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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..f128e5d --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #65003 (https://www.gutenberg.org/ebooks/65003) diff --git a/old/65003-0.txt b/old/65003-0.txt deleted file mode 100644 index 0527e89..0000000 --- a/old/65003-0.txt +++ /dev/null @@ -1,8736 +0,0 @@ -The Project Gutenberg eBook of Porneiopathology, by Robert J. Culverwell - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: Porneiopathology - A Popular Treatise on Venereal and Other Diseases of the Male - and Female Genital System - -Author: Robert J. Culverwell - -Release Date: April 06, 2021 [eBook #65003] - -Language: English - -Character set encoding: UTF-8 - -Produced by: Brian Coe, Quentin Campbell and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The Internet - Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK PORNEIOPATHOLOGY *** - - - Transcriber’s Note - -In what follows, italic text is denoted by _underscores_. Small capitals -in the original text have been transcribed as ALL CAPITALS. - -See the end of this document for details of corrections and other changes. - - ————————————— Start of Book ————————————— - - - - - PORNEIOPATHOLOGY. - - - A - - POPULAR TREATISE ON - - VENEREAL AND OTHER DISEASES - - OF THE - - MALE AND FEMALE GENITAL SYSTEM; - - WITH REMARKS ON - - IMPOTENCE, ONANISM, STERILITY, PILES, AND GRAVEL, - AND PRESCRIPTIONS FOR THEIR TREATMENT. - - BY R. J. CULVERWELL, M. D., - Member of the Royal College of Surgeons, Fellow of many - Learned Societies. - - WITH ONE HUNDRED PLATES. - - ————————————— - - NEW YORK: - J. S. REDFIELD, CLINTON HALL. - ——— - 1844. - - - - - PREFACE. - - ————— - -EVERY medical man who will study to investigate as far as possible, -in every case, the original channel through which disease or -constitutional disorder first found its entry into the system, will -be astonished at the mass of human suffering which may be traced up -to a venereal origin, although its primary symptoms may have been -for years apparently eradicated from the frame. The malady generally -commences its attack in early life, before experience has overcome the -short-sighted heedlessness of youth, and taught it to look beyond the -pains and pleasures of the passing moment. Delicacy or shame will not -allow him to seek assistance, until the poison has acquired strength -and virulence too alarming to be neglected; and the patient then, -instead of applying to his usual professional friends, flies to some -empirical practitioner, who temporarily arrests the external symptoms, -and discharges him as cured. Thus matters go on, until the malady -becomes constitutional; and the patient is at last compelled to place -himself under the treatment of those who, at an earlier period, might -have preserved his constitution untainted, and his body comparatively -uninjured by the ravages of this insidious disease. - -Some years ago the idea first occurred to me that a popular treatise, -divested as much as possible of technical phraseology, explaining -to the non-medical reader the structure and anatomy of the parts -primarily affected by the venereal disease, and describing its first -as well as its subsequent and aggravated symptoms, and pointing out -the safest treatment of it in inexperienced hands, while in its simple -form, would be of much avail in counteracting the effects of the -complaint resulting from mal-treatment or neglect among the young and -thoughtless. This work is intended to teach him where serious danger -exists, or may be apprehended; for the treatment in a great degree, and -under any circumstances, must fall upon the patient himself: and every -medical man knows that, in very many instances, those who are fully -alive to the injury that may arise from such self-management, are yet -reduced, by considerations of delicacy and secrecy, to practise it; and -it is hoped that a perusal will contribute to give him a knowledge and -confidence which he never could acquire from the uneducated empiric. -Under these impressions have I ventured to submit the following pages; -and while I hope their utility may be acknowledged, I would remark, -that they are not intended to supersede medical aid in any stage of -the disorder, but that, on the contrary, I would impress upon the -reader, if he need it, the prudence of having immediate recourse to -a well-educated physician in the earliest stages of the disease, and -to beware of advertising quacks. But where, from circumstances which, -in venereal complaints, very frequently occur, the party can not have -recourse to professional aid, the next best step is certainly to place -in his hands a formula of that treatment which is most likely to be -successful with himself. - -In thus publicly unfolding the mysteries of this department of the -profession, I expect some reprehension from those who assume that -all medical knowledge should be limited to the regular practisers of -the science; but I would fain remind all parties that, although this -branch of medical writing has hitherto been in the hands of mercenary -empirics, it is equally conducive to the honor of the profession, and -the interest of the patient, that these pretenders should be driven -from the field. Conscious of my integrity as a regularly educated -surgeon, and not altogether destitute of successful practice to rest -my claim upon, it is with less hesitation I depart from professional -ceremony; and whatever opinion may be pronounced, as to my success -in performing the task I have undertaken, I may be allowed to hope, -without arrogance, that I am at least entitled to the praise of -industry and humanity. - - R. J. CULVERWELL, M. D. - 1843. - - - - - CONTENTS. - - - Page. - GENERAL REMARKS 7 - Anatomical and Physiological Review of the Male - Organs of Generation, with eight engravings 7 - Of the Testicles, their Structure and Functions, with - seven engravings 14 - On Gonorrhœa, or Morbid Secretion and Irritability - of the Urethra, with five engravings 20 - The Surgical Treatment of Gonorrhœa, with prescriptions 26 - Medical Treatment of Gonorrhœa and its Consequences, - with engravings, prescriptions, and specific remedies 29 - On Gleet 41 - Morbid Irritability of the Urethra 44 - Stricture of the Urethra, with fifteen anatomical engravings - and diagrams, illustrative of the nature of the disease 45 - Treatment of Stricture, with thirty engravings, explanatory - of the mode of treatment, prescriptions, &c. 58 - Diseases of the Testicles, with three engravings 68 - Hydrocele 69 - Radical Cure of Hydrocele 71 - Hydrocele Cured by Acupuncturation 71 - Diseases of the Bladder 73 - Irritability of the Bladder 74 - Paralysis of the Bladder 75 - Inflammation of the Bladder, with prescriptions 75 - Origin of the Venereal Disease 79 - On the Character of the Syphilitic Poison 84 - Of Syphilis, with fifteen engravings 86 - Of Buboes, with two engravings 93 - Of Lues Venerea, or Secondary Symptoms 96 - Of the Symptoms of the First Stage of Lues, with eight - engravings 98 - On the Treatment of Syphilis 104 - Treatment of Chancre, with prescriptions 106 - Bubo, with engravings and prescriptions 112 - Secondary Symptoms 117 - Syphilitic Eruption, with an engraving 117 - Sore Throat, with prescription 121 - Venereal Affections of the Bones, Joints 122 - Secondary Symptoms 123 - Treatment of Ditto, with prescriptions 125 - Syphilitic Lepra 127 - Nodes and Pains in the Bones 128 - Syphilitic Sore Throat, with prescriptions 130 - Advice to Invalids 133 - The Female Organs of Generation—their Structure, - Purposes, and Diseases, with thirteen engravings 136 - On the use of the Speculum, with an engraving 150 - Gonorrhœa in the Female 151 - Syphilis in Females, with five engravings 152 - Leucorrhœa, or the Whites 154 - Treatment of Ditto, with numerous prescriptions 155 - Effects of Incontinence, Celibacy, and Marriage 162 - On the Hereditary Transmission of Disease 169 - On Impuissance, or Impotence 173 - Impotence and Sterility of the Male—four engravings 174 - Impotence and Sterility of the Female—five engravings 180 - Treatment of Impotence 184 - Sexual Debility 188 - On Piles, internal and external, with prescriptions and - four engravings 191 - Prolapsus of the Rectum, with an engraving 196 - Stricture of the Rectum, with an engraving 197 - Diseases of the Urine, with three engravings 200 - On Incontinence of the Urine 204 - The Gravel 212 - Cause of Gravel 213 - Treatment of Gravel 213 - - - - - POPULAR TREATISE - - ON - - VENEREAL DISEASES. - - ————————————— - - GENERAL REMARKS. - - -THE diseases known by the general term of _syphilis_ or _venereal -disease_, and arising from impure coition, appear generally in three -forms, _gonorrhœa_, _chancres_, and _bubo_. These sometimes exist -alone, and sometimes together. As they affect the genital organs and -their appendages, a description of these organs is necessary to a full -understanding of the subject. - -_Genital organs and appendages in the male._—This term embraces the -_penis_, _testicles_, _bladder_, and _kidneys_. The form of the penis -is familiar to every one. It commences at the bladder, is of a _spongy_ -nature, and is composed of three different parts; the two upper and -larger are called the _cavernous_ bodies, and the lower the _spongy_ -body; these bodies are covered by the skin which comes over the head of -the penis, and forms the _prepuce_. When this skin is drawn back, the -head of the penis, or the _glans_ penis is seen, which is a development -of the spongy body, and is extremely sensitive. A whitish secretion, -with a peculiar odor, forms at the end of the glans, where the prepuce -seems to join it. The object of this secretion is to preserve the -sensitiveness of the glans, and to facilitate the withdrawal of the -prepuce in coition and in urinating. This material sometimes collects, -irritates, hardens, and causes much inconvenience. This can be done -away with by circumcision, which is performed as follows:—draw an inked -line on the skin of the prepuce, corresponding to the base of the glans -penis; draw the prepuce forward, and have the inked part held firmly by -an assistant with a pair of forceps. Then the surgeon takes that part -of the prepuce projecting beyond the forceps with his left hand, and -with a bistoury cuts the prepuce at the inked line with his right. When -this is done, the lining skin of the prepuce, which cannot be drawn -forward, remains entire, and covers the glans; this lining is divided -by a single cut with the scissors: then the flaps are removed round to -the frenum, and then the two flaps are held together and removed, with -the frenum, at one cut. The mode of holding the prepuce, &c. is seen in -the cut. - -[Illustration] - -On the under side of the glans, near the mouth of the water passage, -or urethra, the prepuce is attached by a fold called the _frenum_, -or bridle, or martingale of the penis. The use of this frenum is to -confine the movements of the prepuce, and to draw down the mouth of the -water passage to direct the flow of the urine. Sometimes the frenum is -too short, and confines the prepuce too much; it may be slit down with -a pair of scissors as far as is considered expedient. The frenum is -frequently ruptured in a first coition. The frenum is very elastic, and -protects the sensitive surface beneath it as the eyelid does the eye. -Sometimes, however, it becomes permanently contracted;—the glans is -then denuded, but soon loses its sensibility. The person is sometimes -born with this formation. - -The _cavernous bodies_ form two tubes, united in most of the length of -the penis, separated only by a thin partition, and enveloped in a firm -sheath; they are composed of an immense number of cells, principally -formed by dilated veins, which communicate with each other; these, when -the penis is erected, become filled and even distended with blood. The -cavernous bodies terminate abruptly and form rounded points under the -glans penis. At the other extremity they separate, and form the crura -or legs of the penis. - -The _spongy body_ forms the lower and under body of the penis, -terminates at one end at the point in the glans, whilst it extends -the whole length of the penis, again becomes enlarged, and forms the -_bulb_. The urethra or water passage extends through the spongy body, -and connects the penis with the bladder. This cut is a section of the -penis showing the three bodies: - -[Illustration: - _a._ Corpora Cavernosa. - _b._ The division or Septum. - _c._ Corpus Spongiosum. - _d._ Urethra. - _e._ The great vein of the Penis.] - -The cut below shows a section of the cavernous body, showing the blood -vessels that go to it and cause a distension or erection of the penis: - -[Illustration: - _a._ Urethric part. - _b._ Glans. - _c._ Dorsal Artery serving the Glans. - _d._ Dorsal Artery serving the interior of the Corpus Cavernosum. - _e, f._ Deep-seated Arteries.] - -[Illustration: - _a._ Urethra. - _b._ Glans. - _c._ Dorsal Vein. - _d._ Septum. - _e._ Vessels.] - -In the cut above we see the septum or division of the cavernous bodies, -in which are seen the vessels by which, when the erection of the penis -subsides, the blood passes into the dorsal vein of the penis. - -The _Urethra_, or water passage, is the canal that passes through the -spongy body to the bladder. The urine and semen pass through it. It -is very elastic, and may be dilated so as to admit a large instrument -to be passed into the bladder, and it contracts on the smallest. It -is supported in its course by the spongy body and the prostate gland, -between which is a portion unprotected, called the membranous portion. -The passage varies in its size in different parts: thus it is rather -contracted at the orifice, enlarges within, and for an inch again -contracts, dilates nearer the bulb, diminishes at the membranous -portion and near the prostate gland, and finally enlarges into the -bladder. The cut opposite will show these parts. - -[Illustration: - _a._ Bladder, or receptacle of urine. - _b._ Ureters, or passages through which the urine - comes from the kidneys, where it is formed, - to the bladder. - _c._ Vas Deferens, through which the semen passes - from the testicle, where it is formed, to the - seminal vesicles, where it is matured. - _d, d._ Openings of Ureters into the bladder. - _e._ Prostate Gland. - _f._ Orifices of excretory ducts. - _g._ Openings of the seminal ducts. - _h._ Ischio-cavernous muscles. - _i._ Bulb of Urethra divided. - _k._ Cowper’s Glands. - _l._ Wide part of Urethra. - _m._ Narrow part. - _n._ Fossa Navicularis, usually affected in gonorrhœa. - _o, p._ Prepuce.] - -The urethra is constantly moistened with a mucous secretion,—from the -membrane itself, the glands, and the folds which yield to the pressure -of the urine as it flows, or from other altered conditions of the -urethra pour out their contents. The inner surface of the urethra is -very vascular and sensitive, as is shown by the slightest laceration by -the bougie or by chordee, when considerable bleeding often takes place. -Its sensitiveness is well known in the first passing of the bougie, or -in inflammation, when the pain of the former and the act of urinating -in the latter, often causes fainting. - -The bladder is the reservoir of the urine, which is formed in the -kidneys, comes into the ureters, passages leading from the kidneys to -the bladder, and thence flows, drop by drop, into the bladder. The -bladder is shaped somewhat like a pear, but this shape is varied by -its contents, and the relative condition of its adjacent parts. Thus, -when the bladder is full, its upper part may be felt rising above the -pubis, that portion of the lower part of the belly that is covered with -hair. In very fat persons the bladder is flattened by the weight of -the intestines, and obliged to find room where it can, as in pregnant -women. Anatomists, when describing the bladder, speak of its body, -base, or upper part, sides and neck, where the urethra or water passage -begins, and which is surrounded by the prostate gland. These parts are -seen in the first engraving on the opposite page. - -The bladder is composed of several coats. There is a peculiar -membrane investing the important structures in the abdomen called the -peritonœum. The base and back part of the bladder is covered by a -portion of this peritonœum, which in a measure supports the bladder -in its position, and also exercises certain properties which may -hereafter be alluded to. - -[Illustration: - _a._ The inner surface of the Bladder, - showing the direction of the Muscular Fibres. - _b._ The opening of the right _Ureter_ - into the Bladder, whence the urine issues. - _c, c._ The Prostate Gland cut through, and its - sides exhibited. - _d._ The Urethra. - _e._ Verumontanum. - _f, f._ Orifices of the Seminal Ducts, marked by - twigs inserted therein; the other points - mark the orifices from the Prostate and - other Glands.] - -The position of the _perineum_ is seen in the following cuts in which -the skin has been removed, disclosing— - -[Illustration: - 1. The superficial fascia of the Perinœum. - 2. The fascia lata, or shiny covering of the - muscles of the thighs. - 3. The tuberosity of the ischia, or part - whereupon we sit. - 4. The last portion of the spine, called the - Coccyx, easily to be felt posteriorly to - the rectum. - _a._ The Sphincter muscle of the Anus. - _b._ The inferior border of the great - muscles of the buttock, called - the Gluteal. - _c._ The Levator Ani, or muscles which - elevate the rectum.] - -The following cut represents the muscles of the perinœum exposed, the -superficial fascia having been removed. - -[Illustration: - 1. Point in the Perinœum where the principal muscles - arise or meet. - 2. Covering of the Thigh. - 3. Seat. - 4. Corpora Cavernosa of the Penis. - 5. Corpus Spongiosum. - 6. Coccyx. - 7. Great Sacro Sciatic ligament. - _a, a._ Erector Muscles of the Penis. - _b, b._ Accelerator Urinæ Muscles. - _c._ Line whence the above Muscles take their origin. - _d._ Transverse Muscles of the Perinœum. - _e, e._ Sphincter Muscle of the Anus, supposed to - be distended with tow or wool. - _f, f._ Levatores Ani. - _g, g._ Great Gluteal Muscles.] - -A brief description of the structures displayed in the two preceding -and the following drawing (p. 14) will render this part of our subject -perfect. - -The _Fasciæ_ means the coverings of muscles, such as is seen in cutting -a domestic joint—a leg of mutton, for instance—a shiny surface; their -use is to strengthen the action of the muscles, to bind them well -together, and they mostly exist about the buttocks, back, &c. - -The office of a Sphincter Muscle, of which we have several, as that of -the bladder and anus, is to keep closed the aperture they surround. -The sphincter ani closes the rectum, and pulls down the bulb of the -urethra, by which it assists in ejecting the urine and semen. - -The Levator Muscles lift up the part they are connected with. The -levator ani muscles form the funnel appearance of the rectum, and help -to draw it up after the fæces or stools are evacuated. They also assist -in sustaining the contents of the pelvis, and help to eject the semen -and urine, and contents of the rectum, and, perhaps, by pressing upon -the veins, contribute to the erection of the penis. - -[Illustration: - 1. Coccyx. - 2. Semen. - 3. Covering of the Thigh. - 4. Great Sacro Sciatic - Ligament. - _a._ Bulb of the Urethra. - _b._ Corpus Spongiosum. - _c._ Crura of the Penis, being the conclusion of— - _d._ Corpora Cavernosa Penis. - _e._ Sphincter of the Anus. - _f._ Levatores Ani, covered by a fascia or prolongation - of the triangular ligament of the Urethra. - _g._ Great Gluteal Muscles. - _h, h._ Triangular Ligament of the Urethra. The artery - of the bulb is seen on the left as it runs between - the Crus Penis and bulb of the Urethra.] - -The Gluteal Muscles help the rotatory motion of the thigh, and give -support generally to the buttocks. - -The Sacro-Sciatic Ligaments assist in the firm union of the bones of -the pelvis. - -The Erector Muscles of the penis propel the urine and semen forward; -and, by grasping the bulb of the urethra, push the blood toward the -corpus cavernosum and the glans, and thus distend them. - -The Accelerator Urinæ Muscles, as their name implies, help to eject the -urine and semen. - -The Triangular Ligament of the urethra assists the preceding purposes. - -_Testicles._—The testicles are two glandular oval bodies suspended -in the scrotum. They furnish the male seed. They are supported by -what is called the Spermatic Chord, which consists of the spermatic -artery that supplies the testicle with arterial blood, whence the -semen is concocted; the veins that return the superfluous blood, and -the tube that conveys the semen to the urethra. The testicles are -very liable to inflammation, and particularly to changes resulting -from the wear and tear of human life—changes that not simply produce -pain or inconvenience, but those whereby the power of the organs -becomes partially if not wholly lost. A rather ample description of -their complicated structure will show the necessity of attending to -the earliest symptoms of disturbance. The testicles, in embryo, are -lodged in the belly, but they gradually descend, and usually are found -in the scrotum at birth. There are occasional exceptions, when one or -even both testicles do not descend, but are retained in the groin. Mr. -Hunter considered that their virility was thereby impaired, although -such an opinion is negatived by numerous illustrations. The non-descent -of the testicle, necessarily from its confined situation when in the -groin, can not be so fully developed as where it is allowed to range -in the scrotum. It is also exposed to accidents when retained, and -cases have occurred where Hydrocele, a disease to be noticed hereafter, -has ensued, producing much inconvenience, and occasionally the same -has been mistaken for rupture. The testicles have several coats. The -Scrotum should be considered as one, which is merely a continuation of -the common integuments, exceedingly elastic, nearly destitute of fat, -and possessing a peculiar contractile power of its own, whereby it -can closely embrace the testicles, and at other times yield or become -distended, as in hernia or hydrocele, to the size of a melon. The -contractile powers of the scrotum have been assigned to the supposed -presence of a muscle, which is merely a thickened cellular membrane, -and called Dartos. It was stated that the testicles were suspended by -their spermatic chords—their support is rendered more perfect by the -presence of a muscle to each, that descends into the scrotum, and which -is called the Cremaster—it is an expansion of one of the muscles of the -abdomen, called the internal oblique, and it spreads itself umbrella -fashion around the chord, over the upper part of the testicle, and its -fibres extend ray-like over the other coats of the testicle—its office -is to draw up the seminal organs during procreation. - -The testicles, thus suspended, have two coats, one adhering closely, -and the other loosely surrounding the former—between the two, a -lubricating fluid is secreted, whereby the various movements of the -body are permitted without injury; it is between these coats that -water is secreted occasionally, constituting the disease known as -hydrocele. The closely fitting coat is termed from its whiteness and -density Tunica Albuginea—the other Tunica Vaginalis. These coverings -are formed of that extensive membrane in the abdomen called the -Peritonœum. The Tunica Albuginea which surrounds the testicle previous -to its descent, accompanies it into the scrotum, propelling, as it -were, the Tunica Vaginalis before it. On the descent of the testicles -into the scrotum, the opening through which they passed becomes -impermeably closed. - -The annexed diagram will explain the coats and facilitate the -understanding of subsequent descriptions. - -[Illustration: - 1. Body of the Testicle. - 2. Epididymis. - 3. Vas Deferens. - 4. Spermatic Artery. - 5. Veins. - 6. Cremaster Muscle. - 7. Tunica Albuginea. - 8. Tunica Vaginalis. - 9. Scrotum. - 3, 4, 5, 6, and 8 constituting the Spermatic Chord.] - -When the coats of the testicle are taken off, it is found to consist -of innumerable delicate white tubes, which when disengaged from the -cellular membrane that connects them together, and steeped in water, -exhibit a most astonishing length of convoluted vessels; they appear -to consist of one continuous tube, convoluted in partitions of the -cellular membrane. When the _Tubuli_ come out from the body of the -testicle, they run along the back of it and form a net work of vessels -called Rete Testis; it is supposed that by the net work the semen is -conveyed from the testicle. The continuations of this _Rete Testis_ -have been denominated _Vasa Deferentia_, which, ending in a number of -_Vascular Cones_, constitute what is called the Epididymis. The _Vasa -Deferentia_, after forming three conical convolutions, unite and form -larger tubes, which ultimately end in one large excretory duct, called -the Vas Deferens. The following description relates to the accompanying -sketch. - -[Illustration: - _a._ Body of the Testicle. - _b._ Tubuli Testis. - _c, c._ Rete Testis. - _d._ Vasa Deferentia. - _e._ Vascular Cones. - _f._ Epididymis. - _g._ Vas Deferens.] - -The preceding completes the anatomical description of the Testicle. The -semen is supposed to be secreted by the arteries that ramify among the -seminal tubes; the last drawing exhibits the testicle as from the hand -of the dissector. In life and in health the epididymis is attached to -the testicle—the vas deferens passes up the chord, enters the abdomen, -and, passing down into the pelvis, terminates in the vesiculæ seminales -as already, but to be again, alluded to. The two subjoined drawings -illustrate the testicles in their natural situation. - -[Illustration: - _a._ Body of the Testicle. - _b._ Commencement of the Epididymis. - _c._ End of ditto. - _d._ Vas Deferens.] - -In the larger figure the testicle is displayed as enveloped by its -coverings, and in the lesser as stripped of them. The references serve -for both. - -We now come to speak of the Vesiculæ Seminales. It was just observed, -that the Vasa Deferentia terminated in these structures. They -are attached to the lowest and back part of the bladder, behind -the Prostate Gland. The following drawing is the prelude to the -description—It represents the Prostate Gland, the Vesiculæ Seminales -and the Bladder. - -[Illustration: - _a, a._ Prostate Gland. - _b._ Gland cut away to show the Ducts of - the Vesiculæ. - _c._ Ends of the Ducts. - _d, d._ Cells of the Vesiculæ. - _e._ Left Vas Deferens, also cut open to show - its connexion with the Vesiculæ. - _f._ Right Vas Deferens. - _g, g._ Openings of the Vas Deferens and Vesiculæ - into the Urethra. - _h._ Bladder. - _i._ Ureter.] - -The Vesiculæ Seminales appear like two cellular bags. They have two -coats, the one called nervous, and the inner the cellular, a membrane -divided into folds or ridges. The use of the vesiculæ is supposed -to be, to act as reservoirs for the semen; but there are different -opinions upon the subject, some contending that they furnish a fluid, -not spermatic, but merely as an addenda to the seminal secretion; -whereas others, who have examined the vesiculæ of persons who have -suddenly died, have discovered all the essential qualities of the -male seed therein; and, in fact, physiologists, who direct researches -in these matters, advise such examinations as the surest means of -obtaining, in a state of purity, the seminal fluid. - -The Male Semen is a fluid of a _starch-ish_ consistency and of a -whitish color. It has a peculiar odor, “like that of a bone while -being filed—of a styptic and rather acrid taste,” (for physiologists -use more senses than one in these researches), “and of greater specific -gravity than any other fluid of the body.” Shortly after its escape, -“it becomes liquid and translucent;” if suffered to evaporate, it -dries into scurfy-looking substance. By being examined through a -powerful microscope it is ascertained to be animated by an infinite -number of animalcules; but they are only present in healthy semen, and -consequently that fact is taken as a criterion of the virility of the -secretion. - -President Wagner thus describes the germe of future animal life: “The -seminal granules are colorless bodies with dark outlines, round and -somewhat flattened in shape, and measuring from 1-300 to 1-500th of a -line in diameter.” “The animalcules exist in the semen of all animals -capable of procreation. They are diversified in form in all animals -according to their species, but in man they are extremely small, -scarcely surpassing the 1-50th, or almost the 1-40th of a line in -breadth. This transparent and flattened body seldom exceeds from the -1-6th to the 1-800th of a line in length.” - -The annexed drawing exhibits the granules and animalcules of a human -male being magnified from 900 to 1,000 times:— - -[Illustration: - 1. Animalcules of a man, taken from the - Vas Deferens, immediately after death. - 2. Seminal Granules. - 3. A bundle of Animalcules, as grouped - together in the Testicle. - 4. Seminal Globule. - 5. Same surrounded by a cyst or bag.] - -The semen is never discharged pure; it is always diluted with the -secretion from the prostate and other glands, and also the mucus of the -urethra. A chymical analysis is thus given of 100 parts: - - Water 90 - Mucilage 6 - Phosphate of Lime 3 - Soda 1 - ——— - 100 - -The semen may certainly be vitiated and diseased: the odor and color -assume all the gradations of other secretions when in a morbid -condition. - -Semen not discharged is supposed to be absorbed, thereby adding to the -strength and nutriment of the economy; but as it is furnished for a -specific purpose, and its secretion depends much upon the play of our -animal passions, and as they are rarely permanently idle, there is not -only the inducement that the fluid be furnished, but also emitted, and -hence we have nocturnal emissions. These, to a degree, are salutary; -but they may happen so frequently that the function becomes disordered -and perverted, and in some individuals the semen (unconsciously to -them) escapes during sleep, or on the slightest local excitement of -riding, walking, or on the action of the bladder or rectum. - -The prostate gland, as has been stated, contributes much to the -dilution of the semen; it may empty itself independently of it. The -gland is composed of numerous cells, from which proceed some twenty or -thirty pipes or passages that open in the urethra by the sides of the -verumontanum, as shown in the drawing. - -_Morbid Secretions and Irritability of the Urethra._—I have stated that -clap or gonorrhœa is one of the first and most frequent complaints -of the generative apparatus. There are many secretions common to -the urethra, such as those afforded by the various glands for the -purpose of lubrication, &c.; and the lining membrane of the passage -yields a moisture for its own protection, like the membrane of many -other organs, such as the eyes, nose, mouth, and so forth, and these -secretions may become unhealthy or vitiated, and give rise to symptoms -that lead on to confirmed disease; and, what is still more remarkable, -may assume many of the characters and appearances of gonorrhœa, but -they rarely induce such constitutional disturbances as clap. The -symptoms, consequences, and duration of clap, form its distinguishing -features from any other discharge of the urethra: it is very important -that such distinction should be understood, for the treatment of the -two affections differs most materially; the one is an affection of -weakness, and the other of an inflammatory and pestilential nature. -The symptoms of clap are as follow: there is usually first felt an -uneasy sensation at the mouth of the passage or urethra. The patient -is frequently called upon to arrange his person; that uneasy sensation -sometimes amounts to an itching (occasionally of a pleasurable kind) -the feeling extends a little way up the penis; there is oftentimes -an erection and a desire for intercourse, which, if indulged in, -the sooner develops the disease. The itching alone will not convey -the disease from one person to another; but if intercourse be held, -the action of the inflamed vessels is accelerated, and a purulent -secretion which is infectious is urged forth and emitted with the -semen: therefore the very symptom of the tingling or itching, for it -rarely exists in healthy urethræ, should be noticed, and intercourse be -avoided until it shall have ceased. - -About this time is perceived a slight heat on passing water, or at the -conclusion of the act; and shortly after, or may be before, a yellowish -discharge is observed oozing from the mouth of the glans or nut of the -penis; the symptoms then rapidly advance, unless timely and judicious -means be adopted to palliate them or effect a cure; the scalding -becomes intense, and the pain and smarting continue some time after -each operation of passing water: the discharge becomes profuse and -clots on the linen, and continues to ooze out with little intermission: -the orifice of the urethra looks red and inflamed, and the glans itself -swells and is occasionally extremely tender: the foreskin or prepuce -sometimes, but fortunately not always, becomes swollen, and tightened -over the nut of the penis, from which it can not be drawn back, -constituting that form of the disease known by the name of phymosis. -See drawing annexed. - -[Illustration] - -When that is the case, other annoyances ensue; the purulent matter -collects around the glans; excoriations, ulcerations, and sometimes -warts, are the consequence; the whole symptoms become thereby much -aggravated. It also happens that the prepuce from inflammation assumes -a dropsical appearance, that is to say, the edges or point swell, and -appear like a bladder filled with water; thus, the size which the -penis then arrives at is enormous, and to the patient very alarming; -it usually, however, subsides in a day or two, if rest and proper -measures be employed. - -[Illustration] - -The glans with some people, is always bare, and the foreskin drawn up -around it. Such a state may be induced also by disease: in either case, -it may become so inflamed as to resist any efforts to draw it over the -glans and, from the swelling and consequent pressure on the penis, a -kind of ligature is created; and instances have been known where the -most disastrous results have ensued. The circulation of the blood in -the glans is checked; the nut puts on a black appearance, and if the -ligature be not removed or divided, mortification takes place, and the -tip or more of the penis sloughs off or dies away. This state of the -prepuce is called _paraphymosis_: it sometimes happens to young lads, -who, having an indicated opening of the foreskin, endeavor to uncover -the glans: they succeed, but are unable to pull the prepuce back again. -They either take no further notice of it, or else become frightened, -but conceal the accident they have committed: in a few hours, the parts -become painful, swell, and all the phenomena above detailed ensue. - -The annexed diagram exhibits the foreskin in a state of paraphymosis. - -[Illustration] - -The next proceeding which will probably be induced, will be an -extension of the inflammation to the bladder: the symptoms are a -frequent desire to make water, and occasionally ulceration of the -membrane lining the bladder follows, when a quantity of muco-purulent -matter is discharged, which, mingling with the urine gives it the -appearance of whey. Now and then the bladder takes on another form of -disordered function: the patient will be seized with _retention of -urine_, that is, a total inability to discharge his water, except by -the aid of the catheter. A new and most perplexing feature about this -stage of the proceeding is perceived: it is what is called _chordee_. -The existing irritation excites the penis to frequent erections, -which are of the most painful nature. The penis is bent downward; the -occasion is, the temporary agglutinization of some of the cells of the -_corpora cavernosa_ through inflammation, and the distension of the -open ones by the arterial blood, thereby putting the adherent cells -on the stretch, and so constituting the curve, and giving rise to the -pain. This symptom is frequently a very long and troublesome attendant -upon a severe clap; it is more annoying, however, than absolutely -painful, as it prevents sleep, it being present chiefly at night-time -when warm in bed. - -Occasionally the glands in the groin enlarge and are somewhat -painful; they sometimes, but very rarely swell and break; they more -frequently sympathise with the adjacent irritation, and may be viewed -as indications of the amount of general disturbance present; as the -patient gets better the glands go down, leaving a slight or scarcely -perceptible hardness as it were to mark where they had been. The most -painful of all the attendant phenomenon of clap is _swelled testicle_, -or, as in medical phraseology it is called, _Hernia humoralis_. - -The first indication of the approach of the last-named affection is -a slight sense of fulness in the testicle, generally the left first, -although occasionally in the right, sometimes one after the other, -but rarely both together: a smart twinge is now and then felt in -the back upon making any particular movement: the testicle becomes -sensibly larger and more painful, the chord swells also and feels -like a hardened cord in the groin: the patient is soon incapacitated -from walking, or walks very lame; if the inflammation be not subdued -by some means, and if the patient be of a “burning temperament,” that -is, of a very inflammatory constitution, fever is soon set up, and the -patient is laid upon a “sick bed.” There is no form of the complaint -so dangerous to neglect as swelled testicles; they have sometimes been -known to burst or become permanently callous and hardened, and ever -after wholly unfit for procreative purposes: in other instances, -they have entirely disappeared by absorption: in fact, all diseases -of the testicles interfere with the generative power. At the onset of -inflammation there may be a brief increase of sexual appetite, but -when the structure of the testicle becomes altered or impaired, that -appetite is subdued or wholly lost; there is such a wonderful sympathy -betwixt all parts of the generative economy of man, that if one portion -only be injured, the ordinary end of sexual union is frustrated. - -The gonorrhœal poison is capable of producing a similar discharge from -other parts to which it may be applied besides the urethra. It has -been conveyed by means of the finger or towel to the eyes and nose; -and a purulent secretion (attended with much pain and inconvenience, -indeed with great danger, when the eye becomes so attacked), has -oozed plentifully therefrom. Gonorrhœa is an infectious disorder, and -consequently is communicable by whatever means the virus be applied. -It certainly is possible, and (if we are to believe the assertions of -patients, who are often met with, declaring they have not held female -intercourse, and yet have contracted the disease), it certainly is -not improbable that it may be taken up from using a water-closet that -has been visited by an infectious person just before. It may also be -contracted by using a foul bougie. - -[Illustration] - -If the gonorrhœal discharge be suffered to remain on particular parts -of the person, such as around the glans of the penis, or on the outside -of the foreskin, excoriations, chaps, and warts, spring up speedily -and plentifully, and protrude before the prepuce, or sometimes become -adherent to it, as here drawn: it therefore only shows how necessary -cleanliness is in these disagreeable complaints, to escape the -vexations alluded to. A species of insect also is apt to appear about -the hairy part of the genital organs, and indeed extend all over the -body, particularly in those parts where hair grows, such as under the -armpits, chest, head, &c., if cleanliness be not observed. They are -called crabs. The itching they give rise to is very harassing, and the -patient, unable to withstand scratching, rubs the parts unto sores, -which, in healing, exude little crusts that break off and bleed. - -[Illustration: - A. The Pubis studded with these insects. - B. The Crabs, or Pediculi Pubis, as they - are called, about their natural size, - as picked from the skin.] - -When the gonorrhœa has been severe and there has been much -constitutional disturbance, there frequently hang about what are -called flying rheumatic pains; and sometimes, if the patient’s health -be much broken up, confirmed rheumatism seizes hold of him, and -wearies him out of several months of his existence. I have seen many -a fine constitution, by a tedious ill-treated or neglected gonorrhœa, -much injured, that, had the sufferer consulted a medical man of even -ordinary talent, in the first instance, instead of foolishly leaving -the disease to wear itself out with the help of _this_ recommended by -one, and _that_ by the other, he might have shaken off the hydra, and -have averted the hundred vexations that follow. - -I come now to add to the list of calamitous consequences, stricture, -which, in my opinion, prevails to an enormous extent; however, its -consideration will be reserved, as well as the affections of the -bladder, and prostate gland, for their proper places. I will simply -repeat my impression that a stricture, or narrowing of the urethra, -or some organic changes, invariably ensue when the gonorrhœa has been -mismanaged, or its cure unfortunately protracted. - -It is the opinion of many medical men, and it can, no doubt, be borne -out by many patients, that a gonorrhœa if unattended by any untoward -circumstance, will wear itself out, and that the duration of such a -proceeding is from one to two months; there is no disputing but such -has been, and is now and then the case, but such rarely stand even -so fair a chance of recovery as to be left entirely alone: even if -medicine be not taken, rest, abstemiousness, and such like means, are -seldom followed up; either the patient lives gloriously free, or else -goes to the opposite extreme. - -The cases of gleet which seek medical relief are more numerous, as -most professional men must be aware, than those of gonorrhœa, for the -reasons so frequently alluded to; the fair inference would be, that a -gonorrhœa seldom escapes the terminus of a gleet. - -The distinguishing feature of gleet from gonorrhœa is that it is not -considered infectious: it consists of a discharge ever varying in -color and consistence; it is the most troublesome of all urethric -derangements, and doubtlessly helps more to disorganize the delicate -mucous membrane lining the urinary passage than even the severest -clap. Its action is constant though slow; and subject as we are to -alternations of health, of which even the urinary apparatus partakes, -it is not to be wondered at that a part of our system which is so -frequently being employed, should become disturbed at last, and that -stricture and all its horrors should form a finale; but as gleet and -stricture form in themselves such important diseases, I shall devote a -chapter to the consideration of each separately. - -_The Surgical Treatment of Gonorrhœa._—The principal symptoms -indicative of the outbreak of a gonorrhœa are a scalding burning -sensation along the urethra as the urine passes through it, and also -the pouring forth of a profuse discharge of yellow matter from the -same passage. The urethra is lined with a very sensitive membrane, -fashioned, however, to be insensible to the urine in its natural -state; but if the character of the urine or the membrane itself be -altered, the most exquisite misery is produced. Now in gonorrhœa, -when it is a first attack, the initiatory sensation is invariably -heat, itching, or pain in the urethra; the seat of this suffering is -in the mucous membrane. On separating the lips of the orifice of the -urethra, the passage appears highly vascular, very red, and looks, -according to the popular notion, very sore. On examining it with a -powerful glass, little streaks or surfaces of a yellow and tenacious -matter are perceived, which, upon being removed, are soon replaced by -others. When the patient attempts to urinate, this purulent exudation -becomes washed off. By this time, the system is somewhat excited, and -the urine is consequently more deeply impregnated with uric acid, -which renders it more acrid and pungent to the delicate and now tender -outlet through which it flows: the sensation is faint at first, but -is rendered very acute by the combined worry inflicted upon the -urethra, by its muscular contraction to eject every drop of urine, -the denuded state of the membrane itself, and the irritating quality -of the water. Such, however, is the habit of action, that the urethra -in course of time becomes indifferent to the annoyance of the flow -of urine. The nervous sensibility is much diminished, and the urethra -is further protected by an abundance of the venereal secretion. There -are numerous contingencies that prevent the changes ensuing in such -order, and, consequently, the scalding, and the amount of discharge, -are seldom two days alike. Were there to be no interruption, the -inflammation, for such is the whole process in obedience to the animal -law, would fulfil its intention and retire; but molested as it is -by diet, exercise, the varied states of health, and numerous other -fortuitous circumstances, as we well know, it exists indefinitely. It -would be next to an impossibility to explain the process whereby the -character of a secretion becomes altered, or to describe the exact -changes which the structure or vessels undergo when furnishing the -discharge; but we well know that some such changes do take place, and -that a cause must precede an effect. In like manner we can ascertain -the result of certain experiments, although the _modus operandi_ may -baffle our penetration. Gonorrhœa is originally a local complaint, but -if not arrested, it involves not only the neighboring parts, but it -compromises the general health. Now if the same ends can be brought -about by artificial means in a few days, that it takes weeks to effect -in the ordinary routine, all the intermediate suffering may be avoided, -and all the inconvenience of confinement and physic-taking spared. - -To cure this disease I find that in many cases, if the parties apply at -the very onset of the disease, before the discharge and scalding have -set in with anything like severity, and they themselves be not of a -very inflammatory temperament, that a sharp stimulating injection will -at once subdue the sensitiveness of the urethra and alter the action, -and, at the cost of very little, and that only temporary suffering, -effect a speedy cure: the mode, except it be by stimulating the relaxed -vessels, or owing to the specific action of the injection, is, like -all other medical operations, a mystery. A favorite prescription is -the nitrate of silver, say one scruple of the nitrate to the ounce of -water, but the disease must be thus treated at the very first symptom: -the patient must be otherwise in comparatively good health, and his -occupation must not expose him to much bodily fatigue. He must not be -given to intemperance, nor should those instances be selected where -the sufferer is of a very inflammatory constitution. Experience begets -confidence, and confidence begets experience. In cautious hands I -am satisfied of its usefulness; but there are cases that turn out -failures. I have used the injection when the disease itself was a -week old, and with like success; but I am ready to confess I have -known cases, the cure of which were retarded by its employment. The -inflammation has been temporarily aggravated, but they were cases -where the treatment was not appropriate; the disease was far advanced, -there was much heat and swelling, and the patient’s health was in most -instances considerably affected; but yet beyond the few hours’ of -suffering merely, no extraordinary symptoms were produced. The cure was -very shortly after effected by means which I shall presently allude to. - -In all cases of suspicious connexion I recommend copious ablution as -soon as possible.[1] The syringes I would advise to be used should -have their points conically shelved off pear fashion; they fill up -the urethra like a wedge, and prevent the immediate escape of the -injection: all injections should be retained a few seconds, and then be -allowed to flow out. It is seldom worth while to repeat the operation -more than twice on an occasion; but that occasion may be resorted to -two or three times a day. - -When the nitrate of silver is used, the syringe had better be made of -glass. The nitrate of silver discolors the skin, linen, &c.; therefore -gloves should be worn, and care taken that the fluid be not spilt over -the person or dress, but should the skin be stained, it can be removed -by a strong solution of hydriodate of potash. - -The plan of injection, I must remind the reader, is only applicable -in early and old cases. The recent cases, as I have before stated, -are less frequently before the medical man than what we may call a -“ripe” gonorrhœa. The old cases present also some difference as to the -cause of their continuance, and require also some difference in their -treatment, and they will be introduced under the chapter headed “Gleet.” - -The symptoms of a clap, fully developed, are severe scalding, -voluminous discharge, painful erections, local inflammation, probably -phymosis or paraphymosis, glandular swellings, and possibly swelled -testicle. - -But all cases of gonorrhœa are not ushered in with such severity; nor -do many, if common cleanliness and quiet only be maintained, experience -even the various accompaniments just described, and still fewer would -if the following precautions and measures were used. - -The plan just laid down, may be called the surgical treatment of -gonorrhœa; the following may be designated the _Medical_. This is -divided into two methods—the one denominated the Antiphlogistic, -the other Specific. The _Antiphlogistic_ is a term applied to -medicines, plans of diet, and other circumstances, that tend to oppose -inflammation by a diminution of the activity of the _vital powers_, -whereby the inflammation is subdued, and nature rights herself again -of her own accord. The _Specific_ implies a reliance upon a particular -remedy, which is supposed at once to set about curing the disease, as, -for instance, by giving Bark in Ague—Colchicum in Rheumatism—Cubebs or -Copaiba in Gonorrhœa. - -Now, both these plans are successful in curing gonorrhœa; but the -majority of medical men adopt the former method, inasmuch as although -it but _quietly_ conducts the case to a successful termination, still -it _does so_, whereas the specific, in unskilful hands, is often -productive of many annoyances, much delay, and not always a cure. - -Our plan, however, is as follows: in the first place, I take into -consideration the appearance of the patient; if he be strong, robust, -sanguine, or of full habit, and youthful—if it be his first attack, and -if the symptoms be ushered in with any degree of severity, I invariably -and rigidly (where I choose not the surgical) pursue the antiphlogistic -course of treatment; if the case be in a person of phlegmatic -temperament, of mature age, and the disease be but a repetition of the -past, and there be no evidence of physical excitement, I fearlessly -adopt the specific. Where, in the third place, I encounter a patient -with no very prominent peculiarity, nor with symptoms demanding -extraordinarily active measures, experience has taught me the propriety -of cautiously combining the two methods—a mild aperient had best always -a precede a tonic or a stimulant, in cases where there is a doubt of -inflammation lurking in the system; and, recollecting the tendency our -complicated organization has, when assailed by a distemper, to become -irritable, it is always as important to know when to withhold a remedy -as when to prescribe one. - -The three following imaginary cases will serve as no inapt illustration -of the principles laid down:— - - A. B. A man twenty-six years of age, five feet six inches in height, - weighing eleven stone six pounds, of a full rounded form—florid - complexion, of what is termed a sanguine temperament, and harassed - with the following symptoms: profuse discharge in large yellow clotted - lumps of gonorrhœal virus—intolerable scalding on passing water—great - pain at the rectum at the close of micturition—redness and swelling of - the orifice of the glans penis, puffiness of the prepuce, a _vicious_ - chordee—inclination to headache—a bounding pulse—hot skin, and an - anxious mind. Treatment: say first bleeding, then purging; warm - bath, saline powders or mixtures, cold lotions to the part, rest, - abstinence; the following eve, symptoms will be less severe. Continue - the powders, temperance and quiet. In a few days, the discharge will - be lessened, the scalding mitigated, the chordee gone, and the fever - exchanged for the cool skin of health. The resuscitative powers of - nature await only the fillip of some gentle stimulant, and the sick - man throws off his mantle for the coronal of health. - - B. C. At twenty-three, dark countenance, marked features, well - developed muscular form, pulse 66, bilious temperament, accustomed - to late hours, hard drinking, and seldom still, and _subject_ to - clap. Symptoms: plenteous discharge with but little scalding, and - no inconvenience beyond the suspension of ordinary sensualities. - Treatment: cleanliness, cubebs or copaiba, injections, a black - draught, and half a dozen days’ rest, release him from his quarantine. - - C. D. At nineteen, a timid bashful youth, for the first time infected - with gonorrhœa, which he had enduringly borne for the last fortnight, - having neglected until now to seek professional aid, although cajoled - into the purchase and imbibing of some popular “never-failing - antidote” for a “certain disease.” Symptoms: discharge _cured_? right - testicle swollen, and treble the size of the other, and excruciatingly - painful; frequent desire to pass water, pain in the groin and back, - general lassitude, and a feeling of illness all over. Treatment: - leeches, warm bath, bed, purging, fever medicines, cold lotions, hot - fomentations, low diet and patience, a month’s imprisonment, and a - slow recovery. Had the treatment of the first two cases been reversed, - the results would have been very different: and had the last sought - timely and efficient aid, he would have been spared much that he - endured. - -However, to particularize the treatment for each symptom; to commence, -I will request the reader to remember that on the first appearance of -gonorrhœa, attended with an unusual inflammatory aspect, I practise, -where permissible, venesection; if the case demand it not, at least -there should be administered an aperient; let, therefore, a dose of -opening medicine be taken immediately (Form 1). This is the first step -toward reducing inflammatory action—the next should be directed toward -allaying the local symptoms, by diminishing the nervous irritability of -the urethric passage. - -With this view, no plan surpasses that of bathing the penis in warm -water, or immersing the entire body in a warm bath. The former should -be repeated several times in the day; the latter daily, or certainly on -alternate days, so long as the severity lasts. - -By these means, the parts will be preserved clean, and will derive -benefit from the soothing influence of warmth; and, in many cases, this -will be the means of averting chordee or swelled testicle. - -Where, however, from peculiar circumstances, warm water and warm baths -are not to be had, the penis should be bathed in _cold_ water, or -encircled with pledgets of rags or lint, moistened with cold goulard -or rose-water. Warm, however, is to be preferred, although cold water -seldom fails of affording relief. - -To lessen the acrimony of the urine, which keeps up the irritability, -and somewhat to lower the system, all strong drinks, such as ale, beer, -wine, and spirits, should be avoided, and milk, tea, barley-water, -toast and water, linseed tea, gum arabic in solution, and other -such mucilaginous diluting liquors taken instead. The diet should -be lowered: in fact, a spare regimen should be adopted, not wholly -abstaining from animal food, but partaking of it only once in the day, -and carefully excluding all salted meats, rich dishes, soups, gravies, -&c. The usual employment should be suspended, and rest should be taken -as much as possible in a recumbent posture. - -Of course the preceding remarks apply only to cases of severity; I mean -such cases as first attacks ordinarily prove; and which remarks, if -attended to, will greatly mitigate the violence of the disease. - -To assist the foregoing treatment, the aperient medicine, which should -be repeated, at least, on alternate days, until the inflammation is -ameliorated, should be followed by some saline or demulcent medicine to -allay the general disturbance. Several formulæ are suggested for that -purpose, suitable to various temperaments and conditions—[_See Forms_ -2, 3, 4, 5 _in Formulæ annex_.] - -By these means, the disease, if not aggravated by intemperance of -living, or otherwise, will gradually subside, and in the course of a -fortnight or three weeks, cease entirely, without the aid of any other -remedy whatever. - -But we need not rest satisfied with merely “showing” the disease -through its stages; we can expedite it, and many of its steps we can -skip over, and here it is we may call to our aid the specific method of -treatment alluded to. This specific method consists of the suspension -of a vitiated secretion, and a restoration of a healthy one. Now how -this is effected we know not; we only know that it can be done—and -experience has taught us that it may be done safer at one time than -another. During the existence of a fevered state of the circulation, -it would be highly impolitic suddenly to check a discharge from any -surface, much less one situated like the mucous membrane of the -urethra, in the immediate connexion, as it is, of important nerves and -glandular structures—a metastasis of the inflammation will almost -invariably ensue; and hence we account for swollen testicles, buboes, -painful affections of the bladder, &c. Whereas, on the subsidence of -inflammation, the revulsion is borne; and to our satisfaction, the -disease disappears. A constitution in a state of excitement is like a -fretted child—it will have its “will” out, and the rod is not always -the safest corrective. - -On the subsidence, therefore, of the scalding, and a lessening of the -general fever, the specific plan of treatment may be commenced. Upon -the same principle that the surgical treatment is selected according to -the symptoms, so also are the just-named preliminaries in many cases -dispensable, and hence, as hereafter detailed, it will be found that -the antiphlogistic and specific do not go always hand in hand. However, -to explain the latter:— - -By specifics are meant those remedies that exert a positive curative -effect on a particular disease; and the most prominent of those, in -gonorrhœa, are copaiba and cubebs. See Formulæ annex for some useful -recipes of both—Forms 6, 7, 8, 9, 10. - -For instance, cubebs may be taken alone, in water, in doses of a -tablespoonful twice or thrice daily. If cubebs produce no good effect -in four or five days, it had better be discontinued, and other means -sought after. - -These proceedings usually carry the disease to a close, and, if no -adventitious circumstances occur, successfully and speedily. It is well -to deserve success, but it can not be always commanded. - -The business engagements of young men render it almost impossible for -them to devote that care and attention so importantly requisite; and -few, consequently, will be found who will be fortunate enough to escape -the usual concomitants of a gonorrhœa. - -Where, therefore, the scalding or passing the urine is very severe, -the pain may be mitigated by carefully injecting, previously to making -water, either of the formulæ No. 11 or No. 12 (see Formulæ annex) into -the urethra. - -The inflammation extends in general not more than two inches down that -passage, so that much force is not required to inject the intended -fluid, nor should an unnecessary quantity be used. - -When the inflammation reaches the bladder—which is indicated by pain in -that viscus and the perinœum, with a constant desire to pass water—the -taking of a warm bath at a temperature of 100°, and remaining therein -for a quarter of an hour, will afford essential relief. - -When a chordee is attendant on a gonorrhœa, and the patient can not -sleep, the draught (Form 13) may be taken on going to bed, or the -powder (Form 14) in some gruel. The embrocation (Form 15) rubbed on the -parts affected, however, will instantly remove both the pain and the -spasmodic contraction, and not unfrequently prevent their recurrence. -Care must be taken that the embrocation be only used for its specific -purpose, and not swallowed by mistake, as it is poisonous. - -In the event of the patient being obliged to follow his ordinary -occupation, or to go about, the use of a suspensory bandage will be -found of great benefit; indeed it is indispensable, and the neglect of -it has often brought on swelled testicle, or most excruciating chordee. - -By way of recapitulation, the treatment of gonorrhœa thus far consists: -in severe cases, of bleeding; in ordinary ones, and in both, of warm -bathing, local or general—where impracticable, cold—attention to diet, -the taking of aperient, soothing and astringent medicines, rest as much -as possible, and the use of the suspensory bandage. These remarks are -equally applicable, then, through every stage of this complaint that -is accompanied by inflammation, and may be relied upon as the most -effectual to avert all the consequences I now proceed to detail. - -The consideration of the symptoms here following is not in the order -in which they always occur; for swelled testicle may ensue without -phymosis or paraphymosis preceding, or even being present; and the -converse holds equally good with regard to every other. - -The successful treatment of phymosis (that condition of the foreskin -in which it can not be drawn back over the glans) depends very much -upon local management. Bathing the part frequently in warm water, the -daily use of the warm bath, and the frequent injection, by means of a -syringe, of warm milk and water, are generally all that is required -to reduce phymosis; but where it is attended with much inflammation, -where the glans is excoriated, probably by the discharge from the -urethra accumulating between it and the prepuce, and thereby inducing -irritation, bleeding is even sometimes necessary, the strictest -antiphlogistic regimen should be preserved, and the treatment advised -in the early stages of gonorrhœa scrupulously followed. - -Sometimes the prepuce becomes so swollen as to assume an œdematous or -dropsical appearance; in which case it may be scarified with a lancet, -or several leeches applied. With the exception of concealing the state -of the glans, phymosis is less dangerous than paraphymosis, and is -most usually produced by the patient worrying the part, by frequently -uncovering the glans to observe its condition. Where a discharge is -perceived oozing from beneath the prepuce, which is not urethral, -and the glans does not feel sore or tender, the injection (Form 16) -syringed up five or six times a day, will prove very efficacious in -healing the ulceration. - -Where there is an unnatural elongation of the prepuce, it will be -constantly subject to phymosis, not only from gonorrhœal inflammation, -but from the accumulation of the natural secretions of the part. In -that case, cleanliness is the only remedy the patient can employ of -himself. Occasionally it is necessary to have recourse to the surgeon’s -knife. - -Paraphymosis is the opposite to phymosis, and usually arises in this -way: the orifice of the prepuce, being contracted by the inflammation, -is drawn back for the purpose of washing or examination, and is allowed -to remain, or, as frequently happens, it can not be redrawn. When this -continues some time, considerable inflammation, both of the glans and -prepuce, arises. The contracted orifice pressing more tightly, it will -often happen that a sloughing of both it and the glans will take place; -but this occurs only in consequence of neglect, or in constitutions -injured by intemperance. - -If seen and attended to early, this state may be removed very easily. -The penis should be immersed in a basin of cold water, or sponged, so -as to cool it as much as possible; or it may be well oiled. In either -case there will not be much difficulty in pressing up the glans and -drawing up the prepuce over it; but where adhesion has taken place, or -ulceration exists, it will be harder to accomplish: the adhesions must -be separated, or the stricture divided with the scalpel. - -I need scarcely observe, that such an operation is out of the province -of the non-professional person, who should lose no time in consulting -his surgeon. - -I omitted to mention, in the description of the symptoms of gonorrhœa, -that occasionally, in very severe cases, a tumor forms in the perinœum, -which, if neglected, proceeds to suppuration, and establishes a -fistulous communication with the urethra. On the instant of such a -swelling appearing, leeches, fomentations, and poultices, should be -applied with a view to disperse it; but the management of such a case -had better be intrusted to the surgeon. - -Excoriation of the membrane of the glans or prepuce requires for -its treatment frequent ablution with warm water until the redness -and discharge somewhat diminish, when Form 16 may be resorted to, -and applied, if practicable, by a moistened layer of lint; but if -accompanied by phymosis, the syringe must be used. - -Warts, if not large, are easily removed, by brushing them with the -muriated tincture of iron, or the application of a lotion of lunar -caustic (Form 17). - -Where they are numerous and large, and resist the remedies just -recommended, the nitric acid is an excellent escharotic; it gives -little or no pain, and is rarely productive of inflammation. The glans, -if not naturally denuded (in which instance, by the way, warts seldom -accrue), should be kept so for a time; and the nitric acid, after a -few moments, washed off with cold water. Notwithstanding, excision is -sometimes necessary to their complete removal. - -When the organs of generation are infested by pediculi, or crab-lice, -the most efficacious and agreeable remedy is the sulphur-bath; one bath -generally effecting an extinction of every one of them, even though -they be all over the body. - -Some recommend shaving the hair off the pubis, the locality in which -the vermin are most usually engendered, and applying blue ointment -or the black wash. Such a practice is seldom ineffectual, but the -irritation attendant upon the reproduction of hair is absolutely -intolerable. The hair need not be removed, as the above remedies will -be all-sufficient without it. Rubbing the parts well with strong -mercurial (or blue) ointment, or the black wash (Form 18), or even -powdering them with calomel, will at once destroy the insects, and -thereby remove the itching. - -Swelled testicle, or _hernia humoralis_, more especially that -proceeding from gonorrhœal irritation, is ushered in and discovered -in the following manner: The patient, on some sudden movement of the -body, experiences a pain, darting from one of the _testes_ (both being -rarely affected at the same time) to the loins—the left testicle is -the one generally attacked. On examination, he finds that the testicle -is rather swollen and full, and very painful on being handled; the -swelling quickly increases and becomes hard, which hardness extends to -the spermatic chord, presenting the feel of a rope, passing from the -scrotum to the groin. - -It is remarkable that when swelled testicle occurs, the discharge -from the urethra, which, from previously being very profuse, and -the scalding on making water, which was very severe, both suddenly -diminish, or cease entirely, until the inflammation of the _testis_ -declines; hence, it has been supposed by some, that the disease is -translated from the urethra to the testicle. - -It is more probably however, derived from the sympathy between the two; -the irritation of the one affecting the other, and the preponderance -of inflammation in the testicle acting on the principle of -counter-irritation to the urethra, and, for a time, thereby lessening -the disease in it: for it is observed that, as soon as one improves, -the disease returns in the other. The treatment of _hernia humoralis_ -must be strictly antiphlogistic. In no form of gonorrhœal disease is -bleeding more absolutely necessary. - -The timely and prompt loss of twelve or sixteen ounces of blood from -the arm will often cut short the complaint, and render other remedies -almost unnecessary; while the temporising delay, under the vain hope -of the inflammation subsiding, will allow the disease to make rapid -progress, and impose a necessity of several weeks’ rest and absence -from business, before a cure can be effected. - -Immediately, then, on the occurrence of swelled testicle, I would -recommend the patient to be bled—to take some aperient medicine, -and, if the inflammation continues, to apply from twelve to eighteen -leeches, and afterward suffer the wounds to bleed for twenty minutes -in a warm bath; to retire to bed or to the sofa, and to maintain a -horizontal posture. If he be strong, young, and robust, an emetic (Form -19) may be given previous to the aperient, which has been known to -remove the swelling almost instantaneously. - -Iodine (Form 20) also possesses a similar specific property in reducing -swelled testicle, and may be taken during the inflammatory stage after -bleeding and aperients, as may likewise the chlorate or hydriodate of -potass (Form 21). - -With regard to local applications, the repeated employment of leeches, -fomentations, and poultices, with the frequent use of the warm bath, -and, above all, keeping the testicle constantly supported by means of -a bag, truss, or suspensory bandage, will subdue the disease in a very -short time, without impairing the functions of the important organ -concerned. - -[Illustration] - -A hardness, however, of the _epididymis_ commonly remains and continues -during life, but rarely gives rise to any inconvenience, although this -may often be remedied by compressing the testicles with strips of -adhesive plaster, as seen in the cut. - -Almost every case of inflamed testicle will terminate favorably by -strictly pursuing the plan proposed; but when, from any untoward -circumstance, the inflammation proceeds to suppuration, the case must -be treated like one of common abscess, in which event professional aid -should be sought for without delay. - -Other diseases of the testicle will be treated upon under a specific -head. - -To return to the treatment of Gonorrhœa:—On the abatement of all or -any of the enumerated symptoms, such as the diminution of the scalding -upon making water, the subsidence of chordee, the escape from, or -cure of, swelled testicle, phymosis and paraphymosis, warts, crabs, -excoriations, &c., the discharge may still continue, though thicker -in consistence, and deeper in color: and it is at this period, which -I will call chronic gonorrhœa, when all inflammatory symptoms have -left, that stimulants may be judiciously given; but it must be borne in -mind that relapses often occur from imprudence: and this chronic form -requires as much attention as the acute or early stage. (See _article -Gleet_.) - -_Gleet._—Gleet is certainly, as its name implies, a discharge of -thin ichor from a sore. Patients usually understand, and medical men -usually allow, a gleet to be a discharge from the urethra, which has -existed some time, of a whitish color, unattended with pain, and that -is _not infectious_, by which is meant is incapable of producing -gonorrhœa. There are several kinds of morbid secretions, the successful -treatment of which depends upon a knowledge of their differences. -They may be divided into two principal orders—those secreted from the -mucous surface of the urethra or bladder, and those which proceed from -the various glands-leading into one or the other. Gleet is a term -popularly applied to both, but more strictly relates to that which -proceeds from the membrane lining the urinary canal. There is great -analogy in inflammatory affections between the mucous membrane of the -digestive and pulmonary, as well as urinary passages. In inflammatory -sore throat, the secretions assume various appearances; there is a -discharge of viscid mucus, of purulent matter, or of a thin watery -nature; these secretions are dependant upon the amount and duration -of the inflammation present. Exactly in like manner may be explained -those issuing from the urethra. They are consequently alike modified -by treatment, by diet, by rest, and aggravated by a departure from -constant care. It is the nature of all membranes, lining canals that -have external outlets, to attempt the reparative process by pouring -forth discharges, while those which line the structures that have -not, effect their cure by union with the opposite surface. It is an -admirable provision, else important passages might become closed, and -so put a stop to vital processes; and in the other case, accumulations -ensue that could not escape without occasioning serious mischief. -When, however, disease has existed a long time, the operation of -the two kinds of membranes is reversed. The serous,[2] through -inflammation, take on the character of abscess, dropsy, or other -secretions, and the mucous ulcerate or form adhesions, as evidenced -in stricture, or ulceration of the throat or urethra. Gleet may be -a spontaneous disease, that is to say, may arise from other causes -than infection. It may exist independently of gonorrhœa, and be the -result of cold, of intemperance, and of general or of local excess. -Its long continuance and neglect, however, renders it infectious, and -it also gives rise to ulceration, excrescences, and stricture: and -when, from other causes, ulceration, or excrescences, or stricture, -are set up, gleet is in return generally one of their consequences. -Gleet, despite these various occasions, is, after all, most frequently -a remnant of gonorrhœa; and it is very difficult to define the time -or point where the one ends and the other commences. Pathologists -draw this distinction between the two:—they say that gonorrhœal -discharge consists of _globules_, mixed with a _serous_ fluid, while -gleet is merely a mucous secretion. I confess it difficult for a -non-professional person to decide which is which, the resemblance, -in fact, being so great—a gonorrhœal discharge being one day thick -and yellow, a few days afterward thin and whitish, and at one time -in quantity scanty, and the next profuse. Gleet assumes nearly the -same changes. The best test for distinguishing them is, by regarding -the accompanying symptoms. Where there is pain on passing water, -bladder-irritability, tenderness in the perinœum or neighboring parts, -and the discharge plentiful and offensive, staining the linen with -a “foul spot,” it may, without much fear, be decided to be clap; -but where the discharge is next to colorless, like gum-water, for -instance, and where there is no other local uneasiness than a feeling -of relaxation, and where it has existed for a long period, and was, or -was not, preceded by a gonorrhœa, it may fairly be called a gleet. Now -where does the discharge of gleet come from? Let us recapitulate its -causes; first from clap, which is a specific inflammatory affection. It -may therefore be a chronic inflammatory state of the lining membrane -of the urethra, of greater or less extent; in which case we would call -it chronic gonorrhœa, and which would be owing to a relaxed state of -the secretive vessels. We know that when a disease exists for a long -while, and is one not positively destructive to life, a habit of action -is acquired that renders its continuation in that state as natural -as its healthy condition. This is the state of the secretive vessels -in gleet, arising from gonorrhœa; and hence the discharge is poured -forth, instead of the secretion natural to the urethral passage in its -healthy order. Secondly, such may have been the severity of a clap, -that ulceration of some portion of the urethra may have taken place. -The disease may have got well except in that identical spot which, -owing to the constant irritation occasioned by the urine passing over -it, struggles with the reparative intention and effort of nature, -and exists even for years. Thirdly, when stricture is brewing, which -will be explained in an appropriate chapter, the alteration going on -gives forth a discharge, and, as I have stated in another part of -this work, I here repeat, that a long and obstinate gleet, as the -slightest examination would testify, rarely fails to indicate the -presence of a stricture. Lastly, gleet may be produced by loss of -tone in some or the whole portion of the secretive vessels, induced -by one or many of the accidents of life, or the various kinds of -physical intemperance when they not only weep forth various kinds of -fluids, at irregular intervals, which impair the muscular and nervous -energy of the generative organ, but render persons laboring under this -description of weakness very susceptible of infection, if they hold -sexual contact with those but slightly diseased. Hence persons laboring -under this form of debility incur what others escape. An individual so -circumstanced would receive a taint from a female having leucorrhœa. -Very many inconveniences have arisen from this infirmity, giving birth -occasionally to unjust suspicions, and creating alarms of the most -distressing nature. - -Thus, then, we may have gleet from gonorrhœa, gleet from ulceration, -gleet from stricture, gleet from debility and discharges, popularly -understood to be gleet, but in reality glandular secretions, which -will be considered shortly and separately. Gleet is a tiresome and -troublesome disorder. So difficult, occasionally, is its management, -that oftentimes the more regularly a patient lives, and the more -strictly he conforms to medical regimen, the more deceptive is his -disorder. He will apparently be fast approaching to, as he conceives, -a recovery, when, without “rhyme or reason,” the complaint recurs, -and hints that his past forbearance has been thrown away. It would -be dispiriting, indeed, were every case of gleet to realize this -description; but it is well known that many do, either from neglect -or mismanagement. Now it must be evident that the treatment of gleet -depends upon what may happen to be the occasion of it. Where the -membrane of the urethra is entire, internal remedies may, and do -avail. Copaiba will achieve wonders; the use also of a mild injection, -perseveringly employed (as a solution of iodide of iron, or citrate -of iron, ten grains to the ounce of water), will give tone and -stringency to the weakened vessels, and so correct the quantity, at -least, of the secretion. In very obstinate cases, stronger injections, -as of the nitrate of silver, twenty grains to the ounce of water, -are serviceable; and we are not without many useful internal medical -combinations, which, properly administered, conquer this troublesome -complaint. In ulceration and stricture, these two causes must be -removed, else all efforts are unavailing. In general and local -debility, the attention must be devoted to the constitution. Common -sense and common reading must give to persons, possessing both, every -necessary information. The community are beginning to appreciate the -advantages of temperance, air, and exercise, too highly, to need -instructions how much of the one or either of the other two are -essential to the preservation or recovery of health. - -_Morbid Irritability of the Urethra._—Of the varied symptomatic -sensations, few are more provoking and fretting than some continued -troublesome itching or pain that frequently attends the passing of -water. There may be no discharge of any kind, but there is either -a constant tingling, partially pleasurable sensation, drawing the -attention perpetually to the urethra, or there is felt some particular -heat or pain during the act of micturition. These feelings do not -always indicate a venereal affection; they appear to depend upon local -irritation, perhaps induced by a morbid condition of the urine. The -treatment consists in temperate diet, moderatively laxative medicines, -and now and then local applications. Some cases yield to sedatives -topically applied, and alkalies given internally, while others need -local stimulants and specific tonics. At all events, whenever there is -an unhealthy feeling in those parts, it points out some altered action -is going on, which, if not arrested, is likely to end in stricture or -gleet, and therefore attention had better be bestowed upon it as soon -as possible. - -_On Stricture of the Urethra._—Of all diseases of the genito-urinary -system, stricture must be allowed to be the most formidable. It is -not the most difficult to cure; but it involves, when neglected, -more serious disturbances—disturbances which frequently compromise -only with loss of life. Stricture is a disease unfortunately of -extensive prevalence; and in nine cases out of ten is the sequence -of a gonorrhœa; and, what is still more comforting, few persons -who become the prey to the latter infliction escape scot-free from -the former; not because a clap _must_ necessarily be succeeded -by a stricture, but simply because it _is_, and all owing to the -carelessness and inattention manifested by most young men in the -observances so necessary for the perfect cure of the primary disease. -One very prevalent notion, and which explains a principal cause of -the extension of the venereal disease, is entertained, that the way -to give the finishing _coup_ to an expiring clap, is to repeat the -act that gave rise to it: the disease becomes temporarily aggravated, -and the impatient invalid probably flies, from an unwillingness to -confess his new error, from his own tried medical friend to some -professional stranger. From a desire to earn fame as well as profit, -the newly consulted prescribes some more powerful means; the discharge -is arrested for a while, but returns after the next sexual intercourse; -a strong injection subdues the recurrent symptom, which only awaits a -fresh excitement for its reappearance. Thus a gleet is established. -The patient finding little or no inconvenience from the slight oozing, -which, as he observes, is sometimes better and occasionally worse, -according to his mode of living, determines to let nature achieve her -own cure, and for months he drags with him a distemper that, despite -all his philosophy, he can not reflect on without an humiliating -diminution of self-approval. So insidiously, however, does the -complaint worm its progress, that the patient, considering his present -state the worst that can befall him, resolves to endure it, since it -appears his own constitutional powers are incapable of throwing it off. - -In the midst of this contentment, the invalid finds that the process -of urinating engages more time than formerly, the urine appears to -flow in a smaller stream, and is accompanied by a sensation as though -there were some pressure “behind it.” The act of making water is not -performed so cleanly as it used to be; the stream differs in its flow, -seldom coming out full and free, but generally split into three or four -fountain-like spirts, as the annexed drawing displays. - -At other times it twists into a spiral form, and then suddenly splits -into two or more streams, while at the same moment the urine drops -over the person or clothes, unless great care be observed, as witness -diagram. - -In advanced cases, the urethra becoming so narrow the bladder has not -power to expel the urine forward, and it then falls upon the shoes or -trowsers, or between them, as observe illustration. - -[Illustration] - -[Illustration] - -[Illustration] - -Persons afflicted with stricture, and urinating in the streets, may -almost be detected from the singular attitude they are obliged to -assume to prevent the urine from inconveniencing them, and also from -the time occupied in discharging it. Some few minutes after making -water, when dressed and proceeding on his way, the patient finds his -shirt become moist by some drops of urine that continue to ooze from -the penis; and it is only as these annoyances accumulate, he begins to -think he is laboring under some other disease than the gleet. The next -symptom he will experience will be a positive but temporary difficulty -in passing his water—perhaps a total inability to do so; it will, -however, subside in a few minutes. This will lead him to reflect, and -he will even appease his fears by inclining to think it may be the -consequence of his last night’s excess: he resolves to be more careful -for the future, and he gets better; his contemplated visit to his usual -professional adviser, if he have one, is postponed, and a few more -weeks go by without a return of the last symptom. The next attack, -which it is very difficult to avert, and which is sure to accompany -the succeeding debauch, or to follow a cold or fatigue, does not so -speedily subside; the patient finds that he can not complete the act of -making water without several interruptions, and each attended with a -painful desire resembling that induced by too long a retention of that -fluid. In that state he eagerly seeks medical assistance; the treatment -generally adopted consisting of some sedative, immersion in a hot -bath, or the passage of a bougie. Relief being thus easily obtained, -professional advice is thus thrown up, and the symptoms are again -soon forgotten. Before proceeding further with the more severe forms -and consequences of stricture, which may now be fairly said to have -commenced in earnest, a brief anatomical description of the urethra may -enable the reader to understand how the constriction or narrowing of -that canal takes place. - -I have elsewhere stated the urethra to be a membranous canal, running -from the orifice of the penis to the bladder, and situated in the lower -groove formed by the _corpus spongiosum_. - -The difference of opinion entertained by some of our first anatomists, -on the structure of the urethra, is deserving of notice; for only in -proportion to the correctness of our knowledge of it, can we arrive at -a just definition of its diseases. - -One party assert it to be an elastic canal—whether membranous or -muscular they do not say—endowed with similar properties of elasticity -to India rubber, or to a common spring. That it is elastic, is beyond -doubt; but the mere assertion is no explanation of its mode of action. - -Others, from microscopical observations, declare it to consist of two -coats—a fine internal membrane, which, when the urethra is collapsed, -lies in longitudinal folds—and an external muscular one, composed of -very short _fasciculi_ of longitudinal fibres, interwoven together, and -connected by their origins and insertions with each other, and united -by an elastic substance of the consistence of mucus. This is the more -satisfactory of the two. - -They account for the occurrence of stricture in this way. They say -that “a permanent stricture is that contraction of the canal which -takes place in consequence of coagulable lymph being exuded between the -_fasciculi_ of muscular fibres and the internal membrane, in different -quantities, according to circumstances.” - -A spasmodic stricture they define to be “a contraction of a small -portion of longitudinal muscular fibres, while the rest are relaxed; -and as this may take place, either all round, or upon any side, it -explains what is met with in practice—the marked impression of a -stricture sometimes a circular depression upon the bougie, at others -only on one side.” - -With respect to the change consequent upon permanent stricture, -dissection enables us, in some degree, to arrive at the truth. -Excrescences and tubercles have been found growing from the wall of the -urethra; but in the majority of instances, the only perceptible change -is a thickening of the canal here and there, of indefinite length; -but whether it be occasioned by the exudation of coagulable lymph, or -whether it be the adhesion of ulcerated surfaces, which I contend are -more or less present in gleet, is not so easy to determine; at all -events, it is undoubtedly the result of inflammation. - -With regard to the action of spasm, all we know of it is theoretical; -but experience every day furnishes instances of its occurrence. - -Spasmodic stricture is generally seated at the neck of the bladder, -and may occur to persons in good health, from exposure to wet or cold; -from some digestive derangement; from long retention of the urine, -particularly while walking, owing to the absence of public urinals; or -to violent horse exercise; but more frequently does it happen to those -young men who, when suffering from gleet or gonorrhœa, imperfectly or -only partially cured, are tempted to commit an excess in wine, spirits, -or other strong drinks. Surrounded by jovial society, glassful after -glassful is swallowed, each one to be the last. The patient, with -his bladder full to repletion, scarcely able to retain his water, -yet probably “_going_” every moment, represses his desire until the -party breaks up, when, on encountering the cold air, he finds himself -unable to void even a drop, or if so, but with extreme difficulty. The -greater the effort, and the more determined the straining, the greater -is the impossibility, and unless relief should be afforded, the most -alarming consequences may ensue. - -The rationale is this: the patient, opposing the action of the muscles -of the bladder, by contracting those of the urethra, they (the latter), -from irritation, become spasmodically contracted. - -The urine, by the powerful action of the muscles of the bladder, is -forced against the contracted portion of the urethra; and by its -irritation increases the mischief. Where neglected, or unless the -spasms yield, extravasation will take place, mortification ensue, and -death follow. - -The urethra is situated at the under part of the penis, and is embraced -by a substance called the _corpus spongiosum_; it (the urethra) -consists of several different layers or coats—the inner, the one -continuous with that lining the bladder, which possesses the power of -secreting a mucous fluid, and the other made up of muscular fibres, -which give to the urethra the power of contracting and dilating, -that regulates the flowing or jetting of the fluid which has to pass -through it. The mucous membrane of the urethra is of a highly sensitive -nature, and more so in some parts than in others, as, for instance, -in the membranous and bulbous portion of the canal; and hence it will -be found, that those are the parts most liable to disease. The mucous -membrane has several openings called _lacunæ_, for the furnishing a -particular fluid to moisten and lubricate the urinary tube: these also -are frequently the seat of disease. These are seen in the drawing on -page 50. - -In passing a bougie in contracted and irritable urethra, it sometimes -enters the opening marked B, and if violence be used in propelling the -instrument, false passages are made. - -Independently of the function of the urethra being to discharge the -urine, it has also to convey the semen to the orifice of the glans; and -here in this act is to be observed the wonderful adaptation of means -to an end. During the excitement attendant upon venereal commerce, the -seminal fluid accumulates, prior to emission, in the bulbous portion, -and when the fitting moment arrives for its ejection, the membranous -portion spasmodically contracts, thereby preventing the regurgitation -of the semen into the bladder, while the muscles surrounding the -bulbous portion contract with energetic force, and so complete the -transmission of the generative fluid. Such are the functions of the -urethra in health. - -[Illustration: - A—Signifying the urethra cut open. - - B—The lacunæ and the cut end of bougie, - to show the continuation of the urethra.] - -Now, this canal being extensively supplied with nerves, that have more -extensive communication with others than any particular ones have -in the whole body, and made up, as before stated, of surficial and -muscular membranes, and exposed to the performance of several duties -which are often unduly called into exercise, can not be supposed to be -exempt from the consequences of such misappropriation; and therefore -it is very liable to inflammation. From the sensitive nature of the -tube, it is very obnoxious to spasm, which may be partial, general, -temporary, or continuous: hence spasmodic stricture. This condition is -of course dependent upon many causes, excess of diet, fatigue, cold, -&c., irritating the general system; when from the local irritation -previously set up in the urethra by the forenamed causes—a neglected -gleet or clap—the urethra is not long in participating in it: the -phenomena are the symptoms recently narrated. Highly restorative as -the powers of nature may be to remove disease, she does not appear -readily disposed to interfere with the processes set up in the machine -she inhabits, for self-defence, to protect itself from the constant -irritation produced by the daily flow of acrid urine, which in several -cases often produces ulceration; coagulable lymph is thrown out in the -cellular structure of the particular diseased part, thereby thickening -the walls thereof, and constituting permanent stricture, it appearing -preferable to impede a function which a narrowing of the urethric canal -does, namely, that of urinating, than of allowing ulceration to ensue, -whereby the urine would escape into the neighboring parts, and occasion -great devastation, and probably death. Permanent stricture, as its -name implies, outlives the patient; _it never yields, unassisted by -art_. I have described the ordinary symptoms of stricture, especially -that form induced by gonorrhœa. Stricture may arise from other causes. -Inflammation, in whatever way set up, if allowed to go on or remain, -will give rise to stricture, and the celerity or tardiness with which -it takes place depends upon circumstance. An injury from falling -astride any hard substance, blows, wounds, contusions occasioned by -riding, the presence of foreign substances, the injudicious use of -injections, and lastly, which is as frequent a cause as any one of -those heretofore enumerated, _masturbation_. The violent manual efforts -made by a young sensualist to procure the sexual orgasm for the third -or fourth time continuously, I have known to be of that degree that -irritation has been communicated to the whole length of the urethra, -extending even to the bladder; and retention of urine, in the instance -I allude to, ensued, and required much attention before it could be -subdued. Excessive intercourse with females will give rise to the -same effects; not so likely as in the case preceding, inasmuch as -the former can be practised whenever desired, while the latter needs -a participator. The act of masturbation repeated, as it is, by many -youths and others, day after day, and frequently several times within -each twenty-four hours, must necessarily establish a sensitiveness -or irritability in the parts, and alteration of structure is sure to -follow. - -The positive changes which take place in stricture in the urethral -passage are these: there ensues a thickening and condensation of -the delicate membrane and the cellular tissue underneath, which may -possibly unite it to the muscular coat. This thickening or condensation -is the result of what we call effusion of coagulable lymph. It will -be rather difficult to explain the process; but lymph is that fluid -understood to be the nutritious portion of our sustenance or system, -and which is here yielded up by the vessels which absorb it, and which -vessels abound, with few exceptions, in every tissue of our body. -However, it will suffice to say, that where inflammation takes place, -there is an alteration of structure, and that alteration is generally -an increase. In stricture, this increase or thickening takes place, -as I observed before, in particular parts of the urethra, but where -the inflammation is severe, no part is exempt, and whole lengths of -the passage become occasionally involved. It is true, certain parts -are more predisposed than others, as, for instance, the membranous, -bulbous, and prostatic portions of the canal; but there are oftentimes -cases to be met with where these parts are free, and the remainder -blocked up. This effusion or thickening assumes various shapes, and -selects various parts of the urethra. The subjoined diagram will convey -a tolerably perfect idea of the malady in question; indeed it is a -beautiful specimen of simple stricture. - -[Illustration: - A—The cut edges of the corpus spongiosum. - - B—The urethra. - - C—The stricture.] - -To continue the description of the formidable consequences of neglected -stricture. - -In protracted and neglected cases, that part of the urethra between -the stricture and bladder becomes dilated, from the frequent pressure -of the urine upon it, induced by irritability of the bladder, which -has an increasing desire to empty itself. In process of time, complete -retention of urine will ensue, ulceration will take place at the -irritable spot, and effusion of urine into the surrounding parts -will follow; and the consequences will be, as in the instance of -the spasmodic affection, _fatal_, unless controlled by the skilful -interference of the surgeon. - -The symptoms of permanent stricture are often as slow in their -progress, and as insidious in their nature, as they are appalling in -their results, and are seldom distinctly observed by the patient, until -firmly established. - -He is suffering from a long-continued gleet, and is first alarmed by a -partial retention of urine—it passes by drops, or by great straining, -or not at all. This usually occurs after intemperance, and is relieved -by the warm bath, fomentations, and laxative medicines. This is the -first stage, and is attributed to the debauch solely; whereas, at this -time an alteration of structure is going on in the urethra. Its calibre -is becoming diminished, which necessarily causes the urine to flow in a -smaller stream. This is not observed at first; and it is only after a -long period that the patient becomes aware of the fact. - -The disease proceeds. In the morning, from the gluing together of the -sides of the urethra, by the discharge from its diseased surface, -the urine flows in a forked or double stream; and then, as this -agglutinution is dissolved, it become natural. - -There is a greater and more frequent desire to make water, disturbing -sleep many times during the night, but unattended with pain, unless the -neck of the bladder be affected. - -There are also uneasy sensations in the perinœum, a sense of weight -in the pelvis, with flying pains in the hips; and in the permanent -stricture there is a remarkable symptom frequently prevailing—that is, -a pain extending down the left thigh from the perinœum. - -As the disease advances, the urine flows in only a very small stream, -or forked, twisted, double, or broken, or in drops; and the patient -solicits the flow by pressing with his finger on the perinœum, and -elongating the canal, somewhat after the manner in which a dairy-maid -milks a cow. - -The dilatation of the urethra between the stricture and the bladder -already alluded to, now takes place; and some urine remains in the -dilated part, which oozes through the stricture, making the patient wet -and uncomfortable. - -There is great difficulty felt, and more time is occupied in getting -rid of the last drop of water, than formerly. This sensation continues -all along; and the cure is never accomplished until this is finally -removed. - -If the stricture is still neglected, more severe symptoms come on, and -the neighboring parts become affected also. - -The _sphincter ani_, or the muscles of the anus, are relaxed, from the -excessive action of the abdominal muscles; and the fæces pass in small -quantities involuntarily. There is a protrusion of the bowel, which -adds to the distress, and, by its irritation, brings on a looseness or -diarrhœa. - -The prostate gland, which is seated near the neck of the bladder, -suffers inflammation and enlarges, beginning at the orifice of the -ducts, which open into the urethra. - -The emission of semen, which often happens involuntarily, is attended -with agonizing pain, producing cold shiverings, followed by heat; and -fever soon becomes fairly established. - -The liver and its secretions become diseased, discharging in the -intestines large quantities of vitiated bile. The fever assumes the -intermittent character. The discharge from the urethra is greatly -increased in quantity, showing the formation and bursting of an abscess -of the prostrate gland into it. - -The bladder is much thickened and diminished in size, and acutely or -chronically inflamed. The desire to make water is continual, allowing -hardly a moment of rest; and the patient, in the agony of despair, -prays to be relieved from his sufferings. - -Soon succeeding the irritation of the prostate, the testicles become -involved, the disease being propagated by means of their ducts, which -open into the urethra. The testicles swell a little, become uneasy and -painful, and a dropsical or hardened enlargement ensues. - -When the stricture forms a nearly complete obstruction to the passage -of urine, the violent efforts of the bladder to expel it bring on -ulceration or rupture of the urethra, through which the urine is forced -into the cellular membrane, with all the power of a spasmodically -excited bladder. - -The scrotum and neighboring parts become distended, erysipelas -supervenes, black patches of mortification break out in different -places, the febrile symptoms are augmented, and the patient at last -irrecoverably sinks into a state of coma or muttering delirium, and -death closes the scene. Such is the progress and termination of -stricture when neglected. - -The reader, if he be an afflicted one, will eagerly turn to the page -wherein the treatment of this formidable and distressing malady is -considered; and great will be his satisfaction and delight, on finding -it remediable by such simple means, and entirely within his own -control; more especially if he direct his attention to the disease in -its earlier stages. - -He must by no means, however, be too sanguine, from these remarks, or -indulge in the idea that as stricture is remediable, it is unimportant -when the cure be attempted; the longer the delay, the greater will be -the cost to the patient; and, furthermore, the slightest deviation from -the instructions laid down, will surely aggravate the disease, and -increase the embarrassment of the sufferer. - -The following diagrams are further explanatory of the stricture in its -amplified forms. - -[Illustration] - -The dark marginal line denote the calibre of the urethra, and the inner -lines the actual diameter of the obstructed passage. Figure 1 shows the -stricture to be on the lower part of the urethra. Figure 2 the upper -part. Figure 3 exhibits a stricture of some length, and a somewhat -contracted state of the whole canal. Figure 4 denotes a very common -form of stricture, which resembles a flour-bag tied in the middle; it -is the least difficult to cure of any, because it signifies that the -seat of irritation is limited; but these cases are generally precursory -to severer forms, if not promptly attended to. Figure 5 represents -a stricture of considerable length, and of course very difficult of -removal. - -There are many provocatives to stricture, and when once mischief is -progressing, it makes up for its slow initiation by giant strides. A -patient may have a trifling stricture for years without experiencing -much inconvenience. He takes cold, fatigues himself, commits some -stomachic or other excess, may possibly have fever, all of which more -or less disturb the general economy, alter the character of the urine, -and in that manner doubly accelerate the disorganization going on in -the urethra. A small abscess may spring up _in_ the urethra, or _below_ -it among the cellular membranes and integuments. In either case, it -chances now and then to burst an opening and create a communication -externally with the urinary passage, constituting what is called -_fistula_. A person laboring under stricture is always liable to these -occurrences. As much mischief is done oftentimes by mismanagement -as by neglect. The clumsy introduction of a bougie, or, in other -instances, the unjustifiable introduction of one, is likely to, and -very frequently does, lacerate the delicate and irritable membrane, -and make a false passage. Figure 6 exhibits an instance at Nos. 1 and -2; the upper numerical shows a false passage made by a bougie, and an -obliteration of the ordinary passage of the urethra, the result of -inflammation, constituting an impassable stricture; the lower figure -exhibits a false opening made, in the first instance, by a fruitless -effort at passing an instrument, when inflammation completed the -process. No urine escaped from it of course, because communication was -cut off from the bladder by the impassable stricture; the outlet for -the discharge of that fluid being through a sinuous opening marked No. -2, the No. 3 denoting the closed end of the urethra. The case happened -to a man in very ill health, who was prone to ulceration, and he -gradually sunk under exhaustion from debility and premature old age. -Figure 7 exhibits a stricture where the posterior part was enlarged -by the constant pressure of the urine to escape through the narrowed -part of the urethra; ulceration ensued, and a fistulous opening was -the consequence; the stricture was seated high up, and the fistulous -canal was several inches long, terminating in the upper and posterior -part of the thigh; the urine used to dribble through it as well as -through the urethra. The patient had been a seafaring man; he was in -exhausted health from hot climates and intemperate living, and he died -at last of consumption. I have the parts showing the stricture and the -fistulous opening by me, in a state of good preservation. In Figure -8 is presented an illustration of extensive ulceration producing two -fistulous openings; the state of the urethra was only discovered after -death, the patient having concealed his infirmity for many years; -he died suddenly from apoplexy, being found dead in his bed by the -people of the house where he lodged. Figure 9 portrays irregular and -extensive ulceration. The patient died from syphilis, having gonorrhœa -at the same time. I have the preparation. Figure 10 shows an impervious -urethra, and a fistulous opening through which the urine flowed. The -urinary passage was blocked up within two inches from the orifice, and -the length of the obstruction was perhaps a quarter of an inch. It -was perforated successfully by the lanceted stilette, and the passage -thereby rendered continuous; the catheter was worn for several days, -and the false opening soon healed after a slight application or two -of nitric acid. Numerous other illustrations might have been given, -but the preceding convey a passable notion of the simplest, and most -confirmed, and most severe forms, of the malady in question. - -It is melancholy, notwithstanding the resisting and reparative power -of nature to avoid so saddening a disease as stricture, that it is so -very prevalent, and that it is occasioned by so many causes. Where it -is not destructive to life, it is very injurious. It involves, where it -is severe, other important organs beside the seat of its abiding; the -repeated calls upon the bladder, through sympathy of the irritation, -created so near to that viscus, the efforts which at all times it is -obliged to make, although assisted by the muscles of the abdomen and -contiguous parts to void its contents, at last, and very frequently end -in paralysis, and total inability to pass water ensues, except through -the aid of the catheter. Independently of which, where so much disease -exists as in the urethra, the urine also constantly pressing against -ulcerating and irritable surfaces, extravasation of that secretion -takes place, and the most formidable and alarming consequences ensue. -In the simplest form of stricture, many important functions are -disturbed. A very frequent consequence is permanent irritability of the -bladder, so that the patient is obliged, ten or twelve times a day, to -micturate, and is unable to pass through the night without suffering -nearly the same inconvenience. Besides which, the natural sensitiveness -of the genital organs becomes speedily and much impaired. I am -satisfied that where disorganization of the testicles does not exist, -and where the patient is young, or even middle-aged, if he be impotent, -he will in nine cases out of ten be found to have stricture. There -are exceptions, which shall be named when speaking on the infirmities -of the genital system, but in nearly all cases of impuissance there -will be found, if not stricture, at least some morbid irritability of -the urethra. During the existence of stricture, there is generally a -vitiated secretion from the seat of mischief, constituting a gleet; -therefore a gleet at all times should be regarded, lest it be an -indication of something more than a mere weeping from enfeebled vessels. - -_On the Treatment of Stricture._—Having fully described the symptoms -and progress of stricture, I proceed to the more pleasing part -of treatment. Stricture, if early attended to, is a disease easy -remediable: if neglected, its horrors accumulate, and sufferings the -most acute close the scene. Such, however, is the progress of science, -that it is almost possible to cure the most inveterate case, at all -events to relieve it; but that is no reason why the initiatory notices -should be disregarded. Stricture, as must be perceived, is of two -kinds, spasmodic and permanent: the treatment of the first is chiefly -medical, the treatment of the latter chiefly mechanical. The principal -agents I rely upon in the cure of the former, are the warm bath, rest, -sedatives, and certain dietetic restrictions; for the removal of the -latter, I place unbounded confidence in the practice of _dilatation_; -and I am of opinion that the other methods, namely, the application -of caustic or the scalpel, might be dispensed with altogether, if the -dilating method be not delayed too long. - -Before commencing the cure of stricture, I need hardly observe, that we -ought to be fully satisfied of its existence. Symptoms are not always -unerring guides; and, therefore, our reliance should not wholly depend -on them. - - ——“to be once in doubt - Is once to be resolved.” - -The only mode of ascertaining the precise condition of the urethra, is -by an examination of it, which should not be delayed a moment after -suspicion is entertained of the impending evil. - -For this purpose, it is recommended that a solid silver sound should -be used as the best instrument; because it will pass with much less -pain or inconvenience. It should be made conical, that is, smaller -at the point than at the shaft, and of a size to pass very readily -into the orifice; the shaft or body of the sound should not exceed -two thirds of the size of the canal. The sound should be warmed, -and afterward it should be well oiled. The directions for examining -the urethra pertain to the passage of a bougie or catheter; and as -it often falls to the lot of a patient, that he is beyond medical -assistance, it behooves him to learn how an instrument should be -passed, in order that in emergencies he may officiate himself; besides, -it often happens, in cases of diseased bladder, and in those cases -where retention of urine frequently occurs, that an invalid can not -command the necessary constant attendance of his professional man; and -therefore such knowledge will well repay any little time or trouble -bestowed in the acquisition. The two annexed drawings will render the -commonest observer a proficient. The first shows the manner in which -the bougie is to be introduced. Where the instrument can be passed thus -far, without the assistance of the other hand than that which holds -the bougie, it is better, as it keeps the penis and the muscles which -influence it in a passive state. When the instrument has passed as -far as it will, in the direction the dotted lines denote, it is to be -turned gently round, raising the handle toward the abdomen. A slight -pressure is then to be made _downward_, and the handle of the catheter -or bougie at the same time to be borne away from the body. See diagram. -The instrument will, if there be no impediment, gradually slip into the -bladder. A trial or two will perfect and surprise the novice. The same -directions apply to the introduction and use of all other instruments -into the urethra. The sensation experienced on having a bougie passed, -partakes more of a strange tickling feeling than absolute pain, except -there exist stricture, and even then the urethra, on a subsequent -trial, is almost insensible to it. - -[Illustration] - -[Illustration] - -If soreness or pain is felt, on the sound passing over the affected -part, we may presume there is chronic inflammation of the urethra, -or that the surface is ulcerated, as in long standing gleet. If the -sound meet with an impediment, but proceeds after a little pressure, -it indicates a thickening of the mucous membrane, the forerunner of -stricture. - -I may here observe, that stricture is generally found to exist either -within an inch of the orifice, or at about six inches and a half from -it, or in the prostate part of the urethra. - -If the sound passes, without hinderance, the last situation, but with -increased pain, the membrane of that part is diseased, and may extend -to the bladder; which will be indicated by the frequent desire to -micturate during the night, owing to the irritable state of that organ. - -If the instrument be arrested at about six inches and a half, the -complaint, in all probability, is seated in the transverse portion of -the prostate, and requires very cautious treatment. - -When the obstruction is at the very entrance of the bladder, a -resistance will be perceived, which, on yielding, will impart a -peculiar sensation as the sound enters the bladder. When stricture is -thus situated, there is a frequent desire, with almost total inability, -to micturate; and when once formed, it is productive of the most -serious mischief, unless relieved. - -In cases of permanent stricture, the passing of the sound conveys -the sensation of going over a ridge. Where it meets with a temporary -stoppage, and then passes on, it has probably hitched to a fold of the -urethra. Sometimes it will enter the orifice of a dilated follicle; and -if much pressure is used, it will occasion considerable bleeding. - -The nature and situation of the disease being ascertained, the cure -may now be proceeded in, recollecting that no force is to be used, -and that too much be not attempted at one essay. Now without entering -into an inquiry as to the laws on which _contraction_ and _elasticity_ -of certain animal structures depend, it is enough for our purpose to -know, that the urethra possesses both properties; it may contract -so as to oppose the exit or entrance of the smallest stream, and it -may be dilated to admit the introduction of an instrument an inch in -circumference. The urethra maintains these properties in disease as -well as in health, and upon the strength of this fact, is the practice -of dilatation in the cure of permanent stricture founded, permanent -stricture, it will be recollected, is a positive narrowing of the -urethric canal; and as it is the nature of all organic diseases to -progress, unless prevented by art, it needs no stronger argument than -necessity to show how imperative it is to set about their removal. - -The cure by dilatation is as follows:—the seat and size of the -stricture being ascertained (both of which can be easily done by the -passing of the sound as directed, and the observance of the stream of -urine), a bougie in circumference somewhat larger than the calibre -of the urinary current, warmed and dipped in an oleaginous mixture -combined with some sedative (Forms 22, 23, 24) or stimulant (Form 25) -according to circumstances, is to be passed to the stricture, and the -gentlest pressure is to be employed for the space of five, ten, or -twelve minutes, according to the irritation it produces, removing it as -soon as any uneasiness is felt. - -Even in this very simple operation, a certain dexterity is requisite; -for the direction of all urethræ is not alike, and the mere pushing -a bougie against a contracted part is not the only likely method -of effecting a free passage. Much also depends upon the nature of -the bougie—the elastic ones, although assisted in their attempted -passage to the bladder, by the smooth and well lubricated sides of -the urethra, have a tendency to straighten; and unless considerable -rotatory motion be observed, are apt to hitch in a fold of the urethra, -especially if the case befall a person of relaxed fibre, and he be -much worn down by suffering. The bougies that I employ are constructed -upon an improved plan to those in general use, being prepared of a -material that will preserve the shape I adapt them to, previously to -introducing them, but at the same time sufficiently soft to yield to -any accidental tortuosity of the tube they are intended to explore. -The bougie then is to be pressed softly, but steadily, against the -obstruction, now and then withholding for a minute the bearing, so as -to allow a respite to the stretched membrane; then renewing by, what -is better done than expressed, an “insinuating” pressure for the space -of the time advised above. The patient should not be dispirited, even -if the bougie do not perforate the stricture at the first trial; it -would doubtless do so, if longer time were employed, but that is rarely -advisable, except in cases where the urine can scarcely escape, or much -expedition be requisite. Should the operation even be unsuccessful in -this first attempt, the patient will find his ability to micturate much -greater than before the introduction; but, save in long-standing and -obstinate strictures, I rarely find myself foiled, nor do those who -practise the same method, if they have patience and skill enough, in -overcoming the difficulty at the first interview. A great advantage of -the cure by dilatation, independently of its safety and efficacy, is -the insignificant pain it occasions; the sensation produced being only -like a pressing desire to make water, which immediately subsides on -withdrawing the bougie. - -Another method of dilating a stricture, where it happens to be of -chronic existence, is the passing a plastic catheter into the bladder, -and suffering it to remain all night, or even for several nights, -stopping up the handle end with a cork or wooden peg, which the patient -can remove when he desires to urinate. The urethra, by this means, -becomes quickly dilated, and much beyond the size of the instrument. It -necessarily confines the patient to his room and couch; but where an -expeditious cure is the object, as much may be effected in this manner -in six days, as by the ordinary method in as many weeks. Time, however, -it must be remembered, is the working _material_ of nine tenths of -strictured invalids, and a week’s lay-up may cost a twelve-month’s -salary—a purchase too dear to be generally incurred. - -Several other plausible methods have been suggested for the cure of -stricture—one by means of an instrument, that the operator could -enlarge when it was passed into the urethra, through turning a screw; -another, which was to introduce a tube made of some thin skin, and -then to distend it with wind or water; a third, and oftentimes, in -reality, a very useful and available one, is to compress the penis -around the glans, and suffer the urine, as it accumulated, to distend -the anterior part of the urethra before the bandage was removed and the -urine suffered to escape. But they have their several disadvantages: -the processes, with the exception of the last, are complicated and -uncertain in their result; the instrument is not so manageable, or so -useful, as an ordinary sound; and the gut, instead of distending the -strictured part, enlarges the healthy portions of the urethra. The -bougie, in proper hands, notwithstanding it is a simple instrument, -is the most positive and effectual method of curing stricture as -yet, or likely to be, discovered. An entrance, then, having by this -means been gained, a bougie of a larger size is to be selected on the -next occasion, and the same process repeated. It is never advisable -to repeat the operation oftener than once in two days, and when the -urethra is irritable, only every three or four days. - -By continuing in this manner, the stricture gradually yields, and -a bougie as large as the orifice will permit to enter will at last -proceed through the whole passage without meeting any obstacle. The -operation, notwithstanding this apparent success, should not be wholly -laid aside, but continued until the disposition for contraction -is entirely removed; and the patient should never rest without -occasionally examining his urethra, say once a month (at least once a -quarter), lest he encounter a relapse. - -Having disposed of the treatment of stricture in its fortunately most -usual—namely, the mildest—form, I proceed to consider the treatment -of severe kinds—previously to which, a few remarks upon the various -kinds of instruments, their structure, shape, and size, will render any -subsequent allusion more intelligible. - -The diagram here introduced represents the calibre of the various -bougies in general use, and the observer will perceive, that as they -are made to accommodate themselves to the passage they have to pass, -how varied must be the changes which the urethra undergoes. The -last outline indicates the natural and healthy bore of the urethra. -Bougies are manufactured of different materials: waxen cloth rolled -together, elastic and yielding; flexible metal, silver, and gold. -The bougies which I employ are constructed upon an improved plan -to those in general use: the elastic, as they are termed, although -assisted in their attempted passage to the bladder by the smooth and -well-lubricated sides of the urethra, have a constant tendency to -straighten, and consequently are liable to hitch in all the folds they -may encounter, which, in relaxed habits, are very numerous in the -membranous portion of the urethra. To obviate such a possibility, I -prefer that the bougie should be of such a consistence and manufacture -as will admit of its preserving the shape I adapt it to previously to -introducing it; at the same time the material to be sufficiently soft -to enable it to accommodate itself to any accidental tortuosity of the -tube it is exploring. - -[Illustration] - -Catheters are instruments for the purposes of withdrawing the urine; -they are consequently hollow, and are made of the same materials as -bougies; but the most useful and to be depended upon are composed of -silver. Surgeons, like other men, have their fancies: a catheter, -when made of silver, has very little flexibility; accordingly it must -be shaped beforehand. Some medical men prefer them quite straight, -others with an immense curve. A surgeon should possess many forms, as -the direction of the urethra differs almost in all men. The subjoined -exhibits not the size, but the shape of the more useful and those -most generally used. Figures 1, 2, and 3, suffice in most instances, -whereas figure 4 is necessary in cases of enlargement of the prostate -gland, which presses up the bladder, and renders the urethral passage -consequently longer. - -[Illustration] - -The French employ not only variously curved instruments, but variously -shaped. In peculiar cases they are doubtlessly useful; but they require -to be used only by persons of skill and judgment. In the next three -kinds are views of such; they are called conical bougies—the first -curved, the second straight. They are made of silver, waxen cloth, or -India-rubber. The third exhibits a sound, employed to ascertain the -seat of the stricture. - -I have already alluded to the improved method I employ on finding it -necessary to use escharotics. I can not better explain the process -than by submitting a sketch of the instruments, whereby the mode of -application will be instantly perceived. The instruments are made of -silver. The figures represent No. 8 a curved, No. 9 a straightened, No. -10 ditto, with enlarged head, which puts the areola of the stricture on -the stretch, and secures the central part for the application of the -caustic, or whatever substance may be employed. - -The next kind of instruments are for the purposes of dividing or -piercing hardened obstructions—one or two applications creating a -passage which a hundred _cauterizings_ would not effect. When any -styptic is applied to a morbid growth, its tendency is to create a -slough, or to destroy the part whereto it is applied. In some instances -a styptic actually promotes increased action: it may temporarily -destroy the part; but the moment the effect is over, a reaction -follows, and the excrescence is increased. Such is the case in many -long-standing, obstinate strictures; and their removal by perforation -or division is rendered indispensable. The practice requires the -most careful attention and anatomical knowledge; and no one but a -professional man would attempt its employment. - -No. 11 sketch exhibits a curved instrument, with the pointed lancet -projecting as when applied. No. 12 exhibits ditto, but with a -differently formed instrument, consisting of two portions separated, -so as to allow a director, in the form of a thin silver wire with a -silver knob, to pass for the purpose of exploring the passage which the -instrument is to follow and enlarge. It is indispensable in strictures -seated upon the soft and deep parts, lest a false passage should be -made. No. 13 represents a straight instrument; No. 14 ditto, but with -the lancet in reserve—the last a perforator. - -The reader has now been made acquainted with the various resources -the surgeon has at his command. A few words on their employment will -complete the necessary amount of information to render the one as wise -as the other. By way of recapitulation, the treatment of stricture -is by _dilatation_, _cauterization_, and _division_. They are to be -estimated in the order of their arrangement. By dilatation is meant the -enlarging of the urethral passage through the frequent introduction -of bougies of graduated sizes. It is an operation unattended with any -considerable pain; its novelty sometimes renders a patient a little -nervous, but a complaint is rarely made after a second or third -introduction. Indeed, it is oftentimes courted more frequently than is -desirable. The application also of caustic, or even the perforator, -produces scarcely the least inconvenience. Hemorrhage, of most -things to be dreaded, is less frequent, with cauterizing and cutting -instruments (in skilful hands), than the incautious employment of -blunt-pointed bougies. - -_Diseases of the Testicles._—The testicles, from their office and -connexion with other structures equally as important, are liable -to many excitations. In gonorrhœa they are subject to sympathetic -inflammation, as in _hernia humoralis_, which, if neglected or -maltreated, gives rise to abscess or chronic hardness. Inflammation -also occurs in them as in other structures. Accidents, such as blows or -bruises, horse-riding, wearing very tight pantaloons, are all fertile -sources of derangement. Scrofulous constitutions are predisposed to -have their testicles, like the rest of the glands, diseased. The most -frequent disturbance, however, of the testicles, is a dilatation of -the veins, constituting what is called varicocele; and generally -accompanied by a wasting away of the testicle itself. It is rare, -indeed, to find perfectly healthy testicles in an individual who -has been exposed to amatory pleasures and sensualities; and as, of -course, even amative desire, as well as amative power, depends upon -the absolute sound condition of the glands in question, the inference -is, that in very numerous persons, the sexual instinct is considerably -diminished, and not unfrequently wholly suppressed, before half the -natural term of their existence has expired, at which time they ought -in reality to be at the climax of their prime and capability. - -It is not so much a painful complaint, as an unpleasant one. There are -occasionally pains in the back and loins, and other feelings, creating -a sensation of lassitude and weariness; and now and then some local -uneasiness is felt. - -Varicocele gives to the examiner a sensation as though he were -grasping a bundle of soft cords. It sometimes exists to such a degree -as to resemble a rupture. In advanced stages of the disease, or -disorganization, the epididymis becomes detached from the body of the -testicle, and is plainly distinguishable by the finger. The result of -all is, that a considerable diminution of sexual power takes place; -and if means are not adopted to arrest a further break-up of the -structure, the venereal appetite will subside altogether. The annexed -drawing exhibits a tolerably faithful portrait of the disease; it -represents the varicocele to be on the left side—the side most usually -affected. - -[Illustration] - -The folds formed by the veins lapping over each other are clearly -distinguishable, and the dependent state of the scrotum on the affected -side exhibits very well the occasion of it. The treatment consists -in giving support by means of a suspensory bandage, which may be -worn during the day, and the use of local refrigerants night and -morning. The state of health is sometimes mixed up with it; and tonics -and generous diet are useful. The cold shower bath helps to brace -the system. It is a complaint in which, if it be not of very great -severity, nor very long continuance, much good may be done. In some -instances the veins may be allowed to empty themselves, which they will -do when the body is in a recumbent position, and a coated ivory ring, -or a silken band, may be so placed around them as shall prevent their -refilling. It is, however, a case fitter for the surgeon’s management. - -_Abscess in the Testicle._—The testicle is subject to inflammation -and suppuration like any other structure. A case about three years -ago fell under my notice, where a quantity of dark fœtid fluid was -released on puncturing a testicle in which the sense of fluctuation -was very evident; and the patient stated that it had been five or six -years in arriving at that condition. He was wasted considerably from -nocturnal perspirations and acute pain, and his sexual desire was much -diminished. The case did well, and the latter function was restored -without much loss. - -_Hydrocele._—Hydrocele is an accumulation of yellow serous fluid in -the _tunica vaginalis testis_ (refer to the engravings in next page), -or peritoneal covering of the testicle. It is a disease incident to -every period of life, but more commonly met with in grown persons. -The ordinary formation of hydrocele is unattended with pain; and the -patient accidentally discovers the existence of the swelling, but -oftentimes not until it has attained a considerable magnitude. The -tumor, when large, produces an unsightly appearance, and forms a -hindrance to sexual intercourse, from the integuments of the penis -being involved therein, and thereby preventing a perfect erection of -that organ. The disease may appear to originate spontaneously; but it -is usually traceable to some bruise, blow, or other external injury to -the part. - -The two following drawings exhibit the outward and inward appearance of -the scrotum in hydrocele:— - -[Illustration: The Scrotum largely distended.] - -[Illustration: The Scrotum distended to its utmost extent, and the - position of the fluid shown. The penis is almost always more or - less drawn up, and in severe cases it appears drawn up so as - scarcely to be perceptible.] - -The notion that the cure of hydrocele depends on promoting adhesion to -the sides of the tunica vaginalis with the testicle is somewhat upset -by several preparations in the London hospitals, exhibiting the _tunic_ -taken from persons in whom a radical cure was effected by injection, -and in whom no fluid was reproduced; nor were the sides of the said -investment at all adherent with the testicle, but apart, as in the -healthiest individual. Hitherto surgeons, acting on the aforesaid -notion, with a view to obliterate the cavity, adopted various plans of -treatment—such as, for instance, laying open the entire cavity, cutting -away a portion of the tunica vaginalis, the application of caustic, -and, lastly, the seton, as advised by Dr. Pott, which was suffered -to liberate itself by ulceration. When, in any of these instances, -suppuration was induced, the cavity became in time filled up by the -granulating process. The plan of the present day is by perforating -the sac with a trocar, suffering the effused fluid to escape, and -injecting some stimulating liquid which is allowed to remain until a -degree of inflammation is produced, that shall cause an obliteration -of the cavity by adhesion, or, as it has also been proved, prevent -a reproduction of the fluid, by closing the mouths or altering the -diseased action of the exhalent arteries. Whichever be the effect -produced thereby, the cure is almost certain, and the principles of the -treatment consequently judicious. But, notwithstanding, the operation -is not always immediately, nor _ultimately_ successful; the degree of -inflammation set up may be insufficient, and the effusion again take -place, and the operation may require a second and third repetition; -or an excessive degree of inflammation may ensue, that shall occasion -serious constitutional disturbance, either by suffering the injected -fluid to remain too long, or its being of too stimulative a character, -or from its escaping into the cellular membrane of the scrotum, an -accident not unfrequent, unless great care be used in the operation. - -_Radical Cure of Hydrocele._—The term radical is applied to the process -narrated in the last case; but, as has been observed, the operation is -occasionally required to be repeated several times. In the case I am -adverting to, after tapping, several injections were thrown in between -the tunics, and withdrawn; and on one occasion the morbid fluid was -secreted to the greatest possible distension of the scrotum by the -following morning. Its subsequent withdrawal, and the injection of a -more active stimulant, effected, however, a permanent cure. In the -country, surgeons frequently plunge a lancet in the scrotum, suffer the -effused liquid to escape, and desire the patient merely to wrap the -parts up in a handkerchief, to take no further heed, and to ride home: -and these cases generally do well. - -_Hydrocele Cured by Acupuncturation._—A new method of treating -hydrocele has of late years been introduced, namely, by the insertion -of a needle into the sac or bladder of the testicle, which, upon its -withdrawal, permits the fluid to escape into the cellular membrane, -whence it is rapidly absorbed. A pint of fluid may be got rid of in -that way in two or three hours; and, although the disease may not be -radically cured, it will occupy several months before a reaccumulation -of the fluid takes place. In recent cases, this treatment oftentimes -proves permanently successful. Many nervous persons will not submit -to anything approaching an operation, not even to the simple one -of acupuncturation. In such cases, there is no alternative but -counter-irritants, to be applied over the part, such as the tincture of -iodine, or the following ointment (Form 26). - -It is at all times best to attend early to any disease of the -testicles; the progress is so rapid, the mischief so great, and the -consequences so deplorable, of uncontrolled disease. - -_Eruptions incident to the Organs of Generation and the Rectum._—The -structures included in the above heading are subject to a variety of -eruptions, varying in character, intensity, and duration. Thus we have -the _papular_, a chronic inflammation characterized by papules, or very -minute pimples, of nearly the same color as the skin, accompanied by -intense itching, and terminating, when broken by scratching, in small -circular crusts: this is called, by dermoid pathologists, Prurigo. -Another order of eruption is designated the _vesicular_ and _pustular_, -and consists of groups of small pimples of a very bright red color, -and containing a serous fluid. They are accompanied by itching, -which increases as the contained humor becomes turbid, and assumes -the puriform aspect; they then incrustate, and at the end of about a -fortnight drop off, leaving the skin healthy underneath. The name given -to this variety is Herpes. - -The last and most inveterate species is characterized by an itching of -the skin, which, on inspection, appears of a diffused redness, and -gives off, after a while, a number of thin scales: these reaccumulate, -and the entire organs of generation becomes sometimes covered with -similar patches: this is denominated Psoriasis. These affections, which -are but various degrees of inflammation, modified by idiosyncrasy and -habit, arise from local and constitutional causes. Among these are -frequent excitation of the organs of generation, the contact of the -fluids secreted during sexual intercourse, an unhealthy and relaxed -condition of the genitals, and, lastly, a disordered state of the -digestive organs. It is astonishing to what an extent these disorders -prevail, and more so to find how long the individuals, probably from a -sense of diffidence in seeking professional assistance, endure them. I -have encountered many patients who have informed me that they have had -the complaint upon them from five to ten years, purposing during the -whole of that period to consult some medical friend, but postponing it -until their interview with myself; and it is the more to be regretted, -as the cure may always be effected in a week or two, with moderate -attention and perseverance; but if the attempt be neglected, there -is no limiting the extent to which the disease may proceed. Local -diseases, especially of such a nature as those under consideration can -not exist any great length of time without involving the digestive -organs, which become sympathetically deranged; and in like manner do -local diseases participate with dyspeptic disturbances—each, therefore, -goes on aggravating the other. - -_Diseases of the Bladder._—The anatomical description of the bladder -will be found in the earlier pages of this work. It may simply be -restated: - -The bladder is a viscus somewhat similar in structure to the stomach. -It is composed of several coats—muscular, nervous, and mucous. Each are -liable to diseases peculiar to their several structures. The size of -the bladder differs in most persons, and in the sexes. - -The female bladder is generally the largest; but the largeness is -observable more especially in females who have borne children. The -proverbial ability of females to retain their urine longer than men is -thus accounted for. - -Much mischief is often done by both sexes disobeying the particular -“call of nature” to urinate; and the younger branches should have that -fact impressed upon them. I have known children acquire a severe and -obstinate form of irritability of the bladder by retaining their urine -too long. Diseases of the bladder are generally the consequences of -other complaints, and those complaints have already been enumerated. -They may be thus summed up: - -Gonorrhœa extending to the bladder, and producing absolutely a clap -of the bladder. If the inflammation is not subdued, or does not -subside, probably some permanent mischief ensues; at all events, the -inflammation extends, and involves other coats than the interior. -Accordingly, we have inflammation of the muscular coat, the nervous -coat, and, lastly, the peritoneal coat. These terminations, severally, -have certain symptoms, and certain names. - -There are others, and among them may be named colds, local injuries, -hæmorrhoids, excess in drinking particular fluids, sensual indulgences, -diseased condition of the kidneys, or long retention or vitiated states -of the urine, nervousness, and, lastly, the formation of stone in the -bladder. The most common form of bladder ailment is irritability, -which is a milder term for inflammation. Then we have absolutely -inflammation, and, lastly, loss of power, or paralysis. - -_Irritability of the Bladder._[3]—The chief indication of disease -affecting the bladder is a frequent desire which the patient -experiences to pass his water; but that symptom alone does not -determine the nature of the complaint. It may be irritable from -sympathy with surrounding irritation, and disappear on the subsidence -of that irritation. It may constantly be fretting the patient by its -contractions, through the urine (owing to some general derangement -in the system, being altered in its chemical qualities) exciting the -bladder the moment it is secreted therein; or it may be the result of -nervous agitation, with or without any actual diseased state of the -bladder. These causes should be understood to regulate the treatment, -which of course must be qualified by the provocation, and which the -patient, when in doubt, had better leave to the discrimination of his -physician. - -_Paralysis of the Bladder._—The bladder may become, through loss -of nervous stimulus, insensible to irritation, and consequently be -disobedient to its natural functions. The urine, in these cases, -accumulates in large quantities, distends the bladder to its utmost, -which it does without pain; and the excess of secretion then dribbles -away involuntarily. This state of the bladder is called paralysis, and -is an aggravated form of disease, arising from the same causes that -establish inflammation, or from some contiguous nervous injury. The -treatment of paralysis of the bladder must be intrusted to experienced -hands; it consists chiefly of purgatives, stimulative enemata up the -rectum, the introduction of the catheter, the cold bath, rest, and -general medicinal nervous excitants. - -_Inflammation of the Bladder._—Cases of acute inflammation of the -bladder are of rare occurrence; but they do occur, occasionally prove -fatal, and always are productive of much general disturbance, which -yields not without vigorous and active treatment. Gonorrhœa is most -usually the exciting cause. On the sudden suppression of the urethral -discharge, an inflammation sympathetically seizes the testicle, the -glands in the groin, or the bladder; and when the latter is the seat of -the transference, it may be held as the ratio of the severity of the -disease. In inflammation of the bladder, there is a constant desire -to pass water, which, when made, is usually in very small quantities, -and leaves a sediment. The patient often experiences an insupportable -inclination to urinate, with a sensation as though the bladder were -ready to burst—whereas there may be little or no urine in it. There is -much pain at the root of the penis, and it extends along the perinœum -to the rectum, which latter is assailed with almost constant spasms -resembling straining. There is considerable thirst, fever, and anxiety; -the pulse is full and quick, the tongue furred, and all those symptoms -are present that prevail during severe constitutional excitement. -The treatment consists of bleeding, leeching, or cupping; relieving -the bowels by castor oil and injections; giving mucilaginous drinks, -administering opiates, preserving rest, and total abstinence from -stimulating diet. If these means fail in subduing the inflammation it -runs on to ulceration, permitting extravasation of urine occasioning -mortification and death; but where they are effectual, the patient is -soon left free from complaint. It often happens that the inflammation -is not so vigorously treated, or it may be wholly neglected, and yet -it may happily resolve itself without proceeding to the extremity -narrated; but, unfortunately, it may degenerate into a minor but not -less troublesome form, denominated chronic, and which, in fact, is the -disease christened “irritability,” and the one, for obvious reasons, -as above stated, for which relief is most usually sought, the patient -having in vain daily looked for the subsidence of his malady. Having -stated that irritability of the bladder must be treated with reference -to its cause, it is obvious that more than non-medical discrimination -is required. Where it depends upon stricture, the stricture must -be first cured; where upon stone in the bladder, the stone must be -removed; where upon sympathetic inflammation, the source must be -attacked, and so on. - -However, it has been stated that other causes may exist—that it may -even be a primary disease in itself; and as this treatise professes to -be a private mentor to the invalid, I will detail such measures as may -be safely adopted for the cure of a complaint as often borne from being -trusted to unskilful hands, as from a morbid delicacy in seeking proper -and legitimate relief. The ordinary symptoms are, first, an inordinate -desire to make water; it flows in small quantities, with pain before, -during, and after. The urine has an offensive ammoniacal odor; it -deposites a thick, adhesive mucus, of a gray or brown color, sometimes -streaked with blood, and of an alkaline character. - -In this stage of affairs, rest is indispensable; sedatives and opiates -may be given; but alkalies (rarely omitted in prescriptions for -incontinence of urine) should not be indiscriminately given, for they -only render the urine more alkaline, which occasions it to deposite -calcareous flakes, that, if not passed off, accumulate, unite, and -lay the foundation of that frightful disease, stone in the bladder. -The extract of _conium_, or _henbane_, combined with mucilage, may be -given in doses of three to five grains every six hours. The _tincture -of henbane_, in doses of a _fluid-drachm_, or the _tincture of opium_, -not exceeding _ten or fifteen_ _drops_ at a time, may be given in -like manner, and continued for several days, keeping the bowels open -with castor oil. The daily or alternate daily use of the hot, general, -or hip bath, will afford immense relief. The various preparations of -_morphine_, _aconitine_, and of _hops_, possess great power in small -and frequent doses. The _uva ursi_ is a remedy of ancient note, and is -often prescribed with advantage; the dose is one scruple to a drachm -in milk, or any bland fluid, three times a day, or it may be taken in -infusion or decoction, one ounce to a pint of water—that quantity to -be drank during the day. The _pareira brava_, exhibited in a decoction -(by simmering three pints of water, containing half an ounce of the -root, down to a pint), may be taken in divided doses of eight or twelve -ounces during the day, or in the form of extract, in quantity of a -scruple, which equals the above amount of decoction. - -The _achillæ millefoliæ_ is an excellent plant, and possesses -astonishing astringent powers, often restoring the tone of the bladder -to a healthy condition, when all other remedies have failed. A handful -of the leaves are to be infused in a pint of boiling water, which, when -cool, may be poured off, and given in doses of a cupful three times a -day. Any of the preceding sedatives may be given in conjunction with -these preparations. - -Lime-water taken with milk, as an ordinary drink, is a useful -corrective. - -The _buchu_ (the _diosma crenata_)—an ounce infused for several hours -in a pint of boiling water, and a wineglassful of the cooled liquid -administered three or four times a day—has justly obtained some -notoriety. - -Where all these means prove ineffectual, the injection of sedative and -astringent applications often answers the most sanguine expectations; -but they should be employed only by professional persons, and even -then with great care; as when the disease has been at its height, -and they have been used, much inconvenience, and even mischief, has -been occasioned. A mild infusion of poppies, or weak gruel, may be -thrown in, once or twice a day, in quantities not exceeding two or -three ounces at a time, and withdrawn after being suffered to remain -thirty or forty seconds. A catheter, with elastic bag, should be the -instrument used. - -In the more chronic forms, where the urine does not deposite much -mucus, or is tinged with blood, the addition of ten drops (_very -gradually_ increasing the quantity) of the diluted nitric acid may be -made to the fluid injected, repeating or declining the operation, as -the effects are discovered to be advantageous or prejudicial. - -In an irritable state of the bladder depending on some disease of the -kidney, there is a frequent desire to void the urine without there -being any, or but very little, urine in the bladder. There is also a -severe cutting pain felt about the neck of the bladder, especially -after each effort to make water, followed or attended by a “languid” -pain in the loins. The urine is often the color of whey, at other times -tinged with blood, and deposites, when suffered to remain a while, a -purulent sediment. The severe symptoms should be allayed by the same -remedies as prescribed in irritable bladder arising from other causes; -but the original seat of the disease in this instance demands energetic -attention. The various counter-irritants are in great requisition; -leeches, blisters, setons, &c. - -In addition to the tonics and astringents already advised, an infusion -of the _wild-carrot seed_, made by macerating for a couple of hours -one ounce of the seeds bruised in a pint of boiling water (drinking, -when cool and strained, the whole of the liquid in divided doses during -the day), may be taken with every chance of relief. As in the other -infusions, the patient must persevere in the use of this for some time. - - - - - ORIGIN OF THE VENEREAL DISEASE. - - -THE reader will allow that it can not be for want of materials to -produce a book, that this subject is introduced, as the multifarious -nature of this work’s contents will readily testify; but it is -briefly to explain certain probabilities and conjectures which the -afflicted curious are generally desirous of being satisfied upon. Who -ever suffered under syphilis but was solicitous to know how such a -plague came into the world? Many moralists believe and insist that -it is a specific punishment, sent for our physical transgressions. -Philosophically speaking, such it is; because the infringement of any -natural law always incurs a penalty. However, if it be a manifestation -of divine displeasure, it certainly is most unequally apportioned; -for it generally happens to the least licentious, instead of the most -depraved—the timid, scrupulous, and nervous man, contracting it on the -first loose intercourse, whereas the man of the town revels almost -with impunity; and, lastly, he who exercises the greatest caution -and cleanliness escapes it altogether, although he may be the most -deserving of the infliction. In a state of timorous excitement, we -are more apt to catch the latent mischief. The careless, thoughtless -libertine, hardened against infection by indifference, free living, -and probably strong health, often escapes scot-free; and the cool and -calculating pleasure-hunter, who exercises those useful antagonists -to disease, namely, ablution and selection, comes off triumphant with -still greater certainty. - -The point at issue is, when the disease first arose, and where. -Medical historians give credit to America, Spain, and France, for its -propagation; and controversies have been carried on by various parties, -each disclaiming the honor. Now, as I do not propose to analyze the -authorities, but simply to venture my own opinion, with the reasons -for the same, I have no alternative but to refer the reader, if he -be dissatisfied with my attempted exposition, to more comprehensive -and elaborate conjectures than my own. Starting upon the proposition -that nature’s laws are unalterable, and believing that fever is, and -has been fever since the creation of the world; that a cut finger has -healed by the first intention, or has _festered_, and ever may do -so—each condition being modified by the state of health of the party, -and the nature of the wound; that a broken limb was attended with the -same consequences in the year 1 as it will be in the year 1900; and -that dirtiness generated itch, and does so still: I can not reconcile -myself to any other belief, but that any violation of the laws -whereupon sexual intercourse has been permitted, has been, is, and will -be, attended with corresponding results; and as such violations most -likely exist where numbers cohered together, I consider both gonorrhœa -and syphilis to have been coeval with the origin of mankind. They both -doubtlessly are much modified by climate, habits, and constitution; and -therefrom ensue the many modifications we see in Europe, and the other -large portions of the globe. The proofs that can be adduced in favor of -this hypothesis are interminable. - -It is said that, until the arrival of some British sailors at -Otaheite, the disease was unknown in that territory. Possibly, in -its present modification; but previously to this new intercourse, it -is most probable that the sexual cohabitation was not so promiscuous -or frequent, and that that very infringement entailed a new form of -irritation. In married persons, of even temperate passions, and of most -careful habits, local sexual disorders are of frequent occurrence, -the slightest derangement of female health giving rise to vaginal -disturbance, that unsuspectingly is increased by the marital embrace, -and communicated to the husband; and only from its presence does it -occur, that the coitus may have been the cause of it. By attending to -the simple suggestion of nature, namely, abstinence, cleanliness, and -rest, a cure is effected; but where neglected, or should either party -be unfaithful to the marriage vow, the disease becomes magnified, and -extended to, mayhap, innocent parties. - -The next question is, are gonorrhœa and syphilis identical? Certainly -not, any more than the very many modifications of generative sores. -It is absolutely, now-a-days, a difficult question to solve, whether -this or that be syphilis; so numerous and yet so closely in resemblance -are the ulcers that ensue after sexual cohabitation. The eye is not -to be trusted, because so different is real from spurious syphilis -that the French surgeons decide the point by inoculating a healthy -portion of the body with the matter or discharge from what they suppose -to be a syphilitic ulcer. If a corresponding ulcer be produced, the -disease is decided to be syphilis. If, on the other hand, no result -follow, the patient is proclaimed free from that malady, and stated -to be laboring under merely common local irritation. What is still -more curious is this: a patient will have ulcers, which every medical -man will pronounce, on beholding, to be chancres; yet, upon this -trial, the inoculation will not evince them to be so. A while after, -supposing the chancres to be healed, secondary or other symptoms will -show themselves—sore throat, spotted skin, glandular enlargements, or -painful joints, follow. The same consequences oftentimes ensue after -gonorrhœa. The primary diseases can not be identical, because the -symptoms are vastly different, and the parts attacked are also unlike; -and yet there is this anomaly, that the after-consequences frequently -closely resemble each other. - -Another surprising result from loose intercourse is, that one female -will convey to this individual gonorrhœa, to another syphilis; a -third will escape scatheless, and a fourth will have a modifiable -affection of both diseases. A satisfactory exposition of the why and -wherefore such things should be, or are, is I fancy beyond the skill of -pathologists. It is enough to know that they happen; and it is better -to use those means which past and daily experience furnishes to get -rid of them, than to ponder and wonder in the vain endeavor to explore -their origin. - -In giving an opinion that we have always been liable to fever, to -cut fingers, and to syphilis, I am ready to admit that these several -conditions depend upon the varied states of health of the parties. -The fevers (ensuing upon the ill-ventilated places) of olden times, -compared with those of the present day, differ in intensity and -frequency, because the causes are neither so numerous nor severe. The -cut finger of a drunkard, and one of otherwise feeble health, is more -likely to fester, and even mortify, than should the accident befall -a temperate and healthy individual; and the syphilis (or diseases -simulating it) at the present time is less severe than formerly, owing -to greater attention being paid to personal cleanliness, and the -simplicity and earliness of the treatment. - -A question worthy of inquiry is, why gonorrhœa and syphilis should be -infectious? _Contagion_ is a word that many medical men would expel -from worldly usage, not believing in its existence; that is to say, -the extension of a fever or epidemic, for instance, is not traceable -to the disease seizing the individual, but to the peculiar aptitude -of the party to become the recipient of it. Consumption is of the -most extensive prevalence; but it only occurs in the delicate—those -peculiarly formed, or rendered apt for it, from the circumstance of -their lungs being hereditarily feebly constructed, or disordered -through inflammation following a cold, and which effects are traceable -to an infraction of some of nature’s laws. Sickly children owe their -condition to their sickly parents, or to their physical mal-education, -or some other positive violation of nature’s regulations; and in like -manner, where the fire rages or the wind blows, the feeblest and least -protected become the earliest victims. Both gonorrhœa and syphilis -furnish a remarkably irritating purulent fluid, which, applied to -delicate surfaces, produces certain effects. Experiments have not -been made to multiply these effects, beyond those incurred by sexual -freedom; and the one of inoculation by the French surgeons, as quoted; -but accident has proved that the eye, for instance, puts on, after -contact with the discharge of gonorrhœa, the same kind of inflammation -as follows its contact in coition with the antagonist generative organs. - -The rectum has also been the seat of venereal affection; and instances -have been known of the mouth being also the recipient of disease -communicated by a deposition of the poison. If there be such a thing as -contagion, it certainly exists in the venereal disease; for, although -I admit it (the disease) may occur spontaneously, or be generated by -half a dozen of each of the sexes herding and cohabiting together, -and neglecting the duties of cleanliness, or committing excesses, -those very circumstances imply that the disease can be extended, -notwithstanding a majority of the careful and hardy may escape, after a -risk of the same. The fact of its contagious properties is not upset, -because escape is owing to the non-susceptibility of the parties, and -the caution they exercise to prevent a lodgment of, or contact with, -the poisonous matter. - -John Hunter observes, that it is only the developed disease that is -communicable, and for the propagation of venereal affections the -_poisonous secretion_ must be deposited. So confident was he of this, -that he even permitted married men having gonorrhœa to cohabit with -their wives, to save appearances; care being taken first to clear -all the parts of any matter, by syringing the urethra, then making -water, and, _lastly_, washing the glans. Such, however, is my belief -of the rapidity of the formation of the secretion, that, aided by -the excitement of the generative act, the deposite of the same would -necessarily take place with the seminal emission, especially in persons -of full temperament, and in the plenitude of the sexual appetite, and -thereby be liable to communicate the disease. - -It is becoming a prevalent fashion to give new names to the several -forms of venereal disease, such as substituting “urethritis,” -“blenorrhagia,” &c., for gonorrhœa; and even to syphilis are added -“tertiary symptoms;” the names quoted being selected to express more -symptoms than the old ones conveyed. I consider that this circumstance -tends to support my opinion—that gonorrhœa and syphilis are not -identical, and that each disease (the former being distinguished by -urethral discharges, and the latter by ulcers and other cutaneous -disfigurements) has innumerable varieties. I hold them both to be -but modifications of inflammation from a poisonous source, and its -consequences common to the structures in which they respectively become -seated, and differing in degree according to the severity of the -attack. Another proof in support of the last assertion is, I think, the -time of the appearance of the particular disease. There is certainly a -more usual time for a clap to manifest itself, such as from the seventh -to the ninth day; but it very often occurs within twenty-four hours -after connexion, and syphilis sometimes as early; and instances occur -where weeks elapse before either of the forms shows itself. - -Briefly to recapitulate, I consider, then—1. That the generative organs -have ever been liable to disease from misuse; that the disease is -variable and modifiable by many circumstances, such as have been before -stated—namely, climate, age, constitution, and cause. 2. That it is -contagious; mild cases usually producing mild consequences, but those -depending much upon the treatment and health. 3. Newly-indisposed and -severer cases, establishing a worse form of disease, alike modifiable -by circumstances. I am not prepared to insist that the syphilis of the -present time assumes the aspect as it did with the ancients, any more -than I would affirm that it will be the same centuries hence: but I -contend that all abuses of sexual pleasures will be surely followed by -sexual disturbances, and that the most likely form of ailment is marked -either by discharges or ulceration; that these diseases are simple or -complicated, and all are separate in themselves. There is no fixed -order in which what are called secondary symptoms occur. It may more -usually happen that a sore throat will follow the healing of a bubo, -as swelled testicle is more commonly subsequent to the occurrence of a -gonorrhœal discharge; but in very many cases neither occur, or not in -the succession stated. The anomalies in the disease I shall consider in -describing the symptoms and treatment, when the reader will judge how -far the view herein entertained, as to the origin and character of the -disease, facilitates and simplifies its management and control. - -In conclusion of this part of our subject, I may state, that I believe -the form and severity of any syphilitic disease depend more upon the -state of health and other aptitudes of the party receiving, than of the -one communicating the disease. - -_Of the Character of the Syphilitic Poison._—“The venereal poison is -only known by the _action_ which follows its application.” It has -been observed, that it is only communicable by deposition; and that -certain parts are essentially prone to its reception: these are the -generative apparatus of both sexes. The poison is conveyed in the form -of a purulent fluid; that of gonorrhœa from inflamed vessels with -corresponding morbid action; that of syphilis, also from a purulent -fluid emanating from the surface of an ulcer. The disease prevails -only in the human race; it is impossible to transfer it to animals of -a lower kind. John Hunter soaked lint in matter from a gonorrhœa and -chancre, and introduced it into the vaginæ of bitches and asses without -producing any effect. The same experiment was tried by interposing -the purulent matter within the prepuce of dogs and male asses, and -also by inoculation, but with no other effect than that of producing a -common sore. The venereal poison attacks the human body in two ways, -locally and constitutionally; the latter by absorption of the poison -secreted by the patient himself. We can only suppose the local form of -the disease to arise from absorption, and so altering the local action -of parts as to produce specific results. The constitutional form is -generally an after-occurrence, although instances are known where it -has not been preceded by any apparent previous form; albeit, no doubt -such _has_ existed without exciting observation. Gonorrhœa shows -itself without abrasion of surface; but syphilis is marked by another -action—an ulceration of the solids whereon it is found. - -In Hunter’s Work on the Venereal Disease, there is an interesting -chapter respecting the source of the gonorrhœal secretion, in which -it appears that it is produced from the vessels investing the -mucous membrane of the urethra, by their becoming altered in their -action; and that ulceration is seldom found within the urethra, and -when so discovered, it is not from the gonorrhœal poison; and that -where ulceration occurs, it must be ascribable to an accession of -inflammation of a distinct character. Both gonorrhœa and syphilis -are conditions assumed by the human frame in self-defence, and are -processes set up to cure the previous one; and unless the constitution -be much impaired, the disease gets well. Such impediments, however, -exist in the form of moral and social arrangements, occupation -and variable health, that the end, without assistance, is seldom -accomplished. Gonorrhœa may cease of its own accord; but, according -to the belief of Hunter, syphilis never; and certainly every day’s -experience proves the fact. We see gonorrhœa cured by the most ignorant -persons and by the most empirical measures; but syphilis often defies -the most skilful treatment. The first attack of venereal affections, -especially gonorrhœa, is the most severe; from which it is presumed -that a habit of reconciliation takes place between the disease and the -generative organs; so that after a recurrence or two of the complaint, -the same party may almost bid defiance to a new infection. Yet, if a -man lose the habit obtained by frequent intercourse, through abstinence -from venereal pleasures, he will be very likely to contract the -disease even on the first re-essay, with the very same parties, who -may preserve precisely the same condition of health that formerly was -innocuous to him. Cases innumerable can be adduced in support of this -statement. In the first part of this book, statements have been made, -proving that the difference in the symptoms of gonorrhœa are almost -endless. The same may be anticipated with regard to syphilis. - - - - - OF SYPHILIS. - - -SYPHILIS is another and a more violent form of the venereal disease -than gonorrhœa. All its effects and symptoms are divided into two -conditions, _primary_ and _secondary_; the former being those which -arise either from the direct application of the virus or poison to the -part where the ulceration first shows itself, or from the irritative -and specific effects of the poison on the absorbent vessels and glands, -as it is passing through them on its way to the circulation. - -Hence, among the first—the primary—may be classed the _ulcer_, or -_chancre_, which in almost every instance is situated on the parts of -generation, and may or may not be followed by a swelling in the glands -of the groin, constituting that form of the complaint called _bubo_. - -The secondary symptoms may be defined to be all those effects of the -disease which take place subsequently to, and in consequence of, the -absorption of the poison into the system: comprising sore throat, -cutaneous affections—both eruptions and ulcers, pains in the bones and -joints, and swellings thereon, called _nodes_. - -I will first consider the symptoms of primary syphilis—_chancre_ and -_bubo_. - -The coverings and linings of the body differ according to their -situation. The former, the integuments become hardened by exposure -and exercise, and preserve their velvety softness where protected by -clothing, and where they are subject to less use—instance the hands, -feet, face, and abdomen. Certain functions are assigned to each. The -covering of the feet takes on a horny hardness, and in like manner -the hands of a laborer assume a glove-like protection. The abdomen, -by being constantly clothed, preserves its soft texture. The lining -membranes of the body have also separate offices to perform—the -_serous_ and _mucous_, as they are called. The _serous_ is a name given -to those lining the cavities; the _mucous_, to those having outlets. -From the glans penis being generally covered by the prepuce, the parts -in contact are called mucous. It differs, however, in sensitiveness, -from the urethra. The entire covering also of the penis is of a very -delicate and tender structure; and hence also, from sexual intercourse, -these parts become the chief seat of syphilis. Gonorrhœa confines its -attacks to mucous membranes, or, in other words, secreting surfaces. In -fact, the matter deposited on the common and exposed skin is harmless; -so also, but to a less degree, is that of syphilis. Gonorrhœa is -frequently seated _on_ and _around_ the glans, and the inner surface -of the prepuce; but more frequently, by a hundred fold, _within_ the -urethra. The delicate surface, then, of the glans and prepuce, losing -some of its sensitiveness by frequent exposure, and losing also the -defence of the secretion which mucous membranes pour out, becomes -accessible to an occurrence of syphilis—a disease that is readily -communicable, by inoculation, to almost any part of the body. To quote -Hunter, he says: “It is an invariable effect, that when any part of an -animal is irritated to a certain degree, it inflames and forms matter, -the intention of which is to remove the irritating cause. This has -been before stated; but it is common only to secreting surfaces; and -when the same cause is applied to non-secreting surfaces, ulceration -is set up. This is not only the case in common irritation, but also in -specific cases, as in syphilis, burns,” &c. - -It is somewhat difficult to explain how a chancrous sore is produced. -Surmises are at our service, and those which are founded upon certain -facts are the more likely to be true. For instance, a person receiving -syphilis must contract it from another individual having it. The mere -solitary act of coition will not spontaneously produce it, provided the -party be clean, for that surely is not an excess; but having connexion -with an infected one, and thereby exposing a healthy surface to a -diseased one, becomes an infraction of one of nature’s laws. Well, the -patient contaminating the other must have a chancre, which giving off, -by contact, its morbid secretion, produces a specific result, namely, a -small pimple. - -In men, the disease is generally contracted upon the frænum, glans -penis, or prepuce, or upon the common skin of the body of the penis, -but most frequently upon the interior. From the peculiar and alterable -structure of the penis and its prepuce, the poison, unless well washed -off, is apt to lodge in the folds thereof, and sooner or later it -manifests its influence, which may occur in twenty-four hours, or may -be withheld for months. Generally, however, seven or eight or nine -days puts the patient out of suspense. The first symptoms consist in -an itching, succeeded by a redness of the part, out of which is soon -observed to spring up a small elevation or pimple. In connexions where -haste, disproportion of size, or much excitement or excess prevails, an -absolute abrasion of the skin often takes place, and the parts where -such occur are generally the everted portion of the prepuce, or the -frænum of the same. - -[Illustration] - -[Illustration] - -The accompanying drawings represent the extent of the redness and -the first appearance of the pimple. The upper diagram alludes to the -irritation and excoriation around the frænum, and the lower, the -first evidence of a chancre. I am describing the most common form of -chancre, such as is known in the profession as Mr. Hunter’s chancre. A -perceptible hardness next ensues round the pimple, which becomes more -elevated when it ulcerates, or, in other words, the head gets broken -off and a little hollow is left. The tumor (for such it may be called) -is generally of a limited circumference, seldom exceeding the size of -a silver penny, unless in an advanced stage of the disease. When a -chancre attacks the frænum, and undermines it, as it were, the frænum -is often destroyed; and of course, with its destruction, departs its -property of controlling or of directing the orifice of the urethra in -urinating, or in the emission of the semen. - -[Illustration] - -This drawing exhibits three ulcers: one on the prepuce, another under -the frænum, having eaten its way through, as marked by the black -cross-line, and the third situated on the glans. - -When the pimple appears on the outside of the prepuce for instance, it -assumes generally a larger form, and, as the head is broken off, crust -after crust rises up, until the process of ulceration has very far -advanced, or the applications that are generally employed prevent its -re-formation. In the former instance, the crusts are attributable to -evaporation of the discharge; in the latter, their absence is already -explained by the prevention of the same. There is such a thing as -sympathy in eruptive disorders. In skin affections of the corners of -the mouths of children, we often see the inflammation cross from corner -to corner. The same is observable where the attacks comprise the angle -of an eye. So is it with the penis, a structure equally as delicate; -and accordingly the edges of the prepuce often put on a jagged -appearance resembling chaps on hands. - -[Illustration] - -Witness the above wood-cut. It portrays an ulcer somewhat -diffused on the prepuce, and the ragged edge of the same structure. -The sketch just introduced was taken from a patient perhaps only a -fortnight old with the disease. Being a rackety, dissipated young man, -and regardless of the treatment suggested, a week’s neglect produced -the following alteration:— - -[Illustration] - -A new ulcer sprung up, the old one increased in size, and the entire -edge of the prepuce became involved in the irritation. - -Phymosis and paraphymosis occur in syphilis as they do in gonorrhœa. -The treatment is the same in both. Warm, soothing applications are -indispensable; and occasionally, to prevent adherence between the -glans and prepuce, the scalpel must be had recourse to. I have already -expressed my conviction that the progress of the disease rests as -_much_ or _more_ upon the condition of the party receiving it, than the -specific property of the complaint. - -“If the inflammation spreads fast and considerably, it shows a -constitution more disposed to inflammation than natural; if the -pain is great, it shows a strong disposition to irritation. It also -sometimes happens that they begin very early to form sloughs; when this -is the case, they have a strong tendency to mortification. Bleeding -is also a consequence owing to exposure of the ulcered _corpus -cavernosum_.”—_Hunter._ - -The reader will recollect that it has been stated that chancres, like -the many symptoms of gonorrhœa, differ in their characteristics. -Quoting from authorities, and, as will be further illustrated, -the following may be taken as the summary of the most prominent -appearances:— - -The ordinary chancre is characterized by a hollow centre, a hard and -ragged edge, a yellow surface, with a deposite of tenacious matter, -and a red and inflammatory margin. There is also a hardness felt at -its base on taking the part up between the fingers. This has already -been shown; but as illustrations multiply, the possessor of this -publication, especially if he be an invalid, will recognise the -annexed. It exhibits the ordinary chancre on the inner part of the -prepuce, the glans, and the orifice of the urethra—no unfrequent seat -of chancre. - -[Illustration] - -Many ulcers assume a very indolent form, and remain quiescent for a -long period. One patient I knew, who consulted me for rheumatism, and -who disavowed ever having had syphilis. He took vapor baths, which -assuaged the pain, but did not remove it. Accident discovered to me -the existence of a sore on the penis, by observing the dressings -of the same, carefully placed on the corner of the mantel-piece in -the bath-room. The following was the appearance of the sores. He -had endured them for nearly three months, nor had he perceived much -alteration, either for better or worse. The disease was properly -healed, and he soon got well. - -[Illustration] - -Another kind is one denominated the superficial, with raised edges. -It is more frequently seated at the upper part of the prepuce, and -creating a thickening of it, ending in phymosis, which lasts a long -time after the cure of the ulcers. This kind of chancre is sometimes -very obstinate, and continues many weeks. The following illustration -portrays its presence near the edge of the _corona glandis_. - -[Illustration] - -There are two other kinds of sores called the _phagedenic_ and -_sloughing_ ulcers and chancres. - -The phagedenic is a corroding ulcer without granulations. It is -also destitute of any surrounding induration, but frequently -its circumference is of a livid red color. When the disease is -injudiciously treated, the whole of the penis will be destroyed in -a very short time. The absence of coloring detracts from a faithful -representation of the kind of sore just alluded to. The drawing is -sketched from Mr. Skey’s work on Syphilis. - -[Illustration: - _a_—The ulcer.] - -Another and more confirmed specimen from the same authority is -presented. It represents the _sloughing_ ulcer. - -[Illustration: - _a_—The ulcer on the prepuce. - - _b_—The ulcer on the penis.] - -I have witnessed the sloughing, or, in other words, the loss of the -entire top of the glans and prepuce, within half a dozen days. The -subjoined drawing (overleaf) represents a tumefied state of the penis, -ulceration on the glans surrounding the orifice of the urethra, -phymosis of the prepuce, and ulcers in different stages on the outside -thereof. The sketch was taken from Wallace’s work. Such are often -met with. Chancres, as before stated, often become irritable, spread -rapidly, and slough, more particularly in persons of intemperate and -dissipated habits, or when the case has been improperly treated; -and openings into the urethra are formed to a considerable extent, -sometimes to the destruction of the glans, or a portion of the penis. - -[Illustration] - -The illustrative companion to this paragraph exhibits an ulcer that -has wormed its way through the prepuce, as marked by the black line. - -[Illustration] - -Warts are often met with, as in gonorrhœa, and, like those, will arise -from simple local irritation, from the accumulation of the natural -secretions, or want of cleanliness. They are hard and soft, and require -different treatment accordingly. They are not contagious; that is, -they do not communicate a venereal affection, but they very readily -produce a similar disease in parts they come in contact with. The story -is here well told by the engraver’s aid. - -[Illustration] - -It often happens that the ulceration appears checked. A tumor (see next -page) will form, and the surface will look very red and angry—will -even yield a moisture, and finally disappear. I say finally, because -it frequently proves very obstinate, and trespasses upon the patience -and forbearance almost to induce despair. It usually is very irritable, -the itching being most troublesome. The illustration was taken from a -patient who had been an invalid several months. - -[Illustration: - _a_—The tumor.] - -After a certain time, varying in proportion to the virulence of the -disease, the poison is conveyed by the numerous absorbents (which run -from the penis) to the glands in the groin, one or more of which become -inflamed and enlarged, producing that well-known swelling, already -alluded to, called _bubo_. Ulcers, too, are sometimes situated within -the urethra, as is seen in the annexed cut. - -[Illustration] - - - - - OF BUBOES. - - -SURGEONS apply the word bubo to inflamed glands from syphilis, wherever -they happen to be. The body abounds with absorbents, which are small -delicate vessels that form a net-work over the entire surface, and -exist also in every structure. Their purpose is to convey the nutriment -to the circulation. They form _stations_, as it were, or points of -assemblage; and these are generally situated in the angles of the -body—the groin, the armpits, hams, neck, &c.—parts most protected from -injury. When skin inflammation is present, to familiarize the meaning, -the nearest glands sympathize and swell; as, for, instance, who has -escaped a swelling, at one time or other of his life, in the neck, -throat, or armpits? When a sore prevails on the penis, or a gonorrhœa -exists, there most frequently ensues an enlargement of the glands of -the groin. The result of that enlargement depends upon the nature -of the inflammation. In gonorrhœa it is merely temporary, not being -sufficient to provoke suppuration, or the formation and discharge of -matter, or very rarely so; but in the case of venereal ulcers, where -the inflammation is so conveyed, the escape from such consequences is -as seldom. - -The mode which nature adopts to transfer the poison is as inexplicable -in its operation as the production of a swelled testicle. Buboes -(herein meant), then, are—or I should say a bubo is—a specific -inflammation of the glands of the groin. It usually occurs on the -same side of the body as the ulcer is situated; but when the ulcer is -seated on or under the frænum, there seems to be no fixed rule which -side shall have the honor. Another peculiarity is, that they more -readily spring up from ulcers on the prepuce than on the glans, and -are more attributable to ulcers than merely inflamed surfaces. They do -occur sometimes without either being apparent. To facilitate the clear -understanding of what we are talking about, a drawing is presented of -the inguinal glands, and the absorbents leading to and from it, which -conveys but an imperfect idea of the number of the absorbents; but it -serves to show the nature of them, and their mode of communication. - -[Illustration] - -Glands become inflamed from other causes than syphilis; a scratch, -a bruise, or any local irritation, will occasion an enlargement of -the nearest set of glands, or at least one of them. Scrofula is a -specific cause. As the venereal poison carries with it its morbid -nature wherever it happens to be conveyed, the glands become infected -with it; and hence it is the more readily transferred to the system at -large. Very frequently and fortunately the disease terminates _in_ the -glands; that is to say, does not extend to the circulation at large. -The time that intervenes after absorption has taken place, before -bubo manifests itself, is as uncertain as that of chancre appearing -after connexion; but generally the party is safe a fortnight after -the entire disappearance of the chancre. Where it is otherwise, some -trace of irritation on the glans or prepuce is discoverable upon close -investigation, or it will follow great fatigue, venereal excesses, &c. -If the disease extend to the constitution, it rarely affects other -glands than those primarily attacked; and hence it is rare that more -than one gland becomes inflamed. Having given the received notions of -the cause, the symptoms should next be described. - -No person can be unaware of the approach of a bubo. There is seldom -much advance of a swelling without pain, which latter may be said to -attract the patient’s attention to the part, when a tumor, possibly the -size only of a horse-bean, is discovered. If the swelling be venereal, -it rapidly increases in size. It is at first moveable, but soon feels -as though firmly fixed. There is next experienced inconvenience in -walking. If the disease proceed to suppuration, a continued throbbing -is felt in the part, which also swells, assumes a diffused redness, -and at last an evident sense of fluctuation is perceived. It may be -ushered in with a shivering fit. The skin becomes thin and tender, and -a conical point protrudes, which, unless punctured, bursts and emits -its contents. It is astonishing what immense destruction of parts takes -place in large buboes. The theory how solids become converted into -fluids—how muscle, fat, and cellular membrane, become absorbed, and -a thick purulent secretion deposited, is fitter for a work addressed -exclusively to medical men than to the public; and it therefore must -suffice that such happen, and few persons are ignorant of the fact; but -the _modus operandi_ may at best be but the subject of conjecture. - -The artist’s graver has pencilled a faithful picture (see next page) -of the appearance of the disease in question. On the right side is -represented a bubo that has broken, or discharged its contents, and -which is in a state of healing; on the left side a bubo ready to burst; -and, by way of economising space, the left testicle is exhibited in a -state of varicocele, by no means an unfrequent accompaniment to the -previously narrated condition, but at the same time by no means a -necessary attendant, it being a totally distinct affection. Buboes -present more varieties in their size, and duration, and consequences, -than they do on their initiation. Cases in corroboration will be found -in their proper place. - -[Illustration] - - - - - ON LUES VENEREA, OR SECONDARY SYMPTOMS. - - -SECONDARY symptoms are those changes which occur in consequence of the -admission of the venereal poison into the system, or common circulation -at large. The introduction to the disease of bubo explains the mode -of inlet. Like gonorrhœa and primary syphilis, it is often a very -complicated complaint. Secondary symptoms are admitted to occur without -being preceded by any primary form, as, for instance, by immediate -absorption unattended with the irritation which accompanies chancre, or -attendant upon bubo; but where one secondary affection arises without -the primary, at least many hundred arise subsequent to it; and unless, -in the latter instance, treatment, and vigilant too, is adopted, not -one in a hundred escapes them. - -_Lues venerea_ (a synonymous term with syphilis) is supposed to be -imbibed from a very sensitive glans penis, a simple abrasion of the -skin of that organ, an ordinary ulcer, or it may be transferred by -inoculation. The late John Hunter is certainly the most eminent -authority—the _vade mecum_ of professional men. In these matters he -was a man of indefatigable perseverance and untiring observation. Few -new lights have been thrown on syphilis since his time, except on the -treatment, which has become wonderfully simplified. - -In thus again adverting to Mr. Hunter’s name, it is chiefly to -observe, that the basis of my own thoughts and practice has been built -upon his writings; and therefore, in being thus explicit in describing -syphilis and its multitudinous varieties, the reader is assured -that what is here written is, at all events, well founded, and not -compounded of the many new adventurising propositions of the day. Mr. -Hunter considered that contamination took place about the beginning -of the local complaints; that no person was safe from lues while the -original sore was present, and not under treatment; but that, if the -seeds of lues were not already implanted in the constitution, the -consequences might be averted by treatment. Children are born infected -with lues, which they derive from their parents; for instance, a man -laboring under secondary, or primary symptoms, cohabits with a healthy -female, the female _may_ escape both diseases, but the child may -inherit them. - -Instances have been known of children so infected, conveying the -disease to the wet nurse, to whose care they may be removed; and, -like other infectious disorders, the complaint may be diffused _ad -infinitum_. There is an impression abroad, that, like consumption, -healthy persons are obnoxious to the breath and perspiration of the -afflicted; but, as in many other conjectures, corroboration is wanted -to prove the fact. - -Syphilis is divided into primary and secondary; but modern pathologists -add a third stage, called tertiary symptoms. Hunter used to divide lues -into two orders; the first was the most frequent form of the complaint, -after chancre and bubo; the second, the remaining symptoms. The -former consisted of the affections of the skin, throat, nose, mouth, -and tongue; the latter, the bones and their coverings, called the -periosteum and the fasciæ of muscles, as explained in the preliminary -part of this publication. Lues does not always exhibit itself according -to this arrangement; which circumstance explains that the occurrence -is more owing to conditions of health, and peculiar tendencies of -the structures involved to receive the contamination, than to any -properties of the animal poison. - -He considers, also, that the development of the disease depends much -upon the state of weather, and the care the patient may bestow upon -himself; cold being a formidable predisposer to the extension of -secondary symptoms, and that the parts least protected are generally -the first to become diseased. Hence the throat usually exhibits a -morbid action before the skin, furthermore, upon the cure of the more -superficial parts of the body; and, therefore, suddenly suspending -treatment, the symptoms manifest themselves in the deeper seated. The -deduction from this statement is, a necessity for especial care in the -clothing of the body, and the continuance of the treatment some little -while after all external evidences of the complaint have disappeared. - -Mr. Hunter considered that the disease may be engrafted in the -constitution, and remain dormant for a considerable period, through -the parts not being brought into action by any of the aforementioned -causes. Ordinary illness, simple fever, excess, fatigue, and a host -of other occasions, may excite a particular structure into a morbid -condition, when the hitherto dormant disease will sprout out. His -arguments are supported by numerous cases wherein _several years_ -elapsed between the primary and secondary symptoms, although no new -infection was contracted in the intermediate time. - -Mercury was Mr. Hunter’s sheet-anchor; his faith in it was to the -effect that it would cure every stage of the disease, but that one -course of it, although it might cure chancre, would not prevent -secondary symptoms. They might not occur, because the poison may not -have been carried into the circulation; and in like manner the second -stage of the disease need not be followed by a third. But he considered -that, when the several forms of the disease betrayed themselves, their -origin must be traced to a general contamination of the system at the -same time. - - - - - OF THE SYMPTOMS OF THE FIRST STAGE OF LUES. - - -SIX weeks is the time usually allowed to elapse between primary and -secondary symptoms; but it is not invariably the case, instances -having occurred where the disease has embraced, and most severely, -both stages in a fortnight, and others between which a much longer -time has existed. The first symptoms of lues consist either of a sore -throat or a spotted skin. When the skin is the seat, a red spot, not -unlike a flea-bite, is perceived; the color soon dies into a brownish -or copper-colored hue. Occasionally, at the outset, a small pimple is -observed, which breaks and scurfs; the coppery-colored spot next feels -rough, and a kind of scurf will exude that after a few days falls off -to make way for more. The disease being more usually slow than rapid -in its progress, weeks may be consumed before ulceration occurs, and -merely a discoloration of the skin is seen in spots seldom exceeding -the size of a sixpenny or fourpenny piece. Some of these spots will -nearly disappear, leaving a faint scar, and new ones will spring up. -The entire body may be covered with them, but usually those parts -nearer the centre of circulation generally possess the most—such as the -chest, neck, shoulders, arms, wrists, hands, and head. As the disease -progresses, the scurf on the spots accumulates, falls off, re-forms, -getting thicker each time, when upon being detached, for they cling now -more closely, a sore and moist state of the skin is observable. This -may be covered with a new crust, or may at once proceed to suppuration. - -When an ulcer is formed, it will sometimes spread rapidly, and embrace -a patch the size of a crown-piece, when the process of ulceration will -assume the vigor of disease. - -[Illustration] - -The accompanying sketch portrays, perhaps, more the seat of the disease -when attacking the upper part of the body, than the appearance; for -to give a true portraiture, the drawing should be the size of life, -and colored after nature. It is, however, I doubt not, sufficient to -exemplify the site of the disorder. The eruption is smaller on the -face, and less vicious, generally, than on the body; but it proves most -unsightly, and indicates great advancement of the disease. The legs -(see next page), and those parts of the skin least vascular, assume a -mottled appearance resembling recent bruises; at other times, clusters -of spots like grapes hanging together. - -The shoulders, arms, and wrists, also present a somewhat similar -appearance; though perhaps not to the same extent, owing to being more -warmly clad, and less in exercise, than the lower extremity. - -When the disease extends to the hands, it is marked by exfoliations of -the palm, with occasional deep cracks that cause much pain. Nor are the -fingers and nails exempt from this encroaching malady, which, during -its occupation, shows itself by a redness under the nail, that at last -ends in the destruction of the nail. - -[Illustration] - -[Illustration] - -[Illustration] - -The head, also, is a frequent seat of the disorder. It is generally -discovered by running the hands through the hair, when a little crust -will be detected by the fingers, or a slight itching will show its -position, or the brush may break it off. The top and hind parts of the -head are generally the situations selected. Occasionally the hair will -fall off, leaving spots of a smooth baldness. - -[Illustration] - -The vital organs, fortunately, are never subject to syphilitic -inflammation—such as the brain, the viscera of the chest, and abdomen; -nor is even the mucous membrane of the interior of the body affected, -its power being confined solely to those parts or structures subject to -the influence of external causes. - -When the venereal virus attacks the throat or palate, the membrane -of the roof of the mouth becomes red and inflamed, patches ulcerate, -and, if not cured, sooner or later expose the bony palate, which may -be felt by the probe. This is the first stage. The exposed bone next -exfoliates, and a communication is thereby formed between the mouth and -nose, the fluids return through it, the voice is changed into a nasal -twang, and a most offensive discharge is secreted. - -[Illustration] - -This drawing represents ulceration of the tonsils, uvula, and arch of -the palate; also the edges of the tongue. The drawing, p. 102, shows -the under surface of the tongue, the inner part of the lower lip, and -the lower gums affected with venereal ulcers. - -When the tonsils are attacked, ulcers appear, precisely similar in -character to chancres, hollow in the centre, with raised ragged edges, -yellow on the surface, with a livid color on the surrounding margin. -A sense of dryness is perceived, extending up the eustachian tube to -the ear. Sometimes the tongue, gums, and inner part of the lips, are -attacked (see representation). - -[Illustration] - -In the progress of the disease, the pharynx, or top of the gullet, is -brought under its influence, and the ulceration spreads through it to -the vertebræ or back-bone. Extending its course, it next attacks the -larynx, or top of the windpipe, when, if not arrested, it will soon -destroy life. Attending this affection of the larynx, there is always -loss of voice—the patient speaks in a low whisper. It is more fatal -than any other form of the venereal disease. - -The mucous membrane of the nose stands next in order, as subject to the -influence of syphilis. The patient’s attention is first directed to it -by an incrustation which forms in the nostril. On this being removed, a -quantity of blood, mixed with purulent matter, is discharged. In two or -three days, similar incrustations are formed, and under them ulceration -takes place, which frequently lays bare the bone, and occasions it to -exfoliate; and this exfoliating often continues after the venereal -action has ceased. The number of bones which come away is often very -considerable, and horrible deformity is the result. - -The periosteum and bones become in their turn affected by swellings -called nodes—the periosteum first, and the bones subsequently. -Of these, the cylindrical, being most exposed to vicissitudes of -temperature, are commonly the first attacked. Those which are much -covered by muscle are rarely affected, as, for instance, the back -part of the _tibia_, or large bone of the leg, while nothing is more -common than to see nodes on its anterior part, which is only covered -with skin and periosteum. They occur on the _fibula_ only when it is -slightly covered, and only on the _ulna_, or elbow-bone, when similarly -circumstanced. Nodes on the _os humeri_, or shoulder-bone, except -on the outer side, are of very rare occurrence, but are frequently -found on the _clavicle_, or collar-bone, at its scapular and sternal -articulations. - -In the following wood-cut is an illustration of the most frequent -situation of nodes on the forepart of the tibia, or chief bone of -the leg. The swelling is considerable; the upper one proceeding to -suppuration, and the lower indicating merely a tumefaction of the lower -part of the bone, near the instep. - -[Illustration] - -The symptoms which mark the disease are as follow: The patient -experiences in the evening a sensation of pain in the bone which is -afterward the seat of the node. In the course of a few days, a swelling -appears in the evening, which disappears again on the following -morning. It is excessively painful and tender at night, but in the -morning it is hardly perceptible, and the tenderness is almost gone. -At this particular period the periosteum is only affected; but when -the inflammation has continued some time longer, the bone is diseased -and becomes enlarged. The rationale is this: An inflammation of the -periosteum ensues. In a short time a deposite takes place between it -and the surface of the bone. This deposite, in the first instance, is -only a serous fluid, but a cartilaginous substance is soon secreted, -which is gradually converted into bone. - -When attended to early, their treatment is very simple; but -occasionally cases of considerable difficulty will arise. - -Large quantities of fluid will be found fluctuating between the -periosteum and the bone, which, when unaccompanied by redness and -inflammation of the skin, may be absorbed by proper treatment, but -which more usually is only curable by evacuation; and, unless great -care be used, exfoliation of the bone will ensue to a very great, and -sometimes fatal extent. The eyebrows, forehead, and temples, are often -the seat of fluid tumors varying from the size of peas and beans. Their -cure must be effected by absorption, or destruction of the bone is -often produced. - -The flat bones are also subject to syphilis. The one most commonly -attacked is the _os frontis_, the symptoms being just the same as those -on the skin. The side bones of the head now and then are affected; the -os _occipitis_, or back-bone of the head, very rarely; and the _os -temporis_, or temporal bone, being well covered with muscles, and -exposed to very little change of temperature, is never affected. - -The _os frontis_, being the most exposed, is the most frequently -attacked. Suppuration sometimes takes place; and when this has occurred -on the front, it has happened that the same suppurative process has -occurred interiorly between the _dura mater_, or the external membrane -of the brain, and the internal surface of the bone. The matter presses -upon the brain, and death is the consequence, if the pressure be not -removed by the use of the trephine or trepanning instrument. This is a -degree of severity to which the disease rarely reaches now-a-days, from -the more extended knowledge and improved treatment of modern times. - -It must be observed, generally, of both these diseases—that of the -throat and nose, and this of the bones—that they are oftener the result -of improper treatment, such as the excessive use of mercury, and -exposure to great vicissitudes of weather while under its influence, -inducing what is called the mercurial disease (which in fact is, or -was, of more frequent occurrence than the constitutional syphilitic -one), than the result of the natural tendency of the disease in an -otherwise healthy individual. - -_On the treatment of Syphilis._—I consider it a fair presumption that -any invalided reader, except he be an accidental one, of this book—by -which I mean one, not having _sought_ its possession—must be acquainted -with the association of _mercury_ and _syphilis_. If not, let him -be told for the first time, that such association exists as between -copaiba and gonorrhœa; or perhaps what may be rendered more familiar -to him, namely, as between _quinine_ with _ague_, or _colchicum_ with -_rheumatism_. That for upward of three hundred years past mercury has -been held an antidote to venereal affections; and still is, in many -forms of the same, acknowledged indispensable for their removal. - -From old notions afloat, that syphilitic patients to be cured must be -salivated to the extent of furnishing or filling two or three wash-hand -basins daily with saliva—that the teeth drop out, that the breath -becomes horribly fetid, and that the consumer of the poison sacrifices -one third of his probable existence, even though he get well—the -greatest possible prejudice exists against mercury, and the generality -of uninformed patients have acquired a most uncompromising dread of the -remedy. From the frequent difficulty in getting patients to submit -knowingly to mercurial treatment, many new means have been caught up, -and some judiciously applied. - -This new method has its advantages; but it does not realize all that is -promised. It consists in advising rest, cleanliness, simple soothing -applications, and, on the other hand, mild astringent ones, a temperate -diet, fresh air, an easy mind, sarsaparilla, and other alterative -medicines. There are many believers in the efficacy of simplicity; and -the success that follows such treatment of nine tenths of the ailments -of humanity, bears out the usefulness of the preceding methods; but the -remaining tithe have alike a claim upon our consideration, and of this -tithe the syphilitic invalids form a large portion. - -The anti-mercurial advocates have, however, a salvo, and admit now -and then, an exception to exist, that particular cases _do_ require a -mercurial course, but then it should only be adopted in its mildest -possible form, merely with a view to act on the general health, rather -than for any specific property of its own. Again, there are books, -which are very elaborate, and what is equally important, modern ones, -written by talented men,[4] which still profess faith in the curative -powers of mercury, and employ it as the chief agent in the cure of the -venereal disease. Instead of administering it to the same extent as -formerly—instead of attempting to produce salivation to the flow of -quarts—they merely aim at producing an impression on the constitution; -they are satisfied with a proof that their patient is under mercurial -influence: this is ascertained by a coppery taste in the mouth, a -slightly increased secretion of saliva, and the presence of the -accompanying, but temporary depression. - -Now the question to be resolved is, which of the two methods is the -correct one. The many forms of disease of the sexual structures satisfy -me, that their treatment should be modified by circumstances; but I -believe I am wise enough to know, and certainly old enough to have -observed, that the severer forms of syphilis, and even the milder in -some constitutions, require the aid of mercury for their cure; in fact, -_will yield to no other plan of treatment_, thereby admitting the -_specific virtues_ of the remedy. - -The principles, therefore, which I advocate in the treatment of -syphilis, are precisely those I depend upon in gonorrhœa, or, to -familiarize the analogy, in a fit of indigestion, or an attack of local -or general inflammation. Where the health is disturbed, the first -step is to attempt restoration. The fact is almost too familiar to -every one to need repetition, that, as is the condition of the health, -so is the resistance it is capable of opposing to disease. The next -proceeding is, to attempt the subdual of the prevailing symptoms. -Syphilis, whether in the form of chancre, bubo, or any of its secondary -varieties, induces more or less fever, inflammation, and interruption -to the important offices of digestion, and other vital processes, which -consequently require the promptest attention. Equally various are the -local indications of syphilis—the ulcers may be common, superficial, -phagedenic, or sloughing, each requiring various treatment, as -hereafter will be specified; but, above all, too much reliance can -not be placed on the dietetic and physical regimen—two comprehensive -significations, which are, after all, the Alpha and Omega of the -Materia Medica. With this declaration, I pass on to the treatment -in detail of the more frequent and, I may add, leading features of -syphilis. - -_Treatment of Chancre._—_Preliminary remarks._—Chancres are of various -kinds. The most remarkable are:— - -1st. That characterized by its circular form, its excavated surface -covered by a layer of tenacious and adherent matter, and its hard -cartilaginous base and margin. - -2d. Another form of chancre, unaccompanied by induration, but with a -very high margin, appearing often on the outside of the prepuce, and -seldom existing alone, called, from the preceding description, the -“superficial chancre, with raised edges.” These kinds of ulcers are -sometimes very tedious, neither getting better nor worse, but resisting -every plan of treatment for their removal. I have known instances where -they have existed for several months. - -3d. The phagedenic chancre, a “corroding ulcer without granulations,” -and distinguished by its circumference being of a livid red color. This -is the kind of chancre that is invariably rendered worse by mercury: -indeed, cases have occurred where, from the injudicious administration -of that medicine, the whole of the penis has been destroyed. - -4th. A most formidable kind of chancre, denominated the sloughing -ulcer. It first appears as a black spot, which spreads and becomes -detached, leaving a deepened and unhealthy looking surface. The sore is -very painful, and encircled with a dark purple areola. If neglected, or -improperly treated, the process of mortification goes on until all the -parts of generation are destroyed. - -The last-named chancre is more often the consequence of neglect on the -part of the patient, than the natural progress of the disease. - -Now the usual method adopted by surgeons to remove chancres, has been -to excise them, or to apply caustic; the latter is the plan I adopt, -and would recommend; but all chancres are not to be treated alike, some -requiring antiphlogistic remedies, others soothing, others stimulant. -Some practitioners rely entirely upon constitutional remedies. - -On the first appearance of a chancre, I would enjoin an alteration -in the diet, regulating it according to the strength of the patient. -Abstemiousness should be the motto, avoiding extremes, however, lest -debility should be induced. Quietude and rest, in the recumbent -position, are two essential adjuncts in the treatment of primary -syphilis throughout. - -With respect to the treatment of the ulcer, characterized by its -circular form, excavated surface, and hardened base, as detailed, the -plan I almost invariably adopt is, immediately on its appearance, at -least as soon as the pimple has broken or desquamated, to smear it with -a hair pencil filled with the solution of caustic, sometimes twice, at -least once a day (see Form 27), and to keep it frequently washed in the -daytime with a lotion of the chloride of soda (see Form 28), or the -black, red, or blue wash (see Forms 29, 30, 31). - -If the patient be strong, and otherwise in good health, I simply -recommend a dose of purgative medicine, in anticipation of any -irritation that may arise. After which, I suggest a middle diet to be -adopted for the next few days. From the sedative and salutary effects -of the warm bath, I recommend its employment immediately after the -operation of the medicine, and its repetition at frequent intervals. -Independently of its effect on the system, it is the best general -cleanser that can be resorted to. The subsequent treatment is regulated -by the result of the above, which can be ascertained about the third -day. - -In numberless instances, and where the disease is thus early detected -and similarly treated, the mere continuance of either the chloride -lotion, or black wash, the middle diet, an occasional aperient, the -bath, with as much rest as possible, are all that will be found -needful to cure the disease, which generally is effected in about a -week or ten days at farthest. From the universal dread that so sudden -a disappearance of the sore occasions, lest it should “be driven into -the system,” and from the apprehension that it is incurable without -taking mercury, I verily believe that, in many cases, the practitioner, -participating in the fears of his patient, and anxious to allay them, -reluctantly administers that mineral; and to such weak judgment may -be traced the relapses, or the occurrence of other symptoms sometimes -mistaken for secondary. Even when the case terminates favorably, and -within the space of time alluded to, I would not be considered as -recommending a sudden return to free living; on the contrary, I would -not release the patient from the restrictions imposed upon his diet, -exercise, and regimen, for at least the same time as was occupied -in the cure, nor would I predict that, in every instance, secondary -symptoms should not ensue. Mercury was supposed to possess some -antisyphilitic property, inasmuch that, when chancre healed during -its exhibition, secondary symptoms were averted. Facts, however, have -been wanting to corroborate that supposition; for secondary symptoms -have appeared despite the external and internal employment of mercury, -even to the extent of salivation. Authors there are who attach similar -properties to other medicines, such as nitric acid, sarsaparilla, and -such like. Now, how do these medicines act upon the system? Or what is -their tendency of action? Why, by increasing some particular function, -such as the secretive process of the salivary and other glands; by -increasing perspiration or absorption, &c. The remedies whereby these -changes are induced are termed alteratives. I am not going to deny -that these, or some such changes in the system, are unessential for -the eradication, particularly of morbid conditions of structure and -function, dependent probably upon altered condition and diminished -action in others. On the contrary, they are the only antagonists to -disease which we possess. - -But what I contend is, that, in our selection, we should prefer those -which produce most speedily and effectively the desired change, -with the least detriment to the general health. And to this end, I -invariably enjoin, where practicable, warm or vapor bathing. I have -elsewhere considered this subject at length, to which I refer the -reader; but I will fearlessly assert that no one, or any plan of -treatment, will be found so effectual toward increasing physical power -to repel disease, or so permanently preservative of health, as the -modified employment of the warm or vapor bath; and, therefore, in all -cases of doubt and apprehension, or independent of either, the use of -the warm or tepid, plain, or salt-water bath, two or three times a week -for a month, or the vapor bath about every fourth or fifth day for -the same period, is the best preventive that can be adopted to avert -secondary symptoms. Where bathing of every kind is impracticable, as -is the case in some country places, and the same necessity exists, I -advocate the administration of alterative medicines; nor do I object -to the employment of mercury, where, under other circumstances, -without reference to its imaginary efficacy in syphilis, it would be -prescribed. But of this as we proceed. - -Where, at the expiration of a week, the chancre neither recedes nor -advances, and is the only symptom present, it is to be presumed that -the condition of the patient’s health has something to do with it, -and that condition should be minutely inquired into. There may be -diminished or increased appetite, with imperfect digestion; there may -be fever, with restlessness at night; there may be torpor or irritation -of the bowels; or the patient may consider his only ailment to be -the chancre, the irritation of which may be found to arise from too -active exertion. To whichever cause it may be ascribed, the treatment -should be directed. In conjunction with local remedies, which may be -varied, alteratives may be given—five grains of the blue pill twice -a day; for instance, the Plummer’s pill in doses of five grains -every night, the occasional application of an active aperient (see -Forms 33, 34), the decoction of sarsaparilla (see Forms 49, 50, 51). -This plan, carefully pursued, seldom fails in setting up a permanent -cure. The patient should be apprized of the vast importance of quiet, -rest, and abstemiousness; for, where they can be attended to, the -duration of the disease will be diminished one half; whereas, he who -is continually in the erect posture, and subject to much walking -about, who is indifferent to his diet, and lives as free as formerly, -incurs the risk of bubo, and all its alarming consequences. Now, in -no case or description of chancre, do these remarks apply so aptly as -to the phagedenic and sloughing ulcer; in fact, they are applicable -to all, but more particularly the two latter, as they are the result -of already increased action. Mercury, violent aperients, and other -active remedies, should also be avoided in these two forms of chancre; -the local appliances should be poultices of bread and water, linseed -meal, and a solution of opium, or poppy water; the sloughs or mortified -portions we should endeavor to detach, by the application of a _smear_ -of nitric acid, or the chloride lotion (Form 28), or stimulative -ointment (Form 38). The superficial sore usually gets well by the same -means as the ordinary chancre. - -Where the chancre is situated under the prepuce, and the latter -covering is so inflamed and swollen as to prevent its being drawn back -to exhibit the sore, the discharge should be carefully washed out by -any of the lotions already recommended, by means of a syringe, several -times in the twenty-four hours. Much good is often done by varying the -local remedies, occasionally flouring or filling up the ulcer with -calomel, tutty powder, blue ointment, or in fact any substance which -alters the morbid action of the part; but, as a general rule, the -lotions of soda, lime, zinc, or oxymuriate of mercury, will be found -sufficient, if persevered in. - -_Treatment of Bubo._—Bubo I have already stated to be an inflamed and -enlarged condition of the inguinal (as its name implies, signifying -the groin), or, in fact, any other gland, occasioned by the passage of -the venereal poison from the adjacent ulcer through it, preparatory -to its contaminating the constitution. But it is as well to know that -the system may become affected, or, in other words, the poison may -pass through the glands without involving them in the disease, or that -the poison may there stop, and be expelled as the bubo is cured. It -is also observed, that buboes are more frequently consequent upon an -ulcer seated on the prepuce than on the glans. Buboes are not always, -however, a sure criterion of the venereal disease, for they will occur -wherever irritation is superficial and adjacent. Leeches applied to the -temples will affect the cervical glands, a graze or wound in the leg -enlarge the inguinal, and a whitlow on the finger, or any inflammation -of the hand or arm, will very often irritate the glands in the axilla. -In gonorrhœa, the glands in the groin become swollen and painful, -from sympathizing with the sensibility of the urethra; but these and -the preceding may, in general, be distinguished from true venereal -buboes by their disinclination to proceed to suppuration; whereas, in -syphilis, that process runs through its several stages with remarkable -celerity, unless timely prevented. Buboes in the groin are much more -troublesome, and more likely to betray the disease, than chancres, -because they constitute an augmentation to the patient’s suffering, -seldom occurring, unless preceded by a chancre, and because they -occasion a visible and necessary lameness. They also produce more -general disturbance of the patient’s health. - -In the treatment of a bubo, venereal or not, the same principles -recommended in the section devoted to the cure of chancre, should be -followed in this instance—comprising attention to the general health, -and a subdual of the prevailing symptoms. - -In no form of syphilis is rest more essential than in bubo. The patient -will be apt to plead the necessity of following his business, and the -utter impossibility of staying at home; that is his affair, mine is -only to protest against exercise, and urge the importance of rest, and -even the recumbent posture, and I can assure him, _that_ alone will -strip the disease of three fourths of its terrors. - -Certain local diseases produce more constitutional disturbance than -others—among them may be classed buboes; it would, therefore, be -as impolitic suddenly and violently to repel an inflammation of a -gland or glands, without establishing some outlet for the increased -action to vent itself, as it would be to check a flux or suppress an -exanthematous eruption, like measles or scarlatina. - -If the bubo is, therefore, painful and inflamed, my advice is as -follows: Stay at home, and rest; descend to middle diet; take some -aperient; and should chancres alone be present, and a treatment -going on for their extinction, continue the same; or, as bubo often -immediately succeeds the ulcer, and probably may be the first symptom -noticed, adopt, in addition to that recommended above the treatment as -advised for chancre, namely, the administration of some alterative—for -instance, five grains of blue pill every night—or the Plummer’s pill -every night—the aperient powder every other day; and let the local -treatment be directed to remove the prevailing symptom, to subdue -the inflammation, and, if possible, thereby prevent suppuration. It -was formerly supposed that, unless buboes were allowed to suppurate, -the system could not escape the venereal taint. Lower somewhat the -vital powers, or, what may be more intelligible, diminish the general -inflammatory action, establish some slight drain, by determining the -secretions to the intestines or skin: and buboes, even when matter -has absolutely formed, may be fearlessly absorbed, which judicious -treatment will effect, in nine cases out of ten, without at all -impregnating the constitution. To attain this object, warm fomentations -constantly applied, and if possible the warm (hip or full length) bath -every night. When rest is determined upon, if the swelling is great, -red, and painful, leeches are eminently serviceable, but they must be -applied in numbers of at least a dozen at a time, and repeated twice -or thrice if necessary. Three or four, by the irritation of the bites -when healing, and especially if the patient will not or can not remain -quiet, only worry and aggravate the disease. Where the inflammatory -symptoms are great, where there is fever and much heat of skin, -bleeding is the speediest and most effectual plan to subdue them; and, -in my opinion, it is to be preferred before the trouble and bother of -leeches. Where, however, there is no remarkable excitement, local or -universal, the topical application of any of the ointments suggested -will often promote absorption (see Forms 35, 36, 37). - -Blisters applied over the bubo, very often disperse the swelling. -Pressure also, made by means of a pad covered with tin foil (as seen in -the subjoined cut), and continued for several days, frequently urges -the absorption of the accumulated deposition in the gland. - -[Illustration] - -Where _bubo_ has been suffered to proceed, and the suppuration appears -inevitable, it would be highly improper to retard it: poultices and -warm fomentations should be applied, and when fit, an opening should -be made to permit the exit from, and prevent the extension of, the -matter in the surrounding cellular membrane; the operation should not, -however, be prematurely performed; the skin should be permitted to -become thin before an opening is made, and that opening should be made -in the most dependent position, in order to allow complete escape of -the matter, lest fistulæ and sinuses should form. When an abscess is -thus established, its healing must be promoted with all expedition, -and care taken to preserve the strength of the patient. For the former -purpose, poultices, mild healing ointments, or strapping plaster -applied near the edges of the wound, should be used. Poultices may be -applied with a bandage, as seen in the subjoined cut. - -[Illustration] - -When the abscess appears indolent and not disposed to heal, carrot -and linseed-meal poultices may be substituted. Astringent ointments -should also be employed (see Forms 38, 39, 40), or lotions (see Forms -41, 42), and the topical application of caustic to the edges of the -wounds, or even paring them with a scalpel. The occasional use of the -warm or vapor bath will give a healthy tone to the frame, invigorate -the depressed powers, and promote recovery. The strength should be -supported by more generous diet, and any of the formulæ comprised under -the head of tonics, may be taken internally (see Forms 43, 44, 45, 46, -47, 48). As the patient becomes convalescent, change of air, gradual -exercise, the cold shower bath, or sea bathing, will be of essential -service. - -_Treatment of secondary symptoms._—Secondary symptoms usually appear -from the sixth to the sixteenth week, but are not unfrequently -protracted beyond that period; they are commonly ushered in with -fever—a general sense of being ill—a quickened pulse, headache, loss -of appetite, pains in various parts of the body, and restlessness at -night; in short, there is disturbance of all the vital functions, -until it is determined which structures are to be the retreat of the -common enemy. Some authors assign the skin and throat as more liable -to attack than others; but I think the distinction dependant mainly -upon the natural or morbid idiosyncrasy of the invalid. At all events, -the inquiry here would be foreign to the design of this work, and less -useful than the advice, how best to combat the evils when and wherever -they occur. I have already stated secondary symptoms to consist of -eruptions, ulcerations, and disfigurations of the skin, ulcerations -of the mucous membranes of the mouth, throat, and nose, pains in the -joints, swellings of the bones and their coverings, and inflammation of -the various fibrous textures of the body. - -_Treatment of syphilitic eruptions._—The cutaneous eruptions of -syphilis present considerable varieties, assuming a scaly, papular, -tubercular, or pustular appearance. Formerly it was the opinion that no -eruption was _venereal_, unless characterized by a scurfy exfoliation, -and teinted of a copper color. This _test_ is not now relied on. In -the simpler forms, we find that the skin becomes mottled at first, -which appearance may partially die away and reappear, deeper in color, -and the spots become more numerous in extent. The patient should be -apprized that, when the disease has progressed thus far, it is not in -its nature to depart unbidden; but it advances usually from bad to -worse. - -The mottled dots enlarge, exfoliate, or scurf, or desquamate, as it -is called, leaving the subjacent circle thicker and thicker, and -of the same color as the cuticle which peels off. In the ordinary -uninterrupted progression, scabs form, suppurate, and constitute -an ulcer, like a chancre, which ulcer assumes all the varieties of -chancre. In other cases, the eruption, instead of being scaly, “has a -raised surface, from which a whitish matter usually oozes.” - -[Illustration] - -The scaly copper-colored eruption, denominated, according to its -severity and appearance, syphilitic lepra or psoriasis, is regarded as -most characteristic of true syphilis, and is the most frequent. The -annexed is a drawing copied from nature; it is alluded to a few pages -further on: its pattern is frequently to be met with. A celebrated -writer, Mr. Carmichael, attaches considerable importance to the -character and appearance of the eruptions. He divides the venereal -disease into four species or varieties: 1st, the scaly venereal -disease, which he considers consequent upon the ordinary chancre; -2d, the papular, consequent upon gonorrhœal ulceration; 3d, the -tubercular; and 4th, the pustular, he names from its appearance. These -distinctions, if correct, must be more interesting to the surgeon, -than serviceable to the patient, for the principles of treatment must -be alike in all. Now, although mercury may be denied to possess any -specific influence over the syphilitic poison, either by its chemical -action or neutralizing power, except as a counter-irritant to the -system, yet the inability of nature to shake off the pestilential -hydra, unassisted by the weapons of the physician, is most apparent; -and the most powerful of which is, that class of medicines called -alteratives, none of which are more deserving, none more manageable, if -the least judgment be displayed, than mercury. - -The constitution, when under the influence of syphilitic poison, is -being led like a willing horse to its own destruction; and unless -the system be entirely revolutionized, that event is not likely to -be retarded. Here mercury[5] may lend its powerful aid, and may -be carried even so far as to produce mild ptyalism or salivation. -But there are instances where mercury is inadmissible. The patient, -however, need not despair; extensive resources are still open for -him—the preparations of antimony,[6] the mineral acids, sarsaparilla -(Forms 49, 50, 51), iodine (Form 52), and a host of others may be -resorted to; and last, though not least in importance, is the medicated -vapor and fumigating bath. From my connexion with an establishment of -that kind, my disinterestedness might be questioned in advising the -employment of bathing. As well might the apothecary who deals in his -own drugs, or the tradesman who vends his own wares, be suspected of -disingenuousness; the reply I would offer should be, that the reader -or invalid need not pin his faith on my assertion, unless it so please -him; or if he does, may the onus lie at my door. But for his sake, and -to bear out my own assertion, I offer this declaration, that, for the -last twenty years, in conducting my establishment (wherein more cases -of syphilitic eruption have presented themselves, than probably have -fallen under the notice of any other medical man in London within the -same period), no case, of which I have had the management, has failed -of being cured. - -Where syphilitic eruptions terminate in ulceration, the same -local treatment should be used as advised for chancres. Among -the prescriptions will be found formulæ for many useful topical -applications, such as ointments, lotions, and fumigations, for all -the external developments of syphilitic disease, with appropriate -observations appended to each. - -_Treatment of syphilitic sore throat._—It has already been mentioned, -that the order of appearance of secondary symptoms depends more upon -the modified state of health than any fixed law of disease. Syphilitic -sore throat may precede or follow the cutaneous eruptions; and it not -unfrequently happens, that all forms of the disease are present at the -same time: therefore, although they are here separately considered, it -will be found that the treatment corresponds nearly in all, the only -difference being in the local applications. - -_Syphilitic sore throat_ consists of ulcerations of the _fauces_, -_tonsils_, and _soft palate_. The inflammation begins in the part -affected. There is a redness, and sensation of dryness. A small white -spot is perceptible, which rapidly spreads, is detached, reappears, -and in four-and-twenty hours, if seated on the tonsils, a cavity, as -if a portion of them had been scooped out, is observable. The ulcer -has a sharp margin, and its excavated surface is covered by a whitish -or yellowish adhesive matter. At other times, the ulceration will be -more superficial, but not less rapid in its progress, extending over -the upper part of the palate, and back part of the throat. Here the -general treatment is precisely the same as in the other forms of the -disease, viz., rest, abstemiousness, low diet, aperient, saline, and -alterative medicines, the blue pill, preparation of antimony, the bath, -and total exclusion from all excitement. The topical treatment consists -of fumigations, gargles, styptic lotions, nitrous acid gas, blisters -over the larynx, rubbing in of any counter-irritating ointment; the -object being throughout to watch, and endeavor to improve the patient’s -health, support the strength, and mitigate and remove the local -symptoms. - -In the affections of the nose and palate, the fumigations are -indispensable; injections must also be used, and styptic lotions -applied with a camel’s-hair brush. These cases are very tedious, and, -fortunately, in the present day, of rarer occurrence than formerly; and -the patient, thus severely attacked, would be more prudent to rely upon -some confidential medical adviser, than to trust in his own management. - -_Treatment of venereal affections of the bones and joints._—Nodes are -alleged, by medical men of great authority, to be of rare occurrence, -except the patient has been taking mercury; but the observation is not -always correct. - -Their treatment, of course, must be regulated by various circumstances. -When the pain and inflammation are severe, leeches, bleeding, warm -fomentations, or cold evaporating lotions composed of vinegar and -water, must be resorted to. When they are chronic and painful, without -redness and inflammation, the greatest relief will be experienced by -the application of the ointment of iodine and morphine (see Form 53), -also by the internal employment of iodine in doses of five to ten drops -twice or three times a day. Where they are very obstinate, blisters -will be often useful in promoting absorption. When they ulcerate, -the treatment for chancres must be had recourse to. But the most -invaluable remedy, alone or in conjunction with any of the preceding, -is the vapor bath; it seldom fails to give instantaneous relief. I -have seen patients, who were rendered almost insensible by the pain -of nodes in the head, chest, and other parts of the body, experience -an entire remission of the pain, and a diminution of the swelling, by -the application of one bath; and a course of six or a dozen is rarely -inefficient in effecting permanent recovery. - -It has already been mentioned that rheumatism of the bones and joints, -and in fact of various parts of the body, is unfortunately but too -frequently an accompaniment or a consequence of syphilitic disease: and -an observer will discover that nodes rarely exist without rheumatic -inflammation (of which by-the-by they are a species) being more or less -present. - - - - - SECONDARY SYMPTOMS. - - -IN the same manner as bubo, which is more usually preceded by -ulceration, but which may occur without it, secondary symptoms, or -that form of the disease wherein the constitution is involved, may be -carried into the circulation without any local effect on the part to -which the poison was first applied being produced; or, in other words, -secondary symptoms need not necessarily be preceded by primary. I have -already stated that secondary symptoms are also much modified, both -as to the time, form, and severity of their appearance, by the state -of health of the patient affecting and affected; and hence the varied -degrees of syphilitic maladies. By referring to past pages, it will -be seen that the mucous membrane of the throat and nose, the skin or -surface of the body, and the periosteum and bones, are the structures -in which secondary symptoms develop themselves, and accordingly I now -proceed to their several consideration in detail. To illustrate each -of them practically, I will first select diseases of the skin. They -consist of four marked species, distinguished as the scaly, papular, -pustular, and tubercular. - -The most frequent form of eruption is the scaly, and called syphilitic -lepra. It is characterized by dry, flat, and round patches, of -different sizes, and of a coppery-red color. Each spot is ushered -in by a minute but hard elevation of a purplish hue, that gradually -radiates in size until it acquires its limit. It then puts on a scaly -appearance, and, as it desquamates, with the exception of the centre, -which is sometimes left white, maintains its copper color. These -patches may be distinguished from ordinary leprosy by their color, -and their running on to ulceration, if uncontrolled by medicine, and -again by their more speedily yielding to judicious treatment; when they -become paler in appearance, cease to exfoliate, and die away, leaving, -however, a coppery stain. Syphilitic eruptions occur in all parts -of the body, and are to be observed on the head, face, back, legs, -feet, hands, scrotum, &c. (see wood-cut, page 118), but they are much -modified in their external characters by the region they affect. - -The pustular form of syphilitic eruption is also illimitable as to -situation and extent. The pustules, at the onset, are scarcely to be -distinguished from the patches of lepra, being of similar color. They -differ in size, some being very large, and others very small. When they -have existed about a week, a purulent fluid escapes, which hardens and -crusts, constituting a conoid tumor, and surrounded by a copper-colored -areola. This crust after a while drops off, leaving the under surface -of the same teint as the margin. The pustular form of the disease is -mostly consecutive to primary infection of the genital organs, and is -often complicated with affections of the throat, nose, &c. - -Syphiloid tubercles ordinarily attack the face, more particularly the -nose, angles of the lips, ears, &c. They vary in size, are dispersed -or grouped together, and are of a purplish copper color. Like the -pustular, they terminate in ulceration, which on healing leaves an -indelible scar. This and other forms of syphilitic disease are very -irregular in their attacks, first selecting one spot, then another, -then several together, so that the body presents often at the same time -many stages of the eruption. The papular form of eruption is generally -intermixed with the pustular and tubercular. It is less strongly -marked, but, like the others, successive in its development, and -usually complicated with primary symptoms. - -There is a form of cutaneous disfigurement, entitled syphilitic -exanthema, in which the skin is discolored by coppery-red blushes that -disappear under pressure of the finger. There are also deep and painful -fissures and excrescences, called _vegetations_, from their resemblance -to raspberries, strawberries, cauliflowers, and leeks, observed in -syphilis, and most commonly they are to be found about the lips, nose, -eyebrows, chin, genitals, &c. - -It may not be unimportant to know that syphilitic eruptions are -contagious by inoculation, and that secondary symptoms may be -transmitted from one individual to another. - -When I was a pupil of the London hospital, a woman and her child -presented themselves for treatment. The mother was completely covered -with copper-colored scaly eruptions, obviously and unequivocally -syphilitic. The child also had venereal sore throat, and ulceration of -the mouth. The account which the mother gave of herself was, that the -eruption appeared a few weeks after her confinement; and, upon further -inquiry, it was discovered that the husband had had a chancre of the -penis: that was cured, but secondary symptoms showed themselves upon -him. It was during the presence of the latter that he had intercourse -with his wife, at about the sixth month of her pregnancy. The surgeon -of the week gave it as his opinion, that the disease was conveyed by -the male semen being absorbed by the mother, which was sufficient to -occasion the disease. The mother, husband, and child, all submitted -to mercurial treatment and fumigations, and in a few weeks entirely -recovered. - -_Treatment of Secondary Symptoms._—Now in the treatment of these cases, -all of which are more than _skin deep_, it is evident that, unless -the cause which produces them be expelled, all local repellants only -exhaust the physical energies of the patient; for the cure by such -means but provokes a speedier reproduction of the disease, and hence -the necessity of constitutional as well as topical remedies. I have -fully explained my views regarding the employment of mercury; and every -day’s experience convinces me that, where the constitution is imbued -with the venereal virus, there is no alternative but to employ the most -active alteratives, to effect a decisive and speedy change in the state -of the patient’s health. Various habits require various preparations; -the blue pill, the oxymuriate, calomel, and the external application -of the unguentum hydrargyri fortius, are highly useful. I have, -however, of late, been in the habit of employing the proto-ioduret of -mercury, with unqualified success; nor do I limit its administration to -internal exhibition; it may be used externally. The advantage of this -preparation over others is, that it rarely, if ever, produces ptyalism. - -In old and inveterate cases, combined with the use of the warm and -vapor bath, both of which may be impregnated with it, it has wrought -wonders; and in cases that had proved rebellious to every other means, -although sedulously employed, it had effected a speedy and decisive -cure. In the cure of an elderly person, covered almost from head to -foot with syphilitic ulceration, the internal and external application -of the proto-ioduret occasioned, at the end of a few weeks, the -entire disappearance of the sores, leaving only a slight livid trace. -In ulceration of the throat, nose, and in fissures of the genitals, -indolent buboes, &c., the success is no less remarkable than effectual. - -The following is the formula, which may of course be altered according -to circumstances:— - - Form 54. - -Take of the— - Proto-ioduret of mercury 20 grains. - Gum guaiacum, in powder 1 drachm. - Confection of roses, as much as is sufficient. -Mix to form 36 pills—one to be taken twice or thrice a day. - - Form 55. - -For external use, take of the— - Proto-ioduret of mercury 1 drachm. - Lard 2 oz. -Mix. -A portion to be rubbed over, or to dress the affected parts twice a -day. If the ulceration be seated in the throat, honey of roses may be -substituted for the lard. - -The decoction, or any other preparation of sarsaparilla, may be taken -also in conjunction with the treatment just suggested. - -An ounce of the sarsaparilla root infused in one pint of lime-water -(cold) for twenty-four hours, and a wineglassful taken three times a -day, is a very eligible mode of taking it. Or— - -The compound extract of sarsaparilla, dissolved in lime or soft water, -one ounce to the pint, and taken in similar doses to the last, is a -very good mode of exhibition. - -Bathing is indispensable. - - - - - SYPHILITIC LEPRA. - - -A PERSON aged about 29 years suffered under the above disease, and -presented the following appearances and symptoms: He was covered nearly -all over with copper-colored spots, the margins of which were both -elevated and red. The voice of the patient was rather hoarse, and he -complained also of a tenderness on swallowing: the pain extended to the -windpipe and tonsils (or almonds) of the ear, as they are called. He -experienced pain in his limbs, which he described to be worse at night -when in bed. The spots on the skin every now and then desquamated, or -peeled, or scurfed off, leaving the cuticle red and shiny underneath, -and here and there the cutis was ulcerated. On examining the throat, -the swallow appeared very inflamed, and the “pap” very pendulous. He -was hot and feverish, and acknowledged that he had had the venereal -disease about nine weeks ago, and for which he had taken some medicines -that he bought, and which had cured him. When in bed, he complained of -a burning, tingling, and itching of the body, wherever it was covered -with the eruption. - -The treatment was as follows: I bled him to the amount of twelve -ounces, and prescribed a strong aperient powder. On the second day -there was less irritation, and the spots appeared less red. I advised -him forthwith to take a vapor bath, and repeat the same on alternate -days for a fortnight. I prescribed the pills as subjoined, and directed -one to be taken twice a day, to be succeeded by a dose of the decoction -of woods, as directed already. - - Form 56. - -Take of— - Proto-ioduret of mercury 20 grains. - Gum guaiacum, in powder 1 drachm. -To be well mixed together, and made into a mass with syrup, and then -divided into 24 pills. - -The body, on coming out of the vapor bath, or while in it, to be -sponged over with the following wash made warm:— - - Form 57. - -Take of the— - Deuto-chloruret of mercury 1 drachm. - Eau de Cologne 1 oz. - Water 1 pint. -Mix. - -Occasionally I order the patient to be placed in a mercurial bath, of -which there are several kinds, and which can be administered either in -the form of the fumigation or in a fluid state. - -After taking the bath, he could breathe with freedom and comfort; he -could also swallow without difficulty, and he expressed himself much -refreshed and invigorated. Many of the eruptive spots on the body had -exfoliated; and he said he felt a conviction that he should soon get -well. - -At the expiration of a week, when he had taken but three baths, the -soreness of the throat had left, the pains in his limbs were all -gone, and he slept well; the ulcers had healed, and the eruption had -nearly died away. I advised a continuation of all the remedies; and -after three weeks of such perseverance, he was rewarded by an entire -recovery. The only alteration I directed to be made in his diet was an -abandonment of stimulants, such as wine, spirits, or porter. - - - - - NODES AND PAINS IN THE BONES. - - -IN long-standing cases of syphilis, where either much mercury has -been taken, or the constitution weakened by low living or careless -treatment, a painful affection of the bones, periosteum, tendons, and -ligaments, frequently arises. Where the inflammation attacks the bone -or periosteum, it usually exhibits itself in the form of a tumor, that -is at first hard and acutely painful, then becomes soft, and does not -always subside without ulcerating, and occasioning a tedious and -unhealthy sore. These tumors are called nodes, and are extremely rapid -in growth, very uncertain in their duration, and sometimes disappear as -quickly as they come. When the inflammation is seated in the ligament -and tendons, rheumatism is established. Both these affections are very -harassing to the patient; the pains are severest at night, and wholly -prevent sleep, the countenance becomes sallow, appetite, strength, and -flesh fail, and hectic fever completes the list of troubles consequent -upon these forms of the disease. Nodes and rheumatic pains may exist -independently of, or in connexion with, other syphilitic symptoms. -Cases having already been related of gonorrhœal rheumatism, which are -analogous to those proceeding from venereal absorption, any further -detail of such would be superfluous. The treatment should also be -conducted on the same principles in the one as in the other. - -The specific virtues of the vapor bath will be attested by one trial. -I have seen innumerable instances of immediate relief from a single -application. There are few forms of syphiloid disease more distressing -than these pains in the bones; the patient is all but distracted with -the agony he endures. The relief he experiences from the vapor bath -surpasses belief; it verily appears to be magical. It constitutes the -best opiate we have. - -Temporary relief, however, is not all that we want. It is no use to -remove the effect, and leave the cause behind. The aid of medicine -is indispensable. Formulæ of the most appropriate remedies will be -found among the prescriptions. The general directions as to diet, -regimen, and clothing, dispersed throughout these pages, must be -strictly attended to. The stomach must not be at any time overloaded -with indigestible food. Milk diet is the best; milk thickened with -farinaceous food, mild tonics to restore the tone of the stomach and -impart strength, alteratives, sarsaparilla (Form 58), the old Lisbon -diet drink, and all the suggestions hitherto offered with a view of -improving the constitution, should be carried into effect. - - - - - SYPHILITIC SORE THROAT. - - -THE period that elapses between the appearance of the primary and -secondary symptoms has already been stated to vary from six weeks -to six months; and some medical writers assert that, if months may -elapse, upon the same principle years may, and therefore the patient -who has once been afflicted with the primary form of the disease is -never exempt from the liability of the secondary. That syphilis, and -diseases resembling it, do occur at every period of life, is a fact of -daily observation; and it is a matter of less moment to know whether -the invalid has ever had chancre or bubo than is generally supposed, -for the treatment of every form of syphilis, and complaints putting -on like appearances, should be conducted on similar principles. If -mercury do possess anti-venereal properties, it will be found no less -obnoxious to ordinary sore throats, ordinary ulceration, and cutaneous -disfigurement. The presence of any of the abovenamed diseases indicates -a habit predisposed to their occurrence; and that susceptibility may -be induced by a variety of causes, the most prominent of which are -those that debilitate the constitution, such as syphilis itself, or -the remedies exhibited for its extermination, cold, fever, intemperate -or impoverished diet—all of which more or less abstract from, or -derange the distribution of, nervous energy. As in the cure of these -diseases, their removal depends upon an entire alteration of the -system, upon that principle alone should mercury, or any other remedy -be administered, not upon its supposed specific neutralizing or -annihilating antisyphilitic power. - -All this, of course, is a question of experience; and as I profess -that this work should convey the result of mine, I do not hesitate to -express my conviction that secondary symptoms do present themselves -years after a primary affection; but at the same time I admit their -more frequent occurrence to be within three months; and, with regard -to diseases resembling the above, they are entirely independent of -such influences, and are the result of circumstances from which no man -is free. Of syphilitic ulcerations of the throat, which are rarely -solitary symptoms of the disease, being usually accompaniments to -articular eruptions or rheumatic pains, there are several forms. They -are ushered in by feverishness, languor, and a peculiar contour of -the countenance, particularly expressive of anxiety and debility. Of -the first form of ulcerated throat, and which is perhaps the least -frequent, is an excavation of the tonsil, with a tumid and red margin, -accompanied by a stiffness and uneasiness in swallowing. A more common -form, and which, from its occasioning little or no inconvenience, is -seldom discovered by the patient until it degenerates into a worse -state, is that where the ulceration is more superficial, resembling -fissures rather than ulcers, and being situated at the back part and -edges of the tonsils, and low down the throat. From the absence of pain -and difficulty in swallowing, the medical man is usually the first to -detect it, when, on opening the mouth, the throat—that is, the hinder -part of the fauces—will be discovered red and somewhat swollen; and on -pressing down the tongue with a spoon or spatula, the ulceration will -be apparent. - -The last form—the phagedenic—is the most formidable, both in symptoms -and effects. It is characterized by fever, and great pain and -difficulty in swallowing, from the beginning; all denoting acute -inflammation of the throat. The first appearance of ulceration is on -the soft palate, where a small aphthous spot is discovered, surrounded -by a deep erysipelatous redness, that proceeds rapidly to involve the -neighboring parts, which soon assume the appearance of one extensive -slough. This latter disease requires prompt and active treatment, else -the bones of the palate and nose become implicated, exfoliate and -occasion a permanent deformity. - -The process of cure in these cases must be regulated by circumstances. -In persons of full habit, blood-letting will be requisite to arrest at -once the inflammation. An active purgative should also be taken; when, -if the ulceration resist these anti-phlegmonous measures, there is no -alternative left but to subject the system to the influence of mercury. -The proto-ioduret pill will be found the best form, and the diet drink -should be taken in conjunction. The vapor bath, which can be medicated -with poppies, marsh-mallows, and ivy-leaves, or any other emollient -herb, will be found to ease deglutition, promote perspiration, and -afford ease. Local applications, such as gargles, styptics, &c., are -indispensable. Subjoined are a few formulæ, with remarks:— - -Gargle for the milder form of sore throat. - - Form 59. - -Take of— - Honey of borax 1 oz. - Emulsion of bitter almonds 5 oz. -Mix. To be used six or seven times a day. - - Form 60. - -Or take of— - Infusion of bark 6 oz. - Diluted nitric acid 40 drops. -Mix. - -Where the ulcers have an indolent, or present a sloughy appearance, -either of the following will prove useful stimuli:— - - Form 61. - -Take of the— - Oxymel of Verdigris 1 oz. -The ulcer to be smeared with this preparation, with a hair pencil, -twice or thrice a day. - -Or, take of the muriated tincture of iron a small quantity, to be used -in like manner. - -Honey of roses, acidulated with muriatic acid, is a very agreeable -astringent. - -In severer cases, such as the phagedenic ulceration, the subjoined -prescription will be found worthy of a trial:— - - Form 62. - -Take of the— - Oxymuriate of mercury 1 grain. - Mucilage of quince seed 6 oz. -To be mixed to form a gargle, to be used frequently. - -Ulceration of the larynx is an occasional consequence of syphilis; but -fortunately a rare one, as it is generally fatal. - -All the symptoms enumerated in this section have been known to succeed -gonorrhœa, and demand similar treatment. The advocates for the analogy -between gonorrhœa and syphilis herein find a ready explanation for such -an occurrence, which those adverse to the above opinion have no other -means of controverting than by submitting that its rarity is no very -substantial proof. Similar results also transpire from the imprudent, -or too free use of mercury. The following case is a prototype of the -many:— The patient was a person about thirty years of age, and was thus -affected: there was considerable inflammation in the entire back part -of the throat; the tonsils were excavated to some depth by ill-looking -ulcers, the uvula shared also in partial destruction; the tongue was -swollen, the tip and front part of it fissured, and on the left side an -irritable ulcer was apparent; the nose discharged a disagreeable fluid, -and occasionally gave off crusts of hardened secretion. The body of -this person, including the head, was thickly sprinkled with venereal -blotches of the usual copper color. His health was much impaired, and -he stated the disease to have been of nearly twelve months’ duration -from the first to the last. - -The treatment consisted of the exhibition of mercury in the form of -the proto-ioduret, and the sarsaparilla. The ulcers were touched with -nitric acid, and submitted to mercurial fumigation. At the end of -two months he was convalescent. In cases of ulceration of the throat -and nose, I have used the nitrate of silver, both in substance and -solution, with good effect. - - - - - ADVICE TO INVALIDS. - - -HAVING now fully considered every form of syphilitic disease -compatible with the design of this work, a few hints relative to the -after-management of the patient when relieved from his complaint, to -guard against a relapse, and to secure an entire restoration to sound -health, may not detract from its utility. There are many patients who, -on the disappearance of the more prominent symptoms of their complaint, -lose no opportunity of rejoicing in their supposed recovery, and -innocently commit sundry inapparent irregularities, that throw them -back to their former state of suffering, which a little prudence and -attention might have prevented. The more severe the disease has been, -the slower, generally, is the recovery, and also less permanent in -its result. The mere subsidence of pain, the healing of a wound, the -disappearance of a cuticular eruption, or the suppression of a morbid -secretion, are not in themselves sufficient indications of substantial -recovery. The various physical and mental functions which, during -illness, are always more or less involved, have yet to regain their -tone. The digestive powers of the stomach are easily deranged, and -require watchful management to secure the vantage gained. Equal care -is essential, lest the intellectual organs be too prematurely called -into active employment. Convalescence is often protracted to an almost -indefinite period, frequently from the most trifling errors in diet. -The stomach of a person reduced to a low state of debility through -a severe inflammatory disorder, remains for a long time exceedingly -sensitive, and fails not to evince displeasure when oppressed with -indigestible, or too great a quantity of food. No cause predisposes the -patient to a relapse, or retards his recovery, so much as inattention -to diet. It is a popular error to suppose that the weakness consequent -upon severe illness is only to be removed by rich and substantial -food and wines, and other stimulating drinks. Such indiscretion often -rekindles the disease, or predisposes the system to the supervention of -some other complaint. The change from the sick-room to the parlor diet -should be gradual and progressive. The milk and farinaceous meal may be -varied by degrees to the milder forms and preparations of animal food. -Solids should be given at first in small quantities; the diet should -be rigidly adhered to, and in the change from low to full diet, the -intermediate one should not be skipped over. - -With regard to medicines, in no form of disease is it so important, as -in venereal affections, that they should be continued for some time -after the disappearance of symptoms. Many a relapse of gonorrhœa and -secondary symptoms have occurred through the sudden abandonment of the -means adopted for their cure. - -Exercise forms another important part of management in convalescence; -it should not be suddenly resumed, nor should fatigue by any means be -incurred. Early retiring to bed, and early rising in the morning, tend -considerably to promote and preserve health. Warm clothing is very -essential and necessary for invalids. - -The general signs of amendment are as follows: a reduced frequency -of the pulse, which is always accelerated in acute diseases, the -absence of thirst, a clean tongue, a moist skin, a good appetite, -and refreshing sleep; and, lastly, all these are corroborated by an -improvement in the looks. The improved aspect of the countenance has -always been regarded as a sure criterion of returning health. - - - - - STRUCTURE, FUNCTIONS, AND DISEASES, OF - THE FEMALE ORGANS OF GENERATION. - - -THE female genitals occupy the same relative situation in the pelvis -as the male, but they are an antithesis to each other. The male are -constructed to deposite, and the female to receive; consequently, -in the female there is a conduit or passage, in place of the male -penis, termed the _vagina_, leading to the womb—the receptacle for -the impregnating fluid. The vagina is placed between the bladder and -rectum. Its entrance is marked by doublings, or longitudinal folds of -flesh, called _labia_, between the upper part of which is the opening -of the urethra into the bladder, while below is occupied by the -aperture, passage, or fissure, as above described. At the roof of the -vagina is a fleshy ridge, with a pouting apex or point analogous to the -penis in the male, except being impervious, and called the _clitoris_, -which possesses the power of erection, or rather of becoming -intumescent when excited, and also of furnishing a peculiar secretion. -It is exquisitely sensitive, and believed to be the seat of pleasure -in the sexual embrace. The vagina consists of a very soft, vascular, -elastic, and contracting structure, constituting, when its sides are -collapsed, liliputian rugæ, or ridges, like the impressions left on -the sand by a receding sea. Its surface is lined by a delicate mucous -membrane, which secretes a lubricating fluid. It is this membrane -which is the seat of gonorrhœal discharge, fluor albus, &c.; and it is -also subject to ulcerations and other diseases. From the clitoris is -suspended an inner fold, like a graceful mantle, called _nymphæ_, which -are also extremely sensitive, and appear to serve, as they surround the -urethra, also for the purpose of directing the flow of urine. Under the -opening of the urethra, adherent to the external margins of the vagina, -is a membranous veil, or curtain, with a small central aperture, -called the _hymen_, the presence of which is looked upon as a test of -virginity. After the laceration or dilatation of this membrane, which -takes place through other causes than sexual intercourse, the sides of -it contract, and form little wing-like slips, to which the fanciful -name of _carunculæ myrtiformes_ is applied. - -The subjoined diagram will familiarize the reader with the situations -of the female organs thus far given. It exhibits a sectional view of -the contents of the pelvis, or lower part of the abdomen:— - -[Illustration: - 1. The bladder. - 2. The urethra, or entrance to ditto. - 3. The vagina. - 4. The womb. - 5. The ovary. - 6. The fimbria, and fallopian tube. - 7. The rectum, or lower extremity of the bowel. - 8. The hymen.] - -Much has been said regarding the presence of the _hymen_ in its entire -state. It has been deemed by many to be there placed as a moral -evidence of chastity; but its laceration is by no means an infallible -test of dishonor. In females of feeble or consumptive health, and -others of delicate constitutions generally, the aperture of the hymen -may become dilated from natural causes—from too profuse a flow of the -menstrual flux, from local debility of the part itself, such as exist -in the disease known by the name of the _whites_; and it is sometimes -to be traced to the habit of personal and solitary excitement, as will -be presently alluded to. The membrane is occasionally so dense and hard -as to resist sexual cohabitation; and only upon dividing it by the -scalpel, can intercourse be sustained. At other times it is so fragile -and so vascular as to be torn with the least violence, and profuse -hæmorrhage to follow. - -At the end of the vagina is the _uterus_. It is suspended by what -anatomists call its broad ligaments, which have certain local -attachments. It resembles in shape a pear. It is of a peculiar -structure, capable of great distension, and possessing extraordinary -properties. It is divided into a body, neck, and mouth, and when -unimpregnated, is very compact, and occupies but little space. The -interior is consequently very small, and it secretes and pours forth -at certain periods a sanguinous discharge, termed the _menstrua_. When -conception has occurred, the mouth of the womb, which before was open, -becomes permanently closed until the period of delivery. Connected with -the womb, and constituting a most important part of its machinery, -there are discovered in the roof of the interior of the uterus, two -openings, which are the ends of two tubes or canals, called the -fallopian tubes. - -These tubes have their origin in the _ovaria_, which are two small -bodies encased in the ligamentous band supporting the uterus, and -resembling the testicle of the male; hence they have been called the -female _testes_. These ovaria contain a number of little vesicles of -the size of mustard-seeds, and some of the size of a pea, in number -from twelve to fifteen. These vesicles are denominated the eggs of the -human species. Annexed to the ovaria are observed, surrounding the -tubes, certain _fimbriæ_, which grasp the ovaria during the copulative -act, when prolific, and squeeze out, as it were, one of these little -eggs, and propel it into the uterus. - -Still further to facilitate the understanding of the structures -described in addition to the preceding diagram, the following drawing -is presented. It exhibits a section of the female pelvis, and explains -more fully the relative positions of its contents:— - -[Illustration: - _a_—The bony portion of the pelvis separated from - its junction with its companion. - _b_—The spinal column of the back. - _c_—The bladder. - _d_—The orifice of the urethra. - _e_—The body of the womb. - _f_—The neck of the womb. - _g_—The vagina. - _h_—The rectum, or end of the intestines.] - -The subjoined drawing illustrates the shape and appearance of the womb -detached from the body:— - -[Illustration] - -To particularize: The upper part is called the _fundus_; the widest -part, the _body_; the _neck_, the narrow part; and the lower portion -the _mouth_, or the _os tincæ_. The connexion of the fallopian tubes is -well shown. - -The uterus, or womb, is described by physiologists as being of a -spongy structure—a structure that yields with its enlargement—that -grows with its growth—that resumes the former size when disburdened of -its contents. It is supplied with blood-vessels, is duly supported, -has scarcely a cavity when unimpregnated, but is ever in a state of -preparation for changes. Of conception we shall presently treat. - -There is one function too important to omit in this place, and this -is menstruation—a term indicating a monthly periodical discharge that -escapes, or which is given off, from the womb. At the commencement of -this function, woman is said to have arrived at puberty; but there are -cases of precocity, and others wherein it never occurs, that neutralize -this assertion; besides, menstruation, being deferred or protracted, -depends frequently upon peculiarities of health. As soon, however, as -it occurs, a sensible change takes place in the female economy; and -certainly the other developments of womanhood rapidly follow. - -Menstruation is the monthly discharge of a red fluid, common to females -from fifteen or sixteen years of age to between forty and fifty; and -it is held that, while a female menstruates, she is apt, and capable -also, to conceive. Menstruation is a device of nature to relieve -the system, or to preserve the balance of the circulation, from the -non-fulfilment of her intentions, by the absence of procreation. It -usually continues for four, five, or six days, and seldom exceeds a few -ounces. Its suppression is usually attended with marked ill health, and -many of the formidable complaints of females are attributable to its -irregularities. When anticipated, the female encounters feelings of -depression and lassitude, and exhibits an aspect of feeble health. As -a physiological fact, women, before and after menstruation, are more -desirous of the exercise of sexual privileges, and usually the approach -of the menstrual flow is accompanied by a sexual orgasm. It has ever -been deemed, by almost universal consent, prudent for married persons -and others to abstain from the sexual embrace during that period. If -only on the score of cleanliness, it should be observed; besides, -the likelihood of establishing irritability, and the probability of -interfering with this healthful provision of nature, should deter from -the indulgence. In some countries, menstruating women are excluded from -associating with the other sex altogether, and are even forbid mingling -with household duties. At the close of this article will be found a -series of prescriptions and suggestions for the removal of the various -disturbances this function is liable to. - -The act of connexion is urged by what is called the sexual propensity. -It is accompanied by feelings of the intensest kind: the acme of -enjoyment is at the moment of seminal ejaculation. The penis is excited -to erection by the influx or rush of blood into its cavernous or -cellular structure; the scrotum becomes constricted, and compresses -the testicles; the _vesiculæ seminales_, and the prostate gland, are -also elevated by the muscles called _levatores ani_, as shown in the -preliminary anatomical drawings, whence their use may now be better -understood, as well as those of the perineal muscles, which all more -or less assist in causing the prompt and forcible ejaculation of the -spermatic fluid. - -“In[7] the female, the sense of enjoyment, _sub coitu_, appears to -be principally excited by the friction of the _labia interna_ and -_clitoris_, which are alike in a state of turgescence or erection. -This nervous excitement, as in the male, often reaches such a degree -of intensity that a kind of syncoptic state is induced.” A sense of -contented lassitude follows, and the mind is permitted to return from -the regions of excited imagination to its ordinary quietude. - -The due occurrence of the phenomena just detailed does not necessarily -secure, although it generally succeeds in producing, a prolific result. -Health, aptitude, and one important condition, are indispensable; and -the last is—a positive contact between the male sperm and female ovum. - -There are many remarkable eccentricities that embitter married life. -A union may exist between two parties who are wholly inapt for mutual -enjoyment. The sensations belonging to the sexual act are involuntary, -and are provoked independently of the will: hence, in connexion without -consent, or under feelings of great repugnance, the orgasm is sometimes -aroused; and yet, where the greatest affection and desire prevail, the -male oftentimes unseasonably concluding before the female, is a most -tantalizing source of disappointment. Further allusions will be found -to this subject under the heads of “Sterility,” and “Impuissance.” - -As a preliminary aid to the description of the process of impregnation, -which ensues, the following anatomical draft is presented:— - -[Illustration: - 1. Section of the womb, upper part. - 2. Do. of side. - 3. Do. of lateral covering. - 4. Do. of lower part of womb. - 5. Cavity of the womb. - 6. A prominence leading from the openings of the fallopian tubes. - 7. The vagina. - 8 and 9. Fallopian tube cut open. - 10 and 16. The fimbriated extremity of do. - 11. The pavilion. - 12. The ovary. - 13. Vesicles in do. - 14. Continuation of ovary. - 15. Ligament of do. - 17. Pavilion of right ovary. - 18. Right ovary. - 19. Connecting band.] - -Man, unlike other animals, is not smitten with desire to propagate only -at particular periods. In sentient beings, every season is favorable to -the flame of love. - -When conception takes place, the following phenomena are believed to -occur: The womb is supposed to participate in the excitement of the -sexual act, and at the moment of the orgasm, to receive the male seed, -and to mingle with it a fluid of its own. The whole apparatus of the -uterus appears influenced at the same time,[8] by a kind of electric -irritability. A vesicle, owing to the ovaria being grasped or embraced -by the fimbriæ, escapes from its lodgment and enters the fallopian -tube, where it bursts, and its albuminous drop is conveyed into the -womb. - -From the circumstance of the male semen returning from the vagina after -copulation, it has been doubted whether it was intended to enter the -uterus. It certainly can only enter once,[9] and that when impregnation -takes place; and even then a small portion suffices, for immediately -after conception the mouth of the womb becomes impermeably closed. The -mouth of the womb lies horizontally, like the lips of the face, while -that of the orifice of the urethra is arranged perpendicularly: hence -the presumption, from this better adaptation to transmit and receive, -that the semen to impregnate should enter the uterus. - -This question is mooted, because it has been supposed by some that -impregnation ensues from the vapor or odor of the male seed ascending -to the womb. Contending parties admit, while others deny, that the -seed may be, and has been, detected in the womb of females and animals -having been slain (or who may have died) during or soon after the act -of copulation. Impregnation has followed very imperfect penetration, -such as in cases of unruptured hymen, or of disproportion of parts, -and other causes needless to insert here, by which the supposition -is supported that conception takes place from vaginal absorption; -but it must be remembered that the seed is projected generally with -great force, and that the smallest possible quantity is sufficient for -impregnation; also, that the vagina possesses a constrictive movement -of its own, whereby the seed is carried into the womb. - -After the escape of the “albuminous drop,” the vascular membrane -which contained it is converted into what is called a corpus luteum; -denoting thereby—for it assumes the form, after a while, of a fleshy -nucleus—that the female has either conceived, or has been under the -influence of strong amatory excitement. This _salvo_ must be admitted, -for corpora lutea have been discovered in females where intercourse -was even impossible; but as this detection of corpora lutea generally -corroborates the surmise that so many conceptions have taken place -as there are corpora lutea, it is to be presumed that the exception -must be owing to some similarly powerful mental, as well as physical -excitement. - -When impregnation has taken place, the womb begins to enlarge, and -become more soft, vascular, and turgid—the wonderful process of fluids -assuming the form of solids commences, and within a fortnight an -investing membrane is formed, called the _decidua_ (I will insert as -few names as possible), consisting of two kinds of folds, one lining -the womb, and the other containing the _ovum_ which has therein “taken -root.” The ovum is now a soft oval mass, fringed with vessels, and -composed of membranes containing the early fœtus. See sketch. - -[Illustration] - -When opened, the fœtus appears surrounded by three distinct membranes: -first, _the decidua_; secondly, _the chorion_, the inner fold of the -former; thirdly, _the amnios_. The decidua, as before stated, lines the -womb; the two others cover the ovum or fœtus. After a time the amnios -and chorion become adherent to each other, and a fluid is interposed -betwixt the amnios and fœtus, called the _liquor amnii_. The fœtus, as -it advances, is perceived to be hanging by an organized support, called -the umbilical chord, floating in the liquor before named.[10] - -A draft is here presented of an ovum (a section) of a fortnight old; -and adjoining is one just double its age, where the chord will be -perceived. - -[Illustration] - -[Illustration] - -The following further account may aid the description thus far given. -The ovum, protected by a membrane of its own, called the amnios, -descends into the uterus, where it takes its hold of the membranes -already there—the decidua. It pushes its way before, as exemplified in -the subjoined drawing:— - -[Illustration: - _a_—The decidua lining the womb. - _b_—Do. protecting the ovum. - _c_—The upper part of the womb, where the ovum has become adherent. - _d_—The ovum.] - -The next cut shows the advanced condition of the fœtus:— - -[Illustration: - _a_—The womb. - _b_—The liquor amnii, with the fœtus. - _c_—The chorion. - _d_—The decidua. - _e_—The opening of the fallopian tubes.] - -It will answer no practical usefulness to go through the whole minutiæ -of the various physiological changes that take place relative to fœtal -growth from the hour of impregnation to that of delivery. What has -already been detailed, has been offered to unveil a little of that -singular ignorance that exists generally among non-medical persons -regarding the history of themselves. “Too much learning is a dangerous -thing;” and it will readily be allowed, that a sufficient idea that -certain things _happen_ is oftentimes as useful as to know _how_ they -happen, especially when it belongs to a department requiring much -research, time, and ingenuity, thoroughly to understand, and which may -chance to be foreign to our ordinary pursuit. - -The period consumed in gestation is forty weeks, or nine calendar -months, and the time is calculated from a fortnight after the -suspension of menstruation. Some married ladies pride themselves upon -being able to predict to a day—to tell the precise occasion when they -conceive, and which they date from some unusual sensation experienced -at the particular embrace which effected the important change. Many -medical men disallow that such tokens present themselves, and are -opposed to the belief which many mothers entertain, that nature is so -communicative; and also are skeptical of those extraordinary influences -that every day furnish proofs of maternal imagination, occasioning to -the burden they carry, sundry marks, malformations, and monstrosities. -Examinations have found that the order of fœtal organization is -somewhat as follows: the heart and large vessels, the liver and -appendages, the brain, stomach, and extremities. The determination of -sex and number has hitherto defied exploration. In the early months of -pregnancy the womb maintains its natural position; but as it enlarges, -it also emerges from the pelvis into the abdomen. The moment of its -slipping out of the pelvis is termed quickening, of which most women -are sensible—some fainting on the occasion, others being attacked with -nausea, hysteria, and palpitation of the heart. Quickening usually -occurs between the fourth and fifth month. The fœtus is then called -a child—the law ordaining that, if a woman intentionally procure, or -such parties as may assist in so doing, abortion or miscarriage before -quickening, it is misdemeanor, if after, murder. - -The following diagram is presented to show the situation occupied by -the womb containing the child just ready to enter the world:— - -[Illustration: - _a_—The womb. - - _b_—The vagina. - - _c_—The bladder. - - _d_—The rectum.] - -A full pregnant female, like a very corpulent man, walks very erect: -hence the popular notion that ladies in the one condition, and -gentlemen in the other, do not think meanly of themselves, but strut -along well pleased with their own importance. It is an uncharitable -idea; the attitude is unavoidable, the head and shoulders being thrown -back to counterbalance the protuberance in front—to preserve, in fact, -the centre of gravity, to save themselves from falling. - -_Symptoms of Pregnancy._—Mysterious as is the process of impregnation, -there are many forewarnings which, being generally found correct, -are useful to be known. Great as are the changes that take place -in the female economy during child-bearing, and productive as they -frequently are of serious disturbances to health, it is benevolently -ordained that women who fulfil their destiny of becoming mothers, have -better health to sustain them through their travail than the single or -unprolific. The signs of pregnancy during the first few weeks are very -equivocal. The first probability is the suppression of menstruation, -which is accompanied by fulness of the breasts, the nipples of which -become surrounded by a dark areola; headache, flushing in the face, -and heat in the palms of the hands, ensue; also sickness in the -morning, and probably an accession of mental irritability; various -longings exist—many very ridiculous, others bordering on insanity, -and some indicating great perversion of temper, habits, in hitherto -well-conducted inclinations. - -There are many phenomena more readily discovered by medical men -accustomed to the accoucheur’s employment than describable, that -indicate pregnancy; the sinking of the abdomen, the descent and closure -of the uterus, the altered facial looks, the state of the pulse, &c., -&c. - -From the fourth month, when the womb ascends into the abdomen, the -signs are more positive: the protrusion of the navel, the evident -enlargement of the belly, the tenderness and fulness of, and occasional -escape of milk from, the breasts, clearly point out the occasion. - -About the fifth month, the movements of the child are very apparent to -the mother, when all doubt is removed. - -There are some conditions of female life that assimilate to pregnancy, -and which have defied the judgment of matrons, and even medical men, -but they are rare—such as dropsy of the abdomen, or ovaries, tumors, -accumulations of wind, &c. These, with the suspension of menstruation -(which last is but an uncertain sign, for it may depend upon cold, -fever, or inflammation), have destroyed the anticipations of fond -wives, and have alarmed those who desire not to become mothers. - -_Parturition_ takes place at the end of the ninth month; but children -born at the end of seven will live, and examples are related of some -that have “gone” ten. In France, legitimacy is allowed to children born -on the 299th day of pregnancy. - -_Labor_ is distinguished by a softening of the soft parts of the female -organs of generation, an abundant secretion of mucus, a relaxation -of the mouth of the womb, and a forcible contraction of its body. The -expulsion of the child is effected by pains of a straining nature. -After the birth of the child, the womb contracts to its _normal_ or -unimpregnated size, giving forth a discharge, called the _lochia_, -that lasts for several days, and the breasts immediately furnish the -secretion of milk. - -Previously to entering upon the consideration of the diseases arising -from infection, and for which this book was originally composed, a -word or two may be said upon a condition of the womb, unfortunately -of frequent prevalence, called _prolapsus uteri_, or _falling of the -womb_. Such occurrence may take place with single females as well as -with married, or those who have borne children. It may be held as the -result of debility; and according to the degree of descent is the -inconvenience and suffering. The first drawing exhibits the natural -position of the uterus:— - -[Illustration: - _a_—The vagina. - - _b_—The uterus.] - -A partial descent of the uterus gives rise to painful dragging -sensations about the groins and fundament, and it is usually attended -by the “whites,” or leucorrhœa, a disease of which mention is presently -made:— - -[Illustration: - Partial descent of the uterus. - - _a, a, a_—Vagina. - - _b_—Uterus.] - -If _prolapsus_ takes place during pregnancy, the womb impresses upon -the bladder and rectum, and occasions irritability of both those -structures; but as pregnancy advances, and as the womb ascends into the -abdomen, these inconveniences cease, and the womb oftentimes regains -its tone and position after child-birth. The womb sometimes protrudes -externally, and is a source of great distress. See drawing:— - -[Illustration: - Prolapsus uteri. - - _a, a_—Vagina. - - _b_—Uterus.] - -The treatment in these cases is chiefly mechanical, beside supporting -the general health. The first symptoms, however, demand efficient -attention, and the medical attendant should be made acquainted with -every particular. - -It is a question whether the weakened condition of the supports of the -womb, and the consequent relaxed state of the vagina, are not owing to -the manner in which women clothe themselves. The pelvic part of the -female is kept always in a state of unnatural warmth, from the load -of petticoats and other unnameable female attire. Contrast but the -difference between the simple unlined trowsers of the male and five -or six-fold clothing of the other sex: either the one must yield too -much warmth, or the other must strike too cold. The sedentary habits of -women have of course much influence. - -When retention of urine follows the falling down or partial descent of -the womb, the female should lie on her back, press the uterus into the -pelvis, and urinate in that position. - -The womb, beside becoming displaced, is subject to an _eversion_, or -a turning inside out. Happily, such cases are unfrequent, but any -disturbance of so important an organ demands the promptest attention. - - - - - DISEASES OF WOMEN, AND THE USE OF THE SPECULUM. - - -[Illustration] - -THE introduction of the stethoscope and the speculum constitute two -important epochs in medical science—the former ascertaining, by the -conveyance of sound, disease in the most hidden and inaccessible parts -of the human frame, and the latter bringing to view structures which, -without such aid, are necessarily veiled from our sight. The speculum -consists of an instrument formed of silver or steel, that without -pain or inconvenience is passed into the vagina, when, by a simple -contrivance, it is made to expand and dilate the vaginal passage, and -thereby expose to view the entire canal, together with the uterine -aperture. The usefulness of such a method, whereby disease can at -once be detected, admits of no dispute. It is physically painless; -and if opposed to female diffidence and modesty, its importance and -serviceableness should be balanced against the mental distress such a -procedure may occasion. On the one hand, without its assistance, the -treatment of the disease is at best but conjectural; on the other, by -its aid, it is safe and sure—much suspense and suffering is at once -put an end to. Experience has proved that many local disturbances, -that were believed to have been merely vaginal irritation, have been -discovered to depend upon absolute disorganization of the neck and -mouth of the womb. Deep-seated ulceration has been detected, and -cancerous enlargements; the disease thereby having been exposed, has -had the necessary and successful treatment. In Paris, it is considered -so valuable that a chair, termed a “speculum chair,” has been invented -solely for its use. See engraving on previous page. - -The speculum is now in the hands of every respectable medical man, and -the class of disorders that hold it in requisition are being better -understood, and consequently more successfully combated. In no cases is -it more useful than in secretive irregularities, such as in leucorrhœa, -gonorrhœa, or syphilitic ulceration. Without further comment, these -diseases will be considered. - - - - - GONORRHŒA IN THE FEMALE. - - -THIS disease is rarely so violent as in man, it being mostly confined -to the uterine conduit; in fact, except by the discharge, women are -almost unconscious of its existence, mistaking it, when occurring in -married life, for leucorrhœa. Occasionally, however, the inflammation -is highly acute, and a variety of distressing symptoms ensue. There is -considerable excoriation around, and a swelling of the organs, much -_ardor urinæ_, and the same constitutional disturbance as in the other -sex. - -The medical treatment of both sexes is constitutionally alike; but -the female has to depend more upon local treatment than the male. -Hence the importance of injections. Now here is another source of -difficulty: women are as averse to the use of the syringe as they are -to the speculum; and the consequence is, vaginal diseases are generally -protracted to double as long as they need be. However, as these hints -are likely to be seen only by those who doubtlessly have, and who -indisputably ought, to exercise it, namely, influence over the sex in -persuading them to submit to what common sense bespeaks as most prudent -and expedient, appropriate formulæ for the suggestions just recommended -will be found a few pages hence. Frequent ablution, rest, temperate -diet—the more farinaceous and mucilaginous the better, avoiding -entirely wines, fermented and spirituous liquors, together with mild -(Form 63) aperients and salines, constitute the chief means of cure. -Injections are indispensable. - -I have already alluded to the difficulty of getting female patients -to be their own confessors. If they appoint others, every possible -information should be furnished, and fastidiousness by no means should -supplant the avowal of real facts. Although gonorrhœa in women is -generally less severe than in the male, it is vexingly oftentimes more -lasting; which is easily accounted for, owing to the extent of surface -diseased: whereas in man it is limited to the narrow urethra, and -seldom exceeds an inch or two upward, constituting not one tithe part -of the space morbidly affected in the former. See, however, the formulæ. - - - - - SYPHILIS IN FEMALES. - - -THE principal features of syphilis in women consist of ulcers, -excoriations, warts, and buboes. Women, of course, are alike liable to -all the forms of secondary symptoms. Chancres usually appear _within_ -and _on_ the _labiæ_. In the drawing here given, the labiæ are drawn -aside to expose the ulceration; and they are also found within the -vagina and surrounding the mouth or protuberance of the womb. It is in -these cases that the speculum is had recourse to; and in the Parisian -hospitals every case is subject to such a mode of investigation. - -[Illustration] - -The following three illustrations show what a degree of severity -ulceration and other changes put on. The first exhibits superficial -excoriation extending rapidly, and occasionally a swollen appearance of -the _os uteri_; the second shows extensive chancrous ulceration; and -the last of a tuberculous character, like little hardened tumors. But -for the speculum, these conditions might have gone on to worse, and -led to irremediable mischief: their treatment, independently of local -means, such as injections, &c., would have been prolonged to an almost -indefinite time. The use of styptics is demanded in female as well as -male syphilitic developments, and accordingly the employment of nitrate -of silver, copper, &c., is advised, as already explained. - -[Illustration] - -[Illustration] - -[Illustration] - -The following drawing shows the extent of mischief and annoyance to -the external organs of female generation consequent upon neglect. The -external labiæ are studded with chancres. The thighs, buttocks, and -rectum, are dotted and overspread with excoriations. The person from -whom this sketch is taken was an unfortunate woman of the town. As it -is not my intention to particularize cases, although from my peculiar -province I could fill up as many pages as this book contains, with -details of such histories, I have only to add, by way of summary, that -the topical and constitutional treatment being alike in both sexes, -the only modifications required will be the regulating of the doses of -the medicines, which must be done with reference to the idiosyncrasy, -age, and temperament, of the patient. The frail system of woman is less -able to withstand the dire effects of the disease, or the potent means -for its extirpation, than her stronger brotherhood, and therefore the -abler and more experienced the counsel, the fairer the chance of her -recovery; a hint that the writer feels assured will not be received -by those to whom his pages are addressed, as a vain appeal to repose -confidence in other advice than their own. - -[Illustration] - - - - - LEUCORRHŒA, FLUOR ALBUS, OR THE WHITES - - -THIS is the most prevalent of all derangements of the female economy, -connected with the uterine system; and from its debilitating effects, -induces a train of maladies that tend to embitter personal comfort -more than any other human ill. Leucorrhœa consists of a discharge of -acrid, or bland, but variously-colored mucus from the vagina, differing -in intensity according to the cause and duration. It would be idle -to offer the many arguments set up to prove whence it proceeds, or -to examine the discussions as to whether it is the produce of the -uterine vessels, or the vaginal secretives. That both aid in its -formation is doubtless the case (as the employment of the speculum -has satisfactorily proved); and equally certain that, according to -the amount of irritability existing therein, so depends the quantity -and character of the discharge. It exists in the married and single—in -the moral and unchaste; and therefore the cause should be cautiously -divined, it being evident that other than sexual indulgences establish -this annoying and distressing affliction. It may be fairly conceded -to be a vitiated secretion, depending upon a weakened state of the -local vessels, and, moreover, in particular habits, to be a salutary -evacuation. On the other hand, it must not be denied that it is -oftentimes, where it occurs to persons living _sub judice mariti_, -the result of sexual intemperance, or disease springing from an -indiscriminate indulgence in the same. - -However, as my purpose is more with the symptoms and treatment, the -following may be received as a summary of what occurs, and what should -be done for the removal thereof:— - -In addition to the discharge, which at one time is scanty, at another -profuse, there are usually severe pains in the loins and lower part of -the abdomen: there is a sense of bearing down, as though the womb were -descending and even protruding. The general health of the patient is -disturbed, loss of appetite, excessive languor, a pale and emaciated -look, sleepless nights, dark areola around the eyes, various hysterical -and other nervous affections, and numerous disturbances indicating a -weakened and impaired state of mind and body. Among other causes beside -those alluded to, may be enumerated irregular living, late hours, -mental and bodily fatigue, deficient exercise, impure air, and neglect -of personal ablution. Among the consequences of a long-continued -leucorrhœa, an almost certainty of sterility should not be omitted. - -_Treatment._—In leucorrhœa, where or where not consecutive to -gonorrhœa, depending on loss of tone of the secretive vessels of the -internal organs of generation, the chief indication is to impart -vigor and restore strength, which it is evident depends much upon an -avoidance of those causes that first started the disease. - -Although leucorrhœa bears a strong resemblance to gonorrhœa, there are -points by which to distinguish the one from the other. In gonorrhœa, -the discharge is unceasing, but small in quantity, and is usually -accompanied by inflammatory symptoms; whereas in leucorrhœa, the -discharge is irregular and copious, often coming away in large lumps. - -The treatment of fluor albus is indicated by the degree of severity -present. Where the prominent feature is the discharge, the indication -is to increase the action of the absorbents by restoring the tone of -the diseased surface, and at the same time to strengthen the system. -Where the disease is complicated with weakness and relaxation, -astringents should be given by the mouth, and also administered in -the form of injections. The alkaline solution of copaiba is a very -valuable medicament, and may be taken twice or thrice daily. It may -also be employed as an injection, by adding one or two ounces to a pint -of water, and a teacupful thrown up several times in the day. There -are many domestic remedies, which, from their harmless properties, can -at least do no injury, if they are not productive of good; as, for -instance, a strong decoction of green tea, an infusion of oak bark, or -alum-water; or diluted port wine—all to be used as injections, which, -if it shall so please the patient, may be tried prior to the annexed:— - - Form 64. - -_Chalybeate Pills, for Leucorrhœa, or other Female Sexual Weakness._ - -Take of— - Sulphate of iron 1 scruple. -Balsam of copaiba and liquorice powder—of each a sufficiency to form -the mass, which is to be divided into 40 pills, of which 3 or 4 may -be taken three times a day. - -Or, take of— - Sulphate of zinc 1 scruple. - Extract of camomile 1 drachm. - ” gentian 1 ” - Syrup, a sufficiency. -Mix, and form 24 pills. Dose—two twice a day. - - Form 65. - -_Strengthening Mixture._ - -Take of— - Infusion of bark 7½ ounces. - Sulphate of quinine 8 grains. - Diluted sulphuric acid ½ drachm. - Syrup of orange-peel 2 drachms. -Mix. Dose—three tablespoonfuls twice or three times a day. - - Form 66. - -_Astringent Pills for Leucorrhœa._ - -Take of— - Extract of Peruvian bark 1 drachm. - Gum kino 1 ” - Alum ½ ” - Nutmeg 1 scruple. -Syrup, sufficient to form the mass. Divide into 36 pills. Dose—three -pills three times a day, to be followed by a teacupful of lime-water. - - Form 67. - -_Astringent Pills._ - -Take of— - Alum 30 grains. - Catechu 1 drachm. - Opium 5 grains. -Mix to form 30 pills. Dose—three twice a day. Useful in chronic -gonorrhœa and leucorrhœa. - - Form 68. - -_Astringent Pills for obstinate Gleet, or Leucorrhœa._ - -Take of— - Gum kino 1 part. - Canadian turpentine 4 parts. -Powder of tormentilla, as much as may be necessary to form a mass. -Divide the same into pills of 5 grains each, and take from three to -half a dozen of them night and morning. Continue them for a week or -fortnight. A very useful remedy. - - Form 69. - -_Astringent Injections for Leucorrhœa or Gonorrhœa._ - -Take of— - The compound solution of alum ½ oz. to 1 oz. - Water 1 quart. -Mix. - -Injections may be used two or three times a day. If found to irritate, -they should be diluted with water. Appropriate syringes are to be had; -but the best are those formed by the Enema apparatus. - - Form 70. - -_Astringent Injection._ - -Take of— - Sugar of lead 1 scruple. - Water 1 quart. -Mix. - -Or, take of— - Catechu 1 drachm. - Myrrh 1 ” - Lime-water ½ pint. -Mix. - -Or, take of— - Nitrate of silver 1 scr. to 1 dr. - Water 1 quart. -Mix and strain. This lotion is much, and very effectively, used by the -profession. - -Or, take of— - Sulphate of zinc ½ to 1 drachm. - Water 1 quart. -Mix. -See Forms 11 and 12. - -The remaining diseases peculiar to the female pelvic viscera and -their outlet, are hæmorrhoids, irritability and inflammation of the -bladder, disordered uterine functions, urethritis, or inflammation of -the urinary passage, and, lastly, internal and external irritation or -excoriation. But as these fall within the province of every family -practitioner, to the consultation of whom no morbid delicacy should -prevent a patient, having such in their confidence, from resorting, I -shall conclude this section by appending sundry prescriptions, in order -that, should prudence not direct the sick one or her friends to call -in the advised assistance, help may not be entirely withheld, and in -order that, if the aid offered be not the means of supplying the loss -of a more proficient and skilful director, it may at least be found -mitigatory of these interruptions of health and comfort:— - - Form 71. - -_Pills to promote the flow of the Menstrual Secretion._ - -Take of— - Aloetic pills, with myrrh 1 drachm. - Compound iron pill 1 ” -Mix to form 24 pills. Take two twice a day. - -Or, take of— - Compound galbanum pills 1 drachm. - Socotrine aloes 1 ” -Mix to form 24 pills. Dose—two twice a day. - - Form 72. - -_Injection for the retention of the Uterine Periodical Secretion._ - -Take of— - Liquor of ammonia 10 drops. - Milk ½ pint. -To be used morning and evening. This is a remedy that has been used -by many medical men with very great success. - -There are no means so importantly serviceable as the frequent use of -the warm and vapor bath. - - Form 73. - -_Stimulating Drops to restore the Menstrual flow._ - -Take of— - Compound tincture of aloes 1½ oz. - Tincture of black hellebore 1 drachm. - ” castor 1 ” - ” Lyttæ 30 drops. -Mix. Dose—a teaspoonful in water three times a day. - - Form 74. - -_To relieve entire suppression._ - -Take of— - Compound galbanum pills 1 drachm. - Sulphate of iron 1 ” - Extract of savin 10 grains. - Of black hellebore 20 ” -Syrup sufficient to form 36 pills. Dose—three twice a day. - -All these medicines must be given with great caution. - - Form 75. - -_To check an immoderate flow of the Menstrual secretion._ - -Take of— - Infusion of roses 8 oz. - Tincture of opium 30 drops. -Mix. Dose—three tablespoonfuls three times a day. - -Or, take of the tincture of ergot of rye, a teaspoonful in -water twice a day. - -Or, take of the sesqui-chloride tincture of iron, 20 to 30 -drops in water, three times a day. - - Form 76. - -_For painful Menstruation._ - -Add to a portion of gruel, upon going to bed, 15 or 20 drops of -laudanum. This quantity may also be taken in the morning, and repeated -several days; the bowels in the meantime to be relieved by castor oil. - -The warm hip bath, in these cases, is invaluable. - -Or, take of— - The extract of stramonium ½ gr. - Spanish soap 5 grs. -Mix to form a pill to be taken twice a day. - - Form 77. - -_To allay external irritation.—Sedative application._ - -Take of— - Oil of almonds 6 ounces. - Spermaceti ½ ” - White wax[11] ½ ” - Rose-water 3 ” - Orange-flower water 10 ” -Dissolve the wax in the oil, then add the waters, and constantly -stir till cold. This is an admirable application for irritation or -excoriation of the external parts. It is commonly known as “cold cream.” - - Form 78. - -_To heal Excoriations.—Mild drying ointment._[12] - -Take of— - The oxide of zinc 1 drachm. - Ointment of spermaceti 1 ounce. -Mix. - - Form 79. - -_For obstinate Excoriations._ - -Take of— - Ointment of nitrate of mercury ½ ounce. - Superacetate of lead 1 scruple. - Spermaceti ointment, or cold cream 1 ounce. -Mix. - - - - - EFFECTS OF INCONTINENCE, CELIBACY, AND MARRIAGE. - - -THE past pages relate chiefly to the diseases of the generative system -consequent upon contagion, upon accident, and the ordinary wear and -tear of human life: the following, to the ills that ensue from the -over-indulgence in, and abstinence from, the proper purposes of the -reproductive organs, and the benefits derivable from a fulfilment of -the intentions of their natural functions. - -There may be much good policy and correct feeling in objecting to the -too public inquiry into these matters. The private closet and the -public eye are two very different tribunals, and what may be approved -of in the one is very likely to be condemned in the other. The line of -deciding what shall be communicated and what should be suppressed may -be drawn too closely; and that knowledge which is acquired by stealth -is seldom so practical as that obtained by competition. If, therefore, -the topics herein embraced were to be expunged, and their discussion -prohibited, the afflicted would have no other resource than to apply -to the adventuring and ill-educated empiric, instead of confiding his -troubles to the legitimate professional man. A study, to become useful, -should be general; and it is to be hoped that the prudish reserve which -excludes this kind of investigation from our medical schools will be -laid aside, and truth be obtained by allowable investigation. - -The most moral and chaste, at the age of puberty, are assailed with -feelings and desires, that, though new and unanticipated, yet need -little interpretation when present, and so urgent and imperious, that -if not legitimately satisfied, nature and instinct are not slow in -pointing out a means of gratification. - -In the male, imagination commanding a wider range than in the female, -and fed by associations with, and the usages of, the world, elicits -consequences explanatory of life’s purposes; and the youth having once -experienced, perhaps unsolicited, and possibly during sleep, the agony -of seminal secretion, can rarely withstand the afterward tempting -pleasure of seeking a self-repetition of such solitary indulgence, -which the forbidden union of the sexes, at this early period, may urge -him to. - -Setting aside the selfishness and unmanliness of the vice, it -is important that the wearer of the cap and bells should know -the consequences of abusing a given function by such a means of -gratification. There is no mental passion, or physical exertion, that -produces such temporary nervous prostration as the completion of the -act of sexual intercourse; and it therefore can be easily conceived how -debilitating must be the immoderate indulgence of the practice. Health -consists in a due performance of all the functions of the organs of the -body, and an undue exercise of them is sure to lead to a disturbance of -the economy. - -In ordinary sexual commerce, particular phenomena ensue, the -circulation is powerfully roused, the heart thumps violently, the blood -is driven to the brain, and great mental exaltation is induced, and -instances have been known of death suddenly crushing the transport. -The too frequent repetition of such excitement can not fail to -wear out, and disease the overwrought organs, the heart and brain -particularly, upon the healthy condition of which the health of the -entire frame rests; and hence the diseases of the libertine are usually -consumption, physical weakness, and mental imbecility, all the result -of disordered circulation and impaired nervous power. If, therefore, -such consequences follow a waste of the allotted privileges of man, how -much more severe must they be that arise from nervous exhaustion, that -which transpires from an absolute stretch of an already overwrought -imagination, from, in fact, ideal pleasures, instead of those -springing from the instinctive stimulus imparted by the presence of, -and cohabitation with, woman. I have elsewhere treated upon the sad -and withering effects of self-indulgence in a hygæan point of view. -My object here is to portray the consequences of the like, and the -more lawful, intemperance of sexual cohabitation in a domestic light, -in how far it is destructive to the health and happiness of others, -than the party addressed—the partner of our worldly anxieties, and -the offspring that issue from our union. How striking is the change -of _appearance_ only, much less the positive bodily condition of -married persons of both sexes, within one or two years of their union, -especially if the match be a youthful one. Let any one, even with a -limited acquaintance, recollect such of his former female associates, -whom he knew when single, and mayhap may have indulged with in little -modest pleasantries; let him recall the gay-lit countenance, the ruddy -and prominent cheek, the sparkling and lively eye, the plump and well -filled neck—in fact, let him but compare her then and now, and how -disheartening the change; the same being may be recognised, but it is -the same being only in mind, and not in person. There are exceptions, -as I shall presently show, but this is the too frequent portraiture of -those who embark in precocious hymeneal contracts, and restrain not -the marital privileges. The countenance assumes, when thoughtful, the -careworn aspect; the blanched cheek shows here and there a furrowed -imprint; the lustre of the eye is dimmed; and, to drop from the -figurative to the literal, the collar-bones, hitherto “overlaid with -nature’s plastic moulding,” seem appointed only for union’s sake, lest -the fabric of neck and shoulders should drop in pieces. Mark also -the decayed health and spirits; hear the bitter grief of headaches, -sideaches, nerveaches, and behold, perhaps, the puny offspring “mewling -and puling in the nurse’s arms.” - -The bridegroom wears a sorrowful and thoughtful look. He may possess -all the comforts which few inherit, but like Pharaoh’s lean kine, as -chaff thrown before the wind, their purpose is opposed. - -This may be held as a ridiculous picture, but I defy denial of its -unhappily too frequent illustration in real life. A word or two on the -opposite extreme, _continence_. The reader will observe, in another -page, the remark that every part, be it flesh, bone, or nerve, has -its use. The reproductive organs have theirs; but it is not only for -the propagation of the species—they afford an outlet for accumulated -secretion—they aid in resolving the animal passions—they are the secret -incentive to sexual love, and the bond of union between the sexes. -They give an appetite that, like hunger, must be appeased, or nature -revolts; and the harmony of society falls before the ungovernable fury -of maniacal craving. Health, the source of all happiness, without the -possession of which the world with its beauties would be, for all we -cared, tenantless, materially rests upon a proper and moderate use of -the copulative process. Entire continence, a rarity among mankind, -establishes in both sexes the most miserable perversions of mind -and body. In man, we have instances recorded of mania, melancholy, -apoplexy, and foul skin-disorders. Blindness, deafness, and a host -of evils, some greater, and few less than these just penned. It is -true, continence is, as remarked, but seldom observed, especially -in males, who, being denied sexual commerce, are estranged by the -distressful habit of onanism; and thereby, in some measure, the -enumerated maladies are avoided; but as masturbation, like other vices, -grows with unbounded speed, a train of ills, far more distressful, -await the sufferer, who, in addition, becomes, in the meridian of -life, deprived of the very power he in youth was so improvident of. -Continence in females, which all admit to be the brightest ornament a -woman possesses, is attended with a poor requital; and its prevalence -(to the honor of our countrywomen be it spoken) is truly attested by -the miseries of hysteria, and other nervous derangements, that pervade -the junior and elderly maiden branches of every family, and constitute -so formidable an enemy to domestic felicity. A wide field is open for -comment upon this subject, which is better adapted for the moralist -than the physician. This manual, professing to be but a vehicle for -topics of a professional nature only, the writer apologises for the -digression, and can but express his regret, that public opinion -is unfavorable to the discussion of such matters, which embrace -considerations highly important to a nation, both in a moral and hygæan -view. Continent persons but seldom attain old age; whereas, the married -females, for instance, although exposed to the dangers of pregnancy and -delivery, live generally longer than those who are unmarried or chaste; -and provident married men escape the ills and snares that beset single -_blessedness_, as it is called. Libertinism, on the other hand, in -whatever way practised, is hurtful and destructive to long life. - -Continence may be a virtue, but is not imposed where marriage is -allowable; and then, if deviated from with moderation only, the -greatest amount of health and happiness may be elicited, and the -proper end of it obtained. Matrimony, where succeeded by the birth of -children, powerfully conduces to the health and happiness of women. - -Many female disorders are relieved by marriage. Amenorrhœa and -chlorosis, disordered conditions of the uterine functions, hysteria, -scrofula, skin-affections, numerous nervous disorders, and many local -complaints, yield as soon as pregnancy commences. - -Results should, however, be well weighed, before irrevocable steps are -taken. There are many diseases and structural impediments opposed to -the matrimonial contract. Malformation and mental imbecility should -be held as strong interdicts to the conjugal union. People ought not -to marry before manhood is well developed (the male at least 21 to 23 -years of age, the female 18 to 21). Precocious or late marriages are -injurious to reproduction. The unnatural union of old and young of -either sex with the other, entails its own miseries. A curious estimate -of salacious appetites and power has been drawn up as pervading the -different temperaments. The temperaments, as elsewhere noticed, are -four—the Sanguine, Nervous, Bilious, and Phlegmatic. Persons of the -sanguine temperament are generally of good health, and vigorous in -amorous pleasures. The nervous are extremely susceptible in their -sensations, and generally much given to female society. Combined -with the sanguine, they are capable of great amorous excesses. The -bilious temperament imparts a jealous bearing in all affairs of sexual -solicitude, that detracts from the fondness and affection which so -entwine a woman to a lover or a husband. The melancholic or phlegmatic -person is frigid and apathetic in his amours; and love becomes with him -a secondary consideration to advancement in life. These temperaments -are frequently intermixed, and are much modified by age and health; and -the salacious powers correspond. - -Speculations have arisen among physiologists, as to the effect of -climate and season, as well as age and temperament, on the reproductive -powers. Temperate and warm climates are more prolific in exciting the -copulative desire, than the frigid and uncongenial situations of the -northern hemisphere. The seasons bear a somewhat near analogy—spring is -supposed to be more potent than summer, autumn, or winter, in arousing -the amative propensities, which, like the productions of the earth, -come, as it were, at that time into a new existence. This observation -is borne out by the statistical fact of there being a greater number of -births about Christmas and the new year, than any other period. - -Man, however, is allowed to be omnivorous in _all_ his appetites; -and the uniformity of his sexual greediness is preserved by diet -corresponding to the season, which renders the whole twelvemonth a -perpetual spring. Man, as well as other animals, is, when in a state -of health, capable of procreating upon almost any food. But when there -is debility of the digestive or generative organs, the injury can be -repaired by the use of proper stimulating diet, thereby occasioning due -and sufficient secretions. - -Air, exercise, health, and prosperity, are not without considerable -influences. If seasons are not positively influential, certain it is, -that particular lunar and solar periods are, taken in conjunction with -the state of the body. - -“Morning,” says a French writer, “is the spring of the journey, when -all the functions of the body are renovated.” Others declare, that when -night veils the light of the day, the quietude and secresy thereby -afforded, offer moments most congenial to the gratification of mutual -love. Sexual transports should be avoided after a repast, instances -having been known of apoplexy being induced by the excitement of -connexion being superadded to the stimulative influence of wine and -food. - -Henry II. consulted one Fernal for the infertility of his queen, -Catherine de Medicis. The advice submitted, comprised the following -notifications: Abundant and peculiar nourishment; occasional change of -residence; the allowing several days to elapse between each conjugal -act; and lastly, that the most favorable moment for impregnation was -immediately on the cessation of menstruation. It was not until the -adoption of these hints, that her majesty conceived. - -Professor Dewees, of Philadelphia, enjoins that, for the enjoyment -of marriage and the production of children, matrimony should not be -engaged in, until the body is healthily and completely developed; until -then the most scrupulous continency should be preserved. From the 23d -to the 25th year is the suggested period for the male; from the 19th to -the 21st, the female. These observations apply to Europeans chiefly; -for in India, women become mothers at ten, owing to their early -development. Precocious marriages bring premature decay on the father -and mother, and entail on their offspring, diminutive stature, debility -of body, and imbecility of mind, thus generating consumption, scrofula, -insanity, &c. Well-regulated marriages contribute to social and lasting -happiness, and the prosperity of the nation at large; but ill-assorted -ones, those where the peace of either is infringed by opposing -tempers, or by the after-discovery of hitherto concealed physical -incapacities, present a scene of wretchedness and disappointment to -which death itself were preferable. These remarks might be considerably -amplified; but enough has been said, to induce those who approach -to manhood, to be provident of that which, once lost, is, under all -circumstances, difficult to regain; and those on the eve of embarking -in the most binding and solemn obligation of all human contracts, -marriage, to ponder well, ere they compromise the happiness of others -as well as themselves, by engaging in a compact, they may know -themselves incapable of fulfilling or of efficiently performing; one -from which they can not with honor retreat, and one that, once sealed, -demands a rigid compliance with its recognised duties. - -The gist of the present article may then thus be summed up: That -self-indulgence and excessive sexual cohabitation are hurtful in the -highest degree; that they induce early impuissance, and bring down a -load of menial and corporeal ailments. That premature marriages are -destructive to health and long life, and that weak and sickly children -are the general result where impregnation of the female follows. That -entire continence was never ordained, and is alike productive of -disease. That moderate copulation propagates the human kind, preserves -health, and promotes longevity, and the sexual capability is thereby -retained to the latest verge of senility. - -That it is unnatural and unjust for impuissant persons to intermarry -with those having healthy expectations, and the power of enjoyment; -and that it behooves all who have a doubt as to their own capacity, -to have that doubt removed; but, if rendered evident, to abstain from -shipwrecking their own happiness, or from occasioning disappointment to -others. - - - - - THE HEREDITARY TRANSMISSION OF DISEASE. - - -THE topics of Incontinence, Celibacy, and Marriage, having been -severally considered relatively to their effects on society, viewed -alike also as to their influence on the health and happiness of the -sexes in general, another equally engrossing one naturally presents -itself for inquiry to every thinking and sensible person who may -contemplate, or be about embarking in what the world deems “a serious -speculation,” matrimony, namely, the probability of issue, and how far -the health of the progeny may be influenced by that of the parents. -That conception requires the necessary aptitudes in both man and wife -is indisputable; and that although such capacities are rarely absent, -still all unions are not prolific; hence the inference, that some cause -must exist to account for such infertility. - -It may be local or moral, as elsewhere in this volume explained, which -not being the main purport of this paper, needs no other allusion -beyond the mere reference. The prevailing resemblance between parents -and children in features, form, voice, and even constitutional -peculiarities, is sufficiently well known to satisfy any one of the -similar possibility of the transmission of disease, or sound health. -“It is of great consequence to be well-born; and it were happy for -human kind, if only such persons as are sound of body and mind should -be allowed to marry.” - -We find in Boethius’s work, “De veterum Scotorum Moribus,” that -anciently, in Scotland, if any were visited with the falling sickness, -madness, gout, leprosy, or any such dangerous disease, which was likely -to be propagated from the father to the son, he was instantly gelded; a -woman kept from all company of men; and, if by chance, having some such -disease, she were to be found with child, she with her offspring was -buried alive. The Spartans destroyed all weakly and deformed children. - -Great as the anxiety may be to perpetuate our identities, to create -new objects on whom we may concentrate all our affections and love, -and who, when born to us, so instinctively bind us the more to this -already attractive world, where is the man who does not feel humbled -and mortified at beholding in his anxiously looked-for offspring, -the unfolding of infirmity and disease? We are content to encounter -the ordinary chances of mortality, let but our children bear the -impress of health, and possess the shape of perfect man; but sad and -desolating are the reflections that spring from observing in our -issue the developments of the evils we have nurtured in ourselves. -How many existing beings are there, inhaling the breath of life, in -whom every respiration feeds the flame of disease, ignited by those -from whose loins they sprung, and is hastening them to a premature -tomb. How many are there, secluded from the enjoyment of that, which -being deprived of by some scrofulous, pestilential, or other hideous -deformity, renders them like isolated wanderers on the earth, and for -ever forbids their participation in the main charm of existence—social -intercourse. How many living specimens of human prototypes, in whom -reason is obliterated, or never dawned, drag on an existence inferior -in enjoyment to the forest-hunted beast, or the animal whose life -is yielded for the nutriment of man. And are not the diseases that -involve so calamitous a result, consumption, scrofula, gout, idiocy, -or insanity, traceable in particular families, to the remotest periods -of their ancestral records? And should not then a knowledge of cause -and effect, like that just detailed, induce individuals about to fulfil -one of the purposes to which they were certainly destined, for the -perpetuation of their own race, if only from the pride of human nature, -well to consider the result of such a consummation? The health of -either party is generally omitted among the categories bandied about -preliminary to the completion of the other, though decidedly not more -important, arrangements of the nuptial contract; or if it should not -be, many infirmities, that are well known to descend hereditarily, -are (granted in some cases not premeditatedly, but from ignorance of -such a result) yet carefully concealed. Cutaneous blemishes, incipient -tubercles, or a scrofulous predisposition, which may be likened to the -germes of a fruitful plant sown in a torpid soil, lie in ambush, and -await some genial transplantation to display their productiveness, -which matrimony, by the analogous change which it effects in different -constitutions, speedily encourages. In this manner, other morbid -phenomena are aroused from their lurking place, whether it be in the -brain, the lungs, or the blood, and transferred to those who succeed -us. - -I need not, therefore, waste a line prefatory to, or apologetic of, -the following illustrative definition of health, by which any one -with tolerable acumen may estimate the probable “worth of a life,” -or, at all events, be spared the plea of ignorance, or misplaced -confidence, when taking a step of such importance as wedlock. There are -numerous means of calculating upon the durability of human life, by -an examination of the countenance, the gait, the attitude, the form, -the skin, the temperament, the breathing, the speech, the sleep, and -in fact, to a practised professional eye, there is not much difficulty -in observing some diagnostic mark, if sickness be secreted in the -constitution. The countenance in health varies with the age. Health is -indicated by a plump, not puffy or bloated state of the face, a fresh -complexion, and an absence of that depression around and particularly -below the eye, so observable in persons of sick health. The nose should -not be “pinched,” as it were, at its junction with the face, nor -should there be deep indentations, called furrows, or wrinkles, at the -angles of the mouth or eyes, which rarely are manifested in healthy -individuals, except they be aged through care or time. Many people part -very reluctantly with each succeeding year, and few conform to the -outward symbols of age. The era was when age was honorable; now few -aspire to it, and such is the deception that would be practised, that -the coffin-plate is the only tell-tale. - -If the teeth have dropped out or decayed, the lower jaw will be -observed to be more elevated, the lips drawn inward over the gums, -and the chin and nose approximating each other; the cheek bones will -also be very prominent, and the skin thereon shiny and tightly drawn: -these are pretty fair characteristics of disease, or old age. The -temperaments modify the complexion. In the sanguine, it is florid -and soft; in the bilious, dark and rigid; in the phlegmatic, lax and -pallid; and the nervous is modified by its general union with the two -former. In health, the countenance is expressive of contentment and -gayety, which indicate a happy state of mind, and healthy condition of -body. In ill-health, it is pale and expressive of languor and sadness, -signifying discontent and nervous debility. Where asthma exists, or -other nervous affections of the chest prevail, there is pallidness -or lividity, a worn-down and distressing look, and in consumption, -in addition to the above, there are alternately, on the slightest -exertion, gentle flushings. A bluish tint of the skin denotes some -organic affection of the heart. In dropsy, the countenance is bloated, -or of a waxy puffiness; and in acute indigestion, there is a lividity -of the lips, nose, and cheeks. A slow and cautious step, a bending -of the body, a laxity and flabby feel of the muscles of the arms, -chest, and lower extremities, a tumid abdomen, or a swelling of the -feet and ankles, are no indications of health. Tremulous hands mark -age, nervousness, or intemperance. Hurried breathing, palpitation of -the heart, frequent attacks of perspiration, sleeplessness, are all -symptomatic of weakness, hysteria, or disease. Persons subject to -bleedings, are usually of a waxy paleness, and soft fibre. Allowances -must be made for females during the menstrual period, whose complexion, -at that period, being less clear and fair, is marked by a dark areola -around and below the eyes, the breath is slightly tainted, and a -languor is evidenced in all their actions. A voracious or scanty -appetite, a dry and shrinking skin, a furred and loaded tongue with -indented sides, signify the digestive organs to be deranged. In -long-standing dyspepsia, the nose, feet, and hands, are generally cold. -Emaciation is an infallible diagnostic of disturbed health, and a -bloated state equally characteristic. Fits, gout, rheumatic disorders, -asthma, occasional brain affections, diseases of the bladder, &c., can -not be considered as warranties of health. - -Lastly, with respect to intemperance, the bloated appearance, the -tremulous state of the muscular powers, the fetid breath, and the -sunken eye, sufficiently identify the cause, to arrest all doubts on -the subject. Where intemperance exists in married life, it is the bane -of all comfort and enjoyment; and heaven help the unhappy partner of -such a companion. There is but one consolation, that every indulgence -of this insane practice tends to sap and break up the powers of the -constitution, and hastens the close of such a union. The drunkard -should be reminded, that “some leaves fall from the tree every time -that its trunk is shaken;” and the dreary nakedness of winter is -brought on, long before that season would have commenced in the regular -course of nature. - - - - - IMPUISSANCE, OR IMPOTENCE. - - -UPON pursuing the consideration of the following infirmities of the -Reproductive System, a few prefatory observations are requisite. -Perhaps of all the physical powers possessed by man, few are subject -to so much abuse as the procreative organs—certainly none are more -required to be, in a hygiænic point of view, held in a sounder -condition of health, for upon their tone and perfect structure hinge -the happiness and perpetuation of the human race. In this age of luxury -and sensuality, however, the world seems untiringly hunting after, and -more or less obtaining, sexual gratification. There can be no doubt, -that a greater amount of this species of sensual enjoyment is indulged -in before manhood arrives, than can be obtained when man should be -in his vigor. The writer is not insensible to the many alluring -publications upon this topic, the end and aim of which are not, -honestly, to afford relief to the diffident sufferer, but to add to -his misery, by draining his pocket. Of legitimate publications, alas! -there are but few, for it appears that qualified medical men have, from -some prudish or other such notions, kept aloof from entering the lists. -Were it otherwise, many an unfortunate victim might be spared from the -avaricious clutch of the empiric; but invalids, from such a knowledge -of the absence of fair and honorable references, are obliged to seek -(or despair of) relief from the unworthy class in question. How far the -tendency of the present work may lead to a reformation, is left for the -reader to decide. The novelty of the present compendium may subject -it to invidious suspicion; the author but invites comparison, feeling -convinced that the contents best bespeak its legitimacy and usefulness. - -“Increase and multiply,” is the scriptural text. “Plant trees and -beget offspring,” is the apothegm of the Magi. The perpetuation of -the species being, with the great Designer of the universe, an object -of the first interest, all living beings are mentally and physically -formed with a view to this great end. - -In the human species, procreation is effected by a congress of the two -sexes, and a variety of organs are provided, upon whose condition the -due performance of coition mainly depends. The male is destined to -furnish a peculiar fecundating secretion, and is accordingly provided -with glands to prepare such fluid, and a conduit to convey the same -to its proper destination; while the female, being the recipient, -possesses an organ capable of effecting a mysterious yet specific -change upon the fluid so deposited: a failure, therefore, in any of the -structures alluded to, is followed by impotence or sterility. - -Impotence implies the incapability of sexual intercourse; sterility, -the inability of procreation; the causes of either of which may be -deemed organic, functional, or moral. The following section will be -devoted, firstly, to its consideration in its relation to the male. - - - SECTION I. - - IMPOTENCE AND STERILITY OF THE MALE. - -WHERE the hindrance to cohabitation arises from organic defect, -congenital malformation, or diseases of some of the organs of -generation, the disqualification may generally be considered absolute -or irremediable. It is remarkable, however, to what extent mutilation -or disease may occur, without total annihilation of the procreative -powers; the smallest remnant of the penis, for instance, capable of -entering the vagina, provided the testes be sound, being sufficient for -impregnation. - -A learned lecturer on medical jurisprudence gives it as his opinion, -that the smallest quantity of seminal discharge, deposited in the lower -part of the female generative apparatus, _provided the female be apt to -conceive_, is sufficient for impregnation: and it is astonishing how -_minute_ a quantity of this plastic agent is necessary for that purpose -in some species of creatures. Spallanzani took three grains by weight -of the male fluid of the frog, and mixing it with seventeen ounces of -water, found that impregnation of the eggs was produced by as much of -this exceedingly weak mixture as would adhere to the point of a fine -needle. - -Although, in human formation, it is not essentially necessary that the -male material should be deposited in the upper part of the vagina of -the female, yet there is little doubt that the deeper entrance of this -substance conduces to impregnation.[13] - -Malformation of the genital organs has already been stated as a cause -of impotence. Such cases furnish much uneasiness at first, but are -easily relievable. I have met with many instances, where consummation -has been prolonged from months to years, which a slight knowledge of -the functions of the parturient organs might have relieved in a few -days; and with respect to the latter, it may be pardonable to mention -that, as the husband should be the first to instruct his companion in -what is to be expected, but little disappointment will be experienced, -except with the vicious and unworthy. - -There is room for much ingenuity in these matters; and as marriages are -made for better or worse, there exist powerful inducements to resort to -the contrivances of the ingenious and humane. - -The following case of malformation fell under my own observation; the -adjoining delineation is a true picture of the circumstance. - -[Illustration] - -The penis, _b_, at its under surface, was adherent, from birth, to the -scrotum _c_, consequently, when erection ensued, it presented the form -of a half circle; the urine escaped near the root of the penis, _a_. -The penis itself was impervious, but sensible to the amative passion. -The gentleman submitted to a division of the fold which united the -penis with the scrotum, which former, on being thus released, assumed -its proper position; sexual congress was thereby attainable, and during -erection the orifice of the urethra was drawn sufficiently up to allow -of the ejection of the semen into the vagina. Of the ultimate result I -have yet to hear. - -[Illustration] - -It may appear almost incredible, that the sketch here presented can -be a true one of the penis and testicles of a young man upward of 19 -years of age. No less was it a source of wonderment to myself than it -may afford a doubt to others. I carefully examined the individual, and -saw him urinate; the stream was certainly small, but surprisingly large -for so minute an organization. He was quite unconscious of amative -feeling; the testicles were distinctly perceptible by the finger, but -they certainly were not larger than cherry kernels. The young man, in -other respects, preserved the male attributes; he had a slight beard, -and his voice, though not powerful, was by no means effeminate. I had -several interviews with him, and then lost sight of him. - -I have elsewhere portrayed a relaxed state of the testicle, called -varicocele: the accompanying draught exhibits the same in an aggravated -form. The patient possessed but little amative power, and had also -a thickened condition of the prepuce, which produced a perfect -_phymosis_. The case, however, under treatment became considerably -relieved. The phymosis required a division of the prepuce, an operation -productive but of little and momentary pain, or rather twinge, and -healed in a few days. Children are sometimes not procreated for want -of sufficient erectile and consequently penetrative power of the male -organ. Much and often needless misery results from this infirmity. - -[Illustration] - -The loss of erectile power is occasioned through more causes than one. -Erection ensues independently of the will or imagination, as instanced -on awaking in the morning—the cause is most probably a distended -bladder; the phenomena may be a sympathetic irritability of the muscles -of the perinœum, especially the erectores; there is a general pelvic -disturbance, the nervous excitement is increased, and the rush of blood -(obedient to that excitement) is sent to the penis: such, I believe, -is the sympathy between all these structures. The will exercises the -same, and the results of the imagination do not materially differ; -consequently, where the mind fails in producing these effects, local -excitants may be found to supply its office hence the usefulness of art -in combating the eccentricities of nature. The mere handling of the -testicles kindles desire, and in like manner, stimulatives applied over -the scrotum generate amative heat. - -A curve of the penis is sometimes an obstruction to connubial -intercourse; this arises from adhesion or obliteration of the cells of -the _Corpora Cavernosa_ on one side only, preventing the uniform flow -of blood into those structures, and consequently the equal distention -of the penis. The curve is of course laterally, and occasions in the -act of coition pain to both parties, or the power of penetration is -insufficient. Occasionally this malformation is only temporary, and -consequently remediable. - -_Franck_ gives an instance in which so considerable a portion of the -penis had been carried away by a musket-shot, that when the wound -healed, the organ remained curved, and yet proved adequate to the -performance of its functions. - -An opinion formerly prevailed, that the existence of the testes was -unnecessary for effective copulation; but that is no longer a point -of dispute: their absence, whether natural or artificial, invariably -rendering the invalid unfruitful. It is not, however, to be inferred, -that a person is impotent in whom no testicles are discovered in -the scrotum, instances occurring where they do not descend from the -abdomen (their embryotic abode) through the whole period of life. One -testicle, provided it be sound, is sufficient for procreation. Complete -extirpation of the testes, although destructive of procreative powers, -does not extinguish venereal desire. Where the genital organs exist, -but are malformed, or pathologically altered, their virility may be -nullified. - -The most frequent malformation is in the _urethra_, which sometimes -opens in the perinœum—the part marked _a_ in the annexed cut; at -others, on the dorsum of the penis, and not unfrequently under its -surface: so long, however, as the orifice opens in that portion of the -penis which enters the vagina, so that the _emissio seminis_ may be -therein deposited, impregnation may and will take place; and even in -cases where artificial means have been employed to convey the fluid. - -[Illustration] - -A contracted state of the prepuce, its adherence to the glans, or that -condition of it termed phymosis, form impediments to the emission of -the semen which can only be removed by an operation; and if that be -neglected, the evil continues through life. - -Among the diseases which occasion sterility in the male, those -affecting the penis and those incident to the testicles may be -enumerated. With regard to the former, there often exists an excess -or deficiency of muscular or nervous energy, inducing _priapism_ -or permanent erection in some instances, or paralysis or permanent -flaccidity in others. In _priapism_, the erection is so vigorous, -and all the parts so distended, that the semen can not pass into the -urethra; while in _paralysis_, from some inaptitude of nervous or -muscular powers of the genital organs, the _corpora cavernosa_ receive -but a limited supply of blood, insufficient to create erection, or -provoke a seminal discharge. - -Strictures of the urethra are among the barriers to sexual intercourse; -but happily, only in extreme cases, where the urethra is all but -closed, so as to oppose the passing of the finest bougie. - -The testicle is subject to a variety of diseases, wherein such a -relaxation or obliteration of its structure ensues, that the seminal -fluid is no longer formed: and where both testicles are alike affected, -sexual desire is most usually wholly extinguished—the smallest portion, -however, of either gland remaining uninjured, may still be capable of -secreting semen sufficient for impregnation. - -Impotence may follow accidents to the testicles, such as produced by a -bruise; or even a testicle, which shall have become inflamed from clap, -shall become so chronically hardened as to be useless. Bruising the -testicles was the mode adopted by the oriental courts for destroying -masculine efficiency in the attendants of the harem. - -There are certain conditions of health in which, although the genital -organs may be perfect, yet, owing to some constitutional frigidity, -there is an incapability of erection. The offspring of too young, or -very aged, infirm persons, or of those worn down by debauchery, are but -too common instances. - -The appearance of persons of this temperament is thus described by -a French writer: “The hair is white, fair, and thin; no beard, and -countenance pale; flesh soft and without hair; voice clear, sharp, -and piercing; the eyes sorrowful and dull; the form round, shoulders -narrow; perspiration acid; testicle small, withered, pendulous, and -soft; the spermatic chords small; the scrotum flaccid; the gland of the -testicle insensible; no capillary growth on the pubis; a moral apathy; -pusillanimity and fear on the least occasion.” - -The most frequent cause of impotence, at that period of existence when -man should be in the zenith of his procreative power, is in a general -weakness of the generative organs, induced by too early an indulgence -in coition, the pernicious and demoralizing crime of masturbation, or -the abuse of venereal pleasures. In these cases, erection will not -take place, or but feebly, although the mind be highly excited by -lascivious ideas. The erector muscles are paralysed from over-use, -and the semen, if any is secreted, from the lax and withered state of -the testes, is clear, serous, without consistence, and consequently -deficient of prolific virtue. Sometimes there is a want of consent -between the immediate and secondary organs of generation; thus, the -penis acts without the testicles, and becomes erected when there is no -semen to be evacuated; while the testicles secrete too quickly, and an -evacuation takes place without any erection of the penis; the latter -disappointment is of extensive prevalence. - -Impotence is sometimes occasioned by particular diseases during their -continuance, such as nervous and malignant fevers; while, strange to -relate, an opposite effect is sometimes produced by other diseases, -such as gout and rheumatism, hæmorrhoids, &c.; and instances are on -record, that others produce such a change in the constitution, that an -impotent man may find himself cured of his impotency on their cessation. - -Of all the functions of the animal economy, none are so subservient to -nervous influence as those of generation, which, when the organs are -perfect, and respond not to the natural application of them, the cause -may be classed among those impediments termed moral. - -As the parts of generation are not necessary for the existence or -support of the individual, but have a reference to something else in -which the mind has a principal concern; so a complete action in those -parts can not take place without a perfect harmony of body and mind, -that is, there must be both a power of body and disposition of mind; -for the mind is subject to a thousand caprices which affect the action -of these parts. - -As these cases do not arise from real inability, they are to be -carefully distinguished from such as do; and, perhaps, the only way -to distinguish them, is to examine into the state of mind respecting -this act. So trifling often is the circumstance which shall produce -this inability depending on the mind, that the very desire to please -shall have that effect, as in making the woman the sole object to be -gratified. - - - SECTION II. - - IMPOTENCE AND STERILITY OF THE FEMALE. - -A FEMALE may be impotent, and not sterile; and sterile, but not -impotent. Impotence can only exist in the female, when there is an -impervious vagina; but even this condition does not necessarily infer -sterility, many cases being recorded, where the semen, by some means -or another, through an aperture that would not admit a fine probe, has -found entrance to the vagina and occasioned impregnation. - -Impotence may arise from a malformed pelvis, the absence of a vagina, -adhesion of its labia, unruptured hymen, or one of such strength as -to resist intromission. In the two former instances, sterility is -irremediable; but art, and indeed nature, may overcome the latter -impediments. - -Were these pages intended only for the surgery, instead of the -public, the annexed wood cuts would be unnecessary, medical men being -conversant with the inconvenience in question; but all the world not -being blessed with similar anatomical information, the sketches are -presented. The upper one represents the relative situation of the -female urethra (1), and the contracted orifice of the hymen (2). -In the cases of hardened obstruction, where the hymen assumes an -almost cartilaginous texture, the attempts at marital consummation -are fruitless, and often give rise to severe local inflammation. The -infirmity, on the other hand, is easily and painlessly removable by -surgical skill. The lower drawing represents a hymen with two apertures -(2), which, if broken down by violence, leaves a troublesome lacerated -wound. The surgeon’s assistance is indispensable. - -[Illustration] - -[Illustration] - -Where hermaphroditism exists, the sex is usually more masculine; it is -a vulgar error to suppose that the two sexes exist entire, and that -they are capable of giving and receiving the offices of married life. -The present sketch is merely introduced to show the more frequent -malformation. - -The penis exists, but has no urethra: below is an opening resembling -the vagina of the female, which is but of short length, at the bottom -of which (in fact, the perineum) the urethra opens. The testicles are -entire, and the individual from whom the draft was taken possessed -somewhat the desire of the male, without the capability of penetration: -the penis, when excited, from its attachment to the lips of the -imaginary vagina, and also from its contracted form, presenting merely -a kind of bulbous tumor. Even where hermaphroditism more closely -partakes of the female, conception never takes place; hence all such -parties are sterile. - -[Illustration] - -Nature, as if to atone for denying to some the delights of maternity, -has been occasionally doubly bountiful to others. The annexed drawing -exhibits a section of a double uterus. Cases are on record, where both -have been impregnated. - -[Illustration] - -In the instance of a deceased married female, that fell under my -observation, the uterus or womb presented the following appearances: -The usual cavity was discoverable, but it was filled with a -_cheesy_-like substance, and also there were some ulcered-looking -caverns filled with the same material. This female, while living, -endured continued pains in the uterine region, was insensible to -marital physical enjoyments, sterile, although a wife several years, -and the constant sufferer from a vaginal discharge. Her death was -consequent upon a severe cold that ended in consumption. - -[Illustration] - -Leucorrhœa is often attended with barrenness; at all events, it is very -debilitating, and thus impedes conception. A notion once prevailed, -that women who did not menstruate could not conceive; it has since been -disproved, except in those instances where menstruation never occurred: -a single monthly discharge indicates an aptitude for conception. It is -observed that barren women have very small breasts. Women who are very -fat are often barren, for their corpulence either exists as a mark of -weakness of the system, or it depends upon a want of activity in the -ovaria: thus spayed or castrated animals generally become fat. The same -remarks apply to the male kind, who are outrageously corpulent. There -are many other peculiarities in matrimonial life, fertile subjects -for speculation; such as, for instance, the lapse of time that often -occurs after marriage before conception takes place, and the space -between each act of gestation; the solution of which may be, that these -occurrences are modified by certain aptitudes, dispositions, state of -health, &c.; the same may explain why persons have lived together for -years in unfruitful matrimony, and who yet, after being divorced, and -marrying others, have both had children. - -It is not always that the most healthy women are more favorable to -conception than the spare and feeble. High feeding and starvation -are alike occasionally inimical to breeding. The regularity of the -“courses” appears principally essential to secure impregnation; and the -intercourse is generally held likely to be the more fruitful that takes -place early after that customary relief. - -Women in health are capable of bearing children, on an average, for -a period of thirty years, from the age of fifteen to forty-five; -but their incapacity to procreate does not deny them the sexual -gratification, it being well accredited, that women upward of seventy -years of age have been known, who have lost but little of the amative -inclination and enjoyment which they possessed in their early days. Men -certainly possess their procreative power to a longer period, it being -common for men to become fathers at eighty, ninety, and one hundred—old -Parr becoming a parent at the age of one hundred and thirty. Women -rarely fall pregnant beyond fifty. - -Some females endure intense pain during coition, so as to occasion -fainting or great exhaustion. Such suffering is usually traceable to -internal ailments—such as _piles_, _fistulous_ _openings_ between -the _rectum_ and _vagina_, _ulcerated wombs_, _vaginal tumors or -abscesses_. Cases continually present themselves, where, on the removal -of the cause, the effect is cured. - -The number of children that women have individually given birth to is -very variable. It is attested, among a collection of facts of this -nature, that one female gave birth to eighteen children at six births; -another, forty-four children in all, thirty in the first marriage -and fourteen in the second; and in a still more extraordinary case, -fifty-three children in all, in one marriage, eighteen times single -births, five times twins, four times triplets, once six, and once -seven.[14] Men have been known to beget seventy or eighty children in -two or more marriages. With regard to the average proportion of male -and female births, it appears that the males predominate about four -or five only in one hundred. The average number of children in each -marriage is, in England, from five to seven. - -To a continual irritability of temper among females may be ascribed -infertility. Independently of ever fostering domestic disquietude, it -produces thinness and feeble health; and, where pregnancy does ensue, -it most frequently provokes miscarriages, or leads to the birth of -ill-conditioned and puny offspring. - -Perhaps one of the most indispensable and endearing qualifications of -the feminine character is an amiable temper. Cold and callous must be -the man who does not prize the meek and gentle spirit of a confiding -woman. Her lips may not be sculptured in the line of perfect beauty, -her eye may not roll in dazzling splendor, but if the native smile be -ever ready to welcome, and the glance fraught with clinging devotion, -or shrinking sensibility, she must be prized far above gold or rubies. -A few moments of enduring silence would often prevent years of discord -and unhappiness; but the keen retort and waspish argument too often -break the chain of affection, link by link, and leave the heart with no -tie to hold it but a cold and frigid duty. - - - SECTION III. - - TREATMENT OF IMPOTENCE. - -IN venturing upon this part of the subject, it will be as well, first, -to distinguish those cases that are curable from those that admit of no -relief. Among the latter may be enumerated all those arising from an -original or accidental defect in the organs of generation. Where, also, -old age is the cause, little is to be done: medicines are of no avail, -and temporary stimuli not unfrequently worse. - -That certain medicaments, aliments, and so forth, do possess an -_aphrodisiac_ power, is not to be denied; but when adopted by those -weak beings, whose bodies are either worn out by age or excess, and who -pin their faith to such restoratives, the little remaining sensibility -in their frames, the source of life and energy, can not sustain the -shock of reaction; and the result is, total annihilation or death. - -From what has already been stated, it will be perceived, that the mind -exercises no inconsiderable influence over the functions of the organs -of generation: and as the state of the mind depends upon the particular -circumstances under which it may be placed, any attempt to establish a -code of instructions, applicable to every instance in which a sportive -fancy, or disturbed imagination, constituted the prevailing cause, -would be abortive, and might be considered as pandering to a vicious -and depraved appetite, whereas the object of this treatise is only to -encourage the diffident, to assist the afflicted, and render a service -to those legitimately deserving it. - -As excess in sexual indulgence impairs the generative power, no less -injurious may entire abstinence be considered. The due exercise of an -organ tends to its perfection, as the neglect or misuse of it, to its -impairment. Besides, there is not any wonderful virtue in abstaining -from the proper use of the sexes. Why, in the name of morality, were -such powerful impulses and desires bestowed upon us? Why were such -wonderful organizations given to us, if they were not originally -designed to be used by every one who is possessed of them? Society, -in its present form, is not perhaps constructed with a philosophical -regard to our own natural instincts, and our own original rights. - -Among the causes that induce _impuissance_, or that distressing -condition known under the cognomen of _nervous debility_, there is -not one more reprehensive than the unworthy and pernicious practice -of self-abuse. It is much to be regretted, that some medical writer, -of talent and estimation in society, has not turned his attention to -the subject, and given the influence of his name in denouncing to the -world the misery and devastation which are the unerring consequences of -this sordid and solitary vice. It is indeed an unpleasant and thankless -task; and there probably exists in most minds, an unwillingness to -enter upon a subject in which there is so much difficulty in selecting -language sufficiently appropriate to exhibit the folly in its true -colors, without offending the ears of the chaste and virtuous. - -But a question of such paramount importance should not be sacrificed -to any false and prudish notions of delicacy; I shall therefore offer -such observations, as I may think calculated to check the progress -of a vice, that has done more to demoralize the human mind than the -whole catalogue of existing causes besides. It may be deemed an -exaggeration, when it is stated that full three fourths of the insane -owe their malady to the effects of masturbation: but the assertion is -corroborated by one of the first writers on medical jurisprudence, -and is fully borne out by the daily experience of proprietors of -lunatic asylums. The practice of self-abuse usually has its origin -in boarding-schools, and other places where young persons congregate -in numbers; and there are few of us who may have observed the vice -practised, although it may be unpleasant to avow as much, that could -resist the contamination. - - “One sickly sheep infects the flock, - And poisons all the rest.” - -And thus it is, though ninety-and-nine be pure and spotless as -the driven snow, if the hundredth be immoral, the poison is soon -disseminated, and the whole flock become initiated into a vice, which, -if indulged in, will blast their intellectual faculties, and probably -consign them as outcasts of society; rendering them slavering idiots, -or the inmates of a lunatic asylum. It is not only in private schools -that this sin rages, our public foundations and colleges are not exempt -from it. The heads of our universities are particularly scrupulous -in driving from their neighborhood the frail fair, lest they should -contaminate the votaries of learning; while a vice far more degrading -in its practice, and infinitely more baneful in its effects, rages -within the very sanctuaries of classic lore. Many a brilliant genius -has sunk into fatuity beneath its degrading influence. Loss of memory, -idiocy, blindness,[15] total impotence, nervous debility, paralysis, -strangury, &c., are among the unerring consequences of an indulgence -in this criminal passion. I need not bring a greater proof of the dire -effects of an indulgence in the practice of masturbation, than the -deplorable state of mind to which it reduced one of our greatest poets. - -The treatment of this delusive and mentally annihilating propensity, -falls equally within the province of the philosopher and the physician. -Without a total abandonment of the practice, the case is hopeless; and -he to whom the consequences shall have been portrayed and heeds them -not, is unworthy of our sympathy, but deserves the evils he entails -upon himself. - -Now, as the consequences of all criminalities continue to ensue so -long as the provocative be kept up, it is very evident that, as a -first step toward the restoration of order and health, the cause -must be removed or withheld. The mere will or resolution is seldom -sufficient: virtue, like vice, has its allurements, and those belonging -to the former must be called into requisition as antagonists to the -snares of the latter. Physic can not check bad principles, or bad -indulgences. No method is or can be superior to that full employment -of the mental faculties on noble and intellectual subjects, on objects -worthy the high ends for which Nature has adapted them. And though -the difficulty will be great in inducing new and good habits, to the -exclusion of such as are unworthy and degrading, yet the effectual -accomplishment of such a resolution is not of uncommon occurrence; and -the sufferer may be placed under circumstances where good habits may -be more frequently called into action naturally, to the exclusion of -vicious propensities. The time should be well filled, so as to leave -no room for flying to the various usual sources of amusement that fill -up the life of the thoughtless and gay. Every hour and every minute -should be provided for, so as to exclude the admission of idleness and -sloth, the forerunners of mental and bodily disease. Studies connected -with education should be encouraged. Modern languages have a great -claim on the consideration of all who are engaged in business to any -extent, and are of incalculable use after they have fulfilled the -immediate end for which their culture is here recommended. The various -sciences bearing more or less on the pursuits and employments of -every man, are earnestly recommended to the choice of the unfortunate -victim of sensuality. Geology and botany would call him into the -healthful fields, or fill up his time by his fireside, in studying the -many excellent works on those subjects: the still higher utility of -chemistry, as being made of practical use in almost every business, -and demonstrating the else unintelligible phenomena of a multitude of -natural processes and changes, may be held up as another inducement to -call forth his best energies. - -Travelling, to those who can afford the expense or the time, is one of -the best means of conquering this baneful habit. The numerous objects -thereby presented to the eye of the invalid in the manners, government, -and productions of art and nature, of the countries he visits, are an -incessant source of pleasing and useful excitement, and can not fail, -especially if the traveller be accompanied by an intelligent and moral -friend, to weaken and eradicate the bad impressions of the past. - -To diverge, and at the same time to conclude this part of the -subject, I have only to offer a few remarks relative to the medical -and therapeutic treatment of those cases of impuissance, that -age, disorganization, and total incapacity, do not exclude from -consideration. I have already expressed my belief that generative -imbecility is consecutive to general debility; hence, whatever tends -to improve the latter, tends also to remove the former. The diet, -therefore, should be full and generous, with a liberal proportion of -spices; but all stimulating liquids, such as wine, brandy, and the -rest, should be avoided. - -Bathing, in its various forms, constitutes no unimportant feature in -the treatment; the cold plunging, the tepid shower, the douche, the -warm and the vapor baths, possess their several influences. The various -medicines that come under the denomination of aphrodisiacs, are not -wholly uninfluential, such as stomachics, aromatics, gums and balsams, -oils, musk, opium, cantharides, strychnine, and others; but as their -administration can only be permitted under professional direction, -no real utility can follow any specification or formulary of their -proportions. - - - - - OTHER FORMS OF SEXUAL DEBILITY. - - -INVOLUNTARY seminal emissions are oftentimes very serious, distressing, -and intractable. They may be produced in two ways—from continence, or -by a high degree of morbid irritability or weakness. The latter is by -far the more frequent; for the treatment of the former is obvious, -and generally effectual. The difference between seminal discharges in -persons of full health, and those morbidly weak, is very opposite: in -the former it is consequent upon an erection, followed by an act of -coitus; while in the latter both are absent. The general debility in -the generative system, inseparable from morbid irritability, occasions -both a failure in the erection of the penis, and an inability to -retain the fluid in the secreting organs. There is no doubt that this -disposition to seminal emissions, conjoined as it generally is with -more or less deficiency of the _vis virilis_, is too often owing to the -habit of self-abuse in early age. The testes usually wither in these -cases, and the patient becomes nearly, if not entirely, impuissant. -Sometimes these cases are attended by an excessive irritability of -the bladder, accompanied by pains in the loins, kidneys, &c. Their -treatment consists in taking nutritious and digestible food, to impart -strength and invigorate the constitution. Stimulants are at the same -time to be carefully avoided, except where great languor and lassitude -prevail. Abstemiousness in liquids is to be enjoined. Habits of a -relaxing nature should be avoided; the patient, instead of sleeping -on a soft, downy bed, should lie on a firm mattress; the air of the -room should be preserved at a moderate temperature, and but few hours -should be allotted to sleep; he should pass much of his time in the -open air in a cool atmosphere; taking frequent and moderate exercise, -so that it does not occasion fatigue. Cold bathing is a very important -and essential part of the treatment to be observed; the daily use of -the _bidet_, or the frequent application of a towel, dipped in cold -water, to the testes, applied twice or thrice a day, or the _douche -bath_, will be found of much service. To prescribe formulæ for the -various temperaments subject to this affection would be to transcribe -all the tonics from the pharmacopœia: they are severally useful, but -the various preparations of iron surpass all others. During this -treatment the state of the mind should not be neglected: no lascivious -idea should be for a moment encouraged, nor should the imagination be -permitted to wander over the works of fiction or romance in any way -connected with matters of love. - -It not unfrequently happens that patients affected with these -complaints are apt to despond, and become miserably depressed in -spirits; to remove which, every recreation should be encouraged to -prevent them pondering over their own situation, and, if possible, -to divert the mind from gloomy ideas: lively and agreeable company -should be courted; theatres, concerts, or any other rational amusement -consonant with the principles of the patient, should be visited or -pursued, and by an uninterrupted perseverance in this mode of treatment -for a sufficient length of time, I have seen the most beneficial -results arise. The great art and difficulty in treating these cases -consist in giving tonics to a certain extent and no further—avoiding -excess, whereby we stimulate and produce fever; or depletion, and -induce debility. Early hours, fresh air, exercise, attention to diet, -the shower bath, topical application of cold, with properly regulated -sexual intercourse, are rarely ineffectual in curing the disease. - -I could narrate many instances wherein the sexual desire declined on -the intervention of ordinary illness; any powerful mental solicitude -will suffice, but such a cause is commonly remediable. Where the -cause is traceable to excesses and pernicious indulgences, if not -accompanied by disorganization, hope should not be abandoned; but the -patient should not cling to, or hang his reliance upon, hole-and-corner -speculators, or their advertised specifics. He should consult men -legitimately engaged in the profession, in which, perhaps, more talent -and honor are concentrated, than in any other department of science. - - - - - ON PILES OR HŒMORRHOIDS. - - -AS this disease is generally considered to be of a delicate nature, -and one about which the afflicted are unwilling to speak, we shall -say a few words on them. Piles constitute a disease that may be very -slow or very rapid in its progress. The patient complains of an -occasional itching or soreness at the rectum after an evacuation, more -particularly if subject to constipation, or if he be an irregular -liver: when, after a while, he will be surprised on discovering, -subsequent to some straining effort, a knot of elastic but irregularly -formed tumors, of a size varying from a hazel-nut to a horse-bean, -springing out apparently from the rectum, that in a few days, if they -continue, will become sore, and probably be attended with a discharge -of blood. - -[Illustration: - 1. Rectum. - - 2. Hœmorrhoids. - - 3. Perineum.] - -Another patient will experience similar symptoms, as regards the pain, -swelling, and discharge of blood, except that they will be increased -in severity, and be more transitory in their appearance and stay. -Upon examination, a perceptible difference will be discovered. In the -former instance the tumors will be seen to proceed from the outer edge -of the rectum, and will be found to be covered with the common skin. -Professional men designate this form of the disease “External Piles.” - -[Illustration: - 1. Inner part of Rectum. - - 2. Orifice of Rectum. - - 3. External Piles. - - 4. Internal Piles.] - -In the latter, the tumors are, as it were, squeezed out of the rectum, -and swell in a very short space of time to an enormous size. They -are of a much more vivid blood-red color, and will be found to be -covered only by the lining membrane of the lower gut. These are called -“Internal Piles.” - -[Illustration: - 1. Inner part of Rectum. - - 2. Orifice of Rectum. - - 3. Internal Piles.] - -Now piles are nothing more nor less than _dilated veins_, like varicose -veins in the leg or any other part. The office of veins is to receive -the surplus blood of the arteries, after having parted with that -necessary supply for the nourishment of every structure they are -severally distributed to, and to convey it back to the circulating -organ, the heart—and the mesenteric hœmorrhoidal veins, from their -dependant and confined position, the circulation in and above them -being liable to so many interruptions from the frequent hardened state -of the fæces in the rectum, become distended with blood, which acting -really like a wedge, dilates them in time to the size we meet them. -On the removal of the cause, the blood flows on, and the swelling -subsides, and the patient feels no further inconvenience until a -recurrence of the pressure. After repeated attacks, the veins become -inflamed, and lymph, a sort of defensive mucus, is “thrown out” on the -cellular membrane covering the veins, and becomes organized into an -indurated texture, which increases with each attack of inflammation, -and at last gives them that fleshy appearance which resembles a -specific growth (see annexed cut). - -[Illustration] - -The distinction between External and Internal Piles is as follows: In -both instances the same veins are diseased. In external piles, the -lowermost portion of the hœmorrhoidal veins are dilated, and are thrust -by the outer side of the rectum, carrying before them the common skin, -which dilates and constitutes the external coat of the piles. The -rectum is a portion of gut of four or five inches in length, and of -nearly a uniform width; the lower end, constituting the orifice, is, as -it were, tied round with a contracting and yielding band of muscular -fibres, forming a muscle called the _Sphincter Ani_. It is a muscle -of great power, and, from its connexion with the neighboring muscles -of similar strength, helps to afford that support to the contents of -the pelvis, that otherwise would descend, and be always forming a -projecting tumor. External piles consist, then, of a protrusion of the -hœmorrhoidal vein or veins between the cellular union of the sphincter -with other muscles, constituting, in fact, a hernia or rupture in the -perinœum. Internal piles is that condition of the hœmorrhoidal veins, -where, from their dilatation, they become protruded with the fæces, -when, from the contraction of the sphincter acting like a ligature, -they can not regain their situation until emptied of their contents. -Inflammation soon ensues, and the various changes I have and shall -hereafter consider take place. - -Having stated the cause of piles, namely, pressure on, and thereby -prevention of, the circulation of the blood through the hœmorrhoidal -veins, it follows that persons mostly annoyed with constipation must be -the most likely to be afflicted with piles; hence, free and intemperate -livers, great wine-bibbers, feeble and relaxed constitutions, those, -again, who take little exercise, and pregnant women, and women who have -borne many children, seldom escape them. It is rarely that piles attack -people in the lower class of life, and those who have to work hard for -their livelihood and are much in the open air, which accounts for the -prevalence of this disease in the upper ranks of society. The treatment -of piles is very simple, if proceeded with at the commencement of the -complaint, the grand object being to prevent constipation. An excellent -adjunct to the cure of incipient piles, is the warm bath. Its tendency -to overcome local congestions, and thereby equalize the circulation of -the blood, is well known. The best medicine a hœmorrhoidal patient can -take is Turkey rhubarb, to be chewed freely, or castor oil, in doses of -one or two teaspoonfuls every morning, or some mild electuary, which -should be continued until the piles subside. - -The diet during this treatment should be temperate and laxative. Fruits -should be used freely, and also coarse bread, rye and Indian mush and -molasses; wine and exhilarating stimulants being avoided, and, where -admissible, as much out-door exercise taken as possible. An excellent -plan is also to inject half a pint or more of cold pump or spring water -up the rectum every morning, and suffer it to remain for twenty or -thirty minutes, if possible. Where the piles have been of several days’ -continuance, and are very much swollen, puncturing them with a needle, -and so relieving the tension by evacuating, or at least diminishing -their contents, that the obstruction shall be overcome, is serviceable. -After this, pledgets of lint dipped in cold water, the patient -preserving the horizontal posture, may be applied, or an astringent -lotion may be used. - -Where there is much swelling and inflammation, leeches applied to the -neighboring parts will afford relief. It is impolitic, although some -surgeons recommend it, to apply leeches on the tumor, as the bites -are oftentimes very difficult to heal. Where the piles will admit of -it, attempts should be made to empty them, and press them to their -places, after which a pad may be worn to prevent their descent. In the -commencement of the disease, where there is much heat and itching, a -mild and astringent ointment will prove of considerable utility, and a -wash of powdered opium, dissolved in flaxseed tea, will relieve pain -and soreness. - -A very excellent and practical method in the treatment of piles (the -internal I am now speaking of) is to deposite a pear-shaped bougie or -pessary in the rectum, and suffer it to remain as long as possible. The -wearing of bougies gives no pain or even uneasiness, and the patient -may pursue his or her ordinary occupation without hinderance: the -bougie should be worn from one to several weeks. It affords constant -pressure against and support to the dilated veins, and enables them to -regain their tone and strength; and I have known numerous instances -where a lasting cure has been effected. One of the most alarming -consequences of piles is hœmorrhage or bleeding; and it is really -wonderful what an extensive loss of that fluid a patient can sustain. -Day after day, and week after week, have I known instances of constant -bleeding from internal piles, by which the constitution of the patient -has been almost broken up. This symptom mostly prevails with females, -nor is it limited, although more prevalent, to those who are pregnant. -There is naturally a strong objection on the part of a delicate and -susceptible female to submit to a professional examination, and -consequently it is rarely done, until the urgent necessity of the case, -lest death should ensue, induces the patient to consult her medical -adviser, that he becomes acquainted with the real nature of the case. -Where there is ulceration of the piles, and they are very numerous, -and the bleeding frequent and profuse, the only effectual cure is -their removal. Where the operation is objected to, the next method is -to employ astringent enemata, which must be regulated by the medical -attendant. - -The celebrated Weir’s balsam (248½ Grand Street) has the credit of -effecting miraculous cures. It is a medicine of deserved repute, and -ranks high with professional men. Pitch pills have been extolled. - -Now, where piles, both external and internal, do not yield to the -means suggested, or the patient may not think proper to avail himself -of them, the next best step is their removal; and this is done either -by excision or by ligature. Both processes are safe in the hands of a -medical man, and are neither attended with any pain nor suffering worth -notice. - -Among the annoyances incident to the rectum, is an occasional -preternatural contraction of the sphincter muscle. It is generally the -consequence of local irritation set up by purgatives, by which the -orifice becomes sore and excoriated, which, if not timely relieved, -ulcerates, constituting cracks also, and in process of time a portion -sloughs away, and the adjacent edges unite, and thereby diminish the -calibre of the opening. This disease _may_ be congenital, that is, -the individual may be born with a contracted or narrow sphincter. The -treatment, naturally enough, is to dilate the orifice, which is to be -attempted by the introduction of bougies, after the mode advised for -the cure of stricture, of which this in reality is a form. The cracks -of the sphincter are occasionally obstinate to heal; and the ulceration -will spread within the rectum. When that is the case, the application -of any stimulative ointment will promote a healthy action. - -In inveterate cases division of the sphincter is necessary, which is -to be done with a scalpel, and the incision should be made from within -laterally, by which injury to the perineum is avoided. The operation is -very simple, and by no means painful or dangerous: the cure is perfect. -Appropriate medical treatment must not be neglected. - - - - - PROLAPSUS OF THE RECTUM. - - -[Illustration] - -THIS disease is often confounded with piles; and as patients are -generally diffident in submitting to an examination, any extraordinary -protrusion of piles they denominate a falling of the gut. _Prolapsus -Ani_ is distinguished from piles by the muscular coats of the intestine -descending with the mucous membrane, and forming a bag, like a -pendulum, to the length of many inches; the rectum, in fact, becomes -everted, as we see the finger part of gloves when turned inside out; -and the inner membrane being highly vascular, and the vessels in a -congested state, it assumes a blood-red appearance. The case is here -well portrayed. Of course the disease occasions much inconvenience and -if not abated by appropriate treatment, serious consequences ensue. -Piles are most commonly the cause of prolapsus, when, from the frequent -and hard straining, the gut at last descends, bringing the piles with -it, which will be seen winding around the upper part. When that is -the case, the best treatment is first to apply a ligature round the -hœmorrhoids, and then return them and the rectum together. Where -the gut protrudes from relaxation of the sphincter, the treatment -depends upon local support, for which there are many contrivances.[16] -Astringent injections should also be used to give tone to the parts, -and medicines given to render the alvine evacuations less hurtful. -Children are very liable to prolapsus, but with them a return of the -fallen gut, and a brisk purgative is all that is needed to prevent a -repetition, provided proper attention be paid to the bowels afterward—a -disturbance of the latter being, in most instances, the cause. Where a -rectum has been for a long time the seat of disease, excrescences are -apt to arise, resembling warts: they may be removed without much pain, -and with perfect safety. - - - - - STRICTURE OF THE RECTUM. - - -THE rectum, it is presumed, is known to be the lower portion of the -intestines that leads to the outlet called, in domestic language, the -fundament. Now some writers assert that the rectum answers the same -purpose to the bowels generally, as the urethra does to the bladder, -while others contend that it is a receptacle for the fæces previous -to their expulsion. We are all sensible, I think, that it must answer -both purposes; but it is also evident that it is employed more for -the former than the latter purpose. The moment the rectum is full, -there is a desire to empty it, which is the best proof of its office; -but circumstances oftentimes forbid us, for even hours, obeying the -summons, which establishes its capability as a recipient. Well, the -rectum, consisting of muscular and membranous coats, similar to the -urethra, is alike subject to irritation, inflammation, and ulceration, -and imitatively gives forth morbid and other secretions. The rectum, -from its situation and office, is very obnoxious to disease; and in -addition to those already enumerated, it is extremely liable to become -strictured. - -Neither age nor sex are exempt from this strictural change, although -it more usually selects the grown up and female portion of society. -It is, generally speaking, the consequence of constipation, or -the reverse—diarrhœa or dysentery—or it may follow in the wake of -child-bearing. Piles are a frequent precursor. The ordinary symptoms -are at first a slight difficulty in voiding the fæces, which assume the -form of the passage through which they have to pass, presenting at one -time a flattened tape-like shape, at others a spiral appearance, and -again the natural form, but of very small diameter. - -As the disease advances, the pain increases, upon going to the -water-closet, and after the act may be observed a small or copious -discharge of mucus, or blood, from the anus. If the bowels be -constipated, there is necessarily a great deal of straining during -fæcation, that soon establishes spots of inflammation that rarely -resolve, but run on to ulceration; small lodgments then of fæcal -matter take place in the cellular membrane; and without detailing the -pathological phenomena, it may suffice to say, that sooner or later -the whole rectum becomes diseased, and fistula, with its attendant -miseries, lends a speedy help to close life’s brief pilgrimage. - -Patients afflicted with rectal diseases lose flesh rapidly. From -the constant pain and annoyance they endure, their general health -gets undermined, the digestion becomes faulty, the countenance flags -and looks care-worn, hectic fever awaits the break-up of functional -regularity, and a lingering exhaustion closes the scene. - -Stricture of the rectum is a curable disease; but the less complicated, -the greater are the chances of recovery. The principles of treatment -bear a near resemblance to those for stricture of the urethra. After -having ascertained the situation and size of the contraction, a -proper-sized bougie may be introduced, and suffered to remain as long -as it occasions no inconvenience. The introduction should be repeated -every or every other day, increasing the size of the bougie until the -dilatation be fully perfected. After vigilance is necessary to prevent -a recurrence, and the bougie can not with propriety be entirely laid -aside, or the disease will return with increased violence. There are, -however, cases that require more imperative means, such as the use of -the _bistouri_, an instrument for the division of stricture of the -rectum, which, if the resort be objected to, it behooves persons with -the premonitory symptoms to attend to them, that the operation may be -rendered unnecessary. There are many excellent palliative medicines -that the invalid will derive much comfort from in diseases of the -rectum; and enemata constitute a powerful means of relief. The title of -stricture of the rectum is fortunately more familiar than the disease -is frequent; and what is more consolatory to persons of feeble health, -the complaint seldom extends beyond two or three inches from the -orifice, so that it need not be feared beyond the reach of relief. See -annexed drawing:— - -[Illustration: - 1. Rectum. - - 2. Orifice of Rectum. - - 3. Stricture of the Rectum, with internal hæmorrhoids in - the lower portion.] - -There are some surgeons who state all diseases to emanate from a -disordered liver, a weak stomach, or a “broken wind;” and there -are others in this town who are never consulted but they deem the -use of the rectum bougie indispensable. The limit to structural -disorganization of the bowel is not afforded by stricture; there are, -unfortunately, many diseases springing therefrom, and many totally -independent of such; but their detail here would exceed the titular -object of the book. Enough has been stated to convince any person -teased with any of the enumerated symptoms, that however simple may be -his malady in his own opinion, it is impolitic to overlook or neglect -it. - - - - - THE URINE. - - -WE shall conclude our treatise by a few remarks on diseases of the -urine, to which many are subject. Before proceeding to speak of them, -it is necessary, for a full understanding of the subject, to state, -that the urine is secreted by two bodies called _kidneys_, placed one -on each side of the back-bone, as is shown in the cut. After being -formed, the urine passes through the _ureters_ into the bladder whence -it is voided, as every one knows, occasionally. - -[Illustration: - 1—1. The Lungs. - - 2. The Stomach. - - 3—3. The Kidneys. - - 4—4. The Ureters. - - 5. The Bladder.] - -The following diagram shows the bladder and its muscular coats, and -also its neck imbedded in the prostate gland. The bladder is seen -distended, and, of course, as detached from the body. The kidneys are -also seen—one in its natural state, the other divided to show its inner -structure: the kidneys and their ureters are crossed to save space in -the sketch. - -[Illustration: - 1. The entire kidney. 2. Its cortical, or secreting part. 3. The - papilla. 4. The pelvis. 5. The ureter. 6. The bladder. 7. The - detrusor muscle. 8. The sphincter muscle. 9. Prostate gland. - 10. Neck of the bladder.] - -The bladder and adjacent parts are seen more fully in the diagram at -the top of the succeeding page. - -[Illustration: - 1. Corpus cavernosum. - 2. Bulb of urethra. - 3. Membranous portion of ditto. - 4. Prostate gland surrounding urethra. - 5. Seminal vesicles. - 6. The two vasa deferentia. - 7. The ureters. - 8. The bladder.] - -It is a very common observation with patients, that they never were in -better health in their lives than at the moment of consulting their -medical adviser, except in the very particular malady, such as an -ulcered limb, a teazing cough, a gleety discharge, or an irritable -bladder, that they are seeking relief for; “they are quite well,” they -say, “in every other respect.” When illness attacks an individual, it -does not always announce its arrival by sound of trumpet. It does not -always come on like an apoplectic shock: some minor organization is -generally the first to indicate disturbance in the healthy economy by -even so simple a presage (I will take for example, more especially as -the ensuing remarks bear upon the subject) as excretion of disordered -urine. To resume; the patient will content himself, that the only -fault in his system is the disordered condition of his urine, and -he earnestly seeks for something to touch that particular symptom, -forgetting that trifling as he may fancy it, it is not merely owing to -the office of the kidneys and bladder, but to the blood itself, whence -the urine is formed, and to other circumstances in the economy that -influence it. Therefore, it is not merely the urine which is at fault, -but the state of it is a pretty good indication of the general state of -health; and when it becomes vitiated, the urine is generally, unless -restored to a healthy condition, a forerunner of some more serious -evil. Still there are many variations in the character and quality -of the urine, and each depending upon different causes—some upon a -disordered state of the fluids of the body, some upon one remote cause -or another, deranging the balance of the circulation, and inducing -excessive perspiration, and the like; and certainly not the least -important, nor the least influential, exist in the very structures -that make (as it were) and receive the urine, namely, the kidneys and -bladder. I may observe here, that chymists have detected upward of -twenty different substances, animal and saline, in its composition, -but in a state of complete solution. Of all these component parts, the -most important is an animal product named _urea_, which exists in about -the proportion of one in thirty to the water containing it, while the -other materials taken collectively, water excepted, yield only about -double the quantity of the urea: hence, when the urine is disordered, -its specific gravity[17] is increased or diminished, as the case may -be; according to the abundance of the urea, and the various proportions -of the saline ingredients of the urine, so is the urine thick, thin, -acid, or alkaline, pale, or what is called high colored. The various -conditions of the urine are ascertained by producing chymically certain -decompositions, or by suffering the urine to effect its own changes, -which, on being suffered to “stand,” sooner or later it will. - -Healthy urine is perfectly transparent and of a light amber color; -it yields an odor when warm resembling violets. Its taste (for -pathologists trust not only to sight and smell) is saltish and -offensive. As the urine cools, it throws up what may be said to be a -“urinous smell.” As decomposition proceeds, the urine becomes cloudy, -thick, with shining floating patches on the surface; and lastly, a -thick deposite coats the bottom and sides of the vessel, the whole -giving forth at the same time a fetid ammoniacal exhalation, as is -perceived on entering public urinals. - -The rapidity with which these several mutations occur, affords some -criterion of the healthy or disordered state of the excretion we are -talking about, and hence the usefulness of examining especially the -urine of persons laboring under any disorder of the urinary system and -functions connected therewith. A patient will complain, for instance, -of irritable bladder. The symptoms of that complaint, as far as pain -and frequent desire to micturate exist, very closely resemble those -affections known by the name of “Diabetes,” but which is distinguished -from the bladder affection in question by the quantity and character -of the urine. I purpose herein to enumerate, in as familiar a manner -as is possible, the various disordered states of the urine which my -experience has rendered me familiar with, and to present the same as -heretofore, in the form of cases that have fallen under my notice. - -Now, the urinary disorders that I purpose to collect a description of, -and exemplify, may be thus enumerated:— - -First, where too great a quantity of urine is voided. - -Secondly, where too little is discharged; and also, where suppression -of it entirely occurs. - -Thirdly, those states where the urine deposites a sediment, of which -two kinds are mostly prevalent, namely, the Lithates or Acid, and the -Earthy or Alkaline. - -Fourthly, a brief exposition of the many but less frequent morbid -changes of the urine, in which certain salts and substances, not -existing in healthy urine, are precipitated or held in solution. - -And lastly, to add a few to the number of those already presented -herein, of the infirmities of those organs which excrete the fluid -under consideration, namely, the kidneys and bladder. - - - - - ON INCONTINENCE OF URINE. - - -ALTHOUGH this is not the professional term for the disease I am -principally about to speak of, yet under this head will the reader, if -he be an invalid laboring under a complaint of this character, seek for -a description of his own case. Incontinence of urine implies a loss of -the retentive faculty of the bladder; but there is a species of disease -where micturition is carried to such an extent, that a patient will -attribute his leaky condition to the above cause. Not so, however, -is the case; the urine, in the disease alluded to, is generated or -excreted in great quantity, and the bladder merely fulfils its ordinary -duty. Of the affection known under the title of incontinence of urine, -most persons are aware that it is one of more frequent occurrence in -infancy than in adolescence; but the latter is by no means exempt. -In childhood it arises, in all probability, from drinking too much, -and the bladder becomes, during sleep, overloaded, and runs over; or, -perhaps, from the irritability induced by its distension, becomes -excited to action, and so empties itself, the drowsy state of the child -rendering it insensible to the passing circumstances. - -The infirmity soon becomes a habit, which is often rendered worse by -the means taken to check it, namely, chastisement, which is highly -reprehensible. It is fortunately, however, a disease that wears itself -out as the child grows up; and it may at all times be materially -mitigated by a little care and attention, such as inducing the child -to micturate before going to bed, and even awakening it before the -anticipated time when it usually is attacked with the incontinence. -The last fluid meal, which should be a spare one, should be taken some -hours before retiring to rest; and if the complaint has gained much -ascendency, medicines which give tone to the bladder should be taken. -I have known the malady successfully removed, in a very short time, by -a combination of the sulphate of iron and quinine, and any sedative -extract, such as henbane or hops, given in small doses in the form -of pills. Female children are more susceptible of the annoyance than -males, probably owing to the shortness of the urethra. Every measure -tending to give strength to the child should be used, such as cold -bathing, fresh air, or a change of the same, especially if residing -in the city, to the country. Mechanical contrivances are to be had -to collect the escape of urine, whereby the offensive odor arising -from the continually soiled bed-linen may be avoided, and oftentimes -the fretting consequences of the urine passing over the person, which -induce excoriations and troublesome sores. There are contrivances for -both sexes. Where the disease prevails in mid-life, it is generally -traceable to early improvident habits, and of course is the result -of irritability and debility of the bladder. There are many patients -who can somewhat control the functions of that organ while awake, but -have no power over it when asleep. The treatment depends a great deal -upon the observance of abstemiousness both in eating and drinking: -a perseverance in chalybeate remedies, both taken and administered -internally (I have injected the bladder of a person subject to nightly -incontinence of urine with various tonic preparations, with very great -and permanent relief); the use of the warm bath, whereby the skin is -brought into healthier action (for it is generally arid, and parched -when much urine is voided), which tends to lessen the duty of the -kidneys and urinary system, should be adopted; nor should exercise, -that _pabulum vitæ_ of even all feeble persons, be disregarded. It is -of the utmost importance for the preservation of health, under all the -circumstances in which we may be placed. Escaping from this digression, -I now proceed to follow out the idea of the first paragraph of this -chapter, to treat of those complaints wherein the urine is voided in -excess. There is a disease commonly known by the name of diabetes, -wherein the prominent symptom is a continual aptitude to pass urine, -and in much greater quantities than the fluid consumed as ordinary -drink could supply. This is one form of ailment of this class; but -there is another, happily less inimical to life, and which, in the -order of its frequency and simplicity, should take precedence. It -is that state of health, where the patient is of that leaky habit, -that whatever he takes runs through him, and that very quickly too. -Of course, such a condition must depend upon a seriously-deranged -constitution: hence there is present a perpetual thirst, an entire -perversion of the perspiratory function, and a morbid condition of -many of the phenomena of life. Where this disease springs up in early -years, it becomes a habit proper to existence; and although it may not -seriously disturb the economy of the being so as to lessen the duration -of one’s stay here, yet it furnishes a source of much solicitude, by -depriving us of rest, and shutting us out from society. - -The patient (for such he or she may be truly called, and the complaint -invades both sexes) appears to have a perpetual fever. Such is -the desire for drink, that attested cases record the circumstance -of individuals consuming from _one_ to _two pailfuls_ of water in -twenty-four hours! and I positively know an instance, at the moment of -writing this, of a child, fifteen years of age, consuming during the -night, notwithstanding a plentiful supply of liquids during the day, -a large jugful (two quarts) of water: the quantity of urine excreted -is nearly equivalent. In this case, the perspiration is profuse, and -the child enjoys tolerably good health, with the exception of being -occasionally nervous and hysterical. The case is under treatment, and -the quantity of fluid allowed is being daily diminished. The urine on -these occasions is aqueous, very pale, and of little specific gravity; -the properties of the urine otherwise are not altered. These cases -sometimes exist through life; and if they do not terminate fatally, -they ultimately enfeeble the health, and predispose the patient, or, in -other words, render him less able to combat with ordinary complaints -common to us all, and thereby tend to the break-up of his constitution. - -There are many persons tipplers, not for the love of the specific -liquor, but from being always thirsty; and if we reflect a little, we -shall soon find how inclined we are to encourage the habit. Since the -introduction of tea into this country, what inordinate quantities of -that fluid are consumed by individuals. They must, of course, dispose -of it, after having drunk it: the stomach can not retain it, and it -escapes either by the skin or kidneys, more usually the latter. It is -no uncommon thing for nurses, washerwomen, and other females too, to -swallow nine or a dozen cups of tea at a sitting: they declare it is -their best meal. - -Man is a great deal more careful of the quadruped world than the class -he belongs to himself. He will stint his horse drink, who works as much -beyond his strength as man does under his own, while he, the driver, -will swill till his mouth can scarcely receive another drop. The moral -of a volume might doubtlessly be expressed in very few words, but then -it would not be a volume, and, consequently, would not be purchased or -read; therefore, the proposition herein intended to be presented to -the reader would exist unheeded. It is one thing to observe, that we -all drink too much, or that too much fluids are hurtful to digestion -and other functions, the public require some illustration (which their -own reflection would furnish, if they used it), and hence this expense -of verbosity to prove the fact. As one of the consequences, then, of -too great an indulgence in fluids (I am here speaking of quantity -rather than quality), this form of complaint, wherein the patient is -perpetually desiring to urinate, is decidedly the result; and, as -all complaints have a beginning, this may be considered as the first -step toward setting up the several affections of the kidneys and -bladder hereafter treated upon. How important, then, is the arrest of -this practice. Where the inconvenience thus detailed is present, the -quantity of fluids must by degrees be diminished, the general state of -health must be studied. Dieting and warm-bathing are two sheet-anchors, -if properly applied. All remedies tending to afford strength to the -urinary system must be had recourse to; and where the bladder loses -any of its retentive power, I entertain the greatest benefit from an -injection. - -The next form of urinary disturbance of a proximate nature to the -one just described, is also where the urine is discharged in large -quantities; but, unlike the former, excreted in greater abundance than -the supply. The character of the fluid is also different; it assumes -two appearances, modifications doubtlessly owing to the constitution -of the patient and the severity and length of the disease. It is known -by the name of diabetes: it is happily a complaint the least frequent -of urinary derangements, else, from its obstinacy and difficult -management, the slightest urinary disorder would excite much just dread -and apprehension. - -The forms of the complaint thus vary: In the one instance, there is a -deficiency of the animal matter of the urine, namely, the urea, and in -the other, a superabundance of it. In the former instance the urine -is of a pale color, and transparent, and sometimes like clear water, -with a very faint slight odor; whereas, in the latter it is generally -of a higher color, and now and then so thick as to resemble brewer’s -porter: it is decidedly a disease of great debility. The symptoms are, -a wearisomeness and languor of the whole frame, a dry and crimpled -state of the skin, a sinking, gnawing pain at the pit of the stomach, -the bowels are obstinately bound, while a great thirst always prevails. -The body wastes to a mere skeleton, the discharge of urine being -almost constant, at least every hour, accompanied with a call that -must be immediately obeyed: the leading feature in the composition -of the urine, in addition to the varied presence of the urea, is the -saccharine matter contained therein. It rarely attacks others than -those who have led an irregular life, or else have suffered much from -other kinds of sickness. - -Diabetes is supposed to depend upon a perverted action of the kidneys; -but there is little dispute of its being a malady involving the -whole process of animal economization. The quantity of urine got rid -of in a day has been known to amount to ten quarts; as the disease -continues, the patient becomes much emaciated, the feet swell, and he -sinks into a state of low hectic fever; the urine discharged continuing -all this time to exceed nearly double the amount of nourishment, -liquid or solid, that is taken, has given rise to the idea, that -water is absorbed from the atmosphere through the body. The disorder -is generally lingering, and, unless conquered, at last fatal. The -treatment embraces many remedies—bleeding, emetics, diaphoretics, and -sedatives, are mostly employed. It being a complaint involving the -necessity of constant professional watchfulness, a more lengthened -dissertation upon its peculiarities will but little serve the patient. -My own opinion is, that the invalid must look for recovery—presuming -the initiatory symptoms have been duly attacked and subdued—to careful -diet, fresh air, varied scenery, and cheerful society. Bathing, either -vapor or warm, is immensely useful; and, among the cases that have -travelled across my path (for patients laboring under diabetes, like -any other chronic ailment, generally take the round of the profession), -I have seen much and great good achieved by the frequent employment of -the bath. - -As diabetes is mostly a sequence of some previous disturbance of the -urinary system, it the more behooves the afflicted to heed the first -noticial summons of attack: a handful of water will sometimes quench a -mouldering ember that, suffered to rise into a flame, an engineful can -not extinguish. I may add, there is no cause so destructive to virility -as these drainages from the system through the urethra—an additional -reason why they should be attended to upon their first appearance. - -_Cases where but a small quantity of urine is voided, terminating in -suppression, of urine._—The most popular scientific synonymes for -complaints are but little understood by men really of education; for, -as yet, medical knowledge forms not one of the items of collegiate -lore, and few anticipate sickness to render such acumen necessary. The -term “Strangury,” from the frequency of its occurrence, is uppermost in -most men’s minds; and they use it on all occasions when there happens -an interruption to the process of making water. It is oftentimes -misapplied. Strangury implies a difficulty in voiding the urine, but -it does not include those cases wherein little is voided, because -there is little to void. The affection I am now about to make mention -of, is of the latter description. I have stated that the urine is -subject to a multitude of changes, that the human frame is constituted -to exist under a variety of circumstances, and that occurrences are -daily happening, wherein its integrity is put to the test. Excesses, -termed sensual, and others, which in themselves might destroy life, -are counterbalanced by what may be styled the _safety-valves_ of the -system. A violent fit of purging, perspiration, or micturition, is -often the means of warding off an otherwise fatal blow. The skin, the -bowels, and the kidneys, are severally to be acted upon as emergencies -demand: instance the specific operations of diet and medicines. The -color of the urine is altered by (to give a popular illustration) -_rhubarb_; its odor, by _turpentine_ (taken internally, or from an -inhalation of the vapor of them), and by the well-known vegetable -_asparagus_; and its composition by alkaline and other chymicals. The -function of cutaneous exhalation is augmented or diminished by warmth -or cold; and the action of the bowels is suspended or increased by -innumerable substances, forming portions of our daily food. - -Analogous to these effects, is the result of certain conditions of -ill-health. A patient, laboring under fever or inflammation of any -important organ, will scarcely rid himself of a wineglassful of -blood-colored urine in the twenty-four hours; and there are many forms -of ailments, where the function of separating the urine from the blood, -or even the function of supplying the kidneys with that vital fluid, -are suspended, partially or entirely. Few of us have escaped attacks of -this kind; they are sure to follow long-pursued habits of dissipation, -or even occasional displays of it; and they are often the result -of accidents over which we have but little control. A patient will -complain of a frequent desire to make water; each effort so to do, will -be accompanied with excruciating pain. A small quantity, or a few drops -only, will dribble away, excoriating the passage as though vinegar was -passing over it, and putting on an appearance almost resembling muddy -port wine, or a thick solution or suspension of brick dust: there will -be present much fever and constitutional disturbance. The patient may -have shivering fits, pain round the loins, down the thighs, and over -the lower part of the abdomen. He will betray a readiness to submit to -anything, although conscious that his bladder is empty, notwithstanding -the violent and urgent efforts at straining, which he is continually -being called upon to make, as though his bladder were distended, and -ready to burst. On passing the catheter (I am supposing a severe case, -where retention of urine has at last occurred), not a drop will flow, -and the danger of the disease is thereby made apparent. Except very -severe measures be adopted, which it would be idle here to lay down, -the case is sure to terminate fatally. Instances are recorded, where -that event has been retarded upward of a week, during which time the -patient voided not one drop of urine. - -The absolute cause of the disease is very obscure; but it has a -beginning, and to those only who suffer from a long-continued -diminution in this natural excretion, and who disregard it, is this -picture presented. - -The treatment, in advanced stages of the disease, is strictly -professional; but the warning of the altered character of a customary -evacuation, should not for a moment be disregarded. - -Suppression of urine is very different from retention: in the former, -there is none to excrete; in the latter, its escape is impeded. In the -chapter on stricture, the cause and manner of retention is explained, -and the mode of relief laid down, whereby the invalid himself has -a remedy at hand; but, in suppression, the resource is neither so -ready nor so effectual. It is, therefore, much wiser to notice the -first alteration, and to be prompt in seeking the nearest aid. Every -practitioner is acquainted with such. Although such are not ever -present, even in the most extensive practice, still they do occur; and -much as this mode of frightening a patient may be condemned, knowing -the frequently existing disinclination toward “laying up,” yet, if it -only induce a fellow-mortal to take the tenth instead of the eleventh -hour, one life may be saved, and the writer can well submit to the -disapproval and contempt of the thoughtless and indifferent. - - - - - THE GRAVEL. - - -UNDER the head of this disease may be classed all those urinary -affections, wherein a sandy deposite is observed, after the urine -has stood some time. This sandy excretion varies in its composition, -in the quantity voided, and in its continuance: and it is also often -separated, for it is held generally in solution in the urine as it -comes from the bladder, while in the bladder or in the kidneys; and -hence we find gravel in the kidneys, in the bladder, and in the -urine. Where it is precipitated, or formed in the kidneys or bladder, -it is apt to accumulate, and constitute what is called “Stone” in -those organs. As I have just observed, the composition of this gravel -differs, and differs also at different times in the same individual, -according to circumstances. Stones have been detected that, like the -rolling snowball, gather up, as they increase in size, whatever comes -in their way; and, accordingly, as the deposites are principally -composed of concretions, termed, in chymical phraseology, “Lithates” -and “Phosphates,” stones are frequently found to be formed, first of a -layer of one covering, then of another, and so on. - -Gravel may exist for years without inducing much disturbance of -health, or it may produce serious inconvenience in a very short time. -The urine being acid, holds the salts which it contains in solution; -and, therefore, if the acid predominate, it becomes, through its own -excess, thrown down, when it is detected in the form of red sand; but -if there be an insufficiency of acid, the earths and salts of the -urine are thrown down, and they exhibit their existence in the form of -white gravel. Hence the two names “Red” and “White Gravel.” Acidulated -urine is looked upon as certainly indicative of health, and when in -excess, of a high tone of health; which, as the degree ascends, is -marked by inflammation and fever. Alkaline urine betokens feebleness of -constitution, or interrupted health. High living and an excited life -induce red gravel; irregular, or an impoverished living, with much -mental inquietude and physical exhaustion, establish white gravel. -The fact of gravel being known to exist without forming stone, is no -justification to suffer it to incur even the chance of such a finale. -There is no class of diseases so painful and distressing as those -wherein the function of the kidneys or bladder is interrupted, and the -majority of these affections are ushered in by a derangement of the -urinary fluid. - -_Cause of Gravel._—The cause of gravel is owing to chymical affinities. -The urine, among its other constituents, contains _lithic acid_ and -_ammonia_, which two, in healthy urine, are combined and held in -solution. If any other acid, as may be instanced in expelled urine, -possessing a greater affinity for the _ammonia_ than the _lithic -acid_, be added, the _lithic_ will be thrown down. The same process -takes place when effected in the system, the source of which new acid -is the stomach, which, when in an irritable and feeble state, as in -indigestion, furnishes or abounds with muriatic acid. In like manner, -the urine containing salts, called phosphate of lime, ammonia, and -magnesia, on receiving an additional quantity of ammonia,[18] the -lime, for the less affinity to phosphoric acid than the ammonia, -is thrown down; and hence a salt, bearing its name, is generated, -either to be expelled like gravel, or to feed a nucleus already -existing in the bladder. These chymical changes are produced by the -causes before enumerated. We are subject to an infinitude of laws: -we are perpetually changing, and these changes may fairly be stated -as chymical affinities: it is owing to such, that the absorption of -fluids, and the deposition of substances, which exist more or less in -all derangements of health, ensue—to such, that we resist death, and -to such that we become its prey. Gravel is a disease not so productive -of fear or suffering, so long as it escapes when formed; but there are -so many circumstances that may give rise to the formation of stone, -that sandy urine should always command notice and treatment. A clot or -point of blood, that may have been discharged from irritation of the -kidney or bladder, is often found to form the nucleus of a stone: the -slightest substance, once in the bladder, is apt to form a basis for -accumulation: a pin, a fragment of a bougie, or any instrument, hair, -wood, and numberless other things that have found their way into the -bladder, have given rise to the formidable and distressing complaint of -stone. - -_Treatment of Gravel._—It is not to be anticipated that every person -is prone to excrete gravelly urine, else certain dietetics, that -evidently give rise to the same in particular instances, had better -at once be removed from the list of articles of food, and their use -prohibited altogether; but there are instances where a constitutional -disposition exists in particular families, that is even transmitted -from generation to generation, to calculous diseases, and in those -cases, every precaution should be taken to avoid even their development. - -The antidotes to the disposition to gravelly urine are, exercise, -temperance, and the adoption of all those means that tend to promote -a healthy action of the skin and kidneys, namely, the warm bath—it is -a perfect talisman in these affections—it needs but little eulogy; -the comfort and relief, where relief is sought, afforded on the first -experiment, best bespeak its praise. It is decidedly one of the most -useful adjunctive prophylactic measures we have. - -I have already stated, that disorders of the urine arrange themselves -under two great heads—the acid and the alkaline prevalence. The -treatment is to neutralize the excess of either: the acid diathesis, as -it is called, is considered a less healthy deviation than the alkaline, -and is looked upon as indicative of greater constitutional break-up. -The medicines most in vogue in gravelly disorders are, turpentine (to -increase the formation of lithic acid), sulphuric, nitric, and muriatic -acids; while the antagonists to that form of the disease, wherein -the above are given, consist of ammonia, potass, and soda. The great -object, however, is to balance the health, to allay irritation, and -tranquillize the morbid uproar of the system. Here we have an extensive -field to select from in the class of sedatives. Opium, perhaps, is the -best—the most to be depended upon, its properties being best known; the -warm bath comes next; and lastly, the various tonics and astringents of -our pharmacopœia, of which quinine, uva ursi, pareira brava, achillæ -millefoliæ, buchu, &c., &c., stand foremost. - -Although the lithic acid deposition is the most frequent, still, as the -disease advances, there is a strong tendency to the formation of the -alkaline; and as the remedies for the former are apt to accelerate the -latter disorder, it is most important that the urine should undergo -frequent examination to regulate the treatment. To recapitulate the -substance of this article, it may be stated, that gravel is a disease, -not dangerous in itself, but that it is always the forerunner, although -not always productive, of stone; stone being formed by the collection -and chymical union of the sand itself. This collection takes place -in the kidney, the ureters (the vessels that convey the urine to the -bladder), the bladder, and sometimes in the urethra. The stone so -formed varies in its composition and size, and is one of the saddest -ills that can befall human nature. Hence the importance of watching, -and attending to every urinary disturbance, of which gravel forms a -prominent feature, the treatment of which has been already stated; but -which, as it involves more practised judgment than a non-professional -invalid can be supposed to possess, had better be intrusted only to -professional hands. - - - THE END. - - - - - FORMULÆ - - - Form 1. - -Four to six drachms of castor oil, the ordinary black draught, -a dose of salts, or a dose of Weir’s Compound Pills. - - Form 2. - -The following mixtures lessens the acrimony in making water, -abdues the irritability, and tends to diminish the discharge:— - -Take of— - Carbonate of potass 1 drachm. - Nitrate of ditto 1 drachm. - Mucilage of acacia 5½ oz. - Hydrocyanic acid 10 drops. - Syrup of Tolu 2 drachms. -Mix. Take a tablespoonful in a wineglassful of water twice daily. - - Form 3. - -Take of— - Linseed tea ½ pint. - Spirits of Sweet Nitre 2 drachms. - Battley’s Sedative 60 drops. -Mix. Take three tablespoonfuls, twice or thrice daily. - - Form 4. - -Where it is inconvenient for a patient to carry a bottle about his -person, the following electuary, combining the essential ingredients of -the former two, may be substituted:— - -Take of— - Lenitive electuary 2 oz. - Conserve of roses 2 oz. - Strong mucilage of acacia 2 oz. - Nitrate of potass 2 drachms. -Mix. Dose—Two teaspoonfuls twice or thrice a day. - - Form 5. - -A good combination, that may be taken even in the inflammatory stage. - -Take of— - Cubebs 2 oz. - Carbonate of magnesia 1 drachm. -Mix. Dose—A dessert- or tablespoonful twice or thrice daily. - - SPECIFIC REMEDIES. - - Form 6. - -Take of— - Balsam of copaiba 1 oz. - Powder of cubebs ½ oz. - Mucilage of acacia 6½ oz. - Spirits of sweet nitre 2 drachms. - Battley’s sedative 30 drops. -Or— - Hydrocyanic acid (Scheele’s strength) 8 drops. - Syrup of orange-peel 2 drachms. -Mix. Dose—Two tablespoonfuls, once or twice daily, in water. - - Form 7. - -_Turpentine Pills._ - -Take of Venice turpentine 1 drachm, form it into pills by adding as -much rhubarb as is necessary, and take two, three times a day. - - Form 8. - -_Turpentine Mixture._ - -Take of— - Venice turpentine 1 scruple. - Mucilage of gum arabic 2 oz. - Emulsion of bitter almonds 4 oz. - Syrup of orange-peel ½ oz. -Mix. Dose—Two tablespoonfuls three times a day. Sedatives may be -conjoined with the above preparations, if they produce too much action -of the bowels. To the pills may be added one scruple of Dover’s powder -to the drachm of turpentine. To the mixture, thirty drops of laudanum. - - Form 9. - -Take of— - - Terebinthin chiœ 1 oz. - Extract of rhubarb 1½ drachms. - Camphor 1 drachm. -Mix and divide into pills of 5 grains each. Dose—Three, three times a -day. - - Form 10. - -Take of— - Cahio turpentine } - Balsam of copaiba } Of each, equal parts. - Oil of amber } -Mix, according to art. The turpentine must be dissolved by warmth. The -dose is 30 or 40 drops three or four times a day. This medicine is very -nauseous, but very serviceable in long standing gleets and obstinate -claps. The best way to remove the flavor left in the mouth after taking -turpentine, copaiba, and other filthy medicines, is to chew a piece -of gingerbread or cheese, or suck a lemon, or put some salt upon the -tongue. - - Form 11. - -_Injections to diminish the pain on making water._ - -Take of— - Rose-water 3 oz. - Solution of the acetate of morphine 2 drachms. -Mix. - - Form 12. - -Take of— - Goulard water 3 oz. - Mucilage 4 oz. - Solution of the acetate of morphine 2 drachms. -Mix. - - Form 13. - -_Sedative draught to be taken at bed-time when annoyed with chordee._ - -Take of— - Acetated liquor of ammonia ½ oz. - Camphor julep 1 oz. - Solution of the acetate of morphine 20 to 25 drops. -Mix. - - Form 14. - -Take of— - Dover’s powder 12 grains. - James’s powder 5 grains. -Mix. - - Form 15. - -Take of— - Compound camphor liniment ½ oz. - Laudanum ½ oz. -Mix, to form a liniment. - - Form 16. - -_Injection for the ulceration of the glans penis._ - -Take of— - Chloride of soda 1 oz. - Rose-water 5 oz. -Mix. - - Form 17. - -Take of— - Nitrate of silver 1 scruple. - Distilled water 1 oz. -Mix. - - Form 18. - -Take of— - Calomel ½ drachm. - Lime-water 4 oz. -Mix. - - Form 19. - -_Emetic Powder._ - -Take of— - Ipecacuanha powder 1 scruple. - Emetic tartar 1 grain. -Mix. To be taken in a glassful of warm water, and repeated in twenty -minutes, if it do not produce vomiting. - - Form 20. - -_Iodine._ - -Take of tincture of iodine twenty drops twice or thrice a -day in a little water. - - Form 21. - -Take of— - Hydriodate of potass ½ drachm. - Mucilage of acacia ½ oz. - Camphor julep 5½ oz. -Mix. Dose—three tablespoonfuls three times a day. - -_The Sedative Application to anoint a Bougie with._ - - Form 22. - -Take of— - Extract of Aconitine 1 grain. - Oil of Olives 1 drachm. -Mix. - - Form 23. - -Or take of— - Extract of Henbane 5 grains. - Lard or Olive Oil 1 drachm. -Mix. - - Form 24. - -Or take of— - Acetate of Morphine 3 grains. - Simple Cerate or Oil 2 drachms. -Mix. - -_Stimulating Application._ - - Form 25. - -Take of powder of calcined alum, and dust the end of a bougie -previously oiled, and introduce it to the stricture in the usual -manner, and suffer it to remain until the obstacle be overcome. -Occasionally the bougie may be smeared with the balsam copaiba, -where the case is chronic, and there happens to be much secretion -from the part. - - Form 26. - -Take of— - Iodide of potass 1 drachm. - Mercurial ointment 1 do. - Simple cerate 4 do. -Mix. A portion to be rubbed over the scrotum night and morning, as long -as it can be borne. - - Form 27. - -_Strong caustic solution of Dr. Doane._ - -Take of— - Caustic ⅓ drachm. - Distilled water 1 oz. -Mix. - - Form 28. - -_Wash for Chancres._ - -Take of— - The solution of chloride of soda 2 oz. - Rose-water 4 oz. -Mix. - - Form 29. - -_Black wash for Chancres._ - -Take of— - Calomel 1 scruple. - Lime-water 3 ounces. -Mix. - - Form 30. - -_Red wash for Chancres._ - -Take of— - Bi-chloride of mercury 4 grains. - Lime-water 4 oz. -Mix. - - Or, Form 31. - -_Blue wash for Chancres._ - -Take of— - Sulphate of copper 5 grains. - Distilled water 1 oz. -Mix and strain. - -For dressing chancres, lotions and washes generally answer better -than ointments; but their alternate use is sometimes serviceable. -In cracked sores near the prepuce, the blue ointment has wrought -a cure when all the lotions devised were ineffectual. - - Form 32. - -Take of— - Red precipitate of mercury 4 grains. - Ointment of spermaceti 1 oz. -Mix.—A little to be smeared over the ulcer, twice a day. - - Form 33. - -_Active aperient in indolent Chancres._ - -Take of— - Calomel 4 grains. - Powder of jalap 15 to 20 grains. -Mix.—To be taken in something thick, as jelly, honey, or tamarinds. - - Form 34. - -_Active aperient, to be mixed in water and (stirring it) to be drank -off quickly._ - -Take of— - Chloride of mercury, or calomel 5 grains. - Powder of jalap 25 grains. -Mix. - - Form 35. - -_Ointment to promote absorption of Bubo._ - -Take of— - Iodine of potassium 1 drachm. - Tincture of iodine 1 drachm. - Acetate of morphine 10 grains. -Mix.—Apply constantly a plaister of some of this ointment spread upon -rag or lint, over the bubo, and occasionally rub a little of it gently -into the skin.—_Doane._ - - Or, Form 36. - -Take of blue ointment a similar quantity, and use it in like manner to -the preceding. The reliance to be placed on this ointment is precisely -the same as the other, namely, to excite absorption. The following -ointment may also be used for the same purpose. - - Form 37. - -Take of— - Calomel 2 drachms. - Simple ointment 6 drachms. -Mix. - - Form 38. - -_Stimulating ointments to promote the healing of indolent ulcerated -Buboes._ - -Take of— - Red precipitate of mercury 5 grains. - Ointment of spermaceti 1 oz. -Mix.—The ulcer to be dressed with a small portion of this ointment -spread upon lint. Or the following, which is stronger:— - - Form 39. - -Take of— - Red precipitate of mercury 5 grains. - Yellow basilicon 2 drachms. - Ointment of spermaceti 6 drachms. -Mix.—To be used like the preceding. - - Or, Form 40. - -Take of nitrated ointment of mercury, diluted with an equal proportion -of simple ointment. - -Or, the unadulterated strong mercurial ointment. - - Form 41. - -_Styptic application for indolent Ulcers._ - -Take of— - Caustic ½ drachm. -Or, Sulphate of copper ½ do. - Distilled water 1 oz. -Mix and strain, and smear the surface of the sore with a hair pencil, -impregnated with either of the solutions: simple or astringent -dressings may be applied afterward. - - Form 42. - -Take of— - Chloride of soda 2 ounces. - Rose-water 2 do. -Mix. - - Form 43. - -_Preparation of Iron._ - -Take two drachms of carbonate of iron three times a day, gradually -increasing the dose to half an ounce, or even an ounce; the bowels -during the taking of this medicine should be kept open. - - Form 44. - -_The following is an excellent combination._ - -Take of compound iron pill two drachms, to be divided into 24 pills—two -to be taken three times a day. - - Form 45. - -_Quinine._ - -Take three grains of sulphate of quinine three times a day. Or, - - Form 46. - -Take of— - Compound tincture of bark 2 ounces. - Sulphate of quinine 12 grains. - Muriatic acid 20 drops. -Mix.—Dose, a teaspoonful three times a day, in water. - - Form 47. - -_Strengthening Pills._ - -Take of— - Ioduret of iron ½ drachm. - Castile soap ½ do. - Alkaline extract of gentian 1 do. -Mix.—To form 30 pills—take one twice daily. - - Form 48. - -_Tonic and Alterative Mixture._ - -Take of— - Oxymuriate of mercury 2 grains. - Muriatic acid 60 drops. - Tincture of bark 2 oz. -Mix.—A teaspoonful to be taken twice or three times a day in a little -water. - -These drops are highly serviceable to persons of weak constitutions, -whom it is desirable to place under the influence of mercury. They -form the basis of most of the advertised anti-scorbutic drops of the -patent medicine venders. - - Form 49. - -_Compound decoction of Sarsaparilla._ - -Take of— - Sarsaparilla root, sliced 4 ounces. - Boiling water 4 pints. -Macerate for four hours in a vessel lightly covered, and placed -near the fire; then take out the sarsaparilla and bruise it; return -it again to the liquor, and macerate in a similar manner for two -hours; boil it down to two pints, strain it, and then add— - Sassafras root, sliced ¼ ounce. - Guaiacum root, rasped ¼ do. - Liquorice root, bruised ¼ do. - Bark of mezeroon root 1½ drachm. -Boil the whole together for a quarter of an hour, and strain. -Dose, from a quarter to half a pint, three times a day. - -To avoid the tediousness of daily preparing the above, many -manufacturing chemists evaporate a large quantity, and preserve -the extract, which retains all the virtues of the decoction, and -is at all times ready for immediate use. Or, - - Form 50. - -Take of— - Bruised root of Jamaica sarsaparilla 4 ounces. - Liquorice root, sliced ½ ounce. - Lime-water 1 quart. -Macerate for 24 hours in a dark and cool place—strain and bottle it, -and take a pint daily in divided doses. This is a very superior form -of administering sarsaparilla. Or, - - Form 51. - -Take of— - Oxymuriate of mercury 2 grains. - Muriatic acid 5 drops. - Compound extract of sarsaparilla 2 oz. -Dissolve the same in one quart of water, and take a wineglassful twice -a day. - - Form 52. - -_The Iodide of Potass Mixture._ - -Take of— - Iodide of potassium 1 drachm. - Iodine 2 grains. - Mucilage of acacia 3 ounces. - Hydrocyanic acid 12 drops. - Pure water 5 ounces. - White sugar ½ ounce. -Mix. Take a dessert- or tablespoonful twice or thrice daily in a -wineglassful of water. - - Form 53. - -Take of— - Iodide of potassium 1 drachm. - Acetate of morphine 10 grains. - Spermaceti ointment 1 oz. -Mix. Rub a portion, the size of a nut, over the affected part night and -morning. If much irritation be produced, it must be disused for a time. - -Forms 54, 55, 56, 57 see pages 126–128. - - Form 58. - -Take of— - Sarsaparilla sliced 1 oz. - China root 1 oz. - Dry rind of 20 walnuts. - Antimony 2 oz. - Pumice stone 1 oz. -(Tied in separate bags, and boiled with the other ingredients.) - Distilled water 10 pints. -Boil to one half, and strain. -Dose—An aleglassful twice or thrice daily. - -Forms 59, 60, 61, 62 see page 132. - -The best aperient for females is certainly a combination of castor -oil. The following form is a very good one:— - - Form 63. - -Take of— - Castor oil 1 oz. - Mucilage of acacia 2 oz. - Spirits of sweet nitre 1 drachm. - Syrup of orange-peel ½ oz. - Water 1 oz. -Mix. Take half for a dose. - -Forms 64, 65, 66, 67, 68, 69, 70 see pages 156–158. - -Forms 71, 72, 73, 74, 75, 76, 77, 78, 79 see pages 158–161. - - - - - FOOTNOTES - - -[1] A wash composed of one part of the chloride of soda, with five -of water, is as good as can be used; the same may be injected up the -urethra. - -[2] Lining internal structures which have no outlet, as that in the -abdomen, called the peritoneal. - -[3] To enter into a description of the pathological condition of -the bladder in the several states of irritability, paralysis, and -inflammation, would be to swell this article to an inordinate length, -and serve no useful purpose—the symptoms and treatment comprising the -most essential knowledge for the patient to possess. It may be briefly -stated, that the bladder is less subject to become disorganized (the -function being chiefly the disordered symptom), and sooner even regains -its tone than other organs not less important to life. - -[4] Colles, Wallace, Ricord, of the Venereal hospital, Paris. - -[5] _Mercury._ - -The preparations of mercury are various: but those chiefly employed -in the treatment of syphilis are the oxymuriate, or bi-chloride, -the submuriate, or chloride, the red precipitate, or the hydrargyri -nitrico-oxydum, the blue pill, the red sulphate for fumigations, and -the blue ointment. - -Ptyalism or salivation, which implies an extraordinary secretion of -the salivary and other glands, occasioned by the taking of mercury, -inasmuch that when carried to an unwarrantable extent, ulceration is -the consequence, may be produced by the internal exhibition or external -application of almost any of its preparations. With this view, however, -the blue pill is usually administered in doses of five grains twice a -day, or the blue ointment is directed to be rubbed in on the inner part -of the legs and thighs, in quantities varying from one to two drachms -night and morning. Mercury, when given to excite ptyalism, is generally -taken in conjunction with sarsaparilla (see Form 51, or the fluid -extract). The symptoms whereby the effects of mercury are ascertained, -are a coppery taste in the mouth, followed by a tenderness of the gums -on mastication, an increased flow of the saliva, and a peculiar fœtor -of the breath. It is usual, on the tainted taste being perceptible, to -diminish or discontinue the further use of the medicine, unless the -case be very severe, or merely to keep up the effect produced. But it -can not be denied that, although sufficiently manageable in scientific -hands, mercury, or any one of its preparations, is too powerful to be -taken indiscriminately. - -[6] _Antimony._ - -The preparations of antimony consist of the precipitated sulphuret, -called now the oxysulphuret of antimony, and the powder, as directed to -be made in the Pharmacopœia, or its secret modification, known by the -name of “Dr. James’s Powder.” The sulphuret enters into the composition -of the red or Plummer’s pills, which is an admirable alterative, given -in conjunction with sarsaparilla, in doses of five grains, once or -twice a day. The James’s powder, with the like intention, may be taken -in two or three grain doses twice or thrice a day. - -[7] Wagner, translated by Dr. Willis. - -[8] Some say eight days after. - -[9] Instances of different conceptions following connexion at brief -intervals are of occasional occurrence. - -A case is recorded of a negress having brought forth a negro and a -mulatto child, and who confessed having received the embraces of a -white and a negro the same evening. Drs. Dewees of Philadelphia, and -Francis of New York, adduce similar instances. - -[10] The membrane containing the liquid comes away with the after-birth -or placenta; but when it is brought away with the child’s head, it is -named a “caul,” to which the ignorant attach a superstitious belief -that it saves the possessor from drowning, and hence it has been a -source of traffic between the cunning and the weak-minded. Cauls are -made by detaching the membrane from the placenta. - -[11] Yellow wax may be substituted for the white wax, which renders -the ointment stronger and better adapted for excoriations that yield a -discharge. - -[12] Every nurse is acquainted with the usefulness of starch, tutty -powder, Fuller’s earth, &c. - -[13] Blundell. - -[14] Dr. A. Sidney Doane has recorded a case, in his edition of -“Good’s Study of Medicine,” where a woman brought forth fifty-seven -children.—Vol. ii., p. 503. - -[15] A patient was admitted into the ophthalmic wards of the Hotel -Dieu, Paris, with great weakness of sight, amounting almost to -amaurosis. He confessed that he was in the habit of polluting himself, -and that he was immediately seized with complete blindness whenever he -addicted himself to the practice. Cases very similar to the above have -been noticed by Dr. Doane, of New York, who has paid great attention to -diseases of this character. - -[16] The convertibility of India-rubber to so many useful purposes -has not escaped the attention of surgeons, and it is found to be -an excellent material for trusses, pessaries, bougies, &c., and -consequently much used for them. I find them in my own practice -far preferable to metallic or any other description. Many cases of -hæmorrhoids, as well as of prolapsus, that have been given up as -incurable, on account of the parties objecting to wear metallic -instruments, or submit to the operation of excision or ligature, -have speedily yielded to the application of the same manufactured of -India-rubber; indeed, every day’s experience so convinces me of their -superiority and efficacy as a remedy in these disorders, that a patient -afflicted with the most formidable form of either disease need not -despair of a prompt and certain recovery. - -[17] The specific gravity of the urine materially depends upon those -causes which act diuretically, and upon the quantity of fluids -swallowed, which, if taken in excess, of course increases the watery -portion of the urine, and vice versa. The density of the urine is -ascertained by an instrument called an “Hydrometer,” which, upon being -immersed in the urine, indicates its specific gravity. The usual -specific gravity of healthy human urine varies from 1.010 to 1.015, -while the temperature ranges from 75 degrees of Fahrenheit to 120. The -quantity averages from two to three pints per diem, but depends not -only upon the quantity of fluids consumed, but also upon the nature -of the food, vegetables generating more urine than animal substances. -In infancy and old age, the temperature of the urine is below this -standard, but nearly equivalent to each other; whereas it is only at -the period of puberty that the temperature noted exists. - -[18] Furnished in the system by the decomposition of urea. - - - —————————————————— End of Book —————————————————— - - - - - Transcriber’s Note (continued) - - -Obvious punctuation errors in the transcribed text have been repaired. - -Variations in spelling are common in this book. In the case of medical -terms in which the ligatures ‘æ’ and ‘œ’ could be used, the variations -are numerous and noticeable. Thus we find the terms “hemorrhage”, -“hæmorrhage” and “hœmorrhage” being used interchangeably. Similarly for -“hæmorrhoids” and “hœmorrhoids” and all the words derived from the -foregoing terms. - -Except as noted below, unusual or variable spelling and hyphenation as -published in the original book have been retained. - - Page 11 — “membraneous” changed to “membranous” (diminishes at the - membranous portion) - - Page 16 — “then,” changed to “them” (that connects them together) - - Page 21 — “developes” changed to “develops” (the sooner develops the - disease) - - Page 22 — “ay” changed to “any” (to resist any efforts) - - Page 24 — “arm-pits” changed to “armpits” (under the armpits) - - Page 29 — “gonorrhæa” changed to “gonorrhœa” (in curing gonorrhœa;) - - Page 30 — “head-ache” changed to “headache” (inclination to headache) - - Page 50 — “surfacial” changed to “surficial” (surficial and muscular - membranes) - - Page 54 — “fœces” changed to “fæces” (the fœces pass in small - quantities) - - Page 58 — “permaneut” changed to “permanent” (permanent irritability of - the bladder) - - Page 62 — “now” changed to “how” (to show how imperative it is) - - Page 80 — “coherd” changed to “cohered” (where numbers cohered together) - - Page 85 — “empyrical” changed to “empirical” (by the most empyrical - measures) - - Page 87 — “chancerous” changed to “chancrous” (a chancrous sore) - - Page 89 — “accompanying” changed to “above” (Witness the above - wood-cut.) - - Page 102 — “incrustrations” changed to “incrustations” (similar - incrustations are formed) - - Page 107 — “desquemated” changed to “desquamated” (the pimple has - broken or desquamated) - - Page 109 — “raced” changed to “traced” (to such weknesses may be traced - the relapses) - - Page 118 — “desquemate” changed to “desquamate” (exfoliate, or scurf, - or desquamate) - - Page 125 — “are are” changed to “are” (There are also deep and painful - fissures) - - Page 131 — “pecuiar” changed to “peculiar” (a peculiar contour of the - countenance) - - Page 134 — “triflind” changed to “trifling” (trifling errors in diet) - - Page 137 — “unimpergnated” changed to “unimpregnated” (when - unimpregnated, is very compact) - - Page 146 — “corpulant” changed to “corpulent” (like a very corpulent - man) - - Page 149 — “ipresses” changed to “impresses” (the womb impresses upon - the bladder) - - Page 167 — “Henry III.” changed to “Henry II.” (Henry II. consulted - one Fernal for the infertility of his queen, Catherine de - Medicis) - - Page 196 — “protusion” changed to “protrusion” (extraordinary - protrusion of piles) - - Page 200 — “bladders” changed to “bladder” (into the bladder whence it - is voided) - - Page 214 — “pharmacopœa” changed to “pharmacopœia” (of our pharmacopœia) - -In anatomical references, the book uses “chord” throughout in place of -“cord” — see for example “umbilical chord” and “spermatic chord”. - -There are seventy-nine treatment recipes/formulæ (“Forms”) in the -book. All are printed in a similar style. However fifty-five appear as -footnotes while the rest appear in page text. For ease of reference in -the transcription, all the footnoted Forms have been gathered together -and moved to a new FORMULÆ annex at the end of the book. Minor changes -to the page text consequent on the new arrangement are as follows: - - Page 31 — “[See annexed Formulæ 2, 3, 4, 5.]” changed to “[See Forms - 2, 3, 4, 5 in Formulæ annex.]” - - Page 33 — “Subjoined are” changed to “See Formulæ annex for” - - Page 34 — “(see note)” changed to “(see Formulæ annex)” - -While the original style and content of the seventy-nine Forms has -been carefully preserved, minor corrections to the layout of some have -been made so that all are displayed to the reader in a consistent -format. This avoids small but distracting variations on a page that -look like errors in transcription. For the same reason, variations in -the spelling of dosage measures in the Forms have been regularised. -Thus “table spoonful”, “table-spoonful” and “tablespoonful” all appear -as “tablespoonful”. Similarly for “teaspoonful” and “wineglassful”. -Plural forms have been changed in the same way. For consistency, the -regularising of these words has also been applied to their appearance -elsewhere in the body text. - -Ordinary footnotes have been re-indexed using numbers and moved to a -FOOTNOTES section placed after the FORMULÆ annex. - -*** END OF THE PROJECT GUTENBERG EBOOK PORNEIOPATHOLOGY *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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- margin-top: 1.5em; - font-size: small; -} - -p.TN-style-2 { - margin-top: 1.0em; - text-indent: -1em; - margin-left: 3em; - font-size: small; -} - -.center-img-cover { - margin: 2% 33%; - page-break-inside: avoid; - page-break-before: auto; -} - -.coverimg { visibility: visible; display: block; } -@media handheld { - .coverimg { visibility: hidden; display: none; } -} - - </style> - </head> -<body> - -<div style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of Porneiopathology, by Robert J. Culverwell</div> - -<div style='display:block; margin:1em 0'> -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<table style='min-width:0; padding:0; margin-left:0; border-collapse:collapse'> - <tr><td>Title:</td><td>Porneiopathology</td></tr> - <tr><td></td><td>A Popular Treatise on Venereal and Other Diseases of the Male and Female Genital System</td></tr> -</table> - -<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Author: Robert J. Culverwell</div> - -<div style='display:block; margin:1em 0'>Release Date: April 06, 2021 [eBook #65003]</div> - -<div style='display:block; margin:1em 0'>Language: English</div> - -<div style='display:block; margin:1em 0'>Character set encoding: UTF-8</div> - -<div style='display:block; margin-left:2em; text-indent:-2em'>Produced by: Brian Coe, Quentin Campbell and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</div> - -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK PORNEIOPATHOLOGY ***</div> - -<div class="coverimg center-img-cover"> - <img src="images/cover.jpg" alt="cover image" /> -</div> - -<hr class="p4 chap" /> - -<div class="transnote p4"> -<a id="top" name="top"></a> -<p class="noindent center bold small">Transcriber’s Note</p> - -<p class="TN-style-1 center">See the <a class="underline" href="#TN">end - of this document</a> for details of corrections and other changes.</p> -</div> - -<hr class="chap" /> - -<div class="chapter"><h1 style="font-weight: 100;">PORNEIOPATHOLOGY.</h1></div> - -<hr class="h1" /> - -<p class="center noindent bold title medium p2">A</p> - -<p class="center noindent bold title medium p2">POPULAR TREATISE ON</p> - -<p class="center noindent title xx-large p1" style="font-weight: 700;">VENEREAL AND OTHER DISEASES</p> - -<p class="center noindent title small p2">OF THE</p> - -<p class="center noindent title x-large p1">MALE AND FEMALE GENITAL SYSTEM;</p> - -<p class="center noindent title small p2">WITH REMARKS ON</p> - -<p class="center noindent title medium p2">IMPOTENCE, ONANISM, STERILITY, PILES, AND GRAVEL,<br /> -AND PRESCRIPTIONS FOR THEIR TREATMENT.</p> - -<p class="center noindent title p2"><span style="font-size: x-large;">BY R. J. CULVERWELL, M. D.,</span><br /> -<span style="font-size: small;">Member of the Royal College of Surgeons, Fellow of many -Learned Societies.</span></p> - -<p class="center noindent title medium p2">WITH ONE HUNDRED PLATES.</p> - -<hr class="r10 wv" /> - -<p class="center noindent title medium p2">NEW YORK:<br /> -J. S. REDFIELD, CLINTON HALL.</p> - -<hr class="r3 hv" /> - -<p class="center noindent title medium">1844.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_3"></a>[3]</span></p> -<h2 class="no-page-break">PREFACE.</h2> -</div> - -<hr class="r5" /> - -<p><span class="smcap">Every</span> medical man who will study to investigate as far -as possible, in every case, the original channel through -which disease or constitutional disorder first found its entry -into the system, will be astonished at the mass of human -suffering which may be traced up to a venereal origin, -although its primary symptoms may have been for years -apparently eradicated from the frame. The malady generally -commences its attack in early life, before experience -has overcome the short-sighted heedlessness of youth, and -taught it to look beyond the pains and pleasures of the -passing moment. Delicacy or shame will not allow him to -seek assistance, until the poison has acquired strength and -virulence too alarming to be neglected; and the patient -then, instead of applying to his usual professional friends, -flies to some empirical practitioner, who temporarily arrests -the external symptoms, and discharges him as cured. Thus -matters go on, until the malady becomes constitutional; and -the patient is at last compelled to place himself under the -treatment of those who, at an earlier period, might have -preserved his constitution untainted, and his body comparatively -uninjured by the ravages of this insidious disease.</p> - -<p>Some years ago the idea first occurred to me that a popular -treatise, divested as much as possible of technical -phraseology, explaining to the non-medical reader the -structure and anatomy of the parts primarily affected by -the venereal disease, and describing its first as well as its -subsequent and aggravated symptoms, and pointing out the -safest treatment of it in inexperienced hands, while in its -simple form, would be of much avail in counteracting the -effects of the complaint resulting from mal-treatment or -neglect among the young and thoughtless. This work is -intended to teach him where serious danger exists, or may -be apprehended; for the treatment in a great degree, and -under any circumstances, must fall upon the patient himself: -and every medical man knows that, in very many instances,<span class="pagenum"><a id="Page_4"></a>[4]</span> -those who are fully alive to the injury that may -arise from such self-management, are yet reduced, by considerations -of delicacy and secrecy, to practise it; and it is -hoped that a perusal will contribute to give him a knowledge -and confidence which he never could acquire from the -uneducated empiric. Under these impressions have I ventured -to submit the following pages; and while I hope their -utility may be acknowledged, I would remark, that they are -not intended to supersede medical aid in any stage of the -disorder, but that, on the contrary, I would impress upon -the reader, if he need it, the prudence of having immediate -recourse to a well-educated physician in the earliest stages -of the disease, and to beware of advertising quacks. But -where, from circumstances which, in venereal complaints, -very frequently occur, the party can not have recourse to -professional aid, the next best step is certainly to place in -his hands a formula of that treatment which is most likely -to be successful with himself.</p> - -<p>In thus publicly unfolding the mysteries of this department -of the profession, I expect some reprehension from -those who assume that all medical knowledge should be limited -to the regular practisers of the science; but I would -fain remind all parties that, although this branch of medical -writing has hitherto been in the hands of mercenary -empirics, it is equally conducive to the honor of the profession, -and the interest of the patient, that these pretenders -should be driven from the field. Conscious of my integrity -as a regularly educated surgeon, and not altogether destitute -of successful practice to rest my claim upon, it is with -less hesitation I depart from professional ceremony; and -whatever opinion may be pronounced, as to my success in -performing the task I have undertaken, I may be allowed -to hope, without arrogance, that I am at least entitled to -the praise of industry and humanity.</p> - -<p class="right"><span class="right-indent-2em">R. J. CULVERWELL, M. D.</span></p> -<p class="left-indent-1em">1843.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_5"></a>[5]</span></p> -<h2 class="no-page-break">CONTENTS.</h2> -</div> - -<table class="toc"> - <tr> - <td class="tdlb"><p class="toc"> </p></td> - <td class="tdrb">Page.</td> - </tr> - <tr> - <td class="tdlb"><p class="toc"><span class="smcap">General Remarks</span></p></td> - <td class="tdrb"><a href="#Page_7">7</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Anatomical and Physiological Review of the Male Organs of Generation, with eight engravings</p></td> - <td class="tdrb"><a href="#Page_7">7</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Of the Testicles, their Structure and Functions, with seven engravings</p></td> - <td class="tdrb"><a href="#Page_14">14</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On Gonorrhœa, or Morbid Secretion and Irritability of the Urethra, with five engravings</p></td> - <td class="tdrb"><a href="#Page_20">20</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">The Surgical Treatment of Gonorrhœa, with prescriptions</p></td> - <td class="tdrb"><a href="#Page_26">26</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Medical Treatment of Gonorrhœa and its Consequences, with engravings, prescriptions, and specific remedies</p></td> - <td class="tdrb"><a href="#Page_29">29</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On Gleet</p></td> - <td class="tdrb"><a href="#Page_41">41</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Morbid Irritability of the Urethra</p></td> - <td class="tdrb"><a href="#Page_44">44</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Stricture of the Urethra, with fifteen anatomical engravings and diagrams, illustrative of the nature of the disease</p></td> - <td class="tdrb"><a href="#Page_45">45</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Treatment of Stricture, with thirty engravings, explanatory of the mode of treatment, prescriptions, &c.</p></td> - <td class="tdrb"><a href="#Page_58">58</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Diseases of the Testicles, with three engravings</p></td> - <td class="tdrb"><a href="#Page_68">68</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Hydrocele</p></td> - <td class="tdrb"><a href="#Page_69">69</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Radical Cure of Hydrocele</p></td> - <td class="tdrb"><a href="#Page_71">71</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Hydrocele Cured by Acupuncturation</p></td> - <td class="tdrb"><a href="#Page_71">71</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Diseases of the Bladder</p></td> - <td class="tdrb"><a href="#Page_73">73</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Irritability of the Bladder</p></td> - <td class="tdrb"><a href="#Page_74">74</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Paralysis of the Bladder</p></td> - <td class="tdrb"><a href="#Page_75">75</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Inflammation of the Bladder, with prescriptions</p></td> - <td class="tdrb"><a href="#Page_75">75</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Origin of the Venereal Disease</p></td> - <td class="tdrb"><a href="#Page_79">79</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On the Character of the Syphilitic Poison</p></td> - <td class="tdrb"><a href="#Page_84">84</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Of Syphilis, with fifteen engravings</p></td> - <td class="tdrb"><a href="#Page_86">86</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Of Buboes, with two engravings</p></td> - <td class="tdrb"><a href="#Page_93">93</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Of Lues Venerea, or Secondary Symptoms</p></td> - <td class="tdrb"><a href="#Page_96">96</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Of the Symptoms of the First Stage of Lues, with eight engravings</p></td> - <td class="tdrb"><a href="#Page_98">98</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On the Treatment of Syphilis</p></td> - <td class="tdrb"><a href="#Page_104">104</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Treatment of Chancre, with prescriptions</p></td> - <td class="tdrb"><a href="#Page_106">106</a><span class="pagenum" style="padding-left: 1em;"><a id="Page_6"></a>[6]</span></td> - </tr> - <tr> - <td class="tdlb"><p class="toc-indented">Bubo, with engravings and prescriptions</p></td> - <td class="tdrb"><a href="#Page_112">112</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc-indented">Secondary Symptoms</p></td> - <td class="tdrb"><a href="#Page_117">117</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc-indented">Syphilitic Eruption, with an engraving</p></td> - <td class="tdrb"><a href="#Page_117">117</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc-indented">Sore Throat, with prescription</p></td> - <td class="tdrb"><a href="#Page_121">121</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc-indented">Venereal Affections of the Bones, Joints</p></td> - <td class="tdrb"><a href="#Page_122">122</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Secondary Symptoms</p></td> - <td class="tdrb"><a href="#Page_123">123</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Treatment of Ditto, with prescriptions</p></td> - <td class="tdrb"><a href="#Page_125">125</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Syphilitic Lepra</p></td> - <td class="tdrb"><a href="#Page_127">127</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Nodes and Pains in the Bones</p></td> - <td class="tdrb"><a href="#Page_128">128</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Syphilitic Sore Throat, with prescriptions</p></td> - <td class="tdrb"><a href="#Page_130">130</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Advice to Invalids</p></td> - <td class="tdrb"><a href="#Page_133">133</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">The Female Organs of Generation—their Structure, Purposes, and Diseases, with thirteen engravings</p></td> - <td class="tdrb"><a href="#Page_136">136</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On the use of the Speculum, with an engraving</p></td> - <td class="tdrb"><a href="#Page_150">150</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Gonorrhœa in the Female</p></td> - <td class="tdrb"><a href="#Page_151">151</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Syphilis in Females, with five engravings</p></td> - <td class="tdrb"><a href="#Page_152">152</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Leucorrhœa, or the Whites</p></td> - <td class="tdrb"><a href="#Page_154">154</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Treatment of Ditto, with numerous prescriptions</p></td> - <td class="tdrb"><a href="#Page_155">155</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Effects of Incontinence, Celibacy, and Marriage</p></td> - <td class="tdrb"><a href="#Page_162">162</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On the Hereditary Transmission of Disease</p></td> - <td class="tdrb"><a href="#Page_169">169</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On Impuissance, or Impotence</p></td> - <td class="tdrb"><a href="#Page_173">173</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Impotence and Sterility of the Male—four engravings</p></td> - <td class="tdrb"><a href="#Page_174">174</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Impotence and Sterility of the Female—five engravings</p></td> - <td class="tdrb"><a href="#Page_180">180</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Treatment of Impotence</p></td> - <td class="tdrb"><a href="#Page_184">184</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Sexual Debility</p></td> - <td class="tdrb"><a href="#Page_188">188</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On Piles, internal and external, with prescriptions and four engravings</p></td> - <td class="tdrb"><a href="#Page_191">191</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Prolapsus of the Rectum, with an engraving</p></td> - <td class="tdrb"><a href="#Page_196">196</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Stricture of the Rectum, with an engraving</p></td> - <td class="tdrb"><a href="#Page_197">197</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Diseases of the Urine, with three engravings</p></td> - <td class="tdrb"><a href="#Page_200">200</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">On Incontinence of the Urine</p></td> - <td class="tdrb"><a href="#Page_204">204</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">The Gravel</p></td> - <td class="tdrb"><a href="#Page_212">212</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Cause of Gravel</p></td> - <td class="tdrb"><a href="#Page_213">213</a></td> - </tr> - <tr> - <td class="tdlb"><p class="toc">Treatment of Gravel</p></td> - <td class="tdrb"><a href="#Page_213">213</a></td> - </tr> -</table> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_7"></a>[7]</span></p> - -<p class="center noindent bold title large p2">POPULAR TREATISE</p> - -<p class="center noindent bold title small p2">ON</p> - -<p class="center noindent title bold xx-large pxx">VENEREAL DISEASES.</p> - -<hr class="r10" /> - -<h2 class="no-page-break">GENERAL REMARKS.</h2> -</div> - -<p><span class="smcap">The</span> diseases known by the general term of <i>syphilis</i> or -<i>venereal disease</i>, and arising from impure coition, appear -generally in three forms, <i>gonorrhœa</i>, <i>chancres</i>, and <i>bubo</i>. -These sometimes exist alone, and sometimes together. As -they affect the genital organs and their appendages, a description -of these organs is necessary to a full understanding -of the subject.</p> - -<p><i>Genital organs and appendages in the male.</i>—This term -embraces the <i>penis</i>, <i>testicles</i>, <i>bladder</i>, and <i>kidneys</i>. The -form of the penis is familiar to every one. It commences -at the bladder, is of a <i>spongy</i> nature, and is composed of -three different parts; the two upper and larger are called -the <i>cavernous</i> bodies, and the lower the <i>spongy</i> body; these -bodies are covered by the skin which comes over the head -of the penis, and forms the <i>prepuce</i>. When this skin is -drawn back, the head of the penis, or the <i>glans</i> penis is -seen, which is a development of the spongy body, and is -extremely sensitive. A whitish secretion, with a peculiar -odor, forms at the end of the glans, where the prepuce -seems to join it. The object of this secretion is to preserve -the sensitiveness of the glans, and to facilitate the -withdrawal of the prepuce in coition and in urinating. This -material sometimes collects, irritates, hardens, and causes -much inconvenience. This can be done away with by -circumcision, which is performed as follows:—draw an -inked line on the skin of the prepuce, corresponding to -the base of the glans penis; draw the prepuce forward, -and have the inked part held firmly by an assistant with a -pair of forceps. Then the surgeon takes that part of the -prepuce projecting beyond the forceps with his left hand,<span class="pagenum"><a id="Page_8"></a>[8]</span> -and with a bistoury cuts the prepuce at the inked line with -his right. When this is done, the lining skin of the prepuce, -which cannot be drawn forward, remains entire, and -covers the glans; this lining is divided by a single cut -with the scissors: then the flaps are removed round to the -frenum, and then the two flaps are held together and removed, -with the frenum, at one cut. The mode of holding -the prepuce, &c. is seen in the cut.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_008_cropped_477x400.jpg" width="477" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_008_cropped_715x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>On the under side of the glans, near the mouth of the -water passage, or urethra, the prepuce is attached by a -fold called the <i>frenum</i>, or bridle, or martingale of the penis. -The use of this frenum is to confine the movements -of the prepuce, and to draw down the mouth of the water -passage to direct the flow of the urine. Sometimes the -frenum is too short, and confines the prepuce too much; -it may be slit down with a pair of scissors as far as is -considered expedient. The frenum is frequently ruptured -in a first coition. The frenum is very elastic, and protects -the sensitive surface beneath it as the eyelid does the eye. -Sometimes, however, it becomes permanently contracted;—the -glans is then denuded, but soon loses its sensibility. -The person is sometimes born with this formation.</p> - -<p><span class="pagenum"><a id="Page_9"></a>[9]</span></p> - -<p>The <i>cavernous bodies</i> form two tubes, united in most of -the length of the penis, separated only by a thin partition, -and enveloped in a firm sheath; they are composed of an -immense number of cells, principally formed by dilated -veins, which communicate with each other; these, when -the penis is erected, become filled and even distended with -blood. The cavernous bodies terminate abruptly and form -rounded points under the glans penis. At the other extremity -they separate, and form the crura or legs of the -penis.</p> - -<p>The <i>spongy body</i> forms the lower and under body of the -penis, terminates at one end at the point in the glans, whilst -it extends the whole length of the penis, again becomes -enlarged, and forms the <i>bulb</i>. The urethra or water passage -extends through the spongy body, and connects the -penis with the bladder. This cut is a section of the penis -showing the three bodies:</p> - -<div class="screen-only"> - <table class="illo" summary="P9A"> - <tr> - <td style="max-width: 305px;"> - <img src="images/i_b_009a_cropped_305x400.jpg" width="305" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> Corpora Cavernosa.</p> - <p class="side-caption"><i>b.</i> The division or Septum.</p> - <p class="side-caption"><i>c.</i> Corpus Spongiosum.</p> - <p class="side-caption"><i>d.</i> Urethra.</p> - <p class="side-caption"><i>e.</i> The great vein of the Penis.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_009a_cropped_457x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_009a_cropped_305x400.jpg" width="305" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> Corpora Cavernosa.</div> - <div class="line"><span class="bold"><i>b.</i></span> The division or Septum.</div> - <div class="line"><span class="bold"><i>c.</i></span> Corpus Spongiosum.</div> - <div class="line"><span class="bold"><i>d.</i></span> Urethra.</div> - <div class="line"><span class="bold"><i>e.</i></span> The great vein of the Penis.</div> - </div> - </div> - </div> -</div> - -<p>The cut below shows a section of the cavernous body, -showing the blood vessels that go to it and cause a distension -or erection of the penis:</p> - -<div class="screen-only"> - <table class="illo" summary="P9B"> - <tr> - <td style="max-width: 400px;"> - <img src="images/i_b_009b_cropped_400x120.jpg" width="400" height="120" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> Urethric part.</p> - <p class="side-caption"><i>b.</i> Glans.</p> - <p class="side-caption"><i>c.</i> Dorsal Artery serving the Glans.</p> - <p class="side-caption"><i>d.</i> Dorsal Artery serving the interior of the Corpus Cavernosum.</p> - <p class="side-caption"><i>e, f.</i> Deep-seated Arteries.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_009b_cropped_600x180.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_009b_cropped_400x120.jpg" width="400" height="120" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> Urethric part.</div> - <div class="line"><span class="bold"><i>b.</i></span> Glans.</div> - <div class="line"><span class="bold"><i>c.</i></span> Dorsal Artery serving the Glans.</div> - <div class="line"><span class="bold"><i>d.</i></span> Dorsal Artery serving the interior of the Corpus Cavernosum.</div> - <div class="line"><span class="bold"><i>e, f.</i></span> Deep-seated Arteries.</div> - </div> - </div> - </div> -</div> - -<p><span class="pagenum"><a id="Page_10"></a>[10]</span></p> -<div class="screen-only"> - <table class="illo" summary="P10A"> - <tr> - <td style="max-width: 400px;"> - <img src="images/i_b_010a_cropped_400x117.jpg" width="400" height="117" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> Urethra.</p> - <p class="side-caption"><i>b.</i> Glans.</p> - <p class="side-caption"><i>c.</i> Dorsal Vein.</p> - <p class="side-caption"><i>d.</i> Septum.</p> - <p class="side-caption"><i>e.</i> Vessels.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_010a_cropped_600x176.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_010a_cropped_400x117.jpg" width="400" height="117" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> Urethra.</div> - <div class="line"><span class="bold"><i>b.</i></span> Glans.</div> - <div class="line"><span class="bold"><i>c.</i></span> Dorsal Vein.</div> - <div class="line"><span class="bold"><i>d.</i></span> Septum.</div> - <div class="line"><span class="bold"><i>e.</i></span> Vessels.</div> - </div> - </div> - </div> -</div> - -<p>In the cut above we see the septum or division of the -cavernous bodies, in which are seen the vessels by which, -when the erection of the penis subsides, the blood passes -into the dorsal vein of the penis.</p> - -<p>The <i>Urethra</i>, or water passage, is the canal that passes -through the spongy body to the bladder. The urine and<span class="pagenum"><a id="Page_11"></a>[11]</span> -semen pass through it. It is very elastic, and may be dilated -so as to admit a large instrument to be passed into -the bladder, and it contracts on the smallest. It is supported -in its course by the spongy body and the prostate -gland, between which is a portion unprotected, called the -membranous portion. The passage varies in its size in -different parts: thus it is rather contracted at the orifice, -enlarges within, and for an inch again contracts, dilates -nearer the bulb, diminishes at the membranous portion -and near the prostate gland, and finally enlarges into the -bladder. The cut opposite will show these parts.</p> - -<div class="screen-only"> - <table class="illo" summary="P10B"> - <tr> - <td style="max-width: 184px;"> - <img src="images/i_b_010b_cropped_184x400.jpg" width="184" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> Bladder, or receptacle of urine.</p> - <p class="side-caption"><i>b.</i> Ureters, or passages through which the urine comes from the kidneys, where it is formed, - to the bladder.</p> - <p class="side-caption"><i>c.</i> Vas Deferens, through which the semen passes from the testicle, where it is formed, - to the seminal vesicles, where it is matured.</p> - <p class="side-caption"><i>d, d.</i> Openings of Ureters into the bladder.</p> - <p class="side-caption"><i>e.</i> Prostate Gland.</p> - <p class="side-caption"><i>f.</i> Orifices of excretory ducts.</p> - <p class="side-caption"><i>g.</i> Openings of the seminal ducts.</p> - <p class="side-caption"><i>h.</i> Ischio-cavernous muscles.</p> - <p class="side-caption"><i>i.</i> Bulb of Urethra divided.</p> - <p class="side-caption"><i>k.</i> Cowpers Glands.</p> - <p class="side-caption"><i>l.</i> Wide part of Urethra.</p> - <p class="side-caption"><i>m.</i> Narrow part.</p> - <p class="side-caption"><i>n.</i> Fossa Navicularis, usually affected in gonorrhœa.</p> - <p class="side-caption"><i>o, p.</i> Prepuce.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_010b_cropped_276x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_010b_cropped_184x400.jpg" width="184" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> Bladder, or receptacle of urine.</div> - <div class="line"><span class="bold"><i>b.</i></span> Ureters, or passages through which the urine comes from the kidneys, where - it is formed, to the bladder.</div> - <div class="line"><span class="bold"><i>c.</i></span> Vas Deferens, through which the semen passes from the testicle, where it is - formed, to the seminal vesicles, where it is matured.</div> - <div class="line"><span class="bold"><i>d, d.</i></span> Openings of Ureters into the bladder.</div> - <div class="line"><span class="bold"><i>e.</i></span> Prostate Gland.</div> - <div class="line"><span class="bold"><i>f.</i></span> Orifices of excretory ducts.</div> - <div class="line"><span class="bold"><i>g.</i></span> Openings of the seminal ducts.</div> - <div class="line"><span class="bold"><i>h.</i></span> Ischio-cavernous muscles.</div> - <div class="line"><span class="bold"><i>i.</i></span> Bulb of Urethra divided.</div> - <div class="line"><span class="bold"><i>k.</i></span> Cowper’s Glands.</div> - <div class="line"><span class="bold"><i>l.</i></span> Wide part of Urethra.</div> - <div class="line"><span class="bold"><i>m.</i></span> Narrow part.</div> - <div class="line"><span class="bold"><i>n.</i></span> Fossa Navicularis, usually affected in gonorrhœa.</div> - <div class="line"><span class="bold"><i>o, p.</i></span> Prepuce.</div> - </div> - </div> - </div> -</div> - -<p>The urethra is constantly moistened with a mucous secretion,—from -the membrane itself, the glands, and the -folds which yield to the pressure of the urine as it flows, or -from other altered conditions of the urethra pour out their -contents. The inner surface of the urethra is very vascular -and sensitive, as is shown by the slightest laceration -by the bougie or by chordee, when considerable bleeding -often takes place. Its sensitiveness is well known in the -first passing of the bougie, or in inflammation, when the -pain of the former and the act of urinating in the latter, -often causes fainting.</p> - -<p>The bladder is the reservoir of the urine, which is formed -in the kidneys, comes into the ureters, passages leading -from the kidneys to the bladder, and thence flows, drop by -drop, into the bladder. The bladder is shaped somewhat -like a pear, but this shape is varied by its contents, and -the relative condition of its adjacent parts. Thus, when -the bladder is full, its upper part may be felt rising above -the pubis, that portion of the lower part of the belly that -is covered with hair. In very fat persons the bladder is -flattened by the weight of the intestines, and obliged to -find room where it can, as in pregnant women. Anatomists, -when describing the bladder, speak of its body, base, -or upper part, sides and neck, where the urethra or water -passage begins, and which is surrounded by the prostate -gland. These parts are seen in the first engraving on the -opposite page.</p> - -<p>The bladder is composed of several coats. There is a -peculiar membrane investing the important structures in -the abdomen called the peritonœum. The base and back -part of the bladder is covered by a portion of this peritonœum, -which in a measure supports the bladder in its position,<span class="pagenum"><a id="Page_12"></a>[12]</span> -and also exercises certain properties which may -hereafter be alluded to.</p> - -<div class="screen-only"> - <table class="illo" summary="P12A"> - <tr> - <td style="max-width: 333px;"> - <img src="images/i_b_012a_cropped_333x400.jpg" width="333" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> The inner surface of the Bladder, showing the direction of the Muscular Fibres.</p> - <p class="side-caption"><i>b.</i> The opening of the right <i>Ureter</i> into the Bladder, whence the urine issues.</p> - <p class="side-caption"><i>c, c.</i> The Prostate Gland cut through, and its sides exhibited.</p> - <p class="side-caption"><i>d.</i> The Urethra.</p> - <p class="side-caption"><i>e.</i> Verumontanum.</p> - <p class="side-caption"><i>f, f.</i> Orifices of the Seminal Ducts, marked by twigs inserted therein; the other points - mark the orifices from the Prostate and other Glands.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_012a_cropped_500x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_012a_cropped_333x400.jpg" width="333" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> The inner surface of the Bladder, showing the direction of the Muscular Fibres.</div> - <div class="line"><span class="bold"><i>b.</i></span> The opening of the right <i>Ureter</i> into the Bladder, whence the urine issues.</div> - <div class="linep7"><span class="bold"><i>c, c.</i></span> The Prostate Gland cut through, and its sides exhibited.</div> - <div class="line"><span class="bold"><i>d.</i></span> The Urethra.</div> - <div class="line"><span class="bold"><i>e.</i></span> Verumontanum.</div> - <div class="linep7"><span class="bold"><i>f, f.</i></span> Orifices of the Seminal Ducts, marked by twigs inserted therein; the other points - mark the orifices from the Prostate and other Glands.</div> - </div> - </div> - </div> -</div> - -<p>The position of the <i>perineum</i> is seen in the following cuts -in which the skin has been removed, <span class="nobreak">disclosing—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P12B"> - <tr> - <td style="max-width: 277px;"> - <img src="images/i_b_012b_cropped_277x400.jpg" width="277" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. The superficial fascia of the Perinœum.</p> - <p class="side-caption">2. The fascia lata, or shiny covering of the muscles of the thighs.</p> - <p class="side-caption">3. The tuberosity of the ischia, or part whereupon we sit.</p> - <p class="side-caption">4. The last portion of the spine, called the Coccyx, easily to be felt posteriorly to the rectum.</p> - <p class="side-caption"><i>a.</i> The Sphincter muscle of the Anus.</p> - <p class="side-caption"><i>b.</i> The inferior border of the great muscles of the buttock, called the Gluteal.</p> - <p class="side-caption"><i>c.</i> The Levator Ani, or muscles which elevate the rectum.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_012b_cropped_415x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_012b_cropped_277x400.jpg" width="277" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> The superficial fascia of the Perinœum.</div> - <div class="line"><span class="bold">2.</span> The fascia lata, or shiny covering of the muscles of the thighs.</div> - <div class="line"><span class="bold">3.</span> The tuberosity of the ischia, or part whereupon we sit.</div> - <div class="line"><span class="bold">4.</span> The last portion of the spine, called the Coccyx, easily to be felt posteriorly to the rectum.</div> - <div class="line"><span class="bold"><i>a.</i></span> The Sphincter muscle of the Anus.</div> - <div class="line"><span class="bold"><i>b.</i></span> The inferior border of the great muscles of the buttock, called the Gluteal.</div> - <div class="line"><span class="bold"><i>c.</i></span> The Levator Ani, or muscles which elevate the rectum.</div> - </div> - </div> - </div> -</div> - -<p><span class="pagenum"><a id="Page_13"></a>[13]</span></p> - -<p>The following cut represents the muscles of the perinœum -exposed, the superficial fascia having been removed.</p> - -<div class="screen-only"> - <table class="illo" summary="P13"> - <tr> - <td style="max-width: 255px;"> - <img src="images/i_b_013_cropped_255x400.jpg" width="255" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Point in the Perinœum where the principal muscles arise or meet.</p> - <p class="side-caption">2. Covering of the Thigh.</p> - <p class="side-caption">3. Seat.</p> - <p class="side-caption">4. Corpora Cavernosa of the Penis.</p> - <p class="side-caption">5. Corpus Spongiosum.</p> - <p class="side-caption">6. Coccyx.</p> - <p class="side-caption">7. Great Sacro Sciatic ligament.</p> - <p class="side-caption"><i>a, a.</i> Erector Muscles of the Penis.</p> - <p class="side-caption"><i>b, b.</i> Accelerator Urinæ Muscles.</p> - <p class="side-caption"><i>c.</i> Line whence the above Muscles take their origin.</p> - <p class="side-caption"><i>d.</i> Transverse Muscles of the Perinœum.</p> - <p class="side-caption"><i>e, e.</i> Sphincter Muscle of the Anus, supposed to be distended with tow or wool.</p> - <p class="side-caption"><i>f, f.</i> Levatores Ani.</p> - <p class="side-caption"><i>g, g.</i> Great Gluteal Muscles.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_013_cropped_383x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_013_cropped_255x400.jpg" width="255" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Point in the Perinœum where the principal muscles arise or meet.</div> - <div class="line"><span class="bold">2.</span> Covering of the Thigh.</div> - <div class="line"><span class="bold">3.</span> Seat.</div> - <div class="line"><span class="bold">4.</span> Corpora Cavernosa of the Penis.</div> - <div class="line"><span class="bold">5.</span> Corpus Spongiosum.</div> - <div class="line"><span class="bold">6.</span> Coccyx.</div> - <div class="line"><span class="bold">7.</span> Great Sacro Sciatic ligament.</div> - <div class="line"><span class="bold"><i>a, a.</i></span> Erector Muscles of the Penis.</div> - <div class="line"><span class="bold"><i>b, b.</i></span> Accelerator Urinæ Muscles.</div> - <div class="line"><span class="bold"><i>c.</i></span> Line whence the above Muscles take their origin.</div> - <div class="line"><span class="bold"><i>d.</i></span> Transverse Muscles of the Perinœum.</div> - <div class="line"><span class="bold"><i>e, e.</i></span> Sphincter Muscle of the Anus, supposed to be distended with tow or wool.</div> - <div class="line"><span class="bold"><i>f, f.</i></span> Levatores Ani.</div> - <div class="line"><span class="bold"><i>g, g.</i></span> Great Gluteal Muscles.</div> - </div> - </div> - </div> -</div> - -<p>A brief description of the structures displayed in the -two preceding and the following drawing (p. 14) will render -this part of our subject perfect.</p> - -<p>The <i>Fasciæ</i> means the coverings of muscles, such as is -seen in cutting a domestic joint—a leg of mutton, for instance—a -shiny surface; their use is to strengthen the action -of the muscles, to bind them well together, and they -mostly exist about the buttocks, back, &c.</p> - -<p>The office of a Sphincter Muscle, of which we have -several, as that of the bladder and anus, is to keep closed -the aperture they surround. The sphincter ani closes the -rectum, and pulls down the bulb of the urethra, by which -it assists in ejecting the urine and semen.</p> - -<p>The Levator Muscles lift up the part they are connected -with. The levator ani muscles form the funnel appearance -of the rectum, and help to draw it up after the fæces or -stools are evacuated. They also assist in sustaining the -contents of the pelvis, and help to eject the semen and<span class="pagenum"><a id="Page_14"></a>[14]</span> -urine, and contents of the rectum, and, perhaps, by pressing -upon the veins, contribute to the erection of the -penis.</p> - -<div class="screen-only"> - <table class="illo" summary="P14"> - <tr> - <td style="max-width: 293px;"> - <img src="images/i_b_014_cropped_293x400.jpg" width="293" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Coccyx.</p> - <p class="side-caption">2. Semen.</p> - <p class="side-caption">3. Covering of the Thigh.</p> - <p class="side-caption">4. Great Sacro Sciatic Ligament.</p> - <p class="side-caption"><i>a.</i> Bulb of the Urethra.</p> - <p class="side-caption"><i>b.</i> Corpus Spongiosum.</p> - <p class="side-caption"><i>c.</i> Crura of the Penis, being the conclusion <span class="nobreak">of—</span></p> - <p class="side-caption"><i>d.</i> Corpora Cavernosa Penis.</p> - <p class="side-caption"><i>e.</i> Sphincter of the Anus.</p> - <p class="side-caption"><i>f.</i> Levatores Ani, covered by a fascia or prolongation of the triangular ligament of the Urethra.</p> - <p class="side-caption"><i>g.</i> Great Gluteal Muscles.</p> - <p class="side-caption"><i>h, h.</i> Triangular Ligament of the Urethra. The artery of the bulb is seen on the left as it - runs between the Crus Penis and bulb of the Urethra.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_014_cropped_439x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_014_cropped_293x400.jpg" width="293" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Coccyx.</div> - <div class="line"><span class="bold">2.</span> Semen.</div> - <div class="line"><span class="bold">3.</span> Covering of the Thigh.</div> - <div class="line"><span class="bold">4.</span> Great Sacro Sciatic Ligament.</div> - <div class="line"><span class="bold"><i>a.</i></span> Bulb of the Urethra.</div> - <div class="line"><span class="bold"><i>b.</i></span> Corpus Spongiosum.</div> - <div class="line"><span class="bold"><i>c.</i></span> Crura of the Penis, being the conclusion of—</div> - <div class="line"><span class="bold"><i>d.</i></span> Corpora Cavernosa Penis.</div> - <div class="line"><span class="bold"><i>e.</i></span> Sphincter of the Anus.</div> - <div class="line"><span class="bold"><i>f.</i></span> Levatores Ani, covered by a fascia or prolongation of the triangular ligament of the Urethra.</div> - <div class="line"><span class="bold"><i>g.</i></span> Great Gluteal Muscles.</div> - <div class="line"><span class="bold"><i>h, h.</i></span> Triangular Ligament of the Urethra. The artery of the bulb is seen on the left as it - runs between the Crus Penis and bulb of the Urethra.</div> - </div> - </div> - </div> -</div> - -<p>The Gluteal Muscles help the rotatory motion of the -thigh, and give support generally to the buttocks.</p> - -<p>The Sacro-Sciatic Ligaments assist in the firm union of -the bones of the pelvis.</p> - -<p>The Erector Muscles of the penis propel the urine and -semen forward; and, by grasping the bulb of the urethra, -push the blood toward the corpus cavernosum and the -glans, and thus distend them.</p> - -<p>The Accelerator Urinæ Muscles, as their name implies, -help to eject the urine and semen.</p> - -<p>The Triangular Ligament of the urethra assists the -preceding purposes.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>Testicles.</i>—The testicles are two glandular oval bodies -suspended in the scrotum. They furnish the male seed. -They are supported by what is called the Spermatic Chord, -which consists of the spermatic artery that supplies the -testicle with arterial blood, whence the semen is concocted; -the veins that return the superfluous blood, and the tube -that conveys the semen to the urethra. The testicles are<span class="pagenum"><a id="Page_15"></a>[15]</span> -very liable to inflammation, and particularly to changes -resulting from the wear and tear of human life—changes -that not simply produce pain or inconvenience, but those -whereby the power of the organs becomes partially if not -wholly lost. A rather ample description of their complicated -structure will show the necessity of attending to the -earliest symptoms of disturbance. The testicles, in embryo, -are lodged in the belly, but they gradually descend, -and usually are found in the scrotum at birth. There are -occasional exceptions, when one or even both testicles do -not descend, but are retained in the groin. Mr. Hunter -considered that their virility was thereby impaired, although -such an opinion is negatived by numerous illustrations. -The non-descent of the testicle, necessarily from -its confined situation when in the groin, can not be so fully -developed as where it is allowed to range in the scrotum. -It is also exposed to accidents when retained, and cases -have occurred where Hydrocele, a disease to be noticed -hereafter, has ensued, producing much inconvenience, -and occasionally the same has been mistaken for rupture. -The testicles have several coats. The Scrotum -should be considered as one, which is merely a continuation -of the common integuments, exceedingly elastic, nearly -destitute of fat, and possessing a peculiar contractile -power of its own, whereby it can closely embrace the testicles, -and at other times yield or become distended, as in -hernia or hydrocele, to the size of a melon. The contractile -powers of the scrotum have been assigned to the -supposed presence of a muscle, which is merely a thickened -cellular membrane, and called Dartos. It was stated -that the testicles were suspended by their spermatic -chords—their support is rendered more perfect by the presence -of a muscle to each, that descends into the scrotum, -and which is called the Cremaster—it is an expansion -of one of the muscles of the abdomen, called the internal -oblique, and it spreads itself umbrella fashion -around the chord, over the upper part of the testicle, and -its fibres extend ray-like over the other coats of the testicle—its -office is to draw up the seminal organs during procreation.</p> - -<p>The testicles, thus suspended, have two coats, one adhering -closely, and the other loosely surrounding the former—between -the two, a lubricating fluid is secreted, -whereby the various movements of the body are permitted<span class="pagenum"><a id="Page_16"></a>[16]</span> -without injury; it is between these coats that water is -secreted occasionally, constituting the disease known as -hydrocele. The closely fitting coat is termed from its -whiteness and density Tunica Albuginea—the other Tunica -Vaginalis. These coverings are formed of that extensive -membrane in the abdomen called the Peritonœum. -The Tunica Albuginea which surrounds the testicle -previous to its descent, accompanies it into the -scrotum, propelling, as it were, the Tunica Vaginalis before -it. On the descent of the testicles into the scrotum, -the opening through which they passed becomes impermeably -closed.</p> - -<p>The annexed diagram will explain the coats and facilitate -the understanding of subsequent descriptions.</p> - -<div class="screen-only"> - <table class="illo" summary="P16"> - <tr> - <td style="max-width: 473px;"> - <img src="images/i_b_016_cropped_473x400.jpg" width="473" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Body of the Testicle.</p> - <p class="side-caption">2. Epididymis.</p> - <p class="side-caption">3. Vas Deferens.</p> - <p class="side-caption">4. Spermatic Artery.</p> - <p class="side-caption">5. Veins.</p> - <p class="side-caption">6. Cremaster Muscle</p> - <p class="side-caption">7. Tunica Albuginea.</p> - <p class="side-caption">8. Tunica Vaginalis.</p> - <p class="side-caption">9. Scrotum.</p> - <p class="side-caption">3, 4, 5, 6, and 8 constituting the Spermatic Chord.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_016_cropped_710x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_016_cropped_473x400.jpg" width="473" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Body of the Testicle.</div> - <div class="line"><span class="bold">2.</span> Epididymis.</div> - <div class="line"><span class="bold">3.</span> Vas Deferens.</div> - <div class="line"><span class="bold">4.</span> Spermatic Artery.</div> - <div class="line"><span class="bold">5.</span> Veins.</div> - <div class="line"><span class="bold">6.</span> Cremaster Muscle.</div> - <div class="line"><span class="bold">7.</span> Tunica Albuginea.</div> - <div class="line"><span class="bold">8.</span> Tunica Vaginalis.</div> - <div class="line"><span class="bold">9.</span> Scrotum.</div> - <div class="line"><span class="bold">3, 4, 5, 6, and 8</span> constituting the Spermatic Chord.</div> - </div> - </div> - </div> -</div> - -<p>When the coats of the testicle are taken off, it is found -to consist of innumerable delicate white tubes, which when -disengaged from the cellular membrane that connects them -together, and steeped in water, exhibit a most astonishing -length of convoluted vessels; they appear to consist of -one continuous tube, convoluted in partitions of the cellular -membrane. When the <i>Tubuli</i> come out from the -body of the testicle, they run along the back of it and -form a net work of vessels called Rete Testis; it is supposed -that by the net work the semen is conveyed from -the testicle. The continuations of this <i>Rete Testis</i> have -been denominated <i>Vasa Deferentia</i>, which, ending in a -number of <i>Vascular Cones</i>, constitute what is called the<span class="pagenum"><a id="Page_17"></a>[17]</span> -Epididymis. The <i>Vasa Deferentia</i>, after forming three -conical convolutions, unite and form larger tubes, which -ultimately end in one large excretory duct, called the -Vas Deferens. The following description relates to the -accompanying sketch.</p> - -<div class="screen-only"> - <table class="illo" summary="P17A"> - <tr> - <td style="max-width: 581px;"> - <img src="images/i_b_017a_cropped_581x400.jpg" width="581" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> Body of the Testicle.</p> - <p class="side-caption"><i>b.</i> Tubuli Testis.</p> - <p class="side-caption"><i>c, c.</i> Rete Testis.</p> - <p class="side-caption"><i>d.</i> Vasa Deferentia.</p> - <p class="side-caption"><i>e.</i> Vascular Cones.</p> - <p class="side-caption"><i>f.</i> Epididymis.</p> - <p class="side-caption"><i>g.</i> Vas Deferens.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_017a_cropped_872x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_017a_cropped_581x400.jpg" width="581" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> Body of the Testicle.</div> - <div class="line"><span class="bold"><i>b.</i></span> Tubuli Testis.</div> - <div class="line"><span class="bold"><i>c, c.</i></span> Rete Testis.</div> - <div class="line"><span class="bold"><i>d.</i></span> Vasa Deferentia.</div> - <div class="line"><span class="bold"><i>e.</i></span> Vascular Cones.</div> - <div class="line"><span class="bold"><i>f.</i></span> Epididymis.</div> - <div class="line"><span class="bold"><i>g.</i></span> Vas Deferens.</div> - </div> - </div> - </div> -</div> - -<p>The preceding completes the anatomical description of -the Testicle. The semen is supposed to be secreted by -the arteries that ramify among the seminal tubes; the last -drawing exhibits the testicle as from the hand of the dissector. -In life and in health the epididymis is attached to -the testicle—the vas deferens passes up the chord, enters -the abdomen, and, passing down into the pelvis, terminates -in the vesiculæ seminales as already, but to be -again, alluded to. The two subjoined drawings illustrate the testicles in their natural situation.</p> - -<div class="screen-only"> - <table class="illo" summary="P17B"> - <tr> - <td style="max-width: 434px;"> - <img src="images/i_b_017b_cropped_434x400.jpg" width="434" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a.</i> Body of the Testicle.</p> - <p class="side-caption"><i>b.</i> Commencement of the Epididymis.</p> - <p class="side-caption"><i>c.</i> End of ditto.</p> - <p class="side-caption"><i>d.</i> Vas Deferens.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_017b_cropped_651x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_017b_cropped_434x400.jpg" width="434" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a.</i></span> Body of the Testicle.</div> - <div class="line"><span class="bold"><i>b.</i></span> Commencement of the Epididymis.</div> - <div class="line"><span class="bold"><i>c.</i></span> End of ditto.</div> - <div class="line"><span class="bold"><i>d.</i></span> Vas Deferens.</div> - </div> - </div> - </div> -</div> - -<p>In the larger figure<span class="pagenum"><a id="Page_18"></a>[18]</span> -the testicle is displayed as enveloped by its coverings, -and in the lesser as stripped of them. The references -serve for both.</p> - -<p>We now come to speak of the Vesiculæ Seminales. It -was just observed, that the Vasa Deferentia terminated -in these structures. They are attached to the lowest and -back part of the bladder, behind the Prostate Gland. -The following drawing is the prelude to the description—It -represents the Prostate Gland, the Vesiculæ Seminales -and the Bladder.</p> - -<div class="screen-only"> - <table class="illo" summary="P18"> - <tr> - <td style="max-width: 350px;"> - <img src="images/i_b_018_cropped_350x400.jpg" width="350" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a, a.</i> Prostate Gland.</p> - <p class="side-caption"><i>b.</i> Gland cut away to show the Ducts of the Vesiculæ.</p> - <p class="side-caption"><i>c.</i> Ends of the Ducts.</p> - <p class="side-caption"><i>d, d.</i> Cells of the Vesiculæ.</p> - <p class="side-caption"><i>e.</i> Left Vas Deferens, also cut open to show its connexion with the Vesiculæ.</p> - <p class="side-caption"><i>f.</i> Right Vas Deferens.</p> - <p class="side-caption"><i>g, g.</i> Openings of the Vas Deferens and Vesiculæ into the Urethra.</p> - <p class="side-caption"><i>h.</i> Bladder.</p> - <p class="side-caption"><i>i.</i> Ureter.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_018_cropped_525x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_018_cropped_350x400.jpg" width="350" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold"><i>a, a.</i></span> Prostate Gland.</div> - <div class="line"><span class="bold"><i>b.</i></span> Gland cut away to show the Ducts of the Vesiculæ.</div> - <div class="line"><span class="bold"><i>c.</i></span> Ends of the Ducts.</div> - <div class="line"><span class="bold"><i>d, d.</i></span> Cells of the Vesiculæ.</div> - <div class="line"><span class="bold"><i>e.</i></span> Left Vas Deferens, also cut open to show its connexion with the Vesiculæ.</div> - <div class="line"><span class="bold"><i>f.</i></span> Right Vas Deferens.</div> - <div class="line"><span class="bold"><i>g, g.</i></span> Openings of the Vas Deferens and Vesiculæ into the Urethra.</div> - <div class="line"><span class="bold"><i>h.</i></span> Bladder.</div> - <div class="line"><span class="bold"><i>i.</i></span> Ureter.</div> - </div> - </div> - </div> -</div> - -<p>The Vesiculæ Seminales appear like two cellular bags. -They have two coats, the one called nervous, and the inner -the cellular, a membrane divided into folds or ridges. -The use of the vesiculæ is supposed to be, to act as reservoirs -for the semen; but there are different opinions upon -the subject, some contending that they furnish a fluid, not -spermatic, but merely as an addenda to the seminal secretion; -whereas others, who have examined the vesiculæ of -persons who have suddenly died, have discovered all the -essential qualities of the male seed therein; and, in fact, -physiologists, who direct researches in these matters, advise -such examinations as the surest means of obtaining, -in a state of purity, the seminal fluid.</p> - -<p>The Male Semen is a fluid of a <i>starch-ish</i> consistency -and of a whitish color. It has a peculiar odor, “like that<span class="pagenum"><a id="Page_19"></a>[19]</span> -of a bone while being filed—of a styptic and rather acrid -taste,” (for physiologists use more senses than one in these -researches), “and of greater specific gravity than any other -fluid of the body.” Shortly after its escape, “it becomes -liquid and translucent;” if suffered to evaporate, it -dries into scurfy-looking substance. By being examined -through a powerful microscope it is ascertained to be animated -by an infinite number of animalcules; but they are -only present in healthy semen, and consequently that fact -is taken as a criterion of the virility of the secretion.</p> - -<p>President Wagner thus describes the germe of future animal -life: “The seminal granules are colorless bodies with -dark outlines, round and somewhat flattened in shape, and -measuring from 1-300 to 1-500th of a line in diameter.” -“The animalcules exist in the semen of all animals capable -of procreation. They are diversified in form in all animals -according to their species, but in man they are extremely -small, scarcely surpassing the 1-50th, or almost -the 1-40th of a line in breadth. This transparent and -flattened body seldom exceeds from the 1-6th to the 1-800th -of a line in length.”</p> - -<p>The annexed drawing exhibits the granules and animalcules -of a human male being magnified from 900 to -1,000 <span class="nobreak">times:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P19"> - <tr> - <td style="max-width: 233px;"> - <img src="images/i_b_019_cropped_233x200.jpg" width="233" height="200" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Animalcules of a man, taken from the Vas Deferens, immediately after death.</p> - <p class="side-caption">2. Seminal Granules.</p> - <p class="side-caption">3. A bundle of Animalcules, as grouped together in the Testicle.</p> - <p class="side-caption">4. Seminal Globule.</p> - <p class="side-caption">5. Same surrounded by a cyst or bag.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_019_cropped_426x400.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_019_cropped_233x200.jpg" width="233" height="200" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Animalcules of a man, taken from the Vas Deferens, immediately after death.</div> - <div class="line"><span class="bold">2.</span> Seminal Granules.</div> - <div class="line"><span class="bold">3.</span> A bundle of Animalcules, as grouped together in the Testicle.</div> - <div class="line"><span class="bold">4.</span> Seminal Globule.</div> - <div class="line"><span class="bold">5.</span> Same surrounded by a cyst or bag.</div> - </div> - </div> - </div> -</div> - -<p>The semen is never discharged pure; it is always diluted -with the secretion from the prostate and other glands, -and also the mucus of the urethra. A chymical analysis -is thus given of 100 parts:</p> - -<p><span class="pagenum"><a id="Page_20"></a>[20]</span></p> - -<table class="chymical"> - <tr> - <td class="tdl">Water</td> - <td class="tdr">90</td> - </tr> - <tr> - <td class="tdl">Mucilage</td> - <td class="tdr">6</td> - </tr> - <tr> - <td class="tdl">Phosphate of Lime</td> - <td class="tdr">3</td> - </tr> - <tr> - <td class="tdl">Soda</td> - <td class="tdr">1</td> - </tr> - <tr> - <td class="tdl"> </td> - <td class="tdr">——</td> - </tr> - <tr> - <td class="tdl"> </td> - <td class="tdr">100</td> - </tr> -</table> - -<p>The semen may certainly be vitiated and diseased: the -odor and color assume all the gradations of other secretions -when in a morbid condition.</p> - -<p>Semen not discharged is supposed to be absorbed, thereby -adding to the strength and nutriment of the economy; -but as it is furnished for a specific purpose, and its secretion -depends much upon the play of our animal passions, -and as they are rarely permanently idle, there is not only -the inducement that the fluid be furnished, but also emitted, -and hence we have nocturnal emissions. These, to a -degree, are salutary; but they may happen so frequently -that the function becomes disordered and perverted, and in -some individuals the semen (unconsciously to them) escapes -during sleep, or on the slightest local excitement of -riding, walking, or on the action of the bladder or rectum.</p> - -<p>The prostate gland, as has been stated, contributes -much to the dilution of the semen; it may empty itself -independently of it. The gland is composed of numerous -cells, from which proceed some twenty or thirty pipes or -passages that open in the urethra by the sides of the verumontanum, -as shown in the drawing.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>Morbid Secretions and Irritability of the Urethra.</i>—I -have stated that clap or gonorrhœa is one of the first and -most frequent complaints of the generative apparatus. -There are many secretions common to the urethra, such -as those afforded by the various glands for the purpose of -lubrication, &c.; and the lining membrane of the passage -yields a moisture for its own protection, like the membrane -of many other organs, such as the eyes, nose, mouth, -and so forth, and these secretions may become unhealthy -or vitiated, and give rise to symptoms that lead on to confirmed -disease; and, what is still more remarkable, may -assume many of the characters and appearances of gonorrhœa, -but they rarely induce such constitutional disturbances -as clap. The symptoms, consequences, and duration -of clap, form its distinguishing features from any -other discharge of the urethra: it is very important that -such distinction should be understood, for the treatment<span class="pagenum"><a id="Page_21"></a>[21]</span> -of the two affections differs most materially; the one is -an affection of weakness, and the other of an inflammatory -and pestilential nature. The symptoms of clap are as -follow: there is usually first felt an uneasy sensation at -the mouth of the passage or urethra. The patient is -frequently called upon to arrange his person; that uneasy -sensation sometimes amounts to an itching (occasionally -of a pleasurable kind) the feeling extends a little way up -the penis; there is oftentimes an erection and a desire for -intercourse, which, if indulged in, the sooner develops -the disease. The itching alone will not convey the disease -from one person to another; but if intercourse be -held, the action of the inflamed vessels is accelerated, and -a purulent secretion which is infectious is urged forth and -emitted with the semen: therefore the very symptom of -the tingling or itching, for it rarely exists in healthy urethræ, -should be noticed, and intercourse be avoided until -it shall have ceased.</p> - -<p>About this time is perceived a slight heat on passing -water, or at the conclusion of the act; and shortly after, -or may be before, a yellowish discharge is observed oozing -from the mouth of the glans or nut of the penis; the -symptoms then rapidly advance, unless timely and judicious -means be adopted to palliate them or effect a cure; -the scalding becomes intense, and the pain and smarting -continue some time after each operation of passing water: -the discharge becomes profuse and clots on the linen, and -continues to ooze out with little intermission: the orifice -of the urethra looks red and inflamed, and the glans itself -swells and is occasionally extremely tender: the foreskin -or prepuce sometimes, but fortunately not always, becomes -swollen, and tightened over the -nut of the penis, from which it can -not be drawn back, constituting that -form of the disease known by the -name of phymosis. See drawing annexed.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_021_cropped_129x200.jpg" width="129" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_021_cropped_258x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>When that is the case, other annoyances -ensue; the purulent matter -collects around the glans; excoriations, -ulcerations, and sometimes -warts, are the consequence; the whole -symptoms become thereby much aggravated. -It also happens that the<span class="pagenum"><a id="Page_22"></a>[22]</span> -prepuce from inflammation assumes a dropsical appearance, -that is to say, the edges or point swell, and appear -like a bladder filled with water; thus, the size which the -penis then arrives at is enormous, and to the patient very -alarming; it usually, however, subsides in a day or two, -if rest and proper measures be employed.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_022a_cropped_138x200.jpg" width="138" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_022a_cropped_276x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The glans -with some people, is always bare, and the foreskin drawn -up around it. Such a state may be -induced also by disease: in either -case, it may become so inflamed as -to resist any efforts to draw it over -the glans and, from the swelling -and consequent pressure on the penis, -a kind of ligature is created; -and instances have been known -where the most disastrous results -have ensued. The circulation of the -blood in the glans is checked; the -nut puts on a black appearance, and -if the ligature be not removed or divided, -mortification takes place, and -the tip or more of the penis sloughs off or dies away. -This state of the prepuce is called <i>paraphymosis</i>: it sometimes -happens to young lads, who, having an indicated -opening of the foreskin, endeavor -to uncover the glans: they succeed, -but are unable to pull the -prepuce back again. They either -take no further notice of it, or -else become frightened, but conceal -the accident they have committed: -in a few hours, the parts -become painful, swell, and all the -phenomena above detailed ensue.</p> - -<p>The annexed diagram exhibits -the foreskin in a state of paraphymosis.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_022b_cropped_148x200.jpg" width="148" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_022b_cropped_295x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The next proceeding which will probably be induced, -will be an extension of the inflammation to the bladder: -the symptoms are a frequent desire to make water, and -occasionally ulceration of the membrane lining the bladder -follows, when a quantity of muco-purulent matter is -discharged, which, mingling with the urine gives it the<span class="pagenum"><a id="Page_23"></a>[23]</span> -appearance of whey. Now and then the bladder takes on -another form of disordered function: the patient will be -seized with <i>retention of urine</i>, that is, a total inability to -discharge his water, except by the aid of the catheter. A -new and most perplexing feature about this stage of the -proceeding is perceived: it is what is called <i>chordee</i>. The -existing irritation excites the penis to frequent erections, -which are of the most painful nature. The penis is bent -downward; the occasion is, the temporary agglutinization -of some of the cells of the <i>corpora cavernosa</i> through -inflammation, and the distension of the open ones by the -arterial blood, thereby putting the adherent cells on the -stretch, and so constituting the curve, and giving rise to -the pain. This symptom is frequently a very long and -troublesome attendant upon a severe clap; it is more annoying, -however, than absolutely painful, as it prevents -sleep, it being present chiefly at night-time when warm in -bed.</p> - -<p>Occasionally the glands in the groin enlarge and are -somewhat painful; they sometimes, but very rarely swell -and break; they more frequently sympathise with the adjacent -irritation, and may be viewed as indications of the -amount of general disturbance present; as the patient gets -better the glands go down, leaving a slight or scarcely perceptible -hardness as it were to mark where they had been. -The most painful of all the attendant phenomenon of clap -is <i>swelled testicle</i>, or, as in medical phraseology it is called, -<i>Hernia humoralis</i>.</p> - -<p>The first indication of the approach of the last-named -affection is a slight sense of fulness in the testicle, generally -the left first, although occasionally in the right, sometimes -one after the other, but rarely both together: a -smart twinge is now and then felt in the back upon making -any particular movement: the testicle becomes sensibly -larger and more painful, the chord swells also and feels -like a hardened cord in the groin: the patient is soon incapacitated -from walking, or walks very lame; if the inflammation -be not subdued by some means, and if the patient -be of a “burning temperament,” that is, of a very -inflammatory constitution, fever is soon set up, and the patient -is laid upon a “sick bed.” There is no form of the -complaint so dangerous to neglect as swelled testicles; -they have sometimes been known to burst or become permanently -callous and hardened, and ever after wholly unfit<span class="pagenum"><a id="Page_24"></a>[24]</span> -for procreative purposes: in other instances, they have -entirely disappeared by absorption: in fact, all diseases -of the testicles interfere with the generative power. At -the onset of inflammation there may be a brief increase -of sexual appetite, but when the structure of the testicle -becomes altered or impaired, that appetite is subdued or -wholly lost; there is such a wonderful sympathy betwixt -all parts of the generative economy of man, that if one -portion only be injured, the ordinary end of sexual union -is frustrated.</p> - -<p>The gonorrhœal poison is capable of producing a similar -discharge from other parts to which it may be applied -besides the urethra. It has been conveyed by means of -the finger or towel to the eyes and nose; and a purulent -secretion (attended with much pain and inconvenience, -indeed with great danger, when the eye becomes so attacked), -has oozed plentifully therefrom. Gonorrhœa is -an infectious disorder, and consequently is communicable -by whatever means the virus be applied. It certainly is -possible, and (if we are to believe the assertions of patients, -who are often met with, declaring they have not -held female intercourse, and yet have contracted the disease), -it certainly is not improbable that it may be taken -up from using a water-closet that has been visited by an -infectious person just before. It may also be contracted -by using a foul bougie.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_024_cropped_155x200.jpg" width="155" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_024_cropped_310x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>If the gonorrhœal discharge be suffered to remain on -particular parts of the person, such as around the glans -of the penis, or on the outside of the foreskin, excoriations, -chaps, and warts, spring up speedily and plentifully, -and protrude before the prepuce, or -sometimes become adherent to it, as -here drawn: it therefore only shows -how necessary cleanliness is in these -disagreeable complaints, to escape the -vexations alluded to. A species of insect -also is apt to appear about the -hairy part of the genital organs, and -indeed extend all over the body, particularly -in those parts where hair grows, -such as under the armpits, chest, head, -&c., if cleanliness be not observed. They are called crabs. -The itching they give rise to is very harassing, and the -patient, unable to withstand scratching, rubs the parts unto<span class="pagenum"><a id="Page_25"></a>[25]</span> -sores, which, in -healing, exude little -crusts that break off -and bleed.</p> - -<div class="screen-only"> - <table class="illo" summary="P25"> - <tr> - <td style="max-width: 209px;"> - <img src="images/i_b_025_cropped_209x200.jpg" width="209" height="200" alt="" /> - </td> - <td style="min-width: 8em;" > - <p class="side-caption">A. The Pubis studded with these insects.</p> - <p class="side-caption">B. The Crabs, or Pediculi Pubis, as they are called, about their natural size, as picked from the skin.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_025_cropped_418x400.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_025_cropped_209x200.jpg" width="209" height="200" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep2"><span class="bold">A.</span> The Pubis studded with these insects.</div> - <div class="linep2"><span class="bold">B.</span> The Crabs, or Pediculi Pubis, as they are called, about their natural size, as picked from the skin.</div> - </div> - </div> - </div> -</div> - -<p>When the gonorrhœa has -been severe and -there has been much -constitutional disturbance, -there frequently -hang about what are called flying rheumatic pains; -and sometimes, if the patient’s health be much broken -up, confirmed rheumatism seizes hold of him, and wearies -him out of several months of his existence. I have -seen many a fine constitution, by a tedious ill-treated or -neglected gonorrhœa, much injured, that, had the sufferer -consulted a medical man of even ordinary talent, in the -first instance, instead of foolishly leaving the disease to -wear itself out with the help of <i>this</i> recommended by one, -and <i>that</i> by the other, he might have shaken off the hydra, -and have averted the hundred vexations that follow.</p> - -<p>I come now to add to the list of calamitous consequences, -stricture, which, in my opinion, prevails to an enormous -extent; however, its consideration will be reserved, -as well as the affections of the bladder, and prostate gland, -for their proper places. I will simply repeat my impression -that a stricture, or narrowing of the urethra, or some -organic changes, invariably ensue when the gonorrhœa -has been mismanaged, or its cure unfortunately protracted.</p> - -<p>It is the opinion of many medical men, and it can, no -doubt, be borne out by many patients, that a gonorrhœa -if unattended by any untoward circumstance, will wear itself -out, and that the duration of such a proceeding is -from one to two months; there is no disputing but such -has been, and is now and then the case, but such rarely -stand even so fair a chance of recovery as to be left entirely -alone: even if medicine be not taken, rest, abstemiousness, -and such like means, are seldom followed up; -either the patient lives gloriously free, or else goes to the -opposite extreme.</p> - -<p>The cases of gleet which seek medical relief are more -numerous, as most professional men must be aware, than -those of gonorrhœa, for the reasons so frequently alluded -to; the fair inference would be, that a gonorrhœa seldom -escapes the terminus of a gleet.</p> - -<p><span class="pagenum"><a id="Page_26"></a>[26]</span></p> - -<p>The distinguishing feature of gleet from gonorrhœa is -that it is not considered infectious: it consists of a discharge -ever varying in color and consistence; it is the -most troublesome of all urethric derangements, and doubtlessly -helps more to disorganize the delicate mucous membrane -lining the urinary passage than even the severest -clap. Its action is constant though slow; and subject -as we are to alternations of health, of which even the urinary -apparatus partakes, it is not to be wondered at that -a part of our system which is so frequently being employed, -should become disturbed at last, and that stricture -and all its horrors should form a finale; but as gleet and -stricture form in themselves such important diseases, I -shall devote a chapter to the consideration of each separately.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>The Surgical Treatment of Gonorrhœa.</i>—The principal -symptoms indicative of the outbreak of a gonorrhœa are -a scalding burning sensation along the urethra as the urine -passes through it, and also the pouring forth of a profuse -discharge of yellow matter from the same passage. The -urethra is lined with a very sensitive membrane, fashioned, -however, to be insensible to the urine in its natural state; -but if the character of the urine or the membrane itself -be altered, the most exquisite misery is produced. Now -in gonorrhœa, when it is a first attack, the initiatory sensation -is invariably heat, itching, or pain in the urethra; -the seat of this suffering is in the mucous membrane. On -separating the lips of the orifice of the urethra, the passage -appears highly vascular, very red, and looks, according -to the popular notion, very sore. On examining it -with a powerful glass, little streaks or surfaces of a yellow -and tenacious matter are perceived, which, upon being -removed, are soon replaced by others. When the patient -attempts to urinate, this purulent exudation becomes -washed off. By this time, the system is somewhat excited, -and the urine is consequently more deeply impregnated -with uric acid, which renders it more acrid and pungent -to the delicate and now tender outlet through which -it flows: the sensation is faint at first, but is rendered -very acute by the combined worry inflicted upon the urethra, -by its muscular contraction to eject every drop of -urine, the denuded state of the membrane itself, and the -irritating quality of the water. Such, however, is the -habit of action, that the urethra in course of time becomes<span class="pagenum"><a id="Page_27"></a>[27]</span> -indifferent to the annoyance of the flow of urine. The -nervous sensibility is much diminished, and the urethra is -further protected by an abundance of the venereal secretion. -There are numerous contingencies that prevent the -changes ensuing in such order, and, consequently, the -scalding, and the amount of discharge, are seldom two -days alike. Were there to be no interruption, the inflammation, -for such is the whole process in obedience to the -animal law, would fulfil its intention and retire; but molested -as it is by diet, exercise, the varied states of health, -and numerous other fortuitous circumstances, as we well -know, it exists indefinitely. It would be next to an impossibility -to explain the process whereby the character -of a secretion becomes altered, or to describe the exact -changes which the structure or vessels undergo when furnishing -the discharge; but we well know that some such -changes do take place, and that a cause must precede an -effect. In like manner we can ascertain the result of certain -experiments, although the <i>modus operandi</i> may baffle -our penetration. Gonorrhœa is originally a local complaint, -but if not arrested, it involves not only the neighboring -parts, but it compromises the general health. Now -if the same ends can be brought about by artificial means -in a few days, that it takes weeks to effect in the ordinary -routine, all the intermediate suffering may be avoided, and -all the inconvenience of confinement and physic-taking -spared.</p> - -<p>To cure this disease I find that in many cases, if the -parties apply at the very onset of the disease, before the -discharge and scalding have set in with anything like severity, -and they themselves be not of a very inflammatory -temperament, that a sharp stimulating injection will at -once subdue the sensitiveness of the urethra and alter the -action, and, at the cost of very little, and that only temporary -suffering, effect a speedy cure: the mode, except it -be by stimulating the relaxed vessels, or owing to the specific -action of the injection, is, like all other medical operations, -a mystery. A favorite prescription is the nitrate -of silver, say one scruple of the nitrate to the ounce of -water, but the disease must be thus treated at the very -first symptom: the patient must be otherwise in comparatively -good health, and his occupation must not expose -him to much bodily fatigue. He must not be given to intemperance, -nor should those instances be selected where<span class="pagenum"><a id="Page_28"></a>[28]</span> -the sufferer is of a very inflammatory constitution. Experience -begets confidence, and confidence begets experience. -In cautious hands I am satisfied of its usefulness; -but there are cases that turn out failures. I have used -the injection when the disease itself was a week old, and -with like success; but I am ready to confess I have known -cases, the cure of which were retarded by its employment. -The inflammation has been temporarily aggravated, -but they were cases where the treatment was not appropriate; -the disease was far advanced, there was much -heat and swelling, and the patient’s health was in most instances -considerably affected; but yet beyond the few -hours’ of suffering merely, no extraordinary symptoms -were produced. The cure was very shortly after effected -by means which I shall presently allude to.</p> - -<p>In all cases of suspicious connexion I recommend copious -ablution as soon as possible.<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a> The syringes I would -advise to be used should have their points conically shelved -off pear fashion; they fill up the urethra like a wedge, -and prevent the immediate escape of the injection: all injections -should be retained a few seconds, and then be allowed -to flow out. It is seldom worth while to repeat the -operation more than twice on an occasion; but that occasion -may be resorted to two or three times a day.</p> - -<p>When the nitrate of silver is used, the syringe had better -be made of glass. The nitrate of silver discolors the -skin, linen, &c.; therefore gloves should be worn, and -care taken that the fluid be not spilt over the person or -dress, but should the skin be stained, it can be removed -by a strong solution of hydriodate of potash.</p> - -<p>The plan of injection, I must remind the reader, is only -applicable in early and old cases. The recent cases, as I -have before stated, are less frequently before the medical -man than what we may call a “ripe” gonorrhœa. The -old cases present also some difference as to the cause of -their continuance, and require also some difference in -their treatment, and they will be introduced under the -chapter headed “Gleet.”</p> - -<p>The symptoms of a clap, fully developed, are severe -scalding, voluminous discharge, painful erections, local inflammation,<span class="pagenum"><a id="Page_29"></a>[29]</span> -probably phymosis or paraphymosis, glandular -swellings, and possibly swelled testicle.</p> - -<p>But all cases of gonorrhœa are not ushered in with -such severity; nor do many, if common cleanliness and -quiet only be maintained, experience even the various accompaniments -just described, and still fewer would if the -following precautions and measures were used.</p> - -<p>The plan just laid down, may be called the surgical -treatment of gonorrhœa; the following may be designated -the <i>Medical</i>. This is divided into two methods—the one -denominated the Antiphlogistic, the other Specific. The -<i>Antiphlogistic</i> is a term applied to medicines, plans of diet, -and other circumstances, that tend to oppose inflammation -by a diminution of the activity of the <i>vital powers</i>, whereby -the inflammation is subdued, and nature rights herself -again of her own accord. The <i>Specific</i> implies a reliance -upon a particular remedy, which is supposed at once to set -about curing the disease, as, for instance, by giving Bark -in Ague—Colchicum in Rheumatism—Cubebs or Copaiba -in Gonorrhœa.</p> - -<p>Now, both these plans are successful in curing gonorrhœa; -but the majority of medical men adopt the former -method, inasmuch as although it but <i>quietly</i> conducts the -case to a successful termination, still it <i>does so</i>, whereas -the specific, in unskilful hands, is often productive of many -annoyances, much delay, and not always a cure.</p> - -<p>Our plan, however, is as follows: in the first place, I -take into consideration the appearance of the patient; if -he be strong, robust, sanguine, or of full habit, and youthful—if -it be his first attack, and if the symptoms be ushered -in with any degree of severity, I invariably and rigidly -(where I choose not the surgical) pursue the antiphlogistic -course of treatment; if the case be in a person of -phlegmatic temperament, of mature age, and the disease -be but a repetition of the past, and there be no evidence -of physical excitement, I fearlessly adopt the specific. -Where, in the third place, I encounter a patient with no -very prominent peculiarity, nor with symptoms demanding -extraordinarily active measures, experience has taught -me the propriety of cautiously combining the two methods—a -mild aperient had best always a precede a tonic or -a stimulant, in cases where there is a doubt of inflammation -lurking in the system; and, recollecting the tendency -our complicated organization has, when assailed by a distemper,<span class="pagenum"><a id="Page_30"></a>[30]</span> -to become irritable, it is always as important to -know when to withhold a remedy as when to prescribe one.</p> - -<p>The three following imaginary cases will serve as no -inapt illustration of the principles laid <span class="nobreak">down:—</span></p> - -<p class="smalltext-para">A. B. A man twenty-six years of age, five feet six inches in height, -weighing eleven stone six pounds, of a full rounded form—florid -complexion, of what is termed a sanguine temperament, and harassed -with the following symptoms: profuse discharge in large yellow clotted -lumps of gonorrhœal virus—intolerable scalding on passing water—great -pain at the rectum at the close of micturition—redness and swelling of -the orifice of the glans penis, puffiness of the prepuce, a <i>vicious</i> -chordee—inclination to headache—a bounding pulse—hot skin, and an -anxious mind. Treatment: say first bleeding, then purging; warm -bath, saline powders or mixtures, cold lotions to the part, rest, -abstinence; the following eve, symptoms will be less severe. Continue -the powders, temperance and quiet. In a few days, the discharge will -be lessened, the scalding mitigated, the chordee gone, and the fever -exchanged for the cool skin of health. The resuscitative powers of -nature await only the fillip of some gentle stimulant, and the sick -man throws off his mantle for the coronal of health.</p> - -<p class="smalltext-para">B. C. At twenty-three, dark countenance, marked features, well -developed muscular form, pulse 66, bilious temperament, accustomed -to late hours, hard drinking, and seldom still, and <i>subject</i> to -clap. Symptoms: plenteous discharge with but little scalding, and -no inconvenience beyond the suspension of ordinary sensualities. -Treatment: cleanliness, cubebs or copaiba, injections, a black -draught, and half a dozen days’ rest, release him from his quarantine.</p> - -<p class="smalltext-last-para">C. D. At nineteen, a timid bashful youth, for the first time infected -with gonorrhœa, which he had enduringly borne for the last fortnight, -having neglected until now to seek professional aid, although cajoled -into the purchase and imbibing of some popular “never-failing -antidote” for a “certain disease.” Symptoms: discharge <i>cured</i>? right -testicle swollen, and treble the size of the other, and excruciatingly -painful; frequent desire to pass water, pain in the groin and back, -general lassitude, and a feeling of illness all over. Treatment: -leeches, warm bath, bed, purging, fever medicines, cold lotions, hot -fomentations, low diet and patience, a month’s imprisonment, and a -slow recovery. Had the treatment of the first two cases been reversed, -the results would have been very different: and had the last sought -timely and efficient aid, he would have been spared much that he -endured.</p> - -<p>However, to particularize the treatment for each symptom; -to commence, I will request the reader to remember -that on the first appearance of gonorrhœa, attended with -an unusual inflammatory aspect, I practise, where permissible, -venesection; if the case demand it not, at least -there should be administered an aperient; let, therefore, -a dose of opening medicine be taken immediately (Form <a id="FManchor_1"></a><a href="#Form_1" class="fmanchor">1</a>). -This is the first step toward reducing inflammatory<span class="pagenum"><a id="Page_31"></a>[31]</span> -action—the next should be directed toward allaying the -local symptoms, by diminishing the nervous irritability of -the urethric passage.</p> - -<p>With this view, no plan surpasses that of bathing the -penis in warm water, or immersing the entire body in a -warm bath. The former should be repeated several times -in the day; the latter daily, or certainly on alternate days, -so long as the severity lasts.</p> - -<p>By these means, the parts will be preserved clean, and -will derive benefit from the soothing influence of warmth; -and, in many cases, this will be the means of averting -chordee or swelled testicle.</p> - -<p>Where, however, from peculiar circumstances, warm -water and warm baths are not to be had, the penis should -be bathed in <i>cold</i> water, or encircled with pledgets of rags -or lint, moistened with cold goulard or rose-water. Warm, -however, is to be preferred, although cold water seldom -fails of affording relief.</p> - -<p>To lessen the acrimony of the urine, which keeps up -the irritability, and somewhat to lower the system, all -strong drinks, such as ale, beer, wine, and spirits, should -be avoided, and milk, tea, barley-water, toast and water, -linseed tea, gum arabic in solution, and other such mucilaginous -diluting liquors taken instead. The diet should -be lowered: in fact, a spare regimen should be adopted, -not wholly abstaining from animal food, but partaking of -it only once in the day, and carefully excluding all salted -meats, rich dishes, soups, gravies, &c. The usual employment -should be suspended, and rest should be taken as -much as possible in a recumbent posture.</p> - -<p>Of course the preceding remarks apply only to cases -of severity; I mean such cases as first attacks ordinarily -prove; and which remarks, if attended to, will greatly -mitigate the violence of the disease.</p> - -<p>To assist the foregoing treatment, the aperient medicine, -which should be repeated, at least, on alternate -days, until the inflammation is ameliorated, should be followed -by some saline or demulcent medicine to allay the -general disturbance. Several formulæ are suggested for -that purpose, suitable to various temperaments and conditions—[<i>See Forms</i> -<a id="FManchor_2"></a><a href="#Form_2" class="fmanchor">2</a>, -<a id="FManchor_3"></a><a href="#Form_3" class="fmanchor">3</a>, -<a id="FManchor_4"></a><a href="#Form_4" class="fmanchor">4</a>, -<a id="FManchor_5"></a><a href="#Form_5" class="fmanchor">5</a> <i>in Formulæ annex</i>.]</p> -<p><span class="pagenum"><a id="Page_32"></a>[32]</span></p> -<p>By these means, the disease, if not aggravated by intemperance -of living, or otherwise, will gradually subside, -and in the course of a fortnight or three weeks, cease -entirely, without the aid of any other remedy whatever.</p> - -<p>But we need not rest satisfied with merely “showing” -the disease through its stages; we can expedite it, and -many of its steps we can skip over, and here it is we may -call to our aid the specific method of treatment alluded -to. This specific method consists of the suspension of a -vitiated secretion, and a restoration of a healthy one. -Now how this is effected we know not; we only know -that it can be done—and experience has taught us that it -may be done safer at one time than another. During the -existence of a fevered state of the circulation, it would -be highly impolitic suddenly to check a discharge from -any surface, much less one situated like the mucous membrane -of the urethra, in the immediate connexion, as it -is, of important nerves and glandular structures—a metastasis<span class="pagenum"><a id="Page_33"></a>[33]</span> -of the inflammation will almost invariably ensue; -and hence we account for swollen testicles, buboes, painful -affections of the bladder, &c. Whereas, on the subsidence -of inflammation, the revulsion is borne; and to our -satisfaction, the disease disappears. A constitution in a -state of excitement is like a fretted child—it will have its -“will” out, and the rod is not always the safest corrective.</p> - -<p>On the subsidence, therefore, of the scalding, and a lessening -of the general fever, the specific plan of treatment -may be commenced. Upon the same principle that -the surgical treatment is selected according to the symptoms, -so also are the just-named preliminaries in many -cases dispensable, and hence, as hereafter detailed, it will -be found that the antiphlogistic and specific do not go -always hand in hand. However, to explain the <span class="nobreak">latter:—</span></p> - -<p>By specifics are meant those remedies that exert a positive -curative effect on a particular disease; and the most -prominent of those, in gonorrhœa, are copaiba and cubebs. -See Formulæ annex for some useful recipes of both—Forms -<a id="FManchor_6"></a><a href="#Form_6" class="fmanchor">6</a>, -<a id="FManchor_7"></a><a href="#Form_7" class="fmanchor">7</a>, -<a id="FManchor_8"></a><a href="#Form_8" class="fmanchor">8</a>, -<a id="FManchor_9"></a><a href="#Form_9" class="fmanchor">9</a>, -<a id="FManchor_10"></a><a href="#Form_10" class="fmanchor">10</a>. -</p> - -<p><span class="pagenum"><a id="Page_34"></a>[34]</span></p> - -<p>For instance, cubebs may be taken alone, in water, in -doses of a tablespoonful twice or thrice daily. If cubebs -produce no good effect in four or five days, it had better -be discontinued, and other means sought after.</p> - -<p>These proceedings usually carry the disease to a close, -and, if no adventitious circumstances occur, successfully -and speedily. It is well to deserve success, but it can not -be always commanded.</p> - -<p>The business engagements of young men render it almost -impossible for them to devote that care and attention -so importantly requisite; and few, consequently, will be -found who will be fortunate enough to escape the usual -concomitants of a gonorrhœa.</p> - -<p>Where, therefore, the scalding or passing the urine is -very severe, the pain may be mitigated by carefully injecting, -previously to making water, either of the formulæ -No. <a id="FManchor_11"></a><a href="#Form_11" class="fmanchor">11</a> or -No. <a id="FManchor_12"></a><a href="#Form_12" class="fmanchor">12</a> -(see Formulæ annex) into the urethra.</p> - -<p><span class="pagenum"><a id="Page_35"></a>[35]</span></p> - -<p>The inflammation extends in general not more than two -inches down that passage, so that much force is not required -to inject the intended fluid, nor should an unnecessary -quantity be used.</p> - -<p>When the inflammation reaches the bladder—which is -indicated by pain in that viscus and the perinœum, with -a constant desire to pass water—the taking of a warm -bath at a temperature of 100°, and remaining therein for -a quarter of an hour, will afford essential relief.</p> - -<p>When a chordee is attendant on a gonorrhœa, and the -patient can not sleep, the draught (Form <a id="FManchor_13"></a><a href="#Form_13" class="fmanchor">13</a>) may be taken -on going to bed, or the powder (Form <a id="FManchor_14"></a><a href="#Form_14" class="fmanchor">14</a>) in some gruel. -The embrocation (Form <a id="FManchor_15"></a><a href="#Form_15" class="fmanchor">15</a>) rubbed on the parts affected, -however, will instantly remove both the pain and the -spasmodic contraction, and not unfrequently prevent their -recurrence. Care must be taken that the embrocation be -only used for its specific purpose, and not swallowed by -mistake, as it is poisonous.</p> - -<p>In the event of the patient being obliged to follow his -ordinary occupation, or to go about, the use of a suspensory -bandage will be found of great benefit; indeed it is -indispensable, and the neglect of it has often brought on -swelled testicle, or most excruciating chordee.</p> - -<p>By way of recapitulation, the treatment of gonorrhœa -thus far consists: in severe cases, of bleeding; in ordinary -ones, and in both, of warm bathing, local or general—where -impracticable, cold—attention to diet, the taking -of aperient, soothing and astringent medicines, rest as -much as possible, and the use of the suspensory bandage.<span class="pagenum"><a id="Page_36"></a>[36]</span> -These remarks are equally applicable, then, through every -stage of this complaint that is accompanied by inflammation, -and may be relied upon as the most effectual to -avert all the consequences I now proceed to detail.</p> - -<p>The consideration of the symptoms here following is -not in the order in which they always occur; for swelled -testicle may ensue without phymosis or paraphymosis preceding, -or even being present; and the converse holds -equally good with regard to every other.</p> - -<p>The successful treatment of phymosis (that condition of -the foreskin in which it can not be drawn back over the -glans) depends very much upon local management. Bathing -the part frequently in warm water, the daily use of -the warm bath, and the frequent injection, by means of a -syringe, of warm milk and water, are generally all that is -required to reduce phymosis; but where it is attended -with much inflammation, where the glans is excoriated, -probably by the discharge from the urethra accumulating -between it and the prepuce, and thereby inducing irritation, -bleeding is even sometimes necessary, the strictest -antiphlogistic regimen should be preserved, and the treatment -advised in the early stages of gonorrhœa scrupulously -followed.</p> - -<p>Sometimes the prepuce becomes so swollen as to assume -an œdematous or dropsical appearance; in which case it -may be scarified with a lancet, or several leeches applied. -With the exception of concealing the state of the glans, -phymosis is less dangerous than paraphymosis, and is -most usually produced by the patient worrying the part, -by frequently uncovering the glans to observe its condition. -Where a discharge is perceived oozing from beneath -the prepuce, which is not urethral, and the glans -does not feel sore or tender, the injection (Form <a id="FManchor_16"></a><a href="#Form_16" class="fmanchor">16</a>) syringed -up five or six times a day, will prove very efficacious -in healing the ulceration.</p> - -<p>Where there is an unnatural elongation of the prepuce, -it will be constantly subject to phymosis, not only from -gonorrhœal inflammation, but from the accumulation of<span class="pagenum"><a id="Page_37"></a>[37]</span> -the natural secretions of the part. In that case, cleanliness -is the only remedy the patient can employ of himself. -Occasionally it is necessary to have recourse to the surgeon’s -knife.</p> - -<p>Paraphymosis is the opposite to phymosis, and usually -arises in this way: the orifice of the prepuce, being contracted -by the inflammation, is drawn back for the purpose -of washing or examination, and is allowed to remain, -or, as frequently happens, it can not be redrawn. When -this continues some time, considerable inflammation, both -of the glans and prepuce, arises. The contracted orifice -pressing more tightly, it will often happen that a sloughing -of both it and the glans will take place; but this occurs -only in consequence of neglect, or in constitutions -injured by intemperance.</p> - -<p>If seen and attended to early, this state may be removed -very easily. The penis should be immersed in a basin of -cold water, or sponged, so as to cool it as much as possible; -or it may be well oiled. In either case there will -not be much difficulty in pressing up the glans and drawing -up the prepuce over it; but where adhesion has taken -place, or ulceration exists, it will be harder to accomplish: -the adhesions must be separated, or the stricture divided -with the scalpel.</p> - -<p>I need scarcely observe, that such an operation is out -of the province of the non-professional person, who should -lose no time in consulting his surgeon.</p> - -<p>I omitted to mention, in the description of the symptoms -of gonorrhœa, that occasionally, in very severe cases, a -tumor forms in the perinœum, which, if neglected, proceeds -to suppuration, and establishes a fistulous communication -with the urethra. On the instant of such a -swelling appearing, leeches, fomentations, and poultices, -should be applied with a view to disperse it; but the management -of such a case had better be intrusted to the surgeon.</p> - -<p>Excoriation of the membrane of the glans or prepuce -requires for its treatment frequent ablution with warm -water until the redness and discharge somewhat diminish, -when Form <a href="#Form_16" class="fmanchor">16</a> may be resorted to, and applied, if practicable, -by a moistened layer of lint; but if accompanied by -phymosis, the syringe must be used.</p> - -<p>Warts, if not large, are easily removed, by brushing<span class="pagenum"><a id="Page_38"></a>[38]</span> -them with the muriated tincture of iron, or the application -of a lotion of lunar caustic (Form <a id="FManchor_17"></a><a href="#Form_17" class="fmanchor">17</a>).</p> - -<p>Where they are numerous and large, and resist the remedies -just recommended, the nitric acid is an excellent escharotic; -it gives little or no pain, and is rarely productive -of inflammation. The glans, if not naturally denuded -(in which instance, by the way, warts seldom accrue), -should be kept so for a time; and the nitric acid, after a -few moments, washed off with cold water. Notwithstanding, -excision is sometimes necessary to their complete removal.</p> - -<p>When the organs of generation are infested by pediculi, -or crab-lice, the most efficacious and agreeable remedy is -the sulphur-bath; one bath generally effecting an extinction -of every one of them, even though they be all over -the body.</p> - -<p>Some recommend shaving the hair off the pubis, the locality -in which the vermin are most usually engendered, -and applying blue ointment or the black wash. Such a -practice is seldom ineffectual, but the irritation attendant -upon the reproduction of hair is absolutely intolerable. -The hair need not be removed, as the above remedies will -be all-sufficient without it. Rubbing the parts well with -strong mercurial (or blue) ointment, or the black wash (Form <a id="FManchor_18"></a><a href="#Form_18" class="fmanchor">18</a>), -or even powdering them with calomel, will at once destroy -the insects, and thereby remove the itching.</p> - -<p>Swelled testicle, or <i>hernia humoralis</i>, more especially -that proceeding from gonorrhœal irritation, is ushered in -and discovered in the following manner: The patient, on -some sudden movement of the body, experiences a pain, -darting from one of the <i>testes</i> (both being rarely affected -at the same time) to the loins—the left testicle is the one -generally attacked. On examination, he finds that the -testicle is rather swollen and full, and very painful on being -handled; the swelling quickly increases and becomes<span class="pagenum"><a id="Page_39"></a>[39]</span> -hard, which hardness extends to the spermatic chord, presenting -the feel of a rope, passing from the scrotum to the -groin.</p> - -<p>It is remarkable that when swelled testicle occurs, the -discharge from the urethra, which, from previously being -very profuse, and the scalding on making water, which -was very severe, both suddenly diminish, or cease entirely, -until the inflammation of the <i>testis</i> declines; hence, it has -been supposed by some, that the disease is translated from -the urethra to the testicle.</p> - -<p>It is more probably however, derived from the sympathy -between the two; the irritation of the one affecting -the other, and the preponderance of inflammation in the -testicle acting on the principle of counter-irritation to the -urethra, and, for a time, thereby lessening the disease in -it: for it is observed that, as soon as one improves, the -disease returns in the other. The treatment of <i>hernia humoralis</i> -must be strictly antiphlogistic. In no form of gonorrhœal -disease is bleeding more absolutely necessary.</p> - -<p>The timely and prompt loss of twelve or sixteen ounces -of blood from the arm will often cut short the complaint, -and render other remedies almost unnecessary; while the -temporising delay, under the vain hope of the inflammation -subsiding, will allow the disease to make rapid progress, -and impose a necessity of several weeks’ rest and -absence from business, before a cure can be effected.</p> - -<p>Immediately, then, on the occurrence of swelled testicle, I would -recommend the patient to be bled—to take some aperient medicine, -and, if the inflammation continues, to apply from twelve to eighteen -leeches, and afterward suffer the wounds to bleed for twenty minutes -in a warm bath; to retire to bed or to the sofa, and to maintain a -horizontal posture. If he be strong, young, and robust, -an emetic (Form <a id="FManchor_19"></a><a href="#Form_19" class="fmanchor">19</a>) -may be given previous to the aperient, which has been known to remove -the swelling almost instantaneously.</p> - -<p>Iodine (Form <a id="FManchor_20"></a><a href="#Form_20" class="fmanchor">20</a>) -also possesses a similar specific property in reducing -swelled testicle, and may be taken during the inflammatory<span class="pagenum"><a id="Page_40"></a>[40]</span> -stage after bleeding and aperients, as may likewise -the chlorate or hydriodate of potass (Form <a id="FManchor_21"></a><a href="#Form_21" class="fmanchor">21</a>).</p> - -<p>With regard to local applications, the repeated employment of -leeches, fomentations, and poultices, with the frequent use of the warm -bath, and, above all, keeping the testicle constantly supported by -means of a bag, truss, or suspensory bandage, will subdue the disease -in a very short time, without impairing the functions of the important -organ concerned.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_040_cropped_255x400.jpg" width="255" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_040_cropped_383x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>A hardness, however, of the <i>epididymis</i> commonly remains and -continues during life, but rarely gives rise to any inconvenience, -although this may often be remedied by compressing the testicles with -strips of adhesive plaster, as seen in the cut.</p> - -<p>Almost every case of inflamed testicle will terminate favorably -by strictly pursuing the plan proposed; but when, from any untoward -circumstance, the inflammation proceeds to suppuration, the case must -be treated like one of common abscess, in which event professional aid -should be sought for without delay.</p> - -<p><span class="pagenum"><a id="Page_41"></a>[41]</span></p> - -<p>Other diseases of the testicle will be treated upon under -a specific head.</p> - -<p>To return to the treatment of Gonorrhœa:—On the -abatement of all or any of the enumerated symptoms, such -as the diminution of the scalding upon making water, the -subsidence of chordee, the escape from, or cure of, swelled -testicle, phymosis and paraphymosis, warts, crabs, excoriations, -&c., the discharge may still continue, though -thicker in consistence, and deeper in color: and it is at -this period, which I will call chronic gonorrhœa, when -all inflammatory symptoms have left, that stimulants -may be judiciously given; but it must be borne in mind -that relapses often occur from imprudence: and this chronic -form requires as much attention as the acute or early -stage. (See <a href="#Gleet"><i>article Gleet</i></a>.)</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><a id="Gleet"></a><i>Gleet.</i>—Gleet is certainly, as its name implies, a discharge -of thin ichor from a sore. Patients usually understand, -and medical men usually allow, a gleet to be a discharge -from the urethra, which has existed some time, of a whitish -color, unattended with pain, and that is <i>not infectious</i>, -by which is meant is incapable of producing gonorrhœa. -There are several kinds of morbid secretions, the successful -treatment of which depends upon a knowledge of their -differences. They may be divided into two principal orders—those -secreted from the mucous surface of the urethra -or bladder, and those which proceed from the various -glands-leading into one or the other. Gleet is a term popularly -applied to both, but more strictly relates to that -which proceeds from the membrane lining the urinary canal. -There is great analogy in inflammatory affections -between the mucous membrane of the digestive and pulmonary, -as well as urinary passages. In inflammatory -sore throat, the secretions assume various appearances; -there is a discharge of viscid mucus, of purulent matter, -or of a thin watery nature; these secretions are -dependant upon the amount and duration of the inflammation -present. Exactly in like manner may be explained -those issuing from the urethra. They are consequently -alike modified by treatment, by diet, by rest, and -aggravated by a departure from constant care. It is the -nature of all membranes, lining canals that have external -outlets, to attempt the reparative process by pouring -forth discharges, while those which line the structures -that have not, effect their cure by union with the opposite<span class="pagenum"><a id="Page_42"></a>[42]</span> -surface. It is an admirable provision, else important passages -might become closed, and so put a stop to vital processes; -and in the other case, accumulations ensue that -could not escape without occasioning serious mischief. -When, however, disease has existed a long time, the operation -of the two kinds of membranes is reversed. The -serous,<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a> -through inflammation, take on the character of -abscess, dropsy, or other secretions, and the mucous ulcerate -or form adhesions, as evidenced in stricture, or ulceration -of the throat or urethra. Gleet may be a spontaneous -disease, that is to say, may arise from other causes -than infection. It may exist independently of gonorrhœa, -and be the result of cold, of intemperance, and of general -or of local excess. Its long continuance and neglect, -however, renders it infectious, and it also gives rise to ulceration, -excrescences, and stricture: and when, from other -causes, ulceration, or excrescences, or stricture, are set up, -gleet is in return generally one of their consequences. -Gleet, despite these various occasions, is, after all, most -frequently a remnant of gonorrhœa; and it is very difficult -to define the time or point where the one ends and -the other commences. Pathologists draw this distinction -between the two:—they say that gonorrhœal discharge -consists of <i>globules</i>, mixed with a <i>serous</i> fluid, while gleet -is merely a mucous secretion. I confess it difficult for a -non-professional person to decide which is which, the -resemblance, in fact, being so great—a gonorrhœal discharge -being one day thick and yellow, a few days afterward -thin and whitish, and at one time in quantity scanty, -and the next profuse. Gleet assumes nearly the same -changes. The best test for distinguishing them is, by regarding -the accompanying symptoms. Where there is -pain on passing water, bladder-irritability, tenderness in -the perinœum or neighboring parts, and the discharge -plentiful and offensive, staining the linen with a “foul -spot,” it may, without much fear, be decided to be clap; -but where the discharge is next to colorless, like gum-water, -for instance, and where there is no other local uneasiness -than a feeling of relaxation, and where it has existed -for a long period, and was, or was not, preceded by a -gonorrhœa, it may fairly be called a gleet. Now where<span class="pagenum"><a id="Page_43"></a>[43]</span> -does the discharge of gleet come from? Let us recapitulate -its causes; first from clap, which is a specific inflammatory -affection. It may therefore be a chronic inflammatory -state of the lining membrane of the urethra, of -greater or less extent; in which case we would call it -chronic gonorrhœa, and which would be owing to a relaxed -state of the secretive vessels. We know that when -a disease exists for a long while, and is one not positively -destructive to life, a habit of action is acquired that renders -its continuation in that state as natural as its healthy -condition. This is the state of the secretive vessels in -gleet, arising from gonorrhœa; and hence the discharge -is poured forth, instead of the secretion natural to the urethral -passage in its healthy order. Secondly, such may -have been the severity of a clap, that ulceration of some -portion of the urethra may have taken place. The disease -may have got well except in that identical spot which, -owing to the constant irritation occasioned by the urine -passing over it, struggles with the reparative intention -and effort of nature, and exists even for years. Thirdly, -when stricture is brewing, which will be explained in an -appropriate chapter, the alteration going on gives forth a -discharge, and, as I have stated in another part of this -work, I here repeat, that a long and obstinate gleet, as -the slightest examination would testify, rarely fails to indicate -the presence of a stricture. Lastly, gleet may be -produced by loss of tone in some or the whole portion of -the secretive vessels, induced by one or many of the accidents -of life, or the various kinds of physical intemperance -when they not only weep forth various kinds of fluids, -at irregular intervals, which impair the muscular and -nervous energy of the generative organ, but render persons -laboring under this description of weakness very susceptible -of infection, if they hold sexual contact with -those but slightly diseased. Hence persons laboring under -this form of debility incur what others escape. An -individual so circumstanced would receive a taint from a -female having leucorrhœa. Very many inconveniences -have arisen from this infirmity, giving birth occasionally -to unjust suspicions, and creating alarms of the most distressing -nature.</p> - -<p>Thus, then, we may have gleet from gonorrhœa, gleet -from ulceration, gleet from stricture, gleet from debility -and discharges, popularly understood to be gleet, but in<span class="pagenum"><a id="Page_44"></a>[44]</span> -reality glandular secretions, which will be considered -shortly and separately. Gleet is a tiresome and troublesome -disorder. So difficult, occasionally, is its management, -that oftentimes the more regularly a patient lives, -and the more strictly he conforms to medical regimen, the -more deceptive is his disorder. He will apparently be -fast approaching to, as he conceives, a recovery, when, -without “rhyme or reason,” the complaint recurs, and -hints that his past forbearance has been thrown away. It -would be dispiriting, indeed, were every case of gleet to -realize this description; but it is well known that many -do, either from neglect or mismanagement. Now it must -be evident that the treatment of gleet depends upon what -may happen to be the occasion of it. Where the membrane -of the urethra is entire, internal remedies may, and -do avail. Copaiba will achieve wonders; the use also of -a mild injection, perseveringly employed (as a solution of -iodide of iron, or citrate of iron, ten grains to the ounce -of water), will give tone and stringency to the weakened -vessels, and so correct the quantity, at least, of the secretion. -In very obstinate cases, stronger injections, as of -the nitrate of silver, twenty grains to the ounce of water, -are serviceable; and we are not without many useful internal -medical combinations, which, properly administered, -conquer this troublesome complaint. In ulceration and -stricture, these two causes must be removed, else all efforts -are unavailing. In general and local debility, the attention -must be devoted to the constitution. Common -sense and common reading must give to persons, possessing -both, every necessary information. The community -are beginning to appreciate the advantages of temperance, -air, and exercise, too highly, to need instructions how -much of the one or either of the other two are essential -to the preservation or recovery of health.</p> - -<p><i>Morbid Irritability of the Urethra.</i>—Of the varied symptomatic -sensations, few are more provoking and fretting -than some continued troublesome itching or pain that frequently -attends the passing of water. There may be no -discharge of any kind, but there is either a constant tingling, -partially pleasurable sensation, drawing the attention -perpetually to the urethra, or there is felt some particular -heat or pain during the act of micturition. These feelings -do not always indicate a venereal affection; they appear -to depend upon local irritation, perhaps induced by a<span class="pagenum"><a id="Page_45"></a>[45]</span> -morbid condition of the urine. The treatment consists in -temperate diet, moderatively laxative medicines, and now -and then local applications. Some cases yield to sedatives -topically applied, and alkalies given internally, while others -need local stimulants and specific tonics. At all -events, whenever there is an unhealthy feeling in those -parts, it points out some altered action is going on, which, -if not arrested, is likely to end in stricture or gleet, and -therefore attention had better be bestowed upon it as soon -as possible.</p> - -<p><i>On Stricture of the Urethra.</i>—Of all diseases of the genito-urinary -system, stricture must be allowed to be the -most formidable. It is not the most difficult to cure; but -it involves, when neglected, more serious disturbances—disturbances -which frequently compromise only with loss -of life. Stricture is a disease unfortunately of extensive -prevalence; and in nine cases out of ten is the sequence -of a gonorrhœa; and, what is still more comforting, few -persons who become the prey to the latter infliction escape -scot-free from the former; not because a clap <i>must</i> necessarily -be succeeded by a stricture, but simply because it <i>is</i>, -and all owing to the carelessness and inattention manifested -by most young men in the observances so necessary -for the perfect cure of the primary disease. One very -prevalent notion, and which explains a principal cause of -the extension of the venereal disease, is entertained, that -the way to give the finishing <i>coup</i> to an expiring clap, is -to repeat the act that gave rise to it: the disease becomes -temporarily aggravated, and the impatient invalid probably -flies, from an unwillingness to confess his new error, -from his own tried medical friend to some professional -stranger. From a desire to earn fame as well as profit, -the newly consulted prescribes some more powerful means; -the discharge is arrested for a while, but returns after the -next sexual intercourse; a strong injection subdues the -recurrent symptom, which only awaits a fresh excitement -for its reappearance. Thus a gleet is established. The -patient finding little or no inconvenience from the slight -oozing, which, as he observes, is sometimes better and occasionally -worse, according to his mode of living, determines -to let nature achieve her own cure, and for months -he drags with him a distemper that, despite all his philosophy, -he can not reflect on without an humiliating diminution -of self-approval. So insidiously, however, does the<span class="pagenum"><a id="Page_46"></a>[46]</span> -complaint worm its progress, that the patient, considering -his present state the worst that can befall him, resolves to -endure it, since it appears his own constitutional powers -are incapable of throwing it off.</p> - -<p>In the midst of this contentment, the invalid finds that the process -of urinating engages more time than formerly, the urine appears to -flow in a smaller stream, and is accompanied by a sensation as though -there were some pressure “behind it.” The act of making water is not -performed so cleanly as it used to be; the stream differs in its flow, -seldom coming out full and free, but generally split into three or four -fountain-like spirts, as the annexed drawing displays.</p> - -<p>At other times it twists into a spiral form, and then suddenly -splits into two or more streams, while at the same moment the urine -drops over the person or clothes, unless great care be observed, as -witness diagram.</p> - -<p>In advanced cases, the urethra becoming so narrow the bladder has -not power to expel the urine forward, and it then falls upon the shoes -or trowsers, or between them, as observe illustration.</p> - -<div class="figcenter"> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_046a_cropped_140x200.jpg" width="140" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_046a_cropped_280x400.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_046b_cropped_153x200.jpg" width="153" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_046b_cropped_306x400.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_046c_cropped_105x200.jpg" width="105" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_046c_cropped_209x400.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> -</div> - -<p>Persons afflicted with stricture, and urinating -in the streets, may almost be detected -from the singular attitude they are obliged -to assume to prevent the urine from inconveniencing -them, and also from the time occupied -in discharging it. Some few minutes -after making water, when dressed and proceeding on his -way, the patient finds his shirt become moist by some -drops of urine that continue to ooze from the penis; and -it is only as these annoyances accumulate, he begins to -think he is laboring under some other disease than the -gleet. The next symptom he will experience will be a -positive but temporary difficulty in passing his water—perhaps -a total inability to do so; it will, however, subside -in a few minutes. This will lead him to reflect, and<span class="pagenum"><a id="Page_47"></a>[47]</span> -he will even appease his fears by inclining to think it may -be the consequence of his last night’s excess: he resolves -to be more careful for the future, and he gets better; his -contemplated visit to his usual professional adviser, if he -have one, is postponed, and a few more weeks go by without -a return of the last symptom. The next attack, which -it is very difficult to avert, and which is sure to accompany -the succeeding debauch, or to follow a cold or fatigue, -does not so speedily subside; the patient finds that he can -not complete the act of making water without several interruptions, -and each attended with a painful desire resembling -that induced by too long a retention of that -fluid. In that state he eagerly seeks medical assistance; -the treatment generally adopted consisting of some sedative, -immersion in a hot bath, or the passage of a bougie. -Relief being thus easily obtained, professional advice is -thus thrown up, and the symptoms are again soon forgotten. -Before proceeding further with the more severe -forms and consequences of stricture, which may now be -fairly said to have commenced in earnest, a brief anatomical -description of the urethra may enable the reader to -understand how the constriction or narrowing of that canal -takes place.</p> - -<p>I have elsewhere stated the urethra to be a membranous -canal, running from the orifice of the penis to the bladder, -and situated in the lower groove formed by the <i>corpus -spongiosum</i>.</p> - -<p>The difference of opinion entertained by some of our -first anatomists, on the structure of the urethra, is deserving -of notice; for only in proportion to the correctness of -our knowledge of it, can we arrive at a just definition of -its diseases.</p> - -<p>One party assert it to be an elastic canal—whether -membranous or muscular they do not say—endowed with -similar properties of elasticity to India rubber, or to a -common spring. That it is elastic, is beyond doubt; but -the mere assertion is no explanation of its mode of action.</p> - -<p>Others, from microscopical observations, declare it to -consist of two coats—a fine internal membrane, which, -when the urethra is collapsed, lies in longitudinal folds—and -an external muscular one, composed of very short -<i>fasciculi</i> of longitudinal fibres, interwoven together, and -connected by their origins and insertions with each other,<span class="pagenum"><a id="Page_48"></a>[48]</span> -and united by an elastic substance of the consistence of -mucus. This is the more satisfactory of the two.</p> - -<p>They account for the occurrence of stricture in this -way. They say that “a permanent stricture is that contraction -of the canal which takes place in consequence of -coagulable lymph being exuded between the <i>fasciculi</i> of -muscular fibres and the internal membrane, in different -quantities, according to circumstances.”</p> - -<p>A spasmodic stricture they define to be “a contraction -of a small portion of longitudinal muscular fibres, while -the rest are relaxed; and as this may take place, either all -round, or upon any side, it explains what is met with in -practice—the marked impression of a stricture sometimes -a circular depression upon the bougie, at others only on -one side.”</p> - -<p>With respect to the change consequent upon permanent -stricture, dissection enables us, in some degree, to arrive -at the truth. Excrescences and tubercles have been found -growing from the wall of the urethra; but in the majority -of instances, the only perceptible change is a thickening -of the canal here and there, of indefinite length; but -whether it be occasioned by the exudation of coagulable -lymph, or whether it be the adhesion of ulcerated surfaces, -which I contend are more or less present in gleet, is not -so easy to determine; at all events, it is undoubtedly the -result of inflammation.</p> - -<p>With regard to the action of spasm, all we know of it -is theoretical; but experience every day furnishes instances -of its occurrence.</p> - -<p>Spasmodic stricture is generally seated at the neck of -the bladder, and may occur to persons in good health, from -exposure to wet or cold; from some digestive derangement; -from long retention of the urine, particularly while -walking, owing to the absence of public urinals; or to -violent horse exercise; but more frequently does it happen -to those young men who, when suffering from gleet or -gonorrhœa, imperfectly or only partially cured, are tempted -to commit an excess in wine, spirits, or other strong -drinks. Surrounded by jovial society, glassful after glassful -is swallowed, each one to be the last. The patient, -with his bladder full to repletion, scarcely able to retain -his water, yet probably “<i>going</i>” every moment, represses -his desire until the party breaks up, when, on encountering -the cold air, he finds himself unable to void<span class="pagenum"><a id="Page_49"></a>[49]</span> -even a drop, or if so, but with extreme difficulty. The -greater the effort, and the more determined the straining, -the greater is the impossibility, and unless relief should -be afforded, the most alarming consequences may ensue.</p> - -<p>The rationale is this: the patient, opposing the action -of the muscles of the bladder, by contracting those of the -urethra, they (the latter), from irritation, become spasmodically -contracted.</p> - -<p>The urine, by the powerful action of the muscles of the -bladder, is forced against the contracted portion of the -urethra; and by its irritation increases the mischief. -Where neglected, or unless the spasms yield, extravasation -will take place, mortification ensue, and death follow.</p> - -<p>The urethra is situated at the under part of the penis, -and is embraced by a substance called the <i>corpus spongiosum</i>; -it (the urethra) consists of several different layers -or coats—the inner, the one continuous with that lining -the bladder, which possesses the power of secreting a mucous -fluid, and the other made up of muscular fibres, -which give to the urethra the power of contracting and -dilating, that regulates the flowing or jetting of the fluid -which has to pass through it. The mucous membrane -of the urethra is of a highly sensitive nature, and more so -in some parts than in others, as, for instance, in the membranous -and bulbous portion of the canal; and hence it -will be found, that those are the parts most liable to disease. -The mucous membrane has several openings called -<i>lacunæ</i>, for the furnishing a particular fluid to moisten and -lubricate the urinary tube: these also are frequently -the seat of disease. These are seen in the drawing on -page <a href="#Page_50">50</a>.</p> - -<p>In passing a bougie in contracted and irritable urethra, -it sometimes enters the opening marked B, and if violence -be used in propelling the instrument, false passages are -made.</p> - -<p>Independently of the function of the urethra being to -discharge the urine, it has also to convey the semen to the -orifice of the glans; and here in this act is to be observed -the wonderful adaptation of means to an end. During -the excitement attendant upon venereal commerce, the -seminal fluid accumulates, prior to emission, in the bulbous -portion, and when the fitting moment arrives for its -ejection, the membranous portion spasmodically contracts, -thereby preventing the regurgitation of the semen into the -<span class="pagenum"><a id="Page_50"></a>[50]</span> -bladder, while the muscles surrounding the bulbous portion -contract with energetic force, and so complete the -transmission of the generative fluid. Such are the functions -of the urethra in health.</p> - -<div class="screen-only"> - <table class="illo" summary="P50"> - <tr> - <td style="max-width: 231px;"> - <img src="images/i_b_050_cropped_231x400.jpg" width="231" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">A—Signifying the urethra cut open.</p> - <p class="side-caption"> </p> - <p class="side-caption">B—The lacunæ and the cut end of bougie, to show the continuation of the urethra.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_050_cropped_347x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_050_cropped_231x400.jpg" width="231" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold">A</span>—Signifying the urethra cut open.</div> - <div class="linep7"><span class="bold">B</span>—The lacunæ and the cut end of bougie, to show the continuation of the urethra.</div> - </div> - </div> - </div> -</div> - -<p>Now, this canal being extensively -supplied with nerves, that have more extensive -communication with others than any particular ones have -in the whole body, and made up, as before stated, of surficial -and muscular membranes, and exposed to the performance -of several duties which are often unduly called -into exercise, can not be supposed to be exempt from the -consequences of such misappropriation; and therefore it -is very liable to inflammation. From the sensitive nature -of the tube, it is very obnoxious to spasm, which may be -partial, general, temporary, or continuous: hence spasmodic -stricture. This condition is of course dependent -upon many causes, excess of diet, fatigue, cold, &c., irritating -the general system; when from the local irritation -previously set up in the urethra by the forenamed causes—a -neglected gleet or clap—the urethra is not long in participating -in it: the phenomena are the symptoms recently -narrated. Highly restorative as the powers of nature -may be to remove disease, she does not appear readily disposed<span class="pagenum"><a id="Page_51"></a>[51]</span> -to interfere with the processes set up in the machine -she inhabits, for self-defence, to protect itself from the -constant irritation produced by the daily flow of acrid -urine, which in several cases often produces ulceration; -coagulable lymph is thrown out in the cellular structure -of the particular diseased part, thereby thickening the -walls thereof, and constituting permanent stricture, it appearing -preferable to impede a function which a narrowing -of the urethric canal does, namely, that of urinating, -than of allowing ulceration to ensue, whereby the urine -would escape into the neighboring parts, and occasion -great devastation, and probably death. Permanent stricture, -as its name implies, outlives the patient; <i>it never -yields, unassisted by art</i>. I have described the ordinary -symptoms of stricture, especially that form induced by -gonorrhœa. Stricture may arise from other causes. Inflammation, -in whatever way set up, if allowed to go on -or remain, will give rise to stricture, and the celerity or -tardiness with which it takes place depends upon circumstance. -An injury from falling astride any hard substance, -blows, wounds, contusions occasioned by riding, -the presence of foreign substances, the injudicious use of -injections, and lastly, which is as frequent a cause as any -one of those heretofore enumerated, <i>masturbation</i>. The -violent manual efforts made by a young sensualist to procure -the sexual orgasm for the third or fourth time continuously, -I have known to be of that degree that irritation -has been communicated to the whole length of the urethra, -extending even to the bladder; and retention of urine, -in the instance I allude to, ensued, and required much attention -before it could be subdued. Excessive intercourse -with females will give rise to the same effects; not so -likely as in the case preceding, inasmuch as the former -can be practised whenever desired, while the latter needs -a participator. The act of masturbation repeated, as it -is, by many youths and others, day after day, and frequently -several times within each twenty-four hours, must -necessarily establish a sensitiveness or irritability in the -parts, and alteration of structure is sure to follow.</p> - -<p>The positive changes which take place in stricture in -the urethral passage are these: there ensues a thickening -and condensation of the delicate membrane and the cellular -tissue underneath, which may possibly unite it to the -muscular coat. This thickening or condensation is the<span class="pagenum"><a id="Page_52"></a>[52]</span> -result of what we call effusion of coagulable lymph. It -will be rather difficult to explain the process; but lymph -is that fluid understood to be the nutritious portion of our -sustenance or system, and which is here yielded up by the -vessels which absorb it, and which vessels abound, with -few exceptions, in every tissue of our body. However, it -will suffice to say, that where inflammation takes place, -there is an alteration of structure, and that alteration is -generally an increase. In stricture, this increase or thickening -takes place, as I observed before, in particular parts -of the urethra, but where the inflammation is severe, no -part is exempt, and whole lengths of the passage become -occasionally involved. It is true, certain parts are more -predisposed than others, as, for instance, the membranous, -bulbous, and prostatic portions of the canal; but there -are oftentimes cases to be met with where these parts are -free, and the remainder blocked up. This effusion or -thickening assumes various shapes, and selects various -parts of the urethra. The subjoined diagram will convey -a tolerably perfect idea of the malady in question; indeed -it is a beautiful specimen of simple stricture.</p> - -<div class="screen-only"> - <table class="illo" summary="P52"> - <tr> - <td style="max-width: 159px;"> - <img src="images/i_b_052_cropped_159x400.jpg" width="159" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">A—The cut edges of the corpus spongiosum.</p> - <p class="side-caption"> </p> - <p class="side-caption">B—The urethra.</p> - <p class="side-caption"> </p> - <p class="side-caption">C—The stricture.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_052_cropped_238x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_052_cropped_159x400.jpg" width="159" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold">A</span>—The cut edges of the corpus spongiosum.</div> - <div class="linep7"><span class="bold">B</span>—The urethra.</div> - <div class="linep7"><span class="bold">C</span>—The stricture.</div> - </div> - </div> - </div> -</div> - -<p>To continue the description of the formidable consequences -of neglected stricture.</p> - -<p>In protracted and neglected cases, that part of the urethra<span class="pagenum"><a id="Page_53"></a>[53]</span> -between the stricture and bladder becomes dilated, -from the frequent pressure of the urine upon it, induced -by irritability of the bladder, which has an increasing desire -to empty itself. In process of time, complete retention -of urine will ensue, ulceration will take place at the irritable -spot, and effusion of urine into the surrounding parts -will follow; and the consequences will be, as in the instance -of the spasmodic affection, <i>fatal</i>, unless controlled -by the skilful interference of the surgeon.</p> - -<p>The symptoms of permanent stricture are often as slow -in their progress, and as insidious in their nature, as they -are appalling in their results, and are seldom distinctly -observed by the patient, until firmly established.</p> - -<p>He is suffering from a long-continued gleet, and is first -alarmed by a partial retention of urine—it passes by drops, -or by great straining, or not at all. This usually occurs -after intemperance, and is relieved by the warm bath, fomentations, -and laxative medicines. This is the first stage, -and is attributed to the debauch solely; whereas, at this -time an alteration of structure is going on in the urethra. -Its calibre is becoming diminished, which necessarily causes -the urine to flow in a smaller stream. This is not -observed at first; and it is only after a long period that -the patient becomes aware of the fact.</p> - -<p>The disease proceeds. In the morning, from the gluing -together of the sides of the urethra, by the discharge -from its diseased surface, the urine flows in a forked or -double stream; and then, as this agglutinution is dissolved, -it become natural.</p> - -<p>There is a greater and more frequent desire to make -water, disturbing sleep many times during the night, but -unattended with pain, unless the neck of the bladder be -affected.</p> - -<p>There are also uneasy sensations in the perinœum, a -sense of weight in the pelvis, with flying pains in the -hips; and in the permanent stricture there is a remarkable -symptom frequently prevailing—that is, a pain extending -down the left thigh from the perinœum.</p> - -<p>As the disease advances, the urine flows in only a very -small stream, or forked, twisted, double, or broken, or in -drops; and the patient solicits the flow by pressing with -his finger on the perinœum, and elongating the canal, -somewhat after the manner in which a dairy-maid milks -a cow.</p> - -<p><span class="pagenum"><a id="Page_54"></a>[54]</span></p> - -<p>The dilatation of the urethra between the stricture and -the bladder already alluded to, now takes place; and some -urine remains in the dilated part, which oozes through -the stricture, making the patient wet and uncomfortable.</p> - -<p>There is great difficulty felt, and more time is occupied -in getting rid of the last drop of water, than formerly. -This sensation continues all along; and the cure is never -accomplished until this is finally removed.</p> - -<p>If the stricture is still neglected, more severe symptoms -come on, and the neighboring parts become affected -also.</p> - -<p>The <i>sphincter ani</i>, or the muscles of the anus, are relaxed, -from the excessive action of the abdominal muscles; and -the fæces pass in small quantities involuntarily. There -is a protrusion of the bowel, which adds to the distress, -and, by its irritation, brings on a looseness or diarrhœa.</p> - -<p>The prostate gland, which is seated near the neck of -the bladder, suffers inflammation and enlarges, beginning -at the orifice of the ducts, which open into the urethra.</p> - -<p>The emission of semen, which often happens involuntarily, -is attended with agonizing pain, producing cold -shiverings, followed by heat; and fever soon becomes -fairly established.</p> - -<p>The liver and its secretions become diseased, discharging -in the intestines large quantities of vitiated bile. The -fever assumes the intermittent character. The discharge -from the urethra is greatly increased in quantity, showing -the formation and bursting of an abscess of the prostrate -gland into it.</p> - -<p>The bladder is much thickened and diminished in size, -and acutely or chronically inflamed. The desire to make -water is continual, allowing hardly a moment of rest; -and the patient, in the agony of despair, prays to be relieved -from his sufferings.</p> - -<p>Soon succeeding the irritation of the prostate, the testicles -become involved, the disease being propagated by -means of their ducts, which open into the urethra. The -testicles swell a little, become uneasy and painful, and a -dropsical or hardened enlargement ensues.</p> - -<p>When the stricture forms a nearly complete obstruction -to the passage of urine, the violent efforts of the bladder -to expel it bring on ulceration or rupture of the urethra, -through which the urine is forced into the cellular membrane,<span class="pagenum"><a id="Page_55"></a>[55]</span> -with all the power of a spasmodically excited bladder.</p> - -<p>The scrotum and neighboring parts become distended, -erysipelas supervenes, black patches of mortification break -out in different places, the febrile symptoms are augmented, -and the patient at last irrecoverably sinks into a state -of coma or muttering delirium, and death closes the scene. -Such is the progress and termination of stricture when -neglected.</p> - -<p>The reader, if he be an afflicted one, will eagerly turn -to the page wherein the treatment of this formidable and -distressing malady is considered; and great will be his -satisfaction and delight, on finding it remediable by such -simple means, and entirely within his own control; more -especially if he direct his attention to the disease in its -earlier stages.</p> - -<p>He must by no means, however, be too sanguine, from -these remarks, or indulge in the idea that as stricture is -remediable, it is unimportant when the cure be attempted; -the longer the delay, the greater will be the cost to the -patient; and, furthermore, the slightest deviation from the -instructions laid down, will surely aggravate the disease, -and increase the embarrassment of the sufferer.</p> - -<p>The following diagrams are further explanatory of the -stricture in its amplified forms.</p> - -<div class="figcenter" style="max-width: 261px;"> - <img src="images/i_b_056_cropped_261x400.jpg" width="261" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_056_cropped_392x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The dark marginal line denote the calibre of the urethra, -and the inner lines the actual diameter of the obstructed -passage. Figure 1 shows the stricture to be on -the lower part of the urethra. Figure 2 the upper part. -Figure 3 exhibits a stricture of some length, and a somewhat -contracted state of the whole canal. Figure 4 denotes -a very common form of stricture, which resembles a -flour-bag tied in the middle; it is the least difficult to cure -of any, because it signifies that the seat of irritation is -limited; but these cases are generally precursory to severer -forms, if not promptly attended to. Figure 5 represents -a stricture of considerable length, and of course very -difficult of removal.</p> - -<p>There are many provocatives to stricture, and when -once mischief is progressing, it makes up for its slow initiation -by giant strides. A patient may have a trifling -stricture for years without experiencing much inconvenience. -He takes cold, fatigues himself, commits some -stomachic or other excess, may possibly have fever, all of<span class="pagenum"><a id="Page_56"></a>[56]</span> -which more or less disturb the general economy, alter the -character of the urine, and in that manner doubly accelerate -the disorganization going on in the urethra. A -small abscess may spring up <i>in</i> the urethra, or <i>below</i> it -among the cellular membranes and integuments. In either -case, it chances now and then to burst an opening -and create a communication externally with the urinary -passage, constituting what is called <i>fistula</i>. A person laboring -under stricture is always liable to these occurrences. -As much mischief is done oftentimes by mismanagement -as by neglect. The clumsy introduction of a -bougie, or, in other instances, the unjustifiable introduction -of one, is likely to, and very frequently does, lacerate -the delicate and irritable membrane, and make a false<span class="pagenum"><a id="Page_57"></a>[57]</span> -passage. Figure 6 exhibits an instance at Nos. 1 and 2; -the upper numerical shows a false passage made by a -bougie, and an obliteration of the ordinary passage of the -urethra, the result of inflammation, constituting an impassable -stricture; the lower figure exhibits a false opening -made, in the first instance, by a fruitless effort at -passing an instrument, when inflammation completed the -process. No urine escaped from it of course, because -communication was cut off from the bladder by the impassable -stricture; the outlet for the discharge of that -fluid being through a sinuous opening marked No. 2, the -No. 3 denoting the closed end of the urethra. The case -happened to a man in very ill health, who was prone to -ulceration, and he gradually sunk under exhaustion from -debility and premature old age. Figure 7 exhibits a stricture -where the posterior part was enlarged by the constant -pressure of the urine to escape through the narrowed -part of the urethra; ulceration ensued, and a fistulous -opening was the consequence; the stricture was -seated high up, and the fistulous canal was several inches -long, terminating in the upper and posterior part of the -thigh; the urine used to dribble through it as well as -through the urethra. The patient had been a seafaring -man; he was in exhausted health from hot climates and -intemperate living, and he died at last of consumption. I -have the parts showing the stricture and the fistulous -opening by me, in a state of good preservation. In Figure -8 is presented an illustration of extensive ulceration -producing two fistulous openings; the state of the urethra -was only discovered after death, the patient having concealed -his infirmity for many years; he died suddenly -from apoplexy, being found dead in his bed by the people -of the house where he lodged. Figure 9 portrays irregular -and extensive ulceration. The patient died from -syphilis, having gonorrhœa at the same time. I have the -preparation. Figure 10 shows an impervious urethra, -and a fistulous opening through which the urine flowed. -The urinary passage was blocked up within two inches -from the orifice, and the length of the obstruction was -perhaps a quarter of an inch. It was perforated successfully -by the lanceted stilette, and the passage thereby rendered -continuous; the catheter was worn for several days, -and the false opening soon healed after a slight application -or two of nitric acid. Numerous other illustrations<span class="pagenum"><a id="Page_58"></a>[58]</span> -might have been given, but the preceding convey a passable -notion of the simplest, and most confirmed, and most -severe forms, of the malady in question.</p> - -<p>It is melancholy, notwithstanding the resisting and reparative -power of nature to avoid so saddening a disease -as stricture, that it is so very prevalent, and that it is occasioned -by so many causes. Where it is not destructive -to life, it is very injurious. It involves, where it is severe, -other important organs beside the seat of its abiding; -the repeated calls upon the bladder, through sympathy -of the irritation, created so near to that viscus, the -efforts which at all times it is obliged to make, although -assisted by the muscles of the abdomen and contiguous -parts to void its contents, at last, and very frequently end -in paralysis, and total inability to pass water ensues, except -through the aid of the catheter. Independently of -which, where so much disease exists as in the urethra, -the urine also constantly pressing against ulcerating and -irritable surfaces, extravasation of that secretion takes -place, and the most formidable and alarming consequences -ensue. In the simplest form of stricture, many important -functions are disturbed. A very frequent consequence -is permanent irritability of the bladder, so that the -patient is obliged, ten or twelve times a day, to micturate, -and is unable to pass through the night without suffering -nearly the same inconvenience. Besides which, the natural -sensitiveness of the genital organs becomes speedily -and much impaired. I am satisfied that where disorganization -of the testicles does not exist, and where the patient -is young, or even middle-aged, if he be impotent, he -will in nine cases out of ten be found to have stricture. -There are exceptions, which shall be named when speaking -on the infirmities of the genital system, but in nearly -all cases of impuissance there will be found, if not stricture, -at least some morbid irritability of the urethra. During -the existence of stricture, there is generally a vitiated -secretion from the seat of mischief, constituting a -gleet; therefore a gleet at all times should be regarded, -lest it be an indication of something more than a mere -weeping from enfeebled vessels.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>On the Treatment of Stricture.</i>—Having fully described -the symptoms and progress of stricture, I proceed to the -more pleasing part of treatment. Stricture, if early attended -to, is a disease easy remediable: if neglected, its<span class="pagenum"><a id="Page_59"></a>[59]</span> -horrors accumulate, and sufferings the most acute close -the scene. Such, however, is the progress of science, that -it is almost possible to cure the most inveterate case, at -all events to relieve it; but that is no reason why the initiatory -notices should be disregarded. Stricture, as must -be perceived, is of two kinds, spasmodic and permanent: -the treatment of the first is chiefly medical, the treatment -of the latter chiefly mechanical. The principal agents I -rely upon in the cure of the former, are the warm bath, -rest, sedatives, and certain dietetic restrictions; for the -removal of the latter, I place unbounded confidence in the -practice of <i>dilatation</i>; and I am of opinion that the other -methods, namely, the application of caustic or the scalpel, -might be dispensed with altogether, if the dilating method -be not delayed too long.</p> - -<p>Before commencing the cure of stricture, I need hardly -observe, that we ought to be fully satisfied of its existence. -Symptoms are not always unerring guides; and, -therefore, our reliance should not wholly depend on them.</p> - -<div class="centered-poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div class="verse indent">——“to be once in doubt</div> - <div class="verse">Is once to be resolved.”</div> - </div> - </div> -</div> - -<p>The only mode of ascertaining the precise condition of -the urethra, is by an examination of it, which should not -be delayed a moment after suspicion is entertained of the -impending evil.</p> - -<p>For this purpose, it is recommended that a solid silver -sound should be used as the best instrument; because it -will pass with much less pain or inconvenience. It should -be made conical, that is, smaller at the point than at the -shaft, and of a size to pass very readily into the orifice; -the shaft or body of the sound should not exceed two -thirds of the size of the canal. The sound should be -warmed, and afterward it should be well oiled. The directions -for examining the urethra pertain to the passage -of a bougie or catheter; and as it often falls to the lot of -a patient, that he is beyond medical assistance, it behooves -him to learn how an instrument should be passed, in order -that in emergencies he may officiate himself; besides, it -often happens, in cases of diseased bladder, and in those -cases where retention of urine frequently occurs, that an -invalid can not command the necessary constant attendance -of his professional man; and therefore such knowledge -will well repay any little time or trouble bestowed in -the acquisition. The two annexed drawings will render<span class="pagenum"><a id="Page_60"></a>[60]</span> -the commonest observer a proficient. The first shows the manner in -which the bougie is to be introduced. Where the instrument can be -passed thus far, without the assistance of the other hand than that -which holds the bougie, it is better, as it keeps the penis and the -muscles which influence it in a passive state. When the instrument has -passed as far as it will, in the direction the dotted lines denote, it -is to be turned gently round, raising the handle toward the abdomen. A -slight pressure is then to be made <i>downward</i>, and the handle of the -catheter or bougie at the same time to be borne away from the body. -See diagram. The instrument will, if there be no impediment, gradually -slip into the bladder. A trial or two will perfect and surprise the -novice. The same directions apply to the introduction and use of all -other instruments into the urethra. The sensation experienced on having -a bougie passed, partakes more of a strange tickling feeling than -absolute pain, except there exist stricture, and even then the urethra, -on a subsequent trial, is almost insensible to it.</p> - -<div class="figcenter" style="max-width: 400px;"> - <img src="images/i_b_060a_cropped_400x400.jpg" width="400" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_060a_cropped_600x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<div class="figcenter" style="max-width: 327px;"> - <img src="images/i_b_060b_cropped_327x400.jpg" width="327" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_060b_cropped_491x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>If soreness or pain is felt, on the sound passing over -the affected part, we may presume there is chronic inflammation -of the urethra, or that the surface is ulcerated, as -in long standing gleet. If the sound meet with an impediment, -but proceeds after a little pressure, it indicates a -thickening of the mucous membrane, the forerunner of -stricture.</p> - -<p>I may here observe, that stricture is generally found to<span class="pagenum"><a id="Page_61"></a>[61]</span> -exist either within an inch of the orifice, or at about six -inches and a half from it, or in the prostate part of the -urethra.</p> - -<p>If the sound passes, without hinderance, the last situation, -but with increased pain, the membrane of that part -is diseased, and may extend to the bladder; which will be -indicated by the frequent desire to micturate during the -night, owing to the irritable state of that organ.</p> - -<p>If the instrument be arrested at about six inches and a -half, the complaint, in all probability, is seated in the transverse -portion of the prostate, and requires very cautious -treatment.</p> - -<p>When the obstruction is at the very entrance of the -bladder, a resistance will be perceived, which, on yielding, -will impart a peculiar sensation as the sound enters -the bladder. When stricture is thus situated, there is a -frequent desire, with almost total inability, to micturate; -and when once formed, it is productive of the most serious -mischief, unless relieved.</p> - -<p>In cases of permanent stricture, the passing of the -sound conveys the sensation of going over a ridge. Where -it meets with a temporary stoppage, and then passes on, -it has probably hitched to a fold of the urethra. Sometimes -it will enter the orifice of a dilated follicle; and if -much pressure is used, it will occasion considerable bleeding.</p> - -<p>The nature and situation of the disease being ascertained, -the cure may now be proceeded in, recollecting -that no force is to be used, and that too much be not attempted -at one essay. Now without entering into an inquiry -as to the laws on which <i>contraction</i> and <i>elasticity</i> of -certain animal structures depend, it is enough for our purpose -to know, that the urethra possesses both properties; -it may contract so as to oppose the exit or entrance of the -smallest stream, and it may be dilated to admit the introduction -of an instrument an inch in circumference. The -urethra maintains these properties in disease as well as in -health, and upon the strength of this fact, is the practice -of dilatation in the cure of permanent stricture founded, -permanent stricture, it will be recollected, is a positive -narrowing of the urethric canal; and as it is the nature -of all organic diseases to progress, unless prevented by -art, it needs no stronger argument than necessity to show -how imperative it is to set about their removal.</p> - -<p><span class="pagenum"><a id="Page_62"></a>[62]</span></p> - -<p>The cure by dilatation is as follows:—the seat and size -of the stricture being ascertained (both of which can be -easily done by the passing of the sound as directed, and -the observance of the stream of urine), a bougie in circumference -somewhat larger than the calibre of the urinary -current, warmed and dipped in an oleaginous mixture -combined with some sedative (Forms <a id="FManchor_22"></a><a href="#Form_22" class="fmanchor">22</a>, -<a id="FManchor_23"></a><a href="#Form_22" class="fmanchor">23</a>, -<a id="FManchor_24"></a><a href="#Form_22" class="fmanchor">24</a>) or stimulant -(Form <a id="FManchor_25"></a><a href="#Form_25" class="fmanchor">25</a>) according -to circumstances, is to be passed to the stricture, and -the gentlest pressure is to be employed for the space of -five, ten, or twelve minutes, according to the irritation it -produces, removing it as soon as any uneasiness is felt.</p> - -<p>Even in this very simple operation, a certain dexterity -is requisite; for the direction of all urethræ is not alike, -and the mere pushing a bougie against a contracted part -is not the only likely method of effecting a free passage. -Much also depends upon the nature of the bougie—the -elastic ones, although assisted in their attempted passage -to the bladder, by the smooth and well lubricated sides of -the urethra, have a tendency to straighten; and unless -considerable rotatory motion be observed, are apt to hitch -in a fold of the urethra, especially if the case befall a person -of relaxed fibre, and he be much worn down by suffering. -The bougies that I employ are constructed upon<span class="pagenum"><a id="Page_63"></a>[63]</span> -an improved plan to those in general use, being prepared -of a material that will preserve the shape I adapt them -to, previously to introducing them, but at the same time -sufficiently soft to yield to any accidental tortuosity of the -tube they are intended to explore. The bougie then is -to be pressed softly, but steadily, against the obstruction, -now and then withholding for a minute the bearing, so as -to allow a respite to the stretched membrane; then renewing -by, what is better done than expressed, an “insinuating” -pressure for the space of the time advised above. -The patient should not be dispirited, even if the bougie -do not perforate the stricture at the first trial; it would -doubtless do so, if longer time were employed, but that is -rarely advisable, except in cases where the urine can -scarcely escape, or much expedition be requisite. Should -the operation even be unsuccessful in this first attempt, -the patient will find his ability to micturate much greater -than before the introduction; but, save in long-standing -and obstinate strictures, I rarely find myself foiled, nor -do those who practise the same method, if they have patience -and skill enough, in overcoming the difficulty at the -first interview. A great advantage of the cure by dilatation, -independently of its safety and efficacy, is the insignificant -pain it occasions; the sensation produced being -only like a pressing desire to make water, which immediately -subsides on withdrawing the bougie.</p> - -<p>Another method of dilating a stricture, where it happens -to be of chronic existence, is the passing a plastic -catheter into the bladder, and suffering it to remain all -night, or even for several nights, stopping up the handle -end with a cork or wooden peg, which the patient can remove -when he desires to urinate. The urethra, by this -means, becomes quickly dilated, and much beyond the size -of the instrument. It necessarily confines the patient to -his room and couch; but where an expeditious cure is the -object, as much may be effected in this manner in six days, -as by the ordinary method in as many weeks. Time, however, -it must be remembered, is the working <i>material</i> of -nine tenths of strictured invalids, and a week’s lay-up may -cost a twelve-month’s salary—a purchase too dear to be -generally incurred.</p> - -<p>Several other plausible methods have been suggested for -the cure of stricture—one by means of an instrument, that -the operator could enlarge when it was passed into the<span class="pagenum"><a id="Page_64"></a>[64]</span> -urethra, through turning a screw; another, which was to -introduce a tube made of some thin skin, and then to distend -it with wind or water; a third, and oftentimes, in reality, -a very useful and available one, is to compress the -penis around the glans, and suffer the urine, as it accumulated, -to distend the anterior part of the urethra before -the bandage was removed and the urine suffered to escape. -But they have their several disadvantages: the processes, -with the exception of the last, are complicated and uncertain -in their result; the instrument is not so manageable, -or so useful, as an ordinary sound; and the gut, instead -of distending the strictured part, enlarges the healthy portions -of the urethra. The bougie, in proper hands, notwithstanding -it is a simple instrument, is the most positive -and effectual method of curing stricture as yet, or likely to -be, discovered. An entrance, then, having by this means -been gained, a bougie of a larger size is to be selected on -the next occasion, and the same process repeated. It is -never advisable to repeat the operation oftener than once -in two days, and when the urethra is irritable, only every -three or four days.</p> - -<p>By continuing in this manner, the stricture gradually -yields, and a bougie as large as the orifice will permit to -enter will at last proceed through the whole passage without -meeting any obstacle. The operation, notwithstanding -this apparent success, should not be wholly laid aside, -but continued until the disposition for contraction is entirely -removed; and the patient should never rest without -occasionally examining his urethra, say once a month (at -least once a quarter), lest he encounter a relapse.</p> - -<p>Having disposed of the treatment of stricture in its fortunately -most usual—namely, the mildest—form, I proceed -to consider the treatment of severe kinds—previously to -which, a few remarks upon the various kinds of instruments, -their structure, shape, and size, will render any -subsequent allusion more intelligible.</p> - -<p>The diagram here introduced represents the calibre of -the various bougies in general use, and the observer will -perceive, that as they are made to accommodate themselves -to the passage they have to pass, how varied must be the -changes which the urethra undergoes. The last outline -indicates the natural and healthy bore of the urethra. -Bougies are manufactured of different materials: waxen -cloth rolled together, elastic and yielding; flexible metal, -<span class="pagenum"><a id="Page_65"></a>[65]</span> -silver, and gold. The bougies which I employ are constructed -upon an improved plan to those in general use: -the elastic, as they are termed, although assisted in their -attempted passage to the bladder by the smooth and well-lubricated -sides of the urethra, have a constant tendency -to straighten, and consequently are liable to hitch in all -the folds they may encounter, which, in relaxed habits, are -very numerous in the membranous portion of the urethra. -To obviate such a possibility, I prefer that the bougie -should be of such a consistence and manufacture as will -admit of its preserving the shape I adapt it to previously -to introducing it; at the same time the material to be sufficiently -soft to enable it to accommodate itself to any accidental -tortuosity of the tube it is exploring.</p> - -<div class="figcenter" style="max-width: 413px;"> - <img src="images/i_b_065_cropped_413x400.jpg" width="413" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_065_cropped_620x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Catheters are instruments for the purposes of withdrawing -the urine; they are consequently hollow, and are -made of the same materials as bougies; but the most useful -and to be depended upon are composed of silver. Surgeons, -like other men, have their fancies: a catheter, -when made of silver, has very little flexibility; accordingly -it must be shaped beforehand. Some medical men prefer -them quite straight, others with an immense curve. A -surgeon should possess many forms, as the direction of the -urethra differs almost in all men. The subjoined exhibits -not the size, but the shape of the more useful and those -most generally used. Figures 1, 2, and 3, suffice in most -instances, whereas figure 4 is necessary in cases of enlargement<span class="pagenum"><a id="Page_66"></a>[66]</span> -of the prostate gland, which presses up the -bladder, and renders the urethral passage consequently -longer.</p> - -<div class="figcenter" style="max-width: 323px;"> - <img src="images/i_b_066_cropped_323x400.jpg" width="323" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_066_cropped_484x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The French employ not only variously curved instruments, -but variously shaped. In peculiar cases they are -doubtlessly useful; but they require to be used only by -persons of skill and judgment. In the next three kinds -are views of such; they are called conical bougies—the -first curved, the second straight. They are made of silver, -waxen cloth, or India-rubber. The third exhibits a -sound, employed to ascertain the seat of the stricture.</p> - -<p>I have already alluded to the improved method I employ -on finding it necessary to use escharotics. I can not better -explain the process than by submitting a sketch of the<span class="pagenum"><a id="Page_67"></a>[67]</span> -instruments, whereby the mode of application will be instantly -perceived. The instruments are made of silver. -The figures represent No. 8 a curved, No. 9 a straightened, -No. 10 ditto, with enlarged head, which puts the -areola of the stricture on the stretch, and secures the central -part for the application of the caustic, or whatever -substance may be employed.</p> - -<p>The next kind of instruments are for the purposes of -dividing or piercing hardened obstructions—one or two -applications creating a passage which a hundred <i>cauterizings</i> -would not effect. When any styptic is applied to a -morbid growth, its tendency is to create a slough, or to -destroy the part whereto it is applied. In some instances -a styptic actually promotes increased action: it may temporarily -destroy the part; but the moment the effect is -over, a reaction follows, and the excrescence is increased. -Such is the case in many long-standing, obstinate strictures; -and their removal by perforation or division is rendered -indispensable. The practice requires the most careful -attention and anatomical knowledge; and no one but -a professional man would attempt its employment.</p> - -<p>No. 11 sketch exhibits a curved instrument, with the -pointed lancet projecting as when applied. No. 12 exhibits -ditto, but with a differently formed instrument, consisting -of two portions separated, so as to allow a director, -in the form of a thin silver wire with a silver knob, to pass -for the purpose of exploring the passage which the instrument -is to follow and enlarge. It is indispensable in -strictures seated upon the soft and deep parts, lest a false -passage should be made. No. 13 represents a straight instrument; -No. 14 ditto, but with the lancet in reserve—the -last a perforator.</p> - -<p>The reader has now been made acquainted with the various -resources the surgeon has at his command. A few -words on their employment will complete the necessary -amount of information to render the one as wise as the -other. By way of recapitulation, the treatment of stricture -is by <i>dilatation</i>, <i>cauterization</i>, and <i>division</i>. They -are to be estimated in the order of their arrangement. By -dilatation is meant the enlarging of the urethral passage -through the frequent introduction of bougies of graduated -sizes. It is an operation unattended with any considerable -pain; its novelty sometimes renders a patient a little -nervous, but a complaint is rarely made after a second or<span class="pagenum"><a id="Page_68"></a>[68]</span> -third introduction. Indeed, it is oftentimes courted more -frequently than is desirable. The application also of -caustic, or even the perforator, produces scarcely the least -inconvenience. Hemorrhage, of most things to be dreaded, -is less frequent, with cauterizing and cutting instruments -(in skilful hands), than the incautious employment -of blunt-pointed bougies.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>Diseases of the Testicles.</i>—The testicles, from their office -and connexion with other structures equally as important, -are liable to many excitations. In gonorrhœa they -are subject to sympathetic inflammation, as in <i>hernia humoralis</i>, -which, if neglected or maltreated, gives rise to -abscess or chronic hardness. Inflammation also occurs in -them as in other structures. Accidents, such as blows or -bruises, horse-riding, wearing very tight pantaloons, are -all fertile sources of derangement. Scrofulous constitutions -are predisposed to have their testicles, like the rest -of the glands, diseased. The most frequent disturbance, -however, of the testicles, is a dilatation of the veins, constituting -what is called varicocele; and generally accompanied -by a wasting away of the testicle itself. It is -rare, indeed, to find perfectly healthy testicles in an individual -who has been exposed to amatory pleasures and -sensualities; and as, of course, even amative desire, as -well as amative power, depends upon the absolute sound -condition of the glands in question, the inference is, that -in very numerous persons, the sexual instinct is considerably -diminished, and not unfrequently wholly suppressed, -before half the natural term of their existence has expired, -at which time they ought in reality to be at the climax of -their prime and capability.</p> - -<p>It is not so much a painful complaint, as an unpleasant -one. There are occasionally pains in the back and loins, -and other feelings, creating a sensation of lassitude and -weariness; and now and then some local uneasiness is -felt.</p> - -<p>Varicocele gives to the examiner a sensation as though -he were grasping a bundle of soft cords. It sometimes -exists to such a degree as to resemble a rupture. In advanced -stages of the disease, or disorganization, the epididymis -becomes detached from the body of the testicle, -and is plainly distinguishable by the finger. The result -of all is, that a considerable diminution of sexual power -takes place; and if means are not adopted to arrest a further<span class="pagenum"><a id="Page_69"></a>[69]</span> -break-up of the structure, the -venereal appetite will subside altogether. -The annexed drawing -exhibits a tolerably faithful portrait -of the disease; it represents -the varicocele to be on the left -side—the side most usually affected.</p> - -<div class="figcenter" style="max-width: 275px;"> - <img src="images/i_b_069_cropped_275x400.jpg" width="275" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_069_cropped_412x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The folds formed by the veins -lapping over each other are clearly -distinguishable, and the dependent -state of the scrotum on -the affected side exhibits very well -the occasion of it. The treatment -consists in giving support by -means of a suspensory bandage, which may be worn during -the day, and the use of local refrigerants night and -morning. The state of health is sometimes mixed up with -it; and tonics and generous diet are useful. The cold -shower bath helps to brace the system. It is a complaint -in which, if it be not of very great severity, nor very long -continuance, much good may be done. In some instances -the veins may be allowed to empty themselves, which they -will do when the body is in a recumbent position, and a -coated ivory ring, or a silken band, may be so placed -around them as shall prevent their refilling. It is, however, -a case fitter for the surgeon’s management.</p> - -<p><i>Abscess in the Testicle.</i>—The testicle is subject to inflammation -and suppuration like any other structure. A -case about three years ago fell under my notice, where a -quantity of dark fœtid fluid was released on puncturing a -testicle in which the sense of fluctuation was very evident; -and the patient stated that it had been five or six -years in arriving at that condition. He was wasted considerably -from nocturnal perspirations and acute pain, and -his sexual desire was much diminished. The case did -well, and the latter function was restored without much -loss.</p> - -<p><i>Hydrocele.</i>—Hydrocele is an accumulation of yellow serous -fluid in the <i>tunica vaginalis testis</i> (refer to the engravings -in next page), or peritoneal covering of the testicle. -It is a disease incident to every period of life, but more -commonly met with in grown persons. The ordinary formation -of hydrocele is unattended with pain; and the patient<span class="pagenum"><a id="Page_70"></a>[70]</span> -accidentally discovers the existence of the swelling, -but oftentimes not until it has attained a considerable -magnitude. The tumor, when large, produces an unsightly -appearance, and forms a hindrance to sexual intercourse, -from the integuments of the penis being involved -therein, and thereby preventing a perfect erection of that -organ. The disease may appear to originate spontaneously; -but it is usually traceable to some bruise, blow, or -other external injury to the part.</p> - -<p>The two following drawings exhibit the outward and -inward appearance of the scrotum in <span class="nobreak">hydrocele:—</span></p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_070a_cropped_248x400.jpg" width="248" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep0 center">The Scrotum largely distended.</div> - <div class="linep0 center ebhide p1"><a class="underline" href="images/i_b_070a_cropped_372x600.jpg" rel="nofollow">View larger image</a></div> - </div> - </div> - </div> -</div> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_070b_cropped_297x400.jpg" width="297" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep0 justify">The Scrotum distended to its utmost extent, and the position of the fluid shown. - The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as - scarcely to be perceptible.</div> - <div class="linep0 center ebhide p1"><a class="underline" href="images/i_b_070b_cropped_446x600.jpg" rel="nofollow">View larger image</a></div> - </div> - </div> - </div> -</div> - -<p>The notion that the cure of hydrocele depends on promoting -adhesion to the sides of the tunica vaginalis with -the testicle is somewhat upset by several preparations in -the London hospitals, exhibiting the <i>tunic</i> taken from persons -in whom a radical cure was effected by injection, and -in whom no fluid was reproduced; nor were the sides of -the said investment at all adherent with the testicle, but -apart, as in the healthiest individual. Hitherto surgeons,<span class="pagenum"><a id="Page_71"></a>[71]</span> -acting on the aforesaid notion, with a view to obliterate -the cavity, adopted various plans of treatment—such as, -for instance, laying open the entire cavity, cutting away -a portion of the tunica vaginalis, the application of caustic, -and, lastly, the seton, as advised by Dr. Pott, which -was suffered to liberate itself by ulceration. When, in -any of these instances, suppuration was induced, the cavity -became in time filled up by the granulating process. -The plan of the present day is by perforating the sac with -a trocar, suffering the effused fluid to escape, and injecting -some stimulating liquid which is allowed to remain until a -degree of inflammation is produced, that shall cause an -obliteration of the cavity by adhesion, or, as it has also -been proved, prevent a reproduction of the fluid, by closing -the mouths or altering the diseased action of the exhalent -arteries. Whichever be the effect produced thereby, the -cure is almost certain, and the principles of the treatment -consequently judicious. But, notwithstanding, the operation -is not always immediately, nor <i>ultimately</i> successful; -the degree of inflammation set up may be insufficient, and -the effusion again take place, and the operation may require -a second and third repetition; or an excessive degree -of inflammation may ensue, that shall occasion serious -constitutional disturbance, either by suffering the -injected fluid to remain too long, or its being of too stimulative -a character, or from its escaping into the cellular -membrane of the scrotum, an accident not unfrequent, unless -great care be used in the operation.</p> - -<p><i>Radical Cure of Hydrocele.</i>—The term radical is applied -to the process narrated in the last case; but, as has been -observed, the operation is occasionally required to be repeated -several times. In the case I am adverting to, after -tapping, several injections were thrown in between the -tunics, and withdrawn; and on one occasion the morbid -fluid was secreted to the greatest possible distension of the -scrotum by the following morning. Its subsequent withdrawal, -and the injection of a more active stimulant, effected, -however, a permanent cure. In the country, surgeons -frequently plunge a lancet in the scrotum, suffer the -effused liquid to escape, and desire the patient merely to -wrap the parts up in a handkerchief, to take no further -heed, and to ride home: and these cases generally do -well.</p> - -<p><i>Hydrocele Cured by Acupuncturation.</i>—A new method of<span class="pagenum"><a id="Page_72"></a>[72]</span> -treating hydrocele has of late years been introduced, -namely, by the insertion of a needle into the sac or bladder -of the testicle, which, upon its withdrawal, permits the -fluid to escape into the cellular membrane, whence it is -rapidly absorbed. A pint of fluid may be got rid of in -that way in two or three hours; and, although the disease -may not be radically cured, it will occupy several months -before a reaccumulation of the fluid takes place. In recent -cases, this treatment oftentimes proves permanently -successful. Many nervous persons will not submit to -anything approaching an operation, not even to the simple -one of acupuncturation. In such cases, there is no -alternative but counter-irritants, to be applied over the -part, such as the tincture of iodine, or the following ointment -(Form <a id="FManchor_26"></a><a href="#Form_26" class="fmanchor">26</a>).</p> - -<p>It is at all times best to attend early to any disease of -the testicles; the progress is so rapid, the mischief so -great, and the consequences so deplorable, of uncontrolled -disease.</p> - -<p><i>Eruptions incident to the Organs of Generation and the -Rectum.</i>—The structures included in the above heading -are subject to a variety of eruptions, varying in character, -intensity, and duration. Thus we have the <i>papular</i>, a -chronic inflammation characterized by papules, or very -minute pimples, of nearly the same color as the skin, accompanied -by intense itching, and terminating, when broken -by scratching, in small circular crusts: this is called, -by dermoid pathologists, Prurigo. Another order of eruption -is designated the <i>vesicular</i> and <i>pustular</i>, and consists -of groups of small pimples of a very bright red color, and -containing a serous fluid. They are accompanied by itching, -which increases as the contained humor becomes turbid, -and assumes the puriform aspect; they then incrustate, -and at the end of about a fortnight drop off, leaving -the skin healthy underneath. The name given to this variety -is Herpes.</p> - -<p>The last and most inveterate species is characterized by -an itching of the skin, which, on inspection, appears of a<span class="pagenum"><a id="Page_73"></a>[73]</span> -diffused redness, and gives off, after a while, a number of -thin scales: these reaccumulate, and the entire organs of -generation becomes sometimes covered with similar patches: -this is denominated Psoriasis. These affections, which -are but various degrees of inflammation, modified by idiosyncrasy -and habit, arise from local and constitutional -causes. Among these are frequent excitation of the organs -of generation, the contact of the fluids secreted during -sexual intercourse, an unhealthy and relaxed condition -of the genitals, and, lastly, a disordered state of the -digestive organs. It is astonishing to what an extent -these disorders prevail, and more so to find how long the -individuals, probably from a sense of diffidence in seeking -professional assistance, endure them. I have encountered -many patients who have informed me that they have had -the complaint upon them from five to ten years, purposing -during the whole of that period to consult some medical -friend, but postponing it until their interview with myself; -and it is the more to be regretted, as the cure may -always be effected in a week or two, with moderate attention -and perseverance; but if the attempt be neglected, -there is no limiting the extent to which the disease may -proceed. Local diseases, especially of such a nature as -those under consideration can not exist any great length -of time without involving the digestive organs, which become -sympathetically deranged; and in like manner do -local diseases participate with dyspeptic disturbances—each, -therefore, goes on aggravating the other.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>Diseases of the Bladder.</i>—The anatomical description of -the bladder will be found in the earlier pages of this work. -It may simply be restated:</p> - -<p>The bladder is a viscus somewhat similar in structure -to the stomach. It is composed of several coats—muscular, -nervous, and mucous. Each are liable to diseases peculiar -to their several structures. The size of the bladder -differs in most persons, and in the sexes.</p> - -<p>The female bladder is generally the largest; but the -largeness is observable more especially in females who -have borne children. The proverbial ability of females -to retain their urine longer than men is thus accounted -for.</p> - -<p>Much mischief is often done by both sexes disobeying -the particular “call of nature” to urinate; and the younger -branches should have that fact impressed upon them. I<span class="pagenum"><a id="Page_74"></a>[74]</span> -have known children acquire a severe and obstinate form -of irritability of the bladder by retaining their urine too -long. Diseases of the bladder are generally the consequences -of other complaints, and those complaints have -already been enumerated. They may be thus summed -up:</p> - -<p>Gonorrhœa extending to the bladder, and producing -absolutely a clap of the bladder. If the inflammation is -not subdued, or does not subside, probably some permanent -mischief ensues; at all events, the inflammation extends, -and involves other coats than the interior. Accordingly, -we have inflammation of the muscular coat, the -nervous coat, and, lastly, the peritoneal coat. These terminations, -severally, have certain symptoms, and certain -names.</p> - -<p>There are others, and among them may be named colds, -local injuries, hæmorrhoids, excess in drinking particular -fluids, sensual indulgences, diseased condition of the kidneys, -or long retention or vitiated states of the urine, nervousness, -and, lastly, the formation of stone in the bladder. -The most common form of bladder ailment is irritability, -which is a milder term for inflammation. Then we -have absolutely inflammation, and, lastly, loss of power, -or paralysis.</p> - -<p><i>Irritability of the Bladder.</i><a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>—The chief indication of disease -affecting the bladder is a frequent desire which the -patient experiences to pass his water; but that symptom -alone does not determine the nature of the complaint. It -may be irritable from sympathy with surrounding irritation, -and disappear on the subsidence of that irritation. -It may constantly be fretting the patient by its contractions, -through the urine (owing to some general derangement -in the system, being altered in its chemical qualities) -exciting the bladder the moment it is secreted therein; or -it may be the result of nervous agitation, with or without -any actual diseased state of the bladder. These causes<span class="pagenum"><a id="Page_75"></a>[75]</span> -should be understood to regulate the treatment, which of -course must be qualified by the provocation, and which -the patient, when in doubt, had better leave to the discrimination -of his physician.</p> - -<p><i>Paralysis of the Bladder.</i>—The bladder may become, -through loss of nervous stimulus, insensible to irritation, -and consequently be disobedient to its natural functions. -The urine, in these cases, accumulates in large quantities, -distends the bladder to its utmost, which it does without -pain; and the excess of secretion then dribbles away involuntarily. -This state of the bladder is called paralysis, -and is an aggravated form of disease, arising from the -same causes that establish inflammation, or from some -contiguous nervous injury. The treatment of paralysis -of the bladder must be intrusted to experienced hands; it -consists chiefly of purgatives, stimulative enemata up the -rectum, the introduction of the catheter, the cold bath, -rest, and general medicinal nervous excitants.</p> - -<p><i>Inflammation of the Bladder.</i>—Cases of acute inflammation -of the bladder are of rare occurrence; but they do -occur, occasionally prove fatal, and always are productive -of much general disturbance, which yields not without -vigorous and active treatment. Gonorrhœa is most usually -the exciting cause. On the sudden suppression of -the urethral discharge, an inflammation sympathetically -seizes the testicle, the glands in the groin, or the bladder; -and when the latter is the seat of the transference, it may -be held as the ratio of the severity of the disease. In inflammation -of the bladder, there is a constant desire to -pass water, which, when made, is usually in very small -quantities, and leaves a sediment. The patient often experiences -an insupportable inclination to urinate, with a -sensation as though the bladder were ready to burst—whereas -there may be little or no urine in it. There is -much pain at the root of the penis, and it extends along -the perinœum to the rectum, which latter is assailed with -almost constant spasms resembling straining. There is -considerable thirst, fever, and anxiety; the pulse is full -and quick, the tongue furred, and all those symptoms are -present that prevail during severe constitutional excitement. -The treatment consists of bleeding, leeching, or -cupping; relieving the bowels by castor oil and injections; -giving mucilaginous drinks, administering opiates, -preserving rest, and total abstinence from stimulating<span class="pagenum"><a id="Page_76"></a>[76]</span> -diet. If these means fail in subduing the inflammation -it runs on to ulceration, permitting extravasation of urine -occasioning mortification and death; but where they are -effectual, the patient is soon left free from complaint. It -often happens that the inflammation is not so vigorously -treated, or it may be wholly neglected, and yet it may -happily resolve itself without proceeding to the extremity -narrated; but, unfortunately, it may degenerate into a -minor but not less troublesome form, denominated chronic, -and which, in fact, is the disease christened “irritability,” -and the one, for obvious reasons, as above stated, for -which relief is most usually sought, the patient having in -vain daily looked for the subsidence of his malady. Having -stated that irritability of the bladder must be treated -with reference to its cause, it is obvious that more than -non-medical discrimination is required. Where it depends -upon stricture, the stricture must be first cured; where -upon stone in the bladder, the stone must be removed; -where upon sympathetic inflammation, the source must be -attacked, and so on.</p> - -<p>However, it has been stated that other causes may exist—that -it may even be a primary disease in itself; and -as this treatise professes to be a private mentor to the invalid, -I will detail such measures as may be safely adopted -for the cure of a complaint as often borne from being -trusted to unskilful hands, as from a morbid delicacy in -seeking proper and legitimate relief. The ordinary symptoms -are, first, an inordinate desire to make water; it -flows in small quantities, with pain before, during, and -after. The urine has an offensive ammoniacal odor; it -deposites a thick, adhesive mucus, of a gray or brown -color, sometimes streaked with blood, and of an alkaline -character.</p> - -<p>In this stage of affairs, rest is indispensable; sedatives -and opiates may be given; but alkalies (rarely omitted in -prescriptions for incontinence of urine) should not be indiscriminately -given, for they only render the urine more -alkaline, which occasions it to deposite calcareous flakes, -that, if not passed off, accumulate, unite, and lay the -foundation of that frightful disease, stone in the bladder. -The extract of <i>conium</i>, or <i>henbane</i>, combined with mucilage, -may be given in doses of three to five grains every -six hours. The <i>tincture of henbane</i>, in doses of a <i>fluid-drachm</i>, -or the <i>tincture of opium</i>, not exceeding <i>ten or fifteen</i><span class="pagenum"><a id="Page_77"></a>[77]</span> -<i>drops</i> at a time, may be given in like manner, and -continued for several days, keeping the bowels open with -castor oil. The daily or alternate daily use of the hot, -general, or hip bath, will afford immense relief. The -various preparations of <i>morphine</i>, <i>aconitine</i>, and of <i>hops</i>, -possess great power in small and frequent doses. The -<i>uva ursi</i> is a remedy of ancient note, and is often prescribed -with advantage; the dose is one scruple to a -drachm in milk, or any bland fluid, three times a day, or -it may be taken in infusion or decoction, one ounce to a -pint of water—that quantity to be drank during the day. -The <i>pareira brava</i>, exhibited in a decoction (by simmering -three pints of water, containing half an ounce of the -root, down to a pint), may be taken in divided doses of -eight or twelve ounces during the day, or in the form of -extract, in quantity of a scruple, which equals the above -amount of decoction.</p> - -<p>The <i>achillæ millefoliæ</i> is an excellent plant, and possesses -astonishing astringent powers, often restoring the -tone of the bladder to a healthy condition, when all other -remedies have failed. A handful of the leaves are to be -infused in a pint of boiling water, which, when cool, may -be poured off, and given in doses of a cupful three times -a day. Any of the preceding sedatives may be given in -conjunction with these preparations.</p> - -<p>Lime-water taken with milk, as an ordinary drink, is a -useful corrective.</p> - -<p>The <i>buchu</i> (the <i>diosma crenata</i>)—an ounce infused for -several hours in a pint of boiling water, and a wineglassful -of the cooled liquid administered three or four times a -day—has justly obtained some notoriety.</p> - -<p>Where all these means prove ineffectual, the injection -of sedative and astringent applications often answers the -most sanguine expectations; but they should be employed -only by professional persons, and even then with great -care; as when the disease has been at its height, and -they have been used, much inconvenience, and even mischief, -has been occasioned. A mild infusion of poppies, -or weak gruel, may be thrown in, once or twice a day, in -quantities not exceeding two or three ounces at a time, -and withdrawn after being suffered to remain thirty or -forty seconds. A catheter, with elastic bag, should be the -instrument used.</p> - -<p>In the more chronic forms, where the urine does not<span class="pagenum"><a id="Page_78"></a>[78]</span> -deposite much mucus, or is tinged with blood, the addition -of ten drops (<i>very gradually</i> increasing the quantity) -of the diluted nitric acid may be made to the fluid injected, -repeating or declining the operation, as the effects -are discovered to be advantageous or prejudicial.</p> - -<p>In an irritable state of the bladder depending on some -disease of the kidney, there is a frequent desire to void -the urine without there being any, or but very little, urine -in the bladder. There is also a severe cutting pain felt -about the neck of the bladder, especially after each effort -to make water, followed or attended by a “languid” pain -in the loins. The urine is often the color of whey, at -other times tinged with blood, and deposites, when suffered -to remain a while, a purulent sediment. The severe -symptoms should be allayed by the same remedies as prescribed -in irritable bladder arising from other causes; but -the original seat of the disease in this instance demands -energetic attention. The various counter-irritants are in -great requisition; leeches, blisters, setons, &c.</p> - -<p>In addition to the tonics and astringents already advised, -an infusion of the <i>wild-carrot seed</i>, made by macerating -for a couple of hours one ounce of the seeds bruised -in a pint of boiling water (drinking, when cool and strained, -the whole of the liquid in divided doses during the day), -may be taken with every chance of relief. As in the other -infusions, the patient must persevere in the use of this for -some time.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_79"></a>[79]</span></p> -<h2 class="no-page-break">ORIGIN OF THE VENEREAL DISEASE.</h2> -</div> - - -<p><span class="smcap">The</span> reader will allow that it can not be for want of -materials to produce a book, that this subject is introduced, -as the multifarious nature of this work’s contents -will readily testify; but it is briefly to explain certain -probabilities and conjectures which the afflicted curious -are generally desirous of being satisfied upon. Who -ever suffered under syphilis but was solicitous to know -how such a plague came into the world? Many moralists -believe and insist that it is a specific punishment, -sent for our physical transgressions. Philosophically -speaking, such it is; because the infringement of any -natural law always incurs a penalty. However, if it -be a manifestation of divine displeasure, it certainly is -most unequally apportioned; for it generally happens to -the least licentious, instead of the most depraved—the -timid, scrupulous, and nervous man, contracting it on the -first loose intercourse, whereas the man of the town revels -almost with impunity; and, lastly, he who exercises the -greatest caution and cleanliness escapes it altogether, although -he may be the most deserving of the infliction. In -a state of timorous excitement, we are more apt to catch -the latent mischief. The careless, thoughtless libertine, -hardened against infection by indifference, free living, and -probably strong health, often escapes scot-free; and the -cool and calculating pleasure-hunter, who exercises those -useful antagonists to disease, namely, ablution and selection, -comes off triumphant with still greater certainty.</p> - -<p>The point at issue is, when the disease first arose, and -where. Medical historians give credit to America, Spain, -and France, for its propagation; and controversies have -been carried on by various parties, each disclaiming the -honor. Now, as I do not propose to analyze the authorities, -but simply to venture my own opinion, with the reasons -for the same, I have no alternative but to refer the -reader, if he be dissatisfied with my attempted exposition, -to more comprehensive and elaborate conjectures than my -own. Starting upon the proposition that nature’s laws<span class="pagenum"><a id="Page_80"></a>[80]</span> -are unalterable, and believing that fever is, and has been -fever since the creation of the world; that a cut finger has -healed by the first intention, or has <i>festered</i>, and ever may -do so—each condition being modified by the state of health -of the party, and the nature of the wound; that a broken -limb was attended with the same consequences in the year -1 as it will be in the year 1900; and that dirtiness generated -itch, and does so still: I can not reconcile myself -to any other belief, but that any violation of the laws -whereupon sexual intercourse has been permitted, has -been, is, and will be, attended with corresponding results; -and as such violations most likely exist where numbers cohered -together, I consider both gonorrhœa and syphilis to -have been coeval with the origin of mankind. They both -doubtlessly are much modified by climate, habits, and constitution; -and therefrom ensue the many modifications we -see in Europe, and the other large portions of the globe. -The proofs that can be adduced in favor of this hypothesis -are interminable.</p> - -<p>It is said that, until the arrival of some British sailors -at Otaheite, the disease was unknown in that territory. -Possibly, in its present modification; but previously to this -new intercourse, it is most probable that the sexual cohabitation -was not so promiscuous or frequent, and that -that very infringement entailed a new form of irritation. -In married persons, of even temperate passions, and of -most careful habits, local sexual disorders are of frequent -occurrence, the slightest derangement of female health -giving rise to vaginal disturbance, that unsuspectingly is -increased by the marital embrace, and communicated to -the husband; and only from its presence does it occur, -that the coitus may have been the cause of it. By attending -to the simple suggestion of nature, namely, abstinence, -cleanliness, and rest, a cure is effected; but where -neglected, or should either party be unfaithful to the marriage -vow, the disease becomes magnified, and extended to, -mayhap, innocent parties.</p> - -<p>The next question is, are gonorrhœa and syphilis identical? -Certainly not, any more than the very many modifications -of generative sores. It is absolutely, now-a-days, -a difficult question to solve, whether this or that be -syphilis; so numerous and yet so closely in resemblance -are the ulcers that ensue after sexual cohabitation. The -eye is not to be trusted, because so different is real from<span class="pagenum"><a id="Page_81"></a>[81]</span> -spurious syphilis that the French surgeons decide the point -by inoculating a healthy portion of the body with the matter -or discharge from what they suppose to be a syphilitic -ulcer. If a corresponding ulcer be produced, the disease -is decided to be syphilis. If, on the other hand, no result -follow, the patient is proclaimed free from that malady, -and stated to be laboring under merely common local irritation. -What is still more curious is this: a patient will -have ulcers, which every medical man will pronounce, on -beholding, to be chancres; yet, upon this trial, the inoculation -will not evince them to be so. A while after, supposing -the chancres to be healed, secondary or other symptoms -will show themselves—sore throat, spotted skin, -glandular enlargements, or painful joints, follow. The -same consequences oftentimes ensue after gonorrhœa. -The primary diseases can not be identical, because the -symptoms are vastly different, and the parts attacked are -also unlike; and yet there is this anomaly, that the after-consequences -frequently closely resemble each other.</p> - -<p>Another surprising result from loose intercourse is, that -one female will convey to this individual gonorrhœa, to -another syphilis; a third will escape scatheless, and a -fourth will have a modifiable affection of both diseases. -A satisfactory exposition of the why and wherefore such -things should be, or are, is I fancy beyond the skill of pathologists. -It is enough to know that they happen; and -it is better to use those means which past and daily experience -furnishes to get rid of them, than to ponder and wonder -in the vain endeavor to explore their origin.</p> - -<p>In giving an opinion that we have always been liable to -fever, to cut fingers, and to syphilis, I am ready to admit -that these several conditions depend upon the varied states -of health of the parties. The fevers (ensuing upon the -ill-ventilated places) of olden times, compared with those -of the present day, differ in intensity and frequency, because -the causes are neither so numerous nor severe. -The cut finger of a drunkard, and one of otherwise feeble -health, is more likely to fester, and even mortify, than -should the accident befall a temperate and healthy individual; -and the syphilis (or diseases simulating it) at the -present time is less severe than formerly, owing to greater -attention being paid to personal cleanliness, and the simplicity -and earliness of the treatment.</p> - -<p>A question worthy of inquiry is, why gonorrhœa and<span class="pagenum"><a id="Page_82"></a>[82]</span> -syphilis should be infectious? <i>Contagion</i> is a word that -many medical men would expel from worldly usage, not -believing in its existence; that is to say, the extension of -a fever or epidemic, for instance, is not traceable to the -disease seizing the individual, but to the peculiar aptitude -of the party to become the recipient of it. Consumption -is of the most extensive prevalence; but it only occurs in -the delicate—those peculiarly formed, or rendered apt for -it, from the circumstance of their lungs being hereditarily -feebly constructed, or disordered through inflammation following -a cold, and which effects are traceable to an infraction -of some of nature’s laws. Sickly children owe -their condition to their sickly parents, or to their physical -mal-education, or some other positive violation of nature’s -regulations; and in like manner, where the fire rages or -the wind blows, the feeblest and least protected become -the earliest victims. Both gonorrhœa and syphilis furnish -a remarkably irritating purulent fluid, which, applied to -delicate surfaces, produces certain effects. Experiments -have not been made to multiply these effects, beyond those -incurred by sexual freedom; and the one of inoculation -by the French surgeons, as quoted; but accident has -proved that the eye, for instance, puts on, after contact -with the discharge of gonorrhœa, the same kind of inflammation -as follows its contact in coition with the antagonist -generative organs.</p> - -<p>The rectum has also been the seat of venereal affection; -and instances have been known of the mouth being also -the recipient of disease communicated by a deposition of -the poison. If there be such a thing as contagion, it certainly -exists in the venereal disease; for, although I admit -it (the disease) may occur spontaneously, or be generated -by half a dozen of each of the sexes herding and -cohabiting together, and neglecting the duties of cleanliness, -or committing excesses, those very circumstances -imply that the disease can be extended, notwithstanding a -majority of the careful and hardy may escape, after a risk -of the same. The fact of its contagious properties is not -upset, because escape is owing to the non-susceptibility of -the parties, and the caution they exercise to prevent a -lodgment of, or contact with, the poisonous matter.</p> - -<p>John Hunter observes, that it is only the developed disease -that is communicable, and for the propagation of -venereal affections the <i>poisonous secretion</i> must be deposited.<span class="pagenum"><a id="Page_83"></a>[83]</span> -So confident was he of this, that he even permitted -married men having gonorrhœa to cohabit with their -wives, to save appearances; care being taken first to clear -all the parts of any matter, by syringing the urethra, then -making water, and, <i>lastly</i>, washing the glans. Such, however, -is my belief of the rapidity of the formation of the -secretion, that, aided by the excitement of the generative -act, the deposite of the same would necessarily take place -with the seminal emission, especially in persons of full -temperament, and in the plenitude of the sexual appetite, -and thereby be liable to communicate the disease.</p> - -<p>It is becoming a prevalent fashion to give new names -to the several forms of venereal disease, such as substituting -“urethritis,” “blenorrhagia,” &c., for gonorrhœa; -and even to syphilis are added “tertiary symptoms;” the -names quoted being selected to express more symptoms -than the old ones conveyed. I consider that this circumstance -tends to support my opinion—that gonorrhœa and -syphilis are not identical, and that each disease (the former -being distinguished by urethral discharges, and the -latter by ulcers and other cutaneous disfigurements) has -innumerable varieties. I hold them both to be but modifications -of inflammation from a poisonous source, and its -consequences common to the structures in which they respectively -become seated, and differing in degree according -to the severity of the attack. Another proof in support -of the last assertion is, I think, the time of the appearance -of the particular disease. There is certainly a more usual -time for a clap to manifest itself, such as from the seventh -to the ninth day; but it very often occurs within twenty-four -hours after connexion, and syphilis sometimes as early; -and instances occur where weeks elapse before either -of the forms shows itself.</p> - -<p>Briefly to recapitulate, I consider, then—1. That the -generative organs have ever been liable to disease from -misuse; that the disease is variable and modifiable by -many circumstances, such as have been before stated—namely, -climate, age, constitution, and cause. 2. That it -is contagious; mild cases usually producing mild consequences, -but those depending much upon the treatment -and health. 3. Newly-indisposed and severer cases, establishing -a worse form of disease, alike modifiable by circumstances. -I am not prepared to insist that the syphilis -of the present time assumes the aspect as it did with the<span class="pagenum"><a id="Page_84"></a>[84]</span> -ancients, any more than I would affirm that it will be the -same centuries hence: but I contend that all abuses of -sexual pleasures will be surely followed by sexual disturbances, -and that the most likely form of ailment is marked -either by discharges or ulceration; that these diseases -are simple or complicated, and all are separate in themselves. -There is no fixed order in which what are called -secondary symptoms occur. It may more usually happen -that a sore throat will follow the healing of a bubo, as -swelled testicle is more commonly subsequent to the occurrence -of a gonorrhœal discharge; but in very many -cases neither occur, or not in the succession stated. The -anomalies in the disease I shall consider in describing the -symptoms and treatment, when the reader will judge how -far the view herein entertained, as to the origin and character -of the disease, facilitates and simplifies its management -and control.</p> - -<p>In conclusion of this part of our subject, I may state, -that I believe the form and severity of any syphilitic disease -depend more upon the state of health and other -aptitudes of the party receiving, than of the one communicating -the disease.</p> - -<p><i>Of the Character of the Syphilitic Poison.</i>—“The venereal -poison is only known by the <i>action</i> which follows its -application.” It has been observed, that it is only communicable -by deposition; and that certain parts are essentially -prone to its reception: these are the generative apparatus -of both sexes. The poison is conveyed in the form -of a purulent fluid; that of gonorrhœa from inflamed vessels -with corresponding morbid action; that of syphilis, -also from a purulent fluid emanating from the surface of -an ulcer. The disease prevails only in the human race; -it is impossible to transfer it to animals of a lower kind. -John Hunter soaked lint in matter from a gonorrhœa and -chancre, and introduced it into the vaginæ of bitches and -asses without producing any effect. The same experiment -was tried by interposing the purulent matter within the -prepuce of dogs and male asses, and also by inoculation, -but with no other effect than that of producing a common -sore. The venereal poison attacks the human body in two -ways, locally and constitutionally; the latter by absorption -of the poison secreted by the patient himself. We -can only suppose the local form of the disease to arise -from absorption, and so altering the local action of parts<span class="pagenum"><a id="Page_85"></a>[85]</span> -as to produce specific results. The constitutional form -is generally an after-occurrence, although instances are -known where it has not been preceded by any apparent -previous form; albeit, no doubt such <i>has</i> existed without -exciting observation. Gonorrhœa shows itself without -abrasion of surface; but syphilis is marked by another -action—an ulceration of the solids whereon it is found.</p> - -<p>In Hunter’s Work on the Venereal Disease, there is an -interesting chapter respecting the source of the gonorrhœal -secretion, in which it appears that it is produced -from the vessels investing the mucous membrane of the -urethra, by their becoming altered in their action; and -that ulceration is seldom found within the urethra, and -when so discovered, it is not from the gonorrhœal poison; -and that where ulceration occurs, it must be ascribable to -an accession of inflammation of a distinct character. Both -gonorrhœa and syphilis are conditions assumed by the human -frame in self-defence, and are processes set up to cure -the previous one; and unless the constitution be much -impaired, the disease gets well. Such impediments, however, -exist in the form of moral and social arrangements, -occupation and variable health, that the end, without assistance, -is seldom accomplished. Gonorrhœa may cease -of its own accord; but, according to the belief of Hunter, -syphilis never; and certainly every day’s experience proves -the fact. We see gonorrhœa cured by the most ignorant -persons and by the most empirical measures; but syphilis -often defies the most skilful treatment. The first attack -of venereal affections, especially gonorrhœa, is the most -severe; from which it is presumed that a habit of reconciliation -takes place between the disease and the generative -organs; so that after a recurrence or two of the complaint, -the same party may almost bid defiance to a new -infection. Yet, if a man lose the habit obtained by frequent -intercourse, through abstinence from venereal pleasures, -he will be very likely to contract the disease even -on the first re-essay, with the very same parties, who may -preserve precisely the same condition of health that formerly -was innocuous to him. Cases innumerable can be -adduced in support of this statement. In the first part of -this book, statements have been made, proving that the -difference in the symptoms of gonorrhœa are almost -endless. The same may be anticipated with regard to -syphilis.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_86"></a>[86]</span></p> -<h2 class="no-page-break">OF SYPHILIS.</h2> -</div> - - -<p><span class="smcap">Syphilis</span> is another and a more violent form of the venereal -disease than gonorrhœa. All its effects and symptoms -are divided into two conditions, <i>primary</i> and <i>secondary</i>; -the former being those which arise either from the -direct application of the virus or poison to the part where -the ulceration first shows itself, or from the irritative and -specific effects of the poison on the absorbent vessels and -glands, as it is passing through them on its way to the -circulation.</p> - -<p>Hence, among the first—the primary—may be classed -the <i>ulcer</i>, or <i>chancre</i>, which in almost every instance is situated -on the parts of generation, and may or may not be -followed by a swelling in the glands of the groin, constituting -that form of the complaint called <i>bubo</i>.</p> - -<p>The secondary symptoms may be defined to be all those -effects of the disease which take place subsequently to, -and in consequence of, the absorption of the poison into -the system: comprising sore throat, cutaneous affections—both -eruptions and ulcers, pains in the bones and joints, -and swellings thereon, called <i>nodes</i>.</p> - -<p>I will first consider the symptoms of primary syphilis—<i>chancre</i> -and <i>bubo</i>.</p> - -<p>The coverings and linings of the body differ according -to their situation. The former, the integuments become -hardened by exposure and exercise, and preserve their -velvety softness where protected by clothing, and where -they are subject to less use—instance the hands, feet, face, -and abdomen. Certain functions are assigned to each. -The covering of the feet takes on a horny hardness, and -in like manner the hands of a laborer assume a glove-like -protection. The abdomen, by being constantly clothed, -preserves its soft texture. The lining membranes of the -body have also separate offices to perform—the <i>serous</i> and -<i>mucous</i>, as they are called. The <i>serous</i> is a name given -to those lining the cavities; the <i>mucous</i>, to those having -outlets. From the glans penis being generally covered by -the prepuce, the parts in contact are called mucous. It -differs, however, in sensitiveness, from the urethra. The -entire covering also of the penis is of a very delicate and -tender structure; and hence also, from sexual intercourse, -these parts become the chief seat of syphilis. Gonorrhœa<span class="pagenum"><a id="Page_87"></a>[87]</span> -confines its attacks to mucous membranes, or, in other -words, secreting surfaces. In fact, the matter deposited -on the common and exposed skin is harmless; so also, but -to a less degree, is that of syphilis. Gonorrhœa is frequently -seated <i>on</i> and <i>around</i> the glans, and the inner surface -of the prepuce; but more frequently, by a hundred -fold, <i>within</i> the urethra. The delicate surface, then, of -the glans and prepuce, losing some of its sensitiveness by -frequent exposure, and losing also the defence of the secretion -which mucous membranes pour out, becomes accessible -to an occurrence of syphilis—a disease that is -readily communicable, by inoculation, to almost any part -of the body. To quote Hunter, he says: “It is an invariable -effect, that when any part of an animal is irritated -to a certain degree, it inflames and forms matter, the intention -of which is to remove the irritating cause. This -has been before stated; but it is common only to secreting -surfaces; and when the same cause is applied to non-secreting -surfaces, ulceration is set up. This is not only -the case in common irritation, but also in specific cases, as -in syphilis, burns,” &c.</p> - -<p>It is somewhat difficult to explain how a chancrous -sore is produced. Surmises are at our service, and those -which are founded upon certain facts are the more likely -to be true. For instance, a person receiving syphilis must -contract it from another individual having it. The mere -solitary act of coition will not spontaneously produce it, -provided the party be clean, for that surely is not an excess; -but having connexion with an infected one, and -thereby exposing a healthy surface to a diseased one, becomes -an infraction of one of nature’s laws. Well, the -patient contaminating the other must have a chancre, -which giving off, by contact, its morbid secretion, produces -a specific result, namely, a small pimple.</p> - -<p>In men, the disease is generally contracted upon the -frænum, glans penis, or prepuce, or upon the common skin -of the body of the penis, but most frequently upon the interior. -From the peculiar and alterable structure of the -penis and its prepuce, the poison, unless well washed off, -is apt to lodge in the folds thereof, and sooner or later it -manifests its influence, which may occur in twenty-four -hours, or may be withheld for months. Generally, however, -seven or eight or nine days puts the patient out of -suspense. The first symptoms consist in an itching, succeeded<span class="pagenum"><a id="Page_88"></a>[88]</span> -by a redness of the part, out of which is soon observed -to spring up a small elevation or pimple. In connexions -where haste, disproportion of size, or much excitement -or excess prevails, an absolute abrasion of the -skin often takes place, and the parts where such occur are -generally the everted portion of the prepuce, or the frænum -of the same.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_088a_cropped_191x200.jpg" width="191" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_088a_cropped_381x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_088b_cropped_151x200.jpg" width="151" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_088b_cropped_301x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The accompanying drawings represent the extent of the -redness and the first appearance of -the pimple. The upper diagram -alludes to the irritation and excoriation -around the frænum, and the -lower, the first evidence of a chancre. -I am describing the most common -form of chancre, such as is -known in the profession as Mr. -Hunter’s chancre. A perceptible -hardness next ensues round the pimple, -which becomes more elevated -when it ulcerates, or, in other words, the head gets broken -off and a little hollow is left. The tumor -(for such it may be called) is generally -of a limited circumference, seldom -exceeding the size of a silver penny, -unless in an advanced stage of the -disease. When a chancre attacks the -frænum, and undermines it, as it were, -the frænum is often destroyed; and of -course, with its destruction, departs its -property of controlling or of directing -the orifice of the urethra in urinating, or in the emission -of the semen.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_088c_cropped_181x200.jpg" width="181" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_088c_cropped_362x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>This drawing exhibits three ulcers: -one on the prepuce, another under the -frænum, having eaten its way through, -as marked by the black cross-line, and -the third situated on the glans.</p> - -<p>When the pimple appears on the -outside of the prepuce for instance, it -assumes generally a larger form, and, -as the head is broken off, crust after -crust rises up, until the process of ulceration has very far -advanced, or the applications that are generally employed -prevent its re-formation. In the former instance, the<span class="pagenum"><a id="Page_89"></a>[89]</span> -crusts are attributable to evaporation of the discharge; in -the latter, their absence is already explained by the prevention -of the same. There is such a thing as sympathy -in eruptive disorders. In skin affections of the corners of -the mouths of children, we often see the inflammation -cross from corner to corner. The same is observable -where the attacks comprise the angle of an eye. So is it -with the penis, a structure equally as delicate; and accordingly -the edges of the prepuce often put on a jagged -appearance resembling chaps on hands.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_089a_cropped_190x200.jpg" width="190" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_089a_cropped_379x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Witness the above wood-cut. It portrays an -ulcer somewhat diffused on the -prepuce, and the ragged edge of -the same structure. The sketch -just introduced was taken from -a patient perhaps only a fortnight -old with the disease. Being -a rackety, dissipated young man, -and regardless of the treatment -suggested, a week’s neglect produced -the following <span class="nobreak">alteration:—</span></p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_089b_cropped_174x200.jpg" width="174" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_089b_cropped_348x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>A new ulcer sprung up, the old -one increased in size, and the entire -edge of the prepuce became -involved in the irritation.</p> - -<p>Phymosis and paraphymosis -occur in syphilis as they do in -gonorrhœa. The treatment is -the same in both. Warm, soothing -applications are indispensable; -and occasionally, to prevent -adherence between the glans and -prepuce, the scalpel must be had -recourse to. I have already expressed -my conviction that the progress of the disease rests -as <i>much</i> or <i>more</i> upon the condition of the party receiving -it, than the specific property of the complaint.</p> - -<p>“If the inflammation spreads fast and considerably, it -shows a constitution more disposed to inflammation than -natural; if the pain is great, it shows a strong disposition -to irritation. It also sometimes happens that they begin -very early to form sloughs; when this is the case, they -have a strong tendency to mortification. Bleeding is also<span class="pagenum"><a id="Page_90"></a>[90]</span> -a consequence owing to exposure of the ulcered <i>corpus -cavernosum</i>.”—<i>Hunter.</i></p> - -<p>The reader will recollect that it has been stated that -chancres, like the many symptoms of gonorrhœa, differ in -their characteristics. Quoting from authorities, and, as -will be further illustrated, the following may be taken as -the summary of the most prominent <span class="nobreak">appearances:—</span></p> - -<p>The ordinary chancre is characterized by a hollow centre, -a hard and ragged edge, a yellow surface, with a deposite -of tenacious matter, and a red and inflammatory -margin. There is also a hardness felt at its base on taking -the part up between the fingers. This has already -been shown; but as illustrations multiply, the possessor -of this publication, especially if he be an invalid, will -recognise the annexed. It exhibits the -ordinary chancre on the inner part of -the prepuce, the glans, and the orifice -of the urethra—no unfrequent seat of -chancre.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_090a_cropped_183x200.jpg" width="183" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_090a_cropped_366x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Many ulcers assume a very indolent -form, and remain quiescent for a long -period. One patient I knew, who consulted -me for rheumatism, and who disavowed -ever having had syphilis. He -took vapor baths, which assuaged the pain, but did not remove -it. Accident discovered to me the existence of a -sore on the penis, by observing the dressings of the same, -carefully placed on the corner of the mantel-piece in the -bath-room. The following was the appearance of the -sores. He had endured them for -nearly three months, nor had he perceived -much alteration, either for -better or worse. The disease was -properly healed, and he soon got -well.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_090b_cropped_167x200.jpg" width="167" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_090b_cropped_333x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Another kind is one denominated -the superficial, with raised edges. It -is more frequently seated at the upper -part of the prepuce, and creating -a thickening of it, ending in phymosis, -which lasts a long time after the -cure of the ulcers. This kind of chancre is sometimes -very obstinate, and continues many weeks. The following<span class="pagenum"><a id="Page_91"></a>[91]</span> -illustration portrays its presence near -the edge of the <i>corona glandis</i>.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_091a_cropped_208x200.jpg" width="208" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_091a_cropped_415x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>There are two other kinds of sores -called the <i>phagedenic</i> and <i>sloughing</i> -ulcers and chancres.</p> - -<p>The phagedenic is a corroding ulcer -without granulations. It is also -destitute of any surrounding induration, -but frequently its circumference -is of a livid red color. When the disease is injudiciously -treated, the whole of the penis will be destroyed in a very -short time. The absence of coloring detracts from a faithful -representation of the kind of sore just alluded to. The -drawing is sketched from Mr. Skey’s work on Syphilis.</p> - -<div class="screen-only"> - <table class="illo" summary="P91B"> - <tr> - <td style="max-width: 321px;"> - <img src="images/i_b_091b_cropped_321x200.jpg" width="321" height="200" alt="" /> - </td> - <td style="min-width: 14em;"> - <p class="side-caption"><i>a</i>—The ulcer.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_091b_cropped_642x400.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="width: 30em;"> - <img src="images/i_b_091b_cropped_321x200.jpg" width="321" height="200" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7 center"><span class="bold"><i>a</i></span>—The ulcer.</div> - </div> - </div> - </div> -</div> - -<p>Another and more confirmed specimen from the same -authority is presented. It represents the <i>sloughing</i> ulcer.</p> - -<div class="screen-only"> - <table class="illo3" summary="P91C"> - <tr> - <td style="min-width: 14em;"> - <p class="side-caption"><i>a</i>—The ulcer on the prepuce.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>b</i>—The ulcer on the penis.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_091c_cropped_551x400.jpg" rel="nofollow">View larger image</a></p> - </td> - <td style="max-width: 276px;"> - <img src="images/i_b_091c_cropped_276x200.jpg" width="276" height="200" alt="" /> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_091c_cropped_276x200.jpg" width="276" height="200" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The ulcer on the prepuce.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—The ulcer on the penis.</div> - </div> - </div> - </div> -</div> - -<p>I have witnessed the sloughing, or, in other words, the -loss of the entire top of the glans and prepuce, within half -a dozen days. The subjoined drawing (overleaf) represents -a tumefied state of the penis, ulceration on the glans -surrounding the orifice of the urethra, phymosis of the prepuce,<span class="pagenum"><a id="Page_92"></a>[92]</span> -and ulcers in different -stages on the outside thereof. -The sketch was taken from -Wallace’s work. Such are -often met with. Chancres, -as before stated, often become -irritable, spread rapidly, and -slough, more particularly in -persons of intemperate and -dissipated habits, or when the -case has been improperly -treated; and openings into -the urethra are formed to a -considerable extent, sometimes -to the destruction of the -glans, or a portion of the penis.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_092a_cropped_176x200.jpg" width="176" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_092a_cropped_351x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The illustrative companion to this paragraph exhibits an ulcer that has wormed its way through the -prepuce, as marked by the black line.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_092b_cropped_107x200.jpg" width="107" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_092b_cropped_321x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Warts are often met with, as in gonorrhœa, -and, like those, will arise from -simple local irritation, from the accumulation -of the natural secretions, or -want of cleanliness. They are hard -and soft, and require different treatment -accordingly. They are not contagious; -that is, they do not communicate -a venereal affection, but they -very readily produce a similar disease -in parts they come in contact with. -The story is here well told by the engraver’s -aid.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_092c_cropped_206x200.jpg" width="206" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_092c_cropped_411x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>It often happens that -the ulceration appears checked. A -tumor (see next page) will form, -and the surface will look very red -and angry—will even yield a moisture, -and finally disappear. I say -finally, because it frequently proves -very obstinate, and trespasses upon -the patience and forbearance almost -to induce despair. It usually is very -irritable, the itching being most troublesome. The illustration -was taken from a patient who had been an invalid -several months.</p> -<p><span class="pagenum"><a id="Page_93"></a>[93]</span></p> - -<div class="screen-only"> - <table class="illo" summary="P93A"> - <tr> - <td style="max-width: 198px;"> - <img src="images/i_b_093a_cropped_198x200.jpg" width="198" height="200" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a</i>—The tumor.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_093a_cropped_396x400.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_093a_cropped_198x200.jpg" width="198" height="200" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The tumor.</div> - </div> - </div> - </div> -</div> - -<p>After a certain time, varying -in proportion to the -virulence of the disease, -the poison is conveyed by -the numerous absorbents -(which run from the penis) -to the glands in the groin, -one or more of which become -inflamed and enlarged, -producing that well-known -swelling, already -alluded to, called <i>bubo</i>. Ulcers, -too, are sometimes -situated within the urethra, -as is seen in the annexed -cut.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_093b_cropped_153x400.jpg" width="153" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_093b_cropped_230x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">OF BUBOES.</h2> -</div> - -<p><span class="smcap">Surgeons</span> apply the word bubo to inflamed glands from -syphilis, wherever they happen to be. The body abounds -with absorbents, which are small delicate vessels that form -a net-work over the entire surface, and exist also in every -structure. Their purpose is to convey the nutriment to the -circulation. They form <i>stations</i>, as it were, or points of assemblage; -and these are generally situated in the angles of -the body—the groin, the armpits, hams, neck, &c.—parts<span class="pagenum"><a id="Page_94"></a>[94]</span> -most protected from injury. When skin inflammation is -present, to familiarize the meaning, the nearest glands -sympathize and swell; as, for, instance, who has escaped -a swelling, at one time or other of his life, in the neck, -throat, or armpits? When a sore prevails on the penis, -or a gonorrhœa exists, there most frequently ensues an enlargement -of the glands of the groin. The result of that -enlargement depends upon the nature of the inflammation. -In gonorrhœa it is merely temporary, not being sufficient -to provoke suppuration, or the formation and discharge of -matter, or very rarely so; but in the case of venereal ulcers, -where the inflammation is so conveyed, the escape -from such consequences is as seldom.</p> - -<p>The mode which nature adopts to transfer the poison is -as inexplicable in its operation as the production of a -swelled testicle. Buboes (herein meant), then, are—or I -should say a bubo is—a specific inflammation of the glands -of the groin. It usually occurs on the same side of the -body as the ulcer is situated; but when the ulcer is seated -on or under the frænum, there seems to be no fixed rule -which side shall have the honor. Another peculiarity is, -that they more readily spring up from ulcers on the prepuce -than on the glans, and are more attributable to ulcers -than merely inflamed surfaces. They do occur sometimes -without either being apparent. To facilitate the clear understanding -of what we are talking about, a drawing is -presented of the inguinal glands, -and the absorbents leading to and -from it, which conveys but an imperfect -idea of the number of the -absorbents; but it serves to show -the nature of them, and their -mode of communication.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_094_cropped_394x400.jpg" width="394" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_094_cropped_591x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Glands become inflamed from -other causes than syphilis; a -scratch, a bruise, or any local irritation, -will occasion an enlargement -of the nearest set of glands, -or at least one of them. Scrofula is a specific cause. As -the venereal poison carries with it its morbid nature wherever -it happens to be conveyed, the glands become infected -with it; and hence it is the more readily transferred to the -system at large. Very frequently and fortunately the disease -terminates <i>in</i> the glands; that is to say, does not extend<span class="pagenum"><a id="Page_95"></a>[95]</span> -to the circulation at large. The time that intervenes -after absorption has taken place, before bubo manifests itself, -is as uncertain as that of chancre appearing after -connexion; but generally the party is safe a fortnight after -the entire disappearance of the chancre. Where it is otherwise, -some trace of irritation on the glans or prepuce is -discoverable upon close investigation, or it will follow -great fatigue, venereal excesses, &c. If the disease extend -to the constitution, it rarely affects other glands than -those primarily attacked; and hence it is rare that more -than one gland becomes inflamed. Having given the received -notions of the cause, the symptoms should next be -described.</p> - -<p>No person can be unaware of the approach of a bubo. -There is seldom much advance of a swelling without pain, -which latter may be said to attract the patient’s attention -to the part, when a tumor, possibly the size only of a -horse-bean, is discovered. If the swelling be venereal, it -rapidly increases in size. It is at first moveable, but soon -feels as though firmly fixed. There is next experienced -inconvenience in walking. If the disease proceed to suppuration, -a continued throbbing is felt in the part, which -also swells, assumes a diffused redness, and at last an evident -sense of fluctuation is perceived. It may be ushered -in with a shivering fit. The skin becomes thin and tender, -and a conical point protrudes, which, unless punctured, -bursts and emits its contents. It is astonishing -what immense destruction of parts takes place in large -buboes. The theory how solids become converted into -fluids—how muscle, fat, and cellular membrane, become -absorbed, and a thick purulent secretion deposited, is fitter -for a work addressed exclusively to medical men than to -the public; and it therefore must suffice that such happen, -and few persons are ignorant of the fact; but the <i>modus -operandi</i> may at best be but the subject of conjecture.</p> - -<p>The artist’s graver has pencilled a faithful picture (see -next page) of the appearance of the disease in question. -On the right side is represented a bubo that has broken, -or discharged its contents, and which is in a state of healing; -on the left side a bubo ready to burst; and, by way -of economising space, the left testicle is exhibited in a -state of varicocele, by no means an unfrequent accompaniment -to the previously narrated condition, but at the -same time by no means a necessary attendant, it being a<span class="pagenum"><a id="Page_96"></a>[96]</span> -totally distinct affection. Buboes present more varieties in their -size, and duration, and consequences, than they do on their initiation. -Cases in corroboration will be found in their proper place.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_096_cropped_485x400.jpg" width="485" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_096_cropped_728x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">ON LUES VENEREA, OR SECONDARY SYMPTOMS.</h2> -</div> - -<p><span class="smcap">Secondary</span> symptoms are those changes which occur in -consequence of the admission of the venereal poison into -the system, or common circulation at large. The introduction -to the disease of bubo explains the mode of inlet. -Like gonorrhœa and primary syphilis, it is often a very -complicated complaint. Secondary symptoms are admitted -to occur without being preceded by any primary form, -as, for instance, by immediate absorption unattended with -the irritation which accompanies chancre, or attendant -upon bubo; but where one secondary affection arises without -the primary, at least many hundred arise subsequent -to it; and unless, in the latter instance, treatment, and -vigilant too, is adopted, not one in a hundred escapes -them.</p> - -<p><i>Lues venerea</i> (a synonymous term with syphilis) is supposed -to be imbibed from a very sensitive glans penis, a -simple abrasion of the skin of that organ, an ordinary ulcer, -or it may be transferred by inoculation. The late -John Hunter is certainly the most eminent authority—the -<i>vade mecum</i> of professional men. In these matters he -was a man of indefatigable perseverance and untiring observation. -Few new lights have been thrown on syphilis -since his time, except on the treatment, which has become -wonderfully simplified.</p> - -<p>In thus again adverting to Mr. Hunter’s name, it is<span class="pagenum"><a id="Page_97"></a>[97]</span> -chiefly to observe, that the basis of my own thoughts and -practice has been built upon his writings; and therefore, -in being thus explicit in describing syphilis and its multitudinous -varieties, the reader is assured that what is here -written is, at all events, well founded, and not compounded -of the many new adventurising propositions of the day. -Mr. Hunter considered that contamination took place -about the beginning of the local complaints; that no person -was safe from lues while the original sore was present, -and not under treatment; but that, if the seeds of -lues were not already implanted in the constitution, the -consequences might be averted by treatment. Children -are born infected with lues, which they derive from their -parents; for instance, a man laboring under secondary, or -primary symptoms, cohabits with a healthy female, the female -<i>may</i> escape both diseases, but the child may inherit -them.</p> - -<p>Instances have been known of children so infected, conveying -the disease to the wet nurse, to whose care they -may be removed; and, like other infectious disorders, the -complaint may be diffused <i>ad infinitum</i>. There is an impression -abroad, that, like consumption, healthy persons -are obnoxious to the breath and perspiration of the afflicted; -but, as in many other conjectures, corroboration is -wanted to prove the fact.</p> - -<p>Syphilis is divided into primary and secondary; but -modern pathologists add a third stage, called tertiary -symptoms. Hunter used to divide lues into two orders; -the first was the most frequent form of the complaint, after -chancre and bubo; the second, the remaining symptoms. -The former consisted of the affections of the skin, -throat, nose, mouth, and tongue; the latter, the bones -and their coverings, called the periosteum and the fasciæ -of muscles, as explained in the preliminary part of this -publication. Lues does not always exhibit itself according -to this arrangement; which circumstance explains -that the occurrence is more owing to conditions of health, -and peculiar tendencies of the structures involved to receive -the contamination, than to any properties of the animal -poison.</p> - -<p>He considers, also, that the development of the disease -depends much upon the state of weather, and the care the -patient may bestow upon himself; cold being a formidable -predisposer to the extension of secondary symptoms, and<span class="pagenum"><a id="Page_98"></a>[98]</span> -that the parts least protected are generally the first to become -diseased. Hence the throat usually exhibits a morbid -action before the skin, furthermore, upon the cure of -the more superficial parts of the body; and, therefore, -suddenly suspending treatment, the symptoms manifest -themselves in the deeper seated. The deduction from this -statement is, a necessity for especial care in the clothing -of the body, and the continuance of the treatment some -little while after all external evidences of the complaint -have disappeared.</p> - -<p>Mr. Hunter considered that the disease may be engrafted -in the constitution, and remain dormant for a considerable -period, through the parts not being brought into -action by any of the aforementioned causes. Ordinary illness, -simple fever, excess, fatigue, and a host of other occasions, -may excite a particular structure into a morbid -condition, when the hitherto dormant disease will sprout -out. His arguments are supported by numerous cases -wherein <i>several years</i> elapsed between the primary and -secondary symptoms, although no new infection was contracted -in the intermediate time.</p> - -<p>Mercury was Mr. Hunter’s sheet-anchor; his faith in -it was to the effect that it would cure every stage of the -disease, but that one course of it, although it might cure -chancre, would not prevent secondary symptoms. They -might not occur, because the poison may not have been -carried into the circulation; and in like manner the second -stage of the disease need not be followed by a third. -But he considered that, when the several forms of the disease -betrayed themselves, their origin must be traced to a -general contamination of the system at the same time.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">OF THE SYMPTOMS OF THE FIRST STAGE OF LUES.</h2> -</div> - -<p><span class="smcap">Six</span> weeks is the time usually allowed to elapse between -primary and secondary symptoms; but it is not invariably -the case, instances having occurred where the disease has -embraced, and most severely, both stages in a fortnight, -and others between which a much longer time has existed. -The first symptoms of lues consist either of a sore throat -or a spotted skin. When the skin is the seat, a red spot, -not unlike a flea-bite, is perceived; the color soon dies<span class="pagenum"><a id="Page_99"></a>[99]</span> -into a brownish or copper-colored hue. Occasionally, at -the outset, a small pimple is observed, which breaks and -scurfs; the coppery-colored spot next feels rough, and a -kind of scurf will exude that after a few days falls off to -make way for more. The disease being more usually slow -than rapid in its progress, weeks may be consumed before -ulceration occurs, and merely a discoloration of the skin -is seen in spots seldom exceeding the size of a sixpenny or -fourpenny piece. Some of these spots will nearly disappear, -leaving a faint scar, and new ones will spring up. -The entire body may be covered with them, but usually -those parts nearer the centre of circulation generally possess -the most—such as the chest, neck, shoulders, arms, -wrists, hands, and head. As the disease progresses, the -scurf on the spots accumulates, falls off, re-forms, getting -thicker each time, when upon being detached, for they -cling now more closely, a sore and moist state of the skin -is observable. This may be covered with a new crust, or -may at once proceed to suppuration.</p> - -<p>When an ulcer is formed, it will sometimes spread rapidly, -and embrace a patch the size of a crown-piece, when -the process of ulceration will assume the vigor of disease.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_099_cropped_371x400.jpg" width="371" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_099_cropped_557x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The accompanying sketch portrays, perhaps, more the seat of the -disease when attacking the upper part of the body, than the appearance; -for to give a true portraiture, the drawing should be the size of life, -and colored after nature. It is, however, I doubt not, sufficient to -exemplify the site of the disorder. The eruption is smaller on the -face, and less vicious, generally, than on the body; but it proves most -unsightly, and indicates great advancement of the disease. The legs -(see next page), and those parts of the skin least vascular, assume a -mottled appearance resembling recent bruises; at other times, clusters -of spots like grapes hanging together.</p> - -<p><span class="pagenum"><a id="Page_100"></a>[100]</span></p> - -<p>The shoulders, arms, and wrists, also present a somewhat similar -appearance; though perhaps not to the same extent, owing to being more -warmly clad, and less in exercise, than the lower extremity.</p> - -<p>When the disease extends to the hands, it is marked by exfoliations -of the palm, with occasional deep cracks that cause much pain. Nor -are the fingers and nails exempt from this encroaching malady, which, -during its occupation, shows itself by a redness under the nail, that -at last ends in the destruction of the nail.</p> - -<div class="figcenter"> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_100a_cropped_120x200.jpg" width="120" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_100a_cropped_251x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_100b_cropped_120x200.jpg" width="120" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_100b_cropped_360x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_100c_cropped_160x200.jpg" width="160" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_100c_cropped_479x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> -</div> - -<p>The head, also, is a frequent seat of the disorder. It is -generally discovered by running the hands through the<span class="pagenum"><a id="Page_101"></a>[101]</span> -hair, when a little crust will be detected by the fingers, or a slight -itching will show its position, or the brush may break it off. The -top and hind parts of the head are generally the situations selected. -Occasionally the hair will fall off, leaving spots of a smooth -baldness.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_101a_cropped_321x400.jpg" width="321" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_101a_cropped_482x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The vital organs, fortunately, are never subject to syphilitic -inflammation—such as the brain, the viscera of the chest, and abdomen; -nor is even the mucous membrane of the interior of the body affected, -its power being confined solely to those parts or structures subject to -the influence of external causes.</p> - -<p>When the venereal virus attacks the throat or palate, the membrane -of the roof of the mouth becomes red and inflamed, patches ulcerate, -and, if not cured, sooner or later expose the bony palate, which may -be felt by the probe. This is the first stage. The exposed bone next -exfoliates, and a communication is thereby formed between the mouth and -nose, the fluids return through it, the voice is changed into a nasal -twang, and a most offensive discharge is secreted.</p> - -<div class="figcenter" style="max-width: 275px;"> - <img src="images/i_b_101b_cropped_275x400.jpg" width="275" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_101b_cropped_413x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>This drawing represents ulceration of the tonsils, uvula, and arch -of the palate; also the edges of the tongue. The drawing, p. 102, shows -the under surface of the tongue, the inner part of the lower lip, and -the lower gums affected with venereal ulcers.</p> - -<p>When the tonsils are attacked, ulcers appear, precisely similar in -character to chancres, hollow in the centre, with raised ragged edges, -yellow on the surface, with a livid color on the surrounding margin. A -sense of dryness is perceived, extending up the eustachian tube to the -ear. Sometimes the tongue, gums, and inner part of the lips,<span class="pagenum"><a id="Page_102"></a>[102]</span> -are attacked (see representation).</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_102_cropped_337x400.jpg" width="337" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_102_cropped_505x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>In the progress of the disease, the pharynx, or top of the gullet, -is brought under its influence, and the ulceration spreads through it -to the vertebræ or back-bone. Extending its course, it next attacks the -larynx, or top of the windpipe, when, if not arrested, it will soon -destroy life. Attending this affection of the larynx, there is always -loss of voice—the patient speaks in a low whisper. It is more fatal -than any other form of the venereal disease.</p> - -<p>The mucous membrane of the nose stands next in order, -as subject to the influence of syphilis. The patient’s attention -is first directed to it by an incrustation which forms -in the nostril. On this being removed, a quantity of blood, -mixed with purulent matter, is discharged. In two or three -days, similar incrustations are formed, and under them -ulceration takes place, which frequently lays bare the bone, -and occasions it to exfoliate; and this exfoliating often -continues after the venereal action has ceased. The number -of bones which come away is often very considerable, -and horrible deformity is the result.</p> - -<p>The periosteum and bones become in their turn affected -by swellings called nodes—the periosteum first, and the -bones subsequently. Of these, the cylindrical, being most -exposed to vicissitudes of temperature, are commonly the -first attacked. Those which are much covered by muscle -are rarely affected, as, for instance, the back part of the -<i>tibia</i>, or large bone of the leg, while nothing is more common -than to see nodes on its anterior part, which is only -covered with skin and periosteum. They occur on the -<i>fibula</i> only when it is slightly covered, and only on the -<i>ulna</i>, or elbow-bone, when similarly circumstanced. Nodes -on the <i>os humeri</i>, or shoulder-bone, except on the outer -side, are of very rare occurrence, but are frequently found -on the <i>clavicle</i>, or collar-bone, at its scapular and sternal -articulations.</p> - -<p>In the following wood-cut is an illustration of the most -frequent situation of nodes on the forepart of the tibia, or<span class="pagenum"><a id="Page_103"></a>[103]</span> -chief bone of the leg. The swelling is considerable; the -upper one proceeding to suppuration, -and the lower indicating merely a -tumefaction of the lower part of the bone, -near the instep.</p> - -<div class="figcenter" style="max-width: 30em"> - <img src="images/i_b_103_cropped_112x400.jpg" width="112" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_103_cropped_168x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The symptoms which mark the disease are as follow: The patient -experiences in the evening a sensation of pain in the bone which is -afterward the seat of the node. In the course of a few days, a swelling -appears in the evening, which disappears again on the following -morning. It is excessively painful and tender at night, but in the -morning it is hardly perceptible, and the tenderness is almost gone. -At this particular period the periosteum is only affected; but when -the inflammation has continued some time longer, the bone is diseased -and becomes enlarged. The rationale is this: An inflammation of the -periosteum ensues. In a short time a deposite takes place between it -and the surface of the bone. This deposite, in the first instance, is -only a serous fluid, but a cartilaginous substance is soon secreted, -which is gradually converted into bone.</p> - -<p>When attended to early, their treatment is very simple; -but occasionally cases of considerable difficulty will arise.</p> - -<p>Large quantities of fluid will be found fluctuating between the -periosteum and the bone, which, when unaccompanied by redness and -inflammation of the skin, may be absorbed by proper treatment, but -which more usually is only curable by evacuation; and, unless great -care be used, exfoliation of the bone will ensue to a very great, and -sometimes fatal extent. The eyebrows, forehead, and temples, are often -the seat of fluid tumors varying from the size of peas and beans. Their -cure must be effected by absorption, or destruction of the bone is -often produced.</p> - -<p>The flat bones are also subject to syphilis. The one -most commonly attacked is the <i>os frontis</i>, the symptoms -being just the same as those on the skin. The side bones -of the head now and then are affected; the os <i>occipitis</i>, or -back-bone of the head, very rarely; and the <i>os temporis</i>, -or temporal bone, being well covered with muscles, and<span class="pagenum"><a id="Page_104"></a>[104]</span> -exposed to very little change of temperature, is never affected.</p> - -<p>The <i>os frontis</i>, being the most exposed, is the most frequently -attacked. Suppuration sometimes takes place; -and when this has occurred on the front, it has happened -that the same suppurative process has occurred interiorly -between the <i>dura mater</i>, or the external membrane of the -brain, and the internal surface of the bone. The matter -presses upon the brain, and death is the consequence, if -the pressure be not removed by the use of the trephine or -trepanning instrument. This is a degree of severity to -which the disease rarely reaches now-a-days, from the -more extended knowledge and improved treatment of modern -times.</p> - -<p>It must be observed, generally, of both these diseases—that -of the throat and nose, and this of the bones—that -they are oftener the result of improper treatment, such as -the excessive use of mercury, and exposure to great vicissitudes -of weather while under its influence, inducing what -is called the mercurial disease (which in fact is, or was, of -more frequent occurrence than the constitutional syphilitic -one), than the result of the natural tendency of the disease -in an otherwise healthy individual.</p> - -<p><i>On the treatment of Syphilis.</i>—I consider it a fair presumption -that any invalided reader, except he be an accidental -one, of this book—by which I mean one, not having -<i>sought</i> its possession—must be acquainted with the association -of <i>mercury</i> and <i>syphilis</i>. If not, let him be told for -the first time, that such association exists as between -copaiba and gonorrhœa; or perhaps what may be rendered -more familiar to him, namely, as between <i>quinine</i> with -<i>ague</i>, or <i>colchicum</i> with <i>rheumatism</i>. That for upward of -three hundred years past mercury has been held an antidote -to venereal affections; and still is, in many forms of -the same, acknowledged indispensable for their removal.</p> - -<p>From old notions afloat, that syphilitic patients to be -cured must be salivated to the extent of furnishing or filling -two or three wash-hand basins daily with saliva—that -the teeth drop out, that the breath becomes horribly -fetid, and that the consumer of the poison sacrifices one -third of his probable existence, even though he get well—the -greatest possible prejudice exists against mercury, and -the generality of uninformed patients have acquired a most -uncompromising dread of the remedy. From the frequent<span class="pagenum"><a id="Page_105"></a>[105]</span> -difficulty in getting patients to submit knowingly to mercurial -treatment, many new means have been caught up, -and some judiciously applied.</p> - -<p>This new method has its advantages; but it does not -realize all that is promised. It consists in advising rest, -cleanliness, simple soothing applications, and, on the other -hand, mild astringent ones, a temperate diet, fresh air, an -easy mind, sarsaparilla, and other alterative medicines. -There are many believers in the efficacy of simplicity; and -the success that follows such treatment of nine tenths of -the ailments of humanity, bears out the usefulness of the -preceding methods; but the remaining tithe have alike a -claim upon our consideration, and of this tithe the syphilitic -invalids form a large portion.</p> - -<p>The anti-mercurial advocates have, however, a salvo, -and admit now and then, an exception to exist, that particular -cases <i>do</i> require a mercurial course, but then it -should only be adopted in its mildest possible form, merely -with a view to act on the general health, rather than for -any specific property of its own. Again, there are books, -which are very elaborate, and what is equally important, -modern ones, written by talented men,<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a> which still profess -faith in the curative powers of mercury, and employ it as -the chief agent in the cure of the venereal disease. Instead -of administering it to the same extent as formerly—instead -of attempting to produce salivation to the flow of -quarts—they merely aim at producing an impression on -the constitution; they are satisfied with a proof that their -patient is under mercurial influence: this is ascertained -by a coppery taste in the mouth, a slightly increased secretion -of saliva, and the presence of the accompanying, -but temporary depression.</p> - -<p>Now the question to be resolved is, which of the two -methods is the correct one. The many forms of disease of -the sexual structures satisfy me, that their treatment should -be modified by circumstances; but I believe I am wise -enough to know, and certainly old enough to have observed, -that the severer forms of syphilis, and even the milder in -some constitutions, require the aid of mercury for their -cure; in fact, <i>will yield to no other plan of treatment</i>, thereby -admitting the <i>specific virtues</i> of the remedy.</p> - -<p>The principles, therefore, which I advocate in the treatment<span class="pagenum"><a id="Page_106"></a>[106]</span> -of syphilis, are precisely those I depend upon in gonorrhœa, -or, to familiarize the analogy, in a fit of indigestion, -or an attack of local or general inflammation. Where -the health is disturbed, the first step is to attempt restoration. -The fact is almost too familiar to every one to need -repetition, that, as is the condition of the health, so is the -resistance it is capable of opposing to disease. The next -proceeding is, to attempt the subdual of the prevailing -symptoms. Syphilis, whether in the form of chancre, bubo, -or any of its secondary varieties, induces more or less fever, -inflammation, and interruption to the important offices -of digestion, and other vital processes, which consequently -require the promptest attention. Equally various are the -local indications of syphilis—the ulcers may be common, -superficial, phagedenic, or sloughing, each requiring various -treatment, as hereafter will be specified; but, above -all, too much reliance can not be placed on the dietetic -and physical regimen—two comprehensive significations, -which are, after all, the Alpha and Omega of the Materia -Medica. With this declaration, I pass on to the treatment -in detail of the more frequent and, I may add, leading features -of syphilis.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>Treatment of Chancre.</i>—<i>Preliminary remarks.</i>—Chancres -are of various kinds. The most remarkable <span class="nobreak">are:—</span></p> - -<p>1st. That characterized by its circular form, its excavated -surface covered by a layer of tenacious and adherent -matter, and its hard cartilaginous base and margin.</p> - -<p>2d. Another form of chancre, unaccompanied by induration, -but with a very high margin, appearing often on -the outside of the prepuce, and seldom existing alone, -called, from the preceding description, the “superficial -chancre, with raised edges.” These kinds of ulcers are -sometimes very tedious, neither getting better nor worse, -but resisting every plan of treatment for their removal. I -have known instances where they have existed for several -months.</p> - -<p>3d. The phagedenic chancre, a “corroding ulcer without -granulations,” and distinguished by its circumference being -of a livid red color. This is the kind of chancre that is -invariably rendered worse by mercury: indeed, cases have -occurred where, from the injudicious administration of that -medicine, the whole of the penis has been destroyed.</p> - -<p>4th. A most formidable kind of chancre, denominated -the sloughing ulcer. It first appears as a black spot, which<span class="pagenum"><a id="Page_107"></a>[107]</span> -spreads and becomes detached, leaving a deepened and unhealthy -looking surface. The sore is very painful, and encircled -with a dark purple areola. If neglected, or improperly -treated, the process of mortification goes on until -all the parts of generation are destroyed.</p> - -<p>The last-named chancre is more often the consequence -of neglect on the part of the patient, than the natural -progress of the disease.</p> - -<p>Now the usual method adopted by surgeons to remove -chancres, has been to excise them, or to apply caustic; the -latter is the plan I adopt, and would recommend; but all -chancres are not to be treated alike, some requiring antiphlogistic -remedies, others soothing, others stimulant. -Some practitioners rely entirely upon constitutional remedies.</p> - -<p>On the first appearance of a chancre, I would enjoin an -alteration in the diet, regulating it according to the strength -of the patient. Abstemiousness should be the motto, avoiding -extremes, however, lest debility should be induced. -Quietude and rest, in the recumbent position, are two essential -adjuncts in the treatment of primary syphilis -throughout.</p> - -<p>With respect to the treatment of the ulcer, characterized -by its circular form, excavated surface, and hardened base, -as detailed, the plan I almost invariably adopt is, immediately -on its appearance, at least as soon as the pimple has -broken or desquamated, to smear it with a hair pencil filled -with the solution of caustic, sometimes twice, at least once -a day (see Form <a id="FManchor_27"></a><a href="#Form_27" class="fmanchor">27</a>), and to keep it frequently washed in -the daytime with a lotion of the chloride of soda (see Form -<a id="FManchor_28"></a><a href="#Form_28" class="fmanchor">28</a>), or the black, red, or blue wash -(see Forms <a id="FManchor_29"></a><a href="#Form_29" class="fmanchor">29</a>, -<a id="FManchor_30"></a><a href="#Form_30" class="fmanchor">30</a>, -<a id="FManchor_31"></a><a href="#Form_31" class="fmanchor">31</a>).</p> - -<p><span class="pagenum"><a id="Page_108"></a>[108]</span></p> - -<p>If the patient be strong, and otherwise in good health, I -simply recommend a dose of purgative medicine, in anticipation -of any irritation that may arise. After which, I -suggest a middle diet to be adopted for the next few days. -From the sedative and salutary effects of the warm bath, I -recommend its employment immediately after the operation -of the medicine, and its repetition at frequent intervals. -Independently of its effect on the system, it is the best general -cleanser that can be resorted to. The subsequent -treatment is regulated by the result of the above, which -can be ascertained about the third day.</p> - -<p>In numberless instances, and where the disease is thus -early detected and similarly treated, the mere continuance -of either the chloride lotion, or black wash, the middle diet, -an occasional aperient, the bath, with as much rest as possible, -are all that will be found needful to cure the disease, -which generally is effected in about a week or ten days at -farthest. From the universal dread that so sudden a disappearance -of the sore occasions, lest it should “be driven -into the system,” and from the apprehension that it is incurable -without taking mercury, I verily believe that, in -many cases, the practitioner, participating in the fears of -his patient, and anxious to allay them, reluctantly administers<span class="pagenum"><a id="Page_109"></a>[109]</span> -that mineral; and to such weak judgment may be -traced the relapses, or the occurrence of other symptoms -sometimes mistaken for secondary. Even when the case -terminates favorably, and within the space of time alluded -to, I would not be considered as recommending a sudden -return to free living; on the contrary, I would not release -the patient from the restrictions imposed upon his diet, exercise, -and regimen, for at least the same time as was occupied -in the cure, nor would I predict that, in every instance, -secondary symptoms should not ensue. Mercury -was supposed to possess some antisyphilitic property, inasmuch -that, when chancre healed during its exhibition, secondary -symptoms were averted. Facts, however, have -been wanting to corroborate that supposition; for secondary -symptoms have appeared despite the external and internal -employment of mercury, even to the extent of salivation. -Authors there are who attach similar properties -to other medicines, such as nitric acid, sarsaparilla, and -such like. Now, how do these medicines act upon the -system? Or what is their tendency of action? Why, by -increasing some particular function, such as the secretive -process of the salivary and other glands; by increasing -perspiration or absorption, &c. The remedies whereby -these changes are induced are termed alteratives. I am -not going to deny that these, or some such changes in the -system, are unessential for the eradication, particularly of -morbid conditions of structure and function, dependent<span class="pagenum"><a id="Page_110"></a>[110]</span> -probably upon altered condition and diminished action in -others. On the contrary, they are the only antagonists to -disease which we possess.</p> - -<p>But what I contend is, that, in our selection, we should -prefer those which produce most speedily and effectively -the desired change, with the least detriment to the general -health. And to this end, I invariably enjoin, where practicable, -warm or vapor bathing. I have elsewhere considered -this subject at length, to which I refer the reader; -but I will fearlessly assert that no one, or any plan of -treatment, will be found so effectual toward increasing -physical power to repel disease, or so permanently preservative -of health, as the modified employment of the -warm or vapor bath; and, therefore, in all cases of doubt -and apprehension, or independent of either, the use of the -warm or tepid, plain, or salt-water bath, two or three times -a week for a month, or the vapor bath about every fourth -or fifth day for the same period, is the best preventive that -can be adopted to avert secondary symptoms. Where -bathing of every kind is impracticable, as is the case in -some country places, and the same necessity exists, I advocate -the administration of alterative medicines; nor do -I object to the employment of mercury, where, under other -circumstances, without reference to its imaginary efficacy -in syphilis, it would be prescribed. But of this as we proceed.</p> - -<p>Where, at the expiration of a week, the chancre neither<span class="pagenum"><a id="Page_111"></a>[111]</span> -recedes nor advances, and is the only symptom present, it -is to be presumed that the condition of the patient’s health -has something to do with it, and that condition should be -minutely inquired into. There may be diminished or increased -appetite, with imperfect digestion; there may be -fever, with restlessness at night; there may be torpor or -irritation of the bowels; or the patient may consider his -only ailment to be the chancre, the irritation of which may -be found to arise from too active exertion. To whichever -cause it may be ascribed, the treatment should be directed. -In conjunction with local remedies, which may be varied, -alteratives may be given—five grains of the blue pill twice -a day; for instance, the Plummer’s pill in doses of five -grains every night, the occasional application of an active -aperient (see Forms <a id="FManchor_33"></a><a href="#Form_33" class="fmanchor">33</a>, -<a id="FManchor_34"></a><a href="#Form_34" class="fmanchor">34</a>), the decoction of sarsaparilla -(see Forms <a id="FManchor_49"></a><a href="#Form_49" class="fmanchor">49</a>, -<a id="FManchor_50"></a><a href="#Form_50" class="fmanchor">50</a>, -<a id="FManchor_51"></a><a href="#Form_51" class="fmanchor">51</a>). This plan, carefully pursued, seldom -fails in setting up a permanent cure. The patient -should be apprized of the vast importance of quiet, rest, and -abstemiousness; for, where they can be attended to, the -duration of the disease will be diminished one half; whereas, -he who is continually in the erect posture, and subject -to much walking about, who is indifferent to his diet, and -lives as free as formerly, incurs the risk of bubo, and all -its alarming consequences. Now, in no case or description -of chancre, do these remarks apply so aptly as to the -phagedenic and sloughing ulcer; in fact, they are applicable -to all, but more particularly the two latter, as they are<span class="pagenum"><a id="Page_112"></a>[112]</span> -the result of already increased action. Mercury, violent -aperients, and other active remedies, should also be avoided -in these two forms of chancre; the local appliances should -be poultices of bread and water, linseed meal, and a solution -of opium, or poppy water; the sloughs or mortified -portions we should endeavor to detach, by the application -of a <i>smear</i> of nitric acid, or the chloride lotion (Form <a href="#Form_28" class="fmanchor">28</a>), -or stimulative ointment (Form <a id="FManchor_38"></a><a href="#Form_38" class="fmanchor">38</a>). The superficial sore -usually gets well by the same means as the ordinary -chancre.</p> - -<p>Where the chancre is situated under the prepuce, and -the latter covering is so inflamed and swollen as to prevent -its being drawn back to exhibit the sore, the discharge -should be carefully washed out by any of the lotions already -recommended, by means of a syringe, several times in the -twenty-four hours. Much good is often done by varying -the local remedies, occasionally flouring or filling up the -ulcer with calomel, tutty powder, blue ointment, or in fact -any substance which alters the morbid action of the part; -but, as a general rule, the lotions of soda, lime, zinc, or -oxymuriate of mercury, will be found sufficient, if persevered -in.</p> - -<p><i>Treatment of Bubo.</i>—Bubo I have already stated to be -an inflamed and enlarged condition of the inguinal (as its -name implies, signifying the groin), or, in fact, any other -gland, occasioned by the passage of the venereal poison -from the adjacent ulcer through it, preparatory to its contaminating -the constitution. But it is as well to know that -the system may become affected, or, in other words, the -poison may pass through the glands without involving them -in the disease, or that the poison may there stop, and be<span class="pagenum"><a id="Page_113"></a>[113]</span> -expelled as the bubo is cured. It is also observed, that -buboes are more frequently consequent upon an ulcer seated -on the prepuce than on the glans. Buboes are not always, -however, a sure criterion of the venereal disease, for they -will occur wherever irritation is superficial and adjacent. -Leeches applied to the temples will affect the cervical -glands, a graze or wound in the leg enlarge the inguinal, -and a whitlow on the finger, or any inflammation of the -hand or arm, will very often irritate the glands in the -axilla. In gonorrhœa, the glands in the groin become -swollen and painful, from sympathizing with the sensibility -of the urethra; but these and the preceding may, in general, -be distinguished from true venereal buboes by their -disinclination to proceed to suppuration; whereas, in -syphilis, that process runs through its several stages with -remarkable celerity, unless timely prevented. Buboes in -the groin are much more troublesome, and more likely to -betray the disease, than chancres, because they constitute -an augmentation to the patient’s suffering, seldom occurring, -unless preceded by a chancre, and because they occasion -a visible and necessary lameness. They also produce -more general disturbance of the patient’s health.</p> - -<p>In the treatment of a bubo, venereal or not, the same -principles recommended in the section devoted to the cure -of chancre, should be followed in this instance—comprising -attention to the general health, and a subdual of the prevailing -symptoms.</p> - -<p>In no form of syphilis is rest more essential than in bubo. -The patient will be apt to plead the necessity of following -his business, and the utter impossibility of staying at home; -that is his affair, mine is only to protest against exercise, -and urge the importance of rest, and even the recumbent -posture, and I can assure him, <i>that</i> alone will strip the disease -of three fourths of its terrors.</p> - -<p>Certain local diseases produce more constitutional disturbance<span class="pagenum"><a id="Page_114"></a>[114]</span> -than others—among them may be classed buboes; -it would, therefore, be as impolitic suddenly and violently -to repel an inflammation of a gland or glands, without establishing -some outlet for the increased action to vent itself, -as it would be to check a flux or suppress an exanthematous -eruption, like measles or scarlatina.</p> - -<p>If the bubo is, therefore, painful and inflamed, my advice -is as follows: Stay at home, and rest; descend to middle -diet; take some aperient; and should chancres alone be -present, and a treatment going on for their extinction, continue -the same; or, as bubo often immediately succeeds -the ulcer, and probably may be the first symptom noticed, -adopt, in addition to that recommended above the treatment -as advised for chancre, namely, the administration of -some alterative—for instance, five grains of blue pill every -night—or the Plummer’s pill every night—the aperient -powder every other day; and let the local treatment be directed -to remove the prevailing symptom, to subdue the -inflammation, and, if possible, thereby prevent suppuration. -It was formerly supposed that, unless buboes were allowed -to suppurate, the system could not escape the venereal -taint. Lower somewhat the vital powers, or, what may -be more intelligible, diminish the general inflammatory action, -establish some slight drain, by determining the secretions -to the intestines or skin: and buboes, even when -matter has absolutely formed, may be fearlessly absorbed, -which judicious treatment will effect, in nine cases out of -ten, without at all impregnating the constitution. To attain -this object, warm fomentations constantly applied, and -if possible the warm (hip or full length) bath every night. -When rest is determined upon, if the swelling is great, red, -and painful, leeches are eminently serviceable, but they -must be applied in numbers of at least a dozen at a time, -and repeated twice or thrice if necessary. Three or four, -by the irritation of the bites when healing, and especially<span class="pagenum"><a id="Page_115"></a>[115]</span> -if the patient will not or can not remain quiet, only worry -and aggravate the disease. Where the inflammatory -symptoms are great, where there is fever and much heat -of skin, bleeding is the speediest and most effectual plan -to subdue them; and, in my opinion, it is to be preferred -before the trouble and bother of leeches. Where, however, -there is no remarkable excitement, local or universal, -the topical application of any of the ointments -suggested will often promote absorption (see Forms <a id="FManchor_35"></a><a href="#Form_35" class="fmanchor">35</a>, -<a id="FManchor_36"></a><a href="#Form_36" class="fmanchor">36</a>, -<a id="FManchor_37"></a><a href="#Form_37" class="fmanchor">37</a>).</p> - -<p>Blisters applied over the bubo, very often disperse the -swelling. Pressure also, made by means of a pad covered -with tin foil (as seen in the subjoined cut), and continued -for several days, frequently urges the absorption of the -accumulated deposition in the gland.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_115_cropped_319x400.jpg" width="319" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_115_cropped_479x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Where <i>bubo</i> has been suffered to proceed, and the suppuration -appears inevitable, it would be highly improper<span class="pagenum"><a id="Page_116"></a>[116]</span> -to retard it: poultices and warm fomentations should be -applied, and when fit, an opening should be made to permit -the exit from, and prevent the extension of, the matter -in the surrounding cellular membrane; the operation -should not, however, be prematurely performed; the skin -should be permitted to become thin before an opening is -made, and that opening should be made in the most dependent -position, in order to allow complete escape of the -matter, lest fistulæ and sinuses should form. When an -abscess is thus established, its healing must be promoted -with all expedition, and care taken to preserve the -strength of the patient. For the former purpose, poultices, -mild healing ointments, or strapping plaster applied near -the edges of the wound, should be used. Poultices may -be applied with a bandage, as seen in the subjoined cut.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_116_cropped_347x400.jpg" width="347" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_116_cropped_520x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>When the abscess appears indolent and not disposed to -heal, carrot and linseed-meal poultices may be substituted. -Astringent ointments should also be employed (see Forms -<a href="#Form_38" class="fmanchor">38</a>, -<a id="FManchor_39"></a><a href="#Form_39" class="fmanchor">39</a>, -<a id="FManchor_40"></a><a href="#Form_40" class="fmanchor">40</a>), or lotions (see Forms -<a id="FManchor_41"></a><a href="#Form_41" class="fmanchor">41</a>, -<a id="FManchor_42"></a><a href="#Form_42" class="fmanchor">42</a>), and the topical<span class="pagenum"><a id="Page_117"></a>[117]</span> -application of caustic to the edges of the wounds, or even -paring them with a scalpel. The occasional use of the -warm or vapor bath will give a healthy tone to the frame, -invigorate the depressed powers, and promote recovery. -The strength should be supported by more generous diet, -and any of the formulæ comprised under the head of tonics, -may be taken internally (see Forms -<a id="FManchor_43"></a><a href="#Form_43" class="fmanchor">43</a>, -<a id="FManchor_44"></a><a href="#Form_44" class="fmanchor">44</a>, -<a id="FManchor_45"></a><a href="#Form_45" class="fmanchor">45</a>, -<a id="FManchor_46"></a><a href="#Form_46" class="fmanchor">46</a>, -<a id="FManchor_47"></a><a href="#Form_47" class="fmanchor">47</a>, -<a id="FManchor_48"></a><a href="#Form_48" class="fmanchor">48</a>). As the patient becomes convalescent, change of air, -gradual exercise, the cold shower bath, or sea bathing, will -be of essential service.</p> - -<p class="noindent center brhide p1">———<>———</p> -<div class="section"></div> - -<p><i>Treatment of secondary symptoms.</i>—Secondary symptoms -usually appear from the sixth to the sixteenth week, but -are not unfrequently protracted beyond that period; they -are commonly ushered in with fever—a general sense of -being ill—a quickened pulse, headache, loss of appetite, -pains in various parts of the body, and restlessness at -night; in short, there is disturbance of all the vital functions, -until it is determined which structures are to be the -retreat of the common enemy. Some authors assign the -skin and throat as more liable to attack than others; but -I think the distinction dependant mainly upon the natural -or morbid idiosyncrasy of the invalid. At all events, the -inquiry here would be foreign to the design of this work, -and less useful than the advice, how best to combat the -evils when and wherever they occur. I have already -stated secondary symptoms to consist of eruptions, ulcerations, -and disfigurations of the skin, ulcerations of the -mucous membranes of the mouth, throat, and nose, pains -in the joints, swellings of the bones and their coverings, -and inflammation of the various fibrous textures of the -body.</p> - -<p><i>Treatment of syphilitic eruptions.</i>—The cutaneous eruptions -of syphilis present considerable varieties, assuming -a scaly, papular, tubercular, or pustular appearance. Formerly -it was the opinion that no eruption was <i>venereal</i>, -unless characterized by a scurfy exfoliation, and teinted of -a copper color. This <i>test</i> is not now relied on. In the<span class="pagenum"><a id="Page_118"></a>[118]</span> -simpler forms, we find that the skin becomes mottled at -first, which appearance may partially die away and reappear, -deeper in color, and the spots become more numerous -in extent. The patient should be apprized that, -when the disease has progressed thus far, it is not in its -nature to depart unbidden; but it advances usually from -bad to worse.</p> - -<p>The mottled dots enlarge, exfoliate, or scurf, or desquamate, -as it is called, leaving the subjacent circle thicker -and thicker, and of the same color as the cuticle which -peels off. In the ordinary uninterrupted progression, scabs -form, suppurate, and constitute an ulcer, like a chancre, -which ulcer assumes all the varieties of chancre. In other -cases, the eruption, instead of being scaly, “has a raised -surface, from which a whitish matter usually oozes.”</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_118_cropped_224x400.jpg" width="224" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_118_cropped_336x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The scaly copper-colored eruption, denominated, according to its -severity and appearance, syphilitic lepra or psoriasis, is regarded as -most characteristic of true syphilis, and is the most frequent. The -annexed is a drawing copied from nature; it is alluded to a few pages -further on: its pattern is frequently to be met with. A celebrated -writer, Mr. Carmichael, attaches considerable importance to the -character and appearance of the eruptions. He divides the venereal -disease into four species or varieties: 1st, the scaly venereal -disease, which he considers consequent upon the ordinary chancre; 2d, -the papular, consequent upon gonorrhœal<span class="pagenum"><a id="Page_119"></a>[119]</span> -ulceration; 3d, the tubercular; and 4th, the -pustular, he names from its appearance. These distinctions, -if correct, must be more interesting to the surgeon, -than serviceable to the patient, for the principles of -treatment must be alike in all. Now, although mercury -may be denied to possess any specific influence over the -syphilitic poison, either by its chemical action or neutralizing -power, except as a counter-irritant to the system, yet -the inability of nature to shake off the pestilential hydra, -unassisted by the weapons of the physician, is most apparent; -and the most powerful of which is, that class of -medicines called alteratives, none of which are more deserving, -none more manageable, if the least judgment be -displayed, than mercury.</p> - -<p>The constitution, when under the influence of syphilitic -poison, is being led like a willing horse to its own destruction; -and unless the system be entirely revolutionized, that -event is not likely to be retarded. Here mercury<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a> may<span class="pagenum"><a id="Page_120"></a>[120]</span> -lend its powerful aid, and may be carried even so far as to -produce mild ptyalism or salivation. But there are instances -where mercury is inadmissible. The patient, however, -need not despair; extensive resources are still open -for him—the preparations of antimony,<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a> the mineral acids, -sarsaparilla (Forms <a href="#Form_49" class="fmanchor">49</a>, -<a href="#Form_50" class="fmanchor">50</a>, -<a href="#Form_51" class="fmanchor">51</a>), iodine (Form -<a id="FManchor_52"></a><a href="#Form_52" class="fmanchor">52</a>), and a -host of others may be resorted to; and last, though not -least in importance, is the medicated vapor and fumigating -bath. From my connexion with an establishment of that -kind, my disinterestedness might be questioned in advising -the employment of bathing. As well might the apothecary -who deals in his own drugs, or the tradesman who vends -his own wares, be suspected of disingenuousness; the reply -I would offer should be, that the reader or invalid need -not pin his faith on my assertion, unless it so please him; -or if he does, may the onus lie at my door. But for his -sake, and to bear out my own assertion, I offer this declaration, -that, for the last twenty years, in conducting my establishment<span class="pagenum"><a id="Page_121"></a>[121]</span> -(wherein more cases of syphilitic eruption have -presented themselves, than probably have fallen under the -notice of any other medical man in London within the -same period), no case, of which I have had the management, -has failed of being cured.</p> - -<p>Where syphilitic eruptions terminate in ulceration, the -same local treatment should be used as advised for chancres. -Among the prescriptions will be found formulæ for -many useful topical applications, such as ointments, lotions, -and fumigations, for all the external developments of syphilitic -disease, with appropriate observations appended to -each.</p> - -<p><i>Treatment of syphilitic sore throat.</i>—It has already been -mentioned, that the order of appearance of secondary symptoms -depends more upon the modified state of health than -any fixed law of disease. Syphilitic sore throat may precede -or follow the cutaneous eruptions; and it not unfrequently -happens, that all forms of the disease are present -at the same time: therefore, although they are here separately -considered, it will be found that the treatment corresponds -nearly in all, the only difference being in the local -applications.</p> - -<p><i>Syphilitic sore throat</i> consists of ulcerations of the <i>fauces</i>, -<i>tonsils</i>, and <i>soft palate</i>. The inflammation begins in the -part affected. There is a redness, and sensation of dryness. -A small white spot is perceptible, which rapidly -spreads, is detached, reappears, and in four-and-twenty -hours, if seated on the tonsils, a cavity, as if a portion of<span class="pagenum"><a id="Page_122"></a>[122]</span> -them had been scooped out, is observable. The ulcer has -a sharp margin, and its excavated surface is covered by a -whitish or yellowish adhesive matter. At other times, the -ulceration will be more superficial, but not less rapid in its -progress, extending over the upper part of the palate, and -back part of the throat. Here the general treatment is -precisely the same as in the other forms of the disease, viz., -rest, abstemiousness, low diet, aperient, saline, and alterative -medicines, the blue pill, preparation of antimony, the -bath, and total exclusion from all excitement. The topical -treatment consists of fumigations, gargles, styptic lotions, -nitrous acid gas, blisters over the larynx, rubbing in of -any counter-irritating ointment; the object being throughout -to watch, and endeavor to improve the patient’s health, -support the strength, and mitigate and remove the local -symptoms.</p> - -<p>In the affections of the nose and palate, the fumigations -are indispensable; injections must also be used, and styptic -lotions applied with a camel’s-hair brush. These cases are -very tedious, and, fortunately, in the present day, of rarer -occurrence than formerly; and the patient, thus severely -attacked, would be more prudent to rely upon some confidential -medical adviser, than to trust in his own management.</p> - -<p><i>Treatment of venereal affections of the bones and joints.</i>—Nodes -are alleged, by medical men of great authority, to -be of rare occurrence, except the patient has been taking -mercury; but the observation is not always correct.</p> - -<p><span class="pagenum"><a id="Page_123"></a>[123]</span></p> - -<p>Their treatment, of course, must be regulated by various -circumstances. When the pain and inflammation are severe, -leeches, bleeding, warm fomentations, or cold evaporating -lotions composed of vinegar and water, must be resorted -to. When they are chronic and painful, without -redness and inflammation, the greatest relief will be experienced -by the application of the ointment of iodine and -morphine (see Form <a id="FManchor_53"></a><a href="#Form_53" class="fmanchor">53</a>), also by the internal employment -of iodine in doses of five to ten drops twice or three times -a day. Where they are very obstinate, blisters will be often -useful in promoting absorption. When they ulcerate, -the treatment for chancres must be had recourse to. But -the most invaluable remedy, alone or in conjunction with -any of the preceding, is the vapor bath; it seldom fails to -give instantaneous relief. I have seen patients, who were -rendered almost insensible by the pain of nodes in the -head, chest, and other parts of the body, experience an entire -remission of the pain, and a diminution of the swelling, -by the application of one bath; and a course of six -or a dozen is rarely inefficient in effecting permanent recovery.</p> - -<p>It has already been mentioned that rheumatism of the -bones and joints, and in fact of various parts of the body, -is unfortunately but too frequently an accompaniment or -a consequence of syphilitic disease: and an observer will -discover that nodes rarely exist without rheumatic inflammation -(of which by-the-by they are a species) being more -or less present.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">SECONDARY SYMPTOMS.</h2> -</div> - -<p><span class="smcap">In</span> the same manner as bubo, which is more usually preceded -by ulceration, but which may occur without it, secondary -symptoms, or that form of the disease wherein the constitution -is involved, may be carried into the circulation -without any local effect on the part to which the poison -was first applied being produced; or, in other words, secondary -symptoms need not necessarily be preceded by primary. -I have already stated that secondary symptoms are -also much modified, both as to the time, form, and severity -of their appearance, by the state of health of the patient -affecting and affected; and hence the varied degrees -of syphilitic maladies. By referring to past pages, it will -be seen that the mucous membrane of the throat and nose,<span class="pagenum"><a id="Page_124"></a>[124]</span> -the skin or surface of the body, and the periosteum and -bones, are the structures in which secondary symptoms develop -themselves, and accordingly I now proceed to their -several consideration in detail. To illustrate each of them -practically, I will first select diseases of the skin. They -consist of four marked species, distinguished as the scaly, -papular, pustular, and tubercular.</p> - -<p>The most frequent form of eruption is the scaly, and -called syphilitic lepra. It is characterized by dry, flat, -and round patches, of different sizes, and of a coppery-red -color. Each spot is ushered in by a minute but hard elevation -of a purplish hue, that gradually radiates in size until -it acquires its limit. It then puts on a scaly appearance, -and, as it desquamates, with the exception of the centre, -which is sometimes left white, maintains its copper color. -These patches may be distinguished from ordinary leprosy -by their color, and their running on to ulceration, if uncontrolled -by medicine, and again by their more speedily -yielding to judicious treatment; when they become paler -in appearance, cease to exfoliate, and die away, leaving, -however, a coppery stain. Syphilitic eruptions occur in -all parts of the body, and are to be observed on the head, -face, back, legs, feet, hands, scrotum, &c. (see wood-cut, -page 118), but they are much modified in their external -characters by the region they affect.</p> - -<p>The pustular form of syphilitic eruption is also illimitable -as to situation and extent. The pustules, at the onset, -are scarcely to be distinguished from the patches of -lepra, being of similar color. They differ in size, some -being very large, and others very small. When they have -existed about a week, a purulent fluid escapes, which -hardens and crusts, constituting a conoid tumor, and surrounded -by a copper-colored areola. This crust after a -while drops off, leaving the under surface of the same teint -as the margin. The pustular form of the disease is mostly -consecutive to primary infection of the genital organs, -and is often complicated with affections of the throat, -nose, &c.</p> - -<p>Syphiloid tubercles ordinarily attack the face, more particularly -the nose, angles of the lips, ears, &c. They vary -in size, are dispersed or grouped together, and are of a -purplish copper color. Like the pustular, they terminate -in ulceration, which on healing leaves an indelible scar. -This and other forms of syphilitic disease are very irregular<span class="pagenum"><a id="Page_125"></a>[125]</span> -in their attacks, first selecting one spot, then another, -then several together, so that the body presents often at -the same time many stages of the eruption. The papular -form of eruption is generally intermixed with the pustular -and tubercular. It is less strongly marked, but, like the -others, successive in its development, and usually complicated -with primary symptoms.</p> - -<p>There is a form of cutaneous disfigurement, entitled syphilitic -exanthema, in which the skin is discolored by coppery-red -blushes that disappear under pressure of the finger. -There are also deep and painful fissures and -excrescences, called <i>vegetations</i>, from their resemblance to -raspberries, strawberries, cauliflowers, and leeks, observed -in syphilis, and most commonly they are to be found about -the lips, nose, eyebrows, chin, genitals, &c.</p> - -<p>It may not be unimportant to know that syphilitic eruptions -are contagious by inoculation, and that secondary -symptoms may be transmitted from one individual to another.</p> - -<p>When I was a pupil of the London hospital, a woman -and her child presented themselves for treatment. The -mother was completely covered with copper-colored scaly -eruptions, obviously and unequivocally syphilitic. The -child also had venereal sore throat, and ulceration of the -mouth. The account which the mother gave of herself -was, that the eruption appeared a few weeks after her -confinement; and, upon further inquiry, it was discovered -that the husband had had a chancre of the penis: that -was cured, but secondary symptoms showed themselves -upon him. It was during the presence of the latter that -he had intercourse with his wife, at about the sixth month -of her pregnancy. The surgeon of the week gave it as -his opinion, that the disease was conveyed by the male semen -being absorbed by the mother, which was sufficient -to occasion the disease. The mother, husband, and child, -all submitted to mercurial treatment and fumigations, and -in a few weeks entirely recovered.</p> - -<p><i>Treatment of Secondary Symptoms.</i>—Now in the treatment -of these cases, all of which are more than <i>skin deep</i>, -it is evident that, unless the cause which produces them -be expelled, all local repellants only exhaust the physical -energies of the patient; for the cure by such means but -provokes a speedier reproduction of the disease, and hence -the necessity of constitutional as well as topical remedies.<span class="pagenum"><a id="Page_126"></a>[126]</span> -I have fully explained my views regarding the employment -of mercury; and every day’s experience convinces -me that, where the constitution is imbued with the venereal -virus, there is no alternative but to employ the most -active alteratives, to effect a decisive and speedy change -in the state of the patient’s health. Various habits require -various preparations; the blue pill, the oxymuriate, -calomel, and the external application of the unguentum -hydrargyri fortius, are highly useful. I have, however, of -late, been in the habit of employing the proto-ioduret of -mercury, with unqualified success; nor do I limit its administration -to internal exhibition; it may be used externally. -The advantage of this preparation over others is, -that it rarely, if ever, produces ptyalism.</p> - -<p>In old and inveterate cases, combined with the use of -the warm and vapor bath, both of which may be impregnated -with it, it has wrought wonders; and in cases that -had proved rebellious to every other means, although sedulously -employed, it had effected a speedy and decisive -cure. In the cure of an elderly person, covered almost -from head to foot with syphilitic ulceration, the internal -and external application of the proto-ioduret occasioned, -at the end of a few weeks, the entire disappearance of the -sores, leaving only a slight livid trace. In ulceration of -the throat, nose, and in fissures of the genitals, indolent -buboes, &c., the success is no less remarkable than effectual.</p> - -<p>The following is the formula, which may of course be -altered according to <span class="nobreak">circumstances:—</span></p> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_54"></a><a href="#FManchor_54">Form 54</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of the—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Proto-ioduret of mercury</td> - <td class="colw2 tdr">20</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Gum guaiacum, in powder</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="tdl" colspan="3">Confection of roses, as much as is sufficient.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix to form 36 pills—one to be taken twice or thrice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_55"></a><a href="#FManchor_55">Form 55</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">For external use, take of the—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Proto-ioduret of mercury</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lard</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> - <tr> - <td class="tdl" colspan="4">A portion to be rubbed over, or to dress the affected - parts twice a day. If the ulceration be seated in the throat, - honey of roses may be substituted for the lard. - <span class="pagenum" style="padding-left: 1em;"><a id="Page_127"></a>[127]</span></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">The decoction, or any other preparation of sarsaparilla, - may be taken also in conjunction with the treatment just suggested.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">An ounce of the sarsaparilla root infused in one pint of - lime-water (cold) for twenty-four hours, and a wineglassful - taken three times a day, is a very eligible mode of taking it. <span class="nobreak">Or—</span></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">The compound extract of sarsaparilla, dissolved in lime - or soft water, one ounce to the pint, and taken in similar - doses to the last, is a very good mode of exhibition.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Bathing is indispensable.</td> - </tr> -</table> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">SYPHILITIC LEPRA.</h2> -</div> - -<p><span class="smcap">A person</span> aged about 29 years suffered under the above -disease, and presented the following appearances and -symptoms: He was covered nearly all over with copper-colored -spots, the margins of which were both elevated -and red. The voice of the patient was rather hoarse, and -he complained also of a tenderness on swallowing: the -pain extended to the windpipe and tonsils (or almonds) of -the ear, as they are called. He experienced pain in his -limbs, which he described to be worse at night when in -bed. The spots on the skin every now and then desquamated, -or peeled, or scurfed off, leaving the cuticle red and -shiny underneath, and here and there the cutis was ulcerated. -On examining the throat, the swallow appeared -very inflamed, and the “pap” very pendulous. He was -hot and feverish, and acknowledged that he had had the -venereal disease about nine weeks ago, and for which he -had taken some medicines that he bought, and which had -cured him. When in bed, he complained of a burning, -tingling, and itching of the body, wherever it was covered -with the eruption.</p> - -<p>The treatment was as follows: I bled him to the amount -of twelve ounces, and prescribed a strong aperient powder. -On the second day there was less irritation, and the -spots appeared less red. I advised him forthwith to take -a vapor bath, and repeat the same on alternate days for a -fortnight. I prescribed the pills as subjoined, and directed -one to be taken twice a day, to be succeeded by a dose of -the decoction of woods, as directed already.</p> - -<p><span class="pagenum"><a id="Page_128"></a>[128]</span></p> -<table class="forms"> - <caption style="padding-top: 0.5em;"><a id="Form_56"></a><a href="#FManchor_56">Form 56</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Proto-ioduret of mercury</td> - <td class="colw2 tdr">20</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Gum guaiacum, in powder</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="tdl" colspan="4">To be well mixed together, and made into a mass with - syrup, and then divided into 24 pills.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">The body, on coming out of the vapor bath, or while in - it, to be sponged over with the following wash made <span class="nobreak">warm:—</span></td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_57"></a><a href="#FManchor_57">Form 57</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of the—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Deuto-chloruret of mercury</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Eau de Cologne</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">pint.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<p>Occasionally I order the patient to be placed in a mercurial -bath, of which there are several kinds, and which -can be administered either in the form of the fumigation -or in a fluid state.</p> - -<p>After taking the bath, he could breathe with freedom -and comfort; he could also swallow without difficulty, and -he expressed himself much refreshed and invigorated. -Many of the eruptive spots on the body had exfoliated; -and he said he felt a conviction that he should soon get -well.</p> - -<p>At the expiration of a week, when he had taken but -three baths, the soreness of the throat had left, the pains -in his limbs were all gone, and he slept well; the ulcers -had healed, and the eruption had nearly died away. I advised -a continuation of all the remedies; and after three -weeks of such perseverance, he was rewarded by an entire -recovery. The only alteration I directed to be made in his -diet was an abandonment of stimulants, such as wine, -spirits, or porter.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">NODES AND PAINS IN THE BONES.</h2> -</div> - -<p><span class="smcap">In</span> long-standing cases of syphilis, where either much -mercury has been taken, or the constitution weakened by -low living or careless treatment, a painful affection of the -bones, periosteum, tendons, and ligaments, frequently arises. -Where the inflammation attacks the bone or periosteum, -it usually exhibits itself in the form of a tumor, that -is at first hard and acutely painful, then becomes soft, and -does not always subside without ulcerating, and occasioning<span class="pagenum"><a id="Page_129"></a>[129]</span> -a tedious and unhealthy sore. These tumors are called -nodes, and are extremely rapid in growth, very uncertain -in their duration, and sometimes disappear as quickly as -they come. When the inflammation is seated in the ligament -and tendons, rheumatism is established. Both these -affections are very harassing to the patient; the pains are -severest at night, and wholly prevent sleep, the countenance -becomes sallow, appetite, strength, and flesh fail, -and hectic fever completes the list of troubles consequent -upon these forms of the disease. Nodes and rheumatic -pains may exist independently of, or in connexion with, -other syphilitic symptoms. Cases having already been related -of gonorrhœal rheumatism, which are analogous to -those proceeding from venereal absorption, any further detail -of such would be superfluous. The treatment should -also be conducted on the same principles in the one as in -the other.</p> - -<p>The specific virtues of the vapor bath will be attested -by one trial. I have seen innumerable instances of immediate -relief from a single application. There are few forms -of syphiloid disease more distressing than these pains in -the bones; the patient is all but distracted with the agony -he endures. The relief he experiences from the vapor -bath surpasses belief; it verily appears to be magical. It -constitutes the best opiate we have.</p> - -<p>Temporary relief, however, is not all that we want. It -is no use to remove the effect, and leave the cause behind. -The aid of medicine is indispensable. Formulæ of the -most appropriate remedies will be found among the prescriptions. -The general directions as to diet, regimen, and -clothing, dispersed throughout these pages, must be strictly -attended to. The stomach must not be at any time overloaded -with indigestible food. Milk diet is the best; milk -thickened with farinaceous food, mild tonics to restore the -tone of the stomach and impart strength, alteratives, sarsaparilla (Form <a id="FManchor_58"></a><a href="#Form_58" class="fmanchor">58</a>), -the old Lisbon diet drink, and all the suggestions<span class="pagenum"><a id="Page_130"></a>[130]</span> -hitherto offered with a view of improving the constitution, -should be carried into effect.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">SYPHILITIC SORE THROAT.</h2> -</div> - -<p><span class="smcap">The</span> period that elapses between the appearance of the -primary and secondary symptoms has already been stated -to vary from six weeks to six months; and some medical -writers assert that, if months may elapse, upon the same -principle years may, and therefore the patient who has -once been afflicted with the primary form of the disease is -never exempt from the liability of the secondary. That -syphilis, and diseases resembling it, do occur at every period -of life, is a fact of daily observation; and it is a matter -of less moment to know whether the invalid has ever -had chancre or bubo than is generally supposed, for the -treatment of every form of syphilis, and complaints putting -on like appearances, should be conducted on similar principles. -If mercury do possess anti-venereal properties, it -will be found no less obnoxious to ordinary sore throats, -ordinary ulceration, and cutaneous disfigurement. The -presence of any of the abovenamed diseases indicates a -habit predisposed to their occurrence; and that susceptibility -may be induced by a variety of causes, the most -prominent of which are those that debilitate the constitution, -such as syphilis itself, or the remedies exhibited for -its extermination, cold, fever, intemperate or impoverished -diet—all of which more or less abstract from, or derange -the distribution of, nervous energy. As in the cure -of these diseases, their removal depends upon an entire alteration -of the system, upon that principle alone should -mercury, or any other remedy be administered, not upon -its supposed specific neutralizing or annihilating antisyphilitic -power.</p> - -<p>All this, of course, is a question of experience; and as I -profess that this work should convey the result of mine, I -do not hesitate to express my conviction that secondary -symptoms do present themselves years after a primary affection; -but at the same time I admit their more frequent -occurrence to be within three months; and, with regard -to diseases resembling the above, they are entirely independent -of such influences, and are the result of circumstances -from which no man is free. Of syphilitic ulcerations -of the throat, which are rarely solitary symptoms of<span class="pagenum"><a id="Page_131"></a>[131]</span> -the disease, being usually accompaniments to articular -eruptions or rheumatic pains, there are several forms. -They are ushered in by feverishness, languor, and a peculiar -contour of the countenance, particularly expressive of -anxiety and debility. Of the first form of ulcerated throat, -and which is perhaps the least frequent, is an excavation -of the tonsil, with a tumid and red margin, accompanied -by a stiffness and uneasiness in swallowing. A more common -form, and which, from its occasioning little or no inconvenience, -is seldom discovered by the patient until it -degenerates into a worse state, is that where the ulceration -is more superficial, resembling fissures rather than -ulcers, and being situated at the back part and edges of -the tonsils, and low down the throat. From the absence -of pain and difficulty in swallowing, the medical man is -usually the first to detect it, when, on opening the mouth, -the throat—that is, the hinder part of the fauces—will be -discovered red and somewhat swollen; and on pressing -down the tongue with a spoon or spatula, the ulceration -will be apparent.</p> - -<p>The last form—the phagedenic—is the most formidable, -both in symptoms and effects. It is characterized by fever, -and great pain and difficulty in swallowing, from the -beginning; all denoting acute inflammation of the throat. -The first appearance of ulceration is on the soft palate, -where a small aphthous spot is discovered, surrounded by -a deep erysipelatous redness, that proceeds rapidly to involve -the neighboring parts, which soon assume the appearance -of one extensive slough. This latter disease requires -prompt and active treatment, else the bones of the -palate and nose become implicated, exfoliate and occasion -a permanent deformity.</p> - -<p>The process of cure in these cases must be regulated by -circumstances. In persons of full habit, blood-letting will -be requisite to arrest at once the inflammation. An active -purgative should also be taken; when, if the ulceration -resist these anti-phlegmonous measures, there is no alternative -left but to subject the system to the influence of -mercury. The proto-ioduret pill will be found the best -form, and the diet drink should be taken in conjunction. -The vapor bath, which can be medicated with poppies, -marsh-mallows, and ivy-leaves, or any other emollient -herb, will be found to ease deglutition, promote perspiration, -and afford ease. Local applications, such as gargles,<span class="pagenum"><a id="Page_132"></a>[132]</span> -styptics, &c., are indispensable. Subjoined are a few formulæ, -with <span class="nobreak">remarks:—</span></p> - -<table class="forms"> - <tr> - <td colspan="4" class="colwFL tdlXP" style="padding-top: 1em;">Gargle for the milder form of sore throat.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_59"></a><a href="#FManchor_59">Form 59</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Honey of borax</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Emulsion of bitter almonds</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. To be used six or seven times a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_60"></a><a href="#FManchor_60">Form 60</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Or take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Infusion of bark</td> - <td class="colw2 tdr">6</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Diluted nitric acid</td> - <td class="colw2 tdr">40</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">Where the ulcers have an indolent, or present a sloughy - appearance, either of the following will prove useful - <span class="nobreak">stimuli:—</span> - </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_61"></a><a href="#FManchor_61">Form 61</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of the—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Oxymel of Verdigris</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">The ulcer to be smeared with this preparation, with a - hair pencil, twice or thrice a day.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Or, take of the muriated tincture of iron a small quantity, - to be used in like manner.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Honey of roses, acidulated with muriatic acid, is a very - agreeable astringent.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">In severer cases, such as the phagedenic ulceration, the - subjoined prescription will be found worthy of a <span class="nobreak">trial:—</span></td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_62"></a><a href="#FManchor_62">Form 62</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of the—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Oxymuriate of mercury</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">grain.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of quince seed</td> - <td class="colw2 tdr">6</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">To be mixed to form a gargle, to be used frequently.</td> - </tr> -</table> - -<p class="p1">Ulceration of the larynx is an occasional consequence -of syphilis; but fortunately a rare one, as it is generally -fatal.</p> - -<p>All the symptoms enumerated in this section have been -known to succeed gonorrhœa, and demand similar treatment. -The advocates for the analogy between gonorrhœa -and syphilis herein find a ready explanation for such an<span class="pagenum"><a id="Page_133"></a>[133]</span> -occurrence, which those adverse to the above opinion have -no other means of controverting than by submitting that -its rarity is no very substantial proof. Similar results -also transpire from the imprudent, or too free use of mercury. -The following case is a prototype of the many:— The -patient was a person about thirty years of age, and -was thus affected: there was considerable inflammation -in the entire back part of the throat; the tonsils were -excavated to some depth by ill-looking ulcers, the uvula -shared also in partial destruction; the tongue was swollen, -the tip and front part of it fissured, and on the left side -an irritable ulcer was apparent; the nose discharged a -disagreeable fluid, and occasionally gave off crusts of hardened -secretion. The body of this person, including the -head, was thickly sprinkled with venereal blotches of the -usual copper color. His health was much impaired, and -he stated the disease to have been of nearly twelve months’ -duration from the first to the last.</p> - -<p>The treatment consisted of the exhibition of mercury in -the form of the proto-ioduret, and the sarsaparilla. The -ulcers were touched with nitric acid, and submitted to -mercurial fumigation. At the end of two months he was -convalescent. In cases of ulceration of the throat and -nose, I have used the nitrate of silver, both in substance -and solution, with good effect.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">ADVICE TO INVALIDS.</h2> -</div> - -<p><span class="smcap">Having</span> now fully considered every form of syphilitic -disease compatible with the design of this work, a few -hints relative to the after-management of the patient when -relieved from his complaint, to guard against a relapse, -and to secure an entire restoration to sound health, may -not detract from its utility. There are many patients who, -on the disappearance of the more prominent symptoms of -their complaint, lose no opportunity of rejoicing in their -supposed recovery, and innocently commit sundry inapparent -irregularities, that throw them back to their former -state of suffering, which a little prudence and attention -might have prevented. The more severe the disease has -been, the slower, generally, is the recovery, and also less -permanent in its result. The mere subsidence of pain, -the healing of a wound, the disappearance of a cuticular<span class="pagenum"><a id="Page_134"></a>[134]</span> -eruption, or the suppression of a morbid secretion, are not -in themselves sufficient indications of substantial recovery. -The various physical and mental functions which, -during illness, are always more or less involved, have yet -to regain their tone. The digestive powers of the stomach -are easily deranged, and require watchful management -to secure the vantage gained. Equal care is essential, -lest the intellectual organs be too prematurely called -into active employment. Convalescence is often protracted -to an almost indefinite period, frequently from the most -trifling errors in diet. The stomach of a person reduced -to a low state of debility through a severe inflammatory -disorder, remains for a long time exceedingly sensitive, -and fails not to evince displeasure when oppressed with -indigestible, or too great a quantity of food. No cause -predisposes the patient to a relapse, or retards his recovery, -so much as inattention to diet. It is a popular error -to suppose that the weakness consequent upon severe illness -is only to be removed by rich and substantial food and -wines, and other stimulating drinks. Such indiscretion -often rekindles the disease, or predisposes the system to -the supervention of some other complaint. The change -from the sick-room to the parlor diet should be gradual -and progressive. The milk and farinaceous meal may be -varied by degrees to the milder forms and preparations of -animal food. Solids should be given at first in small quantities; -the diet should be rigidly adhered to, and in the -change from low to full diet, the intermediate one should -not be skipped over.</p> - -<p>With regard to medicines, in no form of disease is it so -important, as in venereal affections, that they should be -continued for some time after the disappearance of symptoms. -Many a relapse of gonorrhœa and secondary symptoms -have occurred through the sudden abandonment of -the means adopted for their cure.</p> - -<p>Exercise forms another important part of management -in convalescence; it should not be suddenly resumed, nor -should fatigue by any means be incurred. Early retiring -to bed, and early rising in the morning, tend considerably -to promote and preserve health. Warm clothing is very -essential and necessary for invalids.</p> - -<p>The general signs of amendment are as follows: a reduced -frequency of the pulse, which is always accelerated -in acute diseases, the absence of thirst, a clean tongue, a<span class="pagenum"><a id="Page_135"></a>[135]</span> -moist skin, a good appetite, and refreshing sleep; and, -lastly, all these are corroborated by an improvement in the -looks. The improved aspect of the countenance has -always been regarded as a sure criterion of returning -health.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_136"></a>[136]</span></p> -<h2 class="no-page-break">STRUCTURE, FUNCTIONS, AND DISEASES, OF THE FEMALE ORGANS OF GENERATION.</h2> -</div> - -<p><span class="smcap">The</span> female genitals occupy the same relative situation -in the pelvis as the male, but they are an antithesis to each -other. The male are constructed to deposite, and the female -to receive; consequently, in the female there is a -conduit or passage, in place of the male penis, termed the -<i>vagina</i>, leading to the womb—the receptacle for the impregnating -fluid. The vagina is placed between the bladder -and rectum. Its entrance is marked by doublings, or -longitudinal folds of flesh, called <i>labia</i>, between the upper -part of which is the opening of the urethra into the bladder, -while below is occupied by the aperture, passage, or -fissure, as above described. At the roof of the vagina is -a fleshy ridge, with a pouting apex or point analogous to -the penis in the male, except being impervious, and called -the <i>clitoris</i>, which possesses the power of erection, or rather -of becoming intumescent when excited, and also of furnishing -a peculiar secretion. It is exquisitely sensitive, -and believed to be the seat of pleasure in the sexual embrace. -The vagina consists of a very soft, vascular, elastic, -and contracting structure, constituting, when its sides -are collapsed, liliputian rugæ, or ridges, like the impressions -left on the sand by a receding sea. Its surface is -lined by a delicate mucous membrane, which secretes a lubricating -fluid. It is this membrane which is the seat of -gonorrhœal discharge, fluor albus, &c.; and it is also subject -to ulcerations and other diseases. From the clitoris -is suspended an inner fold, like a graceful mantle, called -<i>nymphæ</i>, which are also extremely sensitive, and appear to -serve, as they surround the urethra, also for the purpose -of directing the flow of urine. Under the opening of the -urethra, adherent to the external margins of the vagina, is -a membranous veil, or curtain, with a small central aperture, -called the <i>hymen</i>, the presence of which is looked upon -as a test of virginity. After the laceration or dilatation -of this membrane, which takes place through other causes -than sexual intercourse, the sides of it contract, and form<span class="pagenum"><a id="Page_137"></a>[137]</span> -little wing-like slips, to which the fanciful name of <i>carunculæ -myrtiformes</i> is applied.</p> - -<p>The subjoined diagram will familiarize the reader with -the situations of the female organs thus far given. It -exhibits a sectional view of the contents of the pelvis, or -lower part of the <span class="nobreak">abdomen:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P137"> - <tr> - <td style="max-width: 600px;"> - <img src="images/i_b_137_illustrators_600x400.jpg" width="600" height="400" alt="" /> - </td> - <td> - <p class="side-caption">1. The bladder.</p> - <p class="side-caption">2. The urethra, or entrance to ditto.</p> - <p class="side-caption">3. The vagina.</p> - <p class="side-caption">4. The womb.</p> - <p class="side-caption">5. The ovary.</p> - <p class="side-caption">6. The fimbria, and fallopian tube.</p> - <p class="side-caption">7. The rectum, or lower extremity of the bowel.</p> - <p class="side-caption">8. The hymen.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_137_illustrators_900x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_137_illustrators_600x400.jpg" width="600" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> The bladder.</div> - <div class="line"><span class="bold">2.</span> The urethra, or entrance to ditto.</div> - <div class="line"><span class="bold">3.</span> The vagina.</div> - <div class="line"><span class="bold">4.</span> The womb.</div> - <div class="line"><span class="bold">5.</span> The ovary.</div> - <div class="line"><span class="bold">6.</span> The fimbria, and fallopian tube.</div> - <div class="line"><span class="bold">7.</span> The rectum, or lower extremity of the bowel.</div> - <div class="line"><span class="bold">8.</span> The hymen.</div> - </div> - </div> - </div> -</div> - -<p>Much has been said regarding the presence of the <i>hymen</i> -in its entire state. It has been deemed by many to be -there placed as a moral evidence of chastity; but its laceration -is by no means an infallible test of dishonor. In -females of feeble or consumptive health, and others of delicate -constitutions generally, the aperture of the hymen -may become dilated from natural causes—from too profuse -a flow of the menstrual flux, from local debility of the part -itself, such as exist in the disease known by the name of -the <i>whites</i>; and it is sometimes to be traced to the habit -of personal and solitary excitement, as will be presently -alluded to. The membrane is occasionally so dense and -hard as to resist sexual cohabitation; and only upon dividing -it by the scalpel, can intercourse be sustained. At -other times it is so fragile and so vascular as to be torn -with the least violence, and profuse hæmorrhage to follow.</p> - -<p>At the end of the vagina is the <i>uterus</i>. It is suspended -by what anatomists call its broad ligaments, which have -certain local attachments. It resembles in shape a pear. -It is of a peculiar structure, capable of great distension, -and possessing extraordinary properties. It is divided into -a body, neck, and mouth, and when unimpregnated, is -very compact, and occupies but little space. The interior -is consequently very small, and it secretes and pours forth<span class="pagenum"><a id="Page_138"></a>[138]</span> -at certain periods a sanguinous discharge, termed the <i>menstrua</i>. -When conception has occurred, the mouth of the -womb, which before was open, becomes permanently closed -until the period of delivery. Connected with the womb, -and constituting a most important part of its machinery, -there are discovered in the roof of the interior of the uterus, -two openings, which are the ends of two tubes or canals, -called the fallopian tubes.</p> - -<p>These tubes have their origin in the <i>ovaria</i>, which are -two small bodies encased in the ligamentous band supporting -the uterus, and resembling the testicle of the male; -hence they have been called the female <i>testes</i>. These -ovaria contain a number of little vesicles of the size of -mustard-seeds, and some of the size of a pea, in number -from twelve to fifteen. These vesicles are denominated -the eggs of the human species. Annexed to the ovaria -are observed, surrounding the tubes, certain <i>fimbriæ</i>, which -grasp the ovaria during the copulative act, when prolific, -and squeeze out, as it were, one of these little eggs, and -propel it into the uterus.</p> - -<p>Still further to facilitate the understanding of the structures -described in addition to the preceding diagram, the -following drawing is presented. It exhibits a section of -the female pelvis, and explains more fully the relative positions -of its <span class="nobreak">contents:—</span></p> - -<div class="screen-only"> - <table class="illo2" summary="P138"> - <tr> - <td colspan="2" style="max-width: 563px;"> - <img src="images/i_b_138_cropped_563x400.jpg" width="563" height="400" alt="" /> - </td> - </tr> - <tr> - <td style="max-width: 14em;"> - <p class="side-caption"><i>a</i>—The bony portion of the pelvis separated from its junction with its companion.</p> - <p class="side-caption"><i>b</i>—The spinal column of the back.</p> - <p class="side-caption"><i>c</i>—The bladder.</p> - </td> - <td style="max-width: 14em;"> - <p class="side-caption"><i>d</i>—The orifice of the urethra.</p> - <p class="side-caption"><i>e</i>—The body of the womb.</p> - <p class="side-caption"><i>f</i>—The neck of the womb.</p> - <p class="side-caption"><i>g</i>—The vagina.</p> - <p class="side-caption"><i>h</i>—The rectum, or end of the intestines.</p> - </td> - </tr> - </table> -</div> -<p class="viewLI2 ebhide"><a class="underline" href="images/i_b_138_cropped_844x600.jpg" rel="nofollow">View larger image</a><br /><br /></p> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_138_cropped_563x400.jpg" width="563" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The bony portion of the pelvis separated from - its junction with its companion.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—The spinal column of the back.</div> - <div class="linep7"><span class="bold"><i>c</i></span>—The bladder.</div> - <div class="linep7"><span class="bold"><i>d</i></span>—The orifice of the urethra.</div> - <div class="linep7"><span class="bold"><i>e</i></span>—The body of the womb.</div> - <div class="linep7"><span class="bold"><i>f</i></span>—The neck of the womb.</div> - <div class="linep7"><span class="bold"><i>g</i></span>—The vagina.</div> - <div class="linep7"><span class="bold"><i>h</i></span>—The rectum, or end of the intestines.</div> - </div> - </div> - </div> -</div> - -<p><span class="pagenum"><a id="Page_139"></a>[139]</span></p> - -<p>The subjoined drawing illustrates the shape and appearance -of the womb detached from the <span class="nobreak">body:—</span></p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_139_cropped_547x400.jpg" width="547" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_139_cropped_820x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>To particularize: The upper part is called the <i>fundus</i>; -the widest part, the <i>body</i>; the <i>neck</i>, the narrow part; and -the lower portion the <i>mouth</i>, or the <i>os tincæ</i>. The connexion -of the fallopian tubes is well shown.</p> - -<p>The uterus, or womb, is described by physiologists as -being of a spongy structure—a structure that yields with -its enlargement—that grows with its growth—that resumes -the former size when disburdened of its contents. -It is supplied with blood-vessels, is duly supported, has -scarcely a cavity when unimpregnated, but is ever in a -state of preparation for changes. Of conception we shall -presently treat.</p> - -<p>There is one function too important to omit in this -place, and this is menstruation—a term indicating a -monthly periodical discharge that escapes, or which is -given off, from the womb. At the commencement of this -function, woman is said to have arrived at puberty; but -there are cases of precocity, and others wherein it never -occurs, that neutralize this assertion; besides, menstruation, -being deferred or protracted, depends frequently upon -peculiarities of health. As soon, however, as it occurs, a -sensible change takes place in the female economy; and -certainly the other developments of womanhood rapidly -follow.</p> - -<p>Menstruation is the monthly discharge of a red fluid, -common to females from fifteen or sixteen years of age to -between forty and fifty; and it is held that, while a female<span class="pagenum"><a id="Page_140"></a>[140]</span> -menstruates, she is apt, and capable also, to conceive. -Menstruation is a device of nature to relieve the system, -or to preserve the balance of the circulation, from the non-fulfilment -of her intentions, by the absence of procreation. -It usually continues for four, five, or six days, and seldom -exceeds a few ounces. Its suppression is usually attended -with marked ill health, and many of the formidable complaints -of females are attributable to its irregularities. -When anticipated, the female encounters feelings of depression -and lassitude, and exhibits an aspect of feeble -health. As a physiological fact, women, before and after -menstruation, are more desirous of the exercise of sexual -privileges, and usually the approach of the menstrual flow -is accompanied by a sexual orgasm. It has ever been -deemed, by almost universal consent, prudent for married -persons and others to abstain from the sexual embrace -during that period. If only on the score of cleanliness, it -should be observed; besides, the likelihood of establishing -irritability, and the probability of interfering with this -healthful provision of nature, should deter from the indulgence. -In some countries, menstruating women are excluded -from associating with the other sex altogether, and -are even forbid mingling with household duties. At the -close of this article will be found a series of prescriptions -and suggestions for the removal of the various disturbances -this function is liable to.</p> - -<p>The act of connexion is urged by what is called the sexual -propensity. It is accompanied by feelings of the intensest -kind: the acme of enjoyment is at the moment of -seminal ejaculation. The penis is excited to erection by -the influx or rush of blood into its cavernous or cellular -structure; the scrotum becomes constricted, and compresses -the testicles; the <i>vesiculæ seminales</i>, and the prostate -gland, are also elevated by the muscles called <i>levatores -ani</i>, as shown in the preliminary anatomical drawings, -whence their use may now be better understood, as well -as those of the perineal muscles, which all more or less -assist in causing the prompt and forcible ejaculation of the -spermatic fluid.</p> - -<p>“In<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a> the female, the sense of enjoyment, <i>sub coitu</i>, appears -to be principally excited by the friction of the <i>labia -interna</i> and <i>clitoris</i>, which are alike in a state of turgescence -or erection. This nervous excitement, as in the<span class="pagenum"><a id="Page_141"></a>[141]</span> -male, often reaches such a degree of intensity that a kind -of syncoptic state is induced.” A sense of contented lassitude -follows, and the mind is permitted to return from -the regions of excited imagination to its ordinary quietude.</p> - -<p>The due occurrence of the phenomena just detailed does -not necessarily secure, although it generally succeeds in -producing, a prolific result. Health, aptitude, and one important -condition, are indispensable; and the last is—a -positive contact between the male sperm and female ovum.</p> - -<p>There are many remarkable eccentricities that embitter -married life. A union may exist between two parties who -are wholly inapt for mutual enjoyment. The sensations -belonging to the sexual act are involuntary, and are provoked -independently of the will: hence, in connexion without -consent, or under feelings of great repugnance, the orgasm -is sometimes aroused; and yet, where the greatest -affection and desire prevail, the male oftentimes unseasonably -concluding before the female, is a most tantalizing -source of disappointment. Further allusions will be found -to this subject under the heads of “Sterility,” and “Impuissance.”</p> - -<p>As a preliminary aid to the description of the process of -impregnation, which ensues, the following anatomical draft -is <span class="nobreak">presented:—</span><br /><br /></p> - -<div class="screen-only"> - <table class="illo2" summary="P141"> - <tr> - <td colspan="2" style="max-width: 979px;"> - <img src="images/i_b_141_cropped_979x400.jpg" width="979" height="400" alt="" /> - </td> - </tr> - <tr> - <td style="min-width: 12em;"> - <p class="side-caption">1. Section of the womb, upper part.</p> - <p class="side-caption">2. Do. of side.</p> - <p class="side-caption">3. Do. of lateral covering.</p> - <p class="side-caption">4. Do. of lower part of womb.</p> - <p class="side-caption">5. Cavity of the womb.</p> - <p class="side-caption">6. A prominence leading from the openings of the fallopian tubes.</p> - <p class="side-caption">7. The vagina.</p> - <p class="side-caption">8 and 9. Fallopian tube cut open.</p> - </td> - <td style="min-width: 12em;"> - <p class="side-caption">10 and 16. The fimbriated extremity of do.</p> - <p class="side-caption">11. The pavilion.</p> - <p class="side-caption">12. The ovary.</p> - <p class="side-caption">13. Vesicles in do.</p> - <p class="side-caption">14. Continuation of ovary.</p> - <p class="side-caption">15. Ligament of do.</p> - <p class="side-caption">17. Pavilion of right ovary.</p> - <p class="side-caption">18. Right ovary.</p> - <p class="side-caption">19. Connecting band.</p> - </td> - </tr> - </table> -</div> -<p class="viewLI2 ebhide"><a class="underline" href="images/i_b_141_cropped_1469x600.jpg" rel="nofollow">View larger image</a></p> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_141_cropped_979x400.jpg" width="979" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Section of the womb, upper part.</div> - <div class="line"><span class="bold">2.</span> Do. of side.</div> - <div class="line"><span class="bold">3.</span> Do. of lateral covering.</div> - <div class="line"><span class="bold">4.</span> Do. of lower part of womb.</div> - <div class="line"><span class="bold">5.</span> Cavity of the womb.</div> - <div class="line"><span class="bold">6.</span> A prominence leading from the openings of the fallopian tubes.</div> - <div class="line"><span class="bold">7.</span> The vagina.</div> - <div class="line"><span class="bold">8</span> and <span class="bold">9.</span> Fallopian tube cut open.</div> - <div class="line"><span class="bold">10</span> and <span class="bold">16.</span> The fimbriated extremity of do.</div> - <div class="line"><span class="bold">11.</span> The pavilion.</div> - <div class="line"><span class="bold">12.</span> The ovary.</div> - <div class="line"><span class="bold">13.</span> Vesicles in do.</div> - <div class="line"><span class="bold">14.</span> Continuation of ovary.</div> - <div class="line"><span class="bold">15.</span> Ligament of do.</div> - <div class="line"><span class="bold">17.</span> Pavilion of right ovary.</div> - <div class="line"><span class="bold">18.</span> Right ovary.</div> - <div class="line"><span class="bold">19.</span> Connecting band.</div> - </div> - </div> - </div> -</div> - -<p class="p1"><span class="pagenum"><a id="Page_142"></a>[142]</span></p> - -<p>Man, unlike other animals, is not smitten with desire to -propagate only at particular periods. In sentient beings, -every season is favorable to the flame of love.</p> - -<p>When conception takes place, the following phenomena -are believed to occur: The womb is supposed to participate -in the excitement of the sexual act, and at the moment -of the orgasm, to receive the male seed, and to mingle -with it a fluid of its own. The whole apparatus of the -uterus appears influenced at the same time,<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a> by a kind -of electric irritability. A vesicle, owing to the ovaria being -grasped or embraced by the fimbriæ, escapes from its -lodgment and enters the fallopian tube, where it bursts, -and its albuminous drop is conveyed into the womb.</p> - -<p>From the circumstance of the male semen returning -from the vagina after copulation, it has been doubted -whether it was intended to enter the uterus. It certainly -can only enter once,<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a> and that when impregnation takes -place; and even then a small portion suffices, for immediately -after conception the mouth of the womb becomes impermeably -closed. The mouth of the womb lies horizontally, -like the lips of the face, while that of the orifice of -the urethra is arranged perpendicularly: hence the presumption, -from this better adaptation to transmit and -receive, that the semen to impregnate should enter the -uterus.</p> - -<p>This question is mooted, because it has been supposed -by some that impregnation ensues from the vapor or odor -of the male seed ascending to the womb. Contending -parties admit, while others deny, that the seed may be, and -has been, detected in the womb of females and animals -having been slain (or who may have died) during or soon -after the act of copulation. Impregnation has followed -very imperfect penetration, such as in cases of unruptured -hymen, or of disproportion of parts, and other causes needless -to insert here, by which the supposition is supported -that conception takes place from vaginal absorption; but -it must be remembered that the seed is projected generally<span class="pagenum"><a id="Page_143"></a>[143]</span> -with great force, and that the smallest possible quantity is -sufficient for impregnation; also, that the vagina possesses -a constrictive movement of its own, whereby the seed -is carried into the womb.</p> - -<p>After the escape of the “albuminous drop,” the vascular -membrane which contained it is converted into what -is called a corpus luteum; denoting thereby—for it assumes -the form, after a while, of a fleshy nucleus—that -the female has either conceived, or has been under the -influence of strong amatory excitement. This <i>salvo</i> must -be admitted, for corpora lutea have been discovered in females -where intercourse was even impossible; but as this -detection of corpora lutea generally corroborates the surmise -that so many conceptions have taken place as there -are corpora lutea, it is to be presumed that the exception -must be owing to some similarly powerful mental, as well -as physical excitement.</p> - -<p>When impregnation has taken place, the womb begins -to enlarge, and become more soft, vascular, and turgid—the -wonderful process of fluids assuming the form of solids -commences, and within a fortnight an investing -membrane is formed, called the <i>decidua</i> (I will insert as -few names as possible), consisting of two kinds of folds, -one lining the womb, and the other containing the <i>ovum</i> -which has therein “taken root.” The ovum is now a soft -oval mass, fringed with vessels, and composed -of membranes containing the early fœtus. See -sketch.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_143_cropped_193x200.jpg" width="193" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_143_cropped_386x400.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>When opened, the fœtus appears surrounded -by three distinct membranes: first, <i>the decidua</i>; -secondly, <i>the chorion</i>, the inner fold of the former; thirdly, -<i>the amnios</i>. The decidua, as before stated, lines the womb; -the two others cover the ovum or fœtus. After a time the -amnios and chorion become adherent to each other, and a -fluid is interposed betwixt the amnios and fœtus, called -the <i>liquor amnii</i>. The fœtus, as it advances, is perceived -to be hanging by an organized support, called the umbilical -chord, floating in the liquor before named.<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a></p> -<p><span class="pagenum"><a id="Page_144"></a>[144]</span></p> - -<p>A draft is here presented of an ovum (a -section) of a fortnight old; -and adjoining is one just -double its age, where the -chord will be perceived.</p> - -<div class="figcenter"> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_144a_cropped_243x200.jpg" width="243" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_144a_cropped_486x400.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_144b_cropped_205x200.jpg" width="205" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_144b_cropped_410x400.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> -</div> - -<p>The following further account may aid -the description thus far given. The ovum, -protected by a membrane of its own, called the amnios, -descends into the uterus, where it takes its hold of the -membranes already there—the decidua. It pushes its way -before, as exemplified in the subjoined <span class="nobreak">drawing:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P144C"> - <tr> - <td style="max-width: 537px;"> - <img src="images/i_b_144c_cropped_537x400.jpg" width="537" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a</i>—The decidua lining the womb.</p> - <p class="side-caption"><i>b</i>—Do. protecting the ovum.</p> - <p class="side-caption"><i>c</i>—The upper part of the womb, where the ovum has become adherent.</p> - <p class="side-caption"><i>d</i>—The ovum.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_144c_cropped_806x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_144c_cropped_537x400.jpg" width="537" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The decidua lining the womb.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—Do. protecting the ovum.</div> - <div class="linep7"><span class="bold"><i>c</i></span>—The upper part of the womb, where the ovum has become adherent.</div> - <div class="linep7"><span class="bold"><i>d</i></span>—The ovum.</div> - </div> - </div> - </div> -</div> - -<p>The next cut shows the advanced condition of the <span class="nobreak">fœtus:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P144D"> - <tr> - <td style="max-width: 537px;"> - <img src="images/i_b_144d_cropped_537x400.jpg" width="537" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a</i>—The womb.</p> - <p class="side-caption"><i>b</i>—The liquor amnii, with the fœtus.</p> - <p class="side-caption"><i>c</i>—The chorion.</p> - <p class="side-caption"><i>d</i>—The decidua.</p> - <p class="side-caption"><i>e</i>—The opening of the fallopian tubes.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_144d_cropped_584x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_144d_cropped_537x400.jpg" width="537" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The womb.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—The liquor amnii, with the fœtus.</div> - <div class="linep7"><span class="bold"><i>c</i></span>—The chorion.</div> - <div class="linep7"><span class="bold"><i>d</i></span>—The decidua.</div> - <div class="linep7"><span class="bold"><i>e</i></span>—The opening of the fallopian tubes.</div> - </div> - </div> - </div> -</div> - -<p><span class="pagenum"><a id="Page_145"></a>[145]</span></p> - -<p>It will answer no practical usefulness to go through the -whole minutiæ of the various physiological changes that -take place relative to fœtal growth from the hour of impregnation -to that of delivery. What has already been -detailed, has been offered to unveil a little of that singular -ignorance that exists generally among non-medical persons -regarding the history of themselves. “Too much -learning is a dangerous thing;” and it will readily be allowed, -that a sufficient idea that certain things <i>happen</i> is -oftentimes as useful as to know <i>how</i> they happen, especially -when it belongs to a department requiring much -research, time, and ingenuity, thoroughly to understand, -and which may chance to be foreign to our ordinary pursuit.</p> - -<p>The period consumed in gestation is forty weeks, or nine -calendar months, and the time is calculated from a fortnight -after the suspension of menstruation. Some married -ladies pride themselves upon being able to predict to -a day—to tell the precise occasion when they conceive, -and which they date from some unusual sensation experienced -at the particular embrace which effected the important -change. Many medical men disallow that such tokens -present themselves, and are opposed to the belief -which many mothers entertain, that nature is so communicative; -and also are skeptical of those extraordinary influences -that every day furnish proofs of maternal imagination, -occasioning to the burden they carry, sundry -marks, malformations, and monstrosities. Examinations -have found that the order of fœtal organization is somewhat -as follows: the heart and large vessels, the liver and -appendages, the brain, stomach, and extremities. The -determination of sex and number has hitherto defied exploration. -In the early months of pregnancy the womb -maintains its natural position; but as it enlarges, it also -emerges from the pelvis into the abdomen. The moment -of its slipping out of the pelvis is termed quickening, of -which most women are sensible—some fainting on the occasion, -others being attacked with nausea, hysteria, and -palpitation of the heart. Quickening usually occurs between -the fourth and fifth month. The fœtus is then -called a child—the law ordaining that, if a woman intentionally -procure, or such parties as may assist in so doing, -abortion or miscarriage before quickening, it is misdemeanor, -if after, murder.</p> - -<p><span class="pagenum"><a id="Page_146"></a>[146]</span></p> - -<p>The following diagram is presented to show the situation -occupied by the womb containing the child just ready -to enter the <span class="nobreak">world:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P146"> - <tr> - <td style="max-width: 279px;"> - <img src="images/i_b_146_cropped_279x400.jpg" width="279" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a</i>—The womb.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>b</i>—The vagina.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>c</i>—The bladder.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>d</i>—The rectum.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_146_cropped_365x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_146_cropped_279x400.jpg" width="279" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The womb.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—The vagina.</div> - <div class="linep7"><span class="bold"><i>c</i></span>—The bladder.</div> - <div class="linep7"><span class="bold"><i>d</i></span>—The rectum.</div> - </div> - </div> - </div> -</div> - -<p>A full pregnant female, like a very corpulent man, -walks very erect: hence the popular notion that ladies in -the one condition, and gentlemen in the other, do not think -meanly of themselves, but strut along well pleased with -their own importance. It is an uncharitable idea; the -attitude is unavoidable, the head and shoulders being -thrown back to counterbalance the protuberance in front—to -preserve, in fact, the centre of gravity, to save themselves -from falling.</p> - -<p><i>Symptoms of Pregnancy.</i>—Mysterious as is the process -of impregnation, there are many forewarnings which, being -generally found correct, are useful to be known. Great<span class="pagenum"><a id="Page_147"></a>[147]</span> -as are the changes that take place in the female economy -during child-bearing, and productive as they frequently -are of serious disturbances to health, it is benevolently ordained -that women who fulfil their destiny of becoming -mothers, have better health to sustain them through their -travail than the single or unprolific. The signs of pregnancy -during the first few weeks are very equivocal. The -first probability is the suppression of menstruation, which -is accompanied by fulness of the breasts, the nipples of -which become surrounded by a dark areola; headache, -flushing in the face, and heat in the palms of the hands, -ensue; also sickness in the morning, and probably an accession -of mental irritability; various longings exist—many -very ridiculous, others bordering on insanity, and -some indicating great perversion of temper, habits, in -hitherto well-conducted inclinations.</p> - -<p>There are many phenomena more readily discovered by -medical men accustomed to the accoucheur’s employment -than describable, that indicate pregnancy; the sinking of -the abdomen, the descent and closure of the uterus, the -altered facial looks, the state of the pulse, &c., &c.</p> - -<p>From the fourth month, when the womb ascends into -the abdomen, the signs are more positive: the protrusion -of the navel, the evident enlargement of the belly, the tenderness -and fulness of, and occasional escape of milk from, -the breasts, clearly point out the occasion.</p> - -<p>About the fifth month, the movements of the child are -very apparent to the mother, when all doubt is removed.</p> - -<p>There are some conditions of female life that assimilate -to pregnancy, and which have defied the judgment of matrons, -and even medical men, but they are rare—such as -dropsy of the abdomen, or ovaries, tumors, accumulations -of wind, &c. These, with the suspension of menstruation -(which last is but an uncertain sign, for it may depend -upon cold, fever, or inflammation), have destroyed the anticipations -of fond wives, and have alarmed those who desire -not to become mothers.</p> - -<p><i>Parturition</i> takes place at the end of the ninth month; -but children born at the end of seven will live, and examples -are related of some that have “gone” ten. In France, -legitimacy is allowed to children born on the 299th day of -pregnancy.</p> - -<p><i>Labor</i> is distinguished by a softening of the soft parts of -the female organs of generation, an abundant secretion<span class="pagenum"><a id="Page_148"></a>[148]</span> -of mucus, a relaxation of the mouth of the womb, and a -forcible contraction of its body. The expulsion of the -child is effected by pains of a straining nature. After the -birth of the child, the womb contracts to its <i>normal</i> or unimpregnated -size, giving forth a discharge, called the <i>lochia</i>, -that lasts for several days, and the breasts immediately furnish -the secretion of milk.</p> - -<p>Previously to entering upon the consideration of the diseases -arising from infection, and for which this book was -originally composed, a word or two may be said upon a -condition of the womb, unfortunately of frequent prevalence, -called <i>prolapsus uteri</i>, or <i>falling of the womb</i>. Such -occurrence may take place with single females as well as -with married, or those who have borne children. It may -be held as the result of debility; and according to the degree -of descent is the inconvenience and suffering. The -first drawing exhibits the natural position of the <span class="nobreak">uterus:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P148A"> - <tr> - <td style="max-width: 475px;"> - <img src="images/i_b_148a_cropped_475x400.jpg" width="475" height="400" alt="Natural position of the uterus" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption"><i>a</i>—The vagina.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>b</i>—The uterus.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_148a_cropped_712x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_148a_cropped_475x400.jpg" width="475" height="400" alt="Natural position of the uterus" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold"><i>a</i></span>—The vagina.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—The uterus.</div> - </div> - </div> - </div> -</div> - -<p>A partial descent of the uterus gives rise to painful dragging -sensations about the groins and fundament, and it is -usually attended by the “whites,” or leucorrhœa, a disease -of which mention is presently <span class="nobreak">made:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P148B"> - <tr> - <td style="max-width: 480px;"> - <img src="images/i_b_148b_cropped_480x400.jpg" width="480" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">Partial descent of the uterus.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>a, a, a</i>—Vagina.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>b</i>—Uterus.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_148b_cropped_720x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_148b_cropped_480x400.jpg" width="480" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep0">Partial descent of the uterus.</div> - <div class="linep7"><span class="bold"><i>a, a, a</i></span>—Vagina.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—Uterus.</div> - </div> - </div> - </div> -</div> - -<p><span class="pagenum"><a id="Page_149"></a>[149]</span></p> - -<p>If <i>prolapsus</i> takes place during pregnancy, the womb -impresses upon the bladder and rectum, and occasions irritability -of both those structures; but as pregnancy advances, -and as the womb ascends into the abdomen, these inconveniences -cease, and the womb oftentimes regains its tone -and position after child-birth. The womb sometimes protrudes -externally, and is a source of great distress. See -<span class="nobreak">drawing:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P149"> - <tr> - <td style="max-width: 443px;"> - <img src="images/i_b_149_cropped_443x400.jpg" width="443" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">Prolapsus uteri.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>a, a</i>—Vagina.</p> - <p class="side-caption"> </p> - <p class="side-caption"><i>b</i>—Uterus.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_149_cropped_664x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_149_cropped_443x400.jpg" width="443" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep0">Prolapsus uteri.</div> - <div class="linep7"><span class="bold"><i>a, a</i></span>—Vagina.</div> - <div class="linep7"><span class="bold"><i>b</i></span>—Uterus.</div> - </div> - </div> - </div> -</div> - -<p>The treatment in these cases is chiefly mechanical, beside -supporting the general health. The first symptoms, -however, demand efficient attention, and the medical -attendant should be made acquainted with every particular.</p> - -<p>It is a question whether the weakened condition of the -supports of the womb, and the consequent relaxed state of -the vagina, are not owing to the manner in which women -clothe themselves. The pelvic part of the female is kept -always in a state of unnatural warmth, from the load of -petticoats and other unnameable female attire. Contrast -but the difference between the simple unlined trowsers of -the male and five or six-fold clothing of the other sex: either -the one must yield too much warmth, or the other -must strike too cold. The sedentary habits of women have -of course much influence.</p> - -<p>When retention of urine follows the falling down or -partial descent of the womb, the female should lie on her -back, press the uterus into the pelvis, and urinate in that -position.</p> - -<p>The womb, beside becoming displaced, is subject to an -<i>eversion</i>, or a turning inside out. Happily, such cases are -unfrequent, but any disturbance of so important an organ -demands the promptest attention.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_150"></a>[150]</span></p> -<h2 class="no-page-break">DISEASES OF WOMEN, AND THE USE OF THE SPECULUM.</h2> -</div> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_150_cropped_509x400.jpg" width="509" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_150_cropped_764x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p><span class="smcap">The</span> introduction of the stethoscope and the speculum -constitute two important epochs in medical science—the -former ascertaining, by the conveyance of sound, disease -in the most hidden and inaccessible parts of the human -frame, and the latter bringing to view structures which, -without such aid, are necessarily veiled from our sight. -The speculum consists of an instrument formed of silver or -steel, that without pain or inconvenience is passed into the -vagina, when, by a simple contrivance, it is made to expand<span class="pagenum"><a id="Page_151"></a>[151]</span> -and dilate the vaginal passage, and thereby expose -to view the entire canal, together with the uterine aperture. -The usefulness of such a method, whereby disease can at -once be detected, admits of no dispute. It is physically -painless; and if opposed to female diffidence and modesty, -its importance and serviceableness should be balanced -against the mental distress such a procedure may occasion. -On the one hand, without its assistance, the treatment of -the disease is at best but conjectural; on the other, by its -aid, it is safe and sure—much suspense and suffering is at -once put an end to. Experience has proved that many -local disturbances, that were believed to have been merely -vaginal irritation, have been discovered to depend upon -absolute disorganization of the neck and mouth of the -womb. Deep-seated ulceration has been detected, and -cancerous enlargements; the disease thereby having been -exposed, has had the necessary and successful treatment. -In Paris, it is considered so valuable that a chair, termed -a “speculum chair,” has been invented solely for its use. -See engraving on previous page.</p> - -<p>The speculum is now in the hands of every respectable -medical man, and the class of disorders that hold it in -requisition are being better understood, and consequently -more successfully combated. In no cases is it more useful -than in secretive irregularities, such as in leucorrhœa, -gonorrhœa, or syphilitic ulceration. Without further -comment, these diseases will be considered.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">GONORRHŒA IN THE FEMALE.</h2> -</div> - -<p><span class="smcap">This</span> disease is rarely so violent as in man, it being -mostly confined to the uterine conduit; in fact, except by -the discharge, women are almost unconscious of its existence, -mistaking it, when occurring in married life, for -leucorrhœa. Occasionally, however, the inflammation is -highly acute, and a variety of distressing symptoms ensue. -There is considerable excoriation around, and a swelling -of the organs, much <i>ardor urinæ</i>, and the same constitutional -disturbance as in the other sex.</p> - -<p>The medical treatment of both sexes is constitutionally -alike; but the female has to depend more upon local treatment -than the male. Hence the importance of injections. -Now here is another source of difficulty: women are as<span class="pagenum"><a id="Page_152"></a>[152]</span> -averse to the use of the syringe as they are to the speculum; -and the consequence is, vaginal diseases are generally -protracted to double as long as they need be. However, -as these hints are likely to be seen only by those who -doubtlessly have, and who indisputably ought, to exercise -it, namely, influence over the sex in persuading them to -submit to what common sense bespeaks as most prudent -and expedient, appropriate formulæ for the suggestions -just recommended will be found a few pages hence. Frequent -ablution, rest, temperate diet—the more farinaceous -and mucilaginous the better, avoiding entirely wines, fermented -and spirituous liquors, together with mild (Form <a id="FManchor_63"></a><a href="#Form_63" class="fmanchor">63</a>) aperients -and salines, constitute the chief means of cure. Injections -are indispensable.</p> - -<p>I have already alluded to the difficulty of getting female -patients to be their own confessors. If they appoint others, -every possible information should be furnished, and -fastidiousness by no means should supplant the avowal of -real facts. Although gonorrhœa in women is generally -less severe than in the male, it is vexingly oftentimes more -lasting; which is easily accounted for, owing to the extent -of surface diseased: whereas in man it is limited to the -narrow urethra, and seldom exceeds an inch or two upward, -constituting not one tithe part of the space morbidly -affected in the former. See, however, the formulæ.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">SYPHILIS IN FEMALES.</h2> -</div> - -<p><span class="smcap">The</span> principal features of syphilis in women consist of -ulcers, excoriations, warts, and buboes. Women, of course, -are alike liable to all the forms of secondary symptoms. -Chancres usually appear <i>within</i> and <i>on</i> the <i>labiæ</i>. In the -<span class="pagenum"><a id="Page_153"></a>[153]</span>drawing here given, the labiæ are drawn -aside to expose the ulceration; and they -are also found within the vagina and surrounding -the mouth or protuberance of the -womb. It is in these cases that the speculum -is had recourse to; and in the Parisian -hospitals every case is subject to -such a mode of investigation.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_153a_cropped_219x400.jpg" width="219" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_153a_cropped_329x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The following three illustrations show what a degree -of severity ulceration and other changes -put on. The first exhibits superficial excoriation -extending rapidly, and occasionally a swollen appearance -of the <i>os uteri</i>; the second shows extensive chancrous -ulceration; and the last of a -tuberculous character, like little -hardened tumors. But for the -speculum, these conditions might -have gone on to worse, and led to -irremediable mischief: their treatment, -independently of local means, -such as injections, &c., would have -been prolonged to an almost indefinite -time. The use of styptics is demanded -in female as well as male syphilitic developments, -and accordingly the employment of nitrate of silver, copper, -&c., is advised, as already explained.</p> - -<div class="figcenter"> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_153b_cropped_211x200.jpg" width="211" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_153b_cropped_633x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_153c_cropped_211x200.jpg" width="211" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_153c_cropped_613x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> - <div class="figsub" style="max-width: 30em;"> - <img src="images/i_b_153d_cropped_211x200.jpg" width="211" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_153d_cropped_610x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> -</div> - -<p>The following drawing shows the extent of mischief and -annoyance to the external organs of female generation -consequent upon neglect. The external labiæ are studded -with chancres. The thighs, buttocks, and rectum, -are dotted and overspread with excoriations. The person<span class="pagenum"><a id="Page_154"></a>[154]</span> -from whom this sketch is taken was an unfortunate woman -of the town. As it is not my intention to particularize -cases, although from my peculiar province I could fill up -as many pages as this book contains, with details of such -histories, I have only to add, by way of summary, that the -topical and constitutional treatment being alike in both -sexes, the only modifications required will be the regulating -of the doses of the medicines, which must be done -with reference to the idiosyncrasy, age, and temperament, -of the patient. The frail system of woman is less able to -withstand the dire effects of the disease, or the potent -means for its extirpation, than her stronger brotherhood, -and therefore the abler and more experienced the counsel, -the fairer the chance of her recovery; a hint that the -writer feels assured will not be received by those to whom -his pages are addressed, as a vain appeal to repose confidence -in other advice than their own.</p> - -<div class="figcenter" style="max-width: 35em;"> - <img src="images/i_b_154_cropped_659x400.jpg" width="659" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_154_cropped_988x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">LEUCORRHŒA, FLUOR ALBUS, OR THE WHITES</h2> -</div> - -<p><span class="smcap">This</span> is the most prevalent of all derangements of the -female economy, connected with the uterine system; and -from its debilitating effects, induces a train of maladies -that tend to embitter personal comfort more than any other -human ill. Leucorrhœa consists of a discharge of acrid, -or bland, but variously-colored mucus from the vagina, differing -in intensity according to the cause and duration. It -would be idle to offer the many arguments set up to prove -whence it proceeds, or to examine the discussions as to -whether it is the produce of the uterine vessels, or the -vaginal secretives. That both aid in its formation is -doubtless the case (as the employment of the speculum has<span class="pagenum"><a id="Page_155"></a>[155]</span> -satisfactorily proved); and equally certain that, according -to the amount of irritability existing therein, so depends -the quantity and character of the discharge. It exists in -the married and single—in the moral and unchaste; and -therefore the cause should be cautiously divined, it being -evident that other than sexual indulgences establish this -annoying and distressing affliction. It may be fairly conceded -to be a vitiated secretion, depending upon a weakened -state of the local vessels, and, moreover, in particular -habits, to be a salutary evacuation. On the other hand, -it must not be denied that it is oftentimes, where it occurs -to persons living <i>sub judice mariti</i>, the result of sexual -intemperance, or disease springing from an indiscriminate -indulgence in the same.</p> - -<p>However, as my purpose is more with the symptoms and -treatment, the following may be received as a summary of -what occurs, and what should be done for the removal -<span class="nobreak">thereof:—</span></p> - -<p>In addition to the discharge, which at one time is scanty, -at another profuse, there are usually severe pains in -the loins and lower part of the abdomen: there is a sense -of bearing down, as though the womb were descending -and even protruding. The general health of the patient -is disturbed, loss of appetite, excessive languor, a pale and -emaciated look, sleepless nights, dark areola around the -eyes, various hysterical and other nervous affections, and -numerous disturbances indicating a weakened and impaired -state of mind and body. Among other causes beside those -alluded to, may be enumerated irregular living, late hours, -mental and bodily fatigue, deficient exercise, impure air, -and neglect of personal ablution. Among the consequences -of a long-continued leucorrhœa, an almost certainty of -sterility should not be omitted.</p> - -<p><i>Treatment.</i>—In leucorrhœa, where or where not consecutive -to gonorrhœa, depending on loss of tone of the secretive -vessels of the internal organs of generation, the chief -indication is to impart vigor and restore strength, which it -is evident depends much upon an avoidance of those causes -that first started the disease.</p> - -<p>Although leucorrhœa bears a strong resemblance to -gonorrhœa, there are points by which to distinguish the -one from the other. In gonorrhœa, the discharge is unceasing, -but small in quantity, and is usually accompanied -by inflammatory symptoms; whereas in leucorrhœa, the<span class="pagenum"><a id="Page_156"></a>[156]</span> -discharge is irregular and copious, often coming away in -large lumps.</p> - -<p>The treatment of fluor albus is indicated by the degree -of severity present. Where the prominent feature is the -discharge, the indication is to increase the action of the -absorbents by restoring the tone of the diseased surface, -and at the same time to strengthen the system. Where -the disease is complicated with weakness and relaxation, -astringents should be given by the mouth, and also administered -in the form of injections. The alkaline solution -of copaiba is a very valuable medicament, and may be taken -twice or thrice daily. It may also be employed as an -injection, by adding one or two ounces to a pint of water, -and a teacupful thrown up several times in the day. There -are many domestic remedies, which, from their harmless -properties, can at least do no injury, if they are not productive -of good; as, for instance, a strong decoction of -green tea, an infusion of oak bark, or alum-water; or diluted -port wine—all to be used as injections, which, if it -shall so please the patient, may be tried prior to the <span class="nobreak">annexed:—</span></p> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_64"></a><a href="#FManchor_64">Form 64</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Chalybeate Pills, for Leucorrhœa, or other Female Sexual Weakness.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of iron</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Balsam of copaiba and liquorice powder—of each a sufficiency - to form the mass, which is to be divided into 40 pills, of - which 3 or 4 may be taken three times a day.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Or, take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of zinc</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Extract of camomile</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl"><span class="tabC1C">”</span><span class="tabC1D">gentian</span></td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="tdl" colspan="3">Syrup, a sufficiency.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix, and form 24 pills. Dose—two twice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_65"></a><a href="#FManchor_65">Form 65</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Strengthening Mixture.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Infusion of bark</td> - <td class="colw2 tdrTP">7½</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of quinine</td> - <td class="colw2 tdr">8</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Diluted sulphuric acid</td> - <td class="colw2 tdrTP">½</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Syrup of orange-peel</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—three tablespoonfuls twice or three times a day.</td> - </tr> -</table> - -<p><span class="pagenum"><a id="Page_157"></a>[157]</span></p> - -<table class="forms"> - <caption style="padding-top: 0.5em;"><a id="Form_66"></a><a href="#FManchor_66">Form 66</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Astringent Pills for Leucorrhœa.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Extract of Peruvian bark</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Gum kino</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Alum</td> - <td class="colw2 tdrTP">½</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Nutmeg</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Syrup, sufficient to form the mass. Divide into 36 pills.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Dose—three pills three times a day, to be followed by a teacupful of lime-water.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_67"></a><a href="#FManchor_67">Form 67</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Astringent Pills.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Alum</td> - <td class="colw2 tdr">30</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Catechu</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Opium</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix to form 30 pills. Dose—three twice a day. Useful in chronic gonorrhœa and leucorrhœa.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_68"></a><a href="#FManchor_68">Form 68</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Astringent Pills for obstinate Gleet, or Leucorrhœa.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Gum kino</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">part.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Canadian turpentine</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">parts.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Powder of tormentilla, as much as may be necessary to form - a mass. Divide the same into pills of 5 grains each, and - take from three to half a dozen of them night and morning. - Continue them for a week or fortnight. A very useful remedy.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_69"></a><a href="#FManchor_69">Form 69</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Astringent Injections for Leucorrhœa or Gonorrhœa.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">The compound solution of alum</td> - <td class="colw2 tdrTP">½</td> - <td class="colw3 tdlTP">oz. to 1 oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">quart.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Injections may be used two or three times a day. If found to irritate, - they should be diluted with water. Appropriate syringes are to be had; - but the best are those formed by the Enema apparatus.</td> - </tr> -</table> - -<p><span class="pagenum"><a id="Page_158"></a>[158]</span></p> -<table class="forms"> - <caption style="padding-top: 0.5em;"><a id="Form_70"></a><a href="#FManchor_70">Form 70</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Astringent Injection.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sugar of lead</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">quart.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Or, take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Catechu</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Myrrh</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lime-water</td> - <td class="colw2 tdrTP">½</td> - <td class="colw3 tdlTP">pint.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> -<table class="forms"> - <tr> - <td class="tdlNP" colspan="4">Or, take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Nitrate of silver</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scr. to 1 dr.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">quart.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix and strain. This lotion is much, and very effectively, used by the profession.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Or, take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of zinc</td> - <td class="colw2 tdrTP">½</td> - <td class="colw3 tdlTP">to 1 drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">quart.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> - <tr> - <td class="tdl" colspan="4">See Forms <a href="#Form_11" class="fmanchor">11</a> - and <a href="#Form_12" class="fmanchor">12</a>.</td> - </tr> -</table> - -<p>The remaining diseases peculiar to the female pelvic -viscera and their outlet, are hæmorrhoids, irritability and -inflammation of the bladder, disordered uterine functions, -urethritis, or inflammation of the urinary passage, and, -lastly, internal and external irritation or excoriation. But -as these fall within the province of every family practitioner, -to the consultation of whom no morbid delicacy -should prevent a patient, having such in their confidence, -from resorting, I shall conclude this section by appending -sundry prescriptions, in order that, should prudence not -direct the sick one or her friends to call in the advised assistance, -help may not be entirely withheld, and in order -that, if the aid offered be not the means of supplying the -loss of a more proficient and skilful director, it may at least -be found mitigatory of these interruptions of health and -<span class="nobreak">comfort:—</span></p> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_71"></a><a href="#FManchor_71">Form 71</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Pills to promote the flow of the Menstrual Secretion.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Aloetic pills, with myrrh</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound iron pill</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix to form 24 pills. Take two twice a day.</td> - </tr> -</table> - -<p><span class="pagenum"><a id="Page_159"></a>[159]</span></p> -<table class="forms"> - <tr> - <td class="tdl" colspan="4">Or, take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound galbanum pills</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Socotrine aloes</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix to form 24 pills. Dose—two twice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_72"></a><a href="#FManchor_72">Form 72</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Injection for the retention of the Uterine Periodical Secretion.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Liquor of ammonia</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Milk</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">pint.</td> - </tr> - <tr> - <td class="tdl" colspan="4">To be used morning and evening. This is a remedy that has been used by - many medical men with very great success.</td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">There are no means so importantly serviceable - as the frequent use of the warm and vapor bath. - </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_73"></a><a href="#FManchor_73">Form 73</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Stimulating Drops to restore the Menstrual flow.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound tincture of aloes</td> - <td class="colw2 tdr">1½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Tincture of black hellebore</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl"><span class="tabC1A">”</span><span class="tabC1B">castor</span></td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl"><span class="tabC1A">”</span><span class="tabC1B">Lyttæ</span></td> - <td class="colw2 tdr">30</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—a teaspoonful in water three times a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_74"></a><a href="#FManchor_74">Form 74</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>To relieve entire suppression.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound galbanum pills</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of iron</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Extract of savin</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Of black hellebore</td> - <td class="colw2 tdr">20</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="tdl" colspan="4">Syrup sufficient to form 36 pills. Dose—three twice a day.</td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">All these medicines must be given with great caution.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_75"></a><a href="#FManchor_75">Form 75</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>To check an immoderate flow of the Menstrual secretion.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Infusion of roses</td> - <td class="colw2 tdr">8</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Tincture of opium</td> - <td class="colw2 tdr">30</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—three tablespoonfuls three times a day.</td> - </tr> -</table> - -<p><span class="pagenum"><a id="Page_160"></a>[160]</span></p> -<table class="forms"> - <tr> - <td class="colwFL tdl">Or, take of the tincture of ergot of rye, a teaspoonful in water twice a day.</td> - </tr> - <tr> - <td class="colwFL tdlNP">Or, take of the sesqui-chloride tincture of iron, 20 to 30 drops in water, three times a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_76"></a><a href="#FManchor_76">Form 76</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>For painful Menstruation.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Add to a portion of gruel, upon going to bed, 15 or 20 - drops of laudanum. This quantity may also be taken - in the morning, and repeated several days; the bowels - in the meantime to be relieved by castor oil.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">The warm hip bath, in these cases, is invaluable.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Or, take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">The extract of stramonium</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">gr.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spanish soap</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grs.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix to form a pill to be taken twice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_77"></a><a href="#FManchor_77">Form 77</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>To allay external irritation.—Sedative application.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Oil of almonds</td> - <td class="colw2 tdr">6</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spermaceti</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">White wax<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a></td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Rose-water</td> - <td class="colw2 tdr">3</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Orange-flower water</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP"><span class="tabC3">”</span></td> - </tr> - <tr> - <td class="tdl" colspan="4">Dissolve the wax in the oil, then add the waters, and constantly - stir till cold. This is an admirable application for irritation - or excoriation of the external parts. It is commonly known as - “cold cream.”</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_78"></a><a href="#FManchor_78">Form 78</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>To heal Excoriations.—Mild drying ointment.</i><a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">The oxide of zinc</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ointment of spermaceti</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">ounce.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<p><span class="pagenum"><a id="Page_161"></a>[161]</span></p> -<table class="forms"> - <caption style="padding-top: 0.5em;"><a id="Form_79"></a><a href="#FManchor_79">Form 79</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>For obstinate Excoriations.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ointment of nitrate of mercury</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">ounce.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Superacetate of lead</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spermaceti ointment, or cold cream</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">ounce.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_162"></a>[162]</span></p> -<h2 class="no-page-break">EFFECTS OF INCONTINENCE, CELIBACY, AND MARRIAGE.</h2> -</div> - -<p><span class="smcap">The</span> past pages relate chiefly to the diseases of the generative -system consequent upon contagion, upon accident, -and the ordinary wear and tear of human life: the following, -to the ills that ensue from the over-indulgence in, and -abstinence from, the proper purposes of the reproductive -organs, and the benefits derivable from a fulfilment of the -intentions of their natural functions.</p> - -<p>There may be much good policy and correct feeling in -objecting to the too public inquiry into these matters. The -private closet and the public eye are two very different tribunals, -and what may be approved of in the one is very -likely to be condemned in the other. The line of deciding -what shall be communicated and what should be suppressed -may be drawn too closely; and that knowledge -which is acquired by stealth is seldom so practical as that -obtained by competition. If, therefore, the topics herein -embraced were to be expunged, and their discussion prohibited, -the afflicted would have no other resource than to -apply to the adventuring and ill-educated empiric, instead -of confiding his troubles to the legitimate professional man. -A study, to become useful, should be general; and it is to -be hoped that the prudish reserve which excludes this kind -of investigation from our medical schools will be laid aside, -and truth be obtained by allowable investigation.</p> - -<p>The most moral and chaste, at the age of puberty, are -assailed with feelings and desires, that, though new and -unanticipated, yet need little interpretation when present, -and so urgent and imperious, that if not legitimately satisfied, -nature and instinct are not slow in pointing out a -means of gratification.</p> - -<p>In the male, imagination commanding a wider range than -in the female, and fed by associations with, and the usages -of, the world, elicits consequences explanatory of life’s -purposes; and the youth having once experienced, perhaps<span class="pagenum"><a id="Page_163"></a>[163]</span> -unsolicited, and possibly during sleep, the agony of seminal -secretion, can rarely withstand the afterward tempting -pleasure of seeking a self-repetition of such solitary indulgence, -which the forbidden union of the sexes, at this early -period, may urge him to.</p> - -<p>Setting aside the selfishness and unmanliness of the vice, -it is important that the wearer of the cap and bells should -know the consequences of abusing a given function by such -a means of gratification. There is no mental passion, or -physical exertion, that produces such temporary nervous -prostration as the completion of the act of sexual intercourse; -and it therefore can be easily conceived how debilitating -must be the immoderate indulgence of the practice. -Health consists in a due performance of all the functions -of the organs of the body, and an undue exercise of -them is sure to lead to a disturbance of the economy.</p> - -<p>In ordinary sexual commerce, particular phenomena ensue, -the circulation is powerfully roused, the heart thumps -violently, the blood is driven to the brain, and great mental -exaltation is induced, and instances have been known of -death suddenly crushing the transport. The too frequent -repetition of such excitement can not fail to wear out, and -disease the overwrought organs, the heart and brain particularly, -upon the healthy condition of which the health -of the entire frame rests; and hence the diseases of the -libertine are usually consumption, physical weakness, and -mental imbecility, all the result of disordered circulation -and impaired nervous power. If, therefore, such consequences -follow a waste of the allotted privileges of man, -how much more severe must they be that arise from nervous -exhaustion, that which transpires from an absolute -stretch of an already overwrought imagination, from, in -fact, ideal pleasures, instead of those springing from the -instinctive stimulus imparted by the presence of, and cohabitation -with, woman. I have elsewhere treated upon -the sad and withering effects of self-indulgence in a hygæan -point of view. My object here is to portray the consequences -of the like, and the more lawful, intemperance of sexual -cohabitation in a domestic light, in how far it is destructive -to the health and happiness of others, than the -party addressed—the partner of our worldly anxieties, and -the offspring that issue from our union. How striking is -the change of <i>appearance</i> only, much less the positive bodily -condition of married persons of both sexes, within one<span class="pagenum"><a id="Page_164"></a>[164]</span> -or two years of their union, especially if the match be a -youthful one. Let any one, even with a limited acquaintance, -recollect such of his former female associates, whom -he knew when single, and mayhap may have indulged with -in little modest pleasantries; let him recall the gay-lit -countenance, the ruddy and prominent cheek, the sparkling -and lively eye, the plump and well filled neck—in fact, let -him but compare her then and now, and how disheartening -the change; the same being may be recognised, but it is -the same being only in mind, and not in person. There are -exceptions, as I shall presently show, but this is the too -frequent portraiture of those who embark in precocious -hymeneal contracts, and restrain not the marital privileges. -The countenance assumes, when thoughtful, the careworn -aspect; the blanched cheek shows here and there a furrowed -imprint; the lustre of the eye is dimmed; and, to -drop from the figurative to the literal, the collar-bones, -hitherto “overlaid with nature’s plastic moulding,” seem -appointed only for union’s sake, lest the fabric of neck and -shoulders should drop in pieces. Mark also the decayed -health and spirits; hear the bitter grief of headaches, sideaches, -nerveaches, and behold, perhaps, the puny offspring -“mewling and puling in the nurse’s arms.”</p> - -<p>The bridegroom wears a sorrowful and thoughtful look. -He may possess all the comforts which few inherit, but like -Pharaoh’s lean kine, as chaff thrown before the wind, their -purpose is opposed.</p> - -<p>This may be held as a ridiculous picture, but I defy denial -of its unhappily too frequent illustration in real life. -A word or two on the opposite extreme, <i>continence</i>. The -reader will observe, in another page, the remark that every -part, be it flesh, bone, or nerve, has its use. The reproductive -organs have theirs; but it is not only for the propagation -of the species—they afford an outlet for accumulated -secretion—they aid in resolving the animal passions—they -are the secret incentive to sexual love, and the bond -of union between the sexes. They give an appetite that, -like hunger, must be appeased, or nature revolts; and the -harmony of society falls before the ungovernable fury of -maniacal craving. Health, the source of all happiness, -without the possession of which the world with its beauties -would be, for all we cared, tenantless, materially rests upon -a proper and moderate use of the copulative process. Entire -continence, a rarity among mankind, establishes in<span class="pagenum"><a id="Page_165"></a>[165]</span> -both sexes the most miserable perversions of mind and -body. In man, we have instances recorded of mania, melancholy, -apoplexy, and foul skin-disorders. Blindness, -deafness, and a host of evils, some greater, and few less -than these just penned. It is true, continence is, as -remarked, but seldom observed, especially in males, who, -being denied sexual commerce, are estranged by the distressful -habit of onanism; and thereby, in some measure, -the enumerated maladies are avoided; but as masturbation, -like other vices, grows with unbounded speed, a train of -ills, far more distressful, await the sufferer, who, in addition, -becomes, in the meridian of life, deprived of the very -power he in youth was so improvident of. Continence in -females, which all admit to be the brightest ornament a -woman possesses, is attended with a poor requital; and its -prevalence (to the honor of our countrywomen be it spoken) -is truly attested by the miseries of hysteria, and other nervous -derangements, that pervade the junior and elderly -maiden branches of every family, and constitute so formidable -an enemy to domestic felicity. A wide field is open -for comment upon this subject, which is better adapted for -the moralist than the physician. This manual, professing -to be but a vehicle for topics of a professional nature only, -the writer apologises for the digression, and can but express -his regret, that public opinion is unfavorable to the -discussion of such matters, which embrace considerations -highly important to a nation, both in a moral and hygæan -view. Continent persons but seldom attain old age; -whereas, the married females, for instance, although exposed -to the dangers of pregnancy and delivery, live generally -longer than those who are unmarried or chaste; and -provident married men escape the ills and snares that beset -single <i>blessedness</i>, as it is called. Libertinism, on the -other hand, in whatever way practised, is hurtful and destructive -to long life.</p> - -<p>Continence may be a virtue, but is not imposed where -marriage is allowable; and then, if deviated from with -moderation only, the greatest amount of health and happiness -may be elicited, and the proper end of it obtained. -Matrimony, where succeeded by the birth of children, powerfully -conduces to the health and happiness of women.</p> - -<p>Many female disorders are relieved by marriage. Amenorrhœa -and chlorosis, disordered conditions of the uterine -functions, hysteria, scrofula, skin-affections, numerous nervous<span class="pagenum"><a id="Page_166"></a>[166]</span> -disorders, and many local complaints, yield as soon as -pregnancy commences.</p> - -<p>Results should, however, be well weighed, before irrevocable -steps are taken. There are many diseases and -structural impediments opposed to the matrimonial contract. -Malformation and mental imbecility should be held -as strong interdicts to the conjugal union. People ought -not to marry before manhood is well developed (the male -at least 21 to 23 years of age, the female 18 to 21). Precocious -or late marriages are injurious to reproduction. -The unnatural union of old and young of either sex with -the other, entails its own miseries. A curious estimate of -salacious appetites and power has been drawn up as pervading -the different temperaments. The temperaments, as -elsewhere noticed, are four—the Sanguine, Nervous, Bilious, -and Phlegmatic. Persons of the sanguine temperament -are generally of good health, and vigorous in amorous -pleasures. The nervous are extremely susceptible in -their sensations, and generally much given to female society. -Combined with the sanguine, they are capable of -great amorous excesses. The bilious temperament imparts -a jealous bearing in all affairs of sexual solicitude, that detracts -from the fondness and affection which so entwine a -woman to a lover or a husband. The melancholic or -phlegmatic person is frigid and apathetic in his amours; and -love becomes with him a secondary consideration to advancement -in life. These temperaments are frequently intermixed, -and are much modified by age and health; and -the salacious powers correspond.</p> - -<p>Speculations have arisen among physiologists, as to the -effect of climate and season, as well as age and temperament, -on the reproductive powers. Temperate and warm -climates are more prolific in exciting the copulative desire, -than the frigid and uncongenial situations of the northern -hemisphere. The seasons bear a somewhat near analogy—spring -is supposed to be more potent than summer, autumn, -or winter, in arousing the amative propensities, -which, like the productions of the earth, come, as it were, -at that time into a new existence. This observation is -borne out by the statistical fact of there being a greater -number of births about Christmas and the new year, than -any other period.</p> - -<p>Man, however, is allowed to be omnivorous in <i>all</i> his -appetites; and the uniformity of his sexual greediness is<span class="pagenum"><a id="Page_167"></a>[167]</span> -preserved by diet corresponding to the season, which renders -the whole twelvemonth a perpetual spring. Man, as -well as other animals, is, when in a state of health, capable -of procreating upon almost any food. But when there -is debility of the digestive or generative organs, the injury -can be repaired by the use of proper stimulating diet, thereby -occasioning due and sufficient secretions.</p> - -<p>Air, exercise, health, and prosperity, are not without -considerable influences. If seasons are not positively influential, -certain it is, that particular lunar and solar periods -are, taken in conjunction with the state of the body.</p> - -<p>“Morning,” says a French writer, “is the spring of the -journey, when all the functions of the body are renovated.” -Others declare, that when night veils the light of the day, -the quietude and secresy thereby afforded, offer moments -most congenial to the gratification of mutual love. Sexual -transports should be avoided after a repast, instances having -been known of apoplexy being induced by the excitement -of connexion being superadded to the stimulative influence -of wine and food.</p> - -<p>Henry II. consulted one Fernal for the infertility of his -queen, Catherine de Medicis. The advice submitted, comprised -the following notifications: Abundant and peculiar -nourishment; occasional change of residence; the allowing -several days to elapse between each conjugal act; and -lastly, that the most favorable moment for impregnation -was immediately on the cessation of menstruation. It was -not until the adoption of these hints, that her majesty conceived.</p> - -<p>Professor Dewees, of Philadelphia, enjoins that, for the -enjoyment of marriage and the production of children, matrimony -should not be engaged in, until the body is healthily -and completely developed; until then the most scrupulous -continency should be preserved. From the 23d to the 25th -year is the suggested period for the male; from the 19th to -the 21st, the female. These observations apply to Europeans -chiefly; for in India, women become mothers at ten, -owing to their early development. Precocious marriages -bring premature decay on the father and mother, and entail -on their offspring, diminutive stature, debility of body, -and imbecility of mind, thus generating consumption, scrofula, -insanity, &c. Well-regulated marriages contribute to -social and lasting happiness, and the prosperity of the nation -at large; but ill-assorted ones, those where the peace<span class="pagenum"><a id="Page_168"></a>[168]</span> -of either is infringed by opposing tempers, or by the after-discovery -of hitherto concealed physical incapacities, present -a scene of wretchedness and disappointment to which -death itself were preferable. These remarks might be considerably -amplified; but enough has been said, to induce -those who approach to manhood, to be provident of that -which, once lost, is, under all circumstances, difficult to regain; -and those on the eve of embarking in the most binding -and solemn obligation of all human contracts, marriage, -to ponder well, ere they compromise the happiness -of others as well as themselves, by engaging in a compact, -they may know themselves incapable of fulfilling or of efficiently -performing; one from which they can not with -honor retreat, and one that, once sealed, demands a rigid -compliance with its recognised duties.</p> - -<p>The gist of the present article may then thus be summed -up: That self-indulgence and excessive sexual cohabitation -are hurtful in the highest degree; that they induce early -impuissance, and bring down a load of menial and corporeal -ailments. That premature marriages are destructive -to health and long life, and that weak and sickly children -are the general result where impregnation of the female -follows. That entire continence was never ordained, and -is alike productive of disease. That moderate copulation -propagates the human kind, preserves health, and promotes -longevity, and the sexual capability is thereby retained to -the latest verge of senility.</p> - -<p>That it is unnatural and unjust for impuissant persons -to intermarry with those having healthy expectations, and -the power of enjoyment; and that it behooves all who have -a doubt as to their own capacity, to have that doubt removed; -but, if rendered evident, to abstain from shipwrecking -their own happiness, or from occasioning disappointment -to others.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_169"></a>[169]</span></p> -<h2 class="no-page-break">THE HEREDITARY TRANSMISSION OF DISEASE.</h2> -</div> - -<p><span class="smcap">The</span> topics of Incontinence, Celibacy, and Marriage, -having been severally considered relatively to their effects -on society, viewed alike also as to their influence on the -health and happiness of the sexes in general, another -equally engrossing one naturally presents itself for inquiry -to every thinking and sensible person who may contemplate, -or be about embarking in what the world deems “a -serious speculation,” matrimony, namely, the probability -of issue, and how far the health of the progeny may be influenced -by that of the parents. That conception requires -the necessary aptitudes in both man and wife is indisputable; -and that although such capacities are rarely absent, -still all unions are not prolific; hence the inference, that -some cause must exist to account for such infertility.</p> - -<p>It may be local or moral, as elsewhere in this volume -explained, which not being the main purport of this paper, -needs no other allusion beyond the mere reference. The -prevailing resemblance between parents and children in -features, form, voice, and even constitutional peculiarities, -is sufficiently well known to satisfy any one of the similar -possibility of the transmission of disease, or sound health. -“It is of great consequence to be well-born; and it were -happy for human kind, if only such persons as are sound -of body and mind should be allowed to marry.”</p> - -<p>We find in Boethius’s work, “De veterum Scotorum -Moribus,” that anciently, in Scotland, if any were visited -with the falling sickness, madness, gout, leprosy, or any -such dangerous disease, which was likely to be propagated -from the father to the son, he was instantly gelded; a woman -kept from all company of men; and, if by chance, -having some such disease, she were to be found with child, -she with her offspring was buried alive. The Spartans -destroyed all weakly and deformed children.</p> - -<p>Great as the anxiety may be to perpetuate our identities, -to create new objects on whom we may concentrate all our -affections and love, and who, when born to us, so instinctively -bind us the more to this already attractive world, -where is the man who does not feel humbled and mortified -at beholding in his anxiously looked-for offspring, the unfolding<span class="pagenum"><a id="Page_170"></a>[170]</span> -of infirmity and disease? We are content to encounter -the ordinary chances of mortality, let but our -children bear the impress of health, and possess the shape -of perfect man; but sad and desolating are the reflections -that spring from observing in our issue the developments -of the evils we have nurtured in ourselves. How many -existing beings are there, inhaling the breath of life, in -whom every respiration feeds the flame of disease, ignited -by those from whose loins they sprung, and is hastening -them to a premature tomb. How many are there, secluded -from the enjoyment of that, which being deprived of by -some scrofulous, pestilential, or other hideous deformity, -renders them like isolated wanderers on the earth, and -for ever forbids their participation in the main charm of -existence—social intercourse. How many living specimens -of human prototypes, in whom reason is obliterated, or -never dawned, drag on an existence inferior in enjoyment -to the forest-hunted beast, or the animal whose life is -yielded for the nutriment of man. And are not the diseases -that involve so calamitous a result, consumption, scrofula, -gout, idiocy, or insanity, traceable in particular families, -to the remotest periods of their ancestral records? And -should not then a knowledge of cause and effect, like that -just detailed, induce individuals about to fulfil one of the -purposes to which they were certainly destined, for the -perpetuation of their own race, if only from the pride of -human nature, well to consider the result of such a consummation? -The health of either party is generally omitted -among the categories bandied about preliminary to the -completion of the other, though decidedly not more important, -arrangements of the nuptial contract; or if it should -not be, many infirmities, that are well known to descend -hereditarily, are (granted in some cases not premeditatedly, -but from ignorance of such a result) yet carefully concealed. -Cutaneous blemishes, incipient tubercles, or a -scrofulous predisposition, which may be likened to the -germes of a fruitful plant sown in a torpid soil, lie in ambush, -and await some genial transplantation to display -their productiveness, which matrimony, by the analogous -change which it effects in different constitutions, speedily -encourages. In this manner, other morbid phenomena are -aroused from their lurking place, whether it be in the -brain, the lungs, or the blood, and transferred to those who -succeed us.</p> - -<p><span class="pagenum"><a id="Page_171"></a>[171]</span></p> - -<p>I need not, therefore, waste a line prefatory to, or apologetic -of, the following illustrative definition of health, by -which any one with tolerable acumen may estimate the -probable “worth of a life,” or, at all events, be spared -the plea of ignorance, or misplaced confidence, when taking -a step of such importance as wedlock. There are -numerous means of calculating upon the durability of human -life, by an examination of the countenance, the gait, -the attitude, the form, the skin, the temperament, the -breathing, the speech, the sleep, and in fact, to a practised -professional eye, there is not much difficulty in observing -some diagnostic mark, if sickness be secreted in the constitution. -The countenance in health varies with the age. -Health is indicated by a plump, not puffy or bloated state -of the face, a fresh complexion, and an absence of that depression -around and particularly below the eye, so observable -in persons of sick health. The nose should not be -“pinched,” as it were, at its junction with the face, nor -should there be deep indentations, called furrows, or -wrinkles, at the angles of the mouth or eyes, which rarely -are manifested in healthy individuals, except they be aged -through care or time. Many people part very reluctantly -with each succeeding year, and few conform to the outward -symbols of age. The era was when age was honorable; -now few aspire to it, and such is the deception that would -be practised, that the coffin-plate is the only tell-tale.</p> - -<p>If the teeth have dropped out or decayed, the lower jaw -will be observed to be more elevated, the lips drawn inward -over the gums, and the chin and nose approximating -each other; the cheek bones will also be very prominent, -and the skin thereon shiny and tightly drawn: these are -pretty fair characteristics of disease, or old age. The temperaments -modify the complexion. In the sanguine, it is -florid and soft; in the bilious, dark and rigid; in the -phlegmatic, lax and pallid; and the nervous is modified by -its general union with the two former. In health, the -countenance is expressive of contentment and gayety, -which indicate a happy state of mind, and healthy condition -of body. In ill-health, it is pale and expressive of languor -and sadness, signifying discontent and nervous debility. -Where asthma exists, or other nervous affections of the -chest prevail, there is pallidness or lividity, a worn-down -and distressing look, and in consumption, in addition to -the above, there are alternately, on the slightest exertion,<span class="pagenum"><a id="Page_172"></a>[172]</span> -gentle flushings. A bluish tint of the skin denotes some -organic affection of the heart. In dropsy, the countenance -is bloated, or of a waxy puffiness; and in acute indigestion, -there is a lividity of the lips, nose, and cheeks. A slow -and cautious step, a bending of the body, a laxity and flabby -feel of the muscles of the arms, chest, and lower extremities, -a tumid abdomen, or a swelling of the feet and ankles, -are no indications of health. Tremulous hands mark age, -nervousness, or intemperance. Hurried breathing, palpitation -of the heart, frequent attacks of perspiration, sleeplessness, -are all symptomatic of weakness, hysteria, or -disease. Persons subject to bleedings, are usually of a -waxy paleness, and soft fibre. Allowances must be made -for females during the menstrual period, whose complexion, -at that period, being less clear and fair, is marked by a -dark areola around and below the eyes, the breath is -slightly tainted, and a languor is evidenced in all their actions. -A voracious or scanty appetite, a dry and shrinking -skin, a furred and loaded tongue with indented sides, -signify the digestive organs to be deranged. In long-standing -dyspepsia, the nose, feet, and hands, are generally -cold. Emaciation is an infallible diagnostic of disturbed -health, and a bloated state equally characteristic. Fits, -gout, rheumatic disorders, asthma, occasional brain affections, -diseases of the bladder, &c., can not be considered -as warranties of health.</p> - -<p>Lastly, with respect to intemperance, the bloated appearance, -the tremulous state of the muscular powers, the -fetid breath, and the sunken eye, sufficiently identify the -cause, to arrest all doubts on the subject. Where intemperance -exists in married life, it is the bane of all comfort -and enjoyment; and heaven help the unhappy partner of -such a companion. There is but one consolation, that -every indulgence of this insane practice tends to sap and -break up the powers of the constitution, and hastens the -close of such a union. The drunkard should be reminded, -that “some leaves fall from the tree every time that its -trunk is shaken;” and the dreary nakedness of winter is -brought on, long before that season would have commenced -in the regular course of nature.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_173"></a>[173]</span></p> -<h2 class="no-page-break">IMPUISSANCE, OR IMPOTENCE.</h2> -</div> - -<p><span class="smcap">Upon</span> pursuing the consideration of the following infirmities -of the Reproductive System, a few prefatory observations -are requisite. Perhaps of all the physical powers -possessed by man, few are subject to so much abuse as the -procreative organs—certainly none are more required to -be, in a hygiænic point of view, held in a sounder condition -of health, for upon their tone and perfect structure hinge -the happiness and perpetuation of the human race. In this -age of luxury and sensuality, however, the world seems -untiringly hunting after, and more or less obtaining, sexual -gratification. There can be no doubt, that a greater -amount of this species of sensual enjoyment is indulged in -before manhood arrives, than can be obtained when man -should be in his vigor. The writer is not insensible to the -many alluring publications upon this topic, the end and -aim of which are not, honestly, to afford relief to the diffident -sufferer, but to add to his misery, by draining his -pocket. Of legitimate publications, alas! there are but -few, for it appears that qualified medical men have, from -some prudish or other such notions, kept aloof from entering -the lists. Were it otherwise, many an unfortunate -victim might be spared from the avaricious clutch of the -empiric; but invalids, from such a knowledge of the absence -of fair and honorable references, are obliged to seek -(or despair of) relief from the unworthy class in question. -How far the tendency of the present work may lead to a -reformation, is left for the reader to decide. The novelty -of the present compendium may subject it to invidious suspicion; -the author but invites comparison, feeling convinced -that the contents best bespeak its legitimacy and usefulness.</p> - -<p>“Increase and multiply,” is the scriptural text. “Plant -trees and beget offspring,” is the apothegm of the Magi. -The perpetuation of the species being, with the great Designer -of the universe, an object of the first interest, all -living beings are mentally and physically formed with a -view to this great end.</p> - -<p><span class="pagenum"><a id="Page_174"></a>[174]</span></p> - -<p>In the human species, procreation is effected by a congress -of the two sexes, and a variety of organs are provided, -upon whose condition the due performance of coition -mainly depends. The male is destined to furnish a peculiar -fecundating secretion, and is accordingly provided with -glands to prepare such fluid, and a conduit to convey the -same to its proper destination; while the female, being the -recipient, possesses an organ capable of effecting a mysterious -yet specific change upon the fluid so deposited: a -failure, therefore, in any of the structures alluded to, is -followed by impotence or sterility.</p> - -<p>Impotence implies the incapability of sexual intercourse; -sterility, the inability of procreation; the causes of either -of which may be deemed organic, functional, or moral. -The following section will be devoted, firstly, to its consideration -in its relation to the male.</p> - - -<hr class="chap" /> - -<h3>SECTION I.</h3> - -<p class="center small">IMPOTENCE AND STERILITY OF THE MALE.</p> - - -<p><span class="smcap">Where</span> the hindrance to cohabitation arises from organic -defect, congenital malformation, or diseases of some -of the organs of generation, the disqualification may generally -be considered absolute or irremediable. It is remarkable, -however, to what extent mutilation or disease -may occur, without total annihilation of the procreative -powers; the smallest remnant of the penis, for instance, -capable of entering the vagina, provided the testes be -sound, being sufficient for impregnation.</p> - -<p>A learned lecturer on medical jurisprudence gives it as -his opinion, that the smallest quantity of seminal discharge, -deposited in the lower part of the female generative apparatus, -<i>provided the female be apt to conceive</i>, is sufficient for -impregnation: and it is astonishing how <i>minute</i> a quantity -of this plastic agent is necessary for that purpose in some -species of creatures. Spallanzani took three grains by -weight of the male fluid of the frog, and mixing it with -seventeen ounces of water, found that impregnation of the -eggs was produced by as much of this exceedingly weak -mixture as would adhere to the point of a fine needle.</p> - -<p>Although, in human formation, it is not essentially necessary -that the male material should be deposited in the -upper part of the vagina of the female, yet there is little<span class="pagenum"><a id="Page_175"></a>[175]</span> -doubt that the deeper entrance of this substance conduces -to impregnation.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a></p> - -<p>Malformation of the genital organs has already been -stated as a cause of impotence. Such cases furnish much -uneasiness at first, but are easily relievable. I have met -with many instances, where consummation has been prolonged -from months to years, which a slight knowledge of -the functions of the parturient organs might have relieved -in a few days; and with respect to the latter, it may be -pardonable to mention that, as the husband should be the -first to instruct his companion in what is to be expected, -but little disappointment will be experienced, except with -the vicious and unworthy.</p> - -<p>There is room for much ingenuity in these matters; -and as marriages are made for better or worse, there exist -powerful inducements to resort to the contrivances of the -ingenious and humane.</p> - -<p>The following case of malformation fell under my own -observation; the adjoining delineation is a true picture of -the circumstance.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_175a_cropped_317x400.jpg" width="317" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_175a_cropped_475x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The penis, <i>b</i>, at its -under surface, was adherent, from birth, -to the scrotum <i>c</i>, consequently, when -erection ensued, it presented the form -of a half circle; the urine escaped near -the root of the penis, <i>a</i>. The penis itself -was impervious, but sensible to the -amative passion. The gentleman submitted -to a division of the fold which -united the penis with the scrotum, which -former, on being thus released, assumed its proper position; -sexual congress was thereby attainable, and during -erection the orifice of the urethra was drawn sufficiently -up to allow of the ejection of the semen into the vagina. -Of the ultimate result I have yet to hear.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_175b_cropped_382x400.jpg" width="382" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_175b_cropped_573x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>It may appear almost incredible, that the sketch here -presented can be a true one of the penis and -testicles of a young man upward of 19 years -of age. No less was it a source of wonderment -to myself than it may afford a doubt to -others. I carefully examined the individual, -and saw him urinate; the stream was certainly -small, but surprisingly large for so minute an organization.<span class="pagenum"><a id="Page_176"></a>[176]</span> -He was quite unconscious of amative feeling; -the testicles were distinctly perceptible by the finger, but -they certainly were not larger than cherry kernels. The -young man, in other respects, preserved the male attributes; -he had a slight beard, and his voice, though not -powerful, was by no means effeminate. I had several interviews -with him, and then lost sight of him.</p> - -<p>I have elsewhere portrayed a relaxed state of the testicle, -called varicocele: the accompanying draught exhibits the -same in an aggravated form. The patient -possessed but little amative power, -and had also a thickened condition of the -prepuce, which produced a perfect <i>phymosis</i>. -The case, however, under treatment -became considerably relieved. The -phymosis required a division of the prepuce, -an operation productive but of little -and momentary pain, or rather twinge, -and healed in a few days. Children are -sometimes not procreated for want of -sufficient erectile and consequently penetrative -power of the male organ. Much -and often needless misery results from -this infirmity.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_176_cropped_193x400.jpg" width="193" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_176_cropped_302x627.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The loss of erectile power is occasioned through more -causes than one. Erection ensues independently of the -will or imagination, as instanced on awaking in the morning—the -cause is most probably a distended bladder; the -phenomena may be a sympathetic irritability of the muscles -of the perinœum, especially the erectores; there is a -general pelvic disturbance, the nervous excitement is increased, -and the rush of blood (obedient to that excitement) -is sent to the penis: such, I believe, is the sympathy -between all these structures. The will exercises the same, -and the results of the imagination do not materially differ; -consequently, where the mind fails in producing these effects, -local excitants may be found to supply its office -hence the usefulness of art in combating the eccentricities -of nature. The mere handling of the testicles kindles desire, -and in like manner, stimulatives applied over the -scrotum generate amative heat.</p> - -<p>A curve of the penis is sometimes an obstruction to connubial -intercourse; this arises from adhesion or obliteration -of the cells of the <i>Corpora Cavernosa</i> on one side only,<span class="pagenum"><a id="Page_177"></a>[177]</span> -preventing the uniform flow of blood into those structures, -and consequently the equal distention of the penis. The -curve is of course laterally, and occasions in the act of coition -pain to both parties, or the power of penetration is -insufficient. Occasionally this malformation is only temporary, -and consequently remediable.</p> - -<p><i>Franck</i> gives an instance in which so considerable a portion -of the penis had been carried away by a musket-shot, -that when the wound healed, the organ remained curved, -and yet proved adequate to the performance of its functions.</p> - -<p>An opinion formerly prevailed, that the existence of the -testes was unnecessary for effective copulation; but that -is no longer a point of dispute: their absence, whether -natural or artificial, invariably rendering the invalid unfruitful. -It is not, however, to be inferred, that a person -is impotent in whom no testicles are discovered in the -scrotum, instances occurring where they do not descend -from the abdomen (their embryotic abode) through the -whole period of life. One testicle, provided it be sound, -is sufficient for procreation. Complete extirpation of the -testes, although destructive of procreative powers, does -not extinguish venereal desire. Where the genital organs -exist, but are malformed, or pathologically altered, their -virility may be nullified.</p> - -<p>The most frequent malformation is in the <i>urethra</i>, which sometimes -opens in the perinœum—the part marked <i>a</i> in the annexed cut; at -others, on the dorsum of the penis, and not unfrequently under its -surface: so long, however, as the orifice opens in that portion of the -penis which enters the vagina, so that the <i>emissio seminis</i> may be -therein deposited, impregnation may and will take place; and even in -cases where artificial means have been employed to convey the fluid.</p> - -<div class="figcenter" style="max-width: 35em;"> - <img src="images/i_b_177_cropped_627x400.jpg" width="627" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_177_cropped_941x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>A contracted state of the prepuce, its adherence to the -glans, or that condition of it termed phymosis, form impediments -to the emission of the semen which can only be -removed by an operation; and if that be neglected, the -evil continues through life.</p> - -<p>Among the diseases which occasion sterility in the male, -those affecting the penis and those incident to the testicles<span class="pagenum"><a id="Page_178"></a>[178]</span> -may be enumerated. With regard to the former, there -often exists an excess or deficiency of muscular or nervous -energy, inducing <i>priapism</i> or permanent erection in some -instances, or paralysis or permanent flaccidity in others. -In <i>priapism</i>, the erection is so vigorous, and all the parts -so distended, that the semen can not pass into the urethra; -while in <i>paralysis</i>, from some inaptitude of nervous or -muscular powers of the genital organs, the <i>corpora cavernosa</i> -receive but a limited supply of blood, insufficient to -create erection, or provoke a seminal discharge.</p> - -<p>Strictures of the urethra are among the barriers to sexual -intercourse; but happily, only in extreme cases, where -the urethra is all but closed, so as to oppose the passing -of the finest bougie.</p> - -<p>The testicle is subject to a variety of diseases, wherein -such a relaxation or obliteration of its structure ensues, -that the seminal fluid is no longer formed: and where -both testicles are alike affected, sexual desire is most usually -wholly extinguished—the smallest portion, however, -of either gland remaining uninjured, may still be capable -of secreting semen sufficient for impregnation.</p> - -<p>Impotence may follow accidents to the testicles, such as -produced by a bruise; or even a testicle, which shall have -become inflamed from clap, shall become so chronically -hardened as to be useless. Bruising the testicles was the -mode adopted by the oriental courts for destroying masculine -efficiency in the attendants of the harem.</p> - -<p>There are certain conditions of health in which, although -the genital organs may be perfect, yet, owing to -some constitutional frigidity, there is an incapability of -erection. The offspring of too young, or very aged, infirm -persons, or of those worn down by debauchery, are but too -common instances.</p> - -<p>The appearance of persons of this temperament is thus -described by a French writer: “The hair is white, fair, -and thin; no beard, and countenance pale; flesh soft and -without hair; voice clear, sharp, and piercing; the eyes -sorrowful and dull; the form round, shoulders narrow; -perspiration acid; testicle small, withered, pendulous, and -soft; the spermatic chords small; the scrotum flaccid; -the gland of the testicle insensible; no capillary growth -on the pubis; a moral apathy; pusillanimity and fear on -the least occasion.”</p> - -<p>The most frequent cause of impotence, at that period<span class="pagenum"><a id="Page_179"></a>[179]</span> -of existence when man should be in the zenith of his procreative -power, is in a general weakness of the generative -organs, induced by too early an indulgence in coition, the -pernicious and demoralizing crime of masturbation, or the -abuse of venereal pleasures. In these cases, erection will -not take place, or but feebly, although the mind be highly -excited by lascivious ideas. The erector muscles are paralysed -from over-use, and the semen, if any is secreted, -from the lax and withered state of the testes, is clear, serous, -without consistence, and consequently deficient of -prolific virtue. Sometimes there is a want of consent between -the immediate and secondary organs of generation; -thus, the penis acts without the testicles, and becomes -erected when there is no semen to be evacuated; while -the testicles secrete too quickly, and an evacuation takes -place without any erection of the penis; the latter disappointment -is of extensive prevalence.</p> - -<p>Impotence is sometimes occasioned by particular diseases -during their continuance, such as nervous and malignant -fevers; while, strange to relate, an opposite effect is sometimes -produced by other diseases, such as gout and rheumatism, -hæmorrhoids, &c.; and instances are on record, -that others produce such a change in the constitution, that -an impotent man may find himself cured of his impotency -on their cessation.</p> - -<p>Of all the functions of the animal economy, none are so -subservient to nervous influence as those of generation, -which, when the organs are perfect, and respond not to the -natural application of them, the cause may be classed -among those impediments termed moral.</p> - -<p>As the parts of generation are not necessary for the existence -or support of the individual, but have a reference -to something else in which the mind has a principal concern; -so a complete action in those parts can not take -place without a perfect harmony of body and mind, that is, -there must be both a power of body and disposition of -mind; for the mind is subject to a thousand caprices which -affect the action of these parts.</p> - -<p>As these cases do not arise from real inability, they are -to be carefully distinguished from such as do; and, perhaps, -the only way to distinguish them, is to examine into -the state of mind respecting this act. So trifling often is -the circumstance which shall produce this inability depending -on the mind, that the very desire to please shall<span class="pagenum"><a id="Page_180"></a>[180]</span> -have that effect, as in making the woman the sole object -to be gratified.</p> - - -<hr class="chap" /> - -<h3>SECTION II.</h3> - -<p class="center small">IMPOTENCE AND STERILITY OF THE FEMALE.</p> - - -<p><span class="smcap">A female</span> may be impotent, and not sterile; and sterile, -but not impotent. Impotence can only exist in the female, -when there is an impervious vagina; but even this condition -does not necessarily infer sterility, many cases being -recorded, where the semen, by some means or another, -through an aperture that would not admit a fine probe, has -found entrance to the vagina and occasioned impregnation.</p> - -<p>Impotence may arise from a malformed pelvis, the absence -of a vagina, adhesion of its labia, unruptured hymen, -or one of such strength as to resist intromission. In -the two former instances, sterility is irremediable; but -art, and indeed nature, may overcome the latter impediments.</p> - -<p>Were these pages intended only for the surgery, instead of the -public, the annexed wood cuts would be unnecessary, medical men being -conversant with the inconvenience in question; but all the world not -being blessed with similar anatomical information, the sketches are -presented. The upper one represents the relative situation of the -female urethra (1), and the contracted orifice of the hymen (2). -In the cases of hardened obstruction, where the hymen assumes an -almost cartilaginous texture, the attempts at marital consummation -are fruitless, and often give rise to severe local inflammation. The -infirmity, on the other hand, is easily and painlessly removable by -surgical skill. The lower drawing represents a hymen with two apertures -(2), which, if broken down by violence, leaves a troublesome lacerated -wound. The surgeon’s assistance is indispensable.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_180a_cropped_169x400.jpg" width="169" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_180a_cropped_253x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_180b_cropped_165x400.jpg" width="165" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_180b_cropped_247x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Where hermaphroditism exists, the sex is -usually more masculine; it is a vulgar error -to suppose that the two sexes exist entire, and that they<span class="pagenum"><a id="Page_181"></a>[181]</span> -are capable of giving and receiving the offices of married -life. The present sketch is merely introduced -to show the more frequent malformation. The penis exists, but has no -urethra: below is an opening resembling -the vagina of the female, which is but of -short length, at the bottom of which (in -fact, the perineum) the urethra opens. -The testicles are entire, and the individual -from whom the draft was taken possessed -somewhat the desire of the male, without -the capability of penetration: the penis, -when excited, from its attachment to the lips of the imaginary -vagina, and also from its -contracted form, presenting -merely a kind of bulbous tumor. -Even where hermaphroditism -more closely partakes -of the female, conception never -takes place; hence all such -parties are sterile.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_181a_cropped_266x400.jpg" width="266" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_181a_cropped_400x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>Nature, as if to atone for denying -to some the delights of -maternity, has been occasionally -doubly bountiful to others. -The annexed drawing exhibits -a section of a double uterus. -Cases are on record, where -both have been impregnated.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_181b_cropped_252x400.jpg" width="252" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_181b_cropped_378x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>In the instance of a deceased -married female, -that fell under -my observation, the uterus or womb presented -the following appearances: The usual -cavity was discoverable, but it was filled -with a <i>cheesy</i>-like substance, and also there -were some ulcered-looking caverns filled -with the same material. This female, while -living, endured continued pains in the uterine -region, was insensible to marital physical -enjoyments, sterile, although a wife several -years, and the constant sufferer from a vaginal -discharge. Her death was consequent -upon a severe cold that ended in consumption.</p> - -<div class="figcenter" style="max-width: 30em;"> - <img src="images/i_b_181c_cropped_185x400.jpg" width="185" height="400" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_181c_cropped_278x600.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p><span class="pagenum"><a id="Page_182"></a>[182]</span></p> - -<p>Leucorrhœa is often attended with barrenness; at all -events, it is very debilitating, and thus impedes conception. -A notion once prevailed, that women who did not menstruate -could not conceive; it has since been disproved, -except in those instances where menstruation never occurred: -a single monthly discharge indicates an aptitude for -conception. It is observed that barren women have very -small breasts. Women who are very fat are often barren, -for their corpulence either exists as a mark of weakness -of the system, or it depends upon a want of activity in the -ovaria: thus spayed or castrated animals generally become -fat. The same remarks apply to the male kind, who are -outrageously corpulent. There are many other peculiarities -in matrimonial life, fertile subjects for speculation; -such as, for instance, the lapse of time that often occurs -after marriage before conception takes place, and the -space between each act of gestation; the solution of which -may be, that these occurrences are modified by certain -aptitudes, dispositions, state of health, &c.; the same may -explain why persons have lived together for years in unfruitful -matrimony, and who yet, after being divorced, and -marrying others, have both had children.</p> - -<p>It is not always that the most healthy women are more -favorable to conception than the spare and feeble. High -feeding and starvation are alike occasionally inimical to -breeding. The regularity of the “courses” appears principally -essential to secure impregnation; and the intercourse -is generally held likely to be the more fruitful that -takes place early after that customary relief.</p> - -<p>Women in health are capable of bearing children, on an -average, for a period of thirty years, from the age of fifteen -to forty-five; but their incapacity to procreate does not -deny them the sexual gratification, it being well accredited, -that women upward of seventy years of age have -been known, who have lost but little of the amative inclination -and enjoyment which they possessed in their early -days. Men certainly possess their procreative power to a -longer period, it being common for men to become fathers -at eighty, ninety, and one hundred—old Parr becoming a -parent at the age of one hundred and thirty. Women -rarely fall pregnant beyond fifty.</p> - -<p>Some females endure intense pain during coition, so as -to occasion fainting or great exhaustion. Such suffering -is usually traceable to internal ailments—such as <i>piles</i>, <i>fistulous</i><span class="pagenum"><a id="Page_183"></a>[183]</span> -<i>openings</i> between the <i>rectum</i> and <i>vagina</i>, <i>ulcerated -wombs</i>, <i>vaginal tumors or abscesses</i>. Cases continually -present themselves, where, on the removal of the cause, -the effect is cured.</p> - -<p>The number of children that women have individually -given birth to is very variable. It is attested, among a -collection of facts of this nature, that one female gave -birth to eighteen children at six births; another, forty-four -children in all, thirty in the first marriage and fourteen in -the second; and in a still more extraordinary case, fifty-three -children in all, in one marriage, eighteen times single -births, five times twins, four times triplets, once six, -and once seven.<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a> Men have been known to beget seventy -or eighty children in two or more marriages. With regard -to the average proportion of male and female births, it appears -that the males predominate about four or five only -in one hundred. The average number of children in each -marriage is, in England, from five to seven.</p> - -<p>To a continual irritability of temper among females -may be ascribed infertility. Independently of ever fostering -domestic disquietude, it produces thinness and feeble -health; and, where pregnancy does ensue, it most frequently -provokes miscarriages, or leads to the birth of ill-conditioned -and puny offspring.</p> - -<p>Perhaps one of the most indispensable and endearing -qualifications of the feminine character is an amiable -temper. Cold and callous must be the man who does not -prize the meek and gentle spirit of a confiding woman. -Her lips may not be sculptured in the line of perfect -beauty, her eye may not roll in dazzling splendor, but if -the native smile be ever ready to welcome, and the glance -fraught with clinging devotion, or shrinking sensibility, -she must be prized far above gold or rubies. A few moments -of enduring silence would often prevent years of -discord and unhappiness; but the keen retort and waspish -argument too often break the chain of affection, link by -link, and leave the heart with no tie to hold it but a cold -and frigid duty.</p> - -<hr class="chap" /> - -<p><span class="pagenum"><a id="Page_184"></a>[184]</span></p> -<h3>SECTION III.</h3> - -<p class="center small">TREATMENT OF IMPOTENCE.</p> - - -<p><span class="smcap">In</span> venturing upon this part of the subject, it will be as -well, first, to distinguish those cases that are curable from -those that admit of no relief. Among the latter may be -enumerated all those arising from an original or accidental -defect in the organs of generation. Where, also, -old age is the cause, little is to be done: medicines -are of no avail, and temporary stimuli not unfrequently -worse.</p> - -<p>That certain medicaments, aliments, and so forth, do -possess an <i>aphrodisiac</i> power, is not to be denied; but -when adopted by those weak beings, whose bodies are either -worn out by age or excess, and who pin their faith to -such restoratives, the little remaining sensibility in their -frames, the source of life and energy, can not sustain the -shock of reaction; and the result is, total annihilation or -death.</p> - -<p>From what has already been stated, it will be perceived, -that the mind exercises no inconsiderable influence over -the functions of the organs of generation: and as the state -of the mind depends upon the particular circumstances -under which it may be placed, any attempt to establish a -code of instructions, applicable to every instance in which -a sportive fancy, or disturbed imagination, constituted the -prevailing cause, would be abortive, and might be considered -as pandering to a vicious and depraved appetite, -whereas the object of this treatise is only to encourage the -diffident, to assist the afflicted, and render a service to -those legitimately deserving it.</p> - -<p>As excess in sexual indulgence impairs the generative -power, no less injurious may entire abstinence be considered. -The due exercise of an organ tends to its perfection, -as the neglect or misuse of it, to its impairment. -Besides, there is not any wonderful virtue in abstaining -from the proper use of the sexes. Why, in the name of -morality, were such powerful impulses and desires bestowed -upon us? Why were such wonderful organizations<span class="pagenum"><a id="Page_185"></a>[185]</span> -given to us, if they were not originally designed to be used -by every one who is possessed of them? Society, in its -present form, is not perhaps constructed with a philosophical -regard to our own natural instincts, and our own original -rights.</p> - -<p>Among the causes that induce <i>impuissance</i>, or that distressing -condition known under the cognomen of <i>nervous -debility</i>, there is not one more reprehensive than the unworthy -and pernicious practice of self-abuse. It is much -to be regretted, that some medical writer, of talent and -estimation in society, has not turned his attention to the -subject, and given the influence of his name in denouncing -to the world the misery and devastation which are the unerring -consequences of this sordid and solitary vice. It is -indeed an unpleasant and thankless task; and there probably -exists in most minds, an unwillingness to enter upon -a subject in which there is so much difficulty in selecting -language sufficiently appropriate to exhibit the folly in its -true colors, without offending the ears of the chaste and -virtuous.</p> - -<p>But a question of such paramount importance should not -be sacrificed to any false and prudish notions of delicacy; -I shall therefore offer such observations, as I may think -calculated to check the progress of a vice, that has done -more to demoralize the human mind than the whole catalogue -of existing causes besides. It may be deemed an -exaggeration, when it is stated that full three fourths of -the insane owe their malady to the effects of masturbation: -but the assertion is corroborated by one of the first -writers on medical jurisprudence, and is fully borne out -by the daily experience of proprietors of lunatic asylums. -The practice of self-abuse usually has its origin in boarding-schools, -and other places where young persons congregate -in numbers; and there are few of us who may have -observed the vice practised, although it may be unpleasant -to avow as much, that could resist the contamination.</p> - -<div class="centered-poetry-container"> - <div class="poetry"> - <div class="stanza"> - <div class="verse">“One sickly sheep infects the flock,</div> - <div class="verse indentSMALL">And poisons all the rest.”</div> - </div> - </div> -</div> - -<p>And thus it is, though ninety-and-nine be pure and spotless -as the driven snow, if the hundredth be immoral, the -poison is soon disseminated, and the whole flock become -initiated into a vice, which, if indulged in, will blast their<span class="pagenum"><a id="Page_186"></a>[186]</span> -intellectual faculties, and probably consign them as outcasts -of society; rendering them slavering idiots, or the -inmates of a lunatic asylum. It is not only in private -schools that this sin rages, our public foundations and colleges -are not exempt from it. The heads of our universities -are particularly scrupulous in driving from their neighborhood -the frail fair, lest they should contaminate the -votaries of learning; while a vice far more degrading in -its practice, and infinitely more baneful in its effects, rages -within the very sanctuaries of classic lore. Many a brilliant -genius has sunk into fatuity beneath its degrading -influence. Loss of memory, idiocy, blindness,<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a> total impotence, -nervous debility, paralysis, strangury, &c., are -among the unerring consequences of an indulgence in this -criminal passion. I need not bring a greater proof of the -dire effects of an indulgence in the practice of masturbation, -than the deplorable state of mind to which it reduced -one of our greatest poets.</p> - -<p>The treatment of this delusive and mentally annihilating -propensity, falls equally within the province of the philosopher -and the physician. Without a total abandonment -of the practice, the case is hopeless; and he to whom the -consequences shall have been portrayed and heeds them -not, is unworthy of our sympathy, but deserves the evils -he entails upon himself.</p> - -<p>Now, as the consequences of all criminalities continue -to ensue so long as the provocative be kept up, it is very -evident that, as a first step toward the restoration of order -and health, the cause must be removed or withheld. The -mere will or resolution is seldom sufficient: virtue, like -vice, has its allurements, and those belonging to the former -must be called into requisition as antagonists to the -snares of the latter. Physic can not check bad principles, -or bad indulgences. No method is or can be superior to -that full employment of the mental faculties on noble and -intellectual subjects, on objects worthy the high ends for<span class="pagenum"><a id="Page_187"></a>[187]</span> -which Nature has adapted them. And though the difficulty -will be great in inducing new and good habits, to the -exclusion of such as are unworthy and degrading, yet the -effectual accomplishment of such a resolution is not of uncommon -occurrence; and the sufferer may be placed under -circumstances where good habits may be more frequently -called into action naturally, to the exclusion of vicious -propensities. The time should be well filled, so as to -leave no room for flying to the various usual sources of -amusement that fill up the life of the thoughtless and gay. -Every hour and every minute should be provided for, so as -to exclude the admission of idleness and sloth, the forerunners -of mental and bodily disease. Studies connected -with education should be encouraged. Modern languages -have a great claim on the consideration of all who are engaged -in business to any extent, and are of incalculable -use after they have fulfilled the immediate end for which -their culture is here recommended. The various sciences -bearing more or less on the pursuits and employments of -every man, are earnestly recommended to the choice of the -unfortunate victim of sensuality. Geology and botany -would call him into the healthful fields, or fill up his time -by his fireside, in studying the many excellent works on -those subjects: the still higher utility of chemistry, as -being made of practical use in almost every business, -and demonstrating the else unintelligible phenomena -of a multitude of natural processes and changes, may -be held up as another inducement to call forth his best -energies.</p> - -<p>Travelling, to those who can afford the expense or the -time, is one of the best means of conquering this baneful -habit. The numerous objects thereby presented to the -eye of the invalid in the manners, government, and productions -of art and nature, of the countries he visits, are -an incessant source of pleasing and useful excitement, and -can not fail, especially if the traveller be accompanied by -an intelligent and moral friend, to weaken and eradicate -the bad impressions of the past.</p> - -<p>To diverge, and at the same time to conclude this part -of the subject, I have only to offer a few remarks relative -to the medical and therapeutic treatment of those cases of -impuissance, that age, disorganization, and total incapacity, -do not exclude from consideration. I have already -expressed my belief that generative imbecility is consecutive<span class="pagenum"><a id="Page_188"></a>[188]</span> -to general debility; hence, whatever tends to improve -the latter, tends also to remove the former. The diet, -therefore, should be full and generous, with a liberal proportion -of spices; but all stimulating liquids, such as wine, -brandy, and the rest, should be avoided.</p> - -<p>Bathing, in its various forms, constitutes no unimportant -feature in the treatment; the cold plunging, the tepid -shower, the douche, the warm and the vapor baths, possess -their several influences. The various medicines that come -under the denomination of aphrodisiacs, are not wholly -uninfluential, such as stomachics, aromatics, gums and -balsams, oils, musk, opium, cantharides, strychnine, and -others; but as their administration can only be permitted -under professional direction, no real utility can follow any -specification or formulary of their proportions.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">OTHER FORMS OF SEXUAL DEBILITY.</h2> -</div> - -<p><span class="smcap">Involuntary</span> seminal emissions are oftentimes very serious, -distressing, and intractable. They may be produced -in two ways—from continence, or by a high degree of -morbid irritability or weakness. The latter is by far the -more frequent; for the treatment of the former is obvious, -and generally effectual. The difference between seminal -discharges in persons of full health, and those morbidly -weak, is very opposite: in the former it is consequent -upon an erection, followed by an act of coitus; while in -the latter both are absent. The general debility in the -generative system, inseparable from morbid irritability, -occasions both a failure in the erection of the penis, and -an inability to retain the fluid in the secreting organs. -There is no doubt that this disposition to seminal emissions, -conjoined as it generally is with more or less deficiency -of the <i>vis virilis</i>, is too often owing to the habit of -self-abuse in early age. The testes usually wither in these -cases, and the patient becomes nearly, if not entirely, impuissant. -Sometimes these cases are attended by an excessive -irritability of the bladder, accompanied by pains in -the loins, kidneys, &c. Their treatment consists in taking -nutritious and digestible food, to impart strength and invigorate -the constitution. Stimulants are at the same -time to be carefully avoided, except where great languor -and lassitude prevail. Abstemiousness in liquids is to be<span class="pagenum"><a id="Page_189"></a>[189]</span> -enjoined. Habits of a relaxing nature should be avoided; -the patient, instead of sleeping on a soft, downy bed, -should lie on a firm mattress; the air of the room should -be preserved at a moderate temperature, and but few hours -should be allotted to sleep; he should pass much of his -time in the open air in a cool atmosphere; taking frequent -and moderate exercise, so that it does not occasion fatigue. -Cold bathing is a very important and essential part of the -treatment to be observed; the daily use of the <i>bidet</i>, or the -frequent application of a towel, dipped in cold water, to -the testes, applied twice or thrice a day, or the <i>douche -bath</i>, will be found of much service. To prescribe formulæ -for the various temperaments subject to this affection -would be to transcribe all the tonics from the pharmacopœia: -they are severally useful, but the various -preparations of iron surpass all others. During this -treatment the state of the mind should not be neglected: -no lascivious idea should be for a moment encouraged, -nor should the imagination be permitted to wander over -the works of fiction or romance in any way connected with -matters of love.</p> - -<p>It not unfrequently happens that patients affected with -these complaints are apt to despond, and become miserably -depressed in spirits; to remove which, every recreation -should be encouraged to prevent them pondering over -their own situation, and, if possible, to divert the mind -from gloomy ideas: lively and agreeable company should -be courted; theatres, concerts, or any other rational -amusement consonant with the principles of the patient, -should be visited or pursued, and by an uninterrupted -perseverance in this mode of treatment for a sufficient -length of time, I have seen the most beneficial results -arise. The great art and difficulty in treating these -cases consist in giving tonics to a certain extent and no -further—avoiding excess, whereby we stimulate and produce -fever; or depletion, and induce debility. Early -hours, fresh air, exercise, attention to diet, the shower -bath, topical application of cold, with properly regulated -sexual intercourse, are rarely ineffectual in curing the -disease.</p> - -<p>I could narrate many instances wherein the sexual desire -declined on the intervention of ordinary illness; any -powerful mental solicitude will suffice, but such a cause<span class="pagenum"><a id="Page_190"></a>[190]</span> -is commonly remediable. Where the cause is traceable -to excesses and pernicious indulgences, if not accompanied -by disorganization, hope should not be abandoned; but -the patient should not cling to, or hang his reliance upon, -hole-and-corner speculators, or their advertised specifics. -He should consult men legitimately engaged in the profession, -in which, perhaps, more talent and honor are concentrated, -than in any other department of science.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_191"></a>[191]</span></p> -<h2 class="no-page-break">ON PILES OR HŒMORRHOIDS.</h2> -</div> - -<p><span class="smcap">As</span> this disease is generally considered to be of a delicate -nature, and one about which the afflicted are unwilling to -speak, we shall say a few words on them. Piles constitute -a disease that may be very slow or very rapid in its -progress. The patient complains of an occasional itching -or soreness at the rectum after an evacuation, more particularly -if subject to constipation, or if he be an irregular -liver: when, after a while, he will be surprised on discovering, -subsequent to some straining effort, a knot of elastic -but irregularly formed tumors, of a size varying from a -hazel-nut to a horse-bean, springing out apparently from -the rectum, that in a few days, if they continue, will become -sore, and probably be attended with a discharge of -blood.</p> - -<div class="screen-only"> - <table class="illo3" summary="P191"> - <tr> - <td style="min-width: 12em;"> - <p class="side-caption">1. Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">2. Hœmorrhoids.</p> - <p class="side-caption"> </p> - <p class="side-caption">3. Perineum.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_191_cropped_895x600.jpg" rel="nofollow">View larger image</a></p> - </td> - <td style="max-width: 597px;"> - <img src="images/i_b_191_cropped_597x400.jpg" width="597" height="400" alt="" /> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 35em;"> - <img src="images/i_b_191_cropped_597x400.jpg" width="597" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Rectum.</div> - <div class="line"><span class="bold">2.</span> Hœmorrhoids.</div> - <div class="line"><span class="bold">3.</span> Perineum.</div> - </div> - </div> - </div> -</div> - -<p>Another patient will experience similar symptoms, as -regards the pain, swelling, and discharge of blood, except -that they will be increased in severity, and be more transitory -in their appearance and stay. Upon examination, a -perceptible difference will be discovered. In the former -instance the tumors will be seen to proceed from the outer -edge of the rectum, and will be found to be covered with<span class="pagenum"><a id="Page_192"></a>[192]</span> -the common skin. Professional men designate this form -of the disease “External Piles.”</p> - -<div class="screen-only"> - <table class="illo" summary="P192A"> - <tr> - <td style="max-width: 493px;"> - <img src="images/i_b_192a_cropped_493x400.jpg" width="493" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Inner part of Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">2. Orifice of Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">3. External Piles.</p> - <p class="side-caption"> </p> - <p class="side-caption">4. Internal Piles.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_192a_cropped_740x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_192a_cropped_493x400.jpg" width="493" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Inner part of Rectum.</div> - <div class="line"><span class="bold">2.</span> Orifice of Rectum.</div> - <div class="line"><span class="bold">3.</span> External Piles.</div> - <div class="line"><span class="bold">4.</span> Internal Piles.</div> - </div> - </div> - </div> -</div> - -<p>In the latter, the tumors are, as it were, squeezed out -of the rectum, and swell in a very short space of time to an -enormous size. They are of a much more vivid blood-red -color, and will be found to be covered only by the lining -membrane of the lower gut. These are called “Internal -Piles.”</p> - -<div class="screen-only"> - <table class="illo" summary="P192B"> - <tr> - <td style="max-width: 542px;"> - <img src="images/i_b_192b_cropped_542x400.jpg" width="542" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Inner part of Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">2. Orifice of Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">3. Internal Piles.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_192b_cropped_813x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_192b_cropped_542x400.jpg" width="542" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Inner part of Rectum.</div> - <div class="line"><span class="bold">2.</span> Orifice of Rectum.</div> - <div class="line"><span class="bold">3.</span> Internal Piles.</div> - </div> - </div> - </div> -</div> - -<p>Now piles are nothing more nor less than <i>dilated veins</i>, -like varicose veins in the leg or any other part. The office -of veins is to receive the surplus blood of the arteries, after -having parted with that necessary supply for the nourishment -of every structure they are severally distributed to, -and to convey it back to the circulating organ, the heart—and -the mesenteric hœmorrhoidal veins, from their dependant -and confined position, the circulation in and above -them being liable to so many interruptions from the frequent -hardened state of the fæces in the rectum, become -distended with blood, which acting really like a wedge, dilates -them in time to the size we meet them. On the removal -of the cause, the blood flows on, and the swelling -subsides, and the patient feels no further inconvenience -until a recurrence of the pressure. After repeated attacks, -the veins become inflamed, and lymph, a sort of defensive<span class="pagenum"><a id="Page_193"></a>[193]</span> -mucus, is “thrown out” on the cellular membrane covering -the veins, and becomes organized into an indurated -texture, which increases with each attack of inflammation, -and at last gives them that fleshy appearance which resembles -a specific growth (see annexed cut).</p> - -<div class="figright" style="max-width: 30em;"> - <img src="images/i_b_193_cropped_282x200.jpg" width="282" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_193_cropped_572x405.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p>The distinction between External and Internal Piles is as follows: -In both instances the same veins are diseased. In external piles, the -lowermost portion of the hœmorrhoidal veins are dilated, and are thrust -by the outer side of the rectum, carrying before them the common skin, -which dilates and constitutes the external coat of the piles. The -rectum is a portion of gut of four or five inches in length, and of -nearly a uniform width; the lower end, constituting the orifice, is, as -it were, tied round with a contracting and yielding band of muscular -fibres, forming a muscle called the <i>Sphincter Ani</i>. It is a muscle -of great power, and, from its connexion with the neighboring muscles -of similar strength, helps to afford that support to the contents of -the pelvis, that otherwise would descend, and be always forming a -projecting tumor. External piles consist, then, of a protrusion of the -hœmorrhoidal vein or veins between the cellular union of the sphincter -with other muscles, constituting, in fact, a hernia or rupture in the -perinœum. Internal piles is that condition of the hœmorrhoidal veins, -where, from their dilatation, they become protruded with the fæces, -when, from the contraction of the sphincter acting like a ligature, -they can not regain their situation until emptied of their contents. -Inflammation soon ensues, and the various changes I have and shall -hereafter consider take place.</p> - -<p>Having stated the cause of piles, namely, pressure on, -and thereby prevention of, the circulation of the blood -through the hœmorrhoidal veins, it follows that persons -mostly annoyed with constipation must be the most likely -to be afflicted with piles; hence, free and intemperate livers, -great wine-bibbers, feeble and relaxed constitutions, -those, again, who take little exercise, and pregnant women, -and women who have borne many children, seldom -escape them. It is rarely that piles attack people in the<span class="pagenum"><a id="Page_194"></a>[194]</span> -lower class of life, and those who have to work hard for -their livelihood and are much in the open air, which accounts -for the prevalence of this disease in the upper ranks -of society. The treatment of piles is very simple, if proceeded -with at the commencement of the complaint, the -grand object being to prevent constipation. An excellent -adjunct to the cure of incipient piles, is the warm bath. -Its tendency to overcome local congestions, and thereby -equalize the circulation of the blood, is well known. The -best medicine a hœmorrhoidal patient can take is Turkey -rhubarb, to be chewed freely, or castor oil, in doses of one -or two teaspoonfuls every morning, or some mild electuary, -which should be continued until the piles subside.</p> - -<p>The diet during this treatment should be temperate and -laxative. Fruits should be used freely, and also coarse -bread, rye and Indian mush and molasses; wine and exhilarating -stimulants being avoided, and, where admissible, -as much out-door exercise taken as possible. An excellent -plan is also to inject half a pint or more of cold pump -or spring water up the rectum every morning, and suffer it -to remain for twenty or thirty minutes, if possible. Where -the piles have been of several days’ continuance, and are -very much swollen, puncturing them with a needle, and so -relieving the tension by evacuating, or at least diminishing -their contents, that the obstruction shall be overcome, is -serviceable. After this, pledgets of lint dipped in cold -water, the patient preserving the horizontal posture, may -be applied, or an astringent lotion may be used.</p> - -<p>Where there is much swelling and inflammation, leeches -applied to the neighboring parts will afford relief. It is -impolitic, although some surgeons recommend it, to apply -leeches on the tumor, as the bites are oftentimes very difficult -to heal. Where the piles will admit of it, attempts -should be made to empty them, and press them to their -places, after which a pad may be worn to prevent their -descent. In the commencement of the disease, where -there is much heat and itching, a mild and astringent ointment -will prove of considerable utility, and a wash of powdered -opium, dissolved in flaxseed tea, will relieve pain and -soreness.</p> - -<p>A very excellent and practical method in the treatment -of piles (the internal I am now speaking of) is to deposite -a pear-shaped bougie or pessary in the rectum, and suffer -it to remain as long as possible. The wearing of bougies<span class="pagenum"><a id="Page_195"></a>[195]</span> -gives no pain or even uneasiness, and the patient may -pursue his or her ordinary occupation without hinderance: -the bougie should be worn from one to several weeks. It -affords constant pressure against and support to the dilated -veins, and enables them to regain their tone and -strength; and I have known numerous instances where a -lasting cure has been effected. One of the most alarming -consequences of piles is hœmorrhage or bleeding; and it -is really wonderful what an extensive loss of that fluid a -patient can sustain. Day after day, and week after week, -have I known instances of constant bleeding from internal -piles, by which the constitution of the patient has been almost -broken up. This symptom mostly prevails with females, -nor is it limited, although more prevalent, to those -who are pregnant. There is naturally a strong objection -on the part of a delicate and susceptible female to submit -to a professional examination, and consequently it is rarely -done, until the urgent necessity of the case, lest death should -ensue, induces the patient to consult her medical adviser, -that he becomes acquainted with the real nature of the -case. Where there is ulceration of the piles, and they are -very numerous, and the bleeding frequent and profuse, the -only effectual cure is their removal. Where the operation -is objected to, the next method is to employ astringent enemata, -which must be regulated by the medical attendant.</p> - -<p>The celebrated Weir’s balsam (248½ Grand Street) has -the credit of effecting miraculous cures. It is a medicine -of deserved repute, and ranks high with professional men. -Pitch pills have been extolled.</p> - -<p>Now, where piles, both external and internal, do not -yield to the means suggested, or the patient may not think -proper to avail himself of them, the next best step is their -removal; and this is done either by excision or by ligature. -Both processes are safe in the hands of a medical man, -and are neither attended with any pain nor suffering worth -notice.</p> - -<p>Among the annoyances incident to the rectum, is an occasional -preternatural contraction of the sphincter muscle. -It is generally the consequence of local irritation set up -by purgatives, by which the orifice becomes sore and excoriated, -which, if not timely relieved, ulcerates, constituting -cracks also, and in process of time a portion sloughs -away, and the adjacent edges unite, and thereby diminish -the calibre of the opening. This disease <i>may</i> be congenital,<span class="pagenum"><a id="Page_196"></a>[196]</span> -that is, the individual may be born with a contracted -or narrow sphincter. The treatment, naturally enough, is -to dilate the orifice, which is to be attempted by the introduction -of bougies, after the mode advised for the cure of -stricture, of which this in reality is a form. The cracks -of the sphincter are occasionally obstinate to heal; and the -ulceration will spread within the rectum. When that is -the case, the application of any stimulative ointment will -promote a healthy action.</p> - -<p>In inveterate cases division of the sphincter is necessary, -which is to be done with a scalpel, and the incision should -be made from within laterally, by which injury to the perineum -is avoided. The operation is very simple, and by -no means painful or dangerous: the cure is perfect. Appropriate -medical treatment must not be neglected.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">PROLAPSUS OF THE RECTUM.</h2> -</div> - -<div class="figleft" style="max-width: 30em;"> - <img src="images/i_b_196_cropped_234x200.jpg" width="234" height="200" alt="Described in surrounding text" /> - <div class="caption"> - <p class="caption ebhide"><a class="underline" href="images/i_b_196_cropped_561x479.jpg" rel="nofollow">View larger image</a></p> - </div> -</div> - -<p><span class="smcap">This</span> disease is often confounded with -piles; and as patients are generally diffident in submitting to an -examination, any extraordinary protrusion of piles they denominate -a falling of the gut. <i>Prolapsus Ani</i> is distinguished from piles -by the muscular coats of the intestine descending with the mucous -membrane, and forming a bag, like a pendulum, to the length of many -inches; the rectum, in fact, becomes everted, as we see the finger -part of gloves when turned inside out; and the inner membrane being -highly vascular, and the vessels in a congested state, it assumes a -blood-red appearance. The case is here well portrayed. Of course the -disease occasions much inconvenience and if not abated by appropriate -treatment, serious consequences ensue. Piles are most commonly the -cause of prolapsus, when, from the frequent and hard straining, the -gut at last descends, bringing the piles with it, which will be -seen winding around the upper part. When that is the case, the best -treatment is first to apply a ligature round the hœmorrhoids, and then return them -<span class="pagenum"><a id="Page_197"></a>[197]</span> -and the rectum together. Where the gut protrudes from -relaxation of the sphincter, the treatment depends upon -local support, for which there are many contrivances.<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a> -Astringent injections should also be used to give tone to -the parts, and medicines given to render the alvine evacuations -less hurtful. Children are very liable to prolapsus, -but with them a return of the fallen gut, and a brisk purgative -is all that is needed to prevent a repetition, provided -proper attention be paid to the bowels afterward—a -disturbance of the latter being, in most instances, the -cause. Where a rectum has been for a long time the seat -of disease, excrescences are apt to arise, resembling warts: -they may be removed without much pain, and with perfect -safety.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">STRICTURE OF THE RECTUM.</h2> -</div> - -<p><span class="smcap">The</span> rectum, it is presumed, is known to be the lower -portion of the intestines that leads to the outlet called, in -domestic language, the fundament. Now some writers -assert that the rectum answers the same purpose to the -bowels generally, as the urethra does to the bladder, while -others contend that it is a receptacle for the fæces previous -to their expulsion. We are all sensible, I think, that -it must answer both purposes; but it is also evident that -it is employed more for the former than the latter purpose. -The moment the rectum is full, there is a desire to empty -it, which is the best proof of its office; but circumstances -oftentimes forbid us, for even hours, obeying the summons, -which establishes its capability as a recipient. Well, the -rectum, consisting of muscular and membranous coats, -similar to the urethra, is alike subject to irritation, inflammation,<span class="pagenum"><a id="Page_198"></a>[198]</span> -and ulceration, and imitatively gives forth -morbid and other secretions. The rectum, from its situation -and office, is very obnoxious to disease; and in addition -to those already enumerated, it is extremely liable -to become strictured.</p> - -<p>Neither age nor sex are exempt from this strictural -change, although it more usually selects the grown up and -female portion of society. It is, generally speaking, the -consequence of constipation, or the reverse—diarrhœa or -dysentery—or it may follow in the wake of child-bearing. -Piles are a frequent precursor. The ordinary symptoms -are at first a slight difficulty in voiding the fæces, which -assume the form of the passage through which they have -to pass, presenting at one time a flattened tape-like shape, -at others a spiral appearance, and again the natural form, -but of very small diameter.</p> - -<p>As the disease advances, the pain increases, upon going -to the water-closet, and after the act may be observed a -small or copious discharge of mucus, or blood, from the -anus. If the bowels be constipated, there is necessarily a -great deal of straining during fæcation, that soon establishes -spots of inflammation that rarely resolve, but run -on to ulceration; small lodgments then of fæcal matter -take place in the cellular membrane; and without detailing -the pathological phenomena, it may suffice to say, that -sooner or later the whole rectum becomes diseased, and -fistula, with its attendant miseries, lends a speedy help to -close life’s brief pilgrimage.</p> - -<p>Patients afflicted with rectal diseases lose flesh rapidly. -From the constant pain and annoyance they endure, their -general health gets undermined, the digestion becomes -faulty, the countenance flags and looks care-worn, hectic -fever awaits the break-up of functional regularity, and a -lingering exhaustion closes the scene.</p> - -<p>Stricture of the rectum is a curable disease; but the less -complicated, the greater are the chances of recovery. The -principles of treatment bear a near resemblance to those -for stricture of the urethra. After having ascertained the -situation and size of the contraction, a proper-sized bougie -may be introduced, and suffered to remain as long as -it occasions no inconvenience. The introduction should -be repeated every or every other day, increasing the size -of the bougie until the dilatation be fully perfected. After -vigilance is necessary to prevent a recurrence, and the<span class="pagenum"><a id="Page_199"></a>[199]</span> -bougie can not with propriety be entirely laid aside, or the -disease will return with increased violence. There are, -however, cases that require more imperative means, such -as the use of the <i>bistouri</i>, an instrument for the division of -stricture of the rectum, which, if the resort be objected to, -it behooves persons with the premonitory symptoms to attend -to them, that the operation may be rendered unnecessary. -There are many excellent palliative medicines -that the invalid will derive much comfort from in diseases -of the rectum; and enemata constitute a powerful means -of relief. The title of stricture of the rectum is fortunately -more familiar than the disease is frequent; and -what is more consolatory to persons of feeble health, the -complaint seldom extends beyond two or three inches from -the orifice, so that it need not be feared beyond the reach -of relief. See annexed <span class="nobreak">drawing:—</span></p> - -<div class="screen-only"> - <table class="illo" summary="P199"> - <tr> - <td style="min-width: 8em;"> - <p class="side-caption">1. Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">2. Orifice of Rectum.</p> - <p class="side-caption"> </p> - <p class="side-caption">3. Stricture of the Rectum, with internal hæmorrhoids in the lower portion.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_199_cropped_326x600.jpg" rel="nofollow">View larger image</a></p> - </td> - <td style="max-width: 217px;"> - <img src="images/i_b_199_cropped_217x400.jpg" width="217" height="400" alt="" /> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_199_cropped_217x400.jpg" width="217" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Rectum.</div> - <div class="line"><span class="bold">2.</span> Orifice of Rectum.</div> - <div class="line"><span class="bold">3.</span> Stricture of the Rectum, with internal hæmorrhoids in the lower portion.</div> - </div> - </div> - </div> -</div> - -<p>There are some surgeons who state all diseases to emanate -from a disordered liver, a weak stomach, or a “broken -wind;” and there are others in this town who are -never consulted but they deem the use of the rectum bougie -indispensable. The limit to structural disorganization -of the bowel is not afforded by stricture; there are, unfortunately, -many diseases springing therefrom, and many -totally independent of such; but their detail here would -exceed the titular object of the book. Enough has been -stated to convince any person teased with any of the enumerated -symptoms, that however simple may be his malady -in his own opinion, it is impolitic to overlook or neglect -it.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_200"></a>[200]</span></p> -<h2 class="no-page-break">THE URINE.</h2> -</div> - -<p><span class="smcap">We</span> shall conclude our treatise by a few remarks on -diseases of the urine, to which many are subject. Before -proceeding to speak of them, it is necessary, for a full understanding -of the subject, to state, that the urine is secreted -by two bodies called <i>kidneys</i>, placed one on each -side of the back-bone, as is shown in the cut. After being -formed, the urine passes through the <i>ureters</i> into the -bladder whence it is voided, as every one knows, occasionally.</p> - -<div class="screen-only"> - <table class="illo" summary="P200"> - <tr> - <td style="max-width: 268px;"> - <img src="images/i_b_200_cropped_268x400.jpg" width="268" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1—1. The Lungs.</p> - <p class="side-caption"> </p> - <p class="side-caption">2. The Stomach.</p> - <p class="side-caption"> </p> - <p class="side-caption">3—3. The Kidneys.</p> - <p class="side-caption"> </p> - <p class="side-caption">4—4. The Ureters.</p> - <p class="side-caption"> </p> - <p class="side-caption">5. The Bladder.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_200_cropped_402x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_200_cropped_268x400.jpg" width="268" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep7"><span class="bold">1—1.</span> The Lungs.</div> - <div class="linep7"><span class="bold">2.</span> The Stomach.</div> - <div class="linep7"><span class="bold">3—3.</span> The Kidneys.</div> - <div class="linep7"><span class="bold">4—4.</span> The Ureters.</div> - <div class="linep7"><span class="bold">5.</span> The Bladder.</div> - </div> - </div> - </div> -</div> - -<p><span class="pagenum"><a id="Page_201"></a>[201]</span></p> -<p>The following diagram shows the bladder and its muscular -coats, and also its neck imbedded in the prostate -gland. The bladder is seen distended, and, of course, as -detached from the body. The kidneys are also seen—one -in its natural state, the other divided to show its inner -structure: the kidneys and their ureters are crossed to -save space in the sketch.</p> - -<div class="screen-only"> - <div class="figcenter" style="max-width: 262px;"> - <img src="images/i_b_201_illustrators_262x400.jpg" width="262" height="400" alt="" /> - <div class="caption"> - <p class="smaller justify"><span class="bold">1.</span> The entire kidney. - <span class="bold">2.</span> Its cortical, or secreting part. - <span class="bold">3.</span> The papilla. - <span class="bold">4.</span> The pelvis. - <span class="bold">5.</span> The ureter. - <span class="bold">6.</span> The bladder. - <span class="bold">7.</span> The detrusor muscle. - <span class="bold">8.</span> The sphincter muscle. - <span class="bold">9.</span> Prostate gland. - <span class="bold">10.</span> Neck of the bladder.</p> - <p class="caption ebhide"><a class="underline" href="images/i_b_201_illustrators_393x600.jpg" rel="nofollow">View larger image</a></p> - </div> - </div> -</div> - -<div class="handheld-only figcenter" style="max-width: 20em;"> - <img src="images/i_b_201_illustrators_262x400.jpg" width="262" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="linep0 justify"><span class="bold">1.</span> The entire kidney. - <span class="bold">2.</span> Its cortical, or secreting part. - <span class="bold">3.</span> The papilla. - <span class="bold">4.</span> The pelvis. - <span class="bold">5.</span> The ureter. - <span class="bold">6.</span> The bladder. - <span class="bold">7.</span> The detrusor muscle. - <span class="bold">8.</span> The sphincter muscle. - <span class="bold">9.</span> Prostate gland. - <span class="bold">10.</span> Neck of the bladder. - </div> - </div> - </div> - </div> -</div> - -<p>The bladder and adjacent parts are seen more fully in -the diagram at the top of the succeeding page.</p> - -<p><span class="pagenum"><a id="Page_202"></a>[202]</span></p> - -<div class="screen-only p2"> - <table class="illo" summary="P202"> - <tr> - <td style="max-width: 528px;"> - <img src="images/i_b_202_cropped_528x400.jpg" width="528" height="400" alt="" /> - </td> - <td style="min-width: 8em;"> - <p class="side-caption">1. Corpus cavernosum.</p> - <p class="side-caption">2. Bulb of urethra.</p> - <p class="side-caption">3. Membranous portion of ditto.</p> - <p class="side-caption">4. Prostate gland surrounding urethra.</p> - <p class="side-caption">5. Seminal vesicles.</p> - <p class="side-caption">6. The two vasa deferentia.</p> - <p class="side-caption">7. The ureters.</p> - <p class="side-caption">8. The bladder.</p> - <p class="side-caption viewLI"><a class="underline" href="images/i_b_202_cropped_792x600.jpg" rel="nofollow">View larger image</a></p> - </td> - </tr> - </table> -</div> - -<div class="handheld-only figcenter" style="max-width: 30em;"> - <img src="images/i_b_202_cropped_528x400.jpg" width="528" height="400" alt="" /> - <div class="centered-legend-container"> - <div class="legend"> - <div class="block"> - <div class="line"><span class="bold">1.</span> Corpus cavernosum.</div> - <div class="line"><span class="bold">2.</span> Bulb of urethra.</div> - <div class="line"><span class="bold">3.</span> Membranous portion of ditto.</div> - <div class="line"><span class="bold">4.</span> Prostate gland surrounding urethra.</div> - <div class="line"><span class="bold">5.</span> Seminal vesicles.</div> - <div class="line"><span class="bold">6.</span> The two vasa deferentia.</div> - <div class="line"><span class="bold">7.</span> The ureters.</div> - <div class="line"><span class="bold">8.</span> The bladder.</div> - </div> - </div> - </div> -</div> - -<p>It is a very common observation with patients, that -they never were in better health in their lives than at the -moment of consulting their medical adviser, except in the -very particular malady, such as an ulcered limb, a teazing -cough, a gleety discharge, or an irritable bladder, that they -are seeking relief for; “they are quite well,” they say, -“in every other respect.” When illness attacks an individual, -it does not always announce its arrival by sound -of trumpet. It does not always come on like an apoplectic -shock: some minor organization is generally the first to -indicate disturbance in the healthy economy by even so -simple a presage (I will take for example, more especially -as the ensuing remarks bear upon the subject) as excretion -of disordered urine. To resume; the patient will -content himself, that the only fault in his system is the -disordered condition of his urine, and he earnestly seeks -for something to touch that particular symptom, forgetting -that trifling as he may fancy it, it is not merely owing to -the office of the kidneys and bladder, but to the blood itself, -whence the urine is formed, and to other circumstances -in the economy that influence it. Therefore, it is not -merely the urine which is at fault, but the state of it is a -pretty good indication of the general state of health; and -when it becomes vitiated, the urine is generally, unless -restored to a healthy condition, a forerunner of some more -serious evil. Still there are many variations in the character -and quality of the urine, and each depending upon -different causes—some upon a disordered state of the fluids -of the body, some upon one remote cause or another, deranging -the balance of the circulation, and inducing excessive<span class="pagenum"><a id="Page_203"></a>[203]</span> -perspiration, and the like; and certainly not the -least important, nor the least influential, exist in the very -structures that make (as it were) and receive the urine, -namely, the kidneys and bladder. I may observe here, -that chymists have detected upward of twenty different -substances, animal and saline, in its composition, but in a -state of complete solution. Of all these component parts, -the most important is an animal product named <i>urea</i>, -which exists in about the proportion of one in thirty to the -water containing it, while the other materials taken collectively, -water excepted, yield only about double the -quantity of the urea: hence, when the urine is disordered, -its specific gravity<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a> is increased or diminished, as the case -may be; according to the abundance of the urea, and the -various proportions of the saline ingredients of the urine, -so is the urine thick, thin, acid, or alkaline, pale, or what -is called high colored. The various conditions of the urine -are ascertained by producing chymically certain decompositions, -or by suffering the urine to effect its own changes, -which, on being suffered to “stand,” sooner or later it -will.</p> - -<p>Healthy urine is perfectly transparent and of a light -amber color; it yields an odor when warm resembling -violets. Its taste (for pathologists trust not only to sight -and smell) is saltish and offensive. As the urine cools, it -throws up what may be said to be a “urinous smell.” As -decomposition proceeds, the urine becomes cloudy, thick, -with shining floating patches on the surface; and lastly, -a thick deposite coats the bottom and sides of the vessel, -the whole giving forth at the same time a fetid ammoniacal -exhalation, as is perceived on entering public urinals.</p> -<p><span class="pagenum"><a id="Page_204"></a>[204]</span></p> -<p>The rapidity with which these several mutations occur, -affords some criterion of the healthy or disordered state -of the excretion we are talking about, and hence the usefulness -of examining especially the urine of persons laboring -under any disorder of the urinary system and functions -connected therewith. A patient will complain, for instance, -of irritable bladder. The symptoms of that complaint, -as far as pain and frequent desire to micturate exist, -very closely resemble those affections known by the -name of “Diabetes,” but which is distinguished from the -bladder affection in question by the quantity and character -of the urine. I purpose herein to enumerate, in as familiar -a manner as is possible, the various disordered states -of the urine which my experience has rendered me familiar -with, and to present the same as heretofore, in the form -of cases that have fallen under my notice.</p> - -<p>Now, the urinary disorders that I purpose to collect a -description of, and exemplify, may be thus <span class="nobreak">enumerated:—</span></p> - -<p>First, where too great a quantity of urine is voided.</p> - -<p>Secondly, where too little is discharged; and also, where -suppression of it entirely occurs.</p> - -<p>Thirdly, those states where the urine deposites a sediment, -of which two kinds are mostly prevalent, namely, -the Lithates or Acid, and the Earthy or Alkaline.</p> - -<p>Fourthly, a brief exposition of the many but less frequent -morbid changes of the urine, in which certain salts -and substances, not existing in healthy urine, are precipitated -or held in solution.</p> - -<p>And lastly, to add a few to the number of those already presented -herein, of the infirmities of those organs which -excrete the fluid under consideration, namely, the kidneys -and bladder.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">ON INCONTINENCE OF URINE.</h2> -</div> - -<p><span class="smcap">Although</span> this is not the professional term for the disease -I am principally about to speak of, yet under this -head will the reader, if he be an invalid laboring under a -complaint of this character, seek for a description of his -own case. Incontinence of urine implies a loss of the retentive -faculty of the bladder; but there is a species of -disease where micturition is carried to such an extent, that -a patient will attribute his leaky condition to the above -cause. Not so, however, is the case; the urine, in the<span class="pagenum"><a id="Page_205"></a>[205]</span> -disease alluded to, is generated or excreted in great quantity, -and the bladder merely fulfils its ordinary duty. Of -the affection known under the title of incontinence of -urine, most persons are aware that it is one of more frequent -occurrence in infancy than in adolescence; but the -latter is by no means exempt. In childhood it arises, in -all probability, from drinking too much, and the bladder -becomes, during sleep, overloaded, and runs over; or, -perhaps, from the irritability induced by its distension, becomes -excited to action, and so empties itself, the drowsy -state of the child rendering it insensible to the passing -circumstances.</p> - -<p>The infirmity soon becomes a habit, which is often rendered -worse by the means taken to check it, namely, chastisement, -which is highly reprehensible. It is fortunately, -however, a disease that wears itself out as the child grows -up; and it may at all times be materially mitigated by a -little care and attention, such as inducing the child to micturate -before going to bed, and even awakening it before -the anticipated time when it usually is attacked with the -incontinence. The last fluid meal, which should be a spare -one, should be taken some hours before retiring to rest; -and if the complaint has gained much ascendency, medicines -which give tone to the bladder should be taken. I -have known the malady successfully removed, in a very -short time, by a combination of the sulphate of iron and -quinine, and any sedative extract, such as henbane or hops, -given in small doses in the form of pills. Female children -are more susceptible of the annoyance than males, probably -owing to the shortness of the urethra. Every measure -tending to give strength to the child should be used, such -as cold bathing, fresh air, or a change of the same, especially -if residing in the city, to the country. Mechanical -contrivances are to be had to collect the escape of urine, -whereby the offensive odor arising from the continually -soiled bed-linen may be avoided, and oftentimes the fretting -consequences of the urine passing over the person, -which induce excoriations and troublesome sores. There -are contrivances for both sexes. Where the disease prevails -in mid-life, it is generally traceable to early improvident -habits, and of course is the result of irritability and -debility of the bladder. There are many patients who can -somewhat control the functions of that organ while awake, -but have no power over it when asleep. The treatment<span class="pagenum"><a id="Page_206"></a>[206]</span> -depends a great deal upon the observance of abstemiousness -both in eating and drinking: a perseverance in -chalybeate remedies, both taken and administered internally -(I have injected the bladder of a person subject to -nightly incontinence of urine with various tonic preparations, -with very great and permanent relief); the use of -the warm bath, whereby the skin is brought into healthier -action (for it is generally arid, and parched when much -urine is voided), which tends to lessen the duty of the kidneys -and urinary system, should be adopted; nor should -exercise, that <i>pabulum vitæ</i> of even all feeble persons, be -disregarded. It is of the utmost importance for the preservation -of health, under all the circumstances in which we -may be placed. Escaping from this digression, I now proceed -to follow out the idea of the first paragraph of this -chapter, to treat of those complaints wherein the urine is -voided in excess. There is a disease commonly known by -the name of diabetes, wherein the prominent symptom is -a continual aptitude to pass urine, and in much greater -quantities than the fluid consumed as ordinary drink could -supply. This is one form of ailment of this class; but -there is another, happily less inimical to life, and which, -in the order of its frequency and simplicity, should take -precedence. It is that state of health, where the patient -is of that leaky habit, that whatever he takes runs through -him, and that very quickly too. Of course, such a condition -must depend upon a seriously-deranged constitution: -hence there is present a perpetual thirst, an entire perversion -of the perspiratory function, and a morbid condition -of many of the phenomena of life. Where this disease -springs up in early years, it becomes a habit proper to existence; -and although it may not seriously disturb the -economy of the being so as to lessen the duration of one’s -stay here, yet it furnishes a source of much solicitude, by -depriving us of rest, and shutting us out from society.</p> - -<p>The patient (for such he or she may be truly called, and -the complaint invades both sexes) appears to have a perpetual -fever. Such is the desire for drink, that attested -cases record the circumstance of individuals consuming -from <i>one</i> to <i>two pailfuls</i> of water in twenty-four hours! -and I positively know an instance, at the moment of writing -this, of a child, fifteen years of age, consuming during -the night, notwithstanding a plentiful supply of liquids -during the day, a large jugful (two quarts) of water: the<span class="pagenum"><a id="Page_207"></a>[207]</span> -quantity of urine excreted is nearly equivalent. In this -case, the perspiration is profuse, and the child enjoys tolerably -good health, with the exception of being occasionally -nervous and hysterical. The case is under treatment, -and the quantity of fluid allowed is being daily diminished. -The urine on these occasions is aqueous, very pale, and of -little specific gravity; the properties of the urine otherwise -are not altered. These cases sometimes exist through life; -and if they do not terminate fatally, they ultimately enfeeble -the health, and predispose the patient, or, in other -words, render him less able to combat with ordinary complaints -common to us all, and thereby tend to the break-up -of his constitution.</p> - -<p>There are many persons tipplers, not for the love of the -specific liquor, but from being always thirsty; and if we -reflect a little, we shall soon find how inclined we are to -encourage the habit. Since the introduction of tea into -this country, what inordinate quantities of that fluid are -consumed by individuals. They must, of course, dispose -of it, after having drunk it: the stomach can not retain it, -and it escapes either by the skin or kidneys, more usually -the latter. It is no uncommon thing for nurses, washerwomen, -and other females too, to swallow nine or a dozen -cups of tea at a sitting: they declare it is their best meal.</p> - -<p>Man is a great deal more careful of the quadruped world -than the class he belongs to himself. He will stint his -horse drink, who works as much beyond his strength as -man does under his own, while he, the driver, will swill -till his mouth can scarcely receive another drop. The -moral of a volume might doubtlessly be expressed in very -few words, but then it would not be a volume, and, consequently, -would not be purchased or read; therefore, the -proposition herein intended to be presented to the reader -would exist unheeded. It is one thing to observe, that we -all drink too much, or that too much fluids are hurtful to -digestion and other functions, the public require some illustration -(which their own reflection would furnish, if -they used it), and hence this expense of verbosity to prove -the fact. As one of the consequences, then, of too great -an indulgence in fluids (I am here speaking of quantity -rather than quality), this form of complaint, wherein the -patient is perpetually desiring to urinate, is decidedly the -result; and, as all complaints have a beginning, this may -be considered as the first step toward setting up the several<span class="pagenum"><a id="Page_208"></a>[208]</span> -affections of the kidneys and bladder hereafter treated -upon. How important, then, is the arrest of this practice. -Where the inconvenience thus detailed is present, the -quantity of fluids must by degrees be diminished, the general -state of health must be studied. Dieting and warm-bathing -are two sheet-anchors, if properly applied. All -remedies tending to afford strength to the urinary system -must be had recourse to; and where the bladder loses any -of its retentive power, I entertain the greatest benefit from -an injection.</p> - -<p>The next form of urinary disturbance of a proximate nature -to the one just described, is also where the urine is -discharged in large quantities; but, unlike the former, excreted -in greater abundance than the supply. The character -of the fluid is also different; it assumes two appearances, -modifications doubtlessly owing to the constitution of -the patient and the severity and length of the disease. It -is known by the name of diabetes: it is happily a complaint -the least frequent of urinary derangements, else, -from its obstinacy and difficult management, the slightest -urinary disorder would excite much just dread and apprehension.</p> - -<p>The forms of the complaint thus vary: In the one instance, -there is a deficiency of the animal matter of the -urine, namely, the urea, and in the other, a superabundance -of it. In the former instance the urine is of a pale color, -and transparent, and sometimes like clear water, with a -very faint slight odor; whereas, in the latter it is generally -of a higher color, and now and then so thick as to resemble -brewer’s porter: it is decidedly a disease of great debility. -The symptoms are, a wearisomeness and languor -of the whole frame, a dry and crimpled state of the skin, -a sinking, gnawing pain at the pit of the stomach, the -bowels are obstinately bound, while a great thirst always -prevails. The body wastes to a mere skeleton, the discharge -of urine being almost constant, at least every hour, -accompanied with a call that must be immediately obeyed: -the leading feature in the composition of the urine, in addition -to the varied presence of the urea, is the saccharine -matter contained therein. It rarely attacks others than -those who have led an irregular life, or else have suffered -much from other kinds of sickness.</p> - -<p>Diabetes is supposed to depend upon a perverted action -of the kidneys; but there is little dispute of its being a<span class="pagenum"><a id="Page_209"></a>[209]</span> -malady involving the whole process of animal economization. -The quantity of urine got rid of in a day has been -known to amount to ten quarts; as the disease continues, -the patient becomes much emaciated, the feet swell, and -he sinks into a state of low hectic fever; the urine discharged -continuing all this time to exceed nearly double -the amount of nourishment, liquid or solid, that is taken, -has given rise to the idea, that water is absorbed from the -atmosphere through the body. The disorder is generally -lingering, and, unless conquered, at last fatal. The treatment -embraces many remedies—bleeding, emetics, diaphoretics, -and sedatives, are mostly employed. It being a -complaint involving the necessity of constant professional -watchfulness, a more lengthened dissertation upon its peculiarities -will but little serve the patient. My own opinion -is, that the invalid must look for recovery—presuming -the initiatory symptoms have been duly attacked and subdued—to -careful diet, fresh air, varied scenery, and cheerful -society. Bathing, either vapor or warm, is immensely -useful; and, among the cases that have travelled across -my path (for patients laboring under diabetes, like any -other chronic ailment, generally take the round of the profession), -I have seen much and great good achieved by the -frequent employment of the bath.</p> - -<p>As diabetes is mostly a sequence of some previous disturbance -of the urinary system, it the more behooves the -afflicted to heed the first noticial summons of attack: a -handful of water will sometimes quench a mouldering ember -that, suffered to rise into a flame, an engineful can not -extinguish. I may add, there is no cause so destructive to -virility as these drainages from the system through the -urethra—an additional reason why they should be attended -to upon their first appearance.</p> - -<p><i>Cases where but a small quantity of urine is voided, terminating -in suppression, of urine.</i>—The most popular scientific -synonymes for complaints are but little understood by -men really of education; for, as yet, medical knowledge -forms not one of the items of collegiate lore, and few anticipate -sickness to render such acumen necessary. The -term “Strangury,” from the frequency of its occurrence, is -uppermost in most men’s minds; and they use it on all occasions -when there happens an interruption to the process -of making water. It is oftentimes misapplied. Strangury -implies a difficulty in voiding the urine, but it does not include<span class="pagenum"><a id="Page_210"></a>[210]</span> -those cases wherein little is voided, because there is -little to void. The affection I am now about to make -mention of, is of the latter description. I have stated that -the urine is subject to a multitude of changes, that the -human frame is constituted to exist under a variety of circumstances, -and that occurrences are daily happening, -wherein its integrity is put to the test. Excesses, termed -sensual, and others, which in themselves might destroy -life, are counterbalanced by what may be styled the <i>safety-valves</i> -of the system. A violent fit of purging, perspiration, -or micturition, is often the means of warding off an -otherwise fatal blow. The skin, the bowels, and the kidneys, -are severally to be acted upon as emergencies demand: -instance the specific operations of diet and medicines. -The color of the urine is altered by (to give a popular -illustration) <i>rhubarb</i>; its odor, by <i>turpentine</i> (taken -internally, or from an inhalation of the vapor of them), -and by the well-known vegetable <i>asparagus</i>; and its composition -by alkaline and other chymicals. The function -of cutaneous exhalation is augmented or diminished by -warmth or cold; and the action of the bowels is suspended -or increased by innumerable substances, forming portions -of our daily food.</p> - -<p>Analogous to these effects, is the result of certain conditions -of ill-health. A patient, laboring under fever or -inflammation of any important organ, will scarcely rid -himself of a wineglassful of blood-colored urine in the -twenty-four hours; and there are many forms of ailments, -where the function of separating the urine from the blood, -or even the function of supplying the kidneys with that -vital fluid, are suspended, partially or entirely. Few of -us have escaped attacks of this kind; they are sure to follow -long-pursued habits of dissipation, or even occasional -displays of it; and they are often the result of accidents -over which we have but little control. A patient will -complain of a frequent desire to make water; each effort -so to do, will be accompanied with excruciating pain. A -small quantity, or a few drops only, will dribble away, excoriating -the passage as though vinegar was passing over -it, and putting on an appearance almost resembling muddy -port wine, or a thick solution or suspension of brick dust: -there will be present much fever and constitutional disturbance. -The patient may have shivering fits, pain round -the loins, down the thighs, and over the lower part of the<span class="pagenum"><a id="Page_211"></a>[211]</span> -abdomen. He will betray a readiness to submit to anything, -although conscious that his bladder is empty, notwithstanding -the violent and urgent efforts at straining, -which he is continually being called upon to make, as -though his bladder were distended, and ready to burst. -On passing the catheter (I am supposing a severe case, -where retention of urine has at last occurred), not a drop -will flow, and the danger of the disease is thereby made -apparent. Except very severe measures be adopted, which -it would be idle here to lay down, the case is sure to terminate -fatally. Instances are recorded, where that event -has been retarded upward of a week, during which time -the patient voided not one drop of urine.</p> - -<p>The absolute cause of the disease is very obscure; but -it has a beginning, and to those only who suffer from a -long-continued diminution in this natural excretion, and -who disregard it, is this picture presented.</p> - -<p>The treatment, in advanced stages of the disease, is -strictly professional; but the warning of the altered character -of a customary evacuation, should not for a moment -be disregarded.</p> - -<p>Suppression of urine is very different from retention: -in the former, there is none to excrete; in the latter, its -escape is impeded. In the chapter on stricture, the cause -and manner of retention is explained, and the mode of relief -laid down, whereby the invalid himself has a remedy -at hand; but, in suppression, the resource is neither so -ready nor so effectual. It is, therefore, much wiser to notice -the first alteration, and to be prompt in seeking the -nearest aid. Every practitioner is acquainted with such. -Although such are not ever present, even in the most extensive -practice, still they do occur; and much as this -mode of frightening a patient may be condemned, knowing -the frequently existing disinclination toward “laying up,” -yet, if it only induce a fellow-mortal to take the tenth instead -of the eleventh hour, one life may be saved, and the -writer can well submit to the disapproval and contempt -of the thoughtless and indifferent.</p> - -<hr class="chap" /> - -<div class="chapter"> -<p><span class="pagenum"><a id="Page_212"></a>[212]</span></p> -<h2 class="no-page-break">THE GRAVEL.</h2> -</div> - -<p><span class="smcap">Under</span> the head of this disease may be classed all those -urinary affections, wherein a sandy deposite is observed, -after the urine has stood some time. This sandy excretion -varies in its composition, in the quantity voided, and in its -continuance: and it is also often separated, for it is held -generally in solution in the urine as it comes from the -bladder, while in the bladder or in the kidneys; and -hence we find gravel in the kidneys, in the bladder, and -in the urine. Where it is precipitated, or formed in the -kidneys or bladder, it is apt to accumulate, and constitute -what is called “Stone” in those organs. As I have just -observed, the composition of this gravel differs, and differs -also at different times in the same individual, according to -circumstances. Stones have been detected that, like the -rolling snowball, gather up, as they increase in size, whatever -comes in their way; and, accordingly, as the deposites -are principally composed of concretions, termed, in -chymical phraseology, “Lithates” and “Phosphates,” -stones are frequently found to be formed, first of a layer -of one covering, then of another, and so on.</p> - -<p>Gravel may exist for years without inducing much disturbance -of health, or it may produce serious inconvenience -in a very short time. The urine being acid, holds the -salts which it contains in solution; and, therefore, if the -acid predominate, it becomes, through its own excess, -thrown down, when it is detected in the form of red sand; -but if there be an insufficiency of acid, the earths and salts -of the urine are thrown down, and they exhibit their existence -in the form of white gravel. Hence the two names -“Red” and “White Gravel.” Acidulated urine is looked -upon as certainly indicative of health, and when in excess, -of a high tone of health; which, as the degree ascends, -is marked by inflammation and fever. Alkaline -urine betokens feebleness of constitution, or interrupted -health. High living and an excited life induce red gravel; -irregular, or an impoverished living, with much mental -inquietude and physical exhaustion, establish white gravel. -The fact of gravel being known to exist without forming -stone, is no justification to suffer it to incur even the -chance of such a finale. There is no class of diseases so -painful and distressing as those wherein the function of<span class="pagenum"><a id="Page_213"></a>[213]</span> -the kidneys or bladder is interrupted, and the majority of -these affections are ushered in by a derangement of the -urinary fluid.</p> - -<p><i>Cause of Gravel.</i>—The cause of gravel is owing to -chymical affinities. The urine, among its other constituents, -contains <i>lithic acid</i> and <i>ammonia</i>, which two, in -healthy urine, are combined and held in solution. If any -other acid, as may be instanced in expelled urine, possessing -a greater affinity for the <i>ammonia</i> than the <i>lithic -acid</i>, be added, the <i>lithic</i> will be thrown down. The same -process takes place when effected in the system, the -source of which new acid is the stomach, which, when in -an irritable and feeble state, as in indigestion, furnishes -or abounds with muriatic acid. In like manner, the urine -containing salts, called phosphate of lime, ammonia, and -magnesia, on receiving an additional quantity of ammonia,<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a> -the lime, for the less affinity to phosphoric acid than -the ammonia, is thrown down; and hence a salt, bearing -its name, is generated, either to be expelled like gravel, -or to feed a nucleus already existing in the bladder. -These chymical changes are produced by the causes before -enumerated. We are subject to an infinitude of laws: -we are perpetually changing, and these changes may fairly -be stated as chymical affinities: it is owing to such, that -the absorption of fluids, and the deposition of substances, -which exist more or less in all derangements of health, -ensue—to such, that we resist death, and to such that we -become its prey. Gravel is a disease not so productive -of fear or suffering, so long as it escapes when formed; -but there are so many circumstances that may give rise to -the formation of stone, that sandy urine should always -command notice and treatment. A clot or point of blood, -that may have been discharged from irritation of the kidney -or bladder, is often found to form the nucleus of a -stone: the slightest substance, once in the bladder, is apt -to form a basis for accumulation: a pin, a fragment of a -bougie, or any instrument, hair, wood, and numberless other -things that have found their way into the bladder, have -given rise to the formidable and distressing complaint of -stone.</p> - -<p><i>Treatment of Gravel.</i>—It is not to be anticipated that -every person is prone to excrete gravelly urine, else certain<span class="pagenum"><a id="Page_214"></a>[214]</span> -dietetics, that evidently give rise to the same in particular -instances, had better at once be removed from the -list of articles of food, and their use prohibited altogether; -but there are instances where a constitutional disposition -exists in particular families, that is even transmitted from -generation to generation, to calculous diseases, and in -those cases, every precaution should be taken to avoid -even their development.</p> - -<p>The antidotes to the disposition to gravelly urine are, exercise, -temperance, and the adoption of all those means -that tend to promote a healthy action of the skin and kidneys, -namely, the warm bath—it is a perfect talisman in -these affections—it needs but little eulogy; the comfort -and relief, where relief is sought, afforded on the first experiment, -best bespeak its praise. It is decidedly one of -the most useful adjunctive prophylactic measures we have.</p> - -<p>I have already stated, that disorders of the urine arrange -themselves under two great heads—the acid and the alkaline -prevalence. The treatment is to neutralize the excess -of either: the acid diathesis, as it is called, is considered -a less healthy deviation than the alkaline, and is looked -upon as indicative of greater constitutional break-up. The -medicines most in vogue in gravelly disorders are, turpentine -(to increase the formation of lithic acid), sulphuric, -nitric, and muriatic acids; while the antagonists to that -form of the disease, wherein the above are given, consist -of ammonia, potass, and soda. The great object, however, -is to balance the health, to allay irritation, and tranquillize -the morbid uproar of the system. Here we have an extensive -field to select from in the class of sedatives. Opium, -perhaps, is the best—the most to be depended upon, its -properties being best known; the warm bath comes next; -and lastly, the various tonics and astringents of our pharmacopœia, -of which quinine, uva ursi, pareira brava, achillæ -millefoliæ, buchu, &c., &c., stand foremost.</p> - -<p>Although the lithic acid deposition is the most frequent, -still, as the disease advances, there is a strong tendency to -the formation of the alkaline; and as the remedies for the -former are apt to accelerate the latter disorder, it is most -important that the urine should undergo frequent examination -to regulate the treatment. To recapitulate the -substance of this article, it may be stated, that gravel is a -disease, not dangerous in itself, but that it is always the -forerunner, although not always productive, of stone;<span class="pagenum"><a id="Page_215"></a>[215]</span> -stone being formed by the collection and chymical union -of the sand itself. This collection takes place in the kidney, -the ureters (the vessels that convey the urine to the -bladder), the bladder, and sometimes in the urethra. The -stone so formed varies in its composition and size, and is -one of the saddest ills that can befall human nature. Hence -the importance of watching, and attending to every urinary -disturbance, of which gravel forms a prominent feature, -the treatment of which has been already stated; but which, -as it involves more practised judgment than a non-professional -invalid can be supposed to possess, had better be -intrusted only to professional hands.</p> - - -<p class="center p4">THE END.</p> - -<hr class="chap" /> - -<div class="chapter"> -<h2 class="no-page-break">FORMULÆ</h2> -</div> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_1"></a><a href="#FManchor_1">Form 1</a>.</caption> - <tr> - <td class="colwFL tdlNP">Four to six drachms of castor oil, the ordinary black draught, - a dose of salts, or a dose of Weir’s Compound Pills.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_2"></a><a href="#FManchor_2">Form 2</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">The following mixtures lessens the acrimony in making water, - abdues the irritability, and tends to diminish the <span class="nobreak">discharge:—</span></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Carbonate of potass</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Nitrate of ditto</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of acacia</td> - <td class="colw2 tdr">5½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Hydrocyanic acid</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Syrup of Tolu</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Take a tablespoonful in a wineglassful of water twice daily.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_3"></a><a href="#FManchor_3">Form 3</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Linseed tea</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">pint.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spirits of Sweet Nitre</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Battley’s Sedative</td> - <td class="colw2 tdr">60</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Take three tablespoonfuls, twice or thrice daily.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_4"></a><a href="#FManchor_4">Form 4</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Where it is inconvenient for a patient to carry a bottle about his - person, the following electuary, combining the essential ingredients - of the former two, may be <span class="nobreak">substituted:—</span> - </td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lenitive electuary</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Conserve of roses</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Strong mucilage of acacia</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Nitrate of potass</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—Two teaspoonfuls twice or thrice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_5"></a><a href="#FManchor_5">Form 5</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">A good combination, that may be taken even in the inflammatory stage.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Cubebs</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Carbonate of magnesia</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—A dessert- or tablespoonful twice or thrice daily.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 2em;">SPECIFIC REMEDIES.</caption> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl"> </td> - <td class="colw2 tdr"> </td> - <td class="colw3 tdl"> </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_6"></a><a href="#FManchor_6">Form 6</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Balsam of copaiba</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Powder of cubebs</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of acacia</td> - <td class="colw2 tdr">6½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spirits of sweet nitre</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Battley’s sedative</td> - <td class="colw2 tdr">30</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Or—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Hydrocyanic acid (Scheele’s strength)</td> - <td class="colw2 tdr">8</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Syrup of orange-peel</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—Two tablespoonfuls, once or twice daily, in water.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_7"></a><a href="#FManchor_7">Form 7</a>.</caption> - <tr> - <td class="colwFL tdc"><i>Turpentine Pills.</i></td> - </tr> - <tr> - <td class="colwFL tdlNP">Take of Venice turpentine 1 drachm, form it into pills by adding as much rhubarb as is necessary, and take two, three times a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_8"></a><a href="#FManchor_8">Form 8</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Turpentine Mixture.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Venice turpentine</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of gum arabic</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Emulsion of bitter almonds</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Syrup of orange-peel</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—Two tablespoonfuls three times a day. Sedatives may be - conjoined with the above preparations, if they produce too much action - of the bowels. To the pills may be added one scruple of Dover’s powder - to the drachm of turpentine. To the mixture, thirty drops of laudanum.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_9"></a><a href="#FManchor_9">Form 9</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Terebinthin chiœ</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Extract of rhubarb</td> - <td class="colw2 tdr">1½</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Camphor</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix and divide into pills of 5 grains each. Dose—Three, three times a day.</td> - </tr> -</table> - -<div class="screen-only"> - <table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_10"></a><a href="#FManchor_10">Form 10</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0x tdl"> </td> - <td class="colw1x tdl">Cahio turpentine</td> - <td class="colw2x tdlTP" rowspan="3" style="max-width: 5px; vertical-align: middle;"> - <img src="images/big_right_bracket_p4.jpg" width="6" height="46" alt="rcurly" /> - </td> - <td class="colw3x tdlTP" rowspan="3" style="vertical-align: middle;">Of each, equal parts.</td> - </tr> - <tr> - <td class="colw0x tdl"> </td> - <td class="colw1x tdl">Balsam of copaiba</td> - </tr> - <tr> - <td class="colw0x tdl"> </td> - <td class="colw1x tdl">Oil of amber</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix, according to art. The turpentine must be dissolved by warmth. The - dose is 30 or 40 drops three or four times a day. This medicine is very - nauseous, but very serviceable in long standing gleets and obstinate - claps. The best way to remove the flavor left in the mouth after taking - turpentine, copaiba, and other filthy medicines, is to chew a piece - of gingerbread or cheese, or suck a lemon, or put some salt upon the - tongue. - </td> - </tr> - </table> -</div> - -<div class="handheld-only"> - <table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_10X"></a><a href="#FManchor_10">Form 10</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0x tdl"> </td> - <td class="colw1x tdl">Cahio turpentine</td> - <td class="colw2x tdlTP">}</td> - <td class="colw3x tdlTP"> </td> - </tr> - <tr> - <td class="colw0x tdl"> </td> - <td class="colw1x tdl">Balsam of copaiba</td> - <td class="colw2x tdlTP">}</td> - <td class="colw3x tdlTP">Of each, equal parts.</td> - </tr> - <tr> - <td class="colw0x tdl"> </td> - <td class="colw1x tdl">Oil of amber</td> - <td class="colw2x tdlTP">}</td> - <td class="colw3x tdlTP"> </td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix, according to art. The turpentine must be dissolved by warmth. The - dose is 30 or 40 drops three or four times a day. This medicine is very - nauseous, but very serviceable in long standing gleets and obstinate - claps. The best way to remove the flavor left in the mouth after taking - turpentine, copaiba, and other filthy medicines, is to chew a piece - of gingerbread or cheese, or suck a lemon, or put some salt upon the - tongue. - </td> - </tr> - </table> -</div> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_11"></a><a href="#FManchor_11">Form 11</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Injections to diminish the pain on making water.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Rose-water</td> - <td class="colw2 tdr">3</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Solution of the acetate of morphine</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_12"></a><a href="#FManchor_12">Form 12</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Goulard water</td> - <td class="colw2 tdr">3</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Solution of the acetate of morphine</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_13"></a><a href="#FManchor_13">Form 13</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Sedative draught to be taken at bed-time when annoyed with chordee.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Acetated liquor of ammonia</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Camphor julep</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Solution of the acetate of morphine</td> - <td class="colw2 tdr">20</td> - <td class="colw3 tdlTP">to 25 drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_14"></a><a href="#FManchor_14">Form 14</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Dover’s powder</td> - <td class="colw2 tdr">12</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">James’s powder</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_15"></a><a href="#FManchor_15">Form 15</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound camphor liniment</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Laudanum</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix, to form a liniment.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_16"></a><a href="#FManchor_16">Form 16</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Injection for the ulceration of the glans penis.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Chloride of soda</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Rose-water</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_17"></a><a href="#FManchor_17">Form 17</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Nitrate of silver</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Distilled water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_18"></a><a href="#FManchor_18">Form 18</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Calomel</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lime-water</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_19"></a><a href="#FManchor_19">Form 19</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Emetic Powder.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ipecacuanha powder</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Emetic tartar</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">grain.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. To be taken in a glassful of warm water, and repeated - in twenty minutes, if it do not produce vomiting.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_20"></a><a href="#FManchor_20">Form 20</a>.</caption> - <tr> - <td class="colwFL tdc"><i>Iodine.</i></td> - </tr> - <tr> - <td class="colwFL tdlNP">Take of tincture of iodine twenty drops twice or thrice a day in a little water.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_21"></a><a href="#FManchor_21">Form 21</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Hydriodate of potass</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of acacia</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Camphor julep</td> - <td class="colw2 tdr">5½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Dose—three tablespoonfuls three times a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_22"></a><i>The Sedative Application to anoint a Bougie with.</i></caption> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl"> </td> - <td class="colw2 tdr"> </td> - <td class="colw3 tdl"> </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 0.1em;"><a href="#FManchor_22">Form 22</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Extract of Aconitine</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">grain.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Oil of Olives</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_23"></a><a href="#FManchor_23">Form 23</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Or take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Extract of Henbane</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lard or Olive Oil</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_24"></a><a href="#FManchor_24">Form 24</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Or take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Acetate of Morphine</td> - <td class="colw2 tdr">3</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Simple Cerate or Oil</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_25"></a><i>Stimulating Application.</i></caption> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl"> </td> - <td class="colw2 tdr"> </td> - <td class="colw3 tdl"> </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 0.1em;"><a href="#FManchor_25">Form 25</a>.</caption> - <tr> - <td class="colwFL tdlNP">Take of powder of calcined alum, and dust the end of a bougie - previously oiled, and introduce it to the stricture in the usual - manner, and suffer it to remain until the obstacle be overcome. - Occasionally the bougie may be smeared with the balsam copaiba, - where the case is chronic, and there happens to be much secretion - from the part.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_26"></a><a href="#FManchor_26">Form 26</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Iodide of potass</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mercurial ointment</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Simple cerate</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. A portion to be rubbed over the scrotum night and morning, as long as it can be borne.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_27"></a><a href="#FManchor_27">Form 27</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Strong caustic solution of Dr. Doane.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Caustic</td> - <td class="colw2 tdr">⅓</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Distilled water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_28"></a><a href="#FManchor_28">Form 28</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Wash for Chancres.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">The solution of chloride of soda</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Rose-water</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_29"></a><a href="#FManchor_29">Form 29</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Black wash for Chancres.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Calomel</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">scruple.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lime-water</td> - <td class="colw2 tdr">3</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_30"></a><a href="#FManchor_30">Form 30</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Red wash for Chancres.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Bi-chloride of mercury</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lime-water</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;">Or, <a id="Form_31"></a><a href="#FManchor_31">Form 31</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Blue wash for Chancres.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of copper</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Distilled water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix and strain.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">For dressing chancres, lotions and washes generally answer better - than ointments; but their alternate use is sometimes serviceable. - In cracked sores near the prepuce, the blue ointment has wrought - a cure when all the lotions devised were ineffectual.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_32"></a><a href="#Form_31">Form 32</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Red precipitate of mercury</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ointment of spermaceti</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—A little to be smeared over the ulcer, twice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_33"></a><a href="#FManchor_33">Form 33</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Active aperient in indolent Chancres.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Calomel</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Powder of jalap</td> - <td class="colw2 tdr">15</td> - <td class="colw3 tdlTP">to 20 grains.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—To be taken in something thick, as jelly, honey, or tamarinds.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_34"></a><a href="#FManchor_34">Form 34</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Active aperient, to be mixed in water and (stirring it) to be drank off quickly.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Chloride of mercury, or calomel</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Powder of jalap</td> - <td class="colw2 tdr">25</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_35"></a><a href="#FManchor_35">Form 35</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Ointment to promote absorption of Bubo.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Iodine of potassium</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Tincture of iodine</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Acetate of morphine</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—Apply constantly a plaister of some of this ointment spread - upon rag or lint, over the bubo, and occasionally rub a little of - it gently into the skin.—<i>Doane.</i></td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;">Or, <a id="Form_36"></a><a href="#FManchor_36">Form 36</a>.</caption> - <tr> - <td class="colwFL tdlNP">Take of blue ointment a similar quantity, and use it in like manner to - the preceding. The reliance to be placed on this ointment is precisely - the same as the other, namely, to excite absorption. The following - ointment may also be used for the same purpose.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_37"></a><a href="#FManchor_37">Form 37</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Calomel</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Simple ointment</td> - <td class="colw2 tdr">6</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_38"></a><a href="#FManchor_38">Form 38</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Stimulating ointments to promote the healing of indolent ulcerated Buboes.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Red precipitate of mercury</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ointment of spermaceti</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—The ulcer to be dressed with a small portion of this ointment - spread upon lint. Or the following, which is <span class="nobreak">stronger:—</span></td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_39"></a><a href="#FManchor_39">Form 39</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Red precipitate of mercury</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Yellow basilicon</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ointment of spermaceti</td> - <td class="colw2 tdr">6</td> - <td class="colw3 tdlTP">drachms.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—To be used like the preceding.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;">Or, <a id="Form_40"></a><a href="#FManchor_40">Form 40</a>.</caption> - <tr> - <td class="colwFL tdlNP">Take of nitrated ointment of mercury, diluted with an equal proportion - of simple ointment.</td> - </tr> - <tr> - <td class="colwFL tdlNP">Or, the unadulterated strong mercurial ointment.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_41"></a><a href="#FManchor_41">Form 41</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Styptic application for indolent Ulcers.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Caustic</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl">Or,</td> - <td class="colw1 tdl">Sulphate of copper</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Distilled water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix and strain, and smear the surface of the sore with a hair - pencil, impregnated with either of the solutions: simple or - astringent dressings may be applied afterward.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_42"></a><a href="#FManchor_42">Form 42</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Chloride of soda</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Rose-water</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_43"></a><a href="#FManchor_43">Form 43</a>.</caption> - <tr> - <td class="colwFL tdc"><i>Preparation of Iron.</i></td> - </tr> - <tr> - <td class="colwFL tdlNP">Take two drachms of carbonate of iron three times a day, gradually - increasing the dose to half an ounce, or even an ounce; the bowels - during the taking of this medicine should be kept open.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_44"></a><a href="#FManchor_44">Form 44</a>.</caption> - <tr> - <td class="colwFL tdc"><i>The following is an excellent combination.</i></td> - </tr> - <tr> - <td class="colwFL tdlNP">Take of compound iron pill two drachms, to be divided into 24 - <span class="nobreak">pills—two</span> to be taken three times a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_45"></a><a href="#FManchor_45">Form 45</a>.</caption> - <tr> - <td class="colwFL tdc"><i>Quinine.</i></td> - </tr> - <tr> - <td class="colwFL tdlNP">Take three grains of sulphate of quinine three times a day. Or,</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_46"></a><a href="#FManchor_46">Form 46</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound tincture of bark</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sulphate of quinine</td> - <td class="colw2 tdr">12</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Muriatic acid</td> - <td class="colw2 tdr">20</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—Dose, a teaspoonful three times a day, in water.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_47"></a><a href="#FManchor_47">Form 47</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Strengthening Pills.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Ioduret of iron</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Castile soap</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Alkaline extract of gentian</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—To form 30 pills—take one twice daily.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_48"></a><a href="#FManchor_48">Form 48</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Tonic and Alterative Mixture.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Oxymuriate of mercury</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Muriatic acid</td> - <td class="colw2 tdr">60</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Tincture of bark</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix.—A teaspoonful to be taken twice or three times a day in a little water.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">These drops are highly serviceable to persons of weak constitutions, - whom it is desirable to place under the influence of mercury. They - form the basis of most of the advertised anti-scorbutic drops of the - patent medicine venders.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_49"></a><a href="#FManchor_49">Form 49</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>Compound decoction of Sarsaparilla.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sarsaparilla root, sliced</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Boiling water</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">pints.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Macerate for four hours in a vessel lightly covered, and placed - near the fire; then take out the sarsaparilla and bruise it; return - it again to the liquor, and macerate in a similar manner for two - hours; boil it down to two pints, strain it, and then <span class="nobreak">add—</span></td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sassafras root, sliced</td> - <td class="colw2 tdr">¼</td> - <td class="colw3 tdlTP">ounce.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Guaiacum root, rasped</td> - <td class="colw2 tdr">¼</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Liquorice root, bruised</td> - <td class="colw2 tdr">¼</td> - <td class="colw3 tdlTP">do.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Bark of mezeroon root</td> - <td class="colw2 tdr">1½</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Boil the whole together for a quarter of an hour, and strain.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Dose, from a quarter to half a pint, three times a day.</td> - </tr> - <tr> - <td class="tdlNP" colspan="4">To avoid the tediousness of daily preparing the above, many - manufacturing chemists evaporate a large quantity, and preserve - the extract, which retains all the virtues of the decoction, and - is at all times ready for immediate use. Or,</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_50"></a><a href="#FManchor_50">Form 50</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Bruised root of Jamaica sarsaparilla</td> - <td class="colw2 tdr">4</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Liquorice root, sliced</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">ounce.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Lime-water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">quart.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Macerate for 24 hours in a dark and cool <span class="nobreak">place—strain</span> and bottle it, - and take a pint daily in divided doses. This is a very superior form - of administering sarsaparilla. Or,</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_51"></a><a href="#FManchor_51">Form 51</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Oxymuriate of mercury</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Muriatic acid</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Compound extract of sarsaparilla</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Dissolve the same in one quart of water, and take a wineglassful twice a day.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_52"></a><a href="#FManchor_52">Form 52</a>.</caption> - <tr> - <td class="tdc" colspan="4"><i>The Iodide of Potass Mixture.</i></td> - </tr> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Iodide of potassium</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Iodine</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of acacia</td> - <td class="colw2 tdr">3</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Hydrocyanic acid</td> - <td class="colw2 tdr">12</td> - <td class="colw3 tdlTP">drops.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Pure water</td> - <td class="colw2 tdr">5</td> - <td class="colw3 tdlTP">ounces.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">White sugar</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">ounce.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Take a dessert- or tablespoonful twice or thrice daily in a wineglassful of water.</td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_53"></a><a href="#FManchor_53">Form 53</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Iodide of potassium</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Acetate of morphine</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP">grains.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spermaceti ointment</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Rub a portion, the size of a nut, over the affected part - night and morning. If much irritation be produced, it must be - disused for a time.</td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">Forms <a id="FManchor_54"></a><a href="#Form_54" class="fmanchor">54</a>, - <a id="FManchor_55"></a><a href="#Form_55" class="fmanchor">55</a>, - <a id="FManchor_56"></a><a href="#Form_56" class="fmanchor">56</a>, - <a id="FManchor_57"></a><a href="#Form_57" class="fmanchor">57</a> - see pages <a href="#Page_126">126</a>–<a href="#Page_128">128</a>. - </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a id="Form_58"></a><a href="#FManchor_58">Form 58</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Sarsaparilla sliced</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">China root</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Dry rind of 20 walnuts.</td> - <td class="colw2 tdr"> </td> - <td class="colw3 tdlTP"> </td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Antimony</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Pumice stone</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">(Tied in separate bags, and boiled with the other ingredients.)</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Distilled water</td> - <td class="colw2 tdr">10</td> - <td class="colw3 tdlTP">pints.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Boil to one half, and strain.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Dose—An aleglassful twice or thrice daily.</td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">Forms <a id="FManchor_59"></a><a href="#Form_59" class="fmanchor">59</a>, - <a id="FManchor_60"></a><a href="#Form_60" class="fmanchor">60</a>, - <a id="FManchor_61"></a><a href="#Form_61" class="fmanchor">61</a>, - <a id="FManchor_62"></a><a href="#Form_62" class="fmanchor">62</a> - see page <a href="#Page_132">132</a>. - </td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;"><a id="Form_63"></a>The best aperient for females - is certainly a combination of castor oil. The following form is a very good <span class="nobreak">one:—</span> - </td> - </tr> -</table> - -<table class="forms"> - <caption style="padding-top: 1em;"><a href="#FManchor_63">Form 63</a>.</caption> - <tr> - <td class="tdlNP" colspan="4">Take of—</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Castor oil</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Mucilage of acacia</td> - <td class="colw2 tdr">2</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Spirits of sweet nitre</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">drachm.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Syrup of orange-peel</td> - <td class="colw2 tdr">½</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="colw0 tdl"> </td> - <td class="colw1 tdl">Water</td> - <td class="colw2 tdr">1</td> - <td class="colw3 tdlTP">oz.</td> - </tr> - <tr> - <td class="tdl" colspan="4">Mix. Take half for a dose.</td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">Forms - <a id="FManchor_64"></a><a href="#Form_64" class="fmanchor">64</a>, - <a id="FManchor_65"></a><a href="#Form_65" class="fmanchor">65</a>, - <a id="FManchor_66"></a><a href="#Form_66" class="fmanchor">66</a>, - <a id="FManchor_67"></a><a href="#Form_67" class="fmanchor">67</a>, - <a id="FManchor_68"></a><a href="#Form_68" class="fmanchor">68</a>, - <a id="FManchor_69"></a><a href="#Form_69" class="fmanchor">69</a>, - <a id="FManchor_70"></a><a href="#Form_70" class="fmanchor">70</a> - see pages <a href="#Page_156">156</a>–<a href="#Page_158">158</a>. - </td> - </tr> -</table> - -<table class="forms"> - <tr> - <td class="colwFL tdlXP" style="padding-top: 1em;">Forms - <a id="FManchor_71"></a><a href="#Form_71" class="fmanchor">71</a>, - <a id="FManchor_72"></a><a href="#Form_72" class="fmanchor">72</a>, - <a id="FManchor_73"></a><a href="#Form_73" class="fmanchor">73</a>, - <a id="FManchor_74"></a><a href="#Form_74" class="fmanchor">74</a>, - <a id="FManchor_75"></a><a href="#Form_75" class="fmanchor">75</a>, - <a id="FManchor_76"></a><a href="#Form_76" class="fmanchor">76</a>, - <a id="FManchor_77"></a><a href="#Form_77" class="fmanchor">77</a>, - <a id="FManchor_78"></a><a href="#Form_78" class="fmanchor">78</a>, - <a id="FManchor_79"></a><a href="#Form_79" class="fmanchor">79</a> - see pages <a href="#Page_158">158</a>–<a href="#Page_161">161</a>. - </td> - </tr> -</table> - - -<hr class="chap" /> - -<div class="footnotes"> - -<div class="chapter"> -<h2 class="no-page-break large">FOOTNOTES</h2> -</div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> -A wash composed of one part of the chloride of soda, with five -of water, is as good as can be used; the same may be injected up -the urethra.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> -Lining internal structures which have no outlet, as that in the -abdomen, called the peritoneal.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> -To enter into a description of the pathological condition of the -bladder in the several states of irritability, paralysis, and inflammation, -would be to swell this article to an inordinate length, and -serve no useful purpose—the symptoms and treatment comprising -the most essential knowledge for the patient to possess. It may -be briefly stated, that the bladder is less subject to become disorganized -(the function being chiefly the disordered symptom), and -sooner even regains its tone than other organs not less important -to life.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> -Colles, Wallace, Ricord, of the Venereal hospital, Paris.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> -<i>Mercury.</i></p> - -<p class="fn-para">The preparations of mercury are various: but those chiefly employed -in the treatment of syphilis are the oxymuriate, or bi-chloride, -the submuriate, or chloride, the red precipitate, or the hydrargyri -nitrico-oxydum, the blue pill, the red sulphate for fumigations, -and the blue ointment.</p> - -<p class="fn-para">Ptyalism or salivation, which implies an extraordinary secretion -of the salivary and other glands, occasioned by the taking of mercury, -inasmuch that when carried to an unwarrantable extent, ulceration -is the consequence, may be produced by the internal exhibition -or external application of almost any of its preparations. -With this view, however, the blue pill is usually administered in -doses of five grains twice a day, or the blue ointment is directed to -be rubbed in on the inner part of the legs and thighs, in quantities -varying from one to two drachms night and morning. Mercury, -when given to excite ptyalism, is generally taken in conjunction -with sarsaparilla (see Form 51, or the fluid extract). The symptoms -whereby the effects of mercury are ascertained, are a coppery taste -in the mouth, followed by a tenderness of the gums on mastication, -an increased flow of the saliva, and a peculiar fœtor of the breath. -It is usual, on the tainted taste being perceptible, to diminish or -discontinue the further use of the medicine, unless the case be very -severe, or merely to keep up the effect produced. But it can not -be denied that, although sufficiently manageable in scientific hands, -mercury, or any one of its preparations, is too powerful to be taken -indiscriminately.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> -<i>Antimony.</i></p> - -<p class="fn-para">The preparations of antimony consist of the precipitated sulphuret, -called now the oxysulphuret of antimony, and the powder, as -directed to be made in the Pharmacopœia, or its secret modification, -known by the name of “Dr. James’s Powder.” The sulphuret enters -into the composition of the red or Plummer’s pills, which is an -admirable alterative, given in conjunction with sarsaparilla, in doses -of five grains, once or twice a day. The James’s powder, with the -like intention, may be taken in two or three grain doses twice or -thrice a day.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> -Wagner, translated by Dr. Willis.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> -Some say eight days after.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> -Instances of different conceptions following connexion at brief -intervals are of occasional occurrence.</p> - -<p class="fn-para">A case is recorded of a negress having brought forth a negro and -a mulatto child, and who confessed having received the embraces -of a white and a negro the same evening. Drs. Dewees of Philadelphia, -and Francis of New York, adduce similar instances.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> -The membrane containing the liquid comes away with the after-birth -or placenta; but when it is brought away with the child’s -head, it is named a “caul,” to which the ignorant attach a superstitious -belief that it saves the possessor from drowning, and hence -it has been a source of traffic between the cunning and the weak-minded. -Cauls are made by detaching the membrane from the placenta.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> -Yellow wax may be substituted for the white wax, which renders -the ointment stronger and better adapted for excoriations that -yield a discharge.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> -Every nurse is acquainted with the usefulness of starch, tutty -powder, Fuller’s earth, &c.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> -Blundell.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> -Dr. A. Sidney Doane has recorded a case, in his edition of -“Good’s Study of Medicine,” where a woman brought forth fifty-seven -children.—Vol. ii., p. 503.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> -A patient was admitted into the ophthalmic wards of the Hotel -Dieu, Paris, with great weakness of sight, amounting almost to -amaurosis. He confessed that he was in the habit of polluting -himself, and that he was immediately seized with complete blindness -whenever he addicted himself to the practice. Cases very -similar to the above have been noticed by Dr. Doane, of New York, -who has paid great attention to diseases of this character.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> -The convertibility of India-rubber to so many useful purposes -has not escaped the attention of surgeons, and it is found to be an -excellent material for trusses, pessaries, bougies, &c., and consequently -much used for them. I find them in my own practice far -preferable to metallic or any other description. Many cases of -hæmorrhoids, as well as of prolapsus, that have been given up as -incurable, on account of the parties objecting to wear metallic instruments, -or submit to the operation of excision or ligature, have -speedily yielded to the application of the same manufactured of India-rubber; -indeed, every day’s experience so convinces me of their -superiority and efficacy as a remedy in these disorders, that a patient -afflicted with the most formidable form of either disease need not -despair of a prompt and certain recovery.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> -The specific gravity of the urine materially depends upon those -causes which act diuretically, and upon the quantity of fluids swallowed, -which, if taken in excess, of course increases the watery -portion of the urine, and vice versa. The density of the urine is -ascertained by an instrument called an “Hydrometer,” which, upon -being immersed in the urine, indicates its specific gravity. The -usual specific gravity of healthy human urine varies from 1.010 to -1.015, while the temperature ranges from 75 degrees of Fahrenheit -to 120. The quantity averages from two to three pints per diem, -but depends not only upon the quantity of fluids consumed, but also -upon the nature of the food, vegetables generating more urine than -animal substances. In infancy and old age, the temperature of the -urine is below this standard, but nearly equivalent to each other; -whereas it is only at the period of puberty that the temperature -noted exists.</p></div> - -<div class="footnote"> -<p class="fn-para"><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> -Furnished in the system by the decomposition of urea.</p></div> - -</div> - -<hr class="chap" /> - -<div class="transnote"> - -<p class="center bold small"><a id="TN" name="TN"></a>Transcriber’s Note (continued)</p> - -<p class="TN-style-1">Obvious punctuation errors in the transcribed text have been repaired.</p> - -<p class="TN-style-1">Variations in spelling are common in this book. In the case of medical terms -in which the ligatures ‘æ’ and ‘œ’ could be used, the variations are -numerous and noticeable. Thus we find the terms “hemorrhage”, “hæmorrhage” and -“hœmorrhage” being used interchangeably. Similarly for “hæmorrhoids” -and “hœmorrhoids” and all the words derived from the foregoing terms.</p> - -<p class="TN-style-1">Except as noted below, unusual or variable spelling and hyphenation as -published in the original book have been retained.</p> - -<p class="TN-style-2">Page 11 — “membraneous” changed to “membranous” (diminishes at the membranous portion)</p> - -<p class="TN-style-2">Page 16 — “then,” changed to “them” (that connects them together)</p> - -<p class="TN-style-2">Page 21 — “developes” changed to “develops” (the sooner develops the disease)</p> - -<p class="TN-style-2">Page 22 — “ay” changed to “any” (to resist any efforts)</p> - -<p class="TN-style-2">Page 24 — “arm-pits” changed to “armpits” (under the armpits)</p> - -<p class="TN-style-2">Page 29 — “gonorrhæa” changed to “gonorrhœa” (in curing gonorrhœa;)</p> - -<p class="TN-style-2">Page 30 — “head-ache” changed to “headache” (inclination to headache)</p> - -<p class="TN-style-2">Page 50 — “surfacial” changed to “surficial” (surficial and muscular membranes)</p> - -<p class="TN-style-2">Page 54 — “fœces” changed to “fæces” (the fœces pass in small quantities)</p> - -<p class="TN-style-2">Page 58 — “permaneut” changed to “permanent” (permanent irritability of the bladder)</p> - -<p class="TN-style-2">Page 62 — “now” changed to “how” (to show how imperative it is)</p> - -<p class="TN-style-2">Page 80 — “coherd” changed to “cohered” (where numbers cohered together)</p> - -<p class="TN-style-2">Page 85 — “empyrical” changed to “empirical” (by the most empyrical measures)</p> - -<p class="TN-style-2">Page 87 — “chancerous” changed to “chancrous” (a chancrous sore)</p> - -<p class="TN-style-2">Page 89 — “accompanying” changed to “above” (Witness the above wood-cut.)</p> - -<p class="TN-style-2">Page 102 — “incrustrations” changed to “incrustations” (similar incrustations are formed)</p> - -<p class="TN-style-2">Page 107 — “desquemated” changed to “desquamated” (the pimple has broken or desquamated)</p> - -<p class="TN-style-2">Page 109 — “raced” changed to “traced” (to such weknesses may be traced the relapses)</p> - -<p class="TN-style-2">Page 118 — “desquemate” changed to “desquamate” (exfoliate, or scurf, or desquamate)</p> - -<p class="TN-style-2">Page 125 — “are are” changed to “are” (There are also deep and painful fissures)</p> - -<p class="TN-style-2">Page 131 — “pecuiar” changed to “peculiar” (a peculiar contour of the countenance)</p> - -<p class="TN-style-2">Page 134 — “triflind” changed to “trifling” (trifling errors in diet)</p> - -<p class="TN-style-2">Page 137 — “unimpergnated” changed to “unimpregnated” (when unimpregnated, is very compact)</p> - -<p class="TN-style-2">Page 146 — “corpulant” changed to “corpulent” (like a very corpulent man)</p> - -<p class="TN-style-2">Page 149 — “ipresses” changed to “impresses” (the womb impresses upon the bladder)</p> - -<p class="TN-style-2">Page 167 — “Henry III.” changed to “Henry II.” (Henry II. consulted one Fernal for the infertility of his queen, Catherine de Medicis)</p> - -<p class="TN-style-2">Page 196 — “protusion” changed to “protrusion” (extraordinary protrusion of piles)</p> - -<p class="TN-style-2">Page 200 — “bladders” changed to “bladder” (into the bladder whence it is voided)</p> - -<p class="TN-style-2">Page 214 — “pharmacopœa” changed to “pharmacopœia” (of our pharmacopœia)</p> - -<p class="TN-style-1">In anatomical references, the book uses “chord” throughout in place of -“cord” — see for example “umbilical chord” and “spermatic chord”.</p> - -<p class="TN-style-1">There are seventy-nine treatment recipes/formulæ -(“Forms”) in the book. All are printed in a similar style. However -fifty-five appear as footnotes while the rest appear in page text. -For ease of reference in the transcription, all the footnoted Forms -have been gathered together and moved to a new FORMULÆ annex at the -end of the book. Minor changes to the page text consequent on the new -arrangement are as follows:</p> - -<p class="TN-style-2">Page 31 — “[See annexed Formulæ 2, 3, 4, 5.]” changed to “[See Forms 2, 3, 4, 5 in Formulæ annex.]”</p> - -<p class="TN-style-2">Page 33 — “Subjoined are” changed to “See Formulæ annex for”</p> - -<p class="TN-style-2">Page 34 — “(see note)” changed to “(see Formulæ annex)”</p> - -<p class="TN-style-1">While the original style and content of the -seventy-nine Forms has been carefully preserved, minor corrections -to the layout of some have been made so that all are displayed to -the reader in a consistent format. This avoids small but distracting -variations on a page that look like errors in transcription. For the -same reason, variations in the spelling of dosage measures in the -Forms have been regularised. Thus “table spoonful”, “table-spoonful” -and “tablespoonful” all appear as “tablespoonful”. Similarly for -“teaspoonful” and “wineglassful”. Plural forms have been changed in the -same way. For consistency, the regularising of these words has also -been applied to their appearance elsewhere in the body text.</p> - -<p class="TN-style-1">Ordinary footnotes have been re-indexed using -numbers and moved to a FOOTNOTES section placed after the FORMULÆ -annex.</p> - -<p class="TN-style-1">References on a page to originally footnoted -Forms are now clickable links to their text in the new FORMULÆ annex. -Ordinary footnote references on a page are now clickable links to their -text in the FOOTNOTES section.</p> - -<hr class="r10" /> - -<p class="TN-style-1 brhide">For technical reasons beyond the control -of the transcriber, long chapters in this EPUB version have had to -be partitioned into smaller segments of text and illustrations. The -reader will see the break between each segment represented as a -‘thought break’. They appear at places in the chapter where the author -has started a new subject for discussion. These are easily recognised -because the author features the subject title in <i>italic font</i> as -the first sentence of a new paragraph. The following extract is an -example:</p> - -<p class="TN-style-1A brhide"><i>The Surgical Treatment of -Gonorrhœa.</i>—The principal symptoms ....</p> - -<p class="TN-style-1 brhide">When a thought break occurs before such -a paragraph, it is displayed to the reader as a short, centered, rule -thus:</p> - -<p class="TN-style-1 brhide" style="padding-left: 10em">———<>———</p> - -<p class="TN-style-1 brhide">The original chapter text around a thought -break is not altered in any way.</p> - -<p class="TN-style-1"><a class="underline" href="#top">Back to top</a></p> -</div> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK PORNEIOPATHOLOGY ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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