Domestic Medicine - Chapter 47



CHAPTER XLVII.
OF THE VENEREAL DISEASE.

IN a former edition of this book the venereal disease was omitted. The 
reasons however which at that time induced me to leave it out, have upon 
more mature consideration vanished. Bad consequences, no doubt, may arise 
from ignorant persons tampering with medicine in this disorder; but the 
danger from that quarter seems to be more than balanced by the great and 
solid advantages, which must arise to the patient from an early knowledge 
of his case, and an attention to a plan of regimen, which, if it does not 
cure the disease, will be sure to render it more mild, and less hurtful to 
the constitution.

IT is peculiarly unfortunate for the unhappy persons who contract this 
disease, that it lies under a sort of disgrace. This renders disguise 
necessary, and makes the patient either conceal his disorder altogether, 
or apply to those who promise a sudden and secret cure; but who in fact 
only remove the symptoms for a time, while they fix the disease deeper in 
the habit. By this means a slight infection, which might have been easily 
removed, is often converted into an obstinate, and sometimes incurable 
malady.

ANOTHER unfavourable circumstance attending this disease is, that it 
assumes a variety of different shapes, and may with more propriety be 
called an assemblage of diseases, than a single one. No two diseases can 
require a more different method of treatment than this does in its 
different stages. Hence the folly and danger of trusting to any particular 
nostrum for the cure of it. Such nostrums are however generally 
administered in the same manner to all who apply for them, without the 
least regard to the state of the disease, the constitution of the patient, 
the degree of infection, and a thousand other circumstances of the utmost 
importance.

THOUGH the venereal disease is generally the fruit of unlawful embraces, 
yet it may be communicated to the innocent as well as the guilty. Infants, 
nurses, midwives, and married women whose husbands lead dissolute lives, 
are often affected with it, and frequently lose their lives by not being 
aware of their danger in due time. The unhappy condition of such persons 
will certainly plead our excuse, if any excuse be necessary, for 
endeavouring to point out the symptoms and cure of this too common disease.

TO enumerate all its different symptoms, however, and to trace the disease 
minutely through its various stages, would require a much larger space 
than falls to this part of my subject; I shall therefore confine my 
observations chiefly to circumstances of importance, omitting such as are 
either trifling, or which occur but seldom. I shall likewise pass over the 
history of the disease, with the different methods of treatment which it 
has undergone since it was first introduced into Europe, and many other 
circumstances of a similar nature; all of which, though they might tend to 
amuse the reader, yet could afford him little or no useful knowledge.


OF THE VIRULENT GONORRHOEA.

THE virulent gonorrhoea is an involuntary discharge of infectious matter 
from the parts of generation in either sex. It generally makes its 
appearance within eight or ten days after the infection has been received; 
sometimes indeed it appears in two or three days, and at other times not 
before the end of four or five weeks. Previous to the discharge, the 
patient feels an itching with a small degree of pain in the genitals. 
Afterwards a thin glary matter begins to distil from the urinary passage, 
which stains the linen, and occasions a small degree of titillation, 
particularly in the time of making water; this gradually increasing, 
arises at length to a degree of heat and pain, which are chiefly perceived 
about the extremity of the urinary passage, where a slight degree of 
redness and inflammation likewise begin to appear.

AS the disorder advances, the pain, heat of urine, and running, increase, 
while fresh symptoms daily ensue. In men the erections became painful and 
involuntary, and are more frequent and lasting than when natural. This 
symptom is most troublesome when the patient is warm in bed. The pain 
which was at first only perceived towards the extremity, now begins to 
reach all up the urinary passage, and is most intense just after the 
patient is done making water. The running gradually recedes from the 
colour of seed, grows yellow, and at length puts on the appearance of 
matter.

WHEN the disorder has arrived at its height, all the symptoms are more 
intense; the heat of urine is so great, that the patient dreads the making 
water, and though he feels a constant inclination this way, yet it is 
rendered with the greatest difficulty, and often only by drops: the 
involuntary erections now become extremely painful and frequent; there is 
also a pain, heat, and sense of fulness about the seat, and the running is 
plentiful and sharp, of a brown, greenish, and sometimes of a bloody 
colour.

BY a proper treatment the violence of the sympttoms gradually abates; the 
heat of urine goes off; the involuntary and painful erections, and the 
heat and pain about the seat become easier; the running also gradually 
decreases, grows whiter and thicker, till at last it entirely disappears.

BY attending to these symptoms, the gonorrhoea may be generally 
distinguished from any other disease. There are however some few disorders 
for which it may be mistaken, as an ulcer in the kidnies or bladder, the 
fluor albus or whites in women, &c. But in the former of these, the matter 
comes away only with the urine, or when the sphincter of the bladder is 
open; whereas in a gonorrhoea, the discharge is constant. The latter is 
more difficult to distinguish, and must be known chiefly from its effects, 
as pain, communicating the infection, &c.

REGIMEN. - When a person has reason to suspect that he has caught the 
venereal infection, he ought most strictly to observe a cooling regimen, 
to avoid every thing of a heating nature, as wines, spirituous liquors, 
rich sauces, spiced, salted, high-seasoned and smoke-dried provisions, &c. 
as also all aromatic and stimulating vegetables, as onions, garlic, 
shallot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His food 
ought chiefly to consist of mild vegetables, milk, broths, light puddings, 
panado, gruels, &c. His drink may be barley-water, milk and water, 
decoctions of marsh-mallows and liquorice, linseed-tea, or clear whey. Of 
these he ought to drink plentifully. Violent exercise of all kinds, 
especially riding on horseback, and venereal pleasures, are to be avoided. 
The patient must beware of cold, and when the inflammation is violent, he 
ought to keep his bed.

MEDICINE - A virulent gonorrhoea cannot always be cured speedily and 
effectually at the same time. The patient ought therefore not to expect, 
nor the physician to promise it. It will often continue for two or three 
weeks, and sometimes for five or six, even where the treatment has been 
very proper.

SOMETIMES indeed a slight infection may be carried off in a few days, by 
bathing the parts in warm milk and water, and injecting frequently up the 
urethra a little sweet oil or linseed-tea about the warmth of new milk. 
Should these not succeed in carrying off the infection, they will at least 
have a tendency to lessen its virulence.

TO effect a cure, however, astringent injections will generally be found 
necessary. These may be various ways prepared, but I think those made with 
the white vitriol are both most safe and efficacious. They can be made 
stronger or weaker as circumstances may require, but it is best to begin 
with the more gentle, and increase their power if necessary. I generally 
order a drachm of white vitriol to be dissolved in eight or nine ounces of 
common, or rose-water, and an ordinary syringe full of it to be thrown up 
three or four times a-day. If this quantity does not perform a cure, it 
may be repeated, and the dose increased. Although it is now very common to 
cure the gonorrhoea by astringent injections, there are still many 
practitioners who do not approve this mode of practice. I can, however, 
from much experience, assert that it is both of the most easy, elegant, 
and efficacious method of cure; and that any bad consequences arising from 
it must be owing to the ignorance or misconduct of the practitioner 
himself, and not to the remedy. Many, for example, use strong preparations 
of lead, all of which are dangerous when applied to the internal surfaces 
of the body; others use escharotics, which inflame and injure the parts. I 
have known a gonorrhoea actually cured by an injection made of green-tea, 
and would always recommend gentle methods where they will succeed.

WHETHER injections be used or not, cooling purges are always proper in the 
gonorrhoea. They ought not however to be of the strong or drastic kind. 
Whatever raises a violent commotion in the body increases the danger and 
tends to drive the disease deeper into the habit. Procuring two or three 
stools every second or third day for the first fortnight, and the same 
number every fourth or fifth day for the second, will generally be 
sufficient to remove the inflammatory symptoms, to diminish the running, 
and to change the colour and consistence of the matter, which gradually 
becomes more clear and ropy as the virulence abates. If the patient can 
swallow a solution of salts and manna, he may take six drachms, or, if his 
constitution requires it, an ounce of the former, with half an ounce of 
the latter. These may be dissolved in an English pint of boiling water, 
whey, or thin water-gruel, and taken early in the morning. If an infusion 
of senna and tamarinds be more agreeable, two drachms of the former, and 
an ounce of the latter, may be infused all night in an English pint of 
boiling water. The infusion may be strained next morning, and half an 
ounce of Glauber's salts dissolved in it. A tea-cupful of this infusion 
may be taken every half-hour till it operates. Should the patient prefer 
an electuary, the following will be found to answer very well. Take of the 
lentitive electuary four ounces, cream of tartar two ounces, jalap in 
powder two drachms, rhubarb one drachm, and as much of the syrup of pale 
roses as will serve to make up the whole into a soft electuary. Two or 
three tea-spoonfuls of this may be taken over-night, and about the same 
quantity next morning, every day that the patient chuses to take a purge. 
The doses of the above medicines may be increased or diminished according 
as the patient finds it necessary. We have ordered the salts to be 
dissolved in a large quantity of water, because it renders their operation 
more mild.

WHEN the inflammatory symptoms run high, bleeding is always necessary at 
the beginning. This operation, as in other topical inflammations, must be 
repeated according to the strength and constitution of the patient, and 
the vehemence and urgency of the symptoms.

MEDICINES which promote the secretion of urine are likewise proper in this 
stage of the disorder. For this purpose, an ounce of nitre and two ounces 
of gum arabic, pounded together, may be divided into twenty-four doses, 
one of which may be taken frequently, in a cup of the patient's drink. If 
these should make him pass his urine so often as to become troublesome to 
him, he may either take them less frequently, or leave out the nitre 
altogether, and take equal parts of gum arabic and cream of tartar. These 
may be pounded together, and a tea-spoonful taken in a cup of the 
patient's drink four or five times a-day. I have generally found this 
answer extremely well both as a diuretic, and for keeping the body gently 
open.

WHEN the pain and inflammation are seated high towards the neck of the 
bladder, it will be proper frequently to throw up an emollient clyster, 
which, besides the benefit of procuring stools, will serve as a 
fomentation to the inflamed parts.

SOFT poultices, when they can conveniently be applied to the parts, are of 
great service. They may be made of the flour of linseed, or of wheat-bread 
and milk, softened with fresh butter or sweet oil. When poultices cannot 
be conveniently used, cloths wrung out of warm water, or bladders filled 
with warm milk and water, may be applied. I have often known the most 
excruciating pains, during the inflammatory state of the gonorrhoea, 
relieved by one or other of these applications.

FEW things tend more to keep off inflammation in the spermatic vessels, 
than a proper truss for the scrotum. It ought to be so contrived as to 
support the testicles, and should be worn from the first appearance of the 
disease till it has ceased some weeks.

THE above treatment will sometimes remove the gonorrhoea so quickly, that 
the person will be in doubt whether he really laboured under that disease. 
This, however, is too favourable a turn to be often expected. It more 
frequently happens, that we are able only to procure an abatement or 
remission of the inflammatory symptoms, so far as to make it safe to have 
recourse to the great antidote mercury.

MANY people, on the first appearance of a gonorrhoea, fly to the use of 
mercury. This is a bad plan. Mercury is often not at all necessary in a 
gonorrhoea; and when taken too early, it does mischief. It may be 
necessary to complete the cure, but can never be proper at the 
commencement of it.

WHEN bleeding, purging, fomentations, and the other things recommended 
above have eased the pain, softened the pulse, relieved the heat of urine, 
and rendered the involuntary erections less frequent, the patient may 
begin to use mercury in any form that is least disagreeable to him.

lF he takes the common mercurial pill, two at night and one in the morning 
will be a sufficient dose at first. Should they affect the mouth too much, 
the dose must be lessened; if not at all, it may be gradually increased to 
five or six pills in the day. If calomel be thought preferable, two or 
three grains of it, formed into a bolus with a little of the conserve of 
hips, my be taken at bed-time, and the dose gradually increased to eight 
or ten grains. One of the most common preparations of mercury now in use 
is the corrosive sublimate. This may be taken in the manner afterwards 
recommended under the confirmed lues or pox. I have always found it one of 
the most safe and efficacious medicines when properly used.

THE above medicines may either be taken every day or every other day, as 
the patient is able to bear them. They ought never to be taken in such 
quantity as to raise a salivation, unless in a very slight degree. The 
disease may be more safely, and as certainly, cured without a salivation 
as with it. When the mercury runs off by the mouth, it is not so 
successful in carrying off the disease, as when it continues longer in the 
body, and is discharged gradually.

SHOULD the patient be purged or griped in the night by the mercury, he 
must take an infusion of senna, or some other purgative, and drink freely 
of water-gruel to prevent bloody stools, which are very apt to happen 
should the patient catch cold, or if the mercury has not been duly 
prepared. When the bowels are weak, and the mercury is apt to gripe or 
purge, these disagreeable consequences may be prevented by taking, with 
the above pills or bolus, half a drachm or two scruples of diascordium, or 
of the Japonic confection.

TO prevent the disagreeable circumstance of the mercury's affecting the 
mouth too much, or bringing on a salivation, it may be combined with 
purgatives. With this view the laxative mercurial pill has been contrived, 
the usual dose of which is half a drachm, or three pills, night and 
morning, to be repeated every other day; but the safer way is for the 
patient to begin with two, or even with one pill, gradually increasing the 
dose.

TO such persons as can neither swallow a bolus nor a pill, mercury may be 
given in a liquid form, as it can be suspended even in a watery vehicle, 
by means of gum-arabic; which not only serves this purpose, but likewise 
prevents the mercury from affecting the mouth, and renders it in many 
respects a better medicine. Take quicksilver one drachm, gum-arabic 
reduced to a mucilage two drachms; let the quicksilver be rubbed with the 
mucilage, in a marble mortar, until the globules of mercury entirely 
disappear: afterwards add gradually, still continuing the trituration, 
half an ounce of balsamic syrup, and eight ounces of simple cinnamon-
water. Two table-spoonfuls of this solution may be taken night and 
morning. Some reckon this the best form in which quicksilver can be 
exhibited for the cure of a gonorrhoea.

IT happens very fortunately for those who cannot be brought to take 
mercury inwardly, and likewise for persons whose bowels are too tender to 
bear it, that an external application of it will answer equally well, and, 
in some respects, better. It must be acknowledged, that mercury, taken 
inwardly for any length of time, greatly weakens and disorders the bowels; 
for which reason, when a plentiful use of it becomes necessary, we would 
prefer rubbing to the mercurial pills. The common mercurial, or blue 
ointment, will answer very well. Of that which is made by rubbing together 
equal quantities of hog's-lard and quicksilver, about a drachm may be used 
at a time. The best time for rubbing it on is at night, and the most 
proper place the inner side of the thighs. The patient should stand before 
the fire when he rubs, and should wear flannel drawers next his skin at 
the time he is using the ointment. If ointment of a weaker or stronger 
kind be used, the quantity must be increased or diminished in proportion.

IF, during the use of the ointment, the inflammation of the genital parts, 
together with the heat and feverishness, should return, or if the mouth 
should grow sore, the gums tender and the breath become offensive, a dose 
or two of Glauber's salts, or some other cooling purge, may be taken, and 
the rubbing intermitted for a few days. As soon, however, as the signs of 
spiting are gone off, if the virulency be not quite corrected, the 
ointment must be repeated, but in smaller quantities, and at longer 
intervals than before. Whatever way mercury is administered, its use must 
be persisted in as long as any virulency is suspected to remain.

DURING this, which may be called the second stage of the disorder, though 
so strict a regimen is not necessary as in the first or inflammatory 
state, yet intemperance of every kind must be avoided. The food must be 
light, plain, and of easy digestion; and the greatest indulgence that may 
be allowed with respect to drink is, a little wine diluted with a 
sufficent quantity of water. Spirituous liquors are to be avoided in every 
shape. I have often known the inflammatory symptoms renewed and 
heightened, the running increased, and the cure rendered extremely 
difficult and tedious, by one fit of excessive drinking.

WHEN the above treatment has removed the heat of urine, and soreness of 
the genital parts; when the quantity of running is considerably lessened, 
without any pain or swelling in the groin or testicle supervening; when 
the patient is free from involuntary erections; and lastly, when the 
running becomes pale, whitish, thick, void of ill smell, and tenacious or 
ropy; when all or most of these symptoms appear, the gonorrhoea is arrived 
at its last stage, and we may gradually proceed to treat it as a gleet 
with astringent and agglutinating medicines,


OF GLEETS.

A GONORRHOEA frequently repeated, or improperly treated, often ends in a 
gleet, which may either proceed from relaxation, or from some remains of 
the disease. It is, however, of the greatest importance in the cure of the 
gleet, to know from which of these causes it proceeds. When the discharge 
proves very obstinate, and receives little or no check from astringent 
remedies, there is ground to suspect that it is owing to the latter; but 
if the drain is inconstant, and is chiefly observable when the patient is 
stimulated by lascivious ideas, or upon straining to go to stool, we may 
reasonably conclude that it is chiefly owing to the former.

IN the cure of a gleet proceeding from relaxation, the principal design is 
to brace, and restore a proper degree of tension to the debilitated and 
relaxed vessels. For this purpose, besides the medicines recommended in 
the gonorrhoea, the patient may have recourse to stronger and more 
powerful astringents, as the Peruvian bark, alum, vitriol, galls, 
tormentil, bistort, balaustines, tincture of gum kino, &c. The injections 
may be rendered more astringent by the addition of a few grains of alum, 
or increasing the quantity of vitriol as far as the parts are able to bear 
it. The Peruvian bark may be combined with other astringents, and prepared 
in the following manner: Take of Peruvian bark bruised six drachms, of 
fresh galls bruised two drachms: boil them in a pound and a half of water 
to a pound: to the strained liquor add three ounces of the simple tincture 
of the bark. A small tea-cupful of this may be taken three times a-day, 
adding to each cup fifteen or twenty drops of the acid elixir of vitriol.

THE last remedy which we shall mention in this case is the cold bath, than 
which there is not perhaps a more powerful bracer in the whole compass of 
medicine. It ought never to be omitted in this species of gleet, unless 
there be something in the constitution of the patient which renders the 
use of it unsafe. The chief objections to the use of the cold bath are, a 
full habit, and an unsound state of the viscera. The danger from the 
former may always be lessened, if not removed, by purging and bleeding, 
but the latter is an insurmountable obstacle, as the pressure of the 
water, and the sudden contraction of the external vessels, by throwing the 
blood with too much force upon the internal parts, are apt to occasion 
ruptures of the vessels, or a flux of humours upon the diseased organs. 
But where no objection of this kind prevails, the patient ought to plunge 
over head in water every morning fasting, for three or four weeks 
together. He should not, however, stay long in the water, and should take 
care to have his skin dried as soon as he comes out.

THE regimen proper in this case is the same as was mentioned in the last 
stage of the gonorrhoea: the diet must be drying and astringent, and the 
drink Spa, Pyrmont, or Bristol waters, with which a little claret or red 
wine may sometimes be mixed. Any person may now afford to drink these 
waters, as they can be every where prepared at almost no expence, by a 
mixture of common chalk and oil of vitriol.

WHEN the gleet does not in the smallest degree yield to these medicines, 
there is reason to suspect that it proceeds from uIcers. In this case, 
recourse must be had to mercury, and such medicines as tend to correct any 
predominant acrimony with which the juices may be affected, as the 
decoction of china, sarsaparilla, sassafras, or the like.

MR. FORDYCE says, he has seen many obstinate gleets of two, three, or four 
years standing, effectually cured by a mercurial inunction, when almost 
every other medicine has been tried in vain. Dr. Chapman seems to be of 
the same opinion; but says, he has always found the mercury succeed best 
in this case when joined with terebinthinate and other agglutinating 
medicines. For which reason, the Doctor recommends pills made of calomel 
and Venice turpentine; and desires that their use may be accompanied with 
a decoction of guaiacum or sarsaparilla. Take Venice turpentine, boiled to 
a sufficient degree of hardness, half an ounce, calomel half a drachm. Let 
these be mixed and formed into sixty pills, of which five or six may be 
taken night and morning. If, during the life of these pills, the mouth 
should grow sore, or the breath become offensive, they must be 
discontinued till these symptoms disappear.

THE last kind of remedy which we shall mention for the cure of ulcers in 
the urinary passage, are the suppurating candles or bougies; as these are 
prepared various ways, and are generally to be bought ready made, it is 
needless to spend time in enumerating the different ingredients of which 
they are composed, or teaching the manner of preparing them: Before a 
bougie be introduced into the urethra, however, it should be smeared all 
over with sweet oil, to prevent it from stimulating too suddenly; it may 
be suffered to continue in from one to seven or eight hours, according as 
the patient can bear it. Obstinate ulcers are not only often healed, but 
tumours and excrescences in the urinary passages taken away, and an 
obstruction of urine removed, by means of bougies.


OF THE SWELLED TESTICLE.

THE swelled testicle may either proceed from infection lately contracted, 
or from the venereal poison lurking in the blood: the latter indeed is not 
very common, but the former frequently happens both in the first and 
second stages of a gonorrhoea; particularly when the running is 
unseasonably checked, by cold, hard drinking, strong drastic purges, 
violent exercise, the too early use of astringent medicines, or the like.

IN the inflammatory stage bleeding is necessary, which must be repeated 
according to the urgency of the symptoms. I have been of use, for some 
time past, to apply leeches to inflamed testicles, which practice has 
always been followed with the most happy effects. The food must be light, 
and the drink diluting. High-seasoned food, flesh, wines, and every thing 
of a heating nature, are to be avoided. Fomentations are of singular 
service. Poultices of bread and milk, softened with fresh butter or oil, 
are likewise very proper, and ought constantly to be applied when the 
patient is in bed: when he is up, the testicle should be kept warm, and 
supported by a bag or truss, which may easily be contrived in such a 
manner as to prevent the weight of the testicle from having any effect.

IF it should be found impracticable to clear the testicle by the cooling 
regimen now pointed out, and extended according to circumstances, it will 
be necessary to lead the patient through such a complete antivenereal 
course as shall ensure him against any future uneasiness. For this 
purpose, besides rubbing the mercurial ointment on the part, if free from 
pain, or on the thighs, as directed in the gonorrhoea, the patient must be 
confined to bed, if necessary, for five or six weeks, suspending the 
testicle all the while with a bag or truss, and plying him inwardly with 
strong decoctions of sarsaparilla.

WHEN these means do not succeed, and there is reason to suspect a 
scrophulous or cancerous habit, either of which may support a scirrhous 
induration, after the venereal poison is corrected, the parts should be 
fomented daily with a decoction of hemlock, the bruised leaves of which 
may likewise be added to the poultice, and the extract at the same time 
taken inwardly. The extract of hemlock may be made into pills, and taken 
in the manner directed under the article Cancer. This practice is strongly 
reommended by Dr. Stork in scirrhous and cancerous cases; and Mr. Fordyce 
assures us, that by this method he has cured diseased testicles of two or 
three years standing, even when ulcerated, and when the scirrhus had begun 
to be affected with pricking and lancing pains.


OF BUBOES.

VENEREAL buboes are hard tumours seated in the groin, occasioned by the 
venereal poison lodged in this part. They are of two kinds; viz. such as 
proceed from a recent infection, and such as accompany a confirmed lues.

THE cure of recent buboes, that is, such as appear soon after impure 
coition, may be first attempted by dispersion, and, if that should not 
succeed, by suppuration. To promote the dispersion of a buboe, the same 
regimen must be observed as was directed in the first stage of a 
gonorrhoea. The patient must likewise be bled, and take some cooling 
purges, as the decoction of tamarinds and senna, Glauber's salts, and the 
like. If, by this course, the swelling and other inflammatory symptoms 
abate, we may safely proceed to the use of mercury, which must be 
continued till the venereal virus is quite subdued. For the dispersion of 
a bubo, a number of leeches applied to the part affected will be found 
equally efficacious as in the inflamed testicle.

BUT if the bubo should, from the beginning, be attended with great heat, 
pain, and pulsation, it will be proper to promote its suppuration. For 
this purpose the patient may be allowed to use his ordinary diet, and to 
take now and than a glass of wine. Emollient cataplasms, consisting of 
bread and milk softened with oil or fresh butter, may be applied to the 
part and, in cold constitutions, where the tumour advances slowly, white-
lily roots boiled, or sliced onions raw, and a sufficient quantity of 
yellow basilicon, may be added to the poultice.

WHEN the tumour is ripe, which may be known by its conical figure, the 
softness of the skin, and a fluctuation of matter plainly to be felt under 
the finger, it may be opened either by caustic or a lancet, and afterwards 
dressed with digestive ointment,

IT sometimes, however, happens that buboes can neither be dispersed nor 
brought to a suppuration, but remain hard, indolent tumours. In this case 
the indurated glands must be consumed by caustic; if they should become 
scirrhous, they must be dissolved by the application of hemlock, both 
externally and internally, as directed in the scirrhous testicle.


OF CHANCRES.

CHANCRES are superficial, callous, eating ulcers; which may happen either 
with or without a gonorrhoea. They are commonly seated about the glans, 
and make their appearance in the following manner: First a little red 
pimple arises, which soon becomes pointed at top, and is filled with a 
whitish matter inclining to yellow. This pimple is hot, and itches 
generally before it breaks: afterwards it degenerates into an obstinate 
ulcer, the bottom of which is usually covered with a viscid mucus, and 
whose edges gradually becomes hard and callous. Sometimes the first 
appearance resembles a simple excoriation of the cuticle; which, however, 
if the cause be venereal, soon becomes a true chancre.

A CHANCRE is sometimes a primary affection, but it is much oftener 
symptomatic, and is the mark of a confirmed lues. Primary chancres 
discover themselves soon after impure coition, and are generally seated in 
parts covered with a thin cuticle, as the lips, the niples of women, the 
glans penis of men, &c. When venereal ulcers arc seated in the lips, the 
infection may be communicated by kissing. I have seen very obstinate 
venereal ulcers in the lips, which I had all the reason in the world to 
believe were communicated in this manner. Nurses ought to beware of 
suckling infected children, or having their breasts drawn by persons 
tainted with the venereal disease. This caution is peculiarly necessary 
for nurses who reside in in the neighbourhood of great towns.

WHEN a chancre appears soon after impure coition, its treatment is nearly 
similar to that of the virulent gonorrhoea. The patient must observe the 
cooling regimen, lose a little blood, and take some gentle doses of salts 
and manna. The parts affected ought frequently to be bathed, or rather 
soaked, in warm milk and water, and, if the inflammation be great, an 
emollient poultice or cataplalsm may be applied to them. This course will, 
in most cases, be sufficient to abate the inflammation, and prepare the 
patient for the use of mercury.

SYMPTOMATlC chancres are commonly accompanied with ulcers in the throat, 
nocturnal pains, scurfy eruptions about the roots of the hair, and other 
symptoms of a confirmed lues. Though they may be seated in any of the 
parts mentioned above, they commonly appear upon the private parts, or the 
inside of the thigh. They are also less painful, but frequently much 
larger and harder than primary chancres. As their cure must depend upon 
that of the pox, of which they are only a symptom, we shall take no 
further notice of them, till we come to treat of a confirmed lues. I have 
found it answer extremely well to sprinkle chancres twice a-day with 
calomel. This will often perform a cure without any other application 
whatever. If the chancres are upon the glans, they may be washed with milk 
and water, a little warm, and afterwards the calomel may be applied as 
above.

THUS we have related most of the symptoms which accompany or succeed a 
virulent gonorrhoea, and have also given a short view of their proper 
treatment; there are however, several others which sometimes attend this 
disease, as a strangury or obstruction of urine, a phymosis, paraphymosis, 
&c.

A STRANGURY may be occasioned either by a spasmodic constriction, or an 
inflammation of the urethra and parts about the neck of the bladder. In 
the former case, the patient begins to void his urine with tolerable ease; 
but, as soon as it touches the galled or inflamed urethra, a sudden 
constriction takes place, and the urine is voided by spurts, and sometimes 
by drops only. When the strangury is owing to an inflammation about the 
neck of the bladder, there is a constant heat and uneasiness of the part, 
a perpetual desire to make water, while the patient can only render a few 
drops, and a troublesome tenesmus, or constant inclination to go to stool.

WHEN the strangury is owing to spasm, such medicines as tend to dilute and 
blunt the salts of the urine will be proper. For this purpose, besides the 
common diluting liquors, soft and cooling emulsions, sweetened with the 
syrup of poppies, may be used. Should these not have the desired effect, 
bleeding, and emollient fomentations, will be necessary.

WHEN the complaint is evidently owing to an inflammation about the neck of 
the bladder, bleeding must be more liberally performed, and repeated 
according to the urgency of the symptoms. After bleeding, if the strangury 
still continues, soft clysters, with a proper quantity of laudanum in 
them, may be administered, and emollient fomentations applied to the 
region of the bladder. At the same time, the patient may take every four 
hours a tea-cupful of barley-water, to an English pint of which six ounces 
of the syrup of marsh-mallows, four ounces of the oil of sweet almonds, 
and half an ounce of nitre, may be added. If these remedies should not 
relieve the complaint, and a total suppression of urine should come on, 
bleeding must be repeated, and the patient set in a warm bath up to the 
middle. It will be proper, in this case, to discontinue the diuretics, and 
to draw off the water with a catheter; but as the patient is seldom able 
to bear its being introduced, we would rather recommend the use of mild 
bougies. These often lubricate the passage, and greatly facilitate the 
discharge of urine. Whenever they begin to stimulate or give any 
uneasiness, they may be withdrawn.

THE phymosis in such a constriction of the prepuce over the glans, as 
hinders it from being drawn backwards; the paraphymosis, on the contrary, 
is such a constriction of the prepuce behind the glans, as hinders it from 
being brought forward.

THE treatment of these symptoms is so nearly the same with that of the 
virulent gonorrhoea, that we have no occasion to enlarge upon it. In 
general, bleeding, purging, poultices, and emollient fomentations are 
sufficient. Should these, however, fail of removing the stricture, and the 
parts be threatened with a mortification, twenty or thirty grains of 
ipecacuanha, and one grain of emetic tartar, may be given for a vomit, and 
may be worked off with warm water or thin gruel.

IT sometimes happens, that, in spite of all endeavours to the contrary, 
the inflammation goes on, and symptoms of a beginning mortification 
appear. When this is the case, the prepuce must be scarified with a 
lancet, and if necessary, divided, in order to prevent a strangulation, 
and set the imprisoned glans at liberty. We shall not describe the manner 
of performing this operation, as it ought always to be done by a surgeon. 
When a mortification has actually taken place, it will be necessary, 
besides performing the above operations, to foment the parts frequently 
with cloths wrung out of a strong decoction of camomile flowers and bark, 
and to give the patient a drachm of the bark in powder every two or three 
hours.

WITH regard to the priapism, chordee, and other distortions of the penis, 
their treatment is no way different from that of the gonorrhoea. When they 
prove very troublesome, the patient may take a few drops of laudanum at 
night, especially after the operation of a purgative through the day.


OF A CONFIRMED LUES.

WE have hitherto treated of those affections in which the venereal poison 
is supposed to be confined chiefly to the particular part by which it was 
received, and shall next take a view of the lues in its confirmed state, 
that is, when the poison is actually received into the blood, and, 
circulating with it through, every part of the body, mixes with the 
several secretions, and renders the whole habit tainted.

THE symptoms of a confirmed lues are, buboes in the groin, pains of the 
head and joints, which are peculiarly troublesome in the night, or when 
the patient is warm in bed; scabs and scurfs in various parts of the body, 
especially on the head, of a yellowish colour, resembling a honey-comb; 
corroding ulcers in various parts of the body, which generally begin about 
the throat, from whence they creep gradually, by the palate, towards the 
cartilage of the nose, which they destroy; excrescences or exostoses in 
the middle of the bones, and their spongy ends become brittle, and break 
upon the least accident; at other times, they are soft, and bend like wax; 
the conglobate glands become hard and callous, and form, in the, neck, 
armpits, groin, and mensentery, hard moveable tumours, like the king's 
evil; tumours of different kinds are likewise formed in the lymphatic 
vessels, tendons, ligaments, and nerves, as the gummata, ganglia, nodes, 
tophs, &c. the eyes are affected with itching, pain, redness, and 
sometimes with total blindness, and the ears with a singing noise, pain, 
and deafness, whilst their internal substance is exulcerated and rendered 
carious; at length all the animal, vital, and natural functions are 
depraved; the face becomes pale and livid; the body emaciated and unfit 
for motion, and the miserable patient falls into an atrophy or wasting 
consumption.

WOMEN have symptoms peculiar to the sex; as cancers of the breast; a 
suppression or overflowing of the menses; the whites; hysteric affections; 
an inflammation, abscess, scirrhus, gangrene, cancer, or ulcer of the 
womb; they are generally either barren or subject to abortion; or, if they 
bring children into the world, they have an universal erysipelas, are half 
rotten, and covered with ulcers.

SUCH is the catalogue of symptoms attending this dreadful disease in its 
confirmed state. Indeed they are seldom all to be met with in the same 
person, or at the same time; so many of them, however, are generally 
present as are sufficient to alarm the patient; and if he has reason to 
suspect the infection is lurking in his body, he ought immediately to set 
about the expulsion of it, otherwise the most tragical consequences will 
ensue.

THE only certain remedy hitherto known in Europe, for the cure of this 
disease, is mercury, which may be used in a great variety of forms, with 
nearly the same success. Some time ago it was reckoned impossible to cure 
a confirmed lues without a salivation; this method is now, however, pretty 
generally laid aside, and mercury is found to be as efficacious, or rather 
more so, in expelling the venereal poison, when administered in such a 
manner as not to run off by the salivary glands.

THOUGH many are of opinion, that the mercurial ointment is as efficacious 
as any other preparation of that mineral; yet experience has taught me to 
think otherwise. I have often seen the most obstinate venereal cases, 
where great quantities of mercurial ointment had been used in vain, yield 
to the saline preperations of mercury. Nor am I singular in this opinion. 
My ingenious friend, Mr. Clare, an eminent surgeon of this city, assures 
me, that for some time past he has employed, in venereal cases, a saline 
preparation of mercury with most happy success. This preparation, rubbed 
with a sufficient quantity of any mild powder, he applies, in small 
portions, to the tongue, where, with a gentle degree of friction, it is 
immediately absorbed, and produces its full effect upon the system, 
without doing the least injury to the stomach or bowels; a matter of the 
greatest importance in the application of this most active and powerful 
remedy.

IT is impossible to ascertain either the exact quantity of medicines that 
must be taken, or the time they ought to be continued in order to perform 
a cure. These will ever vary according to the constitution of the patient, 
the season of the year, the degree of infection, the time it has lodged in 
the body, &c. But though it is difficult, as Astruc observes, to 
determine, a priori, what quantity of mercury will, in the whole, be 
necessary to cure this distemper completely; yet it may be judged of a 
posteori, from the abatement and ceasing of the symptoms. The same author 
adds, that commonly not less than two ounces of the strong mercurial 
ointment is sufficient, and not more than three or four ounces necessary.

THE only chemical preparation of mercury which we shall take notice of, is 
the corrosive sublimate. This was some time ago brought into use for the 
venereal disease, in Germany, by the illustrious Baron Van Swieten; and 
was soon after introduced into Britain by the learned Sir John Pringle, at 
that time physician to the army. The method of giving it is as follows: 
One grain of corrosive sublimate is dissolved in two ounces of French 
brandy or malt spirits; and of this solution, an ordinary table-spoonful, 
or the quantity of half an ounce, is to be taken twice a-day, and to be 
continued as long as any symptoms of the disorder remain. To those whose 
stomach cannot bear the solution, the sublimate may be given in form of 
pill. The sublimate may be given in distilled water, or any other liquor 
that the patient chuses. I commonly order ten grains to be dissolved in an 
ounce of the spirit of wine, for the conveniency of carriage, and let the 
patient take twenty or thirty drops of it night and morning in half a 
glass of brandy or other spirits. Mr. Debraw, an ingenious chymist of this 
place, informs me, that he prepares a salt of mercury much more mild and 
gentle in its operation than the sublimate, though equally efficacious.

SEVERAL roots, woods, and barks, have been recommended for curing the 
venereal disease; but none of them have been found, upon experience, to 
answer the high encomiums which had been bestowed upon them. Though no one 
of these is to be depended upon alone, yet, when joined with mercury, some 
of them are found to be very beneficial in promoting a cure. One of the 
best we know yet is sarsaparilla, which may be prepared and taken 
according to the directions in the Appendix. See Appendix. Decoct. of 
Sarsaparilla.

THE mezereon-root is likewise found to be a powerful assistant to the 
sublimate, or any other mercurial. It may either be used along with the 
sarsaparilla, as directed in the Appendix, or by itself. Those who chuse 
to use the mezereon by itself, may boil an ounce of the fresh bark, taken 
from the root, in twelve English pints of water to eight, adding towards 
the end an ounce of liquorice. The dose of this is the same as of the 
decoction of sarsaparilla.

WE have been told that the natives of America cure the venereal disease, 
in every stage, by a decoction of the root of a plant called the Lobelia. 
It is used either fresh or dried; but we have no certain accounts with 
regard to the proportion. Sometimes they mix other roots with it, as those 
of the ranunculus, the ceanothous, &c. but whether these are designed to 
disguise or assist it, is doubtful. The patient takes a large draught of 
the decoction early in the morning, and continues to use it for his own 
ordinary drink through the day. Though we are still very much in the dark 
with regard to the method of curing this disease among the natives of 
America, yet it is generally affirmed, that they do cure it with speed, 
safety, and success, and that without the least knowledge of mercury. 
Hence it becomes an object of considerable importance to discover their 
method of cure. This might surely be done by making trials of the various 
plants which are found in those parts, and particularly of such as the 
natives are known to make use of. All people in a rude state take their 
medicines chiefly from the vegetable kingdom, and are often possessed of 
valuable secrets with regard to the virtues of plants, of which more 
enlightened nations are ignorant. Indeed we make no doubt but some plants 
of our own growth, were proper pains taken to discover them, would be 
found as efficacious in curing the venereal disease as those of America. 
It must however be remembered, that what will cure the venereal disease in 
one country, will not always be found to have equal success in another.

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


GENERAL OBSERVATIONS.

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

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

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

HYSTERIC and hypochondriac persons, and such as are subject to an habitual 
diarrhoea or dysentery, or to frequent and violent attacks of the 
epilepsy, or who are afflicted with the scrophula, or the scurvy, ought to 
be cautious in the use of mercury. Where any one of these disorders 
prevails, it ought either, if possible, to be cured, or at least 
palliated, before the patient enters upon a course of mercury. When this 
cannot be done, the mercury must be administered in smaller doses, and at 
longer intervals than usual.

THE most proper seasons for entering upon a course of mercury, are the 
spring and autumn, when the air is of a moderate warmth; if the 
cirumstances of the case, however, will not admit of delay, we must not 
defer the cure on account of the season, but must administer the mercury; 
taking care, at the same time, to keep the patient's chamber warmer or 
cooler, according as the season of the year requires.

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

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

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

THERE is hardly any thing of more importance, either for preventing or 
removing venereal infection, than cleanliness. By an early attention to 
this, the infection might often be prevented from entering the body; and, 
where it has already taken place, its effects may be greatly mitigated. 
The moment any person has reason to suspect that he has received the 
infection, he ought to wash the parts with water and spirits, sweet oil, 
or milk and water; a small quantity of the last may likewise be injected 
up the urethra, if it can be conveniently done. Whether this disease at 
first took its rise from dirtiness is hard to say; but wherever that 
prevails, the infection is found in its greatest degree of virulence, 
which gives ground to believe that a strict attention to cleanliness would 
go far towards extirpating it altogether. I have not only often seen a 
recent infection carried off in a few days by means of cleanliness, viz. 
bathing, fomentations, injections, &c. but have likewise found it of the 
greatest advantage in the more advanced stages of the dilsease. Of this I 
had lately a very remarkable instance, in a man whole penis was almost 
wholly consumed by venereal ulcers: the matter had been allowed to 
continue on the sores, without any care having been taken to clean them, 
till, notwithstanding the use of mercury and other medicines, it had 
produced the effects above-mentioned. I ordered warm milk and water to be 
injected three or four times a-day into all the sinuous ulcers, in order 
to wash out the matter; after which they were stuffed with dry lint to 
absorb the fresh matter as it was generated. The patient at the same time 
took every day half a grain of the corrosive sublimate of mercury, 
dissolved in an ounce of brandy, and drank an English quart of the 
decoction of sarsaparilla. By this treatment, in about six weeks, he was 
perfectly cured and, what was very remarkable, a part of the penis was 
actually regenerated. Doctor Gilchrist has given an account of a species 
of the lues venerea which prevails in the west of Scotland, to which the 
natives give the name of Sibbins or Sivvins. The Doctor observes, that the 
spreading of this disease is chiefly owing to a neglect of cleanliness, 
and seems to think, that by due attention to that virtue, it might be 
extirpated. The treatment of this disease is similar to that of a 
confirmed lues or pox. The yaws, a disease which is now very common both 
in America and the West India islands, may also be cured in the same 
manner.

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

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

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

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

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

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