Chapter IV: Of the Power of Celestial Bodies over Men and Women (2)

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 Whenever they begin to stimulate or give any uneasiness, they may be withdrawn.

The _phymosis_ is such a constriction of the prepuce over the glans, as hinders it from being drawn backwards; the _paraphymosis_, 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 the _priapism_, _chordee_, and other distortions of the _penis_, 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 the _gummata_, _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 and rendered 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 mercurial ointment 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 mercury which 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]

Footnote 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 twelve English 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]

Footnote 11:

Though we are still very much in the dark with regard to the method of
curing this disease among the natives of America, yet it is generally
affirmed that they do cure it with speed, safety, and success, and
that without the least knowledge of mercury. Hence it becomes an
object of considerable importance to discover their method of cure.
This might surely be done by making trials of the various plants which
are found in those parts, and particularly of such as the natives are
known to make use of. All people in a rude state take their medicines
chiefly from the vegetable kingdom, and are often possessed of
valuable secrets with regard to the virtues of plants, of which more
enlightened nations are ignorant. Indeed, we make no doubt but some
plants of our own growth, were proper pains taken to discover them,
would be found as efficacious in curing the venereal disease as those
in America. It must, however, be remembered, that what will cure the
venereal disease in one country, will not always be found to have
equal success in another.

Many other roots and woods might be mentioned which have been extolled for curing the venereal disease, as the china roots, the roots of soap-wart, burdock, &c., as also the wood of guaiacum and sassafras; but as none of these have been found to possess virtues superior to those already mentioned, we shall, for the sake of brevity, pass them over, and shall conclude our observations on this disease, with a few general remarks concerning the proper management of the patient and the nature of the infection.

GENERAL OBSERVATIONS.

The condition of the patient ought always to be considered previous to his entering upon a course of mercury in any form. It would be equally rash and dangerous to administer mercury to a person labouring under any violent acute disease, as a putrid fever, pleurisy, peripnuemony, or the like. It would likewise be dangerous in some chronic cases; as a slow hectic fever, or the last stage of a consumption. Sometimes, however, these diseases proceed from a confirmed lues; in which case it will be necessary to give mercury. In chronic diseases of a less dangerous nature, as the asthma, the gravel, and such like, mercury, if necessary, may be safely administered. If the patient’s strength has been greatly exhausted by sickness, labour, abstinence, or any other cause, the use of mercury must be postponed, till by time, rest, and a nourishing diet, it can be sufficiently restored.

Mercury ought not to be administered to women during the menstrual flux, or when the period is near at hand. Neither should it be given in the last stage of pregnancy. If, however, the woman be not near the time of her delivery, and circumstances render it necessary, mercury may be given, but in smaller doses, and at greater intervals than usual; with these precautions, both the mother and child may be cured at the same time, if not, the disorder will at least be kept from growing worse, till the woman be brought to bed, and sufficiently recovered, when a more effectual method may be pursued, which, if she suckles her child, will in all probability be sufficient for the cure of both.

Mercury ought always to be administered to infants with the greatest caution. Their tender condition unfits them for supporting a salivation, and makes it necessary to administer even the mildest preparations of mercury to them with a sparing hand. A similar conduct is recommended in the treatment of old persons, who have the misfortune to labour under a confirmed lues. No doubt the infirmities of age must render people less able to undergo the fatigues of a salivation; but this, as was formerly observed, is never necessary; besides, we have generally found that mercury had much less effect upon very old persons, than on those who were younger.

Hysteric and hypochondriac persons, and such as are subject to an habitual diarrhœa or dysentery, or to frequent and violent attacks of epilepsy, or who are afflicted with the scrofula or the scurvy, ought to be cautious in the use of mercury. Where any one of these disorders prevails it ought either, if possible, to be cured, or at least palliated, before the patient enters upon a course of mercury. When this cannot be done, the mercury must be administered in smaller doses, and at longer intervals than usual. The most proper seasons for entering upon a course of mercury, are the spring and autumn, when the air is of a moderate warmth. If the circumstances of the case, however, will not admit of delay, we must not defer the cure on account of the season, but must administer the mercury; taking care, at the same time, to keep the patient’s chamber warmer or cooler according as the season of the year requires.

The next thing to be considered is the preparation necessary to be observed before we proceed to administer a course of mercury. Some lay great stress upon this circumstance, observing that by previously relaxing the vessels, and correcting any disorder which may happen to prevail in the blood, not only the mercury will be disposed to act more kindly, but many other inconveniencies will be prevented.

We have already recommended bleeding and gentle purges, previous to the administration of mercury, and shall only now add, that these are always to be repeated according to the age, strength, constitution, and other circumstances of the patient. Afterwards, if it can be conveniently done, the patient ought to bathe once or twice a day, for a few days, in lukewarm water. His diet, in the meantime, must be light, moist, and cooling. Wine and all heating liquors, also violent bodily exercise, and all great exertions of the mind, are carefully to be avoided.

A proper regimen is likewise to be observed by such as are under a course of mercury. Inattention to this not only endangers the patient’s life, but often also disappoints him of a cure. A much smaller quantity of mercury will be sufficient for the cure of a person who lives low, keeps warm, and avoids all manner of excess, than of one who cannot endure to put the smallest restraint upon his appetites; indeed, it but rarely happens that such are thoroughly cured.

There is hardly any thing of more importance, either for preventing or removing venereal infection than cleanliness. By an early attention to this, the infection might often be prevented from entering the body; and where it has already taken place, its effects may be greatly mitigated. The moment any person has reason to suspect that he has received the infection, he ought to wash the parts with water and spirits, sweet oil, or milk and water; a small quantity of the last may likewise be injected up the urethra, if it can be conveniently done. Whether this disease at first took its rise from dirtiness is hard to say; but wherever that prevails the infection is found in its greatest virulence, which gives ground to believe that a strict attention to cleanliness would go far towards extirpating it altogether.[12]

Footnote 12:

I have not only seen a recent infection carried off in a few days by
means of cleanliness, _viz._, bathing, fomentations, injections, &c.,
but have likewise found it of the greatest advantage in the more
advanced stages of the disease. Of this I had lately a very remarkable
instance in a man whose penis was almost wholly consumed by venereal
ulcers; the matter had been allowed to continue on the sores without
any care having been taken to clean them, till, notwithstanding the
use of mercury and other medicines, it had produced the effects
mentioned. I ordered warm milk and water to be injected three or four
times a day into all the sinuous ulcers, in order to wash out the
matter; after which they were stuffed with dry lint to absorb the
fresh matter as it was generated. The patient at the same time took
every day half a grain of the corrosive sublimate of mercury,
dissolved in an ounce of brandy, and drank an English quart of the
decoction of sarsaparilla. By this treatment, in about six weeks, he
was perfectly cured; and, what was very remarkable, a part of the
penis was actually regenerated.

Dr. Gilchrist has given an account of a species of the _lues venerea_
which prevails in the west of Scotland, to which the natives give the
name of _Sibbins_ or _Sivvins_. The doctor observes, that the
spreading of this disease is chiefly owing to a neglect of
cleanliness, and seems to think, that by due attention to this
_virtue_, it might be extirpated. The treatment of this disease is
similar to that of a confirmed lues or pox. The _yaws_, a disease
which is now very common both in America and the West India Islands,
may also be cured in the same manner.

When the venereal disease has been neglected, or improperly treated, it often becomes a disorder of the habit. In this case the cure must be attempted by restoratives, as milk diet, the decoction of sarsaparilla, and such like, to which mercury may be added. It is a common practice in North Britain to send such patients to drink goat-whey. This is a very proper plan, providing the infection has been totally eradicated beforehand; but when that is not the case, and the patient trusts to the whey for finishing his cure, he will be often disappointed. I have frequently known the disease return with all its virulence after a course of goat-whey, even when that course had been thought quite sufficient for completing the cure.

One of the most unfortunate circumstances attending patients in this disease, is the necessity they are often laid under of hurrying the cure. This induces them to take medicine too fast, and to leave it off too soon. A few grains more of medicine, or a few days longer confinement, would often be sufficient to perform the cure; whereas, by neglect of these, a small degree of virulence is still left in the system, which gradually vitiates, and at length contaminates the whole mass. To avoid this, we would advise, that the patient should never leave off taking medicine immediately upon the disappearing of the symptoms, but continue it for some time after, gradually lessening the quantity, till there is reason to believe the disease is entirely eradicated.

It is not only difficult, but absolutely impossible, to ascertain the exact degree of virulence that may attend the disease; for which reason it will always be a much safer rule to continue the use of medicine too long, than to leave it off too soon. This seems to be the leading maxim of a modern practitioner of some note for the venereal disease, who always orders his patients to perform a quarantine of forty days, during which time he takes forty bottles of, I suppose, a strong decoction of sarsaparilla, or some other antivenereal simple. Whoever takes this method, and adds a sufficient quantity of corrosive sublimate, or some other active preparation of mercury to the decoction, will seldom fail to cure a confirmed lues.

It is peculiarly unfortunate for the cure of this disease, that not one in ten of those who contract it, are either able or willing to submit to a proper plan of regimen. The patient is willing to take medicine; but he must follow his business, and to prevent suspicions, must eat and drink like the rest of the family. This is the true source of nine-tenths, of all the mischief arising from venereal disease. I never knew the cure attended with any great difficulty or danger where the patient strictly followed the physician’s advice; but a volume would not be sufficient to point out the dreadful consequences which proceed from an opposite conduct. Schirrous testicles, ulcerous sore throats, madness, consumptions, carious bones, and a rotten progeny, are a few of the blessings derived from this source.

There is a species of false reasoning, with regard to this disease, which proves fatal to many. A person of a sound constitution contracts a slight degree of the disorder. He gets well without taking any great care, or using much medicine, and hence concludes, that this will always be the case. The next time the disease occurs, though ten times more virulent, he pursues the same course, and his constitution is ruined. Indeed, the different degrees of virulence in the small-pox are not greater than in this disease, though, as the learned Sydenham observes, in some cases the most skilful physicians cannot cure, and in others the most ignorant old women cannot kill the patient in that disorder. Though a good constitution is always in favour of the patient, yet too great stress may be laid upon it. It does not appear from observation, that the most robust constitution is able to overcome the virulence of the venereal contagion, after it has got into the habit. In this case, a proper course of medicine is always indispensably necessary.

Although it is impossible, on account of the different degrees of virulence, &c., to lay down fixed and certain rules, for the cure of this disease, yet the following general plan will always be found safe, and often successful, viz.: to bleed and administer gentle purges with diuretics during the inflammatory state, and, as soon as the symptoms of inflammation are abated, to administer mercury, in any form that may be most agreeable to the patient. The same medicine, assisted by the decoction of sarsaparilla, and a proper regimen, will not only secure the constitution against the further progress of a confirmed pox, but will generally perform a complete cure.

Although the venereal disease may not be a proper subject of discussion for regular families and the nursery, yet there are many individuals to whom the observations here made may be of service in that complaint. There is no disease which opens so wide a field for the quack, none in which he so completely picks the pocket and ruins the constitution of the ignorant and unwary. Mercury, though looked upon as a certain cure in every species of this disease, is only proper in one; and though every apothecary’s boy pretends to cure the venereal disease by it, there is no medicine oftener misapplied. Though mercury is a certain cure for the _lues venerea_, it is a medicine of so very active a nature that it cannot be administered with too much care; it is the chief ingredient in all the nostrums daily advertised for the cure of this disease, and those who value their health or their life, should beware of allowing themselves to become, in a matter so serious, the dupes of imposture.