ARMY  MEDICAL, LIBRARY

        WASHINGTON

           Poxmeieel 1836
Section__
Number
yj 4 o  6#
       Foem 113o. W. D.. S. G. O.
3—105-13   (Revised June 13, 1936) 
 
 
PRACTICAL TREATISE. 
 
PRACTICAL   TREATISE

                      ON THE

        DISEASES  AND  ABUSES

                      OF THE

   sexual  system:,

           WITH ILLUSTRATIVE PLATES.
        BY JOSEPH  RALPH, M. D.,

Graduate of the University of Edinburgh ;—Member of the Royal
       (College of Surgeons, lyjciltui, ;—and Author of
           "The Family Physician," SfC., fyc.
Note.—In order to treat this subject iu a clear and practical manner, it is necessary to
 be more minute and descriptive 0:1 certain delitate subjects llian would have been
 prop-r in ihe Author's " Family Fhysici 11, or Domestic Guide to Mediciue," a book
 which is kept in numerous families, and much valued lor its general utility aud plain-
 ness ; it is therefore published iu this distinct and separate form.
   EIGHTEENTH EDITION,

REVISED  AND  CORRECTED.
          Wew-Bark:
E. D. LONG No. 121 NASSAU STREET.
1857. 
3
Entered according to an Act of Congress, in the year one thousand eight
        hundred and fifty-seven, by Joseph E. Ralph, M. D.
A ft v\ r
     wC 
CONTENTS.
           \             ---------

Chap. I.—On Gonorrhoea— Its Nature, Symptoms, Progress, and
    Consequences.

Chap. II.—On the Remedies and Treatment of Gonorrhoea.

Chap. III.—On the Accidental Symptoms of Gonorrhoea, viz : Pain
    in  Urinating,  Phymosis,  Paraphymosis, Chordee,  Bubo,
    Swelled Testicle.   Their Treatment.

Chap. IV.—On Gonorrhoea in the Eyes, and Gonorrhoeal Rheuma-
    tism.   Their Treatment.

Chap. V.—On Gonorrhoea in Females—Its Treatment.

Chap. VI.—On Gleet.   Its Nature and Treatment.

Chap. VII.—On certain diseases resembling Gonorrhoea in some
    respects, and which are  frequently  mistaken  for it; hut
    which, nevertheless, are totally distinct and different dis-
    eases.

Chap. VIII.—On Leucorrhcea," Female Weakness," or " Whites.',
    Its Treatment.

Chap.  IX.—On  Stricture of the Urinary  Passage.  Its Nature,
    Symptoms, Consequences, Remedies, and Treatment.

Chap. X.—On Masturbation, called also Onanism, Self pollution ,
    &c. 
Chap. XI.—On the Consequences of Masturbation.

Chap. XII.—On Masturbation.  Its Treatment.

Chap. XIII.—On  Syphilis or  Venereal Disease.  Its Distinguish-
    ing Marks, Nature, Symptoms, Progress, and Consequences.

Chap. XIV—On the Remedies and Treatment of Venereal disease.

Chap. XV.—On Venereal Bubo, Phymosis, Paraphymosis, Venere-
    al Warts.  Their Treatment.

Chap. XVI.—On  Venereal Sore Throat.   Its Treatment.

Ghap. XVII.—On Venereal Blotches and Eruptions on the Skin.
    Their Treatment.

Chap. XVIIL—On  Venereal  in the Bones, Nose, Palate, fyc.  Its
    Treatment.

Chap. XIX.—On  Venereal Taint in the Constitution.  The effects
    of  Venereal Diseases upon Posterity,   The eradication of
    the Poison from the System.  The Treatment of Syphilisin
    Infants.

Chap. XX.—On certain Complaints which resembles Venereal
    Disease, and sometimes arise from Sexual Intercourse, but
    which, nevertheless, are not Venereal, nor can be treated as
    such without the greatest disadvantage.  Persons affected
    with these are often cruelly imposed  upon by advertising
     people. 
        THE    FOLLOWING   REMARKS

On the Nature, Symptoms, and Consequences of a frequent, but generally ill-
  understood Malady, will prove deeply interesting to  many:—to  those  con-
  cerned they may prove invaluable.   Addressed to persons unknown  to the
  author, and post paid, it is hoped no further apology need be offered.
  With regard to the reasons for writing on this subject and in this manner, they arc
several, and, in my opinion, weighty.   The first is, that the complaint which is th«
subject  of the following remarks frequently exists in those who are not in the teasi
aware of it.   It is a disease which, in its earliest stage, is seldom attended with pain
or inconvenience; and those circumstances which do  attend  this stage, are generally
referred to other causes.   Among other symptoms, that want of mental energy in
business, which so remarkably connects itself with this  disease, is attributed to any
cause but the true one.  But, while under this delusion, the disease is gaining ground,
and is quietly forming the foundation of the most serious and distressing maladies,  I
do not know (and I speak with a careful regard to truth) in the whole range of human
maladies, one  more pregnant  with  consequences which embitter life, as well by its
effects upon the mind as on the body, than Stricture of the urinary passage.
  My second reason is, that this, unlike almost every other  malady, never terminates
in cure spontaneously; nor can it be possibly cured by any kind of medicine alone.
This should be ever kept in mind, not only because it will warn you against the trash
of trading advertisers, but will lead you to seize the  period when a cure can so easily
be obtained.  Do me no discredit when I assert the perfect inefficiency  of medicine for
the cure of Stricture.  It is enough to make you doubt it to read of the boasting nos-
trums in the newspapers;  but I repeat,—and indeed,  call every real physician in the
world to attest its truth, that no medicine whatever, alone, can cure a Stricture. Un-
suspecting persons are daily duped by these nostrum venders: I have  had patients
who have assured me they had taken scores of bottles of such things as  Colored Drops,
or Mixtures, or Sarsaparilla, and used "newly inventedinstruments?" iS;c., &c.  To.
refer again to  the advantage of detecting and  attending to Stricture In  its eavlf
stage, I assure my reader, that although there is no example of  Stricture—not even
the most severe and complicated—which does not admit of cure; yet, the ease and
quickness with which a recent case is cured, compared with an old and complicated
one, makes its early detection a point of great importance.
  A last reason I will mention arises from the repugnance which every one of proper
feelings has, to publish of  himself, in a common newspaper., that degree of learning
and ability, as well as integrity of character, which is so peculiarly desirable in the
physician selected for consultation on diseases of this nature. Now, to form an opin-
ion from the statements and promises made by that description of persons who recom-
mend themselves by public advertising, you would conclude  that the diseases of the
urinary and procreative organs were too simple and unimportant to  claim the notice
of a man of rank  in his profession.   But nothing in the world  is more untrue.   On 
the contrary, it is a fact—and one which every physician will accede to—that, among
the wonderfully complicated structures of the body, there is  none  more intimately
connected with the mind and distant  parts, so that  its diseases become more  influ-
enced and modified by various causes ; or which, from their delicacy of structure and
function, demand a deeper measure of anatomical and physiological knowledge, than
the sexual organs, both male and female.   On this account,  I think it appropriate
here to ^ate, as the ground on which I claim the confidence of society, the opportuni-
ties I have enjoyed of making myself thoroughly acquainted with this important sub-
ject, viz  :  Besides a long and very extensive practice principally in this class of dis-
eases, and being author of a practical work upon them (Dr. Ralph's Practical  Trea-
tise), I resided in Paris nearly two years for  the purpose of studying the  subject in
the most  complete manner possible—at the  Hospitals, the University Lectures, and
private classes of the Professors; and have, besides others  not  bearing exclusively on
this speciality, " Certificats d'Etude" from
   Dr.  Pu. R icord, Chirurgien de l'Hopital des Veneriens.  Professeur de Clinique et
de Pathologie Speciales.
   Dr. P. Guersant, Chirurgien de l'Hopital Bieetre.  Professeur particulier-de Chi-
rurgie, &c., &c.
   Dr. Cazenave, Medicin de l'Hopital Saint-Louis.  Professeur des Maladies Vene-
riennes d la peau, ou Syphilides, &e.
   Dr. Rokert,  l'Hopital  Beaujou.   Medicine  Operataire des organes genitaux et
urinaires.
   Dr. Aug. Mkrcier, Professeur d'Anatomie et de  Chirurgie  Speciales: Chirurgien
a l'Hotel-Dieu, &c, &c.
   Dr. Skgalas,  Membre de l'Acadamie Royale.  Cours sur les Maladies genito-
urinaires.
   The-e may be seen in my office by any one.
   I should not have dwelt so long ou my reasons for this letter, but  there are many
 facts and observations interspersed among them, which should be known and thought
 of.  I will now proceed with—
   The Nature, &c, of  Stricture.—A Stricture consists in a thickening  of one
 part or other of the membrane  which lines the urinary  passage.   The  immediate
 cause of this thickening is slow or chronic inflammation, aud  this chronic inflamma-
 tion  is that state which a Gonorrhoea or Clap is apt to settle into when it is not early
 and properly treated, and is called a Gleet.  Now, there is no pain in this early stage
 of Stricture ; neither does the stream of urine become sensibly altered—not enough,
 for instance, to strike the attention.  There is, however, now and then,  a little dis-
 charge, which is very puzzling to those who do not understand it, for, though it may
 be stopped a hundred times,  it will  again  and again  return.  The fact  is, this dis-
 charge is now no longer that of Gonorrhoea, but arises  from a different  cause—a
 Stricture—or a condition very near akin to it.  When the Stricture is free from irri-
 tation, whether under the use of medicine or not, it ceases, but when any thing hap-
 pens to irritate or excite the Stricture, it reappears.   But, while there is but little to
 complain of in thi* early stage of Stricture, arising immediately from the seat of the
 disease,  it is very apt to affect the mind and depress the  spirits.  The reason why it
 should thus affect the spirits will be easily seen by reflecting on the intimate  connec-
 tions which subsist between the mind  and sexual organs.  Who does not know the
 effect of a single thought of a certain nature upon these  organs "i  Now, it happens 
ijpren th.3 spirits—x oircii'tnti'ioe I am inolinyi  to liy a ».-e.iter stress upoa th*»
many authors, for by this I have often been enabled to detect a Stricture when there
was hardly any other indioation of it.
   The Symptoms of Stricture  in its early state.—The very  first of these, I
think I may safely state, is that of a drop or two of urine which  is observed to pass
away after a person has finished making water, so as to wet his shirt a little.  It has
been observed there is at first but little alteration in the stream  of urine ;  nor is
there always a discharge, although, in general, there is a little to be  seen.  Now, a
Stricture is almost always the consequence of a badly-managed Gonorrhoea, (though
 it may arise from long continued irritation of the urinary passage in whatever way
 produced, and sometimes apparently from no cause at all.)  If the treatment of Gon-
orrhoea, for instance, has not been followed up  by injections in  the manner I have
 particularly directed in my Private Treatise, so as to bring its cure within, at farth-
 est, a few weeks, it will slide into a Gleet,  which is indeed itself a Chronic Inflamma-
 tion of a specific kind, and Chronic Inflammation, as has been remarked,  naturally
 produces a thickening—which thickening of the lining membrane of the passage is
 Stricture.  Now, if any one, having had  a Gonorrhoea which  has continued,  say
 from six to eight weeks (or if long ago he had  a Gonorrhoea which was  tedious,  or,
 has had it several times, though apparently each had been cured), and still has a  dis-
 charge, at least occasionally, and he perceives  a drop or  two of urine to escape, as I
 have described, and especially if he can defect any difference in force or in manner of
 urinating; and, more especially still, if in addition to  this he  feels a depression of
 spirits and an inaptitude or iiirapacity for business which is not natural to him, then
 I say, that man has sufficient reason to suspect his malady is either Stricture or is as-
 suming that form, and that it is his duty to consult some competent surgeon on the
 Bubject.
   These being the symptoms which attend  the very early stage of Stricture, of course
 they become  more definite and striking as  the disease proceeds, but with regard to the
 rapidity of their forming, this differs greatly in different individuals  : in some, they
 creep tin very slowly, and it may be months and sometimes years before any difference
 in the maimer of making water is observed.   All this time, however, if the patient
 was aware of it, and were  to pay attention to   his  stream of urine, he would  find it
 was not so large and bold as formerly ;  and especially would he observe, tbat after
 finishing and buttoning up, a drop  or  two would always steal  away  and wet his
 shirt-   This latter is the most  constant of all the symptoms of Stricture :  not that
 it never happens from any other cause, for it may occur  from weakness of the parts
 and other causes ; but though this drop may happen without a Stricture, a Stricture
 cannot exist without this drop.
   The stream of urine- may split or curl about—it may require an effort to begin,  and
 then flow free enough,—the desire may come on so quickly that you can hardly retain
 it for a moment,—you may make water too often, and rise in the night for that pur-
 pose,—there  may or may not be a eleety discharge or weakness, from the passage,
 or only after excitement ;  sexual intercourse may be weak, with too great quickness
 or  even immediate discharge in the act,—there may also be occasional uneasy  sen-
 sations, as itching, pulsation iu the passage, numbness in the thighs, smarting of burn-
 ing pain in the head of the part, or darting to the fundament and  the baek,  pain in
 the hip, inside the knees and even in the soles of the feet.  Again, there is sometimes
 pain  in intercourse, or a  retardation of the  seminal emission, the part  itself may
 shrink or shrivel, or may be affected with paiufui  and constant erections—the testicles
 also may  become inactive, and  the sexual appetite lessen, or altogether oease.   AH
 these symptoms, as 1 h ive said  before, are not present ia every case of Stricture, but
mwiy of them ;nxv be  us! 'ore  e -h;;? ■■:•*• ■''?:■-■' eie"   ••r>«"v ;t. 
  With regard to the more advanced stages of Stricture, no one who  has attentively
read the above will be at a loss to recognise the disease and its attendant symptoms.
  With this I finish these  remarks, my principal object  being to  enable every one to
detect this disorder in its early stage, when it admits of so easy and quick a cure;  and
I think the valuable and practical knowledge herein contained cannot  fail  to prove
aeoeptable, and perhaps invaluable to those it may concern ; but if further knowledge
and assistance is required, these of course could be obtained either personally  or by
letter.
  1 would  add, that besides Stricture, Gleet and  the  various  disorders entailed on
these parts by Gonorrhoea, there are others which are deeply  interesting to the suff-
erer—as Irritability of these organs, Debility,  Impctence, and all the distressing con-
sequences resulting  from Masturbation  or  self-abuse,  and from  sexual excesses ;
Disease of the Prostrate Gland, Grace?, and those  various urinary affections  which
are ignorantly called Gravel or Stone.  Also the consequences of uncured Venereal  Dis-
ease (properly so called) as venereal taint of the blood—Sore Throat and  eruptions
on the skin—Syphilis in the Bones, Ulcers, Warts oVe.,—on all of which those who
consult me mny depend on receiving the most faithful and deliberate attention.

                                                 JOSEPH RALPH, M. D.

  Offices, Corner of Houston and Crosby Streets, (1&9 Crosby.)

  Office  Hours, from 10g  A.M. to 2 P.M.. and  from 6 to L» in the Evening.
  Medicines are sent, safely enveloped and secure from observation,  to any part of
the country, Canada, South America, &c.  .Almost  every case can be successfully
treated in this  way.


  Letters for  Consultation and Treatment may be addressed to  Box 869, Post
Office N. Y. City.  It is better to observe some definite order in describing the ease,
—first, after stating age, habits of life, constitution and occupation, describe what
at the time beins. is complained of, or felt, or to be seen,—then the history of the com-
plaint from its first beginning, with, as far as you can tell, what treatment has been
pursued.   All  Letteis MUbT be accompanied by a fee.
  Dr. Ralph's Practical Treallsc on  the  Diseases  and abuses of the Sexual
System, adapted to the use of every individual.  With Illustrative Plates.  ISth Edi-
tion, Revised and Corrected.   The Nature, Symptoms, Consequences and treatment
of every form of private disease, as well as the variou  diseases growing out of them,
Diseases resembling Venereal, Diseases from Abuse and Excess, Genital Debility, Fe-
male Weakness, Arc, &c, with their remedies, treatment and cure, are given in  so
elear and practical a manner that none can misunderstand.  Some of the chapters are
deeply interesting to every one ; and especially in one (Chap. IX) will be discovered
the real origin of some very common  pains and ailments from which thousand* suffer
year after year without the remotest  idea of their true cause.
  Price $1, to be had at No 2 Vesey  Street, (Astor House,) or at the Authors Offices
139 Crosby Street.  Mailed prepaid and safely enveloped, on receipt of price directed
to Pox 869 P. 0,N. Y. City.                                  F    F
  N. B.—To patients in this city I would observe, that by making application in
the earliest stage of recent cases of diseuse, the cure may generally be effected imme-
diately, as well as radically and safety. 
.A.
PRACTICAL  TREATISE.
                  &c. &c.
PART  THE  FIRST.
                CHAPTER I.

On Gonorrhcea.—Its Nature, Symptoms, Progress and
  Consequences.

  The first thing to know on this subject, is, that Gonor-
rhcea  and Venereal  Disease are two  distinct and very
different disorders.   A person having Gonorrhcea, for
instance, cannot give another the Venereal disease; nor
can one having Venereal Disease give to another the
Gonorrhcea. Neither, again, can a Gonorrhcea change
into the Venereal,  nor Venereal into the Gonorrhcea
Both diseases, however, may perchance exist in one and
the same person, and then, both may be communicated
at the same time, or  one alone, just as it may happen.
But the thing to be remembered is, that they are two dir- 
 ttnd diseases, and this is the more important, because, as
 I shall presently have  to  show, they require very differ-
 ent remedies and modes of cure.

   I will now proceed to give a description of the first of
 these complaints—the Gonorrhcea—the one upon which
 we are now engaged, and  this shall be done in words as
 few and as plain  as possible,  so that, by comparing it
 with the description of the Venereal, which  shall imme
 diately follow, any one may see the difference between
 these two diseases in a  moment.

   Gonorrhcea, then, is  an infectious disease; it is seated
 in the urinary passage,  from the orifice  of which there
 issues  a discharge of matter, attended, more or less, with
 pain and heat in making water.  There  is no outward
 sore or ulcer in Gonorrhcea; neither indeed is  there any
 within the passage.   If it were possible  to take an in-
 side view of the urinary passage, nothing would be seen
 there but redness and a little swelling, and the discharge,
 whether much or little, would  be seen issuing  from  the
 red and swollen state of the membrane which lines it jusl
 as matter is sometimes seen issuing from an inflamed eye

   Venereal Disease, on the contrary, is not seated in the
•urinary passage, but externally, on some part or other of
 the penis or genital organs, and consists in one or more
 little ulcers or sores, which do  not heal like  others, but
 continue unhealed, and, at length assume  a peculiar cha-
 racter. 
  Gonorrhcea, then, consists in a discharge from the urin-
ary passage, attended, more or less, with pain and heat in
making water, without ulceration or sores; whereas Ve-
nereal Disease consists in external  ulceration or sores,
without discharge from the urinary passage, and without
pain or heat in making water.  No  one, it is presumed,
after this can possibly mistake these two diseases, and it
will therefore now be proper to describe particularly how
a Gonorrhoea commences and proceeds.

  But before entering upon  a particular history of this
disease, it is desirable to say a word or two respecting the
time when a Gonorrhoea first appears after an exposure to
it;  for  many  persons wrong  themselves with dread and
apprehension long after there is the  least occasion for it;
To the question then so often put,—When may I consider
I am safe ? I  reply, after the seventh day, if none of the
symptoms presently to be mentioned should  appear, you
may consider you have escaped,—that you are safe.   It
is true there is some difference in the time of its appearing
in different individuals.   Some have said, for instance,
they have known it to appear in twenty-four hours, and
others that it has been delayed for ten or even  fourteen
days.   I very much doubt, however, whether it ever ap-
pears at this early period.  Instances of  this kind which
have occurred to me, have always proved to be cases of
Stricture, not  of Gonorrhoea, the discharge being the im-
mediate consequences of an irritation of the  pre-existing
disease; while those delayed for fourteen days  are very 
rare.   I never met with  one myself, though such are
occasionally related to  me.   By far the most common
period is the third day.   The seventh is the longest I have
ever met with, and it is on the ground of this experience
[ venture now to say that, whoever has passed the seventh
day without any of the symptoms presently to be  men-
tioned, may consider he is safe—that he  has  escaped—
however suspicious the party may have been.   This much
then as  to the time when  a Gonorrhcea begins, and now
as to its manner of beginning.

   A person having been exposed to this infectious malady,
at some period within seven days, if he should have taken
the disorder (which we will suppose to be the first attack)
will feel a  little pain and  heat  in making water.  This
leads him to make an examination, when he will find the
orifice of the urinary passage looks  a little redder than
usual, its lips rather pouting or swollen, and on squeezing
it, an uncommon dampness or thin mucus will be seen.
In the course of a  few hours,  or by  the next day, the
pain and heat in making water will have increased, the
discharge  also increased and  of a  purulent or  white
creamy appearance.   For some days these symptoms go
on increasing in severity, the matter becoming of a yel-
lowish color.  Sometimes the pain and  heat  in  making
water will be exceedingly great, amounting  to a sensa-
tion of absolute  scalding;   at this time the discharge
generally turns to  a greenish color, and  instead of being
about as thick as cream, is thin and watery.  Under these 
circumstances there is also a painful sensation along the
whole length of the urinary passage, and the penis swells
and  is subject to  attacks  of frequent and very painful
erection.

   A Gonorrhoea always begins with pain and inflamma-
tion, more or less, which, after a little while, abates  or
subsides entirely.  In speaking of a Gonorrhcea, therefore,
we call the beginning of it, its Inflammatory Stage.  But
the degree of pain and  inflammation at the beginning  of
Gonorrhcea, differs exceedingly in different persons; some
will have so little as scarcely to complain  at all, while
others suffer most severely; as a general rule,  however,
the oftener it is had, the  less inflammatory is its attack,
so that, those who have had Gonorrhcea several times may
experience actually no  pain at all, the only notice of  its
existence  being  the appearance  of  the matter on the
clothes; but, in every case, after a time, this inflammation
subsides, whether anything is done for it or not.   Persons
(coming from some of  the advertising quacks) will often
say, " but the stuff they gave  me  removed  the burning
pain," when, in  fact it has nothing at all to do with  it;
for unless the heating things they generally give increase
 the burning pain, it subsides itself,  spontaneously- . This
 then is the first or Inflammatory Stage

   The seat  of Gonorrhcea, at  its commencement, is just
 within the orifice of the urinary passage, this necessarily
 being the part that first comes in contact with  the infec- 
tious matter—that first receives the inoculation.  But the
disease is not long confined to this spot, its tendency is to
progress further and further along the urinary canal until
it reaches to very near its other end, and there it  settles
down.   How long a time it  may occupy in  its  progress
through the urinary  canal,  is uncertain,  and differs  in
different individuals and under different circumstances  of
constitution, mode of life, &c.   The painful  inflammato-
ry symptoms however, seem  principally to attend the in-
vasion of the disease, and,  most of all, its  effect upon the
first portion of the passage;  when these are  subsided, at
any rate, we may consider it  has advanced  to its ordinary
distance.

   After a long time then, or, if there has been much pam,
after this has subsided, another stage of the disease com-
mences.   This stage consists simply of an infectious dis-
charge issuing from the orifice of the penis, with little or
no pain.  This discharge is  more or  less in quantity in
different persons, and is much increased by whatever may
excite, or by irregularities of any kind.  This, especially
when the discharge is slight and quite unattended with
pain, is what  is properly called " Gleet," (see Chapter
vi.), and, when once suffered to commence, there  is no
exactly telling how long it may continue, or how it is to
terminate;  but let it ever  be remembered, that, as long
as this discharge continues, the disease may  be communi-
cated  by infection.  This, then, is the Second or Chronic
 Stage of Gonorrhoea. 
  But thus far I have spoken of a Gonorrhoea in its sim-
ple form, and have mentioned those symptoms only which
are essential to it,  and which are never absent from it;
there are however  other symptoms which are only some-
times present, which may or may not exist, but  which,
when they do occur (and some of them generally do) form
the severest part of the complaint and call for immediate
and  peculiar remedies.   In  fact,  it is  for the want of
knowing something of the nature of these accidental symp-
toms, that Gonorrhcea assumes  its  most distressing  cha-
racter, and leads to the  worst consequences.   Those cir-
cumstances which  may or may not occur in Gonorrhoea,
and  are called accidental  symptoms, are the following:
a swelling of the prepuce or foreskin ;—swelling of the
glands in the groin;—very painful erections ofthe penis ;
—and swelling of the testicles.   The nature of these
therefore is now to be explained, but the particular mode
of treating them will be given in  another  Chapter, (in).
First, then of

         Swelling of the Prepuce or  Foreskin.
  This is the effect of inflammation, which  a full and
irritable disposition or irregularity of habits gives rise to.
The  structure of the skin which covers the head of the
penis (the prepuce) is very loose and cellular, so that when
the inflammation happens to  be high, this  structure fills
with the thin and  colorless part of the blood which causes
it to swell. 
  Sometimes the skin is swollen amazingly, and looks of
a bluish white color, being half transparent, and  is very
apt to create alarm.  Indeed, there is sometimes reason
for  alarm, for when this swelling is considerable, the skin
cannot be pushed back over the penis, or, if pushed bacli
it cannot be brought  forward again,  so  as  to  cover it
Now, there is not so much danger in this swelling itself,
as in the consequences of it; for if the  skin cannot be
pushed back, the matter under it accumulates and becomes
acrid and irritating, and you cannot avail yourself of clean-
linesss, which is always of importance. And, on the other
hand, if you cannot bring the prepuce forward,  it  pro-
duces danger by  acting  as though a string were  tied
around the head of the penis, preventing the return of the
blood, so that it swells prodigiously, looks blackish, and
sometimes even mortifies and comes away.   This, how-
ever, can always be  prevented by  proper management,
which will be shown  as I have already said, in a fol-
lowing chapter.   It is called a  Phymosis when the skin
cannot be drawn back from over the gland, or head of
the penis, as in the former instance; and  a Paraphymosis
when, being back, it  cannot be bi ought forward again
over the gland.

          Swelling of the Glands in the Groin.
  This also is the  result of inflammation,  spreading to the
glandular bodies situated in the groin.   In every  part of
the body there are certain little vessels called absorbents;
and these, in their course, run through absorbent  glands, 
of which there are several in each groin.  Now it  hap-
pens that inflammation in the urinary passage is commu-
nicated through the medium of these vessels to the glands
in the groin, which become painful and enlarged in con-
sequence.   It is however worthy of remark, that in Go-
norrhoea, glandular swellings seldom go on to form  an
actual bubo (which is an abscess in the groin) as  they
are apt to do in Venereal Disease, so that they  are com-
paratively  innocent;  after a  little time they generally
subside  and disappear,  (see    plate  3).   Another  of
these occasional symptoms is

   Frequent and very painful Erections of the Penis.
   This is a distressing and tedious symptom,  the  nature
of which I will endeavor to explain;—in fact it is nothing
more than inflammation extending from the lining mem-
brane of the urinary passage into the substance  and body
of the penis; and it seldom occurs unless the inflamma-
tion  runs high.  The structure of the penis is remarkable,
(see piute 1).   It is made up of large  cells,  into which
the blood is determined  under  certain  circumstances  of
excitement, and when these  are filled, the penis is erect.
Now the effect  of the  inflammation having passed into
the walls or substance of the urinary  passage, and into
this cellular tissue, is to deprive these parts of their natur-
al elastic, yielding nature; they become thickened, tense,
unyielding, so that when the blood rushes in, as  we know
it does under sexual and other  kind of excitement, pro-
ducing enlargement and elongation of the penis, these 
EXPLANATION OF  PLATE  I.
  Figure 1.   A transverse section of the penis, exposing
its internal Cellular or Spongy Structure, and the blood-
vessels ramifying through it;  this is called an  Erectile
tissue.   Erection of the penis  takes place  by the filling
up of this spongy texture with  blood which for a time is
retained in it.   It is seen that the spongy structure  is in
two separate masses,  and forms the bulk of the body of
the penis.  The three or four small holes above are the
blood-vessels running along the back of the penis;—the
larger hole underneath is the urinary passage—which is
observed to have another spongy texture surrounding itse1
separately.  The inner  lining skin of the passage (th.
seat of Gonorrhcea, &c.) is seen thrown into longitudinal
folds, which enables it to expand or open when the  urine
passes, or when its spongy tissue is expanded during  erec-
tion.   This is generally the seat of pain in Chordee.

  Figure 2.   A highly magnified view of a portion of
the Spongy or Cellular  tissue. 
PLATE  I
Figure  1.
ficrure  2. 
EXPLANATION  OF PLATE II.
   Figure  1. represents the Testicle, and attached to one
side, the commencement of the  Chord, composed of the
Blood-vessels, Nerves, and Seminal Tube, i. e., the tube
which conveys the Semen from  the Testicle.

   Figure 2 shows  a  dissection of the Chord, in which
everything is removed except the  Seminal Tube itself;
this  is  seen to  be exceedingly  small and  delicate, and
thrown into innumerable convolutions from the spot where
it emerges from the Testicle at the top, and so continued
till it reaches  the bottom, where it gradually becomes
thicker and less intricate,  at last  ending in an almost
straight tube: it has been unravelled and found to  mea-
sure no less than thirty-two feet in length.  This delicate
organ is the seat of disease in Swelled Testicle following
Gonorrhoea and other  inflammations  of the urinary pas-
sage. 
PLATE II.
Figure  1.
Figure 2.
3 
parts resist, are stretched with  difficulty,  or  even torn,
giving excessive pain.  Sometimes, thus thickened and
altered by inflammation they will hardly yield at all, the
figure of the penis is then more or less crooked,  as we
often see; the pain accompanying this is terrible.   It is
what is called Chordee,—the prevention or cure of which
we shall presently come to, (Chapter in).  The  fourth
and last of the occasional symptoms of a Gonorrhoea is

                Swelling of the Testicle
   This I consider  a  very important thing, for here the
pain is so great, and the necessity of rest and lying in bed
so urgent, that it is difficult to cure such cases with that
secrecy which is so often desirable.  Much however, may
be done to prevent it, if early attended  to, and therefore
the symptoms which precede and  lead  to it, shall be no-
ticed carefully.

   The first thing which precedes a swelling of the testicle
is a sense of pain  running down the whole length of the
urinary passage, accompanied with a feeling as if a drop
or two of urine were remaining in the passage after making
water.   To this there succeeds a dull pain  in the  groin,
going on to affect the testicle, which presently feels heavy
and  very tender to the touch; or, the pain and tenderness
of the testicle may  set in at once without any of these
premonitory  symptoms. No time  should be  lost.  It
should be attacked instantly,in order, it possible, to arrest
the inflammation uetore fultv rtevetoned 
  The seat of the disease is not in the body of the tes-
ticle itself, but in a small organ attached to it, (see plate
n),  which, in a healthy state  can, by  carefully feeling
around the testicle, be discovered at its lower and bad*
part; it is small, loose, and feels like a collection of fibres
When attacked  by inflammation it  becomes exquisitely
sensitive and  painful to the touch, and swells rapidly, be-
coming  at the same time hard and solid; it will then
often exceed  in  bulk the testicle itself.  The treatment,
will be found in Chapter in.
             Inflammation of the Bladder.
  Is still  another consequence of  the  extension  of  the
primary gonorrhoeal  inflammation—to the neck  of  the
bladder.   This part is naturally very sensitive, and, when
inflamed,  becomes  so irritable  that the contact  of  the
urine or slight distention of the bladder  gives rise to pain
and desire to urinate.  It may  be slight, causing merely
the  inconvenience of too frequent micturition with diffi-
culty of restraining it; or, the bladder may empty itself
every five or  ten  minutes, passing only an ounce or two
of high-colored urine, with great pain, and followed by
blood, the desire to urinate remaining  unrelieved.  It is
then attended with fever.  This affection oftener appears
in a mild  or sub-acute form, but may set in with  great
severity, and is then a most harassing  and  painful addi-
tion to  the Gonorrhoea,  it  is  therefore prudent  to  use
means tor its pretention or cure directly a tendency to it
is observed, as dneeieu in Chapter in.  The position o* 
EXPLANATION  OF PLATE TIT
  Showing the Glands of the groin, and the absorbeni
vessels coming from every direction to pass into them.
  It is the inflammation of these glands that  constitutes
Bubo.   If, from  any cause, one of these vessels is injured
or inflamtned, the inflammation  generally  passes along
till  the vessel merges into  a gland, where it settles, caus-
ing the  gland   to swell  and  frequently  to  suppurate.
Thus, if  a chancre on the  penis or the inflammation of a
Gonorrhcea happens to implicate  one or more  of these
little absorbent vessels, several of  which are seen passing
along  the penis  and  testicle,  the effect is immediately
transmitted  to   one or  more  of the  glands  of  the
groin,  and Bubo, as it is called, is the consequence. 
PLATE III.
3* 
the neck of the bladder, the seat of this inflammation, is
shown in plate iv.

  This then, is all  that  need be stated on the nature,
symptoms and progress of Gonorrhcea.  With regard to
its consequtijces, tiiey are, indeed, severe and painful, but
there are other remote consequences which are of infinite-
ly more importance, so  much so as to  demand  separate
and lengthened attention.   The consequences to which I
allude  are Gleet and Stricture, which latter, growing
as certainly out of Gleet, as  Gleet does out of Gonor-
rhcea, again gives  occasion to a train  of symptoms  the
most lamentable that can be  conceived, of  which Impo-
tence is one.

         Does Gonorrhcea ever wear itself out ?
  Before I leave this subject, I would  remark that many
have put this question to me,—Does this disorder (Gonor-
rhcea) ever cure itself?—does  it ever wear itself out ?   To
which  I have  always replied, It  may do so; but it is a
most terrible risk to run; for not only will  it wear  out
the patience of the patient, but will leave open the widest
door for the consequences I have just enumerated.   The.
general consequence of  a Gonorrhcea, if not early and
properly treated, is a Gleet,  and a Gleet implies a cer-
tain morbid state of  the urinary  passage, which, if  long
continued, is almost  sure to terminate in Stricture, a
disease than which I know  nothing that, in the  hands of
most people, is more baffling  and truly lamentable 
CHAPTER  II.
On the Remedies  in general use  for Gonorrhcea;—
   How far they are to be depended on;—To what parti-
   cular cases they are suited,—and, How to use them to
   the best advantage.

 ■  The remedies for the cure of Gonorrhcea are very few
in number and  are pretty generally known.  Notwith-
standing  this, however, their real  nature is but little un-
derstood, so that they are cons-tantly misapplied.   They
are internal and external.   Of the  first, the  Balsam of
Copaiva  and the Cubeb are  the  chief;  the external or
local remedies consist of lotions, used as Injections.

   The Internal remedies are vegetable productions, which
in their properties  very  much resemble one another.  All
of them  impart their virtues  to  the urine, which being
retained  in the bladder, impress upon it their peculiar ef-
 fect, and this again is transmitted to the part which is the
 seat of the disease—the urinary passage.*   On the other
 hand,  Injections  are generally mineral substances, and
   * This has besD repeatedly proved.   severed near the scrotum ; he consc-
 Whilst attending the Clinique of the   quent y urinated  principal y by this
 renowned Rico!.', at the Hopital des   artificial opening, and at both this and
 V6,7r"t,  of Pari*, I had an Wportu-   the natural °^"mg  the gonorrheal
 nity of witnessing a raro and curious   matter escaped.  The Balsam of Co-
 me verv illustrative of this fact. A   paiva w«> orderei him, and in a few
 man was admitted into one of the wards   days the discharge from the postenor
 SS^^^MiyW^^^   floWedalmostorquteasfreely^ever 
consist of certain  suitable stimulants, which are applied
more immediately to the seat of the disease by means of
a Syringe.   Both kinds of remedies are exceedingly valu-
able in their proper places, but they are also, both of them,
either useless or dangerous if improperly used  or misap-
plied.  The object of this Chapter, therefore, is to explain
their use and nature more particularly

   It should also be stated, there are other remedies which
are occasionally wanted in the cure of this complaint, but
not always;  these are, chiefly, the common remedies re-
quired to lessen pain  and inflammation.  Various things
are used with such a view, but there are some which are
far more suitable  than others; an account of these there-
fore I  will  afterward subjoin,  pointing out their  proper
use and dose, as well as making such  other observations
on them as may seem required.   The successful treatment
of these diseases depends  more  especially on  the  right
management of the remedies in any given case.

               The Balsam of Copaiva.
   This, every body knows, is very often given for the
 cure of  Gonorrhcea; indeed, Balsam  of Copaiva,  as a
 remedy for Gonorrhoea is so well known, that whoever
 discovers to another he has taken it by the peculiar smell
 it gives the breath, is generally set down for one who is
 contaminated with Venereal malady  Balsam of Copaiva
 is, beyond a doubt, the best of all the  internal  remedies,
 but it has its objections, and the circumstance just  men- 
tioned is one of them.   Another is, its extreme offensive-
ness to  the taste; and a third, its offensiveness to the
stomach, so that it is rejected by vomiting, or, if not re-
jected, it takes away the appetite  and induces a degree
of nausea which can scarcely be endured.  Indeed, it is a
medicine, to some, so perfectly  obnoxious  that they can-
not even think of the time of taking it without nausea or
vomiting.   With respect to the two first of these  objec-
tions, however, (its offensive smell and taste), the latter
of these may be avoided by taking it in  Capsules, and
the former  partly so.   These Capsules are small glutinous
bags, which are closed, and contain a little of the Balsam.
These little bags, when swallowed, are soon dissolved in
the stomach, and thus the Balsam  may be taken  and its
disagreeable taste avoided.   The peculiar  smell imparted
to the breath, however, is not got  rid  of by this means;
for, especially when it  disagrees, the stomach  is  continu-
ally expelling wind, and this affects the breath  offensively
and is equally betraying.  But  the most important of the
objections to the Balsam of Copaiva (that of disagreeing
with the stomach and digestive  organs) is not avoided by
this ingenious way of giving it; for when the Balsam dis-
agrees, it does so whether it is tasted  in the mouth or not.
These things, therefore, taken  altogether, are  great ob-
jections to the Balsam.  But there are others still to be
acquainted  with.   One is,  the  fact, that there are many
persons  in whom the Balsam of Copaiva has no  effect at
all in curing this disease; and there are others in whom 
it will stop the discharge, so iun& as it is taken, but the
moment it is laid  aside, the disease or running  returns.
Now it is of no use for either of these to take the Balsam,
or to continue it alone, at any rate  If such were to take
a ship load of this medicine, it would never cure  them.
When the Balsam does good at all, it does  so very soon,
by lessening the discharge.   A good rule in taking the
Balsam of  Copaiva is, to watch its effect, and  if it do
not, within two days, or three at furthest,  very sensibly
lessen the  discharge, lay it  aside, or add  some other re-
medy to the treatment.

  There is also a time when  the Balsam of Copaiva should
not be given; this is when the inflammatory symptoms of a
Gonorrhoea run high. We always look for more or less of
such inflammatory symptoms at the onset  of this malady;
sometimes indeed they do not happen, but they should al-
ways be prepared for.  It is with this view we always give
an active purge or two, and direct low diet and rest if it
can be had, at the beginning of a Gonorrhcea. This some-
times prevents altogether, and if not, it abates them.  After
an active purging medicine, therefore, if there is no great
pain and heat in making water, you may begin with the
Balsam; but if there  is, it  should be delayed, however
many days it may require to modify these symptoms.

  Likewise, should you have commenced with the Balsam,
and inflammatory symptoms at any time start up, lay it
aside, and first abate these painful  symptoms before you 
begin with it again.   I know that some begin with Bal-
sam of Copaiva under any circumstances, and many times
with impunity; but I  also know that when it has been
given without attention  to these  circumstances, it has
sometimes been followed  by distressing and even danger-
ous events, as inflammation of the bladder, testicles, &c.

   But notwithstanding the truth of these  remarks, the
Balsam of Copaiva, when it agrees, and it is  convenient
to take it, is a remedy of considerable power  in the cure
of Gonorrhcea.   Sometimes  it is trusted to  alone, but
then, for any chance of success, it must be taken in a cer-
tain and well regulated manner, and cautiously abandon-
ed. Let it be always  remembered, however, that, where
it can do good, it does so quickly; perhaps in two days
the discharge is lessened  one  half, and  it then goes on
more gradually to diminish.   But let it  also  be  remem-
bered that in those  cases where it is equal to  the cure
alone, that cure would be affected in less than half the
time if given in connexion with local remedies—Injections.

   If the Balsam of Copaiva is fixed on  as a  remedy for
Gonorrhcea, it should  be  given in  the dose of about a tea-
spoon-full, not less than  thrice a day.   It may be taken
simply in a little  water, on which it floats like castor oil;
but generally it sets better on the stomach when made in
the form of a mixture or  an emulsion.   If it  happen  to
purge, omit it for a day and take  a dose of Rhubarb.   If
this will not do, add to each dose of  the Balsam four  or 
five drops of Laudanum.  It should be continued fur some
time after the discharge has ceased, and then left off only
by degrees.  This is all that need be said about the Bal-
sam of Copaiva,

                The Powdered Cubeb.
  This is an admirable remedy if properly availed of, and
is free  from the offensive smell of the Balsam of Copaiva,
it is also a  pleasant, wholesome aromatic, and generally
agrees with the stomach.   Neither is there the same de-
gree of objection to giving it in the very onset of the dis-
ease (provided high inflammatory symptoms have not set
in)  as there is to the Balsam; indeed,such is its peculiar
effect, that  if given freely and early, it sometimes  super-
cedes the  inflammatory symptoms  altogether, and  leads
to a very speedy cure.  If, however, inflammatory symp-
toms have already suddenly come on before you have had
an opportunity of using the Cubeb, it is then more safe
and proper to  reduce  these symptoms  by rest, purging
and diet, before you venture on this remedy.  So also,
if you had begun early with the Cubeb and such  inflam-
matory symptoms should happen to arise, let it be discon-
tinued  for  a while, or until these symptoms have been
abated by the means above referred to,  and then  resume
the  Cuheb.

  The best way of taking Cubeb  is in the dose of a
piled-up teaspoon-full, mixed in a tumbler of water, and
repeated twice or thrice a day.  It is of no use to take it 
 in small doses, as many do.   There is something also in
 the manner of taking it.  The best way is to fill a tumbler
 half full of water, then  put  a teaspoon-full of the Cubeb
 upon the water, and in  a minute or so it will have sunk
 from the surface to the  bottom, and  thus  is  equally  dif-
 fused ; you then give it a stir and drink it off.

   Should the Cubeb irritate the bowels as a purgative,
 this may be checked by adding five drops of Laudanum
 to each dose; but if it only prove a little laxative, to  this
 there is no objection.   The  virtue of the Cubeb should
 be separated  by the kidnies and carried  into the  bladder,
 and of this you may always be assured  when a  peculiar
 smell is imparted to the urine,—a kind of violet smell,—
 not unlike  that which the urine has on taking turpentine,
 or when an individual has been exposed to breathing the
 atmosphere of a newly painted room.

  But, although I have said so much in favor of the Cu-
 beb, let it not be thought that it is to be depended on in
 every case.   On the contrary, there are  many individuals
 in whom it seems to have no good effect at all; and others
 in whom it will stop the discharge so long as it is con-
 tinued, but the moment  the remedy is laid aside  the dis-
 ease returns.   And what was said  of the Balsam of Co-
 Daiva is  also applicable to  the Cubeb;—viz., when it
 does any good at all, it does so quickly; so that if you
 do not see the most decided advantage from its use in two
or three days, but little or none is to be expected  fiom i*
4 
EXPLANATION OF  PLATE IV.
   The various medicinal substances taken into the sto-
mach for the purpose of acting upon the urine and the
urinary organs, can only reach these along with the cur-
rent of blood, into which they have been absorbed, as it
passes from the main artery of the body into  the Kidnies
by
   A, A,—The Renal Bloodvessels.  During the  circu-
lation of the blood through B, B, the Kidnies, the  refuse
matter destined  to form the urine, as well  as certain
medicinal substances, is seperated from it, and  passes in
the form  of urine along
   C, C,—The Ureters, into
   D,—The Bladder,  or reservoir of the urine.
   E,—Is the Prostrate Gland or neck of the bladder, and
   F,—The Urethra or  urinary passage, which, with the
bladder and prostrate gland, are represented laid open. 
PLATE IV
 
The inconvenience of its bulk, and the mode of taking
it, are also in some cases a great objection to the use of
the Cubeb.
   The virtues of the Balsam of Copaiva and the Cubeb
have now been fairly stated, and the objections to them
shown.   To this  again must be added their uncertainty,
for, in many cases  they entirely fail.   The fact is, that
many cases of Gonorrhoea  defy the virtues  of internal
medicines alone,  and  absolutely require the aid of local
remedies, injections, with  which,  judiciously and skill-
fully managed, the cure is accomplished in less than half
the time, and is far more safe and certain.
   In cases of unusual difficulty or  obstinacy, other local
applications are  used, but they can only be  used under
the immediate direction of  the  surgeon;  they  could not
therefore be properly described  in a work of this kind.
                      Injections.
   The use of these forms an invaluable part in the treat
ment of Gonorrhcea,—it is  applying the remedy to the
disease  itself—the  advantage  of which can scarcely be
doubted.   Yet there are some who  are opposed to Injec-
tions, simply, as it would  seem, because they may be
abused.   But carry on this  reasoning to other diseases—
say  Ophthalmia, for  instance.  Internal remedies, then,
are very good in Ophthalmia, and sometimes will cure it,
but who would withhold the use of Lotions and other ap-
plications  to the eye itself, simply because they may be 
misused or abused.   Is there  a single  medicine which
may not be abused?   Quite the contrary,—and the most
valuable too are the most capable of such abuse.   Oh!
it is said, they may cause a Stricture;  and so may Lo-
tions  and  Ointments put out the eye;  but, if properly
used, they will save the eye, and cure  its malady, and
this in less than half the time it could be  cured without
them.  Indeed there are many  cases of the eye that  can-
not be cured at all without them, and so of Gonorrhcea.
As to the idea of Injections causing  Stricture,  nothing
can be more ridiculous; for, on  the contrary, they prevent
it.  The ultimate result of a Gonorrhcea, long continued,
is  Stricture.   Gonorrhoea  implies a certain virulent  or
specific  inflammation—this is  its essential nature,—the
ultimate tendency of which is to destroy the elastic prin-
ciple  wiih which the  urinary passage  is naturally en-
dowed, and in this consists Stricture.  Whatever shortens
the duration of a Gonorrhoea, therefore, lessens the chance
of a Stricture.  Now, Injections shorten the duration  of
Gonorrhcea,—they therefore prevent Stricture.

   If another argument were required, I might adduce the
fact  that  Injections  are used and recommended by the
greatest surgeons in the world.   This, however, is quite
unnecessary,—it is  enough to state  that, although inter-
nal remedies alone will  sometimes cure a Gonorrhoea, yet
they sometimes totally fail; also, that in those cases where
internal remedies are sufficient to the cure alone, that cure
can be accomplished far more safely and certainly and in

                       *    4 
less than half the time if aided by Injections.   It would
therefore seem superfluous to say another word  upon the
utility of Injections,—it  now only remains to show theii
proper use.
   Injections should not be used in the very early or in-
flammatory stage of Gonorrhcea ; and even when this is
past it is better to begin the cure with internal medicine,
and continue for a day or two, before resorting to Injec-
tions.  After this you may use them  safely and very ad-
vantageously, few Gonorrhoeas can long hold out against
their  proper use
   Injections should not be used too strong.  It is  no dis-
advantage if they give a little tingling sensation, but if it
amount to heating pain their strength should be reduced
by adding a greater portion of water.   It is net proper,
either, to increase the strength of an Injection  to any
great degree, but rather,  if it seems to do no good, to
change it for another.  So if any one has been useful, but
after a time should seem to lose its power, it would be bet-
ter to change it for another than to increase its strength.
Injections will sometimes lose  their good  effect, and  for
this reason several recipes are given for them.  Indeed,
under any circumstances it is better to change an Injec-
tion now and then—the part  becomes accustomed to the
peculiar stimulus of one alone if long continued,—the dis-
ease  is sooner baffled and destroyed when one correcting
stimulus is exchanged for another.  It is better therefore
to change an Injection;  you  may return if you please to 
the one you used  at  first, if that agreed, only change  is
now and then—keeping most to that which best agrees.

  Injections are chiefly mineral ; there is a great variety of
them, but they all act pretty much on the same principle ;
Bonie however are better  than others ;  the most useful and
most generally employed are the Sugar of Lead, the White
Vitriol,  the Alum, the White Vitriol  and Alum combined.
Laudanum is  often added, especially when it is wished  to
allay irritability in  the urethra or to  prevent the irritation,
these chemicals sometimes cause.  It should be recollected,
always, that it is not. so much the strength, as the effect of
change  of Inject] e:  ;hat  is here insisted on.   The  Blue
Vitriol is  sometimes used for Injections, but it is apt to dis-
agree—irritating the  passage, giving  pain and increasing
the discharge.   It  is, however, sometimes excellent on this
very  account—when  a discharge  is  becoming  stationary,
getting neither better or worse with the  other Injections, this
perturbing  effect is often useful, and, after  using it  a few
days  and then  returning to the other, you will find an evi-
dent improvement immediately takes place.

   Catechu, Tannrin, Sulphate of Morphia, Acetate of Zinc,
Tannate of Quinia, Iodide of Iron, &c, &c, are used  as
Injections;  but these  require experience and skill in their
management: indeed,  more depends on the skillful manage-
ment of the applications in form of Injection than upon the
particular preparation used—this is especially true in the
instance  of Gonorrhoea.
   Injections, to secure their  great utility, require  attention
to the manner  and frequency of using them.   Many  times
I have heard it said, " The Injection does no good,"  when 
I have found upon inquiry that it had not been made to
enter the urinary passage.   Of course it must then fail.
To use an Injection  properly it must  pass  up a certain
distance.  No matter how much further, but it must go
up  at least several  inches,  and it  should  be kept and
retained there for a minute or two, by pressing the top
of the penis with the thumb  and finger.  The sensation
an Injection gives is quite enough to  tell whether it has
properly entered—it is as if you wanted to pass out urine;
but the proof of  it is, that a  teaspoon-full  or so  squirts
out again when you let  go your  thumb and  finger. To
insure an  injection running well  up  the passage it is also
necessary to hold the syringe firmly enough into the ori-
fice to prevent any escaping that way.  With respect to
the repetition of their  use, this too is an important point,
 —much depends  on  their regular frequent repetition.
An Injection should be used six or eight times  in the
twenty-four hours: every two hours or every hour and a
half if you please, provided it does  not  irritate or pain;
but certainly not  less than I  have stated.   The common
syringes sold for using these Injections  are often  much
too small; this is particularly the  case  with what are
called the pp  syringes; and the nose or  spout  is also
made much too  long, passing half, and even an inch or
more into the passage, which proves a scource of  irrita-
tion to that part.  A syringe should be chosen, therefore,
with a very short spout,  and it should hold  about  or
nearly half an ounce of  liquid. 
  The preceding remarks relate  exclusively  to the reme-
dies in common  use  for the cure  of Gonorrhoea.    But, it
was mentioned,  there  are  other  medicines now and  then
required—these  are, chiefly, the  common remedies in use
for abating pain  and  inflammation.  To make  this little book
complete, it is necessary here to enumerate these, and  say a
word or two on the dose and proper use of each.

                        Lotions.
  These  are often very useful, and are generally employed
to assuage inflammation,  as, for instance, in the case of
swelling of the prepuce, or of the penis itself, in swelling of
the testicle, &c.  They are always used externally, and ap-
plied by means  of rags soaked in the liquid  and laid on or
wrapped round the inflamed part.

   The manner of making and  applying them will  be  found
in Chapter in, Note.

               Cooling or Diluting Drinks.
   These  reach  the  urine through  the same course  as de-
scribed at Plate iv.  They are  useful  in any case, and,
where there is much inflammatien, with heat in micturition
and high-colored scanty urine,  they become very necessary.
When they are  required it is  important to  know what are
the  best, and how to  make  them.   But it sometimes hap-
 pens a person is so circumstanced that he cannot procure
these—the  request  to have them  prepared would lead to
inquiries as to what they were  wanted for.   To such there-
fore it will be satisfactory to  know that they can be  done
 without.  The softening  mucilaginous  qualities  of   which 
they are  composed, certainly have their use, but this is no-

thing compared with their diluting quality—depending en-

tirely on  the water in which they are dissolved.  If, there-

fore,  you take  a  watery drink  of  any kind,  as  common

water, the  end is answered—that is, if you take plentifully

of it.   A near approach to these mucilaginous drinks, how-

ever, can be easily  and pleasantly made.   Take an ounce

or more  of Gum-Arabic,  in  large lumps, in  the waistcoat

pocket, and consume  it during the day in addition to plen-

tiful drinking, by taking a  lump  into the mouth every now

and then ; or Jujube Paste  may be used  instead of Gum

Arabic ; it is a very pleasant thing, and gives  to the simple

water the softening effects of the  various drinks, viz. : Flax

Seed or Slippery Elm Tea, Barley Water, &c.


                         Purgatives.

   Next  to bleeding, purgatives  form the most active agent

in reducing inflammation.


                       Opium.

   It is a valuable medicine under many circumstances, and

is  sometimes  required  in the   accidental symptoms of

Gonorrhoea.

  Senna and Salts is an excellent  purgative medicine, either alone or
taken in the morning after any pill the night before.
  Take one ounce, or about a handful of Senna leaves, pour on it a pint of
cold, soft water, put it on the fire—taking care to remove it the moment
it boils—stand on the leaves till cold—then strain off, and to the liquor add
one ounce of Epsom Salts, or two ounces of Roohelle Salts.  A little bruis-
ed ginger boiled with the leaves prevents  griping.  Dose a large wineglass-
full and repeated every half-hour or hour till it operates.

  Jalap and Calomel.—Fifteen grains of the former and five of the lat-
ter, taken in sugar or molasses.  A larger dose is sometimes given. 
  Epsom Salts and Antimony.—Dissolve two ounces of Epsom Salts and
two grains of Tartarized Antimony in half a pint of water, and take a
wineglass-full of it two or three times a day, or as often as may be necessary
to keep up a moderate degree of purging.

  Epsom Salts is a good cooling purgative ; an ounce is the usual dose,
taken in water.  This is the purgative that most people take on finding
they have  got a Gonorrhoea.  It is not however the best; for  much of
that quantity of salt passes  through the bladder—adding to the saline ir-
ritating quality of the urir.e, and thereby increasing  the scalding pain in
urinating.  It is better to take one of the other purges above,  but this
will do if no other is at hand.  It is not generally known that a very small
quantity of Epsom  Salts, if taken in a larger quantity of water, will act
more pleasantly, certainly and  effectually than a larger dose in the usual
quantity of water.   A teaspoonful for instance, iu a tumbler of water, in-
stead of an ounce  in a teacup-full of water.   Also, by  repeating this
weaker  solution of  salts it is a very cooling and proper medicine in a hot
and feverish state.   But the best of all medicines for cooling and reducing
the system is the combination of Epsom Salts with Antimony just men-
tioned.

  Seidlitz Powders is a pleasant way of taking a mild dose of saline
medicine.
              COOLING, OR DILUTING DRINKS.

  Barley Watei.—To make this properly, take  a teacup-full of pearl
barley, boil it a few minutes, then throw away this dirty water, and add
to the pearl barley  three quarts of fresh water, and boil  it down to two
quarts.  Some add  a few figs or a little liquorice root towards the end of
uie boiling.  Dose, a tumbler-full as often in the day as possible.

  Flaxseed Tea.—Take of whole flaxseed (not of flaxseed meal) two
ounces or trr-ee or four table-spoons full (there  is no occasion to be very
exact in quantity) and add to a quart of water, which is to stand simmering
by the fire for an hour or two—then strain and, if more agreeable sweeten
it. Let at least this quantity bo taken as common drink during the twenty-
four hours.

  Alkaline Drinks.—Another excellent remedy to abate the pain and
heat in making water is the Super-Carbonate of  Soda.   Procure an ounce
of this, and dissolve  one quarter of it in a quart of common tea, or in plain
water : it may  be sweetened. This quantity should be taken during the day.

  Or, the same  quantity of Soda  may be added to the barley-water or
flaxseed-tea, which would increase their soothing effect.

  If these cannot be had, a little Gum-Arabic or Jujube Paste may be con-
stantly kept in the mouth—remembering to drink frequently and freely of
water.

  Soda Water is also a good remedy and resembles the Alkaline drink.
It must however be  that made from the Soda powders, andnot that drawn
from the fountains, which contains no soda and is merely a pleasant aerated
water. 
/      Syringe for Caustic Injections.
The proper size and form for the common glass Syringe.
 
CHAPTER  III.
On the  AccmENTAL Symptoms  of Gonorrhcea, viz: —
  Excessive pain and heat in making water:
  Swelling ofthePrepuce,—Phymosis and Paraphymosis ;
  Frequent and painful Erections,—Chordee ;
  Swelling of the Glands in the Groin,—Bubo;
  Swelling of the Testicle.

   The nature of  these  Accidental  Symptoms has been
sufficiently explained, in the first Chapter;  to avoid use-
less repetition I shall therefore at once proceed to de-
scribe their treatment and cure.

       Excessive pain and heat in making  water.
   This  is nothing  more than a higher degree of the first
or inflammatory stage of Gonorrhcea which has been al-
ready noticed, but which  must be  subdued before the
remedies for stopping the discharge are entered on.  The
means of reducing inflammation are,—purging, low diet,
rest, and  the  freest  use of diluting drinks, for which di-
rections are given    elsewhere,    and Notes 1 and 2.
You cannot make too free a use of diluents.  The burning
pain arises from the saline urine passing over an inflamed
and irritable  passage.  The urine itself is loaded with
salts—it  is like brine; if, therefore, you dilute  it with
 one of  the cooling drinks, or even with simple water, it is
 easy to imagine how its irritating  property must  be di-
 minished.  Sooner or later  by the means above directed,
5 
this heat and pain will considerably abate, and then, and
not till then, can you safely proceed to lessen the discharge

                Swelling of the  Prepuce.
   The Prepuce (called also the foreskin) will often swell
prodigiously, but  this, of  itself,  is of very little conse-
quence.   A soft rag wet with brandy and water, or any
of the Lotions given below, Note 6,  and wrapped about
the part, together with a dose or  two of purging pills, is
all that is required.   The rag  should be wetted often.   It
is  of  some advantage too if the  penis be kept upright,
which is easily done by pinning or fastening it to a band-
age around the waist.

   But the swelling sometimes is so  great  that the  pre-
puce  cannot  be pulled  back  from over the head of the
penis,—this condition of it is called  a Phymosis ;—and
sometimes again, when it is  pushed back it cannot be
drawn forward,-r-this is called a Paraphymosis.  Now
both  these states are of great consequence,  particularly
the latter.

   In the first, Phymosis, the chief thing  to look to is

           NOTE
Cooling Lotions.
  Evaporating Lotion.—A quarter of
a pint of Alcohol (brandy or othi r spi-
rits may be substituted) in three quar-
ters of a pint of w -iter.  The best way
to  use it h to apply a foil or two of
linen upon and around the part, and
keep this wttted with it. The part
should be otherwise covered up as lit-
Ue as possible.
 Lead Lotion —Sugarof Lead a quar
tei of an ounce, Soft water one pint;-
a tcaspoonful of vinegar should bl
first put into the water: used as the
above.
 Evaporating Lead Lotion.—Sugai
of Lead a quaitcr-'f an ounce. Alcohol
a quarter of a pint, Water three quar
ters of a pint   The  Sui^ar  of Lead
with a little vinegar should be dia-
solved in the alcob.nl before adding the
water; used i-n the same way. 
cleanliness, and here a Syringe, either a common one or
the pocket Syringe  particularly  described at page 43,
will  answer, is of the  utmost use in  washing  out  the
humors that collect beneath the prepuce,  and which, by
becoming acrid and offensive, greatly increase the malady.
It is necessary therefore to inject some  proper fluid  un-
der the piepuce several times a clay.  Anything that will
wash away these humors  is better  than nothing, so that
warm  or even cold  water may  be used; but  the best
thing for this purpose is a  lotion  made ot  the Lead, in-
jection powders, or the lead Lotion in Note    for these
are cooling and healing to the parts, as well as cleansing.

   The Paraphymosis is still  of  more consequence ; in-
deed you should lose no time in endeavoring to reduce it,
that is, to bring the prepuce forw aid again over  the head
of the penis.  With  this object you proceed in the fol-
lowing way:  Take  hold of the  head, which is always
very much  swollen,  with the fingers  and thumb,  and
steadily press  it  gently increasing  the  pressure in order
to squeeze back some of the stagnant blood and  lessen its
size.  It is better if you first  hold the hand in very cold
water.   Immediately after thus diminishing  the size of
the  head, apply the two thumbs  to it, and grasping the
prepuce with the fingers, steadily push  back the head
while you  pull the prepuce forward.   A  little force may
 be necessary, but you will almost always succeed; if not,
 the  only thing a surgeon can do, would be to cut the skin 
on each side, where it  is tightest, and then it will easily
pull over; this might be done with a sharp pen-knife or
razor, after this applying a common  poultice.   In both
these cases, of course,  it would be proper to live low,
keep  as quiet as you can, and purge freely.

   Frequent and very painful Erections of the Penis.
  This is what  is  called  Chordee, and a very  painful
thing it is.   I have already pointed out its nature in the
first Chapter,  Plate   it occurs particularly at night—
the penis often being quite crooked at these times.  When
Chordee is disposed to  come on, it cannot always be pre-
vented entirely, but it  can  always be relieved  and  ren-
dered tolerable.   Further, a Chordee once come on, it is
often the last symptom to leave the patient.

  The best way to prevent a Chordee from coming on is
to prevent inflammation, by rest, purging, and low diet;
the best way to relieve it when it has come on, is to take
two or three of the Anodyne Pills, which are  probably
the   best,  or any other in Note    at bed-time.   After
a few nights, see if you  can leave them  off, but if the
pain  comes on again, return to them.   With a view also
of relieving the inflammation of the  penis, on which this
          NOTE               —the dose is from two and a half to tea
Opiates.                       «raiBi-
  Opium Pills.—Gum opium one grain,
made into a pill.
  Laudanum.—Of this the dose  is from
five to thirty drops, in a little water; to
be repeated until relief is obtained.
  Dover's Powder is given to assuage
pain—it is a soothing and fever medicine 
symptom depends, it is a good thing to immerse  it in a
basin of hot water for a quarter of an hour on going to
bed, and afterward to wet a soft rag with brandy or vine-
gar and  water, or common water, or one of the  Lotions
in Note    and wrap it round the penis.  Some contrive
to have a bottle of cold water near the bed, which they
hold between their legs whenever it awakens them.

         Swelling of the  Glands in the Groin.
   This is of less  consequence in Gonorrhcea than in Ve-
nereal  disease;—it is  a very rare thing in a Gonorrhcea
for these swellings to form into matter and break, as they
do in Venereal.   Brisk purging,! as much rest  as  pos-
sible, and at night, a rag wet with brandy and water, or
vinegar and water, or any of the Lotions just  named,
especially the third, laid on them, is all  that is required;
under  this  plan  these swellings almost always  subside.
I  have indeed sometimes seen them form  matter  and
break, but  it has always been owing  to the constitution
rather  than the  Gonnorrhoea.  In such a case, should
these tumors threaten  to form matter,  leeches would be
proper and desirable;  or,  which may  be very much de-
pended on, a small blister of Spanish fly about the size of
a dollar piece.  Secure it  over the swelling at bed-time,
and remove it in  the morning, dressing with a bit of rag
spread with lard; it may be repeated two or three times,
or  at once followed by the Lotion.  But do not at any
rate omit the purging   Or sometimes, if  verv incon-
•     5 
venient to get the blister, the Liniment in Note 9, p. 71,
may be used ;  it should  be well rubbed  in—till the skin
becomes quite sore and red—once or twice a day.

               Swelling of the Testicle.
  When this complaint happens, it generally begins about
ten or fourteen days from the commencement of the dis-
charge, but it may occur at any time.   At first there is an
uneasy feeling about the part which you might judge to
be the situation of the neck of the bladder—just behind
the Scrotum (the purse).  Then there is a  swelling of
the back  part of one of the testicles—it is  seldom both
are affected at once,thongh one may be  after the other—
frequently with great pain, and fever.  From the moment
a testicle is threatened by these symptoms, give up every
means for  the cure of the Gonorrhoea and turn your whole
attention to this single circumstance.

   In the cure of this affection, the  first thing to be re-
commended (when it can be done) is rest, and resting on
a bed is preferable to any other.  The  next, to support
the testicle by means of a suspensory bandage, which may
generally  be obtained at any apothecary's store.  If you
have not  this  at hand, it may easily be contrived.—Make
a bag of soft linen, large enough to hold the swollen parts,
and then  sew or pin it to a bandage or pocket handker-
chief round the body.  If the testicle is suffered to hang by
its own weight, this alone will prevent its cure and greatly
augment  the  pain.   Next take five or six  purgative 
pills.  Frequent and repeated purging is a powerful means
of relieving this  disease,  and  this may be followed up
either by repeating the pills, or doses of Epsom Salts, or
Senna    Lotions also are of great use,  and the best of
all is the third one in Note    but any of those will do,
applied  by keeping a soft rag, and the suspensory band-
age, constantly wetted with it.   Bleeding  by leeches is
exceedingly useful where  the pain and inflammation are
great, but many persons are placed in such circumstances
as not to admit of their use.   There is, however, another
way of taking blood from the  part, which might be
resorted to in very  urgent cases, or might be  practised
at sea,  where leeches are not always to be had—it is as
follows:  Stand  before a  warm fire and pull up  the
scrotum so as to  put the  skin  on the stretch; you  will
then see several veins of a blue color:—Take a lancet or
very sharp pointed pen-knife and puncture five or six of
them:—then, with a sponge and  warm  water, bathe the
part,  and you  will be able to get  more blood than by
leeches, and with far less trouble and risk of exposure.
The bleeding ceases on laying down;  if not,  applying
cold water will soon stop it.   Sometimes, even under the
best possible treatment, great pain and inflammation  will
continue, and you are under the  necessity of taking  opi-
ates.  Forty  or fifty drops of laudanum  may  be taken at
bed-time,  followed by a purgative draught in the morn-
ing.  The best form, however, of opiate medicine is, if it 
can be procured—fiifteen grains of Dover's Powder, with
two  of calomel at  bed-time.   This is  as far as  I would
advise any one  to go  on his  own judgement.   In ver)
many  cases  these means will stop  the progress  of this
symptom, and indeed remove it;  but, on the other hand,
there are some  cases in which  it will not;  the  pain goes
on and is attended with fever and perfect inability to  go
about.   In this case I would advise, if posible, to call in
medical  assistance;  but, in  many cases, this is quite im-
possible :  you may be at sea, or in the  country, or where
you  cannot  obtain  this  assistance,  and  therefore I will
pursue this subject and describe the  best measure to adopt
in such a case,  in Note
           NOTE

  If rest, low  diet,  purgative  medi-
cines,  lotions,  and perhaps leoches to
the  part, do not succeed in lessening
the pain and inflammation,then copious
bleedii:g should be resorted to  Indeed
bleeding would be proper in any case,
but we do not always have recourse to
it, hoping to succeed with the means be-
fore mentioned.  From one totwopints
of blood may be taken from the arm and
repeated if not successful in allaying the
pain, swelling, and fever.  At the same
time large doses of Tartnrized Antimo-
ny should be taken.  Eight grains may
be dissolved in h-»If a pint of water, and
an eight part of this may be taken evrcy
second or third hour.  This is a large
dose,—at first it may vomit or purge, but
thisshouid be no objection to continuing
it, unless the vomiting should be  exces-
sive ; it will generally cease after a day.
There is no medicine which has such
power to subdue inflammation, and es-
pecially inflammation of the Testicle,
as Tartarized  Antimony, and so impor-
tant aDd so painful is this inflammation
that a little inconvenience or nausea and
vomiting should not hinder from  its use
and benefit  If the pain should be very
great, and prevent sleep at night, three
or four of the Anodyne Pills may bo ta-
b«n it bed-time »r twontv trains of Do-
ver's Powder, with two giains of Calo-
mel, followed by a purgative draught in
the morning.  If this is not at hand, forty
or fifty drops of Laudanum  may be sub-
stituted  Leoches are always of use ;-
fifteen or twenty on the part and after
wards cover with a warm poultice  At
other times, ifit can be, ice may be used.
Sometimes cold  applications will do
when  warm  ones will not;  at others
warm will answer whencold will not. If
one has been tried without success, al-
ways try the other.   When ice  is used,
let it be bruised and put into a bladder
half full of water, and lay it on the in-
flamed and swollen testicle  It is aston-
ishing how quickly  this will sonx'times
relievelhepaiu and inflammation. There
is a way of obtaining cold when you can-
not procure ice. Just mixequal parts of
Sal almoniac Saltpetre, auil Glauber
Salts, and put intoabladderof waterin-
stead  of ice; as these dissolve, much
cold is produced   I have dwelt longer
on this subject than on some, as it is  a
severe complaint  I have found it so in
my practice  A summary of the treat-
ment of inflamed testicle then is as fol-
lows.  Suspend  the testicle,- rest,—
purge,—leeeh,—and apply cooling lo-
tions.  If pain, inflammation  and fever
still run on,—bleeding, leeches, Tartar-
ized Antimony, and the applcation of
cold- 
CHAPTER IV.
On Gonorrhcea in the Eyes  and Gonorrhceal Rheu-
  matism.

                        §1.

  Gonorrhcea in the Eyes, or Gonorrhceal Ophthalmia.
   This subject is introduced, not  for the purpose of in-
ducing a patient to undertake the cure of these complaints
himself, but of apprizing him  of their real nature and
dangerous tendency, particularly the former, and urging
him to loose no time in securing that surgical and prompt
advice they need.   Fortunately, these complaints are not
of every day  occurrence.   Now and  then, however, a
person who is under treatment for a Gonorrhcea will be
suddenly seized with a most severe Ophthalmia.   This
complaint runs on with great rapidity, and if not speedily
arrested, it  accomplishes the  total  loss of sight.   It
begins with great severity of pain and copious discharge
of matter.    In such a case there is not a moment to be
lost:  the advice of a surgeon should be sought.   But as
it is possible,  and especially if the  physician or surgeon
have  practiced principally in the country, that he may
not have seen many cases of this kind; and also for the
benefit of those who  may be  at sea,  and cannot obtain
the advice and assistance  of  a surgeon; or, again, for
 hose  who may  be obliged to wait some  time  for his 
arrival, I will give in the form of a Note (   ) an outline
of the treatment  which is recommended by the most ex-
perienced and competent  men in  Europe.


   With respect to the manner in which the eyes become
affected with Gonorrhcea, there  has been a difference of
opinion.   Three   explanations  have  been given  to it.
First, that it  was owing to  carelessness,  such  as inadver-
tently rubbing the eyes  with  the fingers  after handling
the  penis under the  discharge of Gonorrhcea; next, that
it was owing to the Gonorrhcea affecting the constitution,
when, like Rheumatism, it may change its  seat from place
            NOTE

  In Mackenzie's Practical  Treatment
of the diseasos cf the Eye,  he directs
the following frr this kind of Ophthal-
mia.  *' Abstinence from all stimulants;
blood-letting,  oth  general  and local;
and the exhibition of purgatives,  or
emetic purgatives, and diaphoretics, are
to be had recourse to in theearly stage."
The discharge is to be frequently and
carefully removed  by  injecting under
the eyelids, a lotion, made with a grain
of the Miniate of Mercury to an ounce or
more of water; the globe of the eye is to
be touched once or twice aday with a so-
lution of Lunar Caustic, (four grains to
an ounce of water ;  or six grains of Blue
Vitriol  to an ounce of water  These
are to be used with  a camel haii pencil).
Also, the  lids are ro be kept from ad-
hering by anointing the edges of them
with  the  red  precipitate   Ointment
"Counter-irritati'in ought to bo employ-
ed from tlie very  first, by me,ins ofraus-
tard poultices .md blistOi s to the nape cf
the neck,  between the  shouldors or be-
hind the ears."  "If the pain of the eye
ispu'sative. or the  parts around it are
affected with pain coming on at night—
Calomel and Opium should be given,
m as  to affect the mouth.   Warm fo-
mentations, the  vapor  of  Laudanum,
©prate friction of the head, and the like
will seem to moderate the pain; but our
chief reliance must be placed on deple-
tion.counter-irritation, scarification and
smarting application to the globe 01 the
eye itself,  for removing the disease.
Snipping »ut a portion of the chemosed
membrane, (the outer mcmbiane of the
eye,  whoso vessels are gorged  with
blood), so as to procure a considerable
flow of blood  is highly serviceable."
  " Bleeding alone must not be depen-
ded on."
  "This inflammation," says Mr. Bar-
cet, anothereminent and practical man,
" in the few instances thut have come
under my observation,  is of the most
violent and intractable description, and
has  produced  the total  destruction
of the organ o( vision, in the space  of
two or three days, notwithstanding the
most vigorous employment of general
and topical bleeding, and other antiph-
logistic means."
  To the truth cf this 1 can attest, upon
the ground of my own experience, and
I judge it therefore exceedingly  desi-
rable that person* should be aware of
the dangerous nature and rapidity of
this  complaint, that they may not  be
induced to trifle away the only chance
of cure, for it is on the prompt and
decisive treatment in  the early stage
alone that the invaluable sense of Bigot
depends. 
to place; and thirdly, that it was the consequence of stop-
ping the discharge of Gonorrhcea too suddenly.

   Respecting the two latter explanations, these certainly
are possible but  very doubtful  causes.  With  regard  to
the former, that is, inoculating  the eyes by applying Go-
nonhceal matter to them, this, beyond a doubt, has been
known to be a cause.


   These facts stand  upon  unquestionable  authority, and
in order that others may judge  correctly  and  be careful
on this point, I will  relate an instance or two in Note

   With respect to the  question whether  or no there are
such  diseases as  Ophthalmia from two suddenly stopping
           NOTE

  MacSenzi , on diseases of the Eye,
page 314  states;  "A  patient  was
brought to me from  the country with
violent Ophthalmia. This patient hav-
ing Gonorrhoea  while engaged in re-
moving the discharge fioin the urinary
canal, a drop of the Gonorrhoeal fluid
was by mischance  thrown fairly in
upon his l»ft eye, and  excited the se-
vere puro-mucous Ophthalmia under
which he wan laboring.  The Gonor-
rheal sell cont.nued when 1 saw him.
The inflammation of the eye subsided
undera. ; r. jir: e.means the >. j e;lear-
ed to :i. d •■■ Re l\r beyond my expecta-
tions, and a c< ii. id«rablij shaie of vis-
ion was preserved.:'
  .Yr. Allan reiatt s  the following re-
markable case.  " A gentleman, aged
17 years, Lai1 hid a Gonorrhoea a few
doy >,whfcn viul-;.'it inflammation of the
eye, attended with a discha.i;e similar
to that from  the urinary canul, buist
forth.  The Gonorrhoea! rum v g from
the peris continuing; unanat'd at the
same time.  In a few days his brother,
aged 14, who never had hud V'ei.ereal
diseases in any way, but who slept in
the same room, was attacked with a
similar Ophthalmia in botheyes.  In ad
dition to my own attendance Drs. Munn
and Mr Js. Bell, of Edinburgh,  were
called in, and, notwithstanding every
meaos that could be devised, the elder
brother lost the stent of both his eyes,
and the younger brother of one. No
doubt the younger used the same tow-
el, or wash-hand basin, or the like "
  Again, the very eminent and practi-
cal Astruc relates a case exceeding!}
in point   " A young man had been ir
the habit every moruine cf bathing hit
eyes  with his mine while it was yeti
warm, in ordo  to strengthen his sight
Although  he had contracted a Gonor
rhcea, he did not abstain from this cus-
tom, apprehending no harm from it;
but the urin« | a taking of the  infec-
tious  matter, quickly communicated
the same  disease to the conjunctiva
(the mucous  membiaine which lines
the eyelids). The  consequence was
a severe Ophthalmia, attended with an
acrid  and involuntary  discharge of
tears and purulent matter, but which
yielded to the same remedies which
removed the Gonorrhcea." 
the discharge of Gonorrhoea, and Ophthalmia arising from

the constitution imbued with Gonorrhoeal disease, it is not

necessary here to determine; many persons think there

are, and I have no proof to offer, that it is not so; more-

over, the cases we occasionally meet with here and there

in the various periodicals would seem to corroborate such

opinion.   As 1 have already said, however, if there real-

ly be such cases, they  are  very rare, and I have no doubt

that many of those cases of Ophthalmia, as well as Rheu-

matism, which are there related, have been diseases which

happened to occur at a time when the  patient was labor-

ing under a Gonorrhcea, and had really no other connex-

ion than their accidentally occuring  at  the  same time.

But, as I have said,  as some persons  think otherwise, I

will give in the following Note,   , (principally  for the

perusal of medical men) the peculiar treatment which such

persons have adopted  who have  thus thought.

          NOTE               of the bougie may perhaps produce
                               the effect so much desired ; for any
  Treatment of those cases of Oph-   stimulus applied to the lining mem-
(halmia which are supposed to arise  brane of the urethra, provided it be
from too suddenly stopping the dis-  of sufficient activity to determine
charge —Of course  this  kind of  an irritation apd a secretion of mu-
Ophthelmiu includes only that in  cus, may producearunningsimilar
which the discharge is stopped—  to Gonorrhoea. If this plan is adopt.
On this  subject Mr. Mackenzie,  ed the Bougie must be retained in
(page 376)  observes, "The only  the urethra for Eeveral hours at the
point In which the treatment of this  time, till the effect is produced."
Ohpthalmia differs from ihe former     With regard to the treatment oj
is in the attempt, so much recotn-  those cases of Ophthalmia which are
mended by some authors, to restore  supposed to arise from the constilu-
the suppressed discharge of the ure-  tiofi being imbued with Gonorrhoeal
thra.  This is to be done  by intro-  disease—Scarcely any thing  is re-
ducing a bouv.ie into the urethra,  commended which differs from the
covered with some of the purulent  treatment of a similar state of Oph-
dlscharge from the eye, or with Go-  thalmia from cold or any common
norrhoBHl matter from another sub-  cause.
ject. Even the simple introduction    The discharge from the urinary 
   I fear  I shall  incur blame for having carried out this
note to so great a length, but  the consequences of delay
or  any misconception of the nature of  this malady, es-
pecially  that of inoculating the eye with  Gonorrhoeal
matter, is so dreadful that I  cannot possibly omit it.   It
passage may be present, or may
not; and, it  is worthy of remark,
that when it  has come on, not hav-
ing been observed when  the Oph-
thalmia began, in many cases, the
occurrence of discharge  from the
urethra has made no difference in
the symptoms of the Ophthalmia.
Notwithstanding this,  however, a
celebrated writer upon  Gonorrhcea
(Swediatir)  advises " the  use of
the Bougie for a couple of hours,"
with the intention  of bringing on
discharge.
  This kind of Ophthalmia too, is
less severe than the former, or that
arising from matter applied imme-
diately in the eye ;—it is of a more
chronic nature, and begins in the
eyelids in the form  of a little ulcer
from  which yellowish matter ex-
udes : which in theformer kind, the
whole surface of the globe  of the
eye and inner surface of the lids are
affected with redness and swelling;
the matter  discharged also is pro-
fuse and fiequently acrid and ex-
coriating to the outer lid and sur-
rounding skin.
  Abernethy, in  hie surgical Lec-
tures, calls it irritable  Ophthalmia,
and ascribes it to an irritable state
of the constitution in which the
bowels and digestive organs deeply
participate.   When  this state of the
constitution is brought on,  either
by  the  Gonorrhoea or the  means
adopted to  cure  it, he states that
either this Ophthalmia or Rheuma-
tism may occur; or that they may
both occur,  alternating  with each
other, evm alternating with the dis-
ease  of the urethra, and that  the
proper way of treating it, beside
soothing applications to the eye, is
to give five grains of blue pill every
night and a dose of castor oil in the
morning, keeping the patient on a
strict spare diet. In support of this
opinion he gives the following case.
  A gentleman who had been anx-
iously endeavoring to get appointed
commander of a frigate while in the
country, at length received instruc-
tion  from the admiralty  to  take
command of a frigate then lying at
Falmouth.  He  lost  no  time in
placing  himself in  the mail  coach
for London.  Just before, he left
Edinburgh he had caught a Gonor-
rhoea.  In January his eyes became
inflamed; and  when  he reached
London, he had a violent Ophthal-
mia, with purulent discharge.  He
was  in a dreadful state both of body
and mind,—could not bear the light,
and  had great pain in his eyes.  In
this  state he consulted M. Aberne-
thy.   He stated also that when the
dischargefrom the urethra stopped,
the eyes became bad, and when the
eyes got well the  Gonorrhcea  re-
turned.   In this state  Mr. Aberne-
thy directed him to keep quite in a
darkened  room, to wash  his eyes
frequently in the course of the day
with tepid puppy water, to take five
grains of blue pill every night, and
a dose of castor oil next morning,
and  to live strictly  low.  " During
the first six  days  he  mended very
slowly,  and not considerable, bul
on the seventh day,  when Mr. A
called, he found the pntient sitting
up in his room, the window unco-
vered and his eys almost well. Mr
Si
i.K 
need not, however, incommode  the  general  reader, for
being given in  a note he  can easily pass  it  by, while,
should  he be threatened with this formidable turn of the
disease, he would  derive important  advantages from its
perusal.   But,  indeed,  if  by the prompt  and decisive
means which are urged  in  every instance of this kind,  I
should  be  so happy as to save the sight but of one indi-
vidual, I would willingly incur the blame  of every other

                            §2.

                Gonorrhoeal Rheumatism.
   With regard to  this, I myself  very much  donbt  its ex-
istence ;  for  those however who  may think otherwise,  1
have chosen to insert the following,  also in  the form of  a
Note, (   )
A. expressed his surprise and asked
how this change had  so suddenly
happened, to which he  answered,
that he had had a number of very
copious stools in the night, and that
his complaints  had left him.  It
seemed to be a sort of critical secre-
tion from the liver and the whole of
the alimentary canal, followed by an
almost immediate removal of the
irritable inflammation of the eye."
  Mr. Abernethy also takes occa-
sion to warn persons  against mis-
taking this Ophthalmia arising from
an irritable state of the constitution
and digestive organs, for that fol-
lowing inoculation, or the immedi-
ate application of Gonorrhoeal mat-
ter to the eye, for the means recom-
mended for the first would add to
the irritability and debility of the
constitution, and increase  the dis-
order.  His  words are,  that,  " if
the surgeon is  frightened at this
 irritable Ophthalmia, supposing it
 to be one of the dreadful cases in
 which the eye is clapped, and pro-
 ceeds to bleed and purge the patient
 severely, he will only make the
 matter worse.  Moderate bleeding,"
 he says, " may be useful, but the
 chief object is to attend to the pa-
 tient's  health.  No means are so
 likely to be useful  as setting the
 digestive organs to rights and send-
 ing the patients to the country."

         NOTE

   On the treatment of Rheumatism,
from the same supposed Gonorrhcea),
 taint of the constitution, but little
 can  be recommended in addition
 to what is approved in  Rheuma-
 tism from other causes.  The his-
 tory of a case of this kind will best
 convey what is meant by this dis-
313 ft f j 
  " Major----, aged 25, contracted
Gonorrhoea. In a fortnight he was
seized with a swelling of the testi-
cle.  When this  abated, pain and
swelling of the right knee began;
on travelling in an open carriage on
the second day the other knee, foot,
and joint of the great toe, swelled.
The pain  was excruciating.  He
then came under the care  of Sir
Henry Halford, (the king's  physi-
cian) but no treatment seemed to
posses  any power in removing the
complaint.  Now, in addition, his
right eye was suddenly attacked by
a very violent inflammation which
threatened destruction to the organ.
He then gave up medicine and went
into the country for the restoration
of his health, and after being there
for about three weeks, the Gonor-
rhoea again increased  without any
abatement of the other symptoms.
The joints sp stiff and  swollen he
cmld hnrdly crawl about.   Warm
bathing and a residence by sea were
recommended.  From the  former
he experienced little apparent bene-
fit,  but after a  tedious  convales-
ence of two years, he found him-
self able to join  his  regiment in
Spain.—He recovered  fhe  use of
his  limbs and had no return of his
complaint, though exposed to ma-
ny  hardships in  the campaign of
1812, &c, &c.  Two years after, he
again contracted Gonorrhoea,  a
very violent one.  In a fortnight the
discharge began to abate and  vio-
lent  inflammation  attacked  the
great toe and foot.   The disease
then proceeded to the knees. As
the violence of the  inflammation
of the knee abated, the left eye was
attacked by violent Ophthalmiaand
excited great alarm for its safety.
It seemed to be deep-seated in tha
coats of the eye.   The sight of the
right eye was also impaired.  At
the end of  two  years more, hia
knee joint  was  stiff" and much
swollen,  and the urinary passage
was  all the time subject to returns
of Gonorrhceal discharge."  1 have
given Mis case to show how possi-
ble it is, for Rheumatism  to occui
when a patient is  affected with a
Gonorrhcea, and  how easy it is to
suppose it is  the effect of Gonor-
rhcea, merely because it happened
at such a time.   But after all I see
nothing in  this  case that differs
from Rheumatism from common
causes, and the present differs in no
important point from others I have
seen, which have been thought to
arise from Gonorrhoea. Rheuma-
tism is frequently a tedious com-
plaint; its  peculiarity is,  shifting
from place to place, and in this way
it will sometimes assume the char-
acter of inflammation  of  the eye,
then of the joints,  and  will also
sometimes alternate with disease
of the urethra.   Respecting the
treatment of Gonorrhoea] Rheuma-
tism, if there be  such, I  am not
aware of any particular in which it
differs from the treatment of Rheu-
matism from any common cause.
As it is possible however that soma
connexion may exist between the
inflammation of the urethra and in-
flammation of the eye;in cases of
the  latter kind, occuring when the
patient has Gonorrhoea at the time,
I think  the  recommendation  of
Swediaur, to-employ the bougie, is
a safe and justifiable remedy. 
CHAPTER  V
             On Gonorrhoea in Females.

   There is no difference in this disorder  in  females but
what arises from the difference in  the  organs which are
the seat of it.  Generally  speaking,  however, the in-
flammation  attending is more diffused; in seme cases it
extends to the lower part of the belly, which makes it
painful on pressure; also,  the  urinary  passage  being
shorter, it is more apt to produce irritation in the blad-
der than in males, so that there is a greater inclination
to make water.  There are no ulcers in this disease, al-
though the discharge is sometimes so irritating as to ex-
coriate or take off the skin.   There is  almost always a
swollen state of the external parts.   There are, however,
some  curious circumstances  relating to this disorder in
females which should be known,—the following are of
this nature.

   Generally  speaking, the disease is milder in women
than in men.

   Also, a female may  have a Gonorrhcea without her
knowing it.   This happens from the  complaint  being of
a milder character, and from her  not discriminating be-
tween this disease and certain slighter forms of discharge
which many  females are subject  to.  It is most likely to 
occur in women of unrestrained intercourse, as such per-
sons generally have the slightest  forms of this disorder.

   The same female may give a Gonorrhcea to one per-
son and not to another.  This arises  from the habi>  and
character of the person himself.—If he has pursued « life
of free and  unbridled  intercourse, he  is much less liable
to receive infection than a fresh and healthy  person  of
a contrary  character;  the  latter  will frequently  take a
Gonorrhcea from a female  who  has  only a slight gleety
discharge, when the former would escape it.

   Again, a female may receive  a  Gonorrhcea  from one
 person and give it to  another without having it herself.
 This may appear strange, but it is a  fact;—it happens in
 this way :  A female has an interview with a person hav-
 ino- a Gonorrhoea, and soon after sees a fresh and healthy
 person;  this latter comes in contact  with the infectious
 matter before it has  had  time to engender the disease,
 and removes it; the consequence is that he lakes the Go-
 norrhcea and she escapes it; it is an incident which often
  leads to very puzzling surmises.

    In the last place—a female may  always know, or at
  least have reason to suspect, she  has an infectious dis-
  order,  when she has  lately had a Gonorrhcea  and a dis-
  charge  remains,  greater, or in  any  way different, from
  what she was accustomed  to before  she had the Gonor-
  rhcea. 
  The treatment of  this disease  in the female differs in
Beveral important points from  its treatment in the male;
—viz: there is  much more occasion for  the use of cool-
ing drinks,  especially  those containing soda,—the use  of
the tepid bath,  or warm fomentations is more necessary,—
the  appearance  of her  periodical  illness complicates the
case and demands great caution  in the management of
the remedies at  that time.   And again, with respect to the
internal  remedies, their influence over  the  disease is very
much less ;  though, any of those mentioned already may
be  taken, and sometimes are really used with advantage.
   Now,  just as in the  male,  the first or painful  and in-
flammatory  sytnptoms must be  subdued  before means are
taken  for stopping the discharge;—this will  be done by
repeated purgative doses, and the free use of diluting drinks,
together with low diet and rest.  When there is much ex-
ternal  heat  and inflammation, fomenting by cloths or  flan-
nels wrung  out of hot popy-head tea is very useful.  Four
or  six popy-heads  should be  bruised, and  boiled in  two
quarts of water  for a few minutes, and the liquor kept hot
while used.
  Having then  abated the pain and inflammation, and per-
haps also taken  some internal medicine for a few days, In-
jections are  at once commenced with.
   These Injections of course must be used  by means of a
female Syringe,  which can be procured at any apothecary's
store.
  With regard to the Syringe for  Females in common use,
this is  a very poor contrivance.  Its great fault lies in its 
not  enabling  the  patient  to  retain  the injection  in the
passage ;  it allows  it  to  run  away  and  escape immedi-
ately, even  before it can  have  reached the whole length
of the passage,—thus  the part of the inner surface that
most needs the  application is  often  entirely  untouched.
In  order to have the full effect of an Injection,  the  Sy-
ringe  should   hold  enough to  fill the passage, and  when
filled it   should  be retained there.   My  own  Syringe,  fa
representation of which will  be found  on  this page) is
made to answer both these purposes, as many have happily
experienced;  for, after using  the  common  Syringe for a
length of time to no good  purpose,  they have succeeded
with this  contrivance to their fullest wishes.

          DR. RALPH'S IMPROVED FEMALE SYRINGE.
  With these remarks,  I finish the subject af Gonorrhcea
and Gleet in Females,  and when it is considered that so
long as any  discharge, remaining  after Gonorrhcea, exists,
so long there is a possibility of spreading the disorder to a
second  person, a sufficient reason will be seen for laying so
great  a stress on curing Gleet at once, and doing so by In-
jections, for it scarcely can  be cured in any reasonable time
without them.
  * Manufactured by Mr. Liese, 102 John Street. 
CHAPTER  VI
          On Gleet.—Its Nature and cure.

  A Gleet is almost  always the consequence of a badly
managed Gonorrhcea.  Instead of following up the cure
of that disease by the means which have  been so partic-
ularly dwelt on, viz.  Injections, the discharge is suffered
to go on from month to month, and the effect of this is to
entail a permament disordered condition of the parts affect-
ed and which generally then goes under the name of Gleet,
Weakness, &c.

  It is important to understand the nature of this malady
as well as how  to cure  it, especially  as a  very  serious
error respecting its infectious nature, prevails with many.
It is a  very common thing to hear it said that a Gleet is
not infectious; but this is very wrong,  and often leads to
great  trouble.   Virtuous  and unsuspecting  women are
unintentionally  involved in this complaint in consequence.
A person  who is about to marry, for  instance,  may not
have had  Gonorrhoea for six or nine months, or longer;
but a slight  discharge—so slight  indeed that he has
scarcely observed it—may have continued  all  this time.
But he does not dream of its infectious nature  until the
saddest consequences show themselves.  So, also, unfor-
tunately, does a similar cause of unhappiness frequently
occur in those that have been  abroad or from their family 
for a length of time.   Indeed,  the consequences of this
error are so  very serious that it  merits any pains and
trouble to set the matter in its own true light, and per-
haps I cannot do this better than by giving a case or two
as related by Sir Astley Cooper.

   On  this subject, then, Sir Astley observes,—" Gonor-
rhcea, when neglected, sinks into a Gleet,  and is known
by  the change  of the color of the discharge, and the pain
attending the inflammatory stage  ceasing.  In this state,
is  the  discharge infectious  or  not 1   I  doubt myself
whether a Gonorrhoea ever loses its power of causing
infection as long as any  discharge from the urethra re-
main-, and 1  will give you my  reasons  for this  opinion.
A married gentleman went to Lisbon from this  country,
[England] and whilst at a distance from home, departed,
as too many  do, from the  path of virtue.  The Portu-
guese lady with whom he cohabited gave him the Clap.
He returned to England, and, after the expiration of five
months and three days after  first  observing the  Gonor-
rhoea, he called on me, and asked  whether he might re-
turn home with  safety to  his  wife.  He said he had a
little  discharge, and wished to know, if, after having it
five months and  three days, it were possible for it to be
infectious.  I replied—' Certainly not; you may go home,
taere is no danger of your giving  it to your wife.'  He
nant home,  and unfortunately  give  his wife a severe
dip.   I attended both the parties afterwards, and was
\i Temely sorry for what I  had done;—but I thought, at 
 the time I gave the advice, that a Gleet was not infec-
 tious.   But I think differently now,—and believe that,
 after a continuance of several months, the discharge w
 infectious."

   Another instance.—" A gentleman from the  north  of
 England, who had been recently married, came to me and
 said that he had communicated a Gonorrhoea to his wife.
 Shocked at such an occurrence, I said, ' How could you
 think of acting in such a manner V  ' Why, sir,' said he,
 ' for fourteen months prior to my marriage, I had a Go-
 norrhoea; I made various attempts to get rid of it, and
 had  a variety of advice about it, but a yellow discharge al-
 ways continued.  I was told by every body that it was not
 infectious, and not until after such repeated assurances did
 I get married;  the consequence, however, is, that my wife
 has a severe pain in making water,  and a copious dis-
 charge.'  I  visited her, and found her in this state; she
 was some time under treatment before she quite recovered.
 From what I have seen, I do hold that a medical man is
 not warranted in saying that a discharge of a Gleetykbd
 is not infectious."

  On these two cases thus faithfully related, then, every
 person may be  able to form his own opinion on the infec-
tious nature of a Gleet; I think they are sufficient to make
every reflecting conscientious  person  take care how he
gives advice in  such a case, particularly if his patient is a
married man.   Indeed, it  is from this error, or from a 
total indifference as to its consequence, that we have so
many cases of Gonorrhcea,—they are twenty to one com-
pared with cases of Venereal.   In fact the common wo-
man of the town pay no attention to a Gleet.  After the
first  or  inflammatory  symtoms of a Gonorrhcea  have
subsided, they mix with society as though nothing  ailed
them.  In the patients of the Hospital called the " Lock,"
in London, for instance, nothing is more common than to
see the Venereal and the Gonorrhcea in the same female;
but it is the Venereal which brings them there.   As to
the Gonorrhoea, or Gleet, they will tell you they have had
that  a long time, and thought nothing of it, but having
got the Venereal, in the form of chancres,  they became
alarmed, and  anxious  to be cured.   So also, when the
Venereal is cured, they seldom stop in the  Hospital for
the cure of the Gonorrhcea, or Gleet, but  go out again
promiscuously in the town and spread the Gonorrhcea in
every quarter.

  I do not however, after all, say that every Gleet is in-
fectious, but,  they are so generally, and there is no mark
whatever by which it can be said that this one is infec-
tious and that one is not,—this can only be known by its
consequences.   How serious therefore to say to any one,
especially to a married  man, or one about to marry, that
a Gleet is not infectious.    But it is incumbent also to
state, that there is a discharge from the urethra, in some
measure resembling a Gleet, which is not infectious.  A
discharge of this harmless kind  may  proceed from two 
causes which may be easily understood.  In the first place,
it may proceed  from a little  abscess which occasionally
forms in  the urinary passage, and breaks; and the other
is, a discharge proceeding  from a Stricture.   Now, the
nature of these  two causes of discharge  must be under-
stood, and then  a suspicious Gleety disorder will be easily
detected  and distinguished from either of these.

   First,—With regard to the discharge  from the little
abscesses  above mentioned, it should be known, that, in
the whole length of the urinary passage are situated here
and there, little sacks for  the purpose of secreting a lu-
bricating fluid;  these are called lacunae.  After a Gonor-
rhoea, these  little lacunae  are  sometimes  affected with
common inflammation, which forms into abscesses, and
 when these burst and their contents  are  discharged, the
running ceases.  Now, the circumstance by which these
abscesses may be distinguished from a Gleet, is this;—the
discharge from  these lacunse stops entirely for a week or
two, and then,  when another breaks, it  comes on again,
 suddenly, and again ceases as before;  but the discharge
from an infectious  Gleet never stops;—it  may  increase,
 from  excesses or irrigularities of any kind;  and  it  may
 decrease, so as to become very trifling,—but it never ceases
 altogether. This, therefore, affords a good rule forjudging
 between Gleet and a discharge  from these abscesses in
 the urinary passage

    And  next.—With  respect to the discharge arising from 
Stricture,  this will be easily detected by  considering the
symptoms  proper to Stricture.  For the necessary instruc-
tion on this subject, however the reader must be referred to
 Chapter ix, on Stricture.

           The Treatment and Cure of Gleet.
   A Gleet is often  a very troublesome disease  to manage.
If there were no other reason for saying this, I might safely
 infer it from  the numbers who have  come to me with this
complaint,  having had it on them, more or less, for a length
of  time.    These   patients generally  state  that they  have
tried a great  variety of means, and are quite disheartened.
I  cannot always  learn  particularly what these means  have
been, but two important things I do know ; first, that what-
ever they  have  been, they have always failed; and next,
whatever has been the state  and condition of their case, the
means  I am now about to mention have always succeeded.
I  think it  right to premise these remarks,  because it  may-
be  thought the plan I recommend is very troublesome ; it
may be so : but  then, I would  repeat, this plan succeeds
when every other means fails,—and I am quite sure no bet-
ter can be availed  of.
   In the  first place,  then, I would say, that if Gleet  is
of recent date—that is, if the originating disorder, the  Go-
norrhoea, were not taken above one or two months ago, the
remedies recommended  for the treatment of Gonorrhoea, in
Chapter n, will generally prove perfectly successful.  If,
however it is an affair of several months, perhaps half a year,
or a year, then different measures should be taken and which
r 
r will now describe.  First, the Internal Remedies, as the
Balsam of Copaiva and the Cubeb,—these, I do not hesitate
to say,  are worse  than useless in settled Gleet;—not only
can they never cure it, but, holding it more or less in check
whilst  taken,  they deceive the  patient and induce him to
fritter away valuable time, not to mention unnecessary phy-
sic-taking and loss of money; whilst in ninety-nine cases out
of a hundred, the foundation for a permanent and serious de-
rangement—Stricture, is being surely laid.
   In the use of Injections, however, properly employed, we
may place the most complete confidence; these  sometimes
in conjunction with another remedy presently  to be  men-
tioned,  form a plan of treatment which no Gleet can very
long withstand.   Any of the Injections  employed for the
Gonorrhcea may be used.
   But there is another very useful addition to Injections in
the cure of Gleet:  and this is the  Bougie.  I should advise
it to be used in every case that  had existed three months
(from the originating Gonorrhcea) or more.   You may then
begin with  the Bougie  and  Injections both at the  same
time ; or  commence its  use  only when you have tried the
other plan without proper success.
   Oilier remedies, and indeed several very different modes
of treatment, arc occasionally  required  in those old and ob-
stinate  cases of Gleet that we frequently meet with  ; but
they are mostly of a character  demanding great judgment
and experience in their application, and could not with pro-
priety, or even  with  any utility, be entrusted to public or
non-professional use. 
CHAPTER  VII
On certain diseases Resembling Gonorrhcea in some re-
  spects, and which are frequently mistaken for it;  but
  which, nevertheless, are totally distinct and different
  diseases.

  Nothing can be more valuable to those concerned than
to know how to distinguish  between  real Venereal dis-
eases and diseases which are not Venereal, but which re-
semble it.  Those into whose  hands this little book may
fall will  be enabled to do this effectually, and will thus
escape  the  advertising schemes of a set of people the
most  unprincipled and detestable that  were ever  suffered
to deceive the public.  These people, either from igno-
rance or knavery, call every  thing Venereal they may
happen to see upon the sexual organs.   Now, the struc-
ture of these parts, in many respects, is the same as that
of other parts of the body,  and  they  are subject to the
same diseases we meet  with in other  parts.   It is a fact
 and one which I shall presently show most clearly,  that
 many of the disorders these people call Venereal, have
 nothing at all to do with  that disease.  Nothing is so
 easy as to deceive an inexperienced  person into such a
 belief.   Knowing he has been once exposed,  although it
 might be far too long ago  to be the cause of his com-
 plaint, yet, if he happen to have any strange  appemsy* 
on these organs, he directly thinks it must be this disease.
Indeed I am frequently  troubled to convince them it is
not so;  but let  them go to any of the people I allude to,
and they are sure to be confirmed in this belief.

  There is however another and a far more serious view
to take of this deception: it is, its effects upon the mind.
The money they extort on such a plea is nothing: nor is
the fine and healthy constitution which they ruin half so
great  an evil as the anxiety  and load they fix upon the
mind—it breaks the  spirits.   In  a  single man, a false
impression of such a kind may be of little consequence;
and there  are married couples, of a moral stam;na so firm
and unassailable, that, mutually confiding in their own
integrity, no insinuation  of  this kind could possibly tell
upon  their happiness;  but, on the other hand, there are
others of  a less  confiding disposition,—those in  whom
symptoms  so new  and unaccountable, especially if ex-
plained by insinuations of such a nature,  would leave a
deep impression, if not indeed, destroy the  very  basis  of
connubial confidence.   And  this is no imaginary case,
nor yet a  very  rare one.   Enjoying, as I do, much of the
confidence of this city, and  being known to have given
much attention to this class and order of diseases, cases
of this nature frequently  occur to me, and, sometimes too,
of great importance.   This  indeed will  readily be ima-
gined when the remarks I am now about to make upon
the subject shall have  been perused. 
  The diseases which in some respects resemble Gonor-
rhoea and are frequently Mistaken for it, but which, nev-
ertheless, are totally distinct and different  diseases, are
chiefly four.   These I will now proceed to notice, and
will  also show their  proper treatment, which is always
very simple and successful.

  The first of these complaints occurs in men, and con-
sist of,—

  The natural secretion of the part, accumulated beneath
the fore-skin.

  When this occurs it becomes irritating and excoriates
the inner surface of the fore-skin, as well as the head of
the penis, giving rise to some uneasiness and swelling.
At  this time,  if the fore-skin is pushed back, the parts
beneath it  look quite  serious,—the discharge accompany-
ing is offensive and considerable,—the parts  swollen,—
and the excoriated surface presents a red and quite angry
appearance.   Now, in this state, it is an easy  matter  to
impose upon the mind the false idea of a Clap or Gonor-
rhoea.   Indeed as I have said before, it is sometimes dif-
ficult to persuade a person it is otherwise.   Yet, all this is
a very innocent affair.  To be convinced that this is not
a Gonorrhoea, just look to page    —observe the descrip-
tion of that disease, and  compare  the two.   There you
will find that the discharge  in Gonorrhcea issues from the
orifice of the  urinary passage, from which you may al-
ways squeeze  a little matter; but in this the discharge is

                       •     7 
supplied from the surface of the fort-skin and head of the
penis.  This is quite enough to show it is not a Gonorrhoea

   And that it is not Venereal,  you  may likewise be as
certain from the fact,  that  this—the Venereal—begins
with one or two, seldom with more, distinct little ulcers,
(see Chap, xm), which are inclined to become deep instead
of broad,  and which discharge  but  very  little  matter,
whereas, in this, the discharge is  copious,  and there is no
ulcer at all—it is rather an excoriation of the skin than an
ulceration.   Now it is a grievous thing for a man to be told
that he has got a Gonorrhcea or a  Venereal disease, and to
be treated accordingly, under circumstances like these.
   The truth is, this case is nothing more than a little al-
teration in the secretion of certain glands  situated  under
the fore-skin, occurring frequently in those  who  neglect
to wash these parts, particularly  in hot weather;  and its
cure is easily accomplished, simply by  washing often in
the day with simple Sugar of Lead Lotion,  or brandy and
water, or even plain cold water—taking at the same time,
a dose or  two of physic.
   If this should happen to  be ineffectual,  which  is rare,
a little bit of lint or soft rag,  soaked in one of the Lotions
         NOTE
Lotions for the Above
  1.—Sugar of Lead 15 grains—Tinc-
ture of Myrrh 2 drachms—water, to fill
a two-ounce vial, a few dropsof vine-
garto be added to the water before the
Sugar of Lead.  Another is,
 2.—White Vitriol 10grains—Tincture
of Myrrh 2  diachms- Laudanum 1
drachm—water to fill atwo-uunve vial
 Either one of these will ofteu bo 6uf
ficient— the first is the milder. It is bet
ter, however,  to obtain both, so as to
change the application  every second oi
third day To be used as directed above 
iri  Note    ,  arid  applied  two  or  three times  a  day,
would certainly cure it.  The application  is1 best made
by laying the bit of lint over the head of the penis,  and
then dravving  the  prepuce forward over it; in this w'a'y,
it remains in contact with the inflamed Surfaces.

  The next of these diseases is of more importance ;  it is
one which occurs in females, and often gives occasion to
many painful  and unfounded fears, for it approaches, in
appearance, much  nearer to Gonorrhcea.  It consists of,—

  Symptoms resembling Gonorrhcea,  communicated by
Females in whom no appearance of disease  can be detect-
ed, or who have only those  complaints  which are consid-
ered innocent and common.

  This is  a disorder on which I  am very  anxious to be
plain, and to be thoroughly understood.  It occurs often
in those who have  a discharge resembling what is called
the  " Whites," or " Weakness."   Now the Whites  is a
disorder to which many females, both single and married,
are  subject.  The  discharge of  it varies in  quantify  and
appearance; it may  be much or little;  clear, or opaque
and milky ; thin and watery, or thick and adhesive.   In
one or other of these forms, however, varying from  cir-
cumstances, the  Whites may continue for many years,
proving nothing more than a secretion  of what is nat-
ural to these parts, but increased in quantity or altered as
above described.   The  circumstances  which  originally
cause, and which vary this  disease,  are many,—such as 
•weakness of these organs,—too great fullness of their
vessels,—having children fast,—or too great  excitement
of the parts, and others.  But,  although this  disease, the
Whites, may, and most frequently  does remain  for  any
length of time without producing any corresponding mal-
ady in the other sex, yet, on the other hand,  it may,  and
sometimes  does become infectious,  communicating  the
like disease to another person.

   Now the object of this  chapter is to show that it does
so, as it were, spontaneously,—that is to say, without in-
tercourse writh other, or infectious  persons.

   With respect to the fact itself, that disease resembling
Gonorrhcea  may occur in innocent women, spontaneously,
which is so far contagious as to affect others, I would
only observe, that there are but few Physicians of much
practice who have not had  cases which  they would be
puzzled to explain on  any  other principle.  I will here
give the outline of one or  two as they have  occurred to
me.   A gentleman came, for instance, with the following
statement:—Sir, said he, I have some strange symptoms
of disease about me; and such, indeed, if it were not for
my confidence in another party, I  really  should suspect
to be the symptoms of a Gonorrhcea, for I once contract-
ed that disease and know something of its nature.  Well,
I said, what are the reasons which lead you to determine
it is not a Gonorrhcea?  The party I refer to is a lady
whose word I could not question: besides, I have known 
her long, and am quite certain that no consideration in
the world  would allow her to expose me to the possibility
of such a malady.  And further still,  having mentioned
these circumstances to her, she denied it firmly, and is de-
sirous that some one should see her—so perfectly uncon-
scious is she of having any such  disease.   Now  on this
occasion I could detect no one single symptom of disease,
and what  is still more worthy of  remark, I  learned she
was in the habit of being visited  by  another, and  who
also was perfectly  free from every symptom of disease.
   But in  my Note Book I have a still more  curious case,
and which I think is worth relating more  particularly.
It is this;—A gentleman who had formerly been my pa-
tient, consulted me on what we took to be a Gononhcea,
 and at the same time requested me to see the lady, whom
 he had known some time, and who assured  him that she
 was perfectly free from any such disease.  I did so, and
 found it exactly as he had stated, she had no one symp-
 tom—not even a Gleet.  However, we  treated  his dis-
 ease as Gonorrhcea, and though the cure was tedious, he
 at lenp-th  got well.   But, sometime after, he renewed his
 visits to this lady, and was again attacked with a similar
 disease—symptoms which   differed in no other  respect
 from the  Gonorrhcea, than in their mildness.   After this,
 however, he kept away for a considerable length of time,
 and, although in this interval he bad  interviews  with
 other females without disease, yet, in renewing once more
 his visits  to this lady, he was again,  for the third  time,
 attacked  with all  the symptoms of a Gonorrhoea. 
  I know it may be urged in  all these cases, that they
occurred in females of a certain character, and therefore
they might have been old cases of Gonorrhcea, degenera-
ted into infectious Gleet,—a disease which  continues al-
most  indefinitely,—is not attended with pain,—and  in
which there is frequently but very slight discharge—not
more, indeed, than many women (and females of this de-
scription in particular) are subject to.  But to this objec-
tion I cannot hold, for two reasons:—first, because such
cases sometimes occur in women who never had a Gono-
rhoea; and next, because, if they had been cases of Gon-
orrhoea, or Gleet, they would be infectious to every one
alike, or very generally so.   Now and then, we know, a
person may have an interview  with a female who has
a Gonorrhoea, or infectious Gleet,   and  may escape; but
this is an exception to a very  general rule—it dose not
often happen.  Likewise, that one individual is more sus-
ceptible of infection than  another; but this also is very
limited—the rule being, and pretty uniform it is, that, in
such cases, the disease communicates to all.  Here then,
while a  common Gonorrhcea  will  affect  all that come
within its reach, or pretty generally so, this mild disorder,
while it will affect  some, will as uniformly suffer others
to escape.  It therefore affords a striking difference in its
consequences, aud from this we may infer there is also a
difference in its nature.

  My design in this section  of this work, is to excul-
pate innocent and virtuous women  from injurious and un- 
deserved suspicion;  and this I apprehend to be an object
of immense importance, for the consequences of such un-
just suspicions might be painful  and serious in the ex-
treme.   Even in the limits of my own experience I have
met with lamentable instances of this kind; instances too
in which I am morally certain there was not a particle of
truth, and in which suspicion never would  have gained
possession of the mind, if the subject had been better un-
derstood.

   With this view of importance, I therefore deem  it pro-
per to place this fact upon the best authority in medicine
which can be adduced.   Now I have already shown that
symptoms resembling  Gonorrhcea have been  communi-
cated by females in whom  no symptoms  of the disease
existed, or were ever known to exist; but these females
were not to  be considered exemplary specimens of moral
character.   And  further, I have stated  them  upon my
own experience.  I will now however, show that the
same thing  happens in females of the highest moral cha-
racter, and  will show it also  on  the very best medical
authority.   Here I might refer to the great John Hunter,
to Abernethy, and  a  multitude  of others; but in that
highly esteemed and learned  work—Good's Study  of
Meoicine,—there is a paragraph  on this subject, so clear,
that I cannot do better than transcribe it.  In the fifth
volu-ne. page 8, after speaking of other diseases attended
with mucous or purulent discharge, which  are  now and
then  contagious or  infectious,—such   as  Dysentery, 
purulent  Ophthalmia,  and  others,—he says,  " In like
manner, Leucorrhoea (which js the medical terra for the
' Whites,' in females) as we have already observed, has
sometimes seemed to be contagious;  for I have occasion:
ally found a kind of Blennorrhcea (Gonorrhcea or Clap)
produced in man, accompanied with slight pain in the
urethra, and some difficulty in making water, upon coha-
bitation with women, who upon inspection, had no marks
whatever of  luodic Blennorrhcea, or Clap, and  in some
instances, indeed, were wives and matrons of unimpeach-
able character.''''  This, at any rate, will satisfy the mind
that such a thing is possible.

   But, neither has my  experience on this point been con-
fined to females  of questionable character ; I  have  seen
the same happening between husband  and  wife, where
there  was  no other ground of suspicion,  and where a
proper and scientific opinion, given at first, would have
prevented  much subsequent distress of mind  to say the
least.   I have also had the  satisfaction,  in many  such
cases, of knowing that the information continued in this
little volume has been the means, not only of removing
unjust  and cruel accusations, but of reconciling parties
and even of preventing divorce.

   With respect  to the  question,—how can a harmless se-
cretion be changed  into an infectious one? this I cannot
answer any more than I can tell why the discharge from
Dysentery, or Ophthalmia, or common Catarrh, disorders 
 which are generally harmless,, should sometimes become
 contagious.   The  structure  of the membrane  which is
 the seat of the disease ia all these maladies, is exactly the
 same  as that which is the seat of the disorder in Gonor-
 rhoea.  It may be, and no  doubt often is, from neglect of
 necessary washing;  and to this the habit of irregular in-
 tercourse may give  a greater tendency, for it is not to be
 denied that such  instances are much more frequently ob-
 served in women of bad habits and inconstancy, than  in
 virtuous persons; but this by no means proves that these
 are cases of genuine Gonorrhaea, nor that they do not
 now and  then occur in persons of a strictly virtuous cha-
 racter.

   With regard to the treatment  of this complaint, it is
 axactly that of Gonorrhoea, for which see Chapter n  on
 (he treatment and cure of Gonorrhcea.

   It therefore appears that symptoms very  much resem-
 bling Gonorrhcea, and which are infectious too,  may  be
 received by cohabiting with females who do not  present
 the least appearance of that disease;—that, although these
 are more  frequently  observed in females of lax morality
 and habits than others, they are also known to occur, oc-
 casionally, in women of exemplary  character—even in
         NOTE                instance, in Venereal. Two general
                             principles chiefly regulate the treat-
 On this subject it may be  remarked  ment of them all; the first directs what-
tnat the  treatment of Gonorrhcea is  ever abates inflammatory symptoms, if
very much the same as  that of other  any such exist; tie second, such re-
diseases affecting similar membranes,   medies as supercede specific actions by
as in contagious Dysentery,  Ophthal-  setting up an action of theirown—pre-
mia, &c.  There is no specific remedy   cisely as the Internal  Remedies do in
In any of them, such as  Mercury, for  the cure of Gonorrhoea.
8 
wives and matrons whose habits, age and religion, place
them beyond  uncharitable suspicion;—and, that these
complaints are cured by the treatment proper in the mild-
est forms of Gonnorrhcea.

   A third disorder which resembles a Gonorrhaa, and
which happens in men, is

           Stricture in the  Urinary Passage.
   Stricture, upon excitement, will sometimes produce dis-
charge exceedingly resembling  Gonorrhcea, but without
the usual degree of pain and inflammation attending that
complaint.  What a Stricture is, I will take great  pains
to describe in a future  chapter.  Here it is  only  needful
to say, it is a contraction, or a diseased condition of some
part or other of the urinary  passage, generally the conse-
quence of a badly  treated Gonorrhcea, but  which  often
continues for a time so free  from pain or any inconveni-
ence,  that it is  not suspected to exist, and is only brought
to light by the occurrence of some sufficiently  exciting
cause. Now, the act of sexual intercourse is a sufficiently
exciting  cause, and hence the disorder now  referred to is
frequently observed to follow  quickly after it.   I have
often  been consulted by persons who have remarked that
they are  quite unfortunate, for they scarcely ever are ex-
posed without contracting this disease; and,  what to them
is most remarkable, is, that others  who have visited the
same  female have escaped,  The fact is, that this  is not
a case of Gonorrhoea  at all, but a Stricture ; and their 
friends have not these symptoms, because they have no
Stricture.   Of course, if such a person go to an advertis-
ing knave, he will tell him immediately he has got a Go-
norrhoea; and further, the medicines he may give him
may probably remove the symptoms, so that he will  get
the credit of curing a Gonorrhoea.  But, in truth, he will
no more  have cured a Gonorrhoea than he will have cured
a Cancer; for, with purgatives and a low diet, this dis-
charge generally ceases in a little while.—It would there-
fore seem exceedingly desirable to have some plain and
positive  rule to judge by in cases like the present, and
fortunately, 1 have one to furnish.   This rule is founded
on the time when such symptoms first appear after con-
nexion.  The discharge I am now speaking of, that is,
when it is from Stricture, first appears  within twelve or
four and  twenty hours after such excitement,—a period
shorter than is required in the quickest case of Gonorrhcea.
Now,  Gonorrhcea may  be compared exactly  to inocula-
tion.   There is always a process and a certain  time  re-
quired, in order to produce the inoculated malady.  It is
true that  some inoculations produce their proper symptoms
sooner and  more regularly  than others;  but the  usual
time peculiar to each is generally known, unless delayed
or interrupted by some peculiar state of constitution, and is
pretty regular.  The usual period for the  production of
the symptoms of a Gonorrhcea is the third day after expo-
sure to it.  This however, is sometimes delayed for seve-
ral days by the causes I  have mentioned; and, sometimes
too, is a little quickened; but, as to its appearing in twelve 
or four and twenty hours, that it never does, and  never
can do.  This then I consider a valuable fact,—it forma
the basis of an excellent rule in practice, the use of which
may be seen by the following.   To a person, for instance,
consulting me on Gonorrhcea, I generally put this  ques-
tion first:—How long is it since you were exposed? Now
if he should say, why, it is very  recent—it was only last
night, and I observed some symptoms of it in the  morn-
ing ; or, at any rate, if he should  state  that it is within
twelve, or twenty-four hours after  an exposure, I suspect
at once it cannot be a Gonorrhcea.  I then enquire if he
ever had a Gonorrhoea before, and if he state that he has,
my suspicions are confirmed,  and I explain my reasons
for them.  This of course leads to an examination by the
bougie, by which the real state is ascertained beyond the
pbsibility of doubt, and  he obtains  a permanent and per-
fect cure.  But the value of this true and faithful expla-
nation is greater  than at first it may appear to be; for it
does not only undeceive and save an individual from pay-
ing different persons for pretended cures of Gonorrhcea,
but it also saves him from the consequences of occult or
hidden Stricture—an evil which I deem by far more seri-
ous and distressing than any to be found  in the  whole
range  of Venereal maladies.   The  object of this little
section is therefore to show, that, among other causes ca-
pable of giving rise to symptoms resembling Gonorrhcea,
a hidden, dormant Stricture is one, that this is to be sus-
pected whenever these symptoms  appear within twelve
or  four and  twenty hours,—but  that this is only to be 
known for fact by passing the bougie.  Its treatment con-
sists in a little cooling physic, rest, and low diet; if this
is not sufficient, the usual treatment for Gonorrhcea will
stop the discharge, but the only  proper and permanent
cure, is the cure of Stricture.

  The fourth and last of these disorders resembling Go-
norrhoea is

  A discharge occuring in female children,  and which
frequently creates distressing apprehensions in the minds
of parents.

  This consists in a discharge of matter from the genital
organs, attended with some slight degree of inflammation
and uneasiness.   But this complaint in children does  not
originate  in  the  parts  themself,  but in  some distant
parts, such as the gums, in teething; or in the bowels, from
foul and irritating accumulations there.  This latter is no
uncommon cause of the complaint.  We know that irri-
tation in the bowels in children is readily  transmitted to
tlistant parts, and is the cause of various maladies.   If
this irritation happen to fall  upon the head,  it produces
a dropsy of the brain; or,  if in other parts,  then other
diseases take place, as sore  eyes, or running sores from
behind the ears, a swelling of the neck, or others; so,  if
it happen to fall upon the mucous membrane  of the fe-
male organs, it then  produces the disease we speak of.
It is not, however, that this disease in itself is of so much
consequence as the fear  and misconceptions it may lead

                      *    8 
to.   Filled with  apprehensions, for instance, a mother
takes her little child to some physician, and if he happen
to be unacquainted with its real nature,  these apprehen-
sions are confirmed.   I have  read,  somewhere, of inno-
cent persons being hanged from a misconception of the
nature  of this malady.  With regard to the treatment of
it, this  of course is founded on the view here given of its
nature; remove the cause—that is, scarify the gums il
they are inflamed, and cleanse the bowels with an active
purge or two.   Nothing more is wanted, except plentiful
and frequent washing with cold water, perhaps sometimes
with the addition  of a little alum or sugar of lead. 
CHAPTER  VIII.
A few Remarks on that insidious disorder, Leucorrhoea,
   commonly termed " Female Weakness," or " Whites"

   (The following, though perhaps not properly belong-
ing to this work, is nevertheless closely connected  with
the subject of the preceding chapter, and may prove use-
ful here).

   This disorder consists, essentially, in a deranged condi-
tion of the organs of generation, originating sometimes in
a debility of the  general system, and sometimes in the
sexual organs  alone.  It  may be induced by various
causes, such as—any long continued illness—a damp, un-
healthy residence—having children to fast—sexual ex-
cesses—Gonorrhcea, &c, &c.   But, in delicate and ner-
vous females, it frequently comes on without these inter-
vening causes, and  becomes as it were the settled habit
of the constitution.  It does  not, however, thus invade
the constitution without disturbing one of its most impor-
tant functions, for it leads eventually to Barrenness. There
is  also a most unfortunate coincidence to struggle with in
those  who are the subjects of this complaint, for it affects
the constitution in such a way as to react  upon, and in-
crease the original disorder.   If, for instance, it originate
in  weakness of the sexual organs, this, sooner or later, in-
volves and debilitates the constitution, and thus keeps up 
and  augments the original weakness; or, if it begin in
general nervous debility, this weakening discharge occur-
ring, greatly augments that nervous debility.  There is
scarcely a complaint which the constitution  suffers more
under and has less power to overcome without the aid of
suitable assistance.   This may be clearly seen by reflect-
ing on the influence which the uterine system is wont to
exert upon the stomach and digestive organs.  That train
of distressing symptoms which so frequently occurs in a
state of pregnancy, is a striking illustration of  this  fact.
Numerous as these are, they all proceed from the effect the
uterous (or womb) has upon the stomach, enfeebling and
deranging its digestive functions.   The very same effects
are produced by this complaint, the " Whites," but with
this difference, the derangement of the digestive  organs
from pregnancy is but for a limited duration, while that
from weakness of the sexual organs  is unlimited and per-
petual.   Again, by tracing the sad  inroad this disorder
makes upon the constitution, it will be further seen  how
justly it merits every care and anxiety to remove it; for,
beside the disappointment  of  a  family,  which it is fre-
quently the cause of, there is nothing which more cer-
tainly fades the youthful countenance,  and  prematurely
leads to the failings and  infirmities of age.   The first
effect of this never-ceasing influence on the stomach is to
weaken its digestive power, by which the blood becomes
poor and watery.   This is seen by that pale and sunken
countenance, or bloated state of body, which always more
or less attends it.  Then follows an unequal circulation 
 of the blood* the strength of the body being not suificient
 to maintain  its equal distribution,  some parts have  too
 little and some too much;  the feet  are generally cold,
 marking too low a circulation in them, while the head is
 almost always overcharged, frequently leading the sufferer
 to suppose that bleeding would do  good, than which, by
 the way, nothing would be  more disastrous.   Headache,
 however, arising from  this  cause,  is one only of a long
 train of nervous symptoms,  varying in degree and kind,
 but continuing to harrass and embitter life to its very latest
 moments. A more just and clear apprehension of so serious
 a  disorder, therefore, than is generally entertained, can
 scarcely fail  to secure a due and proper attention  to the
 following account of its treatment and cure.   In the first
 place, as this is a disorder which so greatly weakens the
 digestive organs, and through these the constitution, so the
 constitution scarcely can be strengthened,  while the ori-
 ginal disease is suffered to remain;  it therefore becomes
 expedient to  prescribe both  for the  local weakness of the
 sexual organs, and that of the constitution, at one and
 the same time, and in the neglect of this rule, is the rea-
 son why the  treatment  of this  complaint so often fails.
 Now,  this need of applying remedies  to  the diseased
 organs, at the same time that we act  through the consti-
 tution  generally,  makes the use of a syringe absolutely
 necessary.  But upon the kind of syringe used very much
depends.   The syringe  in common use, as  I have  ob-
served before, is not adapted  to the purpose, and it is
chiefly on this account that we  so frequently  hear of in- 
curable and tedious cases, even when the syringe is used
In the first place they do not hold fluid enough to fill the
passage, and they have no means for returning the inject-
ed fluid for a due and proper time.   These deficiencies
lead to the contrivance of my  " Female Syringe,^ which
is  found to answer most completely.
DR. RALPHS IMPROVED FEMALE SYRINGE.*
A,—The SyriDge as used for Injections for «• Whites."
B,—The piece used for this Injection, separately.
C,—The piece for giving a Glyster lo another person.
O,—The piece for giving a Glyster to one's self.
   Leucorrhoea may occur in opposite states of the consti-
tution, and the  most important point to be ascertained in
any given case, is, whether it is accompanied by strength
or fulness of habit, or by weakness and exhaustion.
• Manufactured by Mr. Liew. No. 102 John-street. 
CHAPTER IX.
On Stricture of the Urinary Passage,—Its Nature-
  Symptoms —Consequences—Remedies—and Cure.

                         §1.
       On the Nature and  Causes of Stricture.

  The essential Nature of Stricture is Chronic Inflam-
mation.

  A Stricture  consists,  at first, in a loss of that dilating
or elastic property by which the urinary passage, which,
while at rest,  is  in a collapsed  state, becomes more or
less unable to  yield  or open before  the column of urine
projected from the bladder:—

  The diseased condition exists, during the early or first
stage of Stricture, only as a soft, swollen or puffy state
of the delicate skin  lining the passage, and perhaps also
of the immediately subjacent tissue.  Could a view of it
be obtained at this time, a small portion of the passage,
from a quarter to one inch in length, would be observed
to be merely a little  swollen and  redder than the  rest,
and this would generally be situated at about five or six
inches  inwards, though occasionally near the external
orifice, and more rarely still, at both places.  The  con-
tact of an instrument  with  this spot,  discovers it to be 
EXPLANATION OF PLATE V.
   Figure 1 Represents the appearance of Stricture in
its first or Incipient Stage, consisting in a thickened or
swollen state of the skin lining the urinary passage.

   Figure 2  Is the appearance of Stricture in its second
or Dilatable Stage.   Here, as is seen, the disease is just
beginning to assume a more permanent form, a slight de-
posit of diseased  substance  has commenced  under the
lining skin,  and ridges or bands are formed.

   Figure 3  Shows the third, or Permanent Stage  of
Stricture.  The deposit under the lining skin is considera-
ble, pushing inward upon the passage, (where least re-
sistance is offered), the diameter of which  is greatly re-
duced. 
PLATE \.
Figui
Figure 2.
9 
very tender or sensitive, the patient describing the sensa^
tion to be as if a sore  or raw  surface were touched—
which, however, is not  the case.   In this state a Stric-
ture offers but  little impediment (sometimes none) to the
stream of urine, and no resistance to the passage of an in-
strument*   So true is this, that, except by a careful, ex-
perienced and well-educated hand, it is easily overlooked
or missed.
   This may be called  the Incipient  Stage  of Stricture.
(See plate in, figure 1).

   In the next or second stage of Stricture, an important
change has taken place.   That portion of the  passage
which  was  before in  a merely tumefied condition,  has
now acquired  a certain firmness,—it  resembles  a band
encircling the passage,  narrowing  it at this  point,  and
actually  reducing its  capacity.  It now  offers a decided
impediment to the urine, and, if a  moderate sized instru-
ment is introduced,  an evident  resistance is met;  though
with a gentle pressure,  it yields,  and  the  instrument
pretty easily passes on.
   This has  been  aptly  called the Dilatable  Stage of
Stricture.   (See plate m, figure 2).
  * This very often happens ; persons
whom I have examined  and declared
to have stricture, have afterwards been
to others, (in several instances which
have come to my knowledge, to Sur-
geons, whose rank aud  ability merit
the highest respect, and whose opinion
would hardly be called in question),
who have said they had none, at the
lame time making use of remarks to-
wards myself of a most ungenerous if
not ungentlemtnlv nature ;Vad wh*-—
in truth merely because T had detected
a disease which had escaped their ex
ploration. I know this to have happen-
ed more than once, though some in-
stances I might not have known, but
fov tho kindnpss of a gentleman who
not only stands first in the profession
in America, but whose name is placed
among the most illustrious of Europe,
as 1 have myself heard from the lips of
Velpeau, Sedillot, and  others 
  In a still more advanced or third stage, the  dilatable
condition has appeared—the Stricture has become firm,
or callous, as it is commonly called;  the  contraction is
unyielding, and an instrument meets  an abrupt positive
resistance, the calibre of the passage being frequently so
diminished as hardly to  allow the urine to pass  at all, or
even an instrument of the smallest possible size.
  This is the Callous or Permanent Stage of Stricture.
(See plate in, figure 3).

  Now, it is not always possible to say  that a  Stricture
is in exactly one or other of these stages, for the disease
passes imperceptibly  from one  to the  other—often so
slowly that several years, sometimes many  years, will
elapse before a Stricture has passed from the first to the
second or from the  second to the third.  I not unfre-
quently meet with cases just verging upon the third stage,
the commencement of which was undoubtedly established
twenty, and even  thirty years previously; others  again
will arrive to the same  degree in a very few years.   A
Stricture, in a  person of  regular  temperate  habits, will
sometimes remain ten  or fifteen years  without having
fairly advanced to the second stage.

   On the nature  of a Stricture  also, it should further be
observed, there  is no  natural  cure for it.  When a
Stricture once begins, it is sure to go on increasing, either
rapidly or slowly.  Fortunately, however, we  have the
means of curing it by art, as will presently be described. 
Neither is it curable by medicine—all the meaicine in the
world, alone, would never cure a Stricture.

   The causes of Stricture  may be  numerous.  It was
said at  the  commencement  of this Chapter, that the
essential nature of a Stricture was chronic inflammation.
It  is now also said  that, whatever is capable of pro-
ducing or keeping up a long continued  irritation or in-
flammation in the urinary passage, may become a cause
of Stricture, and that occasionally,  though very  rarely,
Stricture seems to be spontaneous   In a  work of rather
a domestic character, like the  present, it would be at least
useless to enter minutely into  the causes of Stricture, yet
is it well to state the fact, because, it is of the greatest
importance to detect, early, its existence,  and, when its
symptoms are  present, it  should be examined  into—
whether  the  person  has been  exposed  to its common
causes or not.

   Now,  the great and by very  far the  commonest cause
of Stricture of the urinary passage is, badly cured Gonor-
rhcea, and Gleet; and  the way in which  it does so  is
this:—Gonorrhcea itself is essentially  an inflammation,
only of a specific kind.   In Chapter i. it was  stated that
Gonorrhoea began at the orifice of the  urinary passage,
and that if not promptly  and properly  cured, it reached
the other end and there became fixed, obstinate,  giving
rise to great difficulty of cure  and permanent  Gleet, i. e.,
it passes from the acute to the chronic stage of inflamma- 
taerk  But, it is well known  that the ultimate tendency
of inflammation of any kind is to thicken, to indurate the
organ or tissue which may happen to be the seat of it—
and the specific inflammation of Gonorrhcea has this ten-
dency to a degree perhaps greater than any other—hence
its proneness  to give rise to this  disease,  Stricture.   I
think I should be  safe  in saying that ninty-five out  of
every hundred are from this  cause.   The next  cause in
frequency is Masturbation or Self-pollution*—this would
perhaps account for four  out of the remaining five;—the
other one being from one of the rarer and peculiar causes

                          §2.
              The Symptoms of Stricture.

   The symptoms which denote the existence of a Stricture
should be considered with respect to those which attend
its  early,  and those which attend  its  more established
stage, and the more, as it is an unquestionable fact, that
Stricture may exist  in a mild and dormant form, and for
a long time, and the sufferer be not  in the least aware of
it.  On this account also  it is desirable to be more parti-
cular and plain in pointing out the  early symptoms of  a
Stricture, not only because it is in the early stage that its
cure is so easily accomplished, but because  in this early
stage the symptoms are vague and far from  directing at-

  * The local disease produced by  this   h-r-.ver occupying much about the
banefuf practice Is sometimes actual   sa.,e spot, have some  -7»>Pt<»»»
Stricture, but much mors  commonly   common. (See Chapter xi    Mai-
it differs considerable from it; both   turbetionj- 
tention to the real seat of disease—the urinary passage—
and without this knowledge and the proper plan it leads
to, all the medicine in the world (and very much is often
taken) would never cure it.

  Now, it was stated that a badly treated Gonorrhoea, or
a Gleet,  was by far the  commonest cause of Stricture.
When therefore a  person comes to me with a Gonorrhoea
that has  continued an unusual length of time—several
months, for instance—and especially if he has had a for-
mer Gonorrhcea, I consider the length of time alone a suf-
ficient reason to suspect the possibility of a Stricture, and
it becomes my duty to assertain for fact, whether it be so
or not; and here it should be observed that the symptoms
presently  to be enumerated go no further than to afford a
sufficient  reason to suspect a  Stricture.  They do not
prove that a Stricture really exists:  the positive existence
of a Stricture, especially in this early stage, can only  be
ascertained by examining the passage  with  the  Bougie,
which is a very easy and simple thing to do, as will pre-
sently be seen.  Nothing can better show the  difference
between  the common advertising knave and nostrum seller
and the good and faithful Physician,  than the  difference
of their conduct in the case of Stricture.  The former will
never trouble you with  the sound  of such a  word, but
will sell you colored drops, or pills,  or  some such thing,
as long as you will take them, and then will leave you in
a state of mental misery; while the latter will put his
questions on the ground  of the possibility  of Stricture, 
and if he should detect the least suspicious circumstance,
he will not rest until he  has ascertained the fact whether
it be so or not.   He will then  explain  the nature of a
Stricture, and show the utter inutility of medicine in such
a case;  and afterwards conduct you to a safe and perfect
cure.  None  but those  who see  it daily  can form the
least idea of the  chagrin and misery that man escapes who
falls into the hands of a good Physician in diseases of this
nature.

   The symptoms about to be described are not compiled
from authors, but from the very numerous cases that have
come under my own observation,  and which are minutely
recorded in my Private Case-book.  1 have  given them
pretty nearly in the order of frequency and importance in
which I have found them.

   Among the  very early symptoms of a Stricture, there
is  one  in  which  great  confidence may be placed.   It
relates  to the manner in which the  Last few  drops  of
urine pass, which is by dribbling away.  This is a symp-
tom of great value in determining any  doubtful  case  of
Stricture,  and deserves a word or two of explanation.—
Now it happens in  the very onset of a Stricture, and be-
fore any possitive narrowness has occured, that a certain
elastic power with which  the passage is endowed, in or-
der to expel the  urine with a jerk, becomes weakened  or
is quite destroyed, so that it can no longer contract upon
these last few drops, °"d the consequence  is they have to 
steal or dribble away after the act is over.  Whenever I
have  reason  to  suspect a Stricture, therefore, I put this
question,—Have you observed, when you have finished
making water and buttoned  up  your clothes, whether a
drop or two of urine passes afterwards,  so as to wet  the
shirt a little ? and if they say they have, my  suspicion is
greatly confirmed.   This is the most universal, as well as
the very first of all the symptoms of a Stricture.  Indeed
a Stricture cannot exist without it. Not that I mean that
this dribbling cannot proceed  from any cause but Stricture,
for it may proceed from weakness of the parts and other
causes; but a Stricture cannot exist without this drop  or
two of urine, and therefore whenever this is not observed
you may  be sure you have no Stridure.

   Another of the early symptoms of  a Stricture is, a
scattering of the stream of urine in making  water, or a
splitting of the stream, or  a  stream smaller than former-
ly ; and if these or any one of these exist, my suspicion
is increased.   But even  though he should have noticed
none  of these, still I am  not  certain he  has no Stricture,
for some of them, especially  a diminished stream of urine
may creep on so slowly  as not to be observed; and until
the stream of urine becomes remarkably diminished a
patient is very apt to overlook it, and  say it flows as usual.
I have had persons tell me this, when,  on examining the
passage, I found a well marked Stricture, and then, re-
flecting on their former way of making water, they have
been  convinced their stream was not  so large as formerly. 
   A certain hesitation in commencing to urinate, although
 the  stream flows  fully and  easily enough when once
 started, may be added.   It is very  common to have this
 hesitating or waiting  longer than natural, then a full
 stream, then again the dribbling away afterwards.

   Another  circumstance  attending the early as well  as
 the later stages of a Stricture, and which in some degree
 or other is almost always  present,  is its effect upon the
 Mind and Spirits, to depress them.—In some individuals
 this effect proceeds so far as to make them hypochondriac,
 and  in almost every one there is some degree or other  of
 it, so that he  is not  so  energetic  in, nor so  capable  of
 business as formerly.   By this depression I do not mean
 that  lowness  and  dejection  of the mind  produced by
 gloomy apprehensions, or the deceitful tricks of adver-
 tising people; these are,  indeed, enough to affect the
 spirits, but  the  depression I refer to  arises from a very
 different cause, and is often present  when there isscarcely
 any other mark of Stricture.   This  effect of Stricture on
 the spirits, arises from the intimate connexion which sub-
 sists between the sexual organs and the mind.  Every
 body is aware of the effect of a single thought of a certain
 nature upon these organs.   Now it happens throughout
 the body that whenever one part has the power to affect
 another, the later also has the power to affect the  former.
 For instance, if a sexual thought,  through  the medium
 of the nervous system, has the power of influencing  the
genital organs, in like  manner a  diseased  condition of 
the genital organs has the  power to influence the mind,
and it is on this striking reciprocity of sympathies that
Stricture in the urinary passage is so wont to depress the
spirits.

   Connected with this symptom, is also a loss of memory.
Patients frequently  complain to me  that,  since their
Slricture commenced they have noticed more or less  de-
fect in the  memory, especially of names; and it is often
surprising  to see  the  rapid improvement of this faculty
that attends the relief of the Stricture.   Sometimes there
is  a diminution of memory but without the depression  of
spirits—often both are together.

   A Diminution  of the Sexual Inclination, or of the
Erectile Power.   This is a symptom which in very many
cases  make its appearance  early.  It is in realty  the
commencement of Impotence;  and though in the early
stage of Stricture it is generally  noticed  in  but a slight
degree, still it is occasionally at this period a prominent
source of complaint.   A curious case  of this kind is at
present under my care.   Mr. ----had a  Gonorrhcea
about four years and a half ago—it was four months be-
fore the discharge was stopped,  and then a slight Gleet,
varying in quantity, but always very little, was left.  He
discovered the existence of Stricture about two years af-
terward, and some months later  being with a female he
had long known, he suddenly,  and in  one night, lost his
erectile power—become impotent, and has so remained 
to the present time.   So  sudden an  attack is certainly
rare, but it does happen occasionally; I have seen seve-
ral  such.   It is very  common however to have it creep
on slowly.

  These then are the circumstances which  denote  the
early stage of Stricture; and  when  it is considered  that
they are circumstances which  do not in themselves natu-
rally suggest the idea of Stricture, and also that Stricture
exists in those who are not at all aware of it, they would
seem to be exceedingly worthy of attention.  To reca-
pitulate therefore it may be stated  that,—Stricture  is a
disease which often exists  in those  who are not  in the
least aware of it, but  there  are  certain circumstances
which should always lead to its suspicion; these circum-
stances are—A slight alteration in the manner of urina-
ting, a drop or two of urine which steals  away after the
act is over, so as to wet the shirt a little—Depression of
Spirits  or of wonted  energy of mind, and failing of
memory, or both—Diminution of the Natural Sexual In-
clination or of the Erectile power.

  There are other symptoms which often attend the early
or about the first and  second stages of Stricture, but
which  are  less constant,  that is,  they will  be  found in
some cases while in others they will not be  complained
of at all.

  Gleet.  In many cases of Stricture there is a discharge
from the urinary passage,  but this  does  not happen in 
every case   This discharge may be only a little more of
that mucous which is natural to the part, or it may be real
pus or matter.  Whatever it is,  however, it varies from
many circumstances of excitement, and is generally very
easily brought on or increased;  a glass or two of spirits.
unusual exercise,  sexual  intercourse, will produce it, and
it more or less easily subsides again. When the discharge
is considerable, it is often taken for a Gonorrhcea,  espe
cially as it may be attended with  burning pain in ma
king water, and chordee,  all of  which is very apt to fol-
low the excitement of sexual intercourse.   This  kind ol
Gleet may attend  all stages of Stricture.  (See Chapter
VII

   Weakness and Pain in  the Back, is very  frequent, and
may be present in any stage.   It  sometimes feels as if
the sensation commenced  in the groin and running round
the hips reached the small of the back.   Not uncommon-
ly this  pain is first  noticed  after lifting  some  heavy
weight, and is then  taken for " a  strain;" the different
plasters,  &c, that are applied, seldom give any relief,
and many, still unconscious of the  existence of Stricture,
at last suppose themself  to be  affected with Gravel or
Kidney-disease.  I am often applied to for such supposed
maladies, the majority proving to be cases of Stricture,
and rapidly relieved by an appropriate treatment, to the
great astonishment of the patient.

   Pain running down the thighs and legs, and sometimes 
 most complained of in  the  soles of the f
 added here.

   An Itching or  Tickling  in  the  Urina
 when urinating, is another rather common symptom.

   A frequent desire to Urinate, with more or less inability
 to hold the urine when the desire  comes on, and often
 obliging the person to  rise  several times in the night.
 This, when it exists to any great degree, is a very annoy-
 ing symptom, and often one of the  most  obstinate and
 difficult to overcome; and unlike most of the others, which
 spontaneously disappear along with the cure of the Stric-
 ture, often requires separate treatment.

   Another effect of Stricture, and one very similar in its
 nature to the depression  of Spirit and of Memory,  is that
 which it produces on the Stomach and Organs of Diges-
 tion, for the same medium which connects  the mind with
 the genital organs, connects it also with the functions of
 the stomach.  Nothing  is more common than to see a
 train of nervous or dyspeptic symptoms which have  re-
 sisted every means of cure, most happily and unexpect-
 edly  disappear on proceeding in the cure of Stricture.—
 These two circumstances therefore—depression of spirits
 and  nervous dyspepsia—may  very properly be  placed
 among the symptoms  which attend  the early stage of
 Stricture.   They are not of course  to be depended  on
alone, apart from other symDtoms,  for it is well known
10 
that they  may arise from  other causes; but in cases
where there is only a mere suspicion of Stricture, it would
be well to consider if either of these where present, for, if
so, it would greatly strengthen that suspicion.

   A Shrinking or Dwindling  of the  Penis, often with
diminished erectile power.  It is not easy to account for
this, but of the fact itself I am  well assured.   It is some-
times,  though  more rarely, quite an early symptom.  I
have had patients  apply  to me whose only object of com-
plaint was this, having  observed no  other until  led to
think more particularly on the subject, and not dreaming
of a Stricture.   On removal of the Stricture, it resumes
its wonted size and firmness.

   But,  so far  I have spoken of Stricture  only in its
early stage—at the time  when  its symptoms are often so
few and give so little inconvenience as to allow its exist-
ence to be overlooked; in its advanced  stage however,
the symptoms  are  very numerous, and some of them most
deeply  interesting.  The interesting  nature of  these
symptoms arises from their remoteness from  the seat of
the disease itself, so that when they  present  themselves,
they are never once  suspected to arise from Stricture,
and, consequently, never  get  relieved.   Many serious
diseases, which, from their having proved unyielding
under a variety of modes of treatment, have been thought
incurable, have been  so because  they  have arisen from
Stricture, which was never thought of. 
   Week or sore Eyes.—A few months ago a captain of
a merchant vessel from Havana came to me with a re-
cent Gonorrhoea;  but who, in a little  while, I perceived
had got a Stricture also  from a former Gonorrhoea.   Of
course I soon attacked the Stricture, but, as  the cure of
this proceeded he told me, with the greatest pleasure and
surprise, that  his eyes were better.  Now this was the
first time he had spoken of his eyes, though I had noticed
they were very red and irritable.  He then told me that
his eyes had been bad for years,—that he almost always
wore  a shade, and that they were  frequently so bad at sea
that he could not open them at all in common day-light.
This, therefore,  wras a case of Ophthalmia from a Stric-
ture which had given him so little inconvenience, until
a  fresh  attack  of  Gonorrhcea  occured,   that it was
never  once suspected.  By the time the Stricture was
cured the eyes got entirely well, and I believe will never
trouble him again.  But this is nothing new in the treat-
ment  of Stricture; nothing is so common as to see com-
plaints which  had resisted  every  former mode of cure,
particularly diseases of a dyspeptic nature, entirely disap-
pear on the cure of Stricture.   The  symptoms denoting
confirmed and long-standing cases, therefore, indeed every
thing  relating to this subject, is deeply interesting.  Sim-
ilar cases have frequently occured to me.
  Sores about the head of the penis and foreskin,  much
resembling  Venereal  and  frequently  mistaken for  it,
(see ChaD. xx  ), are also among the symptoms of a  Stric- 
ture.  The late Mr. Abernethy, in his  work on Syphilis,
has admirable shown this fact.  To what he has stated I
can also  add my testimony, for instances have occurred to
me in which these  sores  have proved unyielding under
many surgeons and different modes  of treatment, but
which have got well  immediately on treating  them ac-
cordingly.

   Sores and other affections of the throat are  sometimes
symptoms of Stricture; they occur on the same principle,
viz: the sympathy existing between the organs of gene-
ration and the throat,—so that disorder in one  will  pro-
duce disorder in the other.  Many curious facts might be
stated on this subject, but, as I  observed, being rather
curious than of practical importance, I will state them in
a Note.

   Hypochondria.—There are many remote diseases which
arise from Stricture, in  consequence of the sympathies
which  exist   between  the sexual  organs,  and  distant
parts of the body.   In other words, a Stricture in the  urin-
         NOTE                 upon the lips and chin.—Young wo
                               men  who have beards are generally
  The sympathies between the organs   less prolific than those who have none-
of generation and the throat in both   Bingham mentions a case which camt«
sexes are very striking. Not only is the   under his own knowledge of a young
beard upon the chin prevented if the   lady  who had a beard, but lost  it aftek
testicles are removed before the age of   her marriage.  All this shows  the w-
puberty, but also the developement of   timate connection which exists be-
the throat is hindered, so that the voice   tween these distant organs and ac-
fails to attain the deep and tenor tone   counts for many morbid actions oc-
ofmen It is a curious fact, that when   curing in the  throat  simply from
the corresponding organ of the female   spmpathizing with  a  Stricture. Set
is removed, (as the ovaria in spaded   Chap, yi in which will be found some
animals), the voice becomes deep and   interesting and important remarks on
rough in women, and hair shoots out   this subject. 
ary passage is  capable of disturbing the stomach, and
through this medium, of inducing other and remote com-
plaints, all of which therefore are correctly placed among
the symptoms of Stricture.   These complaints are chiefly
of a nervous character, as head-ache, low spirits, diminu-
tion of wonted  clearness of mind,  and other hypochon-
driacal feelings; and so evidently  are these the effect of
Stricture, that they cease as its cure proceeds, while they
resist every measure short of this.

   The hypochondriacal state of mind resulting from Stric-
ture of the urinary passage sometimes exists to such a de-
gree as to become truly distressing and serious.   There is
no doubt in my  mind that many suicides, happening when
the circumstances and  other relations of the individual
cannot in any way account for the act, are in reality the
consequence of the severe mental depression which some-
times attends Stricture.   In these cases I believe the suf-
ferer is generally ignorant of the existence of such a cause
of his misery—a knowledge of it would have saved him,
for with the knowledge would have come at least a hope
of relief, if not of cure:  but unfortunately again the false
delicacy existing on the subject of diseases of the generative
organs tends to operate very unfavorably on some minds.
A gentleman whom I cured of Stricture  a fewT years ago,
and who was at the time a professor at West Point, as-
sured me that he had twice been  down  to  the  water at
night to drown himself, but happily returned without
doing so, from irresolution,—he had a very bad Stricture
•    10 
Another patient, young, and having a Stricture scarcely
advanced to the second stage, carried arsenic in his pocket
for some time with the view of destroying  himself;—he
was in an excellent and prospering business. Many have
declared to me that their failure in business had been
attributable to the effect of Stricture on their mind  and
energy.   I might give a long list of the like.

   Another symptom I will mention is a hardness and dis-
eased condition of the testicle from  Stricture.   This in-
deed may arise from other things than'Stricture, but when
it thus arises, and  this I often find to be the case, it never
can be cured but by the removal of the Stricture.

   As I have said before, a contracted stream of urine, more
or less,  always attends a Stricture, but this creeps on so
gradually, and with so little  disturbance, that  it often
quite escapes the notice of the patient.  But, as the nar-
rowness of the Strictured part increases, that is, as the
Stricture grows worse,  this  alteration  or  contraction
draws attention, for it becomes very small, or divides  into
two, or  sprinkles  on the ground, and in very bad cases
it passes only drop by drop, and that  not  without some
straining.  Sometimes it is necessary to make a great ef-
fort  at  the  beginning, and afterwards it will flow in a
tolerable stream;  at other  times the  desire comes on so
quickly that you cannot retain the urine for  a moment.
This  is  when the bladder  participates  in the disease. 
The bladder is always more or less disposed to this par-
ticipation, so that many patients are obliged to get up
in the night to urinate, and this generally increases with
the Stricture.

   Mr. Bingham, of London, a very sensible writer, has-
exceedingly well enumerated  the various sensations  and
other  symptoms which may occur  in Stricture.  I shall
transcribe from his work the most important, leaving out
however all technical words.   Nothing, correctly detail-
ed, can be uninteresting to one afflicted with Stricture.

   Mr. Bingham observes—" Various kinds of sensations
also, are produced  in different degrees, by Stricture in
the urinary passage; as an itching of the penis or  the
parts  about, and a fluttering  or pulsating sensation in
some  parts of the  passage;  numness of the thighs is
another  symptom; as are also a  smarting or burning
pain in the head of the penis,  and darting pains shooting
to and fro from the fundament to this part, or up to  the
back  and loins; pain in the hip, down the thighs and on
the inside of the knees, frequently occurs from  Stricture
in the urinary passage, and pain has also been known in
the sole of the foot from the same cause."

   Again he observes—" Sexual intercourse is apt to ag-
gravate the symptoms of Stricture  whatever they are.—
Sometimes this act is attended with pain and inability to 
emit the seminal fluid; at other times only part of it
passes, and the remainder "steals away when the erection
has  ceased.   Retention of urine has many times been
brought on by sexual  connexion in  patients troubled
with Stricture."

   " The penis is  variously affected by Stricture.   Some-
times the erections are excessively frequent and trouble-
some,  and these may or may not be  accompanied with
seminal emissions,  during sleep; at other times the erec-
tions are  weak and inefficient, and, occasionally, alto-
gether wanting."

   " Sometimes swelling of one or more of the glands in
the groin, and enlargement of the testicle, indicates the
existence of Stricture in the urinary  passage: and, ano-
ther symptom is,  hardness to be felt  externally in the sit-
uation of the Stricture.  Inflammation and a gathering
in that part between the anus and the testicles,  are also
symptoms of the disease."

   " It has been stated upon high authority, that strictured
patients cannot comfortably cross their legs; but  when-
ever I have had an opportunity to notice this, there has
been, besides the Stricture, disease of  the prostate gland,"
(a hardish body situated at the entrance of the bladder,
just  where the urinary passage begins, and which is ex-
ceedingly  liable to enlargement in elderly people), " or
inflammation about this part." 
§3.
            The Consequences of Stricture.

  The consequences of a Stricture are truly  lamentable,
not only being distressing to  endure, but  some of them
totally incurable—admitting only of relief.  I speak how-
ever now of old bad cases, such as have been suffered to
run on for years, or  badly  treated.  Besides  those sym-
pathetic disorders which were  noticed in speaking  of
the symptoms  of  a Stricture,  there  are  consequences
which are more immediately connected with it, and these
I next propose to state.

  One of the first of its consequences is, the effect which
straining has upon the bladder.   The more resistance the
Stricture offers to the flow of urine, of course the more
exertion must the bladder make.   This  leads to a thick-
ening of its coats (see plate    ), and to other conditions of
it which make it irritable and  capable of retaining but a
very little urine, so that the calls are frequent and press-
ing,  disturbing sleep  and rest.   From the same cause
also the kidneys are  very apt to  be diseased.

  The next effect of so much straining is produced upon
the passage itself, just  behind the structured part.   The
force  of the urine,  as may easily be imagined, dilates
the  canal and forms a pouch  or  bag, (see plate  4),  in 
which a portion of the urine lodges.  But this, whicn al-
ways happen, more or less, may lead to lamentable con-
sequences.  In the first place it may  render the  passing
of the Bougie impossible; for when the pouch is large,
the orifice leading out of it may not  correspond  exactly
with that leading into it, so that the Bougie  may easily
pass in, but not pass out or through it.  And in the next,
the urine  lodging here,  is very  apt to irritate and produce
disease.   Disease  arising from this cause is of the most
distressing and permanent kind; matter forms in the sub-
jacent structures and  makes its way out, both by opening
into the passage, and also by opening externally, ulcera-
ting through  the  parts between  the thighs.   But the
worst is, the passage  it  thus makes will  not  heal.  It is
difficult and sometimes quite impossible  to prevent the
urine passing through it.   This is what is called a sinus,
or fistula in perinceo,  (plate 4).  I scarcely know a more
disagreeable and inconvenient thing than a sinus in these
parts,—the person is  obliged to squat down in making
water  to  do it  comfortably.  But, to  form  a true and
clear conception of this malady, (and every one  should
do so, in order to avoid that class  of people who produce
it), it is necessary to see it in a plate, and with this view
I have selected the one on the  following page, from one
of the best and latest authors on  the subject,  and from
this it will be  correctly judged how serious a thing it is
to neglect a Stricture.  Indeed, so true is this that a very
eminent writer on this subject,  Sir Everard Home, Sur- 
geon to the late King of England,  in  his third volume,
has a  chapter  upon—Diseases of an incurable nature,
the consequences of a long continued Stricture, before the
proper means of removing it had been  adopted.

   Among the consequences of Stricture also may be no-
ticed, a shrinking and dwindling of the penis, with but
little erectile power, but to a much greater and more se-
rious extent than that mentioned before;  as in the slighter
degree, however, the removal of the Stricture restores its
natural state.

   A similar state of wasting of the testicles is also a con-
sequence of Stricture.

   Impotence  is  another,  and the last to  notice.   This
may occur with  or without the loss of sexual inclination.
There  are two  ways in  which a  Stricture may be the
cause of impotence:—the one mechanical, the other func-
tional.  In the  first, the function of the testicles is per-
formed, but the fluid is impeded in its passage, or its im-
petus so broken  as to fail in accomplishing  its destined
purpose.  In the second, the function of the testes seems
to be disordered, so as to  have lost its essential and vivi-
fying principle.   This is no  difficult  thing to imagine,
when the nervous structure of these organs, and the ex-
quisite sympathies depending on them, are considered.—
And, further, this opinion is supported by the fact of so
many strictured persons having no  children. 
EXPLANATION ON  PLATE VI.
  A,—A section of a bone.
  B,—A part of the penis.
  C,—The scrotum.
  D,—The testicle.
  E,—The  urinary passage.
  F,—The bladder, much thickened in consequence of
straining to make water.
  G,—The lower intestine.
  H,—The Strictured part of the  urinary passage,  the
source of all the disorders of the other parts.
  I,—The ulceration behind the Stricture, from whence
the urine has been discharged into  the sinuses or ulcera-
ted  passages running between the thighs and scrotum.
  K,—The urinary passage and neck of the bladder dila-
ted, (forming a pouch) behind the Stricture.
  L, L, L,—The several openings through which  the
matter and urine have continually flowed. 
PLATE VI.
11 
   These then are the consequences of Stricture, and when
to them is added those sympathetic affections which were
arranged among its symptoms, together with the expense,
and suffering, and keen reflection which is naturally con-
nected with this disorder, it will be seen with what pro-
priety it is urged on every one to be careful as to whose
care  he  intrusts  the cure  of Gonorrhoea.  All  these
consequences  are perfectly unnecessary, and would be
avoided if the same good sense  were exercised in select-
ing a proper person in this complaint as would  be done
in any other.

   But Stricture is a curable disease, and very especially
so in its first stage, and fortunately again, with many, this
first stage continues for a length of time.  It is fortunate
also that its principle of cure is simple, easy and certain.
It requires only to be acquainted with  this, as given in
the fifth section of this Chapter, and at the same time to
be furnished with these simple means, in order to enable
any one to undertake the cure himself with perfect satis-
faction and success.

                         §4-
             The Remedies for  Stricture.

  First, let it be remenbered, no  medicine in the world
will ever cure a Stricture.

  Medicine certainly is given, but it is with the  view of
removing  any other complaint or impediment to the cure. 
It has been stated and explained that Stricture of the uri-
nary passage is capable of materially disturbing the func-
tions of the stomach; a knowledge of this fact is of great
importance in the treatment of Strictures, for, as a Stric-
ture in the urinary  passage has so much influence  on the
stomach, in like manner the Stomach influences the Stric-
ture.   Now,  we can at all times prescribe for these dis-
turbances, and hence  the cure of Stricture  is  so  much
expedited  by attending  to the stomach throughout its
treatment. My own practice verifies this statement daily.
Medicine, therefore, if given, is only for the  purpose of
restoring or  improving  the general health,—not for the
cure of the Stricture.

  The Bougie is that without which you cannot cure the
disease.   Nor is this at all to be regretted, for it is  a sim-
ple, safe,  easy and certain way of curing it.

  Bougies  are made  6f different materials; two  kinds
only however, are fit for use: these are the Wax and the
Elastic*   The  Wax  Bougies are  not so  smooth  and
pleasant to use as the Elastic, but they  have the advan-
tage,  sometimes  very useful  when  there  is any par-
ticular difficulty,  of retaining the shape into  which they
 * Bougies are also made of metals and
different kinds of compositions—even
of Iron, of Catgut, prepared Ivory,
8cc. &c. Some are more fanciful than
useful, and as to metal Bougies  of all
kinds, I do not hesitate to condemn
them altogether; for private use they
are highly improper, and every modern
Surgeon who has much experience in
this department soon renounces them,
finding all can be affected by the wax
and the elastic Bougie far better, easi-
er and safer, and always with less in-
convenience and pain to the patient.
All the modern continental authors on
Stricture, and there are many, are of
this opinion. I have not myself, with
a very extensive practice in this dis-
ease, used a metal Bougie for severs.
years. 
may be bent;—they are not very fit for private use. The
Elastic Bougies  are generally to be preferred, they are
more polished and easier to the patient, and, if always
curved one way, they retain the shape sufficiently well;
they are also, when warm, so pliable as easily to accom-
modate themselves to  the natural curve of the passage.

   Bougies, both Wax and Elastic, are either Cylindrical
or Conic, as here represented.
                   A Cylindrical Bougie.
   ft                                           -----»

   fil.             '                               "»
                     A Conic Bougif.
   The Cylindrical Bougies are fitter for  Stricture in  its
earlier stages,—the  Conic for  more  advanced  cases,
where absolute contraction or narrowness has commenc-
ed;  though  either may  be employed in  either case.  Of
course,in the third stage (see plate in, figure 3) Conic
Bougies are very preferable.

   Bougies are made straight, but when they are to be
used, are bent into a certain form.   This is  easily  done
by warming a little either before the fire or in the hand.
The following represents the curve a Bougie should have.
It is of the greatest consequence to give it this shape.
     Tht proper curve or shape to be given to a Bougie for using. 
    The manner of using or introducing a Bougie.
                   (See Plate VII).
  We will suppose it the first time of using a bougie,—
the object being to ascertain for fact whether there really
be a Stricture or not.   You select an Elastic  Bougie of
medium size, and holding it in the hand or before the fire,
you warm it a little, so as to  give it the curve just repre-
sented without  cracking  its polished surface.  In giving
it the proper curve you will find from its elastic property
that it will become straight  again.   Do not  mind this,
for, having given it the curve while warm, it  will more
easily assume it when it meets  with the corresponding
curve of the passage ; (it is  an  excellent plan to put it
away while  warm in such  a position as to keep  this
curved  form  till  used again).  You next rub on it  a
little sweet oil or lard, and then  proceed to introduce it.
Take the  penis, at its sides, behind the head, between
the thumb and  finger of  the left hand, and stretch it for-
ward a  little, rather pointing upwards,  but very little.
Then with the Bougie between  the thumb and fingers of
the right hand, and with the curved end pointing upward,
introduce  it at the orifice, and pass it steadily  on with a
gentle  and continued pressure till it reaches the bladder,
which can be easily told by a peculiar sensation and the
ceasing of any feeling of  resistance.  Take particular care
to keep the Bougie in the same  position as at first,  that
is, with its point directed upward, for if the point were to
turn to the side, or especially  downward, it would not
*    11 
EXPLANATION OF PLATE VII.
Showing the manner of introducing a Bougie  into the
  Bladder.

  A,—The Bladder, which, it will  be seen, is situated
higher up into the body than the urinary passage.
  B,—The  internal orifice of the urinary passage turning
upward to reach the bladder.
  C C C,—The  lower C represents the external orifice
of the passage, in its common or natural position, and in
this state the urinary passage is seen to have a double
curve, like the letter i/l  reversed.   The upper C shows
the passage, the penis being held out and  upward  from
the body.   The  middle C supposes the penis to be held
out  and  a little  downward,  which position brings the
urinary passage as nearly as possible to a straight line—
the curve being much reduced.  In introducing a Bougie
it should be held  in this position as soon as  the instru-
ment is about two-thirds  of the way in, i. e., as its point
reaches the commencement of the curved portion of the
passage.
   D D,—Shows the Bougie in the  first and second of
these positions, in introducing it. 
PLATE VII.
 
pass at all.   But suppose you pass it smoothly and easily
down a certain distance, and then  it suddenly stops; in
this case you  are to withdraw the instrument about  an
inch, then lower the outer end and the penis together so
as to tilt the point still  more upward,  and  resume  your
attempt to pass it on, at the same time stretching out the
penis more, as it were pulling it over the Bougie.   Pro-
ceeding in this way the Bougie will, if there is no obstruc-
tion, pretty easily enter the bladder.
The manner of Detecting a  Stricture in its Early Stage.
   Now, I  have before said that  Stricture, in its early
stage, offers little or no resistance to the passage of  an
instrument;—how then is its existence to be discovered ?
It is in the following way:  Bring to mind the nature of
Stricture  in its early  stage,  you will recollect it consists
in a tumefied or swollen spot, very sensitive or even pain-
ful to the contract of an instrument, giving the idea of a
sore being touched.   But, in a healthy state of the urin-
ary  passage, such a sore spot never exists;  the neck of
the bladder, indeed, is very sensitive, but the sensation is
altogether different; you feel, when the instrument touches
the neck of the bladder—that is, as it enters the bladder
itself—as if you must urinate,—it  feels difficult for the
moment to hold the urine; and which is also a great dis-
tinguishing mark, it is from  seven  to nine  inches up the
passage,—whereas, the tender Stricture-spot is between
four and six inches up, very seldom beyond six, and I be-
lieve almost never beyond six and a half inches.   This 
statement may be relied on,—it is founded upon  a gneat
number of cases minutely recorded in my Case-Book.
Remember the subject is Stricture.*

  Now, having proceeded with  the introduction of the
Bougie  as described in the preceding page, if the early
stage of Stricture exists, when the instrument  comes to
this  point it will give so positive  a sensation or sorish
feeling as often to lead you to believe it cannot be passed;
this however is imaginary,—hold the instrument steadily
there for a moment, the spot will become accustomed a
little to the touch, and the Bougie will pass through.   Of
course this tenderness varies in degree in different indi-
viduals  and in different conditions of health; it is always
however, sufficiently decided to determine  the question.
A medium size Cylindrical and quite blunt Bougie must
be employed,—a very small one  would be improper for
such an examination.

  In the Dilatable Stage:—The Stricture may however
have passed this early stage, being perhaps in the next or
dilatable condition. We will suppose,then, that the Bougie
has passed quite easily down a certain distance, and then
is suddenly stopped, and you find that even by managing
as was before directed, it will not pass on; you then hold
it steadily to  the  part,  gradually, and to a limited  and
reasonable extent increasing your pressure.  This is the
  * When  this soreness is further in,   (neck of the bladder) or the diseased
it generally indicates either a degree of  state of the (Seminal organs peculiar to
inflammation of the Prostrate Gland  masturbation. 
strictured part, and if it be dilatable, the Bougie will pre-
sently pass through, and you will have accomplished the
first step towards its  cure.  There is seldom more than
one Stricture whilst the  disease is in this stage, and this
one, as  was before said, is generally situated at between
four or  six inches from the external orifice of the passage.
If there is another, it  will generally be only  an inch or
two in,  and would therefore  be met with first.   Thus
w hen you detect a Stricture very near the orifice, you may
reasonably expect to  find  another further  down, but not
always.

   In the Advanced  or   Callous  Stage.—But  suppose
you come to a Stricture, and, after perhaps a second trial,
you find you cannot pass  it.   In this case then you are
to withdraw that Bougie  and try  a smaller  one,  exact-
ly  as before;  (remember a medium  was  recommended
to  begin with)  and  if this will  not pass then  take a
smaller still.  But it  may happen that the smallest will
not succeed.   Indeed the part may be  so irritated by
these frequent attempts, that  it will not pass on the first
trial at  all.   I have  frequently succeeded well  at the
second  when I have failed at  the first.  In general there
is but little or no pain in passing a Bougie, and the de-
gree of force is so limited that there would be none felt
on that account;  except the  Stricture be in what is called
an irritable state, which is known by its giving pain im-
mediately on touching it, and then it should be postponed
until this has  been relieved.   What I mean is, you must 
not give much pain by the mere force of pressure. Nei-
ther should you go on with an attempt at any time if it is
disposed to bleed.   A drop or two of blood is of no con-
sequence ; the part is so delicate and vascular that a drop
may appear  on a slight occasion;  but, if there is more
than a few drops,  this should  induce you to lay aside
the attempt for the present.  In some cases you may not
be able to pass the smallest size till after various attempts
made at intervals of several days; this however but  sel-
dom happens; when it does, you must  pay  attention to
your state of health and habits.   Particularly must  you
pay attention to the state of your stomach and  bowels.
Take a moderate dose of the Purgative Diuretic  Pills
from the case, or any other in note 1,   avoid a stimula-
ting or full diet, and rest as much as possible.  A warm.
bath too is very advisable, but if this cannot be had, bathe
the parts well with hot  water and a large sponge every
night, or night and morning.   These directions however
will seldom be required, still it is necessary to give them.

  As to Stricture at or near the orifice  or entrance of the
passage—this is known at once  when  a Bougie is found
to enter or pass tightly, and yet does not completely fill
up the lips or orifice of the passage.

  Injections.—Although it is not at all generally under-
rtood,  Injections, even  where  there is no Gleet  or Dis-
charge, are useful  in the treatment of this  complaint; 
their effect upon the Stricture is peculiar and excellent, and
is  exerted through the medium  of the delicate skin lining
the urinary passage, and  by the  condition of  which  the
Stricture itself is greatly influenced.  But two kinds, as far
as I have discovered, are efficient, viz: the White Vitriol
and the Nitrate of Silver in very diluted form.

                          §5.
                The Cure of Stricture.
   The  cure of Stricture  can be accomplished only by the
use of the Bougie.  Medicine occasionally assists,  but the
Bougie is that without which you cannot cure the disease
   Success,  in  the treatment of Stricture,  depends in  an
uncommon manner on the proper management of the means
employed.
   The ultimate object in  using the  Bougie is to pass one
into the bladder of such a size (whatever size that may be)
as about fills up the capacity of the  urinary  passage, with-
out stretching or giving pain  at  its  external orifice :* that
is, supposing the orifice to be healthy—that there is no dis-
ease or Stricture just within it.
   When  there  is Stricture at the  orifice, a Bougie that
evidently does not fill the  entrance or lips, is  still more  or
less tight and  painful.*
   It is usually necessary to  commence the  treatment with
a Bougie several sizes smaller than the  one  with which you
end it, and to reach a full size gradually.
   There  is naturally a great difference in the  size or ca-
pacity of the urinary passage, amounting to at least double
from the smaller to the larger. 
   The following are the ordinary natural dimensions of the

passage, as measured at the  orifice  * the middle one may

be taken as the average:





            ooooo


Sometimes it is found smaller or larger.   The  measure of

the size of  the passage is taken  at the  orifice or entrance,

because  here  and just  before  it ends in the bladder  the

passage is smaller than anywhere else ; and,  therefore, what

will enter  easily ought to pass all the way.

   An  occasional  warm bath  is very useful.   Diet should

be ordinary and  moderate, strictly avoiding all  alcoholic.

beverages.

  * Sometimes the external orifice of the urinary passage is exceedingly
large—in which case there will usually be found another ring or circle a
very little way inward, which is the true measure.
  Note.—Every part and structure of the body is endowed with its  own
peculiar power of action; also, every part is endowed with a restoring
power, the activity of which is aroused by every deviation  from the na-
tural and healthy condition of a part.  This is no fiction.  Indeed, every
restoration from disease to health  is  an illustration as  well as a proof of
such a principle.  Numerous as are the laws which regulate and maintain
the healthy actions of the body, these are not more numerous and impor-
tant than those which influence and control its morbid actions.  A Stric-
ture is essentially a morbid action—a deviation from the healthy and na-
tural condition of a part; it has lost is natural elasticity, and if that morbid
action which destroyed this elasticity could be removed, the principle I
allude to would instantly restore it.
  Now the Bougie does this.   The  pressure and excitement of the Bougie
upon this delicate structure breaks  up and destroys  this  morbid action
and the healthy one  immediately  succeeds—the natural elasticity of the
passage is restored.
  On the ?ame principle  also are the  confirmed and callous  Strictures
cured.   Every part of the body is endowed with the principle of absorp-
tion.  The Bougie, in this case, aided by another powerful remedy, not only
destroys the morbid action essential  to  the  Stricture,  but powerfully ex-
cites the action of  tho absorbent vessels, which is the means  of removing
that callosity. Indsed the  cure of  Stricture  is effected by the Bougie
on the same general principle on which  every other disease is cured—it
interrupts or destroys a morbid action, when a healthy one succeeds.
12 
   The Treatment of Stricture at the orifice is conducted
in the same way as when seated further inward, with this
little difference,—it is only necessary to pass the  Bougie
in an inch or two, or a little beyond the ih-ea-ed  spot,—
it will  more frequently  bear  the  use of the instrument
every day without bringing on an  initation;  it is likely
to be rather  slower in its cure.  There is so very  com-
monly a Stricture at the  other end also when there is one
at the orifice,  that, even where it is not  evidently the
fact, it would be wise occasionally during its treatment,
to pass the Bougie all the way into the bladder.

   We sometimes hear of Spasmodic Stricture.   On this
subject much misconception has existed.   It may be ad-
vantageous  however to  know that the muscular fibres
around the mouth of the bladder,  designed  to retain the
urine, and also those fibres a few inches up the passage,
designed to throw  out  the urine  with a  jerk, are both
under  the  influence of  a  Stricture, and   when  this is
rendered irritable by any cause, the action of these mus-
cular fibres is quickly disordered.   It is in this way that
spasm in these muscles is so oftt n  brought on in  persons
after drinking,—the excitement of wine  and company
having  made  the  Stricture irritable.   In this state per-
haps he goes out of the  room to make water, but finds
he cannot make a drop.   The fact is, the moment a drop
of urine^touches the irritable strictured part, the musdes, 
of the mouth of the  bladder are thrown  into a state of
spasm which prevents the urine passing.   Neither can
you always draw it off, in this case, by the  catheter or
hollow Bougie.   The best plan is to foment with warm
water and take an opiate.   If  this will not do, bleeding
aud the warm bath must be superadded.  So also, in pass-
ing a Bougie, if the  Stricture has been rendered irritable
by any such cause, the moment it presses on it, these mus-
cles .we thrown into spasmodic  action which hinders its
passing through.   In this case keep  the  Bougie  gently
pressing against the  Stricture for some few minutes,—it
will  frequently succeed  by  this means,—if not,  desist,
and  give  an opiate, &c, as before directed.  In some
hours afterwards perhaps you may pass it easily.

   But there is another state  of  things  for which the
Bougie is a remedy, beside a Stricture, and that is, a sim-
ple st de of tenderness (without Stricture) extending along
half or a quarter of the passage, and toward either end or
portion  of it.   Being  led to examine the passage from
symptoms warranting the  suspicion of a Stricture, it is
found that the Bougie  passes perfectly well, so far as ob-
stiuction is concerned, but, that along a certain distance a
great degree of pain is felt.  This disorder is different from
a Stricture, inasmuch as it consists  merely in a diseased
or increased degree of insensibility, but it is to be treated
exactly as though it were a  Stricture.  Pass the Bougie,
a medium, or above a medium size, every day, or every
other day, as the degree of irritation will admit, and keep 
the bowels and digestive organs in a regulated and healthy
state.   The effect of this treatment,  very generally, is to
lessen and ultimately remove this morbid sensibility.  If
therefore, on every time of passing it, you find the pain
and tenderness  become less and  less, you may depend
upon a  perfect cure, as well  as the cessation of every
symptom  which originated from it.

   The Treatment of Stricture in the more advanced Stages
is as before said, totally unfit for private hands. When,
however,  a person laboring under this cannot procure pro-
per assistance, it is encouraging to know how he may very
much relieve his condition, and  to a considerable degree
open the passage; generally, at  least.  The  means of
doing this are,—great attention to the state of the bowels,
especially with reference to their free and easy action,—
the use  of cooling drinks when irritation is present  ro of
Soda,  the use of the injection  for Stricture, sometimes
adding to  it (if that composed of Zinc is used) one drachm
of Laudanum.—and the use of small Bougies, conic, when
such can be obtained.   It may be very difficult to get even
the point of the smallest Bougie to  enter the contracted
spot; when this is the case and even a partial entrance has
been secured, the Bougie should be allowed to  remain in
for some time, half an hour or an hour.   A great deal of
tact and  management  is  often  required,  but always in
such  cases, keep in view as  the  most important of all
advice,  never to irritate—to do too much at the time. 
  On the application of Caustic to the cure of Stricture
little or nothing has been said in this volume, because,
in a work of this nature such treatment only should be
given as is safe and practicable for domestic or private
us'e.   And again, it requires particular and expensive in-
struments, which, even if the patient could obtain, he
could  not use.  I ought also to add here, that great mis-
apprehension exists with regard to Cauterization; it is
by no means, as now employed, the dangerous and pain-
ful operation that every one supposes, but quite the con-
trary.

  Another operation required  in some old and  indurated
cases, is Scarification.  The  operation is one of great
nicety in its  performance, but is attended with very little
pain, and, in experienced hands, no danger.
•    12 
PART   THE   SECOND.
                 CHAPTER X

On Masturbation,—called also  Onanism,  Self-Pollu-
  tion, #c.
  The power or influence exerted by the Generative Or-
gans over the body, its different organs, tissues, and even
the moral and intellectual faculties, is immense, it is ab-
solute, and to those who have  never  studied the subject,
might seem at first almost incredible  And this influence
is exerted from the first moments of life to its decline;—in
this place, however, we shall consider it only in youth,
i. e., from  infancy up to the period  of puberty, during
which time these parts are in a state of inactivity or repose,
seeming to slumber, or, to common observation, as serving
no other purpose than a mere  passage for the urine.

   In the following pages of this Chapter I am much in-
debted to a very celebrated French author,* whose excel-
lent mode of illustrating this subject  I have adopted.
 * M. Deslandes. De l'Onanisme, et  dans leurs rapports avec la Santt.—
des autres abus veneriens, considered  Paris 
  Masturbation, is an abuse of the parts which serve to
execute the sexual act,—the Genital Organs.  These are,
thus, placed in such a condition that they become to the
rest of the body, a source of disorder of deterioration, of
disease.  But, what is their power in this respect?  Placed
in a condition to injure, how greatly can they do so?

  The injury which the genital organs may  inflict  upon
the rest of the  body when they  are  abused, i. e., when
subjected to Masturbation or any other improper use or
excess, is the natural consequence of the influence they
exercise  when not abused.   The injury is in a direct ratio
with the influence; it  is, therefore, by this rule that the
injury  should be calculated.   It is plain, indeed, that  if
the various organs of the body possess, in their ordinary,
natural,  and healthy state, different degrees of influence,
they must, when they  become  injurious  from disease or
abuse, be so in different degrees.  Let us then endeavor
to arrive at that which the generative organs possess.  If
it is proved that when they are in a state of inactivity 01
repose, that is from birth up to puberty,  Iheir influence is
great, the question of what it may become When they are
in a condition of abuse, can be judged.

   One might believe that these organs,—when they are
in this state, when neither used or abused, when the sex-
ual power sleeps, when they appear to be occupied only in
themselves, in their own growth,—were taking no part or
but a  very feeble  one in what  passed on around them in 
the other organs and tissues of the body:  we  should be
much deceived.   We shall see that this apparently inac-
tive life which animates them, already suffices to make
them a powerful focus of action; that all the other organs,
all, owe to them a part of their mode of being, of their
form, of their  substance.   From this we shall be able to
judge of the generative organs when aroused,—when, by
the hand or otherwise, their action is carried to the very
highest degree to which it can attain:—look at the eunuch
from  infancy, the man who never has  had any genital
organs, whose body, mind  and soul  has been  developed
without feeling their influence.  Seek, in comparing him
with other men, wherein he is wanting; for in his physical,
intellectual and moral aspects, he ought to  be wanting in
all  that these organs would have afforded.  This study
will reveal to you their influence, in showing you the dif-
ference between the man over whose growth they have
presided and the one who has grown up without them.

  Eunuchs are never tall; often they are even small, and
sometimes very small.  Their  limbs, when  they  are not
swollen by the weaker fluids of the body,  are generally
thin and badly formed.  Their bones neither acquire the
ordinary length or form.   This defective growth is even
still more remarkable in the throat.   That  organ which,
at puberty, commonly acquires two thirds of its size, re-
mains as in childhood; thus the voice retains, in eunuchs,
that sharp tone that it  has in childhood, and if it gains a
little more strength, it is only from the increased size of 
the chest.  Not  only are the various parts of the body
checked in their growth, but some of them are not formed
at all.   Thus in eunuchs there is no beard, no hair about
the sexual organs,—the skin remains naked as in infancy.
The genital organs then interpose a powerful influence
over the nutrition of the body, since, when they are want-
ing, development is but ill or not at all accomplished.
But this interposition is again manifested by the charac-
ters which the different parts present when they have been
deprived of the influence of the generative organs.  To
appreciate these characters we have only to compare the
flesh of animals which  have undergone castration  with
that of others; for example, to compare, in this respect,
the ox with the bull, the wether with the ram, the capon
with the cock, &c, &c.  In the eunuch, these characters
 are not less striking.   His organization is, as it were, at
a stand-still.  Arrived at an adult age,  he preserves to a
great degree the physical attributes of adolescence, and
when he loses these,  it is to  be gradually invested  with
old age,  without  ever  having passed through those of
manhood.   It is then the genital organs which, in the un-
mutilated man, color  and strengthen the skin, give to the
flesh more firmness, and by degrees free the tissues of those
whiter  fluids through which we should in vain seek the
full forms of the bone and muscle.   The organization of
the eunuch  is then unfinished, incomplete.  Organs which
ought to have appeared at the epoch of puberty  are not
to be found; others acquire but a portion of the substance
they  should have had: they all  preserve some of the 
characters they ought to have lost, and witnout  gaining
those they ought to have  acquired.  These facts are  of
great importance.  Their study,  better than any other,
indicates the extent of the evils  which sexual excesses
may cause;  for these organs, which the Masturbator and
the libertine so abuse, are  those very organs which take a
part so active, so profound, in the  internal life of all our
tissues,  which impress upon them that slump of virility
that the eunuch remains forever deprived of.
   Let us now consider him in his life of relation; seek  in
him  the active,  feeling anil thinking man   In this re-
spect, also, how much has he lost! he is a  bad walker, is
supine, without energy : you will see him sew or embroi-
der,  but never raising heavy burthens.   Not less than
the flabbiness of his muscles  and the whiteness of his
skin, his apathy,  his want of sensibility, render him the
very type of the  lymphatic temperament.   He has pre-
served from  his infancy that  disposition  given by weak-
ness, to  be affected, to tremble from the slightest cause;
hence, he is timid, pusillanimous, cowardly.   Deprived
of that internal influence which  renders the soul cheerful,
he is morose, wearisome.   Those  sentiments which bind
an individual to his fellows, which render him capable
of attachment, of love, of devotion,—he is deprived of.
He lives, he vegetates only for himself;  he is the most
perfect egotist.  If he feels any  sentiment, it is hatred  or
envy,—they are the repulsive sentiments;  but he oftener
feels none at all or but very feebly.  His  mind  having, 
like bis oody and his soul, lost its impulse, remains in-
complete,   lie has but a moderate intellect, and is never
known to  conceive nor to execute great projects.   This
picture, let it be well understood, is not drawn for diver-
sion;  it is the resu't  of positive observations made in all
times, in every place,  and on every species of eunuchs.
One, spoken of by M. Bedor, bore in  himself the charac-
ters of this picture.  It was an eunuch from birth, whom
the consciiption of France bad made a soldier.   His man-
ner was humble and  languid,  his hid and  sunken eyes
seemed unable to sustain the look of another; far from
martial, he was timid, pusillanimous, fearing the dead and
especially darkness.  By his own declaration he had never
been attached to  any one, even in his own family; and
also he was incapable of aversion.  Music did not please
him, and  never had he any idea  of singing; he  experi-
enced no kind of enjoyment; neither  did  he complain of
his lot.   His intellect was restricted, his language obscure
and incorrect, and education had so little effect upon him
thet although he  had lived a year in  the barracks he had
in no way contracted the ways of the soldiers.

   Such is the eunuch.  The operator, in mutilating him,
has miitibited bis  soul, his feelings  his mind.  The growth
of the moral and intellectual  powers then is connected,
 like that of the body, with the existence of the generative
 organs.   You nrght deprive an infant of a limb, of his
 four limbs, that is to say of  at least  the half of his sub-
 stance, but the growth of  the rest would go on as if this 
ablation had never taken place.   But take away nis tes-
ticles—all  his tissues, all  his  faculties, will bear the in-
delible marks of this  mutilation.   These organs then
possess, in  themself alone,  an influence  more powerful
than his four limbs together.  Now, it is with them, with
this  power, that  the masturbator trifles  even from  his
childhood,  at every  moment, without scruple, without
limit.  Is there still need to follow out this trifling in its
fatal consequences, in order to declare it dangerous 1

   Again, it is to the  influence which the generative or-
gans exert over the rest, that  the sexes owe the general
characters which separate them.   Submitting to the influ-
ence of a different genital  apparatus, their organization
presents a different mode of being, acting, feeling.  Thus,
observe how the sexual characters, indistinct at the mo-
ment of birth, grow more evident in proportion  as  the
sexual parts are developed, become at once distinct when
puberty arrives, existing  at their greatest height, when
these parts have come to their  perfect state, and again
effaced in old age.  The destruction of the testicles in
man, and  the  ovaries  in woman, has the effect to hin-
der  the  regular developement, or  even  to alter  the
special sexual  characters.  We have  already seen that
this  destruction effeminates man;  we now add  that it
renders masculine the woman, gives her those characters
which, in the natural order, are the exclusive appendices
of the male sex.  This is proved  by well-authenticated
facts.  And do we not see when age extinguishes in wo- 
man the activity of her sexual organs, puts them aside as
it were,  her  voice becomes harsh, more masculine, her
upper lip and chin grow hairy, her moral character ac-
quires more firmness, her tastes, her habits become greatly
changed, and approach  nearer to what they are in man.
The same thing takes place in  animals.

  It is not only the comparison of the two sexes  which
shows that different genital organs have a different influ-
ence.  It is  also shown by observation of those beings
of doubtful sex, named hermaphrodites.   In these indi-
viduals, the genital organs, disturbed in their regular for-
mation, present equivocal appearances  belonging  at the
same time to  both sexes.  And we find that the organi-
zation of these individuals being differently influenced, is
differently developed.   Faithful to these organs,  which
impress upon it the sexual  stamp, the general condition
of the body becomes equivocal  like them, and  presents a
mixture, in various degrees, of the female character and
that of the male.  The general state of the economy,
then, reflects, to a certain extent, that of the generative
parts;  varies with them, and has its share of the altera-
tions which they undergo.  After all this, is it astonish-
ing to see libertines and masturbators become effeminate,
pervert their  constitution by making a use of these parts
which fatigues and deranges them ;—and girls lose, in
the same way, their beauty, the delicacy of  their forms,
and the charm of their voice.
13 
  The  period  of puberty, which  commences  at  from
twelve to fifteen years in  our climate, a little sooner in
girls than in  boys, is that in  which  the  genital organs
exist in their greatest vigor.   Until  then, they were de-
veloped but slowly, and in a manner almost insensible;
suddenly they begin to increase with  great  activity, and
this giowth is not arrested until they have arrived at their
perfection.    At no other epoch of life does the increase
of the substance of the body take  place  with such energy
as at this.   The researches of M. IVI  Quetelet  and  Pil-
erme, on the weight and stature of men of different ages,
leave no doubt on this point.   Thus the annual increase
in the  weight of the body, which, up to the age of pu-
berty,  was only from three to three  and  a  half pounds,
suddenly increases to five and six pounds when  this pe-
riod commences, and goes up  to above twelve pounds,
when it is at its height of inten>ity.  And what is worthy
of remark, in girls, in whom  puberty is more precocious
than boys by about two  years, this increase of nutrition
also commences two years sooner.  An analogous fact is
observed in those exceptionable beings, or monstrosities,
who present from infancy the characters of virility:  in
them the bulk  of the  body is in a direct ratio  with the
genital development: hence their stature and weight are
enormous.    Connect  then these facts with those just
pointed  out  in  speaking  of eunuchism, and it will rest
well proved  that the influence of the genital organs over
nutrition follows out, in its variations, those which them- 
self undergo; that the general growth is in  conformity
with theirs, progressing if theirs  progresses,  and  being
accomplished but incompletely or badly if theirs is hin-
dered.

  This redoubled activity of the nutritive process durino-
puberty is not only revealed by the  increase of the sub-
stance of the body, it is also manifested by other symp-
toms.  Thus, more animal heat is generated in the body,
this is clearly shown by the ease with which  pubescents
resist or bear cold.  And, at the same time, indispositions,
illness of  all sorts, demonstrate in  most such  subjects,
that  the influence of the generative organs over all parts
of the body may go so far as even  to derange  the various
functions.   Indeed, the  body reflects like an echo all that
goes on within  the generative apparatus.  Need  it be
added that in eunuchs nothing of the sort happens'

  The active development of the  genital parts exercises
no less influence over the  functions of the life of relation,
over the faculties of feeling, acting,  thinking.   These
faculties, of  which  the  eunuch is so deficient, are, during
puberty, in the height  of their action.  It is the age of
muscular activity, of agility.   If pubescents  sometimes
experience indifference for exercise, this, resulting from
plethora of the nervous system, soon passes over.   The
moral susceptibility is now even more  exalted than  the
physical.  The mind, directed, excited, by the  most lively
and varied impressions, imagines, abandons, resumes opin- 
 ions the most opposite, adopts and would accomplish pro-
 jects the least calculated, and sometimes the most hazard-
 ous.  But what above all  characterizes the mental con-
 dition resulting from the operations of puberty, is the fa-
 cility with which such participate the affections of others,
 are interested in  their interest, forget themself for them,
 sympathize with  them.   It is  the moment  of generous
 ideas, or, as say those whose minds no longer feel the in-
 fluence  of organs that are  become  mute, the moment of
 illusions.   How great development, what trial  must the
 mind reap in passing  through  this moral tempest!  Can
 we then be astonished to find weak intellect, cold hearts,
 benumbed feelings, in the eunuch 1  Deprived of those or-
 gans which, at the epoch  of  puberty, agitate so power-
 fully, they have never felt it;  the most active of all mo-
 ral excitants has  failed them.   Judge then of its power;
 and yet it is this—this is the excitant, that  the mastur-
 bator dreads not to abuse !

   Assuredly, those who have  not feared to say that the
possible consequences of sexual abuse and excess have
 been exaggerated, have not reflected upon all this. 
CHAPTER XI
        On Masturbation.—Its Consequences.

  All authors agree that  sexual excesses and  abuses,
and especially Masturbation, constitute a prolific scource
of disease, and to an alarming extent, of deterioration in
the human race.

  There is no disease  or infirmity which Masturbation
may not, in one  way or other,  directly or indirectly, be
the cause  of.   Many serious  and fatal disorders  of  the
nervous and circulating systems  are the direct consequen-
ces of it—while  others to which the constitution was  lia-
ble from predisposition, (as hereditary influence, weakness
of particular organs, &c),  are developed or brought  out
under its influence, when otherwise the power of nature
might have outgrown or overcome them.   Innumerable
cases, in proof of these assertion*, might be adduced,—
every  work on this subject abounds with them.  I intend
here, however, only to  state the fact, leaving the rest to
the good sense of the reatler—especially to  those who
are, unfortunately, more interested in such knowledge.

   In this  Chapter I  propose  to enumerate briefly those
forms of disease  which have most frequently and most
clearly been known to  be  caused by Masturbation,  and
which may, for convenience, be classed as follows:

                       *    13 
   §.—Diseases directly or indirectly induced by its effed
upon the rest of the body.

   Consumption is, of all the fatal diseases, that most fre-
quently developed  under the depressing influence of sex-
ual abuse.  Where an hereditary or family predisposition
exists, Masturbation rarely fails to bring it into  action.
It is impossible to estimate the number of individuals who
thus yearly fall a prey to Consumption,  th: ir friends and
parents generally little suspecting its real cause, and who
might, in most instances, have outgrown the tendency to
this disease, had not the  blight of  Masturbation arrived
at the very moment their constitution  was in need of all
its vigor and resouice.

   Insanity is another of its frequent and terrible conse-
quences: look at the reports of all lunatic  asylums   The
nervous  system, of which  the  brain is  the great centre,
always suffers early and seriously, from Masturbation   If
we reflect upon the dejection and depression of spirits and
of all the higher faculties of the mind which characterize
the victims of this  habit, we must rather wonder that the
wreck of intellect  is not still  commoner;  it is  possible
that many of those cases of insanity whose cause is un-
known are  in truth due to this.*

   Epilepsy very  frequently has this origin, as also various
other convulsive affections, palsies, &c.  Even positive
 * A severe case ol this kind cimenn-   tunatily vieled entirety *.o a treatment
icr my observation last winter, it for-   principally moral and dietetic 
destruction of the brain itself has been distinctly ana un-
doubtedly traced to  it.   Loss of speech, as a variety of
palsy, sometimes happens.   A case of this kind came un-
der my own observation last year,—in a young man  from
Rochester, in this Slate, about  18 years of  age; his ap-
pearance was  palie  and haggard,  his eyes inexpressive
and  downcast; he was weak, trembling, emaciated, and
his behavior decidedly silly.  A week or two previously
he had suddenly lost his voice and  could not articulate a
single  word ; he carried a slate, by means of which he ex-
pressed himself.  Loss of memory, more or less, is  very
common.

   Disease of the Spinal  Chord—a prolongation of the
brain and fully as important in the animal  economy, is
also  among the frequent consequences.   Nor is this to be
wondered at,  every  Masturbator, as well as those  who
commit sexual excesses, even in the most legitimate man-
ner, soon complain of weakness of the back and especially
of the loins,—aud this, if the cause is continued does not
fail,  at first merely following each abuse or excess, to be-
come at length permanent.   Disease, and even destruc"
lion  (caries) of the back-bone itself, have repeatedly had
this  origin.   Also, permanent contraction of the limbs,
crooked or hooped backs, &c.

   Diseases of the Eyes.   Sudden blindness, or the more
gradual  approach of Amaurosis, Chronic Opthalmia, 
 Strabismus  or  Squinting, &c.   What  Masturbator has
 not observed his eyes become red, watery, swollen, assume
 every appearance of a degree  of  inflammation, immedi-
 ately after his  unnatural efforts?  Who among  such  is
 not also aware that his eyes are becoming more and more
 weak—that  he cannot work or  read  by  candle-light?
 symptoms known to be the precursors of loss of sight.

   Diseases of the Heart are also directly induced  by sex-
 ual abuses and  excesses.   The circulating system is al-
 ways deeply agitated  and excited by  these acts;  and
 when too often repeated, or excited in an unnatural way,
 it cannot be wondered  at that a permanent derangement
 should at last set  in.  What but  a threatening of such
 disease  is the palpitation, the short breath, that so con-
 stantly attend the abuse of the  sexual organs.

   Rheumatism, as supposed by many, is more frequently
 than is generally imagined, the consequence of the gene-
 ral prostrating  effect of Masturbation on the nervous sys-
 tem;  especially a form of Nervous Rheumatism.

   Asthma, short  breath, and especially a kind of Ner-
 vous Asihma.
   Piles.  The  morbid  attraction and detention of blood
in the lower abdomen, where the genital organs are situ-
 ated, together with the general debility accompanying,
is necessarily a  frequent cause of Piles.

   Fevers. Sexual excesses and M>:siuro«ti  .  )eeo,.'te the 
cause of Fevers, because, by weakening the system gene-
rally, they deprive it of its naturally inherent power  of
resisting diseases;  hence, the moment such person is ex-
posed to an atmosphere bearing an  epidemic poison, as
Cholera, or the more local  miasmntous poisons, as Yel-
low Fever, it at once yields, the fever is caught;  Nature,
deprived of her internal  power of repelling injurious  in-
fluences, stands an unfair chance—she surrenders.

   While on this subject, let me reiterate some valuable
and important advice, viz:  That all persons, whether in
good or bad health, refrain from sexual intercourse on  ar-
riving at tropical or unhealthy places, until they have be-
come, at least to some degree, acclimated.  It constantly
happens, more particularly to Europeans, that one single
sexual act throws the constitution open to Fever, which
would not have been taken but for a too early indulgence.

   §.—Diseases directly induced in the Genital Organs.
   An Eruption  on  the  Prepuce, generally  towards its
edge; it commences with little watery pimples, and after
a time spontaneously subsides, to appear  again however.
This is  sometimes the cause of permanent Phymosis.

   Gleet, or discharge of matter from the  urinary passage.
This often happens, it is generally  very  slight  and  but
little mattery—sometimes, however, it   is copious and
purulent, and occasionally has all the characters of Go-
norrhcea or Clap. 
   Disease of the Testicle.   Those who abuse their sexual
 organs seldom escape without some injury to the testicle,
 but which, very fortunately, for a long  time exists in a
 sympathetic form  only.   Such  persons always have a
 weakness or hanging down, an occasional  shooting pain
 running up towards the groin, or an unnatural tenderness
 ^nd flabbiness of  these  organs.   Cancer, Dropsy, Wast-
 ing away of the Testicle may result.   A hard  and pain-
 ful swelling attached to one side, or a  swollen spongy
 state of the veins of the chord, in its nature very much
' like Piles, are quite common.

   Incontinence of Urine and Retention of Urine, may
 both be caused.   A milder  form of incontinence of urine,
 consisting in a very frequent desire to urinate, with more
 or less inability to hold  it, is very common.   I have seen
 several cases of complete retention  of urine, from spas-
 modic derangement of the muscles concerned, which have
 lasted  until relieved  by the passage of an instrument.
 With these there is often some slight pain or uneasiness
 in urinating or at other times.

   Stricture, as stated  in Chaptenx. may be the conse-
 quence of the  irritation produced and continued in the
 urinary passage by Masturbation.   Several of the  most
 severe and obstinate cases I have had to treat have been
 from this cause.
   Inability to perform the  Sexual act.  If the erectile
 power has been brought to such a state of excitability 
that the slightest cause suffices  to  produce an  erection,
why  should not its termination be as hurried, if the same
cause continues to act?—It is especially so in this case ;—
in attempting actual intercourse with a female,  an emis-
sion piecipitately takes place, before the act ought to be
half  completed, often  at the very commencement, at the
hist moment  of the attempt, to the  great mortification
of the individual.   This is one of the earliest injuries in-
flicted on the sexual faculty by Masturbation.

   Seminal Emissions.   These, at first, are rare, happen-
ing only in one or two weeks, and are accompanied by a
dream ;  by degrees  they  become more  frequent,—though
accompanied by a dream, they do not wake the person;  at
last they happen almost or quite insensibly—even without
erection—day or night, on the slightest provocation. No
one who has not seen it car: conceive th_* miserable condi-
tion of a person  arrived at this stage of Seminal Emissions.

   Constant Erections (f the Penis,  more or less  attended
with  pain, quite out of the control of the will, devoid of
any pleasurable sensations, is almost sure to  follow long
abuse, or, which is almost the same  thing in a less degree,
an erection produced by the slightest totich, by the sight
of a  female, or by lascivious ideas which  are constantly
haunting the imagination, and attended by a frequent dis-
charge of semen.  This latter,  in a slighter or incipient
form, must be familiar to every Masturbator.

  Palsey, or total loss of sensibility of the Genital Organs, 
may at last take place, it is the natural ultimate effect of
inordinate excitation.    In this condition, not even Mas-
turbation, much less sexual intercourse, is capable of af-
fording the usual feeling, or indeed sometimes any at all
  §.—The Special, disease of Masturbation
  In the long list of diseases just  enumerated  as  conse-
quences or effects of sexual  abuses, either  one of them
may or may not be present in a given case;  some of them
are very frequently met with, others more rarely, while
some of the latter are  pretty constant, to one degree or
other happening in every case.   But there is a certain
diseased state of the Genital Organs consequent upon the
abuse which  is  never  absent in any case whatever, and
which I here call the special disease of Masturbation, and
upon this  one depend many of the other disorders, func-
tional or otherwise, of the Genital Organs themselves, as
well as  some of those of the brain: it is, essentially, a
Chronic Inflammation of the urinary passage—of that
portion of it near the neck of the bladder, into which open
the seminal ducts.  This special disease is of more real
importance than any of the others, because they are all,
to some degree, influenced by it, and cannot be cured un-
less this is first  removed; and also because the first and
most important part of the treatment must be directed to
it, for any chance of success.  It is also important because
it is generally but little  understood, and by practitioners
in general is too often  totally overlooked  or forgotten.
Almost every patient 1 treat is a proof of this last assertion. 
  The Special disease of Masturbation, then, is a Chronic
Inflammation  in  the  urinary passage, at its inward ex-
tremity, being seated immediately in front of the neck of
the bladder    But it may extend several inches forward
along the passage,—or the whole passage may be unna-
turally sensitive or irritable, exactly as mentioned at page
162, under  the name of "tenderness of the passage,"—
but the most decided and acute  inflammation will always
be found near  the bladder.
  As I have before  stated, Stricture is sometimes the con-
sequence of Masturbation; this inflammation becoming
after  a  while  so  concentrated  in space, so localized in
certain points, that besides the general and extended ten-
derness, one or more distinctly swollen or  tightish spots
are found to exist, or  the exploring bougie may be ar-
rested by a positively thickened and  contracted spot, an
actual Stricture.
  Commonly this inflammation  is found to begin at about
six or seven inches up the passage and extends inward to
the bladder, perhaps between the  seventh  and ninth or
tenth inch  from  the  external  orifice;—further onward
than Stricture is  found, as will be seen by referring to
page  150;  though  the irritation produced, by Stricture
may also extend  backward  to  the  bladder in the same
way, and it is then that Stricture gives rise to many symp-
toms belonging more particularly to  Masturbation.
  This special disease of Masturbation has  been divided
into three Stages:
14 
        EXPLANATION OF PLATE VIII.

   Figure 1.  The back part of the Urinary Bladder,
 presenting a view of the Seminal Organs.
   A,—The Bladder.
   B, B,—The Seminal  Vesicles,  two  small  lobulated
 bladders, the reservoirs of the Semen.
   C, C,—The Ducts or tubes leading the Semen, as fast
 as it is secreted, from the Testicles into these receptacles.
   D,—The Prostrate Gland—through which the Semi-
 nal ducts pass to  open into the  Urethra or urinary pas-
 sage;  shown at g, fig. 2.
   E, E,—The Urethra ;  see pi.  iv.
   F,—Part of the Urethra.

   Figure 2.   Interior view of the above.
   A,—The Bladder laid open, showing  its inside.
   B, B,—The Ureters.
  C' C,—The openings of the ureters into the bladder.
  D, D,—The Seminal ducts, leading from the testicles.
  E> E,—The Prostrate Gland,—which, with
  F,—A portion of the Urethra, are laid open to show
  G,—The openings of the Seminal -Ducts into the Ure-
thra, just  in  front of the neck of the bladder, having
passed  through the Prostrate Gland. 
PLATE Vni.
Figure 2. 
   In the first stage, the inflammation consists, as I have
iust described it;  the derangement of the Genital Organs,
and  of the  Nervous System, is  moderate; none of the
more serious consequences yet show themselves: in this
stage it is very curable, and the patient may safely un-
dertake the  management himself.

   In the second, the inflammation is  more  intense; the
Seminal Organs  are more seriously involved; Seminal
Emissions become frequent, and effect the constitution, the
mind and nervous system suffer severely; the derangement
of the Genital apparatus and its functions increases, diges-
tion suffers:  this  stage also is curable, but can no longer
be entrusted to the patient; surgical assistance must be
had.  In both stages, time and patient perseverance may
be required,  but will assuredly be crowned with success,
and often  with perfect restoration of health and strength.

   In the third stage, ulceration of the Seminal Ducts has
taken place; the  Seminal fluid is then watery, mingled
with matter  or blood, and escapes frequently, or even un-
interruptedly ;  a consumption of the whole body and often
destruction of the mind, is evident, where indeed, some
more rapidly fatal disorder has not intervened to end the
scene.   Nothing, in this stage, can be promised, but little
done. 
CHAPTER  XII
         On Masturbation.—Its Treatment.

  In the treatment of Masturbation, or the disorders re-
sulting from it, the first  and most important step, as it
would seem almost unnecessary to say, is the prompt and
perfect abandonment of the practice.   This no one, espe-
cially if he has read the two preceding Chapters, will for
a moment doubt; happy were it as easily done as said:—
but it is often far from being so  ; the whole moral force of
the individual, aided by other means, must be summoned.
For instance, every thing calculated to excite lascivious
ideas should be strictly  avoided, or such thoughts sup-
pressed ; to this end the mind itself should be occupied in
some interesting pursuit or business.  Active bodily ex-
ercise also is important;  inactivity and  especially sitting
occupations, and still more especially in heated apartments
being injurious.   Solitude must  be avoided, keeping as
much as  possible in  society.  Diet must be moderate,
using a  very small portion of animal food, or, which
would be better, none  at all, and no late supper.  Perfect
abstinence from all alcoholic beverage must be observed.
The  exercise taken during the  day should  produce suffi-
cient fatigue to ensure sound  sleep; the bed should  be
hard, and the covering cool and  light; a feather bed is
quite inadmissible. Very early rising is important. Fre-
quent cold bathing should be  practiced.   Another point

                      •    14 
of very great importance is the state of the boweis;  cos-
tiveness is apt to prevail and must be prevented.   The
bowels should be kept naturally free and open, occasion-
ally even taking a purgative dose.

   When nocturnal seminal emissions have not set in, or
even  if they  have but slightly commenced, the above
treatment,  consisting of merely hygienic measures  will
suffice ; indeed, the habit broken  off, Nature in the ma-
jority of cases soon restores a regular and healthy state.
The simple discontinuance of the abuse, without any other
means being taken, has constantly been attended with the
most rapid and perfect restoration.

   We will suppose, however, that  after some months, the
person still finds himself nervous, weakly, troubled  with
frequent and  easily excited erections, and perhaps  with
nocturnal seminal emissions happening every week or two
or oftener;  also having some of the symptoms of Inci-
pient Stricture.    A  judicious  plan of local treatment,
directed to the special disease before referred to, and which
in this case must be supposed to have become established,
must be adopted;  afterward taking  a rather tonic course
of medicine, and resuming the before mentioned hygienic
measures of cold bathing, exercise, &c.

   I must not close this subject without making a few obser- 
vations, which it is important that every one in any way
.nterested, should well understand and bear in mind, viz*

  When the derangement consequent upon Masturbation
refuses to yield  to the  Hygienic  measures stated at the
commencement of this chapter, the special disease of. the
inner extremity of the urinary passage must be considered
to have set in;—it is then a disease requiring local treat-
ment—it connot be cured by medicine.   Be not deceived
therefore by the specious advertisements that every where
meet the eye, of various " Cordials"  and " Elixirs"  of
wondrous efficacy in the  cure of  " Constitutional Debil-
ity," Nervous Debility," " Impotence," " Incontinence,"
&c. &c, as the complaint is always called by these kna-
vish  traffickers.   They always use the name of some cel-
ebrated foreign physician;  in several instances I have
seen  their very advertisements copied almost verbatim
from others I had  before read in London.   Such medi-
cines are worse than useless.   Your money is their sole
object—disappointment their sure effect.

  In the treatment of any  case, ever so slight a one, do
not  expect a rapid cure, you  cannot have it; time and
perseverence, in this perhaps more than almost any other
complaint,  are  absolutely necessary,—but final success
may  be relied on.
  Especially in regard to the symptom of Seminal Emis-
sions do not expect a rapid cure.   Indeed  there is a fact
relating to this point, which should be well impressed 
upon the mind of every one at all interested, viz: ihat,
in an adult, Seminal Emissions  having once set in, they
can never be totally  arrested.   Now, these  Emissions do
not always and necessarily imply disease, and this is  the
reason why it cannot be arrested.  But, so far  as there
is disease in it, so far it can be arrested or  cured.—This
is the explanation:  Nature intended man, at least occa-
sionally, to cohabit,  and hence the testicles are constantly
secreting  or  forming, with  more  or less  activity,  the
Seminal fluid, which by means of the proper conducting
tube (a part  of the chord of the testicle, see  plate vm),
is carried  to two little pouches or sacs destined to contain
it; these are situated immediately behind the bladder,just
about its neck or where the urinary passage begins. Here
it collects and is gradually absorbed again into the body,
to which, as  is generally believed, it imparts strength and
vigor.   But if in an adult, and it is especially likely to
happen under the stimulating effect of certain reading,  ob-
scence pictures or society, &c. &c, or merely from a  na-
turally large development of certain cerebral organs,  the
testicles produce faster than absorption removes, an Emis-
sion must necessarily take place.   Nature  thus  relieves
herself  of an undue  accumulation.—The  question then
comes to be,—How  often may be considered as natural
and healthy? and by what rule  can one judge?  As to
the first point, Authors agree  that it may happen once in
four or six wTeeks, according to the temperament, &c, the
individual and organs being healthy:  as to the second, in 
this case Emissions do not leave the person dull and lan-
guid, while, if they are the consequence of a diseased
condition, a very decided languor and dullness are always
experienced, and which may even last a long time.

  Avoid, as much as possible, brooding over your condi-
tion ;—this must be resisted.  The progress will often at
first seem  unpromising, the cure slow, and relapses may
repeatedly occur;  but, be  assured  that  perfect success
awaits  a steady perseverence.

  The Treatment of the Second Stage of Masturbation*
is not adapted to private hands. 
PART  THE  THIRD.
                 CHAPTER XIII.

On Syphilis or Venereal Disease.—Its Distinguishing
   Marks, Nature, Symptoms, Progress and Consequences.

   Venereal Disease, in the first place, should be carefully
distinguished from Gonorrhoea.  In common conversation
the word Venereal is often used in a general way, to ex-
press both one and  the  other;  but this is not a proper
way of speaking, for no two diseases can differ more,
either in their nature, train  of symptoms,  consequences,
or modes of cure.  It is true, as was stated in the first
Chapter, that Venereal, (also vulgarly called Pox),  is
caught in the same way  as Gonorrhcea,  and that both
may be taken at the same time, if the female happen to
be afflicted with both diseases; still let it be remembered
they are distinct and  very different complaints.  And this
is the more important to explain, inasmuch as I find con-
tinually, that among  those who apply to me, very many
have been  taking, in Gonorrhcea, the medicines that were
intended only for the Venereal;  and,  in Venereal, nos-
trums intended for the fea orrhcea.  Now the medicines 
that are proper in  Gonorrhcea never can cure Venereal,
neither can those proper for Venereal ever cure a Gonor-
rhcea,—hence so much waste of time and disappointment.
And this is not  the worst of  it, for this mistake cannot
be made without injury to the constitution, so that when
the proper and  necessary medicines  are given  in either
complaint, especially in Venereal, the constitution is less
able to bear them with impunity.

   In place then of a  disease beginning with  pain and
heat in making water, and a discharge  issuing from the
urinary passage, as in  Gonorrhcea, the  Venereal disease
begins with  an  ulcer or sore on  some  external  part or
other of the  Genital Organs.   It may begin in any part,
but is seen  most frequently on the extremity or head of
the penis, or upon the internal surface of the prepuce or
skin which covers it, for the reason that the texture of the
skin in these  places is thinner than elsewhere;  and, as
the skin forms a bridle under the  penis making  a little
fold which is calculated to  retain  the Venereal fluid, the
sore is perhaps oftener found there than  in  any  other
place.—There may be at first more than  one sore, but
this does not often happen, there are but rarely many.—
These parts are subject to other diseases besides the Ve-
nereal,  and which are infectious too, but these appear in
crops, while the real Venereal generally commences with
one solitary sore, and that usually appears at some period
between the second and seventh day after exposure.  The 
little ulcer then begins and proceeds in this way.  First,
there is a little pimple, but this is so small and attended
with so little pain that it is  often not observed until it
breaks.  When it breaks, however, it forms an ulcer which
differs from every other ulcer in these parts or elsewhere,
and  is what is  called a Chancre; or it may begin as an
excoriation, or crack, or from the very first as an ulcer,
but so small  and without any soreness as to elude detec-
tion  for days.   Now, the principal difference between a
Venereal Chancre and other ulcers is, that provided it has
already existed a few days, the Venereal Chancre is sur-
rounded with a hard, thick feeling substance which ex-
tends around  and underneath it.  This  is so peculiar to
the Venereal ulcer that you may always judge of its na-
ture  by it.   If therefore at  any time you  are  in doubt
about the nature of a sore upon the  genital organs, just
take hold of it between your thumb and finger, and pinch
it up a little, and if you find it has this hard feeling edge
and  base, then it is Venereal, you may be quite sure it is
so.   But, although you may be quite sure a sore is Vene-
real  if it have this  hard feeling  edge and base, you are
not to be quite so sure it is not Venereal if it be wanting;
for, as I shall  presently have to show, this hardness is
sometimes slow in forming, and  sometimes it forms im-
perfectly.  It is, however, a valuable criterion, for when-
ever it is present it  settles the question at once,—it is
Venereal.  But, as I'have just now said, a sore on the
genitals may be Venereal  and not have  this thick and 
hard feeling, what is  to  be done then?   The  follow-
ing :—If it be a recent sore, wait a little, (unless you de-
termine at  once upon  the abortive  treatment, described
at the end of  Chapter xvm), and do  nothing to it but
watch its  progress  and keep it clean,—washing it often
with water or  soap and water.  If it  is Venereal, in a
few days, in all probability, it will form its peculiar edge
and base.  There are but very few instances  of Vene-
real sores which do not, in some degree or other, present
this character.   But if this should not appear, or  only in
a slight degree, then some other characters must be looked
for.   Now, another peculiarity of a Venereal Chancre is
to eat deep into the part,  rather than  to  spread;  then,
again, the surface  of the  sore  is of a  yellowish brown
color—or is as  it were coated with a tough layer of mat-
ter of this color,—it is  quite different from other  florid,
red sores which are frequently seen on these parts.  Also,
except any thing has happened to inflame or fret it, there
is seldom very much pain about  a Venereal sore.   Per-
haps the most correct  description of a  clear  and well-
marked Venereal Chancre is that given by John Hunter,
a great  and eminent surgeon, and the  first writer  who
gave to the world any definite and systematic view of this
disease.   His words are these: " A Venereal Chancre is
a sore of a somewhat circular  form,  excavated, without
granulations, (that is, without the little red points or emi-
nences on the surface of a sore, which denote its healthy
and "healing state,) with matter adhering to its surface,
15 
and with a thickened  edge and  base."   It will be well
to keep this short and correct description  of a Venereal
Chancre in mind, as it will serve to compare ulcers of any
other kind with it.  It is  not, however, to be supposed
that every Venereal  Chancre will exactly agree with it
in every respect, for peculiarities of constitution and other
circumstances have their effect upon the chancre, as well
as upon sores of  any other kind,  and will sometimes pre-
vent its perfect development of character, still there will
be always enough about a Venereal sore  resembling the
picture of it given by Hunter, to show its true nature, and
those features which are wanting to make the resemblance
perfect may  often be  accounted  for.  For instance, the
sore may have commenced in a  little laceration  or tear-
ing of the skin, Venereal matter having come in contact
with it.  In  this  case, it is some  time—a week or two—
before it looks like anything more than a com mo i tear of
the skin, and when the hardness does form, it forms slow-
ly; in this case also, the ulcer, instead of being  circular
and deep, is  irregular, superficial  and  broad.  Still you
see it does not heal up by simply washing, as a common
sore would do.  So also, if the person has been foolishly
dabbling with mercury,—that is  to say, has been taking
enough to inflame the sore, but not to  cure the disease;—
this, it is well known, will prevent the  formation of its
true character for a while, but when it is left off, and the
part merely kept  clean, for the sake of watching its pro-
gress, this characteristic hardness of edge and base, or 
some other Venereal peculiarity will appear, so as to
enable  you to judge safely as to its real nature.  Let it.
however, be remarked, it is not said that a sore upon the
Genital Organs can in no case possibly be Venereal without
this peculiar hardness of its edge and base, for exceptions
do occur rarely.  The Chancre has appeared in some rare
instances after a swelling in the groin had taken place for
many days.   And further, there have been  known such
things as Venereal sores whose edges have been thin, hav-
ing no hardness  at all;  but all these are very rare occur-
rences,  and such would not  have been worth  while  to
perplex the reader with, were it not  for the necessity of
acknowledging candidly the fact   When these deviations
occur, we also get assistance  in forming an opinion from
our knowledge of the character of each party, the time the
sore appears after exposure, and any  peculiarity of con-
stitution or circumstances we can become acquainted with.

   This therefore is all that need  be  said on the distin-
 guishing  marks of the Venereal  disease, especially as I
 shall refer to  the subject again in the last Chapter, (xxv),
 on diseases which resemble Venereal.

            The Nature of Venereal Disease.
   But little need be said on  this  subject.   Venereal dis-
 ease (in many books called Syphilis) is well known to be
 infectious.  It is  communicated very much like inocula-
 tion of small  pox, only in that case it is done by slightly
 cutting the skin with a lancet and then applying small 
pox matter to the sore, whereas, in Venereal the matter
is so infectious that it is received without a breach of the
skin, especially in those parts where this is very thin, as
on the genitals; it is, however, much more sure to take
if the skin of these parts should be torn or abraded.  It
is most generally  communicated by sexual intercourse,
though it  may be given and taken in a more innocent
way, such as kissing, or suckling an infant, and in these
unsuspected ways it  has been most disastrous and fatal.
It is a disease which scarcely ever, perhaps never, wears
itself out, but, unless cured by art, continues  sometimes
for years,  undergoing different forms, until the miserable
sufferer dies, generally as  though he were in  a decline.
Formerly  death was  more rapid, but the disease seems to
have become moderated in its intensity, though not in its
ultimate  effect.  If,  however, mercury has been  taken,
but not in such a way as to cure the disease, the  patient
then may  live many  years, and the original disorder be-
come so altered as scarcely to present  any symptoms by
which its  original character can  be judged of.  Further,
it differs from most other contagious disease, inasmuch as
they, when they have once occurred, leave the constitu-
tion  protected  for ever against their  recurrence.   The
small pox,  measles, hooping cough, and others do this;
and even  typhus fever leaves the constitution safe from a
fresh attack for a long while; but with respect to the Ve-
nereal disease, this may be cured and taken afresh a hun-
dred times;  and, indeed, may be again  taken the next
moment after being cured, if exposed at such a time. 
  The following  facts relating to the contagious nature
of this disease, are  not generally  known, viz: Syphilis
or Venereal Disease can only be communicated from one
person to another during its first stage, i. e., during  the
existence of its first  symptom—the Chancre.  In its se-
cond stage it cannot be given  or taken  by sexual  inter-
course, but, if  conception takes  place, the child will be
Syphilitic, being either prematurely born dead and putrid,
or if alive, covered with Venereal eruptions, &c.  &c.   In
its third stage  also, it is not contagious, i. e., cannot be
given or taken, but any offspring would be born scrofu-
lous and injured for life, if they passed through childhood

   The Symptoms and Progress of Venereal Disease.
  This is a subject worthy of much attention.  The pro-
gress of this disorder is divided  into three stages:—the
Primary Stage, the  Secondary Stage, and  the Tertiary
Stage, and each stage  is attended with  its  own  peculiar
symptoms.

   The Primary Stage consists in the Chancre, which has
already been described: it is the only way in which Syph-
ilis can first make its  appearance, or be imparted from
one individual to another;  it marks the precise spot where
the virus or poison was  first imbibed or inoculated  into
the skin.  Chancre then is the principal or constant symp-
tom of this stage.  The occasional or Accidental Symp-
toms, which may or may not be present, are Bubo, Phy-
mosis, Paraphymosis;  they are  described at Chapter  xv.

                       •    15 
   The Secondary Stage is  that in which the effect of
constitutional empoisonment first  show  itself, and hap-
pens only when the disease  has  been allowed to take its
course, or has not been thoroughly cured in its first stage,
but left in the blood; hence the symptoms are no longer to
be looked for in their original seat, the  Genital Organs,
but in distant parts of the body, or over its whole sur-
face.   It is a curious fact, that there are certain parts of
the body that this disorder  attacks in a  regular order of
succession, and it seldom attacks one of these parts before
the other out of that  order; when, therefore, a Chancre
has been only healed up, as  by an ignorant use of caustic,
or an ignorant and ineffectual  use of mercury, without
really curing the disease, then, at some period, usually
before the end of the second month, after laying aside all
remedies, it will  appear again,  either in  the  throat, or
sometimes the throat and skin together, and this is called
the constitutional or secondary form of the disease.  Then,
if  mercury is again resorted to,  but not so as thoroughly
to cure the disease, the skin  and  throat may appear to get
well, but after another period, it will be seen  again on
the skin, sometimes in the same, and sometimes in a dif-
ferent form of blotch, or scab, or sore,—see Chapters xvi
and xvn.  Thus it may appear and disappear many times

   The Tertiary Stage is that in which  the bony system
is attacked;  its symptoms are, tumors and disease of the
bones, especially those only covered by skin, as the head, 
wrist, shin, &c, attended with some pain which comes on
at night only.   (See Chapter xvm.)

         The Consequences of Venereal Disease.
  Left to its own course, it is a fatal  disease.   If partly
cured, a progressive deterioration of health and strength,
deformity, impotency, or a diseased offspring, &c.  (See
Chapter  xix.) 
CHAPTER  XIV.
On the Remedies in general use for Venereal Disease.
  The mode of employment.
  Their value.

  The remedies used for the cure of Syphilis or Vene-
real  Disease  are  External and Internal:  the External
remedies consist in Lotions, Poultices, Caustic;—the In-
ternal are Purgatives, Mercury in  different forms, and
sometimes Opium, Bark, Sarsaparilla, Nitric Acid.

  Lotions.—These are required either as a means of al-
laying pain and  inflammation, or  as  applications to the
Chancre  or  other sore.  Thus, a Chancre, on whatever
part of the penis it may be situated, sometimes becomes
very painful  and angry; the surrounding skin, as the
prepuce, or  even the whole penis will often in this case
be similarly affected, sometimes swelling enormously with
much redness, pain and heat; in this way, phymosis and
paraphymosis are induced by the  presence of a Chancre.
Here, just as in Gonorrhoea, cooling  lotions are very ne-
cessary and useful.  They are applied by means of a rag
wet in them and wrapped around  the penis, or  laid  on
the skin  if in any  other part, and which rag should be
repeatedly wetted or soaked, the more heat and inflam-
mation in the part the more will the rag get hot and dry
if not attended to;  on this depends the utility of Lotions, 
(see Chapter     ).   Of the Lotions used as application
to the Chancre or other sore, the Black-Wash is the prin-
cipal ;  in this preparation the black powder or sediment
which falls to the bottom is the only useful part, the wa-
tery portion being of  no value;  to use it properly there-
fore you must collect the black  powder on a little piece
of lint, which is easily done by holding the vial  for a few
seconds mouth downwards, on a  bit of lint in  the palm
of the hand, then applying the black side carefully against
and in contact with the  surface of the sore.   This is  a
mercurial wash, and ought  to be used, generally,  only
when mercury is taken internally.   Other Lotions, how-
ever, are often useful and even preferable to this; this is
the case when  the Chancre is free from any hard indura-
ted edge or base, and only needs urging to  heal.  These
Lotions are generally composed of Sugar of Lead or
White Vitriol,  at  about  three  or four times the strength
of Gonorrhoea Injections.  Sometimes a vegetable astrin-
gent or aromatic is added to them, as Tincture of Myrrh
or Compound Spirits of  Lavender, or a little Laudanum,
if the sore is painful.

   Poultices are sometimes required for Chancre or Bubo,
especially when they become very inflamed and irritable.
Bread and Milk, Flaxseed  and Bread, or Slippery Elm,
form the principal ingredients, and such are called simple
or plain poultices.   They may however be medicated, to
render them mercurial, or opiate and soothing, as the case
may require. 
   Caustic—The only substance of  this nature at all fit
for1'private'  hands is the Lunar  Caustic, lightly run over
the surface of a Chancre or other sore, every one, two or
three days; it is a most excellent and powerful healing
remedy.   When used as an abortive  application to Chan-
cre, the rulesfor•the' Abortive Treatment of Chancre,, to
avoid  risk,'   must be strictly adhered to.

   Purgatives  constitute  a very active means of reducing
inflammation,  or a too full or plethoric state of the sys-
tem.   There is  much, however, in selecting the proper
purgative for the particular case.  Thus, when the object
is  to act against inflammation, a vegetable, or vegetable
and saline medicine is the best.   When preparatory to a
course of mercury, a saline purgative with antimony.  As
a mercurial  purgative, five grains of calomel in a pill, at
night, followed by a dose of epsom salts in the morning,
is the best.
   Mercurial Medicines.—There are many preparations
of Mercury, each varying to some degree in its influence
over the constitution  and the disease;  the following are
the principal and the most valuable.
   Blue Pill, is a mild and very excellent preparation of
mercury.  The dose is five grains (in a pill) at  night, and
is increased  by taking another such  pill in the  morning,
or still further by taking two pills, (10 grains), at night;
this is the highest dose.  It will often purge at first, if it 
does so a little at first, or even very moderately through-
out the course, there need be  no  objection to it, rather
the contrary ;  for, where the bowels are not at least na-
turally open, it becomes necessary to keep them so  by
taking some additional medicine, as a mild aperient along
with the dose of mercurial at bed-time.   But, if it abso-
lutely purges, and this effect does not cease as it general-
ly will after the first  few doses, it is then necessary to
check it;  this is done  by having  one eighth of a grain
of opium  mixed  with each pill.  Blue Pill is  perhaps
the safest and  best of all the preparations of mercury, in
ordinary cases.

   But it is one of the most frequently adulterated, and often
difficult to be obtained pure and in proper proportions.

   Calomel.—This, as  is generally known,  is a purgative
preparation of Mercury, and when taken as such should
always be followed up by a purging draught of Salts, or
Senna tea, some hours afterward.  When taken to affect
the system, however, this purgative effect is not required,
and indeed generally subsides after it has been taken for
a few days; though, it may persist, and then  it should
always be checked by the addition  of  a little opium, as
directed for the blue-pill.  The dose of Calomel is from
two to five grains,  made inlo  a pill and taken  at  night
or night and morning.  If it gripes, a quarter or half  a
drop of one of the stomachic essential oils might be add-
ed to each pill. 
  Corrosive  Sublimate.—This is a very active prepara-
tion of Mercury, and should be used only in urgent cases.
There are  forms  of Venereal Disease, however, which
require a very quick effect of Mercury;  when it attacks
the nose or throat for instance, in some constitutions, it
spreads so rapidly, that, if we were to wait the slower op-
eration of the milder mercurials, it would  eat away the
parts  before the Mercury could be brought to act upon it;
and it should be known, that, when the soft parts cover-
ing the  roof of the  mouth or the thin bones of the nose
are once gone, they do not grow again—they are  gone
forever.  It is therefore most desirable to have some re-
medy that will very quickly  put  a stop  to its progress.
When this is done, however, this active  medicine should
be laid aside, and the  cure completed with a milder and
safer  preparation.  It is not a remedy to be relied upon
for the cure of this disorder, but  to check  and arrest it
when the  destruction  of important parts  is threatened,
and this it will speedily do.  An eighth, or at the utmost,
a quarter of  a grain may be taken three or four times a
day;  but for the  manner of taking it more particularly,
A knowledge of particular  care is needed.

  Blue Ointment is another  excellent form  in which to
exhibit  Mercury, and  is  preferred by some eminent sur-
geons, to  any other;  but the trouble and inconvenience,
as well as the soiling of the linen it  gives rise to, is an
objection to its general use.   It  is sometimes necessary 
as additional to the internal medicine, either to hasten
Salivation;  or when, as in some of the Secondary forms
of Syphilis, the internal medicines cannot be alone trusted
to; or again, when the stomach  will not  bear any pre-
paration of Mercury, this form alone is used.

   When the Blue Ointment is  fixed on from one half a
drachm to a drachm is rubbed into the thigh every night
and sometimes night and morning.   But in the manner
of using Mercurial Ointment, I must be more particular.
In the first place, it should  be  rubbed in by the patient
himself, but, if from debility or any cause he should not
be able, then those who rub it on  should have their hand
guarded with a bladder, and the  best way to arrange it
is the following:  Get a  pig's bladder, and, after being
steeped in tepid water, turn  it inside out; then  soften it
well with lard or sweet oil, and put it on the hand like a
glove, tying it round the wrist with a piece of tape.  Still
it is better that a patient rub it himself.  Take therefore
a quarter of the quantity to be used in the hollow of the
hand and rub it briskly up and down  the inside of the
thigh till it has entered the skin, when the hand will not
pass so smoothly;  then take another quantity, and so on
till it Is all rubbed in.  It is common for it to make the
thigh a little sore, or to bring out a crop of pimples on
it by rubbing; in this case, change the thigh, and if the
same thing happen again, take the inside of the arm ;
any part will do' where  the  skin  is thin.   It is a good
thing also to wash the old ointment off now and  then
16 
with soap and water—the skin will take the ointment bet-
ter for it.   The rubbing may be either night or morning.
Throughout this course of rubbing, wear a pair of flannel
drawers next the skin, the same pair the whole of the time.
   Fumigating Mercury.—This, like the Corrosive Subli-
mate, is chiefly valuable in cases of spreading Venereal
sores particularly of the throat and  roof of the mouth,
and, when  these  are attacked, it is indeed a valuable
remedy.  Its effect  is much more speedily seen than that
of the  Sublimate, but the manner of using it hitherto has
involved so much trouble  and impossibility of privacy,
that, invaluable as it is, it has seldom been availed of.—
The preparation used for this purpose is the Red Sulphu-
ret of Mercury, (Red Cinnabar)—The directions for using
which  have been  the following:—Take a red-hot com-
mon heater, or better, a red-hot brick, and place it upon
a brick; then throw on this  half a drachm of the  Red
Cinnabar, when fumes will instantly arise; these are di-
rected  to the throat  and nose by breathing  in the fumes
through an inverted funnel held over them.   In this man-
ner fumes may be applied  once or twice a day.  This
plan, however, will instantly be seen to be quite impossi-
ble, without betraying for what purpose it  is done, and
therefore the following contrivance, which I call a fumi-
gating candle, will be esteemed highly.
   Fumigating Candle.—For this contrivance I am in-
debted to a  late work on Venereal Disease by Mr. Colles,
an eminent Surgeon of Dublin.   This plan of fumigating 
by the burning of a candle, is rather hinted at than des-
cribed, but its real value struck  me so immediately, that
I lost no time in putting it in practice, the result of which
proved most satisfactory.   The  plan  adopted is to com-
bine the Cinnabar with wax, and  make of this a candle
of the common size, an inch or two in length, divided by
a line around it, into four parts.   With  this,  ihere  is
nothing more  to do than to light the candle and to inhale
the smoke arising  from it, this contains  the Mercury  in
sublimation,—a  penetrating way of applying Mercury  to
parts otherwise of difficult access, and which has a most
immediate effect.  It  has  also an  excellent effect on the
female genital organs, as well as on the sores which fre-
quently occur about  the  fundament.   For  this purpose
the candle is placed in a chamber  utensil, or night stool,
over  which the patient sits awhile.  When the candle is
burnt down to the line, it is to be blown out.  Each can-
dle an inch or two in length, contains four mercurial fu-
migations.  It is a most convenient and speedy way  of
arresting  Venereal in  these parts.   I have effectually
stopped the  progress of it in twelve hours; and  have
cured excressences and sores about the anus in as many
days as they had existed months before.

   Opium,—Is a valuable medicine under many circum-
stances.  It is sometimes necessary and extremely useful
in allaying general irritability, and enabling the system
to bear the mercurial action with proper calmness.  (See 
   Bark.—Occasionally, in the treatment of Venereal dis-
 ease especially, it is necessary to support and re-invigo-
 rate  the  constitution.  In cases of great weakness, or
 when a Venereal sore takes on  a spreading and unkindly
 character, there is this occasion.  Nothing succeeds bet-
 ter in these  instances than the Peruvian Bark,—some-
 times alone,  but more generally combined with the Car-
 bonate of Ammonia, Opium, &c.

   Sarsaparilla—Is  a well known and valuable medicine
 in the treatment of Venereal disease.   Not  that every case
 of Venereal requires Sarsaparilla—far from it; but there
 are states and conditions of the constitution  exceedingly
 unfavorable to Mercury, (the specific remedy), but which,
 by its aid, are rendered capable of bearing Mercury well.

   These are  also conditions of the constitution in  which
 it is advantageous to give  the Sarsaparilla and the Mer-
 cury together,—the  constitution bears the Mercury better,
 and  the  disease is more completely  and  more certainly
 cured thereby.   It will be seen therefore,  that the Sarsa-
 parilla is not given to cure  Venereal,—it  has  not the
power to do this,—but it enables the constitution to bear
 the Mercury  which will, and this under such circumstan-
 ces as would render it dangerous to give,  or to continue
 that remedy without it.  It is true, Venereal  symptoms
 will disappear under a course of Sarsaparilla alone, but
they will return.   This fact experience  abundantly con- 
firms.  Innumerable cases are on record, where,  under
the Sarsaparilla, the symptoms of Venereal in the consti-
tutions have disappeared, and  returned again and again,
until a course of Mercury has been entered on, when they
have disappeared for ever.

   Remember, therefore, Sarsaparilla is not given to cure
Venereal disease, but only to  enable the constitution to
bear that remedy which will; also, that Sarsaparilla is
not required in many cases, but only in weak and irritable
constitutions, or in those  in which  Mercury is found to
disagree—rendering the patient feverish and irritable.

   With respect  to  the manner  of  taking Sarsaparilla,
many  preparations of it are  in  use; some of them are
very troublesome, inconvenient,  and expensive;  and  it
does not seem to me, that these latter have any great ad-
vantages above the former.   The most simple,  conveni-
ent, and least expensive is the  powder;  a  good large
tea-spoon full of which, in milk and  water, I  have  found,
 as far as I could see, to answer  all  the valuable purposes of
this medicine; but   it  may  require   the other forms,
 according to circumstances.

   Nitric Acid—Is  sometimes given and  may  be  very
 useful in Venereal Disease.   Not that it has the  power
 of curing  Syphilis,—that I do  not believe it has.  But
 sometimes, especially in the secondary stage, after Mer-
•    16 
cury has been given in one  form or other for the full
length of time that should ever be necessary—still some of
the symptoms remain,  or return  repeatedly;  or, when
sores exist on the body and do not heal up, Mercury hav-
ing been given to its full extent—and seeming incapable
of curing the disease; the truth is,  the disease is cured,
but some other remedy is wanting to re-invigorate the con-
stitution, to enable it  to throw of that habit of disease
under which it has long  suffered, and  for the want of
which the sore still remains unhealed, or the throat either
continues superficially sore  or it  constantly re-appears.
Under these circumstances  Nitric Acid is exceedingly
valuable, not but that other remedies might be used, and
Bark  is one, or both may  be  given together.   I happen
at this moment to have twTo just such cases, one of Secon-
dary Syphilis with an ulcer on the leg nearly as large as
one's  hand, the other also Secondary,  with superficial
soreness of the throat constantly re-appearing, both re-
maining after a full  course  of Mercury, and  both  very
nearly well under the influence of this medicine.  Nitric
Acid is taken in this way: to about a pint of water in a
jug or bottle  add, little by little, some Nitric Acid, taking
care to taste  it after each few drops, so as to make the
water pleasantly sour, but not painfully so—this quantity
to be  drunk during the day—It may be sweetened. 
  And  now, a course of Mercury being quite completed,
and  every symptom perfectly removed,  many people are
anxious about the Mercury—to get it out of the system,
as they call it, but this is quite superfluous.   It  is far
better to  let the Mercury pass off itself, which it always
naturally  does in a little time.   All that is required is
to take  a little more than  common care against catching
cold, and  to take a few doses of mild laxative  physic.
It is a  fact, that  Mercury leaves a person  rather  more
susceptible of cold for a week or  two, on which  account,
if exposure to wet cold weather could be avoided, it should
be done ;  but,  if  not,  it  can safely be  encountered by
clothing suitably and warmly.
   If, however,  any remarkable  degree of nervous weak-
 ness, or Dyspepsia,  or irregularity of bowels  should be
 left, these would be best removed by some mild aperient,
 as  the  common Aloetic or  Rhubarb Pill;  or  which  is
 probably the best thing for this purpose,  if you have not
 that,  a  little  piece of  Turkey  Rhubarb  to chew occa-
 sionally.   Indeed  nothing  will be found more useful  and
 restorative in a constitution weakened  and exhausted from
 any cause, than such  restorative  aperients.   They should
 be taken once  a day,  immediately after  a  meal,  either
breakfast, dinner or supper, and in such a dose  as just to 
keep the bowels a little more relaxed than natural.  Gen-
erally, however it is seen that a course of Mercury, given
and conducted in the manner  here  described, leaves  a
constitution better than it found it.

   But, the treatment  and cure of a common, simple case
of Chancre, having now been shown, it is necessary here
to state that they  will  sometimes assume a state of greater
severity, an inflammatory condition, which demands par-
ticular attention;  this I  will proceed to mention :—

   An Inflamed and  Irritable  Chancre.—This is  some
times seen in a very  high  degree, and, if Mercury were
given before it were reduced, it would endanger even the
very  member itself.   By the ignorant use,—the abuse, of
Mercury, in  such circumstances, loss of the penis has
again and again  happened, and even the life of the indi-
vidual.   I saw a fatal case of this kind in the N. Y. Hos-
pital  three or four years ago.  Naturally  and properly,
pain  and inflammation do  not belong to a Chancre, and
if any be present, it is owing to accidental causes.  Many
bring these on by habits of irregularity,  excitement, and
intemperance, and in others they  will spring from a full
and plethoric habit.   When a Chancre is highly inflamed,
the skin  around  it is of a fiery  red color, the parts are
swollen,  and the Chancre very  sore  and  spreading.—
Never give Mercury in  such a state  as this.

   The best means of removing this high degree of inflam-
mation are those  made use of in preparing for a course of 
 Mercury,  so that  here they answer a two-fold purpose.
 Especially is it advantageous, if possible,  to  rest.   In-
 deed, in some cases  the consequences are so threatening
 and dangerous that  every consideration of secrecy must
 be laid  aside, and absolute  rest in bed enjoined.   More
 generally, however,  smart and repeated  purging with the
 Antimonial  Saline, or Senna and Salts,  with low diet
 and partial rest, together, if  the patient  be  full habited,
 with a copious bleeding, will be sufficient.   At the same
 time, a soft  bandage, constantly  wetted with  a  cooling
 Lotion,  and if necessary a Poultice,  should  be applied,
 But  still  it   may take many days  before this inflam-
 matory state is thoroughly subdued, but however long it
 be, Mercury must not be given until it is removed.
   With  respect to the  Irritable Chancre, this may be said
 to be the case  when  it is exquisitely painful,  of a dark
 color, and  evidently spreading.   To this, other applica-
 tions are required.   Lint soaked in the Black Wash, or
 in Tincture  of Myrrh, or Laudanum, should be applied,
 and over this a Poultice  composed of grounds of beer, or
         NOTE                 ters of a pint.  The sugar of lead with
                              a little vinegar should be first dissolved
 Cooling Lotions.                 in the Alcohol.
                                The Best way to use  these is to ap-
  Evaporating Lotion.—A quarter of a  ply a'fold or two of soft rag, (linen or
 pint of Alcohol,  (brandy or other spi-  cotton), upon or around the part, and
 rits may be substituted), in three quar-  keep this wetted with it. The part
 ters of a pint of water.               should be otherwise covered up as lit-
  Lead Lotion.—Sugar of Lead a quar-  tie as possible.
 ter of an ounce, soft water one pint,-
 a tea-spoon full of vinegar should be           NOTE
 first mixed with the water.
  Evaporating Lead Lotion— Sugar of  Poultices.
 Lead a quarter of an ounce, Alcohol a
quarter of a pint, soft water three quar-    Common Poultices, are those made of 
a plaster of simple Cerate or Lard.  Also Bark, Ammonia,
and Opium should be given freely  for a time.  But I need

not here do more than mention them, for in such a case I

should certainly  advise that medical  aid be sought.


   There yet seems one remark to make upon the  use of
Mercury in the cure of  Chancre.  It relates, especially,
to when it should be discontinued.   I have said that Mer-
cury never  should be commenced when a Chancre is at-
tended with high inflammatory symptoms ; I now would
add that it  should never be  continued, but immediately
discontinued,  whenever  such appearances occur  in the
progress of its cure.   It  generally happens that when  a
Chancre or any Venereal  symptom does well with Mer-

cury, it goes on progressively to improve until the cure is
perfectly accomplished;  but, if instead  of this, after im-
proving for a time it suddenly changes in its appearance,
and inflames and spreads, depend upon it Mercury is dis-

agreeing,  and it  would be vain  and  dangerous to expect
Bread and Milk—or Bread, Flax-seed   in but little water and smash them. It
meal and water or milk—or, Ground   corrects the smell and agrees with many
Slippery-Elm Bark. They are made   bad sores.
just stiffenough to hold together a lit-
tle,  and applied as warm as can be            NOTE
borne.
  Mercurial Poultice, is the Bread, or     If the Bark alone is given, a tea-
Bread and  Flax-seed  meal Poultice   spoon full of the powder in a glass of
made up with Black-Wash, instead of   water or wine and water, is a proper
Milk or Water.  Used to spreading   dose, and repeated two or three times
Chancres.                        or oftener in the day. Another way of
  Soothing or Opiate Poultice, by ad-   taking the bark, especially in unkindly
ding to one of  the Poultices half an   spreading sores, is the following:—De-
ounce or an ounce of Laudanum, ac-   coction of Bark, half a pint—Carbonate
cording to its size.                 of Ammonia, two scruples—Compound
  Grounds of Seer Poultice,—made by   Tincture of Bark, six drachms—Tinct
using grounds of Beer instead of wa-   ure of Opium, one drachm, of which ■
ter*.    ^  . .   ^ .,  .  „          wine Slass '■a dose, taken every third
  Carrot Poultice, boll the Carrots weU   or fourth hour. 
it would re-assume a healing state under the continuance
of Mercury.   Either the Mercury is  acting too powerfully
upon the system, or the Venereal nature of the disease is
cured, and Mercury is no longer needed : at any rate it is
disagreeing, and must now be discontinued.

            The Use and Abuse of Caustic.
  The application of Caustic to a Chancre is very com-
mon ; it is done on the principle of destroying the  Chan-
cre, of destroying its specific action before it had attained
a certain maturity, by ,which it  can  contaminate the sys-
tem.  But this must be considered—as a common practice,
and in private and ill-informed  hands—a very dangerous
speculation.  If we know for fact that the matter secreted
by a recent  Chancre, at  any certain early period, is not
infectious, then indeed it would be  highly advantageous
to cauterize.   Now, in the case of Chancre—such an one
as is defined at the commencement of this Chapter—the
Venereal action has not only gone so far as to produce a
pimple or pustule, but this has broken, and if it has ex-
isted already a few  days, an ulcer, secreting virulent and
contagious matter, is presented.  If indeed a part inocu-
lated with Venereal matter were cauterized  or cut  out
immediately, like the part bitten by a mad dog, before it
had instituted an action at all, it might be then depended
on;  but this cannot be, (for we cannot  tell  that a part
has been affected with Venereal, until it is shown by ul-
ceration or pimple);—or, further, if we have* a means of
judging if there is any period at which the matter of the 
 pustule or ulcer is not  infectious, then indeed we have a
 ground on which we can rely that the  constitution will
 not be afterwards affected, if the Chancre  be early and
 perfectly destroyed by Caustic.  I would  not  therefore
 say that in no case whatever is the constitution thus pro-
 tected, but I would ask, who, where the least uncertainty
 existed,  would choose to risk his own upon this peradven-
 ture 1   I hold therefore that it is exceedingly speculative
 and unwise,  except within certain and restricted circum-
 stances,  to depend on Caustic for the cure of Chancre.
 And this too is  exactly in  accordance with the  opinion
 of  Sir Astley Cooper.   After dissuading from the use of
 Caustic,  for other reasons, Sir Astley adds, that if Caustic
 should be used, there being no certainty in this means of
 cure,* a  course of Mercury must still be entered  on, as if
 no  Caustic had been  used at all.  He  also  then goes on
 to show  the folly of this practice, by  relating the conse-
 quence of a case which occurred  in a particular friend of
 his, and  which I will give in  his own  words.

  He  states, " A young person  with  whom I was inti-
 mate, whilst  I lived with my old  master, got a Chancre,
which, to use his  own expression, he burned  out by the
 application of Caustic: I laughed at him  for being so
foolish:  the  Caustic produced a slough but cured the
Chancre, and I thought nothing more of the circumstance.
Some time afterwards, I visited  him in the  country, and
 * At the time Sir Astley Cooper wrote,
the rules respecting its proper use as an
Abortive Treatment had not been dis-
covered. 
asked him how he was 1  ' Very well, now,' he replied,
'but I have been in a fine scrape; I was engaged, when
I left town, to a  young hdy, the nuptials were to have
been soon celebrated, and the business of life commenced.'
I involuntarily smiled, but he said, < Not quite so merry :
when I got into the  country, I had  what I conceived at
the time was only a huskiness of the throat which I had
caught from cold.   My throat becoming  more painful, I
looked into the glass, and  perceived that I had a large
sore on the tonsils, decidedly  Syphilitic.   You may con-
ceive how I felt;  I wrote to the young  lady that I was
unwell, who, exceedingly hurt at such news, came and
nursed me while I underwent  a course of mercurial treat-
ment, (she being  perfectly  unconscious  of the  cause of
my complaint), by which means I was quite restored, and
the marriage ceremony  was celebrated.'':   The follow-
ing remarks-of Sir Astley are so much to this point that
I must conclude with them.   He then goes on—"It was
a proper punishment for his  folly.   The application  of
Caustic to a Chancre does not render a person safe from
its effects, for, if the sore  be a Chancre, the  Syphilitic
poison must have been  admitted into the constitution.   I
will tell  you what treatment you should pursue; as soon
 as a patient applies to you for this complaint, you should
 ask him  if he wishes to be properly cured at once, by  a
 simple  Mercurial treatment, or have the Chancre cured
 without  it, and run the risk of having secondary symp-
 toms occurring at a further period 1   His answer will be—
 ' for God's sake,  give me what is proper now for my cure,
IT 
without submitting me to the chance of being  laid up a
second time with this complaint.' "

   Notwithstanding these facts and  reasons  against the
indiscriminate use of Caustic for the  cure of Chancre,
however, there still are those who practice it.   Most of
such persons, no doubt, are perfectly ignorant of its con-
sequences ; but there  are also those whose opinions are
entitled to the highest defference, and who, under certain
circnmstances,  advocate  the  use of  Caustic.  Among
these, an eminent surgeon in France,  who has had for
many years the unusual  advantages afforded by a large
Venereal hospital, has  lately recommended it, and has
pointed out the particular circumstances  under which  it
may or may not be had  recourse to.   The rules and the
treatment he (M. Ricord) has laid down my own practice
daily verifies.  Indeed,  ever  since I had  the satisfaction
of witnessing  this treatment,  as practiced  by himself at
the Hopital des Veneriens at Paris, I have adopted  it
myself with perfect success. 
CHAPTER  XV.
On Venereal Bubo;
  Phymosts ano Paraphymosis ;
  Venereal Warts;   Their Treatment and Cure.
                   (Primary Stage.)
  Venereal Bubo.—This is a swelling in one or more of
the glands of the groin, seldom more than one, and is fre-
quently observed in connexion with a Chancre.   There
is almost always some  degree of pain and stiffness in the
joint along with Chancre, but if this  be only slight, no
application will be needed.  The Mercurial Treatment is
to proceed exactly as if there was no such feeling or swell-
ing, and as soon as the  constitution is affected, the pain
will lessen and the swelling gradually decline.   But  if
the swelling should go on and pain and  throbbing com-
mences, with inflammatory redness, and  perhaps some
feverishness, then  an actual Bubo is setting in,—the use
of Mercury must be delayed, or, if commenced, omitted,
while attempts are made to  reduce  this inflammation.
These attempts are made by such means as are proper in
other inflammatory affections, and which have several
times been mentioned, viz.—rest, purging,  and low diet.
To the part itself  any thing which will  abate the pain is
proper.   Cooling Lotions  are very useful; but  in case
of Bubo, from Chancre, more energetic measures had bet-
ter at once be employed.   Leeches, half a  dozen would 
be applied with very good effect, and followed by a com-
mon poultice,  to ensure a plentiful escape of blood for as
long as possible  afterward.  After this the Cooling Lo-
tion would be proper;  but if not very greatly relieved by
the Leeching, a  Blister of Spanish-flies should be put on
the same or the next day; it should  be  large enough to
perfectly cover the  swollen  gland, and  might be left on
about six hours.   The dressing required after this is merely
a little sweet lard spread upon a rag.  The blister ought
to be repeated the  next day or so, unless the Bubo was
much relieved by it, when the Cooling  Lotion might be
trusted to.  Also  an  Opiate  pill or Dover's Powderf
should be taken  at  night to assuage the pain and obtain
sleep, is necessary.   If, notwithstanding  all these means,
the swelling still goes on to suppurate, that is, to form an
abscess, it should be opened and  treated in the common
way.   Let it only be remembered that Mercury is not to
be given while matter seems to be forming, nor even after
it is opened, until the pain and inflammation have sub-
sided.  After this, the mercurial course is to be continued
as though it had not happened.  It should also be known
that these abscesses are not always found to heal so quick-
ly as the  Chancre  which produces  them, but will often
continue for many  weeks after  the  Venereal disease is
cured.   Neither is  the  hardness or scar, which they are
very apt to leave, to be regarded in the same light as the
hardness of a Chancre.   In  fact, these Bubos seldom go 
on to form an abscess but in constitutions that are not
exactly healthy, such as  those  embued with  scrofula, or
affected from derangement of the organs of digestion, and
therefore  require means calculated  to  correct this  state
and to improve the general health and strength, as Qui-
nine or Bark,  with some strengthening laxative pills, as
mild aperient preparations kept in the stores, or any of'the
milder Vegetable Pills, or the common Rhubarb or Alo-
etic Pill of the apothecary stores.  As to such things as
panaceas and the like, this is altogether quackery.   En
deavor to recruit the strength by  rational  means,  as a
suitable and rather  generous diet, the regulation of the
bowels and the digestive organs  by restorative aperient
means, and adding to these a moderate share  of patience,
nothing need  be feared,—time will remove the remaining
hardness, especially if assisted by any  of the preparations
mentioned

   Inflammatory Swelling of the Prepuce,—Phymosis,
Paraphymosis.—If a Chancre becomes inflamed and irri-
table from any  cause, it is likely to induce a  swelling oi
the foreskin to such  an extent as  to  prevent its being
pushed back over the head of the penis, or if pushed back,
it cannot be drawn forward again.   The former of these
cases  is  called a Phymosis, the  latter, a Paraphymosis.
Both  these states are attended with disagreealle  conse-
quences.   In the first, the sore or Chancre cannot be kept
clean, nor can the discharge attending it escape  it there-
•    17 
fore becomes irritating and thus adds to the inflammation
of the parts; and in the other, the penis itself being swol-
len, the foreskin acts the part of a tight  ligature behind
the head of the penis, preventing the return of the blood
from it, on which account it swells still more, looks pur-
ple or blackish, and not unfrequently, mortifies and comes
off. " It is  therefore  particularly  necessary  to point out
what to do in each  of these cases.   In  the first place,
then, never begin with Mercury when  the foreskin or
head of the penis is thus  swollen or inflamed;  if it has
been commenced, and  these should happen to come on,
leave it off.  I have  often said already, never give  Mer-
cury in any case of high inflammatory local disease.  This
is the  principle to act on, for it might happen  that the
foreskin did not admit of pushing back,  and yet no high
inflammatory symptoms be present,—no  high degree of
redness, nor excessive  pain, nor  feverish complaint; in
this case the Mercury should not be discontinued, for, as
it proceeds to exert its benign effect, the Chancre beneath
the foreskin will heal, and a natural condition return.

   But the particular treatment  of this  case consists in
local management.   One of the first things is to wash
away the matter that continually forms beneath the fore
skin, and to keep the Chancre  clean.  For this purpose
you must procure a  common Syringe.   Warm water, or
soap and water, will answer one  good purpose—the re-
moval of irritating humors, and will also sooth the parts.
It can scarcely be used too  thoroughly.   Throw up thp 
water with sufficient  force to distend the skin, and hold
it in a little while.  In short, do it in any way which you
may suppose suited to wash away the matter.  It should
be repeated night and morning  for the sake of cleansing,
but if its soothing effect should also seem to benefit, it may
be repeated oftener.

   But, beside the cleansing effect of warm water, a heal-
ing one may be superadded.   Nothing in general answers
this purpose so well as the Black  Wash.    It  may  be
used warm if convenient, but this is not essential.  As a
healing, cooling thing, the Lead Lotion  is found an ex-
cellent one, while the other Healing Lotions   employed,
a little weakened, are valuable when any kind of gentle
stimulant is required.
   At the same time, and  especially when the inflamma-
tory redness is considerable, Cooling Lotions  or poultice
should be applied, wetting a strip of linen with them and
rolling  it round  the  penis.  Or even an Opiate  Poultice
may be advisable.   Of course  rest, purging,  and  low
diet are of great importance.   It  is a good thing to keep
the penis from hanging down if possible.

   With respect to the  treatment of the other case—the
foreskin pushed back and remaining fixed—the  same ge-
neral plan which has just been pointed  out is equally  ap-
plicable, with the addition, however, of the means adopted
to bring the  foreskin forward  again;  but  these, having 
been already given for this case in  Chapter iv, they can
be referred to.  I must also further add, that in this case,
being much more dangerous than the former, and> especi-
ally, as it now and then  requires a little incision of the
skin to liberate and relieve the head of the penis, I would
always recommend that a surgeon be consulted.,

   Venereal Warts.—These sometimes follow after Chan-
cre, as well as after Gonorrhcea, and are called Venereal,
though they frequently have nothing of Venereal in their
nature.  It is  a curious thing, however, that they some-
times secrete a humor which communicates the same to
others.   Thus, persons having them have married, and
after a time the wife has had a similar production. And
these  sometimes increase to a great extent in women,—
they have been known to occupy a  considerable space in
the female passage, giving rise to much confusion and
inconvenience. 
CHAPTER XVI.
On Venereal Sore Throat,—Its Treatment and Cure.
             (Secondary, or Constitutional Stage).
   It has been observed  that Chancre is the form of the
disease in which Venereal first appears, and is therefore
called the primary form; and that when a Chancre is
only healed and the disorder not eradicated from the con-
stitution, in a certain time, it appears again, not however
as at first, on the organs of generation, but in some other
part of the body, but they far more frequently first appear
in the throat or on the skin than any other.

   In ordinary cases there is  but little  pain attending the
accession  of Venereal sore  throat.   A  person  perhaps
feels a little huskiness, which he may attribute to catch-
ing cold, but this increasing, he is led to examine it in the
glass, when he is surprised  to  see  an ulcer there.  The
most frequent situation of this ulcer is the tonsil glands.
These are two roundish bodies on  each side of the back
part of the mouth, between  that  curtain-like fold which
is suspended from the roof.   It will be observed  that this
divides as it descends, and at the bottom, between this di-
vision, the tonsil  glands are situated.  Now, on one or
both of these, which are always swollen and red-looking,
an ulcer will  be seen.  It looks as if a part of its sub-
Stance had been dug out—the edges  overhanging—the 
 ulcer also looking foul, with  a  yellowish  thick  matter
 tightly  adhering to it.  There is generally some pain felt,
 particularly on swallowing the spittle, and  also running
 upwards  towards the ear, and sometimes down the neck
 even to the shoulders.  This is a true picture of a genu-
 ine Venereal  ulcer in the throat; it may however differ
 materially and yet  be Venereal.  But  an  ulcer  in  the
 throat ever so exactly corresponding  with  this picture,
 must not, on account of its appearance  alone, be called
 Venereal,—it cannot safely and certainly be called  so,
 unless its  history be traced to some absolute prior Vene-
 real affection.

   With regard to the treatment of Venereal sore throat,
 nothing more can be said than has been directed for the
 cure of Chancre,  except that the  Mercury should be con-
 tinued some weeks  longer.   The  same preparation  for
 a mercurial course is necessary, as well as the  same oc-
 casion to discontinue it in the event of high inflammatory
 symptoms  and appearances.   In general the action of
 Mercury should  be kept up  for eight  or nine weeks, in
 Venereal  sore throat.  If any one should be induced to
 make it shorter, in consequence of the kindly healing of
the sore,  in all  probability,  after a few weeks, it  would
return, perhaps in the same, or perhaps, in the other ton-
sil gland,  and looking much as it did at first.

  But it should also here be stated, that after the disorder
has been  perfectly cured, a pain  on swallowing, accom- 
panied with a slight degree of inflammation, is very apt to
occur again on slight occasions, to the great but ground-
less alarm of the patient.  In this case nothing more than
a slight  inflammatory redness is to  be discovered—no
Venereal ulcer.  This is merely a nervous affection, and
can only be explained on the well known fact that ner-
vous pain is very easily re-produced in parts that have
been once the seat of ulceration or disorder.

  Further, a feeling of this kind is often complained  of
in connexion with some derangement of the organs  of
digestion, or irregularity of the bowels, for which some
restorative laxative should be taken in a regular manner,
and persevered in until a healthy condition of the diges-
tive  organs is  established.  Washing and well rubbing
the throat with cold water is also found to be beneficial.
But the practical use  of this remark, is, to avoid the repe-
tition of the use of Mercury in such a  case, and to relieve
the mind of the harrassing apprehension of remaining
Venereal disease.

  Another thing to be  further apprised of, is, that  al-
though the Venereal ulcer in  the throat is generally situ-
ated on the tonsils where it can be seen  immediately, it
is sometimes situated  in parts where it cannot be seen  so
easily, and consequently may avoid detection.  Venereal
ulcers situated in these obscurer parts shall therefore next
be mentioned, and the means of bringing them into view
described. 
   1st.  An ulcer on the upper and back part of the throaty
concealed by a curtain-like fold suspended from the roof.
—A person who  has had Venereal disease, for instance,
complains of a pain  whenever  he attempts to swallow;
it may even be so constant as to deprive him of sleep,
and yet, upon inspection, no ulcer, nor even appearance
of inflammation can be  seen.   But now we  should re-
member there are places where it may lie concealed, and
the first of these to be supected is behind the  curtain of
the mouth.   To bring this into view,  therefore,  direct
the person to  draw in  his  breath deeply, when the cur-
tain will draw up, and we  may see at least a  part of an
ulcer on the upper and back part of the throat.   A still
better  view of this may be  obtained by pressing down
the tongue and lifting up the middle point of the curtain
with a curved probe, or with any other  convenient arti-
cle.   An ulcer here is generally circular, deep, and foul,
the surrounding inflammation extending a very little way
beyond its margin.

   In addition to the internal use of Mercury,  as directed
for Chancre, these ulcerations  require a peculiar, local,
and decided mode of treatment.   I would however men-
tion, once for all, that these local remedies would  not be
safe in the hands of private individuals, and I shall there-
fore barely mention them.   My principal object  in ma-
king these remarks  is merely to apprise the  sufferer of
the nature of these affections, in order that he may know
when  and how to obtain efficient aid before it is too late. 
  The principal danger of these  maladies depends not so
much upon their nature as their obscurity, and  the conse-
quent  delay  of the proper  means of cure.   Under these
circumstances the  disease is apt to spread, and some of the
parts within this neighborhood are next to vital—the top of
the windpipe for instance.  It should  be also known that
the process of ulceration is to  destroy, and  that parts de-
stroyed by this disease are never re-produced.


   One of the best local applications to sores of this kind is
the caustic called  Butter of Antimony.   It gives pain, but
this is of short duration,  and is soon followed with ease in
swallowing and sleep at night.   This is a very active caus-
tic application.   When  used for  venereal  ulcers of the
throat, a little lint rolled pretty firmly in the eye of a sil-
ver probe, is to  be dipt into the  liquid,  and  this gently
pressed upon the surface of the ulcer.  Care must be taken
that none fall upon the. surrounding parts.   In  cauterising
ulcers upon  the roof of the mouth, the edges only  must be
touched  and not the  centre of the sore, for here the soft
parts are so thin  that an  ulcer soon  exposes the bone.
 Milder  applications  are sometimes  used,  as solution  of
 nitrate of silver, tincture ofbenzoes, &c.


   2d. An Ulcer on the  back of the throat below  the level of
 the  tongue.—When  we do  not discover a  sore above, we
 should see   if there  is  one  below the level of the root of
 the  ton<me.   If there be  an  ulcer here  it  is  desirable
18 
to ascertain  it,  for in this  place it is very apt to creep
lower still and fix on the top of the wind-pipe, which, of
all places is  most dangerous and fatal.  An  ulcer  low
down in the back of  the throat has this peculiarity—it is
shallow at its upper edge, but deep at its lower part.  A
pretty sure sign  of an ulcer in such a place  is, that  on
eating, a morsel seems to stop at  a certain point, and can
only be got rid of by taking a sip of any liquid.

   An ulcer discovered in this situation  is  best treated by
the application  of the Muriate of Antimony, as before
described.

   3d. An ulcer  situated at the lower part of the curtain-
like fold of the mouth, just as it terminates in the base of
the tongue.—An ulcer in this place is attended with pain
on swallowing, as well as pain  shooting  upon  one side
of the head and  face;  it is also complained of on pressing
down the tongue.   This sore is exquisitely sensible, and
this sensibility should be destroyed by touching it with the
Muriate of Antimony, or a strong solution of Lunar Caustic.

  4th.—An ulcer situated high up the roof of the mouth,
behind the curtain, and which cannot be brought into view
by any means.—An ulcer  is judged to be situated in this
part by the voice, which  is nasal, and there is not only-
pain on  swallowing, but  the person is teased with the
frequent desire to  draw down the mucus from the nose,
which also when coughed up is found  tinged with blood. 
This case too  is one which requires the application of
some Caustic to allay its  extreme sensibility before  the
slower and curative  operation of Mercury can exert its
influence upon it.  It is done by a piece of lint dipped in
a strong solution of Caustic, and well secured upon the eye
of a probe, which is bent up or curved so as to reach it.

   The sores I have now described are so many specimens
of well-marked Venereal ulcers.   But it should be known
that Venereal  ulcerations  in the throat are occasionally
seen to differ greatly from these  appearances.  They are
made to do so partly from the improper use of Mercury,
and partly from the influence which a scrofulous consti-
tution has upon them.  To describe all these differences
would be almost impossible, as well as useless.  The fact
itself, however, should be known.

   But there is one particular state of the throat which it
 may be as well to mention, being of frequent occurrence,
 which gives rise to much  perplexing  and unfounded ap-
 prehensions.  It has nothing at all to do with Venereal,
 for it frequently occurs in those who never had this  mal-
 ady, yet it happens to occur in those  who have once had
 the disorder, it is difficult to divest their minds of the fear
 that it is a  remainder of it.  This state consists of a thin
 covering of a whitish  or yellowish  hardened mucus on
 the back part of the throat.  It is more troublesome and
 harder in the morning than during the day, for then much
 of it will be  removed by swallowing and talking.   Al- 
 though this is a very obstinate affection, and will  some-
 times continue to give trouble for years, and not improve
 by any means employed.   Yet it is not dangerous—it is
 only troublesome.   To ascertain the present disease, it is
 only necessary to rub off  a portion of the mucus with a
 piece of lint wrapped round a probe and we shall see
 there is no ulceration,—the parts  beneath  only look a
 little rougher  and dryer than natural.   It is  sometimes
 benefitted by gargling with sea water, or by sea-bathing.
   Further, there are certain affections of the throat and
 mouth, which sometimes appear after the perfect cure of
 the Venereal disease  by Mercury, and which seem to be
 the effect of Mercury; and what is very singular is, these
 affections never  appear when Mercury is given for any
 other malady; it seems  therefore  that they are the com-
 bined effect of Mercury, with the former, but now cured,
 Venereal disorder.   It would only be to harass the mind
 to say any thing more  than merely  mention  that  such
 may happen.
   With respect to Venereal ulcers in the mouth, it is only
 necssary to say that these may appear on the  gums as
 well as on  the  tongue, and  on any part of it.  These,
however require  no other treatment than a  Mercuria.
course  as recommended for Chancre, together  with  such
local applications as have been mentioned, the necessity
of empl<\ ing which, rx wever, being determined by  the..
rapidity or pain demanding a more immediate relief than
the ; lower process of Salivation would affvd 
CHAPTER XVII
On  Venereal Eruptions,  or Blotches on the  skm,-
  Their Treatment and Cure.
              (Secondary Constitutional Stage.)

  This constitutional or secondary form of Venereal dis
ease I have placed in order  after Venereal sore  throat,
but it should be remarked that the two very often appeal
together, and sometimes the eruptions will first appear in
order, or without the sore throat at all.

  The word blotches is very often used to express Vene-
real disease affecting the  skin;  but it is very far from
being confined to blotches or copper colored spots; indeed
there is  scarcely  a single  order of cutaneous eruptions
which Venereal does not now  and then  assume, so that
it may appear in the form of  specks, blotches, pimples,
vesicles, pustules, tumors, branny spots or patches, scab-
by  sores  or open ulceration.  It would be  quite  imppssi-
ble to give a particular and distinct description of all the
various forms of Venereal disease upon the skin.  In fact
there is nothing in the appearance of these eruptions, con-
sidered in themselves, that can  in any safe  and certain
manner establish theopinion that they are Venereal.  This
the most distinguished surgeons are  aware of, and in  or-
der to form their judgement upon any'given case, they 
always have recourse to the history of the disease, consi-
dering especially the manner in which Mercury has been
given, and observing also, whether there are any other
symptoms connected with them of a suspicious or Vene-
real character.   This, therefore, shall be the manner in
which I will now endeavor to assist my reader in judging
of his own or any other case.

  But first, it should be known  of these eruptions, that,
although there is great variety in the appearance of them,
there  are certain forms which much more frequently ap-
pear than others, and there are certain changes which all
are more or less disposed to undergo.  Perhaps the most
frequent form is a branny or scaly  appearance, occurring
especially in the palm of their hands, or on the head, or
the margin of the hair.   The next  to this in frequency
may be that of copper-colored blotches, which in time
become scabby, particularly about the forehead.  A rash,
not unlike the measles, is another not uncommon form—
covering  sometimes  only a small part, and at others the
whole surface of the limbs and body.  Pimples and little
pustules containing  matter might next be mentioned.

  Venereal eruptions also are disposed to change in their
appearance.  If they are allowed to subside spontaneous-
ly, which they generally do after some few weeks, at least
to some degree, the  form in which they re-appear is pretty
much the same;  but if Mercury  has  been given,  (not
however in a way to effect  a cure, its re-appearance is 
most frequently in some different form.  For instance, if
the eruption had been in little pimples, it may now be in
little pustules containing matter; or if it  had been in
branny scales, it may be next in larger patches or in scabs
Further, there is a remarkable tendency in  all Venereal
eruptions to become scabby and incrusted ;—thus pimples
and scales at length  assume a scabby covering, and those
which begin in pustules, and naturally terminate in scabs,
become exceedingly  thick and crusty, forming elevations
on the skin.

   There is a period at which Venereal eruptions natural-
ly and spontaneously abate or disappear and  re-appear.
This is very apt to deceive, as to  the efficacy of useless
medicines.   Frequently such things as panaceas, or other
foolish things are taken, and  if the disorder happens to
abate, it is supposed  that these are curing it; this, how-
ever, at length  turns out to be complete deception.

   The re-appearance of Venereal eruption, also, as well
as its first appearance, is always preceded,  more or less,
with some general feelings of disorder; as head-ache, or
pain in the bones and lassitude, which are relieved as the
eruption  advances.

   On the going off and perfect cure of Venereal eruption
by Mercury, it  frequently happens that some spots of dis-
coloration of the skin  remain for a long while after the
absolute cure of the disease  This, time only will remove; 
 any further use of Mercury on this account, or any appli-
 cations to them would  be useless, and  indeed, far worse
 than useless.

   Before the means of cure are entered on, it still remains
 to say a word or two to assist in ascertaining whether an
 eruption really be Venereal or not.

   Many persons  both from far and near, come to me with
 one single question.  After stating a  few preliminaries,
 and showing some specimen of disease, they ask, "Is this
 Venereal ?"  To this I frequently reply, " I cannot say this
 moment, but I  will soon find out."  I then begin to enter
 on  the history of the symptoms, and see to  what I  can
 fairly trace them back.   Perhaps it will come out, as it
 often does, that the person never had Venereal at all, but
 only Gonorrhoea, (vulgarly called Clap)—this of course
 is satisfactory,  and I say at once, "It  is ?«o^/"   Gonor-
 rhoea never causes eruptions of this kind; the  remedies
 which are often used in this complaint may produce erup-
 tions, which however are very  different.

  But supposing it be fairly traced to a Venereal affec-
 tion and that Mercury has been taken, the next enquiry is
 as to the manner  in which  it had been  taken ; and  here
 I generally find a satisfactory  answer.  Few, very few,
 indeed I may say none of those who come to me with
secondary forms of Venereal  disease,  are found to have
taken Mercury  properly. 
 This   is  a   very  universal  fault.  The most part have
 never taken it so as  to  affect the gums at all,—others
 have left it off the moment the first tenderness was felt,
 and those in whom it brought about a salutary spitting,
 continued it for a period well known  to be too short to
 effect a perfect cure.

  But, suppose again we cannot be so  well assured that
 Mercury  was taken ineffectually.   In this case we natu-
 rally look with more anxiety for any other  symptom.
 Now, the one most frequently occurring in connexion with
 Venereal disorder is sore throat, and if this appears at the
 same time and in a way  resembling what has  been  said
 upon this subject in another place, it will afford a  strong
 corroboration of the fact.

  The time, too, which may  have elapsed from the period
 of taking  Mercury for its cure, is  another thing  which
 throws some light upon  the  subject.   Although there is
 a general interval between the apparent cure of Chancre
 or a Venereal eruption, and the re-appearance of the dis-
 ease, which  may  be  stated to be from eight  to  ten or
 twelve weeks more, yet, if an interval of six months, for
 instance should occur from the last appearance of Venereal
symptoms, I should consider this longer interval as  afford-
ing a stong  presumption of the perfect  cure of the com-
plaint whatever eruption or circumstance should follow

  After these remarks,  then, it is presumed, no  person 
would conclude of any disorder he might have upon his
skin, or face, that  it was of a Venereal  nature, without
considering—-first, that he must really have been once the
subject of ths malady ;—next, that the course of Mercu-
ry he had undergone had not been satisfactory,—and last,
that the interval between the former disorder and the pre-
sent symptoms, is one of at least six or eight weeks.

   And  now, on the subject of the treatment of Venereal
eruptions, I can really say nothing in addition to what has
been said on the cure of Chancre, only that, as in the case
of sore throat, it is to continue two or  three weeks longer
than in  the cure of Chancre.   A course of two months at
bast should be taken.   There is one hint however I will
give upon this subject.   Do not allow the  early and kindly
disappearing of the eruption to lull you into a false secu-
rity that the disease is cured, so as to induce you to shor-
ten the course on this account.   There is no form  of Ve-
nereal which so quickly yields to the influence of Mercury
as some of these eruptions. 
CHAPTER XVIIL
On Venereal in the Bones;—Nodes,—Disease in the
  Nose,—the Palate tyc.

              (Tertiary Constitutional Stoge).
  This disorder does not usually appear in the bones until
after it has attacked the throat or skin ; but it does some
times occur soon after the healing of a Chancre, without
a previous affection  of the throat.

  The parts more frequently the seat of this disease are
the hard portions of the  long  bones—those particularly
which are least covered with flesh, as the shins, the bones
of the fore-arm and the forhead.   The softer parts or ex-
tremities of  the long bones, as well as the small ones of
the hands and feet,  are but rarely affected, and then only
when the disease has continued a long time and the con-
stitution has been  distressed  with  various ineffectual re-
medies and  attempts to cure it.  Our  business therefore
will be to consider it chiefly in its earlier and more com-
mon form—that of lumps or tumors on the hard bones,
called nodes.

                    Venereal Nodes.
  These  are attended, generally,  with severe pain—re-
markable  for coming on in the evening and continuing 
until an early hour in the morning, say till 3 or 4 o'clock,
when it abates  considerably  so as scarcely  to be com-
plained of in the day ; as evening  approaches however,
it returns to its  accustomed or increased severity.   But it
should be also known, lest in any case its absence should
mislead in judging of its nature, that, now and then, the
formation  of a Venereal  Node is attended with but little
pain; also in some instances, a  Node will commence with
a feeling of softness  in the swelling, with much pain, but
which, after a few days, becomes hard with scarcely any
pain.

  Nodes are disposed to suppuration—that is, to form
into an abscess and break; but this they proceed to very
slowly. A Node once formed will often remain for many
months without the least change—no discoloration of the
skin or feeling of matter; more frequently however, they
slowly proceed  to suppurate.   When Nodes proceed thus
far, the bone itself partakes of the  disease, and is a long
while in getting well.

  I should also observe that a Node, at first, is nothing
more  than an inflammatory state of the membrane which
covers the bone, causing the  effusion of a little fluid.

   The Treatment of Venereal Nodes  differs in no wise
from  that of other Venereal affections.   The Mercurial
course however should be continued  longer.   The con-
stitution, also, in this form  of  the  disease, is frequently
found to be reduced, and to need      assistance. 
  When a Venereal Node is cured, the swelling and hard-
ness generally disappears; but on the contrary sometimes
the swelling will remain after the disease is perfectly ex-
tinguish,—to be  removed  only by slow degrees, or even
not at all.

  Thus the cure  of  Venereal  disorder in the bones con-
sists in continuing a course of  Mercury for a longer pe-
riod, frequently in conjunction with Sarsaparilla, and in
means adapted for the more immediate relief of pain and
suffering—repeated  blistering.   The Mercurial course
must not be less than two months.

  Rheumatic Pains, or those occasioned by the improper
use of Mercury must carefully be distinguished from Ve-
nereal.  Those who have been  affected once with this
complaint are very apt to fear that any pains they after-
wards may have must be Venereal.  They are  further
led to this conclusion by remembering their former pains
came on at night.   But, although Venereal pains are re-
markable for their severity at  night, this is not confined
to Venereal.  Rheumatic and other nervous pains are
generally worse at night  than in the day; a better rule
to judge by is the situation of the  pain.   A Venereal
sufferer will direct you to the middle of the bones, as the
shin or fore-arm; or to some particular spot on the head
or forehead, and  if you gently press your hand along the
part a roundish swelling will be felt, generally hard and
painful to the touch, while those who have Rheumatic or
19 
Mercurial pains, complain  of pain  all over; especially
about the chest and arms and down  the  legs  and joints
These are not Venereal.  Such patients  get better in tht
summer.   They should  be  directed to live  temperate!)
and wear warm clothing.   The Compound Sarsaparilla
is valuable in such cases.   Dover's  Powder  at  bed-time
also will afford relief.
           Venereal in the Nose and  Palate.
   The bones of the Nose and those which form the roof
of the Mouth, also merit particular notice here.   I might
have included what I have to say on this subject in the
Chapter  on Venereal Sore Throat, for  the disease in these
bones often begins with a sore on the  soft parts covering
the roof of the mouth;  but as it sometimes  commences
also with little Scabby pustules which appear above the
angle of the nose and upper lip and cheek, and sometimes
on the membrane lining the bones themselves,  it comes
better in this place.
   The sores in a Venereal affection  of the  throat  most
generally appear  upon the tonsil glands, but they are
sometimes seen  upon the roof of the mouth, and those
beginning on the tonsils may spread upwards to this part
It is important therefore to watch these  sores, particular-
ly when on the roof of the mouth, for if they spread, the
soff part here being very thin, the  bone is soon exposed
and so diseased as to form  an artificial  opening between
the nose and mouth.  This is always a very serious thing, 
for the voice is rendered nasal by it, and if it be of any
size, a portion of the  food  on eating is pressed through
it upon the face.

  The treatment of an ulcer in the roof of the  mouth does
not differ from one on  the tonsils, except it should become
inflamed or spreading.   Venereal sores wherever seated,
so long as nothing accidentally occurs to  make  them
otherwise, are very slow in spreading and are  attended
with very little pain  or surrounded redness; whenever
any thing of this kind happens, depend upon it there is
something wrong.

   Generally,  when a Venereal ulcer in the throat  is do-
ing well, soon after the commencement of Mercury, the
sore will begin to improve, that is, from  looking foul and
covered with  a yellowish matter, it will become cleaner,
and  little elevated points of redness will be seen upon
it;—these are healthy granulations, and the  surest pre-
sage of its cure.  And if this favorable change should not
occur before, it is sure to happen as soon as the constitu-
tion is fully under the influence of the remedy—shown
by the swelling of the gums and  spitting.   A Venereal
ulcer in the throat therefore should be treated exactly as
a Chancre, and so long as it does not  get worse, this
treatment should be pursued in the  confidential  expecta-
tion of amendment as soon as the Mercury is brought to
act upon the gums and salivary  glands.

   But if, instead of this, a Venereal  sore throat is going 
wrong and threatens to involve the bones, there are three
things which should  be considered  before we can safely
determine what to do;—these are, whether it is an inflam-
matory effect of Mercury, instead of the proper one;—or
whether it is a more than usual rapid and spreading Ve-
nereal sore, requiring a quicker effect  of Mercury;—or
whether, its Venereal nature being cured, it  is not now a
Mercurial, instead of a Venereal sore.

  An inflammatory sore throat, the effed of Mercury, I
have  already spoken of,  elsewhere.   In this case, how-
ever,  there was no previous sore,  but little  superficial
whitish spots, like thrush, appearing upon  inflamed and
reddened parts.  Here, on the contrary, a sore is first ob-
served, and this, from being very little  painful, and hav-
ing scarcely  any redness around  it, suddenly  becomes
exceedingly  painful, with  high inflammatory symptoms
may fairly be attributed to the Mercury, and we therefore
discontinue it, at the same time the usual means  for aba-
ting inflammation should be adopted—purging, low diet,
and rest.  If any other remedies were required these would
be,  bleeding and antimonial purges, for which see dire-
ctinos when the inflammation has abated, the Mercury
should be resumed in smaller doses, but increased as might
seem  necessary.

  A  rapidly spreading  Venereal sore  Throat is a verj
serious thing.   I have stated that this is not the natural 
touibc of th n disease, and when "it happens it implies the
existence of something very wrong.

  The  cause most  frequently observed  in cases of this
kii.d is a disordered or weakened state of constitution,
generally rendered so by habits of irregularity,  or an  un-
successful and injudicious use of Mercury.  The previous
treatment therefore should be a subject of consideration,
and if Mercury  has  been taken, it should be ascertained,
as near as can be, to what extent.   If, upon enquiry, it
should seem that the spreading character of these sores
commenced while under the free use of Mercury, it should
be  discontinued, at least, for a time;  or,  if  Mercury
should not have been commenced, it should  now be  en-
tered on, and in such a way as to bring  the  constitution
within its influence in the shortest time.  But  in  every
case the  state of the  constitution will demand  particular
attention, whether it be with a view of recruiting from
the  effects  of  irregularities or of Mercury, or, with a
view of enabling it to bear that  quick and decided in-
fluence of this medicine which may now be meditated.—
Here then we are accustomed to look to the Sarsaparilla
 with much confidence and pleasure.

   The Sarsaparilla is a medicine peculiarly  adapted to
 these  cases, inasmuch as it  has  the following three dis-
 tinct effects;—it is the best medicine that can be taken
 to renovate a constitution, depraved  and weakened  from
 any  cause,  especially  from Mercury; it  has also the

                        •    19 
power of  arresting  the' progress of Venereal  disease,
though not of curing it;—and it has  the  peculiar effect
of enabling the constitution to bear that quick effect and
quantity of Mercury which it could not bear without it.
In every  case of Venereal  sore throat,  which  did  not
seem to be doing well, whether  it was deemed expedient
to increase the dose of Mercury, or to diminish  it, or to
delay its use, I should always advise that Sarsaparilla be
immediately  commenced with.   As to  the best or most
convenient form to take it, this may be seen at Note
The form I have generally used, and  with the happiest
effect, but without knowing  that  it is better than  any
other, is the  Compound Decoction.  The  Bark, with
Ammonia, or with Nitric Acid, as mentioned     already.
is also an admirable medicine in these cases.   It may be
given in conjunction with, or without  the Sarsaparilla.
  I have at this moment a remarkable and most gratify-
ing instance of the combined  effects of the Sarsaparilla
and Bark, now under my care.   This  gentleman  came to
me  from the hands of one of the advertising persons of
our city six days ago.  He tells me  that when  he  first
went to  this person he  had only a little sore upon the
yard, (on the site of which there is at present a considera-
ble  degree of hardness,)  for  which he gave him  drops
and pills.   However, six days ago his throat was in  a
state of deep, ragged, foul and spreading ulceration.   In-
deed  the tonsil glands  were entirely eaten away, there 
being nothing of them left but their swollen edges.   It
was so far unfortunate  that the disease had principally
fallen upon these glands.   He was also pale and emaci-
ated, and as he said, exceedingly weak  and alarmed.  In
this case it  was not easy to say with confidence whether
it was the effect of Mercury, ignorantly given, or of the
disease, upon an irritable  and exhausted constitution.—
However, I determined  to bring  him, as quickly as pos-
sible, under the full  influence of Mercury,  and, at  the
same time, to give him  all the support I could demand.
With this view I  began with the Compound  Decoction
of Sarsaparilla, of which  he took a quart a day.   After
two days, I found no change for the better, but was con-
fident the disease had not  increased.  I then directed, in
addition to the Sarsaparilla, the following mixture. Pe-
ruvian Bark in powder, six drachms,—Compound  Tinc-
ture of Bark, six drachms,—Nitric Acid, one drachm,—
Tincture  of Opium,  one  drachm,  Decoction  of  Bark,
enough to make a half  pint bottle of mixture, of which
he was to  take the sixth part,  three  times, and, if he
could, four times a day.   In two days more, making the
fourth, I thought I saw a little improvement in the throat;
but, what was to me  a source of satisfaction, the gums
were now affected by Mercury, with an increased flow  of
spittle.  The Mercury was now omited.  This morning,
being now the sixth day, he came a different person—he
walked with a firmer step, and with a countenance of one
conscious of an  escape from misery far more dreaded
than death;—he said, expressively, I am better,—I am 
safe.   The ulcerations  in  the throat  wetc  iuw to.ally
changed; they had lost their foul appearance, and were
studded with little elavated points of redness, and which,
in fact, could only be produced by re-producing life ;md
health.  Thus in six  days  we see a  constitution reduced
to a deplorable condition, not only brought to bear the
full and happiest effect  of Mercury, but so  recruited and
sustained, as absolutely to commence the healing pvocess;
and this, totally and altogether the  effect  of the Sarsa-
parilla and the Bark.   Nor  will I allow, in any one re-
spect, that this case should be supposed to be exaggerated,
for I have it in my power to afford the fullest evidence of
its correct detail.  This gentleman (trusting that I would
not indiscreetly expose his case to every one) has given me
permission to refer any one I choose to him, and whom he
will permit to inspect his throat and to acquaint  himself
with any facts concerning it.  But this is no new thing ;
similar instances are continually occuring to me.

   It would therefore seem that the Sarsaparilla, alone, or,
in more deplorable conditions, the Sarsaparilla conjoined
with Peruvian Bark, affords the means, either  of recruit-
ing almost immediately a constitution sinking beneath the
abuse of Mercury, or of propping up its powers in such a
manner as to enable it to bear the full effect of Mercury
necessary to put an instant stop to the ravages of Vene-
real in the throat.

   Respecting the form  of Mercury to be used  in such  a 
 case as this, there are some more suitable than others.  Ia
 the case just related, I  used mercury with guaiacum, &c
 quickened by the aid of the Blue Ointment, nightly rub-
 bed into the thigh;  but if this had not shown its due ef-
 fect upon the mouth within the time it did, or, if it had
 been a case in which every thing depended on this quick
 effect, I should have used  the  corrosive sublimate, as di-
 rected   previously;  and perhaps have aided this by local
 remedies,  next to be explained.

   Local applications to  Venereal ulcers in the throat are
 adapted to two  objects;—the  one temporarily  to check
 their rapidity and to give relief to present pain,—the other
 to remove them permanently by curing the disease itself.
 Those  adapted to the first of these intentions  have been
 already  mentioned  at Notes before given; and the various
 ways of using them defined.  They chiefly act as caustics
 or as stimulants, and their value in allaying pain and giv-
 ing a  momentary check to encroaching sores, is great;
 but the one I have now  to mention is Mercury in the form
 or fumes, for this, while it re-excites a healthy action in
 these sores, as the former do, also cures them.    Nothing
 that I am acquainted with more  certainly and  speedily
 controls an eating Venereal ulcer in the throat  than the
 fumes of Mercury, and therefore what I now propose to say
 about this is of  much importance.  The great  objection
to Mercury in fumes used to be the trouble and difficulty
of using it without its being known.   It was necessary, 
for instance, as mentioned in page 209, to procure a red-
hot heater, wThich was placed upon a brick; on this red
cinnabar was sprinkled, (from half a drachm to a drachm,)
when fumes will instantly arise;  these were then drawn
in with the breath by holding an inverted funnel  over
them, and thus was Mercury, in its most penetrating form,
applied to the surface and edges of the sores.  But how
few could  avail themself of  this remedy—excellent as
it was ?  Any contrivance therefore calculated to secure
so great a good without this trouble and exposure must
be of value.   Now, this  is perfectly secured in the sim-
plest possible manner.  Just  add  four drachms of cinna
bar to one ounce of melted wax and make a candle with
it of a common size.  It will be an inch or more in length.
Then mark three lines around it to make four fumigations
of the  whole;—of  course  when it has burnt down to the
first line, one drachm is used, and you put the candle out.
The moment I first saw this excellent specimen of  sim-
plicity and contrivance suggested, I resolved to  lose no
time in applying it to practice.   I can  now add  that I
have used it since with the utmost satisfaction and  con-
fidence.

  The fumigating candle, therefore, is my favorite appli-
cation to spreading ulcers in the mouth, and I find it stops
their progress and  removes their  foul appearance more
quickly than any other application.  A drachm of cinna-
bar at night, or night and morning, is my usual dose.  But
I have also said the fumes of Mercury cure the disease as 
well as cleanse the sores.  This it does by its effect upon
the constitution.   There  is no quicker way of inducing
salivation than by the fumes of Mercury, used more free-
ly  than now directed.   It is  not often used with  this in-
tention because it is apt to salivate too severely; but when
Mercury is  given internally, which is generally the case
when fumes are used,  this  more  limited  use of it accele-
lerates its salutary action.

   The last remark to make upon this subject is, that when
the throat is brought into a healthy, healing state, the
Mercury is to  be continued for the permanent cure  of the
disease on the common principle.

   The next cause of ulceration of the bones of the nose,
or roof of the  mouth,  is one  which begins in the form of

   Little ulcerations about the angle of the nose and upper
lip and cheek.—These, when they seem to spread upward
in the nose, or without such apparent spreading, when a
pain or uneasiness referred to the upper and inner part of
the nose, accompanied by an occasional  discharge  of mu-
cus tinged  with  blood, are present and  complained of—
occurring also when  the system has been exposed to the
disease—afford sufficient reason to consider the bones are
threatened.   This case  demands the most judicious and
 decided use of Mercury, in conjunction with such local
 remedies as are known to  expedite  its  influence on the
system as well as on  the part itself, viz., the cinnabar in 
fumes.  Of course these should be drawn m by the nose
instead of the mouth.

   But beside these causes, viz., spreading ulceration of
the throat and roof of the month, and  ulceration begin-
ning about the angle of the nose and upper lip,—a Ve-
nereal ulceration may commence in  the bones of the nose
at once.   It first affects the membrane covering them, but
this being very thin, the bones are soon affected too, and
are very soon disfigured.  There is no occasion to make
a single comment upon the disgusting appearance which
disfiguration of the nose gives rise to.

   A Venereal ulceration in the bones  of the  nose  may
always be  suspected, when a person lately having had
Venerea], feels  a  little scabby sore in the nose which
being pricked away is followed by a little bloody mucus.
This in a day or two will form again, and upon removing
it will again be  followed by the same  appearance.   In
this case no time should be lost to bring the constitution
under the full effect of Mercury.   If there should be delay
and difficulty in  doing this, then  fumigating should cer-
tainly be had recourse to, for these will  not only expedite
the effect of Mercury, but in the mean while immediately
arrest the progress of the ulceration.

   There  is  now but  one additional remark I wish to
make upon Venereal ulceration of the bones, particularly
of the nose. 
  Whenever any kind of ulceration of the bones takes
place, its healing or curative process is a slow one;—the
diseased part must be separated from the sound part, and
the prosess by which this is effected is termed exfoliation.
Now, we will suppose a course of Mercury has been well
managed in a case of Venereal  ulceration of the  bones
and nose, and that the disease is cured, the Mercury dis-
continued, and the general health, if perchance it had been
reduced, thoroughly restored.  Perhaps, after some weeks,
or a month or two, there is some uneasiness in the nose
complained of, with a little discharge of matter, and this
perhaps offensive to the smell.  But what would all this
be more likely to suggest than that  the old disease had
not been cured, and that a fresh appeal to Mercury should
be had recourse to.   So sure however as this should be
the course pursued, so surely would it be repented of most
bitterly.  The uneasiness  in the nose and the offensive
discharge attending is nothing more than the necessary
consequence of the seperation or exfoliation of the disor-
dered portion of the bone, of the old disorder—the disor-
der being cured.  Now a fresh recourse to Mercury in this
would only have the  effect of renewing the inflamation of
the bone and producing a fresh exfoliating process.   Let
this remark therefore serve to guard against so great an
error.   Whenever such uneasiness and  discharge occurs
(a judicious and sufficient course of Mercury having been
completed) it is to be treated, not as Venereal requiring
the further use of Mercury, but as a necessary process
in consequence of past disease.   The  means to have re-
26 
course to,  if indeed any are required  at  all, are those
adapted to support the constitution—of which the Sarsa-
parilla, and the regulation of the digestive organs, together
with change of air, are the most important.   These how-
ever are not often needed : only let it be remembered that
Mercury is not to be repeated. 
CHAPTER  XIX.
 On Venereal Taint in the Constitution :—
   Its Effects upon  Posterity,—the  Treatment and Cure.
   On Venereal in  Infants,—their Treatment and Cure.

   The proper questions in this Chapter are—in what man-
 ner does a lurking Venereal taint affect posterity ?—under
 what circumstances  would it be a reasonable thing to sus-
 pect the  existence of such a cause 1—and what are  the
 means of removing it ?   With  regard to Stricture, the
 result of a badly-treated Gonorrhcea, as a cause of impo-
 tence, this I have noticed  in another place.

   In a former edition I ventured to reason  on  this subject,
 and, beside the effects of the disease upon the infant which
 were visible and beyond all doubt, I concluded there was
 another manner in which this latent poison  acted, viz.,th&t
 of enfeebling and destroying the power  of  propagation
 altogether.   In this  edition, however, I intend  to confine
 myself to facts, and  those which  shall rest on the autho-
 rity of others rather than my  own,—venturing only to
 suggest those inferences which seem naturally and una-
 voidably to follow.

  In the  first  place  then, I would observe, that but few
persons can have had  much  practice in midwifery with-
out having met with many instances of women  who have 
n< ver gone their time; or, having completed the full pe-
riod, have given birth  to children  either dead or which
have always,  very  shortly afterwards died—so that in
both cases they were childless women.

  In  the former instance, the  infant thus prematurely
born has presented  proofs that it had died some days be-
fore delivery.   The following are a few instances of these
facts, selected from many of the same kind, from a work
by the late Dr. Beatty of Dublin.   It is only necessary
to say, that  Dr.  Beatty was an eminent, learned and
practical  man, for  many years Physician to the lying-in
Hospital in that city.

  " I delivered a woman in Great Britain  street, Dublin,
of a putrid child, in the eighth month of her pregnancy,
which, she told me, had been the case with several child-
ren that she had had before, and that  she dispaired of
ever having living  issue.  I enquired very  particularly
into the state of health of both  parents, and suspecting
Venereal  taint to be the cause, I proposed to them the
use of Mercury and seperate beds, until I should be satis-
fied with the quantity of Mercury  used.   They  readily
complied with  the  proposal, and the result was a living
boy in due time, after the  Mercury had  been  discon-
tinued ; and  their happiness at  the  event may be more
readily supposed than  described, as  they  were both at
the time pretty far  advanced in life,  and  never had ano-
ther child." 
  " I delivered the wife of a cavalry officer of a  putrid
child in the fifth  month.  The gentleman had  been on
the continent with his regiment without his wife, and had
contracted a slight Venereal complaint, of which his sur-
geon considered him well before his wife joined him in
France.   I could  not  detect any Venereal  symptom in
the parents, but was so satisfied  with  the  cause of the
child's death, from the peculiar appearance  on the body,
that  I  recommended him to consult some eminent  sur-
geon ; and Mr. Todd was  called in, who saw the regi-
mental surgeon with me, and advised the use of Mercury,
which was regularly persevered in by both for  several
weeks.  After this course pregnancy was soon the result,
and  I had the gratification of attending her when she
had a living girl.   She has had  several  living  children
since."
   " In April, 1818, I attended a very fine hearty looking
 women, of her first child, which was born  in the eighth
 month, dead and  putrid.  This, I hoped, was from some
 accidental cause, particularly as she  said she  had re-
 ceived a  fright some time  before,   However, in June,
 1819, she again  lay-in, in the  eight  month, of a dead
 Venereal child; and 1 recommended that she should see
 some surgeon, as her husband now confessed that he had
 been disordered  before marriage.  Mr. Todd  saw  her,
 and took both under his care until he was satisfied with
 the use of Mercury.   She lay-in in September, 1820, ot
 a living boy."
                       *    20 
   Now the inference  from all this, and which I take it
every rational being will agree to is the'folio wing:  That
Venereal disease, not properly cured, may lie so dormant
in the constitution as to show itself in no other way than
in the destruction of posterity.

   Admitting this fact, then, what would be the course
which  every man to whom a succession  of such births
has happened, would be anxious to pursue?  Would he
not pursue the following ?  (I say  he, for with the mother
it is, for the most part, out  of the question,—it is with the
father the fault lies).  The first consideration would be,
whether he had ever had Venereal disease at all.  If not,
it would be in vain to reason further, and he would safely
conclude it arose from  some other cause.   But if he ever
had had the Venereal,  no matter how long ago, he would
first consider in what manner he had  been  treated, (and
here the observations made in this little book  upon the
proper and necessary use of Mercury, in the cure of this
disease, will  enable  him to form a pretty accurate opin-
ion on this matter).  Then the question, to whose care
he had been under, would  naturally occupy his mind;—
that is, whether he had fallen into the hands of a boast-
ing, knavish  empiric, or a man of integrity and skill.—
And lastly, the consideration  whether he  had had  any
healthy living children, would materially aid him,—for
where  this disease exists it pertains  to all—not one es-
»pes its deadly influence.  Reflecting on  these circum-
stances then, he  would soon determine  whether he  had 
had just ground to suspect himself to be the cause of these
serious events, and if this should  be  the  cause, he would
next inquire if there were any means of cure.   This ques-
tion, however, may be answered with the most gratifying
confidence—there are; and they  are of a nature too, con-
sidering the importance of the object, of no extraordinary
severity or inconvenience.

  The means of cure in a case of lurking Venereal taint
consists in submitting both husband and  wife to a simple
steady use of  Mercury, exactly as for Chancre, but con-
tinued for a somewhat longer time.   During this course,
the  husband and wife must rigidly observe a state of se-
paration.

  Again, in no wise would it be of any use to put one
upon a course of Mercury without the other; or to sub-
mit  each to Mercury at different periods.   It is no matter
whether the husband alone had  the disease, originally,
and the wife apparently never at  all.  Without  any kind
of reasoning, we must be  governed by the fact, and how-
ever much a mystery it is, experience teaches that it is of
no use to submit the one  to Mercury without the other.

  These things being premised, a course of Mercury, ac-
cording to the rules laid  down for the cure of  Chancre,
but  continued for two or  three weeks longer, may be en-
tered on with the  greatest  confidence of success.   The
course of treatment should be followed  by some of the
tonic restorative decoctions, and, if bowels are not regu- 
lar with restorative aperient medicine, if the constitution
should in any way be disordered by the Mercury.

   Perhaps it will not be unnecessary here to give one case
of my own in addition to those selected from Dr. Beatty's,
—it will show how easily and  successfully it is managed.

   I was engaged to attend a lady in her first confinement.
It was then  about the third month.  We went on very
well till about the seventh, when it was observed she did
not at all increase in size, nor did  she  feel the child  as
she had done before.   None of us knew exactly what to
make of it.   At  the full time, however, I was sent for,
as labor pains came on, and in a few hours she was de-
livered  of a  putrid mass, scarcely in the  form of  a child.
But she did well.  A few days afterwards I ventured to
ask the husband if he ever had  the Venereal disease, to
which he said he had, but it was many months before his
marriage.   Then I inquired into the manner in which he
had taken Mercury, and found it was far  from being sa-
tisfactory.  This was quite enough.  I persuaded  them
both to undergo  a proper course, to which they readily
consented, and in thirteen months I delivered her again at
the full time, of a fine healthy boy.

   But another effect of Venereal taint is shown upon  in-
fants born at  the full time of living.   Here additional
information is required, both  as to the  symptoms which
indicate the disease, and the means required to cure it. 
  In some instances infants born under these circumstan-
ces indicate the disease by a weak and impoverished con-
dition, together with copper-colored blotches  about the
fundament and genitals, which soon spread to other parts
of the body.   These peculiar copper-colored blotches, es-
pecially  occurring in these parts, are considered  almost
unequivocally as marks of Venereal disease.  The coun-
tenance  of such infants have also a peculiar appearance,
it is a resemblance of extreme old age.

  It still more  generally happens, however, that infants
of such  parents that are born alive, have the appearance
of being healthy and well at first, but in a few  days  pine
away and suddenly die; or, that they live to develop the
fuller marks and unequivocal symptoms of the disease by
slow degrees.   These symptoms Dr. Colles observes, be-
gin " in a period varying from six  to  eight days to as
many weeks."   They first appear in copper-colored spots,
and what is remarkable,  these are almost always  seen
about the fundament and organs of generation, spreading
to the groin, showing  a tendency to  pass into sores and
ulcerations.   At this time also the voice changes, and it
cries with a peculiar hoarseness of sound.  The disorder
then proceeds to show itself in little whitish sores about
the mouth, tongue, throat and  nose, from which latter a
discharge of matter flows, and often dries into crusts, very
much obstructing its breathing through the nose.   If the
child lives on, other symptoms appear, as sore eys, swell-
ing of glands,  &c, &c.   But  we must not suppose all 
these symptoms occur together in every case,—sometimes
but few of them appear, the most common of which are,
the copp*er-colored blotches  about the  fundament and
adjoining parts—generally followed by some appearances
in the  throat  and  mouth.  Neither, indeed, must it  be
thought that in every instance in which  these or similar
symptoms occur, they are Venereal, for some of them may
be the consequence of neglect of cleanliness, or a poor
diet, &c.—and then  an attention to these causes, with
simple remedies, will improve their  appearance and ulti-
mately heal them.   Other  circumstances also will  assist
the judgement,  such as having other  children that  are
healthy, and the additional testimony of the conscience on
the subject.   With regard to the

   Treatment of the Venereal disease in Infants, this, in
seme measure, is peculiar.   Of course, in  general, when a
child comes under treatment for this complaint, its parents,
or its mother at least, does so too.   Now, it is a well at-
tested  fact,  that when the  mother  has been put under a
proper course of Mercury, and she at the same time has
suckled the  child, both the mother and child have got well
togethei, without giving the child  any medicine at  all.
In this case no doubt the  infant is cured  by the effect of
Mercury conveyed to it by the milk.  It used  to be the
fashion, particularly when the state of the mother's health
did not allow of sucking, to salivate a goat, and sustain
the child upon its milk; but this is  not so often  now the
plan pursued.  Admitting the fact,  however, that  the 
milk of the mother under a course of Mercury may cure
the child, it is generally thought advisable to give the
infant Mercury too.   When therefore it is determined on
to give the infant  Mercury, one of those preparations
must be chosen that can be most depended on for gentle
ness of operation.   The very greatest caution is required
to bring an infant successfully through a mercurial course,
yet it is not impossible.  If it should purge, this would
be checked with a little mixture made of—twenty grains
of chalk, one  drop  of laudanum, and a little syrup with
water  to two ounces,—one quarter part of which may be
given  every third or fourth hour  till the bowels are re-
lieved  and easy.  And, in like manner  as in adults, if the
breath should  become offensive, and the gums sore and
ulcerated, the Mercurial medicine should be omitted for
a time at least.
   The mildest preparations of Mercury  are,  first—the
Creta  cum Magnesia, then  the  Creta  cum Hydrargyro,
then the Blue Pill.  The dose of the  two former is two
to five grains, given night and morning; of the latter one
to three grains.   In giving these directions  it is not by
any means intended  to recommend their domestic employ-
ment.   Such  cases  demand the physician's utmost care
for any chance of success.
   Without a  doubt  therefore, it  seems that  an uncured
Venereal disease has a fatal effect upon posterity;—it
either destroys the  infant before its maturity of birth  01 
more gradually unfolds its  nature in the living cnild.
With respect to a third effect, that is,  whether it may
destroy the power of propagation  altogether, this, as I
have said before, having no such positive proofs of, I will
not  venture  +o  say,  farther than  as a matter of opinion,
for I think it does.   There are many other curious circum-
stances which might be mentioned on the subject of this
Chapter, but with which I could  not  conveniently swell
this  little volume.  All that are useful and important, as
well as curious, I have mentioned, of which I think none
can present a deeper interest than the fact,—that Vene-
real  disorder, if not paoperly  cured, may lie so dormant
and unsuspeded in the constitution as to show itself in no
other way than in its fatal, or miserable effects upon pos-
terity, if it do not  even  destroy the procreating faculty
altogether.
I 
CHAPTER  XX
On Certain Complaints which Resemble Venereal Dis-
  ease, and sometimes arise from sexual intercourse, but
  which,  nevertheless, are not Venereal, nor can be
  treated as such without the greatest disadvantage.
(Persons affected with these complaints are often cruelly
  imposed upon by advertising people.)
  In Chapter the Eighth I undertook to show  that  the
Genital Organs are subject to several disorders resembli»g
Gonorrhoea, which  are not really so, but which, however,
either from ignorance or knavery, are taken for that  dis-
ease and  treated as  such.   The evils arising from  thi*
dishonorable conduct are there also correctly pointed  out.
But, if the consequences of taking every casual disorder
of these parts for Gonorrhcea be so lamentable, the mis-
fortune of taking them for  Venereal, and treating the*
accordingly, is  ten times more disastrous.  It will  there-
fore be my object  here, first to show that such innocent
diseases do occur,  and next, how to know them.
   That the Genital  Organs are subject to other diseases
besides the Venereal, must be evident to every one who will
for a moment consider the structure of these parts.   The
external organs, for instance, are covered with a  con-
tinuation of  the same structure which covers the surface
of the body,  ami therefore must be subject to most of the
21 
diseases which the skin is subject to.  If, therefore, a cut
or tear were to happen to these parts, this would proceed
in the same manner it would do in any other part of the
body.  Suppose, for example, a simple cut were to bap-
pen  on any other part; this, in good health, would, if
kept clean, soon get well.   But suppose the health were
not good, or, instead of  being  protected from any cause
of irritation, putrid and offensive matter were applied to
the wound,—would it then get well?  Certainly  not;
but would inflame and degenerate into what the surgeons
call "an ill-conditioned tumor."  Now this happens  con-
tinually to the Genital Organs.   Under excitement, per-
haps a little  laceration  or  tear takes place, but this, in
good health and kept clean, soon gets well; if, however,
on the contrary, cleanliness  were not observed, or if any
offensive and  acrimonious discharge of the female were
applied to the laceration, then  it would not do well, but
would inflame  and become an  obstinate, suspicious, ill-
conditioned sore.   Still, it  would not be  Venereal, and
to treat it as Venereal  would be to expose the patient to
the possible destruction  of the parts,  and certainly  to
much needless anxiety and suffering.   Some females are
very apt to have the natural secretions of  the sexual or-
gans increased  in  quantity, and  when,  from any acci-
dental cause, they are altered  in quality also, irritation
and,ulceration  after connexion  are the  frequent  conse-
quences of it.

   Another cause of ulceration arises from want of clean- 
 liness  in  men.   Sometimes  the  natural secretion under
 the foreskin becomes increased in quantity, and, if it  is
 suffered  to  accumulate, it irritates and inflames.  The
 discharge from this cause may be considerable, and then
 it is often taken  for a  Gonorrhcea;  at other times it ul-
 cerates rather than excoriates, and is then taken for Ve-
 nereal disease.

   Again, a Stricture in the urinary passage, as has been
 already noticed, is, now and  then, the cause of little ul-
 cers on the penis, which are very apt to be mistaken for
 Venereal sores.

   There is still another kind of ulceration arising from
 Venereal disorder partly cured by Mercury and partly un-
 cured.   The organs of generation, as well as  other parts
 of the  body are subject  to them.   They have, however,
 very little of the nature of Venereal in them, nor are they
 to be  treated  as  Venereal.  Many call these " Pseudo*
 Syphilitic, or  Bastard  Venereal," of which I shall pre-
 sently  have to speak.

   There may  also be other disorders of these parts which
 are occasionally mistaken for Venereal, but those I have
 mentioned are the most common, and with a little  care
 can easily be distinguished.  Indeed  there  is something
so peculiar in Venereal disease—something so unlike dis-
eases of any other kind, that, if its progress be not hasti-
ly interrupted by ignorance  or officiousness, it will be 
 easy to destinguish it from every other.  The first thing
 is to get acquainted  with the genuine peculiar character
 of a true Venereal  sore, and, in any particular case in
 which there is a doubt, just wait a little, and if it be Ve-
 nereal, it will put on this  peculiarity of character so sa-
 tisfactorily  as to leave no  doubt  about it.   The five
 disorders then which I have stated to be most frequently
 mistaken for Venereal, are,—simple laceration,—sores
 arising from acrimonious  secretions  in the  female,—ul-
 cers from a Stricture in the urinary passage,—and sores
 from improperly  cured Venereal disease.   I will  there-
 fore now explain how you can detect them, and how they
 should be treated.

   First,—Simple laceration of the  skin during sexual
 excitement.—It  will  be  of great service in this inquiry to
 keep in mind what was said in the former Chapter on the
 true Venereal Chancre.  The description there given of
 it is in the words of the great John  Hunter,  and  which I
 will repeat.—A genuine  Venereal  ulcer, he says, is " a
 sore of a somewhat circular form, excavated, with matter
 adhering to  its surface, and with a thickened edge and
 base."  It was  also observed, that  a genuine Venereal
 sore did not always put on these peculiarities immediately,
 nor did it always put on every one without exception at
 all,—one or other of them might form imperfectly.   Give
it a little  time, however, and  a  true Venereal sore will
 assume this character, or if in any point it should chance
to be defective, still there will be enough of  what is pe- 
cuiiar to this kind of sore to enable you to recognize its
true and specific nature.
  Suppose then you had a simple tear upon  the penis
You  would first consider how  long it was  since  you
had been  exposed.   But perhaps this  might  be only a
few hours,—six  or  eight;—in  this case of course  you
would consider it to be  a laceration, and it would have
been seen  immediately if it had been looked  for.   But
still, the other party might have been diseased, and  Ve-
nereal  matter may  have been  superadded.   Now  this
possibility gives  occasion to the  advice I am now about
to press.   Do nothing but keep it dean with cold water
and watch it.   Never in such a case consult that  class of
people who call  every thing they see upon these parts Ve-
nereal.  This tear, it is true, may be Venereal, but  it is
impossible, at this early period, for any one to say  for
certainty whether it is or not, and a  misstatement here,
whether from ignorance or knavery,  would involve  the
direst consequences.

  It is most desirable to impress  this fact—the obscurity
and  uncertainty of  these early  appearances—deeply on
the mind, and to do  it more effectually  I will  subjoin the
words of that eminent physician, Dr. Adam Smith, upon
the  subject.   In his learned  work on morbid  poisons,
page 111, he says—"In whatever part a Chancre occurs,
its*first appearance is  often uncertain, depending on the
constitution,  or  the  sta'.e of it at the time the irritation
21 
commences.  It is seldom we see the first vesicle which
is formed; more commonly, especially if the disease is on
the gland, this  vesicle is broken  and discovers an excori-
ation, and sometimes a slough.   In either of these states,
it is net easy to ascertain the real character of the disease,
and all  prudent, perhaps I may  say all honest men, sus-
pend their opinions and treatment beyond what may be
necessary for the immediate symptoms, till the part shows
a disposition to heal, or discover its true character.

  He then  goes on to say—" Nothing can be more cer-
tain than the true character of  a Venereal Chancre, and
nothing cured with more certainty.   The difficulties and
intricacies attending this form of disease, have arisen from
indolence, ignorance, or artifice.  Those who have  not
industry to attend  to the discrimination of ulcers on these
parts, or who have not had opportunities of distinguishing
them, may be mistaken; but unfortunately there is a class
of men too  often  applied to in these cases, whose only
object is  the advantage they can make of their patient,
and  who indiscriminately condemn  whatever ulcers are
found in  these parts.  This is the more disgraceful,  not
only because in the early stage  it is  often impossible to
ascertain what such ulcers  may be, but because the  use
of Mercury  will exasperate some, and induce a degree
of uncertainty on  all whose character has not shown it-
self  before the  use of the remedy."

  In a case of  laceration, or an  abrasion  of the skin of 
the penis, after  an exposure to disease,  therefore, your
business is to wait and watch its progress, doing nothing
more than keep it clean by washing it with water.  If
the sore is on the head of the penis, or  beneath the fore-
skin which covers  it, it would be as well to apply a little
piece  of lint, simply wetted with  water, and draw the
prepuce  over it.   Thus watching  it, and  doing nothing
that would change its natural  course and outward cha-
racter, you will soon arrive at a knowledge of its real na-
ture.   If it be a simple tear, and nothing of Venereal in
it, it will soon get well, as any other common sore would
do.  But if Venereal matter should have been superadded
to the tear,  then, sooner or later, generally in a few days,
it will assume the character given by Hunter of a Vene-
real Chancre, 01 present  at least some of its peculiarities;
and again, if it should neither heal nor  exhibit any of the
proper characters of Chancre, but  present the appearance
of a common ulcer, then we may conclude it is one of
those other disorders which are frequently communicated
by sexual intercourse, but which have  nothing of Vene-
real in them. I have already said that  certain vitiated
secretions in females, or neglect of  cleanliness, will pro-
duce  such ulcers, these, however,  are not the only causes
of them.
   If, then, a laceration or an  abrasion of the skin upon
 the Genital Organs should be Venereal, it will be known
 by its putting on  the peculiar  character of a Chancre, as
 before described.  The first  thing usually observed is a 
tte¥dhess( both1 around and beneatfr it.   This you can feel
by preying* on it with the finger, but by pinching it up"
between the  thumb arid finger, it is very sensibly distiri-
gtifabed.  Yoti cannot well  mistake this feel, it is so pe-
culiar, and as far as I know, it belongs to no other recent
sore but the1 true Venereal.
   The next thing is, that simple laceration, if it enlarge,
does so by spreading  superficially;  whereas a Venereal
sore enlarges  by eating deep into the substance of the
part, and  the middle of the  ulcer is always the  deepest
part, while the edges of it are a little elevated above the
surrounding skin, as well as  hard.
   Neither does the  peculiar color of a Venereal sore al-
ways show itself immediately, but after a time;, and very
shortly  after the symptoms I have  mentioned  have ap»
peared, is is covered  with a toughish adhering  kind of
matter of a brownish yellowish' color, which a simple la-
ceration never presents.  Another thing to remark upon
these lacerations or abrasions, is, that when they inoculate
with Venereal matter,* that is, when  they  are  Venereal,
their peculiar  Venereal characters do not show them-
selves so soon, nor in  such  regular order, nor  are they
always so well defined, as when  the  disease appears in
its natural way—when it is  absorbed through  the skin
and first appears in the form of a little pimple, without a
tear or  art abrasion of the skin, and on this account it is
prudent to wait for severeal  days, perhaps eight or ten,
before wp settle whether they really are  Venereal or not 
  In the event, however, of having waited a reasonable
and sufficient time, and none of these Venereal characters
appear, then, if they should not heal, but are inclined to
inflame or spread, it will be proper to adopt some means
of healing them.—If pain and inflammation attend, wash-
ing and bathing them  with warm water, or milk and
water is very good, and after this the common white wash
(sugar of lead water) is a proper thing; —some may even
require a poultice.    But if thfy simply remain stationary,
without much inflammation, then gently stimulating Lo-
tions would be proper, such as brandy and water, or one
of the  Lotions or Black Wash,  or, if they still remain un-
healed, touch them with the Lunar Caustic every or every
other day.   Also, take an  active purging dose or two of
pills.

   The second,—Sores arising from the natural secretion
beneath the foreskin, which in hot weather or from want
of cleanliness,  accumulates, becoming acrimonious  and
irritating.—The  effects of this irritating secretion  are
 frequently such  as to be taken for Gonorrhcea, as I have
 described Chapter vni; in  this case the head of the penis
is excoriated and the discharge of matter very copious j
 at other times it causes ulceration instead of excoriation,
 and then it is that it is apt to be taken for Venereal dis-
 ease.   Now the same means which were advised on  the
 subject of detecting a suspicious laceration of these parts 
are to be depended on in this case, viz., cleanliness and
watching.   If the sore be Venereal it will show itself by
assuming the distinguishing marks of that disease, just as
was described in laceration, but in a shorter time.  If not,
it is probable it will heal under the plan of simple clean-
liness.   If, however, it would not heal, and still present
none of that  hardness so peculiar to  Venereal, then a
stimulent plan, similar to that recommended in simple la-
ceration, should be resorted to.

   The third,—Sores arising from sexual intercourse with
females of uncleanly habits, or having certain  mild dis-
orders totally unconnected with Venereal disease.—In this
place I need do little more than repeat the fact that such
disorders do  occur, referring those who doubt it to  what
was said on this important subject in the eighth Chapter,
that which treats on disorders which resemble Gonorrhcea,
but which have nothing of the nature of that disorder in
them  Here, however, it is proper to observe, that while
in some  these irritating  fluids will produce disorder re-
sembling Gonorrhcea, in  others it produces sores which
are frequently mistaken  for Venereal disease.    But  these
may easily be detected.—Just compare these little ulcer-
ations with what was said about the  genuine Venereal
Sore or Chancre.   Not that it is necessary to keep in mind
the whole of these peculiarities;  for there is one of  them
alone  of much more value than all the rest together—it
is the hardness of its edge and base.  Now the sores we 
    considering nave not this  hardness; it is, therefore,
only necessary to ascertain this fact to be pretty certain
they are not Venereal.

  With respect to the treatment of them, the more sim-
ple  this is the better, for  although  they will not  always
heal with  simple  remedies, such simple remedies should
always first be tried.  I would, therefore, advise that at
first nothing but lint soaked in cold water be applied to
them.  This is best suited to those which  are  situated
between the prepuce and the head of the penis, for/here
the  prepuce can be drawn over and made to cover it; but
if they are situated on the outer parts, white  cerate may
be spread  upon the lint and this lapped round the penis
and confined there.   You are not however to expect that
these will always heal like common sores, for  it must be
remembered they  originate in  a kind  of animal poison,
though not Venereal.   If, therefore, they do not heal
under this simple means,  we must advance upon  the
stimulating plan, just as in  the two former  species.  I
should therefore begin with the Black Wash,  and if that
did  not succeed,  I would try another  Lotion,  soaking
a piece of lint with it instead of the cold water.  In some
instances I have dipped my finger in the powder of white
vitriol, and held it to the sores for a minute or two, or
more, with very good effect.   In  other slow and tedious
cases, I have touched them with the Lunar Caustic every
day or two. 
  These sores in general do  not require the internal use
of Mercury; indeed, some of them are generally exaspe-
rated by it, while others are as greatly benefitted;  in such
however, the Mercury is given in a milder form  than in
Venereal.  In every case it is of especial  service to re-
gard the state of the digestive organs, that  is, the sto-
mach and the bowels.  If these are in a disordered state,
which  is shown  by a whitish looking tongue, furred in
the morning at its root with a brownish coat, the bowels
*t the same time irregular, and the stools of an unnatural
smell or color, depend upon it there will  be  difficulty in
healing them while this continues.   Nothing however is
easier than to correct this state.   The best way to do it is
to take  Rhubarb and Soda for a week or  ten days, with
a blue pill  every other night, or, the  rhubarb alone would
do.    Just  keep a  piece  of Turkey rhubarb  in  your
waistcoat pocket, and every morning nibble off a  portion
a little  larger than a pea, or just enough to keep the
bowels  rather  more  relaxed  than  natural.  Simple as
these remedies may seem, it is  astonishing to see the
good which results, and not  only in  this, but in a vast
variety  of  maladies accompanied  with these symptoms
of disordered stomach.

  The  fourth,—Sores  on  the Penis  in  consequence of
Stricture in the  urinary  passage.—When speaking  of
Stricture in a former Chapter, it was stated that among
a number of consequences  arising from that disorder,  ul- 
 cers on some part or other of the Genital Organs was one.
 The fact itself is strange, but admits of explanation.  It
 depends on a law of sympathy —a  power of the nervous
 system which produces  disease in one  part from a disor-
 der seated in another; thus disorder of the stomach pro-
 duces  pain and disease  in the head; and in that painful
 disease the stone, the  pain is felt not in the bladder, the
 seat of the disease, but  in the tip of the penis.   In like
 manner a Stricture  occasionally  produces irritation and
 disease of the penis, or in the testicles,  or elsewhere.
   The late Mr. Abernethy of London  took much pains
 to explain the  nature  and treatment of these ulcers.  He
 was led to this from meeting  occasionally with very ob-
 stinate sores on the penis which did not correspond  with
 what he called Pseudo-Syphilitic, (a kind of sore I shall
 presently have  to mention,) and which at length he found
 to originate in  Stricture of the urinary passage.  Further,
 in the  correctness of this opinion be became afterwards
 fully satisfied, by finding that ulcers of this kind, which
 had resisted every means that could be  devised, or which
 if healed, would afterwards re-appear again and  again,
 were speedily and permanently cured on the removal of
 the Stricture.  My own experience also warrants me in
 saying that  Stricture  does occasionally produce this ob-
 stinate  and  often-recurring kind of ulcer on the  penis;
 and, indeed,  accordingly, whenever  I meet with sores of
 a peculiarly unyielding  nature, being  also  deficient  in
 other features  proper  to Venereal, I am always inclined
to suspect they  originate in  Stricture; and  further, if
22 
 upon inquiry, it appears my patient  never had  the  true
 Venereal, but only a Gonorrhoea, my suspicion is con-
 firmed, nor do I rest  until, by passing a bougie, I ascer-
 tain the fact whether it be so or not.

   With respect  to  the treatment of this kind of sore, it
 is scarcely necessary to say that it consists in a removal
 of the Stricture.   When this is done, and even while it is
 doing, these ulcers generally heal under any simple dres-
 sing—if not, those dressings already recommenced under
 the stimulant  plan   never fail to heal them once for all.

  The fifth,—A species of sore upon the penis, the result
 of an ineffectual course of Mercury for the cure of Vene-
real disease, the same which Mr. Abernethy has  denomi-
 nated "Pseudo-Syphilitic, or Bastard VenereolP—This
 is a difficult part of the subject to write about, and it does
 not, I  think, properly concern the general reader.  In-
 deed, I should not have mentioned it at all, but for a wish
 to make this little volume  as complete  as  possible, and
 also to interest the medical as wel 1 as the general reader.
 Those who are afflicted with the  obscurer forms of Vene-
 real disease, should  never  undertake their management
 themself, but, if posible, should  consult  the most  expe-
 rienced surgeon to be found.
  Mr. Colles, that practical and  excellent author on Ve-
 nereal disease, so often referred  to in this little  work,
justly observes, there is no  doss of complaints which does 
not occasionally fail to present its distinguishing charac-
ters, or present them so faintly as scarcely to  be recog-
nized.   Now, it is just this that creates the difficulty;  for,
when a suspicious or irregular sore presents  itself,  it is
hard to tell  whether it  is one  of these Venereal sores
which  have failed in exhibiting its distinguishing charac-
ters, or of a Pseudo-Syphilitic kind.

   This bastard sort of Venereal we are now considering is
supposed  to be a compound of Venereal disease, partially
cured by Mercury, blended with some other disorder of the
constitution, such as Scrofula.  The great scource of this
kind of disease is the use of Mercury by unskillful peo-
ple.   Being known  to almost  every one that Mercury
will cure  the Venereal disease, persons of every grade of
ignorance presume on this, and  give it  indiscriminately
and  ineffectually.   There is  scarcely a  shoe-black who
will not prescribe it to his acquaintance if he is fool enough
to take it, and hence, almost exclusively, that perplexing
host of Pseudo-Syphilitic maladies   The fact is, although
Mercury is the safest and most certain remedy for the cure
of Venereal disease, there is no article in medicine which
requires a more skillful and experienced mind in prescri-
bing it;  or, closer attention to the rules which have been
given in a preceding Chapter for its proper management
And it may be further added, neither is there any one dis-
order which calls for profounder knowledge in every  sin-
gle department of medical education, than that for which
Mercury is so peculiarly the remedy—the Venereal  dis- 
ease.   Who then can wonder that these perplexing and
destructive cases  should so frequently occur.

  Mercury, therefore, given  ineffectually, fails in curing
the Venereal disease ; in this case, after a time, it re-ap
pears, and Mercury is again  resorted to.  Still, however,
given as before, the  disease  again  appears, not perhaps
exactly in the same form;  for, being interrupted thus re-
peatedly, it looses much of its external Venereal charac-
ter, so that it is not so easy to tell whether  it is Venereal
or not.  At length, however,  these repeated ineffectual
modes of giving Mercury break down  the constitution,
and thus  excite  in it whatever malady it  might be dis-
posed to.   This, very frequently, is some form or other of
Scrofula, and this disorder, Scrofula, blending with Vene-
nereal, forms this Pseudo-Syphilis—appearing sometimes
in the bones, or in blotches on the skin, and sometimes in
a little ulcer on the penis.

   Now, in order to detect the nature of these sores, it is
necessary to ponder well  both  over the history and the
treatment in each case.  It  is of course essential to as-
certain that there has been, at some  time  or other, real
Venereal disease; and also, that Mercury has been given
for its cure.  It is  also expedient  to be certain they do
not arise from  Stricture, for a person may have had Go-
norrhoea and Venereal too, and the Venereal being cured,
these sores may arise from  Stricture, the  result of Go-
norrhoea. 
  With respect to the treatment of them, I can do little
more than speak of this in general terms.  It consists m
giving very small doses of Mercury, and continuing it for
a considerable length of time.   This also combined with
such remedies as support or recruit the general  health
and strength; such as Bark, Quinine, or Sarsaparilla.—
Change of air, especially to the sea-side, has been found
exceedingly useful.  Also, all  that has been said on the
utility of maintaining a regular and healthy state of the
stomach and bowels in diseases generally, applies espe-
cially to this case.   Indeed, I have known many obstinate
disorders of the Genital Organs  greatly benefitted or en-
tirely cured simply by attending to this one subject, and
I should consider that that case was under no unpromising
course of  cure which  was under the treatment  of the
Rhubarb and Soda, or  some  mild kind  of  tonic  ape-
 rient  and,  perhaps, together  with the Blue  Pill, as di-
rected  beforehand,  and continued for some months.  In
such a case the mixture or  pill might  be omitted  after  a
week  or  two,  or only  resorted to  as the state of the
bowels might require, while the Blue  Pill should be con-
tinued regularly every other night. 
 
 
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