fistula & the parts they lead to are laid open the external parts should be kept from healing, until the deep seated ones have acquired a disposition for Restoration & the Ulcer can be healed from the bottom. 1106. These observations may be better understood by considering 1st. Fistula in Ano. 2d. Fistula in Perineo – 3d Fistula leading to Joints..4th. Fistula of the Lungs Liver &ca. 5 Fistula Lacrymalis 6th. Fistula of the Parotid Duct – 7th Fistula of Coopers Glands in the Female. – 1107. Fistula in Ano is the consequence of inflammation beginning two or three, or more inches higher up in the Cellular Substance, or the outside of the rectum, which going on to suppuration the matter descending commonly makes a point externally near the Anus & bursts but sometimes the rectum becomes so diseased that it will also give way & a breach be made in it opposite to where the Inflammation began. – 1108. The Cure (1097) will consist in laying open the whole Cavity making its External mouth equal to or larger than the Surface of any side of the Cavity & preventing the too early reunion of the lips of the Wound. Φ. (1106). 1109. Fistula in Perineo. there will often be several Sinuses whose mouths open Externally communicating with the fixed point of the disease, there it is right to treat if we can according to Rule given above, but before a Cure can be accomplished the diseased disposition in the parts must be changed, for instance ♃: 1110 As fistula in perineo will not get well though a Wound in the same part in Lithotomy easily heals, in the latter the external parts have not lost their disposition to healing, hence there is no obstacle to the Cure. – ♄ 1112. We take no notice of Amputation for Fistula in joints as it has nothing to do with the doctrines now before us. – 44 1110. Fistula in Perineo may have for its cause. Stricture in the Urethra, disease in the prostate Gland or membranous part of Urethra, the external Orifice cannot heal as long as the disease remains uncured. ♃. 1111. Fistula communicating with Joints will not heal because they communicate with parts whose powers of restoration are weak and making free openings only increase the disposition to disease, & the violence of the Hectic, neither can we Cure Fistula of the Lungs or Liver, because we cannot lay open the Cavity. 1112. In Cases therefore where we cannot have recourse to the treatment recommended (1097 &ca. we can[not] only endeavour to give power to the constitution by time & Strengthening Medicines. that if possible a natural Cure (though little to be expected) may be obtained. ♄. 1113. Fistula Lacrymalis is sometimes an Original local disease, sometimes a constitutional Local, a arising from Syphilis, Scrophula, &ca. 1114. From whatever cause the ductus ad nasum may become obstructed, whether from Inflammation or a disposition to contract similar to that which arises in other membranous canals (as the Urethra &ca.) forming stricture in it, the passage of the Lachrymal fluid is impeded; distention gives a stimulus to the Lachrymal Sac, which stimulus is also increased by the Salts in the Tears. hence Inflammation & Suppuration is produced, & the matter bursts through the Skin near the Eye. 1115. Through this new & unnatural opening the purulent matter  45 matter mixed with the Tears continues to flow until the Surgeon either dilates the natural Canal, or makes a new one, so that the tears may again have a passage into the nostril & then the fistula will heal. 1116. If the Obstruction in the natural passage is very great dilatation of it will rarely cure because we cannot in general destroy the disposition of the Canal to form strictures, & these recurring the disease will also return, so that most commonly a New & Artificial Canall into the nostrils must be formed. 1117. Fistula of the Parotid Gland, the duct from the Parotid Gland passing over the Masseter & Buccinator Muscles consequently lying very superficially is extreemly liable to be divided & the Saliva will flow outward from the end next the Gland, or suppuration from any cause whatever arising in the Duct & bursting externally a similar circumstance will take place. 1119. The Cure is performed by passing a Needle armed with a round ligature of Thread from without through the duct into the mouth & let the Thread remain there until the wound made by the needle has lost a disposition to heal, the External Wound we should suffer & encourage to heal. 1120. The ducts leading from Coopers Glands to the inner surface of the Vagina in Women are sometimes obstructed & a Sac will be formed Containing a slimy matter which will cause a distention or Enlargement of one of the labia to a prodigious size & produces the resemblance of an Hernia. 1121. An incision should be made into the tumor & the matter discharged, after which the incision should be suffered to heal.  46 1122. Then a second Crucial incision should be made into the Sac near to the natural opening of the duct, & this should be kept Open until it has lost all disposition for healing, & the mucus is discharged by it as formerly was by the natural passage. 1123. Unsound Abscesses. these are to be considered as two fold Viz. 1. those forming in a part 2. Abscesses of a part. 1124. In the first we have a collection of matter formed in the part where they appear, & in the second the matter is formed in some other part more or less distant & from thence makes its way to the part where it appears. 1125. Of the first we have instances in many Scrophulous suppurations in abscesses of the Joints &ca. 1126. Of the second we have instances in the Psoas Muscles & Hip Joint, which often present their matter in the thigh or Groin. 1127. Whether the latter burst, or are opened, the doctrine of Fistula will apply to them, nor will opening unsound Abscesses of a part be of Utility unless we can also induce in it a disposition to heal, or we have some foreign body to remove as Splinters of Bone &ca.. – 1128. Unsound Abscesses are generally caused by some Specific disposition as Scrophula, Lues Venerea &ca. or from a disposition to indolence either acquired or natural, that is Either in parts which have natural powers of healing but fall into a state of diseased indolence, or in parts which have natural but small powers of healing as in joints, ligamentous parts &ca. – ☉ 1132 By This definition, Glass, Metallic Salts, even Arsenic & a variety of Vegetable Substances as Crow figs. Hemlock, Opium &ca. are excluded from the Class of Poisons, also Honey, Particular kinds of Fish &ca. for three Reasons. 1st. Because these are not poisonous in the smallest Possible Quantity 2d. Because their action is not universal. 3d. Because their irritation is not specific but common. 47 1129. New formed parts as Cicatrices & Calluses are sometimes suddenly falling into the ulcerative & intersticial Absorption & the progress of the absorption will be uncommonly rapid as this arises from an unsound disposition in the Constitution, that disposition is to be removed or altered. 1130. We come now to Poisons (Poisons) especially the Animal & principally Morbid. 1131. But we can give no unexceptionable definition of poisons. 1132. The definition however which we can give & most free from Exception is A matter which produces a peculiar mode of irritation & affects the vital principle in a peculiar manner, when even used in the smallest possible quantity; & this without any relation to any known chemical or Mechanical powers, or by any common irritation. ☉. 1133. We know no substance in the mineral kingdom answering to this description, nor is there much poison of this nature in the Vegetable, but the Animal kingdom possesses it in great abundance. 1134. No secreted fluids are poisonous to the part secreting them but they will act as poisons on any other part of the Animal they belong to. 1135. Poisons answering our definition (1132) are of four kinds 1st. Those which act locally as the sting of a Cancer Itch &ca 2d. Those which have their effect on the Constitution, as Jail fever, hooping Cough &ca. - 3d. Those whose influence is upon the whole Nervous System, 1135 In the Animal Kingdom, some Animals as the bug & muskitoe & probably the, poison the part at the same time that they get their food from it. The Bugs, for instance poisons the part & produces an Extravasation of its Juices which it feeds upon. The leech after making a Wound poisons the Vessels of the part Wounded, so as to almost destroy their power of contracting, hence the Hemorrhage which often continues so long after a leech has been sucking which never follows other similar Wound 48. as the poison of the dog, of Indian poisoned Arrows &ca. 4th. Those whose powers are mixed as the Poison of the small Pox, Lues Venerea &ca. acting both locally & on the Constitution. 1136. We intend to consider Animal poisons only, & these are of two kinds, viz. 1. Natural 2. Morbid. 1137. The Natural are such as belong Originally & Naturally to the Animal possessing them & not depending upon any Preternatural affection or alteration in the Structure of any body or its path. 1138. The Natural has no power of propagating its effects beyond the individual its powers are exerted in poisoning. 1139. The morbid on the contrary depends on a preternatural action, or change of Structure in the Body communicating. 1140. But the morbid in general may be communicated by the body poisoned to other bodies & therefore may be propagated to many individuals; because the individual poisoned receives the same power of poisoning others as the Animal possessed by which it was poisoned. 1141. Some of the natural act locally only, as the Wasp, others both locally & constitutionally, as the Viper, Rattle Snake &ca. – 1142. Those acting on the constitution generally first produce local effects, before they are absorbed & affect the System. 1143. Pain in the part receiving the poison, red Streaks & swellings of the Lymphatic Glands in the course of absorption are sometimes preludes to rigors, Convulsions, general livid extravasations Swelling of the whole body & Death. ♀ 1151. Mr. Hunter suspects the Venereal poison militates a little against the general definition of poisons, in that he imagines its action depends on some measure in the quantity applied. Small Pox by inoculation between the time of its application & the time of its visible irritation requires 2 or 3 days Natural Small Pox 23 days – Measles 9 days. Cancer some Months – Itch time not ascertained. 49 1144. Inflammation is produced in the part of the adhesive kind (for the parts swell) which rarely terminates in suppuration tho sometimes pus is formed. 1145. The pus is of the common kind, when it does form, & it contains no poison, whereas when suppuration takes place in the morbid poisons, the pus itself is poisonous. 1146. All the natural poisons must come in Actual Contact with the part to be poisoned, some require to be inserted by a Wound in order that their influence may be [hastened] Exerted. 1147. Morbid poisons probably all arose at first from a [Wound] diseased state of the Body or of parts. 1148. Many are obliged to the power of Contamination for their continuance & that power destroyed would Cease to be known. 1149. In what they differ from the natural has been already shewn, they are like the natural communicated by contact & some of them in a state of Vapor. 1150. Those which arise spontaneously seem to be confined to the species of Animals in which they arise, as Cancer, Syphilis &ca. which are peculiar to the human Species & cannot be communicated to any other Animal. 1151. Morbid poisons applied to Animal Bodies have specific distances of time, between the time of applying the poison & the time of its producing irritation &ca. ♀. 1152. The natural poisons do not in general produce Extensive local Sympathy. 1153. Morbid poison being applied to a part, that part becomes  50 infected & diseased without a power of contaminating other parts by means of the absorbents, as in the Itch, or 1154. Morbid poisons being applied to a part, that part becomes diseased, & has a power of communicating the disease to other parts but not to the Constitution, as Cancer &ca. – 1155. When a part has the power of contaminating the System as the Small Pox. 1156. Of the action of some poisons, as Small Pox, Measles &ca. the constitution is sensible only once in the course of Life; of others it may have the action repeated. 1157. Cancer. is a disease produced by a morbid poison arising spontaneously in a part without our being able to account for the manner in which it is generated. 1158. It is a local disease which may produce a consequent similar local disease in another part but has never the power of infecting the Constitution. 1159. Some parts are more liable to the affections produced from difft. poisons than others, so the secretory Glands are most commonly the seat of Cancer. The breast & uterus in Women. The lips, external Nose, Pancreas, Pylorus, & Testicle are commonly seized with this disease. 1160. It is a poison of whose action the human Species are alone susceptible, Experiments have shewn us that it cannot be communicated to other Species of Animals. 1161. We find in parts affected with Cancer an indurated knotted feel with a kind of suppuration in the Centre, or an ulceration of the external surface attended with pain. 🝄 1169. “We may infer that cancerous Virus has no Power of infecting the blood or producing similar diseases in any part by means of the Blood.” “One Reason why Cancerous matter should not be able to act upon the system when Absorbed may be, that it is so slow in producing its Action that time cannot be sufficient for that purpose after its being absorbed, before it is thrown out of the body.” 51 1162. previous to a disposition to ulceration being formed the pain is dull & heavy but this disposition being produced, the pain becomes violent, giving a shooting burning sensation. 1163. The part affected has its functions destroyed, if a secretory Organ it loses entirely the power of Secretion. 1164. In its suppurating process the Cancers becomes adherent to the surrounding parts. The Skin becomes discoloured, smooth & shining & matter is formed, sometimes without much previous Inflammation 1165. When the Cancer is cut into previous to ulceration having taken place, there is sometimes found the appearance of a Cyst which contains an ill conditioned Serum, Blood, Curdly matter &ca. but seldom or never matter resembling good pus. 1166. The process of Cancer in all its stages & states is in general slow. 1167. When ulcerative Absorption has taken place, the integuments round the Ulcer, are tight & rigid, the Skin is tucked in at the edges & wrinkled into folds, an ill conditioned matter is discharged. 1168. The Lymphatic Glands in the Neighbourhood become indurated & Enlarged, sometimes soon, sometimes even before the Ulceration has taken place, & little Lumps are sometimes formed in the circumjacent Skin. 1169. It has a power of poisoning other parts, & of producing in them a similar disease, but it has no power of Contaminating the Constitution. 🝄. 1170. A Cancer of one part may produce Sympathetic swellings of the parts, but not true Cancer unless of Parts which are in the course of absorption.  52 1171. Constitutional effects as Hectic Fever &ca. may arise in Consequence of a patients labouring under a Cancer from the irritation the disease produces, but the affection of the Constitution will be only that, common to simple irritation, nor will there be anything specific or peculiar in the manner in which Cancerous irritation acts upon the System. – 1172. The time of life seems to be the powerful predisponent cause of Cancer, the Age which most strongly predisposes is from 40 to 60 it sometimes however appears Earlier tho’ rarely. 1173. The Exciting Cause. 1174. The parts most susceptible of the cancerous disposition seem to be those proper to the Sexes. 1175. Women are more susceptible of the Cancerous disposition than Men probably because they have more parts peculiar to Sex. 1176. Is there not another cause in the parts peculiar to Sex in Women at the given time of Life, undergoing a Change which renders them unfit for procreation. 1177. We know of no Medicine which will cure a Cancer. 1178. Arsenic is probably a specific for the Cancerous disposition but its powers are too weak to produce a Cure, nor will the System allow of its being introduced in sufficient quantity. 1179. Yet, a Cancer, if left to itself always kills, either by its constant irritation it exhausts the principle of Life, or by Producing continued or contiguous Sympathy, & thereby inducing a similar diseased affection in some part necessary to Life. 1180. Therefore Extirpation of the diseased part is always to be desired & if practicable always to be preferred before a consequent  53. cancerous affection has taken place any other part. 1181. We are always to consider not only the Original or first formed Cancer but also any part which may have been poisoned by matter absorbed from it, & which we call the Consequent Cancerous Affection. 1182. Nor can we always be certain that a consequent Cancer is not formed because ulceration & the formation of cancerous matter has not taken place for 1183. Coagulable Lymph which had been extravasated, in the thickening & induration, if absorbed will equally contaminate & poison the parts it is applied to, for whatever the fluid seperated in a part may be it will always possess the specific properties of the part from which it is secreted. 1184. The Consequent affection begins Either in the Lymphatic Glands or the Lymphatics themselves but a Cancer once formed whether Original or Consequent, there is no part contiguous to which it may not extend its action, even to bones. 1185. Hence Cancers should always be extirpated as Early as possible the Earlier they are removed the fairer prospect has the patient of future health. 1186. Previous to Extirpation it is always necessary to observe a. The common rules laid down touching the Extirpation of Tumors. b. Whether any Consequent is already formed & where. c. Though no Consequent cancer is Visible whethere there is just reason to believe a disposition for one is any where formed. 1187. In extirpation it must be an invariable rule to take away the whole of the disease. (1188 non est inventus) 1189. If the whole of the disease cannot be removed Extirpation  54 is not to be attempted. 1190. If the Tumor adheres to the Skin it should always be a rule to remove more Skin than the diseased part is adhering to that if possible, we may be sure of not only taking away the present diseased parts, but also of taking away any part in which it is probable from its Contiguity that a disposition for a consequent Cancer may be formed. 1191. The Consequent if left will be equally injurious & equally fatal with the Original Cancer, & though the Original be taken away, will itself contaminate other parts in the same manner & to the same degree as the Original & is equally incurable by any powers of Medicine. 1193. Notwithstanding all our Care the disease will sometimes appear again, even after we have removed all evidently diseased parts & these also which we are justified in suspecting. 1194. For, the slowness with which the Cancerous Virus sometimes acts may be a Cause of deceiving us, a disposition to a consequent disease may be formed in some part, which we can by no Signs whatever ascertain the Existence of. 1195. Nevertheless when the operation is admissible we ought always to endeavour at the Extirpation of a Cancer. 1196. Cancer must be distinguished from Scrophula & from indolent thickenings of all kinds which may be done, not only from its appearance, pain, &ca. but also from its acting as a poison on the neighbouring parts, which scrophula & simply indolent thickenings never do.  55 1197. It should also be distinguished from the Fungated Sore wch. though it is not a poison as it has already been considered as Cancerous may not improperly be noticed in this place. 1198 The fungated Sore is a specific disease entirely local & has no power of contaminating or poisoning parts, beyond the Extent of continued Sympathy & even this not widely diffused. 1199. It has its seat in every part of the body without Exception. 1200. It begins in a circumscribed Tumor partly solid or encysted is not for a time very painful, it gradually & not very hastily enlarges, the Skin becomes discoloured & at length burst & ulcerates 1201. A lose Spungy fungus of the colour of dark Cruor is then thrown out, which rises & enlarges faster than Escharotics can take it down, it bleeds easily from the surface of the fungus & its pain is Acute. 1202. It resembles Cancer in being absolutely incurable by Medicine & if left to itself destructive. 1203. But it differs from Cancer in not being poisonous, & in never producing either in the Lymphatics or Lymphatic Glands a similar affection. 1204. This disease kills without seeming to have done so much mischief as might be supposed admissable without destruction of life. 1205. Nothing can be done to relieve the patient, but extirpation in which we should be extreemly careful to remove every Atom of disease, otherwise the part will again take on the same Affection. 1206. Many diseased appearances on the face, which have been considered as Cancerous are only fungated Sores.  56 1207. In the extirpation of Cancer two methods have been Employed. Viz. 1st. the Knife or Excision 2d. The use of such means as produce the death of the whole of the diseased parts & the subsequent seperation of them from the second parts. 1208. Diseased as well as new formed Parts ( ) have much less power of preserving life & resisting Death than sound parts, hence we can conceive how the application of Arsenic to Cancers shall sometimes produce the destruction of the whole of the parts laboring under Cancer, without depriving the Circumjacent parts of life 1209. Chemical applications as the different Caustics ( ) have also been employed, but the powers of Arsenic are the greatest, the Caustics making less distinction in their action between ye sound & unsound parts, the latter Acting Chemically, Arsenic by its irritation & exciting an Action under which the diseased parts have not strength to live or subsist. 1210. If we employ the Knife we should always cut into sound parts, in general we can employ excision more universally than the other means. 1211. We should in the Course of the Cure of the Ulcer after the operation if any lumps arise, or any consequent Cancer appear it is right to remove them as soon as discovered. 1212. If a Cancerous disposition remain after the Operation the Wound either will not heal or the catrix will soon ulcerate afresh, or the consequent disease will make its appearance. 1213. It is necessary to take notice of some Cancerous Affections of particular parts.  57 1214. A Cancer of the Breast most commonly begins in a small Schirrous Lump, which is in general circumscribed; at other times it begins with a discharge of blood, or a kind of matter from the nipple, sometimes the Skin becomes diseased very Early being thickened, discoloured &ca. – 1215. The natural function of the breast is destroyed, it loses the power of secreting Milk, is painful &ca. – 1216. It should be amputated before there is any adhesion of the breast to the pectoral Muscle or ribs, & before the Glands in the Axilla become affected, or at least before these Circumstances take place in any great degree. 1217. We must be cautious in Examining the Axillary Glands sometimes when enlarged they may seem moveable but when we come to operate we may find a Chain of little diseased Glands extending beyond the reach of the Knife, & rendering our endeavours fruitless. 1218. If the Cancer of the breast is suffered to become irremediable the ulceration increases with a stiffness & tightness of the surrounding parts, the breathing becomes affected & is difficult & laborious. 1219. The Axillary Glands being universally & greatly Enlarged the return of the Lymph from the Arm is obstructed, hence an Oedema of the whole Arm, sometimes soft, sometimes hard, takes place. 1220. In some patients the integuments on that side of the body will become Oedematous, & even a paralytic affection of that side of the body on which the disease is situated may ensue.  58 1221. Consequent Cancers will be formed, at length the patient worn out for want of sleep, with pain & hectic from the constant irritation, until at length she sinks & end is put to her sufferings 1222. In this as in all other Cancerous affections the liberal & unlimited use of Opium is to be permitted. 1223. If Cancer is seated in the Testicle it should be removed before the spermatic Chord is thickened, or at least whilst so much of it is apparently undiseased without the abdominal ring as to have room for the performance of Castration & then we are justified in operating, though the success is uncertain. 1224. In the Cancer of the Testis the pain is more excruciating than in the breast; with regard to the Extirpation & the Administration of Opium the rules given will apply. 1225. In the Cancer of the Testis the consequent Cancer will be in the spermatic Chord, the absorbents of the Testicle pursuing its course. 1226. If the Scrotum is the Seat of Cancer, the consequent disease will be in the Inguinal Glands. 1227. In the Lips the disease begins with a thickening. It is to be removed by the operation for the Hare lip, in other respects the preceding general rules must be observed. 1228. It is not necessary to dwell on the particular Cancers of other parts, as the Eye, the Nose, the Uterus &ca. Extirpation when practicable should be early employed, when impracticable means of alleviating pain, can only be had recourse to.  59 1230 The Itch, is a specific disease produced by a morbid poison which being applied to the Skin occasions ulceration in it. 1231. The Itch is Contagious, the person infected with it being always able to communicate it to others in the same manner as he received it. 1232. Contact of parts is necessary to its being communicated in a state of Vapour it has no power of Contagion, & its powers of infecting are very weak & easily guarded against. 1233. Animalcula may exist in the Matter but not necessarily nor universally. 1234. Continued Sympathy produced by it is very little & contiguous Sympathy hardly ever takes place from its action it has no power of poisoning the System nor have the Absorbents ever been seen to be affected by it. 1235. Its most ordinary seat is where the cuticle is Thin, its first appearance is a small Vesicle containing a little fluid to this succeeds an Ulcer discharging pus, which in the recent state is very minute, but when of some standing considerably increases in breadth, so as to be sometimes as large as a Sixpence. 1236. The little Ulcers made by the Itch never heal Spontaneously, & when healed by Art they do not again break out nor do other ulcerations arise in the surrounding Skin. 1237. Its power of irritating is not very considerable, the surface of the body must be healed to be sensible of its irritation, the sensation it Occasions is Itching not Pain. 1238. Different remedies are found to be specific for the itch  60 Sulphur, Hellebore, Mercury, externally used are known to cure it, but Sulphur Ointment seems to be the most powerful remedy. 1239. A Mercurial Girdle has been known to Cure the disease even when Mercurial Ointment applied to the Skin has failed. Brimstone taken internally will sometimes Produce a Cure. The ☍. 1243. Men who have a gleet, after all inflammation is gone off may infect Women & Women Men. 61 The Venereal Disease. 1240. The Venereal disease is one of the most Morbid compound Animal poisons, & like other morbid Animal poisons may be communicated by the persons infected to others. 1241. It is always communicated in the form of or united with purulent matter, which shews that it originally arises from Inflammation. 1242. When communicated to a part it produces in general Inflammation; but its progress is attended with Symptoms Peculiar to itself & distinct from those of other Animal poisons. 1243. The presence of Inflammation is not however necessary to its Existence, an infected person may communicate it to others after all Inflammation has left him, as in the Case of a venereal Gleet. ☍ 1244. To produce infection the Venereal matter must be communicated in a fluid state, or in a state rendered immediately fluid by the Juices of the receiving part, in the form of a Vapour it cannot infect, nor can it be communicated without the presence of purulent matter. (1242). 1245. The poison first arose probably in the Genital parts in the intercourse between the Sexes. This intercourse is not however necessary, it may be communicated from other parts besides the Genitals, & Even when applied by means of other substances than living 🜔v 1245. A Gentleman by Passing a bougie that had been formerly used by him when he had a Clap, caught a Gonorrhea. 1247. Mr. Hunter has sometimes known Gonorrhea arise without any preceding inflammation & confessed himself very much puzzled concerning the nature of such a Case, if they were venereal it should seem this Aphorism will not universally hold good. 62 bodies. 🜔v 1246. Actual Contact with the part to be infected is however always necessary. 1247. Venereal matter applied to sound parts has generally the effect of producing inflammation, which is always of a specific kind. 1248. From what has been said it is evident those parts which are not naturally or Accidentally secreting surfaces cannot communicate the Venereal contagion. 1249. It may affect the body either locally or universally & therefore may be divided into two Genera viz. 1st. Genus. Original or immediately local. 2d. Genus Constitutional. 1250. The first Genus has two species seemingly different yet their ultimate effect is the same Vizt. 1st. without ulceration or breach in the Solids called a Clap or Gonorrhea. 2d. with a breach in the Solids, or solution of continuity called a Chancre. 1251. The Bubo or local consequent may follow either the first or second species of the first Genus & when suppurating differs in nothing from the Chancre except in size. 1252. When the infecting matter is applied to a secreting surface the first species will be produced, when to a non secreting Surface as the Skin covered with the cuticle, the 2d. species will arise; from  63. either of these a Gland in the line of absorption being affected the bubo or local consequent, will be brought on. 1253. All secreting surfaces in the human body having nearly the same mode of action will take up the infection from simple Contact & may any or either of them be the seat of the 1st. Species. 1254. The second species may be induced a by a Wound. b by application of the Matter to the Cuticle. C by application of the matter to a Sore. 1255. Secreting surfaces being natural as that of the Urethra & Nostrils &ca. or accidental as an Ulcer, whenever the Venereal Matter is applied to them increase their secretion to wash away the offending matter. 1256. But the further consequence of the application of Venereal matter to the Natural & Accidental secreting surface will be different, of the former it will in general only change the nature of the secreted fluid from the latter, it will first increase the quantity of secretion, & then producing for a time, a Gonorrhœa of the Sore, it will change the nature of the Sore from a common one to a Venereal one, & then the disposition to ulcerate will be increased & the sore be in every respect converted into a chancre of the 2d. species. – 1257. Whenever a part becomes infected with the Venereal Virus it takes on a new action, if it is a secreting or sine Cuticular Surface as above described the nature of the secretion will be changed, if on a secreting surface the ulcerative Absorption of the part will take place & the pus will be secreted. 1258. Some secreting surfaces seem more susceptible of the Venereal 🜍 1262 A Gentleman had Chancres many times, they always healed very readily but the slightest scratch from any accident he received always was extreemly difficult to heal, so that some are very susceptible of this Specific or Venereal Irritation tho highly so of any irritation. – 64 Venereal irritation than others, the urethra seems evidently distinguished to take it on. 1259. Absorption of Extraneous matter always goes on more readily from an Ulcer than from a fresh wound, or from a Canal, it must be evident then that the local consequent must more readily & frequently arise from the first than the second Species. 1260 The Venereal poison will be always the same in point of Strength or acrimony, it may indeed at one time be diluted through a larger quantity of Fluids than at another, but it will produce the effects of a poison in the smallest possible quantity. 1261. Yet it produces different effects in different subjects, in some it will cause the most violent in others the slightest affection, it is therefore evident the susceptibilities of different persons of its irritation must be very much. 1262. This (1261) will not be easily explained for the susceptability of venereal irritation will not be in proportion to the susceptability of other irritations. 🜍. 1263. The local consequent will differ nothing either in its nature or its ultimate Effects from the original local having the same power of poisoning other parts, or the constitution & the matter secreted in it being equally infectious as that of the 1st. or 2d. Species of the first Genus. 1264. A natural secreting surface cannot be affected by this poison, longer than a certain time for had it a power of keeping up a specific Action in the part longer than a certain time the duration of the disease would be endless, for fresh matter being continually secreted would be the cause of a still further secretion of similar 🜔🜹 1264. Parts lose their sensibility of the Stimuli applied to them, in the Urethra the nature of the Solids is not changed but only the mode of the Secretion, now in process of time the membrane becomes habituated to the presence of Venereal matter & is then no longer sensible of its Stimulus, which can now no more produce the specific disease & therefore the disease [always] decays & a natural Cure takes place (see Note 1265). 🜔 1265. When we consider the different methods different people have to curing the gonorrhœa & that all are successful many of whom cannot possibly have any specific action upon the part we may readily suppose in General the complaint goes off of itself. Cases. A Married Man, during several years had known no other Woman but his Wife, he at length lay with a Woman of the Town & caught a severe clap. The Woman who gave it to him was not sensible herself of the ailment she continued her connection with him for several months without perceiving any change. She then formed a new attachment & gave a Gonorrhœa to her second Lover, she had no marks whatever of the disease herself he continued his intercourse with her for sometime, but notwithstanding got cured the while at length the first lover Returned to her had connection with her only once & she clapped him again. 2 A Gentleman kept a Mistress who becoming clapped left him she applied to & was taken into the Magdalen hospital, where she was apparently cured, she continued in that Hospital 2 Years seemingly 65 similar matter & so on ad infinitum for it would still continue its secreting action. 🜔🜹. 1265. We are induced to believe this to be the case from knowing 1st. That all Gonorrhœas are cured without any Specific remedies. 2d. That a secreting surface will retain Venereal Matter after Inflammation is gone off & also a power of poisoning other parts for a considerable length of time without being sensible of the presence of Venereal matter or undergoing any morbid affection from its remaining in Contact with it. 3d. That the application of fresh Venereal matter may be applied to the secretory surface in question without increasing the present disease or even retarding the Cure 🜔. 1266 Note continued. ~ quite well & when discharged was picked up again immediately on her dismission by the Gentleman who had formerly kept her, to whom she nevertheless gave a severe gonorrhœa, he continued however to Cohabit with her & got quite well without interrupting his connection which at last he broke off. A Married Gentleman in the City took her into keeping & was immediately clapped by her he was likewise Cured although he continued his intercourse with her during the cure, his Mistress however left him & returned to her former lover whom she clapped the second time. These histories abundantly shew & serve to prove what has been advanced. Many more of the same kind could be adduced, moreover if the Venereal matter of a Gonorrhœa or a Chancre is applied to a Bubo, or that of a Bubo to a Chancre it will not in the least increase the disease or retard the Cure. If a Man continues to be intimate with a woman who has clapped him, & if he is cured & she not, still he will not receive fresh infection, that is provided he continues to cohabit with her but if he absents himself from her for sometime, that is until his Genital parts have recovered themselves & as it were lost the recollection of the Venereal Stimulus he will then get a fresh Gonorrhœa. This we see depends upon the force of habit, from being long accustomed to the Stimulus of Venereal Virus the parts lose their sensibility of it & cannot be irritated by it. thus in general if a Man gets several successive Claps the first will be the severest & they will become slighter & slighter every time, was a Man once clapped to continue during his Cure even so long afterwards his intercourse with Venereal Woman, it is extremly probable he would find it impossible to contract a fresh Venereal Gonorrhea (see habit 98) 🜖 1270. Where the pus discharged from Ulcers in the Urethra the Gonorrhea would not be cured without Mercury, which we [have] know is by no means the Case. – 66 1266. But this natural decay of the specific morbid action & spontaneous cure will only arise in natural secreting surfaces. wherever a chancre or Venereal Ulcer is formed no natural or spontaneous cure is ever effected, but the disease continues increasing in violence until it is cured by Art. 1267. The matter of a Gonorrhœa & Chancre is exactly similar & equally capable of poisoning other parts. A Gonorrhœa will produce in the same person a Chancre or a chancre, a Gonorrhœa, & both or either may produce a Constitutional disease, in general when the Chancre appears the Gonorrhœa goes off, & frequently the Gonorrhœa appearing the chancre will go off. It should therefore seem that one irritation cures the other, the two parts sympathizing with each other. 1268. It is extremly difficult to decide when the power of Contamination is entirely lost, persons sometimes retain a power of communicating the disease after not only inflammation but even the discharge has seemingly disappeared. 1269. If the Venereal poison is applied to a fresh Wound, or by means of any Wound, suppuration must in general first take place, before it can produce any effects on the body. 1270. The discharge from a Gonorrhœa is purulent but is very rarely attended with any Ulceration of the Urethra. 🜖. 1271. The local Consequent or bubo, sometimes neither Suppurates nor goes off by resolution, but becomes indolent & will 🜁 1272. We have seen the Chancre readily Cured in a person & he afterwards contracted a Gonorrhœa which was very severe and very difficult to remove. ∇ 1276. A Boy Eight years old swallowed some Milk & Water in which some Chancre had been bathed, with impunity; A Lady drank by mistake a bason of Milk & Water in which a Gentleman had washed his Chancre, it was near Eight hours after before she took an Emetic yet no bad consequence ensued. 67 frequently remain in that state notwithstanding the use of the most powerful remedies. 1272. Not only different person will be affected by the Venereal Virus in different degrees of violence (1261) but the same Remark will hold good with respect to different parts of the Body. 🜁. 1273. The second Genus or Constitutional ( ) takes place when the Venereal Virus is absorbed & carried into the Circulation. 1274. It may be communicated to the constitution by means either of Gonorrhœa or Chancres, sometimes although rarely from Venereal matter being applied to the surface at the body without Ulceration having previously taken place & sometimes from application of it to an Ulcer, without producing any change, but those two latter modes of infection are very Unfrequent. 1275. It may also be introduced into the System by poisoning a Wound, but there it must first produce inflammation & Suppuration in the same manner as inoculated Small Pox must produce Inflammation & suppuration in the place of incision before the constitution becomes infected. 1276. The Venereal Virus will not act as a poison applied to some parts of the body, it will have no effect upon the Stomach as has been proved by Experiment. ∇. 1277. The Venereal Virus cannot be taken in from the breath, sweat, saliva, milk or any other natural Secretion of a person labouring under the disease in its worst state. 1278. When the Venereal Virus is absorbed into the Circulation, it produces no change in the Blood, but has a power of producing local effects in different parts of the body, as blotches Ulcers, Nodes 1281. A Nurses breast inflamed & Ulcerated after suckling a child who had lately died. A Physician gave it as his opinion that the was Universal & that she had been giving suck to a pocky Child, but the event of the Case contradicted him Mercury did not mend the state of the sore, indeed New Sores broke out upon the breast while she was taking it, at length she left off Mercury & recovered by good diet & Country Air. 🜆. 1282. It has been supposed that if a pregnant Woman is poxed, the Infant in Utero must partake of the disease, if ever this is the Case, it can only happen from the original matter from a Sore being conveyed unaltered to the Child which is what we can hardly conceive to happen. 68 &ca. but it is certain the Venereal matter undergoes some change as the Ulcer &ca. so produced, that is from the constitution, have no poisonous quality, the matter from a Venereal constitutional Ulcer will not communicate Venereal infection nor will it differ in its powers from pus of common ulcers. 1279. The blood although the matter has been absorbed into the circulation will not communicate the disease to a second person nor are any of the secretions of a patient labouring under the 2d. Genus any ways infectious. 1280. The Venereal Virus then can never be communicated unless from a part, that labours under the 1st. Genus, or has an original local Complaint. 1281. It must be from hence evident, that the opinion that an infected Child unless it has its mouth or lips originally infected cannot communicate the disease to its Nurse, nor can the Milk of an infected Nurse communicate the disease to the Child. 1282. It is also most to be believed that a Child in Utero is never poxed, it may receive the infection in its passage through the Vagina &ca. & thus it may be locally & in the end universally effected. 🜆. 1283. Many Anomalous morbid appearances resemble the Venereal disease from which it is by no means easy to distinguish it by the Eye. 1284. The only unequivocal Criterions for assisting us in discriminating one from the other are. 1st. The Venereal Eruption, blotches, ulcer, or other  69 affection (Gonorrhœa excepted) whether originally local or constitutional ever disappears or is cured without the operation of Mercury its true & specific remedy. 2d. No Eruption, blotch, ulcer, or other affection that is truly Venereal will appear whilst the constitution is under the influence of Mercury. 1285. The same person may have both an Original local & a constitutional disease at the same time. Of the 1st. Genus a person may have both the first & second species at once & the first species or Gonorrhœa may be cured the Chancre or 2d. Species remaining notwithstanding & vice versa. 1286. So either or both species of the first genus may Exist together with the second or Constitutional & either or both Gonorrhœa & Chancre may be cured without the removal of the Constitutional disease. 1287. But the Chancre will not remain uncured when the 2d Genus is cured although the Gonorrhœa will yet continue to Exist 1288. [But the Chancre without will not remain un] The Constitutional as above noted almost always arises from some species of the first Genus but the Chancre or Gonorrhœa does not at all become altered or have its action awakened by Poxing the constitution. (1285) 1289. The specific local diseases have all their specific distance for action which they do not Exceed. So also the Venereal disease has its specific distance for local action [which they do not exceed] this is however not always the same Extent, being sometimes ♂. 1290. Mr. Hunter has proved this by a variety of Experiments on the dog, the Ass, the Bitch &ca. by soaking Lint in Venereal Virus from a Gonorrhœa & Chancres & introducing into the Vagina &ca. ♀ 1293. A Gentleman had blotches in his face which resembled Venereal ones & had been deem’d so by many Medicinal Men, he had also blotches in his Legs & Thighs, they continued for Six Months several of them having got well during that time & others broken out notwithstanding he took Mercury, he at length consulted Mr. J Hunter who judging of them according to his idea advanced in the Text, assured him they were not Venereal & advised him to leave off Medicines, to live well tho temperately & bath in the Sea if he chose it, in a few weeks he lost his complaints. A Nobleman labouring under some complaints which appeared to be Venereal (& which those who attended him assured him was so) consulted Mr. J. Hunter he was with much difficulty persuaded to leave off Medicines & take a sea voyage to change the Air, he followed this advice & was cured. When any disease affects the Genital parts, they are generally considered as Venereal, but Gonorrhœa, Sores in the Glans penis, Buboes may all arise without any Venereal infection, moreover there may be a variety of the morbid appearances that take place 70 affecting a small space; sometimes a larger one it is however always circumscribed, but when it spreads more widely than Common it has always a mixture of the Erysipelatous. 1290. The Venereal disease is peculiar to the human species other Animals not being susceptible of its irritation. ♂. 1291. Does the Venereal disease produce its effects by fermentation, or by producing a peculiar Action in the Solids? The Question is not easily determined. 1292. A Man who has got a pox may notwithstanding get a chancre or Gonorrhœa without increasing the Pox, it is evident then that when the habit is once infected with the Venereal poison, it cannot receive any addition from the absorption of fresh Venereal matter. 1293. Many diseases may imitate the appearance of Venereal but they arise, heal & break out again, a local disease from a pox never disappears until it is Cured, this then differs from other poisons never wearing itself out nor ever suffering the part to make a progress tow’rds a cure. ♀. 1294. When the Venereal Virus has been absorbed into the System it has in itself no particular tendency to produce affections of one part more than another but from some peculiarities in different parts of the body themselves, some parts will be more susceptible of the Venereal irritation than others & of course take on Venereal action soonest. 1295. One Cause which disposes parts to take on Venereal action readily is, Exposure to cold therefore it makes its appearances in in the constitutional disease or second Genus, which are common also to other diseases we are not therefore hastily to determine whether a disease is Venereal or not, but together with observing appearance, inform[ing] ourselves also of the history of the complaint previously. 🜋 1299. Thus the Tibia being of all bones most Exposed to the action of Cold is of all others most frequently affected. it may be objected that the tibia is actually colder than many parts which take on the disease before it, but we know whatever dispositions are formed in Bones they come into Action much more slowly than the soft parts. ☽︎☉ 1300. They are either not susceptible of the Venereal irritates or else they never come into the venereal action before the disease is totally Cured. 71 the more External parts of the body first, this reasoning is strengthened by observing. 1296. That the disease is found to prove much more speedy as well as much more violent in its action in cold than in warm Climates, in the latter it rarely arises to any great violence. 1297. The parts first in order of susceptibility are a. the Skin. b. the inside of the Mouth & throat &ca. c. the Tonsils 1298. The parts second in order of susceptibility are a. the Periosteum b the Fascia – c the Bones. 1299. The bones seem to be the more susceptible of it the more hard they are & the nearer the surface of the body, consequently the more exposed to the action of Cold 🜋 1300. Many of the internal parts are not liable (as far as experiment hath proved) to the venereal Action as the brain, the Stom: the Liver, the heart &ca. - ☽︎☉. 1301. The Lungs are sometimes the Seat of the Venereal disease although they are late in coming into action, perhaps their susceptibility of this irritation depends upon their being in some measure an External part. 1302. The Venereal Matter when taken into the constitution does not long continue in the Circulation, but produces its action on the parts susceptible of the disease & is then thrown off by some of the secretions as any other extraneous matter. 1303. It does not long continue circulating in the System we know this because the parts first in order may be cured & the parts second in order still remain uncured, yet the first parts will not again take on the diseased Action now were the Venereal matter 🝄 1303. Thus if a Man with Venereal blotches & also diseased bones is put under a course of mercury, the disease of the Skin may be cured that of the bones notwithstanding remaining the diseased action of the bones may continue to go on if he leaves of mercury but the disease will not again appear on the Skin. 1306. When a part has received a strong disposition fraction a cure sometimes cannot be effected until the disposition has actually gone into Action. A Man might suppose that those parts which are most susceptible of the Venereal irritation, would in the advanced Stages of the disease suffer the most violently, but this is not the case a part having gone fully into action loses the susceptibility of the irritation which it had at first. 🜔 1309. A Man who has a Gleet though he has connection with a venereal Woman, will not catch a fresh Gonorrhœa. 72 still circulating in the blood there would be no reson why the parts first in order should not again fall into disease. 🝄. 1304. Dispositions once formed will go on to action though some time may Elapse before that action appears (see 167) Parts having received the Venereal taint; will if left to themselves always go on to diseased action although the distance of time may be considerable. 1305. Hence we may understand why many parts of the different orders may be contaminated at the same time, but their diseased appearance may take place at different Periods. – 1306. Those parts which most readily fall into the specific Action are the first in going through a Cure. 1307. As a further proof that the Venereal matter becomes altered when taken into the Constitution, we may observe that an ulcer that is constitutional Venereal, on the application of venereal matter from originally & locally diseased parts will catch a Gonorrhœa & so take on the action of an original Sore, now the matter of one Constitutional Sore will not excite another Constitutional Sore. 1308. If the matter of a Gonorrhœa is applied to a chancre it will produce no new effect vice versa. Again the matter of one originally local sore or Chancre will not irritate another Chancre. 1309. A part which has lately been under the irritation of Venereal matter will not readily take on the same diseased Affection again. 🜔. 1310. The seat of the first species of the first Genus ( ) in Men is the Urethra; the surface of the glans penis, the internal surface of the proputium. ∇ 1318. Perhaps the changes of Colour in the discharge will [depe??] upon a small quantity of blood being extravasated & mixed with it: 73 1311, Its attack on the prepuce & glans Penis is generally at the root of the latter & the beginning of the preputium, here the cuticle is extreemly thin & the cutis is easily affected. 1312. It there produces itching, soreness & tenderness with a discharge of thin matter. 1313. When this part takes on the disease the Symptoms begin very early. Forty Eight hours have been the whole of the time elapsed between the Infection & the appearance of them. 1314. When the Urethra is the seat of the Clap, the inflammation generally has its place within an inch or an inch & half of the external opening. 1315. It mostly begins with a sense of itching at the end of the orifice & sometimes over the whole glans, the lips of the orifice will be unusually full & turned somewhat outwards. The Penis in general seems somewhat enlarged. Pain, heat & uneasiness in passing the Urine, sometimes preceded by & sometimes following the appearance of a running from the Urethra, the canal of the urethra fells inflamed, the Patient voids his urine with fear from the sense of the smarting & then the urine comes off in small or in divided streams. 1316. The Glands of the Urethra become inflamed & swollen, they become hard & may be felt on the underside of the Urethra. 1317. According to the period & the degree of inflammation the discharge becomes of different colours & different in consistence its Venereal virulency is however always the same. 1318. The matter if received upon cloth will be found to give it spots of variegated hues in the centre of the Spot the colour will be darker & paler in the circumference. ∇.  74 1319. The matter will have a Smell peculiar to itself which will be fœtid & disposed to putrefaction. 1320. The Symptoms & progress of the Complaint will differ very much according to the susceptibility of the parts & the degree & Extent of inflammation. 1321. The more violent the Inflammation &ca. the more commonly will it produce great extravasation of coagulable lymph Occasioning Cordee, Soreness of the whole length of the Urethra, Even to the Anus, producing a sensation like that of Chordee Inflammation & hardness of the Glans Penis. Hemorrhage from the Urethra, Various Sympathies. 1322. The running comes from the urethra & its glands & in general not high up, it does not come from the bulbous portion of the Urethra, otherwise it would be thrown out by Jerks & not run off in the manner it is known to do. 1323. On the Examination of patients after death which at the time of their dissolution laboured under this complaint, the ducts leading from the Glands have been found filled with matter. 1324. The inflammation penetrating very deep, Coopers Glands may inflame, suppurate, & produce an abscess which is frequently the cause of fistula in Perineo. 1325. [The inflammation penetrating very deep, Coopers glands] [may inflame, &] The cause of the Gonorrhœa of the Urethra must be a transition of the matter from the external part to the inner surface of that membrane although it is difficult to account for the manner in which it is introduced. 1326. It certainly can never be introduced, but 1326. We know it may be communicated this way. An Officer who had no intercourse with the female Sex for a considerable length of time when in Germany, went to a necessary the tube of which according to the custom of the country went tapering downwards, when he arose from his seat he found something sticking to his Penis upon taking it off he found it was a plaister from a sore which some other person using the necessary had left behind him in a few days after a gonorrhœa appeared. 75. the external part must always receive the venereal infection. 1327. Chordee is of two kinds Viz. 1st. The Inflammatory 2d. The simple spasmodic. 1328. The first is owing to an Extravasation of Coagulable Lymph in the reticular substance & in the Corpus Spongiosum generally in the lower part of the penis, this is much more obstinate & remains much longer than the spasmodic which is without extravasation & comes & goes at uncertain periods of time. 1329. The Hemorrhage arises from rupture of some Vessel of the Urethra, either by a Spasm, or giving way to the encreased violence of the circulation. The Hemorrhage is sometimes considerable & for the present relieves not unfrequently the violence of the Inflammation & its consequences. 1330. The parts that Sympathize with the Urethra will be a. the Testicle. b. the Bladder c. the Muscles of the Urethra & Penis. d. the Glands of the Groin. e. the Whole Pelvis f. the Loins. g. the Stomach h. the Whole Constitution. 1331. Sometimes there will be an Erysipelatous Eruption of the neighbouring parts. 1332. At different periods of the Gonorrhœa, the testicle will sometimes becomes swolen, this is never to be accounted a Venereal but 🜨 1339. The Inguinal Glands swell, it is to be doubled if they are sometimes Inflammatory but purely spasmodic. The swelling of the Testicle will sometimes arise suddenly in a few minutes & go off as readily requires [only] often less time for it to subside in by a great deal than the common swelling of the Testicle after the radical cure of the Hydrocele the swelling will sometimes change sides being similar as to the Gouty sympathy of the Testicle. 76 purely a sympathetic affection of the testicle, sympathizing with ye. Urethra. 1333. A swelling of the Testicle may arise from any Cause irritating the Urethra, even the passing a bougie has brought it on. 1334. It sometimes appears during the more inflammatory Stage of the gonorrhœa but more frequently when the inflammation has abated, & it is sometimes attended with an increased, sometimes with a stopping of the running. 1335. The complaint begins with a pulpy & softened feel of the Testicle a slight enlargement of it, & a sense of increased painfulness on the touch or pressure, its tumefaction then increases & it grows hard, especially the Epidydymis. 1336. Sympathy produces pain in the original seat of the Testicle the loins, nausea & sickness, even Vomiting loss of appetite, uneasiness in the Bowels &ca.. – 1337. The swelling of the Testicle is not peculiar to the gonorrhœa it is often produced by Gout, Cancer & Scrophula, although more slowly by the latter. 1338. When the bladder Sympathizes, Strangury & the common symptoms of Stone in the bladder will occur. 1339. The inguinal Glands swell from Sympathy, rarely terminate in suppuration & as well as the swolen testicle are often curable without Mercury which shews that they are not Venereal. 🜨 1340. The Muscles of the penis will Sympathize, & often undergo a Spasm producing sudden & involuntary erections of the Organ which are called Spasmodic. ☿. 1343. In one person---10 hours. Another---20 hours In many---36 hours D°.---2 Days D°.---6 Days. In a great number---12 Days In many---4 Weeks In some---6 Weeks. 🜔🜹 1345. In a boy the Gonorrhœa returned twice whilst he was cutting his Teeth. – 77 1341. Of the Loins, Pelvis, & Kidney sympathizing with the Urethra it is unnecessary to speak, further than noticing the facts that Pain of those parts often attends Gonorrhœa. 1342. When the whole Constitution sympathizes there will be slight rigors, heat & other mild Symptoms of general irritation. 1343. The distance between the time of infection & the appearance of the Symptoms, so far as can be ascertained is all the intermediate time between 10 hours & 6 Weeks, most commonly however within twelve days. ☿. 1344. The Gonorrhœa is not peculiar to the Venereal diseases a discharge from the Urethra, without heat &ca. has been known to accompany gouty & rheumatic affections of the body. 1345. It has moreover been known to Sympathize with cutting the teeth. 🜔🜹. 1346. The Urethra of a Patient who has once had the disease is ever after Extreemly liable to it. 1347. We should endeavour to distinguish a gleet from a Venereal Gonorrhœa, in the gleet the glans penis does not change color nor does it sweat a kind of pus as it does in the Venereal Gonorrhœa 1348. It often goes off spontaneously & then it makes a somewhat puzzling Case, it has no specific remedy. 1349. A Constitutional disease in the 2d. Genus is as we have above observed sometimes though not very often known to Arise from the first Species of the first Genus, whenever there is a kind of hard Cord arises, leading from the penis to the Glands in the groin absorption of the virus is always to be suspected & the Constitutional 1354 The Vagina is not a part very sensible to common irritation hence matter may remain. ♀ 1356 A Woman had a Bubo formed in the Groin without having the least of any preceding affection. – 78 Genus feared. 1350 This circumstance most usually Occurs in the gonorrhea of the Glands & Prepuce. The 2d. Genus has also followed an internal gonorrhea in which there was a rupture of a vessel & an hemorrhage from the urethra consequently an internal wound, but it is very rarely the virus is communicated to the System by means of a Wound. 1351. The seat of the first species of the first Genus in Women is the Vagina, Nymphe, Clitoris & Urethra. 1352 It is not so complicated in women as in men, its symptoms are much milder & it is still with more difficulty ascertained. 1353. Appearances will in general give little information nor will its Symptoms enable us to decide. 1354. We can only judge the Woman has the disease, if she has the common symptoms following her connection with an infected Man, or if she whilst labouring under these Symptoms gives the disease to some sound person. 1355. We cannot however always determine that a woman has a Gonorrhœa because she communicates infection to a Man as her genital parts may have a power of receiving & communicating the infection without having ever felt any Complaint herself, or may retain the power of poisoning after the gonorrhœa has been Cured. 1356 From this it must be evident that a Woman does not always, know whether she has or has not the disease. ♀. 1357. The common Symptoms of a Gonorrhœa in Women are  79 pretty similar to these in Men, as smarting in making water a Running from the Vagina, a disagreable Sensation of the External Parts as the Clitoris & Nymphæ a fullness of the Labia pain in walking & the complaint rarely having exacerbations except at the time of making water. 1358. Sometimes the discharge will run down from the Vagina to the Anus & produce exulcerations of the Perineum. 1359. When the disease goes on, as in (1358) it is very doubtful whether it will there spend its violence as in the Gonorrhœa in Men 1360. In both Sexes previous to the appearance of the discharge the constitution will sometimes become affected (as in 1342) & a strange & unusual sensation of the parts will be perceived. 1361. Gonorrhœa without infection may arise in both Sexes from Various Causes. (1344). 1362 Although a Gonorrhœa will sometimes cure itself ( ) & we have no Specific for the disease ( ) yet we can shorten its duration & lessen its Symptoms by proper remedies. 1363. These remedies are divided into internal & topical 1364. The internal ones are Either a. Evacuants – or b. Astringents. The topical ones are Either a. Injections.. or b. Bougies. 1365. Mercury is the Specific for the Venereal disease but it seems of no other use in the Gonorrhea, than with a view to the absorption of the Venereal matter in the part thereby preventing  80 preventing its affecting the constitution, but this we have observed rarely happens & we have no reason to believe Mercury has any Specific power on the Affection of the membranous part of the Urethra 1366. Keeping the bowels regular is necessary in health & therefore useful in this Complaint, tho purging is not generally serviceable yet we have seen a brisk purge entirely cure the affection in which case it must operate either by derivation or by Sympathy. 1367. Diuretics are so far useful as by their effects in the urinary secretion they may lessen the violence of the irritation. Water is the best but will generally require to be accompanied with some mucilaginous substance. 1368. Balsams & Turpentines may be their Specific Operation on the part affected produce also a change in its diseased action & consequently effect a Cure. 1369. Astringents (1364b). do not lessen the Venereal irritation, but they may prove of some service by lessening the quantity of the discharge. 1370. Topical Applications (1364) must either be fluid or Solid, the fluids are injections, the solids bougies. 1371. The effects of the solid must be more permanent as it can be kept longer in contact with the parts affected; however it produces so much irritation that in general their use is better omitted. 1372. Injections may be divided into a Irritating b Astringent  81 c Sedative d. Emollient injections. 1373. Injections curing Gonorrhœa suddenly have been supposed to lock up the poison & throw it into the Constitution, but this Opinion is erroneous – for 1374 The Effect of the Injection here is to stop the farther secretion of matter, if then this is accomplished, it is evident that injections must contribute rather to the prevention of the 2d. Genus than bringing it on, the common vehicle of the poison being matter. 1375. Injections may either take off the Inflammation & the consequent increased secretion, or they may stop the secretion without removing the Venereal Inflammation. 1376. The irritating Injections are mostly astringent when made Weaker & astringent injections when made stronger will act as irritating. 1377. Injections are irritating when they produce an irritation greater than that of the disease itself. 1378. Irritating injections are in general improper, where the Constitution is extremly irritable & the inflammation has spread beyond the Venereal point, when used in this case they have become the causes of Fistula in Perineo. 1379. Where the disease is milder they generally succeed sooner in removing the Symptoms, for they produce the Cure by giving an irritation greater than that given by the disease which being overcome by a greater Stimulus leaves the part. They must therefore be improper where the parts cannot without danger of increased mischief bear 🜍 1379. A proper injection for this purpose is a solution of Sublimate in water (weak) if it gives pain it may be still further diluted. 🜔 1381. When a secreting Surface has been inflamed, & the part has received a disposition to secrete, the compleat Action being taken on is a step tow’rds the Cure, we therefore see why Astringents by checking the secretion may sometimes produce a Cure. 82 a more powerful irritation than that already produced & present. 🜍 1380. Astringents may Cure a slight disease, they act by lessening the discharge, & as they produce an affection of the living Solids they may contribute to a Cure. 1381. They make the Vessels contract & lessen the discharge, however they often produce a lessening of the discharge only, without forwarding the Cure, nay they sometimes protract the Cure. 🜔. 1382. Emollients in violent inflammations are very useful washing away the stimulating matter & leaving the surface of the part Soft & smooth. 1383. Sedatives ( ) sooth pain & abate inflammation, Opium is undoubtedly the best & most general sedative, but does not agree universally. 1384. Sometimes the end of the Canal & of the Urethra at the Glands is contracted by Inflammation, which is a troublesome circumstance & indicates the Omission for the present of bougies or injections. 1385. Other topical means as Mercurial Ointment, medicated Poultices, Fomentations &ca. can do little good Except when the External parts are the seat of the disease, or unless the Glands of the Urethra are so swolen as to be perceptible externally in which case we may use Ung: Cerul: fort. 1386. In Hemorrhages from the Urethra we have seen benefit afforded by the internal use of Turpentine & Balsams, Injections are not only useless but hurtful here. 1387. Opium given internally has powerful effects in preventing painful Erections & soreness of the Penis.  83 1388. The Cordee is in the beginning relieved by bleeding from the System & still more by Leeches applied to the part, & we are the more encouraged to practice the latter as we have observed that a Spontaneous hemorrhage from the rupture of some vessel in the Urethra has removed Chordee; Medicated Poultices & Camphor internally, sometimes affords relief. 1389. Chordee often continues after inflammation of the parts has subsided, from the Coagulable Lymph remaining Extravasated, whatever then will tend to produce absorption of the lymph will carry it off Mercurial Ointment, Electricity, Friction & Cicuta are all found serviceable, the affection will however continue often, long after the complaints have ceased & then go off slowly. 1390. In the Spasmodic Chordee ( ) we have known Bark singularly useful. 1391. If the Glands of the Urethra suppurate they become of the nature & produce the effect of chancres, & as such they may be treated. 1392. When the bladder takes on the affections (1338) the complaint is rarely inflammatory but mostly Sympathetic. Bleeding is rarely useful, & is if employed at all, to be managed with caution & in general topically the Warm bath. Plasters of Opium to the Perineum & to the origin of the Nerves of the Bladder & Clysters with Opium will commonly succeed. 1393. This Symptom in general is not hazardous but it is to be suspected that it sometimes lays the foundation for future mischief. Δ 1396. Perhaps the Practice of employing Vomits arose from Relief having been given by a Vomit administred to cure a sickness in the Stomach caused by Inflammation of the Testicle. 84 1394 When the Testis is swoln (1333) Rest in an horizontal Position, with the common treatment of inflammatory affections is to be insisted on. 1396. Vomits have sometimes great power in carrying off this affection. Δ. 1397. It is not determined how far Mercury is useful in Cases of swelled Testicle, we have reason to believe it may sometimes be Efficacious after the Inflammation is over. 1398. Sometimes the Testis takes on the suppurative Inflammation & an Abscess is formed which however requires no Particular treatment, as it is not Venereal matter that is formed Mercury is unnecessary. 1399. When resolution takes place the swelling of the Testicle subsides but slowly when it diminishes it grows gradually softer especially in the forepart & which sometimes becomes even softer than natural. 1400. The Epidydymis however generally continues hard & it is to be suspected that in consequence of that circumstance the testis is sometimes rendered useless, yet in general no inconvenience is observed to arise from it. 1401. The cure of the Gonorrhœa in Women is still more simple than in Men, Washes & Injections are proper here also. When the Vagina is the seat of the complaint, the internal surface of it should be several times be greased as high as it can be reached by the finger with Mercurial Ointment. 1402. As the Vagina is less irritable & sensible than the Male  85 Urethra, the injections to be used for the former may be prepared of greater strength. 1403. If the Female Urethra is affected, injections will not be admissible, but Mercurial Ointment may be insinuated into that Canal as observed above, it is not easy to know when the Cure is compleated. 1404. Should the inflammation spread & affect Coopers Glands The Mercurial Ointment may have also be used, if they suppurate they are to be considered & treated as suppuratory Buboes. 1405. It is sometimes necessary to attend to the constitution in the Cure of Gonorrhœa. 1st. if the Constitution is strong & disposed to Fever, it may be right to bleed. 2d. if the Complaint should take place in a low weak irritable habit, & when the Inflammation has a disposition to diffuse itself (which sometimes it will even to the Bladder) then Evacuations will be hurtful, & the liberal use of Bark will be adviseable to destroy the diseased irritability. 1406. It is generally found that the Constitution disposed to fever & inflammation admits most easily of the gonorrhea being Cured. 1407. In some irritable Constitutions it has been observed that a fever arising the Symptoms have gone off & that when the fever has left the patient the local Symptoms have returned. Again in others the coming on of a Fever even when the disease was mild has increased the Gonorrhœa & the Fever again going off the Gonorrhœa ☍ 1409. It is difficult to say, if giving Mercury will always prove a preventitive to the second Genus, but it is the most sure means we know of at present & therefore to be advised, either the Mercurius Calcinatus, or Ointment are recommended 🜔🜹 1411. We have remarked that there is perhaps an impossibility of distinguishing between a Gleet & a Gonorrhea, we shall observe a case or two. Case 1 A Gentleman in April 1780 got a Gonorrhœa, Swelled Testicle &ca. in June all his Symptoms left him, except now & then a little discharge of slimy matter & mucus, Sept.1. he married & gave his Wife a clap. It is to be observed that he met with some difficulty in entering the Vagina & that perhaps from the force he exerted his inflammatory Symptoms returned. Case 2 A Gentleman had a Gonorrhea two Weeks after he lost every Symptom except a gleet he lay with & clapped his Wife. We know in some that the inflammation & running has been kept up even for 12 months & yet the patients have not clapped the Woman with whom during that time they have been connected. 86. Gonorrhœa has been cured. 1408. It is perhaps always right to have in view the possibility of absorption of Venereal matter into the habit especially whe the disease has been long standing. 1409. Altho’ Mercury has no specific Action on the Inflammation of the Urethra yet with a view to prevent the ill effects that may arise from venereal matter being absorbed into the System it is right to administer it, especially tow’rds the latter end of the Cure & when the process of absorption must be nearly at an end. ☍. 1410. We judge of the Gonorrhœas advancing to a Cure when the cherry colour of the Glans changes to a pale hue & other Symptoms also abate, as the running decreasing in quantity & becoming more slimy, Pain & tenderness of the penis going off. 1411. It often happens that the Symptoms will leave the patient he will continue well even for a month & then they shall return, but it is probable that they will not be found to be Venereal when they appear a second time. 🜔🜹. 1412. Strange sensations in the Urethra & Glans (especially when the bladder has been affected) will often be perceived by the Patient after the Gonorrhœa is gone off. These will sometimes be obstinate & troublesome & too commonly render the dissatisfied & credulous Patient the dupe of Quacks. 1413. An obstinate Gleet will sometimes be cured by means similar to these which gave rise to it. Viz. a New Inflammation. 1414. Among the Complaints which will remain after a Gonorrhœa is cured, are those (1411.1412) swelling of the Testicle & hardness  87 hardness of the Epidydymis, wasting of the Testicle, affections of the bladder, strictures in the urethra, Carbuncles, Fistula in Perineo Swelling of the prostate, paralysis of the Urethra & Paralysis of the Bladder. 1415. Gleet has nothing Specific in its Nature, nor can it produce in others a similar disease; it differs from Gonorrhea in a. That the true Gleet is never infectious. b. The discharge has its Globules, but the Globules swim in mucus not in Serum. 1416. It is incidental to all constitutions, the strong as well as the weak, it arises from various causes besides Gonorrhea. 1417. It sometimes goes of naturally but whether from some change taking place in the state of the parts which are the seat of the disease, or from the want of power to continue the discharge we do not determine. 1418. It generally takes its rise from an habit of action in the part & almost always accompanies strictures in the Urethra. 1419. We attempt to cure it by Art in three ways Viz. a. Constitutionally b Locally c Sympathetically. 1420. The Constitutional Cure may be divided into a Specific b Strengthening. 1421. Specific Medicines are Bals: Copais: &ca. if they do service it will generally be immediately perceived; but should no benefit be found for 5 or 6 Days they should be left off, should they relieve they should be persisted in for a length of time for if discontinued  88 discontinued the complaint will not uncommonly return. 1422. The strengthening Medicines act upon the disposition of the parts in question, or in common with that of the Habit in general. 1423. Medicinal applications, [cross out] may affect locally 1st. as Specific & these have more influence when applied locally than when by means of the System (1421). 2dly. As Astringents, as decoction of bark, solution of white Vitriol, Alum &ca. These produce their effects by causing a Peculiar tonic action in the parts, their use should be long persevered in to produce a Cure. 3dly. Local medicines may produce a Cure by the Violence they offer to the parts, but their use should be deferred until other methods have been tried they are followed by an increase of the discharge from the Urethra, of this kind are very stimulating injections as Solutions of Sublimate, & Bougies either simple or medicated. As to the time these should be employed of the injections are very irritating 2 or 3 times will be enough, if less irritating a Week or two. Simple bougies may be used 5 or 6 Weeks for bougies made irritating a much shorter time will suffice. 1424. The third general method is by means of Sympathy or Perhaps derivation, as a Gleets being cured by two Chancres being formed on the Glans Penis, or by applying a blister to the underside of the Urethra; or by Electricity &ca. – 1425. Uneasy sensations of the bladder & Urethra have been removed by blisters applied to the Perineum or loins, the use of Hemlock; injections of sublimate & other means, but blisters to the Perineum have 1425 Case. 1st: Sir Charles Bunburgs Servant had for a complaint of this kind consulted Dr. Warren. Messr. Pitt & Gunning without relief. Mr. Hunter applied a blister ad Perineum which soon cured him, it was kept open 6 Days. Case. 2d. A Portuguese Gentleman had for 2 Years after a Gonorrhœa, such uneasy sensations in his Urethra & bladder as to give Suspicion of a Stone. Mr. Hunter examined him per Anum as well as by sounding & found nothing unnatural, a blister was applied to the Perineum Which cured him almost immediately 2 Weeks after he got a fresh gonorrhœa but no Extraordinary circumstance attended it, nor dis his old Complaint return. 14 ☽︎ 1430. Case 1st A Surgeon had a Gonorrhea & Bubo, the testicle on one side Entirely disappeared. Case 2d. A Young Gentleman Aged 18, without any Clap had a spontaneous Inflammation of the Testis on one side it was wasted gradually to the size of an hone bean the spermatic chord unaltered, he had afterwards a similar attack upon the other Testis which continued wasting until not a trace of it was left. Case 3rd. By Dr. Atham late Worcester. A Gentleman had a fever, & an inflammation in the left Groin & Testis. The Testis suppurated, at length however the matter was 89. seemed imminently useful. 1426. In the Gleet. Rest in general should be recommended though sometimes the complaint has been removed by riding on Horseback, Regularity & Temperance are also generally necessary, though there are not wanting instances of the opposite effecting a Cure. 1427. In Women the Vagina is the seat of the Gleet the treatment recommended in Men will here also apply the use of bougies Excepted. 1428. Chordee remaining after the cessation of the other Symptoms. Rub the parts externally with Ung, Mer, joined with Camphor, Electricity may also be had recourse to. 1429. Hardness of the Epididymis after a swelling of the Testicle will sometimes remain through life without any ill consequences. Sometimes relief has been afforded by rubbing the Scrotum with Mercurial Ointment, sitting on the steam of warm Water &c. - 1430. The Testicles are subject to spontaneous diseases more than most (if any) other parts of the Body, like the teeth they are added only for particular purposes, & they will be (similar to the Thymus Gland or membrana pupillaris) sometimes wasted & at length entirely absorbed This may happen at any Age. ☽︎. 1431. This absorption of the Testicle will follow an inflammation of the Testis, Hydrocele, & hernia Scrotalis but sometimes will take place without any preceding disease at all. 1432. Obstruction to the free passage of the urine through the urethra may arise from different causes. Vizt. 1 Excrescences in the Canal reabsorbed & the testis continued to waste until not a vestige of it except a few loose fibres could be found. 90 2d. Tumor without the urethra pressing on its sides & hindering its free dilatation. 3d. Strictures of the Urethra. 1433. If when the urine passes off only in a small stream & with difficulty we pass a middling sized bougie & find we can introduce it with ease we have reason to suspect a tumor (1432 2). 1434. Caruncles or fleshy excrescences (1432 1) growing in the urethra are seldom though they are sometimes known to exist, Probably they are a kind of internal Wart. Ulcers in the urethra we have never met with. 1435. Strictures in the urethra (1432 3) are of 3 kinds. 1 Permanent – 2d. Spasmodic – 3 Mixed. 1436. All Canals whatever are subject to strictures consequently the Urethra is not exempt, & indeed this Canal is subject to them not particularly as the consequence of Gonorrhea because they frequently take place in the Urethra without any Venereal Symptom whatever preceding. 1437. The seat of the Gonorrhea is commonly very near the Orifice of the Urethra, the seat of the stricture is commonly in the membranous portion. 1438. They do not seem to arise from the use of injections nor do Bougies ever produce them. 1439. Ulcers in the Urethra have been supposed to be the Causes of strictures, but we have never met with such a Case. 1440. We do not understand properly the causes of Strictures in the Urethra any more than we understand why they should Occur in other Canals. 🜔^ 1446 This proves that the Urethra has something of a Muscular power. 91. 1441. When a Gleet remains obstinate & the urine flows in a smaller stream than common, or in divided Streams, or is Escerned wth. some difficulty there is reason to suspect a Stricture & we should Examine by passing a Bougie. 1442. Permanent Strictures may take place in the whole circumstance of the urethra making an annular stricture & opening the area of the Canal as though a piece of cord was drawn tight round the urethra, or they must Occupy one side of the urethra in which case the Contraction will not be circular, but only on one side & then the Area will not be so much diminished as in the other case but the general dilatation of the Urethra being resisted the figure of the Canal will be necessarily altered, the Extent of the strictures will also differ in length, more or less of the Urethra being occupied by them. 1443. The number of Strictures will be also different in different Urethra sometimes only one, sometimes 4. 5. or Six. 1444. The portion of Urethra in which the permanent Strictures takes place will be whiter & harder than the rest of the Canal. 1445. Permanent Strictures will continue to a great length of time even Years their formation & progress is slow they are generally for obvious reasons overlooked until they have become considerable. 1446. They are generally more troublesome in cold weather than in warm & therefore are worse in Winter than in Summer. 🜔^. 1447. Permanent stricture continuing for years, teizes the Patient & at length gives rise to the worst diseases irregular enlargements  92 in the Urethra, diseases of the Bladder, Fistula in Perineo &ca. 1448. To understand properly why these consequences should arise from strictures of the urethra as also the nature of spasmodic Stricture we should have a clear Idea of the Structure & functions of the bladder & Urethra. 1449. The Bladder is a Muscular bag & has a power of Contraction for expelling the Urine, it can contract itself to the smallest Size. – 1450. The Urethra is also a Muscular body & can contract itself so as to shut up its Canal entirely. 1451. In a natural & healthy state of both Urethra & bladder the following Circumstances must be present. 1st. The actions of the bladder & Urethra must be alternate, that is whilst the bladder is contracting itself to Expel the Urine it is necessary that the Urethra should dilate itself or become relaxed in order to admit of the free & regular Exit of the Urine. 2ndly. When the Bladder has ceased from acting then it is requisite that the urethra should contract itself to present the dribbling away of Urine whilst the Bladder is in a state of relaxation. 3rdly. The Area of the Urethra when dilated must bear a certain proportion to the force with which the bladder acts in the Expulsion of the Urine. 4thly. The disposition of the bladder to contract and the disposition of the Urethra universally to be dilated must take place in the same point of time & the strength of the disposition in ♁. 1453. The Muscular coat of the Urethra has by these irritations been made 1/4 of an Inch thick. The Stone in the Bladder also produces a similar state of it by acting & dilating irregularly it often becomes fasciculated hence Sacs are formed in which Calculi are sometimes lodged. 93 each must be always in a certain & exact proportion. One to the other. 1452. From considering what is advanced (1449-50-51) we readily foresee, [greater than] That as a resistance given to the actions of an muscular body greater than it can overcome, & that frequently repeated, either increases its susceptibility of a disposition to Act, or otherwise Produces [adhes] a destruction of its Muscular powers & so renders it Paralytic, if by the Urethra not receiving or being insusceptible of a disposition to relax when the bladder is contracting, or not relaxing & dilating in due proportion of time & to a proper size of Canal, either an increased irritability & susceptibility of action in the bladder must take place, or its muscular powers being destroyed & Paralysis must occur. 1453. The Urethra not dilating in due time or to a proper size (1451-4.) & resistance being thereby made to the action of the bladder the latter increases the violence of its action to overcome the resistence, & this resistence being repeated every time the bladder has a disposition to Act, the Viscus becomes thickened, for the bladder like other muscular parts increases in density from frequent action & for a time at least in strength, it also becomes more irritable. ♁. 1454. If the resistance made to the Bladder is so great that it cannot overcome it but continues a length of time until the Urethra is either spontaneously or artificially dilated & this unconquerable resistence often repeated the muscular power of the bladder is destroyed & a paralysis of that Organ Succeeds. – 1459. Sometimes matter has been discharged from the Kidnies, Perhaps from the irritation & this without finding any Ulcer on dissection. 94 1455. If in consequence of Inflammation, partial contraction [&ca.] of the urethra &ca. the upper part of the urethra loses its power of Contraction, A paralysis of its muscular powers takes place, the Urethra is paralysed & no Contraction of the Urethra attends the dilatation of the Bladder, & the urine is continually dribbling off. 1456. If the Area of an portion of the Canal of the Urethra is diminished by permanent strictures in the Urethra, or any Tumor compressing its sides, so that although the Urethra has a disposition, in due time to become dilated, yet the urine not being evacuated with speed proportionable to the force with which the bladder acts will induce an irritable bladder & a thickening of its Coats. 1457. The Urethra may receive a disposition to contract irregularly without alteration of its structure & that only in particular parts this constitutes the Spasmodic stricture (1435 2). 1458. The Urethra may be permanently dilated in particular parts & contracted in others, by this means its surface will be unequal & often rough. 1459. The state of the bladder may be rendered such by distension of it & resistance of its contraction that it cannot admit the influx of fresh urine by the Ureters & the distention & enlargement of them shall be continued even to the pelvis of the Kidney which shall itself also become distended. 1460. It frequently happens that there shall be not only a permanent stricture lessening the size of the Canal of the Urethra, but also in the same Urethra a disposition to spasmodic contraction, this  95 constitutes the mixed Stricture (1451 3). 1461. The Urethra has sometimes a disposition to contract & close its canal independent of any alteration of its structure & loses not the disposition when the bladder gets into action, this being in fact a spasm of the Urethra we call it Spasmodic Stricture. 1462. Another cause of obstruction to the free passage of the urine may be as swelling of the prostrate gland. 1463 The use of the prostrate Gland is not understood, from its making a part of the urinary canal, it is evident that a swelling of it must produce an alteration in the state of the Urethra. 1464. When it is enlarged it stretches the Urethra Anteriorly & Posteriorly & flattens & narrows it laterally, the small Portion at the back part of it will Act as a valve to the Canal hindering the free Egress of the Urine. 1465. When greatly enlarged little or no Urine will be voided & all the Symptoms of an irritable bladder will come on. 1466. When there is no Symptom of disease in the Urinary canal & we can find neither stricture nor stone we should be led to Examine the state of the Prostate Gland. 1467. Pass the finger in Ano as far as the first joint if an hardness is felt extending higher than the finger can reach we may believe it to be a disease of the Gland. 1468. We may find this disease in two Stages. Vizt. 1st. When the Obstruction is not so great but a bougie or Catheter may still be passed into the bladder. 8. 1469 A Gentleman laboured under a Complaint of this kind by forcing the Catheter into the Bladder an Hemorrhage ensued the blood coagulating stopped up the holes of the Catheter when afterwards introduced into the bladder the Urine could not be drawn off & the patient died. – 96. 2dly. When neither one or the other can be introduced. 1469. we have noticed (1464) that a small posterior portion of the prostrate projecting into the Urethra sometimes Acts as a Valve through this projecting substance, a catheter has been sometimes forced into the Bladder which has ultimately terminated in death. 8. 1470. Permanent Strictures in the urethra give rise also to Fistula in Perineo. Nature endeavours to get rid of the stricture by producing an Ulcer in the part it occupies. 1471. But this is not always the Case the Seat of the Ulceration will be not unfrequently between the Stricture & the Bladder, whichever is the Case the ulceration directs its course from within outwards to give an exit to the urine as ulceration in Abscess observes a similar course to give an exit to the pus, with this difference however, that in the present instance the progress is slow with little or no inflammation, hence the Urine will insinuate itself into the Cellular substance & Corpus Spongiosum of the Urethra, so that the openings formed in the skin shall not correspond with the openings in the Urethra. 1472 This latter remark however will in general hold good only when the seat of the stricture is before the membranous part of the urethra, [than] when more posteriorly, the Ulceration is more Regular & more similar to that of Common Abscess. 1473. By the insinuation of the Urine into the Cellular Substance Inflammation of a considerable Extent followed by suppuration or even Gangrene may be induced. – ♂ 1479. Mr. Hunter does not allow that the Vesicula Semilaries contain Semen 97 1474. The prostate Gland, Coopers Glands, the bulbous part of the Urethra as well as the cellular substance may partake of the suppuration & the matter point externally. 1475. When an Abscess forms in perineo from this cause there is generally a free passage for the urine into the abscess & both its Opening from the Urethra & its external opening will not unusually admit a Catheter into the cavity. 1476. As in other Fistula so in those of the Perineum, the Ulcer in the Skin has generally a stronger disposition to heal than that of the deeper seated parts, hence the external Orifice will sometimes close & then the Urine insinuating itself diffusively into the cellular substance of the surrounding parts will at length make its way through a number of Orifices formed by Ulceration in the Skin of the Perineum Scrotum & even inside of the Thighs which are commonly the mouths of an equal member of surfaces. 1477. Seminal Weakness is considered as a consequence of Gonorrhœa Virulenta. 1478. The disease which commonly goes by this name is a copious discharge of a Dreglike mucus at the end of making Urine & in straining at going to stool in which Case there is often a copious discharge of Mucus which is considered as semen. 1479. But in reality this is not semen but the liquor of the prostate gland & Vesicula Seminales. ♂. 1480. As a proof that this is no discharge of semen we observe that it is common to old Men & that those who are afflicted wth. it find no diminution either of their venereal desires or of their  98. powers, that the quantity evacuated is often more than the quantity of Semen the Patient emits, that to produce it in some violent efforts are required as straining at stool or evacuating the last drops of urine, & lastly that patients have been immediately after this discharge has come away able to emit a fresh & natural quantity of real Semen which had the first been really it would have been impossible to do. 1481. It generally preys much upon the mind & imagination of the patient & hence rather than from its proper effects on the constitution renders him weak & debilitated. 1482. But real involuntary discharges of semen, may attend some patients & this is a matter of serious consideration. 1483. The Organs of Generation like many other parts consist of two parts. 1st. Those whose Action is primary as the Testes. 2d. Those whose Action is secondary as the Penis. The actions of the second should always follow the Actions of the 1st. irregularity in this circumstance is productive of Disease. 1484. When the Penis takes on action without the disposition of the Testes for action being increased, we have involuntary Erection of the Penis which may be similar to Cordee, except that it is attended with no pain or at most with only a sense of uneasiness similar to that which we experience in the part after Coition. 1485. Involuntary Erections of the Penis may be spontaneous 🜋 1485. I should imagine that Mr. Hunter means in this place Erections of the Penis taking place without any libidinous Ideas being first Excited in the mind. 99 or may arise from visible irritation of the member as virulent Gonorrhœa. 🜋. 1486. These Erections are to be considered as Spasmodic affections of the Muscular powers of the penis & therefore similar in their nature to Spasm of any other muscular part. 1487. But the Penis may not only act without any corresponding disposition in the Testicles, but the Testes may also act without any corresponding action in the Penis. 1488. This is the reverse of the other disease, the semen will here be discharged in every even the slightest occasion, the least friction of the Glans Penis, as in walking will produce an Emission, without any erection of the Penis, so will the most simple thought in Venereal matters, a dream in the least degree lascivious &ca. & here the Semen runs off like Stools or urine. 1489. Caruncles (1438) we may attempt the of by Producing ulceration of the carnosity whether this can be done by the Bougie is doubtful, when it fails the Caustic should be used in the manner hereafter described in the treatment of strictures. 1490. The permanent stricture is to be cured either by a. Dilatation. or – b. Ulceration. 1491. The method (a) is by means of Bougies, in the use of which we must attend to certain directions here laid down. 1492. We are to be extreemly careful not to make a false or New passage by means of the bougie & we are also to ascertain if Possible whether any false passage for the Bougie has been  100. already made. 1493 If upon enquiry we learn from the patient that bougies have been already used & that ground was gained in the length of the bougie which was last introduced without however getting clear of the Stricture we have reason to fear a false passage is already made. 1494. Near the orifice in the glans Penis a bougie may by chance be thrust into the mouth of a Lacuna this should be attended to, because it scarcely happens that strictures so low down obstruct the passage of the bougie. 1495. We should first attempt to introduce a middling size bougie, if that will not pass we have recourse to a smaller and smaller until we come down to one of a minute size. 1496. The great inconvenience of using a small bougie is that it bends in the urethra & so doubles, we should in our introduction of the instrument endeavour to ascertain this, least we think that the bougie is advancing when it is only doubling 1497. When a bougie is introduced if it is doubling, it will generally recoil if the hand is removed, if it is really advanced into the Urethra the length that it seems to be it will not recoil if by taking away the hand we cease to push it forwards. 1498. When a bougie hesitates in its passage but does not Recoil we should stroak the perineum with one hand at the same time that with the other we gently push on the Instrument.  101 1499. sometimes an advantage is gained by giving the bougie (before it is introduced) the natural bend of the Urethra. 1500. If we can introduce the smallest bougie the cure of the Patient is generally in our hands as by increasing the size of the bougie in future introductions we can produce the necessary dilatation. 1501. We suffer the bougie to remain in the Urethra a longer, or shorter time according as the Patient can endure its pressure from 5 or 10 minutes to 2 or 3 hours & this we at first repeat daily until a large bougie can be easily passed & no obstruction to the stream of urine remains, we then pass it less frequently but as there is always a possibility of the complaint returning those therefore who have been afflicted with strictures should never pass any length of time without introducing a bougie. 1502. The most convenient season for using the bougie will be a little before bed time, or an hour or two before the Patient gets up in the Morning. 1503. If the weather is very cold the stricture may be more violent so as to prevent any urine passing off or the introduction of the smallest bougie hence we are to make use of such remedies as are temporary relaxants, as the warm bath, Clysters with opium, blisters to the Perineum &ca. – 1504. A Bougie sometimes cannot be introduced beyond the stricture the first time, in that Case we are to introduce it ♂ 1508. Formula for making bougies RS. Diachylon Shel lac. When bougies are introduced care should be taken to prevent the slipping into the bladder by tying thread or Narrow tape to the round their upper end & bending it over the Glans Penis. Some persons have such a disposition to form calcareous concretions that a bougie Cannot remain in their bladder a few hours without being incrusted with calcareous matter & persons should use a great deal of exercise. Mr. Bromfied cut a Bougie out of a young Mans bladder when it had remained two weeks & a large quantity of calcareous Earth had Crystalized upon it. In passing a bougie it may be stopped by a Lacuna draw it back in that case, turn it & you will avoid that orifice 102 gently as far as practicable into the Urethra & leave it there for sometime by several repetitions of this practice we may expect in general to get beyond the stricture. 1505. From an increase in the disposition of the urethra to contraction, it will sometimes happen that we may be able this day to pass a bougie & quite unable the next. 1506. The passage through the stricture is not always straight this we shall best judge of from the appearance of the bougie after it is withdrawn. 1507. The Bougie does not act in the cure of strictures simply as a wedge, that is in the manner it could do in a dead Urethra but it acts upon & produces a reaction of the living parts & the cure is accomplished either by the parts habituating themselves to the pressure or by intesticial Absorption being excited. 1508, We also proposed to Cure strictures in the Urethra by ulceration & this is effected either by the irritation of a large bougie continued until ulcerative absorption arises or by means of a caustic. ♂. - 1509. Although the stricture is not an originally forms and therefore being a weak part may without much difficulty be made to ulcerate, yet great care must be taken that the Bougie is not forced into the Corpus Spongiosum Urethra which has been done & the instrument pushed even through the cellular substance of the Rectum.  103 1510 It may not be useless to repeat the remark, that if in passing a bougie it seems to make considerable progress & at the same time to be confined by the stricture there is room to suspect there is a new Passage forced open. 1511. Of this as well as of suffering a bougie to slip into the bladder the Surgeon should ever be extreemly cautious. 1512. The Cure by Ulceration is (generally speaking) to be Confined to that part of the Urethra which is straight & then in Cases Strictures not readily yielding to the pressure of the bougie it may be properly had recourse to. 1513. The method of producing ulceration by means of the Caustic may be employed When the bougie cannot be passed & the stricture is in the straight part of the [cross out] Urethra. 1514. The following instruments are necessary. 1st A Silver Canula 2d A Stillet, one End of which solid like a blunt probe, the other made of Gold, like a port Crayon & in the [Gill??] a piece of caustic is to be fixed. 1515. In this Operation the Canula Enclosing the stillet with the probe end downwards is to be introduced up the urethra until the probe strikes against the stricture the stillet is then to be withdrawn & turning the end Armed with the Caustic downwards to be again introduced through the Canula until the Caustic comes in contact with the Stricture where it is to be held for a ☿ 1515. Mr. Hunter observes that in some cases of stricture in the Urethra he has succeeded by means of Caustic beyond all Expectation. In one Case where the Stricture was between the membranous part of the Urethra & the Glans Penis a few to with the caustic enabled him to pass a bougie. In two other Cases in which the stricture had produced Fistula in Perineo & one of which suffered no Urine to Pass by the Penis the Caustic produced a Cure He farther remarks that it is safer to use the caustic than to persevere too long in irritating the Stricture the bougie, as force in the latter case is so easily products of a new Passage. 1519. If it slips within the Urethra so that it cannot taken hold of by the finger or forceps endeavour by grasper the Penis tight in one hand to prevent its getting further towards the Bladder, & with the other hand gently draw the Penis forward then backwards, so as if possible to work the End of the bougie upwards until it comes within reach of the Forceps 104. minute or two & then removed, this process is to be repeated every other day until the intent is accomplished. ☿. 1516. The patient should make water immediately after the Stillet is withdrawn or else warm water should be gently injected to wash off any portions of caustic that may be left in the Urethra. 1517. A slight Ischuria sometimes follows this method of cure which rarely yields to the common remedies. 1518. The ill effects that may follow the use of bougies besides making falsa passages are 1st. That the first time or two that the bougie is introduced many patients will be affected with sickness & Syncope but this goes off of its own accord & does not return on subsequent Repetitions of the use of the bougie. 2d. a discharge of pus from the urethra when before there was none & an increase of that secretion when before existing this is however an effect of little consequence. 3d. An inflammation & swelling of the Testicle in which the common treatment is to be had recourse to. 4th A Sympathetic Swelling of the inguinal Glands 5th. A Bougie slipping into the Bladder may form an nucleus for stone, should it slip so far that it cannot be taken of in the urethra, it must be extracted by the operation of Lithotomy. 1520. The Bougie making a new passage is not in general Forceps or Fingers, should this be ineffectual the bougie must be fixed steadily in the Urethra, Cut down upon & Extracted. ♎︎ 1522. Pass a staff into the Urethra as far as it will go which will generally be to the bottom of the new passage & beyond the stricture; the feel for the end of the Instrument Externally & cut down into its groove, making a wound of an inch or an Inch & half long, carrying the incision a little way into the Scrotum, then take a probe & pass it through the wound into the Urethra to the Stricture if it meets with an Obstruction pass two Canulas one on each side of the Obstruction until they are brought as near to each other as possible, then thrust a piercer from within one Canula, through the obstruction into the other Canula & withdrawing it supply its place with a bougie, next remove the lower Cannula & the Bougie will appear in the Wound, next take out the upper Canula & introduce the bougie along the Canal of the Urethra into the Bladder, it may be right then to lay the new passage Open through the whole of its extent that all may heal together, & least the new passage should receive in future the end of the bougie & prove an hindrance to the Cure As it may be difficult to introduce a second bougie after withdrawing the first, the first should be suffered to remain in the bladder for some time or perhaps it may be better to use the first time a flexible Catheter afterwards the bougies should be increased in size & their use persisted in until a Cure is attained. 105 productive of new disease, as the mischief done is generally early discovered but will impede the Cure of the present. 1521 If the Bougie [making a new passage is not in go] has made its way through the Spongy body of the Urethra it will pass onwards towards the Rectum if in the membranous portion it will take another direction. 1522. The Remedy for or cure of the New Passage is to be performed by incision. ♎︎. 1523 In the performing of which it must be a principle that the Urethra is to be fairly incised beyond the extent of the Stricture. 1524. In the spasmodic Stricture if the Symptoms are urgent we must have recourse at once to the bougie or the Catheter, the bougie is the least hazardous & a large one can often be Easily passed & will then readily relieve the patient even when we cannot pass it, by carrying it as far as we can without force & then leaving it, the stimulus its presence gives to the Urethra will take off the stricture & permit the urine to flow. 1525. We may internally administer Opium & the Turpentines Camphor may relieve this Spasm as well as strangury produced by Cantharides. Externally we may use Fomentations – Warm Bath – Steams of warm Water Blisters to the Perineum or loins &ca. 1526. There will rarely be permanent strictures producing  106 urgent Symptoms without spasmodic Affections of the Urethra also taking place. In the mixed stricture we shall find sufficient directions for practice by attending to what has been advanced in the other two Species the permanent & Spasmodic. 1527. In endeavouring to relieve the [Spasm] Bladder rendered morbidly irritable we should observe the following directions 1st. We should endeavour to remove all obstructions to the ready exit of the Urine. 2d. We should instruct the patient never to suppress an inclination to make water. 3d. We should endeavour to relieve the present urgent Symptoms by giving opium internally Clysters &ca. and 4th. We should try the effects of new irritation as a blister to the Perineum or to the loins. 1528. In case of paralysis of the bladder the catheter should be often introduced to keep the bladder from being distended & when we are evacuating the urine, pressure should be made by the hand upon the Belly we should also apply blisters to the Perineum or to the loins & give stimulating medicines internally. 1529. In paralysis of the Urethra which is a more rare complaint [attended with discharges] a similar mode of treatment is to be adopted especially the application of a blister to the Perineum [or to the loins & give]. 1530. Hemlock has seemed to be serviceable in the complaint Catheters employed for drawing of Urine should be considerably curved at the end & should be introduced carefully yet with some expedition, a flexible Catheter is to be preferred 🝄 1534 As the Female Urethra is short & straight no obstacle will arise to the use of the Caustic but should Bougies be used it will be requisite to retain them in their proper place & situation by means of a T bandage. 107 attended with a discharge of the liquor of the Prostate Gland & Vesicula Seminalis falsely called Seminal weakness ( ) bark & other astringents & strengtheners are also adviseable. 1531 Involuntary erections of the Penis being a nervous & Spasmodic Complaint, Antispasmodic Remedies may with propriety be called in such as Warm & Cold Bathing, Opium &ca. – 1532. In cases of real seminal weakness ( ) Opium has afforded singular benefit & may be use both internally & externally that is applied to the scrotum. 1533. The Enlarged Prostate ( ) is mostly incidental to Old men although Young Men have sometimes been affected wth. it. 1534. No cure is known for this complaint, Hemlock & Sea bathing may be beneficial, as the disease may not impossibly be owing to Scrophula, Opiates & Clysters should be frequently thrown up to Relieve the pain & lessen the irritation. 1535. In strictures of the Female urethra we can more easily succeed by the use of Caustic than bougies from the difficulty of retaining the latter & from the impracticability of their being passed by the patient herself. 1536. When in consequence of obstruction to the Exit of the Urine nature has made New passages for that fluid by the ulceration of the urethra & the formation of fistula in Perineo, we are to attempt the cure by carrying in our minds the general principles of the treatment of Fistula & also what has been already 🜖 1537. As the External parts are generally in a very disease and callus state we are not to be very delicate or sparing on using the Knife upon them, but if possible proceed so far as to make the several openings into one & to cut the Urethra beyond the stricture if the seat of the stricture is not already destroyed by ulceration. – 108 already laid down concerning the cure of new passages formed by an unskillful introduction of the bougie. (1522). 1537. In the Cure the staff is to be introduced in the manner before described upon which we are to cut down into the urethra then from the Urethra we are to pass a probe or flexible director into the sinuses that lead from the opening into the urethra & lay them all open as far as we can follow them. 🜖 1538. An hollow bougie is then to be introduced in the manner before described into the Bladder & the wound healed over it but there is a disadvantage attending the rise of the hollow bougie, which is, that its bore in too small to admit of the exit of the urine in a velocity proportioned to the force with which the Bladder acts. ( ). § We have already considered the consequences of Venereal irritation applied to a secreting or sine Cuticular surface, we now proceed to consider its effects when the matter is applied to a non secreting or cuticular surface the primary effects of which constitution the second species of the first Genus ( ) or local disease. 1539. If any irritating matter is applied to a secreting surface & the irritation is carried to a certain degree, then a change of that Secretion & a discharge of pus or the suppurative inflammation must take place. [1540. (If any irritating matter is applied to a non secre-]  109 1540. Irritation to a certain degree applied to a non secreting surface, suppuration must also follow, but that must be proceeded by ulceration 1541. We see therefore that if venereal matter is applied to the Skin & its application continued a sufficient length of time, ulcerative absorption of a small portion of the Skin takes place, & a chancre is formed. 1542. We have shewn (1254) that there are three ways in which a chancre may be formed. 1543. The second species, like the first is generally caught in Coition; it is not so common as the first species, we calculate that the first species is contracted four times for once that the second is, for the cuticle in general prevents its action on the cutis until the Venereal matter is some how washed off. 1544. The prepuce & Glans penis is the ordinary seat of it but the most common is the Frænum or the Angle between it & the Glans & this from the irregularity of its Surface. 1545. The distance of time between the infection & the appearance of the chancre is uncertain, it generally however makes its appearance later than the Gonorrhea. 1546. We have known a chancre appear 36 hours after coition we have known 7 weeks elapse between the time of Coition & the time of ulceration, we have known also an interval of two Months. 1547. It begins with an itching of the parts affected; if its  110 seat is the Glans there is not much tumefaction, if on the Prepuce there is a little discharge from the beginning at least more so than when the Glans as being a laxer part, the parts ulcerate or a small pimple is formed, or a little abscess especially if the Glans is the seat of it, a little hardness round about the pimple or ulceration is noticed. 1548. Should the Chancre be situated on the body of the Penis it generally begins with a Pimple which breaks & being little attended to at first, Scabs, the Scab is then Picked or rubbed off & a larger one forms, here the inflammation is more considerable than if the chancre begins on the Glans, less however than if upon the prepuce; an hardness generally surrounds it. 1549 The Canal of the Urethra often sympathizes with the External parts so far at least as Smarting, itching, tingling. Whether a discharge will arise simply from this sympathetic affection, we do not affirm, possibly however, not all Gonorrhea which are preceeded by a Chancre are specific. 1550. The Sympathy of the neighbourings parts with the seat of the Chancre is sometimes so strong that even touching the hairs on the Pubis create uneasiness. 1551. The Chancre will be attended with more or less pain & Inflammation according to the peculiar habit & disposition of the Patient. 1552. The local disease will spread with greater or less violence  111. sometimes considerable & deep sloughs will form Early & there will be Gangrene of some extent. The Ulceration will sometimes Penetrate so deep as to open the canal of the Urethra. 1553. The Prepuce is only a doubling of the Skin of the penis that it may be loose & convenient for Erection. The Phymosis or stricture confining it over the end of the Glans so that it cannot be retracted is a frequent consequence of chancre. 1554. The Phymosis often preceeds the Paraphymosis & is in fact frequently the cause of the latter for in patients attempting to get the Skin back it will sometimes be made to slip behind the Root of the Glans & will then take on a Stricture Strangulating the glans. 1555. The Phymosis in some Patients so entirely purses up the end of the prepuce as even to prevent the Exit of the Urine after it has passed through the urethra. 1556. In this disease there is a thickening of the Cellular substance of the prepuce & often an adhesive is formed between it and the Glans. 1557. It has often for its cause a disposition of the Erysipelatous kind, accompanying the venereal inflammation. 1558. The Phymosis if severe produces such a swelling of the prepuce as shall press violently against the end of the glans, & if there are sores or chancres underneath it which is not uncommonly the case the matter issuing from them will be confined ♄ 1559. A Young Man with chancres had a paraphymosis he came into St. Georges Hospital, the entire Glans & all the diseased parts gangrened & sloughed away the patient [reco??] Φ. 1565 Lunar Caustic is recommended, as most convenient it should be pointed like a pencil & the Sores touched with it once or twice a day, until they assume the red & healthy appearance of a common healing ulcer. 112 confined from which & from the pressure on the penis, the worst consequences will ensue even a mortification of the Penis. 1559. The paraphymosis strangulating the Glans will if not relieved sometimes produce a gangrene of the part strangulated & even a seperation of the whole diseased part. ♄ 1560. In Women chancres are apt to be more numerous than in Men & to spread to a larger size because the surface they have to spread over is of greater Extent, In them the Perineum is more subject to Chancres than in Men, from the facility with which the matter in their chancres in the labia & &ca. runs down to that part. 1561. Chancres are frequently attended with some peculiarities independent of the specific affections, & therefore some variety in their treatment may be necessary consequently it is requisite to attend to concomitant circumstances whether local or of the Constitution. 1562. Two modes of local Cure of Chancre are practised the one by extirpation the other by altering the nature of the irritation. 1563. In extirpating the object is not only to cure the chancre but also to prevent any communication of the vines to the System. 1564. Two methods of extirpation have been practised one by the dissecting out of the Chancre the other by destroying the diseased part by means of Caustic. 1565. When the Glans is the seat of the Chancre the Caustic is undoubtedly preferable. Φ. 🜔v 1569. Mercury is applied either in the form of an Ointment or by means of a watery Vehicle, the latter from its ready mixibility with the animal fluids is probably most efficacious; but it should be a rule to change the application often, as any one dressing will have its Efficacy diminished as the sore becomes more or less habituated to its action. 113 1566. Chancres may be dissected off the prepuce &ca. with a Knife, whether dissection or Caustic is employed it is proper afterwards to dress the Sore with mercurial Ointment as by that means we destroy any venereal Infection which may remain. 1567. Extirpation is improper when the chancre is large. 1568. The other mode of local Cure is by means of altering the nature of the Ulcer (which is done by Mercurial Ointment) in which there is no destruction of parts but only a destruction of venereal irritation. 1569. Mercury although it does not cure the first species is a Specific for the Second. ( ) 🜔v. 1570. Chancres to their specific disposition will often have superadded either indolence or irritability. In the former Mercurials should be mixed with stimulating balsams, in the latter Mercurials should be mixed with Opium & the oftener the latter are dressed, the better. – 1571. If a patient with a phymosis cannot submit to keeping his bed (a circumstance to be desired) he should use a proper suspensory bandage. 1572. Between the pressure & Glans an injection should be thrown often prepared either of Calomel, Gum Arabic & Water, or of mercurial Ointment incorporated with Mucilage of Gum Arabic, with Water, between the times of injecting mercurial Ointment may be rubbed on the outside, sometimes a poultice of vegeto mineral water & linseed meal affords relief. ♀ 1573. Oil of Turpentine is the best Styptic we are acquainted with. 🜔🜹. 1577. Many have recommended us not to open the prepuce by one longitudinal incision the whole length of it, but to make two slits one on each side which they say will save the necessity of making so long a wound, but they have drawn this reasoning from the natural Phymosis, which will by no means apply to the Phymosis from disease, in which the prepuce is very much tightned & incapable of yielding & stretching as in the natural Phymosis. Whenever disease makes it necessary to operate the Prepuce should be slit up its whole length. 114 1573. An Hæmorrhage the consequence of ulceration will sometimes happen, & is an extremly troublesome Symptom. ♀ 1574. When the Inflammation abates more the prepuce of the Glans frequently to prevent adhesions which would subject the patient to a permanent inconvenience. 1575. Should it happen that an ulceration of both the surfaces of Glans & Prepuce has taken place, the we must endeavour to prevent adhesion by the frequent use of injections thrown between the Glans & the prepuce. 1576. If the preputium is drawn much over the Glans & Contractd. & the opening of the Urethra is in a straight line with the end of the prepuce pass a bougie into the canal in order to prevent the ill consequences of the passage of the Urine being obstructed by the preputium adhering to the end of the Glans & closing itself over the Orifice of the Urethra. 1577. In this latter case, or in case the orifice in the Urethra is not in a right line with the end of the preputium we must slit open the prepuce & expose the Orifice. 🜔🜹 1578. In many Cases the Operation of the Phymosis is not adviseable, as where the inflammation is violent, or there is much tendency to Gangrene as the additional Violence of the operation must tend to encrease both. 1579. When matter is collected & confined in any part from the adhesion of the prepuce to the Glans, a wound by a Launcet should be made & the matter discharged, or if the fears of the Patient ☿. 1582 It sometimes however happens that mercury encreases the tendency to Gangrene, under which circumstance Bark should be administred alone. 115. patient object to the lancet, a small caustic may be employed. 1580. Mortification sometimes takes place in Phymosis & we have seen cases in which the whole Prepuce has slough’d away 1581. Hence we may suspect a faulty constitution & that the Inflammation was of the Erysipelatous kind. 1582. In these Cases Bark should be administred with Mercury thereby attacking at once the Venereal infection & the Constitutional disposition. ☿. 1583. A necessity for performing the operation for the Phymosis will appear to arise 1st. When the prepuce is so contracted over the Orifice of the Urethra as to become the Cause of hindering the exit of the Urine. & 2ndly. When added to this inconvenience or without it the matter from chancre is concluded by the prepuce becomes confined & cannot be evacuated on applications made to the Chancre Without dividing the Prepuce. 1584. An Operation for the relief of the [Patient] Paraphymosis becomes oftener necessary than in the Phymosis & danger of Gangrene &ca. from this Stricture will more often occur. 1585. The Operation consists in drawing up the integuments as much as may be with the fingers & Thumb & then passing a crooked bistory through the most strictured part & bringing it through from within outwards. 1586. In consequence of the Inflammation of the prepuce in Phymosis or Paraphymosis it will be often much elongated &  116. thickened so as to be much inconvenience to the Patient. 1587. If by proper applications as the steam of warm water, the fumes of Cinnabar or hemlock fomentations, we cannot reduce the swelling, it will be right to perform circumcision. 1588. Or we should at least remove as much of the prepuce as projects beyond the Glans, taking care however not to include any part of the Glans in the extirpation of the prepuce, & in healing the wound we should direct the patient often to draw the prepuce up & down to prevent the cicatrix contracting & forming a phymosis or stricture over the end of the Glans. 1589. Warts are no sign of a Pox, they arise in Gonorrhœa from the discharge from the Urethra touching any of the neighbouring parts. Chancres heal into Warts, Warts have an increasing power in themselves, often bleed, & are frequently painful. 1590. Mercury has been employed for their use & it is asserted will remove them, but our Experience does not warrant us to Affirm this to be the Case. 1591. As being new formed parts it is evident that their powers of supporting action must be weak by exciting a strong action in them & the surrounding parts by means of Powerful Stimulants we may produce in them a disposition to decay as a a more violent action will be thus produced than they are able to support. 1592. Rust of Copper mixed with powdered Savine is found to  117 answer this purpose (1591). 1593. They may also be extirpated by means of ligature, Excision or Caustic, but it is often found that by what means so ever they are removed they will frequently sprout up a fresh, in this case a repetition of the former process is necessary. 1594. Although Chancres may in general be cured by the local means above described, yet the introduction of Mercury into the System is adviseable, & generally to be insisted on both as forwarding the Cure of the local disease & as counteracting the effects of the virus if absorbed into the System. 1595. As we have remarked (1556) some variety will be necessary in the mode of treating chancres according to the concomitant disposition of the constitution or the part & this internally as well as Externally thus if there is a disposition to indolence we join some stimulating Medicines as the balsams with Mercury, if to irritability Opium, bark, &ca. – 1596. The quantity of Mercury to be introduced into the constitution should be in proportion to the number of chancres, their size & the time they have continued, it will be right to produce a slight spitting as a criterion of the Mercury having Acted in the System. 1597. Mercury may be carried into the System either from the Stomach or the Skin; when all the hardness is become softened & the Sore is skinned over the cure may in general be supposed  118. to be accomplished. 1598. This rule should however be applied to a large rather than to a small Chancre for in the former the Virus must in general be destroyed before the chancre will heal, yet in the latter the sore will sometimes skin over before the venereal virus is destroyed. 1599. It is better for the most part to continue the Mercury for sometime after the Chancre is healed to prevent any further action of the Venereal Virus by means of the Constitution. 1600. Chancres in Women should be often washed with solutions of corrosive sublimate & mercurial Ointment should be applied to them. 1601. The quantity of Mercury thrown into the Constitution should be greater in them than in others because their Chancres are commonly larger & more numerous. 1602. When the Ulcers spread considerably, if the seat of them is in the Vagina some extraneous body as lint &ca, should be kept between its sides to prevent their Cohering & Straitning & Closing the passage through the Vagina, an accident that has been known to take place. 1603. New diseased dispositions not venereal may arise during the Cure of chancres & remain after the venereal virus is destroyed. 1604. In some there will be a diffused inflammation of a Purplish 1606. Mr. Hunter has once known them to break out in two Months, these new ulcerations do not always appear immediately where the original Chancres were situated by a very small distance from the Cicatrix. 119. Purplish hue, about the sore which will be ragged & assume a cancerous appearance, these have been commonly considered as Cancers, but for the most part are only Scrophulous. In others there is a swelling & hardness with an indolent disposition. 1605 freely used in these Cases has proved serviceable, the Lisbon diet drink has also been found of singular utility Extract of Hemlock has done service, so has Sea bathing, & Opium used externally, if the disease extends near to the orifice of the Urethra care should be taken to prevent its closing, by means of a bougie, Extirpation of the diseased part if indolent may sometimes be requisite. 1606. The Cicatrices of Chancres after all the Virus is eradicated will sometimes breakout again such are generally but falsly considered as Venereal, the cure of these Ulcerations is uncertain. 1607. We recommend Sea bathing as highly useful in this diseased affection having experienced its efficacy in such Cases. 1608. From whatever surface the Venereal poison is absorbed the effect is ultimately the same. 1609. The Constitution may be affected by Venereal Virus in four ways 1st. By Venereal matter applied to a surface & absorbed into the System without any previous local effects. 2d. By Gonorrhœa. 3d. By a Venereal Ulcer, whether Chancre or Bubo. 4th. By a Wound. 🜔 1609. Mr. Hunter calculates the proportions of infection in the 2d. way to the 1st. was 100 to 1 & the 3d. to the 2d. is as 100 to 1 also. 120 The most general way by far is the third, the first scarcely ever happens. 🜔. 1610. The Venereal Matter being taken up (1609) by the Absorbents may previous to any constitutional affection give rise to the bubo or local consequent. (1252, 1263). 1611. The Venereal Bubo may be divided into. a. That in which the Absorbent Vessel itself being contaminated is the seat of the disease. b. Where the Lymphatic Gland in the line of Absorption is the part affected. 1612. The first very rarely occurs, when it does it is known by a resemblance to an hard Chord running along the dorsum Penis & leading to a Gland. 1613. The hardness is occasioned by a thickening of the coats of the inflamed Vessels. The absorbent sometimes suppurates & form a chain of abscesses along the Penis similar to the Abscesses of Veins (543) when suppurating they are to be considered as chancres. 1614. The first species is so rare that it is not noticed in speaking generally of Bubo. (1252). 1615. In the second kind which we commonly Call bubo the Venereal Matter is carried by the absorbents to the nearest of the Lymphatic Glands. 1616. The Lymphatic Glands consist of a Convolution of Vessels construded so, as very much to favour the stay of Venereal Matter in them a sufficient time to produce their contamination. ♀ 1617. First in Order---Inguinal Second in Order---Glands of the back. It would appear from this that the matter is diluted in its passage, the more probable reason however is, that the second order are not so easily irritated as the first being deeper seated. – (1295). 121. 1617. The Lymphatic Glands nearest in order to the Source of the Matter are the parts affected, those of the second order scarce Ever. ♀ 1618. In Men the seat of the Bubo will be in the Lymphatic Gland of the Groin, but as to the situation of the Lymphatic Glands it is not always the same precisely & the nearest Lymphatic Gland will sometimes not be in the groin but just above pouparts Ligament near to the os pubis, that will sometimes be the seat of the bubo. 1619. In case the Bubo arises from Gonorrhœa the seat of the Tumor may be on either side, if from a chancre, the Bubo will form on the same side as the chancre, but if the chancre is in the middle of the Penis then the Bubo may arise at either side. 1620. In Women the surface of Absorption being larger than in Men there are three different Parts which a Bubo may occupy & that dependant on the site of the Chancre. 1621. If the chancre appears on the Labia or Nympha the Venereal matter will pass on when absorbed in the course of the Ligamentum Rotundum & just before that ligament enters the abdominal ring the bubo will form, but never within the ring. 1622. This Bubo we refer to the first kind not considering it as Glandular but as an inflammation of the absorbing Vessel only, & this strengthens our Opinion that deep seated & internal parts are not readily susceptible of the Venereal irritation & that a bubo can only be External. (1617). 1623. If the Chancre be situated further backwards, then the bubo will form between the labia & the Groin or as in Men in the Groin 1624. “To this because the surface of the Glans Penis approaches nearest to a secretory surface than that of the Prepuce. We see absorption goes on slowly from a secreting surface. 122 1624. Absorption of Venereal Matter goes one more readily from some surfaces than from others, e.g. it is much more frequently taken up from the Preputium than from the Glans Penis. 1625. The first notice given to the patient of the formation of a bubo, is a sense of pain in the part affected, in which upon Examination he feels an hard tumor. 1626. This Tumor is generally of the common inflammatory kind & often advances to Suppuration speedily. 1627. Sometimes the Tumor is more of an indolent disposition & will then be long in coming to maturation. 1628. When the Bubo is of the truly inflammatory kind [& often] [advances to suppuration speedily.] [1627. Sometimes the Tumor is more of an indolent disposition &] [will then belong in common to maturation.] [1628. When the Bubo] the pain attending the suppuration will be very considerable when of the indolent nature it will be less acute, more dull & heavy, a disposition to indolence especially prevails in Patients of Scrophulous dispositions. 1629. The inflammation of the bubo will however sometimes be found of the Erysipelatous kind & then though the pain may be considerable, the Inflammation will be considerable & the part oedematous. 1630. Inflammations & Swellings of the inguinal Glands are not always Venereal, great will be the difficulty however sometimes ♄ 1632. It is however doubtful whether we do not often meet with Cases in which the Venereal disposition is mixed with the Scrophulous. in this Case we are to attack the predominant disposition whether it be Scrophulous or Syphilitic. Case Colonel W. had a gonorrhea preceeded by Buboes which suppurated they were opened & for a time went on healing kindly but at length became Stationary. Mr. Hunter suspected that a New disposition was taking place therefore ordered sea bathing &ca. when the new disposition which was Scrophulous, abated, the Venereal disposition increased so that it was necessary to return to Mercury. ☉ If Buboes were critical deposits from the constitution why do they not arise in some other Glands as those of the Neck &ca. & not in the Sympathetic Glands of the Groin or always in the nearest to the source of Absorption; again if Critical why should it be necessary to administer Mercury when they form. 123. in ascertaining the nature of an inguinal bubo. 1631 If a Gland in the Groin swells without a visible Cause, is painful, & goes on to suppuration quickly, venereal matter should be suspected & Mercury given, as in cases of chancres. 1632. But if the Tumor has an indolent nature & is attended with a Cold & Feverish indisposition & arises without any visible cause we may for the most part consider it as Scrophulous. ♄. - 1633. Bubo’s both in Men & Women are entirely local & are no more connected with the Constitution than the preceding local affection of which they are the consequence. 1634. They are not critical deposits from the Constitution as has been some supposed. ☉. 1635. In order to the cure of Buboes, having first ascertained their being Venereal we have recourse to the exhibition of Mercury. 1636. We are always to desire the resolution of the bubo & to avoid suppuration for the Bubo when it forms matter is similar to a chancre & has equal powers of contaminating the System. 1637. It is necessary to observe that in the Cure of the bubo, Mercury should be employed, but as that will only destroy the specific disposition of the Gland, it is necessary to attend also to the nature of the concomitant inflammation whether common Scrophulous, or erysipelatous. 1638. In the first we have recourse to bleeding & Purging according to the violence of the Inflammation. For the second, or Scrophulous, Cicuta, Sea bathing &ca. ☍ 1639. A Gentleman had a suppuration considerably advanced, he went to sea & the Sea sickness he endured & the consequent vomiting caused an Absorption of the matter & the cure of the Abscess. 🜍 1641. Thus if a chancre in the prepuce preceded the bubo – the Mercurial ointment should be rubbed on the side of the Penis where the Chancre formed itself & on the inside of the Thigh, in the Scrotum & belly &ca. as the Lymphatics from those parts take their route through the Inguinal Glands. 1642. Of all the patients Mr. Hunter has had under his Care for 16 years past, only 3 have had buboes which suppurated, that is of those which applied to him at the commencement of the bubo. 124 For the third Bark. 1639. Vomiting has been known to produce resolution of the Bubo even when suppuration had taken place, acting upon the principle of resolution. Vomit also powerfully Excite the action of the absorbents. ☍ 1640 In the [course] Cure of the Bubo we can much increase the Powers of our Remedies by the manner of applying them, & it should be a Rule to endeavour to produce an Action of the Mercury on the part before we produce its action on the System. 1641. We should therefore cause Mercurial Ointment to be rubbed on the surface from which the Absorbents begin that pass through the affected part, & as near as possible the part from which the first absorption of the venereal matter took place, thus introducing the Mercury into the System by the same road which the Virus persued, & as it were making the Antidote tread on the heels of the Poison. 🜍. 1642. By the early use of Mercury in the manner recommended (1641). The suppuration of buboes will commonly be prevented but should they happen notwithstanding to form matter, or should the matter be formed before the Surgeon is consulted; Mercury should be used during the whole time of maturation though in a more moderate quantity than before as well as after the bubo is opened or has burst. 1643. If the bubo is to be opened by Art the Skin should be permitted to come exceeding thin before the Operation is Performed, that a disposition may have taken place prior to exposing the Abscess to heal from the bottom. 1644. The opening may be made Either by the Launcet or by Caustic 1646. Sir William Fordyce first recommended Orange & Lemon juice which Mr. Hunter has since prescribed to advantage. Gold beaters Water is in use at the lock Hospital & sometimes does service. ♃ 1647. Case A Gentleman has a bubo which was opened he used Mercury 2 Months, still the Ulcer continued without the least disposition to heal, Mr. Hunter considering his constitution as too much of a Mercurial one & therefore little Affected by that Remedy he left it off & confined him to Milk diet &ca. for sometime, he then returned to Mercury again & continued its use for 2 Months when the Ulcer became stationary, he then again discontinued it returned to the Milk & gave Cicuta, the Ulcer was sinuous. The sinuositus were laid open & the patient was sent to Sea he persued this plan 4 Months & returned home without benefit. Mercury was again ineffectually administred, the patient at last got well having left off all Medicines. 125 Caustic according to the inclination of the Patient, it should however be small. When left to the choice of the Surgeon, if the Skin is very loose he may use a Caustic, & the lapis Infernalis is to be preferred, if the Skin is not loose, the lancet is best as thereby none will be destroyed, the Wound is to be drest according to the nature of the discharge. 1645. Mercury should be thrown into the constitution during the whole of the time from the ulceration until after the healing of the bubo, or at least until the Bubo has lost its venereal appearance which the Experienced Surgeon alone will be able to determine. 1646. Some exceptions however to this, are found to arise, sometimes the bubo takes on a New diseased disposition which mercury increases, the sore will continue obstinately spreading & the more freely Mercury is administred, the more progress the Ulceration will make. In this Case we perhaps have a Scrophulous or Scorbutic habit to encounter, & we shall find benefit probably from the use of Hemlock & Sea bathing & from Orange & Lemon Juice. 1647. In some of these Cases we have found no Medicine of any Utility but the disposition at length has worn itself out & the Ulcer healed. ♃. 1648 Another Exception to the constant use of Mercury is that the patients Constitution may become so habituated to it, that it shall lose its power of acting as a specific, in this Case we should discontinue the Mercury for some Weeks & then have recourse to it again. 1649. As the Venereal disease may be communicated by other  126 means than coition, so buboes may be formed in other Glands as well as those in the vicinity of the parts of generation, if the infection was received on the Lip; the Bubo would be seated in the Neck, if Venereal matter was absorbed from an ulcer or wound in the Finger, we should find the Bubo in the Axilla. 1650. In the Cure of these the same principle is to be kept in view, as if they had formed in the Groin (1636-1640). 1651. Some uncertainty must prevail as to the precise Quantity of Mercury necessary to be used for the removal of buboes, where the resolution is obstinate the quantity of Mercury should be pushed so as to affect the Mouth in general we may begin with ½ dram of Ointment (prepared with Axunge & Mercury) & increase or diminish according as the bubo is affected by it. 1652. When the Venereal Virus has been absorbed into the habit, & the second Genus arises Variety of appearances are produced & these will be according to the following Circumstances. 1653. 1st. the time since it was Absorbed into the Constitution. 2d the peculiarities of the Constitution. 3d the different Solids affected by it. 4th. The different dispositions the solids were in when they first became affected with it. 1654. The time in which the second Appearances take place after the infection depends upon the nature of the constitution, at a medium the period is found to be 6 Weeks in some it is sooner ♄. 1654. A Case occurred in which almost the whole body was covered with general Eruptions within a fortnight after the breaking out of a Chancre. ☉ 1659. In some persons, Copper Coloured, dry Scurfs, or as it were Cuticles appear which are thrown off from time to time & spread at times to the size of a Sixpence. 127. in others later. ♄. 1655. The deep seated parts, or parts second in order of [succession] susceptibility (1298) do not always come later into action than the superficial parts (1297) as we have known the Periosteum to become diseased without any previous affection of the Skin or Throat. 1656. We have accounted for the reasonsy why parts shall fall into the Venereal Action after parts labouring under the same diseased action shall be cured (1303-1304). 1657. We have also shewn that Venereal matter does not continue circulating in the Blood for any length of time, that the secretions are not contaminated by the Venereal Matter, nor the Blood rendered Capable of communicating the infection to other persons but that after the absorption into the System it Circulates for a short time with the common mass of Fluids, gives a venereal disposition to the different solids having first undergone a change in its nature & is soon thrown out by the different excretions. 1658. In some the Eruption upon the Skin appears in distinct blotches not very observeable until Scurfs are forming upon them, at other times as small pimples with inflammation & the pimples filled with matter. ☉. 1659. The first appearance after Absorption is generally upon the Skin, throat or Mouth, the appearance in the throat often precedes the others. 1660. When Skin is opposed to Skin, as in Axilla &ca. the above described appearances never take place, but the Skin rises while  128 & smooth, & a whitish kind of matter is secreted & they attended with more pain than the former, whether this attends the disease in question only we will not pretend to determine. 1661. The hair falls off the parts that are attacked with it & so long as the disease continues the new hair cannot grow. The fingers are sometimes the seat of the disease & then the nails fall off. 1662. When the throat inside of the mouth & tongue are the seats of the Venereal Action, an Ulcer rapid in its progress but without much tumefaction is formed it is foul & has thickened or bordered Edges; but this is a circumstance attending all sores that have no disposition to heal. 1663. These Ulcers are painfull although much less so than a common inflammation of these parts, & oblidge the patient to speak thick & snuffle. 1664. The matter secreted upon them does not remain to form a Scab, but is washed off in swallowing. 1665. The Eye sometimes become the seat of disease & a venereal Ophthalmia is produced which with difficulty can be distinguished from the common Ophthalmia. 1666. When the disease has been affecting the constitution for sometime, then the parts second in order may shew the action of the Virus or the same Effect may occur when it had first appeared in the External part, & the diseased appearances there had been Cured. 1667. A total deafness is not uncommon at this time, now & then attended with pain & suppuration in the parts.  129. 1668. A Node often appears several months after any possible infection, the progress of this is very slow & the consequence of any suppuration is a very slimy matter instead of good pus. 1669. When the Periosteum &ca. becomes affected the Pain is very considerable but not always so. 1670. Nodes will sometimes continue several Years before they come to Suppuration, the inflammation being very slow. 1671. Venereal pains are periodical being more particularly Severe at night & in this respect they resemble the Rheumatic. 1672. The Effects of the Venereal disease upon the Constitution are similar to the effects of all other irritations whether locar or Costitutional. 1673. In some a slow kind of nervous fever with loss of appetite is produced, or there are Rigors, frequent hot fits head Achs. &ca. 1674. In the cure the disease may be considered as in two extreemes, not different in their nature but only as requiring a more mild or more severe treatment. 1675. In the first Genus our senses will generally inform as when a Cure is compleated but in the second Genus we labour under great difficulties as the Virus has circulated in the blood & we know the contaminated Solids only by their shewing a diseased action. 1676. The Effects arising from the constitution are local & may be cured locally, but as other parts may have received the Venereal disposition, although they have not yet come into action, we must attack the ☽︎ 1682. Mr. Hunter observes that a smaller quantity of Calomel is sufficient to Salivate by the Bowels than by the Skin, & again that using precipitate to Sores has salivated patients. 130. Blood, not as now containing the poison, but as the Vehicle carrying the specific through all the solids of the body, curing present diseased effects, & destroying dispositions which would have produced future ones. 1677. It is not clear whether those parts which have first been attacked are easier to Cure then those which took a diseased Action later. 1678. If parts are susceptible of Cure in proportion to their susceptibility of diseased action then the parts first in order must have their diseased disposition & action removed. 1679. The second in order may appear diseased when the first has been already cured, but the order is rarely reversed. 1680. Mercury is the true specific remedy for this disease & none other whatever can be depended on, when taken into the constitution it circulates with the juices cures those parts which are diseased & little affects those that are not. 1681. There are two modes of administring it Vizt. By the Stomach---By the Skin. 1682. Like other substances it is more readily absorbed from some surfaces than from others. ☽︎. 1683. In the administration of Mercury it is necessary to consider. a. The Constitution of the Patient. b. The quantity of Mercury necessary c. The proportion that will best agree wth. The Patient d. The mode of giving it.  131. e. The Regimen necessary to be observed by the Patient during his Mercurial Course. 1684. As to the constitution we should endeavour to learn whether it is very much disposed to irritability or indolence, if possible whether it is easily or difficultly affected with Mercury, & again the time the Constitution has been contaminated. 1685. With respect to the second circumstance belonging to the constitution we may in general take the History given us of the degree in which it has been affected by a given quantity of Mercury on any former occasion as a guide for our practice for it rarely happens that the Constitution Varies much in this particular. 1686. The quantity of Mercury to be given must be equal to the Violence of the disease but it becomes necessary at the same time to consider the period of time within which a given quantity is introduced into the System & the effects of that quantity on the Constitution. Thus one ounce of Mercurial Ointment rubbed into the Skin in two days will have more Effect on the constitution & secretions than two Ounces rubbed in within ten days. 1687. A large quantity of Mercury quickly introduced into the System, a sudden Alarm is given & its effects are rendered mostly local consisting in the unusual Excitement of some sensation. 1688. But if we introduce the Mercury slowly a very considerable quantity may be thrown in without visibly affecting the constitution. – ☿. 1694. All parts do not become Sore together but severally the lips may alone become thick & inflamed & the Cheeks or Gums become Sore. – 132 1689. From a knowledge of these circumstances we find Mercury a much larger & more manageable Remedy than it was formerly known to be. 1690. Mercury when first applied affects the System much more readily than when the patient has been sometime accustomed to its use we are therefore enabled by beginning with a small quantity & going on gradually to throw into the constitution a much larger quantity than could have otherwise been born by the Patient. 1691. If given with care so as to avoid Stimulating any secretory Part to Action, & thus producing Evacuation, any quantity of mercury may be introduced that the disease can require. 1692. The effects of Mercury are generally in the following order. 1st. On the salivary Glands – 2d. on the intestinal Glands. 3d. On the Skin 4th. on the Kidneys. 1693. These are affected sometimes singly, sometimes more than One, sometimes altogether. 1694. Soreness of the mouth most commonly though not always attends the increased action of the Salivary Glands ☿. 1695. Evacuations by any of the secretories are of no use in curing the disease, they only shew the susceptibility of the secretory Organ to be affected by the remedy, however they afford some Evidence of the constitutions being acted on by the Remedy. 1696. If the secretory Organs are too susceptible of the stimulus of the Mercury it will be difficult to Cure the disease because ♃. 1696 A Gentleman had a Chancre & a bubo he rubbed in Mercurial Ointment once, his mouth became affected, a slavering came on, the spitting was kept up for a month during which time the Chancre & Bubo got well, soon after his Throat became affected with the disease this Mr. Hunter attributed to the too great susceptibility of stimulus in the Salivary Glands which suffered the Mercury to be evacuated so fast, that it had not time or power to affect all the other parts of the System. 134. The Patient will not bear a sufficient quantity of the specific to be introduced into the Circulation. ♃. 1697. The too ready susceptibility of any secretory Organ should be obviated by proper astringents hereafter to be mentioned. 1698. Mercury can act only upon the constitution & upon the Poison. 1699. Upon the Poison either by destroying its properties & decomposing it, or By attracting it & carrying it out of the Circulation together with itself, or By counteracting the venereal irritation & producing a new & opposite irritation. 1700. If the latter conjecture is true then the readiest way of curing the disease must be, giving Mercury so as to produce visible effects on the disease yet in such a quantity as to produce a different disposition in the System. 1701. It should be given slowly so as to produce at length some local Effects, yet however in such manner that a quantity may be introduced into the System sufficient to cure the disease. 1702. As a general rule it is right & necessary to give Mercury in such quantities as shall produce good effects on the disease yet no ill ones on the Constitutions & to continue its exhibition until some local irritation is produced. 1703. Of the two modes of throwing Mercury into the constitution if the patients way of Life & circumstances renders it convenient that of rubbing it into the Skin is most Eligible & most certain ♀ 1709. Should it be found that purging has any effects in diminishing Salivation it might be right to give sulphur in sufficient quantities to act as a purgative. 135. in its effects. 1704 If the Patient has been unused to Mercury, he should begin with a scruple or half a dram of the Ointment prepared with & rub that quantity in every night for 4 or 6 nights & then he may increase the quantity to a drachm & so on gradually until two drams are rubbed in every night. 1705. If the Symptoms disappear gradually it will be right in general to continue the medicine a fortnight after their removal. 1706. When the mouth becomes affected by the mercury we must suspend its administration, until the soreness abates. 1707. If the Mercury runs off by any of the secretions they should be restrained no danger arises from checking a too violent secretion although that encreased secretion does not arise from the constitution. 1708. Sulphur has certainly been serviceable in diminishing too violent secretion by the Salivary Glands in what manner it produces this effect we do not determine, it can only act upon the mercury after the latter has got into the blood probably it is a kind of Antimercurial Stimulus. has it any powers of combining with the Mercury in the constitution. ☍ 1709. We should distinguish a Mercurial salivation from a Salivation which goes on from habit after the mercury is Evacuated 1710. purging had probably no power in diminishing a Mercurial Salivation. ♀. 1711. Sulphur certainly Enters the Blood unchanged & as Sulphur. ♄ 1716 Mercury cannot act in the body as it does not of it, all the preparations of it undergoes a change & after being taken into the System a New Combination peculiar to the animal body is formed & that is the same whatever may be the preparation of mercury employed. Did Mercury Act when in the System as it does in the Primæ viæ or applied Externally, the preparations would have different effects. e.g. Turboth Mineral when in the blood would act as an emetic in the same manner as Ipecacoanha does when thrown into the blood Vessels, but all the preparations of Mercury after they are dissolved in the Animal juices form one particular combination when dissolved in the Saliva they have all the same taste. Mr. Hunter held crude mercury in his mouth for sometime, it was very slow in giving the proper metallic taste to the saliva which shewed that it dissolved in the Mouth & gave the same taste. Calomel did the same. Corrosive sublimate held in the Mouth, for a time the acid taste was prevalent, but that going off the proper Mercurial taste similar to that of M. Cale: Argent. vis: &ca. took place; introduced by means of the skin into the System, they all have one common Effect, tho some are quicker in producing their Effect than others. – 136 1712. Should the Secretion by the bowels be violent we restrain it by opium which seldom fails in removing the irritation of those parts the violent action of Mercury on which, is by far more dangerous than on any of the other secretory organs. 1713. Mercurial sweatings or Evacuations by the Skin, we check with most success by the use of peruvian Bark. 1714. The encreased action of the Kidneys is not near so troublesome as the others, Bark may be given as it corrects; but it will sometimes go on whatever means are employed to check it. 1715. Mercury probably cures most of the Symptoms of the first stage locally, that is applied to the parts by means of some of the secretions, thus it probably cures the sore throat locally, the saliva loaded with Mercury proving an antivenereal Gargle, so also in Cutaneous affections, being applied to the skin by means of the sweat. 1716. Mercury cannot act upon the Venereal or any other disease but in a state of solution & that in the Animal juices. ♄. 1717. It is however certain that different preparations of Mercury will produce Effects upon the system & upon the secreting Organs at different periods of time & will affect different indviduals in different manners, & that those who are not cured by one preparation of mercury will by another therefore it is right to try different Preparations when the disease is obstinate. 1718. All the preparations of Mercury are readily voluble in Saliva. Mercurius Calcinatus is the most simple & easily dissolved  137 in the mouth, mixed with a quantity of opium it makes one of the most efficacious internal remedies. 1719. Calomel in proportion as to strength & its effects in the Constitution to Mercurius Calcinatus is as One to three. One Grain of calcined Mercury is equally powerful with 3 of Calomel 1720. Corrosive Sublimate is a powerful preparation of mercury its action in curing any diseased part is mostly local as being carried to them by means of some secreted fluid, it cures ulcers in the throat sooner than any Medicine, acting perhaps as a gargle. A cure by it however is not to be entirely depended upon as it does not seem to have any great powers in the constitution & relapses more frequently happen after a supposed cure by Corrosive Sublimate than by any other preparation of Mercury. 1721. For too small a quantity of Mercury only when we use sublimate can be introduced into the System, to effect a proper change of the constitution, it too readily passes off by the Skin &ca. – 1722. Crude Mercury divided with any substance by triture is the weaker of all the mercurial preparations. 15 Grains of it being only equal to one grain of mercurius Calcinatus. 1723. A Grain of Calcined Mercury may be taken [into] every night for five six or seven Nights, if no affection of the mouth is thereby produced the quantity may be increased. 1724. Either of these may be joined with Quaiacum ( ) in dose & will in general produce a cure of the Symptoms in one month. 1725. If the Symptoms diappear suddenly, for instance in the ☉ 1726 It is with this view probably that Mercurius is prescribed. – 138 first eight days, it will be still right to persist in the use of the remedy a considerable time, & even when the suppuration gradually decreases it will not be improper to persevere in the use of the Remedy for a fortnight afterwards & this whether the external or internal method is employed, for we should always consider the danger of having incurred a venereal disposition in parts not yet come into action. In this first Stage it is much easier to cure the Symptoms than to rid the constitution of the specific disposition. 1726. If Mercury is given internally either in a Saline form as sublimate, or formed into a salt by any acid it may meet with in the Stomach, regard is to be had to the irritation it may produce on the Stomach & Primæ Viæ. if they are disposed to irritability Opium & Essential Oil may be administred with it, or alkaline Medicines accompanying its Exhibition. ☉. 1727. In general if Mercury is properly administred the constitution may be cured in six Weeks. 1728 In the second or worst Stage as affections of the Periosteum, Tendons, Ligaments & Bones. a more severe course is to be pursued & mercury is often required to be given in the largest quantities that the patient can with saftey bear. 1729. Here we must begin with a large quantity at first, in order as it were to surprise the system & we should produce a sensible effect in 5 or 6 days & a soreness in the mouth in 12 days Here the quantity of Mercury to be employed will be so great that it is scarcely possible to prevent a Salivation.  139. 1730 In this Case more attention will be required to the Patients diet, as he will not be able to Eat solid food from the soreness of his mouth & yet will require his strength to be supported, Egged Wine, Sagoe &ca. will be proper viands. 1731. In our use of the mercury we are to observe that in this Stage it is easier to cure the constitution than the local disease & therefore it is not necessary to persist in the use of mercury until all the local Complaints are removed as the parts may remain in a diseased state after every Venereal disposition is destroyed. 1732. Topical remedies in this stage will be useful, as will readily be conceived from (1731). 1733. Previous to beginning the Mercurial Course we must make the same enquiries as are directed to be made preparatory to a less severe Course ( ) that is whether the patient has heretofore taken Mercury whether lately, or in what quantities. 1734. If he has lately taken Mercury (& this is to be considered as it were a continuation of a Course already begun we must begin with a large quantity as two drachms of Ointment, rubbing the same quantity of Ointment into the Skin every night, if the Patient can bear it, or even encreasing it to ʒiij. Or if he has heretofore borne a large quantity of Mercury without inconvenience, we may proceed with similar boldness. 1735. But if the Patient has not been used to mercury or is weak & irritable we must proceed with some Caution; One drachm ☽︎. 1738. We perhaps shall not be surprized at the length of time which may Elapse between a Venereal disposition being given to a Bone & the time of its action on the bone appearing for we see not only Venereal Virus is very slow in its Operation but that processes of all kinds in bones go on with tediousness & difficulty. ♂. 1739 Why does Mercurial Ointment cure Nodes? It cannot be by the Mercury acting locally by Contact, it must either be by the System, or by Sympathy. 140. of Ointment is as much as we should venture to employ. 1736. Mercury in any stage can only Cure the constitution by being absorbed into the System. This we must be aware of, & therefore if the surface of the Skin, will not absorb it, we must give it internally if the absorbents of the bowels will not take it up, no more than those of the Skin the Case of the Patient is really deplorable, & the Cure impossible. 1737. Some particular local affections in this Stage deserve attention as. a. Nodes 1738. If the affection of the Periosteum or bone has proceeded no further than inflammation & swelling, in general no particular application is necessary but the Venereal Virus only will require to be destroyed. ☽︎. 1739. Sometimes however it will be other wise, then they may be covered with Mercurial plaister or rubbed with the Ointments the latter is best. ♂. 1740. If these do not succeed we must try the effects if a new inflammation. Blisters applied round the Node have removed the pain & assisted the Cure. If Blisters fail an incision should be freely made in the diseased part that by the processes of Inflammation a new disposition may be formed in the parts, & the nature of a common sore produced. 1741. As parts may remain in a state of disease after the Venereal Virus is destroyed & the Constitution cured we may often very  141 safely leave the Nodes to time which will not uncommonly effect a Cure, but sometimes however a particular local treatment will be necessary. 1742. Nodes are often blended with Abscesses which seldom produce good matter, but generally a kind of slime or mucus which his flat on the bone & renders it difficult to determine whether there is a fluid underneath or of what kind. In this Case there is but little of the adhesive Inflammation. 1743. Inducing Violence of Action in the diseased parts, here facilitates their cure by destroying the present irritation, we should therefore make free openings. Exfoliation may more readily take place in bone affected with the Venereal disposition than any other diseased disposition, because here we have a specific remedy by which we can correct the present disposition. 1744. When a Node Occurs in a Tendon, if blistering does not relieve the tumor should be laid open as a ground work is laid for a very obstinate & disagreable Swelling which will neither yield to time nor Medicines & must therefore be attacked locally. 1745. As in the other Genus so here also New dispositions may be taken on by the parts affected which it may be difficult to distinguish from the Venereal disposition, & therefore may render it difficult to determine when the cure of the Venereal Virus is effected. 1746. To these new dispositions Mercury may be a poison increasing instead of lessening the evil. Many of them will take on a Cancerous ☿ 1746. A poor Woman in St. James’s Workhouse had Venereal complaints for which she underwent a course of Mercury, she had ulceration in her face which took on a new disposition seemingly Cancerous. Hemlock was applied internally & externally & she got well after having lost part of her Nose & part of her right cheek, in 12 months she relapsed. Hemlock & other means were tried in vain for she died of the complaint. ♃. 1747. One drachm of Opium dissolved in of water makes a very useful application to Venereal Ulcer. – ♀. 1749. Mr. Hunter has given powder of Sarsaparilla mixed with some farinaceous substances made into a pudding, that the patient might take it in very large doses. ♄. 1750. A Young Man had Venereal Eruptions & Ulcers in different parts of his body, under the Armpits on his Thighs. Scrotum &ca. some even of the size of a half penny a poultice of Gum Guaiacum Was applied to the right armpit & a poultice of Sarsaparilla To the left, removed every day, & continued for a fortnight, the sores in the right Armpit were cured, those in the left rather worse, left off the Sarsaparilla & applied the Guaiacum to the left which then healed in a fortnight. Gum Guaiacum ʒss joined with Opium was also given 3 times a day, by which means all the eruptions disappeared in a Month, he was allowed to stay in the Hospital 2 or 3 Weeks, after this seeming cure at the end of which time Eruptions again appeared 142 appearance. ☿. 1747. Ulcers in the mouth & throat often arise during the use of Mercury, these should be distinguished from Venereal Ulcers and treated with Bark, or Opium as Gargles. ♃. 1748. In some persons the long use of Mercury is followed by General debility of the constitution with all its effects as profuse sweatings an inclination to Hectic &ca. In this case the general strengthning plan is to be pursued Bark is useful but is no specific, Scrophula seems to have something to do in the present Case & this is rendered. the more probable by the disposition giving way 1749. Sarsaparilla has no power over the Venereal Virus, it is however very useful & seemingly specific, for many of the new dispositions taking place after the virus is destroyed. It may be of use in preventing the formation of [matter] such disposition & may be exhibited with Mercury. It is best taken in substance & in large doses or its Extract may be given. ♀. 1750. Guaiacum has some specific powers over the Venereal disease; how far these powers extend is not ascertained. We can however place no dependance on this remedy in serious Cases. Mercury is the only true & [useful] universal Specific, on it alone can we depend for it will cure in despight of every unfavourable concomitant circumstance, as irregularity in the patient, intemperance, Climate &ca. ♄ 1751. Hemlock is frequently of Utility in many of the new dispositions which form during or after the course of the Venereal disease Recourse was again had to the Guaiacum, that it had lost its powers. Mercury cured him. this shews that Guaiacum has some specific powers, though weak ones over the venereal disease. Mercury properly applied is the only true Specific. Mr. Hunter does not object to his Patients indulging in the usual diet or taking his usual Exercise, he may take the Sports of the Field by day & his Bottle of Wine at Night. 143. especially in such as from their appearance give cause to suspect cancer. 1752. A salivation will often go on from habit long after the Mercury is Eliminated from the System, it will sometimes remain for Months, though this is now rarely known to be the case, as the Mercury is seldom given in such manner as to produce violent Secretions by the salivary Glands, it is to be considered as a Gleet of those parts. 1753. Gargles prepared with peruvian Bark, Gargles of Opium, Sea bathing & good Air are beneficial. Dr. Mead used to recommend Tincture of Cantharides which may be tried. 1754. Sometimes the Alveolar processes of the teeth becoming [loose] diseased may be a cause of keeping up the spitting when this happens we cannot hope for a Cure until exfoliation has taken place. 1755. Prevention of the Venereal disease is effected by Applications Previous to or immediately after exposure to infection. 1756. Applications to be used previous to exposure are such substances as will not suffer the Venereal matter to come in contact with the Skin. 1757. Venereal matter being immiscible with oil, the part Exposed may be depended by anointing it with the most viscid Oil that can be conveniently had. 1758 Means to be employed after exposure are caustic Alkali properly diluted which will dissolve the Venereal Matter, or Goulards  144. – Extract of Lead which is a powerful coagulater of Animal juices & will coagulate the virus a Solution of Corrosive sublimate is also used & said to have succeeded when other means have been found inefficacious. – Finis.  145 Proposals for the recovery of drowned Persons. By Mr. J. Hunter Philosophical Transactions Vol: 66th. London 4to. 1st. Whilst an animal retains the powers though deprived of the motions of Life, the cause of that privation may be frequently removed; but when the powers of Life are destroyed, the action ceases to be recoverable. 2nd. Part of the living principle is in the Blood. 3d. The Stomach Sympathizes with every part of the Animal & every part with the Stomach, Cordials by their action on the Stomach excite universal motion & there is also a peculiar Sympathy between the heart & Lungs, many poisons, steams of phlogiston & Charcoal &ca. received into the Lungs the hearts motion instantly ceases & that much sooner than if the trachea had been tyed. From experiments anything salutary applied to the Lungs will restore the hearts action after it has been at rest for some time. Violent deaths are divided into 3 kinds. 1st. When only a stop is put to the action of Life in the Animal, not however by any irreparable injury to a Vital part. If this action be not restored in a certain time it will be irrecoverably lost. 2d. When an injury is done to a vital part. 3d. To when absolute death instantly takes place in every part as  146. is the case in Strokes of Lightening. Which of these three Deaths does the case of Drowning come under? probably the first. Here it first affects Respiration, then the Hearts motion. – Restore Respiration & Cure drowning. New born infants have been animated by blowing into their Lungs. Put the juice of Hone Radish, peppermint, Spt. Coma. Cervi into the Stomach & Anus. Avoid Phlebotomy & the fumes of Tobacco. Mr. Hunter has invented a Bellows to exhaust as well as to fill the Lungs & also a Syringe. –       INDEX Aphorism Page A Aneurism spurious---872---4 Aneurism---878---4 Abscesses---893---8 ___unsound---1123---46 B Bubo---1610---120 C Corns---944---18 Chilblains---946---18 Carbuncle---984---23 Coopers Glands obstructions of in Women---1120---45 Cancer---1157---50 Chordee---1327---75 ___cure of---1387---82 Chancre---1539---108 F Fistula---7090---40 ___in Ano---1107---43 ___in Perineo---1109,1475---43,97. ___Lachrymalis---1113---44 ___of the Parotid Gland---1117---45 ___communicating with Joints---1111---44 Fungated Sore---1198---55 G Gonorrhea---1310---72 ___cure---1362---79 H Hæmorrhages---848---1 I Indolence & Irritability---918---14 Itch---1230---59 Infection of the second order of Parts---1652---126 M Mercury mode of exhibiting---1680---130 ___ulcers in the mouth from---1747---142 N Nodes---1737---140 P Poisons---1130---47 Prostate enlarged---1533---107 Phymosis & Paraphymosis---1553---111 Prevention---1755---143 S Scrophula---1017---29 ___cure---1051---35 Seminal Weakness---1477---97 Salivation---1752---143 Strictures---1490---99 T Tendons ruptured---912---11 Tumors---955---19 Testicle swelling of---1332---75 ___cure---1394---84 Tetanus---996---25 U Urethra obstructions of---1432---89 ___strictures of---1435---90 ___cure---1490---99 V Veins Varicose---945---18 Venereal disease---1240---61 W Wounds---888---8 Warts---1589---108                  Thomas Windsor Manchester ?-1745 (1845) LECTURES on the RATIONALE of SURGERY by JOHN HUNTER. VOL. 2.  1 Volume. 2nd. – Part. 2nd. (continued) Aphorism 848th. Hemorrhages. may depend on various causes either a Wound made in an Artery by external force, or by such a state of weakness being produced by a disease in the Coats of the Arteries themselves, as to render them incapable of withstanding the impetus of the blood. 849. When an Artery in health is divided there is a natural power of contractility in its Coats, that disposes its orifice to Close & prevent the future escape of Blood. 850. This contractile power is stronger in inverse proportion to the largeness of the Artery, in the larger Vessels it is not Equal to the business of restraining the Hemorrhage, & therefore renders the assistance of Art necessary. 851. Another natural cause of the restraining of an Hemorrhage & wch. we call the accidental, is the plugging up the mouth of the Vessel by coagulate Lymph. 852. Art is employed in restraining Hemorrhages in three ways 1st by increasing the Contractile power of the Arteries. 2nd by increasing the Coagulation & thus plugging up the Mouth. of the Vessel 3rd. 🜹 855. It is evident the artificial retardment of the motion of the Blood commonly takes place when the bleeding is from / an Extremity We have sufficient testimonies of the use of the retardment of the bloods motion in the stopping of Hemorrhage, when we see people faint who have suffered great losses of Blood, & that on the Syncope taking place the hemorrhage commonly ceases. + 857. If the actual Cautery is used, the Iron should be very thick and heated nearly to a red heat. 2 3rd by Compression of the sides of the Artery together near its mouth & thus rendering it impervious to blood. 853: The first intention (852.1.) we fulfill by the use of Stimulants & of these the most powerful is Oil of Turpentine. 854. The second intention (852.2) by such remedies as will forward the natural & produce an artificial Coagulation of the Animal Juices. 855. This Coagulation will be forwarded by the retardment of the Blood motion. 🜹. - 856. The substances forwarding the formation of the Coagulum, are spungy bodies, as lint, fur, agaric, flower, Cobwebs. &ca. – 857. The means productive of an Artificial Coagulation of the Animal Juices, are the application of matter which act chemically upon them, such will be the actual Cautery, concentrated Acids, boiling Water &ca. +. 858. The mechanical means of stopping Hemorrhage is by compression this is made by enclosing the Vessel near its Orifice in a ligature applied by the use either of the Tenaculum of needle. 859. The Tenaculum should only be used when we have sound & unossified Arteries, & those situated not in the Centre of a muscle but loose in the interstices of Muscles & in the Cellular membrane. 860. The use of the needle is to be preferred, where there is reason to suspect the Artery is not quite sound when it is situated in the middle of a Muscle. 861. When the Needle is used, a considerable portion of the circumjacent parts as muscular flesh, cellular Substance, Nerves &ca. is commonly included together with the Artery in the ligature which gives an additional support to the Artery when weak or suspected to be unsound. 🜹. 864. Of this the Millers case, whose Arm was torn off by the Wheel of a Mill at the Articulation with the Scapula is an ample testimony (see Cheselden’s Anatomy) So also the Case of a person sometime ago in the Middlesex Hospital. The Farmers are sensible of this for they divide the funis of the Calves & Lambs by tearing it in two. + 865. Of this Mr. Hunter is satisfied having several times tied the Nerves with the Artery & no ill consequence supervened. ☿ 866. In St. Georges Hospital a Boys thigh was Amputated for a disease of the Knee Joint, by repeated bleedings from the Stump which always stopped spontaneously the Patient was so much reduced, that at last he Sunk, upon examining the Limb after death, the Artery appeared sound, until within an inch of its termination in the Extremity of the Stump, where it was black & had lost its Elasticity. The Bleeding anew happens more frequently in the Radial or Ulnar Arteries than any other. – 3 862. The degree of tightness to which the ligature is to be drawn will be in proportion to the size of the Artery, & the quantity of surrounding parts enclosed in the ligature. 863. The ligature should be made thicker than is commonly done that a larger extent of surface of the Artery may be compressed. 864. An accidental method of stopping Hemorrhages is tearing the Vessel asunder, for in contused Wounds the bleeding of a Vessel is less than in incised. 🜹. 865. The disagreable & sometimes fatal Symptoms following the use of the needle, where it is necessary to compress the sides of an Artery together, do not arise from irritation produced by a Nerve being enclosed in a Ligature, but from some peculiarity of constitution. +. 866. It sometimes happens that after tying an Artery consequent on an Accident or Operation, that the Artery shall bleed afresh at some distant time, as one, two, or three days, or even when granulation is going on, this mostly happens in the large Vessels. ☿. 867. When it arises within two or three days it commonly is owing to some circumstances attending the Operation, as tying the ligature too loosely or too tight. 868. When this is not the Case ( ) & when Bleeding happens after Granulation has taken place it may be attributed to a diseased state of the Artery. 869. The Artery should be laid bare (if diseased) until the sound part comes in view, & there a ligature should be passed. 870. In some patients when granulation has taken place after a wound or a considerable surface is stripped of its integuments, (as after Amputation Φ 876 The thickening of the Cellular Substance wound the Artery & its being lined with tough Coagulum will make this Complaint resemble the real Aneurism, but in the latter the Coats of the Artery are always forming the Cyst in the former the Coats of the Artery are never dilated. 4 Amputation of a thigh) there will be a profuse bleeding from every point of the exposed surface. 871. This will occur in patients who are extremely debilitated & whose Vessels (even the smallest) want the power of contracting. 872. The term spurious Aneurism has been improperly applied to an Extravasation of Blood in the Cellular substance, which blood has escaped from a puncture through the coats of an Artery. 873. This may be either recent, or not recent. In both those will in general be necessity for performing the operation of the Aneurism. 874. In this Case as there is a lateral Wound in the Artery, the escape of the Blood will continue to go on because the Artery cannot contract itself longitudinally. & was it to contract circularly, There would be an obliteration. 875. Therefore there will be no natural Cure for the Accident, it must either kill, or the operation be performed. 876. In the non recent Spurious Aneurism the Wound in the Skin is healed, the Cellular substance has thickened & with some Coagulum of Blood formed a Cyst, into which Blood from the unclosed Wound in the Artery is continually effused, this must ultimately burst & destroy the Patient unless the Operation for the Aneurism is previously performed. Φ. 877. To this state ( ) the recent Spurious Aneurism must always proceed, unless it either destroys the Patient or the Operation is specially performed. 878. The Arteries are subject to two diseases. Ossification & weakness the latter will be the predisponent cause of a dilatation of the Coats ♁ 883. This has been supposed to happen & has been called the mixed Aneurism, but from Experiments similar to the following the Conclusion is to be made. Mr. Hunter laid bare the Carotid artery of a Dog, and afterwards thinned it with a knife even to transparency, no dilatation of the Vessel ensued, three weeks afterwards the animal was killed, & the Artery on which the experiment was made was not found the least dilated but thickened by the adhesive inflammation & the adhesion of the adjacent Cellular Substance. 884. The dilatation if an Aneurism takes place In the Arch of the Aorta will be upwards. In the Abdomen---Forwards. In the Carotid Artery---outwards. In the Axilla---downwards. In the Ham---backwards. In the Groin---forwards. In the Leg---uncertain. Hence absorption of bone so often arises from its making pressure against them. The Artery will continue to swell in that direction in which it first begins to tumefy & the lower part will be dilated more than the upper. 🜔^ 885. It may suffocate by pressing on the trachea, if the Carotid or the Aorta is the seat of the disease. Its pressure on the returning vessels may occasion dropsy &ca. if the Aorta in the abdomen is the diseased part it may burst inwardly, or if it produces 5 of an Artery to which alone the name of Aneurism should be given 879. The immediate cause of Aneurism is a disparity between the force of the bloods motion, & the powers of resistance, in the Artery. 880. Accident (as some violent Exertion of muscular power) may give rise to it, but it most commonly depends entirely upon some diseased state of the Coats of the Artery. 881. This is more probable because it is not unusual to find several Aneurisms in the same person from which it should, appear that the disease is a weakness & disposition to dilatation in the Arterial System. 882. Moreover the common seat of the Aneurism is in the large Arteries whose seats are less muscular than those of the smaller 883 An Aneurism we believe never takes place from a rupture or wound of some of the Coats of an Artery & a dilatation of the rest. ♁ 884. The dilatation of the Artery will always be to that side on which there is the least resistance from the surrounding parts if there is no resistance from the surrounding parts of either side it will then be in that direction in which the blood is most forcibly thrown, if these circumstances are equal on all sides, it is then uncertain in what direction the dilatation will be made. 885. The natural tendency of the disease is to destroy life, this is effected either by the tumor bursting & the Patient dying of the Hemorrhage, or by its enlargement so as to press upon some parts Essential to Life, & hinder their functions. 🜔^ 886. When the Operation for the Aneurism is proper, it should absorption of the Bones of the Spine it may swell outwardly & at length the Skin inflaming & sloughing & the Coats of the Artery undergoing the same change the Coagulum gives way & a fatal Hemorrhage Ensues. ♂ 887. By the first rule, all the Aneurisms of internal parts will of Course be excluded from the Operation. As to rule 2d. the only Arteries admitting of a question will be the femoral & the brachial, but success here is only to be doubted of, yet by no means improbable the other Arteries are either out of the way of operation or have. In the Aneurism of the Interosscal, Anterior & Posterior Tibial Arteries the operation cannot take place from the difficulty of taking up these Vessels, therefore recourse must be had to Amputation & also when a diseased state of the bones &ca. in any part is induced by a pressure of the Tumor. On the whole, this Aphorism will allow of the Operation if Rules 3. 4. 5 permit it in the following Arteries. In the Carotid above the Sternum. In any of the branches of the external Carotid. In the Subclavian when it has passed the Scalenic Muscle & in any of its branches. In the Crural after it has given off the Profundus, & In the Popliteal. Directions for the Operation. 1st. When the Tourniquet is applied, that is if possible between the Aneurism & the Heart, make a longitudinal Incision in the Course of 6 always be performed as early as possible, this rule will also extend to spurious Aneurism. 887. The Operation is proper 1st. When the dilated Artery can be included between the ligatures. 2nd. When there is a probability that the parts to whose support the Artery in question was subservient heretofore, will be still Nourished & supplied with blood. 3d. When it has done no mischief to surrounding. Parts as bones &ca. – 4th. Where it is distinct & Circumscribed, not connected with parts which may be incurable when Exposed, as bones &ca. 5th. When there is distinct Pulsation in the Tumor. 6th. When it is probable that there is no other Aneurism between it & the Heart. ♂. 888. Note continued. the Artery through the integuments & to a greater extent than that of the tumor, then cut it into the Aneurism & scoop out the Coagulable blood as well as Evacuate that which is fluid. The inferior Orifice will be most readily discovered as it will throw out some little blood of a venous colour, to discover the Superior the Tourniquet should be slackened. Tye the Artery at least one inch above the superior Orifice, the same caution is not necessary respecting the inferior. When the Tourniquet cannot be applied, the ligature may be passed both above and below the Tumor, before the incision into is [is] made, it is then to be laid open throughout its Extent. The Sac need not be cut but left to slough away; the dark colour of the Blood issuing from the inferior Orifice is caused by the Bloods taking & slow & retrograde motion which is explained by the annexed diagram. For Blood by having a slow motion or by stagnating will even in the Arteries acquire a dark hue, the older the Aneurism the more will the Coagulum approach to a brown Colour & the more recent the nearer will it be to the natural colour of Arterial blood. When an Aneurism forms, the Cellular substance thickens round it but being inelastic readily yields to distention. Aneurismal Cases. 1 A Young Man had a pain in the Calf of his Leg for two Years at length he received a blow on the Ham, after which a pulsation & Swelling soon appeared. The Operation was performed, every thing went on well to the 5th. day, when the Artery burst either from the upper ligature being applied too tight or too low, before the Tourniquet could be applied he lost as much blood as Occasioned his death. Upon dissection the Artery was found perfectly sound above the part where the ligature was made. 2 An Aneurism of the Crural Artery in the middle of the Thigh extended 5 or 6 Inches in length the Tumor being Oblong, the Operation was performed & the Patient in a short time recovered. 3 Mr. Martin had an Aneurism in the Popliteal Artery, the Operation was performed & he recovered the use of his Limb so perfectly as to be able to dance &ca. Remarks on the propriety of operating for the Aneurism of the 7 (Note continued.) Popliteal Artery in preference to Amputation. Whatever Objections are made to the Operation, the same must hold good against Amputation of the Limb. That one, so much insisted on of the disease being most commonly a disease of the Arterial System & not of the part in question only, if true militates equally against Amputation as against the Operation. If there is not only an Aneurism in the Ham, but another higher up as in the Femoral Artery, or in the Aorta, it is evident that Amputation of the Limb does not give the Patient a greater chance for his Life, than tying the Artery, but it not uncommonly, perhaps most commonly it happens, that whatever may be the general disposition of the Arterial System, yet the Actual dilatation shall only have taken place in one part, now if tying up & removing the diseased part can be accomplished the patient still retaining the use of his Limb, it is certain that the Operation must be highly preferable to Amputation, as the latter though it may preserve the patients life yet leaves him imperfect & mutilated. – 🜖 890 In treating of Gun shot Wounds it is observed that Contused & lacerated Wounds will not heal without Suppuration In wounds penetrating Cavities, if the Wound is made to heal without Inflammation & Suppuration it is then similar to any other simple Wound, But if the Suppurative Inflammation is to take place, it will be requisite to advert to the doctrine of Exposure of Cavities & of penetrating Gunshot Wounds, it must be evident also that if Extraneous bodies are introduced into the Cavity either by accident or intention & not removed the suppurative Inflammation will be necessary. 🜔🜹 891 A Poultice answers this description & the best manner of Preparing it, is to pour boiling Water into Linseed Meal & add as much oil or hogs lard as will keep it from drying, but Poultices cannot universally be had recourse to, & in lieu of them we use Lint dipped in Olive Oil. 8 888. In our treatment of Fresh Wounds it is necessary to consider. 1st. The nature of the part wounded 2nd. The management of an Hemorrhage should one arise 3rd. When the 1st. or 2nd. mode of union, is to be desired, or whether Suppuration is indicated. – 2 889. If the united parts are to be divided by the first mode of union, the indication will be bring them into Contact & retain them so This will be fulfilled by means of bandage & in some cases Sutures. 890. But when a part is to inflame & suppurate it is better to defer the application of Bandage, until after Inflammation has subsided. 891. Whenever a Wound is to go through either the adhesive or the suppurative inflammation, it is generally improper to use applications which will adhere to the wounded surface, become dry & which cannot be removed at the pleasure of the Surgeon, hence The use of dry Lint is extreemly improper. But if the substance to be applied is somewhat that is soft & moist, has no continuity of parts & which can with ease be removed on any Occasions it can do no injury. 🜔🜹 892. When a wound [is to go through either the adhesive] has suppurated & granulations are arising, if they do not readily Contract so as by their contraction to forward the formation of a Cicatrix it will be proper to employ the pressure of a bandage. 893. Abscess will be either Sound or Unsound. By the former we understand Abscess arising in healthy constitutions, or from some Specific disease. 894. The nature & treatment of sound Abscesses will be readily  9 understood from reconsidering the doctrines of the adhesive & suppurative Inflammation. 895. The Evacuations of the Matter contained in an Abscess is either obtained by the Abscess bursting of itself or by an Artificial Opening. Abscesses may be suffered to burst unless some particular circumstances require an Artificial opening. 896. The circumstances most generally requiring an artificial Opening is the danger arising from a long retention of the matter. 897. All Abscesses of the Abdomen Thorax, Brain, Eye & Joints should be opened Artificially & early. 898. When an Abscess is opened Artificially it will in general be necessary that the opening be large to prevent the future inconveniency of a Fistula. – 899. When an incision is made into an abscess, the wound should be so dressed as to prevent the reunion of the incised parts by the first or second mode of Union. 900. There are two methods of opening an Abscess Viz. a by Caustic b by Incision. Where no particular Circumstances (as the seat of the Abscess) forbid, the choice may be left to the patient. 901. Another circumstance indicating the Artificial opening of an abscess will be, its being of such a magnitude that the natural opening will not be sufficient for the discharge of the matter. 902. In determining the Size of our opening it is necessary to have regard to the present distension & future contraction of the ☽︎. 902. This Note is added to explain the text as I am not clear Whether I have there properly conveyed Mr. J. Hunters Ideas. “If the magnitude of the Abscess has produced only simple distention without considerable absorption (ulcerative or interstitial) of the parts in which it is seated it is not necessary to make a very large Opening, because when the distending fluid is removed the parts will immediately contract themselves, & discovering their original Situation the cavity will become obliterated, but if the Cavity has been made by ulceration & absorption of the parts in which the matter is lodged & not by simple distension of the surrounding parts then it will be necessary to make a larger & free Opening to prevent the inconveniency of a succeeding Fistula, because here the parts cannot Contract themselves to Obliteration of the Cavity but the cure must be Accomplished by Granulations. (See Fistula). 10 integuments. ☽︎. 903. The living principle will always be uneasy under extensive exposure & will therefore be powerfully excited to action. hence large openings in Abscesses, where the Contraction of the parts is not sufficient for the obliteration of the Cavity & consequently for the Cure, are always useful, because they are the means of exciting the Process of restoration. 904. Abscesses may be free from any specific disease, may arise in an healthy constitution, & yet certain Circumstances may retard their healing. 905. These may be. 1st. Peculiarities of situation 2nd The Stimulus of some deep seated foreign body, as a Ball, Splinter of Bone &ca. – The first causes of backwardness to heal we cannot alter. The second causes we must wait for the removal of, before we can hope for the healing of the Abscess. 906. When sores of any kind have a disposition to healing, the Surgeon has little to do, except to prevent any obstacles arising that may hinder the process of restoration. 907. If dry Lint is used to healing Sores it should be applied so as not to extend quite to their margin, if ointments are used they should be free from Stimulus. 908 – Amongst the Obstacles to the healing of a Sore will be. Intemperance. Neglect of rest, and The Granulations rising too high above the Surface 912. This will be best illustrated by considering the rupture of the [Tendo?] Achilles, it is generally affected when the Muscles of the leg become tired & unfit for voluntary motion as after long continued dancing, & therefore the Muscle will act involuntarily, hence the Cramp, &ca. by this acting very Violently & involuntarily they rupture the Tendon. In doing this the Patient feels little or no Pain in the Part, but seems to receive a blow on the Gastrocnemius Muscles & hears a Noise as of some Elastic body snapping in two. Inflammation &ca, may succeed, the Muscles may be squeezed out & the Ends of the Tendons approximated together & as much as can be retained so, When those Symptoms are removed no inconvenience can arise from suffering the Patient to walk if he himself has courage enough to do so, for there is no danger of the will throwing the Muscle into Action & Merely producing a further seperation of the divided Ends of the Tendon, for the will cannot now act upon the Muscle, but an involuntary action of the muscles may take place during sleep, & this is to be guarded against by a tight bandage round the calf of the Leg & making the Patient wear an high heeled Slipper or Sandal. The Bandage & Sandal are more particularly necessary by night, & whilst the patient sleeps, during the day time their use may Commonly be dispensed with; from the back of the Sandal a piece of Leather is to be Carried & fixed to the bandage or a Leather Strap Placed tight round the Calf. Where the Rupture happens no Bandage should be applied. 11 Surface of the sound Skin. 909. The latter obstacle is to be removed by pressure as that of a bandage, & by touching the Granulations with some Metallic Salt, as Vitriol of Copper, lunar Caustic &ca. – 910. New formed parts being weaker than Original parts, are less able to support the fatigues of the Offices of life than the latter; hence upon a slight stimulus being applied, they readily inflame & if that Inflammation is not removed, the suppurative & ulcerative Stages come on Rapidly, or mortification speedily takes place. 911. The absorption of new formed parts may be either a Ulcerative, or b Intersticial. 912. The Tendons of Muscles are sometimes ruptured & the Accident arises from causes similar to those of the broken Patella, the Muscle being in violent action at the same instant of time, that there is an unconquerable resistance made by the point to which the Tendon is attached. Note continued. The patient will find little Amendment during the first two months, but will after that period generally recover the use of his Limb. Keep the foot nearly at a right Angle with the Leg the Heel a little raised when the patient walks he should turn his Toe outwards & not attempt to bend his Knee. The Ankle & Foot will commonly swell considerably. About three weeks from the accident the roller & slipper may be left off, it may be asked when the Patient may attempt to use his Muscles We answer, whenever he feels a consciousness of a power to use them. Mr. Hunter broke his own Tendo Achilles in dancing, he is not clear, whether Cramp of the Muscles precedes the snapping of the Tendon, but it certainly immediately follows it. 916. The motions of the Shoulder joint are most difficultly restored after any Wound, or considerable injury of that Joint, because to some of them the gravity of the Arm is an obstacle, were it possible to cure a Wound of the shoulder joint with the Arm elevated, then the motion would be as easily restored as those of other Joints. – 12 913. In order to the Cure of this accident, the indications will be. 1st. to place the divided Ends of the Tendons as nearly as possible to their natural situation. 2nd. To take off or prevent Inflammation. 3rd To prevent the involuntary action of the Muscles. 914. It is unnecessary to forbid voluntary action of the Muscle because in the present state it will be no longer subservient to the Will. 915. Should the divided ends of the Tendon not be brought into contact, but remain at some distance asunder, the union will be accomplished by new formed substance & therefore the Tendon be somewhat lengthened the Muscle will however be thereby shortened & its power of contraction lessened, no inconvenience will ultimately take place, for the muscle (as in the Cases of Fractures of the Patella & Olecranon) will acquire new powers of contracting adapted to its necessities. 916. In Wounds connected with Joints, it is necessary to pay great attention to the Motion of the Joint, during the Cure if, there has been loss of substance without great care on the part of the Surgeon rigidity & loss of motion will be the Event. 917. After the Inflammation has entirely subsided, & the Cure is somewhat advanced, the joint should be gradually moved by the Surgeon from time to time, that the irritating matter may be elongated in a manner similar to the elongation of the coagulable Lymph in adhesions between the Lungs & the Pleura. – End of the Second Part.  13 We now come to treat of those Affections of the body which are the objects of Surgery, that may be more properly called diseases, that is, those Affections in which parts have no disposition for restoration, but only a disposition to destruction, & which disposition will continue to exist, until either it has worn itself out, or has destroyed the Patient, or is cured by Art, in short those affections for which there is no natural Cure. Inflammations whether arising spontaneously or from External violence, suppuration &ca. & all accidents (unless so much mischief is done either to a vital part or to the constitution that the functions of the body cannot go on) become themselves the causes of Restoration. These we have already inquired into so far as concerns the principle on which their different Phenomena depend, & have also considered the particular attentions by which we shall facilitate the natural process of healing in wch. in fact little is to be done except removing all the impediments to the natural Cure. But in diseases the present disposition is to be removed & a new one induced in its stead. –  14 It has been shewn that as irritation in health induces disease ( ) so irritating / in disease is to bring back Health. “This Aphorism generally hold good tho’ in some Cases of diseased irritability an objection may be made to it. “After some previous general remarks on indolence we come to particular diseases originating from that Cause. Tumors are those spoken of, but those only which originate from indolence are those meant to be explained.” the definition given of them indeed will apply to swellings from other causes than indolence, as Inflammation &ca. but the subsequent remarks will shew that Mr. Hunter when speaking of Tumors in that place had it only in view to treat of indolent swellings. 918. Diseases or unsound dispositions will be properly divided into the irritable & the indolent, or those in which there is a disposition to too great or too little action. 919. Either of these dispositions will be a hindrance to restitution of health, & must be changed before health can be restored. 920. It is easier in general to increase the disposition of a part to action than to abate it. 921. In the indolent diseased disposition there is neither sufficient power, nor sufficient excitement to action. In the irritable there is too great excitement without corresponding powers. 922. Again in diseased irritability, parts are impatient under any removal from a state of perfection, yet have no disposition to at about the process of restoration. This disposition may be ♀. 929. Caustics are not followed by so speedy or Extensive an Inflammation as the Knife, an incised wound in such circumstances has frequently for its Sequel, an Erysipelatous Inflammation. 15 either Simple or Connected with some specific disease as Syphilis Cancer, &ca. – 923. When simple we must have respect to the principle laid down ( ) but when complicated with some specific disease, both the specific & the irritable disposition require attention. 924 Diseased irritability may be local, or it may be a state of the constitution at large. 925. It appears in general to be passive requiring the application of some stimulus to bring it into action. 926. An encreased [action] degree of sensibility will generally accompany diseased irritability, the living & sensible principle commonly Sympathizing. 927. Inflammations with diseased irritability should not be hurried into suppurations, nor on the contrary should those means be used which lessen their powers, the indication being simply to lessen violence of action, not to diminish Powers. Opium may be properly used in Solution or mixed with emollient Poultices, for preperations of Lead see, ( ). 928 The diseased irritability of the Constitution is lessened by the use of the Bark & those means which encrease the strength. 929. When a suppuration has taken place in parts under this state, if an opening is to be made to discharge the matter, a caustic is to be employed in preference to the Knife, for incision has not here in general such favourable consequences as the other method. ♀. 930. Ulcers have sometimes a diseased irritability & when this ☍ 931. Some Ulcers which shew every sign of the greatest irritability &ca. will have their Symptoms unrelieved & often increased by mild dressings, but will grow easy under the use of the most powerful Stimulants as Ol. Terebinth, but we would first by Poultices with Opium. &ca. – 932 We meet with few constitutions which will not readily take on Inflammation, a Stimulus being applied to any part of the body in which there is no particular local affection, how far constitutional indolence may prevail, we have a proof in Scrophula. – 16 is the case the dressings should in general be of the mildest kind. 931. We cannot a priori always determine what application will assuage the pain & other Symptoms we must therefore change our dressings until we meet with one fulfilling that intention. ☍ 932. The unsound disposition with indolence, or the diseased indolent, may be either an affection of the constitution or of a part, the constitution will rarely be indolent in a great degree. 933. Specific diseases may give rise to or accompany indolence in parts, as the Syphilis, the Scrophula, & sometimes the Gout. 934. The common effect of indolence in parts is a thickening of them. the process of restoration in parts in a state of indolence is very slow. – 935. As the Extent & spreading of disease, in diseased irritable parts is great & rapid, so the disease of parts in a state of indolence is in general very circumscribed & rarely spreads to any considerable extent. 936. The thickning of Swelling of parts morbidly indolent is of 2 kinds Viz. 1st. Intersticial. 2nd Superadded. & Indolent swellings commonly go on to a considerable degree before any knowledge of them is communicated to the mind, But when very far advanced, some dull, heavy pain, with sickness will be produced, &ca. but this probably arises from the distention of the surrounding parts. 937. The Causes of indolent disposition arising in parts are 1st. The long Continued Action of Cold.  17 2nd. Violent actions terminating in weakness. 3 Pressure from Mechanical Causes. Indolence may be also spontaneous, arising without any visible or known cause. 930. The first Species (936) or intersticial thickening, is that in which no new or distinct parts are formed but there is simply a swelling or enlargement of the original Parts, as a Corn varices of Veins &ca. – 939. The Second (936) or diseased indolence with parts superadded is that in which new parts are actually formed distinct from the old. 940. The intention of Cure will be to encrease both actions and powers. In the intersticial thickening, as swelling generally consists in the disposition of Coagulable Lymph in the cellular substance &ca. We endeavour to procure a reabsorption of it, & to this end we employ those means which increase the action of the Absorbents as Mercury, pressure applied so as to stimulate fumigations &ca.. Care however is necessary not to excite the parts to greater action than they can support least mortification ensue. 941. When those thickenings cannot be removed by absorption (940) stimulating applications may induce a Cure, by exciting the Suppurative Inflammation in them, however their suppuration is with difficulty brought about, & when it has taken place, & Ulceration followed it, the Cure is not always easily obtained. 942. Abscesses have been divided into sound & unsound, of ∇ 944. The cure of Corns consists in obtaining a seperation from the cuticle, which may be brought about rather by leaving off the pressure, soaking the part often in warm water & keeping it always moist & defended by some proper Plaister, or by removing it at once, when a corn has been of long standing it is often difficult to remove by Excision, as a wound of the parts underneath is sometimes followed by Inflammation, & even Gangrene, but we may attempt it by removing the Pressure, soaking the part long in warm water, & then applying a blister to obtain a seperation of the Cuticle from the Cutis. 18 Sound Abscess an account has already been given, of those wch. are unsound, & which have a disposition to indolence, it will be better to speak when their common Cause & consequences. Scrophula & Fistula come under consideration. 943. Ulcers or Sores may have an indolent disposition and thence a backwardness to heal, when simple indolence is the cause we have recourse to those means which will excite the parts to action, as Turpentine, Balsams &ca. 944. Corns are an instance of indolence from pressure, the Cuticle thickens from the stimulus of necessity, & as it acquires thickness presses on the Skin & produces uneasiness & pain. ∇. 945 Various Veins are also an indolent thickening from pressure if the disease is not too extensive or the operation too hazardous, they may be dissected out, & the inconveniency thus removed. 946 Chilblains may be given as an instance of indolent thickening from cold. Though they have in them especially at first somewhat of an increased irritability. The constitutions most disposed to this kind of indolent thickening are the delicate & such as have but small Powers of generating heat. 947. Schirrus of a Gland may be offered as an Example of Violent action terminating in weakness, & acting as the Cause of an indolent thickening. 948. Of the spontaneous indolence ( ) proofs may be given, in the swelling of the Legs, so common in Barbadoes & sometimes 🜔 950. Of this kind are those swellings of the inguinal Glands which have been so often mistaken for venereal & for which people have even been salivated. Sometimes these enlarged Glands are so situated, that extirpation is difficult & to be undertaken with the greatest caution, this will be spoken to, when we come to Tumors & Scrophula to which two Articles they belong. ☽︎☉ 953. When we speak of indolent swellings being diffused we only speak as comparing them to Tumors, for indolent thickenings compared to swellings of parts from other causes are generally circumscribed. – 19 seen in this Country, & in the swelling of the Lymphatic Glands 949. Some indolent Swellings may require extirpation, as in encreasing their action in order to suppuration, they may be made to turn out Cancerous. 950. Lymphatic Glands may slowly, gradually & indolently tumify until they become of a size which may render extirpation necessary from their making pressure on some important part & disturbing its Œconemy, or from their occasioning deformity. 🜔 951. Wherever a cure can be obtained the indication will be the same, either to encrease the action of the absorbents, or to remove the part entirely. 952. In all indolent thicknings we should endeavour to ascertain whether they arise from the constitution or whether they are purely local (see Constitution local & original local). 953. Indolent swellings of parts will either be circumscribed or diffused, by the former we understand a Tumor (954, the latter we mean when we speak of thicknings of parts. ☽︎☉ 954. By the Term Tumor we mean a circumscribed substance produced by disease & differing in its nature & consistence from the surrounding parts. 955. Tumors may be divided into a. the Solid b. the Encysted. 956. The Solid (956.a.) may be subdivided into three Vizt. 1. The Intesticial.  20 2 The Superadded, or new formal Substances. 3 The mixed. 957 The 1st. or Intesticial (956) belongs to Scrophula. The 2d. or Superadded are entirely new formed substances, they take their rise from some fixed point from which they grow, as from a root which will be of different Sizes, they are perfectly circumscribed, are generally more detached than a Lymphatic Gland & they have no Coat. The 3d. or mixed consists of these Tumors called Wens. & Schirri, in which there is a mixture both of enlarged & original & of new formed Parts. 958. These differ very much in their appearance & consistence being only fatty Tumors, sometimes almost cartilaginous, when cut through they resemble somewhat a divided Lemon. 959. The 2d & 3d. Species will rarely if ever admit of any other treatment in order to a cure than extirpation. 960. Previous to the extirpation of any Tumor it is necessary that we enquire. 1st. What part it adheres to, or is connected with & its situation 2d. The manner in which it ought to be extirpated. 3d. Whether it is necessary to remove any of the surrounding parts with it. 961. The second Species ( ) may be of different degrees of hardness, may grow from a bone & be bony, or from a Tendon & be of a ligamentous firmness. 962. They may also be adherent to the Skin, to a Muscle &ca. & they 967. A Young Lady had a Tumor situated on the lower Jaw it became hard & almost bony. Mr. Hunter pared it away even to the Surface of the Jaw bone, but it arose again, when it had been pared off a second time & the Maxilla Cauterized the patient got well, the Tumor consisted of a thin Plate of bone forming a shell which contained a cartilaginous substance. A Young Woman had a Cartilaginous excrescence growing from the upper Jaw after the extraction of a Tooth, they were removed but grew again, after being a second time extirpated the Patient got well, these seem to occur most frequently in the Jaw bone or on the Tibia. In the 3d or mixed Calcareous Earth is sometimes deposited, they not unusually fall into a kind of suppuration without the surrounding part being affected, in removing them great caution is sometimes required. Mr. Hunter has dissected them off the temporal [Muscle] and Carotid Arteries & once laid the Trachea itself bare. 21 may be either superficial or deep seated. 963. The third may be loose under the Skin, or they may adhere to the Skin, they may be situated superficially or deep, upon Muscles, a Bone, or a large Blood Vessel &ca.. 964. If the surrounding parts are not diseased, they may be suffered to remain, they must be removed as far as the disease extends, for it must be a rule to remove the whole of the disease. 965. If a Tumor is loose & does not adhere to the Skin a longitudinal or crucial Incision, according as it is large or small, deep seated or superficial may be sufficient & then the Tumor may be raised from its bed & removed. 966. But if it is adherent to the Skin then a portion of the Integuments must also be removed, at least as large as the adhesion extends. 967. If it springs from a root originating from above, it is to be removed by the Saw, Pincers or Chisel, in this Case it may also be necessary to Cauterize that part of the Bone from which it Sprang. 968. If it is situated on any large Vessel &ca, great care will be required in the dissection of from its seat (see Note on 967). 969. If it be only a fatty Tumor not adhering & of a small Size a simple incision down to it will be found sufficient & then the Surgeon may squeeze it from its bed, with his Fingers. 970 When the third or mixed, very much enlarges they are not unfrequently productive of pain, however it does not prove acute, but is of a dull heavy kind & it depends on pressure upon parts more sensible. The Stomach sympathizes with the affection & ☉ 978. Hydatids. It is difficult to explain the manner in wch. these are formed, or to determine which are formed first the Exterior or interior ones. – Are they not Animals of the Polypi kind? – Remarks on particular Hydatids. Hydatids of the Brain are sometimes found & usually on the Plexus Choroides, these occasion no symptom peculiar to themselves & from their situation can admit of no Cure. Uterus & Ovaria. The fluid contained within the Hydatids found in those places is sometimes of a gelatinous nature, they are more detaches at first than afterwards, sometimes encrease to an enormous size occupying greatest part of the abdominal Cavity, & is then called encysted dropsy. It is to be distinguished from Ascites by the manner of attack, the Patient first feels a weight & swelling on one side, which as it grows larger rolls about, until at length encreasing gradually in size, it becomes fixed, & then the abdomen swells regularly & gradually, the health of the Patient is often little affected by it tapping is the Palliative Cure, & should be done with a large Trochar least the fluid be gelatinous, when large they will adhere to the Parieties of the Abdomen & then the operation is safer than at any other time, they are often made up of a number of cells, so that sometimes a Small quantity of fluid is only discharged by one Tapping, as this disease will certainly kill in the end, if it can be ascertained early, it would perhaps be right to make an incision through the whole length of the Tumor & Extirpate it entirely, Electricity has seemed 22 Sickness is not an unusual circumstance. 971. As is the pain so likewise is the Inflammation when it arises, that of the surrounding parts, these however are seldom much thickened. 972. As to endeavouring to induce in these Tumors the suppurative Inflammation, the Opinion given ( ) will now be applicable. 973. The encysted Tumors are substances contained in a coat wch. is either natural or acquired. 974. The natural are the Hydrocele; Dropsy of the Ovaria, Pericardium, Saccule Mucosi &ca. in which the contents are enclosed in a natural bag. 975. The contents of Encysted Tumors whose Tunic is acquired will be various in their consistence & natural Hydatids form a considerable Class of these Tumors. 976. Hydatids are collections of watry fluid enclosed in an adventitious bag, we do not know the cause, nature, or manner of their formation. 977. Every part of the body where there is cellular Substance, becomes the seat of Hydatids, but more commonly the Plexus Choroides of the Brain, Tunica Vaginalis of the Testicles forming a spurious kind of Hydrocele ( ). 978 They are of different Sizes, as they enlarge their Coats, thicken & become stronger, their Coats are but little Vascular, sometimes one large Hydatid will contain several smaller ones, one within another, they are often found in the Uterus, Kidnies, Liver, Thyroid Gland, Lungs &ca. but how ☉ of late to have been of very great service to one patient affected with this disease. Hydatids in the Kidnies. – Here they are generally situated between the External & Internall Lamella of the proper tunic of the Viscus, & are not out of the reach of relief. In the Liver. – They are most commonly found in the Substance sometimes they are discharged Externally, the bags making their way to the Peritoneum adhering to it. Inflammation & Suppuration coming on, the integuments ulcerate & the Hydatids are discharged. Mr. Hunter on opening a Woman found a great number of them enclosed in one common bag. In the Lungs. Sometimes they make their way into the Trachea & are coughed up. In the Thyroid Gland. They may become troublesome by impeding deglutition. They are found in the Cellular Substance in different parts of the Body. Especially in the neck & about the lips of Woman. – 🜔v 982. In this manner we suppose hair is formed which is found in tumors of the Ovaria. Mr. Hunter Once found an encysted tumor in a sheep, which contained a Ball of Wool, now it is probable this was thrown off from the interior surface of that tumor on which it had formerly grown. – 23 formed is unknown. 979. As to the Cure of Encysted tumors we can do little unless we can either procure a discharge of the contents & an obliteration of the Cavity of the Cyst, or an entire removal of the whole. 980. Tumors mat appear in parts whose they was not formed but into which they have made their way from some deeper part This Circumstance the Surgeon should consider when he is about to extirpate a Tumor. 981. If the Surgeon is not attentive to this circumstance he may be deceived, & operate ineffectually only removing a superficial appearance of disease & neglecting the deep seated cause of it & when probably some other tumor arising has driven the first into its present situation. 982. Some encysted Tumors are found to contain a quantity of hair the internal surface of these has taken on the natural disposition of the Cutis & Cuticle & thus given Room for the growth of hair. 🜔v. 983. The Carbuncle as to its ultimate Effect might have been classed with Mortification, as it produces a considerable sloughing of soft parts, but some characteristic appearances attend it, which would shew it to be a distinct disease & of a specific nature. 984 The predisposing Causes we cannot easily ascertain, It cannot be supposed to be owing to weakness as in general it arises not far from the source of the Circulation, & it does not commonly arise in weak parts, or in weak habits, its seat is commonly the  24 posterior part of the body, as the hinder part of the Neck, the Back &ca. 985. It begins with a considerable inflammation of the Skin approaching nearer the Erysipelatous than any other, the Skin is somewhat tumid but not prominent the part has a doughy feel. For a short time a pimple Arises, the Inflammation spreads rapidly and widely, & the Cellular Membrane to a considerable Extent, Mortifies; the Skin & Muscles still retaining their Life. 986. The Skin above has pimples which now Ulcerate, forming large holes, through which the sloughs of the cellular Membrane are thrown off, & as they come away leave large chasms which are loosely covered by the Skin, which is flaccid & hanging inwards, sometimes the matter discharges itself through an infinite Number of small holes. 987. The disease though it has its Progress chiefly in the Cellular membrane, seems to begin in the Skin, & the matter generated seems of a specific nature, which contrary to the course of all other matter tends inwards, & burrows in the cellular membrane, which wants power to resist its spreading, from a want of the adhesive Inflammation. 988. Should not free openings be made in the Infancy of the disease to give free Exit to the matter, & to prevent its spreading & diffusing itself through the Cellular Membrane. 989. The loose Skin remaining after the coming away of the sloughs of Cellular Substance should not be removed, as it will commonly in the end unite with the subjacent parts, & thus 🜔^ 995. (see Lord Ansons Voyage) Here the Constitution not having a power of supporting the new parts or Even the original reclaims at were the former & causes them to be absorbed. 25. greatly forward the cure, which if things go on well from this time proceeds as in a common sound Ulcer. – 990. Boils seem to be a species of Carbuncles but more of the adhesive Inflammation arising in the Circumjacent parts they do not spread. The cure of boils vulgarly so called is in fact a slough or mortified part thrown off. 991. The Aged & free Livers are most Subject to Carbuncles the Young to Boils. 992. Though the cellular membrane sloughs, yet suppuration freely goes on, in which matter is either furnished from living cells which are endeavouring to throw off the dead, or from cells which are themselves also about to die. 993. Carbuncles are sometimes local & sometimes seem connected with a diseased state of the System. 994. Bleeding is rarely proper, though at the beginning may be indicated sometimes, if there appears Symptoms of Inflammatory Diathesis. 995. A diseased state of the System as Scurvy, may occasion both intersticial, & ulcerative Absorption of new formed substances which we have shewn are weaker than the Original, hence in violent Scurvy, cicatrices have been known hastily to Ulcerate & even Calluses which formerly reunited broken bones become absorbed & the Ends of the bones loosened. 996. Tetanus. Or Locked Jaw is a disease which consists in an involuntary Contraction of voluntary muscles, sometimes it becomes an unnatural contraction of voluntary Muscles & Δ 996. Unnatural Contraction of Muscles is a Genus of disease wch. has many orders to it belongs tetanus, Cramp, Wry Neck, St. Vitus’s dance, Subsultus Tendinum, One of the kinds of Quincey, Ague, it bears some Analogy to Epilepsy & Catalepsy, though these are properly affections of the brain, it is not peculiar to the human Species, Horses, Monkeys, Stags &ca. are subject to Tetanus. – 1000. In this it is so similar to other Spasmodic Complaints which are very common in Warm Climates, but rarely felt in Cold ones. – ♀ 1001. These act upon the principles of producing weakness & an irritable state of the Nervous System. Locked Jaw has been often attributed to the Wound of a Nerve or Tendon, with respect to the former, the opinion seems quite erroneous, with respect to the latter, as Wounds of the Tendons do not heal readily, they induce an irritable & weak state of the System & this being present irritations which do not become sensible give rise to it. Upon that Principle it is, that it is known to follow large Wounds which have considerable Suppurations & which induce a weak & irritable state of the habit It does not arise here from Inflammation, for it does not take place until after Inflammation is gone off. Mr. Hunter is satisfied from his Experiments, that wounds of Nerves or the including a Nerve in a Ligature made upon an Artery have no particular Tendency to bring on locked Jaw which he has frequently found to take place where it was Evident no more was wounded. 26 then perhaps it becomes fatal. Δ. 997. When it affects the Muscles of the lower Jaw, it is called Locked Jaw, when it Extends to the anterior Muscles of the body it is called Emprosthotonos when the posterior Opisthotonos 998 The predisponent Causes will be whatever can render the habit weak & irritable. 999. Amongst these (998) Climate is a very powerful one. In hot Climates it is extreemly common, being produced by the slightest occasional causes & even sometimes arising Spontaneously. 1000. In Temperate Climates it is more rare, in very cold Climates it is unknown. 1001. Other predisponent causes may be fever, large suppurations, Wounds of Tendons, & ligamentous parts. ♀. 1002. The most trifling external injury may be the occasional cause of this Disease, even a Scratch or puncture, where neither Nerve nor Tendon are found to have suffered. 1003. It appears to be a disease of the nervous system & not of the Principle of Life, every circumstance appertaining to the latter commonly remain natural & unaltered, sometime after the attack of the disease. 1004. The Muscles of the lower Jaw seem more disposed to take on this Affection than any other Muscles, here the Disease commonly begins & soon spreads itself to other Muscles those whose Action is involuntary & necessary to Life then the Patient is destroy. 🜍 1005. Stupor. This Shews that the brain must be somehow affected, as it is neither Muscular, nor connected with Muscles, it is difficult to say how this affection of it is produced, is it from any compression on the Brain, induced by the Spasm of the Muscles of the Neck making pressure on the Jugular Veins, or is it from sympathy. 27 1005. It begins with a small degree of stiffness in the Muscles raising the lower Jaw, the patient finding a difficulty to open his mouth, at length the Jaw becomes less & less capable of being depressed, the muscles of the Eyelids are next affected, & the upper Eyelid falls more & more so that the Patient looks like a person going to Sleep, sometimes soreness of the mouth & Throat precedes, but this is only accidental, then the Muscles of the Head became affected; at first the head is held immediately Erect by the Spasm, then it is drawn backwards, the muscles of the Spine become nex Affected & the body of the Patient is bent [for] backward, then those of the Abdomen, the bowels are drawn inwards; the patient complains of a pain in the lower part of the Sternum, perhaps from the Diaphragm being affected; a difficulty of respiration from the spasm extending to the Diaphragm, Intercostal Muscles &ca. in which last an excruciating cramp-like pain is felt Universal convulsive motions of the Body sometimes attend like to Subsultus Tendinum. In other respects health seems to remain & the functions of the Body go on. The Spasms of the Involuntary Muscles, however increasing in violence & perhaps the heart also becoming similarly affected the Patient is cut off, sometimes Stupor produces his Death. 🜍. 1006. Should the patient live until the habit becomes accustomed to the disease it then wears itself out & at length the patient gets well, in general however it Kills before the System can be habituated to its Action. 1007. The disease does not always increase gradually & regularly  28 regularly as described (1005) but sometimes it will Extend itself suddenly from the Jaw over the whole body, so as to Excite unnatural contraction in the Muscles in general. When the Spasm confines itself to the Jaw the disease may be called Mild & then it does not prove fatal. 1008. The disease kills at different periods of time, but if the patient lives through the second or third Week from the Commencement of the complaint, the constitution becomes so much habituated to it, that it loses its power of destroying Life; then wears itself out. – 1009. The disease continues sometimes even Ten Weeks, a great part of the time remaining Stationary & at last the Patient gradually loses the Spasmodic Affection & his Muscles are resolved to a natural State. 1010. All Ages are subject to it, of Constitutions the delicate & relaxed are most liable to its attack. 1011. When it Kills the Muscles remain contracted until the contraction is removed by force, but when Art has relaxed than they do not contract again, no preternatural appearance presents itself upon dissection in any part of the body in general the disease kills suddenly. 1012. From considering what has been said, we are perhaps enabled to discover. – Why the Patient remains under the disease a long time without his general health being affected. Why the Disease kills – why it may Kill at different 🜺 1013 & 1014. Bark, Opium, Blister, Camphor, Bleeding, Warm bathing & a variety of other methods have been tried, wherever Mr. Hunter has seen the patient recover, the disease has seemed to have gone through its natural course, & to have worn out itself without his having had any reason to attribute anything to the power of Medicine. He recommends the Sugar Lead to be tried upon the principle of the known tendency of Lead to produce relaxation of Muscles & inability in them to contract. Externally as a substitute for change of Climate he recommends that the Patient should be put into a cold bath or an Ice house, he never saw a Patient die after the third Week. ☍ 1016. Cases of Locked Jaw. 1. A locked Jaw & Convulsions of the Muscles of the Arm from a compound fracture of the Radius. Heat & Perturbation of Mind encreased the Symptoms, he was always observed to be worse after drinking anything warm, or after warm External applications. Opium & Bleeding was tried he died the sixth day. 2. A Soldier received a Wound in his leg when it was nearly well a locked Jaw came on. Musk & Opium were tried for three Weeks, the patient finding no Change would take no more. He continued in the same state for Seven Weeks & more, & then began to mend, which he continued to do insensibly until he Recovered his health. – He took Bark & Port Wine during the whole of his illness his Wound healed long before, his Complaint left him. 3 A Soldier with a locked Jaw after using Musk, Opium, Camphor 29 periods, & why it [may] commonly cutts off the Patient suddenly. 1013. No internal remedy has been yet discovered that will cure or relieve this disease. 🜺 1014. External application have also been found ineffectual as Climate is one great predisposing Cause to the disease a change from the present to a colder might be tried. Electricity has once been found serviceable. 🜺 1015. As the indication of Cure must be to relax the present contractions of the Muscles, & to take off every disposition in other Muscles to unnatural Contractions, the internal use of Lead might probably deserve trial, as lead by inducing paralysis may cure one disease by producing another. – 1016. If the locked Jaw here follows a Wound in any part of the Body, the removal of the part wounded is not found to remove or lessen, the disease unless the Tetanus arises during the State of Inflammation in the Wound. For when the Inflammation & irritation of the part which received the injury is gone off, it must be evidently useless to remove it in case a locked Jaw should have come on, because whatever irritation was heretofore applied to the part is now taken away, & that is no longer the diseased part, nor can it now tend to cause or keep up the Spasm its Action on the System has been already produced & terminated ☍ Upon the whole from what has been related we may be justified in acceeding to the conclusion given in (1013 & 1006.). – 1017. Scrophula. is a disease which may be considered as constitutionally local ( ) it is not hereditary, as in other diseases so in this a susceptibility of the disposition for diseased Action & even the cold Bath & finding no relief left off all his Medicine, he took none for eight days, & then began gradually to mend. 4 A Young man had his thigh Amputated, had violent pain in it & frequent spasmodic Affection of the Muscles, 13th. day locked Jaw came on, 15th. became locked all over, 16th. he died. Opium Æther & Sweating were Employed; Muscles continued rigid after death, but when Relaxed by force did not contract again. – 5. A Sailor had a Tetanus affecting the Jaw & Muscles of the Spine, came on 2 Weeks after having received a Wound in his Wrist, during his Illness had Ischuria & Costiveness, both of which were relieved by a Clyster, Opium, Camphor, Bark, Steel, Cold Bathing were all tried, he lived some days had pain in his heart & great sense of oppression about that Organ having come on he died suddenly. 6 A Man had a locked Jaw, it was uncertain whether this disposition to it was induced by a Wound on the foot, or by a Wound of the Tongue, he died the 9th. day. The second day of his illness the Spasm extended to the Muscles of the Neck & Spine, the 4th. his Skin became exquisitely sore to the touch, his Eyelids did not open properly he had universal Spasm, & a degree of Stupor – 8th. his breathing was difficult & he had a pain in the lower part of the Sternum 9th. he died suddenly. – 7 Locked Jaw cam on after Trepang, Opium was freely given no visible good effect followed it, but after a fortnight the Patient mended gradually & got well. 8. Locked Jaw arose spontaneously after Nervous Fever, the 30 is all that can be inherited. ( ).. 1018. It is a specific disease, every process of which is marked with indolence & slowness of actions, whether it produces tumefaction, suppuration, or ulceration, all of which when the disease is true Scrophula go on with little or no pain. 1019. When it produces Swelling of a part the tumefaction encreases slowly, there is hardness with little pain or soreness, all the appearances of common inflammation are wanting no Resolution of the tumor take place a kind of suppuration is produced. 1020. When the Tumor becomes soft & suppurates, which it does very slowly & without pain, the matter very gradually makes its way to the External parts. 1021. The ulceration of the Integuments in order for the Evacuation of the matter is equally slow & tedious, the matter does not make a point as in healthy Abscesses but it stretches the Skin equally to some extent & renders it as far as it distends it, Shining of a Purplish hue, in this state the disease will sometimes remain stationary for months, when the Skin can no longer resist the [?ressure] of the matter it bursts & a fluid like a mixture of Curds & Whey is evacuated, there is rarely any common Pus when the Scrophula has gone on pure & unmixed with the Common Inflammation. 1022. When the Abscess has emptied itself it does not readily [??ll] up or suffer its Cavity to be obliterated but will often remain fistula the small hole through which the matter bursts remaining open. Patient took nothing but Port Wine & recovered. – 9 Locked Jaw arose in a Child of two years old after a scratch of a Finger by a Saw – died the 10th. day. – 10. Locked Jaw arose Spontaneously after Dysentery. – 🜔🜹 1028. It is not peculiar to the human Species, Several Quadrupeds, as Monkeys, some Birds, as Turkeys, are subject to the action of Scrophula. 31 1023. When Scrophulous Ulcers granulate, the granulations are large, soft, pointed appearing like a transparent glassy Substance their sensibility is little, the Margin of the Sore is loose flabby & turned inward, the Skin round about it has a purplish hue the granulations want the power of contracting ( ) so that the Ulcer will continue stationary, or at most its sore will be slowly diminished. 1024: The process of Cicatrization is equally difficult & tedious & when formed has not an healthy appearance. 1025. The disease seems to have a sedative effect upon the System diminishing all the actions of the parts which it invades. 1026. It has a power of producing in the parts, surrounding the part originally diseased a similar State, but it does not produce continued Sympathy in any great extent. 1027. The predisposing cause is a delicate & irritable constitution with weak powers of action. The parts most disposed to take on Scrophulous action are the Lymphatic Glands, especially those wch. are most Exposed to the influence of the atmosphere, as the Glands of the neck & lungs, “the Mesenteric Glands”. Joints particularly those of the Foot & Hand, ligaments, the soft Ends of Bones, in all which parts the strength & powers of restoration are but small. 1028. Persons between the Age of 15 & 40. of a fair Complexion & light hair, who do not appear to have the usual quantity of red Blood in their Vessels, & those who live in climates which are very changeable & irregular are most liable to this disease. 🜔🜹. 1029. Though it produces continued Sympathy to a small distance it has no power of affecting the Absorbents, nor is the disease capable of being communicated by them, it cannot like  32 the small Pox be communicated by innoculation. 1030. The Skin is rarely if ever originally & primarily affected by this disease, it may however fall into it from continued Sympathy. 1031. The Exciting causes will be external Violence especially if not very great, sudden application of, or unusual exposure to Cold, the use of Mercury. The slightest degree of external violence in habits predisposed to it (1026-27) will cause the part to take on a Scrophulous action. 1032. The Susceptibility of Scrophula in some Constitutions is so great that any complaint which deranges the habit for a time, as Fever, Syphilis, Small Pox &ca. will give occasion to a Scrophulous disposition & action. 1033. The appearances of Scrophula will vary according as different parts are affected, however it will always be found with one of the following circumstances. 1. A Circumscribed Tumor. 2. A Tumefaction more diffused 3. Suppuration without tumefaction. 1034. The circumscribed Tumors are chiefly Lymphatic Glands although they are sometimes found in the brain, breast, Uterus & Testicle. 1035. When the disease attacks a part which may suffer without much disturbance of the general health, we are often unacquainted with the nature of the disease, until a swelling in consequence of Suppuration appears, either in the part originally diseased, or in some other part to which the matter has made its way, the suppuration going on without inflammation & perhaps without pain ♂ 1042. A Fever has sometimes cured Scrophula & hence we might be led to think that Stimulating Remedies are indicated, but the Analogy will not hold good, for the disease is a specific one & will not go until it has worn itself out, until it has destroyed Life or is Cured by some specific. Should Lumbar & Hip Abscesses be opened? They are in themselves incurables possibly a chance for Life may be given to the Patient by opening them early that is as soon we are satisfied Absorption of the matter cannot be brought about. In some Scrophulous Abscesses we can obtain a Real Absorption of the fluid, it is always to be desired as the healing of them after ulceration has taken place is Accomplished with difficulty. – 33 1036. When the disease affects the Knee, the pain is more considerable than when the other parts are attacked & here somewhat of the true inflammation is mixed with it. 1037. Whenever the lower extremity is the seat of the disease, the Limb appears longer than the other, this is from the Patients particularly favouring that side & leaning on the other. 1038. Children are often lame for Months, & at length a swelling has appeared in the foot. When Scrophulous Abscesses appear about the fingers, hand or foot, the swelling sometimes does not subside even after the matter has been discharged. 1039. Lumbar Abscesses sometimes appear without any Previous pain, sometimes patients remember to have had pains in the loins in general however, if they have pain it is felt beyond the seat of the disease, as in the thigh, the Knee, or Foot, the Matter here very frequently presents itself in the thigh though formed in the Loins. 1040. Patients under 30 are most subject to this complaint it is produced by the common Exciting causes of Scrophula, it is to be distinguished from a disease of the Hip by attending to the motion of the Foot. 1041. Abscess in the joint of the Thigh is of the Scrophulous kind there is commonly a thickening of the soft Parts forming & surrounding the joint, the patient has a sense of weakness in the limb, wch. wastes & has its motions contracted. 1042. White Swelling is a term that may be applied to every Scrophulous swelling of a Joint, before the Skin becomes inflamed it is generally attended with an increase of Synovia, sometimes is truely Scrophulous & sometimes has a mixture of the common Inflammation. ♂.  34 1043. The common Pulmonary Consumption is generally a Scrophulous Affection of the Lungs. 1044. The Young, the fair & the delicate are most subject to it & the common Exciting Cause is Cold, it commences with tubercles in the lungs, swelling of the Glands of the neck often appear in the beginning, the disease increases slowly, the tubercles Suppurate & ulceration being formed, the patient becomes hectic & is at length destroyed. 1045 The Pulmonary Consumption is however seldom a purely Scrophulous affection it has generally somewhat of the common Inflammation mixed with it, as we know from this pain in the Chest, the quick hard Pulse &ca. – 1046. An Hemorrhage from the Lungs is not uncommonly the fore runner of pulmonary consumption but how far this has to do with Scrophula we cannot determine. 1047. The Testicle is also the seat of Scrophula As in its Actions upon other parts so here also its attack is scarcely known & its progress slow. 1048. It rarely occurs before the Age of Sixteen or in Old Age. 1049. The Breasts of Women also fall into this disease in which they will gradually, slowly, & with little pain swell to an Enormous Size.. 1050. The Scrophulous Testis (1047-1048) & Breast (1049) are to be distinguished from Cancer of those parts, by the want of Swelling in the Spermatic Chord & [Axillary] [inguinal] Glands, also by the abscence of local Sympathy, at least until the Skin is beginning  35 to be affected by the Suppuration. ( ). 1051. The indications of cure in Scrophula with respect to the constitution are. A. 1st: to give strength to the System. 2d: to Counteract the effects of Climate. 3d: the use of some Specific. with respect to a apart B. 1st: to produce resolution of the tumor or Absorption of matter if it has suppurated. or 2d: to Extirpate the disease if practicable. 1052. The indication (a.1) we endeavour to fulfill by means of bark & other tonic Remedies. The indication (a.2.) by changing the situation of the Patient, or if that cannot be done, by rendering the Systems less susceptible of the influence of the Climate in which the patient lives The indication (a.3) By the administration & application of such remedies as Experience has proved. 1053. If Climate cannot be changed which is to be desired & wch. should always be altered to a warmer & more regular; then we may lessen the susceptibility of the body by tonic Medicines. Cold bathing & the use of such Cloathing as will maintain on the surface of the body an uniform & equable heat, such as flannel which conducts heat from the body badly. 1054. Experience seems to have approved the powers of Sea bathing as the most powerful specific in every Scrophulous Complaint whether Hip Cases, white swellings. Consumptions &ca. & some + 1055. We consider Sea Bathing as a specific in Scrophula but we are also to consider under what circumstances it will Act most powerfully, for instance whether Sea bathing & a Cold Bath, Sea Bathing & a Tepid Bath, Sea Bathing & a Warm Bath, will best agree with our Patient, for we are not only to consider what will cure the specific disease but also what will best agree with the Patients Constitution. Some Persons cannot bear Cold bathing but will find themselves much refreshed by the tepid Bath, again others require the heat of the Warm bath to render Sea Water Agreable to their Constitutions, Again the season of the Year is to be considered for more additional heat will be required to be given to the water in the Winter than in the Summer, if the cold Bath cannot be endured. In the warm or tepid Bath the patient should remain 10 or 15 Minutes with the precaution of tempering the heat to the agreable degree. Sea Bathing may be employed in all Cases of Scrophula Even pulmonary Consumption. To prove that the Bath agrees with the patient he should feel a Glow of heat, & his Spirits be enlivened by its use, if these appearance are wanting after a 2d. or 3d. trial & the patient feels himself [cross out] chilly & enervated, some other degree of heat should be tried. In bathing the sores of Scrophulous Patients should always be uncovered. 36 Specific powers are also attributed to the fossil Alkali & Hemlock. 1055. Sea bathing is to be used with that degree of heat which is found most agreable to the System & followed by the greatest encrease of vigor & Spirits. + 1056. The means recommended (1052-1053-1054-1055) are most to be insisted on when there is greatest predisposition to the disease & the patient most disposed to the action of Exciting Causes. hence Children & Young persons stand more in need of them than those advanced in Life, also in irregular climates & in Winter more than in regular Climates or in Summer, for the Winter favours the Progress of Scrophula, therefore sea bathing & flannel Cloathing are more necessary in Winter than in Summer (It is a bad practice with Parents & Nurses to carry young children about in the cold with the extremities naked & exposed to the Atmosphere the bear cold ill & suffer from it more than those advanced in Life) 1057. We are not to expect a speedy Cure from any remedies used in the treatment of Scrophula, length of time being always required to give them Efficacy from 3 Months to 2 Years. 1058. Moderate Exercise is to be recommended & perhaps Vegetable diet may be employed with advantage. 1059. Mercury is in general improper in Scrophulous Complaints Bleeding is often necessary in Scrophulous Lungs to diminish the quantity of blood circulated through the Pulmonary Artery & proportion it to the quantity of unobstructed Lungs. 1060. As to the topical treatment where the disease admits of it &  37 it can be removed with propriety all at once, Extirpation is the best method. 1061. In the resolution of tumours, or the healing of Scrophulous Sores few topical application Except sea water & the Juice of Hemlock are of any advantage. 1062. Stimulating applications are generally injurious, Violence increases the action of the parts & at the same time does not cure but adds to the disease. 1063. When there is suppuration the Abscess should not be opened with a Knife in general they should be left to break of themselves. 1064. Variations in Age will often lend to the spontaneous Cure of the complaint, & this is most observable in Females. 1065. In scrophulous bones Exfoliation is tedious and obtained with difficulty, In those as in soft Parts every process of Exfoliation goes on not without difficulty. 1066. In Scrophulous Swellings sometimes only a White Curdy or Caseous matter is formed, indeed the parts being altered in their Structure & incapable of carrying on their functions lose their life, but do not putrefy, nor is there a disposition of parts immediately in contact to throw them off, themselves also being affected by continued Sympathy. 1067. Rickets may be defined 1st. a want of disposition in the Vessels of the Bones to form calcareous Earth arising from a weakness of a peculiar kind, or  38 2nd. too great & hasty absorption of Earth from the bone in proportion to the quantity formed by the Vessels. 1068. It is a disease of the Constitution & Originates in a weakness of a peculiar kind, for weakness in general does not produce Ricketty Complaints, although Rickets are always attended with weakness. The first Cause (1067-1) operates in the production of Rickets in Children, the second (1067-2) produces the disease in Adults. 1069. The Rickets in children are known by the bones becoming Enlarged, by their bending under the incumbent weight of the body & yielding to the ordinary Action of the Muscles so as to be thereby distorted. 1070. A certain Size in the Bones & a certain proportion of Earth should be present together as the Size of the bones is determined in adults it is impossible, the encrease of the bones in Size beyond their grown Subject. 1071. But in Children this is the Case, it is a known fact that during the time of growth, the enlargement of the bones is the greatest whilst the quantity of the Earth formed in them is the least, for the formation of Earth checks the growth of bone. 1072. The animal matter of the Bones is also altered, for it is found to be different from the Animal matter of Bones simply deprived of their Earth. 1073. The Rickets cannot produce an encreased growth of Bone in the Adult, but in other respects, as softness of the Bones 🜁 1077. If the bones of the Cranium have been affected, an irregular ossification may arise on the inside nearest the Brain & by its pressure induce morbid affections of that Viscus. On the concave side of incurved bones nature will sometimes form an additional quantity of bone in order to strengthen the Original. Of the softness of ricketty Bones a case occurred at Lime-house, when the Bones were as soft as Tendons. “It is necessary to add that Mr. Hunter considers the molities Opium as a species of Rickets, & that it is here described as in Adults. 39 & their inability to support weight & Muscular Motion, though the causes of rickets in the Infant & adult may be different tho’ effects will ultimately be the same. 1074. The general consequences of Rickets in parts supporting Weight are, that the Joints are obliged to form more Acute Angles. 1075. From what has been advanced, we are [without] enabled to understand why bones of the Inferior Extremities, are more frequently bent, than those of the Superior, & also why those of the superior themselves are sometimes bent, why the Bones are knocked. 1076. Why the disease affecting the Spine shall produce difficulty of breathing & other complaints of the Viscera & why it should render the pelvis distorted & labours difficult. – 1077. The bending of the bones & their [becoming] throwing an increase of weight upon a joint, gives rise to the Stimulus of necessity which excites a disposition in some parts to take on ossific Inflammation & to generate new bone hence irregular Exostoses, Anchyloses of the Joints &ca. – 🜁. 1078. From what has been said we also understand why bones bend in particular, & in different directions. 1079. For [in] this disease no certain remedy has yet been discovered. 1080. The disease is either a species of or allied to Scrophula & Sea Bathing seems to be what approaches nearest to a Specific remedy, as well as for Scrophula. 1089. Where the removal of the Tumors by Mechanical means is feasible & convenient it should be done by the Pincers, Chisel or saw 40 7081 The general indications of Cure are to give strength to the System, hence the Cold bath, Exercise, bark, & othe tonics may be advantageously employed. 7082 Exostosis, has probably somewhat in its native similar to Rickets, it is a growing out of a bone from a bone. 7083. It appears to be of two kinds 1. Constitutional 2. Local In the first a Similar disposition shews itself in almost every bone, in the latter perhaps only in a single bone. 7084. It has generally its seat near the heads of bones & therefore seems much connected with soft parts. 7085. The tumor sometimes arises all at once out of the Substance of the bone, sometimes very gradually. 7086. When near the Joints it sometimes produces lameness altering the direction of the Muscles & tendons. – 7087. It is peculiar to Youth & rarely appears in the more advanced Stages of Life. 7088. Though we know the [causes] Absorbents have a power of removing superfluous substances, even bony ones, yet we know not of any Medicine whose powers will either produce a removal of those Tumors, or a prevention of them. 7090. Fistula are of two kinds 1st. A passage for the discharge of pus &ca. from a diseased part 2d. An artificial opening or Canal in lieu of some natural one being obstructed. –  41 1091 It is the consequence of some parts being affected with disease, which they are not able to get the better of, although the fistula itself is seated in a sound part. 1092. The diseased part to which the fistula leads is always larger & more Extensive than the fistula itself. 1093. As the Fistula commonly opens in the Skin, & as the diseased parts is more deeply seated the lips of the Skin will be more tucked inwards (though sometimes the lips of the Orifice are turned outwards, so as to resemble a prolapsus Ani,) and the Orifice will be nearly filled up with loose fungus Granulations, which if destroyed, radily shoot up again. 1094. Whatever is the disease in the part to which the Fistula leads until the obstruction to its restoration is removed, or its disposition if Specific or unsound is changed no cure will be obtained. 1095. If the seat of the disease extends to or occupies a vital part, it will teize a patient & the constitution until hectic is induced & death succeeds. – 1096. The indication of cure in the 1st. Species of fistula (1090) will be 1st. the removal of whatever obstructs the healing of the Parts. & 2d. The inducing a new disposition in the diseased part. 1097. The second intention (1096) will be fulfilled by laying open the fistula or cavity, throughout its whole length & even carrying incision into sound parts that the mouth of the cavity may be as large or larger than the surface of its bottom, & that the whole  42 being exposed, a necessity for some New Process in consequence of the exposure may arise. 1098. non est inventus. 1099. The first indication of cure will consist in the removal of all foreign bodies or such as stimulate, as splinters of bone &ca. under the limitations heretofore given in cases of Gun shot wounds & diseases of Bones. 1100. If the parts in question have any powers of restoration, the consequence of (1097) this treatment, will be the Excitement of Inflammation Suppuration & ultimately granulation, which will at length fill up the cavity which is unnatural & cure it. 1101. In the second Species of Fistula the indication of cure will consist (1090) 1st. in opening again the natural Canal – or 2d in making some New one which will answer the purposes of the original one. 1102. In the first species there is a greater disposition to heal in the parts through which the fistula passes, than in the deeper seated parts, hence the disproportion of size (1091-1092-1097.). – 1103. We cannot simply from the appearance of a Fistulous Orifice determine its extent, we must therefore examine its depth, the seat & extent of the disease by some convenient instrument as a probe &ca. – 1104. Sometimes one diseased Cavity will have several openings leading to it, it is generally necessary to lay open the whole Cavity making it into one, & to induce a disposition to heal, at the bottom Φ 1108 A person had a Fistula in Ano for which he was cut, but the part still remained Fistulous upon a more accurate Examination it was found that the Sinus extended two inches above the Anus & then penetrated, above the orifice it continued its course along the Gut, for another Inch, the incision was then carried to the End & the Man got well. 43 bottom of that cavity. 1105. When Fistula & the parts they lead to are laid open the external parts should be kept from healing, until the deep seated ones have acquired a disposition for Restoration & the Ulcer can be healed from the bottom. 1106. These observations may be better understood by considering 1st. Fistula in Ano. 2d. Fistula in Perineo – 3d Fistula leading to Joints..4th. Fistula of the Lungs Liver &ca. 5 Fistula Lacrymalis 6th. Fistula of the Parotid Duct – 7th Fistula of Coopers Glands in the Female. – 1107. Fistula in Ano is the consequence of inflammation beginning two or three, or more inches higher up in the Cellular Substance, or the outside of the rectum, which going on to suppuration the matter descending commonly makes a point externally near the Anus & bursts but sometimes the rectum becomes so diseased that it will also give way & a breach be made in it opposite to where the Inflammation began. – 1108. The Cure (1097) will consist in laying open the whole Cavity making its External mouth equal to or larger than the Surface of any side of the Cavity & preventing the too early reunion of the lips of the Wound. Φ. (1106). 1109. Fistula in Perineo. there will often be several Sinuses whose mouths open Externally communicating with the fixed point of the disease, there it is right to treat if we can according to Rule given above, but before a Cure can be accomplished the diseased disposition in the parts must be changed, for instance ♃: 1110 As fistula in perineo will not get well though a Wound in the same part in Lithotomy easily heals, in the latter the external parts have not lost their disposition to healing, hence there is no obstacle to the Cure. – ♄ 1112. We take no notice of Amputation for Fistula in joints as it has nothing to do with the doctrines now before us. – 44 1110. Fistula in Perineo may have for its cause. Stricture in the Urethra, disease in the prostate Gland or membranous part of Urethra, the external Orifice cannot heal as long as the disease remains uncured. ♃. 1111. Fistula communicating with Joints will not heal because they communicate with parts whose powers of restoration are weak and making free openings only increase the disposition to disease, & the violence of the Hectic, neither can we Cure Fistula of the Lungs or Liver, because we cannot lay open the Cavity. 1112. In Cases therefore where we cannot have recourse to the treatment recommended (1097 &ca. we can[not] only endeavour to give power to the constitution by time & Strengthening Medicines. that if possible a natural Cure (though little to be expected) may be obtained. ♄. 1113. Fistula Lacrymalis is sometimes an Original local disease, sometimes a constitutional Local, a arising from Syphilis, Scrophula, &ca. 1114. From whatever cause the ductus ad nasum may become obstructed, whether from Inflammation or a disposition to contract similar to that which arises in other membranous canals (as the Urethra &ca.) forming stricture in it, the passage of the Lachrymal fluid is impeded; distention gives a stimulus to the Lachrymal Sac, which stimulus is also increased by the Salts in the Tears. hence Inflammation & Suppuration is produced, & the matter bursts through the Skin near the Eye. 1115. Through this new & unnatural opening the purulent matter  45 matter mixed with the Tears continues to flow until the Surgeon either dilates the natural Canal, or makes a new one, so that the tears may again have a passage into the nostril & then the fistula will heal. 1116. If the Obstruction in the natural passage is very great dilatation of it will rarely cure because we cannot in general destroy the disposition of the Canal to form strictures, & these recurring the disease will also return, so that most commonly a New & Artificial Canall into the nostrils must be formed. 1117. Fistula of the Parotid Gland, the duct from the Parotid Gland passing over the Masseter & Buccinator Muscles consequently lying very superficially is extreemly liable to be divided & the Saliva will flow outward from the end next the Gland, or suppuration from any cause whatever arising in the Duct & bursting externally a similar circumstance will take place. 1119. The Cure is performed by passing a Needle armed with a round ligature of Thread from without through the duct into the mouth & let the Thread remain there until the wound made by the needle has lost a disposition to heal, the External Wound we should suffer & encourage to heal. 1120. The ducts leading from Coopers Glands to the inner surface of the Vagina in Women are sometimes obstructed & a Sac will be formed Containing a slimy matter which will cause a distention or Enlargement of one of the labia to a prodigious size & produces the resemblance of an Hernia. 1121. An incision should be made into the tumor & the matter discharged, after which the incision should be suffered to heal.  46 1122. Then a second Crucial incision should be made into the Sac near to the natural opening of the duct, & this should be kept Open until it has lost all disposition for healing, & the mucus is discharged by it as formerly was by the natural passage. 1123. Unsound Abscesses. these are to be considered as two fold Viz. 1. those forming in a part 2. Abscesses of a part. 1124. In the first we have a collection of matter formed in the part where they appear, & in the second the matter is formed in some other part more or less distant & from thence makes its way to the part where it appears. 1125. Of the first we have instances in many Scrophulous suppurations in abscesses of the Joints &ca. 1126. Of the second we have instances in the Psoas Muscles & Hip Joint, which often present their matter in the thigh or Groin. 1127. Whether the latter burst, or are opened, the doctrine of Fistula will apply to them, nor will opening unsound Abscesses of a part be of Utility unless we can also induce in it a disposition to heal, or we have some foreign body to remove as Splinters of Bone &ca.. – 1128. Unsound Abscesses are generally caused by some Specific disposition as Scrophula, Lues Venerea &ca. or from a disposition to indolence either acquired or natural, that is Either in parts which have natural powers of healing but fall into a state of diseased indolence, or in parts which have natural but small powers of healing as in joints, ligamentous parts &ca. – ☉ 1132 By This definition, Glass, Metallic Salts, even Arsenic & a variety of Vegetable Substances as Crow figs. Hemlock, Opium &ca. are excluded from the Class of Poisons, also Honey, Particular kinds of Fish &ca. for three Reasons. 1st. Because these are not poisonous in the smallest Possible Quantity 2d. Because their action is not universal. 3d. Because their irritation is not specific but common. 47 1129. New formed parts as Cicatrices & Calluses are sometimes suddenly falling into the ulcerative & intersticial Absorption & the progress of the absorption will be uncommonly rapid as this arises from an unsound disposition in the Constitution, that disposition is to be removed or altered. 1130. We come now to Poisons (Poisons) especially the Animal & principally Morbid. 1131. But we can give no unexceptionable definition of poisons. 1132. The definition however which we can give & most free from Exception is A matter which produces a peculiar mode of irritation & affects the vital principle in a peculiar manner, when even used in the smallest possible quantity; & this without any relation to any known chemical or Mechanical powers, or by any common irritation. ☉. 1133. We know no substance in the mineral kingdom answering to this description, nor is there much poison of this nature in the Vegetable, but the Animal kingdom possesses it in great abundance. 1134. No secreted fluids are poisonous to the part secreting them but they will act as poisons on any other part of the Animal they belong to. 1135. Poisons answering our definition (1132) are of four kinds 1st. Those which act locally as the sting of a Cancer Itch &ca 2d. Those which have their effect on the Constitution, as Jail fever, hooping Cough &ca. - 3d. Those whose influence is upon the whole Nervous System, 1135 In the Animal Kingdom, some Animals as the bug & muskitoe & probably the, poison the part at the same time that they get their food from it. The Bugs, for instance poisons the part & produces an Extravasation of its Juices which it feeds upon. The leech after making a Wound poisons the Vessels of the part Wounded, so as to almost destroy their power of contracting, hence the Hemorrhage which often continues so long after a leech has been sucking which never follows other similar Wound 48. as the poison of the dog, of Indian poisoned Arrows &ca. 4th. Those whose powers are mixed as the Poison of the small Pox, Lues Venerea &ca. acting both locally & on the Constitution. 1136. We intend to consider Animal poisons only, & these are of two kinds, viz. 1. Natural 2. Morbid. 1137. The Natural are such as belong Originally & Naturally to the Animal possessing them & not depending upon any Preternatural affection or alteration in the Structure of any body or its path. 1138. The Natural has no power of propagating its effects beyond the individual its powers are exerted in poisoning. 1139. The morbid on the contrary depends on a preternatural action, or change of Structure in the Body communicating. 1140. But the morbid in general may be communicated by the body poisoned to other bodies & therefore may be propagated to many individuals; because the individual poisoned receives the same power of poisoning others as the Animal possessed by which it was poisoned. 1141. Some of the natural act locally only, as the Wasp, others both locally & constitutionally, as the Viper, Rattle Snake &ca. – 1142. Those acting on the constitution generally first produce local effects, before they are absorbed & affect the System. 1143. Pain in the part receiving the poison, red Streaks & swellings of the Lymphatic Glands in the course of absorption are sometimes preludes to rigors, Convulsions, general livid extravasations Swelling of the whole body & Death. ♀ 1151. Mr. Hunter suspects the Venereal poison militates a little against the general definition of poisons, in that he imagines its action depends on some measure in the quantity applied. Small Pox by inoculation between the time of its application & the time of its visible irritation requires 2 or 3 days Natural Small Pox 23 days – Measles 9 days. Cancer some Months – Itch time not ascertained. 49 1144. Inflammation is produced in the part of the adhesive kind (for the parts swell) which rarely terminates in suppuration tho sometimes pus is formed. 1145. The pus is of the common kind, when it does form, & it contains no poison, whereas when suppuration takes place in the morbid poisons, the pus itself is poisonous. 1146. All the natural poisons must come in Actual Contact with the part to be poisoned, some require to be inserted by a Wound in order that their influence may be [hastened] Exerted. 1147. Morbid poisons probably all arose at first from a [Wound] diseased state of the Body or of parts. 1148. Many are obliged to the power of Contamination for their continuance & that power destroyed would Cease to be known. 1149. In what they differ from the natural has been already shewn, they are like the natural communicated by contact & some of them in a state of Vapor. 1150. Those which arise spontaneously seem to be confined to the species of Animals in which they arise, as Cancer, Syphilis &ca. which are peculiar to the human Species & cannot be communicated to any other Animal. 1151. Morbid poisons applied to Animal Bodies have specific distances of time, between the time of applying the poison & the time of its producing irritation &ca. ♀. 1152. The natural poisons do not in general produce Extensive local Sympathy. 1153. Morbid poison being applied to a part, that part becomes  50 infected & diseased without a power of contaminating other parts by means of the absorbents, as in the Itch, or 1154. Morbid poisons being applied to a part, that part becomes diseased, & has a power of communicating the disease to other parts but not to the Constitution, as Cancer &ca. – 1155. When a part has the power of contaminating the System as the Small Pox. 1156. Of the action of some poisons, as Small Pox, Measles &ca. the constitution is sensible only once in the course of Life; of others it may have the action repeated. 1157. Cancer. is a disease produced by a morbid poison arising spontaneously in a part without our being able to account for the manner in which it is generated. 1158. It is a local disease which may produce a consequent similar local disease in another part but has never the power of infecting the Constitution. 1159. Some parts are more liable to the affections produced from difft. poisons than others, so the secretory Glands are most commonly the seat of Cancer. The breast & uterus in Women. The lips, external Nose, Pancreas, Pylorus, & Testicle are commonly seized with this disease. 1160. It is a poison of whose action the human Species are alone susceptible, Experiments have shewn us that it cannot be communicated to other Species of Animals. 1161. We find in parts affected with Cancer an indurated knotted feel with a kind of suppuration in the Centre, or an ulceration of the external surface attended with pain. 🝄 1169. “We may infer that cancerous Virus has no Power of infecting the blood or producing similar diseases in any part by means of the Blood.” “One Reason why Cancerous matter should not be able to act upon the system when Absorbed may be, that it is so slow in producing its Action that time cannot be sufficient for that purpose after its being absorbed, before it is thrown out of the body.” 51 1162. previous to a disposition to ulceration being formed the pain is dull & heavy but this disposition being produced, the pain becomes violent, giving a shooting burning sensation. 1163. The part affected has its functions destroyed, if a secretory Organ it loses entirely the power of Secretion. 1164. In its suppurating process the Cancers becomes adherent to the surrounding parts. The Skin becomes discoloured, smooth & shining & matter is formed, sometimes without much previous Inflammation 1165. When the Cancer is cut into previous to ulceration having taken place, there is sometimes found the appearance of a Cyst which contains an ill conditioned Serum, Blood, Curdly matter &ca. but seldom or never matter resembling good pus. 1166. The process of Cancer in all its stages & states is in general slow. 1167. When ulcerative Absorption has taken place, the integuments round the Ulcer, are tight & rigid, the Skin is tucked in at the edges & wrinkled into folds, an ill conditioned matter is discharged. 1168. The Lymphatic Glands in the Neighbourhood become indurated & Enlarged, sometimes soon, sometimes even before the Ulceration has taken place, & little Lumps are sometimes formed in the circumjacent Skin. 1169. It has a power of poisoning other parts, & of producing in them a similar disease, but it has no power of Contaminating the Constitution. 🝄. 1170. A Cancer of one part may produce Sympathetic swellings of the parts, but not true Cancer unless of Parts which are in the course of absorption.  52 1171. Constitutional effects as Hectic Fever &ca. may arise in Consequence of a patients labouring under a Cancer from the irritation the disease produces, but the affection of the Constitution will be only that, common to simple irritation, nor will there be anything specific or peculiar in the manner in which Cancerous irritation acts upon the System. – 1172. The time of life seems to be the powerful predisponent cause of Cancer, the Age which most strongly predisposes is from 40 to 60 it sometimes however appears Earlier tho’ rarely. 1173. The Exciting Cause. 1174. The parts most susceptible of the cancerous disposition seem to be those proper to the Sexes. 1175. Women are more susceptible of the Cancerous disposition than Men probably because they have more parts peculiar to Sex. 1176. Is there not another cause in the parts peculiar to Sex in Women at the given time of Life, undergoing a Change which renders them unfit for procreation. 1177. We know of no Medicine which will cure a Cancer. 1178. Arsenic is probably a specific for the Cancerous disposition but its powers are too weak to produce a Cure, nor will the System allow of its being introduced in sufficient quantity. 1179. Yet, a Cancer, if left to itself always kills, either by its constant irritation it exhausts the principle of Life, or by Producing continued or contiguous Sympathy, & thereby inducing a similar diseased affection in some part necessary to Life. 1180. Therefore Extirpation of the diseased part is always to be desired & if practicable always to be preferred before a consequent  53. cancerous affection has taken place any other part. 1181. We are always to consider not only the Original or first formed Cancer but also any part which may have been poisoned by matter absorbed from it, & which we call the Consequent Cancerous Affection. 1182. Nor can we always be certain that a consequent Cancer is not formed because ulceration & the formation of cancerous matter has not taken place for 1183. Coagulable Lymph which had been extravasated, in the thickening & induration, if absorbed will equally contaminate & poison the parts it is applied to, for whatever the fluid seperated in a part may be it will always possess the specific properties of the part from which it is secreted. 1184. The Consequent affection begins Either in the Lymphatic Glands or the Lymphatics themselves but a Cancer once formed whether Original or Consequent, there is no part contiguous to which it may not extend its action, even to bones. 1185. Hence Cancers should always be extirpated as Early as possible the Earlier they are removed the fairer prospect has the patient of future health. 1186. Previous to Extirpation it is always necessary to observe a. The common rules laid down touching the Extirpation of Tumors. b. Whether any Consequent is already formed & where. c. Though no Consequent cancer is Visible whethere there is just reason to believe a disposition for one is any where formed. 1187. In extirpation it must be an invariable rule to take away the whole of the disease. (1188 non est inventus) 1189. If the whole of the disease cannot be removed Extirpation  54 is not to be attempted. 1190. If the Tumor adheres to the Skin it should always be a rule to remove more Skin than the diseased part is adhering to that if possible, we may be sure of not only taking away the present diseased parts, but also of taking away any part in which it is probable from its Contiguity that a disposition for a consequent Cancer may be formed. 1191. The Consequent if left will be equally injurious & equally fatal with the Original Cancer, & though the Original be taken away, will itself contaminate other parts in the same manner & to the same degree as the Original & is equally incurable by any powers of Medicine. 1193. Notwithstanding all our Care the disease will sometimes appear again, even after we have removed all evidently diseased parts & these also which we are justified in suspecting. 1194. For, the slowness with which the Cancerous Virus sometimes acts may be a Cause of deceiving us, a disposition to a consequent disease may be formed in some part, which we can by no Signs whatever ascertain the Existence of. 1195. Nevertheless when the operation is admissible we ought always to endeavour at the Extirpation of a Cancer. 1196. Cancer must be distinguished from Scrophula & from indolent thickenings of all kinds which may be done, not only from its appearance, pain, &ca. but also from its acting as a poison on the neighbouring parts, which scrophula & simply indolent thickenings never do.  55 1197. It should also be distinguished from the Fungated Sore wch. though it is not a poison as it has already been considered as Cancerous may not improperly be noticed in this place. 1198 The fungated Sore is a specific disease entirely local & has no power of contaminating or poisoning parts, beyond the Extent of continued Sympathy & even this not widely diffused. 1199. It has its seat in every part of the body without Exception. 1200. It begins in a circumscribed Tumor partly solid or encysted is not for a time very painful, it gradually & not very hastily enlarges, the Skin becomes discoloured & at length burst & ulcerates 1201. A lose Spungy fungus of the colour of dark Cruor is then thrown out, which rises & enlarges faster than Escharotics can take it down, it bleeds easily from the surface of the fungus & its pain is Acute. 1202. It resembles Cancer in being absolutely incurable by Medicine & if left to itself destructive. 1203. But it differs from Cancer in not being poisonous, & in never producing either in the Lymphatics or Lymphatic Glands a similar affection. 1204. This disease kills without seeming to have done so much mischief as might be supposed admissable without destruction of life. 1205. Nothing can be done to relieve the patient, but extirpation in which we should be extreemly careful to remove every Atom of disease, otherwise the part will again take on the same Affection. 1206. Many diseased appearances on the face, which have been considered as Cancerous are only fungated Sores.  56 1207. In the extirpation of Cancer two methods have been Employed. Viz. 1st. the Knife or Excision 2d. The use of such means as produce the death of the whole of the diseased parts & the subsequent seperation of them from the second parts. 1208. Diseased as well as new formed Parts ( ) have much less power of preserving life & resisting Death than sound parts, hence we can conceive how the application of Arsenic to Cancers shall sometimes produce the destruction of the whole of the parts laboring under Cancer, without depriving the Circumjacent parts of life 1209. Chemical applications as the different Caustics ( ) have also been employed, but the powers of Arsenic are the greatest, the Caustics making less distinction in their action between ye sound & unsound parts, the latter Acting Chemically, Arsenic by its irritation & exciting an Action under which the diseased parts have not strength to live or subsist. 1210. If we employ the Knife we should always cut into sound parts, in general we can employ excision more universally than the other means. 1211. We should in the Course of the Cure of the Ulcer after the operation if any lumps arise, or any consequent Cancer appear it is right to remove them as soon as discovered. 1212. If a Cancerous disposition remain after the Operation the Wound either will not heal or the catrix will soon ulcerate afresh, or the consequent disease will make its appearance. 1213. It is necessary to take notice of some Cancerous Affections of particular parts.  57 1214. A Cancer of the Breast most commonly begins in a small Schirrous Lump, which is in general circumscribed; at other times it begins with a discharge of blood, or a kind of matter from the nipple, sometimes the Skin becomes diseased very Early being thickened, discoloured &ca. – 1215. The natural function of the breast is destroyed, it loses the power of secreting Milk, is painful &ca. – 1216. It should be amputated before there is any adhesion of the breast to the pectoral Muscle or ribs, & before the Glands in the Axilla become affected, or at least before these Circumstances take place in any great degree. 1217. We must be cautious in Examining the Axillary Glands sometimes when enlarged they may seem moveable but when we come to operate we may find a Chain of little diseased Glands extending beyond the reach of the Knife, & rendering our endeavours fruitless. 1218. If the Cancer of the breast is suffered to become irremediable the ulceration increases with a stiffness & tightness of the surrounding parts, the breathing becomes affected & is difficult & laborious. 1219. The Axillary Glands being universally & greatly Enlarged the return of the Lymph from the Arm is obstructed, hence an Oedema of the whole Arm, sometimes soft, sometimes hard, takes place. 1220. In some patients the integuments on that side of the body will become Oedematous, & even a paralytic affection of that side of the body on which the disease is situated may ensue.  58 1221. Consequent Cancers will be formed, at length the patient worn out for want of sleep, with pain & hectic from the constant irritation, until at length she sinks & end is put to her sufferings 1222. In this as in all other Cancerous affections the liberal & unlimited use of Opium is to be permitted. 1223. If Cancer is seated in the Testicle it should be removed before the spermatic Chord is thickened, or at least whilst so much of it is apparently undiseased without the abdominal ring as to have room for the performance of Castration & then we are justified in operating, though the success is uncertain. 1224. In the Cancer of the Testis the pain is more excruciating than in the breast; with regard to the Extirpation & the Administration of Opium the rules given will apply. 1225. In the Cancer of the Testis the consequent Cancer will be in the spermatic Chord, the absorbents of the Testicle pursuing its course. 1226. If the Scrotum is the Seat of Cancer, the consequent disease will be in the Inguinal Glands. 1227. In the Lips the disease begins with a thickening. It is to be removed by the operation for the Hare lip, in other respects the preceding general rules must be observed. 1228. It is not necessary to dwell on the particular Cancers of other parts, as the Eye, the Nose, the Uterus &ca. Extirpation when practicable should be early employed, when impracticable means of alleviating pain, can only be had recourse to.  59 1230 The Itch, is a specific disease produced by a morbid poison which being applied to the Skin occasions ulceration in it. 1231. The Itch is Contagious, the person infected with it being always able to communicate it to others in the same manner as he received it. 1232. Contact of parts is necessary to its being communicated in a state of Vapour it has no power of Contagion, & its powers of infecting are very weak & easily guarded against. 1233. Animalcula may exist in the Matter but not necessarily nor universally. 1234. Continued Sympathy produced by it is very little & contiguous Sympathy hardly ever takes place from its action it has no power of poisoning the System nor have the Absorbents ever been seen to be affected by it. 1235. Its most ordinary seat is where the cuticle is Thin, its first appearance is a small Vesicle containing a little fluid to this succeeds an Ulcer discharging pus, which in the recent state is very minute, but when of some standing considerably increases in breadth, so as to be sometimes as large as a Sixpence. 1236. The little Ulcers made by the Itch never heal Spontaneously, & when healed by Art they do not again break out nor do other ulcerations arise in the surrounding Skin. 1237. Its power of irritating is not very considerable, the surface of the body must be healed to be sensible of its irritation, the sensation it Occasions is Itching not Pain. 1238. Different remedies are found to be specific for the itch  60 Sulphur, Hellebore, Mercury, externally used are known to cure it, but Sulphur Ointment seems to be the most powerful remedy. 1239. A Mercurial Girdle has been known to Cure the disease even when Mercurial Ointment applied to the Skin has failed. Brimstone taken internally will sometimes Produce a Cure. The ☍. 1243. Men who have a gleet, after all inflammation is gone off may infect Women & Women Men. 61 The Venereal Disease. 1240. The Venereal disease is one of the most Morbid compound Animal poisons, & like other morbid Animal poisons may be communicated by the persons infected to others. 1241. It is always communicated in the form of or united with purulent matter, which shews that it originally arises from Inflammation. 1242. When communicated to a part it produces in general Inflammation; but its progress is attended with Symptoms Peculiar to itself & distinct from those of other Animal poisons. 1243. The presence of Inflammation is not however necessary to its Existence, an infected person may communicate it to others after all Inflammation has left him, as in the Case of a venereal Gleet. ☍ 1244. To produce infection the Venereal matter must be communicated in a fluid state, or in a state rendered immediately fluid by the Juices of the receiving part, in the form of a Vapour it cannot infect, nor can it be communicated without the presence of purulent matter. (1242). 1245. The poison first arose probably in the Genital parts in the intercourse between the Sexes. This intercourse is not however necessary, it may be communicated from other parts besides the Genitals, & Even when applied by means of other substances than living 🜔v 1245. A Gentleman by Passing a bougie that had been formerly used by him when he had a Clap, caught a Gonorrhea. 1247. Mr. Hunter has sometimes known Gonorrhea arise without any preceding inflammation & confessed himself very much puzzled concerning the nature of such a Case, if they were venereal it should seem this Aphorism will not universally hold good. 62 bodies. 🜔v 1246. Actual Contact with the part to be infected is however always necessary. 1247. Venereal matter applied to sound parts has generally the effect of producing inflammation, which is always of a specific kind. 1248. From what has been said it is evident those parts which are not naturally or Accidentally secreting surfaces cannot communicate the Venereal contagion. 1249. It may affect the body either locally or universally & therefore may be divided into two Genera viz. 1st. Genus. Original or immediately local. 2d. Genus Constitutional. 1250. The first Genus has two species seemingly different yet their ultimate effect is the same Vizt. 1st. without ulceration or breach in the Solids called a Clap or Gonorrhea. 2d. with a breach in the Solids, or solution of continuity called a Chancre. 1251. The Bubo or local consequent may follow either the first or second species of the first Genus & when suppurating differs in nothing from the Chancre except in size. 1252. When the infecting matter is applied to a secreting surface the first species will be produced, when to a non secreting Surface as the Skin covered with the cuticle, the 2d. species will arise; from  63. either of these a Gland in the line of absorption being affected the bubo or local consequent, will be brought on. 1253. All secreting surfaces in the human body having nearly the same mode of action will take up the infection from simple Contact & may any or either of them be the seat of the 1st. Species. 1254. The second species may be induced a by a Wound. b by application of the Matter to the Cuticle. C by application of the matter to a Sore. 1255. Secreting surfaces being natural as that of the Urethra & Nostrils &ca. or accidental as an Ulcer, whenever the Venereal Matter is applied to them increase their secretion to wash away the offending matter. 1256. But the further consequence of the application of Venereal matter to the Natural & Accidental secreting surface will be different, of the former it will in general only change the nature of the secreted fluid from the latter, it will first increase the quantity of secretion, & then producing for a time, a Gonorrhœa of the Sore, it will change the nature of the Sore from a common one to a Venereal one, & then the disposition to ulcerate will be increased & the sore be in every respect converted into a chancre of the 2d. species. – 1257. Whenever a part becomes infected with the Venereal Virus it takes on a new action, if it is a secreting or sine Cuticular Surface as above described the nature of the secretion will be changed, if on a secreting surface the ulcerative Absorption of the part will take place & the pus will be secreted. 1258. Some secreting surfaces seem more susceptible of the Venereal 🜍 1262 A Gentleman had Chancres many times, they always healed very readily but the slightest scratch from any accident he received always was extreemly difficult to heal, so that some are very susceptible of this Specific or Venereal Irritation tho highly so of any irritation. – 64 Venereal irritation than others, the urethra seems evidently distinguished to take it on. 1259. Absorption of Extraneous matter always goes on more readily from an Ulcer than from a fresh wound, or from a Canal, it must be evident then that the local consequent must more readily & frequently arise from the first than the second Species. 1260 The Venereal poison will be always the same in point of Strength or acrimony, it may indeed at one time be diluted through a larger quantity of Fluids than at another, but it will produce the effects of a poison in the smallest possible quantity. 1261. Yet it produces different effects in different subjects, in some it will cause the most violent in others the slightest affection, it is therefore evident the susceptibilities of different persons of its irritation must be very much. 1262. This (1261) will not be easily explained for the susceptability of venereal irritation will not be in proportion to the susceptability of other irritations. 🜍. 1263. The local consequent will differ nothing either in its nature or its ultimate Effects from the original local having the same power of poisoning other parts, or the constitution & the matter secreted in it being equally infectious as that of the 1st. or 2d. Species of the first Genus. 1264. A natural secreting surface cannot be affected by this poison, longer than a certain time for had it a power of keeping up a specific Action in the part longer than a certain time the duration of the disease would be endless, for fresh matter being continually secreted would be the cause of a still further secretion of similar 🜔🜹 1264. Parts lose their sensibility of the Stimuli applied to them, in the Urethra the nature of the Solids is not changed but only the mode of the Secretion, now in process of time the membrane becomes habituated to the presence of Venereal matter & is then no longer sensible of its Stimulus, which can now no more produce the specific disease & therefore the disease [always] decays & a natural Cure takes place (see Note 1265). 🜔 1265. When we consider the different methods different people have to curing the gonorrhœa & that all are successful many of whom cannot possibly have any specific action upon the part we may readily suppose in General the complaint goes off of itself. Cases. A Married Man, during several years had known no other Woman but his Wife, he at length lay with a Woman of the Town & caught a severe clap. The Woman who gave it to him was not sensible herself of the ailment she continued her connection with him for several months without perceiving any change. She then formed a new attachment & gave a Gonorrhœa to her second Lover, she had no marks whatever of the disease herself he continued his intercourse with her for sometime, but notwithstanding got cured the while at length the first lover Returned to her had connection with her only once & she clapped him again. 2 A Gentleman kept a Mistress who becoming clapped left him she applied to & was taken into the Magdalen hospital, where she was apparently cured, she continued in that Hospital 2 Years seemingly 65 similar matter & so on ad infinitum for it would still continue its secreting action. 🜔🜹. 1265. We are induced to believe this to be the case from knowing 1st. That all Gonorrhœas are cured without any Specific remedies. 2d. That a secreting surface will retain Venereal Matter after Inflammation is gone off & also a power of poisoning other parts for a considerable length of time without being sensible of the presence of Venereal matter or undergoing any morbid affection from its remaining in Contact with it. 3d. That the application of fresh Venereal matter may be applied to the secretory surface in question without increasing the present disease or even retarding the Cure 🜔. 1266 Note continued. ~ quite well & when discharged was picked up again immediately on her dismission by the Gentleman who had formerly kept her, to whom she nevertheless gave a severe gonorrhœa, he continued however to Cohabit with her & got quite well without interrupting his connection which at last he broke off. A Married Gentleman in the City took her into keeping & was immediately clapped by her he was likewise Cured although he continued his intercourse with her during the cure, his Mistress however left him & returned to her former lover whom she clapped the second time. These histories abundantly shew & serve to prove what has been advanced. Many more of the same kind could be adduced, moreover if the Venereal matter of a Gonorrhœa or a Chancre is applied to a Bubo, or that of a Bubo to a Chancre it will not in the least increase the disease or retard the Cure. If a Man continues to be intimate with a woman who has clapped him, & if he is cured & she not, still he will not receive fresh infection, that is provided he continues to cohabit with her but if he absents himself from her for sometime, that is until his Genital parts have recovered themselves & as it were lost the recollection of the Venereal Stimulus he will then get a fresh Gonorrhœa. This we see depends upon the force of habit, from being long accustomed to the Stimulus of Venereal Virus the parts lose their sensibility of it & cannot be irritated by it. thus in general if a Man gets several successive Claps the first will be the severest & they will become slighter & slighter every time, was a Man once clapped to continue during his Cure even so long afterwards his intercourse with Venereal Woman, it is extremly probable he would find it impossible to contract a fresh Venereal Gonorrhea (see habit 98) 🜖 1270. Where the pus discharged from Ulcers in the Urethra the Gonorrhea would not be cured without Mercury, which we [have] know is by no means the Case. – 66 1266. But this natural decay of the specific morbid action & spontaneous cure will only arise in natural secreting surfaces. wherever a chancre or Venereal Ulcer is formed no natural or spontaneous cure is ever effected, but the disease continues increasing in violence until it is cured by Art. 1267. The matter of a Gonorrhœa & Chancre is exactly similar & equally capable of poisoning other parts. A Gonorrhœa will produce in the same person a Chancre or a chancre, a Gonorrhœa, & both or either may produce a Constitutional disease, in general when the Chancre appears the Gonorrhœa goes off, & frequently the Gonorrhœa appearing the chancre will go off. It should therefore seem that one irritation cures the other, the two parts sympathizing with each other. 1268. It is extremly difficult to decide when the power of Contamination is entirely lost, persons sometimes retain a power of communicating the disease after not only inflammation but even the discharge has seemingly disappeared. 1269. If the Venereal poison is applied to a fresh Wound, or by means of any Wound, suppuration must in general first take place, before it can produce any effects on the body. 1270. The discharge from a Gonorrhœa is purulent but is very rarely attended with any Ulceration of the Urethra. 🜖. 1271. The local Consequent or bubo, sometimes neither Suppurates nor goes off by resolution, but becomes indolent & will 🜁 1272. We have seen the Chancre readily Cured in a person & he afterwards contracted a Gonorrhœa which was very severe and very difficult to remove. ∇ 1276. A Boy Eight years old swallowed some Milk & Water in which some Chancre had been bathed, with impunity; A Lady drank by mistake a bason of Milk & Water in which a Gentleman had washed his Chancre, it was near Eight hours after before she took an Emetic yet no bad consequence ensued. 67 frequently remain in that state notwithstanding the use of the most powerful remedies. 1272. Not only different person will be affected by the Venereal Virus in different degrees of violence (1261) but the same Remark will hold good with respect to different parts of the Body. 🜁. 1273. The second Genus or Constitutional ( ) takes place when the Venereal Virus is absorbed & carried into the Circulation. 1274. It may be communicated to the constitution by means either of Gonorrhœa or Chancres, sometimes although rarely from Venereal matter being applied to the surface at the body without Ulceration having previously taken place & sometimes from application of it to an Ulcer, without producing any change, but those two latter modes of infection are very Unfrequent. 1275. It may also be introduced into the System by poisoning a Wound, but there it must first produce inflammation & Suppuration in the same manner as inoculated Small Pox must produce Inflammation & suppuration in the place of incision before the constitution becomes infected. 1276. The Venereal Virus will not act as a poison applied to some parts of the body, it will have no effect upon the Stomach as has been proved by Experiment. ∇. 1277. The Venereal Virus cannot be taken in from the breath, sweat, saliva, milk or any other natural Secretion of a person labouring under the disease in its worst state. 1278. When the Venereal Virus is absorbed into the Circulation, it produces no change in the Blood, but has a power of producing local effects in different parts of the body, as blotches Ulcers, Nodes 1281. A Nurses breast inflamed & Ulcerated after suckling a child who had lately died. A Physician gave it as his opinion that the was Universal & that she had been giving suck to a pocky Child, but the event of the Case contradicted him Mercury did not mend the state of the sore, indeed New Sores broke out upon the breast while she was taking it, at length she left off Mercury & recovered by good diet & Country Air. 🜆. 1282. It has been supposed that if a pregnant Woman is poxed, the Infant in Utero must partake of the disease, if ever this is the Case, it can only happen from the original matter from a Sore being conveyed unaltered to the Child which is what we can hardly conceive to happen. 68 &ca. but it is certain the Venereal matter undergoes some change as the Ulcer &ca. so produced, that is from the constitution, have no poisonous quality, the matter from a Venereal constitutional Ulcer will not communicate Venereal infection nor will it differ in its powers from pus of common ulcers. 1279. The blood although the matter has been absorbed into the circulation will not communicate the disease to a second person nor are any of the secretions of a patient labouring under the 2d. Genus any ways infectious. 1280. The Venereal Virus then can never be communicated unless from a part, that labours under the 1st. Genus, or has an original local Complaint. 1281. It must be from hence evident, that the opinion that an infected Child unless it has its mouth or lips originally infected cannot communicate the disease to its Nurse, nor can the Milk of an infected Nurse communicate the disease to the Child. 1282. It is also most to be believed that a Child in Utero is never poxed, it may receive the infection in its passage through the Vagina &ca. & thus it may be locally & in the end universally effected. 🜆. 1283. Many Anomalous morbid appearances resemble the Venereal disease from which it is by no means easy to distinguish it by the Eye. 1284. The only unequivocal Criterions for assisting us in discriminating one from the other are. 1st. The Venereal Eruption, blotches, ulcer, or other  69 affection (Gonorrhœa excepted) whether originally local or constitutional ever disappears or is cured without the operation of Mercury its true & specific remedy. 2d. No Eruption, blotch, ulcer, or other affection that is truly Venereal will appear whilst the constitution is under the influence of Mercury. 1285. The same person may have both an Original local & a constitutional disease at the same time. Of the 1st. Genus a person may have both the first & second species at once & the first species or Gonorrhœa may be cured the Chancre or 2d. Species remaining notwithstanding & vice versa. 1286. So either or both species of the first genus may Exist together with the second or Constitutional & either or both Gonorrhœa & Chancre may be cured without the removal of the Constitutional disease. 1287. But the Chancre will not remain uncured when the 2d Genus is cured although the Gonorrhœa will yet continue to Exist 1288. [But the Chancre without will not remain un] The Constitutional as above noted almost always arises from some species of the first Genus but the Chancre or Gonorrhœa does not at all become altered or have its action awakened by Poxing the constitution. (1285) 1289. The specific local diseases have all their specific distance for action which they do not Exceed. So also the Venereal disease has its specific distance for local action [which they do not exceed] this is however not always the same Extent, being sometimes ♂. 1290. Mr. Hunter has proved this by a variety of Experiments on the dog, the Ass, the Bitch &ca. by soaking Lint in Venereal Virus from a Gonorrhœa & Chancres & introducing into the Vagina &ca. ♀ 1293. A Gentleman had blotches in his face which resembled Venereal ones & had been deem’d so by many Medicinal Men, he had also blotches in his Legs & Thighs, they continued for Six Months several of them having got well during that time & others broken out notwithstanding he took Mercury, he at length consulted Mr. J Hunter who judging of them according to his idea advanced in the Text, assured him they were not Venereal & advised him to leave off Medicines, to live well tho temperately & bath in the Sea if he chose it, in a few weeks he lost his complaints. A Nobleman labouring under some complaints which appeared to be Venereal (& which those who attended him assured him was so) consulted Mr. J. Hunter he was with much difficulty persuaded to leave off Medicines & take a sea voyage to change the Air, he followed this advice & was cured. When any disease affects the Genital parts, they are generally considered as Venereal, but Gonorrhœa, Sores in the Glans penis, Buboes may all arise without any Venereal infection, moreover there may be a variety of the morbid appearances that take place 70 affecting a small space; sometimes a larger one it is however always circumscribed, but when it spreads more widely than Common it has always a mixture of the Erysipelatous. 1290. The Venereal disease is peculiar to the human species other Animals not being susceptible of its irritation. ♂. 1291. Does the Venereal disease produce its effects by fermentation, or by producing a peculiar Action in the Solids? The Question is not easily determined. 1292. A Man who has got a pox may notwithstanding get a chancre or Gonorrhœa without increasing the Pox, it is evident then that when the habit is once infected with the Venereal poison, it cannot receive any addition from the absorption of fresh Venereal matter. 1293. Many diseases may imitate the appearance of Venereal but they arise, heal & break out again, a local disease from a pox never disappears until it is Cured, this then differs from other poisons never wearing itself out nor ever suffering the part to make a progress tow’rds a cure. ♀. 1294. When the Venereal Virus has been absorbed into the System it has in itself no particular tendency to produce affections of one part more than another but from some peculiarities in different parts of the body themselves, some parts will be more susceptible of the Venereal irritation than others & of course take on Venereal action soonest. 1295. One Cause which disposes parts to take on Venereal action readily is, Exposure to cold therefore it makes its appearances in in the constitutional disease or second Genus, which are common also to other diseases we are not therefore hastily to determine whether a disease is Venereal or not, but together with observing appearance, inform[ing] ourselves also of the history of the complaint previously. 🜋 1299. Thus the Tibia being of all bones most Exposed to the action of Cold is of all others most frequently affected. it may be objected that the tibia is actually colder than many parts which take on the disease before it, but we know whatever dispositions are formed in Bones they come into Action much more slowly than the soft parts. ☽︎☉ 1300. They are either not susceptible of the Venereal irritates or else they never come into the venereal action before the disease is totally Cured. 71 the more External parts of the body first, this reasoning is strengthened by observing. 1296. That the disease is found to prove much more speedy as well as much more violent in its action in cold than in warm Climates, in the latter it rarely arises to any great violence. 1297. The parts first in order of susceptibility are a. the Skin. b. the inside of the Mouth & throat &ca. c. the Tonsils 1298. The parts second in order of susceptibility are a. the Periosteum b the Fascia – c the Bones. 1299. The bones seem to be the more susceptible of it the more hard they are & the nearer the surface of the body, consequently the more exposed to the action of Cold 🜋 1300. Many of the internal parts are not liable (as far as experiment hath proved) to the venereal Action as the brain, the Stom: the Liver, the heart &ca. - ☽︎☉. 1301. The Lungs are sometimes the Seat of the Venereal disease although they are late in coming into action, perhaps their susceptibility of this irritation depends upon their being in some measure an External part. 1302. The Venereal Matter when taken into the constitution does not long continue in the Circulation, but produces its action on the parts susceptible of the disease & is then thrown off by some of the secretions as any other extraneous matter. 1303. It does not long continue circulating in the System we know this because the parts first in order may be cured & the parts second in order still remain uncured, yet the first parts will not again take on the diseased Action now were the Venereal matter 🝄 1303. Thus if a Man with Venereal blotches & also diseased bones is put under a course of mercury, the disease of the Skin may be cured that of the bones notwithstanding remaining the diseased action of the bones may continue to go on if he leaves of mercury but the disease will not again appear on the Skin. 1306. When a part has received a strong disposition fraction a cure sometimes cannot be effected until the disposition has actually gone into Action. A Man might suppose that those parts which are most susceptible of the Venereal irritation, would in the advanced Stages of the disease suffer the most violently, but this is not the case a part having gone fully into action loses the susceptibility of the irritation which it had at first. 🜔 1309. A Man who has a Gleet though he has connection with a venereal Woman, will not catch a fresh Gonorrhœa. 72 still circulating in the blood there would be no reson why the parts first in order should not again fall into disease. 🝄. 1304. Dispositions once formed will go on to action though some time may Elapse before that action appears (see 167) Parts having received the Venereal taint; will if left to themselves always go on to diseased action although the distance of time may be considerable. 1305. Hence we may understand why many parts of the different orders may be contaminated at the same time, but their diseased appearance may take place at different Periods. – 1306. Those parts which most readily fall into the specific Action are the first in going through a Cure. 1307. As a further proof that the Venereal matter becomes altered when taken into the Constitution, we may observe that an ulcer that is constitutional Venereal, on the application of venereal matter from originally & locally diseased parts will catch a Gonorrhœa & so take on the action of an original Sore, now the matter of one Constitutional Sore will not excite another Constitutional Sore. 1308. If the matter of a Gonorrhœa is applied to a chancre it will produce no new effect vice versa. Again the matter of one originally local sore or Chancre will not irritate another Chancre. 1309. A part which has lately been under the irritation of Venereal matter will not readily take on the same diseased Affection again. 🜔. 1310. The seat of the first species of the first Genus ( ) in Men is the Urethra; the surface of the glans penis, the internal surface of the proputium. ∇ 1318. Perhaps the changes of Colour in the discharge will [depe??] upon a small quantity of blood being extravasated & mixed with it: 73 1311, Its attack on the prepuce & glans Penis is generally at the root of the latter & the beginning of the preputium, here the cuticle is extreemly thin & the cutis is easily affected. 1312. It there produces itching, soreness & tenderness with a discharge of thin matter. 1313. When this part takes on the disease the Symptoms begin very early. Forty Eight hours have been the whole of the time elapsed between the Infection & the appearance of them. 1314. When the Urethra is the seat of the Clap, the inflammation generally has its place within an inch or an inch & half of the external opening. 1315. It mostly begins with a sense of itching at the end of the orifice & sometimes over the whole glans, the lips of the orifice will be unusually full & turned somewhat outwards. The Penis in general seems somewhat enlarged. Pain, heat & uneasiness in passing the Urine, sometimes preceded by & sometimes following the appearance of a running from the Urethra, the canal of the urethra fells inflamed, the Patient voids his urine with fear from the sense of the smarting & then the urine comes off in small or in divided streams. 1316. The Glands of the Urethra become inflamed & swollen, they become hard & may be felt on the underside of the Urethra. 1317. According to the period & the degree of inflammation the discharge becomes of different colours & different in consistence its Venereal virulency is however always the same. 1318. The matter if received upon cloth will be found to give it spots of variegated hues in the centre of the Spot the colour will be darker & paler in the circumference. ∇.  74 1319. The matter will have a Smell peculiar to itself which will be fœtid & disposed to putrefaction. 1320. The Symptoms & progress of the Complaint will differ very much according to the susceptibility of the parts & the degree & Extent of inflammation. 1321. The more violent the Inflammation &ca. the more commonly will it produce great extravasation of coagulable lymph Occasioning Cordee, Soreness of the whole length of the Urethra, Even to the Anus, producing a sensation like that of Chordee Inflammation & hardness of the Glans Penis. Hemorrhage from the Urethra, Various Sympathies. 1322. The running comes from the urethra & its glands & in general not high up, it does not come from the bulbous portion of the Urethra, otherwise it would be thrown out by Jerks & not run off in the manner it is known to do. 1323. On the Examination of patients after death which at the time of their dissolution laboured under this complaint, the ducts leading from the Glands have been found filled with matter. 1324. The inflammation penetrating very deep, Coopers Glands may inflame, suppurate, & produce an abscess which is frequently the cause of fistula in Perineo. 1325. [The inflammation penetrating very deep, Coopers glands] [may inflame, &] The cause of the Gonorrhœa of the Urethra must be a transition of the matter from the external part to the inner surface of that membrane although it is difficult to account for the manner in which it is introduced. 1326. It certainly can never be introduced, but 1326. We know it may be communicated this way. An Officer who had no intercourse with the female Sex for a considerable length of time when in Germany, went to a necessary the tube of which according to the custom of the country went tapering downwards, when he arose from his seat he found something sticking to his Penis upon taking it off he found it was a plaister from a sore which some other person using the necessary had left behind him in a few days after a gonorrhœa appeared. 75. the external part must always receive the venereal infection. 1327. Chordee is of two kinds Viz. 1st. The Inflammatory 2d. The simple spasmodic. 1328. The first is owing to an Extravasation of Coagulable Lymph in the reticular substance & in the Corpus Spongiosum generally in the lower part of the penis, this is much more obstinate & remains much longer than the spasmodic which is without extravasation & comes & goes at uncertain periods of time. 1329. The Hemorrhage arises from rupture of some Vessel of the Urethra, either by a Spasm, or giving way to the encreased violence of the circulation. The Hemorrhage is sometimes considerable & for the present relieves not unfrequently the violence of the Inflammation & its consequences. 1330. The parts that Sympathize with the Urethra will be a. the Testicle. b. the Bladder c. the Muscles of the Urethra & Penis. d. the Glands of the Groin. e. the Whole Pelvis f. the Loins. g. the Stomach h. the Whole Constitution. 1331. Sometimes there will be an Erysipelatous Eruption of the neighbouring parts. 1332. At different periods of the Gonorrhœa, the testicle will sometimes becomes swolen, this is never to be accounted a Venereal but 🜨 1339. The Inguinal Glands swell, it is to be doubled if they are sometimes Inflammatory but purely spasmodic. The swelling of the Testicle will sometimes arise suddenly in a few minutes & go off as readily requires [only] often less time for it to subside in by a great deal than the common swelling of the Testicle after the radical cure of the Hydrocele the swelling will sometimes change sides being similar as to the Gouty sympathy of the Testicle. 76 purely a sympathetic affection of the testicle, sympathizing with ye. Urethra. 1333. A swelling of the Testicle may arise from any Cause irritating the Urethra, even the passing a bougie has brought it on. 1334. It sometimes appears during the more inflammatory Stage of the gonorrhœa but more frequently when the inflammation has abated, & it is sometimes attended with an increased, sometimes with a stopping of the running. 1335. The complaint begins with a pulpy & softened feel of the Testicle a slight enlargement of it, & a sense of increased painfulness on the touch or pressure, its tumefaction then increases & it grows hard, especially the Epidydymis. 1336. Sympathy produces pain in the original seat of the Testicle the loins, nausea & sickness, even Vomiting loss of appetite, uneasiness in the Bowels &ca.. – 1337. The swelling of the Testicle is not peculiar to the gonorrhœa it is often produced by Gout, Cancer & Scrophula, although more slowly by the latter. 1338. When the bladder Sympathizes, Strangury & the common symptoms of Stone in the bladder will occur. 1339. The inguinal Glands swell from Sympathy, rarely terminate in suppuration & as well as the swolen testicle are often curable without Mercury which shews that they are not Venereal. 🜨 1340. The Muscles of the penis will Sympathize, & often undergo a Spasm producing sudden & involuntary erections of the Organ which are called Spasmodic. ☿. 1343. In one person---10 hours. Another---20 hours In many---36 hours D°.---2 Days D°.---6 Days. In a great number---12 Days In many---4 Weeks In some---6 Weeks. 🜔🜹 1345. In a boy the Gonorrhœa returned twice whilst he was cutting his Teeth. – 77 1341. Of the Loins, Pelvis, & Kidney sympathizing with the Urethra it is unnecessary to speak, further than noticing the facts that Pain of those parts often attends Gonorrhœa. 1342. When the whole Constitution sympathizes there will be slight rigors, heat & other mild Symptoms of general irritation. 1343. The distance between the time of infection & the appearance of the Symptoms, so far as can be ascertained is all the intermediate time between 10 hours & 6 Weeks, most commonly however within twelve days. ☿. 1344. The Gonorrhœa is not peculiar to the Venereal diseases a discharge from the Urethra, without heat &ca. has been known to accompany gouty & rheumatic affections of the body. 1345. It has moreover been known to Sympathize with cutting the teeth. 🜔🜹. 1346. The Urethra of a Patient who has once had the disease is ever after Extreemly liable to it. 1347. We should endeavour to distinguish a gleet from a Venereal Gonorrhœa, in the gleet the glans penis does not change color nor does it sweat a kind of pus as it does in the Venereal Gonorrhœa 1348. It often goes off spontaneously & then it makes a somewhat puzzling Case, it has no specific remedy. 1349. A Constitutional disease in the 2d. Genus is as we have above observed sometimes though not very often known to Arise from the first Species of the first Genus, whenever there is a kind of hard Cord arises, leading from the penis to the Glands in the groin absorption of the virus is always to be suspected & the Constitutional 1354 The Vagina is not a part very sensible to common irritation hence matter may remain. ♀ 1356 A Woman had a Bubo formed in the Groin without having the least of any preceding affection. – 78 Genus feared. 1350 This circumstance most usually Occurs in the gonorrhea of the Glands & Prepuce. The 2d. Genus has also followed an internal gonorrhea in which there was a rupture of a vessel & an hemorrhage from the urethra consequently an internal wound, but it is very rarely the virus is communicated to the System by means of a Wound. 1351. The seat of the first species of the first Genus in Women is the Vagina, Nymphe, Clitoris & Urethra. 1352 It is not so complicated in women as in men, its symptoms are much milder & it is still with more difficulty ascertained. 1353. Appearances will in general give little information nor will its Symptoms enable us to decide. 1354. We can only judge the Woman has the disease, if she has the common symptoms following her connection with an infected Man, or if she whilst labouring under these Symptoms gives the disease to some sound person. 1355. We cannot however always determine that a woman has a Gonorrhœa because she communicates infection to a Man as her genital parts may have a power of receiving & communicating the infection without having ever felt any Complaint herself, or may retain the power of poisoning after the gonorrhœa has been Cured. 1356 From this it must be evident that a Woman does not always, know whether she has or has not the disease. ♀. 1357. The common Symptoms of a Gonorrhœa in Women are  79 pretty similar to these in Men, as smarting in making water a Running from the Vagina, a disagreable Sensation of the External Parts as the Clitoris & Nymphæ a fullness of the Labia pain in walking & the complaint rarely having exacerbations except at the time of making water. 1358. Sometimes the discharge will run down from the Vagina to the Anus & produce exulcerations of the Perineum. 1359. When the disease goes on, as in (1358) it is very doubtful whether it will there spend its violence as in the Gonorrhœa in Men 1360. In both Sexes previous to the appearance of the discharge the constitution will sometimes become affected (as in 1342) & a strange & unusual sensation of the parts will be perceived. 1361. Gonorrhœa without infection may arise in both Sexes from Various Causes. (1344). 1362 Although a Gonorrhœa will sometimes cure itself ( ) & we have no Specific for the disease ( ) yet we can shorten its duration & lessen its Symptoms by proper remedies. 1363. These remedies are divided into internal & topical 1364. The internal ones are Either a. Evacuants – or b. Astringents. The topical ones are Either a. Injections.. or b. Bougies. 1365. Mercury is the Specific for the Venereal disease but it seems of no other use in the Gonorrhea, than with a view to the absorption of the Venereal matter in the part thereby preventing  80 preventing its affecting the constitution, but this we have observed rarely happens & we have no reason to believe Mercury has any Specific power on the Affection of the membranous part of the Urethra 1366. Keeping the bowels regular is necessary in health & therefore useful in this Complaint, tho purging is not generally serviceable yet we have seen a brisk purge entirely cure the affection in which case it must operate either by derivation or by Sympathy. 1367. Diuretics are so far useful as by their effects in the urinary secretion they may lessen the violence of the irritation. Water is the best but will generally require to be accompanied with some mucilaginous substance. 1368. Balsams & Turpentines may be their Specific Operation on the part affected produce also a change in its diseased action & consequently effect a Cure. 1369. Astringents (1364b). do not lessen the Venereal irritation, but they may prove of some service by lessening the quantity of the discharge. 1370. Topical Applications (1364) must either be fluid or Solid, the fluids are injections, the solids bougies. 1371. The effects of the solid must be more permanent as it can be kept longer in contact with the parts affected; however it produces so much irritation that in general their use is better omitted. 1372. Injections may be divided into a Irritating b Astringent  81 c Sedative d. Emollient injections. 1373. Injections curing Gonorrhœa suddenly have been supposed to lock up the poison & throw it into the Constitution, but this Opinion is erroneous – for 1374 The Effect of the Injection here is to stop the farther secretion of matter, if then this is accomplished, it is evident that injections must contribute rather to the prevention of the 2d. Genus than bringing it on, the common vehicle of the poison being matter. 1375. Injections may either take off the Inflammation & the consequent increased secretion, or they may stop the secretion without removing the Venereal Inflammation. 1376. The irritating Injections are mostly astringent when made Weaker & astringent injections when made stronger will act as irritating. 1377. Injections are irritating when they produce an irritation greater than that of the disease itself. 1378. Irritating injections are in general improper, where the Constitution is extremly irritable & the inflammation has spread beyond the Venereal point, when used in this case they have become the causes of Fistula in Perineo. 1379. Where the disease is milder they generally succeed sooner in removing the Symptoms, for they produce the Cure by giving an irritation greater than that given by the disease which being overcome by a greater Stimulus leaves the part. They must therefore be improper where the parts cannot without danger of increased mischief bear 🜍 1379. A proper injection for this purpose is a solution of Sublimate in water (weak) if it gives pain it may be still further diluted. 🜔 1381. When a secreting Surface has been inflamed, & the part has received a disposition to secrete, the compleat Action being taken on is a step tow’rds the Cure, we therefore see why Astringents by checking the secretion may sometimes produce a Cure. 82 a more powerful irritation than that already produced & present. 🜍 1380. Astringents may Cure a slight disease, they act by lessening the discharge, & as they produce an affection of the living Solids they may contribute to a Cure. 1381. They make the Vessels contract & lessen the discharge, however they often produce a lessening of the discharge only, without forwarding the Cure, nay they sometimes protract the Cure. 🜔. 1382. Emollients in violent inflammations are very useful washing away the stimulating matter & leaving the surface of the part Soft & smooth. 1383. Sedatives ( ) sooth pain & abate inflammation, Opium is undoubtedly the best & most general sedative, but does not agree universally. 1384. Sometimes the end of the Canal & of the Urethra at the Glands is contracted by Inflammation, which is a troublesome circumstance & indicates the Omission for the present of bougies or injections. 1385. Other topical means as Mercurial Ointment, medicated Poultices, Fomentations &ca. can do little good Except when the External parts are the seat of the disease, or unless the Glands of the Urethra are so swolen as to be perceptible externally in which case we may use Ung: Cerul: fort. 1386. In Hemorrhages from the Urethra we have seen benefit afforded by the internal use of Turpentine & Balsams, Injections are not only useless but hurtful here. 1387. Opium given internally has powerful effects in preventing painful Erections & soreness of the Penis.  83 1388. The Cordee is in the beginning relieved by bleeding from the System & still more by Leeches applied to the part, & we are the more encouraged to practice the latter as we have observed that a Spontaneous hemorrhage from the rupture of some vessel in the Urethra has removed Chordee; Medicated Poultices & Camphor internally, sometimes affords relief. 1389. Chordee often continues after inflammation of the parts has subsided, from the Coagulable Lymph remaining Extravasated, whatever then will tend to produce absorption of the lymph will carry it off Mercurial Ointment, Electricity, Friction & Cicuta are all found serviceable, the affection will however continue often, long after the complaints have ceased & then go off slowly. 1390. In the Spasmodic Chordee ( ) we have known Bark singularly useful. 1391. If the Glands of the Urethra suppurate they become of the nature & produce the effect of chancres, & as such they may be treated. 1392. When the bladder takes on the affections (1338) the complaint is rarely inflammatory but mostly Sympathetic. Bleeding is rarely useful, & is if employed at all, to be managed with caution & in general topically the Warm bath. Plasters of Opium to the Perineum & to the origin of the Nerves of the Bladder & Clysters with Opium will commonly succeed. 1393. This Symptom in general is not hazardous but it is to be suspected that it sometimes lays the foundation for future mischief. Δ 1396. Perhaps the Practice of employing Vomits arose from Relief having been given by a Vomit administred to cure a sickness in the Stomach caused by Inflammation of the Testicle. 84 1394 When the Testis is swoln (1333) Rest in an horizontal Position, with the common treatment of inflammatory affections is to be insisted on. 1396. Vomits have sometimes great power in carrying off this affection. Δ. 1397. It is not determined how far Mercury is useful in Cases of swelled Testicle, we have reason to believe it may sometimes be Efficacious after the Inflammation is over. 1398. Sometimes the Testis takes on the suppurative Inflammation & an Abscess is formed which however requires no Particular treatment, as it is not Venereal matter that is formed Mercury is unnecessary. 1399. When resolution takes place the swelling of the Testicle subsides but slowly when it diminishes it grows gradually softer especially in the forepart & which sometimes becomes even softer than natural. 1400. The Epidydymis however generally continues hard & it is to be suspected that in consequence of that circumstance the testis is sometimes rendered useless, yet in general no inconvenience is observed to arise from it. 1401. The cure of the Gonorrhœa in Women is still more simple than in Men, Washes & Injections are proper here also. When the Vagina is the seat of the complaint, the internal surface of it should be several times be greased as high as it can be reached by the finger with Mercurial Ointment. 1402. As the Vagina is less irritable & sensible than the Male  85 Urethra, the injections to be used for the former may be prepared of greater strength. 1403. If the Female Urethra is affected, injections will not be admissible, but Mercurial Ointment may be insinuated into that Canal as observed above, it is not easy to know when the Cure is compleated. 1404. Should the inflammation spread & affect Coopers Glands The Mercurial Ointment may have also be used, if they suppurate they are to be considered & treated as suppuratory Buboes. 1405. It is sometimes necessary to attend to the constitution in the Cure of Gonorrhœa. 1st. if the Constitution is strong & disposed to Fever, it may be right to bleed. 2d. if the Complaint should take place in a low weak irritable habit, & when the Inflammation has a disposition to diffuse itself (which sometimes it will even to the Bladder) then Evacuations will be hurtful, & the liberal use of Bark will be adviseable to destroy the diseased irritability. 1406. It is generally found that the Constitution disposed to fever & inflammation admits most easily of the gonorrhea being Cured. 1407. In some irritable Constitutions it has been observed that a fever arising the Symptoms have gone off & that when the fever has left the patient the local Symptoms have returned. Again in others the coming on of a Fever even when the disease was mild has increased the Gonorrhœa & the Fever again going off the Gonorrhœa ☍ 1409. It is difficult to say, if giving Mercury will always prove a preventitive to the second Genus, but it is the most sure means we know of at present & therefore to be advised, either the Mercurius Calcinatus, or Ointment are recommended 🜔🜹 1411. We have remarked that there is perhaps an impossibility of distinguishing between a Gleet & a Gonorrhea, we shall observe a case or two. Case 1 A Gentleman in April 1780 got a Gonorrhœa, Swelled Testicle &ca. in June all his Symptoms left him, except now & then a little discharge of slimy matter & mucus, Sept.1. he married & gave his Wife a clap. It is to be observed that he met with some difficulty in entering the Vagina & that perhaps from the force he exerted his inflammatory Symptoms returned. Case 2 A Gentleman had a Gonorrhea two Weeks after he lost every Symptom except a gleet he lay with & clapped his Wife. We know in some that the inflammation & running has been kept up even for 12 months & yet the patients have not clapped the Woman with whom during that time they have been connected. 86. Gonorrhœa has been cured. 1408. It is perhaps always right to have in view the possibility of absorption of Venereal matter into the habit especially whe the disease has been long standing. 1409. Altho’ Mercury has no specific Action on the Inflammation of the Urethra yet with a view to prevent the ill effects that may arise from venereal matter being absorbed into the System it is right to administer it, especially tow’rds the latter end of the Cure & when the process of absorption must be nearly at an end. ☍. 1410. We judge of the Gonorrhœas advancing to a Cure when the cherry colour of the Glans changes to a pale hue & other Symptoms also abate, as the running decreasing in quantity & becoming more slimy, Pain & tenderness of the penis going off. 1411. It often happens that the Symptoms will leave the patient he will continue well even for a month & then they shall return, but it is probable that they will not be found to be Venereal when they appear a second time. 🜔🜹. 1412. Strange sensations in the Urethra & Glans (especially when the bladder has been affected) will often be perceived by the Patient after the Gonorrhœa is gone off. These will sometimes be obstinate & troublesome & too commonly render the dissatisfied & credulous Patient the dupe of Quacks. 1413. An obstinate Gleet will sometimes be cured by means similar to these which gave rise to it. Viz. a New Inflammation. 1414. Among the Complaints which will remain after a Gonorrhœa is cured, are those (1411.1412) swelling of the Testicle & hardness  87 hardness of the Epidydymis, wasting of the Testicle, affections of the bladder, strictures in the urethra, Carbuncles, Fistula in Perineo Swelling of the prostate, paralysis of the Urethra & Paralysis of the Bladder. 1415. Gleet has nothing Specific in its Nature, nor can it produce in others a similar disease; it differs from Gonorrhea in a. That the true Gleet is never infectious. b. The discharge has its Globules, but the Globules swim in mucus not in Serum. 1416. It is incidental to all constitutions, the strong as well as the weak, it arises from various causes besides Gonorrhea. 1417. It sometimes goes of naturally but whether from some change taking place in the state of the parts which are the seat of the disease, or from the want of power to continue the discharge we do not determine. 1418. It generally takes its rise from an habit of action in the part & almost always accompanies strictures in the Urethra. 1419. We attempt to cure it by Art in three ways Viz. a. Constitutionally b Locally c Sympathetically. 1420. The Constitutional Cure may be divided into a Specific b Strengthening. 1421. Specific Medicines are Bals: Copais: &ca. if they do service it will generally be immediately perceived; but should no benefit be found for 5 or 6 Days they should be left off, should they relieve they should be persisted in for a length of time for if discontinued  88 discontinued the complaint will not uncommonly return. 1422. The strengthening Medicines act upon the disposition of the parts in question, or in common with that of the Habit in general. 1423. Medicinal applications, [cross out] may affect locally 1st. as Specific & these have more influence when applied locally than when by means of the System (1421). 2dly. As Astringents, as decoction of bark, solution of white Vitriol, Alum &ca. These produce their effects by causing a Peculiar tonic action in the parts, their use should be long persevered in to produce a Cure. 3dly. Local medicines may produce a Cure by the Violence they offer to the parts, but their use should be deferred until other methods have been tried they are followed by an increase of the discharge from the Urethra, of this kind are very stimulating injections as Solutions of Sublimate, & Bougies either simple or medicated. As to the time these should be employed of the injections are very irritating 2 or 3 times will be enough, if less irritating a Week or two. Simple bougies may be used 5 or 6 Weeks for bougies made irritating a much shorter time will suffice. 1424. The third general method is by means of Sympathy or Perhaps derivation, as a Gleets being cured by two Chancres being formed on the Glans Penis, or by applying a blister to the underside of the Urethra; or by Electricity &ca. – 1425. Uneasy sensations of the bladder & Urethra have been removed by blisters applied to the Perineum or loins, the use of Hemlock; injections of sublimate & other means, but blisters to the Perineum have 1425 Case. 1st: Sir Charles Bunburgs Servant had for a complaint of this kind consulted Dr. Warren. Messr. Pitt & Gunning without relief. Mr. Hunter applied a blister ad Perineum which soon cured him, it was kept open 6 Days. Case. 2d. A Portuguese Gentleman had for 2 Years after a Gonorrhœa, such uneasy sensations in his Urethra & bladder as to give Suspicion of a Stone. Mr. Hunter examined him per Anum as well as by sounding & found nothing unnatural, a blister was applied to the Perineum Which cured him almost immediately 2 Weeks after he got a fresh gonorrhœa but no Extraordinary circumstance attended it, nor dis his old Complaint return. 14 ☽︎ 1430. Case 1st A Surgeon had a Gonorrhea & Bubo, the testicle on one side Entirely disappeared. Case 2d. A Young Gentleman Aged 18, without any Clap had a spontaneous Inflammation of the Testis on one side it was wasted gradually to the size of an hone bean the spermatic chord unaltered, he had afterwards a similar attack upon the other Testis which continued wasting until not a trace of it was left. Case 3rd. By Dr. Atham late Worcester. A Gentleman had a fever, & an inflammation in the left Groin & Testis. The Testis suppurated, at length however the matter was 89. seemed imminently useful. 1426. In the Gleet. Rest in general should be recommended though sometimes the complaint has been removed by riding on Horseback, Regularity & Temperance are also generally necessary, though there are not wanting instances of the opposite effecting a Cure. 1427. In Women the Vagina is the seat of the Gleet the treatment recommended in Men will here also apply the use of bougies Excepted. 1428. Chordee remaining after the cessation of the other Symptoms. Rub the parts externally with Ung, Mer, joined with Camphor, Electricity may also be had recourse to. 1429. Hardness of the Epididymis after a swelling of the Testicle will sometimes remain through life without any ill consequences. Sometimes relief has been afforded by rubbing the Scrotum with Mercurial Ointment, sitting on the steam of warm Water &c. - 1430. The Testicles are subject to spontaneous diseases more than most (if any) other parts of the Body, like the teeth they are added only for particular purposes, & they will be (similar to the Thymus Gland or membrana pupillaris) sometimes wasted & at length entirely absorbed This may happen at any Age. ☽︎. 1431. This absorption of the Testicle will follow an inflammation of the Testis, Hydrocele, & hernia Scrotalis but sometimes will take place without any preceding disease at all. 1432. Obstruction to the free passage of the urine through the urethra may arise from different causes. Vizt. 1 Excrescences in the Canal reabsorbed & the testis continued to waste until not a vestige of it except a few loose fibres could be found. 90 2d. Tumor without the urethra pressing on its sides & hindering its free dilatation. 3d. Strictures of the Urethra. 1433. If when the urine passes off only in a small stream & with difficulty we pass a middling sized bougie & find we can introduce it with ease we have reason to suspect a tumor (1432 2). 1434. Caruncles or fleshy excrescences (1432 1) growing in the urethra are seldom though they are sometimes known to exist, Probably they are a kind of internal Wart. Ulcers in the urethra we have never met with. 1435. Strictures in the urethra (1432 3) are of 3 kinds. 1 Permanent – 2d. Spasmodic – 3 Mixed. 1436. All Canals whatever are subject to strictures consequently the Urethra is not exempt, & indeed this Canal is subject to them not particularly as the consequence of Gonorrhea because they frequently take place in the Urethra without any Venereal Symptom whatever preceding. 1437. The seat of the Gonorrhea is commonly very near the Orifice of the Urethra, the seat of the stricture is commonly in the membranous portion. 1438. They do not seem to arise from the use of injections nor do Bougies ever produce them. 1439. Ulcers in the Urethra have been supposed to be the Causes of strictures, but we have never met with such a Case. 1440. We do not understand properly the causes of Strictures in the Urethra any more than we understand why they should Occur in other Canals. 🜔^ 1446 This proves that the Urethra has something of a Muscular power. 91. 1441. When a Gleet remains obstinate & the urine flows in a smaller stream than common, or in divided Streams, or is Escerned wth. some difficulty there is reason to suspect a Stricture & we should Examine by passing a Bougie. 1442. Permanent Strictures may take place in the whole circumstance of the urethra making an annular stricture & opening the area of the Canal as though a piece of cord was drawn tight round the urethra, or they must Occupy one side of the urethra in which case the Contraction will not be circular, but only on one side & then the Area will not be so much diminished as in the other case but the general dilatation of the Urethra being resisted the figure of the Canal will be necessarily altered, the Extent of the strictures will also differ in length, more or less of the Urethra being occupied by them. 1443. The number of Strictures will be also different in different Urethra sometimes only one, sometimes 4. 5. or Six. 1444. The portion of Urethra in which the permanent Strictures takes place will be whiter & harder than the rest of the Canal. 1445. Permanent Strictures will continue to a great length of time even Years their formation & progress is slow they are generally for obvious reasons overlooked until they have become considerable. 1446. They are generally more troublesome in cold weather than in warm & therefore are worse in Winter than in Summer. 🜔^. 1447. Permanent stricture continuing for years, teizes the Patient & at length gives rise to the worst diseases irregular enlargements  92 in the Urethra, diseases of the Bladder, Fistula in Perineo &ca. 1448. To understand properly why these consequences should arise from strictures of the urethra as also the nature of spasmodic Stricture we should have a clear Idea of the Structure & functions of the bladder & Urethra. 1449. The Bladder is a Muscular bag & has a power of Contraction for expelling the Urine, it can contract itself to the smallest Size. – 1450. The Urethra is also a Muscular body & can contract itself so as to shut up its Canal entirely. 1451. In a natural & healthy state of both Urethra & bladder the following Circumstances must be present. 1st. The actions of the bladder & Urethra must be alternate, that is whilst the bladder is contracting itself to Expel the Urine it is necessary that the Urethra should dilate itself or become relaxed in order to admit of the free & regular Exit of the Urine. 2ndly. When the Bladder has ceased from acting then it is requisite that the urethra should contract itself to present the dribbling away of Urine whilst the Bladder is in a state of relaxation. 3rdly. The Area of the Urethra when dilated must bear a certain proportion to the force with which the bladder acts in the Expulsion of the Urine. 4thly. The disposition of the bladder to contract and the disposition of the Urethra universally to be dilated must take place in the same point of time & the strength of the disposition in ♁. 1453. The Muscular coat of the Urethra has by these irritations been made 1/4 of an Inch thick. The Stone in the Bladder also produces a similar state of it by acting & dilating irregularly it often becomes fasciculated hence Sacs are formed in which Calculi are sometimes lodged. 93 each must be always in a certain & exact proportion. One to the other. 1452. From considering what is advanced (1449-50-51) we readily foresee, [greater than] That as a resistance given to the actions of an muscular body greater than it can overcome, & that frequently repeated, either increases its susceptibility of a disposition to Act, or otherwise Produces [adhes] a destruction of its Muscular powers & so renders it Paralytic, if by the Urethra not receiving or being insusceptible of a disposition to relax when the bladder is contracting, or not relaxing & dilating in due proportion of time & to a proper size of Canal, either an increased irritability & susceptibility of action in the bladder must take place, or its muscular powers being destroyed & Paralysis must occur. 1453. The Urethra not dilating in due time or to a proper size (1451-4.) & resistance being thereby made to the action of the bladder the latter increases the violence of its action to overcome the resistence, & this resistence being repeated every time the bladder has a disposition to Act, the Viscus becomes thickened, for the bladder like other muscular parts increases in density from frequent action & for a time at least in strength, it also becomes more irritable. ♁. 1454. If the resistance made to the Bladder is so great that it cannot overcome it but continues a length of time until the Urethra is either spontaneously or artificially dilated & this unconquerable resistence often repeated the muscular power of the bladder is destroyed & a paralysis of that Organ Succeeds. – 1459. Sometimes matter has been discharged from the Kidnies, Perhaps from the irritation & this without finding any Ulcer on dissection. 94 1455. If in consequence of Inflammation, partial contraction [&ca.] of the urethra &ca. the upper part of the urethra loses its power of Contraction, A paralysis of its muscular powers takes place, the Urethra is paralysed & no Contraction of the Urethra attends the dilatation of the Bladder, & the urine is continually dribbling off. 1456. If the Area of an portion of the Canal of the Urethra is diminished by permanent strictures in the Urethra, or any Tumor compressing its sides, so that although the Urethra has a disposition, in due time to become dilated, yet the urine not being evacuated with speed proportionable to the force with which the bladder acts will induce an irritable bladder & a thickening of its Coats. 1457. The Urethra may receive a disposition to contract irregularly without alteration of its structure & that only in particular parts this constitutes the Spasmodic stricture (1435 2). 1458. The Urethra may be permanently dilated in particular parts & contracted in others, by this means its surface will be unequal & often rough. 1459. The state of the bladder may be rendered such by distension of it & resistance of its contraction that it cannot admit the influx of fresh urine by the Ureters & the distention & enlargement of them shall be continued even to the pelvis of the Kidney which shall itself also become distended. 1460. It frequently happens that there shall be not only a permanent stricture lessening the size of the Canal of the Urethra, but also in the same Urethra a disposition to spasmodic contraction, this  95 constitutes the mixed Stricture (1451 3). 1461. The Urethra has sometimes a disposition to contract & close its canal independent of any alteration of its structure & loses not the disposition when the bladder gets into action, this being in fact a spasm of the Urethra we call it Spasmodic Stricture. 1462. Another cause of obstruction to the free passage of the urine may be as swelling of the prostrate gland. 1463 The use of the prostrate Gland is not understood, from its making a part of the urinary canal, it is evident that a swelling of it must produce an alteration in the state of the Urethra. 1464. When it is enlarged it stretches the Urethra Anteriorly & Posteriorly & flattens & narrows it laterally, the small Portion at the back part of it will Act as a valve to the Canal hindering the free Egress of the Urine. 1465. When greatly enlarged little or no Urine will be voided & all the Symptoms of an irritable bladder will come on. 1466. When there is no Symptom of disease in the Urinary canal & we can find neither stricture nor stone we should be led to Examine the state of the Prostate Gland. 1467. Pass the finger in Ano as far as the first joint if an hardness is felt extending higher than the finger can reach we may believe it to be a disease of the Gland. 1468. We may find this disease in two Stages. Vizt. 1st. When the Obstruction is not so great but a bougie or Catheter may still be passed into the bladder. 8. 1469 A Gentleman laboured under a Complaint of this kind by forcing the Catheter into the Bladder an Hemorrhage ensued the blood coagulating stopped up the holes of the Catheter when afterwards introduced into the bladder the Urine could not be drawn off & the patient died. – 96. 2dly. When neither one or the other can be introduced. 1469. we have noticed (1464) that a small posterior portion of the prostrate projecting into the Urethra sometimes Acts as a Valve through this projecting substance, a catheter has been sometimes forced into the Bladder which has ultimately terminated in death. 8. 1470. Permanent Strictures in the urethra give rise also to Fistula in Perineo. Nature endeavours to get rid of the stricture by producing an Ulcer in the part it occupies. 1471. But this is not always the Case the Seat of the Ulceration will be not unfrequently between the Stricture & the Bladder, whichever is the Case the ulceration directs its course from within outwards to give an exit to the urine as ulceration in Abscess observes a similar course to give an exit to the pus, with this difference however, that in the present instance the progress is slow with little or no inflammation, hence the Urine will insinuate itself into the Cellular substance & Corpus Spongiosum of the Urethra, so that the openings formed in the skin shall not correspond with the openings in the Urethra. 1472 This latter remark however will in general hold good only when the seat of the stricture is before the membranous part of the urethra, [than] when more posteriorly, the Ulceration is more Regular & more similar to that of Common Abscess. 1473. By the insinuation of the Urine into the Cellular Substance Inflammation of a considerable Extent followed by suppuration or even Gangrene may be induced. – ♂ 1479. Mr. Hunter does not allow that the Vesicula Semilaries contain Semen 97 1474. The prostate Gland, Coopers Glands, the bulbous part of the Urethra as well as the cellular substance may partake of the suppuration & the matter point externally. 1475. When an Abscess forms in perineo from this cause there is generally a free passage for the urine into the abscess & both its Opening from the Urethra & its external opening will not unusually admit a Catheter into the cavity. 1476. As in other Fistula so in those of the Perineum, the Ulcer in the Skin has generally a stronger disposition to heal than that of the deeper seated parts, hence the external Orifice will sometimes close & then the Urine insinuating itself diffusively into the cellular substance of the surrounding parts will at length make its way through a number of Orifices formed by Ulceration in the Skin of the Perineum Scrotum & even inside of the Thighs which are commonly the mouths of an equal member of surfaces. 1477. Seminal Weakness is considered as a consequence of Gonorrhœa Virulenta. 1478. The disease which commonly goes by this name is a copious discharge of a Dreglike mucus at the end of making Urine & in straining at going to stool in which Case there is often a copious discharge of Mucus which is considered as semen. 1479. But in reality this is not semen but the liquor of the prostate gland & Vesicula Seminales. ♂. 1480. As a proof that this is no discharge of semen we observe that it is common to old Men & that those who are afflicted wth. it find no diminution either of their venereal desires or of their  98. powers, that the quantity evacuated is often more than the quantity of Semen the Patient emits, that to produce it in some violent efforts are required as straining at stool or evacuating the last drops of urine, & lastly that patients have been immediately after this discharge has come away able to emit a fresh & natural quantity of real Semen which had the first been really it would have been impossible to do. 1481. It generally preys much upon the mind & imagination of the patient & hence rather than from its proper effects on the constitution renders him weak & debilitated. 1482. But real involuntary discharges of semen, may attend some patients & this is a matter of serious consideration. 1483. The Organs of Generation like many other parts consist of two parts. 1st. Those whose Action is primary as the Testes. 2d. Those whose Action is secondary as the Penis. The actions of the second should always follow the Actions of the 1st. irregularity in this circumstance is productive of Disease. 1484. When the Penis takes on action without the disposition of the Testes for action being increased, we have involuntary Erection of the Penis which may be similar to Cordee, except that it is attended with no pain or at most with only a sense of uneasiness similar to that which we experience in the part after Coition. 1485. Involuntary Erections of the Penis may be spontaneous 🜋 1485. I should imagine that Mr. Hunter means in this place Erections of the Penis taking place without any libidinous Ideas being first Excited in the mind. 99 or may arise from visible irritation of the member as virulent Gonorrhœa. 🜋. 1486. These Erections are to be considered as Spasmodic affections of the Muscular powers of the penis & therefore similar in their nature to Spasm of any other muscular part. 1487. But the Penis may not only act without any corresponding disposition in the Testicles, but the Testes may also act without any corresponding action in the Penis. 1488. This is the reverse of the other disease, the semen will here be discharged in every even the slightest occasion, the least friction of the Glans Penis, as in walking will produce an Emission, without any erection of the Penis, so will the most simple thought in Venereal matters, a dream in the least degree lascivious &ca. & here the Semen runs off like Stools or urine. 1489. Caruncles (1438) we may attempt the of by Producing ulceration of the carnosity whether this can be done by the Bougie is doubtful, when it fails the Caustic should be used in the manner hereafter described in the treatment of strictures. 1490. The permanent stricture is to be cured either by a. Dilatation. or – b. Ulceration. 1491. The method (a) is by means of Bougies, in the use of which we must attend to certain directions here laid down. 1492. We are to be extreemly careful not to make a false or New passage by means of the bougie & we are also to ascertain if Possible whether any false passage for the Bougie has been  100. already made. 1493 If upon enquiry we learn from the patient that bougies have been already used & that ground was gained in the length of the bougie which was last introduced without however getting clear of the Stricture we have reason to fear a false passage is already made. 1494. Near the orifice in the glans Penis a bougie may by chance be thrust into the mouth of a Lacuna this should be attended to, because it scarcely happens that strictures so low down obstruct the passage of the bougie. 1495. We should first attempt to introduce a middling size bougie, if that will not pass we have recourse to a smaller and smaller until we come down to one of a minute size. 1496. The great inconvenience of using a small bougie is that it bends in the urethra & so doubles, we should in our introduction of the instrument endeavour to ascertain this, least we think that the bougie is advancing when it is only doubling 1497. When a bougie is introduced if it is doubling, it will generally recoil if the hand is removed, if it is really advanced into the Urethra the length that it seems to be it will not recoil if by taking away the hand we cease to push it forwards. 1498. When a bougie hesitates in its passage but does not Recoil we should stroak the perineum with one hand at the same time that with the other we gently push on the Instrument.  101 1499. sometimes an advantage is gained by giving the bougie (before it is introduced) the natural bend of the Urethra. 1500. If we can introduce the smallest bougie the cure of the Patient is generally in our hands as by increasing the size of the bougie in future introductions we can produce the necessary dilatation. 1501. We suffer the bougie to remain in the Urethra a longer, or shorter time according as the Patient can endure its pressure from 5 or 10 minutes to 2 or 3 hours & this we at first repeat daily until a large bougie can be easily passed & no obstruction to the stream of urine remains, we then pass it less frequently but as there is always a possibility of the complaint returning those therefore who have been afflicted with strictures should never pass any length of time without introducing a bougie. 1502. The most convenient season for using the bougie will be a little before bed time, or an hour or two before the Patient gets up in the Morning. 1503. If the weather is very cold the stricture may be more violent so as to prevent any urine passing off or the introduction of the smallest bougie hence we are to make use of such remedies as are temporary relaxants, as the warm bath, Clysters with opium, blisters to the Perineum &ca. – 1504. A Bougie sometimes cannot be introduced beyond the stricture the first time, in that Case we are to introduce it ♂ 1508. Formula for making bougies RS. Diachylon Shel lac. When bougies are introduced care should be taken to prevent the slipping into the bladder by tying thread or Narrow tape to the round their upper end & bending it over the Glans Penis. Some persons have such a disposition to form calcareous concretions that a bougie Cannot remain in their bladder a few hours without being incrusted with calcareous matter & persons should use a great deal of exercise. Mr. Bromfied cut a Bougie out of a young Mans bladder when it had remained two weeks & a large quantity of calcareous Earth had Crystalized upon it. In passing a bougie it may be stopped by a Lacuna draw it back in that case, turn it & you will avoid that orifice 102 gently as far as practicable into the Urethra & leave it there for sometime by several repetitions of this practice we may expect in general to get beyond the stricture. 1505. From an increase in the disposition of the urethra to contraction, it will sometimes happen that we may be able this day to pass a bougie & quite unable the next. 1506. The passage through the stricture is not always straight this we shall best judge of from the appearance of the bougie after it is withdrawn. 1507. The Bougie does not act in the cure of strictures simply as a wedge, that is in the manner it could do in a dead Urethra but it acts upon & produces a reaction of the living parts & the cure is accomplished either by the parts habituating themselves to the pressure or by intesticial Absorption being excited. 1508, We also proposed to Cure strictures in the Urethra by ulceration & this is effected either by the irritation of a large bougie continued until ulcerative absorption arises or by means of a caustic. ♂. - 1509. Although the stricture is not an originally forms and therefore being a weak part may without much difficulty be made to ulcerate, yet great care must be taken that the Bougie is not forced into the Corpus Spongiosum Urethra which has been done & the instrument pushed even through the cellular substance of the Rectum.  103 1510 It may not be useless to repeat the remark, that if in passing a bougie it seems to make considerable progress & at the same time to be confined by the stricture there is room to suspect there is a new Passage forced open. 1511. Of this as well as of suffering a bougie to slip into the bladder the Surgeon should ever be extreemly cautious. 1512. The Cure by Ulceration is (generally speaking) to be Confined to that part of the Urethra which is straight & then in Cases Strictures not readily yielding to the pressure of the bougie it may be properly had recourse to. 1513. The method of producing ulceration by means of the Caustic may be employed When the bougie cannot be passed & the stricture is in the straight part of the [cross out] Urethra. 1514. The following instruments are necessary. 1st A Silver Canula 2d A Stillet, one End of which solid like a blunt probe, the other made of Gold, like a port Crayon & in the [Gill??] a piece of caustic is to be fixed. 1515. In this Operation the Canula Enclosing the stillet with the probe end downwards is to be introduced up the urethra until the probe strikes against the stricture the stillet is then to be withdrawn & turning the end Armed with the Caustic downwards to be again introduced through the Canula until the Caustic comes in contact with the Stricture where it is to be held for a ☿ 1515. Mr. Hunter observes that in some cases of stricture in the Urethra he has succeeded by means of Caustic beyond all Expectation. In one Case where the Stricture was between the membranous part of the Urethra & the Glans Penis a few to with the caustic enabled him to pass a bougie. In two other Cases in which the stricture had produced Fistula in Perineo & one of which suffered no Urine to Pass by the Penis the Caustic produced a Cure He farther remarks that it is safer to use the caustic than to persevere too long in irritating the Stricture the bougie, as force in the latter case is so easily products of a new Passage. 1519. If it slips within the Urethra so that it cannot taken hold of by the finger or forceps endeavour by grasper the Penis tight in one hand to prevent its getting further towards the Bladder, & with the other hand gently draw the Penis forward then backwards, so as if possible to work the End of the bougie upwards until it comes within reach of the Forceps 104. minute or two & then removed, this process is to be repeated every other day until the intent is accomplished. ☿. 1516. The patient should make water immediately after the Stillet is withdrawn or else warm water should be gently injected to wash off any portions of caustic that may be left in the Urethra. 1517. A slight Ischuria sometimes follows this method of cure which rarely yields to the common remedies. 1518. The ill effects that may follow the use of bougies besides making falsa passages are 1st. That the first time or two that the bougie is introduced many patients will be affected with sickness & Syncope but this goes off of its own accord & does not return on subsequent Repetitions of the use of the bougie. 2d. a discharge of pus from the urethra when before there was none & an increase of that secretion when before existing this is however an effect of little consequence. 3d. An inflammation & swelling of the Testicle in which the common treatment is to be had recourse to. 4th A Sympathetic Swelling of the inguinal Glands 5th. A Bougie slipping into the Bladder may form an nucleus for stone, should it slip so far that it cannot be taken of in the urethra, it must be extracted by the operation of Lithotomy. 1520. The Bougie making a new passage is not in general Forceps or Fingers, should this be ineffectual the bougie must be fixed steadily in the Urethra, Cut down upon & Extracted. ♎︎ 1522. Pass a staff into the Urethra as far as it will go which will generally be to the bottom of the new passage & beyond the stricture; the feel for the end of the Instrument Externally & cut down into its groove, making a wound of an inch or an Inch & half long, carrying the incision a little way into the Scrotum, then take a probe & pass it through the wound into the Urethra to the Stricture if it meets with an Obstruction pass two Canulas one on each side of the Obstruction until they are brought as near to each other as possible, then thrust a piercer from within one Canula, through the obstruction into the other Canula & withdrawing it supply its place with a bougie, next remove the lower Cannula & the Bougie will appear in the Wound, next take out the upper Canula & introduce the bougie along the Canal of the Urethra into the Bladder, it may be right then to lay the new passage Open through the whole of its extent that all may heal together, & least the new passage should receive in future the end of the bougie & prove an hindrance to the Cure As it may be difficult to introduce a second bougie after withdrawing the first, the first should be suffered to remain in the bladder for some time or perhaps it may be better to use the first time a flexible Catheter afterwards the bougies should be increased in size & their use persisted in until a Cure is attained. 105 productive of new disease, as the mischief done is generally early discovered but will impede the Cure of the present. 1521 If the Bougie [making a new passage is not in go] has made its way through the Spongy body of the Urethra it will pass onwards towards the Rectum if in the membranous portion it will take another direction. 1522. The Remedy for or cure of the New Passage is to be performed by incision. ♎︎. 1523 In the performing of which it must be a principle that the Urethra is to be fairly incised beyond the extent of the Stricture. 1524. In the spasmodic Stricture if the Symptoms are urgent we must have recourse at once to the bougie or the Catheter, the bougie is the least hazardous & a large one can often be Easily passed & will then readily relieve the patient even when we cannot pass it, by carrying it as far as we can without force & then leaving it, the stimulus its presence gives to the Urethra will take off the stricture & permit the urine to flow. 1525. We may internally administer Opium & the Turpentines Camphor may relieve this Spasm as well as strangury produced by Cantharides. Externally we may use Fomentations – Warm Bath – Steams of warm Water Blisters to the Perineum or loins &ca. 1526. There will rarely be permanent strictures producing  106 urgent Symptoms without spasmodic Affections of the Urethra also taking place. In the mixed stricture we shall find sufficient directions for practice by attending to what has been advanced in the other two Species the permanent & Spasmodic. 1527. In endeavouring to relieve the [Spasm] Bladder rendered morbidly irritable we should observe the following directions 1st. We should endeavour to remove all obstructions to the ready exit of the Urine. 2d. We should instruct the patient never to suppress an inclination to make water. 3d. We should endeavour to relieve the present urgent Symptoms by giving opium internally Clysters &ca. and 4th. We should try the effects of new irritation as a blister to the Perineum or to the loins. 1528. In case of paralysis of the bladder the catheter should be often introduced to keep the bladder from being distended & when we are evacuating the urine, pressure should be made by the hand upon the Belly we should also apply blisters to the Perineum or to the loins & give stimulating medicines internally. 1529. In paralysis of the Urethra which is a more rare complaint [attended with discharges] a similar mode of treatment is to be adopted especially the application of a blister to the Perineum [or to the loins & give]. 1530. Hemlock has seemed to be serviceable in the complaint Catheters employed for drawing of Urine should be considerably curved at the end & should be introduced carefully yet with some expedition, a flexible Catheter is to be preferred 🝄 1534 As the Female Urethra is short & straight no obstacle will arise to the use of the Caustic but should Bougies be used it will be requisite to retain them in their proper place & situation by means of a T bandage. 107 attended with a discharge of the liquor of the Prostate Gland & Vesicula Seminalis falsely called Seminal weakness ( ) bark & other astringents & strengtheners are also adviseable. 1531 Involuntary erections of the Penis being a nervous & Spasmodic Complaint, Antispasmodic Remedies may with propriety be called in such as Warm & Cold Bathing, Opium &ca. – 1532. In cases of real seminal weakness ( ) Opium has afforded singular benefit & may be use both internally & externally that is applied to the scrotum. 1533. The Enlarged Prostate ( ) is mostly incidental to Old men although Young Men have sometimes been affected wth. it. 1534. No cure is known for this complaint, Hemlock & Sea bathing may be beneficial, as the disease may not impossibly be owing to Scrophula, Opiates & Clysters should be frequently thrown up to Relieve the pain & lessen the irritation. 1535. In strictures of the Female urethra we can more easily succeed by the use of Caustic than bougies from the difficulty of retaining the latter & from the impracticability of their being passed by the patient herself. 1536. When in consequence of obstruction to the Exit of the Urine nature has made New passages for that fluid by the ulceration of the urethra & the formation of fistula in Perineo, we are to attempt the cure by carrying in our minds the general principles of the treatment of Fistula & also what has been already 🜖 1537. As the External parts are generally in a very disease and callus state we are not to be very delicate or sparing on using the Knife upon them, but if possible proceed so far as to make the several openings into one & to cut the Urethra beyond the stricture if the seat of the stricture is not already destroyed by ulceration. – 108 already laid down concerning the cure of new passages formed by an unskillful introduction of the bougie. (1522). 1537. In the Cure the staff is to be introduced in the manner before described upon which we are to cut down into the urethra then from the Urethra we are to pass a probe or flexible director into the sinuses that lead from the opening into the urethra & lay them all open as far as we can follow them. 🜖 1538. An hollow bougie is then to be introduced in the manner before described into the Bladder & the wound healed over it but there is a disadvantage attending the rise of the hollow bougie, which is, that its bore in too small to admit of the exit of the urine in a velocity proportioned to the force with which the Bladder acts. ( ). § We have already considered the consequences of Venereal irritation applied to a secreting or sine Cuticular surface, we now proceed to consider its effects when the matter is applied to a non secreting or cuticular surface the primary effects of which constitution the second species of the first Genus ( ) or local disease. 1539. If any irritating matter is applied to a secreting surface & the irritation is carried to a certain degree, then a change of that Secretion & a discharge of pus or the suppurative inflammation must take place. [1540. (If any irritating matter is applied to a non secre-]  109 1540. Irritation to a certain degree applied to a non secreting surface, suppuration must also follow, but that must be proceeded by ulceration 1541. We see therefore that if venereal matter is applied to the Skin & its application continued a sufficient length of time, ulcerative absorption of a small portion of the Skin takes place, & a chancre is formed. 1542. We have shewn (1254) that there are three ways in which a chancre may be formed. 1543. The second species, like the first is generally caught in Coition; it is not so common as the first species, we calculate that the first species is contracted four times for once that the second is, for the cuticle in general prevents its action on the cutis until the Venereal matter is some how washed off. 1544. The prepuce & Glans penis is the ordinary seat of it but the most common is the Frænum or the Angle between it & the Glans & this from the irregularity of its Surface. 1545. The distance of time between the infection & the appearance of the chancre is uncertain, it generally however makes its appearance later than the Gonorrhea. 1546. We have known a chancre appear 36 hours after coition we have known 7 weeks elapse between the time of Coition & the time of ulceration, we have known also an interval of two Months. 1547. It begins with an itching of the parts affected; if its  110 seat is the Glans there is not much tumefaction, if on the Prepuce there is a little discharge from the beginning at least more so than when the Glans as being a laxer part, the parts ulcerate or a small pimple is formed, or a little abscess especially if the Glans is the seat of it, a little hardness round about the pimple or ulceration is noticed. 1548. Should the Chancre be situated on the body of the Penis it generally begins with a Pimple which breaks & being little attended to at first, Scabs, the Scab is then Picked or rubbed off & a larger one forms, here the inflammation is more considerable than if the chancre begins on the Glans, less however than if upon the prepuce; an hardness generally surrounds it. 1549 The Canal of the Urethra often sympathizes with the External parts so far at least as Smarting, itching, tingling. Whether a discharge will arise simply from this sympathetic affection, we do not affirm, possibly however, not all Gonorrhea which are preceeded by a Chancre are specific. 1550. The Sympathy of the neighbourings parts with the seat of the Chancre is sometimes so strong that even touching the hairs on the Pubis create uneasiness. 1551. The Chancre will be attended with more or less pain & Inflammation according to the peculiar habit & disposition of the Patient. 1552. The local disease will spread with greater or less violence  111. sometimes considerable & deep sloughs will form Early & there will be Gangrene of some extent. The Ulceration will sometimes Penetrate so deep as to open the canal of the Urethra. 1553. The Prepuce is only a doubling of the Skin of the penis that it may be loose & convenient for Erection. The Phymosis or stricture confining it over the end of the Glans so that it cannot be retracted is a frequent consequence of chancre. 1554. The Phymosis often preceeds the Paraphymosis & is in fact frequently the cause of the latter for in patients attempting to get the Skin back it will sometimes be made to slip behind the Root of the Glans & will then take on a Stricture Strangulating the glans. 1555. The Phymosis in some Patients so entirely purses up the end of the prepuce as even to prevent the Exit of the Urine after it has passed through the urethra. 1556. In this disease there is a thickening of the Cellular substance of the prepuce & often an adhesive is formed between it and the Glans. 1557. It has often for its cause a disposition of the Erysipelatous kind, accompanying the venereal inflammation. 1558. The Phymosis if severe produces such a swelling of the prepuce as shall press violently against the end of the glans, & if there are sores or chancres underneath it which is not uncommonly the case the matter issuing from them will be confined ♄ 1559. A Young Man with chancres had a paraphymosis he came into St. Georges Hospital, the entire Glans & all the diseased parts gangrened & sloughed away the patient [reco??] Φ. 1565 Lunar Caustic is recommended, as most convenient it should be pointed like a pencil & the Sores touched with it once or twice a day, until they assume the red & healthy appearance of a common healing ulcer. 112 confined from which & from the pressure on the penis, the worst consequences will ensue even a mortification of the Penis. 1559. The paraphymosis strangulating the Glans will if not relieved sometimes produce a gangrene of the part strangulated & even a seperation of the whole diseased part. ♄ 1560. In Women chancres are apt to be more numerous than in Men & to spread to a larger size because the surface they have to spread over is of greater Extent, In them the Perineum is more subject to Chancres than in Men, from the facility with which the matter in their chancres in the labia & &ca. runs down to that part. 1561. Chancres are frequently attended with some peculiarities independent of the specific affections, & therefore some variety in their treatment may be necessary consequently it is requisite to attend to concomitant circumstances whether local or of the Constitution. 1562. Two modes of local Cure of Chancre are practised the one by extirpation the other by altering the nature of the irritation. 1563. In extirpating the object is not only to cure the chancre but also to prevent any communication of the vines to the System. 1564. Two methods of extirpation have been practised one by the dissecting out of the Chancre the other by destroying the diseased part by means of Caustic. 1565. When the Glans is the seat of the Chancre the Caustic is undoubtedly preferable. Φ. 🜔v 1569. Mercury is applied either in the form of an Ointment or by means of a watery Vehicle, the latter from its ready mixibility with the animal fluids is probably most efficacious; but it should be a rule to change the application often, as any one dressing will have its Efficacy diminished as the sore becomes more or less habituated to its action. 113 1566. Chancres may be dissected off the prepuce &ca. with a Knife, whether dissection or Caustic is employed it is proper afterwards to dress the Sore with mercurial Ointment as by that means we destroy any venereal Infection which may remain. 1567. Extirpation is improper when the chancre is large. 1568. The other mode of local Cure is by means of altering the nature of the Ulcer (which is done by Mercurial Ointment) in which there is no destruction of parts but only a destruction of venereal irritation. 1569. Mercury although it does not cure the first species is a Specific for the Second. ( ) 🜔v. 1570. Chancres to their specific disposition will often have superadded either indolence or irritability. In the former Mercurials should be mixed with stimulating balsams, in the latter Mercurials should be mixed with Opium & the oftener the latter are dressed, the better. – 1571. If a patient with a phymosis cannot submit to keeping his bed (a circumstance to be desired) he should use a proper suspensory bandage. 1572. Between the pressure & Glans an injection should be thrown often prepared either of Calomel, Gum Arabic & Water, or of mercurial Ointment incorporated with Mucilage of Gum Arabic, with Water, between the times of injecting mercurial Ointment may be rubbed on the outside, sometimes a poultice of vegeto mineral water & linseed meal affords relief. ♀ 1573. Oil of Turpentine is the best Styptic we are acquainted with. 🜔🜹. 1577. Many have recommended us not to open the prepuce by one longitudinal incision the whole length of it, but to make two slits one on each side which they say will save the necessity of making so long a wound, but they have drawn this reasoning from the natural Phymosis, which will by no means apply to the Phymosis from disease, in which the prepuce is very much tightned & incapable of yielding & stretching as in the natural Phymosis. Whenever disease makes it necessary to operate the Prepuce should be slit up its whole length. 114 1573. An Hæmorrhage the consequence of ulceration will sometimes happen, & is an extremly troublesome Symptom. ♀ 1574. When the Inflammation abates more the prepuce of the Glans frequently to prevent adhesions which would subject the patient to a permanent inconvenience. 1575. Should it happen that an ulceration of both the surfaces of Glans & Prepuce has taken place, the we must endeavour to prevent adhesion by the frequent use of injections thrown between the Glans & the prepuce. 1576. If the preputium is drawn much over the Glans & Contractd. & the opening of the Urethra is in a straight line with the end of the prepuce pass a bougie into the canal in order to prevent the ill consequences of the passage of the Urine being obstructed by the preputium adhering to the end of the Glans & closing itself over the Orifice of the Urethra. 1577. In this latter case, or in case the orifice in the Urethra is not in a right line with the end of the preputium we must slit open the prepuce & expose the Orifice. 🜔🜹 1578. In many Cases the Operation of the Phymosis is not adviseable, as where the inflammation is violent, or there is much tendency to Gangrene as the additional Violence of the operation must tend to encrease both. 1579. When matter is collected & confined in any part from the adhesion of the prepuce to the Glans, a wound by a Launcet should be made & the matter discharged, or if the fears of the Patient ☿. 1582 It sometimes however happens that mercury encreases the tendency to Gangrene, under which circumstance Bark should be administred alone. 115. patient object to the lancet, a small caustic may be employed. 1580. Mortification sometimes takes place in Phymosis & we have seen cases in which the whole Prepuce has slough’d away 1581. Hence we may suspect a faulty constitution & that the Inflammation was of the Erysipelatous kind. 1582. In these Cases Bark should be administred with Mercury thereby attacking at once the Venereal infection & the Constitutional disposition. ☿. 1583. A necessity for performing the operation for the Phymosis will appear to arise 1st. When the prepuce is so contracted over the Orifice of the Urethra as to become the Cause of hindering the exit of the Urine. & 2ndly. When added to this inconvenience or without it the matter from chancre is concluded by the prepuce becomes confined & cannot be evacuated on applications made to the Chancre Without dividing the Prepuce. 1584. An Operation for the relief of the [Patient] Paraphymosis becomes oftener necessary than in the Phymosis & danger of Gangrene &ca. from this Stricture will more often occur. 1585. The Operation consists in drawing up the integuments as much as may be with the fingers & Thumb & then passing a crooked bistory through the most strictured part & bringing it through from within outwards. 1586. In consequence of the Inflammation of the prepuce in Phymosis or Paraphymosis it will be often much elongated &  116. thickened so as to be much inconvenience to the Patient. 1587. If by proper applications as the steam of warm water, the fumes of Cinnabar or hemlock fomentations, we cannot reduce the swelling, it will be right to perform circumcision. 1588. Or we should at least remove as much of the prepuce as projects beyond the Glans, taking care however not to include any part of the Glans in the extirpation of the prepuce, & in healing the wound we should direct the patient often to draw the prepuce up & down to prevent the cicatrix contracting & forming a phymosis or stricture over the end of the Glans. 1589. Warts are no sign of a Pox, they arise in Gonorrhœa from the discharge from the Urethra touching any of the neighbouring parts. Chancres heal into Warts, Warts have an increasing power in themselves, often bleed, & are frequently painful. 1590. Mercury has been employed for their use & it is asserted will remove them, but our Experience does not warrant us to Affirm this to be the Case. 1591. As being new formed parts it is evident that their powers of supporting action must be weak by exciting a strong action in them & the surrounding parts by means of Powerful Stimulants we may produce in them a disposition to decay as a a more violent action will be thus produced than they are able to support. 1592. Rust of Copper mixed with powdered Savine is found to  117 answer this purpose (1591). 1593. They may also be extirpated by means of ligature, Excision or Caustic, but it is often found that by what means so ever they are removed they will frequently sprout up a fresh, in this case a repetition of the former process is necessary. 1594. Although Chancres may in general be cured by the local means above described, yet the introduction of Mercury into the System is adviseable, & generally to be insisted on both as forwarding the Cure of the local disease & as counteracting the effects of the virus if absorbed into the System. 1595. As we have remarked (1556) some variety will be necessary in the mode of treating chancres according to the concomitant disposition of the constitution or the part & this internally as well as Externally thus if there is a disposition to indolence we join some stimulating Medicines as the balsams with Mercury, if to irritability Opium, bark, &ca. – 1596. The quantity of Mercury to be introduced into the constitution should be in proportion to the number of chancres, their size & the time they have continued, it will be right to produce a slight spitting as a criterion of the Mercury having Acted in the System. 1597. Mercury may be carried into the System either from the Stomach or the Skin; when all the hardness is become softened & the Sore is skinned over the cure may in general be supposed  118. to be accomplished. 1598. This rule should however be applied to a large rather than to a small Chancre for in the former the Virus must in general be destroyed before the chancre will heal, yet in the latter the sore will sometimes skin over before the venereal virus is destroyed. 1599. It is better for the most part to continue the Mercury for sometime after the Chancre is healed to prevent any further action of the Venereal Virus by means of the Constitution. 1600. Chancres in Women should be often washed with solutions of corrosive sublimate & mercurial Ointment should be applied to them. 1601. The quantity of Mercury thrown into the Constitution should be greater in them than in others because their Chancres are commonly larger & more numerous. 1602. When the Ulcers spread considerably, if the seat of them is in the Vagina some extraneous body as lint &ca, should be kept between its sides to prevent their Cohering & Straitning & Closing the passage through the Vagina, an accident that has been known to take place. 1603. New diseased dispositions not venereal may arise during the Cure of chancres & remain after the venereal virus is destroyed. 1604. In some there will be a diffused inflammation of a Purplish 1606. Mr. Hunter has once known them to break out in two Months, these new ulcerations do not always appear immediately where the original Chancres were situated by a very small distance from the Cicatrix. 119. Purplish hue, about the sore which will be ragged & assume a cancerous appearance, these have been commonly considered as Cancers, but for the most part are only Scrophulous. In others there is a swelling & hardness with an indolent disposition. 1605 freely used in these Cases has proved serviceable, the Lisbon diet drink has also been found of singular utility Extract of Hemlock has done service, so has Sea bathing, & Opium used externally, if the disease extends near to the orifice of the Urethra care should be taken to prevent its closing, by means of a bougie, Extirpation of the diseased part if indolent may sometimes be requisite. 1606. The Cicatrices of Chancres after all the Virus is eradicated will sometimes breakout again such are generally but falsly considered as Venereal, the cure of these Ulcerations is uncertain. 1607. We recommend Sea bathing as highly useful in this diseased affection having experienced its efficacy in such Cases. 1608. From whatever surface the Venereal poison is absorbed the effect is ultimately the same. 1609. The Constitution may be affected by Venereal Virus in four ways 1st. By Venereal matter applied to a surface & absorbed into the System without any previous local effects. 2d. By Gonorrhœa. 3d. By a Venereal Ulcer, whether Chancre or Bubo. 4th. By a Wound. 🜔 1609. Mr. Hunter calculates the proportions of infection in the 2d. way to the 1st. was 100 to 1 & the 3d. to the 2d. is as 100 to 1 also. 120 The most general way by far is the third, the first scarcely ever happens. 🜔. 1610. The Venereal Matter being taken up (1609) by the Absorbents may previous to any constitutional affection give rise to the bubo or local consequent. (1252, 1263). 1611. The Venereal Bubo may be divided into. a. That in which the Absorbent Vessel itself being contaminated is the seat of the disease. b. Where the Lymphatic Gland in the line of Absorption is the part affected. 1612. The first very rarely occurs, when it does it is known by a resemblance to an hard Chord running along the dorsum Penis & leading to a Gland. 1613. The hardness is occasioned by a thickening of the coats of the inflamed Vessels. The absorbent sometimes suppurates & form a chain of abscesses along the Penis similar to the Abscesses of Veins (543) when suppurating they are to be considered as chancres. 1614. The first species is so rare that it is not noticed in speaking generally of Bubo. (1252). 1615. In the second kind which we commonly Call bubo the Venereal Matter is carried by the absorbents to the nearest of the Lymphatic Glands. 1616. The Lymphatic Glands consist of a Convolution of Vessels construded so, as very much to favour the stay of Venereal Matter in them a sufficient time to produce their contamination. ♀ 1617. First in Order---Inguinal Second in Order---Glands of the back. It would appear from this that the matter is diluted in its passage, the more probable reason however is, that the second order are not so easily irritated as the first being deeper seated. – (1295). 121. 1617. The Lymphatic Glands nearest in order to the Source of the Matter are the parts affected, those of the second order scarce Ever. ♀ 1618. In Men the seat of the Bubo will be in the Lymphatic Gland of the Groin, but as to the situation of the Lymphatic Glands it is not always the same precisely & the nearest Lymphatic Gland will sometimes not be in the groin but just above pouparts Ligament near to the os pubis, that will sometimes be the seat of the bubo. 1619. In case the Bubo arises from Gonorrhœa the seat of the Tumor may be on either side, if from a chancre, the Bubo will form on the same side as the chancre, but if the chancre is in the middle of the Penis then the Bubo may arise at either side. 1620. In Women the surface of Absorption being larger than in Men there are three different Parts which a Bubo may occupy & that dependant on the site of the Chancre. 1621. If the chancre appears on the Labia or Nympha the Venereal matter will pass on when absorbed in the course of the Ligamentum Rotundum & just before that ligament enters the abdominal ring the bubo will form, but never within the ring. 1622. This Bubo we refer to the first kind not considering it as Glandular but as an inflammation of the absorbing Vessel only, & this strengthens our Opinion that deep seated & internal parts are not readily susceptible of the Venereal irritation & that a bubo can only be External. (1617). 1623. If the Chancre be situated further backwards, then the bubo will form between the labia & the Groin or as in Men in the Groin 1624. “To this because the surface of the Glans Penis approaches nearest to a secretory surface than that of the Prepuce. We see absorption goes on slowly from a secreting surface. 122 1624. Absorption of Venereal Matter goes one more readily from some surfaces than from others, e.g. it is much more frequently taken up from the Preputium than from the Glans Penis. 1625. The first notice given to the patient of the formation of a bubo, is a sense of pain in the part affected, in which upon Examination he feels an hard tumor. 1626. This Tumor is generally of the common inflammatory kind & often advances to Suppuration speedily. 1627. Sometimes the Tumor is more of an indolent disposition & will then be long in coming to maturation. 1628. When the Bubo is of the truly inflammatory kind [& often] [advances to suppuration speedily.] [1627. Sometimes the Tumor is more of an indolent disposition &] [will then belong in common to maturation.] [1628. When the Bubo] the pain attending the suppuration will be very considerable when of the indolent nature it will be less acute, more dull & heavy, a disposition to indolence especially prevails in Patients of Scrophulous dispositions. 1629. The inflammation of the bubo will however sometimes be found of the Erysipelatous kind & then though the pain may be considerable, the Inflammation will be considerable & the part oedematous. 1630. Inflammations & Swellings of the inguinal Glands are not always Venereal, great will be the difficulty however sometimes ♄ 1632. It is however doubtful whether we do not often meet with Cases in which the Venereal disposition is mixed with the Scrophulous. in this Case we are to attack the predominant disposition whether it be Scrophulous or Syphilitic. Case Colonel W. had a gonorrhea preceeded by Buboes which suppurated they were opened & for a time went on healing kindly but at length became Stationary. Mr. Hunter suspected that a New disposition was taking place therefore ordered sea bathing &ca. when the new disposition which was Scrophulous, abated, the Venereal disposition increased so that it was necessary to return to Mercury. ☉ If Buboes were critical deposits from the constitution why do they not arise in some other Glands as those of the Neck &ca. & not in the Sympathetic Glands of the Groin or always in the nearest to the source of Absorption; again if Critical why should it be necessary to administer Mercury when they form. 123. in ascertaining the nature of an inguinal bubo. 1631 If a Gland in the Groin swells without a visible Cause, is painful, & goes on to suppuration quickly, venereal matter should be suspected & Mercury given, as in cases of chancres. 1632. But if the Tumor has an indolent nature & is attended with a Cold & Feverish indisposition & arises without any visible cause we may for the most part consider it as Scrophulous. ♄. - 1633. Bubo’s both in Men & Women are entirely local & are no more connected with the Constitution than the preceding local affection of which they are the consequence. 1634. They are not critical deposits from the Constitution as has been some supposed. ☉. 1635. In order to the cure of Buboes, having first ascertained their being Venereal we have recourse to the exhibition of Mercury. 1636. We are always to desire the resolution of the bubo & to avoid suppuration for the Bubo when it forms matter is similar to a chancre & has equal powers of contaminating the System. 1637. It is necessary to observe that in the Cure of the bubo, Mercury should be employed, but as that will only destroy the specific disposition of the Gland, it is necessary to attend also to the nature of the concomitant inflammation whether common Scrophulous, or erysipelatous. 1638. In the first we have recourse to bleeding & Purging according to the violence of the Inflammation. For the second, or Scrophulous, Cicuta, Sea bathing &ca. ☍ 1639. A Gentleman had a suppuration considerably advanced, he went to sea & the Sea sickness he endured & the consequent vomiting caused an Absorption of the matter & the cure of the Abscess. 🜍 1641. Thus if a chancre in the prepuce preceded the bubo – the Mercurial ointment should be rubbed on the side of the Penis where the Chancre formed itself & on the inside of the Thigh, in the Scrotum & belly &ca. as the Lymphatics from those parts take their route through the Inguinal Glands. 1642. Of all the patients Mr. Hunter has had under his Care for 16 years past, only 3 have had buboes which suppurated, that is of those which applied to him at the commencement of the bubo. 124 For the third Bark. 1639. Vomiting has been known to produce resolution of the Bubo even when suppuration had taken place, acting upon the principle of resolution. Vomit also powerfully Excite the action of the absorbents. ☍ 1640 In the [course] Cure of the Bubo we can much increase the Powers of our Remedies by the manner of applying them, & it should be a Rule to endeavour to produce an Action of the Mercury on the part before we produce its action on the System. 1641. We should therefore cause Mercurial Ointment to be rubbed on the surface from which the Absorbents begin that pass through the affected part, & as near as possible the part from which the first absorption of the venereal matter took place, thus introducing the Mercury into the System by the same road which the Virus persued, & as it were making the Antidote tread on the heels of the Poison. 🜍. 1642. By the early use of Mercury in the manner recommended (1641). The suppuration of buboes will commonly be prevented but should they happen notwithstanding to form matter, or should the matter be formed before the Surgeon is consulted; Mercury should be used during the whole time of maturation though in a more moderate quantity than before as well as after the bubo is opened or has burst. 1643. If the bubo is to be opened by Art the Skin should be permitted to come exceeding thin before the Operation is Performed, that a disposition may have taken place prior to exposing the Abscess to heal from the bottom. 1644. The opening may be made Either by the Launcet or by Caustic 1646. Sir William Fordyce first recommended Orange & Lemon juice which Mr. Hunter has since prescribed to advantage. Gold beaters Water is in use at the lock Hospital & sometimes does service. ♃ 1647. Case A Gentleman has a bubo which was opened he used Mercury 2 Months, still the Ulcer continued without the least disposition to heal, Mr. Hunter considering his constitution as too much of a Mercurial one & therefore little Affected by that Remedy he left it off & confined him to Milk diet &ca. for sometime, he then returned to Mercury again & continued its use for 2 Months when the Ulcer became stationary, he then again discontinued it returned to the Milk & gave Cicuta, the Ulcer was sinuous. The sinuositus were laid open & the patient was sent to Sea he persued this plan 4 Months & returned home without benefit. Mercury was again ineffectually administred, the patient at last got well having left off all Medicines. 125 Caustic according to the inclination of the Patient, it should however be small. When left to the choice of the Surgeon, if the Skin is very loose he may use a Caustic, & the lapis Infernalis is to be preferred, if the Skin is not loose, the lancet is best as thereby none will be destroyed, the Wound is to be drest according to the nature of the discharge. 1645. Mercury should be thrown into the constitution during the whole of the time from the ulceration until after the healing of the bubo, or at least until the Bubo has lost its venereal appearance which the Experienced Surgeon alone will be able to determine. 1646. Some exceptions however to this, are found to arise, sometimes the bubo takes on a New diseased disposition which mercury increases, the sore will continue obstinately spreading & the more freely Mercury is administred, the more progress the Ulceration will make. In this Case we perhaps have a Scrophulous or Scorbutic habit to encounter, & we shall find benefit probably from the use of Hemlock & Sea bathing & from Orange & Lemon Juice. 1647. In some of these Cases we have found no Medicine of any Utility but the disposition at length has worn itself out & the Ulcer healed. ♃. 1648 Another Exception to the constant use of Mercury is that the patients Constitution may become so habituated to it, that it shall lose its power of acting as a specific, in this Case we should discontinue the Mercury for some Weeks & then have recourse to it again. 1649. As the Venereal disease may be communicated by other  126 means than coition, so buboes may be formed in other Glands as well as those in the vicinity of the parts of generation, if the infection was received on the Lip; the Bubo would be seated in the Neck, if Venereal matter was absorbed from an ulcer or wound in the Finger, we should find the Bubo in the Axilla. 1650. In the Cure of these the same principle is to be kept in view, as if they had formed in the Groin (1636-1640). 1651. Some uncertainty must prevail as to the precise Quantity of Mercury necessary to be used for the removal of buboes, where the resolution is obstinate the quantity of Mercury should be pushed so as to affect the Mouth in general we may begin with ½ dram of Ointment (prepared with Axunge & Mercury) & increase or diminish according as the bubo is affected by it. 1652. When the Venereal Virus has been absorbed into the habit, & the second Genus arises Variety of appearances are produced & these will be according to the following Circumstances. 1653. 1st. the time since it was Absorbed into the Constitution. 2d the peculiarities of the Constitution. 3d the different Solids affected by it. 4th. The different dispositions the solids were in when they first became affected with it. 1654. The time in which the second Appearances take place after the infection depends upon the nature of the constitution, at a medium the period is found to be 6 Weeks in some it is sooner ♄. 1654. A Case occurred in which almost the whole body was covered with general Eruptions within a fortnight after the breaking out of a Chancre. ☉ 1659. In some persons, Copper Coloured, dry Scurfs, or as it were Cuticles appear which are thrown off from time to time & spread at times to the size of a Sixpence. 127. in others later. ♄. 1655. The deep seated parts, or parts second in order of [succession] susceptibility (1298) do not always come later into action than the superficial parts (1297) as we have known the Periosteum to become diseased without any previous affection of the Skin or Throat. 1656. We have accounted for the reasonsy why parts shall fall into the Venereal Action after parts labouring under the same diseased action shall be cured (1303-1304). 1657. We have also shewn that Venereal matter does not continue circulating in the Blood for any length of time, that the secretions are not contaminated by the Venereal Matter, nor the Blood rendered Capable of communicating the infection to other persons but that after the absorption into the System it Circulates for a short time with the common mass of Fluids, gives a venereal disposition to the different solids having first undergone a change in its nature & is soon thrown out by the different excretions. 1658. In some the Eruption upon the Skin appears in distinct blotches not very observeable until Scurfs are forming upon them, at other times as small pimples with inflammation & the pimples filled with matter. ☉. 1659. The first appearance after Absorption is generally upon the Skin, throat or Mouth, the appearance in the throat often precedes the others. 1660. When Skin is opposed to Skin, as in Axilla &ca. the above described appearances never take place, but the Skin rises while  128 & smooth, & a whitish kind of matter is secreted & they attended with more pain than the former, whether this attends the disease in question only we will not pretend to determine. 1661. The hair falls off the parts that are attacked with it & so long as the disease continues the new hair cannot grow. The fingers are sometimes the seat of the disease & then the nails fall off. 1662. When the throat inside of the mouth & tongue are the seats of the Venereal Action, an Ulcer rapid in its progress but without much tumefaction is formed it is foul & has thickened or bordered Edges; but this is a circumstance attending all sores that have no disposition to heal. 1663. These Ulcers are painfull although much less so than a common inflammation of these parts, & oblidge the patient to speak thick & snuffle. 1664. The matter secreted upon them does not remain to form a Scab, but is washed off in swallowing. 1665. The Eye sometimes become the seat of disease & a venereal Ophthalmia is produced which with difficulty can be distinguished from the common Ophthalmia. 1666. When the disease has been affecting the constitution for sometime, then the parts second in order may shew the action of the Virus or the same Effect may occur when it had first appeared in the External part, & the diseased appearances there had been Cured. 1667. A total deafness is not uncommon at this time, now & then attended with pain & suppuration in the parts.  129. 1668. A Node often appears several months after any possible infection, the progress of this is very slow & the consequence of any suppuration is a very slimy matter instead of good pus. 1669. When the Periosteum &ca. becomes affected the Pain is very considerable but not always so. 1670. Nodes will sometimes continue several Years before they come to Suppuration, the inflammation being very slow. 1671. Venereal pains are periodical being more particularly Severe at night & in this respect they resemble the Rheumatic. 1672. The Effects of the Venereal disease upon the Constitution are similar to the effects of all other irritations whether locar or Costitutional. 1673. In some a slow kind of nervous fever with loss of appetite is produced, or there are Rigors, frequent hot fits head Achs. &ca. 1674. In the cure the disease may be considered as in two extreemes, not different in their nature but only as requiring a more mild or more severe treatment. 1675. In the first Genus our senses will generally inform as when a Cure is compleated but in the second Genus we labour under great difficulties as the Virus has circulated in the blood & we know the contaminated Solids only by their shewing a diseased action. 1676. The Effects arising from the constitution are local & may be cured locally, but as other parts may have received the Venereal disposition, although they have not yet come into action, we must attack the ☽︎ 1682. Mr. Hunter observes that a smaller quantity of Calomel is sufficient to Salivate by the Bowels than by the Skin, & again that using precipitate to Sores has salivated patients. 130. Blood, not as now containing the poison, but as the Vehicle carrying the specific through all the solids of the body, curing present diseased effects, & destroying dispositions which would have produced future ones. 1677. It is not clear whether those parts which have first been attacked are easier to Cure then those which took a diseased Action later. 1678. If parts are susceptible of Cure in proportion to their susceptibility of diseased action then the parts first in order must have their diseased disposition & action removed. 1679. The second in order may appear diseased when the first has been already cured, but the order is rarely reversed. 1680. Mercury is the true specific remedy for this disease & none other whatever can be depended on, when taken into the constitution it circulates with the juices cures those parts which are diseased & little affects those that are not. 1681. There are two modes of administring it Vizt. By the Stomach---By the Skin. 1682. Like other substances it is more readily absorbed from some surfaces than from others. ☽︎. 1683. In the administration of Mercury it is necessary to consider. a. The Constitution of the Patient. b. The quantity of Mercury necessary c. The proportion that will best agree wth. The Patient d. The mode of giving it.  131. e. The Regimen necessary to be observed by the Patient during his Mercurial Course. 1684. As to the constitution we should endeavour to learn whether it is very much disposed to irritability or indolence, if possible whether it is easily or difficultly affected with Mercury, & again the time the Constitution has been contaminated. 1685. With respect to the second circumstance belonging to the constitution we may in general take the History given us of the degree in which it has been affected by a given quantity of Mercury on any former occasion as a guide for our practice for it rarely happens that the Constitution Varies much in this particular. 1686. The quantity of Mercury to be given must be equal to the Violence of the disease but it becomes necessary at the same time to consider the period of time within which a given quantity is introduced into the System & the effects of that quantity on the Constitution. Thus one ounce of Mercurial Ointment rubbed into the Skin in two days will have more Effect on the constitution & secretions than two Ounces rubbed in within ten days. 1687. A large quantity of Mercury quickly introduced into the System, a sudden Alarm is given & its effects are rendered mostly local consisting in the unusual Excitement of some sensation. 1688. But if we introduce the Mercury slowly a very considerable quantity may be thrown in without visibly affecting the constitution. – ☿. 1694. All parts do not become Sore together but severally the lips may alone become thick & inflamed & the Cheeks or Gums become Sore. – 132 1689. From a knowledge of these circumstances we find Mercury a much larger & more manageable Remedy than it was formerly known to be. 1690. Mercury when first applied affects the System much more readily than when the patient has been sometime accustomed to its use we are therefore enabled by beginning with a small quantity & going on gradually to throw into the constitution a much larger quantity than could have otherwise been born by the Patient. 1691. If given with care so as to avoid Stimulating any secretory Part to Action, & thus producing Evacuation, any quantity of mercury may be introduced that the disease can require. 1692. The effects of Mercury are generally in the following order. 1st. On the salivary Glands – 2d. on the intestinal Glands. 3d. On the Skin 4th. on the Kidneys. 1693. These are affected sometimes singly, sometimes more than One, sometimes altogether. 1694. Soreness of the mouth most commonly though not always attends the increased action of the Salivary Glands ☿. 1695. Evacuations by any of the secretories are of no use in curing the disease, they only shew the susceptibility of the secretory Organ to be affected by the remedy, however they afford some Evidence of the constitutions being acted on by the Remedy. 1696. If the secretory Organs are too susceptible of the stimulus of the Mercury it will be difficult to Cure the disease because ♃. 1696 A Gentleman had a Chancre & a bubo he rubbed in Mercurial Ointment once, his mouth became affected, a slavering came on, the spitting was kept up for a month during which time the Chancre & Bubo got well, soon after his Throat became affected with the disease this Mr. Hunter attributed to the too great susceptibility of stimulus in the Salivary Glands which suffered the Mercury to be evacuated so fast, that it had not time or power to affect all the other parts of the System. 134. The Patient will not bear a sufficient quantity of the specific to be introduced into the Circulation. ♃. 1697. The too ready susceptibility of any secretory Organ should be obviated by proper astringents hereafter to be mentioned. 1698. Mercury can act only upon the constitution & upon the Poison. 1699. Upon the Poison either by destroying its properties & decomposing it, or By attracting it & carrying it out of the Circulation together with itself, or By counteracting the venereal irritation & producing a new & opposite irritation. 1700. If the latter conjecture is true then the readiest way of curing the disease must be, giving Mercury so as to produce visible effects on the disease yet in such a quantity as to produce a different disposition in the System. 1701. It should be given slowly so as to produce at length some local Effects, yet however in such manner that a quantity may be introduced into the System sufficient to cure the disease. 1702. As a general rule it is right & necessary to give Mercury in such quantities as shall produce good effects on the disease yet no ill ones on the Constitutions & to continue its exhibition until some local irritation is produced. 1703. Of the two modes of throwing Mercury into the constitution if the patients way of Life & circumstances renders it convenient that of rubbing it into the Skin is most Eligible & most certain ♀ 1709. Should it be found that purging has any effects in diminishing Salivation it might be right to give sulphur in sufficient quantities to act as a purgative. 135. in its effects. 1704 If the Patient has been unused to Mercury, he should begin with a scruple or half a dram of the Ointment prepared with & rub that quantity in every night for 4 or 6 nights & then he may increase the quantity to a drachm & so on gradually until two drams are rubbed in every night. 1705. If the Symptoms disappear gradually it will be right in general to continue the medicine a fortnight after their removal. 1706. When the mouth becomes affected by the mercury we must suspend its administration, until the soreness abates. 1707. If the Mercury runs off by any of the secretions they should be restrained no danger arises from checking a too violent secretion although that encreased secretion does not arise from the constitution. 1708. Sulphur has certainly been serviceable in diminishing too violent secretion by the Salivary Glands in what manner it produces this effect we do not determine, it can only act upon the mercury after the latter has got into the blood probably it is a kind of Antimercurial Stimulus. has it any powers of combining with the Mercury in the constitution. ☍ 1709. We should distinguish a Mercurial salivation from a Salivation which goes on from habit after the mercury is Evacuated 1710. purging had probably no power in diminishing a Mercurial Salivation. ♀. 1711. Sulphur certainly Enters the Blood unchanged & as Sulphur. ♄ 1716 Mercury cannot act in the body as it does not of it, all the preparations of it undergoes a change & after being taken into the System a New Combination peculiar to the animal body is formed & that is the same whatever may be the preparation of mercury employed. Did Mercury Act when in the System as it does in the Primæ viæ or applied Externally, the preparations would have different effects. e.g. Turboth Mineral when in the blood would act as an emetic in the same manner as Ipecacoanha does when thrown into the blood Vessels, but all the preparations of Mercury after they are dissolved in the Animal juices form one particular combination when dissolved in the Saliva they have all the same taste. Mr. Hunter held crude mercury in his mouth for sometime, it was very slow in giving the proper metallic taste to the saliva which shewed that it dissolved in the Mouth & gave the same taste. Calomel did the same. Corrosive sublimate held in the Mouth, for a time the acid taste was prevalent, but that going off the proper Mercurial taste similar to that of M. Cale: Argent. vis: &ca. took place; introduced by means of the skin into the System, they all have one common Effect, tho some are quicker in producing their Effect than others. – 136 1712. Should the Secretion by the bowels be violent we restrain it by opium which seldom fails in removing the irritation of those parts the violent action of Mercury on which, is by far more dangerous than on any of the other secretory organs. 1713. Mercurial sweatings or Evacuations by the Skin, we check with most success by the use of peruvian Bark. 1714. The encreased action of the Kidneys is not near so troublesome as the others, Bark may be given as it corrects; but it will sometimes go on whatever means are employed to check it. 1715. Mercury probably cures most of the Symptoms of the first stage locally, that is applied to the parts by means of some of the secretions, thus it probably cures the sore throat locally, the saliva loaded with Mercury proving an antivenereal Gargle, so also in Cutaneous affections, being applied to the skin by means of the sweat. 1716. Mercury cannot act upon the Venereal or any other disease but in a state of solution & that in the Animal juices. ♄. 1717. It is however certain that different preparations of Mercury will produce Effects upon the system & upon the secreting Organs at different periods of time & will affect different indviduals in different manners, & that those who are not cured by one preparation of mercury will by another therefore it is right to try different Preparations when the disease is obstinate. 1718. All the preparations of Mercury are readily voluble in Saliva. Mercurius Calcinatus is the most simple & easily dissolved  137 in the mouth, mixed with a quantity of opium it makes one of the most efficacious internal remedies. 1719. Calomel in proportion as to strength & its effects in the Constitution to Mercurius Calcinatus is as One to three. One Grain of calcined Mercury is equally powerful with 3 of Calomel 1720. Corrosive Sublimate is a powerful preparation of mercury its action in curing any diseased part is mostly local as being carried to them by means of some secreted fluid, it cures ulcers in the throat sooner than any Medicine, acting perhaps as a gargle. A cure by it however is not to be entirely depended upon as it does not seem to have any great powers in the constitution & relapses more frequently happen after a supposed cure by Corrosive Sublimate than by any other preparation of Mercury. 1721. For too small a quantity of Mercury only when we use sublimate can be introduced into the System, to effect a proper change of the constitution, it too readily passes off by the Skin &ca. – 1722. Crude Mercury divided with any substance by triture is the weaker of all the mercurial preparations. 15 Grains of it being only equal to one grain of mercurius Calcinatus. 1723. A Grain of Calcined Mercury may be taken [into] every night for five six or seven Nights, if no affection of the mouth is thereby produced the quantity may be increased. 1724. Either of these may be joined with Quaiacum ( ) in dose & will in general produce a cure of the Symptoms in one month. 1725. If the Symptoms diappear suddenly, for instance in the ☉ 1726 It is with this view probably that Mercurius is prescribed. – 138 first eight days, it will be still right to persist in the use of the remedy a considerable time, & even when the suppuration gradually decreases it will not be improper to persevere in the use of the Remedy for a fortnight afterwards & this whether the external or internal method is employed, for we should always consider the danger of having incurred a venereal disposition in parts not yet come into action. In this first Stage it is much easier to cure the Symptoms than to rid the constitution of the specific disposition. 1726. If Mercury is given internally either in a Saline form as sublimate, or formed into a salt by any acid it may meet with in the Stomach, regard is to be had to the irritation it may produce on the Stomach & Primæ Viæ. if they are disposed to irritability Opium & Essential Oil may be administred with it, or alkaline Medicines accompanying its Exhibition. ☉. 1727. In general if Mercury is properly administred the constitution may be cured in six Weeks. 1728 In the second or worst Stage as affections of the Periosteum, Tendons, Ligaments & Bones. a more severe course is to be pursued & mercury is often required to be given in the largest quantities that the patient can with saftey bear. 1729. Here we must begin with a large quantity at first, in order as it were to surprise the system & we should produce a sensible effect in 5 or 6 days & a soreness in the mouth in 12 days Here the quantity of Mercury to be employed will be so great that it is scarcely possible to prevent a Salivation.  139. 1730 In this Case more attention will be required to the Patients diet, as he will not be able to Eat solid food from the soreness of his mouth & yet will require his strength to be supported, Egged Wine, Sagoe &ca. will be proper viands. 1731. In our use of the mercury we are to observe that in this Stage it is easier to cure the constitution than the local disease & therefore it is not necessary to persist in the use of mercury until all the local Complaints are removed as the parts may remain in a diseased state after every Venereal disposition is destroyed. 1732. Topical remedies in this stage will be useful, as will readily be conceived from (1731). 1733. Previous to beginning the Mercurial Course we must make the same enquiries as are directed to be made preparatory to a less severe Course ( ) that is whether the patient has heretofore taken Mercury whether lately, or in what quantities. 1734. If he has lately taken Mercury (& this is to be considered as it were a continuation of a Course already begun we must begin with a large quantity as two drachms of Ointment, rubbing the same quantity of Ointment into the Skin every night, if the Patient can bear it, or even encreasing it to ʒiij. Or if he has heretofore borne a large quantity of Mercury without inconvenience, we may proceed with similar boldness. 1735. But if the Patient has not been used to mercury or is weak & irritable we must proceed with some Caution; One drachm ☽︎. 1738. We perhaps shall not be surprized at the length of time which may Elapse between a Venereal disposition being given to a Bone & the time of its action on the bone appearing for we see not only Venereal Virus is very slow in its Operation but that processes of all kinds in bones go on with tediousness & difficulty. ♂. 1739 Why does Mercurial Ointment cure Nodes? It cannot be by the Mercury acting locally by Contact, it must either be by the System, or by Sympathy. 140. of Ointment is as much as we should venture to employ. 1736. Mercury in any stage can only Cure the constitution by being absorbed into the System. This we must be aware of, & therefore if the surface of the Skin, will not absorb it, we must give it internally if the absorbents of the bowels will not take it up, no more than those of the Skin the Case of the Patient is really deplorable, & the Cure impossible. 1737. Some particular local affections in this Stage deserve attention as. a. Nodes 1738. If the affection of the Periosteum or bone has proceeded no further than inflammation & swelling, in general no particular application is necessary but the Venereal Virus only will require to be destroyed. ☽︎. 1739. Sometimes however it will be other wise, then they may be covered with Mercurial plaister or rubbed with the Ointments the latter is best. ♂. 1740. If these do not succeed we must try the effects if a new inflammation. Blisters applied round the Node have removed the pain & assisted the Cure. If Blisters fail an incision should be freely made in the diseased part that by the processes of Inflammation a new disposition may be formed in the parts, & the nature of a common sore produced. 1741. As parts may remain in a state of disease after the Venereal Virus is destroyed & the Constitution cured we may often very  141 safely leave the Nodes to time which will not uncommonly effect a Cure, but sometimes however a particular local treatment will be necessary. 1742. Nodes are often blended with Abscesses which seldom produce good matter, but generally a kind of slime or mucus which his flat on the bone & renders it difficult to determine whether there is a fluid underneath or of what kind. In this Case there is but little of the adhesive Inflammation. 1743. Inducing Violence of Action in the diseased parts, here facilitates their cure by destroying the present irritation, we should therefore make free openings. Exfoliation may more readily take place in bone affected with the Venereal disposition than any other diseased disposition, because here we have a specific remedy by which we can correct the present disposition. 1744. When a Node Occurs in a Tendon, if blistering does not relieve the tumor should be laid open as a ground work is laid for a very obstinate & disagreable Swelling which will neither yield to time nor Medicines & must therefore be attacked locally. 1745. As in the other Genus so here also New dispositions may be taken on by the parts affected which it may be difficult to distinguish from the Venereal disposition, & therefore may render it difficult to determine when the cure of the Venereal Virus is effected. 1746. To these new dispositions Mercury may be a poison increasing instead of lessening the evil. Many of them will take on a Cancerous ☿ 1746. A poor Woman in St. James’s Workhouse had Venereal complaints for which she underwent a course of Mercury, she had ulceration in her face which took on a new disposition seemingly Cancerous. Hemlock was applied internally & externally & she got well after having lost part of her Nose & part of her right cheek, in 12 months she relapsed. Hemlock & other means were tried in vain for she died of the complaint. ♃. 1747. One drachm of Opium dissolved in of water makes a very useful application to Venereal Ulcer. – ♀. 1749. Mr. Hunter has given powder of Sarsaparilla mixed with some farinaceous substances made into a pudding, that the patient might take it in very large doses. ♄. 1750. A Young Man had Venereal Eruptions & Ulcers in different parts of his body, under the Armpits on his Thighs. Scrotum &ca. some even of the size of a half penny a poultice of Gum Guaiacum Was applied to the right armpit & a poultice of Sarsaparilla To the left, removed every day, & continued for a fortnight, the sores in the right Armpit were cured, those in the left rather worse, left off the Sarsaparilla & applied the Guaiacum to the left which then healed in a fortnight. Gum Guaiacum ʒss joined with Opium was also given 3 times a day, by which means all the eruptions disappeared in a Month, he was allowed to stay in the Hospital 2 or 3 Weeks, after this seeming cure at the end of which time Eruptions again appeared 142 appearance. ☿. 1747. Ulcers in the mouth & throat often arise during the use of Mercury, these should be distinguished from Venereal Ulcers and treated with Bark, or Opium as Gargles. ♃. 1748. In some persons the long use of Mercury is followed by General debility of the constitution with all its effects as profuse sweatings an inclination to Hectic &ca. In this case the general strengthning plan is to be pursued Bark is useful but is no specific, Scrophula seems to have something to do in the present Case & this is rendered. the more probable by the disposition giving way 1749. Sarsaparilla has no power over the Venereal Virus, it is however very useful & seemingly specific, for many of the new dispositions taking place after the virus is destroyed. It may be of use in preventing the formation of [matter] such disposition & may be exhibited with Mercury. It is best taken in substance & in large doses or its Extract may be given. ♀. 1750. Guaiacum has some specific powers over the Venereal disease; how far these powers extend is not ascertained. We can however place no dependance on this remedy in serious Cases. Mercury is the only true & [useful] universal Specific, on it alone can we depend for it will cure in despight of every unfavourable concomitant circumstance, as irregularity in the patient, intemperance, Climate &ca. ♄ 1751. Hemlock is frequently of Utility in many of the new dispositions which form during or after the course of the Venereal disease Recourse was again had to the Guaiacum, that it had lost its powers. Mercury cured him. this shews that Guaiacum has some specific powers, though weak ones over the venereal disease. Mercury properly applied is the only true Specific. Mr. Hunter does not object to his Patients indulging in the usual diet or taking his usual Exercise, he may take the Sports of the Field by day & his Bottle of Wine at Night. 143. especially in such as from their appearance give cause to suspect cancer. 1752. A salivation will often go on from habit long after the Mercury is Eliminated from the System, it will sometimes remain for Months, though this is now rarely known to be the case, as the Mercury is seldom given in such manner as to produce violent Secretions by the salivary Glands, it is to be considered as a Gleet of those parts. 1753. Gargles prepared with peruvian Bark, Gargles of Opium, Sea bathing & good Air are beneficial. Dr. Mead used to recommend Tincture of Cantharides which may be tried. 1754. Sometimes the Alveolar processes of the teeth becoming [loose] diseased may be a cause of keeping up the spitting when this happens we cannot hope for a Cure until exfoliation has taken place. 1755. Prevention of the Venereal disease is effected by Applications Previous to or immediately after exposure to infection. 1756. Applications to be used previous to exposure are such substances as will not suffer the Venereal matter to come in contact with the Skin. 1757. Venereal matter being immiscible with oil, the part Exposed may be depended by anointing it with the most viscid Oil that can be conveniently had. 1758 Means to be employed after exposure are caustic Alkali properly diluted which will dissolve the Venereal Matter, or Goulards  144. – Extract of Lead which is a powerful coagulater of Animal juices & will coagulate the virus a Solution of Corrosive sublimate is also used & said to have succeeded when other means have been found inefficacious. – Finis.  145 Proposals for the recovery of drowned Persons. By Mr. J. Hunter Philosophical Transactions Vol: 66th. London 4to. 1st. Whilst an animal retains the powers though deprived of the motions of Life, the cause of that privation may be frequently removed; but when the powers of Life are destroyed, the action ceases to be recoverable. 2nd. Part of the living principle is in the Blood. 3d. The Stomach Sympathizes with every part of the Animal & every part with the Stomach, Cordials by their action on the Stomach excite universal motion & there is also a peculiar Sympathy between the heart & Lungs, many poisons, steams of phlogiston & Charcoal &ca. received into the Lungs the hearts motion instantly ceases & that much sooner than if the trachea had been tyed. From experiments anything salutary applied to the Lungs will restore the hearts action after it has been at rest for some time. Violent deaths are divided into 3 kinds. 1st. When only a stop is put to the action of Life in the Animal, not however by any irreparable injury to a Vital part. If this action be not restored in a certain time it will be irrecoverably lost. 2d. When an injury is done to a vital part. 3d. To when absolute death instantly takes place in every part as  146. is the case in Strokes of Lightening. Which of these three Deaths does the case of Drowning come under? probably the first. Here it first affects Respiration, then the Hearts motion. – Restore Respiration & Cure drowning. New born infants have been animated by blowing into their Lungs. Put the juice of Hone Radish, peppermint, Spt. Coma. Cervi into the Stomach & Anus. Avoid Phlebotomy & the fumes of Tobacco. Mr. Hunter has invented a Bellows to exhaust as well as to fill the Lungs & also a Syringe. –       INDEX Aphorism Page A Aneurism spurious---872---4 Aneurism---878---4 Abscesses---893---8 ___unsound---1123---46 B Bubo---1610---120 C Corns---944---18 Chilblains---946---18 Carbuncle---984---23 Coopers Glands obstructions of in Women---1120---45 Cancer---1157---50 Chordee---1327---75 ___cure of---1387---82 Chancre---1539---108 F Fistula---7090---40 ___in Ano---1107---43 ___in Perineo---1109,1475---43,97. ___Lachrymalis---1113---44 ___of the Parotid Gland---1117---45 ___communicating with Joints---1111---44 Fungated Sore---1198---55 G Gonorrhea---1310---72 ___cure---1362---79 H Hæmorrhages---848---1 I Indolence & Irritability---918---14 Itch---1230---59 Infection of the second order of Parts---1652---126 M Mercury mode of exhibiting---1680---130 ___ulcers in the mouth from---1747---142 N Nodes---1737---140 P Poisons---1130---47 Prostate enlarged---1533---107 Phymosis & Paraphymosis---1553---111 Prevention---1755---143 S Scrophula---1017---29 ___cure---1051---35 Seminal Weakness---1477---97 Salivation---1752---143 Strictures---1490---99 T Tendons ruptured---912---11 Tumors---955---19 Testicle swelling of---1332---75 ___cure---1394---84 Tetanus---996---25 U Urethra obstructions of---1432---89 ___strictures of---1435---90 ___cure---1490---99 V Veins Varicose---945---18 Venereal disease---1240---61 W Wounds---888---8 Warts---1589---108                  Thomas Windsor Manchester ?-1745 (1845) LECTURES on the RATIONALE of SURGERY by JOHN HUNTER. VOL. 2.  1 Volume. 2nd. – Part. 2nd. (continued) Aphorism 848th. Hemorrhages. may depend on various causes either a Wound made in an Artery by external force, or by such a state of weakness being produced by a disease in the Coats of the Arteries themselves, as to render them incapable of withstanding the impetus of the blood. 849. When an Artery in health is divided there is a natural power of contractility in its Coats, that disposes its orifice to Close & prevent the future escape of Blood. 850. This contractile power is stronger in inverse proportion to the largeness of the Artery, in the larger Vessels it is not Equal to the business of restraining the Hemorrhage, & therefore renders the assistance of Art necessary. 851. Another natural cause of the restraining of an Hemorrhage & wch. we call the accidental, is the plugging up the mouth of the Vessel by coagulate Lymph. 852. Art is employed in restraining Hemorrhages in three ways 1st by increasing the Contractile power of the Arteries. 2nd by increasing the Coagulation & thus plugging up the Mouth. of the Vessel 3rd. 🜹 855. It is evident the artificial retardment of the motion of the Blood commonly takes place when the bleeding is from / an Extremity We have sufficient testimonies of the use of the retardment of the bloods motion in the stopping of Hemorrhage, when we see people faint who have suffered great losses of Blood, & that on the Syncope taking place the hemorrhage commonly ceases. + 857. If the actual Cautery is used, the Iron should be very thick and heated nearly to a red heat. 2 3rd by Compression of the sides of the Artery together near its mouth & thus rendering it impervious to blood. 853: The first intention (852.1.) we fulfill by the use of Stimulants & of these the most powerful is Oil of Turpentine. 854. The second intention (852.2) by such remedies as will forward the natural & produce an artificial Coagulation of the Animal Juices. 855. This Coagulation will be forwarded by the retardment of the Blood motion. 🜹. - 856. The substances forwarding the formation of the Coagulum, are spungy bodies, as lint, fur, agaric, flower, Cobwebs. &ca. – 857. The means productive of an Artificial Coagulation of the Animal Juices, are the application of matter which act chemically upon them, such will be the actual Cautery, concentrated Acids, boiling Water &ca. +. 858. The mechanical means of stopping Hemorrhage is by compression this is made by enclosing the Vessel near its Orifice in a ligature applied by the use either of the Tenaculum of needle. 859. The Tenaculum should only be used when we have sound & unossified Arteries, & those situated not in the Centre of a muscle but loose in the interstices of Muscles & in the Cellular membrane. 860. The use of the needle is to be preferred, where there is reason to suspect the Artery is not quite sound when it is situated in the middle of a Muscle. 861. When the Needle is used, a considerable portion of the circumjacent parts as muscular flesh, cellular Substance, Nerves &ca. is commonly included together with the Artery in the ligature which gives an additional support to the Artery when weak or suspected to be unsound. 🜹. 864. Of this the Millers case, whose Arm was torn off by the Wheel of a Mill at the Articulation with the Scapula is an ample testimony (see Cheselden’s Anatomy) So also the Case of a person sometime ago in the Middlesex Hospital. The Farmers are sensible of this for they divide the funis of the Calves & Lambs by tearing it in two. + 865. Of this Mr. Hunter is satisfied having several times tied the Nerves with the Artery & no ill consequence supervened. ☿ 866. In St. Georges Hospital a Boys thigh was Amputated for a disease of the Knee Joint, by repeated bleedings from the Stump which always stopped spontaneously the Patient was so much reduced, that at last he Sunk, upon examining the Limb after death, the Artery appeared sound, until within an inch of its termination in the Extremity of the Stump, where it was black & had lost its Elasticity. The Bleeding anew happens more frequently in the Radial or Ulnar Arteries than any other. – 3 862. The degree of tightness to which the ligature is to be drawn will be in proportion to the size of the Artery, & the quantity of surrounding parts enclosed in the ligature. 863. The ligature should be made thicker than is commonly done that a larger extent of surface of the Artery may be compressed. 864. An accidental method of stopping Hemorrhages is tearing the Vessel asunder, for in contused Wounds the bleeding of a Vessel is less than in incised. 🜹. 865. The disagreable & sometimes fatal Symptoms following the use of the needle, where it is necessary to compress the sides of an Artery together, do not arise from irritation produced by a Nerve being enclosed in a Ligature, but from some peculiarity of constitution. +. 866. It sometimes happens that after tying an Artery consequent on an Accident or Operation, that the Artery shall bleed afresh at some distant time, as one, two, or three days, or even when granulation is going on, this mostly happens in the large Vessels. ☿. 867. When it arises within two or three days it commonly is owing to some circumstances attending the Operation, as tying the ligature too loosely or too tight. 868. When this is not the Case ( ) & when Bleeding happens after Granulation has taken place it may be attributed to a diseased state of the Artery. 869. The Artery should be laid bare (if diseased) until the sound part comes in view, & there a ligature should be passed. 870. In some patients when granulation has taken place after a wound or a considerable surface is stripped of its integuments, (as after Amputation Φ 876 The thickening of the Cellular Substance wound the Artery & its being lined with tough Coagulum will make this Complaint resemble the real Aneurism, but in the latter the Coats of the Artery are always forming the Cyst in the former the Coats of the Artery are never dilated. 4 Amputation of a thigh) there will be a profuse bleeding from every point of the exposed surface. 871. This will occur in patients who are extremely debilitated & whose Vessels (even the smallest) want the power of contracting. 872. The term spurious Aneurism has been improperly applied to an Extravasation of Blood in the Cellular substance, which blood has escaped from a puncture through the coats of an Artery. 873. This may be either recent, or not recent. In both those will in general be necessity for performing the operation of the Aneurism. 874. In this Case as there is a lateral Wound in the Artery, the escape of the Blood will continue to go on because the Artery cannot contract itself longitudinally. & was it to contract circularly, There would be an obliteration. 875. Therefore there will be no natural Cure for the Accident, it must either kill, or the operation be performed. 876. In the non recent Spurious Aneurism the Wound in the Skin is healed, the Cellular substance has thickened & with some Coagulum of Blood formed a Cyst, into which Blood from the unclosed Wound in the Artery is continually effused, this must ultimately burst & destroy the Patient unless the Operation for the Aneurism is previously performed. Φ. 877. To this state ( ) the recent Spurious Aneurism must always proceed, unless it either destroys the Patient or the Operation is specially performed. 878. The Arteries are subject to two diseases. Ossification & weakness the latter will be the predisponent cause of a dilatation of the Coats ♁ 883. This has been supposed to happen & has been called the mixed Aneurism, but from Experiments similar to the following the Conclusion is to be made. Mr. Hunter laid bare the Carotid artery of a Dog, and afterwards thinned it with a knife even to transparency, no dilatation of the Vessel ensued, three weeks afterwards the animal was killed, & the Artery on which the experiment was made was not found the least dilated but thickened by the adhesive inflammation & the adhesion of the adjacent Cellular Substance. 884. The dilatation if an Aneurism takes place In the Arch of the Aorta will be upwards. In the Abdomen---Forwards. In the Carotid Artery---outwards. In the Axilla---downwards. In the Ham---backwards. In the Groin---forwards. In the Leg---uncertain. Hence absorption of bone so often arises from its making pressure against them. The Artery will continue to swell in that direction in which it first begins to tumefy & the lower part will be dilated more than the upper. 🜔^ 885. It may suffocate by pressing on the trachea, if the Carotid or the Aorta is the seat of the disease. Its pressure on the returning vessels may occasion dropsy &ca. if the Aorta in the abdomen is the diseased part it may burst inwardly, or if it produces 5 of an Artery to which alone the name of Aneurism should be given 879. The immediate cause of Aneurism is a disparity between the force of the bloods motion, & the powers of resistance, in the Artery. 880. Accident (as some violent Exertion of muscular power) may give rise to it, but it most commonly depends entirely upon some diseased state of the Coats of the Artery. 881. This is more probable because it is not unusual to find several Aneurisms in the same person from which it should, appear that the disease is a weakness & disposition to dilatation in the Arterial System. 882. Moreover the common seat of the Aneurism is in the large Arteries whose seats are less muscular than those of the smaller 883 An Aneurism we believe never takes place from a rupture or wound of some of the Coats of an Artery & a dilatation of the rest. ♁ 884. The dilatation of the Artery will always be to that side on which there is the least resistance from the surrounding parts if there is no resistance from the surrounding parts of either side it will then be in that direction in which the blood is most forcibly thrown, if these circumstances are equal on all sides, it is then uncertain in what direction the dilatation will be made. 885. The natural tendency of the disease is to destroy life, this is effected either by the tumor bursting & the Patient dying of the Hemorrhage, or by its enlargement so as to press upon some parts Essential to Life, & hinder their functions. 🜔^ 886. When the Operation for the Aneurism is proper, it should absorption of the Bones of the Spine it may swell outwardly & at length the Skin inflaming & sloughing & the Coats of the Artery undergoing the same change the Coagulum gives way & a fatal Hemorrhage Ensues. ♂ 887. By the first rule, all the Aneurisms of internal parts will of Course be excluded from the Operation. As to rule 2d. the only Arteries admitting of a question will be the femoral & the brachial, but success here is only to be doubted of, yet by no means improbable the other Arteries are either out of the way of operation or have. In the Aneurism of the Interosscal, Anterior & Posterior Tibial Arteries the operation cannot take place from the difficulty of taking up these Vessels, therefore recourse must be had to Amputation & also when a diseased state of the bones &ca. in any part is induced by a pressure of the Tumor. On the whole, this Aphorism will allow of the Operation if Rules 3. 4. 5 permit it in the following Arteries. In the Carotid above the Sternum. In any of the branches of the external Carotid. In the Subclavian when it has passed the Scalenic Muscle & in any of its branches. In the Crural after it has given off the Profundus, & In the Popliteal. Directions for the Operation. 1st. When the Tourniquet is applied, that is if possible between the Aneurism & the Heart, make a longitudinal Incision in the Course of 6 always be performed as early as possible, this rule will also extend to spurious Aneurism. 887. The Operation is proper 1st. When the dilated Artery can be included between the ligatures. 2nd. When there is a probability that the parts to whose support the Artery in question was subservient heretofore, will be still Nourished & supplied with blood. 3d. When it has done no mischief to surrounding. Parts as bones &ca. – 4th. Where it is distinct & Circumscribed, not connected with parts which may be incurable when Exposed, as bones &ca. 5th. When there is distinct Pulsation in the Tumor. 6th. When it is probable that there is no other Aneurism between it & the Heart. ♂. 888. Note continued. the Artery through the integuments & to a greater extent than that of the tumor, then cut it into the Aneurism & scoop out the Coagulable blood as well as Evacuate that which is fluid. The inferior Orifice will be most readily discovered as it will throw out some little blood of a venous colour, to discover the Superior the Tourniquet should be slackened. Tye the Artery at least one inch above the superior Orifice, the same caution is not necessary respecting the inferior. When the Tourniquet cannot be applied, the ligature may be passed both above and below the Tumor, before the incision into is [is] made, it is then to be laid open throughout its Extent. The Sac need not be cut but left to slough away; the dark colour of the Blood issuing from the inferior Orifice is caused by the Bloods taking & slow & retrograde motion which is explained by the annexed diagram. For Blood by having a slow motion or by stagnating will even in the Arteries acquire a dark hue, the older the Aneurism the more will the Coagulum approach to a brown Colour & the more recent the nearer will it be to the natural colour of Arterial blood. When an Aneurism forms, the Cellular substance thickens round it but being inelastic readily yields to distention. Aneurismal Cases. 1 A Young Man had a pain in the Calf of his Leg for two Years at length he received a blow on the Ham, after which a pulsation & Swelling soon appeared. The Operation was performed, every thing went on well to the 5th. day, when the Artery burst either from the upper ligature being applied too tight or too low, before the Tourniquet could be applied he lost as much blood as Occasioned his death. Upon dissection the Artery was found perfectly sound above the part where the ligature was made. 2 An Aneurism of the Crural Artery in the middle of the Thigh extended 5 or 6 Inches in length the Tumor being Oblong, the Operation was performed & the Patient in a short time recovered. 3 Mr. Martin had an Aneurism in the Popliteal Artery, the Operation was performed & he recovered the use of his Limb so perfectly as to be able to dance &ca. Remarks on the propriety of operating for the Aneurism of the 7 (Note continued.) Popliteal Artery in preference to Amputation. Whatever Objections are made to the Operation, the same must hold good against Amputation of the Limb. That one, so much insisted on of the disease being most commonly a disease of the Arterial System & not of the part in question only, if true militates equally against Amputation as against the Operation. If there is not only an Aneurism in the Ham, but another higher up as in the Femoral Artery, or in the Aorta, it is evident that Amputation of the Limb does not give the Patient a greater chance for his Life, than tying the Artery, but it not uncommonly, perhaps most commonly it happens, that whatever may be the general disposition of the Arterial System, yet the Actual dilatation shall only have taken place in one part, now if tying up & removing the diseased part can be accomplished the patient still retaining the use of his Limb, it is certain that the Operation must be highly preferable to Amputation, as the latter though it may preserve the patients life yet leaves him imperfect & mutilated. – 🜖 890 In treating of Gun shot Wounds it is observed that Contused & lacerated Wounds will not heal without Suppuration In wounds penetrating Cavities, if the Wound is made to heal without Inflammation & Suppuration it is then similar to any other simple Wound, But if the Suppurative Inflammation is to take place, it will be requisite to advert to the doctrine of Exposure of Cavities & of penetrating Gunshot Wounds, it must be evident also that if Extraneous bodies are introduced into the Cavity either by accident or intention & not removed the suppurative Inflammation will be necessary. 🜔🜹 891 A Poultice answers this description & the best manner of Preparing it, is to pour boiling Water into Linseed Meal & add as much oil or hogs lard as will keep it from drying, but Poultices cannot universally be had recourse to, & in lieu of them we use Lint dipped in Olive Oil. 8 888. In our treatment of Fresh Wounds it is necessary to consider. 1st. The nature of the part wounded 2nd. The management of an Hemorrhage should one arise 3rd. When the 1st. or 2nd. mode of union, is to be desired, or whether Suppuration is indicated. – 2 889. If the united parts are to be divided by the first mode of union, the indication will be bring them into Contact & retain them so This will be fulfilled by means of bandage & in some cases Sutures. 890. But when a part is to inflame & suppurate it is better to defer the application of Bandage, until after Inflammation has subsided. 891. Whenever a Wound is to go through either the adhesive or the suppurative inflammation, it is generally improper to use applications which will adhere to the wounded surface, become dry & which cannot be removed at the pleasure of the Surgeon, hence The use of dry Lint is extreemly improper. But if the substance to be applied is somewhat that is soft & moist, has no continuity of parts & which can with ease be removed on any Occasions it can do no injury. 🜔🜹 892. When a wound [is to go through either the adhesive] has suppurated & granulations are arising, if they do not readily Contract so as by their contraction to forward the formation of a Cicatrix it will be proper to employ the pressure of a bandage. 893. Abscess will be either Sound or Unsound. By the former we understand Abscess arising in healthy constitutions, or from some Specific disease. 894. The nature & treatment of sound Abscesses will be readily  9 understood from reconsidering the doctrines of the adhesive & suppurative Inflammation. 895. The Evacuations of the Matter contained in an Abscess is either obtained by the Abscess bursting of itself or by an Artificial Opening. Abscesses may be suffered to burst unless some particular circumstances require an Artificial opening. 896. The circumstances most generally requiring an artificial Opening is the danger arising from a long retention of the matter. 897. All Abscesses of the Abdomen Thorax, Brain, Eye & Joints should be opened Artificially & early. 898. When an Abscess is opened Artificially it will in general be necessary that the opening be large to prevent the future inconveniency of a Fistula. – 899. When an incision is made into an abscess, the wound should be so dressed as to prevent the reunion of the incised parts by the first or second mode of Union. 900. There are two methods of opening an Abscess Viz. a by Caustic b by Incision. Where no particular Circumstances (as the seat of the Abscess) forbid, the choice may be left to the patient. 901. Another circumstance indicating the Artificial opening of an abscess will be, its being of such a magnitude that the natural opening will not be sufficient for the discharge of the matter. 902. In determining the Size of our opening it is necessary to have regard to the present distension & future contraction of the ☽︎. 902. This Note is added to explain the text as I am not clear Whether I have there properly conveyed Mr. J. Hunters Ideas. “If the magnitude of the Abscess has produced only simple distention without considerable absorption (ulcerative or interstitial) of the parts in which it is seated it is not necessary to make a very large Opening, because when the distending fluid is removed the parts will immediately contract themselves, & discovering their original Situation the cavity will become obliterated, but if the Cavity has been made by ulceration & absorption of the parts in which the matter is lodged & not by simple distension of the surrounding parts then it will be necessary to make a larger & free Opening to prevent the inconveniency of a succeeding Fistula, because here the parts cannot Contract themselves to Obliteration of the Cavity but the cure must be Accomplished by Granulations. (See Fistula). 10 integuments. ☽︎. 903. The living principle will always be uneasy under extensive exposure & will therefore be powerfully excited to action. hence large openings in Abscesses, where the Contraction of the parts is not sufficient for the obliteration of the Cavity & consequently for the Cure, are always useful, because they are the means of exciting the Process of restoration. 904. Abscesses may be free from any specific disease, may arise in an healthy constitution, & yet certain Circumstances may retard their healing. 905. These may be. 1st. Peculiarities of situation 2nd The Stimulus of some deep seated foreign body, as a Ball, Splinter of Bone &ca. – The first causes of backwardness to heal we cannot alter. The second causes we must wait for the removal of, before we can hope for the healing of the Abscess. 906. When sores of any kind have a disposition to healing, the Surgeon has little to do, except to prevent any obstacles arising that may hinder the process of restoration. 907. If dry Lint is used to healing Sores it should be applied so as not to extend quite to their margin, if ointments are used they should be free from Stimulus. 908 – Amongst the Obstacles to the healing of a Sore will be. Intemperance. Neglect of rest, and The Granulations rising too high above the Surface 912. This will be best illustrated by considering the rupture of the [Tendo?] Achilles, it is generally affected when the Muscles of the leg become tired & unfit for voluntary motion as after long continued dancing, & therefore the Muscle will act involuntarily, hence the Cramp, &ca. by this acting very Violently & involuntarily they rupture the Tendon. In doing this the Patient feels little or no Pain in the Part, but seems to receive a blow on the Gastrocnemius Muscles & hears a Noise as of some Elastic body snapping in two. Inflammation &ca, may succeed, the Muscles may be squeezed out & the Ends of the Tendons approximated together & as much as can be retained so, When those Symptoms are removed no inconvenience can arise from suffering the Patient to walk if he himself has courage enough to do so, for there is no danger of the will throwing the Muscle into Action & Merely producing a further seperation of the divided Ends of the Tendon, for the will cannot now act upon the Muscle, but an involuntary action of the muscles may take place during sleep, & this is to be guarded against by a tight bandage round the calf of the Leg & making the Patient wear an high heeled Slipper or Sandal. The Bandage & Sandal are more particularly necessary by night, & whilst the patient sleeps, during the day time their use may Commonly be dispensed with; from the back of the Sandal a piece of Leather is to be Carried & fixed to the bandage or a Leather Strap Placed tight round the Calf. Where the Rupture happens no Bandage should be applied. 11 Surface of the sound Skin. 909. The latter obstacle is to be removed by pressure as that of a bandage, & by touching the Granulations with some Metallic Salt, as Vitriol of Copper, lunar Caustic &ca. – 910. New formed parts being weaker than Original parts, are less able to support the fatigues of the Offices of life than the latter; hence upon a slight stimulus being applied, they readily inflame & if that Inflammation is not removed, the suppurative & ulcerative Stages come on Rapidly, or mortification speedily takes place. 911. The absorption of new formed parts may be either a Ulcerative, or b Intersticial. 912. The Tendons of Muscles are sometimes ruptured & the Accident arises from causes similar to those of the broken Patella, the Muscle being in violent action at the same instant of time, that there is an unconquerable resistance made by the point to which the Tendon is attached. Note continued. The patient will find little Amendment during the first two months, but will after that period generally recover the use of his Limb. Keep the foot nearly at a right Angle with the Leg the Heel a little raised when the patient walks he should turn his Toe outwards & not attempt to bend his Knee. The Ankle & Foot will commonly swell considerably. About three weeks from the accident the roller & slipper may be left off, it may be asked when the Patient may attempt to use his Muscles We answer, whenever he feels a consciousness of a power to use them. Mr. Hunter broke his own Tendo Achilles in dancing, he is not clear, whether Cramp of the Muscles precedes the snapping of the Tendon, but it certainly immediately follows it. 916. The motions of the Shoulder joint are most difficultly restored after any Wound, or considerable injury of that Joint, because to some of them the gravity of the Arm is an obstacle, were it possible to cure a Wound of the shoulder joint with the Arm elevated, then the motion would be as easily restored as those of other Joints. – 12 913. In order to the Cure of this accident, the indications will be. 1st. to place the divided Ends of the Tendons as nearly as possible to their natural situation. 2nd. To take off or prevent Inflammation. 3rd To prevent the involuntary action of the Muscles. 914. It is unnecessary to forbid voluntary action of the Muscle because in the present state it will be no longer subservient to the Will. 915. Should the divided ends of the Tendon not be brought into contact, but remain at some distance asunder, the union will be accomplished by new formed substance & therefore the Tendon be somewhat lengthened the Muscle will however be thereby shortened & its power of contraction lessened, no inconvenience will ultimately take place, for the muscle (as in the Cases of Fractures of the Patella & Olecranon) will acquire new powers of contracting adapted to its necessities. 916. In Wounds connected with Joints, it is necessary to pay great attention to the Motion of the Joint, during the Cure if, there has been loss of substance without great care on the part of the Surgeon rigidity & loss of motion will be the Event. 917. After the Inflammation has entirely subsided, & the Cure is somewhat advanced, the joint should be gradually moved by the Surgeon from time to time, that the irritating matter may be elongated in a manner similar to the elongation of the coagulable Lymph in adhesions between the Lungs & the Pleura. – End of the Second Part.  13 We now come to treat of those Affections of the body which are the objects of Surgery, that may be more properly called diseases, that is, those Affections in which parts have no disposition for restoration, but only a disposition to destruction, & which disposition will continue to exist, until either it has worn itself out, or has destroyed the Patient, or is cured by Art, in short those affections for which there is no natural Cure. Inflammations whether arising spontaneously or from External violence, suppuration &ca. & all accidents (unless so much mischief is done either to a vital part or to the constitution that the functions of the body cannot go on) become themselves the causes of Restoration. These we have already inquired into so far as concerns the principle on which their different Phenomena depend, & have also considered the particular attentions by which we shall facilitate the natural process of healing in wch. in fact little is to be done except removing all the impediments to the natural Cure. But in diseases the present disposition is to be removed & a new one induced in its stead. –  14 It has been shewn that as irritation in health induces disease ( ) so irritating / in disease is to bring back Health. “This Aphorism generally hold good tho’ in some Cases of diseased irritability an objection may be made to it. “After some previous general remarks on indolence we come to particular diseases originating from that Cause. Tumors are those spoken of, but those only which originate from indolence are those meant to be explained.” the definition given of them indeed will apply to swellings from other causes than indolence, as Inflammation &ca. but the subsequent remarks will shew that Mr. Hunter when speaking of Tumors in that place had it only in view to treat of indolent swellings. 918. Diseases or unsound dispositions will be properly divided into the irritable & the indolent, or those in which there is a disposition to too great or too little action. 919. Either of these dispositions will be a hindrance to restitution of health, & must be changed before health can be restored. 920. It is easier in general to increase the disposition of a part to action than to abate it. 921. In the indolent diseased disposition there is neither sufficient power, nor sufficient excitement to action. In the irritable there is too great excitement without corresponding powers. 922. Again in diseased irritability, parts are impatient under any removal from a state of perfection, yet have no disposition to at about the process of restoration. This disposition may be ♀. 929. Caustics are not followed by so speedy or Extensive an Inflammation as the Knife, an incised wound in such circumstances has frequently for its Sequel, an Erysipelatous Inflammation. 15 either Simple or Connected with some specific disease as Syphilis Cancer, &ca. – 923. When simple we must have respect to the principle laid down ( ) but when complicated with some specific disease, both the specific & the irritable disposition require attention. 924 Diseased irritability may be local, or it may be a state of the constitution at large. 925. It appears in general to be passive requiring the application of some stimulus to bring it into action. 926. An encreased [action] degree of sensibility will generally accompany diseased irritability, the living & sensible principle commonly Sympathizing. 927. Inflammations with diseased irritability should not be hurried into suppurations, nor on the contrary should those means be used which lessen their powers, the indication being simply to lessen violence of action, not to diminish Powers. Opium may be properly used in Solution or mixed with emollient Poultices, for preperations of Lead see, ( ). 928 The diseased irritability of the Constitution is lessened by the use of the Bark & those means which encrease the strength. 929. When a suppuration has taken place in parts under this state, if an opening is to be made to discharge the matter, a caustic is to be employed in preference to the Knife, for incision has not here in general such favourable consequences as the other method. ♀. 930. Ulcers have sometimes a diseased irritability & when this ☍ 931. Some Ulcers which shew every sign of the greatest irritability &ca. will have their Symptoms unrelieved & often increased by mild dressings, but will grow easy under the use of the most powerful Stimulants as Ol. Terebinth, but we would first by Poultices with Opium. &ca. – 932 We meet with few constitutions which will not readily take on Inflammation, a Stimulus being applied to any part of the body in which there is no particular local affection, how far constitutional indolence may prevail, we have a proof in Scrophula. – 16 is the case the dressings should in general be of the mildest kind. 931. We cannot a priori always determine what application will assuage the pain & other Symptoms we must therefore change our dressings until we meet with one fulfilling that intention. ☍ 932. The unsound disposition with indolence, or the diseased indolent, may be either an affection of the constitution or of a part, the constitution will rarely be indolent in a great degree. 933. Specific diseases may give rise to or accompany indolence in parts, as the Syphilis, the Scrophula, & sometimes the Gout. 934. The common effect of indolence in parts is a thickening of them. the process of restoration in parts in a state of indolence is very slow. – 935. As the Extent & spreading of disease, in diseased irritable parts is great & rapid, so the disease of parts in a state of indolence is in general very circumscribed & rarely spreads to any considerable extent. 936. The thickning of Swelling of parts morbidly indolent is of 2 kinds Viz. 1st. Intersticial. 2nd Superadded. & Indolent swellings commonly go on to a considerable degree before any knowledge of them is communicated to the mind, But when very far advanced, some dull, heavy pain, with sickness will be produced, &ca. but this probably arises from the distention of the surrounding parts. 937. The Causes of indolent disposition arising in parts are 1st. The long Continued Action of Cold.  17 2nd. Violent actions terminating in weakness. 3 Pressure from Mechanical Causes. Indolence may be also spontaneous, arising without any visible or known cause. 930. The first Species (936) or intersticial thickening, is that in which no new or distinct parts are formed but there is simply a swelling or enlargement of the original Parts, as a Corn varices of Veins &ca. – 939. The Second (936) or diseased indolence with parts superadded is that in which new parts are actually formed distinct from the old. 940. The intention of Cure will be to encrease both actions and powers. In the intersticial thickening, as swelling generally consists in the disposition of Coagulable Lymph in the cellular substance &ca. We endeavour to procure a reabsorption of it, & to this end we employ those means which increase the action of the Absorbents as Mercury, pressure applied so as to stimulate fumigations &ca.. Care however is necessary not to excite the parts to greater action than they can support least mortification ensue. 941. When those thickenings cannot be removed by absorption (940) stimulating applications may induce a Cure, by exciting the Suppurative Inflammation in them, however their suppuration is with difficulty brought about, & when it has taken place, & Ulceration followed it, the Cure is not always easily obtained. 942. Abscesses have been divided into sound & unsound, of ∇ 944. The cure of Corns consists in obtaining a seperation from the cuticle, which may be brought about rather by leaving off the pressure, soaking the part often in warm water & keeping it always moist & defended by some proper Plaister, or by removing it at once, when a corn has been of long standing it is often difficult to remove by Excision, as a wound of the parts underneath is sometimes followed by Inflammation, & even Gangrene, but we may attempt it by removing the Pressure, soaking the part long in warm water, & then applying a blister to obtain a seperation of the Cuticle from the Cutis. 18 Sound Abscess an account has already been given, of those wch. are unsound, & which have a disposition to indolence, it will be better to speak when their common Cause & consequences. Scrophula & Fistula come under consideration. 943. Ulcers or Sores may have an indolent disposition and thence a backwardness to heal, when simple indolence is the cause we have recourse to those means which will excite the parts to action, as Turpentine, Balsams &ca. 944. Corns are an instance of indolence from pressure, the Cuticle thickens from the stimulus of necessity, & as it acquires thickness presses on the Skin & produces uneasiness & pain. ∇. 945 Various Veins are also an indolent thickening from pressure if the disease is not too extensive or the operation too hazardous, they may be dissected out, & the inconveniency thus removed. 946 Chilblains may be given as an instance of indolent thickening from cold. Though they have in them especially at first somewhat of an increased irritability. The constitutions most disposed to this kind of indolent thickening are the delicate & such as have but small Powers of generating heat. 947. Schirrus of a Gland may be offered as an Example of Violent action terminating in weakness, & acting as the Cause of an indolent thickening. 948. Of the spontaneous indolence ( ) proofs may be given, in the swelling of the Legs, so common in Barbadoes & sometimes 🜔 950. Of this kind are those swellings of the inguinal Glands which have been so often mistaken for venereal & for which people have even been salivated. Sometimes these enlarged Glands are so situated, that extirpation is difficult & to be undertaken with the greatest caution, this will be spoken to, when we come to Tumors & Scrophula to which two Articles they belong. ☽︎☉ 953. When we speak of indolent swellings being diffused we only speak as comparing them to Tumors, for indolent thickenings compared to swellings of parts from other causes are generally circumscribed. – 19 seen in this Country, & in the swelling of the Lymphatic Glands 949. Some indolent Swellings may require extirpation, as in encreasing their action in order to suppuration, they may be made to turn out Cancerous. 950. Lymphatic Glands may slowly, gradually & indolently tumify until they become of a size which may render extirpation necessary from their making pressure on some important part & disturbing its Œconemy, or from their occasioning deformity. 🜔 951. Wherever a cure can be obtained the indication will be the same, either to encrease the action of the absorbents, or to remove the part entirely. 952. In all indolent thicknings we should endeavour to ascertain whether they arise from the constitution or whether they are purely local (see Constitution local & original local). 953. Indolent swellings of parts will either be circumscribed or diffused, by the former we understand a Tumor (954, the latter we mean when we speak of thicknings of parts. ☽︎☉ 954. By the Term Tumor we mean a circumscribed substance produced by disease & differing in its nature & consistence from the surrounding parts. 955. Tumors may be divided into a. the Solid b. the Encysted. 956. The Solid (956.a.) may be subdivided into three Vizt. 1. The Intesticial.  20 2 The Superadded, or new formal Substances. 3 The mixed. 957 The 1st. or Intesticial (956) belongs to Scrophula. The 2d. or Superadded are entirely new formed substances, they take their rise from some fixed point from which they grow, as from a root which will be of different Sizes, they are perfectly circumscribed, are generally more detached than a Lymphatic Gland & they have no Coat. The 3d. or mixed consists of these Tumors called Wens. & Schirri, in which there is a mixture both of enlarged & original & of new formed Parts. 958. These differ very much in their appearance & consistence being only fatty Tumors, sometimes almost cartilaginous, when cut through they resemble somewhat a divided Lemon. 959. The 2d & 3d. Species will rarely if ever admit of any other treatment in order to a cure than extirpation. 960. Previous to the extirpation of any Tumor it is necessary that we enquire. 1st. What part it adheres to, or is connected with & its situation 2d. The manner in which it ought to be extirpated. 3d. Whether it is necessary to remove any of the surrounding parts with it. 961. The second Species ( ) may be of different degrees of hardness, may grow from a bone & be bony, or from a Tendon & be of a ligamentous firmness. 962. They may also be adherent to the Skin, to a Muscle &ca. & they 967. A Young Lady had a Tumor situated on the lower Jaw it became hard & almost bony. Mr. Hunter pared it away even to the Surface of the Jaw bone, but it arose again, when it had been pared off a second time & the Maxilla Cauterized the patient got well, the Tumor consisted of a thin Plate of bone forming a shell which contained a cartilaginous substance. A Young Woman had a Cartilaginous excrescence growing from the upper Jaw after the extraction of a Tooth, they were removed but grew again, after being a second time extirpated the Patient got well, these seem to occur most frequently in the Jaw bone or on the Tibia. In the 3d or mixed Calcareous Earth is sometimes deposited, they not unusually fall into a kind of suppuration without the surrounding part being affected, in removing them great caution is sometimes required. Mr. Hunter has dissected them off the temporal [Muscle] and Carotid Arteries & once laid the Trachea itself bare. 21 may be either superficial or deep seated. 963. The third may be loose under the Skin, or they may adhere to the Skin, they may be situated superficially or deep, upon Muscles, a Bone, or a large Blood Vessel &ca.. 964. If the surrounding parts are not diseased, they may be suffered to remain, they must be removed as far as the disease extends, for it must be a rule to remove the whole of the disease. 965. If a Tumor is loose & does not adhere to the Skin a longitudinal or crucial Incision, according as it is large or small, deep seated or superficial may be sufficient & then the Tumor may be raised from its bed & removed. 966. But if it is adherent to the Skin then a portion of the Integuments must also be removed, at least as large as the adhesion extends. 967. If it springs from a root originating from above, it is to be removed by the Saw, Pincers or Chisel, in this Case it may also be necessary to Cauterize that part of the Bone from which it Sprang. 968. If it is situated on any large Vessel &ca, great care will be required in the dissection of from its seat (see Note on 967). 969. If it be only a fatty Tumor not adhering & of a small Size a simple incision down to it will be found sufficient & then the Surgeon may squeeze it from its bed, with his Fingers. 970 When the third or mixed, very much enlarges they are not unfrequently productive of pain, however it does not prove acute, but is of a dull heavy kind & it depends on pressure upon parts more sensible. The Stomach sympathizes with the affection & ☉ 978. Hydatids. It is difficult to explain the manner in wch. these are formed, or to determine which are formed first the Exterior or interior ones. – Are they not Animals of the Polypi kind? – Remarks on particular Hydatids. Hydatids of the Brain are sometimes found & usually on the Plexus Choroides, these occasion no symptom peculiar to themselves & from their situation can admit of no Cure. Uterus & Ovaria. The fluid contained within the Hydatids found in those places is sometimes of a gelatinous nature, they are more detaches at first than afterwards, sometimes encrease to an enormous size occupying greatest part of the abdominal Cavity, & is then called encysted dropsy. It is to be distinguished from Ascites by the manner of attack, the Patient first feels a weight & swelling on one side, which as it grows larger rolls about, until at length encreasing gradually in size, it becomes fixed, & then the abdomen swells regularly & gradually, the health of the Patient is often little affected by it tapping is the Palliative Cure, & should be done with a large Trochar least the fluid be gelatinous, when large they will adhere to the Parieties of the Abdomen & then the operation is safer than at any other time, they are often made up of a number of cells, so that sometimes a Small quantity of fluid is only discharged by one Tapping, as this disease will certainly kill in the end, if it can be ascertained early, it would perhaps be right to make an incision through the whole length of the Tumor & Extirpate it entirely, Electricity has seemed 22 Sickness is not an unusual circumstance. 971. As is the pain so likewise is the Inflammation when it arises, that of the surrounding parts, these however are seldom much thickened. 972. As to endeavouring to induce in these Tumors the suppurative Inflammation, the Opinion given ( ) will now be applicable. 973. The encysted Tumors are substances contained in a coat wch. is either natural or acquired. 974. The natural are the Hydrocele; Dropsy of the Ovaria, Pericardium, Saccule Mucosi &ca. in which the contents are enclosed in a natural bag. 975. The contents of Encysted Tumors whose Tunic is acquired will be various in their consistence & natural Hydatids form a considerable Class of these Tumors. 976. Hydatids are collections of watry fluid enclosed in an adventitious bag, we do not know the cause, nature, or manner of their formation. 977. Every part of the body where there is cellular Substance, becomes the seat of Hydatids, but more commonly the Plexus Choroides of the Brain, Tunica Vaginalis of the Testicles forming a spurious kind of Hydrocele ( ). 978 They are of different Sizes, as they enlarge their Coats, thicken & become stronger, their Coats are but little Vascular, sometimes one large Hydatid will contain several smaller ones, one within another, they are often found in the Uterus, Kidnies, Liver, Thyroid Gland, Lungs &ca. but how ☉ of late to have been of very great service to one patient affected with this disease. Hydatids in the Kidnies. – Here they are generally situated between the External & Internall Lamella of the proper tunic of the Viscus, & are not out of the reach of relief. In the Liver. – They are most commonly found in the Substance sometimes they are discharged Externally, the bags making their way to the Peritoneum adhering to it. Inflammation & Suppuration coming on, the integuments ulcerate & the Hydatids are discharged. Mr. Hunter on opening a Woman found a great number of them enclosed in one common bag. In the Lungs. Sometimes they make their way into the Trachea & are coughed up. In the Thyroid Gland. They may become troublesome by impeding deglutition. They are found in the Cellular Substance in different parts of the Body. Especially in the neck & about the lips of Woman. – 🜔v 982. In this manner we suppose hair is formed which is found in tumors of the Ovaria. Mr. Hunter Once found an encysted tumor in a sheep, which contained a Ball of Wool, now it is probable this was thrown off from the interior surface of that tumor on which it had formerly grown. – 23 formed is unknown. 979. As to the Cure of Encysted tumors we can do little unless we can either procure a discharge of the contents & an obliteration of the Cavity of the Cyst, or an entire removal of the whole. 980. Tumors mat appear in parts whose they was not formed but into which they have made their way from some deeper part This Circumstance the Surgeon should consider when he is about to extirpate a Tumor. 981. If the Surgeon is not attentive to this circumstance he may be deceived, & operate ineffectually only removing a superficial appearance of disease & neglecting the deep seated cause of it & when probably some other tumor arising has driven the first into its present situation. 982. Some encysted Tumors are found to contain a quantity of hair the internal surface of these has taken on the natural disposition of the Cutis & Cuticle & thus given Room for the growth of hair. 🜔v. 983. The Carbuncle as to its ultimate Effect might have been classed with Mortification, as it produces a considerable sloughing of soft parts, but some characteristic appearances attend it, which would shew it to be a distinct disease & of a specific nature. 984 The predisposing Causes we cannot easily ascertain, It cannot be supposed to be owing to weakness as in general it arises not far from the source of the Circulation, & it does not commonly arise in weak parts, or in weak habits, its seat is commonly the  24 posterior part of the body, as the hinder part of the Neck, the Back &ca. 985. It begins with a considerable inflammation of the Skin approaching nearer the Erysipelatous than any other, the Skin is somewhat tumid but not prominent the part has a doughy feel. For a short time a pimple Arises, the Inflammation spreads rapidly and widely, & the Cellular Membrane to a considerable Extent, Mortifies; the Skin & Muscles still retaining their Life. 986. The Skin above has pimples which now Ulcerate, forming large holes, through which the sloughs of the cellular Membrane are thrown off, & as they come away leave large chasms which are loosely covered by the Skin, which is flaccid & hanging inwards, sometimes the matter discharges itself through an infinite Number of small holes. 987. The disease though it has its Progress chiefly in the Cellular membrane, seems to begin in the Skin, & the matter generated seems of a specific nature, which contrary to the course of all other matter tends inwards, & burrows in the cellular membrane, which wants power to resist its spreading, from a want of the adhesive Inflammation. 988. Should not free openings be made in the Infancy of the disease to give free Exit to the matter, & to prevent its spreading & diffusing itself through the Cellular Membrane. 989. The loose Skin remaining after the coming away of the sloughs of Cellular Substance should not be removed, as it will commonly in the end unite with the subjacent parts, & thus 🜔^ 995. (see Lord Ansons Voyage) Here the Constitution not having a power of supporting the new parts or Even the original reclaims at were the former & causes them to be absorbed. 25. greatly forward the cure, which if things go on well from this time proceeds as in a common sound Ulcer. – 990. Boils seem to be a species of Carbuncles but more of the adhesive Inflammation arising in the Circumjacent parts they do not spread. The cure of boils vulgarly so called is in fact a slough or mortified part thrown off. 991. The Aged & free Livers are most Subject to Carbuncles the Young to Boils. 992. Though the cellular membrane sloughs, yet suppuration freely goes on, in which matter is either furnished from living cells which are endeavouring to throw off the dead, or from cells which are themselves also about to die. 993. Carbuncles are sometimes local & sometimes seem connected with a diseased state of the System. 994. Bleeding is rarely proper, though at the beginning may be indicated sometimes, if there appears Symptoms of Inflammatory Diathesis. 995. A diseased state of the System as Scurvy, may occasion both intersticial, & ulcerative Absorption of new formed substances which we have shewn are weaker than the Original, hence in violent Scurvy, cicatrices have been known hastily to Ulcerate & even Calluses which formerly reunited broken bones become absorbed & the Ends of the bones loosened. 996. Tetanus. Or Locked Jaw is a disease which consists in an involuntary Contraction of voluntary muscles, sometimes it becomes an unnatural contraction of voluntary Muscles & Δ 996. Unnatural Contraction of Muscles is a Genus of disease wch. has many orders to it belongs tetanus, Cramp, Wry Neck, St. Vitus’s dance, Subsultus Tendinum, One of the kinds of Quincey, Ague, it bears some Analogy to Epilepsy & Catalepsy, though these are properly affections of the brain, it is not peculiar to the human Species, Horses, Monkeys, Stags &ca. are subject to Tetanus. – 1000. In this it is so similar to other Spasmodic Complaints which are very common in Warm Climates, but rarely felt in Cold ones. – ♀ 1001. These act upon the principles of producing weakness & an irritable state of the Nervous System. Locked Jaw has been often attributed to the Wound of a Nerve or Tendon, with respect to the former, the opinion seems quite erroneous, with respect to the latter, as Wounds of the Tendons do not heal readily, they induce an irritable & weak state of the System & this being present irritations which do not become sensible give rise to it. Upon that Principle it is, that it is known to follow large Wounds which have considerable Suppurations & which induce a weak & irritable state of the habit It does not arise here from Inflammation, for it does not take place until after Inflammation is gone off. Mr. Hunter is satisfied from his Experiments, that wounds of Nerves or the including a Nerve in a Ligature made upon an Artery have no particular Tendency to bring on locked Jaw which he has frequently found to take place where it was Evident no more was wounded. 26 then perhaps it becomes fatal. Δ. 997. When it affects the Muscles of the lower Jaw, it is called Locked Jaw, when it Extends to the anterior Muscles of the body it is called Emprosthotonos when the posterior Opisthotonos 998 The predisponent Causes will be whatever can render the habit weak & irritable. 999. Amongst these (998) Climate is a very powerful one. In hot Climates it is extreemly common, being produced by the slightest occasional causes & even sometimes arising Spontaneously. 1000. In Temperate Climates it is more rare, in very cold Climates it is unknown. 1001. Other predisponent causes may be fever, large suppurations, Wounds of Tendons, & ligamentous parts. ♀. 1002. The most trifling external injury may be the occasional cause of this Disease, even a Scratch or puncture, where neither Nerve nor Tendon are found to have suffered. 1003. It appears to be a disease of the nervous system & not of the Principle of Life, every circumstance appertaining to the latter commonly remain natural & unaltered, sometime after the attack of the disease. 1004. The Muscles of the lower Jaw seem more disposed to take on this Affection than any other Muscles, here the Disease commonly begins & soon spreads itself to other Muscles those whose Action is involuntary & necessary to Life then the Patient is destroy. 🜍 1005. Stupor. This Shews that the brain must be somehow affected, as it is neither Muscular, nor connected with Muscles, it is difficult to say how this affection of it is produced, is it from any compression on the Brain, induced by the Spasm of the Muscles of the Neck making pressure on the Jugular Veins, or is it from sympathy. 27 1005. It begins with a small degree of stiffness in the Muscles raising the lower Jaw, the patient finding a difficulty to open his mouth, at length the Jaw becomes less & less capable of being depressed, the muscles of the Eyelids are next affected, & the upper Eyelid falls more & more so that the Patient looks like a person going to Sleep, sometimes soreness of the mouth & Throat precedes, but this is only accidental, then the Muscles of the Head became affected; at first the head is held immediately Erect by the Spasm, then it is drawn backwards, the muscles of the Spine become nex Affected & the body of the Patient is bent [for] backward, then those of the Abdomen, the bowels are drawn inwards; the patient complains of a pain in the lower part of the Sternum, perhaps from the Diaphragm being affected; a difficulty of respiration from the spasm extending to the Diaphragm, Intercostal Muscles &ca. in which last an excruciating cramp-like pain is felt Universal convulsive motions of the Body sometimes attend like to Subsultus Tendinum. In other respects health seems to remain & the functions of the Body go on. The Spasms of the Involuntary Muscles, however increasing in violence & perhaps the heart also becoming similarly affected the Patient is cut off, sometimes Stupor produces his Death. 🜍. 1006. Should the patient live until the habit becomes accustomed to the disease it then wears itself out & at length the patient gets well, in general however it Kills before the System can be habituated to its Action. 1007. The disease does not always increase gradually & regularly  28 regularly as described (1005) but sometimes it will Extend itself suddenly from the Jaw over the whole body, so as to Excite unnatural contraction in the Muscles in general. When the Spasm confines itself to the Jaw the disease may be called Mild & then it does not prove fatal. 1008. The disease kills at different periods of time, but if the patient lives through the second or third Week from the Commencement of the complaint, the constitution becomes so much habituated to it, that it loses its power of destroying Life; then wears itself out. – 1009. The disease continues sometimes even Ten Weeks, a great part of the time remaining Stationary & at last the Patient gradually loses the Spasmodic Affection & his Muscles are resolved to a natural State. 1010. All Ages are subject to it, of Constitutions the delicate & relaxed are most liable to its attack. 1011. When it Kills the Muscles remain contracted until the contraction is removed by force, but when Art has relaxed than they do not contract again, no preternatural appearance presents itself upon dissection in any part of the body in general the disease kills suddenly. 1012. From considering what has been said, we are perhaps enabled to discover. – Why the Patient remains under the disease a long time without his general health being affected. Why the Disease kills – why it may Kill at different 🜺 1013 & 1014. Bark, Opium, Blister, Camphor, Bleeding, Warm bathing & a variety of other methods have been tried, wherever Mr. Hunter has seen the patient recover, the disease has seemed to have gone through its natural course, & to have worn out itself without his having had any reason to attribute anything to the power of Medicine. He recommends the Sugar Lead to be tried upon the principle of the known tendency of Lead to produce relaxation of Muscles & inability in them to contract. Externally as a substitute for change of Climate he recommends that the Patient should be put into a cold bath or an Ice house, he never saw a Patient die after the third Week. ☍ 1016. Cases of Locked Jaw. 1. A locked Jaw & Convulsions of the Muscles of the Arm from a compound fracture of the Radius. Heat & Perturbation of Mind encreased the Symptoms, he was always observed to be worse after drinking anything warm, or after warm External applications. Opium & Bleeding was tried he died the sixth day. 2. A Soldier received a Wound in his leg when it was nearly well a locked Jaw came on. Musk & Opium were tried for three Weeks, the patient finding no Change would take no more. He continued in the same state for Seven Weeks & more, & then began to mend, which he continued to do insensibly until he Recovered his health. – He took Bark & Port Wine during the whole of his illness his Wound healed long before, his Complaint left him. 3 A Soldier with a locked Jaw after using Musk, Opium, Camphor 29 periods, & why it [may] commonly cutts off the Patient suddenly. 1013. No internal remedy has been yet discovered that will cure or relieve this disease. 🜺 1014. External application have also been found ineffectual as Climate is one great predisposing Cause to the disease a change from the present to a colder might be tried. Electricity has once been found serviceable. 🜺 1015. As the indication of Cure must be to relax the present contractions of the Muscles, & to take off every disposition in other Muscles to unnatural Contractions, the internal use of Lead might probably deserve trial, as lead by inducing paralysis may cure one disease by producing another. – 1016. If the locked Jaw here follows a Wound in any part of the Body, the removal of the part wounded is not found to remove or lessen, the disease unless the Tetanus arises during the State of Inflammation in the Wound. For when the Inflammation & irritation of the part which received the injury is gone off, it must be evidently useless to remove it in case a locked Jaw should have come on, because whatever irritation was heretofore applied to the part is now taken away, & that is no longer the diseased part, nor can it now tend to cause or keep up the Spasm its Action on the System has been already produced & terminated ☍ Upon the whole from what has been related we may be justified in acceeding to the conclusion given in (1013 & 1006.). – 1017. Scrophula. is a disease which may be considered as constitutionally local ( ) it is not hereditary, as in other diseases so in this a susceptibility of the disposition for diseased Action & even the cold Bath & finding no relief left off all his Medicine, he took none for eight days, & then began gradually to mend. 4 A Young man had his thigh Amputated, had violent pain in it & frequent spasmodic Affection of the Muscles, 13th. day locked Jaw came on, 15th. became locked all over, 16th. he died. Opium Æther & Sweating were Employed; Muscles continued rigid after death, but when Relaxed by force did not contract again. – 5. A Sailor had a Tetanus affecting the Jaw & Muscles of the Spine, came on 2 Weeks after having received a Wound in his Wrist, during his Illness had Ischuria & Costiveness, both of which were relieved by a Clyster, Opium, Camphor, Bark, Steel, Cold Bathing were all tried, he lived some days had pain in his heart & great sense of oppression about that Organ having come on he died suddenly. 6 A Man had a locked Jaw, it was uncertain whether this disposition to it was induced by a Wound on the foot, or by a Wound of the Tongue, he died the 9th. day. The second day of his illness the Spasm extended to the Muscles of the Neck & Spine, the 4th. his Skin became exquisitely sore to the touch, his Eyelids did not open properly he had universal Spasm, & a degree of Stupor – 8th. his breathing was difficult & he had a pain in the lower part of the Sternum 9th. he died suddenly. – 7 Locked Jaw cam on after Trepang, Opium was freely given no visible good effect followed it, but after a fortnight the Patient mended gradually & got well. 8. Locked Jaw arose spontaneously after Nervous Fever, the 30 is all that can be inherited. ( ).. 1018. It is a specific disease, every process of which is marked with indolence & slowness of actions, whether it produces tumefaction, suppuration, or ulceration, all of which when the disease is true Scrophula go on with little or no pain. 1019. When it produces Swelling of a part the tumefaction encreases slowly, there is hardness with little pain or soreness, all the appearances of common inflammation are wanting no Resolution of the tumor take place a kind of suppuration is produced. 1020. When the Tumor becomes soft & suppurates, which it does very slowly & without pain, the matter very gradually makes its way to the External parts. 1021. The ulceration of the Integuments in order for the Evacuation of the matter is equally slow & tedious, the matter does not make a point as in healthy Abscesses but it stretches the Skin equally to some extent & renders it as far as it distends it, Shining of a Purplish hue, in this state the disease will sometimes remain stationary for months, when the Skin can no longer resist the [?ressure] of the matter it bursts & a fluid like a mixture of Curds & Whey is evacuated, there is rarely any common Pus when the Scrophula has gone on pure & unmixed with the Common Inflammation. 1022. When the Abscess has emptied itself it does not readily [??ll] up or suffer its Cavity to be obliterated but will often remain fistula the small hole through which the matter bursts remaining open. Patient took nothing but Port Wine & recovered. – 9 Locked Jaw arose in a Child of two years old after a scratch of a Finger by a Saw – died the 10th. day. – 10. Locked Jaw arose Spontaneously after Dysentery. – 🜔🜹 1028. It is not peculiar to the human Species, Several Quadrupeds, as Monkeys, some Birds, as Turkeys, are subject to the action of Scrophula. 31 1023. When Scrophulous Ulcers granulate, the granulations are large, soft, pointed appearing like a transparent glassy Substance their sensibility is little, the Margin of the Sore is loose flabby & turned inward, the Skin round about it has a purplish hue the granulations want the power of contracting ( ) so that the Ulcer will continue stationary, or at most its sore will be slowly diminished. 1024: The process of Cicatrization is equally difficult & tedious & when formed has not an healthy appearance. 1025. The disease seems to have a sedative effect upon the System diminishing all the actions of the parts which it invades. 1026. It has a power of producing in the parts, surrounding the part originally diseased a similar State, but it does not produce continued Sympathy in any great extent. 1027. The predisposing cause is a delicate & irritable constitution with weak powers of action. The parts most disposed to take on Scrophulous action are the Lymphatic Glands, especially those wch. are most Exposed to the influence of the atmosphere, as the Glands of the neck & lungs, “the Mesenteric Glands”. Joints particularly those of the Foot & Hand, ligaments, the soft Ends of Bones, in all which parts the strength & powers of restoration are but small. 1028. Persons between the Age of 15 & 40. of a fair Complexion & light hair, who do not appear to have the usual quantity of red Blood in their Vessels, & those who live in climates which are very changeable & irregular are most liable to this disease. 🜔🜹. 1029. Though it produces continued Sympathy to a small distance it has no power of affecting the Absorbents, nor is the disease capable of being communicated by them, it cannot like  32 the small Pox be communicated by innoculation. 1030. The Skin is rarely if ever originally & primarily affected by this disease, it may however fall into it from continued Sympathy. 1031. The Exciting causes will be external Violence especially if not very great, sudden application of, or unusual exposure to Cold, the use of Mercury. The slightest degree of external violence in habits predisposed to it (1026-27) will cause the part to take on a Scrophulous action. 1032. The Susceptibility of Scrophula in some Constitutions is so great that any complaint which deranges the habit for a time, as Fever, Syphilis, Small Pox &ca. will give occasion to a Scrophulous disposition & action. 1033. The appearances of Scrophula will vary according as different parts are affected, however it will always be found with one of the following circumstances. 1. A Circumscribed Tumor. 2. A Tumefaction more diffused 3. Suppuration without tumefaction. 1034. The circumscribed Tumors are chiefly Lymphatic Glands although they are sometimes found in the brain, breast, Uterus & Testicle. 1035. When the disease attacks a part which may suffer without much disturbance of the general health, we are often unacquainted with the nature of the disease, until a swelling in consequence of Suppuration appears, either in the part originally diseased, or in some other part to which the matter has made its way, the suppuration going on without inflammation & perhaps without pain ♂ 1042. A Fever has sometimes cured Scrophula & hence we might be led to think that Stimulating Remedies are indicated, but the Analogy will not hold good, for the disease is a specific one & will not go until it has worn itself out, until it has destroyed Life or is Cured by some specific. Should Lumbar & Hip Abscesses be opened? They are in themselves incurables possibly a chance for Life may be given to the Patient by opening them early that is as soon we are satisfied Absorption of the matter cannot be brought about. In some Scrophulous Abscesses we can obtain a Real Absorption of the fluid, it is always to be desired as the healing of them after ulceration has taken place is Accomplished with difficulty. – 33 1036. When the disease affects the Knee, the pain is more considerable than when the other parts are attacked & here somewhat of the true inflammation is mixed with it. 1037. Whenever the lower extremity is the seat of the disease, the Limb appears longer than the other, this is from the Patients particularly favouring that side & leaning on the other. 1038. Children are often lame for Months, & at length a swelling has appeared in the foot. When Scrophulous Abscesses appear about the fingers, hand or foot, the swelling sometimes does not subside even after the matter has been discharged. 1039. Lumbar Abscesses sometimes appear without any Previous pain, sometimes patients remember to have had pains in the loins in general however, if they have pain it is felt beyond the seat of the disease, as in the thigh, the Knee, or Foot, the Matter here very frequently presents itself in the thigh though formed in the Loins. 1040. Patients under 30 are most subject to this complaint it is produced by the common Exciting causes of Scrophula, it is to be distinguished from a disease of the Hip by attending to the motion of the Foot. 1041. Abscess in the joint of the Thigh is of the Scrophulous kind there is commonly a thickening of the soft Parts forming & surrounding the joint, the patient has a sense of weakness in the limb, wch. wastes & has its motions contracted. 1042. White Swelling is a term that may be applied to every Scrophulous swelling of a Joint, before the Skin becomes inflamed it is generally attended with an increase of Synovia, sometimes is truely Scrophulous & sometimes has a mixture of the common Inflammation. ♂.  34 1043. The common Pulmonary Consumption is generally a Scrophulous Affection of the Lungs. 1044. The Young, the fair & the delicate are most subject to it & the common Exciting Cause is Cold, it commences with tubercles in the lungs, swelling of the Glands of the neck often appear in the beginning, the disease increases slowly, the tubercles Suppurate & ulceration being formed, the patient becomes hectic & is at length destroyed. 1045 The Pulmonary Consumption is however seldom a purely Scrophulous affection it has generally somewhat of the common Inflammation mixed with it, as we know from this pain in the Chest, the quick hard Pulse &ca. – 1046. An Hemorrhage from the Lungs is not uncommonly the fore runner of pulmonary consumption but how far this has to do with Scrophula we cannot determine. 1047. The Testicle is also the seat of Scrophula As in its Actions upon other parts so here also its attack is scarcely known & its progress slow. 1048. It rarely occurs before the Age of Sixteen or in Old Age. 1049. The Breasts of Women also fall into this disease in which they will gradually, slowly, & with little pain swell to an Enormous Size.. 1050. The Scrophulous Testis (1047-1048) & Breast (1049) are to be distinguished from Cancer of those parts, by the want of Swelling in the Spermatic Chord & [Axillary] [inguinal] Glands, also by the abscence of local Sympathy, at least until the Skin is beginning  35 to be affected by the Suppuration. ( ). 1051. The indications of cure in Scrophula with respect to the constitution are. A. 1st: to give strength to the System. 2d: to Counteract the effects of Climate. 3d: the use of some Specific. with respect to a apart B. 1st: to produce resolution of the tumor or Absorption of matter if it has suppurated. or 2d: to Extirpate the disease if practicable. 1052. The indication (a.1) we endeavour to fulfill by means of bark & other tonic Remedies. The indication (a.2.) by changing the situation of the Patient, or if that cannot be done, by rendering the Systems less susceptible of the influence of the Climate in which the patient lives The indication (a.3) By the administration & application of such remedies as Experience has proved. 1053. If Climate cannot be changed which is to be desired & wch. should always be altered to a warmer & more regular; then we may lessen the susceptibility of the body by tonic Medicines. Cold bathing & the use of such Cloathing as will maintain on the surface of the body an uniform & equable heat, such as flannel which conducts heat from the body badly. 1054. Experience seems to have approved the powers of Sea bathing as the most powerful specific in every Scrophulous Complaint whether Hip Cases, white swellings. Consumptions &ca. & some + 1055. We consider Sea Bathing as a specific in Scrophula but we are also to consider under what circumstances it will Act most powerfully, for instance whether Sea bathing & a Cold Bath, Sea Bathing & a Tepid Bath, Sea Bathing & a Warm Bath, will best agree with our Patient, for we are not only to consider what will cure the specific disease but also what will best agree with the Patients Constitution. Some Persons cannot bear Cold bathing but will find themselves much refreshed by the tepid Bath, again others require the heat of the Warm bath to render Sea Water Agreable to their Constitutions, Again the season of the Year is to be considered for more additional heat will be required to be given to the water in the Winter than in the Summer, if the cold Bath cannot be endured. In the warm or tepid Bath the patient should remain 10 or 15 Minutes with the precaution of tempering the heat to the agreable degree. Sea Bathing may be employed in all Cases of Scrophula Even pulmonary Consumption. To prove that the Bath agrees with the patient he should feel a Glow of heat, & his Spirits be enlivened by its use, if these appearance are wanting after a 2d. or 3d. trial & the patient feels himself [cross out] chilly & enervated, some other degree of heat should be tried. In bathing the sores of Scrophulous Patients should always be uncovered. 36 Specific powers are also attributed to the fossil Alkali & Hemlock. 1055. Sea bathing is to be used with that degree of heat which is found most agreable to the System & followed by the greatest encrease of vigor & Spirits. + 1056. The means recommended (1052-1053-1054-1055) are most to be insisted on when there is greatest predisposition to the disease & the patient most disposed to the action of Exciting Causes. hence Children & Young persons stand more in need of them than those advanced in Life, also in irregular climates & in Winter more than in regular Climates or in Summer, for the Winter favours the Progress of Scrophula, therefore sea bathing & flannel Cloathing are more necessary in Winter than in Summer (It is a bad practice with Parents & Nurses to carry young children about in the cold with the extremities naked & exposed to the Atmosphere the bear cold ill & suffer from it more than those advanced in Life) 1057. We are not to expect a speedy Cure from any remedies used in the treatment of Scrophula, length of time being always required to give them Efficacy from 3 Months to 2 Years. 1058. Moderate Exercise is to be recommended & perhaps Vegetable diet may be employed with advantage. 1059. Mercury is in general improper in Scrophulous Complaints Bleeding is often necessary in Scrophulous Lungs to diminish the quantity of blood circulated through the Pulmonary Artery & proportion it to the quantity of unobstructed Lungs. 1060. As to the topical treatment where the disease admits of it &  37 it can be removed with propriety all at once, Extirpation is the best method. 1061. In the resolution of tumours, or the healing of Scrophulous Sores few topical application Except sea water & the Juice of Hemlock are of any advantage. 1062. Stimulating applications are generally injurious, Violence increases the action of the parts & at the same time does not cure but adds to the disease. 1063. When there is suppuration the Abscess should not be opened with a Knife in general they should be left to break of themselves. 1064. Variations in Age will often lend to the spontaneous Cure of the complaint, & this is most observable in Females. 1065. In scrophulous bones Exfoliation is tedious and obtained with difficulty, In those as in soft Parts every process of Exfoliation goes on not without difficulty. 1066. In Scrophulous Swellings sometimes only a White Curdy or Caseous matter is formed, indeed the parts being altered in their Structure & incapable of carrying on their functions lose their life, but do not putrefy, nor is there a disposition of parts immediately in contact to throw them off, themselves also being affected by continued Sympathy. 1067. Rickets may be defined 1st. a want of disposition in the Vessels of the Bones to form calcareous Earth arising from a weakness of a peculiar kind, or  38 2nd. too great & hasty absorption of Earth from the bone in proportion to the quantity formed by the Vessels. 1068. It is a disease of the Constitution & Originates in a weakness of a peculiar kind, for weakness in general does not produce Ricketty Complaints, although Rickets are always attended with weakness. The first Cause (1067-1) operates in the production of Rickets in Children, the second (1067-2) produces the disease in Adults. 1069. The Rickets in children are known by the bones becoming Enlarged, by their bending under the incumbent weight of the body & yielding to the ordinary Action of the Muscles so as to be thereby distorted. 1070. A certain Size in the Bones & a certain proportion of Earth should be present together as the Size of the bones is determined in adults it is impossible, the encrease of the bones in Size beyond their grown Subject. 1071. But in Children this is the Case, it is a known fact that during the time of growth, the enlargement of the bones is the greatest whilst the quantity of the Earth formed in them is the least, for the formation of Earth checks the growth of bone. 1072. The animal matter of the Bones is also altered, for it is found to be different from the Animal matter of Bones simply deprived of their Earth. 1073. The Rickets cannot produce an encreased growth of Bone in the Adult, but in other respects, as softness of the Bones 🜁 1077. If the bones of the Cranium have been affected, an irregular ossification may arise on the inside nearest the Brain & by its pressure induce morbid affections of that Viscus. On the concave side of incurved bones nature will sometimes form an additional quantity of bone in order to strengthen the Original. Of the softness of ricketty Bones a case occurred at Lime-house, when the Bones were as soft as Tendons. “It is necessary to add that Mr. Hunter considers the molities Opium as a species of Rickets, & that it is here described as in Adults. 39 & their inability to support weight & Muscular Motion, though the causes of rickets in the Infant & adult may be different tho’ effects will ultimately be the same. 1074. The general consequences of Rickets in parts supporting Weight are, that the Joints are obliged to form more Acute Angles. 1075. From what has been advanced, we are [without] enabled to understand why bones of the Inferior Extremities, are more frequently bent, than those of the Superior, & also why those of the superior themselves are sometimes bent, why the Bones are knocked. 1076. Why the disease affecting the Spine shall produce difficulty of breathing & other complaints of the Viscera & why it should render the pelvis distorted & labours difficult. – 1077. The bending of the bones & their [becoming] throwing an increase of weight upon a joint, gives rise to the Stimulus of necessity which excites a disposition in some parts to take on ossific Inflammation & to generate new bone hence irregular Exostoses, Anchyloses of the Joints &ca. – 🜁. 1078. From what has been said we also understand why bones bend in particular, & in different directions. 1079. For [in] this disease no certain remedy has yet been discovered. 1080. The disease is either a species of or allied to Scrophula & Sea Bathing seems to be what approaches nearest to a Specific remedy, as well as for Scrophula. 1089. Where the removal of the Tumors by Mechanical means is feasible & convenient it should be done by the Pincers, Chisel or saw 40 7081 The general indications of Cure are to give strength to the System, hence the Cold bath, Exercise, bark, & othe tonics may be advantageously employed. 7082 Exostosis, has probably somewhat in its native similar to Rickets, it is a growing out of a bone from a bone. 7083. It appears to be of two kinds 1. Constitutional 2. Local In the first a Similar disposition shews itself in almost every bone, in the latter perhaps only in a single bone. 7084. It has generally its seat near the heads of bones & therefore seems much connected with soft parts. 7085. The tumor sometimes arises all at once out of the Substance of the bone, sometimes very gradually. 7086. When near the Joints it sometimes produces lameness altering the direction of the Muscles & tendons. – 7087. It is peculiar to Youth & rarely appears in the more advanced Stages of Life. 7088. Though we know the [causes] Absorbents have a power of removing superfluous substances, even bony ones, yet we know not of any Medicine whose powers will either produce a removal of those Tumors, or a prevention of them. 7090. Fistula are of two kinds 1st. A passage for the discharge of pus &ca. from a diseased part 2d. An artificial opening or Canal in lieu of some natural one being obstructed. –  41 1091 It is the consequence of some parts being affected with disease, which they are not able to get the better of, although the fistula itself is seated in a sound part. 1092. The diseased part to which the fistula leads is always larger & more Extensive than the fistula itself. 1093. As the Fistula commonly opens in the Skin, & as the diseased parts is more deeply seated the lips of the Skin will be more tucked inwards (though sometimes the lips of the Orifice are turned outwards, so as to resemble a prolapsus Ani,) and the Orifice will be nearly filled up with loose fungus Granulations, which if destroyed, radily shoot up again. 1094. Whatever is the disease in the part to which the Fistula leads until the obstruction to its restoration is removed, or its disposition if Specific or unsound is changed no cure will be obtained. 1095. If the seat of the disease extends to or occupies a vital part, it will teize a patient & the constitution until hectic is induced & death succeeds. – 1096. The indication of cure in the 1st. Species of fistula (1090) will be 1st. the removal of whatever obstructs the healing of the Parts. & 2d. The inducing a new disposition in the diseased part. 1097. The second intention (1096) will be fulfilled by laying open the fistula or cavity, throughout its whole length & even carrying incision into sound parts that the mouth of the cavity may be as large or larger than the surface of its bottom, & that the whole  42 being exposed, a necessity for some New Process in consequence of the exposure may arise. 1098. non est inventus. 1099. The first indication of cure will consist in the removal of all foreign bodies or such as stimulate, as splinters of bone &ca. under the limitations heretofore given in cases of Gun shot wounds & diseases of Bones. 1100. If the parts in question have any powers of restoration, the consequence of (1097) this treatment, will be the Excitement of Inflammation Suppuration & ultimately granulation, which will at length fill up the cavity which is unnatural & cure it. 1101. In the second Species of Fistula the indication of cure will consist (1090) 1st. in opening again the natural Canal – or 2d in making some New one which will answer the purposes of the original one. 1102. In the first species there is a greater disposition to heal in the parts through which the fistula passes, than in the deeper seated parts, hence the disproportion of size (1091-1092-1097.). – 1103. We cannot simply from the appearance of a Fistulous Orifice determine its extent, we must therefore examine its depth, the seat & extent of the disease by some convenient instrument as a probe &ca. – 1104. Sometimes one diseased Cavity will have several openings leading to it, it is generally necessary to lay open the whole Cavity making it into one, & to induce a disposition to heal, at the bottom Φ 1108 A person had a Fistula in Ano for which he was cut, but the part still remained Fistulous upon a more accurate Examination it was found that the Sinus extended two inches above the Anus & then penetrated, above the orifice it continued its course along the Gut, for another Inch, the incision was then carried to the End & the Man got well. 43 bottom of that cavity. 1105. When Fistula & the parts they lead to are laid open the external parts should be kept from healing, until the deep seated ones have acquired a disposition for Restoration & the Ulcer can be healed from the bottom. 1106. These observations may be better understood by considering 1st. Fistula in Ano. 2d. Fistula in Perineo – 3d Fistula leading to Joints..4th. Fistula of the Lungs Liver &ca. 5 Fistula Lacrymalis 6th. Fistula of the Parotid Duct – 7th Fistula of Coopers Glands in the Female. – 1107. Fistula in Ano is the consequence of inflammation beginning two or three, or more inches higher up in the Cellular Substance, or the outside of the rectum, which going on to suppuration the matter descending commonly makes a point externally near the Anus & bursts but sometimes the rectum becomes so diseased that it will also give way & a breach be made in it opposite to where the Inflammation began. – 1108. The Cure (1097) will consist in laying open the whole Cavity making its External mouth equal to or larger than the Surface of any side of the Cavity & preventing the too early reunion of the lips of the Wound. Φ. (1106). 1109. Fistula in Perineo. there will often be several Sinuses whose mouths open Externally communicating with the fixed point of the disease, there it is right to treat if we can according to Rule given above, but before a Cure can be accomplished the diseased disposition in the parts must be changed, for instance ♃: 1110 As fistula in perineo will not get well though a Wound in the same part in Lithotomy easily heals, in the latter the external parts have not lost their disposition to healing, hence there is no obstacle to the Cure. – ♄ 1112. We take no notice of Amputation for Fistula in joints as it has nothing to do with the doctrines now before us. – 44 1110. Fistula in Perineo may have for its cause. Stricture in the Urethra, disease in the prostate Gland or membranous part of Urethra, the external Orifice cannot heal as long as the disease remains uncured. ♃. 1111. Fistula communicating with Joints will not heal because they communicate with parts whose powers of restoration are weak and making free openings only increase the disposition to disease, & the violence of the Hectic, neither can we Cure Fistula of the Lungs or Liver, because we cannot lay open the Cavity. 1112. In Cases therefore where we cannot have recourse to the treatment recommended (1097 &ca. we can[not] only endeavour to give power to the constitution by time & Strengthening Medicines. that if possible a natural Cure (though little to be expected) may be obtained. ♄. 1113. Fistula Lacrymalis is sometimes an Original local disease, sometimes a constitutional Local, a arising from Syphilis, Scrophula, &ca. 1114. From whatever cause the ductus ad nasum may become obstructed, whether from Inflammation or a disposition to contract similar to that which arises in other membranous canals (as the Urethra &ca.) forming stricture in it, the passage of the Lachrymal fluid is impeded; distention gives a stimulus to the Lachrymal Sac, which stimulus is also increased by the Salts in the Tears. hence Inflammation & Suppuration is produced, & the matter bursts through the Skin near the Eye. 1115. Through this new & unnatural opening the purulent matter  45 matter mixed with the Tears continues to flow until the Surgeon either dilates the natural Canal, or makes a new one, so that the tears may again have a passage into the nostril & then the fistula will heal. 1116. If the Obstruction in the natural passage is very great dilatation of it will rarely cure because we cannot in general destroy the disposition of the Canal to form strictures, & these recurring the disease will also return, so that most commonly a New & Artificial Canall into the nostrils must be formed. 1117. Fistula of the Parotid Gland, the duct from the Parotid Gland passing over the Masseter & Buccinator Muscles consequently lying very superficially is extreemly liable to be divided & the Saliva will flow outward from the end next the Gland, or suppuration from any cause whatever arising in the Duct & bursting externally a similar circumstance will take place. 1119. The Cure is performed by passing a Needle armed with a round ligature of Thread from without through the duct into the mouth & let the Thread remain there until the wound made by the needle has lost a disposition to heal, the External Wound we should suffer & encourage to heal. 1120. The ducts leading from Coopers Glands to the inner surface of the Vagina in Women are sometimes obstructed & a Sac will be formed Containing a slimy matter which will cause a distention or Enlargement of one of the labia to a prodigious size & produces the resemblance of an Hernia. 1121. An incision should be made into the tumor & the matter discharged, after which the incision should be suffered to heal.  46 1122. Then a second Crucial incision should be made into the Sac near to the natural opening of the duct, & this should be kept Open until it has lost all disposition for healing, & the mucus is discharged by it as formerly was by the natural passage. 1123. Unsound Abscesses. these are to be considered as two fold Viz. 1. those forming in a part 2. Abscesses of a part. 1124. In the first we have a collection of matter formed in the part where they appear, & in the second the matter is formed in some other part more or less distant & from thence makes its way to the part where it appears. 1125. Of the first we have instances in many Scrophulous suppurations in abscesses of the Joints &ca. 1126. Of the second we have instances in the Psoas Muscles & Hip Joint, which often present their matter in the thigh or Groin. 1127. Whether the latter burst, or are opened, the doctrine of Fistula will apply to them, nor will opening unsound Abscesses of a part be of Utility unless we can also induce in it a disposition to heal, or we have some foreign body to remove as Splinters of Bone &ca.. – 1128. Unsound Abscesses are generally caused by some Specific disposition as Scrophula, Lues Venerea &ca. or from a disposition to indolence either acquired or natural, that is Either in parts which have natural powers of healing but fall into a state of diseased indolence, or in parts which have natural but small powers of healing as in joints, ligamentous parts &ca. – ☉ 1132 By This definition, Glass, Metallic Salts, even Arsenic & a variety of Vegetable Substances as Crow figs. Hemlock, Opium &ca. are excluded from the Class of Poisons, also Honey, Particular kinds of Fish &ca. for three Reasons. 1st. Because these are not poisonous in the smallest Possible Quantity 2d. Because their action is not universal. 3d. Because their irritation is not specific but common. 47 1129. New formed parts as Cicatrices & Calluses are sometimes suddenly falling into the ulcerative & intersticial Absorption & the progress of the absorption will be uncommonly rapid as this arises from an unsound disposition in the Constitution, that disposition is to be removed or altered. 1130. We come now to Poisons (Poisons) especially the Animal & principally Morbid. 1131. But we can give no unexceptionable definition of poisons. 1132. The definition however which we can give & most free from Exception is A matter which produces a peculiar mode of irritation & affects the vital principle in a peculiar manner, when even used in the smallest possible quantity; & this without any relation to any known chemical or Mechanical powers, or by any common irritation. ☉. 1133. We know no substance in the mineral kingdom answering to this description, nor is there much poison of this nature in the Vegetable, but the Animal kingdom possesses it in great abundance. 1134. No secreted fluids are poisonous to the part secreting them but they will act as poisons on any other part of the Animal they belong to. 1135. Poisons answering our definition (1132) are of four kinds 1st. Those which act locally as the sting of a Cancer Itch &ca 2d. Those which have their effect on the Constitution, as Jail fever, hooping Cough &ca. - 3d. Those whose influence is upon the whole Nervous System, 1135 In the Animal Kingdom, some Animals as the bug & muskitoe & probably the, poison the part at the same time that they get their food from it. The Bugs, for instance poisons the part & produces an Extravasation of its Juices which it feeds upon. The leech after making a Wound poisons the Vessels of the part Wounded, so as to almost destroy their power of contracting, hence the Hemorrhage which often continues so long after a leech has been sucking which never follows other similar Wound 48. as the poison of the dog, of Indian poisoned Arrows &ca. 4th. Those whose powers are mixed as the Poison of the small Pox, Lues Venerea &ca. acting both locally & on the Constitution. 1136. We intend to consider Animal poisons only, & these are of two kinds, viz. 1. Natural 2. Morbid. 1137. The Natural are such as belong Originally & Naturally to the Animal possessing them & not depending upon any Preternatural affection or alteration in the Structure of any body or its path. 1138. The Natural has no power of propagating its effects beyond the individual its powers are exerted in poisoning. 1139. The morbid on the contrary depends on a preternatural action, or change of Structure in the Body communicating. 1140. But the morbid in general may be communicated by the body poisoned to other bodies & therefore may be propagated to many individuals; because the individual poisoned receives the same power of poisoning others as the Animal possessed by which it was poisoned. 1141. Some of the natural act locally only, as the Wasp, others both locally & constitutionally, as the Viper, Rattle Snake &ca. – 1142. Those acting on the constitution generally first produce local effects, before they are absorbed & affect the System. 1143. Pain in the part receiving the poison, red Streaks & swellings of the Lymphatic Glands in the course of absorption are sometimes preludes to rigors, Convulsions, general livid extravasations Swelling of the whole body & Death. ♀ 1151. Mr. Hunter suspects the Venereal poison militates a little against the general definition of poisons, in that he imagines its action depends on some measure in the quantity applied. Small Pox by inoculation between the time of its application & the time of its visible irritation requires 2 or 3 days Natural Small Pox 23 days – Measles 9 days. Cancer some Months – Itch time not ascertained. 49 1144. Inflammation is produced in the part of the adhesive kind (for the parts swell) which rarely terminates in suppuration tho sometimes pus is formed. 1145. The pus is of the common kind, when it does form, & it contains no poison, whereas when suppuration takes place in the morbid poisons, the pus itself is poisonous. 1146. All the natural poisons must come in Actual Contact with the part to be poisoned, some require to be inserted by a Wound in order that their influence may be [hastened] Exerted. 1147. Morbid poisons probably all arose at first from a [Wound] diseased state of the Body or of parts. 1148. Many are obliged to the power of Contamination for their continuance & that power destroyed would Cease to be known. 1149. In what they differ from the natural has been already shewn, they are like the natural communicated by contact & some of them in a state of Vapor. 1150. Those which arise spontaneously seem to be confined to the species of Animals in which they arise, as Cancer, Syphilis &ca. which are peculiar to the human Species & cannot be communicated to any other Animal. 1151. Morbid poisons applied to Animal Bodies have specific distances of time, between the time of applying the poison & the time of its producing irritation &ca. ♀. 1152. The natural poisons do not in general produce Extensive local Sympathy. 1153. Morbid poison being applied to a part, that part becomes  50 infected & diseased without a power of contaminating other parts by means of the absorbents, as in the Itch, or 1154. Morbid poisons being applied to a part, that part becomes diseased, & has a power of communicating the disease to other parts but not to the Constitution, as Cancer &ca. – 1155. When a part has the power of contaminating the System as the Small Pox. 1156. Of the action of some poisons, as Small Pox, Measles &ca. the constitution is sensible only once in the course of Life; of others it may have the action repeated. 1157. Cancer. is a disease produced by a morbid poison arising spontaneously in a part without our being able to account for the manner in which it is generated. 1158. It is a local disease which may produce a consequent similar local disease in another part but has never the power of infecting the Constitution. 1159. Some parts are more liable to the affections produced from difft. poisons than others, so the secretory Glands are most commonly the seat of Cancer. The breast & uterus in Women. The lips, external Nose, Pancreas, Pylorus, & Testicle are commonly seized with this disease. 1160. It is a poison of whose action the human Species are alone susceptible, Experiments have shewn us that it cannot be communicated to other Species of Animals. 1161. We find in parts affected with Cancer an indurated knotted feel with a kind of suppuration in the Centre, or an ulceration of the external surface attended with pain. 🝄 1169. “We may infer that cancerous Virus has no Power of infecting the blood or producing similar diseases in any part by means of the Blood.” “One Reason why Cancerous matter should not be able to act upon the system when Absorbed may be, that it is so slow in producing its Action that time cannot be sufficient for that purpose after its being absorbed, before it is thrown out of the body.” 51 1162. previous to a disposition to ulceration being formed the pain is dull & heavy but this disposition being produced, the pain becomes violent, giving a shooting burning sensation. 1163. The part affected has its functions destroyed, if a secretory Organ it loses entirely the power of Secretion. 1164. In its suppurating process the Cancers becomes adherent to the surrounding parts. The Skin becomes discoloured, smooth & shining & matter is formed, sometimes without much previous Inflammation 1165. When the Cancer is cut into previous to ulceration having taken place, there is sometimes found the appearance of a Cyst which contains an ill conditioned Serum, Blood, Curdly matter &ca. but seldom or never matter resembling good pus. 1166. The process of Cancer in all its stages & states is in general slow. 1167. When ulcerative Absorption has taken place, the integuments round the Ulcer, are tight & rigid, the Skin is tucked in at the edges & wrinkled into folds, an ill conditioned matter is discharged. 1168. The Lymphatic Glands in the Neighbourhood become indurated & Enlarged, sometimes soon, sometimes even before the Ulceration has taken place, & little Lumps are sometimes formed in the circumjacent Skin. 1169. It has a power of poisoning other parts, & of producing in them a similar disease, but it has no power of Contaminating the Constitution. 🝄. 1170. A Cancer of one part may produce Sympathetic swellings of the parts, but not true Cancer unless of Parts which are in the course of absorption.  52 1171. Constitutional effects as Hectic Fever &ca. may arise in Consequence of a patients labouring under a Cancer from the irritation the disease produces, but the affection of the Constitution will be only that, common to simple irritation, nor will there be anything specific or peculiar in the manner in which Cancerous irritation acts upon the System. – 1172. The time of life seems to be the powerful predisponent cause of Cancer, the Age which most strongly predisposes is from 40 to 60 it sometimes however appears Earlier tho’ rarely. 1173. The Exciting Cause. 1174. The parts most susceptible of the cancerous disposition seem to be those proper to the Sexes. 1175. Women are more susceptible of the Cancerous disposition than Men probably because they have more parts peculiar to Sex. 1176. Is there not another cause in the parts peculiar to Sex in Women at the given time of Life, undergoing a Change which renders them unfit for procreation. 1177. We know of no Medicine which will cure a Cancer. 1178. Arsenic is probably a specific for the Cancerous disposition but its powers are too weak to produce a Cure, nor will the System allow of its being introduced in sufficient quantity. 1179. Yet, a Cancer, if left to itself always kills, either by its constant irritation it exhausts the principle of Life, or by Producing continued or contiguous Sympathy, & thereby inducing a similar diseased affection in some part necessary to Life. 1180. Therefore Extirpation of the diseased part is always to be desired & if practicable always to be preferred before a consequent  53. cancerous affection has taken place any other part. 1181. We are always to consider not only the Original or first formed Cancer but also any part which may have been poisoned by matter absorbed from it, & which we call the Consequent Cancerous Affection. 1182. Nor can we always be certain that a consequent Cancer is not formed because ulceration & the formation of cancerous matter has not taken place for 1183. Coagulable Lymph which had been extravasated, in the thickening & induration, if absorbed will equally contaminate & poison the parts it is applied to, for whatever the fluid seperated in a part may be it will always possess the specific properties of the part from which it is secreted. 1184. The Consequent affection begins Either in the Lymphatic Glands or the Lymphatics themselves but a Cancer once formed whether Original or Consequent, there is no part contiguous to which it may not extend its action, even to bones. 1185. Hence Cancers should always be extirpated as Early as possible the Earlier they are removed the fairer prospect has the patient of future health. 1186. Previous to Extirpation it is always necessary to observe a. The common rules laid down touching the Extirpation of Tumors. b. Whether any Consequent is already formed & where. c. Though no Consequent cancer is Visible whethere there is just reason to believe a disposition for one is any where formed. 1187. In extirpation it must be an invariable rule to take away the whole of the disease. (1188 non est inventus) 1189. If the whole of the disease cannot be removed Extirpation  54 is not to be attempted. 1190. If the Tumor adheres to the Skin it should always be a rule to remove more Skin than the diseased part is adhering to that if possible, we may be sure of not only taking away the present diseased parts, but also of taking away any part in which it is probable from its Contiguity that a disposition for a consequent Cancer may be formed. 1191. The Consequent if left will be equally injurious & equally fatal with the Original Cancer, & though the Original be taken away, will itself contaminate other parts in the same manner & to the same degree as the Original & is equally incurable by any powers of Medicine. 1193. Notwithstanding all our Care the disease will sometimes appear again, even after we have removed all evidently diseased parts & these also which we are justified in suspecting. 1194. For, the slowness with which the Cancerous Virus sometimes acts may be a Cause of deceiving us, a disposition to a consequent disease may be formed in some part, which we can by no Signs whatever ascertain the Existence of. 1195. Nevertheless when the operation is admissible we ought always to endeavour at the Extirpation of a Cancer. 1196. Cancer must be distinguished from Scrophula & from indolent thickenings of all kinds which may be done, not only from its appearance, pain, &ca. but also from its acting as a poison on the neighbouring parts, which scrophula & simply indolent thickenings never do.  55 1197. It should also be distinguished from the Fungated Sore wch. though it is not a poison as it has already been considered as Cancerous may not improperly be noticed in this place. 1198 The fungated Sore is a specific disease entirely local & has no power of contaminating or poisoning parts, beyond the Extent of continued Sympathy & even this not widely diffused. 1199. It has its seat in every part of the body without Exception. 1200. It begins in a circumscribed Tumor partly solid or encysted is not for a time very painful, it gradually & not very hastily enlarges, the Skin becomes discoloured & at length burst & ulcerates 1201. A lose Spungy fungus of the colour of dark Cruor is then thrown out, which rises & enlarges faster than Escharotics can take it down, it bleeds easily from the surface of the fungus & its pain is Acute. 1202. It resembles Cancer in being absolutely incurable by Medicine & if left to itself destructive. 1203. But it differs from Cancer in not being poisonous, & in never producing either in the Lymphatics or Lymphatic Glands a similar affection. 1204. This disease kills without seeming to have done so much mischief as might be supposed admissable without destruction of life. 1205. Nothing can be done to relieve the patient, but extirpation in which we should be extreemly careful to remove every Atom of disease, otherwise the part will again take on the same Affection. 1206. Many diseased appearances on the face, which have been considered as Cancerous are only fungated Sores.  56 1207. In the extirpation of Cancer two methods have been Employed. Viz. 1st. the Knife or Excision 2d. The use of such means as produce the death of the whole of the diseased parts & the subsequent seperation of them from the second parts. 1208. Diseased as well as new formed Parts ( ) have much less power of preserving life & resisting Death than sound parts, hence we can conceive how the application of Arsenic to Cancers shall sometimes produce the destruction of the whole of the parts laboring under Cancer, without depriving the Circumjacent parts of life 1209. Chemical applications as the different Caustics ( ) have also been employed, but the powers of Arsenic are the greatest, the Caustics making less distinction in their action between ye sound & unsound parts, the latter Acting Chemically, Arsenic by its irritation & exciting an Action under which the diseased parts have not strength to live or subsist. 1210. If we employ the Knife we should always cut into sound parts, in general we can employ excision more universally than the other means. 1211. We should in the Course of the Cure of the Ulcer after the operation if any lumps arise, or any consequent Cancer appear it is right to remove them as soon as discovered. 1212. If a Cancerous disposition remain after the Operation the Wound either will not heal or the catrix will soon ulcerate afresh, or the consequent disease will make its appearance. 1213. It is necessary to take notice of some Cancerous Affections of particular parts.  57 1214. A Cancer of the Breast most commonly begins in a small Schirrous Lump, which is in general circumscribed; at other times it begins with a discharge of blood, or a kind of matter from the nipple, sometimes the Skin becomes diseased very Early being thickened, discoloured &ca. – 1215. The natural function of the breast is destroyed, it loses the power of secreting Milk, is painful &ca. – 1216. It should be amputated before there is any adhesion of the breast to the pectoral Muscle or ribs, & before the Glands in the Axilla become affected, or at least before these Circumstances take place in any great degree. 1217. We must be cautious in Examining the Axillary Glands sometimes when enlarged they may seem moveable but when we come to operate we may find a Chain of little diseased Glands extending beyond the reach of the Knife, & rendering our endeavours fruitless. 1218. If the Cancer of the breast is suffered to become irremediable the ulceration increases with a stiffness & tightness of the surrounding parts, the breathing becomes affected & is difficult & laborious. 1219. The Axillary Glands being universally & greatly Enlarged the return of the Lymph from the Arm is obstructed, hence an Oedema of the whole Arm, sometimes soft, sometimes hard, takes place. 1220. In some patients the integuments on that side of the body will become Oedematous, & even a paralytic affection of that side of the body on which the disease is situated may ensue.  58 1221. Consequent Cancers will be formed, at length the patient worn out for want of sleep, with pain & hectic from the constant irritation, until at length she sinks & end is put to her sufferings 1222. In this as in all other Cancerous affections the liberal & unlimited use of Opium is to be permitted. 1223. If Cancer is seated in the Testicle it should be removed before the spermatic Chord is thickened, or at least whilst so much of it is apparently undiseased without the abdominal ring as to have room for the performance of Castration & then we are justified in operating, though the success is uncertain. 1224. In the Cancer of the Testis the pain is more excruciating than in the breast; with regard to the Extirpation & the Administration of Opium the rules given will apply. 1225. In the Cancer of the Testis the consequent Cancer will be in the spermatic Chord, the absorbents of the Testicle pursuing its course. 1226. If the Scrotum is the Seat of Cancer, the consequent disease will be in the Inguinal Glands. 1227. In the Lips the disease begins with a thickening. It is to be removed by the operation for the Hare lip, in other respects the preceding general rules must be observed. 1228. It is not necessary to dwell on the particular Cancers of other parts, as the Eye, the Nose, the Uterus &ca. Extirpation when practicable should be early employed, when impracticable means of alleviating pain, can only be had recourse to.  59 1230 The Itch, is a specific disease produced by a morbid poison which being applied to the Skin occasions ulceration in it. 1231. The Itch is Contagious, the person infected with it being always able to communicate it to others in the same manner as he received it. 1232. Contact of parts is necessary to its being communicated in a state of Vapour it has no power of Contagion, & its powers of infecting are very weak & easily guarded against. 1233. Animalcula may exist in the Matter but not necessarily nor universally. 1234. Continued Sympathy produced by it is very little & contiguous Sympathy hardly ever takes place from its action it has no power of poisoning the System nor have the Absorbents ever been seen to be affected by it. 1235. Its most ordinary seat is where the cuticle is Thin, its first appearance is a small Vesicle containing a little fluid to this succeeds an Ulcer discharging pus, which in the recent state is very minute, but when of some standing considerably increases in breadth, so as to be sometimes as large as a Sixpence. 1236. The little Ulcers made by the Itch never heal Spontaneously, & when healed by Art they do not again break out nor do other ulcerations arise in the surrounding Skin. 1237. Its power of irritating is not very considerable, the surface of the body must be healed to be sensible of its irritation, the sensation it Occasions is Itching not Pain. 1238. Different remedies are found to be specific for the itch  60 Sulphur, Hellebore, Mercury, externally used are known to cure it, but Sulphur Ointment seems to be the most powerful remedy. 1239. A Mercurial Girdle has been known to Cure the disease even when Mercurial Ointment applied to the Skin has failed. Brimstone taken internally will sometimes Produce a Cure. The ☍. 1243. Men who have a gleet, after all inflammation is gone off may infect Women & Women Men. 61 The Venereal Disease. 1240. The Venereal disease is one of the most Morbid compound Animal poisons, & like other morbid Animal poisons may be communicated by the persons infected to others. 1241. It is always communicated in the form of or united with purulent matter, which shews that it originally arises from Inflammation. 1242. When communicated to a part it produces in general Inflammation; but its progress is attended with Symptoms Peculiar to itself & distinct from those of other Animal poisons. 1243. The presence of Inflammation is not however necessary to its Existence, an infected person may communicate it to others after all Inflammation has left him, as in the Case of a venereal Gleet. ☍ 1244. To produce infection the Venereal matter must be communicated in a fluid state, or in a state rendered immediately fluid by the Juices of the receiving part, in the form of a Vapour it cannot infect, nor can it be communicated without the presence of purulent matter. (1242). 1245. The poison first arose probably in the Genital parts in the intercourse between the Sexes. This intercourse is not however necessary, it may be communicated from other parts besides the Genitals, & Even when applied by means of other substances than living 🜔v 1245. A Gentleman by Passing a bougie that had been formerly used by him when he had a Clap, caught a Gonorrhea. 1247. Mr. Hunter has sometimes known Gonorrhea arise without any preceding inflammation & confessed himself very much puzzled concerning the nature of such a Case, if they were venereal it should seem this Aphorism will not universally hold good. 62 bodies. 🜔v 1246. Actual Contact with the part to be infected is however always necessary. 1247. Venereal matter applied to sound parts has generally the effect of producing inflammation, which is always of a specific kind. 1248. From what has been said it is evident those parts which are not naturally or Accidentally secreting surfaces cannot communicate the Venereal contagion. 1249. It may affect the body either locally or universally & therefore may be divided into two Genera viz. 1st. Genus. Original or immediately local. 2d. Genus Constitutional. 1250. The first Genus has two species seemingly different yet their ultimate effect is the same Vizt. 1st. without ulceration or breach in the Solids called a Clap or Gonorrhea. 2d. with a breach in the Solids, or solution of continuity called a Chancre. 1251. The Bubo or local consequent may follow either the first or second species of the first Genus & when suppurating differs in nothing from the Chancre except in size. 1252. When the infecting matter is applied to a secreting surface the first species will be produced, when to a non secreting Surface as the Skin covered with the cuticle, the 2d. species will arise; from  63. either of these a Gland in the line of absorption being affected the bubo or local consequent, will be brought on. 1253. All secreting surfaces in the human body having nearly the same mode of action will take up the infection from simple Contact & may any or either of them be the seat of the 1st. Species. 1254. The second species may be induced a by a Wound. b by application of the Matter to the Cuticle. C by application of the matter to a Sore. 1255. Secreting surfaces being natural as that of the Urethra & Nostrils &ca. or accidental as an Ulcer, whenever the Venereal Matter is applied to them increase their secretion to wash away the offending matter. 1256. But the further consequence of the application of Venereal matter to the Natural & Accidental secreting surface will be different, of the former it will in general only change the nature of the secreted fluid from the latter, it will first increase the quantity of secretion, & then producing for a time, a Gonorrhœa of the Sore, it will change the nature of the Sore from a common one to a Venereal one, & then the disposition to ulcerate will be increased & the sore be in every respect converted into a chancre of the 2d. species. – 1257. Whenever a part becomes infected with the Venereal Virus it takes on a new action, if it is a secreting or sine Cuticular Surface as above described the nature of the secretion will be changed, if on a secreting surface the ulcerative Absorption of the part will take place & the pus will be secreted. 1258. Some secreting surfaces seem more susceptible of the Venereal 🜍 1262 A Gentleman had Chancres many times, they always healed very readily but the slightest scratch from any accident he received always was extreemly difficult to heal, so that some are very susceptible of this Specific or Venereal Irritation tho highly so of any irritation. – 64 Venereal irritation than others, the urethra seems evidently distinguished to take it on. 1259. Absorption of Extraneous matter always goes on more readily from an Ulcer than from a fresh wound, or from a Canal, it must be evident then that the local consequent must more readily & frequently arise from the first than the second Species. 1260 The Venereal poison will be always the same in point of Strength or acrimony, it may indeed at one time be diluted through a larger quantity of Fluids than at another, but it will produce the effects of a poison in the smallest possible quantity. 1261. Yet it produces different effects in different subjects, in some it will cause the most violent in others the slightest affection, it is therefore evident the susceptibilities of different persons of its irritation must be very much. 1262. This (1261) will not be easily explained for the susceptability of venereal irritation will not be in proportion to the susceptability of other irritations. 🜍. 1263. The local consequent will differ nothing either in its nature or its ultimate Effects from the original local having the same power of poisoning other parts, or the constitution & the matter secreted in it being equally infectious as that of the 1st. or 2d. Species of the first Genus. 1264. A natural secreting surface cannot be affected by this poison, longer than a certain time for had it a power of keeping up a specific Action in the part longer than a certain time the duration of the disease would be endless, for fresh matter being continually secreted would be the cause of a still further secretion of similar 🜔🜹 1264. Parts lose their sensibility of the Stimuli applied to them, in the Urethra the nature of the Solids is not changed but only the mode of the Secretion, now in process of time the membrane becomes habituated to the presence of Venereal matter & is then no longer sensible of its Stimulus, which can now no more produce the specific disease & therefore the disease [always] decays & a natural Cure takes place (see Note 1265). 🜔 1265. When we consider the different methods different people have to curing the gonorrhœa & that all are successful many of whom cannot possibly have any specific action upon the part we may readily suppose in General the complaint goes off of itself. Cases. A Married Man, during several years had known no other Woman but his Wife, he at length lay with a Woman of the Town & caught a severe clap. The Woman who gave it to him was not sensible herself of the ailment she continued her connection with him for several months without perceiving any change. She then formed a new attachment & gave a Gonorrhœa to her second Lover, she had no marks whatever of the disease herself he continued his intercourse with her for sometime, but notwithstanding got cured the while at length the first lover Returned to her had connection with her only once & she clapped him again. 2 A Gentleman kept a Mistress who becoming clapped left him she applied to & was taken into the Magdalen hospital, where she was apparently cured, she continued in that Hospital 2 Years seemingly 65 similar matter & so on ad infinitum for it would still continue its secreting action. 🜔🜹. 1265. We are induced to believe this to be the case from knowing 1st. That all Gonorrhœas are cured without any Specific remedies. 2d. That a secreting surface will retain Venereal Matter after Inflammation is gone off & also a power of poisoning other parts for a considerable length of time without being sensible of the presence of Venereal matter or undergoing any morbid affection from its remaining in Contact with it. 3d. That the application of fresh Venereal matter may be applied to the secretory surface in question without increasing the present disease or even retarding the Cure 🜔. 1266 Note continued. ~ quite well & when discharged was picked up again immediately on her dismission by the Gentleman who had formerly kept her, to whom she nevertheless gave a severe gonorrhœa, he continued however to Cohabit with her & got quite well without interrupting his connection which at last he broke off. A Married Gentleman in the City took her into keeping & was immediately clapped by her he was likewise Cured although he continued his intercourse with her during the cure, his Mistress however left him & returned to her former lover whom she clapped the second time. These histories abundantly shew & serve to prove what has been advanced. Many more of the same kind could be adduced, moreover if the Venereal matter of a Gonorrhœa or a Chancre is applied to a Bubo, or that of a Bubo to a Chancre it will not in the least increase the disease or retard the Cure. If a Man continues to be intimate with a woman who has clapped him, & if he is cured & she not, still he will not receive fresh infection, that is provided he continues to cohabit with her but if he absents himself from her for sometime, that is until his Genital parts have recovered themselves & as it were lost the recollection of the Venereal Stimulus he will then get a fresh Gonorrhœa. This we see depends upon the force of habit, from being long accustomed to the Stimulus of Venereal Virus the parts lose their sensibility of it & cannot be irritated by it. thus in general if a Man gets several successive Claps the first will be the severest & they will become slighter & slighter every time, was a Man once clapped to continue during his Cure even so long afterwards his intercourse with Venereal Woman, it is extremly probable he would find it impossible to contract a fresh Venereal Gonorrhea (see habit 98) 🜖 1270. Where the pus discharged from Ulcers in the Urethra the Gonorrhea would not be cured without Mercury, which we [have] know is by no means the Case. – 66 1266. But this natural decay of the specific morbid action & spontaneous cure will only arise in natural secreting surfaces. wherever a chancre or Venereal Ulcer is formed no natural or spontaneous cure is ever effected, but the disease continues increasing in violence until it is cured by Art. 1267. The matter of a Gonorrhœa & Chancre is exactly similar & equally capable of poisoning other parts. A Gonorrhœa will produce in the same person a Chancre or a chancre, a Gonorrhœa, & both or either may produce a Constitutional disease, in general when the Chancre appears the Gonorrhœa goes off, & frequently the Gonorrhœa appearing the chancre will go off. It should therefore seem that one irritation cures the other, the two parts sympathizing with each other. 1268. It is extremly difficult to decide when the power of Contamination is entirely lost, persons sometimes retain a power of communicating the disease after not only inflammation but even the discharge has seemingly disappeared. 1269. If the Venereal poison is applied to a fresh Wound, or by means of any Wound, suppuration must in general first take place, before it can produce any effects on the body. 1270. The discharge from a Gonorrhœa is purulent but is very rarely attended with any Ulceration of the Urethra. 🜖. 1271. The local Consequent or bubo, sometimes neither Suppurates nor goes off by resolution, but becomes indolent & will 🜁 1272. We have seen the Chancre readily Cured in a person & he afterwards contracted a Gonorrhœa which was very severe and very difficult to remove. ∇ 1276. A Boy Eight years old swallowed some Milk & Water in which some Chancre had been bathed, with impunity; A Lady drank by mistake a bason of Milk & Water in which a Gentleman had washed his Chancre, it was near Eight hours after before she took an Emetic yet no bad consequence ensued. 67 frequently remain in that state notwithstanding the use of the most powerful remedies. 1272. Not only different person will be affected by the Venereal Virus in different degrees of violence (1261) but the same Remark will hold good with respect to different parts of the Body. 🜁. 1273. The second Genus or Constitutional ( ) takes place when the Venereal Virus is absorbed & carried into the Circulation. 1274. It may be communicated to the constitution by means either of Gonorrhœa or Chancres, sometimes although rarely from Venereal matter being applied to the surface at the body without Ulceration having previously taken place & sometimes from application of it to an Ulcer, without producing any change, but those two latter modes of infection are very Unfrequent. 1275. It may also be introduced into the System by poisoning a Wound, but there it must first produce inflammation & Suppuration in the same manner as inoculated Small Pox must produce Inflammation & suppuration in the place of incision before the constitution becomes infected. 1276. The Venereal Virus will not act as a poison applied to some parts of the body, it will have no effect upon the Stomach as has been proved by Experiment. ∇. 1277. The Venereal Virus cannot be taken in from the breath, sweat, saliva, milk or any other natural Secretion of a person labouring under the disease in its worst state. 1278. When the Venereal Virus is absorbed into the Circulation, it produces no change in the Blood, but has a power of producing local effects in different parts of the body, as blotches Ulcers, Nodes 1281. A Nurses breast inflamed & Ulcerated after suckling a child who had lately died. A Physician gave it as his opinion that the was Universal & that she had been giving suck to a pocky Child, but the event of the Case contradicted him Mercury did not mend the state of the sore, indeed New Sores broke out upon the breast while she was taking it, at length she left off Mercury & recovered by good diet & Country Air. 🜆. 1282. It has been supposed that if a pregnant Woman is poxed, the Infant in Utero must partake of the disease, if ever this is the Case, it can only happen from the original matter from a Sore being conveyed unaltered to the Child which is what we can hardly conceive to happen. 68 &ca. but it is certain the Venereal matter undergoes some change as the Ulcer &ca. so produced, that is from the constitution, have no poisonous quality, the matter from a Venereal constitutional Ulcer will not communicate Venereal infection nor will it differ in its powers from pus of common ulcers. 1279. The blood although the matter has been absorbed into the circulation will not communicate the disease to a second person nor are any of the secretions of a patient labouring under the 2d. Genus any ways infectious. 1280. The Venereal Virus then can never be communicated unless from a part, that labours under the 1st. Genus, or has an original local Complaint. 1281. It must be from hence evident, that the opinion that an infected Child unless it has its mouth or lips originally infected cannot communicate the disease to its Nurse, nor can the Milk of an infected Nurse communicate the disease to the Child. 1282. It is also most to be believed that a Child in Utero is never poxed, it may receive the infection in its passage through the Vagina &ca. & thus it may be locally & in the end universally effected. 🜆. 1283. Many Anomalous morbid appearances resemble the Venereal disease from which it is by no means easy to distinguish it by the Eye. 1284. The only unequivocal Criterions for assisting us in discriminating one from the other are. 1st. The Venereal Eruption, blotches, ulcer, or other  69 affection (Gonorrhœa excepted) whether originally local or constitutional ever disappears or is cured without the operation of Mercury its true & specific remedy. 2d. No Eruption, blotch, ulcer, or other affection that is truly Venereal will appear whilst the constitution is under the influence of Mercury. 1285. The same person may have both an Original local & a constitutional disease at the same time. Of the 1st. Genus a person may have both the first & second species at once & the first species or Gonorrhœa may be cured the Chancre or 2d. Species remaining notwithstanding & vice versa. 1286. So either or both species of the first genus may Exist together with the second or Constitutional & either or both Gonorrhœa & Chancre may be cured without the removal of the Constitutional disease. 1287. But the Chancre will not remain uncured when the 2d Genus is cured although the Gonorrhœa will yet continue to Exist 1288. [But the Chancre without will not remain un] The Constitutional as above noted almost always arises from some species of the first Genus but the Chancre or Gonorrhœa does not at all become altered or have its action awakened by Poxing the constitution. (1285) 1289. The specific local diseases have all their specific distance for action which they do not Exceed. So also the Venereal disease has its specific distance for local action [which they do not exceed] this is however not always the same Extent, being sometimes ♂. 1290. Mr. Hunter has proved this by a variety of Experiments on the dog, the Ass, the Bitch &ca. by soaking Lint in Venereal Virus from a Gonorrhœa & Chancres & introducing into the Vagina &ca. ♀ 1293. A Gentleman had blotches in his face which resembled Venereal ones & had been deem’d so by many Medicinal Men, he had also blotches in his Legs & Thighs, they continued for Six Months several of them having got well during that time & others broken out notwithstanding he took Mercury, he at length consulted Mr. J Hunter who judging of them according to his idea advanced in the Text, assured him they were not Venereal & advised him to leave off Medicines, to live well tho temperately & bath in the Sea if he chose it, in a few weeks he lost his complaints. A Nobleman labouring under some complaints which appeared to be Venereal (& which those who attended him assured him was so) consulted Mr. J. Hunter he was with much difficulty persuaded to leave off Medicines & take a sea voyage to change the Air, he followed this advice & was cured. When any disease affects the Genital parts, they are generally considered as Venereal, but Gonorrhœa, Sores in the Glans penis, Buboes may all arise without any Venereal infection, moreover there may be a variety of the morbid appearances that take place 70 affecting a small space; sometimes a larger one it is however always circumscribed, but when it spreads more widely than Common it has always a mixture of the Erysipelatous. 1290. The Venereal disease is peculiar to the human species other Animals not being susceptible of its irritation. ♂. 1291. Does the Venereal disease produce its effects by fermentation, or by producing a peculiar Action in the Solids? The Question is not easily determined. 1292. A Man who has got a pox may notwithstanding get a chancre or Gonorrhœa without increasing the Pox, it is evident then that when the habit is once infected with the Venereal poison, it cannot receive any addition from the absorption of fresh Venereal matter. 1293. Many diseases may imitate the appearance of Venereal but they arise, heal & break out again, a local disease from a pox never disappears until it is Cured, this then differs from other poisons never wearing itself out nor ever suffering the part to make a progress tow’rds a cure. ♀. 1294. When the Venereal Virus has been absorbed into the System it has in itself no particular tendency to produce affections of one part more than another but from some peculiarities in different parts of the body themselves, some parts will be more susceptible of the Venereal irritation than others & of course take on Venereal action soonest. 1295. One Cause which disposes parts to take on Venereal action readily is, Exposure to cold therefore it makes its appearances in in the constitutional disease or second Genus, which are common also to other diseases we are not therefore hastily to determine whether a disease is Venereal or not, but together with observing appearance, inform[ing] ourselves also of the history of the complaint previously. 🜋 1299. Thus the Tibia being of all bones most Exposed to the action of Cold is of all others most frequently affected. it may be objected that the tibia is actually colder than many parts which take on the disease before it, but we know whatever dispositions are formed in Bones they come into Action much more slowly than the soft parts. ☽︎☉ 1300. They are either not susceptible of the Venereal irritates or else they never come into the venereal action before the disease is totally Cured. 71 the more External parts of the body first, this reasoning is strengthened by observing. 1296. That the disease is found to prove much more speedy as well as much more violent in its action in cold than in warm Climates, in the latter it rarely arises to any great violence. 1297. The parts first in order of susceptibility are a. the Skin. b. the inside of the Mouth & throat &ca. c. the Tonsils 1298. The parts second in order of susceptibility are a. the Periosteum b the Fascia – c the Bones. 1299. The bones seem to be the more susceptible of it the more hard they are & the nearer the surface of the body, consequently the more exposed to the action of Cold 🜋 1300. Many of the internal parts are not liable (as far as experiment hath proved) to the venereal Action as the brain, the Stom: the Liver, the heart &ca. - ☽︎☉. 1301. The Lungs are sometimes the Seat of the Venereal disease although they are late in coming into action, perhaps their susceptibility of this irritation depends upon their being in some measure an External part. 1302. The Venereal Matter when taken into the constitution does not long continue in the Circulation, but produces its action on the parts susceptible of the disease & is then thrown off by some of the secretions as any other extraneous matter. 1303. It does not long continue circulating in the System we know this because the parts first in order may be cured & the parts second in order still remain uncured, yet the first parts will not again take on the diseased Action now were the Venereal matter 🝄 1303. Thus if a Man with Venereal blotches & also diseased bones is put under a course of mercury, the disease of the Skin may be cured that of the bones notwithstanding remaining the diseased action of the bones may continue to go on if he leaves of mercury but the disease will not again appear on the Skin. 1306. When a part has received a strong disposition fraction a cure sometimes cannot be effected until the disposition has actually gone into Action. A Man might suppose that those parts which are most susceptible of the Venereal irritation, would in the advanced Stages of the disease suffer the most violently, but this is not the case a part having gone fully into action loses the susceptibility of the irritation which it had at first. 🜔 1309. A Man who has a Gleet though he has connection with a venereal Woman, will not catch a fresh Gonorrhœa. 72 still circulating in the blood there would be no reson why the parts first in order should not again fall into disease. 🝄. 1304. Dispositions once formed will go on to action though some time may Elapse before that action appears (see 167) Parts having received the Venereal taint; will if left to themselves always go on to diseased action although the distance of time may be considerable. 1305. Hence we may understand why many parts of the different orders may be contaminated at the same time, but their diseased appearance may take place at different Periods. – 1306. Those parts which most readily fall into the specific Action are the first in going through a Cure. 1307. As a further proof that the Venereal matter becomes altered when taken into the Constitution, we may observe that an ulcer that is constitutional Venereal, on the application of venereal matter from originally & locally diseased parts will catch a Gonorrhœa & so take on the action of an original Sore, now the matter of one Constitutional Sore will not excite another Constitutional Sore. 1308. If the matter of a Gonorrhœa is applied to a chancre it will produce no new effect vice versa. Again the matter of one originally local sore or Chancre will not irritate another Chancre. 1309. A part which has lately been under the irritation of Venereal matter will not readily take on the same diseased Affection again. 🜔. 1310. The seat of the first species of the first Genus ( ) in Men is the Urethra; the surface of the glans penis, the internal surface of the proputium. ∇ 1318. Perhaps the changes of Colour in the discharge will [depe??] upon a small quantity of blood being extravasated & mixed with it: 73 1311, Its attack on the prepuce & glans Penis is generally at the root of the latter & the beginning of the preputium, here the cuticle is extreemly thin & the cutis is easily affected. 1312. It there produces itching, soreness & tenderness with a discharge of thin matter. 1313. When this part takes on the disease the Symptoms begin very early. Forty Eight hours have been the whole of the time elapsed between the Infection & the appearance of them. 1314. When the Urethra is the seat of the Clap, the inflammation generally has its place within an inch or an inch & half of the external opening. 1315. It mostly begins with a sense of itching at the end of the orifice & sometimes over the whole glans, the lips of the orifice will be unusually full & turned somewhat outwards. The Penis in general seems somewhat enlarged. Pain, heat & uneasiness in passing the Urine, sometimes preceded by & sometimes following the appearance of a running from the Urethra, the canal of the urethra fells inflamed, the Patient voids his urine with fear from the sense of the smarting & then the urine comes off in small or in divided streams. 1316. The Glands of the Urethra become inflamed & swollen, they become hard & may be felt on the underside of the Urethra. 1317. According to the period & the degree of inflammation the discharge becomes of different colours & different in consistence its Venereal virulency is however always the same. 1318. The matter if received upon cloth will be found to give it spots of variegated hues in the centre of the Spot the colour will be darker & paler in the circumference. ∇.  74 1319. The matter will have a Smell peculiar to itself which will be fœtid & disposed to putrefaction. 1320. The Symptoms & progress of the Complaint will differ very much according to the susceptibility of the parts & the degree & Extent of inflammation. 1321. The more violent the Inflammation &ca. the more commonly will it produce great extravasation of coagulable lymph Occasioning Cordee, Soreness of the whole length of the Urethra, Even to the Anus, producing a sensation like that of Chordee Inflammation & hardness of the Glans Penis. Hemorrhage from the Urethra, Various Sympathies. 1322. The running comes from the urethra & its glands & in general not high up, it does not come from the bulbous portion of the Urethra, otherwise it would be thrown out by Jerks & not run off in the manner it is known to do. 1323. On the Examination of patients after death which at the time of their dissolution laboured under this complaint, the ducts leading from the Glands have been found filled with matter. 1324. The inflammation penetrating very deep, Coopers Glands may inflame, suppurate, & produce an abscess which is frequently the cause of fistula in Perineo. 1325. [The inflammation penetrating very deep, Coopers glands] [may inflame, &] The cause of the Gonorrhœa of the Urethra must be a transition of the matter from the external part to the inner surface of that membrane although it is difficult to account for the manner in which it is introduced. 1326. It certainly can never be introduced, but 1326. We know it may be communicated this way. An Officer who had no intercourse with the female Sex for a considerable length of time when in Germany, went to a necessary the tube of which according to the custom of the country went tapering downwards, when he arose from his seat he found something sticking to his Penis upon taking it off he found it was a plaister from a sore which some other person using the necessary had left behind him in a few days after a gonorrhœa appeared. 75. the external part must always receive the venereal infection. 1327. Chordee is of two kinds Viz. 1st. The Inflammatory 2d. The simple spasmodic. 1328. The first is owing to an Extravasation of Coagulable Lymph in the reticular substance & in the Corpus Spongiosum generally in the lower part of the penis, this is much more obstinate & remains much longer than the spasmodic which is without extravasation & comes & goes at uncertain periods of time. 1329. The Hemorrhage arises from rupture of some Vessel of the Urethra, either by a Spasm, or giving way to the encreased violence of the circulation. The Hemorrhage is sometimes considerable & for the present relieves not unfrequently the violence of the Inflammation & its consequences. 1330. The parts that Sympathize with the Urethra will be a. the Testicle. b. the Bladder c. the Muscles of the Urethra & Penis. d. the Glands of the Groin. e. the Whole Pelvis f. the Loins. g. the Stomach h. the Whole Constitution. 1331. Sometimes there will be an Erysipelatous Eruption of the neighbouring parts. 1332. At different periods of the Gonorrhœa, the testicle will sometimes becomes swolen, this is never to be accounted a Venereal but 🜨 1339. The Inguinal Glands swell, it is to be doubled if they are sometimes Inflammatory but purely spasmodic. The swelling of the Testicle will sometimes arise suddenly in a few minutes & go off as readily requires [only] often less time for it to subside in by a great deal than the common swelling of the Testicle after the radical cure of the Hydrocele the swelling will sometimes change sides being similar as to the Gouty sympathy of the Testicle. 76 purely a sympathetic affection of the testicle, sympathizing with ye. Urethra. 1333. A swelling of the Testicle may arise from any Cause irritating the Urethra, even the passing a bougie has brought it on. 1334. It sometimes appears during the more inflammatory Stage of the gonorrhœa but more frequently when the inflammation has abated, & it is sometimes attended with an increased, sometimes with a stopping of the running. 1335. The complaint begins with a pulpy & softened feel of the Testicle a slight enlargement of it, & a sense of increased painfulness on the touch or pressure, its tumefaction then increases & it grows hard, especially the Epidydymis. 1336. Sympathy produces pain in the original seat of the Testicle the loins, nausea & sickness, even Vomiting loss of appetite, uneasiness in the Bowels &ca.. – 1337. The swelling of the Testicle is not peculiar to the gonorrhœa it is often produced by Gout, Cancer & Scrophula, although more slowly by the latter. 1338. When the bladder Sympathizes, Strangury & the common symptoms of Stone in the bladder will occur. 1339. The inguinal Glands swell from Sympathy, rarely terminate in suppuration & as well as the swolen testicle are often curable without Mercury which shews that they are not Venereal. 🜨 1340. The Muscles of the penis will Sympathize, & often undergo a Spasm producing sudden & involuntary erections of the Organ which are called Spasmodic. ☿. 1343. In one person---10 hours. Another---20 hours In many---36 hours D°.---2 Days D°.---6 Days. In a great number---12 Days In many---4 Weeks In some---6 Weeks. 🜔🜹 1345. In a boy the Gonorrhœa returned twice whilst he was cutting his Teeth. – 77 1341. Of the Loins, Pelvis, & Kidney sympathizing with the Urethra it is unnecessary to speak, further than noticing the facts that Pain of those parts often attends Gonorrhœa. 1342. When the whole Constitution sympathizes there will be slight rigors, heat & other mild Symptoms of general irritation. 1343. The distance between the time of infection & the appearance of the Symptoms, so far as can be ascertained is all the intermediate time between 10 hours & 6 Weeks, most commonly however within twelve days. ☿. 1344. The Gonorrhœa is not peculiar to the Venereal diseases a discharge from the Urethra, without heat &ca. has been known to accompany gouty & rheumatic affections of the body. 1345. It has moreover been known to Sympathize with cutting the teeth. 🜔🜹. 1346. The Urethra of a Patient who has once had the disease is ever after Extreemly liable to it. 1347. We should endeavour to distinguish a gleet from a Venereal Gonorrhœa, in the gleet the glans penis does not change color nor does it sweat a kind of pus as it does in the Venereal Gonorrhœa 1348. It often goes off spontaneously & then it makes a somewhat puzzling Case, it has no specific remedy. 1349. A Constitutional disease in the 2d. Genus is as we have above observed sometimes though not very often known to Arise from the first Species of the first Genus, whenever there is a kind of hard Cord arises, leading from the penis to the Glands in the groin absorption of the virus is always to be suspected & the Constitutional 1354 The Vagina is not a part very sensible to common irritation hence matter may remain. ♀ 1356 A Woman had a Bubo formed in the Groin without having the least of any preceding affection. – 78 Genus feared. 1350 This circumstance most usually Occurs in the gonorrhea of the Glands & Prepuce. The 2d. Genus has also followed an internal gonorrhea in which there was a rupture of a vessel & an hemorrhage from the urethra consequently an internal wound, but it is very rarely the virus is communicated to the System by means of a Wound. 1351. The seat of the first species of the first Genus in Women is the Vagina, Nymphe, Clitoris & Urethra. 1352 It is not so complicated in women as in men, its symptoms are much milder & it is still with more difficulty ascertained. 1353. Appearances will in general give little information nor will its Symptoms enable us to decide. 1354. We can only judge the Woman has the disease, if she has the common symptoms following her connection with an infected Man, or if she whilst labouring under these Symptoms gives the disease to some sound person. 1355. We cannot however always determine that a woman has a Gonorrhœa because she communicates infection to a Man as her genital parts may have a power of receiving & communicating the infection without having ever felt any Complaint herself, or may retain the power of poisoning after the gonorrhœa has been Cured. 1356 From this it must be evident that a Woman does not always, know whether she has or has not the disease. ♀. 1357. The common Symptoms of a Gonorrhœa in Women are  79 pretty similar to these in Men, as smarting in making water a Running from the Vagina, a disagreable Sensation of the External Parts as the Clitoris & Nymphæ a fullness of the Labia pain in walking & the complaint rarely having exacerbations except at the time of making water. 1358. Sometimes the discharge will run down from the Vagina to the Anus & produce exulcerations of the Perineum. 1359. When the disease goes on, as in (1358) it is very doubtful whether it will there spend its violence as in the Gonorrhœa in Men 1360. In both Sexes previous to the appearance of the discharge the constitution will sometimes become affected (as in 1342) & a strange & unusual sensation of the parts will be perceived. 1361. Gonorrhœa without infection may arise in both Sexes from Various Causes. (1344). 1362 Although a Gonorrhœa will sometimes cure itself ( ) & we have no Specific for the disease ( ) yet we can shorten its duration & lessen its Symptoms by proper remedies. 1363. These remedies are divided into internal & topical 1364. The internal ones are Either a. Evacuants – or b. Astringents. The topical ones are Either a. Injections.. or b. Bougies. 1365. Mercury is the Specific for the Venereal disease but it seems of no other use in the Gonorrhea, than with a view to the absorption of the Venereal matter in the part thereby preventing  80 preventing its affecting the constitution, but this we have observed rarely happens & we have no reason to believe Mercury has any Specific power on the Affection of the membranous part of the Urethra 1366. Keeping the bowels regular is necessary in health & therefore useful in this Complaint, tho purging is not generally serviceable yet we have seen a brisk purge entirely cure the affection in which case it must operate either by derivation or by Sympathy. 1367. Diuretics are so far useful as by their effects in the urinary secretion they may lessen the violence of the irritation. Water is the best but will generally require to be accompanied with some mucilaginous substance. 1368. Balsams & Turpentines may be their Specific Operation on the part affected produce also a change in its diseased action & consequently effect a Cure. 1369. Astringents (1364b). do not lessen the Venereal irritation, but they may prove of some service by lessening the quantity of the discharge. 1370. Topical Applications (1364) must either be fluid or Solid, the fluids are injections, the solids bougies. 1371. The effects of the solid must be more permanent as it can be kept longer in contact with the parts affected; however it produces so much irritation that in general their use is better omitted. 1372. Injections may be divided into a Irritating b Astringent  81 c Sedative d. Emollient injections. 1373. Injections curing Gonorrhœa suddenly have been supposed to lock up the poison & throw it into the Constitution, but this Opinion is erroneous – for 1374 The Effect of the Injection here is to stop the farther secretion of matter, if then this is accomplished, it is evident that injections must contribute rather to the prevention of the 2d. Genus than bringing it on, the common vehicle of the poison being matter. 1375. Injections may either take off the Inflammation & the consequent increased secretion, or they may stop the secretion without removing the Venereal Inflammation. 1376. The irritating Injections are mostly astringent when made Weaker & astringent injections when made stronger will act as irritating. 1377. Injections are irritating when they produce an irritation greater than that of the disease itself. 1378. Irritating injections are in general improper, where the Constitution is extremly irritable & the inflammation has spread beyond the Venereal point, when used in this case they have become the causes of Fistula in Perineo. 1379. Where the disease is milder they generally succeed sooner in removing the Symptoms, for they produce the Cure by giving an irritation greater than that given by the disease which being overcome by a greater Stimulus leaves the part. They must therefore be improper where the parts cannot without danger of increased mischief bear 🜍 1379. A proper injection for this purpose is a solution of Sublimate in water (weak) if it gives pain it may be still further diluted. 🜔 1381. When a secreting Surface has been inflamed, & the part has received a disposition to secrete, the compleat Action being taken on is a step tow’rds the Cure, we therefore see why Astringents by checking the secretion may sometimes produce a Cure. 82 a more powerful irritation than that already produced & present. 🜍 1380. Astringents may Cure a slight disease, they act by lessening the discharge, & as they produce an affection of the living Solids they may contribute to a Cure. 1381. They make the Vessels contract & lessen the discharge, however they often produce a lessening of the discharge only, without forwarding the Cure, nay they sometimes protract the Cure. 🜔. 1382. Emollients in violent inflammations are very useful washing away the stimulating matter & leaving the surface of the part Soft & smooth. 1383. Sedatives ( ) sooth pain & abate inflammation, Opium is undoubtedly the best & most general sedative, but does not agree universally. 1384. Sometimes the end of the Canal & of the Urethra at the Glands is contracted by Inflammation, which is a troublesome circumstance & indicates the Omission for the present of bougies or injections. 1385. Other topical means as Mercurial Ointment, medicated Poultices, Fomentations &ca. can do little good Except when the External parts are the seat of the disease, or unless the Glands of the Urethra are so swolen as to be perceptible externally in which case we may use Ung: Cerul: fort. 1386. In Hemorrhages from the Urethra we have seen benefit afforded by the internal use of Turpentine & Balsams, Injections are not only useless but hurtful here. 1387. Opium given internally has powerful effects in preventing painful Erections & soreness of the Penis.  83 1388. The Cordee is in the beginning relieved by bleeding from the System & still more by Leeches applied to the part, & we are the more encouraged to practice the latter as we have observed that a Spontaneous hemorrhage from the rupture of some vessel in the Urethra has removed Chordee; Medicated Poultices & Camphor internally, sometimes affords relief. 1389. Chordee often continues after inflammation of the parts has subsided, from the Coagulable Lymph remaining Extravasated, whatever then will tend to produce absorption of the lymph will carry it off Mercurial Ointment, Electricity, Friction & Cicuta are all found serviceable, the affection will however continue often, long after the complaints have ceased & then go off slowly. 1390. In the Spasmodic Chordee ( ) we have known Bark singularly useful. 1391. If the Glands of the Urethra suppurate they become of the nature & produce the effect of chancres, & as such they may be treated. 1392. When the bladder takes on the affections (1338) the complaint is rarely inflammatory but mostly Sympathetic. Bleeding is rarely useful, & is if employed at all, to be managed with caution & in general topically the Warm bath. Plasters of Opium to the Perineum & to the origin of the Nerves of the Bladder & Clysters with Opium will commonly succeed. 1393. This Symptom in general is not hazardous but it is to be suspected that it sometimes lays the foundation for future mischief. Δ 1396. Perhaps the Practice of employing Vomits arose from Relief having been given by a Vomit administred to cure a sickness in the Stomach caused by Inflammation of the Testicle. 84 1394 When the Testis is swoln (1333) Rest in an horizontal Position, with the common treatment of inflammatory affections is to be insisted on. 1396. Vomits have sometimes great power in carrying off this affection. Δ. 1397. It is not determined how far Mercury is useful in Cases of swelled Testicle, we have reason to believe it may sometimes be Efficacious after the Inflammation is over. 1398. Sometimes the Testis takes on the suppurative Inflammation & an Abscess is formed which however requires no Particular treatment, as it is not Venereal matter that is formed Mercury is unnecessary. 1399. When resolution takes place the swelling of the Testicle subsides but slowly when it diminishes it grows gradually softer especially in the forepart & which sometimes becomes even softer than natural. 1400. The Epidydymis however generally continues hard & it is to be suspected that in consequence of that circumstance the testis is sometimes rendered useless, yet in general no inconvenience is observed to arise from it. 1401. The cure of the Gonorrhœa in Women is still more simple than in Men, Washes & Injections are proper here also. When the Vagina is the seat of the complaint, the internal surface of it should be several times be greased as high as it can be reached by the finger with Mercurial Ointment. 1402. As the Vagina is less irritable & sensible than the Male  85 Urethra, the injections to be used for the former may be prepared of greater strength. 1403. If the Female Urethra is affected, injections will not be admissible, but Mercurial Ointment may be insinuated into that Canal as observed above, it is not easy to know when the Cure is compleated. 1404. Should the inflammation spread & affect Coopers Glands The Mercurial Ointment may have also be used, if they suppurate they are to be considered & treated as suppuratory Buboes. 1405. It is sometimes necessary to attend to the constitution in the Cure of Gonorrhœa. 1st. if the Constitution is strong & disposed to Fever, it may be right to bleed. 2d. if the Complaint should take place in a low weak irritable habit, & when the Inflammation has a disposition to diffuse itself (which sometimes it will even to the Bladder) then Evacuations will be hurtful, & the liberal use of Bark will be adviseable to destroy the diseased irritability. 1406. It is generally found that the Constitution disposed to fever & inflammation admits most easily of the gonorrhea being Cured. 1407. In some irritable Constitutions it has been observed that a fever arising the Symptoms have gone off & that when the fever has left the patient the local Symptoms have returned. Again in others the coming on of a Fever even when the disease was mild has increased the Gonorrhœa & the Fever again going off the Gonorrhœa ☍ 1409. It is difficult to say, if giving Mercury will always prove a preventitive to the second Genus, but it is the most sure means we know of at present & therefore to be advised, either the Mercurius Calcinatus, or Ointment are recommended 🜔🜹 1411. We have remarked that there is perhaps an impossibility of distinguishing between a Gleet & a Gonorrhea, we shall observe a case or two. Case 1 A Gentleman in April 1780 got a Gonorrhœa, Swelled Testicle &ca. in June all his Symptoms left him, except now & then a little discharge of slimy matter & mucus, Sept.1. he married & gave his Wife a clap. It is to be observed that he met with some difficulty in entering the Vagina & that perhaps from the force he exerted his inflammatory Symptoms returned. Case 2 A Gentleman had a Gonorrhea two Weeks after he lost every Symptom except a gleet he lay with & clapped his Wife. We know in some that the inflammation & running has been kept up even for 12 months & yet the patients have not clapped the Woman with whom during that time they have been connected. 86. Gonorrhœa has been cured. 1408. It is perhaps always right to have in view the possibility of absorption of Venereal matter into the habit especially whe the disease has been long standing. 1409. Altho’ Mercury has no specific Action on the Inflammation of the Urethra yet with a view to prevent the ill effects that may arise from venereal matter being absorbed into the System it is right to administer it, especially tow’rds the latter end of the Cure & when the process of absorption must be nearly at an end. ☍. 1410. We judge of the Gonorrhœas advancing to a Cure when the cherry colour of the Glans changes to a pale hue & other Symptoms also abate, as the running decreasing in quantity & becoming more slimy, Pain & tenderness of the penis going off. 1411. It often happens that the Symptoms will leave the patient he will continue well even for a month & then they shall return, but it is probable that they will not be found to be Venereal when they appear a second time. 🜔🜹. 1412. Strange sensations in the Urethra & Glans (especially when the bladder has been affected) will often be perceived by the Patient after the Gonorrhœa is gone off. These will sometimes be obstinate & troublesome & too commonly render the dissatisfied & credulous Patient the dupe of Quacks. 1413. An obstinate Gleet will sometimes be cured by means similar to these which gave rise to it. Viz. a New Inflammation. 1414. Among the Complaints which will remain after a Gonorrhœa is cured, are those (1411.1412) swelling of the Testicle & hardness  87 hardness of the Epidydymis, wasting of the Testicle, affections of the bladder, strictures in the urethra, Carbuncles, Fistula in Perineo Swelling of the prostate, paralysis of the Urethra & Paralysis of the Bladder. 1415. Gleet has nothing Specific in its Nature, nor can it produce in others a similar disease; it differs from Gonorrhea in a. That the true Gleet is never infectious. b. The discharge has its Globules, but the Globules swim in mucus not in Serum. 1416. It is incidental to all constitutions, the strong as well as the weak, it arises from various causes besides Gonorrhea. 1417. It sometimes goes of naturally but whether from some change taking place in the state of the parts which are the seat of the disease, or from the want of power to continue the discharge we do not determine. 1418. It generally takes its rise from an habit of action in the part & almost always accompanies strictures in the Urethra. 1419. We attempt to cure it by Art in three ways Viz. a. Constitutionally b Locally c Sympathetically. 1420. The Constitutional Cure may be divided into a Specific b Strengthening. 1421. Specific Medicines are Bals: Copais: &ca. if they do service it will generally be immediately perceived; but should no benefit be found for 5 or 6 Days they should be left off, should they relieve they should be persisted in for a length of time for if discontinued  88 discontinued the complaint will not uncommonly return. 1422. The strengthening Medicines act upon the disposition of the parts in question, or in common with that of the Habit in general. 1423. Medicinal applications, [cross out] may affect locally 1st. as Specific & these have more influence when applied locally than when by means of the System (1421). 2dly. As Astringents, as decoction of bark, solution of white Vitriol, Alum &ca. These produce their effects by causing a Peculiar tonic action in the parts, their use should be long persevered in to produce a Cure. 3dly. Local medicines may produce a Cure by the Violence they offer to the parts, but their use should be deferred until other methods have been tried they are followed by an increase of the discharge from the Urethra, of this kind are very stimulating injections as Solutions of Sublimate, & Bougies either simple or medicated. As to the time these should be employed of the injections are very irritating 2 or 3 times will be enough, if less irritating a Week or two. Simple bougies may be used 5 or 6 Weeks for bougies made irritating a much shorter time will suffice. 1424. The third general method is by means of Sympathy or Perhaps derivation, as a Gleets being cured by two Chancres being formed on the Glans Penis, or by applying a blister to the underside of the Urethra; or by Electricity &ca. – 1425. Uneasy sensations of the bladder & Urethra have been removed by blisters applied to the Perineum or loins, the use of Hemlock; injections of sublimate & other means, but blisters to the Perineum have 1425 Case. 1st: Sir Charles Bunburgs Servant had for a complaint of this kind consulted Dr. Warren. Messr. Pitt & Gunning without relief. Mr. Hunter applied a blister ad Perineum which soon cured him, it was kept open 6 Days. Case. 2d. A Portuguese Gentleman had for 2 Years after a Gonorrhœa, such uneasy sensations in his Urethra & bladder as to give Suspicion of a Stone. Mr. Hunter examined him per Anum as well as by sounding & found nothing unnatural, a blister was applied to the Perineum Which cured him almost immediately 2 Weeks after he got a fresh gonorrhœa but no Extraordinary circumstance attended it, nor dis his old Complaint return. 14 ☽︎ 1430. Case 1st A Surgeon had a Gonorrhea & Bubo, the testicle on one side Entirely disappeared. Case 2d. A Young Gentleman Aged 18, without any Clap had a spontaneous Inflammation of the Testis on one side it was wasted gradually to the size of an hone bean the spermatic chord unaltered, he had afterwards a similar attack upon the other Testis which continued wasting until not a trace of it was left. Case 3rd. By Dr. Atham late Worcester. A Gentleman had a fever, & an inflammation in the left Groin & Testis. The Testis suppurated, at length however the matter was 89. seemed imminently useful. 1426. In the Gleet. Rest in general should be recommended though sometimes the complaint has been removed by riding on Horseback, Regularity & Temperance are also generally necessary, though there are not wanting instances of the opposite effecting a Cure. 1427. In Women the Vagina is the seat of the Gleet the treatment recommended in Men will here also apply the use of bougies Excepted. 1428. Chordee remaining after the cessation of the other Symptoms. Rub the parts externally with Ung, Mer, joined with Camphor, Electricity may also be had recourse to. 1429. Hardness of the Epididymis after a swelling of the Testicle will sometimes remain through life without any ill consequences. Sometimes relief has been afforded by rubbing the Scrotum with Mercurial Ointment, sitting on the steam of warm Water &c. - 1430. The Testicles are subject to spontaneous diseases more than most (if any) other parts of the Body, like the teeth they are added only for particular purposes, & they will be (similar to the Thymus Gland or membrana pupillaris) sometimes wasted & at length entirely absorbed This may happen at any Age. ☽︎. 1431. This absorption of the Testicle will follow an inflammation of the Testis, Hydrocele, & hernia Scrotalis but sometimes will take place without any preceding disease at all. 1432. Obstruction to the free passage of the urine through the urethra may arise from different causes. Vizt. 1 Excrescences in the Canal reabsorbed & the testis continued to waste until not a vestige of it except a few loose fibres could be found. 90 2d. Tumor without the urethra pressing on its sides & hindering its free dilatation. 3d. Strictures of the Urethra. 1433. If when the urine passes off only in a small stream & with difficulty we pass a middling sized bougie & find we can introduce it with ease we have reason to suspect a tumor (1432 2). 1434. Caruncles or fleshy excrescences (1432 1) growing in the urethra are seldom though they are sometimes known to exist, Probably they are a kind of internal Wart. Ulcers in the urethra we have never met with. 1435. Strictures in the urethra (1432 3) are of 3 kinds. 1 Permanent – 2d. Spasmodic – 3 Mixed. 1436. All Canals whatever are subject to strictures consequently the Urethra is not exempt, & indeed this Canal is subject to them not particularly as the consequence of Gonorrhea because they frequently take place in the Urethra without any Venereal Symptom whatever preceding. 1437. The seat of the Gonorrhea is commonly very near the Orifice of the Urethra, the seat of the stricture is commonly in the membranous portion. 1438. They do not seem to arise from the use of injections nor do Bougies ever produce them. 1439. Ulcers in the Urethra have been supposed to be the Causes of strictures, but we have never met with such a Case. 1440. We do not understand properly the causes of Strictures in the Urethra any more than we understand why they should Occur in other Canals. 🜔^ 1446 This proves that the Urethra has something of a Muscular power. 91. 1441. When a Gleet remains obstinate & the urine flows in a smaller stream than common, or in divided Streams, or is Escerned wth. some difficulty there is reason to suspect a Stricture & we should Examine by passing a Bougie. 1442. Permanent Strictures may take place in the whole circumstance of the urethra making an annular stricture & opening the area of the Canal as though a piece of cord was drawn tight round the urethra, or they must Occupy one side of the urethra in which case the Contraction will not be circular, but only on one side & then the Area will not be so much diminished as in the other case but the general dilatation of the Urethra being resisted the figure of the Canal will be necessarily altered, the Extent of the strictures will also differ in length, more or less of the Urethra being occupied by them. 1443. The number of Strictures will be also different in different Urethra sometimes only one, sometimes 4. 5. or Six. 1444. The portion of Urethra in which the permanent Strictures takes place will be whiter & harder than the rest of the Canal. 1445. Permanent Strictures will continue to a great length of time even Years their formation & progress is slow they are generally for obvious reasons overlooked until they have become considerable. 1446. They are generally more troublesome in cold weather than in warm & therefore are worse in Winter than in Summer. 🜔^. 1447. Permanent stricture continuing for years, teizes the Patient & at length gives rise to the worst diseases irregular enlargements  92 in the Urethra, diseases of the Bladder, Fistula in Perineo &ca. 1448. To understand properly why these consequences should arise from strictures of the urethra as also the nature of spasmodic Stricture we should have a clear Idea of the Structure & functions of the bladder & Urethra. 1449. The Bladder is a Muscular bag & has a power of Contraction for expelling the Urine, it can contract itself to the smallest Size. – 1450. The Urethra is also a Muscular body & can contract itself so as to shut up its Canal entirely. 1451. In a natural & healthy state of both Urethra & bladder the following Circumstances must be present. 1st. The actions of the bladder & Urethra must be alternate, that is whilst the bladder is contracting itself to Expel the Urine it is necessary that the Urethra should dilate itself or become relaxed in order to admit of the free & regular Exit of the Urine. 2ndly. When the Bladder has ceased from acting then it is requisite that the urethra should contract itself to present the dribbling away of Urine whilst the Bladder is in a state of relaxation. 3rdly. The Area of the Urethra when dilated must bear a certain proportion to the force with which the bladder acts in the Expulsion of the Urine. 4thly. The disposition of the bladder to contract and the disposition of the Urethra universally to be dilated must take place in the same point of time & the strength of the disposition in ♁. 1453. The Muscular coat of the Urethra has by these irritations been made 1/4 of an Inch thick. The Stone in the Bladder also produces a similar state of it by acting & dilating irregularly it often becomes fasciculated hence Sacs are formed in which Calculi are sometimes lodged. 93 each must be always in a certain & exact proportion. One to the other. 1452. From considering what is advanced (1449-50-51) we readily foresee, [greater than] That as a resistance given to the actions of an muscular body greater than it can overcome, & that frequently repeated, either increases its susceptibility of a disposition to Act, or otherwise Produces [adhes] a destruction of its Muscular powers & so renders it Paralytic, if by the Urethra not receiving or being insusceptible of a disposition to relax when the bladder is contracting, or not relaxing & dilating in due proportion of time & to a proper size of Canal, either an increased irritability & susceptibility of action in the bladder must take place, or its muscular powers being destroyed & Paralysis must occur. 1453. The Urethra not dilating in due time or to a proper size (1451-4.) & resistance being thereby made to the action of the bladder the latter increases the violence of its action to overcome the resistence, & this resistence being repeated every time the bladder has a disposition to Act, the Viscus becomes thickened, for the bladder like other muscular parts increases in density from frequent action & for a time at least in strength, it also becomes more irritable. ♁. 1454. If the resistance made to the Bladder is so great that it cannot overcome it but continues a length of time until the Urethra is either spontaneously or artificially dilated & this unconquerable resistence often repeated the muscular power of the bladder is destroyed & a paralysis of that Organ Succeeds. – 1459. Sometimes matter has been discharged from the Kidnies, Perhaps from the irritation & this without finding any Ulcer on dissection. 94 1455. If in consequence of Inflammation, partial contraction [&ca.] of the urethra &ca. the upper part of the urethra loses its power of Contraction, A paralysis of its muscular powers takes place, the Urethra is paralysed & no Contraction of the Urethra attends the dilatation of the Bladder, & the urine is continually dribbling off. 1456. If the Area of an portion of the Canal of the Urethra is diminished by permanent strictures in the Urethra, or any Tumor compressing its sides, so that although the Urethra has a disposition, in due time to become dilated, yet the urine not being evacuated with speed proportionable to the force with which the bladder acts will induce an irritable bladder & a thickening of its Coats. 1457. The Urethra may receive a disposition to contract irregularly without alteration of its structure & that only in particular parts this constitutes the Spasmodic stricture (1435 2). 1458. The Urethra may be permanently dilated in particular parts & contracted in others, by this means its surface will be unequal & often rough. 1459. The state of the bladder may be rendered such by distension of it & resistance of its contraction that it cannot admit the influx of fresh urine by the Ureters & the distention & enlargement of them shall be continued even to the pelvis of the Kidney which shall itself also become distended. 1460. It frequently happens that there shall be not only a permanent stricture lessening the size of the Canal of the Urethra, but also in the same Urethra a disposition to spasmodic contraction, this  95 constitutes the mixed Stricture (1451 3). 1461. The Urethra has sometimes a disposition to contract & close its canal independent of any alteration of its structure & loses not the disposition when the bladder gets into action, this being in fact a spasm of the Urethra we call it Spasmodic Stricture. 1462. Another cause of obstruction to the free passage of the urine may be as swelling of the prostrate gland. 1463 The use of the prostrate Gland is not understood, from its making a part of the urinary canal, it is evident that a swelling of it must produce an alteration in the state of the Urethra. 1464. When it is enlarged it stretches the Urethra Anteriorly & Posteriorly & flattens & narrows it laterally, the small Portion at the back part of it will Act as a valve to the Canal hindering the free Egress of the Urine. 1465. When greatly enlarged little or no Urine will be voided & all the Symptoms of an irritable bladder will come on. 1466. When there is no Symptom of disease in the Urinary canal & we can find neither stricture nor stone we should be led to Examine the state of the Prostate Gland. 1467. Pass the finger in Ano as far as the first joint if an hardness is felt extending higher than the finger can reach we may believe it to be a disease of the Gland. 1468. We may find this disease in two Stages. Vizt. 1st. When the Obstruction is not so great but a bougie or Catheter may still be passed into the bladder. 8. 1469 A Gentleman laboured under a Complaint of this kind by forcing the Catheter into the Bladder an Hemorrhage ensued the blood coagulating stopped up the holes of the Catheter when afterwards introduced into the bladder the Urine could not be drawn off & the patient died. – 96. 2dly. When neither one or the other can be introduced. 1469. we have noticed (1464) that a small posterior portion of the prostrate projecting into the Urethra sometimes Acts as a Valve through this projecting substance, a catheter has been sometimes forced into the Bladder which has ultimately terminated in death. 8. 1470. Permanent Strictures in the urethra give rise also to Fistula in Perineo. Nature endeavours to get rid of the stricture by producing an Ulcer in the part it occupies. 1471. But this is not always the Case the Seat of the Ulceration will be not unfrequently between the Stricture & the Bladder, whichever is the Case the ulceration directs its course from within outwards to give an exit to the urine as ulceration in Abscess observes a similar course to give an exit to the pus, with this difference however, that in the present instance the progress is slow with little or no inflammation, hence the Urine will insinuate itself into the Cellular substance & Corpus Spongiosum of the Urethra, so that the openings formed in the skin shall not correspond with the openings in the Urethra. 1472 This latter remark however will in general hold good only when the seat of the stricture is before the membranous part of the urethra, [than] when more posteriorly, the Ulceration is more Regular & more similar to that of Common Abscess. 1473. By the insinuation of the Urine into the Cellular Substance Inflammation of a considerable Extent followed by suppuration or even Gangrene may be induced. – ♂ 1479. Mr. Hunter does not allow that the Vesicula Semilaries contain Semen 97 1474. The prostate Gland, Coopers Glands, the bulbous part of the Urethra as well as the cellular substance may partake of the suppuration & the matter point externally. 1475. When an Abscess forms in perineo from this cause there is generally a free passage for the urine into the abscess & both its Opening from the Urethra & its external opening will not unusually admit a Catheter into the cavity. 1476. As in other Fistula so in those of the Perineum, the Ulcer in the Skin has generally a stronger disposition to heal than that of the deeper seated parts, hence the external Orifice will sometimes close & then the Urine insinuating itself diffusively into the cellular substance of the surrounding parts will at length make its way through a number of Orifices formed by Ulceration in the Skin of the Perineum Scrotum & even inside of the Thighs which are commonly the mouths of an equal member of surfaces. 1477. Seminal Weakness is considered as a consequence of Gonorrhœa Virulenta. 1478. The disease which commonly goes by this name is a copious discharge of a Dreglike mucus at the end of making Urine & in straining at going to stool in which Case there is often a copious discharge of Mucus which is considered as semen. 1479. But in reality this is not semen but the liquor of the prostate gland & Vesicula Seminales. ♂. 1480. As a proof that this is no discharge of semen we observe that it is common to old Men & that those who are afflicted wth. it find no diminution either of their venereal desires or of their  98. powers, that the quantity evacuated is often more than the quantity of Semen the Patient emits, that to produce it in some violent efforts are required as straining at stool or evacuating the last drops of urine, & lastly that patients have been immediately after this discharge has come away able to emit a fresh & natural quantity of real Semen which had the first been really it would have been impossible to do. 1481. It generally preys much upon the mind & imagination of the patient & hence rather than from its proper effects on the constitution renders him weak & debilitated. 1482. But real involuntary discharges of semen, may attend some patients & this is a matter of serious consideration. 1483. The Organs of Generation like many other parts consist of two parts. 1st. Those whose Action is primary as the Testes. 2d. Those whose Action is secondary as the Penis. The actions of the second should always follow the Actions of the 1st. irregularity in this circumstance is productive of Disease. 1484. When the Penis takes on action without the disposition of the Testes for action being increased, we have involuntary Erection of the Penis which may be similar to Cordee, except that it is attended with no pain or at most with only a sense of uneasiness similar to that which we experience in the part after Coition. 1485. Involuntary Erections of the Penis may be spontaneous 🜋 1485. I should imagine that Mr. Hunter means in this place Erections of the Penis taking place without any libidinous Ideas being first Excited in the mind. 99 or may arise from visible irritation of the member as virulent Gonorrhœa. 🜋. 1486. These Erections are to be considered as Spasmodic affections of the Muscular powers of the penis & therefore similar in their nature to Spasm of any other muscular part. 1487. But the Penis may not only act without any corresponding disposition in the Testicles, but the Testes may also act without any corresponding action in the Penis. 1488. This is the reverse of the other disease, the semen will here be discharged in every even the slightest occasion, the least friction of the Glans Penis, as in walking will produce an Emission, without any erection of the Penis, so will the most simple thought in Venereal matters, a dream in the least degree lascivious &ca. & here the Semen runs off like Stools or urine. 1489. Caruncles (1438) we may attempt the of by Producing ulceration of the carnosity whether this can be done by the Bougie is doubtful, when it fails the Caustic should be used in the manner hereafter described in the treatment of strictures. 1490. The permanent stricture is to be cured either by a. Dilatation. or – b. Ulceration. 1491. The method (a) is by means of Bougies, in the use of which we must attend to certain directions here laid down. 1492. We are to be extreemly careful not to make a false or New passage by means of the bougie & we are also to ascertain if Possible whether any false passage for the Bougie has been  100. already made. 1493 If upon enquiry we learn from the patient that bougies have been already used & that ground was gained in the length of the bougie which was last introduced without however getting clear of the Stricture we have reason to fear a false passage is already made. 1494. Near the orifice in the glans Penis a bougie may by chance be thrust into the mouth of a Lacuna this should be attended to, because it scarcely happens that strictures so low down obstruct the passage of the bougie. 1495. We should first attempt to introduce a middling size bougie, if that will not pass we have recourse to a smaller and smaller until we come down to one of a minute size. 1496. The great inconvenience of using a small bougie is that it bends in the urethra & so doubles, we should in our introduction of the instrument endeavour to ascertain this, least we think that the bougie is advancing when it is only doubling 1497. When a bougie is introduced if it is doubling, it will generally recoil if the hand is removed, if it is really advanced into the Urethra the length that it seems to be it will not recoil if by taking away the hand we cease to push it forwards. 1498. When a bougie hesitates in its passage but does not Recoil we should stroak the perineum with one hand at the same time that with the other we gently push on the Instrument.  101 1499. sometimes an advantage is gained by giving the bougie (before it is introduced) the natural bend of the Urethra. 1500. If we can introduce the smallest bougie the cure of the Patient is generally in our hands as by increasing the size of the bougie in future introductions we can produce the necessary dilatation. 1501. We suffer the bougie to remain in the Urethra a longer, or shorter time according as the Patient can endure its pressure from 5 or 10 minutes to 2 or 3 hours & this we at first repeat daily until a large bougie can be easily passed & no obstruction to the stream of urine remains, we then pass it less frequently but as there is always a possibility of the complaint returning those therefore who have been afflicted with strictures should never pass any length of time without introducing a bougie. 1502. The most convenient season for using the bougie will be a little before bed time, or an hour or two before the Patient gets up in the Morning. 1503. If the weather is very cold the stricture may be more violent so as to prevent any urine passing off or the introduction of the smallest bougie hence we are to make use of such remedies as are temporary relaxants, as the warm bath, Clysters with opium, blisters to the Perineum &ca. – 1504. A Bougie sometimes cannot be introduced beyond the stricture the first time, in that Case we are to introduce it ♂ 1508. Formula for making bougies RS. Diachylon Shel lac. When bougies are introduced care should be taken to prevent the slipping into the bladder by tying thread or Narrow tape to the round their upper end & bending it over the Glans Penis. Some persons have such a disposition to form calcareous concretions that a bougie Cannot remain in their bladder a few hours without being incrusted with calcareous matter & persons should use a great deal of exercise. Mr. Bromfied cut a Bougie out of a young Mans bladder when it had remained two weeks & a large quantity of calcareous Earth had Crystalized upon it. In passing a bougie it may be stopped by a Lacuna draw it back in that case, turn it & you will avoid that orifice 102 gently as far as practicable into the Urethra & leave it there for sometime by several repetitions of this practice we may expect in general to get beyond the stricture. 1505. From an increase in the disposition of the urethra to contraction, it will sometimes happen that we may be able this day to pass a bougie & quite unable the next. 1506. The passage through the stricture is not always straight this we shall best judge of from the appearance of the bougie after it is withdrawn. 1507. The Bougie does not act in the cure of strictures simply as a wedge, that is in the manner it could do in a dead Urethra but it acts upon & produces a reaction of the living parts & the cure is accomplished either by the parts habituating themselves to the pressure or by intesticial Absorption being excited. 1508, We also proposed to Cure strictures in the Urethra by ulceration & this is effected either by the irritation of a large bougie continued until ulcerative absorption arises or by means of a caustic. ♂. - 1509. Although the stricture is not an originally forms and therefore being a weak part may without much difficulty be made to ulcerate, yet great care must be taken that the Bougie is not forced into the Corpus Spongiosum Urethra which has been done & the instrument pushed even through the cellular substance of the Rectum.  103 1510 It may not be useless to repeat the remark, that if in passing a bougie it seems to make considerable progress & at the same time to be confined by the stricture there is room to suspect there is a new Passage forced open. 1511. Of this as well as of suffering a bougie to slip into the bladder the Surgeon should ever be extreemly cautious. 1512. The Cure by Ulceration is (generally speaking) to be Confined to that part of the Urethra which is straight & then in Cases Strictures not readily yielding to the pressure of the bougie it may be properly had recourse to. 1513. The method of producing ulceration by means of the Caustic may be employed When the bougie cannot be passed & the stricture is in the straight part of the [cross out] Urethra. 1514. The following instruments are necessary. 1st A Silver Canula 2d A Stillet, one End of which solid like a blunt probe, the other made of Gold, like a port Crayon & in the [Gill??] a piece of caustic is to be fixed. 1515. In this Operation the Canula Enclosing the stillet with the probe end downwards is to be introduced up the urethra until the probe strikes against the stricture the stillet is then to be withdrawn & turning the end Armed with the Caustic downwards to be again introduced through the Canula until the Caustic comes in contact with the Stricture where it is to be held for a ☿ 1515. Mr. Hunter observes that in some cases of stricture in the Urethra he has succeeded by means of Caustic beyond all Expectation. In one Case where the Stricture was between the membranous part of the Urethra & the Glans Penis a few to with the caustic enabled him to pass a bougie. In two other Cases in which the stricture had produced Fistula in Perineo & one of which suffered no Urine to Pass by the Penis the Caustic produced a Cure He farther remarks that it is safer to use the caustic than to persevere too long in irritating the Stricture the bougie, as force in the latter case is so easily products of a new Passage. 1519. If it slips within the Urethra so that it cannot taken hold of by the finger or forceps endeavour by grasper the Penis tight in one hand to prevent its getting further towards the Bladder, & with the other hand gently draw the Penis forward then backwards, so as if possible to work the End of the bougie upwards until it comes within reach of the Forceps 104. minute or two & then removed, this process is to be repeated every other day until the intent is accomplished. ☿. 1516. The patient should make water immediately after the Stillet is withdrawn or else warm water should be gently injected to wash off any portions of caustic that may be left in the Urethra. 1517. A slight Ischuria sometimes follows this method of cure which rarely yields to the common remedies. 1518. The ill effects that may follow the use of bougies besides making falsa passages are 1st. That the first time or two that the bougie is introduced many patients will be affected with sickness & Syncope but this goes off of its own accord & does not return on subsequent Repetitions of the use of the bougie. 2d. a discharge of pus from the urethra when before there was none & an increase of that secretion when before existing this is however an effect of little consequence. 3d. An inflammation & swelling of the Testicle in which the common treatment is to be had recourse to. 4th A Sympathetic Swelling of the inguinal Glands 5th. A Bougie slipping into the Bladder may form an nucleus for stone, should it slip so far that it cannot be taken of in the urethra, it must be extracted by the operation of Lithotomy. 1520. The Bougie making a new passage is not in general Forceps or Fingers, should this be ineffectual the bougie must be fixed steadily in the Urethra, Cut down upon & Extracted. ♎︎ 1522. Pass a staff into the Urethra as far as it will go which will generally be to the bottom of the new passage & beyond the stricture; the feel for the end of the Instrument Externally & cut down into its groove, making a wound of an inch or an Inch & half long, carrying the incision a little way into the Scrotum, then take a probe & pass it through the wound into the Urethra to the Stricture if it meets with an Obstruction pass two Canulas one on each side of the Obstruction until they are brought as near to each other as possible, then thrust a piercer from within one Canula, through the obstruction into the other Canula & withdrawing it supply its place with a bougie, next remove the lower Cannula & the Bougie will appear in the Wound, next take out the upper Canula & introduce the bougie along the Canal of the Urethra into the Bladder, it may be right then to lay the new passage Open through the whole of its extent that all may heal together, & least the new passage should receive in future the end of the bougie & prove an hindrance to the Cure As it may be difficult to introduce a second bougie after withdrawing the first, the first should be suffered to remain in the bladder for some time or perhaps it may be better to use the first time a flexible Catheter afterwards the bougies should be increased in size & their use persisted in until a Cure is attained. 105 productive of new disease, as the mischief done is generally early discovered but will impede the Cure of the present. 1521 If the Bougie [making a new passage is not in go] has made its way through the Spongy body of the Urethra it will pass onwards towards the Rectum if in the membranous portion it will take another direction. 1522. The Remedy for or cure of the New Passage is to be performed by incision. ♎︎. 1523 In the performing of which it must be a principle that the Urethra is to be fairly incised beyond the extent of the Stricture. 1524. In the spasmodic Stricture if the Symptoms are urgent we must have recourse at once to the bougie or the Catheter, the bougie is the least hazardous & a large one can often be Easily passed & will then readily relieve the patient even when we cannot pass it, by carrying it as far as we can without force & then leaving it, the stimulus its presence gives to the Urethra will take off the stricture & permit the urine to flow. 1525. We may internally administer Opium & the Turpentines Camphor may relieve this Spasm as well as strangury produced by Cantharides. Externally we may use Fomentations – Warm Bath – Steams of warm Water Blisters to the Perineum or loins &ca. 1526. There will rarely be permanent strictures producing  106 urgent Symptoms without spasmodic Affections of the Urethra also taking place. In the mixed stricture we shall find sufficient directions for practice by attending to what has been advanced in the other two Species the permanent & Spasmodic. 1527. In endeavouring to relieve the [Spasm] Bladder rendered morbidly irritable we should observe the following directions 1st. We should endeavour to remove all obstructions to the ready exit of the Urine. 2d. We should instruct the patient never to suppress an inclination to make water. 3d. We should endeavour to relieve the present urgent Symptoms by giving opium internally Clysters &ca. and 4th. We should try the effects of new irritation as a blister to the Perineum or to the loins. 1528. In case of paralysis of the bladder the catheter should be often introduced to keep the bladder from being distended & when we are evacuating the urine, pressure should be made by the hand upon the Belly we should also apply blisters to the Perineum or to the loins & give stimulating medicines internally. 1529. In paralysis of the Urethra which is a more rare complaint [attended with discharges] a similar mode of treatment is to be adopted especially the application of a blister to the Perineum [or to the loins & give]. 1530. Hemlock has seemed to be serviceable in the complaint Catheters employed for drawing of Urine should be considerably curved at the end & should be introduced carefully yet with some expedition, a flexible Catheter is to be preferred 🝄 1534 As the Female Urethra is short & straight no obstacle will arise to the use of the Caustic but should Bougies be used it will be requisite to retain them in their proper place & situation by means of a T bandage. 107 attended with a discharge of the liquor of the Prostate Gland & Vesicula Seminalis falsely called Seminal weakness ( ) bark & other astringents & strengtheners are also adviseable. 1531 Involuntary erections of the Penis being a nervous & Spasmodic Complaint, Antispasmodic Remedies may with propriety be called in such as Warm & Cold Bathing, Opium &ca. – 1532. In cases of real seminal weakness ( ) Opium has afforded singular benefit & may be use both internally & externally that is applied to the scrotum. 1533. The Enlarged Prostate ( ) is mostly incidental to Old men although Young Men have sometimes been affected wth. it. 1534. No cure is known for this complaint, Hemlock & Sea bathing may be beneficial, as the disease may not impossibly be owing to Scrophula, Opiates & Clysters should be frequently thrown up to Relieve the pain & lessen the irritation. 1535. In strictures of the Female urethra we can more easily succeed by the use of Caustic than bougies from the difficulty of retaining the latter & from the impracticability of their being passed by the patient herself. 1536. When in consequence of obstruction to the Exit of the Urine nature has made New passages for that fluid by the ulceration of the urethra & the formation of fistula in Perineo, we are to attempt the cure by carrying in our minds the general principles of the treatment of Fistula & also what has been already 🜖 1537. As the External parts are generally in a very disease and callus state we are not to be very delicate or sparing on using the Knife upon them, but if possible proceed so far as to make the several openings into one & to cut the Urethra beyond the stricture if the seat of the stricture is not already destroyed by ulceration. – 108 already laid down concerning the cure of new passages formed by an unskillful introduction of the bougie. (1522). 1537. In the Cure the staff is to be introduced in the manner before described upon which we are to cut down into the urethra then from the Urethra we are to pass a probe or flexible director into the sinuses that lead from the opening into the urethra & lay them all open as far as we can follow them. 🜖 1538. An hollow bougie is then to be introduced in the manner before described into the Bladder & the wound healed over it but there is a disadvantage attending the rise of the hollow bougie, which is, that its bore in too small to admit of the exit of the urine in a velocity proportioned to the force with which the Bladder acts. ( ). § We have already considered the consequences of Venereal irritation applied to a secreting or sine Cuticular surface, we now proceed to consider its effects when the matter is applied to a non secreting or cuticular surface the primary effects of which constitution the second species of the first Genus ( ) or local disease. 1539. If any irritating matter is applied to a secreting surface & the irritation is carried to a certain degree, then a change of that Secretion & a discharge of pus or the suppurative inflammation must take place. [1540. (If any irritating matter is applied to a non secre-]  109 1540. Irritation to a certain degree applied to a non secreting surface, suppuration must also follow, but that must be proceeded by ulceration 1541. We see therefore that if venereal matter is applied to the Skin & its application continued a sufficient length of time, ulcerative absorption of a small portion of the Skin takes place, & a chancre is formed. 1542. We have shewn (1254) that there are three ways in which a chancre may be formed. 1543. The second species, like the first is generally caught in Coition; it is not so common as the first species, we calculate that the first species is contracted four times for once that the second is, for the cuticle in general prevents its action on the cutis until the Venereal matter is some how washed off. 1544. The prepuce & Glans penis is the ordinary seat of it but the most common is the Frænum or the Angle between it & the Glans & this from the irregularity of its Surface. 1545. The distance of time between the infection & the appearance of the chancre is uncertain, it generally however makes its appearance later than the Gonorrhea. 1546. We have known a chancre appear 36 hours after coition we have known 7 weeks elapse between the time of Coition & the time of ulceration, we have known also an interval of two Months. 1547. It begins with an itching of the parts affected; if its  110 seat is the Glans there is not much tumefaction, if on the Prepuce there is a little discharge from the beginning at least more so than when the Glans as being a laxer part, the parts ulcerate or a small pimple is formed, or a little abscess especially if the Glans is the seat of it, a little hardness round about the pimple or ulceration is noticed. 1548. Should the Chancre be situated on the body of the Penis it generally begins with a Pimple which breaks & being little attended to at first, Scabs, the Scab is then Picked or rubbed off & a larger one forms, here the inflammation is more considerable than if the chancre begins on the Glans, less however than if upon the prepuce; an hardness generally surrounds it. 1549 The Canal of the Urethra often sympathizes with the External parts so far at least as Smarting, itching, tingling. Whether a discharge will arise simply from this sympathetic affection, we do not affirm, possibly however, not all Gonorrhea which are preceeded by a Chancre are specific. 1550. The Sympathy of the neighbourings parts with the seat of the Chancre is sometimes so strong that even touching the hairs on the Pubis create uneasiness. 1551. The Chancre will be attended with more or less pain & Inflammation according to the peculiar habit & disposition of the Patient. 1552. The local disease will spread with greater or less violence  111. sometimes considerable & deep sloughs will form Early & there will be Gangrene of some extent. The Ulceration will sometimes Penetrate so deep as to open the canal of the Urethra. 1553. The Prepuce is only a doubling of the Skin of the penis that it may be loose & convenient for Erection. The Phymosis or stricture confining it over the end of the Glans so that it cannot be retracted is a frequent consequence of chancre. 1554. The Phymosis often preceeds the Paraphymosis & is in fact frequently the cause of the latter for in patients attempting to get the Skin back it will sometimes be made to slip behind the Root of the Glans & will then take on a Stricture Strangulating the glans. 1555. The Phymosis in some Patients so entirely purses up the end of the prepuce as even to prevent the Exit of the Urine after it has passed through the urethra. 1556. In this disease there is a thickening of the Cellular substance of the prepuce & often an adhesive is formed between it and the Glans. 1557. It has often for its cause a disposition of the Erysipelatous kind, accompanying the venereal inflammation. 1558. The Phymosis if severe produces such a swelling of the prepuce as shall press violently against the end of the glans, & if there are sores or chancres underneath it which is not uncommonly the case the matter issuing from them will be confined ♄ 1559. A Young Man with chancres had a paraphymosis he came into St. Georges Hospital, the entire Glans & all the diseased parts gangrened & sloughed away the patient [reco??] Φ. 1565 Lunar Caustic is recommended, as most convenient it should be pointed like a pencil & the Sores touched with it once or twice a day, until they assume the red & healthy appearance of a common healing ulcer. 112 confined from which & from the pressure on the penis, the worst consequences will ensue even a mortification of the Penis. 1559. The paraphymosis strangulating the Glans will if not relieved sometimes produce a gangrene of the part strangulated & even a seperation of the whole diseased part. ♄ 1560. In Women chancres are apt to be more numerous than in Men & to spread to a larger size because the surface they have to spread over is of greater Extent, In them the Perineum is more subject to Chancres than in Men, from the facility with which the matter in their chancres in the labia & &ca. runs down to that part. 1561. Chancres are frequently attended with some peculiarities independent of the specific affections, & therefore some variety in their treatment may be necessary consequently it is requisite to attend to concomitant circumstances whether local or of the Constitution. 1562. Two modes of local Cure of Chancre are practised the one by extirpation the other by altering the nature of the irritation. 1563. In extirpating the object is not only to cure the chancre but also to prevent any communication of the vines to the System. 1564. Two methods of extirpation have been practised one by the dissecting out of the Chancre the other by destroying the diseased part by means of Caustic. 1565. When the Glans is the seat of the Chancre the Caustic is undoubtedly preferable. Φ. 🜔v 1569. Mercury is applied either in the form of an Ointment or by means of a watery Vehicle, the latter from its ready mixibility with the animal fluids is probably most efficacious; but it should be a rule to change the application often, as any one dressing will have its Efficacy diminished as the sore becomes more or less habituated to its action. 113 1566. Chancres may be dissected off the prepuce &ca. with a Knife, whether dissection or Caustic is employed it is proper afterwards to dress the Sore with mercurial Ointment as by that means we destroy any venereal Infection which may remain. 1567. Extirpation is improper when the chancre is large. 1568. The other mode of local Cure is by means of altering the nature of the Ulcer (which is done by Mercurial Ointment) in which there is no destruction of parts but only a destruction of venereal irritation. 1569. Mercury although it does not cure the first species is a Specific for the Second. ( ) 🜔v. 1570. Chancres to their specific disposition will often have superadded either indolence or irritability. In the former Mercurials should be mixed with stimulating balsams, in the latter Mercurials should be mixed with Opium & the oftener the latter are dressed, the better. – 1571. If a patient with a phymosis cannot submit to keeping his bed (a circumstance to be desired) he should use a proper suspensory bandage. 1572. Between the pressure & Glans an injection should be thrown often prepared either of Calomel, Gum Arabic & Water, or of mercurial Ointment incorporated with Mucilage of Gum Arabic, with Water, between the times of injecting mercurial Ointment may be rubbed on the outside, sometimes a poultice of vegeto mineral water & linseed meal affords relief. ♀ 1573. Oil of Turpentine is the best Styptic we are acquainted with. 🜔🜹. 1577. Many have recommended us not to open the prepuce by one longitudinal incision the whole length of it, but to make two slits one on each side which they say will save the necessity of making so long a wound, but they have drawn this reasoning from the natural Phymosis, which will by no means apply to the Phymosis from disease, in which the prepuce is very much tightned & incapable of yielding & stretching as in the natural Phymosis. Whenever disease makes it necessary to operate the Prepuce should be slit up its whole length. 114 1573. An Hæmorrhage the consequence of ulceration will sometimes happen, & is an extremly troublesome Symptom. ♀ 1574. When the Inflammation abates more the prepuce of the Glans frequently to prevent adhesions which would subject the patient to a permanent inconvenience. 1575. Should it happen that an ulceration of both the surfaces of Glans & Prepuce has taken place, the we must endeavour to prevent adhesion by the frequent use of injections thrown between the Glans & the prepuce. 1576. If the preputium is drawn much over the Glans & Contractd. & the opening of the Urethra is in a straight line with the end of the prepuce pass a bougie into the canal in order to prevent the ill consequences of the passage of the Urine being obstructed by the preputium adhering to the end of the Glans & closing itself over the Orifice of the Urethra. 1577. In this latter case, or in case the orifice in the Urethra is not in a right line with the end of the preputium we must slit open the prepuce & expose the Orifice. 🜔🜹 1578. In many Cases the Operation of the Phymosis is not adviseable, as where the inflammation is violent, or there is much tendency to Gangrene as the additional Violence of the operation must tend to encrease both. 1579. When matter is collected & confined in any part from the adhesion of the prepuce to the Glans, a wound by a Launcet should be made & the matter discharged, or if the fears of the Patient ☿. 1582 It sometimes however happens that mercury encreases the tendency to Gangrene, under which circumstance Bark should be administred alone. 115. patient object to the lancet, a small caustic may be employed. 1580. Mortification sometimes takes place in Phymosis & we have seen cases in which the whole Prepuce has slough’d away 1581. Hence we may suspect a faulty constitution & that the Inflammation was of the Erysipelatous kind. 1582. In these Cases Bark should be administred with Mercury thereby attacking at once the Venereal infection & the Constitutional disposition. ☿. 1583. A necessity for performing the operation for the Phymosis will appear to arise 1st. When the prepuce is so contracted over the Orifice of the Urethra as to become the Cause of hindering the exit of the Urine. & 2ndly. When added to this inconvenience or without it the matter from chancre is concluded by the prepuce becomes confined & cannot be evacuated on applications made to the Chancre Without dividing the Prepuce. 1584. An Operation for the relief of the [Patient] Paraphymosis becomes oftener necessary than in the Phymosis & danger of Gangrene &ca. from this Stricture will more often occur. 1585. The Operation consists in drawing up the integuments as much as may be with the fingers & Thumb & then passing a crooked bistory through the most strictured part & bringing it through from within outwards. 1586. In consequence of the Inflammation of the prepuce in Phymosis or Paraphymosis it will be often much elongated &  116. thickened so as to be much inconvenience to the Patient. 1587. If by proper applications as the steam of warm water, the fumes of Cinnabar or hemlock fomentations, we cannot reduce the swelling, it will be right to perform circumcision. 1588. Or we should at least remove as much of the prepuce as projects beyond the Glans, taking care however not to include any part of the Glans in the extirpation of the prepuce, & in healing the wound we should direct the patient often to draw the prepuce up & down to prevent the cicatrix contracting & forming a phymosis or stricture over the end of the Glans. 1589. Warts are no sign of a Pox, they arise in Gonorrhœa from the discharge from the Urethra touching any of the neighbouring parts. Chancres heal into Warts, Warts have an increasing power in themselves, often bleed, & are frequently painful. 1590. Mercury has been employed for their use & it is asserted will remove them, but our Experience does not warrant us to Affirm this to be the Case. 1591. As being new formed parts it is evident that their powers of supporting action must be weak by exciting a strong action in them & the surrounding parts by means of Powerful Stimulants we may produce in them a disposition to decay as a a more violent action will be thus produced than they are able to support. 1592. Rust of Copper mixed with powdered Savine is found to  117 answer this purpose (1591). 1593. They may also be extirpated by means of ligature, Excision or Caustic, but it is often found that by what means so ever they are removed they will frequently sprout up a fresh, in this case a repetition of the former process is necessary. 1594. Although Chancres may in general be cured by the local means above described, yet the introduction of Mercury into the System is adviseable, & generally to be insisted on both as forwarding the Cure of the local disease & as counteracting the effects of the virus if absorbed into the System. 1595. As we have remarked (1556) some variety will be necessary in the mode of treating chancres according to the concomitant disposition of the constitution or the part & this internally as well as Externally thus if there is a disposition to indolence we join some stimulating Medicines as the balsams with Mercury, if to irritability Opium, bark, &ca. – 1596. The quantity of Mercury to be introduced into the constitution should be in proportion to the number of chancres, their size & the time they have continued, it will be right to produce a slight spitting as a criterion of the Mercury having Acted in the System. 1597. Mercury may be carried into the System either from the Stomach or the Skin; when all the hardness is become softened & the Sore is skinned over the cure may in general be supposed  118. to be accomplished. 1598. This rule should however be applied to a large rather than to a small Chancre for in the former the Virus must in general be destroyed before the chancre will heal, yet in the latter the sore will sometimes skin over before the venereal virus is destroyed. 1599. It is better for the most part to continue the Mercury for sometime after the Chancre is healed to prevent any further action of the Venereal Virus by means of the Constitution. 1600. Chancres in Women should be often washed with solutions of corrosive sublimate & mercurial Ointment should be applied to them. 1601. The quantity of Mercury thrown into the Constitution should be greater in them than in others because their Chancres are commonly larger & more numerous. 1602. When the Ulcers spread considerably, if the seat of them is in the Vagina some extraneous body as lint &ca, should be kept between its sides to prevent their Cohering & Straitning & Closing the passage through the Vagina, an accident that has been known to take place. 1603. New diseased dispositions not venereal may arise during the Cure of chancres & remain after the venereal virus is destroyed. 1604. In some there will be a diffused inflammation of a Purplish 1606. Mr. Hunter has once known them to break out in two Months, these new ulcerations do not always appear immediately where the original Chancres were situated by a very small distance from the Cicatrix. 119. Purplish hue, about the sore which will be ragged & assume a cancerous appearance, these have been commonly considered as Cancers, but for the most part are only Scrophulous. In others there is a swelling & hardness with an indolent disposition. 1605 freely used in these Cases has proved serviceable, the Lisbon diet drink has also been found of singular utility Extract of Hemlock has done service, so has Sea bathing, & Opium used externally, if the disease extends near to the orifice of the Urethra care should be taken to prevent its closing, by means of a bougie, Extirpation of the diseased part if indolent may sometimes be requisite. 1606. The Cicatrices of Chancres after all the Virus is eradicated will sometimes breakout again such are generally but falsly considered as Venereal, the cure of these Ulcerations is uncertain. 1607. We recommend Sea bathing as highly useful in this diseased affection having experienced its efficacy in such Cases. 1608. From whatever surface the Venereal poison is absorbed the effect is ultimately the same. 1609. The Constitution may be affected by Venereal Virus in four ways 1st. By Venereal matter applied to a surface & absorbed into the System without any previous local effects. 2d. By Gonorrhœa. 3d. By a Venereal Ulcer, whether Chancre or Bubo. 4th. By a Wound. 🜔 1609. Mr. Hunter calculates the proportions of infection in the 2d. way to the 1st. was 100 to 1 & the 3d. to the 2d. is as 100 to 1 also. 120 The most general way by far is the third, the first scarcely ever happens. 🜔. 1610. The Venereal Matter being taken up (1609) by the Absorbents may previous to any constitutional affection give rise to the bubo or local consequent. (1252, 1263). 1611. The Venereal Bubo may be divided into. a. That in which the Absorbent Vessel itself being contaminated is the seat of the disease. b. Where the Lymphatic Gland in the line of Absorption is the part affected. 1612. The first very rarely occurs, when it does it is known by a resemblance to an hard Chord running along the dorsum Penis & leading to a Gland. 1613. The hardness is occasioned by a thickening of the coats of the inflamed Vessels. The absorbent sometimes suppurates & form a chain of abscesses along the Penis similar to the Abscesses of Veins (543) when suppurating they are to be considered as chancres. 1614. The first species is so rare that it is not noticed in speaking generally of Bubo. (1252). 1615. In the second kind which we commonly Call bubo the Venereal Matter is carried by the absorbents to the nearest of the Lymphatic Glands. 1616. The Lymphatic Glands consist of a Convolution of Vessels construded so, as very much to favour the stay of Venereal Matter in them a sufficient time to produce their contamination. ♀ 1617. First in Order---Inguinal Second in Order---Glands of the back. It would appear from this that the matter is diluted in its passage, the more probable reason however is, that the second order are not so easily irritated as the first being deeper seated. – (1295). 121. 1617. The Lymphatic Glands nearest in order to the Source of the Matter are the parts affected, those of the second order scarce Ever. ♀ 1618. In Men the seat of the Bubo will be in the Lymphatic Gland of the Groin, but as to the situation of the Lymphatic Glands it is not always the same precisely & the nearest Lymphatic Gland will sometimes not be in the groin but just above pouparts Ligament near to the os pubis, that will sometimes be the seat of the bubo. 1619. In case the Bubo arises from Gonorrhœa the seat of the Tumor may be on either side, if from a chancre, the Bubo will form on the same side as the chancre, but if the chancre is in the middle of the Penis then the Bubo may arise at either side. 1620. In Women the surface of Absorption being larger than in Men there are three different Parts which a Bubo may occupy & that dependant on the site of the Chancre. 1621. If the chancre appears on the Labia or Nympha the Venereal matter will pass on when absorbed in the course of the Ligamentum Rotundum & just before that ligament enters the abdominal ring the bubo will form, but never within the ring. 1622. This Bubo we refer to the first kind not considering it as Glandular but as an inflammation of the absorbing Vessel only, & this strengthens our Opinion that deep seated & internal parts are not readily susceptible of the Venereal irritation & that a bubo can only be External. (1617). 1623. If the Chancre be situated further backwards, then the bubo will form between the labia & the Groin or as in Men in the Groin 1624. “To this because the surface of the Glans Penis approaches nearest to a secretory surface than that of the Prepuce. We see absorption goes on slowly from a secreting surface. 122 1624. Absorption of Venereal Matter goes one more readily from some surfaces than from others, e.g. it is much more frequently taken up from the Preputium than from the Glans Penis. 1625. The first notice given to the patient of the formation of a bubo, is a sense of pain in the part affected, in which upon Examination he feels an hard tumor. 1626. This Tumor is generally of the common inflammatory kind & often advances to Suppuration speedily. 1627. Sometimes the Tumor is more of an indolent disposition & will then be long in coming to maturation. 1628. When the Bubo is of the truly inflammatory kind [& often] [advances to suppuration speedily.] [1627. Sometimes the Tumor is more of an indolent disposition &] [will then belong in common to maturation.] [1628. When the Bubo] the pain attending the suppuration will be very considerable when of the indolent nature it will be less acute, more dull & heavy, a disposition to indolence especially prevails in Patients of Scrophulous dispositions. 1629. The inflammation of the bubo will however sometimes be found of the Erysipelatous kind & then though the pain may be considerable, the Inflammation will be considerable & the part oedematous. 1630. Inflammations & Swellings of the inguinal Glands are not always Venereal, great will be the difficulty however sometimes ♄ 1632. It is however doubtful whether we do not often meet with Cases in which the Venereal disposition is mixed with the Scrophulous. in this Case we are to attack the predominant disposition whether it be Scrophulous or Syphilitic. Case Colonel W. had a gonorrhea preceeded by Buboes which suppurated they were opened & for a time went on healing kindly but at length became Stationary. Mr. Hunter suspected that a New disposition was taking place therefore ordered sea bathing &ca. when the new disposition which was Scrophulous, abated, the Venereal disposition increased so that it was necessary to return to Mercury. ☉ If Buboes were critical deposits from the constitution why do they not arise in some other Glands as those of the Neck &ca. & not in the Sympathetic Glands of the Groin or always in the nearest to the source of Absorption; again if Critical why should it be necessary to administer Mercury when they form. 123. in ascertaining the nature of an inguinal bubo. 1631 If a Gland in the Groin swells without a visible Cause, is painful, & goes on to suppuration quickly, venereal matter should be suspected & Mercury given, as in cases of chancres. 1632. But if the Tumor has an indolent nature & is attended with a Cold & Feverish indisposition & arises without any visible cause we may for the most part consider it as Scrophulous. ♄. - 1633. Bubo’s both in Men & Women are entirely local & are no more connected with the Constitution than the preceding local affection of which they are the consequence. 1634. They are not critical deposits from the Constitution as has been some supposed. ☉. 1635. In order to the cure of Buboes, having first ascertained their being Venereal we have recourse to the exhibition of Mercury. 1636. We are always to desire the resolution of the bubo & to avoid suppuration for the Bubo when it forms matter is similar to a chancre & has equal powers of contaminating the System. 1637. It is necessary to observe that in the Cure of the bubo, Mercury should be employed, but as that will only destroy the specific disposition of the Gland, it is necessary to attend also to the nature of the concomitant inflammation whether common Scrophulous, or erysipelatous. 1638. In the first we have recourse to bleeding & Purging according to the violence of the Inflammation. For the second, or Scrophulous, Cicuta, Sea bathing &ca. ☍ 1639. A Gentleman had a suppuration considerably advanced, he went to sea & the Sea sickness he endured & the consequent vomiting caused an Absorption of the matter & the cure of the Abscess. 🜍 1641. Thus if a chancre in the prepuce preceded the bubo – the Mercurial ointment should be rubbed on the side of the Penis where the Chancre formed itself & on the inside of the Thigh, in the Scrotum & belly &ca. as the Lymphatics from those parts take their route through the Inguinal Glands. 1642. Of all the patients Mr. Hunter has had under his Care for 16 years past, only 3 have had buboes which suppurated, that is of those which applied to him at the commencement of the bubo. 124 For the third Bark. 1639. Vomiting has been known to produce resolution of the Bubo even when suppuration had taken place, acting upon the principle of resolution. Vomit also powerfully Excite the action of the absorbents. ☍ 1640 In the [course] Cure of the Bubo we can much increase the Powers of our Remedies by the manner of applying them, & it should be a Rule to endeavour to produce an Action of the Mercury on the part before we produce its action on the System. 1641. We should therefore cause Mercurial Ointment to be rubbed on the surface from which the Absorbents begin that pass through the affected part, & as near as possible the part from which the first absorption of the venereal matter took place, thus introducing the Mercury into the System by the same road which the Virus persued, & as it were making the Antidote tread on the heels of the Poison. 🜍. 1642. By the early use of Mercury in the manner recommended (1641). The suppuration of buboes will commonly be prevented but should they happen notwithstanding to form matter, or should the matter be formed before the Surgeon is consulted; Mercury should be used during the whole time of maturation though in a more moderate quantity than before as well as after the bubo is opened or has burst. 1643. If the bubo is to be opened by Art the Skin should be permitted to come exceeding thin before the Operation is Performed, that a disposition may have taken place prior to exposing the Abscess to heal from the bottom. 1644. The opening may be made Either by the Launcet or by Caustic 1646. Sir William Fordyce first recommended Orange & Lemon juice which Mr. Hunter has since prescribed to advantage. Gold beaters Water is in use at the lock Hospital & sometimes does service. ♃ 1647. Case A Gentleman has a bubo which was opened he used Mercury 2 Months, still the Ulcer continued without the least disposition to heal, Mr. Hunter considering his constitution as too much of a Mercurial one & therefore little Affected by that Remedy he left it off & confined him to Milk diet &ca. for sometime, he then returned to Mercury again & continued its use for 2 Months when the Ulcer became stationary, he then again discontinued it returned to the Milk & gave Cicuta, the Ulcer was sinuous. The sinuositus were laid open & the patient was sent to Sea he persued this plan 4 Months & returned home without benefit. Mercury was again ineffectually administred, the patient at last got well having left off all Medicines. 125 Caustic according to the inclination of the Patient, it should however be small. When left to the choice of the Surgeon, if the Skin is very loose he may use a Caustic, & the lapis Infernalis is to be preferred, if the Skin is not loose, the lancet is best as thereby none will be destroyed, the Wound is to be drest according to the nature of the discharge. 1645. Mercury should be thrown into the constitution during the whole of the time from the ulceration until after the healing of the bubo, or at least until the Bubo has lost its venereal appearance which the Experienced Surgeon alone will be able to determine. 1646. Some exceptions however to this, are found to arise, sometimes the bubo takes on a New diseased disposition which mercury increases, the sore will continue obstinately spreading & the more freely Mercury is administred, the more progress the Ulceration will make. In this Case we perhaps have a Scrophulous or Scorbutic habit to encounter, & we shall find benefit probably from the use of Hemlock & Sea bathing & from Orange & Lemon Juice. 1647. In some of these Cases we have found no Medicine of any Utility but the disposition at length has worn itself out & the Ulcer healed. ♃. 1648 Another Exception to the constant use of Mercury is that the patients Constitution may become so habituated to it, that it shall lose its power of acting as a specific, in this Case we should discontinue the Mercury for some Weeks & then have recourse to it again. 1649. As the Venereal disease may be communicated by other  126 means than coition, so buboes may be formed in other Glands as well as those in the vicinity of the parts of generation, if the infection was received on the Lip; the Bubo would be seated in the Neck, if Venereal matter was absorbed from an ulcer or wound in the Finger, we should find the Bubo in the Axilla. 1650. In the Cure of these the same principle is to be kept in view, as if they had formed in the Groin (1636-1640). 1651. Some uncertainty must prevail as to the precise Quantity of Mercury necessary to be used for the removal of buboes, where the resolution is obstinate the quantity of Mercury should be pushed so as to affect the Mouth in general we may begin with ½ dram of Ointment (prepared with Axunge & Mercury) & increase or diminish according as the bubo is affected by it. 1652. When the Venereal Virus has been absorbed into the habit, & the second Genus arises Variety of appearances are produced & these will be according to the following Circumstances. 1653. 1st. the time since it was Absorbed into the Constitution. 2d the peculiarities of the Constitution. 3d the different Solids affected by it. 4th. The different dispositions the solids were in when they first became affected with it. 1654. The time in which the second Appearances take place after the infection depends upon the nature of the constitution, at a medium the period is found to be 6 Weeks in some it is sooner ♄. 1654. A Case occurred in which almost the whole body was covered with general Eruptions within a fortnight after the breaking out of a Chancre. ☉ 1659. In some persons, Copper Coloured, dry Scurfs, or as it were Cuticles appear which are thrown off from time to time & spread at times to the size of a Sixpence. 127. in others later. ♄. 1655. The deep seated parts, or parts second in order of [succession] susceptibility (1298) do not always come later into action than the superficial parts (1297) as we have known the Periosteum to become diseased without any previous affection of the Skin or Throat. 1656. We have accounted for the reasonsy why parts shall fall into the Venereal Action after parts labouring under the same diseased action shall be cured (1303-1304). 1657. We have also shewn that Venereal matter does not continue circulating in the Blood for any length of time, that the secretions are not contaminated by the Venereal Matter, nor the Blood rendered Capable of communicating the infection to other persons but that after the absorption into the System it Circulates for a short time with the common mass of Fluids, gives a venereal disposition to the different solids having first undergone a change in its nature & is soon thrown out by the different excretions. 1658. In some the Eruption upon the Skin appears in distinct blotches not very observeable until Scurfs are forming upon them, at other times as small pimples with inflammation & the pimples filled with matter. ☉. 1659. The first appearance after Absorption is generally upon the Skin, throat or Mouth, the appearance in the throat often precedes the others. 1660. When Skin is opposed to Skin, as in Axilla &ca. the above described appearances never take place, but the Skin rises while  128 & smooth, & a whitish kind of matter is secreted & they attended with more pain than the former, whether this attends the disease in question only we will not pretend to determine. 1661. The hair falls off the parts that are attacked with it & so long as the disease continues the new hair cannot grow. The fingers are sometimes the seat of the disease & then the nails fall off. 1662. When the throat inside of the mouth & tongue are the seats of the Venereal Action, an Ulcer rapid in its progress but without much tumefaction is formed it is foul & has thickened or bordered Edges; but this is a circumstance attending all sores that have no disposition to heal. 1663. These Ulcers are painfull although much less so than a common inflammation of these parts, & oblidge the patient to speak thick & snuffle. 1664. The matter secreted upon them does not remain to form a Scab, but is washed off in swallowing. 1665. The Eye sometimes become the seat of disease & a venereal Ophthalmia is produced which with difficulty can be distinguished from the common Ophthalmia. 1666. When the disease has been affecting the constitution for sometime, then the parts second in order may shew the action of the Virus or the same Effect may occur when it had first appeared in the External part, & the diseased appearances there had been Cured. 1667. A total deafness is not uncommon at this time, now & then attended with pain & suppuration in the parts.  129. 1668. A Node often appears several months after any possible infection, the progress of this is very slow & the consequence of any suppuration is a very slimy matter instead of good pus. 1669. When the Periosteum &ca. becomes affected the Pain is very considerable but not always so. 1670. Nodes will sometimes continue several Years before they come to Suppuration, the inflammation being very slow. 1671. Venereal pains are periodical being more particularly Severe at night & in this respect they resemble the Rheumatic. 1672. The Effects of the Venereal disease upon the Constitution are similar to the effects of all other irritations whether locar or Costitutional. 1673. In some a slow kind of nervous fever with loss of appetite is produced, or there are Rigors, frequent hot fits head Achs. &ca. 1674. In the cure the disease may be considered as in two extreemes, not different in their nature but only as requiring a more mild or more severe treatment. 1675. In the first Genus our senses will generally inform as when a Cure is compleated but in the second Genus we labour under great difficulties as the Virus has circulated in the blood & we know the contaminated Solids only by their shewing a diseased action. 1676. The Effects arising from the constitution are local & may be cured locally, but as other parts may have received the Venereal disposition, although they have not yet come into action, we must attack the ☽︎ 1682. Mr. Hunter observes that a smaller quantity of Calomel is sufficient to Salivate by the Bowels than by the Skin, & again that using precipitate to Sores has salivated patients. 130. Blood, not as now containing the poison, but as the Vehicle carrying the specific through all the solids of the body, curing present diseased effects, & destroying dispositions which would have produced future ones. 1677. It is not clear whether those parts which have first been attacked are easier to Cure then those which took a diseased Action later. 1678. If parts are susceptible of Cure in proportion to their susceptibility of diseased action then the parts first in order must have their diseased disposition & action removed. 1679. The second in order may appear diseased when the first has been already cured, but the order is rarely reversed. 1680. Mercury is the true specific remedy for this disease & none other whatever can be depended on, when taken into the constitution it circulates with the juices cures those parts which are diseased & little affects those that are not. 1681. There are two modes of administring it Vizt. By the Stomach---By the Skin. 1682. Like other substances it is more readily absorbed from some surfaces than from others. ☽︎. 1683. In the administration of Mercury it is necessary to consider. a. The Constitution of the Patient. b. The quantity of Mercury necessary c. The proportion that will best agree wth. The Patient d. The mode of giving it.  131. e. The Regimen necessary to be observed by the Patient during his Mercurial Course. 1684. As to the constitution we should endeavour to learn whether it is very much disposed to irritability or indolence, if possible whether it is easily or difficultly affected with Mercury, & again the time the Constitution has been contaminated. 1685. With respect to the second circumstance belonging to the constitution we may in general take the History given us of the degree in which it has been affected by a given quantity of Mercury on any former occasion as a guide for our practice for it rarely happens that the Constitution Varies much in this particular. 1686. The quantity of Mercury to be given must be equal to the Violence of the disease but it becomes necessary at the same time to consider the period of time within which a given quantity is introduced into the System & the effects of that quantity on the Constitution. Thus one ounce of Mercurial Ointment rubbed into the Skin in two days will have more Effect on the constitution & secretions than two Ounces rubbed in within ten days. 1687. A large quantity of Mercury quickly introduced into the System, a sudden Alarm is given & its effects are rendered mostly local consisting in the unusual Excitement of some sensation. 1688. But if we introduce the Mercury slowly a very considerable quantity may be thrown in without visibly affecting the constitution. – ☿. 1694. All parts do not become Sore together but severally the lips may alone become thick & inflamed & the Cheeks or Gums become Sore. – 132 1689. From a knowledge of these circumstances we find Mercury a much larger & more manageable Remedy than it was formerly known to be. 1690. Mercury when first applied affects the System much more readily than when the patient has been sometime accustomed to its use we are therefore enabled by beginning with a small quantity & going on gradually to throw into the constitution a much larger quantity than could have otherwise been born by the Patient. 1691. If given with care so as to avoid Stimulating any secretory Part to Action, & thus producing Evacuation, any quantity of mercury may be introduced that the disease can require. 1692. The effects of Mercury are generally in the following order. 1st. On the salivary Glands – 2d. on the intestinal Glands. 3d. On the Skin 4th. on the Kidneys. 1693. These are affected sometimes singly, sometimes more than One, sometimes altogether. 1694. Soreness of the mouth most commonly though not always attends the increased action of the Salivary Glands ☿. 1695. Evacuations by any of the secretories are of no use in curing the disease, they only shew the susceptibility of the secretory Organ to be affected by the remedy, however they afford some Evidence of the constitutions being acted on by the Remedy. 1696. If the secretory Organs are too susceptible of the stimulus of the Mercury it will be difficult to Cure the disease because ♃. 1696 A Gentleman had a Chancre & a bubo he rubbed in Mercurial Ointment once, his mouth became affected, a slavering came on, the spitting was kept up for a month during which time the Chancre & Bubo got well, soon after his Throat became affected with the disease this Mr. Hunter attributed to the too great susceptibility of stimulus in the Salivary Glands which suffered the Mercury to be evacuated so fast, that it had not time or power to affect all the other parts of the System. 134. The Patient will not bear a sufficient quantity of the specific to be introduced into the Circulation. ♃. 1697. The too ready susceptibility of any secretory Organ should be obviated by proper astringents hereafter to be mentioned. 1698. Mercury can act only upon the constitution & upon the Poison. 1699. Upon the Poison either by destroying its properties & decomposing it, or By attracting it & carrying it out of the Circulation together with itself, or By counteracting the venereal irritation & producing a new & opposite irritation. 1700. If the latter conjecture is true then the readiest way of curing the disease must be, giving Mercury so as to produce visible effects on the disease yet in such a quantity as to produce a different disposition in the System. 1701. It should be given slowly so as to produce at length some local Effects, yet however in such manner that a quantity may be introduced into the System sufficient to cure the disease. 1702. As a general rule it is right & necessary to give Mercury in such quantities as shall produce good effects on the disease yet no ill ones on the Constitutions & to continue its exhibition until some local irritation is produced. 1703. Of the two modes of throwing Mercury into the constitution if the patients way of Life & circumstances renders it convenient that of rubbing it into the Skin is most Eligible & most certain ♀ 1709. Should it be found that purging has any effects in diminishing Salivation it might be right to give sulphur in sufficient quantities to act as a purgative. 135. in its effects. 1704 If the Patient has been unused to Mercury, he should begin with a scruple or half a dram of the Ointment prepared with & rub that quantity in every night for 4 or 6 nights & then he may increase the quantity to a drachm & so on gradually until two drams are rubbed in every night. 1705. If the Symptoms disappear gradually it will be right in general to continue the medicine a fortnight after their removal. 1706. When the mouth becomes affected by the mercury we must suspend its administration, until the soreness abates. 1707. If the Mercury runs off by any of the secretions they should be restrained no danger arises from checking a too violent secretion although that encreased secretion does not arise from the constitution. 1708. Sulphur has certainly been serviceable in diminishing too violent secretion by the Salivary Glands in what manner it produces this effect we do not determine, it can only act upon the mercury after the latter has got into the blood probably it is a kind of Antimercurial Stimulus. has it any powers of combining with the Mercury in the constitution. ☍ 1709. We should distinguish a Mercurial salivation from a Salivation which goes on from habit after the mercury is Evacuated 1710. purging had probably no power in diminishing a Mercurial Salivation. ♀. 1711. Sulphur certainly Enters the Blood unchanged & as Sulphur. ♄ 1716 Mercury cannot act in the body as it does not of it, all the preparations of it undergoes a change & after being taken into the System a New Combination peculiar to the animal body is formed & that is the same whatever may be the preparation of mercury employed. Did Mercury Act when in the System as it does in the Primæ viæ or applied Externally, the preparations would have different effects. e.g. Turboth Mineral when in the blood would act as an emetic in the same manner as Ipecacoanha does when thrown into the blood Vessels, but all the preparations of Mercury after they are dissolved in the Animal juices form one particular combination when dissolved in the Saliva they have all the same taste. Mr. Hunter held crude mercury in his mouth for sometime, it was very slow in giving the proper metallic taste to the saliva which shewed that it dissolved in the Mouth & gave the same taste. Calomel did the same. Corrosive sublimate held in the Mouth, for a time the acid taste was prevalent, but that going off the proper Mercurial taste similar to that of M. Cale: Argent. vis: &ca. took place; introduced by means of the skin into the System, they all have one common Effect, tho some are quicker in producing their Effect than others. – 136 1712. Should the Secretion by the bowels be violent we restrain it by opium which seldom fails in removing the irritation of those parts the violent action of Mercury on which, is by far more dangerous than on any of the other secretory organs. 1713. Mercurial sweatings or Evacuations by the Skin, we check with most success by the use of peruvian Bark. 1714. The encreased action of the Kidneys is not near so troublesome as the others, Bark may be given as it corrects; but it will sometimes go on whatever means are employed to check it. 1715. Mercury probably cures most of the Symptoms of the first stage locally, that is applied to the parts by means of some of the secretions, thus it probably cures the sore throat locally, the saliva loaded with Mercury proving an antivenereal Gargle, so also in Cutaneous affections, being applied to the skin by means of the sweat. 1716. Mercury cannot act upon the Venereal or any other disease but in a state of solution & that in the Animal juices. ♄. 1717. It is however certain that different preparations of Mercury will produce Effects upon the system & upon the secreting Organs at different periods of time & will affect different indviduals in different manners, & that those who are not cured by one preparation of mercury will by another therefore it is right to try different Preparations when the disease is obstinate. 1718. All the preparations of Mercury are readily voluble in Saliva. Mercurius Calcinatus is the most simple & easily dissolved  137 in the mouth, mixed with a quantity of opium it makes one of the most efficacious internal remedies. 1719. Calomel in proportion as to strength & its effects in the Constitution to Mercurius Calcinatus is as One to three. One Grain of calcined Mercury is equally powerful with 3 of Calomel 1720. Corrosive Sublimate is a powerful preparation of mercury its action in curing any diseased part is mostly local as being carried to them by means of some secreted fluid, it cures ulcers in the throat sooner than any Medicine, acting perhaps as a gargle. A cure by it however is not to be entirely depended upon as it does not seem to have any great powers in the constitution & relapses more frequently happen after a supposed cure by Corrosive Sublimate than by any other preparation of Mercury. 1721. For too small a quantity of Mercury only when we use sublimate can be introduced into the System, to effect a proper change of the constitution, it too readily passes off by the Skin &ca. – 1722. Crude Mercury divided with any substance by triture is the weaker of all the mercurial preparations. 15 Grains of it being only equal to one grain of mercurius Calcinatus. 1723. A Grain of Calcined Mercury may be taken [into] every night for five six or seven Nights, if no affection of the mouth is thereby produced the quantity may be increased. 1724. Either of these may be joined with Quaiacum ( ) in dose & will in general produce a cure of the Symptoms in one month. 1725. If the Symptoms diappear suddenly, for instance in the ☉ 1726 It is with this view probably that Mercurius is prescribed. – 138 first eight days, it will be still right to persist in the use of the remedy a considerable time, & even when the suppuration gradually decreases it will not be improper to persevere in the use of the Remedy for a fortnight afterwards & this whether the external or internal method is employed, for we should always consider the danger of having incurred a venereal disposition in parts not yet come into action. In this first Stage it is much easier to cure the Symptoms than to rid the constitution of the specific disposition. 1726. If Mercury is given internally either in a Saline form as sublimate, or formed into a salt by any acid it may meet with in the Stomach, regard is to be had to the irritation it may produce on the Stomach & Primæ Viæ. if they are disposed to irritability Opium & Essential Oil may be administred with it, or alkaline Medicines accompanying its Exhibition. ☉. 1727. In general if Mercury is properly administred the constitution may be cured in six Weeks. 1728 In the second or worst Stage as affections of the Periosteum, Tendons, Ligaments & Bones. a more severe course is to be pursued & mercury is often required to be given in the largest quantities that the patient can with saftey bear. 1729. Here we must begin with a large quantity at first, in order as it were to surprise the system & we should produce a sensible effect in 5 or 6 days & a soreness in the mouth in 12 days Here the quantity of Mercury to be employed will be so great that it is scarcely possible to prevent a Salivation.  139. 1730 In this Case more attention will be required to the Patients diet, as he will not be able to Eat solid food from the soreness of his mouth & yet will require his strength to be supported, Egged Wine, Sagoe &ca. will be proper viands. 1731. In our use of the mercury we are to observe that in this Stage it is easier to cure the constitution than the local disease & therefore it is not necessary to persist in the use of mercury until all the local Complaints are removed as the parts may remain in a diseased state after every Venereal disposition is destroyed. 1732. Topical remedies in this stage will be useful, as will readily be conceived from (1731). 1733. Previous to beginning the Mercurial Course we must make the same enquiries as are directed to be made preparatory to a less severe Course ( ) that is whether the patient has heretofore taken Mercury whether lately, or in what quantities. 1734. If he has lately taken Mercury (& this is to be considered as it were a continuation of a Course already begun we must begin with a large quantity as two drachms of Ointment, rubbing the same quantity of Ointment into the Skin every night, if the Patient can bear it, or even encreasing it to ʒiij. Or if he has heretofore borne a large quantity of Mercury without inconvenience, we may proceed with similar boldness. 1735. But if the Patient has not been used to mercury or is weak & irritable we must proceed with some Caution; One drachm ☽︎. 1738. We perhaps shall not be surprized at the length of time which may Elapse between a Venereal disposition being given to a Bone & the time of its action on the bone appearing for we see not only Venereal Virus is very slow in its Operation but that processes of all kinds in bones go on with tediousness & difficulty. ♂. 1739 Why does Mercurial Ointment cure Nodes? It cannot be by the Mercury acting locally by Contact, it must either be by the System, or by Sympathy. 140. of Ointment is as much as we should venture to employ. 1736. Mercury in any stage can only Cure the constitution by being absorbed into the System. This we must be aware of, & therefore if the surface of the Skin, will not absorb it, we must give it internally if the absorbents of the bowels will not take it up, no more than those of the Skin the Case of the Patient is really deplorable, & the Cure impossible. 1737. Some particular local affections in this Stage deserve attention as. a. Nodes 1738. If the affection of the Periosteum or bone has proceeded no further than inflammation & swelling, in general no particular application is necessary but the Venereal Virus only will require to be destroyed. ☽︎. 1739. Sometimes however it will be other wise, then they may be covered with Mercurial plaister or rubbed with the Ointments the latter is best. ♂. 1740. If these do not succeed we must try the effects if a new inflammation. Blisters applied round the Node have removed the pain & assisted the Cure. If Blisters fail an incision should be freely made in the diseased part that by the processes of Inflammation a new disposition may be formed in the parts, & the nature of a common sore produced. 1741. As parts may remain in a state of disease after the Venereal Virus is destroyed & the Constitution cured we may often very  141 safely leave the Nodes to time which will not uncommonly effect a Cure, but sometimes however a particular local treatment will be necessary. 1742. Nodes are often blended with Abscesses which seldom produce good matter, but generally a kind of slime or mucus which his flat on the bone & renders it difficult to determine whether there is a fluid underneath or of what kind. In this Case there is but little of the adhesive Inflammation. 1743. Inducing Violence of Action in the diseased parts, here facilitates their cure by destroying the present irritation, we should therefore make free openings. Exfoliation may more readily take place in bone affected with the Venereal disposition than any other diseased disposition, because here we have a specific remedy by which we can correct the present disposition. 1744. When a Node Occurs in a Tendon, if blistering does not relieve the tumor should be laid open as a ground work is laid for a very obstinate & disagreable Swelling which will neither yield to time nor Medicines & must therefore be attacked locally. 1745. As in the other Genus so here also New dispositions may be taken on by the parts affected which it may be difficult to distinguish from the Venereal disposition, & therefore may render it difficult to determine when the cure of the Venereal Virus is effected. 1746. To these new dispositions Mercury may be a poison increasing instead of lessening the evil. Many of them will take on a Cancerous ☿ 1746. A poor Woman in St. James’s Workhouse had Venereal complaints for which she underwent a course of Mercury, she had ulceration in her face which took on a new disposition seemingly Cancerous. Hemlock was applied internally & externally & she got well after having lost part of her Nose & part of her right cheek, in 12 months she relapsed. Hemlock & other means were tried in vain for she died of the complaint. ♃. 1747. One drachm of Opium dissolved in of water makes a very useful application to Venereal Ulcer. – ♀. 1749. Mr. Hunter has given powder of Sarsaparilla mixed with some farinaceous substances made into a pudding, that the patient might take it in very large doses. ♄. 1750. A Young Man had Venereal Eruptions & Ulcers in different parts of his body, under the Armpits on his Thighs. Scrotum &ca. some even of the size of a half penny a poultice of Gum Guaiacum Was applied to the right armpit & a poultice of Sarsaparilla To the left, removed every day, & continued for a fortnight, the sores in the right Armpit were cured, those in the left rather worse, left off the Sarsaparilla & applied the Guaiacum to the left which then healed in a fortnight. Gum Guaiacum ʒss joined with Opium was also given 3 times a day, by which means all the eruptions disappeared in a Month, he was allowed to stay in the Hospital 2 or 3 Weeks, after this seeming cure at the end of which time Eruptions again appeared 142 appearance. ☿. 1747. Ulcers in the mouth & throat often arise during the use of Mercury, these should be distinguished from Venereal Ulcers and treated with Bark, or Opium as Gargles. ♃. 1748. In some persons the long use of Mercury is followed by General debility of the constitution with all its effects as profuse sweatings an inclination to Hectic &ca. In this case the general strengthning plan is to be pursued Bark is useful but is no specific, Scrophula seems to have something to do in the present Case & this is rendered. the more probable by the disposition giving way 1749. Sarsaparilla has no power over the Venereal Virus, it is however very useful & seemingly specific, for many of the new dispositions taking place after the virus is destroyed. It may be of use in preventing the formation of [matter] such disposition & may be exhibited with Mercury. It is best taken in substance & in large doses or its Extract may be given. ♀. 1750. Guaiacum has some specific powers over the Venereal disease; how far these powers extend is not ascertained. We can however place no dependance on this remedy in serious Cases. Mercury is the only true & [useful] universal Specific, on it alone can we depend for it will cure in despight of every unfavourable concomitant circumstance, as irregularity in the patient, intemperance, Climate &ca. ♄ 1751. Hemlock is frequently of Utility in many of the new dispositions which form during or after the course of the Venereal disease Recourse was again had to the Guaiacum, that it had lost its powers. Mercury cured him. this shews that Guaiacum has some specific powers, though weak ones over the venereal disease. Mercury properly applied is the only true Specific. Mr. Hunter does not object to his Patients indulging in the usual diet or taking his usual Exercise, he may take the Sports of the Field by day & his Bottle of Wine at Night. 143. especially in such as from their appearance give cause to suspect cancer. 1752. A salivation will often go on from habit long after the Mercury is Eliminated from the System, it will sometimes remain for Months, though this is now rarely known to be the case, as the Mercury is seldom given in such manner as to produce violent Secretions by the salivary Glands, it is to be considered as a Gleet of those parts. 1753. Gargles prepared with peruvian Bark, Gargles of Opium, Sea bathing & good Air are beneficial. Dr. Mead used to recommend Tincture of Cantharides which may be tried. 1754. Sometimes the Alveolar processes of the teeth becoming [loose] diseased may be a cause of keeping up the spitting when this happens we cannot hope for a Cure until exfoliation has taken place. 1755. Prevention of the Venereal disease is effected by Applications Previous to or immediately after exposure to infection. 1756. Applications to be used previous to exposure are such substances as will not suffer the Venereal matter to come in contact with the Skin. 1757. Venereal matter being immiscible with oil, the part Exposed may be depended by anointing it with the most viscid Oil that can be conveniently had. 1758 Means to be employed after exposure are caustic Alkali properly diluted which will dissolve the Venereal Matter, or Goulards  144. – Extract of Lead which is a powerful coagulater of Animal juices & will coagulate the virus a Solution of Corrosive sublimate is also used & said to have succeeded when other means have been found inefficacious. – Finis.  145 Proposals for the recovery of drowned Persons. By Mr. J. Hunter Philosophical Transactions Vol: 66th. London 4to. 1st. Whilst an animal retains the powers though deprived of the motions of Life, the cause of that privation may be frequently removed; but when the powers of Life are destroyed, the action ceases to be recoverable. 2nd. Part of the living principle is in the Blood. 3d. The Stomach Sympathizes with every part of the Animal & every part with the Stomach, Cordials by their action on the Stomach excite universal motion & there is also a peculiar Sympathy between the heart & Lungs, many poisons, steams of phlogiston & Charcoal &ca. received into the Lungs the hearts motion instantly ceases & that much sooner than if the trachea had been tyed. From experiments anything salutary applied to the Lungs will restore the hearts action after it has been at rest for some time. Violent deaths are divided into 3 kinds. 1st. When only a stop is put to the action of Life in the Animal, not however by any irreparable injury to a Vital part. If this action be not restored in a certain time it will be irrecoverably lost. 2d. When an injury is done to a vital part. 3d. To when absolute death instantly takes place in every part as  146. is the case in Strokes of Lightening. Which of these three Deaths does the case of Drowning come under? probably the first. Here it first affects Respiration, then the Hearts motion. – Restore Respiration & Cure drowning. New born infants have been animated by blowing into their Lungs. Put the juice of Hone Radish, peppermint, Spt. Coma. Cervi into the Stomach & Anus. Avoid Phlebotomy & the fumes of Tobacco. Mr. Hunter has invented a Bellows to exhaust as well as to fill the Lungs & also a Syringe. –       INDEX Aphorism Page A Aneurism spurious---872---4 Aneurism---878---4 Abscesses---893---8 ___unsound---1123---46 B Bubo---1610---120 C Corns---944---18 Chilblains---946---18 Carbuncle---984---23 Coopers Glands obstructions of in Women---1120---45 Cancer---1157---50 Chordee---1327---75 ___cure of---1387---82 Chancre---1539---108 F Fistula---7090---40 ___in Ano---1107---43 ___in Perineo---1109,1475---43,97. ___Lachrymalis---1113---44 ___of the Parotid Gland---1117---45 ___communicating with Joints---1111---44 Fungated Sore---1198---55 G Gonorrhea---1310---72 ___cure---1362---79 H Hæmorrhages---848---1 I Indolence & Irritability---918---14 Itch---1230---59 Infection of the second order of Parts---1652---126 M Mercury mode of exhibiting---1680---130 ___ulcers in the mouth from---1747---142 N Nodes---1737---140 P Poisons---1130---47 Prostate enlarged---1533---107 Phymosis & Paraphymosis---1553---111 Prevention---1755---143 S Scrophula---1017---29 ___cure---1051---35 Seminal Weakness---1477---97 Salivation---1752---143 Strictures---1490---99 T Tendons ruptured---912---11 Tumors---955---19 Testicle swelling of---1332---75 ___cure---1394---84 Tetanus---996---25 U Urethra obstructions of---1432---89 ___strictures of---1435---90 ___cure---1490---99 V Veins Varicose---945---18 Venereal disease---1240---61 W Wounds---888---8 Warts---1589---108