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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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