V,'.V,V.VK.
iV/.'.'.'/.v. ,'.\W/,V>V
 ' ■ ■ ■'.' '.•s/.'.Vrts.. »*£.'/.w.v.v.'.■,';,',
-.-.'.'.'.-.'A/.- >//. '.:• *'////■/>'. //■'>'•'///*
:«:W:%S....... 
H   SCrfrs,..................       ^
\]          No.3 iT/.£> L.           c 
 
 
   A PRIVATE TREATISE



            ON



VENEREAIi DISEASE,




     GONORRHCEA,



           &c.  &c. 
the private chest complete.
 tThe chest complete contains the book Jilted, in the
lid,—the medicine for the Venereal disease,—the
medicine for Gonorrhoea,—the Patent Syringe,—
and ingredients for injections,—price $15.
  A smaller chest containing the medicine for Gon-
orrhoea  alone, together with  the  book, patent sy-
ringe, $c, is $10; and one containing the medicine
for Venereal  alone, with the book,  is $10.  The
book alone is $1.

   The whole is fitted in a little mahogany chest
not larger  than a small book, with lock and key,
and is  conveniently and privately forwarded in
the form of a package to any part of  the  United
Slates,  the West Indies, or elsewhere. 
THE PATENT SYRINGE BAG.
A. The bottle open.
B. The pipe.
C. The cap.
D. The syringe filled.
   The. Injections are made by putting one of the
powders into the bag, and filling it with water j
the pipe is then screwed on, and over this cap, for
the purpose of carrying it in the pocket. 
Entered according to an Act of Congress, in the year 1840,
             by Joseph Ralph, M. D.
C. C. & E. Childs, Jon. Printers,
  80 Vesey st. New York. 
    A  PRIVATE  TREATISE
                     ON

VENEREAL  DISEASE,
IN  TWO PARTS.
The First on Gonorrhoea,—vulgarly called clap.
  The Second on Venereal, properly so called.

Adapted to the  use of every one, but more especi-
  ally designed for those whoa|e delicately circum-
  stanced and require a private as %ell as a speedy
  cure.         .  "            . V
         BY JOSEPH'j^ALPH^.D.
Graduate of the University of Edinburgh;—Member of the
  Royal College of Surgeons, London ;—and author of
          " The Family Physician." &c. &c.
SECOND EDITION,—Greatly Enlarged.
  Sold by the author—Dr. Ralph—38 Courtland street, JV.
 Y.: who may also be consulted confidentially, by post  or
otherwise, on those various and delicate circumstances and dis-
eases which relate especially to  sexual weakness in either male
or female. The consultation fee is five dollars, but this is not
expected when the little chest, &c.—described in page 121 —
is requested. 
 we

  \4~Q       INDEX.

RW3p            __

  1840
  Introductory remarks,—which should be read by every one.

                                               Page.
CHAP. I.—On Gonorrhoea,—Its nature, symptoms,
          progress, and consequences.   -    -        1
CHAP. II.—On  certain  diseases  which  resemble
         ■ Gonorrhoea in some respects, and are fre-
          quently mistaken for  it,   but which are
          totally distinct and different diseases.   -    2
CHAP. III.—On the remedies in general use both in
          Gonorrhoea and venereal disease      -    28
CHAP. IV.—On Gonorrhoea,—Its treatment and cure.   55
CHAP. V.—On Gleet,—Its nature and  cure.     -      68
CHAP. VI.—On Stricture,—Its symptoms, nature,
          consequences and cure.                   77
CHAP. VII.—On Gonorrhoea in the eyes, and Gon-
          orrhoeal Rheumatism.     -             105
CHAP. VIII.—On Gonorrhoea in Females.     -   « 114
CHAP. IX.—On venereal disease, properly so called,—
          Its distinguishing marks, its nature, pro-
          gress, and general principle of cure.   -   123
CHAP. X.—On certam complaints which  resemble
          venereal   disease,  and  sometimes  arise
          from sexual intercourse, but which, never-
          theless, are not  venereal, nor can be
          treated .as such without the greatest dis-
          advantage.  Persons  affected with these
          complaints are often cruelly imposed on
          by advertising people.     -              137
CHAP. XI.—On the use and abuse of Mercury, with
          rules for its proper management  in the
          cure of venereal disease.   -    -    -    j 55
CHAP.—XII.—On venereal disease,—Its treatment
          and cure.    -    -             t     -   195
CI HAP- XIII —On venereal sore throat,
CHAP. XIV.—On venereal  blotches and eruptions
            on the skin.     -                     223
CHAP.—XV.—On Venereal in the Bones     -     230
CHAP.  XVI.—On the  effects of Venereal on pos-
            terity, &c,                            249 
INTRODUCTORY.
  If it were only for  the purpose of knowing as
much of this disease as to be able to distinguish it
from others, (for  there  are several diseases which
resemble venereal in some respects, but are not so
in reality;) or, in case it should be, to be enabled to
fix upon the best and most convenient way of cure-
ing it, instead of  being harassed and deceived by
a certain class of people, by  whom the spirits and
the health  are loo  often broken down and ruined,
these alone would afford sufficient reasons for pub-
lishing this little  private volume.   There is howe-
ver another, and one of infinitely greater weight—the
effect of this disease upon posterity. It is a fact which
no intelligent Physician will deny, (nor, with ihe ex-
ception  only of  a heartless,  advertising  quack,
would any human  being disregard) that, venereal
disease, not  properly  cured, may lie so dormant
and unsuspected in the constitution as to show it-
self in no other way  than in  its fatal influence
upon  children.  Now,  to show my reader how he
may detect  the imposter who wishes to make-him
believe  he has the venereal disorder when he really
has not:  or, if he  really  have  it, to enablejhim to fix
upon the best, and most convenient, and private way
of curing it, is the object of this little volume, and
this I have attempted in the very plainest words and
manner.

  For the purposes of clearness and convenience it
appeared desirable to arrange it in chapters ; and here
it is my intention to state the subjects of them, seve-
rally, and just to mention some of the most important
parts of  each, so that, on running over these intro- 
vm.
INTRODUCTORY.
ductory pages, any one may fix at once on whatever
may appear most useful to  hirnself.

   The first chapter—is,, on  the nature, symptoms,
progress, and consequences  of  Gonorrhoea—vul-
garly  called  clap.   This  should more  especially
be  read by  those who do  not  know that  Gon-
orrhoea  and venerealj are  two  disiinct'  and  dif-
ferent  diseases,  requiring  very  different  modes
of treatment.   It  will be also seen that Gon-
orrhoea  is  sometimes  a very difficult and tedious
complaint to cure, requiring  much  skilful and  pa-
tient perseverance in  the use of proper means ; at
other  times it will yield more  kindly and quickly, al-
most to any of the usual remedies.  No doubt, most of
the tedious cases  met with are  the consequence of
taking certain pills and drops  which are daily adver-
tised ; and others, again, are  owing to peculiarities
of constitution—being unfavorable to a speedy cure ;
but by far the greatest  number of these bad cases
arise from the want of  knowing  something of the
nature and progress of the disease itself, so that the
proper  remedy should be taken at a proper  period,
and under certain circumstances only.  These cir-
cumstances therefore  in this chapter are carefully
pointed out.

   The  second—is, on  certain  diseases  which  re-
semble  Gonorrhoea  in some  respects, and are  fre-
quently mistaken for it;  but which, nevertheless, are
totally distinct  and  different diseases.  This is a
subject of the deepest interest, particularly as there
is a class of  persons, who,  either  from ignorance or
knavery, call every thing they see upon these organs
venereal. It is not however, as I have there observed
the being thus cajoled and put to inconvenience and'
expense, whjch is the worst of this, but it often leads 
INTRODUCTORY.
IX.
to painful and  most unfounded  apprehensions and
suspicions. I have known it to interrupt the happiness
and even threaten the disunion of virtuous couples.

   The third chapter—is on the remedies in gene-
ral use both for the cure of Gonorrhoea and vene-
real  disease.  It seemed proper, before entering on
the cure of these diseases, to explain the value and
proper use of such  remedies, especially as I have
often found that many had been taking medicines in
one of these complaints, which was intended for the
other; and also, because the same medicine which is
useful in one may be absolutely useless and injuri-
ous in the constitution of an other. But here I cannot
pass without a word or two upon a fact which I am
certain will be  granted  by every thinking man,—I
mean  the  absurdity and   wickedness of  selling
any  one a box of pills  or bottle pf  drops for the
indiscriminatecure of these complaints, and under all
the various circumstances which may attend them.
These circumstances  I have shown  to be  nume-
rous  and  important, arising as they do from habits
of life, age, sexes, and peculiar kinds of constitution.
In fact, the circumstances which may at any time
occur in the course of this disease, but which do not
properly  belong to  it, are far more dangerous and
distressing than the  disease  itself.—In this chapter,
also, is the nature of injections,—their safety, effica-
cy, and sometimes  indispensable necessity, is ex-
plained.  I have also here described my pocket, gum
elastic syringe,—contrived for the purpose of  conve-
nience and privacy—the value, simplicity, and con-
venience of which can scarcely be  conceived with-
out referring  to the plate, page 43.

   The fourth chapter.—This is on the cure of Gon-
orrhoea.—The nature of Gonorrhoea and its reme- 
X.
INTRODUCTORY.
dies having been explained, its cure is now exceed-
ingly easy to understand and manage.   Not that it
is  necessary for every one to read these chapters
severally, on the contrary, it is sufficient only to pe-
ruse this single one  on the cure of this complaint;
most people however  feel a pleasure  in  being  ac-
quainted with  the  principle on which their cure
proceeds, as well as  with the fact itself.

   The fifth chapter—is on Gleet—a  consequence
of a badly  treated  Gonorrhoea.  On  this subject
the remarks as to whether a gleet retains the infec-
tious nature of Gonorrhoea or no, are  well worthy
of  attention,  especially as  some  very  erroneous
notions  are  entertained  upon it.  Many a person
has  unintentionally   involved  others   in   this
complaint  in   consequence of  such errors.   This
indeed  I have felt  to  be of so much consequence
as to take the greatest pains to place it in  its  proper
light; and, that I might put  every one seriously
on his  guard  I have  given  the opinion, and also
the very words, of one of the greatest Surgeons in
the world upon the subject—Sir Astley Cooper.

   The  sixth  chapter—is on  stricture—a subject
 than which there is none of more importance in the
 whole range of venereal maladies.  It is also  one
 which  affords the  richest  field for all  imposters.
 Here  you will find them persuading  unsuspecting
 people to  take  their  drops  or pills, or some  such
 thing,  for  months  together, while  every real Phy-
 sician absolutely knows that all the medicine in the
 world, alone, would never cure it.  This every one
 will see immediately on reading the  remarks upon
 the nature of  stricture.  Here also he will see  that
 the  discharge which  now and  then  attends  a
 stricture,  may perhaps be stopped, to return again 
INTRODUCTORY.
XI.
on some occasion of excitement, but that this is a
a very different thing from curing the disease;  and
that perhaps it is better not to stop it, for in this case
a person is more completely off his guard, and ismore
likely to remain unconscious of it, even for years, or
or until some of its remoter consequences draw his
attention to it.  Many persons have been  to me with
these effects who  never dreamed  they  arose from
stricture until  it was explained and its existence
proved to them.  I have therefore spared  no pains to
make the nature of a stricture understood, as well as
the symptoms which attend it; and it gives me plea-
sure here to add, that, although I consider  stricture
to be the most serious thing that can possibly befall
an individual, yet the  means of curing it are sim-
ple, easy, safe and certain ; hundreds under my own
immediate care can attest this truth, many of  whom
have been cured in as many weeks as it had existed
years before.

   The eighth chapter—is on Gonorrhoea in females,
in which every necessary direction is given to ena-
ble them to curl this malady in a speedy and private
manner.

   The ninth chapter—is on Venereal disease, pro-
perly so called.   The necessity of distinguishing
this  from  Gonorrhoea,  together with  its general
principle of cure, are here most clearly pointed out.

   Tlie tenth  chapter—relates to  certain disorders
which resemble venereal  disease, and  sometimes
arise from sexual intercourse, but  which, neverthe-
less, are not  venereal, nor can be treated as such
without  the  greatest disadvantage, &c.  &c.   It
 is impossible to mention any part of this chapter 
XII.              INTRODUCTORY.
as more interesting than another.  The heading of
it implies the nature  of the remarks  it may be ex-
pected to contain,  and these must be read  in con-
nexion to be understood and  properly appreciated.
This,  indeed, is  the  case with  regard  to every
following chapter  on  venereal disease.   I propose
therefore, with  one exception, to do  nothing more
than merely state the subjects of them.  The excep-
tion I allude to is—

  The  eleventh chapter—in which the use  and
abuse  of Mercury, with  rules  for  its proper man-
agement in the cure  of venereal  disease is given
with every  possible  degree of  plainness.  As in
Gonorrhoea,  so  of venereal,  after  describing  its
nature, and  the circumstances  which  distinguish
it from  disorders that resemble it, it seemed  proper,
before  entering  on its cure,  first  to  explain parti-
cularly  the  nature  and properties of  its  peculiar
remedy—Mercury. I will  venture to say few per-
sons  will read this  chapter  without  shuddering
at  the  idea  of  taking  Mercury from  advertising
quacks.   Well  may they disclaim, as  many do,
the use of Mercury in their pills and drops;  this
pretention however  I will  explain,  for  it will
enable every one to judge exactly of its value.

  As may be seen, (page 131) it was once suppos-
ed  that venereal disease could not be cured  effectu-
ally without the  aid of Mercury;  later investigations
however, proved it could  be.   This  admitted, the
question then was, which was the best—the most ex-
pedient  plan ? Now, this latter discovery consisted,
not in  any new or particular medicine or remedy
which<eould be substituted  in the place of  Mercury
but in a certain plan and course of management. This
plan, however, was such, as very few could possibly 
INTRODUCTORY.
XIII.
comply with ; it consisted in confinement in the house
or bed, together with such a course of antimonial or
other reducing medicines as greatly unfitted, even
after the cure, for any bodily fatigue; not to mention
the frequent instances of a return of the disease after
the  supposed cure.  Not even  the warmest ad-
vocates for  the non-mercurial plan, as  it is called,
ever pretend  that there is any  medicine whatever,
or pill, or drops, that  is a substitute for Mercury.
I put it then to every man of common  sense—with
what honesty can  any  person advertise a box of
pills,  or bottle  of  drops, or  any thing  of  this
kind, to cure venereal;  or, if it be Mercury—with
what feeling  could he  put this medicine  into the
hands of any one, without apprising him of all the'
serious incidents that may possibly attend its use,
together with the  means  of avoiding or correcting
them.   I leave  it  however  to my reader to ad-
judge such characters.  But  this I know, and will
here state—the worst and most complicated  cases
of venereal that  have ever consulted me, have all
been the unfortunate  dupes  of some of these pre-
tenders.   For myself, conscious that Mercury is the
best, the safest, the speediest, and  indeed the only
certain remedy for the cure of venereal disease ; but,
persuaded also that  this, of all valuable remedies, is
most  easily abused by ignorant and presuming peo-
ple, I have bestowed in this chapter the utmost car«
to show its safe and proper use.

  The twelfth—is on the  cure of venereal disease.
Here I have begun with the first appearance  of it,
(a chancre)  following it  through every stage, in-
cluding the  various accidental  circumstances  that
may attend—as inflammatory swellings, bubo, &c.
&c., and I trust have given in each  those rules and 
XIV.              INTRODUCTORY.
explanations which will be found so satisfactory and
plain, as to make it next to impossible to mistake.

  The  thirteenth chapter—is  on  venereal  sore
throat.

  TKe fourteenth—is on venereal blolches on the
skin, &c.

  The fifteenth—is on venereal disease in the bones.
In this  I  have noticed particularly the progress of
the disease from the throat or roof of the mouth to
the bones  of the nose, and have taken especial pains
to point out the means of immediately stopping the
progress of it, when it threatens to affect the bones,—
the destruction of which causes so much inconve-
nience as  well-as disfiguration of the countenance.

  Tlie sixteenth—and last, is on the effect of ve-
nereal  disease  upon posterity.    In this  place it
would  be in  vain to  attempt  a summary of this
chapter; and,  indeed, it would be of very little use
to do so,  as those to whom it  should in any way
relate,  would  certainly make it  the  subject of pe-
rusal.

  As a concluding paragraph or two, I  would now
observe, that,  among other benefits  accruing  from
this publication, if it should only have the effect of
putting  individuals on their guard against the divers
snares and traps which beset them upon every side
on the subject of these diseases, it will be no slight
one.—Alarmed artd delicatelycircumstanced as many
are, I do not wonder that they should be caught by a
promise of being cured with a bottle of drops, or box
of pills,—or in a day, or an hour, or any thing else
they choose;—but why not exercise the same good 
INTRODUCTORY.
XV.
sense on this as on any'other subject?  Would you
risk your health and happiness, in any other case, to
one  with  whose talent  and integrity  you  were
perfectly unacquainted?—As to the idea that Vene-
real disease is of such a nature as to be safely trusted
to the cure of any one who assumes the name of Doc-   ■
tor, nothing can be  more fallacious.—Look for in-4 '*'.
stance at the case related page 238. This gentleman
came fresh from the hands of such a person; and
he is only one of thousands.—And even in the case
of Gonorrhoea, this also often proves a much  more
serious and distressing malady than you would sup-
pose, to listen to the boastings of these kind of peo-
ple.   Hear the avowal  of one of the greatest sur-
geons in the  world  upon the subject,—Sir Astley
Cooper.—" Gonorrhoea," Sir Astley affirms, " is  a
" disease which may often baffle the longest expe-
" rience, and the greatest professional skill."   If
then Gonorrhoea is  so  serious a  disorder  in  such
hands, what must it be  with persons of the descrip-
tion here alluded to !  The fact is, as I have already
stated, Gonorrhoea, in some few instances, and  if
taken early, is very speedily cured ; but this depends,
not on any particular medicine, to be made a secret
of, but on a favorable kind of constitution.  The best
thing that  possibly can be taken at such an  early
period,  and with such  a  view,  is the  Cubebs,  as
mentioned page 33, and when this fails to cut  short
the disease, as I would  express it, it is still the best
preparatory means to any other.

  It  therefore seems that the. cure  of Gonorrhoea
will sometimes prove a tedious thing in spite of verv
skilful treatment.  In this case the only step to take
is to consider well the kind of person in whose judg-
ment and fidelity you have trusted.  If for instance
it is one of those who promise to cure in a day, and 
XVI.              INTRODUCTORY.
boasts of wondrous  remedies and secrets, depend
upon  it you have made a wrong selection.   As to
the praises such  folks bestow upon themselves, or
any list of long certificates, these are of little conse-
quence ; make enquiries rather of the most respecta-
ble and eminent physicians of our city ; these only
are capable of givingthe information you require.

  Of course, after these remarks, I can have no pos-
sible objection that such enquiries should be made
about myself; on the  contrary, I invite such; and
being in the constant practice of meeting the most
eminent physicians of our city in consultations, there
will  be ho difficulty in doing it.  But, in, addition,
(and in addition also to my rank as graduate of the
University of Edinburgh, and member of the Royal
College of Surgeons, London, &c, as well as being
author of a The Family Physician"—the  result of
nearly thirty years experience,) I have the happiness
of possessing letters of commendation from the most
eminent  men in  Europe to the  most eminent in
America—as the  late Doctor Physick of "Philadel-
phia,—Doctor Mott, of our city, and others, and
which letters may be seen by any onewho wishes it.

   I will only now request, that those who consult me
from  a distance,  would be more particular in de-
scribing  the  symptoms and  circumstances which
attended the first appearance of their disease, as
well  as  the  plan of treatment they  first adopted.
My consultation fee on these occasions is Five Dol-
lars ;  but if the little  chest of medicine is requested,
I  do not expect my fee for consultation. 
(Every one should read the introductory pages.)
                       A
        PRIYATE  TREATISE
                      ON

VENEREAL   DISEASE.
              IN  TWO PARTS.
    The First on Gonorrhcea, <$•<:. vulgarly catted Clap.
   The Second on Venereal Disease, properly so called.
                   FIRST PART.

                 CHAPTER I.

On Gonorrhoea,—its Nature, Symptoms, Progress
               and Consequences.

  The first thing to be acquainted with on this sub-
ject is the fact, that Gonorrhcea and Venereal Disease
are two distinct and very different disorders.  A per-
son having  Gonorrhcea, for  instance,  cannot give
another the Venereal Disease; neither  can one hav-
ing Venereal Disease give to another the Gonorrhoea.
Again, a Gonorrhoea never changes into Venereal;
nor does Venereal ever change into Gonorrhcea. Both
diseases  may,  indeed, exist together, in one and
the same person, and  then, both may be communi-
cated at the  same time, or one alone, just as it may 
2           Gonorrhoea,—Its Nature.

happen.  The principal thing however to remember
is, that they are two distinct diseases, and this is the
more important, because, as I shall presently have
to show, they require very  different remedies and
methods of cure.  The  following sketch, however,
will place them in a clear and proper light.

  Gonorrhoea is a specific infectious disease,—it is
seated in  the urinary passage, from the orifice of
which there issues a  discharge  of matter; it is
also attended, more or  less,  with  pain and  heat in
making water.   On the  contrary,  Venereal  disease
(which also is infectious) is not seated in the urinary
passage, but on  some part or other of the penis or
genital organs.  Further, Venereal disease begins
in a little ulcer, which, in general, is not painful;
whereas, in Gonorrhoea, there is no ulcer whatever.
If it were possible to see into the urinary passage,
(the seat  of  this disease) you  would find  nothing
there but a redness and a little  swelling,—the dis-
charge, whether much  or little, would be seen pro-
ceeding from the surface of the passage, without an
ulcer.  From this  account  then  I presume  everv
one  will  be able to tell immediately whether  his
complaint is  Gonorrhcea or  Venereal disease, and
therefore I will now go on to show  in what manner it
begins and how it proceeds,—I mean the Gonorrhcea.

  One word, however, had, better first be said  aboui
the time at which a Gonorrhoea first appears after ar» 
           Gonorrhcea,—Its Nature.           3

exposure to it, for many persons worry themselves
with fear and dread long after there is occasion.  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 24 hours, and others, that it has been de-
layed for 10 and even 14 days.   I very much doubt.
however, whether it ever appears at this early period.
Instances of this kind which have come to me, have
always proved to be cases of Stricture, not of Gonorr-
hoea ; while those delayed for fourteen days are very
rare,—I  have never  met with one.   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 I 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 es-
caped,—however suspicious the party may have
been.  Thus much then as to the time when a
Gonorrhoea begins, and now, as  to its manner of be
ginning.                                -»

   A person having been  exposed to this  infectious
malady, at  some period  within seven days, if he
should have taken the disorder, will feel a little pain 
 4         Gonorrhcea—Its  Symptoms.

 and heat in making water.  This soon leads him t©
 examine the part, and then, on squeezing it, a little
 matter of a whitish color is seen coming out of the
 urinary passage.  Next day this painful heat and dis-
 charge will  haye increased, and the color  of  the
 matter become a little yellowish.   Sometimes the
 pain and heat in making water  will be exceedingly
 great,  amounting to a  sensation of absolute scald-
 ing; at this time the discharge generally turns to a
 greenish color, and, instead of being about as thick as
 cream, it is  thin and  watery.   Under these cir-
 cumstances also  there  is a  painful sensation along
 the whole length  of the urinary passage, and the pe-
 nis swells, and is subject to attacks of frequent and
 very painful erections.

   A Gonorrhoea always begins with pain and infla-
 mation, more or less,  which, after  a little while
 abates  or subsides entirely.  In  speaking of a Go-
 norrhoea, therefore, we call the beginning of it its in-
flammatory stage.  But the degree of pain and infla-
mation at the beginning of Gonorrhcea,differs exceed-
ingly in different  persons; some  will have  so little
as scarcely to complain at all,  while others suf-
fer most  severely; in  every case, however, after a
little time it subsides, whether any thing is done  for
it or not.   Persons (coming from some of the adver
tising  quacks,) will  often say "but the  stuff they
gave me removed the burning pain," when, in fact, it
had nothing at all to do with  it; for,unless the heat. 
          Gonorrhcea—Its  Symptoms.         5

ing things they generally give, increase the burning
pain, it subsides itself, spontaneously.

  After a short time, then, or, if there has been much
pain, after this has subsided, what we call the sec-
ond stage  commences.  This consists simply  of
an infectious discharge, issuing from the orifice  of
the penis, without much pain.  This  discharge is
more  or  less in quantity in different persons, and is
much increased by whatever may excite, or irregu-
larities of  any kind.  And, when  it once sets in
there is no exactly telling how long it  may contin-
ue, or how it is to terminate; but let it ever be
remembered, that, as  long as this discharge contin-
ues the disease may be communicated by infection.

  But, thus far, I have only spoken of a Gonorrhoea
in its simple form, and have mentioned  those symp-
toms only which are essential to it, and which are
never absent from it;  there are  however  other
symptoms which are only sometimes present,—which
may, or  may not present  themselves, 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 from the  want of knowing something of the na-
ture of these symptoms which gives to Gonorrhcea
its most distressing character and leads  to the worst
of consequences.   These circumstances which may,
pr may not occur in Gonorrhoea, are  called occasional 
6     Gonorrhcea—Swelling of the Foreskin.

symptoms, and are the following:—aswelling of the
foreskin—swelling of the glands in the groin—very
frequent and painful erections of the penis—and
swelling of the testicles.   The nature of these cir-
cumstances therefore are now to  be explained, but
the particular mode of treatment them will be  given
when we come to speak  of the cure of Gonorrhoea
itself.  First, then,

   Swelling of the foreskin.—This is the effect of
inflammation which a full and irritable state, or  ir-
regularity of habits, give rise to.  The structure of the
skin which covers the head of the penis, (the prepu-
ice,) 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.
   Sometimes the skin is  swollen  amazingly, and
looks of a bluish white, being half transparent, and
is  very apt to create alarm. Indeed, there is  some-
times reason for  alarm,  for when this swelling is
considerable the skin cannot be pushed  back over
the penis, or, if pushed back, 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 con-
sequences of it;  for, if the skin cannot be pushed
back, the matter under it becomes acrid and irritat-
ing, and you  cannot avail yourself of cleanliness,
which is always of importance.  And, on the other
hand, if you  cannot bring the  prepuice forward, it
produces danger by acting as though a string wer^ 
  Gonorrhcea—Swelling in the Groin $ Cordee. 7

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, however, can always be pre-
vented by proper management, which will be shown,
as I have already said, in the  chapter on the treat
ment and cure of Gonorrhcea.

  Swelling of the glands in  the groin.—This also
is the result of inflammation, spreading to glandolar
bodies situated in  the  groin.  In every  part of the
body there  are certain little vessels called absorb-
ents, and these, in their course, run through absorb-
ent glands, of  which there are  several in each
groin.  Now it  happens,  that inflammation  in the
urinary passage  is  communicated  through the me-
dium of  these vessels  to the glands in the groin,
which  are  therefore painful  and enlarged.   It is
however worthy of remark, that, in Gonorrhcea, these
glandular swellings seldom go  on to form a bubo,
(which is an abscess in the groin) as they are apt to
do in Venereal disease, so that they are comparative-
ly innocent; after  a little time they generally sub-
side and  disappear.  We now come to the third of
these occasional  symptoms, which is,—

  Frequent and very painful erections of the pe-
nis.  This  is  a  distressing and tedious symptom,
the nature  of which I  will  endeavor  to explain.
In fact, it is nothing more than inflamation extend- 
 8    Gonorrhcea—Swelling of the Testicle.

 ing from the urinary passage into  -the substance
 and body of the penis, and it seldom occurs except
 the inflammation  run  high.   The  structure  of
 the penis is remarkable; it is  made  up  of large
 cells, into which the blood is determined under cer-
 tain circumstances of excitement, and when these
 are filled, the penis is erect.  Now,  the  effect of
 inflammation in these cells is to glue them together.
 so that when the  blood is rushing into them, as it
 occasionally does,  we know, it tears them apart, and
 gives excessive, pain.  Sometimes these cells, thus
 glued together, will not yield, the figure of the penis
 is then a little crooked, as we often see.  The pain
 accompanying  this  is terrible.  This  is what the
 French call Cordee—the cure or preventing of which
 we  shall presently come to.   The fourth and last of
 the occasional symptoms of a Gonorrhcea is,—

  Swelling  of  the Testicles.—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 suchcases with that secre-
 cy which  is often so  desirable.  Much, however
may be done to prevent it, if early attended to, and,
 therefore, the symptoms which precede and lead to
it, are to be noticed carefully.  These are, principly,
first, 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 was remaining
 in the passage after you have finished making water. 
      Gonorrhcea—Does it ever cure itself.     9

To this  there, succeeds  a dull pain in the groin,
which goes on to effect the testicle.   When  these
occur, no time should be lost.  The first thing to be
done is  to suspend  the testicle.  This, if you have
not a proper suspensory bandage, you can easily do
by making a Utile bag of muslin, which you can pin
to a bandage  round the waist.  At the same time
take an active purge or two, and remain as quiet as
possible ; but  more will be said upon its  treatment
in its proper place.

  This, then is all that  need be stated on the nature,
symptoms, and progress  of Gonorrhoea.  With re-
gard to its consequences, these I have only occasion
here to enumerate, for  each of these is of so much
individual importance as to demand a separate chap-
ter.  The consequences then which a badly treated
Gonorrhcea lead  to, are—Gleet  and Stricture;
which  latter again gives occasion to a train of symp-
toms the most lamentable that can be conceived, of
which impotence is one.

  But, before this subject is  dispatched I must re-
mark, some persons have put the question to me,—
does this disorder (Gonorrhoea) ever cure itself,—
does it ever wear itself out ?  To which I reply, it
does.  It may do so ;  but, it is a most terrible  risk
to run; for not only will it first wear out the patience
of the patient, but will leave  open the widest door
for the consequences I have just enumerated.   The 
10          Gonorrhcea—Summary of.

general consequence of a Gonorrhcea, if not early and
properly treated, is a Gleet, and a Gleet implies  a
certain morbid state  of the passage  of  the urine,
which, if long continued, is almost sure to terminate
in Stricture,—a  disease, then which  I know  of
nothing more balling and truly lamentable.

  As I intend to give at the conclusion of each chap-
ter of this little book, a summary of its contents, to
begin the sum total of the foregoing may be express-
ed in the following few words.

  Gonorrhoea is an infectious disease, attended with
pain and heat in making water and a discharge from
the urinary passage.   In its progress it gives rise to
various  symptoms, as,—excessive  pain  in making
water,—swelling of the foreskin,—swelling of the
groin,—painful erections of the penis,—and swelling
of the testicle.  Its  consequences are,—Gleet and
Stricture,—the  latter of which  frequently termina-
ting in impotency. 
   Gonorrhcea,— Disorders which resemble it. 1 (


                CHAPTER II.

On certain diseases which resemble Gonorrhoea in
  some respects, and 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 Vene-
real disease and diseases  which are not venereal,
but which resemble it.  Those into whose hands
this little book may fall will  be enabled  to do this
effectually, and will thus  escape the advertizing
schemes of a set of people the most unprincipled and
detestable  that were  ever suffered to  deceive  the
public.   These people, either from ignorance  or
knavery, call every thing venereal they may happen to
see upon the sexual organs.  Now, the structure 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. It  is a fact, and one which I will
presently show most clearly, that many of the dis-
orders these people call venereal, have nothing at
all to do with that disease whatever.  Nothing is so
easy as to deceive an inexperienced person into such
a belief.  Knowing he has been  once  exposed, al-
though  it might be far too long ago to be the cause
of his complaint, yet, if he happen to have any strange
appearance on these organs, he directly thinks it must 
12  Gonorrhcea,—Disorders which resemble it.

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 confirm-
ed in this belief.

  There is however another and a far more serious
view to take of this deception,—it is, its effect 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 mar-
ried couples, of a moral stamina so firm and unas-
sailable, that, mutually confiding in their own integ-
rity, no  insinuations 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, espe-
cially if explained by insinuations so false and cruel,
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 be-
ing known to have given much attention to this class
and  order of diseases, cases of  this nature  fre-
quently occur to  me, and, sometimes, too, of great
importance.  This indeed will readily be imagined
when the remarks I am now about to make upon the
subject shall have been perused. 
   Gonorrhcea,—Disorders which resemble it.  13

   The diseases which in some respects resemble
 Gonorrhcea and are frequently mistaken for it, but
 which, nevertheless, are totally distinct and differ-
 ent diseases,  are chiefly  four.  These I will  now
 proceed to notice, and will also  show  their proper
 treatment,  which is always very  simple and  suc-
 cessful.

   The first of these complaints  occurs in men, and
 consists of,—

   The natural secretion of the part, accumulated
 beneath the fore-skin.—When this occurs it becomes
 irritatingand 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 accompanying is offen-
 sive and considerable,—the parts swollen,—and the
 excoriated surface presents a red and  quite an angry
 appearance.  Now,  in this state, it  is  an easy matter
to impose upon the  mind the false idea of a Clap or
Gonorrhoea.  Indeed, as I have said before, it is some-
times difficult  to persuade a person it is otherwise.
Yet, all this is a very innocent affair.  To be  con-
vinced that this is  not a  Gonorrhoea, just look to
page 4,—observe the description of that disease, and
compare the two.  There you  will  find that the dis-
charge in Gonorrhoea issues from the orifice of the
urinary passage, from which you may always squeeze 
14  Gonorrhoea,—Disorders which resemble it.

a little matter; but in this the discharge is supplied
from the surface of  the  fore-skin and head of the
penis.   This is quite enough to show it is not a
Gonorrhea.

  And, that it is not Venereal, you may likewise be
as certain from the  fact, that  this—the Venereal—
begins with one, or at most  with two, distinct little
ulcers, which are inclined to become deep instead of
>road,  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 grievious
thing for a man to be told he has got a Gonorrhoea,
and be treated as such, under  circumstances like
these.

  The  truth is, this case  is nothing more than a
little alteration in the  secretion of certain glands situ-
ated 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 Gonlard's
Lotion, (sugar of lead wash) or  brandy  and water
or even plain cold water—taking, at the same time,
a dose or two of cooling physic.

  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 
   Gonorrhcea,—Disorders which resemble ii. 15

for it approaches,  in  appearance, much nearer to
Gonorrhcea.   It consists of,—

  Symptoms resembling Gonorrhoea, communica-
ted by Females in whom no appearance of diseaes
can be detected, or who have only those complaints
which are considered innocent and common.—This
is a disorder on which I am very anxious to be plain
and 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 married and
single, are subject.   The discharge of it varies in
quantity  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, how-
ever, varying from circumstances, the Whites  may
continue for many years, proving to be nothing more
than a secretion of what is natural 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  fulness 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 correspond-
ing malady in the other sex, yet, on the other hand,
it may, and  sometimes does, become infectious,—
communicating the like  disease to another person. 
 16 Gonorrhcea,—Disorders which resemble it.

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

   The opinion that  disorder, giving rise to symptoms
 resembling Gonorrhcea, may arise spontaneously in
 women, may  be inferred from the circumstance, that
 such symptoms, now and then, occur in men of the
 most  unblemished  character  and  truth,  and who
 could have received it only from their wives,—per-
 sons, also, whose age, habits, and religion, place them
 beyond suspicion.

   With respect to the former of these instances, I
 should think but few can have seen much practice
 in surgery or medicine, without having met with
 cases that would puzzle him  to account for on any
 other principle.  I will, however, state the outline
of some as they have occurred to me.—A gentleman
 applied  to me, for instance, and  said—Sir, I have
some strange  symptoms of disease  about me; and
 such, indeed,  that if it were not for my confidence in
another party, I really should suspect  to be the symp-
 toms of a Gonorrhoea,for I once contracted that disease
and know something of its nature.  Well, I said, what
are the reasons which lead you to determine it is not
 a Gonorrhoea  ?  He replied, 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 word would allow her to expose 
   Gonorrhcea,—Disorders which resemble it.  17

me to the possibility of such a malady.  And further
still, having mentioned these  circumstances to her,
she  denied  it firmly, and is desirous even  that
some one should see her—so perfectly  unconscious
is she of having any such disease.  Now, my inter-
views on these  occasions have often  lead to two
remarks—the first, that the female had no single
symptom of this disease  whatever;—and the next,
that she was in the habit of being visited by another,
and that he likewise was perfectly free  from every
symptom. These are important facts to keep in mind
by those who have to form opinions of the real nature
of these cases.

  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 patient, consulted me on what we
took to  be a Gonorrhoea, and at the  same time re-
quested me to  see  the lady, whom he  had known
some time, and who assured him she was perfectly
free from any such disease.  I did so, and found it ex-
actly as she had stated,—she had no one symptom,—
not even of  a Gleet.   However, we  treated his dis-
ease as Gonorrhcea—and though the cure was tedious,
he at length got well.  But, some time  after, he re-
newed his visits to this lady, and was again attacked
with a similar disease—symptoms which differed in
no other respect from Gonorrhoea, than in their mild-
ness.  After this, however, he kept away for a con- 
18  Gonorrhcea,—Disorders which resemble it.

siderable length of time, and, although in this inter-
val he had 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 Gonor-
rhoea, degenerated into infectious Gleet,—a disease
which continues almost indefinitely,—is not attended
with  pain,—and in which there  is  frequently but
very little discharge—not more, indeed, than many
women (and females of this description in particular)
are subject to.   But to this I cannot consent, for two
reasons ;—first, because these cases sometimes occur
in women who afford  no reason  for believing ever
had a Gonorrhoea;  and next, because, if they had
been cases of protracted Gonorrhoea—or Gleet—they
would be infectious to every one alike, or very gene-
rally so.   Now and then,  we know,  a person may-
have an interview with a female who has a Gonor-
rhoea, or infectious Gleet, and may escape ; but this
is an exception to a very general  rule—it does not
often happen.  Likewise, that one individual is more
susceptible 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
effect all that come within its reach, or pretty gene- 
   Gonorrhoea,—Disorders which resemble it. 19

rally so, this mild disorder, while it will effect some,
will as uniformly suffer others to escape.   It there-
fore affords a striking difference in its consequences,
and from this we may infer there is also a difference
in its nature.

  My design in this section of my little book is to
exculpate innocent and virtuous  women from un-
deserved and injurious suspicions. And this I ap-
prehend to be an object of immense importance;—
for, within the limits of my own experience I have
met  with  lamentable  instances  of  unjust suspi-
cion ; instances  too in which I  am morally certain
there was not a particle of truth,  and which suspi-
cion never would have gained possession of the
mind if the subject had been better understood.

  With this view of its importance, I therefore deem
it proper to place this fact upon the best authority in
medicine which  can be adduced.  Now, I  have al-
ready shown that symptoms resembling Gonarrhea
have been  communicated  by females in whom no
symptom of the disease existed,  or was ever known
to exist; but these females were not to be consider-
ed exemplary specimens of moral character, and,
farther, I have stated them  upon my own experi-
ence ; I will now,  however show, that the same
thing happens  in females  of  the highest moral
character, and will show it also on the very best of
medical authority.  Here I might refer to the great 
20  Gonorrhoea—Disorders which resemble it.

John Hunter, Abernelhy and a multitude of others ;
but, in that highly esteemed and learned work—
Good's Study  of Medicine,—there is a paragraph
so clear upon this subject, that I cannot do  better
than transcribe it.  In the fifth volume, page the 81st,
after speaking of  other diseases  attended with a
mucous or  purulent  discharge, which  are now
and then contagious, or infectious,—such as Dys-
entery, purulent opthalmia, and others,— he says,—
"In like  manner, Leucorrhoa (which is the medi-
cal term  for   'the whites'  in  females)  as we
have already observed, has  sometimes  seemed to
be contagious; for I have occasionally found a kind
of blennorrhea (Gonorrhoea or Clap) produced in
men, accompanied with slight pain in the urethra,
and some difficulty in making water, upon cohabi-
tation with  women, who, upon inspection, had no
marks whatever of luodic blenorrhoa, or clap; and,
in some instances, indeed, were wives and matrons
of unimpeachable character."  This, at  any rate,
will satisfy the mind that such a thing is possible.

  With respect to the question,—how can a harm-
less secretion be changed into an infectious one, this
I cannot answer any more than I can tell why the
discharge  from Dysentery, or opthalmia, or com-
mon catarrh, which are generally harmless  disor-
ders should sometimes become  contagious.  The
structure of the membrane  which is the seat of the
disease in all these maladies, is exactly the same as 
Gonorrhcea,—Disorders which resemble it.  21
that which is the seat of the disorder in Gonarrhcea.
It may be, and often is, no  doubt, from neglect  of
necessary washing; and to this the habit of irregu-
lar intercourse may give a greater tendency, for it is
not to be denied that such instances are much more
frequently observed in women of bad habits and in
constancy than in virtuous persons;  but this by
no  means proves that these are cases of genuine
Gonorrhcea, nor that they do not now and then oc-
cur in persons of a strictly virtuous character.

  With regard to the treatment of this complaint, it
is exactly that of Gonorrhoea, for which, see chap. 4
—on the treatment and cure of Gonorrhoea. (Note 1.)

  It therefore appears, that symptoms very  much
resembling 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 alos known to occur, occasionally, in  women of
exemplary character—even in wives  and matrons

  Note 1.—On this subject it general principles chiefly re-
 may  be remarked  that the gulate the treatment of them
 treatment of Gonorrhcea is  all;-the first directs  what-
 very much the same as that  ever  abates  inflammatory
 of  other  diseases  affecting  symptoms, if any such ex-
 similar  membranes,—as m  ist; the second, such reme-
 oontagious Dysenteryt  Op-  dies as supercede specific ac-
 thalmia, &c.  There is  no  tions by setting up an action
 specific remedy  in any of  of their own—precisely as
 J.  m —such as Mercury, for   The Black Pill" does in the
 instance, in  Venereal.  Two  cure of b onorrhcsa. 
 22 Gonorrhcea,—Disorders which resemble it.

 whose habits, age, and religion, place them beyond
 uncharitable suspicion ;—and that, these complaints
 are cured by the treatment proper in the milder forms
 of Gonorrhcea.—A third disorder  which lesembles
 Gonorrhcea, is,—

   Stricture in  the  urinary  passage.—This, up-
 on excitement, will sometimes produce discharge
 exceedingly  resembling Gonorrhoea, but  without
 the, usual degree of pain and inflammation attending
 that complaint.   What a stricture is, I have taken
 pains to explain in the 6th chapter.  Here it is need-
 ful only just to say, it is a contraction, or a diseased
 condition, of some part or other of the urinary pas-
 sage, generally the consequence of a badly treated
 Gonorrhcea, but which often continues for  a  time
 so free from pain or any inconvenience, 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 re-
marked they are quite unfortunate, for they scarcely
 ever are exposed 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 Gonorrhcea at
all, but of Stricture; and their friends have not these
symptoms, because  they  have no stricture..   Of 
   Gonorrhoea—Disorders which resemble it. 23

course, if such a person go to an advertising Knave,
he will tell him immediately he has got a Gonor-
rhoea ; and what is still worse, the medicines he may
give him will be very likely to remove the symptoms,
so that he will get the credit of curing a Gonorrhcea,
But, in truth, he will no more have  cured a Gonor-
rhoea than he will have cured a Cancer; for,  with
purgatives  and a low diet this discharge generally
ceases in a little  while.  It would therefore seem
exceedingly desirable to have some plain and positive
rule to judge by  in cases like the present, and, fortu-
nately I have one to furnish.  This rule is founded
on the time when such symptoms first appear  after
connexion. 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 Gonorrhoea.   Now, Gonorrhoea may be compared
exactly to  inoculation.   There is always a process
and a certain time required, in order to produce the
inoculated  malady.  It  is true that some  inocula-
tions  produce their  proper symptoms  sooner and
more regular than others ; but, the usual time pecu-
liar to each is generally known, and, unless  delayed
or interrupted by some peculiar state of constitution,
is pretty regular.  The usual period for the produc-
tion of the symptoms of a Gonorrhoea is the third
day after exposure to it.  This however, is some-
times delayed for several days by the causes I have
mentioned; and, sometimes  too, it is a little quick- 
24  Gonorrhcea,—Disorders which resemble it.

ened, but, as to  its appearing in twelve, or fous-
and-twenty hours, that it never does, and never can
do. This then I consider a valuable fact,—it forms 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 gener-
ally put this question  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 ob-
served some  symptoms of it in the morning; 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 Gonorrhoea.  I then enquire if
he ever  had a Gonorrhoea  before, and if he  state he
has, my suspicions are confirmed, and I  explain my
reasons  for them.  This of course leads to an exam-
ination by the bougie, and then the  truth is  ascer-
tained beyond the possibility of doubt, and he obtains
a permanent and perfect cure.  But thejvalue of this
true and faithful explanation is greater than at first
it may appear to be ;  for it does  not only undeceive
and save  an individual from paying different per-
sons for pretended cures of Gonorrhcea, but it also
saves him from the consequences of occult or hid,
den Stricture,—an evil which I deem  by  far more
serious  and  distressing than any to be  found in the
whole range of Syphilitic malady.  The  object of
this little section  therefore, is to show,  that, among
other causes capable of giving rise to symptoms re-
sembling Gonorrhoea, a hidden  dormant Stricture 
    Gonorrhoea,—Disorders which resemble it. 25

is one,—that this is to be  suspected whenever such
symptoms appear within twelve or four-and-twenly
hours,—but  that  this  is  only to  be known  for
fact, by passing the bougie.  Its treatment consists
in a little cooling physic, rest, and low diet; if this
is  not sufficient, the usual treatment for Gonorrhoea
will stop the discharge,  but  the  only proper and
permanent cure is  the cure of the Stricture.—The
fourth and  last of these disorders resembling Gonor*
rhcea, is,—

   .1 discharge occuring in female  children,—and
which frequently creates  distressing apprehensions
in the mind of parents.  It 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 themselves, but in some distant part, 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 irritation  in the bowels in children  is readily
transmitted to distant parts, and is the cause of va-
rious maladies.  If this irritation happen to fall up-
on  the head, it produces dropsy of the brain  ; or if
on other parts,  then other diseases take place, as
 sore eyes, or running sores from behind the ears, a
 swelling of the neck and others ;  so, if it happen to
 fall upon the mucous membrane of the female organs.
 it then produces the disease we.speak of.  It is  not, 
26  Gonorrhoea—Disorders which resemble it.

however, that this disease  in  itself is  of so much
consequence, as it is the fear and misconceptions it
may lead 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 na-
ture, these  apprehensions are  confirmed.   Then
suspicion falls  on some one of having taken impro-
per liberties with her, and she is threatened to con-
fess.  Perhaps, from fear  of  punishment, she may
say that some one has.  This would be very unfor-
tunate, for such is the violence of prejudice on these
occasions, that it would be totally unavailing to af-
firm the contrary.  I have read, somewhere,  of per-
sons innocently hanged from a misconception of the
nature  of this malady.  With regard  to the treat-
ment  of it, this of course is  founded on the  view
here given of its nature ; remove the cause,—that is,
scarify the -gums if they aTe  inflamed, and cleanse
the bowels with an active purge or two.  Nothing
more is wanted except plentiful and frequent wash-
ing with cold water, perhaps  sometimes with the
addition of a little alum or sugar of lead.

  The following then, is the  substance of all that
has been said upon this subject.  That, there are four
complaints  which in some respects resemble Go-
norrhoea and are frequently mistaken for  it.   1st,—-
The natural secretion of the parts, which, collect be-
neath the foreskin and becoming acrid, inflame and
and excoriate the  penis, producing a discharge;-~ 
    Gonorrhcea,—Disorders which resemble it. 27

,this however, does not  come  from the urinary pas-
 sage, but from the surface of the skin, and may easi-
 ly be detected by comparing it with what  is said
 on Gonorrhcea.  2d,—A discharge more nearly still
 resembling  Gonorrhoea, (and is infectious too,) is  re-
 ceived by cohabiting with women in whom no symp-
 toms of this disease can be detected, and this, not
 only in women in whom exceptions  might be taken
 to their habits and morality, but also in those of un-
 exampled moral  character,—being wives and ma-
 trons, whose habits, age,  and religion, place them
 at once beyond  suspicion.  3d,—A  discharge aris-
 ing from a  dormant  stricture which, upon  excite-
 ment, now  and then becomes the cause of  similar
 symptoms,—is known chiefly by its quick appearance
 after sexual excitement;—-the proper  and permanent
 cure of this, is the  cure of  the Stricture. 4th,—A
 discharge occurring in female children,—the result
 of distant irritation, chiefly of the gums in teething'
 and foul accumulations in the bowels. 
28        Gonorrhcea,—Its Remedies.
                CHAPTER III.

On the remedies in general use for .the cure of
  Gonorrhoea,—how far these are to be depended
  on,—to what particular cases they are suited,—
  and how to use them to the best advantage.

  The remedies for the cure of Gonorrhoea are very
few in number and are pretty generally known.  Not-
withstanding  this  however, their  real  nature is
but little understood, so that they are often  misap-
plied.   They are, internal and external. Of the first,
the Balsam of Copaiva—the Cubebs—and the Tur-
pentines, are the chief; the external or local consist
of Lotions, used as injections.  These internal re-
medies are vegetable productions, whose  properties
very much resemble one another.  All of them im-
part their virtues to the urine, which, being retained
in the bladder, impress upon it their peculiar effect,
and this again is transmitted to the part which is the
seat of the disease—the  urinary passage.   On the
other  hand, Injections consist of certain  suitable
stimulants, which are applied by means of a little
syringe, more immediately to the seat of this dis-
ease.   Both kinds are exceedingly valuable  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. 
          Gonorrhcea,—Its  Remedies.        29

  It should be also stated, there are other reme-
dies which are occasionally wanted  in the cure of
this complaint, but not always; these are, chiefly,
the common remedies required to lessen pain and
inflammation.   Various things are used with such
a view, but of such there are some which are  far
more suitable than others; a list of these therefore I
will afterwards subjoin,—pointing out their proper
use and dose, as well as make such other observa-
tions on them as may seem required.  I will begin
with—

  The  Balsam of Copaiva.—This,  every body
knows, is very often given for the cure of Gonorrhoea;
indeed, this 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.  This how-
ever is not the only objection to Balsam of Copaiva;—
another is, its extreme offensiveness.to the taste ;—
and a third, its offensiveness to the stomach, so that
it is rejected by vomiting, or, if not rejected, 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
cannot even think of the time of taking it without
this Nausea or Vomiting.  With respect to the two
first of these objections however, (its offensive smell
and taste) the latter of these may be avoided by taking
it in Capsules—and the  former partly so.   These 
30         Gonorrhcea,—Its Remedies.

Capsules are made of little glutinous bags, which,
being closed, contain a little of the Balsam.  These
little bags, when swallowed, are  soon  digested in
the stomach, and thus the Balsam may be taken and
its  disgusting 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 continually expelling wind, and  this af-
fects 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 Bal-
sam disagrees, it does so whether it is tasted in the
mouth or not.  These things therefore, taken  alto-
gether, are gieat objections to the Balsam. But there
are others still to be acquainted with.  The first 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 where it will stop the
discharge, so long  as it  is taken, but the moment it
is laid aside, the  running and disease 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,4t 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 does not, within two days
or  three at farthest,  very sensibly lessen the  dis- 
          Gonorrhoea,—Its Remedies.        31

charge, lay it aside, or add some other remedy 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 these at  the onset of this
malady ; sometimes indeed  they do not happen, but
they should always be prepared for.  It is with this
view we always give an active purge or two, direct
low diet, and rest, if it can be had, at the beginning
of a Gonorrhoea.  This sometimes  prevents them
altogether, and if not, it abates them. After an ac-
tive 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 moderate these
symptoms.

  Likewise, should  you have commenced with the
Balsam, and  inflammatory  symptoms at any time
start up, lay it aside, and first abate them before you
begin with it again.—I know that some begin with
Balsam of Copaiva  under any circumstances, and
many times  with strict  impunity ;  but I also know
that when it has been given without attention to
these  circumstances, it has been  followed by dis-
tressing and even dangerous events—as inflamma-
tion of the bladder, testicles, &c. 
32         Gonorrhosa,—Its Remedies.

  But notwithstanding the truth of these remarks,

the Balsam of Copaiva, where  it agrees, and it is
convenient  to take it, is a remedy of considerable
power in the. cure of  Gonorrhoea.  Sometimes it is

trusted to  alone, but then it must be taken for a

length of time—for many weeks together.   Let it be
remembered, however, that, where it does do good, it

does so quickly;  perhaps in two days the discharge
is lessened one half, and it then goes on "more grad-
ually  to diminish.  But let it also be remembered,
that in those cases where it is equal to  the cure
alone, that cure w^ould  be effected  in half, and less
than half the time if given in connexion wTith local

remedies—Injections,


  If  the  Balsam  of Copaiva   is  fixed   on  as  a
remedy for Gonorrhoea, it should  be given in the
dose  of about  a  tea-spoon full, in a little  water or
sugar, twice or thrice  a day.   With some it sets

better on the stomach when made up in the form of
mixture, the best prescription for which is given be-
low—Note 2.   If it happen to purge, omit it for a day
  Note 2.—Sir Astley Coop-
er's favorite form for the Bal-
sam  of Copaiva was,—one
ounce of the Balsam with one
ounce of Mucilage of Gum
Arabic, mixed in a bottle with
four ounces of Camphor Ju-
lep, of which a table-spoon
full is to be taken twice  or
thrice a day. To some  an
ounce of any simple syrup, or
Syrup of Ginger is an agree-
able addition.
  It is very common to give
the  Balsam with an equal
part of Sweet Spirit of Nitre,
This however is  not a good
mixture—the Spirit of Nitre
does no good and makes the
Balsam  very  offensive  t«
some. 
          Gonorrhoea,—/^ Remedies.        33

and take a dose of Rhubarb.  If this will not do,
give with each dose of it four or five drops of Lauda-
num.—It should be continued for some time after
the discharge  has ceased,  and then left off only
by degrees.   This is all that need be  said about
the Balsam of Copaiva,—the next of these remedies
is—

   The Powdered Cubebs.— This is a species of
mild aromatic pepper which is imported in large
quantities from Java, and, as I understand, princi-
pally for the cure of Gonorrhoea.  It is an admi-
rable 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
objection to giving it in the very onset of the disease
(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 supercedes these inflammatory symptoms
altogether, and leads to a very speedy cure.  If, bow-
ever, inflammatory symptoms have already suddenly
come on before you have had an opportunity of try-
ing the Cubebs, 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 Cubebs and such inflam-
matory symptoms should happen to arise, let it be
discontinued for a while, or until these  symptoms 
34        Gonorrhcea,—Its Remedies.

have been abated by the means above referred to, and
then resume the Cubebs.

  The best way of taking Cubebs is  in the dose of
a piled up  table-spoon full, mixed in a tumbler of
water, and repeated  twice or  thrice  a day.   It is
of no use to take them in the dose of a tea-spoon full
ai the time, as many  do.—There is something also
in the manner of mixing them.  The  best way is to
all a tumbler half full of water, then put a table-spoon
full of the Cubebs upon the water, and in a minute
or so you will find they will have sunk  from the
surface  to  the  bottom,  and  thus  are equally
diffused. If you adopt any other  way of mixing
them,  they get in lumps,, which is very  disagree-
able.

  Should the Cubebs irritate the bowels as a purga-
tive would do, this may be checked by adding five
drops of Laudanum to eaeh dose; but if  they only
prove a little laxative, to this there  is no  objection.
The virtue of the Cubebs 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 being exposed to a newly painted room.

  But, although I have said so much in favor of the>
Cubebs, let it not be thought that they are to be de- 
          Gonorrhoea,—Its Remedies.        35

pended on in every case.  On the contrary, there are
many individuals  in whom they seem  to have no
good effect at all; and others in whom they will stop
the discharge so long as they are continued, but the
moment the remedy is laid aside, the disease returns.
And what was said of the Balsam of Copaiva is also
applicable to the Cubebs;—viz. when  they  do any
good at all, they do it quickly; so that if you do not
see the most decided  advantage from their use in
two or three days, but little or none is to be expected
from them.   The fact is, that many cases of Gonor-
rhoea  defy the virtues of internal medicines alone,
and absolutely need the aid of local remedies.   The
inconvenience of  its bulk is also another objection
to the use of Cubebs.—This brings me to the subject
of my favorite remedy,—

   The Black Pill.—The virtues of the Balsam of
Copaiva and the Cubebs have now been fairly stated,
and the objections to them shown.  These objections
are, first, to  the Balsam, its smell, being peculiar
strong and  disagreeable—betraying the disease for
which it  is taken; also, its  effect upon the stomach
and the bowels, which is obnoxious and intolerable
to many ; next, to the  Cubebs, its bulky  form—ren-
dering it  exceedingly inconvenient.  To these again
must  be  added, the uncertainty  of their curative
effect, for the influence of either of them alone is in
many cases so small as to fail entirely in the  cure
of  the disease.   It therefore seemed desirable,  if it 
36         Gonorrhcea,—Its Remedies.

could possibly be done, to extract the virtues of them
both from their disagreeable and offensive parts and
unite them in one compound.  And more especially
so, as it had been found, that, in those cases in which
one of these medicines was not equal to the cure of
this  disease alone,  yet, that when combined they
frequently succeeded well.  Modern Chemistry had
also shown that the active properties of a vegetable
medicine frequently resided in a very small portion
of its bulk.  The article Quinine, for instance, (taken
from Peruvian Bark) is an example of this  fact, for
of this a quantity not larger than a pea is even more
effectual in the cure of Ague, or any of those com-
plaints for which the Bark is  given, than a whole
table-spoon full of  the Bark itself.  In this, after
divers and repeated  trials, I succeeded to my utmost
wishes.  At first I made  this Extract in the form of
Conserve, but, as some of my patients could not take
a Conserve, and as, in very hot weather, it became
too dry, I made it afterwards in Pills—which I call
" The  Black  Pill."  This medicine  I have  now
used for three  years, very  extensively, and do not
hesitate to say that it is by far  the best internal
medicine  that can be taken for the cure of Gonor-
rhoea.  If contains the virtues of  the Balsam, with-
out  its disgusting  smell  and taste;   and of the
Cubebs, without its inconvenient bulk; while, uni-
ting the  properties  of both in one,  it  cures those
cases which one of them alone so often proves un-
equal to. 
          Gonorrhcea,—Its  Remedies.        37

  Let it however be remembered, I do not recom-
mend that the cure of Gonorrhoea should be trusted
to internal remedies alone; certainly, the use of In-
jections should co-operate,—the cure is then accom-
plished in less than half the time, and  far more safe
and certain.  But there are persons who are preju-
diced against injections, and it is of great importance
that such should have the best internal remedy.  To
such therefore the composition of " The Black Pill"
is doubly valuable.

  I will only add  upon this subject, that the  same
precautions  that  were enjoined on the Balsam and
the Cubebs are requisite in the use of the Black Pill;—
do not begin with them  until high inflammatory
symptoms, if any such exist, are abated by purgatives
and low diet.  The dose is five, or six, or more, three
limes a day.   They set agreeably on  the stomach,
and rather increase the appetite and strength than
weaken either.

  Injections.—The use of these form an invaluable
part of the treatment of Gonorrhoea,—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  injections, simply, as it would
seem, because they may be abused.  But carry on
this reasoning to other diseases—say Opthalmia, for
instance.  Internal remedies then, are very good in
Opthalmia, and sometimes will cure it, but who would 
38        Gonorrhcea,—Its Remedies.

withhold the-use of Lotions and other applications
to the eye itself, simply because they may be mis-
used  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, but they may cause a Stricture; and
so may Lotions and Ointments put out the ey e; 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 cannot be cured at all without
them, and so of Gonorrhoea.  As to the idea of injec-
tions  causing Stricture, nothing can be more ridicu-
lous ; for, on the contrary, they prevent them.   The
ultimate result of a Gonorrhoea, long continued, is
Stricture.  Gonorrhoea  implies Chronic  inflamma-
tion,—this is its essential nature,—the ultimate ten-
dency of which is to destroy the elastic principle with
which the urethra is naturally endowed, and in this
consists  incipient Stricture.   Whatever shortens
the duration of Gonorrhoea, therefore, lessens the
chance of Stricture.  Now, Injections shorten the
duration of Gonorrhoea; therefore, Injections prevent
Stricture.

  If another argument  were required, I  might ad-
duce  the fact, that Injections  are used and recom-
mended by the greatest surgeons in the world.   This
however is quite unnecessary,—it is enough to state
that, although internal remedies alone will sometimes 
          Gonorrhoea,—Its Remedies.         39

cure a Gonorrhcea, yet they sometimes totally fail;
also, that in those cases where internal remedies are
sufficient to the cure alone, that cure can be accom-
plished far more safely and certainly, and in less than
half the time,  if aided by  Injections.  It would
therefore seem superfluous to say another word upon
the utility  of Injections,—it only now remains to
show their proper use.

  Injections should not be used in the very early or
inflammatory state of Gonorrhoea; and even when
this is past, it is better to begin the cure with internal
medicine, and continued this a day or two, before
resorting to injections.   After this you may use them
safely and very  advantageously,—few Gonorrhoea
cases can long hold out against their proper use.

  Injections should not be used too strong.  It is no
disadvantage if it give a little tingling sensation, but
if it amount  to heating pain, its strength should be
reduced  by adding a greater portion of water to it.
It is not proper however, on the contrary, to increase
the strength of an injection to any great  degree, but
rather, if it seem to do no good, to change it for an-
other.  So, if any one which has been  useful, but
after a time should seem to lose its power,  it would
be better to change it for another than to  increase
its strength.   Injections will sometimes lose their
good effect, and for this reason several prescriptions
are  given  for  them.  Indeed  under  any  circum- 
40        Gonorrhoea,—Its  Remedies.
stances it is better to change an Injection now and
then—the part becomes accustomed  to  the pecu-
liar stimulus  of one alone if long continued,—the
disease is sooner baffled and destroyed  when one
correcting stimulus is now and then exchanged for
another.  It is better  therefore to  change  an in-
jection;  you  may   return if you  please  to the
one you used  at first, if that agreed,  only  change  it
now  and then—keeping most to that which  best
agreed.

  Injections  are chiefly mineral;  there is a great
variety  of them, but they all act pretty much on the
same principle;  some however  are  better  than
others,  and  these   are  carefully  selected  in—
note 3.  I call them No. 1, 2, 3, and 4.  The higher
numbers may be a little the strongest, but it is not
the strength, it is the effect of change, I lay the great-
er stress upon; it is however always as well to be-
gin with No.  1.

  Injections,  to  secure their great  utility, require
  Note 3.—The best forms of  grains of common alum dis-
injecrions are the following,  solved in  a half pint vial of
—at least they are the best  water.
that  can be procured at any    White IHtriol  Injection.—
apothecary's store.          Sixteen grains of white vitri-
  Saturnine Injection.—For-  ol dissolved in a half pint cf
ty grains of Sugar of Lead  water.
dissolved in a half pint vial    Blue  Vitriol  Injection__
of ram water.               Eight grains of blue vitriol in
   Mum Injection.---Forty  a half pint bottle of water- 
           Gonorrhcea,—Its Remedies.         41

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
enquiry that it had not been made to enter the  uri-
nary passage.  Of course it then  must  fail.  To
use an injection properly it must pass up a certain
distance.   No  matter how much farther, but they
must go  up at least two  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 Avhether it has properly enter-
ed—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.—
With respect  to the  repetition of their  use, this
too is an  important point,— much depends on their
regular  and frequent  repetition.    An  injection
should be  used six or eight times in the  four-and-
twenty hours;—oftener if you please, if they do not
irritate  or pain, but certainly not less than I have
stated.  I know, that with the common syringe,1 this
repetition of them was often quite impossible ; how
could a person engaged in business  and perhaps be-
hind the counter for instance, retire often and  pri-
vately enough for  such a purpose.   And  not only
was  a syringe to be carried in the pocket, but a bot-
tle of injection too, and a cup to pour it out in.  It
was  quite impossible for one in a hundred to comply
with this as frequently as was  required, and hence 
42        Gonorrhcea,—Its Remedies.

the use and  value of injections was never properly
ascertained.   But these objections no longer now ex-
ist, for with my patent pocket syringe next to be de-
scribed, an injection may be used just as often as is
needful and with perfect convenience  and privacy.

   The Patent Syringe.—It is a little flat  elastic
bottle, holding two ounces, the neck of which is at-
tached to a metallic ring.  To this ring a little pipe
is screwed, and over this again a little cap, so as to
make it water-tight, and suited to the breeches pock-
et.  When you want to use  the injection you have
nothing more to do than unscrew the cap; and when
you wish  to refill it, put one of the papers of ingre-
dients (Avhich are put up with the syringe) into the
bottle by the ring, fill it with water, shake it, and the
injection is made.  Nothing can be more convenient
and private ; but the woodcut on the following page
will" show more clearly the use of this contrivance.

   Two of the patent syringes (in case one  by any
chance should break,) together with  a  set  of the
ingredients and a full quantity of the Black Pill,
cfc. tf-c,  are put up in a little chest, with lock and
key,—having also the book fitted in the lid.  This
contains every thing necessary for the cure of Go-
norrhoea, and is sent by Steam-Boat, or otherwise
to  any part of the United  States.   7 he price is
$10.  A similar little chest containing every thing
necessary for the cure of Venereal Disease, is also
$10.  But the complete chest, containing the medi-
cines, $c, for both complaints,— Gonorrhoea and
the Venereal—is $15.  The book alone is $1. 
Gonorrhcea,—Its Remedies.         43

    The Patent Syringe.
  A, the bottle open.—B, the pipe.—C, the cap.—D, the syr-
inge filled.
  The preceding remarks  relate exclusively to the
remedies in general use for the cure of Gonorrhcea.
But it was mentioned, there were other medicines
now and then required, chiefly the common reme-
dies in use for abating pain and inflammation.  To
make  this little book complete, however, it  is ne-
cessary here to enumerate these and say a word or
two upon the dose  and proper use of each.

  Lotions.—These are often very useful,  sometimes 
44          Gonorrhcea,—Its Remedies.

to assuage inflammation, and sometimes to assist the
healing of  ulcers,—for  the  manner  of making and
applying which, see note 4.


  Poultices.—Are more frequently required in vene-
real disease than in Gonorrhoea—vide note 5.


   Cooling  Emolient  Drinks.—These  are  some-
times  very useful,  and when they are  required it is
  Note  4.—Sugar  of Lead
Lotion.—Sugar of Lead sixty
grains to half a pint of water.
some add a little vinegar.—
The best way to  use it, is to
apply a fold or two of linen
upon  and around  the part,
and keep it wetted with it.—
The part should  be covered
up as little as possible.
  Spirit Lotion.—One part
of brandv and two of water,
used as the above.
   Ulack Wash.---Is made
with calomel and lime water,
and is an admirable applica-
tion in many sores, particu-
larly  those  of  a  venereal
character.   To  make lime
water,—put a lump of lime
as big as an egg into a gallon
of water, stir it  a little, and
in an hour or two  strain it
off"the lime and keep it cork-
ed. To a pint of lime water,
add a drachm  of  calomel,
and shake it well in the bot-
tle, when mixed  it  will turn
black.   It is the  black pow-
der that is most  useful, and
to obtain that, hold a piece of
linen to the mouth of a small
bottle of the black wash and
tu«i it downwards, some of
the black powder will fall
upon the lint which you then
apply to the sore.
  Nitric acid Lotion.—From
30 to 50 drops of Nitric acid
added to a quart of water.—
excellent to some venereal
sores.
  Note 5.—Common Poul-
ice---Is  best   made  with
equal parts of crumb of bread
and linseed meal boiled a few
minutes ;n a sufficient quan-
tity of water. It is one which
will  not dry and separate as
bread and milk.
i   Grounds of Beer Poultice.
—Made by using grounds of
beer instead of water.
   Black  Wash  Poultice.—
Crum of bread and linseed
meal, with Black  wash in-
stead  of water—used  to
spreading chancres.
  Carrot  Poultice.—Boil the
carrots well in but little wa-
ter and mash them.  It cor-
rects  the smell and agrees
with many bad sores. 
          Gonorrhcea,—Its Remedies.        45

important to know  what are the best and Iioav to
make them.   But it sometimes happens, a person is
so circumstanced that he cannot procure these—the
request to have them prepared would lead to enqui-
ries as to what they are wanted for.   To such there-
fore it will be satisfaction to know they can be donr
without.   In fact  it is  their diluting quality which
is chiefly useful.  The softening mucilagenous qual-
ities of which they are  composed, certainly has its
use, but this is nothing compared with their diluting
quality—depending entirely on the water on which
they are dissolved.   If therefore you take a watery
drink of any kind, as  common water, the end  is
answered—that is, if you take plentifully of it. From
half a pint to a pint of water may be taken eight or"
ten times a day—this is at the command of every one
and it is  of consequence to know it.   A near ap-
proach to  these  mucilagenous drinks however, can
be easily and pleasantly made.  Just take an ounce
or more of gum arabic, in large lumps, in the waist-
coat pocket, and consume it  during the day ; put a
lump in the  mouth every now and then as you would
do sugar candy ; it is a very pleasant  thing and gives
to the simple water drank the softening effects of the
various drinks described in the following note 6.

  Note 6.—Barley Water.—  three quarts of fresh water,
To make this properly, take and boil it  down  to two
a tea-cupful of pearl barley— quarts.  Some add a few figs
boil it a few minutes, then or a little  liquorice root to-
throw away this dirty water,  ward the end of the boiling.
and  add to the  pearl barley It may be repeated,—none of 
46          Gonorrhcea—Its Remedies.
   Purgatives.—Next  to  bleeding, purgatives form
the most active agent  in  reducing inflammation.—
There is however, much  in the selecting a  proper
purgative in particular  diseases.   The best that can
be selected  for  the  disease now  in question, is  the
purgative  Diuretic of  my chest, next to be  men-
tioned ;  but where this cannot be had, those men-
tioned in note 7. may be substituted.
these cooling, diluting fluids,
can be taken to excess, in the
early or inflammatory  stage
of Gonorrhcea ; and the oc-
casion  for taking them  is
just in proportion as the pain
and heat in making water is
great:  when these have sub-
sided, there use may be laid
aside.
   Flaxseed  Tea.—Take  of
bruised  flaxseed,  or linseed,
(not linseed meal) two oun-
ces, or  two or th.ee  table-
spoonsful, (there is no occa-
sion to be very exact in quan-
tity) and put this  to a quart
of water, which is to  stand
simmering by  the  fire for an
hour or two;  then  strain,
and, if more agreeable, sweet-
en it,  and let  at  least this
quantity be taken  as  com-
mon drink during every 24
hours.
   Alkaline  Drink.—Another
excellent remedy to abate the
pain and heat cf making wa-
ter is the carbonate of pot-
ash, or of  soda. Procure an
ounce of either of these, and
dissolve one quarter of it in
a qiiar of common tea, and
take this quantity during  the
day.  Soda water is  also a
good remedy, a glass may be
taken three or four times a
day.

  Note 7.—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 Go-
norrhcea.  It is not however
the best;  for much of that
quantity  of   salts  passes
through the bladder- adding
to the saline irritating quali-
ty of the urine, and thereby
increasing the scalding pain
in urinating.  It is better to
take one of the rougher pur-
ges below, but  this will do if
no  other is  at hand. It is
not generally known that a
very small quantity of Ep-
som salts, if taken in a  lar-
ger quantity of water,  will
act more pleasantly, certain-
ly,  and effectually, than a
larger dose in the usual quan-
tity of water.  A  tea-spoon-
ful for instance, in a tumbler
of water, instead of an ouno« 
            Gonorrhcea—Its Remedies.         47

   The Purgative Diuretic Pill.—This is the pur-

gative  of my chest; it is the one I give generally
and  find it  the most  easy,  comfortable  and  ef-
ficient  of any composition I ever met with.  Five

pills taken at bed time  is the usual dose;—this ope-
rates in the morning, and those Avho take it seldom
fail to speak of its excellent effect.  It may be taken

also with great advantage in. almost any disorder in

which  a cleansing purge is  necessary, particularly
where the  stools are of an unnatural color  and arr
offensive.


   Opium.—Is a valuable medicine under many cir-
cumstances.   The usual  dose  is one grain in the
in a small tea-cupful of wa-
ter.  Also, by repeating this
weaker solution.of salts,  it
is a very cooling and proper
medicine in a hot and fever-
ish state.   But  the  best of
all medicines for cooling, re-
ducing,  and preparing  the
system  for  a   mercurial
course, as  in venereal  dis-
ease, is  to  combine  Epsom
6alts with  antimony, as in
the following.
  Epsom Salts and Antimo-
ny.---Add  two  ounces of
Epsom salts and two grains
of  tartarized antimony to
half a  pint  of  hot  water,
and take a wine glass full of
it two or three times a  day,
or as often as may be neces-
sary to keep up a moderate
degree of purging.
  Senna  and Salts.—Is an
excellent purgative medicine
either alone or taken in the
morning after a dose of Calo-
mel the night before   Take
a handful or an ounce of
senna leaves, and one ounce
of Epsom  salts, and  add
them  to a little  more than
half  a pint  of boiling  wa-
ter, and when cold, strain it
and  take  a  tea-cupful for
a dose.  (A little bruised gin-
ger would^warm and prevent
its griping, which all purga-
tives will sometimes do.)
  Jalap and  Calomel.—Fif-
teen grains of the former and
five of the latter, taken in
sugar or molasses.   A  lar-
ger dose is sometimes  given.
  Seidlitz  Powders.—Is a
pleasant  way  of taking a
mud dose of Saline medicine. 
48          Gonorrhoea,—Its Remedies.
form of a pill; but it is given in different forms.—
See note 8.


  Mercurial Medicine.—Of  this  there are  many
preparations, but for  the most useful, safe, and con-
venient of these—See note 9.
  Note  8.—Laudanum.—Of
this the  dose is from  five to
thirty, or fifty drops.
  Dover's^ Powder,—Is giv-
en  to assuage  pain, it is  a
soothing and fever medicine
—the dose is from two and a
half to twenty grains.

  Note  9.—Mercuri(d Medi-
cine.—Calomel and Opium.—
Calomel sixty grains—Pow-
dered opium fifteen grains
—made  into  forty pills,  of
which  two  may' be  taken
every night,  and sometimes
one in the morning.
  The Blue  Pill.—Is a mild
and very excellent prepara-
tion of  Mercury, as well in
other diseases as in venereal.
The dose in the latter is ten
grains at  night and some-
times five in the morning.—
The dose however is regulat-
ed by various circumstances,
all of which are carefully re-
ferred to in  chapter  nth—
"On  the management  of
mercury."

  Blue  Ointment—Is anoth-
er excellent form in which to
exhibit mercury  and is pre-
ferred 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.
When this is fixed on, from
half a drachm to  a drachm
is   nibbed  into  the  thigh
every night, and sometimes
night and morning.  But in
the manner of using mercu-
rial  ointment  I   must  be
more   particular.   In  the
first place, it should be rub-
bed in by the patient himself,
but, if from  debility or any
cause  he should not be able,
then  those who  rub  it in
should  have  their  hand
guarded .with a bladder,  and
the best way to fix it is  the
following.  Get a pigs' blad-
der, and  after being steep, ed
in  warm water turn it inside
out; then soften it  well with
lard or sweet oil, and put it
on the hand like a glove, ty-
ing it round the waist with a
piece of tape.  Still it is  bet-
ter that  a patient  rub it in
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 
Occasional Remedies.              49
   Corrosive Sublimate.—This is a very active pre-
paration of Mercury, and  should be used  only in
urgent cases.   There are forms of venereal  disease
however, which require a very quick effect of Mer-
cury ; when  it  attacks the throat or nose  for in-
stance, in some constitutions, it spreads so rapidly,
that, if we were to wait the slower operation of the
milder mercurials, it  would eat away the  parts be-
fore the Mercury could  be brought to act upon it ;
and it should be known, that, when  the  soft parts
covering 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
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 with soap and water —
the skin will take the oint-
ment better for it.  The rub-
bing may be either night or
morning.   Throughout this
course  of  rubbing, wear  a
flannel  pair   of  drawers
next the skin,—-the   same
pair the whole of the  time.
   The  Specific  Pill.—But
far better than the Calomel,
the Blue Pill, "or the Blue
ointment, is the compound
called "The Specific Pill,"
which  is contained in the
chest for venereal.  It is a
mild  mercurial,   and  one
which  always  agrees.   I
have used it now for many
years and can depend on the
mercurial action of this med-
icine better than any other.
It is continually referred to
in the pages of this little vol-
ume.  But, use what form of
mercury you will, it is some-
times quite necessary to have
the aid of another, and then
I  prefer the  Blue ointment in
addition to my specific pills ;
this necessity however, does
not often  occur.  The usual
dose of the " specific pill" is
two at night and one in the
morning. 
50             Occasional Remedies.

to have some remedy 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, as it is  to  check and arrest  it when the
destruction  of important  parts are  threatened, and
this it  will  speedily do.   An  eighth, or at the ut-
most,  a  quarter  of a  grain may  be taken three or
four times a day;  but for the  manner  of taking it
more particularly,  see Note 10.


  Fumigating.Mercury.—This, like the corrosive
  Note 10.— Corrosive Subli-
mate and Muriate of Ammo-
nia,  (Sal Ammoniac.)—Of
each  six  grains—dissolve
themin sixty drops of water,
then add crumbs of bread
enough  to make into forty
eight pills—One of which will
contain   an  eighth  of  a
grain, and may be taken two
or three times  a  day.  But if
a larger quantity  is to  be
made, the following prescrip-
tion is better,  as the crumb
af bread would  become too
hard and perhaps would not
dissolve, in  the stomach.—
Corrosive Sublimate twenty
grains—starch half an ounce
—Gum arabic, two drachms
—water enough  to make into
a mass for one hundred and
forty-four Pills-each of which
will contain one eighth of a
grain of Corrosive Sublimate.
Some add  one  drachm of
Opium  to the  mass—it pre-
vents griping.  The best time
of taking them is after meal.
  If a liquid form is preferred
—then'dissolve one grain of
the Corrosive  Sublimate and
one grain of Muriate of Am-
monia in four  ounces of dis-
tilled water—and  take the
eighth part (a table spoonful)
for a dose.   Any  pleasant
syrup may be added if agreea-
ble.  The Muriate of Ammo-
nia makes it dissolve quicker
in water.
  Avery excellent Tonic and
anti-venereal   medicine  in
scrophulous and  weak con-
stitutions is one grain of the
Corrosive  Sublimate to one
ounce and a half of the Com-
pound Tincture  of Bark, of
which  one twelfth, or one
eighth  pa; t, taken m a glass
of water twice a  day 
            Occasional Remedies.            51

sublimate, is chiefly valuable  in cases of spreading
venereal sores, particularly of the throat and roof of
the mouth, and, when it has attacked these it is in-
deed, 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 prepa-
ration used for this purpose is the Red Sulphuret of
Mercury, (red cinnabar.)—The directions for using
which, have been the following:—take a red-hot com-
mon heater and place it on a  brick;—then throw on
this half a drachm of the red cinnabar, when fumes
will instantly arise ; these are directed to the throat
or nose by breathing in the fumes through an in-
verted  funnel  held  over them.  In this manner
fumes  may be applied once or twice a day.  This
plan however, will instantly be  seen to be quite
impossible with  many without betraying for what
purpose it is  done, and therefore the following con-
trivance which I call a fumigating candle, will be
estimated highly.

   Fumigating Candle.—For this contrivance I am
indebted 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 than described, but its real value struck
me so immediately, that I lost no time in putting it
in practice, the result of which proved  most satis- 
52
Occasional Remedies.
factory.  The plan adopted is to combine the cinna-
bar with wax, and make of this a candle of the com-
mon size, an inch or two in length, divided by a line
around it into four parts.  With this there is nothing
more to do than 10 light the candle and inhale the
smoke arising from it, this contains the Mercury in
sublimation,—a penetrating way of applying Mercu-
ry 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
sores which frequently occur  about the fundament.
For this purpose the candle is placed  in a cham-
ber  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 candle, an inch or
two in length, contains four mercurial fumigations.
It is a most convenient and speedy way of arrest-
 ing venereal in these parts.   I have effectually stop-
 ped the progress of it in the throat in 12 hours; and
 have cured excressence and sores  about the anus in
 as many days as they had existed months before.

   Bark.—Occasionally, in the treatment of Vene-
 real disease especially, it  is  necessary to support
 and re-invigorate the constitution.  In  cases of great
 weakness, or when a venereal sore takes on a spread-
 ing and unkindly character there is this occasion.—
 Nothing succeeds better in these instances than the
 Peruvian bark,—sometimes alone, but more general- 
Occaeional Remedies.
53
If combined with remedies such  as  are mentioned
in note 11.

   SarsapariUa,—Is a well known valuable medi-
cine in the treatment of Venereal disease.  Not that
every case of Venereal requires sarsapariUa,—far from
it; but there are. states and conditions of the consti-
tution  exceedingly unfavorable  to  mercury, (the
specific remedy) but which by its aid, are rendered
capable of bearing mercury well.
   There  are also conditions  of the  constitution in
which  it is advantageous to give the  sarsapariUa
and the mercury together,—the constitution  bears
the mercury better, and the  disease is more com-
pletely and more certainly cured thereby.   It will
be seen therefore, that the sarsapariUa is not given
to cure the venereal,—it has not  the power for
this,—but it enables the constitution to bear  the
mercury which will,  and  this under such circum-
stances which would render it dangerous to give,
or to continue that remedy without it.  It is true,
venereal  symptoms  will  disappear  under a course
of sarsapariUa  alone, but they will return.  This

  Note 11.—If the Bark alone  is the following :-Decoction
is given—a teaspoon  full of  of Bark, half a pint—Volatile
the  powder in a glass of  Ammonia,  two  scruples-
wine or wine and water, is a  Compound Tincture of Bark
proper dose—and  repeated  —Six drachms. Tincture of
two or three times or oftener  Opium, one drachm, of which
in the day.  Another  way of  a.wine glass is a dose, taken
taking the bark—especially  every third or fourth hour.
jn unkindly spreading sores 
54         Gonorrhcea,—Its Remedies.

fact experience abundantly confirms.  Innumera-
ble cases are on record, where, under the  sarsa-
pariUa, the symptoms of venereal in the constitution
have disappeared, and returned again and again, until
at length a course of mercury has been entered on.
when they have disappeared forever.

   Remember,  therefore, sarsapariUa is not giv-
en to cure venereal  disease, but only to enable the
constitution to bear that remedy which will ; also,
that sarsapariUa is not  required in many cases, but
only in those of weak and irritable constitutions, or in
those in whom mercury is found to disagree—render-
ing the patient feverish and irritable.

  With respect to the manner of taking sarsapariUa.
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 advantages above the former.  The most
simple, convenient, and  least expensive is the pow-
der ;—a good large tea-spoonful 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 in  note 12, I wiU give the other forms,  leav-
ing it to circumstance or partiality to fix on either.

  Note 12.----The Powder in a tumbler of milk & water,
of SarsapariUa, is taken  in or in any thing more agreea-
doses of a teaspoonful mixed  hie-three or four times a day. 
Gonorrhoea—Treatment and Cure.     55
                  CHAPTER IV.


   On the Treatment and Cure of Gonorrhoea.


   It is reasonable to suppose that  those who have
read  the preceding  remarks on the ordinary reme-
dies  for   Gonorrhcea, will prefer  those I  recom-
mend to any others.   These are put up together in a
little chest—including my pocket syringe, on which
  Simple  decoction  of  Sar-
sapariUa,—may be  made in
this way.  Boil two  ounces
of the sliced or bruised root
in three pints of water till it
is reduced to  a  pint and a
half (which is  a  wine quart
bottle), after boiling  an  hour
or two, it is recommended to
take it out of the  water, and
bruise it again in a mortar-
then finish the boiling—strain
it and fill a wine quart bottle
with it.  This quantity should
be drank daily—half a pint at
the  time.  As a larger quan-
tity can be made  with but
little  extra  trouble,   most
will see the advantage  of
making two or three bottles
at the time.  Some make the
proportions  of the decoction
stronger, but this I take to be
the  medium and the best. But
there is  an easier way of ma-
king the simple decoction,—it
is by boiling three drachms or
the  Extract of SarsapariUa for
a few minutes in a pint and
a half of water.
  The  Compound  Decoction
of Sarsaparilla.-This is of the
same nature as the  famous
Lisbon Diet Drink or  Decoc-
tion  of the  Woods,   and  is
made by adding to the sim-
 le  decoction a pint  and a
 alf of the  following ingre-
dients ;—Guaiacum  rasped,
sassafras and  liquorice root,
of each two drachms, me-
zereon root,   one drachm :
then boil them together for
about ten minutes  and strain
again.  Te  be taken  as the
simple decoction.
  Syrup of  SarsapariUa.—
This, if you can get it good,
and with a proper portion of
the extract, is a pleasant way
of taking it,—from half, to a
full wine-glass may be taken
in a tumbler of water, three
times a day,—or it may  be
added  to either of the decoc-
tions to make them stronger. 
56     Gonorrhcea—Treatment and Cure.

so much convenience and utility depend.  But beside
being more convenient and certain, they will  also
be found cheaper in the end  than procuring medi-
cine from time to time at any apothecary's store.—
In this chapter on the treatment and cure of Gonor-
rhoea, therefore, I shall refer continuaUy to the reme-
dies of my chest;  but as  this may not  be in the
possession  of every one, I shall also refer to  those
other, though inferior remedies, already mentioned
and described.

  A Gonorrhcea, as stated in the second chapter.
commences with a discharge  from the urinary pas-
sage, attended more or less with  pain and heat in
making water.   These symptoms  generally appear
in about two or three days from the period of  expo-
sure to it.   There  are  also  other  circumstances
which may or may not appear, and may be therefore
called occasional symptoms;  these are,—excessive
pain in making water,—swelling of the  foreskin,—
swelling in the groin,—painful erections  of the pe-
nis,—and swelling of the testicles.  Now, the treat-
ment under all these circumstances must be consid-
ered ;  but  it will add to the plainness of the subject
if these be considered separately.  I will  therefore
first describe the treatment of the simplest case of
Gonorrhcea, and when that is done, will  take  those
other circumstances—or occasional symptoms, in ro
tation. 
       Gonorrhcea,— Treatment and Cure.    57

  In every case of Gonorrhcea there are two distinct
and  separate stages ;—the inflammatory or painful,
with which it begins ;—and the specific, or that con-
sisting in a continuation of infectious discharge, but
without much pain and inflammation.

  It is true, that in some cases, the first, or inflam-
matory  stage is very slight, but  there  is  always
something of it, and  though  there  may be scarcely
any,rit is always right to guard  against it.   For this
reason I  recommend  that  in  every case of  Gonor-
rhoea an  active purgative should first be given. Take
five or six of the purgative  diuretics  of the chest,
or any other in note  7 you please.  If the pills are
taken at bed time, they will probably operate briskly
in the morning, if not, repeat the dose.   But if, not-
withstanding their purgative effect,  low  diet,  a
free use  of  some  cooling drink, (note 6 ,) and  as
much  rest as you can command—the pain and
heat in making water should come on, or, having
already been complained of, should increase, it will
be proper to repeat the purgative again, before ad-
vancing further with any other  remedy.  This pain
and heat, if at all considerable,  must be  abated
first.  I will suppose,  however, that a purgative dose
or two being taken, it is very moderate, or, if it had
been pretty  severe, abated, that now therefore  is
the time  to commence with other remedies, to begin
to lessen the discharge. Begin with the  black pill, 
$8    Gonorrhcea,— Treatment and Cure.

five or six of them three times a day.  In a day or
two  it  is probable  the discharge will lessen ;  but
whether it do or not, provided the pain and heat in
making water should not return, begin with  the in-
jections precisely as mentioned in page 37.   There
is no occasion to enlarge this little book by repeating
these directions here,—they are given in the fuUest
and plainest manner.  At  the  same  time  continue
the black pill.   Under this plan, sooner or later (but
remember it is not equally soon in every case)  the
discharge will cease entirely.  When this happens
leave off  the pills,  or take but half  the dose a few-
days more, then leave them off entirely.  Next, begin
to lessen in frequency the use of the injections, but
do not leave them off too suddenly.

  One of these remedies (the injection or black pill)
should be continued for 10 or  14 days after the  dis-
charge  has disappeared.   If the case should happen
to be more tedious  than common, the pill  may be
omitted—more than  are contained in  the chest need
 not  be taken—the injections will  finish the cure of
it alone.—This is the treatment of Gonorrhcea in its
 simple  and common form ;  but,  as I have said be-
 fore, there are  other circumstances  which may or
 may not occur, and  which must  now be mentioned
 separately.  Before however finishing these remarks
 on the cure of Gonorrhcea,—it may be as well to say
 a word or two on the difference there is found in the 
       Gonorrhcea,— Treatment and Cure.    59

time of curing this complaint  in  different  individ-
uals.   Even  under the same  degree  of active and
judicious  treatment, and this  especially adapted to
each peculiarity of constitution, the time required in
one will  be  ten times longer than  in another.—
Neither is it  always easy to  foretel  the individual
in whom the  cure  will  prove so tedious.   The
fact itself however, is noticed by  every author* of
experience, and it is well to know it, that such
cases may be endured with patience  and persever-
ance.   As an instance of good authority  for this
statement, I  will here transcribe the words of Sir
Astley Cooper on  the  subject:—he  states,—" Go-
" norrhcea sometimes continues for so long a time,
" notwithstanding all the means which  may be em-
" ployed for its cure, as to be an opprobrium to our
"art." Again, " Gonorrhcea is a disease which-very
" often baffles the longest  experience,  and the great-
" est professional skill."  And, he remarks  still fur-
" ther on this subject,—" You will generally find the
" cure of Gonorrhoea  difficult in  proportion as the
" constitution of the patient is disposed to Scrophu-
" lous affections.  If a patient has pimples in  his
" face, enlargement of the glands of the neck, a thin
" delicate skin and irritable fibre, you may expect to
'' have great  difficulty in curing him of Gonorrhoea,"

  Now, if this be true (and no one of much experi-
ence will doubt  it) who ean wonder at  the fre 
60    Gonorrhcea,— Treatment and Cure.

quent cases of misery, disappointment, Gleet, and
Stricture, which result from trusting to that swarm
of advertising people who fill our little daily papers;
for, if Gonorrhoea may prove so difficult under men
of so much faithfulness and skill, what  can  be ex-
pected from persons of the description I allude to.

  There is however one advising hint I cannot forbear
to give to those who are laboring under a long contin-
ued Gonorrhoea;—be sure  that the  person  whose
care you are under is a man of integrity and skill;
do  not  be  dissatisfied merely because the case is
tedious, but be satisfied  its tediousness is  not the
consequence of ignorance.  Neither pay the  least
attention to what you may have heard of his curing
other persons ; for, as I have  shown in a  former
chapter, Gonorrhcea  is sometimes of most  simple
and easy cure, and many of these are not cases of
Gonorrhoea at all,  though they are sure to call them
so.  Nor, in your enquiries, should you ever trust to
what they say about themselves.  If it were not too
serious a subject, it would be quite laughable to read
the long imposing titles which some of those will
give themselves ;—but rather enquire of some re-
spectable physician as to who and what they are 1
 —I do  not hesitate to say, there are no two diseases
 in the whole  range of medicine, which more truly
 require the assistance of a physician of integrity and
 skill; than Gonorrhcea and Venereal.  I now  pro- 
       Gonorrhcea,— Treatment and Cure.     61

ceed to those other circumstances which occasionally
occur in Gonorrhoea,—the first of which is,—

  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 already noticed, but which must be subdu-
ed before the remedies for stopping  the discharge
are entered on.  The means for reducing inflamma-
tion are,—purging, low diet, rest, and  the freest use
of diluting  drinks,  for which directions are given
in note 6 and 7.  You cannot make too free a use
of  dilutants.  The  burning pain arises from the
saline nature of the urine passing over an inflamed
and irritable passage.  The urine is loaded  with
salts---it is like  brine;   if, therefore, you dilute
it with perhaps a gallon or more of water, it is easy
to imagine  how its stimulating  property must be
diminished.  Sooner or later, by the  means above
directed, this heat and pain will  considerably abate,
and then, and  not till then, can you safely proceed
to lessen the discharge.

  Swelling of the Foreskin.—The foreskin, called
the prepuce, will often swell prodigiously, but this,
of itself, is  of very little  consequence.   A soft rag
wet with brandy and water, simple  water, or any
cooling  lotion, as in note 4, and wrapped about the
part, together with a dose or two of  purging  pills.
is all that is required.  The rag  should be  wetted 
 62     Gonorrhcea,— Treatment and Cure.

 often.  It is of some  advantage too if the  penis
 is kept upright, which can easUy be done by pinning
 or fastening it to a bandage around the waist.  But
 this swelling sometimes is  so great that the fore-
 skin cannot  be pushed back  from  over the  glans
 or head of the penis.  This condition of it is  called
 a phymosis, and, sometimes again, when it is  push-
 ed  back  it  cannot  be  drawn  forward, and this is
 called a paraphymosis.

  Now, both these  states are of great consequence,
 particularly the latter.  The chief thing  to look to
 in  the  first  (the  phymosis)  is  cleanliness, and
 here the patent syringe in the little case is of the ut-
 most use in  washing out the  humours that collect
 beneath  the foreskin, and  which,  by becoming,
 acrid and offensive, increase the  malady greatly.—
 It is necessary therefore to inject  some proper fluid
 under the foreskin  several times a day.   Any  thing
 that will wash away these humours  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 of no. 1, of the injection powders—for this is
cooling and healing to the part  as well as cleansing.

  The paraphymosis, is of still more consequence;
 indeed, you should loose no time in endeavoring to
reduce it,—that is, to  bring the  foreskin forward
again over the glans, or  head of the  penis.   With
 this object you proceed in the following way.   Take 
       Gonorrhcea,— Treatment and Cure.    63

 hold of  the  glans,  which  is  always  very much
 swelled,  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  diminish-
 ing its size, apply the two thumbs to the glans, and
 grasping the foreskin with the fingers, steadily push
 back the  glans while you pull the foreskin forward.
 A little force may be necessary, but you will almost
 always succeed;   if not, the only thing a surgeon
 could do, would be to  cut the  skin on each  tide,
 where it  is the tightest, and then it will easUy pull
 over; this  might  be  done with a  sharp  pen-knife
 or razor,  after this apply a poultice.  In both these
 cases, of course, it would be proper to live  low, keep
 as quiet as you can, and to purge freely.

  Frequent and very painful  erections of the pe-
 nis.—This is what the  French  people call Cordce,
 and a very painful thing it is.  I have already pointed
out its nature  in page 7,—it  occurs particularly at
night—the penis often being quite  crooked at these
times.  When  cordee is  disposed  to  come on, it
 cannot always be prevented entirely, but  it can al-
ways  be  relieved  and rendered  tolerable.  Further
a cordee  once come on,  it is often the last  symptom
to leave a patient.
The best way to prevent a cordee from coming 
*H     Gonorrhcea,— Treatment and Cure.

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 in
the little case, at bed-time, or those in note 13 be-
low.  After a few nights, see if you can leave them
off, but if the pain  come  on  again, return  to them.
With a view also of relieving the  inflammation of
the penis, on which this symptom  depends, it  is a
good thing to emerse it in a  basin of warm water
for a quarter  of an hour on going to bed, and after-
wards to  wet a  soft rag with brandy, or  vinegar
and  water, or common water, and wrap it round the
penis.  Some contrive to have a bottle of  cold wa-
ter near the bed, which they hold between their legs
whenever it awakens them.

  Swelling of the glands of the Groin.----This is
of less consequence in Gonorrhoea than in Venereal
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 with the
pills,—as much rest as  possible,—and at  night  a
rag wet with brandy and water or vinegar and water
laid on them, is all that is required ; under  this plan
these swellings  almost always subside.  I have in-

  Note 13.—Those who have  and ten of Opium in twenty
not the little case,  may  imi-  pills—of which take two or
tate the anodyne pills in the  three at  bed time. If this
following  way.   Get  an  cannot be done let thirty or
apothecary to make up forty  forty drops of Laudanum be
grains of camphor—twenty  taken in a little water.
of the extract of Hyosciamus 
     Gonorrhcea,—lis Treatment and Cure.   65

deed sometimes  seen them form matter and break,
but it has always been in scrofulous habits, and has
been owing to the constitution rather than the  Go-
norrhoea.  In such  a case should tumours threat-
en to form matter, leeches to it would be proper and
desirable.

   Swelling of the  Testicle.—When this complaint
happens, it  geneially begins  about 10 or  14 days
from the commencement of  the discharge, but it
may occur at any time.  At first there is an uneasy
feeling about the part which you riiight 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 or of both the  testicles, and
when the inflammation proceeds into the substance
of the testicles, there is great pain and fever.  From
the moment  an  inflamed testicle is threatened by
these symptoms give up every means for the cure
of Gonorrhoea and turn your whole attention to this
single circumstance.

  In the cure of this affection, the first thing to be
recommended (when it can  be done) is rest, and
resting on  the bed is preferable to any other.  The
next, to support the testicles by means of a suspen-
sory bandage.—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-handkerchief round 
66   Gonorrhcea,—Its Treatment and Cure.

the body.  If the testicle is suffered to hang by k&
own weight,  this alone will  prevent its  cure  and
greatly augment the pain.—Next, take 5 or 6 purga-
tive pills.—Frequent and repeated purging is a pow-
powerful means of relieving this disease, arid this
may be followed up either by repeating the pills, or
doses of Epsom  salts.  Lotions also are of great
use, and the best of all is  the common evaporating
spirit Lotion ;—it is  made  by mixing  one part  of
brandy to  two  of water, and applied by keeping a
soft rag and the suspensory bandage constantly wet-
ted 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  lance  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 lying down, if not applying cold
water will soon  stop it.  Sometimes,  even under
the best possible  treatment, great  pain and inflam-
mation wiU continue and you are under the necessi- 
     Gonorrhcea,—Its Treatment and Cure.   67

ty of taking opiates.  Forty or fifty drops of lauda-
num  may be taken at bed time.  The best form
however, of opiate medicine is, if it can be procur
ed—15 grains of Dovers powder,  with two of Calo-
mel at bed  time.   This is as far  as I would advise
any one  to go on his own judgment.  In very 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 possible, to call in the aid of medical as-
sistance  ; but, in many cases, this is quite impossi-
ble,—you may be at sea, or in the country, or where
you cannot command this assistance,  and  therefore
I will pursue this subject and describe the best mea-
sure to adopt in such a case in note 14.
  Note 14.—If rest, low diet,
purgative  medicine, lotions,
said perhaps leeches to the
part, do not succeed in lessen-
ing the pain and  inflamma-
tion,  then  a  very  copious
bleeding 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 before mentioned.
From  one to   two pints of
blood may be taken from the
arm and repeated if not suc-
cessful in  allaying the pain,
swelling, and fever.   At the
same  time, large doses  of
Tartarized Antimony should
betaken.  Eight grains may
be dissolved in half a pint of
water, and an eighth part of
this may  be  taken  every
second or third hour.  This
is a ljBge dose, at first it may
vomit  or  purge,  but  this
should  be  no objection to
continuing it, unless the  vo-
miting should be excessive,—
it wilf generally cease after a
day or two-  There is  no
medicine  which  has such
power to subdue inflamma-
tion,  and especially inflam-
mation of the Testicle, as
Tartarized Antimony, and so
important and  so  painful is
this inflammation.that a little
inconvenience or nausea and
vomiting should not hinder 
68             Gleet,—Its Nature.
                  CHAPTER V.


        On the Nature and Cure of Gleet.


  A Gleet  is  almost always  the consequence of a
badly  managed Gonorrhoea.   Instead  of following
up the cure of that disease by the injections which
are here so particularly dwelt on, the  discharge  is
suffered to go on from month to month, and the effect
of this is to entail a permanent weakness of the parts
affected.
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 be taken
at  bed  time,—or  twenty
grains  of Dover's  powder
with two grains of calomel.
If this is not at hand, forty or
fifty drops of Laudanum may
be substituted.   Leeches are
always of  use—fifte#i or
twenty on the part and after-
wards cover with  a warm
poultice.  At other times, if it
ean be had, ice may be used.
Sometimes cold applications
will do when warm ones will
not; at others warm will an-
swer when cold  will not. If
»ne has  been tried  without
success always try the other.
When ice is  used let it be
powdered and put into a blad-
der half full of water, and lay
it on the inflamed and swollen
testicle.  It is  astonishing
how quickly this will some-
times relieve the pain and in-
flammation. There is a way
of obtaining cold when yon
cannot  procure ice.  Just
mix equal parts of Sal ammo-
niac, Saltpetre, and  Glauber
Salts,  and put into a blad-
der of water, instead 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 sum-
mary of the treatment of in-
flamed testicle then is as fol-
lows.   Suspend the testicle,--
rest,—purge,—leech, — and
apply  cooling  lotions.   If
pain, inflammation,and fever,
still run on--Bleeding, Leech-
es, Tartarized Antimony, and
the application of cold. 
               Gleet,—Its Nature.             69

   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 terrible disasters;—
 virtuous and unsuspecting women are,unintention-
 ally involved in this complaint  in consequence.—A
 person who is about to marry, for instance, may not
 have  had  Gonorrhcea  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 sadest consequences show them-
 selves.   So also, unfortunately, does a similar cause
 of unhappiness frequently occur in those  who 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 perhaps 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.—
 u Gonorrhcea, when neglected, sinks into a Gleet, and
 :< is known by  the change of the color of the  dis-
 u charge, and the pain attending the inflammatory
 " stage  ceasing.  In this state, is the  discharge in-
u fectious or not ?  I doubt myself whether a Gonor-
" rhoea ever loses its power of causing infection as 
70            Gleet,—Its Nature.
" long as any discharge from the  urethra remains,
" and I will give you my reasons for this opinion.  A
" married gentleman went to Lisbon from this coun-
" try, [England] and whUst at a distance from home,
" departed, as too many do,  from the path  of virtue,
" and went astray.  The Portuguese 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 Gonorrhcea,
" 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 had it five months and three days, it were
"possible  for it to be infectious.  I replied—' Cer-
" tainly not; you may go home—there is no danger
" of your  giving it  to your wife.'  He went home.
tc and unfortunately gave his wife  a severe Clap.  I
" attended both the  parties afterwards, and was ex-
" tremely sorry for what I had done ;—but I thought,
" at the time I gave the advice, that a Gleet was not
" infectious.  But I  think differently now,—and be-
 ' lieve that, after a continuance of several months,
" the discharge is infectious."

  Another instance.—" A gentleman from the north
" of England, and who had  been  recently married,
" came to  me, and said  that  he had communicated a
" Gonorrhcea to his wife. Shocked at such an oc-
" currence, I said, ' How could you think of acting
 ; i n such a manner V  ' Why, sir,' said he,' for four- 
Gleet,—Its Nature.            71
''" teen months prior to my marriage, I had a Gonor-
'■'• rhoea; I made various attempts to get rid of it, and
" had a variety of advice about it, but a yellow dis-
" charge  always 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 discharge.'   I
" visited  her, and found her in this  state; she was
'"'• some time  under treatment before she quite re-
" covered.  From what I  have seen, I do hold that
:' a medical man is not warranted in saying that a
" discharge of a gleety kind is not infectious."

   On these two cases thus faithfully related, then,
every person will be able  to form his own  opinion
on the infectious nature of a Gleet; I think they are
sufficient to make every reflecting conscientious per-
son 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
Gonorrhoea,—they are twenty to one, compared with
cases of VenereaL  In fact, the common women of
the town pay no attention to a Gleet.  After the first
or inflammatory symptoms of a Gonorrhoea 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 Go- 
72            Gleet,—Its Nature.
     norrhcea in the same female; but it is the Venereal
     which brings them there.  As to the Gonorrhcea, 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 Hos-
     pital for the  cure of the Gonorrhcea, or Gleet, but go
     out again promiscuously in the town and spread the
     Gonorrhoea in every quarter.

       I do not however, after all, say, that every Gleet is
     infectious, but, they are so generally, and there is no
     mark whatever by which it can be said that  this is
     infectious and that  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
#    m 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
     understood, and then a  suspicious gleety disorder
    wiU be easily detected and distinguished from either
     of these. 
Gleet,—Its Nature.            73
   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 situ-
 ated, here and there, little sacks for the purpose of
 secreting a lubricating fluid; these  are  called,—la-
 cuna.  After a Gonorrhoea, these little lacunas 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 dis-
 charge from these lacunae 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 irregularities of any
 kind; and  it  may decrease,  so  as  to become very
 trifling,—but it never ceases altogether.  This, there-
 fore, affords a good rule of judging 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 con-
sidering the  symptoms proper  to  Stricture;  and,
should any doubt exist, this may easily be removed
by the use of  a Bougie.  For the symptoms proper
to Stricture, and for the use of the Bougie, the reader
is referred to the next chapter, which treats expressly
on those subjects. 
74     Gleet,—Its Treatment and Cure.

  The Treatment and Cure.—A Gleet is a very
troublesome disease to manage.   If there were no
other reason, I might safely infer this from the num-
bers who come to me with this  complaint, having
had  it on them, more or less, for a length  of time.
These patients generally state they have tried a great
variety of means, and are quite disheartened.  I can-
not always learn particularly what these means have
been, but two  important things I do know; the first
is, that whatever they have been, they have always
failed; and the 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 fails,—and I am quite
sure no better can be availed of.

   In the first place then, begin with the Black Pill;—
or, if prefered, either of the other remedies mentioned
in chapter  III.  At the same  time  also begin with
the Injection.   Both the internal medicine and the
Injection are  to be used exactly as for Gonorrhcea.
To save unnecessary repetition therefore, you are re-
ferred to chapter IV, on the treatment of Gonorrhcea.

   But the  most troublesome part of the treatment I
recommend, is the use of the Bougie.   Many per-
 sons, I know, may not be able to procure them,  and 
         Gleet,—Its Treatment and Cure.     75

^ others may not like to venture on their use.  It will
 be satisfactory therefore for such to hear that I do
 not consider the Bougie  absolutely necessary, but
 only state, that, cases which have been very tedious
 and obstinate under every other-means,  have got
 well very quickly when the use of  the Bougie was
 added to them.—Instructions for the use of the Bou-
 gie I shall give in the next chapter, on Stricture; here
 I would observe only, that it is not required to begin
 with the small size, as in Stricture, but to select a
 medium or  full sized  Bougie, and pass  it in the
 manner  there directed every day; or, if it give un-
 easiness, (which is not usual) every other day, as
 long as the disease continues.  It often happens there
 is a little increase of discharge  on first using it, but
 this soon goes off.   The  stretching of the urinary
 passage  by the bougie, and the stimulus thus afford-
 ed, expedites the cure of Gleet exceedingly.  Those
 therefore who have been long tormented with  this
 complaint should not think the trouble of the Bougie
 too much to get rid of it.   When, however, it cannot
 be procured, or is exceedingly disagreeable, it may
 be dispensed with.

  There is  another medicine sometimes taken for
the cure  of Gleet—the Cantharides, or Spanish Fly.
I have sometimes given it, by way of change, in cases
which have proved unusuaUy obstinate—see note 15.

 Note 15.—The best way to  form of pills, which should
take  this medicine is in the  contain  one quarter or  one 
76      Gleet,—Its Treaiment and Cure.
   The following then is a summary of what has now
been said on Gleet.  It is a dischaige of a bluish or
yellowish humor from  the urinary passage—some-
times clear—sometimes opaque;—there is no pain
attending;—it  is almost always the consequence of
a  badly  treated  Gonorrhoea.  Its treatment is like
that of Gonorrhcea, but  the  use of the Bougie is a
valuable addition;—this however is not essential to
its cure—it expedites it only.  Another addition to
the treatment is, the internal use of Cantharides, or
Spanish Fly.
half of a grain of the powder
in each; one of  these pills
should be taken  night and
morning, and,  after a  little
while, three times a day.  It
is better  to make the cantha-
ridas into  pills with one  or
either of  the thicker kinds of
turpentine; the best of these
is that called Chio turpentine.
of which five grains should
be allowed to each pill; if this
size is two  large, it may be
made into two instead of one.
  It should  be continued a
considerable time to do any
good.  If it produce heat and
frequency of making water,
leave it off for a day or two,
and take flaxseed tea, or bar-
ley water. 
Stricture,—Its Symptoms.         77
                CHAPTER  VI.

On Stricture,—its Symptoms, Nature, Consequen-
                 ces, and Cure.

  When a person comes to  me with a Gonorrhcea
that has continued an unusual length of time,—up-
wards of two  months, for instance, I consider  this
to be a sufficient reason to suspect he may possibly
have a Stricture, and that it  is my duty to ascertain
for  fact whether it  be so or not.  Now, the early
symptoms of Stricture are a  scattering of the urine
in making water, or a splitting of the stream,  or a
smaller stream of urine than formerly.   If these or
any one of them, is  acknowledged, my suspicion is
increased.  But  if he says he has not noticed these,
I  am stiU not certain he has  no Stricture,  for these,
sometimes, particularly the smallness of the stream
of urine, will come on so gradually  that he may not
have noticed it.  Until the stream becomes remark-
ably diminished, a patient is  very apt to believe  and
say it flows as usual.  I have had patients tell me
this, when, on examining the passage, I have found
a considerable Stricture, and  then, reflecting on their
former way of making water, they have acknowledged
that the stream had become diminished.  But, if still
in doubt, there is another question I often put;—it is
if they remember,  when they have done making 
 78         Stricture,—Its Symptoms.

 water and have buttoned up their clothes, whether a
 single drop or two of urine ever passes afterwards,
 so as to wet the shirt a little.   This is the very first
 of all the symptoms of a Stricture, and the answer
 to this question has frequently determined me, and
 correctly too, upon this subject.  If, however, to all
 these questions a negative  is  given, so that  he has
 neither  a scattering of the urine, nor a diminished
 stream,  nor  a drop or  two which passes after he
 thinks he has finished making water, then he has no
 Stricture, and you may boldly proceed  to cure the
 disease on the principle of common Gleet.

   On the other hand, if be states he has these symp-
 toms, or any one of them, this will afford sufficient
 reason to suspect a Stricture, and no faithful physi-
 cian will proceed one step further without ascertain-
 ing for  fact whether it be so or not.  This can be
 done only by  passing a bougie,—a safe and simple
 means in proper hands, but which will be mentioned
 more particularly presently.

   Nothing can better serve to distinguish the dis-
 engenuous, advertizing,  boasting knave, from the
good physician, than the  difference of their conduct
in the  case  of Stricture.  The former  Avill never
trouble- himself or you with  the sound of Stricture,
but will sell you drops, or pills, or some such thin°-
as long as you will take it, and in the end leave you
in mental misery and incurable disease; the latter 
           Stricture,—Its Symptoms.         79

will not rest until he has ascertained the case,—he
will then explain its nature, show the utter inutility
of medicine alone, and conduct  you, by a rational,
safe, and easy course of treatment, to a perfect cure.
None  but those who see it daily can form the least
idea of the misery escaped by falling into the hands
of such a man.

   But, so far I  have spoken of Stricture only in its
early  stage,—at the time when its symptoms are so
few and give so little inconvenience as to allow its
existence 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 remote-
ness from the seat of the disease itself, so that when
they present themselves, they are never once  sus-
pected  to arise from  Stricture,  and, consequently,
never get relieved.   Many serious diseases, which, v
from  their having proved unyielding under a variety
of modes of treatment, have been thought incurable,
 and have been so because they have arisen from Stric-  ^
 lure, which was never thought of.—As an instance;—
 a few months  ago  a captain of a merchant vessel
 from Havana, came to mc with a recent 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 
SO          Stricture,—Its Symptoms.

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, was a
case of Opthalmia from  Stricture, but which had
given him so little pain  or inconvenience, until a
fresh attack of Gonorrhoea occurred, that a Stricture
was never once suspected.  By the time the Stricture
was cured, the eyes got well  entirely, and I believe
will never trouble him again.   But this is nothing
new in the treatment of Stricture; nothing is so
common as to see complaints which  had resisted
every former mode of cure, particularly  diseases of a
dyspeptic nature, entirely disappear on the cure of
Stricture.  The symptoms denoting confirmed and
longer standing cases, therefore,—indeed every thing
relating to this subject, is deeply interesting.

  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 narrowness of the strictured part increases
however, this  alteration or contraction draws atten-
tion, 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
much straining.  Sometimes it is necessary to make 
           Stricture,—Its Symptoms.         81

a great effort at the beginning, and afterwards it will
flow in a full enough stream; at other times the
desire comes on so quickly that you cannot retain the
urine for a moment.   This is when the bladder par-
ticipates in the disease.  The bladder is always more
or less disposed to this participation, so  that many
patients are obliged to get up in the night, or oftener
than they were accustomed to do.

  In many cases of Stricture also, there  is a dis-
charge from  the  urinary passage, but this does not
happen in every case.  This discharge may.be only
a little more of that mucus 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.   When the discharge is considerable,
it is often taken for a  Gonorrhcea, especially as this
may be attended with burning pain in making water,
and Cordee, all of which is very apt  to follow the
excitement of sexual intercourse.

  There are also various sensations and other symp-
toms which may  or may not occur.   These are ex-
ceedingly well enumerated  by Mr.  Bingham,  of
London,—a very sensible writer on Stricture,—from
whose work I will transcribe the most important,—
leaving out however all technical words.   Nothing,
correctly detailed, can be uninteresting to one afflict-
ed with Stricture.
                       6 
32         Stricture,—Its Symptoms.
   Mr. Bingham observes—" Various kinds of sen-
 " sations 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  part of the passage;
 " numbness in 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
 " Strictures 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
 "' aggravate the symptoms of  Stricture  whatever
 "they are.  Sometimes  this act is  attended  with
 "pain  and inability to emit the  semenal fluid;  at
 " other times only part of it passes, and the remainder
 " steals away when the erection  has ceased.  Reten-
 " tion of  urine has many  times  been  brought on by
 "sexual connexion,  in patients  troubled with Stric-
 " ture."

   "The  penis  is variously  affected by Stricture.
" Sometimes the erections are excessively frequent
"and troublesome, and these may or may  not be
" accompanied with semenal emissions during sleep; 
            Stricture,—Its Symptoms.         83

 " at other times the erections are weak and ineffi-
 " cient, and, occasionally, altogether wanting."

  " Sometimes swelling of one or more of the glands
 " in the groin, and enlargement of the testicle, indi-
 " cates the existence of Stricture in the urinary pas-
 " sage : and another symptom is, hardness to be felt
 " externally in the- situation of the Stricture.  In-
 " fiammation  and a gathering in that part of the
 " middle 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 whenever I have had an opportunity to
 " notice this,  there has  been, beside the Stricture,
 " disease of the prostate gland," (a hardish body situ-
 ated at the entrance of the bladder, just where the
 urinary passage  begins, and which  is exceedingly
 liable to  enlargement in elderly people) " or inflam-
 " mation about this part."

  The sympathy between the organs of generation
 and those of digestion is very great, giving rise to
 many remote affections of a dyspeptic nature.  In
other words, a stricture in the urethra is capable of
 disturbing the stomach, and  through this medium,
 of inducing other and remote complaints, all of which
 therefore are correctly placed among the symptoms of
 stricture.   These complaints are chiefly of a nervous 
 84         Stricture—Its Symptoms.

 character, as  head-ache, low  spirits, diminution of
 wonted clearness and energy of mind, and other hy-
 pochondriac feelings ; and so evidently are these the
 effect of stricture, that they cease as its cure pro-
 ceeds, while they resist every measure short of this.
 A knowledge of this fact is of great importance too,
 in the treatment of strictures, for, as a stricture in
 the  urethra has so much influence on the stomach,
 in like manner the stomach influences the stricture.
 Now, we can  at all times prescribe for these distur-
 bances, and hence the cure of stricture is so much
 expedited  by  attending to the stomach throughout
 its  treatment.  My own practice  verifies this state-
 ment daily.

  Sores about the head of the penis and foreskin.
 much resembling Venereal and frequently mistaken
 for it, are also among the  symptoms of stricture.—
 The  late Mr. Abernethy in his work on Syphilis.
 has  admirably shown this  fact.  To what he has
 stated I  can also add my testimony, for instances
 have occured to me in which these sores have prov-
 ed unyielding under many surgeons and different
 modes of treatment, but  which have got well speed-
 ily on treating them accordingly.

  Sores and other affections of the throat are some-
times symptoms  of stricture,—they  occur on the
same principle,  viz :—the  sympathy  existing be-
tween the organs of generation and the throat—so 
             Stricture—Its Symptoms.          85

 that disorder in one will produce disorder in the oth-
 er.  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 (16.)


   The last symptom I will mention, is a hardness and
 diseased condition of the testicle from  stricture.—
 This indeed may arise from other things than stric-
 ture, but when  it thus arises, and  this I often find
 to be  the case, it never can be cured but by the re-
 moval of the stricture.


   A  summary  then on  the symptoms  of stricture
may be stated thus;—that, in the early stage, or when
its progress has been slow  or almost  stationary for a
length of time, the symptoms of it chiefly relate to
the size of the stream of urine, or to the manner in
which it passes; this however only affords a ground
of suspicion  of a stricture.—But, in more confirm
  Note 16.—The sympathies
 between the organs of gene-
 ration and the throat in both
 sexes are very striking.  Not
 only is the beard  upon the
 chin prevented if the testicles
 are removed before the age
 of puberty—but also the de-
 velopment of the  throat is
 hindered, so that  the voice
 fails to attain  the deep and
 tenor tone of men.  It i9 a
 curious fact, that, when the
 corresponding organ of the
female is removed (as in the
ovaria in spaded animals) the
 voice  becomes  deep  and
rough in women,  and hair
shoots out upon the lips and
chin.  Young  women who
have beards are generally less
prolific than those who have
none.  Bingham mentions a
case which came under  his
own knowledge, of a young
lady who had  a beard, but
lost it after her marriage..—
All  this  shows the intimate
connection which exists be-
tween these distant organs,
and accounts for many mor-
bid  actions occuring in the
throat simply from sympa-
thizing with a stricture. 
 86         Stricture—Its Symptoms'.

 ed, or longer standing cases, the symptoms are much
 more numerous and important, as have been descri-
 bed ; still these alone do not prove the existence of
 it, for all these symptoms may arise from other cau-
 ses. It is therefore needful to have some other means
 of coming to the point, and this is amply furnished in
 the Bougie.—A bougie  is  a soft smooth instru-
 ment, which, if no  stricture or disorder in the pas-
 sage hinder, can  be passed without pain  or incon-
 venience through the urinary passage to the bladder—
 —but which, if there be a  stricture, stops and proves
 the fact.

   The Nature of Stricture.—This is easily explain-
 ed.  The urinary passage is  composed of a dense
 skin, having an elastic power, so that when the urine
 is forced into it by the bladder it enlarges to transmit
 the stream.

  Gonorrhoea, essentially, is a state of inflammation,
 and the effect of inflammation, when long continued,
 is to alter the natural condition of the part in which
it may be  seated.  Now, in the present instance, it
alters and destroys the elastic power with which the
urinary  passage is  endowed,  so  that it  no longer
yields to the flow of urine as it  ought to do, and
hence the stream is lessened and its force diminished.

  Also,  there are certain portions of the urinary pas-
sage, it  is well known, more liable to  inflammation 
             Stricture,—Its Nature.           87

 than others, and, accordingly, Stricture is most fre-
 quently found to be seated in these very portions.

   Again, long-continued  inflammation is known to
 thicken any partf in which it may be seated, and this
 is the case in Stricture.   Beside the loss of its elas-
 tic yielding power, therefore,  the passage also be-
 comes thick and callous; so hard and thickened u
 an old bad Stricture as to  threaten an aclual oblitera-
 tion of  the  passage,  for the  urine  passes  in the
 smallest stream, and sometimes only drop by drop.

   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 medicine in the world, alone, would never cure
 a Stricture.

   On the nature of Stricture then, it may be said, it
consists, at first,  in a loss of the dilating power of the
urinary passage, by which the stream is lessened;
and next, in a thickening of the parts, by which the
stream  is  constantly  diminishing;  and, that  it is
curable by art.

   The  Consequences  of a Stricture.—These are
truly lamentable,—not only being distressing to en- 
88       Stricture,—/** Consequences.

dure, but, some of them totally incurable,—admitting
only of relief.  I speak however now of old bad cases
such as have been suffered to run on for years, or
badly treated.

 Beside those sympathetic disorders then 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 these 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 thickening of its coats and to other
conditions of it which make it irritable and  incapable
of retaining but a very little urine, so that the calls
are frequent and  pressing,—disturbing  sleep  and
rest.  From  the same cause also,  the kidnies are
very apt to be diseased.

  The next effect of so much straining is produced
upon  the  passage itself, just behind the  strictured
part.   The force of the urine, as may easily  be im-
agined, dilates the canal and forms a pouch or bag
in which a portion of  the urine lodges.   But  this,
which always happens more or less, may lead to la-
mentable  consequences.  In  the  first place it may
render the passing of the  bougie impossible ; for,
when  the  pouch is large^ the orifice leading out of 
          Stricture—Its Consequences.        89

it may not correspond  exactly with that leading in-
to 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 dis-
ease.  Disease arising from this  cause is  of the
most distressing and permanent kind ; matter forms
in the subjacent  structures  and makes its way out,
both by opening into the passage, and also by open-
ing externally, ulcerating 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 whatis called a sinus, or fistula in peri n&o.
I scarcely know a more disagreeable and inconven-
ient 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 concep-
tion 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 sub-
ject, 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,—Surgeon to the late
King of England, in  his third volume, has a chapter
upon,— Diseases of an incurable nature, the con-
sequence  of long-continued Stricture, before the
proper means of removing it had been adopted. 
90        Stricture,—Its Consequences.
2-    o*    2. ^    c^       °
" J"*  I: * =  5"  " |  ffl P  » ."3 W O  O M J>
Ir^^I  I  ^ | h h  | ^^>h   0

b     oi^»»r»£0^t'tlinS   G
   BJ  r» to  — ■    oa-j?<i<-»P'--tB'-to2.   «

2. =»  S p  ^  §  5- 5- s  c  & -  «  "  3 ro o   H

P  El.    3  p     co S  p     pp-s?       J°o

§  3    g, ~          3-      *"                H
g <S    5" S- 5  »    g       I                w
5= 5-     E
p  a    £        -•                Hfl
p. « 2.
  CD O
  Among the consequences of stricture also may be
noticed,  a shrinking and dwindling of  the  penis
with but little erectile power.   It is not easy to ac-
count for this, but of the fact itself I am well assured.
On the removal of the stricture it resumes its wont-
ed size and firmness.

  A similar state of wasting of the testicles is also
a consequence 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 stric- 
 
92        Stricture—//* Consequences.

ture may be  the cause of impotence—the one me-
chanical, the other functional.   In the first, the func-
tion of the testicles is performed, but the fluid is im-
peded in its passage, or its impetus so  broken as to
fail in accomplishing its destined purpose.  In the
second, the function of the testes seems to be disor-
dered, so as to  have lost its essential and vivifying
principle.  This  is  no difficult thing to imagine,
when the nervous  structure of these organs, and the
exquisite sympathies depending on  them, are con-
sidered.  And,  further, this opinion is supported by
the fact of so many strictured persons who have no
children.

  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  connected  with this disorder, it
will be  seen with what propriety it is urged on ev-
ery one to be careful as to whose care  he entrusts
the cure of a Gonorrhoea.  All these consequences
are perfectly  unnecessary, and would be avoided if
the same good sense were  exercised in selecting a
proper person in  this  complaint as would be  done
in any other.

  But  stricture in its first stage is a  very curable
disease, and fortunately, with many, this first stage
continues for  a length of time.   It is fortunate also. 
          Stricture,—Its Consequences.        93

 that its principle of cure is simple, easy, and certain.
 It requires only to be acquainted with this, as given
 in the following section, and at the same time to be
 furnished with these simple means, in order to ena-
 ble  any one to undertake the cure himself with
 perfect satisfaction and success.

   The Cure of Stricture.—It is  in the first stage
 only, that a patient can  safely undertake  the cure
 himself.  At  this  time it is soft and yielding, and
 is therefore called a dilatable stricture.   In advanc-
 ed and bad cases it is hard and callous, and requires
 a little difference of treatment.   As  I have observed
 before, however, the  first  stage  continues a long
 time, and the inconvenience of it generally leads to
 its proper treatment  before it  has  had  time  to be-
 come hard and callous.  In my practice I meet with
 fifty cases that  are dilatable to one that  is not.—
 It is the treatment of the dilatable stricture  there-
 fore that I am now about to describe.

  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.  Nor is this at  all  to be
regretted, for it  is a simple, safe, easy, and certain
 way of curing it.

  Bougies  are  made  of  different  materials, but
those which  are soft and pliable are the safest and
best  for a patients own use; indeed, I seldom 
94            Stricture,—Its Cure.

use any  other myself.  These are made of a com-
position of wax, spread on a strip of linen, and rolled
up into the proper form, and are called common bou-
gies ; or are made of India rubber, and are then call-
ed Gum  Elastic.   There are other kinds as metal-
ic, caustic, &c, but the former of these are not so safe,
and the latter are only required in bad  cases, such
as no patient should undertake himself.

  Common wax  bougies as  well as common gum
elastic, are  straight, but  when they are  to be used
are bent into a certain form.  This is easily  done
after holding them before the  fire a moment, or in
the warm hand.   The following plate  will show the
form and figure of a common bougie, as well as its
curve. It  is  of  some consequence to give it  this
certain degree of curve.

                     Plate.
  Shewing a straight, and a curved common xoax Bougie.
                     Fio.  I.







                    Fig. 2.
 Fig. 1,—A Straight  Bougie.  Fig. 2,—A  Curved Bougie. 
             Stricture,—Its Cure.           95

  (For the convenience of those who consult me at
a distance, I have put them  up in sets, in a little
case, containing also a small bottle of oil, eye, to-
gether with  necessary  instructions.   This little
package, including my consultation feP, is $10—
and is forwarded  by steamboat or otherwise, as
requested.)

  Now the manner of using the bougie is the fol-
lowing.

  We will suppose it the first time of using one, the
object being to ascertain for fact,  whether there
really  be a  Stricture, and if so, where it may be
situated.  Soft bougies, until you  bend them, are
straight.  You therefore select either a wax or elas-
tic  straight  bougie, of a medium size,  and, holding
it in the hand or before a fire,  you warm it a little, so
as to give it the curve represented in the plate.  You'
may take which kind you please, but surgeons gene-
rally begin  with the wax, because, from  a certain
tact and management, they can sometimes take an
impression on the point of the wax bougie, and there-
by tell the shape and size of the Stricture.   How-
ever this is not so easily done, and if you should find
you do not succeed with one, then try  the other.  I
can sometimes succeed with the Gum-elastic when
I could not with the wax.  But, in giving  the Gum-
elastic bougie  the  proper curve, you will find, from
its  elastic property, it  will  become straight again. 
96            Stricture,—Its Cure.
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.
You next rub upon it a little olive oil, or lard, or
candle grease, and then proceed to introduce it.—
Take the penis between the thumb and finger of the
left hand, and stretch  it forward  a little,—rather
pointing upwards.  Then, with the bougie between
the thumb and fingers of the right hand, introduce it
by the orifice, and pass it steadily on, with a gentle
and continued progress, till it reaches the bladdei.
which can easily be told by the ceasing of any feeling
of resistance.  In passing the bougie down, do not
undertake to give a definite direction to the point,
but rather hold it between  the thumb and finger so
loosely that it may take its own direction.—But, sup-
pose you pass it smoothly down a.certain distance,
and then it  suddenly stops.  In that case you are
not to withdraw the instrument immediately, but to
hold it steadily to the part, gradually, and to a limited
and reasonable extent,  increasing your  pressure.
This  is the  strictured part, and, if il be  dilatablei
and not very much contracted, it will presently pass
through, and you will have accomplished then, one
step towards its perfect cure.  There may however
be a second  stricture, or a third, which, if there  be,
must be treated in the same way, but this does not
often happen.  It should be also known that a Stric-
ture may be  situated in any part of the urinary pas-
sage, but there are some parts more frequently its seat 
Stricture,—Its Cure.           97
than others.  The most frequent seat of Stricture is
somewhere within three inches before it terminates
in the bladder.—In this first passing of the bougie
therefore, we ascertain three things,—the fact, wheth-
er a Stricture exist or not—whether there are more
than one—and where its situation is.

   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, exactly as before; (remember,
a medium size 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  on  the
second when I  had  failed in  the first.  In general
there is but little pain in  passing a bougie, and the
degree of force directed is so limited that there will
be very little felt, except  the Stricture be in what
we call an  irritable  state, which is known by  its
giving  pain immediately  on touching it.   What I
mean is, you must not give much pain by the mere
force of pressure. Neither 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 consequence; the part
is so delicate and vascular that a drop may appear
on a slight occasion; but, if there is  more than a
drop or two, this should  .induce you  to  lay aside 
99            Stricture,—Its  Cure.

the attempt for the present.  In some cases yon may
not be able to pass the smallest  size tiU after various
attempts made at intervals  of several days; this
however but seldom happens; when  it does, you
must pay attention to your state of health and habits.
Particularly must you attend to the state of your
stomach and bowels.  Take a moderate dose of the
purgative diuretic piUs from the case, avoid a stimu-
lating 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.

  But  I will suppose, which is generally the case,
that a middle size bougie, or a smaller one, has passed
on the first attempt.  If it pass pretty easy you with-
draw it and immediately pass a larger one.  With
this be contented—it is pretty well  for the first at-
tempt, and now it should be considered, when, and
how often, it should be repeated.   The repetition of
a bougie should always depend on the degree of irri
tation which the last attempt has caused.  If there
be but little or none, it may be iepeated on the fol-
lowing day, but  if any considerable degree of pain
and irritation should be caused, this must be suffered
to subside before it is repeated.   After  the first, and
sometimes after  every trial, there is felt a little heat
in making water which soon goes off;  and  some- 
Stricture,—rlts Cure.           89
times a little increase of discharge (if any had existed
before) may be observed; neither of these are of the
slightest consequence; as the cure goes on, the dis-
charge will cease, if not, it is easily made to do so
permanently.

  The Bougie then is to  be repeated either on the
following day or a few days after just as the part
may feel.  You begin now, first, by taking the bou-
gie you last used and pass it as before; it is presum-
ed this will pass  easier than at first;  you therefore
then select a larger size  and pass it through the
stricture into the bladder,  keeping it  there for about
ten minutes.  If it give much uneasiness however,
you may withdraw  it sooner, but if it do not, and
it is convenient to spare the time, keep it there for
half an  hour.  In some  instances  I have recom-
mended  it to be kept in for hours, and some have
continued it all night with the greatest possible ad-
vantage  and ease.  In this case it should be fasten-
ed to the penis with  a piece of tape.   Thus you go
on, increasing the size of the bougie every day or
two, or as  you find the part enlarges until  you can
pass the largest or next to the largest size with ease-
There may always be some little  uneasiness in this
operation, but by comparing it with what was for
merly felt,  you can easily tell when the passage has
been widened to its natural dimensions.

  When the passage is restored  to its natural  die 
 100           Stricture,—Its Cure.

 mansions,-—or, when a fuU size bougie can be passed
 into the  bladder with tolerable ease and readiness,
 you  then begin to leave them off, but this must not
 be done too suddenly.  If, up to this time you  had
 passed it every day, now do it every other day,  and
 after a few times use it only twice a week, and then
 ba4 once.   It should be known there is a disposition
 i"i j  stricture to return, but this disposition is effectu-
 ally"  removed by this plan of repeating the bougie for
 w^eks and even  months after it is cured.  Indeed,
 f find  it is  entirely for want of  attending to  this
 practice, that  so  many cases  of  stricture prove so
 i'.edious.   I urge it therefore upon every one to con
 • inue the bougie for weeks after a  Stricture is cured,
 and  even  then about  once a month for  some time
 j iter wards.   This then is the final  and permanent
 ' uie of a stricture, as well as the removal of  every
 .-.ymptom  and circumstance which  had depended
 on il.

  We sometimes hear of Spasmodic Stricture.  On
 this  subject much misconception has existed.  It
 may be advantageous  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 Stricture  is rendered  irrita-
ble by any cause, the action of these  muscular fibres
 is quickly disordered.   It is in thus way that spasm 
Stricture,—Its Cure.           iOl
in these muscles is so often brought on in persons
after  drinking,—the excitement of wine and  com-
pany  having made the Stricture irritable.  In  this
state  perhaps 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 muscles of the mouth of the blad-
der 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 and the
warm bath must be superadded.  So also, in passi^
a bougie, if the Stricture has been rendered irritable
by any such cause, the moment it presses on it, therc
muscles are thrown  into spasmodic  action which
hinders its passing through.  In this case keep the
bougie gently pressing on the Stricture for eight ci
ten minutes,—it  will frequently  succeed by  th>«
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
simple  state of  tenderness (without a  Stricture) in
some point or other of the passage.  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 obstruction is  con- 
 102           Stricture,—Its Cure.

 cerned, but, that in passing some certain point a
 great degree of pain is felt.   This disorder is differ-
 ent from a Stricture, inasmuch as it consists merely
 in a morbid or increased degree of sensibility, 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 irri-
 tation wiU 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 there-
 fore, on every time of passing it, you find the pain
 and tenderness becomes less and less, you may de-
 pend upon a perfect cure, as well as the cessation
 of every symptom which originated from it.

   Thus have  I finished the subject of dilatable
 Stricture,—its symptoms, nature, consequences, and
 cure. It is gratifying to have been able to point out ari
 easy and  practical remedy for so formidable a dis-
 ease.  But,  this remedy has often  been  doubted by
patients.  They have  said,—is  it possible  that an
operation  so simple can cure a disease so incurable
and  dangerous under any other means?—The best
answer to this, it might be replied, is the daily occur-
rence of the fact; but, as some may not have had an
opportunity  of  witnessing an instance of it, and as
the intelligent  and  discerning mind of others may
require some explanation of the power by which it
does so, I  wiU endeavor to give this explanation iq 
Stricture,—Its  Cure.             10
a note (17)—repeating however;—there is no other

way of curing Stricture.


   With regard to the confirmed or callous Stricture,
I will not go into the minutiae of its treatment, be-
cause I  do not consider that the cure of this should
 ever be undertaken by the patient.  The object aimed
at, however, is to promote absorption of the callous
 body, and for this purpose metalic bougies are  more
 useful, and  these should be continued in the part for
  Note 17.—Every part and
structure of the body is en-
dowed with its own peculiar
power of action;  also, every
part is. endowed with a re-
storing power, the activity of
which is  aroused by every
deviation  from the  natural
and healthy  condition of  a
part.  This is no fiction.  In-
deed  every restoration from
disease to health is an illus-
tration as well as a proof of
such  a principle.  Numerous
as are the laws which regu-
late and maintain the healthy
actions of the body, these are
not more numerous and im-
portant than  those which in-
fluence and control its mor-
bid actions.  A Stricture is,
essentially, a morbid action—
a deviation from the healthy
and natural  condition of a
part;—it has  lost  its natural
powerof elasticity, and if that
morbid action which destroy-
ed this elasticity could be re-
moved, the principle 1 allude
to would  instantly restore
that power.
  Now, the.Bougie does this.
The pressure and excitement
of the bougie, upon this deli-
cate structure, breaks up and
destroys this  morbid action,
and the healthy one immedi-
ately  succeeds—the natural
elasticity of the  passage is
restored.
  On the same principle also
are the confirmed and callous
strictures cured.  Every part
of the body is endowed with
the principle  of  absorption.
The bougie, in this  case,  not
only destroys the morbid ac-
tion essential to the Stricture,
but powerfully excites the ac-
tion of the absorbing vessels,
which is the means of remo-
ving that callosity. Indeed
the cure of Stricture is affect-
ed 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. 
104           Stricture,—Its Cure.
some hours at the time.   The caustic bougie is alto-
gether unfit for private use, and is only required id
very peculiar circumstances, when it is a valuable
means. 
Gonorrhcea,—In the Eyes.        105
                CHAPTER VII.

Gonorrhoea in the Eyes, and  Gonorrhoea! Rheu-
                    matism.

  This subject is introduced, not for the purpose of
inducing 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 lose  no  time in securing
that surgical and prompt advice they need.  Fortu-
nately, these complaints are  not of every day occur-
rence.  Now and then, however, a person who is
under treatment for a Gonorrhcea will be suddenly
seized with a most severe Opthalmia.  This  com-
plaint 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 a copious dis-
charge of matter.  In such a case there is not a mo-
ment  to be lost—the advice of a surgeon  should be
sought.  But, as it is possible, and, especiaUy  if the
physician or surgeon have practised principaUy.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 those who may be obliged
to wait some time for his arrival, I  will give, in the 
106         Gonorrhcea,—In the Eyes.

form of a note below (18), an outline of the treatment
which is recommended by the most experienced and
competent men in Europe.
  Note  18.—In Mackenzie's
Practical  Treatment of the
diseases of the Eye, he directs
the following for  this  kind
of opthalmia.—"Abstinence
from  all stimulants; blood-
letting, both general and  lo-
cal;  and the exhibition of
purgatives, or emetic-purga-
tives, and  diaphoretics, are
to be. had resource  to in the
early stage "  The discharge
is to be frequently and  care-
fully  removed  by  injecting
under the  eyelidy,  a lotion
made with a grain of the mu-
riate of Mercury to an ounce
or more of water ; the globe
of the eye is to be touchtd
once or twice a day with a
solution 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-hair pencil.)  Also, the
lids are to be kept from ad
hering by anointing the edges
of them with the red precipi-
tate  Ointment.  "Counter-
irritation ought to be employ-
ed from  the very  first,  by
means of mustard poultices
arid blisters to the nape of the
neck, between the shoulders,
or behind the ears."   "If the
pain of the eye is pulsative -
or the parts around it are
affected with pain coming on
at night—Calomel and Opi-
um should be given, so as to
affect the mouth. Warm fer-
mentations, the vapor of lau-
danum, opiate friction of the
head, and the like, will seem
to moderate the pain; but our
chief reliance must be placed
on depletion, counter-irrita-
tion, scarification, and smart-
ing applications to the globe
of the eye itself for removing
the disease.   Snipping out
a  portion of the chemosed
membrane (the outer mem-
brane of the eye, whose ves-
sels are go i gedwith blood) so
as to procure a considerable
flow of blood, is highly ser-
viceable."
  " Bleeding alone must not
be depended on."
  "This inflammation," (says
Mr. Barcet, another eminent
and practical man) in the few
instances that have come un-
der my observation, is of the
most violent and  intractable
description, and hasproduced
the total aestruction of the
organ of vision, in the space
of two or three days, notwith-
standing the  most vigorous
employment of general and
topical  bleeding,  and other
antiphlogistic means."
  To the truth of all this I can
attest,  upon  the  ground of
my own observation and ex-
perience, and I judge it there-
fore  exceedingly  desirable
that persons should be aware
of the dangerous nature and
rapidity of this complaint.
that they may not be induced 
           Gonorrhcea,—In the Eyes.        107

  With respect to the manner in which the eyes
become affected with Gonorrhoea, there has been a
difference of opinion.  Three explanations have been
given of it.  First, that it was owing to carelessness,
such as inadvertently rubbing the eye with the fin-
gers after handling the penis  under the discharge of
Gonorrhoea;  next, that it was owing to the Gonor-
rhcea affecting the constitution, when, like Rheuma-
tism, it may change its seat from place to place; and
thirdly, that it was the consequence of stopping the
discharge of Gonorrhcea too suddenly.

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

  Formerly I was not so well aware of these facts,
but I find they 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 a note (19).

to trifle away the only chance  to  me from the country with
of cure, for it is on the prompt  violent Opthalmia. This pa-
and decisive treatment in the  tieht  having  Gonorrhoea,
early stage alone that the in-  while  engaged  in removing
valuable sense of sight de-  the discharge from the urina-
pends.                    ry canal, a drop of the Gonor-
                          rhceal fluid was by mischance
  Note 19.—Mackenzie,  on  thrown fairly in upon his left
diseases of the Eye, page 344,  eye, and excited  the severe
states—"A patient was bro't  puro mucous opthalmia un> 
108         Gonorrhoea,—In the Eyes.
   With respect to the question whether or no there
are such diseases  as Opthalmia from too suddenly
stopping the discharge in Gonorrhoea; and Opthalmia
arising from the constitution embued with Gonor-
rhoeal 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; moreover, the cases we occa-
sionally meet with  here and there in the various
periodicals would seem  to corroborate such opinion.
As I have already said  however,  if there really be
der which he was laboring.
The Gonorrhoea still contin-
ued when I saw him. The in-
flammation of the eye subsi-
ded under appropriate means,
the eye cleared to a  degree
far beyond  my expectations,
and  a c nsiderable share  of
vision was preserved."
  Mr. Allan relates the fol-
lowing remarkable case. "A
gentleman, aged 17 years, had
had Gonorrhoea a few days,
when violent inflammation
of the  eye,  attended with a
dischargesimdar to that from
the urinary canal burst forth.
The gonorrheal running from
the penis continuing unaba-
ted at the same time.  In a
few days his brother, aged
14—who never had had vene-
real  disease in any way but
who slept in the same room,
was attacked with a similar
opthalmia in both eyes.  In
addition te  my own attend-
ance, Drs. Munn and Mr. Is
Bell, of Edinburgh, were call-
ed in, and notwithstanding
every means  that could  be
devised, the elder brother lost
the sight of both his eyes, and
the younger brother of one.
No doubt the younger used
the same towel, or wash-hand
bason, or the like."
  Again, the very eminent
and practical Astruc relates
a case exceedingly in point.
"A young man nad been in
the habit every morning of
bathing  his eyes with his
urine while it was yet warm,
in order to strengthen his
sight.   Although he had con-
tracted a Gonorrhoea, he did
not abstain from this custom,
apprehending no harm from
it; but the urine partaking of
the infectious matter, quickly
communicated the same dis-
ease to the mucous mem-
brane  which covers the eye
and eyelids (the conjunctiva).
The consequence was a se-
vere opthalmia.attended with
an acrid and involuntary dis-
charge of tears and purulent
matter, but which  yielded to
the same remedies which re-
moved the Gonorrhcea," 
            Gonorrhcea,—In the Eyes.        109

such  cases they are very rare, and I have no doubt
that many of those cases of Opthalmia, as well as
Rheumatism,  which are there  related, have been
diseases which happened to occur at a time when the
patient was laboring under Gonorrhcea, and had really
no other connexion than their accidentally occurring
at the same time.   But, as I have said, as some per-
sons  think otherwise I will give  in the  following
note 20, (principally for the perusal of medical men)
the peculiar treatment which  such persons have
adapted who have thus  thought.
  Note  20. — Treatment of
those cases of Opthalmia which
are supposed to arise from too
suddenly  stopping  the  dis-
charge.—Of course this kind
of Opthalmia includes only
that in which the discharge
is stopped.  On this subject
Mr. Makenzie (page 376) ob~
serves—"The only point in
which the  treatment of this
opthalmia  differs  from  the
former, is in the attempt, so
much recommended by some
authors, to restore the  sup-
pressed discharge of the ure-
thra.  This is to be done by
introducing a bougie into the
urethra, covered with some of
the purulent discharge from
the eye, or with Gonorrheal
matter from another subject.
Even the simple introduction
of the bougie may perhaps
produce the effect so much
desired; for any stimulus ap-
plied to the lining membrane
c»f the urethra, provided it be
of sufficient activity to deter-
mine an irritation and a secre-
tion of mucus, may produce
a running similar to Gonor-
lhea.  If this plan is adopted
the bougie must be retained
in the urethra for  several
hours at  the time, till the ef-
fect is produced."
  With regard to the treatment
of those  cases  of  Opthalmia
which are supposed to arise
from  the  constitution  being
embued with Gonorrhaal dis-
ease,—Scarcely any thine is
recommended  which  diners
from the  treatment of a simi-
lar state  of opthalmia from
cold or any common cause.
 . The discharge from the uri-
nary passage may be present,
or may not; and, it is worthy
of remark, that when it has
come on, not having been
ooserved when the opthalmia
began, in many cases,  the
occurrence of discharge from
the urethra has made no dif- 
110          Gonorrhcea,—In the Eyes.
  I fear I shall incur 1
this  note to so great a
ferencein the symptoms of the
opthalmia. Notwithstanding
this  however, a  celebrated
writer  upon   Gonorrhoea—
Swediaur—advises "theuse
of  the Bougie for a couple of
hours," with the intention of
bringing on discharge.
  This kind of opthalmia, too,
is less severe than theformer,
or  that arising from  matter
applied immediately  to  the
eye;—it is of a more chronic
nature, and begins in the eye-
lids in the form of little ulcers
from which a yellowish mat-
ter exudes; while in the for-
mer kind, the whole surface
of  the globe of the eye and
inner surface of the lids are
affected  with  redness and
swelling,—the  matter dis-
charged also is profuse and
frequently acrid and excoria-
ting to the outer lid and sur-
rounding skin.
  Abernethy, in his Surgical
Lectures,  calls it  irritable
Opthalmia, and ascribes it to
an  irritable state of the con-
stitution in which the bowels
and digestive  organs  deeply
participate.  When this state
of the constitution is brought
on,  either by the Gonorrhea,
or the means adapted to cure
it, he states that either this
Opthalmia, or  Rheumatism,
may occur; or that they may
both  occur, alternating with
each  other, even alternating
with  the disease of the ure-
thra, and that the proper way
for having  carried  out
1, but the consequence
 of treating it, beside soothing
 applications to the eye, is to
 give five grains of blue  pill
 every night and a dose of cas-
 tor oil in the morning,  keep-
 ing  the  patient on  a  strict
 spare diet. In support of this
 opinion he gives the following
 case.
  A gentleman who had been
 anxiously endeavoring  to get
 appointed  commander of a
 frigate while in the country,
 at length received instruction
 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 Gonorrhea.
 In January his  eyes  became
 inflamed; and when he reach-
 ed i ondon, he had a violent
 Opthalmia, with purulent dis-
 charge.  He was in a dread-
 ful  state  both of  body and
 mind, could not bear the light,
 and had great pain in his eyes.
 In  this  state  he  consulted
 Mr   Abernethy.  He  stated
 also that when the discharge
 from the urethra stopped,  the
 eyes became  bnd,  and  when
 the  eyes got well the Cionor-
 rhea returned.  In  this state
 Mr. Abernethy  directed him
 to keep quiet in a darkened
 room, to wash  his eyes fre-
 quently in the course of  the
 day with tepid poppy water,
 to take five grains of blue pill
every night,  and  a dose of 
Gonorrhcea,—Rheumatic.          Ill
of delay or any misconce]
malady, especially that of
castor oil next morning, and
to live strictly low.  " During
the first six days he mended
very slowlv, and not  consi-
derably.  But on the seventh
day, when  Mr. A. called, he
found the patient sitting up in
his room,  the window un-
covered, and his eyes almost
well   Mr. A.  expressed his
surprise, and asked how this
change had so suddenly hap-
pened, 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 secretion
from the liver and the whole
of  the alimentary canal, fol-
lowed by an almost immedi-
ate removal of the irritable
inflammation  of the eye "
  Mr.  Abernethy  also takes
occasion  to  warn  persons
against  mistaking this  Op-
thalmia  arising from  an irri-
table state of the constitution
and digestive organs, for that
following innoculation, or the
immediate application of Go-
norrheal matter  to the eye,
foT the means recommended
for the first would add to the
irritability  and debility of the
constitution, and increase the
disorder. His words are, that,
"if the surgeon is frightened
at. this  irritable  opthalmia,
supposing it to be one of the
dreadful cases in which the
eye is  clapped, and proceeds
to bleed and purge the patient
jtion of the nature of this
innoculating the eye with
severely,  he will only make
the matter worse.  Moderate
bleeding," he says, "maybe
useful, but the chief object is
to attend  to  the patient's
health.   No means  are so
likely to be useful as setting
the digestive organs to rights,
and  sending the patients to
the country.
   On the treatment of Rheu-
matism, from the same  sup-
posed Gonorrheal taint of the
Constitution, but little can be
recommended in  addition to
what is  approved in Rheu-
matism  from  other  causes.
The history of a case of this
kind will best convey what is
meant by this disease.
   Major---, aged 25,  con-
tracted Gonorrhea. In a fort-
night  he  was  seized  with
swelling of the testicle. When
this abated pain and swelling
of the right knee began; on
travelling in an open  carriage
on the second day the  other
kneer foot,  and joint of the
great toe swelled. The pain
was  excrutiating  He  then
came under the care of Sir
Henry Halford,  (the king's
physician) but  no treatment
seemed to possess any power
in removing the complaint.
Now, in addition, his  right
eye  was suddenly attacked
by a very violent inflamma-
 tion which  threatened de-
 struction to the organ.  He
 I hen gave up  medicine and 
112          Gonorrhoea,—Rheumatic.
Gonorrhoeal matter, is so dreadful that I cannot pos-
sibly omit it.  It need  not however incommode the
 went into the country for the
 restoration of his health, and
 after being there for about
 three weeks, the Gonorrhea
 again increased without  any
 abatement of the other symp-
 toms.  The joints so stiff and
 swollen he could hardly crawl
 about   Warm bath and  a
 residence by sea were recom-
 mended.   From the  former
 he experienced little apparent
 benefit, but after a  tedious
 convalescence of two years
 he found himself able to join
 his regiment in Spain.—He
 recovered the use of his limbs
 and had no return of his com-
 plaint  though  exposed  to
 many hardships in the cam-
 paign of 1812, &c. <fcc. Two
 years after he again contract-
 ed Gonorrhea, a very violent
 one.   In a fortnight the dis-
 charge began  to abate  and
 violent inflammation attack-
 ed the great toe and foot.
 The  disease then  proceeded
 to his knees. As the violence
 of the inflammation  of  the
 knee abated, the left eye was
 attacked by violent Opthal-
 mia,  and excited great alarm
 for its  safety.  It seemed to
 be deep seated in the coats of
 the eye.  The  sight  of  the
right eye was also impaired.
At the end of two years more,
 his knee joint was  stiff  and
much swelled, and the urina-
ry passage was all the time
subject to returns of Gonor-
rheal discharge.
  I have given this case to
 show how possible it is for
 Rheumatism to occur when
 a patient is affected with  a
 Gonorrhea, and -how easy it
 is to suppose it is the effect of
 Gonorrhea, merely because it
 happened at such a time But
 after all I see nothing in this
 case that differs from Rheu-
 matism from common cau-
 ses, and the present differs in
 no important point from oth-
 ers I have seen which have
 been thought to arisefromGo-
 norrhea.  Rheumatism is fre-
 quently a tedious complaint;
 its peculiarity is, shifting from
 place to place, and in this
 way it will sometimes assume
 the character of  inflamma-
 tion of the eye, then of ,the
joints,  and will also some-
 times alternate with disease
 of the urethra.  Respecting
 the treatment of Gonorrheal
 Rheumatism, if there be such,
 I am not aware of any par-
 ticular in which it differs from
 the treatment of R heumatism
from any common cause. As
it is possible however that
same connexion  may exist
between the inflammation of
the urethra and inflammation
of the eye,  in  cases of the
latter kind, occurring  when
the patient has Gonorrhea at
the time, I think the recom-
mendation of  Swediaur  to
employ the bougie is a safe
and justifiable remedy. 
           Gonorrhcea,—Rheumatic.         113

general reader,  for being given in a note he  can
easily pass it by, whUe, should  he be threatened
with this formidable turn of the disease, he would
derive important advantage 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 individ-
ual, I would  willingly incur  that  blame of every
other.
« 
114        Gonorrhcea,—In Females.
               CHAPTER VIII.

Gonorrhoea in Females,—Its Nature and Treat
                     ment.

  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, how-
ever,  the  inflammation attending is more diffused ;
in some 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 bladder than in males, so
that there is a greater inclination to make water.—
There are no ulcers in this disease, although the
discharge is  sometimes so irritating as to excoriate
or take off the skin.  There is almost always a swol-
len 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 natuie.

  GeneraUy speaking, the disease is milder in  wro-
men than in men.

  Also, a female may have a Gonorrhcea without
her knowing.it. This happens from the complaint 
          GoNORRHCEEAf— In Females.        115

being of a milder character, and from her not dis-
criminating between this disease and certain slight-
er forms of discharge which many females are sub-
ject to.  It is most likely to occur in women of unre-
strained intercourse, as such persons generally have
the slightest forms of this disorder.

   The  same female may give a Gonorrhcea to one
person  and not  to another.   This arises from the
habit and character of the person  himself.—If  he
have pursued a 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 Gonorihoea 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 inter-
view with a person having a Gonorrhcea, 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  re-
moves  it; the consequence is  that he takes the Go-
 norrhoea  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 
 116        Gonorrhcea,—In Females.

 at least have reason to suspect she has an infectious
 disorder, when she has lately had a Gonorrhcea and
 a discharge remains, greater, or in any way different
 from, what she was accustomed to before  she had
 the  Gonorrhcea.   Indeed, it is on this  important
 truth,  that  the  necessity of a speedy and perfect
 cure of Gonorrhcea is urged; for it is this remaining
 gleety and slight discharge  which  is the cause of
 most of the Gonorrhoeas we meet with; and when
 the  advice  here given  becomes   more generally
 known and acted on, we shall but  seldom  hear of
 Gonorrhcea or Clap at aU.

  The Treatment of Gonorrhoea  in Females.—
 With respect to internal remedies, it  should  be
 known that neither the  Cubebs, nor the Balsam of
 Copaiva,  nor any of the  other  Balsams,  are  so
 useful  in  the  cure of Gonorrhcea in females as in
 males,—they cannot therefore  be  depended on.—
 After subduing the inflammatory and painful symp-
 toms by  repeated  doses of the Purgative-Diuretic
 Pills, together with the free use of diluting drinks,
 low diet, and  rest, just as in males, a speedy and
 effectual cure must then be looked for from  the use
of injections.  The injections, however, which are
most serviceable in  females are  a little different
from those of males; and, on this account,  as well
 as that the quantity necessary to be used at each
 time is greater than in males, it will be proper here 
            Gonorrhcea,—In Females.        117

to give receipts  for making them,—especially as
the ingredients can so easily be obtained.

  The best cooling wash for this purpose is  the
common sugar of lead lotion, called the white wash ;
—it is made by adding one drachm of sugar of lead
to one pint of rain water,—adding also a table-spoon
full of common vinegar to  it.—On  account  of its
cooling quality this lotion  is generally used to begin
with, especially as there is often some little remain-
ing pain at that time.  This  too is a good lotion to
be applied to the swelling of the external parts,  and
may also be used advantageously as  an  internal ap-
plication.   For the latter purpose a small piece of
soft sponge wetted with the same should be intro-
duced a little way and suffered to remain.  It should
be frequently removed to be washed and moistened
afresh with the lotion.

  Another excellent wash or injection, and which
is more calculated to stop the  discharge, is one of
common green tea, made pretty strong.

  A third injection, and still  a little  stronger, is
made of three drachms of common alum  dissolved
in one pint of boiling water.  If a little  gum arabic
(half an ounce) be added to this it will improve it.

  A fourth  and yet stronger  injection is  made by 
118         Gonorrhoea,—In Females.

adding one drachm of white vitriol to the  one last
mentioned.

  A fifth injectionis made by putting a lump or two
of camphor (as much as the bulk of a nutmeg,) into
a pint of hot water;  when cold, strain the  water
from the undissolved camphor' and add to it twenty
grains of blue vitriol.

  A  sixth and last is made by boiling one ounce of
bruised oak bark in a quart of water, till reduced to
a pint and a half—then strain, and add to this, alum
two drachms, and white vitriol one drachm.

  These injections of course must be used by means
of a female syringe, which can be procured at any
apothecary's store, and  they should be used about
six times  a day, and continued until  the Gonor-
rhoea or any other discharge shall have entirely dis-
appeared, and then must be discontinued by degrees.

  With regard to  the syringe  for females in com-
mon use, this is a very poor contrivance.   In order
to have the full effect of an injection, the syringe
should hold enough to fill  the  passage, and  when
filled it should be retained there.  My own syringe
is made to answer both these purposes, as  many
have happily experienced ;  for, after using the com-
mon syringe for a length of time to no good purpose,
they have  succeeded with this  contrivance to their 
Gonorrhoea,—in Females.         119
fullest  wishes.   And, not only is this syringe so
useful in the cure  of Gonorrhcea  and  Gleet, but is
equally so in the cure of that weakening complaint
the  whites, and female barrenness,—a subject on
which some further and important observations may
be seen in note 21 below.
   Note 21.—A few  remarks
 upon that insiduou3 disorder
 termed ' Female Weakness,'
 or  ' Whites,'—though  not
 properly  belonging  to  this
 subject   may  nevertheless
 prove useful here.  This dis-
 order consists, essentially, in
 a state of weakness, originat-
 ing sometimes in  a debility of
 the  general   system,   and
 sometimes in the sexual or-
 gans alone.  It may be in-
 duced  by  various  causes,
 such as,—any long continu-
 ed illness,-adamp unhealthy
 residence,—having  children
 too fast,—sexual excesses,—
 Gonorrhcea, &c. dbc.  But.
 in delicate and nervous fe-
 males it frequently comes on
 without  these   intervening
 causes,  and becomes  as it
 were  the settled habit of the
 constitution.   It does  not
 however thus invade the con-
 stitution without disturbing
 one of  its  most important
 functions,  for  it leads  even-
 tually to barrenness.  There
 :s .also  a  most unfortunate
 coincidence to struggle with
in those who are the subjects
 of this complaint, for it af-
 fects  the constitution in such
 a  way as to react upon, and
increase the original disorder.
 If, for instance, it originate
 in weakness of  the  sexual
 organs, this, sooner or later,
 involves and debilitates the
 constitution, and  thus keeps
 up and augments the origi-
 nal  weakness; or, if it be-
 gin  in general  nervous de-
 bility,  this weakening  dis-
 charge occuring, greatly aug-
 ments that nervous debility.
 There is scarcely a complaint
 under which the constitution
 suffers  more,  and has  iess
 power to overcome  without
 the aid of suitable  assistance.
 This may be clearly seen by
 reflecting on the influence
 which the uterine system is
 wont to exert upon the stom-
 ach  and  digestive organs.—
 That train  of  distressing
 symptoms which so frequent-
 ly occurs in a state of preg-
 nancy, is a striking illustra-
 tion  of this fact.  Numerous
 as these are they all  proceed
from the effect the uterus has
upon the stomach, enfeebling
 and  deranging  its digestive
 functons.   The very  same
effects are produced by this
complaint, the " whites/' but
with this difference, the dis-
 order of the digestive organs
from pregnancy is but for a
 hmited  duration,  while that 
120          Gonorrhea,—In Females.
  The apparatus now alluded to also affords a most
convenient  way of curing  Gonorrhcea  in females
 from weakness of the sex-
 ual  organs is unlimited and
 perpetual.  Again,  by trac-
 ing the sad inroad this disor-
 der makes upon the constitu-
 tion, it will be  further seen
 how  justly it  merits every
 care  and anxiety to remove
 it; for, beside the disappoint-
 ment  of a family, which it
 is frequently th^causeof,there
 is nothing whjBh more cer-
 tainly  fades nhe  youthful
 countenance, and premature-
 ly leads to the failings and in-
 firmities of age.  The first
 effect  of  this never-ceasing
 influence  on the stomach is
 to weaken its digestive pow-
 er, by which  the blood be-
 comes poor and watery. This
 is seen by that pale and sunk-
 en countenance, or bloated
 state of body, which always
 more or less attends it.  Then
 follows an  unequal  circula-
 tion of the blood, the strength
 of the body, being not suffi-
 cient to maintain its equal dis-
 tribution, 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 suffer-
 er to  suppose that bleeding
 would do good,  than which,
 by the  way,  nothing  would
 be more disasterous.   Head-
 ache,  however,  arising from
this cause, is one only of a
long train of nervous symp-
 toms, varyingAi degree-and
 kind, but continuing to har-
 rass and embitter  life to its
 very latest moments.  A just
 and clearer  apprehension  of
 so  serious a disorder, there
 fore, than is generally enter-
 tained,  can scarcely fail to
 secure a due and proper at-
 tention to the  following ac-
 count of its cure and treat-
 ment.   In the first  place, as
 this is  a disorder which so
 greatly weakens the  diges-
 tive organs,  and  through
 these the constitution, so the
 constitution scarcely can be
 strengthened, while the origi-
 nal disease is suffered to re-
 main ; it  therefore  becomes
 expedient to prescribe both
 for the local weakness of the
 sexual  organs, and that of
 the general constitution  at
 one and the same time, and
 this makes the use of a syr-
 inge absolutely necessary.—
 But upon the kind of syringe
 used very much  aepends-—
 The syringes  in   common
 use, as  I have  observed be-
 fore, are not adapted  to the
 purpose,-and it is chiefly on
 this account that we so fre-
 quently hear of incurable and
 tedious cases.  Having been
 myself physician to a  Dys-
pensary in London, institut-
ed chiefly for the disorders oj
women  and children, I have
had abundant opportunities
of observing this fact, and
here I would repeat that they 
          Gonorrhcea,—In Females.          121

where it is necessary to do it privately; for being-
intended professedly to cure  the Whites, it is fre-
quently availed of to cure the one disease under the
name of the other.


  For the convenience of those who consult me  at
a distance, the female  syringe, together with in-
gredients for making the injections and. every oth-
er necessary medicine, including also an explan-
atory treatise  on these diseases, are put  up in  a
little mahogany chest with lock and key, and which
is forwarded  by steamboat or stage, to any dis-
tance.   The price of the Chest complete is $20  00
The female syringe and  ingredients for the cure
of Gonorrhoea alone, is $10.   My consultation fee,
without the Medicine, <$c. is $5.


  With these remarks I finish the subject  of Go-
norrhoea and Gleet in females, and when it is con-
are deficient in two respects;
in the first place they do not
hold ffuid enough to fill and
moderately distend the pas-
sage, and next  they have no
means  for retaining the in-
jected fluid for a due and pro-
per time. These deficiencies
lead  to the  contrivance  of
my " Female Syringe," and
which  I am  happy to  say is
found to answer  most com-
pletely.  Many who had fail-
ed with the common syringe
in connexion with a variety
of other means, have perfect-
ly succeeded with this more
convenient, simple, and effi-
cient apparatus.
  The treatment of this com-
plaint therefore  consists in
the use of injections, together
with such internal remedies
as tend  to re-establish the
vigor of the body, but more
especially the function of the
sexual organs, a fmore mi-
nute account of which is giv-
en in the Treatise which ac-
companies the Syringe. 
122        Gonorrhcea,—In Females.

sidered that so long as any discharge remaining af-
ter Gonorrhcea exists, so long there is a possibility of
preading the disorder to a second person, a suffi-
cient reason will be seen for laying so great a stress
on curing Gleet at once, and doing so by injections,
for it scarcely can be cured in any reasonable time,
without them.  We  now proceed  with  Venereal
disease, properly  so called. 
SECOND PART.
                    ON

    VENEREAL  DISEASE,

            (properly SO calleu.)

               CHAPTER I.

Venereal Disease,—Its  distinguishing marks,-^-
  Its Nature,—Progress,—And General Princi-
  ple of Cure.

  Venereal Disease,—In the first place, should be
carefully distinguished from Gonorrhcea.   In com-
mon conversation, the word venereal is often used
in a general way to  express both the one and  the
other, but this is not a proper way of speaking, for
no two diseases can differ-more, either in their na-
ture, train of symptoms, consequences, or modes of
cure.  It is true, as was stated in the second chapter,
that Venereal, (which  also by some is called the
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 affected with both diseases ;  still
let it be remembered they are distinct and very differ 
124
VENEREAL DISEASE.
ent complaints.  And this is the more important to
explain, inasmuch as I find continually, 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, nostrums
intended for the Gonorrhoea.  Now  the medicines
that are proper  in Gonorrhoea never can  cure Ve-
nereal, neither can those proper for Venereal ever
cure a  Gonorrhcea,—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 Gonorrhoea;  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 it  is  seen most
frequently on the extremity or nut of the yard, or upon
the internal surface of the skin which covers  it, fo
the reason that the texture of the skin in these pla-
ces is  thinner than  elsewThere ;  and, as  the skin
forms a bridle under the head of  the yard 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 
VENEREAL DISEASE.
125
one  sore, but  this  does not often  happen.—These
parts are subject to other diseases beside the Vene-
real, and which are infectious too, but these appear
in crops, while the real Venereal generally commen-
ces with one solitary sore, and that usually appears
at some period  between  the 2d  and 7th 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. Now, the  principle difference
between a Venereal chancre and other ulcers, is,
that the Venereal chancre is surrounded with a hard
thick feeling substance which extends around and
underneath it.  This is so peculiar to the Venereal
ulcer that you may always judge of its nature  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 venereal if it have this hard feel-
ing edge and base,  you are not to be quite 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 imperfectly.  It is
however a valuable criterion, for whenever it is pre- 
126            VENEREAL DISEASE.
sent it settles the question at once—it is Venereal.
But, as I have  just now said, a sore on the geni-
tals may be Venereal, and yet  not  have this thick
hardfeei,—what is to be done then?  The follow-
ing. If it be a recent sore, wait a little 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 Venereal sore 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 col-
or—or is as if it were  coated with a  tough  layer
of matter 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 very seldom much pain
about a Venereal sore.   Perhaps 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 chan-
" ere is a sore of a somewhat circular form, excavat-
" ed, without granulations, (that is without little red
" points or eminences on the surface of a  sore, which 
VENEREAL DISEASE.            127
," denote its healthy and healing state) with matter
'** adhering to its surface, and with a thickened edge
" and base." It will be well to keep this short and cor-
rect 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 eve-
ry venereal chancre will exactly agree with it in eve-
ry respect, for peculiarities of constitution and other
circumstances have their effect upon  a chancre, as
well as upon sores of any other kind, and wiU some-
times prevent their perfect development of charac-
ter, still there will be always enough about Venereal
sores resembling the picture of it given  by Hunter,
to show their 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 tearing of
the  skin,—Venereal matter having come in contact
with it.  In this case it is sometime, a week or two
before  it looks like any thing more than a common
tear of the skin, and when the hardness does form,
it forms slowly, 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 sim-
ply  washing,  as a common sore would do.  So also,
if the person has been foolishly  dabbing with mer-
cury,—that is to say, has been taking enough to influ-
ence 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 
128             VENEREAL  DISEASE.
part merely kept clean for the sake of watching its
progress,  this characteristic hardness of edge an-.".-
base, or some other venereal peculiarity wiU 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 in no case can possibly
be Venereal without  this peculiar hardness of its
edge and base, for rarely exceptions do occur.   The
Venereal  disease for  instance, has  been communi-
cated  without any  sore  at  all, the matter having
been absorbed by the  thin and  tender skin without
ulceration.  And again, 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
wnose  edges have been thin, having no hardness
at all; but all these  are very  rare occurrences, and
such would not  have been worth whfle to perplex
the reader with, were it not for the necessity of ac-
knowledging candidly the fact.   When these devia-
tions occur, we also get assistance in forming an opi-
nion from our knowledge of  the character of each
party—the time the sore  appears after exposure,—
and any peculiarity of constitution or circumstances
we can become acquainted with.

  This  therefore is all that need  be said on the
distinguishing marks  of the Venereal disease, espe-
cially as I shall refer to the subject again in the next
chapter—that on diseases which resemble Venereal. 
        Venereal Disease,—Its Nature.     129

  The Nature of Venereal Disease.—But little
however need be said on this  subject.  Venereal
disease (in many books called Syphilis) is well known
to be infectious.  It is communicated very much
like innoculation 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 it 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 in-
fant,  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, un-
less cured by art, continues for years, undergoing
different fcrnis until the miserable sufferer dies, gen-
erally as though he were in  a decline.   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 become so altered
as scarcely to present any symptoms by which  its
Venereal character can be  judged of.  Further, it
differs from  most other contageous  diseases, inas-
much as they, when they have once  occurred, leave
the constitution protected against their recurrence for
ever.  The small pox, measles, hooping cough, and 
130    Venereal Disease,—Its Progress.

others do this; and even typhus  fever leaves the
constitution safe from a fresh attack for a long while;
but with respect  to the Venereal disease, this may
be cured and taken afresh a hundred times ;  and.
indeed, may be taken again  the next moment after
being cured, if exposed at such a time.

   The Progress  of Venereal  Disease.—This is
a  subject worthy of much attention.—The  symp-
toms of this disorder are divided into two classes—
the primary and  the secondary  symptoms.   The
primary are those which appear first, and consist of
the Chancre, of which we have spoken, and swelling
in the groin, called Buboes.  The secondary symp-
toms are those which arise out of the constitution
when the disease  has not been thoroughly cured in
its first stage, but has been left in the constitution.
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 caustic, or
an ignorant and ineffectual use of mercury, without
really curing the  disease, then, at some period, usu-
ally before the end of the second month after laying
aside all remedies, it will appear again, not however
in its original  place, the Genital organs, but in the
throat, and 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, 
   Venereal Disease,—Its Principle of Cure. 13.1

 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 little different form
 of blotch, or scab, or sore.  Thus it may appear and
 disappear many times upon the skin, until at length
 it assumes a totally different form,—such as tumors
 and thickenings of the bones, attended with severe
 pain at night.  This then is the usual order in which
 the secondary symptoms of Venereal disease appear,
 —first in the throat, then the skin, or thioat and skin
 together, and  then  in  the bones; it is generally a
 long time however before the bones become affected.

   The general Principle of its Cure.—This con-
 sists  in introducing mercury into the system; and
 the principle on which this remedy cures, is, by in-
 stituting a peculiar action in  the  constitution, and
 maintaining that action for a certain  time, or for a
 period  which  experience has  taught  is  sufficient
 effectually to destroy the morbid action—the disease
 itself.  Formerly it was supposed there was no other
 possible way of curing Venereal diseasebut by mer-
 cury, but this, later observation has shown us  to be
 incorrect.  More than twenty years ago  it was stated
as a fact, that Venereal disease could be cured with'
out mercury, and, as much and serious mischief was
frequently observed  from mercury, given by ignorant
advertising people, that announcement was joyfully
received.  Many however doubted it, and some con. 
  132  Venereal Disease,—Its Principle of Cure.

  tinue still  to  doubt it, but the fact itself is well
  established, and from it has risen what is called the
 non-mercurial treatment.   Allowing, however, all
 that may be claimed for the non-mercurial treatment,
 the question is,—which is the best ?—Many things,
 we know,  are  possible,  but  may not be expe-
 dient.  Now, my own opinion is, decidedly, that the
 mercurial treatment is the best, the most convenient,
 and the surest, and I think so for these two reasons ;
 —first, because the  non-mercurial treatment  re-
 quires  retirement,  chiefly in* bed, and induces so
 much weakness from antimonial medicines and low
 living, that  it is often a long time before the patient
 can return to business or ordinary labor;—and next,
 because the  evils said to arise  from mercury have
 \\ot necessarily arisen from this medicine, but from
 the ignorance of those who have given it.  It is  the
 abuse and not the proper use of merGury therefore,
 which should be feared.

   And  further,  with  regard to the first of these
 reasons—the  inconvenience of, and the weakness
 induced  by,  the  non-mercurial plan,—in   this I
 am well supported by Dr. CoUes of  Dublin, who is
 considered to have written one of  the best practical
 works on Venereal disease  that has ever yet been
 offered to the world, and whose  opinion I will give
in his own words, (note 22)  and which I would re-
  Note 22.—Upon the subject  Colles observes—"I shall not,
of the non-mercurial  treat-  with my limited experience
meat Of Venereal disease, Dr.  of this plan of treatment, at- 
Venereal Disease,—Its Principle of Cure. 133
commend to the perusal of those who have any doubt
upon the subject.
tempt to enter into a detailed
account of its application  to
particular symptoms;  I shall
only offer a few general re-
marks.   When this plan first
attracted the notice  of the
surgeons of  Great Britain,
both my colleagues and my-
self adopted it m our Hospi-
tal. , In general we confined
this treatment to  men who
had not  used any mercury;
but, asin Dublin it is extreme-
ly difficult to meet with vene-
real cases in  the  Hospital
who have not applied to some
apothecary, or received medi-
cines at  a dispensary, we
could not adopt it as the gene-
ral practice of the institution.
However, we  tried it  till we
all became convinced of this
fact,—that it  was not suited
to patients who were obliged
to earn their bread by labor;
for  we saw that after they
had left the Hospital, and got
into-employment, they gene-
rally found themselves weak.
and  unequal  to their usual
labor; and often, at the end
of two or three months, they
returned emaciated, pale, and
enfeebled, in  consequence  of
the hectic form of fever which
was about to usher in a new
series of  venereal symptoms.
Their stay in  the  Hospital
also proved, in general, very
protracted; so  that they be-
came impatient of this treat-
ment, especially when they
saw others with similar symp-
toms, in the same ward, have
their complaints more quickly
cured by the use of Mercury.
In private practice also, ,1
employed  it for a time; but
not finding it superior in point
of quickness of cure, or of se-
curity against a relapse, and
observing  that these relapses
were more frequently reitera-
ted, in a-short time I ceased
to employ it, except at the
express solicitation of the pa-
tient.   But I had many op-
portunities of witnessing the
results of the practice of some
of my brethren,  who adopted
it more fully.  Of course I
could not know much of those
cases in which  this practice
was successful; but in many
of those who suffered  from
secondary  symptoms,   and
from relapses of the different
series  of  secondary symp-
toms, I had melancholy proof
that  this treatment was too
often unequal to remove sy-
phylis.  No  doubt fewer of
the  non-mercurial  patients
complained of  affections of
the  bones, than those who
had been ineffectually treated
with mercury; but I saw in-
stances of closed pupil  and
blindness,  produced by vene-
real inflammation in the eye,
which  had been  neglected,
not having been considered
as venereal  symptoms.  I
have seen  many cases where
soft parts  of the throat  had
suffered severe  mutilations;
and,  above  all,  I  had  too
many opportunities of watch- 
 134 Venereal Disease,—Its Principle of Cure.

   Dr. Colles,  however, does not deny the value of
the fact itself.  Every fact is valuable, and this espe-
cially as it lead to the correction of an error which
prevailed  for  many years, viz.—that the constitu-
tion,-unaided by mercury,  had  no power to cure
Venereal disease.  Now, the principal value of this
fact is this,—that it presents a second line of treat-
ment for this  disorder;  and, as  there  are constitu-
tions, or  peculiar  combinations  of disorders  with
Venereal which  utterly forbid the  use of mercury,
so the value of this second Une of treatment in such
cases becomes, indeed, incalculable.
mg the very slow and silent,
but sure inroads, which the
often repeated attacks of se-
condary symptoms made on
the constitutions of the pa-
tients; of witnessing the phe-
nomenon, that  the venereal
disease,  from year to year,
showed  itself with  less stri-
king  characteristics,  while
other  diseases  appeared  to
spring up; so that,  for some
months  before  the death of
such patients, it would require
a close examination  to dis-
cover the one or two slightly
marked symptoms of syphilis
which  remained;  and  also
required  close  research  to
trace the symptoms of appa-
rently the last and fatal dis-
ease to  its true  source,  the
infection of syphilis.   But on
tracing the state of health,
from the primary ulcer down
to the final and fatal disease,
I could clearly see that at no
period was the unhappy suf-
ferer altogether free from ve-
nereal disease; so that both
the patients and their friends,
in many instances, lost sight
of the original syphilitic dis-
ease, and referred the death
to some other apparent cause,
such as dropsy, or some dis-
ease of  the lungs.  Nor is it
to be wondered at, that non-
professional  persons should
form such an erroneous opi-
nion, seeing  that the course
of some of these fatal cases
had occupied a period of four
or five years, between the ap-
pearance of the primary ulcer
(the  chancre)  and the fatal
event.   In a word, after the
experience of one years' full
trial  of  the non-mercurial
plan, we have since, in  our
hospital practice, only  em-
ployed it rarely, and generally
in very mild slight cases oi
primary symptoms. 
  Venereal Disease,—Its Principle of Cure. 135

  And, again, with respect to the inexpediency of the
non-mercurial plan, we have on this point the gene-
rous testimony of one of the  first who proved that
the disorder could be cured without the aid of mer-
cury.  In general,  even great men are  too much
wedded to their own discoveries, and are blind to
the real merits of those they wish to supercede, but
it was not so with this eminent  individual, for we
hear him frankly state, (hat, though he had proved
the efficacy of the non-mercurial treatment, he would
by  no means recommend the plan.  Mr. Rose, of
whom I now speak, also, was surgeon of one of the
regiments of the  Guards, and from the  strict dis-
cipline of their hospital practice,  he had the advan-
tage of knowing that the men took nothing but what
he directed.  His observations and opinions there-
fore are peculiarly worthy of respect and confidence.
Now, the facts which Mr. Rose related,  and which
may be  seen in Sir Astley Cooper's Lectures upon
Surgery, are these;—he found that the first appear-
ance  of Venereal—the  Chancre—could be easily
cured without mercury, but that  out of every three
patients so treated, one was afterwards afflicted with
secondary, or constitutional disease.  If, again, these
secondary symptoms were still treated without mer-
cury, and disappeared, they would come  again, and
again disappear.  But not being  satisfied with this,
Sir Astley Cooper put the question to him,—"Now,
Sir, said he, if a gentleman were to come under your
care, what would you do,—would you give him mer- 
136 Venereal Disease,—Its Principle of Cure.
 cury or not ?"  To which Mr. Rose replied, I should
 certainly  give my patient  mercury!—And Sir
 Astley then goes on to say, " / advise you to do the
 "same.  I will not declare that those persons are dis-
 "honest who recommend a contrary  practice; but,
 " if they had seen wbat I have, I am sure they would
 "still place their reliance on the use of Mercury."

   And  also with  regard  to my second reason for
 prefering mercury, I repeat that most of the evils
 which are laid to the charge of mercury have arisen,
 not from its proper use, but its great abuse.  It is
 astonishing to see what  ignorance respecting the
 use of mercury prevails, especially among that boast-
 ing class of advertising people, some of whom may
 be seen to  have three or four advertisements in one
 little paper daily.  It is however highly important to
 be acquainted with several facts regarding mercury,
 as well as with certain rules to regulate its dose and
 its continuance  or discontinuance under the varied
 circumstances which occur, and this I will  endeavor
to give as plainly as possible in the chapter  follow-
ing the next, on the subject of the use and the abuse
of mercury. 
VENEREAL DISEASE.
137
                CHAPTER II.

On certain complaints which resemble Venereal
  disease, and sometimes arise from sexual inter-
  course, but which, nevertheless, are not Venereal,
  nor can be treated as such without the greatest
  disadvantage.  Persons affected with these com-
  plaints are often cruelly imposed  on by adver-
  tising people.

  In Chapter the 3d I  undertook to show that  the
genital  organs are subject  to several disorders re-
sembling Gonorrhoea, which  are not  really so,  but
which, however, either from  ignorance or knavery,
are taken for that disease and treated as such.  T he
evils arising from this 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 misfortune of taking
them for Venereal, and treating them accordingly,
is ten times more disastrous.  It will therefore 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 beside  the Venereal, must be evident to
every one who will for a moment consider the struc- 
138            VENEREAL DISEASE.
ture of these  parts.—The external  organs, for in-
stance, are covered with a continuation of the same
structure which covers the surface of the body, and
therefore must be subject to  most of the  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
happen on any other part;  this, in  good health,
if kept clean, would 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-con-
ditioned  ulcer "  Now this  happens continually to
the genital organs.   Under excitement perhaps 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  obsti-
nate, 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 organs increased
in quantity, and when, from any accidental cause, 
VENEREAL DISEASE.             139
they are altered in quality also, irritation and ulcera-
tion after  connexion are the frequent consequences
of it.

  Another cause of ulceration arises from want of
cleanliness in men.  Sometimes the natural secre-
tion under the fore-skin becomes increased in quan-
tity, 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
Gonorrhoea;  at other times it ulcerates  rather  than
excoriates, and then it is taken for Venereal disease.

  Again,  a Stricture in  the  urethra, as has  been
already noticed, is, now and then, the cause of  little
ulcers on the penis, which are very apt to be  mis-
taken for Venereal sores.

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

  There may be  also other disorders of these parts
which are occasionally mistaken for Venereal, but 
HO
VENEREAL DISEASE.
those which 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 diseases of any other
kind, that, if its progress be not hastily interrupted
by ignorance or officiousness, it will be easy to dis-
tinguish 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 Venereal, it will put on this peculiarity of character
so satisfactorily as to leave no doubt about it.—The
five  disorders then which I have stated to be mos*
frequently mistaken for Venereal,-are,—simple lace-
ration,—sores arising from acrimonious secretions in
the female,—ulcers from the secretion of the fore-
skin of  the male,—ulcers  from a stricture in the
urethra,—and sores from improperly  cured Venereal
disease.  I will therefore 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 
VENEREAL DISEASE.            141
" edge and 6ase."  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 be absent, or might form imperfectly.
Give  it a little time however, and a true Venereal
sore wiU assume this character, or if in any point
it should chance to be defective, still there will be
enough of what is peculiar 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 that 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 Venereal matter may  have been
superadded.  Now this possibility gives occasion to
the advice I am now about to press.   Do nothing
but keep it clean with cold water and watch it.
Never in  such a case consult that class of people
who caU every thing they see upon these parts Vene
real.  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 mis-state-
ment here, whether from ignorance or knavery, would
involve the direst consequences. 
142
VENEREAL DISEASE.
   It is most desirable to  impress this fact—the ob-
 scurity 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 state of it at the time the irritation com-
 " mences.  It is seldom we see the first vesicle which
 "is formed; more commonly, especially if the dis-
 " ease is  on the glands,  this vesicle is broken and
 " discovers arr excoriation, and sometimes a slough.
 " In either of these states, it is not easy to ascertain
 " the real character of the disease, and all  prudent,
 " perhaps I might say all honest men, suspend their
 " opinion  and treatment beyond what may be neces-
 " sary for the  immediate symptoms, till  the  part
 " shows a disposition to heal, or discovers its  true
 " character."

' He then goes on- to say—" Nothing  can be more
 " certain than the true character of a Venereal Chan-
 " ere, and nothing cured with more certainty.  The
 " difficulties  and intricacies attending this  form of
 " the 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 
VENEREAL DISEASE.
143
 " 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 uncertainly  on  all whose character  has  not
 " shown itself 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 Avait 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  fore-skin over it.  Thus
 watching it,  and  doing nothing that  would change
 its natural course and outward character, you will
 soon arrive at a knowledge of its real nature.  If it
be a simple tear, and nothing of Venereal in it, then
 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, gene
rally in a few days,  it will assume the character
given by Hunter of a Venereal Chancre, or present
at least some of  its  peculiarities; and, again, if it
should neither heal nor exhibit any  of  the proper 
144            VENEREAL DISEASB.
 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 com-
 municated by sexual  intercourse,' but  which have
 nothing  of Venereal  in  them.   I have  already said
 that certain vitiated secretions in females, or neglect
 of cleanliness, will produce such ulcers, these how-
 ever are not the only causes of them.

   If then a laceration or an abration 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 usut
 ally observed is a hardness both around and under-
 neath it.  This you can  feel by pressing on it with
 the finger, but by pinching it up between the thumb
 and  finger, it  is very sensibly distinguished.  You
 cannot well mistake this feel, it is so peculiar, and,
 as far as I know, it belongs to no other  recent sore
 but the true Venereal.

   The next thing is, that simple laceration, if it en-
large at all, does so by spreading superficially ; where-
as 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 
     Venereal,—Diseases mistaken for it.   145

always show itself immediately, but after a time, and
very shortly after the  symptoms I have mentioned
have appeared, it is covered with a toughish adhe-
ring kind of matter of a brownish yellowish color,
which a simple laceration never presents.

  Another thing to remark upon  these lacerations
or abrations, is, that when they are innoculated with
Venereal  matter, that is, when they are Venereal,
their  peculiar Venereal characters  do  not show
themselves 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 ab-
sorbed through the skin and first appears in the form
of a little pimple, without a tear  or an abrasion of
the skin, and on this account it is prudent to wait
for  several days, perhaps eight  or  ten, before we
settle whether they really be Venereal or not.

  In the event however of having waited a reason-
able 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,  washing  and bathing  them
with warm water, or  milk and wajer 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 they simply remain sta-
tionary, without much inflammation, then  gently 
  146  Venereal,—Diseases mistaken for it.

  stimulating lotions would be proper, such as brandy
  and water, or the Zinc Lotion, or Black Wash,
  (page 44;) or, if they still  remain unhealed, touch
 them with Blue Vitriol daily, or with Lunar Caus-
 tic  every other day.   Also, take  an active purg-
 ing dose or two of pills.

   The second.—Sores arising  from the natural
 secretion beneath the foreskin, which in hot weath-
 er or from want of cleanliness accumulates, be-
 coming acrimonious and irritating.  The effects
 of this irritating secretion are frequently such as to
 be taken for Gonorrhcea, as I have described in the
 2nd chapter; in this case the head of the penis is
 excoriated and the discharge of matter very copious;
 at other times it causes ulceration instead of excoria-
 tion, and then it is that it  is apt to be taken for Ve-
 nereal disease.  Now the  same means which were
 advised on the subject of detecting a suspicious la-
 ceration 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 dis-
 tinguishing marks of that disease, just as was de-
 scribed 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 should not  heal, and  still
present none of that hardness so. peculiar to Vene-
real, then a stimulant plan, similar to that recom-
mended in simple laceration, should be resorted to. 
      Venereal,—Diseases mistaken for il.   147

   The third.—Sores arising from sexual inter-
course with females of uncleanly habits, or having
certain mild disorders totally unconnected with
 Venereal disease.   In this place I need do little
more than repeat the  fact that such disorders do
occur, refering those who doubt it to what was said
on this important subject in  the second chapter,—
that which treats on disorders  which resemble Go-
norrhcea, but which  have nothing of the nature of
that disorder in them.   It is  a  subject of  immense
importance.  Here, however, it is proper to observe,
that while in some these irritating fluids will produce
disorder resembling Gonorrhcea, in others it produc-
es sores which are frequently mistaken for Venere-
al disease.   But these  may easily be  detected.—
Just compare these  little ulcerations 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 to-
gether—it is the hardness of its edge and base.—
Now the sores we are  considering have 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
simple this  the better, for although they will  not
always heal with simple remedies such simple reme-
dies should always first be tried.  I would therefore
first advise that nothing but lint soaked in cold water 
148   Venereal,—Diseases mistaken for it.

be applied to them. This is best suited to those which
are situated between the foreskin and the head of the
penis, for here the prepuice 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 poi-
son,  though not Venereal.  If therefore they do not
heal under this simple means we must advance up-
on 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 should try a lotion
of white or blue vitriol, soaking apiece of lint instead
of the cold water with it.   In some instances I have
dipt my finger in the powder of white vitriol and
held it to the sores for arninute or two or more with
very good effect.  In other slow and  tedious cases
I  have applied the blue vitriol itself daily, or have
touched  them with the  Lunar Costie every other
day.

  These sores in general  do not require the internal
use of mercury ;  indeed, some of 'them are great-
ly exasperated  by it, while others are  as greatly
benefited; in such however the mercury is given in
a milder form than in venereal.—In  every case it is
of especial service to regard the state of the diges-
li«e  organs,, that is, the  stomach and the bowels. 
      Venereal,— Diseases mistaken for it.   148

If these are in a disordered state, which  is shown
by a whitish looking tongue, and this furred in the
morning at its root, with a brownish coat, the bow-
els at the same time being irregular and the stools
of an unnatural smell'or color, depend upon it there
will  be  difficulty in  healing them while this  con-
tinues.   Nothing however is  easier  than to cor-
rect  this state.   The best wTay to do it is to take
Rhubarb and Soda for a week or ten days, with a
blue pill every other night.  An excellent mixture of
this  kind will be  seen below (Note 22),—but if this
could not  be easily procured, the rhubarb  alone
would  do.   Just keep  a piece  of  Turkey  Rhu-
barb in your waistcoat pocket,  and every morn-
ing  nibble off a  portion a little larger  than a pea,
or just  enough to keep the bowels rather more re-
laxed than natural.  Simple  as this remedy  may
seem, it is astonishing to see  the good which  thus
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

  Note 22.— The  Rhubarb   glass full, twice a day. Should
and  Soda mixture.  Take of  it  operate more than as a
powdertd Rhubarb half  a   laxative, that is. quite in a
drachm -.—Carbonate of So-   purgative manner.takeitonly
da, two drachms; compound   once a day, or in a smaller
 incture of gentian 6 drach's;   dose.   At the same time take
—mix with water enough to   also five grains of the blue
fill a  half pint vial—of which   pill every other night.
take  the sixth part, or a wine 
 150  Venereal,—Diseases mistaken for it.

 of  stricture in the-.urethra.  When speaking of
stricture in  a former  chapter, it  was  stated, that
among a number of consequences arising from that
disorder, ulcers on some part or other of the genital
organs was one.  The fact itself is strange, but ad-
mits of explanation.  It depends on a law of sym-
pathy—a power of the  nervous system which pro-
duces disease in one part, from a disorder seated in
another; thus, disorder of the stomach produces pain
and diseases in the head ; and in that painful disease
the stone, the pain is felt, not in the bladder, tbe seat
of  the  disease,  but in  the tip of the  penis.   In
Like manner a Stricture occasionally produces Irri-
tation 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 lead to this from meeting occasionally with
very obstinate 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 stric-
ture of  the urethra.  Fuither, in the correctness of
this Opinion he became afterwards fully satisfied by
finding  that ulcers of  this kind which had resisted
every means that could be devised, or which if heal-
ed,  would afterwards re-appear again  and again,
were  speedily and  permanently cured on  the  re-
moval of the  Stricture.  My own  experience also 
      Venereal,—Diseases mistaken for it.   151

warrants me in saying that Stricture does occasion-
ally produce this obstinate and often-recurring kind
of ulcer on the penis; and, indeed, accordingly, when-
ever I meet with sores of a peculiarly unyielding na-
ture, being also deficient in other features proper to
Venereal, I am always inclined to suspect they origi-
nate in Stricture; and further, if, upon  enquiry, it ap-
pear my patient never had the true Venereal, but only
a Gonorrhcea, my suspicion  is confirmed, nor do I
rest, until by passing a bougie I ascertain 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  dressing,—if not, those dressings
already recommended under the stimulant plan nev-
er 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 Venereal disease, the same which Mr.
Abernethy has denominated " Pseudo-syphilitic, or
Bastard Venereal."  This is a difficult part of the
subject to write about, but  it does not, I think, pro-
perly concern the general reader.  Indeed,  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 well as the general read.- 
 152   Venereal,—Diseases mistaken for it.

er.   Those who are afflicted with thex>bscurer forms
of Venereal disease, should never undertake their
management themselves,  but, if possible, should
consult the most experienced surgeon to be found.

  Mr. Colles, that practical and excellent author on
Venereal disease so often alluded to in this little work,
justly observes, there is  no class of complaints
which does  not occasionally fail to present its dis-
tinguishing characters, or, presents them so faintly
as scarcely to be recognized.   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 has
failed in exhibiting its distinguishing character, or
one of a Pseudo-syphilatic kind.

  This bastard sort of Venereal we are now consider-
ing is supposed to be a compound of Venereal disease,
partially cured by mercury, blended with some other
disorder  of the constitution, such as Scrophula.
The great source of this kind of disease is  the
use of mercury by unskilful people.  Being known
almost to every one that mercury will cure the Vene-
real disease, persons of every grade of ignorance pre-
sume on this and give it indiscriminately and ineffi-
ciently.   There is scarcely a  shoeblack who  will
not prescribe it to his acquaintance if he is fool enough
to take it, and hence, almost exclusively, that  per-
plexing  host  of pseudo-syphilitic maladies..  The 
      Venereal,—Diseases mistaken for it.   153

fact is, although mercury is the safest and most cer-
tain  remedy for the cure of Venereal disease, there
is  no article in medicine  which requires  a more
skilful and experienced  mind in  prescribing it; or,
closer  attention to the rules  which wiU be given
in the following chapter for its proper management.
And it may.be further added, neither is there  any
one  disorder which calls for profounder knowledge
 in every  single department of medical education,
than that for  which  mercury is so peculiarly the
remedy—the  Venereal disease.   Who then  can
wonder that these perplexing and distructive cases
should so frequently occur.

  Mercury, therefore, given ineffectually, fails in
curing the Venereal  disease;.in this case, after a
time, it re-appears, 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 repeatedly, it looses much of
its external Venereal  character, 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 should be disposed to. This.
very frequently, is some or other form of scrofula, and
this disorder, scrofula, blending with Venereal, forma
this Pseudo-Syphilis—appearing, sometimes in the
bones, or in blotches  on the skin, and sometimes in
little ulcers on the penis. 
  154   Venereal,—Diseases mistaken for it.

    Now, in order to detect the nature of these sores.
  it is necessary to ponder well both over the history
  and the  treatment of each case.  It is of course
  essential to ascertain  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 ex-
  pedient to be certain they do not arise from stricture,
  for a person may have had Gonorrhoea and Venereal
  too, and, the Venereal being cured, these sores may
  arise from stricture, the result of the Gonorrhcea.

    With  respect to the treatment of them, I can do
  little more than speak  of this in general terms.  It
  consists in giving very small doses of mercury and
  continuing it for a considerable length of time. This
  also is combined with such remedies as support or
  recruit the general health  and strength,—such aa
  Bark, Quinine, or SarsapariUa.  Change of air, espe-
  cially 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
  especially to this case.  Indeed, I have known many
  obstinate disorders of the genital organs greatly bene-
  fitted or  entirely cured simply by attending  to this
  one object, and I should consider that that case wa9
  under  no unpromising course of cure which was
  under the simple treatment of the Rhubarb and Soda
  Mixture, together  with  the Blue Pill, as directed in
* page 149, and continued for  some months.  In such 
      Venereal,—Diseases mistaken for it.   155

a case the mixture 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 continued
regularly every other night. 
156      Mercury,—Its use and abuse.
                CHAPTER XL

On the use and abuse of Mercury, with rules for
  its proper management in the cure of Venereal.
  disease.

  This subject will be rendered plain and useful by
arranging it  in the  following order.—How  far is
Meicury to be considered a specific for Venereal
disease;—What is the general effects of Mercury
on the constitution;—Is any preparation necessary
for its safe and successful  use;—What is meant by
Salivation;—How far is  salivation  necessary for
the cure of Venereal disease;—At what period of a
mercurial course  should salivation be produced ;—
What is the best form of Mercury  to use, and on
what principle should the  dose be regulated ;—How
long should a  course of Mercury be -continued;—
What are the difficulties which now and then occur
to interrupt a regular and satisfactory course of Mer-
cuiy;—and, what are the bad effects which Mercury
may possibly produce, denotingthat it disagrees and
must be discontinued.  These therefore will consti-
tute the different sections  of this chapter.

  How far Mercury is to be considered a  specific
for Venereal disease,—is a subject well worthy of
consideration.   Now, if by specific is meant a  reme- 
         Mercury,—Its use and abuse.       157

dy which always, without exception, and under every
variety of circumstances, cures any particular dis-
ease, then Mercury has no such claim, for there is
no such remedy in nature.—The Peruvian  Bark is
said to be a specific for the Ague, but there are cases
of ague  continually occurring which the Bark will
not cure; and beside, the Bark may be given so in-
judiciously, and under circumstances so adverse to
it. that,  if given before  these latter were removed, it
would not only fail to cure the ague, but exasperate
or make it fatal;—and  this  is just the case with re-
gard to  Mercury in Venereal disease.   All  that can
be justly said of Mercury  then is this,—that  it so
generally cures  the Venereal disease as to  be given
for it with the greatest imaginable confidence; but,
that there are cases (rare  indeed to meet with) in
which  it seems to fail; and also, there  are many
occasional circumstances so adverse to its good effect
as to require to be removed before it can be entered
on, or persisted in, with safety ; and further still, that
even then, and in all  cases, Mercury is a  safe and
efficacious remedy, only when given in a certain ju-
dicious  way and manner.   To give this remedy then
in a safe and efficacious manner, it is necessary next
to consider,—

   What is, the general effect of Mercury on the
Constitution.—The general effect of Mercury is to
excite  the constitution; so much indeed is this the
 ease as to induce a fever, called Mercurial Fever, 
 158       Mercury,—//* use and abuse.

 This febrile state, however, in general, is but a slight
 disturbance, and does not interfere with the ordinary
 pursuits of business.  But, it may however  easily
 be imagined that the habit and constitution  might
 be so excitable and full, as to be quickly thrown into
 a high degree of fever,  and hence  the necessity of
 preparation for a course of Mercury.  And it should
 also  be  observed, that in this case, it would not only
 be to endure  this higher  degree of  fever without
 occasion, but also to miss  the object for which Mer-
 cury is taken, for these higher degrees of fever seem
 to prevent the  curative  effects of Mercury, so that,
 after a certain  period, the  disease is  often seen  to
 return, and this how long soever the Mercury may
 have been continued.—By preparing the constitution
 for the effect of Mercury, also, we succeed in curing
 the  disease  with  much less  of this  remedy than
 otherwise would be required.—I feel  I  cannot lay
 too great a stress on the necessity of  preparing the
 constitution for a course of Mercury, for I am per-
 suaded it is too little insisted upon, and that this is
 the cause of much unnecessary inconvenience  as
 well as  failure even in the cure of  the disease.—It
 therefore becomes a proper enquiry,—

  What is the preparation necessary  for the
safe and successful use of Mercury.—In general,
 all that  is required  is to reduce the system mode-
 rately by repeated doses  of  some purging  medi-
 cine, and to observe  a  lower  diet.  Of course th« 
         Mercury,—Its use and abuse.       159

extent to which this should be carried should be de-
termined by the healthful state and  condition pre-
sent.  Persons wrho are most frequently the subject
of this complaint are the young, the robust, and san-
guine, and these always  bear depleting weU; but
even in the more delicate  this preparatory measure
should  never  be totally omitted.   In these  latter
cases, for instance, I  would  recommend to take a
purgative medicine for four or five  days at any rate,
but not  in such a manner as to weaken and unfit for
business.  Almost any active purge will answer, but
the best of all is that of Epsom Salts and Antimony.
as directed in  page 47;  and. the  next to this is the
Senna and Salts;  but even Epsom Salts alone will
do.  Of course it should be repeated  once, or twice,
01 thriee in the day, just as it may prove active or
otherwise.   With the more robust  however I would
continue the purging longer, carry it on brisker, and
the diet lower.  In many of these  latter cases also,
perhaps in all  of such, it would be advantageous to
undergo a copious  bleeding, but  this is not insisted
on, especially  as such a measure might lead to un-
wished-for inquiries and attention.

  Keeping this effect of Mercury in mind, we likewise
see the propriety of avoiding labor and exertion, both
of mind and body, as far, at least, as can be  done
conveniently.  There is no doubt but it would be
better for eveiy one,  upon entering  on a course of
Mercury, to keep his room, as well as lower his diet, 
160       Mercury,— Its use and abuse.

and  there are cases so bad  and complicated as to
render such  a measure  absolutely necessary ;  but
with the great majority of patients this is altogether
out of the question, all that is required being that
they keep as  much  as possible in the house in wet
cold weather, particularly at  night, and that  they
avoid unnecessary labor.   I have thought it as well
however just to  state the fact, leaving it for every
wie to do the best he can  in this respect.

  Tiiis also seems the place to mention, thai a course
of Mercury should-not be commenced while  a person
is laboring under other disorders; or, rather, that
there are many complaints which require first to be
removed, and others which should be remedied  and
relieved  if possible.  Inflammatory complaints of
the chest, and Dysentery,  and Diarrhoea, are of the
former kind, while Consumption, Dyspepsia, and a
general low emaciated condition, are examples of the
latter.  If, for instance, you were to begin and persist
in a course of Mercury while there was pain in the
side  or chest, with a cough, or what is called Bron-
chitis, it is ten to one if it did not convert this malady
into incurable consumption.  Such symptoms there-
fore must be first removed  by bleeding, blisters,  &c.;
and, if commenced while laboring under Dysentery,
or Diarrhoea, the Mercury would increase such mala-
dies, and never affect  the  constitution  beneficially;
(hese therefore also must be first removed by such
medicines as  Rhubarb and opiates, suitably repeat- 
         Mercury,—Its use and abuse.       161

ed.—So also if Consumption or Dyspepsia were pre-
sent, a watchful attention should be paid to the effect
which Mercury might have upon these symptoms, so
as to be ready to control or mitigate them.  And, in
the  last case—a low emaciated nervous state of con-
stitution—this  should be  recruited by such means
as change of air, milk diet, SarsapariUa, and the like,
before a course of Mercury could be entered on with
safety and success.  But, beside the general effect
of Mercury on the constitution, and  the necessity
of preparation  for. it, it has also a particular effect
upon the salivary glands of the mouth, called Sali-
vation.  This shall therefore  next be stated,—

  What is meant by Salivation.—When Mercury
is given for the cure of Venereal disease,  it is begun
with in certain medium doses, and repeated daily,
or night and morning, with the expectation that in
a few days, it will produce a soreness of the gums;
but, if this is not produced, nor any indications of it,
then the dose is rendered  larger, or some other pre-
paration of the medicine is superadded,  and thus it
is increased, under  certain  limitations,  until  this
soreness is produced.—But a simple soreness of the
gums is not a salivation,—it is only the commence-
ment of it, and, if the Mercury were left  off as soon
as this soreness should be first complained of, it is
probable it would soon get  well,  when the  diffi-
culty  of re-producing it might be great.  At an*
rate, it is not likely it would be done without a larger 
 162       Mercury,— Its use and abuse.

 quantity of Mercury than otherwise would be need-
 ed.  It is therefore deemed expedient to continue
 with the Mercury,  either in the  same or smaUer
 doses  until  a moderate but perfect salivation is
 established.—Now, in a case of moderate but perfect
 salivation, we observe the following:—the gums are
 swollen  and tender—inclined to separate from the
 teeth, and sometimes a little ulcerated;  the cheeks
 also near the double teeth are inclined to ulcerate,
 and present a kind of leaden color ; further, there is
 always some degree of pain  on eating solids, so that
 the softer articles of food are naturally selected;  the
 spittle too has a disagieeable taste and smell, and is
 more or less increased in quantity, giving rise to fre-
 quent spitting, and,  not  unfrequently, it will drivel
 from the  mouth  at  night while sleeping.   All this
 however does not come to pass at  once.  The first
 symptom of a salivation is a disagreeable or  coppery
 taste in the mouth, with a slight degree of swelling
 of the gums, but  after this it may  be  several days,
 although full doses of Mercury are continued, before
 it completes this  state.   At the same  time, nothing
 is  more  desirable  than  to secure this point,  for
 then the  danger of the disease,  as well as  the
 various untoward cirsumstances which frequently
 attend  a  course of Mercury, may be  considered to
 have passed away, while the cure  of  the disease is
 safe and certain.—It is true, that, in many cases, if
the Mercury were now to be entirely omitted, this
tenderness might still increase for  many days, and 
          Mercury,—Its use and abuse.       163

 at length attain to a fuU and satisfactory salivation;
 but which, it is still more probable, might die away
 and get quite well.  On this account it is deemed
 advisable  to continue on with Mercury, although
 at the  risk of causing a greater degree of soreness
 of the  mouth than might be wished for.  Not
 that  I  approve  of violent  salivations; quite the
 contrary, as  will presently be seen; but it is  not an
 easy matter always to hit the exact degree we  aim at.

   Perhaps there is no period in the Ireatment  of Ve-
 nereal disease which requires  more steadiness and
 caution than that between the first effect of Mercury
 on the gums and its full effect upon the salivary glands.
 While  therefore it is wise to be firm in continuing
 on with Mercury under the complaint of soreness, it
 is necessary  to be watchful of its more slow or rapid
 progress.  If, for instance, this soreness  of the gums
 were stationary, the dose should be increased;—if
 steadily advancing, it should be diminished; but if
 rapidly progressing, it should of course be omitted.

   The  necessity of Salivation.—Having shown
 what Salivation is, and, withal, that it is an  incon-
 venient thing, it seems proper next to enquire how
 far it  is a necessary part of the treatment.—There
 are those who consider  this effect as an  essential
 point  in the cure of Venereal  disease by Mercury
and who are not satisfied  if it be not produced
however much or long continued the Mercury may 
 164       Mercury,—Its use and abuse.

have been.  But this is going certainly too far, for I
have met with many in whom it was found impos-
sible to produce a salivation, and yet the disease was
perfectly and  permanently cured.  Allowing this,
however, there still remains  no doubt but a saliva-
tion marks the salutary influence  of this medicine,
and affords the only proof that it is acting favorably
on the constitution and disease.   And further "still,
it is a fact, that among  those in whom the disease
returns after having taken Mercury, it is found that
in a groat majority of such a salivation never was
produced, or properly maintained.   Witnout agree-
ing therefore with those who  consider  a salivation
to be absolutely necessary for the cure of the disease
by Mercury, I do not scruple to recommend it as an
important object.   With respect  to  those cases in
which it may be found impossible to produce a sali-
vation, and the means to be pursued in such, these
I shall notice when I come to the  subject of pecu-
liarities of constitution.

  At what period should Salivation be produ-
ced.—This also is a point of  some importance, for
if it be produced too suddenly, it cannot be depended
on, and there is a disadvantage if. delayed  too long.
The most favorable period at which a salivation can
be produced is within the fourth and tenth  day from
the commencement  of the course.  To accomplish
it, if po-rsible, within this period  is an object even
of anxiety, and to this end the dope is lo be promptly 
         Mercury,—Its use and abuse.       165

and  regularly  augmented,  as  will presently  be
shown.

  What form of Mercury is the best to use, and
on what principle should the dose be regulated.
—The best of the preparations of Mercury perhaps
is that in the form of ointment, (page 48) but there
are many objections to the use of this, as have been
already  stated.   Some form of mercurial medicine
10 be taken internally, is generally more convenient.
Of this kind the Blue Pill, or Calomel, is in common
use ; but, that which I prefer, and use myself almost
exclusively, is The Specific Pill, (page 49).  This
is  a mild,  safe, convenient, and  effectual form  of
mercurial medicine, of which a  sufficient quantity
to cure any case of Venereal disease, however long
it has been standing, is put up in my little private
chest, and which I frequently forward to the most
distant States.   With respect to the dose of mercu-
rial medicine, this, as might be supposed, must vary
under different circumstances, and  must be dimin-
ished or increased as it may be  found  to act on dif-
ferent constitutions.  There is however a general or
ordinary dose to begin with;  this, in  a common case,
and healthy person, if the ointment is used, 'is half a
drachm to a drachm, every night; if it is the Blue
Pill, ten grains  divided  into two pills; if Calomel.
from two to three grains, made into a pill or powder ■
or, if it is " The Specific Pill,'1 of these, three are an
ordinary commencing dose.  They  are to be taken 
 166       Mercury,—Its use and abuse.

 nightly.   The great object, however, as I have said
 before, is  so to increase  or diminish the dose  as to
 bring about a moderate but  perfect salivation in a
 given time; and, to show how this is done, I will
 now suppose a case, and treat it exactly ,as I am in
 the practice of doing daily.

  I will suppose a healthy young man with a Vene-
 real sore (a chancre) on the penis, and that it has
 been there a week or two; also, that he has  taken
 several  doses of active  purging medicine, and has
 put himself upon a lower diet.  He now begins by
 taking three of  " The Specific Pills" at bed  time.
 These we do notexpect or wish to produce any effect
 at all at first; if however  they should happen to purge,
 and continue to do so, this should be checked;  it can
 be easily done by taking five or six drops of lauda-
 num, or a tea-spoonful of paragoric once or twice;
 or, if he should  become costive, he  might.obviate
 this by taking a seidhtz  powder, or any laxative pill
 or medicine he choose.   But, about the fourth day,
 it should be  enquired if any effect upon. the mouth
 has been produced.  Perhaps-there  is none—no
 disagreeable taste or tenderness of the gums  is yet
 complained of.   This therefore gives occasion for
 an increase of the dose, and  now  four  pills are
given instead of three.  Yet, having  waited two
 days more, there still is  no complaint.  This would
 imply a degree of dullness of the constitution to
 the effect of Mercury, and would authorize  its freer 
          Mercury,—Its use and abuse,      167

 ase.  Accordingly, two pills would be  directed  to
 be taken in the morning in addition to four at night.
 This would make six specific pills in four-and-twenty
 hours, and should  be considered an ordinary full
 dose of Mercury,  It should be therefore watched
 more closely.  But now however, perhaps in two
 days from the latter dose, making  eight days from
 commencing, the gums become a little tender, and
 there is  a coppery  taste complained of.  Now, this
 is the moment which demands judicious  manage-
 ment.—If we were to stop the Mercury here, as I have
 observed before, the soreness of the gums might still
 go on and ultimately reach a state of perfect saliva-
 tion; more probably however it would not do so, but
 in two or three days would get quite well.  In this
 case we should find it difficult to renew the soreness,
 nor could we do it  without the use of  much  more
 Mercury than otherwise would have been required.
 Indeed it  sometimes happens when this opportunity
 has once been suffered to escape, it cannot be pro-
 duced  again  without a fearful quantity of Mercury.
 Many content themselves with the simple quantity.
 they have used, instead of its peculiar effect, and thus
 become exposed to  the horrors  of a deep Venereal
 taint.  But this is  easily avoided.   In  the present
case, after the eighth day, we find the gums a little
 swelled and sore, but not sufficiently, and therefore
 we continue  on.  Here it may be a question,—shall
 the same dose be  given?   When the dose under
 which the soreness happens is very large, is may  be 
 168      Mercury,—Its use and abuse.

 diminished; but if in a day or two the soreness does
 not seem to be advancing, it must be increased again.
 In the present case the dose is large  and may  be di-
 minished.  The two pills in the morning" are there-
 fore now omitted, and in a few days  more a greater
 degree of swelling-  of the gums, with an increased
 flow of spittal,  now completes the  salivation,  when
 the medicine of course is omitted altogether.

  The  accomplishment of salivation, especially if
 within the regular and proper time, may always be
 esteemed a source of satisfaction and congratulation.
 It is  an inconvenient thing no  doubt, but now the
 cure  is completely in  our hands, and with a little
 management, any considerable degree of inconve-
 nience may generally be avoided.

  It now becomes  our  chief concern to  avoid an
 excess  of soreness on the one hand, and prevent
 its  getting totally  well  upon the other.   Accord-
 ingly, we  must omit the  medicine,as long as  cir-
 cumstances may permit.   Sometimes a mild and
 salutary spitting will continue for ten or fourteen
 days without additional medicine;  at  others,  not
 only will the spitting cease, but the mouth get well
 in three or four.  Whenever  the spitting cease en-
 tirely, and even when it rapidly abates, although the
-mouth may yet be sore,  the pills should be resumed,
 not however in the  same full  dose,  but just in such
 as  may be sufficient to re-excite the spitting and 
         Mercury,—Its use and abuse.       169

maintain it.   This is much more easily done if the
medicine is resorted to  before the mouth gets weU.

  It may be of use to mention here, that whenever
the mouth gets well too soon, and there is a»difficulty
in re-producing it, nothing will act so well as Calo-
mel.  Of this, three grains, with one of Cayenne pep-
per, repeated twice or thrice a  day for a day or two,
will generally effect the object.   Thus, by increasing
or lessening the dose of pills, we endeavor to perpet-
uate a moderate state of salivation for as long a period
as the nature of the case demands, or  as will pre-
sently be determined on.

   It may be remarked I have been  particular in de-
fining the exact degree to which a salivation should
be-carried;  I  have been so from observing that I
was not sufficiently explicit on this subject in my
last edition.  Anxious  that no one should suffer the
least degree of unnecessary pain or inconvenience,
it is possible I there leaned too much upon  the cau-
tious side.  I have now however given my directions
more decidedly, as well as my reasons for them.  And
now, the nature of a salivation and the necessity of
it having been discussed, the question naturally fol-
lows,—

   HOW LONG  SHOULD   MERCURY BE CONTINUED—
This, as might be supposed, can be  determined only
by the circumstances of each case.  There are how- 
 170      Mercury,—Its use and abuse.

 ever certain circumstances or conditions of the dis-
 ease which uniformly require a difference as it re-
 gards the period of a mercurial course.  For instance,
 the circumstance of its being a recent or an old dis-
 ease,—the  readiness and regularity with which a
 salivation is produced and kept up,—the kindly dis-
 appearing of  every single symptom,—the circum-
 stance of having taken mercury ineffectually before,
 •—and  the occurrence of any other diseases, blending
 with Venereal.—All of these require a difference as
 to the  length  of time that Mercury should be con-
 tinued, and  therefore will properly form the basis of
 what I have to say upon the subject.

  1st.— The circumstance of its being a recent or
 an old disease.—The shortest courses of Mercury,
 no  doubt, are  those required in chancres—the first
 form in which Venereal disease appears; and, as a
 general rule, the older the disease the longer the use
 of mercury is  required.—Some forms of the  disease
 however,  it is considered, require more protracted
 courses, independently of the time it has  existed ;—
 thus Venereal sore throat and eruptions  of the skin
 require a longer course than chancre, and ulceration
 of the  bones,  longer than sore throat.  It is quite
 impossible to fix the exact time required  in any one
 of these,  but, as a  general rule, it may be said, that
a chancre would require  a four or six weeks course
 of Mercury;  sore   throat and eruptions of the skin 
          Mercury,—Its use and abuse.      171

 from six to seven weeks;  and ulceration of the
 bones from eight to ten weeks.

   2d.— The readiness and regularity with which
 a salivation is produced and  kept  up.—If there
 should be found an unusual  difficnlty and  delay in
 producing salivation, notwithstanding the dose be
 properly increased, so that salivation should not ap-
 pear for two or three weeks, then it would not be,
 safe to  limit the course as has been suggested, but
 rather to reckon from a  few days previous to the
 time'of salivation.  So also if anything should occur
 to interrupt a course of Mercury, even if salivation
 had commenced, on a removal of that cause, that is
 to say, if any considerable interval had elapsed, the
 former time  is not to be  taken in the account, but
 the reckoning is to be  made as though Mercury
 had not been given before at all.

  3d.— The kindly disappearing of every single
 symptom.—Although  I  have given a general rule
 for the continuance of Mercury in every given case,
 yet it may happen that after this  has been observed,
 and  the  disease apparantly been cured, there  will
 remain  one  single symptom, demanding a further
 continuance of the remedy.—The most frequent cir-
cumstance of this kind is a hardness remaining in
the  skin after  the healing  of a  chancre.  Now so
sure as this  is overlooked, or slighted, so sure are
we  exposed to the possibility, nay, to the probability 
 172      Mercury,—Its use and abuse.

 of  a second appearance  of the disorder.  But on
 continuing the use of Mercury on this account it is
 not necessary to carry it on so far as to maintain a
 state of salivation.  Indeed, unless the  hardness be
 considerable,  it is not necessary to continue it inter-
 nally at all.  What is now required is merely to rub
 a portion of Mercurial  ointment into the indurated
 part, once or twice a day, and continue to do so until
 it is absorbed  and made to disappear entirely.  Per-
 haps a portion of Mercurial or blue ointment,  as it is
 called, not larger  than  a  pea, well rubbed upon it
 with the finger until it is quite absorbed, and repeat-
 ed nightly or night and morning for a week or two
may be sufficient; but, however long it may be re-
quisite, let it  be  remembered, it must  not be laid
aside until this hardness entirely disappear.   It
will be seen I lay a stress upon this treatment, and
I do so  from observing that many persons*are in-
 clined to slight it.  Having gone through the course
 prescribed, and feeling  well,  they do not like this
 further trouble.  Bui what is the  trouble of thia
triffling attention to secure an object of such import-
ance ; or even if it were ten times greater where is
the  remedy !   This hardness is the peculiar charac-
teristic of a Venerial soie.   In  fact we are often
obliged  to wait for its formation, in doubtful cases,
before we can tell whether an ulcer really be Ve-
nereal Or not; how reasonable then to suppose that
 while any of  it should remain, the  essential  nature
of the disease  should be unextinguished ; and, if so, 
          Mercury,—Its use and abuse.       173

it will most assuredly appear  again at some future
time.  I repeat, therefore, that while any degree of
positive hardness after the healing of a Venereal
sore upon the genital organs should  remain, thin
milder use of Mercury must not be laid aside.

  4th.— The circumstance of having taken Mercu-
ry ineffectually before.—It is well known that tha
constitution does not bear a Mercurial  course so
well the  second or the third  time, as  at  first, espe-
cially if it have been carried on severely.  You can-
not so easily nor so certainly produce a salivation;
more time and larger doses are generally required ;
and when it is considered that a second or third sa-
livation should always be carried  on a week  or two
longer than a first, it would seem that this circum-
stance is  the cause  of a considerable  protraction of
a course of Mercury.

  5th.— The occurrence of other diseases, blend-
ing with  Venereal.—This circumstance gives oc-
casion for  a longer course of Mercury than any other.
The most common examples of this complex dis-
ease,  are those  in which it becomes  blended with
scrofula.  In this,  the Venereal sore, completely
merging into the character of scrofula,  loses much of
its own external form and appearance.  Now it is well
known that scrofulous constitutions do not bear the
influence  of full and decided doses of Mercury, but
require that it be administered in small and cautions 
 171      Mercury,—Its use and abuse.

 doses.  This  therefore  accounts  for these  longer
 courses in  complex  forms  of  Venereal.   I am
 happy however to add, that Mercury, even in these
 worst of cases, if given thus judiciously, is attended
 with the happiest effect.

   But now, having shown the importance of saliva-
 tion and the extent to which it should be carried, it
 is next my duty  to advert to certain circumstances
 which now  and then occur and make it difficult to
 obtain this object.  These I will mention in italics,
 and will explain the proper management of Mercury
 in each.  In doing this, however, I must first ac-
 knowledge,  that,  for a more clear and definite view
 of the nature of these several difficulties than I once
 possessed, I am  much indebted to that excellent
 author  on Venereal, Dr. Colles  of Dublin, whose
 very words, indeed, cm some occasions, I shall use
 myself.

  6th.—A Dysenteric state of bowels.—This is no
 uncommon  thing before a salivation is produced ;
 but whether it is before or  after, it shows the Mer-
 cury is acting on  the intestinal passage, rather than
 the salivary  glands—the  only proof of  its favorable
action or the disease itself.   In this case, therefore,
 stop the Mercury a day or so, and take five grains
of Rhubarb with ten drops of Laudanum for two or
 three times ; or, have a four ounce bottle of mixture
made, of Tincture of Rhubarb half an ounce,—Tine 
         Mercury,—Its use and abuse.      175

ture of opium eighty drops,—and peppermint, or any
other water, enough to fill the bottle, of which take
one quarter  immediately after  every  Dysenteric
stool.   This very seldom fails" to quiet the bowels,
but, if it do, an injection of  thirty drops of  Lauda-
num in half a tea cup full of warm milk and water,
and repeated perhaps once or twice, may be said to
be a certain means, and those who happen  to have
my little patent syringe, contained in the chest  for
Gonorrhoea, will find this the most convenient, as
well as expeditious mode of cure.  The Dysentery
being removed, of course the Mercurial medicine is
to be resumed.

   7th.—A state of soreness of the  gums which is
not followed by a salutary spitting.—It may hap-
pen that about the usual time, a slight degree of
soreness of the gums and smell of the breath occur ;
and yet,  although the Mercury is continued  for sev-
eral days, no increased  flow of spittal is observed.
If the gums are now examined it will be found they
are not  soft and swollen as in  a  regular saliva
tion, but their edges are more inclined to ulcerate.
Indeed, the ulceration of their  edges is the only
change they appear to have undergone.   Such cases
also are attended with too much fever.   Now, if we
were to go on with the  same dose of Mercury, we
should only increase the ulceration  and the fever,
without producing salivation.  In this case therefore
we do not increase  the Mercury, but diminish it. 
 176      Mercury,—Its use and abuse.

 In fact, this  condition is a proof of an over dose of
 Mercuiy.  If therefore you were taking five pills at
 night, take now but two, and these only every other
 night.  Also, if the "fever were considerable, lower
 the diet and drink freely of warm tea, or any thing
 that would induce a perspiration and abate the fever.
 You might  further take thirty drops of  antimonial
 wine, two or three times a day, as a fever medicine.
 By these means you will soon convert this spurious,
 into the true and genuine kind of salivation.

  8th.— When the effect of Mercury falls upon the
 throat, rather than  the salivary glands.—In this
 case the soreness is  referred to the thrpat, and is
 commonly attributed  to catching cold.  On looking
 in the mouth a high degree of inflammatary redness
 and swelling is to be seen, particularly on that cur-
 tain-like part suspended from its arch and behind it.
 We see also upon the tonsils (two glandular bodies,
 situated, one on each  side the back of the mouth) a
 superficial ulcer or two, covered with a  whitish or
greyish matter.  Now, in this case, always stop the
Mercury immediately.   If you were to persist in it
you would endanger the  distruction of these parts.
In  the mean while the throat  may  be  frequently
gargled  with port wine and water, to  which a little
honey and vinegar may be added. In a few days,
either with or without the gargle, the throat will get
decidedly easier and better, and then  you are to re-
sume the Mercury in smaller doses.   By this treat- 
          Mercury,—Its use and abuse.       177

 ment, Dr. Colles observes, " I have seen in some of
 these cases, a  regular salivation come on, but in a
 few others I could not succeed in producing this de-
 sirable result, the renewed action of Mercury pro-
 ducing the same condition of the throat; such cases,
 however, are conducted safely through the Mercu-
 rial course, by watching them closely, aud taking
 care that the inflammatory state should not be al-
 lowed to rise high."  By this is he means, that the
 moment the inflammation raises high, the; Mercury
 should  be omitted for a  day or two and then resum-
 ed, to be again withdrawn on the recurrence of such
 a state.

   4th.— The gums beginning to be affected at  the
 proper  time, but do not  proceed to a  salutary spit-
 ting, notwithstanding the medicine is continued.__
 In ordinary cases the same dose of Mercury which
 produces a beginning tenderness of the gums, will,
 on continuing it, mature that state into a mild but
 perfect  salivation; in some instances, however, it
 will fail to do so; neither in this case is there  any
 disposition to ulcerate the gums, or to excite fever,
 the only thing  remarkable  being its  stationary and
 limited  effects.  Here it is  necessary to increase the
 dose ; but, as it is not usual for Mercury when it has
gone so far, then to stop, it may happen that some
other form of the medicine may suit that particular
constitution better, and therefore the additions made
may be in some other form of the medicine.  Accord-
                       12 
 17S       Mercury,—Tits use and abuse.

ingly,iflhe pills have been taken, we may now use the
Mercurial ointment,—continuing the same dose of
the pills as before.   Half a drachm of the ointment
therefore may be now rubbed in at night, and this
in two days more may be  increased to a drachm,
lessening this large dose of Mercury as we may see
the mouth advancing towards a salivation.

  5th.— When fever is produced  instead of sali-
vation.—This is still another and a very different
effect, and also  one  which  shows the Mercury is
disagreeing and  must  be  stopped.   Here it pro-
duces no effect upon the mouth or throat at all, but
in a few days from its commencement, the skin be-
comes hot, and the pulse quick, with much feverish
restlessness.  This feverish state, unaccompanied
by any  marks   of salivation,  is a  proof that the
Mercury  given, whatever the dose may have been,
is too much for the constitution.  The course to pui-
suethenis to omit the Mercury and use such means
as are calculated to abate the fever; cool air, gentle
purging, and any diaphoretic or fever medicine are
calculated to effect this object.  Then, after a little
time,  or when the  strength has been recruited, the
Mercury should  be resumed  in smaller doses, and
repeated at longer intervals, (perhaps in half the
usual dose) and  this only every other night.  It is
also  proper   on  recommencing  Mercury to give
twenty or thirty drops of antimonial  wine two or
three times a day,  to keep the bowels open with an 
         Mercury,—Its use and abuse.       179

occasional  purgative, and, if convenient, to take a
warm bath or twro.   With these means you will be
able gradually to/increase  the dose of  the Mercury
and at length induce a favorable salivation.   This fe-
verish state, it should be observed, is not unfrequently
the consequence of hastily plunging a patient into a
Mercurial  course  without  the  preparation for  it
already insisted on, especiaUy in a young and vigor-
ous person.

  But, in addition to  the  difficulties  already men-
tioned, there are others also arising  from peculiai
and very opposite  constitutions,—the one being too
sensible, the other too insensible to  the effects of
Mercury.

  6th.—A Constitution too  sensible to the effects
of Mercury.—It will happen that some individuals
will become salivated on taking one single dose ; but
this is a kind of salivation that  cannot be relied on.
Without  reasoning  on the  subject, which, indeed,
would be to very little purpose, we must rely upon
experience, and this  teaches  that those who become
salivated on taking the first or second moderate dose
of Mercury are not thereby exempted from future
forms of Venereal disease ; it behooves therefore to
enquire how such singular  constitutions should be
managed.  The  directions  of  Dr.  Colles  on this
head are  remarkably plain  and correct.  He  says,
"such a patient  should be  directed  to  keep very 
 180       Mercury,—Its use and abuse.

 " much out in the open air, to take a nutritious diet,
 " and two or three glasses of wine daily; the dose
 " of the medicine also should  be  reduced  to one
 " fourth, and an interval of one, two, or even three
 " days left between each.   When we have proceed-
 " ed thus for a little while, we may prescribe larger
 " doses, or shorten the periods between them, so as
 " to induce a salivation, which will then occur with-
 out any unfavorable symptom."  The salivation
 thus produced must be maintained and regulated as
 has before been shown.  But I cannot in this place
 forbear remarking, how correctly these means accord
 with  the principles on which the utility of a prepa-
 ration for a Mercurial course was urged in a former
 part of this chapter.  Was it, for instance, in order
 that Mercury should make its early and salutary im-
 pression on the mouth, that the preparatory means
 of  purgatives, and  low diet, and  warm clothing
 were  directed; so, when  that effect should show
 itself too early, the opposite means are  introduced,
 and, by cool air, a generous diet, and a little wine,
 this premature effect of Mercury is delayed and the
 constitution brought to bear the necessary quantity.
 I should not however have pointed  ont this  beauti-
ful  consistency, but for my solicitude to press upon
the mind the utility  of preparation for a course of
Mercury,—persuaded as I am that its omission is
 a terrible  evU, and that it is far from being suffi-
 ciently enforced. 
          Mercury,—Its use and abuse.       181

  7th.—A Constitution too insensible to Mercury.
—This when it happens is a more perplexing case.
It differs from all the preceeding.  For  instance, it
presents neither ulceration of the gums, nor inflam-
mation of the throat, nor fever.  Indeed, its pecu^
liarity consists in presenting no effect at all.—It has
been shown that in giving Mercury in this complaint,
the object is to induce a salivation, and this within
a certain  time if possible.  With this view  a regu-
lar system of enlargement of the dose is early acted
on, that is to say, to a limited extent.  Thus pro-
ceeding, therefore, it generally happens, that after a
second or third increase  of  the dose some effect
upon the mouth  wUl be discernable, but in this case
there is none; nor is there any on the constitution,
by which we might be warned it is  acting in one
way or another.  It is frequently now supposed that
it is the fault of the medicine—the particular prepa-
ration  that has been used—and therefore it is chang-
ed,  or some other is added  to it, as calomel, or cor-
rosive  sublimate, but  to  no purpose.   Others have
gone on to increase the dose  to an incredible, and I
might  add, dangerous extent—to the quantity of
half an ounce of the  ointment, for  instance, every
night and morning, together with large  doses of
calomel or Blue  pill.  But  a frequent consequence
of this has been, either an alarming degree of debil-
ity and fever, or a violent salivation, suddenly com-
ing  on;   and, what is still  more  melancholy  to
superadd,  without  curing the  disease; for,  after 
182       Mercury,—Its use and abuse.

these excessive salivations  it is no uncommon thing
to find the malady return.  It is not a violent, but a
moderate and  gentle  salivation that  can safely be
relied on for the cure  of Venereal disease.

  Now the following  is  the  most judicious course
in such  a case.  After increasing  the dose for
thiee  or  four times, and perhaps adding some
other form to that originally used, without the slight-
est visible  effect, except it may be some degree of
wasting of flesh and strength, then stop it altogether.
This advice is given on the  supposition  that the
dose was larger than  was suited to the constitution.
It is  a fact,  however difficult to explain, that in
some constitutions,  small  doses of Mercury will
produce the best effect, when large ones exhibit no
visible effect at all.—Neither must  the  Mercury be
resumed for ten or fourteen days, or 'till it is sup-
posed the influence of the  former quantity  has sub-
sided and the strength has been recruited.   Be-
fore   a second  trial  also   the patient  should  be
bled, and freely  purged, and  put upon  a lower diet.
The Mercury now being recommenced, perhaps in
half the  usual dose,  a kindly salivation generally
comes on.  But, if that should not occur in ten or
fourteen days, then the Mercury is to be increased
in the ordinary way and manner, and this until it
reach a full, or more  than full and ordinary dose.—
Six  specific pills,  with half  a  drachm of ointment
every four and twenty hours, might be  considered a 
         Mercury,—Its use and abuse.      183

lull and liberal dose, and beyond this, it should not
be increased with a view of bringing on a salivation
at any rate.   This course however should be  con-
tinued a week or two  longer than the  usual time,
and then, although not so satisfactory as in an  ordi-
nary case of salivation, may be relied on as a per-
fect cure.   We have the best authorities for  stating
that there are constitutions which do not admit of
salivation, but yet  admit of the  cure of Venereal
disease by Mercury, cases of which they have given
in detail.

  I do not scruple  therefore to say, that cases  of
this kind,  treated and tried with Mercury in -the
manner here directed, are to be considered safe and
secure, and that the failures in attempts at saliva-
tion are owing  to  "peculiarity of constitution."—
There is one thing in their treatment however, that
would seem to merit more particular attention  than
in ordinary cases, and that is, the  perfect disappear-
ance  of every symptom, particularly the hardness
which is sometimes inclined to remain after the  heal-
ing of chancres.   Let the Mercury therefore  be con-
tinued even for a little time longer than usual after
the total disappearance of this symptom.  Indeed,
the perfect and total disappearance of this and every
external symptom  might be regarded as an  addi-
tional and valuable proof of the efficacy of the course.

   But  there is  still another class  of  circumstan-
ces, or definite  effects  of  Mercury, which  show 
 184      Mercury,—Its use and abuse.

 it to be disagreeing and demand its immediate dis-
 continuance.  These therefore must foUow in  this
 enumeration.

   8th.—r An unfavorable effect  of Mercury  on  a"
 Chancre, or Bubo, or Ulcerated throat.—In gen-
 eral, soon after a  Mercurial  course  of Mercury  is
 commenced, the local or visible part, whether chan-
 cre, bubo, or sore throat, will begin to improve, and
 after a little further time, more or less rapidly pro-
 ceed to heal.  Indeed, these changes  are regarded
 as a general rule of judging whether the Mercury  is
 acting  favorably   or  no.   It  sometimes happens,
 however,  that after a chancre or any other local
 symptom has been doing weU for a length of time,
 it suddenly alters, and  becomes painful, inflamed,
 and spreading. Now this is the effect alluded to  in
 this section and shows that Mercury is disagreeing.
 But this must carefully be distinguished from a slight
 and temporary change, occurring at an earlier period
 of the course.  It is a fact that every one should be
aware of, that a chancre will, almost always be  a
little painful and inflamed, and often spread a little,
just at the time when Mercury is about to act upon
 the gums; but this, in a day or two, improves again.
Very  different, however,  are  the  circumstances
which  denote  that Mercury  is disagreeing.  It  is
then an unequivocal and increasing change for the
worse, and, which  is a point of great importance  to
obseive, it is after the Mercury has been proved  to 
         Mercury,—Its use and abuse.       185

be the proper remedy, by the previous improvement
of the sores.  In this latter case the chancre, from
looking healthy, filling up, and without surrounding
inflammation, on a sudden becomes painful, inflamed,
and spreading; or, if a bubo,this, from being slightly
tender, would become exquisitely painful and inflam-
ed, with  fever; or, if it were  an ulcerated'throat,
this would become inflamed and spread.   Such
changes  indeed  would unequivocally  prove that
Mercury was disagreeing and must be discontinued.

  9th.—A Mercurial Rash, covering  most  part
of the body.—This is  another circumstance which
requires the immediate  discontinuance of  Mercury.
Sometimes, about the period when the gums begin
to be affected, and when also there  is generally
some slight degree of fever, there appears, about the
groin or between  the thighs and scrotum, a patch of
redness,  or  Rash, which, if not attended to, will
soon  become extended  over the  whole surface of
the limbs and body.

  This Rash is not a very serious thing if early seen;
but as it commences in parts which are likely to es-
cape attention, and is not at first attended with much
uneasiness, it is often overlooked a day or two, or
until a high degree of  pain or itching disturbs the
rest and draws attention to it.   On examination it
then is found that the  limbs and  body are coveied
with a continuous vivid redness, constituting, under 
186       Mercury,—Its use and abuse.

mismanagement, one of the more distressing and
serious effects of Mercury.   It does not seem to de-
pend on any given quantity  of the medicine,  for it
has been seen under very small  as well as larger
doses.   There is  however  a particular  period of a
Mercurial course to which it  is chiefly, if not entirely
confined.   This period is just when the Mercury is
about to affect the gums, and  when, as I have ob-
served before, there is always some degree of fever
present.   When a spitting has commenced it  never
need  be feared.  And this  remark indeed applies
to most of the other  untoward effects of Mercury ;
when once the constitution  is fairly under its influ-
ence it is  comparatively safe; and hence the great
necessity  of watchfulness at this particular period.
It is on this account I always wish to see my patient
every day or two, (if it can be done conveniently)
from the time of commencing Mercury, until a spit-
ling is established ;  but where this cannot be com-
plied with, I guard against  these incidents by pro-
viding this little book for their  perusal..  Nothing
can  be more  cruel,  if not  criminal, than  to give
a person Mercury and leave him ignorant of these
possible effects, and  the  peculiar management they
require.   What then should be  thought or said of
those  who advertise their drops  or pills  to cure Ve-
nereal disease, and send away the unsuspecting pur-
chaser without the least conception of these various
incidental circumstances.

   Should such a rash as this appear, the following 
            t
         Mercury,—Its use and abuse.      187

is the course to be pursued.  Immediately stop the
use of Mercury. If you were to continue it, one of the
most distressing eruptive diseases, with great debili-
ty, and even danger, would result.  In lieu of this,
give a cooling purgative medicine and repeat it so
as to produce  a moderate effect for two or three days
together.    If under  this the  eruption should  in-
crease,  avail  yourself of cool and even  cold air ;
also dress  lightly.—Keep  to put  in the open  air
and ventilate your chamber as far as  the  weather
may permit. With respect to the eruption itself, any
thing that cools and affords comfort may be availed
'of; this is sometimes accomplished by wetting clothes
with cold  water  and applying them ;  at others, by
dusting the part  with common starch or oatmeal;
if the skin  become excoriated, as it sometimes will,
 then some stiff ointment to prevent the linen stick-
 ing to the part is good—such as equal parts of bees-
 wax and suet melted together and spread on cloth.
 The shirt and sheets have sometimes been spread over
 with this composition.  In this place however I  am
 more anxious to prevent the malady by showing when
 the Mercury should be  stopped, than to direct about
 its cure.—When it disappears, the Mercury must
 be resumed, in small doses, paying particular atten-
 tion to coolness.  It will also be expedient frequently
 to watch  the skin, particularly those parts  which
 fold and  lie  together,  as  between the thighs, and
 oroin; and should any thing of this kind again ap-
 pear, withhold the mercury for a  day or two again, 
 IS8      Mercury,—Its use and abuse.

 to recommence it as it  fades away again.  By this
 attention to the skin, even  in cases where it thus
 returns, it may be kept so limited, as to allow of the
 perfect cure of the venerial disease by mercury.

   10th.—Red pimples on the wrist.—This is very
 much of the nature of the former,—it makes its ap-
 pearance at the same period of time  (just as the
 mercury is about to effect the constitution) and re-
 quires  the same  positive  discontinuance of the
 medicine.  It differs only in appearing,  not in the
 form of a rash, but in little pimples, and  beginning,
 not in  the groin  or folds  of the skin, but on the
 wrist and back of the hand and fingers.   Such pa-
 tients generally think they have got the itch, and,
 indeed, it is often taken for it by others.   It is men-
 tioned, however, separately, as it forms another po-
 sitive rule for discontinuing mercury, for being so
 unlike the former it might not be regarded as a dis-
 order equaUy  requiring  a discontinuance of  the
 medicine.  A few  days employed in gentle purging
 and low diet is generally sufficient for its  cure.

   11th.—An  excoriation of  the skin  in certain
 parts of the body.—This differs from  the former
 two in beginning, not with a rash, nor with pimples,
 but in  a  simple excoriation, as  if the  patient had
 been chaffed.  The parts more usually thus effected
 are also  those between the thighs,  or scrotum, or
groin.  If this be noticed on the onset it will consist 
          Mercury,—Its use and abuse.       189

simply in excoriation, limited to the angular fold of
the part, but if overlooked it will spread extensively,
and give out a copious discharge of very  offensive
humor.   Now, if this were nothing really but a little
chafe, it would be  indeed a very trifling matter, but
it is found a very different thing, and if not attended to
at first,  will become a very painful and distressing
malady.  There is no such thing as sleep at night,
neither  can you move one limb upon another with-
out agonizing  pain, and this too, may continue many
days, perhaps  weeks together.  Under this effect of
mercury, the  first thing, as before, should  be  the
discontinuance of the medicine; and the next, some
soothing application to the part.   Opiates are found
to be of very little use, nor does purging afford  any
great relief.   The  chief resource  for  ease  in  this
complaint is a suitable application to the part itself.
As a remedy of this  kind, a  powder  composed of
equal parts of  " Lapis Calamindris" and of Starch,
finely powdered, is the best.   This should be put
into a muslin bag,  the part well dusted and covered
with it,  and then a fold of soft old linen nicely laid
upon it, between the two surfaces of the skin.  An-
other thing which  has been found to answer an ex-
cellent purpose is the Black wash,  (page 44); lint,
kept wet with this lotion should be applied to the
parts affected  as above discribed.

   This  effect of mercury is supposed to be the conse-
quence of giving it in too large a dose, and therefor, in 
 190       Mercury,— Its use and abuse.

 reassuming the'mercury, it must be given in a smaller
 dose ,and, steadily, but cautiously increased.  There
 is however one general remark to make upon the sub-
 ject of resuming mercury—it is, that when it is to be
 given again, it should be resorted to as soon as the
 circumstance on account of which it was omitted, has
 abated.  If it were delayed  a longer time than this,
 the other and necessary effects  of mercury  would
 also die away, so that a greater length of time, and
 a greater quantity of mercury would be required to
 re-produce them.

   12th.— The effects  of Mercury when it disa-
 grees icith the Constitution  generally.—Of all the
 untoward effects of mercury, this is the most worthy
 of  attention.   Heretofore I have spoken of  this
 medicine only when it has exerted an injurious effect
 on  some  particular part, shown  by  inflamation,
 fever, and  affections  of the skins; but  now we
 come to  speak of  its effects when  exerted in-
 juriously on the  constitution  generally—when it
 may be looked on as a kind of poison.

  However excellent and valuable a medicine mer-
 cury is, it must be acknowledged, that,  if misman-
aged, or misapplied,  it may be turned to very bad
account.  But this in fact is saying nothing more
 than what relates to every valuable remedy. Indeed,
the more valuable a remedy, when  properly used
the more dangerous when ignorantly abused. With- 
          Mercury,—Its use and abuse.      191

out attempting to describe the pecuhar nature of the
constitution with which mercury  disagrees, I will
merely detail the  symptoms by which it  may  be
known.

  In  a case where  mercury disagrees, about the
time when it might be expected to  show itself upon
the mouth, a remarkable degree  of general prostra-
tion is complained of, with a sense of anxiety and
palpitation of the heart; there is also frequent sigh-
ing, partial or universal trembling, occasional vomit-
ing, a pale contracted countenance, and  a general
sense of coldness.  All these  circumstances, to one
acquainted with the laws of physical vitality, would
argue a great reduction of its power.  Indeed, every
one would be aware  of this, but still might not  be
quite  aware that  they arose from mercury,  and
therefore, might not so promptly discontinue  it.
My present object therefore is to state this fact  so
clearly  that those who  have this little book can
scareely  overlook  or slight it.  Not that this is a
common effect  of mercury by any means; on the
contrary, it is exceedingly uncommon ; still it is pro-
per that every one  who undertakss the use of mer-
cury should be  acquainted with it, though it were
only as a possibility.  It is not in the active and pecu-
liar effect of any medicine,but in the ignorance of such
that the danger lies.   With respect to what should
be done under circumstances of this kind  the first
thing of course is  to  omit the mercury.   Even the 
 192      Mercury,—Its use and abuse.

 dress and bed  clothes might be changed  lest they
 should contain any portion of it.  Next, he should
 be careful to avoid  the least  exertion, such as even
 rising suddenly, or getting out of bed without assis-
 tance.   Cordials in  small but frequent quantities
 should be allowed; but above all, exposure in  the
 horizontal posture, and in the  free and open air, both
 day and night, should be rigidly insisted on.  If  this
 treatment prove successful, mercury must not again
 be had recourse to for three or four weeks at least,
 and not then if the  health and  strength be not re-
 stored.  If however it be determined on, give it in
 :he following cautious manner:—Begin with doses
 very small, and interpose a gentle purgative about
 every  second  day.   Be  careful  also that he take
 daily, but  gently, exercise in the open  air.  If by
 this means the  salivary  glands should  be affected
 and a spitting follow, the danger may be considered
passed, and the cure as certain as though nothing of
 this kind had happened.

  With this I finish what I had to say upon the  use
 and abuse of mercury, having also mentioned with
 especial care, every  difficulty that can possibly at-
tend it.  For   the  latter, however,  I  am aware
I shall be blamed by some, on the ground that many
of these evils are of rare occurrence, and therefore
that I am creating unnecessary fears.  But to this I
would reply, that many consult me from a distance;
others, who are not,  within the reach of Physicians 
          Mercury,—Its use and abuse.       193

who have seen much  practice in this  complaint;
and not a few obtain my little private chest on going
to sea, and of necessity rely upon it in every time
of need.  What therefore  could such   do in  the
event of any of these  untoward effects of Mercury.
I grant most cheerfully that many of these evils are
of rare occurrence, and that the management of
Mercury in  the cure  of this disease is  easily ren-
dered  safe and certain; but to  this end  the rules
which are here given should be carefully  considered,
and especially should every possible untoward effect
be known and rightly managed.  With what pre-
tentions to propriety or justice then could I have put
this  little volume into  the  hands of such, and omit
to mention any single one  of these effects. Indeed,
there is no part of this little book from which I anti-
pate more usefulness,  or  derive more conscious sa-
tisfaction, than from this very chapter.  With this
feeling, therefore, I will endeavor to present these
difficulties in  a still more clear  and useful manner
in the following kind of table:—

A CONDENCED VIEW OF  THE  DIFFICULTIES  WHICH NOW
      AND THEN ATTEND A COURSE  OF MERCURY.

   1st.  A Dysenteric state of the bowels, showing
that the Mercury is acting on  the intestiral pas-
sage, rather than on  the gums.
  2d. A state of ulceration of the gums instead of
a swelling and salutary spitting. 
194       Mercury,—Its use and abuse.

  3d. The effect of Mercury falling on the throat
and  curtain of the mouth, producing a high de-
gree  of redness,  and whitish looking sores, like
thrush.
  4th- The gums beginning to be affected in the
proper manner, but not proceeding to an increas-
ed flow  of spittal, notwithstanding the medicineis
continued.
  5th. When a feverish state of body is produced
in lieu of salivation.
  6th. A constitution too  sensible to the  effects of
Mercury.
  7th. A constitution too insensible to Mercury.
  8th. When Mercury  produces  an unfavorable
effect upon  a chancre, a bubo, or an  ulcerated
sore throat.
  9th. When Mercury produces  Rash upon  the
limbs and body.
  10th.  When it produces pimples on the  wrist
like  the itch.
  11th.  When it produces excoriation of the skin
in those parts which fold together, as the groin,
scrotum, cj-c.
  12th.  When it seems  to disagree mith the con-
stitution generally.

  These,  together with the symptoms which denote
their coming on and the proper management of each,
have been carefully pointed out. 
Venereal,--iis Treatment and Cure.   195
                CHAPTER XII.

     On the Treatment of Venereal Disease.

  A Chancre (a Venereal sore on some part or
other of the genital organs) is the most common
form of the disease we have to treat, and is the way in
which every other form begins.   The following is
a definition of Chancre :—" A sore of a somewhat
circular form, excavated, with matter adhering to
its surface, and icith a thickened edge and base."—
You must not however expect every chancre  to ex-
hibit all these points of character; sometimes they
do not appear for many  days, so that a real Venereal
sore may look just  like any other sore or abration
of the skin ; and sometimes some  of these particu-
lars  do not  appear  at  all.   If there is' any  doubt
about  the  matter,  however,  you  must refer  to
Chapter X,  "upon  diseases resembling Venereal,
&c."   In a case  of  recent chancre, the first thing I
always do  myself is to pinch  it up  between my
thumb and finger, and if I feel a hardness and  thick-
ening  around and underneath it, the question with
me  is  settled—I know  it to be a chancre.  But, re-
member, if this hardness and thickening should not
be felt, yon  are  not immediately to conclude it  is
not a chancre; for,  as  I have just now said, this
hardness may be delayed in forming. 
196   Venereal,—Its Treatment and Cure.

  Being satisfied however that you have a chancre,
what then is'the first thing to be done?  Now this
naturally leads to a word or two upon the use of
caustic.

  The application of caustic to a recent chancre has
been recommended on the principle of destroying its
specific action before it has attained a certain matu-
rity, by which it can contaminate the system.  But
this  I have always considered  a very  dangerous
speculation.  If wre knew for fact that the matter
secreted by a recent  chancre, at any certain early
period, was not infectious, then indeed it would be
highly advantageous to cauterize; but this, as far as I
kndw, is not ascertained.  Neither does analogy sanc-
tion such a theory.  The case of small pox or vacci-
nation may be considered analogous ; here, a poison
being innoculated, a pimple forms containing matter;
but after  the  formatjoion  this pustule, if it were
cauterized, or even removed entirely, this would not
protect the constitution.  Neither would it in the case
of chancre. And here again, in the case of chancre,
the Venereal action has gone still further,—it has not
only gone so far as to produce a pimple or pustule, but
this has broken, and an ulcer, secreting  matter, is
presented.  If, indeed, a part innoculated with Vene-
real matter were cauterized or cut out immediately,
like the bitten part of a mad dog, before it had insti-
tuted any action at all, it might  be  then  depended
on; but, as this cannot be, (for we cannot tell that a 
Venereal,—Its Treatment and Cure.   197
part has been affected with Venereal, until it is shown
by ulceration or a pimple), and further, as we have
no means of judging whether there is any period at
which  the  matter  of the pustule or ulcer is not in-
fectious,  so we have  no ground on which we can
rely that  the constitution will not be afterwards af-
fected,  though the chancre be early and perfectly
destroyed by caustic.  I would not  say that in no
case whatever is the constitution thus protected, but
I would ask, who would choose to risk his own upon
this peradventure ?  I hold therefore that it is ex-
ceedingly speculative and unwise to depend on caus-
tic 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.   alsHeo then goes on
to show the folly of this practice by relating the  con-
sequences of a case which occurred in  a particular
friend of his, and which I will give in his own words
below (note 23).

  Note 23.—The case of Sir  plication of caustic: I laughed
Jlstley Cooper's friend who  at him for being  so foolisli: the
undertook to cure himself by  caustic produced a slough,
caustic. He states«"A young  h^1 cu''ed the chancre, and I
person with whom I was in-  thought nothing more of the
timate whilst I lived with mv  ™mj a?C?'-  Sometime af-
old  master, got  a chancre,  temards I-^mt^ him in the
which, to use his own expres-  u°u"try!, and asked him how
sion. he burned out by the ap-  he was ?    Fery well now," 
198    Venereal,—Its  Treatment and Cure.

  Notwithstanding these facts and reasons  against
the use of caustic for the cure of chancre, hoAVever,
there still are those who practice it.   Most of such
persons, no doubt, are totally ignorant of its  conse-
quences ; but there are also those whose  opinions
are entitled to the highest deference, and who, under
certain limited cirrumstances, 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,
  he replied, "but I have been
  in a,nne scrape; I was en-
  gaged when I left town, to a
  young bady, the nuptials were
  to have been soon celebrated,
  and the business of life com-
  menced."   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 throa t,
  which I had  caught  from
  cold.  My  throat becoming
  more painful, I  looked ihio
  the glass, and perceived that
  I had a large sore on the ton-
  sils, decidedly syphilitic. You
  may conceive  howl felt; I
  wrote to the 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
  meanfe I was quite restored,
  and the  marriage ceremony
  was celebrated."  The fol-
lowing 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 fol-
ly.  The application of caus-
tic to a chancre does not ren-
der a Rerson safe from  its
eHccts, 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 tor this
complaint, you should ask
him if he wishes to be, pro-
perly cured at once, by a sim-
ple mercurial treatment,  or
have the chancre cured with-
out it, and run the risk of
having secondary symptoms
occurring at a future period.
His answer will be—for God's
sake, give me what is proper
now for  my cure,  without
submitting me to the chance
of being laid up a second time
with this complaint." 
      Venereal,—Its Treatment and Cure.   199

has lately recommended it, and has endeavored to
point out  the particular circumstances under which
it may or may not be had recourse to.  Happy indeed
should I be to be made acquainted with any particu-
lar circumstance, on which, being  prese*nt, I could
rely with confidence for the cure of Venereal disease
by caustic; but, after what I have seen and known,
it must be a pretty good and solid kind of evidence
that would get my consent  to a dependence  upon
caustic inFany well marked case of chancre.

  There is one  thing at  any rate which  should be
observed upon this subject:—it is, that it is onTjrm
the case  of recent chancre  it can be reasonably
thought of by any class.   After it has existed, for
instance, some  weeks, by which time it  will  have
acquired the peculiar hardness of its edge  and basis,
it is of course out of the question altogether.

  The  Treatment of  Chancre,—is commenced
by preparing the constitution for the use of Mercury.
Purging, a low  diet, and as much quietness or free-
dom from  excessive bodily labor as he can command,
is recommended.  Salts, or almost any purging me-
dicine will do, but the Antimonial Mixture (page 47)
is the best.  If any further hints respecting prepa-
ration are required, these will be found in page 158.
About a week is usual! y occupied in this way, but this
is not considered lost; for, during this purging treat-
ment the disorder cannot make advancement, while 
  200  Venereal,—Its Treatment and Cure.

  its effect will be to lessen the quantity of Mercury
  required, and shorten the period of the course. From
  the commencement of this treatment apply nothing
  to the chancre, (unless it is in a state of unusual pain
  and inflammation) but lint, wetted with cold water,
  if it is any where underneath the foreskin;  or spread
  with spermaceti, or any simple cerate, if it is exter-
  nal, on the prepuice or the penis.

    You therefore now begin with Mercury.—Begin
  with three  " Specific Pills." and repeat them every
  night.  You need not look for any sensible effect
  from these at first; if  any should occur, as purging
  or costiveness,  these may be corrected as pointed
  out in page 166.   But on  the fourth or fifth day, per-
  haps some tenderness of the gums, or coppery taste
— Sn the mouth, may be complained of; if not, increase
  the dose to four at night.  In two days further, should
  no effect  be felt upon the mouth, take in addition,
  two pills in the morning.  This would  bring the
  dose to six pills in the four-and-twenty hours.   This
  being an ordinary full dose,  may  be  continued a
  few days more.   But if this, in three days further,
  making the 9th, were to be followed by no soreness
  of the gums, nor any bad  effects, (for which refer to
  page 174) then add to this treatment from  half a
  drachm to a drachm of mercurial ointment,  in the
  manner described page 48, and continue  it for four
  or five days more.  If still no soreness of the gums
  should be produced, you then are to consider it a 
      Venereal,—Its Treatment and Cure.   201

 case in which the constitution is peculiarly insensible
 to Mercury, and treat it as directed in page 181.

   Above  however I have described a case which
 very seldom  happens.  In general, long before this
 dose  of Mercury is attained to, the gums become a
 little tender  and the taste is coppery.  Whenever
 this occurs a spitting may be looked  for.   To  en-
 courage this, the dose must be continued, perhaps a
 few days  more, but when the gums are further swol-
 len, and perhaps a little  ulcerated, and the flow of
 spittal is increased—then stop the medicine.   The
 object now will be to keep this soreness within tole-
 rable bounds. On the one hand, then, you must not
 let it get  quite well,  nor, on the  other, make  it too
 sore, and  this you can easily accomplish by omitting
 repeorating  the medicine, or by diminishing or in-
 creasing the dose as  you  see fit.  If the present ten-
 der state of the gums and spitting should continue,
 which it frequently will do for eight or ten days, you
 may omit the medicine for this time, or give it in
 smaller doses.  A better  practice however, and one
 which I adopt myself, is  to wait  a  few days only,
 and then renew the medicine in the same full dose,
 and not diminish it again, unless from an increasing
 soreness of the mouth, I see  it necessary.  Thus I
avoid a very  common error,—that of allowing the
 mouth to  get too well.   What I mean by too well
 is, a total  absence of swelling and tenderness; I do
not take the  spitting into the account;—this may 
202  Venereal,—Its Treatment and Cure.

cease while the efficacy of the medicine is secured,
but if the swelling and  tenderness also cease, we
have  no proof that the Mercury is acting with its
full effect.  Thus we  proceed for a period of four to
five weeks  from the  time of beginning with  the
Mercury.

  During this period, we seldom have occasion
to apply any thing but lint and  cold water, or sim-
ple cerate, to the chancre itself.   If the patient is
particularly  anxious to heal the chancre, the black
wash (page 44) is as good a thing as  can be used.
But it is better not to hasten its  healing, but rather
allow this to depend  on the medicine taken  for the
cure of the disease.  It  is astonishing to see the
immediate and beautiful effect of the Mercury upon
a Venereal sore, as soon as the  constitution acknow-
ledges the general influence  of  the medicine by a
tenderness of the gums.   Just at  the time when this
is about to happen, however, the chancre, for a day
or two, may appear  a  little worse  and feel a little  ^
painful, but as soon  as the  tenderness  advances, it
suddenly improves, looks  red and healthy, and more
or less rapidly fills up  and heals.

  In general, before this course of Mercury is com-
pleted, the chancre will have healed, leaving nothing
but the color,—no hardness to tell where it had been
seated; but  sometimes an ulcer will remain unheal-
ed.  In this case, however, it is no longer a Venereal 
       Venereal,—Tte Treatment and Cure.   20;-!

 ulcer,  requiring the  further use of Mercury, but a
 common indolent sore, requiring only common stim-
 ulating applications.  Spontaneous sores of this kind,
 which, by ignorant or designing people are always
 called Venereal, frequently occur upon these parts.
 but there is nothing of Venereal in them.   The best
 way to treat such sores has been pointed out, (page
 148) but I will here repeat it in a word or two.  Take
 white  vitriol in powder on  your damped finger, and
 hold it to them for a minute or two, then dress them
 with lint wetted with cold water, or spread with
 simple cerate.   The powder may»be repeated every
 other day.   Or, touch them with the Blue Vitriol, or
 with the Lunar Caustic, every'other day, dressing
 them as before every night and morning.

  But  the chancre may have healed, and left a hard-
 ness where the ulcer had been seated.—Now this,
 of all things, is what I wish to draw attention to.   It
has been particularly noticed in page 172, but here
too  I will repeat, it never must be overlooked.  You
need not however continue the Mercury internally,
but  apply mercurial ointment to the part.—A quan-
tity a little larger than a pea should be well rubbed
into it  night and morning, until it is removed.  Rub
the  ointment into it with the finger until it is quite
absorbed, and repeat it, however  long it may  be
needed, until this hardness is perfectly removed.

  And now, the course of Mercury being quite com- 
204   Venereal,—Its Treatment and Cure.

pleted, 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 su-
perfluous.  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.  11 is a fact
that Mercury leaves  a person rather more suscepti-
ble 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  encoun-
tered by clothing suitably and warm.

   If  however any remarkable  degree  of  nervous
weakness, or  Dyspepsia, or  irregularity of bowels
should be left, these would be best  removed by the
strengthening laxative pills, No. 2.  Indeed nothing
will be found more useful and  restorative in a con-
stitution weakened and exhausted from any cause,
than these  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.  Generally, 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 neces- 
      Venereal,—Its Treatment and Cure.  205

sary here to state, that there are certain circumstan- *
ces frequently starting up which demand particular at-
tention.  These I will proceed to mention, severally,
and begin with,

  An inflamed and irritable  Chancre.—This is
sometimes seen in a very high degree, and, if Mer-
cury were given  before it were reduced,  it would
endanger  even the very member itself.  Naturally
and properly, pain and inflammation do not  belong
to chancre, and if any be present, it is owing to ac-
cidental 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 swol-
len, 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
inflammation are  those made use of in preparing for
a  course  of Mercury,  so that here they answer  a
twofold purpose.   Especially is it  advantageous,  if
possible, to rest.  Indeed, in some  cases the  conse-
quences are so threatening and dangerous that every
consideration of secrecy must be laid aside and ab-
solute rest in  bed enjoined.  More generally how-
ever, smart and repeated purging with the antimonial
saline, or senna and salts, (page 47)  with low diet
and partial rest, together, if the patient be fuU habit 
206   Venereal,—As  Treatment and Cure.

ed, with a copious bleeding, will be sufficient.   At
the same  time, a  soft  bandage, constantly wetted
with a cooling lotion  should  be  applied.  It may
take many days before this inflammatory state be
thoroughly subdued, but however long it be, Mer-
cury 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 applications are lequired.  Lint soaked in  the
black wash, or in tincture  of myrrh, or tincture of
opium, should be applied, and over this a poultice of
grounds of beer, or a plaster of simple cerate.—Also,
bark, ammonia, and opium should be given freely.
These and the doses of them will be seen in chapter
3d, "on remedies," page 53.  But I need not here
do more  than merely mention  them, for in such a
case I should certainly advise  that  medical aid be
sought.

   Venereal Bubo.—This is a swelling  in  one or
more of the glands of  the groin, seldom more than
one, and is frequently observed in connexion Avith a
chancre.  There  is always some degree of pain  and
stiffness with it,  but if  this be only moderate, no
application will be needed.  The mercurial treat-
ment is to proceed exactly as though there was no
swelling, and as soon as the constitution is affected,
the pain will lessen and the swelling gradually de- 
      Venereal,—Its Treatment and Cure.   207

cline.  But  if the pain and throbbing of the bubo
should be very great, with inflammatory redness, and
some fever,  then the use of Mercury must be delay-
ed, or, if commenced, omitted, while attempts are
made to reduce this inflammation.  These attempts
are made by such means as are  proper in other in-
flammatory  affections,  and which  have just been
mentioned, viz.—rest, purgatives, and low diet.  To
the part itself, any thing which will abate the pain  is
proper.   The cooling lotion mentioned under "reme-
dies," or one made with weak brandy and water,  is
often very useful.  Many apply leeches with very good
effect, and after these a common  poultice.  Also an
opiate, or Dover's powder, should be taken to assuage
the pain at night.   All these, and the doses of them,
are carefully mentioned in the chapter upon reme-
dies.—if; notwithstanding all these means, the swell-
ing still goes  on  to suppurate, that is, to form an
abscess, it should be opened and treated in the com-
mon 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 in-
flammation have subsided.  After this, the mercurial
course is to be continued as though it  had not hap-
pened.

  It should be also hinted that these abscesses are
not always found to heal so quickly as chancres, but
will often continue for many weeks after the Vene-
real  disease is cured.  Neither  is  the hardness or 
208   Venereal,—Its Treatment and Cure.

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 Quinine
or Bark, with the strengthening laxative piUs, No. 2.
A£ to such things as panaceas, and the like, this is al-
together peifect quackery.—Endeavor to recruit the
strength by rational means,—as a suitable and rather
generous diet—the regulation of the bowels and di-
gestive organs with the restorative aperient pill, and,
adding to these a moderate share of patience, nothing
need be feared,—time will remove  the remaining
hardness.

  Inflammatory  Swelling of the Foreskin.—If a
chancre becomes  inflamed and  irritable from  any
cause, it is likely to induce a swelling of 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 para-
phymosis,—words however I will not use, if I can
help it).  Both these states are attended with dis-
agreeable consequences.  In  the first,  the sore or
 chancre cannot be kept clean,  nor can the discharge
 attending  escape,—it  therefore  becomes irritating 
      Venereal,—Its Treatment and Cure.   209

:nd thus  adds to the inflammation of the parts :
and in the other, the penis itself being swollen,
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 purple or blackish, and, not unffequently,
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 Avhen the foreskin or head of the penis is
thus  swollen  or inflamed; if it  should have  been
commenced, leave it  off if these should happen to
come on.  I have  often  said already,  never give
Mercury  in any  case of  high inflammatory  local
disease.   This is the principle to act on, for  it
might happen  that the foreskin might not admit of
pushing back, and  yet no high inflammatory symp-
toms  might 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 all will be re-
stored to  order and a  natural condition.

   But the particular treatment of this case consists
in local management.  One of the first things is to
wash away the matter from beneath the foreskin,
 and to keep the chancre clean.  For this purpose the
 patent syringe contained in the chest for Gonorrhcea
 is admirably  suited,  but those who have not this 
210   Venereal,—Its  Treatment and Cure.

apparatus must procure a common syringe.   Warm;
water, or soap and  water, will answer  one good
purpose—the removal of irritating humors, and will
also  sooth  the parts.  It can  scarcely be used too
thoroughly.  Throw up the  water with  sufficient
force to distend the skin, and hold it in a little wrhile.
In short, do it in any way which you may suppose
best 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 also  superadded.   Nothing in gene-
ral answers this purpose so well as the Black Wash,
(page 44).  It may be  used warm if convenient, but
 this is not essential.—As  a healing, cooling thing,
 the powder No. 1, as  used for Gonorrhoea, is found an
 excellent injection, while the other numbers are valu-
 able when any kind  of gentle stimulant is required.

   At the same time, and especially when the inflam-
 matory redness is considerable, cooling lotions (page
 44) should be applied,—wetting a strip of linen with
 them and rolling it round the penis.  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.  I will only  add, that I  have seen the ap-
 plication of a few leeches to the inflamed and swol-
  len foreskin of the most signal service. 
      Venereal,—Its Treatment and Cure.   211

  With respect to the treatment of the other case—
the foreskin pushed back and remaining fixed—the
same, general plan which has just been pointed out
is equally applicable, with the addition however of
the means to be adopted  to  bring the foreskin for-
ward again; but  these, having been already given
on this case in Gonorrhoea, (page 62) they can be re-
ferred to.  I must also further add, that in this case,
being much more dangerous than the former, and,
especially, as it now and  then  requires a little  inci-
sion 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
chancre, as well as after Gonorrhoea,  and  are called
Venereal, though  they frequently have nothing of
Venereal in their nature.   It is a curious thing how-
ever'that they sometimes secret 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.

  These warty excrescences are either hard or  soft.
The mildest remedy to the soft ones  is the white
wash,—pieces of linen  dipt in this and kept applied 
212   Venereal,—Its Treatment and Cure.

by bandaging or otherwise.  A better thing however
is to touch them with a drop or two of the muriated
Tincture of Steel, for two oi three days together.
Mercurial ointment, applied on lint, will also cure
them.

   The hard warts should first be poulticed and then
touched daily, or every other  day, with blue Vitriol,
or Lunar Caustic.  If they have any kind of neck,
the most expeditious way of cure is to snip them off
with a pair of scissors, and afterwards touch the part
with caustic.

   On looking over what has now been said upon this
subject, there yet  seems one remark to make upon
the use of Mercury in the cure of Chancre.  It re-
lates, especially, to when it should be discontinued.—
 I  have said, that Mercury never should  be com-
 menced when a chancre is attended with  high in-
 flammatory symptoms; I now would  add that  it
 should never be continued, but immediately discon-
 tinued, whenever  such appearances occur in the pro-
 gress of its cure.  It generally happens that when a
 chancre or any Venereal  symptom  does well with
 Mercury, it goes on progressively to improve until
 the cure is perfectly accomplished; but, if instead
 of  this,  after improving for  a  time   it suddenly
 changes in its appearance, and inflames and spreads,
 depend upon it Mercury is disagreeing, and it would
 be in vain and dangerous to expect it would re-as 
     Venereal,—Its Treatment and Cure.   213

sume a healing state under the continuance of Mer-
cury.—Either the Mercury is acting too powerfully
on 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. 
214        Venereal,—Sore Throat.
               CHAPTER XIII.

           On Venereal Sore  Throat.

  It has been observed that chancre is the form of
the disease in which Venereal  first appears, and is
therefore called its primary form;  and that when a
chancre is  only healed and the disorder not eradi-
cated from the constitution, in a certain time, it ap-
pears again, not however as at first, on the organs
of generation, but in some other  part, and this is
called its  constitutional or secondary form.  The
secondary  symptoms  of  Venereal  disease  may
appear almost on any 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 per-
haps feels a little huskiness, which he may attribute
to catching 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. 
Venereal,—Sore Throat.        215
 between this division, the tonsil glands are situated.
 Now, on one or both of these, which are also swollen
 and red-looking, an ulcer will be seen.  It looks as
 if a part of its  substance 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 swallow-
 ing 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 genuine
 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 abso-
 lute prior venereal affection.

   With  regard  to  the treatment of Venereal sore
 throat, nothing more can be said than has been di-
 rected for the cure of  chancre, except  that the Mer-
 cury should be  continued a week or two longer.
 The same preparation for a Mercurial course is ne-
 cessary, as well  as the same occasion to discontinue
 it  in the event of high inflammatoiy symptoms and
appearances.  In general the action  of  Mercury
 should.be kept up for  eight or nine weeks, in Vene-
 real sore throat. If any one should be induced to make
 it  shorter, in consequence  of the kindly heelin°- of
the sore, in all probability, after a few weeks, it would 
216         VENEREAL,T-<Sore Throat.

return, perhaps,  in  the same,  or  it may  be in  the
other tonsil 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 swal-
lowing,accompanied with a slight degree of inflamma-
tion, is very apt to occur again on slight occasions, to
the great, but groundless 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 ex-
plained on the well known fact that nervous pain is
very easily re-produced in parts that have been once
the seat of ulceiation or disorder.

  Further, a feeling  of this  kind  is  often com-
plained of in connexion  with some derangement
of the  organs of digestion, or irregularity of  the
bowels,  for which  the restorative  laxative pills,
No. 2, are so  excellent a remedy.  Washing  and
well rubbing the throat with cold water is also found
to be a  beneficial practice.   But the practical use to
make of this remark, is, to avoid the repetition of the
use of Mercury  in such a case, and to  relieve  the
mind of the harassing apprehension of remaining
venereal disease.

   Another thing to be apprized  of further is, that,
although the venereal ulcer in the throat  is gene- 
            Venereal,—Sore Throat.        217

rally situated on the tonsils where  it can be seen
immediately, it is sometimes situated in parts where
it can not be seen  so easily, and consequently may
avoid detection.  Venereal ulcers situated in these
obscuer 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
throat, concealed by the  curtain-like fold suspend-
ed 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 appearances of inflammation can be seen.
But now we  should  remember, there are places
where it may lie concealed, and the first of these to
be suspected is behind  the curtain of the  mouth.
To bring this into view  therefore direct the person
to draw in his breath deeply, when the curtain 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 article.  An  ulcer here is general-
 ly circular, deep, and foul, the surrounding inflamma-
 tion extending a very little way beyond its margin.
   In addition to the internal use of Mercury, as di- 
218         Venereal,—Sore Throat.

rected for chancre, these ulcerations require a pecu-
liar local and decided mode of treatment.  I would
however mention once for all, that these local  re-
medies would not be safe in the hands  of private
individuals, and  I  shall therefore  barely  mention
them.  My principal object in making these remarks
is merely to apprize 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
consequent  delay  of the  proper means of cure.
Under these circumstances the  disease is apt to
spread, and some of the  parts within this neigh-
borhood  are  next  to vital—the  top of  the  wind-
pipe for  instance.  It should be also known  that
the  process of ulceration is  to destroy, and  that
parts destroyed by this disease are never reproduced.

  The best of all the local applications to sores of this
kind is what is called butter of antimony, (note 24)
It gives pain, but this is  of short duration, and is
soon followed with ease in swallowing and sleep at

  Note 24.— The Butter of  ly pressed upon the  surface
Antimony— Is  simply the   of the ulcer.  Care must be
muriate of Antimony—a very   taken  not .t0  ™ake the lint
active caustic    application,   too wet with it, lest a drop
When used for venereal ulcers   shoul,d fal1  uP°n, the  ST>
in the throat, a little lint, roll-   rounding parts, which woulu
ed pretty firmly in the eve of a   §lve unnecessary  pain  and
silver probe is to be dipped   suffering.
into  the liquid, and this gent- 
             Venereal,—Sore Throat.         219

 night.    There are  milder  applications  which it
 would  be as well  to mention also,  (note 25)


   2nd.  An ulcer on the back of the throat below the
 level of the tongue.—When we do  not discover a
 sore above, Ave should see if there is one below the
 level of the root of the tongue.   If there be an ulcer
 here it  is most desirable  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 pret-
 ty 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 treat-
  Note  25.— A Solution of
Lunar   Caustic.---Lunar
Caustic   twenty  grains, to
water one  ounce is  a good
proportion
  The Honey of Verdigris—
Is another.
  The Tincture of Benzoes,
is still a milder one —
  When caustic applications
are made to.ulcers on the roof
of the mouth, they should be
made to the edges only, not in
the centre, for here the soft
parts are so thin  that an ul-
cer soon exposes the bone,
and  the  caustic  application
had  better  not  touch  the
bone.
  The  various things now
mentioned may be applied by
a piece of lint secured on a
probe, or by a camel's hair
pencil cut short and stubby
— the mouth and throat be-
ing washed afterwards with
simple water.  These toge-
ther  with  the  fumigations,
page 51, comprehend"all that
is  useful   or necessary  as
topical remedies for venereal
sore throat. 
220        Venereal,—Sore Throat.

ed 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  termi-
nates 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 which sensi-
bility should be destroyed by  touching  it with the
Muriate of Antimony, or a strong solution of lunar
caustic.

   4th.—An ulcer situated high  up on  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 appli-
cation of some causlic to allay  its  extreme sen
sibility 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. 
            Venereal,—Sore Throat,        22*

  The sores I have now described are so many spe-
cimens of well marked venereal ulcers. But it should
be known  that venereal ulcerations in the throat
are occasionally seen to differ greatly from these ap-
pearances.   They are made to do so partly  from
the improper use of Mercury, and partly from the
influence which a scrofulous constitution 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 fre-
quent  occurrence, which gives rise to much per-
plexing  and unfounded  apprehensions.   It has
nothing at all to do with venereal, for it frequently
occurs in those who never had this  malady, yet
when 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 afterwards in the day, for then
much  of it will  be  removed by swallowing and
talking.  Although this  is a very obstinate affection
and  wUl sometimes  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 necessa- 
222         Venereal,'—Sore Throat.

ry to rub off a portion of the mucus with a bit 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
benefited 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 Mer-
cury is given for  any  other malady ; it seems there-
fore that they are the combined 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 hap-
pen.

  With respect tovenereal ulcers in the mouth, it i*
only necessary to say that these mar appear on the
gums as well as on the tongue, and on any part of it.
These however  require no  other treatment than a
Mercural course as  recommended for chancre, to-
gether with such local applications as  have been
mentioned, the  necessity of employing which, be-
ing determined  by their rapidity or the pain, de-
manding a  more immediate  relief than the slower
process of salivation  would afford. 
Venereal,— Blotches, Scabs, $c.      223
               CHAPTER XIV.

           On Venereal Blotches, cfc.

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

  The word blotches  is very often used  to express
venereal disease affecting the skin ; but it is very far
from  being confined  to  blotches or  copper color
spots; indeed there is scarcely a single order  of
cutaneous eruption which venereal does not now and
then  assume, so  that it may appear  in the form of
specs, blotches, pimples, vesicles, postules, turners,
branny spots or patches, scabby sores, or open ulcera-
tion.  It would be quite impossible  to give  a par-
ticular and distinct description of all the  various
forms of venereal disease upon the skin. In fact their
is nothing in the appearance of these eruptions, con-
sidered in themselves,  that can  in any safe and cer-
tain manner establish  the opinion that they are ve-
nereal.   This  the most distinguished Surgeons art
aware of, and in order to form their judgment upon
any given case, they always  have resource to the 
224      Venereal,—Blotches, Scabs, §c,

history of the disease, considering especially the man-
ner in which Mercury has been given, and observing
also, whether there is any other symptoms connected
with  them  of a suspicious  or venereal 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 appear-
ance of them, there are certain forms wrhich much
more frequently appear 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 the 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 be-
come  scabby, particularly  about the forehead.  A
Rash, not unlike the measles, is another not uncom-
mon form—covering  sometimes only a small part,
 and at others the whole surface of the limbs  and
body.  Pimples and  little pustules  containg matter
 might next be mentioned.

   Venereal eruptions also are disposedjto change in
 their appearance.   If they are  allowed to  subside
 spontaneously, 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 
         Venereal,— Blotches, Scabs, $c.      225

  if Mercury has been  given (not however  in away
  to effect  a  cure,) its  re appearance is most  fre-
.  quently  in some different form.   For  instance, if
  the  eruption had been  in little pimples, it  may
  now be in little postules containing matter; or  if
  it  had been in branny scales, it  may  be  next  in
  larger patches or in scabs.  Further, there is a re-
 markable tendency in all venereal eruptions to be-
 come scabby and incrust;—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, form-
 ing elevations on the skin.

   There is a period at which venereal eruptions na-
 turally  and spontaneously  abate or disappear and
 re-appear.  This is very apt to deceive, as to the ef-
ficacy of useless medicines.  Frequently such things
as panaceas, or other useless things are taken, and if
the disorder happens to abate,  it is  supposed that
these are curing it; this however at length turns out
to be  complete deception.

  The re-appearance of  venereal eruption, atso,  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 perfectcureof venereal erup- 
226      Venereal,—Blotches, Scabs, §c.

tion  by Mercury, it frequently happens that some
spots of  discoloration  of the skin  remain for  a
long while after the absolute cure of the  disease.
These time only will  remove ; any further use  of
Mercury on  this account, or  any applications 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 ascertain-
ing 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—"isthis venereal?"   To this I
frequently reply, " I cannot say this moment, but I'll
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
Gonorrhcea (vulgarly called Clap)—this of course is
satisfactory, and I say at once—" It is not /" Gon-
orrhoea never causes  eruptions of  this kind ;—the
remedies which are often used in this complaint may
produce eruptions, which however are very different.

  But supposing it is fairly traced to a venereal affec-
tion, and that Mercury has been taken, the next en-
quiry is—as to the manner  in which it  had  been 
            Venereal,—Blotches, Scabs, $c.     227

   taken;  and here I generally find a satisfactory an-
   swer. 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 in the man-
   ner directed in the chapter on " The use of Mercury "
   &c.  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  naturally look with  more anxiety for any other
  symptom.   Now,  the one  most frequently  occur-
  ring  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 sub-
  ject in another place, it will  afford  a strong corrobo-
  ration 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 ap-
 parent cure  of chancre or a  venereal eruption  and
 the   re-appearance  of the disease, which may be
 stated to be fiom eight to ten or twelve weeks,  and 
228     Venereal,—Blotches, Scabs, $c

although this period may be extended even for some
weeks more, yet, if an interval of six months for in-
stance should occur from  the last appearance  of
venereal symptoms, I should consider this longer in-
terval as affording a strong presumption of the per-
fect cure  of the complaint, 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 this malady;—
next,  that the course of Mercury he had undergone
had not been satisfactory, at least, not so according
to the rules prescribed  in this little volume for its
management;—and last, that  the interval between
the former disorder and the present symptoms, is
one at least of three or four months.

  And now, on the subject of  the treatment of ve-
nereal eruption, 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 be continu-
ed two or three weeks  longer  than in  the cure of
chancre.  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 security that the disease  is cured, so as to 
       Venereal,—Blotches, Scabs, $c.      229

induce you to shorten the course on this account.
There is  no form  of  venereal  which so  quick-
ly yields to the influence of Mercury as some of these
eruptions. 
230       Venereal,—In the Bones, $c.
                CAAPTER XVI.

        Veneral Disease in the Bones, &c.

  This disorder does not usually appear in the bones •
until after it has attacked the throat or skin; but it
does sometimes 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 par-
ticularly which are least covered with  flesh, as the
shins,  the bones of the fore-arm and the forehead.
The softer parts or extremities 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 along time and the constitution has been
distressed with various ineffectual remedies and at-
tempts to cure it.' Our business therefore will be to
consider it  chiefly in its earlier  and  more common
form—that of lumps  or tumors on the hard bones,
called nodes.

  Venereal Nodes are attended generally with se-
vere pain—remarkable 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
«o as scarcely to be complained of in the  day; as 
          Venereal,— In the Bones, &c.       231

 evening approaches  however, it returns  to its ac-
 customed or increased severity.  But it should be
 also known, least in any case its  absence  should
 mislead in jndging of its nature, that, now and then,
 the  formation  of a venereal node is attended with
 but  little pain;  also  in  some instances,  anode
 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 re-
 main 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 along while in
 getting well.

   I should also observe that anode, at first, is nothing*
 mote than an  inflammatory state  of the membrane
 which   covers the bone, causing the affusion of a
 little fluid.

   The treatment of venereal nodes differs in nowise
 from that of other venereal affections. The Mercurial
 course  however should be continued longer.  The
 constitution, also, in this form of the disease, is fre-
quently found to  be reduced,  and to need the assis- 
232       Venereal,—In the Bones, $c.

tance which sarsapariUa gives to enable it to endure
the Mercury thus long continued.  The compound
decoction (page 54) is therefore often given with the
Mercury,—half a pint, twice or three times a day.
Also  in  consequence of the  severity of pain, any
means calculated to relieve it before the mercury can
be brought to act upon the malady should be adopted.
With this view, nothing is so beneficial as a blister
applied immediately over it.  Do not be induced to open
a node because it fluctuates and you are sure of its
containing matter.  A blister is the proper thing to
be applied in this case, which should be repeated in
four or five days.  Under  this plan  the matter is
generally absorbed and thus a most tedious healing
process is avoided.   Even  when the skin which co-
vers it is very thin aud red, a blister will frequently
succeed.

  When a venereal node is cured, the swelling and
hardness generally disappears ; but on the contrary
sometimes the swelling will remain after the disease
is perfectly  extinguished,—to be removed only by
slow  degrees, or even not  at all.

  Thus the cure of venereal disorder in the bones
consists  in continuing a  course  of Mercury for a
longer period, frequently in conjunction with sarsa-
pariUa, and in means adapted for the more immedi-
ate relief of pain and suffering—repeated blistering.

  Rheumatic pains, or those occasioned by the im- 
          Venereal,—In the Bones, $c.        233

 proper use of Mercury, must carefully be distinguish-
 ed from veneral.  Those who have been affected
 once with this complaint are very apt to fear that
 any pains they afterwards may have must be vene-
 real.   They are further led to this conclusion by re-
 membering  their  former pains came on at  night.
 But, although venereal pains are remarkable for their
 severity at  night this is not peculiar 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 Mercurial pains, complain of
 pain all over; especially  about  the chest and arms
 and down the legs and joints.   These are not vene-
 real.  Such patients get better in summer.  They
 should  be  directed  to  live temperately and wear
 warm clothing.  The compound  sarsapariUa (page
 54) is valuable in such  cases.  Dovers  powder at
 bed time also will afford  relief.

   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 
234       Venereal,—In the Bones, $c.

sore on the soft parts covering the roof of the mouth ;
but as it sometimes commences also with little scab-
by pustules which appear above the angle of the nose
and upper lip or cheek, and sometimes on the mem-
brane 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 up-
wards to this  part.  It is important  therefore  to
watch these sores,  particularly when on the roof of
the mouth, for if they spread,  the soft parts here be-
ing very thin, the bone  is  soon exposed and so dis-
eased 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, out upon  the face.

   The treatment  of an  ulcer in the roof of the
mouth  does  not  differ  from one on the tonsils, ex-
 cept it  should become inflamed on spreading. Ve-
 nereal sores wherever seated, so long as nothing  ac-
 cidentally occurs to make them otherwise, are very
 slow in spreading and  are attended with very little
 pain  or surrounding redness ;  whenever  any thing
 of this kind happens, depend upon it there is some-
 thing wrong. 
          Venereal,—In the Bones, cfc.       235

  Generally, when a venereal ulcer in the throat is
doing^ well, soon after  the  commencement of Mer-
cury, the sore will begin to improve, that is, from
looking foul and  covered  with a  yellowish mat-
ter,  it  will become  cleaner, and  little  elevated
points of .-edness will  be seen upon it;—these are
healthy granulations,  and the.surest presage of
its cure.  And if this  favorable change should  not
occur before, it is sure  to happen as  soon as the con-
stitution is  fully under the influence  of the reme-
dy-shown by the  swelling of the  gums and spit-
ting.  A venereal ulcer in the throat  therefore shuold
be  treated exactly as  a chancre, and  so long as it
does not get worse this treatment should be pursued
in the confident expectation 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 cured by an inflammatory effect of mer-
cury, instead of the proper one ;—or whether it is a
more than usually lapid and spreading venereal 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 effect of Mer-
cury, I have already spoken of, (page 76)   In that 
236       Venereal,—In the Bones, fyc.

case however, there was  no previous sore, but little
superficial whitish spots, like thrush, appearing upon
inflamed and reddened  parts.  Here, on the con*
trary, a sore is first observed,  and this, from  being
very little painful,  and having scarcely any redness
round  it, suddenly becomes  exceedingly painful,
with high inflammatory redness  extensively diffus-
ed.  Now these inflammatory symptoms may fairly
be attributed to the Mercury and we  therefore dis^
continue it, at the  same  time the usual means for
abating inflammation should be adopted—purging,
low diet, and rest.  If any  other remedies were re-
quired thse would  be, bleeding, and antimonial pur-
ges,  for which see page 47, 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 very serious thing.—I have  stated that  this is
not the natural course  of this disease, and when it
happens it implies the existence  of something very
wrong.

   The cause most frequently observed in cases of
this kind is a disordered or weakened state of con-
stitution, generally rendered so by habits of irregu-
larity, or an unsuccessful  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 
          Venereal,—In the Bones, $c.      237

be, to what extent.  If, upon inquiry, it should seem
that  the spreading character  of  these  sores com-
menced 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 entered 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 constitu-
tion will demand particular attention, whether it be,
with a view of recruiting from the effects of irregu-
larities, or of Mercury, or, with a view of enabling
it to bear that quick and decided  influence  of this
medicine which may now be meditated.  Here then
we are accustomed to look to  the SarsapariUa with
much confidence and  pleasure.

  The SarsapariUa is a medicine peculiarly adapted
to these cases, inasmuch as it has the following three
distinct effects;—it is the best medicine that can be
taken to renovate a constitution, depraved and weak-
ened from any cause, especially from Mercury;—it
has also the power of arresting the progress of  Ve-
nereal 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  Ve-
nereal  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 sarsapariUa be 
 238      Venereal,—In the Bones, $c.

 immediately commenced with.  As  to the best or
 most convenient form to take it in, this may be seen
 page 55. <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 Avith Nitiic Acid, as
 mentioned page 53, is also an admirable  medicine
 in these cases. It may be given in conjunction with,
 or without the sarsapariUa.

  I have  at this moment a  remarkable  and most
 gratifying instance of these combined effects of the
 sarsapariUa and bark now under my care.—This gen-
 tleman came to me from the hands of one of the ad-
 vertising 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 considerable 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.  Indeed the  tonsil
 glands were  entirely eaten away, there being nothing
 of them left but their swollen edges.   It was so far
fortunate that the disease had principally fallen upon
 these glands.  He was also pale and emaciated, 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 consti-
tution.  However,  I  determined to bring him, as 
          Venereal,—In the Bones, <$c.      239

quick as possible, under the full influence of Mer-
cury, and, at the same time, to give him all the sup-
port I  could  command.  With this view I began
with the Compound Decoction, of which he took a
quart a day.  After two days, I found rro change for
the better, but was confident  the disease had not
increased.  I then directed, in addition to the sar-
sapariUa, the  following mixture.—Peruvian Bark in
powder, six drachms,—Compound Tincture 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 satis-
faction, the gums were now affected by the Mercury,
with an increased  flow  of spittal.  The Mercury
was now  omitted.—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 more dreaded far
than death;—he said, expressively, I am better,—I am
safe.   The ulcerations in the throat were now totally
changed—they had lost their foul appearance, and
were studded with little elevated points of redness,
and which, in fact, could only be produced  by re-
producing life and 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 
240       Venereal,—In the Bones, $c.

Mercury, but so recruited and  sustained, as abso-
lutely to commence the healing process; and this,
totally and altogether, the effect of the  sarsapariUa
and the bark.  Nor will I allow, in any one respect,
that this case should be supposed to be exaggerated,
for I have it in my power to afford the fullest evi-
dence of its correct detail.  This  gentleman (trust-
ing 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 occurring to me.

   It would therefore  seem, that the  sarsapariUa,
alone, or, in more deplorable conditions, the sarsapa-
riUa conjoined with Peruvian bark, affords the means,
either of recruiting almost immediately, a constitu-
tion 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 Venereal in the
in throat.

   Respecting the form of Mercury to be used such
a case  as  this, there are some more suitable than
others.  In the case justxelated, I used my own " Spe-
cific pill"—quickened by the aid of ointment, night-
ly rubbed into the thigh, but if this had not shown
its due effect upon the mouth within the time it did ; 
          Venereal,— //! the Bones, &c.       241

 or, if it had been a case in  which every thing de-
 pended on this quick effect, I should have used the
 corrosate sublimate,  as  directed in page 49, 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 pre-
 sent pain,—the other  to remove them permanently
 by curing the disease  itself.  Those adapted  to the
 first of these intentions have  been already mention-
 ec*5 Page 219, and the va/ious ways of useing them
 defined.   They chiefly act as caustics  or as stimu-
 lants, and their value in allaying pain and giving a
 momentary  check to encroaching sores, is  gTeni;
 but the one I have now to mention is Mercury  m the
 form  of fumes, for this, while it re-excites a heal-
 thy action  in these sores, as  the former do, it also
 cures them.  Nothing  that I am acquainted  with
 more  certainly and  speedily  controls an eating ve-
 nereal ulcer in the throat than the fumes of Mercu-
ry, and therefore what  I now propose to say  about
 them is of much  importance.  The great objec-
tion to Mercury in fumes used to be the trouble and
difficulty of useing it without its being known.   It
was necessary, for instance,, as  mentioned in page
 50, to procure a red  hot  heater,  which was placed
upon a brick; on this  red cinnabon was sprinkled,
 (from half a drachm  to a  drachm)  when  lumes
 v                      16 
242       Vsnereal,—In the Bones, $c.

would 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 fewconld avail themselves of this remedy—
excellent  as  it was.   Any contrivance therefore
calculated to secure so great a good without this trou-
ble and exposure must be of value. Now, this is per-
fectly secured in the simplest possible manner.  Just
add we'll say, four drachms of Cinnebar to one ounce
of melted  wax and make a candle of it with a com-
mon wick and 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
simplichy and contrivance  suggested, I  resolved 10
lose no time in applying  it to  practice.  I can  now
add that I have ever used it since with  the utmost
satisfaction and convenience.

   The fumigating candle therefore  is my favorite
application  to spreading  ulcers  in  the mouth,
and I find it  stops  their  progress and  remove*
their foul  appearance more quickly than any other
application.  A  drachm  of cinnaban at night, or
oight or morning, ismyusual 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 
          Venereal,—In the Bones, $c.      243

 upon the constitution.  There is no quicker way of
 inducing salivation than by the fumes of Mercury,
 used more freely than now directed.  It is not often
 used with this intention 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 accelerates its salutary action.

   The last remark  to make  upon this  subject is,
 that when the throat is brought into a healthy heal-
 ing state, the Mercury is to be continued for  the per-
 manent cure of the disease on the common principle.
 —The next consideration is,—

   Whether the sore  may not have lost its venereal
 nature and become Mercurial.—This is a question to
 be determined rather by the history of each individu-
 al case than any particular appearance of the sore it-
 self.  In fact there is not a single thing in the appear-
 ance of an ill-looking, foul, and spreading ulcer in the
 throat,which would authorize any one to say—this  is
 venereal—or, that is mercurial; it is altogether a mat-
 ter for good sense to decide, founded on an accurate
 knowledge and a due consideration of its history and
 of all that has passed concerning it, and even then
 it  may be mistaken.

   The first question to settle in every such  case of
ulcerated throat, is—whether the original sore really
was  venereal at alU   It may appear odd to put this 
244       Venereal,—In the Bones, $e.

question, but there is more good reason for it than may
at first be thought of.  It was clearly shown in the
ninth chapter of this little book, that other complaints
occur in the genital organs in some  respects resem-
bling venereal, but which have nothing at all of the
nature of this disorder in them ;  and, that a certain
class of people, either from ignorance or knavery, al-
ways call  whatever may occur upon these parts
venereal.  Now if  such  a case  is treated  with
Mercury in  a  decided and  proper manner, noth-
ing is  more likely than  that  the throat  should be-
come affected.   This immediately alarms the  par-
ties  and they conclude the disease  is getting in the
system, and that it demands a brisker use of Mer-
cury.  The eflect of this  however maybe easily
foreseen.  It is a fact that the worst cases of supposed
venereal ulceration of the throat I  have even  seen
have been in those who never had venereal at all.
They were instances of casual and innocent diseases
forwhich Mercury was not required, and with which
it disagreed.  It would be to swell this little book too
largely [already larger than at first intended] to ad-
 duce instances of this nature, of which I could give
 the most distressing kind.   In order to feel satisfied,
 that the original sore in any given case was really a ve-
 nereal one, then its first appearance and the first chan-
 ges it underwent should be a subject of enquiry and the
 more nearly this history should agree with that beauti-
 ful delineation of a venereal chancre given in  page
 140, the more you may feel satisfied it really was so. 
         Venereal,—In the Bones, cfc.        245

   But it may be that very little information can be
obtained,—its first appearance may be forgotten, or
may have been destroyed by caustic, or its natural
changes interrupted by some improper application.
In this case other  considerations should be availed
of—such as the manner in which Mercury had been
given,—the time which  had expired between the
original sore upon the  genitals,  and those in  the
throat,—and the co-existence of any other suspici-
ous symptom, as blotches and eruptions on the skin,
all  of which have been  mentioned more particular
in chapter the fourteenth;—these Avill afford  much
help in any doubtful case.

  Of all the considerations  however which  afford
a just and  satisfactory ground of suspicion that a
spreading ulcer in the throat is not venereal, but mer-
curial, the change it may have undergone, while un-
der the effect of Mercury, is the best. If, for instance,
under Mercury,  an ulcer in the throat had been for
sometime doing ordinarily well, and, especially, if a
kindly salivation  had been  instituted,  and  then,
without apparent cause,  it should suddenly become
foul and spreading, it would afford just reason to sus-
pect it was no longer a venereal, but a mercurial sore;
—at any rate a continuance of the same plan would
in all probability endanger any bony structure near
the part.  The Mercury therefore should be immedi-
ately discontinued, and the use of those remedies we
have  seen  so useful in restoring a healthy action to 
246       Venereal,—In the Bones, $c.

spreading ulcerations, viz: the. sarsapariUa and the
bark, be substituted.

  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 upwards in the nose, or without such ap-
parent spreading, when  a pain or uneasiness refer-
ed to  the upper and inner part of the nose, accom-
panied by an occasional discharge of mucus tinged
with blood, are present and complained of—occurr-
ing 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 parti itself—viz: the  cinnabar in  fumes.   Of
course these should be  drawn in by  the nose in-
stead  of the mouth.

  But beside these causes viz,—spreading ulcera-
tion of the throat and roof of the mouth, and ulceration
beginning about  the angle of the nose and upper lip,
—a venereal 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. 
          Venereal,—In the Bones, e}c.        247

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 hav-
ing had venereal, feels a little scabby sore in the
nose, which being picked away is followed by a lit'
tie bloody mucus.   This in a day or two will form
again, and upon removing  it will again be follow-
ed 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  fumigations should cer-
tainly be had resource to, for these will not only ex-
pedite 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, pel-
licular of  those in the nose.

  Whenever any  kind  of ulceration of the bones
take place, its healing or  curative process is a slow
one ;—the diseased part must be separated from the
sound, and the process by which this is effected is
termed exfoliation.—Now, we will suppose acourse
of Mercury has been  well  managed in  a case of
venereal ulceration of the  bones  of the nose, and
that the disease is  cured,—the Mercury discontin-
ued, and the general health, if perchance it had been 
248       Venereal,—In the Bones, $c.

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 woud 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 per-
sued so surely would it be repented of most bitterly.
The uneasiness in the nose and the  offensive  dis-
charge attending, is nothing more than the necessa-
ry consequence of the separation, or  exfoliation of
the disordered portion of the bone of  the old disor-
der—that disorder being cured. Now, afresh recourse
to Mercury in this case would only have the effect
of renewing the inflammation of  the bone and pro-
ducing  a fresh exfoliating process.   Let this  re-
mark therefore serve   to guard against so great an
error.   Whenever  such uneasiness  and discharge
occurs  (a judicious  and sufficient course of Mer-
cury having  been  completed) it is  to be  treated,
not as venereal, requiring the  further use of Mer-
cury, but as a necessary process in consequence of
past disease.   The'means to have recourse to, if in-
deed any are  required at all,  are those adapted to
support the constitution—of which the sarsapariUa,
and the regulation of the digestive organs,—toge-
ther with  change  of air,  are  the most  important.
 These however are not often needed: only  let it be
remembered that Mercury is not to be repeated. 
Venereal,—Tte Effects Upon Posterity, $c. 249
               CHAPTER XVII.

     On the effects of Venereal Disease upon
                  Posterity, cj-c.

   The proper questions in this chapter are—in what
manner does a lurking venereal taint affect posterity;
—under what circumstances would it be a reasonable
thing to suspect the existence of such a cause;—and
what are the means of removing it.  With regard to
stricture,the result of a badly treated Gonnorrhoea, as
a cause of importance, I  have noticed in another
place.

   In  the  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: that of enfeeb-
ling and destroying the power  of propagation alto-
gether.  In this edition, however, I intend to confine
myself to facts, and those which shall rest on the au-
thority  of others rather than my own,—venturing
only to suggest those inferences what seem natural-
ly and unavoidably to follow.

  In the first place then, I would observe, that but few
persons can have had much practice in midwifery
without having met with many instances of women 
250  Venereal,—Its Effects Upon Posterity, §c.

who have never gone their time; or,  having com-
pleted the full period, have given birth to children
which  have always, 01 very shortly afterwards, died
—so that in both cases they were childless women.

  In the former instance, the  infant thus prema-
turely  born has presented proofs  that  it had died
some days before 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.  Beat-
ty was an eminent, learned, 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 8th month of heir
pregnancy, which,  she told me, had been the case
with several  children that she had had  before, and
that she  despaired of ever having living issue.  I
enquired very particular into  the state of health of  «
both parents, and suspecting venereal taint  to  be
the cause, 1 proposed to them the use of mercury,
and  separate  beds,  until I should be satisfied with
the quantity  of mercury used.  They readily com-
plied with the proposal, and the result was a  living
boy in due  time, after  the  mercury had been dis-
continued ; and their happiness at the event may be
more readily  supposed than described, as they were 
  Venereal,—Its Effects Upon Posterity, $c. 251

 both at the time pretty  far advanced in  life, and
 never had another child."

   " I delivered the  wife of a  cavalry  officer of a
 putrid child in the 5th month.  The gentleman had
 been on the  continent with  his  regiment  without
 his wife, and had contracted a slight venereal com-
 plaint, of which his  surgeon 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 appearances on the body, that  I recom-
 mended him  to consult some eminent surgeon ; and
 Mr.  Todd was called in, who saw the regimental
 surgeon with me, and advised the use of mercury,
 which was regularly presevered in by both for seve-
 ral weeks.  After this course pregnancy was  soon
 the  resu't, and I had the gratification  of attending
 her, when she had  a  living girl.  She has had,sev-
 eral living children since."

  " In April  1818  I  attended a  very  fine  hearty
 looking woman,  of her first child, which was born
 in the 8th month, dead and putrid.   This, I hoped,
was  from some accidental cause, particularly as she
said  she had  received a fright some  time  before.
However, in June 1819, she again lay-in, in the 8th
month, of a dead venereal child; and I recommend-
ed that she should  see some surgeon, as her hus-
band now confessed he had been  disordered before 
252  Venereal,—Its Effects Upon Posterity, $c.

marriage.  Mr. Todd saw her, and took both under
his care until he was satisfied with the use of mer-
cury.  She lay-in,  in  September 1820, of a living
boy."

  Now the inference from all this, and which I take
it every rational being will agree to, is the follow-
ing;— That venereal disease, not properly cured,
may lie so dominant 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 pur-
sue.  Would he not peruse 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  evil lies.)
T he 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 con-
clude it arose  from some other   cause.  But if he
ever had had the venereal, no matter how long ago,
he would most 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 opinion  on this matter.)
Then the question, as to whose  care he  had been
under,  would naturally occupy his mind;—that is. 
Venereal,—Tte Effects Upon Posterity,cfc.  253
whether he had fallen into the hands of a boasting,
knavish empirick, 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  escapes its deadly  influence  Reflecting on
these circmstances then,  he would soon  determine
whether he had just ground to  suspect himself to
be the cause of these  serious  events,  and if this
should be the case, he wrould next enquire if there
were any means of cure. This question however
may be answered with the most gratifying confidence
—there are;—and they are of a nature too, consider-
ing the importance of the  object, of no extraordinary
severity or inconvenience.

  The means of cuie 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 continued for a somewhat longer time.
There are however  a few things to mention with
regard to Mercuiy in this case which are very im-
portant.  One of the most singular is, that Mercury
will  not cure the disease in a female while she is
pregnant. It will keep in check and remove apparent
symptoms, but  after confinement these will appear
afresh, and then it is, that if a proper course of Mer-
cury is entered on, it wiU finally'and perfectly cur«
the disorder once for all.   During pregnancy, there-
fore, Mercury never should be giveD, except oooa- 
254  Venereal.—/to Effects Upon Posterity, $c.

sionally and in smaller doses^—it should be reserved
until after confinement.  In cases where every thing
is doing well, in about ten or twelve days the Mer-
cury may be commenced.  For the reason just stat-
ed during this course the husband and wife must
rigidly observe a state or separation.  Having stat-
ed the fact out of which this necessity arises, it is
hardly needful to enforce the  observance of it by any
kind of argument.

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

  These things being premised, a course of Mercu-
ry, according to the rules laid doAvn for the cure of
chancre, but  continued for two or three weeks
longer, may be entered on  with the greatest con-
fidence of success.  The little chest of  medicine
which accompanies this book  contains  enough for
any two individuals, as well as the restorative ape-
rient medicine if the constitution should in anyway
be disordered by  the Mercury.

   Perhaps it will not be unnecessary here to give 
  Venereal,—Its Effects Upon Posterity, cfc 255

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 con-
finement.  It was Jhen 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 trme
however I was sent for, as labor pains came on, and
in a few hours she was delivered of a putrid mass,
scarcely in the form  of a child.  But she did well.
A few days afterwards I ventured to  ask the hus-
band if he  ever had the venereal  disease, to which
he said he had, but it was many months before his
marriage.  Then I  enquired  into the  manner in
which he had  taken Mercury and found it was far
from  being satisfactory.  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
healthy thriving boy.

  But another  effect of venereal  taint is  shown
upon  infants born  at  the full  time and  living.
Here additional information is required, both  as to
the symptoms which indicate the disease, and the
the means required to cure it. 
256  Venereal,—Its Effects  Upon-Posterity, $c.

  In some instances infants born under these cir-
cumstances indicate the disease by a weak and im-
poverished condition, together with  copper-colored
blotches  about  the fundament and genitals, which
soon spread to other parts of  the body.  The'*']:6"
culiar copper-colored  blotches, especially  occuring
in these parts, are considered  almost  unequivocally
as marks of venereal disease.  The countenance of
such infants have also a peculiar appearance,—it is
a resemblance of extreme old age.

  It still more generally happens, however, that in-
fants 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 develope  the fullermarks and unequivo-
cal symptoms of the disease by slow degrees. These
symptoms Dr.  Colles observes,  begin "in a period
varying from six or 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 
   Venereal,—Its Effects Upon Posterity, cfc. 25T

 other symptoms appear, as sore  eyes, swelling  of
 glands, &c. &c.   But we must not suppose aU these
 symptoms occur together in every case,—sometimes
 but few of them appear, the most common of which
 are, the coppex-colored blotches about the fundament
 and adjoining parts—generally followed by some
 appearances in the throat and mouth.   Neither, in-
 deed, must it be thought that in  every instance in
 which these or similar  symptoms occur, that they
 are venereal, for some  of them may be the conse-
 quence 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 judgment, 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 some 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 attested 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
together, without giving the child any medicine at
all.  In this case no doubt the infant is  cured by
the effects  of Mercury conveyed to it  by the milk.
It used  to  be  the fashion, particulariv when the
                       17 
258 Venereal,—-Its Effect Upon Posterity, cfc.

state of the mother's health, did  not allow of suck-
ing, 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 therrfore it is de-
termined on  to give the infant  Mercury, I know of
nothing better for this purpose than the specific pills
contained  in  my private chest.  • One  of them may
be broken  down into a powder, and to an infant a
week old,  one half a pill, mixed with syrup, may  be
given night and inorning.   The same attention  to
its effects  are necessary, as in adults.  If it  should
purge, this should be  checked with a Utile mixture
made of,—twenty grains of chalk, one drop of lauda-
num," and  a little syrup;—one quarter part of which
may be given  every third  or fourth  hour  till the *
bowels are relieved and easy.  And,  in  like man-
ner as in  adults,  if the breath should become  of-
fensive, and the gums sore and ulcerated, the Mer-
eureal  medicine  should be omitted  for a time at
least.

   If, however, the specific pill could not be  obtain-
ed, then a preparation of Mercury known  by the
name  of  " Creta cum Hydrargyro"—to  be  obtain-
ed at any Apothecary's store, should be substituted,
—two  grains and a  half  of  this  powder night
and  morning.  Others give blue  pill,  of which a 
   Venereal,—Its Effects Upon Posterity, $c. 259

  grain  or  a grain  and a half may  be given every
  night.

    Without a doubt therefore it seems an uncured ve-
  nereal disease has a fatal effect upon posterity;—it
  either destroys the infant before its maturity of birth ;
  or more gradually unfolds its nature in the living child.
  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 to say, farther, however, than
 as a matter of opinion, for  I think it does.  There
 are many other curious circumstances 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
 as well as curious,  I have  mentioned, of which I
 think none can  present  a deeper interest that the
 fact,—that venereal disorder, if not properly cured,
 may lie so  dormant and unsuspected in the con- .
 stitution as to show  itself in no other way than in
 its fatal, or miserable effects upon posterity, if it
 do not even destroy  the  procreating faculty  alto-
gether. 
K		%v		&5K*5t