LECTURE IV.
ONEXTERNAL DISEASES,AND THEIRCURE.
ONEXTERNAL DISEASES,AND THEIRCURE.
ON
EXTERNAL DISEASES,
AND THEIR
CURE.
In this lecture I shall treat of external disorders, which may take their origin either from injuries, or from internal acrimony of habit; for whatever disturbs the animal œconomy, prevents the natural order of the fibres, and those again when in disorder, corrupt the fluids.
Be the causes what they will, certain it is, that there is a strict connexion between the external and the internal parts, to which due regard ought ever to be paid. I shall without delay proceed to their various kinds.
SECT. I.
When either the solids are so injured that they will not transmit the circulation with their natural freedom; or when the humours are become so acrimonious, as to constrict the small tubes, that part of the fluids becomes confined in them, there must then of course be an obstruction of the circulation of the fluids, thence accumulation must follow and consequently swell the parts. And this is the nature of an inflammation.
The blood being obstructed, the parts must naturally swell; the blood being forced into the small lymphatic vessels, thence proceed the redness; and lastly, from the vessels being distended and irritated by the stagnated humours, proceeds the pain.
An inflammation terminates three different ways. When the solids relax, or the fluids become attenuated, so that the accumulated humours disperse, and are admitted a free circulation again, it is termedresolution; and this is the best and most favourable way for an inflamed and tumified part to terminate.
When some of the small vessels by the over-stretching of their contained humours break, together with the lymphatic vessels,and the extravasated blood intermixed with lymph is converted into matter, it is termed asuppuration; this is also a favourable way of termination, provided the matter is properly concocted and discharged, and the parts properly healed up again. And this ought to be the second indication when the first does not succeed.
When however the imprisoned humours enclosed by their tubulæ are inspissated, and mix irregularly with the solids that contain them, obstinate tumours are apt to ensue. This is the third kind of termination, and should be avoided if possible; for it either becomes tedious, or occasions malignant ulcers; which in glandulous parts are the first foundation of cancers.
But, when the humours that are obstructed get malignantly corrupted into a pernicious acrimony, and stimulate the distended solids, so that they stretch beyond their natural tone, without admitting any circulation, the parts become insufferably painful; the patient is restless, anxious, and attended with an acute fever; the humours become offensive and fœtid, and the parts at length turn of a livid colour, and this is then called agangrene. Gradually the parts begin to putrefy and grow black, the humours acquire a cadaverous fœtor, the solids lose their natural texture, and die. This is called asphacelus, or mortification; and unless the mortified parts are removed from the sound, death must inevitably be the consequence.
These are the different terminations of inflammation; and whether the cause is from external injuries, or from internal acrimony, the indication must ever be the same, I shall consider each separately.
Inflammation that attends wounds, contusions, &c. should be dispersed by the application I have already mentioned in the foregoing lectures, viz.camphorated spirit(A), orliniment of soap(B), the first suits best the fleshy part, and the latter the inflammation on the joints and tendinous parts. But when with the inflammation a wound is compounded, and is obstructed in its suppuration, recourse should be had to poultices; as thereby the fibres may be the more relaxed, so that the ulcer may the freer discharge the matter, thence drain the inflamed part of the obstructed humour, and consequently remove the cause of the inflammation.
Of Suppuration.
When an inflammation arises from an internal cause, there generally is some acrimonious humour that wants to be discharged; in this case resolvents is not always safe, as it is ever apt to increase the pain and inflammation. Of that kind are the boils and swellings under the armpits, hams, and other parts. In this case, poultices should be applied as warm as possible; the ingredients may be oatmeal, or biscuit powdered, honey and a little butter, warm and largely applied. When the swelling increases, grows red, and acquires a top, together with constant throbbing, it is a sign that matter is forming, which is the more confirmed by its growing soft. When the fluctuation of matter is actually felt, and that the top becomes somewhat of a black and yellow colour, it then is mature for being opened, in order to let out the matter, which is best performed with a lancet: this being done, apply the poultices again. And when the matter is fully discharged, lay on the diachylon plaister, in order to heal up the part. Should however an ulcer be the result, it must then be treated accordingly, as will be directed under that head.
Of Tumours.
When inflammations will neither disperse nor come to suppuration, it is apt to form hard tumours; sometimes they are indolent, at other times very painful. In this case, nothing is better applied, thanmercurial plaister(21), and especially if there is any venereal taint in the habit. At the same time, whenever tumours are dispersing, care should be taken to use internal medicines, in order to correct the acrimony, and a purge now and then, in order to incline the humours to be carried off. If, however, they incline to suppuration, poultices should be again applied; and to bring them sooner to a head, purges should be omitted, till after the matter is discharged.
A Mortification has two degrees; gangrene, the beginning, and sphacelus the compleated mortification. When an inflammation will neither disperse, suppurate, nor become indurated, but, on the contrary, increase with a burning inflammation, and is prodigious painful; when the swelling continually increases, the parts become uncommonly tender, attended with a numbness; thecolour changing from a fiery red into a livid ash colour, and the cuticula seems to separate on the touch, a gangrene has commenced. In this melancholy case there is no time to lose.—Apply the following powerful medicine, which in a gangrene, and even a sphacelus, has proved beneficial to a miracle.
Take Mercurial Ointment(P)one ounce; Calomel(N)and Powder’d Precipitate(O)of each one drachm; Oil of Peppermint(U),one drachm; Spread this upon a rag, and apply it to the gangrenous part.
If a sphacelus has commenced, the skin turned livid, attended with a cadaverous fœture, and seems to the touch to be rotten, it must be scarified to the quick with the lancet, and then the above remedy applied. But if it has already reached the bone, (which a mortification soon will) and seems to make a rapid progress, all external remedies are of little avail, and nothing but amputating the limb can save life. But as that operation ought to be performed by a skilful surgeon, I shall therefore omit it here; only observe, that there are very few cases, but that this dreadful catastrophe may be prevented, if timely assistance is given.
To conclude this section, I think it requisite to observe, that a gangrene and sphacelus, or mortification, is far from being so often the case as many from the pain theyundergo, are apt to persuade themselves. A common boil, whilst it is in an inflamed state, is sometimes so very painful as to put the patient in a fever, and will be excessively tender. But, notwithstanding, a suppuration is the result.
A gangrene and mortification is only to be dreaded, when a whole limb is inflamed, such as an arm, a leg, &c. When the inflammation is dreadful, that the blood can find no passage at all, but is obstructed on all sides, then the part must naturally die, and become cadaverous. The cause of this misfortune may be either a heavy contusion, a compound fracture, a gun-shot wound, or an internal malignity of the bone itself; and as a caution, I must also add, that pricking a tendon in bleeding may occasion this dreadful malady.
There is another kind of mortification which proceeds from a bad habit of body, a poorness of constitution, or when the whole mass of blood is corrupted by the scurvy. This shall be taken notice of in its proper place.
SECT. II.
This is a part of surgery that many pretend to, but what very few really understand. There are however laws in the animal œconomy, which when they are violated, leads us to trace its many evil consequences.
An ulcer is a dissolution of solids, occasioned by acrimonious humours, which not only act spontaneously upon each other, but prevent the remaining circulating part from the formation of unnatural substances.
Exulceration, strictly speaking, is what every part of the animal fabric is subject to; from the external surface, to the very substance of the bone itself. In this sense, every eruption, as well as the carius of the bones come under that denomination; but more particularly, the corruption of the softer parts on the surface of our body, is here the subject.
I shall not enter into a detail of the many kinds of ulcers generally enumerated; they have all in common an corruptive acrimony, and a depraved accretion of excressence in their nature; which differ only, according to the parts ulcerated, and the habit of body; and Ihave ever found in my practice, that one proper method serves for all; I shall therefore in a simple manner give such directions as will ever be attended with success.
The principal intention is to correct the malignity of the humour peculiar to ulcers; to bring them into a good suppuration, and nature, all kindNature! will perform the rest.
When an ulcer is inflamed all round, filled up with fungous substance, of various colours, the matter thin, ferous, and is very fœtid; then first wash the sore gently with some good soap suds, or let the part ulcerated be steeped in it for some little time, which will draw out the malignity; then apply the following dressing:
Take the powder of burn’dAllum(17), and with a little lint dab it all over the fungous part, then spread a pledget of the salve mentioned in gun-shot wounds, No.I. and over which apply a good warm poultice there also mentioned. Let this dressing be repeated twice or thrice a day, till the inflammation ceases, and the fungous substance becomes reduced; when then, the washing, the allum and poultice may be left off, but the mentioned salve continued till the sore looks of a pale red, and begins all round the edge to heal up.
Cleanliness is very commendable; but in this case, when a sore looks well, the matter becomes of a pale yellow; wiping should be very sparingly; and then, dressing once a day(the morning) is full sufficient; for by wiping, and often meddling with it, the small granulations of the flesh is hindered from growing, and healing is retarded.
A sore leg is very troublesome, and very often attended with pain and expence, to no purpose. It generally swells, is inflamed and troublesome at night. Let the leg be bathed every night, (with the open sore) in some good warm soap suds; or instead of that, take what you can have plenty of, namely, sea water. If you can have it warm, it is well, if not, make use of it cold, rather half a dozen times of the day, than omitting it altogether; and by dressing the leg as before directed you’ll have reason to thank me for my good advice.
Sometimes the bone is affected; in which case, the cure with the best dressing in the world will frequently be tedious. A sore of this kind will not heal till the bone has discharged a scale, (termedexfoliation.) But tedious as it is, very often it is made more so, by unnecessary trouble. Without intending to give offence to my brother surgeons, I have frequently seen bad consequences attending methods taught with diligence in hospitals; take my word for it, you will do no good with your scraping tools,throw them over board, and you’ll succeed better than using them in this case.
The bones, though the hardest, are the most delicate parts in the whole body; but when it is affected, nature forms a new periosteum over the sound part, and gradually pushes forward the decayed scale. This wonderful work is performed by nature only, and must not be disturbed. By scraping, and boring of it, the tender periosteum will only be molested, the sound bone will become foul again, and so you may go on for ever; and I never saw a sore of that kind healed up by this improper method, till nature over-powered art, or the surgeon was tired with scraping, perforating, &c. but I have known many amputations in consequence of it, and many lives lost in consequence of that again; yet there is no rule without exception. There are cases where operations of that kind on the bones is required; but that ought to be referred to a judicious and experienced surgeon.
When the sore remains fungous, the proud flesh sprouts out in little bunches, and the matter is muddy and stinking, it is almost a sure sign the bone is foul; and if you examine with a probe, you may generally feel it, or even see it, and the bone, is sometimes black, brown, &c. and generally very rough on the surface. In such a case, continue the dressing as before observed, and frequentlyexamine whether the scale loosens; at the same time examine (not too roughly) which way the scale inclines, also the bigness of it; and if there is a probability of extracting it, so that the fungosity only stops it, then freely use a bistoury to make way for it; but in this be not in too great a hurry, for care should be taken (as I have said above) not to extract the scale, till the separation from the fresh bone is mature.
If an ulcer is sinous, inject in the sinus, a mixture of burnt allum and water, viz.
Take water two ounces; burnt allum(17)two drachms; mix them well for injection.After two or three dressings with this, inject theantacrid injection.
Take two ounces of water, with one scruple of calomel(N), as I have described in my treatise on the venereal disease.
This is the proper management of ulcers in general, and will ever be attended with success, even in the most inveterate kind. In venereal ulcers, the mercurial ointment with the precipitate, may be applicable, especially in shankers. I shall therefore end this section, for having directed the management of the worst of ulcers, the inferior kind will of course yield to the same method.
SECT. III.
Under this head I shall consider all kinds of breaking out, exclusive of that, which attends inflammatory and acute fevers, as they are all of one nature, and will all yield to one method of cure.—All proceed from a corrupted humour, which nature endeavours to expell from the body, by driving them to the surface, as that is the least resisting part.
The itch may either proceed from original acrimony, or it may be catched from a mess-mate who is infested with the disease. In itself it is of different kinds, but the diversity in this respect depends principally on the habit of body afflicted with it. Sometimes it is dry, scaly, and attended with very great itching; in that case, it proceeds generally from a scorbutic habit, and is attended with a slow inward fever. Sometimes it is more moist, and utters itself with bladders all about the hands, particularly betwixt the fingers, and is a sufficient testimony of the disorder. The principal indication is to purifythe blood; and in the mean time recourse may be had to external means. A purge is first requisite.
Take powder of jalap(R)one scruple; calomel(N)three grains, mix it with a little sugar and water, and let the patient take it early in the morning, working it off with balm or any other tea; after this some pills may be made of calomel.
Take stomach powder(M)two scruples, calomel(N)one scruple; sugar about one scruple; mix them, and with a few drops of water make it into a mass, and divide it into twenty pills.Of which let him take one every morning and night.
Externally make use of the following:
Take Turner’s Cerate(K)two ounces; Precipitate(O)two drachms; mix them.
Let this be sparingly rubb’d on the itchy part; if it should be too hard, mix with it a little sweet oil. When the pills are all used, another purge like the former may be given; after which if requisite, a few of the same pills, one every night, will not be amiss. Should it be very obstinate, a littlemercurial ointment(P) about one drachm to the above quantity may be added; particularly if the ship is in a warm climate. Should these medicines seem to affect the mouth, as peoplevary much in this respect, a purge will set all to rights again. This is a safe and expeditious method of curing the rankest itch, even of the worst kind. If however there is a fever attending, a fewfever powders(L) should be given when going to rest, in order to promote perspiration; at the same time using the before mentioned medicines. In regard to the scorbutic itch, that I shall take notice of, under the title of that disorder. During the cure of the itch, a decoction of thesassafras(14) should be drank, as that is a great purifier of the blood.
Boils are sometimes very troublesome, and at times exquisitely painful; especially when they are on tendinous parts: they are always a sign of foul blood, and nature very often that way frees the body from diseases. They may frequently be dispersed in the beginning of their coming, by pressing, and gently pinching them: but unless they are very numerous, such a method is unsafe; because it forces into the blood again what nature endeavours to discharge. The best method is to bring them to a head as soon as possible, to which purpose I shall here recommend a paste that is very powerful.
Take oatmeal and make it into a paste with honey(E);this will speedily ripen them, and facilitate the collection of matter.
Should the boil not open of its own accord, and matter should be observed to fluctuate in it, open it with the incision lancet; and continue with your honey paste, till the core is discharged; when thediachylon plaisterwill heal it up.
These are very troublesome, and though at first they seem but insignificant, very often they lay the foundation to stubborn evils. In fact they are but a peculiar kind of itch; and the very same remedy that is recommended above for the itch, is equally powerful to remove this: what necessity is there then, of increasing words with a tedious description of their various appearances; since they will all yield to one substantial remedy?
It is an unhappy circumstance on board a ship, when a man is afflicted with this filthy distemper; and such a man is as pernicious to a ship’s crew, as a rotten sheep in a whole herd. If it proceeds from a lazy filthiness of body, a gentle washing with a good scrubbing-brush, and rubbing the backwith the boatswain’s towel,[12]is a pretty amusement enough to circulate the blood and to excite cleanliness. But sometimes this disorder has its seat in the very blood itself, and that filthy vermin will breed under the skin, and eat their way through, by clusters.—I have opened boils as big as pigeons eggs, from which large bunches of lice have followed the lancet.
12.A cat of nine tails.
12.A cat of nine tails.
These patients are in every respect wretched, and are actually objects of pity. They generally have a pale, sullen, heavy, half-starved, cowardly, in short a lousy, look; habitually lazy, and seem to be void of every manly passion; neither good nor ill-natured; and are stimulated by nothing but pusillanimity; and as they seem neither sick nor well, I say they are objects both of pity and contempt; though the latter is unjust, because they cannot help it.
The reason of all this wretchedness is because the blood is degenerated into a lifeless mass of pituitous corruption; and wants that spirit which gives a relish to life. Hence we see in this one instance, how much the mental faculties depend upon the state of the body.
In order to cure this unhappy patient, the blood must be purified, and the whole systemstimulated to a brisk circulation. Nothing less than mercury will do the one, and stimulants together with exercise, effect the other.
In the first place give him the following medicine.
Take ipecacuanha(S)one scruple; jalap(R)ten grains; calomel, (N)four grains; make it into a draught or bolus.
Let him take this in a morning upon a fasting stomach, and let him drink plenty of chamomile tea after every vomiting; then give him the following electuary.
Take lenitive electuary(I.)two ounces; black pepper powdered, two drachms; calomel(N),one scruple; mix them.
Of this let him take every morning one tea spoonful; upon which let him rub himself all over with the mercurial cloth as follows, till he comes by this exercise into a breathing sweat, at least for an hour; and for the rest of the day keep him in continual exercise.
The mercurial cloth.
Take a cloth or rag as much as half a yard square, upon which spread one ounce of mercurial ointment; let the patient work this into the cloth with his hands, so that it is equally all over alike.
With this cloth let him rub his wrists,arms, shoulders, top of his head, his back, knees, waist, thighs, and legs; and continue this rubbing once every morning with the same cloth for a whole month, putting the cloth in his pocket when he has done.
His sores may be dressed with the above ointment No.XI. The decoction of sassafras, and a dram of spirits, with a littleTurlington’s Balsamafter his morning’s exercise, will prove greatly to facilitate the cure. This is the method I have pursued with this filthy disorder; and I have succeeded to my most sanguine expectations. And by this, I have been fortunate enough to be the means of making men again, of wretches that were a burden to themselves, and a nuisance to the people that were obliged to associate with them.
Having thus treated on the most material ailments that want immediate assistance, I shall in this section consider promiscuous disorders, that have no relation to each other; but set them down as they occur to my memory.
Of the Tooth-Ach.
Those who have experienced the tooth-ach, best know how much they have wished for ease. No man can preserve attention to his affairs, who has bodily pain; and a severe tooth-ach is enough to disturb both body and mind.—But what is to be done?
Tooth-achs are of two kinds;—It may either proceed from cold, or from a decayed tooth, or from both. If the tooth is decayed, the sooner you have it out the better; but if your tooth is sound, then it is as unreasonable to draw it, as it would be to sling you over board, because you feel the pain. In regard to drawing the tooth, take this direction.
Observe first, what tooth it is; and shift the hook on the key instrument accordingly. Ordinarily the hook is to be inside, and the comb outside. When this is adjusted, wrap a little rag on the comb of the key, so that it may bear a little softly on the gums.—Then seat the patient steady on a chair or chest, (and if he is a coward, let somebody hold his hands, but a man of spirit will not want this officiousness) place yourself right before him—then fix the instrument on the tooth, the hook inwards, and the comb outwards; the hook on thetooth close to the gum, pushed a little towards the jaw bone, and be careful that you have hold but of one tooth, and the right one.
When your instrument is fixed as gentle as possible, without giving pain, (for if you fumble too long, and give pain, you intimidate the patient) I say then, when you have fixed your instrument properly on all sides, so that you have the condemned tooth, and no more; then shift your hand so, that you may have a good and firm hold, allowing for the turning of your hand.—Thus being ready, give your hand a gradual, and steadfast turn, and wrench the tooth out of its socket. In this you must be calmly resolute, neither spare your strength if requisite, nor let an untimely compassion get the better of your duty; but keep your hold till you have performed the operation. When the tooth is out of its socket, it will sometimes hang a little by the gum; introduce your fingers, and they may nimbly perform the rest if requisite.—It will sometimes happen, especially by the grinders, that a little of the jaw bone follows, sticking to the tooth;—let this not frighten you, it is sometimes impossible to avoid it; but not to frighten the patient with it, pick it off before he perceives it.
The moment the tooth is out, introduce your thumb and fore finger, and compress the socket of the drawn tooth; by which youreplace every thing in order again; and after which, one dram of good old stingo, for washing the mouth, and another for comforting the heart, will make the patient forget all the pain he felt in the operation.
This method is certainly the most substantial for the tooth-ach. But sometimes this is not practicable, either because that the stump is so rotted as not to suffer a hold; or that none on board are intrepid or capable enough to perform the operation; in this case a Palliative will be very acceptable.—Turlington’s Balsam(W), upon a little lint put into the hollow tooth will frequently give ease, alittle Spirits of Wine and Camphor(A), or if very raging, alittle Liquid Laudanum(T). But as I have said, they are only palliatives; and neither spirits, or any thing else can be depended upon for a certainty. Sometimes stopping up the hollow tooth with wax, with lead, or sometimes putting in a little saltpetre will give ease—each method may do, and each method may fail: so that sometimes if the tooth is not extracted, all powerfulPatienceat last must step in and prove the best doctor, till nature recovers, and comforts the patient with the balm of Ease.
Very frequently a cold occasions this troublesome pain; in which case the head should be well muffled up, in order to bring on a perspiration, and a blister behind the earalso of singular service—rubbing the face also with somespirits of wine and camphoris of great benefit, and attention should be had, if there be any fever in the system.
Bad weather sometimes will effect the eyes, whence they will become raw and blood shot; which ought to be remedied in time, in order to prevent further inflammation. In this case make the following eye water.
Take Alum, One Scruple.Fine Sugar, Two Scruples.Spirit of Wine, and Camphor(A)Ten Drops.Fresh Water, Three Ounces.
Mix them in a vial, and hang it up so that it may settle; then pour off the clear into another vial, which keep for use.
Of this excellent eye-water, drop a few drops into the blood-shot eye, which in a little time, will bring it to health again.——If the eye lids are raw and inflamed,Turner’s Cerate, or what is yet better, No.XI. which prove very beneficial.—Should the inflammation be very heavy, apply the following poultice, from which you may expect great benefit.
Take Oatmeal, and Sugar powdered an equalquantity, and make it into a poultice with the yolk of eggs; upon which pour a few drops of the spirit of Camphor.
This kind of poultice you will find very cooling and agreeable to the eye, in order to assuage the pain; or take the following.
Take the white of an egg upon a stone, or pewter plate, which rub with a piece of alum, till you get a fine white cream-like substance.
This is a fine cooling application. The Camphor agrees very well with some people, but with others it will not, in which case the last is preferable; or thespirits of camphormay be rejected from the other receipts.
The causes of that complaint are many. I shall only here observe two kinds; namely that proceeding from cold, and that which is occasioned from hardened ear wax.
In the first case, be very cautious how you tamper with your ears—a few drops of the spirit of Camphor upon a bit of lint, and that gently put into the ear, will sometimes perform great benefit; but never drop any thing considerable into the ear itself; it is frequently dangerous; from more reasons than what I here have room to enter into.
In cases where the ear wax is hardened,put in a little slice ofrusty bacon, or abit of fat ham, which you will find very powerful in softening the ear wax; and then with gentleness you may pick them; take care however not to go too deep.——Ear-ach frequently follows a heavy fit of sickness; in which case you can’t do any thing better with safety, than keeping them warm.
There are many degrees of this ailment. I shall first mention that of a common cold; which is either without a fever, or only a slight one.
Immediately on perceiving symptoms of a sore throat, a gargle should be applied. This, make of the following ingredients.
Take vinegar, and water, each four ounces.Alum powdered half an ounce.Honey about a good spoonful.
This gargle should be used two or three times of the day——if it is warm, it is so much the more powerful——a mouthful at a time is sufficient. If the palate is down,
Take alum powdered, common salt, of each two drams, black pepper, ten grains, mix it into a powder.
Of this powder take a little on the tip ofyour spatula, and apply it to the palate, when it will immediately shrink up; and frequently make the person who before was hoarse, speak immediately quite clear again with a distinct voice; then proceed with the gargle as above directed.
But if the sore throat is of a more malignant nature, the parts inflamed and swelled, the patient seeming almost strangled, and attended with a high fever; it is certainly the quincey, and should be treated accordingly. In this case you must bleed freely and repeatedly, and give the fever powders, as will be directed in the treatment of the fever, and the management of the quincey.
The gargle notwithstanding should be plentifully used——a blistering plaister betwixt the shoulders, and if need requires, on the calves of the legs, the bigness of the palm of the hand, will also prove of singular service; and in every respect the treatment, as I shall observe under its proper head.
SECT. V.
I have written and published a full treatise of this disease; divided in three parts; namely, I. An anatomical and physiological description of the genital parts of both sexes. II. An ætiological enquiry in the various stages of this disease. III. A true and rational method of cure. Nevertheless I shall here concisely give a safe method of the cure, in its various local degrees. But to those who would wish to know more circumstantial the true nature of that malady, and of the animal œconomy, I must refer to the above treatise.
The venereal disease may be considered in different degrees; namely thefirstandsecond infection.
To the first, I consider the gonorrhœa or clap, the phimosis, paraphimosis, chordee, priapism, shankers, dysuria, bubo, swelled testicles, and venereal excrescences, in their various degrees, in a local state. To the second infection, I consider those diseases that proceed from the venereal virus, infecting the whole mass of blood; namely cutaneous diseases; glandular diseases; diseases of the bones; dry pox; and the confirmed lues itself.
The first infection is what I shall here briefly consider, and give such remedies, which though simple and few, will prove efficacious. But the second I shall here only consider in the general.
The gonorrhœa or clap, commences with an agreeable tickling in the urethra, attended with a thin limpid ouzing, which however soon degenerates into a disagreeable pain. A discharge of sharp fœtid matter, gradually commences with a scalding of urine; the præpuce and glans sometimes swells, with inflammation and a painful involuntary erection, which adds considerable pain to the patient, and under which, the whole system seem disordered.
When all these symptoms appear, there is no room left to doubt a confirmed clap.
The first thing to be done, is to take some of thefever powders(L) in order to promote a perspiration, and to abate the scalding of the urine.
In the next place, and which is the principal object; have immediate recourse to my antacrid injection, which is simply this,
Take clean water one ounce,Calomel(N)one scruple,Mix it, and shake it when it is made use of.
Let this be injected up into the urethra, three times of the day, which if duely performed will stop the evil in its first bud; and prevent all the generally attending consequences. For it perfectly eradicates all the malignities of the venereal virus; prevents shankers, priapism, chordee, and any farther spreading of the infection. At the same time the calomel should be given internally; namely the pills, No.X. to be taken every morning one.
A Phimosis is when the præpuce is so swelled, that the glans cannot be uncovered; and a Paraphimosis is when the præpuce is swelled behind the glans, so as not to cover the glans. Either way proceeds from the venereal virus having insinuated itself into the præpuce.
If theinjection, No.XXI. is made use of in time, all this will be prevented; but sometimes it is of a very stubborn nature. If the inflammation is very great, the poultice, No.II. should immediately be applied, to which it will yield; being of a very powerful quality, particularly, if to the poulticemercurial ointment(P) two drachmes is added, by which it becomes an immediate antidote to the venereal virus.
Of the Chordee, and Priapism.
A priapism is an involuntary erection; and the chordee is a stricture in the urethra, by which the penis is bent either ways, according to the seat of the contraction, this however is generally downwards; whereby it makes the involuntary erection prodigiously painful.
It proceeds from some imprisoned virus in the urethra; which together with its contraction, irritates the penis to erection.
Theantacrid injectionNo.XXI. will generally, if timely applied, prevent this; but if by neglect, or the great virulence of the venom, it has actually commenced, recourse should be had to mercurial ointment; which should three or four times of the day be rubbed on the penis. Should the priapism be very violent, the poultice, No.II. with the addition ofmercurial ointment(P) must be applied.
The dysuria is a scalding of the urine in the urethra; this likewise is obviated by timely using theinjection, No.XXI. or No.VIII. But when it is actually become troublesome, drink plentifully of dilutingdrinks, such asbalm tea, &c. and take a few fever powders which will soon set this to right again; particularly as that is a symptom which generally vanishes, as the disease becomes milder.
These are little ulcers coming upon the glans, the frænum, and the præpuce of the yard. They are not only troublesome, but sometimes tedious in the cure; theantacrid injectionNo.XXI. if timely applied, will generally prevent them.
But sometimes these very unwelcome visitors will appear even without a clap; and then they generally gain great ground, before timely remedies can be applied.
TheinjectionNo.XXI. should in this case be injected betwixt the præpuce and glans; but if this is not sufficient, apply the following.
Take mercurial ointment, two drachmes; calomel(N),two scruples; precipitate(O),ten grains. Mix it into an ointment.
By the dressing with this, all the shankers will speedily heal up.
If warts sprout out, they should immediately be cut off, with a pair of good sharp scissars, and then dressed with the above ointment.
Shankers, when they appear, without a previous gonorrhœa or clap, ought always to be taken as a forerunner of the pox itself; and the patient must have immediately recourse to themercurial pills, No.X. one to be taken night and morning, in order to prevent the threatening evil consequences.
A Bubo is a swelling that appears on a venereal infection, sometimes in one, sometimes in both groins. This swelling proceeds either from a transposed virus, or comes as the first messenger of a venereal infection.
A bubo appears with symptoms of a heavy dull pain in the groin, which on examination discovers itself with a little kernel that is painful to the touch: If left to itself it gradually encreases both in bulk as well as in pain, and at length forms a collection of matter.
The moment a bubo appears, take a purge, No.IX. rub the part in the groin withmercurial ointment, and spread amercurial plaisterthe bigness of a crown-piece, which, (the hair being removed,) lay on the part; let it remain on, till it separates from the skin, and the swelling is dispersed; the patient should be kept warm, and not have muchexercise; at the same time the body should be kept open.
By this means the bubo will soon disperse, and the virus be destroyed in its first bud. But if it has already gained too much head to be dispersed, and matter is formed, it becomes larger and soft, and a fluctuation of matter is felt, then suppuration must be promoted; and when ripe be opened as soon as possible, for an outlet of the matter.
When it is come to its maturity, (that is the matter plainly perceived,) open it and dress it like an ulcer, first with the ointment, No.I. and when it discharges pretty well, dress it with the ointment, No.XXII.
By this management, though easy, you will not fail of success.
The venereal virus is liable to attack the testicles, which makes one of the most disagreeable circumstances of all venereal diseases; sometimes one, and sometimes both will be the seat of this complaint.
It begins with a heavy dull pain, attended with a disagreeable tightness in the spermatic vessels, leading from the testicle into the bowels. Gradually the testicle swells, becomes hard and grows very painful, and if not timely remedied, a suppuration, or ascirrhus, or even a gangrene and sphacelus, may be the consequences.
The moment the pain in the testicles is perceived, remove the hair all round the scrotum, and apply a mercurial plaister spread upon leather; over which put a suspensorium, and tie it up to the body as tight as it can be borne; which together with a purge, No.IX. will not fail of giving immediate relief.
The patient should be kept as quiet as possible; for hard labour not only retards the cure, but becomes very painful. Should this not be sufficient, apply the poultice, No.II. with the mercurial addition as warm as sufferable, and repeat it as often as it is necessary for keeping it warm to the part. By this method it will not fail of dispersing.
Should it however against all expectation come to a suppuration, it must be opened the same as another aposthume, and treated accordingly. But should a scirrhus, or a mortification ensue, extirpation is the only recourse. For which see my treatise.
Besides all these disorders before mentioned that are the consequence of impure coition, there is one more to be mentioned, and that is a variety of disagreeable excrescences, which sometimes arise about the penis, thescrotum perinæum, and about the fundament.
When these appear, I generally take it for granted, that the pox is in the blood, and the patient ought to be treated accordingly.
If there is a possibility of extirpating them, either by a bistoury, or a pair of good sharp scissars, it ought to be done, and dressed with the following ointment.
Take mercurial ointment(P),and precipitate(O)equal parts: mix them.
The roots of these stubborn companions are frequently seated very deep; if this is particularly taken notice of, together with proper internal medicines, the excrescences taken away at the root, and the ointment applied, they may all of them soon be drove off from the field.
In regard to the second infection, this is too tedious here to enter into, and to do properly justice, I must refer the reader to the treatise itself.
All I have at present to say, is, that my method of cure is particularly easy and simple, in itself; and I am happy to think at the same time, that it is more efficacious, than any former method, or practice, made use of.
Theantacrid injectionNo.XXI. is the most efficacious for subduing the gonorrhœa, and all the evil consequences in that part; and theother mercurial preparations in the manner I have recommended them, is equally powerful.
I am utterly averse to salivation; it is using mercury as a poison; very few have ever been cured by it, and those few have been more indebted to their good constitution, than the treatment which they have with so much danger undergone. But many, very many, have had their constitutions ruined by salivation, past the art of man to recover; and thousands have been sent miserable objects to the grave.
I am also averse to bleeding in venereal cases, unless the greatest necessity requires it; for in general it serves only to infect all the fluids, since the veins emptied, will naturally absorb from all parts of the body, and thence liable to infect the whole mass of blood. Purging needs but be used very sparingly.
Mercury inwardly taken, should be used with the greatest moderation, and taken in very small doses; for with such judicious management it becomes one of the best medicines in the whole Materia Medica; but if abused, it is converted into a poison. The decoction of the sassafras should be plentifully made use of during the whole course of the venereal disease.
And lastly, from the real effect that the mercury has on the blood, I must add, thatthe same gentle method with respect to its internal use, as is recommended for the first infection, must also be pursued for the second infection; let the malignities be ever so bad, even in the most inveterate diseases of the bones themselves; with this difference, that in proportion as the disease is engrafted, time must be allowed for the cure.
Nature may be led by the gentle hand of assistance, and tenderness; but he who attempts to do good by main force, acts as a fool, and deceives not only himself, but those who are so unfortunate, as to trust to his pretended skill.
It has been observed by all diligent inquirers into nature, that poisons are of two kinds, with respect to their effect in the animal œconomy. One kind will destroy if taken inwardly, but not have such ill consequences in wounded parts, externally. Another kind will be fatal in wounds; at the same time it does not affect the viscera.
The first which destroys internally, are poisons, either from corrosive minerals, or vegetables; but of the latter, namely what seems inoffensive taken in the mouth, is the poison that follows the bite of most venomous animals whose poison are natural; such is the scorpion, the adder, the rattle snake, &c. whose poison have by various experiments, been found to be attended with no ill consequences internally taken. This was known to the ancients, as well as to us; for we find Celsus,[13]to have spoken of this in his medical works.