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A MANUAL
OF
VENEREAL DISEASES
BEING A CONDENSED DESCRIPTION
OF THOSE AFFECTIONS
AND THEIK
HOMOEOPATHIC TREATMENT.
BY
E. C. FRANKLIN, M. D.
Professor of Surgery in theiiomceopathic Department of the Univereity of
Michigan, Surgeon to the University Hospital, Author of "Science
and Art of Surgery," "A Complete Minor Surgery".
"Monograph on Mammary Tumors," "Treatise
on Spinal Curvature," etc.
CHICAGO:
GROSS & DELBRIDGE
18 8 3.
WCA
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Copyrighted 1883, by Gboss £ Delbbidge.
PREFACE.
This compendium of venereal diseases has been prepared by
the author for the use of practitioners and students of medicine,
as a summary only of the recent investigations and advance views
touching the various sequelae that follow in the train of these
contagious disorders, and to lay before the profession the knowl-
edge of the present day gained by the use of comparatively small
doses of medicine in their treatment.
Believing in the " dualistic theory" that the origin of the
exciting virus which produces the local contagious ulcer, differs
from that which develops true syphilis, the terms chancroid and
syphilis are used to designate these two essentially distinct con-
ditions.
It is not intended that this little treatise shall take the place
of the larger works on venereal diseases, but that it shall be a
useful guide and a ready reference to the general practitioner; a
synopsis of the more accurate and scientific observations lately
gained in the therapeutics of these disorders.
As such it is committed to the profession, trusting that human-
ity may be benefited by its teachings, and that homoeopathy may
receive the proper credit due it in the more successful treatment
of these affections by attenuated medicines, which our brethren
of the allopathic school are slowly and grudgingly adopting.
E. C. Franklin.
University of Michigan, 1883.
TABLE OF CONTENTS.
Preface............................................................. 3
Chapter I. — Htstory of Venereal Diseases ..................... 9
CHAPTEll II. — GONORRHOEA. AND OTHER DISEASES.................... U
Sec. 1.—First sta#e(Accession); Second stage( Acute Inflammation); Third
stage (Decline).— Urethritis or Blennorrhagia.— Treatment.—Special
Indications.
Sec. 2.-Orchitis.—Treatment.................................... I6
Balanitis.—Treatment.—Cystitis; Symptoms and Treatment —
Special Indications—Ischuria.—Treatment.
Sec 3.—Special Indications for Diseases of the Bladder and
Urethra...................................................... *®
Sec. 4.—Various Affections of the Penis......:.................. 27
Phimosis.—Treatment.—Paraphimosis.—Treatment.—Herpes of the
Glans and Prepuce—Hypertrophy of the Prepuce—Condylomata,
Warts or Sycosis.—Pathology and Treatment.—Horny Excrescences.
—Follicular Inflammation of the Urethra.—Treatment.—Chordee.—
Treatment.—Chafing of Glans.—Treatment.—Rupture of the Frc
num.—Priapism.—Gangrene.—Fibroid Tumor of the Penis. -Hypos-
padias. —Epispadias.
Sec 5.—Various Affections of the Testes........................ 35
Chronic Orchitis.—Treatment.—Fungoid Growths of the Testicle.—
Treatment.—Cystic Sarcocele.—Trealment.—Enchondroma of the
Testicle.—Cancer of the Testicle.—Treatment.
Sec 6.—Stricture.—Prostatitis, Etc............................... 37
Spasmodic antiinflammatory Stricture.—Organic Stricture.—Patho-
logy, Symptoms Treatment.—Resilient Strictures of Large Caliber.
—External Urethrotomy.—Electrolysis.—Retention of Urine; Symp-
toms ; Treatment.- Urinary Abscess-Urinary Fistula.-Acute and
Chronic Prostatitis.-Senile Hypertrophy of the Prostate.—Special
Indications for Treatment.
Section 7.—Gonorrheal Ophthalmia and Treatment............ 53
Gonorrhceal Rheumatism and Treatment.—Gonorrhoea in Women.-
Vulvitis.—Urethritis.-Uteritis.-Treatment.—Vaginal Injections.—
Chronic Urethritis.—Chronic Discharges from the Uterus or Vagina.
6
CONTENTS.
Page-
CHAPTER III.—Chancroid......................................... 6Z
Pathology.—The Bubo of Chancroid.—The Simple, Indolent, Viru-
lent, and Spontaneous Bubo.—Treatment.—Special Indications for
Treatment of the three varieties of Bubo.—Local Treatment.—Anal
and Rectal Chancroids,—Subpreputial Chancroid.—Chancroid of the
Preputial Margins.—Chancroids of the Vulva and Vagina.—Chan-
croid of the fingers.
CHAPTER IV.—Syphilis............................................ ™
Differentiation between Typical Chancroid and Chancre .—The Mixed
Chancre.—Urethral Chancre.-The Excision Treatment. —Special
Indications.—Accessory means.
CHAPTER V. —Constitutional Syphilis......................... 82
Syphilides- Syphilitic Ulcerations. —Syphilitic Ulceration of the
Larynx and of the Mucous Membrane.—Syphilitic Ostitis.—Perios-
titis.r-Osteocopic Pains.—Syphilitic Cephalalgia.—Syphilitic Nodes.
—Alopecia.—Onychia Syphilitica —SyphiliticIritis.—Papulae Syphi-
lide.—Condylomata.— Pustular Syphilides.—Superficial Ecthyma.—
Pigmentary Syphilide. Vesicular Syphilide.—Squamous, Tubercu-
lar, and Tertiary Syphilides.— Rupia.—Gumma of the Skin.—Gumma
of the Nose and Mouth.—Scaly Patches.—Treatment of the Syphi
lides.—Special Indications for Treatment.—Syphilis of the Respi-
ratory System.—Gumma.
CHAPTER VI.—.................................................. 104
Infantile Syphilis,—Spermatorrhoea.—Impotence.—Asperma.—Mar-
riage.
MANUAL
or
VENEREAL DISEASES.
HIbTORY OF VENEREAL DISEASBB.
Venereal and Sexual Diseases.
CHAPTER I.
A Condensed History of Venereal Diseases.
There are three forms of venereal diseases; viz., gonorrhoea,
chancroid, and syphilis, or chancre. The first two possess imme-
morial antiquity, having been described in Chinese systems of
medicine nearly 4,500 years ago. In the Hindoo, Greek, Arabic,
.and Latin literature, descriptions of these diseases date back
to the remotest periods of time; and recent syphilographers
refer the origin of syphilis to the earliest history of the pre-
ceding, though the identification with the present disease is not
so fully established. During the middle ages, a peculiar eruptive
disorder, termed lepra, was found to be communicated by sexual
intercourse, in connection with certain venereal derangements.
These are supposed by modern writers to correspond to the ter-
tiary forms of syphilis, as at present known. It spread from
person to person during sexual intercourse, was contagious, and
maintained certain and uniform characters wherever observed.
During the early periods it was known as the "great pox," in
contradistinction to another type of disease of a very different
origin and development. It was supposed by some, that Colum-
'bus brought it from America with his fleet, and from this nucleus
it spread like a plague through all Europe. It is well known,
that syphilis was not recognized as a morbid unity until the end
of the fifteenth century, at or about the period of the siege of
Naples, 1494, during the reign of Charles VIII. It was then called
the mal de Naples. About the middle of the sixteenth century, all
venereal disorders were attributed to the same origin. Previous
to this, a line of distinction was observed and insisted on between
gonorrhoea and chancroid and syphilis; and up to the present
10 VENEREAL DISEASES.
century, there was no classified distinction between these diseases.
Amid all this confusion and want of formulation, we see diseases
entirely dissimilar from syphilis, classified under the syphilitic
form, and vice versa. Hence, the diseases were called, at different
times, yaws, in the West Indies; sibbens, in Scotland; radezyge,
in Norway; scherlievo, in Dalmatia; and by other names in differ-
ent parts of the world; and they were not supposed to possess
a truly venereal origin, until 'they were undoubtedly proven to
be only varieties of the one disease, syphilis.
Throughout all these conditions and variations, the fact is
patent, that syphilis has changed to a considerable extent; that
the characteristics that designated it in the past are different
from the features that envelop it in the present. It has lost some
of its more virulent and destructive properties: its genius is the
same; but its sting has lost its malignancy. Thus, we are led to
infer that the syphilis of the older writers is not the syphilis of
modern observers. " In a majority of cases," says a distinguished
author,* " the type of the disease, as encountered at the present
day, is mild. It can be controlled, to a great extent, by treat-
ment. Thousands of individuals pass through it, unharmed in
tissue, in feature, in function, to reach a green old age, and die
of natural causes, leaving behind them healthy offspring, who
know not the sins of their fathers." How different are these
truly scientific and recently formed views, from those of certain of
our own syphilographers, who, at this present writing, aver, that,
" of all the ills to which flesh is heir, there are none that can be
compared to this, in malignancy, inveteracy, and profound vital
disturbance." If this doleful sentence had been written away
back in the darkness of our past knowledge of this disease, as
it then appeared, carrying fear and dismay to all who fell under
its baneful influence, rather than at the present time of our
advanced status of medical science, touching this disorder, it
would fall far less harshly upon the ears of the advanced student
of our own time.
* Keys on "Venereal Diseases," p. 55.
GONORRHOEA. l£
CHAPTER II.
Gonorrhoea and Other Diseases.
SECTION I.
Gonorrhoea and Urethritis.
Gonorrhoea is the term applied to a specific inflammation of
the urethra or vagina; the result of impure sexual intercourse,
and accompanied by a purulent discharge. After exposure to
infection, an uncertain period elapses before the symptoms are
developed, called the period of incubation, which lasts from four
to seven days. The disease is divided into three stages, each
having distinctive peculiarities; viz., accession, acute inflamma-
tion, and decline.
First Stage (Accession). —In the male, the disease comes on
with gentle heat and irritation; a sense of tickling or slight itch-
ing within the meatus. The glans becomes congested; the lining
membrane is red, swollen, and the orifice partly closed; and there
is emitted a thin, whitish watery discharge; while the urine is
passed with difficulty, and the stream is diminished, twisted, and
forked. Accompanying these symptoms, there is a dull, aching
pain in the back, loins, and testicles, with more or less pyrexia.
Second Stage (Acute Inflammation).—In this stage all the
symptoms are aggravated; the discharge becomes thick, puri-
form, and perhaps of a greenish or reddish tinge, with prolonged
and painful erections at night; pain and scalding in passing
urine, which is more frequent. The penis is often curved as if
tied down with a string (chordee), which is due to deposit of
lymph in the corpus spongiosum, which interferes with the uni-
form expansion of the organ, and is exquisitely painful. At
times the prepuce is oedematous, which may give rise to phimosis
or paraphimosis. Abscess may form in the substance of the
penis, causing much pain and trouble; or a metastasis may take
place to the testicle, producing orchitis. The lymphatic glands.
12
GONORRHOEA.
in the groin may become inflamed and suppurate (bubo); or, at
the termination of this stage, there may occur rheumatic pains
of an exceedingly obstinate kind, in the larger joints (gonorrhceal
rheumatism).
Third Stage (Decline).—When the inflammation has run
its course and is on the decline, there follows a thin, muco-puru-
lent discharge (gleet), which may continue for some time, and
become very inimical to treatment (incipient stricture).
Urethritis, or Blennorrhagia.—There is a form of disease
resembling gonorrhoea, but which is not produced by a specific
virus. This disease may be caused by external violence, the use
of instruments, masturbation, excessive coitus, and by accidental
causes; each case wanting the direct contagion. This disease is
less violent than the preceding, cannot be generated by auto-
inoculation, and is more amenable to treatment than gonorrhoea.
Great caution should be exercised in discriminating between
these diseases; and, when in doubt, inoculation should be per-
formed, and a correct diagnosis arrived at. A preponderance of
cases of urethal inflammation are of this type of disease, and
are produced by the causes assigned. As a rule, the first attack
of urethral inflammation is more violent than subsequent attacks.
Treatment. —The treatment is both prophylactic and curative.
The difficulty in employing the first is that the physician does
not see the patient till too late to use the abortive treatment,
which should *zdy be done in the "accession" period. This is
accomplished jy injecting into the urethra, never beyond the
inflammatory portion, which is about the fossa navicularis, a weak
solution of Nitrate of Silver, Sulphate of Zinc, or Cuprum; one
grain of the Nitrate in three ounces of distilled water, or three
grains of either Zinc or Cuprum in the same amount of water,
and add six grains of Gum Arabic to each mixture.
The following recipes are highly recommended as prophylactic
agents, and should be used warm:
R. Merc, corros., 0 gr. i. ; Aqua Rosse, 1 viii
R. Nitric acid, 0 git. iii. to vi.; Aqua bull., § viii.
R. Nux vomica, 0 gtt. xx. ; Aqua Rosso, § iv.
R Cannabis sat., 0 gtt. xii. ; Aqua bull., § vi.
R. Eryngium aquat , 0 gtt. xii. ; Aqua bull., 1 viii.
R . Gelsemium, 0 gtt. xii. ; Aqua bull , § viii.
GONOItllHCEA.
13:
This should be employed with rigid regularity every four
hours, till all the primary inflammation is destroyed. The patient
should void urine just previous to the injection, or the urethra be
washed with warm water. If the injection of Silver (my favorite
remedy) passes away loaded with a pearly looking discharge, it
must be repeated till it comes away unmixed with any of this
peculiar product. After each injection, the discharge will be
increased for an hour or two, when it becomes gradually thinner
and less copious. Two or three days are ample for a perfect cure
if strict attention is given to the details of the operation, hygienic
treatment, etc. Injections should never be employed stronger
than the above, and never during the inflammatory stage.
The medical treatment consists in the use of the following
remedies : Sepia in the accession stage ; Aeon., Gels., and Merc.
in the inflammatory period; to be followed by Can. sat., Merc. sol.
and cor., Canth., Copaib., Santal., Petros., Caps., Sepia., Erecth.,
Erie/., Euealyp., Agnus cast.
Special Indications.
Sepia. — This remedy, given in the higher potencies, is one of our most
valuable agents for the cure of urethritis in the stage of accession; and I
have made numberless cures with it. It corresponds faithfully to the tin-
gling, smarting, and titillntion, itching of the prepuce, and discharge of milky
fluid; and, whenever I could hold my patient well in hand, I have rarely
required any other remedy. It corresponds with the urging, frequent and
painful micturition, mucous discharge, smarting, tenesmus, and bearing-
down sensation about the perinaeum.
Gelscmium.—This is a precious remedy in all cases of urethritis and
gonorrhoea when the symptoms are sub-acute; discharge moderate; frequent
irritation, with considerable heat and little pain, with smarting and redness
at the meatus. In sub-acute cases, or in severe cases when the inflammatory
symptoms have been subdued by previous treatment.
Aconite. — In acute gonorrhoea, inflammation well developed, even scald-
ing, copious, thick greenish discharge ; frequent and painful erections, Avith
more or less febiile disturbance ; lips of the meatus red and swollen. After
inflammatory symptoms hive subsided, give Can. sat. for smarting pain,
burning and stinging during micturition, ardor uriiue, constant urging,
titillation, copious, thinner, yellow or whitish discharge; the lips of the
meatus glued together, and retaining the matter within ; prepuce swollen and
painful, with burning, smarling, stitching, darting pain in the urethra,
extending from the orifice of the penis to the bladder; strangury, with
pains extending to the scrotum, with dragging of the testicles.
Mercurius Corrosivus. —Another valuable agent in the acute stage, with
thick green and bloody discharge, painful erections, swollen prepuce, con-
stant desire to urinate; muco-purulent matter mixed with blood; cutting
14
GONORRHOEA.
pains in the urethra ; swelling and burning of the prepuce ; lips of the meatus
red and Oedematous ; drawing pains in the testicles, with swelling of the
glands ; chordee; stream of urine smaller, and passes away feebly. Mercu^
rius solubilis acts well in cachectic and impaired constitutions ; in sub-acute
cases, especially after Aconite /discharge slight; itching and stinging pains,
mostly confined to the glans.
Copaiba. —When the inflammatory symptoms have been mitigated by
Aconite, or previous treatment; or in sub-acute cases, with itching, smarting,
and burning in the urethra, with nocturnal chordee ; urine emitted in drops ;
swelling and redness of the urethra; urging pressure ; pulsative pains along
the urethra; the urine has the odor of violets, with a constant desire for
itsvoidance; discharge yellow and copious, the urine depositing a sediment
resembling albumen. A peculiar erythema, with sub-acute synovitis, has
frequently occurred in my practice from its use in the crude form.
Oleum Sandalum. — This remedy has of late done me good service in
the cure of this often intractable disorder, after the use of Aconite for
twenty-four or thirty-six hours, when the discharge is thick, yellowish, or
mucopurulent, attended with burning, smarting pain ; frequent.desire to
urinate ; swelling n,nd redness of the meatus, with smarting, stinging pain in
voiding urine ; painful erections ; swelling of the prepuce as if distended
with water. I have used it in the first and second potencies with the most
satisfactory results. I prefer the latter. After amelioration by the second
the third acts even more satisfactorily.
Petroselinnm. —Another new remedy; and, like the former, most appro-
priate when the more violent symptoms have been controlled by Aconite
or other appropriate treatment. Especially in cases where the inflamma-
tion has passed up the urethra, rapidly involving the base of the bladder,
"with distressing ardor urinae, with strangury ; discharge profuse, thick, and
whitish. (See Cantharides and Capsicum.)
Cantharides. — Cutting, stinging pain during and after micturition;
discharge thick and yellow, with severe pains at base of bladder, continuing
before and after urinating, with ardor urinae. (Consult Capsicum.)
Cubeba. — This is a remedy too much overlooked in those chronic, sub-
acute, or gleety conditions of the genito-urinary tract; and in the blennor
rhagias that occur in relaxed or impaired constitutions, especially after fre-
quent attacks of urethritis, with an absence of the more violent symptoms.
Mezereum.—In mild cases, with stinging, titillating pains, beginning
at the bladder, and extending to the meatus ; discharge thin and yellowish;
soreness along the urethra after voiding the urine, which is acrid and red,
like blood.
Terebinth. —In sub-acute and chronic blennorrhcea, with burning during
urination; suppression of urine; urethra sore, discharge whitish; unsuc-
cessful attempts at micturition ; irritation extending from the bladder to the
meatus.
Kali Hydriodicum. — In chronic urethritis of long standing, with con-
stant urging to urinate, with thick, green mucous discharge ; pain during
micturition ; irritable and sensitive urethra.
GONORRHOEA.
15
Erigeron Canadensis.—In chronic blennorrhceas, with irritation of the
urethra, and increase of offensive urine ; drawing pain in the back, running
down to right testicle.
Stillingia has been given in chordee with painful erections, burning and
itching during the act of micturition ; irritation extending to the bladder.
Thuja.—Tn chronic and ill-treated cases, with burning in the urethra;
stitching pain at the meatus, between the acts of micturition; sensation
of titillation, as if a drop of urine was passing along the urethra.
Sulphur. —In chronic gonorrhoea, when the discharge is slight, but the
smarting and burning continue during urination ; urine passes in a thin
stream ; walls of the urethra thickened; itching along the urethra, with
constant desire to void the urine ; pain, stinging, and tearing, between
the acts of micturition, when the appropriate remedy seems to have lost its
curative action.
Dr. Price, of Baltimore, advises, as soon as the first drop
appears, to inject a few drops of clear Glycerine, enough to fill
the urethra as far back as the inflammation extends; hold it
there for five minutes, then let it escape; urinate before using.
Another plan is to wrap a piece of raw cotton around Emmett's
silver probe, saturated with Glycerine; pass it into the urethra
an inch or more; repeat if necessary. These prophylactic meas-
ures may be tried, I think, with fair success.
My experience has led me, after many years of practice, and
large numbers of patients treated, to resort to the medium poten-
cies, when the best-directed efforts with the crude and lower
attenuations effected little or no good. A resort to the middle
and higher potencies, as high as the thirtieth, has almost always
resulted in marked improvement and speedy cures. I can
confidently recommend their employment when both physician
and patient are wandering about in the maze of unrelief.
During treatment, the patient must abstain from all stimu-
lants, condiments, strong coffee and tea, and tobacco in every
form; quiet and rest should be enjoined, and the strictest cleanli-
ness be observed. In such cases, when a " drop or two" still
appears after a well-conducted course of treatment, suspect
incipient stricture, and use mechanical dilatation. Some authors
speak of a kind of inflammation of this character, which they
term "gonorrhoea sicca," or dry clap. I do not attach any
importance to this as a variety of gonorrhoea. Use suspensory
bandage to the scrotum if the patient will attend to business.
Sexual excitement should not be permitted, and all hygienic pre-
cautions enforced during treatment, and two weeks after, for fear
of a relapse.
16 ORCHITIS.
SECTION II.
Orchitis, Balanitis, Cystitis, and Ischuria.
t .—Orchitis.
Orchitis is an inflammation of the testis proper. When the
epididymis is involved, it is termed epididymitis. In a badly
managed gonorrhoea, both structures may be involved; especially
so, after exposure to cold, or strong caustic injections. When
it occurs coincident with gonorrhoea, there is a temporary cessa-
tion of the discharge; the disease, by metastasis, attacking the
testicle. The symptoms are, weight and tenderness in the peri-
nseum; pain in the back and loins, extending from the scrotum;
testicle swollen; skin covering scrotum tense, dark red or
purplish; tenderness to touch; with fever; furred tongue; dry
skin. This may terminate in abscess, with an increase of all of
the above symptoms, with a feeling of pulsation and pain deep in
the organ; shiverings are present, and even the pressure of the
bedclothes is insupportable. The pus is mostly ill conditioned;
fluctuation is felt; and, if left alone, the abscess will be discharged
by several openings, and a peculiar fungous growth spring forth
from these outlets.
Treatment.—Remedies act exceedingly prompt in this affec-
tion. In mild cases a few doses of Sulphur will restore the ure-
thral discharge, and allay all inflammatory trouble connected with
Fig.i. ^ne testicle. In plethoric persons, Aconite and
Belladonna are very serviceable. Gels., Puis.,
Phytol., Clem., Ham., Merc, Rhod., Ant. tart.t
Verat. vir., Spong., Hep., will be found compe-
tent to cure the worst cases. After inflammation
has passed, use adhesive straps and the suspen-
sory bandage. (Fig. 1.)
Special Indications.
Aconite.—If there is fever, hot and dry skin, full
pulse, and other active indications of vascular excitement.
Gelsemium. —When the disease arises from suppressed
gonorrhceal discharge; from exposure to cold or wet
weather, or when biliary disorders exist, with tendency
to congestion.
BALANITIS.
17
Clematis Erecta.—After activity of the inflammatory conditions has
subsided. If the disease began in the epididymis ; or if it assumes a chronic
type, with induration and sensitive prepuce ; retraction of the testicles
and cord ; coming on after exposure to cold. (See Aurum.)
Belladonna.—If the organ is hot and swollen; in plethoric persons,
with tendency to delirium, and congestion to the head.
Pulsatilla. — Is serviceable in persons of mild disposition, easily affected
to tears; delicate organizations. When the inflammation is subacute, the
glands alone being affected, pain shooting down the back, or into the thigh,
and changing suddenly, with little or no thirst during the fever.
Hamamelis. — Dull, heavy pain in the testicle, at times excruciating;
unconscious seminal losses ; scrotum hot, congested, and swollen, the cover-
ing having lost its corrugated appearance, and becoming tense, smooth, and
shining. (See Belladonna.)
Hepar Sulph. — For abscess of the testicle fully formed ; after pus is
formed, evacuate with bistoury or aspirator; close wound with a piece of
adhesive plaster. Silicea and Phosphorus may be required to complete the
cure.
Mercurius. — After subsidence of inflammation, and the formation of
pus threatens, with shivering and profuse perspiration ; the gland hard and
sensitive. If testicle continues hard, lodium. The scrotum should be well
supported on a small pillow placed between the thighs. Apply locally,
Aeon., Bell., Clemat., Puis., or Ham. lotions to scrotum ; low diet, and rest in
the recumbent position ; strapping of the testicle.
In rheumatic orchitis, Aeon., Gels., Bell., and Merc, in the
lower attenuations, have done good service in my hands.
II. —Balanitis.
Balanitis, or spurious gonorrhoea, is caused by impure coitus,
or a want of cleanliness about the glans penis, and is accom-
panied with itching, burning, and soreness under the prepuce;
increased by walking. The inflammation may be very severe,
with oedema of the prepuce and phimosis, and become very dis-
tressing, yielding a muco-purulent discharge. It frequently arises
from the sebaceous glands around the corona, which secrete a
cheesy kind of matter; this, becoming disorganized, produces an
inflammation which envelops the lining membrane of the glans,
and gives rise to excoriation and swelling of the prepuce.
It is called posthitis when the inflammation extends to the lin-
ing membrane of the prepuce.
The causes are, want of cleanliness, leucorrhcea, menstrual
secretions, violent coition, as well as contagion.
Treatment is cleanliness and lotions of Hydrastis or Calendula.
18
CYSTITIS.
If the swelling of the prepuce is so tense as to prevent preputial
retraction over the glans, cleanse with a small syringe, its nozzle
being introduced within the aperture of the prepuce, and the
lotion applied three or four times a day. When the prepuce can
be retracted, apply Calendula or Hydrastis cerate to the part, or
sprinkle the abraded surface with Mercurius dulcis, first tritura-
tion. If phimosis occurs, treat as advised under that affection.
Aconite, Corallium, Mercurius, Nitric acid, or Pulsatilla may be
required internally. A quantity of yellowish humor behind the
corona may indicate Lycopodium; humid, soft excrescences
behind the corona, which itch on being rubbed, Staphysagria.
III. - Cystitis.
Cystitis may arise spontaneously from neglected gonorrhoea,
or from metastasis, caused by violent abortive measures; the
unskillful use of instruments, cold, haemorrhoids, and injuries.
Symptoms.—Pain in the supra-pubic region, extending to
the sacrum, the perinaeum, and along the urethra. Tenderness
on deep pressure over the pubes; frequent micturition with pain
and difficulty, the symptoms being aggravated rather than
relieved when the bladder is emptied; a tumor in the region of
the bladder, with pains of a burning, lancinating, or throbbing
kind; pulse frequent; skin hot and dry; tongue furred and
whitish. If the neck of the bladder is affected, pain is mostly felt
in the perinseum, and there is entire or partial retention of urine,
with dysuria or strangury. The introduction of a bougie is exceed-
ingly painful. If the posterior part of the bladder is chiefly
affected, violent tenesmus will be felt, from its contiguity to the
rectum. It sometimes terminates in abscess, or complete sup-
pression, which is a serious complication.
Treatment.—The principal remedies are, Aeon., Apis, Aloes,
Bell., Canth., Chimaph., Dulc, Dig., Erig., Chin., Can. sat., Eup.
purp., Sant., Hydrast., Kali jod., Puis., Terebinth., Uva ursi,
Squill., and Sidph. Injections of warm Hydrastis lotions thrown
into the bladder. Hot fomentations, and sitz baths, locally, are
very beneficial. A high degree of inflammation, with suppres-
sion, is very serious. It may terminate in resolution, suppura-
tion, induration of its wall, or gangrene. In resolution, there is
a gradual decline of symptoms. In suppuration, chills or rigors
occur, with white matter in the urine. Induration is known by
ISCHURIA.
19
subsequent irritation, gangrene, coldness, prostration, weak pulse,
hiccough, and pallor.
Special Indications.
Aconite. — Excessive and fruitless desire to urinate, with the emission of
a few drops of red, deep-colored urine ; violent fever and thirst ; pains
increased on making water ; great tenderness in the supra-pubic region. In
rheumatic cystitis it is invaluable.
Cantharides.—Shooting and burning pains in the vesical region, both
before and after emission, a few drops of bloody urine passing at a time;
cutting pains from the loins to the bladder; ardor urinae ; bloody urine, with
cutting, burning pains in the pcrinamm.
Colocyntll. —Tenesmus ; pains at urination felt over the whole abdomen;
urine light-colored, depositing a tenacious sediment; after inflammatory
symptoms have subsided, and mucus is discharging. In induration of the
bladder walls after inflammation. (See Merc, sol.)
Cannabis.—Complete retention; great desire to pass urine; a few drops
of bloody urine is passed, with burning pain.
Digitalis.—The neck of the bladder principally affected; constrictive
pain in the bladder, with retention; urine turbid or deep-colored, and passed
in drops.
Kali Carb. — Great desire to urinate, with scanty emission ; great pres-
sure before urinating ; hot, scanty urine ; frequent painful emissions of small
quantities, desire continuing after emission.
Phosphorus.—Inability to retain urine long; constant desire for its
evacuation, and at the same time a movement of the bowels ; profuse urina-
tion ; dull pain in the hypogastrium prevents micturition; paralysis of the
bladder, — chronic cases.
Squilla. — Great desire to pass urine; emission scanty; urine hot and
red, with sticking pains in the fundus of the bladder, producing movements
of the bowels (Phos.).
Sulphur. —Urine mixed with mucus or blood • burning during urination.
Nux Vomica.—When haemorrhoids are present. In chronic catarrh of
the bladder. Acid phos., Lye, Caust., Copaiva, Carbo teg. when paralysis sets
in ; Ars. and Lach. for gangrene. The diet should be regulated; avoid
animal food, spices, wine. Carbonated water has a good effect.
IV.— Ischuria.
Retention of urine differs from suppression. In the latter, the
kidneys do not perform their accustomed functions. In ischuria,
more or less pain exists in the bladder, which is distended, and
can be felt, in some cases, above the pubes. There is urgent
desire to urinate, with pain and sickness, and a very small quan-
tity is emitted. The disease, as a rule, yields readily to remedies.
If the bladder is over-distended, and a species of paralysis has
20
SPECIAL INDICATIONS.
set in, Aconite, Hellebore, Nux vomica, and Dulcamara are impor-
tant remedies. Opium, if the difficulty is purely nervous. If there
are stabbing.pains in the urethra, with feeling of stiffness, worse
at night, Digitalis; Apis, if complete suppression exists: Buchu
relieves spasmodic retention. The following remedies may be
consulted in particular cases: Aconite, Cannabis, Cantharides,
Pulsatilla, and Stramonium.
If the symptoms are urgent, and remedies have not had the
desired effect, warm baths are beneficial; Electro-Galvanism, and
finally the catheter, if the patient is suffering from over-disten-
tion. In cases of stricture or paralysis, if it is found impossible
to relieve the bladder by these means, recourse must be had to
puncture of the over-distended viscus, either by aspiration or
puncture with a trocar.
SECTION III.
Special Indications for Diseases of the Bladder
and Urethra.
Aconite. —This great antiphlogistic is indicated when the skin is dry and
hot; great thirst; unrest: nervous excitement; fear and anxiety; pain in the
region of the bladder ; rettntion of urine, with stitches in the kidneys ; fre-
quent and violent urging to urinate, with scanty emissions of red, turbid urine.
Angustura. —Tenesmus of the bladder, followed by profuse emission of
white urine; tenesmus after micturition. One is obliged frequently to
urinate, although but a few dark yellow drops are emitted each time, causing
a burning pain ; orange-colored urine, soon becoming turbid.
Anathoruin.—Frequent emission of urine, which is turbid, or soon
becoming so ; sensation of numbness and obstruction in the kidneys ; sensa-
tion as if the kidneys and bladder were always full and swollen. Pressure
and burning pains in the bladder, with urging to urinate every minute; the
bladder cannot hold the smallest quantity of urine. Difficult, painful, inter-
mittent urination ; it stops, and begins again the next moment. Fullness and
distention of the bladder, with inability to urinate, urine turbid, thick, and
full of mucus, as in catarrh of the bladder; retention of urine, with retrac-
tion of the urethral canal; urine brownish or yellowish, and bloody ; very
frequent urging to urinate, with burning urine, which is discharged in drops;
urine with yellowish, grayish, or dark sediment; incontinence of urine, with
involuntary urination when walking, and even at night in bed during sleep,
as if caused by paralysis of neck of bladder; tenesmus vesicae, with ischuria.
Apis. — Burning in the urethra before and after micturition ; disagreeable
sensation in the bladder, with a bearing-down in the region of the sphincter,
and frequent desire to urinate; incontinence of urine, with great irritation of
SPECIAL INDICATIONS.
21
the parts ; worse at night and when coughing; almost incessant desire to
pass urine; urine high-colored, and more frequent emissions of small
quantities; straw-colored urine, with brickdust sediment.
Asparagus.—Urging to urinate ; burning in the urethra; frequent uri-
nating, with fine stitches in the orifice of the urethra; urine scanty and
cloudy; a little straw-colored urine is passed, which becomes turbid imme-
diately after being passed, and is full of motes; after urinating, burning in
the urethra, with sensation as if there was some urine to pass.
Arnica.—This remedy will often be indicated in affections of the blad-
der arising from mechanical injury, when retention of urine is present, with
tenesmus*of the neck of the bladder, with ineffectual efforts to urinate; urg-
ing, the urine dropping out involuntarily ; brown urine, with brick-red sedi-
ment; one has to stand a great while before the urine is emitted; urine
strongly acid ; specific gravity increased.
Arsenicum Album. — Retention of urine, as if the bladder was paralyzed ;
scanty urine, passing with difficulty ; burning in the urethra during micturi-
tion, tenesmus and strangury; great desire to urinate, but does not pass any
urine: urinates more frequently than usual. Involuntary emission of urine
in the night when sleeping; ischuria; urine copious and burning hot.
Greenish, dark brown urine, turbid when emitting it: urine profuse and dark
brown ; haematuria; much sediment in the urine.
Belladonna. —Difficult micturition, the urine being passed guttatim, with
frequent urging; the urine is jellow and turbid, sometimes depositing a
reddish sediment; constant dribbling of urine ; sharp stitches low down in
the abdomen in the direction of the perinaeum ; pains come on suddenly, and
cease in the same way; feeling in the back as if it would break ; enuresis,
with profuse perspiration ; paralysis of the sphincter vesicae.
Bprberis Vulg. —Violent stitching pains in the bladder, extending from
the kidneys into the urethra, with urging to urinate ; frequently recurring
crampy pain in the bladder; cutting, constrictive pain in the bladder, when
full or empty ; burning in the urethra; burning pain in the female urethra
during and after micturition; stitching pain in the female urethra, beginning
in the bladder; violent stitches in the bladder, which compel one to urinate ;
burning pain in the bladder. Urine dark yellow, red, becoming turbid;
copious mucous sediment, mixed with a whitish gray, and later a reddish,
mealy sediment. Greenish urine, depositing mucus. Blood-red urine, which
soon becomes turbid, and deposits a thick mucus and bright red mealy sedi-
ment, slowly becoming clear, but retaining its blood-red color; pains in the
loins and kidneys frequently accompanying the morbid urine, but not always;
movement brings on or increases the urinary troubles.
Benzoic Acid.—Vesical catarrh; irritability of the bladder; nocturnal
enuresis in children ; too frequent desire to evacuate the bladder ; the urine
normal in appearance ; decrease of the quantity of urine ; urine aromatic;
urine of a very repulsive color, of a changeable color, brownish, cloudy, of
an alkaline reaction ; dark, reddish-brown urine, of greater specific gravity
than normal urine, with an acid reaction. Indicated when the urine contains
22
SPECIAL INDICATIONS.
an excess of uric acid. The patient is pale, languid, with a feeling of weak-
ness in the loins. Fleeting pains in the region of the bladder; a granular
mucus mixed with phosphates in the sediment of the urine.
Calcarea Carb. - Pain in the bladder, and cutting on urinating ; burning
in the urethra before and after urinating ; fine tickling stitches through the
urethra ; much sour-smelling urine passed at night: trickling of urine after
micturition ; involuntary passage of urine on every motion during menstrua-
tion ; nocturnal enuresis; urine very dark-colored, without sediment; the
urine has a pungent odor, is clear and pale; offensive, dark brown urine,
with a whitish sediment ; the urine soon becomes turbid, and deposits a
whitish, flaky sediment; a fatty pellicle forms on the surface.
Camphora. —Diminished power of the bladder. Retention of urine, with
urging to urinate; tenesmus of the neck of the bladder. Painful urination ;
burning urine ; strangury; the urine passes in a thin stream, as if the urethra
were contracted; yellowish green, turbid urine, of a musty odor; brown
urine ; red urine ; the urine on standing becomes very turbid and thick, of a
whitish green color, without deposit of sediment, urine contains mucus
without sediment; urine with white or red sediment; urine increased, of a
dark brown color; urine profuse, colorless, frequent; urine scanty.
Cannabis Indica.—Inflammation of the bladder; burning, scalding,
stinging pain before, during, and after urination ; urging to urinate, with
much straining; copious discharge of clear, bright-colored urine ; the urine
passes freely at times, then again in small quantities, with burning and
biting; the urine dribbles out after the stream ceases; aching in the kidneys ;
thick, red urine.
Cannabis Sativa. —Enuresis; paralysis of the bladder; drawing pain
in the region of the kidneys, extending into the inguinal glands, with
anxious, nauseous sensation in the pit of the stomach ; burning while urinat-
ing, but especially afterward ; urging to urinate, with pressive pain ; stitches
along the urethra when not urinating; white turbid urine ; urine red and
turbid: urine full of fibers, as of mucus with pus.
Cantharides. — Inflammation of uropoietic organs; pains in the region
of the kidneys, and urging to urinate ; burning, tenesmus, and violent pains
in the bladder ; ardor urinae; urine scalds, and is passed drop by drop, with
extreme pain ; hot, acrid, and bloody urine ; urine dark colored, turbid, and
scanty; urine loaded with mucus and sediment; cloudy urine, like mealy
water, with white sediment.
Carbo Veg. — Pressing pain in the bladder ; contraction of the urethra
every morning; frequent urging to urinate; copious emissions of light
yellow urine; the urine has a strong odor; dark-colored urine ; dark red
urine, as if it were mixed with blood ; the urine deposits a red sediment.
Causticum. — Frequent, difficult, and'painful micturition; involuntary
emissions of urine when coughing; nocturnal enuresis ; smarting pain in the
urethra while urinating; light-colored urine, with flocculent sediment.
Chimnphila Umbellata. — Chronic catarrh of the bladder; scanty urine,
containing a large quantity of mucopurulent sediment; urine thick, ropy,
of brick color, and copious bloody sediment ; dysuria ; inability to pass
SPECIAL INDICATIONS.
23
the urine without standing with the feet wide apart, and the body inclined
forward.
Colchicum.—Ischuria ; frequent micturition, with diminished discharge
of urine ; constant burning in the urinary organs, with diminished secretion;
brown, black urine ; whitish deposit in the urine.
Colocynthis.—Alternate stitches in the bladder and rectum; itching
at the orifice of the urethra, with desire to micturate ; retention of urine,
with a retraction of the testicles and priapism. Urine fetid ; it soon thickens,
and becomes viscid. Urine becomes turbid, with copious deposit, often
like gravel.
Conium Mac.—Pressure on the bladder; frequent micturition during
the night, the urine cannot be retained ; the flow of urine suddenly stops,
and continues after a short interruption ; the urine is thick, white, and
turbid, or clear as water, with frequent calls to pass it; burning sensation
when urinating; pressure in the neck of the bladder, with stitches, worse
when walking, better when sitting ; burning in the urethra.
Copaivae Balsam.—Excessive irritation of the bladder. Inflammation
of the urinary organs; swelling and dilatation of the orifice of the urethra,
with pulsative pain throughout the penis. Constant, ineffectual desire to
urinate ; the urine is emitted in drops; foaming urine, greenish, turbid,
with the odor of violets.
Digitalis Purpurea. —Inflammation of the neck of the bladder; pressure
on the bladder, with the sensation as if it were too full, continuing after
micturition. Continual desire to urinate, only a few drops being passed
at each effort; the urine is dark brown, hot, and burning when emitted.
The urine is more easily retained in the recumbent posture; alternate emis-
sion of large and small quantities of colorless urine; contractive pain in the
bladder during micturition.
Dulcamara. — Paralysis of the bladder, with involuntary discharge
of urine; catarrh of the bladder; thickening of the coats of the bladder;
retention of urine ; strangury ; painful micturition ; urine turbid and white;
reddish, burning urine ; mucous sediment in the urine.
Erigeron. — Vesical catarrh, with pain and irritation; dysuria in chil-
dren ; they have frequent desire, and cry when urinating ; the urine is
profuse, and of a very strong odor ; the external parts are inflamed and
swollen.
Gelsemium Sem. — Enuresis from paralysis of the sphincter, in children
at night ; profuse urination ; urging, with scanty emission, and tenesmus
of the bladder ; spasm of the bladder, with alternate dysuria and enuresis.
Graphites. — Micturition is preceded by a cutting pressing from the
kidneys; anxious pressure in the bladder, with sudden desire to urinate, but
scanty emission ; nightly desire to urinate; nocturnal enuresis; frequent
micturition ; the urine has a sourish smell ; the urine becomes very turbid,
and deposits a reddish sediment.
Hepar Sulph. Calc. — Nocturnal enuresis ; weakness of the bladder;
the urine is passed slowly, without force, dropping perpendicularly from the
24 SPECIAL INDICATIONS.
urethra; the urine is flocculent and turbid; dark yellow urine, burning
while passing ; brown-red urine, the last drops are mixed with blood ; sharp,
burning urine, which corrodes the internal surface of the prepuce ; the orifice
of the urethra is red and inflamed ; discharge of mucus from the urethra.
Hedeoma Pul.—Suppression of urine ; tenesmus; painful urination;
cutting, burning pains in urethra; scanty emission of urine, with frequent
and urgent desire ; urine very dark, like black tea.
Hyoscyamus Niger.— Enuresis ; paralysis of the bladder; retention of
urine, with pressure in the bladder ; frequent micturition, with scanty
discharges.
Ignatia Amara. — Irresistible desire to urinate ; painful pressure, with a
scraping sensation in the neck of the bladder, especially when walking;
turbid urine ; frequent emission of watery urine.
Jodium.—Nocturnal urination ; retention of urine ; increased secretion
of thick urine, with dark sediment; urine dark; turbid ; milky ; with a
variegated cuticle on its surface ; ammoniacal smell of the urine.
Kali Bichrom.—Frequent discharges of watery.urine of strong odor;
painful drawing from the perinaeum toward the urethra ; urine with white
film, and deposit of mucous sediment.
Lachesis. — Copious emission of foaming urine ; yellow-colored urine;
copious brown-red urine ; urine with red or brickdust sediment; turbid and
dark urine, with a sediment of brown sand, and a severe cutting during
micturition. Sensation as if a ball were rolling in the bladder.
Laurocerasus. — Retention of urine; pale yellow urine, scanty, acrid,
depositing a thick reddish sediment; burning in the urethra, and pressing
after urinating.
Lycopodium Clav. — Involuntary micturition ; stitches in the bladder;
frequent emission of large quantities of pale urine ; frequent micturition at
night, with rare and scanty emissions of urine during the day ; urine dark,
with diminished discharge; red, sandy sediment in the urine; painless
hemorrhage from the bladder; itching in the urethra during and after mictu-
rition ; greasy pellicle floats on the urine.
Mercurius Vivus. — The quantity of urine passed is larger than that of the
fluid drank; burning in the urethra between the acts of micturition ; inability
to retain urine ; frequent and violent desire to urinate, Avith scanty emission
in a feeble stream ; scanty red urine ; urine turbid and fetid ; dark red urine,
as if mixed with blood ; the urine is very turbid, and deposits a sediment;
pieces of white filaments are emitted after the urine ; the urine looks as if it
contained pus or mucus, and has a sour smell.
Natrum Mur.—Involuntary micturition when walking, coughing, and
laughing; desire to urinate day and night; stitches in the bladder during
micturition, with a smarting, burning sensation in the urethra ; pale urine,
with brickdust sediment; discharge of mucus from the urethra; dark, coffee-
colored urine.
Nitrate of Uranium. — Sore feeling in the pubic region ; increased fre-
quency of micturition ; profuse nocturnal urination, straw-colored and fetid;
SPECIAL INDICATIONS.
25
burning in the urethra, with very acrid urine ; desire to urinate immediately
after voiding urine.
Nitric Acid.—Enuresis ; nightly desire to urinate, with cutting pain in
the abdomen ; scanty, turbid, bad-smelling urine ; fetid urine; smarting,
burning pain in the urethra while urinating ; cramp-like, contractive pain
from the kidneys toward the bladder ; discharge of bloody mucus, or of pus
from the urethra ; the urine is cold when emitted.
Xux Vomica. —Retention of urine ; strangury; painful, ineffectual desire
to urinate; painful emission of thick urine; discharge of pale urine, fol-
lowed by pr.ssage of thick, viscid, whitish, purulent mucus from the bladder;
reddish urine, with brickdust sediment; burning and lacerating pain in the
neck of the bladder during micturition ; haematorrhcea.
Opium. —Atony of the urinary bladder; retention of urine from a weak-
ened condition of the contractile power of the bladder ; dark-colored urine,
which deposits a brickdust sediment; lemon-colored urine, depositing much
sediment.
Pareira Brava. — Violent pains in the bladder; pain in the thighs,
extending down into the feet; strangury, with paroxysms of violent pain;
the urine can only be voided while the patient is on the knees, with the head
pressing against the floor ; the paroxysms more usually occur in the morning,
from 3 to G o'clock ; the urine has a strong ammoniacal smell, and contains a
thick, viscid, white mucus.
Phosphorus.—Involuntary emission of urine; urine with a sediment of
white flocculi; smarting and burning in the urethra, with frequent desire to
urinate; tension over the region of the bladder; acrid, offensive-smelling
urine ; brown urine, with red, sandy sediment; hematuria.
Phosphoric Acid. — Enuresis, with cutting, burning pain in the urethra,
and cramp pain in the region of the kidneys ; spasmodic constriction of the
bladder; profuse discharge of watery urine, in which immediately forms a
white cloud; milky urine, with bloody, jelly-like lumps; burning in the
urethra while urinating.
Phytolacca Dec. — Copious nocturnal micturition; violent urging to
urinate ; urine excessive in quantity, or scanty ; dark-red urine, which leaves
a stain on the urinal of a mahogany color, which adheres very clcsely; the
urine deposits a chalk-like sediment; pain in the bladder before and during
micturition ; albuminous urine, with increased specific gravity ; frequent
and painful inclination to urinate.
Plumbum. —Paratysis of the bladder ; tenesmus of the neck of the blad-
der ; ischuria ; difficult emission of urine ; the urine is mixed with blood;
copious red or yellow urine.
Pulsatilla. —Vesical catarrh ; incontinence of urine ; enuresis nocturna;
frequent desire to urinate, with a drawing sensation in the abdomen ; spas-
modic pain in the neck of the bladder after micturition, extending to the
pelvis and thighs ; involuntary discharge of urine when coughing; the urine
Is discharged in drops when sitting or walking; burning in the urethra while
urinatin"-; haematuria ; scanty red-brown urine, with brick-colored sediment;
bloody or mucous deposit,
26 SPECIAL INDICATIONS.
Rhus Tox. — Tenesmus vesica;, with the emission of only a few drops of
blood red urine ; diminished secretion of urine ; incontinence of urine ; urine
hot, white, and muddy, or pale, with white sediment; dark urine, soon
becoming turbid.
Ruta Grav.-^-Nocturnal enuresis ; continual pressure on the bladder, as
if always full; the desire to urinate continues after micturition ; involuntary
discharge of urine at night in bed, and while walking during the day ; fre-
quent urging, with emission of green urine.
Sarsaparilla. — Pain and cramps in the bladder, with urging and burn-
ing ; urine pale and copious ; frequent urging to urinate, with scanty but
painless discharge; urine clear and red. Severe strangury, with discharge
of white, acrid, turbid matter, with mucus; painful retention of urine ;
urine frequently voided ; does not become turbid, but deposits a cloud ;
frequent and copious discharge of pale urine, which becomes turbid on
standing, like clay water; urine either too frequent, copious, and pale, or
scanty, slimy, flaky, clayey, or sandy ; iridescent pellicle on the urine.
Sepia. —Nocturnal enuresis, especially during the first sleep ; constant
desire to urinate, with painful bearing-down in the pe'vis in the morning-,
burning in the bladder and urethra; pressure on the bladder in the evening,
with burning after urinating; urine turbid, with red, sandy sediment, and
a cuticle on the surface ; urine has an offensive smell, and deposits a white
sediment.
Squilla Mar. — Tenesmus of the bladder after micturition; frequent
calls to urinate, especially at night, with scanty emission, or profuse dis-
charge of pale urine ; sanguinolent urine, with a deposit of red sediment.
Stannum. — Painless retention of urine ; the urging to urinate is absent,
as in atony of the bladder.
Staphysagria. —Profuse discharge of pale urine, with urging ; frequent
desire to urinate, with emission of a small quantity of dark-colored urine,
burning in the urethra during and after urinating ; urging after micturition,
as if the bladder had not been emptied.
Strychnia. — Atony of the bladder ; retention of urine, or incontinence,
when these conditions depend on impaired power of the detrusor muscle-
of the bladder, from over-distention.
Sulphur. —Nocturnal enuresis ; violent desire to urinate at night ; copi-
ous micturition after midnight; stitches in the bladder ; cutting pain in the
urethra while passing urine ; the urine is sometimes clear, and sometimes
contains a thick sediment; rose-colored urine ; fetid urine, a greasy film
forming on the surface.
Terebinthina. — Strangury ; dysuria ; violent dragging and cutting pain
In the bladder ; burning in the bladder; urine scanty and red, or bloody
urine ; difficult micturition ; the urine has the odor of violets, with deposit
of mucus, or a thick, muddy sediment.
Thuja Occident.—Frequent urging to urinate, with profuse emission ;
the urine looks like water when passing, but becomes cloudy on standing;.
PHIMOSIS.
27
red urine, depositing a brickdust sediment; burning in the urethra during
and for some time after micturition.
Dva Ursi. —Haematuria ; painful micturition, with burning; urine slimy
and purulent.
Veratrum Album.—Diuresis; involuntary emission of urine; painful
pressure on the bladder, and burning during micturition; frequent but
scanty emissions of dark red urine ; green urine
SECTION IV.
Various Affections of the Penis.
I. — Phimosis.
Phimosis is an abnormal contraction of the terminal border
of the prepuce, in front of the glans. It may be congenital or
acquired, acute or chronic. Congenital, though rare, is when the
prepuce is imperforate, or nearly so, and the
urine, not being emitted, collects between
the prepuce and glans, forming a sac or
tumor. The acquired, is the result of cica-
trization of ulcers or chancres, or is sym-
pathetic with gonorrhoea, balanitis, etc.
Frequently constitutional symptoms are
developed in the chronic variety, varying
from nervous derangements to complete in-
coordination of motion, and loss of equili-
brating power. In the acquired variety the
preputial secretion is retained, producing
much irritation, and occasional attacks of inflammation, with
discharge (balanitis). (Fig. 2.)
Treatment. —The remedies curative of this affection, if sur-
gical action is not demanded, are Aeon., Am., Ars., Caps.,
Cann., Calc, Hepar, Euphras., Hyperic, Merc, Rhus, Sepia,
Thuja, Sulph., Viola tri. The remedy is to be selected in accord-
ance with the constitutional and local manifestations.
' The local treatment consists of warm medicated lotions of
Calend., Hyperic, or Thuja, frequently employed. When all
medical agents fail, recourse may be had to an operation; viz.:
If the foreskin is long and tight, or thickened by cicatricial sur-
faces, draw it well forward, hold between the blades of a forceps,
2b PARAPHYMOSIS.
and cut off by one sweep of the bistoury.* (Fig. 3.) In cases
of less severity, the prepuce may be slit up on the dorsum as far
as the base of the glans, by means of an oiled director passed
Fig. 3.
underneath the foreskin. (Fig. 4.) The chief seat of constric-
tion being in the mucous membrane, care should be taken that
Fj 4 it is well opened, and a second piece snipped
out, if necessary, and stitched to the skin.
Apply cooling lotions of Hypericum to the parts
after operation, to prevent inflammation.
Rupturing the mucous membrane by Hutchin-
son's forceps has proved successful.
II. — Paraphimosis.
Paraphimosis is the reverse of the former.
When the prepuce is drawn over the glans, and
allowed to remain there, producing contraction and stricture of
the foreskin, serious results may follow. The penis is constricted,
* Dr. E. P. Hurd reports a case where locomotor ataxia was developed
in a lad seven years of age. Various methods of treatment were employed,
unsuccessfully. The true cause of the disorder proved to be phimosis ; and
circumcision was performed, with gradual improvement and final recovery.
Dr. Thompson, of Albany, N. Y., reports a case where epileptiform convul-
sions followed phimosis. This also recovered by circumcisiou.
^>M
HERPES OF THE GLANS AND PREPUCE.
29
the skin becomes oedematous, and the mucous lining of the
prepuce, and the glans, become congested, followed by ulceration
or sloughing; and the strangulated glans, being ill provided with.
resistant power or control, may become gangrenous, and ulti-
mately die. (Fig. 5.)
Treatment.—In recent cases, efforts should
be made to reduce the stricture, and release
the glans from its incarceration. The parts
having been well oiled, the surgeon takes the
penis between the fingers of both hands, and
draws the constricted portion slowly but
steadily forward; with the thumbs, at the
same time, he compresses the glans, and
pushes carefully backward. If this fails, the
constriction may require division by raising a
fold of the skin by introducing a sharp-pointed
bistoury beneath the tightened band, and
cutting outward, when reduction can be effected. Local applica-
tions of Hypericum or Staphysagria should be employed, and the
patient placed in a recumbent position, with the penis elevated,
so as to favor the circulation of the blood through the weakened
parts.
The following remedies may be beneficial in overcoming the
inflammation in the external structures: Arnica, Apis, Arseni-
cum, Mercurius, Calendula.
III. —Herpes of the Glans and Prepuce.
These eruptions are characterized by the formation of small
vesicles or excoriated points upon the mucous membrane of the
glans, attended by smarting and itching, and chiefly occurring in
persons of a gouty dyscrasia, with an irritable mucous membrane.
Treatment will be required to overcome the constitutional irrita-
tion. Local lotions of Rhus rad. or Ranunculus are very bene-
ficial. Internal remedies are Dulc, Hepar, Graph., Merc, Phos.,
Rhus tox., Ranunc, Sarsap., Sepia, Tellur., Tiglium. Cleanliness
should be observed.
IV. — Hypertrophy of the Prepuce.
Hypertrophy of .the prepuce is the result of chronic irritation
or disease ; is usually limited, but may become so extensive as to
30 CONDYLOMATA, WARTS.—HORNY EXCRESCENCES.
call for surgical interference. It consists of solid cedema of the
areolar tissue of the prepuce, and of the sub-integumental struct-
ures of the body of the penis, which becomes enlarged and club-
shaped. For remedies, consult Nat carb., Graph., Elaps cor.,
Cal. scg., and Puis. Surgical relief consists in the excision of a
V-shaped piece from the dorsum of the penis.
V. —Condylomata, Warts, or Sycosis.
Condylomata, Warts, or Sycosis, often follow gonorrhoea,
particularly if the patient has not observed due cleanliness, the
discharge being permitted to lodge beneath the prepuce. They
are generally situated along the corona or on the fraenum; in
females they occur about and in the pudenda. They present
different appearances; are fig-shaped, cauliflower-like, or like a
cock's comb, pear, or raspberry.
Pathology. — The pathological condition is a morbid thicken-
ing of the chorion, rete mucosum, and epidermis, with hypertrophy
of the papillary body. They sometimes appear at the verge of the
anus, the angles of the mouth, and on the perinaeum; are soft,
spongy, bleed easily, and are liable to return after cauterization,
excision, or ligation. They secrete a peculiar gleety and fetid
fluid, and are dependent upon venereal infection.
Treatment.—The remedies are: Acid nit., Cann., Lye,
Phos. ac, Calc carb., Merc cor., Magn., Staph., Sabina, and
Thvja. I have never failed in the cure of these little pests by
excision, and Nitric acid or Thuja applied to the base, and at the
same time given internally.
VI—Horny Excrescences.
These formations sometimes spring from the glans penis,
and appear first as soft, semi-transparent masses, enclosed in
complete cysts. As they increase in size they become dense and
hard, and assume all the characteristics of horny structure.
They grow slowly, and sometimes attain considerable size. An
instance of this growth is reported by Dr. Jewett, of Connecticut,
who describes it as 3£ inches long and f of an inch in diameter
at the base. The treatment is the same as that for other horny
tumors; which see.
INFLAMMATION OF URETHRA.—CHORDEE. 31
Follicular Inflammation of Urethra.—In all acute inflam-
mations of the urethra the follicles are more or less involved. It
is through this chain of cryptae mucosae that the surface inflam-
mation reaches the deeper structures and produces the peculiar
affection termed chordee, its severity depending upon the violence
of the surface congestion.
When the inflammation extends to the prostate it yields slowly
as compared with complications elsewhere. It is recognized by
the oozing of a peculiar thin gleety discharge, which is accom-
panied by irritability of the bladder, a sense of heat and fullness
in the perinaeum, increased by sitting, jolting and even crossing
the legs. These symptoms are so severe at times as to resemble
stone in the bladder, from which they may be distinguished by
the history of the case and other marked and positive indications
of calculus. Persons of a gouty or rheumatic diathesis, and also
those of broken down or cachectic habits, are predisposed to pros-
tate complications.
Treatment. — The treatment of these forms of follicular disease
of the male urethra is as a rule quite simple and effective. In
two well marked cases that came under my observation, where
mild attacks of chordee were of nightly occurrence, local" applica-
tions of Hamamelis and the internal administration of Capsicum
frequently repeated effected a cure within two days. When the
disease involves the prostate there is a greater disposition to
invasion of the denser structures of the gland, and, as a con-
sequence, a greater resistance to treatment. In such cases I
recommend a study of the pathogeneses of those remedies men-
tioned under the head of Prostates,—page 49.
Chordee.—Whenever inflammation of the urethral surface ex-
tends into the deeper tissues of the penis through the minute ducts
into the cryptae mucosae and from thence is reflected to the delicate
and interminable net-work of connective tissue which composes
the corpus spongiosum, the product of inflammation (plasma) is
thrown out, which stiffens and agglutinates together a limited
area of this net-work of tissue. The influx of blood, which during
erection distends all other portions of the spongy structure, meets
with an obstacle at the part invaded by disease, and no blood is
permitted to enter the area so involved by plastic exudation; as
a result of this excitability the corpus spongiosum is filled with
blood in all portions except the limited area, which remains
32
CHORDEE.
empty. This empty part having lost its power ot expansion,
being relatively too short, acts upon the same principle of a cord
to a bow, and in this way the penis is curved, its greatest con-
cavity corresponding to the inflamed area of corpus spongiosum.
The greater the amount of erection, therefore, the greater will be
the curve, and as a consequence the pain will be correspondingly
increased. This constitutes the pathology of chordee, which takes
place ordinarily at the end of the second or third week when the
inflammatory symptoms are, as a rule, at their greatest intensity.
Chordee is the usual accompaniment of primary claps, and seldom
occurs after the first attack. During this state of extreme tur-
gescence it occasionally happens that the minute vessels of the
urethra will become ruptured, which is recognized by the discharge
being streaked with blood. The prepuce in some cases becomes
swollen, inflamed, and white with oedema, which may extend the
whole length of the organ. This often leads to both phymosis and
paraphymosis; to phymosis if the prepuce is long, and paraphy-
mosis when it is short. Balanitis and posthitis may occur as the
result of a tight foreskin, the gonorrhoeal discharge being retained
in the furrow behind the glans penis, where it may lead to the
formation of warts and condylomata. Cleanliness and frequent
injections of Hydrastis or Boracic acid thrown into the prepuce
to wash away the imprisoned discharges that have accumulated
behind the corona will readily effect a cure. When the preputial
contractions do not yield to the measures indicated, recourse
must be had to the more active measures which are spoken of
under their appropriate headings.
Treatment.—The treatment of chordee is naturally associated
with the gonorrhoeal inflammation, and the remedies for the latter
are curative of the former, and should be promptly and vigorously
administered both locally and constitutionally. Aconite, Gcl-
semium, Oleum sandalum, Cannabis sat., Bcdsam copaiba, Can-
tharides, Mercurius, Petroselinum, Sulphur and Stillingia are the
remedies of chief importance. The special indications for these
will be found under the treatment for gonorrhoea. Locally, the
application of cold water to the penis, or a piece of cold metal
applied whenever the erection becomes painful, or a spermat-
orrhoea ring placed over the organ when going to bed has done
considerable service by the waking of the patient before the
erection has attained its maximum intensity. Oftentimes the
CHAFING OF GLANS.—RUPTURE OF FRENUM.
33
simple evacuation of the accumulated urine in the bladder will be
sufficient to prevent the erection and with it the pain produced.
Chafing of Glans.—These affections of the mucous lining of
the glans penis occasion no little concern among those who may
have risked their persons to the infection of the venereal taint,
and are often mistaken for chancres by the patient and occa-
sionally by the medical attendant. When these occur behind the
corona from laceration or abrasion they are very liable to deceive
the patient. A little careful scrutiny of their shallowness, irregular,
lacerated shape, the smarting and itching which follow soon after
coit, and the rapidity with which they yield to cleanliness readily
determine their character. If neglected they will cause pain,
swelling and phymosis, and in this way greatly disturb the patient.
Frequently I have had patients presenting themselves to me
in this condition, possessing all the moral depression of having
the venereal taint, especially in those cases where they have run
the risk of contamination. Although these affections need not
be confounded with the venereal type of diseases, still, by some
who associate a sore upon the frenum or glans with chancroid, and
especially by the patient who fears every little abrasion and thinks
he has "caught the pox," they often present no little concern.
Treatment.—Bathe the parts with a weak solution of Boracic
acid and water, or Hydrastis lotion, taking care to throw the
injection well back on the corona, which will cause a little annoy-
ance to do thoroughly if the prepuce is much swollen. In severe
cases I have used the Black-wash with good success. The chief
indication is to keep the parts well cleansed and prevent the
accumulation of matter behind the glans.
Rupture of the Frenum is an occasional consequence of sex-
ual intercourse, when the frenum is very short or the intercourse
is attended with considerable difficulty. When torn, the haemor-
rhage is sometimes quite profuse, especially if the laceration ex-
tends to the meatus urinarius. Touching the raw surface with
the point of Nitrate of Silver, or applying a styptic of the Per-
sulphate of Iron or Matico will ordinarily arrest the bleeding,
except when the artery of the frenum is open. To close this, a
very delicate silk ligature may be applied to the bleeding point
with the best result. A wad of cobweb placed over the torn part
and held by a small bandage in situ, effected a cure in a case under
my treatment.
34
PRIAPISM.
VII. —Priapism.
Persistent priapism is the result of excessive venery. The
erection of the penis is not accompanied with any sexual desire,
but is attended with great pain, a feeling of weight about the
perinaeum, and much anxiety and constitutional disturbance.
The organ is singularly hard and unyielding, and may remain in
this condition for hours and even days.
The pathology of this disease is supposed by some to be the
result of extravasation of blood into the corpora cavernosa; by
others it is referred to sympathetic or reflex nervous irritation.
A case of this kind I saw many years ago, at St. Louis, in a newly
married man, where the organ became so hard and unyielding
that I was compelled to incise the corpora cavernosa and let out
a quantity of blood. After a few hours, with three or four doses
of Aconite, given internally, and followed by Capsicum, I suc-
ceeded soon in overcoming the trouble.
VIII. —Gangrene,
Gangrene of the penis occurs in broken constitutions, from
syphilitic phagedsena, or as the result of gonorrhoeal phimosis.
This is an exceedingly rare disease at the present time, owing
either to non-Mercurial complication, or to the gradual decrease
of the more virulent forms of syphilis. The treatment is like that
for gangrene in other parts; which see.
IX. — FibroiidL Tumor of the Penis.
The penis may become the seat of this formation, in common
with other structures of the body; and the tumor maintains the
same peculiarities that occur in the ordinary fibroid growth, and
is treated the same as in other parts. (Consult Franklin's Sur-
gery.)
X. — Hypospadias.
Hypospadias is an arrest of development in the mesial line of
the penis, leaving a slit or a fissure connecting with the urethra;
occurring on the under surface of the organ, and confined to
the glans and upper part of the penis; though it occasionally
extends backward to the root of the organ, cleaving the scrotum in
twain, being sometimes erroneously considered as an example of
hermaphroditism. (See Part XVI1L, Franklin's Operative Sur-
EPISPADIAS.—CHRONIC ORCHITIS.
35
gery, p. 657: "Malformation of the Urethra.") The treatment
consists in plastic operations; though they are mostly incurable.
XI. — Epispadias.
Epispadias is the reverse of the former, where the deformity
occupies the upper surface of the penis. It is a rare deformity,
and is referred tc the condition termed extroversion of the blad-
der. (See Part XVI1L, Operative Surgery, p. 657.)
SECTION V.
Various Affections of the Testes.
I. — Chronic Orchitis.
Chronic orchitis, or sarcocele of some authors, may be the result
of an imperfectly cured acute orchitis; or it may be chronic from
the commencement of the disease, resulting from gonorrhoea, or
occurring as an independent affection. The epididymis is often
the primary seat of the disease, which gradually involves the
whole gland, which presents the appearance of an inelastic, uni-
form, oval tumor, exceeding two or three times fhe size of the
normal testicle. The disease progresses insidiously; is more
severe at night than in the daytime; the sensitiveness of the gland
is largely lost. When it is accompanied with effusion within the
tunica vaginalis, it is termed hydro-sarcocele. Its pathological
structure consists of a yellow, solid lymph, effused into the sub-
stance of the gland, extending into the vas deferens, and deposited
in the tubuli seminiferi. Its smoothness, uniformity, gradual
progress, and the absence of glandular enlargement, distinguish
it from malignant disease of the testicle.
Treatment. — Piest in a recumbent position, with applications
of Hamamelis, Belladonna, or Hypericum lotions, the scrotum
being supported by a hair pillow, as in all cases of inflammation
of its external structures. Give one of the following remedies:
Aur., Clem,., Agnus cast., Graph., Argent, nit., Bell., Kali carb.,
Kali jod., Lye, Rhod., Merc, and Rhus. Strapping the testicle,
and use of a suspensory bandage. (See "Orchitis.")
36 FUNGOID GROWTHS OF THE TESTICLE.
II. —Fungoid Growths of the Testicle.
These growths from the testicle, following orchitis, are of two
varieties, benign and malignant. In the benign, the mass is
granular, hard, very sensitive, not disposed to heal, and bleeds
easily. The growth is paler and more consistent than the latter,
with tumefaction of the cord. Pressure upon the testicle pro-
duces that peculiar sickening sensation resembling a healthy
condition; while the malignant is soft and spongy, color darker,
with frequent attacks of hemorrhage, and pressure upon the
testicle gives no sickening sensation.
Treatment.—The remedies are Merc viv., Phos., Clem., Calc
carb., Ars., Con., Baryt., Carlo veg., Mez., Kali carb., Nit. ac,
Spong., Oleand., Thuja. When remedial agents fail, castration is
the only means of relief. (See remedies for orchitis.)
III. — Cystic Sarcocele.
Cystic sarcocele is an enlarged, somewhat elastic, indurated,
lobulated, and globular tumor occupying the testis, attended with
weight, heaviness, aching, and numbness, with an enlarged and
varicose state of the veins of the cord. It is a rare disease, grows
insidiously, with cystic fluctuation at its upper portion, resem-
bling somewhat hydrocele of the cord. The enlarged testicle may
become of very great size.
Pathology.—A stroma of various modifications of connective
tissue in all stages of growth, in the midst of which are irregular
epithelial spaces, which dilate and form cysts lined by epithelium.
It may become malignant by degeneration, the stroma assuming
the form of cancer, and the epithelium taking on the true carci-
noma cells. It is said by Curling to be the result of morbid
changes in the ducts of the rete testis. It may be confounded
with hydrocele; but the absence of translucency, its globular
shape, weight, and the varicose state of the veins of the cord, will
determine its nature. An exploratory incision will solve all doubt,
or the use of the aspirator will determine diagnosis.
Treatment in Dubious Cases.—Apis.,Clem.,Calc, Dig., Ars.,
Con., Graph., Lye, Plat., Sepia., Sil., and Sulph. I cured two
cases of well-marked cystic disease of the testicle with Apis and
Conium. Removal of the diseased gland is the last resort of the
surgeon.
SPASMODIC AND INFLAMMATORY STRICTURE. 37
IV. — Enchondroma of the Testicle.
This is a frequent accompaniment of cystic sarcoma, and may
appear alone, deposited in larger or smaller nodules, or infiltrat-
ing the gland. Its usual seat is the body; but it may invade the
epididymis. When it attains a large size, it loses its purely car-
tilaginous character, and is found mixed with sarcoma tissue, and
complicated with cysts, and merges into the disease just consid-
ered. For treatment, consult "Enchondroma," under the head of
"Tumors," Franklin's Surgery.
V. —Cancer of the Testicle.
Cancer of the testicle, or malignant sarcocele, invariably
assumes the encephaloid character, and is the only form of cancer
ever occurring in that gland. Symptoms: Dragging pain, and
weight, with induration and enlargement; tense and elastic, but
smooth and heavy; as it increases, it becomes rounded, doughy,
or pulpy, sometimes hard and knobby; the cord becomes enlarged,
hard, and knotty, and the scrotum becomes adherent to the
growth; ulceration ensues; and finally a fungus projects, when all
doubt will be removed as to the nature of the malady.
Treatment.—Refer to carcinoma. Removal of the organ is
advised; to be of permanent service, it should be done early.
SECTION VI.
Stricture, Prostatitis, Etc.
I.— Spasmodic and Inflammatory Stricture.
Stricture of the urethra may be either spasmodic or temporary,
inflammatory or pathologic, organic or permanent, involving three
distinct conditions. In the first, there is a spasmodic action of
the muscular tissues surrounding the urethra;—the result of
high living, stimulation, exposure, free sexual indulgence in per-
sons of excessive nervous irritability; irritation in the rectum,
dependent upon ascarides, haemorrhoids, faecal accumulations, etc.
The second proceeds from congestion or inflammation in the
structures of the urethra, wherein an inflammatory stricture
exists. It occurs in gouty and rheumatic subjects, suffering from
irritability of the skin and mucous membrane.
38
STRICTURE.
The size of the male urethra, as influenced by the size of the
penis, has been made the subject of much controversy. Dr. Otis
contends that there always exists a constant relation between the
size of the flaccid penis and the capacity of the urethra. Helmuth
and others, on the contrary, maintain an opposite opinion; and
my experience corroborates that of Professor Helmuth, "that a
small penis may have a large urethra, and the tube may be of
small caliber in an organ of good size." The urethra is subject
to abnormal contractions along its whole extent. The portions
of the urethra most liable to stricture are also a matter of dispute.
I am inclined to accept the views of Dr. Otis, that a large propor-
tion of strictures are found within the first four inches from the
meatus, and they decrease in frequency as you measure toward
the vesical opening. In one respect, however, all authors agree
in assigning the most frequent position to be at the sub-pubic
curvature. Small urethras are more predisposed to stricture
than large ones : in all cases the danger of permitting gleet to run
on indefinitely is very great, as it will almost invariably eventuate
in stricture, and of itself should arouse the apprehensions of the
surgeon as to the existence of stricture.
Treatment. — Spasmodic and inflammatory stricture yield
readily to appropriate medication. In the early stages, prompt
relief will be afforded by the sitz bath, hot sponge, or hot fomen-
tations to the perinaeum, Richardson's Nebulizer, Chloroform ; or
either of the following remedies, in accordance with their patho-
genesis, may be given.: Aeon., Bell., Canth., Con., Lach., Graph.,
Gels., Camph., Clem., Dig., Merc, Eupat. purp., Cann., Nux vom.,
Thuja, Petros., Prunus spinosa, Sandalum, etc. A soft, flexible
catheter or bougie maybe used after the inflammatory contraction
has in part yielded, which may be employed from time to time,
till all pathological conditions have yielded to treatment. (Con-
sult "Special Indications," at the end of this section.)
II. — Organic Stricture.
Permanent or organic stricture is the result of inflammation
in or near the urethra; it is due to the organization of plastic
lymph during the inflammatory stage, either upon the surface or
into the submucous areolar tissue; and is caused by ill-treated
gonorrhoea, ulceration, intemperance, morbid urine, or trauma-
tism. It varies in form, sometimes being annular, long, or one-
STRICTURE.
39
sided, and partakes of a gristly, cartilaginous material, blocking
up and contracting the urethra. Its most frequent seat is in front
of the pubic arch. Once formed, it tends to become worse.
Pathology.—Contraction gradually increases the size of the
urethra behind the stricture, which dilates and becomes saccu-
lated. The muscular coat of the bladder thickens and hyper-
trophies, sacculi are formed, and the mucous membrane is disor-
dered. Its evil influences gradually extend backward, the ureters
become distended and tortuous, the kidneys congested, and prone
to inflammation. Calculi may be formed, and a general nervous
depression is produced. It is not a disease of advanced life,
except when it proceeds from venereal disease.
Symptoms.—Frequent desire to void urine, with pain and
difficulty ; stream diminished, twisted, forked, or scattered ; urine
dribbles away after evacuation; uneasy sensation in perinaeum;
itching at the glans, with gleety discharge. As the affection pro-
gresses, all symptoms increase; irritation extends to the testicles,
prostate, and thighs. In bad cases, the urine passes drop by
drop, with much straining; rigors or prostration ; fits of retention
take place, through congestion and spasm; pain during coitus,
with a sonse of heat and soreness in perinaeum.
Treatment.—The first thing to be done in the treatment of
stricture is to ascertain its locality and extent. To accomplish
this, the urethra-meter of Otis is most reliable. It is introduced
into the urethra closed; and, having passed it onward as far as
the membranous portion, the surgeon turns the screw in the
handle, until a sensation of fullness is felt by the patient, when
it is gradually withdrawn till it engages the stricture. At this
point the screw must be turned in the opposite direction until
it is reduced to such a size that it will pass the obstruction. The
hand on the dial will mark the size of the stricture. The bougie
h boule, or the metallic bulbous sound, is also used to define the
locality and extent of the stricture. Dr. Otis has invented a
urethral endoscopic tube for viewing the interior of that canal.
It is six inches in length, and from 17 to 19 of the English scale.
Having ascertained the location and extent of the stricture, the
next process is its cure, or rather to restore the canal to its
normal caliber, and maintain it in that state. To the accom-
plishment of this object, the profession is greatly indebted to
Dr. Otis, of New York, for his valuable suggestions and practical
40
STRICTURE.
experience in the treatment of this disease. The question then
presents itself, whether we shall follow the treatment of Dr.
Otis, of slitting open the stricture, divulsing it, or overcoming
it by dilatation. The last of these processes is, I think, the best
adapted for the cure of the stricture. These mechanical measures
are: 1st. Dilatation by a bougie or sound; 2d. Dilatation by
means of expanding instruments; 3d. By a catheter retained;
4th. By'the caustic bougie; 5th. By incision from within; 6th.
By external incision, or dividing it from the perinaeum. Com-
pensating strictures occur in front of the main one, and the
anterior portion of the canal becomes alternately dilated and
contracted by the stream of urine being deflected in an oblique
direction after it passes the first obstacle. The point of impinge-
ment against the urethral wall takes on inflammatory action,
and the result is a compensating stricture. Like all derange-
ments of compensation, the secondary stricture relieves the
morbid status of the primary one.
Early attention should be given to all disorders of the system,
mental disquietudes, and especially those involving the pelvic
organs; chastity, temperance, rest, early hours, warm baths, and
remedies given to meet the various subjective symptoms that
may arise. In this way very much relief may be obtained, and,
in some cases, cures have been effected. The chief remedies are :
Dig., Clem., Eupat.purp., Primus, Sepia, Gels., Bell, Thuja, Nit.
acid, Kali jod., and medicated plasters to the perinaeum. When
medication fails, then use the second class of remedies, which is
to restore the urethra to its normal caliber, and to maintain it so.
This is done by gradual or forcible dilatation, incisions, or elec-
trolysis. Gradual dilatation consists in passing a graduated
bougie from time to time until the urethra is restored. In very
bad cases, use a horse hair, a filiform bougie, a whalebone guide,
or a metallic sound. Be careful of the entanglement of the
instrument in one of the lacunae, and beware of false passages.
A skillful hand will detect the slightest irregularity or accident.
Remember, every stricture can be cured that permits the slightest
flow of urine. Dilate gradually, if possible, and begin with the
smallest filiform bougie, increasing the size from time to time till
restoration of the canal. Rapid and forcible dilatation may be
made when the stricture yields readily, and time is of the greatest
moment to the patient. This is effected by divulsion (Otis's or
Holt's dilators), or internal division by the urethrotome. In the
STRICTURE. 41
latter case, care must be exercised to divide the stricture entirely,
which can be ascertained by passing one of Otis's bulbous sounds.
In very resilient strictures, two or more attempts may be required
to completely cut through the stricture: if success is desired, the
division must be thorough. The operation requires great care,
and an intimate knowledge of the structures, as well as consider-
able experience in manipulation. All internal operations are
referred to two important principles: division of the structure
from or toward the bladder, each process having its own advo-
cates. I prefer dividing it from the vesical side to the meatus.
Dr. Otis, an ardent advocate of internal incision, thus writes:
" I am a believer in the true curability of urethral stricture, not-
withstanding that authorities are a unit to the contrary. I think
I can bring evidence that will be convincing, that, in the great
majority of cases of urethral stricture, a complete eradication
of the trouble is within the reach of every competent surgeon.
To warrant the reasonable expectation of cure, the stricture must
be completely divided at some one point; and this cannot be
with certainty accomplished without a knowledge of the normal
urethral caliber. The normal caliber once ascertained by means
of the urethra-meter, or by measuiement of the flaccid penis, the
method by which the sundering of the stricture at some one
point is accomplished, may vary, and rests with the judgment of
the operator. If dilatation or divulsion be selected as the
medium through which to effect this result, the procedure must
be carried far enough to completely rupture every fiber of the
contraction; if division, every fiber must be completely severed,
or subsequent recontraction is certain. Neither divulsion alone,
nor simple urethrotomy, is capable of effecting this with any
certainty. It requires a combination of those two methods to
accomplish the desired result. My first dilating urethrotome was
constructed for the purpose of meeting these necessary require-
ments, which has proved permanent so far as the principles of
operation are concerned." He further adds: "In all cases of
stretching at or near the meatus, I am accustomed to make the
divulsion on the inferior wall of the canal, and very thoroughly,
with a straight, bulb-pointed bistoury. The utmost freedom to the
passage of the bulbous sound must be here insisted on, and not
a single trace of contraction left uncut." As a means of prevent-
ing inflammatory action after operation upon the penis, Dr. Otis
uses cold water, "by means of a small India-rubber tube arranged
42
STRICTURE.
so as to encircle the penis, and through which water of any
desired temperature is carried by syphonic action." In none of
the 100 cases reported by him, has subsequent dilatation been
attempted or required, to effect a cure after the healing of the
wound made during the operation. The use of sounds subsequent
to the operations, is simply to separate the cut surfaces, and not
for the purposes of dilatation, and their use is discontinued so
soon as a full-sized bulb can be passed through and beyond the
previous site of stricture, and withdrawn without a trace of blood
accompanying or following the use of the instrument. "Recon-
traction of stricture after operation is simply due to the incom-
plete division; and this will, as a rule, be detected within one
week, or at most, two weeks, by which time stricture tissue dis-
tended, not divided, will sufficiently recontract to become readily
recognized by the full-sized bulb. If, then, no stricture can
be recognized, the cure of the difficulty may be considered com-
plete, and no further treatment will be required." The urethro-
tome of Dr. Otis, is one of the latest and very best instruments
devised for that purpose. It is made to cut from before back-
ward ; and, in my hands, it has equaled its fullest commendation.
Nevertheless, I hold it as a rule, that every stricture can be cured
by dilatation, that permits the passage of the smallest filiform
bougie through it.
All organic strictures of large and small caliber, are to be
treated at first by dilatation; should this fail, other means will
be required. In organic stricture, a surgical operation is of
the first importance to consider; and the use of the bougie or
sound is the first step to be taken, commencing with an instru-
ment as large as the stricture will admit, that will pass the con-
tracted part, and gradually increasing the different sizes till the
urethra has been restored to its normal caliber. Having oiled
the bougie thoroughly after warming it, introduce it carefully
into the urethra, and pass it gently along till it engages the
stricture; then press it onward cautiously, turning it in various
directions, corresponding with the sinuosities of the urethra,
till it passes the obstacle and enters the bladder. The
conical, nickel-plated steel sound, an instrument made on the
principle of the short curve, greatly facilitates introduction,
especially when the stricture is at or near the triangular liga-
ment, the point hugging closely the roof of the canal. The
instrument, acting upon the double principle of the wedge and
STRICTURE.
43
lever, possesses considerable power, and should be used cau-
tiously. My plan is to introduce as large a conical instrument
as will pass the stricture, and, after letting it remain for five
minutes or more, gradually withdraw it. The immediate effect
of this is an increase of pain, urging to urinate, and a muco-
purulent discharge, which subsides in a day or two, generally; if
it does not, a few doses of Sepia, Dig., Cann., or Clem., will soon
dissipate it. In four or five days all inflammatory action will
pass away, and the urethra will regain its previous condition.
In forty-eight or even twenty-four hours more, the same instru-
ment may be passed again, and be permitted to remain ten or
twelve minutes. The third time it may remain fifteen or twenty
minutes; and so on. Each time of instrumentation, the symp-
toms will be less aggravated ; and improvement will begin earlier,
and be more decided. It is not until the passage of the instru-
ment produces little or no perturbation in the urethra, that a
larger one may be used, in the same manner as the preceding;
and thus we shall continue until the constricted portion of the
canal is restored to its normal caliber. The great difficulty here-
tofore has been, that practitioners are too anxious to cure their
patients in the quickest time possible. Nothing is more injurious
to the patient, and more offends the delicate lining of the urethra,
than this rapid and forcible method of cure. It is on this very
account that we hear of so many failures to cure this disease,
and complications that follow in the track of this method of
rapid dilatation. The most satisfactory and effective treatment,
especially by large instruments, is that detailed above, which
should be continued till all symptoms of stricture have disap-
peared, and then gradually withdrawn, so that instrumentation
will be effected once a month only, for two or three treatments.
In this way, I have cured some of the most violent forms of
stricture, that have been pronounced incurable except by opera-
tion, and I have seen these cases remain well for years without
giving any evidences of urinary trouble. I am decidedly opposed
to the old and baneful method of retaining an instrument in the
urethra for days at a time, and only withdrawing it to cleanse
and re-introduce.
Resilient strictures of large caliber, which are recognized by a
gleety discharge and other accompanying symptoms of a nar-
rowing of the urethral canal, are not so readily cured by the
method of treatment just detailed. In these cases, it will be
44 STRICTURE.
observed, first, that the patient's general health antagonizes the
cure by local means alone, as is evidenced by the tendency to
catarrhal affections, and other disturbances of the mucous mem-
branes, that first demand active interference on the part of the
practitioner. Before treating the stricture, therefore, attention
must be given to the cure of the patient's general condition, and
especially to the hygiene of the sexual organs. Many of such
patients have been permanently cured by marriage, after all other
means, afforded by dilatation and incision, have failed; others
have been permanently benefited by change of climate, and such
general restoratives, including the continued wearing of a sup-
porter, when preceding treatment, mechanical and otherwise,
had effected little or no good. The continuance of this variety
of stricture seems to depend upon some systemic dyscrasia
which seizes the genital organs, probably on account of some
hereditary or acquired weakness at this point, and there expends
its disease-producing force: it is simply idle, therefore, to attempt
to cure this stricture until the constitutional cause has been
eradicated.
The really resilient strictures, that possess within themselves
that " tenacious cicatricial and retractile " power to withstand
advantageous dilatation, in which the symptoms yield but do not
entirely disappear, are the most obstinate of all strictures to cure.
If this stricture is situated under the pubic arch, it should be
treated by gradual and continuous dilatation, or that method
with which I have accomplished some of the most gratifying
results; viz: electrolysis. If dilatation is employed it should
be carried gently and persistently to the greatest limit of dis-
tention ; then, by the use of one or more of the remedies recom-
mended for urinary troubles, for a long time persevered in, the
best and most satisfactory results will be produced. If, on the
contrary, this kind of stricture is situated without the pubic arch,
internal urethrotomy, thoroughly done, is not only a safe pro-
cedure, but it affords the best chance of success, not only in
ridding the patient of all unpleasant symptoms connected with
his disorder, but also of the necessity of employing further
mechanical dilatation.
Organic strictures within the pubic arch, after dilatation to
the extreme limit, will not always remain cured, "voept by the
occasional use of instrumentation, from time to time, ..s circum-
STRICTURE.
45
stances demand; but, when we consider the danger that attends
internal urethrotomy in such cases, it is far better to maintain
the caliber of the canal by the occasional passage of a full-sized
bougie during the rest of the patient's life, than to accept the risk
that attends its internal division by any known method.
External Urethrotomy.—External urethrotomy may be justi-
fied only in exceedingly obstinate cases, in traumatism, or in
impassable strictures. Syme's method, or rather modification of
external incision, is the only safe and sure means of performing
this operation from without. The patient is placed in the lithot-
omy position, a grooved director (after dilatation of the stricture)
is passed through the stricture, the left forefinger as a guide
introduced into the rectum, and a straight bistoury, its back to
the rectum, is plunged into the median line of the perinaeum,
behind the stricture, and into the groove of the director, when the
bistoury is made to divide the stricture from behind forward.
Another method, which I hold to be preferable to this, is to shave
the perinaeum, introduce a capillary whalebone bougie (probe
pointed) carefully into the bladder, pass along this a grooved
metallic staff, engaging the free end of the guide, an assistant
holding the staff and guide. The surgeon, after an examination
per rectum, incises freely the skin and superficial fascia of the
perinaeum, along the median line, from the base of the scrotum to
within half an inch of the anus. Dissect inward, till the urethra
is seen, and divide it, the knife falling into the groove of the
catheter. The edges of the urethral incision are kept open by
loops of silk. After withdrawing the guide, the stricture and a
corresponding portion of the urethra are divided by a modified
canalicular knife. The catheter is now introduced into the blad-
der. I have performed this latter operation three times success-
fully; yet I regard it as a principle which should guide every
surgeon, that, while a director or curved grooved staff can be
made to pass the stricture, external urethrotomy is never justifi-
able : internal urethrotomy produces the best results. A catheter
may be retained in the bladder by placing a ring around the penis,
which is secured to the body, and attaching two pieces of narrow
tape from the rings of the catheter to the ring around the penis.
Another simple contrivance is to pass around the catheter a piece
of thin gauze or linen, and make it encircle the penis; then put
around all an India-rubber ring. A catheter may be retained in
the female bladder by a T-bandage, and two narrow pieces of
46 RETENTION OF URINE.
tape attached to the two tails of the vertical portion of the
roller.*
Electrolysis. — This is the best, most satisfactory, and most
rational means of treating stricture, under any form or method.
The modus operandi is as follows: " Introduce into the urethra
an electrode, soaped, not oiled, one size larger than the stricture
will admit (insulated to the tip), down to the stricture; attach to
the negative pole of the battery; complete circuit by the broad
sponge rheophore, moistened with salt and water, placed in the
hand of the patient or upon some part of his body. As soon as
the patient feels the current, the intensity is sufficient, and should
not be increased beyond this point. Be careful to avoid all pro-
duction of pain, keeping the electrode pressed in contact with the
stricture, but not forced; in a few minutes we find the electrode
slipping through the stricture easily. If a second stricture is
found, treat it in the same way. Repeat this operation every few
days, till the stricture is cured. A current from six to twelve cells
of Mcintosh's elements! is all that is needed. Great stress is
laid upon the introduction of the ncgath-c electrode ; as the positive
produces an eschar which heals by cicatrization, and, instead of
curing a stricture, will increase it. I have seen this method tried
with most brilliant results in several cases. For subsequent
internal treatment of the urinary and other troubles that arise
during the local treatment recommended in this disease, see
remedies presented under the heading of "Special Indications," at
the end of this chapter.
III.— Retention of Urine.
Retention of urine must not be confounded with suppression,
wherein no urine is secreted; but it is an inability to void the con-
tents of the bladder. There are two varieties: the first, from a
want of power in the bladder to perform the act; and the second,
from an obstruction to the passage of urine. The first is due to
some lesion of the spinal cord, followed by paralysis. The urine
* See section on "Bandaging," pp. 52-95.Franklin's "Minor Surgery."
f Mcintosh Galvano-Faradic batteries are by far the best instruments for
performing electrolj-sis that I have ever used. I have been so many times
disappointed in the use of other instruments, that I have at times abandoned
the idea of this brilliant and successful method of cure. Since my attention
has been called to the Mcintosh instrument, I have made two remarkable
cures of this terrible disease, and I cannot too highly recommend its use.
EXTRAVASATION OF URINE. 47
collects in the bladder, is forced out, and dribbles away by the
urethra.
Symptoms.—Retention from obstruction ; has an urgent desire
to pass water, with inability; straining; pain, with great anxiety
and distress; the bladder rises above the pubes, forming an elastic,
fluctuating tumor, dull on percussion; if retention is not removed,
the ureters become involved, the kidneys are affected with pyelitis,
suppression, followed by coma and death. It frequently happens
that the urethra yields behind the point of obstruction, and
extravasation of urine results.
Treatment.—When retention results from stricture, or en-
largement of prostate, the cause must be removed if possible, by
catheterization; if this cannot be effected, try warm baths, Bella-
donna enemas, Chloroform,anaesthesia, Electro-Magnetism; con-
joined with one of the remedies recommended under the head of
Fig. 6.
"Special Indications," at the end of this chapter. If all means
fail, recourse must be had to puncture by trocar and canula,
through the rectum behind the prostate, or above the pubes (Fig.
6), or by aspiration: the latter is by far the safest and freest
from danger. After relief, attention must be given to removal of
the cause.
IV. — Extravasation of Urine.
Extravasation of urine may proceed from the bladder or ure-
thra, by ulceration, from surgical operation, by direct violence,
by stricture, or by traumatism.
48
URINARY ABSCESS.
Symptoms.—Patient is conscious that something has given
away, perhaps while straining; the rupture is in front of the tri-
angular ligament; relief is afforded; soon the scrotum and lower
abdomen become infiltrated with urine; the skin is stretched,
crepitates, feels doughy, and, if not met with free incisions,
sloughs and becomes gangrenous; inflammatory symptoms of an
asthenic type follow; the tongue is brown; great prostration
ensues, with a tendency to delirium. If extravasation is from
injury, the rupture occurs in the urethra, perhaps in the bladder,
the latter being most certainly fatal.
Treatment. —Free incisions, to give vent to the imprisoned
urine, and the case treated as in gangrene.
V.—Urinary Abscess.
Urinary abscess is a frequent result of stricture, and follows
ulceration of the urethra, terminating in abscess in the perinaeum,
taking its origin from the bulb or membranous portion of the
urethra.
Symptoms.—It begins as a small, hard, circumscribed, and
painful tumor in the perinaeum, and increases steadily; produces
some constitutional trouble, with weight and throbbing in the
perinaeum, heaviness in the loins, uneasy sensation at neck of
the bladder, with shivering, nausea, and febrile manifestations;
suppuration results, the pus is discharged naturally or arti-
ficially, and there remains a fistula through which urine continu-
ally escapes.
VI. —Urinary Fistula.
Urinary fistula forms most frequently in the perinaeum, as a
consequence of stricture or urinary abscess, as above stated.
They are sometimes met with in the groin, inside of the thigh,
and in the scrotum; they are usually single in the scrotum and
penile portions of the urethra, but are numerous in the perinaeum;
they differ in size and tortuosity; the scrotum and penis become
enlarged, indurated, and almost cartilaginous in structure; the
urine oftentimes is entirely voided through these openings. Fis-
tulas may likewise arise from injuries or falls, by which the
urethra is ruptured; the urine is then extravasated into the loose
cellular tissues of the perinaeum and scrotum, where it occasions
much inflammation and distention of the textures, merging, per-
PROSTATITIS.
49
haps, into gangrene and sphacelus, and becoming a disease of the
most serious import. It sometimes lays bare the urethra and
testicles; at others, it dissects its way in different directions, pro-
ducing one or more fistulas, and endangering the patient's life.
A very interesting case of this kind was presented at my clinic at
one time, U., of M., where there were two fistulas, the one termi-
nating in the rectum, the other above the pubes, and about midway
between the symphysis and the anterior superior spinous process
of the ilium. I operated upon this case after the rectal opening
was occluded, by making Syme's external urethrotomy, opening
into the urethra at the point of rupture, and introducing a seton
into the pubic fistula, downward to the urethra, and emerging it
at the perineal opening. Within three days I had the satisfac-
tion of seeing all the urine pass through the new orifice along-
side of the seton. I gave directions to have a strand or two of
the seton removed every day or two after the stream was well
established through the perineal opening, with the intention of
closing and healing up the pubic fistula, and transferring it to
the perinaeum; and the boy returned home under the care of his
physician, with the intention of returning to have the case com-
pleted. By some inadvertence, the seton came out; and, as a
consequence, the perineal opening closed, and the urine again
escaped through the pubic aperture. The case fell into the hands
of another surgeon; several unsuccessful operations were made.
The patient grew rapidly worse, and was sent home in a more
serious condition than when he left me. Since then, I have no
knowledge of the case.
Treatment.—The first thing is to dilate the urethra, and
establish the natural channel for the urine. The next, to cure
the fistulae; this may be done by free incisions to the bottom of
the fistulae, and dressings applied so a3 to heal them from the
bottom to the surface; it is often effected by constitutional and
local remedies. The remedies of most service are: Ars., Berb.,
Cede, Carb. an., Phos., Puis., Sil., and Sulph.; in small fistulae,
Cantharides in tincture injected into the sinus; incisions and
Galvanism, and a urethro-plastic operation may be required.
VII.—Prostatitis.
The acute form is produced by gonorrhoea, injuries, irritation
of the genitals or rectum, and exposure to cold or wet.
50
SENILE HYPERTROPHY OF THE PROSTATE.
Acute Symptoms are pain; heat in perinaeum; tenderness on
deep pressure; frequent micturition, and with difficulty; painful
evacuation of the bowels; rectal exploration denotes enlargement
of the gland, and tenderness to touch; fever and thirst accom-
pany; terminates in resolution, suppuration, or abscess.
Chronic prostatitis is common to old age, and comes on insidi-
ously. There are weight and fullness in the perinaeum, extending
to the anus; pain with diminished power in voiding urine; urine
cloudy; gleety discharge; pain in coitus and defecation, and
sometimes spermatorrhoea, and cystic irritation; muscular fiber
hypertrophied. Sometimes the whole gland is enlarged; at others,
one lateral lobe; occasionally, the middle lobe, between the "ejac-
ulatory ducts," is involved. This alters the course and dimen-
sions of the urethra. It will be twisted when one lateral lobe is
enlarged; flattened and compressed, when the posterior middle lobe
is hypertrophied. As a consequence, the urine is passed slowly
and with great pressure; incontinence, discomfort, and urinary
tenesmus follow.
Treatment.—Aeon., Bell., Hepar, Puis., Merc, Thuja, for
the acute; and Agnus, Alum., Bar. jod., Calc. jod., Con., Dig.,
Caust., Lye, Kali hyd., Iod., Hepar, Senecio, Sepia, Sil., Puis.,
Thuja, and Sulph., for the chronic. Long continuance of the
appropriate remedy is required. In the surgical treatment, use
the long shaft and large curve, or ordinary sound. The verte-
brated bougie is highly recommended in aggravated cases.
VIII. —Senile Hypertrophy of the Prostate.
This affection, peculiar to old age, consists of an hypertrophy
or enlargement of the natural muscular structure, and incidentally
of the glandular. The increase may be but slightly above the
normal size, that of a chestnut, to the bulk of a man's fist, or
even larger. If it affects the whole organ uniformly, the prostatic
portion of the urethra will be lengthened; if one side is involved
more than the other, the canal will be twisted; if it affects the
posterior median portion, the part which lies between the ejacula-
tory ducts, enlargement of what is called the middle or third lobe
takes place, when the prostatic portion of the urethra is either
very much narrowed, twisted, or obstructed, or it is extended
into a sort of pouch, which eventually contains calcareous forma-
tion, thereby adding to the sufferings of the patient. Fibrous
SPECIAL INDICATIONS.
51
tumors also are developed within the organ, involving more or
less granular tissue, adding to the constitutional trouble.
The symptoms which are developed are slowness and difficulty
in making water, weight in the perinaeum, and tenesmus. The
bladder becomes irritable, with frequent urination. The projec-
tion formed by the tumor prevents all the urine from being
voided, a portion remains behind, decomposes, and becomes am-
moniacal. Sometimes there is complete retention, with its
attendant troubles; at others, the mucous coat of the bladder,
irritated by the alkaline urine, inflames, and secretes a viscid
mucus; and finally the kidneys become disorganized, the ureters
dilate, and the urine continually dribbles away, and the patient
dies exhausted. During the manifestation of these phenomena,
the constitutional symptoms become more and more marked,
fever, sweats, painful micturition, sleeplessness, and constant
urinary irritation wear away the life of the sufferer. Physical
examination per rectum will reveal the nature of the trouble.
Treatment.— The urine, if possible, must all be removed from
the bladder several times a day by a prostatic catheter. Squires'
vertebrated catheter is highly recommended for this purpose.
The medical treatment consists in the use of one of the follow-
ing remedies, according to indications: Agnus cast., Apis, Alum.,
Cyclamen, Copaiba, Dig., Caust., Hepar, Lye, Puis., Secale,
Selenium, and Sidph. acid. The Iodide of Potash, Iodine, Pids.,
Calc. carb., Sil., Thuja, and Sulph. exercise a curative control if
given early. (See "Special Indications," below.)
Special Indications.
Aconite.—With great urging to urinate; great pain in micturition, or in
milder cases when there is great pain in walking, especially going down
stairs.
Aloes. — Sensation as if a plug was wedged between the symphysis and
coccyx, pressing downward ; incontinence of urine from enlarged prostate.
Apis Mel. —Excessive pain in vesical region ; frequent desire to urinate;
pressing down in the region of the sphincter; the calls to urinate are both
day and night; severe pain in passing urine, as if some impediment prevented.
Causticum. — Pulsations in the perinaeum ; pain in urethra and bladder
after a few drops have passed ; spasms in the rectum, with renewed desire
for micturition.
Chimaphila. —Sensation of swelling in perinaeum when sitting down,
sensation as if a ball was pressing against the perinaeum; excessive itching
and painful irritation of urethra from the end of the penis to neck of the
bladder; prostatic disease, with waste of prostatic fluid; urine thick and ropy.
52
SPECIAL INDICATIONS.
Conium. —Discharge of prostatic fluid on every change of emotion, with
voluptuous thoughts, and itching of prepuce.
Copaiva. —Urine is emitted by drops ; burning and sensation of dryness-
in the region of the prostate gland ; induration of the prostate.
Cyclamen. —Drawing, pressing pain in the perinaeum, and in and near
the anus, as if a small spot was undergoing ulceration ; increased when walk-
ing or sitting.
Digitalis. — Fruitless efforts to urinate, or discharge of only a few drops
of urine, and continued fullness after micturition ; throbbing pain in region
of neck of the bladder during straining effort to pass water; increased
desire to urinate after a few drops have passed, causing the patient to walk
about in great distress, although motion increased the desire to urinate;
frequent desire to defecate at the same time ; very small soft stools passed
without relief.
Hepar. —Discharge of prostatic fluid after micturition and during hard
stool; also independent of either.
lodium. — Swelling and induration of the testicles and of the prostate
gland ; incontinence of urine in the aged.
Kali Bichrom.—Stitches in prostate when walking; must stand still;
prostatic fluid escapes at stool; painful drawing from perinaeum into urethra;
after micturition, burning in back part of urethra as if one drop had remained
behind, with unsuccessful efforts to void it; stitches in urethra.
Lycopodium. —Pressing on perinaeum near anus during and after mictu-
rition ; stitches in neck of bladder and anus at the same time; urging to
urinate ; must wait long before it passes ; incontinence of urine.
Oleum Sandal. — With sensation of pain and uneasiness deep in peri-
naeum; desire to change position constantly to get relief ; stream small, and
passed with hesitation; sensation of a ball pressing against the urethra;
pain decreased when walking; .increased when standing some time ; heavi-
ness in the feet in the morning when first rising from bed ; sexual power*
weak ; erections feeble ; urine red and scanty. (Clinical.)
Populus. — Enlarged prostate ; painful micturition ; catarrh of bladder.
Psorinum.—Discharge of prostatic fluid before urinating; frequent
scanty urine, burning and cutting in urethra.
Pulsatilla.—Painfulness in the region of bladder; frequent desire to
urinate, dull stitch in the region of the bladder ; spasmodic pains in neck of
the bladder, extending to pelvis and thighs; faeces flat, of small size from
enlarged prostate.
Selenium.—Prostatic juice oozes while sitting, during sleep, when
walking, and at stool, causing a disagreeable sensation ; the same sensation
is felt shortly before and after stool.
Staphysagria. —Frequent and copious urination; burning in the whole
length of the urethra, when urinating, for many days ; frequent urging,
with scanty discharge of a thin stream of red-looking urine ; urging as if the
bladder was not emptied; discharge of dark urine by drops.
GONORRHOEAL OPHTHALMIA. 53
Thuja.-Syphilis and sycosis, especially suppressed or badly treated
gWi Stltches m urethra fr<>m behind, also from rectum into the
Remedies Indicated for Special Symptoms.-Escape of urine involun.
tanly drop by drop : Am., Bell., Mur. ac., Dig., Petr., Puis., and Sepia.
Difficulty in voiding urine; must press a long time before it flows-
Alum., Apis., Hepar, Nuph., Sec, and Tax.
The stream of urine is small: Graph., Olean., Sars., Spong., Staoh
Sulph., Tax., and Zinc. y '
Burning in the neck of the bladder while urinating: Cham., Nux Petr
and Sulph. '' '*
After micturition, desire continues : Bar carb., Bov., Calc. carb Caust
Dig., Merc, Ruta, Staph., and Zinc. ' '*
Impossibility to uiinate : Dig., Sepia.
Continued desire to urinate : Amm. carb., Apis., Bell., Canth. Copaib
Dig., Iod., Merc, Mur. ac, Phos , Puis., Sep., Scilla, Sulph.,-Jmd Thuja *'
Pupation in perinaeum : Caust. Heaviness in the perinaeum : Copaib.
and Graph. In favorable cases, prostatitis ends in resolution. Badly
managed cases suppurate, and abscesses extend and perforate into the
rectum, urethra, or bladder, and discharge; other cases assume a chronic
form, and by exudation, infiltration, and deposition of tubercles and cysts,
produce a permanent enlargement.
SECTION VII.
Gonorrhoeal Ophthalmia.
Gonorrhoeal ophthalmia, or ophthalmia gonorrhoica, is an acute
specific inflammation of the conjunctiva of the eyeball and lids,
and characterized by a profuse discharge of yellow purulent mat-
ter, similar to that which issues from the urethra in gonorrhoea.
This disease is the most violent, rapid, and destructive to
which the eye is subject. Frequently, when the patient applies
for relief, the eye is irreparably injured; and, unless the course of
the disease be promptly arrested, the eye will be lost.
In this form of ophthalmia, as also in the purulent or con-
tagious variety, there is great danger that the conjunctiva will
swell extremely and overlap the margin of the cornea, and lead
to its sloughing, apparently by strangulation of the vessels by
which it is nourished. When this condition occurs, it is called
Chemosis.
Cause. — The disease arises from the accidental contact of
gonorrhosal matter with the eye, and not, as some have supposed,
54
GONORRHEAL OPHTHALMIA.
from a metastasis of the disease from the organs of generation to
the eyes. In this way, the matter may be accidentally applied
to the eye of a healthy person through the medium of cloths,
towels, etc. Even children are sometimes thus contaminated.
The disease presents symptoms similar to those of purulent oph-
thalmia, and to that disease affecting infants.
The disease is usually confined to one eye; if the other be dis-
eased, it is because there has not been sufficient care to prevent
inoculation.
Treatment.—Use Aeon., Arg. nit., Merc, Bell., Sulph. Addi-
tional remedies are, Sulph., Sil, Puis., Lye, Aur., Rhus, Spig.,
Tussilago pet., Thuja, Macrotin, and Euphorbin. (See, also,
"Leading Indications for Ophthalmic Medicines," below.)
Leading Indications for Some Ophthalmic Medicines.
Belladonna. —Pain, redness, and swelling ; throbbing pain in the temples
or eyes ; flushed cheeks, glistening eyes, and great intolerance of light. One
or more.drops of the remedy may be mixed with half a dozen tablespoonfuls
of water, and a teaspoonful given during the acute stage every hour, and
afterward every three to six hours. Belladonna is often required when there
are general feverish symptoms; or, a few doses of Aconite may precede
Belladonna.
Aconite. — Ophthalmia, with quick pulse, dry skin, thirst, and when
arising from cold. The early administration of this remedy, with the local
use of compresses, will generally promptly relieve and cure catarrhal oph-
thalmia. For gonorrhoeal ophthalmia, Dr. Angel recommends it every hour,
with the topical application of ice, or iced water, and Aconite during the
first stage.
Mercurius Sol. — Ophthalmia marked at first by a copious discharge of
watery fluid, which afterward changes to mucus and pus; agglutination of
the lids; smarting heat and pressure, with aggravation of the pains when
moving or touching the eyes. There is considerable itching and irritation,
but not much fever present.
Mercurius Cor. —In the most violent forms of acute ophthalmia, with
extreme dread of light, or in chemosis, the 1st or 2d dec. att. of this remedy
will often cut short the attack.
Euphrasia. — Catarrhal ophthalmia, with profuse secretion of tears, sen-
sitiveness to light, stinging as from sand, and catarrhal inflammation of the
frontal sinuses and of the lining of the nose. In simple catarrhal inflamma-
tion, profuse lachrymation being the chief symptom, it often cures with-
out the aid of any other remedy. In severe cases it may be applied locally.
Argentum Nit. — This remedy is especially valuable in the purulent oph-
thalmia of children, which it cures rapidly and completely, without the local
use of the nitrate. It is also valuable in chronic ophthalmia. Dr. Dudgeon
highly recommends it as homoeopathic to gonorrhoeal ophthalmia; two to
GONORRHEAL OPHTHALMIA.
55
four grains to an ounce of distilled water; a small quantity of the solution to
be introduced under the eyelids with a camel's-hair brush once a day, or
every two, three, or four days, according to the symptoms.
Phytolacca Decandra.— Itching in the eyes, aggravated by gaslight;
chronic conjunctivitis, and rheumatic pains ; reddish-blue swelling of the lids.
Arsenicum.— Obstinate ophthalmia in weak, nervous patients, particu-
larly if the secretion be acrid, with burning, tearing, or stinging pains in the
globe and lids, aggravated by light; paroxysms of pain ; violent stabbings
in the eye; eyeball feels like a globe of fire.
Phosphorus. — Chronic and obstinate cases which have resisted the usual
remedies, with sensitiveness to light, heat and itching of the eyes, sudden
attacks of blindness, black spots floating before the eyes, and secretion of
viscid mucus.
Nitric Acid. — Purulent ophthalmia ; swelling and redness of the mucous
membrane and lids ; secretion of viscid mucus or pus; burning and smarting
in the eyes ; photophobia; nightly agglutination; and pains in the bones and
parts around the eyes. Nitric'acid is required in cases originating in
Byphilis, or aggravated by Mercurial preparations.
Gelseuiium. — Squinting ; desire for light; orbital neuralgia.
Pulsatilla Nut.—Eyelids agglutinated; increased secretion of tears;
neuralgic pains in the eyeballs.
Hepar Sulph. — Similar cases to Nitric acid, which it may follow, if
necessary.
Arnica. — Inflammation affecting either the mucous membrane or the
deeper structures of the eye, from mechanical injuries. In addition to its
administration, the eye should be bathed with a lotion of Arnica (twelve
drops to four tablespoonfuls of water). After well bathing the eyes, a piece
of lint or linen should be saturated with the lotion, applied to the eye, cov-
ered with oiled silk, and secured by a handkerchief.
Accessory Measures.—Assiduous bathing, fomentations, hot
medicated water compresses, etc.; astringent collyria, and some-
times surgical measures, are employed. In the treatment of the
various forms of ophthalmia, with weak and imperfect vision gen-
erally, the causes of the disease should be correctly ascertained,
bo that they may, as far as possible, be guarded against or
removed. Patients in crowded and unhealthy towns should
resort to the country, at least for a time, where they may take
daily out-of-door exercise, and enjoy a pure, bracing air. Fre-
quent careful tepid washing of the eyes to prevent accumulations
of matter; the occupation of a spacious, well-ventilated apart-
ment ; and avoidance of all causes likely to keep up the inflam-
matory process, are necessary precautions. The food should
be* plain and nourishing, coffee and fermented drinks being
excluded; the habits early and regular; and frequent bathing
56
GONORRHEAL RHEUMATISM.
Bhould be practiced. A small wet compress, covered with oil-skin
or India-rubber, worn over the nape of the neck, is a valuable
counter-irritant when the more violent inflammatory symptoms
have been subdued; it is also useful in obstinate cases. The
alum curd poultices I have used with good results.
SECTION VIII.
Gonorrhoeal Rheumatism.
Gonorrhoeal rheumatism differs from ordinary rheumatism
in that it follows one or more attacks of gonorrhoea. It has pain,
swelling, weakness, and rigidity of the larger joints and overlying
muscles. The knee-joint is most frequently attacked; motion
increases pain; the affected parts are inclined to become cold,
are sensitive to damp and changeable weather; fever and pain
are not so marked as in ordinary arthritis; generally occurs
toward the decline of gonorrhoea. Attacks in preference young
people of a delicate, strumous habit.
Treatment.—The remedies are: Aeon, or Gels, in the first
stage; subsequently, Bry., Clem., Kali jod., Kalm ; aggravated
by motion, Mezer., Sarsap., Sulph., Thuja, Cimicif., Euphorb.,
Rhus, Sep., Stram., Verat., and Phytol. The hot springs of
Arkansas are highly beneficial.
Special Indications.
Aconite.—During febrile disturbances ; when the large joints are affected,
with little rigidity; when the heart is attacked, with congestion and a sense of
anguish ; in rheumatism of the shoulders.
Bryonia. — When the lower limbs are affected ; severe pains in the joint;
heat and dryness of the parts ; severe pains shooting down the limbs ; shin-
ing, red swellings ; greatly increased by motion.
Arnica. — Stiffness in the large joints ; tearing pain in the smaller joints,
with a tearing, bruised sensation.
Causticum. —In rheumatic swellings and stiffness of joints; enlarged
joints with tophi; contraction of tendons ; shooting and tearing pains,
especially in chronic cases and scrofulous patients.
Cimicifuga. —Local forms of rheumatism, with muscular implication;
heart affections ; wandering pains.
Rhus Tox.—When sheaths of tendons and muscles are most affected j
tightening, lameness, tearing, bruised, and sprain-like pains in the larger
joints ; aggravated at night by the warmth of the bed, or when beginning~to
GONORRHEA IN WOMEN.
57
move after rest; lessened by gentic and continued motion ; chronic thicken-
ing of joints ; affection of periosteum.
Rhododendron. — Pains worse during rect, in the warmth of the bed, and
with every unfavorable change of the weather, especially when easterly
winds prevail; swelling and redness of both Large and small joints ; tension
and riridity.
Pulsatilla. — When ankle, instep, or knee is affected; fugitive pains in
various parts of the body; pains moving from one point to another, espe-
cially in females with menstrual irregularities.
Mercurius. — Puffy swelling of joints; pains deep-seated in the bones or
joints, increased by warmth and at night; profuse perspiration, which does
not give relief.
Phytolacca.—Chronic cases, with swelling and stiffness of joints, even
to loss of motion in the limb; when periosteum is implicated. (Consult
Guaiacum and Mczcrcum )
Sulphur.—After remedies when improvement halts; to complete the
cure begun by another remedy ; hereditary taint, or when associated with
eruptive disorders.
Ledum. —Rheumatism of small joints, fingers and toes ; chilliness.
Dulcamara.—Rheumatism from exposure to wet, changes of the weather
from dry to damp increases pains ; relieved by rest.
Colch., Coloe, Bell, Kali bichrom., Ranunc bulb., Many., may
be advantageously employed as accessories.
Eheumatic patients should always wear flannel and warm
clothing to guard against atmospheric changes. Protect the feet
from cold and damp. Occasionally warm salt-water, vapor or
hot-air baths, are very useful. Diet should be easy of digestion,
and all condiments be avoided.
fECTION IX.
Gonorrhoea in Women.
Gonorrhoea in women is a much less formidable disease than
in men, arising from the fact that the parts inflamed are com-
paratively less sensitive, more expanded, and structurally more
simple.
The symptoms are much less acute than in males, and it is
much more apt to degenerate into a chronic gleet. Complica-
tions are bubo, and ulceration of the neck of the womb. The
discharge may proceed from either the external parts; the labia,
nympha3, meatus urinarius, vagina, or from the cervix uteri.
58
GONORRHEA IN WOMEN.
When it involves the cervix, it will be associated with superficial
ulceration. Differentiate carefully between it and leucorrhoea,
and the various discharges that follow simple derangement of
the uterus and urethra. Verminous affections produce purulent
discharges of the vulva in young girls. The presence of ure-
thritis, accompanied with acute inflammation, is the strongest
symptom of gonorrhoea. There is frequent desire to pass water.
The speculum should be employed in all doubtful cases.
It occurs under four forms, gonorrhoeal vulvitis, urethritis,
vaginitis, and uteritis.
Symptoms.—There is urgent desire to pass water; heat;
burning, swelling, and discharge, muco-purulent and offensive;
attended with swelling and irritation of the clitoris; the mucous
membrane is reddened and tumefied, with high inflammatory
action.
G. Vulvitis.—This form attacks the external organs of
generation; the symptoms are heat and pruritus; the mucous
membrane is of a deeper red than usual, moist and slightly
swollen; and it is followed by scalding on urinating, bearing-
down pains, and a feeling of weight in the external genitals.
The discharge at first is albuminous; assumes soon a purulent
character; irritating and offensive, which occasionally gives
rise to nymphomania, a most distressing complication. Small
abscesses sometimes form in the vicinity of the vulvo-vaginal
glands.
G. Urethritis. — This is rarely met with in the female as a
distinct affection; it is associated with vulvitis. It is indicated
by a burning urethral pain, intensified during micturition; the
discharge is slight; lips of the meatus, red, swollen, and painful.
The finger introduced per vaginam, detects a thickening of the
urethra; upon pressure against the pubic arch, it feels like whip-
cord; abscesses sometimes form in the vagina and perinaeum,
and the glands of the groin enlarge and suppurate.
G. Vaginitis.—This is the most frequent seat of the disease,
the membrane looks red, is hot, and devoid of moisture; itching,
smarting pain exists, with frequent micturition; the vagina feels
hot and puffy, and soon there exudes a large quantity of yellow,
or greenish, muco-purulent matter. In a few days the discharge
diminishes, and the disease becomes chronic and difficult to cure.
GONORRHOEAL UTERITIS.
59
The anterior half of the vagina, immediately under the arch of
the pubis, is the part most affected, which presents an aphthous
appearance when examined with the speculum.
G. Uteritis.— Vaginitis extends sometimes to the internal
surface of the uterus, when it becomes a severe disease, and
difficult to manage. The ovaries may become implicated, the
general health undermined, and the reproductive processes inter-
fered with. The os becomes excoriated, the uterus congested,
and there exudes from it a gleety, whitish matter, offensive, and
at times quite abundant. The diagnosis between it and leucor-
rhcea can only be made in some cases by inoculation.
Treatment.—For vulvitis, Aeon, and Merc, in the acute
stage; Thuja and Sulph., in its chronic form. For vaginitis,
Aeon., Bell, Merc, and Puis., in the acute form; Sepia and
Creosote, in sub-acute varieties. For urethritis, Aeon., Cann.,
and Canth., in the active stage; and Copaib., Petros., Cubeba,
and Sulph., in the chronic. For uteritis, Aeon., Canth., Nit.
acid, and Mere, for the acute type; Sepia, Plat., and Alum.,
for the sub-acute. Great cleanliness, warm fomentations, and
medicated lavements of Alum., Hyd., Tannic acid, and Borax,
will be found very serviceable during treatment.
The treatment is the same as that recommended for the male*
Frequent ablutions and injections should be employed. The
vagina should be well distended with the injection. This is
an important auxiliary in the treatment, and should be insisted
upon. The fountain syringe and the vaginal douche is one of
the best instruments for the purposes of injection. Hip baths
are valuable auxiliaries. The temperature should be regulated
according to the feelings of the patient. Hygienic measures
should be rigidly enforced, and sexual congress prohibited for at
least ten days after all evidence of the disease has passed away.
Best and absolute cleanliness are two of the essential
indications for the treatment of vaginal and urethral inflam-
mation in the female. Beside the injections recommended,
the parts should be constantly moistened with a lotion of Boracic
acid and a very weak per centage of Carbolic acid, or, what I have
employed with good effect, a mild solution of Hydrastis and Rose-
water. Cloths with either of these lotions should be constantly
applied to the external labia. An occasional sitz bath, of agree-
able temperature to the patient, will be found a grateful as well
€0
VAGINAL INJECTIONS.
as a curative measure. Abscesses are prone to form in the vulvo-
vaginal glands without these precautions, and sometimes they
appear in spite of our best directed treatment. In such cases I
have used alum curd poultices applied as warm as they can be
borne and the inflamed portions covered. They should be applied
often and possess considerable density to effect the most good.
If pus forms it should be discharged, as recommended in my
work on the Science and Art of Surgery, by hyperdistension, etc.
Sometimes fistulas follow these abscesses and become very
troublesome; they should be treated either by stimulating injec-
tions, the slightly caustic tent, or by excision. The latter pro-
cedure is by far the most certain of success, and consists in
cutting into the fistula in correspondence with the long axis of the
labium and dissecting out the inflamed tissues and dressing the
wound with Hypericum or Calendula lotions.
Vaginal Injections.—To bathe the vagina properly in all
cases, the patient should lie on her back with the hips elevated
somewhat above the shoulders, the nates lying either upon a bed-
water-pan or a fold of Indiarubber cloth, in which a drain is made
to conduct the fluids into a vessel as they flow out from the vagina.
The temperature of the water to be used before the injection is
applied, should be as warm as the patient can bear, and the
vagina must be thoroughly and effectually cleansed from all im-
purities before the medicated injection is employed, which should
not be warmer than 96° Farenheit. This must be so employed
as to come into contact with every portion of the inflamed mucous
membrane, and the most effectual method to accomplish it is to
have the nozzle of the syringe, warmed and well oiled, carried
along the posterior vaginal wall until the bulb reaches the upper
portion of the cul-de-sac behind the posterior lip of the uterus;
the force applied should be gradual and not too hastily performed,
for in the posterior cul-de-sac will be found the accumulated
secretions in greater quantity than in other portions. In this
manner the injection employed will cleanse out the vagina from
within outward, and the vehicle used will carry with it all the
accumulated secretions in the canal.
The injections to be used are the same as recommended for
the male urethra.
As soon as the inflammation has subsided, which will be
recognized by the diminished and thinned discharge, examinations
CHANCROID.
61
by the speculum should be made to ascertain if any eroded spots
of congested membrane appear; if so, they should be touched
daily with a camel's hair pencil dipped into a strong solution of
Tannic or Boracic acid, or perhaps a weak solution of Nitrate
of Silver. The after dressings of tampons of absorbent cotton,
for the purpose of absorbing the discharges as they are thrown
off, will prove an excellent auxilliary to the local applications
above indicated. These tampons, or bullets, may be tied together
by a silk ligature, in form resembling the tail of a kite, and in-
troduced through the speculum. This method of application
materially assists the healing process within and permits the
bullets to be readily withdrawn. See Franklin's Minor Surgery,
apparatus of dressing, page 44.
A lingering, chronic urethritis, mentioned by some authors,
which gives no symptoms, yet emits a single drop of pus by
pressing the urethra from behind forward in the intervals
between urination, can be finally cured by the application of a
solution of Picric acid (one grain to three ounces of Rose water)
injected into the urethra in very small quantities and permitting
it to flow out by the natural contractility of the parts will be
found an exceedingly efficacious remedy. In very obstinate cases,
when resistance to all other treatment marks the stubbornness of
the disease, a prompt and sure cure will be found in quickly
passing through the urethra a pointed stick of solid Nitrate of
Silver once or twice at weekly intervals.
Chronic discharges from the cervix of the uterus or vagina,
the remnants of an old gonorrhoea or other deranged condition of
the vaginal mucous membrane, yield to the same persistent and
well applied means that are employed to cure other discharges of
the vagina that are not due to virulent causes.
CHAPTER II.
Chancroid.
Chancroid is the simple, soft, non-infecting sore, or local
contagious ulcer, unaccompanied by any prominent or perturb-
ing influences in the system. The recent developments of the
62
CHANCROID.
disease, and the present unsatisfactory condition in which its kin
disorder, chancre, is held by those who have abundant means
of observation, and the many theories propounded in reference
to its course and effects, are evidences of the still undetermined
nature of the disease, and the progress made toward a keener
realization of its true character.
Pathology.—The period of incubation is short, say from
twenty-four hours to the third day after infection. It begins as
an ulcer, which develops immediately after absorption of the
poison. Its shape is round or oval, and only becomes irregular
from the fusion of multiple pustules; the edges are clean cut,
perpendicular, often everted and undermined; it
is seldom single; is rarely present except on or
near the genitals; is of a yellowish color, with a
reddish areola around the sore; is auto-inoculable,
and is situated in the sulcus between the prepuce
and the glans, and at the sides of the fraenum.
(Fig. 7.) The germ of the chancroidal virus
having been deposited upon the exposed surface,
the work of local destruction begins at the moment
of its contact. The base of the ulcer is soft, and can be easily
compressed between the fingers. The discharge from the surface
contains pus globules, or degenerate leucocytes, mixed with the
debris of the tissues. The lymphatic glands in the groin soon
become involved, inflame, and generally suppurate; but the
system does not become infected. Therefore, no constitutional
symptoms occur. Uncomplicated chancroid soon gets well, and
the only result is a trifling local scar: malignant chancroid, on
the other hand, is attended by serious complications, but it never
produces syphilis. The damage it produces is purely local; by
its severity and extent, it may lead to distressing results, such as
phimosis, the complete closure of the meatus urinarius, an open-
ing into the urethra, or stricture of the rectum; but these conse-
quences are exceedingly rare.
The Bubo of Chancroid.—The term bubo is no longer
confined to enlargements of the inguinal glands, but is applied
to all swellings of lymphatics in any part of the body, when the
immediate cause is a recent venereal ulcer.
I shall divide bubo into four varieties; viz., the simple, the
indolent, the virulent, and the spontaneous. The three former are
CHANCROID.
63
of the venereal type: the latter may be produced by a strain,
cachexy, local injury, or indolent ulcer on the leg. Rarely the
sore spreads deeply and rapidly, and this only when Mercuriali-
zation has been produced, or when a peculiar constitutional
dyscrasia exists in connection with the chancroid.
About two-thirds of all chancroids remain purely local, the
other third is attended with bubo, which may be either inflam-
matory, and resolve itself, or indolent and suppurate. The term
bubo I shall apply to enlargement of any lymphatic gland in the
body, having for its immediate cause a recent venereal ulcer. It
is more common in men than in w^omen; and in strumous, lym-
phatic constitutions, rather than in those of a vigorous type.
The Simple Bubo.—In the simple bubo, as a rule, only one
gland is affected; it occurs early, within a week or two after the
chancroid is developed. It begins with a sensation of stiffness in
the groin, is sensitive to pressure, and painful from walking and
ascending stairs. The pain keeps pace with the increasing enlarge-
ment ; it becomes red and oedematous, and soon a central soft spot
appears, indicating suppuration; and, if left to itself, it opens and
discharges.
The Indolent Bubo. — The indolent bubo occurs in impaired
constitutions; it grows slowly, involves the neighboring lymphat-
ics, and all become matted together by inflammatory changes
into a compound tumor. Increasing in size, it presents a livid,
shining, dead hue, sometimes smooth, cedematous, and increases
to the size of an egg, occupying the folds of the groin. Its course
is variable: at times it becomes peri-glandular, when it opens
through the skin with one or more small perforations, which dis-
charge a small amount of sanious fluid, containing a few pus
corpuscles. The glands do not break down; but the discharge
may continue for months, and even years, if not attended to, leav-
ing rigid fistula? to discharge interminably.
The Virulent Bubo. — The virulent bubo is a subcutaneous
chancroid, and is a violent form of the indolent type, and, when
opened to the air, its true chancroid characters begin to appear.
The cut edge of the skin is immediately inoculated, and the whole
cut-border ulcerates, and the opening grows larger by being
eaten away by the advancing ulceration. The borders of the
ulcer become hard, livid, and undermined; the integument
adjoining the ulcer assumes a dusky, purplish hue, and sloughs
awav. The floor of the abscess is uneven, pultaceous, irregular,
64
CHANCROID.
worm-eaten, and discharges an ill-conditioned pus, inoculable
upon the sufferer. It has all the appearances of a true chan-
croid, and is subject to all the conditions and complications to
which a chancroid is liable. Phagedena may attack this kind
of bubo in either the sloughing or serpiginous form, the latter
of which is the most common. Its course usually is upward over
the abdomen, destroying the connective and cutaneous layers
down to the deep fascia, sweeping away everything except the
glands, leaving a raw, ulcerated spot in the groin and over the
abdomen as large as the hand.
The Spontaneous Bubo.—This is a simple lymphangioma, aris-
ing from a strain, fatigue, struma, cachexy, local injury, etc.,
and has no connection with either chancre or chancroid. Its
accidental position in the groin only gives it interest in a differen-
tial point of view from the general bubo of the chancroid ulcer.
Treatment.—Local treatment consists in touching the ulcer
in the early stage, or pustule when first discovered, with strong
Nitric acid, and in light dressings of Calend., Acid nit., or Hydras-
tis. The constitutional remedies are: Acid nit., Acid carbol,
Ars., Caust., Mere, Carbo veg., Cinnab., Kali hi., Lye, Phos. ae,
Sepia, Sil. If the inguinal glands become inflamed, they must
be treated the same as inflammation of glands under other cir-
cumstances, by hyper-clistention, etc. Whenever the system is
impaired by any cause, attention should be given to its reinvig-
oration and support. If any complications arise, such as
phagedena, or any of its varieties, which is rare nowadays, good
results may be obtained by the internal use of Arsenicum, Carbo
veg., Bromine, Kali chlor., Graphites, Nitric and Sidphuric acids,
Stillingia, Tartar emet.
Treatment of the Simple Bubo.—The simple bubo may fre-
quently be aborted by rest, antiphlogistic regimen, vesicants, or
irritants to the skin, such as a mild tincture of Iodine, poultice of
horseradish, local application of Chloroform, pressure applied to
the gland, the tincture of Aconite or Belladonna, applied to the
part several times a day with a camel's-hair brush. The two
latter I have found more efficacious than either of the preceding
remedies. Hot applications are much preferable to cold as an
abortive agent. Hepar sulph. or Mercurius, given internally, with
either the Aconite or Belladonna application, I have seldom been
disappointed with. If the bubo put on a decided inflammatory
CHANCROID.
65
type, Aconite is the better remedy; but, if the gland possess more
of a congestive character than inflammatory, Belladonna is my
favorite local agent for aborting the growth.
If, in spite of all our remedies, the bubo goes on to suppuration,
my plan is to evacuate the contents of the abscess with a fine
aspirator needle; and, after throwing into the cavity a syringe-
ful or two of equal parts of the tincture of Calendula and water,
withdraw the needle, and apply firm pressure over the gland.
When two or more glands were involved in the inflammatory
process, and the parts were highly inflamed, red, and painful,
I have used a poultice, applied as hot as the patient would permit,
of ground flaxseed, or elm bark, moistened with either Aconite
or Belladonna, according to the severity of the inflammation. As
soon as the slightest degree of pustulation is discovered, open
freely, and let out the discharges, and treat as before indicated.
In making an opening into the abscess, let the direction of the
bistoury be along the fold of the groin; if bleeding should be in
excess, touch the oozing surfaces with the liquid Persulphate of
Iron, and apply wet dressings of Calendula lotion, retained in
position by the crossed bandage of the thigh. Change frequently,
and see that the parts are kept perfectly clean. Cut off all the
hair in the vicinity of the inflamed gland, to avoid accumulating
filth, and treat as a simple abscess.
Treatment of the Indolent Bubo. —^-Tliis variety of bubo cannot
be aborted so readily as the simple kind; although I have suc-
ceeded in entirely cutting short the inflammatory process, by
saturating a pledget with Belladonna lotion, applying it to the
enlarged gland, and placing over it a strong, unyielding hernia
truss, keeping up the'p ssure externally; while Hepar sulph. or
Mercurius sol. is given internally, to counteract the formative
processes of suppuration. The dry sponge, applied firmly to the
part, and moistened with Belladonna lotion, has also proved
valuable in my hands. I have employed the strong tincture of
Iodine as a derivative, but with little success. The skin becomes
dark, cracks, and becomes sore; then little good can be accor
plished by the external use of Iodine. Keys endorses highly " tho
punctuate cauterization, applied with Paquelin's thermo-cautery.
The platinum point is first brought to a white heat, kept at that
point of temperature, and rapidly touched upon the skin over the
tumor, at twenty to fifty different points, according to the size of
the lump." The pain produced by its apphcation, and the moral
66
CHANCROID.
effect upon the patient, is enough, I think, to debar any extended
observations in this direction, when such gentle curative agencies
as those given above, are at hand. If the abscess is large, and
suppuration exists, it should be opened, its contents be evacuated,
and treated like an indolent abscess in other parts of the body.
The local applications above mentioned, with the internal admin-
istration of one or more of the following remedies, will be found
ordinarily sufficient for the cure of the worst cases : Arsenicum,
Mercurius cor., Cinnabar, Mercurius jod., Nitric acid, Kali jod.,
Kali bichrom., Graphites, Hepar sulph., Carbo veg., Lachesis,
Silicea, Sulphuric acid, and Thuja. They may be selected accord-
ing to the special indications given below.
Treatment of the Virulent Bubo. — The virulent bubo should be
treated differently from the preceding, from the fact of the threat-
ening suppuration, which advances with considerable rapidity.
Any erosion or abrasion of the skin will furnish fresh foci for
inoculation with the discharged pus. Hence prompt action should
be had, and the gland opened, by a long, free incision; the sooner
the better. It is advised, that the integument be divided from
without inward, and the suppuration be permitted to discharge
freely. In certain cases it is recommended, if the suppuration is
peri-glandular exclusively, to remove the gland at once unopened.
The cut edges will take on the ulcerative action, and a large, open,
virulent chancroid will be formed. Here cleanliness will accom-
plish much, and attention must be given to the administration of
such remedies, internally, as will antagonize the chancroidal virus,
promote the healing process, and establish the cure. The appli-
cations recommended in the indolent variety will accomplish
much here. The general detail of treatment will correspond with
that of ordinary chancroid.
Special Indications for the Three Varieties of Bubo.
Nitric Acid. — This may be used when Mercurius has been employed
without any benefit; when the ulcer is ragged, painful, and disposed to
spread. It is a formidable antagonist to chancroid, especially in strumous,
cachectic, or impaired constitutions ; raised edges; bleeds easily ; granula-
tions pale, flabby, prominent. It gives splendid results applied locally.
Arsenicum. — In indurated buboes with gangrenous edges; florid and
elevated granulations ; the margins bleeding at the slightest touch ; the dis-
charge thin and offensive ; the margins are jagged, sharp, undermined, and
livid; intense burning pains; gangrene threatened, with a livid or mottled
appearance of the sore, and the formation of a black slough; falling-off of
the hair and nails.
chancroid. 67
Kali Jodatum. — In scrofulous constitutions after Mercurius and Nitric
acid have been tried unsuccessfully ; the ulcer is hard, indolent, and suppu-
rating with difficulty ; the discharge is curdy, discolored, and foul smelling,
especially if the spermatic cord is thickened and painful.
Lachesis. — When there is considerable prostration; the parts are
extremely livid and mottled; in phagedenic ulcer, gangrenous ulcers and
blisters ; the sore is flat aud spreading.
Belladonna. — Large and painful buboes, with congestive type of
inflammation ; the skin is of a deep red color, disappearing under pressure,
and returning slowly after the finger is removed ; phlegmonous inflammation
extending to adjacent parts.
Causticum.—In buboes secreting an acrid, corrosive pus, with sys-
temic complications, such as scurvy and gout; chancroid, with disposition
to fungous growths ; patients subject to cutaneous eruptions.
Sepia. — Indolent chancroids, with burning itching, humid or scurfy
herpes about the parts; eruptions extending to the glans and prepuce.
Phosphoric Acid.—Buboes with raised edges; granulations pale and
flabby; margins of sore thick, rounded, and prominent; corroding, itching
herpes on the prepuce ; heat, burning, and soreness when sitting or walking;
nocturnal pains in the bones, as if they were scraped with a knife.
Phytolacca.—Inguinal glands inflamed, swollen; ulcers appear as if
parched out; lardaceous bottom, with general weakness and prostration.
Local Treatment. — A solution of Chloral Hydrate, ten parts to
one hundred parts of water, is an excellent topical application in
the simple and indolent varieties of bubo; but it fails to produce
much good in the virulent form.
Phytolacca dec. I have employed this in obstinate cases of
indolent bubo, when all other remedies of the first class had failed.
Carbolic acid. A weak solution of Carbolic acid, applied
locally, is highly recommended.
I have frequently tried Ricord's great and vaunted remedy,
which he styles the " born enemy " of phagedena, in those violent
forms of the virulent bubo, with good results. I believe it will
accomplish more good than the caustics in ordinary use, such as
the Vienna paste, Potash, and the actual cautery. I have
employed it prepared as follows; viz.: Ferri et Potassa tart, half
an ounce; water and sirup in equal quantities, each three ounces.
Of this I have given one teaspoonful three or four times a day.
It can be employed as a topical application as well, and certainly
possesses remarkable virtues in checking the disease, and restor-
ing the ulcerated surfaces to a more healthy condition.
Chromic acid has been successfully employed by Dr. T. G.
Comstock, of St. Louis, Mo., who claims that it possesses highly
68
CHANCROID.
curative powers in the more virulent forms of bubo. He says he
has cured in thirty hours the most intractable ulcers of this class,
that resisted all previous efforts; he succeeded perfectly, not only
in thwarting the spread of the ulcer, but changed its phagede-
nic and ill-conditioned character to that of a healthy granulating
surface. It certainly deserves an extended trial, vouched for as
it is by the authority above mentioned.
The frequency with which local applications are to be renewed,
depends upon the quantity and character of the secretions. Clean-
liness should be rigidly enforced, and the patient should be allowed
a wholesome, generous diet. Due attention should be given to
hygienic influences, and the patient be placed under the most
favorable conditions of health.
Anal and Rectal Chancroids are among the most obstinate
and difficult to cure of all others wherever they may be situated,
on account perhaps of the unfavorable locations of these sores,
as well as the daily dilations and contractions of the tissues by
faecal evacuations, and the almost impossibility of maintaining
cleanliness and the required applications. Frequent applications
of medicated lotions, mentioned on page 12, containing Carbolic
acid or Chlorinated soda, perfect rest in bed, with a constant use
of Iodiform powder sprinkled upon the ulcerated surfaces during
the intervals of the medicated lavements furnish the best means
of cure. When stricture of the rectum follows, as the result of
these long existing chancroids, extirpation, linear rectotomy, or
resection of the constrictor ani are the only means that promise
permanent relief or a sure cure. When chancroids appear at the
external margin of the sphincter, thorough cauterization is the
most reliable remedy; but this is inappropriate when the ulcers
are situated within the constrictor. When they appear at the
verge of the meatus urinarius and not involving the inner portion
of the urethral membrane, cauterization is effectual: but if they
extend far within the urethra, little can be done by way of local
treatment—they do best by being let alone, their ultimate effect
being a stricture of the urethra.
Sub-preputial Chancroid is an ulcer of the chancroid type
concealed within a closely fitting prepuce, attended with pus-like
discharge and a little tumor occupying the corona or the furrow
just behind it, which can be felt by careful manipulation. These
chancroids are more readily treated than the preceding, and an
CHANCROID.
69
easier access is gained to the diseased part. Here cleanliness
effected by repeated ablutions of medicated lotions thrown into
the posterior portion of the glans by means of a long flattened
nozzle attached to an ordinary penis syringe, cleanses the parts
and keeps the pus from accumulating behind the corona-glandis.
Injections of Hydrastis, Boracic acid or the Permanganate of
Potassa should be applied warm and frequently. Keys recom-
mends iodoform mixed thoroughly with Balsam of Peru as an
excellent remedy. If the prepuce becomes very much inflamed,
with danger of Phymosis, the more active interference of the
knife may be employed and the prepuce be slit open, when an easy
access is gained to the inflamed parts; then apply the lotion as
above indicated. Generally the progress of these chancroids is
slow, and very much can be gained by early and continuously
applied cleanliness and medicated lavements.
Chancroid of the Preputial Margins if situated on the
border and readily exposed, may be cauterized with great ad-
vantage ; but if they undermine the prepuce and extend within,
deep down toward the corona, they should be treated like the
preceding. When they attack the frenum it is better to divide
the bridle and forestall the slow action of pathological division by
the corrosive chancroid. If the artery of the frenum should be
accidentally ruptured or destroyed by the phagedenic process of
ulceration, the bleeding may be prevented by passing a tenaculum
through the frenum and throwing around it a stout silken ligature,
which is made to embrace the bleeding vessel, and then cut off
short and treated as before advised.
Chancroids of the Vulva and Vagina require great care in
their manipulation. If they be quite recent, cauterization may
be effectual, but if they are old they are best treated by the means
before advised, such as cleanliness, disinfectant medicated lave-
ments, Iodoform applications. The speculum should always be
employed and the parts well exposed so that cauterization may
be done with exactness and thoroughness. Make a thorough
search of the whole surface extent of the vagina so that none
escape the curative process of the surgeon. Follicular chancroids
on the external vulva at the roots of the hairs, are quite frequent
in women, and when they take place in these locations are readily
cured by the processes already recommended.
70
SYPHILIS.
Chancroid of the Fingers. —When the finger of the surgeon
becomes infected by chancroid, it should be instantly cauterized
and covered with Idoform and Balsam of Peru and all retained by
retentive dressings. When it occurs upon the knuckle it becomes
very difficult to cure owing to the constant motion of the parts;
after cauterization and dressing, the finger should be placed in a
firm splint and be maintained in a perfect state of rest. An
ordinary abrasion upon a knuckle may terminate in ulceration
and continue sore for two or three weeks. Keys states that he
has " known one such abrasion to be diagnosticated as a syphilitic
chancre, and the patient kept miserable for years, fearing syphilitic
eruptions, which never came. A splint putting the knuckle at
rest is all the special treatment required in these cases."
CHAPTER IV.
Syphilis.
The recent investigations of syphilis, a disease hitherto so
much dreaded, have proven its present mildness as compared
with the former virulence that marked its existence. Mr. Keys
speaks of it as "a disease of magnificent exceptions, full of absorb-
ing interest;" and Professor Dana says, "that
the disease is not so virulent now as it was
during the century when it first conspicuously
appeared; "* and all authors agree that its
severity, from some cause, has abated. To
what is this cause attributed? To my mind
the answer is, that the widespread dissemina-
tion of the disease throughout the world, and
the almost universal prevalence of its heredi-
tary characteristics, have established an immunity from its
severe attacks, just as vaccination, wherever practiced, has given
protection from the heretofore deadly ravages of small-pox. This,
coupled with the fact that professional men have been gradually
lessening the poisonous quantities of Mercurials given to cure the
disease, has, in my opinion, done very much to strip this disorder
* Professor Charles L. Dana, on the "Benignity of Syphilis."
SYPHILIS.
71
of the horrors with which it was associated during the reign of
the crude, destructive doses of Mercury. It is true that the type
of the disease, whenever manifested, proves that its nature has
not changed, its features have not altered; but its sting has
become less virulent, and, consequently, less dreaded. There is
no question of the fact, that of all people, occupations, or trades,
there are none in whom the manifestations of syphilis would be
more prominent, its characters more universally displayed, than
in the seamen of this and other countries. Yet we observe among
this class such a mildness in syphilitic attacks, such exemption
from the virulence of the past, such an immunity from its consti-
tutional characteristics, that we are forced to accept the doctrine
of its growing moderation, and agree with Professor Dana, (1)
that syphilis, as a rule, runs a very mild course indeed among
American seamen, and physically incapacitates them less than
either soft chancre or gonorrhoea, with their complications
and sequelae; and (2), that it runs this course often without
treatment, and almost always in spite of irregular living and
unhygienic surroundings.
The initial lesion of chancre begins as a papule, generally single,
or an erosion with indurated areola; it either remains to the end,
or the papule bursts, resulting in an ulcer with a hardened base.
The virus has a lengthened period of incubation (fifteen to
twenty-five days) before development of the papule. It is usu-
ally circular ; its edges are smooth, not undermined ; often
elevated and adherent, and gradually melt into the shining floor
of the ulcer. It may exist on any part of the body, but more
frequently on the genitals. Its secretion is scanty, and serous in
character, unless irritated, when it assumes a purulent form. It
is not auto-inoculable. One attack exempts from subsequent
invasion. It is peculiar to man, is seldom phagedenic, and
shows little disposition to spread; is slow in development, but
heals rapidly when once reparative action begins. The affection
of the inguinal glands is usually painless, multiple, and rarely
ends in suppuration, unless due to extraneous causes. The
disease, though at first manifesting local trouble, may become
constitutional, and then the person can never be inoculated with
the virus of the chancre. " The proportion of chancre to chan-
croid is about one to three," says Dana, in his reported tables
of the U. S. Marine Hospital service; and, according to the
tables of Dr. King, the mortality from syphilis was one-fortieth
72
SYPHILIS.
of one per cent. From a return to the House of Commons of
all the deaths from syphilis in the workhouses in England and
Wales, beginning in the year 1875, there are only eight per million.
Differentiation between Typical Chancroid and Chancre.
CHANCROID.
1. Nature and Cause. ~-J. local tis-
sue disease, caused by contamination
with chancroid pus in sexual inter-
course ; auto or hetero inoculation of
chancroidal pus.
2. Situation. — Upon the genitals or
in the groin; very uncommon else-
where.
3. Number. — Often multiple, both
in origin, and by spontaneous auto-
inoculation.
4. Second attack in same individual
entirely possible.
5. Auto-inoculability.—Always pos-
sible in generations.
6. Transmissible to animals.—Pos-
sible.
7. Begins as a pustule or an ulcer,
and so remains; advances rapidly;
heals slowly ; no incubation.
8. Color. — Dirty yellowish white,
or pinkish, with free creamy secre-
tion.
9. Induration absent; edges per-
pendicular ; floor uneven and dull,
with pain.
10. Phagedena, an occasional coin-
plication.
11. Bubo occurs in about one-third
of all cases, either simple or virulent,
and painful as a rule.
12. No appreciable constitutional
contamination.
13. Syphilis, as a result of chan-
croid, impossible.
14. Local treatment all important.
15. A chancroid may be cured by
cauterization without, and not pro-
duce consequent trouble.
chancre.
1. A general blood disease, caused by
contamination with syphilitic virus in
sexual intercourse; hetero-inocula-
tion of the chancre virus upon a
non-syphilitic person.
2. Upon the genitals; not unfre-
quent upon the lips, lJpples, and fin-
gers ; very uncommon elsewhere.
3. Generally single; sometimes mul -
tiple from the start; not usually
spreading by spontaneous auto-inoc-
ulation.
4. Almost impossible.
5. Impossible, unless the ulcer se-
cretes pus.
6. Quite probable.
7. Begins as papule, or an excoria-
tion, and remains an indurated ulcer;
advances slowly; heals quickly; has a
distinct incubation from 5 to 20 days.
8. Livid red or bright blood color, or
gray, with scanty, serous, sanguino-
lent discharge.
9. Induration invariably present;
edges slanting and adherent, with
smooth, bright floor, and painless.
10. A very rare complication.
11. Invariable, and always indolent,
exceptions two per cent of all cases;
never becomes virulent; painless as
a rule.
12. Constitutional contamination
occurs as a rule.
13. Syphilis, as a result of chancre,
is invariable.
14. Local treatment unimportant.
15. Chancre cannot be cured by cau
tcrization, and not produce constitu
tional implication.
SYPHILIS.
73
Treatment. —The remedies which are most successful in
curing this disease, are the following: Ars. iod., Aurum., Badi-
aga, Carbo an., Carbo veg., Cinnabar, Corydal, Kali hichrom.,
Kali hyd., Lach., Lye, Merc cor., jod., and sol, Nitric acid.
The most important of all these remedies are the Mercu-
rials ; and, if we examine into the pathogenesis of Mercury, we
will find that no remedy possesses such a closely related sim'illi-
mum to syphilis. It is upon this very Homoeopathic principle, as
Dr. Bumstead reproachfully says, " that the elastic principle of
similia similibus is also made to cover" the true curative action
of this disease. This " elasticity " proves the essential element of
the Homoeopathic law, and its engraftment upon Allopathic
practice " covers " all that is valuable in that system in the cure
of syphilis. With all due deference to some of our friends, who
seem better versed theoretically than practically in the treatment
of syphilis, I believe, as I have oftentimes asserted, that the Mer-
curials, as a rule, are the only really reliable remedies for the
cure of the indurated chancre: and it is through this remedy,
properly administered, and diligently continued, that patients are
dismissed "cured," without the necessity for their return to the
surgeon, as has been sneeringly written by some who preach bet-
ter than they practice.
Let us compare the effects of syphilis on the human system,
with the toxicological symptoms of Mercury as given by Pereira,
in his famous Materia Medica, justly accorded as one of the very
best works on that branch in the Allopathic school:
SYPHILIS.
Syphilis produces on the skin pus-
tules, scales, and tubercles.
Excites inflammation of the perios-
teum, and caries of the bones.
Produces inflammation of the iris.
Produces inflammation and ulcera-
tion of the mouth and throat.
Produces enlargement and harden-
ing of the glands.
Produces chloro-anaemia, a diminu-
tion of blood-corpuscles, and an in-
crease in the proportion of serum.
Produces ulcers on the genital
organs.
MERCURY.
Mercury, says Pereira,* produces
severe forms of skin diseases.
Produces inflammation of the bones
and periosteum, says Pereira.
A disease called Mercurial iritis.
Ulceration of the mouth and throat
a well-known effect, says Pereira.
Produces enlargement of the ingui-
nal and other glands, says Deterich.
Diminishes the coagulation of the
blood, and increases the proportion of
serum.
Produces ulcers, with induration,
on the glans and prepuce, says Fick,
of Hamburg.
* Pereira's Materia Medica, Vol. I., p. 588, elsequitur.
74
SYPHILIS.
The difference between the two prevailing schools is simply
this: that, while Homoeopathic practice cures the disease " tuto,
cite, et jucundc" Allopathy too often dooms the unhappy victim
to all the attendant horrors of Mercurial toxsemia, which, accord-
ing to Mr. Druitt's own confession, is useless, except to show that
the system is affected. Professor Gross also remarks: " My own
opinion is, that the more simple and gentle the Mercurial course
is, the better." Professor Keys* says syphilis is "a self-limiting
malady." Professor Danat remarks that the disease is innocu-
ous, as compared with its early history. Professor Keys states,
that it gets wrell under all treatment, but yields best to small doses
of Mercury, continued for a long time. Diday remarks that it is
"cured by the grace of God:" that is the do-nothing treatment.
Sigmund and Zeissl, two late German authors of high position,
render their verdict in favor of Diday's method of treating syph-
ilis. Keys says the question now is, how to use Mercury; and he
settles the matter for the old school, and recommends what he
terms the "tonic dose," which is one-half of the "full dose," viz.,
one-twelfth of a grain of the Proto-iodide of Mercury; and in late
years, he has been in the habit of using a much less quantity; for
instance, one equal to one-third instead of one-half of the " full
dose," which is equivalent to one-eighteenth of a grain of the
crude drug. With this diminished "tonic dose," he adds, that it
is given " rather to his [the patient's] advantage; for he feels well
under it in most cases ; he eats well, his functions go on perfectly,
and his blood is richer in red corpuscles than it was before." He
also recommends that this dose shall be continued for about
"three years," and "a year's freedom from evidences of the
disease is desirable before the tonic is stopped." (This is good
similia practice.) I mention these facts, gathered from recent
and approved Allopathic authority, to show that the tendency in
that school is to yield their old and cruel treatment of ponderable
doses of Mercury, with all its multiplied horrors, to the minute
and all-curative remedy of the recognized " elastic " simillimum.
While these things are being done in the old school, to the credit
and the relief of poor hi manity be it said, I ask what is the posi-
tion of our own syphilographers upon this important subject.
The only two representative authors in the Homoeopathic school
* "Venereal Diseases," p. 104.
f In a monograph on Venereal Diseases.
SYPHILIS.
75
who have written late surgical treatises including the treatment
of this disease, seem to be further from the mark, so far as an
intelligent knowledge of the method of curing syphilis homceo-
pathically, than those of our Allopathic brethren whom I have
previously quoted. One proclaims his belief that the disease can
be cured, but only by material doses, oft repeated, and recommends
Mercurials to be employed in the first trituration; while the other
declares that syphilis is "absolutely incurable," except it be "by
the extinction of the sufferer, and the absence of any heirs of his
body;" yet, in the treatment, the latter gives, most profoundly
and most unerringly, "fidl indications for remedies," and adds,
the " Corrosivus is the sole simillimum, so far as my [his] experience
goes." How far does that experience go, when the true and " sole
simillimum " yields up its curative powers, and negatively awaits
the slow extinction of the sufferer? With all due deference to
such authority, I still believe, as before stated, that Mercurials
are the only real and reliable remedies in the treatment of the
indurated chancre; and it is through this remedy, properly
selected and judiciously given, that cases are being continually
dismissed as "cured," without the necessity of coming again
under the notice of the surgeon. I have "cured" hundreds of
these cases, both in hospital and civil life, in a practice of nearly
forty years, by the aid of Mercurial treatment, without imposing
upon my patients the painful penalties of the remedy, or com-
pelling their return for further treatment; and this I have accom-
plished by the medium potencies. I also believe, that, with the
medium potencies, there is just as much certainty in "curing" this
disease as any other affection in the nosology; and the longer 1
continue in the practice of prescribing for this disease, the more I
am convinced that the medium potencies act the most promptly,
most certainly, and most curatively. As a rule, I employ the
Corrosivus in persons of strong vital reaction, and the Proto-
iodide or the Solubilis in those of scrofulous systems, dyscrasias,
broken-down bodies, and in females. No disease at all equal to
syphilis in obstinacy and virulence, yields a more ready response
to the indicated remedy than this.
The mixed chancre of Rollet combines both the characteristics
of chancroid and chancre. Each sore runs its distinct course,
and the compound lesion possesses the peculiarities of both, and
the treatment must be adapted to the combined characters. One
may be cured before the other is fairly developed, when attention
76
SYPHILIS.
must be given to the remaining sore. The mixed chancre is very
rare.
Urethral chancre is one of the least common of all chancres,
and is situated just within the meatus, one of the lips of which
it may involve. It will be felt as a tumor along the course of the
urethra, with pain on urinating and during erection. A slight
discharge usually accompanies its presence, of a muco-sanguin-
ous character. This may continue for three or four weeks, and
there is some danger that the cicatrix may produce a stricture of
greater or less importance. The inguinal glands also become
affected as in the ordinary chancre.
Chancres in different parts of the body are to be treated in the
same manner as those already spoken of.
The excision treatment, or rather the attempt to cure syphilis
radically by excision of the chancre, is a recent and interesting
method of effecting a cure of this disease, based upon the theory
that " the poison, after being absorbed, lies latent locally through-
out the period of incubation, and then commences to increase in
quantity, at first locally." It is unnecessary to enter into a discus-
sion upon a theory which is neither sustained by analogy or fact.
Auspitz, a German syphilogist of considerable repute, has
attempted to prove the affirmative of the proposition; but, on
close analysis, his statements are unsatisfactory and unreliable.
The inunction method, the vapor bath, fumigation by volatili-
zation of Mercury, are dirty, unscientific, and dangerous plans of
employing the Mercurial treatment; and no true Homoeopath
should be induced to try such crude and unsatisfactory measures,
when the whole range of Mercurials, and their various attenua-
tions are so easily obtained. A rule to guide us in the treatment
of true syphilis is the condition of the floor of the chancre. If it
exhibits a reddish, unhealthy appearance, or, if the color of the
spot presents any strong contrast with the surrounding tissue, it
is almost certain evidence that the constitutional disease is not
completely cured. Treatment should be continued till the origi-
nal base of the chancre is covered with healthy tissue, and no
difference is perceptible between it and the contiguous structures.
The practice, hitherto so strongly insisted upon, of destroying the
chancre by the violent caustic preparations employed, cannot be
too strongly reprobated. The destruction of the chancre in this
way does not cure the disease already transmitted to the system:
on the contrary, it removes a valuable guide in our treatment;
SYPHILIS.
77
and there is no other way open to us whereby we can determine
the condition of the patient, or the progress of the case. The
appearance and characteristics of the spot where the chancre
existed is the syphilo-meter, whereby we can safely and surely
prognose the progressive recovery of the patient, or otherwise.
When the caustic agents are employed to destroy the chancre,
the systemic contagion becomes more intractable and complicated
with the various conditions that develop during the progress of
the disease. Confusing and complicating symptoms arise, making
it difficult oftentimes to select the proper remedy; and the
patient may finally succumb to "all the miseries of ill health,"
referable to his cruel treatment in the early period of his disorder-
One of the preparations of Mercury, given with reference to
the constitutional and moral status of the patient, the form, extent,
and duration of the ulceration, must be selected and diligently
persevered in. The greatest cleanliness, locally and generally,.
should be insisted upon; dressings to the local sore enforced, and
rest as far as possible enjoined. The following remedies, classi-
fied with reference to the progress and persistence of the disease,
may be given according to their indications.
1. Primary Syphilis. — Mercurius (hard chancre); Acid nit.
(Sloughing chancre, or if Mercury has been given to excess);
Merc cor. or Cinnabar (combined gleet and syphilis); Thuja.
(warty growths); Bell, (inflamed and painful buboes); Ars. iod.
(buboes, painful, and threatening suppuration); Phyto., Podoph.,
or Sulph. (co-existing chancre and skin affections).
2. Secondary Syphilis. — Acid nit. and fluor., Ei"yng. aquat.,
Merc, Cundurango, lodium, Kali chl (sore throat and mouth);
Merc, cor., Kali hyd. (iritis); Aurum, Stillingia, Sarsaparilla (rheu-
matic or bone pains).
3. Tertiary Syphilis. — Kali hyd., Aurum, Phos., Acid, phos.,
Sil, Mez., Asaf. (nodes and bone diseases,—exostosis, caries,
necrosis, etc.); Ars., Ars. iod. (cachectic ulcers); Aurum, Kali
bichrom., Calc carb., Kali chlor. (ozsena); Aurum, China, Phos.,
Carbo. veg., Ars. (syphilitic cachexia.)
4. Hereditary Syphilis.— Merc, Nit. ac, Aurum, Phyto., China,
Ars. iod., Sulph., lodium.
Special Indications.
Mercurius Sol.—This remedy stands in the front rank among the few
that are capable of destroying the venereal poison in the system. Its patho-
genesis contains nearly the entire phenomena resulting from venereal infec-
78
SYPHILIS.
tion. It is of special value in primary symptoms, and in inherited syphilis
of infants and children. Dr. S. P. Hedges, of Chicago, 111., has found, that,
whenever it fails to cure, the diathesis of the patient is complex ; so that no
one remedy will alone effect a cure. It is especially indicated in Chancre
with red edges, cheesy or lardaceous bottom, painful, and readily bleeding.
Chancre with indurated base and margin. Erythematous and papular
eruption ; ulcers in the throat; fauces and tonsils swollen, inflamed, and
ulcerated ; rupia with violent itching; necrosis ; emaciation, with slow
hectic fever; osteocopic pains and general hyperemia.
Nitric Acid.—Constitutional syphilitic ulcerations, especially the in-
herited ulcerations of children, and when the Mercurial cachexia has been
engrafted upon inherited syphilis. Chancre with raised edges, bleeds easily
and profusely ; pale, flabby, and prominent granulations ; ulcers inclined to
spread in circumference rather than in depth ; fungous growths ; discharge
corrosive ; buboes threaten to suppurate; coppery and violet-colored spots
on the skin, squamaj, rupia, mucous tubercles, condylomata, drawing and
pressing pains in the head. Also in primary chancre, with spongy, elevated
margins, not painful, but bleeding readily and profusely. The remedy
should be administered in both high and low dilutions, and not too hastily
abandoned if one dilution has not answered.
In case of sloughy (eating) ulcers, Kitric acid should be used topically in
a low caustic form, and thus will be found to act well with its constitutional
administration.
Kali Hyd. —No remedy surpasses this as an antidote to the syphilitic
poison in the secondary, and especially in the tertiary form of the disease.
Nodes, Gummata, Erythema, tubercular skin eruptions, ulcers on tonsils,
periostitis, and coryza are distinctly under its influence. After abuse of
Mercury, hard bubo in a scrofulous system ; ulceration of nose, mouth, or
throat, with corrosive, burning discharge; lancinating pains in the throat;
secondary and tertiary types of syphilis, threatening abscesses, system
depressed. The pain of nodes is quickly relieved; and, when not very
chronic, the nodes soon disappear. According to Ringer, large doses arrest
the rapid sloughing of some syphilitic sores, and promote the healing process.
Mercurius Cor.—Chancres inflamed and painful; ulcers with a larda-
ceous floor, which secrete a thin, ichorous pus; acute inflammatory bubo,
secondary symptoms make an early appearance ; in iritis with affections of
the conjunctivae; soft, flat condylomata, mucous tubercles. Chancre, with
ichor adhering to the bottom, and discharging thin pus, which stains the
linen; combined chancre and gonorrhoea; buboes; skin affections, the
symptoms being worse in bed, and at night.
Cinnabar. —Similar symptoms to the above occurring in scrofulous
indolent constitutions. Useful in secondary and tertiary forms; chancres
with hard base in scrofulous persons; the middle of the chancre is raised
and fungoid ; indurated bubo ; iritis, with pain in the supra-orbital region •
circular ulcerations of the skin, mouth, and throat; ulceration of the tonsils
in the secondary stage, when the vegetations aud mucous patches are the
predominant lesions.
SYPHILIS.
79
Merc. Prot.—Painless chancres; when the glandular system is largely
implicated, inguinal glands large, swollen., but not disposed to suppurate;
affections of the throat, indurated tonsils, secretions small in quantity bu<
tenacious ; orchitis following venereal taint.
Fluoric Acid. — Secondary syphilis of the throat, and tongue, or osseous
caries, pains in the bones generally; aching pains in the bones; dull and
bruised pains in the breast and sacrum.
Cundurango. — Congestion of the Schneiderian membrane, extending to
the frontal sinus; pimples, pustules, and blotches on the skin, especially the
lips, giving rise to painful cracks in the corners of the mouth. It first came
into notice by an accidental cure of constitutional syphilis.
Arsenicum.— Gangrenous sores, with florid, unhealthy granulations,
which bleed on the slightest touch, and are painful and burning; or painless
ulcers, secreting a water}', corrosive, and offensive fluid ; rapid emaciation,
prostrating diarrhoea ; scaly skin, or malignant ulcerations in the secondary
or tertiary stage; excessive sensitiveness; great restlessness ; general rapid
sinking of strength; dry, scaly, shriveled skin ; blotches, eruptions, and
ulcerations of the skin.
Arsenicum Iod.—According to Dr.H. Noah Martin, of Philadelphia,
this remedy excels all others in the rapid cure of venereal bubo. It quickly
reduces and disperses acute swellings of the inguinal and axillary glands,
even after the peculiar throbbing pains have set in which seem to threaten
suppuration.
Belladonna.—As an occasional remedy, Belladonna is very beneficial;
especially in cases in which there is great pain, redness, and erysipelatous
appearance.
Thuja.—Warty growths (Sabina if they are large, moist, and painful);
small warts on the iris; mottled eruptions. Condylomatous excrescences on
the penis, vulva, and about the anus ; painful inguinal glands; purulent
pimples ; brown or red mottled spots, with itching ; red nodosities ; rupia.
Carbo Veg. —In cachexia syphilitica ; extreme prostration ; impairment
of digestion, suppuration of bubo, parts livid and mottled, falling-off of the
hair, furfuraceous desquamation ; yellow skin, with impairment of digestion ;
ulcers having a gangrenous character, with nightly burning pains.
Carbo An. —Bubo assuming the phagedenic type.
Merc. Praecip. — When bubo puts on a phagedenic form and the various
ulcerative processes become destructive, as in affection of the long bones;
nodosities with severe pain at night.
Aurum. — Ulceration of the mouth and nose; ozaena, bone diseases,
sarcocele. Particularly beneficial when the system has been broken down by
the combined influence of syphilis and Mercury, and the mind, equally
depressed, dwells upon suicidal thoughts. Mercurial cachexia ; syphilis in
the secondary and tertiary forms ; ulcers of the nose and mouth, with fetid
discharge ; necrosis of the nasal bones ; nodes of cranial bones ; ulcers and
crusts within the nose, with putrid smell; burning and boring pains in the
bones.
80
SYPHILIS.
Sarsaparilla.—Purulent vesicles, itching furiously; various skin affec-
tions.
Sulphur. — As an intercurrent remedy in all stages: In superficial
ulcer, with alardaceous base ; when the disease threatens to assume a serious
form, or is very obstinate ; also of special value in sycosis.
Phosphorus. —Affections of the long bones, or the jaw bones ; and when
a dry cough, burning, stinging pain, bloody expectoration, and great debility
indicate danger to the lungs.
Mezereum.—Exostosis, necrosis, or caries, particularly of the shin
bones, the part feels sore, and is aggravated by touch.
Clematis.—Orchitis, excrescences, scabies, tetters discharging bloody
matter ; pain and irritation, worse at night.
Epitome of Symptoms.
Acid Nitric. - For violent, pains in
the bones; ulceration of the mu-
cous membranes; Mercurial symp-
toms, combined with bone-pains,
congestions, ulcerations, and affec-
tions of the periosteum and bones;
syphilitic pains in the head. Anti-
dotes Mercurial impressions.
Acid Phos. — For periostitis.
Artemisia. —Mercurialization with
bone-pains and rheumatism.
Asafoetida.—For caries and ozaena.
Aurum. — For syphilitic cachexia,
scrofula, and ozaena.
Cinchona. — Excessive weakness,
sweats, sensitiveness of the skin
to changes of atmosphere ; affec-
tions of the periosteum and bones;
loss of strength and humors.
Creosote. — Scorbutic symptoms;
mucous ulcerations; cutaneous
ulcers ; salivation.
FerrumPhos.— Mercurialization
combined with scrofula; indolent
ulcers; periostitis.
Guaiacum. — Mercurialization com-
bined with rheumatism and gout.
Lachesis. —Mucous ulcers; gangrene
from Hydrargyrosis.
Lycopodium.—Affections of bones;
Night-pains.
Mezereum.—Ostitis and periostitis;
impetigo and herpes.
Phosphorus. — Mercurialism ; Ostitis
and periostitis; paralysis.
Sarsaparilla.—Cutaneous eruptions,
Mercurialism.
Silicea. — Ulcerations and caries ;
bone fistulas.
Staphysagria. — Ostitis and perios-
titis ; hypochondria.
Sulphur.—Worst forms of Mercu-
rialism ; cutaneous eruptions and
ulcers; iritis; aflections of the
bones, and Mercurial asthma.
Accessory Means. — All wear and tear of system, such as over-
exertion of the mind in business or pleasure, must be avoided.
Generous but plain diet, and avoidance of stimulants; comfort-
ably warm clothing, rest, fresh air, and moderate daily out-of-
door exercise, and other good hygienic surroundings are essential.
SYPHILIS.
81
Generally, a warm bath about twice a week, at bedtime, is
advantageous; also daily cold or tepid sponging, with abundant
friction by means of a bath-sheet, on rising. The importance of
thorough cleanliness in this disease may be inferred from the fact
that some of the worst cases of primary disease have been suc-
cessfully treated by prolonged warm baths. The septic discharge
being removed as soon as formed, the sore heals much more
rapidly than under ordinary circumstances. Cleanliness is not
only valuable curatively, but, practiced thoroughly and imme-
diately, is the best prophylactic. Abstinence from tobacco and
all stimulants should be insisted on.
In those patients who for a long series of years have been
addicted to the daily use of stimulants, it is recommended that
they be not entirely and suddenly deprived of them, but that
they be used twice a day, in diminished doses, with their meals
rather than upon an empty stomach. High livers, on the other
hand, should be restricted in the quality and quantity of food,
and be brought as soon as possible to a plain, unstimulating, but
nutritious regimen. The influence of the mind upon the body is
nowhere more clearly witnessed than in syphilitic patients. It
is advised, therefore, that the surgeon be frank and candid in
regard to the curability of the disease; not buoying him up with
hope of a speedy recovery, which is sure to be followed by dis-
appointment and chagrin, nor yet delivering a gloomy prognosis,
dooming him to utter and inconsolable despair. There is no
disease°that produces such a profound impression upon the sys-
tem, even to the complete wrecking of all functional and organic
action, as syphilophobia. To prevent this, the surgeon should be
frank at the outset, and assure the patient, that, though the cure
may be protracted, and though it may even be subject to modified
relapses, yet the treatment, if persisted in, will ultimately restore
him to health and constitutional vigor.
As a rule, simple lint soaked in tepid or cold Calendula water,
and renewed every three or four hours, is the only application
required for the local sore. But for primary sores and ulcerated
glands (buboes), a solution of twenty grains of Chloral Hydrate
to one drachm of water is exceedingly beneficial. The healing
process is regulated and hastened, and auto-inoculation prevented,
by its use Powdered Chlorate of Potash is another valuable local
remedy especially for removing fetor and hastening healing.
The powder should be sprinkled over the open sores, and covered
8'2 CONSTITUTIONAL SYPHILIS.
with a wet compress. As topical applications in sloughy ulcers,
Carbolic acid and Nitric acid have been already recommended.
CHAPTER V.
Constitutional Syphilis.
When the poison of syphilis has infected the system, it pro-
duces certain symptoms which develop at variable periods, from
two weeks to six months or more, after the primary disease.
The skin and mucous membranes first become affected, after-
ward the bones and internal organs. The result is rarely fatal,
unless the brain or other vital organ is affected. When once
involving the system, it is difficult to entirely eradicate it; and, in
the earlier periods, it may be communicated by means of the
saliva, the milk, or even the discharges from secondary sores;
later in the disease the poison seems more localized, and is less
prone to be eliminated from the blood.
The more frequent forms of syphilis, as they are presented to
the practitioner, are treated of in this and the accompanying
chapters; but almost every organ of the body falls under the
baneful influence of the disease. All its varied manifestations
are treated in accordance with the principles already laid down.
The special indications for remedial agents to cure it are given
on pages 77 to 80 and 87 and 88, to which reference should
be made in the treatment of all its diverse pains and disturbances,
whether of function or organism.
Syphilides.—The syphilitic eruptions on the skin correspond
quite closely to the ordinary cutaneous diseases. They are all
characterized by a dull, copper-colored areola; are grouped together,
and possess a circular shape; do not itch, and leave behind a
brownish stain or discoloration, which remains some time after
their complete cure.
Mr. Keys gives ten varieties of eruptions, named in accordance
with the prominent lesion which characterizes them; viz.:
1. The erythematous syphilide (roseola).
2. Pustular syphilide.
8. Papular syphilide.
CONSTITUTIONAL SYPHILIS.
83
4. Vesicular syphilide.
5. Pigmentary syphilide.
6. Squamous syphilide.
7. Tubercular syphilide.
These various forms of the syphilides, owing their origin to
the same poisonous contamination, are to be treated very much
in the same manner; so also will the mucous tubercles, which
occur near the orifices of the mucous canals, especially where the
parts are bathed in perspiration, and where irritation is kept up
by more or less movement. They form small, soft, flattened
tumors, which secrete a thin, offensive discharge.
Syphilitic Ulcerations.—The mucous membrane of the
pharynx is subject to a peculiar foul, excavated ulcer, with
ragged edges, and covered with a grayish-yellow slough. The
inside of the mouth, lips, tongue, and even the larynx, are liable
to be affected by syphilitic ulcerations. Small gummy tumors
appear upon the legs, then soften, break, and form deep ulcers,
characterized by their circular form, their clean-cut edges,
irregular base, and unhealthy discharge. They occur generally
about the knee-joint.
Syphilitic Ulceration of the Larynx.—This is caused by
an extension of the ulceration of the palate. It is characterized
t>y tenderness, great huskiness of voice, suffocating cough, and
expectoration of sticky, tenacious mucus or bloody matter. There
is slight difficulty in swallowing at times, the voice degenerates
into a mere whisper, and it is accompanied with great loss of
flesh, etc. Strength is impaired, and life often terminated by it.
Treatment. —The medicines which have produced most marked
benefits, are the Kali bichrom., Kali jod., and Merc. cor. Professor
Helmuth has derived much benefit from Ars., Iod., Macrot.
and Podoph. A weak solution of Iodine thrown into the throat
by means of an atomizer is recommended as highly efficacious.
Professor Helmuth uses a solution of ten drops of the first deci-
mal dilation of Iodine in a gill of water, applied twice a week.
Syphilis of the Mucous Membranes.—The following mani-
festations of syphilis usually occur late in the disease, but may
take place during all its stages. They appear in the mouth,
throat, and nose. 1st. Erythematous patches, with erosions and
superficial ulcers. 2d. Mucous patches, which appear late. 3d.
84
CONSTITUTIONAL SYPHILIS.
Scaly patches. 4th. Gummatous ulcers, which also come on late
in the disease.
Syphilitic Ostitis, Periostitis, and Osteocopic Pains.—The
bones and also their coverings may be involved in constitutional
syphilis; also the ligaments and joints, attended by pain and
fever, with nocturnal exacerbations. The bones most frequently
affected are the tibia, clavicle, ulna, and bones of the skull. It
may begin either in-the periosteum, or in the bone itself as a
slow inflammation. The affected part is exquisitely tender, with
great pain, aggravated at night. Gummy deposits take place in
the capsule of the joints, in a diffused form, producing thicken-
ing, weakness of the joints, and finally loss of motion. Osteocopic
pains occur in constitutional syphilis, and are of a boring, split-
ting, bone-breaking character, coming on at night with great
regularity and terrible earnestness, and disappearing in the early
morning. They are supposed to be due to a febrile exacerba-
tion, coming on toward evening, which dilates the peripheral
blood-vessels, producing periosteal irritation and congestion; the
warmth of the bed seems to increase their severity, and they
become so intense that the sufferer is not able to bear the weight
of the bedclothes. Thermometrical observations in a few cases
that I have examined, show an increase of two or three degrees
in temperature; these examinations were made in patients suf-
fering greatly from these osteocopic pains, and when the w7hole
system showed a considerable hyperemia. They are most fre-
quent about the upper extremities, the head, and the chest, and
oftentimes are felt in the continuity of the long bones of the
lower limbs. They are occasionally felt at the insertion of the
tendons into the extremities of the long bones.
Syphilitic Cephalalgia.—The severe cephalalgias that accom-
pany syphilis, and come on regularly at night, are a disease of like
character, and are cured by the same remedy, viz., Mercurius,
to be given in accordance with the principles already laid down.
Syphilitic Nodes.—These result from an inflammatory peri-
ostitis, generally terminating in the new formation of bone. The
sub-periosteal tissues become congested; and soft, round, and
spindle cells are formed, which proliferate and increase till they
separate the periosteum from the bone, giving rise, by degrees, to an
oval lump or tumor (node), which shades off into the surrounding
tissues, and which may remain for years. This tumor, or node,
CONSTITUTIONAL SYPHILIS.
85
at first feels doughy, but afterward becomes distinctly fluctuating
After remaining soft for a considerable time, it becomes firmer,
and either disappears under treatment by absorption, or disin-
tegrates, leaving behind an ulcer, the floor of which is bone,
denuded of its periosteum. The bone becomes dark-colored from
exposure, and after a time separates and comes away, after which
the ulcer heals. The bones most involved are the superficial
flat bones.
The course of a node is usually slow, its primitive softness
yields to firmness and solidity, till it feels like a hard, oval tumor,
freely movable under the skin, and exquisitely painful, espe-
cially at night. Under treatment, it loses its solidity, and finally
disappears by absorption, leaving little or no trace of its existence.
At times they put on a feeling of softness centrally; the over-
lying skin becomes dark red, and adherent to the mass, and soon
yields to the inflammatory process, producing an ulcer, the floor
of which is bone, and which is exceedingly difficult to cure.
If it affects the skull, the outer table becomes necrosed, and
requires removal. I removed a piece of the outer table of the
skull over four inches square, with a considerable portion of the
diploe, successfully, in a patient who was at the time an inmate
of the Good Samaritan Hospital, St. Louis, Mo. It may also
produce meningitis and death; or it may involve the brain, by
destroying the inner table of the skull, the brain protruding
through the opening made, with the serious results that usually
follow this condition.
There is a form of bony outgrowth that is frequently developed
in the epiphysal ends of long bones, of an irregular-shaped pro-
jection, or of a prominent pedunculated form, that resembles the
outgrowths often seen in rheumatic gout.
The treatment of nodes is simple, and they are generally very
responsive to medication. The Mercurial preparations, if not
counter-indicated by other conditions, are usually competent to
effect their cure. It must be understood, in this connection, that,
whatever remedy is found capable of curing this disease, that
remedy should be continued, at lengthened intervals, for months,
after all evidences of the trouble have passed away. The older
the node, as a rale, the longer treatment will be required. (Con-
sult syphilitic remedies, pp. 77-80.)
Alopecia. — Alopecia frequently occurs as one of the condi-
tions of the syphilitic contagion. The roots of the hair are prin-
QQ CONSTITUTIONAL SYPHILIS.
cipally involved; large quantities of scales or scurfs form about
them, and destroy the capillary radices; the hair, as a conse-
quence, falls out, leaving, in some instances, the scalp perfectly
bare. The eyebrows are also affected in the same way, and the
hair of the breast and limbs sometimes becomes involved. Ter-
tiary syphilitic lesions, so called, whether the effect of Mercury
or contagion, are seldom seen at present, and, I believe, are more
frequently the result of poisonous doses of the drug than the
sequel® of the syphilitic virus. A careful investigation will show
that the ravages of syphilis, as described in the works of Allo-
pathic syphilographers, two or three decades ago, as compared
with those of the present day, hold an inverse ratio to the poi-
sonous quantities of Mercury given in its treatment. (For treat-
ment, see " Special Indications," pp. 77-80.)
Onychia Syphilitica. —This consists of inflammation of the
matrix of the nail, and consequent loss or disfigurement of the
nail itself, and is an occasional attendant upon both secondary
and tertiary syphilis. Its further consideration will be referred
to the treatment of constitutional syphilis.
Syphilitic Iritis.—The primary seat of the disease is in the
iris ; but other tissues of the eye may be implicated. Generally,
but one eye is involved, which presents most of the symptoms of
common iritis. At the beginning of the disease, says Helmuth,
the iris becomes duller, with a grayish appearance, the radii
being more or less effaced; the small circle of this membrane is
livid or copper-colored ; its tissue tumefies, and forms an elevated
ring composed of thick, downy flakes. The pupil is more or less
contracted, and assumes an irregular shape ; the cornea is some-
what dimmed, and on its inner surface may be seen small fasci-
culi of congested vessels; the tunica albuginea is of a rose color,
which, at its juncture with the cornea, is converted into a dark-
red hue, called the dyscrasia circle. As the disease advances, the
iris becomes more discolored, its surface is covered with exuda-
tion, its free margin is tumefied, and upon its anterior surface
there are elevations of a grayish or yellow tinge. The pupil at
length becomes perfectly immovable ; pedunculated excrescences,
called condylomata of the iris, spring from the membrane, and
adhesion takes place between the iris and the lenticular capsule.
At the bottom of the anterior chamber, pus mixed with blood can
be seen. There are at this time violent constrictive, boring pains
CONSTITUTIONAL SYPHILIS. 87
in the supra-orbital region of the affected side, which radiate
toward the head; they are increased toivard evening, most violent at
midnight, and abate toivard morning, the peculiar characteristics of
syphilitic pains. Sight is more or less affected, by reason of the
plastic exudations formed in the pupillary opening. Photophobia
is rarely present in this disease.
Treatment. — The object of the surgeon, in the treatment of
this formidable disease, is to allay inflammatory action, eliminate)
the syphilitic poison, and to arrest further extension of the inflam •
matory process. To accomplish this, the pupil must be artifi*
cially dilated; this can be accomplished by dropping into the eye,
three or four,times a day, a few drops of a solution of Atropine.*
This dilates the pupil, and rests the inflamed muscular fibers.
Rhus tox. is useful in the primary stage, accompanied with
profuse lachrymation.
Petroleum should be given when there is heat in the eyes, with
pain, heat, and throbbing in the occuput.
Cinnabar, when pain affects the supra-orbital region; when
abscess forms in the iris, Hepar., Merc, sol, and Sulph.
When chancrous ulceration attacks the corona, Ars. and Calc.
are remedies of value.
The Erythematous Syphilide (roseola) is the earliest and
most frequent of all the secondary symptoms, and appears usually
within one month or two after the appearance of chancre. Its
first appearance is upon the front and lower part of the thorax, in
the flanks and over the abdomen. The eruption appears as a
group or series of rounded macules, at first red, then brown and
finally pigmented, varying in size from an eighth to half an inch.
At first they are flat and are covered with minute papular eleva-
tions, which occasionally vesicate and very rarely pustulate.
Pressure by the finger, in the early stage, causes the disappear-
ance of the ledish color, which at a later period leaves a livid
stain, and in the third stage pressure produces no effect whatever.
The hands and face are ordinarily exempt from the eruption
entirely. It lasts from a few days to as many weeks, and may
relapse under unfavorable circumstances. If Mercurial treat-
ment is begun as soon as the chancre appears, it is either post-
poned or never appears at all. The absence of the invasory
fever and local itching, the existence of chancre and throat symp-
toms, the scabs that develop on the scalp, the aggravated pains
at night, and the history of the case, makes it easy of diagnosis.
88
CONSTITUTIONAL SYPHILIS.
Treatment will be the same as in all constitutional contamin-
ations.
The Papular Syphilide, as a rule, succeeds the roseola, or
it may be mingled with it and appear as the first skin affection.
It occurs usually after the second or third month, and appears
upon the flanks, trunk, extremities and face. Unlike the roseola
they are not in groups but are scattered about in all directions.
Its characteristic features are at first small, flat, smooth and
hard, and pinkish or red; as it increases it becomes slightly
depressed centrally and then assumes the ordinary livid hue,
the epithelium dries, cracks and thickens, and curls away from
the base, giving it a peculiar appearance. Soon thev gradually
disappear and leave pigmented spots, but no scars. They appear
in successive crops and assume different stages of development
in different parts of the body.
There are quite a variety of these papules occurring upon the
body, protean in character and variegated in color. They are
not so readily diagnosed as some of the other forms of the syphi-
lides. Their duration is also variable; relapses are by no means
uncommon, and if they run into patches they remain particularly
rebellious to treatment. They are contagious when the papules
are covered by a moist secretion, and from their tendency to
spread are more dangerous than the primary stage of the syphilitic
chancre. The pus-like discharge of these papules, whenever they
become irritated by extraneous causes, is auto-inoculable, the
result being an ulcer somewhat similar to the chancroid. Auto-
inoculation of a moist syphilitic papule produces a pustule sui
generis.
It is difficult to differentiate these papules from cutaneous
forms of lichen; their umbilication, large size, their formation in
patches, the history of the case and the absence of the concomit-
ant symptoms of syphilis are the principal evidences in these
cases
Condylomata. — The condylomata, which is a flat elevated
papule of syphilitic origin, really belongs to this class, and is
readily diagnosed, but its original nature is not yet settled by
syphilographers. A few consider them of syphilitic origin and
others maintain that they may exist without any taint of syphilis.
A doubt exists as to whether these lesions are not a variety of the
CONSTITUTIONAL SYPHILIS.
89
ordinary vegetations that are found in connection with gonorrhoea,
leucorrhcea and such like conditions that are the result of personal
uncleanliness and an absence of pelvic hygiene.
The condylomata are either elevated and acuminated or broad
and flat, having their origin historically in a morbid hypertro-
phy of the papillae of the corion, which are covered by a thickened
epidermis. Certain authors, including Hahnemann, believed that
these excrescences arose from a peculiar miasm independent of
both syphilis and gonorrhoea, while others stoutly affirm that they
are the products of the virus of gonorrhoea and of chancre. The
latter opinion is undoubtedly correct; at least it is the one to
which I subscribe.
The venereal wart has a more uneven surface than the condy-
lomata, is more split up and segmented into papillary prolonga-
tions and has more of a resemblance to the ordinary "seed wart."
Their color is brighter than the syphilitic papule and they rarely
attack the penis and scrotum, but have a decided penchant for
the glans and prepuce in the male and the ostium vaginas in the
female.
Treatment is both local and constitutional. In my own ex-
perience the remedies that have proved most serviceable,
especially when the warts were complicated with chancre, are
Cinnabaris, Nitric acid, Phosphoric acid, Mercurius cor., and
Staphysagria, according to indications. When complicated with
gonorrhoea, I have derived the most benefit from Thuja, Mere
jod., Lycopodium, Sulphur, and Tartaric acid. When the condy-
lomata are humid I usually begin the treatment with Nitric acid
and follow it with Thuja. For the dry condylomata, especially if
they assume the cauliflower or mulberry shape, Staphysagria
followed by Thuja. The locality of these growths have little or
no influence upon treatment. For the fig shape variety I have
found Tartar emetic a very valuable remedy, employed both
locally and constitutionally. Locally I employ Thuja, Mercurius
corrosivus, Nitric acid, and Tartar emetic. In very severe and
obstinate cases, excision and cauterization are demanded. See
page
The Pustular Syphilides occur in two varieties. 1st, small
pustules, when they are scattered or grouped together and occupy
by preference the extremities of the body. They originate from
within a follicle, show little or no inflammatory redness, and
90
CONSTITUTIONAL SYPHILIS.
occur independently upon an intervening portion of skin. The
second develops in the form of a superficial ecthyma, are superficial
but are set upon an inflamed base.
The Pustular Syphilide appears early in the constitutional con-
tamination, and indicates a depraved habit, with tendency to the
formation of pus-producing conditions. They vary greatly in size,
mature slowly, requiring several weeks to reach their maximum,
when they usually burst open and scab over, or become dry and
crusty and heal up. They leave behind a depression of a livid
color, the skin is thickened and is marked by a central depression
corresponding with the hole left by the suppurated follicle. Each
pustule is surrounded by a pigmentary ring or bronzed areola,
which may remain for years but finally dies out and disappears.
The Superficial Ecthyma, a variety of the pustular syphilide,
possesses more distinct and more intense qualities than the pre-
ceding. It appears later in the constitutional contamination
than the small pustule as a rule, but in exceedingly virulent cases
it may follow soon upon the chancre, when it indicates a severe
type of syphilis. They begin as pustules, at first discrete then
becoming confluent; are large, flattened, and often, from their
umbilicated depression, resemble variola; develop slowly, with
little or no pain, and finally scab over, an ulcer remaining for
some time under the scab with a pigmented areola, after the
latter has formed. When the scab falls off there remains a pur-
plish scar, thickened and slightly elevated, and sometimes these
scars are pitted at several points, representing the follicles that
have passed through the stages of suppuration. This disease
may be mistaken for variola, but the absence of the usual back
pains, the invasory fever in small-pox; the slow development,
the history of the case, and the presence of other concomitant
symptoms belonging to this disease are positive evidence of
syphilis.
Treatment is the same as that of constitutional syphilis, which
will be given at the close of the syphilides.
The Pigmentary Syphilide consists merely in a discolora-
tion of the skin, from a light-bronze to an almost black, presented
in groups or patches of various colors, and situated upon the sides
of the neck and upon the chest; the trunk and limbs are not
usually involved. It is said to occur most frequently upon delicate
CONSTITUTIONAL SYPHILIS.
91
lymphatic women who have a fair skin, but this is not confirmed
by later observers. Dr. Fox has given this subject much careful
observation, and thus describes its formation. He says, there
first appears the red syphilitic macule or papule; 2nd, the pig-
mentation increases gradually, then becomes white and shades
off in a dark center, which he terms the " bull's eye," surrounded
by a white areola; this in time is absorbed with the pigment
originally occupying the site of the lesion, leaving behind "a
generalized hyper-pigmentation in the interrnacular spaces."
It appears late in the first year of the chancre, continues
several months, and finally disappears. It possesses no sub-
jective symptoms with which to determine its true nature, and is
of value only as corroborative of past syphilis.
The Vesicular Syphilide is an exceedingly rare eruption,
and when it appears it comes on late in the constitutional con-
tamination. It presents itself as small, accuminated vesicles, of
varied size, and are found clustered in groups of circles or seg-
ments of circles upon the trunk and extremities. The bases of
the vesicles are of a livid color, which shade off into a bronzed
appearance, when they dry up and drop off or become purulent
and scab over.
Mr. Keys describes a variety of the vesicular syphilide that
appears earlier in the syphilitic contagion (within the first six
months following chancre) where the vesicles are large, umbilica-
ted and situated upon a reddened base, surrounded by an areola
at first livid then shading off into a bronze color. All the
varieties of this disease increase slowly, have successive out-crops,
the latter appearing as the former desquamate and dry up. A
distinguishing feature of these vesicles is that they do not have a
moist and secreting surface as do some of the previous syphilides,
and the only distinguishing symptoms from the non-syphilitic
eruptions are the color, the grouping, the pigmented areola and
the absence of itching and the history of tbe case. Treatment
follows the end of these disorders.
The Squamous Syphilide consist of solid patches of thickened
skin, livid, infiltrated but not distinctly papulated. Their sizes
and shapes are protean in character, from a small circumscribed
livid point or dot to a broad irregularly rounded, scaly eruption
as large as the hand. The fine scales that cover the surface fall
off and are succeeded by new crops, until finally the infiltration
92 CONSTITUTIONAL SYPHILIS.
disappears and the patch heals up, leaving no scar or trace of the
patch. It occurs usually at the termination of the first year
following chancre, and belongs to the tertiary stage of the con-
stitutional syphilixia, as laid down by some authors. A peculiar
characteristic of the squamous syphilide is that it sometimes is
developed from syphilixa, and may appear years after the last
vestige of syphilis has passed away. In such cases it attacks
the nose and face, and is called lupus by the careless diagnos-
tician, or it may develop upon the lips and assume many of the
characteristics of epithilioma and be treated as such. The
differentiation between these two forms of diseases rests upon
ihe important and principal fact that the squamous disease shows
no tendency to return, while the true lupus and epithilioma is
especially marked by this recreative character. Other forms of
the squamous syphilide have been observed by late authors, such
as the circinate, plantar and palmar varieties, but they all develop
a like facial expression, and are referred to the same principles
of treatment. See end of chapter.
The Tubercular Syphilide is divided into two varieties the
•general tubercular and the tubercular squamous sypJiilide. The first
form is rather a gummatous product than a papular, and is
developed deep in the tissues, or it occupies the true skin beneath
the papillary layer. It develops as an eruption of patches and
groups of clustered lesions in circles and segments of circles.
When they become confluent the patch assumes a solid, livid
elevation of the skin, covered with scales and irregular on the
upper surface. The base possesses a livid hue, which gradually
becomes of a bronze color, capped with a scale or small pustule.
These tubercles vary in size from a grain of rice to a small sized
pea, and when they disappear they leave a livid cicatrix.
The Tubercular Squamous is a variety of syphilitic lesions
that occupy the border line between the secondary and tertiary
forms of syphilxia. It occurs most frequently upon the face, but
may develop in any portion of the body. Keys speaks of these
patches "as livid patches of thickened skin—scales upon these
patches are quite obvious, but the tubercles may be scarcely so,
perhaps not visible at all. Sometimes, the only reason one has
to call the affection tuberculo-squamous, is the existence of round,
white, depressed scars upon the surface in among the scales, of
CONSTITUTIONAL SYPHILIS.
93
the size of a pea, marking the site of tubercular infiltration of the
true skin, with gummatous material, the interstial absorbtion of
which has produced the white scars." These tubercles are plainly
visible upon the skin; they are isolated, but when lying in close
proximity they sometimes coalesce and present large patches, in
some cases as large as a silver dollar. New crops develop when
the old ones disappear, and thus a succession of crops alternate
and flourish. At times the gummatous infiltration proceeds so
rapidly that ulceration takes place, resulting in a serpiginous ulcer,
in which the integument is seriously involved. Treatment at the
end of the chapter.
The Tertiary Syphilides, as they are called, because they
appear late in the syphilixia, are the rupia, ulcerative syphilis and
the gumma, are thus classified by our friends of the allopathic
school more in reference to their treatment than their pathology.
Viewing this subject from a homoeopathic stand-point I cannot
see why these syphilides should be clothed with a distinct formu-
lation, when it is known that the same poisonous influences that
generate the one variety also create the other. That they occur
late in the disease, that they destroy the skin and leave unseemly
scars behind only proves that the disease-pervading influence of
syphilis is not the same but that it becomes more virulent and
more destructive the longer it is pent up in the system un-
influenced by remedies.
The eruptions belonging to this class are oftentimes met with
when the constitutional powers of the patient seem fully up to the
normal standard. They appear as painless eruptions, unless a
bone or joint is invaded in common with the skin, when they
become intensely painful.
The Rupia begins as a flat pustule, sometimes as a bulla, sup-
purating quickly and then scabbing over, while ulceration is going
on beneath, and the process goes on in this way, repeating itself.
In this way the scab is thickened and raised by new layers of pus,
forming a projection of considerable length, called a horn, or it
may spread out, become thick and rough like an oyster shell; it
is attatched at the borders and by this means the pus is im-
prisoned, which by pressure or accident is made to ooze out at
the edges of the sore. The base is surrounded by a bronzed
areola and the cicatrices, when healed, become white.
94 CONSTITUTIONAL SYPHILIS.
The Pustular Syphilide belongs to the same family as the
above, and begins with a red spot which soon terminates in small
pustules, which coalesce and form a scab with ulceration beneath.
When the scab falls off a new one is formed, and when the patch
has acquired a considerable size it dries up and contracts, cica-
trizating taking place under the crust. There is left a livid scar
with a bronzed areola; the center whitens and the areola generally
disappears.
The Gumma of the Skin is an infiltration of the integument,
developing in a tubercular or ecthymatous patch, and may ter-
minate in ulceration. The gummy tumor consists of a localized
aggregation of gummatous cells in the sub-connective tissue,
which first appear as hard, shot-like granules beneath the skin,
insensitive, unattached and the surrounding structures and the
integument freely movable over them. It may remain thus for
months and gradually disappear without any known cause, leav-
ing not the slightest trace of its former existence. Generally,
however, the tumor enlarges, becomes fixed to the adjoining
tissues, pustulates and slowly ulcerates to the surface, when it
breaks and discharges its contents, which consist of blood mixed
with a thick, honey-like product of a grayish yellow color tinged
with green, which consists of the broken down gummatous cells
and the debris of the intervening tissues. A deep syphilitic ulcer
remains, which gradually heals, leaving a characteristic scar.
When gumma attacks the bone or periosteum it is exceedingly
painful, develops slowly and finally ulcerates, involving the death
of a considerable portion of bone, which assumes the necrotic
type of inflammation.
Gumma of the nose leads to destruction of the nasal cartilages
and bone, causing perforation, necrosis and permanent deformity.
Whenever gumma is developed the implicated structures become
involved, disintegrate and necrose.
Syphilis of mucous membranes consist of mucous and scaly
patches, gummatous ulcers of the mouth and fauces and gummy
tumors of the buccal cavity, which may appear in modified form
throughout the disease, either independently or in connection
with the various eruptions heretofore described.
The typical mucous patch is a flat papule, covered with a
sodden epithelium, and is only found in early syphilis and is seen
in the greatest perfection coincident with the general papular
CONSTITUTIONAL SYPHILIS.
95
syphilide of the skin. Cornil describes it as found upon the
tonsil, to consist of hypertrophied papillae, with a thickened
epithelium, the deeper tissues infiltrated with new cells and num-
bers of cavities containing pus-corpuscles and innumerable pus-
cells between the epithelial scales, opening and pouring out upon
the surface the secretion that covers the mucous patch. The
mucous patch is a round, or irregular rounded, raised patch of a
yellowish color, sometimes red and granulating and covered with
a puriform secretion. They vary in size, occur about the tonsils,
lips, tongue, larynx, and trachea, and within the nose; are painless,
except during inflammation and ulceration, and relapse frequently
as the result of local irritation. They may appear upon almost
every portion of the body wherever two moist surfaces lie together.
Vegetations may spring up around them, and the patches, par-
taking of their characteristics, may become large, pedunculated,
flat warts. All mucous patches are covered with a peculiar
mucous secretion, as capable of transmitting the poison of syphilis
as is the secretion of a chancre.
Scaly patches are frequently mistaken for the mucous patches,
but, as a rule, the former appear late in the disease, and by pref-
erence occupy the angles of the lips, the tips, sides and dorsum
of the tongue. They are caused by epithelial thickening, and their
whiteness establishes this fact. They are very sensitive, bleed
easily, and the contact of condiments occasion pain and discom-
fort when eating. They rarely or ever ulcerate, develop long
after signs of syphilis have disappeared, yield readily to local
treatment, and do not demand a renewal of syphilitic remedies,
for they afford no evidence that the previous syphilitic disease
has again been revived.
The tertiary syphilides, as they are called, are the most des-
tructive of all the syphilides, and when they are deposited around
joints or attack the bony structure they create a great deal of
both local and constitutional disturbance, and may continue for
years if not properly treated. The practitioner must be ever on
the alert, and not confound these tertiary ulcers when they occur
upon the lip or tongue with epithilioma, upon the face with a
rodent ulcer or an ulcerative lupus, upon the scrotum or penis
with a chancroid or an epithelioma. Their peculiar characteristics,
the history of the patient and the profound cachexia that accom-
panies these diseases, are sufficient evidences of their real nature.
96
CONSTITUTIONAL SYPHILIS.
Treatment.—In conducting the treatment of any of these
secondary or tertiary syphilides, the hygienic and dietary influences
thrown around the patient should be in accordance with the
strictest homoeopathic treatment. In the warm latitudes these
syphilides run a more rapid and favorable course, and the cure is
more readily effected than in the colder regions of the north. It
must not be forgotten that the character of the syphilides change;
they readily change their forms and pass from one to another.
In the erythematous syphilide (roseola) the following remedies will
be found efficient and curative under all ordinary circumstances:
Antimon. cruel, Cinnabar, Cantharis, Kali jod., Lachesis, Merc.
corros. sol. and jod., Oleum gurjun, Sarsap., Staph., Sulph. and
Tartar emetic. 2nd, Aurum, Ars., Bell, Calc. carb. and jod.,
Hepar, Lycop, Mezereum, Petrol, Phosph. and Thuja.
For the Papular Syphilide — Arsenic, Coral rube, Corydalis'
Cundurango, Graph., Iodine, Iris, Kali jod., Lithia, Merc cor. jod'
and sol, Oleum gurjun, Nitric acid, Phosph., Staph., Sarsap. and
Lineum. 2nd, Ageiric, Amnion mar., Arsenic, Aurum mur., Bo-
vista, Caust., Conium, Copaib., Graph., Ledum, Sycop, Phosph.
and Tobac
For the Pustular Syphilide—Antim. crud., Nitric acid,
Argent, nit., Cantharis, Carbo. an., Cinnabar, Creosote, Guaic,
Kali jod., Merc, corros. jod. and sol, Oleum gurjun, Rumex, Sarsap.
and Tartar emetic.
For the Pigmentary Syphilide — The remedies most suitable
are those mentioned above under the papular and pustular variety.
The special indications will be given at the close of the chapter.
For the Vesicular Syphilide — Arsenic jod., Antim. crud.,
Cantharis, Cinnabeir, Copaib., Nitric eicid, Hyelrocotyle, Merc
corros., jod. and sol, Kali jod., Lithia, Oleum gurjun, Sarsap.,
Staph, and Tartar emetic 2nd, Aurum mur., Bell, Calc. jod.,
Corydalis, Creosote, Graph., Gratiola, Ferritin, Hepar, Sulph.,
Mezereum, Phos., Tobac and Terebinth.
For the Squamous Syphilide. — Arsenic, jod., Antim. crud.,
Cantharis, Corydedis, Kali jod.. Hydrocotyle, Merc corros. jod. and
sol, Nitric acid, Oleum gurjun, Sarsap, Stilling, Tartar emetic.
2nd, Argent, nit., Bell., Berberis, Caust., Carbo. veg., Copaib.,
Cundurango, Dulcam., Hepar, Sulph., Creosote, Thuja, Ferrum,
Phytol, Rumex, Tobac. and Lineum.
CONSTITUTIONAL SYPHILIS. 97
For the Tubercular Syphilide. — Arsenic jod., Cantharis,
Cinnabar, Corydalis, Hydrocot, Lycop., Kali jod., Merc, corros.,
iod. and sol, Nitric acid, Mezereum, Oleum gurjun, Sarsap.,
Stilling., and Tartar emetic. 2nd, Antim. crud,, Argent, nit.,
Caust., Cundurango, Clemat., Copaib., Culeum., Graph., Kali carb.,
Phosph., Ranunculus bulb., Sulph., Tabae, and Terebinth,
For the Tertiary Syphilides.— Acid fluor., Acid nitric, Cin-
nabetr, Corydalis, Cundurango, Iodine, Hydrocotyle, Kali jod,,
Merc, corros. iod. and sol, Mezereum, Phytolacca, Platina, Stilling.,
Sarsap., and Tartar emetic 2nd, Arsenic, Ascalep syr., Aurum
mur., Carb. an., Corallia rub., Corydalis, Ferrum jod,. Fluoric ac,
Gaiac, Lachesis, Lycop., Phos. ac, Phytolacca, Sarsap., Staph,,
Sulph., Tobac, and Thuja.
Special Indications.
Arsenicum Jod. — Phagedenic and gangrenous u/cerations, copper-
colored eruptions on the skin, prostration of the vital energies, burning
pimples or pustular eruptions on the skin, great restlessness, mental weak-
ness, chilliness of the body, with excessive sensitiveness ; lesser phlegmatic
temperament.
Assafoet.—Tertiary syphilis, especially after mercury when the bones
are affected; skin ulcers, discharging a thin fetid and ichorous pus, ulcers
sensitive to touch, osteocopic pains ; crampy, jerking and drawing pains in
the bones ; affections of long bones.
Aurum.— Secondary syphilis, depressed state of mind, low spirited;
bones of skull painful when lying upon them ; pains in the bones of the
head, as if broken ; sore feeling in the nose with swelling and loss of smell;
putrid discharge from the nose ; bony tumors on the head, arms and legs ;
nodes developing on the short and flat bones ; caries of the palate bones ;
ulcers in the mouth and nose ; violent headache from tophi in different
parts of the cranial bones; mental disturbance, which not infrequently results
in attempts at suicide.
Berberis Aq. —Inveterate cases o' tertiary syphilis.
Carbo Yeg. — Syphilitic ulcers, iiritable and sensitive, with sharp, ragged
and undermined margins, discharging thin, acrid and offensive matter;
cachexia syphilitica ulcers, painful and bleed easily ; burning eruptions on
the skin ; weakness, such as is caused by loss of animal fluids ; coldness and
blueness of the skin.
Cinnabar.—Secondary syphilis, chronic mucous patches in the buccal
cavity, sleepiness during the day and sleeplessness by night; in the transi-
tion stage between primary and secondary stages of syphilis, when vegeta-
tions and mucous patches are the predominant lesions ; sycotic excrescences;
small ulcers on the roof of the mouth, on the tip of the tongue and on the
98
constitutional syphilis.
lips; it is suited to the whole range of the syphilides, from the macular to
the luxuriant condylomata, and disorganization of the tonsils ; in syphilis of
scrofulous children and impaired systems of females.
Corydalis. — Syphilitic nodes on skull; ulceration of fauces; profuse
morbid secretion of mucus ; fetid breath ; secondary syphilides.
Hecla Lava. — Destructive ulceration of the nasal bones.
Hepar Sulph. —After abuse of mercury ; mercurious-syphilitic diseases,
falling off of the hair; painful lumps on the head and osteocopic pains in
the bones of the skull; eruptions around the mouth ; swollen tonsils and
hard glandular swellings on the neck ; chancres that bleed easily but are not
painful; margins of ulcers elevated and spongy ; buboes after mercurial
treatment; humid sores on genitals, scrotum and folds of the thighs and
scrotum; herpes preputialis.
Jodium. — Mercurial cachexy; syphilixia ; salivation from mercury;
gumma in the buccal cavity.
Kali Bichrom. — Deep ulcers on the edge of the tongue ; ulcers in the
mouth and fauces ; fetid discharge from the nose ; bone-pains all over the
body; pustular syphilides ; suppurating tubercles forming deep excavations;
caries of the bones of the nose ; ulcers having a disposition to become phage-
denous ; indurated chancre, syphilitic laryngitis, with dry, hoarse, hacking
cough and tenacious sputa.
. Kali Jod.—After abuse of mercury; secondary and tertiary syphilis;
tuberculous pustules on the face ; roseola on chest and ex remities; large
discolored ulcers on the skin ; gumma of the buccal cavity ; swelling of
bones ; osteocopic pains, aggravated at night; alopecia ; ulcerations of the
nose, mouth and throat; the system depressed ; effusions of serum into the
cellular tissues ; deep chancres with callous edges ; papulous eruptions of
the skin; ulceration of nose, mouth or throat with corrosive, burning dis-
charge.
Lachesis.—Phagedenic chancre ; gangrenous ulcers in the mouth and
throat, caries of tibia ; flat ulcers on the lower extremities with livid areolae ;
earthy yellowish appearance of the face ; ulcerated sore throat with constant
coughing: retching, painful deglutition.
Lycopod. — Secondary, tetter-like eruptions on the skin ; ulcers in the
throat of a dark, yellowish-gray color ; cough and horseness from affections
of the larynx ; coppery eruptions bn the forehead and cachectic appearance
of the face ; dry pedunculated, painless condylomata on the sexual organs ;
osteocopic pains in the limbs during wet weather; low-spirited, despondent
and nervous weakness.
Mercuri.ls.—See page 77 — 79. Compare syphilis and mercury,
page 73.
Mezereum. — Syphilitic periostitis; mercurialism; constant headache
from nodes in the skull bones ; dark redness of the fauces ; pains through
the whole body; osteocopic pains in the bones, worse at night; bones
constitutional syphilis.
99
inflamed and swollen, especially shafts of long bones ; oone-pains produced
by mercury, syphilis or both combined; stinging, pricking pains in the
urethra ; fainting, with vertigo.
Nitric Acid. —Phagedenic chancres ; ulcers in urethra with purulent or
bloody mucous discharge ; syphilitic ulcers (gumma) in the mouth ; ulcers
bleed when touched, with exuberant but pale and flabby granulations,
irregular edges; ulcers in vagina covered with a yellowish pus (gummav;
copper or bronzed colored spots on the skin ; squamae, rupia, mucous tuber-
cles ; condylomata ; ulcers inclined to spread with tendency to fungous
growths; moist condylomata, like cauliflower, or on thin pedicles; syphilitic
epilepsy and melancholia ; dryness and itching of the skin ; ulceration of the
skin with stinging pains ; ulceration of the uvula, pharynx, fauces ; soreness
of the tongue and its edges ; alopecia ; sadness and despondency; nervous-
ness with taciturnity, ill-humor and aversion to work; weakness of memory;
dizziness and inability to perform any mental work ; in mercurial or mercu-
rio-syphilitic diseases.
Phosphoric Acid.—Corroding itching herpes preputialis ; condylomata
in the penis ; sycotic excrescences; fig-warts complicated with ch'ancre;
interstitial ostitis of syphilitic or of mercurio-syphilitic origin, with noctur-
nal pains as if the bones were scraped by a knife ; alopecia in the sexual
organs ; heat and burning in sycosis ; depressed spirits, forgetfulness ; weak-
ness of memory with difficulty of comprehension ; objects appear unstable,
with tendency to paresis.
Phosphorus.—Syphilitic psoriasis in palms of the hands and soles of
the feet; syphilitic roseola; squamous syphilides ; mercurio-syphilitic ulcers
on the prepuce ; bone-pains and exostosis ; nodes on the long bones.
Phytolacca. — Secondary syphilis; ulcers in throat; syphilitic rheuma-
tism and syphilitic eruptions ; pains shift; joints swollen and red ; perios-
teum affected (nodes) ; pains in shafts of long bones', worse at night and in
damp weather ; glands swollen and inflamed ; ulcers with lardaceous base ;
weakness and prostration of the whole system ; blotches on the skin, after-
wards invading the throat; rupia and. the syphilides in secondary syphilis ;
periostitis of the skull bones.
Sepia.—Burning, itching, humid, or scurfy herpes preputialis; chappy
herpes, with a circular desquamation of skin , eruptions on glans or on the
labia externa; itching and dry eruptions on mons veneris; syphilitic ero-
sions in women.
Stillingia.— Secondary syphilis; severe osteocopic pains; nodes on
head and legs ; syphilides of the skin with ulcerations, and scabs on the body
from syphilis ; enlarged cervical glands ; moist, brownish, excoriating erup-
tions on the scalp ; muco-purulent discharge from the nose, with excoriation
of the upper lip and alse nasi; dull pasty complexion ; dark-red, soft tuber-
cular eruptions on the skin, ulcerating and furnishing a large quantity of
unhealthy pus. (Hale.)
Staphysagria. —Mercurialism ; secondary syphilides ; round or oval,
whitish and raised patches (gumma) the mucous membrane of the mouth.
100
CONSTITUTIONAL SYPHILIS.
nose, prepuce and anus; a diptheritic exudation, which, when wiped off,
leaves a raw surface behind; throbbing headache from the nape of the neck
to the head ; soft, humid excrescences on and behind the corona glandis ;
excrescences and nodosities of gums, female sexual organs painfully sensi-
tive ; dry pedunculated fig-warts and mucous tubercles ; nervous prostration
Silica. — Mercurio syphilitic ulceration of skin and bones ; moist or dry
eruptions of red pimples or spots on genitals ; chancres-with raised edges in
impaired systems ; painful eruptions on genital organs.
Sulphur. — Mercurio-syphilis ; itching ulcers, which are soon covered
with a scab ; thick crusts on the prepuce discharging pus from underneath ;
tertiary syphilide ; bronzed-colored spots on the forehead ; excoriations on
the genitals with burning ; glandular swellings, indurated or suppurating ;
moist condylomata on the genitals ; cock's comb like excrescenses on the
glans, soft, spongy and easily bleeding,
Thuja. — Syphilitic erosions on the female genitals, with profuse dis-
charges ; erosions between the thighs and on the sides of the scrotum ;
mucous tubercles in the fauces; moist mucous tubercles; itching ulcers
with unclean bases, or whitish chancres with hard edges; condylomata;
sycotic, moist excrescences on prepuce and glans—alopecia ; chronic ulcers
with flat and indurated edges; syphilitic cachexia ; teeth decaying in the
fangs; rupia, condylomata in various parts of the body; iritis, followed
by tubercles or watery excrescences on the iris ; purulent pustules; red
nodosities on the temples.
In the selection of remedies for the various syphilides, it is
necessary to examine minutely not only the manifestations of the
disease but also the idiosyncrasies of the patient. If the patient
has been mercurialized to the extent of producing drug symp-
toms, I recommend Nitric acid, Kali jod., Staphysagria, and such
remedies as are in close rapport to the mercurialism.
If the patient is strumous, lymphatic, or of impaired physical
force, and has not been mercurialized, I give Merc jod. This
remedy closely corresponds with syphilitic angina ; ulcers in the
mouth, fauces, and throat; the secondary syphilides; pains in
the throat and osteocopic pains, aggravated at night.
In quite a large experience in the treatment of syphilides, both
in the army and in civil life, I am convinced not only that mer-
curials are the proper remedies ordinarily for the primary and
secondary stages of this, malady, but that there are conditions
under which they become useful even in the transitional and ter-
tiary stages. Corollary to this, I will state, that in each of the
stages of disease named, there are circumstances under which
mercurials are not only not beneficial but absolutely injurious.
CONSTITUTIONAL SYPHILIS.
101
It is, I believe, a pretty generally recognized fact that persons of
a delicate, sensitive organization, those of a highly strumous dia-
thesis, and those whose constitutions have been impaired by in-
cidental causes, are not only exceedingly intolerant of mercury,
but are unpleasantly and sometimes seriously affected by the use
of this remedy. These effects become more pernicious, and
the evil impressions made in such cases more baneful, in propor-
tion to the crudity of the mercurials employed. The error lies
not in the fact that mercurials are curative of syphilis, but in the
evil impressions made by the poisonous doses of the remedy. In
the first and second stages of syphilis, in active, strong, rotund
and robust constitutions, mercury may be employed in the lower
potencies (and when I say lower, I mean the first and second
potencies) without producing any marked perturbating influences
contraindicating its use; but if the remedy is continued too long,
or is too frequently given, the syphilitic poison gradually yields
its pernicious effects, and there is a merging of the syphilitic into
a mercurial disease, which becomes even more inimical to treat-
ment than the original malady. Therefore I advise that mer-
curials be used with more caution than is recommended by certain
of our syphilographs. As a rule, the first stage of syphilis bears
the mercurials better than the advancing periods, and the further
removed the patient is from this first stage, the better effects are
produced by the higher potencies. For years past I have never
employed the mercurials in the first stage lower than the second
potency, and in the secondary and tertiary stages lower than the
3rd to the 12th attenuation; and I assert (modestly be it said)
that my results in the treatment of syphilis in its varied forms
have been, to say the least, successful.
The curative action of mercury depends, first of all, in the
judicious selection of the cases to whom the remedy is to be
administered; second, the form of the mercury which is to be
given; and third the potency of the mercurial to be employed.
The allopathic school, while denouncing the law of similars, or as
Bumstead remarks, " the elastic principle of similia," is gradually
deserting the beaten track of its fathers, and are recommending
what they call the "tonic dose," that is, the dose that does not
produce the multiplied horrors of the past heroic treatment, but
which cures, because it does not poison so extensively; for, as is
alleged, the patient " feels well under it in most cases, he eats
well, his functions go on perfectly, and his blood is richer in
102
CONSTITUTIONAL SYPHILIS.
red corpuscles than it was before," This "tonic dose," so called,
is the 1/18 of a grain of the iodide of mercury, or the 1/100 of
a grain of bichloride. Is not this an important advance over
those of the same school, who taught that to cure syphilis by
mercury the gums must be touched, to show that the system is
fully under the influence of the mercurial poison ? The tendency
of the allopathic school is to advance toward the plane of attenu-
ated medicine, in the treatment not only of this disease, but of all
others; while to our discredit, I regret to say, there is a disposi-
tion on the part of some to fall back into the mire of ponderable
and poisonous doses of this remedy. While my observations in
the treatment of this malady do not carry me beyond the 12th
potency, I know there are those who testify that high potencies
(the 200th to the 1000th) "will cure syphilis even in the first
stage." This proposition does not seem so clear to me, from an
analysis of the history of such cases, and the treatment pursued
by the so termed " high potencies ; " for the fact is patent, that
hundreds of cases with undoubted chancre, having no treatment
at all, neither mercurial nor otherwise in the first stage, do not
have either secondary or tertiary symptoms. These are the cases
that get well without treatment " under all systems of treatment,"
or, as Diday expresses it, "by the grace of God." Prof. Dana
has written an interesting and valuable monograph, in which he
shows that syphilis runs its course without treatment, and even
underneath the most unhygienic surroundings, without either
serious complications or sequelae. Mr. Keys and others, contend
that it is " a self-limiting malady, and its general treatment may
be, and often is, left entirely to nature." One thing is certain,
that while the virus of syphilis invades the system, under all
circumstances the patient should be placed under the most favor-
able dietetic and hygienic influences while undergoing treatment.
He should be placed under the highest possible condition of bodily
vigor while the poisonous influences within are controlled by the
mercurial similimum. Frequent bathing, warm clothing, un-
stimulating diet, abstinence from alcohol and moderate exercise
in the open air and sexual abstinence should be rigidly insisted
upon. If mercury be given early, it not only facilitates the dis-
persion of the primary lesion (chancre), but it mitigates and often
entirely eradicates the severity of the syphilides and the manifold
symptoms that accompany them. For these reasons the effect
of the mercurials upon the system should be continued for at
CONSTITUTIONAL SYPHILIS.
103
least six months after all the conditions of infection have sub-
sided. The hygiene of the genito-urinary organs should be
diligently cared for during and after the appearance of the initial
lesion. These parts should be kept scrupulously clean and dry,
and salt water or medicated baths employed at least daily, and
the glans, anus and perineum well cleansed with soap and water.
In patients whose stomachs fail to perform their accustomed
functions, when digestion and assimilation are at fault, attention
must be given to properly directed food, together with such reme-
dies as are appropriate to overcome the attendant troubles.
Smoking and the use of tobacco in all its forms is strictly for-
bidden.
Syphilis of the Respiratory System, of the bones, muscles,
tendons, joints, heart and great blood-vessels, as well as that
which attacks the brain, nerves and organs of special sense,
including the affection of the kidneys and genito-urinary system,
find their diagnosis in the history of the case and the antecedent
character of the symptoms presented. The gummy forms of
disease are found invading the structures of almost all the organs
indicated, with degeneration of tissue and the accompanying
lesions that have been described under the head of syphilides,
including both the secondary and tertiary forms of the malady.
The treatment of these conditions will be the same as previously
mentioned under the head of constitutional syphilis; and the
iodide of potash, the iodides of mercury, and the iodides alone,
and such remedies that have been already spoken of, will be
found the most serviceable methods of cure in all these affections.
Gumma may form in any structure of the body, and whenever
developed consists at first of a collection of nucleated, round and
spindle cells, which becoming absorbed remain as a mass of
cheesy debris, or soften and make their way to the surface. No
muscle or tissue is exempt from liability to attack, and it invades
the large muscles of the body as well as the delicate organs of the
mouth and fauces alike. It may begin as a painless tumor, either
movable or stationary, but it terminates in the destruction of all ,
tissues involved in the new growth, whether it becomes cheesy,
or softens and discharges. The treatment consists in the adminis-
tration of the iodides of mercury and potash, nitric acid, etc.
104 INFANTILE SYPHILIS.
It must be remembered that in syphilis, whether in the pri-
mary, secondary, or the tertiary stages, we have to encounter a
virulent, destructive and all-pervading poison, which contamin-
ates the blood, attacks various organs, impairs function, enfeebles
nutrition and gradually undermines the vital powers. To oppose
these depressing effects, to arouse and revivify the drooping
powers and to reinstate the innervated vital forces, is the chief
object of the practitioner. Here I would refer to what I have
before said of the remedies to be employed and the potencies to be
selected. To bring about the usual standard of health, we should
employ all such means as will impart vigor and strength to the
unfortnnate invalid. Among these are a generous and nutritious
diet, friction of the skin, baths, well-directed exercise in the open
air, warm clothing, absence of all depressing moral influencies,
and above all, the absolute necessity of a continued and prolonged
perseverence in the proper course of medical treatment as hitherto
directed.
CHAPTER VI.
Infantile Syphilis.
If either of the parents are syphilitic, the infant may inherit
the disease. If the father is contaminated, he may transmit the
disease to the foetus directly, at the time of conception, and the
mother may be infected through her offspring; or he may com-
municate it to the mother, and she may infect the child; or, if
the mother alone is syphilitic, the foetus may become affected
during intra-uterine life, through the blood of the mother. Under
such circumstances, the fcetus is apt to die about the fourth
month, which ends in miscarriage. Eepeated miscarriages, with-
out some overt act, at once suggest syphilitic contamination.
Under more favorable auspices, the child may be either born
alive, thin, and shriveled, with a prematurely old expression, a
hoarse voice, a snuffling breathing, nasal discharge, and perhaps
covered with a scaly eruption; or it may be born apparently
healthy, and the syphilitic symptoms develop a month or two
afterward.
SPERMATORRHOEA.
105
Treatment. —The infant should be removed from the breast,
and be brought up by hand, that it may not imbibe further poison
from its mother, or infect a hired nurse. This having been done,
either of the following remedies may be employed, in accordance
with their pathogenesis, and the characters of the case: Fer.
jod., Calc carb. and jod,, Hepar, Kali jod., Mere jod., Mez.,
Lach., Nit. ac, Phytol, Sang., and Thuja. The utmost attention
should be given to those general hygienic and dietetic principles
that are so imperatively demanded in all cases of blood poison
and otherwise depraved systems.
CHAPTER VII.
Spermatorrhoea.
Spermatorrhoea, or seminal flux, is chiefly met with in young
men, usually from the ages of eighteen to thirty years, and is
commonly the consequence of that terrible vice, which, practiced
in solitude, emasculates the body, enfeebles the mind, and degrades
the moral status of the mind to a condition of absolute loathing
and disgust of self. The generative organs seem to be impressed
with a dual mixture of irritability and debility; the testes are
excited into action by the simplest causes; a look, a thought, the
gentle motion of a carriage, or the effort at stool, will produce
a feeble ejaculatory effort, a few drops passing the urethra. From
two to four emissions during the week, or oftener in the more
advanced stages, mark the debility of the organs, and the irrita-
bility that invests them. In a short time, the physical and
mental powers suffer; 'the face is pallid, sallow, and anaemic;
there are ringing in the ears, dyspepsia, and emaciation; the
features are drawn; expression is listless; eyes lifeless; spirits
depressed to the very verge of despondency and despair. Coitus
is impracticable, as the gush of semen takes place either before
erection occurs or without its occurrence, the most melancholy
forebodings ensue, and the patient is dragged down to the very
depths of degradation and moral discomfort.
Causes. — Self-abuse; morbid conditions of the urethra; irri-
tability of the bladder; constipation; rectal irritation; ascarides;
106
SPERMATORRHOEA.
haemorrhoids; prolapsus ani; elongation of the prepuce; fre-
quent excitations of the passions without natural gratification;
sexual excesses; excitation of the sexual organs from novel read-
ing, etc.
Treatment.—The curative treatment consists in the use of
those agents, which, while they diminish irritability, invigorate
and strengthen the genito-urinary organs. Happily for human-
ity, Homoeopathy offers a rich Materia Medica for the various.
conditions and varieties of this truly pitiable disorder, among
the most valued of which are the following: Anac, Aur., Agnus
cast., Bell, China, Camph., Bufo, Brom., Calc, Canth., Eryng.
aquat., Cobalt, Gels., Dig., Ferr. brom., Phos., Phos. ac, Plat.,
Puis., Iris vers., Nux vom., Kali brom., Nuphar lute a, Selen.,
Staph., Sepia, Ustilago, Zinc ox., Sidph. (See " Special Indica-
tions," at the end of this chapter.)
Local Measures are the cold salt-water sitz bath, every night
and morning, or the cold shower bath; light bed-covering, and a
hard mattress; light suppers, entire absence from all highly
seasoned food, wines, liquors, tobacco, etc.; properly directed
exercise, ventilation, a well-regulated diet, Electricity, the pleas-
ant occupation of the mind, the avoidance of stimulants and of
all enervating habits, and, above all, the cheering effects of pleas-
ant society, pursuits, and amusements. A suspensory should be
worn constantly; and a knotted towel, the knot to the spine,
should be tied around the body, so that the patient will be
awakened by the pressure whenever he lies over upon his back.
The wet girdle at nights, the spermatic ring, and Electricity are
valuable expedients.*
Impotence.—Impotence is often met with in persons ordi-
narily healthy, and in some cases where great muscular power
exists, and arises from either a natural 'deficiency in individual
organization, or from exhaustion of the nervous power by habitual
mental or physical exertion, by excessive sexual indulgence, over-
exercise, or study, carried to an intemperate degree.
Asperma.—This is very rare, except in cases of atrophy,
absence of the testes, or organic degeneration of their structure.
* "Roech's Emission Preventer," manufactured by Gross & Delbridge,
Chicago, has proved of great value in the hands of many physicians. It is a
bandage that keeps the penis in a position in which an erection, as well!
as any discharge, is impossible.
SPERMATORRHOEA.
107
It has been observed that each individual possesses a certain
given amount of procreative power, which/being early exhausted
or habitually wasted by frequent intercourse, can be restored par-
tially only by such attenuated remedies as have a decided
penchant for these organs. Among the remedies are: Agnus.
cast,, Anacard., Berb., .Bufo, Calad., Con., Gels., Phos. ac,
Papaya, Selcn., Staph., Ustilago. Other general and local means,
as already recommended, should be employed during the prog-
ress of the treatment.
Marriage. — This important question, so frequently referred
to the practitioner as to its curative value, is hereby presented for
future guidance:
1st. If spermatorrhoea exist in the spinal or cerebral form, mar-
riage is injurious.
2d. If the disease exists in its general form mainly, and the
act can be consummated without injurious consequences to the
patient, although imperfectly, marriage may be advised.
3d. As a rule, marriage should not be recommended as a cura-
tive remedy.
Special Indications for Spermatorrhoea.
Ferrnm Met. —Impotence from abuse of sexual organs in weak people;.
great debility following the discharge, and nocturnal emissions.
Stillingia and Nux Vom. — Caused by masturbation, or abuse of alcoholic
liquors, coffee, sedentary habits, and mental exertion.
Plumbum.—With a relaxed penis, after drinking wine, with lassitude
next morning; violent, painful erections from the least excitation.
Gelseminm. — From relaxation, weakness, and irritability of the seminal
vesicles.
Belladonna. —From weakness of the seminal vesicles, with sweating of
the sexual organs, and pressing and lacerating pains in the parts ; indifference
to voluptuous excitement; sexual desire extinguished ; sadness, with increased
sexual desire.
Selenium. —Itching and coldness of the genitals; nocturnal emissions,
with amorous dreams ; the semen escapes with every stool, and after urinat-
ing ; dribbles away unperceived during sleep ; is very thin, and odorless ; he
is hopelessly distressed.
Ustilago Madis. — With erotic, amorous dreams.
Ferrum Brom. —Great debility, anaemia, and depression of spirits.
Cantharides. — With great impotence, and inability to retain the urine.
Nuphar Lut. —With painless morning diarrhcea.
Sepia. —Mental symptoms; after coitus, anxious and restless all day;
discouraged and easily frightened in the evening ; vertigo.
108 spermatorrhea.
Antimonium Crudum. —After lascivious fancies, less sexual desire.
Phosphorus.—Cerebral excitement, with flushed face and glistening
eyes ; satyriasis.
Stramonium. —Depression of spirits, with spermatorrhoea; great delir-
ium ; sexual excitement during the night; during mental derangement;
sexual irritation.
Dioscorea Till.—Depression of spirits; great weakness of the knees
after pollution, without erection, sensation, or dreams.
Natrum Carb. —Dissatisfied and vexatious; out of humor after painful
emission.
Natrum Mur. — During lascivious thoughts, without erection, profuse
discharge of prostatic fluid.
Lycopodium. — Exciting imagination even causes no erection, although
there is sexual inclination.
Digitalis.—Frequent lascivious fancies, day and night.
Hamamelis Virg.—Gloomy and depressed mood after emissions, with
amorous dreams.
Ustilago Madis. — Great despondency, and irritability of the mind, with
great despondency; great prostration, and great pain in the lumbar region
the day after an emission, with sexual dreams; erotic ideas, fancies, and
amorous, with seminal emissions, and spermatorrhoea.
Thuja Occid. —Heaviness and ill humor after emissions.
Selenium. —Hopelessly distressed, semen escapes with every stool, and
•after urinating.
Conium Mac.—Hypochondriasis from denial of sexual intercourse;
among single men ; sad, anxious, low spirited ; suppression of sexual desire.
Staphysagria. — Indifference, low spirits, and dullness of mind, after
onanism.
Ignatia. — Lascivious and amorous fancies, with exalted sexual desire ;
weakness of the parts, and impotence, and sexual fancies and dreams.
Mercurius Vivus. — Excitement, with painful nocturnal erections, with
tension seemingly caused by flatulence. Impotence from abuse of the sexual
•organs.
Ambra Gris.—Imaginations, without irritation of the sexual organs.
Silicea. — Thoughts with sexual desire very much excited day and
night, with frequent erections, and drawn-up testicles ; ill-humor and irrita-
bility after coitus.
Caladium Seg. —Lewd thoughts without erections.
Calcarea Carb. —Nervous relaxation ; discontent, and irascibility, with
trembling and great weakness in the legs, principally in the knees ; ill humor
and dissatisfaction.
Graphites. — Thoughts run on sexual subjects, tormenting him so that
he fears insanity.
INDEX.
A
Page.
Abscess, urinary............... 4 s?
Accession period of gonorrhoea . 11
Acute inflammation of gonor-
rhoea ..................... 11
Alopecia, syphilitica......... 85
Anal, chancroid................ 6S
Asperma...................10G
B
Balanitis..................... 17
Blenorrhagia................. 12
treatment of...... 12
Bladder, indications for remedies 20
Bubo of chancroid............ 62
" indolent ................. 63
" simplo................... 63
" spontaneous....... ...... 64
" virulent.................. 63
C
Cancer of the testicle........... 37
Chafing of the glans.......... 33
Chancre....................... 71
Chancre, urethral.......... . 76
Chancroid.................... 61
Chancroid, anal and rectal...... 68
Chancroid of the fingers........ 70
Chancroidal bubo............. 02
Chancroid, subpreputial........ 68
Chancroid, vulval and vaginal.. 09
Chordee...................... 31
Chronic orchitis.............. 35
Comparative symptoms of mer-
cury and syphilis.......... 73
Condylomata, gonorrhoeal...... 30
Condylomata of the iris........ 87
Page.
Condylomata, syphilitica..... 88
Constitutional syphilis......... 82
Cystitis........................ 18
Cystic sarcocele............,.. . 36
D
Differentiation between typical
chancre and chancroid..... 72
Dilatation in organic stricture. . 40
Discharges, chronic from vagina 61
Diseases, venereal and sexual . . 9
E
Ecthyma superficial, syphilitica 90
Enchondroma of testicle....... 37
Epididymitis.................. 16
Epispadias.................. 35
Excision of chancre........... 76
Excrescences, horny........... 30
External urethrotomy........ 43
Extravasation of urine......... 47
Erythematous syphilide........ 87
F
Fistula, urinary................ 48
Follicular inflammation of ure-
thra.................... 31
Frenum, rupture of............ 33
Fibroid tumor of the penis..... 34
Fungoid growth of testicle..... 36
G
Gangrene of the penis......... 34
Glans, chafing of.............. 33
Gonorrhoea and other diseases . 11
110
INDEX.
Page.
Gonorrhoea, indications of re-
medies for............... 13
Gonorrhoeal, ophthalmia...... 53
Gonorrhoea in women.......... 57
Gonorrhoeal, rheumatic........ 56
Gonorrhoea, sicca.............. 15
" urethritis.......... 58
" uteritis ............ 59
vulvitis............ 58
Gumma of the larynx.......... 95
" " nose........... 94
" " skin............ 94
H
Herpes of the glans and prepuce 29
History of venereal diseases--- 9
Horny excrescences............ 30
Hypertophy of the prepuce--- 29
Hypospadias.................. 34
I
Impotence..................... 106
Incubation of gonorrhoea....... 11
Indolent bubo................. 65
Infantile syphilis..............104
Inflammatory stricture......... 37
Injections, vaginal............. 60
urethral............ 12
Internal urethrotomy.......... 41
Iris, condylomata of........... . 86
Iritis, syphilitica............... 86
Ischuria....................... 19
L
Larynx, syphilis of............ 83
M
Maniage for spermatorrhoea.... 107
Mucous membrane, syphilis of.. 83
N
Nodes, syphilitic.............. 84
O
Onychia, syphilitica........... 86
Ophthalmia, gonorrhoeal....... 53
Page.
Organic stricture............... 38
Orchitis, acute................. 16
" chronic.............. 35
Osteocopic pains............... 84
Ostitis, syphilitica............ 84
P
Pains, osteocopic.............. 84
Papular syphilide.............. 88
Paraphimosis.................. 28
Patches, scaly................. 95
Periostitis, syphilitica......... 88
Phimosis...................... 27
Pigmentary syphilide.......... 20
Posthitis...................... 17
Priapism..................... 84
Prostatitis, acute.............. 49
" chronic.............. 50
Prostate, senile hypertrophy of 50
Prophylactics in gonorrhoea--- 12
Pustular syphilide............. 89
B
Rectal chancroid............... 68
Resilient stricture ............. 43
Retention of urine..... ..... 46
Rheumatism, gonorrhoeal...... 56
Roseola syphilitica............. 87
Rupia......................... 93
Rupture of the perineum...... 33
S
Sarcocele..................... 35
Sarcocele, cystic.............. 36
Scaly patches................. 95
Senile, hypertrophy of prostate. 50
Simple bubo................... 63
Spermatorrhoea................105
Spontaneous bubo............. 64
Sqamous syphilide............ 91
Subperiosteal chancroid........ 68
Stricture, organic............. 38
" resilient............. 43
" spasmodic........... 37
Syphilis...................... 70
Syphilides..................... 82
INDEX.
Ill
Pase.
Syphilis, constitutional........ 82
Syphilitic cephalalgia.......... 84
Syphilis, infantile.............. 73
Syphilitic iritis............... 86
Syphilis of mucous membranes. 83
Syphilitic nodes................. 84
Syphilide, papular............. 88
•' pustular ............ 89
squamous........... 91
tubercular........... 92
Syphilitic ulcerations.......... 83
Syphilide, vesicular............ 91
Sycosis........................ 30
T
Testicle, cancer of.............. 37
" encondroma of........ 37
" fungoid growths of___ 36
Tertiary syphilides ............ 93
Title page..................... 1
Tubercular syphilide ....... 92
U
Urethra, indications for remedies 20
Urethral chancre............... 76
Page.
Urethra, follicular inflamma-
tion of................ 31
Urethritis .................. 12
Urethritis, chronic in women... 61
Urethrotomy, external ......... 45
internal......... 41
Urethritis, gonorrhoeal......... 58
Urinary abscess............. 48
Urine, extravasion of.......... 97
Urinary fistula................. 48
Urine, retention of............. 46
Uteritis ...................... 59
V
Vaginal chancroid............. 69
Vaginal injections............. 60
Venereal diseases............... 9
warts ............... 88
Vesicular syphilide .......... 91
Virulent bubo................. 66
Vulval chancroid.............. 69
Vulvitis, gonorrhoeal........... 58
W
Warts or sycosis............... 30
Women, gonorrhoea in......... 57
MAECH 1883.
DESCRIPTIVE CATALOGUE
GROSS & DELBRIDGE'S
HOMOEOPATHIC
Medical Woeks.
For Sale at all Homoeopathic Pharmacies, or
will be sent prepaid on receipt of price.
CHICAGO:
GEOSS & DELBEIDGE.
1883.
GEOSS & DELBEIDGE'S Publications.
The Science and Art of Obstetrics, by Sheldon Leavitt, M. D.,
Prof, of Obstetrics and Clinical Midwifery in Hahnemann
Medical College and Hospital, Chicago; author of " The
Therapeutics of Obstetrics," etc. With an Introduction by
Prof. Ludlam. 659 pages, royal octavo. Price, cloth,
$6.00; sheep, $7.00.
This work is intended to fill the want so long felt by Homoeo-
pathic teachers of Obstetrics, students, and practitioners, of a
text book which should deal with the subject as both a science
and art, and embody the researches and improvements which
have been made in this branch of medicine during the past few
years. The work has been carefully prepared, and sets in the
foreground no theories or empty chimeras in respect to etiology,
pathology, diagnosis or treatment, but accepted ideas, and rational
deductions from extensive observations and experience.
Indeed, we may say at once, that in the completeness and care with which
the subject is presented, in perspicuousness of arrangement, and in the judg-
ment with which the latest and most approved views and practice of leading
authorities, at home and abroad, are brought together, it surpasses all the
other treatises on Midwifery of our school.—New England Med. Gazette.
The work of Dr. Leavitt has been carefully examined both by Dr. Southwick,
and by myself, and both of us have formed a most favorable opinion of the
ability and conscientiousness of the author. We shall both have much
pleasure in recommending the book warmly to our students.— W. Wesselhoeft,
Prof, of Obstetrics in Boston University.
The author is already favorably known to the profession. Taking the
advance pages as a sample of the book. Professor Leavitt has evidently done
his work thoroughly. It promises to be a valuable addition to our obstetric
literature.—Medical Advance.
Professor Leavitt has honored himself and the profession by his book. It
will take high rank as a Text Book, and prove most serviceable to the prac-
titioner.—J. O. Sanders, M. D., Prof, of Obstetrics in the Cleveland Horn. College.
We unhesitatingly place this book at the head of its department and have
no doubt it will become the Text Book of all our colleges.—New York Med-
ical Times.
The author has achieved a signal triumph for medical literatnre. His lan-
guage is clear and forcible, and his arrangement of topics excellent. The me-
chanical part of the work is almost perfect.—Homeopathic Journal of Obstetrics.
I have given Prof. Leavitt's Obstetrics a prominent place among my books
of reference. I consider it one of the best Text Books in our literature, and an
honor to the publishers thereof.—E. 31. Hale, 31. D.
Leavitt's Science and Art of Obstetrics I have examined with care, and re-
gard it second to no work on the subject It is an hor.or to the profession, and
the mechanical part a credit to the publishers.—D. S. tmith, 31. D.
I am highly pleased with it.—Henry 3Iinton, 31. D., Editor Homoeopathic Journal
of Obstetrics.
I have read Prof. Leavitt's work on Obstetrics, and am delighted with it.—
I. T. Talbot, 31. D., Prof, of Surgery in Boston University.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
A Physiological Materia Medica, containing all that is
known of the Physiological Action of our Eemedies, their
Characteristic Indications, and their Pharmacology. By W.
H. Burt, M. D. Chicago: Gross & Delbridge. 1881. 992
pages. Cloth, $7 ; Sheep, $8. Third edition. For sale by
Homoeopathic Pharmacies, or sent free by the Publishers, on
receipt of price.
We believe that no book on Materia Medica in our literature so
completely meets the requirements of the Physician and Student
as this; and, as proof of the correctness of this opinion, we have
to announce the sale of two editions in fifteen months.
Such a reception has never been awarded before to any book in
Homoeopathic literature. The demand for the work indicates that
its appearance was opportune, and that its plan and execution
are approved by the Profession. We have received a large num-
ber of favorable notices both from Physicians and the Press, from
which we make the following selections:
Dr. Burt has brought together in a compact and well-arranged form an im-
mense amount of information. The profession will fully appreciate the labor
and skill with which the author has presented the physiological and patho-
logical action of each drug on the organism.—New York Medical Times.
"We are sure that Dr. Burt's' new work will have deservedly a rapid sale.
■Gross & Delbridge are a new publishing house in the medical line ; but cer-
tainly they must be old hands in the business, for paper and printing leave
nothing to be desired. May they never falter in such laudable work, and the
eyes of the readers will bless them forever.—Dr. Lilienthal in North Ameri-
can Journal of Homoeopathy.
An enthusiastic yearning for the whys and wherefores of our wondrous
Therapeutic art has brought Dr. Burt to the front again among the best book-
makers of our time.—St. Louis Clinical Review.
Dr. Burt has enriched our literature with many valuable contributions, and
the work before us gives proof of the value of his well directed labors.—
Detroit Medical Observer.
We can recommend the book as full of interesting and profitable reading.
—Hahnemwnnian Monthly.
Dr. Burt has the power of sifting the tares from the wheat.—Chicago Med-
ical Times.
We cordially recommend Dr. Burt's book.— New England Medical Gazette.
Have just received Burt's Materia Medica. It is a work long needed, and
the printing and binding are a credit to your house.—B. W. Nelson, M. D.
It is a keystone of medical study, and the printing and binding are the very
best.—67. a. Morrison, M. D.
The work is a credit to Chicago.—Medical Investigator.
GBOSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
An Index of Comparative Therapeutics, with a pro-
nouncing Dose-List in the genitive case,—a Homoeopathic
Dose-List,—Tables of Differential Diagnosis, Weights and
Measures,—Memoranda concerning Clinical Thermometry,
Incompatibility of Medicines, Ethics, Obstetrics, Poisons,
Anaesthetics, Urinary Examinations, Homoeopathic Pharma-
cology and Nomenclature, etc., etc. By Samuel 0. L. Potter,,
A. M., M. D., late President of the Milwaukee Academy ofj
Medicine, author of " The Logical Basis of the High Potency,
Question," "Munchausen Microscopy," etc. Second edition.'
The leading feature of this book is its comparative tabular ar-
rangement of the therapeutics of the two great medical schools.
Under each disease are placed in parallel columns the remedies
recommended by the most eminent and liberal teachers in both
branches of the profession. By a simple arrangement of the
type used, there are shown at a glance the remedies used by both
schools, as well as the remedies peculiar to each, for any given
morbid condition. Over forty prominent teachers are referred to^
besides occasional references to mtjre than thirty others. In the
first class are Bartholow, Einger, Phillips, Piffard, Trousseau, and
Waring of the old school; Hempel, Hughes, Hale, Buddock and
Jousset among modern homoeopathic authorities.
"Dr. Potter's compilation must be the result of a large amount of pains-
taking and accurate work, and will be appreciated. As an index it is very
elaborate and serviceable."—New England Medical Gazette.
"The work is really a multum in parvo ; as an index it is exhaustive, and
very often it supplies in few words the very information that is wanted."—
British Journal of Homaiopathy.
"I am much pleased with your Index. It is strong and will find salcj
among old as well as new school men."—Dr. J. P. Dake, Nashville, Tenn.
"It will furnish the busy practitioner with a summary of immense practicr.-'
value."—Dr. H. M. Paine, Albany, N. Y.
"It will be held in high appreciation by a large class of practitioners."—
Dr. C. P. Hart, Wyoming, 0.
"As a work of merit it will be appreciated by the profession generally."—
Dr. J. S. Fisher, Ada, 0.
"I like the idea very much; besides giving many valuable hints to the
practical physician, it is very interesting from a theoretical point of view."—
Dr. H. C. Clapp, Boston.
For sale at the Pharmacies, or sent free on receipt of price.
Price, in cloth, $2.00; in flexible morocco, tuck, $2.50.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
Lectures on Clinical Medicine. By M. Le Dr. P. Jousset,
Physician to the Hospital Saint-Jacques, of Paris; Professor
of Pathology and Clinical Medicine ; Editor of LArt Medical.
Translated with copious Notes and Additions by E. Ludlam,
M. D., Professor of the Medical and Surgical Diseases of
Women and of Clinical Midwifery in the Hahnemann Medi-
cal College and Hospital of Chicago. Large 8vo. of over 500
pages, cloth, $4.50; half morocco, $5.00.
This work is one of very great interest to the profession and to
students, embodying, as it does, about forty years of experience
on the part of the author, and that of nearly thirty years by the
translator. It sets forth the best and freshest pathological views ;
the most practical application of the homoeopathic method of
treating disease; and a clear and forcible bed-side analysis of the
cases that are presented. The author discusses, from a very
practical standpoint, the questions of Alternation, Attenuation,
Dose and Eepetition, and of Individualization and Aggravation.
The subjects embraced in these lectures include Asthma, Emphy-
sema, Eheumatic Endocarditis, Articular Eheumatism, Bronchitis,
Pneumonia, Croup, Diphtheria, Typhoid Fever, Nephritis, Albu-
minuria, Haemoptysis, Haemorrhoids,Chronic Gastritis,Scrofulous
Ophthalmia, Hydrarthrosis, Pelvi-Peritonitis, Vaginismus, Men-
orrhagia, etc.
The practitioner may here find cases analogous to puzzlers
which occur in his own practice, and cannot fail to be benefited
by their perusal.
"The work presents the latest pathological data, the most practical method
of treating disease homasopathically, and a critical analysis of each case
related. It is eminently practical and demands the use of well proved reme-
dies."—From the Hahnemannian Monthly, Philadelphia.
It contains the very best and most reliable clinical experience in the prac-
tice of homoeopathy of any work extant in the profession.—A. E. Small, M.
D., in the, Chicago Tribune.
I have carefully read the work and hardly know whether I admire more,
the plain thorough pathology and diagnosis, or the practical common sense,
honest treatment set forth. * * The Notes of Dr. Ludlam are in keeping
with our best American authorship.— J. P. Dake, M. D., Nashville, Tenn.
The book is of great value to practitioners and students of medicine.—J
W Dowling, M. D., Dean of the New York Homaiopathic 3fcdical College.
I have read the work with a great deal of interest and find it to be eminently
practical, and of great value to the profession.— T. 67. Comstock, M. D., St.
Louis, Mo.
I have spent considerable time in examining Dr. Ludlam's translation of
Jousset's Clinical Medicine and cannot speak too highly of it. It fills a place
in our literature which has hitherto always been vacant — H. C. Clapp, M. D.,
Editor of tJie New England Medical Gazette, Boston, Mass.
GROSS & DELBRIDGE, Publishers,
48 Madison St.. CHICAGO.
GEOSS Sc DELBEIDGE'S Publications.
A NEW AND IMPORTANT BOOK.
Practitioner's Guide in Urinalysis. By Clifford Mitch-
ell, A. D., M. D., author of "Manual of Urinary Analysis,"
" Clinical Significance of Urine," etc. 12mo. Cloth. 205 pp. $1.50.
Gross & Delbridge, Chicago.
The object sought in this volume is twofold : First, to teach any one
who has had little or no experience in Practical Chemistry or Microscopy,
the use of chemicals and the microscope; and second, to give information
in regard to the clinical significance of urine, further than can be ascer-
tained in any other small and comparatively inexpensive work. The book
consists of an Introduction, Part I, Part II and an Appendix. The In-
troduction is devoted to a description of chemical apparatus, reagents,
nomenclature and processes, together with an explanation of the micro-
scope, its workings, reagents in urinalysis, and the like; a full and clear
description of te<-tubzs. test-glasses, pipefe*, filters, is given (with cuts)
and how to use them; a list of chemical reagents, how to prepare them
and how to keep them ; followed by a few pages of explanation of chemi-
cal terms, such as AUcmi, Acid, Sal s. Precipitate, etc., when the author
has made use of his experience as a teacher to put the definitions in such
a way as to remove the usual obscurity attendant upon these phrases.
The object of part first is to enable the physician or student to readily
acquire the essentials of urinalysis. All the tests given are such as can
be easily comprehended, the methods of quantitative estimation simple
and approximate, and the Clinical Summaries contain a world of infor-
mation condensed into small space.
Part second is devoted to the 'Clinical Significance of Urine," written
from the results of the author's own extensive experiments, and those of
Vogel, Kalfe and other English, French and German writers on this sub-
ject.
It seems to be exceedingly clear and intelligible in style, and admirably
adapted to the requirements of the medical practitioner especially in view ©f
its very full discussion of the relations of the results of urine analysis to medi-
cal diagnosis.—G. E. Moore, Ph. D., New York.
I have already bad occasion to make use of Mitchell's " Guide in Urinalysis,"
which I consider to be the best, the clearest and the fullest work on the subject
yet published, containing a remarkable amount of information in a most con-
venient form.—Ch. Gatchill, 31. D.
No abler or more painstaking scholar than Dr. Mitchell adorns our school
of medicine, and his work shows forth these characteristics in a marked degree.
It supplies a long felt want, and no wide-awake physician can do without it.—
Nicho. Francis Cooke, 31. D.
We cordially recommend this excellent work to all our practitioners. The
publishers have done their part well; paper and binding are good.—American
Observer.
The doctor has in this little work treated the subject concisely, and at the
same time in a plain and forcible manner.—T. D. Williams, 31. D.
Prof. Mitchell's work on Urinalysis is the clearest, fullest, and yet most con-
cise work on this subject with which I am acquainted.—Eobt. N. Tooker, 31. D.
A careful perusal enables us unhesitatingly to commend this admirable
monograph alike to the idle and " the busy practitioner."— Chicago Tribune.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CH'CACO-
GEOSS & DELBEIDGE'S Publications.
Antiseptic Medication, or Declat's Method. — By Nicho.
Francis Cooke, M. D., LL. D. Emeritus Professor of The-
ory and Practice in the Hahnemann Medical College and
Hospital of Chicago. 128 pp. 12 mo. cloth, 1882. Price $1.00.
Gross & Delbridge, Chicago, Publishers.
This is the first, and must continue to be for some time, the
only treatise on this vitally important subject, in the English
language. It is plain and practical. Though written only for the
physician, it cannot fail to attract attention from the intelligent
layman every where. Especially will it be welcome to the sufferers
from Consumption, Cancer, Pyemia, Necrosis and all forms of
blood-poisoning, and Malaria.
For the matter of this volume Dr. Cooke confesses his large indebtedness to
Dr. D£clat; but the remarkable cures of tuberculosis, cancer, septicaemia,
eczema, and malarial fevers recorded in the latter half of the book are strictly
original. The only treatise on the subject in the language, it must inevitably
fall under the eye of every intelligent physician, and the present notice may
therefore be limited to a description of its contents. These consist of an intro-
duction, which not more lucidly sets forth the teachings of De"clat than it ef-
fectually demolishes the claims of his rivals, Lemaire and Lister; some remarks
on • antiseptics in general, giving preference to phenic acid and the
protochloride of iron prepared according to Boudreaux's method; and an ex-
amination of phenic acid, both in its chemical and therapeutical aspects. Be-
sides all this, we have directions for the use of the hypodermic syringe; and
last, and most interesting of all to the laity, who care little how they are cured,
full accounts of a number of cases that have been successfully treated by the
method of Declat. The average medical man, who is more likely to close his
ears to the voice of the sage than to the song of the siren, vill skim lightly
over the cases of cancer, and say in his easy, superior way, that not one of them
was a case of true cancer. He will certainly say this to his own patients, for
whose enlightenment it may be well to mention that Dr. Cooke is an Emeritus
Professor of Diagnosis. Dr. Cooke has been wonderfully fortunate in his use
of the new remedy, but he has the candor to admit that he has not always
been victorious.—Ttie Chicago Tribune, Sept. 11th, 1882.
" Antiseptic Medication " is a small volume by Dr. N. F. Cooke, of the Hahne-
mann Medical college of this city, avowedly a treatise on the theory and method
of Dr. De'clat, a recent visitor from the old world, which have attracted a great
deal of attention of late. It is pretty generally safe to suspect something of
exaggeration in almost anything which takes so "sudden a hold upon popular
enthusiasm, but it must be said, from hastily running through Dr. Cooke's ad-
vance sheets, that he makes out a pretty strong case. * * -x *
The subject-matter treated of in Dr. Cooke's book belongs especially to the
medical profession, and the volume can scarcely fail to be one of great interest
to all of that profession not "hide-bound," as it is called, in foregone conclusions.
It is clearly the work of an earnest, thoughtful, and scientific man, even
if nothing else was known of the author.—Chicago Times, Sept. 11th, 1882.
Sent free on receipt of price.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
How to Feed the Sick; or, Diet in Disease. By Charles
Gatchell, M. D. Second edition, revised and enlarged.
12 mo. 160 pp., 1882. Price $1.00.
This work is a very practical and timely volume not only for
those who are sick, but also for those who are not really well, and
to whom the problem, "What shall I eat," is of vital importance.
As introductory, the various forms of animal, vegetable and
inorganic foods are considered and their relative merits carefully
pointed out. The Chapters that follow are devoted to such prac-
tical subjects as How to feed your patients, Diet for Dyspepsia
with aids to Digestion, Diet for Constipation, Eectal Alimenta-
tion, etc.; Diet in Consumption, Diet in Diabetis, Bright's
Disease, Gravel; How to nurse the Baby, How to choose a Wet
Nurse, How to wean the Baby, How to feed the Baby, Diet for
Cholera Infantum, Diet for Travelers, Seasickness, the Corpulent,
Scrofula, Eickets, Scurvy, Chlorosis, Collapse, Bheumatism,
Asthma, Heart Disease, Alcoholism, Diarrhoea, Dysentery, Chol-
era, Diphtheria, Gastritis, Biliousness, etc. Diet for convales-
cents is a valuable chapter. Then follows a long and carefully
prepared list of recipes for the preparation of Beverages, Meats,
Broths, Soups, Breads, Gruels, etc., etc.
Milwaukee, Wis.
"I consider your work on "How to Feed the Sick" to be the most
practical, and therefore the most useful, work on the subject with which I
am acquainted. No physician should be without it; every mother should
have it. It is in use in many of the households in which I practice."
C. C. Olmsted, M. D.
"This work is plain, practical and valuable. It is really a clinical guide
on diet, and one the profession will find reliable and correct."— United States
Medical Investigator.
"Evidently much investigation, thought and carefulness have entered
into the production of this work, and we believe it to be worthy a place in
every household."—1 he Magnet.
* * * <<"We have carefully examined the work and shall cheerfully
recommend it for family use. The directions as to what food and drinks,
and modes of preparation are very judicious." *****
Janesville, Wis. Kesp. Yours, Dr. G. W. Chittenden & Son.
Milwaukee, Wis., Sept. 8, 1880.
"Professor Gatchell's "How to Feed the Sick" is the best book on the
subject for the people. It contains in 160 pages an astonishing amount of
condensed information on a subject of great importance, and one but little
understood. Its style is admirable, pithy and to the point. The book has
no padding about it, and deserves an immense sale."
Sam'l Potter, M. D.
GEOSS & DELBBIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
The Key Notes of Medical Practice. By Ch. Gatchell, M. D.,
author of " How to Feed the Sick;" and formerly Pro-
fessor of the Theory and Practice of Medicine, University
of Michigan; Fellow of the Pulte Medical College, Cin-
cinnati, O.; Clinical Lecturer and Attending Physician
to Cook County Hospital, Chicago.
This book will contain, in convenient form, all the essential
points in the Practice of Medicine, including also Obstetrics and
Surgery, arranged for ready reference. An idea of the full and
varied character of the work may be gathered from the follow-
ing:
TABLE OF CONTENTS.
PART I.
General Diseases. Fevers. Continued Fevers. Typhoid Fever; Typhus
Fever; Cerebro Spinal Fever); Simple Continued Fever. Periodical Fevers.
Intermittent Fever; Remittent Fever; Pernicious Fever; Yellow Fever.
Eruptive Fevers. Scarlet Fever; Measles; Small Pox. Diseases of the Stomach.
Acute Gastric Catarrh; Acute Gastritis; Gastric Ulcer; Gastric Cancer; Gas-
tric Hemorrhage; Atonic Dyspepsia. Diseases of the Intestinal Canal. Cholera
Morbus; Cholera Infantum; Acute Dysentery; Proctitis; Typhlitis. Diseases
of the Respiratory Organs. Pleuritis; Pneumonia; Diseases of the Heart. Dis-
eases of the Blood. Erysipelas; Rheumatism; Diphtheria. Diseases of the
Kidneys. Diseases of the Brain and Nervous System. Diseases of the Eye and
Ear.
iAET II.
Obstetics and the Diseases of Women. Post-Partum Hemorrhage. Placenta
Praevia. Dystosia. Agalactia. Sore Nipples. Amenorrhcea. Dysmenorrhcea.
Menorrhagia. Metrorrhagia.
PART III.
surgery.
Operation for Tracheotomy ; Strangulated Hernia; Paracentesis Abdominis;
Thoracenteris. Surgical Emergencies. Hemostatics. The Venereal. Syphilis.
Gonorrhoea.
PART IV.
ACCESSORIES.
Diet in Disease. Nursing. Disinfectants. Urinalysis. Prescriptions. Clini-
■cal Thermometry. Weights and Measures. Poisoning.
The work is designed for the student, and for the young practitioner, and will
contain in the Accessory Treatment much that is of importance in daily prac-
tice—what older physicians have learned only after years of experience, and
accumulated a little at a time—and much which forms an important part of
the physician's practical education, and yet is not taught in the college lecture-
room. It will present to the busy doctor what he could only find after pro-
longed search through many books, journals, and carefully kept note-books.
Will be ready about April 1st, 1883.
GBOSS & DELBBIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
IK PTtESS.
Lectures on Fevers. By J. E. Kippax, M. D., LL. B., Prof.
of Principles and Practice of Medicine in the Chicago
Homoeopathic Medical College; Clinical Lecturer and
Visiting Physician to the Cook County Hospital; Author
of " Handbook of Skin Diseases," etc. Octavo 500 pp.
The work will comprise thirty lectures, embracing every form
of Fever; their Definition, History, Etiology, Pathology and
Homoeopathic Treatment, making a most important and valuable
addition to our literature. In large type and^on the best paper.
LECTURE I—Fevers. Introduction. Classification of Fevers. Miasmatic, or Mala-
rial. Miasmatic-Contagious and Contagious. The Thcrnometry of Fevers.
LECTURE II.—Fevers. Simple Continued Fever. — Malarial Fevers. Laws of
Malarial, Miasmatic. Geographical Distribution, and Incubation.
LECTURE III.—Intermittent Fever.—Intermittent Fever. Definition. Synonym.
Historical Notice. Etiology. Clinical History. Types of Intermittent. Morbid Anatomy
and Differential Diagnosis.
LECTURE IV.—Intermittent Fever (continued). Complications and Sequela.
Prognosis Chart of Characteristics Prophylaxis. Treatment.
LECTURE V.—Remittent Fever. Definition. Synonym. Historical Notice. Etio-
logy. Clinical History. Morbid Anatomy.
LECTURE VI.—Remittent Fever (continued). Differential Diagnosis. Complica-
tions and Sequelae. Prognosis. Chart of Characteristics. Treatment.
LECTURE VII.—Pernicious Malarial Fever.—Definition Svnonym. Historical
Notice. Etiology, and Clinical History Types'of Pernicious Malarial Fever. Duration.
Morbid Anatomy. Differential Diagnosis. Complications and Sequelae. Prognosis. Chart
of Characteristics. Treatment. Chronic Malarial Infection.
LECTURE VIII.—Dengue. Definition. Synonym. Historical Survey. Etiology.
Clinical History. Duration. Morbid Anatomy. Differential Diagnosis. Prognosis. Chart
of Characteristics. Treatment.
LECTURE IX— Hay Fever. Definition. Synonym. History and Statistics. Etiology.
Clinical History. Differential Diagnosis. Prognosis. Prophylaxis. Treatment.
LECTURE X.—Typho-Malarial Fever. Definition. Synonym. Historical Notice.
Etiology. Types of Typho-M'ilaiial Fever. Clinical History. Duration.
LECTURE XI.—Typho-Malarial Fever (continued). Morbid Anatomy. Complica-
tions and Sequelae. Differential Diagnosis. Prognosis. Chart of Characteristics. Treat-
ment.
LECTURE XIT.—Miasmatic-Contagious Fevers. Typhoid Fever. Definition.
Synonym. History and Statistics. Etiology.
LECTURE XIII.—Typhoid Fever (continued). Clinical History. Duration. Morbid
Anatomy.
LECTURE XIV.—Typhoid Fever (continued). Complications and Sequelae. Differ-
ential Diagnosis. Prognosis. Chart of Characteristics. Treatment.
LECTURE XV-Yelrow Fever. Definition. Synonym. History and Statistics.
Etiology. Clinical History. Differential Diagnosis. Morbid Anatomy. Complications and
Sequelae. Prognosis. Chart of Characteristics. Treatment.
The above selections from the table of contents will give the
reader some idea of the value of this new book. The work is now
in press and will be ready about January 1st, 1883
GBOSS & DELBBIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
The Physician's Condensed Account Book. An Epit-
omized System of Book-Keeping, avoiding the necessity o\
separate Journal, Day Book and Ledger, combining system,
accuracy and easy reference, with a minimum of labor. 272
pages. Price, $3,50.
The book furnishes an entirely unique system of keeping books
for physicians. No separate Day Book, Journal or Ledger is
required. The doctor's whole month's business is spread out
before him on a double page, and each patron for the month has
a line all to himself. In posting the book for the month, there is
a column of charges against each patient treated ; another column
in which that patient's unpaid balance of old account is brought
forward; another column totals due, cash paid, etc. Opposite
each name is a column for the patient's residence, street and
number, the year and the month. The system is simple and
plain.
"The book is the best I ever saw. All before your eyes. Have made
some collections already which were forgotten, because not seen. Every
physician should have one." Charles E. Pinkham, M D.,
Woodland, Cal.
"Gentlemen: I have received the Physician's Condensed Account Book,.
and am very much pleased with it. I pronounce it a grand success."
J. Deitrick, M. D.,
Petrolia, Pa.
Gross & Delbridge,
Gentlemen : The Account Book came to hand all right. After a trial we
can truly say that we are very much pleased with it. It is all any medical
man can ask in the way of book-keeping. By using every other line we are
enabled to keep a record of our prescriptions, and we thus have a complete
picture of our business before us. We have no hesitation in recommending
it to the'busy practitioner Yours,
Drs. Dayfoot & McKay,
Mt. Morris, N. Y.
"Gross & Delbridge,
Gentlemen: Having used the Physician's-Condensed Account Book for a
year past, I am prepared to speak intelligently as to its merits, and I truly
regaid it as the Ne plus ultra of book-keeping for the busy practitioner. My
accounts are always in order. It combines accuracy with condensation."
R. N. Tooker, M. D.,
Professor of Diseases of Children,
in the Chicago Homoeopathic College.
The price of the Physician's Condensed Account Book is
5>3.50 net, and will be sent per express on receipt of price.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICACO.
GEOSS & DELBEIDGE'S
Publications.
A Complete Minor Surgery. The Physician's Vade-mecum.
Including a Treatise on Venereal Diseases. Just published.
By E. C. Franklin, M. D., Professor of Surgery in the Uni-
versity of Michigan. Author of "Science and Art of Sur-
gery," etc. Illustrated with 260 wood cuts. 423 pps. Octavo.
Price, cloth, $4.00. Sheep, $4.50.
This work is just such a one as might be expected from the pen of one
experienceO in teaching as our veteran author, and is properly designated as
"complete." The text is lucidly and concisely written, the therapeutics
clear and practical, and the whole is well adapted to the uses of the general
practitioner. This book fills a gap which has never before been met, and we
prognosticate a large demand for it.—New York Medical Times.
Prof. Franklin has given us a work containing some new features, and
embracing a larger field than has heretofore been covered by manuals of
minor surgery. The work is well illustrated, and is every way a most con-
venient and satisfactory treatise.— Chicago Medical Times {Eclectic.)
This is a work containing all the general practitioner of medicine should
endeavor to assimilate on the subject of surgery. For ready references and
emergencies this work is not surpassed. We heartily recommend the work
to the profession. The publishers have done good work in issuing the book
so creditably, and the profession will appreciate the large distinct type used,
and the prominence given words so as to enable the reader to secure readily
that which he is looking for.— Cincinnati Medical Advance.
Dr. Charles Adams, Professor of Surgery in the Chicago Homoeopathic
College says of this new work: I have been very much pleased in the perusal
of Franklin's Min>>r Surgery, issued by your house. The book, I have no
doubt, will prove useful to the busy practitioner, and add to the reputation
of the learned author."
Dr. R. N. Tooker, Professor of Diseases of Children, in the Chicago
Homoeopathic College, in reviewing the book says : " It could not be ex-
pected that Dr. Franklin would do otherwise than write a book that would
be creditable both to himself and to the school of medicine to whtch he
belongs. He'has done more than this, for this work is a veritable and vnlua
ble 'Vade mecum' to the practitioner, and there arc very few members of our
profession who would not find it a profitable companion. His instruction on
Bandaging and the application and construction of apparatus, are full and
unusually explicit. His chapters on Venereal Diseases are alone worth the
price of the book, and are fully up to the times."
With this book in possession no practitioner will need any other text
book on Minor Surgery. It is full and complete, and any bandage, dressing
and instrument known or used is illustrated.—Dr. Valentine in Clinical Re-
view (St. Louis.)
For Sale at all the Pharmacies, or sent free on receipt of
price.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
IN PRESS.
The American Homoeopathic Dispensatory. Designed as a
Text-Book for the Physician, Pharmacist and Student.
About 500 pp. octavo. Illustrated.
This important work is written in a plain and concise manner
by a gentleman of large experience as a pharmacist, and who
seems therefore to have fully comprehended the long felt want of
a reliable and scientific pharmacopoeia.
Indeed we can safely assert that this work will be to the
Homoeopathic School what the United States Dispensatory now
is to the Allopathic School, a desideratum.
"The American Homoeopathic Dispensatory"
was conceived, born and bred as a pharmaceutical text-book, and,
as such, is intended for the druggist, the student, and the physi-
cian. In brief, the contents are but a series of modern practical
paragraphs, each one of which is equally important. Not in any
one instance is there any attempt made to contort or re-arrange
the subject matter of other Homoeopathic Pharmacopoeias, but
the work is wholly original and replete with practical informa-
tion.
It is the Book for Practical Instruction.
The volume will be an octavo of about 500 pages, printed on
the best paper, and bound in the best manner. Be sure and buy
no work on the subject until you have seen and examined " The
American Homoeopathic Dispensatory."
All orders should be addressed to
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
GEOSS & DELBEIDGE'S Publications.
Label Book, for the use of Physicians and Pharmacists,
containing more than thirty-five hundred gummed labels in
larga clear type, and bound in neat and substantial manner.
Price, 50 cents. For sale by Homoeopathic Pharmacies,
or sent postpaid, on receipt of price.
Sample Page.
Belladonna. Belladonna. Belladonna.
Belladonna. Belladonna. Belladonna.
Belladonna. Belladonna. Belladonna.
Belladonna. Belladonna. Belladonna.
Belladonna. Belladonna. Belladonna.
Belladonna. Belladonna. Belladonna.
Belladonna. Belladonna. Belladonna.
Benzoic acid. Benzoic acid. Benzoic acid.
Benzoic acid. Benzoic acid. Benzoic acid.
Berbeiin. Berberin. Berberin.
Berberis vulg. Berberis vulg. Berberis vulg.
Bismuth, met. Bismuth, met. Bismuth, met.
Bismuth, nit. Bismuth, nit. Bismuth, nit.
Bismuth, nit. Bismuth, nit. Bismuth, nit.
Boletus lari. Boletus lari. Boletus lari.
Boletus pini. Boletus pini. Boletus pini.
Boletus sat. Boletus sat. Boletus sat.
GROSS & DELBRIDGE, Publishers,
48 Madison St., CHICAGO.
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