Chapter XXII: Part II: Of Diseases (12)

The wound may be dressed with salt and water, or a pickle made of vinegar and salt, and afterwards dressed twice a-day with yellow basilicon mixed with red precipitate of mercury.

The patient should begin to use either Dr. Mead’s medicine, or some of the others mentioned above. If he takes Mead’s medicine, he may use it as the Doctor directs for four days successively. Let him then omit it for two or three days, and again repeat the same number of doses as before.

During this course, he must rub into the parts about the wound, daily, one drachm of the mercurial ointment. This may be done for ten or twelve days at least.

When this course is over, he may take a purge or two, and wait a few days till the effect of the mercury be gone off. He must then begin to use the cold bath, into which he may go every morning for five or six weeks. If he should feel cold and chilly for a long time after coming out of the cold bath, it will be better to use a tepid one, or to have the water a little warmed.

In the mean time, we would advise him not to leave off all internal medicines, but to take either one of the boluses of snake-root, asafœtida, and camphire; or one of the powders of nitre, camphire, and snake-root, twice a-day. These may be used during the whole time he is bathing.

During the use of the mercurial ointment, the patient must keep within doors, and take nothing cold.

A proper regimen must be observed throughout the whole course. The patient should abstain from flesh, and all salted and high-seasoned provisions. He must avoid strong liquors, and live mostly upon a light and rather spare diet. His mind should be kept as easy and cheerful as possible, and all excessive heat and violent passions avoided with the utmost care.

I have never seen this course of medicine, with proper regimen, fail to prevent the hydrophobia, and cannot help again observing, that the want of success must generally be owing either to the application of improper medicines, or not using proper ones for a sufficient length of time.

Mankind are extremely fond of every thing that promises a sudden or miraculous cure. By trusting to these they often lose their lives, when a regular course of medicine would have rendered them absolutely safe. This holds remarkably in the present case. Numbers of people, for example, believe if they or their cattle were once dipped in the sea, it is sufficient; as if the salt-water were a charm against the effects of the bite. This, and such like whims, have proved fatal to many.

It is a common notion, if a person be bit by a dog which is not mad, that, if he should go mad afterwards, the person would be affected with the disorder at the same time; but this notion is too ridiculous to deserve a serious consideration. It is a good rule, however, to avoid dogs as much as possible, as the disease is often upon them for some time before its violent symptoms appear. The hydrophobia has been occasioned by the bite of a dog which shewed no other symptoms of the disease but listlessness and a sullen disposition.

Though we do not mean to treat fully of the cure of the hydrophobia, yet we are far from reckoning it incurable. The notion that this disease could not be cured, has been productive of the most horrid consequences. It was usual either to abandon the unhappy persons, as soon as they were seized with the disease, to their fate, to bleed them to death, or to suffocate them between matrasses or feather-beds, &c. This conduct certainly deserved the severest punishment! We hope, for the honour of human nature, it will never again be heard of.

I have never had an opportunity of treating this disease, and therefore can say nothing of it from my own experience; but the learned Dr. Tissot says, it may be cured in the following manner:

1. The patient must be bled to a considerable quantity; and this may be repeated twice, or thrice, or even a fourth time, if circumstances require it.

2. The patient should be put, if possible, into a warm bath; and this should be used twice a-day.

3. He should every day receive two, or even three emollient clysters.

4. The wound, and the parts adjoining to it, should be rubbed with the mercurial ointment twice a-day.

5. The whole limb which contains the wound should be rubbed with oil, and be wrapped up in an oily flannel.

6. Every three hours a dose of Cob’s powder should be taken in a cup of the infusion of lime-tree and elder-flowers. This powder is made, by rubbing together in a mortar, to a very fine powder, of native and factitious cinnabar, each twenty-four grains; of musk, sixteen grains[162].

7. The following bolus is to be given every night, and to be repeated in the morning, if the patient is not easy, washing it down with the infusion mentioned above: Take one drachm of Virginian snake-root in powder; of camphire and asafœtida, ten grains each; of opium, one grain; and, with a sufficient quantity of conserve, or rob of elder, make a bolus.

8. If there be a great nausea at the stomach, with a bitterness in the mouth, thirty-five or forty grains of ipecacuanha, in powder, may be taken for a vomit.

9. The patient’s food, if he takes any, must be light; as panado, soups made of farinaceous or mealy vegetables, &c.

10. If the patient should long continue weak, and subject to terrors, he may take half a drachm of the Peruvian bark thrice a-day.

The next poisonous animal which we shall mention is the VIPER. The grease of this animal rubbed into the wound is said to cure the bite. Though that is all the viper-catchers generally do when bit, we should not think it sufficient for the bite of an enraged viper. It would surely be more safe to have the wound well sucked[163], and afterwards rubbed with warm salad-oil. A poultice of bread and milk, softened with salad-oil, should likewise be applied to the wound; and the patient ought to drink freely of vinegar whey, or water-gruel with vinegar in it, to make him sweat. Vinegar is one of the best medicines which can be used in any kind of poison, and ought to be taken very liberally. If the patient be sick, he may take a vomit. This course will be sufficient to cure the bite of any of the poisonous animals of this country.

With regard to poisonous insects, as the bee, the wasp, the hornet, &c. their stings are seldom attended with danger, unless when a person happens to be stung by a great number of them at the same time; in which case something should be done to abate the inflammation and swelling. Some, for this purpose, apply honey, others lay pounded parsley to the part. A mixture of vinegar and Venice treacle is likewise recommended; but I have always found rubbing the part with warm salad-oil succeed very well. Indeed, when the stings are so numerous as to endanger the patient’s life, which is sometimes the case, he must not only have oily poultices applied to the part, but should likewise be bled, and take some cooling medicines, as nitre, or cream of tartar, and should drink plentifully of diluting liquors.

It is the happiness of this island to have very few poisonous animals, and those which we have are by no means of the most virulent kind. Nine-tenths of the effects attributed to poison or venom in this country, are really other diseases, and proceed from quite different causes.

We cannot however make the same observation with regard to poisonous vegetables. These abound every where, and prove often fatal to the ignorant and unwary. This indeed is chiefly owing to carelessness. Children ought early to be cautioned against eating any kind of fruit, roots, or berries, which they do not know, and all poisonous plants to which they can have access, ought, as far as possible, to be destroyed. This would not be so difficult a task as some people imagine.

Poisonous plants have no doubt their use, and they ought to be propagated in proper places; but, as they prove often destructive to cattle, they should be rooted out of all pasture-grounds. They ought likewise, for the safety of the human species, to be destroyed in the neighbourhood of all towns and villages; which, by the bye, are the places where they most commonly abound. I have seen the poisonous hemlock, henbane, wolfsbane, and deadly night-shade, all growing within the _environs_ of a small town, where, though several persons, within the memory of those living in it, had lost their lives by one or other of these plants; yet no method, that I could hear of, had ever been taken to root them out; though this might be done at a very trifling expence.

Seldom a year passes but we have accounts of several persons poisoned by eating hemlock-roots instead of parsnips, or some kinds of fungus which they had gathered for mushrooms. These examples ought to put people upon their guard with respect to the former, and to put the latter entirely out of use. Mushrooms may be a delicate dish, but they are a dangerous one, as they are generally gathered by persons who do not know one kind of fungus from another, and take every thing for a mushroom which has that appearance.

We might here mention many other plants and animals of a poisonous nature which are found in foreign countries; but, as our observations are chiefly intended for this island, we shall pass these over. It may not however be amiss to observe, for the benefit of such of our countrymen as go to America, that an effectual remedy is now said to be found for the bite of the rattle-snake.—The prescription is as follows: Take of the roots of plantain and horehound, in summer, roots and branches together, a sufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give, as soon as possible, one large spoonful; if the patient be swelled, you must force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another spoonful, which never fails.—If the roots are dried, they must be moistened with a little water. To the wound may be applied a leaf of good tobacco moistened with rum.

We give this upon the faith of Dr. Brookes, who says it was the invention of a negro; for the discovery of which he had his freedom purchased, and a hundred pounds _per annum_ settled upon him during life, by the General Assembly of Carolina.

It is possible there may be in nature specific remedies for every kind of poison; but as we have very little faith in any of those which have yet been pretended to be discovered, we shall beg leave again to recommend the most strict attention to the following rules, _viz._ That when any poisonous substance has been taken into the stomach, it ought, as soon as possible, to be discharged by vomits, clysters, and purges; and, when poison has been received into the body by a wound, that it be expelled by medicines which promote the different secretions, especially those of sweat, urine, and insensible perspiration; to which may be joined antispasmodics, or such medicines as take off tension and irritation; the chief of which are opium, musk, camphire, and asafœtida.

CHAP. XLVII.
OF THE VENEREAL DISEASE.

In the first 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 persons who contract 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 called an assemblage of diseases, than a single one. No two diseases can require a more different method 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 matter 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 indeed 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 in 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 begin to appear.

As the disorder advances, the pain, heat of 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 all up the urinary passage, and is most intense just after the patient has done making water. The running gradually recedes from the colour of seed, grows yellow, and at length puts on the appearance of matter.

When the disorder has arrived at its height, all the symptoms are more intense; the heat of 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 of urine goes off; the involuntary and painful erections, and the heat and pain about the seat, become easier; 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 in the kidnies or bladder, the _fluor 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 every thing of a heating nature, as wines, spirituous liquors, rich sauces, spiced, salted, high-seasoned and smoke-dried provisions, &c. as also all aromatic and stimulating vegetables, as onions, garlic, shallot, 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 marsh-mallows 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 cannot always 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. These may be various ways prepared, but I think those made with the white vitriol are both most 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 order a drachm of white vitriol to be dissolved in eight or 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[164].

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[165].

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, or bladders 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 or other of these applications.

Few things tend more to keep off inflammation in the spermatic vessels, than a proper truss 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 only to procure an abatement or remission of the inflammatory symptoms, so far as to make it safe to have recourse to the great antidote _mercury_.

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 erections 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 too much, the dose must be lessened; if not at all, it may be gradually 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 above 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. The 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 must take an infusion of senna, or some other purgative, and drink freely of water-gruel to prevent bloody stools, which are very 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 above pills or bolus, half a drachm 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 combined with purgatives. With this view the laxative mercurial pill has been contrived, the usual dose of which is half a drachm, 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[166].

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 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 hog’s lard and quicksilver, about a drachm may be used at a time. The best time for rubbing it on is at night, and the most proper place the inner side of the thighs. The patient should stand before 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 become 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 must 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. Spirituous 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 considerably 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, thick, 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.

OF GLEETS.

A gonorrhœa frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from 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 inconstant, 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, the patient may have recourse to stronger and more powerful astringents, as the Peruvian bark[167], alum, vitriol, galls, tormentil, bistort, baldustines, 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.

The last remedy which we shall mention in this case is the cold bath, than which there is not perhaps 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 from 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 objection of this kind prevails, 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. Any person may now afford to drink these waters, as they can be every where prepared at almost no expence, by a mixture of common chalk and oil of vitriol.

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[168]; and desires that their use may be accompanied with a decoction of guaiacum or sarsaparilla.

The last kind of remedy which we shall mention for the cure of ulcers in the urinary passage, are the suppurating candles or bougies: as these are prepared various ways, and are generally to be 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 or eight hours, according as the patient can bear it. Obstinate ulcers are not only often healed, but tumours and 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.

OF THE SWELLED TESTICLE.

The swelled testicle may either proceed from infection lately contracted, or from the venereal poison lurking in the blood: 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[169]. The food must be light, and the drink diluting. High-seasoned food, flesh, wines, and every thing of a heating nature, 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 bag or truss, which may easily be contrived in such a manner as to prevent the weight of the testicle from having any effect.

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 part, if free from pain, or 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 scrophulous or cancerous habit, either of which may support a scirrhous induration, after the 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[170]. This practice is strongly recommended by Dr. Stork in scirrhous 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 scirrhus had begun to be affected with pricking and lancing pains.

OF BUBOES.

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 by _dispersion_, and, if that should not succeed, by _suppuration_. To promote the dispersion of a bubo, 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 the use of mercury, which must be continued till the venereal virus is quite subdued[171].

But if the bubo 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 cold constitutions, 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 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 scirrhous, they must be dissolved by the application of hemlock, both externally and internally, as directed in the scirrhous testicle.

OF CHANCRES.

Chancres are superficial, callous, eating ulcers; which may happen either with or without a gonorrhœa. They are commonly seated about the glans, 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 oftner symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after impure coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, the _glans penis_ of men, &c.[172].

When a 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, scurfy 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 also less painful, 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[173].

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 a _strangury_ or obstruction of urine, _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, and 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 troublesome _tenesmus_, 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 cooling emulsions, 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 marsh-mallows, 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 ipecacuanha, 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 performing 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 drachm 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 in 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, armpits, 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, whilst 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, scirrhus, 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 an 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 consequences 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 by the salivary 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 singular in this opinion. My ingenious friend, Mr. Clare, an eminent surgeon of this city, assures me, that for some time past he has 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 applies, in small portions, to the tongue, where, with a gentle degree of friction, it is immediately absorbed, and produces its full effect; upon the system, without doing the least injury to the stomach or bowels; a matter of the greatest 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 _à priori_, what quantity of mercury will, in the whole, be necessary to cure this distemper completely; yet it may be judged of _à 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 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 stomach cannot bear the solution, the sublimate may be given in form of pill[174].

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, which may be prepared and taken according to the directions in the Appendix[175].

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, as directed in the Appendix, or by itself. Those who chuse 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 these 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 through the day[176].

Many other roots and woods might be mentioned which have been extolled for curing the venereal disease, as the china-root, the roots of soap-wort, 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, peripneumony, 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.