A PRIVATE TREATISE ON VENEREAL DISEASE, GONORRHCEA, «fec. &c. THE PRIVATE CHEST COMPLETE. The chest complete containing the book fitted in the lid,—the medicine for the Venereal disease,— the medicine for Gonorrhoea,—the Patent Syringe, and ingredients for injections,—price $15. A smaller chest containing the medicine for Gonorrhoea alone, together with the book, patent syringe, <$c, is $10; and one containing the medi- cine for Venereal alone, with the book, is $10. The book alone is $1. The le is fitted in a little mahogany chest, not larger than a small book, with lock and key, and is conveniently and privately forwarded in the form of a package to any part of the United States, the West Indies, or elsewhere.. THE PAPENT SYRINGE BAG. D A, The bottle open.' B, The pipe. C, The cap. D, The syringe filled. The Injections are made by putting one of the powders into the bag, and filling it with water; the pipe is then screwed on, and over this the cap, for the purpose of carrying it in the pocket. Entered according to an Act of Congress, in the year 1840, by Joseph Ralph, M. D. Casper C. Childs, Printer, 80 Vesey-si. A PRIVATE TREATISE ON VENEREAL DISEASE, IN TWO PARTS. The First on Gonorrhoea,—vulgarly called Clap. The Second on Venereal, properly so called. Adapted to the use of every one, but more espe- cially designed for those who are delicately cir- cumstanced and require a private as well as a speedy cure. BY JOSEPH RALPH^fM. D. Graduate of the University of Edinburgh;—Member of the Royal College of Surgeons, London ;—and Author of " The Family Physician,''' fyc. fyc. THIRD EDITION, ---- \ V- v *. r-% Sold by the Author—Dr. Ralph—SB G'men.KfflL-itreel',' N. Y.: who may also be consulted confidentially, by post or othei'wise, on those various and delicate circumstances and, diseases which relate especially to sexual weakness in either male or female. The consultation fee is five dollars, but this is not expected when the Utile chest, fyc.—described in page 142—is requested. wc 140 R\t*3]p INDEX. Introductory remarks,—which should be read by every one. PAGE. CHAP. I—On Gonorrhoea,—Its nature,, symptoms, progress, and consequences. * - - 1* CHAP. II.—On certain diseases which resemble Gonorrhoea in some respects, and are fre- quently mistaken for it, but which are totally distinct and different diseases. - 23 CHAP. III.—On the remedies in general use both in Gonorrhoea and Venereal disease. 45 CHAP. IV.—On Gonorrhoea—Its treatment and cure. 73 CHAP. V.—On Gleet,—Its nature and cure. - - 85 CHAP. VI.—On Stricture,—Its symptoms, nature, consequences, and cure. - - - - 95 CHAP. VII.—On Gonorrhoea in the eyes, and Gonor- rhoea! Rheumatism. - - - - 126 CHAP. VIII—On Gonorrhoea in Females. - - 135 CHAP. IX.—On Venereal disease, properly so called— Its distinguishing marks, its nature, pro- gress, and general principle of cure. - 144 CHAP. X.—On certain complaints which resemble Venereal disease, and sometimes arise from sexual intercourse, but which, never- theless, are not Venereal, nor can be treated as such without the greatest dis- advantage. Persons affected with these complaints are often cruelly imposed on by advertising people. - - - - 153 CHAP. XI.—On the use and abuse of Mercury, with rules for its proper management in the cure of Venereal disease. - - - - 177 CHAP. XII.—On Venereal disease,—Its treatment and cure......- - 217 CHAP. XIII.—On Venereal sore throat. - - - 236 CHAP. XIV.—On Venereal blotches and eruptions on the skin.......245 CHAP. XV.—On Venereal in the Bones. - - - 252 CHAP- XVI.—On the effects of Venereal on pos- terity, &c.......271 INTRODUCTORY. The principal object of this little book is to place before the reader a plain and faithful account of two infectious maladies—Venereal Disease, and Gonor- rhoea, together with the best and most private way of curing them; also to enable every individual to detect and escape those various impositions and deceptions which are daily practised by people who literally swarm about in almost every city. It is by no means surprising that so many persons should be unacquainted with these maladies, as the opportunities of gaining knowledge of this kind are not common; still the consequences of this total ignorance are often very serious. There are those, for instance, who are not even aware, that under the common name of Venereal, there are two dis- tinct and very different diseases. Now it happens that remedies which are good and proper in one of these complaints, are always useless, and sometimes exceedingly injurious in the other. How unfortu- nate therefore to find, after taking one or other of some boasting nostrum for many weeks together, that it was not intended for your complaint, but for one of a different kind, and this is a thing which happens continually. It would be easy also to show that these boasting remedies.are miserable speci- mens at the best, but being sold as they are, alike to persons of every kind of constitution, habits, and age and other circumstances, the consequences are often still more serious, while it is the merest chance they should do good in any given case. But there is a still more weighty reason why this subject is more worthy ©f attention than many may1 suppose,—it is because there are several other dis- orders of the urinary and sexual organs which very V1U. INTRODUCTORY. much resemble the Venereal, but which have nothing at all to do with that complaint, being perfectly in- nocent in their nature, and which arise, sometimes spontaneously, and sometimes by communication between persons of the most virtuous character. Now it is a terrible thing for an individual in such a case to fall into the hands of an advertizing quack, for he would be sure to say immediately it was Venereal, and beside the injury inflicted on the constitution by uncalled-for remedies, he would also break the peace of mind, if not the heart of innocent parties. I solemnly avow that I never pass a single week in which I have not persons come to me from knaves of this description, who have been taking medicines for many months, and even yeais, and all this time have suffered in their minds beyond expression, but whom, I am morally certain, never had the complaint at all. Is not the subject of this little volume therefore worthy the attention, if not of every person, cer- tainly of those who are in the least concerned, and especially being written, as it is, by one whose ex- perience and reputation, and the references he will presently allude to, so fully guarantee the truth and faithfulness of what he states. For the purposes of plainness and convenience, it seems desirable to divide the subject into chap- ters, and merely mention in this place the chief points which each embraces, so that on running over these few remarks, any one may fix at once on whatever may appear most useful to himself. The first chapter, then, embraces, the nature, symptoms, progress and consequences of Gonor- rhoea—vulgarly called Clap. This should more especially be read by those who do not know that Gonorrhoea and Venereal are two distinct and dif- ferent diseases, requiring very different modes of treatment. It will be also seen that Gonorrhoea is INTRODUCTORY. IX. sometimes a very difficult and tedious complaint to cure, requiring much skilful and patient perseve- rance in the use of proper means; at other times it will yield more kindly and quickly, almost to any of the usual remedies. No doubt, most of the tedi- ous cases met with are the consequence of taking certain pills and drops which are daily advertised; and others, again, are owing to peculiarities of con- stitution—being unfavorable to a. speedy cure ; but by far the greatest number of these bad cases arise from the want of knowing something of the nature and progress of the disease itself, so that the proper remedy should be taken at a proper period, and under certain circumstances only. These circum- stances therefore in this chapter are carefully pointed out. The second—is on certain diseases which resem- ble Gonorrhoea in some respects, and are frequently mistaken for it; but which, nevertheless, are totally distinct and different diseases. This is a subject of the deepest interest, particularly as there is a class of persons, who, either from ignorance or knavery, call every thing they see upon these organs Venereal. It is not however, as 1 have there ob- served, the being thus cajoled and put to inconve- nience and expense, which is the Worst of this, but it often leads to painful and most unfounded appre- hensions and suspicions. I have known it to inter- rupt the happiness and even threaten the disunion of virtuous couples. The third chapter—is on the remedies in general use both for the cure of Gonorrhoea and Venereal disease. It seemed proper, before entering on the cure of these diseases, to explain the value and pro- per use of such remedies, especially as I have often found that many had been taking medicines in one of these complaints, which was intended for the other j and also, because the same medicine which X. INTRODUCTORY. is useful in one may be absolutely useless and inju- rious in the constitution of another. But here I cannot pass without a word or two upon a fact which I am certain will be granted by every thinking man,— I mean the absurdity and wickedness of selling any one a box of pills or bottle of drops for the indis- criminate cure of these complaints, and under all the various circumstances which may attend them. These circumstances I have shown to be numerous and important, arising as they do from habits of life, age, sexes, and peculiar kinds of constitution. In fact, the circumstances which may at any time occur in the course of this disease, but which do not properly belong to it, are far more dangerous and distressing than the disease itself.—In this chapter, also, the nature of injections,—their safety, efficacy, and sometimes indispensable necessity, is explained. I have also here described my pocket gum-elastic syringe,—contrived for the purpose of convenience and privacy—the value, simplicity, and convenience of which can scarcely be conceived without refer- ring to the plate, page 60. The fourth chapter.—This is on the cure of Gonorrhoea.—The nature of Gonorrhoea and its remedies having been explained, its cure is now exceedingly easy to understand and manage. Not that it is necessary for every one to read these chap- ters severally, on the contrary, it is sufficient only to peruse this simple one on the cure of this com- plaint ; most people however feel a pleasure in being acquainted with the principle on which their cure proceeds, as well as with the fact itself. The fifth chapter—is on Gleet—a consequence of a badly treated Gonorrhoea. On this subject the remarks as to whether a Gleet retains.the infectious nature of Gonorrhoea or no, are well worthy of at- tention, especially as some very erroneous notions are entertained upon4t. Many a person has unin- INTRODUCTORY. XI. tentionally involved others in this complaint in con- sequence of such errors. This indeed I have felt to be of so much consequence as to take the greatest pains to place it in its proper light; and, that I might put every one seriously on his guard, I have given the opinion, and also the very words, of one of the greatest Surgeons in the world, upon the sub- ject—Sir Astley Cooper. The sixth chapter—is on Stricture—a subject than which there is none of more importance in the whole range of Venereal maladies. It is also one which affords the richest field for all impostors. Here you will find them persuading unsuspecting people to take their drops or pills, or some such thing, for months together, while every real Physi- cian absolutely knows that all the medicine in the world, alone, would never cure it. This every one will see immediately on reading the remarks upon the nature of Stricture. Here also he will see that the discharge which now and then attends a Stric- ture, may perhaps be stopped, to return again on some occasion of excitement, but that this is a very different thing from curing the disease; and that perhaps it is better not to stop it, for in this case a person is more completely off his guard, and is more likely to remain unconscious of it, even for years, or until some of its remoter consequences draw his attention to it. Many persons have been to me with these effects who never dreamed they arose from Stricture, untrl it was explained and its exist- ence proved to them. I have therefore spared no pains to make the nature of a Stricture understood, as well as the symptoms which attend it; and it gives me pleasure here to add, that, although I con- sider Stricture to be the most serious thing that can possibly befall an individual, yet the means of curing it are simple, easy, safe and certain ; hundreds un- der my own immediate care can attest this truth, Xll. INTRODUCTORY. many of whom have been cured in as many weeks as it had existed years before. The eighth chapter—is on Gonorrhoea in females, in which every necessary direction is given to ena- ble them to cure this malady in a speedy and private manner. The ninth chapter—is on Venereal disease, pro- perly so called. The necessity of distinguishing this from Gonorrhoea, together with its general prin- ciple of cure, are here most clearly pointed out. The tenth chapter—relates to certain disorders which resemble Venereal disease, and sometimes arise from sexual intercourse, but which, neverthe- less, are not Venereal, nor can be treated as such without the greatest disadvantage, &c., &c. It is impossible to mention any part of this chapter as more interesting than another. The heading of it implies the nature of the remarks it may be expect- ed to contain, and these must be read in connexion, to be understood and properly appreciated. This, indeed, is the case with regard to every following chapter on Venereal disease. I propose therefore, with one exception, to do nothing more than merely state the subjects of them. The exception I allude to is— The eleventh chapter—in which the use and abuse of Mercury, with rules for its proper manage- ment in the cure of Venereal disease, is given with every possible degree of plainness. As in Gonor- rhoea, so of Venereal, after de'scribing its nature, and the circumstances which distinguish it from disorders that resemble it, it seemed proper, before entering on its cure, first to explain particularly the nature and properties of its peculiar remedy—Mer- cury. I will venture to say few persons will read this chapter without shuddering at the idea of taking Mercury from advertising quacks. Well may they disclaim, as many do, the use of Mercury in their INTROnUCTORY. Xlll. pills and drops; this pretension however I will ex- plain, for it will enable every one to judge exactly of its value. As may be seen, (page 152) it was once supposed that Venereal disease could not be cured effectually without the aid of Mercury; later investigations however, proved it could be. This admitted, the question then was, which was the best—the most expedient plan? Now, this latter discovery con- sisted, not in any new or particular medicine or remedy which could be substituted in the place of Mercury, but in a certain plan and course of man- agement. This plan, however, was such, as very few could possibly comply with; it consisted in confinement in the house or bed, together with such a course of antimonial or other reducing medicines as greatly unfitted, even after the cure, for any bodily fatigue; not to mention the frequent instances of a feturn of the disease after the supposed cure. Not even the warmest advocates for the non-mercurial plan, as it is called, ever pretend that there is any medicine whatever, or pill, or drops, that is a sub- stitute for Mercury. I put it then to every man of common sense—with what honesty can any person advertise a box of pills, or bottle of drops, or any thing of this kind, to cure Venereal; or, if it be Mercury—with what feeling could he put this medi- cine into the hands of any one, without apprising him of all the serious incidents that may possibly attend its use, together with the means of avoiding or correcting them. I leave it however to my reader to adjudge such characters. But this I know, and will here state—the worst and most complicated cases of Venereal that have ever consulted me, have all been the unfortunate dupes of some of these pre- tenders. For myself, eonscious that Mercury is the best, the safest, the speediest, and indeed the only certain remedy for the cure of Venereal disease; XIV. INTRODUCTORY. but, persuaded also that this, of all valuable remedies, is more easily abused by ignorant and presuming people, I have bestowed in this chapter the utmost care to show its safe and proper use. The twelfth—is on the cure of Venereal disease. Here I have begun with the first appearance of it, (a chancre,) following it through every stage^ in- cluding the various accidental circumstances that may attend—as inflammatory swellings, bubo, &c. &c, and I trust have given in each those rules and explanations which will be found so satisfactory and plain, as to make it next to impossible to mistake. The thirteenth chapter—is on Venereal sore throat. The fourteenth—is on Venereal blotches on the skin, &c. The fifteenth—is on Venereal disease in the bones. In this I have noticed particularly the pro- gress of the disease from the throat or roof of the mouth to the bones of the nose, and have taken especial pains to point out the means of immediately stopping the progress of it, when it threatens to affect these bones,—the destruction of which causes so much inconvenience as well as disfigurement of the countenance. The sixteenth—and last, is on the effect of Vene- real disease upon posterity. In this place it would be in vain to attempt a summary of this chapter; and, indeed, it would be of very little use to do so, as those to whom it should in any way relate, would certainly make it the subject of perusal. As a concluding paragraph or two, I would now observe, that, among other benefits accruing from this publication, if it should only have the effect of putting individuals on their guard against the divers snares and traps which beset them upon every side on the subject of these diseases, it will be no slight -••■-—Alarmed and delicately *;-«■.*-*>*+-—' ■.« INTRODUCTORY. XV. many are, I do not wonder that they should be caught by a promise of being cured with a bottle of drops, or box of pills,—or in a day, or an hour, or any thing else they'choose;—but why not exercise the same good sense on this as on any other sub- ject? Would you risk your health and happiness, in any other case, to one with whose talent and integrity you were perfectly unacquainted?—As to the idea that Venereal disease is of such a nature as to be safely trusted to the cure of any one who assumes the name of Doctor, nothing can be more fallacious.—Look for instance at the case related page 260. This gentleman came fresh from the hands of such a person; and he is only one of thou- sands.—And even in the case of Gonorrhoea, this also often proves a much more serious and distress- ing malady than you would suppose, to listen to the boastings of these kind of people. Hear the avowal of one of the greatest surgeons in the world upon the subject,—Sir Astley Cooper.—"Gonorrhoea," Sir Astley affirms, " is a disease which may often " baffle the longest experience, and the greatest " professional skill." If then Gonorrhoea is so seri- ous a disorder in such hands, what must it be with persons of the description here alluded to! The fact is, as I have already stated, Gonorrhoea, in some few instances, and if taken early, is very speedily cured; but this depends, not on any particular medi- cine, to be made a secret of, but on a favorable kind of constitution. The best thing that possibly can be taken at such an early period, and with such a view, is the Cubebs, as mentioned page 50, and when this fails to cut short the disease, as I would express it, it is still the best preparatory means to any other. It therefore seems that the cure of Gonorrhoea will sometimes prove a tedious thing in spite of very skilful treatment. In this case the only step to take Xvi. INTRODUCTORY. is to consider well the kind of person in whose j udg- * ment and fidelity you have trusted. If for instance it is one of those who promise to cure in a day, and boast of wondrous remedies and secrets, depend upon it you have made a wrong selection. As to the praises such folks bestow upon themselves, or any list of long certificates, these are of little conse- quence ; make inquiries rather of the most respecta- ble and eminent physicians of our city; these only are capable of giving the information you require. Of course, after these remarks, I can have no pos- sible objection that such inquiries should be made about myself; on the contrary, I invite such; and being in the constant practice of meeting the most eminent physicians of our city in consultations, there will be no difficulty in doing it. But, in addition, (and in addition also to my rank as graduate of the University of Edinburgh, and member of the Royal College of Surgeons, London, &c, as well as beiDg author of " The Family Physician"—the result of nearly thirty years experience,) I have the happiness of possessing letters of commendation from the most eminent men in Europe to the most eminent in America—as the late Doctor Physick of Philadel- phia,—Doctor Moti, of our city, and others, and which letters may be seen by any one who wishes it. I will only now request, that those who consult me from a distance, would be more particular in describing the symptoms and circumstances which attended the first appearance of their disease, as well as the plan of treatment they first adopted. My consultation fee on these occasions is Five Dol- lars ; but if the little chest of medicine is requested, I do not expect my fee for consultation. (Every one should read the introductory pages.\ A PRIVATE TREATISE ON VENEREAL DISEASE. IN TWO PARTS. The First on Gonorrhoea, fyc, vulgarly called Clap. The Second on Venereal Disease, properly so called. FIRST PART. CHAPTER I. On Gonorrhoea,—its Nature, Symptoms, Progress and Consequences. The first thing to know on this subject is, that Gonorrhoea and Venereal Disease are two distinct and very different disorders.—A person having Gonorrhoea, for instance, cannot give another the Venereal Disease; nor can one having Venereal Disease give to another the Gonorrhoea. Neither, again, can a Gonorrhoea change into the Venereal; nor Venereal into the Gonorrhoea. Both diseases however may perchance exisi in one and the same person, and then, both may be communicated at the same time, or one alone, just as it may happen. But 18 Gonorrhoea,—Its Nature. the thing to be remembered is, that they are two distinct diseases, and this is the more important, because, as I shall presently have to show, they require very different remedies and modes of cure. I cannot do better now than give a description of the first of these complaints—the Gonorrhoea—and this shall be done in words as few and plain as pos- sible, so that, by comparing it with the description of the Venereal, which shall immediately follow, any one will see the difference of these two diseases in a moment. Gonorrhoea, then, is an infectious disease;—it is seated in the urinary passage, from the orifice of which there issues a discharge of matter, attended, more or less, with pain and heat in making water. There is no outward sore or ulcer in Gonorrhoea; neither indeed is there any within the passage. If it were possible to take an inside view of the uri- nary passage, nothing would be seen there but red- ness and a little swelling, and the discharge, whether much or little, would be seen issuing from the red and swollen state of the membrane which lines it,— just as matter is sometimes seen issuing from an inflamed eye. Venereal Disease, on the contrary, is not seated in the urinary passage, but externally, on some part or other of the penis or genital organs, and consists Gonorrhoea,—Its Nature. 19 in a little ulcer or sore which does not heal like other sores, but continues unhealed, and, at length, assumes a peculiar character. Gonorrhoea, then, consists in a discharge from the urinary passage, attended, more or less, with pain and heat in making water, without ulceration or sores; whereas Venereal Disease consists in ex- ternal ulceration or sores, without discharge from the urinary passage, and without pain and heat in making water.;—No one then, it is presumed, afier this can possibly mistake these two diseases, and it will therefore now be proper to describe particularly, how a Gonorrhoea commences and proceeds. But before entering upon a particular history of this disease, it is desirable to say a word or two respecting the time when a Gonorrhoea first appears after an exposure to it, for many persons wrong themselves with dread and apprehension long after there is the least occasion for it. To the question then so often put,—when may I consider I am safe? I reply, after the seventh day, if none of the symptoms presently to be mentioned should appear, you may consider you have escaped,—that you are safe. It is true there is some difference in the time of its appearing in different individuals. Some have said, for instance, they have known it to appear in 24 hours, and others, that it has been delayed for 10 and even 14 days. I very much doubt, however. 20 Gonorrhoea,—Its Nature. whether it ever appears at this early period. In- stances of this kind which have occurred to me, have always proved to be cases of Stricture, not of Gonor- rhoea; while those delayed for fourteen days are very rare,—I have never met with one. By far the most common period is the third day. The seventh is the longest I have ever met with, and it is on the ground of this experience I venture now to say, that, whoever has passed the seventh day without any of the symptoms presently to be mentioned, may consider be is safe—that he has escaped,—however suspicious the party may have been. Thus much then as to the time when a Gonorrhoea begins, and now, as to its manner of beginning. A person having been exposed to this infectious malady, at some period within seven days, if he should have taken the disorder, will feel a little pain and heat in making water. This soon leads him to examine the part, and then, on squeezing it, a little matter of a whitish color is seen coming out of the urinary passage. Next day this painful heat and discharge will have increased, and the color of the matter become a little yellowish. Sometimes the pain and heat in making water will be exceedingly great, amounting to a sensation of absolute scald- ing ; at this time the discharge generally turns to a greenish color, and, instead of being about as thick as cream, it is thin and watery. Under these cir- cumstances also there is a painful sensation along Gonorrhoea,—Its Symptoms. 21 the whole length of the urinary passage, and the penis swells, and is subject to attacks of frequent and very painful erections. A Gonorrhoea always begins with pain and infla- mation, more or less, which, after a little while, abates or subsides entirely. In speaking of _a Go- norrhoea, therefore, we call the beginning of it its inflammatory stage. But the degree of pain and inflamation at the beginning of Gonorrhoea, differs exceedingly in different persons; some will have so little as scarcely to complain at all, while others suffer most severely; in every case, however, after a little time it subsides, whether any thing is done for it or not. Persons (coming from some of the adver- tising quacks) will often say, "but the stuff they gave me removed the burning pain," when, in fact, it had nothing at all to do with it; for, unless the healing things they generally give increase the burning pain, it subsides itself, spontaneously. After a short time, then, or, if there has been much pain, after this has subsided, what we call the second stage commences. This second stage of the disease consists simply of an infectious dis- charge, issuing from the orifice of the penis, with- out much pain. This discharge is more or less in quantity indifferent persons, and is much increased by whatever may excite, or by irregularities of any kind. And, when once this second stage has been 22 Gonorrhoea,—Swelling of the Foreskin. suffered to commence, there is no exactly telling how long it may continue, or how it is to terminate ; but let it ever be remembered, that, as long as this discharge continues the disease may be communi- cated by infection. But, thus far, I have spoken of a Gonorrhoea in its simple form, and have mentioned those symp- toms only which are essential to it, and which are never absent from it; there are however other symptoms which are only sometimes present, which may, or may not present themselves, but which when they do occur (and some of them generally do) form the severest part of the com; laint and call for immediate and peculiar remedies. In fact, it is for the want of knowing something of the nature and importance of these accidental symptoms, that Gonorrhoea assumes its most distressing character, and leads to the worst consequences. Those, cir- cumstances which may, or may not occur in Gon- orrhoea, are called occasional symptoms, and are the following :—a swelling of the foreskin—swel- ling of the glands in the groin—very painful erections of the penis—and swelling of the testi- cles. The nature of these circustances therefore are now to be explained, but the particular mode of treating them will be given when we come to speak of the cure of Gonorrhoea. First, then. Swelling of the foreskin.—This is the effect of Gonorrhoea,—Swelling of the Foreskin. 23 inflammation, which a full and irritable constitution or irregularity of habits gives rise to. The struc- ture of the skin which covers the head of the penis, (the prepuce,) is very loose and cellular, so that when the inflammation happens to be high, this structure fills with the thin and colorless part of the blood and causes it to swell. Sometimes the skin is swollen amazingly, and looks of a bluish white, being half transparent, and is very apt to create alarm. Indeed, there is some- times reason for alarm, for when this swelling is considerable the skin cannot be pushed,back over the penis, or, if pushed back, it cannot be brought forward again, so as to cover it. Now, there is not so much danger in this swelling itself, as in the consequences of it; for if the skin cannot be push- ed back, the matter under it accumulates and be- comes acrid and irritating, and you cannot avail yourself of cleanliness, which is always of import- ance. And on the other hand, if you cannot bring the prepuce forward, it produces danger by acting as though a string were tied around the head of the penis, preventing the return of the blood, so that it swells prodigiously,—looks blackish,—and some- times even mortifies and comes away. This, how- ever, can always be prevented by proper manage- ment, which will be shown, as I have already said, in the chapter on the treatment and cure of Gon- orrhsea. 24 Gonorrhoea—Swelling in the Groin $■ Cordee. Swelling of the glands in the groin.—This also is the result of inflammation, spreading to the gland- ular bodies situated in the groin. In every part of the body there are certain little vessels called ab- sorbents, and these, in their course, run through ab- sorbent glands, of which there are several in each groin. Now it happens that inflammation in the urinary passage is communicated through the me- dium of these vessels to the glands in the groin, which become painful and enlarged in consequence. It is however worthy of remark, that in Gonorrhoea, these glandular swellings seldom go on to form a bubo, (which is,an abcess in the groin) as they are apt to do in Venereal disease, so that they are com- paratively innocent; after a little time they gener- ally subside and disappear. Another of these oc- casional symptoms, is,— Frequent and very painful erections of the pe- nis.—This is a distressing and tedious symptom, the nature of which I will endeavour to explain.— In fact, it is nothing more than inflammation ex- tending from the urinary passage into to the sub- stance and body of the penis, and it seldom occurs except the inflammation runs high. The structure of the penis is remarkable,—it is made up of large cells, into which the blood is determined under cer- tain circumstances of excitement, and when these are filled, the penis is erect. Now the effect of the inflammation in these cells is to glue them together, Gonorrhoea,—Swelling of the Testicle. 25 so that when the blood is rushing into them, as we know it does under sexual or other kind of excite- ment, it tears them apart, and gives excessive pain. Sometimes these cells, thus glued together, will not yield, the figure of the penis is then a little crooked, as we often see. The pain accompanying tills is terrible. This is what the French call Cor- dee—the cure or preventing of which we shall pre- sently come to. The fourth and last of the occa- sional symptoms of a Gonorrhoea is,— Swelling of the Testicles.—This I consider a very important thing, for here, the pnin is so great, and the necessity of rest and lying in bed so urgent, that it is difficult to cure such cases with that secre- cy which is so often desirable. Much, however, may be done to prevent it, if early attended to, and therefore the symptoms which precede and lead to it, shall be noticed carefully. The first thing which precedes a swelling of the testicles, is a sense of pain running down the whole length of the urinary passage, accompanied with a feeling as if a drop or two of urine was remaining in the passage after you have finished making water. To this there succeeds a dull pain in the groin, which goes on to effect the testicles. When these occur, no time should be lost. In this case never omit to suspend the testicles immediately. This, if you have not a proper suspensory bandage, you can 26 Gonorrhoea,—Does it ever cure itself. easily do, by making a little bag of muslin, which you can pin to a bandage round the waist. At the same time take an active purge or two, and remain as quiet as possible ; but more will be said upon its treatment in its proper place. This then, is all that need be stated on the nature, symptoms, and progress of Gonorrhoea. With re- gard to its consequences, these I shall only mention here, for the consequences which too frequently re- sult from Gonorrhoea, are of so much importance in themselves as to demand a separate chapter. The consequences then which a badly treated Gonorrhoea lead to, are—Gleet and Stricture ; which latter again gives occasion to a train of symptoms the most lamentable that can be conceived, of which impotence is one. But, before I leave this subject, I would remark that many have put this question to me,—does this disorder (Gonorrhoea) ever cure itself,—does it ever wear itself out? To which I have always replied, it may do so; but it is a most terrible risk to run; for not only will it wear out the patience of the patient, but will leave open the widest door for the consequences I have just enumerated. The general consequence of a Gonorrhoea, if not early and properly treated, is a Gleet, and a Gleet im- plies a certain morbid state of the passage of the urine, which, if long continued, is almost sure to Gonorrhoea,—Summary of. 27 terminate in Stricture,—a disease than which I knew nothing which, in the hands of most people, is more baffling and truly lamentable. The following then is a Summary of the first chapter:— Gonorrhoea is an infectious disease, attended with pain and heat in making water and a discharge from the urinary passage. In its progress it gives rise to various symptoms, as,—excessive pain in making water,—swelling of the foreskin,—swelling of the groin,—painful erections of the penis,—and swelling of the testicles. Its consequences are,— Gleet and Stricture,—the latter frequently termina- ting in impotency. 2S Gonorrhoea,—Disorders which resemble it. CHAPTER II. Oh certain diseases which resemble Gonorrhoea in some respects, and are frequently mistaken for it; but which, nevertheless, are totally distinct and different diseases. Nothing can be more valuable, to those concerned, than to know how to distinguish between real Vene- real disease and diseases which are not venereal, but which resemble it. Those into whose hands this little book may fall will be enabled to do this effectually, and will thus escape the advertising schemes of a set of people the most unprincipled and detestable that were ever suffered to deceive the public. These people, either from ignorance or knavery, call every thing venereal they may happen to see upon the sexual organs. Now, the structure of these parts, in many respects, is the same as that of other parts of the body, and they are subject to the same diseases we meet with in other parts. It is a fact, and one which I shall presently show most clearly, that many of the disorders these people call Venereal, have nothing at all to do with that dis- ease. Nothing is so easy as to deceive an inex- perienced person into such a belief. Knowing he has been once exposed, although it might be far too long ago to be the cause of his complaint, yet, if he Gonorrhoea,—Disorders which resemble it. 29 happen to have any strange appearance on these organs, he directly thinks it must be this disease. Indeed I am frequently troubled to convince them it is not so; out, let them go to any of the people I allude to, and they are sure to be confirmed in this belief. There is however another and a far more serious view to take of this deception,—it is, its effect upon the mind.—The money they extort on such a plea is nothing; nor is the fine and healthy constitution which they ruin half so great an evil as the anxiety and load they fix upon the mind—it breaks the spirits. In a single man, a false impression of such a kind may be of little consequence; and there are married couples, of a moral stamina so firm and un- assailable, that, mutually confiding in their own in- tegrity, no insinuations of this kind could possibly tell upon their happiness ; but, on the other hand, there are others of a less confiding disposition,— those in whom symptoms so new and unaccountable, especially if explained by insinuations of such a nature, would leave a deep impression, if not, in- deed, destroy the very basis of connubial confidence. And this is no imaginary case, nor yet a very rare one. Enjoying, as I do, much of the confidence of this city, and being known to have given much at- tention to this class and order of diseases, cases of this nature frequently occur to me, and, sometimes too, of great importance. This indeed will readily 30 Gonorrhoea,—Disorders which resemble it. be imagined when the remarks I am now about to make upon the subject shall have been perused. The diseases which in some respects resemble Gonorrhoea and are frequently mistaken for it, but which, nevertheless, are totally distinct and different diseases, are chiefly four. These I will now proceed to notice, and will also show their proper treatment, which is always very simple and successful. The first of these complaints occurs in men, and consists of,— The natural secretion of the part, accumulated beneath the fore-skin—When this occurs it becomes irritating and excoriates the innersurface of the fore- skin, as well as the head of the penis, giving rise to some uneasiness and swelling. At this time, if the fore-skin is pushed back, the parts beneath it look quite serious,—the discharge accompanying is offen- sive and considerable,—the parts swollen,—and the excoriated surface presents a red and quite angry appearance. Now, in this state, it is an easy matter to impose upon the mind the false idea of a Clap or Gonorrhoea. Indeed, as I have said before, it is sometimes difficult to persuade a person it is other- wise. Yet, all this is a very innocent affair. To be convinced that this is not a Gonorrhoea, just look to page 4,—observe the description of that disease, and Gonorrhoea,—Disorders which resemble it. 31 compare the two. There you will find that the dis- charge in Gonnorrhoea issues from the orifice of the urinary passage, from which you may always squeeze a little matter: but in this the discharge is supplied from the surface of the fore-skin and head of the penis. This is quite enough to show it is not a Gonorrhoea. And that it is not Venereal, you may likewise be as certain from the fact, that this—the Venereal— begins with one, or at most with two, distinct little ulcers, which are inclined to become deep instead of broad, and which discharge but very little matter, whereas, in this, the discharge is copious, and there is no ulcer at all—it is rather an excoriation of the skin than an ulceration. Now it is a grievous thing for a man to be told he has got a Gonorrhoea, and to be treated accordingly, under circumstances like these. The truth is, this case is nothing more than a little alteration in the secretion of certain glands situated under the fore-skin, occurring frequently in those who neglect to wash these parts, particularly in hot weather; and its cure is easily accomplished, simply by washing often in the day with Goulard's Lotion, (sugar of lead wash,) or brandy and water, or even plain cold water—taking at the same time, a dose or two of cooling physic. 32 Gonorrhea,—Disorders which resemble it. The next of these diseases is of more importance ; it is one which occurs in females, and often gives occasion to many painful and unfounded fears, for it approaches, in appearance, much nearer to Gon- orrhoea. It consists of,— Symptoms resembling Gonorrhoea, communica- ted by Females in whom no appearance of disease can be detected, or who have only those complaints which are considered innocent and common.—This is a disorder on which 1 am very anxious to be plain, and to be thoroughly understood. It occurs often in those who have a discharge resembling what is called the " Whites," or " Weakness." Now the Whites is a disorder to which many females, both married and single, are subject. The discharge of it varies in quantity and appearance; it may be much or little ; clear, or opaque and milky; thin and watery, or thick and adhesive. In one or other of these forms, how- ever, varying from circumstances, the Whites may continue for many years, proving to be nothing more than a secretion of what is natural to these parts, but increased in quantity or altered as above described. The circumstances which originally cause, and which vary this disease, are many,—such as weak- ness of these organs,—too great fullness of their vessels,—having children fast,—or too great excite- ment of the parts, and others. But, although this disease, the Whites, may, and most frequently does Gonorrhoea,—Disorders which resemble it. 33 remain for any length of time without producing any corresponding malady in the other sex, yet, on the other hand, it may, and sometimes does become infectious, communicating the like disease to another person. Now, the object of this chapter is to show that it does so, as it were, spontaneously,—that is to say, without intercourse with other, or infectious persons. With respect to the fact itself, that disease resem- bling Gonorrhoea may occur in innocent women, spontaneously, which is so far contagious as to af- fect others, I would only observe, that there are but few Physicians of much practice who have not had cases which they would be puzzled to explain on any other principle. I will here give the out- line of one or two as they have occurred to me.— A gentleman came, for instance, with the following statement:—Sir, said he, I have some strange symp- toms of disease about me; and such, indeed, that if it were not for my confidence in another party, I really should suspect to be the symptoms of a Gon- orrhoea, for I once contracted that disease and know something of its nature. Well I said, what are the reasons which lead you to determine it is not a Gon- orrhoea? He replied, the party I refer to is a lady whose word I could not question; besides, I have known her long, and am quite certain that no con- sideration in the world would allow her to expose 3 34 Gonorrhoea,— Disorders which resemble it. me to the possibility of such a malady. And fur- ther still, having mentioned these circumstances to her, she denied it firmly, and is desirous that some one should see her—so perfectly unconscious is she of having any such disease. Now on this occasion I could detect no one single symptom of disease, and what is still more worthy of remark, I learned she was in the habit of being visited by another, and who also was perfectly free from every symptom of disease. But in my Note Book 1 have a still more curious case, and which I think is worth relating more particularly. It is this. A gentleman who had formerly been my patient, consulted me on what we took to be a Gonorrhoea, and at the same time re- quested me to see the lady, whom he had known some time, and who assured him she was perfectly free from any such disease. I did so, and found it exactly as she had stated, she had no one symptom— not even of a Gleet. However, we treated his dis- ease as Gonorrhoea, and though the cure was tedious, he at length got well. But, sometime after, he re- newed his visits to this lady, and was again attacked with a similar diseases-symptoms which differed in no other respects from Gonorrhoea, than in their mild- ness. After this, however, he kept away for a con- siderable length of time, and, although in this inter- val he had interviews with other females without disease, yet, in renewing once more his visits to this Gonorrhoea,—Disorders which resemble it. 35 lady, he was again, for the third time, attacked with all the symptoms of a Gonorrhoea. I know it may be urged in all these cases, that they occurred in females of a certain character, and therefore they might have been old cases of Gonor- rhoea, degenerated into infectious Gleet,—a disease which continues almost indefinitely,—is not attended with pain,—and in which there is frequently but very slight discharge—not more, indeed, than many women (and females of this description in particu- lar) are subject to. But to this objection I cannot hold, for two reasons:—first, because such cases sometimes occur in Women who never had a Gon- orrhoea ; and next, because, if they had been cases of Gonorrhoea, or Gleet, they would be infectious to every one alike, or very generally so. Now and then, we know, a person may have an interview with a female who has a Gonorrhoea,, or infectious Gleet, and may escape; but this is an exception to a very general rule—it does not often happen.— Likewise, that one individual is more susceptible of infection than another;—but this also is very limited,—the rule being, and pretty uniform it is, that, in such cases, the disease communicates to all. Here, then, while a common Gonorrhoea will affect all that come within its reach, or pretty gene- rally so, this mild disorder, while it will affect some, will as uniformly suffer others to escape. It there- fore affords a striking difference in its consequences, 36 Gonorrhoea,—Disorders which resemble it. and from this we may infer there is also a difference in its nature. My design in this section of my little book, is to exculpate innocent and virtuous women from injuri- ous and undeserved suspicion; and this I appre- hend to be an object of immense importance, for the consequences of such unjust suspicions, might be painful and serious in the extreme. Even in the limits of my own experience I have met with la- mentable instances of this kind; instances too in which I am morally certain there was not a parti- cle of truth, and which suspicion never would have gained possession of the mind, if the subject had been better understood. With this view of its importance, I therefore deem it proper to place this fact upon the best authority in medicine which can be adduced. Now I have already shown that symptoms resembling Gonorrhoea, have been communicated by females in whom no symptom of the disease existed, or was ever known to exist; but these females were not to be considered exemplary specimens of moral char- acter. And farther, I have stated them upon my own experience. I will now however, show that the same thing happens in females of the highest moral character, and will show it also on the very best medical authority. Here I might refer to the great John Hunter, to Abernethy, and a multitude Gonorrhoea,—Disorders which resemble it. 37 • of others ; but in that highly esteemed and learned work—Good's Study of Medicine,—there is a para- graph on this subject, so clear, that I cannot do better than transcribe it. In the fifth volume, page 81st. after speaking of other diseases attended with a mucous or purulent discharge, which are now and then contagious or infectious,—such asDysentery, purulent opthalmia, and others,—he says,—" In like manner, Leucorrboea (which is the medical term for the ' Whites' in females) as we have already ob- served, has sometimes seemed to be contagious ; for I have occasionally found a kind of blennorrhoea (Gonorrhoea or Clap) produced in men, accompa. nied with slight pain in the urethra, and some dif- ficulty in making water, upon cohabitation with wo- men, who, upon inspection, had no marks whatever of luodic blennorrhoea, or clap ; and in some instan. ces, indeed, were wives and matrons of unim- peachable character?' This, at any rate, will sat- isfy the mind that such a thing is possible. With respect to the question,—how can a harm- less secretion be changed into an infectious one,— this I cannot answer any more than I can tell why the discharge from Dysentery, or -opthalmia, or common catarrh, disorders which are generally harmless, should sometimes become contagious.— The structure of the membrane which is the seat of the disease in all these maladies, is exactly the same as that which is the seal of the disorder in 38 Gonorrhoea,—Disorders which resemble it. Gonorrhoea. It may be, and no doubt often is, from neglect of necessary washing; and to this the habit of irregular intercourse may give a greater tend- ency, for it is not to be denied that such instances are much more frequently observed in women of bad habits and inconstancy, than in virtuous persons; but this by no means proves that these are cases of genuine Gonorrhoea, nor that they do not now and then occur in persons of a strictly virtuous character. With regard to the treatment of this complaint, it is exactly that of Gonorrhoea, for which, see chap. 4— on the treatment and cure of Gonorrhoea. (Note 1.) It therefore appears, that symptoms very much resembling Gonorrhoea, and which are infectious too, may be received by cohabiting with females who do not present the least appearance of that disease;— that, although these are more frequently observed in females of lax morality and habits than others, they are also known to occur, occasionally, in women of exemplary character—even in wives and matrons Note l.—On. this subject it may be remarked that the treatment of Gonorrho&a ia very much the same as that of other diseases affecting similar membranes,—as in contagious Dysentery, Op- thalmia, &c. There is no specific remedy in any of them,—such as Mercury, for instance, in Venereal. Two general principles chieflv re- gulate the treatment of-them all;.—the first directs what- ever abates inflammatory symptoms, if any such ex- ist ; the second, such reme- dies as supercede specific ac- tions by setiing up an action of their own—precisely as "The Black Pill" does in the cure of Gonorrhoea. Gonorrhoea,— Disorders which resemble it. 39 whose habits, age, and religion, place them beyond uncharitable suspicion;—and, that these complaints are cured by the treatment proper in the milder forms of Gonorrhoea.—A third disorder which resembles Gonorrhoea, is,— Stricture in the urinary passage.—Stricture, upon excitement, will sometimes produce discharge exceedingly resembling Gonorrhoea, but without the usual degree of pain and inflammation attending that complaint. What a Stricture is, I will take great pains to explain in a future chapter. Here it is only needful to say, it is a contraction, or a diseased condition, of some part or other of the uri- nary passage, generally the consequence of a badly treated Gonorrhoea, but which often continues for a time so free from pain or any inconvenience, that it is not suspected to exist, and is only brought to light by the occurrence of some sufficiently exciting cause. Now, the act of sexual intercourse is a sufficiently exciting cause, and hence the disorder now referred to is frequently observed to follow quickly after it. I have often been consulted by persons who have remarked that they are quite unfortunate, for they scarcely ever are exposed without contracting this disease; and, what to them is most remarkable, is, that others who have visited the same female have escaped. The fact is, that this is not a case of Gonor- rhoea at all, but of Stricture; and theirfriends have not these symptoms, because they have 110 Stricture, Of 40 Gonorrhoea,—Disorders which resemble it. course, if such a person go to an advertising Knave, he will tell him immediately he has got a Gonor- rhoea; and further, the medicines he may give him may probably remove the symptoms, so that he will get the credit of curing a Gonorrhoea. But, in truth, he will no more have cured a Gonorrhoea than he will have cured a Cancer; for, with purgatives and a low diet, this discharge generally ceases in a little while.—It would therefore seem exceedingly desi- rable to have some plain and positive rule to judge by in cases like the present, and fortunately, I have one to furnish. This rule is founded on the time when such symptoms first appear after connexion. The discharge I am now speaking of, that is, when it is from Stricture, first appears within twelve or four and twenty hours after such excitement,—a period shorter than is required in the quickest case of Gonorrhoea. Now, Gonorrhoea may be compared exactly to inoculation. There is always a process and a certain time required, in order to produce the inoculated malady. It is true that some inocula- tions produce their proper symptoms sooner and more regularly than others; but, the usual time pecu- liar to each is generally known, and, unless delayed or interrupted by some particular state of constitu- tion, is pretty regular. The usual period for the pro- duction of the symptoms of a Gonorrhoea is the third day after exposure to it. This however, is some- times delayed for several days by the causes I have mentioned; and, sometimes too, it is a little quick- Gonorrhoea,— Disorders which resemble it. 41 ened; but, as to its appearing in twelve, or four and twenty hours, that it never does, and never can do. This then Iconsider a valuable fact,—it forms the basis of an excellent rule in practice, the use of which may be seen by the following.—To a per- son, for instance, consulting me on GonorrhcEa, I generally put this question first;—How long is it since you were exposed? Now if he should say, why, it is very recent,-—it was only last night, and I observed some symptoms of it in the morning ; or, at any rate, if he should state that it is within twelve, or twenty-four hours after an exposure, I suspect at once it cannot be a Gonorrhoea. I then enquire if he ever had a Gonorrhoea before, and if he state that he has, my suspicions are confirmed, and I explain my reasons for them. This of course leads to an examination by the bougie, by Avhich the real state is ascertained beyond the possibility of doubt, and he obtains a permanent and perfect cure. But the value of this true and faithful explanation is greater than at first it may appear to be; for it does not only undeceive and save an individual from paying different persons for pretended cures of Gonorrhoea, but it also saves him from the conse- quences of occult or hidden Stricture,—an evil which I deem by far more serious and distressing than any to be found in the whole range of Syphilitie maladies. The object of this little section therefore is to show, that, among other causes capable of giv- ing rise to symptoms resemhling Gonorrhoea, a hid* 42 Gonorrhoea,—Disorders which resemble it. den dormant Stricture is one,—that this is to be suspected whenever these symptoms appear within twelve or four and twenty hours,—but that this is only to be known for fact by passing the bougie. Its treatment consists in a little cooling physic, rest, and low diet; if this is not sufficient, the usual treatment for Gonorrhoea will stop the discharge, but the only proper and permanent cure, is the cure of the Stricture.—The fourth and last of these dis- orders resembling Gonorrhoea, is,— A discharge occurring in female children,—and which frequently creates distressing apprehensions in the minds of parents. It consists in a discharge of matter from the genital organs, attended with some slight degree of inflammation and uneasiness. But this complaint in children does not originate in the parts themselves, but in some distant part, such as the gums in teething; or in the bowels, from foul and irritating accumulations there. This latter is no uncommon cause of the complaint. We know that irritation in the bowels in children is readily transmitted to distant parts, and is the cause of va- rious maladies. If this irritation happen to fall upon the head, it produces dropsy of the brain; or if on other parts, then other diseases take place, as sore eyes, or running sores from behind the ears, a swelling of the neck, or others; so, if it happen to fall upon the mucous membrane of the female organs, it then produces the disease we speak of. It is not, Gonorrhoea,— Disorders which resemble it. 43 however, that this disease in itself is of so much consequence as the fear and misconceptions it may lead to. Filled with apprehensions, for in- stance, a mother takes her little child to some physi- cian, and if he happen to be unacquainted with its real nature, these apprehensions are confirmed. I have read, somewhere, of innocent persons being hanged from a misconception of the nature of this malady. With regard to the treatment of it, this of course is founded on the view here given of its na- ture; remove the cause,—that is, scarify the gums if they are inflamed, and cleanse the bowels with an active purge or two. Nothing more is wanted, except plentiful and frequent washing with cold water, perhaps sometimes with the addition of a lit- tle alum or sugar of lead. The following then, is the substance of all that has been said upon this subject. That there are four complaints which, in some respects, resemble Gonorrhoea, and are frequently mistaken for it.— 1st.—The natural secretion of the parts which col- lects beneath the foreskin, and, becoming acrid, in- flames and excoriates the penis,—producing a dis- charge;—this however does not come from the urinary passage, but from the surface of the skin, and may easily be detected by comparing it with what is said on Gonorrhoea. 2d,—A discharge still more nearly resembling Gonorrhoea, (aslo infectious) is received by cohabiting with women in whom 44 Gonorrhoea,—Disorders which resemble it. no symptoms of this disease can be detected, and this, not only with those in whom exceptions might be taken On the score of their habits and morality, but also with women of unexampled moral charac- ter,—being wives and matrons, whose habits, age, and religion, place them at once beyond suspicion. 3d,—A discharge arising from a dormant Stricture, which, upon excitement, now and then becomes the cause of similar symptoms,-—and which is known chiefly by its quick appearance after sexual excite- ment;—the proper and permanent cure of this, is the cure of the Stricture. 4lh,—A discharge occur- ring in female children,—the result of distant irri- tation, chiefly of the gums in teething, and foul accumulations in the bowels. Gonorrhoea,—Its Remedies. 45 CHAPTER III. On the remedies in general use for the cure of Gonorrhoea,—how far these are to be depended on,— to what particular cases they are suited,— and how to use them to the best advantage. The remedies for the cure of Gonorrhoea are very few in number and. are pretty generally known. Notwithstanding,this however, their real nature is but little understood, so that they are often misap- plied. They are internal and external. Of the first the Balsam Of Copaiva—the Cubebs—and the Tur- pentines, are the chief; the external or local reme- dies consist of Lotions, used as injections. The internal remedies are vegetable productions, whose properties very much resemble one another. All of them impart their virtues to the urine, which, being retained in the bladder, impress upon it their peculiar effect, and this again is transmitted to the part which is the seat of the disease—the urinary passage. On the other hand, Injections consist of certain suitable stimulants which are applied by means of a little syringe more immediately to the seat of this disease. Both kinds are exceedingly valuable in their proper places, but they are also, both of them, either useless or dangerous if impro- perly used or misapplied. The object of this chap- 46 Gonorrhea,—Its Remedies. ter therefore is to explain their use and nature more particularly. It should also be stated, there are other reme- dies which are occasionally wanted in the cure of this complaint, but not always; these are, chiefly, the common remedies required to lessen pain and inflammation. Vaiious things are used with such a view, but of such there are some which are far more suitable than others; a list of these therefore I will afterwards subjoin, pointing out their proper use and dose, as well as make such other observa- tions on them as may seem required. I will begin with— The Balsam of Copaiva.—This, every body knows, is very often given for the cure of Gonor- rhoea; indeed, Balsam of Copaiva as a remedy for Gononhoea is so well known that, whoever dis- covers to another he has taken it, by the peculiar smell it gives the breath, is generally set down for one who is contaminated with Venereal malady. This however is not the only objection to Balsam of Copaiva;—another is, its extreme offensiveness to the taste;—and a third, its offensiveness to the stomach, so that it is rejected by vomiting, or, if not rejected, it takes away the appetite and induces a degree of nausea which can scarcely be endured. Indeed, it is a medicine, to some, so perfectly ob- noxious that they cannot even think of the time of Gonorrhoea,—Its Remedies. 47 taking it without Nausea or Vomiting. With re- spect to the two first of these objections however, (its offensive smell and taste,) the latter of these may be avoided by taking it in Capsules—and the former partly so. These Capsules are small gluti- nous bags, which, being closed, contain a little of the Balsam. These little bags, when swallowed, are soon digested in the stomach, and thus the Bal- sam may be taken and its disgusting taste avoided. The peculiar smell imparted to the breath however is not got rid of by this means; for, especially when it disagrees, the stomach is continually expelling wind, and this affects the breath offensively and is equally betraying. But the most important of the objections to the Balsam of Copaiva (that of dis- agreeing with the stomach and digestive organs) is not avoided by this ingenious way of giving it; for when the Balsam disagrees, it does so whether it is tasted in the mouth or not. These things therefore, taken altogether, are great objections to the Balsam. But there are others still to be acquainted with. The first is, the fact, that there are many persons in whom the Balsam of Copaiva has no effect at all in curing this disease; and there are others where it will stop the discharge, so long as it is taken, but the moment it is laid aside, the running and disease returns. Now it is of no use for either of these to take the Balsam, or to continue it alone, at any rate. If such were to take a ship load of this medicine, it would never cure them. When the Balsam does 4S Gonorrhcea,—Its Remedies. good at all, it does so very soon, by lessening the discharge. A good rule in taking the Balsam of Copaiva is, to watch its effect, and if it does not, within two days, or three at farthest, very sensibly lessen the discharge, lay it aside, or add some other remedy to the treatment. There is also a time when the Balsam of Copaiva should not be given; this is when the inflammatory symptoms of a Gonorrhoea run high. We always look for more or less of such inflammatory symptoms at the onset of this malady; sometimes indeed they do not happen, but they should always be prepared for. It is with this view we always give an active purge or two, direct low diet, and rest if it can be had, at the beginning of a Gonorrhoea. This some- times prevents them altogether, and if not, it abates them. After an active purging medicine, therefore, if there is no great pain and heat in making water, you may begin with the Balsam; but, if there is, it should be delayed, however many days it may re- quire to moderate these symptoms. Likewise, should you have commenced with the Balsam, and inflammatory symptoms at any time start up, lay it aside, and first abate these painful feelings before you begin with it again.—I know that some"begin with Balsam of Copaiva under any circumstances, and many times with impunity ; but I also know that when it has been given without at- Gonorrhoea,—Its Remedies. 49 tention to these circumstances, it has sometimes been followed by distressing and even dangerous events, as inflammation of the bladder, testicles, &c. But notwithstanding the truth of these remarks, the Balsam of Copaiva, where it agrees, and it is convenient to take it, is a remedy of considerable power in the cure of Gonorrhoea. Sometimes it is trusted to alone, but then it must be taken for a length of time—for many weeks together. Let it be remembered, however, that, where it does do good, it does so quickly; perhaps in two days the discharge is lessened one-half, and it then goes on more grad- ually to diminish. But let it also be remembered, that in those cases where it is equal to the cure alone, that cure would be effected in half, and less than half the time, if given in connexion with locai remedies, Injections. If the Balsam of Copaiva is fixed on as a remedy for Gonorrhoea, it should be given in the dose of about a tea-spoon full, in a little water or sugar, twice or thrice a day. With some it sets better on the stomach when made up in the form of mixture, the best prescription for which is given below— Note 2. If it happen to purge, omit it for a day and Note 2.—Sir Astley Coop- ounce of Mucilage of Gum er's favorite form for the Bal- Arabic, mixed in a bottle with sam of Copaiva was,—one four ounces of Camphor Ju- ounce of the Balsam with one lep, of which a table-spoon 4 50 Gonorrhoea,—Its Remedies. take a dose of Rhubarb. If this will not do, add to each dose of it four or five drops of Lauda- num.—It should be continued for some time after the discharge has ceased, and then left off only by degrees. This is all that need be said about the Balsam of Copaiva,-r-the next of these remedies is-r- The Powdered Cubebs.—This is a species of mild aromatic pepper which is imported in large quantities from Java, and, as I understand, princi- pally for the cure of Gonorrhoea. It is an admi- rable remedy if properly availed of, and is free from the offensive smell of the Balsam of Copaiva; it is also a pleasant wholesome aromatic, and generally agrees with the stomach. Neither is there the same objection to giving it in the very onset of the disease (provided high inflammatory symptoms have not set in,) as there is to the Balsam; indeed, such is its peculiar effect, that, if given freely and early, it sometimes supercedes these inflammatory symptoms altogether, and leads to a very speedy cure. If, how- ever, inflammatory symptoms havealready suddenly come on before you have had an opportunity of try- ing the Cubebs, it is then more safe and proper to full is'to be taken twice or part of Sweet Spirit of Nitre. thrice a day. To some an This however is not a good ounce of any simple syrup, as mixture—the Spirit of Nitre Syrup of Ginger, is an agree- does no good and makes the able addition. Balaam very offensive to It is very common to give some. the Balsam with an equal Gonorrhoea,—Its Remedies. 51 reduce these symptoms by rest, purging, and diet, before you venture on this remedy. So also, if you had begun early with the Cubebs and such inflam- matory symptoms should happen to arise, let it be discontinued for a while, or until these symptoms have been abated by the means aboye referred to, and then resume the Cubebs. The best way of taking Cubebs is in the dose of a piled-up table-spoon full, mixed in a tumbler of water, and repeated twice or thrice a day. It is of no use to take them in the dose of a tea-spoon full at the time, as many do.—There is something also in the manner of mixing them. The best way is to fill a tumbler half full of water, then put a table- spoon full of the Cubebs upon the water, and in a minute or so you will find they will have sunk from the surface to the bottom, and thus are equally dif- fused. If you adopt any other way of mixing them, they get in lumps, which is very disagreeable. Should the Cubebs irritate the bowels as a purga- tive would do, this may be checked by adding five drops of Laudanum to each dose; but if they only prove a little laxative, to this there is no objection. The virtue of the Cubebs should be separated by the kidnies and carried into the bladder, and of this you may always be assured when a peculiar smell is imparted to the urine,—a kind of violet smell,—not 52 Gonorrhea,—Its Remedies. unlike that which the urine has on taking turpentine, or being exposed to a newly painted room. But, although I have said so much in favor of the Cubebs, let it not be thought that they are to be depended on in every case. On the contrary, there are many individuals in whom they seem to have no good effect at all; and others in whom they will stop the discharge so long as they are continued, but the moment the remedy is laid aside, the disease returns. And what was said of the Balsam of Copaiva is also applicable to the Cubebs;—viz. when they do any good at all, they do it quickly; so that if you do not see the most decided advantage from their use in two or three days, but little or none is to be expected from them. The fact is, that many cases of Gonor- rhoea defy the virtues of internal medicines alone, and absolutely need the aid of local remedies. The inconvenience of its bulk is also another objection to the use of Cubebs.—This brings me to the subject of my favorite remedy,— The Black Pill.—The virtues of the Balsam of Copaiva and the Cubebs have now been fairly stated, and the objections to them shown. These objections are, first, to the Balsam, its smell, being peculiar, strong and disagreeable—betraying the disease for which it is taken; also, its effect upon the stomach and the bowels, which is obnoxious and intolerable to many; next, to the Cubebs, its bulky form—ren- Gonorrhoea,—Its Remedies. 53 dering it exceedingly inconvenient. To these again must be added, the uncertainty of their curative effect, for the influence of either of them alone is in many cases so small as to fail entirely in the cure of the disease. It therefore seemed desirable, if it could possibly be done, to extract the virtues of them both from their disagreeable and offensive parts and unite them in one compound. And more especially so, as it had been found, that, in those cases in which one of these medicines was not equal to the cure of this disease alone, yet, that when combined they frequently succeeded well. Modern Chemistry had also shown that the active properties of a vegetable medicine frequently resided in a very small portion of its bulk. The article Quinine, for instance, (taken from Peruvian Bark,) is an example of this fact, for of this a quantity not larger than a pea is even more effectual in the cure of Ague, or any of those com- plaints for which the Bark is given, than a whole table-spoon full of the Bark itself. In this, after divers and repeated trials, I succeeded to my utmost wishes. At first I made this Extract in the form of Conserve, but, as some of my patients could not take a Conserve, and as, in very hot weather, it became too dry, I made it afterwards in Pills—which I call " The Black Pill." This medicine I have now used for three years, very extensively, and do not hesitate to say that it is by far the best internal medicine that can be taken for the cure of Gonor- rhoea. It contains the virtues of the Balsam, with- 54 GortoRRHtEA,—Its Remedies. out its disgusting smell and taste; and of the Cubebs, without its inconvenient bulk; while, uni- ting the properties of both in one, it cures those cases which one of them alone so often proves unequal to. Let it however be remembered, I do not recom- mend that the cure of Gonorrhoea should be trusted to internal remedies alone; certainly, the use of In- jections should co-operate,—the cure is then accom- plished in less than half the time, and is far more safe and certain. But there aie persons who are preju- diced against injections, and it is of great importance that such should have the best internal remedy. To such therefore the composition of a The Black Pill" is doubly valuable. I will only add upon this subject, that the same precautions that were enjoined on the Balsam and the Cubebs are requisite in the use of the Black Pill;—do not begin with them until high inflam- matory symptoms, if any such exist, are abated by purgatives and low diet. The dose is five, or six, or more, three times a day. They set agreeably on the stomach, and rather increase the appetite and strength than weaken either. Injections.—The use of these form an invaluable part of the treatment of Gonorrhoea,—it is applying the remedy to the disease itself—the advantage of Gonorrhoea,—Its Remedies. 55 which can scarcely be doubted. Yet there are some who are opposed to injections, simply, as it would seem, because they may be abused. But carry on this reasoning to other diseases—say Opthalmia, for instance. Internal remedies, then, are very good in Opthalmia, and sometimes will cure it, but who would withhold the use of Lotions and other appli- cations to the eye itself, simply because they may be misused or abused. Is there a single medicine which may not be abused ? Quite the contrary, arid the most valuable too are the most capable of such abuse. Oh, it is said, but they may cause a Stric- ture; and so may Lotions and Ointments put out the eye; but, if properly used, they will save the eye, and cure its maladyf and this in less than half the time it could be cured without them. Indeed there are many cases of the eye that cannot be cured at all without them, and so of Gonorrhoea. As to the idea of injections causing Stricture, nothing can be more ridiculous; for, on the contrary, they pre- vent them. The ultimate result of a Gonorrhoea, long continued, is Stricture. Gonorrhoea implies Chronic inflammation—this is its essential nature,— the ultimate tendency of which is to destroy the elastic principle with which the urethra is naturally endowed, and in this consists incipient Stricture. Whatever shortens the duration of Gonorrhoea, therefore, lessens the chance of Stricture. Now, Injections shorten the duration of Gonorrhoea j they therefore prevent Stricture. 56 Gonorrhoea,—Its Remedies. If another argument were required, I might ad- duce the fact that Injections are used and recom- mended by the greatest surgeons in the world. This however is quite unnecessary,—it is enough to state, that, although internal remedies alone will some- times cure a Gonorrhoea, yet they sometimes totally fail; also, that in those cases where internal reme- dies are sufficient to the cure alone, that cure can be accomplished far more safely and certainly, and in less than half the time, if aided by Injections. It would therefore seem superfluous to say another word upon the utility of Injections,—it only now remains to show their proper use. Injections should not be used in the very early or inflammatory state of Gonorrhoea; and even when this is past, it is better to begin the cure with internal medicine, and continued this a day or two, before resorting to injections. After this you may use them safely and very advantageously,—few Gonorrhoea oases can long hold out against their proper use. Injections should not be used too strong. It is no disadvantage if it give a little tingling sensation, but if it amount to heating pain, its strength should be reduced by adding a greater portion of water to it. It is not proper however, either to increase the strength of an injection to any great degree, but rather, if it seem to do no good, to change it for another. So, if any one has been useful, but after Gonorrhoea,—Its Remedies. 57 a lime should seem to lose its power, it would be better to change it for another than to increase its strength. Injections will sometimes lose their good effect, and for this reason several prescriptions are given for them. Indeed, under any circum- stances it is better to change an Injection now and then—the part becomes accustomed to the peculiar stimulus of one alone if long continued,—the disease is sooner baffled and destroyed when one correcting stimulus is now and then exchanged for another. It is better therefore to change an injection ; you may return if you please to the one you used at first, if that agreed, only change it now and then—keep- ing most to that which best agreed. Injections are chiefly mineral; there is a great variety of them, but they all act pretty much on the same principle; some however are better than others, and these are carefully selected in—note 3. I call them No. 1, 2, 3, and 4. The higher numbers may be a little the strongest, but it is not the strength, it is the effect of change that I lay the greater stress Note 3.—The best forms of injections are the following, —at least they are the best that can be procured at any apothecary's store. Saturnine Injection —For- ty grains of Sugar of Lead dissolved in a half pint vial of rain water. Alum Injection.—Forty grains of common alum dis- solved in a half pint vial of water. White Vitriol Injection.— Sixteen grains of white vitri- ol dissolved in a half pint of water. Blue Vitriol Injection.— Eight grains of blue vitriol in a half pint bottle of water. 58 Gonorrhoea,—Its Remedies. upon; it is however always as well to begin with No. 1. Injections, to secure their great utility, require attention to the manner and frequency of using them. Many times I have heard it said, " The injection does no good," when I have found upon enquiry that it had not been made to enter the uri- nary passage. Of course it must then fail. To use an injection properly it must pass up a certain distance. No matter how much farther, but they must go up at least several inches, and it should be kept and retained there for a minute or two, by pressing the top of the penis with the thumb and finger. The sensation an injection gives is quite enough to tell whether it has properly entered—it is as if you wanted to pass out urine; but the proof of it is, that a teaspoon full or so squirts out again when you let go your thumb and finger-. With respect to the repetition of their use, this too is an important point,—much depends on their regular frequent repetition. An injection should be used six or eight times in the four and twenty hours ;— oftener if you please, if they do not irritate or pain, but certainly not less than I have stated. I know, that with the common syringe, this repetition of them was often quite impossible. How could a person engaged in business and perhaps behind the counter, for instance, retire often and privately enough for such a purpose. And not only was a Gonorrhoea,—Its Remedies. 59 syringe to be carried in the pocket, but a bottle of injection too, and a cup to pour it out in. It was quite impossible for one in a hundred to comply with this as frequently as was required, and henee the use and value of injections was never properly ascertained. But these objections now no longer exist, for with my patent pocket syringe next to be described, an injection may be used just as often as is needful and with perfect convenience and privacy. The Pocket Syringe.—It is a little flat elastic bottle, holding two ounces, the neck of which is attached to a metallic ring. To this ring a little pipe is screwed, and over this again a little cap, so as to make it water-tight, and suited to the breeches pocket. When you want to use the injection you have nothing more to do than unscrew the cap; and when you wish to refill it, put one of the papers of ingredients (which are put up with the syringe) into the bottle by the ring, fill it with water, shake it, and the injection is made ;—it will last you a whole day or more. Nothing can be more convenient and private; but the wood cut on the following page will show more clearly the use of this contrivance. One of the patent syringes, together with a set of the ingredients and a full quantity of the Black Pill, $c, <£c, are put up in a little chest, with lock and key,—having also the book fitted in the lid, 60 Gonorrhoea,—Zte Remedies. This contains every thing necessary for the cure of Gonorrhoea, and is sent by steam-boat or otherwise to any part of the United States. The price is $10. A similar little chest containing every thing necessary for the cure of Venereal Disease, is also $10. But the complete chest, containing the medi- cines, $c, for both complaints,—Gonorrhoea and the Venereal—is $15. The book alone is $1. The Patent Syringe. A, the bottle open.—B, the pipe.—C, the cap.—D, the syringe filled. The preceding remarks relate exclusively to the remedies in general use for the cure of Gonorrhoea. But it was mentioned, there were other medicines now and then required, chiefly the common reme- dies in use for abating pain and inflammation. To Gonorrhoea,—Its Remedies. 61 make this little book complete, however, it is neces- sary here to enumerate these, and say a word or two upon the dose and proper use of each. Lotions.—These are often very useful, sometimes to assuage inflammation, and sometimes to assist the healing of ulcers,—for the manner of making and applying which, see note 4. Poultices—Are more frequently required in Vene- real disease than in Gonorrhoea—vide note 5. Note 4.—Sugar of Lead Lotion—Sugar of Lead sixty grains to half a pint of water, some add a little vinegar.— The best way to use it is to apply a fold or two of linen upon and around the part, and keep this wetted with it. The part should be covered up as little as possible. Spirit Lotion.—One part of brandy and two of water, used as the above. Black Wash — Is made with calomel and lime water, and is an admirable applica- tion in many sores, particu- larly those of a Venereal character. To make lime water,—put a lump of ^ime as big as^n egg into a gallon of water, stir it a little, and in an hour or two strain it off the lime and keep it cork- ed. To a pint of lime water, add a drachm of calomel, and shake it well in the bot- tle, when mixed it will turn black. It is the black pow- der that is most useful, an to obtain that, hold a piece of linen to the mouth of a small bottle of the black wash and turn it downwards, some of the black powder will fall upon the lint, which you then apply to the sore. Nitric acid Lotion—From 80 to 50 drops of Nitric acid added to a quart of water,— excellent to some Venereal sores. Note 5,-r-Common Poul- tice— Is best made with equal parts of crumb of bread and linseed meal,boiled a few minutes in a sufficient quan- tity of water. It is one which will not dry and separate as bread and milk. Grounds of Beer Poultice" — Made by using grounds of beer instead of water. Black Wash Poultice.— Crum of bread and linseed 62 Gonorrhoea,^-Its Remedies. Cooling Emolient Drinks.—These are some- times very useful, and when they are required it is important to know what are the best, and how to make them. But it sometimes happens a person is so circumstanced that he cannot procure these—the request to have them prepared would lead to enqui- ries as to what they are wanted for. To such there- fore it will be satisfactory to know that they can be done without. In fact it is their diluting quality which is chiefly useful. The softening mucilaginous qual- ities of which they are composed, certainly have their use, but this is nothing compared with their diluting quality—depending entirely on the water in which they are dissolved. If therefore you take a waterv drink of any kind, as common water, the end is an- swered—that is, if you take plentifully of it. From half a pint to a pint of water may be taken eight or ten limes a day—this is at the command of every one and it is of consequence to know it. A near approach to these mucilaginous drinks however, can be easily and pleasantly made. Just take an ounce or more of gum arabic, in large lumps, in the waist- coat pocket, and consume it during the day; put a lump in the mouth every now and then as you would do sugar candy; it is a very pleasant thing, and gives to the simple water drank the softening effects meal, with black 'wash in- carrots well in but little wa- stead of water —used to ter and.'mash them. It cor- spreading chancres. rects the smell and agrees Carrot Poultice.—Boil the with many bad sores. Gonorrhoea,—Its Remedies. 63 of the various drinks described in the following note 6. Purgatives.—Next to bleeding, purgatives form the most active agent in reducing inflammation.— There is however much in the selecting a proper purgative in particular diseases. The best that can be selected for the disease now in question, is the Purgative Diuretic of my chest, next to be men- tioned ; but where this cannot be had, those men- tioned in note 7 may be substituted. Note 6.—Barley Water— To make this properly, take a tea:cup full of pearl barley, boil it a few minutes, then throw away this dirty water, and add to the pearl barley three quarts of fresh water, and boil it down to two quarts. Some add a few figs or a little liquorice root to- ward the end of the boiling. It may be repeated,—none of these cooling, diluting fluids, can be taken to excess, in the early or inflammatory stage of Gonorrhoea, and the oc- casion for taking them is just in proportion as the pain and heat in making water is great: when these have sub- sided, their use may be laid aside. Flaxseed Tea.—Take of bruised flaxseed, or linseed, (not linseed meal) two oun- ces, or two or three table- spoonsful, (there is no occa- sion to be very exact in quan- tity,) and put this to a quart of water, which is to stand simmering by the fire for an hour or two; then strain, and, if more agreeable, sweet- en 'it, and let sX least this quantity be taken as com- mon drink during every 24 hours. Alkaline Drink—Another excellent remedy to abate the pain and heat of making wa- ter is the carbonate of pot- ash, or of soda. Procure an ounce of either of these, and dissolve one quarter of it in a-quart of common tea, and take this quantity during the day. Soda water is also a good remedy, a glass may be taken three or four times a day. Note 7.—Epsom Salts—Is a good cooling purgative, an ounce is the usual dose, taken in water. This is the purga- tive that most people take on 64 Gonorrhoea,—7i?s Remedies. The Purgative Diuretic Pill.—This is the pur- gative of my chest; it is the one I give generally and find the most easy, comfortable, and efficient of any composition I ever met with. Five pills ta- ken at bed time is the usual dose ;—this operates in the morning, and those who take it seldom fail to speak of its excellent effect. It may be taken also finding they have got a Go- norrhoea. It is not however the best; for much of that quantity of salts passes through the bladder—adding to the saline irritating quali- ty of the urine, and thereby increasing the scalding pain in urinating. It is better to take one of the rougher pur- ges below, but this will do if no other is at hand. It is not generally known that a very small quantity of Ep- som salts, if taken in a lar- ger quantity of water, will act more pleasantly, certain- ly, and effectually, than a larger dose in the usual quan- tity of water. A tea-spoon- ful for instance, in a tumbler of water, instead of an ounce in a small tea-cupful of wa- ter. Also, by repeating this weaker solution of salts, it is a very cooling and proper medicine in a hot and fever- ish state. But the best of all medicines for cooling, re- ducing, and preparing the system for a mercurial course, as in Venereal dis- ease, is to combine Epsom salts with antimony, as in the following. Epsom Salts and Antimo- ny.— Add two ounces of Epsom salts and two grains of tartarized antimony to half a pint of hot water, and take a wine glass full of it two or three times a day. or as often as may be necessary to keep up a moderate degree of purging. Senna and Salts—Is an excellent purgative medicine either alone or taken in the morning,after a dose of Calo- mel the night before. Take a hahdful or an ounce of senna leaves, and one ounce of Epsom salts, and add them to a little more than half a pint of boiling water, and when colds strain it and take a tea-cupful for a dose. (A little bruised ginger would warm and prevent itsgriping, which all purgatives will sometimes do.) Jalap and Calomel.—Fif- teen grains of the former and five of the latter, taken in sugar or molasses. A larger dose is sometimes given. Seidlitz Powders—Is a pleasant way of taking a mild dose of Saline medicine. Gonorrhoea,—/^ Remedies. 65 with great advantage in almost any disorder in which a cleansing purge is necessary, particularly where the stools are of an unnatural color and are offensive. Opium.—Is a valuable medicine under many cir- cumstances. The usual dose is one grain in the form of a pill; but it is given in different forms.— See note 8. Mercurial Medicine.—Of this there are many preparations, but for the most'useful, safe, and con- venient of these—see note 9. Note 8.—Laudanum—Of this the dose is from five to thirty, or fifty drops. Dover's Powder—Is giv- en to assuage pain, it is a soothing and fever medicine ■—the dose is from two and a half to twenty grains. Note 9—Mercurial Medi- cine—Calomel and Opium— Calomel sixty grains—Pow- dered opium fifteen grains —made into forty pills, of which two may be taken every night, and sometimes one in the morning. The Blue Pill-^-ls a mild and very excellent prepara- tion of Mercury, as well in other diseases as in Venereal. The dose in the latter is ten grains at night and some- times five in the morning.— 5 The dose however is regula- ted by various circumstances, all of which are carefully re- ferred to in chapter nth— " On the management of mercury." Blue Ointment—Is anoth- er excellent form in which to exhibit mercury, and is pre- ferred ry some eminent sur- geons, to any other; but the trouble and inconvenience, as well as the spiling of the linen it gives rise to, is an objection to its general use. When this is fixed on, from half a drachm to a drachm is rubbed into the thigh every night, and sometimes night and morning. But in the manner of using mercu- rial ointment I must be more particular. In the first place, it should be rubbed in by the patient himself, but, 66 Gonorrhoea,—Occasional Remedies. Corrosive Sublimate.—This is a very active pre- paration of Mercury, and should be used only in urgent cases. There are forms of venereal disease however, which require a very quick effect of Mer- cury; when it attacks the nose or throat for in- stance, in some constitutions, it spreads so rapidly, that, if we were to wait the slower operation of the if from debility or any cause he should not be able, then those who rub it in should have their hand guarded with a bladder, and the best way to arrange it is the following. Get a pigs' blad- der, and after being steeped in warm water turn it inside out; then soften it well with lard or sweet oil, and put it on the hand like a glove, ty- ing it round the waist with a piece of tape. Still it is bet- ter that a patient rub it in himself. Take therefore a quarter of the quantity to be used in the hollow of the hand and rub it briskly up and down the inside of the thigh till it has entered the skin, when the hand will not pass so smoothly ; then take another quantity, and so on till it is all rubbed in. It is common for it to make the thigh, a little sore, or to bring out a crop of pimples on it by rubbing; in this case change the thigh, and if the same thing happen again, take the inside of the arm ; any part will do where the skin is thin. It is a good thing also to wash the old ointment off now and then with soap and water—the skin will take the ointment better for it. The rubbing may be either night or morning. Throughout this course of rubbing, wear a pair of flannel drawera next the skin,—the same pair the whole of the time. The Specific Pill—Bat far better than the Calomel, the Blue Pill, or the Blue Ointment, is the compound called "The Specific Pill," which is contained , in the chest for Venereal. It is a mild mercurial, and one which always agrees. Ihave used it now for many years and can depend on the mer- curial action of this medicine better than any other. It is continually referred to in the pages of this little volume. But, use what form of mer- cury you will, it is sometimes quite necessary to have the aid of another, and then I prefer the Blue Ointment in addition to my specific pills; this necessity however, does not often occur. The usual dose of the "specific pill" is two at night and one in the morning. Gonorrhoea,— Occasional Remedies. 67 milder mercurials, it would eat away the parts be- fore the Mercury could be brought to act upon it; and it should be known, that, when the soft parts covering the roof of the mouth or the thin bones of the nose are once gone, they do not grow again— they are gone forever. It is therefore most desira- ble to have some remedy that will very quickly put a stop to its progress. When this is done, however, this active jnedicine should be laid aside, and the cure completed with a milder and safer preparation. It is not a remedy to be relied upon for the cure of this disorder, but to check and arrest it when the destruction of important parts is threatened and this it will speedily do. An eighth, or at the utmost, a quarter of a grain may be taken three or four times a day; but for the manner of taking it more particularly, see note 10. Note 10—Corrosive Subli- mate and Mui iate of Ammo- nia, (Sal Ammoniac.)—Of each six grains—dissolve them in sixty drops of water, then add crumbs of bread enough to make into forty- eight pills-one of which will contain an eighth of a grain, and may be taken two or three times a day. But if a larger quantity is to be made, the following prescription is better, as the crumb of bread would become too hard and perhaps would not dissolve in the stomach. Corrosive Sub'imate twenty grains- starch half an ounce—Gum arabic two drachms—water enough to make into a mass for one hundred and forty- four pills—each of which will contain one-eighth of a grain of Corrosive Sublimate.— Some add one drachm of Opium to the mass—it pre- vents griping. The best time of taking them is after meals. ]f a liquid form is preferred —then dissolve one grain of the Corrosive Sublimate and one grain of Muriate of Am- monia in four ounces of dis- tilled water—and take the eighth part (a tahle-spoon full) for a dose. Any pleas- 68 Gonorrhoea,— Occasional Remedies. Fumigating Mercury.—This, like the corrosive sublimate, is chiefly valuable in cases of spreading Venereal sores, particularly of the throat and roof of the mouth, and, when these are attacked, it is indeed a valuable remedy. Its effect is much more speedily seen than that of the sublimate, but the manner of using it, hitherto, has involved so much trouble and impossibility of privacy, that, invaluable as it is, it has seldom been availed of. The prepa- ration used for this purpose is the Red Sulphuret of Mercury, (red cinnabar.)—The directions for using which, have been the following:—take a red-hot common heater and place it on a brick;—then throw on this half a drachm of the red cinnabar, when fumes will instantly arise; these are directed to the throat or nose by breathing in the fumes through an inverted funnel held over them. In this manner fumes may be applied once or twice a day. This plan however, will instantly be seen to be quite impossible with many, without betraying for what purpose it is done, and therefore the following con- trivance, which I call a fumigating candle, will be estimated highly. Fumigating Candle.—For this contrivance I am ant syrup may be added if stitutions is one grain of the agreeable. The Muriate of Corrosive Sublimate to one Ammonia makes it dissolve ounce and a half of theOom- quicker in water. pound Tincture of Bark, of A very excellent Tonic and which one-twelfth, or one- anti-venereal medicine in eighth part, taken in a glass scrophulous and w-«k con- of water twice a day. 4 Gonorrhoea,— Occasional Remedies. ou indebted to a late work on Venereal disease by Mr. Colles, an eminent surgeon of Dublin. This plan of fumigating by the burning of a candle is rather hinted at than described, but its real value struck me so immediately, that I lost no time in putting it in practice, the result of which proved most satis- factory. The plan adopted is to combine the cin- nabar with wax, and make of this a candle of the common size, an inch or two in length, divided by a line around it, into four parts. With this, there is" nothing more to do than to light the candle and inhale the smoke arising from it, this contains the Mercury in sublimation,—a penetrating way of ap- plying Mercury to parts otherwise of difficult access, and which has a most immediate effect. It has also an excellent effect on the female genital organs, as well as on sores which frequently occur about the fundament. For this purpose the candle is placed in a chamber utensil, or night stool, over which the patient sits awhile. When the candle is burnt down to the line it is to be blown out. Each candle, an inch or two in length, contains four mercurial fumi- gations. It is a most convenient and speedy way of arresting Venereal in these parts. I have effect- ually stopped the progress of it in the throat in 12 hours; and have cured excressence and sores about the anus in as many days as they had existed months before. Bark.—Occasionally, in the treatment of Vene- 70 Gonorrhea,— Occasional Remedies. real disease especially, it is necessary to support and re-invigorate the constitution. In cases of great weakness, or when a Venereal sore takes on a spread- ing and unkindly character, there is this occasion.— Nothing succeeds better in these instances than the Peruvian bark,—sometimes alone, but more gene- rally combined with remedies such as are mentioned in note 11. Sarsaparilla—Is a well known valuable medi- cine in the treatment of Venereal disease. Not that every case of Venereal requires Sarsaparilla,—far from it; but there are states and conditions of the constitution exceedingly unfavorable to Mercury, (the specific remedy,) but which, by its aid, are rendered capable of bearing Mercury well. There are also conditions of the constitution in which it is advantageous to give the Sarsaparilla and the Mercury together,—the constitution bears the Mercury better, and the disease is more com- pletely and more certainly cured thereby. It will be seen therefore, that the Sarsaparilla is not given Notell.—If the Bark alone is the following:—Decoction is given—a tea-spoon full of of Bark, half a pint—Carbo- ihe powder in a glass of nate of Ammonh, two scru- wine or wine and water, is a pies—Comoound Tincture of proper dose—and repeated Bark, six drachms—Tincture two or three times or oftener of Opium, one drachm, of in the day. Another way of which a wine glass is a dose, taking the bark—especially taken every third or fourth in unkindly spreading sores hour. Gonorrhoea,— Occasional Remedies. 71 to cure the Venereal,—it has not the power for this,—but it enables the constitution to bear the Mercury which will, and this under such circum- stances as would render it dangerous to give, or to continue that remedy, without it. It is true, Venereal symptoms will disappear under a course of Sarsaparilla alone, but they will return. This fact experience abundantly confirms. Innumerable cases are on record, where, under the Sarsaparilla, the symptoms of Venereal in the constitution have disappeared, and returned again and again, until at length a course of Mercury has been entered on, when they have disappeared forever. Remember, therefore, Sarsaparilla is nOt given to cure Venereal disease, but only to enable the con- stitution to bear that remedy which will; also, that Sarsaparilla is not required in many cases, but only in those of weak and irritable constitutions, or in those in which Mercury is found to disagree—ren- dering the patient feverish and irritable. With respect to the manner of taking Sarsaparilla, many preparations of it are in use; some of them are very troublesome, inconvenient,and expensive; and it does not seem to me, that these latter have any great advantages above the former. The most simple, convenient, and least expensive is the pow- der;—a good large tea-spoon full of which, in milk and water, I have found, as far as I could see, to 72 Gonorrhoea,— Occasional Remedies. answer all the valuable purposes of this medicine; but in note 12, I will give the other forms,, leaving it to circumstance or partiality to fix on either. Note la. — Ths Powder of Sarsaparilla—Is taken in doses of a tea-spoon full mix- ed in a tumbler of milk and water, or in any thing more agreeable— three or four times a day. Simple decoction of Sar- saparilla—May be made in this way. Boil two ounces of the sliced or bruised root in three pints of water till it is reduced to a pint and a half, (which is a wine quart bottle,) after boiling an hour or two, it is recommended to take it out of the water, and bruise it again in a mortar- then finish the boiling--strain it and fill a wine quart bottle with it. This quantity should be drank daily—half a pint at the time. As a larger quan- tity can be made with but little extra trouble, most will see the advantage of making two or three bottles at the time. Some make the pro- portions of the decoction stronger, but this I take to be the medium and the best. But there is an easier way of ma- king the simple decoction—it is by boiling three drachms of the Extract of Sarsaparilla for a few minutes in a pint and a half of water. The Compound Decoction »f Sarsaparilla.—This is of the same nature as the fa- mous Lisbon Diet Drink, or Decoction of the Woods, and is made by adding to a pint and a half of the simple de- coction, the following ingre- dients : — Guaiacum rasped, sassafras and liquorice root, of each two drachms, meze- reon root, one drachm: then boil them tdfcether for about ten minutes and strain again. To be taken as the simple decoction. Syrup of Sarsaparilla.— This, if you can get it good, and with a proper portion of the extract, is a pleasant way of taking it,—(rom half, to a full wine glass maybe taken in a tumber of water, three times a day,—or it maybe added to either of the decoc- tions to make them stronger. Gonorrhoea,— Treatment and Cure. 73 CHAPTER IV. On the Treatment and Cure of Gonorrhoea. It is reasonable to suppose that those who have read the preceding remarks on the ordinary reme- dies for Gonorrhoea, will prefer those I recommend to any others. These are put up together in a little chest—including my pocket syringe, on which so much convenience and utility depend. Bui beside being more convenient and certain, they will also be found cheaper in the end than procuring medi- cine from time to time at any apothecary's store.— In this chapter on the treatment and cure of Gonor- rhoea, therefore, I shall refer continually to the reme- dies of my chest; but as this may not be in the possession of every one, I shall also refer to those other, though inferior remedies, already mentioned and described. A Gonorrhoea, as stated in the second chapter, commences with a discharge from the urinary pas- sage, attended more or less with pain and heat in making water. These symptoms generally appear in about two or three days from the period of expo- sure to it. There are also other circumstances which may or may not appear, and may be therefore called occasional symptoms; these are,—excessive 74 Gonorrhoea,— Treatment and Cure. pain in making water,—swelling of the foreskin,— swelling in the groin,—painful erections of the penis,—and ^welling of the testicles. Now, the treatment under all these circumstances must be considered; but it will add to the plainness of the subject if these be considered separately. I will therefore first describe the treatment of the simplest case of Gonorrhoea, and when that is done, will take those other circumstancesror occasional symptoms, in rotation. In every case of Gonorrhoea there are two distinct and separate stages;—the inflammatory or painful, with which it begins;—and the specific, or that con- sisting in a continuation of infectious discharge, hut without much pain and inflammation^ It is true that in some cases the first, or inflam- matory stage, is very slight, but there is always something of it, and though there may be scarcely any, it is always right to guard against it. For this reason I recommend that in every case of Gonor- rhoea, an active purgative should first be given. Take five or six of the purgative diuretics of the chest, or any other in note 7 you please. If the pills are taken at bed time, they will probably operate briskly in the morning, if not, repeat the dose. But if, not- withstanding their purgative effect, low diet, a free use of some cooling drink, (note 6,) and as much rest as you can command—the pain and heat in Gonorrhoea,— Treatment and Cure. 75 making water should come on, or, having already been complained of, should increase, it will be proper to repeat the purgative again, before advancing further with any other remedy. This pain and heat, if at all considerable, must be abated first. I will suppose, however, that it is very moderate, a purgative dose or two having been taken, or, if it had been pretty severe, that it is much abated, and now therefore is the time to commence with other remedies which lessen the discharge. Begin with the Black Pill, five or six of them three times a day. In a day or two it is pro- bable the discharge will lessen; but whether it do or not, provided the pain and heat in making water should not return, begin with the injections, precisely as mentioned in page 54. There is no occasion to enlarge this little book by repeating these directions,—they are there given in the fullest and plainest manner. At the same time continue the Black Pill. Under this plan, sooner or later, (but remember it is not equally soon in every case,) the discharge will cease entirely. When this happens leave off the pills, or take but half the dose a few days more, then leave them off entirely. Next, begin to lessen in frequency the use of the injections, but do not leave them off too suddenly. One of these remedies (the injection or black pill) should be continued for 10 or 14 days after the dis- charge has disappeared. If the case should happen 76 Gonorrhoea,— Treatment and Cure. to be more tedious than common, the pill may be omitted—more than are contained in the chest need not be taken—the injections will finish the cure of it alone.—This is the treatment of Gonorrhoea in its simple and common form; but, as I have said before, there are other circumstances which may or may not occur, and which must now be mentioned separately. Before however finishing these remarks on the cure of Gonorrhoea,—it may be as well to say a word or two on the difference there is found in the time of curing this complaint, in different indi- viduals. Even under the same degree of active and judicious treatment, and this especially adapted to each peculiarity of constitution, the time required in one will be ten times longer than in another.— Neither is it always easy to foretell the individual in whom the cure will prove so tedious. The fact itself however is noticed by every author of experi- ence, and it is well to know it, that such cases may be endured with patience and perseverance. As an instance of good authority for this statement, I will here transcribe the words of Sir Astley Cooper on the subject:—he states,—"Gonorrhoea some- " times continues for so long a time, notwithstand- " ing all the means which may be employed for its " cure, as to be an opprobrium to our art." Again, " Gonorrhoea is a disease which very often baffles " the longest experience, and the greatest profes- " sional skill." And, he remarks still further on " this subject,—u You will generally find the cure Gonorrhoea,— Treatment and Cure. 77 " of Gonorrhoea difficult in proportion as the consli- " tution of the patient is disposed to Scrophulous " affections. If a^ patient has pimples on his face, " enlargement of the glands of the neck, a thin deli- l' cate skin and irritable fibre, you may expect to " have great difficulty in curing him of Gonorrhoea." Now, if this be true, (and no one of much experi- ence will doubt it,) who can wonder at the frequent cases of misery, disappointment, Gleet, and Stric- ture, which result from trusting to that swarm of advertising people who fill our little daily papers; for, if Gonorrhoea may prove so difficult under men of so much faithfulness and skill, what can be ex- pected from persons of the description I allude to. There is however one advising hint I cannot for- bear to give to those who are laboring under a long continued Gonorrhoea;—be sure that the person whose care you are under is a man of integrity and skill; and then, do not be dissatisfied merely because the case is tedious, but be satisfied its tediousness is not the consequence of ignorance. Neither pay the least attention to what you may have heard of other cures; for, as I have shown in a former chapter, Gonorrhoea is sometimes of most simple and easy cure; and many of these so easily and quickly cured cases, are not cases of Gonorrhoea at all, though some are sure to call them so. Nor, in your enquiries about the boasting people, should 78 Gonorrhea,— Treatment and Cure. you ever trust to what they say about themselves. If it were not too serious a subject, it would be quite laughable to read the long imposing titles which some of these will give themselves;—but rather enquire of some respectable physician as to who and what they arc.—I do not hesitate to say, there are no two diseases in the whole range of medicine, which more truly require the assistance of a physi- cian of integrity and skill, than Gonorrhoea and Venereal. I now proceed to those other circum- stances which occasionally occur in Gonorrhoea,— the first of which is,— Excessive pain and heat in making water.— This is nothing more than a higher degree of the first or inflammatory stage of Gonorrhoea which has been already noticed, but which must be subdued before the remedies for stopping the discbarge are entered on. The means for reducing inflamma- tion are,—purging, low diet, rest, and the freest use of diluting drinks, for which directions are given in note 6 and 7. You cannot make too free a use of diluents. The burning pain arises from the saline urine passing over an inflamed and irritable passage. The urine itself is loaded with salts—it is like brine; if, therefore, you dilute it with perhaps a gallon or more of water, 'uring the day, it is easy to imagine how its stimulating property must be diminished. Sooner or later, by the means above directed, this heat and pain will considerably abate, and then, and Gonorrhoea,— Treatment and Cure. 79 not till then, can you safely proceed to lessen the discharge. Swelling of the Foreskin.—The foreskin, called the prepuce, will often swell prodigiously, but this of itself, is of very little consequence. A soft rag wet with brandy and water, simple water, or any cooling lotion, as in note 4, and wrapped about the part, together with a dose or two of purging pills, is all that is required. The rag should be wetted often. It is of some advantage too if the penis is kept upright, which can easily be done by pinning or fastening it to a bandage around the waist. But this swelling^sometimes is so great that the fore- skin cannot be pushed back from over the glans or head of the penis. This condition of it is called a phymosis ; and, sometimes again, when it is pushed back it cannot be drawn forward, this is called a paraphymosis. Now, both these states are of great consequence, particularly the latter. The chief thing to look to in the first (the phymosis) is cleanliness; and here the patent syringe in the little case is of the ut- most use in washing out the humours that collect beneath the foreskin, and which, by becoming acrid and offensive, greatly increase the malady.— It is necessary therefore to inject some proper fluid under the foreskin several times a day. Any thing that will wash away these humours is better than 80 Gonorrhea,— Treatment and Cure. nothing, so that warm or even cold water may be used; but the best thing for this purpose is a lotion made of no. 1, of the injection powders—for this is cooling and healing to the parts, as well as cleansing. The paraphymosis, is still of more consequence; indeed, you should loose no time in endeavoring to reduce it,—that is, to bring the foreskin forward again over the glans, or head of the penis. With this object you proceed in the following way. Take hold of the glans, which is always very much swollen, with the fingers and thumb, and steadily press it, gently increasing the pressure in order to squeeze back some of the stagnant blood and lessen its size. It is better if you first hold the hand in very cold water. Immediately after thus diminish- ing its size, apply the two thumbs to the glans, and grasping the foreskin with the fingers, steadily rush back the glans while you pull the foreskin forward. A little force may be necessary, but you will almost always succeed; if not, the only thing a surgeon could do, wonld be to cut the skin on each side, where it is tightest, and then it will easily pull over; this might be done with a sharp pen-knife or razor, after this apply a poultice. In both these cases, of course, it would be proper to live low, keep as quiet as you can, and to purge freely. Frequent and very painful erections of the pe- nis.—This is what the French people call Cordee, Gonorrhoea,— Treatment and Cure. 81 and a very painful thing it is. I have already point- ed out its nature in page 24,—it occurs particularly at night—the penis often being quite crooked at these times. When cordee is disposed to come on, it cannot always be prevented entirely, but it can al- ways be relieved and rendered tolerable. Further, a cordee once come on, it is often the last symptom to leave the patient. The best way to prevent a coidee from coming on, is to prevent inflammation, by rest, puiging, and low diet; the best way to relieve it when it has come on, is to take two or three of the anodyne pills in the little chest, at bed-time, or those in note 13 be- low. After a few nights, see if you can leave them off, but if the pain come on again, return to them. With a view also of relieving the inflammation of the penis, on which this symptom depends, it is a good thing to immerse it in a basin of warm water for a quarter of an hour on going to bed, and after- wards to wet a soft rag with brandy, or vinegar and water, or common water, and wrap it round the penis. Some contrive to have a bottle of cold wa- ter near the bed, which they hold between their legs whenever it awakens them. Note 13.—Those who have and ten of Opium in twenty not the little case, may imi- pills—of which take two or tate the anodyne pills in the three at bed time. If this following way. Get an apo- cannot be done, let thirty or thecary to make up forty forty drops of Laudanum be grains of camphor,—twenty taken in a little water. of the extract of Hy osciamus 82 Gonorrhoea,—Treatment and Cure. Swelling of the glands of the Groin.—This ig of less consequence in Gonorrhoea, than in Venereal disease;—it is a very rare thing in a Gonorrhoea for these swellings to form into matter and break, as they do in Venereal. Brisk purging with the pills,—as much rest as possible,—and at night a rag wet with brandy and water, or vinegar and wa- ter laid on them, is all that is required; under this plan these swellings almost always subside. I have indeed sometimes seen them form matter and break, but it has always been in scrofulous habits, and has been owing to the constitution rather than to the Gonorrhoea. In such a case, should these tumours threaten to form matter, leeches would be proper and desirable. Swelling of the Testicle.—When this complaint happens, it generally begins about 10 or 14 days from the commencement of the discharge, but it may occur at any time. At first there is an uneasy feeling about the part which you might judge to be the situation of the neck of the bladder—just be- hind the Scrotum (the purse.) Then there is a swelling of the back part of one or of both the testi- cles, and when the inflammation proceeds into the substance of the testicle, there is great pain and fe- ver. From the moment a testicle is threatened by these symptoms give up every means for the cure of Gonorrhoea and turn your whole attention to this single circumstance. Gonorrhoea,— Treatment and Cure. 83 In the cure of this affection, the first thing to be recommended (when it can be done) is rest, and resting on a bed is preferable to any other. The next, to support the testicles by means of a suspen- sory bandage.—If you have not this at hand, it may easily be contrived.—Make a bag of soft linen, large enough to hold the swollen parts, and then sew or pin it to a bandage or pocket-handkerchief round the body. If the testicle is suffered to hang by its own weight, this alone will prevent its cure and greatly augment the pain.—Next, take 5 or 6 purga- tive pills.—frequent and repeated purging is a pow- erful means of relieving this disease, and this may be followed up either by repeating the pills, or doses of Epsom salts. Lotions also are of great use, and the best of all is the common evaporating spirit Lotion;—it is made by mixing one part of brandy to two of water, and applied by keeping a soft rag and the suspensory bandage constantly wetted with it. Bleeding by leeches is exceedingly useful where the pain and inflammation are great, but many per- sons are placed in such circumstances as not to ad- mit of their use. There is however, another way of taking blood from the part which might be re- sorted to in very urgent cases, or might be practised at sea, where leeches are not always to be had;—it is as follows.—Stand before a warm fire and pull up the scrotum so as to put the skin on the stretch,— you will then see several veins cf a blue color:— Take a lancet or very sharp pointed pen-knife and 84 Gonorrhoea,— Treatment and Cure. puncture five or six of them;—then, with a sponge and warm water bathe the part, and you will be able to get more blood than by leeches and with far less trouble and risk of exposure. The bleeding ceases on lying down; if not, applying cold water will soon stop it. Sometimes, even under the best possible treatment, great pain and inflammation will- continue and you are under the necessity1' of taking opiates. Forty or fifty drops of laudanum may be taken at bed time. The best form however, of opiate medicine is, if it can be procured—15 grains of Dover's powder, with two of Calomel at bed time. This is as far as I would advise any one to go on his own judgment. In very many cases these means will stop the progress of this symptom, and, indeed, remove it; but, on the other hand, there are some cases in which it will not,—the pain goes on and is attended with fever and perfect inability to go about. In this case I would advise, if possible, to call in the aid of medical assistance; but, in many cases, this is quite impossible,—you may be at sea, or in the country, or where you cannot command this assistance, and therefore I will pursue this subject and describe the best measure to adopt in such a case, in note 14. Note 14.—If rest, low diet, purgative medicine, lotions, ana perhaps leeches to the part, do not succeed in les- sening the pain and inflam- mation, then a very copious bleeding should be resorted to. Indeed bleeding would be proper in any case, but we do not always have recourse to it, hoping to succeed with the means before mentioned. Gleet,—Its Nature. 85 CHAPTER V. On the Nature and Cure of Gleet. A Gleet is almost always the consequence of a badly managed Gonorrhoea. Instead of following up the cure of that disease by the injections which From one to two pints of blood maybe taken from the arm and repeated if not suc- cessful in allaying the pain, swelling, and fever. At the same time, large doses of Tartarized Antimony should be taken. Eight grains may be dissolved in half a pint of water, and an eighth part of this may be taken every second or third hour. This is a large dose, at first it may vomit or purge, but this should be no objection to continuing it. unless the vo- miting should be excessive,— it will generally cease after a day or two. There is no medicine which has such power to subdue inflamma- tion, and especially inflam- mation of the Testicle, as Tartarized Antimony, and so important and so painful is this inflammation, that a lit- tle inconvenience, or nausea and vomiting should not hin- der from its use and benefit. If the pa;n should be very great, and prevent sleep at night—three or four of the anodyne pills may be taken at bed time, — or twenty grains of Dover's powder with two grains of calomel. If this is not at band, forty or fifty drops of Laudanum may be substituted. Leeches are always of use — fifteen or twenty on the part and after- wards cover with a warm poultice. Atother times, if"it can be had, ice may be used. Sometimes cold applications will do wlien warm ones will not; at others warm will an- swer when cold will not. If one has been tried without success always try the other. When ice is used let it be powdered and put into a blad- der half full of water, and lay it on the inflamed and swol- len testicle. It is astonishing how quickly this will some- times relieve the pain and in- flammation. There is a way of obtaining cold when you cannot procure ice. Just mix equal parts of Sal ammo- niac, Saltpetre, and Glauber Salts, and put into a bladder of water, instead of ice: as 86 Gleet,—Its Nature. are here so particularly dwelt on, the discharge is suffered to go on from month to month, and the effect of this is to entail a permanent weakness of the parts affected. It is important to understand the nature of this malady, as well as how to cure it, especially as a very serious error respecting its infectious nature, prevails with many. It is a very common thing to hear it said that a Gleet is not infectious; but this is very wrong, and often leads to terrible diasters;— virtuous and unsuspecting women are unintention- ally involved in this complaint in consequence.—A person who is about to marry, for instance, may not have had Gonorrhoea for six or nine months, or longer; but a slight discharge—so slight indeed that he has scarcely observed it—may have continued all this time. But he does not dream of its infec- tious nature until the sadest consequences show themselves. So also, unfortunately, dees a similar cause of unhappiness frequently occur in those who have been abroad or from their family for a length of time. Indeed, the consequences of this error are so very serious that it merits any pains and trouble these dissolve much cold is Suspend the testicle,—rest,— produced. I have dwelt long- purge, — leech, — and apply er on this subject than on cooling lotions. If pain, in- some, as it is a severe com- flammation, and fever still plaint. I have found it so in run on,—bleeding, leeches, my practice. A summary of Tartarized Antimony, and the treatment of inflamed the application of cold. testicle then is as follows. Gleet,—Its Nature. 87 to set the matter in its own true light, and perhaps I cannot do this better than by giving a case or two, as related by Sir Astley Cooper. On this subject, then, Sir Astley observes,— " Gonorrhoea, when neglected, sinks into a Gleet, " and is known by the change of the color of the " discharge, and the pain attending the inflamma- " tory stage ceasing. In this state, is the discharge "infectious or not? 1 doubt myself whether a " Gonorrhoea ever loses its power of causing infec- " tion as long as any discharge from the urethra " remains, and I will give you my reasons for this " opinion. A married gentleman went to Lisbon " from this country, [England] and whilst at a dis- " tance from home, departed, as too many do, from " the path of virtue. The Portuguese lady with " whom he cohabited, gave him the Clap. He re- " turned to England, and, after the expiration^of five " months and three days after first observing the " Gonorrhoea, he called on me, and asked whether " he might return home with safety to his wife. " He said he had a little discharge, and wished to " know, if, after having had it five months and three " days, it were possible for it to be infectious. I re- plied—'Certainly not; you may go home—there " is no danger of your giving it to your wife.' He " went home, and unfortunately gave his wife a " severe Clap. I attended both the parties after- " wards, and was extremely sorry for what I hail 88 Gleet,—Its Nature. " done;—but I thought, at the time I gave the ad- " vice, that a Gleet was not infectious. But I think " differently now,—and believe that, after a con- " tinuance of several months, the discharge is " infectious." Another instance.—"A gentleman from the north " of England, and who had been recently married, " came to me, and said that he had communicated " a Gonorrhoea to his wife. Shocked at such an <{ occurrence, I said, ' How could you think of act- " ing in such a manner?' ' Why, sir,' said he, ' for " fourteen months prior to my marriage, I had a " Gonorrhoea; I made various attempts to get rid " of it, and had a variety of advice about it, but a " yellow discharge always continued. I was told " by every body that it was not infectious,—and " not until after such repeated assurances did I get "married; the consequence, however, is, that my " wife has a severe pain in making water, and a " copious discharge.' I visited her, and found her " in this state ; she was some time under treatment " before she quite recovered. From what I have " seen, I do hold that a medical man is not war- " ranted in saying that a discharge of a gleety kind ({is not infectious." On these two cases thus faithfully related, then, every person will be able to form his own opinion on the infectious nature of a Gleet; I think they are Gleet,—Its Nature. 89 sufficient to make every reflecting, conscientious person take care how he gives advice in such a case, particularly if his patient is a married man.—Indeed, it is from this error, or from a total indifference as to its consequence, that we have so many cases of Gonorrhoea,—they are twenty to one, compared with cases of Venereal. In fact, the common women of the town pay no attention to a Gleet. After the first or inflammatory symptoms of a Gonorrhoea have subsided, they mix with society as though nothing ailed them. In the patients of the Hospital called the :;Lock," in London, for instance, nothing is more common than to see the Venereal and the Gonorrhoea in the same female; but it is the Vene- real which brings them there. As to the Gonorrhoea, or Gleet, they will tell you they have had that a long time, and thought nothing of it, but having got the Venereal, in the form of chancres, they became alarmed, and anxious to be cured. So also, when the Venereal,is cured, they seldom stop in the Hos- pital for the cure of the Gonorrhoea, or Gleet, but go out again promiscuously in the town and spread the Gonorrhoea in every quarter. I do not however, after all, say that every Gleet is infectious, but, they are so generally, and there is no mark whatever by which it can be said that this is infectious and that is not,—this can only be known by its consequences. How serious therefore to say to any one, especially to a married man, or 90 Gleet,—Its Nature. one about to marry, that a Gleet is not infectious. But it is incumbent also to state, that there is a dis- charge from the urethra, in some measure resembling a Gleet, which is not infectious. A discharge of this harmless kind may proceed from two causes which may be easily understood. In the first place, it may proceed from a little abscess which occasion- ally forms in the urinary passage, and breaks; and the other is, a discharge proceeding from a Stricture. Now, the nature of these two causes of discharge must be understood, and then a suspicious gleety disorder will be easily detected and distinguished from either of these. First,—With regard to the discharge from the little abscesses above mentioned, it should be known, that, in the whole length of the urinary passage are situated, here and there, little sacks for the purpose of secreting a lubricating fluid; these are called lacunae. After a Gonorrhoea, these little lacunae are sometimes affected with common inflammation, which forms into abscesses, and when these burst and their contents are discharged, the running ceases. Now, the circumstance by which these abscesses may be distinguished from a Gleet, is this;—the discharge from these lacunae stops en- tirely for a week or two, and then, when another breaks, it comes on again, suddenly, and again ceases as before; but the discharge from an infec- tious Gleet never stops;—it may increase, from Gleet,—Its Treatment and Cure. 91 excesses or irregularities of any kind; and it may decrease, so as to become very trifling,—but it never ceases altogether. This,,therefore, affords a good rule of judging between Gleet and a discharge from these abscesses in the urinary passage. And next,—With respect to the discharge arising from Stricture, this will be easily detected by con- sidering the symptoms proper to Stricture; and, should any doubt exist, this may easily be removed by the use of a Bougie. For the symptoms proper to Stricture, and for the use of the Bougie, the reader is referred to the next chapter, which treats expressly on those subjects. The Treatment and Cure.—A Gleet is a very troublesome disease to manage. If there were no other reason for saying this, I might safely infer it from the numbers who come to me with this com- plaint, having had it on them, more or less, for a length of time. These patients generally state that they have tried a great variety of means, and are quite disheartened. I cannot always learn particularly what these means have been, but two important things I do know; first, that whatever they have been, they have always failed ; and, next, whatever has been the state and condition of their case, the means I am now about to mention have always succeeded. I think it right to premise these remarks, because it may be thought the plan I recommend is 92 Gleet,—Its Treatment and Citre. very troublesome; it may be so; but then, I would repeat, this plan succeeds when every other fails,— and I am quite sure no better can be availed of. In the first place then, in the case of Gleet, begin with the Black Pill;—or, if preferred, either of the other remedies mentioned in chapter III. At the same time also begin with ihe Injection. Both the internal medicine and the Injection are lobe used exactly as for Gonorrhoea. To save unnecessary repetition therefore, you are referred to chapter IV, on the treatment of Gonorrhoea. But the most troublesome part of the treatment I recommend, is the use of the Bougie. Many per- sons, I know, may not be able to procure them, and others may not like to venture on their use. It will be satisfactory therefore for such to hear that I do not consider the Bougie absolutely necessary, but only state, that, cases which have been very tedious and obstinate under every other means, have got well very quickly when the use of the Bougie was added to them.—Instructions for the use of the Bougie I shall give in the next chapter, on Stric- ture; here I would only observe, that it is not re- quired to begin with the small size, as in Stricture, but to select a medium or full sized Bougie, and pass it in the manner there directed, every day ; or, if it give uneasiness, (which is not usual,) every other day, as long as the disease continues. It often 9 Gleet,—Its Treatment and Cure. 93 happens there is a little increase of discharge on first using it, but this soon goes off. The stretching of the urinary passage by the bougie, and the stimu- lus thus afforded, expedite the cure of Gleet ex- ceedingly. Those therefore who have been long tormented with this complaint should not think the trouble of the Bougie too much, to get rid of it. When, however, it cannot be procured, or is exceed- ingly disagreeable, it may be dispensed with. There is another medicine sometimes taken for the cure of Gleet—the Canlharides, or Spanish Fly. I have sometimes given it, by way of change, in cases which have proved unusually obstinate—see note 15. The following then is a summary of what has now been said on Gleet. It is a discharge of a bluish or yellowish humor from the urinary pas- sage—sometimes clear—sometimes opaque;—there is no pain attending;—it is almost always the con- Note 15.—The best way to take this medicine is in the form of pills, which should contain one-quarter or one- half of a grain of the powder in each; one of these pills should be taken night and mornine, and, after a little while, three times a day. It is better to make the cantha- rides into pills with one or other of the thicker kinds of turpentine; the best of these is that called Chio turpen- tine, of which five grains should be allowed to each pill; if this size is too large, it may be made into two in- stead of one. It should be continued a considerable time to do any good. J f it produce heat and frequency of making water, leave it off for a day or two, and take flaxseed tea, or bar- ley water. 94 Gleet,—Its Treatment and Cure. sequence of a badly treated Gonorrhoea. Its treat- ment is like that of Gonorrhoea, but the use of the Bougie is a valuable addition;—this however is not essential to its cure—it expedites it only. Another addition to the treatment is, the internal use of Cantharides, or Spanish Fly. -Stricture,—Its Symptoms. 95 CHAPTER VI. On Stricture,—its Symptoms, Nature, Consequen- ces, and Cure. The symptoms which denote the existence of a Stricture, should be considered with respect to those which attend it early, and those which attend its more established stage, and the more, as it is an un- questionable fact, that Stricture may exist in a mild and dormant form, and for a long time, and the suf- ferer be not in the least aware of it. On this ac- count also it is desirable to be more particular and plain in pointing out the early symptoms of a stric- ture, not only because it is in the early stage that its cure is so easily accomplished, but because, with- out this knowledge, and the proper plan it leads to, all the medicine in the world would never cure it.—It should first be mentioned that the most com- mon cause of Stricture is a badly treated Gonor- rhoea. If for instance, the earliest appearance of a clap has not been seized upon to cut it short by proper means, or if this has been neglected, and the cure has not been followed up, in some such • manner as directed with my patent syringe, it slides into a Gleet, and a Gleet is naturally disposed to become a Stricture. When therefore a person comes to me with a Gonorrhoea that has continued 9(5 Stricture,—Its Symptoms. an unusual length of lime, a month or two, for in- stance, I consider the length of time alone, a suffi- cient reason to suspect the possibility of Stricture, and it becomes my duty to ascertain for fact, whether it be so, or not.—Now among the early symptoms of a Stricture, are, a scattering of the stream of urine in making v/ater, or a splitting of the stream, or a stream smaller than formerly; and if these, or any one of these exist, my suspicion is increased. But even tho' he should have noticed none of these, still I am not certain he has no Stricture, for some of them, especially a diminished stream of urine, may creep on so slowly as not to be observed ; and until the stream of urine beeomes remarkably diminished a patient is very apt to overlook it and say it flows as usual. I have had persons tell me this, when, on examining the passage I found a well marked Stric- ture, and then, reflecting on their former way of making water, they have been convinced their stream was not so large as formerly.—But among the very early symptoms of a Stricture, there is another in which I have still more confidence,—it relates to the manner in which the last few drops of urine pass, which is by dribbling away. This is a symptom of great value in determining any doubt- ful case of Stricture, and deserves a word or two of explanation. Now it happens in the veiy onset of a Stricture, and before any positive narrowness has occurred, that a certain elastic power with which the passage is endowed, in order to expel the urine. Stricture,—Its Symptoms. 97 with a jerk, becomes weakened or is quite destroyed, so that it can no longer contract upon these last few drops, and the consequence is they have to steal or dribble away after the act is over, Whenever I have reason to-suspect a Stricture, therefore, I put this question,—Have you observed, when you have finished making water and buttoned up your clothes, whether a drop or two of urine passes afterwards, so as to wet the shirt a liltle ; and if they say they have, my suspicion is greatly confirmed. This is the most universal, as well as the very first of all the symptoms of a Stricture. Indeed a Stric- ture cannot exist Avithoul it. Not that I mean that this dribbling cannot proceed from any cause but Stricture, for it may proceed from weakness of the parts and other causes ; but a Stricture cannot exist without this drop or two of urine, and therefore whenever this is not observed you may be sure you have no Stricture. Another circumstance attending the early as well as the later stages of a Stricture, and which in some degree or other is almost always present, is its effect upon the mind and spirits, to depress them. In some individuals this effect proceeds so far as to make them hypochondriac, and in almost every one there is some degree or other of it, so that he is conscious he is not so energetic in, nor so capable of business as formerly. By this depression I do not mean that lowness and dejection of the mind 7 98 Stricture,—Its Symptoms. produced by gloomy apprehensions, or the deceitful tricks of advertising people; these are, indeed, enough to affect the spirits, but the depression I refer to arises from a very different cause, and ia often present when there is scarcely any other mark of Stricture. This effect of Stricture on the spirits, arises from the intimate connexion which subsists between the sexual organs and the mind. Every body is aware of the effect of a single thought of a eertain nature upon these organs. Now it happens throughout the body that wherever one part has the power to affect another, the latter also has the power to affect the former. For instance, if a sexual thought, through the medium of the nervous system, has the power of influencing the genital organs, in like manner a diseased condition of the genital organs has the power to influence the mind, and it is on this striking reciprocity of sympathies that Stricture in the urinary passage is so wont to de- press the spirits. Another and very similar effect of Stricture is that which it produces on the stomach and organs of digestion, for the same medium which connects the mind with the genital organs, connects it also with the functions of the stomach. Nothing is more common than to see a train of nervous or dyspeptic symptoms which have resisted every means of cure, most happily and unexpectedly disappear on pro- ceeding in the cure of Stricture. Stricture,—Its Symptoms. 99 These two circumstances therefore—depression of spirits and nervous dyspepsia—may very properly be placed among the symptoms which attend the early stage of Stricture. They are not of course to be depended on alone, apatt from other symptoms, for it is well known that they may arise from other causes; but in cases where there is only a mere suspicion of Stricture, it would be well to consider if either of these were present, for, if so, it would greatly strengthen that suspicion. These then are the circumstances which denote the early stage of Stricture; and, when it is con- sidered that they are circumstances which do not in themselves naturally suggest the idea of Stric- ture, and also that Stricture frequently exists in those who are not at all aware of it, they would seem to be exceedingly worthy of attention. To recapitulate therefore it may be stated that,—Stric- ture is a disease which often exists in those who are not in the least aware of it, but that there are certain circumstances which should always lead to its suspicion; these circumstances are,—a slight alteration in the manner of urinating,—a drop or two of urine which steals away after the act is over, bo as to wet the shirt a little,—and depression of spitits, or an irregular train of dyspeptic symptoms which cannot be accounted for. Here it should be observed that the symptoms 100 Stricture,—/^ Symptoms. just enumerated go no further than n> afford a suffi- cient reason to suspect a Stricture,—they do not prove that a Stricture really exists; the positive existence of a Stricture, especially in this early stage, can only be ascertained by examining the passage with a bougie, which is a very easy and simple thing to do, as will presently be seen. Nothing can better show the difference between the common adver- tising knave and nostrum seller, and the good and faithful Physician, than the difference of their con- duct in the case of Stricture. The former will never trouble you with the sound of such a word, but will sell you colored drops, or pills, or some such thing, as long as you will take them, and then will leave you in a state of mental misery; while the latter will put his questions on the ground of the possibility of Stricture, and if he should detect the least suspicious circumstance, he will not rest until he has ascertained the fact whether it be so or not. He will then explain the nature of a Stricture, and show the utter inutility of medicine in such a case; and afterwards conduct you to a safe and perfect cure. None but those who see it daily can foim the least idea of the chagrin and misery that man escapes who falls into the hands of a good Physi- cian in diseases of this nature. But, so far I have spoken of Stricture only in its early stage,—at the time when its symptoms are so few and give so little inconvenience as to allow its Stricture,—Its Sijrnptoms> 101 existence to be overlooked; in its advanced stage however, the symptoms are very numerous, and some of them most deeply interesting. The inte- resting nature of these symptoms arises from their remoteness from the seat of the disease itself, so that when they present themselves, they are never once suspected to arise from Stricture, and, conse- quently, never get relieved. Many serious diseases, which, from their having proved unyielding under a variety of modes of treatment, have been thought incurable, have- been so because they have arisen from Stricture, which was never thought of.—As an instance;—a few months ago a captain of a mer^ chant vessel from Havana, came to me with a recent Gonorrhoea; but who, in a little while, I perceived had got a Stricture, also, from a former Gonoirhoea. Of course I soon attacked the Stricture, but, as the cure of this proceeded, he told me with the greatest pleasure and surprise that his eyes were better. Now this was the first time he had spoken of his eyes, though I had noticed they were very red and irritable. He then told me that his eyes had been bad for years—that he almost always wore a shade, and that they were frequently so bad at sea that he could not open them at all in common day-light. This, therefore, was a case of Opthalmia from a Stricture, which had given him so little pain or in- convenience, until a fresh attack of Gonorrhoea occurred, that Stricture was never once suspected. By the time the Stricture was cured, the eyes got 102 Stricture,—Its Symptoms. entirely well, and I believe will never trouble him again. But this is nothing new in the treatment of Stricture; nothing is so common as to see com- plaints which had resisted every former mode of cure, particularly diseases of a dyspeptic nature, entirely disappear, on the cure of Stricture. The symptoms denoting confirmed and longer standing cases, therefore,—indeed every thing relating to this subject, is deeply interesting. As I have said before, a contracted stream of urine, more or less, always attends a Stricture, but this creeps on so gradually, and with so little disturb- ance, that it often quite escapes the notice of the patient. But, as the narrowness of the strictured part increases, this alteration or contraction draws attention, for it becomes very small, or divides into two, or sprinkles on the ground; and, in very bad cases, it passes only drop by drop, and that not without some straining. Sometimes it is necessary to make a great effort at the beginning, and after- wards it will flow in a full enough stream; at other times the desire comes on so quickly that you cannot retain the urine for a moment. This is when the bladder participates in the disease. The bladder is always more or less disposed to this participation, so that many patients are obliged to get up in the night, or oftener than they were accustomed to do. In many cases of Stricture also, there is a dis- Stricture,—Its Symptoms. 103 charge from the urinary passage, but this does not happen in every case. This discharge may be only a little more of that mucus which is natural to the part, or it may be real pus or matter. Whatever it is, however, it varies from many circumstances of excitement. When the discharge is considerable, it is often taken for a Gonorrhoea, especially as this may be attended with burning pain in making water, and Cordee, all of which is very apt to follow the excitement of sexual intercourse. There are also various sensations and other symp- toms which may or may not occur. These are exceedingly well enumerated by Mr. Bingham, of London,—a very sensible writer on Stricture,—from whose work 1 shall transcribe the most important,— leaving out however all technical words. Nothing, correctly detailed, can be uninteresting to one afflict- ed with Stricture. Mr. Bingham observes—" Various kinds of sea- " sations also, are produced in different degrees, by " Stricture in the urinary passage: as, an itching " of the penis or the parts about, and a fluttering or " pulsating sensation in some part of the passage; " numbness of the thighs is another symptom; as " are also a smarting or burning pain in the head " of the penis, and darting pains shooting to and fro " from the fundament to this part, or up to the back " and loins; pain in the hip, down the thighs and 104 Stricture,—Its Symptoms. " on the inside of the knees, frequently occurs from " Strictures in the urinary passage, and pain has " also been known in the sole of the foot from the " same cause." Again he observes—"Sexual intercourse is apt " to aggravate the symptoms of Stricture whatever "they are. Sometimes this act is attended with "pain and inability to emit the seminal fluid; at " other times only part of it passes, and the remain- " der steals away when the erection has ceased. " Retention of urine has many times been brought "on by sexual connexion, in patients troubled with "Stricture." " The penis is Variously affected by Stricture. " Sometimes the erections are excessively frequent " and troublesome, and these may or may not be " accompanied with seminal emissions during sleep; " at other times the erections are weak and ineffi- " cient, and, occasionally, altogether wanting." "Sometimes swelling of one or more of the glands " in the groin, and enlargement of the testicle, indi- " cates the existence of Stricture in the urinary " passage: and another symptom is, hardness to be " felt externally in the situation of the Stricture. " Inflammation and a gathering in that part between " the anus and the testicles, are also symptoms of "4he disease." Stricture,—/te Symptoms. 105 "It has been stated upon high authority, that " strictured patients cannot comfortably cross their " legs ; but whenever I have had an opportunity to " notice this, there has been, beside the Stricture, " disease of the prostate gland," (a hardish body situated at the entrance of the bladder, just where the urinary passage begins, and which is exceed- ingly liable to enlargement in elderly people,) "or " inflammation about this part." And, as in the early, so in the later stages, there are many remote diseases which arise from Stric- ture, in consequence of the sympathies which exist between-the urinary and sexual organs, and distant parts of the body. In other words, a Stiicture in the urethra is capable of disturbing the stomach, and through this medium, of inducing other and remote complaints, all of which therefore are cor- rectly placed among the symptoms of Stricture. These complaints are chiefly of a nervous character, as head-ache, low spirits, diminution of wonted clearness and energy of mind, and other hypochon- driac feelings; and so evidently are these the effect of Stiicture, that they cease as its cure proceeds, while they resist every measure short of this. A knowledge of this fact is of great importance too, in the treatment of Strictures, for, as a Stricture in the UTethra has so much influence on the stomach, in like manner the stomach influences the Stricture. Now, we ean at all times prescribe for these disturb- 10t> Stricture,—Its Symptoms. ances, and hence the cure of Stricture is so much expedited by attending to the stomach throughout its treatment. My own practice verifies this state- ment daily. Sores about the head of the penis and foreskin, much resembling Venereal and frequently mistaken for it, are also among the symptoms of Stricture.— The late Mr. Abernethy, in his work on Syphilis, has admirably shown this fact. To what he has stated I can also add my testimony, for instances have occurred to me in which these sores have proved unyielding under many surgeons and differ- ent modes of treatment, but which have got well speedily on treating them accordingly. Sores and other affections of the throat are some- times symptoms of Stricture,—they occur on the same principle, viz:—the sympathy existing be- tween the organs of generation and the throat—so that disorder in one will produce disorder in the other. Many curious facts might be stated on this subject, but, as I observed, being rather curious than of practical importance, I will state them in a note (16.) Note 16.—The sympathies are removed before the age between the organs of gene- of puberty—but also the de- ration and the throat in both veloprnent of the throat ia sexes are very striking. Not hindered, so that the voice only is the beard upon the fails to attain the deep and chin prevented if the testicles tenor tone of men. It is a Stricture,—Its Symptoms. 107 The last symptom I will mention, is a hardness and diseased condition of the testicle from Stricture. This indeed may arise from other things than Stric- ture, but when it thus arises, and this I often find to be the case, it never can be cured but by the removal of the Stricture. A summary of all that has been said on Stricture then may be stated thus;—that, in the early stage, or when its progress has been slow or almost sta- tionary for a length of time, the symptoms of it chiefly relate to the size of the stream of urine, or to the manner in which it passes; this however only affords a ground of suspicion of a Stricture.—But, in more confirmed, or longer standing cases, the symptoms are much more numerous and important, as have been described; still these alone do not prove the existence of it, for all these symptoms may arise from other causes. It is therefore need- ful to have some other means of coming to the point, and this is amply furnished in the Bougie.— A bougie is a soft smooth instrument, which, if no curious fact, that, when the corresponding organ of the female is removed, (as in the ovaria in spaded animals,) the voice becomes deep and rough in women, and hair shoots out upon the lips and chin. Young women who havebeards are generally less prolific than those who have none. Bingham mentions a case which came under his own knowledge, of a young lady who had a beard, but lost it after her marriage — All this shows the intimate connection which exists be- tween these distant organs, aud accounts for many mor- bid actions occurrin.a in the throat simply from sympa- thizing with a Stricture, 108 Stricture,—Its Nature. Stricture or disorder in the passage hinder, can be passed without pain or inconvenience through the urinary passage to the bladder—but which, if there be a Stiicture, stops and proves the fact. The Nature of Stricture.—This is easily ex- plained. The urinary passage is composed of a dense skin, having an elastic power, so that when the urine is forced into it by the bladder it enlarges to transmit the stream. Gonorrhoea, essentially, is a slate of inflammation, and the effect of inflammation, when long continued, is to alter the natural condition of the part in which it may be seated. Now, in the present instance, it alters and destroys the elastic power with which the urinary passage is endowed, so that it no longer yields to the flow of urine as it ought to do, and hence the stream is lessened and its force diminished. Also, there are certain portions of the urinary passage, it is well known, more liable to inflamma- tion than others, and, accordingly, Stricture is most frequently found to be seated in these very portions. Again, long-continued inflammation is known to thicken any part in which it may be seated, and this is the case in Stricture. Besides the loss of its elas- tic yielding nature, therefore, the passage also be- comes thick and callous: so hard and thickened is Stricture,—Its Consequences. 109 an old bad Stricture as to threaten an actual oblit- eration of the passage, for the urine passes in the smallest stream, and sometimes only drop by drop. On the nature of a Stricture also, it should fur- ther be observed, there is no natural cure for it.— When a Stricture once begins it is sure to go on in- creasing, either rapidly or slowly. Fortunately, however, we have the means of curing it by art. as will presently be described,—-neither is it curable by medicine; all the medicine in the world, alone, would never cure a Stricture. On the nature of Stricture then, it may be said, it consists, at first, in a loss of the dilating power of the urinary passage, by which the stream is lessen- ed ; and next, in a thickening of the parts, by which the stream is constantly diminishing; and, that it is curable by art. The Consequences of a Stricture.—These are truly lamentable,—not only being distressing to en- dure, but, some of them totally incurable,—admit- ting only of relief. I speak however now of old bad cases, such as have been suffered to run on for years, or badly treated. Besides those sympathetic disorders then, which were noticed in speaking of the symptoms of a Stricture, there are consequences which are more 110 Stricture,—Its Consequences. immediately connected with it, and these I next propose to state. One of the first of these consequences is, the ef- fect which straining has upon the bladder. The more resistance the Stricture offers to the flow of urine, of course the more exertion must the blad- der make. This leads to a thickening of its coats and to other conditions of it which make it irritable and capable of retaining but a very little urine, so that the calls are frequent and pressing,—dis- turbing sleep and rest. From the same cause also the kidnies are very apt to be diseased. The next effect of so much straining is produced upon the passage itself, just behind the strictured part. The force of the urine, as may easily be im- agined, dilates the canal and forms a pouch or bag in which a portion of the urine lodges. But this, which always happen more or less, may lead to la- mentable consequences. In the first place it may render the passing of the bougie impossible; for when the pouch is large, the orifice leading out of it may not correspond exactly with that leading in to it, so that the bougie may easily pass in, but not pass out or through it. And, in the next, the urine lodging here, is very apt to irritate and produce dis- ease. Disease arising from this cause is of the most distressing and permanent kind ; matter forma in the subjacent structures and makes its way out, Stricture,—Its Consequences. Ill both by opening into the passage, and also by open- ing externally, ulcerating through the parts between the thighs. But the worst is, the passage it thus makes will not heal. It is difficult and sometimes quite impossibleto preventthe urine passing through it. This is what is called a sinus, of fistula in pe- rinceo. I scarcely know a more disagreeable and inconvenient thing than a sinus in these parts,— the person is obliged to squat down in making wa- ter to do it comfortably. But to form a true and clear conception of this malady (and every one should do so, in order to avoid that class of people who produce it,) it is necessary to see it in a plate, and with this view I have selected the one on the fol- lowing page, from one of the best and latest authors on the subject, and from this it will be correctly judged how serious a thing it is to neglect a Stric- ture. Indeed, so true is this that a very eminent writer on this subject,—Sir Everard Home,—Sur- geon to the late King of England, in his third vol- ume, has a chapter upon,—Diseases of an incura- ble nature, the consequence of a long-continued Stricture, before the proper means of removing it had been adopted. Among the consequences of stricture also may be noticed, a shrinking and dwindling of the penis with but little erectile power. It is not easy to ac- count for this, but of the fact itself I am well as- sured. On the removal of the stricture it resumes its wonted size and firmness. 112 Stricture,—Its Consequences. A similar state of wasting of the testicles is also a consequence of stricture. Impotence is another and the last to notice.— This may occur with, or without, the loss of sexual inclination. There are two ways in which a stric- ture may be the cause of impotence—the one me- chanical, the other functional. In the first, the func- tion of the testicles is performed, but the fluid is impeded in its passage, or its impetus so broken as to fail in accomplishing its destined purpose. In the second, the function of the testes seems to be disordered, so as to have lost its essential and vivi- fying principle. This is no difficult thing to im- 114 Stricture,—Its Cure. agine, when the nervous structure of these organs, and the exquisite sympathies depending on them, are considered. And, further, this opinion is sup- ported by the fact of so many strictured persons having no children. These then are the consequences of stricture, and when to them is added those sympathetic affections which were arranged among its symptoms, together with the expense, and suffering, and keen reflection which is naturally connected with this disorder, it will be seen with what, propriety it is urged on every one to be careful as to whose care he entrusts the cure of a Gonorrhoea. All these consequences are per- fectly unnecessary, and would be avoided if the same good sense were exercised in selecting a proper per- son in this complaint as would be done in any other. But stricture in its first stage is a very curable disease, and fortunately, with many, this first stage continues for a length of time. It is fortunate also that its principle of cure is simple, easy and certain. It requires only to be acquainted with this, as given in the following section, and at the same time to be furnished with these simple means, in oder to ena- ble any one to undertake the cure himself with perfect satisfaction and success. The cure of Stricture.—It is in the first stage only, that a patient can safely undertake the cure Stricture,—Its Cure. 115 himself. At this time it is soft and yielding, and is therefore called a dilatable stricture. In advanced and bad cases it is hard and callous, and requires a little difference of treatment. As I have observed before, however, the first stage continues a long time, and the inconvenience of it generally leads to its proper treatment before it has had time to be- come hard and callous. In my practice I meet with fifty cases that are dilatable to one that is not.— It is the treatment of the dilatable stricture there- fore that I am now about to describe. The cure of stricture can be accomplished only by the use of the bougie. Medicine occasionally assists, but the bougie is that without which you cannot cure the disease. Nor is this at all to be regretted, for it is a simple, safe, easy, and certain way of curing it. Bougies are made of different materials, but those which are soft and pliable are the safest and best for a patients own use ; indeed, I seldom use any other myself. These are made of a composi- tion of wax, spread on a strip of linen, and rolled up ino the proper form, and are called common bou- gies ; or are made of India rubber, and are then called Gum Elastic. There are other kinds as metalic, caustic, &c, but the former of these are not so safe, and the latter are only required in bad cases, such as no patient should undertake himself. 116 Stricture,—/te Cure. Common wax bougies as well as common gum- elastic, are straight, but when they are to be used are bent into a certain form. This is easily done after holding them before the fire a moment, or in the warm hand. The following plate will show the form and figure of a common bougie, as well as its curve. It is of some consequence to give it this certain degree of curve. Plate. Shewing a straight, and a curved common wax bougie. Fig. 1. Fig. 2. Fig. 1,—A Straight Bougie. Fig. 2,—A Curved Bougie. (For the convenience of those who consult me at a distance, I have put them up in sets, in a little case, containing also a small bottle of oil, <$*c, to- gether with necessary instructions. This little package, including my consultation fee, is $10— and is forwarded by steamboat or otherwise, as requested.) Stricture,—Its Cure. 117 Now the manner of using the bougie is the fol- lowing :— We will suppose in the first time of using one, the object being to ascertain for fact, whether there really be a Stricture, and if so, where it may be situated. Soft bougies, until you bend them, are straight. You therefore select either a wax or elas- tic straight bougie, of medium size, and, holding it in the hand or before a fire, you warm it a little, so as to give it the curve represented in the plate. You may take which kind you please, but surgeons gene- rally begin with the wax, because from a certain tact and management, they can sometimes take an impression on the point of the wax bougie, and there- by tell the shape and size of the Stricture. How- ever, this is not so easily done, and if you should find you do not succeed with one, then try the other. I can sometimes succeed with the Gum-elastic when I could not with the wax. But in giving the Gum- elastic bougie the proper curve, you will find, from its elastic property, it will become straight again. Do not mind this—for, having given it the curve while warm, it will more easily assume it when it meets with the corresponding curve of the passage. You next rub upon it a little olive oil, or lard, or candle grease, and then proceed to introduce it.—- Take the penis between the thumb and finger of the left hand, and stretch it forward a little,—rather pointing upwards. Then with the bougie between 118 Stricture,—Its Cure. the thumb and fingers of the right hand, introduce it by the orifice, and pass it steadily on, with a gentle and continued progress, till it reaches the bladder, which can easily be told by the ceasing of any feeling of resistance. In passing the bougie down, do not undertake to give a definite direction to the point. but rather hold it between the thumb and finger so loosely that it may take its own direction.—But sup- pose you pass it smoothly down a certain distance, and then it suddenly stops. In that case you are not to withdraw the instrument immediately, but to hold it steadily to the part, gradually, and to a limi- ted and reasonable extent, increasing your pressure. This is the strictured part, and if it be dilatable, and not very much contracted, it will presently pass through, and you will have accomplished then, one step towards its perfect cure. There may however be a second stricture, or a third, which, if there be, must be treated in the same way, but this does not often happen. It should be also known that a stric- ture may be situated in any part of the urinary pas- sage, but there are some parts more frequently its seat than others. The most frequent seat of Stric- ture is somewhere within three inches before it ter- minates in the bladder.—In this first passing of the bougie therefore, we ascertain three things,—the fact, whether a Stricture exists or not—whether there are more than one—and where its situation is. But suppose you come to a Stricture, and, after Stricture,—Its Cure. 119 perhaps a second trial, you find you cannot pass it. In this case then you are to withdraw that bougie and try a smaller one, exactly as before; (remember a medium size was recommended to begin with) and if this will not pass, then take a smaller one. But it may happen that the smallest will not succeed. Indeed the pari may be so irritated by these frequent attempts, that it will not pass on the first trial at all. I have frequently succeded well on the second when I had failed in the first. In general there is but little pain in passing a bougie, and the degree of force directed is so limited that there will be very little felt, except the Stricture be in what we call an irritable state, which is known by its giving pain immediately on touching it. What I mean is, you must not give much pain by the mere force of pres- sure. Neither should you go on with an attempt at any time if it is disposed to bleed. A drop or two of blood is of no consequence; the part is so delicate and vascular that a drop may appear on a slight occasion; but, if there is more than a drop or two, this should induce you to lay aside the at- tempt for the present. In some cases you may not be able to pass the smallest size till after various attempts made at intervals of several days; this however but seldom happens; when it does, you must pay attention to your state of health and habits. Particularly must you attend to the state of your stomach and bowels. Take a moderate dose of the purgative diuretic pills from the case, avoid a stimu- 120 Stricture,—Its Cure. lating or full diet, and rest as much as possible. A warm bath too is very advisable, but if this cannot be had, bathe the parts well with hot water and a large sponge every night, or night and morning.— These directions however will seldom be required, still it is necessary to give them. But I will suppose, which is generally the case, that a middle size bougie, or a smaller one, has pas- sed on the first attempt. If it pass pretty easy you withdraw it and immediately pass a larger one.— With this be contented—it is pretty well for the first attempt, and now it should be considered, when, and how often it should be repeated. The repeti- tion of a bougie should always depend on the de- gree of irritation which the last attempt has caused. If there be but little or none, it may be repeated on the following day, but if any considerable degree of pain and irritation should be caused, this must be suffered to subside before it is repeated. After the first, and sometimes after every trial, there is felt a little heat in making water, which soon goes off; and sometimes a little increase of discharge (if any had existed before) may be observed; neither of these are of the slightest consequence; as the cure goes on, the discharge will cease, if not, it is easily made to do so permanently. The Bougie then is to be repeated either on the following day or a few days after, just as the part Stricture,—Its Cure. 121 may feel. You begin now, first, by taking the bou- gie you last used and pass it as before ; it is pre- sumed this will pass easier than at first; you there- fore then select a larger size and pass it through the stricture into the bladder, keeping it there for about ten minutes. If it give much uneasiness however, you may withdraw it sooner, but if it do not, and it is convenient to spare the time, keep it there for half an hour. In some instances I have recom- mended it for to be kept in for hours, and some have continued it all night with the greatest possible ad- vantage and ease. In this case it should be fastened to the penis with a piece of tape. Thus you go on, increasing the size of the bougie every day or two, or as you find the part enlarges until you can pass the largest or next to the largest size with ease.— There may always be some little uneasiness in this operation, but by comparing it with what was for- merly felt, you can easily tell when the passage has been widened to its natural dimensions. When the passage is restored to its natural di- mensions,—or, when a full size bougie can be passed into the bladder with tolerable ease and readiness, you then begin to leave them off, but this must not be done too suddenly. If, up to this time, you had passed it every day, now do it every other day, and after a few limes use it only twice a week, and then but once. It should be known there is a disposition in a Stricture to return, but this disposition is effect- 122 Stricture,—Its Cure. ually removed by this plan of repeating the bougi6 for weeks and even months after it is cured. Indeed, I find it is entirely for want of attending to this practice, that so many cases of Stricture prove so tedious. I urge it therefore upon every one to con- tinue the bougie for weeks after a Stricture is cured, and even then about once a month for some time afterwards. This then is the final and permanent cure of a Stricture, as well as the removal of every symptom and circumstance which had depended on it. We sometimes hear of Spasmodic Stricture. On this subject much misconception has existed. It may be advantageous however to know that the muscular fibres around the mouth of the bladder, designed to retain the urine, and also those fibres a few inches up the passage, designed to throw out the urine with a jerk, are both under the influence of a Stricture, and when this Stricture is rendered irritable by any cause, the action of these muscular fibres is quickly disordeied. It is in this way that spasm in these muscles is so often brought on in persons after drinking,—the excitement of wine and company having made the Stricture irritable. In this state perhaps he goes out of the room to make water, but finds he cannot make a drop. The fact is, the moment a drop of urine touches the irritable strictured part, the muscles of the mouth of the blad- der are thrown into a state of spasm which prevents Stricture,—Its Cure. 123 the urine passing. Neither can you always draw it off, in this case, by the catheter or hollow bougie. The best plan is to foment with warm water and take an opiate. If this will not do, bleeding and the warm bath must be superadded. So also, in passing a bougie, if the Stricture has been rendered irritable by any such cause, the moment it presses on it, these muscles are thrown into spasmodic action which hinders its passing through. In this case keep the bougie gently pressing on the Stricture for eight or ten minutes,—it will frequently succeed by this means,—if not, desist, and give an opiate, &c, as before directed. In some hours afterwards perhaps you may pass it easily. But there is another state of things for which the bougie is a remedy, beside a Stricture, and that is, a simple state of tenderness (without a Stricture) in some point or other of the passage. Being led to examine the passage from symptoms warranting the suspicion of a Stricture, it is found that the bougie passes perfectly well, so far as obstruction is con- cerned, but, that in passing some certain point a great degree of pain is felt. This disorder is differ- ent from a Stricture, inasmuch as it consists merely in a morbid or increased degree of sensibility, but it is to be treated exactly as though it were a Stricture. Pass the bougie, a medium, or above a medium size, every day, or every other day, as the degree of irri- tation will admit, and keep the bowels and digestive 124 Stricture,—Its Cure. organs in a regulated and healthy state. The effect of this treatment, very generally, is to lessen and ultimately remove this morbid sensibility. If there- fore, on every time of passing it, you find the pain and tenderness become less and less, you may de- pend upon a perfect cure, as well as the cessation of every symptom which originated from it. Thus have I finished the subject of dilatable Stricture,—its symptoms, nature, consequences, and cure. It is gratifying to have been able to point out an easy and practical remedy for so formidable a dis- ease. But, this remedy has often been doubted by patients. They have said,—is it possible that an operation so simple can cure a disease so incurable and dangerous under any other means?:—The best answer to this, it might be replied, is the daily oc- currence of the fact; but, as some may not have had an opportunity of witnessing an instance of it, and as the intelligent and discerning mind of others may require some explanation of the power by which it does so, I will endeavor to give this explanation in a note (17)—repeating however,—thereis no other way of curing a Stricture. Note 17.—Every part and and healthy condition of a structure of the body is en- part. This is no fiction. In- dowed with its own peculiar deed every restoration from power of action; also, every disease to health is an illus- part is endowed with a re- tration as well as a proof of storing power, the activity of such a principle. Numerous which is aroused by every as are the laws which regu- devialion from the natural late and maintain the healthy Stricture,—Its Cure. 125 With regard to the confirmed or callous Stricture, I will not go into the minutiae of its treatment, be- cause I do not consider that the cure of this should ever be undertaken by the patient. The object aimed at, however, is to promote absorption of the callous body, and for this purpose metalic bougies are more useful, and these should be continued in the part for some hours at the time. The caustic bougie is altogether unfit for private use, and is only required in very peculiar circumstances, when it is a valuable means. actions of the body, these are not more numerous and im- portant than those which in- fluence and control its mor- bid actions. A Stricture is, essentially, a morbid action— a deviation from the healthy and natural condition of a part;—it has lost its natural power of elasticity, and if that morbid action which de- stroyed this elasticity could be removed, the principle I allude to would instantly re- store that power. Now, the Bougie does this. The pressure and excitement of the bougie, upon this deli- cate structure, breaks up and destroys this morbid action, and the healthy one immedi- ately succeeds—the natural elasticity of the passage is restored. On the same principle also are the confirmed and callous strictures cured. Every part of the body is endowed with the principle of absorption. The bougie, in this case, not only destroys the morbid ac- tion essential to the Stricture, but powerfully excites the ac- tion of the absorbing vessels, which is the means of remo- ving that callosity. Indeed the cure of Stricture is affect- ed by the bougie on the same general principle on which every other disease is cured,— it interrupts or destroys a morbid action, when a heal- thy one succeeds. 126 Gonorrhoea,—In the Eyes. CHAPTER VII. Gonorrhoea in the Eyes, and Gonorrheal Rheu- matism. This subject is introduced, not for the purpose of inducing a patient to undertake the cure of these complaints himself, but of apprising him of their real nature and dangerous tendency, particularly the former, and urging him to lose no time in securing that surgical and prompt advice they need! Fortu- nately, these complaints are not of every day occur- rence. Now, and then, however, a person who is under treatment for a Gonorrhoea will be suddenly seized with a most severe Opthalmia. This com- plaint runs on with great rapidity, and if not speedily arrested, it accomplishes the total loss of sight. It begins with great severity of pain and copious dis- charge of matter. In such a case there is not a mo- ment to be lost—the advice of a surgeon should be sought. But as it is possible, and especially if the physician or surgeon have practised principally in the country, that he may not have seen many cases of this kind; and also for the benefit of those who may be at sea, and cannot obtain the advice and assistance of a surgeon; or, again, for those who may be obliged to wait some time for his arrival, I Gonorrhoea,—In the Eyes. 127 will give, in the form of a note below (18), an out- line of the treament which is recommended by the most experienced and competent men in Europe. Note 18.—In Mackenzie's Practical Treatment of the diseases of the Eye, he directs the following for this kind of opthalmia.— "Abstinence from all stimulants; blood- letting, both general and lo- cal ; and the exhibition of purgatives, or emetic purga- tives, and diaphoretics, are to be had recourse to in the early stage." The discharge is to be frequently and care- fully removed by injecting under the eyelids, a lotion made with a grain of the mu- riate of Mercury to an ounce or more of water; the globe of the eye is to be touched once or twice a day with a solution of Lunar Caustic— (four grains to an ounce of water; or, six grains of.blue Vitriol to an ounce of water. These are to be used with a camel-hair pencil.) Also, the lids are to be kept from ad- hering by anointing the edges of them with the red precipi- tate Ointment. " Counter- irritation ought to be employ- ed from the very first, by means of mustard poultices and blisters to the nape of the neck, between the shoulders, or behind the ears." "If the pain of the eye is pulsative— or the parts around it are affected with pain coming on at night—Calomel and Opi- um should be given, so as to affect the mouth. Warm fo- mentations, the vapor of lau- danum, opiate friction of the head, and the like, will seem to moderate the pain; but our chief reliance must be placed on depletion, counter-irrita- tion, scarification, and smart- ing applications to the globe of the eye itself for removing the disease. Snipping out a portion of the chemosed membrane, (the outer'mem- brane of the eye, whose ves- sels are gorged with blood) so as to procure a considerable flow of blood, is highly ser- viceable." " Bleeding alone must not be depended on." "This inflammation,"(says Mr. Barcet, another eminent and practical man) in the few instances that have come un- der my observation, is of the most violent and intractable description,and has produced the total destruction of the organ of vision, in the space of two or three days, notwith- standing the most vigorous employment of general and topical bleeding, and other antiphlogistic means." To the truth of all this I can attest, upon the ground of my own observation and ex- perience, and I judge it there- fore exceedingly desirable that persons should be awara of the dangerous nature and rapidity of this complaint, that they may not be induced 128 Gonorrhoea,—In the Eyes. With respect to the manner in which the eyes become affected with Gonorrhoea, there has been a difference of opinion. Three explanations have been given of it. First, that it was owing to carelessness, such as inadvertently rubbing the eye with the fin- gers after handling the penis under the discharge of Gonorrhoea; next, that it was owing to the Gonor- rhoea affecting the constitution, when, like Rheuma- tism, it may change its seat from place to place; and thirdly, that it was the consequence of stopping the discharge of Gonorrhoea too suddenly. Respecting the two latter explanations, these cer- tainly are possible but very doubtful causes. With regard to the former, that is, inoculating the eyes by applying Gonorrhoeal matter to them, this, beyond a doubt, has been known to be a cause. Formerly I was not so well aware of these facts, but I find they stand upon unquestionable authority, and in order that others may judge correctly and be careful on this point, I will relate an instance or two in a note (19). to trifle away the only chance of cure, for it is on the prompt and decisive treatment in the early stage alone that the in- valuable sense of sight de- pends. Note 19.—Mackenzie, on diseases of the Eye, page 344, states—"A patient was bro't to me from the country with violent Opthalmia. This pa- tient having Gonorrhoea, while engaged in removing the discharge from the urina- ry canal, a drop of the Gonor- rhoeal fluid was by mischance thrown fairly in upon his left eye, and excited the severe puro mucous opthalmia un- Gonorrhoea,—In the Eyes. 129 With respect to the question whether or no, there are such diseases as Opthalmia from too suddenly stopping the discharge in Gonorrhoea, and Opthalmia arising from the constitution imbued with Gonor-. rhoeal disease, it is not necessary here to determine; many persons think there are, and I have no proof to offer that it is not so; moreover, the cases we occasionally meet with here and there in the vari- ous periodicals would seem to, corroborate such opinion. As I have already said however, if there der which he was laboring. The Gonorrhoea still contin- ued when I sa w him. The in- flammation of the eye subsi- ded under appropriate means, the eye cleared to a degree far beyond my expectations, and a considerable share of vision was preserved." Mr. Allan relates the fol- lowing remarkable case. "A gentleman, aged 17years, had had Gonorrhoea a few days, when violent inflammation of the eye, attended with a discharge similar to that from the urinary canal burst forth. The Gonorrhoeal running from the penis continuing un- abated at the same time. In a few pays his brother, aged 14, who never had had Vene- real disease in any way, but who slept in the same room, was attacked with a similar opthalmia in both eyes. Jn addition to my own attend- ance, Drs. Munn and Mr. Is. Bell, of Edinburgh, were call- ed in, and notwithstanding every means that could be devised, the elder brother lost the sight of both his eyes, and the younger brother of one. No doubt the younger used the same towel, or wash- hand basin, or the like." Again, the very eminent and practical Astruc relates a case exceedingly in point. " A young man had been in the habit every morning of bathing his eyes with his urine while it was yet warm, in order to strengthen his sight. Although he had con- tracted a Gonorrhosa, he did not abstain from this custom, apprehending no harm from it; but the urine partaking of the infectious matter, quickly communicated the same dis- ease to the mucous mem- brane which covers the. eye and eyelids (the conjunctiva.) The consequence was a se- vere opthalmia, attended with an acrid and involuntary dis- charge of tears and purulent matter, but which yielded to the same remedies which re- moved the Gonorrhoea." 130 Gonorrhoea,—In the Eyes. really be such cases they are very rare, and I have no doubt that many of those cases of Opthalmia, as well as Rheumatism, which are there related, have been diseases which happened to occur at a time when the patient was laboring under Gonorrhoea, and had really no other connexion than their acci- dentally occurring at the same time. But, as I have said, as some persons think otherwise I will give in the following note 20, (principally for the perusal of medical men) the peculiar treatment which such persons have adapted who have thus thought. Note 20.— Treatment of those cases of Opthalmia which are supposed to arise from too suddenly stopping the discharge. — Of course this kind of Opthalmia in- cludes only that in which the discharge is stopped. On this subject Mr. Makenzie (page 376) observes—" The only point in which the treatment of this opthalmia differs from the former, is in the attempt, so much recommended by some authors, to restore the suppressed discharge of the urethra. This is to be tlone by introducing a bougie into the urethra, covered with some of the purulent dis- charge from the eye, or with gonorrhceal matter from an- other subject. Even the sim- ple introduction of the bougie may perhaps produce the ef- fect so much desired; for any stimulus applied to the lining membrane of the urethra, provided it be of sufficient ac- tivity to determine an irrita- tion and a secretion of mucus, may produce a running simi- lar to Gonorrhoea. If this plan is adopted the bougie must be retained in the ure- thra for several hours at the time, till the effect is pro- duced." With regard to the treat- ment of those cases of Op- thalmia which are supposed to arise from the constitution being imbued with Gonor- rheal disease.—Scarcely any thing is recommended which differs from the treatment of a similar state of opthalmia from cold or any common cause. The discharge from the uri- nary passage may be present, or may not; and, it is worthy of remark, that when it has come on, not having been observed when the opthalmia began, in many cases, th« Gonorrhoea,—In the Eyes. 131 I fear I shall incur blame for having carried out this note to so great a length, but the consequence of delay or any misconception of the nature of this occurrence of discharge from the urethra has made no dif- ference in the symptoms of the optha'mia. Notwith- standing this however, a cel- ebrated writer upon Gonor- rhoea,—Swediaur—-advises " the use of the Bougie for a couple of hours," with the intention of bringing on dis- charge. This kind of opthalmia too, is less severe than the former, or that arising from matter applied immediately to the eye;—it is of a more chronic nature, and begins in the eye- lids in the form of little ulcers from which yellowish mat- ter exudes; while in the for- mer kind, the whole surface of the globe of the eye and inner surface of the lids are affected with redness and swelling,—the matter dis- charged also is profuse and frequently acrid and excoria- ting to the outer lid and sur- rounding skin. Abernethy, in-hrs Surgical Lectures, calls it irritable opthalmia, and ascribes it lo an irritable state of the con- stitution in which the bowels and digestive organs deeply participate. When this state of the constitution is brought on, either by the Gonorrhoea or the means adapted to cure it, he states that either this , Opthalmia or Rheumatism, may occur; or that they may both occur, alternating with each other, even alternating with the disease of the ure- thra, and that the proper way of treating it, beside soothing applications to the eye, is to give five, grains of blue pill every night and a dose of cas- tor oil in the morning, keep- ing the patient on a strict spare diet. In support of this opinion he gives the follow- ing case. A gentleman who had been anxiously endeavoring to get appointed commander of a frigate while in the country, at length received instruction from the admiralty to take command of a frigate then lying at Falmouth. He lost no time in placing himself in the mail coach lor London. Just before he left Edinburgh he had caught a Gonorrhoea. In January his eyes became inflamed; and when he reach-- ed London, he had a violent Opthalmia, with purulentdis- charge. He was in a dread- ful state both of body and mind, could not bear the light, and had great pain in his eyes. In this state he consulted Mr. Abernethy.— He stated also that when the discharge from the urethra stopped, the eyes became bad, and when the eyes got well the Gonorrhoea returned. In this state Mr. Abernethy di- rected him to keep quiet in a 132. Gonobrhcea,—Rheumatic. malady,, especially that of inoculating the eye with gonorrheal matter, is so dreadful that I cannot pos- sibly omit it. It need not however incommode the darkened room, to wash his eyes-frequently in the course of the day with tepid poppy water, to take five grains of blue pill every night, and a dose of castor oil next morn- ing, and to live strictly low. " During the first six days he mended very slowly, and not considerably. But on the seventh day, when Mr. A. called, he found the patient sitting up in his room, the window uncovered, and his eyes almost well. Mr. A. expressed his- surprise, and asked how this change had so suddenly happened, to which he answered, that he had had a number of very copious stools in the night, and that his complaints had left him. 11 seemed to be a sort of critical secretion from the liver and the whole of the alimentary canal, followed by an almost immediate remo- val of the irritable inflamma- tion of the eye." Mr. Abernethy also takes occasion to warn persons against mistaking this Op- thalmia arising from an irri- table state of the constitution and digestive organs, for that following inoculation, or the immediate application of go- norrhceal matter to the eye, for the means recommended for the first would add to the irritability and debility of the constitution, and increase the disorder. His words are,that, " if the surgeon is frightened at this irritable opthalmia, supposing it to be one of the dreadful cases in which the eye is clapped, and proceeds to bleed and purge the patient severely, he will only make the matter worse. Moderate. bleeding," he says, " may be useful, but the chief object ia to attend to the patient's health. No means are so likely to be useful as setting the digestive organs to rights, and sending the patients to the country/' On the treatment of Rheu- matism, from the same sup- posed gonorrheal taint of the constitution, but little can be recommended in addition to what is approved in Rheu- matism from other causes. The history of a case of this kind will best convey what is meant by this disease. Major----, aged 25, con- tracted Gonorrhoea. In a fortnight he was seized with swelling of the testicle.— When this abated pain and swelling of the right knee began; on travelling in an open carriage on the second day the other knee, foot, and joint of the great toe swelled. The pain was excruciating. He then came under the care of Sir Henry Halford, (the king's physician,) but no Gonorrhoea,—Rheumatic. 133 general reader, for being given in a note he can easily pass it by, while, should he be threatened with this formidable turn of the disease, he would treatment seemed to possess any power in removing the complaint. Now, in addi- tion, his right eye was sud^ denly attacked by a very violent inflammation which threatened destruction to the organ. He then gave up me- dicine and went into the country for the restoration of his health, and after being there for about three weeks, the ^Gonorrhoea again in- creased without any abate- ment of the other symptoms. The joints so stiff and swol- len he could hardly crawl about. Warm bathing and a residence by sea were recom- mended. From the former he experienced little apparent benefit, but after a tedious convalescence of two years he found himself able to join his regiment in Spain.—He recovered the use of his limbs and had no return of his complaint though exposed to many hardships in the cam- paign of 1812, &c. &c. Two years after he again contract- ed Gonorrhoea, a very violent one. In a fortnight the dis- charge began to abate and violent inflammation attack- ed the great toe and foot. The disease then proceeded to his knees. As the violence of the inflammation of the knee abated, the left eye was attacked by violent Opthal- mia, and excited great alarm for its safely. It seemed to be deep seated in the coats of the eye. The sight of the right eye was also impaired. At the end of two years more, his knee joint was stiff and much swollen, and the uri- nary passage was all the time subject to returns of gonorrhceal discharge. I have given this case to show how possible it is for Rheumatism to occur when a patient is affected with a Gonorrho3arand how easy it is to suppose it is the effect of Gonorrhoea, merely because it happened at sach a time. But after all I see nothing in this case that differs from Rheumatism from common causes, and the present dif- fers in no important point from others I have seen, which have been thought to arise from Gonorrhoea.— Rheumatism is frequently a tedious complaint; its pecu- liarity is, shifting from place to place, and in this way it will sometimes assume the character of inflammation of the eye, then of the joints, and will also sometimes alter- nate with disease of the ure- thra. Respecting the treat- ment of Gonorrhceal Rheu- matism, if there be such, I am not aware of any particu- lar in which it differs from the treatment of Rheuma- tism from any common cause. 134 Gonorrhoea,—Rheumatic. derive impoitant advantage from its perusal. But, indeed, if by the prompt and decisive means which are urged in every instance of this kind, I should be so happy as to save the sight but of one indi- vidual, I would willingly incur that blame of every other. > As it is possible however that the patient has Gonorrhoea some connexion may exist at the time, I think the re- between the inflammation of commendation of Swediaur the urethra and inflamma- to employ the bougie is a safe tion of the eye, in cases of the and justifiable remedy. latter kind, occurring when Gonorrhoea,—In Females. 135 CHAPTER VIII. Gonorrhoea in Females,—Its Nature and Treat- ment. There is no difference in this disorder in females, but what arises from the difference in the organs which are the seat of it. Generally speaking, how- ever, the inflammation attending is more diffused; in some cases it extends to the lower part of the belly, which makes it painful on pressure; also, the urinary passage being shorter, it is more apt to pro- duce irritation in the bladder than in males, so that there is a greater inclination to make water.—There are no ulcers in this disease, although the discharge is sometimes so irritating as to excoriate or take off the skin. There is almost always a swollen state of the external parts. There are however, some curious circumstances relating to this disorder in females which should be known,-r-the following are of this nature. Generally speaking, the disease is milder in women than in men. Also, a female may have a Gonorrhoea without her knowing it. This happens from the complaint being of a milder character, and from her not dis- 136 Gonorrhoea,—In Females. criminating between this disease and certain slighter forms of discharge which many females are subject to. It is most likely to occur in women of unre- strained intercourse, as such persons generally have the slightest forms of this disorder. The same female may give a Gonorrhoea to one person and not to another. This arises from the habit and character of the person himself.—If he has pursued a life of free and unbridled intercourse, he is much less liable to receive infection than a fresh and healthy person of a contrary character; the latter will frequently take a Gonorrhoea from a female who has only a slight gleety discharge, when the former would escape it. Again, a female may receive a Gonorrhoea from one person and give it to another without having it herself. This may appear strange, but it is a fact :— it happens in this way. A female has an interview with a person having a Gonorrhoea, and soon after sees a fresh and healthy person; this latter comes in contact wiih the infectious matter before ft has had time to engender the disease, and removes it; the consequence is that he takes the Gonorrhoea and she escapes it; it is an incident which often leads to very puzzling surmises. In the last place,-—a female may always know, or at least have reason to suspect she has an infectious Gonorrhoea,—In Females. 137 disorder, when she has lately had a Gonorrhoea and a discharge remains, greater, or in any way different, from what she was accustomed to before she had the Gonorrhoea. Indeed, it is on this important truth, that the necessity of a speedy and perfect cure of Gonorrhoea is urged; for it is this remaining gleety and slight discharge which is the cause of most of the Gonorrhoeas we meet with ; and when the advice here given becomes more generally known and acted on, we shall but seldom hear of Gonorrhoea or Clap at all. The Treatment of Gonorrhoea in Females.— With respect to internal remedies, it should be known that neither the Cubebs, nor the Balsam of Copaiva, nor any of the other Balsams, are so useful in the cure of Gonorrhoea in females, as in males,—they cannot therefore be depended on.— After subduing the inflammatory and painful symp- toms by repeated doses of the Purgative Diuretic Pills, together with the free use of diluting drinks, low diet, and rest, just as in males, a speedy and effectual cure must then be looked for from the use of injections. The injections, however, which are most serviceable in females, are a little different from those for males ; and, on this account, as well as that the quantity necessary to be used at each time is greater than in males, it will be proper here to give receipts for making them,—especially as the ingredients can so easily be obtained. 138 Gonorrhoea,— In Females. The best cooling wash for this purpose is the common sugar of lead lotion, called the white wash; —it is made by adding one drachm of sugar of lead to one pint of rain water,—adding also a table-spoon full of common vinegar to it.—On account of its cooling quality this lotion is generally used to begin with, especially as there is often some little remain- ing pain at that time. This too is a good lotion to be applied to the swelling of the external parts, and may also be used advantageously as an internal application. For the latter purpose a small piece of soft sponge wetted with the same should be in- troduced a little way and suffered to remain. It should be frequently removed to be washed and moistened afresh with the lotion. Another excellent wash or injection, and which is more calculated to stop the discharge, is one of common green tea, made pretty strong. A third injection, and still a little stronger, is made of three drachms of common alum dissolved in one pint of boiling water. If a little gum arabic (half an ounce) be added to this it will improve it. A fourth and yet stronger injection is made by adding one drachm of white vitriol to the one last mentioned. A fifth injection is made by putting a lump or Gonorrhoea,—In Females. 139 two of camphor (as much as the bulk of a nutmeg) into a pint of hot water; when cold,- strain the water from the undissolved camphor and add to it twenty grains of blue vitriol. A sixth and last is made by boiling one ounce of bruised oak bark in a quart of water, till reduced to a pint and a half—then strain, and add to this, alum (two drachms, and white vitriol one drachm. These injections of course must be used by means of a female syringe, which can bo procured at any apothecary's store, and they should be used about six times a day, and continued until the Gonorrhoea or any other discharge shall have entirely disap- peared, and then must be discontinued by degrees. With regard to the syringe for females in com- mon use, this is a very poor contrivance. In order to have the full effect of an injection, the syringe should hold enough to fill the passage, and when filled it should be retained there. My own syringe is made to answer both these purposes, as many have happily experienced ; for, after using the com- mon syringe for a length of time to no good purpose, they have succeeded with this contrivance to their fullest wishes. And, not only is this syringe so useful in the cure of Gonorrhoea and Gleet, but is equally so in the cure of that weakening complaint, the whites, and female barrenness,—a subject on 140 Gonorrhoea,—In Females. which some further and important observations may be seen in note 21 below. Note 21.—A few remarks upon that insidious disorder termed 'Female Weakness,' or ' Whites,'— though not properly belonging to this subject, may nevertheless prove useful here. This dis- order consists, essentially, in a state of weakness, origina- ting sometimes in a debility of the general system, and sometimes in the sexual or- gans alone. It may be in- duced by various causes, such as,—any long continued illness,—a damp unhealthy residence,—having children too fast.—sexual excesses,— Gonorrhoea, &c. &c. But, in delicate and nervous fe- males it frequently comes on without these intervening causes, and becomes as it were the settled habit of the constitution. It does not however thus invade the con- stitution without disturbing one of its most important functions, for it leads event- ually to barrenness. There is also a most unfortunate coincidence to struggle with in those who are the subjects of this complaint, for it af- fects the constitution in such a way as to react upon, and increase the original disorder. If, for instance, it originate in weakness of the sexual organs, this, sooner or later, involves and debilitates the constitution, and thus keeps up and augments the original weakness; or, if it begin in general nervous debility, this weakening discharge occur- ring, greatly augments that nervous debility. There is scarcely a complaint which the constitution suffers more under and has less power to overcome without the aid of suitable assistance. This may be clearly seen by re- flecting on the influence which the uterine system is wont to exert upon the stom- ach and digestive organs.— That train of distressing symptoms which so frequent- ly occurs in a state of preg- nancy, is a striking illustra- tion of this fact. Numerous as these are, they all proceed from the effect the uterus has upon the stomach, enfeebling and deranging its digestive functions. The very same effects are produced by this complaint, the 'Whites,' but with this difference, the dis- order of the digestive organs from pregnancy is but lor a limited duration, while that from weakness of the sexual organs is unlimited and per- petual. Again, by tracing the sad inroad this disorder makes upon the constitution, it will be further seen how justly it merits every care and anxiety to remove it; for, beside the disappoint- ment of a family, which it is frequently the cause of, there is nothing which more cer- Gonorrhoea,—In Females. 141 The apparatus now alluded to also affords a most convenient way of curing Gonorrhoea in females tainly fades the youthful countenance, and premature- ly leads to the failings and infirmities of age. The first effect of this never-ceasing influence on the stomach is to weaken its digestive pow- er, by which the blood be- comes poor and watery. This is seen by that pale and sunk- en countenance, or bloated state of body, which always more or less attends it. Then follows an unequal circula- tion of the blood, the strength of the body being not suffi- cient to maintain its equal distribution, some parts have too little and some too much; the feet are generally cold, marking too low a circulation in them, while the head is almost always overcharged, frequently leading the suf- ferer to suppose that bleeding would do good, than which, by the way, nothing would be more disastrous. Head- ache, however, arising from this cause, is one oniy of a long train of nervous symp- toms, varying in degree and kind, but continuing to har- .rass and embitter life to its very latest moments. A just and clearer apprehension of so serious a disorder, there- fore, than is generally enter- tained, can scarcely fail to secure a due and proper at- tention to the following ac- count of its cure and treat- ment. In the first place, as this is a disorder which so greatly weakens the digestive organs, and through these the constitution, so the con- stitution scarcely can be strengthened, while the ori- ginal disease is suffered to remain; it therefore becomes expedient to prescribe both for the local weakness of the sexual organs, and that of the general constitution at one and the same time, and this makes the use of a sy- ringe absolutely necessary. But upon the kind of syringe used very much depends.— The syringes in common use, as I nave observed before, are not adapted to the pur- pose, and it is chiefly on this account that we so frequent- ly hear of incurable and te- dious cases. Having been myself physician to a Dys- pensary in London, institu- ted chiefly for the disorders of women and children, I have had abundant opportunities of observing this fact, and here I would repeat that they are deficient in two respects ; in the first place they do not hold fluid enough tp fill and moderately distend" the pas- sage, arid next, they have no means for retaining the in- jected fluid for a due and proper time. These deficien- cies lead to the contrivance of my "Female Syeinqe," and which I am happy to say is found to answer most 142 Gonorrhoea,—In Females. where it is necessary to do it privately; for being intended professedly to cure the Whites, it is fre- quently availed of to cure the one disease under the name of the other. For the convenience of those who consult me at a distance, the female syringe, together with in- gredients for making the injections, and every other necessary medicine, including also an ex- planatory treatise on these diseases, are put up in a little mahogany chest with lock and key, and which is forwarded by steamboat or stage, to any distance. The price of the chest complete is $20. The female syringe and ingredients for the cure of Gonorrhoea alone, is §10. My consultation fee. without the medicine, <$-c, is $5. With these remarks I finish the subject of Gonor- rhoea and Gleet in females, and when it is con- sidered that so long as any discharge remaining after Gonorrhoea exists, so long there is a possibility of spreading the disorder to a second person, a suf- ficient reason will be seen for laying so great a completely. IVtany who had the use of injections, together failed with the common sy- with such internal remedies ringe, in connexion with a as tend to re-establish the variety of other means, liave vigor of the body, but more perfectly succeeded with this especially the function of the more convenient, simple, and sexual organs, a more mi- efficient apparatus. nute account of which is The treatment of this com- given in the Treatise which plaint therefore consists in accompanies the Syringe. Gonorrhoea,—In Females. 143 stress on curing Gleet at once, and doing so by in- jections, for it scarcely can be cured in any reason- able time, without them. We now proceed with Venereal disease, properly so called, SECOND PART. ON VENEREAL DISEASE, (properly so called.) CHAPTER IX. Venereal Disease,—Its distinguishing marks,— Its Nature,—Progress,—and General Princi- ples of Cure. Venereal Disease,—In the first place, should be carefully distinguished from Gonorrhoea. In com- mon conversation, the word venereal is often used in a general way to express both the one and the other, but this is not a proper way of speaking, for no two diseases can differ more, either in their na- ture, train of symptoms, consequences, or modes of cure. It is true, as was stated in the second chapter, that Venereal, (which also by some is called the pox,) is caught in the same way as Gonorrhoea, and that both may be taken at the same time, if the female happen to be affected with both diseases; still let it be remembered they are distinct and very Venereal Disease. 145 different complaints. And this is the more impor- tant to explain, inasmuch as I find continually, that among those who apply to me, very many have been taking, in Gonorrhoea, the medicines that were intended only for the Venereal ^ and, in Venereal, nostrums intended for the Gonorrhoea. Now the medicines that are proper in Gonorrhoea never can cure Venereal, neither can those proper for Vene- real ever cure a Gonorrhoea,—hence so much waste of time and disappointment. And this is not the worst of it, for this mistake cannot be made without injury to the constitution, so that when the proper and necessary medicines are given in either com- plaint, especially in Venereal, the constitution is less able to bear them with impunity. In place then of a disease beginning with pain and heat in making water, and a discharge issuing from the urinary passage, as in Gonorrhoea; the Venereal disease begins with an ulcer or sore on some external part, or other, of the Genital organs. It may begin in any part, but it is seen most fre- quently on the extremity or nut of the yard, or upon the internal surface of the skin which covers it, for the reason that the texture of the skin in these places is thinner than elsewhere; and, as the skin forms a bridle under the head of the yard, making a little fold which is calculated to retain the Venereal fluid, the sore is perhaps oftenerfound there than in any other place.—There may be at first more than 146 Venereal Disease. one sore, but this does not often happen.—These parts are subject to other diseases beside the Vene- real, and which are infectious too, but these appear in crops, while the real Venereal generally com- mences with one solitary sore, and that usually appears at some period between the 2d and 7th day after exposure. The little ulcer then begiqs and proceeds in this way. First, there is a little pimple, but this is so small and attended with so little pain that it is often not observed until it breaks. When it breaks, however, it forms an ulcer which differs from every other ulcer in these parts or elsewhere, and is what is called a chancre. Now, the principal difference between a Venereal chancre and other ulcers, is, that the Venereal chancre is surrounded with a hard thick feeling substance which extends around and underneath it. This is so peculiar to the Venereal ulcer that you may always judge of its nature by it. If therefore at any time you are in doubt about the nature of a sore upon the genital organs, just take hold of it between your thumb and finger, and pinch it up a little, and, if you find it has this hard feeling edge and base, then it is Venereal, you may be quite suie it is so. But, although you may be quite sure a sore is Venereal if it have this hard feeling edge and base, you are not to be quite sure it is not Venereal if it be wanting; for, as I shall presently have to show, this hardness is some- times slow in forming, and sometimes it forms im- perfectly. It is however a, valuable criterion, for Venereal Disease. 147 whenever it is present it settles the question at once—it is Venereal. But, as I have just now said, a sore on the genitals may be Venereal, and yet not have this thick hard feel,—what is to be done then? The following. If it be a recent sore, wait a little and do nothing to it but watch its progress and keep it clean—washing it often with water or soap and water. If it is Venereal, in a few days in all proba- bility it will form its peculiar edge and base. There are but very few instances of Venereal sores which do not in some degree or other, present this charac- ter. But if this should not appear, or only in a slight degree, then some other characters must be looked for. Now, another peculiarity of a Venereal chancre is to eat deep into the part, rather than to spread; then, again, the surface of the sore is of a yellowish brown color—or is as if it were coated with a tough layer of matter of this color,—it is quite different from other florid red sores which are frequently seen on these parts. Also, except any thing has happened to inflame or fret it, there is very seldom much pain about a Venereal sore.— Perhaps the most correct description of a clear and well marked Venereal chancre is that given by John Hunter—a great and eminent surgeon and the first writer who gave to the world any definite and sys- tematic view of this disease. His words are these, (f a Venereal chancre is a sore of a somewhat cir- " cular form, excavated, without granulations, (that '■? is, without little red points or eminences on the 148 Venereal Disease. " surface of a sore, which denote its healthy and " healing state,) with matter adhering to its surface, " and with a thickened edge and base." It will be Well to keep this short and correct description of a Venereal chancre in mind, as it will serve to com- pare ulcers of any other kind with it. It is not how- ever to be supposed that every Venereal chancre will exactly agree with it in every respect, for pecu- liarities of constitution and other circumstances have their effect upon a chancre, as well as upon sores of any other kind, and will sometimes prevent its perfect development of character, still there will be always enough about a Venereal sore resembling the picture of it given by Hunter, to show its true nature, and those features which are wanting to make the resemblance perfect, may often be ac- counted for. For instance, the sore may have com- menced in a little laceration or tearing of the skin,— Venereal matter having come in contact with it. In this case it is some time, a week or two, before it looks like any thing more than a common tear of the skin, and when the hardness does form, it forms slowly, in this case also, the ulcer, instead of being circular and deep, is irregular, superficial and broad. Still you see it does not heal up by simply washing, as a common sore would do. So also, if the person has been foolishly dabbling with mercury,—that is to say, has been taking enough to influence the sore, but not to cure the disease, this, it is well known, will prevent the formation of its true character for Venereal Disease. 149 a while, but when it is left off, and the part merely kept clean for the sake of watching its progress, this characteristic hardness of edge and base, or some other Venereal peculiarity will appear, so as to en- able you to judge safely as to its real nature. Let it however be remarked, it is not said that a sore upon the genital organs can in no case possibly be Venereal without this peculiar hardness of its edge and base, for exceptions do occur rarely. The Vene- real disease, for instance, has been communicated without any sore at all, the matter having been ab- sorbed by the thin and tender skin without ulcera- tion. .And again, the chancre has appeared in some rare instances after a swelling in the groin had taken place for many days. And further, there have been known such things as Venereal sores whose edges have been thin, having no hardness at all; but all these are very rare occurrences, and such would not have been worth while to perplex the reader with, were it not for the necessity of acknow- ledging candidly the fact. When these deviations occur, we also get assistance in forming an opinion from our knowledge of the character of each party— the time the sore appears after exposure,—and any peculiarity of constitution or circumstances we can become acquainted with. This therefore is all that need be said on the distinguishing marks of the Venereal disease, espe- cially as I shall refer to the subject again in the 150 Venereal Disease,—Its Nature. next chapter,—that on diseases which resemble Venereal. The Nature of Venereal Disease.—But little need be said on this subject. Venereal disease (in many books called Syphilis) is well known to be infectious. It is communicated very mueh like in- oculation of small pox, only in that case it is done by slightly cutting the skin with a lancet and then applying small-pox matter to ihe sore, whereas in Venereal the matter is so infectious that it is re- ceived without a breach of the skin, especially in those parts where this is very thin, as on the geni- tals ; it is however much more sure to take if the skin of these parts should be torn or abraded.—It is most generally communicated by sexual intercourse, though it may be given and taken in a more inno- cent way, such as kissing, or suckling an infant, and in these unsuspected ways it has been most disastrous and fatal. It is a disease which scarcely ever, perhaps never, wears itself out, but, unless cured by art, continues for years, undergoing dif- ferent forms until the miserable sufferer dies, gene- rally as though he were in a decline. If however mercury has been taken, but not in" such a way as to cure the disease, the patient then may live many years, and the original disorder become so altered as scarcely to present any symptoms by which its Venereal character can be judged, of. Further, it differs from most other contagious diseases, inas- Venereal Disease,—/^ Progress. 151 much as they, when they have once occurred, leave the constitution protected forever against their re- currence. The small pox, measles, hooping cough, and others do this; and even typhus fever leaves the constitution safe from a fresh attack for a long while; but with respect to the Venereal disease, this may be cured and taken afresh a hundred times > and, indeed, may be again taken the next moment after being cured, if exposed at such a time. The Progress of Venereal Disease.—This is a subject worthy of much attention.—The symptoms of this disorder are divided into two classes—the primary and the secondary symptoms. The pri- mary are those which appear first, and consist of the Chancre, of which we have spoken, and swelling in the groin, called Buboes. The secondary symp- toms are those which arise out of the constitution when the disease has not been thoroughly cured in its first stage, but has been left in the constitution. It is a curious fact, that there are certain parts of the body that this disorder attacks in a regular order of succession, and it seldom attacks one of these parts before the other out of that order; when there- fore a chancre has been only healed up, as by caus-- tic, or an ignorant and ineffectual use of mercury, without really curing the disease, then, at some period, usually before the end of the second month after laying aside all remedies, it will appear again, not however in its original place, the genital organs, 152 Venereal Disease,—Its Principle of Cure. but in the throat, and sometimes the throat and skin together, and this is called the constitutional or secondary form of the disease. Then, if mercury is again resorted to, but not so as thoroughly ta cure the disease, the skin and throat may appear to get well, but after another period it will be seen again on the skin, sometimes in the same, and sometimes in a little different form of blotch, or scab, or sore. Thus it may appear and disappear many times upon the skin, until at length it assumes a totally different form,—such as tumors and thickenings of the bones, attended wit,h severe pain at night. This then is the usual order in which the secondary symptoms of Venereal disease appear,—first in the throat, then the skin, or throat and skirt together, and then in the bones; it is generally a, long lime however be-i fore the bones become affected. The general Principle of its Cure.— This con- sists in introducing mercury into the system; and the principle on which this remedy cures, is, by in- stituting a peculiar action in the constitution, and maintaining that action for a certain time, or for a period which experience has taught is sufficient effectually to destroy the morbid action-^-the disease itself. Formerly it was supposed there was no other possible way of curing Venereal disease but by mer- cury, but this, later observation has shown us to be incorrect. More than twenty years ago it was stated a,s a fact, that Venereal disease could be cured with- Venereal Disease,—lis Principle of Cure. 153 out mercury, and, as much and serious mischief was frequently observed from mercury, given by ignorant advertising people, that announcement was joyfully received. Many however doubted it, and some con- tinue still to doubt it, but the fact itself is well established, and from it has risen what is called the non-mercurial treatment. Allowing, however, all that may be claimed for the non-mercurial treatment the question is,—which is the best?—Many things we know, are possible, but may not be expedient. Now, my opinion is, decidedly, that the mercurial treatment is the best and most convenient,—and the surest, and I think so for these two reasons; ±—first, because the non-mecurial treatment re- quires retirement, chiefly in bed, and induces so much weakness fromantimonial medicines and low living, that it is often a long time before the patient can return to business or ordinary labor; and next, because the evils said to arise from mercury have not necessarily arisen from this medicine, but from the ignorance of those who have given it. It is the abuse and not the proper use of mercury therefore which should be feared. And further, with regard to the first of these reasons—the inconvenience of, and the weakness induced by the non-mercurial plan,— in this I am well supported by Dr. Colles of Dublin, who is considered to have written one of the best practical works on Venereal disease that has ever yet been 154 Venereal Disease,—Its Principle of Cure. offered to the world, and whose opinion I will give in his own words, (note 22) and which I would re- commend to the perusal of those who have any doubt upon the subject. Note 22.—Upon the subject of the non-mercurial treat- ment of Venereal disease, Dr. Collesobserves--"I shall not, with_ my limited experience of this plan of treatment, at- tempt to enter into a detailed account of its application to particular symptoms ; I shall only offer a few general re- marks. When this plan first attracted the notice of the surgeons of Great Britain, both my colleagues and my- self adopted it in our Hospi- tal. In general we confined this treatment to men who had not used any mercury; but, as in Dublin it is ex- tremely difficult to meet with Venereal cases in the Hospi- tal who have not applied to some apothecary, or received medicines at a dispensary, we could not adopt it as the general practice of the insti- tution. However, we tried it till we all became convinced of this fact,—that it was not suited to patients who were obliged to earn their bread by labor; for we saw that after they had left the Hospital, and got into employment, they generally found them- selves weak, and unequal to their usual labor; and often, at the end of two or three months, they returned ema- ciated, pale, and enfeebled, in consequence of the hectic form of fever which was about to usher in a new series of venereal symptoms. Their stay in the Hospital also proved, in general, very pro- tracted ; so that they became impatient of this treatment, especially when they saw others with similar symp- toms, in the same ward, have their complaints more quick- ly cured by the use of Mer- cury. In private practice also I employed it for a time; but not findingit superior in point of quickness of cure, or of se- curity against a relapse, and observing that these relapses were more frequently reitera- ted, in a short time I ceased to employ it, except at the express solicitation of the pa- tient. But I had many op- portunities of witnessing the results of the practice of som« of my brethren, who adopted it more fully. Of course I could not know much of those cases in which this practice was successful; but in many of those who suf- fered from secondary symp- toms, and from relapses of the different series of second- ary symptoms, I had melan- choly proof that this treat- ment was to often unequal to remove syphilis. No doubt fewer of the non-mercurial patients complained of affec- tions of the bones, than those Venereal Disease,—Its Principle of Cure. 155 Dr. Colles, however dose not deny the value of the fact itself. Every fact is valuable, and this espe- cially as it leads to the correction of an error which prevailed for many years, viz.—that the constitu- tion, unaided by mercury, had no power to cure Veneral disease. Now, the principal value of this fact is this,;—that it presents a second line of treat- ment for this disorder; and, as there are constitu- who had -been ineffectually treated with mercury; but I saw instances of closed pupil and blindness, produced by venereal inflammation in the eye, which had been neglect- ed, not having been consid- ered as venereal symptoms. I have seen many cases where the soft parts of the throat had suffered severe mutilations; and above all, I had too many opportunities of watching. (the very slow and silent, but sure inroads, which the often repeated at- tacks of secondary symp- toms made on ijje constitu- tions of the patients; of wit- nessing the phenomenon, that the Venereal disease. from year to year, showed itself with less striking cha- racteristics, while other dis- eases appeared to spring up; so that, for some months be- fore the death of such pa- tients, it would require a close examination to discover the one or two slightly marked symptoms of syphilis which remained; and also required close research to trace the symptoms of apparently the last and fatal disease to its true source, the infection of syphilis. But on tracing the state of health, from the pri- mary ulcer down to the final and fatal disease, I could clearly see that at no period was the unhappy sufferer al- together free from Venereal disease; so that both the pa- tients and their friends, in many instances, lost sight of the original syphilitic disease, and referred the death to some other apparent cause, such as dropsy, or some dis- ease of the lungs. Nor is it to be wondered at, that non- professional persons should form such an erroneous opi- nion, seeing that the course of some of these fatal cases had occupied a period of four or five years, between the ap- pearance of the primary ulcer (the chancre) and the fatal event. In a word, after the experience of one years' full trial of the non-mercurial plan, we have since, in our hospital practice, only em- ployed it rarely, and generally in very mild slight cases of primary symptoms. 156 Venereal Disease,—Its Principle of Cure. tions, or peculiar combinations of disorders with Venereal which utterly forbid the use of mercury, so the value of this second line of treatment in such cases becomes,indeed, incalculable. And, again,with respect to the inexpediency ol'the non-mercurial plan, we have on this point the gene- rous testimony of one of the first who proved that the disorder could be cured without the aid of mer- cury. In general, even great men are too much wedded to their own discoveries, and are blind to the real merits of those they wish to supercede, but it was not so with this eminent individual, for we hear him frankly state, that, though he had proved the efficacy of the non-mercurial treatment, he would by no means recommend the plan. Mr. Rose, of whom I now speak, also, was surgeon of one of the regiments of the Guards, and from the strict dis- cipline of their hospital practice, he had the advan- tage of knowing that the men took nothing but what he directed. His observations and opinions there- fore are peculiarly worthy of respect and confidence. Now, the facts which Mr. Rose related, and which may be seen in Sir Astley Cooper's Lectures upon Surgery, are these ;—he found that the first appear- ance of Venereal—the Chancre—could be easily cured without mercury, but that out of every three patients so treated, one was afterwards afflicted with secondary, or constitutional disease. If, again, these secondary symptoms were still treated without mer- Venereal Disease,—Its Principle of Cure. 157 cury, and disappeared, they would come again, and again disappear. But not being satisfied with this, Sir Astley Cooper put the question to him,—" Now, Sir, said he, if a gentleman were to come under your care, what would you do,—would you give him mer- cury or not?" To which Mr. Rose replied, I should certainly give my patient mercury!—And Sir Astley then goes on to say. "/ advise you to do the " same. I will not declare that those persons are dis- " honest who recommend a contrary practice; but, " if they had seen what I have, I am sure they would " still place their reliance on the use of mercury." And also with regard to my second reason for prefering mercury, I repeat that most of the-evils which are laid to the charge of mercury have arisen not from its proper use, but from its great abuse. It is astonishing to see what ignorance respecting the use of mercury prevails, especially among that boast- ing class of advertising people, some of whom may be seen to have three or four advertisements in one little paper daily. It is however highly important to be acquainted with several facts regarding mercury, as well as with certain rules to regulate its dose, and its continuance or discontinuance under the varied circumstances which occur, and this I will endeavor to give as plainly as possible in the chapter follow- ing the next, on the subject of the use and the abuse of mercury 158 Venereal,—Diseases mistaken for it. CHAPTER X. On certain complaints which resemble Venereal disease, and sometimes arise from sexual inter- course, but which, nevertheless, are not Venereal, nor can be treated as such without the greatest disadvantage. Persons affected with these com- plaints are often cruelly imposed on by adver- tising people. In chapter the 3d I undertook to show that the genital organs are subject to several disorders re- sembling Gonorrhoea, which are not really so, but which, however, either from ignorance or knavery, are taken for that.disease and treated as such. The evils arising from this dishonorable conduct are there also correctly pointed out. But, if the conse- quences of taking every casual disorder of these parts for Gonorrhoea be so lamentable, the misfor- tune of taking them for Venereal, and treating them accordingly, is ten times more disastrous. It will therefore be my object here, first to show that such innocent diseases do occur, and next, how to know them. That the genital organs are subject to other dis- eases beside the Venereal, must be evident to every one who will for a moment consider the structure Venereal,—Diseases mistaken for it. 159 of these parts.—The external organs, for instance, are covered with a continuation of the same struc- ture which covers the surface of the body, and there- fore must be subject to most of the diseases which the skin is subject to. If, therefore, a cut or tear were to happen to these parts, this would proceed in the same manner it would do in any other part of the body. Suppose, for example, a simple cut were to happen on any other part; this, in good health, would, if kept clean, soon get well. But suppose the health were not good, or, instead of being protected from any cause of irritation, putrid and cffensive matter were applied to the wound,— would it then get well? Certainly not, but would inflame and degenerate into what the surgeons call " an ill-conditioned ulcer." Now this happens con- tinually to the genital organs. Under excitement perhaps a little laceration or tear takes place, but this, in good health and kept clean, soon gets well; if, however, on the contrary, cleanliness were not observed, or if any offensive and acrimonious dis- charge of the female were applied to the laceration, then it would not do well, but would inflame and become an obstinate, suspicious, ill-conditioned sore. Still, it would not be Venereal, and to treat it as Venereal would be to expose the patient to the pos- sible destruction of the parts, and certainly to much needless anxiety and suffering. Some females aTe very apt to have the natural secretions of the sexual organs increased in quantity, and when, from any 160 Venereal,—Diseases mistaken for it. accidental cause, they are altered- in quality also, irritation and ulceration after connexion are the frequent consequences of it. Another cause of ulceration arises from want of cleanliness in men. Sometimes the natural secre- tion under the foreskin becomes increased in quan* tity, and, if it is suffered to accumulate, it irritates and inflames. The discharge from this cause may be considerable, and then it is often taken for a Gonorrhoea ; at other times it ulcerates rather than excoriates, and is then taken for Venereal disease. Again, a Stricture in the urethra, as has been already noticed, is, now and then, the cause of little ulcers on the penis, which are very apt to be mis- taken for Venereal sores. There is still another kind of ulceration arising from Venereal disorder partly cured by mercury and partly uncured. The organs of generation, as well as other parts of the body, are subject to them.— They have however but very little of the nature of Venereal in them, nor are they to be treated as Venereal. Many call these ulcers " Pseudo-Syphi- litic, or Bastard Venereal," of which I shall presen tly have to speak. There may be also other disorders of these parts which are occasionally mistaken for Venereal but Venereal,—Diseases mistaken for it. 161 those I have mentioned are the most common, and with a little care can easily be distinguished. In- deed there is something so peculiar in Venereal disease—something so unlike diseases of any other kind, that, if its progress be not hastily interrupted by ignorance or officiousness, it will be easy to dis- tinguish it from every other. The first thing is to get acquainted With the genuine peculiar character of a true Venereal sore, and, in any particular case in which there is a doubt, just wait a little, and if it be Venereal, it will put on this peculiarity of charac- ter so satisfactorily as to leave no doubt about it.— The five disorders then which I have stated to be most frequently mistaken for Venereal, are,—simple laceration,—sores arising from acrimonious secre- tions in the female,—ulcers from the secretion of the foreskin of the male,—ulcers from a stricture in the urethra,—and sores from improperly cured Vene- real disease. I will therefore now explain how you can detect them, and how they should be treated. First,— J? Vv .<^ ^a LIBRARY OF MEDICINE NLM 03277bl7 M Sri'?-::''-' NLM032776174