THE VENEREAL DISEASE.

In a former edition of this book the venereal disease was omitted. The reasons, however, which at that time induced me to leave it out, have, upon more mature consideration, vanished. Bad consequences, no doubt, may arise from ignorant persons tampering with medicine in this disorder; but the danger from that quarter seems to be more than balanced by the great and solid advantages which must arise to the patient from an early knowledge of his case, and an attention to a plan of regimen, which, if it does not cure the disease, will be sure to render it more mild, and less hurtful to the constitution.

It is peculiarly unfortunate for the unhappy person who contracts this disease, that it lies under a sort of disgrace. This renders disguise necessary, and makes the patient either conceal his disorder altogether, or apply to those who promise a sudden and secret cure; but who, in fact, only remove the symptoms for a time, while they fix the disease deeper in the habit. By this means a slight infection, which might have been easily removed, is often converted into an obstinate, and sometimes incurable malady.

Another unfavourable circumstance attending this disease is, that it assumes a variety of different shapes, and may with more propriety be calledan assemblage of diseases, than a single one. No two diseases can require a more different mode of treatment than this does in its different stages. Hence the folly and danger of trusting to any particular nostrum for the cure of it. Such nostrums are, however, generally administered in the same manner to all who apply for them, without the least regard to the state of the disease, the constitution of the patient, the degree of infection, and a thousand other circumstances of the utmost importance.

Though the venereal disease is generally the fruit of unlawful embraces, yet it may be communicated to the innocent as well as the guilty. Infants, nurses, midwives, and married women whose husbands lead dissolute lives, are often affected with it, and frequently lose their lives by not being aware of their danger in due time. The unhappy condition of such persons will certainly plead our excuse, if any excuse be necessary, for endeavouring to point out the symptoms and cure of this too common disease.

To enumerate all its different symptoms, however, and to trace the disease minutely through its various stages, would require a much larger space than falls to this part of my subject; I shall therefore confine my observations chiefly to circumstances of importance, omitting such as are either trifling, or which occur but seldom. I shall likewise pass over the history of the disease, with the different methods of treatment which it has undergone, since it was first introduced into Europe, and many other circumstances of a similar nature; all of which, though they might tend to amuse the reader, yet could afford him little or no useful knowledge.

OF THE VIRULENT GONORRHŒA.

The Virulent Gonorrhœa is an involuntary discharge of infectious mucus from the parts of generation in either sex. It generally makes its appearance within eight or ten days after the infection has been received; sometimes it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the discharge, the patient feels an itching, with a small degree of pain in the genitals. Afterwards a thin glary matter begins to distil from the urinary passage, which stains the linen, and occasions a small degree of titillation, particularly at the time of making water; this gradually increasing, arises at length to a degree of heat and pain, which are chiefly perceived about the extremity of the urinary passage, where a slight degree of redness and inflammation likewise begins to appear.

As the disorder advances, the pain, heat of the urine, and running, increase, while fresh symptoms daily ensue. In men the erections become painful and involuntary, and are more frequent and lasting than when natural. This symptom is most troublesome when the patient is warm in bed.

The pain which was at first only perceived towards the extremity, now begins to reach up all the urinary passage, and is more intense just after the patient has done making water. The running gradually recedes from the colour of semen, grows yellow, and at length puts on the appearance of mucus.

When the disorder has arrived at its height,all the symptoms are more intense; the heat of the urine is so great, that the patient dreads the making water; and though he feels a constant inclination this way, yet it is rendered with the greatest difficulty, and often only by drops; the involuntary erections now become extremely painful and frequent; there is also a pain, heat, and sense of fulness about the seat, and the running is plentiful and sharp, of a brown, greenish, and sometimes of a bloody colour.

By a proper treatment, the violence of the symptoms gradually abates; the heat and urine goes off, the involuntary and painful erections, and the heat and pain about the seat, become easier; and the running also gradually decreases, grows whiter and thicker, till at last it entirely disappears.

By attending to these symptoms, the gonorrhœa may be generally distinguished from any other disease. There are, however, some few disorders for which it may be mistaken, as an ulcer of the kidneys or bladder, thefluor albus, or whites in women, &c. But in the former of these, the matter comes away only with the urine, or when the sphincter of the bladder is open; whereas in a gonorrhœa the discharge is constant. The latter is more difficult to distinguish, and must be known chiefly from its effects; as pain, communicating the infection, &c.

Regimen.—When a person has reason to suspect that he has caught the venereal infection, he ought most strictly to observe a cooling regimen, to avoid everything of a heating nature, as wines, spiritous liquors, rich sauces, spices, salted, high seasoned, and smoke dried provisions, particularly salt itself in every shape; as also all aromaticand stimulating vegetables, as onions, garlic, shalot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His food ought chiefly to consist of mild vegetables, milk, broths, light puddings, panado, gruels, &c. His drink may be barley-water, milk and water, decoctions of marshmallows and liquorice, linseed tea, or clear whey. Of these he ought to drink plentifully. Violent exercise of all kinds, especially riding on horseback, and venereal pleasures, are to be avoided. The patient must beware of cold, and when the inflammation is violent, he ought to keep his bed.

Medicine.—A virulent gonorrhœa can rarely be cured speedily and effectually at the same time. The patient ought, therefore, not to expect nor the physician to promise it. It will often continue for two or three weeks, and sometimes for five or six, even where the treatment has been very proper.

Sometimes, indeed, a slight infection may be carried off in a few days, by bathing the parts in warm milk and water, and injecting frequently up the urethra a little sweet oil, or linseed tea, about the warmth of new milk. Should these not succeed in carrying off the infection, they will at least have a tendency to lessen its virulence.

To effect a cure, however, astringent injections will generally be found necessary. There may be various ways prepared, but I think those made with the white vitriol are both more safe and efficacious. They can be made stronger or weaker as circumstances may require; but it is best to begin with the more gentle, and increase their power if necessary. I generally ordered a dram of white vitriol to be dissolved in eightor nine ounces of common or rose-water, and an ordinary syringe full of it to be thrown up three or four times a day. If this quantity does not perform a cure, it may be repeated, and the dose increased.

Whether injections be used or not, cooling purges are always proper in the gonorrhœa. They ought not, however, to be of the strong or drastic kind. Whatever raises a violent commotion in the body increases the danger, and tends to drive the disease deeper into the habit. Procuring two or three stools every second or third day for the first fortnight, and the same number every fourth or fifth day for the second, will generally be sufficient to remove the inflammatory symptoms, to diminish the running, and to change its colour and consistence. It gradually becomes more white and ropy as the virulence abates.[1]

1. If the patient can swallow a solution of salts and manna, he may take six drams; or, if his constitution requires it, an ounce of the former, with half an ounce of the latter. These may be dissolved in an English pint of boiling water, whey, or thin water-gruel, and taken early in the morning. If an infusion of senna and tamarinds be more agreeable, two drams of the former, and an ounce of the latter, may be infused all night in an English pint of boiling water. The infusion may be strained next morning, and half an ounce of Glauber’s salts dissolved in it. A tea-cupful of this infusion may be taken every half hour till it operates. Should the patient prefer an electuary, the following will be found to answer very well. Take of the lenitive electuary, four ounces, cream of tartar two ounces, jalap in powder two drams, rhubarb one dram, and as much of the syrup Of pale roses as will serve to make up the whole into a soft electuary. Two or three tea-spoonfuls of this may be taken over night, and about the same quantity next morning, every day that the patient chooses to take a purge. The doses of the above medicines may be increased or diminished, according as the patient finds it necessary. We have ordered the salts to be dissolved in a large quantity of water, because, it renders their operation more mild.

When the inflammatory symptoms run high, bleeding is always necessary at the beginning. This operation, as in other topical inflammations, must be repeated according to the strength and constitution of the patient, and the vehemence and urgency of the symptoms.

Medicines which promote the secretion of urine are likewise proper in this stage of the disorder. For this purpose an ounce of nitre and two ounces of gum-arabic, pounded together, may be divided into twenty-four doses, one of which may be taken frequently in a cup of the patient’s drink. If these should make him pass his urine so often as to become troublesome to him, he may either take them less frequently, or leave out the nitre altogether, and take equal parts of gum-arabic and cream of tartar. These may be pounded together, and a tea-spoonful taken in a cup of the patient’s drink four or five times a day. I have generally found this answer extremely well, both as a diuretic, and for keeping the body gently open.

When the pain and inflammation are seated high, towards the neck of the bladder, it will be proper frequently to throw up an emollient clyster, which, besides the benefit of procuring stools will serve as a fomentation to the inflamed parts.

Soft poultices, when they can conveniently be applied to the parts, are of great service. They may be made of the flour of linseed, or of wheat-bread and milk softened with fresh butter or sweet oil. When poultices cannot be conveniently used, cloths wrung out of warm water, orbladders filled with warm milk and water, may be applied. I have often known the most excruciating pains, during the inflammatory state of the gonorrhœa, relieved by one of these applications.

Few things tend more to keep off inflammation in the spermatic vessels, than a proper suspensory for the scrotum. It ought to be so contrived as to support the testicles, and should be worn from the first appearance of the disease, till it has ceased some weeks.

The above treatment will sometimes remove the gonorrhœa so quickly, that the person will be in doubt whether he really laboured under that disease. This, however, is too favourable a turn to be often expected. It more frequently happens, that we are able to procure an abatement or remission of the inflammatory symptoms, so far as to make it safe to have recourse to the great antidotemercury.

Many people, on the first appearance of a gonorrhœa, fly to the use of mercury. This is a bad plan. Mercury is often not at all necessary in a gonorrhœa; and when taken too early, it does mischief. It may be necessary to complete the cure, but can never be proper at the commencement of it.

When bleeding, purging, fomentations, and the other things recommended above, have eased the pain, softened the pulse, relieved the heat of urine, and rendered the involuntary ejections less frequent, the patient may begin to use mercury in any form that is least disagreeable to him.

If he takes the common mercurial pill, two at night and one in the morning will be a sufficient dose at first. Should they affect the mouth toomuch, the dose must be lessened; if not at all, it may be increased to five or six pills in the day. If calomel be thought preferable, two or three grains of it, formed into a bolus, with a little of the conserve of hips, may be taken at bed-time, and the dose gradually increased to eight or ten grains. One of the most common preparations of mercury now in use is the corrosive sublimate. This may be taken in the manner afterwards recommended under the confirmed lues or pox. I have always found it one of the most safe and efficacious medicines when properly used.

The foregoing medicines may either be taken every day, or every other day, as the patient is able to bear them. They ought never to be taken in such quantity as to raise a salivation, unless in a very slight degree. This disease may be more safely, and as certainly, cured without a salivation as with it. When the mercury runs off by the mouth, it is not so successful in carrying off the disease, as when it continues longer in the body, and is discharged gradually.

Should the patient be purged or griped in the night by the mercury, he may take half a dram of the opiate confection dissolved in an ounce of cinnamon-water, to prevent bloody stools, which are apt to happen should the patient catch cold, or if the mercury has not been duly prepared. When the bowels are weak, and the mercury is apt to gripe or purge, these disagreeable consequences may be prevented by taking, with the foregoing pills or bolus, half a dram or two scruples of diascordium, or of the Japonic confection.

To prevent the disagreeable circumstance of the mercury’s affecting the mouth too much, or bringing on a salivation, it may be combinedwith purgatives. With this view the laxative mercurial pill has been contrived, the usual dose of which is half a dram, or three pills night and morning, to be repeated every other day; but the safer way is for the patient to begin with two, or even with one pill, gradually increasing the dose.

To such persons as can neither swallow a bolus nor a pill, mercury may be given in a liquid form, as it can be suspended even in a watery vehicle, by means of gum-arabic, which not only serves this purpose, but likewise prevents the mercury from affecting the mouth, and renders it in many respects a better medicine.[2]

2. Take quicksilver one dram, gum-arabic reduced to a mucilage two drams; let the quicksilver be rubbed with the mucilage, in a marble mortar, until the globules of mercury entirely disappear; afterwards and gradually, still continuing the trituration, add half an ounce of balsamic syrup, and eight ounces of simply cinnamon-water. Two table-spoonfuls of this solution may be taken night and morning. Some reckon this the best form in which quicksilver can be exhibited for the cure of gonorrhœa.

It happens very fortunately for those who cannot be brought to take mercury inwardly, and likewise for persons whose bowels are too tender to bear it, that an external application of it will answer equally well, and in some respects better. It must be acknowledged, that mercury, taken inwardly for any length of time, greatly weakens and disorders the bowels; for which reason, when a plentiful use of it becomes necessary, we would prefer rubbing in to the mercurial pills. The common mercurial, or blue ointment, will answer very well. Of that which is made by rubbing together equal quantities of hogslard andquicksilver, about a dram may be used at a time. The best time for rubbing it in is at night, and the most proper place the inner side of the thighs. The patient should sit beside the fire when he rubs, and should wear flannel drawers next his skin at the time he is using the ointment. If ointment of a weaker or stronger kind be used, the quantity must be increased or diminished in proportion.

If, during the use of the ointment, the inflammation of the genital parts, together with the heat and feverishness, should return, or if the mouth should grow sore, the gums tender, and the breath becomes offensive, a dose or two of Glauber’s salts, or some other cooling purge, may be taken, and the rubbing intermitted for a few days. As soon, however, as the signs of spitting are gone off, if the virulency be not quite corrected, the ointment must be repeated, but in smaller quantities, and at longer intervals than before. Whatever way mercury is administered, its use must be persisted in as long as any virulency is suspected to remain.

During this, which may be called the second stage of the disorder, though so strict a regimen is not necessary as in the first or inflammatory state, yet intemperance of every kind ought to be avoided. The food must be light, plain, and of easy digestion; and the greatest indulgence that may be allowed, with respect to drink, is a little wine diluted with a sufficient quantity of water. Spiritous liquors are to be avoided in every shape. I have often known the inflammatory symptoms renewed and heightened, the running increased, and the cure rendered extremely difficult and tedious, by one fit of excessive drinking.

When the above treatment has removed the heat of urine, and soreness of the genital parts; when the quantity of running is lessened, without any pain or swelling in the groin or testicle supervening; when the patient is free from involuntary erections; and lastly, when the running becomes pale, whitish, void of ill smell, and tenacious or ropy; when all or most of these symptoms appear, the gonorrhœa is arrived at its last stage, and we may gradually proceed to treat it as a gleet with astringent and agglutinating medicines.

A gonorrhœa frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from a relaxation, or from some remains of the disease. It is, however, of the greatest importance in the cure of the gleet, to know from which of these causes it proceeds. When the discharge proves very obstinate, and receives little or no check from astringent remedies, there is ground to suspect that it is owing to the latter; but if the drain is constant, and is chiefly observable when the patient is stimulated by lascivious ideas, or upon straining to go to stool, we may reasonably conclude that it is chiefly owing to the former.

In the cure of a gleet proceeding from relaxation, the principal design is to brace and restore a proper degree of tension to the debilitated and relaxed vessels. For this purpose, besides the medicines recommended in the gonorrhœa, thepatient may have recourse to stronger and more powerful astringents, as the Peruvian bark,[3]alum, vitriol, galls, tormentil, bistort, ballustines, tincture of gum kino, &c. The injections may be rendered more astringent by the addition of a few grains of alum, or increasing the quantity of vitriol as far as the parts are able to bear it.

3. The Peruvian bark may be combined with other astringents, and prepared in the following manner:—Take of Peruvian bark bruised six drams, of fresh galls bruised two drams, boil them in a pound and a half of water to a pound; to the strained liquor add three ounces of the simple tincture of the bark. A small tea-cupful of this may be taken three times a day, adding to each cup fifteen or twenty drops of the acid elixir of vitriol.

The last remedy which we shall mention, in this case, is the cold bath, than which there is not a more powerful bracer in the whole compass of medicine. It ought never to be omitted in this species of gleet, unless there be something in the constitution of the patient which renders the use of it unsafe. The chief objections to the use of the cold bath are a full habit, and an unsound state of the viscera. The danger of the former may always be lessened, if not removed, by purging and bleeding; but the latter is an insurmountable obstacle, as the pressure of the water, and the sudden contraction of the external vessels, by throwing the blood with too much force upon the internal parts are apt to occasion ruptures of the vessels, or a flux of humours upon the diseased organs. But where no objections of this kind prevail, the patient ought to plunge over head in water every morning fasting, for three or four weeks together. He should not, however, stay long in the water, and should take care to have his skin dried as soon as he comes out.

The regimen proper in this case is the same as was mentioned in the last stage of the gonorrhœa: the diet must be drying and astringent, and the drink Spa, Pyrmont, or Bristol waters with which a little claret or red wine may sometimes be mixed.

When the gleet does not in the smallest degree yield to these medicines, there is reason to suspect that it proceeds from ulcers. In this case recourse must be had to mercury, and such medicines as tend to correct any predominant acrimony with which the juices may be affected, as the decoction of China, sarsaparilla, sassafras, or the like.

Mr. Fordyce says, he has seen many obstinate gleets, of two, three, or four years standing, effectually cured by a mercurial inunction, when almost every other medicine has been tried in vain. Dr. Chapman seems to be of the same opinion; but says, he has always found the mercury succeed best in this case when joined with terebinthinate and other agglutinating medicines. For which reason the Doctor recommends pills made of calomel and Venice turpentine;[4]and desires that their use may be accompanied with a decoction of guaiacum or sarsaparilla.

4. Take Venice turpentine, boiled to a sufficient degree of hardness, half an ounce, calomel half a dram. Let these be mixed and formed into sixty pills, of which five or six may be taken night and morning. If, during the use of these pills, the mouth should grow sore, or the breath become offensive, they must be discontinued till these symptoms disappear.

The last kind of remedy which we shall mention for the cure of ulcers in the urinary passage, are the supperating candles or bougies. As these are prepared various ways, and are generally tobe bought ready made, it is needless to spend time in enumerating the different ingredients of which they are composed, or teaching the manner of preparing them. Before a bougie be introduced into the urethra, however, it should be smeared all over with sweet oil, to prevent it from stimulating too suddenly. It may be suffered to continue in from one to seven hours, according as the patient can bear it. Obstinate ulcers are not only often healed, but tumours or excrescences in the urinary passages taken away, and an obstruction of urine removed, by means of bougies. Obstinate gleets may be removed by the use of bougies.

The swelled testicle may either proceed from infection lately contracted, or from the venereal poison lurking in the body; the latter indeed is not very common, but the former frequently happens both in the first and second stages of a gonorrhœa; particularly when the running is unseasonably checked, by cold, hard drinking, strong drastic purges, violent exercise, the too early use of astringent medicines, or the like.

In the inflammatory stage, bleeding is necessary, which must be repeated according to the urgency of the symptoms.[5]The food must be light, and the drink diluting. High-seasoned food, flesh, wines, and every thing of a heatingnature, are to be avoided. Fomentations are of singular service. Poultices of bread and milk, softened with fresh butter or oil, are likewise very proper, and ought constantly to be applied when the patient is in bed; when he is up the testicles should be kept warm, and supported by a suspensory, which may easily be contrived in such a manner as to prevent the weight of the testicle from having any effect.

5. I have been accustomed for some time past to apply leeches to inflamed testicles, which practice has always been followed with the most happy effects.

If it should be found impracticable to clear the testicle by the cooling regimen now pointed out, and extended according to circumstances, it will be necessary to lead the patient through such a complete antivenereal course as shall ensure him against any future uneasiness. For this purpose, besides rubbing the mercurial ointment on the thighs as directed in the gonorrhœa, the patient must be confined to bed, if necessary, for five or six weeks, suspending the testicle, all the while, with a bag or truss, and plying him inwardly with strong decoctions of sarsaparilla.

When these means do not succeed, and there is reason to suspect a scrofulous or cancerous habit, either of which may support a schirrous induration, after a venereal poison is corrected, the parts should be fomented daily with a decoction of hemlock, the bruised leaves of which may likewise be added to the poultice, and the extract at the same time taken inwardly.[6]This practice is strongly recommended by Dr. Storck in schirrous and cancerous cases; and Mr. Fordyce assures us, that by this method he has cured diseased testicles of two or three years standing, even when ulcerated, and when the schirrous hadbegun to be affected with pricking and lancing pains.

6. The extract of hemlock may be made into pills, and taken in the manner directed under the article Cancer.

Venereal buboes are hard tumours seated in the groin, occasioned by the venereal poison lodged in this part. They are of two kinds, viz. such as proceed from a recent infection, and such as accompany a confirmed lues.

The cure of recent buboes, that is, such as appear soon after impure coition, may be first attempted bydispersion; and, if that should not succeed, bysuppuration. To promote the dispersion of a buboe, the same regimen must be observed as was directed in the first stage of a gonorrhœa. The patient must likewise be bled, and take some cooling purges, as the decoction of tamarinds and senna, Glauber’s salts, and the like. If by this course the swelling and other inflammatory symptoms abate, we may safely proceed to use the mercury, which must be continued till the venereal virus is quite subdued.[7]

7. For the dispersion of a Bubo, a number of leeches applied to the part affected will be found equally efficacious as in the inflamed testicle.

But if the buboe should, from the beginning, be attended with great heat, pain, and pulsation, it will be proper to promote its suppuration. For this purpose the patient may be allowed to use his ordinary diet, and to take now and then a glass of wine. Emollient cataplasms, consisting of bread and milk softened with oil or fresh butter, may be applied to the part; and, in coldconstitutions, where the tumour advances slowly, white lily roots boiled, or sliced onions raw, and a sufficient quantity of yellow basilicon, may be added to the poultice.

When the tumour is ripe, which may be known by its conical figure, the softness of the skin, and a fluctuation of the matter plainly to be felt under the finger, it may be opened either by a caustic or a lancet, and afterwards dressed with digestive ointment.

It sometimes, however, happens that buboes can neither be dispersed nor brought to a suppuration, but remain hard indolent tumours. In this case the indurated glands must be consumed by caustic; if they should become schirrous, they must be dissolved by the application of hemlock, both externally and internally, as directed in the schirrous testicle.

Chancres are superficial, callous, eating ulcers, which may happen either with or without gonorrhœa. They are commonly seated about the glands, and make their appearance in the following manner:—First a little red pimple arises, which soon becomes pointed at top, and is filled with a whitish matter inclining to yellow. This pimple is hot, and itches generally before it breaks; afterwards it degenerates into an obstinate ulcer, the bottom of which is usually covered with a viscid mucus, and whose edges gradually become hard and callous. Sometimes the first appearance resembles a simple excoriation of the cuticle;which, however, if the cause be venereal, soon becomes a true chancre.

A chancre is sometimes a primary affection, but it is much oftener symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after the coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, theglens penisof men, &c.[8]

8. When the venereal ulcers are seated in the lips, the infection may be communicated by kissing. I have seen very obstinate venereal ulcers in the lips, which I have all the reason in the world to believe were communicated in this manner. Nurses ought to beware of suckling infected children, or having their breasts drawn by persons tainted with the venereal disease. This caution is peculiarly necessary for nurses who reside in the neighbourhood of great towns.

When the chancre appears soon after impure coition, its treatment is nearly similar to that of the virulent gonorrhœa. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected ought frequently to be bathed or rather soaked in warm milk and water, and if the inflammation be great, an emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the inflammation, and prepare the patient for the use of mercury.

Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scabby eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of the parts mentioned above, they commonly appear upon the private parts, or the inside of the thigh. They are lesspainful, but frequently much larger and harder than primary chancres. As their cure must depend upon that of the pox, of which they are only a symptom, we shall take no further notice of them till we come to treat of a confirmed lues.[9]

9. I have found it answer extremely well to sprinkle chancres twice a day with calomel. This will often perform a cure without any other application whatever. If the chancres are upon theglans, they may be washed with milk and water a little warm, and afterwards the calomel may be applied as above.

Thus we have related most of the symptoms which accompany or succeed a violent gonorrhœa, and have also given a short view of their proper treatment; there are, however, several others which sometimes attend this disease, as astranguryor obstruction of urine,a phymosis,paraphymosis, &c.

A strangury may be occasioned either by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former case the patient begins to void his urine with tolerable ease; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, sometimes by drops only. When the strangury is owing to an inflammation about the neck of the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesometenesmus, or constant inclination to go to stool.

When the strangury is owing to spasm, such medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and coolingemulsions, sweetened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding and emollient fomentations will be necessary.

When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum in them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which six ounces of the syrup of marshmallows, and four ounces of the oil of sweet almonds, and half an ounce of nitre may be added. If these remedies should not relieve the complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm bath up to the middle. It will be proper in this case to discontinue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, we would rather recommend the use of mild bougies. These often lubricate the passage, and greatly facilitate the discharge of urine. Whenever they begin to stimulate or give any uneasiness, they may be withdrawn.

Thephymosisis such a constriction of the prepuce over the glans, as hinders it from being drawn backwards; theparaphymosis, on the contrary, is such a constriction of the prepuce behind the glans, as hinders it from being brought forward.

The treatment of these symptoms is so nearly the same with that of the virulent gonorrhœa, that we have no occasion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomentations, are sufficient. Should these, however, fail of removing the stricture, and the parts be threatened with a mortification, twenty or thirty grains of ipecacuana, and one grain of emetic tartar may be given for a vomit, and may be worked off with warm water or thin gruel.

It sometimes happens, that in spite of all endeavours to the contrary, the inflammation goes on, and symptoms of a beginning mortification appear. When this is the case, the prepuce must be scarified with a lancet, and, if necessary, divided, in order to prevent a strangulation, and set the imprisoned glans at liberty. We shall not describe the manner of performing this operation, as it ought always to be done by a surgeon. When a mortification has actually taken place, it will be necessary, besides the above operations, to foment the parts frequently with cloths wrung out of a strong decoction of camomile-flowers and bark, and to give the patient a dram of the bark in powder every two or three hours.

With regard to thepriapism,chordee, and other distortions of thepenis, their treatment is no way different from that of the gonorrhœa. When they prove very troublesome, the patient may take a few drops of laudanum at night, especially after the operation of a purgative through the day.

OF A CONFIRMED LUES.

We have hitherto treated of those affections in which the venereal poison is supposed to be confined chiefly to the particular part by which it was received, and shall next take a view of the lues in its confirmed state: that is, when the poison is actually received into the blood, and circulating with it through every part of the body, mixes with the several secretions, and renders the whole habit tainted.

The symptoms of a confirmed lues are, buboes in the groin, pains of the head and joints, which are peculiarly troublesome in the night, or when the patient is warm in bed; scabs and scurfs on various parts of the body, especially on the head, of a yellowish colour, resembling a honey-comb; corroding ulcers in various parts of the body, which generally begin about the throat, from whence they creep gradually, by the palate, towards the cartilage of the nose, which they destroy; excrescences or exostoses arise in the middle of the bones, and their spongy ends become brittle and break upon the least accident; at other times they are soft, and bend like wax: the conglobate glands become hard and callous, and form in the neck, arm-pits, groin, and mesentery, hard moveable tumours, like the king’s-evil; tumours of different kinds are likewise formed in the lymphatic vessels, tendons, ligaments, and nerves, as thegummata,ganglia,nodes,tophs, &c.; the eyes are affected with itching, pain, redness, and sometimes with total blindness, and the ears with a singing noise, pain, and deafness, while their internal substance is exulcerated andrendered carious; at length all the animal, vital, and natural functions are depraved; the face becomes pale and livid; the body emaciated and unfit for motion, and the miserable patient falls into an atrophy or wasting consumption.

Women have symptoms peculiar to the sex; as cancers of the breast; a suppression or overflowing of the menses; the whites; hysteric affections; an inflammation, abscess, schirrus, gangrene, cancer, or ulcer of the womb: they are generally either barren or subject to abortion; or if they bring children into the world, they have universal erysipelas, are half rotten, and covered with ulcers.

Such is the catalogue of symptoms attending this dreadful disease in its confirmed state. Indeed, they are seldom all to be met with in the same person, or at the same time; so many of them, however, are generally present as are sufficient to alarm the patient; and if he has reason to suspect the infection is lurking in his body, he ought immediately to set about the expulsion of it, otherwise the most tragical consequence will ensue.

The only certain remedy hitherto known in Europe for the cure of this disease, is mercury, which may be used in a great variety of forms, with nearly the same success. Some time ago it was reckoned impossible to cure a confirmed lues without a salivation. This method is now, however, pretty generally laid aside, and mercury is found to be as efficacious, or rather more so, in expelling the venereal poison, when administered in such a manner as not to run off the salivatory glands.

Though many are of opinion that the mercurialointment is as efficacious as any other preparation of that mineral; yet experience has taught me to think otherwise. I have often seen the most obstinate venereal cases, where great quantities of mercurial ointment had been used in vain, yield to the saline preparations of mercury. Nor am I so singular in this opinion. Mr. Clare, a very eminent surgeon, assured me, that for some time past he had employed in venereal cases a saline preparation of mercury with most happy success. This preparation, rubbed with a sufficient quantity of any mild powder, he applied, in small portions, to the tongue, where, with a gentle degree of friction, it was immediately absorbed, and produced its full effect upon the system, without doing the least injury to the stomach or bowels; a matter of greater importance in the application of this most active and powerful remedy.

It is impossible to ascertain either the exact quantity of medicines that must be taken, or the time they ought to be continued in order to perform a cure. These will ever vary according to the constitution of the patient, the season of the year, the degree of infection, the time it has lodged in the body, &c. But though it is difficult, as Astruc observes, to determine a priori, what quantity of mercury will, in the whole, be necessary to cure this distemper completely, yet it may be judged of a posteriori, from the abatement and ceasing of the symptoms. The same author adds, that commonly not less than two ounces of the strong mercurial ointment is sufficient, and not more than three or four ounces necessary.

The only chemical preparation of mercurywhich we shall take notice of, is the corrosive sublimate. This was some time ago brought into use for the venereal disease in Germany, by the illustrious Baron Van Swieten; and was soon after introduced into Britain by the learned Sir John Pringle, at that time a physician to the army. The method of giving it is as follows: One grain of corrosive sublimate is dissolved in two ounces of French brandy or malt spirits; and of this solution an ordinary table-spoonful, or the quantity of half an ounce, is to be taken twice a day, and to be continued as long as any symptoms of the disorder remain. To those whose stomachs cannot bear the solution, the sublimate may be given in form of a pill.[10]

10. The sublimate may be given in distilled water, or any other liquid that the patient chooses. I commonly order ten grains to be dissolved in an ounce of the spirit of wine, for the convenience of carriage, and let the patient take twenty or thirty drops of it night and morning, in half a glass of brandy or other spirits.

Several roots, woods, and barks, have been recommended for curing the venereal disease; but none of them have been found, upon experience, to answer the high encomiums which had been bestowed upon them. Though no one of these is to be depended upon alone, yet, when joined with mercury, some of them are found to be very beneficial in promoting a cure. One of the best we know yet is sarsaparilla.

The mezereon-root is likewise found to be a powerful assistant to the sublimate, or any other mercurial. It may either be used along with the sarsaparilla, or by itself. Those who choose to use the mezereon by itself, may boil an ounce of the fresh bark, taken from the root, in twelveEnglish pints of water, to eight, adding towards the end an ounce of liquorice. The dose of this is the same as of the decoction of sarsaparilla.

We have been told, that the natives of America cure the venereal disease, in every stage, by a decoction of the root of a plant called the Lobelia. It is used either fresh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as those of the ranunculus, the ceanothus, &c.; but whether they are designed to disguise or assist it, is doubtful. The patient takes a large draught of the decoction early in the morning, and continues to use it for his ordinary drink throughout the day.[11]

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