SALIVATION EXPLODED: OR, A PRACTICAL ESSAY. ON THE VENEREAL DISEASE, FULL DEMONSTRATING THE Inefficacy of SALIVATION, and recommend- ing an approved SUCCEDANEUM. ILLUSTRATED With some remarkable CASES, which had withstood Three, Four, or Five Salivations, and were afterwards cured, by that safe, easy and certain Method, the Alterative One, of which a particular Account is given, and the Medicines used therein. TO WHICH IS SUBJOINED, A Dissertation on Gleets and Weaknesses, Seminal as Well as Venereal, in both Sexes; with the Remedies best adapted to each. Herein are described, not only the most eligible Medi- cines for the Cure of the Venereal Disease, but the most powerful Ones to prevent it also. By CHARLES SWIFT, SURGEON. opprime dum nova funt, subiti mala femina morbi, nam mora dat vires. OVID. THE SECOND EDITION. LONDON: Printed for S. BLADON, No. 13, Pater-Noster Row, MDCCLXXX. [Price Two Shillings.] ADVERTISEMENT. Notwithstanding the number and variety of publications upon the present subject, the Author flatters himself that his observations (the result of much experience) will not be un- acceptable to the Faculty especially the junior part of it, to whose perusal this Essay is par- ticularly recommended. Common cases, or such as daily occur, and are not attended with any unusual symptoms, are purposely omitted; and to avoid prolixity, a few only of the other kind are inserted, they being thought sufficient to elucidate the subject. Recent cases are likewise pretermitted, in order to obviate the idea of relapses, which even the most impartial reader might otherwise have suggested. Parliament Street, June 26th, 1780. A PRACTICAL ESSAY ON THE VENEREAL DISEASE, &c. THE Venereal Disease, beyond all others, having, by its peculiar virulence and frequent attacks upon the human body, made the most alarming depredations therein, no temporal subject I presume ought sooner to claim our attention, than the thorough investi- gation and speedy subjection of so formidable an enemy.—Many and various have been the opinions of the learned, relative to the time and place of its first appearance—this cir- cumstance has afforded an ample field for disputation to both ancients and moderns; of whom some the most eminent, at different periods, have very ingeniously and candidly treated upon the subject: notwithstanding which, the matter is yet doubtful and likely to remain so. A knowledge of the Precise origin of the disease must however appear of but little importance, when Put in competition with that of the most effectual remedy for the radical cure ot B it. [2] it. I shall therefore leave such contro- versies to those who are fonder of, or may be better qualified to adjust them than my- self, and rest contented with recommending the most rational and easy method of remov- ing so loathsome a disease. This mode of cure is the most gentle and efficacious, as will appear in the following pages; it will stand the test of the strictest scrutiny, being founded on the broad basis of long experience and uninterrupted success. In support of this assertion, I shall produce some very re- markable cases, selected from many hun- dreds, where the usual or general modes of cure had proved abortive. IT has been frequently observed, that the knowledge of a disease is half its cure; in no instance can I suppose this adage to have been more fully verified than in the Venereal Disease; which, Proteus like, appears in so many different forms, that very often it will require no small share of judgment and ex- perience to distinguish it from some other distemper, whose symptoms it may resemble in many respects, or with which it may in reality [3] Reality be combined. This being the case, must not wonder at the many errors daily committed by the ignorant, or inexpe- rienced in the profession. Almost innume- rable have been the instances of reputed rheu- matisms, nervous head-achs, wandering gouts, scurvies, declines, consumptions, &c. &c. which, upon a minute investigation, have been proved to be venereal. A happy cir- cumstance, when this discovery is made early enough to save the patient from an untimely grave; but alas! how frequently does the re- verse happen? This melancholy observation is particularly corroborated in the great num- ber of atrophies, or consumptions, by which the inhabitants of this island are many of them supposed to be destroyed. This sata- lity has generally been ascribed to the cli- mate, but I am firmly persuaded, that, upon a strict and impartial enquiry, many other causes may be assigned; and amongst them, Venus will be found to have had no small share. I am induced to be of this opinion from the many instances that have fallen un- der my own immediate inspection, where patients, after having been pronounced to be B2 in [4] in the last stages of a consumption, and given over as lost, have been perfectly restored by the use of anti-venereals. A circumstance of such importance, most certainly merits the attention of every medical practitioner. Should this admonition take the desired effect, I shall experience the greatest satisfaction in hav- ing rendered such an essential service to the community. In the following sheets it will evidently appear, that the Venereal Disease, in every state or stage, from the mildest to the most inveterate, may be perfectly, easily, and safely cured, without salivation: and that the patient, although labouring under a confirmed pox, will not be confined within doors a single day during the whole time he may be taking such medicines as will effect a radical cure. I shall likewise demonstrate that gleets of every denomination are curable, provided the origin of each be duly investi- gated, and in consequence thereof, a suitable remedy not only applied, but regularly per- severed in for a length of time, proportion- able to the cause: to the want of that perse- verance, in my opinion, may often be as- cribed the want of success in the general treatment [5] treatment of gleets; for I do not recollect (amongst the great number and variety of my patients for several years past) three cases which did not give way, or were not cured, by properly and strictly persisting in the use of injections or bougies, and some internal alteratives. To prove not only the inexpedi- ency, but the inefficacy of salivation in ve- nereal maladies, I shall produce several cases, in which its effects were merely palliative; in other words, afforded only a temporary relief, although repeated even to a fourth or fifth time; after which the same patients (notwithstanding the violent shock, and ma- nifest injury their constitutions had thereby sustained) were perfectly and radically cured by that easy gentle method, which I mean to recommend, namely, the alterative one. For argument fake only, suppose we admit that salivation is efficient and might be de- pended upon; what man in his senses but would give the preference to the method here proposed? When he considers how extremely disgusting and painful the process of saliva- tion is universally allowed to be, the conse- quent confinement indispensably, necessary therein, [6] therein, and the many other disagreeables that generally or frequently succeed it; such as destruction of teeth and gums, and the fœtid or stinking breath thereby occasioned; the great relaxation of the salivary glands, or an erosion of their excretory ducts, pro- ducing a copious troublesome flow of saliva, perhaps for the remainder of life; together with the derangement of the whole frame, in such a degree as seldom to be got the bet- ter of, even by those who may have been originally possessed of the best stamina, or strongest constitutions. All these circum- stances duly considered, it is rather surpris- ing that salivation has not long since been universally exploded; the only assignable rea- son must be the want of a proper succeda- neum; that, however, very happily for man- kind, can no longer be pleaded in excuse, as the alterative method is daily gaining ground, from the following very cogent reasons, viz. the operation of proper alteratives being so extremely mild and gentle as to admit of being safely administered at any time or sea- son, to persons of all ages, and of each sex: to pregnant women almost the whole time of gestation, [7] gestation, even to the last month, from which happy circumstance, the fœtus and its mo- ther both receive a cure at the same time. Two other very material advantages are to be derived from the use of alteratives, first, the certainty of cure, even in the worst, the most inveterate cases, where many repeated salivations have proved ineffectual; secondly, hot the least confinement being requisite throughout the whole course; which to the mercantile part of the world is a circum- stance of no little importance. The patient being able to transact business as well in the open air as elsewhere, and there being no other restriction or alteration respecting his diet, than the omission of acids, he will not he under any apprehension of a discovery taking place in the family. Another parti- cular in favour of these medicines, is, that contrary to the effects of most others, they will encrease the appetite, and thereby acce- lerate the cure, during the performance of which, the patient’s food cannot be of too nutritious a nature, insomuch that meat may be allowed twice or thrice per day, in pre- ference [8] ference to gruels, ptysans, or flops of any kind. The only disadvantage that attends the alterative method, is this; patients being at large the whole time, and capable of pursuing either business or pleasure, some are apt to prefer the latter, and very fre- quently not only neglect taking the medi- cine, but commit various excesses, and some- times contract fresh infections, while we are endeavouring to remove the old one. Indeed some have been frank enough to confess, that a species of œconomy had given rise to these irregularities; from a supposition that no additional expence would be incurred, they thought it therefore the properest time to gratify such inclinations: not considering that violent exertions of the parts affected must certainly procrastinate the cure, should they even be fortunate enough to escape an increase of the venereal virus. SALIVATION has none of these obstacles to combat with: for when once a man has completely immersed himself into that de- lightful state, it will seldom, if ever hap- pen, that he will, so circumstanced, be pos- 3 sessed [9] sessed of either ability or inclination to deviate from the most rigid injunctions that may be imposed by his doctors, medicinal or divine. In support of this opinion, nothing more will be necessary than a recital of some few of the concomitant symptoms or constant attendants on a perfect salivation; namely, a tumefaction of the head, face and throat, to a great degree, with much pain and in- flammation therein: the tongue frequently becomes too large for the mouth, which by this time is excoriated and extremely tender, together with the gums, tonsils, and all the neighbouring parts: in fine, the whole mouth and its appendages becomes one foul ulcer, from which issues a stench that may be better conceived than described, accompanied with a ptyalism or spitting, in quantity from two to fix pints in the twenty-four hours; which agreeable process is to be continued some weeks, and in the course of a few months, perhaps, repeated again and again. The same advantage as the foregoing, has the old me- thod of curing claps by mercurials and dras- tic purges, which were generally repeated every two or three days for a considerable C length [10] length of time, till the discharge put on a more benign aspect; or the patience, or strength of the patient being exhausted, oc- casioned a discontinuance thereof. From these premises we must readily infer, that a person thus constantly harassed by strong, rough medicines, could have little relish or inclination to transgress the laws of sobriety. Consideratis considerandis, every impartial man most certainly will prefer the alterative mode of cure, to that by salivation. HAVING premised thus much, now let us turn our thoughts to the most eligible means of obtaining a radical cure for this prevalent disease; it having often with great truth been observed, that as nothing can be done with greater facility, than to cavil or find fault, therefore no merit will be derived from such a procedure, unless at the same time it shall be accompanied with some plan or scheme more likely to effect the purpose in question. To obviate this reflection, I shall not only propose such a remedy as will be most likely to answer, but shall also produce, in support of it, some cases which (from the peculiar success [11] success attending them) will go near to call in question the veracity of the man who re- cords them: be that as it may, such an idea shall not prevent my giving a faithful rela- tion of them. Before however we enter upon that part of the business, I shall make some observations on the means by which those events took place. Very numerous and different are the prescriptions which at va- rious periods have been recommended, as fully competent to subdue the venereal poi- son; amongst the great variety offered for this salutary purpose, many were diametri- cally opposite to each other, advocates how- ever were not wanting to extol their mani- fold virtues: on these occasions, both the vegetable and mineral kingdoms were tho- roughly ransacked and attentively examined, and many of their properties ascertained by a series of ingenious experiments: and even at the present period, we are sometimes under the necessity of having recourse to both, in the reduction of so powerful an opponent as the venereal disease. Be it remembered how- ever, that vegetables alone, when properly prepared, will effect a cure in many cases. C 2 although [12] although in others it must be acknowledged that minerals will likewise be required. The gums will some of them be found of singular use, particularly camphor, in every stage of the disease, from a gonorrhœa to a confirmed lues; in the former it will greatly contri- bute to alleviate the heat of urine, as well as correct the virulence; and in the latter it ought never to be omitted, for several rea- sons; in the first place, it is a most power- ful alterative; in the next, it strengthens the nerves, exhilarates the spirits, and when joined with minerals, fortifies the stomach and bowels against any of their disagreeable or pernicious effects. It diffuses a general warmth throughout the body, and greatly assists in conducing other medicines towards the cuticular and renal glands. As to the choice of alterative medicines best adapted to the cure of the venereal disease, I believe none will be found more efficacious than a composition of the following, viz. camphor, antimony and sulphur: in some cases it may be necessary to add both mercury and opium. These must be assisted with decoctions of the 3 woods [13] woods * in quantities sufficient to attenuate and saturate the whole mass of contaminated juices. Any particular recipe or prescription of the above, would be of very little use, as not only the doses, but the quantity of each ingredient must so frequently be either increased or diminished agreeable to the vari- ation of symptoms and circumstances; which sometimes require even the omission of one or more of those ingredients. The age, sex, temperament or constitution of the patient, as well as the degree of infection, must render indispensably necessary to make the alte- rations above mentioned. Another material circumstance frequently occurs, namely, the addition of other acrimonious humours to which, particular attention must be paid, or we shall not succeed in our endeavours to remove the venereal one. From hence it must evidently appear, that no particular re- cipe can be invariably relied upon, in this or any other disease. * Guaiacum, sarsaparilla, china, sassafras, santalum glycyrrhiza, &c. THE [14] THE symptoms of a virulent gonorrhœa (commonly termed a clap) are too well known to require any description in this place: let us therefore consider upon the means most eligible for its removal. The cure may be easily and speedily effected, if undertaken when the first symptoms are per- ceived; particularly that gentle irritation, or trickling sensation in the urinary passage, which so frequently precedes the discharge: the disease, when taken at this stage, may be very safely removed in the space of two days, by applying medicine immediately to the part affected; this cannot be conveniently done in any other form than that of an in- jection, which should be composed of some gentle detergent that will stop the further progress of the venereal virus, by preventing its absorption. Chancres may likewise be almost as speedily removed, provided the re- medy be applied at their very first appear- ance. Should this precaution be omitted, the acrid matter will corrode the parts, and pro- duce ulcerations; consequently a longer time will [15] will be required to effect a cure; and it may be necessary to administer internals to pre- vent a flow of humours to the part which might retard the cure, if not entirely frus- trate our intentions. IF the complaint be not removed in the early stages, it will soon become confirmed; and then due regard must be paid to the pa- tient's habit of body, mode of living. &c. IT is with me a matter of surprise, that injections have not been in more general practice; as nothing certainly can be more rational, than to apply the remedy to the part affected. The advantages or the reverse, at- tending the use of them, must evidently arise from the ingredients of which they are composed: no man sure can be so prejudiced as to declare that his objection is merely to particular mode of conveying a medi- cine: to speak impartially; if crude, cor- rosive, indigested ulcers in every other part the body require topical applications, why, in the name of common sense, should they be neglected or omitted in parts natu- rally [16] rally so very delicate and sensible, as the or- gans of generation are incontestably allowed to be? neglects of this kind are frequently productive of the most disagreeable conse- quences; they may, independent of the injuries from absorption, give rise to gleets and obstructions in the urethra, which if not attended to, may terminate fatally. The stil- licidium, or running, is very uncertain as to the time of its appearance; sometimes it will happen in six hours after the embrace, at others, twice as many weeks have elapsed before it has been perceived; these, I must acknowledge, are not very common cases, but such as have really fallen under my inspec- tion, as will be seen in the sequel: in general however, it appears in less than ten days. Chancres likewise vary as much in this parti- cular. In the treatment of a confirmed clap, a great deal will depend upon its being simple or compound; in other words, whether it originated from a person who had only a go- norrhœa, or who at the same time was poxed likewise. In the latter case, power- ful internals will be absolutely necessary; in the former, a cure may frequently be accom- plished [17] plished by injection only. Claps and Chancres are often contracted at the same time, but do not always make their first appearance together; I have seen instances even where some weeks have intervened. As the composition of injection, like that of every other remedy, must vary according to circumstances, I shall decline giving any particular recipe; one general ingredient how- ever I will venture to recommend, namely, Armenian bole, which from its absorbent and other good qualities will prove highly beneficial both in correcting the venereal acri- mony, and defending the found parts of the urethra therefrom. IN the cure of claps, some practitioners have attended too much to the colour of the discharge, others to the consistence of it; both are fallacious, particularly the former; as it will sometimes be of a deep yellow, even to the last day, especially in bilious habits: frequently it is equally high coloured in old gleets of seven or ten years standing, where the party has been entirely free from infec- D tion [18] tion all that time, as in some cases has been sufficiently manifested by the healthy state of wives and children. A discharge of similar colour and consistence is often to be found attending the fluor albus, as it is called. From hence will follow the indispensable necessity of examining further, than just the state of the running: the best criterion will be the aspect of the urethral orifice, and the sensations throughout that tube. MANY families have been rendered un- happy from the length of time this disease sometimes requires to make its first appear- ance: for a man, after performing a kind of quarantine of three weeks, or a month, and no symptom of infection having shewn it- self during that time, would naturally con- clude himself entirely free from it, and pro- ceed accordingly; but how great his asto- nishment, as well as chagrin, to discover (perhaps a month or two afterwards) the most indisputable signs of his being infected : se- veral instances of this kind have fallen under my inspection, some of which, I must con- fers, I should not have credited, had not they [19] they been accompanied with proofs not to be contested. From this we may infer, that although the virus very often makes the most rapid progress, at other times its operations are as sluggish: this may arise from the de- gree of infection, or the patient’s habit of body, or from both. CASE I. A MERCHANT in the city of London, four years since, applied to me in consequence of great heat in making urine, painful erections, and a discharge of matter from the urethra, so acrid, as to threaten a phymosis, it having already excoriated the greatest part of the glans penis. Thus situated, he desired to know if I did not call his disorder a clap; to which I replied in the affirmative, and that it was not of the mildest kind ; “ Then sir, said he, I shall mention a circumstance, that I think will surprize you, which is, that not a single symptom of the disease appeared until two months and three days after it was contracted:" upon this account he deemed it not venereal, assured him however that it was so, and D2 could [20] could be removed only by treating it as such. My patient was not of a bad habit of body, nor had his blood been previously heated by intemperance, the chordee was notwithstand- ing so troublesome, that I expected to have been obliged to use opiates, which I am very seldom under the necessity of doing; injec- tions generally answering the purpose, by speedily removing the inflammation and its consequences: my only objection to opium in these cases, is, the constipation which mostly attends the use of it; although I am not an advocate for the old method by cathartics, yet I would not be understood to recommend absolutely the reverse; which must indubi- tably tend to encrease, rather than alleviate symptoms arising from inflammation. It will be found fully sufficient, that the intes- tinal evacuations be the same as at the time of perfect health.—Now to return to my pa- tient; he was much alarmed at the high de- gree of pain and inflammation, which how- ever was considerably lessened in the space of two days, by means of injection and internal alteratives; three weeks continuance of which perfectly cured him, without any confinement or [21] or alteration in his usual mode of living, ex- cept abstinence from acids and spirituous li- quors. CASE II. A GENTLEMAN of Dorsetshire, in the month of February, 1778, came to town on purpose to be under my care; his symptoms at that time were a discharge of yellow mat- ter from the urethra, chancres on the glans penis, a large bubo in the left groin, and a smaller one in the right. Upon my enquir- ing into particulars, he solemnly declared that he had not the least; reason to think him- self infected, till upwards of nine weeks after coition, when he was attacked with a trick- ling sensation in the urethra, which was fol- lowed by a running and heat of urine; chan- cres soon afterwards appeared, and were suc- ceeded in a short time by tumefaction of the inguinal glands, which thereupon became extremely painful. He was at first attended hy a surgeon in his own neighbourhood, who bled him very freely, gave strong mercurial purges repeatedly, and ordered him to dilute plentifully with barley water, &c. Fomen- tations [22] tations and cataplasms were applied to the buboes till suppuration took place, when he proposed to discharge their contents by means of caustic or inscision, but the patient not consenting to either, immediately left the country, and soon after applied to me, re- questing that I would remove them without opening or suffering them to break, as he had the greatest aversion to sores of every kind, and much dreaded all chirurgical operations: I told him, that considering the very forward state in which the buboes at that time were, (the fluctuation of matter being readily felt upon the slightest pressure) I could make no other promise, than to exert my best abilities in endeavouring to effect what he so ardently desired; observing likewise, that I frequently had been fortunate enough to render those pain- ful operations unnecessary by the use of inter- nal medicines alone; which, in my opinion, are the only ones that can safely be relied upon. As to the repelling of buboes (in the vul- gar phrase, putting them back) I never make the least hesitation of attempting to effect it, for this obvious reason, that a bubo is not a critical [23] a critical abscess, of which I am well con- vinced from daily experience, notwithstand- ing the general received opinion to the con- trary; I have seen many instances where buboes have been carefully brought forward to the most perfect suppuration, liberally opened, and a copious discharge very indus- triously encouraged for the space of four, five, or six months; notwithstanding which the parties have remained completely poxed; as the nocturnal pains, foul ulcers, and erup- tions sufficiently manifested a few months afterwards, when they became my patients, and were radically cured by the alterative me- thod in half that time. This being a fact not to be controverted, why should suppura- tion be encouraged, as it must be attended with great pain, filthiness and inconvenience? And after all, not being critical, a regular course of medicines will be indispensably necessary; the cicatrix or scar is likewise a circumstance not the most agreeable, especi- ally to the fair sex.—Without apologizing for this digression, I will hasten to my Dorset- shire friend. Entertaining these sentiments, I immediately sat about the discussion of his 3 buboes; [24] buboes; for which purpose alteratives were administered internally, and detergent injec- tions and dressings applied to the urethra and the chancres on the penis: by these means the symptoms gradually abated, and at the end of a month he thought himself cured; but I advised a continuance of the medicines three or four weeks longer, on account of the high degree of virulence we had had to en- counter with: he readily consented to per- severe in the use of them, having already ex- perienced such salutary effects; and to shew that he did not think the decoction at all nauseous, he generally drank it at meals in lieu of any other liquor. Thus, in less than two months, without being confined to the house a single day during the whole course, he was perfectly re-established in health, and has remained well ever since. He was highly pleased at the removal of the buboes without opening, and very generously rewarded my services. CASE [25] CASE III. IN the month of July, 1777, a gentleman requested my advice upon the following symp- toms; an unusual (though not painful) sen- sation in the urethra, a discharge therefrom very small in quantity, and of colour so light as scarce to tinge his linen. I was of opinion that these symptoms were the harbin- gers or forerunners of a clap; but he strongly insisted that his disorder could be nothing more than weakness, or a strain, as he had had no venereal connection for eleven weeks previous to this indisposition. I informed him, that should the cure of his disease be undertaken in this early stage, I believed it might be removed in less than a week, if he would strictly adhere to my instructions, but as he seemed so firmly persuaded that his disorder was not infectious, I advised him to wait only a short time, and he would then be perfectly sensible of the real nature and ten- dency of it. Three days only had elapsed, before he paid me a second visit, when I found my prognostick sufficiently verified; the urethra and glans penis being highly inflamed, E great [26] great heat in making water, some pain in erection, and a discharge of yellow matter issuing from the urinary canal: he was by this time fully convinced of his error, and re- quested that I would relieve him as expedi- tiously as possible.—I told him that his delay of three days would procrastinate the cure more than a week, and in the present state of the disease I judged that it would at least require a fortnight, should even his tempe- rance and regularity not be called in question. However, by the use of injection and a few alterative pills, he was perfectly cured in thirteen days. CASE IV. A GENTLEMAN in Westminster sent for me two years since, to give an opinion upon a stillicidium, or discharge from the urethra, which had first made its appearance two days before I saw him; he was quite at a loss to account for it, not having copulated for up- wards of two months prior to that period. I enquired whether he felt any irritation or trickling in the urinary passage, he answered in [27] in the affirmative, upon which I pronounced the case to be venereal, although the run- ning was perfectly clear, and the parts en- tirely free from any external inflammation, my patient, however, seemed to think that I had formed an erroneous opinion; I there- fore desired him to defer using medicine of any kind for a day or two, in which time I made no doubt of an alteration in his senti- ments. The next morning I was again sent for, and informed, that the parts did not look quite so cool as on the preceding day, and that his urine felt rather warmer than usual, these symptoms he attributed to some things he had ate and drank the day before. I replied, that in twenty-four hours I was fully persuaded he would assign another cause. before breakfast the next day, he sent for me again, and said that he no longer entertained the least doubt of the disease being infec- tious, having lately perceived some symptoms of an approaching chordee; the running was now become yellow, the parts were inflamed externally as well as within, and he could not make urine without some degree of pain. I prepared for him a cooling injection, of E2 which [28] which he used a syringeful night and morning, and as he was very subject to the gout, I ad- ministered no other medicines internally, than decoctions of the woods and camphor, by which means, in the space of seventeen days, the cure was very easily completed. CASE V. A GENTLEMAN in the county of Kent, put himself under my care on the ninth day of December, 1779; he had enjoyed a very good state of health for some years, till within three days ol his application to me, when he discovered a yellow running from the urethra, attended with a heat of urine, and an inflam- mation of the glans penis and præputium. There was likewise a small chancre on the frænum. After ocular demonstration, I as- sured him that his disease was venereal, my patient was not of a different opinion (having been frequently infected before) but he ex- pressed great astonishment at its being so; from the circumstance of not having had any vene- real intercourse since the fifth day of the preced- ing September, and having been entirely free of [29] of every symptom of the disease till the sixth day of December; an interval of thirteen weeks and upwards from the time of con- tracting the disease, to that of its appearance, Upon my interrogating him very closely as to the commencement of this affair, his an- swer was, that he could have no interest in deceiving me, and that it was impossible he should be mistaken, having a memorandum in his pocket-book of some particular occur- rences of that day, relative to this business, which with him reduced the matter to an ab- solute certainty. I observed, that probably sometime subsequent to that period he might have been too free in his libations to Bacchus, and be thereby deprived of recollecting his last engagement with Venus. This supposi- tion he obviated, by declaring upon his honour that he had not been inebriated for several months past, on the contrary, he had rather lived abstemiously than otherwise. This gentleman’s health was perfectly re-established in three weeks, by the use of internal alte- rants and external detergents. The foregoing cases having been selected from many similar ones, to shew what great length of time the venereal [30] venereal disease sometimes requires to mami- fest itself; let us now advert to others diame- trically the reverse in point of time. CASE VI. A MERCHANT in the city, who several years ago had been rny patient, consulted me in January last; he complained of an irrita- tion in the urethra, and some heat in the glans penis, which appeared rather inflamed externally. He informed me, that his last connexion had been only on the preceding evening, at about eleven o’clock, and antece- dent to that, he had not committed an act of venery for more than five months, during which time his health had been remarkably good. At six o’clock that morning he was awakened by a sharp pain in the yard, which soon abated, but did not entirely go off, a disagreeable heat and irritation still remaining. From the symptoms coming on so early as within seven hours after the embrace, he could not believe his complaint to be venereal, but supposed that it arose from friction, and the bad wine he had that night drank; I therefore declined to [31] to prescribe any medicines, but advised that he should live after his usual manner, and think no more of the disease till it might become more worthy of his attention; which happened two nights afterward, by the pain he experienced from a chordee; there was likewise a yellow running from the urethra, accompanied with a heat of urine; his doubts by this time being perfectly removed, he im- mediately entered upon the use of injection and pills, by which he obtained a cure in less than three weeks. CASE VII. A NAVAL officer in the month of March, 1778, was attacked with an unusual warmth in the urinary passage, in less than six hours after coition, and it gradually encreased for three days, when a copious running came on, attended with a smarting of urine: in this stage of the disease, he placed himself under my care, informing me that he was lately returned from a long voyage, and for several months past had not had an opportunity of getting the infection, he could therefore be [32] be very certain as to the date of his dis- order, having been entirely free from vene- real complaints for two years before. In effecting this gentleman’s cure, near a month was required, by reason of the high degree of scurvy with which he was at that time in- fected. CASE VIII. A GENTLEMAN in the county of Essex, about six months since, paid me a visit on the following account; having taken a night’s lodging with a lady of his acquaintance, the very next morning at breakfast he felt some uneasiness in the urethra, which in the course of a few hours encreased, and at the end of five days terminated in the symptoms of both clap and pox, viz. a discharge of viru- lent matter from the urethra, with heat of urine, &c. and three chancres externally; two on the præputium, and one on the glans penis. He was not much surprised at the early appearance of the disease, as with him it generally happened so; he neglected how- ever to use medicine of any kind, till it had arrived at the state above-mentioned, when, 3 he [33] became my patient; and without further delay began upon a course of alteratives and detergents, which effected his cure in less than a month. To the peculiarities of constitution, as well as degrees of infection, must be attri- buted the different periods in which parti- cular diseases make their appearance. This circumstance may depend on the dispropor- tion of one or more of the ingredients or materials which compose the human body. Some men are naturally so irritable and in- flammable both in body and mind, as instantly to take fire like tinder or touchwood, from the smallest spark; while others of cold phlegmatic habits, are (as is to be expected) quite the reverse. CASE IX. FOUR years since, a gentleman in the county of Northampton, made a journey to town, to consult me upon what he called a weakness of a particular kind, as it was ac- companied with great inflammation; I im- F mediately [34] mediately suspected what the case was, and upon examination, found it to be a most virulent clap, with an incipient phymosis; he complained likewise of a chordee. I was much surprised when he told me that his apothecary had not deemed it venereal, but treated it as arising merely from relaxation, giving large doses of Peruvian bark and elixir of vitriol. My patient said that the only reason why his disorder had not been judged infectious was, that it did not discover it- self till more than six weeks after coition; from which circumstance the apothecary had declared, that it could not possibly be vene- real. By the use of detersive injections and alterative pills, he returned home in perfect health at the expiration of about three weeks, CASE X. IN the month of December, 1778, a tradesman in Westminster commenced my patient, in consequence of a virulent gonor- rhœa which he had contracted more than a month before his application to me, and of which he gave the following account; that in [35] in six hours after copulation, he perceived an unusual sensation in the yard, a kind of trick- ling or itching in the urinary canal, which for upwards of three weeks had been a little troublesome, but bv no means painful, until the 26th day, when a clear colourless dis- charge issued from the urethra, which now began to be much inflamed, and felt very sore whenever the urine passed through it; on the 28th day, the running was quite yel- low and rather copious; and upon the twen- ty-ninth he was attacked with a chordee, which induced him to be under my care the next morning; he said he should certainly have applied sooner, but the inconvenience he experienced previous to the 26th day was so trifling, that he had not entertained the least idea of his complaint being venereal; it was however entirely removed in fifteen days, by the same means as were used in some of the preceding cases. F2 CASE [36] CASE XI. A GENTLEMAN in the county of Surry sent for me in the month of August, 1778, I found him labouring under a confirmed pox, of which the following were his symp- toms, a violent head-ach, nocturnal pains in the shin bones, with nodes thereon, a large foul ulcer in his throat, upon the left tonsil, a heat in the urethra, and an obstruction therein: upon my requesting to know every particular relative to the rise and progress of the disease; he informed me, that it was contracted about ten months before, and one thing appeared very strange to him, namely, his knowing himself to be infected in less than twelve hours after the connection, from a very troublesome irritation in the urinary passage, which seized him about that time, and for some days encreased notwithstanding his im- mediate application to a surgeon, who ordered almond emulsions with nitre, manna and salt; and to dilute freely with barley water, in which gum arabic had been dissolved, partial warm baths and venesection were not omitted; in the course of a week of ten days, mercu- rial [37] rial ointment was used very liberally for at least a month, with brisk purges at intervals. The running, he said, was very plentiful for the space of five or six weeks; he then too balsamics for three weeks, and was thought to be cured; however, in about seven or eight weeks afterwards, he perceived his health to be gradually on the decline, a dimi- nution of appetite, strength and spirits, and sleep interrupted by wandering pains in his head and limbs:—nodes soon after formed on the shins and an ulcer in the throat. On the appearance of these symptoms, another sur- geon was employed, who administered large quantities of the sublimate solution for a considerable time, when finding that the dis- ease did not give way, he put himself under my care, and was perfectly cured in two months, by the alteratives recommended in the 12th page, and a few bougies to remove the urethral obstructions. BE it observed, that no injections had been used in this gentleman’s case; to which cir- cumstance, in my opinion, may be attributed the want of success, for had a proper deter- gent [38] gent one been applied in the beginning, the venereal matter would not have been ab- sorbed, and consequently the pox with its disagreeable attendants been thereby pre- vented. CASE XII. A GENTLEMAN in Westminster, eighteen months since, consulted me in consequence of a boil (as he termed it) seated amongst the hair on the pubes very near the penis. This ulcer had resisted every application his surgeon had made to it for three or four weeks. From the hard edges and other appearances, I pro- nounced it to be a chancre; this my patient did not at that time credit, however, not long after he altered his opinion upon the appear- ance of a bubo in the left groin, which in a few days became very painful, when he paid me a second visit, and requested to have it repelled: that was performed, and a cure effected by an alterative course in about thirty days. CASE [39] CASE XIII. IN the month of November, 1778, a gen- tleman in the county of Middlesex labouring under a confirmed lues venerea, applied to me for its cure the symptoms at that time a small node on the right shin bone, an ulcer in the nose, nocturnal pains, and a cop- per coloured eruption overspreading a great part of his body. He informed me, that, till within the last twelve months, he had never experienced a single symptom of the venereal disease, and that his present afflictions, if they were venereal, must arise from a clap contracted a year before, which denoted a high degree of malignity, the inflammation being very considerable and of long duration, attended with heat of urine, chordee, &c. the running he said was copious, and continued upwards of five weeks, in which time he had been purged every three or four days, had rubbed in a large quantity of mercurial oint- ment, and afterwards taken electaries and pills in abundance: in consequence of this process the symptoms had disappeared, and at 3 the [40] the end of two months his cure was pro- nounced. Some few months after, however, he perceived his health to be gradually on the decline, without being able to assign the real cause, not having the least suspicion of vene- real matter; his appetite and strength daily decreased, his sleeps were short, interrupted, and afforded little or no refreshment, and at length colliquative sweats ensued: thus cir- cumstanced, he consulted a physician, who, judging his case to be a consumption, put him under a course of ass’s milk, &c. &c. for a considerable time, but growing every day worse and worse, he was ordered a change of air, and removed into another county. Find- ing however no greater relief from the alte- ration of air, than he had before experienced from medicine; he began to despair, and most earnestly wished for his dissolution. Fortu- nately, an old acquaintance from town called to see him, and upon hearing some of his symptoms strongly urged him to become my patient, he accordingly did so, and was per- fectly cured in the space of three months, merely by the use of alteratives. CASE [41] CASE XIV. A GIRL on the town applied to me upon the tenth of November, 1778, and said the sup- posed it would be necessary for her to undergo a thorough repair, not having been free from infection for a considerable time; her symp- toms then were, an ulcer in the throat, a foul eruption on the abdomen, a brace of small buboes, and a great discharge of acrid matter from the pudendum. As the was ex- tremely anxious to have the buboes dispersed, I told her that no time should be lost, and consequently advised the immediate use of medicine; the replied that it must be deferred till next day, as her mistress expected much company that evening, and had engaged her to one gentleman in particular, with whom she was to sleep that night, his name having been entered in the book for that purpose some days since; and for which he had paid the usual retaining fee.—I was not surprised at this account, similar ones having occurred before, and particularly this instance; a friend of mine, an officer in the army, made appli- cation to a lady Abbess to know on what G night [42] night a particular nymph would be disen- gaged; after inspecting her ledger, the in- formed him that the lady was disposed of for twenty-two nights, and if he pleased the would take down his name for the twenty- third, upon paying the usual compliment.— But to return to my patient; the called upon me again the next day, and without any fur- ther delay entered upon a course of alteratives, by means of which her health was perfectly re-established in less than seven weeks. She was under great apprehensions left the bu- boes should suppurate and occasion scars, but was soon made easy on that head, as they dispersed very kindly in a few days, the other symptoms gradually disappeared, and in little more than three weeks the thought herself well, it was therefore with some difficulty that the could be persuaded to continue the medicines a short time longer, in order to confirm the cure. CASE XV. A MECHANIC in Westminster, being em- ployed in the house of a nobleman, became acquainted [43] with common dressings, and made use of the præcipitate digestive, but without any success. Upon this I gave antiphlogistics, and the being of a sanguine habit, I bled her; this proved successful; the foul ap- pearance at the bottom was changed, and shewed a good disposition to incarn. By a continuance of this method, and simple dressings, in ten weeks, the cure was ef- fected ; tho’, during the whole cure, I ordered her to use free exercise; and after the cicatrisation, I directed her to conti- nue the medicines for one month. CASE XXI. MR. W—, Theobald’s Row, made application to me for the cure of an old callous ulcer, which had been of long standing, and had resisted many at- tempts which had been made for the cure; and amongst the rest a Quack, who by means of powerful mercurials inwardly, and astringent applications externally, to make good his boasted promise, dried up the sore; which, however, in a short time after, broke out again, and became as troublesome as ever; and had the appear- G2 ance [44] ance of a very inveterate ulcer, discharg- ing a thin acrimonious serum; which greatly inflamed the leg, and in some parts occasioned an excoriation. Under these circumstances, I began the cure with an- tiphlogistics, which soon altered the dis- charge, and brought on a good digestion, tho’ the ulcer was dressed with nothing else than the yellow cerate, softened with ol- lini. Finding this method so successful, I repeated the remedies, and by this means this obstinate ulcer was foundly healed. CASE XXII. MRS. Milnes, wife of Mr. Milnes, founder, Mercer Street, Long Acre, applied to me for the cure of an ulcer on the lower part of the leg, which had been in a bad state many years, the discharge was thin and acrimonious, attended with great pain and inflammation. At first I ordered antiphlogistics, and occasionally a laxative, which, however, did not imme- diately answer my expectation; on which I took a large quantity of blood from the arm, and repeated my remedies, and not without success; for soon after the ulcer began [45] began to incarn from the bottom, and by repeating the remedies the cure was effec- ted in seven weeks from her first applica- tion. This cure was performed about three years ago ; I have seen the patient lately, who is in good health, and the leg remains found. CASE XXIII. An Ulcer cured of Thirty-eight Years standing. MRS. Nichols, aged sixty, servant at Greenwell’s, grocer, in Holborn, ap- plied to me for the cure of an ulcer, which was very foul, attended with inflamma- tion, and very great pain. She informed me, that this leg had been diseased near thirty-eight years; originally owing to a fever settling in it, to use her own expres- sion. About four years before the applied to me, the had been under the care of one of the surgeons of St. George’s hospital, who is justly esteemed one of the most eminent in town, who advised her to have her leg cut off, as the most effectual cure, at the same time declaring it dangerous and impossible to effect the cure, with- out endangering her life. I began the cure [46] cure with antiphlogistics and camphor, which had very excellent effects; for in about fourteen days, the ulcer shewed evident signs of the efficacy of the medi- cines; upon which I increased the dose, and in about two months I had the hap- piness to cure this obstinate ulcer, without the least inconvenience to the patient whatever, the using considerable exercise during the whole cure. When the first took the medicine, after each dose the felt very great pain all round the ulcer: which effects I have observed in other cases; and where it has happen- ed, the cure has been sooner performed than could be reasonably expected. This cure has been performed now about three years, the patient is in good health, and the leg remains found. She now lives at Mr. Peters’s, broker, the corner of Cross Lane, in Castle Street, Long Acre. CASE XXIV. MARY WEMS, in Parker’s Street, had been afflicted, between three and four years, with an ulcer of the leg, which was quite superficial, but very large, [47] Upon examining the lady, her skin in some places appeared rather discoloured, (as if na- ture was labouring to throw off part of the noxious humour that way, but wanted strength to effect it) and she had likewise every symp- tom of a pocky hectick. The disease had been communicated to her entirely by the contaminated semen of the man, without its having done the least injury to the vagina, or any other part of the pudendum. After hav- ing made the necessary enquiries, I recom- mended a course of alteratives to both man and wife, by the use of which, in less than two months they were perfectly cured, as ap- pears at this time by the healthiness of their offspring. The lady became pregnant about two months after leaving off the medicines, and has borne several children since. Had this gentleman adopted the salutary plan pur- sued by some of our modern debauchees, prior to entering into the connubial state, all the foregoing disagreeables would have been prevented. This prudent plan or measure, is nothing more than going through a short course of alteratives; which in many in- stances must be highly necessary, particularly after [48] after a series of irregularities, and a variety of infections, which through neglect or im- proper treatment, may be productive of great mischief in future. THE inefficacy of a first or second saliva- tion occurring so very frequently, I do not think those cases worthy of insertion here, I shall therefore immediately proceed to the re- lation of such as have withstood three, four or five repetitions of that foul process. CASE XVIII. IN the year 1775, a gentleman in the city of London put himself under my care, on account of a confirmed pox, with which he had been infected some years, notwithstand- ing three salivations, and long courses of the solution of corrosive sublimate and sarsaparilla decoctions.—He gave the following parti- culars of his case; that he contracted the in- fection in the year 1769, which at that time manifested itself in a clap and chancres; his surgeon administered medicines for eight or nine weeks, and then dismissed him as cured. In [49] In the course of a few months a foul erup- tion overspread his body, and ulcers formed in his throat; he again applied to the sur- geon, who advised salivation, and soon after put him in a course of spitting for some weeks, and then pronounced his cure to be radical. In less than six months the disease re-appeared, but with much greater malignity than before: the ulcer in the throat broke out afresh, with the addition of two in the nose, which soon swelled to such a degree, as to obstruct in some measure the sight of the left eye, and he was deprived of rest by nocturnal pains. Thus circumstanced, he employed another surgeon, who also salivated him; the spitting he said was continued above three weeks longer than in the preceding sa- livation, after which he was assured by his medical friend, that the disease was perfectly removed. Business some months afterwards required his taking a journey into the North, where he was alarmed with the return of some of his former symptoms, nocturnal pains, &c. During his residence in the coun- try, he took a great deal of mercury in various forms and preparations for several weeks; H which [50] which proving to be merely palliative, he returned to town and consulted another sur- geon, who recommended a third salivation; this he did not very readily agree to, having experienced its inefficacy twice before. How- ever, being informed that it was the dernier resource, and at the same time entertaining a very high opinion of the abilities and inte- grity of his surgeon, he at length consented to be salivated a third time; when a copious spitting was continued for a considerable time, as long as it could with any degree of either safety or propriety be pursued. HE was attended likewise by a physician, who, with the surgeon, declared that the dis- ease was entirely vanquished, and that nothing more was necessary than pure air and nutri- tious diet to recruit his strength, and finally complete the cure. Indeed they were, he said, quite positive as to the success of this last salivation, the symptoms having given way so readily, and the process in every re- spect been so satisfactorily conduced through- out. The patient acquiesced in the prog- nostic, and without further delay removed into [51] into the country for the benefit of air, &c. This pleasing delusion lasted not many months, for he had the mortification to per- ceive that some of the symptoms of his old disoder were gradually coming forward again; he thereupon consulted his physician once more, by whose direction he took sublimate solution and sarsaparilla for some months; these medicines afforded him only a temporary relief, and were not attended with better success than the three salivations which had preceded them, as evidently appeared not many months after by a return of the disease. His patience as well as constitution was by this time nearly exhausted; insomuch that he frequently declared, no one should ever persuade him to make any further trial of medicine, it having fo repeatedly proved sal- acious. The disease however becoming al- most insupportable, he was prevailed upon to make one effort more for its removal: in consequence of which he became my patient at the time above-mentioned, when he had several foul ulcers on the back, two in his nose, one on the cheek, and another behind the right ear; his head was almost covered H2 with [52] with scabs, as was likewise the scrotum: from all these issued such nauseous effluvia, that his nearest relations and friends could not re- main in the same room with him long at a time. Pains in his head and limbs prevented him from sleeping, except towards morning or in the day. His appetite, strength and spirits were so much reduced, that he des- paired of relief from any thing but a total dissolution. After having attentively given ear to this melancholy detail of repeated dis- appointments, and examined the ulcers, &c. and made the proper enquiries relative to his former habit of body, or natural tempera- ment previous to the disease, I declared as my opinion, that he might be cured by alte- ratives, if of the most powerful kind, and regularly persevered in for some weeks. He assented, though not without first observing, that by this time be had entirely lost all faith in medicine. I prepared for him strong de- coctions of the woods, and likewise alterative pills, and desired him to take them in such doses, and as repeatedly as the strength of his stomach would admit of. Relying solely on the effects of internals, I applied no other dressing [53] dressing to the ulcers than dry lint through- out the whole time. I recommended diet of the most nutritious kind, and that it should ge taken in small quantities, frequently re- peated, by reason of the very weak state to which the disease and reiterated salivations had reduced him. In little better than a week, the nocturnal pains entirely left him, tue scabs soon after fell off, and the ulcers were in good condition; his appetite and spi- rits daily encreased, insomuch that he thought himself well in less than a month, the ulcers being all healed, and every symptom of the disease having by that time disappeared.—Not- withstanding which, I judged it necessary to continue the medicines a month longer, to prevent a relapse. My patient had no ob- jection to persevere in the use of them for any length of time, having already experienced such salutary effects; which, with great plea- sure he contracted to those of the methods he had formerly pursued; instead of being con- fined to his chamber, and undergoing one of the greatest punishments (as he expressed it) in the power of the faculty to inflict, namely, that nauseous process a salivation, he had enjoyed [54] enjoyed moderate exercise in the open air every day the whole time he was under cure, and experienced an encrease of appetite, strength and spirits in proportion to the time of using the medicines; and as a proof of their not being unpleasant, he constantly drank the apozem at meals, and at other times when thirsty. Thus was he radically cured in the space of two months, having never experi- enced any return of the complaint, as he not long since informed me. CASE XIX. THREE years since, a merchant in West- minster employed me to extricate him from the following disagreeables; nodes on the shins, an ulcer in the throat, nocturnal pains, and a scabby eruption on his body, which from its stench was extremely offensive. He was much emaciated, and had little or no ap- petite. I desired to be informed of particu- lars, the date of the disease, in what manner it first appeared, and what methods had been used for its removal. To which he replied, that in the year 1772 he caught the infection, which [55] which made its first appearance in a bubo on the right groin, and was not preceded by ei- ther chancre or clap, nor had he ever been infected before. The tumor encreased very fast and was extremely painful, his surgeon encouraged suppuration, and when that was complete, opened it by caustic. The dis- charge continued upwards of three months, during which time he rubbed in large quan- tities of mercurial ointment, and was purged at intervals to prevent a sore mouth; and at the end of about fourteen weeks his cure was pronounced. In a few months however, the disease returned; ulcers having formed in the throat, accompanied with nocturnal pains in his head and limbs, for which he under- went a salivation, and was again supposed to have received a cure; but in less than six months he was obliged to apply once more to his surgeon, the disease having re-appeared with the addition of a node on the left shin- bone; he was salivated a second time, and was said to be perfectly cured. After some months the disease again appeared, when he employed another surgeon who persuaded him to make trial of salivation for the third time, 3 which [56] which affording only a temporary relief, he consulted a physician, by whose direction he took medicines for several months, until the disease was thought to be removed; being reduced by this process to a very languid state, country air and ass’s milk was recommended, but they had not the desired effect; for soon after the discontinuance of anti-venereals, he gradually relapsed into his former situation. His medical friends being again consulted, they strongly urged the necessity of a fourth salivation, as the only probable means of suc- ceeding; by this time he entertained no very high opinion of salivation, but being almost worn out with pain and disappointment, he agreed to it with this proviso, that it should be carried to such a degree, as to terminate in the perfect re-establishment of his health, or in the grand cure of all mortal complaints. To humour him they acquiesced in the pro- posal, and he was salivated for the fourth time; the spitting they assured him was continued as long, and to as great a degree as his strength possibly could admit of; and every circum- stance considered, they had not the least reason to doubt but a radical cure would be the con- sequence. [57] sequence. This desireable prediction how- ever, was by no means verified, as evidently appeared in the course of a few months, the disease returning with seemingly accumulated virulence, which he observed to be the case after each of the preceding salivations. Hav- ing finished the narrative, he desired to be informed whether I could render him any service, which he was induced to believe might happen, from some accounts he had lately heard of my having effected cures after the failure of repeated salivations. I told him that I had been successful in that line, and notwithstanding the obstinacy of his dis- ease, I entertained some hopes of relieving him. After some further conversation, he desired me to administer what I thougnt pro- per, and that he would strictly observe my directions in every respect. Accordingly, recommended a course of alteratives, and at the same time the most nutritious diet, with moderate exercise in the open air, to be fre- quently repeated, proportionally to his en- crease of strength. Within the first fortnight I sent him three times to a bagnio, in order both to cleanse the skin and promote perspi- I ration. [58] ration. By these means he obtained a per- fect cure in the space of ten weeks, and has remained healthy ever since. CASE XX. A GENTLEMAN in the county of Cornwall, four years ago, put himself under my care, his case was a confirmed pox, under which he had laboured near eight years, the symp- toms at times having been palliated by five salivations, and a variety of medicines. Upon my requesting to be informed of every par- ticular relative to his complaint, he told me, that being a man of few words, he never dealt in long narrations, of which his case would prove one if given in detail; he should therefore mention a few of the most material circumstances, and wrap them up in very small compass. He said, “ That about eight years before, he contracted a small chancre on the penis near the frænum, which his surgeon healed in a few days by the use of mercurials both externally and internally. A short time after, a bubo formed in the groin; it suppurated, was opened by caustic, and, after [59] after discharging some weeks, healed; he took medicines six or eight weeks, and was said to be cured. In the course of a few months he was visited by an ulcer in the throat, nodes, and nocturnal pains. In fine, the inveteracy of his disease was such, that, from the time above-mentioned, to that in which he was speaking, it had withstood five salivations, and great quantities of different medicines administered between each or them: and (as he expressed it) had he not had the constitution of a horse, the disease or the methods used for its removal, must in that length of time have destroyed him; but thanks to heaven, his stamina were naturally of the strongest kind. He was now quite emaciated and worn down with nocturnal pains in his head, limbs, &c. There were three nodes on his ribs, and a large ulcer on the head, from whence several pieces of bone had exfoliated, and many more were so loose as to require extraction soon after be- came my patient; this opening had been made by a caustic, for the purpose of dis- charging a large collection of matter. These were his symptoms at the time he made ap- I2 plication [60] plication to me; and notwithstanding the measures hitherto adopted had succeeded no better than as mere palliatives, I despaired not of removing the disease; having so frequently experienced the powerful effects of alterants in the most confirmed cases, where many repeated salivations had proved abortive. This gentleman acquired a radical cure in three months by the use of alteratives; had the ex- foliations been completed sooner, I should not have given him the medicines so long. CASE XXI. IN the year 1777, a gentleman from the county of York, came up to town to be un- der my care. He had been afflicted with a venereal complaint almost ever since his birth, by means of an infected nurse, whose foul milk so gradually affected him, that some weeks elapsed before his parents were able to account for his declining state of health; happily however, the cause was discovered, and a check put to the rapid progress of the disease, by means of anti-venereals. The growth however of the child was much impeded, [61] impeded, as the medicines though continued a long time had only palliated the symptoms, and saved the life of the patient. When he consulted me, his age did not exceed twenty years, he carried but little flesh, and was low in stature, although his parents were the re- verse. Foul eruptions frequently infested many parts of his body, and sometimes af- forded a temporary relief from the achs and pains which he generally at other times experienced. His eyes were extremely weak, and often so much effected by this acrid hu- mour, as to be threatened with a loss of sight. The infection having been thus deeply rooted in the constitution, and in a manner inter- woven with it from his infancy, I entertained very slender hopes of totally eradicating it; this opinion I communicated to my patient, who, nevertheless, entered very chearfully upon a course of my medicines, which some of his acquaintance had frequently given him a very favourable account of. In the space of three weeks he acquired a good appetite; the cutaneous eruptions gradually gave way, as did likewise the pains in his limbs, &c. he daily improved in strength and spirits, and at the [62] the end of three months appeared to be in high health, and was grown fat. By my ad- vice he continued the medicines three months longer, and was then perfectly cured. Let this, amongst many other similar instances, serve as a caution to parents how they entrust their infant offspring to mercenaries. Other acrid humours may often be derived from the same unhappy source. CASE XXII. A TRADESMAN in Westminster, about two years and a half since, became my patient, to- gether with his wife and child, who, at that time, were all infected with the venereal dis- ease: the man had a copper-coloured erup- tion on his body, and an ulcer in the throat; the woman a bubo in the right groin, and nocturnal pains; and the child a venereal eruption which overspread the greatest part of its body. This complicated scene of dis- tress took its rise from the husband, who in- formed me, that nine or ten months before, he had made an imprudent connection; twelve days after which, a small ulceration (a com- [63] (a common excoriation he supposed it to he, though in reality a chancre *) made its appearance on the glans penis, near the fræ- num; not suspecting it to be venereal, he ap- plied a piece of dry lint or cotton, which healed it in a few days. On examining the part, I found, that notwithstanding it had skinned over so readily, there yet remained a small collosity, from which all this mischief had originated. In the course of a few months he had reason to suspect himself to be in- fected, and a short time after the mortifica- tion to find that he had communicated the disease to his wife, from whose milk it was conveyed to the child also. An enlargement of the inguinal gland was the first venereal symptom that attacked the woman, none of the neighbouring parts having been at all af fected; we may therefore conclude, that she received the infection from the contaminated semen of the man. The family surgeon and apothecary having for some time administered medicines without the desired effect; I was * By the patient’s account not much larger than a pin’s head. thereupon [64] thereupon called in, and found the parties in the situation as above described. The child at this time was not more than twelve months old, consequently very little success could be expected from the application of medicine immediately to the infant itself, for, let the preparation be ever so palatable to the taste, or gentle in its effects, a sufficient quantity would not be taken to eradicate a disease of this kind. Therefore, I desired the mother to continue suckling her child, that the re- medy might be conveyed to it through the same channel that had communicated the disease; for this purpose, I immediately put her under a course of alteratives, of which she could take only small doses on account of the infant, whereby the cure was protrac- ted to near four months, at which period I had the satisfaction of seeing both mother and child perfectly freed from this loathsome disease. The man’s health was re-established in half the time that had been requisite for the cure of his wife and child, by reason of his taking the medicines in their full doses. I COULD mention several cases similar to the foregoing ones, was I not of opinion, 3 that [65] that they will elucidate the subject as well as ten times their number. N. B. IN the treatment of chancres, their callosity should be removed as expeditiously as possible, to prevent the ill effects ox ab- sorption which will otherwise ensue. EXCORIATIONS on the glans penis and præ- putium of men, and on the labia pudendi, vagina, &c. of women, have very frequently been treated in the most erroneous manner; some that were truly venereal, have been totally neglected, whilst others that arose from very different causes, have been so carefully at- tended to, as almost to endanger the life of the patient; by the application of strong meri- curials, drastic purges, &c. Nor are instances wanting, of persons having been salivated on the like occasion. PROPHYLACTICS. HAVING treated hitherto on curatives only, let us now bestow a few thoughts upon pre- ventives. The doctrine of prevention, altho' K it [66] it may not be coeval with the disease, is ne- vertheless of considerable antiquity: for the accomplishment of so desirable a purpose, a great variety of methods have been proposed; many of them are to the highest degree ab- surd, and a few only that bear even the sem- blance of probability, particularly amongst those recommended by the ancients. During my attendance at the lectures of medical pro- fessors several years since, I have frequently been much entertained at the ingenuity with which this subject has been handled. One of these gentlemen has strongly contended, that a mucilaginous or oleaginous application is the only topical one that can be depended upon; and in support of this opinion, expa- tiated on the power of emollient, and unctuous remedies in correcting or counter- acting the most acrid and corrosive substan- ces, by blunting their spicula, and sheathing the acute angles, &c. thereof. Another pro- fessor perhaps equally learned, and probably, not inferior to the former in experience, in- sists, that a strong alkali is the only thing which can effect this grand desideratum, and for this reason, that in order to expel the ve- neral [67] nereal virus as expeditioustly as possible, no- thing will be so likely to answer that pur- pose, as a medicine of this kind, which im- mediately stimulates the glands to such a de- gree, as to produce a very copious secretion of their fluids, and thereby dislodge the enemy without either impediment or de- lay. With equal plausibility, acids have been recommended by some, and spirits by others; not considering that the pain, &c. arising therefrom, would frequently injure as much, and perhaps sometimes more, than the disease which they were intended to guard against. VERY numerous have been the advocates for mercurial preparations, whilst several have given the preference to those of lead. Every man of experience, however, must acknow- ledge that theories in general (how specious soever they may appear) are, the major part of them, extremely defective, when put to the test. I have myself seen a number of va- rious experiments made on the present sub- ject; indeed, the line of practice in which for many years I have been materially engaged, as enabled me to prosecute an enquiry K2 this [68] this kind to as great an extent as most men; and after all, I am persuaded that very gentle stimulants will answer the purpose more ef- fectually than applications of any other sort: I am led to be of such an opinion from the very great success that has attended this mode of preservation for several years past; those of my patients who have made the pro- per and timely use of a composition of this kind, have not been infected, I believe, once in fifty times upon an average: which, con- sidering all circumstances, is as much as can be reassonably expected. Were I to assert that any medicine or preparation is infallible, I should pay no great compliment to the under- standing of my readers, by advancing so pal- pable a falsehood; suffice it to observe, that some of my friends entertain the highest opi- nion of this composition, from the great and repeated risks they have ran for many months successively, without receiving the least in- jury; notwithstanding their sometimes copu- lating with such as they knew to be infected at the time of action. To guard against the infection, some prac- titioners have thought it sufficient to advise the [69] the application of unctuous or other substances to the glans penis, in order to obstruct or close up the absorbent vessels or pores thereof, being of opinion, that the enemy always gets admission that way: in opposition to such doctrine, be it remembered, that chancres fre- quently fix upon other parts of the penis, and sometimes attack the scrotum and its vici- nities, from which buboes have ensued, as appears in some of the foregoing cases. GLEETS, OF gleets issuing from the urethra, there are two species upon which I propose making some observations; namely, the venereal gleet, and the seminal one. The former is the dis- charge which succeeds a clap; in other words, the running that continues after the removal of infection; this disease arises from the ure- thral ulcerations not having been healed in pro- per time, which may he occasioned by various means; for instance, by too frequent repeti- tions of strong cathartics; by unctuous appli- cations long continued; by acrimonious hu- mours; in fine, by any thing which relaxes to [70] to too great a degree, or for too long a conti- nuance. The cure is often protracted by the irregularity of the patient, who sometimes is kind enough to impute it to the mismanage- ment of his surgeon; and on the other hand, it may so happen, as to be really the case. Some of the reasons assigned for the diffi- culty of curing ulcers on the legs, will hold good in those of the urethra: the situation of both affording a depending orifice, or drain to the humours, which consequently will very readily flow down thereto; and when Nature has been accustomed for a length of time to any particular evacuation, or the outlet there- of, the flux of humours will there be very considerable, and the task of diverting them to any other channel will be proportionably difficult. Another disagreeable circumstance attending ulcerations of the urethra, is, the frequent flows of urine over them, which at times being highly acrimonious, must inter- rupt the digestion of the ulcers; and a part of it lodging in them, may corrode in some degree, unless prevented by proper topical ap- plications, which cannot here be conveyed in a more suitable form than that of injection. And [71] And even after the ulcers are healed, it will generally be found expedient to continue in- jection a week or ten days longer, to confirm the parts, and defend them from the urinous salts, which (should this precaution be omit- ted) are sometimes so acrid as to abrade the new skin, and make the sores discharge afresh The same thing may happen when the urine is loaded with coarse gravel or stones, which will soon destroy the tender cicatrix; and if neglected but for a few days, a fluxion of humours to the part may ensue, and must consequently retard the cure. So high an opinion do I entertain of in- jections, that I will venture to affirm, that almost every gleet (unaccompanied with ca- runcles, or callous edges of those ulcers from whence it proceeds) may be cured by injec- tion, provided the redundant acrimony (if there happened to be any) shall have been pre- viously corrected. Innumerable almost are the instances which might be produced in support of this opinion; a few only of most remarkable ones will be here introduced to elucidate that point.—Gleets, attended with great [72] great obstructions in the urethra, occasioned by carnosities, caruncles, callosities, funguses, &c. (call them by what names you please) will generally require medicated bougies to remove them before we can expect a radical cure of the gleet. They will likewise be ne- cessary in the removal of strictures, and the callous edges of old obstinate ulcers in this part. As to the composition of bougies, great care must be had that nothing corrosive or very stimulating be introduced therein; on the contrary, it must consist of the mildest di- gestives; and when formed into bougies, must have a very even polished surface, and be of such temper or consistence as readily to adapt themselves to the curvatures, &c. of the urethra, and yet at the same time be endued with sufficient strength to make the necessary pressure. The foregoing caution relative to the composition of bougies, cannot be too much inculcated, when we consider the de- licate texture of the urethra and its extreme irritability: no two parts of the body, I pre- sume, bear greater analogy in point of sensi- bility, than the urethra to the eye. In the management of bougies, more attention is 3 necessary [73] necessary than people in general imagine; for instance, if too large a one be introduced, or too much force used, either an hæmorrhage (that very much alarms the patient, though in other respects not prejudicial) or an inflam- mation ensues, which must retard the cure, should it produce no other disagreeable ef- fect. The distention of these parts ought to be made very gradually for the reasons above assigned, as well as to avoid the pain that must otherwise be occasioned. If the end of the bougie be suffered to press against the neck of the bladder, it generally stimu- lates to such a degree, as to produce a stran- gury. A LIGATURE of some kind should always he affixed to a bougie, previous to, or im- mediately after its introduction, both to pre- vent it from flipping into the bladder, and to retain it exactly in the proper situation. How long each bougie may be worn, will depend upon the irritation it occasions; it must not remain in the urethra after it becomes painful, for reasons very obvious. When the urethra has been habituated to them, they may be L retained [74] retained the whole night, provided sleep be not thereby prevented, or much interrupted. Antecedent to a course of bougies, it will fre- quently be necessary to prepare the parts with a cooling injection, and to repeat it during the use of them, as soon as the least symptom of inflammation makes its appearance. Gen- tle aperients at this time may likewise be ser- viceable, such as lenitive electary, sulphur, magnesia, &c. Moderate exercise, and a to- tal abstinence from acids and strong liquors must also be enjoined. As to the length of time which may be proper to continue the use of bougies, that must depend upon the degree of obstruction in the passage, and the irritability thereof, together with the patient’s habit of body, and many other circumstances. It will not I believe be disputed, that there may be the abuse, as well as proper use of bougies, for should they be continued long after the disappearance of discharge, a fresh running will be produced, by the very means employed to remove the old one; they are not, however, to be left off abruptly; it must be done gradatim, left the cicatrix should exceed its due bounds, and thereby lessen the diameter [75] diameter of the urethra. Men sometimes want patience under a course of bougie; but the time may be greatly shortened by the as- sistance of proper injections. Many instances indeed have occurred, where injection has performed a cure after bougie, and every other remedy has proved ineffectual. Such im- provement has of late been made in this re- spect, that I do not find it necessary to use half the number of bougies which I formerly did, cures now being effected in so much less time. CASE XXIII. IN the month of March, 1777, I was ap- plied to by a gentleman of fortune in the county of Derby, who had laboured under a venereal gleet for more than six years; in the course of which time he had employed several of the faculty in his own neighbour- hood, and had made journies to town for the opinions and prescriptions of some eminent ones in the metropolis, in consequence where- of, he had used a variety of medicines both external and internal, which afforded him only a temporary relief; the discharge gene- L2 rally [76] rally returning in ten days or a fortnight after- wards. The disease commenced, he said, in the year 1770, when he contracted a clap, for the cure of which, his surgeon had purged him pretty briskly, and used a considerable quan- tity of mercurial ointment, until the infec- tion was supposed to be removed; then, bal- samics, astringents, &c. &c. were adminis- tered; and he afterwards used the cold bath for several weeks successively. All these ex- pedients however proved merely palliative, as the complaint constantly returned soon after their discontinuance. The discharge was copious and of a deep yellow colour; I desired permission to examine the urethra with a bougie, he readily assented, but ob- served that bougies would be of no service to him, having used them upwards of eleven months without any good effect; I informed him that I did not propose his wearing them, unless there should be a very material ob- struction in the passage; which upon exami- nation not being the case, I recommended alteratives and an astringent injection, the former to be continued three weeks or a month, and the latter, double that time— with [77] with moderate exercise, and a strict abstinence from acids of every kind: and at the same time to keep his body solutive with sulphur or magnesia alba. By these means he was ra- dically cured in the space of two months, and has remained well ever since, as he per- sonally informed me in the month of January, 1780. CASE XXIV. ABOUT two years since, a gentleman in Westminster applied to me for the removal of a gleet, which had troubled him twelve years; during that time, he had at intervals taken a great deal of medicine, and of various kinds. One remarkable circumstance attend- ing this case, was, that notwithstanding the very long continuance of the running, no carnosities or obstructions of any sort had formed in the urethra, which I ascertained by the introduction of a bougie, previous to delivering any opinion upon it; when finding the passage perfectly clear, I told my patient that his complaint in all probability might be removed without much difficulty, pro- vided [78] vided he would live temperately, and adhere strictly to the rules I should prescribe; namely, to avoid acids, strong liquors, and violent exercise; and regularly to use every night and morning a syringeful of injec- tion. These he did; and was perfectly cured in the course of three months. CASE XXV. A NOBLE Lord, in the month of May, 1778, sent for me, on account of a gleet attended with a small obstruction in the urethra: he informed me that his disorder was of four years standing, and had resisted every means prescribed for its removal; that he had taken a variety of medicines, been once salivated, and had used bougies. The discharge was thin, yellow, and copious, unaccompanied with either pain or inflammation. As his Lordship was of a good habit of body, I did not prescribe any internal remedies, but trusted wholly to injection, which in the space of six weeks effected a radical cure. N. B. THE [79] N. B. THE same regimen was observed as in the preceding case, and the injection was used three times each day. CASE XXVI. A STATIONER in Westminster, three years ago applied to me, in consequence of a gleet with a small caruncle in the urinary canal, which complaint he had laboured under up- wards of five years, and during that time had used various medicines, but they had all proved ineffectual: he was however, perfectly cured in less than two months, merely by the of injection. CASE XXVII. I was consulted about two years since by a coal-merchant in the county of Middlesex, who had then contracted a virulent gonorrhæa, in addition to an old gleet with which he had been troubled for some years. He expressed much concern at this accident, imagining that the gleet would be a great impediment to the cure of the gonorrhæa; but I soon made [80] made him easy on that head, by observing, that probably both complaints would be re- moved at the same time, as I had very fre- quently been fortunate enough to cure clap and gleet both together: and indeed it so happened in this case, at the end of five weeks, by means of injection and an alterative apozem. CASE XXVIII. ABOUT seventeen months ago, an Irish Peer became my patient; his case was a ve- nereal gleet, with which he had been afflicted many years: bougies as well as internal me- dicines had been repeatedly used without suc- cess. Upon examination I found a small carnosity in the urethra, from which issued a moderate quantity of yellow matter. I pro- posed injection, but he at first objected to it, alledging his having tried it without effect; not considering (as I observed to him) that the composition of injections were as likely to vary as that of any other remedy. I likewise related to him some instances wherein that mode of cure had been particularly successful 3 after [81] after every other had proved the reverse. He thereupon agreed to put it once more to the test, but was obliged to defer it for a few weeks on account of a long journey he was the next to set out upon. In the course of a month had lordship returned, and then informed me that my attendance was doubly necessary to him; having, on the journey, added a clap to the old disorder. The running was plen- tiful, and accompanied with a heat of urine and chordee. I IMMEDIATELY recommended the use of injection and a few alterative pills, which, with a proper regimen, perfectly cured him of both clap and gleet in the space of thirty- two days. FROM the number of cases that I have seen similar to the preceding ones, where fresh infection has been engrasted upon an old gleet, and the little difficulty generally experienced in removing both together I am led to believe, that in many instances, the sti- mulus produced by the venereal virus, has fre- quently contributed to accelerate the cure of the gleet; and particularly so, when it fixes M immediately [82] immediately upon the old ulcer; whose cal- lous edges may thus be removed more speedily perhaps than by any other means. A VERY striking instance of this kind will be found in the subsequent case: CASE XXIX. FOUR years since, a linen-draper in the city, after having ineffectually employed se- veral gentlemen of the faculty for the re- moval of a venereal gleet which had troubled him eight years, made application to me for the same purpose. I examined the urethra with a bougie, and found very little obstruc- tion therein; I then enquired into the dif- ferent methods of cure that had been adopted by his other surgeons, to which he replied, that after going through several mercurial courses, taking a great quantity of balsamies, and using a variety of astringents internally as well as topically, bougies were at last recom- mended; and notwithstanding the uninter- rupted application of them for some months, and the strictest regimen at the same time 3 being [83] being observed, the disease still maintained its ground. Upon further enquiry, I found that my patient was a very temperate man, and rather of a cold phlegmatic habit; I therefore judged that an alteration in his mode of living might be of use, and accordingly prescribed half a pint of good port wine to be taken every day after dinner, and twice or thrice that quantity after supper. I likewise ordered an injection to be used night an morning, and a few internal alteratives. This plan was pursued for a fortnight or three weeks without producing any very materia alteration in the disease; his spirits and appe- tite however were greatly benefitted, insomuch, that in the course of a week or ten days longer perseverance therein, he was induced once more to pay his devoirs at the shrine of Venus, and there again became a burnt-offering, having then acquired both clap and chancres, His reward for stealing fire (if it may deemed a theft) differed widely from that which metheus experienced: for to his great joy and surprise, the old inveterate gleet was ra- dically cured by the means used to remove the gonorrhœa and chancres, in the course of M2 twenty- [84] twenty-nine days. It may be asked, whether no succedaneum can be invented to answer the purpose as well as venereal matter? To which I should only give this answer, let future experiments and observations ascertain that point. It may likewise be suggested, that the supposed advantages accruing from this fresh infection, do not absolutely arise there- from, but from the medicines used in con- sequence of it, which may so correct the la- tent acrimony of the blood and juices, as to effect a cure merely by that circumstance. My reply to this will be, that I have admi- nistered the same kind of medicines, and for a longer time in some of these cases, previous to the new infection. It may then perhaps be said, that they were not continued long enough: be it so; or at this rate we might go on ad infinitum, and never put a period to our suppositions, we will therefore leave to practice instead of theory, the determination of this matter. CASE XXX. I WAS consulted a few years ago by the captain of a marching regiment, who had been [85] been afflicted many years with obstructions in the urethra—they were particularly distressing to him during the late war, occasioning re- peated suppressions of urine, which at length became so frequent, as to oblige him to carry a small catheter or a bougie generally in his pocket; unluckily, however, he was unpro- vided in that respect once upon a forced march, when being attacked with a total sup- pression of urine, and having no assistance at hand, he was under the necessity of taking a small twig from a tree, and after properly shaping, forced it through the obstructions into the bladder, made a passage for the urine, thereby saved his life, which had often keen in the most imminent danger from the same cause. At the time he applied to me, the urethra was so much obstructed with caruncles, that I found great difficulty in passing the smallest bougie, and therefore recommended the im- mediate application of them: his answer was “ That if no other means were used, he was very certain no cure would be obtained, hav- ing worn bougies at times for some years past; ” I replied, [86] I replied, “ That internal remedies were like- wise indispensably necessary in his case, by reason of the very high degree of scurvy with which he was most evidently infected; his body being almost covered with pustules, bolls and scabs, the rankest of the kind that I had ever seen. Very powerful antiscorbutics were therefore liberally administered during the whole course of bougie, in order to correct that acrimony, which would otherwise have much impeded, if not entirely prevented the formation of a proper cicatrix. The discharge from the urethra was very plentiful for the first three weeks, and from its sharpness some- times inflamed the glans penis and præputium, as well as the urinary duct, but was kept within bounds by the use of emollient and cooling injections. Thus, was the urethra entirely cleared of obstructions, the body of its acrimonious humour, and in less than four months the patient’s health perfectly re-esta- blished. CASE XXXI. A MEMBER of the House of Commons about a year ago sent for me, on account of an [87] an obstruction in the urethra, which had troubled him some years, and of late pro- duced a frequent inclination to make urine, though it could flow now only in a very small stream, and with much difficulty, from the encreased size of the carnosity. The ob- struction was so great, that it would not ad- mit the smallest bougie to pass it; I therefore contented myself with introducing one up to the caruncle, upon which it made a gentle pressure, being properly fixed with a ligature: I gave directions for its being retained in the same position as long as possible, that the bougie might gradually either insinuate itself through this fleshy substance, or else flip pass it. My patient persevered in the method I had proposed for the space of near eleven hours, when he had the satisfaction of per- ceiving that the obstruction gave way to the bougie. A small hæmorrhage ensued, which in a few minutes ceased of itself—soon after- wards he attempted to make urine, but at first found the passage more obstructed than usual; however, upon straining, he forced out some- thing, which he imagined was coagulated blood, but on examination it proved to be the [88] the carnocity itself—in shape and size it nearly resembled a pea, and was composed of a tough membranous substance,—the basis of it was very small, as will be readily conceived from its being so easily separated. The un- usual frequency of making water immediately ceased upon the removal of the excrescence, which without doubt had so simulated the parts as to be the occasion of it; upon the same principle I presume as any extraneous body would have done. Astringent injections now became necessary to procure a firm cica- trix; bougies were likewise frequently intro- duced to preserve the natural diameter of the urethra in that particular part; and, in order to confirm the cure, these applications were continued about a week or ten days. CASE XXXII. A TRADESMAN in Westminster, was for several weeks incommoded with a frequent desire to void urine, which at length encreased to such a degree as to prevent his attendance on business: thus circumstanced, he became my patient. Upon enquiry, I found that he had [89] had not been subject to either gravel or stone, nor was there any reason to suspect that infection had given rise to the complaint. I then proposed to examine the urethra with a bougie, but was prevented by a wart just within the orifice; that excrescence I re- moved with scissor, and destroyed its roots with an escharotic. The patient informed me next day that he no longer felt any irri- tation at the neck of his bladder, nor had any inclination to urine oftener than he usually did before the disorder took place. The parts soon healed; and he has been free from strangury ever since. HERE we may observe, that a disease at one end of the urethra, will produce disagree- able sensation at the other. It frequently happens that a stone in the bladder, when it presses in a particular direction, will create such an itching at the glans penis and præ- putium, that the patient cannot retrain from rubbing and pulling those parts. EXCRESCENCES in the urethra sometimes effect very materially the seminal ducts, as will appear in some of the following case. N IT [90] IT often occurs, even in claps, that the patient thinks his disease seated in one part of the urethra, when it happens to be in another: indeed, we cannot wonder at the many instances of very great sympathy in these parts, when we consider their exquisite sensibility. CASE XXXIII. A GENTLEMAN in the county of Norfolk, had many years laboured under a difficulty of making urine, occasioned by excrescences in the urethra, the consequence of a long con- tinued gleet. He had had frequent suppres- sions of urine after violent exercise, hard drinking, or excesses of any kind; this he deemed merely a temporary inconvenience, it having generally been soon removed by the introduction of a catheter or a bougie; which circumstance rendered him negligent as to the making of proper application for a radical cure. However, he at last suffered very se- verely for his inattention, as will appear in the sequel. In the month of June, 1777, being very much heated with exercise and high [91] high living, he was attacked by his old com- plaint, (the suppression of urine) and recourse was immediately had to the former expe- dients, but the inflammation and obstruction were so great, that no instrument could be passed into the bladder-his surgeon endeavoured to relieve him by the usual means, such as bleeding, warm bathing, terebinthinate and other clysters, anodynes, &c. but they proved ineffectual. After the suppression had continued upwards of thirty hours, he determined to come up to town, though at the distance of more than one hundred miles. The anxiety and pain that he experienced during the journey, may be better imagined than described. On his arrival in town he immediately sent for me, but half an hour before I saw him, the urine had forced its way through the perinæum, a part of which, and of the adjoining scrotum, found in a mortified date. The mortification extended at least six inches in circumference, from the pale emaciated aspect of my pa- tient, I could not expect any great assistance from his constitution, which by his own ac- count had been much impaired by a long N2 succession [92] succession of irregularities. His age did not exceed forty years; in the last ten of which, he had been frequently attacked with severe fits of the gout. Ail these circumstances considered, I could not form the most fa- vourable prognosis; however, I was parti- cularly careful, that my opinion should not be couched in such terms as might depress his spirits, being fully aware of the bad con- sequences that frequently ensue from the mind’s influence upon the body, especially in putrid complaints. Having in these cases no time to lose, I immediately proceeded to sca- rify the parts as deeply as the nature of them would admit of, or as circumstances required. After stuping the wound extremely well with a spirituous somentation, I applied warm digestives, and over them (instead of cata- plasm of any kind) soft rags moistened with camphorated spirits, and ordered the nurse to dip a sponge in the same every half hour, and squeeze it over the dressings and the neighbouring parts, in order to prevent as much as possible the mortification from ex- tending itself any further. The dressings were often renewed, on account of the urine’s flowing [93] flowing so frequently through the wound. As internal antiseptics were likewise indis- pensably necessary, I prescribed an electary of Peruvian bark and Virginian snake-root, be taken as often and in as large doses as his stomach would bear, and that it should washed down with camphorated julep or good Port wine, of both which I allowed him to take very freely. His liquors were most of them acidulated with elixir of vi- triol, to which was added the aromatic tinc- ture, to prevent its offending the stomach, and at the same time render it more cardiac. There were likewise prepared for him strong rich soups, and what is called beef-tea, of which he drank plentifully. Opiates were administered the first twelve days, aaci at suitable intervals, clysters to keep his bowels in a proper state. By these means the pro- gress of the mortification was soon impeded, and in a short time entirely stopped. The sloughs began to separate in the course of twelve days, when I thought it adviseable to attempt regaining the natural passage for the urine, the whole of which constantly flowed through the wound ever since it had first [94] first made an outlet that way. The caruncles in the urethra made so much resistance, that four days elapsed before the smallest bougie could be passed through them; but as soon as that point was gained, a bougie was con- stantly kept in the urethra both night and day. The urine by this method soon reco- vered the natural channel, and in less than a fortnight, not a drop of it passed through the wound, which now digested well, and in a few days incarned, and soon after cicatrised as kindly as could have been expected. By continuing the bougies six weeks longer, the urethra was entirely cleared of all its obstruc- tions, and the parts firmly healed. Soon afterwards, my patient returned to the coun- try in high spirits, and in a much better state of health than he had been for many preced- ing months. SEMINAL GLEET. HAVING hitherto made little or no men- tion of the seminal gleet, I will now offer a few observations upon the origin of that dis- ease, and produce some particular cases, both to [95] to illustrate the subject, and recommend a method of cure that has frequently succeeded after every other had proved ineffectual. That seminal gleets or weaknesses (call them by which name you please) are of all others, the most difficult to cure, I presume, will be controverted by any experienced prac- titioner; this difficulty will be encreased in proportion to the immediate cause or the dis- ease, and the contingencies that may attend it, the habit of body, mode of living, cli- mate, profession or occupation, &c. of the patient. The disease may arise from those excrescences in the urethra, which we term caruncles, carnosities, &c. and it is some- time occasioned by the destruction of that natural caruncle, the caput gallinaginis ure- thræ. It originates likewise from an acri- monious state of the blood and juices. Some- times it is produced by a general relaxation of the whose frame, from whatever cause soever that may take its rise, whether from a series of debaucheries, excessive venery, self- pollution, &c. &c. IN some of the foregoing cases, I have de- monstrated that an excrescence in the urethra will [96] will stimulate the bladder (though at the dis- tance of some inches) to such a degree as to bring on a frequent inclination to evacuate its contents: and when that stimulus hap- pens to fix upon the seminal ducts, the re- servoirs, or the testicles themselves, similar effects must naturally be expected. After the seminals have been thus stimulated for a length of time, their retentive faculties must indubitably become so much impaired and weakened, as to admit of very frequent and involuntary emissions. The same conse- quences may also be expected, when the blood is much impregnated with acrimony of any kind, and a considerable share of it falls upon any particular organ (a gland for instance, or its excretory duct) the irritation thereby pro- duced must excite an unnatural secretion, as well as expulsion of that particular fluid, and will at the same time alter the quality of it. A long cotinued repetition of this stimulus gradu- ally relaxes the mouths of the excretory ducts, together with their valves or sphincters, those natural obstacles to involuntary evacuations; in fine, they entirely lose their original powers of retention, and the fluid is frequently dis- 3 charging [97] charging itself, almost as soon as secerned, or upon the least exertion in making urine or going to stool, supposing the seminal vessels to have been thus visited by the acrimonious humour. CASE XXXIV. AN officer in the navy? after having la- boured under a seminal gleet for six years and upwards, put himself under my care about two years and a half since. His spirits, strength, appetite, &c. were greatly reduce, insomuch, that he was threatened with a total loss of virility. After interrogating him as to the cause of his disease, I examine the urethra with a bougie, and found it perfectly free from obstruction: I then inspected the colour and consistence of the discharge, and soon perceived that it had lost its natural texture, and seemed to abound, with acri- mony which upon further enquiry proved to be scorbutic. He informed me that he had been much afflicted with the scurvy for some years previous to the appearance of his present complaint. Having now investigated the O cause [98] cause of the disease, I had but little difficulty to apprehend in performing the cure of it; as my patient, from his appearance, as well as promises, persuaded me, that nothing on his part would be wanting for the completion of it. I had not formed a wrong conjecture; for with the greatest regularity and attention he persevered in a course of antiscorbutics, which in a few months entirely removed his gleet, and at the same time perfectly re-esta- blished his health in every other respect. CASE XXXV. A GENTLEMAN in the county of Middle- sex, applied to me two years ago, on account of a seminal gleet, to which at times he had been for some years subject, though at inter- vals entirely free from it; his vigour there- fore was not very much impaired thereby, but as the returns of the complaint, had of late been more frequent than usual, he began to be very apprehensive of consequences. Upon examination, I found that the cause of this gleet might be truly deemed arthritic; it was indeed sufficiently evident from the appear- ance [99] ance of the discharge, and the patient's own account of his case. The semen was loaded with a cretaceous matter, similar to the chalk stones produced by the gout; in proof of which, he informed me that he had been afflicted with the gout many years, chalk stones had appeared on his feet, but that no more of them had formed after the creta- ceous matter found its way to the spermatic vessels, and (as he very rationally supposed,) discharged itself with the semen ever since that period. Being perfectly sensible that the disease originated from the gout, I recom- mended patience, and a resignation to his fate. This prescription not satisfying him, I pro- mised to consider further upon his case, and exert my best abilities to serve him. After a little reflection, there occurred to my memory the case of a gentleman, who some years since employed me to cure him of the venereal disease, and as he was great afflicted with the gout, requested very earnestly that I would not give him the least particle of mercury; I acquiesced therewith, and in the course of a few weeks removed his complaint, merely by the use of vegetables. O2 SOME- [100] SOMETIME afterwards he informed me, that these medicines had so purified his blood and juices, that the gout had not visited him so frequently as usual, and the paroxysms were much milder and of shorter duration than they formerly had been. He has therefore taken the medicine since that time as an anti- arthritic. The recollection of this circum- stance induced me to administer remedies of a similar kind for the cure of this arthritic gleet; and I had soon the satisfaction of per- ceiving that the discharge gradually decreased, and was less and less impregnated with the chalk, 'till it entirely disappeared, which happened in about two months: I advised nevertheless a continuance of the medicines sometime longer in order to prevent a re- lapse. The medicines used upon this occasion were, diuretics and diaphoretics, in the com- position of which, camphor was no inconsi- derable ingredient. Before we dismiss the subject, it may not be improper to mention some other disorders, to which the organs of generation are liable, from this arthritic acri- mony. I have been informed from very good authority, of priapisms originating from the same [101] same source; one in particular, of a gentle in the county of Surry, which is said to have continued an incredible length of time. Instances I have myself seen, where the gout has produced tumefactions of the testicles, to as high a degree as those in ve- nereal cases, and which, like them, have been removed by discutient fomentations, and emol- lient cataplasms, assisted with powerful sudo- rifics internally. In these cases opiates like- wise may repeatedly be administered to very great advantage. CASE XXXVI. ABOUT eighteen months since, I was con- sulted by an eminent artist in the vicinity of London, who had for many years been trou- bled with a gleet and obstructions in the uri- nary passage, occasioned by a clap which was contracted eleven years before, there had been, ever since that period, a discharge of yellowish matter that might be said to ebb and flow, being very copious at one time, and quite the reverse at others; excess of any kind, never failed to encrease it very consi- 3 derably. [102] derably. Within the last three years he per- ceived the urethra to be materially obstructed, and from that time a new symptom made its appearance, namely, a mixture of semen with the old running; in proportion to the en- crease of the caruncles, the seminal discharge became more plentiful, insomuch, that dur- ing the last four or five months, he very seldom made urine or went to stool, without a considerable quantity of feed being evacu- ated at the same time. He informed me of his having taken large quantities of the most bra- cing and strengthening medicines, but with no other effect, than a temporary palliation of the symptoms. The long continuation of the disease, added to a close attention to business, made terrible havock with his constitution, reduced him almost to a skeleton, and relaxed his nerves to such a degree, as to render life burthensome in the extreme. The excres- cences had so choaked up the urethra, that the smallest bougie could not be passed with- out great difficulty. I began his cure, by attempting to remove these obstructions, being fully convinced that no medicine could be of use till that was effected. I advised him [103] him to wear a bougie both night and day, and for as many hours together as the parts would admit of, without occasioning pain or loss of rest. His bowels were at the same time kept in proper order by the use ot gentle aperients: to which circumstance it will al- ways be found indispensably necessary to at- tend in every complaint of this nature, both in order to prevent inflammation, and to ob- viate any material exertion in the evacuation the fæces. His diet was of the most nu- tritious kind, but as he at first had little or no appetite, I gave him strong decoctions of the woods, which soon procured one, and at the same time corrected any latent acrimo- nious humours: after which, corroborants and restoratives were administered with the greatest success. By these means, at the ex- piration of four months, he was so far reco- vered as to imagine himself cured; the medi- cines however were continued seven or eight weeks longer, by which time his health was perfectly re-established. CASE [104] CASE XXXVII. ALMOST similar to the preceding case, was that of a gentleman in the county of Cam- bridge, who had been afflicted for several years with a seminal gleet, and had taken a great quantity of medicines of different kinds, without receiving any material benefit—a cir- cumstance not to be wondered at, when we consider that the cause of the disease had not hitherto been understood, no attention having been paid to a caruncle in the urethra, which at last encreased so much, as almost entirely to prevent the passing of his urine; upon this account it was that he made application to me, having long before given up all ex- pectation of removing the seminal gleet, every effort for that purpose having so repeatedly proved abortive. Luckily however, the stop- page of urine obliged him to have recourse to the only method that could possibly remedy his old disorder. By using bougies, the ure- thra was cleared of obstruction in the course of a few weeks, in consequence of which, the seminal discharge gradually abated, and with [105] with the assistance of some internal bracers, a radical cure was effected in less than five months. CASE XXXVIII. A GENTLEMAN in the western part of Eng- land, became my patient three years since, in consequence of a seminal weakness or gleet, which had been his companion for thirteen years, and was at length very near putting a period to his existence, notwithstanding a long continued use of the most powerful re- storatives both in medicine and diet, which had been prescribed for him by several very eminent practitioners. HE had taken astringents, balsamics, strengtheners and bracers of almost every kind, large quantities of bark, steel, ginsang, &c. &c. nor was the cold bath omitted, which in the beginning, he said, afforded a tempo- rary relief, but after a few months use en- tirely lost its effect. The disease had ren- dered him so weak, as to be scarce able to walk or stand upright, and his spirits were P likewise [106] likewise proportionally depressed. He in- formed me, that his present complaints took their rise from a clap contracted upwards of thirteen years since, that it was not attended with much pain or inflammation, nor were any of the symptoms such, as indicated any high degree of virulence; his surgeon, how- ever, had supplied him very liberally with mercurials and drastic purges, and had con- tinued them some weeks, by which means his appetite, strength, &c. were much im- paired, and a gleet ensued, which from a venereal, degenerated into a seminal one. Fre- quent nocturnal emissions of semen inter- rupted his sleep, and a discharge of the same kind generally happened whenever he made urine or went to stool. After having given this account, he requested to have my opinion upon his case. My answer was; that from the long continuance of the venereal gleet, I suspected some excrescence had formed in the urethra, and should that be the case, I doubted not of rendering him very essential service. He replied, “ That he did not imagine there could be any material obstruction in the pas- sage, as his urine flowed almost as well as ever; [107] ever; but that it did not pass quite so freely, which he attributed wholly to the debility of the parts. However, upon examination with a bougie, I found a caruncle about four inches up the urethra, which, in that place, diminished its diameter nearly one third part; the rest of the canal was perfectly free from either stricture or any other obstruction: this discovery gave my patient much pleasure, and at the same time great surprise, that such a substance should have formed without his perceiving it; that was a circumstance, I told him, which frequently occurred, and might be very easily accounted for, by only reflecting upon the very flow, gradual progress of these carnosities; in the present instance above twelve years had elapsed during the forma- tion of a very small one. I then advise him to enter upon the use or bougies; and that they should remain in the urethra as many hours as possible, both night and day, pro- vided neither pain nor inflammation ensued, to prevent which, as well as too great efforts in discharging the fæces; his body was kept rather in a laxative state than otherwise, by taking occasionally flos sulphuris, magnesia P2 alba, [108] alba, or electarium lenitivum. In the course of a week he was able to wear the bougies twelve hours in the twenty-four; by which means a copious discharge of matter was pro- duced, and in proportion to that, did the ca- runcle decrease, and the seminal evacuation abate. In less than a month the carnosity was removed, and with it the stimulus which had operated so powerfully upon the sperma- tic vessels, &c. At this time I thought cor- roborative medicines would take the desired effect, I accordingly administered them in as large doses, and as repeatedly as his stomach would bear, his diet was likewise of the most nutritious kind, and as simple as possible, all high seasoned sauces, &c. being studiously avoided, together with spirituous liquors, and vegetable acids. By the above method this gentleman was restored to perfect health in the space of eight months; he married soon after, and has got an heir to his estate. IN these cases I always recommend animal food, or a meat diet in preference to any other; and when the stomach is too weak to admit of it in substance, strong soups or broths 3 must [109] must be extracted from it, and taken very li- berally. After meals, a glass or two of good old Madeira or Mountain wine may be drank, and will generally prove beneficial. Mode- rate exercise will likewise be useful, but great care must be had that it never amounts to fatigue. The patient should be thinly clad both night and day; rise earty, and go to bed the same. I fine, the same regimen may be observed in these complaints as is ge- nerally recommended in those termed nervous. ALL excrescences or carnosities in the ure- thra have not a venereal origin, that, in com- mon with every other glandulous membrane, may certainly produce them from some other causes; among which, coarse gravel and small rough or sharp stones passing through this tube may sometimes occasion them. An in- stance of this kind I remember to have seen in a Kentish farmer, who applied to me on account of obstructions in the urethra, which could not be supposed to arise from any ve- nereal cause, as he solemnly declared, that he never been so infected. He had however frequently voided gravel and stones with his urine; [110] urine; which, I make not the least doubt, gave rise to the excrescences, from having wounded the membrane, which afterwards healed, but not without producing these fungi. THE glandulous membrane that lines the nose, we know will sometimes send forth ex- crescences named polypi, independent of any venereal matter whatever. BEFORE we close our observations upon gleets and weaknesses, let us turn our thoughts upon those which are peculiar to the fair sex. THE leucorrhæa, fluor albus, or the disease vulgarly termed the whites, though often with very great impropriety, the discharge being at times as high coloured as that pro- duced by the venereal virus itself. This gleet is the cause of many disorders, and as frequently the consequence of others. It sometimes arises merely from a cacochymia, at others from a profluvium mensium, bad la- bours, miscarriages, a general relaxation, im- moderate venery, acrimonious humours, &c. When this discharge is very copious and of long [111] long duration, it produces many very disa- greeable (if not fatal) effects: it may give rise to the whole tribe of what are called nervous complaints, hysterics, &c. and may sometimes occasion an atrophy or consump- tion. It is to be lamented, that they are most subject to this disorder, who apparently are the least able to sustain it, namely, those of the most delicate frames and constitutions. A sedentary mode of living, improper diet, too much cloathing, bed-warming and tea drink- ing, contribute greatly to encrease, if not to produce this disease: the use of strong liquors (I am afraid) may sometimes be added to the catalogue of causes. From a desire of becoming more delicate, many good constitutions have been greatly injured, (if not entirely ruined) by the too frequent repetition of phlebotomy and strong cathartics. The pudenda of each sex being generally very much benefitted cold bathing, why, in the name or common sense, is it not more frequently practised? Women, in particular, would derive infinite advantage from washing these parts regularly night and morning with cold water, except at the time of menstruation; as I believe that few [112] few things would tend more to prevent the disease in question than these ablutions, if properly pursued. An immersion of the whole body would certainly be preferable to a partial bath, but as the former is not always practi- cable, and is generally attended with great trouble and inconvenience, we must content ourselves with the latter, provided it be dili- gently persisted in. Certain sects are strictly enjoined to make frequent ablutions, as a ce- remony or duty incumbent on the professors of such religions: a custom, however, of this kind, (if viewed only in a temporal light) must be highly beneficial to society. Can any good reason be assigned, why the external parts of generation should not be as often washed as our faces, they must certainly re- quire it as frequently, although seldom exposed to view? Courtesans (for more reasons than one) are the strictest observers of this salutary custom. The great difficulty attending the cure of the fluor albus, may in some degree be ascribed to the very lax texture and de- pending situation of the parts subject to this discharge. IN [113] IN the cure of female gleets, we must ad- minister such alteratives as will remove any latent acrimony, and at the same time recom- mend the most nutritious diet, together with a proper regulation of the other non-naturals. After the blood and juices shall have been sufficiently purified by the means abovemen- tioned; then may balsamics and astrigents be used to great advantage. Be it remembered also, that we must not rely solely upon inter- nals, for it will generally be found necessary to use topical applications at the same time, viz. lotions and injections, which must be composed of the most powerful astringents. The cold bath will likewise be of service. Where unfound viscera or very great tender- ness of lungs do not prohibit the use of it. The alteratives recommended in the former part of this Essay, will, upon trial, be allowed the most efficacious ones in the present com- plaint. Opiates, in many stages of the dis- ease, may likewise be administered to very great advantage, provided they be so cor- rected, as to obviate any material constipation of body. Of all the non-naturals, a due regulation of the passions must very strictly Q attended [114] attended to; nay, it will be found indispen- sably necessary, as without it no cure will ever be obtained; indeed, it will generally prove one grand essential in the cure of many female complaints. That the vagina uteri, and its vicinities are very liable to great defluxions, is sufficiently evident from the disease just now mentioned, which in general does not make its appearance before the age of puberty: some females however, even in the infant state, experience so great a flow of humours, as to produce a discharge, in colour, not un- like the gonorrhæal one, and frequently acri- monious enough, to occasion much inflam- mation, pain, and tumefaction in these parts. Several instances of this kind have fallen un- der my inspection, and upon enquiry, I have generally found that the complaint arose from either a scorbutic or a scrophulous humour. Emollient fomentations and cataplasms, as- sisted with gentle purgatives, and mild alte- rants, will soon abate the symptoms, which generally disappear in the course of a few days; especially if the discharge has been ra- ther copious in the beginning. To [115] To prevent a relapse, it will be necessary to keep the intestines in a laxative state, which may be easily effected by the use of lac sul- phuris, or magnesia alba; the preference however must be given to the former, as it will at the same time prove no insignificant alterative. The most obstinate cases are such as derive their origin from a leprous humour, one of these I remember to have seen; it was attended with a very high degree of inflam- mation, and required venæsection, opiates and cathartics, together with the most powerful internal alteratives, and external emollients. A composition of camphor, antimony and sulphur, was in this case extremely useful; the cure indeed might with justice be wholly ascribed to it; every other medicine having proved ineffectual. THE cure of gleets and weaknesses in either sex, will generally require a considerable time, but if the methods I have recommended be put in practice, and properly pursued, I am firmly persuaded that they will very seldom fail of success. FINIS.