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Venereal  and  Urinary
DISEASES
—BY—
    TEMPLE S. HOYNE, A. M., M. D.,

Clinical Professor of Skin and Venereal Diseases in Hering Medical
         College and Hospital of Chicago.
SECOND  EDITION.
  Revised and Enlarged.
    HALSEY BROTHERS,
CiIIOA.S-0, DETROIT AND B-U-:F,:F'.A-X_0.

    JOHN MORRIS COMPANY, PR1NTER8, CHICAGO.

           1894. 
\
Entered according to Act of Congress in the year 1883, by
            T. S. Hoyne, A. M„ M. D.,
      In the office of the Librarian of Congress.

                  Copyright, 1893. 
PREFACE  TO  FIRST   EDITION.

    At the urgent  request of  members  of the College classes of
1881 and '82, and 1882 and '83, I have consented to the publication of
the following pages, which were prepared for my lectures on venereal
diseases.   As the time devoted to this branch of study in  the Col-
lege curriculum is  necessarily short, the lectures were arranged with
the idea  of presenting  the whole subject in as brief a manner as
possible;  hence, long discussions on many disputed points are en-
tirely  omitted.  The student  and practitioner will, I hope, find that
while  I have condensed  as much as possible all that is said on the
subject, that I have not  thereby failed to  give  a clear exposition of
the different affections mentioned.
    It may be proper to  state that I still hold the opinion that there
is but one  kind of syphilitic virus, producing in the one case a hard
chancre, and in the other a soft  chancre, and that both these eores
may be followed by secondary symptoms.
    At the request  of my publishers, who  claim that a slight resume
of the remedies suitable  for urinary disorders is greatly needed,  I
have added the last few pages.
                                              T. S. Hoyne.
    1634 Wabash Avenue, Chicago. 
 
    Preface  to  Second Edition.

   The first edition of Venereal and Urinary Diseases has been out
of print for a number of years, and it is only after repeated demands
from students and physicians that I have carefully revised the volume
and furnished the publishers with the sheets.
   Many changes and additions have been made in the text, a chapter
upon gleet inserted,  and the symptoms of the various affections of the
kidney added.
   It is hoped that the profession will accord the present edition as
favorable a reception as the former.
                                          T. S. Hoyne.
   1833 Indiana Avenue, Chicago. 
 
Venereal Diseases. 
 
VENEREAL  DISEASES.
    Venereal disease is a term U6ed to denote affections arising primarily
 from sexual intercourse.  The word venereal comes from the Latin word
 veneris, meaning that which relates to pleasure.  In a more  restricted
 Bense, however, the word  is considered synonymous with syphilis or
 syphilitic.  Some writers have proposed that  those diseases should be
 called venereal which are produced by excesses in venery, and that the
 term  syphilitic should be applied to those which are the result of impure
 connection.  The custom is to include under the head of venereal all
 affections arising from sexual intercourse, hence the  terms venereal and
 syphilitic are generally used as synonyms.
    The venereal diseases  are two, viz.: gonorrhoea and syphilis.  The
 etymology  of syphilis is unknown. It may be derived from djuS, a hog,
 and q>i\so, I love, or from duv, with,and <pi\eo, I love; or fromtfzipaAoS,
 a reproach, etc.  It was supposed  by Hunter and other eminent writers
 that all specific diseases arising from sexual intercourse were due to the
 same poison which affected different individuals in various ways. These
 views were, however, incorrect.
    Syphilis, in  brief, is  a  specific, infectious  disease, acquired only by
 inheritance, or due in the majority of cases to sexual intercourse, and is
 communicable by coition, or by the contact of parts that are abraded, or
 are only lined with a thin epidermis, as the lips, nipples, etc., and is char-
 acterized by periods of eruption and periods of repose  of variable dura-
 tion.  In fact,  the  disease may at any time be communicated by the
 contact of  a  sound  with the  secretion from a diseased surface.  It is
 essentially a contagious, virulent disease, of quite regular course, suscepti-
 ble of  cure,  but liable  to  become an heir-loom in the  family, and be
 transmitted to the offspring.  It manifests itself in a variety of ways, not
 always as a special affection, but impresses a peculiar form on all inflam-
 matory diseases which it  induces.   The earlier symptoms are, as a rule,
 superficial, the later ones visceral.
    The definition just given is incomplete, but is the best that can be
 given without a thorough  classification of all its phases.  As a rule, it
attacks a person but  once, although there  are  numerous exceptions on
record.  A  subsequent attack is usually much lighter.  Syphilis always
                                 13 
14
ORIGIN  OF SYPHILIS.
makes its first appearance in the form of a chancre, followed sooner or
later  by a bubo, and perhaps  by secondary or so-called  constitutional
symptoms.
    The origin of syphilis is enveloped in great uncertainty. It was for-
merly claimed that the disease was introduced into Europe  from America
by Columbus at the end of the fifteenth century, and many  hold this
opinion at the present day, notwithstanding the fact that a Chinese writer
who lived 2637 years before Christ described two kinds of  chancres, and
gave a full description of the secondary stage. In ancient Hindoo, Arabic,
Greek and  Latin  literature similar  descriptions are found. While the
Bible does  not anywhere give an accurate description of syphilis, we find
numerous references to it, e. g., King David complained of sharp pains
in his bones.   We are satisfied that the  disease is not a modern one, and
certainly do not as Americans wish  to claim the honor (?) of inventors.
It is more than probable than in ancient times leprosy and  syphilis were
confounded, as the former was  said to  have frequently followed sexual
intercourse, and hence in the  Bible and elsewhere many symptoms occa-
sioned by the latter were attributed to the former affection.
    The progress of syphilis is extremely variable, as well as its duration,
being unlimited if not treated skillfully and continuously. But of this
we shall speak later.
    Nearly all authorities ag;ee that syphilis is  growing milder as the
ages roll by.   It is still a disease difficult to eradicate, chronic  in its na-
ture, but far less horrible than it was in the past,.  Death results in only
a minority  of cases under the benign treatment of the present age.
    The only proper way to study the disease is at the bedside, or face to
face, where every little symptom that goes to make up its history can be
carefully weighed and compared.  No  two cases will be found  exactly
alike  in every particular, but all will present a  striking similarity.  You
will find a great many obstacles in the road, even when the patient is de-
sirous of a cure.  The  diagnosis is not always clear, especially when
complicated with  other affections; the chancre  may not be in sight, but
concealed within  the urethra; congenital phymosis may  obstruct  your
vision; the  patient may be ignorant and  unintentionally deceive you, de-
nying the existence of a primary sore which was so insignificant that' he
thought it of no consequence, or considered it merely an abrasion, or he
may shamefully lie to you, thus endeavoring to shield himself from all
culpability. In the  secondary stage it  is not uncommon for patients to
deny having had a chancre or primary sore; in chancre about the mouth
or secondary ulcerations, when the origin is due to contact  of the mouth
with the genital organs, seldom  is the truth obtained from the patient-
neither is it when sodomy has been  committed.  But by carefully ques-
tioning and cross-examining, the physician will finally arrive at the true
state of the case. 
THE THREE  STAGES.
15
    The  disease  generally commences in the genital organs, as sexual
intercourse is  by far the most common cause, and shows itself in the
form of a sore of a specific character, and if not immediately arrested,
which is not always possible, it  invades the lymphatic ganglions of the
groin, next the skin and mucous membranes, and  lastly, the bones, car-
tilages and fibrous tissues.  It should not be inferred from  this  that all
of these parts are affected at one and the same time, for it is not so (with
few exceptions); the essential poison upon which the infection depends
lies dormant, so to speak, for a certain length of time, say from four to
six weeks, in the tissues in which it has been deposited, limiting its pois-
onous influences strictly to the genital organs, and sometimes to the lym-
phatic ganglions of the groin.  If the  disease is not arrested in this the
first stage, in about a month or six weeks, the skin and mucous mem-
branes are affected, as we stated a moment ago, and if still unarrested, in
from  five to eighteen months, we find the  bones, cartilages and fibrous
tissues diseased.
    For  convenience  of  description, syphilis, the  progress of which is
regular, is  divided into three stages, viz.:  primary, secondary and terti-
ary.   There is also another division called the  period of  incubation; for
example, when  the syphilitic  poison has  been innoculated,  or  been
placed in contact with a surface capable of absorption,  it  gives no evi-
dence of its presence for several days,  and  then shows itself  by indura-
tion at the point of innoculation.  A similar period of incubation is com-
mon in all contagious diseases which involve the purity of the blood.
    By primary syphilis we understand  that  period during which the
poison is limited in its action to the genital organs, or to any healthy sur-
face to which it  has been brought in  contact, manifesting itself in the
form  of  sores and ulcers, called chancres, no matter where they occur.
Lymphangitis and adenitis may also be present.  By secondary, that the
mucous and cutaneous surfaces are affected, only, however, after primary
has been known to exist; and  by tertiary, that the  bones, cartilages,
fibrous tissues and  internal  organs are implicated.  Some authors have
divided  the  disease  according to time,  everything  appearing  under
six months  being considered secondary, and every symptom after  that
time tertiary.
    The  three stages  are usually separated by pauses of greater or less
duration, but not invariably, for occasionally patients exhibit signs of all
three simultaneously, the stages following one another  in very rapid suc-
cession.  If syphilis is not arrested in the primary stage by proper treat-
ment, which may destroy the  syphilitic diathesis, the  symptoms always
follow in the same order, never skipping any stage, as it was at one time
supposed possible by Ricord.
    It is definitely settled that syphilis never arises spontaneously, but is
always the result  of innoculation with a peculiar  poison known as the 
16
IS  SYPHILIS  HUE TO A  MICROBE.
 poison of syphilis or chancre.  It never exists without chancre, or a lesion
 of some sort at the point of entry of the poison, except when hereditary.
 This  primary sore may exist in  some  unusual situation, where its pres-
 ence  remains undetected and unsuspected as the anus, buccal cavity,
 etc.   Of the precise nature of this poison we are wofully ignorant; we
 only know it by its effects on the system.   It should be stated, however,
 that Klebs and others suppose that they have discovered what it is, and
 are now at work  trying to demonstrate that it is  due  to a spore  in the
 blood.
    Even at the  present time (1893) the results of  laboratory investiga-
 tions are very contradictory, although physicians pretty generally believe
 that syphilis is due to the presence of  a specific  microbe found in hard
 chancres, but  not in those of a soft variety.  The poison, when brought
 in contact with a healthy surface, invariably gives rise to a disease  sim-
 ilar to itself, the resulting sore or ulcer yielding a virus  in every respect
 identical with that which produced it.   The virus reproduces and multi-
 plies  itself by a  process of zymosis or fermentation; hence  syphilis is
 similar to other zymotic diseases—affections produced by a morbific prin-
 ciple acting on the organism like a ferment,  The gravity of the  symp-
 toms is not in  proportion to the amount of virus absorbed, for the small-
 est inconceivable atom, perhaps  the  third  potency, when  brought in
 contact  with an appropriate surface, is sufficient to fully develop a dis-
 ease, which, if unarrested, may give rise to fearful results both local and
 constitutional, leaving a peculiar and distinctive  impression upon all the
 organs and tissues affected, and  often  affecting  the solids and fluids so
 that the disease is transmissible  from parent to child.
    The pus from a chancre or other sore, containing the syphilitic virus,
 even when subjected to the most rigorous analysis, does  not exhibit in its
 chemical, physical or microscopical characters, any differences from other
 pus, and may  possess all the  characteristics of what is termed healthy
 pus.  (At one time it was claimed that a vegetable parasite had been dis-
 covered in the secretion.)  Neither does  the blood, subjected  to the
 same  rigorous test, present  anything which  may be termed diagnostic
 (unless Klebs' reported discoveries are  true), although we know that if it
 is innoculated it will produce syphilis.   It is claimed that the syphilitic
virus may be preserved in a well corked vial, in a moderate temperature,
 for a number of weeks, without losing  its poisonous character, or infec-
ting properties.  Cases are on record in which it has been thus preserved
for a  number of months without any loss  of virility.   Its poisonous
quality can be destroyed by acids and  other  agents, or  by  altering its
chemical constitution by excessive heat, and it is rendered inert by gan-
grene of the surface to which it is applied.  Cold destroys the  gonorrheal
poison, but  not the  syphilitic virus, which  may be  frozen and again 
SYPHILIS  AFFECTS  ALL RACES.            17
thawed without losing its infecting properties.   Could this be true if the
disease was caused by a microbe?
    All races, ages, temperaments and both sexes are equally liable to be
affected by it.  It is no respecter of persons; rich and poor are both alike
subjected to its ravages if brought in contact with it.  It is more severe
in coid than  in temperate climates, and always more severe in hot or cold
climates in those who are not acclimated or are foreigners.  When  the
affection first makes its appearance in a community, its progress is more
rapid and the cases more severe in persons of enfeebled constitution or
in those of a scrofulous diathesis.  As regards race we should perhaps
make one exception in  modern times, and that is the Jews, who are rarely
affected with syphilis.  Out of a vast number of cases, we have seen  but
two who were afflicted. The reason of this comparative exemption is, we
believe, due to the fact that the foreskin being gone, there is less chance
for the retention of the virus upon the exposed parts; and  furthermore
the penis, especially the head and anterior portion of the skin, becomes
hardened and toughened, thus rendering the circumcized ones less liable
to an abrasion of the parts.
    Syphilis produces its  peculiar impression  most readily  when  the
virus is applied to a clean, ulcerated surface, an abrasion or a recent
wound; but innoculation frequently takes  place in other ways,  it simply
being necessary that the poison  should be retained or kept in  contact
with a part until its structure is brought thoroughly under its influence.
When the virus of chancre  is applied to a 60und  external integument,
which has become hardened by constant exposure to the air, it  is gener-
ally innocuous.  If, however, the syphilitic virus is applied to a perfectly
healthy part not so  hardened, several days usually elapse before it is
absorbed or gives any evidence of its presence, because it has first to act
as a common irritant corroding the surface, or  it  may  be wiped off or
otherwise destroyed before this occurs. • It has been noticed that women,
unconsciously, frequently give syphilis in this  way without themselves
being affected. For instance, they have sexual intercourse with a person
affected  with chancre, the pus of which may lodge in a fold of the
mucous membrane of the vagina, and then, without washing, they repeat
the act with another comer who takes up  the deposited virus.   Thus a
woman is often merely a carrier of the disease.   However, they  are not
the only ones who thus carry it, for there is a case on record in which a
man having seen his mistress the early part of the night, and his wife the
latter part, carried on the prepuce the syphilitic virus from the former to
the latter.   Ricord  says: "Venereal diseases would be less frequent if
women were more cleanly," and we may add to  this that  they  would be
still less frequent if men were less intemperate.
    The syphilitic virus is  communicated in a number  of ways, not, as
was believed in the fifteenth century,  by  the breath of  the invalid, by 
18
THE WAYS OF COMMUNICATION.
 means of the air which surrounded him, by the perspiration, through the
 medium of holy water (which is not impossible), and in numerous other
 ways;  but (1) by sexual intercourse, which is by far the  most common;
 (2) by unuatural connection, giving rise to chancre of the  anus and peri-
 neum; (3) by sucking the genital organs, as in circumcision, or as a crime,
 giving rise to chancres in the mouth, or upon the tongue  or cheeks; (4)
 by vaccination (this is denied by many, but a sufficient number of cases
 are recorded to establish the truth of this method of communication); (5j
 by towels, spoons, forks, pipes,  tumblers, children's toys, pens, pencils,
 bank-notes,cigars and other articles; (6) by chamber vessels and water-
closets; (7) by surgical instruments, sponges and dressings; (8) by kissing
 (9) by nursing syphilitic children; (10) by the fingers of the affected indi-
 vidual.   An affected individual  may by means of the fingers  innoculate
 his eyes, lips, nose or any abraded, raw or open surface upon any portion
of his body.  Physicians occasionally innoculate themselves in this  way
 from their fingers, after examining women during labor, or those affected
 with chancre of the vulva, vagina or uterus.  There must  be an abraded
 surface, however.  We recall to mind a case where a man was  bitten on
the nose  in a street fight by a syphilitic person, and a chancre occurred
 at the site of the injury in about a week.  Dentists  sometimes contract
the disease from examining patients with mucous patches in the mouth.
    The length  of time the syphilitic virus remains in contact with a  part
 before it begins to act is still an open question, as in some cases a chan-
 cre is found within twenty-four hours, and, in othercases,  not for a num-
 ber of days or even weeks, one  instance being reported by  Fournier
 where the incubation lasted seventy-five days. The average time is from
 five to ten days.   It is undoubtedly true that the virus acts immediately,
 but with greater or  less rapidity according to the  susceptibility of the
 patient; the greatest  rapidity  usually being observed  in persons of a
 scrofulous diathesis. 
PRIMARY   SYPHILIS.
     Primary syphilis is usually considered strictly a local disease, con-
 sisting  of a  chancre  (something which  eats) or ulcer  of  the  genital
 organs, with  or without a bubo, or swelling of the lymphatic ganglions
 of the groin,  sometimes ending in suppuration and other bad effects; we,
 however, consider it a constitutional disease from  the start, and look
 upon the chancre simply as the  local manifestation of the disorder.  If
 we take a small quantity of virus and insert it with a lancet just below
.the epidermis, at the end of the first day we shall see a little red speck,
 such as might follow any puncture of the skin. The part is slightly in-
 flamed, hot, red and itchy.  The  following day a minute papule will be
 noticed, which changes into a vesicle about  the  fourth day, and is sur-
 rounded by an areola of a deep red hue.   The next change is to that of a
 pustule on the fifth day, the pustule resembling that seen in small-pox,
 with the umbilicated appearance, and the distinctive areola.  Now the
 structures about the  pustule become hard from  the deposit of plastic
 matter, and when pressed  between the fingers feel like a mass of fibro-
 cartilage.  On the sixth day, at the time the  induration just described
 occurs, the sore becomes possessed of the requisite  properties for sup-
 plying  infecting matter.    The  pustule  now turns dark, its contents
 solidify, and  a small, round but thick scab forms, having the shape of a
 truncated cone.  If we remove the  scab, we shall find  a circular and
 depressed ulcer, which looks as if it had been scooped out with a punch.
 The edges are steep and slightly ragged, the base firm and hard, and its
 bottom covered with  a layer of grayish lymph.  The discharge is  thin,
 sanious or  ichorous.   This ulcer has received various names, viz., the
 infecting chancre, the indurated chancre, the Hunterian chancre.
    The main points  to be remembered are that the disease  commences
with a papule, becomes a  vesicle, then  a pustule  followed by  an ex-
cavated  ulcer, with a  hardened base, covered with pus which is capable
of contaminating the  fluids or solids  of the body.
    A chancre may appear upon any part of the body, although it gener-
ally occurs on the head of the penis, the fra'num,  the prepuce, the four-
chette, the clitoris, the  vulva, vagina or uterus,  these parts being the
ones most exposed to the contagion.  Sometimes, but not  very often, the
urethra is attacked; and in other cases, chancres are met with at the mar-
                                19 
20
SITE  OF THE SORE.
gin of the meatus.  It fact, any portion of the genital organs or other
parts of the body may be the site of the sore,  from the  presence of an
abrasion or scratch of a pin, although it most frequently appears on the
corona or frcenum,  because the construction  of these parts is such that
the poison is more  really retained until absorbed.  In the female chan-
cre is more frequent on the vulva, although the perineum is occasionally
attacked.  From the scratching of pins and buttons the abdomen is some-
times the seat of the disease.
    Arthur Cooper remarks that  the "primary  sore on the face, fingers,
etc., may be very unlike the characteristic hard  chancre on the  penis,
and the accompanying bubo is not uncommonly attended with marked
inflammatory symptoms, hence mistakes  in  diagnosis."   We have seen
quite a number of cases of chancre of the lip which were mistaken for
other diseases.
    There are no general or local symptoms that usher in the disease,
with the exception of some heat,  itching and  increased sensibility of the
part which has become innoculated.  If the virus of a chancre is depos-
ited on an abraded  surface, it should be  remembered that the  primary
sore commences as an ulcer, and  does not necessarily pass through the
stages described a moment ago, and  the progress of the disease is more
rapid than if otherwise absorbed. When  the virus has been absorbed
into the orifice of a mucuous follicle, the disease commences with a boil
or abscess.  A follicular chancre  (i. e., one commencing in a follicle and
appearing like an acne pustule) is more frequent in women than in men,
and is usually observed on the labia majora as  a small rounded ulcera-
tion, with a hair passing through it, and is depressed in the center with
slightly elevated edges.   The discharge is purulent and copious.
    The patient does not usually present himself during the vesicular
or  pustular stage  of incipient chancre,  and • the  physician only sees
him when the sore possesses all the characters  of a well  defined chan-
cre, and thus we are  unable to say how long it has existed.  The early
commencement of a chancre is  so  insidious,  that it often passes un-
noticed, and it is  only when an ulcer exists  that remedial measures
are sought, or it  may  be  so  insignificant that  the patient  thinks
it of no importance, and it is only by accident  that it  is  seen,  if at all.
Surgeons have  divided chancre into two varieties, the indurated or hard
(also called the infecting chancre and the true chancre), and  the non-
indurated or soft (sometimes called chancroid or  chancrelle), both de-
pendent on the same poison, but modified or aggravated according to
some  unknown, or local or constitutional  cause.   There  is always  a
period of incubation, but it is extremely variable in both—one day being
the shortest time and seventy-two days the longest.  The  average time is
from five to ten days.  Why the  syphilitic virus should produce  an in-
durated chancre in one case and a soft in another is not known, but it is 
HARD AND SOFT CHANCRE.
21
supposed that this virus acts as other poisons, with very different effects
on different constitutions.  Bumstead  states that a " soft chancre trans-
mits either a chancroid or a  syphilitic (hard) chancre, according to its
origin.  If it was derived from a chancroid, its innoculation will occasion
a chancroid; if it was produced by the syphilitic virus, it will give rise to
the initial lesion of syphilis."  But  we should have stated that Ricord)
Bumstead and others maintain that there are two kinds of syphilitic poi-
son, one giving  rise to the true (hard) chancre,  which is followed by
secondary or tertiary symptoms, and, the other giving rise  to chancroids
(soft chancre), a  merely local trouble, often troublesome and persistent,
but never  followed  by secondary or tertiary syphilis.  If we accept the
conclusion of Bumstead given above,  we are always left in the dark as
regards the prognosis, unless we can  have brought  before  us the one
from whom it was contracted, and perhaps five or six  others before the
last.  The  fact is, two persons affected from the same  source do not nec-
essarily have the  same type of chancre, although the}'  acquire the same
poison, and as yet we have no  rational solution of the problem.   The
whole subject of primary syphilis is at yet improperly understood, although
the so-called dualists explain or attempt to explain the occurrence of hard
and soft chancres contracted from the same identical sore, on the theory
that some chancres are mixed sores  capable of communicating both vari-
eties.  The soft,  infecting chancre, it  is also claimed, is only or rarely
found in an individual not previously syphilitic.  Our own views are that
we have but one poison  and  that  may cause a hard or a soft chancre.
Hard chancre is sometimes contracted from the virus  of a soft chancre)
and vice versa, but this is exceptional, as chancres usually  reproduce
themselves in kind.  Soft  chancre is really a milder form of the disease.
It is  true  that hard  chancre is  more often followed by constitutional
symptoms, but there is plenty of proof that the soft chancre is also fol-
lowed by the same symptoms in quite a number of cases.   We only wish
that we could believe that the soft chancre  is not followed by constitu-
tional effects, for  it is much more frequent than hard chancre. The cases
we have presented in the clinic of Hahnemann Hospital have shown con-
clusively that  secondary  syphilis is not rare  after the soft  variety of
chancre.
    Sometimes patients are not aware of the presence  of  chancre at all
until  some other complaint induces them to visit a  physician, and he
then makes the discovery for them.   This is particularly true in the  case
of soft  chancre  when it commences  as an ecthymatous pustule, the
patient not supposing the  difficulty to  be anything more than  a slight
boil.  Should it commence, however, as an ulcer, then  his suspicions are
immediately aroused.
    The table below gives the differential diagnosis between hard and soft
chancre. 
22
DIFFERENTIAL  DIAGNOSIS.
              HARD.
   Shape, round, oval or a fissure;
 diameter of a 5 cent piece.
   Surface  hollow,  as if scooped
 out, and incrusted  with a layer of
 dirty-grayish colored lymph, firmly
 adherent.
   Edges are hard,  adherent, ele-
 vated and inclined  slopingly from
 within  outward.   Never under-
 mined.
   Adenitis  constant, multiple and
 indolent.
   Base  hard like a  mass of  fibro-
 cartilage. Induration begins about
 the fifth day, and increases up  to
 the tenth; the amount varies, being
 greatest on the head of  the  penis
and less on the prepuce; is  often
absent in females;   it lasts  even
after the chancre is cicatrized.
  Cicatrix,  round, honey-combed.
  Generally solitary, but not always
by any means.
  Situated upon the genitals, lips,
nipples or fingers.
  Does not spread.
  Pain absent.
  Areola distinct.
  Progress slow.
  Discharge thin, serous, sanguino-
lent or ichorous—not very free, and
difficult of innoculation.
  Bubo  accompanies generally, or
follows.
  Secondary and tertiary symptoms
are the result.
  Period of  incubation from seven
to twenty days.
  Complications rare.
              SOFT.
  Occasionally  round,  but   not
usually.
  Superficial, flat, uneven, covered
with a yellowish, grayish  or dirty
deposit.  Often  looks  as if worm-
eaten.
  Overhanging,  sloping  or shelv-
ing, ragged, painful.   When  the
sore is on the head of the penis, it
looks as if cut out with a punch.
  Not constant.

  Not  hard,  except  when  due  to
inflammation  or when  irritating
applications have been used, caus-
ing a plastic deposit.
  No special characters.
  Multiple as a rule; often as many
as six or eight, situated at the  free
margin of the prepuce.  May all
arise at once, or be  formed from
one by fresh innoculation.
  Anywhere.

  Spreads; often phagedenic.
  Present, but moderate.
  Has none.
  Rapid, but gets well slowly.
  Purulent and abundant,  easily
innoculated.

  Not generally.

  Also true, but not uniformly.

  Two or more days.

  Frequent. 
INFLAMMATORY CHANCRE.
23
    As regards the relative frequency of hard and  soft chancre, it has
been observed that in the lower classes the soft is much more  common,
probably four to one; while in the upper the indurated is  seen in three
cases out of four;  thus proving, what was stated a short time ago, that
intemperance, bad hygienic  surroundings and bad food  were  remote
causes for the soft variety of chancre.
    How long does a chancre retain its specific character? We know
that the contagious power is at its maximum during the stationary period
of the ulcer, and that this power gradually diminishes as  healing com-
mences, but the exact time at which it ceases to be contagious we do not
know.   Some authors believe that a chancre loses its infecting properties
in ten days, others in two weeks, and others not for many months, while
many maintain that it loses the infecting virus as soon as healthy granu-
lations are observed.  At any rate, it is safe to say that it may possess con-
tagious properties until it is completely cicatrized.
    Ricord states that one attack of hard chancre protects the individual
against a subsequent one, but as we have already stated proof is wanting
on this point. In fact, enough cases have already been reported to show
that it is not true.  It is not denied that the same individual can  repeat-
edly experience attacks of soft chancre.   Other varieties of chancre are
mentioned by authors, such as the inflammatory, phagedenic or ulcera-
tive, sloughing or gangrenous, diphtheritic, etc., etc., but there is really
no necessity  of such a division, as these are complications, strictly speak-
ing, of hard or soft chancre, dependent on want of cleanliness, frequent
sexual intercourse, bad treatment, bad sanitary surroundings,  alcoholic
drinks, the state of the general health, the season of  the year, too stimu-
lating or too  sparing diet, etc., etc.
    The worst chancres we are called upon to treat are found in the low-
est of the low, half-starved, drunken wretches, who have frequent inter-
course with persons  as vile as themselves.  Do not imagine from this,
however, that we never find bad cases among the rich, surrounded by
every luxury, and enjoying the best of health; syphilis is no respecter of
persons, and takes strange freaks at times.
    All chancres are inflammatory affections, hence  it  is only when an
excessive amount  of inflammation is present that we  are warranted in
pronouncing  it an inflammatory chancre.  This variety occurs in dirty,
intemperate or aged  persons or in  those who  are obliged to follow very
laborious occupations.  Another frequent cause is the  strangulation pro-
duced by phymosis, congenitial or accidental, and paraphymosis, which
increase the flood of  blood to  the part.  In this form of chancre there is
considerable pain and swelling of the parts involved, accompanied by an
increased discoloration, with more or less phlegmonous engorgement and
an unhealthy aspect of the ulcer, which discharges a copious thin ichor.
Erections  are usually present, the prepuce oedematous, and the whole 
24
GANGRENE.
penis greatly enlarged.  The inflammatory chancre  sometimes  follows
the too rapid administration of mercury or its compounds.
    Sometimes gangrene sets in, usually in  consequence of the confine-
ment of pus  under an elongated  prepuce, and  is  always a  serious
complication.    It  always follows  violent inflammation; and  mental
emotions, sexual indulgence, alcoholic  drinks, want of  cleanliness
and  intestinal  disorders are predisposing  causes.   Gangrene affects
usually the upper portion  of the prepuce, the slough  being limited to
the tissues surrounding the ulcer and is always accompanied by phymosis.
While affecting by preference the prepuce, it occasionally  attacks the
penis, or it may spread from one structure to the other, or  may attack
both simultaneously.  The  progress of gangrene is  more or less rapid,
and the  destruction of tissue  often very great—in bad  cases  destroying
the whole penis.  The  occurrence  of  gangrene, which occurs early in
the course of the chancre, is announced by a blackish spot, preceded and
accompanied by an  intense burning pain and increase of the other in-
flammatory phenomena. When the  chancre is concealed, we  recognize it
by the swelling, pain and fetid sanious discharge which is always present.
There is increased febrile action, with an accelerated and irritable pulse,
considerable thirst, loss of  appetite, constipation and restless sleep.  Gan-
grene, as we have already stated, destroys the syphilitic poison.
    Phagedena is a rare, but the most serious complication of chancre. It
is very similar to hospital gangrene and occurs, but not invariably, in those
whose constitutions  have  been  ruined by  mercury, intemperance, im-
proper  hygienic surroundings,  improper  and  insufficient  food and
other debilitating influences.  Sailors, prisoners, soldiers and inhabitants
of tenement houses are the victims of this terrible affliction.  The appli-
cation of ointments (greasy) predisposes the patient to this form of chan-
cre ;  so also does cold weather. Phagedena usually attacks the soft variety
of chancre, but not invariably.  When  present, the  sore extends rather
slowly, but continuously, eating and destroying the parts, both laterally
and  inferiorly.  Sometimes its ravages are very rapid, destroying in a
few hours a vast amount of tissue.  Its  favorite sites are the  gutter upon
the head of the penis and the under surface  of the penis at the side of the
iraenum.  If by chance the dorsal artery of the penis is in its way and
becomes corroded, a serious, if not fatal, hemorrhage takes place.  Occa-
sionally phagedena occurs as an endemic in crowded hospitals, where the
atmosphere is  unhealthy and foul.   Its duration is always prolonged and
is difficult of arrest.  It does not lessen the danger of constitutional in ■
fection,  as gangrene does, provided that  we accept the theory that pri-
mary syphilis is merely a local disease.
    An interesting form of chancre is the serpiginous or erosive, the sore
extending about, like a snake, in different directions, usually in circles
or half circles  and seemingly without limit.  Another peculiarity is that 
DIPHTHERITIC CHANCRE.
25
while one part of the ulcer is perhaps  cicatrizing  another portion  is
steadily advancing in an opposite direction.  Sometimes the sore  seems
to be arrested and nearly well when rapid ulcerationagain sets in.  We
find this variety, as a rule, in scrofulous persons, such as are predisposed
to phthisis,  scurvy  and chronic eruptions; such  as  have thin, delicate
skins,  which ulcerate from the  slightest injury. This  ulcer, though
usually of a superficial character, sometimes  penetrates deeply into the
tissues, and, as  it is  essentially of a chronic nature,  destroys a  great
amount of tissue before it can be checked. Its surface is uneven, covered
with a dirty, grayish lymph, with more or less ichorous fluid, and its
edges are thin, livid, ragged, steep and somewhat everted; often are so
extensively  undermined that  they can be turned back like a flap.  It
sometimes extends under the skin of the penis as far as the  abdomen,
leaving as it heals an indelible white scar.
    The French authors describe a diphtheritic chancre to be one which
is very sensitive to the touch, accompanied by a sharp, continuous pain,
and which is covered with a thick layer of glistening gray or  yellowish
white lymph, resembling leather.  It is very rare, occurs  only in persons
of debilitated  constitution, appears at any period of  the  ulceration and
always denotes an irritable and inflamed  condition of the parts. Nature
is unable to convert  this lymph into healthy  granulations, and hence it
is thrown off as of no further use.  The edges of the  ulcer bleed on the
slightest touch, and sometimes very profusely, almost amounting to a
hemorrhage.  Any attempt to detach this diphtheritic layer is also atten-
ded by hemorrhage.
    The diagnosis of  chancre is in the  majority of cases comparatively
easy, when we consider the period of incubation and the condition of the
base, and it is only occasionally that one is in doubt whether the ulcer
on the genitals or elsewhere  is or is not a chancre; but the  physician
may require considerable time to determine whether  he has the hard  or
soft variety to deal with.  The table given  a few pages back will aid greatly
if the sore is regular and uncomplicated.  The physician  should be very
cautious about pronouncing a positive opinion concerning the ulcer upon
the genitals, following a suspicious connection. Let him take time enough
to fully observe its  true character, and if necessary examine the person
from whom it was derived. If all other means of diagnosis fail, a small por-
tion  of the  suspected matter may be innoculated, which, if specific, will
soon show itself. Chancre is liable to be confounded with simple abrasions,
eczema, herpes, or balanitis.  Herpes is an eruption of groups of vesicles,
preceded  by fever and slight digestive  trouble.  The  vesicles are of a
whitish color,  about the size of a pin's head, and are seated on a red base
and attended by considerable itching, heat and pain.  They occur on the
head of the penis and prepuce a day or two after exposure.  When they
occur on the lips the diagnosis is more difficult and more time is required. 
26
PROGNOSIS AND TREATMENT.
Cleanliness and time  will soon  render a  positive diagnosis possible.
Innoculation will  produce  an ecthymatous pustule, if syphilitic.  In
eczema we find the vesicles still smaller, and greater irritation; the sur-
face constantly discharges a  thin,  watery fluid, which stains and  stiffens
linen.  The parts  are  swollen, red, hot and itchy.  The prepuce is the
site of the eruption.  In balanitis the discharge is profuse, thick and
muco-purulent, and the inflammation widely diffused. The history of the
case often affords the means of diagnosis.  Young or married men some-
times have abrasions accidentally  produced by excessive friction  during
coitus, by the action of irritating secretions or the entanglement of a hair,
and seek the physician for a diagnosis.  In such cases time must betaken
in order to determine whether the sore is of a specific nature or simple
in its character.  In all doubtful cases  carefully examine the  groins, for
bubo is rare in non-specific affections.
    As regards the prognosis, we may state, in general  terms, that hard
chancre is a mild disease, locally  considered, its danger  being due to its
after effects, as  shown in the secondary stage;  but it should be remem-
bered that secondary  symptoms do not always  follow,  even when the
chancre is left to itself.  If the patient is experiencing a second attack of
hard chancre the  symptoms  are very mild indeed unless phagedena is
present.  The duration of this sore is shorter than that of the other
variety.  The soft, on the other hand, is apt to be a serious affection,
owing to the complications usually present (gangrene, phimosis, phage-
dena, etc.) and the  extensive destruction of tissue.  Secondary symptoms
follow in a certain  proportion of cases.
    Having described chancre, it now remains to consider the  treatment.
The allopathic school usually employ nitrate  of  silver or some other
caustic in the first  instance, that is, if the chancre is seen before the fifth
day.  Some authors advise removing the diseased surface with the knife,
while others doubt the  propriety of such an operation and also affirm that
it is attended with  great danger of fresh innoculation from the diseased
portions.  Mercury and its compounds  constitute the internal  treatment.
Berjeau  very sensibly remarks "that  the practice of  destroying the
chancre by lunar caustic is one of  the most fatal practices of the present
day.  It does not by any means follow that because we have suppressed
the outward manifestations of the disease we have thereby vanquished
it.  On the contrary, we have destroyed our most valuable guide, and one
cannot possibly tell whether or when the patient is rid of his complaint.
When we find the chancre yielding to the internal use of medicine, prop-
erly selected, we can be certain that the patient is in a fair way to recov-
ery; but when caustics or various repellants are employed the  disease
becomes more intractable and complicated, secondary symptoms Urise, or
the patient is carried off by consumption or suffers for the remainder of
his life from some  chronic complaint, it being no uncommon thing to find 
TREATMENT.                        27
 persons attributing, and with good reason, all the miseries of ill health
 they have undergone to  syphilis badly treated  in  by-gone days.  The
 proper remedy must be selected with reference to the form, extent and
 duration of the ulceration, the constitutional and moral disposition being
 taken into consideration."
     " Cleanliness is akin to godliness," and the parts should  be  kept as
 clean  as  possible, either  by the  introduction of patent lint between the
 glans and the prepuce or by frequent injections of warm carbolized water
 under the prepuce.  When the sore is extremely painful a sponge soaked
 in warm carbolized water can be squeezed over the ulcer from  time to
 time.  From  an  experience of many  years we must decidedly protest
 against the use of cosmoline  or other  ointments.  Ulcers thus treated
 rarely do well.  The  patient, should be kept as quiet as possible, and if
 gangrene or  phagedena occurs absolute rest should be insisted upon, as
 neglect of this precaution greatly prolongs and enhances  the danger of
 the disease in spite of the treatment.  Alcohol, stimulants of every kind,
 fat and salty food, should be prohibited.  The best diet is rice, fish, corn
 starch, bread, fruit, and black tea  or mineral water as a beverage.
     Mercury,  though  a partial similium to chancre, is  not a  perfect
 one,  hence  we   cannot   always depend  upon  this  remedy alone.
 It is  indicated  provided  the patient  has not  already taken  it  in
 allopathic doses, when the ulcer has  hard, sharp and irregular edges,
 painful to the touch, the base  hard covered with lardaceous matter;  in
 all recently acquired, superficial ulcers, with free secretion of thick pus;
 spreading and deeply penetrating ulcers on the glans and prepuce; phag-
 edenic appearance of the  chancre, with a thin, ichorous secretion; chan-
 cres which bleed readily are very painful, and secrete a yellowish, white
 fetid pus.  The above symptoms  are usually cured by  mercurius solu-
 bilis.  However it may be necessary to resort to
     Mercurius cor or mercurius  precipitatus rubrum, if the  above fails
 to produce  any effect in four or five days, especially  when the ichor
 firmly adheres to the bottom of the ulcer and cannot be removed  without
 considerable bleeding.
    Cinnabar will be found of benefit in scrofulous patients when Mercury,
 although indicated, does not seem to benefit  the patient.  Old, neglected
 or badly treated cases.
    Nitric acid would naturally be considered next, as it  is the most val-
uable  remedy in  cases which  have been mercurialized; and, in fact, it
takes equal rank with Mercurius in the treatment of chancre.  It is indi-
cated in chancre with  raised edges, easily bleeding and often profusely;
superficial or elevated ulcer with  zig-zag edges, when no signs of central
granulation are present, or if they are, they are  pale  and flabby; ulcers
with a thin, ichorous discharge, and a dark, dirty base.
    Arsenic, when  the chancre  becomes gangrenous or  phagedenic; 
28
HEMORRHAGE.
ulcers with a thin, offensive discharge, hard, readily bleeding edges, and
proud flesh; gangrenous  ulcers with bloody edges; painless ulcers with
hard edges; ulcers secreting a copious watery, fetid ichor;  persons who
love warmth.
    Thuya, for  elevated ulcers with exuberant granulations;  flat ulcers
with unclean base and red edges; pale red vesicles about the ulcers.  A
very useful medicine in cases that resist Nitric Acid.
    Aconite is sometimes  temporarily useful for the inflammatory chan-
cre, or when the exhibition of Mercury  is followed by violent  inflam-
mation.
    Argentum nitras for 6mall  ulcers, which spread slowly,  and are cov-
ered with a lardaceous substance.  Silica in scrofulous individuals, when
the ulcer discharges an excessive amount of fetid, thin and bloody ichor.
Causticum, when the  discharge is acrid  and corrosive; gouty, scorbutic
or ill-nourished persons.  Sulphur  in psoric  constitutions, when other
remedies do not act, especially for superficial ulcers and excoriations, or
for torpid ulcers; sores with the characteristic  lardaceous secretion and
discharge of fetid ichor.
    Lachesis should be thought of in gangrene, and in ulcers surrounded
by a bluish halo.
    Iodine has cured quite a number of cases after  the inguinal glands
have become implicated.  The urine  has an ammoniacal odor.   Corra-
liuut has served us in a few cases after the failure of mercury.
    Other remedies might be mentioned, such as Aurum, Hepar, St<iph,
etc. The potency to be used  is probably not as important as the right
remedy. We use the higher  potencies almost invariably,  while others
claim equal  success with the  lower.  But we must caution you  against
using mercury below the  third, as bad results are very apt to follow.
    As has already been stated, hemorrhage sometimes arises during the
progress of  chancre, and it  should  be arrested at once.  If the  hemor-
rhage should occur from the destruction of some vessel, the  compressing
forceps or the ligature will be required, which, however, does not always
arrest it; if from a number of points there is constant oozing, use com-
presses  soaked in hamamelis; or, if still unarrested, some styptic,  such as
the persulphate of iron,  should  be employed.  Nitric acid  internally
is very valuable.  TheMreatment of erections, which are sometimes quite
frequent, will receive  special attention when we speak of gonorrhoea.
    Chancre sometimes occurs in the urethra, and is then often mistaken
for gonorrhoea on account of the similarity of the  discharge.   It is of
the utmost importance to distinguish between  these  affections, and  all
cases should be very carefully  examined.   When the sore is just within
the meatus, its  most frequent site,  there  is but slight liability of being
mistaken, for, on spreading the lips,  it will be exposed to view; but when
it occurs some two inches or more  from  the extremity of the penis (in 
CHANCRE  OF  URETHRA.
29
the membranous and prostatic regions), the diagnosis is often difficult.
Chancres  have been found by Ricord to extend along the whole of the
urethra.  The discharge is usually much less than inordinary gonorrhoea;
it is also thin or of a lighter color, mingled with streaks of blood.  When
the accompanying inflammation is unusually severest may be both profuse
and of a thick, bloody character, or thick and yellow with a greenish tinge.
The smarting, burning pain during micturition is referred to in a limited
portion of the canal, and is not so great as in gonorrhoea, while the site of
the urethral chancre is nearly always indicated by a kernel of induration,
easily distinguished by the thumb and finger. Erections are not as fre-
quent nor as  painful as in gonorrhoea.  Chancre in the  urethra, as else-
where, may be followed by secondary symptoms.   Bubo is a rare compli-
cation, but contraction of the urethra is [nearly always one of its effects.
The only positive  diagnostic characters of chancre in this  situation are
furnished by inoculation.  The  induration  may exist in gonorrhoea in
consequence  of the development of an abscess, and from other causes;
the discharge, if profuse and thick, is not diagnostic; the scalding during
micturition may be slight also in gonorrhoea, and the extraordinary length
of time between the indiscretion and the onset of the disease may also be
present in gonorrhoea.  It should have been stated before that the period of
latency of chancre in the urethra is much longer than when in other situ-
ations, on the theory that the quantity of virus is small,  or that the virus
becomes entangled in one or more of the lacunae of the tube, and is inca-
pable of exciting the same influence as when brought in contact with an
abraded  surface.  If  urine is  passed soon after the  virus is introduced
into the urethra, it is either washed away or neutralized by this fluid.
    The treatment of  chancre  in the  urethra will vary according to cir-
cumstances.  If the sore  can be seen by separating the lips of the meatus
or by the ear speculum, the treatment just given for chancre in other
situations will  be applicable; if not, we must depend  entirely on the
symptoms given by the  patient, and  then the treatment does not differ
materially from  that of  gonorrhoea.   The remedies will be  mentioned
when we speak of the latter affection.
    Chancre in the female necessarily requires the same treatment as in
the male.  The seat of the sore is more often the vulva than elsewhere,
although, as we have already remarked, the vagina and uterus are some-
times affected.  The chancres are sometimes concealed, or  partially so,
between the rugae of the skin on the  external genitals as well as in the
vagina, especially when the sores are  small.  Females  are more often
affected with the soft variety of chancre than the indurated, and the pain
is much greater than in the male.  Frequent washing of  the parts is abso-
lutely necessary, as is rest, also, if there is much inflammation.
    Chancre  appears, as has  been  before stated, on the  fingers, lips,
tongue, eyes, nose, cheek, scalp (rarely), anus, trunk, extremities, eto 
30
PHIMOSIS  AND PARAPHIMOSIS.
 wherever the virus has  been accidentally or purposely  inoculated, and
 the diagnosis is deduced from the history of the case, and a very careful
 observation of  the suspected ulcer.   No  matter what the  situation, the
 treatment is the same, viz., frequent cleansing of the part, and the admin-
 istration of that remedy which covers the most symptoms of the case.
    Phimosis  is that condition of the penis in which the prepuce cannot
 be drawn back of the corona glandis, and  does not require any special
 attention.  It is a very inconvenient complication as it prevents our ascer-
 taining the exact condition of the ulcer, and may cause gangrene.   It is
 caused, when not congenital, by the infiltration of fluid into the cellular
 tissue of the prepuce, forming a bulbous swelling at the extremity of the
 penis, its borders being usually inflamed, enlarged, cracked,  and often
 so narrow that but a small  portion of the secreted pus can make its
 escape,  thus rendering  the retraction of the prepuce behind the glans
 impossible, and the retained pus collecting underneath forms a fluctu-
 ating swelling.  Blenorrhcea is almost always present, and persons with
 a long, narrow prepuce are most subject to  phimosis.  The  remedy
 administered, for the chancre is  usually sufficient for the cure  of  this
 complication, but in some cases  Rhus tox, is required, when there  is a
 puffy swelling of both prepuce and glans, with  itching and moist erup-
 tion on the scrotum.
    Apis may be of service if the swelling is of a dropsical character, the
 parts being tense, shining and transparent.
    Sulphur is  valuable  in   scrofulous patients when  other remedies
 have failed-
    Cinnabar is indicated when there is  a dark red, hot and  inflamed
 prepuce.
    If gangrene threatens, the knife should be used dividing the parts
 carefully, and immediately washing the edges with a solution of carbolic
 acid.  Above all, do not forget to insist on cleanliness.  Order the patient
 to inject under the foreskin a little carbolized water several times a day.
    Paraphimosis, that is  retraction of the prepuce behind  the glans
 so that  it cannot again  be brought  forward,   is  occasionally  present,
 and is a much  more dangerous complication than phimosis, for, if the
 constriction is  not immediately relieved,  it may cut off  the circulation
of blood in the glans, and eventually lead to  swelling,  inflammation
and gangrene of the part, a frequent result. An effort should be made
at once to restore the parts by manual efforts aided by chloroform.  Be-
 fore attempting reduction, the.penis should be soaked in  cold water, and
the swollen part kneaded between the fingers.  If this fails, as it not un-
frequently does, there is no remedy but the bistoury; a narrow-bladed
one is the best to slip beneath the constricting ring formed by the pre-
 puce, and it should be carried back toward the pubes, and then turned 
BUBO.
31
cutting outward.  In  milder cases, the same remedies that are recom-
mehned for phymosis may be used.
    Bubo, strictly speaking, is an enlargement of one or more of the lym-
phatic ganglions of the groin, although the term with propriety may be
and has been applied to any engorgement of the lymphatic ganglia.  Any-
thing tending to irritate or inflame the lymphatic vessels leading to these
glands may produce it.  The most frequent causes being excessive sexual
indulgence, strains, gonorrhoea, catarrhal  or cutaneous inflammation,
fatigue from protracted exercise, forced  marches, injuries of the  lower
extremities, tight boots, or the presence of a boil on the thighs, nates or
perineum.   It occasionally occurs  without  known exciting  cause.  The
inflammation  attacks the glands nearest and in direct communication
with  the ulcer, and almost invariably the ganglia of  the superficial
chain.
    Bubo is very liable to occur in young people of a scrofulous diathesis,
often arising from the most trivial causes and disappearing usually with-
out much treatment.  Bubo, however, arising from  syphilitic cause is  a
specific disease, the result of inoculation  with the virus of chancre, and
eventually furnishes  a  secretion similar to that by which it was itself
produced.   An open  or suppurating syphilitic bubo is really a chancre,
and is  merely a primary form of disease.  The syphilitic bubo  arises
two or three weeks after the first  appearance of the primary sore; in a
few instances  coming on as early as the  eighth day, and in others the
time is postponed for even four or  five weeks.
    Bubo follows both varieties of chancre.  Gross says: " An active open
state of the ulcer, and the smallest conceivable amount of inflammation
in the structures  immediately around, are, other things being equal, the
conditions  most  favorable  to the development  of  the  true syphilitic
bubo."
    The hard chancre is always followed  by bubo, while the soft is thus
followed only  once in three times.  The swelling after hard chancre in-
volves several ganglions, and is hard and chronic, with very slight dispo-
sition  to suppurate (if pus does  . form  it  is not  considered  specific),
although all authorities contend that it is  sure to contaminate the system.
On the other hand, the  bubo following soft chancre usually affects but
one gland, runs its course rapidly, terminating  in  an abscess,  the dis-
charge being abundant and of a specific character.  The bubo generally
forms on the side on which the chancre is situated, and exceptionally and
rarely  on the  opposite  side.  A very  bad form of bubo  occasionally
occurs at the root of the penis, or upon the pubes, caused by the presence
of an infected ganglion.
    Males suffer much  more frequently from bubo than females, owing
to the difference in the  arrangement of the  lymphatic vessels—those in
the male passing directly from the seat of the disease, while the course
is more circuitous in  the woman.  In chancre of the uterus and upper 
32
CREEPING  BUBO.
part of the vagina, bubo is uncommon, and the same is true in chancre
of the  urethra in  men.  The older writers on syphilis asserted  that a
syphilitic  bubo occasionally occurred without the intervention or ante-
cedence of chancre, and this was called a  primary  bubo.  This  theory
was incorrect, the proof insufficient, and fortunately has  but few parti-
sans at the present day.  It may happen that the chancre  is quite small,
and thus escape the attention of both patient and physician, for there is
no reason to doubt that  very small and  insignificant ulcers sometimes
appear on the  genitals and are followed by violent constitutional symp-
toms.
    A bubo  is a very uncertain kind of swelling; it may remain station-
ary for a number o f weeks or months, or it may become  hardened, the
latter being considered a dangerous form by those who do not think
chancre a constitutional affection, as they  claim that one  can  hardly
escape contamination of the system when this occurs. Gross calls the
bubo a hot-bed, not merely for the temporary lodgment of the virus, but
for its zymotic operation and its gradual  extension  to other and more
important structures.  When a bubo suppurates, it is important that the
matter should be evacuated  early, otherwise the pus is apt to burrow
among the  neighboring  tissues, causing  an  extensive  sinus.  Many
writers assert that a suppurating bubo can be cured without  an incision
by aspirating the  swelling and  then  injecting vaseline and iodoform.
The discharge from an open bubo varies greatly, sometimes being thin
and ichorous; at others, thick, yellow and bloody, although  there is sel-
dom hemorrhage.  The edge of the sore exhibits about the same appear-
ance as that of an  ordinary chancre, and the bottom  is covered with a
dirty,  greenish or yellowish matter.  This open  bubo  may become
phagedenic the same as a chancre, and then produces just as frightful
a destruction of tissue.  Again,  it may become gangrenous—true  gan-
grene, which latter complication  only occurs in half-famished, dirty per-
sons, who have no regard for cleanliness, the inmates of prisons, aim-
houses, cellars and other foul habitations.  The patients usually die un-
der the regular practice.
    There is a form of bubo called the creeping, which is the exact count-
erpart of the serpiginous chancre, creeping snake-like about in different
directions.  Syphilitic bubo is liable to be confounded with bubo from
other causes, but the following points render the diagnosis comparatively
easy, viz.: the history of the case; the syphilitic bubo comes on about two
or more weeks after the chancre; the common in  one or two days  after
the exciting cause; the syphilitic bubo lasts several weeks or months, the
common disappears  with the  exciting cause; the first suppurates and
ulcerates, the latter hardly ever,  except in  scrofulous persons; the pus
from one is inoculable, from the other, never; the syphilitic bubo is situ-
ated above Poupart's  ligament, affecting generally  but one gland__the
common below, or under the ligament affecting several glands usually. 
SECONDARY  SYPHILIS.
    This brings us to secondary syphilis, another step in the progress of
the disease.  This stage follows the primary sore in from four to twenty
weeks, the average time being six weeks, and is transmissible by heredi-
tary descent,  In general terms, the tissues now affected are the skin and
the mucous membranes, not necessarily both at the same time, but some-
times the skin, at others the mucous  membranes, and again both.   The
exact time of the appearance of secondary symptoms cannot be  foretold,
as much depends upon the mode of life of the patient and  his  personal
idiosyncrasies. Occasionally we find rheumatic pains present during this
stage, but these  do  not by any means  denote  affection of the bones.
What the poison is and where it resides are questions which are still un-
decided, and which we have already discussed.  We know, however, that
it circulates in the blood.  These  symptoms follow both varieties of
chancre.  It is not uncommon for these symptoms to present themselves
before the chancre or bubo has disappeared, but usually if  the patient is
under proper treatment the primary sore has entirely disappeared, and
the sufferer imagines himself well before they make their appearance.
    The following facts should be  carefully noted:  1,  That the hard
chancre is nearly always followed by secondary symptoms; 2, That the
soft chancre is also followed by secondary symptoms, if multiple  or of
great extent; 3, That secondary symptoms are contagious and inoculable;
4, Chancres which become gangrenous are not apt to affect the system;
5, Feeble and scrofulous persons  are more liable  to secondary than
healthy persons; 6, Mercury is a predisposing cause of secondary syphilis;
7, Chancre of the urethra is rarely followed by constitutional contamina-
tion; 8, If the local inflammation is  unusually severe, secondary symp-
toms rarely occur.  The foregoing points should be remembered, for on
them you base your prognosis.  Secondary syphilis is both contagious
and inoculable, and produces a degree of contamination which  is almost
impossible to cure without prolonged and skillful treatment.  If we
take upon a lancet a small portion of the serum of the blood  of an in-
fected person and insert it into the arm of a healthy person, a chancre
will be the result.  This same serum, however, will have no effect upon
the arm of the  person from whom it was taken, or upon any  other
   8                            33 
34         SYMPTOMS  OF SECONDARY SYPHILIS.
syphilitic individual.  The  period  of  incubation  after  inoculation  is
from twenty to forty days.  We have already referred to the propagation
of syphilis by means of vaccination, the lymph used  having been con-
taminated with the blood of the infected individual.  In this connection
it may not be amiss to say that  writers upon this  subject formerly be-
lieved that syphilis once implanted in the system never could be  eradi-
cated, and that it ran through one generation after another; but these views
are not held at the present  day, and syphilis is  considered a curable
disease.  Our own experience teaches us that many of these patients are
thoroughly cured and afterward give birth to healthy children,  entirely
free from all traces of this dreaded malady.
    The symptoms first noticed in the invasion of secondary syphilis are
very variable.  The following are often noticed, not all of them by any
means in any given case, but one or more of them, and of varying inten-
sity.  For a number of days, previous to the eruption, the patient com-
plains of malaise; he is not really sick, and yet he  is not well; has  some
dizziness at times; headache on one side only at night; he is gloomy and
low-spirited, with  aversion to doing anything; has the blues in fact; his
appetite is impared; his breath is short, with a quickened pulse, and his
heart palpitates from time to time; his limbs and joints feel sore and stiff,
especially at night; he has a pain under the sternum, with some tenderness
to the touch; his  look is dull and  heavy; there is more or less gastric
trouble, with constipated bowels; the urine is scanty, and high colored;
with acid reaction; he is easily fatigued; his limbs are numb;  his sleep
is restless, and full of anxious dreams.  The post cervical glands will be
found indolently indurated at this time, and the hair will commence thin-
ning out, as the result of feebleness.
    A few days after, he has what is termed the syphilitic fever; that is,
he is suddenly seized with chilly sensations or rigors, followed by mod-
erate fever (occasionally very high fever), or by fever and profuse  morn-
ing sweats, reminding one very forcibly of the sweats of pulmonary tub-
erculosis. The type of the fever bears a great resemblance, at times, to
intermittent or remittent fever, and  at others to rheumatic  fever.   This
fever is present in only twenty-five per cent, of the cases.  The eruption
now makes its appearance, and the  fever soon disappears, and with  it
the other general  symptoms mentioned a moment ago.  In place of the
eruption upon the skin, we may have an affection of the mucous surface.
    The  skin eruptions are of  an erythematous, scaly, papular,  tubercu-
lar, vesicular or pustular character, differing in intensity in  different
individuals.   No two cases are exactly alike, although  all present a strik-
ing family likeness.  Some of these eruptions belong to both the second-
ary and  tertiary  stage, because we cannot,  as yet, exactly define the
limits of each definitely.   In fact we cannot say that any one variety
belongs exclusively to either secondary or tertiary syphilis.  It is almost 
ERYTHEMATOUS ERUPTION.              35
impossible to give any general characteristics that shall apply equally to
all  syphilitic eruptions.  We are  only able to give some general rules
which have some exceptions.  They often present varied lesions side by
side;  macules, papules, pustules maybe associated together. They pursue
a chronic course, and occur upon all parts of the body, but more especially
upon the  inside of the  arm and  thigh, face, forehead, nose, back and
shoulders.  They are not always of a copper color in their earlier and
more acute stages, but invariably present this appearance after a time.
They are readily distinguished from non-specific  skin diseases by the
history  of the  case;  by  the absence of  heat, itching and pain; by the
peculiar copper color; by the tendency to destroy the tissues on which
they are seated, and by the concurrence of lesions of the integument and
mucous membranes.
    The erythematous form, the earliest and the most common, some-
times comes on before the disappearance of the  primary  symptoms,
usually  in about two months.  It may appear suddenly or gradually, with
or without pyrexial disturbance, the  spots  appearing on the skin and
mucous membrane, at first  of a red color, then  coppery.  They are  of
circular shape, one-eight to one-half  inch in diameter, and do not pro-
ject above the level of the skin. They are most  prominent and numer-
ous on the thorax and belly, although they may appear upon any part
of the body; they do  not entirely disappear under pressure;  are rarely,
if ever, confluent, healthy skin  existing between  them, and usually pass
off with a very  slight  desquamation of the skin.  Oftentimes the spots
are considerably smaller, more irregular in shape, and of  a brighter red
color.  This variety, the mildest of all syphilitic  eruptions, has received
the name of roseola, from its great  resemblance to measles.  The physi-
cian frequently is the first to discover it, as there is no itching, heat  or
pain.  It is found all over the body, except the sides of the neck.  There
is no perceptible elevation of the skin in either variety.  After ten days,
more  or less, the  eruption fades and becomes dingy or grayish brown.
Its  duration varies from a few days to  four  or  five weeks, and it may
relapse.  The history  of the case, the absence of itching, its location, and
other difference just  mentioned, distinguish  it from other skin diseases
for which it might be mistaken. It lacks the catarrhal symptoms  of
measles, and hence could not be confounded with rubeola.
    The scaly variety of  syphilis  makes its  appearance from six to ten
months  after the  primary disease, and  usually without any marked
precursory symptoms.  It may  form the connecting link between sec-
ondary and tertiary syphilis, or  may belong  wholly to one or the  other
stage.  It is quite generally associated  with other well-marked symp-
toms, such as  inflammation of  the throat and palate, iritis, and bone
pains of greater  or less  intensity. The eruption generally  occurs  in
small patches of an irregular or circular shape of a red and  somewhat 
36
PSORIASIS.   BULLAE.
 coppery color, and is most common on the forehead, scalp,  face, arms
 and palms of hands and soles  of  feet, although it may appear upon
 any part of the body.  The scales are distinct, hard but small, of a dull,
 opaque-grayish or whitish appearance, or they may be thin  and filmy,
 resting on a copper-colored b^se.  Often they are circular in form and
 slightly depressed in the center, the skin underneath showing  a tendency
 to ulcerate or to form cracks and fissures.  If ulceration does  take place
 a thick, brown, dry crust soon forms. When the ulcer has healed, a whitish
 cicatrix, somewhat depressed in the center, remains to mark the original
 site of the sore.  The most frequent form of this variety is psoriasis pal-
 maris and plantaris.  This affection commences with the appearance of
 from three to a dozen or more small, flat  papules, devoid of  itching or
 pain, which increase in size, forming irregular patches by fusion, after a
 time.  The papules are prone to seek the furrows in the hand, and it is
 here we most frequently see the  disease as a true scaling syphilide. The
 diagnosis is sometimes quite difficult.  The history of the case should be
 carefully considered, and the co-existence of other lesions sought for.
 Ordinary psoriasis is not usually confined to the hands and feet but occurs
 elsewhere at the same time.
    The vesicular variety of syphilis is  of very rare occurrence, is always
 chronic and greatly resembles eczema  and herpes in its general charac-
 acters.  Its  favorite site is the neck, chest  and extremities, the face
 usually escaping.  In very rare cases, the vesicles are so numerous as to
 cover nearly the whole surface of the body.  When present it marks the
 transition of primary into secondary syphilis, coming on as it does about
 eight weeks after the appearance of the chancre.  The eruption appears
 first as minute circumscribed pimples,  soon changing to vesicles filled
 with a transparent serous fluid;  and surrounded  by the characteristic
 copper-colored areola.  The contents may become turbid and purulent,
 but are finally absorbed or dry down into thin  scales, which, when they
 fall off or are removed, leave  the part a dirty  yellow hue. As accom-
 panying symptoms usually present, we  may mention rheumatic pains in
 the bones and joints, and dryness of the throat.  The  diagnosis is  fre-
 quently difficult  without the previous  history of the case, for there is
 nothing aside from the copper-colored areola to distinguish it from other
 vesicular diseases, except the absence of itching.
    Syphilitic bullae are simply enlarged vesicles,  and appear as pem-
 phigus and rupia.  Pemphigus is subacute and transcient in  its charac-'
ter, is rather rare and  appears early in secondary  syphilis,  but  never
except in children, as the first eruption.   In children of syphilitic parents
it is not uncommon,  and nearly  all the little  ones die.  Hepar  sulph.
served us well in one case.  The vesicles usually run an indolent course
 after their contents  become pustular, do not increase much in size and
 finally crust over.  These crusts, on falling  off, leave pigmented  spots. 
SYPHILITIC PUSTULES.                  37
Rupia is more common, appearing sometimes during the first year, but
usually  very late in the disease.  It is essentially a disease of adults, and
pursues a very chronic course.  All the lesions of rupia begin as  a red
spot, which soon is the seat of a large or small bulla, the contents of
which soon become purulent, and then dries into a  yellow or greenish
brown crust of variable size, but usually one-eighth to one-fourth  of an
inch in diameter.  Underneath this crust is an ulcerated,  infiltrated sur-
face, which extends somewhat beyond the  original crust.  As they grow
older and new additions are added from  the bottom, gradually elevating
the mass, the crusts become darker and the base  presents the usual cop-
per-colored areola.  The lower crust may grow  to the size of three or
more inches  in diameter.   The scabs constantly cover foul ulcers, for if
at any time we remove the oyster shell as it is  called, we find a foul,
grayish looking ulceration, which again becomes crusted over, and thus
it continues  until influenced by anti-syphilitic  remedies. Rupia may
occur anywhere on the body, but usually selects  the forearms  or  lower
extremities.  In the worse case which came under our observation, the
forehead was the seat of the disease,  which is rather an infrequent place
of development.  There is no pain at any  time.  The diagnosis is easy,
as there is but one other disease which at  all resembles  it, and that is
psoriasis rupioides; but in the latter affection there is a want of the char-
acteristic dirty color of the scabs and the copper-colored areola.  The
prognosis should be guarded, as this is an affection of considerable  grav-
ity and really belongs to the tertiary stage.
     Syphilitic  pustules are  less common than erythematous and papu-
lar eruptions, but present similar appearances outwardly to other pus-
tules, except  that each pustule rests upon a hard copper-colored base.
They are found upon any  part of the body, scalp, face or extremities;
they may be single, multiple or confluent; their  shape is round or oval;
the size Varies  from that  of a pin's  head to that of a  hazel nut.  They
occasionally exist as the earliest eruption at six weeks, or with the pri-
mary disease; but no  matter when  they  appear, they always denote  a
severe  constitutional contamination.  The  number of  these  pustules
varies greatly, sometimes  being so numerous that hundreds are scattered
over a small surface, and  the suffering  and exhaustion may be so great
as to destroy life. They may begin  as papules  or as distinct pustules,
and relapses are very common.  There are two varieties, the one termed
psydracious in which the  pustules occur in groups, and the other phlyza-
cious in which they are scattered.   After two or more weeks, the con-
tents of the pustules escape, concrete and  form scabs of a varying thick-
ness, of a yellow or greenish black color, and quite firmly adherent.  In
simple cases under small  crusts, there is usually little if any ulceration,
but a  chronic  induration, a  dusky stain or a small cicatrix.  In severe
cases under large crusts, deep, circular ulcers are exposed with a foul, 
38
TUBERCULAR  SYPHILIS.
grayish bottom, or a covering of thick, yellow pus.  The edges are Cir-
cumscribed, perpendicular, and often undermined; in  healing, a white
indelible scar remains.  These ulcerations are long-lasting and very diffi-
cult to heal.  This form of syphilis is often a connecting link between
the secondary and tertiary stage; is sometimes associated with iritis, and
with the tubercular and  papular eruptions, and less  frequently with
roseola and the  squamous  forms of syphilis.  If high fever accompa-
nies, it may be mistaken for  small-pox, but a day or two clears up the
diagnosis.
    We have a form of syphilitic  acne which  appears  in  the secondary
stage (third to sixth month),  accompanied by fever.  The pustules are
scattered over the whole body, thus differing from ordinary acne, which
is confined  mainly to the face and shoulders.  The general health is
more frequently impaired after this rash than after others.  After the
disappearance of the pustules, small brown spots  remain  for some time,
and exceptionally, minute cicatrices.
    Syphilitic ecthyma appears during the first year, and is distinguished
from non-specific disease by the history of the case, the absence of itch-
ing,  and light inflammatory  action.   A  guarded prognosis should be
given in these cases.
    The tubercular form of syphilis, the  most formidable and most fre-
quent  of all, is  really an exaggerated form of  syphilitic papules.  It
makes its appearance at any time, from one to twenty years after the pri-
mary sore, in cases that have  not been properly treated.  The tubercles
begin as small, red, copper-colored eminences, which slowly increase in
Bize, until when  fully developed, they are as large  as an olive  or an
orange.  They may occur upon any part of the body or face, and possess
a decided tendency to ulcerate. They are of a rounded, flattened or conoidal
shape, isolated in groups or arranged  in  perfect circles or  segments of
circles. They are smooth, and have a shining appearance; cause little
or no pain, heat or  itching, and become  covered  in a  short time with
a dry, scaly incrustation, very similar to psoriasis, which is  generally
reproduced as fast as it falls off.  In the  aggravated form, the tubercles
are very large, from %Xo \  inch or more in diameter,  at first of  a dark
red, or a light pink  color, becoming  a deep, violet hue, and surrounded
by a well-marked copper-colored areola.  The  course of the eruption is
very slow, but in a few months or years a number of tubercles inflame
and suppurate, giving  rise to deep, foul, painful ulcers, with  sharp-cut
edges,  resting upon a hard base.  Such cases, fortunately, are very rare.
The thick, greenish-black crust, which covers the ulcer, is frequently
renewed, showing, when removed, that the sore is constantly spreading.
In broken-down subjects, or drunkards, the ulcers may merge together,
forming sores of frightful size, which in healing, leave disfiguring scars,
somewhat depressed.  It should be remembered that syphilitic tubercle 
PAPULAR ERUPTIONS.
39
is a very serious form of disease, as it may last a long time, exhausting
the patient, and  the eruption maybe kept up by successive outbreaks.
Relapses occur even when we  have every reason  to expect continued
improvement from skillful treatment.
    There are two varieties of  papular syphilis, which may appear as
the first eruption on the skin, or may be associated with roseola.  The
first consists of  very  small, hard,  solid elevations, about the size of  a
pin's head or larger,  conical or rounded, disjointed or grouped, devoid
of  fluid, and terminating in desquamation.  They  may  appear upon
any portion of the body,  but seem to prefer the anterior part of  the
trunk.  The papules are sometimes umbilicated; are  of  a pale  rose
color at first, and  afterward of a  coppery  red, and  are  surrounded
by  violet areolae,  which  are often' confluent.   The  color disappears
under  pressure  at first, but  not at a later stage.  They appear simul-
taneously upon  different parts  of  the  body, backs of the  hands, scro-
tum, penis,  and often the face (similar to  acne), disappear in  a short
time, and are followed by desquamation of the skin, rarely resulting in
ulceration.  Upon the scrotum and penis, however, they usually become
excoriated,  and are then transformed into condylomata.   Frequently,
these papules  are seated at the openings of follicles,  a feature rarely
noticed in any other  form of syphilitic papule.  After their disappear-
ance, pigmented spots remain, i-nich become white only after a number
of weeks.  In the other variety, the eruption  is developed gradually,
commencing with  minute, yellow  spots, which rapidly increase in size,
and are located on the forehead, scalp and upper and lower extremities.
The papules are larger than the other variety, with a diameter of from ^
to % inch or even  more.   They are flat, round or oval, grouped,  of a
light, red color, soon  becoming coppery, and devoid of  an  areola.   The
surface of the papule becomes covered with a thin, dry,  grayish pellicle,
which is re-formed as fast as it is thrown off, until the disease is finally
arrested.  The skin between the papules becomes dry and shriveled, of
a dingy, yellowish color, and is apt to be the seat of a constant exfolia-
tion of the  skin.  No scars are left upon its disappearance, simply  pig-
mented spots.   Upon surfaces that are moist, as the perinaeum, for
example,  the papules become transformed  into condylomata.   This
result  is usually met with during the second or third year of syphilis,
and very rarely during the first twelve months.  The earlier its appear-
ance, the more copious is the  eruption; the later it comes on, the more
apt it is to be accompanied by iritis, alopecia, condylomata, and pustular
eruptions on the hairy parts.
    Treatment.   Our old school  friends  recommend  mercury, tartar
emetic, iodide of potash, etc., etc., for the different variety of skin affec-
tions, combining them with aconite for violent fever, with morphine for
restlessness, sleeplessness, etc., with  sulphate of magnesia  for constipa- 
40                         ALOPECIA.
tion, etc., etc.  It will be difficult  to  give you the Homoeopathic treat-
ment for these eruptions without other symptoms, so we shall  content
ourselves with a brief resume  of the  more important only, recommend-
ing that in  every case you  should note carefully all the symptoms and
Select a remedy in accordance  with them:
    For syphilitic erythema and roseola—Aurum, Ant. crud., Ant. tart.,
Ars.,  Bell., Calc, Canth.,  Lye, Merc, Nit. ac, Phos., Sulph., Sulph-ac,
Tereb.
    For squamous or scaly  diseases—Alum, Alum carb., Ars., Ars. jod.,
Aur., Bry., Calc, Carbol. ac,  Clem., Coral.,  Dulc, Hep., Iris., Kali, brom.,
Led., Lye, Merc, Nitr.  ac, Petrol,  Phos., Phos-ac, Phytol.,  Psor., Rhus.,
Sep., Sulph., Tell., Teucr.
    For vesicular—Amm. c,  Ant. c, Ant. t., Arg., Ars., Aur., Brom., Bry.,
Calc, Canth.,  Carbo. veg.,  Carbol. ac, Clem.,  Dulc, Graph., Hep., Iris.,
Kali., Lach., Led., Lye, Merc, Mezer., Natr. m., Nitr.  ac, Petr., Phos.
Rhus., Sep., Sil., Staph., Sulph., Thuj.
    For pustular—Alum, Alnus, Amm. c, Ant. c,  Ant. t., Ars., Ars. jod.,
Baryta., Calc, Carbo. veg., Carbol. ac, Caust., Con.,  Dulc,  Graph., Hep.,
Kali., Kreos., Lach., Lye, Mere, Natr.  m., Nitr. ac,Phos., Phos. ac, Rhus.,
Sarsap., Sep., Sil., Staph., Sulph., Viola.
    For papular—Ars., Bry.,  Calc, Caust., Cicuta., Con,, Dulc, Graph.,
Lye,  Merc,  Mur. ac, Nitr. ac, Phytol.,  Puis.,  Rhus., Sil., Staph., Sulph.,
Thuj.
    For tubercular—Same remedies as papular.
    Alopecia, or falling out of the hair, is more a symptom than a dis-
ease, and  may arise during  the course  of many other  acute or chronic
diseases.  When due to syphilis, which is of very common occurrence,
it generally  commences within eight or ten weeks, dating from the com-
mencement  of the  primary sore, and is attended by no marked subjec-
tive symptoms as heat or itching.  It arises gradually, the hair coming
out when  combed or pulled,  in patches or  circular disks of  variable size.
Upon examining the head  well-marked copper colored spots  will  be
found as  a  rule.  It varies greatly in  degree,  being  generally quite
moderate, but in some  cases  not only the hair of the head, but that of the
face, pubes, genitals and other portions of the body, falls out.  The hair
first becomes usually dry, loosing its soft and glossy feel, and is stiff and
brittle, soon afterward  falling  out in great abundance, leaving exposed to
view circular blotches of a dusky, copper color.  Accompanying this
affection we  usually find  wandering  rheumatic pains  in  the  muscles,
bones and joints.  Even  in  very severe  cases, in persons of middle age,
we may expect the hair to grow again,  but it is never so soft and glossy
as before, but becomes coarse, stiff  and  sparse.  Ulcerating eruptions
which affect the scalp sometimes destroy the follicles, and in such cases
we expect as a matter of course permanent bald spots as the result. 
CERVICAL ADENITIS.                    41
Alopecia is due to the impaired nutrition of the hair follicles, occasioned
by the adynamic influence of syphilis.
    The following remedies are valuable for falling out of the  hair:
Alum, Ambr., Amm., Amm. to., Ant. c, Ars., Aur.,  Bar., Bell.,  Bor., Calc,
Canth., Carbo. an., Carbo. veg., Caust., Chel.,  Colch., Con., Creos., Cycl.,
Dulc, Ferr., Graph., Hell., Hep., Ign., Iod., Kali.,  Lach., Lye, Mezer.,
Magn., Merc, Natr., Natr. to., Nitr. ac, Op., Par., Petr., Phos., Phos. ac,
Plumb., Rhus, Sarsap., Sdbin., Sec corn., Selen., Sep., Sil., Staph., Sulph.,
Sulph. ac, Zinc.
    Falling out in tufts, Phos.
    Falling out in circular patches, Ars.
    Falling out from back of  head,  Calc, Carbo. veg., Hep., Petr., Sep.,
Sil., Staph., Sulph.
    Falling out from crown of head, Bar.,  Calc, Carb. av., Phos., Hep.,
Lye,  Nitr. ac, Plumb., Selen., Sep., Sil., Zinc
    Falling out from forepart, Ars., Bell.,  Hep., Merc, Natr. m., Phos.,
Sil.
    Falling out from sides of head, Bov., Graph., Kali., Phos. ac, Staph.,
Zinc.
    Falling out from temples, Calc, Kali., Lye, Merc,  Natr.  m., Par.,
Sabin.
     Falling out from eyebrows, Agar, Bell., Caust., Hell., Kali., Mezer.,
Par., Plumb., Selen.
    Falling out from whiskers, Agar., Ambr.,  Calc,  Graph., Natr., Natr.
m., Nitr. ac, Plumb., Sil.
    Falling out from moustaches, Bar., Kali., Plumb.
    Falling out from nostrils, Calc, Caust.,  Graph., Sil.
    Falling out from genitals, Bell., Hell, Natr., Natr. to., Nitr. ac, Rhus,
Selen., Zinc
    Falling out from body generally, Ars., Calc, Carbo. v., Graph., Hell.,
Kali., Natr. to., Op., Phos., Sabin., Sec corn., Sulph.
     Hair brittle, Ars., Bell.
    Hair dry, Aloe, Alum., Bad., Chel., Hip., Kali., Phos., Sec corn. ■
    Hair stiff, Ars., Canth.
    We have already spoken briefly of cervical adenitis.  Suffice it to say
say that usually the posterior cervical glands become affected at a very early
period of secondary syphilis, becoming enlarged to the size of an almond,
and slightly tender at first, though never painfully so.   It will be remem-
bered that in health these glands are so small that they can scarcely be de-
tected.  This engorgement of glands at a distance from the primary sore
and at about the sixth or seventh week, is considered the earliest and most
characteristic symptom of secondary syphilis.   It is present in over ninety
per cent of  all cases.  There are seldom more than one or two glands in-
volved, although in very rare cases there may be as many as six or eight. 
42      AFFECTIONS OF THE MUCOUS MEMBRANES.
The posterior cervical glands referred to are  situated along the upper
half of the posterior border of  the sterno-cleido-mastoideus muscle.
The glands never suppurate, at least there is only one case on record
showing an exception to the rule.  The  duration of these glandular in-
durations is quite protracted.  This enlargement  of glands is only im-
portant from its constancy as a means of  diagnosis, and is something the
physician should never  fail to look for  in cases of difficult diagnosis.
They require no special treatment, as the remedies adapted to the other
Bymptoms present remove this  affection  also.  The remedies exerting a
special curative action on these glands are Bar., Calc, Hell., Iod., Mur.
ac, Petr., Phos., Sil., Sulph.
    We shall next consider the various affections  of the mucous mem-
branes, bearing in mind  that while the  cutaneous and mucous surfaces
are but one continuous  membrane, the  constant moisture, exposure to
friction, etc., of the latter, very greatly alters the character of the various
eruptions.  These affections, as we have already stated, may exist with
the eruption upon  the skin or independently of it; but, as a rule, both
structures are affected at the same  time.  They make their appearance
usually after the chancre has disappeared, but in many cases even before
this has occurred.  The  parts most frequently attacked are the tonsils,
palate, pharynx, tongue, cheek and lips, although  any portion of the
mucous membrane which is visible may be  affected.  As regards the
stomach and bowels, all we can say is that nothing satisfactory is known,
although the anus and rectum are frequently involved.  It  is not known
positively whether the urinary organs are ever affected.  These eruptions
appear frequently upon  the foreskin, head  of the  penis, the vulva, the
vagina and the uterus.   They manifest themselves in a variety of forms,
sometimes  as  an erythematous disease, corresponding to  the roseolar
form  of  cutaneous  syphilis;  sometimes as tubercle, corresponding  to
squamous syphilis, and again as an ulcer, crack or fissure.   These three
forms may coexist in some cases.
    One of the earliest  and most common manifestations is erythema
of  the  mucous  membrane, which is usually identical with  the  same
eruption upon the skin.  It is seen chiefly in the throat, affecting princi-
pally  the arches of the  palate,  tonsil,  uvula, root of the tongue and
pharynx; occasionally, however, it is observed upon the vulva of women
who have frequent sexual intercourse, and upon the  glans penis of m,en
with long prepuce. It is often so ephemeral and ill-defined  as to entirely
escape notice.  When noticed it  usually presents  itself in the form of
distinct patches, from one-eighth to three-fourths of an inch in diameter,
the surface between the patches  being healthy; or the eruption may be
widely diffused with well-defined  borders. The color is red, sometimes
copper-color, but there  is really nothing distinctive about it.  A deposit
of lymph sometimes takes place, occurring in  small  aphthous-looking 
ULCERS OF THE THROAT.
43
specks in patches of  considerable size, firmly adherent  and of a  pale
orange color.
    Erythema occurs six or eight weeks after the first appearance of the
primary sore, although it may be present in a more or less modified form
throughout the entire disease.  There is usually no great  inconvenience
arising from it, no soreness in the throat nor difficulty of swallowing; but
cases vary greatly, and in some instances there is pain, dryness, and con-
siderable hoarseness.  This affection usually denotes but a slight consti-
tutional taint;  often disappears quite suddenly, but is very apt to return.
Tobacco chewers complain somewhat of pain and smarting when chewing.
    Ulcers of  the throat are not uncommon, involving principally the
posterior portion of the  throat, the tonsils and  the palate.  The  deep
excavated ulcer,  with a hard base, of circular or oval form,  looks as if it
had been cut out with a punch—it looks in fact like aHunterian chancre.
The  surface likewise presents a similar appearance, being covered  with
a foul, greenish or yellowish  lymph, giving it a dirty, unhealthy look.
Its most frequent site is one or the other  tonsil.  The superficial ulcer
corresponds in appearance and other respects, to the soft chancre, seldom
existing  alone, but being multiple, without induration,  and possessing
well-defined, ragged and undermined edges.   Its surface is covered with
whitifeh or yellowish,  tenacious lymph.   It is usually situated in the
pharynx,  on the  uvula, or on the side of the throat or  palate,  and is
accompanied with much swelling of the  parts.  Either of these ulcers
may become phagedenic or gangrenous, and thus cause rapid and exten-
sive  destruction of the parts, difficulty of  deglutition and permanent
alteration of the voice.  While  febrile action  is  not common, it  may
accompany either form of ulcer; and when the sore is located upon the
tonsil, its most frequent site, the swelling may be so great as to greatly
impede respiration.  Small ulcers sometimes form on the tongue, inside
of cheek, etc., and  if  not accompanied by the characteristic ulcer in
other localities or other marks of syphilis,  their diagnosis  is a matter of
considerable difficulty.  The history of the case should be carefully con-
sidered, and abundant time taken before a positive diagnosis is declared.
    Mucous tubercles or patches, as they are usually  termed, are found
only in syphilis, and make their appearance early in the secondary stage,
about the same time  as roseola.  They come on without much if any
pain, occurring generally on mucous membranes, and in the neighbor-
hood of outlets of mucous canals. They appear upon the tonsils, tongue,
lips, inside of  cheeks, nose, pharynx and larynx, and also upon the  body
in the natural folds of the skin, where a constant state  of warmth and
moisture is maintained.  So painless are they in the  mouth, as  a  rule,
that  they are  frequently  first detected by the physician.  The  tonsils
seem to be a favorite site, and ulceration is more  apt to occur here, owing
to the constant irritation and friction from swallowing. In women, the 
44                    MUCOUS PATCHES.
most frequent site is the vulva; in  men, the anus and mouth.  Mucous
patches consist of very slight elevations of the mucous membrane, of an
oval or elliptical shape,  of a dirty-whitish hue (only rarely red), and of
the size of a pea up to that of a silver dollar, or even larger, when several
patches run  together.  They do  not  seem to be painful, even when
pressed firmly between the thumb and finger.  When  the patches are
seated upon the skin, they consist of rounded disks, of a reddish or gray-
ish color, and slightly elevated above the surrounding integument,  and
are then covered with an  offensive  muciform secretion, particularly if
situated in the neighborhood of the genitals.  These patches are then
called  condylomata.  Relapses  are very frequent. Mucous patches do
not leave  scars, unless they ulcerate,  which they are very apt to  do.
Cleanliness will usually prevent ulceration.
    Allopathically, these affections are treated locally  with Nitrate of
silver,  Acid nitrate  of mercury and  Nitric acid, with  constitutional
treatment according to circumstances.  Homoeopathic treatment, how-
ever, is vastly  superior to this. The  ulcers in the  throat require the
same remedies that would be indicated in ulcers  occurring  on  the
penis or elsewhere,  and  hence we need  not repeat those indications
here.  For the gangrenous and phagedenic ulcers,  the same is true.
For  mucous  tubercles, there  are no  remedies  equal  to  Thuja and
Nitric acid, although in rare cases  we may be obliged to resort to Calc,
Puis., or Arg. nit.  We invariably use, as a local wash, the third attenua-
tion of the remedy administered internally.
    The homoeopathic physician should  remember  that  he  must  be
guided in  his choice  of a remedy by the symptoms present. Lach. Bell.,
Bry. or some other drug may be indicated.   Bryonia cured a case for the
author after the failure of other remedies.  Bry.  works well after Mer-
cury in this disease. 
TERTIARY  SYPHILIS.
    Having briefly considered primary and secondary syphilis, it now re-
mains to discuss the tertiary stage, affecting the skin, mucous membranes,
periosteum, bones, fibro-cartilages, aponeuroses, tendons and testicles. It
may be as  well to state at this time that the dividing line between this,
the tertiary stage, and secondary syphilis, cannot be accurately  deter-
mined, as the latter runs gradually  and insensibly into the former.  It
will be found also that some of the affections which we shall mention un-
der this the last stage, do occasionally appear in the secondary stage. It
is customary to designate those symptoms which appear before the sixth
month as  secondary, and those  appearing at a later date as tertiary, but
this is really too arbitrary a division, as we have already remarked;  it is
preferable, as far as possible, to divide the disease into stages according
to the tissue or parts affected.
    The syphilitic poison, we have already told you, may lie dormant in
the system for a number of months or even years, and then break out, at-
tacking and destroying with great rapidity various tissues  and organs
which seems to be its especial prey.  Any part  of the body may become
involved, although the parts mentioned a moment ago are the most fre-
quently attacked.  The heart, lungs, liver, brain, kidneys, etc., are not
exempt from  syphilitic disease, and, in bad cases, a fatal result is to be
apprehended.  It should  be borne in mind, for it is a well-established
fact, that occasionally the second stage is skipped entirely, the disease
passing directly from the primary to the tertiary stage. It is also claimed
and we think truthfully, that this stage is not always preceded by bubo.
    The predisposing causes of tertiary syphilis are bad treatment of the
former  stages—intemperance, abuse of mercury, scrofula, bad hygienic
surroundings, debility, and impoverished state of the blood.   The inor-
dinate use  of  mercury is, perhaps,  the  most important predisposing
cause, and in  such cases we have the worst possible form of syphilis to
deal with; we may say, in fact, that we have two  distinct  diseases to
treat—syphilis  and mercurialization,   Tertiary symptoms follow both
varieties of chancre, but more often the hard than the soft variety.  The
longer a soft chancre  remains uninfluenced by treatment, the more apt
it is to be followed by tertiary  symptoms.   The specific virus  is de-
stroyed  in this stage, and hence the  matter obtained from ulcers, ab-
scesses and other sores is not  inoculable.
                                 45 
46
NERVOUS PHENOMENA.
    The diagnosis is comparatively easy when we take into consideration
 the history of the case, and a host of  characteristic  symptoms, more or
 less of  which are always present.  The main ones are, loss of appetite
 and strength, eruptions on the skin of a coppery color,  ulcers in  the
 throat, paleness of the face when free of eruptions, low spiritedness and
 melancholy, nocturnal pains, fetid discharge from the nose, enlarged and
 indurated testicle and impotence.  In addition to these symptoms, we
 also find various  local affections  which are readily distinguished, and
 of which we  shall speak  presently.  The important diagnostic points are
 the history of the case, and the existence of substernal tenderness, which
 it is claimed  is present in the great majority of cases of  constitutional
 syphilis.
    The prognosis is always serious, for, at most, we can only promise a
 certain degree of relief, although cures do take place with some disfig-
 urement, as the loss of a nose or  palate, extensive scars, etc.  There is
 always some reminder of the disease left.
    When secondary symptoms are light, or when  tertiary symptoms
 come on very early, we fear syphilis of the brain and spinal cord, which,
 although of comparatively rare occurrence, is sometimes seen  in  hard
 drinkers, sedentary persons, and those who have had much mental anxiety
 or some previous  nervous affection.   Syphilis of the nervous system has
 received considerable attention and study the  past five years, and al-
 though not perfectly understood, we are still in a position to intelligently
 treat all such cases.  Men are more prone to nervous  affections  than
 women, and are affected  at any time from  six months to twenty years
 after infection.  The brain is more frequently affected than the spinal
 cord—in fact very little is known concerning syphilis of the cord.  Para-
 plegia is, however, the leading symptom of the latter.
    Bumstead  states that "the nervous phenomena of syphilis  gen-
 erally originates in lesions developed  in one or more of the following
 structures: 1.  The cranial bones  and  vertebra; 2.   The dura mater;  3.
 The arachnoid and pia mater; 4.  The  brain and cord; 5.  The arteries;
 6.  The nerves."  These  nervous  phenomena may be due to (1) inflam-
 mation of the brain caused by the  presence of nodes, caries, necrosis; (2)
 to thickening of the dura mater, this  membrane being  peculiarly sus-
 ceptible to the syphilitic  influence; (3) to congestion of the arachnoid
 and pia  mater, with thickening of their membranes or gummatous infil-
tration;  (4) to red or white softening of the brain and cord; (5) to inter-
 ference with  the  circulation of the blood caused  by thickening of the
coats of the vessels  and deposit of white  blood corpuscles along  their
inner walls; (6) to compression of the  nerves by swellings, to neuritis or
perineuritis, or alterations in the texture of the nerve.
    The symptoms of syphilis of the brain depend greatly on the locality
of the lesion.   If situated in the cranial bones or meninges, intense, per- 
TERTIARY AFFECTIONS OF THE MOUTH.        47
sistent headache with nightly aggravation, is a prominent symptom, but
vertigo, sleeplessness, delirium and photophobia, are not unusual.  This
headache is  frequently limited to one-half of the head, although it may
shift its position.  The symptoms are of a most varied character depend-
ing upon the amount of structure involved, and the degree of pressure
upon the surface of the brain.  Mental imbecility, epilepsy and paralysis
are caused when the arachnoid and pia mater become thickened  and in-
durated or infiltrated with a gummy deposit.  Coma, convulsions, para-
plegia and hemiplegia are almost always the result of excessive doses of
mercury. Very often the diagnosis can only be made by the process of
exclusion and by the history of  the case.  The prognosis is not as grave
as in other similar maladies, for  it has been found  that  the gummy
nodules found in the substance of the  brain, the caries and necrosis of the
skull-bones,  and other  evidences of disorganization are  wonderfully
affected  by  remedial  agents.   For instance, Sil., Aurum, Nitric ac,
Fluor ac, Hepar, etc.
    Tertiary affections of the mouth and throat are very common. They
manifest themselves as scaly patches due to epithelial thickening, resem-
bling icthyosis, but cannot be scraped off as they bleed readily on being
touched, or  as characteristic ulcers, which, if not arrested, gradually
spread to the maxillary and palate bones, destroying everything in their
way, even the bones, so that the  buccal and nasal cavities  become  one.
In all such cases the voice becomes  greatly altered.  Aurum, Sil., and
Nit. ac. have served  us best in such cases, as they have also in tertiary
syphilis  of the tongue.  This form appears  in a similar way in the shape
of scaly  patches, or as ulcers situated  upon the sides of the tongue at or
near its middle, and are of considerable extent and depth.   The base of
the ulcer has a hard feel like that of a chancre.   The diagnosis is some-
times quite difficult unless the history of the case can be obtained.  In
some cases it has been confounded with cancer.
    In a certain proportion of cases the teeth become affected in  tertiary
syphilis, as  is shown by the crown gradually separating from the  fang.
It is still an open  question whether syphilitic erythema takes place in
the intestines, but  it is generally conceded that it does.  At any  rate we
are positive that ulcerations of a syphilitic  character occur  in a certain
proportion of cases, affecting principally the colon  and the small intes-
tine, near the illeo-caecal valve.   They may occur also in  the stomach,
and are  manifested only by indigestion and  pain  in the  epigastrium.
The diagnosis of intestinal ulceration  can be made only by the existence
of long-continued diarrhoea cr  dysentery, which  does not yield to ordin-
ary treatment, by the existence of well-marked syphilitic lesions else-
where, and the history of the case.  In one case which came under our
observation, but not  under our care, the dysentery resisted  all treatment
for a period of ten months, and death was the result.  Excessive doses of 
48                TERTIARY ULCERATIONS.
mercury, we believe, is a predisposing cause  of  this complication, and
Nitric acid is our most valuable remedy, although often  Merc. cor. high,
acts well.   Aloes in  one case relieved greatly.  Sulphur should  not be
overlooked.
    Ulceration  of the nasal mucous membrane  may occur as a second-
ary or  tertiary manifestation,  and even  as a primary  disease, the
chancre sometimes  appearing here first.  We shall, however, confine
ourselves to the third  stage, merely  remarking in  passing that sec-
ondary ulcerations  are recognized by the  copious,  bloody and  puru-
lent discharge,  which is  persistent.  In tertiary ulcerations, or  syph-
ilitic ozaena, as  it is frequently called, a very disgusting  and offensive
disease, there is a  similar  discharge, but it is  very fetid.  The voice
is altered,  becoming- muffled and nasal.  This variety  is slow and
insidious  in its progress,  involving  eventually the cartilaginous and
osseous structures, and the ulcerative  process may perforate the  sep-
tum  or the floor  of the  nasal  cavity,  or destroy the  entire nose,
unless soon arrested.  The sense of smell  is  usually destroyed, and the
taste  somewhat impaired.   Pain at night may or may  not be present.
When the cartilages are destroyed, the tip of the nose is  flattened and
depressed;  when necrosis of the nasal bones occurs, the  tip is elevated.
After a cure in  these cases, the bridge of the nose is permanently sunken,
giving a peculiar appearance to this important feature of the face.  Aurum
is by far the most important remedy in these cases, although Nitric acid,
Sil., Hepar, and other remedies have been successfully employed. Nitric
acid should be given if the  patient has already taken mercury in large
doses.
    The mucous membrane of the larynx is not unfrequently affected in
the secondary and tertiary stage.  In the former, as erythema, superficial
ulceration, mucous  patches and chronic inflammation with  hypertrophy
of the mucous membrane—in the latter as deep  ulcerations, gummy tu-
mors, perichondritis and necrosis.  The tertiary lesions seem to be more
common and occur from two to eight years after the primary sore.   The
symptoms of laryngeal syphilis are very deceptive and not  in proportion
to their gravity. A superficial ulcer  may be complicated with oedema
threatening life on the one hand, and on the other the cartilages may be
partially destroyed without the patient being aware of anything  serious.
It is unnecessary to here mention the  secondary  manifestations, as they
are similar in appearance to those situated on other mucous membranes.
Suffice it  to say that the  inflammation or  ulceration  pursues  a very
chronic course and is quite difficult to cure. In the tertiary form, the vocal
cords, the arytaenoid cartilages, and the epiglottis become involved, and are
finally destroyed by the ulcerative process. Frequently, instead of ulcer-
ation, the mucous membrane becomes  covered with a number of gummy
tumors of a red, fleshy appearance, of the size of  a mustard seed or small 
SYPHILIS OF THE AIR PASSAGES.
49
shot, and are usually most abundant about the vocal cords. These tumors
often degenerate into deep, ragged ulcerations, which may eventually
impede respiration and destroy life. The tracheal  rings are sometimes
necrosed and thrown off, and suffocation may result from oedema  of the
glottis, or even from the attendant ulceration.
    The  symptoms present in syphilitic disease  of  the larynx are not
uniform in degree;  pain may be entirely absent, or there may be painful
and difficult deglutition, especially on swallowing  fluids, at which times
the patient may be threatened with suffocation.  Pain  in the ear  of the
affected  side is  usually complained of.  The voice may be hoarse and
husky for months, and in time is either completely lost or reduced to  a
mere whisper.  Cough is always present to a greater  or less extent, the
expectoration  being scanty, or copious,  fetid,  bloody, and sometimes
mixed with fragments of cartilage  or bone.  The  larynx is frequently
tender on motion and pressure; copious and exhausting sweats are not
uncommon; emaciation and debility follow in due course of time, and
the patient may  die of exhaustion,  suffocation or even  hemorrhage from
the ulceration of some one of the laryngeal arteries.
    The diagnosis is rarely attended with difficulty when we take into
consideration the history of the case, the symptoms just enumerated, and
the presence of  syphilis  in other  portions of the body.  The prognosis
should be guarded, as oedema of the glottis is a  frequent and dangerous
complication.  The remedies best  suited to  this variety of syphilis  are
Lach., Carbo. veg., Ars., Sil., Hep. and Nit. ac.
    Syphilis affects the lungs but rarely, and usually presents itself in
the form of gummy tumors, six or eight in  number, of a  dirty white or
grayish  color.   These  tumors  resemble those of other organs.  The
symptoms  of  pulmonary syphilis  are identical with those of chronic
phthisis, viz.:  night-sweats, cough, emaciation,  shortness  of breath, etc.
The diagnosis would be impossible without a history of the case or  the
presence of other evidences of syphilis.  Carbo.  veg. was the only remedy
we used in the case of a physician, and a complete cure was the result.
The disease had lasted several months.  Nit. ac, Ilepar., Sil. and Sulph.
have also proved valuable.
    The bronchial tubes are also sometimes the seat of syphilitic  ulcera-
tions.  The prognosis is unfavorable in all cases, for cicatrization of the
ulcer leads to contraction and stricture, and the  same is true of the  air-
passages generally.  The remedies mentioned above may be given, and
some relief will  be experienced, if not a cure.
    Deafness  may occur early in  syphilis  as a temporary  ailment, but
later in the disease it  is apt to  be  permanent.  It is sometimes pro-
duced by. syphilitic  growth of the  external  meatus, at  others by  a
mechanical obstruction  of the pharyngeal openings  of the Eustachian
tube, or by the remains of a  soft palate  becoming adherent to the pos-
    4' 
50
IRITIS.
 terior and  lateral  walls of  the  pharynx.   Syphilis  of  the  ear is of
 rare occurrence, about one-half of one per cent, of all cases, and is
 not as well understood, particularly when affecting  the inner ear, as
 when affecting other organs of the body,  It occurs,  when not hered-
 itary, in intemperate persons, and makes its appearance in  the  form of
 sudden deafness, the result of catarrhal inflammation or other causes,
 accompanied with more or less pain, or at least a sense of fullness in the
 ear.  Both ears  are usually affected at the same time, but not invariably.
 This inflammation may result in ulceration and destruction  of the tym-
 panum, and consequent deafness, which is permanent.  In bad cases, the
 Eustachian  tube, the middle  ear and even the bones, not only of  the ear,
 but the petrous portion of the temporal, also, become involved.  The
 diagnosis is based entirely on the history of the case, as there  are abso-
 lutely no other diagnostic symptoms in most cases.  Ars. Aurum, Hepar,
 Nit. ac. and Sil. are  useful.
     Iritis is the  most common, as well as the  most  serious  affection  of
 the eye developed in the course of syphilis.  It is generally claimed that
 more than one-fourth of all cases of iritis are of syphilitic origin.  It may
 be either acute or chronic, and occurs either as a secondary or  tertiary
 manifestation  after  exposure to cold,  even  in  strong  and  otherwise
 healthy people.  It  is  usually associated  with papular,  tubercular or
 pustular eruptions, ulcerations of the mucous membranes,  rupial sores
 or rheumatic pains in the bones.  This affection will be recognized by a
 peculiar vascularity around the cornea and of the iris, by the fixed and
 contracted pupil and its displacement upward and inward.  The iris is
 changed in color, and is covered with reddish-brown tubercles or minute
 yellow abscesses.  Accompanying these changes is pain, either slight or
 severe, deep in the eye, forehead and temples, with nightly exacerbation.
 The disease is not limited to one eye, but almost invariably attacks both
 simultaneously  or successively.  It sometimes see-saws from one to the
 other eye.  The  disease rapidly extends to the cornea,  retina and other
 structures of the eye, and if not speedily arrested usually results in im-
 pairment of or total loss of sight. Surgeons have laid down certain definite
 symptoms for rheumatic and  syphilitic iritis, when in fact  there  are  no
 certain means of distinguishing them, aside  from the  connection of the
 one with rheumatism and the other  with syphilis.   In rheumatic iritis
often only one eye is affected,  while in the syphilitic variety it is first one
 and  then the other; the pain in the former is nearly constant, with slight
aggravation at night; in the latter the pain is variable, slight or very bad
at night,but absent during the day.  The exceptions make the diagnosis
difficult.
    As regards the treatment  of this serious complaint, mercury  is  rec-
ommended by  both  schools,  and if  the pupil does not dilate rapidly,
atropine  locally. When tubercles or small  warts  appear  on  the iris 
RUPIAL SORES.
51
Thuja may be used to advantage, although some physicians prefer Nitric
acid, especially if the patient has had a thorough course of  mercury.
Cinnabar is valuable in scrofulous individuals.  Hepar is necessary if
pus forms.  Aurum is indicated in advanced cases of tertiary, with a dis-
position to commit suicide.
    Ulcers of the skin or rupial sores  (to which we have already briefly
referred), may be met within the secondary stage,but usually they make
their appearance late in the tertiary, and hence should be at least men-
tioned in this place.  These ulcers are accompanied by nodes, rheumatic
or bone pains,  or with ulceration of the throat, nose and larynx, or with
all these ailments combined, or may result from  pustules, tubercles or
boils.  At all events, they are usually  preceded by papules, pustules,
tubercles or scaly eruptions.  These  sores appear only  in those with
broken-down constitutions, and show intense  syphilitic infection. They
make their appearance most frequently on the extremities, or where the
integument is thin, or where they are  moistened by the secretion of the
part, and occasionally on the scalp, forehead and temples.  They vary
greatly in size, being as small as a split pea or as large as a cut melon, or
even larger when several run together.  Their shape is usually circular
or  oval, and they tend to spread  in circles.  The  edges are  callous,
elevated and ragged, often everted; the surface is covered with a  foul
grayish or greenish matter, the discharge being thin, ichorous, offensive
and often profuse.  They are sometimes painful  to the slightest touch,
but not usually.  The ulcers are generally superficial, the depth being
about  one-half the thickness of the  integument, although they do in rare
instances penetrate to the muscles and bones.  Their duration is usually
chronic  when  not influenced by medicines.  They  continue for  some
time; at certain intervals creeping along slowly and eating deeply, at
others healing, and again at others  showing  no appreciable change for
days at a time.  They  may become phagedenic, gangrenous, etc., the
Bame as the primary sore.
     Febrile action  is not uncommon during their existence, although
it is slight. The  patient complains of being tired  and weak, has no
ambition, no appetite  and an uneasy, unrefreshing sleep; his bowels are
costive; his skin is dry and hot;  his  pulse small and somewhat accel-
erated;  his  appearance  is  that  of  an  old man; frequently  suicidal
thoughts enter his mind.  The scars left by the healing of the ulcers
are at  first brown or bluish and finally very white, puckered in the center.
They are prone to re-open from the slightest  irritation.
     The diagnosis is usually easily  made, for the ulcers  present a chan-
cre-like appearance, with the copper-colored areola, and, in addition, we
find other evidences of syphilis present in the great majority of cases.
     As regards the treatment, we shall mention  Asaf. when the ulcers
are very sensitive to the touch. 
52                SYPHILIS OF THE NAILS.
    Lachesis for bluish appearance of, and gangrenous ulcers.
    Arsen. for phagedenic ulcers.
    Sil. for penetrating ulcers, with thin, offensive discharge.
    Aurum for suicidal tendency.
    Nitric acid, Mercurius, Carbo. veg. Ars. jod, and  other remedies may
be called for in special cases.
    The nails are sometimes attacked by syphilis.  The various erup-
tions we have described,  may occur upon the fingers  and involve the
nutrition of the nails. Onychia or inflammation of the matrix is a com-
mon result in such cases, and the nails become dry and black and drop
off, leaving an ulcer.  Or there may be destruction of  the  nail without
ulceration or without inflammation of the matrix—this, however, is very
rare.  Not all of the nails of a hand or foot  are attacked—usually not
more than two or three altogether.   There is no pain, as a rule, although
the affection continues a long time. In  exceptional  cases, the pain is
intense, and runs up the arm.  If the disease is not speedily arrested,
the matrix is apt to be  completely destroyed, and the nail,  of course,
never forms again.  When the matrix  is  not  destroyed, the nail  grows
again, perhaps normally, but usually distorted in various ways.  Consult
Aur., Ant. e Ars., Caust., Graph., Hep.,  Merc, Sil., Sulph.
    Tubercles, or gummata as they are termed, are liable to form where
the sub-cutaneous cellular tissue is loose and abundant,  during the prog-
ress of  tertiary syphilis  (rarely  earlier than this  stage), especially in
enfeebled persons or those of broken-down constitutions. Gummata are
essentially syphilitic indurations of the connective tissue, varying in size
from that of a pea to that of an orange, and in number  from one to six.
These tumors are of slow growth; they are painless, but slightly tender
to the touch;  they  have a firm, semi-elastic feel, retaining their shape
under firm  pressure, and they are hardly ever situated near together, but
are widely separated. When located just  beneath  the  skin, they have a
deep reddish-brown color previous  to suppuration.  They are  movable
at first for a period of several weeks or months, but gradually contract
adhesions to the  surrounding skin, and eventually suppurate and ulcerate
if uninfluenced by internal treatment, discharging a honey-like  or thick
gummy matter, with a slight admixture of bloody pus.  After the dis-
charge, a cavity, circumscribed by  a cyst, remains, or an ulcer resembling
a chancre, which may become phagedenic, gangrenous, etc., the same as
the primary sore.
    As one crop  of these tubercles disappears, it is usual for  another to
take its place, and thus  the disease may be  prolonged for a number of
years.   The tubercles consist of fibro-plastic matter, small nuclei and
fatty granules, intermixed with amorphous substance.  Quite  frequently
gummata form in the muscles and  tendons, and in  the  viscera as well. 
AFFECTIONS OF THE BONES.
53
 Gummata of the muscles and viscera are usually preceded by disease of
 the bones, but not invariably.  The diagnosis is easily made, as a rule.
    The treatment consists in building up the system, prohibiting alco-
 holic stimulants and administering such  remedies as Hepar, Nitric acid,
 Sil., etc.
    Lesions of the periosteum  and bones are almost always preceded by
 a series of superficial  secondary symptoms, and do not usually declare
 themselves  until very late in the tertiary stage, that is from two to four
 or more years after the  primary  sore, although we may find hone pains
 previous  to the cutaneous  eruption, or  may have nodes in secondary
 syphilis, but they are simply a sub-periosteal oedema  and hyperemia,
 and disappear promptly  under treatment. Mauriac asserts that the bones
 may  be affected even before  the appearance of cutaneous  eruptions;
 but this opinion is not generally indorsed, except  when the disease is
 hereditary.  Affections  of the osseous  system are met with  only in
 scrofulous or intemperate persons, or in those who have been  actively
 treated with mercury. We thus see  another form of syphilis which can
 often be laid at  the door  of this poisonous drug, notwithstanding many
 of our allopathic friends  deny that mercury ever  causes bone  disease.
 Truly, the remedy is worse than the disease.  Mercury administered even
 in small doses and continued for some  time, deteriorates the system  and
 renders it more  prone to  take on a low grade of inflammation, and this is
 particularly true of its action on the osseous system.
    The limit of lesions of  the bones cannot be assigned—they are liable
 to last as long as the syphilitic diathesis continues.  This form of tertiary
 occurs as nodes or soft tumors, inflammatory hypertrophy, exostosis, ca-
 ries and necrosis. The bones usually affected are the superficial  ones, as
 the tibia,  fibula, ulna, clavicle,  palate, nose, upper jaw and the bones of
 the skull, although in exceptional cases almost every bone in the body
 becomes affected.
    A node  is  a  gummy formation, and may be defined as an inflamma-
 tory osteo-periostitis,  terminating  usually in a new formation of bone.
 Nodes occur generally on the tibia,  ulna, clavicle and skull.  They  are
 of a rounded or elongated shape, semi-solid, elastic  and somewhat pain-
 ful to the touch, and from a quarter of an inch to two inches in diameter.
 They  begin beneath the periosteum upon the surface of the bone, to
which they are attached, as an inflammation, followed in a few days by the
deposition of a gummy substance  of a greenish hue, often mixed with
pus, or  the gummy substance may be entirely wanting, and the tumor
composed entirely of pus.  This  tumor should never be opened, as it
may undergo resolution at any time under appropriate treatment.  Even
in cases where it seemed on the point  of bursting through the thinned
skin, this has  happened.   Not  only  the periosteum, but the bone, like-
wise, is  inflamed, softened and ulcerated, and, as  the  tumor grows, it 
54
CARIES.
involves the structures above, which become reddened and painful.   If
opened artificially or otherwise, the discharge consists of a gummy sub-
stance mixed with pus, or of pus alone.
    A node is really an abscess of the fibrous and  osseous tissues.   Its
course is always indolent, and the pain which accompanies it is of a neu-
ralgic character, greatly aggravated at night.  This pain in most cases is
only present at night, and seems to be occasioned by the heat of the bed,
for if the patient  from any cause fails to go to bed and remains  up all
night, the pain does not  come on.  In a night watchman the pain came
on when he went to bed every morning.  After a node ulcerates, it shows
but slight  tendency to extend, but it may become gangrenous, phage1
denic, indolent, etc.; in other words, it may take on  any kind of  action
common to syphilis. Sometimes  a node will remain as a hard, fibrous
swelling, perfectly  painless, for a number of years, causing  the  patient
but slight  inconvenience, but at  any time it may suddenly soften and
involve the bone in destruction.  After anode ulcerates, the floor is bone
denuded of its periosteum, which soon becomes black, and  necrosis
occurs. Scars  are  always left to tell  the  tale, and  they are  white,
puckered, attached to the bone, and  often pigmented at the circumfer-
ence.
    The diagnosis  is not difficult, as the appearance of the swelling, the
course of  its growth and  the  nocturnal pains are characteristic. The
treatment consists in the use of one of the following remedies:
    Asaf, nodes very sensitive to the slightest touch,
    Nitric  acid or Kali, jod., after the abuse  of mercury.
    Hepar or Sil., during the suppurative stage.
    Ars., Lach., Carbo. veg., for phagedena or gangrene.
    Mezer., Staph.,  Phos. ac, for intense pains in the periosteum.
    Fluor acid, burning, intermittent pains in the bones.
    Caust., excessive physical depression and loss of strength.
    Plumb., Plat.,   Phos.,  Puis., Petr., Sulph., Lye, Natr. m. and Ars
should also be carefully studied.
    Dry caries, which is characterized by the entire absence of suppura-
tion, occurs late in syphilis, and is recognized by intense localized pain
without swelling.   The parts affected are the flat bones, as the frontal
and parietal, sometimes one table only and at others both.   It is caused
by gummy deposits in the outer sheaths of the vascular  supply, or by a
cutting-off of the nutrition of the part by an  inflammation and degenera-
tion of the vascular periosteum.   The disease occurs only in those of
advanced age.  Caries, or ulceration of the bone, affects principally the
tibia, ulna,  palate, maxillary, turbinated and ethmoid bones, and presents
itself  in different forms, viz.: As the  simple ulcer, serpiginous ulcer, or
as worm-eating caries. It is denied that caries is strictly syphilitic, but is
due entirely to a development of the scrofulous diathesis.   Caries is usu- 
NECROSIS.  EXOSTOSIS.                 55
ally conjoined with necrosis, although it may exist alone.  In some cases
as we  have already remarked, the mouth and nose  communicate, the
intervening structures being totally destroyed.
    Necrosis or  death  of the  bone usually follows  caries, especially in
the thin bones of the nose, palate, etc., but it also occurs in the cranial
and jaw bones in very many cases.
    Hypertrophy, or hyperostosis,  may  implicate  any portion of the
osseous system,  although  it  usually affects the  superficial and  long
bones.  It is occasioned by the deposition of gummy tubercules in the
medullary  canal, and  in the  substance of the bone itself.  The sur-
rounding  tissues  exhibit  no sign  of  inflammation,  but the  part
affected becomes greatly enlarged, a solid osseous substance is substi-
tuted for the spongy matter, the medullary canal is obliterated and the
bone becomes similar  to ivory in  texture.  The symptoms present are
few  in number, viz: The characteristic  nocturnal  pains and neuralgic
pains of varying intensity at all times in the muscles and tissues in inti-
mate connection with  the  diseased part, with  an  increased feeling of
weight in the limb.
    An exostosis originates in a plastic periostitis, and is the same thing,
but usually does not affect but a small portion of  the bone, the tumor
being  of variable size, knotty and irregular with  a  broad base.  The
tumor or tumors may  at first be movable  upon  the bone  beneath, but
after a time, if resolution does not occur, becomes attached and  a part of
it.  When  an exostosis springs from the inner surface of one of the cra-
nial bones, it gives rise to very serious symptoms, terminating frequently
in convulsions and paralysis.  In deep-seated regions where direct explo-
ration  cannot be made, exostosis can only be suspected from  the history
of the case.  When the tumor becomes eburnated, no internal treatment
is of avail,  and surgical interference may be' necessary.
    The cartilages are sometimes attacked by gummy infiltration as well
as the bones, particularly the cartilages of the larynx, and necrosis maybe
the result.  We  have already spoken of this.
    Mercurius is recommended for exostosis, but as patients thus afflicted
have usually taken large doses of  mercury, we  find Nitric  acid a  more
useful remedy for this as well as for other bone affections.
    Aurum is valuable when the bones of the face, nose or skull are af-
fected.  Suicidal tendency.
    Sil., Kali, jod., in scrofulous persons. Ulceration of the bones with
fistulous openings;  inflammation of the periosteum.
    Fluor acid, burning and intermittent pains in the bones.  Imaginary
fears;  ill-humored.
    Phos. ac, intense pains in the periosteum of all the bones as if scraped
with a knife; low-spiritedness. 
56
SYNOVITIS.
    Asaf, violent pain in the bones, and discharge of fetid, thin, ichorous
pus; crampy jerking and drawing in the bones at night.
    Hepar, swelling or inflammation of the bones.
    Mezer., tearing and burning pains in the bones; dark, turbid urine.
    Petr., brown spots on the wrists; skin ulcerates easily; fetid urine.
    Rhus.  Rheumatic pains aggravated on first moving after rest and on
getting up in the morning.  Worse during rest, better  from  continued
motion; paralysis of lower limbs; warts on various parts of the body.
    Staph., caries, particularly of the teeth; pressive  pains in the peri-
osteum; confusion of the intellect.
    The joints  are occasionally involved  in both secondary and tertiary
syphilis.   Specific inflammation may attack the articulations at the out-
Bet, or by the extension of an osteitis from the articular extremity of the
bone.  It  occurs in weak, ill-fed and ill-clothed persons.  In  secondary
syphilis, synovitis is attended by pain, fever, sweat, etc., much resembling
in its general symptoms acute articular rheumatism, but the affection
begins slowly and painlessly.   There is always effusion into the joint, but
there is an intermittent character to this effusion, the fluid sometimes ap-
pearing and disappearing rapidly, to again re-appear, or it may make its
appearance slowly and as  slowly go away; but in either event, it is very
prone to re-appear from very slight causes.  There is no tendency to sup-
puration or to destruction of the joint.  The synovitis of the tertiary stage,
however, is attended with lesions of the  joint structures. The synovial
membrane becomes thickened  and incrusted with gummy matter, while
its cavity contains a turbid, viscid fluid.  Stiffness of the joint and of  the
surrounding muscles and structures is complained of, especially on motion
in  the morning.  The  pains  are  usually worse at  night and in wet
weather.   The  character of the pain is dull and aching,  seldom tearing
or burning.  Aside from the* deposit in the synovial membrane, there is
usually a gummy infiltration in the muscles and other structures  about
the joint.   The knee, elbow and wrist joints are the parts most liable to
be attacked, although in rare cases hardly any joint is exempt.
    The disease may remain stationary for years.  There is but slight ten-
dency to complete anchylosis. Unless the syphilitic antecedents of a white
swelling are known, the diagnosis is impossible, although we know that
its  onset is insidious, and that it pursues an  indolent course.  Consult
Bry., Rhus., Caust., Asaf, Led., Merc, Stict., Sil., Sulph.
    The  urinary organs  are not  entirely exempt from  the  ravages of
syphilis,  but as yet  the lesions are not very well understood, and their
diagnosis is often a matter of considerable  difficulty.   Gummata  are
rarely met with in  the kidney, but  when found they  seldom exceed
the size of a pea. Deposits in the kidney are always associated with sim-
ilar deposits in the liver  and spleen.  As a rule, there is  no local pain or
general fever, and the existence of the  disease is surmised  only by the 
«
SARCOCELE.  ORCHITIS.                  57
presence of albumen in the urine and the history of the case.  It should
be remembered, however, that the urine  is not always albuminous, and
then the diagnosis cannot be made, except by a post mortem examination.
     Syphilis of the ureter and prostate does not seem to occur, neither
does syphilis of the bladder, except in connection  with disease of the
spinal cord.   The spermatic cord is sometimes the seat of gummy deposits.
    Gummata occur in  the corpora  spongiosum, and in the corpora
cavernosa in very rare  cases as a hard, painless nodule without redness.
It has a semi-elastic feel when pressed between the fingers.  If seated on
one side, it causes deflection of the penis when erect toward that side;
but if it assume the annular form, the penis, during erection, is turged
from the crura to the seat of the lesion,  but beyond  that is flaccid and
hangs at right angles to the rest of the organ.   The tumor reaches a cer-
tain size, and then may soften and shrivel away, or possibly may become
fibrous,  A  patient under treatment now who  has been treated  with the
Iodides, Mercury, etc., besides the local application of Iodine  is steadily
improving under the administration of Conium.
     Syphilis of the testicle, known under the name of syphilitic sarco-
cele, orchitis or albuginitis, makes its appearance  from two to fifteen
years after  the primary sore, and is usually accompanied by some form
of tertiary, as periostitis, exostosis, ozaena, or ulcers in the throat, although
in  rare instances it is  the only manifestation of syphilis present.   It
always denotes a low state of the system.   Exceptionally, in malignant
cases, orchitis may be developed in a very few months.   The exciting
cause of this form of syphilis may be  a blow or other injury of the parts.
The disease generally involves both testicles, either at the same time, or
first one  and then the  other at variable intervals.  In some cases, the
scrotum remains healthy and non-adherent, in others the disease event-
ually extends to the epididymus, forming one inseparable mass of  the
two structures.  Usually there is an entire absence of pain and an insen-
sibility to pressure.  To the touch, the testicle resembles a stone or block
of  wood, with slight  knobby projections.  Toward night the testicles
feel very heavy, and if left hanging  unsupported, occasion a dragging
sensation in the spermatic  cord, but there  is no »-eal nocturnal exacer-
bation as in bone disease.  There is usually  a slight aching pain in
the small of the back.  The testicles not only become heavier and harder,
but are greatly enlarged, sometimes becoming three times their natural
size. The surface of the tumor, which preserves the normal shape of the
testicle, is usually smooth, only rarely knobby. In advanced cases, the
spermatic cord becomes involved, and is hardened  and thickened.   In
malignant cases, fortunately very rare, tubercular deposits occur, which
terminate in the formation of ulcers and in the production of fungi.  The
course of orchitis is exceedingly slow and chronic.  The sexual desire is
greatly diminished, or entirely lost.  Orchitis is of occasional occurrence 
58
SYPHILIS OF THE LIVER.
in inherited syphilis.  The affection terminates in resolution or in fibrous
atrophy, and, as we have already stated, in ulceration in bad cases. Early
and persistent treatment will restore the parts to their normal condition.
    The testicle has frequently been amputated, under the  supposition
that the affection was of a cancerous nature.  In cancer, pain is a promi-
nent feature, but not in orchitis.   The diagnostic points are absence of
pain, insensibility to pressure and a syphilitic history.  As regards treat-
ment, we have found Conium of very great service—in fact, it is the most
important remedy.  Clem., Puis., Nit. ac. and Lye are also useful. Hepar,
in cases with ulceration.  The remedy should be chosen according to the
totality of the symptoms.  Spongia has proved curative in several cases—
in one the testicle was four times its natural size.  A sailor was greatly
benefitted by Aurum, but was lost sight of before a cure resulted.
    Impotence, as  we have shown, is sometimes due to orchitis, but in
other  cases it may come on independently of any cachexia,  or may be due
to some impression upon the nervous system.
    Syphilitic ovaritis is not uncommon, and is  apt to be associated with
gummy tumors in the breast. The only symptom is painless  swelling of
the organ.
    The rectum  is frequently involved  in  syphilis, either  through
chancres situated near the margin of the anus,  or through secondary or
tertiary ulcerations  within the gut.   In  either  event, stricture of the
rectum is usually the result.  The  patient complains of a great desire to
go to stool, with pain in the rectum, attended by an excessive discharge
of pus and bloody feces.   Constipation is rare, and is present only at the
commencement of the'ulceration, or in  very exceptional cases.  As a
result of this constant losss  of blood, the  patient becomes  weak, loses
flesh and suffers from gastric difficulties.  We have never  seen these
rectal  ulcerations in men, and hence infer that they are much more
common in women.  The stricture when present yields to the influence
of properly selected remedies, such  as Nitric acid, Phos. acid, Caust.,
Hepar.
    Syphilis attacks the .liver  more  frequently than any other of the
viscera; in secondary, in the form of congestion, with icterus; in tertiary,
as chronic interstitial hepatitis, as  gummata, or  as amyloid degeneration.
The symptoms of chronic  hepatitis are those of ordinary cirrhosis.   The
diagnosis  of gummata is  very difficult and often impossible. Pain, if
present, does not extend  to  the shoulder, as in other affections of the
liver.   Blood may be  expectorated and passed with  the clay-colored
stools; epist'axis is not uncommon; icterus is present in a certain propor-
tion of cases; the skin is dry and cool. The symptoms of amyloid degen-
eration resemble those of cirrhosis.  Treatment promises but little, except
in gummata of  the liver, when  such anti-syphilitic remedies as we have
frequently mentioned may be administered. 
HEREDITARY  SYPHILIS.
     The terms congenital and infantile have been used, and are still used,
 to  designate  this  form of syphilis.  The term congenital  should be
 employed only where a child is infected during labor; and as the term
 Infantile means simply syphilis of children, it is better and more accu-
 rate to call this division of our  subject  hereditary syphilis.  Hunter
 denied the inheritance of syphilis, but at ihe present day his opinion  is
 not accepted.   It is true that we are  still  ignorant of the  amount and
 nature of the  constitutional affection of the parents that  is  necessary
 for the development of syphilis in their children; but we are not ignor-
 ant of the fact that it is possible for syphilis to be transmitted by inherit-
 ance.  There  is a vast  difference  of  opinion as regards the etiology of
 this form of syphilis, and we can in this lecture  give you only a brief
 summary.
     Arbitrary rules regarding the parental  influence in the  transmission
 of syphilis unfortunately cannot be laid down, and, as a matter of fact,
 there are two  sides to almost every question which we shall discuss.  We
 are certainly not warranted in concluding  from our present knowledge
 that a parent who has been, or even who is, suffering from constitutional
 symptoms will necessarily procreate a syphilitic child.  The vexed ques-
 tion, and one which seems as far from solution as ever, is: Does the child
 derive its disease solely from the father, the mother being healthy?
     Some authorities assert, and others  deny, that the father  can com-
 municate  the  disease  to the offspring.  Cases are  reported  showing:
 1st.  A syphilitic father, and  a healthy child.  2d.  A syphilitic mother
 and a healthy child, and even, 3d.  Both parents syphilitic  and still a
 healthy child.   It may be stated as a  general  rule, however, that when
 both parents  are syphilitic the child will  be affected.   And  this rule
 usually holds  good, even after the disease has  become latent in the
 parents, that is, even after they seem to have entirely  recovered.  In
 course of time syphilis wears itself out or  is relieved by treatment and
 the offspring escape infection. Parents suffering from active syphilis are
 not able to raise the child—it dies  in  a  few weeks  or months—or more
 often still, the  foetus fails to reach maturity. A child born of  parents in
whom the disease is on the wane, or greatly modified by treatment, shows
usually but slight evidences of the malady, and it is stated and believed
by  many authorities  that after  six years  the risk of transmission is 
60       SYPHILITIC MOTHER—SYPHILITIC CHILD.
 extremely  slight.  M. M. Fournier and Barthelemy,  of  the St.  Louis
 Hospital, Paris, quote two cases showing that the taint of syphilis may
 be  transmitted to the offspring twenty years after the disappearance of
 all  symptoms of  the disease.   Such cases are very uncommon,  and
 it is likely that in such instances the disease had been  suppressed by
 active treatment, not cured.
    It is a fact known to all who have thoroughly investigated the sub-
 ject that there are certain periods of repose in, this affection—of longer
 or shorter duration—and during these  intervals it is possible that healthy
 children may be born.  For instance, the first, third and fifth child may
 be healthy, whereas the second  and fourth may be  diseased.  In other
 words it may be said that when there is no venereal  manifestation the
 child procreated runs but slight risk  of being infected.  But arbitrary
 rules cannot be laid down, and the statement, while it may be true as
 regards the father, is not as certain as  regards the mother, who may bear
 syphilitic children at any time  and under all circumstances.   There are
 so many peculiarities about the transmission of  syphilis  by inheritance
 that one can hardly make any statement that cannot be proved or dis-
 proved by numberless cases.  Syphilis tends to exhaust itself, and, as  a
 general rule, the children become less' and less diseased as  time goes on—
 that is, with syphilis—but scrofula may takejts place.
    There can be no possible doubt that when the mother alone  is syph-
 ilitic the child is quite certain to inherit the disease, except  during the
 intervals of  repose already  referred  to.  The ovum  being a  part
 of the   mother, whose fluids are poisoned,  it is almost  a   matter of
 necessity that it  should develop into an  unhealthy child.  Syphilis, it
 should be remembered,  while  occasionally a mild disease  in  women,
 generally affects  them  more profoundly than men.  Hence, there  are
 numerous exceptions, owing to this occasional mildness, and to the inter-
 vals of repose, and a syphilitic  mother may bring forth a healthy child.
 Oullerier, Notta, Adam  Owre, Sturgis, J. W. Thompson, Mireur, Follin,
 Charrier and others contend that syphilis is always inherited from the
 mother alone.  A peculiar fact, if fact it be, difficult of explanation, is,
 that a perfectly healthy woman having a syphilitic husband, and bearing
 syphilitic children, should, upon a subsequent marriage to a perfectly
 healthy man, continue, for a time at least, to bear syphilitic children.  It
 is impossible to account for it, except  upon the supposition that  the
semen makes a permanent impression upon the  ovaries, or that the dis-
ease is masked in the woman.
    When the father alone is syphilitic,  the child usually escapes if  the
mother remains well.  Nearly all authorities admit that the father is less
liable to transmit syphilis to his child  than the mother; but very few
deny that he does exceptionally  transmit it.  Caspary,  Keyfel, Van Har-
linger, Trousseau, Mayer, Kassowitz, Bumstead and others ascribe  equal 
SYPHILITIC CHILDREN RARE IN  SOCIETY.      61
if not more power to the father than to the mother in transmitting the
disease.  They believe in the main that the father alone—the mother be-
ing sound—may be the cause of syphilitic offspring, and that the mother,
if healthy at the time of conception, may remain  so.   Every practitioner
knows of scores of cases, if he has  paid especial attention to  syphilis,
where a diseased father  and a sound mother have given birth to perfectly
healthy children; but he does not remember more than one, or  possibly,
two  cases, where  a sound father  and a  syphilitic mother  produced
healthy children.  When we look at the vast number of young men, who
are, or have been affected with syphilis, the rarity of diseased children is
surprising, if we adopt the theory of transmission from the father.   And
yet we have evidence sufficient to prove that  exceptionally the father is
the cause of the syphilitic child.
    It is  a well-known  fact that in the higher walks of life, syphilitic
children are a rarity, and yet comparatively few young men of this class
escape contagion.   In the  lower walks of life, the  women are not  so
virtuous, and syphilitic children are quite common, hence adding weight
to the opinion that syphilis  is derived entirely  from the mother.  Henock
observed the  birth of  a  syphilitic child twenty years after the  infection
of the mother.
    It has never been conclusively shown that a healthy mother who had
given birth to a syphilitic  child, diseased from its father,  afterward be-
came herself poisoned by experimental or accidental inoculation.  Colles
states that a child with inherited  disease  may poison a healthy stranger
whom it suckles by inoculating the breast, but that the same child never
locally infects its mother.   If we accept  this  statement, we are obliged
to conclude  that the mother is already  affected.   He also holds the
opinion that the disease  may be communicated to the nurse by mere con-
tact without the presence of an abrasion or crack upon the nipple.  We
have  seen one instance of this where the most careful scrutiny failed to
discover any  abrasion, and yet the diseased child communicated syphilis
to the  nurse, in this instance  its aunt.   Caspary  found a seemingly
healthy woman with  a  syphilitic husband and a syphilitic child, and  he
inoculated the woman with the  specific virus without effect.   Thus the
woman, although  apparently healthy, probably had .a mild  form  of
Byphilis.  We say probably, because inoculation does not always succeed
any more than vaccination does.
    The date at which a pregnant woman may become syphilitic without
poisoning her child is after the seventh month.  If she gets chancre at
the moment of conception,  or soon after, she  is  apt to miscarry.  If she
gets it later, the  child  goes to term, but is  born thoroughly  poisoned,
with a poor chance  of surviving.  The  common agreement is that if the
chancre does not appear before the seventh month, the child is safe, but
there are numerous exceptions.  Bumstead  takes  the ground that the 
62
ABORTION.
 syphilitic virus of the mother cannot be conveyed through her blood to
 the child, for the reason that the essential vehicles of the specific virus
 are cells or albuminoid molecules, derived from an active syphilitic lesion,
 and the embryo is not supplied with cells of any kind after fecundation.
 So that a syphilitic child, born at full term of a mother infected at some
 time during gestation, is poisoned by the father.  For the same reason,
 he contends  that a healthy mother can bear a syphilitic child, the im-
 munity of  the mother depending on the absence of cellular elements in
 the fluid interchanged.
    Ricord speaks of this mode of infection, and  calls it choc-en-retour.
 He contends that a healthy  woman may conceive by a syphilitic man,
 and the ovum become diseased  through impregnation with diseased se-
 men, and in its turn poison the mother, the latter never undergoing chan-
 cre, but becoming directly contaminated by contact of her fluids with the
 infected fluids of the  foetus, thus giving the mother the modified form of
 the disease.  The semen nowadays is not supposed to contain the specific
 virus, but we do not believe a great many cases could be explained if we
 deny that it is ever the source of contagion.
    The transmission of syphilis to the third generation has been gener-
 ally doubted. Most authorities believe after it has once been transmitted
 by inheritance  it degenerates into scrofula, which, in its turn, may be
 transmitted.   The probable  reason  that cases are not met with is that
 children either  die before maturity or  get far  into the tertiary stage
 before they are old enough to marry.  One would think that this subject
 could be definitely settled with such a mass of cases constantly present-
 ing themselves, but the difficulty is to ascertain all  the facts, particularly
 in cases occurring in  families of good social position.   Men and women
 both will deny little  peccadillos that would throw much light on  the
 subject.
    As regards the mortality of syphilitic  children, it is  given  as fully
 thirty-five  per cent.  Abortion, the  result of the death  of the foetus,
 takes place before the seventh month, as the result of infection of  the
 mother during pregnancy  between  the first and  seventh months.  The
 foetus thrown off has  a livid,  purple  color; the skin shows nothing char-
 acteristic, but is .easily detatched.  The viscera show syphilitic lesions.
    As regards the  frequency of abortion, we quote the following from
 Dr. H. C. Jessen's monograph on "Hereditary Syphilis:"
    "For the  most careful analysis hitherto made of the fate of the  off-
spring of syphilitic marriages, with reference to the frequency of abor-
tion, the number of viable children, etc., we have  again to thank Kasso-
witz.  His  statistics include 330 births occurring in 119 marriages under
the influence of  syphilis of the father, the mother or of both parents.
    "Of these 330 children, 127, or 67 per cent., were bom prematurely
and of  these  127 births 31 were abortions, properly so-called.   Again of 
THE SYPHILITIC CHILD.
63
these 127 births, 80 per cent, occurred when the mother and 32 per cent.
when the father  alone was syphilitic.  Further, of these 127 children
102 were still-born; 11 died in the course of the first day;  7 in the course
of the first week; 4 before the end of the first  month, and but three sur-
vived.
    "Of these 330 children, only 203 were  carried to  full  term; of these
again 9 were still-born, so that of 330 children  of syphilitic parents 111,
or about every third child, was still-born.  Of  the  remaining  219, 80
died within six months, so that only 139 lived beyond childhood.   If we
now assume that all of these premature deaths were due to syphilis,which
is not quite justified, then of 330 children only  191, or about 58 per cent.,
are carried off from the parental infection.
    "These statistics, which are not from a hospital, but from the  private
practice of a single observer in the lapse of ten years, may give us some
idea of the enormous number of children which are sacrificed every
year to hereditary syphilis."
     It is usually stated that the syphilitic child born at full term is thin
and wrinkled. This  is  not always true.  As a  rule they appear well
nourished  and perfectly healthy, but before  many days or weeks  evi-
dences of  disease show themselves. The severity of the malady is in
proportion to its activity in either or each parent at the time of concep-
tion. The time of its appearance after the birth,  seems to depend upon
its severity.  Its early appearance indicates a very  malignant type.
     The prognosis is always grave in children  born with  manifestations
of the disease, such as pemphigus or large bullae scattered over the body,
filled with serum and blood.  The longer, however, the  syphilitic dys-
crasia is in making its appearance, the more favorable the prognosis.
     Among the first indications seen in a child born apparently healthy are
(about the sixth week) loss of appetite—the baby nurses  badly, has rest-
less sleep, its bowels are more or  less disturbed and it has the snuffles.
There is a difference of opinion as regards  this snuffling, some attribut-
ing it simply to a congested condition of the nose  with affection of the
mucous  membrane, and  others to disease of the nasal bones.  Some
authorities go so far as to say that it is never present as a  syphilitic man-
ifestation unless the bones are implicated.  The discharge may be offen-
sive or crusts may form, seriously impeding the respiration of the child.
    Emaciation commences as a result of  the  loss of the  appetite
and is usually progressive  until  the child is a mere skeleton, but in
exceptional cases the diminution in weight is  not  noticeable.  The skin
of the face becomes discolored and is drawn tight over the bones.  The
eyes become  very prominent—seldom sunken.   The  voice becomes
hoarse, feeble and  moaning from the implication of the larynx.  The
breathing is accompanied by a  slight  rattling and  is performed through
the mouth.  Mucous  tubercles soon make their  appearance about the 
64
SYPHILITIC PEMPHIGUS.
anus and in a short time on the  genital organs  and in the  folds of the
skin, irritated by the urine and feces.  On examining the chest and ab-
domen roseola will usually be found, after the sixth week, either preced-
ing or accompanying  the coryza.  The early change  of color  from a
bright red to  a coppery hue is an  important diagnostic  feature.  In
place of roseola we may find small and large flat papules,  at first dull
red and afterward coppery, scattered  over the body, similar to the same
affection in adults.  The  pustular syphilide appears about the  eighth
week and is found more  abundant on the thighs, buttocks  and face, al-
though invading the entire  body.  It is  sometimes associated with the
vesicular syphilide.
    Pemphigus is sometimes seen at birth, but more often when the child
is from one to  six weeks  old, and is situated mainly on the palms of the
hands  and soles of the feet.  Gummata and gummatous ulcers may ap-
pear as  early as the third year, but generally not  until  the tenth or
twelfth.  The viscera are affected at varying periods, from a few months
to several years, the liver almost uniformly being the organ first impli-
cated.  Affections of the osseous, fibrous and cellular tissues are usually
late in making their appearance, but exceptionally are very early.  The
temporary teeth are cut unusually early, are of a very bad color and soon
crumble away.  The child may possibly survive  under good treatment
until second dentition when the teeth, especially the upper central incisors,
present certain characteristics, diagnostic of hereditary syphilis, and first
described by Mr. Jonathan Hutchinson. The  upper central incisors when
first cut are unusually short, narrow from side to side at their edges and
very thin. After a time a crescentic  portion from their edge breaks
away, leaving a broad, shallow, vertical  notch, which is prominent for
some years. The  two teeth often converge and sometimes they stand
widely apart.   When this notching  is not present or but slightly marked,
there is still a dirty brownish color of the teeth and a narrow squareness
of form.
    Keratitis is seen in children of from five  to  fifteen years of age.
The opacity commences  in  the center of the cornea and gradually in-
creases until  the  greater part of the cornea is involved, giving to the
whole  structure the appearance of  ground glass.  It  is  followed by
vascularization, not confined  to the  surface, but invading the whole
thickness of the cornea, without  any tendency to ulceration.  Both eyes
are usually affected, first  one and then the other.
    The treatment of  hereditary syphilis varies according to  the symp-
toms present in any given case.  Nitric  acid we have  found one of the
best remedies,  particularly for ulceration of the  uvula, pharynx  and
fauces; vesicles on the  tongue and inside of the cheeks; swelling and
phimosis of the prepuce;  old ulcers on the body.  All cases  where much
mercury has been taken  by the parents.  Ulcerations of  mucous  mem- 
TREATMENT OF HEREDITARY SYPHILIS.       65
branes; affections of the  periosteum and bones; hemorrhages; yellow-
ness of the skin with constipation; oppressed breathing.
    Arsen.—For pemphigus, ulcerations, suppurations;  great exhaustion;
marasmus; skin dry,  shriveled; coldness and  chiliness of the body;
eruptions discharging a thin, acrid, burning ichor; excoriating discharge
from the nose; restless  sleep; cold,  clammy  sweats;  black vesicles, or
black  eruption; complexion white  and pasty-looking; pulse weak and
fluttering;  catarrh threatening suffocation at night.
    Aurum—Disease of the nasal or cranial bones, with  ozaena; scrofulous
children; eyes prominent; redness of  the sclerotica; swelling  of  the
parotid gland; swelling of the testicles; roseola.
    Asaf—C&ries and  ozaena.  Child  cries when dressing the  sores, or
even when preparing dressings; irritable; distention of the stomach and
bowels; colicky pains; stools brown and offensive; swelling of the  female
genitals; coldness of the hands with blue nails, and heat of the face.
    Calc. carb.—Thin,  pale   face, with dark  circles  around the eyes;
whitish  stools; great  debility;  painless  glandular  swellings;  offensive
smell  from the teeth;  swelling of the tonsils; milk does not agree; sour
vomiting;  very frequent  urination; unhealthy ulcerating skin; profuse
sweat  of the head.
     Carbo. veg.—Child peevish, restless; skin  blue and cold; urine dark
and red with red sediment; hoarse, rough voice; oozing from the anus
at night of a musty mucous; bleeding of the gums and nose.
     Hepar. — Suppuration  of indurated  glands;   pustular eruptions;
ulceration of  the  throat; fetid  breath; voice  hoarse  and husky;  fall-
ing out of the hair;  scurvy  eruptions; burning urine, excoriating the
parts;  iritis;  soreness and moisture in the fold between the  scrotum and
thigh, and about the anus; agglutination  of the eyes at night;  the nasal
mucus is bloody.
     Staph.—Caries of the teeth; ostitis and  periostitis;  restless sleep;
very nervous, starting at the least noise.
     }/e7.c._Affection6 of the mucous  membrane, the skin and the glan-
dular structures; greenish stools; turbid urine; loss  of  appetite;  pale,
bloated or sallow face; emaciation; nose pointed; breath offensive; the
gums  recede from the teeth; keratitis;  copper-colored eruptions on the
body.
     Cinnabaris.—When mercury, although indicated, seems to be of no
benefit.  Ulcers with hard,  raised, indolent edges; ulceration about the
anus;  swollen glands.
     Fluoric acid.—Softening, swelling and curvature of the bones; pain-
ful ulcers in the mouth; offensive urine;  sour, offensive perspiration.
     Benzoic  ac^.-Copious,  watery,  but very  fetid  diarrhoea; stools
watery, white; urine deep red, and very offensive; copper-colored erup-
tion on the fingers; copious perspiration at night.
    5 
66        TREATMENT OF HEREDITARY SYPHILIS.
    China.—Excessive weakness; one eye  open  and the other  closed
during sleep.
    Tartar  emetic.—Pustular  eruptions on  the thighs  and scrotum;
swelling of §the inguinal or cervical  glands; slimy, watery, yellowish
stools; rattling breathing; ulceration of  the mouth and tongue.
    Argent, nitras, Sepia, Silic, Phos., Phos. ac,  Kali, jod., Kali, hyd.,
Sulph., Lach., Lye, Thuja and other remedies may be called for, and have
proved valuable.  The symptoms should be carefully studied in every
case, as it is only by the most skillful treatment that  hereditary syphilis
can be cured. 
Gonorrhoea and Gleet
• 
 
GONORRHOEA.
    Various names have been  applied  to  this disease of the mucous
membranes of the genital organs and eye, at different times and places.
The American and English writers uniformly use  the  term, gonorrhoea;
the French, the words, blenorrhagia, or " chaude-pisse," the latter being
the popular name for clap.
    The disease is a very ancient one, and numerous references to it can
be found in the Bible.  See Leviticus, xv,  2-13.  It  is also, by far, the
most frequent affection originating in sexual intercourse, and is much
more common in males than females.  The causes are intercourse with
persons similarly affected, or with one suffering from leucorrhcea,  men-
strual or acrid discharges.  However, the affection is usually due to con-
tagion, for married men, whose wives suffer from leucorrhcea discharges
are rarely afflicted with urethritis.
    Among the causes of urethritis are mentioned masturbation, the use
of bougies, stricture, prolonged excitement of the genitals,  fermented
liquors, internal use of cantharis or turpentine, cancer of the womb, veg-
etations in the urethra, ascarides in the rectum, acrid urine, and cold.
    Urethral gonorrhoea in males is a violent inflammation of the mucous
membrane of the urethra, accompanied by a muco-purulent discharge, is
usually produced by the contact of a specific virus, and is by far the most
frequent affection arising from sexual indulgence.  The word gonorrhoea,
we should have stated, literally means a flow of sperm; the disease was
so named because the older writers considered the  discharge a flux  of
semen.  Of the nature  of the specific virus which gives rise to this affec-
tion, but little is known.  It is true that  the gonococcus  has sometimes
been found,  in the early stages, in the discharge, but it by no means fol-
lows that this microbe is the cause of  the disease.   In women  it
is exceedingly difficult to find.   The discharge  containing it  does
not differ,  chemically or  microscopically,  from  mucous  discharges
occurring in other situations.  It has been definitely  ascertained, how-
ever, that the virus is not identical, but  is distinct from that of syphilis,
and that it does not affect any other tissue  except the mucous. The spe-
cific poison is found usually in a purulent discharge from the urethra, al-
though the mucous membrane of the anus, mouth, eye or  nose may fur-
nish the same specific discharge if inoculated with the poison.
    Men  are more liable to contract gonorrhoea than women, and the
                                 69 
70
SYMPTOMS OF GONORRHOEA.
 parts usually affected are the urethra, inner surface of the prepuce, and
 the  head of the penis; in the female, the urethra is not often affected,
 the disease being confined to the vagina, mucous membrane of the vulva
 and uterus.
     The disease manifests itself, without any period of incubation, from
 two to eight days after an impure connection;  that is, the symptoms are
 not well marked before  the second to eighth day, although the poison
 probably acts immediately upon the affected tissue.  In rare cases, the
 disease is developed in a few hours; in others, again, the affection does
 not make its appearance for fourteen days.  Males with a large orifice of
 the  urethra, and those with a long, narrow prepuce, are most subject to
 the disease.
     The symptoms  make their appearance in the following order: the
 first being a slight titillation along the course of the urethra and at the
 end of the penis, increased considerably by an erection.  This symptom is
 usually, not always, accompanied by a feeling of weight in the penis.  The
 seat of the disease is at  first limited to the anterior portion of the urethra)
 but  soon extends to the bulbous and membranous parts.   Upon examin-
 ing  the penis, the  orifice is found to be red, swollen, and stuck together
by a thin, whitish secretion; if the penis is pressed between the thumb
 and  finger,  a small quantity of watery  mucus  oozes out; there is not
 much scalding or  burning in  urinating at this time—a slight smarting
 being felt only in  the  anterior portion of the canal during micturition.
 The foregoing are the usual symptoms of the first stage, which continues
 from two to four days.
    In a short time, say a week or less, the discharge becomes abund-
 ant,  thick like cream,  and of a bright yellow or green color, staining
 the linen; or in some cases the discharge is mixed with blood, or consists
 of pure blood, due to the  rupture of some minute blood vessel.  A slight
 hemorrhage is sometimes a benefit rather than a detriment, as it relieves
 the congestion of the swollen parts.  The glans penis now becomes hot,
 red, swollen, tender and painful, and  the  prepuce enlarged and oede-
 matous.
    General febrile disturbance  is often well marked in first attacks,
 but not in subsequent attacks.  The pain in voiding urine is now very
severe, and  extends the whole length of the canal, the  patient feeling
 during the passage of urine as if he could bite a nail in two.  The stream
is  apt to be forked or twisted.  Erections  occur  almost nightly, often
several  times a night,  producing excessive  pain  and  hindering sleep.
Chordee is the term applied to this form of erection, the  penis being
bent in the form of an arc with its concavity downward.
    In many cases, in addition  to these symptoms, there are tensive and
drawing pains  in the spermatic cords, testicles, perinaeum, and groins.
The disease is  now at  its height, and  from this time on the symptoms 
PATHOLOGY OF GONORRHOEA.               71
become less severe;  the inflammatory or second stage is over, the erec-
tions  occur but seldom, and the burning during micturition is slight.
The duration of this stage varies from seven to twenty  days, according
to the habits and surroundings of the patient.
    The  disease rapidly subsides, leaving a whitish, viscid, stringy dis-
charge, which gradually disappears, or remains for a long time, when it
is called  gleet.  The  duration of this, the last stage, is apt to be greatly
prolonged  when not influenced by the proper medicine.   Relapses or
aggravations from the neglect of hygienic and other laws of health are
quite frequent. Everything which tends to irritate the urethra or genital
organs should be strictly prohibited.
    A discharge similar to gonorrhoea in its  nature  is sometimes occa-
sioned by  leucorrhcea, or  by the menstrual  flow, by excessive  sexual
intercourse, by the exposure of  the parts  to a  cold wind, by want of
cleanliness, and by the use of new wine, stimulants or unfermented beer.
It is not easy to distinguish this form of gonorrhoea from  the Simon-pure
article when there are no other  complications present,  except that the
symptoms  are, as a rule, very much milder.   The persons most liable to
suffer from this form are those of a rheumatic or scrofulous diathesis, or
those who  have become weakened through any cause.  We meet with
many cases which have received no treatment whatever, and the duration
seems to be indefinite.
    In regard to the pathology  of gonorrhoea, it is  only necessary to
state  that  it is an inflammation of the mucous  tissue  of the urethra,
commencing at a small  spot  in the  anterior  portion  of the  canal,
extending  backward its entire length, and forward  involving the pre-
puce.  The  inflammation rarely involves  the peri-urethral cellular
tissue.  This membrane  presents the  same  appearance as inflamma-
tion of other mucous structures.  It becomes  red, the  follicles are
enlarged, there  is  hyper-secretion  of  mucus,  becoming  purulent
and  the   membrane  becomes  thickened,  diminishing  the size of
the canal and of the stream. As the inflammation subsides, the surface
becomes marked  with patchy  redness and fine granulations resembling
small warts.  When  the inflammatory action is unusually  severe, there
is an effusion of lymph or  plastic matter into the spongy substance of the
urethra, causing that painful affection known as chordee.
    Should the peri-urethral tissue be invaded at any time, abscesses are
liable to form, which  may or may not communicate with the interior of the
canal, but are apt to form ulceration of the mucous membrane from with-
out inward and open internally.  "The result is a communication which
permits infiltrations  of urine,  and which may become the commence-
ment of a urethral perforation."
    Gonorrhoea may  be complicated with balanitis, phimosis, paraphi-
mosis, general  inflammation of the penis, orchitis, prostatitis, nephritis, 
72                   CYSTITIS.  ORCHITIS.
cystitis, chancre, bubo, retention of urine, haemorrhage, phlebitis of the
penis,  conjunctivitis, arthritis, or abscess of the  urethra, prostate gland
or perineum.  Balanitis, or gonorrhoea spuria, is simply an inflammation
of the  head of the penis and prepuce, and it is usually a very insignifi-
cant affection, but occasionally gangrene results, giving rise to very odd
deformities.  We need not dwell upon phimosis and paraphimosis, hav-
ing already considered these affections in a former lecture.
    General  inflammation  of the  penis is rare, and yields  readily to
treatment.  It is characterized by an erysipelatous  redness and tume-
faction of the whole organ.   Rhus, acts well in this complication: so also
does Aconite.
    Cystitis,  or inflammation of the bladder, is due  to the extension of
the inflammation from the urethra to the bladder, and rarely occurs until
the fourth week.  As  predisposing causes, may be mentioned the use of
irritating injections, abuse of alcoholic  stimulants and overwork.   The
diagnostic symptoms are the passage of a few drops of blood at the  close
of micturition, with vesical  tenesmus, itching  in the head of the penis
and constipation.
    It  must be understood  that the inflammation seldom if ever impli-
cates more than the neck of the bladder.
    Chancre, of course, is not caused by the gonorrhoeal poison, but may
exist at the same time.  Bubo may also be  present in connection  with
the chancre, or may follow  the gonorrhoea.   In the latter case, the  bubo
will be found usually on but one side, and below Poupart's  ligament—
the number of ganglions involved varying from one to four.   Retention
of urine is occasioned by spasm of the neck of the  bladder, excited by
inflammatory irritation of this structure.   Haemorrhage, I have already
stated,  is due  to the rupture of some minute blood vessel of the urethra.
It is of rare occurrence, and takes place only during a violent erection or
prolonged sexual excitement.
    Orchitis,  or gonorrhoeal epididymitis, as  it  is now termed, is usually
the result of a repulsion of the gonorrhoeal inflammation  by exposure to
cold, or by the use  of powerful injections, as  the nitrate of silver,  sul-
phate of copper, etc.  Very rarely indeed is  it  occasioned by the contin-
uous extension of the  inflammation to the epididymus.  The left testicle
is more frequently attacked  than the right, although, in some instances
the inflammation see-saws from one to the other.  The epididymus proper
is the part chiefly involved in the majority  of cases.   Next to this, the
tunica  vaginalis, and lastly the spermatic cord.   But it is not unusual for
the three parts to be affected at the  same time.  It is rare, however, for
any one of the three to be implicated alone.  We need not take the time
to here give  the symptoms  of this inflammation, as  they have already
been considered by  your  professor of surgery; suffice it to say that the
organ is at first swollen, tender to the touch, and on motion, the pain in- 
PROSTATITIS.  RHEUMATISM.              73
creasing, in many cases, to that degree that sleep is impossible, and the
weight of the bed-clothes unendurable.  Febrile disturbance accompanies
in the majority of cases, but in others the patient is able to attend to his
business.  The termination is usually favorable, but exceptionally ab-
scesses form in the cellular tissue underlying the scrotum, or even in the
testicle.
    Phlebitis of the penis is a very rare and unusual  complication.  Ab-
scesses  of the urethra, perineum and prostate gland are also very rare;
they are due generally  to, or at least happen  in persons affected with
stricture of the urethra.
    Prostatitis, occurring  in connection  with gonorrhoea, occurs after
the  second week,  and is due  to the extension of the inflammation to
the substance of the  prostate gland.   Irritating injections, exposure
to cold and wet, protracted exercise  and  the use of alcoholic  stimu-
lants are predisposing causes.   The patient complains first of a sense
of weight  in the perinium, followed by frequent  and  urgent desire
to urinate,  the  stream being small and  requiring considerable strain-
ing to force it out.   Scalding, if present, is felt in the deeper portion of
the canal.  Constipation, with frequent and ineffectual urging to evacu-
ate the  bowels, is often  a well-marked symptom.  On introducing the
finger into the rectum, the prostate  gland will be found to be  enlarged
and very sensitive to pressure.  Prostatitis usually terminates in  resolu-
tion, rarely  in suppuration.  Should suppuration occur, it  is recognized
by chilly sensations or a pronounced chill, followed by high fever. Com-
plete retention.of urine is not uncommon in bad cases.   The abscess may
break and empty into the  urethra, the bladder or the rectum, according
to its situation.  The rectum usually receives the contents of the abscess,
and the termination is eventually satisfactory.
    Cowperitis, or inflammation of Cowper's glands, is  an occasional
complication.  The  symptoms are similar  to those of prostatitis, with
which it is frequently associated.  There  is pain, deep  seated, in  the
perineum, and suppuration is by no means an unusual termination.  A
urinary fistula may be the result.
    Arthritis, or gonorrhoeal rheumatism,  is by no  means  a  frequent
affection, occurring in less than one per cent, of all cases, and only in con-
nection with urethral inflammation.  The exciting causes are not known.
    The knee joint is the part most frequently affected, although no joint
Beems to be exempt.  Compared with ordinary rheumatism, we find that
the pain is never as great, the fever much less, the sweating  absent, and
the disease is not inclined to shift from one joint to another.  The  du-
ration seldom exceeds five or six weeks at the most, under proper Ho-
moeopathic  treatment.  In badly treated cases, the duration may be  in-
definite and anchylosis the result.
    Gonorrhoeal ophthalmia is a frequent complication and a  serious one. 
74              GONORRHOEA OF THE FEMALE.
 The virus is carried from the penis to the eye by the finger of the affected
 individual.  The conjunctiva is the part usually affected, although the iris
 and cornea may be involved, as the  vessels of the tissues of the eye are
 intimately connected.  When the conjunctiva alone is affected, the dis-
 charge is muco-purulent,
     Chordee, as we have already stated, is present to a greater or  less
 degree in nearly every case of gonorrhoea, coming on specially at night,
 after getting warm in bed, and it does not as a rule disappear at the close
 of the inflammatory stage.  It is always attended with some  pain, but
 when the penis, during the erection, is bent back toward the perinaeum,
 the  suffering is intolerable.  Hemorrhage  from the urethra sometimes
 accompanies the erection.
     Stricture of the urethra often follows gonorrhoea, in consequence of
 the use of very irritating injections.  Such a result does not often follow
 proper Homoeopathic treatment.  I  say this because I have  never yet
 seen a case of stricture  following gonorrhoea that was not directly or in-
 directly due to  nitrate of silver or other powerful injections.  The treat-
 ment of stricture, aside from remedial agents, will be considered by your
 professor of surgery.
     Gonorrhoea in the female is much less common and far  less trouble-
 some as a rule  than in males.  The  reason  for this partial immunity of
 women is owing to the fact that their parts are more or less protected by
 the natural secretion of the numerous glands;  and secondly, by the fact
 that men are, in most  cases, compelled  to  abstain from sexual inter-
 course while suffering from  the disease.  Owing to the fact that their
 menstrual and  other  discharges are frequently poisonous to  the male
 urethra,women  may be said to more frequently communicate than receive
 gonorrhoea.  If the attack comes on suddenly in the female, accompanied
 by heat, pain and  burning  along the course of the urethra, aggravated
 during urination, and accompanied by a  discharge from the meatus, we
 may be pretty  certain what the matter is, for no form of leucorrhcea is
 attended with a discharge from the urethra.   But gonorrhoea  of  the
 female  urethra is the  rarest of affections,  for  the reason  that during
 coition the urethra is not apt to come  in contact with the penis—the vulva»
 vagina and uterus being the parts most exposed.*  It is in such or chronic
 cases or in cases of infection of the vulva, vagina and uterus, where  the
previous history cannot be ascertained, that it is impossible to  make the
 diagnosis positively; but that need  not  interfere with your  promptly
 curing the case.  Dr. Ashwell says:  "It  is the duty of the physician to
cure the disease, but rarely to venture  upon an exposition of its nature.
 If he can positively affirm that it is of simple origin, let him do so, if

    ♦Eminent authorities believe that women sometimes contract serious gonorrhoeal
inflammation of the tubes and pelvic peritoneum without exhibiting other signs of
the disease. 
DIFFERENTIAL DIAGNOSIS.
75
     suspicion has been aroused; if not, it is better to avoid any distinct allu-
     sion to the matter."
         My friend,  Dr. Jessen, gives the following differential  diagnosis:
     —"The history of the attack furnishes more important aid to its diag-
     nosis.  Gonorrhoea has a  very short period of incubation,  and,  as  a
     rule, its  symptoms advance  with a rapidity and acuteness  which is
     rarely met with in catarrhal  inflammations.  Therefore, if the sexual
     organs suddenly become the seat of a burning pain, which is soon  fol-
     lowed by an itching irritation, with painful desire to urinate, increased
     sexual appetite, swelling, and local  pain, with blenorrhagia, where no
     local irritants have  been applied, and there is no traumatism, there is
     good reason to believe that the case is gonorrhoeal, and not leucorrhceal;
•    for.leucorrhcea, with which this affection is most likely to be confounded,
     develops  slowly,  or, so  to speak,  has a chronic  stamp  from  its  very
     beginning.
         " Where  the  symptoms of a catarrhal  leucorrhcea and of a gonor-
     rhoeal inflammation are  pronounced, the  experienced  physician will be
     clear in his diagnosis,  but when the  inflammation is slight, and the dis-
     charge is mild in its character, he will have more trouble in differentiat-
     ing them.  This is especially true if the woman is interested in  conceal-
     ing the real nature of  her disease.
         " In utero-vaginal catarrh, the general symptoms are congestion, in-
     flammation and  exudation, just as in catarrhal inflammations that are
     located elsewhere.  These symptoms are identical with  those of gonor-
     rhoea, but in the latter affection they are characterized by a more rapid
     course and a greater degree of intensity, by an especial proneness to in-
     volve the urethra, and also the inguinal glands.
         " The principal features of catarrhal inflammation are hyperaemia,
     swelling and structural changes, as oedema, with increased  formation of
     epithelial cells, mucus and pus.  In severe gonorrhoea of the  vagina, for
     example, there is  a copious secretion of serum from the vaginal follicles,
     but there is no great soreness of the vagina itself.  In the mucous stage
     there is  considerable tenderness,  which increases as the case passes into
     the purulent form.  In both,  the secretion, which, from  having been
     whitish or yellowish and slimy, becomes  creamy, greenish and purulent,
     with an acid reaction.  This last symptom is important, because the
     secretions from inflamed  mucous membrane in other parts of the body
     are always  alkaline.   In this stage the discharge has  a peculiar, strong
     and offensive odor."
         Urethral gonorrhoea, although rare by itself, is sometimes associated
     with vulvitis or vaginitis, in which case the itching and  smarting of the
     urethra  is  seldom very troublesome.  It  never gives  rise  to cystitis,
     although the inflammation may extend as far as the neck of the bladder
     and then cause considerable  pain on micturition. 
76
VULVITIS.
VAGINITIS.
    We have already hinted that in women several portions of the geni-
tal organs are affected, so that we may find in addition to or independent
of urethritis, vulvitis, vaginitis or metritis.  Inflammation of the parts
composing the vulva is less  common than  vaginitis,  and when not
occasioned by the gonorrhoeal virus, may be due to uncleanliness, mas-
turbation, frequent coitus, chancre, injuries of the parts and numerous
other causes.  Vulvitis is analagous to balanitis in the male.   It is said
that when the inflammation is limited to the clitoris it is a sign of mas-
turbation, and that when it commences at the fourchette and base of the
labia  minora it indicates an attempt at  rape or repeated coitus.  We
need  not repeat that the diagnosis is difficult and must frequently be
made by the process of exclusion.
    The symptoms do not differ materially from those of inflammation
of other mucous membranes, consisting at first of heat and itching, with
a reddened, tumefied and moist surface.   In a very few days the dis-
charge increases,  becoming  muco-purulent and  quite offensive.  There
is much sensitiveness to touch, and the inflamed parts are  painful  on
motion.  Whenever the urine comes in contact with the inflamed parts,
there  is severe burning  pain, and even the  discharge irritates and
inflames the skin  if  allowed to  remain in  contact with it.  Nympho-
mania,  or at  least increased sexual desire and very painful coitus, are
attendant symptoms in the majority of cases.   If  the  disease is  not
speedily relieved by treatment, ulceration  of  the  parts is apt to occur,
and in some instances, an abscess in the groin.
    Vaginitis, acute or  chronic, may be due to contagion, but there are
numerous causes  which may produce it, viz., sexual excesses, ascarides.
or foreign bodies in the vagina, the use of pessaries, uncleanliness, mas-
turbation, syphilitic or other eruptions, exposure to cold  and moisture
and the eruptive fevers.   Gonorrhoea of the vagina is more common than
that of the urethra,  vulva or uterus, and it is less painful than when the
vulva is affected.  The main symptoms are, at first, dryness, redness and
tumefaction, with increased heat and sensibility; some pain on motion;
frequent desire to urinate, with some smarting; dull  pain in the hypo-
gastric region;  acrid discharge, at first thin and transparent, later, offen-
sive, purulent, of  a  yellowish or greenish  color, and sometimes bloody.
It is very prone to  become chronic, although the acute symptoms yield
to treatment in a very short  time.  Contraction of  the vagina may  fol-
low, and may even be so great as to completely  occlude the canal
    Gonorrhoea of the uterus is not uncommon, but is less frequent than
that of  the vagina  or urethra.  It  is very rarely primary, but is usu-
ally owing to  the extension of the vaginal inflammation. There is  no
pain of consequence, but usually some slight disturbance of digestion,
general malaise and irregular menses. The discharge is alkaline, whit-
ish and  gelatinous, and irritates the vagina while passing through it. 
TREATMENT OF GONORRHOEA.
77
    The complications in women are not so numerous nor so severe as in
men.  Bubo, inflammation of the Fallopian tubes, ovaritis, chancres and
vegetations  are  the main  complications, but,  with the exception of
chancre, are quite rare.  Bubo, except when due to chancre, is less fre-
quent in women than in men suffering from gonorrhoea.
    Prophylactic Treatment.—Whether the  prophylactic  treatment of
this affection should be told to  the general public or not, is a question.
As the disease is usually the result of an impure connection, the parties
should suffer for their misdemeanors.   Still we give you the best means
known of preventing the disease.  The  parts should be well anointed
with oil before, and well washed after the connection.  If these precau:
tions are followed there is slight danger of infection.
    In regard to the treatment after the disease is fully developed (and we
may here say that it is often obstinate and rebellious to our best endeav-
ors), the following  general directions  should be  given  to the patient:
Take no more exercise than is absolutely necessary; keep  in bed if pos-
sible; keep the parts clean  by bathing them in warm water, and  by pla-
cing pledgets  of lint between the prepuce and head of  the penis; if
obliged to be on the feet much, suspend the parts in a suspensory band-
age; avoid stimulants, coffee, acids and meats, living on rice, bread, bar-
ley water, gum water, weak  tea, etc.  Avoid all impure thoughts.  As
for the remedies to be employed, every author and physician has his own
peculiar set.  The symptoms should decide in  this affection as in other
diseases, if you can get hold of  them, but many physicians always give
the same  remedy in the first stage of every case;  for instance, Grauvogl
recommends Natr.  sulph.;  Wahle, Bryonia; Jahr,  Sepia;  Baehr,  Merc.
sol; Kafka, Sulph.; Berjeau, Aeon.; and many others Cannabis.   It is
seldom, however, that we see cases  in the first stage, as  many persons
imagine that while  they have gonorrhoea they can contract no other dis-
ease, and  thus let  it run.  They are also acquainted with the fact that
often the disease subsides without treatment.
    If we see a patient in the onset of the disease, we administer Acon-
ite, which  is often sufficient to cure the affection.  The patient complains
of burning  in urethra when  urinating, dysuria, and sometimes a tender-
ness of the neck of the bladder.  If this drug does not control the inflam-
mation, we are obliged to resort to Gels., or some other remedy.  Almost
every drug  in the Materia Medica has been recommended for gonor-
rhoea, but, in speaking  of  the different  remedies, we shall confine our-
selves to those which have  been found curative for a certain definite set
of symptoms.  We shall speak of them, not according to their real and
comparative value, but alphabetically.
    Agave Americana has been recommended for " excruciating, painful
erections, chordee, strangury, drawing in the spermatic cords and testi-
cles, extending to the thighs, so  violent that he wishes to die." 
78              TREATMENT OF GONORRHOEA.
     Agnus castus is indicated in "old sinners" (when the inflammatory
 symptoms have subsided), who have no sexual desire or erections, espe-
 cially if the discharge is yellow and purulent.
     Ant.  crud.  Hempel  mentions this  remedy  and says it  should be
 used in tolerably large doses.  The symptoms indicating it are: Burn-
 ing when urinating, the urine being mixed with blood; "the urethra
 feels sore to the touch, knotty; the emission of urine may even be com-
 pletely repressed."
     Argentum nit.,  the great remedy, used as an injection in old school
 practice,  may be successfully employed, homceopathically, for the  fol-
 lowing symptoms:  Burning during urination, with a sensation as if  the
 urethra were closed and  sore inside, or swollen inside; the last  few
 drops of  the  urine are not emitted; in  addition, there is a cutting pain
 extending to  the anus, and  a discharge of pus excoriating the parts
 (male or female). It may also be used for swelling of the penis, chordee,
 or for enlargement and induration of the testicle in consequence of sup-
 pressed gonorrhoea.
     Berjeau recommends  Arsenicum  in  gonorrhoea  of  the  female,
 "when  there  is smarting, gnawing discharge, causing  soreness of
 the  parts with  which it  comes in contact;  when  standing, the  dis-
 charge  drops  down, accompanied with emission of  flatulence; or when
 there is also great redness of the parts."  In the male, it has been  suc-
 cessfully employed for tearing deep in the urethra.
     Aurum is  also recommended by the same author "for profuse  dis-
 charge which excoriates the perineum and the inner parts of the thigh,
 with vesicular eruptions on these parts, or when labor-like  pains  are
 present.  This remedy will be found useful also where there is inability
 to retain the urine, or for stricture of the urethra, with  continual urging
 to urinate.
     Byronia is  another  useful  remedy in  gonorrhoea of the male or
 female, when the discharge, which had  almost ceased, increases again.
 Valuable when the labia are greatly swollen.
     In  regard to the curative power of Cannabis in this affection, there
 has been considerable dispute.  Some assert that it is almost a specific.
 The remedy is certainly of  service when the  symptoms indicate it; when
 they do not, it is about as  valuable as most  of the new remedies which
 have been declared specifics in gonorrhoea.  It  is indicated iu the in-
 flammatory stage, when the urethra feels as if drawn up into knots; when
 the prepuce is greatly swollen and sensitive  to the touch; when there is
 constant urging, with difficult urination; when there is darK  redness of
 the  glans and prepuce;  and when chordee is  a  prominent symptom
. Hempel recommends it for the symptoms which frequently  accompany
 gonorrhoea, as rush of blood to the head, frontal headache, etc., but his
 doses are hardly what could be called homoeopathic.   He advises  the 
TREATMENT OF GONORRHOEA.              79
practitioner to give as high as fifteen to twenty drops of the strong tinct-
ure for a dose.  If Cannabis is  the indicated remedy, the 30th or 200th
will act better than the strong tincture.   This remedy  is also of service
in gonorrhoea of the female, "when there  is cutting between the labia
during micturition, the orifice of the urethra also being closed with pus,
there being violent sexual desire, with swelling of the vagina."
    Cantharis is sometimes called for when the inflammation extends to
the bladder, with tenesmus; constant desire to urinate, passing but a few
drops at a  time, often  mixed with blood; great  difficulty in urinating
with intense  pain; the discharge is yellow or bloody; excessive sexual
desire, with erections at night.  In the female, it is indicated for swelling
of the neck of the  womb, for pains in the kidneys and copious debilitat-
ing discharges, especially if the symptoms are accompanied with constant
desire to urinate.
    Some authors advise  Capsicum for intense burning in the urethra,
with white, cream-like discharge; and others for thick, purulent, yellow
discharge,  accompanied with pricking,  burning,  cutting pains in the
urethra.
    Cocculus is occasionally of benefit, especially "when there is  tensive,
aching pain in the orifice of the urethra when not urinating."
    Copaiba, Berjeau says, is indicated "for a violet smell  of the urine, or
when the discharge is accompanied by a cutaneous eruption like measles
or nettle rash, attended with great itching."  It is also useful for yellow,
purulent discharges from the urethra, and for bloody urine, with constant
desire to urinate.
  Berjeau also recommends Cubebaj for the same violet odor of the urine,
especially w,hen the discharge is dark and reddish.  It is  useful for re-
tention of the urine also.
    Calc. carb. is a useful remedy in gonorrhoea of  the  female, when the
discharge is burning or milky; also in gleet, especially in fat, lymphatic
persons. The general  symptoms are well  marked when this remedy is
called for.  Cham., likewise, may be  used in gonorrhoea  of the female
when the discharge from the vagina is yellow, acrid, smarting or watery.
    Carbo.  veg., if the gonorrhoeal discharge is very offensive, will prove
curative.
    Conium we have used when the testicles were  indurated, especially
if the patient had been the subject of frequent nocturnal emissions.
    Hempel advises Dulc. for gonorrhoea from suppressed tetter.
    Hydrastis has been used as an injection with more or less relief of
the smarting during urination.
    Hepar  sulphuris has been found of  service  in scrofulous  persons
when the discharge is white, yellow or fetid.
    Kali. nit. is used by the French and other physicians for frequent
urging to urinate, with burning during and after urination. 
80
TREATMENT OF GONORRIKE.'.
    In gonorrhcea of the female, Kreas. is of service if the  discharge is
bloody, acrid or yellowish, and of a foul odor, especially when accompa-
nied with smarting in the external parts.
    Medor, suppressed gonorrhoea, or discharge thin, transparent, mixed
with opaque, whitish mucus staining the linen yellow.  It is likewise
indicated for profuse,  yellow,  purulent discharge, most copious in the
morning.  Also for gleet of long standing.
    Merc, should  always  be  used  when  gonorrhea  is  complicated
with chancre or phimosis, unless the  remedy  has already been used
to excess, when Nit. ac.  would be better adapted to the case.  It is
also indicated when the discharge is yellowish, green or purulent, aggra-
vated at night.  When the gonorrhoea is not complicated with chancre,
we prefer Merc, cor., but when there is a chancre we U6e Merc. sol. to the
best of advantage.   Berjeau also recommends  this remedy "when  the
orifice of the urethra is inflamed, and the forepart swollen with suppur-
ation between the glans and prepuce, the glands being red, hot and pain-
ful when touched, accompanied with burning pain and itching, stinging
and throbbing in the urethra, the urine  passing with a  feeble stream."
In the  female it will prove serviceable if the vaginia is swollen and in-
flamed, with a sensation of rawness or excoriation, the discharge being
acrid or greenish and purulent.
    Dr. Raue recommends Mezereum  for haematuria during gonorrhoea.
The discharge  is thin and watery, greatly increased by exercise, and  the
urethra is very painful to the touch.
    Millefolium has been used when the discharge consists of blood and
watery slime, with swelling of the penis.
    Nat. mur. is the best remedy to administer after the patient has used
injections of nitrate of silver.  Cutting  in  urethra after  urination; thin,
watery discharge.
    Nit. ac. will be found of benefit  in  cases which  have been badly
treated with Merc, especially when accompanied with  chancres or bala-
nitis.   Some authors have  recommended this remedy also for  condylo-
mata.  Nit. ac is just as useful in gonorrhoea of the female as  of  the
male.  Hemorrhage from the penis, scanty or profuse, is also a good in-
dication for its administration.
    Nux vom. is an excellent remedy when the patient has been treated
allopathically with copaiba, cubebs, and other hot stuffs.   The symptoms
indicating it are constipation, haemorrhoids, " pressive pains occurring at
the orifice of the urethra when not urinating, accompanied with shudder-
ing," and sharp, cutting pains near the orifice of  the urethra, with more
or less  dull pain in the back of the head.  In the female, it  is indicated
for swelling of  the  vagina, which  is very  sensitive to  the touch;  for
"gnawing, itching eruptions on the genitals; for painless discharge of 
                TREATMENT OF GONORRHOEA.              81

yellow mucus or fetid mucus, with burning in the parts, and violent sex-
ual desire."
    Petroselinum may be used for tickling and itching in the urethra, es-
pecially near the root of the penis, with constant desire to urinate.  The
discharge is milky or yellowish.
    Phosphorus is of service in the female when there is decided aversion
to an embrace, especially if the discharge is milky.   Tall, slim women.
    Pulsatilla should be thought of in mild, timid persons,  when the
discharge is very abundant, no matter what the color; also in suppressed
gonorrhoea, with swelling of the testicles.  It is also useful in gonorrhoea
of the female, when there is considerable pain in the uterus, vagina and
labia.
    Sulphur is important as an intercurrent remedy in persons of a scrof-
ulous diathesis.  In some cases it is sufficient to complete the cure, espe-
cially when there is considerable burning at the orifice of the urethra, ac-
companied by constant desire to urinate, the stream being  smaller  than
usual.    In the  female  the   same general  considerations   indicate
it, and in addition, " itching of  the  clitoris and burning of  the  exte-
rior parts, accompanied with vesication, attended with a smarting,  burning
thin discharge, especially in the morning."
    Thuja would be indicated if  fig-warts were present, but, as we  have
already stated, they are generally an accompaniment of secondary or ter-
tiary syphilis, and not of gonorrhoea.  We might mention fifty other rem-
edies which have been recommended in this disease, but enough has been
said already in regard to the treatment, which is, at best, often  unsatis-
factory.
    It has been stated time and again that the high potencies are power-
less in the treatment of  gonorrhoea and syphilis.  This is a great mistake,
and the cases now under treatment at the hospital, prove the truth of the
assertion, that the properly selected remedy will  cure in the  30th  anJ
200th attenuation, or in  fact in any potency. 
GLEET.
    Gleet or chronic urethritis, or, as it is sometimes called, blenorrhoea,
is the most frequent, the most annoying and the  most persistent sequel
of gonorrhoea, which it follows, usually, without interval, or at most with
an interval of but a few weeks.  It is a disease generally devoid of pain
and other signs of acute inflammation, and is  always accompanied by a
chronic discharge from the urethra.
    The chronic inflammation is usually limited to a small portion of the
mucous membrane, or may be located at several points, where it remains
indolent for an  indefinite length of time, or until it is aroused by some
exciting  cause.  The accompanying discharge, invariably scanty,  is not
constant as in gonorrhoea, and consists of a blue, thick, mucoid material,
more or less purulent and creamy.   It is somewhat  increased by  alco-
holic drinks, active exercise and  fatiguing  occupations.  It sometimes
disappears spontaneously for a few days at a time, and then returns with-
out appreciable cause.
    At times the urine contains long shreds, looking like vermicelli, even
when the discharge is not particularly  noticeable, or is unseen by the
patient.  On rising from bed in the  morning, the afflicted one finds the
lips of the meatus stuck together, occasioned  by the drying  up  of the
gluey discharge, forming a sort of scab over the meatus; or he perceives
especially en deep pressure of the uretha, a single drop of transparent
matter—neither of these conditions being attended by pain of any conse-
quence on micturition. This characteristic  drop is entirely absent dur-
ing the day.
    Gleety discharges  may be present from other causes  aside  from a
past attack of gonorrhoea, such as  stricture of the  urethra, prostatitis,
ascarides of the rectum, masturbation and other  troubles of the  sexual
and excretory organs.   In children, it is sometimes seen  during  denti-
tion, and in adults from want of cleanliness, from excess of coitus, from
excess in alcoholic drinks and other causes.  This  form of gleet, how-
ever, is not contagious, whereas that following gonorrhoea is decidedly
so.  The symptoms of the two forms are identical.
    In general terms, it may be stated that when the discharge is more
or less purulent, it is contagious; but when blue,  mucoid and  sticky,
                                 82 
GLEET AND STRICTURE.                 83
without stain, it is usually not so.  It should be  remembered,  however,
that any excess in eating or drinking, or sexual excitement,  may aggra-
vate the existing discharge, and convert what had  become a non-conta-
gious into a contagious gleet, the thin, bluish discharge becoming a puru-
lent one.  This aggravation lasts but a few days, usually, if the exciting
causes are removed.
    In all cages of gleet which are examined with the bougie, one or
more tender spots will be  found which usually bleed slightly.  This
tenderness is often due to a slight stricture already present, or is depend-
ent upon inflammation  of the deeper  portions  of  the  canal  or of the
prostate.  It is estimated that at least eight causes in ten are dependent
on stricture or to a granular and thickened condition of the  urethra, the
incipient stage of stricture.
    As regards the pathological changes met with in gleet, it is sufficient
to state that they are similar to those met with in chronic inflammation
of other mucous surfaces.  We need not dwell upon  them  in  this con-
nection.
    The point which interests us most  as  practitioners is what will cure
this aggravating and  obstinate disease.  Our  old school  friends use
tonics,alteratives, astringent  injections, bougies, etc., etc.,  and still the
percentage of cures is very small indeed.  Cases hang on for months and
years in spite of the treatment.  The majority of physicians believe that
urethral discharge is not  invariably accompanied by stricture, while a
limited number contend that the presence of  gleet always means strict-
ure, and that by removing this a cure will certainly follow.
    That the removal or cure  of a stricture often dissipates a gleet no
one will deny,  but that it invariably does so, no one of any experience
will for a moment consent to. We have in our limited experience, seen
a number of failures where there was no longer  any sign of the stricture.
It is well known that gleet sometimes resists all sorts of treatment, and
then suddenly disappears of its own accord, after the patient has " thrown
physic to the dogs," and ceased to do anything.
    Can we do better with our small pills?  We are certain that we can
if we follow Hahnemann's  advice, and treat  the patient and not the
disease. When we treated gleet as such our efforts were nil, but since
we have treated the patient, taking into account all of his symptoms, we
have had better success.
    The treatment should consist, first, of strict  attention to  the diet and
habits of the patient, for the use of alcoholic drinks, salty things, aspara-
gus and excessive sexual intercourse all  tend to aggravate  and prolong
the disease.   The patient should drink freely of water, in order to dilute
the urine, and thus prevent irritation of the urethra by its salts. If stric-
ture exists, this should  receive attention.
    As regards remedies,  many might be mentioned, but we shall confine 
84
TREATMENT OF GLEET.
 ourself to those which have been found beneficial, remarking that Sep.,
 Sil. and Sulph. have proved the most useful.  It will not be possible in
 this paper to give all the  indications  for each remedy, but only those
 symptoms which one is most apt to meet with; and it is only by carefully
 questioning the  sufferer that you will learn  that there is anything the
 matter aside from the gleety discharge.
     Sepia  we place first on the list.  The  characteristic indications for
 its use are a  milky  or  yellowish discharge; urine dark  and turbid, or
 offensive; copious perspiration of the genitals; fetid perspiration  of the
 axillae, pain in the small  of the back, occipital headache, melancholy
 mood.                  ,
     Sil.—Thin,  fetid discharge;  urine  yellow or  light-colored; night
 sweats; fetid sweat of the feet; chilliness; chronic constipation;  scrofu-
 lous, broken-down persons;  constant  feeling  of chilliness, even while
 taking exercise.
     Sulph.—Discharge whitish, mucous;  urine covered with a  greasy
 pellicle; coldness of  the feet,  and pain in  the top of the head; weak*
 faint spells occurring frequently through the day.   It follows well after
 Sepia has ceased to benefit the patient.
     Cannab.—Discharge thin and watery, of disagreeable smell; urine is
 voided in  a spray; urine  mixed with filaments or blood; feeling as of a
 weight on the vertex;  sleepiness during the  day and sleeplessness at
 night.
     Caps--Discharge muco-purulent; cold  and  shriveled  testicles;
 patient is taciturn and obstinate; is very sensitive to the open air.
     Ferr.— Discharge is mucous; face fiery-red at times, and at others
 earthy and pale;  puffiness of the face around the  eyes; paleness  of the
 mucous membranes.
     Kali-bi.—Discharge  stringy, jelly-like; escape of  prostatic  fluid
 during stool;  high colored urine with pain across the back; complete
 indifference as regards his  disease.
     Nit-ac.—Discharge occasionally  bloody; after the abuse of mercury;
 urine smells like that of  horses; fig-warts;   patient is irritable and vin-
 dictive; herpes-like eruption about the genitals.
     Nux ww.—After allopathic drugging,  or for  aggravation  of the
 disease after alcoholic stimulants or other excesses;  valuable in hem-
 orrhoidal subjects.  Hypochondriac  patients, or those who want to talk
 about their condition; bowels constipated, as a rule.
     Graph.—Discharge gluey; urine  turbid; patient  sad and despondent;
 ansemic, constipated;  tending to ulcerations  of  the skin.
     Nat-mur— Discharge thin and watery;  after injections of nitrate  of
 silver; craves  salty things, although the use aggravates  the  trouble;
aching in the testicles; the patient  is very anxious about the result of
the long continuance of the disease. 
TREATMENT OF GLEET.                   85
    Petro.—Gleet of old people;  slight burning in the navicular fossa
while urinating; discharge milky; voluptuous itching of the genitals.
    Agnus.—Discharge yellow, purulent; impotence; discharge of pros-
tatic fluid while bearing down at stool; excoriations about the anus and
genital organs.
    Phos.—Discharge watery; profuse, strong-smelling urine, sometimes
with greasy pellicle; tall, thin persons with black hair; pale,sickly per-
sons; weakness of the memory; tendency to cough, and painless, watery
diarrhoea from the least exposure.
    Puis.—Discharge smells badly; urine discharged in a thin stream;
mild, gentle persons predisposed to catarrh, diarrhoea,  etc.  Smoking
seems to aggravate the disease, and so also does the use of rich food.
    Thuja.—Copibus, watery discharge; fig warts; sweet, honey-smelling
sweat on the genitals;  the patient experiences the feeling of a liquid
passing along the urethra,  drop by drop; continued dropping of the
urine after micturition.
    This list might be indefinitely extended.  Consult also remedies
mentioned for gonorrhoea. 
REPERTORY.
          GONOKRHCEA OB  GLEET OF MEN.

Urethra, aching in—Bry., Canth.
          aching after micturition—Puis.
          aching at the orifice—Canth., Nux-vom.
          aching, with pressure—Cannab.
          agreeable sensation in, during micturition—Gels.
          agglutination of orifice—Calc, Cannab., Natr-m., Petros.
          biting pains in the fore part—Cannab., Copaib., Merc.
Urethra, biting pains during micturition—Ars., Canth., Cham., Graph.,
              Merc, sol., Natr.-m.
          biting pains after micturition—Copaib.
          biting pains when not urinating—Berb.;  Cannab.
          burning pains—Bry., Canth., Con., Thuj.
          burning pains morning after erection—Natr.-m.
          burning pains morning during micturition—Flu-ac, Seneg.
          burning  pains morning  after  micturition—Con.,  Flu-ac,
              Thuj.
          burning pains forenoon after micturition—Lye
          burning pains forenoon during micturition—Lye
          burning  pains  afternoon during micturition—Hell., Natr-c,
              Thuj.
          burning pains evening—Natr-c, Petr., Phos., Sulph.
          burning pains evening during micturition—Seneg.
          burning pains evening after micturition—Sep.
          burning pains night—Canth., Sulph.
          burning pains night after micturition—Thuj.
          burning, before micturition—Bry., Cannab., Merc.
          burning at commencment of urination—Cannab., Merc.
          burning  during  micturition—Ac,  Agar.,  Agnus.,  Ant-c,
              Ant-t., Arg-nit., Ars., Aur.,  Bov.,  Calc, Cannab., Canth.,
              Caps.,  Carbo-veg., Caust.,  Chin., Clem.,  Cocc, Colch.,
              Con., Copaib.,  Cubeb.,  Hep.,   Lye,  Medor.,  Merc,
              Mezer.,  Millif.,   Natr-c,  Natr-m.,  Natr-sul.,  Nit-ac,
                                80 
REPERTORY.                        87
              Nux-v.,  Petr.,  Petros.,   Sep.,  Sil.,  Staph.,   Sulph.,
              Thuj.
Urethra, burning, extending into bladder after urination—Lye.
          burning, at  the  orifice,—Canth., Caps., Nit-ac, Puis., Sep.,
              Thuj.
          burning, with itching—Apis., Copaib.
          burning, with soreness of prepuce—Chin.
          burning, with stitches—Cannab.
         ■ burning, with stitches in fore part—Bry.
          burning in middle of, when not urinating—Staph.
          contraction of—Bry., Canth., Clem., Puis., Sulph.
          crawling pains, extending backward—Camph., Nux.
          crawling, after micturition—Canth.
          crawling, when not urinating—Mezer.
          crawling, in morning in bed—Petros.
          crawling, when moving—Thuj.
          cutting, morning during micturition—Graph., Merc.
          cutting, evening  before  micturition—Bry.,  Calc,  Canth.,
              Phos-ac
          cutting, evening during micturition—Calc, Canth., Carbo-v.,
              Con., Hep., Puis., Rhus.
          cutting, at close of micturition—Natr-m., Sulph., Arg-nit.
          cutting, after micturition—Calc,  Canth., Natr-m., Sulph.
          cutting, extending backward—Copaib.
          cutting, when not urinating—Caps.
          cutting, before and after stool—Sulph.
          drawing, morning after micturition—Carbo-v., Natr-m.
          drawing, when not urinating—Puis.
          drawing, extending to anus—Phos-ac
          hemorrhage from—Arg-nit., Canth., Lye, Mere, Nit-ac.
          itching in fore part of—Aur.,  Canth., Cannab.,  Ign., Merc.
          pinching, before urination—Natr-m.
          pinching, when not urinating—Verat.
          pinching, during urination—Arg-nit., Carbo-v.
          sensation of dropping from, after micturition—Thuj.
          sensation as  if burning drops  ran along, after micturition—
              Arg-n.
          sensation of constant urging to urinate—Sulph.
          soreness at the meatus—Copaib., Clem., Nux., Nit-ac.
          soreness,   internal,  continuing  after urination — Arg-nit.,
              Medor., Nux.
          stitches in—Aeon.,  Apis.,  Arn., Aurum.,  Calc,   Cannab.,
              Canth., Cocc, Con., Ign., Merc,  Sep., Sulph., Thuj. 
88
REPERTORY.
          stitches  in,  when  not  urinating — Bell.,  Caps.,  Cannab.,
              Phos-ac.
          stitches in, while walking—Ign.
          stitches in meatus—Phos-ac.
          stitches in, extending to abdomen—Mere
          stinging, when not urinating—Phos-ac, Thuj.
          tearing in the fore part—Ant-t., Lye, Thuj.
          tearing, when not urinating—Ars., Bry., Ruta., Sulph.
L'rethra, tearing, extending to the perimvum—Mezer.
          throbbing in—Copaib., Hep., Merc.
          twitching pain in—Petr., Thuj.
Ineffectual desire to urinate—Canth., Sarsap.
Spermatic Cord, pain in—Puis., Spong.
Testicles, pain—Arn., Aur., Clem., Con., Nux., Puis., Spong.
Cowper's Gland, itching and pressure—Petros.
Genitals, coldness of—Gels., Lye
          sweat of—Gels., Thuj.
Discharge, acrid—Copaib., Creas.,  Sarsap.
           albuminous—Petros.
           bloody—Canth., Millefol., Nitr-ae,  Puis.
           green—Merc.
           milky—Copaib., Lach., Petros.
           mucous—Caps., Ferr., Medor.
           offensive—Carbo., Puis., Silie
           of pus—Agnus., Bar., Caps., Copaib., Con., Natr-m., Medor.
           thin—Medor., Natr-m., Phos-ac, Phos.
           transparent—Medor., Mezer., Phos-ac.
           watery and slimy—Cannab., Natr-m., Thuj., Fluor-ae
           yellowish—Agnus., Canth., Calc, Caps.,  Hep.,  Medor.,  Nit-
               ac, Sarsap., Thuj.
           increases, after having  decreased—Bry. 
GONORRHOEA  OF  WOMEN.
Urethritis—Aeon., Canth., Cannab., Gels., Thuj.
Vulvitis—Bell., Bry., Calc, Canth., Cannab., Carbo., Con., Creos., Lye,
              Mere, Nit-ac, Sabin., Sep., Sulph., Thuj.
Vaginitis—Aeon., Bell., Cham., Calc, Canth., Creos., Nux, Nit-ac, Puis.,
              Sabin., Sep., Sulph.
Metritis—Aeon., Ars.,  Bell., Bry., Canth., Carbo-v., Coloe, Con., Creos.,
              Ign.,  Hep., Nit-ac, Phos., Plat., Puis., Sep., Sulph., Lach.,
              Lye, Mere, Nux.
Discharge, acrid—Alum., Ars.,  Aurum., Cham.,  Creos.,  Ferr.,  Ign.,
                Mere, Phos.. Sabin., Sep., Sil., Sulph.
            bloody—Chin., Cocc, Lye, Nitr-ae, Sabina.
            greenish—Cubeb., Mere, Natr-m., Puis., Sep.
            milky—Calc, Creos., Gels., Lye, Phos.,  Puis., Sep.,  Sil.,
                Sulph.
            mucous—Bell., Calc, Mez., Nitr-ac, Nux., Phos.
            offensive—Creos., Nux., Nitr-ae, Sabin., Sep.
            watery—Cham., Creos., Ferr.,  Graph., Mere, Sulph., Sep.
            yellow—Ars.,  Cham.,  Creos.,  Mere,  Nux,  Stann.,  Sep.,
                Sulph.
            purulent—Ign., Mere, Sabin., Sep.
Before Urination,  burning—Apis., Bry., Calc,  Camph., Canth., Caps.,
                       Puis.
                    cutting—Bry., Camph., Canth.
                    cutting in abdomen—Nit-ac, Sulph.
                    colic—Puis.
                    contraction in urethra and rectum—Natr-m.
                    discharge of mucus—Creos.
                    impatience—Sulph.
                    pressing pain—Mere, Nux., Puis., Petr.
                    pressure in bladder—Arn.
                    pain in neck of bladder—Nux.
                    stinging—Nux.
During Urination,  anxiety—Cham.
                    abdominal pains—Bry., Lye
                                89 
90                 GONORRHOEA OF WOMEN.
 During Urination, burning—Apis.,  Arg-nit.,  Arn.,  Ars., Bell., Bry.,
                        Calc, Camph., Cannab., Canth.,  Caps.,  Caust.,
                        Cham.,  Chin., Con., Creos.,  Gel., Ign.,  Lye,
                        Mere, Mezer., Natr-e, Natr-m., Nit-ac, Nux,
                        Petr., Phos., Puis., Sil., Stann., Staph., Sulph.,
                        Thuj.
                    burning in, vulva—Creos.
                    biting in orifice—China.
                    biting—Ign., Mezer., Mere, Natr-m.,  Sep., Thuj.
                    constriction in left groin—Ars^
                    cutting—Calc,  Canth., Con., Merc,  Nit-ac, Puis.,
                        Staph., Thuj.
                    drawing—Con.
                    gnawing—Caust.
                    itching—Arg-nit., Cham., Petr., Sulph., Thuj.
                    nausea—Merc
                    pinching about navel—Aeon.
                    prickling— Caps.
                    pressure upon uterus—Con.
                    soreness—Calc,  Cannab., Ign., Lye, Mezer., Natr-c,
                       Nit-ac,  Phos., Sil.
At End of Urination, cutting pain in orifice of urethra—Arn., Canth.
                     dropping of blood—Cannab., Canth., Puis.
After Urination, burning—Apis., Camph., Cannab., Canth., Caps., Chin.,
                     Con., Lye, Merc, Nit-ac, Puis., Thuj. .
                 cutting—Arg-nit.,  Camph.,  Canth., Caps., Mezer.,
                     Staph., Sulph.
                 colic—Staph.
                 crawling—Canth., Lye
                 dribbling—Arg-nit., Natr-e, Petr., Sulph., Thuj.
                 discharge  of mucus—Nit-ac.
                 feeling as  if more were to come—Stann.
                 involuntary discharge—Sil.
                 passes drops of blood—Mezer., Sulph.
                 renewed desire—Calc, Nit-ac.
                 soreness—Nux.
                 stinging—Mere, Sulph.
                 stitches—Arn., Con.
                 tenesmus—Con., Sulph.
                 tickling—Canth.
                 weakness—Ars., Phos.
During Menses  [Only those symptoms are given  here which are cov-
                     ered by less than seven remedies.]
                 attacks of  faintness in the morning—Nux. 
GONORRHOEA  OF  WOMEN.
91
During  Menses, asthma—Chin.
                 agglutination of eyelids in morning—Calc.
                 bloatedness—Alum., Cocc, Natr-c.
                 bearing down—Bell., Thuj.
                 breathing difficult—Calc.
                 breasts, pain in—Con., Mere, Thuj.
                 burning in eyes—Nit-ac.
                 cramp in calves—Phos.
                 cold perspiration on forehead—Phos.
                 coughing up blood—Sep.
                 clonic spasms—Chin.
                 contraction in rectum—Cocc.
                 convulsions—Cocc, Puis.
                 coryza—Alum.
                 constipation—Apis.
                 colic—Aur., Chin., Natr-c.
                 chills—Bell., Creos., Natr-c. Nux., Phos., Puis.
                 coldness of limbs—Cham.
                 general coldness—Thuj.
                 diarrhoea—Alum, Caust., Cham., Creos., Natr-c.
                 deglutition painful—Calc.
                 darkness before eyes—Chin., Sep.
                 dullness of teeth—Merc.
                 drowsiness—Sulph.
                 dryness and burning of tongue—Merc.
                 epistaxis—Sulph.
                 eruption—Apis., Con.,  Sil.
                 eructation—Nit-ac.
                 ears, rushing sound in—Creos.
                 ears, singing and roaring in—Petr.
                 face-ache—Natr-m.
                 face yellow—Caust.
                 face, swollen—Chin.
                 face, pale—Puis.
                 feet, swelling of—Calc, Lye
                 feet, heaviness of—Sulph.
                 feet, cold—Sil., Sulph.
                 foul taste—Sep.
                 foul odor from mouth—Sep.
                 flatus—Creos.
                 gums swollen—Mere, Nit-ac.
                 heat in head—Apis., Bell., Calc, Ign.
                 heat in hands and soles of feet—Petr.
                 hardness of hearing—Calc, Creos. 
92                 GONORRHOEA OF WOMEN.
During  Menses, itching of vulva—Lye
                 inclination to commit murder—Merc.
                 improvement of mental condition—Stann.
                 ineffectual straining at  stool—Calc, Puis., Sulph.
                 lachrymation in morning—Calc.
                 obscured vision—Puis., Sep.
                 pain in ovary-—Cham., Phos.
                 pain in right ovary—Apis.
                 pain in rectum—Apis.
                 pain in limbs—Bell., Bry., Calc.
                 perspiration of chest—Bell.
                 perspiration of chest and back—Creos.
                 prolapse of rectum—Aur.
                 pressure in epigastrium—Caps.
                 pressure in abdomen  as from a stone—Cocc.
                 palpitation—Nit-ac, Sulph, Thuj.
                 restlessness of  the legs—Thuj.
                 salty taste in the mouth—Merc.
                 stitches in rectum—Ars.
                 stitches in chest—Con.,  Puis.
                 stitches in side—Creos., Natr-c.
                 spasms of stomach—Puis.
                 sleeplessness—Sep.
                 soreness  about  vulva—Sil.
                 soreness  of  throat—Sulph.
                 toothache—Ars., Calc, Natr-m., Nit-ac, Phos.
                 thirst—Bell.
                 twitching of eyelids—Natr-m.
                 vomiting—Ign., Phos., Puis.
                 vertigo—Nux.,  Sulph.
                 weeping  mood—Puis., Thuj. 
COMPLICATIONS  OF  GONORRHCEA.
Abscess.—Apis., stinging pains ; Asaf.,  dark red, hot; Bry., frequent
          thirst; Cham.,  pain of chronic ; Hep., hastens suppuration ;
          Lye, worse at 4 p. m. ; Petr., unhealthy skin, small wounds
          suppurate;  Sil., prevents  unsightly  scars;  Stram.,  violent
          pain, driving one mad.
Arthritis.—Apis., stinging pains ;  Arn., bruised feeling ; Ars., restless-
            ness,  with relief from  motion ; Aeon., high fever, thirst,
            anxiety; Bry.,  worse  from motion ; Benz. ac, scanty, dark
            brown, fetid  urine ;  Calc,  after  Rhus;  Kali-jod., great
            general  debility; Led.,  pains  run  up,  worse in warmth
            of  bed;   Lye,  old  people,  worse  from 4 to 8 p.  m.;
            Menzer.,  urine  hot  with  red  sediment;  Nux., habitual
            drinkers ;  Puis.,  constant chilliness,  diarrhoea, thirst-
            lessness;   Rhus,  worse  during rest,  better from  con-
            tinued motion ;  Sars., shooting pains in head ; Sil., acute
            pains  remitting  from time to time ; Sulph, tearing pains
            from knee to crest of ilium, left side ; Thuj., covered parts
            hot and dry, uncovered moist.
Balanitis.—Aeon., itching  in prepuce ; Arn., injury;  Bry., increased
            discharge  after  improvement; Calc, scrofulous  persons ;
          . Cann.,  gets angry  at  trifles ; Caps., constant  pressure in
            glans ; Chin, burning in  glans and prepuce ; Ign., nervous ;
            Merc, purulent greenish secretion, worse at night ; Mezer.,
            fine  pricking stitches  in the glans; Nit-ac, discharge  of
            bloody slime ; Nux.,  secretion,  copious, worse evenings ;
            Phos-ac,  gnawing pains ;  Puis.,  mild,  gentle persons ;
            Rhus, after getting wet ; Sabin., violent erections ;  Sulph.,
            icy  coldness and swelling,  with  redness of glans ; Thuj.,
            violent stitches and soreness in the glans.
Bubo.—Ant-t., quarrelsome ;  Apis.,  great pain  and sensibility ; Ars.,
       intense  burning ;  Bapt.,  painless ;  after  exposure to  cold ;
       Carbo-an., constipation, passing  flatus  only; Carbo-veg., great
       prostration  ; Graph.,  scrofulous women ;  Hep.,  suppurating ; 
94
COMPLICATIONS OF GONORRHOEA.
        Mere, very painful; Nit. ac, after abuse of mercury; Sil., scro-
        fulous persons ; Thuj., with fig warts ; Zinc, left side.
Cowperitis.—Aeon., from cold  ; Cinn., increased sexual desire;  Hep.,
              when suppuration threatens ; Mere, desire to urinate after
              micturition ; Sil.,  after suppuration ; Thuj., much strain-
              ing during urination.
Cystitis.—(See urinary complaints for indications)  Aeon.,  Apis., Arn.,
           Ars., Bell., Calc, Cann., Canth.,  Caps., Carbo. veg., Caust.,
           Coff.,  Coloe, Cupr.,  Dig., Dulc, Graph., Hell, Hep., Hyos.,
           Lach., Lye, Nit. ac,  Nux., Phos. ac, Puis., Ruta.,  Sars., Sep.,
           Sil., Sulph., Thuj.
Chordee.—Camph.,  acrid urine; Canth., bloo ly urine; Caps.,  urine
           increased; Iod., frequent and inveterate urethritis; Lupulin;
           Puis., mild persons; predisposed to catarrh or diarrhoea.
Eczema or Herpes.—Arn., from irritation or  injury; Caust., rheumatic
          subjects; Dulc,  bleeding; Hep., after merenry or ointments;
          Mere, voluptuous itching;  Petr.,  constant  oozing,  itching;
          Phos. ac, itching creeping, moist; Sep.aggravated by scratch-
          ing; Thuj., worse from cold water, better from warm.
Epididymitis (Orchitis).—Ant. t., nausea;  Arg. n., bruised or contusive
              pains; Ars., cramp-like, cutting colic; Aur., aching, tensive
              pains;  Bell., violent  lancinations,  worse  p.   m.; Brom.,
              induration of left testicle;  sensation of coldness; Cann.,
             pulling or pressure in testicle;  Caps., cramp-like pains in
             testicles; Chin., tearing pains in  left  testicle; Clem., swell-
             ing of right half of scrotum; piuching pains;   Cos.,  from
             injuries; Cocc, spasmodic drawing pains; Ign., peculiar
              feeling of weakness in pit of stomach; Mere, tearing and
             shooting pains, shining redness of scrotum; Nit. ac, pain-
             ful  swelling of spermatic cord; Nux., suppressed gonor-
             rhoea,  ineffectual  desire to urinate; Phos. ac, gnawing
             pains; Puis., suppressed gonorrhoea; pressive and tensive
             pains, right testicle; Rhod.,  testes intensely painful to the
             touch; contusive  pains;  Spong., chronic  drawing  pains;
              Staph.,  drawing, burning stitches in right spermatic cord;
             Sulph.,  when induration has commenced;  persons with a
             dirty greasy skin;  Thuj., aching pain, aggravated by walk-
              ing.

General Inflammation of Penis.—Aeon., with fever, thirst, etc.; Bell.,
               with nervousness; Canth., urinary troubles;  Rhus., ery-
               sipelatous redness. 
COMPLICATIONS OF GONORRHOEA.           95
Hemorrhage.—Aeon., hot,  dry skin, thirst;  Arg. nit., with painful ten-
                sive erection; Canth., with sharp pains in back; Cinnab.,
                scrofulous  persons; Hep., urine blood red; Merc, moist
                tongue with great thirst; Nit. ac, discharge of bloody
                slime or pure  blood; Sep., pain in small of back and
                region of kidneys;  Sil., scrofulous persons, fetid smell
                of feet; Tereb., bloody urine.
Hydrocele.—Ars., with tendency to general dropsy; Aur., melancholy
              persons; Calc, young scrofulous persons;  Con.,  from
              injury; Dig., nausea, poor digestion; Dulc, after taking
              cold; Fluor, ac, suppression of  stool and urine;  Graph.,
              persons subject to herpetic affections; Hell., of children;
              coolness of body; puffiness of legs;  Mere, flesh soft and
              flabby, perspiration at night; Phos., in consumptives; Puis.,
              persons subject to varicose veins;  blue eyes, light hair;
              Rhus., left side only  affected; Sil., ill-feed, ill-nourished
              persons; Spong., young scrofulous persons; Sulph.,  very
              large swelling, tense and shining.
Nymphomania.—Agar.,  selfishness;  Ars., restlessness, thirst  for  cold
                 water;  Cannab.,  sterile women; Canth., aggravated
                 urinary complaints; Carbo. veg., varicose veins in the
                 vulva; Chin.,lying-in-women;Cimicif.,with acute mania;
                 Cocc, chlorotic women; Coff., would like  to  rub the
                 part, but  it is too  sensitive,  ecstacy; Dig., very  slow
                 pulse; Dulc, sexual desire increased by a cool change
                 in the weather;  Hyos., desires to expose her person;
                 Lach., worse  after sleeping, sadness;  Mosch., intoler-
                 able tickling  in the genitials; Phos., pregnant women
                 with spasms; Plat., in virgins, with soft,  clay-like stools;
                 Puis.,  mild, gentle women,  with  blue eyes; Sabin.,
                 music is  intolerable;  Sil.,  nausea during an embrace;
                 Staph., thinks all the time about sexual things;  very
                 sensitive to the least impression; Stram., face bloated
                 with blood; Thuj., fig warts;  Verat., mania, with lewd-
                 ness; Zinc, better during the menstrual flow.
Ophthalmia.—Aeon., after exposure to cold winds; Ailan., cases inclined
                  to  become chronic;  Ant-t., with  nausea;   Arg-nit.,
                  children; Ars., skin  rough, dry and dirty  looking;
                  profuse  purulent discharge; Mere,  discharge  thin;
                  frequent relapses; Nit-ac, copious yellow discharge,
                  worse at  night; Puis.,  discharge  profuse, thick,
                  white or yellow; mild, gentle persons; Sulph., erup-
                  tions on the  head and face; aversion  to and  aggrava- 
96            COMPLICATIONS OF GONORRHOEA.
                 tion from  washing the eyes with  water: scrofulous
                 persons.
Ovaritis.—Aeon., from cold or fright; Ant-c, with nausea and vomiting;
                ■ Apis, stinging pains;  Ars.,  intense burning pains;
                 Aur., melancholy;  Bell., right ovary, pains come sud-
                 denly; Bry., worse from motion; Canth.. with dysuria;
                 Chin., from frequent sexual intercourse; Coloe, colicky
                 pains;  Con., labor-like pains;  Hep., when suppuration
                 is feared;  Ign.,  with weak, empty  feeling in pit of
                 stomach; Lye, shooting pain  from right to left ovary,
                 worse  at 4 p.  m.; Nux, after drugging,  stimulating
                 drinks, etc.; Plat., with excessive sexual desire: Rhus,
                 pain, better from motion; Thuj., left ovary worse from
                 walking, riding, and during menses; Zinc, left ovary,
                 better during menses.
Paraphimosis.—Aeon., accidental;  Cannab.; Cinnab., scrofulous persons;
                 Coloe, tumefaction of the prepuce; Con.,  when due to
                 contusions; Kali-jod.,  Merc. Nit-ac,  after abuse of
                 mercury;  Rhus, rheumatic persons; puffy swelling;
                 Sulph., when well indicated remedies do not act.
Phimosis.—Cannab., dark redness of prepuce; Caps., urethra painful to
                 touch; dwindling  of testes;  Cinnab.,  penis  swollen,
                 jerking in the penis; Coloe,  tumefaction of the pre-
                 puce; Con. and  Arn., when due to contusions; Mere,
                 in syphilitic  persons; Rhus,  puffy swelling  of both
                 prepuce and glans;  worse from wet poultices; Sulph.,
                 scrofulous  persons, when other well-chosen remedies
                 fail.
Prostatitis.—Aeon., High fever; Apis., incessant desire to urinate; Ars.,
                 chronic cases; debility; Bell.,  pain worse on right side;
                 Bry., with constipation; Cannab., darting stitches in pos-
                 terior  part of urethra;  Con.,  urine flows and stops;
                 Cycl., pressing pain as from sub-cutaneous ulceration
                 near the anus; Dig.,  pale  urine, but scanty; motion
                 increases  the  desire to urinate; Hep.,  when  suppur-
                 ation  threatens; Kali-jod.,  lancinating  and throbbing
                 pains;  Jod., testicles diminished in size; Lye, stitches
                 in neck of bladder and anus at the same time; Mere,
                 continual desire to urinate,  continuing  after mictu-
                 rition; aching in perinaeum; Phos.,  tall, slim  persons
                 with chronic constipation; Puis., great heat and pres-
                 sure in perinaeum; stools small and of flat shape;  Sil., 
COMPLICATIONS OF GONORRHOEA
97
                 scrofulous,  broken down persons; Sulph., pain of a
                 burning character from  prostate to end of penis;
                 Spong., chronic enlargment; Thuj., sensation in the
                 rectum as though a bladder had formed.
Retention of Urine.—(See urinary  complaints)  Aeon.,  Apis., Am.,
                 Ars., Bell., Cann., Canth., Carbo., Con., Hell., Hyos.,
                 Lye, Nux., Puis., Rhus., Sulph., Zinc.
Stricture Spasmodic or otherwise.—Aeon., with inflammatory fever;
                 Agar., Arg-nit., pain in urethra as if swollen and closed;
                 Bell.,  sudden  lancinating  pains;  Berb.,  premature
                 emission of semen; burning in  left testis, epididymus,
                 spermatic cord; Cann., obstinate, irresistable urging to
                 urinate; Camph., strangury, acid urine passed drop by
                 drop;  Canth., passes but a few bloody drops at a time;
                 Cie, following inflammations; Clem.,  urine passes
                 slowly and in a thin stream; Con., urine flows and stops;
                 Dig.,  pressing and burning in  middle  of urethra, as
                 if too narrow; Jod., violent and continual erections;
                  Kali-jod., excessive swelling of the glans penis; Medor,
                 chronic stricture; Mere, with  greenish discharge,
                  worse at night; Nit-ac, after abuse of mercury; Natr-m.,
                  after  abuse of nitrate of silver; Nux.,  painful, inef-
                  fectual desire to urinate; Op., constipation, hard, black
                  balls; Sil., discharge of thin, watery matter; Stram.,
                  cadaverous smelling stools; Sulph., morning diarrhoea;
                  suppressed gonorrhoea; Thuj., dropping of urine after
                  micturition; the stream is frequently arrested.
Varicocele.—Aeon., Arn. and Con., due to injuries; Bell., congestion in
                  head or other parts of the body; Calc, increased sexual
                  desire; Ham.,  Lye, weakened sexual power; Lach.,
                  great depression of spirits, livid appearance of veins;
                  Nux., constipation,  gastric derangements; Puis., per-
                  sons of a lymphatic temperament; Sep., heavy and
                  tender feeling, chronic cases; Sulph., morning diar-
                  rhoea, scrofulous persons.
Vegetations (Condylomata).—Nit-ac, Staph., Thuj. 
          DISEASES OF GENITAL OEGANS.

NOT   NECESSARILY  COMPLICATIONS  OF  GONORRHCEA.
IMPOTENCE.
    (Incapacity for sexual power in men or women.  Due  to malforma-
tion of copulatory organs; to spermatorrhoea,  varicocele, castration, mas-
turbation and nervous influences.)
Agar.—Entire relaxation of the penis; every attempt at coition is followed
      by great debility and languor, and  sometimes by burning-itchin g
      of the skin.
Agnus.—Great deficiency of sexual instinct, the  penis being so relaxed
      that nothing excites it; discharge of prostatic fluid at stool; dis-
      charge of mucus from the urethra during sexual excitement.
Baryta.—Numbness  of the  genitals; heaviness in  small of back and
      loins; cloudy urine with yellow sediment.
Camph.—Coldness, weakness and atrophied condition of the genital
      organs.
Canth.—Coldness of the penis and utter absence of erections, the result
      of previous excesses.
Caps.—Cold and shriveled testicles, scrotum and spermatic cord; drawing
      pains in the cord.
Cupr-acet.—Transient  erections, with tension in  the perinaeum, and
      rheumatic pains in the back and legs.
Gels.—The result of masturbation;  organs relaxed;  absence  of sexual
      feeling; mind depressed; constipation.
Lyc.—Penis cold, blue, relaxed; loss  of sexual desire; exhaustion; result
      of sexual  excesses.   In  women,  pain  in  back,  right  ovary;
      leucorrhcea.
                               98 
IMPOTENCE.
99
Mosch.—With diabetes, or following a cold.
Nit-ac—In syphilitic cases after the abuse of mercury.
Phos.—From conjugal onanism; weak memory; emaciation; tendency to
      cough; pulse unsteady and tremulous; anxiety.
Phos-ac.—Semen is discharged without erection; feeling of weakness of
      the genitals; debility and apathy.
Plumb.—Excessive emaciation and great debility; hectic  fever.
Sulph.—From masturbation; ejaculation takes place as soon as  he
      approaches  his wife; icy coldness and swelling of  the parts.
      Women who have lewd dreams, with discharge from the vagina.
» 
ONANISM.
     (Masturbation, self-abuse).
 Ant-c.—Sadness;  gastric derangements; alternating  constipation and
       diarrhoea.
 Calc-carb.—Palpitation of heart;  cough; vertigo; headache; constipa-
       tion, with chalky stools; increased sexual desire at night.  Women
       with  too  early and  too  profuse  menses, acrid leucorrhcea, cold,
       damp feet.
 Carbo-v.—The most innocent food disagrees; greenish, acrid leucorrhcea,
       irritable and ill-tempered.
 Chin.—Weakness; painless diarrhoea; aversion to society.
 Cocc.—Sadness;  irascibility;  anxiety; imaginary  fears;  frontal head-
       ache.
 Creos.—Chronic  cases, epistaxis, fetid  diarrhoea and coldness of the
       skin.
 Dig.—Pale cloudy urine; slowness of the pulse.
 Gels.—Pale face with blue rings around  the eyes;  mind depressed; loss
       of flesh.
 Nux.—Foul taste in the mouth in the morning; flaccidity of the penis;
       increased sexual desire; continual pain in testicles; irritable, and
       wishing to be alone;  when due to high living.
 Phos.—Weak memory; blotches  on  the face;  frontal or occipital head-
       ache; tendency to cough.
 Plat.—Red urine, becoming  turbid and depositing a red sediment.
       Women—excessive sexual desire; genitals excessively sensitive to
       the touch.
Puls.—Great sexual excitement; milky leucdTrhcea with backache; menses
       profuse, of a blackish color.
Staph.—Cases of long  standing; imaginary  fears;  confused and weak
       memory;  toothache,  with caries of  the  teeth; deficiency  of
       animal  heat: penis .relaxed,  with  dull and continuous  pain in
       testicles.
                                100 
SPERMATORRHOEA.
    (Abnormal discharge of semen, occurring  oftener than once in ten
days.   Cause, masturbation;  sexual excesses; gonorrhoea; worms).
Aloes.—Coldness and sweat of  genital organs; scrotum relaxed; sexual
       desire increased; tenderness of testicles.
Camph.—Great nervous excitability with vertigo and throbbing pains in
       the head; dragging in spermatic cord.
Carbo-v.—Prostration; constipation; flatulence after eating the smallest
       quantity of food.
Canth.—Inability to retain the  urine; coldness of the penis; insatiable
       desire for sexual intercourse,  with discharge of blood instead of
       semen.
Caps.—Sleeplessness; great sensitiveness to open air; atrophy and  cold-
       ness of the genitals;  morning erections; shriveling of spermatic
       cord.
Caust.—Confused memory; urine contains stringy mucus; continued loss
       of prostatic fluid.
Cina.—When due to irritation from worms.
Chin.—Great  debility; painless diarrhoea; menses  increased; canine
       hunger.
Collin.—Urine high-colored; light-colored stools; bitter taste.
Con.—Jerking pain in the teeth; teeth seem to be loose  when chewing;
       difficult urination.
Gels.—Depression of spirits; tottering gait; emission of semen during
       stool; pale face, with  blue rings around the eyes.
Graph.—Emissions involuntary, without erection; pain in the back of
       the neck.
Lach.—Emissions followed by sweat. 
102
SPERMATORRHOEA.
Merc—Clammy cold sweats at night; chilliness and great sensitiveness
       to cold; moist tongue with great thirst; burning in the anus dur-
       ing and after stool; drowsiness.
Nux.—Aggravation from liquor; frequent and ineffectual desire for stool;
       gastric irritability; highly seasoned food or liquors aggravate the
       disease.
Phos.—Anxious and irritable;  easily  alarmed; pains in the chest; mem-
       ory impaired.
Phos-ac—Apathy; semen is lost on the least provocation;  loss of semen
       during stool; black streaks before the  eyes not removed by wip-
       ing them.
Puls.—Aggravated by frequent bathing; mild, gentle persons predisposed
       to catarrh.
Sars.—Amorous dreams; bitter taste in the mouth; pain in the back, ex-
       tending down the spermatic cords; intolerable smell of the  geni-
       tals.
Sil.—Burning of the feet, with sweat; perspiration of the  scrotum; ach-
       ing in sacrum; weakness and heaviness of the arms; melancholy.
Staph.—Very sensitive to the least impression; discontented, low-spirited;
       emissions seldom awaken him; shooting pains through  right
       testicle.
Sulph.—Emissions without erections; watery in character  and excessive
       in amount. 
Urinary  Diseases. 
 
DISEASES  OF  THE   KIDNEY.
             ACUTE  RENAL  HYPERAEMIA,
                    (ACUTE CONGESTION).
Symptoms:  Frequent  painless passage of small quantities of high col-
      ored concentrated urine.  It contains a little  blood and hence
      traces of albumen.  There  is slight fever; aching in the back;
      some headache and occasionally vomiting.


            CHRONIC RENAL HYPERAEMIA,
                  (CHRONIC CONGESTION).
Symptoms:  Similar to the above, but chronic and associated with disease
      of the heart; abundant deposit of urates; feeling of weight  in
      the loins and dragging pain in the testicles.


        ACUTE  PARENCHYMATOUS  NEPHRITIS,
                 (ACUTE  BRIGHTS DISEASE).
Symptoms:  Urine dark,  scanty, of high specific gravity and  contains
      casts of epithelium, free epithelial cells, free blood corpuscles and
      a large amount of albumen; odor that  of  beef tea; slight fever
      with thirst,  nausea, vomiting and diarrhoea; later on stupor, head-
      ache and dropsy.


      CHRONIC PARENCHYMATOUS NEPHRITIS,
               (CHRONIC BRIGHTS  DISEASE).
Symptoms:  Urine usually  scanty  and of  high  specific gravity,  con-
      taining granular  casts with  shrivelled  granular epithelium, and
      later fatty casts.   Dropsy commences in the eye-lids and face;
      anaemia, which is  progressive; vomiting and diarrhoea; headache; 
106             DISEASES OF THE KIDNEY.
       irritability of temper; weakness of memory; sleepiness; defective
       sight; at first functional disturbance of the heart, later hypertro-
       phy with dilatation.


         CHRONIC INTERSTITIAL  NEPHRITIS,
    (GRANULAR, CONTRACTED OR  CIRRHOTIC KIDNEY).
Symptoms:  Obscure headache;  palpitation;  chilliness; local paralysis;
       urine increased, of low specific gravity, containing a  very small
       amount of albumen;  later small granular or hyaline casts.


                  ALBUMINOID  KIDNEY,
                  (LARDACEOUS  KIDNEY).
Symptoms:  Urine increased, of  low specific gravity, containing  much
       albumen and waxy casts; accompanies wasting diseases.


     CYSTIC DEGENERATION OF THE  KIDNEY.
Symptoms:  Frequent  passage of more or less bloody urine; failure of
       strength; enlargement of the  kidneys can be felt through the
       abdominal walls  as  soft bodies.
                         PYELITIS,
    (INFLAMMATION  OF THE PELVIS OF THE KIDNEY).
Symptoms:  Frequent painless urination, the urine containing pus and
      columnar epithelial  cells  from the  pelvis of  the  kidney; dull
      aching pain over  the loins.  When the structure of the kidney
      is also affected the urine will be found to be albuminous and will
      contain tube casts; hectic fever.
      TUBERCULAR  DISEASE OF  THE  KIDNEY.
Symptoms:  Severe pain in loins;  dribbling of  bloody urine; profuse
      night sweats.


               CANCER OF  THE  KIDNEY.
Symptoms:  Pains in lumbar region; hematuria and often albuminuria;
      enlargement of the kidney, forming a tumor which is  easily
      recognized. 
               DISEASES  OF THE KIDNEY.             107

                     PERINEPHRITIS,
    (INFLAMMATION OF  TISSUE ABOUT THE KIDNEY).
Symptoms: Tenderness in the loin of one side with pain increased by
      motion; a fullness over the situation of the kidney, with fluctua-
      tion; urine normal.


             ACUTE  ATROPHY OF  KIDNEY.
Symptoms:  Scanty albuminous urine  with deposits of casts; tendency
      to hemorrhages; jaundice; uraemic nervous affections.


                    HYDRONEPHROSIS,
                 (DROPSY  OF THE KIDNEY).
Symptoms:  Tumor in  lumbar region, displacing and compressing the
      colon;  occasionally constipation; more or less fluctuation of the
      tumor; may be confounded with ascites, hydatids of the kidney,
      and perinephritic  abscess.


           SYPHILITIC  DISEASE  OF  KIDNEY.
Symptoms:  Slight temporary albuminuria  with  other evidences of
      syphilis.
t 
ALBUMINURIA.
    (Albumen in the urine.  Due to acute and febrile diseases, Bright's
or organic  disease of kidney, leucorrhceal or  gleety  discharges and
blood).
Arsen.—Restlessness; drinking often and little at a time; pale, puffed
       face.
Apis.—Thirstlessness; frequent and copious discharges of urine, or dark-
       colored and scanty urine; oedematous swelling of the face and ex-
       tremities; gastric derangements.
Arg-nit.—Acute or dull pains,  extending from  the kidneys down the
       ureters to the bladder, dark, dried-up or bluish countenance.
Aurum.—Melancholy mood, with desire for death; bloated, shining face;
       urine like butter-milk; mucus sediment; hot, red  urine, contain-
       ing sand.
Bry.—Irritable;  aversion to motion; faintness when rising from bed.
Canth.—Burning,  stinging,  tearing pains  in the  kidneys,  extending
       along the ureters into the bladder; much mucus  in the urine;
       burning in the neck of the bladder.
Cupr.—Fever in irregular fits; twitching of the limbs and biting of  the
       tongue; excessive thirst.
Colch.—GMematous swelling and coldness of the feet and legs; urine
       dark and  scanty; gouty subjects.
Dig.—Slowness of the pulse; bluish hue.of the skin; alternate emissions
       of large and small quantities of colorless urine.
Dulc—Aggravation  from  taking cold, or cold  weather; turbid, foul-
       smelling  urine; micturition painful.
Gels.—During pregnancy; high fever without thirst; flushed  face; sud-
       den spasmodic pains in the abdomen.
Lach.—Urine dark, almost black, scanty; face puffed, yellowish; climac-
       teric period; patient worse after sleeping.
Lyc—Increased  secretion of a  whitish, turbid, foaming urine; pain in
       the back previous to urination,  with relief as soon as the urine
       begins to  flow; low-spiritedness and great weariness.
Sulph.—When due to suppressed eruptions or alchoholic drinks; pains
       of all sorts in the small of the back.
                               10s 
CYSTITIS.
    (Catarrh or inflammation of the bladder.  Due to gonorrhoea, taking
cold, irritation from calculi and morbid growths, and medicinal  agents).
Acon.—Brought on by exposure to cold, dry winds, and accompanied
       by high fever, restlessness, thirst and burning urine of a  reddish
       color; micturition painful,  difficult, and often  passed drop by
       drop; children place their hands on the genitals and cry out with
       the pain.
Arn.—When due to an injury.
Ars.—Burning pain at commencement of micturition; distension of the
       bladder; cloudy urine, containing pus and  blood; intense thirst;
       anxiety and restlessness, with fear of death.
Apis.—Urine dark-colored and scanty; thirstlessness; bearing-down feel-
       ing in the bladder, with frequent desire to urinate.
Bell.—If Acon. has not proved  beneficial; rapid sinking of strength;
       spasm of neck of bladder; region of bladder very sensitive to
       touch; urine hot and fiery-red.
Carbo-veg.—Chronic cases in old  people; weakness, with coldness,
       chilliness, and palpitation  of the heart.
Caust.—Frequent,  difficult and painful urination;  light-colored urine
       with cloudy  sediment; thirst; urine loaded with lithic acid and
       lithates; great debility.
Canth.—Burning tenesmus and  violent pains in the bladder; urine
       dark colored, bloody, and is passed drop by  drop, with extreme
       pain; violent fever, with thirst, but drinking  increases the pain;
       flushed face, often delirium, and even nausea and vomiting.
Cann.__When due to gonorrhoea;  burning during and after micturition;
       urine red and turbid or white and turbid.
Caps.—Urine scanty and light-colored; spasmodic  and  cutting pains in
       neck of bladder; burning in urethra after urinating.
Coff —Urine dark-brown, fetid, much mucus, some  blood, hot and very
                                109 
110
CYSTITIS.
       painful on passing; very nervous and  restless; sleepless; cannot
       pass urine without catheter.
 Coloc.—Thick, brown, fetid urine; alternate stitches in the bladder and
       rectum; frequent tenesmus; colicky pains in the abdomen.
 Cupr.—After  child-birth; micturition preceded,  accompanied and fol-
       lowed  by forcing pains, similar to those of labor; cold hands and
       feet; thirst.
 Dig.—Pressure  on the bladder, with a sensation  as if it were too full
       continuing after  micturition;  continual desire to urinate, only a
       few drops being passed at each time.
 Dulc—From  taking cold; constant desire to urinate; painful micturi-
       tion; urine turbid and white.
 Hell.—Constant desire to urinate, with painful emission of small quan.
       tities of urine, which is turbid and dark, depositing a mucous  or
       purulent sediment.  Children cry and fret all the time.
 Hyos.—Frequent urination with  scanty discharge;  urine yellow or tur-
       bid depositing a grayish, white sediment.
 Hep.—Urine blood red or brownish  red; flocculent and covered with.a
       greasy  pellicle; pus in the  urine.
 Lyc—Worse from 4 to 8 p. m.; pain in small of back before urination;
       turbid,  milky urine,  depositing a thick,  purulent  sediment;
       bloody urine; foul-smelling urine.
 Lach.—Feeling as of a ball rolling in the bladder, with dull pain; copi-
       ous discharge of foaming urine; yellow  or copious  brown-red
       urine, depositing a brick-dust sediment.
 Nit-ac—Urine smells like that of horses; urging after micturition, with
       Bhuddering along the spine.
Nux.—After suppressed gonorrhoea  or  allopathic  drugging, painful,
       ineffectual urging to  urinate; discharge of urine drop by drop,
       with  burning and tearing;  spasmodic retention of urine.
Phos-ac—Urine  like milk;  cramp-like constriction of the  bladder,
       anguish and  uneasiness before micturition; paleness  of  face;
      thirst; emaciation.
Puls.—Tenesmus  of  bladder, with painful  pressure; after  urinating,
       spasmodic  pain in neck of bladder, extending to the pelvis and
       thighs; slimy sediment in urine.
Sarsap.—Chronic cases;  much pain at the close of urination; discharge 
CYSTITIS
111
       of white, acrid, turbid matter from the urethra; severe tenesmus
       as in gravel.
Sep.—Chronic cases;  greasy cuticle  on the  surface of the turbid urine;
       fetid urine, depositing a clay-colored  sediment; during and after
       micturition, chilliness and heat in the head.
Sulph.—After  gonorrhoea;  scrofulous  persons;  painful  discharge  of
       bloody urine; sediment thick, tough, mucus or purulent;  pain in
       urethra after micturition.
Thuja.—After gonorrhoea; urine clear when voided, but becomes cloudy
       on standing; red urine, depositing a brick-dust sediment.
Uva Ursi.—Mucus discharge mixed with blood. 
DIABETES.
    (Profuse flow of urine.  Causation—hereditary, often.)
Ars.—Drinks often and little at a time; earthy complexion; faintness.
Arg-nit.—Desire for sweets; debility; pale but strong smelling urine.
Arg-met.—Urine greatly increased in amount and contains sugar in
      large quantities; oedematous swelling of feet and scrotum.
Arn.—Turbid urine, like butter-milk.
Amm-carb.—Much thirst; bitter taste in morning; desire for sugar.
Baryta-carb.—Frequent and profuse urination every other day; scrofu-
       lous persons.
Canth.—Urinates every few minutes and a large quantity  at  a time;
       rapid loss of strength.
Chel.—After drinking wine; large quantities of sugar in the urine.
Carbo-veg.—The most innocent food disagrees.
Caust.—Frequent and urgent desire to urinate in hysterical females.
Coloc.—The  urine when voided  is white and turbid, but after standing
       becomes a milk-white, jelly-like  mass; pale  urine,  with a light
       brown, transparent, flocculent sediment; renal pains.
Eup. purp.—Constant urging with copious discharge, attended with  ach-
       ing in bladder.                            *
Helonias.—Urine profuse,  clear,  light colored;  over-sensitiveness to
       fresh air.
Kali-carb.—Violent thirst in evening and at night; sunken eyes; fre-
       quent and violent  desire to urinate  at night;  urine of a pale,
       green color; feeling of cold in intestines, as if water were dropped
       upon them; fetid breath; irritable; surly state of mind.
Kreos.—Drowsiness with frequent yawning; no appetite; sediment red
       or white; cold feeling in the epigastric region.
Lyc.—Urine clear like   water, or turbid; excessive  thirst, especially at 
DIABETES.
113
       night;  obstinate  constipation; low-spiritedness; loss  of sexual
       power.
Merc—Scrofulous or syphilitic persons; flabby tongue; offensive breath;
       great thirst; canine hunger; constant desire to urinate, with cut-
       ting  pains in  left kidney;  faint, sickish pain in  abdomen; always
       feel worse at night.
Mosch.—With impotence; insatiable thirst; constipation;  emaciation;
       sugar abundant.
Murex.—Urine smells like valerian; discharges blood while urinating,
Natr-sulph.—Patient is depressed, tired of  life.  Increased flow of
       urine, with burning  sensation when passing it.  Brick dust or
       whitish-yellow sediment.
Nux.—The  most urine is voided at night; after allopathic  drugging, or
       abuse of stimulants.
Phos.—White urine  with  brick-dust  deposit  and  variegated  cuticle;
       nervous debility and trembling.
Phos-ac.—Urine  like  milk mixed with jelly-like, bloody pieces, with
       pain in kidneys; passes large  quantities  of colorless  urine at
       night;  nausea and vomiting; is very indifferent.
Plumb.—Hectic fever, with  dry, hacking cough and great exhaustion;
       excessive emaciation; great hunger; constipation, sweetish belch-
       ing  and  vomiting; copious red or  green urine;  anxiety with
       restlessness.
Rhus.—In rheumatic subjects.
Terebin.—Dull, languid feeling, relieved by micturition.
Uran.—Dyspeptic symptoms; profuse urination at night.
8 
DYSUR1A.
    (Painful urination.  This is the first degree of retention of urine).
Consult also remedies for gonorrhoea and strangury.
Axon — After a cold; high  fever; dry, hot skin; urine pale, watery, or
       very dark; plethoric persons.
Arn.—After mechanical injuries;  feeling of fullness  in  the  bladder;
       plethoric persons with red face.
Ars.—Restlessness; exhaustion;  great thirst; burning pains in bladder
       and urethra; urine normal or green, blue or black.
Canth.—Intense pain on urinating; violent cutting, pressing and cramp-
       ing pains in bladder, extending into the  urethra  and kidneys;
       urine is mixed with blood or with pus and blood.
Camph.—After the abuse of cantharis, turpentine or other drugs.
Con.—The urine flows arid stops, and flows and stops at each emission;
       difficult and painful urination.
Cann.—Painful jerks in the abdomen; frequent urging to urinate, with
       profuse flow; very difficult and painful urination.
Dulc—From cold; getting feet wet;  cold drinks.
Lyc—During pregnancy; red sand in the urine.
Nux.—From suppression of hemorrhoids, abuse of  beer  or  alcoholic
       stimulants; after allopathic drugging or hot stuffs.
Op.—When occasioned by fright or chagrin, with constipation.
Puls.—From menstrual suppression.
Phos.—Difficult and scanty urination; tall, slender persons.
Sulph.—Scrofulous subjects and those with cutaneous eruptions;  great
       pain on urination, the urine being mixed with blood.
114 
ENURESIS.
    (Involuntary  discharge of  urine, incontinence of  urine.  Due  to
worms,  calculus,  struma, hysteria,  paralysis,  prostatitis and willful
laziness).
Acon.—From fright or cold; hysterical women; urine pale and watery.
Aloes.—Enlarged  prostate; constant  urging for stool; passing  small
       quantities.                                           ,
Amm-c—At night; pale urine with red sediment.
Apis.—Great irritation of the parts; worse at night.
Arg-nit.—Pale, fetid urine; drinking coffee aggravates.
Arn.—Injuries; paralysis of sphincter; constant dribbling.
Aur.—Especially at night; paralysis of bladder.
Bell.—Spasmodic  action  of  bladder; profuse  perspiration; moaning
       during sleep.
Benz-ac—Urine high-colored, irritating, and smells like that of horses.
      {Nit-ac).
Calc—Small, fat children, who sweat easily and catch cold easily.
Camph.—After irritating drugs {Canth., Tereb., Copaib., etc).
Carbo-veg.—With acidity of the stomach.
Caust.—Children (boys) with black hair and eyes; always during first
       sleep;  urine loaded with lithic acid and lithates; great debility;
      ' aggravated by coughing, sneezing, etc.
Cham.—With whooping-cough;  straw-colored, watery urine.,
Cina or Santon.—With worm symptoms and canine hunger.
Dig—Slow pulse; palpitation of heart; vertigo.
Dulc.__The result of catarrh of  bladder, or cold; copious, turbid, foul-
       smelling urine.
Ferr.—Only  during the day. 
116
ENURESIS.
 Ferr-phos.—Enuresis nocturna, from weakness  of the muscles, often
       seen in women when every cough causes the urine to spurt.
 Graph.—Sour-smelling urine; scanty discharge.
 Hep.—Urine passed slowly and  without  force;  discharge  of  mucus
       from the urethra; very hasty in his actions.
 Hyos.—Loss of will to urinate;  or frequent scanty urination.
 Kreos.—Wakes at night with  urging, but  cannot hold the  urine  only
       during deep sleep; strong-smelling urine.
 Lyc—Urine acid;  red sand in urine; observing dispositions.
 Merc-sol.—Children  who  perspire  easily; urine hot, acrid and sour-
       smelling.
 Merc-bin.—Cannot hold the water a moment.
 Natr-mur.—Tenesmus;  brick-dust sediment.
 Petr.—Weakness of neck of bladder; chronic blenorrhoea; urine drops
       out after urination.
 Puls.—Of little girls;  worse in the fall.
 Rhus.—Worse during rest;  better from continued motion;  dreams of
       walking, running, etc.
 Kuta.—While walking and at night;  greenish urine.
 Sep.—Always during first sleep;  {Caust.); those who practice masturba-
       tion; talks during sleep.
 Sil.—With worms; in chorea; from blows upon the head; feet smell badly.
 Staph.—Teeth decay early; fetid perspiration.
 Sulph.—Pale, lean children, who dislike to be washed;  twitches during
       sleep;  obstinate cases.
Thuj.—Warty growths.
Uva Ursl—Burning after the discharge of slimy  urine; green  urine;
       bloody urine. 
«
HEMATURIA.
    (Bloody urine.  Due to gonorrhoea, affections of the bladder, kidney,
ureter and urethra; abnormal conditions of the blood; malignant fevers;
suppression of menses;  and mental emotions).
Acon.—Plethoric persons; after a cold; high fever.
Arn.—After straining from lifting, or other injuries.
Ars.—Characteristic restlessness, thirst and burning pains.
Calc.—From getting feet wet; blood discharged in clots; putrid-smelling
      urine; greenish urine.
Camph.—From the abuse of Canth,. Tereb., Copaib., and other irritating
       drugs.
Cann.—With painful jerks in abdomen.
Canth.—Blood continually  dropping from the urethra; burning pain
       before, during and after micturition;  urethra  painful to touch.
Carbo-veg.—With epistaxis, exhaustion and flatulency..
Chimaphil., Ham.—Passive  hemorrhage.
Erigeron.—Urine profuse, of strong odor.
Hep.—Urine blood-red;  flocculent and covered with a greasy pellicle.
Ip.—Profuse with faintness; nausea; flow of blood when not urinating;
      great debility.
Lyc—Chronic catarrh or gravel; discharge of bloody coagula.
Merc.—Painless  discharge during sleep;  or very painful micturition,
       with profuse sweat.
Natr-m.—Cutting pain  in  the urethra after  micturition.  Hematuria
      after scurvy.
Nit-ac.—Active hematuria, urging after  micturition, with  shuddering
      along the spine;  discharge of blood between the acts  of micturi-
       tion.
Nux__After coffee, liquors, or allopathic  drugging; suppressed hemor-
                                 117 
118
HEMATURIA.
       rhoids or menses; constant desire to urinate, passing but little at
       a time.
Phos.—After sexual excesses;  urination difficult and scanty.
Puls.—Females with discharge of dark-colored clots; burning and spas-
       modic pains in bladder and urethra.
Sep.—Burning and cutting in urethra; pain in Bmall of back and region
       of  kidneys; yellowish face.
Sulph.—Burning, stinging and spasmodic pains in the urethra;  puts feet
       out of bed; soles burn.
Tereb.—Burning  in  region of  kidney;  tenesmus of  bladder; urine
       black.
Zinc—Vicarious bleeding, in consequence of suppressed menses; invol-
       untary discharge of urine. 
RETENTION  OF  URINE.
    (Due to loss of contractility, paralysis of the bladder, etc.; pressure
of womb on bladder; tumors; foreign bodies in urethra or bladder;
injuries; urethritis; strictures; prostatitis; and malignant diseases.)
Acon.—From cold, particularly in children, with  much crying and rest-
       lessness; high fever; stitches in the kidneys.
Arn.—With feeling of- fullness in the bladder;  tenesmus of neck of
       bladder; injuries.
Ars.—After childbirth; severe thirst and anguish.
Bell.--In  pregnant women when due  to over  distention; from delay in
       urinating; in scarlet fever.
Calc.—From getting feet wet.
Camph.—After abuse of  cantharis, turpentine, or other irritating drugs;
       constant pressure on bladder.
Cann.—When obstinate; blood discharged drop by drop.
Canth.—Urine scalds, and is  passed drop by drop with extreme pain;
       drinking increases the pains.
Carbo-veg.—Old people, with, coldness, chilliness, and palpitation of the
       heart.
Caust.—Paralysis of muscular coat of  the bladder; lithic acid gravel.
Dulc—From cold; getting feet wet;  cold drinks.
Hell.—Cross  and irritable children;  will not  allow  any one to touch
       them; bladder distended; atony of bladder.
Hyos.—In  acute or malignant  affections; pregnant or lying-in women; •
       delirium; much thirst.
Nux.—Urging to stool; dribbling'of urine.
Puls.—Heat, redness and soreness of the vesical region; mild  persons.
Rhus.—Rheumatic  persons after getting wet.
Sil.—Scrofulous children suffering from worms.
Sulph.—Painful desire to urinate; if any urine is passed, it is attended
       with great pain and effort and is mixed  with blood.
Stram.—Bladder distended, but no pain.
                                119 
STONE-CALCULUS.
    (Gravel, sand.   Predisposing  causes:  Fevers,  dyspepsia,  nervous
exhaustion, injuries, disease of  kidneys or bladder, poverty.)
Aspar.—Gouty diathesis.
Arg-nit.—Uric acid disappears from the urine;  scanty and rare emis-
       sion of dark yellow urine.
Bell.—Urine gold-colored, depositing a red sediment; nocturnal pain in
       bladder;, oxalic calculus.
Berb.—Pains  extending  from kidney to bladder, especially left  side;
       pains extend to left testicle, which is drawn up.
Calc--Scrofulous or chlorotic children.
Cann. -Urine turbid; strangury.
C©lch.—Gouty persons; urine scanty, brown or black; white deposit.
Erig.—Vesical irritation from stone.
Lyc.—Much red sand  in the urine; chronic affections of the  mucous
       membranes.
Lith-carb.—Our best  remedy.  Dark reddish-brown  deposit;  pain in
       the ureter and spermatic cord into the testicle.
Nit-ac.—Urging after  mictu ition, with  shuddering along the  spine;
       urine smells like that of horses.
Nux.—Chronic derangements of the digestive organs.
Op.—Dark, red urine, with very thick sediment; or drowsiness, with full
       bladder.
Petr.—Reddish, brown and fetid urine; red sediment;  dark, mucous
       clouds  in urine.
Phos.—Broken-down constitutions from loss of fluids; old people.
Puls.—Urine retained, with redness, heat  and  soreness in the region of
       the bladder; urinary tenesmus.
                                120 
STONE—CALCULUS.
121
Sars.—Urine scanty, slimy, flaky, clayey, sandy; intolerable smell of the
        genitals; much pain at the end of urination.
Sediment, bloody—Acon., Sep.
        bright—Nit-ac.
        brown—Ambr., Crot-t., Dig.
        chalky—Led., Phyt.
        cheesy—Sec-cor.
        clayey—Amm-m., Berb., Phos., Sars., Thuj.
        dirty brown—Acon.
        gray—Kali-j.
        light brown—Coloc, Puis.
        milky—Ant-t.
        pink—Sep., Lob.
        purple—Ant-t., Bov., Flu-ac.
        red—Ambr., Ars.,  Bell., Berb.,  Camph.,  Carbo-v., Chel., Con.,
             Creos., Graph., Lach., Led., Lyc,  Mezer., Natr-m., Nit-ac,
             Petr., Plat., Puis., Sec-cor., Seneg., Sep., Sulph.,  Verat-vir.
        reddish-brown—Lith-carb., Nit-ac.
        white—Acon., Aloe., Alum., Bell., Benz-ac, Berb., Bry., Calc,
             Camph., Canth., Caps., Chin., Colch.j Dig., Ferr., Graph.,
             Hep., Ign.,  Nit-ac,  Petr.,  Phos.,  Phyt.,  Sec-cor., Sep.,
             Sulph.
        yellow—Aloe., Bary., Kali-j., Lyc, Phos., Sep., Sil., Spong. 
STRANGURY.
    (Extreme difficulty in urinating; urine passed drop by  drop,  with
tenesmus of neck of bladder.  See also Dysuria.)
Acon.—A few drops are passed with great pain; urine dark  red and
        cloudy.
Apis.—Dark,  scanty urine, stinging pains.
Bell.—When due to over-distension; from delay in urinating.
Cannab.—Urine bloody; discharged drop by drop.
Camph.—From cantharis poisoning.
Canth.—Urine dark colored, bloody,  turbid; thirst, but drinking  in-
        creases the pain.
Caust.—Brought on by taking cold; burning pain.
Dig.—Thick,  blood-red sediment.
Gels.—Spasmodic cases; great nervous irritation.
Hyos.—Bladder  greatly distended.
Lyc.—With tympanitic distention   of the  abdomen; children  during
        dentition.
Merc—Perspiration on making  the attempt to urinate; chilliness and
        heat alternating.
Nux.—Spasmodic cases; suppression of  hemorrhoids; abuse of beer or
        stimulants; spasmodic contractions of the urethra; chronic irri-
        tation lower part  of spine.
Op.—Sensation as if the passage were closed.
Phos.—Anxious and irritable; emaciated; tall persons with black hair
        and eyes; sensation as if the passage of urine was impeded.
Puls.—Due to getting  wet; penis and scrotum drawn up.
Pareira.—Can only pass  urine  when on his  knees;  strong-smelling
        urine.
Thuj.—Violent stitches in glans.
                                122 
SUPPRESSION   OF URINE.
Ailanth.—With jaundice and constipation.
Apis.—Pulse almost imperceptible.
Arn.—After injuries.
Ars.—With anxiety, restlessness, thirst and rapid prostration.
Bell.—With violent delirium; jerking of the limbs; face red and hot;
        constipation; profuse sweat.
Bis.—Vomiting, with great prostration; paralytic weakness  and weari-
        ness in right arm.
Camph.—Complete after cantharis and turpentine.
Calc-carb.—Scrofulous children.
Canth.—In yellow or typhoid fevers; chronic inflammation of kidneys.
Caust.—With paralysis of the limbs, following diphtheria or other acute
        diseases.
Con.—Unusual   severe pain in the  kidneys  at night; old men and
        women.
Cupr.—Alternation of convulsions with talkative delirium; bluish color
        of the skin.
Dig.—Scarlet fever with  dropsy; bluish,  doughy  appearance  of  the
        swollen parts.
Hyper.—After injuries of the spine.
Hyos.—In children suffering from  meningitis,  scarlet  fever., etc.;
        twitching and jerking in all the muscles of the body.
Ign.  and Mosch.—Hysterical women.
Merc.—Great perspiration at night, but no urine.
Nit-ac—After the abuse of mercury ; constipation.
Nux.—From lead poisoning.
Petr.—Imagining another person lies in the same bed.
pHos.—Quick, small, thread-like pulse ; cold perspiration  of the head
       and extremities ; great  emaciation.
Phyt.—Pulse slow and feeble ; pain in the  loins.
Sec-cor.—Thin,  greenish  stools ; pulse  small, very rapid, contracted,
       frequently intermittent.
Stram.—Talkative delirium ; pulse frequent and irregular.
                               123 
URGING TO  URINATE.
Acon.—Discharge of only a few drops of scalding hot, dark  red  urine ;
       sometimes excited by merely touching the abdomen ;  children
       place their hands on the genitals and cry out with the pain.
Arn.—After mechanical injuries ; scanty, yellow-red urine.
Agar.—With copious emission of urine.
Anac.—With scanty discharge.
Bell.—With scanty discharge.
Bry.—With sensation as if  the urine passed off spontaneously.
Creos.—In bed, with contractive pain in the vagina.
C ann.—With aching pain.
Canth.—With scanty discharge of dark or bloody urine.
Carbo-an.—Followed by voluptuous tickling in urethra.
Cham.—With anguish during micturition.
Chin.—Urging after micturition ; constipation.
Dig.—At night; when  rising,  giddy and  drowsy ; passes  only a few
       drops at a time.
Gels.—Scanty discharge with tenesmus.
Hell.—With spasms.
Hyper.—At night, with vertigo in and out of bed.
Merc—With  scanty discharge  of dark  red urine, soon becoming
       turbid.
Nit-ac—With cutting pain in abdomen.
Nux.—Painful, ineffectual  desire, passing but a few drops of red, bloody
       urine.
Puls.—In mild, gentle women, after getting feet wet, with cutting pain
       during micturition.
Sabad.—Worse after passing a few drops, with drawing  in the urethra
       and violent burning.
Sep.—With painful bearing down in pelvis.
Staph.—With the discharge of a little dark yellow urine in a thin stream,
        with continued dribbling after urinating.
Thuj.—With straining  and scanty urine.
Uva Ursa.—With slight discharge  and burning, cutting pain after.
                                124 
CONDITION  OF  THE STREAM.
Forked.—Arg-n., Cannab., Canth., Petr., Rhus., Thuj.

Feeble.—Arg-n., Cham., Chin., Creos., Merc, Op., Verat.
Slow.—Arg-n., Amm-m., Clem., Petr., Plat., Sulph., Zinc.
Spreading, Fan-shape.—Cann.

Thin.—Bell., Camph., Clem., Graph., Mere, Nit-ac, Puis., Sars.,  Staph.,
       Sulph., Thuj., Zinc.

The Stream  is interrupted several times before the urine is entirely
       voided.—Con., Chin., Thuj. 
 
INDEX.
                                                              PAGE.
Abortion.......................................................   62
Abrasions.......................................................   26
Abscess..........................................................   93
Acne............................................................   38
Acute renal hyperaemia...........................................  105
   "  parenchymatous nephritis..................................  105
   "  atrophy of kidney.....................*....................  107
Adenitis........................................................   41
Albuginitis........................................■..............   57
Albuminoid kidney..............................................  106
Albuminuria......................................................  108
Alopecia.......................................................   40
    "    a treatment of...........................................   41
American origin of syphilis......................................   14
Aphonia.........................................................   43
Arthritis......................................................73,   93
Balanitis.......................................................25,   93
Bladder, syphilis  of.............................................   57
    "    inflammation of.........................................   72
Bloody  urine.........................*..........................  117
Bones, affections of............................................53,   55
Brain, syphilis of................................................   46
Brights disease, acute............................................  105
   "       "    chronic..........................................  105
Bronchi, syphilis of..............................................   49
Bubo......................................................31,  72,   93
  "  syphilitic...................................................   31
  "  suppurating.................................................   31
  "  creeping...................................................   32
Bullae...........................................................   36
Calculus........................................................  120
Cancer of kidney................................................  106
Caries, syphilitic.....................,..........................   54
Carriers of syphilis___..........................................   17
Cartilage, affections of...........................................   55
                                 127 
128                          INDEX.
                                                              PAGE.
Chancre, Hunterian..............................................  19
         seat of.......................................;.........  19
    "    symptoms of............................................  19
         follicular...............................................  20
  .  "    hard...................................................  20
  ,  "    indurated................................................  20
    "    infecting...............................................  19
    "    true....................................................  19
    "    non-indurated...........................................  20
         soft....................................................  20
    "    period of incubation.....................................  19
    "    differential diagnosis....................................  22
    "    relative frequency of hard and Boft.......................  23
    "    how long specific........................................  23
    "    inflammatory...........................................  23
    "    phagedenic  ............................................  24
    "    ulcerative........................,.....................  24
    "    sloughing..............................................  24
    "    gangrenous.............................................  24
    "    diphtheritic............................................  25
    "    serpiginous.............................................  24
    "    erosive.................................................  24
    "    diagnosis of.............................................  25
    "    prognosis...............................................  26
    "    treatment...............................................  27
    "    in women..............................................  29
    "    of the urethra..........................................  28
Chancrelle......................................................  20
Chancroid........................................................  20
Choc-en-retour..................................................  62
Chordee..................................................70,  74,  94
Chronic interstitial nephritis..................................... 106
Condylomata...................................................39,  97
Congenital syphilis..............................................  59
Congestion of  kidney, acute ,..................................... 105
      "         "     chronic.................................... 105
Cornea, affections of............................................  64
Corpora cavernosa........................................,......  57
   "    spongiosum.............................................  57
Cowperitis___......'..........................................73,  94
Cystic degeneration of kidney.................................... 106
Cystitis...................................................72, 94, 109
Deafness........................................................  49 
INDEX.                          129
                                                              PAGE.
  Diabetes........................................................  112
  Diarrhoea........................................................   47
  Diseased ovum..................................................   62
  Dropsy of the kidney............................................  107
  Dry caries.......................................................   54
  Dualists, views of..........................................-...'...   21
  Dysentery......................................,................   47
  Dysuria.........................................................  114
  Ear, syphilis of...................................................   50
  Ecthyma-form eruption..........................................   38
  Eczema.......................................................25,   94
  Enuresis............:...........................................'.  115
  Epididymitis, syphilitic...........  ..............................   57
       "       gonorrhoeal....................................72,   94
 Eruptions, treatment of...........................................   40
 Erythema of mucous membranes..................................   42
 Erythematous eruption...........................................   35
       "      treatment...........................................   40
 Exostosis........................................................   55
 Eye, syphilis of..................................................   50
 Fever, syphilitic.................................................   34
 Fingers, affections of........................."....................   52
 Gangrenous chancre.............................................   24
 General inflammation of penis....................................   94
 Gleet............................................................   82
   "  treatment of................................................   84
 Gonorrhoea......................................................   69
     "     causes..........................:.....................   69
     "     symptoms.............................................   70
     "     pathology.............................................   71
     "     in the female.....................•...................74,   89
     "     vulva..................................................   76
     "     vagina................................................   76
     "     uterus.............................,...................   76
     "     treatment.............................................   77
     "     complications.......................!..................   93
 Gonorrhoeal  rheumatism..........................................   73
      "      ophthalmia.........................................   73
 Gravel..........................................................  120
 Gummata........................................................   52
"Hematuria.................,......................................  H7
 Hereditary syphilis..............................................   59
     "        "   parental influence in transmission..............   59
    10 
130                          INDEX.
                                                                PAGE.
  Hereditary syphilis, diagnosis.....................................   63
      "         "    prognosis.....................................   63
      "         "    treatment of..................................   64
  Hemorrhage in syphilis..........................................   28
  Hemorrhage in gonorrhoea........................................   95
  Herpes..........................................................   25
  Hydrocele.......................................................   95
  Hydronephrosis..................................................  107
  Hyperostosis.....................................................   55
  Hypertrophy  of bone.............................................   55
  Impotence....................................................58,   98
  Infantile syphilis.................................:.............-..   59
  Inflammation, general, of penis...................................   94
  Intestines, syphilis of............................................   47
  Iritis............................................................   50
   "  treatment of................................................   50
  Joints, affections of...............................................   56
  Keratitis.........................................................   64
  Kidney, atrophy of...............................................  107
    "     acute congestion  of......................................  105
    "     chronic congestion of....................................  105
    "     contracted......."........................................  106
    "     cancer..........................,........................  106
    "     cirrhotic................................................  106
    "     dropsy...................................................  107
    "     granular.................................................  106
    "     lardaceous...............................................  106
    "     cystic degeneration":......................................  106
    "     inflammation of  pelvis...................................  106
    "     tubercular disease.......................................  106
.  Kidneys, syphilis of........'......................................   56
  Larynx,  syphilis of...............................................   49
  Liver, syphilis of.................................................   58
  Lungs, syphilis of................................................   49
  Masturbation.....................................................  100
  Maternal infection......".........................................   60
  Mercury, injurious effects of......................................   53
  Mouth, affections of..........................................47,   42
  Mortality in hereditary syphilis...................................   62
  Mucous membranes, affections of.................................   42
    "        "       erythema....................................   42
  Mucous patches..................................................   43
    "        "  treatment  of.....................................   44 
INDEX.                           131
                                                               PAGE.
  Nails, affections of...............................................  52
  Necrosis.........................................................  55
  Nephritis, acute parenchymatous................................. 105
     "     chronic      "        ................................. 105
     "        "   interstitial...................................... 106
  Nervous system, affections of.....................................  46
  Nodes...........................................................'  53
    "  treatment of...............................................  54
  Nose, syphilis of.................................'................  48
  Nymphomania...................................................  95
  Onanism..........................,.............................. 100
  Onychia....................................,.....................  52
  Orchitis, gonorrhoeal..........................................72,  94
     "    syphilitic.....................'.........................,.  57
     "   treatment of.............................................  58
  Ophthalmia, gonorrhoeal..........................................   95
  Osseous system..................................................   53
  Ovaries, syphilis of...............................................  58
  Ovaritis..........................................................  96
  Ozcena..........................................................  48
  Papular eruptions............................... ..'..............   39
     "      "     treatment of...............................___   40
  Paraphimosis................................................30,  96
       "      treatment of.........................................   30
. Parenchymatous nephritis, acute.................................  105
 Paternal infection...............................................   61
 Pemphigus...................................................36,  64
 Periosteum, affections of.........................................   53
 Perinephritis..........................*...........................  107
 Pharynx, syphilis of.............................................   42
 Phimosis.....................................................30,  96
     "   treatment...............................................   30
 Phlebitis.........................................................   73
 Prostatitis..................................................73,  96
 Prostate.........................................'................   57
 Psoriasis........................................................   36
 Pustular eruptions...............................................   37
     "        "    treatment of....................................40
 Pyelitis.........................................................  106
 Renal hyperaemia, acute..........................................  105
   "       "     chronic.........................................  105
 Repertory...........................'............................   86
 Respiratory, organs, affections of.................................   48 
132                          INDEX.
                                                              PAGE.
Retention of urine............... < >.........................73,97,119
Rheumatism, gonorrhoeal........................................  73
      "     syphilitic...........................................  34
Roseola.........................................................  39
Rupia........................................................36,  51
Sarcocele........................................................  57
Scaly eruption...................................................  35
  "     "    treatment of..............................>.....   40
Seminal emissions............................................... 101
Skin symptoms...........  ......................................  34
Soft chancre.....................................................  20
Spermatic cord, syphilis of.......................................  57
Spermatorrhoea.................................................. 101
Spinal cord, syphilis of...........................................  46
Spleen, syphilis of...............................................  56
Stomach,   "   "  ...............................................  47
Stone............................................................ 120
Stream, the...................................................... 125
Strangury....................................................... 122
Stricture.....................................................74,  97
Suppression of urine............................................. 123
Swelled testicle............................................57, 72,  94
Symptoms of hereditary syphilis..................................  63
Synovitis........................................................  56
Syphilis, definition of............................................  13
    "   etymology of............................................  13
    "   contagiousness  .........................................  13
    "   origin of................................................  14
    "   progress of............*..................................  14
    "   way to study............................................  14
    "   stages of................................................  15
    "   period of incubation..................................13,  17
    "■   primary................................................  19
    "   secondary..............................................  33
    "       "      contagiousness of.............................  34
    "       "      symptoms of..................................  34
    "   tertiary.................................................  45
    "       "    predisposing causes.............................  45
    "   stages defined...........................................  15
    "   never arises spontaneously...............................  15
    "   nature of poison of......................................  16
    "   due to spores............................................  16
    "    persons affected by......................................  17 
•
INDEX.                           133
                                                              PAGE.
Syphilis, reason for exemption of Jews............................   17
    "    inoculation of...........................................   17
    "    methods of communication..............................   17
    "    tends to exhaust itself...................................   60
    "    in pregnant women......................................   61
Syphilitic fever..................................................   34
    "     poison, kinds of........................................   21
Teeth in syphilis......................................'........47,   64
Testis, inflammation of........................................72,   94
Testicle, syphilis  of..............................................   57
The stream......................................................  125
Throat, ulcers of.................................................   43
Tertiary syphilis.................................................   45
    "      "  predisposing causes..............................   45
    "      "  diagnosis........................................   46
    "      "  prognosis........................................   46
    "      "  of mouth........................................   47
    "      "  of throat.........................................   47
    "      "  of tongue........................................   47
Transmission of syphilis..........................................   62
Tubercles.......................................................   52
     "    treatment of...........................................   53
Tubercular syphilis..............................................-  38
Ureter, syphilis of...............................................   57
Urging to urinate................................................  124
Ulcers of skin...................................................   51
Urinary organs, syphilis of.......................................   56
Urine, retention of.............................................97,119
   "   suppression of............................................  123
Vagina, contraction of............................................   76
Vaginitis.........................................................   76
Varicocele.......................................................   97
Vegetations.....................................................38,97
Venereal, definition of............................................   13
Vesicular eruptions..............................................   36
    "          "    treatment.....................................   40
Virus, syphilitic.................................................   16
  "       "    can be destroyed by acids..........................   16
  "       "    action of..........................................   18
Vulvitis........................................................   76
Warts,  venereal..................................................   37
White swelling, syphilitic........................................   56 
 
 


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