The Project Gutenberg eBook of Porneiopathology
    
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Title: Porneiopathology

Author: Robert James Culverwell

Release date: April 6, 2021 [eBook #65003]

Language: English

Credits: Brian Coe, Quentin Campbell and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)


*** START OF THE PROJECT GUTENBERG EBOOK PORNEIOPATHOLOGY ***


                         Transcriber’s Note

In what follows, italic text is denoted by _underscores_. Small capitals
in the original text have been transcribed as ALL CAPITALS.

See the end of this document for details of corrections and other changes.

             ————————————— Start of Book —————————————




                         PORNEIOPATHOLOGY.


                                A

                        POPULAR TREATISE ON

                    VENEREAL AND OTHER DISEASES

                              OF THE

                   MALE AND FEMALE GENITAL SYSTEM;

                          WITH REMARKS ON

          IMPOTENCE, ONANISM, STERILITY, PILES, AND GRAVEL,
                AND PRESCRIPTIONS FOR THEIR TREATMENT.

                     BY R. J. CULVERWELL, M. D.,
       Member of the Royal College of Surgeons, Fellow of many
                         Learned Societies.

                      WITH ONE HUNDRED PLATES.

                           —————————————

                             NEW YORK:
                    J. S. REDFIELD, CLINTON HALL.
                                ———
                               1844.




                              PREFACE.

                               —————

EVERY medical man who will study to investigate as far as possible,
in every case, the original channel through which disease or
constitutional disorder first found its entry into the system, will
be astonished at the mass of human suffering which may be traced up
to a venereal origin, although its primary symptoms may have been
for years apparently eradicated from the frame. The malady generally
commences its attack in early life, before experience has overcome the
short-sighted heedlessness of youth, and taught it to look beyond the
pains and pleasures of the passing moment. Delicacy or shame will not
allow him to seek assistance, until the poison has acquired strength
and virulence too alarming to be neglected; and the patient then,
instead of applying to his usual professional friends, flies to some
empirical practitioner, who temporarily arrests the external symptoms,
and discharges him as cured. Thus matters go on, until the malady
becomes constitutional; and the patient is at last compelled to place
himself under the treatment of those who, at an earlier period, might
have preserved his constitution untainted, and his body comparatively
uninjured by the ravages of this insidious disease.

Some years ago the idea first occurred to me that a popular treatise,
divested as much as possible of technical phraseology, explaining
to the non-medical reader the structure and anatomy of the parts
primarily affected by the venereal disease, and describing its first
as well as its subsequent and aggravated symptoms, and pointing out
the safest treatment of it in inexperienced hands, while in its simple
form, would be of much avail in counteracting the effects of the
complaint resulting from mal-treatment or neglect among the young and
thoughtless. This work is intended to teach him where serious danger
exists, or may be apprehended; for the treatment in a great degree, and
under any circumstances, must fall upon the patient himself: and every
medical man knows that, in very many instances, those who are fully
alive to the injury that may arise from such self-management, are yet
reduced, by considerations of delicacy and secrecy, to practise it; and
it is hoped that a perusal will contribute to give him a knowledge and
confidence which he never could acquire from the uneducated empiric.
Under these impressions have I ventured to submit the following pages;
and while I hope their utility may be acknowledged, I would remark,
that they are not intended to supersede medical aid in any stage of
the disorder, but that, on the contrary, I would impress upon the
reader, if he need it, the prudence of having immediate recourse to
a well-educated physician in the earliest stages of the disease, and
to beware of advertising quacks. But where, from circumstances which,
in venereal complaints, very frequently occur, the party can not have
recourse to professional aid, the next best step is certainly to place
in his hands a formula of that treatment which is most likely to be
successful with himself.

In thus publicly unfolding the mysteries of this department of the
profession, I expect some reprehension from those who assume that
all medical knowledge should be limited to the regular practisers of
the science; but I would fain remind all parties that, although this
branch of medical writing has hitherto been in the hands of mercenary
empirics, it is equally conducive to the honor of the profession, and
the interest of the patient, that these pretenders should be driven
from the field. Conscious of my integrity as a regularly educated
surgeon, and not altogether destitute of successful practice to rest
my claim upon, it is with less hesitation I depart from professional
ceremony; and whatever opinion may be pronounced, as to my success
in performing the task I have undertaken, I may be allowed to hope,
without arrogance, that I am at least entitled to the praise of
industry and humanity.

                                        R. J. CULVERWELL, M. D.
  1843.




                              CONTENTS.


                                                                  Page.
    GENERAL REMARKS                                                  7
    Anatomical and Physiological Review of the Male
      Organs of Generation, with eight engravings                    7
    Of the Testicles, their Structure and Functions, with
      seven engravings                                              14
    On Gonorrhœa, or Morbid Secretion and Irritability
      of the Urethra, with five engravings                          20
    The Surgical Treatment of Gonorrhœa, with prescriptions         26
    Medical Treatment of Gonorrhœa and its Consequences,
      with engravings, prescriptions, and specific remedies         29
    On Gleet                                                        41
    Morbid Irritability of the Urethra                              44
    Stricture of the Urethra, with fifteen anatomical engravings
      and diagrams, illustrative of the nature of the disease       45
    Treatment of Stricture, with thirty engravings, explanatory
      of the mode of treatment, prescriptions, &c.                  58
    Diseases of the Testicles, with three engravings                68
    Hydrocele                                                       69
    Radical Cure of Hydrocele                                       71
    Hydrocele Cured by Acupuncturation                              71
    Diseases of the Bladder                                         73
    Irritability of the Bladder                                     74
    Paralysis of the Bladder                                        75
    Inflammation of the Bladder, with prescriptions                 75
    Origin of the Venereal Disease                                  79
    On the Character of the Syphilitic Poison                       84
    Of Syphilis, with fifteen engravings                            86
    Of Buboes, with two engravings                                  93
    Of Lues Venerea, or Secondary Symptoms                          96
    Of the Symptoms of the First Stage of Lues, with eight
      engravings                                                    98
    On the Treatment of Syphilis                                   104
    Treatment of Chancre, with prescriptions                       106
            Bubo, with engravings and prescriptions                112
            Secondary Symptoms                                     117
            Syphilitic Eruption, with an engraving                 117
            Sore Throat, with prescription                         121
            Venereal Affections of the Bones, Joints               122
    Secondary Symptoms                                             123
    Treatment of Ditto, with prescriptions                         125
    Syphilitic Lepra                                               127
    Nodes and Pains in the Bones                                   128
    Syphilitic Sore Throat, with prescriptions                     130
    Advice to Invalids                                             133
    The Female Organs of Generation—their Structure,
      Purposes, and Diseases, with thirteen engravings             136
    On the use of the Speculum, with an engraving                  150
    Gonorrhœa in the Female                                        151
    Syphilis in Females, with five engravings                      152
    Leucorrhœa, or the Whites                                      154
    Treatment of Ditto, with numerous prescriptions                155
    Effects of Incontinence, Celibacy, and Marriage                162
    On the Hereditary Transmission of Disease                      169
    On Impuissance, or Impotence                                   173
    Impotence and Sterility of the Male—four engravings            174
    Impotence and Sterility of the Female—five engravings          180
    Treatment of Impotence                                         184
    Sexual Debility                                                188
    On Piles, internal and external, with prescriptions and
      four engravings                                              191
    Prolapsus of the Rectum, with an engraving                     196
    Stricture of the Rectum, with an engraving                     197
    Diseases of the Urine, with three engravings                   200
    On Incontinence of the Urine                                   204
    The Gravel                                                     212
    Cause of Gravel                                                213
    Treatment of Gravel                                            213




                         POPULAR TREATISE

                                ON

                         VENEREAL DISEASES.

                           —————————————

                          GENERAL REMARKS.


THE diseases known by the general term of _syphilis_ or _venereal
disease_, and arising from impure coition, appear generally in three
forms, _gonorrhœa_, _chancres_, and _bubo_. These sometimes exist
alone, and sometimes together. As they affect the genital organs and
their appendages, a description of these organs is necessary to a full
understanding of the subject.

_Genital organs and appendages in the male._—This term embraces the
_penis_, _testicles_, _bladder_, and _kidneys_. The form of the penis
is familiar to every one. It commences at the bladder, is of a _spongy_
nature, and is composed of three different parts; the two upper and
larger are called the _cavernous_ bodies, and the lower the _spongy_
body; these bodies are covered by the skin which comes over the head of
the penis, and forms the _prepuce_. When this skin is drawn back, the
head of the penis, or the _glans_ penis is seen, which is a development
of the spongy body, and is extremely sensitive. A whitish secretion,
with a peculiar odor, forms at the end of the glans, where the prepuce
seems to join it. The object of this secretion is to preserve the
sensitiveness of the glans, and to facilitate the withdrawal of the
prepuce in coition and in urinating. This material sometimes collects,
irritates, hardens, and causes much inconvenience. This can be done
away with by circumcision, which is performed as follows:—draw an inked
line on the skin of the prepuce, corresponding to the base of the glans
penis; draw the prepuce forward, and have the inked part held firmly by
an assistant with a pair of forceps. Then the surgeon takes that part
of the prepuce projecting beyond the forceps with his left hand, and
with a bistoury cuts the prepuce at the inked line with his right. When
this is done, the lining skin of the prepuce, which cannot be drawn
forward, remains entire, and covers the glans; this lining is divided
by a single cut with the scissors: then the flaps are removed round to
the frenum, and then the two flaps are held together and removed, with
the frenum, at one cut. The mode of holding the prepuce, &c. is seen in
the cut.

[Illustration]

On the under side of the glans, near the mouth of the water passage,
or urethra, the prepuce is attached by a fold called the _frenum_,
or bridle, or martingale of the penis. The use of this frenum is to
confine the movements of the prepuce, and to draw down the mouth of the
water passage to direct the flow of the urine. Sometimes the frenum is
too short, and confines the prepuce too much; it may be slit down with
a pair of scissors as far as is considered expedient. The frenum is
frequently ruptured in a first coition. The frenum is very elastic, and
protects the sensitive surface beneath it as the eyelid does the eye.
Sometimes, however, it becomes permanently contracted;—the glans is
then denuded, but soon loses its sensibility. The person is sometimes
born with this formation.

The _cavernous bodies_ form two tubes, united in most of the length of
the penis, separated only by a thin partition, and enveloped in a firm
sheath; they are composed of an immense number of cells, principally
formed by dilated veins, which communicate with each other; these, when
the penis is erected, become filled and even distended with blood. The
cavernous bodies terminate abruptly and form rounded points under the
glans penis. At the other extremity they separate, and form the crura
or legs of the penis.

The _spongy body_ forms the lower and under body of the penis,
terminates at one end at the point in the glans, whilst it extends
the whole length of the penis, again becomes enlarged, and forms the
_bulb_. The urethra or water passage extends through the spongy body,
and connects the penis with the bladder. This cut is a section of the
penis showing the three bodies:

[Illustration:
  _a._ Corpora Cavernosa.
  _b._ The division or Septum.
  _c._ Corpus Spongiosum.
  _d._ Urethra.
  _e._ The great vein of the Penis.]

The cut below shows a section of the cavernous body, showing the blood
vessels that go to it and cause a distension or erection of the penis:

[Illustration:
  _a._ Urethric part.
  _b._ Glans.
  _c._ Dorsal Artery serving the Glans.
  _d._ Dorsal Artery serving the interior of the Corpus Cavernosum.
  _e, f._ Deep-seated Arteries.]

[Illustration:
  _a._ Urethra.
  _b._ Glans.
  _c._ Dorsal Vein.
  _d._ Septum.
  _e._ Vessels.]

In the cut above we see the septum or division of the cavernous bodies,
in which are seen the vessels by which, when the erection of the penis
subsides, the blood passes into the dorsal vein of the penis.

The _Urethra_, or water passage, is the canal that passes through the
spongy body to the bladder. The urine and semen pass through it. It
is very elastic, and may be dilated so as to admit a large instrument
to be passed into the bladder, and it contracts on the smallest. It
is supported in its course by the spongy body and the prostate gland,
between which is a portion unprotected, called the membranous portion.
The passage varies in its size in different parts: thus it is rather
contracted at the orifice, enlarges within, and for an inch again
contracts, dilates nearer the bulb, diminishes at the membranous
portion and near the prostate gland, and finally enlarges into the
bladder. The cut opposite will show these parts.

[Illustration:
  _a._ Bladder, or receptacle of urine.
  _b._ Ureters, or passages through which the urine
       comes from the kidneys, where it is formed,
       to the bladder.
  _c._ Vas Deferens, through which the semen passes
       from the testicle, where it is formed, to the
       seminal vesicles, where it is matured.
  _d, d._ Openings of Ureters into the bladder.
  _e._ Prostate Gland.
  _f._ Orifices of excretory ducts.
  _g._ Openings of the seminal ducts.
  _h._ Ischio-cavernous muscles.
  _i._ Bulb of Urethra divided.
  _k._ Cowper’s Glands.
  _l._ Wide part of Urethra.
  _m._ Narrow part.
  _n._ Fossa Navicularis, usually affected in gonorrhœa.
  _o, p._ Prepuce.]

The urethra is constantly moistened with a mucous secretion,—from the
membrane itself, the glands, and the folds which yield to the pressure
of the urine as it flows, or from other altered conditions of the
urethra pour out their contents. The inner surface of the urethra is
very vascular and sensitive, as is shown by the slightest laceration by
the bougie or by chordee, when considerable bleeding often takes place.
Its sensitiveness is well known in the first passing of the bougie, or
in inflammation, when the pain of the former and the act of urinating
in the latter, often causes fainting.

The bladder is the reservoir of the urine, which is formed in the
kidneys, comes into the ureters, passages leading from the kidneys to
the bladder, and thence flows, drop by drop, into the bladder. The
bladder is shaped somewhat like a pear, but this shape is varied by
its contents, and the relative condition of its adjacent parts. Thus,
when the bladder is full, its upper part may be felt rising above the
pubis, that portion of the lower part of the belly that is covered with
hair. In very fat persons the bladder is flattened by the weight of
the intestines, and obliged to find room where it can, as in pregnant
women. Anatomists, when describing the bladder, speak of its body,
base, or upper part, sides and neck, where the urethra or water passage
begins, and which is surrounded by the prostate gland. These parts are
seen in the first engraving on the opposite page.

The bladder is composed of several coats. There is a peculiar
membrane investing the important structures in the abdomen called the
peritonœum. The base and back part of the bladder is covered by a
portion of this peritonœum, which in a measure supports the bladder
in its position, and also exercises certain properties which may
hereafter be alluded to.

[Illustration:
  _a._ The inner surface of the Bladder,
       showing the direction of the Muscular Fibres.
  _b._ The opening of the right _Ureter_
       into the Bladder, whence the urine issues.
  _c, c._ The Prostate Gland cut through, and its
          sides exhibited.
  _d._ The Urethra.
  _e._ Verumontanum.
  _f, f._ Orifices of the Seminal Ducts, marked by
          twigs inserted therein; the other points
          mark the orifices from the Prostate and
          other Glands.]

The position of the _perineum_ is seen in the following cuts in which
the skin has been removed, disclosing—

[Illustration:
  1. The superficial fascia of the Perinœum.
  2. The fascia lata, or shiny covering of the
     muscles of the thighs.
  3. The tuberosity of the ischia, or part
     whereupon we sit.
  4. The last portion of the spine, called the
     Coccyx, easily to be felt posteriorly to
     the rectum.
  _a._ The Sphincter muscle of the Anus.
  _b._ The inferior border of the great
       muscles of the buttock, called
       the Gluteal.
  _c._ The Levator Ani, or muscles which
       elevate the rectum.]

The following cut represents the muscles of the perinœum exposed, the
superficial fascia having been removed.

[Illustration:
  1. Point in the Perinœum where the principal muscles
     arise or meet.
  2. Covering of the Thigh.
  3. Seat.
  4. Corpora Cavernosa of the Penis.
  5. Corpus Spongiosum.
  6. Coccyx.
  7. Great Sacro Sciatic ligament.
  _a, a._ Erector Muscles of the Penis.
  _b, b._ Accelerator Urinæ Muscles.
  _c._ Line whence the above Muscles take their origin.
  _d._ Transverse Muscles of the Perinœum.
  _e, e._ Sphincter Muscle of the Anus, supposed to
          be distended with tow or wool.
  _f, f._ Levatores Ani.
  _g, g._ Great Gluteal Muscles.]

A brief description of the structures displayed in the two preceding
and the following drawing (p. 14) will render this part of our subject
perfect.

The _Fasciæ_ means the coverings of muscles, such as is seen in cutting
a domestic joint—a leg of mutton, for instance—a shiny surface; their
use is to strengthen the action of the muscles, to bind them well
together, and they mostly exist about the buttocks, back, &c.

The office of a Sphincter Muscle, of which we have several, as that of
the bladder and anus, is to keep closed the aperture they surround.
The sphincter ani closes the rectum, and pulls down the bulb of the
urethra, by which it assists in ejecting the urine and semen.

The Levator Muscles lift up the part they are connected with. The
levator ani muscles form the funnel appearance of the rectum, and help
to draw it up after the fæces or stools are evacuated. They also assist
in sustaining the contents of the pelvis, and help to eject the semen
and urine, and contents of the rectum, and, perhaps, by pressing upon
the veins, contribute to the erection of the penis.

[Illustration:
  1. Coccyx.
  2. Semen.
  3. Covering of the Thigh.
  4. Great Sacro Sciatic
  Ligament.
  _a._ Bulb of the Urethra.
  _b._ Corpus Spongiosum.
  _c._ Crura of the Penis, being the conclusion of—
  _d._ Corpora Cavernosa Penis.
  _e._ Sphincter of the Anus.
  _f._ Levatores Ani, covered by a fascia or prolongation
       of the triangular ligament of the Urethra.
  _g._ Great Gluteal Muscles.
  _h, h._ Triangular Ligament of the Urethra. The artery
          of the bulb is seen on the left as it runs between
          the Crus Penis and bulb of the Urethra.]

The Gluteal Muscles help the rotatory motion of the thigh, and give
support generally to the buttocks.

The Sacro-Sciatic Ligaments assist in the firm union of the bones of
the pelvis.

The Erector Muscles of the penis propel the urine and semen forward;
and, by grasping the bulb of the urethra, push the blood toward the
corpus cavernosum and the glans, and thus distend them.

The Accelerator Urinæ Muscles, as their name implies, help to eject the
urine and semen.

The Triangular Ligament of the urethra assists the preceding purposes.

_Testicles._—The testicles are two glandular oval bodies suspended
in the scrotum. They furnish the male seed. They are supported by
what is called the Spermatic Chord, which consists of the spermatic
artery that supplies the testicle with arterial blood, whence the
semen is concocted; the veins that return the superfluous blood, and
the tube that conveys the semen to the urethra. The testicles are
very liable to inflammation, and particularly to changes resulting
from the wear and tear of human life—changes that not simply produce
pain or inconvenience, but those whereby the power of the organs
becomes partially if not wholly lost. A rather ample description of
their complicated structure will show the necessity of attending to
the earliest symptoms of disturbance. The testicles, in embryo, are
lodged in the belly, but they gradually descend, and usually are found
in the scrotum at birth. There are occasional exceptions, when one or
even both testicles do not descend, but are retained in the groin. Mr.
Hunter considered that their virility was thereby impaired, although
such an opinion is negatived by numerous illustrations. The non-descent
of the testicle, necessarily from its confined situation when in the
groin, can not be so fully developed as where it is allowed to range
in the scrotum. It is also exposed to accidents when retained, and
cases have occurred where Hydrocele, a disease to be noticed hereafter,
has ensued, producing much inconvenience, and occasionally the same
has been mistaken for rupture. The testicles have several coats. The
Scrotum should be considered as one, which is merely a continuation of
the common integuments, exceedingly elastic, nearly destitute of fat,
and possessing a peculiar contractile power of its own, whereby it
can closely embrace the testicles, and at other times yield or become
distended, as in hernia or hydrocele, to the size of a melon. The
contractile powers of the scrotum have been assigned to the supposed
presence of a muscle, which is merely a thickened cellular membrane,
and called Dartos. It was stated that the testicles were suspended by
their spermatic chords—their support is rendered more perfect by the
presence of a muscle to each, that descends into the scrotum, and which
is called the Cremaster—it is an expansion of one of the muscles of the
abdomen, called the internal oblique, and it spreads itself umbrella
fashion around the chord, over the upper part of the testicle, and its
fibres extend ray-like over the other coats of the testicle—its office
is to draw up the seminal organs during procreation.

The testicles, thus suspended, have two coats, one adhering closely,
and the other loosely surrounding the former—between the two, a
lubricating fluid is secreted, whereby the various movements of the
body are permitted without injury; it is between these coats that
water is secreted occasionally, constituting the disease known as
hydrocele. The closely fitting coat is termed from its whiteness and
density Tunica Albuginea—the other Tunica Vaginalis. These coverings
are formed of that extensive membrane in the abdomen called the
Peritonœum. The Tunica Albuginea which surrounds the testicle previous
to its descent, accompanies it into the scrotum, propelling, as it
were, the Tunica Vaginalis before it. On the descent of the testicles
into the scrotum, the opening through which they passed becomes
impermeably closed.

The annexed diagram will explain the coats and facilitate the
understanding of subsequent descriptions.

[Illustration:
  1. Body of the Testicle.
  2. Epididymis.
  3. Vas Deferens.
  4. Spermatic Artery.
  5. Veins.
  6. Cremaster Muscle.
  7. Tunica Albuginea.
  8. Tunica Vaginalis.
  9. Scrotum.
  3, 4, 5, 6, and 8 constituting the Spermatic Chord.]

When the coats of the testicle are taken off, it is found to consist
of innumerable delicate white tubes, which when disengaged from the
cellular membrane that connects them together, and steeped in water,
exhibit a most astonishing length of convoluted vessels; they appear
to consist of one continuous tube, convoluted in partitions of the
cellular membrane. When the _Tubuli_ come out from the body of the
testicle, they run along the back of it and form a net work of vessels
called Rete Testis; it is supposed that by the net work the semen is
conveyed from the testicle. The continuations of this _Rete Testis_
have been denominated _Vasa Deferentia_, which, ending in a number of
_Vascular Cones_, constitute what is called the Epididymis. The _Vasa
Deferentia_, after forming three conical convolutions, unite and form
larger tubes, which ultimately end in one large excretory duct, called
the Vas Deferens. The following description relates to the accompanying
sketch.

[Illustration:
  _a._ Body of the Testicle.
  _b._ Tubuli Testis.
  _c, c._ Rete Testis.
  _d._ Vasa Deferentia.
  _e._ Vascular Cones.
  _f._ Epididymis.
  _g._ Vas Deferens.]

The preceding completes the anatomical description of the Testicle. The
semen is supposed to be secreted by the arteries that ramify among the
seminal tubes; the last drawing exhibits the testicle as from the hand
of the dissector. In life and in health the epididymis is attached to
the testicle—the vas deferens passes up the chord, enters the abdomen,
and, passing down into the pelvis, terminates in the vesiculæ seminales
as already, but to be again, alluded to. The two subjoined drawings
illustrate the testicles in their natural situation.

[Illustration:
  _a._ Body of the Testicle.
  _b._ Commencement of the Epididymis.
  _c._ End of ditto.
  _d._ Vas Deferens.]

In the larger figure the testicle is displayed as enveloped by its
coverings, and in the lesser as stripped of them. The references serve
for both.

We now come to speak of the Vesiculæ Seminales. It was just observed,
that the Vasa Deferentia terminated in these structures. They
are attached to the lowest and back part of the bladder, behind
the Prostate Gland. The following drawing is the prelude to the
description—It represents the Prostate Gland, the Vesiculæ Seminales
and the Bladder.

[Illustration:
  _a, a._ Prostate Gland.
  _b._ Gland cut away to show the Ducts of
       the Vesiculæ.
  _c._ Ends of the Ducts.
  _d, d._ Cells of the Vesiculæ.
  _e._ Left Vas Deferens, also cut open to show
       its connexion with the Vesiculæ.
  _f._ Right Vas Deferens.
  _g, g._ Openings of the Vas Deferens and Vesiculæ
          into the Urethra.
  _h._ Bladder.
  _i._ Ureter.]

The Vesiculæ Seminales appear like two cellular bags. They have two
coats, the one called nervous, and the inner the cellular, a membrane
divided into folds or ridges. The use of the vesiculæ is supposed
to be, to act as reservoirs for the semen; but there are different
opinions upon the subject, some contending that they furnish a fluid,
not spermatic, but merely as an addenda to the seminal secretion;
whereas others, who have examined the vesiculæ of persons who have
suddenly died, have discovered all the essential qualities of the
male seed therein; and, in fact, physiologists, who direct researches
in these matters, advise such examinations as the surest means of
obtaining, in a state of purity, the seminal fluid.

The Male Semen is a fluid of a _starch-ish_ consistency and of a
whitish color. It has a peculiar odor, “like that of a bone while
being filed—of a styptic and rather acrid taste,” (for physiologists
use more senses than one in these researches), “and of greater specific
gravity than any other fluid of the body.” Shortly after its escape,
“it becomes liquid and translucent;” if suffered to evaporate, it
dries into scurfy-looking substance. By being examined through a
powerful microscope it is ascertained to be animated by an infinite
number of animalcules; but they are only present in healthy semen, and
consequently that fact is taken as a criterion of the virility of the
secretion.

President Wagner thus describes the germe of future animal life: “The
seminal granules are colorless bodies with dark outlines, round and
somewhat flattened in shape, and measuring from 1-300 to 1-500th of a
line in diameter.” “The animalcules exist in the semen of all animals
capable of procreation. They are diversified in form in all animals
according to their species, but in man they are extremely small,
scarcely surpassing the 1-50th, or almost the 1-40th of a line in
breadth. This transparent and flattened body seldom exceeds from the
1-6th to the 1-800th of a line in length.”

The annexed drawing exhibits the granules and animalcules of a human
male being magnified from 900 to 1,000 times:—

[Illustration:
  1. Animalcules of a man, taken from the
     Vas Deferens, immediately after death.
  2. Seminal Granules.
  3. A bundle of Animalcules, as grouped
     together in the Testicle.
  4. Seminal Globule.
  5. Same surrounded by a cyst or bag.]

The semen is never discharged pure; it is always diluted with the
secretion from the prostate and other glands, and also the mucus of the
urethra. A chymical analysis is thus given of 100 parts:

                  Water                   90
                  Mucilage                 6
                  Phosphate of Lime        3
                  Soda                     1
                                         ———
                                         100

The semen may certainly be vitiated and diseased: the odor and color
assume all the gradations of other secretions when in a morbid
condition.

Semen not discharged is supposed to be absorbed, thereby adding to the
strength and nutriment of the economy; but as it is furnished for a
specific purpose, and its secretion depends much upon the play of our
animal passions, and as they are rarely permanently idle, there is not
only the inducement that the fluid be furnished, but also emitted, and
hence we have nocturnal emissions. These, to a degree, are salutary;
but they may happen so frequently that the function becomes disordered
and perverted, and in some individuals the semen (unconsciously to
them) escapes during sleep, or on the slightest local excitement of
riding, walking, or on the action of the bladder or rectum.

The prostate gland, as has been stated, contributes much to the
dilution of the semen; it may empty itself independently of it. The
gland is composed of numerous cells, from which proceed some twenty or
thirty pipes or passages that open in the urethra by the sides of the
verumontanum, as shown in the drawing.

_Morbid Secretions and Irritability of the Urethra._—I have stated that
clap or gonorrhœa is one of the first and most frequent complaints
of the generative apparatus. There are many secretions common to
the urethra, such as those afforded by the various glands for the
purpose of lubrication, &c.; and the lining membrane of the passage
yields a moisture for its own protection, like the membrane of many
other organs, such as the eyes, nose, mouth, and so forth, and these
secretions may become unhealthy or vitiated, and give rise to symptoms
that lead on to confirmed disease; and, what is still more remarkable,
may assume many of the characters and appearances of gonorrhœa, but
they rarely induce such constitutional disturbances as clap. The
symptoms, consequences, and duration of clap, form its distinguishing
features from any other discharge of the urethra: it is very important
that such distinction should be understood, for the treatment of the
two affections differs most materially; the one is an affection of
weakness, and the other of an inflammatory and pestilential nature.
The symptoms of clap are as follow: there is usually first felt an
uneasy sensation at the mouth of the passage or urethra. The patient
is frequently called upon to arrange his person; that uneasy sensation
sometimes amounts to an itching (occasionally of a pleasurable kind)
the feeling extends a little way up the penis; there is oftentimes
an erection and a desire for intercourse, which, if indulged in,
the sooner develops the disease. The itching alone will not convey
the disease from one person to another; but if intercourse be held,
the action of the inflamed vessels is accelerated, and a purulent
secretion which is infectious is urged forth and emitted with the
semen: therefore the very symptom of the tingling or itching, for it
rarely exists in healthy urethræ, should be noticed, and intercourse be
avoided until it shall have ceased.

About this time is perceived a slight heat on passing water, or at the
conclusion of the act; and shortly after, or may be before, a yellowish
discharge is observed oozing from the mouth of the glans or nut of the
penis; the symptoms then rapidly advance, unless timely and judicious
means be adopted to palliate them or effect a cure; the scalding
becomes intense, and the pain and smarting continue some time after
each operation of passing water: the discharge becomes profuse and
clots on the linen, and continues to ooze out with little intermission:
the orifice of the urethra looks red and inflamed, and the glans itself
swells and is occasionally extremely tender: the foreskin or prepuce
sometimes, but fortunately not always, becomes swollen, and tightened
over the nut of the penis, from which it can not be drawn back,
constituting that form of the disease known by the name of phymosis.
See drawing annexed.

[Illustration]

When that is the case, other annoyances ensue; the purulent matter
collects around the glans; excoriations, ulcerations, and sometimes
warts, are the consequence; the whole symptoms become thereby much
aggravated. It also happens that the prepuce from inflammation assumes
a dropsical appearance, that is to say, the edges or point swell, and
appear like a bladder filled with water; thus, the size which the
penis then arrives at is enormous, and to the patient very alarming;
it usually, however, subsides in a day or two, if rest and proper
measures be employed.

[Illustration]

The glans with some people, is always bare, and the foreskin drawn up
around it. Such a state may be induced also by disease: in either case,
it may become so inflamed as to resist any efforts to draw it over the
glans and, from the swelling and consequent pressure on the penis, a
kind of ligature is created; and instances have been known where the
most disastrous results have ensued. The circulation of the blood in
the glans is checked; the nut puts on a black appearance, and if the
ligature be not removed or divided, mortification takes place, and the
tip or more of the penis sloughs off or dies away. This state of the
prepuce is called _paraphymosis_: it sometimes happens to young lads,
who, having an indicated opening of the foreskin, endeavor to uncover
the glans: they succeed, but are unable to pull the prepuce back again.
They either take no further notice of it, or else become frightened,
but conceal the accident they have committed: in a few hours, the parts
become painful, swell, and all the phenomena above detailed ensue.

The annexed diagram exhibits the foreskin in a state of paraphymosis.

[Illustration]

The next proceeding which will probably be induced, will be an
extension of the inflammation to the bladder: the symptoms are a
frequent desire to make water, and occasionally ulceration of the
membrane lining the bladder follows, when a quantity of muco-purulent
matter is discharged, which, mingling with the urine gives it the
appearance of whey. Now and then the bladder takes on another form of
disordered function: the patient will be seized with _retention of
urine_, that is, a total inability to discharge his water, except by
the aid of the catheter. A new and most perplexing feature about this
stage of the proceeding is perceived: it is what is called _chordee_.
The existing irritation excites the penis to frequent erections,
which are of the most painful nature. The penis is bent downward; the
occasion is, the temporary agglutinization of some of the cells of the
_corpora cavernosa_ through inflammation, and the distension of the
open ones by the arterial blood, thereby putting the adherent cells
on the stretch, and so constituting the curve, and giving rise to the
pain. This symptom is frequently a very long and troublesome attendant
upon a severe clap; it is more annoying, however, than absolutely
painful, as it prevents sleep, it being present chiefly at night-time
when warm in bed.

Occasionally the glands in the groin enlarge and are somewhat
painful; they sometimes, but very rarely swell and break; they more
frequently sympathise with the adjacent irritation, and may be viewed
as indications of the amount of general disturbance present; as the
patient gets better the glands go down, leaving a slight or scarcely
perceptible hardness as it were to mark where they had been. The most
painful of all the attendant phenomenon of clap is _swelled testicle_,
or, as in medical phraseology it is called, _Hernia humoralis_.

The first indication of the approach of the last-named affection is
a slight sense of fulness in the testicle, generally the left first,
although occasionally in the right, sometimes one after the other,
but rarely both together: a smart twinge is now and then felt in
the back upon making any particular movement: the testicle becomes
sensibly larger and more painful, the chord swells also and feels
like a hardened cord in the groin: the patient is soon incapacitated
from walking, or walks very lame; if the inflammation be not subdued
by some means, and if the patient be of a “burning temperament,” that
is, of a very inflammatory constitution, fever is soon set up, and the
patient is laid upon a “sick bed.” There is no form of the complaint
so dangerous to neglect as swelled testicles; they have sometimes been
known to burst or become permanently callous and hardened, and ever
after wholly unfit for procreative purposes: in other instances,
they have entirely disappeared by absorption: in fact, all diseases
of the testicles interfere with the generative power. At the onset of
inflammation there may be a brief increase of sexual appetite, but
when the structure of the testicle becomes altered or impaired, that
appetite is subdued or wholly lost; there is such a wonderful sympathy
betwixt all parts of the generative economy of man, that if one portion
only be injured, the ordinary end of sexual union is frustrated.

The gonorrhœal poison is capable of producing a similar discharge from
other parts to which it may be applied besides the urethra. It has
been conveyed by means of the finger or towel to the eyes and nose;
and a purulent secretion (attended with much pain and inconvenience,
indeed with great danger, when the eye becomes so attacked), has
oozed plentifully therefrom. Gonorrhœa is an infectious disorder, and
consequently is communicable by whatever means the virus be applied.
It certainly is possible, and (if we are to believe the assertions of
patients, who are often met with, declaring they have not held female
intercourse, and yet have contracted the disease), it certainly is
not improbable that it may be taken up from using a water-closet that
has been visited by an infectious person just before. It may also be
contracted by using a foul bougie.

[Illustration]

If the gonorrhœal discharge be suffered to remain on particular parts
of the person, such as around the glans of the penis, or on the outside
of the foreskin, excoriations, chaps, and warts, spring up speedily
and plentifully, and protrude before the prepuce, or sometimes become
adherent to it, as here drawn: it therefore only shows how necessary
cleanliness is in these disagreeable complaints, to escape the
vexations alluded to. A species of insect also is apt to appear about
the hairy part of the genital organs, and indeed extend all over the
body, particularly in those parts where hair grows, such as under the
armpits, chest, head, &c., if cleanliness be not observed. They are
called crabs. The itching they give rise to is very harassing, and the
patient, unable to withstand scratching, rubs the parts unto sores,
which, in healing, exude little crusts that break off and bleed.

[Illustration:
  A. The Pubis studded with these insects.
  B. The Crabs, or Pediculi Pubis, as they
     are called, about their natural size,
     as picked from the skin.]

When the gonorrhœa has been severe and there has been much
constitutional disturbance, there frequently hang about what are
called flying rheumatic pains; and sometimes, if the patient’s health
be much broken up, confirmed rheumatism seizes hold of him, and
wearies him out of several months of his existence. I have seen many
a fine constitution, by a tedious ill-treated or neglected gonorrhœa,
much injured, that, had the sufferer consulted a medical man of even
ordinary talent, in the first instance, instead of foolishly leaving
the disease to wear itself out with the help of _this_ recommended by
one, and _that_ by the other, he might have shaken off the hydra, and
have averted the hundred vexations that follow.

I come now to add to the list of calamitous consequences, stricture,
which, in my opinion, prevails to an enormous extent; however, its
consideration will be reserved, as well as the affections of the
bladder, and prostate gland, for their proper places. I will simply
repeat my impression that a stricture, or narrowing of the urethra,
or some organic changes, invariably ensue when the gonorrhœa has been
mismanaged, or its cure unfortunately protracted.

It is the opinion of many medical men, and it can, no doubt, be borne
out by many patients, that a gonorrhœa if unattended by any untoward
circumstance, will wear itself out, and that the duration of such a
proceeding is from one to two months; there is no disputing but such
has been, and is now and then the case, but such rarely stand even
so fair a chance of recovery as to be left entirely alone: even if
medicine be not taken, rest, abstemiousness, and such like means, are
seldom followed up; either the patient lives gloriously free, or else
goes to the opposite extreme.

The cases of gleet which seek medical relief are more numerous, as
most professional men must be aware, than those of gonorrhœa, for the
reasons so frequently alluded to; the fair inference would be, that a
gonorrhœa seldom escapes the terminus of a gleet.

The distinguishing feature of gleet from gonorrhœa is that it is not
considered infectious: it consists of a discharge ever varying in
color and consistence; it is the most troublesome of all urethric
derangements, and doubtlessly helps more to disorganize the delicate
mucous membrane lining the urinary passage than even the severest
clap. Its action is constant though slow; and subject as we are to
alternations of health, of which even the urinary apparatus partakes,
it is not to be wondered at that a part of our system which is so
frequently being employed, should become disturbed at last, and that
stricture and all its horrors should form a finale; but as gleet and
stricture form in themselves such important diseases, I shall devote a
chapter to the consideration of each separately.

_The Surgical Treatment of Gonorrhœa._—The principal symptoms
indicative of the outbreak of a gonorrhœa are a scalding burning
sensation along the urethra as the urine passes through it, and also
the pouring forth of a profuse discharge of yellow matter from the
same passage. The urethra is lined with a very sensitive membrane,
fashioned, however, to be insensible to the urine in its natural
state; but if the character of the urine or the membrane itself be
altered, the most exquisite misery is produced. Now in gonorrhœa,
when it is a first attack, the initiatory sensation is invariably
heat, itching, or pain in the urethra; the seat of this suffering is
in the mucous membrane. On separating the lips of the orifice of the
urethra, the passage appears highly vascular, very red, and looks,
according to the popular notion, very sore. On examining it with a
powerful glass, little streaks or surfaces of a yellow and tenacious
matter are perceived, which, upon being removed, are soon replaced by
others. When the patient attempts to urinate, this purulent exudation
becomes washed off. By this time, the system is somewhat excited, and
the urine is consequently more deeply impregnated with uric acid,
which renders it more acrid and pungent to the delicate and now tender
outlet through which it flows: the sensation is faint at first, but
is rendered very acute by the combined worry inflicted upon the
urethra, by its muscular contraction to eject every drop of urine,
the denuded state of the membrane itself, and the irritating quality
of the water. Such, however, is the habit of action, that the urethra
in course of time becomes indifferent to the annoyance of the flow
of urine. The nervous sensibility is much diminished, and the urethra
is further protected by an abundance of the venereal secretion. There
are numerous contingencies that prevent the changes ensuing in such
order, and, consequently, the scalding, and the amount of discharge,
are seldom two days alike. Were there to be no interruption, the
inflammation, for such is the whole process in obedience to the animal
law, would fulfil its intention and retire; but molested as it is
by diet, exercise, the varied states of health, and numerous other
fortuitous circumstances, as we well know, it exists indefinitely. It
would be next to an impossibility to explain the process whereby the
character of a secretion becomes altered, or to describe the exact
changes which the structure or vessels undergo when furnishing the
discharge; but we well know that some such changes do take place, and
that a cause must precede an effect. In like manner we can ascertain
the result of certain experiments, although the _modus operandi_ may
baffle our penetration. Gonorrhœa is originally a local complaint, but
if not arrested, it involves not only the neighboring parts, but it
compromises the general health. Now if the same ends can be brought
about by artificial means in a few days, that it takes weeks to effect
in the ordinary routine, all the intermediate suffering may be avoided,
and all the inconvenience of confinement and physic-taking spared.

To cure this disease I find that in many cases, if the parties apply at
the very onset of the disease, before the discharge and scalding have
set in with anything like severity, and they themselves be not of a
very inflammatory temperament, that a sharp stimulating injection will
at once subdue the sensitiveness of the urethra and alter the action,
and, at the cost of very little, and that only temporary suffering,
effect a speedy cure: the mode, except it be by stimulating the relaxed
vessels, or owing to the specific action of the injection, is, like
all other medical operations, a mystery. A favorite prescription is
the nitrate of silver, say one scruple of the nitrate to the ounce of
water, but the disease must be thus treated at the very first symptom:
the patient must be otherwise in comparatively good health, and his
occupation must not expose him to much bodily fatigue. He must not be
given to intemperance, nor should those instances be selected where
the sufferer is of a very inflammatory constitution. Experience begets
confidence, and confidence begets experience. In cautious hands I
am satisfied of its usefulness; but there are cases that turn out
failures. I have used the injection when the disease itself was a
week old, and with like success; but I am ready to confess I have
known cases, the cure of which were retarded by its employment. The
inflammation has been temporarily aggravated, but they were cases
where the treatment was not appropriate; the disease was far advanced,
there was much heat and swelling, and the patient’s health was in most
instances considerably affected; but yet beyond the few hours’ of
suffering merely, no extraordinary symptoms were produced. The cure was
very shortly after effected by means which I shall presently allude to.

In all cases of suspicious connexion I recommend copious ablution as
soon as possible.[1] The syringes I would advise to be used should
have their points conically shelved off pear fashion; they fill up
the urethra like a wedge, and prevent the immediate escape of the
injection: all injections should be retained a few seconds, and then be
allowed to flow out. It is seldom worth while to repeat the operation
more than twice on an occasion; but that occasion may be resorted to
two or three times a day.

When the nitrate of silver is used, the syringe had better be made of
glass. The nitrate of silver discolors the skin, linen, &c.; therefore
gloves should be worn, and care taken that the fluid be not spilt over
the person or dress, but should the skin be stained, it can be removed
by a strong solution of hydriodate of potash.

The plan of injection, I must remind the reader, is only applicable
in early and old cases. The recent cases, as I have before stated,
are less frequently before the medical man than what we may call a
“ripe” gonorrhœa. The old cases present also some difference as to the
cause of their continuance, and require also some difference in their
treatment, and they will be introduced under the chapter headed “Gleet.”

The symptoms of a clap, fully developed, are severe scalding,
voluminous discharge, painful erections, local inflammation, probably
phymosis or paraphymosis, glandular swellings, and possibly swelled
testicle.

But all cases of gonorrhœa are not ushered in with such severity; nor
do many, if common cleanliness and quiet only be maintained, experience
even the various accompaniments just described, and still fewer would
if the following precautions and measures were used.

The plan just laid down, may be called the surgical treatment of
gonorrhœa; the following may be designated the _Medical_. This is
divided into two methods—the one denominated the Antiphlogistic,
the other Specific. The _Antiphlogistic_ is a term applied to
medicines, plans of diet, and other circumstances, that tend to oppose
inflammation by a diminution of the activity of the _vital powers_,
whereby the inflammation is subdued, and nature rights herself again
of her own accord. The _Specific_ implies a reliance upon a particular
remedy, which is supposed at once to set about curing the disease, as,
for instance, by giving Bark in Ague—Colchicum in Rheumatism—Cubebs or
Copaiba in Gonorrhœa.

Now, both these plans are successful in curing gonorrhœa; but the
majority of medical men adopt the former method, inasmuch as although
it but _quietly_ conducts the case to a successful termination, still
it _does so_, whereas the specific, in unskilful hands, is often
productive of many annoyances, much delay, and not always a cure.

Our plan, however, is as follows: in the first place, I take into
consideration the appearance of the patient; if he be strong, robust,
sanguine, or of full habit, and youthful—if it be his first attack, and
if the symptoms be ushered in with any degree of severity, I invariably
and rigidly (where I choose not the surgical) pursue the antiphlogistic
course of treatment; if the case be in a person of phlegmatic
temperament, of mature age, and the disease be but a repetition of the
past, and there be no evidence of physical excitement, I fearlessly
adopt the specific. Where, in the third place, I encounter a patient
with no very prominent peculiarity, nor with symptoms demanding
extraordinarily active measures, experience has taught me the propriety
of cautiously combining the two methods—a mild aperient had best always
a precede a tonic or a stimulant, in cases where there is a doubt of
inflammation lurking in the system; and, recollecting the tendency our
complicated organization has, when assailed by a distemper, to become
irritable, it is always as important to know when to withhold a remedy
as when to prescribe one.

The three following imaginary cases will serve as no inapt illustration
of the principles laid down:—

  A. B. A man twenty-six years of age, five feet six inches in height,
  weighing eleven stone six pounds, of a full rounded form—florid
  complexion, of what is termed a sanguine temperament, and harassed
  with the following symptoms: profuse discharge in large yellow clotted
  lumps of gonorrhœal virus—intolerable scalding on passing water—great
  pain at the rectum at the close of micturition—redness and swelling of
  the orifice of the glans penis, puffiness of the prepuce, a _vicious_
  chordee—inclination to headache—a bounding pulse—hot skin, and an
  anxious mind. Treatment: say first bleeding, then purging; warm
  bath, saline powders or mixtures, cold lotions to the part, rest,
  abstinence; the following eve, symptoms will be less severe. Continue
  the powders, temperance and quiet. In a few days, the discharge will
  be lessened, the scalding mitigated, the chordee gone, and the fever
  exchanged for the cool skin of health. The resuscitative powers of
  nature await only the fillip of some gentle stimulant, and the sick
  man throws off his mantle for the coronal of health.

  B. C. At twenty-three, dark countenance, marked features, well
  developed muscular form, pulse 66, bilious temperament, accustomed
  to late hours, hard drinking, and seldom still, and _subject_ to
  clap. Symptoms: plenteous discharge with but little scalding, and
  no inconvenience beyond the suspension of ordinary sensualities.
  Treatment: cleanliness, cubebs or copaiba, injections, a black
  draught, and half a dozen days’ rest, release him from his quarantine.

  C. D. At nineteen, a timid bashful youth, for the first time infected
  with gonorrhœa, which he had enduringly borne for the last fortnight,
  having neglected until now to seek professional aid, although cajoled
  into the purchase and imbibing of some popular “never-failing
  antidote” for a “certain disease.” Symptoms: discharge _cured_? right
  testicle swollen, and treble the size of the other, and excruciatingly
  painful; frequent desire to pass water, pain in the groin and back,
  general lassitude, and a feeling of illness all over. Treatment:
  leeches, warm bath, bed, purging, fever medicines, cold lotions, hot
  fomentations, low diet and patience, a month’s imprisonment, and a
  slow recovery. Had the treatment of the first two cases been reversed,
  the results would have been very different: and had the last sought
  timely and efficient aid, he would have been spared much that he
  endured.

However, to particularize the treatment for each symptom; to commence,
I will request the reader to remember that on the first appearance of
gonorrhœa, attended with an unusual inflammatory aspect, I practise,
where permissible, venesection; if the case demand it not, at least
there should be administered an aperient; let, therefore, a dose of
opening medicine be taken immediately (Form 1). This is the first step
toward reducing inflammatory action—the next should be directed toward
allaying the local symptoms, by diminishing the nervous irritability of
the urethric passage.

With this view, no plan surpasses that of bathing the penis in warm
water, or immersing the entire body in a warm bath. The former should
be repeated several times in the day; the latter daily, or certainly on
alternate days, so long as the severity lasts.

By these means, the parts will be preserved clean, and will derive
benefit from the soothing influence of warmth; and, in many cases, this
will be the means of averting chordee or swelled testicle.

Where, however, from peculiar circumstances, warm water and warm baths
are not to be had, the penis should be bathed in _cold_ water, or
encircled with pledgets of rags or lint, moistened with cold goulard
or rose-water. Warm, however, is to be preferred, although cold water
seldom fails of affording relief.

To lessen the acrimony of the urine, which keeps up the irritability,
and somewhat to lower the system, all strong drinks, such as ale, beer,
wine, and spirits, should be avoided, and milk, tea, barley-water,
toast and water, linseed tea, gum arabic in solution, and other
such mucilaginous diluting liquors taken instead. The diet should
be lowered: in fact, a spare regimen should be adopted, not wholly
abstaining from animal food, but partaking of it only once in the day,
and carefully excluding all salted meats, rich dishes, soups, gravies,
&c. The usual employment should be suspended, and rest should be taken
as much as possible in a recumbent posture.

Of course the preceding remarks apply only to cases of severity; I mean
such cases as first attacks ordinarily prove; and which remarks, if
attended to, will greatly mitigate the violence of the disease.

To assist the foregoing treatment, the aperient medicine, which should
be repeated, at least, on alternate days, until the inflammation is
ameliorated, should be followed by some saline or demulcent medicine to
allay the general disturbance. Several formulæ are suggested for that
purpose, suitable to various temperaments and conditions—[_See Forms_
2, 3, 4, 5 _in Formulæ annex_.]

By these means, the disease, if not aggravated by intemperance of
living, or otherwise, will gradually subside, and in the course of a
fortnight or three weeks, cease entirely, without the aid of any other
remedy whatever.

But we need not rest satisfied with merely “showing” the disease
through its stages; we can expedite it, and many of its steps we can
skip over, and here it is we may call to our aid the specific method of
treatment alluded to. This specific method consists of the suspension
of a vitiated secretion, and a restoration of a healthy one. Now how
this is effected we know not; we only know that it can be done—and
experience has taught us that it may be done safer at one time than
another. During the existence of a fevered state of the circulation,
it would be highly impolitic suddenly to check a discharge from any
surface, much less one situated like the mucous membrane of the
urethra, in the immediate connexion, as it is, of important nerves and
glandular structures—a metastasis of the inflammation will almost
invariably ensue; and hence we account for swollen testicles, buboes,
painful affections of the bladder, &c. Whereas, on the subsidence of
inflammation, the revulsion is borne; and to our satisfaction, the
disease disappears. A constitution in a state of excitement is like a
fretted child—it will have its “will” out, and the rod is not always
the safest corrective.

On the subsidence, therefore, of the scalding, and a lessening of the
general fever, the specific plan of treatment may be commenced. Upon
the same principle that the surgical treatment is selected according to
the symptoms, so also are the just-named preliminaries in many cases
dispensable, and hence, as hereafter detailed, it will be found that
the antiphlogistic and specific do not go always hand in hand. However,
to explain the latter:—

By specifics are meant those remedies that exert a positive curative
effect on a particular disease; and the most prominent of those, in
gonorrhœa, are copaiba and cubebs. See Formulæ annex for some useful
recipes of both—Forms 6, 7, 8, 9, 10.

For instance, cubebs may be taken alone, in water, in doses of a
tablespoonful twice or thrice daily. If cubebs produce no good effect
in four or five days, it had better be discontinued, and other means
sought after.

These proceedings usually carry the disease to a close, and, if no
adventitious circumstances occur, successfully and speedily. It is well
to deserve success, but it can not be always commanded.

The business engagements of young men render it almost impossible for
them to devote that care and attention so importantly requisite; and
few, consequently, will be found who will be fortunate enough to escape
the usual concomitants of a gonorrhœa.

Where, therefore, the scalding or passing the urine is very severe,
the pain may be mitigated by carefully injecting, previously to making
water, either of the formulæ No. 11 or No. 12 (see Formulæ annex) into
the urethra.

The inflammation extends in general not more than two inches down that
passage, so that much force is not required to inject the intended
fluid, nor should an unnecessary quantity be used.

When the inflammation reaches the bladder—which is indicated by pain in
that viscus and the perinœum, with a constant desire to pass water—the
taking of a warm bath at a temperature of 100°, and remaining therein
for a quarter of an hour, will afford essential relief.

When a chordee is attendant on a gonorrhœa, and the patient can not
sleep, the draught (Form 13) may be taken on going to bed, or the
powder (Form 14) in some gruel. The embrocation (Form 15) rubbed on the
parts affected, however, will instantly remove both the pain and the
spasmodic contraction, and not unfrequently prevent their recurrence.
Care must be taken that the embrocation be only used for its specific
purpose, and not swallowed by mistake, as it is poisonous.

In the event of the patient being obliged to follow his ordinary
occupation, or to go about, the use of a suspensory bandage will be
found of great benefit; indeed it is indispensable, and the neglect of
it has often brought on swelled testicle, or most excruciating chordee.

By way of recapitulation, the treatment of gonorrhœa thus far consists:
in severe cases, of bleeding; in ordinary ones, and in both, of warm
bathing, local or general—where impracticable, cold—attention to diet,
the taking of aperient, soothing and astringent medicines, rest as much
as possible, and the use of the suspensory bandage. These remarks are
equally applicable, then, through every stage of this complaint that
is accompanied by inflammation, and may be relied upon as the most
effectual to avert all the consequences I now proceed to detail.

The consideration of the symptoms here following is not in the order
in which they always occur; for swelled testicle may ensue without
phymosis or paraphymosis preceding, or even being present; and the
converse holds equally good with regard to every other.

The successful treatment of phymosis (that condition of the foreskin
in which it can not be drawn back over the glans) depends very much
upon local management. Bathing the part frequently in warm water, the
daily use of the warm bath, and the frequent injection, by means of a
syringe, of warm milk and water, are generally all that is required
to reduce phymosis; but where it is attended with much inflammation,
where the glans is excoriated, probably by the discharge from the
urethra accumulating between it and the prepuce, and thereby inducing
irritation, bleeding is even sometimes necessary, the strictest
antiphlogistic regimen should be preserved, and the treatment advised
in the early stages of gonorrhœa scrupulously followed.

Sometimes the prepuce becomes so swollen as to assume an œdematous or
dropsical appearance; in which case it may be scarified with a lancet,
or several leeches applied. With the exception of concealing the state
of the glans, phymosis is less dangerous than paraphymosis, and is
most usually produced by the patient worrying the part, by frequently
uncovering the glans to observe its condition. Where a discharge is
perceived oozing from beneath the prepuce, which is not urethral,
and the glans does not feel sore or tender, the injection (Form 16)
syringed up five or six times a day, will prove very efficacious in
healing the ulceration.

Where there is an unnatural elongation of the prepuce, it will be
constantly subject to phymosis, not only from gonorrhœal inflammation,
but from the accumulation of the natural secretions of the part. In
that case, cleanliness is the only remedy the patient can employ of
himself. Occasionally it is necessary to have recourse to the surgeon’s
knife.

Paraphymosis is the opposite to phymosis, and usually arises in this
way: the orifice of the prepuce, being contracted by the inflammation,
is drawn back for the purpose of washing or examination, and is allowed
to remain, or, as frequently happens, it can not be redrawn. When this
continues some time, considerable inflammation, both of the glans and
prepuce, arises. The contracted orifice pressing more tightly, it will
often happen that a sloughing of both it and the glans will take place;
but this occurs only in consequence of neglect, or in constitutions
injured by intemperance.

If seen and attended to early, this state may be removed very easily.
The penis should be immersed in a basin of cold water, or sponged, so
as to cool it as much as possible; or it may be well oiled. In either
case there will not be much difficulty in pressing up the glans and
drawing up the prepuce over it; but where adhesion has taken place, or
ulceration exists, it will be harder to accomplish: the adhesions must
be separated, or the stricture divided with the scalpel.

I need scarcely observe, that such an operation is out of the province
of the non-professional person, who should lose no time in consulting
his surgeon.

I omitted to mention, in the description of the symptoms of gonorrhœa,
that occasionally, in very severe cases, a tumor forms in the perinœum,
which, if neglected, proceeds to suppuration, and establishes a
fistulous communication with the urethra. On the instant of such a
swelling appearing, leeches, fomentations, and poultices, should be
applied with a view to disperse it; but the management of such a case
had better be intrusted to the surgeon.

Excoriation of the membrane of the glans or prepuce requires for
its treatment frequent ablution with warm water until the redness
and discharge somewhat diminish, when Form 16 may be resorted to,
and applied, if practicable, by a moistened layer of lint; but if
accompanied by phymosis, the syringe must be used.

Warts, if not large, are easily removed, by brushing them with the
muriated tincture of iron, or the application of a lotion of lunar
caustic (Form 17).

Where they are numerous and large, and resist the remedies just
recommended, the nitric acid is an excellent escharotic; it gives
little or no pain, and is rarely productive of inflammation. The glans,
if not naturally denuded (in which instance, by the way, warts seldom
accrue), should be kept so for a time; and the nitric acid, after a
few moments, washed off with cold water. Notwithstanding, excision is
sometimes necessary to their complete removal.

When the organs of generation are infested by pediculi, or crab-lice,
the most efficacious and agreeable remedy is the sulphur-bath; one bath
generally effecting an extinction of every one of them, even though
they be all over the body.

Some recommend shaving the hair off the pubis, the locality in which
the vermin are most usually engendered, and applying blue ointment
or the black wash. Such a practice is seldom ineffectual, but the
irritation attendant upon the reproduction of hair is absolutely
intolerable. The hair need not be removed, as the above remedies will
be all-sufficient without it. Rubbing the parts well with strong
mercurial (or blue) ointment, or the black wash (Form 18), or even
powdering them with calomel, will at once destroy the insects, and
thereby remove the itching.

Swelled testicle, or _hernia humoralis_, more especially that
proceeding from gonorrhœal irritation, is ushered in and discovered
in the following manner: The patient, on some sudden movement of the
body, experiences a pain, darting from one of the _testes_ (both being
rarely affected at the same time) to the loins—the left testicle is
the one generally attacked. On examination, he finds that the testicle
is rather swollen and full, and very painful on being handled; the
swelling quickly increases and becomes hard, which hardness extends to
the spermatic chord, presenting the feel of a rope, passing from the
scrotum to the groin.

It is remarkable that when swelled testicle occurs, the discharge
from the urethra, which, from previously being very profuse, and
the scalding on making water, which was very severe, both suddenly
diminish, or cease entirely, until the inflammation of the _testis_
declines; hence, it has been supposed by some, that the disease is
translated from the urethra to the testicle.

It is more probably however, derived from the sympathy between the two;
the irritation of the one affecting the other, and the preponderance
of inflammation in the testicle acting on the principle of
counter-irritation to the urethra, and, for a time, thereby lessening
the disease in it: for it is observed that, as soon as one improves,
the disease returns in the other. The treatment of _hernia humoralis_
must be strictly antiphlogistic. In no form of gonorrhœal disease is
bleeding more absolutely necessary.

The timely and prompt loss of twelve or sixteen ounces of blood from
the arm will often cut short the complaint, and render other remedies
almost unnecessary; while the temporising delay, under the vain hope
of the inflammation subsiding, will allow the disease to make rapid
progress, and impose a necessity of several weeks’ rest and absence
from business, before a cure can be effected.

Immediately, then, on the occurrence of swelled testicle, I would
recommend the patient to be bled—to take some aperient medicine,
and, if the inflammation continues, to apply from twelve to eighteen
leeches, and afterward suffer the wounds to bleed for twenty minutes
in a warm bath; to retire to bed or to the sofa, and to maintain a
horizontal posture. If he be strong, young, and robust, an emetic (Form
19) may be given previous to the aperient, which has been known to
remove the swelling almost instantaneously.

Iodine (Form 20) also possesses a similar specific property in reducing
swelled testicle, and may be taken during the inflammatory stage after
bleeding and aperients, as may likewise the chlorate or hydriodate of
potass (Form 21).

With regard to local applications, the repeated employment of leeches,
fomentations, and poultices, with the frequent use of the warm bath,
and, above all, keeping the testicle constantly supported by means of
a bag, truss, or suspensory bandage, will subdue the disease in a very
short time, without impairing the functions of the important organ
concerned.

[Illustration]

A hardness, however, of the _epididymis_ commonly remains and continues
during life, but rarely gives rise to any inconvenience, although this
may often be remedied by compressing the testicles with strips of
adhesive plaster, as seen in the cut.

Almost every case of inflamed testicle will terminate favorably by
strictly pursuing the plan proposed; but when, from any untoward
circumstance, the inflammation proceeds to suppuration, the case must
be treated like one of common abscess, in which event professional aid
should be sought for without delay.

Other diseases of the testicle will be treated upon under a specific
head.

To return to the treatment of Gonorrhœa:—On the abatement of all or
any of the enumerated symptoms, such as the diminution of the scalding
upon making water, the subsidence of chordee, the escape from, or
cure of, swelled testicle, phymosis and paraphymosis, warts, crabs,
excoriations, &c., the discharge may still continue, though thicker
in consistence, and deeper in color: and it is at this period, which
I will call chronic gonorrhœa, when all inflammatory symptoms have
left, that stimulants may be judiciously given; but it must be borne in
mind that relapses often occur from imprudence: and this chronic form
requires as much attention as the acute or early stage. (See _article
Gleet_.)

_Gleet._—Gleet is certainly, as its name implies, a discharge of
thin ichor from a sore. Patients usually understand, and medical men
usually allow, a gleet to be a discharge from the urethra, which has
existed some time, of a whitish color, unattended with pain, and that
is _not infectious_, by which is meant is incapable of producing
gonorrhœa. There are several kinds of morbid secretions, the successful
treatment of which depends upon a knowledge of their differences.
They may be divided into two principal orders—those secreted from the
mucous surface of the urethra or bladder, and those which proceed from
the various glands-leading into one or the other. Gleet is a term
popularly applied to both, but more strictly relates to that which
proceeds from the membrane lining the urinary canal. There is great
analogy in inflammatory affections between the mucous membrane of the
digestive and pulmonary, as well as urinary passages. In inflammatory
sore throat, the secretions assume various appearances; there is a
discharge of viscid mucus, of purulent matter, or of a thin watery
nature; these secretions are dependant upon the amount and duration
of the inflammation present. Exactly in like manner may be explained
those issuing from the urethra. They are consequently alike modified
by treatment, by diet, by rest, and aggravated by a departure from
constant care. It is the nature of all membranes, lining canals that
have external outlets, to attempt the reparative process by pouring
forth discharges, while those which line the structures that have
not, effect their cure by union with the opposite surface. It is an
admirable provision, else important passages might become closed, and
so put a stop to vital processes; and in the other case, accumulations
ensue that could not escape without occasioning serious mischief.
When, however, disease has existed a long time, the operation of
the two kinds of membranes is reversed. The serous,[2] through
inflammation, take on the character of abscess, dropsy, or other
secretions, and the mucous ulcerate or form adhesions, as evidenced
in stricture, or ulceration of the throat or urethra. Gleet may be
a spontaneous disease, that is to say, may arise from other causes
than infection. It may exist independently of gonorrhœa, and be the
result of cold, of intemperance, and of general or of local excess.
Its long continuance and neglect, however, renders it infectious, and
it also gives rise to ulceration, excrescences, and stricture: and
when, from other causes, ulceration, or excrescences, or stricture,
are set up, gleet is in return generally one of their consequences.
Gleet, despite these various occasions, is, after all, most frequently
a remnant of gonorrhœa; and it is very difficult to define the time
or point where the one ends and the other commences. Pathologists
draw this distinction between the two:—they say that gonorrhœal
discharge consists of _globules_, mixed with a _serous_ fluid, while
gleet is merely a mucous secretion. I confess it difficult for a
non-professional person to decide which is which, the resemblance,
in fact, being so great—a gonorrhœal discharge being one day thick
and yellow, a few days afterward thin and whitish, and at one time
in quantity scanty, and the next profuse. Gleet assumes nearly the
same changes. The best test for distinguishing them is, by regarding
the accompanying symptoms. Where there is pain on passing water,
bladder-irritability, tenderness in the perinœum or neighboring parts,
and the discharge plentiful and offensive, staining the linen with
a “foul spot,” it may, without much fear, be decided to be clap;
but where the discharge is next to colorless, like gum-water, for
instance, and where there is no other local uneasiness than a feeling
of relaxation, and where it has existed for a long period, and was, or
was not, preceded by a gonorrhœa, it may fairly be called a gleet. Now
where does the discharge of gleet come from? Let us recapitulate its
causes; first from clap, which is a specific inflammatory affection. It
may therefore be a chronic inflammatory state of the lining membrane
of the urethra, of greater or less extent; in which case we would call
it chronic gonorrhœa, and which would be owing to a relaxed state of
the secretive vessels. We know that when a disease exists for a long
while, and is one not positively destructive to life, a habit of action
is acquired that renders its continuation in that state as natural
as its healthy condition. This is the state of the secretive vessels
in gleet, arising from gonorrhœa; and hence the discharge is poured
forth, instead of the secretion natural to the urethral passage in its
healthy order. Secondly, such may have been the severity of a clap,
that ulceration of some portion of the urethra may have taken place.
The disease may have got well except in that identical spot which,
owing to the constant irritation occasioned by the urine passing over
it, struggles with the reparative intention and effort of nature,
and exists even for years. Thirdly, when stricture is brewing, which
will be explained in an appropriate chapter, the alteration going on
gives forth a discharge, and, as I have stated in another part of
this work, I here repeat, that a long and obstinate gleet, as the
slightest examination would testify, rarely fails to indicate the
presence of a stricture. Lastly, gleet may be produced by loss of
tone in some or the whole portion of the secretive vessels, induced
by one or many of the accidents of life, or the various kinds of
physical intemperance when they not only weep forth various kinds of
fluids, at irregular intervals, which impair the muscular and nervous
energy of the generative organ, but render persons laboring under this
description of weakness very susceptible of infection, if they hold
sexual contact with those but slightly diseased. Hence persons laboring
under this form of debility incur what others escape. An individual so
circumstanced would receive a taint from a female having leucorrhœa.
Very many inconveniences have arisen from this infirmity, giving birth
occasionally to unjust suspicions, and creating alarms of the most
distressing nature.

Thus, then, we may have gleet from gonorrhœa, gleet from ulceration,
gleet from stricture, gleet from debility and discharges, popularly
understood to be gleet, but in reality glandular secretions, which
will be considered shortly and separately. Gleet is a tiresome and
troublesome disorder. So difficult, occasionally, is its management,
that oftentimes the more regularly a patient lives, and the more
strictly he conforms to medical regimen, the more deceptive is his
disorder. He will apparently be fast approaching to, as he conceives,
a recovery, when, without “rhyme or reason,” the complaint recurs,
and hints that his past forbearance has been thrown away. It would
be dispiriting, indeed, were every case of gleet to realize this
description; but it is well known that many do, either from neglect
or mismanagement. Now it must be evident that the treatment of gleet
depends upon what may happen to be the occasion of it. Where the
membrane of the urethra is entire, internal remedies may, and do
avail. Copaiba will achieve wonders; the use also of a mild injection,
perseveringly employed (as a solution of iodide of iron, or citrate
of iron, ten grains to the ounce of water), will give tone and
stringency to the weakened vessels, and so correct the quantity, at
least, of the secretion. In very obstinate cases, stronger injections,
as of the nitrate of silver, twenty grains to the ounce of water,
are serviceable; and we are not without many useful internal medical
combinations, which, properly administered, conquer this troublesome
complaint. In ulceration and stricture, these two causes must be
removed, else all efforts are unavailing. In general and local
debility, the attention must be devoted to the constitution. Common
sense and common reading must give to persons, possessing both, every
necessary information. The community are beginning to appreciate the
advantages of temperance, air, and exercise, too highly, to need
instructions how much of the one or either of the other two are
essential to the preservation or recovery of health.

_Morbid Irritability of the Urethra._—Of the varied symptomatic
sensations, few are more provoking and fretting than some continued
troublesome itching or pain that frequently attends the passing of
water. There may be no discharge of any kind, but there is either
a constant tingling, partially pleasurable sensation, drawing the
attention perpetually to the urethra, or there is felt some particular
heat or pain during the act of micturition. These feelings do not
always indicate a venereal affection; they appear to depend upon local
irritation, perhaps induced by a morbid condition of the urine. The
treatment consists in temperate diet, moderatively laxative medicines,
and now and then local applications. Some cases yield to sedatives
topically applied, and alkalies given internally, while others need
local stimulants and specific tonics. At all events, whenever there is
an unhealthy feeling in those parts, it points out some altered action
is going on, which, if not arrested, is likely to end in stricture or
gleet, and therefore attention had better be bestowed upon it as soon
as possible.

_On Stricture of the Urethra._—Of all diseases of the genito-urinary
system, stricture must be allowed to be the most formidable. It is
not the most difficult to cure; but it involves, when neglected,
more serious disturbances—disturbances which frequently compromise
only with loss of life. Stricture is a disease unfortunately of
extensive prevalence; and in nine cases out of ten is the sequence
of a gonorrhœa; and, what is still more comforting, few persons
who become the prey to the latter infliction escape scot-free from
the former; not because a clap _must_ necessarily be succeeded
by a stricture, but simply because it _is_, and all owing to the
carelessness and inattention manifested by most young men in the
observances so necessary for the perfect cure of the primary disease.
One very prevalent notion, and which explains a principal cause of
the extension of the venereal disease, is entertained, that the way
to give the finishing _coup_ to an expiring clap, is to repeat the
act that gave rise to it: the disease becomes temporarily aggravated,
and the impatient invalid probably flies, from an unwillingness to
confess his new error, from his own tried medical friend to some
professional stranger. From a desire to earn fame as well as profit,
the newly consulted prescribes some more powerful means; the discharge
is arrested for a while, but returns after the next sexual intercourse;
a strong injection subdues the recurrent symptom, which only awaits a
fresh excitement for its reappearance. Thus a gleet is established.
The patient finding little or no inconvenience from the slight oozing,
which, as he observes, is sometimes better and occasionally worse,
according to his mode of living, determines to let nature achieve her
own cure, and for months he drags with him a distemper that, despite
all his philosophy, he can not reflect on without an humiliating
diminution of self-approval. So insidiously, however, does the
complaint worm its progress, that the patient, considering his present
state the worst that can befall him, resolves to endure it, since it
appears his own constitutional powers are incapable of throwing it off.

In the midst of this contentment, the invalid finds that the process
of urinating engages more time than formerly, the urine appears to
flow in a smaller stream, and is accompanied by a sensation as though
there were some pressure “behind it.” The act of making water is not
performed so cleanly as it used to be; the stream differs in its flow,
seldom coming out full and free, but generally split into three or four
fountain-like spirts, as the annexed drawing displays.

At other times it twists into a spiral form, and then suddenly splits
into two or more streams, while at the same moment the urine drops
over the person or clothes, unless great care be observed, as witness
diagram.

In advanced cases, the urethra becoming so narrow the bladder has not
power to expel the urine forward, and it then falls upon the shoes or
trowsers, or between them, as observe illustration.

[Illustration]

[Illustration]

[Illustration]

Persons afflicted with stricture, and urinating in the streets, may
almost be detected from the singular attitude they are obliged to
assume to prevent the urine from inconveniencing them, and also from
the time occupied in discharging it. Some few minutes after making
water, when dressed and proceeding on his way, the patient finds his
shirt become moist by some drops of urine that continue to ooze from
the penis; and it is only as these annoyances accumulate, he begins to
think he is laboring under some other disease than the gleet. The next
symptom he will experience will be a positive but temporary difficulty
in passing his water—perhaps a total inability to do so; it will,
however, subside in a few minutes. This will lead him to reflect, and
he will even appease his fears by inclining to think it may be the
consequence of his last night’s excess: he resolves to be more careful
for the future, and he gets better; his contemplated visit to his usual
professional adviser, if he have one, is postponed, and a few more
weeks go by without a return of the last symptom. The next attack,
which it is very difficult to avert, and which is sure to accompany
the succeeding debauch, or to follow a cold or fatigue, does not so
speedily subside; the patient finds that he can not complete the act of
making water without several interruptions, and each attended with a
painful desire resembling that induced by too long a retention of that
fluid. In that state he eagerly seeks medical assistance; the treatment
generally adopted consisting of some sedative, immersion in a hot
bath, or the passage of a bougie. Relief being thus easily obtained,
professional advice is thus thrown up, and the symptoms are again
soon forgotten. Before proceeding further with the more severe forms
and consequences of stricture, which may now be fairly said to have
commenced in earnest, a brief anatomical description of the urethra may
enable the reader to understand how the constriction or narrowing of
that canal takes place.

I have elsewhere stated the urethra to be a membranous canal, running
from the orifice of the penis to the bladder, and situated in the lower
groove formed by the _corpus spongiosum_.

The difference of opinion entertained by some of our first anatomists,
on the structure of the urethra, is deserving of notice; for only in
proportion to the correctness of our knowledge of it, can we arrive at
a just definition of its diseases.

One party assert it to be an elastic canal—whether membranous or
muscular they do not say—endowed with similar properties of elasticity
to India rubber, or to a common spring. That it is elastic, is beyond
doubt; but the mere assertion is no explanation of its mode of action.

Others, from microscopical observations, declare it to consist of two
coats—a fine internal membrane, which, when the urethra is collapsed,
lies in longitudinal folds—and an external muscular one, composed of
very short _fasciculi_ of longitudinal fibres, interwoven together, and
connected by their origins and insertions with each other, and united
by an elastic substance of the consistence of mucus. This is the more
satisfactory of the two.

They account for the occurrence of stricture in this way. They say
that “a permanent stricture is that contraction of the canal which
takes place in consequence of coagulable lymph being exuded between the
_fasciculi_ of muscular fibres and the internal membrane, in different
quantities, according to circumstances.”

A spasmodic stricture they define to be “a contraction of a small
portion of longitudinal muscular fibres, while the rest are relaxed;
and as this may take place, either all round, or upon any side, it
explains what is met with in practice—the marked impression of a
stricture sometimes a circular depression upon the bougie, at others
only on one side.”

With respect to the change consequent upon permanent stricture,
dissection enables us, in some degree, to arrive at the truth.
Excrescences and tubercles have been found growing from the wall of the
urethra; but in the majority of instances, the only perceptible change
is a thickening of the canal here and there, of indefinite length;
but whether it be occasioned by the exudation of coagulable lymph, or
whether it be the adhesion of ulcerated surfaces, which I contend are
more or less present in gleet, is not so easy to determine; at all
events, it is undoubtedly the result of inflammation.

With regard to the action of spasm, all we know of it is theoretical;
but experience every day furnishes instances of its occurrence.

Spasmodic stricture is generally seated at the neck of the bladder,
and may occur to persons in good health, from exposure to wet or cold;
from some digestive derangement; from long retention of the urine,
particularly while walking, owing to the absence of public urinals; or
to violent horse exercise; but more frequently does it happen to those
young men who, when suffering from gleet or gonorrhœa, imperfectly or
only partially cured, are tempted to commit an excess in wine, spirits,
or other strong drinks. Surrounded by jovial society, glassful after
glassful is swallowed, each one to be the last. The patient, with
his bladder full to repletion, scarcely able to retain his water,
yet probably “_going_” every moment, represses his desire until the
party breaks up, when, on encountering the cold air, he finds himself
unable to void even a drop, or if so, but with extreme difficulty. The
greater the effort, and the more determined the straining, the greater
is the impossibility, and unless relief should be afforded, the most
alarming consequences may ensue.

The rationale is this: the patient, opposing the action of the muscles
of the bladder, by contracting those of the urethra, they (the latter),
from irritation, become spasmodically contracted.

The urine, by the powerful action of the muscles of the bladder, is
forced against the contracted portion of the urethra; and by its
irritation increases the mischief. Where neglected, or unless the
spasms yield, extravasation will take place, mortification ensue, and
death follow.

The urethra is situated at the under part of the penis, and is embraced
by a substance called the _corpus spongiosum_; it (the urethra)
consists of several different layers or coats—the inner, the one
continuous with that lining the bladder, which possesses the power of
secreting a mucous fluid, and the other made up of muscular fibres,
which give to the urethra the power of contracting and dilating,
that regulates the flowing or jetting of the fluid which has to pass
through it. The mucous membrane of the urethra is of a highly sensitive
nature, and more so in some parts than in others, as, for instance,
in the membranous and bulbous portion of the canal; and hence it will
be found, that those are the parts most liable to disease. The mucous
membrane has several openings called _lacunæ_, for the furnishing a
particular fluid to moisten and lubricate the urinary tube: these also
are frequently the seat of disease. These are seen in the drawing on
page 50.

In passing a bougie in contracted and irritable urethra, it sometimes
enters the opening marked B, and if violence be used in propelling the
instrument, false passages are made.

Independently of the function of the urethra being to discharge the
urine, it has also to convey the semen to the orifice of the glans; and
here in this act is to be observed the wonderful adaptation of means
to an end. During the excitement attendant upon venereal commerce, the
seminal fluid accumulates, prior to emission, in the bulbous portion,
and when the fitting moment arrives for its ejection, the membranous
portion spasmodically contracts, thereby preventing the regurgitation
of the semen into the bladder, while the muscles surrounding the
bulbous portion contract with energetic force, and so complete the
transmission of the generative fluid. Such are the functions of the
urethra in health.

[Illustration:
  A—Signifying the urethra cut open.

  B—The lacunæ and the cut end of bougie,
    to show the continuation of the urethra.]

Now, this canal being extensively supplied with nerves, that have more
extensive communication with others than any particular ones have
in the whole body, and made up, as before stated, of surficial and
muscular membranes, and exposed to the performance of several duties
which are often unduly called into exercise, can not be supposed to be
exempt from the consequences of such misappropriation; and therefore
it is very liable to inflammation. From the sensitive nature of the
tube, it is very obnoxious to spasm, which may be partial, general,
temporary, or continuous: hence spasmodic stricture. This condition is
of course dependent upon many causes, excess of diet, fatigue, cold,
&c., irritating the general system; when from the local irritation
previously set up in the urethra by the forenamed causes—a neglected
gleet or clap—the urethra is not long in participating in it: the
phenomena are the symptoms recently narrated. Highly restorative as
the powers of nature may be to remove disease, she does not appear
readily disposed to interfere with the processes set up in the machine
she inhabits, for self-defence, to protect itself from the constant
irritation produced by the daily flow of acrid urine, which in several
cases often produces ulceration; coagulable lymph is thrown out in the
cellular structure of the particular diseased part, thereby thickening
the walls thereof, and constituting permanent stricture, it appearing
preferable to impede a function which a narrowing of the urethric canal
does, namely, that of urinating, than of allowing ulceration to ensue,
whereby the urine would escape into the neighboring parts, and occasion
great devastation, and probably death. Permanent stricture, as its
name implies, outlives the patient; _it never yields, unassisted by
art_. I have described the ordinary symptoms of stricture, especially
that form induced by gonorrhœa. Stricture may arise from other causes.
Inflammation, in whatever way set up, if allowed to go on or remain,
will give rise to stricture, and the celerity or tardiness with which
it takes place depends upon circumstance. An injury from falling
astride any hard substance, blows, wounds, contusions occasioned by
riding, the presence of foreign substances, the injudicious use of
injections, and lastly, which is as frequent a cause as any one of
those heretofore enumerated, _masturbation_. The violent manual efforts
made by a young sensualist to procure the sexual orgasm for the third
or fourth time continuously, I have known to be of that degree that
irritation has been communicated to the whole length of the urethra,
extending even to the bladder; and retention of urine, in the instance
I allude to, ensued, and required much attention before it could be
subdued. Excessive intercourse with females will give rise to the
same effects; not so likely as in the case preceding, inasmuch as
the former can be practised whenever desired, while the latter needs
a participator. The act of masturbation repeated, as it is, by many
youths and others, day after day, and frequently several times within
each twenty-four hours, must necessarily establish a sensitiveness
or irritability in the parts, and alteration of structure is sure to
follow.

The positive changes which take place in stricture in the urethral
passage are these: there ensues a thickening and condensation of
the delicate membrane and the cellular tissue underneath, which may
possibly unite it to the muscular coat. This thickening or condensation
is the result of what we call effusion of coagulable lymph. It will
be rather difficult to explain the process; but lymph is that fluid
understood to be the nutritious portion of our sustenance or system,
and which is here yielded up by the vessels which absorb it, and which
vessels abound, with few exceptions, in every tissue of our body.
However, it will suffice to say, that where inflammation takes place,
there is an alteration of structure, and that alteration is generally
an increase. In stricture, this increase or thickening takes place,
as I observed before, in particular parts of the urethra, but where
the inflammation is severe, no part is exempt, and whole lengths of
the passage become occasionally involved. It is true, certain parts
are more predisposed than others, as, for instance, the membranous,
bulbous, and prostatic portions of the canal; but there are oftentimes
cases to be met with where these parts are free, and the remainder
blocked up. This effusion or thickening assumes various shapes, and
selects various parts of the urethra. The subjoined diagram will convey
a tolerably perfect idea of the malady in question; indeed it is a
beautiful specimen of simple stricture.

[Illustration:
  A—The cut edges of the corpus spongiosum.

  B—The urethra.

  C—The stricture.]

To continue the description of the formidable consequences of neglected
stricture.

In protracted and neglected cases, that part of the urethra between
the stricture and bladder becomes dilated, from the frequent pressure
of the urine upon it, induced by irritability of the bladder, which
has an increasing desire to empty itself. In process of time, complete
retention of urine will ensue, ulceration will take place at the
irritable spot, and effusion of urine into the surrounding parts
will follow; and the consequences will be, as in the instance of
the spasmodic affection, _fatal_, unless controlled by the skilful
interference of the surgeon.

The symptoms of permanent stricture are often as slow in their
progress, and as insidious in their nature, as they are appalling in
their results, and are seldom distinctly observed by the patient, until
firmly established.

He is suffering from a long-continued gleet, and is first alarmed by a
partial retention of urine—it passes by drops, or by great straining,
or not at all. This usually occurs after intemperance, and is relieved
by the warm bath, fomentations, and laxative medicines. This is the
first stage, and is attributed to the debauch solely; whereas, at this
time an alteration of structure is going on in the urethra. Its calibre
is becoming diminished, which necessarily causes the urine to flow in a
smaller stream. This is not observed at first; and it is only after a
long period that the patient becomes aware of the fact.

The disease proceeds. In the morning, from the gluing together of the
sides of the urethra, by the discharge from its diseased surface,
the urine flows in a forked or double stream; and then, as this
agglutinution is dissolved, it become natural.

There is a greater and more frequent desire to make water, disturbing
sleep many times during the night, but unattended with pain, unless the
neck of the bladder be affected.

There are also uneasy sensations in the perinœum, a sense of weight
in the pelvis, with flying pains in the hips; and in the permanent
stricture there is a remarkable symptom frequently prevailing—that is,
a pain extending down the left thigh from the perinœum.

As the disease advances, the urine flows in only a very small stream,
or forked, twisted, double, or broken, or in drops; and the patient
solicits the flow by pressing with his finger on the perinœum, and
elongating the canal, somewhat after the manner in which a dairy-maid
milks a cow.

The dilatation of the urethra between the stricture and the bladder
already alluded to, now takes place; and some urine remains in the
dilated part, which oozes through the stricture, making the patient wet
and uncomfortable.

There is great difficulty felt, and more time is occupied in getting
rid of the last drop of water, than formerly. This sensation continues
all along; and the cure is never accomplished until this is finally
removed.

If the stricture is still neglected, more severe symptoms come on, and
the neighboring parts become affected also.

The _sphincter ani_, or the muscles of the anus, are relaxed, from the
excessive action of the abdominal muscles; and the fæces pass in small
quantities involuntarily. There is a protrusion of the bowel, which
adds to the distress, and, by its irritation, brings on a looseness or
diarrhœa.

The prostate gland, which is seated near the neck of the bladder,
suffers inflammation and enlarges, beginning at the orifice of the
ducts, which open into the urethra.

The emission of semen, which often happens involuntarily, is attended
with agonizing pain, producing cold shiverings, followed by heat; and
fever soon becomes fairly established.

The liver and its secretions become diseased, discharging in the
intestines large quantities of vitiated bile. The fever assumes the
intermittent character. The discharge from the urethra is greatly
increased in quantity, showing the formation and bursting of an abscess
of the prostrate gland into it.

The bladder is much thickened and diminished in size, and acutely or
chronically inflamed. The desire to make water is continual, allowing
hardly a moment of rest; and the patient, in the agony of despair,
prays to be relieved from his sufferings.

Soon succeeding the irritation of the prostate, the testicles become
involved, the disease being propagated by means of their ducts, which
open into the urethra. The testicles swell a little, become uneasy and
painful, and a dropsical or hardened enlargement ensues.

When the stricture forms a nearly complete obstruction to the passage
of urine, the violent efforts of the bladder to expel it bring on
ulceration or rupture of the urethra, through which the urine is forced
into the cellular membrane, with all the power of a spasmodically
excited bladder.

The scrotum and neighboring parts become distended, erysipelas
supervenes, black patches of mortification break out in different
places, the febrile symptoms are augmented, and the patient at last
irrecoverably sinks into a state of coma or muttering delirium, and
death closes the scene. Such is the progress and termination of
stricture when neglected.

The reader, if he be an afflicted one, will eagerly turn to the page
wherein the treatment of this formidable and distressing malady is
considered; and great will be his satisfaction and delight, on finding
it remediable by such simple means, and entirely within his own
control; more especially if he direct his attention to the disease in
its earlier stages.

He must by no means, however, be too sanguine, from these remarks, or
indulge in the idea that as stricture is remediable, it is unimportant
when the cure be attempted; the longer the delay, the greater will be
the cost to the patient; and, furthermore, the slightest deviation from
the instructions laid down, will surely aggravate the disease, and
increase the embarrassment of the sufferer.

The following diagrams are further explanatory of the stricture in its
amplified forms.

[Illustration]

The dark marginal line denote the calibre of the urethra, and the inner
lines the actual diameter of the obstructed passage. Figure 1 shows the
stricture to be on the lower part of the urethra. Figure 2 the upper
part. Figure 3 exhibits a stricture of some length, and a somewhat
contracted state of the whole canal. Figure 4 denotes a very common
form of stricture, which resembles a flour-bag tied in the middle; it
is the least difficult to cure of any, because it signifies that the
seat of irritation is limited; but these cases are generally precursory
to severer forms, if not promptly attended to. Figure 5 represents
a stricture of considerable length, and of course very difficult of
removal.

There are many provocatives to stricture, and when once mischief is
progressing, it makes up for its slow initiation by giant strides. A
patient may have a trifling stricture for years without experiencing
much inconvenience. He takes cold, fatigues himself, commits some
stomachic or other excess, may possibly have fever, all of which more
or less disturb the general economy, alter the character of the urine,
and in that manner doubly accelerate the disorganization going on in
the urethra. A small abscess may spring up _in_ the urethra, or _below_
it among the cellular membranes and integuments. In either case, it
chances now and then to burst an opening and create a communication
externally with the urinary passage, constituting what is called
_fistula_. A person laboring under stricture is always liable to these
occurrences. As much mischief is done oftentimes by mismanagement
as by neglect. The clumsy introduction of a bougie, or, in other
instances, the unjustifiable introduction of one, is likely to, and
very frequently does, lacerate the delicate and irritable membrane,
and make a false passage. Figure 6 exhibits an instance at Nos. 1 and
2; the upper numerical shows a false passage made by a bougie, and an
obliteration of the ordinary passage of the urethra, the result of
inflammation, constituting an impassable stricture; the lower figure
exhibits a false opening made, in the first instance, by a fruitless
effort at passing an instrument, when inflammation completed the
process. No urine escaped from it of course, because communication was
cut off from the bladder by the impassable stricture; the outlet for
the discharge of that fluid being through a sinuous opening marked No.
2, the No. 3 denoting the closed end of the urethra. The case happened
to a man in very ill health, who was prone to ulceration, and he
gradually sunk under exhaustion from debility and premature old age.
Figure 7 exhibits a stricture where the posterior part was enlarged
by the constant pressure of the urine to escape through the narrowed
part of the urethra; ulceration ensued, and a fistulous opening was
the consequence; the stricture was seated high up, and the fistulous
canal was several inches long, terminating in the upper and posterior
part of the thigh; the urine used to dribble through it as well as
through the urethra. The patient had been a seafaring man; he was in
exhausted health from hot climates and intemperate living, and he died
at last of consumption. I have the parts showing the stricture and the
fistulous opening by me, in a state of good preservation. In Figure
8 is presented an illustration of extensive ulceration producing two
fistulous openings; the state of the urethra was only discovered after
death, the patient having concealed his infirmity for many years;
he died suddenly from apoplexy, being found dead in his bed by the
people of the house where he lodged. Figure 9 portrays irregular and
extensive ulceration. The patient died from syphilis, having gonorrhœa
at the same time. I have the preparation. Figure 10 shows an impervious
urethra, and a fistulous opening through which the urine flowed. The
urinary passage was blocked up within two inches from the orifice, and
the length of the obstruction was perhaps a quarter of an inch. It
was perforated successfully by the lanceted stilette, and the passage
thereby rendered continuous; the catheter was worn for several days,
and the false opening soon healed after a slight application or two
of nitric acid. Numerous other illustrations might have been given,
but the preceding convey a passable notion of the simplest, and most
confirmed, and most severe forms, of the malady in question.

It is melancholy, notwithstanding the resisting and reparative power
of nature to avoid so saddening a disease as stricture, that it is so
very prevalent, and that it is occasioned by so many causes. Where it
is not destructive to life, it is very injurious. It involves, where it
is severe, other important organs beside the seat of its abiding; the
repeated calls upon the bladder, through sympathy of the irritation,
created so near to that viscus, the efforts which at all times it is
obliged to make, although assisted by the muscles of the abdomen and
contiguous parts to void its contents, at last, and very frequently end
in paralysis, and total inability to pass water ensues, except through
the aid of the catheter. Independently of which, where so much disease
exists as in the urethra, the urine also constantly pressing against
ulcerating and irritable surfaces, extravasation of that secretion
takes place, and the most formidable and alarming consequences ensue.
In the simplest form of stricture, many important functions are
disturbed. A very frequent consequence is permanent irritability of the
bladder, so that the patient is obliged, ten or twelve times a day, to
micturate, and is unable to pass through the night without suffering
nearly the same inconvenience. Besides which, the natural sensitiveness
of the genital organs becomes speedily and much impaired. I am
satisfied that where disorganization of the testicles does not exist,
and where the patient is young, or even middle-aged, if he be impotent,
he will in nine cases out of ten be found to have stricture. There
are exceptions, which shall be named when speaking on the infirmities
of the genital system, but in nearly all cases of impuissance there
will be found, if not stricture, at least some morbid irritability of
the urethra. During the existence of stricture, there is generally a
vitiated secretion from the seat of mischief, constituting a gleet;
therefore a gleet at all times should be regarded, lest it be an
indication of something more than a mere weeping from enfeebled vessels.

_On the Treatment of Stricture._—Having fully described the symptoms
and progress of stricture, I proceed to the more pleasing part
of treatment. Stricture, if early attended to, is a disease easy
remediable: if neglected, its horrors accumulate, and sufferings the
most acute close the scene. Such, however, is the progress of science,
that it is almost possible to cure the most inveterate case, at all
events to relieve it; but that is no reason why the initiatory notices
should be disregarded. Stricture, as must be perceived, is of two
kinds, spasmodic and permanent: the treatment of the first is chiefly
medical, the treatment of the latter chiefly mechanical. The principal
agents I rely upon in the cure of the former, are the warm bath, rest,
sedatives, and certain dietetic restrictions; for the removal of the
latter, I place unbounded confidence in the practice of _dilatation_;
and I am of opinion that the other methods, namely, the application
of caustic or the scalpel, might be dispensed with altogether, if the
dilating method be not delayed too long.

Before commencing the cure of stricture, I need hardly observe, that we
ought to be fully satisfied of its existence. Symptoms are not always
unerring guides; and, therefore, our reliance should not wholly depend
on them.

                     ——“to be once in doubt
             Is once to be resolved.”

The only mode of ascertaining the precise condition of the urethra, is
by an examination of it, which should not be delayed a moment after
suspicion is entertained of the impending evil.

For this purpose, it is recommended that a solid silver sound should
be used as the best instrument; because it will pass with much less
pain or inconvenience. It should be made conical, that is, smaller
at the point than at the shaft, and of a size to pass very readily
into the orifice; the shaft or body of the sound should not exceed
two thirds of the size of the canal. The sound should be warmed,
and afterward it should be well oiled. The directions for examining
the urethra pertain to the passage of a bougie or catheter; and as
it often falls to the lot of a patient, that he is beyond medical
assistance, it behooves him to learn how an instrument should be
passed, in order that in emergencies he may officiate himself; besides,
it often happens, in cases of diseased bladder, and in those cases
where retention of urine frequently occurs, that an invalid can not
command the necessary constant attendance of his professional man; and
therefore such knowledge will well repay any little time or trouble
bestowed in the acquisition. The two annexed drawings will render the
commonest observer a proficient. The first shows the manner in which
the bougie is to be introduced. Where the instrument can be passed thus
far, without the assistance of the other hand than that which holds
the bougie, it is better, as it keeps the penis and the muscles which
influence it in a passive state. When the instrument has passed as
far as it will, in the direction the dotted lines denote, it is to be
turned gently round, raising the handle toward the abdomen. A slight
pressure is then to be made _downward_, and the handle of the catheter
or bougie at the same time to be borne away from the body. See diagram.
The instrument will, if there be no impediment, gradually slip into the
bladder. A trial or two will perfect and surprise the novice. The same
directions apply to the introduction and use of all other instruments
into the urethra. The sensation experienced on having a bougie passed,
partakes more of a strange tickling feeling than absolute pain, except
there exist stricture, and even then the urethra, on a subsequent
trial, is almost insensible to it.

[Illustration]

[Illustration]

If soreness or pain is felt, on the sound passing over the affected
part, we may presume there is chronic inflammation of the urethra,
or that the surface is ulcerated, as in long standing gleet. If the
sound meet with an impediment, but proceeds after a little pressure,
it indicates a thickening of the mucous membrane, the forerunner of
stricture.

I may here observe, that stricture is generally found to exist either
within an inch of the orifice, or at about six inches and a half from
it, or in the prostate part of the urethra.

If the sound passes, without hinderance, the last situation, but with
increased pain, the membrane of that part is diseased, and may extend
to the bladder; which will be indicated by the frequent desire to
micturate during the night, owing to the irritable state of that organ.

If the instrument be arrested at about six inches and a half, the
complaint, in all probability, is seated in the transverse portion of
the prostate, and requires very cautious treatment.

When the obstruction is at the very entrance of the bladder, a
resistance will be perceived, which, on yielding, will impart a
peculiar sensation as the sound enters the bladder. When stricture is
thus situated, there is a frequent desire, with almost total inability,
to micturate; and when once formed, it is productive of the most
serious mischief, unless relieved.

In cases of permanent stricture, the passing of the sound conveys
the sensation of going over a ridge. Where it meets with a temporary
stoppage, and then passes on, it has probably hitched to a fold of the
urethra. Sometimes it will enter the orifice of a dilated follicle; and
if much pressure is used, it will occasion considerable bleeding.

The nature and situation of the disease being ascertained, the cure
may now be proceeded in, recollecting that no force is to be used,
and that too much be not attempted at one essay. Now without entering
into an inquiry as to the laws on which _contraction_ and _elasticity_
of certain animal structures depend, it is enough for our purpose to
know, that the urethra possesses both properties; it may contract
so as to oppose the exit or entrance of the smallest stream, and it
may be dilated to admit the introduction of an instrument an inch in
circumference. The urethra maintains these properties in disease as
well as in health, and upon the strength of this fact, is the practice
of dilatation in the cure of permanent stricture founded, permanent
stricture, it will be recollected, is a positive narrowing of the
urethric canal; and as it is the nature of all organic diseases to
progress, unless prevented by art, it needs no stronger argument than
necessity to show how imperative it is to set about their removal.

The cure by dilatation is as follows:—the seat and size of the
stricture being ascertained (both of which can be easily done by the
passing of the sound as directed, and the observance of the stream of
urine), a bougie in circumference somewhat larger than the calibre
of the urinary current, warmed and dipped in an oleaginous mixture
combined with some sedative (Forms 22, 23, 24) or stimulant (Form 25)
according to circumstances, is to be passed to the stricture, and the
gentlest pressure is to be employed for the space of five, ten, or
twelve minutes, according to the irritation it produces, removing it as
soon as any uneasiness is felt.

Even in this very simple operation, a certain dexterity is requisite;
for the direction of all urethræ is not alike, and the mere pushing
a bougie against a contracted part is not the only likely method
of effecting a free passage. Much also depends upon the nature of
the bougie—the elastic ones, although assisted in their attempted
passage to the bladder, by the smooth and well lubricated sides of
the urethra, have a tendency to straighten; and unless considerable
rotatory motion be observed, are apt to hitch in a fold of the urethra,
especially if the case befall a person of relaxed fibre, and he be
much worn down by suffering. The bougies that I employ are constructed
upon an improved plan to those in general use, being prepared of a
material that will preserve the shape I adapt them to, previously to
introducing them, but at the same time sufficiently soft to yield to
any accidental tortuosity of the tube they are intended to explore.
The bougie then is to be pressed softly, but steadily, against the
obstruction, now and then withholding for a minute the bearing, so as
to allow a respite to the stretched membrane; then renewing by, what
is better done than expressed, an “insinuating” pressure for the space
of the time advised above. The patient should not be dispirited, even
if the bougie do not perforate the stricture at the first trial; it
would doubtless do so, if longer time were employed, but that is rarely
advisable, except in cases where the urine can scarcely escape, or much
expedition be requisite. Should the operation even be unsuccessful in
this first attempt, the patient will find his ability to micturate much
greater than before the introduction; but, save in long-standing and
obstinate strictures, I rarely find myself foiled, nor do those who
practise the same method, if they have patience and skill enough, in
overcoming the difficulty at the first interview. A great advantage of
the cure by dilatation, independently of its safety and efficacy, is
the insignificant pain it occasions; the sensation produced being only
like a pressing desire to make water, which immediately subsides on
withdrawing the bougie.

Another method of dilating a stricture, where it happens to be of
chronic existence, is the passing a plastic catheter into the bladder,
and suffering it to remain all night, or even for several nights,
stopping up the handle end with a cork or wooden peg, which the patient
can remove when he desires to urinate. The urethra, by this means,
becomes quickly dilated, and much beyond the size of the instrument. It
necessarily confines the patient to his room and couch; but where an
expeditious cure is the object, as much may be effected in this manner
in six days, as by the ordinary method in as many weeks. Time, however,
it must be remembered, is the working _material_ of nine tenths of
strictured invalids, and a week’s lay-up may cost a twelve-month’s
salary—a purchase too dear to be generally incurred.

Several other plausible methods have been suggested for the cure of
stricture—one by means of an instrument, that the operator could
enlarge when it was passed into the urethra, through turning a screw;
another, which was to introduce a tube made of some thin skin, and
then to distend it with wind or water; a third, and oftentimes, in
reality, a very useful and available one, is to compress the penis
around the glans, and suffer the urine, as it accumulated, to distend
the anterior part of the urethra before the bandage was removed and the
urine suffered to escape. But they have their several disadvantages:
the processes, with the exception of the last, are complicated and
uncertain in their result; the instrument is not so manageable, or so
useful, as an ordinary sound; and the gut, instead of distending the
strictured part, enlarges the healthy portions of the urethra. The
bougie, in proper hands, notwithstanding it is a simple instrument,
is the most positive and effectual method of curing stricture as
yet, or likely to be, discovered. An entrance, then, having by this
means been gained, a bougie of a larger size is to be selected on the
next occasion, and the same process repeated. It is never advisable
to repeat the operation oftener than once in two days, and when the
urethra is irritable, only every three or four days.

By continuing in this manner, the stricture gradually yields, and
a bougie as large as the orifice will permit to enter will at last
proceed through the whole passage without meeting any obstacle. The
operation, notwithstanding this apparent success, should not be wholly
laid aside, but continued until the disposition for contraction
is entirely removed; and the patient should never rest without
occasionally examining his urethra, say once a month (at least once a
quarter), lest he encounter a relapse.

Having disposed of the treatment of stricture in its fortunately most
usual—namely, the mildest—form, I proceed to consider the treatment
of severe kinds—previously to which, a few remarks upon the various
kinds of instruments, their structure, shape, and size, will render any
subsequent allusion more intelligible.

The diagram here introduced represents the calibre of the various
bougies in general use, and the observer will perceive, that as they
are made to accommodate themselves to the passage they have to pass,
how varied must be the changes which the urethra undergoes. The
last outline indicates the natural and healthy bore of the urethra.
Bougies are manufactured of different materials: waxen cloth rolled
together, elastic and yielding; flexible metal, silver, and gold.
The bougies which I employ are constructed upon an improved plan
to those in general use: the elastic, as they are termed, although
assisted in their attempted passage to the bladder by the smooth and
well-lubricated sides of the urethra, have a constant tendency to
straighten, and consequently are liable to hitch in all the folds they
may encounter, which, in relaxed habits, are very numerous in the
membranous portion of the urethra. To obviate such a possibility, I
prefer that the bougie should be of such a consistence and manufacture
as will admit of its preserving the shape I adapt it to previously to
introducing it; at the same time the material to be sufficiently soft
to enable it to accommodate itself to any accidental tortuosity of the
tube it is exploring.

[Illustration]

Catheters are instruments for the purposes of withdrawing the urine;
they are consequently hollow, and are made of the same materials as
bougies; but the most useful and to be depended upon are composed of
silver. Surgeons, like other men, have their fancies: a catheter,
when made of silver, has very little flexibility; accordingly it must
be shaped beforehand. Some medical men prefer them quite straight,
others with an immense curve. A surgeon should possess many forms, as
the direction of the urethra differs almost in all men. The subjoined
exhibits not the size, but the shape of the more useful and those
most generally used. Figures 1, 2, and 3, suffice in most instances,
whereas figure 4 is necessary in cases of enlargement of the prostate
gland, which presses up the bladder, and renders the urethral passage
consequently longer.

[Illustration]

The French employ not only variously curved instruments, but variously
shaped. In peculiar cases they are doubtlessly useful; but they require
to be used only by persons of skill and judgment. In the next three
kinds are views of such; they are called conical bougies—the first
curved, the second straight. They are made of silver, waxen cloth, or
India-rubber. The third exhibits a sound, employed to ascertain the
seat of the stricture.

I have already alluded to the improved method I employ on finding it
necessary to use escharotics. I can not better explain the process
than by submitting a sketch of the instruments, whereby the mode of
application will be instantly perceived. The instruments are made of
silver. The figures represent No. 8 a curved, No. 9 a straightened, No.
10 ditto, with enlarged head, which puts the areola of the stricture on
the stretch, and secures the central part for the application of the
caustic, or whatever substance may be employed.

The next kind of instruments are for the purposes of dividing or
piercing hardened obstructions—one or two applications creating a
passage which a hundred _cauterizings_ would not effect. When any
styptic is applied to a morbid growth, its tendency is to create a
slough, or to destroy the part whereto it is applied. In some instances
a styptic actually promotes increased action: it may temporarily
destroy the part; but the moment the effect is over, a reaction
follows, and the excrescence is increased. Such is the case in many
long-standing, obstinate strictures; and their removal by perforation
or division is rendered indispensable. The practice requires the
most careful attention and anatomical knowledge; and no one but a
professional man would attempt its employment.

No. 11 sketch exhibits a curved instrument, with the pointed lancet
projecting as when applied. No. 12 exhibits ditto, but with a
differently formed instrument, consisting of two portions separated,
so as to allow a director, in the form of a thin silver wire with a
silver knob, to pass for the purpose of exploring the passage which the
instrument is to follow and enlarge. It is indispensable in strictures
seated upon the soft and deep parts, lest a false passage should be
made. No. 13 represents a straight instrument; No. 14 ditto, but with
the lancet in reserve—the last a perforator.

The reader has now been made acquainted with the various resources
the surgeon has at his command. A few words on their employment will
complete the necessary amount of information to render the one as wise
as the other. By way of recapitulation, the treatment of stricture
is by _dilatation_, _cauterization_, and _division_. They are to be
estimated in the order of their arrangement. By dilatation is meant the
enlarging of the urethral passage through the frequent introduction
of bougies of graduated sizes. It is an operation unattended with any
considerable pain; its novelty sometimes renders a patient a little
nervous, but a complaint is rarely made after a second or third
introduction. Indeed, it is oftentimes courted more frequently than is
desirable. The application also of caustic, or even the perforator,
produces scarcely the least inconvenience. Hemorrhage, of most
things to be dreaded, is less frequent, with cauterizing and cutting
instruments (in skilful hands), than the incautious employment of
blunt-pointed bougies.

_Diseases of the Testicles._—The testicles, from their office and
connexion with other structures equally as important, are liable
to many excitations. In gonorrhœa they are subject to sympathetic
inflammation, as in _hernia humoralis_, which, if neglected or
maltreated, gives rise to abscess or chronic hardness. Inflammation
also occurs in them as in other structures. Accidents, such as blows or
bruises, horse-riding, wearing very tight pantaloons, are all fertile
sources of derangement. Scrofulous constitutions are predisposed to
have their testicles, like the rest of the glands, diseased. The most
frequent disturbance, however, of the testicles, is a dilatation of
the veins, constituting what is called varicocele; and generally
accompanied by a wasting away of the testicle itself. It is rare,
indeed, to find perfectly healthy testicles in an individual who
has been exposed to amatory pleasures and sensualities; and as, of
course, even amative desire, as well as amative power, depends upon
the absolute sound condition of the glands in question, the inference
is, that in very numerous persons, the sexual instinct is considerably
diminished, and not unfrequently wholly suppressed, before half the
natural term of their existence has expired, at which time they ought
in reality to be at the climax of their prime and capability.

It is not so much a painful complaint, as an unpleasant one. There are
occasionally pains in the back and loins, and other feelings, creating
a sensation of lassitude and weariness; and now and then some local
uneasiness is felt.

Varicocele gives to the examiner a sensation as though he were
grasping a bundle of soft cords. It sometimes exists to such a degree
as to resemble a rupture. In advanced stages of the disease, or
disorganization, the epididymis becomes detached from the body of the
testicle, and is plainly distinguishable by the finger. The result of
all is, that a considerable diminution of sexual power takes place;
and if means are not adopted to arrest a further break-up of the
structure, the venereal appetite will subside altogether. The annexed
drawing exhibits a tolerably faithful portrait of the disease; it
represents the varicocele to be on the left side—the side most usually
affected.

[Illustration]

The folds formed by the veins lapping over each other are clearly
distinguishable, and the dependent state of the scrotum on the affected
side exhibits very well the occasion of it. The treatment consists
in giving support by means of a suspensory bandage, which may be
worn during the day, and the use of local refrigerants night and
morning. The state of health is sometimes mixed up with it; and tonics
and generous diet are useful. The cold shower bath helps to brace
the system. It is a complaint in which, if it be not of very great
severity, nor very long continuance, much good may be done. In some
instances the veins may be allowed to empty themselves, which they will
do when the body is in a recumbent position, and a coated ivory ring,
or a silken band, may be so placed around them as shall prevent their
refilling. It is, however, a case fitter for the surgeon’s management.

_Abscess in the Testicle._—The testicle is subject to inflammation
and suppuration like any other structure. A case about three years
ago fell under my notice, where a quantity of dark fœtid fluid was
released on puncturing a testicle in which the sense of fluctuation
was very evident; and the patient stated that it had been five or six
years in arriving at that condition. He was wasted considerably from
nocturnal perspirations and acute pain, and his sexual desire was much
diminished. The case did well, and the latter function was restored
without much loss.

_Hydrocele._—Hydrocele is an accumulation of yellow serous fluid in
the _tunica vaginalis testis_ (refer to the engravings in next page),
or peritoneal covering of the testicle. It is a disease incident to
every period of life, but more commonly met with in grown persons.
The ordinary formation of hydrocele is unattended with pain; and the
patient accidentally discovers the existence of the swelling, but
oftentimes not until it has attained a considerable magnitude. The
tumor, when large, produces an unsightly appearance, and forms a
hindrance to sexual intercourse, from the integuments of the penis
being involved therein, and thereby preventing a perfect erection of
that organ. The disease may appear to originate spontaneously; but it
is usually traceable to some bruise, blow, or other external injury to
the part.

The two following drawings exhibit the outward and inward appearance of
the scrotum in hydrocele:—

[Illustration: The Scrotum largely distended.]

[Illustration: The Scrotum distended to its utmost extent, and the
  position of the fluid shown. The penis is almost always more or
  less drawn up, and in severe cases it appears drawn up so as
  scarcely to be perceptible.]

The notion that the cure of hydrocele depends on promoting adhesion to
the sides of the tunica vaginalis with the testicle is somewhat upset
by several preparations in the London hospitals, exhibiting the _tunic_
taken from persons in whom a radical cure was effected by injection,
and in whom no fluid was reproduced; nor were the sides of the said
investment at all adherent with the testicle, but apart, as in the
healthiest individual. Hitherto surgeons, acting on the aforesaid
notion, with a view to obliterate the cavity, adopted various plans of
treatment—such as, for instance, laying open the entire cavity, cutting
away a portion of the tunica vaginalis, the application of caustic,
and, lastly, the seton, as advised by Dr. Pott, which was suffered
to liberate itself by ulceration. When, in any of these instances,
suppuration was induced, the cavity became in time filled up by the
granulating process. The plan of the present day is by perforating
the sac with a trocar, suffering the effused fluid to escape, and
injecting some stimulating liquid which is allowed to remain until a
degree of inflammation is produced, that shall cause an obliteration
of the cavity by adhesion, or, as it has also been proved, prevent
a reproduction of the fluid, by closing the mouths or altering the
diseased action of the exhalent arteries. Whichever be the effect
produced thereby, the cure is almost certain, and the principles of the
treatment consequently judicious. But, notwithstanding, the operation
is not always immediately, nor _ultimately_ successful; the degree of
inflammation set up may be insufficient, and the effusion again take
place, and the operation may require a second and third repetition;
or an excessive degree of inflammation may ensue, that shall occasion
serious constitutional disturbance, either by suffering the injected
fluid to remain too long, or its being of too stimulative a character,
or from its escaping into the cellular membrane of the scrotum, an
accident not unfrequent, unless great care be used in the operation.

_Radical Cure of Hydrocele._—The term radical is applied to the process
narrated in the last case; but, as has been observed, the operation is
occasionally required to be repeated several times. In the case I am
adverting to, after tapping, several injections were thrown in between
the tunics, and withdrawn; and on one occasion the morbid fluid was
secreted to the greatest possible distension of the scrotum by the
following morning. Its subsequent withdrawal, and the injection of a
more active stimulant, effected, however, a permanent cure. In the
country, surgeons frequently plunge a lancet in the scrotum, suffer the
effused liquid to escape, and desire the patient merely to wrap the
parts up in a handkerchief, to take no further heed, and to ride home:
and these cases generally do well.

_Hydrocele Cured by Acupuncturation._—A new method of treating
hydrocele has of late years been introduced, namely, by the insertion
of a needle into the sac or bladder of the testicle, which, upon its
withdrawal, permits the fluid to escape into the cellular membrane,
whence it is rapidly absorbed. A pint of fluid may be got rid of in
that way in two or three hours; and, although the disease may not be
radically cured, it will occupy several months before a reaccumulation
of the fluid takes place. In recent cases, this treatment oftentimes
proves permanently successful. Many nervous persons will not submit
to anything approaching an operation, not even to the simple one
of acupuncturation. In such cases, there is no alternative but
counter-irritants, to be applied over the part, such as the tincture of
iodine, or the following ointment (Form 26).

It is at all times best to attend early to any disease of the
testicles; the progress is so rapid, the mischief so great, and the
consequences so deplorable, of uncontrolled disease.

_Eruptions incident to the Organs of Generation and the Rectum._—The
structures included in the above heading are subject to a variety of
eruptions, varying in character, intensity, and duration. Thus we have
the _papular_, a chronic inflammation characterized by papules, or very
minute pimples, of nearly the same color as the skin, accompanied by
intense itching, and terminating, when broken by scratching, in small
circular crusts: this is called, by dermoid pathologists, Prurigo.
Another order of eruption is designated the _vesicular_ and _pustular_,
and consists of groups of small pimples of a very bright red color,
and containing a serous fluid. They are accompanied by itching,
which increases as the contained humor becomes turbid, and assumes
the puriform aspect; they then incrustate, and at the end of about a
fortnight drop off, leaving the skin healthy underneath. The name given
to this variety is Herpes.

The last and most inveterate species is characterized by an itching of
the skin, which, on inspection, appears of a diffused redness, and
gives off, after a while, a number of thin scales: these reaccumulate,
and the entire organs of generation becomes sometimes covered with
similar patches: this is denominated Psoriasis. These affections, which
are but various degrees of inflammation, modified by idiosyncrasy and
habit, arise from local and constitutional causes. Among these are
frequent excitation of the organs of generation, the contact of the
fluids secreted during sexual intercourse, an unhealthy and relaxed
condition of the genitals, and, lastly, a disordered state of the
digestive organs. It is astonishing to what an extent these disorders
prevail, and more so to find how long the individuals, probably from a
sense of diffidence in seeking professional assistance, endure them. I
have encountered many patients who have informed me that they have had
the complaint upon them from five to ten years, purposing during the
whole of that period to consult some medical friend, but postponing it
until their interview with myself; and it is the more to be regretted,
as the cure may always be effected in a week or two, with moderate
attention and perseverance; but if the attempt be neglected, there
is no limiting the extent to which the disease may proceed. Local
diseases, especially of such a nature as those under consideration can
not exist any great length of time without involving the digestive
organs, which become sympathetically deranged; and in like manner do
local diseases participate with dyspeptic disturbances—each, therefore,
goes on aggravating the other.

_Diseases of the Bladder._—The anatomical description of the bladder
will be found in the earlier pages of this work. It may simply be
restated:

The bladder is a viscus somewhat similar in structure to the stomach.
It is composed of several coats—muscular, nervous, and mucous. Each are
liable to diseases peculiar to their several structures. The size of
the bladder differs in most persons, and in the sexes.

The female bladder is generally the largest; but the largeness is
observable more especially in females who have borne children. The
proverbial ability of females to retain their urine longer than men is
thus accounted for.

Much mischief is often done by both sexes disobeying the particular
“call of nature” to urinate; and the younger branches should have that
fact impressed upon them. I have known children acquire a severe and
obstinate form of irritability of the bladder by retaining their urine
too long. Diseases of the bladder are generally the consequences of
other complaints, and those complaints have already been enumerated.
They may be thus summed up:

Gonorrhœa extending to the bladder, and producing absolutely a clap
of the bladder. If the inflammation is not subdued, or does not
subside, probably some permanent mischief ensues; at all events, the
inflammation extends, and involves other coats than the interior.
Accordingly, we have inflammation of the muscular coat, the nervous
coat, and, lastly, the peritoneal coat. These terminations, severally,
have certain symptoms, and certain names.

There are others, and among them may be named colds, local injuries,
hæmorrhoids, excess in drinking particular fluids, sensual indulgences,
diseased condition of the kidneys, or long retention or vitiated states
of the urine, nervousness, and, lastly, the formation of stone in the
bladder. The most common form of bladder ailment is irritability,
which is a milder term for inflammation. Then we have absolutely
inflammation, and, lastly, loss of power, or paralysis.

_Irritability of the Bladder._[3]—The chief indication of disease
affecting the bladder is a frequent desire which the patient
experiences to pass his water; but that symptom alone does not
determine the nature of the complaint. It may be irritable from
sympathy with surrounding irritation, and disappear on the subsidence
of that irritation. It may constantly be fretting the patient by its
contractions, through the urine (owing to some general derangement
in the system, being altered in its chemical qualities) exciting the
bladder the moment it is secreted therein; or it may be the result of
nervous agitation, with or without any actual diseased state of the
bladder. These causes should be understood to regulate the treatment,
which of course must be qualified by the provocation, and which the
patient, when in doubt, had better leave to the discrimination of his
physician.

_Paralysis of the Bladder._—The bladder may become, through loss
of nervous stimulus, insensible to irritation, and consequently be
disobedient to its natural functions. The urine, in these cases,
accumulates in large quantities, distends the bladder to its utmost,
which it does without pain; and the excess of secretion then dribbles
away involuntarily. This state of the bladder is called paralysis, and
is an aggravated form of disease, arising from the same causes that
establish inflammation, or from some contiguous nervous injury. The
treatment of paralysis of the bladder must be intrusted to experienced
hands; it consists chiefly of purgatives, stimulative enemata up the
rectum, the introduction of the catheter, the cold bath, rest, and
general medicinal nervous excitants.

_Inflammation of the Bladder._—Cases of acute inflammation of the
bladder are of rare occurrence; but they do occur, occasionally prove
fatal, and always are productive of much general disturbance, which
yields not without vigorous and active treatment. Gonorrhœa is most
usually the exciting cause. On the sudden suppression of the urethral
discharge, an inflammation sympathetically seizes the testicle, the
glands in the groin, or the bladder; and when the latter is the seat of
the transference, it may be held as the ratio of the severity of the
disease. In inflammation of the bladder, there is a constant desire
to pass water, which, when made, is usually in very small quantities,
and leaves a sediment. The patient often experiences an insupportable
inclination to urinate, with a sensation as though the bladder were
ready to burst—whereas there may be little or no urine in it. There is
much pain at the root of the penis, and it extends along the perinœum
to the rectum, which latter is assailed with almost constant spasms
resembling straining. There is considerable thirst, fever, and anxiety;
the pulse is full and quick, the tongue furred, and all those symptoms
are present that prevail during severe constitutional excitement.
The treatment consists of bleeding, leeching, or cupping; relieving
the bowels by castor oil and injections; giving mucilaginous drinks,
administering opiates, preserving rest, and total abstinence from
stimulating diet. If these means fail in subduing the inflammation it
runs on to ulceration, permitting extravasation of urine occasioning
mortification and death; but where they are effectual, the patient is
soon left free from complaint. It often happens that the inflammation
is not so vigorously treated, or it may be wholly neglected, and yet
it may happily resolve itself without proceeding to the extremity
narrated; but, unfortunately, it may degenerate into a minor but not
less troublesome form, denominated chronic, and which, in fact, is the
disease christened “irritability,” and the one, for obvious reasons,
as above stated, for which relief is most usually sought, the patient
having in vain daily looked for the subsidence of his malady. Having
stated that irritability of the bladder must be treated with reference
to its cause, it is obvious that more than non-medical discrimination
is required. Where it depends upon stricture, the stricture must
be first cured; where upon stone in the bladder, the stone must be
removed; where upon sympathetic inflammation, the source must be
attacked, and so on.

However, it has been stated that other causes may exist—that it may
even be a primary disease in itself; and as this treatise professes to
be a private mentor to the invalid, I will detail such measures as may
be safely adopted for the cure of a complaint as often borne from being
trusted to unskilful hands, as from a morbid delicacy in seeking proper
and legitimate relief. The ordinary symptoms are, first, an inordinate
desire to make water; it flows in small quantities, with pain before,
during, and after. The urine has an offensive ammoniacal odor; it
deposites a thick, adhesive mucus, of a gray or brown color, sometimes
streaked with blood, and of an alkaline character.

In this stage of affairs, rest is indispensable; sedatives and opiates
may be given; but alkalies (rarely omitted in prescriptions for
incontinence of urine) should not be indiscriminately given, for they
only render the urine more alkaline, which occasions it to deposite
calcareous flakes, that, if not passed off, accumulate, unite, and
lay the foundation of that frightful disease, stone in the bladder.
The extract of _conium_, or _henbane_, combined with mucilage, may be
given in doses of three to five grains every six hours. The _tincture
of henbane_, in doses of a _fluid-drachm_, or the _tincture of opium_,
not exceeding _ten or fifteen_ _drops_ at a time, may be given in
like manner, and continued for several days, keeping the bowels open
with castor oil. The daily or alternate daily use of the hot, general,
or hip bath, will afford immense relief. The various preparations of
_morphine_, _aconitine_, and of _hops_, possess great power in small
and frequent doses. The _uva ursi_ is a remedy of ancient note, and is
often prescribed with advantage; the dose is one scruple to a drachm
in milk, or any bland fluid, three times a day, or it may be taken in
infusion or decoction, one ounce to a pint of water—that quantity to
be drank during the day. The _pareira brava_, exhibited in a decoction
(by simmering three pints of water, containing half an ounce of the
root, down to a pint), may be taken in divided doses of eight or twelve
ounces during the day, or in the form of extract, in quantity of a
scruple, which equals the above amount of decoction.

The _achillæ millefoliæ_ is an excellent plant, and possesses
astonishing astringent powers, often restoring the tone of the bladder
to a healthy condition, when all other remedies have failed. A handful
of the leaves are to be infused in a pint of boiling water, which, when
cool, may be poured off, and given in doses of a cupful three times a
day. Any of the preceding sedatives may be given in conjunction with
these preparations.

Lime-water taken with milk, as an ordinary drink, is a useful
corrective.

The _buchu_ (the _diosma crenata_)—an ounce infused for several hours
in a pint of boiling water, and a wineglassful of the cooled liquid
administered three or four times a day—has justly obtained some
notoriety.

Where all these means prove ineffectual, the injection of sedative and
astringent applications often answers the most sanguine expectations;
but they should be employed only by professional persons, and even
then with great care; as when the disease has been at its height,
and they have been used, much inconvenience, and even mischief, has
been occasioned. A mild infusion of poppies, or weak gruel, may be
thrown in, once or twice a day, in quantities not exceeding two or
three ounces at a time, and withdrawn after being suffered to remain
thirty or forty seconds. A catheter, with elastic bag, should be the
instrument used.

In the more chronic forms, where the urine does not deposite much
mucus, or is tinged with blood, the addition of ten drops (_very
gradually_ increasing the quantity) of the diluted nitric acid may be
made to the fluid injected, repeating or declining the operation, as
the effects are discovered to be advantageous or prejudicial.

In an irritable state of the bladder depending on some disease of the
kidney, there is a frequent desire to void the urine without there
being any, or but very little, urine in the bladder. There is also a
severe cutting pain felt about the neck of the bladder, especially
after each effort to make water, followed or attended by a “languid”
pain in the loins. The urine is often the color of whey, at other times
tinged with blood, and deposites, when suffered to remain a while, a
purulent sediment. The severe symptoms should be allayed by the same
remedies as prescribed in irritable bladder arising from other causes;
but the original seat of the disease in this instance demands energetic
attention. The various counter-irritants are in great requisition;
leeches, blisters, setons, &c.

In addition to the tonics and astringents already advised, an infusion
of the _wild-carrot seed_, made by macerating for a couple of hours
one ounce of the seeds bruised in a pint of boiling water (drinking,
when cool and strained, the whole of the liquid in divided doses during
the day), may be taken with every chance of relief. As in the other
infusions, the patient must persevere in the use of this for some time.




                  ORIGIN OF THE VENEREAL DISEASE.


THE reader will allow that it can not be for want of materials to
produce a book, that this subject is introduced, as the multifarious
nature of this work’s contents will readily testify; but it is
briefly to explain certain probabilities and conjectures which the
afflicted curious are generally desirous of being satisfied upon. Who
ever suffered under syphilis but was solicitous to know how such a
plague came into the world? Many moralists believe and insist that
it is a specific punishment, sent for our physical transgressions.
Philosophically speaking, such it is; because the infringement of any
natural law always incurs a penalty. However, if it be a manifestation
of divine displeasure, it certainly is most unequally apportioned;
for it generally happens to the least licentious, instead of the most
depraved—the timid, scrupulous, and nervous man, contracting it on the
first loose intercourse, whereas the man of the town revels almost
with impunity; and, lastly, he who exercises the greatest caution
and cleanliness escapes it altogether, although he may be the most
deserving of the infliction. In a state of timorous excitement, we
are more apt to catch the latent mischief. The careless, thoughtless
libertine, hardened against infection by indifference, free living,
and probably strong health, often escapes scot-free; and the cool and
calculating pleasure-hunter, who exercises those useful antagonists
to disease, namely, ablution and selection, comes off triumphant with
still greater certainty.

The point at issue is, when the disease first arose, and where.
Medical historians give credit to America, Spain, and France, for its
propagation; and controversies have been carried on by various parties,
each disclaiming the honor. Now, as I do not propose to analyze the
authorities, but simply to venture my own opinion, with the reasons
for the same, I have no alternative but to refer the reader, if he
be dissatisfied with my attempted exposition, to more comprehensive
and elaborate conjectures than my own. Starting upon the proposition
that nature’s laws are unalterable, and believing that fever is, and
has been fever since the creation of the world; that a cut finger has
healed by the first intention, or has _festered_, and ever may do
so—each condition being modified by the state of health of the party,
and the nature of the wound; that a broken limb was attended with the
same consequences in the year 1 as it will be in the year 1900; and
that dirtiness generated itch, and does so still: I can not reconcile
myself to any other belief, but that any violation of the laws
whereupon sexual intercourse has been permitted, has been, is, and will
be, attended with corresponding results; and as such violations most
likely exist where numbers cohered together, I consider both gonorrhœa
and syphilis to have been coeval with the origin of mankind. They both
doubtlessly are much modified by climate, habits, and constitution; and
therefrom ensue the many modifications we see in Europe, and the other
large portions of the globe. The proofs that can be adduced in favor of
this hypothesis are interminable.

It is said that, until the arrival of some British sailors at
Otaheite, the disease was unknown in that territory. Possibly, in
its present modification; but previously to this new intercourse, it
is most probable that the sexual cohabitation was not so promiscuous
or frequent, and that that very infringement entailed a new form of
irritation. In married persons, of even temperate passions, and of most
careful habits, local sexual disorders are of frequent occurrence,
the slightest derangement of female health giving rise to vaginal
disturbance, that unsuspectingly is increased by the marital embrace,
and communicated to the husband; and only from its presence does it
occur, that the coitus may have been the cause of it. By attending to
the simple suggestion of nature, namely, abstinence, cleanliness, and
rest, a cure is effected; but where neglected, or should either party
be unfaithful to the marriage vow, the disease becomes magnified, and
extended to, mayhap, innocent parties.

The next question is, are gonorrhœa and syphilis identical? Certainly
not, any more than the very many modifications of generative sores.
It is absolutely, now-a-days, a difficult question to solve, whether
this or that be syphilis; so numerous and yet so closely in resemblance
are the ulcers that ensue after sexual cohabitation. The eye is not
to be trusted, because so different is real from spurious syphilis
that the French surgeons decide the point by inoculating a healthy
portion of the body with the matter or discharge from what they suppose
to be a syphilitic ulcer. If a corresponding ulcer be produced, the
disease is decided to be syphilis. If, on the other hand, no result
follow, the patient is proclaimed free from that malady, and stated
to be laboring under merely common local irritation. What is still
more curious is this: a patient will have ulcers, which every medical
man will pronounce, on beholding, to be chancres; yet, upon this
trial, the inoculation will not evince them to be so. A while after,
supposing the chancres to be healed, secondary or other symptoms will
show themselves—sore throat, spotted skin, glandular enlargements, or
painful joints, follow. The same consequences oftentimes ensue after
gonorrhœa. The primary diseases can not be identical, because the
symptoms are vastly different, and the parts attacked are also unlike;
and yet there is this anomaly, that the after-consequences frequently
closely resemble each other.

Another surprising result from loose intercourse is, that one female
will convey to this individual gonorrhœa, to another syphilis; a
third will escape scatheless, and a fourth will have a modifiable
affection of both diseases. A satisfactory exposition of the why and
wherefore such things should be, or are, is I fancy beyond the skill of
pathologists. It is enough to know that they happen; and it is better
to use those means which past and daily experience furnishes to get
rid of them, than to ponder and wonder in the vain endeavor to explore
their origin.

In giving an opinion that we have always been liable to fever, to
cut fingers, and to syphilis, I am ready to admit that these several
conditions depend upon the varied states of health of the parties.
The fevers (ensuing upon the ill-ventilated places) of olden times,
compared with those of the present day, differ in intensity and
frequency, because the causes are neither so numerous nor severe. The
cut finger of a drunkard, and one of otherwise feeble health, is more
likely to fester, and even mortify, than should the accident befall
a temperate and healthy individual; and the syphilis (or diseases
simulating it) at the present time is less severe than formerly, owing
to greater attention being paid to personal cleanliness, and the
simplicity and earliness of the treatment.

A question worthy of inquiry is, why gonorrhœa and syphilis should be
infectious? _Contagion_ is a word that many medical men would expel
from worldly usage, not believing in its existence; that is to say,
the extension of a fever or epidemic, for instance, is not traceable
to the disease seizing the individual, but to the peculiar aptitude
of the party to become the recipient of it. Consumption is of the
most extensive prevalence; but it only occurs in the delicate—those
peculiarly formed, or rendered apt for it, from the circumstance of
their lungs being hereditarily feebly constructed, or disordered
through inflammation following a cold, and which effects are traceable
to an infraction of some of nature’s laws. Sickly children owe their
condition to their sickly parents, or to their physical mal-education,
or some other positive violation of nature’s regulations; and in like
manner, where the fire rages or the wind blows, the feeblest and least
protected become the earliest victims. Both gonorrhœa and syphilis
furnish a remarkably irritating purulent fluid, which, applied to
delicate surfaces, produces certain effects. Experiments have not
been made to multiply these effects, beyond those incurred by sexual
freedom; and the one of inoculation by the French surgeons, as quoted;
but accident has proved that the eye, for instance, puts on, after
contact with the discharge of gonorrhœa, the same kind of inflammation
as follows its contact in coition with the antagonist generative organs.

The rectum has also been the seat of venereal affection; and instances
have been known of the mouth being also the recipient of disease
communicated by a deposition of the poison. If there be such a thing as
contagion, it certainly exists in the venereal disease; for, although
I admit it (the disease) may occur spontaneously, or be generated by
half a dozen of each of the sexes herding and cohabiting together,
and neglecting the duties of cleanliness, or committing excesses,
those very circumstances imply that the disease can be extended,
notwithstanding a majority of the careful and hardy may escape, after a
risk of the same. The fact of its contagious properties is not upset,
because escape is owing to the non-susceptibility of the parties, and
the caution they exercise to prevent a lodgment of, or contact with,
the poisonous matter.

John Hunter observes, that it is only the developed disease that is
communicable, and for the propagation of venereal affections the
_poisonous secretion_ must be deposited. So confident was he of this,
that he even permitted married men having gonorrhœa to cohabit with
their wives, to save appearances; care being taken first to clear
all the parts of any matter, by syringing the urethra, then making
water, and, _lastly_, washing the glans. Such, however, is my belief
of the rapidity of the formation of the secretion, that, aided by
the excitement of the generative act, the deposite of the same would
necessarily take place with the seminal emission, especially in persons
of full temperament, and in the plenitude of the sexual appetite, and
thereby be liable to communicate the disease.

It is becoming a prevalent fashion to give new names to the several
forms of venereal disease, such as substituting “urethritis,”
“blenorrhagia,” &c., for gonorrhœa; and even to syphilis are added
“tertiary symptoms;” the names quoted being selected to express more
symptoms than the old ones conveyed. I consider that this circumstance
tends to support my opinion—that gonorrhœa and syphilis are not
identical, and that each disease (the former being distinguished by
urethral discharges, and the latter by ulcers and other cutaneous
disfigurements) has innumerable varieties. I hold them both to be
but modifications of inflammation from a poisonous source, and its
consequences common to the structures in which they respectively become
seated, and differing in degree according to the severity of the
attack. Another proof in support of the last assertion is, I think, the
time of the appearance of the particular disease. There is certainly a
more usual time for a clap to manifest itself, such as from the seventh
to the ninth day; but it very often occurs within twenty-four hours
after connexion, and syphilis sometimes as early; and instances occur
where weeks elapse before either of the forms shows itself.

Briefly to recapitulate, I consider, then—1. That the generative organs
have ever been liable to disease from misuse; that the disease is
variable and modifiable by many circumstances, such as have been before
stated—namely, climate, age, constitution, and cause. 2. That it is
contagious; mild cases usually producing mild consequences, but those
depending much upon the treatment and health. 3. Newly-indisposed and
severer cases, establishing a worse form of disease, alike modifiable
by circumstances. I am not prepared to insist that the syphilis of the
present time assumes the aspect as it did with the ancients, any more
than I would affirm that it will be the same centuries hence: but I
contend that all abuses of sexual pleasures will be surely followed by
sexual disturbances, and that the most likely form of ailment is marked
either by discharges or ulceration; that these diseases are simple or
complicated, and all are separate in themselves. There is no fixed
order in which what are called secondary symptoms occur. It may more
usually happen that a sore throat will follow the healing of a bubo,
as swelled testicle is more commonly subsequent to the occurrence of a
gonorrhœal discharge; but in very many cases neither occur, or not in
the succession stated. The anomalies in the disease I shall consider in
describing the symptoms and treatment, when the reader will judge how
far the view herein entertained, as to the origin and character of the
disease, facilitates and simplifies its management and control.

In conclusion of this part of our subject, I may state, that I believe
the form and severity of any syphilitic disease depend more upon the
state of health and other aptitudes of the party receiving, than of the
one communicating the disease.

_Of the Character of the Syphilitic Poison._—“The venereal poison is
only known by the _action_ which follows its application.” It has
been observed, that it is only communicable by deposition; and that
certain parts are essentially prone to its reception: these are the
generative apparatus of both sexes. The poison is conveyed in the form
of a purulent fluid; that of gonorrhœa from inflamed vessels with
corresponding morbid action; that of syphilis, also from a purulent
fluid emanating from the surface of an ulcer. The disease prevails
only in the human race; it is impossible to transfer it to animals of
a lower kind. John Hunter soaked lint in matter from a gonorrhœa and
chancre, and introduced it into the vaginæ of bitches and asses without
producing any effect. The same experiment was tried by interposing
the purulent matter within the prepuce of dogs and male asses, and
also by inoculation, but with no other effect than that of producing a
common sore. The venereal poison attacks the human body in two ways,
locally and constitutionally; the latter by absorption of the poison
secreted by the patient himself. We can only suppose the local form of
the disease to arise from absorption, and so altering the local action
of parts as to produce specific results. The constitutional form is
generally an after-occurrence, although instances are known where it
has not been preceded by any apparent previous form; albeit, no doubt
such _has_ existed without exciting observation. Gonorrhœa shows
itself without abrasion of surface; but syphilis is marked by another
action—an ulceration of the solids whereon it is found.

In Hunter’s Work on the Venereal Disease, there is an interesting
chapter respecting the source of the gonorrhœal secretion, in which
it appears that it is produced from the vessels investing the
mucous membrane of the urethra, by their becoming altered in their
action; and that ulceration is seldom found within the urethra, and
when so discovered, it is not from the gonorrhœal poison; and that
where ulceration occurs, it must be ascribable to an accession of
inflammation of a distinct character. Both gonorrhœa and syphilis
are conditions assumed by the human frame in self-defence, and are
processes set up to cure the previous one; and unless the constitution
be much impaired, the disease gets well. Such impediments, however,
exist in the form of moral and social arrangements, occupation
and variable health, that the end, without assistance, is seldom
accomplished. Gonorrhœa may cease of its own accord; but, according
to the belief of Hunter, syphilis never; and certainly every day’s
experience proves the fact. We see gonorrhœa cured by the most ignorant
persons and by the most empirical measures; but syphilis often defies
the most skilful treatment. The first attack of venereal affections,
especially gonorrhœa, is the most severe; from which it is presumed
that a habit of reconciliation takes place between the disease and the
generative organs; so that after a recurrence or two of the complaint,
the same party may almost bid defiance to a new infection. Yet, if a
man lose the habit obtained by frequent intercourse, through abstinence
from venereal pleasures, he will be very likely to contract the
disease even on the first re-essay, with the very same parties, who
may preserve precisely the same condition of health that formerly was
innocuous to him. Cases innumerable can be adduced in support of this
statement. In the first part of this book, statements have been made,
proving that the difference in the symptoms of gonorrhœa are almost
endless. The same may be anticipated with regard to syphilis.




                            OF SYPHILIS.


SYPHILIS is another and a more violent form of the venereal disease
than gonorrhœa. All its effects and symptoms are divided into two
conditions, _primary_ and _secondary_; the former being those which
arise either from the direct application of the virus or poison to the
part where the ulceration first shows itself, or from the irritative
and specific effects of the poison on the absorbent vessels and glands,
as it is passing through them on its way to the circulation.

Hence, among the first—the primary—may be classed the _ulcer_, or
_chancre_, which in almost every instance is situated on the parts of
generation, and may or may not be followed by a swelling in the glands
of the groin, constituting that form of the complaint called _bubo_.

The secondary symptoms may be defined to be all those effects of the
disease which take place subsequently to, and in consequence of, the
absorption of the poison into the system: comprising sore throat,
cutaneous affections—both eruptions and ulcers, pains in the bones and
joints, and swellings thereon, called _nodes_.

I will first consider the symptoms of primary syphilis—_chancre_ and
_bubo_.

The coverings and linings of the body differ according to their
situation. The former, the integuments become hardened by exposure
and exercise, and preserve their velvety softness where protected by
clothing, and where they are subject to less use—instance the hands,
feet, face, and abdomen. Certain functions are assigned to each. The
covering of the feet takes on a horny hardness, and in like manner
the hands of a laborer assume a glove-like protection. The abdomen,
by being constantly clothed, preserves its soft texture. The lining
membranes of the body have also separate offices to perform—the
_serous_ and _mucous_, as they are called. The _serous_ is a name given
to those lining the cavities; the _mucous_, to those having outlets.
From the glans penis being generally covered by the prepuce, the parts
in contact are called mucous. It differs, however, in sensitiveness,
from the urethra. The entire covering also of the penis is of a very
delicate and tender structure; and hence also, from sexual intercourse,
these parts become the chief seat of syphilis. Gonorrhœa confines its
attacks to mucous membranes, or, in other words, secreting surfaces. In
fact, the matter deposited on the common and exposed skin is harmless;
so also, but to a less degree, is that of syphilis. Gonorrhœa is
frequently seated _on_ and _around_ the glans, and the inner surface
of the prepuce; but more frequently, by a hundred fold, _within_ the
urethra. The delicate surface, then, of the glans and prepuce, losing
some of its sensitiveness by frequent exposure, and losing also the
defence of the secretion which mucous membranes pour out, becomes
accessible to an occurrence of syphilis—a disease that is readily
communicable, by inoculation, to almost any part of the body. To quote
Hunter, he says: “It is an invariable effect, that when any part of an
animal is irritated to a certain degree, it inflames and forms matter,
the intention of which is to remove the irritating cause. This has
been before stated; but it is common only to secreting surfaces; and
when the same cause is applied to non-secreting surfaces, ulceration
is set up. This is not only the case in common irritation, but also in
specific cases, as in syphilis, burns,” &c.

It is somewhat difficult to explain how a chancrous sore is produced.
Surmises are at our service, and those which are founded upon certain
facts are the more likely to be true. For instance, a person receiving
syphilis must contract it from another individual having it. The mere
solitary act of coition will not spontaneously produce it, provided the
party be clean, for that surely is not an excess; but having connexion
with an infected one, and thereby exposing a healthy surface to a
diseased one, becomes an infraction of one of nature’s laws. Well, the
patient contaminating the other must have a chancre, which giving off,
by contact, its morbid secretion, produces a specific result, namely, a
small pimple.

In men, the disease is generally contracted upon the frænum, glans
penis, or prepuce, or upon the common skin of the body of the penis,
but most frequently upon the interior. From the peculiar and alterable
structure of the penis and its prepuce, the poison, unless well washed
off, is apt to lodge in the folds thereof, and sooner or later it
manifests its influence, which may occur in twenty-four hours, or may
be withheld for months. Generally, however, seven or eight or nine
days puts the patient out of suspense. The first symptoms consist in
an itching, succeeded by a redness of the part, out of which is soon
observed to spring up a small elevation or pimple. In connexions where
haste, disproportion of size, or much excitement or excess prevails, an
absolute abrasion of the skin often takes place, and the parts where
such occur are generally the everted portion of the prepuce, or the
frænum of the same.

[Illustration]

[Illustration]

The accompanying drawings represent the extent of the redness and
the first appearance of the pimple. The upper diagram alludes to the
irritation and excoriation around the frænum, and the lower, the
first evidence of a chancre. I am describing the most common form of
chancre, such as is known in the profession as Mr. Hunter’s chancre. A
perceptible hardness next ensues round the pimple, which becomes more
elevated when it ulcerates, or, in other words, the head gets broken
off and a little hollow is left. The tumor (for such it may be called)
is generally of a limited circumference, seldom exceeding the size of
a silver penny, unless in an advanced stage of the disease. When a
chancre attacks the frænum, and undermines it, as it were, the frænum
is often destroyed; and of course, with its destruction, departs its
property of controlling or of directing the orifice of the urethra in
urinating, or in the emission of the semen.

[Illustration]

This drawing exhibits three ulcers: one on the prepuce, another under
the frænum, having eaten its way through, as marked by the black
cross-line, and the third situated on the glans.

When the pimple appears on the outside of the prepuce for instance, it
assumes generally a larger form, and, as the head is broken off, crust
after crust rises up, until the process of ulceration has very far
advanced, or the applications that are generally employed prevent its
re-formation. In the former instance, the crusts are attributable to
evaporation of the discharge; in the latter, their absence is already
explained by the prevention of the same. There is such a thing as
sympathy in eruptive disorders. In skin affections of the corners of
the mouths of children, we often see the inflammation cross from corner
to corner. The same is observable where the attacks comprise the angle
of an eye. So is it with the penis, a structure equally as delicate;
and accordingly the edges of the prepuce often put on a jagged
appearance resembling chaps on hands.

[Illustration]

Witness the above wood-cut. It portrays an ulcer somewhat
diffused on the prepuce, and the ragged edge of the same structure.
The sketch just introduced was taken from a patient perhaps only a
fortnight old with the disease. Being a rackety, dissipated young man,
and regardless of the treatment suggested, a week’s neglect produced
the following alteration:—

[Illustration]

A new ulcer sprung up, the old one increased in size, and the entire
edge of the prepuce became involved in the irritation.

Phymosis and paraphymosis occur in syphilis as they do in gonorrhœa.
The treatment is the same in both. Warm, soothing applications are
indispensable; and occasionally, to prevent adherence between the
glans and prepuce, the scalpel must be had recourse to. I have already
expressed my conviction that the progress of the disease rests as
_much_ or _more_ upon the condition of the party receiving it, than the
specific property of the complaint.

“If the inflammation spreads fast and considerably, it shows a
constitution more disposed to inflammation than natural; if the
pain is great, it shows a strong disposition to irritation. It also
sometimes happens that they begin very early to form sloughs; when this
is the case, they have a strong tendency to mortification. Bleeding
is also a consequence owing to exposure of the ulcered _corpus
cavernosum_.”—_Hunter._

The reader will recollect that it has been stated that chancres, like
the many symptoms of gonorrhœa, differ in their characteristics.
Quoting from authorities, and, as will be further illustrated,
the following may be taken as the summary of the most prominent
appearances:—

The ordinary chancre is characterized by a hollow centre, a hard and
ragged edge, a yellow surface, with a deposite of tenacious matter,
and a red and inflammatory margin. There is also a hardness felt at
its base on taking the part up between the fingers. This has already
been shown; but as illustrations multiply, the possessor of this
publication, especially if he be an invalid, will recognise the
annexed. It exhibits the ordinary chancre on the inner part of the
prepuce, the glans, and the orifice of the urethra—no unfrequent seat
of chancre.

[Illustration]

Many ulcers assume a very indolent form, and remain quiescent for a
long period. One patient I knew, who consulted me for rheumatism, and
who disavowed ever having had syphilis. He took vapor baths, which
assuaged the pain, but did not remove it. Accident discovered to me
the existence of a sore on the penis, by observing the dressings
of the same, carefully placed on the corner of the mantel-piece in
the bath-room. The following was the appearance of the sores. He
had endured them for nearly three months, nor had he perceived much
alteration, either for better or worse. The disease was properly
healed, and he soon got well.

[Illustration]

Another kind is one denominated the superficial, with raised edges.
It is more frequently seated at the upper part of the prepuce, and
creating a thickening of it, ending in phymosis, which lasts a long
time after the cure of the ulcers. This kind of chancre is sometimes
very obstinate, and continues many weeks. The following illustration
portrays its presence near the edge of the _corona glandis_.

[Illustration]

There are two other kinds of sores called the _phagedenic_ and
_sloughing_ ulcers and chancres.

The phagedenic is a corroding ulcer without granulations. It is
also destitute of any surrounding induration, but frequently
its circumference is of a livid red color. When the disease is
injudiciously treated, the whole of the penis will be destroyed in
a very short time. The absence of coloring detracts from a faithful
representation of the kind of sore just alluded to. The drawing is
sketched from Mr. Skey’s work on Syphilis.

[Illustration:
  _a_—The ulcer.]

Another and more confirmed specimen from the same authority is
presented. It represents the _sloughing_ ulcer.

[Illustration:
  _a_—The ulcer on the prepuce.

  _b_—The ulcer on the penis.]

I have witnessed the sloughing, or, in other words, the loss of the
entire top of the glans and prepuce, within half a dozen days. The
subjoined drawing (overleaf) represents a tumefied state of the penis,
ulceration on the glans surrounding the orifice of the urethra,
phymosis of the prepuce, and ulcers in different stages on the outside
thereof. The sketch was taken from Wallace’s work. Such are often
met with. Chancres, as before stated, often become irritable, spread
rapidly, and slough, more particularly in persons of intemperate and
dissipated habits, or when the case has been improperly treated;
and openings into the urethra are formed to a considerable extent,
sometimes to the destruction of the glans, or a portion of the penis.

[Illustration]

The illustrative companion to this paragraph exhibits an ulcer that
has wormed its way through the prepuce, as marked by the black line.

[Illustration]

Warts are often met with, as in gonorrhœa, and, like those, will arise
from simple local irritation, from the accumulation of the natural
secretions, or want of cleanliness. They are hard and soft, and require
different treatment accordingly. They are not contagious; that is,
they do not communicate a venereal affection, but they very readily
produce a similar disease in parts they come in contact with. The story
is here well told by the engraver’s aid.

[Illustration]

It often happens that the ulceration appears checked. A tumor (see next
page) will form, and the surface will look very red and angry—will
even yield a moisture, and finally disappear. I say finally, because
it frequently proves very obstinate, and trespasses upon the patience
and forbearance almost to induce despair. It usually is very irritable,
the itching being most troublesome. The illustration was taken from a
patient who had been an invalid several months.

[Illustration:
  _a_—The tumor.]

After a certain time, varying in proportion to the virulence of the
disease, the poison is conveyed by the numerous absorbents (which run
from the penis) to the glands in the groin, one or more of which become
inflamed and enlarged, producing that well-known swelling, already
alluded to, called _bubo_. Ulcers, too, are sometimes situated within
the urethra, as is seen in the annexed cut.

[Illustration]




                             OF BUBOES.


SURGEONS apply the word bubo to inflamed glands from syphilis, wherever
they happen to be. The body abounds with absorbents, which are small
delicate vessels that form a net-work over the entire surface, and
exist also in every structure. Their purpose is to convey the nutriment
to the circulation. They form _stations_, as it were, or points of
assemblage; and these are generally situated in the angles of the
body—the groin, the armpits, hams, neck, &c.—parts most protected from
injury. When skin inflammation is present, to familiarize the meaning,
the nearest glands sympathize and swell; as, for, instance, who has
escaped a swelling, at one time or other of his life, in the neck,
throat, or armpits? When a sore prevails on the penis, or a gonorrhœa
exists, there most frequently ensues an enlargement of the glands of
the groin. The result of that enlargement depends upon the nature
of the inflammation. In gonorrhœa it is merely temporary, not being
sufficient to provoke suppuration, or the formation and discharge of
matter, or very rarely so; but in the case of venereal ulcers, where
the inflammation is so conveyed, the escape from such consequences is
as seldom.

The mode which nature adopts to transfer the poison is as inexplicable
in its operation as the production of a swelled testicle. Buboes
(herein meant), then, are—or I should say a bubo is—a specific
inflammation of the glands of the groin. It usually occurs on the
same side of the body as the ulcer is situated; but when the ulcer is
seated on or under the frænum, there seems to be no fixed rule which
side shall have the honor. Another peculiarity is, that they more
readily spring up from ulcers on the prepuce than on the glans, and
are more attributable to ulcers than merely inflamed surfaces. They do
occur sometimes without either being apparent. To facilitate the clear
understanding of what we are talking about, a drawing is presented of
the inguinal glands, and the absorbents leading to and from it, which
conveys but an imperfect idea of the number of the absorbents; but it
serves to show the nature of them, and their mode of communication.

[Illustration]

Glands become inflamed from other causes than syphilis; a scratch,
a bruise, or any local irritation, will occasion an enlargement of
the nearest set of glands, or at least one of them. Scrofula is a
specific cause. As the venereal poison carries with it its morbid
nature wherever it happens to be conveyed, the glands become infected
with it; and hence it is the more readily transferred to the system at
large. Very frequently and fortunately the disease terminates _in_ the
glands; that is to say, does not extend to the circulation at large.
The time that intervenes after absorption has taken place, before
bubo manifests itself, is as uncertain as that of chancre appearing
after connexion; but generally the party is safe a fortnight after
the entire disappearance of the chancre. Where it is otherwise, some
trace of irritation on the glans or prepuce is discoverable upon close
investigation, or it will follow great fatigue, venereal excesses, &c.
If the disease extend to the constitution, it rarely affects other
glands than those primarily attacked; and hence it is rare that more
than one gland becomes inflamed. Having given the received notions of
the cause, the symptoms should next be described.

No person can be unaware of the approach of a bubo. There is seldom
much advance of a swelling without pain, which latter may be said to
attract the patient’s attention to the part, when a tumor, possibly the
size only of a horse-bean, is discovered. If the swelling be venereal,
it rapidly increases in size. It is at first moveable, but soon feels
as though firmly fixed. There is next experienced inconvenience in
walking. If the disease proceed to suppuration, a continued throbbing
is felt in the part, which also swells, assumes a diffused redness,
and at last an evident sense of fluctuation is perceived. It may be
ushered in with a shivering fit. The skin becomes thin and tender, and
a conical point protrudes, which, unless punctured, bursts and emits
its contents. It is astonishing what immense destruction of parts takes
place in large buboes. The theory how solids become converted into
fluids—how muscle, fat, and cellular membrane, become absorbed, and
a thick purulent secretion deposited, is fitter for a work addressed
exclusively to medical men than to the public; and it therefore must
suffice that such happen, and few persons are ignorant of the fact; but
the _modus operandi_ may at best be but the subject of conjecture.

The artist’s graver has pencilled a faithful picture (see next page)
of the appearance of the disease in question. On the right side is
represented a bubo that has broken, or discharged its contents, and
which is in a state of healing; on the left side a bubo ready to burst;
and, by way of economising space, the left testicle is exhibited in a
state of varicocele, by no means an unfrequent accompaniment to the
previously narrated condition, but at the same time by no means a
necessary attendant, it being a totally distinct affection. Buboes
present more varieties in their size, and duration, and consequences,
than they do on their initiation. Cases in corroboration will be found
in their proper place.

[Illustration]




               ON LUES VENEREA, OR SECONDARY SYMPTOMS.


SECONDARY symptoms are those changes which occur in consequence of the
admission of the venereal poison into the system, or common circulation
at large. The introduction to the disease of bubo explains the mode
of inlet. Like gonorrhœa and primary syphilis, it is often a very
complicated complaint. Secondary symptoms are admitted to occur without
being preceded by any primary form, as, for instance, by immediate
absorption unattended with the irritation which accompanies chancre, or
attendant upon bubo; but where one secondary affection arises without
the primary, at least many hundred arise subsequent to it; and unless,
in the latter instance, treatment, and vigilant too, is adopted, not
one in a hundred escapes them.

_Lues venerea_ (a synonymous term with syphilis) is supposed to be
imbibed from a very sensitive glans penis, a simple abrasion of the
skin of that organ, an ordinary ulcer, or it may be transferred by
inoculation. The late John Hunter is certainly the most eminent
authority—the _vade mecum_ of professional men. In these matters he
was a man of indefatigable perseverance and untiring observation. Few
new lights have been thrown on syphilis since his time, except on the
treatment, which has become wonderfully simplified.

In thus again adverting to Mr. Hunter’s name, it is chiefly to
observe, that the basis of my own thoughts and practice has been built
upon his writings; and therefore, in being thus explicit in describing
syphilis and its multitudinous varieties, the reader is assured
that what is here written is, at all events, well founded, and not
compounded of the many new adventurising propositions of the day. Mr.
Hunter considered that contamination took place about the beginning
of the local complaints; that no person was safe from lues while the
original sore was present, and not under treatment; but that, if the
seeds of lues were not already implanted in the constitution, the
consequences might be averted by treatment. Children are born infected
with lues, which they derive from their parents; for instance, a man
laboring under secondary, or primary symptoms, cohabits with a healthy
female, the female _may_ escape both diseases, but the child may
inherit them.

Instances have been known of children so infected, conveying the
disease to the wet nurse, to whose care they may be removed; and,
like other infectious disorders, the complaint may be diffused _ad
infinitum_. There is an impression abroad, that, like consumption,
healthy persons are obnoxious to the breath and perspiration of the
afflicted; but, as in many other conjectures, corroboration is wanted
to prove the fact.

Syphilis is divided into primary and secondary; but modern pathologists
add a third stage, called tertiary symptoms. Hunter used to divide lues
into two orders; the first was the most frequent form of the complaint,
after chancre and bubo; the second, the remaining symptoms. The
former consisted of the affections of the skin, throat, nose, mouth,
and tongue; the latter, the bones and their coverings, called the
periosteum and the fasciæ of muscles, as explained in the preliminary
part of this publication. Lues does not always exhibit itself according
to this arrangement; which circumstance explains that the occurrence
is more owing to conditions of health, and peculiar tendencies of
the structures involved to receive the contamination, than to any
properties of the animal poison.

He considers, also, that the development of the disease depends much
upon the state of weather, and the care the patient may bestow upon
himself; cold being a formidable predisposer to the extension of
secondary symptoms, and that the parts least protected are generally
the first to become diseased. Hence the throat usually exhibits a
morbid action before the skin, furthermore, upon the cure of the more
superficial parts of the body; and, therefore, suddenly suspending
treatment, the symptoms manifest themselves in the deeper seated. The
deduction from this statement is, a necessity for especial care in the
clothing of the body, and the continuance of the treatment some little
while after all external evidences of the complaint have disappeared.

Mr. Hunter considered that the disease may be engrafted in the
constitution, and remain dormant for a considerable period, through
the parts not being brought into action by any of the aforementioned
causes. Ordinary illness, simple fever, excess, fatigue, and a host
of other occasions, may excite a particular structure into a morbid
condition, when the hitherto dormant disease will sprout out. His
arguments are supported by numerous cases wherein _several years_
elapsed between the primary and secondary symptoms, although no new
infection was contracted in the intermediate time.

Mercury was Mr. Hunter’s sheet-anchor; his faith in it was to the
effect that it would cure every stage of the disease, but that one
course of it, although it might cure chancre, would not prevent
secondary symptoms. They might not occur, because the poison may not
have been carried into the circulation; and in like manner the second
stage of the disease need not be followed by a third. But he considered
that, when the several forms of the disease betrayed themselves, their
origin must be traced to a general contamination of the system at the
same time.




             OF THE SYMPTOMS OF THE FIRST STAGE OF LUES.


SIX weeks is the time usually allowed to elapse between primary and
secondary symptoms; but it is not invariably the case, instances
having occurred where the disease has embraced, and most severely,
both stages in a fortnight, and others between which a much longer
time has existed. The first symptoms of lues consist either of a sore
throat or a spotted skin. When the skin is the seat, a red spot, not
unlike a flea-bite, is perceived; the color soon dies into a brownish
or copper-colored hue. Occasionally, at the outset, a small pimple is
observed, which breaks and scurfs; the coppery-colored spot next feels
rough, and a kind of scurf will exude that after a few days falls off
to make way for more. The disease being more usually slow than rapid
in its progress, weeks may be consumed before ulceration occurs, and
merely a discoloration of the skin is seen in spots seldom exceeding
the size of a sixpenny or fourpenny piece. Some of these spots will
nearly disappear, leaving a faint scar, and new ones will spring up.
The entire body may be covered with them, but usually those parts
nearer the centre of circulation generally possess the most—such as the
chest, neck, shoulders, arms, wrists, hands, and head. As the disease
progresses, the scurf on the spots accumulates, falls off, re-forms,
getting thicker each time, when upon being detached, for they cling now
more closely, a sore and moist state of the skin is observable. This
may be covered with a new crust, or may at once proceed to suppuration.

When an ulcer is formed, it will sometimes spread rapidly, and embrace
a patch the size of a crown-piece, when the process of ulceration will
assume the vigor of disease.

[Illustration]

The accompanying sketch portrays, perhaps, more the seat of the disease
when attacking the upper part of the body, than the appearance; for
to give a true portraiture, the drawing should be the size of life,
and colored after nature. It is, however, I doubt not, sufficient to
exemplify the site of the disorder. The eruption is smaller on the
face, and less vicious, generally, than on the body; but it proves most
unsightly, and indicates great advancement of the disease. The legs
(see next page), and those parts of the skin least vascular, assume a
mottled appearance resembling recent bruises; at other times, clusters
of spots like grapes hanging together.

The shoulders, arms, and wrists, also present a somewhat similar
appearance; though perhaps not to the same extent, owing to being more
warmly clad, and less in exercise, than the lower extremity.

When the disease extends to the hands, it is marked by exfoliations of
the palm, with occasional deep cracks that cause much pain. Nor are the
fingers and nails exempt from this encroaching malady, which, during
its occupation, shows itself by a redness under the nail, that at last
ends in the destruction of the nail.

[Illustration]

[Illustration]

[Illustration]

The head, also, is a frequent seat of the disorder. It is generally
discovered by running the hands through the hair, when a little crust
will be detected by the fingers, or a slight itching will show its
position, or the brush may break it off. The top and hind parts of the
head are generally the situations selected. Occasionally the hair will
fall off, leaving spots of a smooth baldness.

[Illustration]

The vital organs, fortunately, are never subject to syphilitic
inflammation—such as the brain, the viscera of the chest, and abdomen;
nor is even the mucous membrane of the interior of the body affected,
its power being confined solely to those parts or structures subject to
the influence of external causes.

When the venereal virus attacks the throat or palate, the membrane
of the roof of the mouth becomes red and inflamed, patches ulcerate,
and, if not cured, sooner or later expose the bony palate, which may
be felt by the probe. This is the first stage. The exposed bone next
exfoliates, and a communication is thereby formed between the mouth and
nose, the fluids return through it, the voice is changed into a nasal
twang, and a most offensive discharge is secreted.

[Illustration]

This drawing represents ulceration of the tonsils, uvula, and arch of
the palate; also the edges of the tongue. The drawing, p. 102, shows
the under surface of the tongue, the inner part of the lower lip, and
the lower gums affected with venereal ulcers.

When the tonsils are attacked, ulcers appear, precisely similar in
character to chancres, hollow in the centre, with raised ragged edges,
yellow on the surface, with a livid color on the surrounding margin.
A sense of dryness is perceived, extending up the eustachian tube to
the ear. Sometimes the tongue, gums, and inner part of the lips, are
attacked (see representation).

[Illustration]

In the progress of the disease, the pharynx, or top of the gullet, is
brought under its influence, and the ulceration spreads through it to
the vertebræ or back-bone. Extending its course, it next attacks the
larynx, or top of the windpipe, when, if not arrested, it will soon
destroy life. Attending this affection of the larynx, there is always
loss of voice—the patient speaks in a low whisper. It is more fatal
than any other form of the venereal disease.

The mucous membrane of the nose stands next in order, as subject to the
influence of syphilis. The patient’s attention is first directed to it
by an incrustation which forms in the nostril. On this being removed, a
quantity of blood, mixed with purulent matter, is discharged. In two or
three days, similar incrustations are formed, and under them ulceration
takes place, which frequently lays bare the bone, and occasions it to
exfoliate; and this exfoliating often continues after the venereal
action has ceased. The number of bones which come away is often very
considerable, and horrible deformity is the result.

The periosteum and bones become in their turn affected by swellings
called nodes—the periosteum first, and the bones subsequently.
Of these, the cylindrical, being most exposed to vicissitudes of
temperature, are commonly the first attacked. Those which are much
covered by muscle are rarely affected, as, for instance, the back
part of the _tibia_, or large bone of the leg, while nothing is more
common than to see nodes on its anterior part, which is only covered
with skin and periosteum. They occur on the _fibula_ only when it is
slightly covered, and only on the _ulna_, or elbow-bone, when similarly
circumstanced. Nodes on the _os humeri_, or shoulder-bone, except
on the outer side, are of very rare occurrence, but are frequently
found on the _clavicle_, or collar-bone, at its scapular and sternal
articulations.

In the following wood-cut is an illustration of the most frequent
situation of nodes on the forepart of the tibia, or chief bone of
the leg. The swelling is considerable; the upper one proceeding to
suppuration, and the lower indicating merely a tumefaction of the lower
part of the bone, near the instep.

[Illustration]

The symptoms which mark the disease are as follow: The patient
experiences in the evening a sensation of pain in the bone which is
afterward the seat of the node. In the course of a few days, a swelling
appears in the evening, which disappears again on the following
morning. It is excessively painful and tender at night, but in the
morning it is hardly perceptible, and the tenderness is almost gone.
At this particular period the periosteum is only affected; but when
the inflammation has continued some time longer, the bone is diseased
and becomes enlarged. The rationale is this: An inflammation of the
periosteum ensues. In a short time a deposite takes place between it
and the surface of the bone. This deposite, in the first instance, is
only a serous fluid, but a cartilaginous substance is soon secreted,
which is gradually converted into bone.

When attended to early, their treatment is very simple; but
occasionally cases of considerable difficulty will arise.

Large quantities of fluid will be found fluctuating between the
periosteum and the bone, which, when unaccompanied by redness and
inflammation of the skin, may be absorbed by proper treatment, but
which more usually is only curable by evacuation; and, unless great
care be used, exfoliation of the bone will ensue to a very great, and
sometimes fatal extent. The eyebrows, forehead, and temples, are often
the seat of fluid tumors varying from the size of peas and beans. Their
cure must be effected by absorption, or destruction of the bone is
often produced.

The flat bones are also subject to syphilis. The one most commonly
attacked is the _os frontis_, the symptoms being just the same as those
on the skin. The side bones of the head now and then are affected; the
os _occipitis_, or back-bone of the head, very rarely; and the _os
temporis_, or temporal bone, being well covered with muscles, and
exposed to very little change of temperature, is never affected.

The _os frontis_, being the most exposed, is the most frequently
attacked. Suppuration sometimes takes place; and when this has occurred
on the front, it has happened that the same suppurative process has
occurred interiorly between the _dura mater_, or the external membrane
of the brain, and the internal surface of the bone. The matter presses
upon the brain, and death is the consequence, if the pressure be not
removed by the use of the trephine or trepanning instrument. This is a
degree of severity to which the disease rarely reaches now-a-days, from
the more extended knowledge and improved treatment of modern times.

It must be observed, generally, of both these diseases—that of the
throat and nose, and this of the bones—that they are oftener the result
of improper treatment, such as the excessive use of mercury, and
exposure to great vicissitudes of weather while under its influence,
inducing what is called the mercurial disease (which in fact is, or
was, of more frequent occurrence than the constitutional syphilitic
one), than the result of the natural tendency of the disease in an
otherwise healthy individual.

_On the treatment of Syphilis._—I consider it a fair presumption that
any invalided reader, except he be an accidental one, of this book—by
which I mean one, not having _sought_ its possession—must be acquainted
with the association of _mercury_ and _syphilis_. If not, let him
be told for the first time, that such association exists as between
copaiba and gonorrhœa; or perhaps what may be rendered more familiar
to him, namely, as between _quinine_ with _ague_, or _colchicum_ with
_rheumatism_. That for upward of three hundred years past mercury has
been held an antidote to venereal affections; and still is, in many
forms of the same, acknowledged indispensable for their removal.

From old notions afloat, that syphilitic patients to be cured must be
salivated to the extent of furnishing or filling two or three wash-hand
basins daily with saliva—that the teeth drop out, that the breath
becomes horribly fetid, and that the consumer of the poison sacrifices
one third of his probable existence, even though he get well—the
greatest possible prejudice exists against mercury, and the generality
of uninformed patients have acquired a most uncompromising dread of the
remedy. From the frequent difficulty in getting patients to submit
knowingly to mercurial treatment, many new means have been caught up,
and some judiciously applied.

This new method has its advantages; but it does not realize all that is
promised. It consists in advising rest, cleanliness, simple soothing
applications, and, on the other hand, mild astringent ones, a temperate
diet, fresh air, an easy mind, sarsaparilla, and other alterative
medicines. There are many believers in the efficacy of simplicity; and
the success that follows such treatment of nine tenths of the ailments
of humanity, bears out the usefulness of the preceding methods; but the
remaining tithe have alike a claim upon our consideration, and of this
tithe the syphilitic invalids form a large portion.

The anti-mercurial advocates have, however, a salvo, and admit now
and then, an exception to exist, that particular cases _do_ require a
mercurial course, but then it should only be adopted in its mildest
possible form, merely with a view to act on the general health, rather
than for any specific property of its own. Again, there are books,
which are very elaborate, and what is equally important, modern ones,
written by talented men,[4] which still profess faith in the curative
powers of mercury, and employ it as the chief agent in the cure of the
venereal disease. Instead of administering it to the same extent as
formerly—instead of attempting to produce salivation to the flow of
quarts—they merely aim at producing an impression on the constitution;
they are satisfied with a proof that their patient is under mercurial
influence: this is ascertained by a coppery taste in the mouth, a
slightly increased secretion of saliva, and the presence of the
accompanying, but temporary depression.

Now the question to be resolved is, which of the two methods is the
correct one. The many forms of disease of the sexual structures satisfy
me, that their treatment should be modified by circumstances; but I
believe I am wise enough to know, and certainly old enough to have
observed, that the severer forms of syphilis, and even the milder in
some constitutions, require the aid of mercury for their cure; in fact,
_will yield to no other plan of treatment_, thereby admitting the
_specific virtues_ of the remedy.

The principles, therefore, which I advocate in the treatment of
syphilis, are precisely those I depend upon in gonorrhœa, or, to
familiarize the analogy, in a fit of indigestion, or an attack of local
or general inflammation. Where the health is disturbed, the first
step is to attempt restoration. The fact is almost too familiar to
every one to need repetition, that, as is the condition of the health,
so is the resistance it is capable of opposing to disease. The next
proceeding is, to attempt the subdual of the prevailing symptoms.
Syphilis, whether in the form of chancre, bubo, or any of its secondary
varieties, induces more or less fever, inflammation, and interruption
to the important offices of digestion, and other vital processes, which
consequently require the promptest attention. Equally various are the
local indications of syphilis—the ulcers may be common, superficial,
phagedenic, or sloughing, each requiring various treatment, as
hereafter will be specified; but, above all, too much reliance can
not be placed on the dietetic and physical regimen—two comprehensive
significations, which are, after all, the Alpha and Omega of the
Materia Medica. With this declaration, I pass on to the treatment
in detail of the more frequent and, I may add, leading features of
syphilis.

_Treatment of Chancre._—_Preliminary remarks._—Chancres are of various
kinds. The most remarkable are:—

1st. That characterized by its circular form, its excavated surface
covered by a layer of tenacious and adherent matter, and its hard
cartilaginous base and margin.

2d. Another form of chancre, unaccompanied by induration, but with a
very high margin, appearing often on the outside of the prepuce, and
seldom existing alone, called, from the preceding description, the
“superficial chancre, with raised edges.” These kinds of ulcers are
sometimes very tedious, neither getting better nor worse, but resisting
every plan of treatment for their removal. I have known instances where
they have existed for several months.

3d. The phagedenic chancre, a “corroding ulcer without granulations,”
and distinguished by its circumference being of a livid red color. This
is the kind of chancre that is invariably rendered worse by mercury:
indeed, cases have occurred where, from the injudicious administration
of that medicine, the whole of the penis has been destroyed.

4th. A most formidable kind of chancre, denominated the sloughing
ulcer. It first appears as a black spot, which spreads and becomes
detached, leaving a deepened and unhealthy looking surface. The sore is
very painful, and encircled with a dark purple areola. If neglected, or
improperly treated, the process of mortification goes on until all the
parts of generation are destroyed.

The last-named chancre is more often the consequence of neglect on the
part of the patient, than the natural progress of the disease.

Now the usual method adopted by surgeons to remove chancres, has been
to excise them, or to apply caustic; the latter is the plan I adopt,
and would recommend; but all chancres are not to be treated alike, some
requiring antiphlogistic remedies, others soothing, others stimulant.
Some practitioners rely entirely upon constitutional remedies.

On the first appearance of a chancre, I would enjoin an alteration
in the diet, regulating it according to the strength of the patient.
Abstemiousness should be the motto, avoiding extremes, however, lest
debility should be induced. Quietude and rest, in the recumbent
position, are two essential adjuncts in the treatment of primary
syphilis throughout.

With respect to the treatment of the ulcer, characterized by its
circular form, excavated surface, and hardened base, as detailed, the
plan I almost invariably adopt is, immediately on its appearance, at
least as soon as the pimple has broken or desquamated, to smear it with
a hair pencil filled with the solution of caustic, sometimes twice, at
least once a day (see Form 27), and to keep it frequently washed in the
daytime with a lotion of the chloride of soda (see Form 28), or the
black, red, or blue wash (see Forms 29, 30, 31).

If the patient be strong, and otherwise in good health, I simply
recommend a dose of purgative medicine, in anticipation of any
irritation that may arise. After which, I suggest a middle diet to be
adopted for the next few days. From the sedative and salutary effects
of the warm bath, I recommend its employment immediately after the
operation of the medicine, and its repetition at frequent intervals.
Independently of its effect on the system, it is the best general
cleanser that can be resorted to. The subsequent treatment is regulated
by the result of the above, which can be ascertained about the third
day.

In numberless instances, and where the disease is thus early detected
and similarly treated, the mere continuance of either the chloride
lotion, or black wash, the middle diet, an occasional aperient, the
bath, with as much rest as possible, are all that will be found
needful to cure the disease, which generally is effected in about a
week or ten days at farthest. From the universal dread that so sudden
a disappearance of the sore occasions, lest it should “be driven into
the system,” and from the apprehension that it is incurable without
taking mercury, I verily believe that, in many cases, the practitioner,
participating in the fears of his patient, and anxious to allay them,
reluctantly administers that mineral; and to such weak judgment may
be traced the relapses, or the occurrence of other symptoms sometimes
mistaken for secondary. Even when the case terminates favorably, and
within the space of time alluded to, I would not be considered as
recommending a sudden return to free living; on the contrary, I would
not release the patient from the restrictions imposed upon his diet,
exercise, and regimen, for at least the same time as was occupied
in the cure, nor would I predict that, in every instance, secondary
symptoms should not ensue. Mercury was supposed to possess some
antisyphilitic property, inasmuch that, when chancre healed during
its exhibition, secondary symptoms were averted. Facts, however, have
been wanting to corroborate that supposition; for secondary symptoms
have appeared despite the external and internal employment of mercury,
even to the extent of salivation. Authors there are who attach similar
properties to other medicines, such as nitric acid, sarsaparilla, and
such like. Now, how do these medicines act upon the system? Or what is
their tendency of action? Why, by increasing some particular function,
such as the secretive process of the salivary and other glands; by
increasing perspiration or absorption, &c. The remedies whereby these
changes are induced are termed alteratives. I am not going to deny
that these, or some such changes in the system, are unessential for
the eradication, particularly of morbid conditions of structure and
function, dependent probably upon altered condition and diminished
action in others. On the contrary, they are the only antagonists to
disease which we possess.

But what I contend is, that, in our selection, we should prefer those
which produce most speedily and effectively the desired change,
with the least detriment to the general health. And to this end, I
invariably enjoin, where practicable, warm or vapor bathing. I have
elsewhere considered this subject at length, to which I refer the
reader; but I will fearlessly assert that no one, or any plan of
treatment, will be found so effectual toward increasing physical power
to repel disease, or so permanently preservative of health, as the
modified employment of the warm or vapor bath; and, therefore, in all
cases of doubt and apprehension, or independent of either, the use of
the warm or tepid, plain, or salt-water bath, two or three times a week
for a month, or the vapor bath about every fourth or fifth day for
the same period, is the best preventive that can be adopted to avert
secondary symptoms. Where bathing of every kind is impracticable, as
is the case in some country places, and the same necessity exists, I
advocate the administration of alterative medicines; nor do I object
to the employment of mercury, where, under other circumstances,
without reference to its imaginary efficacy in syphilis, it would be
prescribed. But of this as we proceed.

Where, at the expiration of a week, the chancre neither recedes nor
advances, and is the only symptom present, it is to be presumed that
the condition of the patient’s health has something to do with it,
and that condition should be minutely inquired into. There may be
diminished or increased appetite, with imperfect digestion; there may
be fever, with restlessness at night; there may be torpor or irritation
of the bowels; or the patient may consider his only ailment to be
the chancre, the irritation of which may be found to arise from too
active exertion. To whichever cause it may be ascribed, the treatment
should be directed. In conjunction with local remedies, which may be
varied, alteratives may be given—five grains of the blue pill twice
a day; for instance, the Plummer’s pill in doses of five grains
every night, the occasional application of an active aperient (see
Forms 33, 34), the decoction of sarsaparilla (see Forms 49, 50, 51).
This plan, carefully pursued, seldom fails in setting up a permanent
cure. The patient should be apprized of the vast importance of quiet,
rest, and abstemiousness; for, where they can be attended to, the
duration of the disease will be diminished one half; whereas, he who
is continually in the erect posture, and subject to much walking
about, who is indifferent to his diet, and lives as free as formerly,
incurs the risk of bubo, and all its alarming consequences. Now, in
no case or description of chancre, do these remarks apply so aptly as
to the phagedenic and sloughing ulcer; in fact, they are applicable
to all, but more particularly the two latter, as they are the result
of already increased action. Mercury, violent aperients, and other
active remedies, should also be avoided in these two forms of chancre;
the local appliances should be poultices of bread and water, linseed
meal, and a solution of opium, or poppy water; the sloughs or mortified
portions we should endeavor to detach, by the application of a _smear_
of nitric acid, or the chloride lotion (Form 28), or stimulative
ointment (Form 38). The superficial sore usually gets well by the same
means as the ordinary chancre.

Where the chancre is situated under the prepuce, and the latter
covering is so inflamed and swollen as to prevent its being drawn back
to exhibit the sore, the discharge should be carefully washed out by
any of the lotions already recommended, by means of a syringe, several
times in the twenty-four hours. Much good is often done by varying the
local remedies, occasionally flouring or filling up the ulcer with
calomel, tutty powder, blue ointment, or in fact any substance which
alters the morbid action of the part; but, as a general rule, the
lotions of soda, lime, zinc, or oxymuriate of mercury, will be found
sufficient, if persevered in.

_Treatment of Bubo._—Bubo I have already stated to be an inflamed and
enlarged condition of the inguinal (as its name implies, signifying
the groin), or, in fact, any other gland, occasioned by the passage of
the venereal poison from the adjacent ulcer through it, preparatory
to its contaminating the constitution. But it is as well to know that
the system may become affected, or, in other words, the poison may
pass through the glands without involving them in the disease, or that
the poison may there stop, and be expelled as the bubo is cured. It
is also observed, that buboes are more frequently consequent upon an
ulcer seated on the prepuce than on the glans. Buboes are not always,
however, a sure criterion of the venereal disease, for they will occur
wherever irritation is superficial and adjacent. Leeches applied to the
temples will affect the cervical glands, a graze or wound in the leg
enlarge the inguinal, and a whitlow on the finger, or any inflammation
of the hand or arm, will very often irritate the glands in the axilla.
In gonorrhœa, the glands in the groin become swollen and painful,
from sympathizing with the sensibility of the urethra; but these and
the preceding may, in general, be distinguished from true venereal
buboes by their disinclination to proceed to suppuration; whereas, in
syphilis, that process runs through its several stages with remarkable
celerity, unless timely prevented. Buboes in the groin are much more
troublesome, and more likely to betray the disease, than chancres,
because they constitute an augmentation to the patient’s suffering,
seldom occurring, unless preceded by a chancre, and because they
occasion a visible and necessary lameness. They also produce more
general disturbance of the patient’s health.

In the treatment of a bubo, venereal or not, the same principles
recommended in the section devoted to the cure of chancre, should be
followed in this instance—comprising attention to the general health,
and a subdual of the prevailing symptoms.

In no form of syphilis is rest more essential than in bubo. The patient
will be apt to plead the necessity of following his business, and the
utter impossibility of staying at home; that is his affair, mine is
only to protest against exercise, and urge the importance of rest, and
even the recumbent posture, and I can assure him, _that_ alone will
strip the disease of three fourths of its terrors.

Certain local diseases produce more constitutional disturbance than
others—among them may be classed buboes; it would, therefore, be
as impolitic suddenly and violently to repel an inflammation of a
gland or glands, without establishing some outlet for the increased
action to vent itself, as it would be to check a flux or suppress an
exanthematous eruption, like measles or scarlatina.

If the bubo is, therefore, painful and inflamed, my advice is as
follows: Stay at home, and rest; descend to middle diet; take some
aperient; and should chancres alone be present, and a treatment
going on for their extinction, continue the same; or, as bubo often
immediately succeeds the ulcer, and probably may be the first symptom
noticed, adopt, in addition to that recommended above the treatment as
advised for chancre, namely, the administration of some alterative—for
instance, five grains of blue pill every night—or the Plummer’s pill
every night—the aperient powder every other day; and let the local
treatment be directed to remove the prevailing symptom, to subdue
the inflammation, and, if possible, thereby prevent suppuration. It
was formerly supposed that, unless buboes were allowed to suppurate,
the system could not escape the venereal taint. Lower somewhat the
vital powers, or, what may be more intelligible, diminish the general
inflammatory action, establish some slight drain, by determining the
secretions to the intestines or skin: and buboes, even when matter
has absolutely formed, may be fearlessly absorbed, which judicious
treatment will effect, in nine cases out of ten, without at all
impregnating the constitution. To attain this object, warm fomentations
constantly applied, and if possible the warm (hip or full length) bath
every night. When rest is determined upon, if the swelling is great,
red, and painful, leeches are eminently serviceable, but they must be
applied in numbers of at least a dozen at a time, and repeated twice
or thrice if necessary. Three or four, by the irritation of the bites
when healing, and especially if the patient will not or can not remain
quiet, only worry and aggravate the disease. Where the inflammatory
symptoms are great, where there is fever and much heat of skin,
bleeding is the speediest and most effectual plan to subdue them; and,
in my opinion, it is to be preferred before the trouble and bother of
leeches. Where, however, there is no remarkable excitement, local or
universal, the topical application of any of the ointments suggested
will often promote absorption (see Forms 35, 36, 37).

Blisters applied over the bubo, very often disperse the swelling.
Pressure also, made by means of a pad covered with tin foil (as seen in
the subjoined cut), and continued for several days, frequently urges
the absorption of the accumulated deposition in the gland.

[Illustration]

Where _bubo_ has been suffered to proceed, and the suppuration appears
inevitable, it would be highly improper to retard it: poultices and
warm fomentations should be applied, and when fit, an opening should
be made to permit the exit from, and prevent the extension of, the
matter in the surrounding cellular membrane; the operation should not,
however, be prematurely performed; the skin should be permitted to
become thin before an opening is made, and that opening should be made
in the most dependent position, in order to allow complete escape of
the matter, lest fistulæ and sinuses should form. When an abscess is
thus established, its healing must be promoted with all expedition,
and care taken to preserve the strength of the patient. For the former
purpose, poultices, mild healing ointments, or strapping plaster
applied near the edges of the wound, should be used. Poultices may be
applied with a bandage, as seen in the subjoined cut.

[Illustration]

When the abscess appears indolent and not disposed to heal, carrot
and linseed-meal poultices may be substituted. Astringent ointments
should also be employed (see Forms 38, 39, 40), or lotions (see Forms
41, 42), and the topical application of caustic to the edges of the
wounds, or even paring them with a scalpel. The occasional use of the
warm or vapor bath will give a healthy tone to the frame, invigorate
the depressed powers, and promote recovery. The strength should be
supported by more generous diet, and any of the formulæ comprised under
the head of tonics, may be taken internally (see Forms 43, 44, 45, 46,
47, 48). As the patient becomes convalescent, change of air, gradual
exercise, the cold shower bath, or sea bathing, will be of essential
service.

_Treatment of secondary symptoms._—Secondary symptoms usually appear
from the sixth to the sixteenth week, but are not unfrequently
protracted beyond that period; they are commonly ushered in with
fever—a general sense of being ill—a quickened pulse, headache, loss
of appetite, pains in various parts of the body, and restlessness at
night; in short, there is disturbance of all the vital functions,
until it is determined which structures are to be the retreat of the
common enemy. Some authors assign the skin and throat as more liable
to attack than others; but I think the distinction dependant mainly
upon the natural or morbid idiosyncrasy of the invalid. At all events,
the inquiry here would be foreign to the design of this work, and less
useful than the advice, how best to combat the evils when and wherever
they occur. I have already stated secondary symptoms to consist of
eruptions, ulcerations, and disfigurations of the skin, ulcerations
of the mucous membranes of the mouth, throat, and nose, pains in the
joints, swellings of the bones and their coverings, and inflammation of
the various fibrous textures of the body.

_Treatment of syphilitic eruptions._—The cutaneous eruptions of
syphilis present considerable varieties, assuming a scaly, papular,
tubercular, or pustular appearance. Formerly it was the opinion that no
eruption was _venereal_, unless characterized by a scurfy exfoliation,
and teinted of a copper color. This _test_ is not now relied on. In
the simpler forms, we find that the skin becomes mottled at first,
which appearance may partially die away and reappear, deeper in color,
and the spots become more numerous in extent. The patient should be
apprized that, when the disease has progressed thus far, it is not in
its nature to depart unbidden; but it advances usually from bad to
worse.

The mottled dots enlarge, exfoliate, or scurf, or desquamate, as it
is called, leaving the subjacent circle thicker and thicker, and
of the same color as the cuticle which peels off. In the ordinary
uninterrupted progression, scabs form, suppurate, and constitute
an ulcer, like a chancre, which ulcer assumes all the varieties of
chancre. In other cases, the eruption, instead of being scaly, “has a
raised surface, from which a whitish matter usually oozes.”

[Illustration]

The scaly copper-colored eruption, denominated, according to its
severity and appearance, syphilitic lepra or psoriasis, is regarded as
most characteristic of true syphilis, and is the most frequent. The
annexed is a drawing copied from nature; it is alluded to a few pages
further on: its pattern is frequently to be met with. A celebrated
writer, Mr. Carmichael, attaches considerable importance to the
character and appearance of the eruptions. He divides the venereal
disease into four species or varieties: 1st, the scaly venereal
disease, which he considers consequent upon the ordinary chancre;
2d, the papular, consequent upon gonorrhœal ulceration; 3d, the
tubercular; and 4th, the pustular, he names from its appearance. These
distinctions, if correct, must be more interesting to the surgeon,
than serviceable to the patient, for the principles of treatment must
be alike in all. Now, although mercury may be denied to possess any
specific influence over the syphilitic poison, either by its chemical
action or neutralizing power, except as a counter-irritant to the
system, yet the inability of nature to shake off the pestilential
hydra, unassisted by the weapons of the physician, is most apparent;
and the most powerful of which is, that class of medicines called
alteratives, none of which are more deserving, none more manageable, if
the least judgment be displayed, than mercury.

The constitution, when under the influence of syphilitic poison, is
being led like a willing horse to its own destruction; and unless
the system be entirely revolutionized, that event is not likely to
be retarded. Here mercury[5] may lend its powerful aid, and may
be carried even so far as to produce mild ptyalism or salivation.
But there are instances where mercury is inadmissible. The patient,
however, need not despair; extensive resources are still open for
him—the preparations of antimony,[6] the mineral acids, sarsaparilla
(Forms 49, 50, 51), iodine (Form 52), and a host of others may be
resorted to; and last, though not least in importance, is the medicated
vapor and fumigating bath. From my connexion with an establishment of
that kind, my disinterestedness might be questioned in advising the
employment of bathing. As well might the apothecary who deals in his
own drugs, or the tradesman who vends his own wares, be suspected of
disingenuousness; the reply I would offer should be, that the reader
or invalid need not pin his faith on my assertion, unless it so please
him; or if he does, may the onus lie at my door. But for his sake, and
to bear out my own assertion, I offer this declaration, that, for the
last twenty years, in conducting my establishment (wherein more cases
of syphilitic eruption have presented themselves, than probably have
fallen under the notice of any other medical man in London within the
same period), no case, of which I have had the management, has failed
of being cured.

Where syphilitic eruptions terminate in ulceration, the same
local treatment should be used as advised for chancres. Among
the prescriptions will be found formulæ for many useful topical
applications, such as ointments, lotions, and fumigations, for all
the external developments of syphilitic disease, with appropriate
observations appended to each.

_Treatment of syphilitic sore throat._—It has already been mentioned,
that the order of appearance of secondary symptoms depends more upon
the modified state of health than any fixed law of disease. Syphilitic
sore throat may precede or follow the cutaneous eruptions; and it not
unfrequently happens, that all forms of the disease are present at the
same time: therefore, although they are here separately considered, it
will be found that the treatment corresponds nearly in all, the only
difference being in the local applications.

_Syphilitic sore throat_ consists of ulcerations of the _fauces_,
_tonsils_, and _soft palate_. The inflammation begins in the part
affected. There is a redness, and sensation of dryness. A small white
spot is perceptible, which rapidly spreads, is detached, reappears,
and in four-and-twenty hours, if seated on the tonsils, a cavity, as
if a portion of them had been scooped out, is observable. The ulcer
has a sharp margin, and its excavated surface is covered by a whitish
or yellowish adhesive matter. At other times, the ulceration will be
more superficial, but not less rapid in its progress, extending over
the upper part of the palate, and back part of the throat. Here the
general treatment is precisely the same as in the other forms of the
disease, viz., rest, abstemiousness, low diet, aperient, saline, and
alterative medicines, the blue pill, preparation of antimony, the bath,
and total exclusion from all excitement. The topical treatment consists
of fumigations, gargles, styptic lotions, nitrous acid gas, blisters
over the larynx, rubbing in of any counter-irritating ointment; the
object being throughout to watch, and endeavor to improve the patient’s
health, support the strength, and mitigate and remove the local
symptoms.

In the affections of the nose and palate, the fumigations are
indispensable; injections must also be used, and styptic lotions
applied with a camel’s-hair brush. These cases are very tedious, and,
fortunately, in the present day, of rarer occurrence than formerly; and
the patient, thus severely attacked, would be more prudent to rely upon
some confidential medical adviser, than to trust in his own management.

_Treatment of venereal affections of the bones and joints._—Nodes are
alleged, by medical men of great authority, to be of rare occurrence,
except the patient has been taking mercury; but the observation is not
always correct.

Their treatment, of course, must be regulated by various circumstances.
When the pain and inflammation are severe, leeches, bleeding, warm
fomentations, or cold evaporating lotions composed of vinegar and
water, must be resorted to. When they are chronic and painful, without
redness and inflammation, the greatest relief will be experienced by
the application of the ointment of iodine and morphine (see Form 53),
also by the internal employment of iodine in doses of five to ten drops
twice or three times a day. Where they are very obstinate, blisters
will be often useful in promoting absorption. When they ulcerate,
the treatment for chancres must be had recourse to. But the most
invaluable remedy, alone or in conjunction with any of the preceding,
is the vapor bath; it seldom fails to give instantaneous relief. I
have seen patients, who were rendered almost insensible by the pain
of nodes in the head, chest, and other parts of the body, experience
an entire remission of the pain, and a diminution of the swelling, by
the application of one bath; and a course of six or a dozen is rarely
inefficient in effecting permanent recovery.

It has already been mentioned that rheumatism of the bones and joints,
and in fact of various parts of the body, is unfortunately but too
frequently an accompaniment or a consequence of syphilitic disease: and
an observer will discover that nodes rarely exist without rheumatic
inflammation (of which by-the-by they are a species) being more or less
present.




                         SECONDARY SYMPTOMS.


IN the same manner as bubo, which is more usually preceded by
ulceration, but which may occur without it, secondary symptoms, or
that form of the disease wherein the constitution is involved, may be
carried into the circulation without any local effect on the part to
which the poison was first applied being produced; or, in other words,
secondary symptoms need not necessarily be preceded by primary. I have
already stated that secondary symptoms are also much modified, both
as to the time, form, and severity of their appearance, by the state
of health of the patient affecting and affected; and hence the varied
degrees of syphilitic maladies. By referring to past pages, it will
be seen that the mucous membrane of the throat and nose, the skin or
surface of the body, and the periosteum and bones, are the structures
in which secondary symptoms develop themselves, and accordingly I now
proceed to their several consideration in detail. To illustrate each
of them practically, I will first select diseases of the skin. They
consist of four marked species, distinguished as the scaly, papular,
pustular, and tubercular.

The most frequent form of eruption is the scaly, and called syphilitic
lepra. It is characterized by dry, flat, and round patches, of
different sizes, and of a coppery-red color. Each spot is ushered
in by a minute but hard elevation of a purplish hue, that gradually
radiates in size until it acquires its limit. It then puts on a scaly
appearance, and, as it desquamates, with the exception of the centre,
which is sometimes left white, maintains its copper color. These
patches may be distinguished from ordinary leprosy by their color,
and their running on to ulceration, if uncontrolled by medicine, and
again by their more speedily yielding to judicious treatment; when they
become paler in appearance, cease to exfoliate, and die away, leaving,
however, a coppery stain. Syphilitic eruptions occur in all parts
of the body, and are to be observed on the head, face, back, legs,
feet, hands, scrotum, &c. (see wood-cut, page 118), but they are much
modified in their external characters by the region they affect.

The pustular form of syphilitic eruption is also illimitable as to
situation and extent. The pustules, at the onset, are scarcely to be
distinguished from the patches of lepra, being of similar color. They
differ in size, some being very large, and others very small. When they
have existed about a week, a purulent fluid escapes, which hardens and
crusts, constituting a conoid tumor, and surrounded by a copper-colored
areola. This crust after a while drops off, leaving the under surface
of the same teint as the margin. The pustular form of the disease is
mostly consecutive to primary infection of the genital organs, and is
often complicated with affections of the throat, nose, &c.

Syphiloid tubercles ordinarily attack the face, more particularly the
nose, angles of the lips, ears, &c. They vary in size, are dispersed
or grouped together, and are of a purplish copper color. Like the
pustular, they terminate in ulceration, which on healing leaves an
indelible scar. This and other forms of syphilitic disease are very
irregular in their attacks, first selecting one spot, then another,
then several together, so that the body presents often at the same time
many stages of the eruption. The papular form of eruption is generally
intermixed with the pustular and tubercular. It is less strongly
marked, but, like the others, successive in its development, and
usually complicated with primary symptoms.

There is a form of cutaneous disfigurement, entitled syphilitic
exanthema, in which the skin is discolored by coppery-red blushes that
disappear under pressure of the finger. There are also deep and painful
fissures and excrescences, called _vegetations_, from their resemblance
to raspberries, strawberries, cauliflowers, and leeks, observed in
syphilis, and most commonly they are to be found about the lips, nose,
eyebrows, chin, genitals, &c.

It may not be unimportant to know that syphilitic eruptions are
contagious by inoculation, and that secondary symptoms may be
transmitted from one individual to another.

When I was a pupil of the London hospital, a woman and her child
presented themselves for treatment. The mother was completely covered
with copper-colored scaly eruptions, obviously and unequivocally
syphilitic. The child also had venereal sore throat, and ulceration of
the mouth. The account which the mother gave of herself was, that the
eruption appeared a few weeks after her confinement; and, upon further
inquiry, it was discovered that the husband had had a chancre of the
penis: that was cured, but secondary symptoms showed themselves upon
him. It was during the presence of the latter that he had intercourse
with his wife, at about the sixth month of her pregnancy. The surgeon
of the week gave it as his opinion, that the disease was conveyed by
the male semen being absorbed by the mother, which was sufficient to
occasion the disease. The mother, husband, and child, all submitted
to mercurial treatment and fumigations, and in a few weeks entirely
recovered.

_Treatment of Secondary Symptoms._—Now in the treatment of these cases,
all of which are more than _skin deep_, it is evident that, unless
the cause which produces them be expelled, all local repellants only
exhaust the physical energies of the patient; for the cure by such
means but provokes a speedier reproduction of the disease, and hence
the necessity of constitutional as well as topical remedies. I have
fully explained my views regarding the employment of mercury; and every
day’s experience convinces me that, where the constitution is imbued
with the venereal virus, there is no alternative but to employ the most
active alteratives, to effect a decisive and speedy change in the state
of the patient’s health. Various habits require various preparations;
the blue pill, the oxymuriate, calomel, and the external application
of the unguentum hydrargyri fortius, are highly useful. I have,
however, of late, been in the habit of employing the proto-ioduret of
mercury, with unqualified success; nor do I limit its administration to
internal exhibition; it may be used externally. The advantage of this
preparation over others is, that it rarely, if ever, produces ptyalism.

In old and inveterate cases, combined with the use of the warm and
vapor bath, both of which may be impregnated with it, it has wrought
wonders; and in cases that had proved rebellious to every other means,
although sedulously employed, it had effected a speedy and decisive
cure. In the cure of an elderly person, covered almost from head to
foot with syphilitic ulceration, the internal and external application
of the proto-ioduret occasioned, at the end of a few weeks, the
entire disappearance of the sores, leaving only a slight livid trace.
In ulceration of the throat, nose, and in fissures of the genitals,
indolent buboes, &c., the success is no less remarkable than effectual.

The following is the formula, which may of course be altered according
to circumstances:—

                              Form 54.

Take of the—
  Proto-ioduret of mercury               20 grains.
  Gum guaiacum, in powder                 1 drachm.
  Confection of roses, as much as is sufficient.
Mix to form 36 pills—one to be taken twice or thrice a day.

                              Form 55.

For external use, take of the—
  Proto-ioduret of mercury                1 drachm.
  Lard                                    2 oz.
Mix.
A portion to be rubbed over, or to dress the affected parts twice a
day. If the ulceration be seated in the throat, honey of roses may be
substituted for the lard.

The decoction, or any other preparation of sarsaparilla, may be taken
also in conjunction with the treatment just suggested.

An ounce of the sarsaparilla root infused in one pint of lime-water
(cold) for twenty-four hours, and a wineglassful taken three times a
day, is a very eligible mode of taking it. Or—

The compound extract of sarsaparilla, dissolved in lime or soft water,
one ounce to the pint, and taken in similar doses to the last, is a
very good mode of exhibition.

Bathing is indispensable.




                          SYPHILITIC LEPRA.


A PERSON aged about 29 years suffered under the above disease, and
presented the following appearances and symptoms: He was covered nearly
all over with copper-colored spots, the margins of which were both
elevated and red. The voice of the patient was rather hoarse, and he
complained also of a tenderness on swallowing: the pain extended to the
windpipe and tonsils (or almonds) of the ear, as they are called. He
experienced pain in his limbs, which he described to be worse at night
when in bed. The spots on the skin every now and then desquamated, or
peeled, or scurfed off, leaving the cuticle red and shiny underneath,
and here and there the cutis was ulcerated. On examining the throat,
the swallow appeared very inflamed, and the “pap” very pendulous. He
was hot and feverish, and acknowledged that he had had the venereal
disease about nine weeks ago, and for which he had taken some medicines
that he bought, and which had cured him. When in bed, he complained of
a burning, tingling, and itching of the body, wherever it was covered
with the eruption.

The treatment was as follows: I bled him to the amount of twelve
ounces, and prescribed a strong aperient powder. On the second day
there was less irritation, and the spots appeared less red. I advised
him forthwith to take a vapor bath, and repeat the same on alternate
days for a fortnight. I prescribed the pills as subjoined, and directed
one to be taken twice a day, to be succeeded by a dose of the decoction
of woods, as directed already.

                              Form 56.

Take of—
  Proto-ioduret of mercury               20 grains.
  Gum guaiacum, in powder                 1 drachm.
To be well mixed together, and made into a mass with syrup, and then
divided into 24 pills.

The body, on coming out of the vapor bath, or while in it, to be
sponged over with the following wash made warm:—

                              Form 57.

Take of the—
  Deuto-chloruret of mercury              1 drachm.
  Eau de Cologne                          1 oz.
  Water                                   1 pint.
Mix.

Occasionally I order the patient to be placed in a mercurial bath, of
which there are several kinds, and which can be administered either in
the form of the fumigation or in a fluid state.

After taking the bath, he could breathe with freedom and comfort; he
could also swallow without difficulty, and he expressed himself much
refreshed and invigorated. Many of the eruptive spots on the body had
exfoliated; and he said he felt a conviction that he should soon get
well.

At the expiration of a week, when he had taken but three baths, the
soreness of the throat had left, the pains in his limbs were all
gone, and he slept well; the ulcers had healed, and the eruption had
nearly died away. I advised a continuation of all the remedies; and
after three weeks of such perseverance, he was rewarded by an entire
recovery. The only alteration I directed to be made in his diet was an
abandonment of stimulants, such as wine, spirits, or porter.




                    NODES AND PAINS IN THE BONES.


IN long-standing cases of syphilis, where either much mercury has
been taken, or the constitution weakened by low living or careless
treatment, a painful affection of the bones, periosteum, tendons, and
ligaments, frequently arises. Where the inflammation attacks the bone
or periosteum, it usually exhibits itself in the form of a tumor, that
is at first hard and acutely painful, then becomes soft, and does not
always subside without ulcerating, and occasioning a tedious and
unhealthy sore. These tumors are called nodes, and are extremely rapid
in growth, very uncertain in their duration, and sometimes disappear as
quickly as they come. When the inflammation is seated in the ligament
and tendons, rheumatism is established. Both these affections are very
harassing to the patient; the pains are severest at night, and wholly
prevent sleep, the countenance becomes sallow, appetite, strength, and
flesh fail, and hectic fever completes the list of troubles consequent
upon these forms of the disease. Nodes and rheumatic pains may exist
independently of, or in connexion with, other syphilitic symptoms.
Cases having already been related of gonorrhœal rheumatism, which are
analogous to those proceeding from venereal absorption, any further
detail of such would be superfluous. The treatment should also be
conducted on the same principles in the one as in the other.

The specific virtues of the vapor bath will be attested by one trial.
I have seen innumerable instances of immediate relief from a single
application. There are few forms of syphiloid disease more distressing
than these pains in the bones; the patient is all but distracted with
the agony he endures. The relief he experiences from the vapor bath
surpasses belief; it verily appears to be magical. It constitutes the
best opiate we have.

Temporary relief, however, is not all that we want. It is no use to
remove the effect, and leave the cause behind. The aid of medicine
is indispensable. Formulæ of the most appropriate remedies will be
found among the prescriptions. The general directions as to diet,
regimen, and clothing, dispersed throughout these pages, must be
strictly attended to. The stomach must not be at any time overloaded
with indigestible food. Milk diet is the best; milk thickened with
farinaceous food, mild tonics to restore the tone of the stomach and
impart strength, alteratives, sarsaparilla (Form 58), the old Lisbon
diet drink, and all the suggestions hitherto offered with a view of
improving the constitution, should be carried into effect.




                       SYPHILITIC SORE THROAT.


THE period that elapses between the appearance of the primary and
secondary symptoms has already been stated to vary from six weeks
to six months; and some medical writers assert that, if months may
elapse, upon the same principle years may, and therefore the patient
who has once been afflicted with the primary form of the disease is
never exempt from the liability of the secondary. That syphilis, and
diseases resembling it, do occur at every period of life, is a fact of
daily observation; and it is a matter of less moment to know whether
the invalid has ever had chancre or bubo than is generally supposed,
for the treatment of every form of syphilis, and complaints putting
on like appearances, should be conducted on similar principles. If
mercury do possess anti-venereal properties, it will be found no less
obnoxious to ordinary sore throats, ordinary ulceration, and cutaneous
disfigurement. The presence of any of the abovenamed diseases indicates
a habit predisposed to their occurrence; and that susceptibility may
be induced by a variety of causes, the most prominent of which are
those that debilitate the constitution, such as syphilis itself, or
the remedies exhibited for its extermination, cold, fever, intemperate
or impoverished diet—all of which more or less abstract from, or
derange the distribution of, nervous energy. As in the cure of these
diseases, their removal depends upon an entire alteration of the
system, upon that principle alone should mercury, or any other remedy
be administered, not upon its supposed specific neutralizing or
annihilating antisyphilitic power.

All this, of course, is a question of experience; and as I profess
that this work should convey the result of mine, I do not hesitate to
express my conviction that secondary symptoms do present themselves
years after a primary affection; but at the same time I admit their
more frequent occurrence to be within three months; and, with regard
to diseases resembling the above, they are entirely independent of
such influences, and are the result of circumstances from which no man
is free. Of syphilitic ulcerations of the throat, which are rarely
solitary symptoms of the disease, being usually accompaniments to
articular eruptions or rheumatic pains, there are several forms. They
are ushered in by feverishness, languor, and a peculiar contour of
the countenance, particularly expressive of anxiety and debility. Of
the first form of ulcerated throat, and which is perhaps the least
frequent, is an excavation of the tonsil, with a tumid and red margin,
accompanied by a stiffness and uneasiness in swallowing. A more common
form, and which, from its occasioning little or no inconvenience, is
seldom discovered by the patient until it degenerates into a worse
state, is that where the ulceration is more superficial, resembling
fissures rather than ulcers, and being situated at the back part and
edges of the tonsils, and low down the throat. From the absence of pain
and difficulty in swallowing, the medical man is usually the first to
detect it, when, on opening the mouth, the throat—that is, the hinder
part of the fauces—will be discovered red and somewhat swollen; and on
pressing down the tongue with a spoon or spatula, the ulceration will
be apparent.

The last form—the phagedenic—is the most formidable, both in symptoms
and effects. It is characterized by fever, and great pain and
difficulty in swallowing, from the beginning; all denoting acute
inflammation of the throat. The first appearance of ulceration is on
the soft palate, where a small aphthous spot is discovered, surrounded
by a deep erysipelatous redness, that proceeds rapidly to involve the
neighboring parts, which soon assume the appearance of one extensive
slough. This latter disease requires prompt and active treatment, else
the bones of the palate and nose become implicated, exfoliate and
occasion a permanent deformity.

The process of cure in these cases must be regulated by circumstances.
In persons of full habit, blood-letting will be requisite to arrest at
once the inflammation. An active purgative should also be taken; when,
if the ulceration resist these anti-phlegmonous measures, there is no
alternative left but to subject the system to the influence of mercury.
The proto-ioduret pill will be found the best form, and the diet drink
should be taken in conjunction. The vapor bath, which can be medicated
with poppies, marsh-mallows, and ivy-leaves, or any other emollient
herb, will be found to ease deglutition, promote perspiration, and
afford ease. Local applications, such as gargles, styptics, &c., are
indispensable. Subjoined are a few formulæ, with remarks:—

Gargle for the milder form of sore throat.

                              Form 59.

Take of—
  Honey of borax                          1 oz.
  Emulsion of bitter almonds              5 oz.
Mix. To be used six or seven times a day.

                              Form 60.

Or take of—
  Infusion of bark                        6 oz.
  Diluted nitric acid                    40 drops.
Mix.

Where the ulcers have an indolent, or present a sloughy appearance,
either of the following will prove useful stimuli:—

                              Form 61.

Take of the—
  Oxymel of Verdigris                     1 oz.
The ulcer to be smeared with this preparation, with a hair pencil,
twice or thrice a day.

Or, take of the muriated tincture of iron a small quantity, to be used
in like manner.

Honey of roses, acidulated with muriatic acid, is a very agreeable
astringent.

In severer cases, such as the phagedenic ulceration, the subjoined
prescription will be found worthy of a trial:—

                              Form 62.

Take of the—
  Oxymuriate of mercury                   1 grain.
  Mucilage of quince seed                 6 oz.
To be mixed to form a gargle, to be used frequently.

Ulceration of the larynx is an occasional consequence of syphilis; but
fortunately a rare one, as it is generally fatal.

All the symptoms enumerated in this section have been known to succeed
gonorrhœa, and demand similar treatment. The advocates for the analogy
between gonorrhœa and syphilis herein find a ready explanation for such
an occurrence, which those adverse to the above opinion have no other
means of controverting than by submitting that its rarity is no very
substantial proof. Similar results also transpire from the imprudent,
or too free use of mercury. The following case is a prototype of the
many:— The patient was a person about thirty years of age, and was thus
affected: there was considerable inflammation in the entire back part
of the throat; the tonsils were excavated to some depth by ill-looking
ulcers, the uvula shared also in partial destruction; the tongue was
swollen, the tip and front part of it fissured, and on the left side an
irritable ulcer was apparent; the nose discharged a disagreeable fluid,
and occasionally gave off crusts of hardened secretion. The body of
this person, including the head, was thickly sprinkled with venereal
blotches of the usual copper color. His health was much impaired, and
he stated the disease to have been of nearly twelve months’ duration
from the first to the last.

The treatment consisted of the exhibition of mercury in the form of
the proto-ioduret, and the sarsaparilla. The ulcers were touched with
nitric acid, and submitted to mercurial fumigation. At the end of
two months he was convalescent. In cases of ulceration of the throat
and nose, I have used the nitrate of silver, both in substance and
solution, with good effect.




                        ADVICE TO INVALIDS.


HAVING now fully considered every form of syphilitic disease
compatible with the design of this work, a few hints relative to the
after-management of the patient when relieved from his complaint, to
guard against a relapse, and to secure an entire restoration to sound
health, may not detract from its utility. There are many patients who,
on the disappearance of the more prominent symptoms of their complaint,
lose no opportunity of rejoicing in their supposed recovery, and
innocently commit sundry inapparent irregularities, that throw them
back to their former state of suffering, which a little prudence and
attention might have prevented. The more severe the disease has been,
the slower, generally, is the recovery, and also less permanent in
its result. The mere subsidence of pain, the healing of a wound, the
disappearance of a cuticular eruption, or the suppression of a morbid
secretion, are not in themselves sufficient indications of substantial
recovery. The various physical and mental functions which, during
illness, are always more or less involved, have yet to regain their
tone. The digestive powers of the stomach are easily deranged, and
require watchful management to secure the vantage gained. Equal care
is essential, lest the intellectual organs be too prematurely called
into active employment. Convalescence is often protracted to an almost
indefinite period, frequently from the most trifling errors in diet.
The stomach of a person reduced to a low state of debility through
a severe inflammatory disorder, remains for a long time exceedingly
sensitive, and fails not to evince displeasure when oppressed with
indigestible, or too great a quantity of food. No cause predisposes the
patient to a relapse, or retards his recovery, so much as inattention
to diet. It is a popular error to suppose that the weakness consequent
upon severe illness is only to be removed by rich and substantial
food and wines, and other stimulating drinks. Such indiscretion often
rekindles the disease, or predisposes the system to the supervention of
some other complaint. The change from the sick-room to the parlor diet
should be gradual and progressive. The milk and farinaceous meal may be
varied by degrees to the milder forms and preparations of animal food.
Solids should be given at first in small quantities; the diet should
be rigidly adhered to, and in the change from low to full diet, the
intermediate one should not be skipped over.

With regard to medicines, in no form of disease is it so important, as
in venereal affections, that they should be continued for some time
after the disappearance of symptoms. Many a relapse of gonorrhœa and
secondary symptoms have occurred through the sudden abandonment of the
means adopted for their cure.

Exercise forms another important part of management in convalescence;
it should not be suddenly resumed, nor should fatigue by any means be
incurred. Early retiring to bed, and early rising in the morning, tend
considerably to promote and preserve health. Warm clothing is very
essential and necessary for invalids.

The general signs of amendment are as follows: a reduced frequency
of the pulse, which is always accelerated in acute diseases, the
absence of thirst, a clean tongue, a moist skin, a good appetite,
and refreshing sleep; and, lastly, all these are corroborated by an
improvement in the looks. The improved aspect of the countenance has
always been regarded as a sure criterion of returning health.




               STRUCTURE, FUNCTIONS, AND DISEASES, OF
                  THE FEMALE ORGANS OF GENERATION.


THE female genitals occupy the same relative situation in the pelvis
as the male, but they are an antithesis to each other. The male are
constructed to deposite, and the female to receive; consequently,
in the female there is a conduit or passage, in place of the male
penis, termed the _vagina_, leading to the womb—the receptacle for
the impregnating fluid. The vagina is placed between the bladder and
rectum. Its entrance is marked by doublings, or longitudinal folds of
flesh, called _labia_, between the upper part of which is the opening
of the urethra into the bladder, while below is occupied by the
aperture, passage, or fissure, as above described. At the roof of the
vagina is a fleshy ridge, with a pouting apex or point analogous to the
penis in the male, except being impervious, and called the _clitoris_,
which possesses the power of erection, or rather of becoming
intumescent when excited, and also of furnishing a peculiar secretion.
It is exquisitely sensitive, and believed to be the seat of pleasure
in the sexual embrace. The vagina consists of a very soft, vascular,
elastic, and contracting structure, constituting, when its sides are
collapsed, liliputian rugæ, or ridges, like the impressions left on
the sand by a receding sea. Its surface is lined by a delicate mucous
membrane, which secretes a lubricating fluid. It is this membrane
which is the seat of gonorrhœal discharge, fluor albus, &c.; and it is
also subject to ulcerations and other diseases. From the clitoris is
suspended an inner fold, like a graceful mantle, called _nymphæ_, which
are also extremely sensitive, and appear to serve, as they surround the
urethra, also for the purpose of directing the flow of urine. Under the
opening of the urethra, adherent to the external margins of the vagina,
is a membranous veil, or curtain, with a small central aperture,
called the _hymen_, the presence of which is looked upon as a test of
virginity. After the laceration or dilatation of this membrane, which
takes place through other causes than sexual intercourse, the sides of
it contract, and form little wing-like slips, to which the fanciful
name of _carunculæ myrtiformes_ is applied.

The subjoined diagram will familiarize the reader with the situations
of the female organs thus far given. It exhibits a sectional view of
the contents of the pelvis, or lower part of the abdomen:—

[Illustration:
  1. The bladder.
  2. The urethra, or entrance to ditto.
  3. The vagina.
  4. The womb.
  5. The ovary.
  6. The fimbria, and fallopian tube.
  7. The rectum, or lower extremity of the bowel.
  8. The hymen.]

Much has been said regarding the presence of the _hymen_ in its entire
state. It has been deemed by many to be there placed as a moral
evidence of chastity; but its laceration is by no means an infallible
test of dishonor. In females of feeble or consumptive health, and
others of delicate constitutions generally, the aperture of the hymen
may become dilated from natural causes—from too profuse a flow of the
menstrual flux, from local debility of the part itself, such as exist
in the disease known by the name of the _whites_; and it is sometimes
to be traced to the habit of personal and solitary excitement, as will
be presently alluded to. The membrane is occasionally so dense and hard
as to resist sexual cohabitation; and only upon dividing it by the
scalpel, can intercourse be sustained. At other times it is so fragile
and so vascular as to be torn with the least violence, and profuse
hæmorrhage to follow.

At the end of the vagina is the _uterus_. It is suspended by what
anatomists call its broad ligaments, which have certain local
attachments. It resembles in shape a pear. It is of a peculiar
structure, capable of great distension, and possessing extraordinary
properties. It is divided into a body, neck, and mouth, and when
unimpregnated, is very compact, and occupies but little space. The
interior is consequently very small, and it secretes and pours forth
at certain periods a sanguinous discharge, termed the _menstrua_. When
conception has occurred, the mouth of the womb, which before was open,
becomes permanently closed until the period of delivery. Connected with
the womb, and constituting a most important part of its machinery,
there are discovered in the roof of the interior of the uterus, two
openings, which are the ends of two tubes or canals, called the
fallopian tubes.

These tubes have their origin in the _ovaria_, which are two small
bodies encased in the ligamentous band supporting the uterus, and
resembling the testicle of the male; hence they have been called the
female _testes_. These ovaria contain a number of little vesicles of
the size of mustard-seeds, and some of the size of a pea, in number
from twelve to fifteen. These vesicles are denominated the eggs of the
human species. Annexed to the ovaria are observed, surrounding the
tubes, certain _fimbriæ_, which grasp the ovaria during the copulative
act, when prolific, and squeeze out, as it were, one of these little
eggs, and propel it into the uterus.

Still further to facilitate the understanding of the structures
described in addition to the preceding diagram, the following drawing
is presented. It exhibits a section of the female pelvis, and explains
more fully the relative positions of its contents:—

[Illustration:
  _a_—The bony portion of the pelvis separated from
       its junction with its companion.
  _b_—The spinal column of the back.
  _c_—The bladder.
  _d_—The orifice of the urethra.
  _e_—The body of the womb.
  _f_—The neck of the womb.
  _g_—The vagina.
  _h_—The rectum, or end of the intestines.]

The subjoined drawing illustrates the shape and appearance of the womb
detached from the body:—

[Illustration]

To particularize: The upper part is called the _fundus_; the widest
part, the _body_; the _neck_, the narrow part; and the lower portion
the _mouth_, or the _os tincæ_. The connexion of the fallopian tubes is
well shown.

The uterus, or womb, is described by physiologists as being of a
spongy structure—a structure that yields with its enlargement—that
grows with its growth—that resumes the former size when disburdened of
its contents. It is supplied with blood-vessels, is duly supported,
has scarcely a cavity when unimpregnated, but is ever in a state of
preparation for changes. Of conception we shall presently treat.

There is one function too important to omit in this place, and this
is menstruation—a term indicating a monthly periodical discharge that
escapes, or which is given off, from the womb. At the commencement of
this function, woman is said to have arrived at puberty; but there are
cases of precocity, and others wherein it never occurs, that neutralize
this assertion; besides, menstruation, being deferred or protracted,
depends frequently upon peculiarities of health. As soon, however, as
it occurs, a sensible change takes place in the female economy; and
certainly the other developments of womanhood rapidly follow.

Menstruation is the monthly discharge of a red fluid, common to females
from fifteen or sixteen years of age to between forty and fifty; and
it is held that, while a female menstruates, she is apt, and capable
also, to conceive. Menstruation is a device of nature to relieve
the system, or to preserve the balance of the circulation, from the
non-fulfilment of her intentions, by the absence of procreation. It
usually continues for four, five, or six days, and seldom exceeds a few
ounces. Its suppression is usually attended with marked ill health, and
many of the formidable complaints of females are attributable to its
irregularities. When anticipated, the female encounters feelings of
depression and lassitude, and exhibits an aspect of feeble health. As
a physiological fact, women, before and after menstruation, are more
desirous of the exercise of sexual privileges, and usually the approach
of the menstrual flow is accompanied by a sexual orgasm. It has ever
been deemed, by almost universal consent, prudent for married persons
and others to abstain from the sexual embrace during that period. If
only on the score of cleanliness, it should be observed; besides,
the likelihood of establishing irritability, and the probability of
interfering with this healthful provision of nature, should deter from
the indulgence. In some countries, menstruating women are excluded from
associating with the other sex altogether, and are even forbid mingling
with household duties. At the close of this article will be found a
series of prescriptions and suggestions for the removal of the various
disturbances this function is liable to.

The act of connexion is urged by what is called the sexual propensity.
It is accompanied by feelings of the intensest kind: the acme of
enjoyment is at the moment of seminal ejaculation. The penis is excited
to erection by the influx or rush of blood into its cavernous or
cellular structure; the scrotum becomes constricted, and compresses
the testicles; the _vesiculæ seminales_, and the prostate gland, are
also elevated by the muscles called _levatores ani_, as shown in the
preliminary anatomical drawings, whence their use may now be better
understood, as well as those of the perineal muscles, which all more
or less assist in causing the prompt and forcible ejaculation of the
spermatic fluid.

“In[7] the female, the sense of enjoyment, _sub coitu_, appears to
be principally excited by the friction of the _labia interna_ and
_clitoris_, which are alike in a state of turgescence or erection.
This nervous excitement, as in the male, often reaches such a degree
of intensity that a kind of syncoptic state is induced.” A sense of
contented lassitude follows, and the mind is permitted to return from
the regions of excited imagination to its ordinary quietude.

The due occurrence of the phenomena just detailed does not necessarily
secure, although it generally succeeds in producing, a prolific result.
Health, aptitude, and one important condition, are indispensable; and
the last is—a positive contact between the male sperm and female ovum.

There are many remarkable eccentricities that embitter married life.
A union may exist between two parties who are wholly inapt for mutual
enjoyment. The sensations belonging to the sexual act are involuntary,
and are provoked independently of the will: hence, in connexion without
consent, or under feelings of great repugnance, the orgasm is sometimes
aroused; and yet, where the greatest affection and desire prevail, the
male oftentimes unseasonably concluding before the female, is a most
tantalizing source of disappointment. Further allusions will be found
to this subject under the heads of “Sterility,” and “Impuissance.”

As a preliminary aid to the description of the process of impregnation,
which ensues, the following anatomical draft is presented:—

[Illustration:
  1. Section of the womb, upper part.
  2. Do. of side.
  3. Do. of lateral covering.
  4. Do. of lower part of womb.
  5. Cavity of the womb.
  6. A prominence leading from the openings of the fallopian tubes.
  7. The vagina.
  8 and 9. Fallopian tube cut open.
  10 and 16. The fimbriated extremity of do.
  11. The pavilion.
  12. The ovary.
  13. Vesicles in do.
  14. Continuation of ovary.
  15. Ligament of do.
  17. Pavilion of right ovary.
  18. Right ovary.
  19. Connecting band.]

Man, unlike other animals, is not smitten with desire to propagate only
at particular periods. In sentient beings, every season is favorable to
the flame of love.

When conception takes place, the following phenomena are believed to
occur: The womb is supposed to participate in the excitement of the
sexual act, and at the moment of the orgasm, to receive the male seed,
and to mingle with it a fluid of its own. The whole apparatus of the
uterus appears influenced at the same time,[8] by a kind of electric
irritability. A vesicle, owing to the ovaria being grasped or embraced
by the fimbriæ, escapes from its lodgment and enters the fallopian
tube, where it bursts, and its albuminous drop is conveyed into the
womb.

From the circumstance of the male semen returning from the vagina after
copulation, it has been doubted whether it was intended to enter the
uterus. It certainly can only enter once,[9] and that when impregnation
takes place; and even then a small portion suffices, for immediately
after conception the mouth of the womb becomes impermeably closed. The
mouth of the womb lies horizontally, like the lips of the face, while
that of the orifice of the urethra is arranged perpendicularly: hence
the presumption, from this better adaptation to transmit and receive,
that the semen to impregnate should enter the uterus.

This question is mooted, because it has been supposed by some that
impregnation ensues from the vapor or odor of the male seed ascending
to the womb. Contending parties admit, while others deny, that the
seed may be, and has been, detected in the womb of females and animals
having been slain (or who may have died) during or soon after the act
of copulation. Impregnation has followed very imperfect penetration,
such as in cases of unruptured hymen, or of disproportion of parts,
and other causes needless to insert here, by which the supposition
is supported that conception takes place from vaginal absorption;
but it must be remembered that the seed is projected generally with
great force, and that the smallest possible quantity is sufficient for
impregnation; also, that the vagina possesses a constrictive movement
of its own, whereby the seed is carried into the womb.

After the escape of the “albuminous drop,” the vascular membrane
which contained it is converted into what is called a corpus luteum;
denoting thereby—for it assumes the form, after a while, of a fleshy
nucleus—that the female has either conceived, or has been under the
influence of strong amatory excitement. This _salvo_ must be admitted,
for corpora lutea have been discovered in females where intercourse
was even impossible; but as this detection of corpora lutea generally
corroborates the surmise that so many conceptions have taken place
as there are corpora lutea, it is to be presumed that the exception
must be owing to some similarly powerful mental, as well as physical
excitement.

When impregnation has taken place, the womb begins to enlarge, and
become more soft, vascular, and turgid—the wonderful process of fluids
assuming the form of solids commences, and within a fortnight an
investing membrane is formed, called the _decidua_ (I will insert as
few names as possible), consisting of two kinds of folds, one lining
the womb, and the other containing the _ovum_ which has therein “taken
root.” The ovum is now a soft oval mass, fringed with vessels, and
composed of membranes containing the early fœtus. See sketch.

[Illustration]

When opened, the fœtus appears surrounded by three distinct membranes:
first, _the decidua_; secondly, _the chorion_, the inner fold of the
former; thirdly, _the amnios_. The decidua, as before stated, lines the
womb; the two others cover the ovum or fœtus. After a time the amnios
and chorion become adherent to each other, and a fluid is interposed
betwixt the amnios and fœtus, called the _liquor amnii_. The fœtus, as
it advances, is perceived to be hanging by an organized support, called
the umbilical chord, floating in the liquor before named.[10]

A draft is here presented of an ovum (a section) of a fortnight old;
and adjoining is one just double its age, where the chord will be
perceived.

[Illustration]

[Illustration]

The following further account may aid the description thus far given.
The ovum, protected by a membrane of its own, called the amnios,
descends into the uterus, where it takes its hold of the membranes
already there—the decidua. It pushes its way before, as exemplified in
the subjoined drawing:—

[Illustration:
  _a_—The decidua lining the womb.
  _b_—Do. protecting the ovum.
  _c_—The upper part of the womb, where the ovum has become adherent.
  _d_—The ovum.]

The next cut shows the advanced condition of the fœtus:—

[Illustration:
  _a_—The womb.
  _b_—The liquor amnii, with the fœtus.
  _c_—The chorion.
  _d_—The decidua.
  _e_—The opening of the fallopian tubes.]

It will answer no practical usefulness to go through the whole minutiæ
of the various physiological changes that take place relative to fœtal
growth from the hour of impregnation to that of delivery. What has
already been detailed, has been offered to unveil a little of that
singular ignorance that exists generally among non-medical persons
regarding the history of themselves. “Too much learning is a dangerous
thing;” and it will readily be allowed, that a sufficient idea that
certain things _happen_ is oftentimes as useful as to know _how_ they
happen, especially when it belongs to a department requiring much
research, time, and ingenuity, thoroughly to understand, and which may
chance to be foreign to our ordinary pursuit.

The period consumed in gestation is forty weeks, or nine calendar
months, and the time is calculated from a fortnight after the
suspension of menstruation. Some married ladies pride themselves upon
being able to predict to a day—to tell the precise occasion when they
conceive, and which they date from some unusual sensation experienced
at the particular embrace which effected the important change. Many
medical men disallow that such tokens present themselves, and are
opposed to the belief which many mothers entertain, that nature is so
communicative; and also are skeptical of those extraordinary influences
that every day furnish proofs of maternal imagination, occasioning to
the burden they carry, sundry marks, malformations, and monstrosities.
Examinations have found that the order of fœtal organization is
somewhat as follows: the heart and large vessels, the liver and
appendages, the brain, stomach, and extremities. The determination of
sex and number has hitherto defied exploration. In the early months of
pregnancy the womb maintains its natural position; but as it enlarges,
it also emerges from the pelvis into the abdomen. The moment of its
slipping out of the pelvis is termed quickening, of which most women
are sensible—some fainting on the occasion, others being attacked with
nausea, hysteria, and palpitation of the heart. Quickening usually
occurs between the fourth and fifth month. The fœtus is then called
a child—the law ordaining that, if a woman intentionally procure, or
such parties as may assist in so doing, abortion or miscarriage before
quickening, it is misdemeanor, if after, murder.

The following diagram is presented to show the situation occupied by
the womb containing the child just ready to enter the world:—

[Illustration:
  _a_—The womb.

  _b_—The vagina.

  _c_—The bladder.

  _d_—The rectum.]

A full pregnant female, like a very corpulent man, walks very erect:
hence the popular notion that ladies in the one condition, and
gentlemen in the other, do not think meanly of themselves, but strut
along well pleased with their own importance. It is an uncharitable
idea; the attitude is unavoidable, the head and shoulders being thrown
back to counterbalance the protuberance in front—to preserve, in fact,
the centre of gravity, to save themselves from falling.

_Symptoms of Pregnancy._—Mysterious as is the process of impregnation,
there are many forewarnings which, being generally found correct,
are useful to be known. Great as are the changes that take place
in the female economy during child-bearing, and productive as they
frequently are of serious disturbances to health, it is benevolently
ordained that women who fulfil their destiny of becoming mothers, have
better health to sustain them through their travail than the single or
unprolific. The signs of pregnancy during the first few weeks are very
equivocal. The first probability is the suppression of menstruation,
which is accompanied by fulness of the breasts, the nipples of which
become surrounded by a dark areola; headache, flushing in the face,
and heat in the palms of the hands, ensue; also sickness in the
morning, and probably an accession of mental irritability; various
longings exist—many very ridiculous, others bordering on insanity,
and some indicating great perversion of temper, habits, in hitherto
well-conducted inclinations.

There are many phenomena more readily discovered by medical men
accustomed to the accoucheur’s employment than describable, that
indicate pregnancy; the sinking of the abdomen, the descent and closure
of the uterus, the altered facial looks, the state of the pulse, &c.,
&c.

From the fourth month, when the womb ascends into the abdomen, the
signs are more positive: the protrusion of the navel, the evident
enlargement of the belly, the tenderness and fulness of, and occasional
escape of milk from, the breasts, clearly point out the occasion.

About the fifth month, the movements of the child are very apparent to
the mother, when all doubt is removed.

There are some conditions of female life that assimilate to pregnancy,
and which have defied the judgment of matrons, and even medical men,
but they are rare—such as dropsy of the abdomen, or ovaries, tumors,
accumulations of wind, &c. These, with the suspension of menstruation
(which last is but an uncertain sign, for it may depend upon cold,
fever, or inflammation), have destroyed the anticipations of fond
wives, and have alarmed those who desire not to become mothers.

_Parturition_ takes place at the end of the ninth month; but children
born at the end of seven will live, and examples are related of some
that have “gone” ten. In France, legitimacy is allowed to children born
on the 299th day of pregnancy.

_Labor_ is distinguished by a softening of the soft parts of the female
organs of generation, an abundant secretion of mucus, a relaxation
of the mouth of the womb, and a forcible contraction of its body. The
expulsion of the child is effected by pains of a straining nature.
After the birth of the child, the womb contracts to its _normal_ or
unimpregnated size, giving forth a discharge, called the _lochia_,
that lasts for several days, and the breasts immediately furnish the
secretion of milk.

Previously to entering upon the consideration of the diseases arising
from infection, and for which this book was originally composed, a
word or two may be said upon a condition of the womb, unfortunately
of frequent prevalence, called _prolapsus uteri_, or _falling of the
womb_. Such occurrence may take place with single females as well as
with married, or those who have borne children. It may be held as the
result of debility; and according to the degree of descent is the
inconvenience and suffering. The first drawing exhibits the natural
position of the uterus:—

[Illustration:
  _a_—The vagina.

  _b_—The uterus.]

A partial descent of the uterus gives rise to painful dragging
sensations about the groins and fundament, and it is usually attended
by the “whites,” or leucorrhœa, a disease of which mention is presently
made:—

[Illustration:
  Partial descent of the uterus.

  _a, a, a_—Vagina.

  _b_—Uterus.]

If _prolapsus_ takes place during pregnancy, the womb impresses upon
the bladder and rectum, and occasions irritability of both those
structures; but as pregnancy advances, and as the womb ascends into the
abdomen, these inconveniences cease, and the womb oftentimes regains
its tone and position after child-birth. The womb sometimes protrudes
externally, and is a source of great distress. See drawing:—

[Illustration:
  Prolapsus uteri.

  _a, a_—Vagina.

  _b_—Uterus.]

The treatment in these cases is chiefly mechanical, beside supporting
the general health. The first symptoms, however, demand efficient
attention, and the medical attendant should be made acquainted with
every particular.

It is a question whether the weakened condition of the supports of the
womb, and the consequent relaxed state of the vagina, are not owing to
the manner in which women clothe themselves. The pelvic part of the
female is kept always in a state of unnatural warmth, from the load
of petticoats and other unnameable female attire. Contrast but the
difference between the simple unlined trowsers of the male and five
or six-fold clothing of the other sex: either the one must yield too
much warmth, or the other must strike too cold. The sedentary habits of
women have of course much influence.

When retention of urine follows the falling down or partial descent of
the womb, the female should lie on her back, press the uterus into the
pelvis, and urinate in that position.

The womb, beside becoming displaced, is subject to an _eversion_, or
a turning inside out. Happily, such cases are unfrequent, but any
disturbance of so important an organ demands the promptest attention.




           DISEASES OF WOMEN, AND THE USE OF THE SPECULUM.


[Illustration]

THE introduction of the stethoscope and the speculum constitute two
important epochs in medical science—the former ascertaining, by the
conveyance of sound, disease in the most hidden and inaccessible parts
of the human frame, and the latter bringing to view structures which,
without such aid, are necessarily veiled from our sight. The speculum
consists of an instrument formed of silver or steel, that without
pain or inconvenience is passed into the vagina, when, by a simple
contrivance, it is made to expand and dilate the vaginal passage, and
thereby expose to view the entire canal, together with the uterine
aperture. The usefulness of such a method, whereby disease can at
once be detected, admits of no dispute. It is physically painless;
and if opposed to female diffidence and modesty, its importance and
serviceableness should be balanced against the mental distress such a
procedure may occasion. On the one hand, without its assistance, the
treatment of the disease is at best but conjectural; on the other, by
its aid, it is safe and sure—much suspense and suffering is at once
put an end to. Experience has proved that many local disturbances,
that were believed to have been merely vaginal irritation, have been
discovered to depend upon absolute disorganization of the neck and
mouth of the womb. Deep-seated ulceration has been detected, and
cancerous enlargements; the disease thereby having been exposed, has
had the necessary and successful treatment. In Paris, it is considered
so valuable that a chair, termed a “speculum chair,” has been invented
solely for its use. See engraving on previous page.

The speculum is now in the hands of every respectable medical man, and
the class of disorders that hold it in requisition are being better
understood, and consequently more successfully combated. In no cases is
it more useful than in secretive irregularities, such as in leucorrhœa,
gonorrhœa, or syphilitic ulceration. Without further comment, these
diseases will be considered.




                      GONORRHŒA IN THE FEMALE.


THIS disease is rarely so violent as in man, it being mostly confined
to the uterine conduit; in fact, except by the discharge, women are
almost unconscious of its existence, mistaking it, when occurring in
married life, for leucorrhœa. Occasionally, however, the inflammation
is highly acute, and a variety of distressing symptoms ensue. There is
considerable excoriation around, and a swelling of the organs, much
_ardor urinæ_, and the same constitutional disturbance as in the other
sex.

The medical treatment of both sexes is constitutionally alike; but
the female has to depend more upon local treatment than the male.
Hence the importance of injections. Now here is another source of
difficulty: women are as averse to the use of the syringe as they are
to the speculum; and the consequence is, vaginal diseases are generally
protracted to double as long as they need be. However, as these hints
are likely to be seen only by those who doubtlessly have, and who
indisputably ought, to exercise it, namely, influence over the sex in
persuading them to submit to what common sense bespeaks as most prudent
and expedient, appropriate formulæ for the suggestions just recommended
will be found a few pages hence. Frequent ablution, rest, temperate
diet—the more farinaceous and mucilaginous the better, avoiding
entirely wines, fermented and spirituous liquors, together with mild
(Form 63) aperients and salines, constitute the chief means of cure.
Injections are indispensable.

I have already alluded to the difficulty of getting female patients
to be their own confessors. If they appoint others, every possible
information should be furnished, and fastidiousness by no means should
supplant the avowal of real facts. Although gonorrhœa in women is
generally less severe than in the male, it is vexingly oftentimes more
lasting; which is easily accounted for, owing to the extent of surface
diseased: whereas in man it is limited to the narrow urethra, and
seldom exceeds an inch or two upward, constituting not one tithe part
of the space morbidly affected in the former. See, however, the formulæ.




                        SYPHILIS IN FEMALES.


THE principal features of syphilis in women consist of ulcers,
excoriations, warts, and buboes. Women, of course, are alike liable to
all the forms of secondary symptoms. Chancres usually appear _within_
and _on_ the _labiæ_. In the drawing here given, the labiæ are drawn
aside to expose the ulceration; and they are also found within the
vagina and surrounding the mouth or protuberance of the womb. It is in
these cases that the speculum is had recourse to; and in the Parisian
hospitals every case is subject to such a mode of investigation.

[Illustration]

The following three illustrations show what a degree of severity
ulceration and other changes put on. The first exhibits superficial
excoriation extending rapidly, and occasionally a swollen appearance of
the _os uteri_; the second shows extensive chancrous ulceration; and
the last of a tuberculous character, like little hardened tumors. But
for the speculum, these conditions might have gone on to worse, and
led to irremediable mischief: their treatment, independently of local
means, such as injections, &c., would have been prolonged to an almost
indefinite time. The use of styptics is demanded in female as well as
male syphilitic developments, and accordingly the employment of nitrate
of silver, copper, &c., is advised, as already explained.

[Illustration]

[Illustration]

[Illustration]

The following drawing shows the extent of mischief and annoyance to
the external organs of female generation consequent upon neglect. The
external labiæ are studded with chancres. The thighs, buttocks, and
rectum, are dotted and overspread with excoriations. The person from
whom this sketch is taken was an unfortunate woman of the town. As it
is not my intention to particularize cases, although from my peculiar
province I could fill up as many pages as this book contains, with
details of such histories, I have only to add, by way of summary, that
the topical and constitutional treatment being alike in both sexes,
the only modifications required will be the regulating of the doses of
the medicines, which must be done with reference to the idiosyncrasy,
age, and temperament, of the patient. The frail system of woman is less
able to withstand the dire effects of the disease, or the potent means
for its extirpation, than her stronger brotherhood, and therefore the
abler and more experienced the counsel, the fairer the chance of her
recovery; a hint that the writer feels assured will not be received
by those to whom his pages are addressed, as a vain appeal to repose
confidence in other advice than their own.

[Illustration]




               LEUCORRHŒA, FLUOR ALBUS, OR THE WHITES


THIS is the most prevalent of all derangements of the female economy,
connected with the uterine system; and from its debilitating effects,
induces a train of maladies that tend to embitter personal comfort
more than any other human ill. Leucorrhœa consists of a discharge of
acrid, or bland, but variously-colored mucus from the vagina, differing
in intensity according to the cause and duration. It would be idle
to offer the many arguments set up to prove whence it proceeds, or
to examine the discussions as to whether it is the produce of the
uterine vessels, or the vaginal secretives. That both aid in its
formation is doubtless the case (as the employment of the speculum
has satisfactorily proved); and equally certain that, according to
the amount of irritability existing therein, so depends the quantity
and character of the discharge. It exists in the married and single—in
the moral and unchaste; and therefore the cause should be cautiously
divined, it being evident that other than sexual indulgences establish
this annoying and distressing affliction. It may be fairly conceded
to be a vitiated secretion, depending upon a weakened state of the
local vessels, and, moreover, in particular habits, to be a salutary
evacuation. On the other hand, it must not be denied that it is
oftentimes, where it occurs to persons living _sub judice mariti_,
the result of sexual intemperance, or disease springing from an
indiscriminate indulgence in the same.

However, as my purpose is more with the symptoms and treatment, the
following may be received as a summary of what occurs, and what should
be done for the removal thereof:—

In addition to the discharge, which at one time is scanty, at another
profuse, there are usually severe pains in the loins and lower part of
the abdomen: there is a sense of bearing down, as though the womb were
descending and even protruding. The general health of the patient is
disturbed, loss of appetite, excessive languor, a pale and emaciated
look, sleepless nights, dark areola around the eyes, various hysterical
and other nervous affections, and numerous disturbances indicating a
weakened and impaired state of mind and body. Among other causes beside
those alluded to, may be enumerated irregular living, late hours,
mental and bodily fatigue, deficient exercise, impure air, and neglect
of personal ablution. Among the consequences of a long-continued
leucorrhœa, an almost certainty of sterility should not be omitted.

_Treatment._—In leucorrhœa, where or where not consecutive to
gonorrhœa, depending on loss of tone of the secretive vessels of the
internal organs of generation, the chief indication is to impart
vigor and restore strength, which it is evident depends much upon an
avoidance of those causes that first started the disease.

Although leucorrhœa bears a strong resemblance to gonorrhœa, there are
points by which to distinguish the one from the other. In gonorrhœa,
the discharge is unceasing, but small in quantity, and is usually
accompanied by inflammatory symptoms; whereas in leucorrhœa, the
discharge is irregular and copious, often coming away in large lumps.

The treatment of fluor albus is indicated by the degree of severity
present. Where the prominent feature is the discharge, the indication
is to increase the action of the absorbents by restoring the tone of
the diseased surface, and at the same time to strengthen the system.
Where the disease is complicated with weakness and relaxation,
astringents should be given by the mouth, and also administered in
the form of injections. The alkaline solution of copaiba is a very
valuable medicament, and may be taken twice or thrice daily. It may
also be employed as an injection, by adding one or two ounces to a pint
of water, and a teacupful thrown up several times in the day. There
are many domestic remedies, which, from their harmless properties, can
at least do no injury, if they are not productive of good; as, for
instance, a strong decoction of green tea, an infusion of oak bark, or
alum-water; or diluted port wine—all to be used as injections, which,
if it shall so please the patient, may be tried prior to the annexed:—

                              Form 64.

_Chalybeate Pills, for Leucorrhœa, or other Female Sexual Weakness._

Take of—
  Sulphate of iron                        1 scruple.
Balsam of copaiba and liquorice powder—of each a sufficiency to form
the mass, which is to be divided into 40 pills, of which 3 or 4 may
be taken three times a day.

Or, take of—
  Sulphate of zinc                        1 scruple.
  Extract of camomile                     1 drachm.
      ”      gentian                      1   ”
  Syrup, a sufficiency.
Mix, and form 24 pills. Dose—two twice a day.

                              Form 65.

_Strengthening Mixture._

Take of—
  Infusion of bark                       7½ ounces.
  Sulphate of quinine                     8 grains.
  Diluted sulphuric acid                  ½ drachm.
  Syrup of orange-peel                    2 drachms.
Mix. Dose—three tablespoonfuls twice or three times a day.

                              Form 66.

_Astringent Pills for Leucorrhœa._

Take of—
  Extract of Peruvian bark                1 drachm.
  Gum kino                                1   ”
  Alum                                    ½   ”
  Nutmeg                                  1 scruple.
Syrup, sufficient to form the mass. Divide into 36 pills. Dose—three
pills three times a day, to be followed by a teacupful of lime-water.

                              Form 67.

_Astringent Pills._

Take of—
  Alum                                   30 grains.
  Catechu                                 1 drachm.
  Opium                                   5 grains.
Mix to form 30 pills. Dose—three twice a day. Useful in chronic
gonorrhœa and leucorrhœa.

                              Form 68.

_Astringent Pills for obstinate Gleet, or Leucorrhœa._

Take of—
  Gum kino                                1 part.
  Canadian turpentine                     4 parts.
Powder of tormentilla, as much as may be necessary to form a mass.
Divide the same into pills of 5 grains each, and take from three to
half a dozen of them night and morning. Continue them for a week or
fortnight. A very useful remedy.

                              Form 69.

_Astringent Injections for Leucorrhœa or Gonorrhœa._

Take of—
  The compound solution of alum           ½ oz. to 1 oz.
  Water                                   1 quart.
Mix.

Injections may be used two or three times a day. If found to irritate,
they should be diluted with water. Appropriate syringes are to be had;
but the best are those formed by the Enema apparatus.

                              Form 70.

_Astringent Injection._

Take of—
  Sugar of lead                           1 scruple.
  Water                                   1 quart.
Mix.

Or, take of—
  Catechu                                 1 drachm.
  Myrrh                                   1   ”
  Lime-water                              ½ pint.
Mix.

Or, take of—
  Nitrate of silver                       1 scr. to 1 dr.
  Water                                   1 quart.
Mix and strain. This lotion is much, and very effectively, used by the
profession.

Or, take of—
  Sulphate of zinc                        ½ to 1 drachm.
  Water                                   1 quart.
Mix.
See Forms 11 and 12.

The remaining diseases peculiar to the female pelvic viscera and
their outlet, are hæmorrhoids, irritability and inflammation of the
bladder, disordered uterine functions, urethritis, or inflammation of
the urinary passage, and, lastly, internal and external irritation or
excoriation. But as these fall within the province of every family
practitioner, to the consultation of whom no morbid delicacy should
prevent a patient, having such in their confidence, from resorting, I
shall conclude this section by appending sundry prescriptions, in order
that, should prudence not direct the sick one or her friends to call
in the advised assistance, help may not be entirely withheld, and in
order that, if the aid offered be not the means of supplying the loss
of a more proficient and skilful director, it may at least be found
mitigatory of these interruptions of health and comfort:—

                              Form 71.

_Pills to promote the flow of the Menstrual Secretion._

Take of—
  Aloetic pills, with myrrh               1 drachm.
  Compound iron pill                      1   ”
Mix to form 24 pills. Take two twice a day.

Or, take of—
  Compound galbanum pills                 1 drachm.
  Socotrine aloes                         1   ”
Mix to form 24 pills. Dose—two twice a day.

                              Form 72.

_Injection for the retention of the Uterine Periodical Secretion._

Take of—
  Liquor of ammonia                      10 drops.
  Milk                                    ½ pint.
To be used morning and evening. This is a remedy that has been used
by many medical men with very great success.

There are no means so importantly serviceable as the frequent use of
the warm and vapor bath.

                              Form 73.

_Stimulating Drops to restore the Menstrual flow._

Take of—
  Compound tincture of aloes             1½ oz.
  Tincture of black hellebore             1 drachm.
      ”       castor                      1   ”
      ”       Lyttæ                      30 drops.
Mix. Dose—a teaspoonful in water three times a day.

                              Form 74.

_To relieve entire suppression._

Take of—
  Compound galbanum pills                 1 drachm.
  Sulphate of iron                        1   ”
  Extract of savin                       10 grains.
  Of black hellebore                     20   ”
Syrup sufficient to form 36 pills. Dose—three twice a day.

All these medicines must be given with great caution.

                              Form 75.

_To check an immoderate flow of the Menstrual secretion._

Take of—
  Infusion of roses                       8 oz.
  Tincture of opium                      30 drops.
Mix. Dose—three tablespoonfuls three times a day.

Or, take of the tincture of ergot of rye, a teaspoonful in
water twice a day.

Or, take of the sesqui-chloride tincture of iron, 20 to 30
drops in water, three times a day.

                              Form 76.

_For painful Menstruation._

Add to a portion of gruel, upon going to bed, 15 or 20 drops of
laudanum. This quantity may also be taken in the morning, and repeated
several days; the bowels in the meantime to be relieved by castor oil.

The warm hip bath, in these cases, is invaluable.

Or, take of—
  The extract of stramonium               ½ gr.
  Spanish soap                            5 grs.
Mix to form a pill to be taken twice a day.

                              Form 77.

_To allay external irritation.—Sedative application._

Take of—
  Oil of almonds                          6 ounces.
  Spermaceti                              ½   ”
  White wax[11]                           ½   ”
  Rose-water                              3   ”
  Orange-flower water                    10   ”
Dissolve the wax in the oil, then add the waters, and constantly
stir till cold. This is an admirable application for irritation or
excoriation of the external parts. It is commonly known as “cold cream.”

                              Form 78.

_To heal Excoriations.—Mild drying ointment._[12]

Take of—
  The oxide of zinc                       1 drachm.
  Ointment of spermaceti                  1 ounce.
Mix.

                              Form 79.

_For obstinate Excoriations._

Take of—
  Ointment of nitrate of mercury          ½ ounce.
  Superacetate of lead                    1 scruple.
  Spermaceti ointment, or cold cream      1 ounce.
Mix.




          EFFECTS OF INCONTINENCE, CELIBACY, AND MARRIAGE.


THE past pages relate chiefly to the diseases of the generative system
consequent upon contagion, upon accident, and the ordinary wear and
tear of human life: the following, to the ills that ensue from the
over-indulgence in, and abstinence from, the proper purposes of the
reproductive organs, and the benefits derivable from a fulfilment of
the intentions of their natural functions.

There may be much good policy and correct feeling in objecting to the
too public inquiry into these matters. The private closet and the
public eye are two very different tribunals, and what may be approved
of in the one is very likely to be condemned in the other. The line of
deciding what shall be communicated and what should be suppressed may
be drawn too closely; and that knowledge which is acquired by stealth
is seldom so practical as that obtained by competition. If, therefore,
the topics herein embraced were to be expunged, and their discussion
prohibited, the afflicted would have no other resource than to apply
to the adventuring and ill-educated empiric, instead of confiding his
troubles to the legitimate professional man. A study, to become useful,
should be general; and it is to be hoped that the prudish reserve which
excludes this kind of investigation from our medical schools will be
laid aside, and truth be obtained by allowable investigation.

The most moral and chaste, at the age of puberty, are assailed with
feelings and desires, that, though new and unanticipated, yet need
little interpretation when present, and so urgent and imperious, that
if not legitimately satisfied, nature and instinct are not slow in
pointing out a means of gratification.

In the male, imagination commanding a wider range than in the female,
and fed by associations with, and the usages of, the world, elicits
consequences explanatory of life’s purposes; and the youth having once
experienced, perhaps unsolicited, and possibly during sleep, the agony
of seminal secretion, can rarely withstand the afterward tempting
pleasure of seeking a self-repetition of such solitary indulgence,
which the forbidden union of the sexes, at this early period, may urge
him to.

Setting aside the selfishness and unmanliness of the vice, it
is important that the wearer of the cap and bells should know
the consequences of abusing a given function by such a means of
gratification. There is no mental passion, or physical exertion, that
produces such temporary nervous prostration as the completion of the
act of sexual intercourse; and it therefore can be easily conceived how
debilitating must be the immoderate indulgence of the practice. Health
consists in a due performance of all the functions of the organs of the
body, and an undue exercise of them is sure to lead to a disturbance of
the economy.

In ordinary sexual commerce, particular phenomena ensue, the
circulation is powerfully roused, the heart thumps violently, the blood
is driven to the brain, and great mental exaltation is induced, and
instances have been known of death suddenly crushing the transport.
The too frequent repetition of such excitement can not fail to
wear out, and disease the overwrought organs, the heart and brain
particularly, upon the healthy condition of which the health of the
entire frame rests; and hence the diseases of the libertine are usually
consumption, physical weakness, and mental imbecility, all the result
of disordered circulation and impaired nervous power. If, therefore,
such consequences follow a waste of the allotted privileges of man, how
much more severe must they be that arise from nervous exhaustion, that
which transpires from an absolute stretch of an already overwrought
imagination, from, in fact, ideal pleasures, instead of those
springing from the instinctive stimulus imparted by the presence of,
and cohabitation with, woman. I have elsewhere treated upon the sad
and withering effects of self-indulgence in a hygæan point of view.
My object here is to portray the consequences of the like, and the
more lawful, intemperance of sexual cohabitation in a domestic light,
in how far it is destructive to the health and happiness of others,
than the party addressed—the partner of our worldly anxieties, and
the offspring that issue from our union. How striking is the change
of _appearance_ only, much less the positive bodily condition of
married persons of both sexes, within one or two years of their union,
especially if the match be a youthful one. Let any one, even with a
limited acquaintance, recollect such of his former female associates,
whom he knew when single, and mayhap may have indulged with in little
modest pleasantries; let him recall the gay-lit countenance, the ruddy
and prominent cheek, the sparkling and lively eye, the plump and well
filled neck—in fact, let him but compare her then and now, and how
disheartening the change; the same being may be recognised, but it is
the same being only in mind, and not in person. There are exceptions,
as I shall presently show, but this is the too frequent portraiture of
those who embark in precocious hymeneal contracts, and restrain not
the marital privileges. The countenance assumes, when thoughtful, the
careworn aspect; the blanched cheek shows here and there a furrowed
imprint; the lustre of the eye is dimmed; and, to drop from the
figurative to the literal, the collar-bones, hitherto “overlaid with
nature’s plastic moulding,” seem appointed only for union’s sake, lest
the fabric of neck and shoulders should drop in pieces. Mark also
the decayed health and spirits; hear the bitter grief of headaches,
sideaches, nerveaches, and behold, perhaps, the puny offspring “mewling
and puling in the nurse’s arms.”

The bridegroom wears a sorrowful and thoughtful look. He may possess
all the comforts which few inherit, but like Pharaoh’s lean kine, as
chaff thrown before the wind, their purpose is opposed.

This may be held as a ridiculous picture, but I defy denial of its
unhappily too frequent illustration in real life. A word or two on the
opposite extreme, _continence_. The reader will observe, in another
page, the remark that every part, be it flesh, bone, or nerve, has
its use. The reproductive organs have theirs; but it is not only for
the propagation of the species—they afford an outlet for accumulated
secretion—they aid in resolving the animal passions—they are the secret
incentive to sexual love, and the bond of union between the sexes.
They give an appetite that, like hunger, must be appeased, or nature
revolts; and the harmony of society falls before the ungovernable fury
of maniacal craving. Health, the source of all happiness, without the
possession of which the world with its beauties would be, for all we
cared, tenantless, materially rests upon a proper and moderate use of
the copulative process. Entire continence, a rarity among mankind,
establishes in both sexes the most miserable perversions of mind
and body. In man, we have instances recorded of mania, melancholy,
apoplexy, and foul skin-disorders. Blindness, deafness, and a host
of evils, some greater, and few less than these just penned. It is
true, continence is, as remarked, but seldom observed, especially
in males, who, being denied sexual commerce, are estranged by the
distressful habit of onanism; and thereby, in some measure, the
enumerated maladies are avoided; but as masturbation, like other vices,
grows with unbounded speed, a train of ills, far more distressful,
await the sufferer, who, in addition, becomes, in the meridian of
life, deprived of the very power he in youth was so improvident of.
Continence in females, which all admit to be the brightest ornament a
woman possesses, is attended with a poor requital; and its prevalence
(to the honor of our countrywomen be it spoken) is truly attested by
the miseries of hysteria, and other nervous derangements, that pervade
the junior and elderly maiden branches of every family, and constitute
so formidable an enemy to domestic felicity. A wide field is open for
comment upon this subject, which is better adapted for the moralist
than the physician. This manual, professing to be but a vehicle for
topics of a professional nature only, the writer apologises for the
digression, and can but express his regret, that public opinion
is unfavorable to the discussion of such matters, which embrace
considerations highly important to a nation, both in a moral and hygæan
view. Continent persons but seldom attain old age; whereas, the married
females, for instance, although exposed to the dangers of pregnancy and
delivery, live generally longer than those who are unmarried or chaste;
and provident married men escape the ills and snares that beset single
_blessedness_, as it is called. Libertinism, on the other hand, in
whatever way practised, is hurtful and destructive to long life.

Continence may be a virtue, but is not imposed where marriage is
allowable; and then, if deviated from with moderation only, the
greatest amount of health and happiness may be elicited, and the
proper end of it obtained. Matrimony, where succeeded by the birth of
children, powerfully conduces to the health and happiness of women.

Many female disorders are relieved by marriage. Amenorrhœa and
chlorosis, disordered conditions of the uterine functions, hysteria,
scrofula, skin-affections, numerous nervous disorders, and many local
complaints, yield as soon as pregnancy commences.

Results should, however, be well weighed, before irrevocable steps are
taken. There are many diseases and structural impediments opposed to
the matrimonial contract. Malformation and mental imbecility should
be held as strong interdicts to the conjugal union. People ought not
to marry before manhood is well developed (the male at least 21 to 23
years of age, the female 18 to 21). Precocious or late marriages are
injurious to reproduction. The unnatural union of old and young of
either sex with the other, entails its own miseries. A curious estimate
of salacious appetites and power has been drawn up as pervading the
different temperaments. The temperaments, as elsewhere noticed, are
four—the Sanguine, Nervous, Bilious, and Phlegmatic. Persons of the
sanguine temperament are generally of good health, and vigorous in
amorous pleasures. The nervous are extremely susceptible in their
sensations, and generally much given to female society. Combined
with the sanguine, they are capable of great amorous excesses. The
bilious temperament imparts a jealous bearing in all affairs of sexual
solicitude, that detracts from the fondness and affection which so
entwine a woman to a lover or a husband. The melancholic or phlegmatic
person is frigid and apathetic in his amours; and love becomes with him
a secondary consideration to advancement in life. These temperaments
are frequently intermixed, and are much modified by age and health; and
the salacious powers correspond.

Speculations have arisen among physiologists, as to the effect of
climate and season, as well as age and temperament, on the reproductive
powers. Temperate and warm climates are more prolific in exciting the
copulative desire, than the frigid and uncongenial situations of the
northern hemisphere. The seasons bear a somewhat near analogy—spring is
supposed to be more potent than summer, autumn, or winter, in arousing
the amative propensities, which, like the productions of the earth,
come, as it were, at that time into a new existence. This observation
is borne out by the statistical fact of there being a greater number of
births about Christmas and the new year, than any other period.

Man, however, is allowed to be omnivorous in _all_ his appetites;
and the uniformity of his sexual greediness is preserved by diet
corresponding to the season, which renders the whole twelvemonth a
perpetual spring. Man, as well as other animals, is, when in a state
of health, capable of procreating upon almost any food. But when there
is debility of the digestive or generative organs, the injury can be
repaired by the use of proper stimulating diet, thereby occasioning due
and sufficient secretions.

Air, exercise, health, and prosperity, are not without considerable
influences. If seasons are not positively influential, certain it is,
that particular lunar and solar periods are, taken in conjunction with
the state of the body.

“Morning,” says a French writer, “is the spring of the journey, when
all the functions of the body are renovated.” Others declare, that when
night veils the light of the day, the quietude and secresy thereby
afforded, offer moments most congenial to the gratification of mutual
love. Sexual transports should be avoided after a repast, instances
having been known of apoplexy being induced by the excitement of
connexion being superadded to the stimulative influence of wine and
food.

Henry II. consulted one Fernal for the infertility of his queen,
Catherine de Medicis. The advice submitted, comprised the following
notifications: Abundant and peculiar nourishment; occasional change of
residence; the allowing several days to elapse between each conjugal
act; and lastly, that the most favorable moment for impregnation was
immediately on the cessation of menstruation. It was not until the
adoption of these hints, that her majesty conceived.

Professor Dewees, of Philadelphia, enjoins that, for the enjoyment
of marriage and the production of children, matrimony should not be
engaged in, until the body is healthily and completely developed; until
then the most scrupulous continency should be preserved. From the 23d
to the 25th year is the suggested period for the male; from the 19th to
the 21st, the female. These observations apply to Europeans chiefly;
for in India, women become mothers at ten, owing to their early
development. Precocious marriages bring premature decay on the father
and mother, and entail on their offspring, diminutive stature, debility
of body, and imbecility of mind, thus generating consumption, scrofula,
insanity, &c. Well-regulated marriages contribute to social and lasting
happiness, and the prosperity of the nation at large; but ill-assorted
ones, those where the peace of either is infringed by opposing
tempers, or by the after-discovery of hitherto concealed physical
incapacities, present a scene of wretchedness and disappointment to
which death itself were preferable. These remarks might be considerably
amplified; but enough has been said, to induce those who approach
to manhood, to be provident of that which, once lost, is, under all
circumstances, difficult to regain; and those on the eve of embarking
in the most binding and solemn obligation of all human contracts,
marriage, to ponder well, ere they compromise the happiness of others
as well as themselves, by engaging in a compact, they may know
themselves incapable of fulfilling or of efficiently performing; one
from which they can not with honor retreat, and one that, once sealed,
demands a rigid compliance with its recognised duties.

The gist of the present article may then thus be summed up: That
self-indulgence and excessive sexual cohabitation are hurtful in the
highest degree; that they induce early impuissance, and bring down a
load of menial and corporeal ailments. That premature marriages are
destructive to health and long life, and that weak and sickly children
are the general result where impregnation of the female follows. That
entire continence was never ordained, and is alike productive of
disease. That moderate copulation propagates the human kind, preserves
health, and promotes longevity, and the sexual capability is thereby
retained to the latest verge of senility.

That it is unnatural and unjust for impuissant persons to intermarry
with those having healthy expectations, and the power of enjoyment;
and that it behooves all who have a doubt as to their own capacity,
to have that doubt removed; but, if rendered evident, to abstain from
shipwrecking their own happiness, or from occasioning disappointment to
others.




               THE HEREDITARY TRANSMISSION OF DISEASE.


THE topics of Incontinence, Celibacy, and Marriage, having been
severally considered relatively to their effects on society, viewed
alike also as to their influence on the health and happiness of the
sexes in general, another equally engrossing one naturally presents
itself for inquiry to every thinking and sensible person who may
contemplate, or be about embarking in what the world deems “a serious
speculation,” matrimony, namely, the probability of issue, and how far
the health of the progeny may be influenced by that of the parents.
That conception requires the necessary aptitudes in both man and wife
is indisputable; and that although such capacities are rarely absent,
still all unions are not prolific; hence the inference, that some cause
must exist to account for such infertility.

It may be local or moral, as elsewhere in this volume explained, which
not being the main purport of this paper, needs no other allusion
beyond the mere reference. The prevailing resemblance between parents
and children in features, form, voice, and even constitutional
peculiarities, is sufficiently well known to satisfy any one of the
similar possibility of the transmission of disease, or sound health.
“It is of great consequence to be well-born; and it were happy for
human kind, if only such persons as are sound of body and mind should
be allowed to marry.”

We find in Boethius’s work, “De veterum Scotorum Moribus,” that
anciently, in Scotland, if any were visited with the falling sickness,
madness, gout, leprosy, or any such dangerous disease, which was likely
to be propagated from the father to the son, he was instantly gelded; a
woman kept from all company of men; and, if by chance, having some such
disease, she were to be found with child, she with her offspring was
buried alive. The Spartans destroyed all weakly and deformed children.

Great as the anxiety may be to perpetuate our identities, to create
new objects on whom we may concentrate all our affections and love,
and who, when born to us, so instinctively bind us the more to this
already attractive world, where is the man who does not feel humbled
and mortified at beholding in his anxiously looked-for offspring,
the unfolding of infirmity and disease? We are content to encounter
the ordinary chances of mortality, let but our children bear the
impress of health, and possess the shape of perfect man; but sad and
desolating are the reflections that spring from observing in our
issue the developments of the evils we have nurtured in ourselves.
How many existing beings are there, inhaling the breath of life, in
whom every respiration feeds the flame of disease, ignited by those
from whose loins they sprung, and is hastening them to a premature
tomb. How many are there, secluded from the enjoyment of that, which
being deprived of by some scrofulous, pestilential, or other hideous
deformity, renders them like isolated wanderers on the earth, and for
ever forbids their participation in the main charm of existence—social
intercourse. How many living specimens of human prototypes, in whom
reason is obliterated, or never dawned, drag on an existence inferior
in enjoyment to the forest-hunted beast, or the animal whose life
is yielded for the nutriment of man. And are not the diseases that
involve so calamitous a result, consumption, scrofula, gout, idiocy,
or insanity, traceable in particular families, to the remotest periods
of their ancestral records? And should not then a knowledge of cause
and effect, like that just detailed, induce individuals about to fulfil
one of the purposes to which they were certainly destined, for the
perpetuation of their own race, if only from the pride of human nature,
well to consider the result of such a consummation? The health of
either party is generally omitted among the categories bandied about
preliminary to the completion of the other, though decidedly not more
important, arrangements of the nuptial contract; or if it should not
be, many infirmities, that are well known to descend hereditarily,
are (granted in some cases not premeditatedly, but from ignorance of
such a result) yet carefully concealed. Cutaneous blemishes, incipient
tubercles, or a scrofulous predisposition, which may be likened to the
germes of a fruitful plant sown in a torpid soil, lie in ambush, and
await some genial transplantation to display their productiveness,
which matrimony, by the analogous change which it effects in different
constitutions, speedily encourages. In this manner, other morbid
phenomena are aroused from their lurking place, whether it be in the
brain, the lungs, or the blood, and transferred to those who succeed
us.

I need not, therefore, waste a line prefatory to, or apologetic of,
the following illustrative definition of health, by which any one
with tolerable acumen may estimate the probable “worth of a life,”
or, at all events, be spared the plea of ignorance, or misplaced
confidence, when taking a step of such importance as wedlock. There are
numerous means of calculating upon the durability of human life, by
an examination of the countenance, the gait, the attitude, the form,
the skin, the temperament, the breathing, the speech, the sleep, and
in fact, to a practised professional eye, there is not much difficulty
in observing some diagnostic mark, if sickness be secreted in the
constitution. The countenance in health varies with the age. Health is
indicated by a plump, not puffy or bloated state of the face, a fresh
complexion, and an absence of that depression around and particularly
below the eye, so observable in persons of sick health. The nose should
not be “pinched,” as it were, at its junction with the face, nor
should there be deep indentations, called furrows, or wrinkles, at the
angles of the mouth or eyes, which rarely are manifested in healthy
individuals, except they be aged through care or time. Many people part
very reluctantly with each succeeding year, and few conform to the
outward symbols of age. The era was when age was honorable; now few
aspire to it, and such is the deception that would be practised, that
the coffin-plate is the only tell-tale.

If the teeth have dropped out or decayed, the lower jaw will be
observed to be more elevated, the lips drawn inward over the gums,
and the chin and nose approximating each other; the cheek bones will
also be very prominent, and the skin thereon shiny and tightly drawn:
these are pretty fair characteristics of disease, or old age. The
temperaments modify the complexion. In the sanguine, it is florid
and soft; in the bilious, dark and rigid; in the phlegmatic, lax and
pallid; and the nervous is modified by its general union with the two
former. In health, the countenance is expressive of contentment and
gayety, which indicate a happy state of mind, and healthy condition of
body. In ill-health, it is pale and expressive of languor and sadness,
signifying discontent and nervous debility. Where asthma exists, or
other nervous affections of the chest prevail, there is pallidness
or lividity, a worn-down and distressing look, and in consumption,
in addition to the above, there are alternately, on the slightest
exertion, gentle flushings. A bluish tint of the skin denotes some
organic affection of the heart. In dropsy, the countenance is bloated,
or of a waxy puffiness; and in acute indigestion, there is a lividity
of the lips, nose, and cheeks. A slow and cautious step, a bending
of the body, a laxity and flabby feel of the muscles of the arms,
chest, and lower extremities, a tumid abdomen, or a swelling of the
feet and ankles, are no indications of health. Tremulous hands mark
age, nervousness, or intemperance. Hurried breathing, palpitation of
the heart, frequent attacks of perspiration, sleeplessness, are all
symptomatic of weakness, hysteria, or disease. Persons subject to
bleedings, are usually of a waxy paleness, and soft fibre. Allowances
must be made for females during the menstrual period, whose complexion,
at that period, being less clear and fair, is marked by a dark areola
around and below the eyes, the breath is slightly tainted, and a
languor is evidenced in all their actions. A voracious or scanty
appetite, a dry and shrinking skin, a furred and loaded tongue with
indented sides, signify the digestive organs to be deranged. In
long-standing dyspepsia, the nose, feet, and hands, are generally cold.
Emaciation is an infallible diagnostic of disturbed health, and a
bloated state equally characteristic. Fits, gout, rheumatic disorders,
asthma, occasional brain affections, diseases of the bladder, &c., can
not be considered as warranties of health.

Lastly, with respect to intemperance, the bloated appearance, the
tremulous state of the muscular powers, the fetid breath, and the
sunken eye, sufficiently identify the cause, to arrest all doubts on
the subject. Where intemperance exists in married life, it is the bane
of all comfort and enjoyment; and heaven help the unhappy partner of
such a companion. There is but one consolation, that every indulgence
of this insane practice tends to sap and break up the powers of the
constitution, and hastens the close of such a union. The drunkard
should be reminded, that “some leaves fall from the tree every time
that its trunk is shaken;” and the dreary nakedness of winter is
brought on, long before that season would have commenced in the regular
course of nature.




                     IMPUISSANCE, OR IMPOTENCE.


UPON pursuing the consideration of the following infirmities of the
Reproductive System, a few prefatory observations are requisite.
Perhaps of all the physical powers possessed by man, few are subject
to so much abuse as the procreative organs—certainly none are more
required to be, in a hygiænic point of view, held in a sounder
condition of health, for upon their tone and perfect structure hinge
the happiness and perpetuation of the human race. In this age of luxury
and sensuality, however, the world seems untiringly hunting after, and
more or less obtaining, sexual gratification. There can be no doubt,
that a greater amount of this species of sensual enjoyment is indulged
in before manhood arrives, than can be obtained when man should be
in his vigor. The writer is not insensible to the many alluring
publications upon this topic, the end and aim of which are not,
honestly, to afford relief to the diffident sufferer, but to add to
his misery, by draining his pocket. Of legitimate publications, alas!
there are but few, for it appears that qualified medical men have, from
some prudish or other such notions, kept aloof from entering the lists.
Were it otherwise, many an unfortunate victim might be spared from the
avaricious clutch of the empiric; but invalids, from such a knowledge
of the absence of fair and honorable references, are obliged to seek
(or despair of) relief from the unworthy class in question. How far the
tendency of the present work may lead to a reformation, is left for the
reader to decide. The novelty of the present compendium may subject
it to invidious suspicion; the author but invites comparison, feeling
convinced that the contents best bespeak its legitimacy and usefulness.

“Increase and multiply,” is the scriptural text. “Plant trees and
beget offspring,” is the apothegm of the Magi. The perpetuation of
the species being, with the great Designer of the universe, an object
of the first interest, all living beings are mentally and physically
formed with a view to this great end.

In the human species, procreation is effected by a congress of the two
sexes, and a variety of organs are provided, upon whose condition the
due performance of coition mainly depends. The male is destined to
furnish a peculiar fecundating secretion, and is accordingly provided
with glands to prepare such fluid, and a conduit to convey the same
to its proper destination; while the female, being the recipient,
possesses an organ capable of effecting a mysterious yet specific
change upon the fluid so deposited: a failure, therefore, in any of the
structures alluded to, is followed by impotence or sterility.

Impotence implies the incapability of sexual intercourse; sterility,
the inability of procreation; the causes of either of which may be
deemed organic, functional, or moral. The following section will be
devoted, firstly, to its consideration in its relation to the male.


                             SECTION I.

                IMPOTENCE AND STERILITY OF THE MALE.

WHERE the hindrance to cohabitation arises from organic defect,
congenital malformation, or diseases of some of the organs of
generation, the disqualification may generally be considered absolute
or irremediable. It is remarkable, however, to what extent mutilation
or disease may occur, without total annihilation of the procreative
powers; the smallest remnant of the penis, for instance, capable of
entering the vagina, provided the testes be sound, being sufficient for
impregnation.

A learned lecturer on medical jurisprudence gives it as his opinion,
that the smallest quantity of seminal discharge, deposited in the lower
part of the female generative apparatus, _provided the female be apt to
conceive_, is sufficient for impregnation: and it is astonishing how
_minute_ a quantity of this plastic agent is necessary for that purpose
in some species of creatures. Spallanzani took three grains by weight
of the male fluid of the frog, and mixing it with seventeen ounces of
water, found that impregnation of the eggs was produced by as much of
this exceedingly weak mixture as would adhere to the point of a fine
needle.

Although, in human formation, it is not essentially necessary that the
male material should be deposited in the upper part of the vagina of
the female, yet there is little doubt that the deeper entrance of this
substance conduces to impregnation.[13]

Malformation of the genital organs has already been stated as a cause
of impotence. Such cases furnish much uneasiness at first, but are
easily relievable. I have met with many instances, where consummation
has been prolonged from months to years, which a slight knowledge of
the functions of the parturient organs might have relieved in a few
days; and with respect to the latter, it may be pardonable to mention
that, as the husband should be the first to instruct his companion in
what is to be expected, but little disappointment will be experienced,
except with the vicious and unworthy.

There is room for much ingenuity in these matters; and as marriages are
made for better or worse, there exist powerful inducements to resort to
the contrivances of the ingenious and humane.

The following case of malformation fell under my own observation; the
adjoining delineation is a true picture of the circumstance.

[Illustration]

The penis, _b_, at its under surface, was adherent, from birth, to the
scrotum _c_, consequently, when erection ensued, it presented the form
of a half circle; the urine escaped near the root of the penis, _a_.
The penis itself was impervious, but sensible to the amative passion.
The gentleman submitted to a division of the fold which united the
penis with the scrotum, which former, on being thus released, assumed
its proper position; sexual congress was thereby attainable, and during
erection the orifice of the urethra was drawn sufficiently up to allow
of the ejection of the semen into the vagina. Of the ultimate result I
have yet to hear.

[Illustration]

It may appear almost incredible, that the sketch here presented can
be a true one of the penis and testicles of a young man upward of 19
years of age. No less was it a source of wonderment to myself than it
may afford a doubt to others. I carefully examined the individual, and
saw him urinate; the stream was certainly small, but surprisingly large
for so minute an organization. He was quite unconscious of amative
feeling; the testicles were distinctly perceptible by the finger, but
they certainly were not larger than cherry kernels. The young man, in
other respects, preserved the male attributes; he had a slight beard,
and his voice, though not powerful, was by no means effeminate. I had
several interviews with him, and then lost sight of him.

I have elsewhere portrayed a relaxed state of the testicle, called
varicocele: the accompanying draught exhibits the same in an aggravated
form. The patient possessed but little amative power, and had also
a thickened condition of the prepuce, which produced a perfect
_phymosis_. The case, however, under treatment became considerably
relieved. The phymosis required a division of the prepuce, an operation
productive but of little and momentary pain, or rather twinge, and
healed in a few days. Children are sometimes not procreated for want
of sufficient erectile and consequently penetrative power of the male
organ. Much and often needless misery results from this infirmity.

[Illustration]

The loss of erectile power is occasioned through more causes than one.
Erection ensues independently of the will or imagination, as instanced
on awaking in the morning—the cause is most probably a distended
bladder; the phenomena may be a sympathetic irritability of the muscles
of the perinœum, especially the erectores; there is a general pelvic
disturbance, the nervous excitement is increased, and the rush of blood
(obedient to that excitement) is sent to the penis: such, I believe,
is the sympathy between all these structures. The will exercises the
same, and the results of the imagination do not materially differ;
consequently, where the mind fails in producing these effects, local
excitants may be found to supply its office hence the usefulness of art
in combating the eccentricities of nature. The mere handling of the
testicles kindles desire, and in like manner, stimulatives applied over
the scrotum generate amative heat.

A curve of the penis is sometimes an obstruction to connubial
intercourse; this arises from adhesion or obliteration of the cells of
the _Corpora Cavernosa_ on one side only, preventing the uniform flow
of blood into those structures, and consequently the equal distention
of the penis. The curve is of course laterally, and occasions in the
act of coition pain to both parties, or the power of penetration is
insufficient. Occasionally this malformation is only temporary, and
consequently remediable.

_Franck_ gives an instance in which so considerable a portion of the
penis had been carried away by a musket-shot, that when the wound
healed, the organ remained curved, and yet proved adequate to the
performance of its functions.

An opinion formerly prevailed, that the existence of the testes was
unnecessary for effective copulation; but that is no longer a point
of dispute: their absence, whether natural or artificial, invariably
rendering the invalid unfruitful. It is not, however, to be inferred,
that a person is impotent in whom no testicles are discovered in
the scrotum, instances occurring where they do not descend from the
abdomen (their embryotic abode) through the whole period of life. One
testicle, provided it be sound, is sufficient for procreation. Complete
extirpation of the testes, although destructive of procreative powers,
does not extinguish venereal desire. Where the genital organs exist,
but are malformed, or pathologically altered, their virility may be
nullified.

The most frequent malformation is in the _urethra_, which sometimes
opens in the perinœum—the part marked _a_ in the annexed cut; at
others, on the dorsum of the penis, and not unfrequently under its
surface: so long, however, as the orifice opens in that portion of the
penis which enters the vagina, so that the _emissio seminis_ may be
therein deposited, impregnation may and will take place; and even in
cases where artificial means have been employed to convey the fluid.

[Illustration]

A contracted state of the prepuce, its adherence to the glans, or that
condition of it termed phymosis, form impediments to the emission of
the semen which can only be removed by an operation; and if that be
neglected, the evil continues through life.

Among the diseases which occasion sterility in the male, those
affecting the penis and those incident to the testicles may be
enumerated. With regard to the former, there often exists an excess
or deficiency of muscular or nervous energy, inducing _priapism_
or permanent erection in some instances, or paralysis or permanent
flaccidity in others. In _priapism_, the erection is so vigorous,
and all the parts so distended, that the semen can not pass into the
urethra; while in _paralysis_, from some inaptitude of nervous or
muscular powers of the genital organs, the _corpora cavernosa_ receive
but a limited supply of blood, insufficient to create erection, or
provoke a seminal discharge.

Strictures of the urethra are among the barriers to sexual intercourse;
but happily, only in extreme cases, where the urethra is all but
closed, so as to oppose the passing of the finest bougie.

The testicle is subject to a variety of diseases, wherein such a
relaxation or obliteration of its structure ensues, that the seminal
fluid is no longer formed: and where both testicles are alike affected,
sexual desire is most usually wholly extinguished—the smallest portion,
however, of either gland remaining uninjured, may still be capable of
secreting semen sufficient for impregnation.

Impotence may follow accidents to the testicles, such as produced by a
bruise; or even a testicle, which shall have become inflamed from clap,
shall become so chronically hardened as to be useless. Bruising the
testicles was the mode adopted by the oriental courts for destroying
masculine efficiency in the attendants of the harem.

There are certain conditions of health in which, although the genital
organs may be perfect, yet, owing to some constitutional frigidity,
there is an incapability of erection. The offspring of too young, or
very aged, infirm persons, or of those worn down by debauchery, are but
too common instances.

The appearance of persons of this temperament is thus described by
a French writer: “The hair is white, fair, and thin; no beard, and
countenance pale; flesh soft and without hair; voice clear, sharp,
and piercing; the eyes sorrowful and dull; the form round, shoulders
narrow; perspiration acid; testicle small, withered, pendulous, and
soft; the spermatic chords small; the scrotum flaccid; the gland of the
testicle insensible; no capillary growth on the pubis; a moral apathy;
pusillanimity and fear on the least occasion.”

The most frequent cause of impotence, at that period of existence when
man should be in the zenith of his procreative power, is in a general
weakness of the generative organs, induced by too early an indulgence
in coition, the pernicious and demoralizing crime of masturbation, or
the abuse of venereal pleasures. In these cases, erection will not
take place, or but feebly, although the mind be highly excited by
lascivious ideas. The erector muscles are paralysed from over-use,
and the semen, if any is secreted, from the lax and withered state of
the testes, is clear, serous, without consistence, and consequently
deficient of prolific virtue. Sometimes there is a want of consent
between the immediate and secondary organs of generation; thus, the
penis acts without the testicles, and becomes erected when there is no
semen to be evacuated; while the testicles secrete too quickly, and an
evacuation takes place without any erection of the penis; the latter
disappointment is of extensive prevalence.

Impotence is sometimes occasioned by particular diseases during their
continuance, such as nervous and malignant fevers; while, strange to
relate, an opposite effect is sometimes produced by other diseases,
such as gout and rheumatism, hæmorrhoids, &c.; and instances are on
record, that others produce such a change in the constitution, that an
impotent man may find himself cured of his impotency on their cessation.

Of all the functions of the animal economy, none are so subservient to
nervous influence as those of generation, which, when the organs are
perfect, and respond not to the natural application of them, the cause
may be classed among those impediments termed moral.

As the parts of generation are not necessary for the existence or
support of the individual, but have a reference to something else in
which the mind has a principal concern; so a complete action in those
parts can not take place without a perfect harmony of body and mind,
that is, there must be both a power of body and disposition of mind;
for the mind is subject to a thousand caprices which affect the action
of these parts.

As these cases do not arise from real inability, they are to be
carefully distinguished from such as do; and, perhaps, the only way
to distinguish them, is to examine into the state of mind respecting
this act. So trifling often is the circumstance which shall produce
this inability depending on the mind, that the very desire to please
shall have that effect, as in making the woman the sole object to be
gratified.


                            SECTION II.

               IMPOTENCE AND STERILITY OF THE FEMALE.

A FEMALE may be impotent, and not sterile; and sterile, but not
impotent. Impotence can only exist in the female, when there is an
impervious vagina; but even this condition does not necessarily infer
sterility, many cases being recorded, where the semen, by some means
or another, through an aperture that would not admit a fine probe, has
found entrance to the vagina and occasioned impregnation.

Impotence may arise from a malformed pelvis, the absence of a vagina,
adhesion of its labia, unruptured hymen, or one of such strength as
to resist intromission. In the two former instances, sterility is
irremediable; but art, and indeed nature, may overcome the latter
impediments.

Were these pages intended only for the surgery, instead of the
public, the annexed wood cuts would be unnecessary, medical men being
conversant with the inconvenience in question; but all the world not
being blessed with similar anatomical information, the sketches are
presented. The upper one represents the relative situation of the
female urethra (1), and the contracted orifice of the hymen (2).
In the cases of hardened obstruction, where the hymen assumes an
almost cartilaginous texture, the attempts at marital consummation
are fruitless, and often give rise to severe local inflammation. The
infirmity, on the other hand, is easily and painlessly removable by
surgical skill. The lower drawing represents a hymen with two apertures
(2), which, if broken down by violence, leaves a troublesome lacerated
wound. The surgeon’s assistance is indispensable.

[Illustration]

[Illustration]

Where hermaphroditism exists, the sex is usually more masculine; it is
a vulgar error to suppose that the two sexes exist entire, and that
they are capable of giving and receiving the offices of married life.
The present sketch is merely introduced to show the more frequent
malformation.

The penis exists, but has no urethra: below is an opening resembling
the vagina of the female, which is but of short length, at the bottom
of which (in fact, the perineum) the urethra opens. The testicles are
entire, and the individual from whom the draft was taken possessed
somewhat the desire of the male, without the capability of penetration:
the penis, when excited, from its attachment to the lips of the
imaginary vagina, and also from its contracted form, presenting merely
a kind of bulbous tumor. Even where hermaphroditism more closely
partakes of the female, conception never takes place; hence all such
parties are sterile.

[Illustration]

Nature, as if to atone for denying to some the delights of maternity,
has been occasionally doubly bountiful to others. The annexed drawing
exhibits a section of a double uterus. Cases are on record, where both
have been impregnated.

[Illustration]

In the instance of a deceased married female, that fell under my
observation, the uterus or womb presented the following appearances:
The usual cavity was discoverable, but it was filled with a
_cheesy_-like substance, and also there were some ulcered-looking
caverns filled with the same material. This female, while living,
endured continued pains in the uterine region, was insensible to
marital physical enjoyments, sterile, although a wife several years,
and the constant sufferer from a vaginal discharge. Her death was
consequent upon a severe cold that ended in consumption.

[Illustration]

Leucorrhœa is often attended with barrenness; at all events, it is very
debilitating, and thus impedes conception. A notion once prevailed,
that women who did not menstruate could not conceive; it has since been
disproved, except in those instances where menstruation never occurred:
a single monthly discharge indicates an aptitude for conception. It is
observed that barren women have very small breasts. Women who are very
fat are often barren, for their corpulence either exists as a mark of
weakness of the system, or it depends upon a want of activity in the
ovaria: thus spayed or castrated animals generally become fat. The same
remarks apply to the male kind, who are outrageously corpulent. There
are many other peculiarities in matrimonial life, fertile subjects
for speculation; such as, for instance, the lapse of time that often
occurs after marriage before conception takes place, and the space
between each act of gestation; the solution of which may be, that these
occurrences are modified by certain aptitudes, dispositions, state of
health, &c.; the same may explain why persons have lived together for
years in unfruitful matrimony, and who yet, after being divorced, and
marrying others, have both had children.

It is not always that the most healthy women are more favorable to
conception than the spare and feeble. High feeding and starvation
are alike occasionally inimical to breeding. The regularity of the
“courses” appears principally essential to secure impregnation; and the
intercourse is generally held likely to be the more fruitful that takes
place early after that customary relief.

Women in health are capable of bearing children, on an average, for
a period of thirty years, from the age of fifteen to forty-five;
but their incapacity to procreate does not deny them the sexual
gratification, it being well accredited, that women upward of seventy
years of age have been known, who have lost but little of the amative
inclination and enjoyment which they possessed in their early days. Men
certainly possess their procreative power to a longer period, it being
common for men to become fathers at eighty, ninety, and one hundred—old
Parr becoming a parent at the age of one hundred and thirty. Women
rarely fall pregnant beyond fifty.

Some females endure intense pain during coition, so as to occasion
fainting or great exhaustion. Such suffering is usually traceable to
internal ailments—such as _piles_, _fistulous_ _openings_ between
the _rectum_ and _vagina_, _ulcerated wombs_, _vaginal tumors or
abscesses_. Cases continually present themselves, where, on the removal
of the cause, the effect is cured.

The number of children that women have individually given birth to is
very variable. It is attested, among a collection of facts of this
nature, that one female gave birth to eighteen children at six births;
another, forty-four children in all, thirty in the first marriage
and fourteen in the second; and in a still more extraordinary case,
fifty-three children in all, in one marriage, eighteen times single
births, five times twins, four times triplets, once six, and once
seven.[14] Men have been known to beget seventy or eighty children in
two or more marriages. With regard to the average proportion of male
and female births, it appears that the males predominate about four
or five only in one hundred. The average number of children in each
marriage is, in England, from five to seven.

To a continual irritability of temper among females may be ascribed
infertility. Independently of ever fostering domestic disquietude, it
produces thinness and feeble health; and, where pregnancy does ensue,
it most frequently provokes miscarriages, or leads to the birth of
ill-conditioned and puny offspring.

Perhaps one of the most indispensable and endearing qualifications of
the feminine character is an amiable temper. Cold and callous must be
the man who does not prize the meek and gentle spirit of a confiding
woman. Her lips may not be sculptured in the line of perfect beauty,
her eye may not roll in dazzling splendor, but if the native smile be
ever ready to welcome, and the glance fraught with clinging devotion,
or shrinking sensibility, she must be prized far above gold or rubies.
A few moments of enduring silence would often prevent years of discord
and unhappiness; but the keen retort and waspish argument too often
break the chain of affection, link by link, and leave the heart with no
tie to hold it but a cold and frigid duty.


                           SECTION III.

                      TREATMENT OF IMPOTENCE.

IN venturing upon this part of the subject, it will be as well, first,
to distinguish those cases that are curable from those that admit of no
relief. Among the latter may be enumerated all those arising from an
original or accidental defect in the organs of generation. Where, also,
old age is the cause, little is to be done: medicines are of no avail,
and temporary stimuli not unfrequently worse.

That certain medicaments, aliments, and so forth, do possess an
_aphrodisiac_ power, is not to be denied; but when adopted by those
weak beings, whose bodies are either worn out by age or excess, and who
pin their faith to such restoratives, the little remaining sensibility
in their frames, the source of life and energy, can not sustain the
shock of reaction; and the result is, total annihilation or death.

From what has already been stated, it will be perceived, that the mind
exercises no inconsiderable influence over the functions of the organs
of generation: and as the state of the mind depends upon the particular
circumstances under which it may be placed, any attempt to establish a
code of instructions, applicable to every instance in which a sportive
fancy, or disturbed imagination, constituted the prevailing cause,
would be abortive, and might be considered as pandering to a vicious
and depraved appetite, whereas the object of this treatise is only to
encourage the diffident, to assist the afflicted, and render a service
to those legitimately deserving it.

As excess in sexual indulgence impairs the generative power, no less
injurious may entire abstinence be considered. The due exercise of an
organ tends to its perfection, as the neglect or misuse of it, to its
impairment. Besides, there is not any wonderful virtue in abstaining
from the proper use of the sexes. Why, in the name of morality, were
such powerful impulses and desires bestowed upon us? Why were such
wonderful organizations given to us, if they were not originally
designed to be used by every one who is possessed of them? Society,
in its present form, is not perhaps constructed with a philosophical
regard to our own natural instincts, and our own original rights.

Among the causes that induce _impuissance_, or that distressing
condition known under the cognomen of _nervous debility_, there is
not one more reprehensive than the unworthy and pernicious practice
of self-abuse. It is much to be regretted, that some medical writer,
of talent and estimation in society, has not turned his attention to
the subject, and given the influence of his name in denouncing to the
world the misery and devastation which are the unerring consequences of
this sordid and solitary vice. It is indeed an unpleasant and thankless
task; and there probably exists in most minds, an unwillingness to
enter upon a subject in which there is so much difficulty in selecting
language sufficiently appropriate to exhibit the folly in its true
colors, without offending the ears of the chaste and virtuous.

But a question of such paramount importance should not be sacrificed
to any false and prudish notions of delicacy; I shall therefore offer
such observations, as I may think calculated to check the progress
of a vice, that has done more to demoralize the human mind than the
whole catalogue of existing causes besides. It may be deemed an
exaggeration, when it is stated that full three fourths of the insane
owe their malady to the effects of masturbation: but the assertion is
corroborated by one of the first writers on medical jurisprudence,
and is fully borne out by the daily experience of proprietors of
lunatic asylums. The practice of self-abuse usually has its origin
in boarding-schools, and other places where young persons congregate
in numbers; and there are few of us who may have observed the vice
practised, although it may be unpleasant to avow as much, that could
resist the contamination.

                “One sickly sheep infects the flock,
                 And poisons all the rest.”

And thus it is, though ninety-and-nine be pure and spotless as
the driven snow, if the hundredth be immoral, the poison is soon
disseminated, and the whole flock become initiated into a vice, which,
if indulged in, will blast their intellectual faculties, and probably
consign them as outcasts of society; rendering them slavering idiots,
or the inmates of a lunatic asylum. It is not only in private schools
that this sin rages, our public foundations and colleges are not exempt
from it. The heads of our universities are particularly scrupulous
in driving from their neighborhood the frail fair, lest they should
contaminate the votaries of learning; while a vice far more degrading
in its practice, and infinitely more baneful in its effects, rages
within the very sanctuaries of classic lore. Many a brilliant genius
has sunk into fatuity beneath its degrading influence. Loss of memory,
idiocy, blindness,[15] total impotence, nervous debility, paralysis,
strangury, &c., are among the unerring consequences of an indulgence
in this criminal passion. I need not bring a greater proof of the dire
effects of an indulgence in the practice of masturbation, than the
deplorable state of mind to which it reduced one of our greatest poets.

The treatment of this delusive and mentally annihilating propensity,
falls equally within the province of the philosopher and the physician.
Without a total abandonment of the practice, the case is hopeless; and
he to whom the consequences shall have been portrayed and heeds them
not, is unworthy of our sympathy, but deserves the evils he entails
upon himself.

Now, as the consequences of all criminalities continue to ensue so
long as the provocative be kept up, it is very evident that, as a
first step toward the restoration of order and health, the cause
must be removed or withheld. The mere will or resolution is seldom
sufficient: virtue, like vice, has its allurements, and those belonging
to the former must be called into requisition as antagonists to the
snares of the latter. Physic can not check bad principles, or bad
indulgences. No method is or can be superior to that full employment
of the mental faculties on noble and intellectual subjects, on objects
worthy the high ends for which Nature has adapted them. And though
the difficulty will be great in inducing new and good habits, to the
exclusion of such as are unworthy and degrading, yet the effectual
accomplishment of such a resolution is not of uncommon occurrence; and
the sufferer may be placed under circumstances where good habits may
be more frequently called into action naturally, to the exclusion of
vicious propensities. The time should be well filled, so as to leave
no room for flying to the various usual sources of amusement that fill
up the life of the thoughtless and gay. Every hour and every minute
should be provided for, so as to exclude the admission of idleness and
sloth, the forerunners of mental and bodily disease. Studies connected
with education should be encouraged. Modern languages have a great
claim on the consideration of all who are engaged in business to any
extent, and are of incalculable use after they have fulfilled the
immediate end for which their culture is here recommended. The various
sciences bearing more or less on the pursuits and employments of
every man, are earnestly recommended to the choice of the unfortunate
victim of sensuality. Geology and botany would call him into the
healthful fields, or fill up his time by his fireside, in studying the
many excellent works on those subjects: the still higher utility of
chemistry, as being made of practical use in almost every business,
and demonstrating the else unintelligible phenomena of a multitude of
natural processes and changes, may be held up as another inducement to
call forth his best energies.

Travelling, to those who can afford the expense or the time, is one of
the best means of conquering this baneful habit. The numerous objects
thereby presented to the eye of the invalid in the manners, government,
and productions of art and nature, of the countries he visits, are an
incessant source of pleasing and useful excitement, and can not fail,
especially if the traveller be accompanied by an intelligent and moral
friend, to weaken and eradicate the bad impressions of the past.

To diverge, and at the same time to conclude this part of the
subject, I have only to offer a few remarks relative to the medical
and therapeutic treatment of those cases of impuissance, that
age, disorganization, and total incapacity, do not exclude from
consideration. I have already expressed my belief that generative
imbecility is consecutive to general debility; hence, whatever tends
to improve the latter, tends also to remove the former. The diet,
therefore, should be full and generous, with a liberal proportion of
spices; but all stimulating liquids, such as wine, brandy, and the
rest, should be avoided.

Bathing, in its various forms, constitutes no unimportant feature in
the treatment; the cold plunging, the tepid shower, the douche, the
warm and the vapor baths, possess their several influences. The various
medicines that come under the denomination of aphrodisiacs, are not
wholly uninfluential, such as stomachics, aromatics, gums and balsams,
oils, musk, opium, cantharides, strychnine, and others; but as their
administration can only be permitted under professional direction,
no real utility can follow any specification or formulary of their
proportions.




                   OTHER FORMS OF SEXUAL DEBILITY.


INVOLUNTARY seminal emissions are oftentimes very serious, distressing,
and intractable. They may be produced in two ways—from continence, or
by a high degree of morbid irritability or weakness. The latter is by
far the more frequent; for the treatment of the former is obvious,
and generally effectual. The difference between seminal discharges in
persons of full health, and those morbidly weak, is very opposite: in
the former it is consequent upon an erection, followed by an act of
coitus; while in the latter both are absent. The general debility in
the generative system, inseparable from morbid irritability, occasions
both a failure in the erection of the penis, and an inability to
retain the fluid in the secreting organs. There is no doubt that this
disposition to seminal emissions, conjoined as it generally is with
more or less deficiency of the _vis virilis_, is too often owing to the
habit of self-abuse in early age. The testes usually wither in these
cases, and the patient becomes nearly, if not entirely, impuissant.
Sometimes these cases are attended by an excessive irritability of
the bladder, accompanied by pains in the loins, kidneys, &c. Their
treatment consists in taking nutritious and digestible food, to impart
strength and invigorate the constitution. Stimulants are at the same
time to be carefully avoided, except where great languor and lassitude
prevail. Abstemiousness in liquids is to be enjoined. Habits of a
relaxing nature should be avoided; the patient, instead of sleeping
on a soft, downy bed, should lie on a firm mattress; the air of the
room should be preserved at a moderate temperature, and but few hours
should be allotted to sleep; he should pass much of his time in the
open air in a cool atmosphere; taking frequent and moderate exercise,
so that it does not occasion fatigue. Cold bathing is a very important
and essential part of the treatment to be observed; the daily use of
the _bidet_, or the frequent application of a towel, dipped in cold
water, to the testes, applied twice or thrice a day, or the _douche
bath_, will be found of much service. To prescribe formulæ for the
various temperaments subject to this affection would be to transcribe
all the tonics from the pharmacopœia: they are severally useful, but
the various preparations of iron surpass all others. During this
treatment the state of the mind should not be neglected: no lascivious
idea should be for a moment encouraged, nor should the imagination be
permitted to wander over the works of fiction or romance in any way
connected with matters of love.

It not unfrequently happens that patients affected with these
complaints are apt to despond, and become miserably depressed in
spirits; to remove which, every recreation should be encouraged to
prevent them pondering over their own situation, and, if possible,
to divert the mind from gloomy ideas: lively and agreeable company
should be courted; theatres, concerts, or any other rational amusement
consonant with the principles of the patient, should be visited or
pursued, and by an uninterrupted perseverance in this mode of treatment
for a sufficient length of time, I have seen the most beneficial
results arise. The great art and difficulty in treating these cases
consist in giving tonics to a certain extent and no further—avoiding
excess, whereby we stimulate and produce fever; or depletion, and
induce debility. Early hours, fresh air, exercise, attention to diet,
the shower bath, topical application of cold, with properly regulated
sexual intercourse, are rarely ineffectual in curing the disease.

I could narrate many instances wherein the sexual desire declined on
the intervention of ordinary illness; any powerful mental solicitude
will suffice, but such a cause is commonly remediable. Where the
cause is traceable to excesses and pernicious indulgences, if not
accompanied by disorganization, hope should not be abandoned; but the
patient should not cling to, or hang his reliance upon, hole-and-corner
speculators, or their advertised specifics. He should consult men
legitimately engaged in the profession, in which, perhaps, more talent
and honor are concentrated, than in any other department of science.




                      ON PILES OR HŒMORRHOIDS.


AS this disease is generally considered to be of a delicate nature,
and one about which the afflicted are unwilling to speak, we shall
say a few words on them. Piles constitute a disease that may be very
slow or very rapid in its progress. The patient complains of an
occasional itching or soreness at the rectum after an evacuation, more
particularly if subject to constipation, or if he be an irregular
liver: when, after a while, he will be surprised on discovering,
subsequent to some straining effort, a knot of elastic but irregularly
formed tumors, of a size varying from a hazel-nut to a horse-bean,
springing out apparently from the rectum, that in a few days, if they
continue, will become sore, and probably be attended with a discharge
of blood.

[Illustration:
  1. Rectum.

  2. Hœmorrhoids.

  3. Perineum.]

Another patient will experience similar symptoms, as regards the pain,
swelling, and discharge of blood, except that they will be increased
in severity, and be more transitory in their appearance and stay.
Upon examination, a perceptible difference will be discovered. In the
former instance the tumors will be seen to proceed from the outer edge
of the rectum, and will be found to be covered with the common skin.
Professional men designate this form of the disease “External Piles.”

[Illustration:
  1. Inner part of Rectum.

  2. Orifice of Rectum.

  3. External Piles.

  4. Internal Piles.]

In the latter, the tumors are, as it were, squeezed out of the rectum,
and swell in a very short space of time to an enormous size. They
are of a much more vivid blood-red color, and will be found to be
covered only by the lining membrane of the lower gut. These are called
“Internal Piles.”

[Illustration:
  1. Inner part of Rectum.

  2. Orifice of Rectum.

  3. Internal Piles.]

Now piles are nothing more nor less than _dilated veins_, like varicose
veins in the leg or any other part. The office of veins is to receive
the surplus blood of the arteries, after having parted with that
necessary supply for the nourishment of every structure they are
severally distributed to, and to convey it back to the circulating
organ, the heart—and the mesenteric hœmorrhoidal veins, from their
dependant and confined position, the circulation in and above them
being liable to so many interruptions from the frequent hardened state
of the fæces in the rectum, become distended with blood, which acting
really like a wedge, dilates them in time to the size we meet them.
On the removal of the cause, the blood flows on, and the swelling
subsides, and the patient feels no further inconvenience until a
recurrence of the pressure. After repeated attacks, the veins become
inflamed, and lymph, a sort of defensive mucus, is “thrown out” on the
cellular membrane covering the veins, and becomes organized into an
indurated texture, which increases with each attack of inflammation,
and at last gives them that fleshy appearance which resembles a
specific growth (see annexed cut).

[Illustration]

The distinction between External and Internal Piles is as follows: In
both instances the same veins are diseased. In external piles, the
lowermost portion of the hœmorrhoidal veins are dilated, and are thrust
by the outer side of the rectum, carrying before them the common skin,
which dilates and constitutes the external coat of the piles. The
rectum is a portion of gut of four or five inches in length, and of
nearly a uniform width; the lower end, constituting the orifice, is, as
it were, tied round with a contracting and yielding band of muscular
fibres, forming a muscle called the _Sphincter Ani_. It is a muscle
of great power, and, from its connexion with the neighboring muscles
of similar strength, helps to afford that support to the contents of
the pelvis, that otherwise would descend, and be always forming a
projecting tumor. External piles consist, then, of a protrusion of the
hœmorrhoidal vein or veins between the cellular union of the sphincter
with other muscles, constituting, in fact, a hernia or rupture in the
perinœum. Internal piles is that condition of the hœmorrhoidal veins,
where, from their dilatation, they become protruded with the fæces,
when, from the contraction of the sphincter acting like a ligature,
they can not regain their situation until emptied of their contents.
Inflammation soon ensues, and the various changes I have and shall
hereafter consider take place.

Having stated the cause of piles, namely, pressure on, and thereby
prevention of, the circulation of the blood through the hœmorrhoidal
veins, it follows that persons mostly annoyed with constipation must be
the most likely to be afflicted with piles; hence, free and intemperate
livers, great wine-bibbers, feeble and relaxed constitutions, those,
again, who take little exercise, and pregnant women, and women who have
borne many children, seldom escape them. It is rarely that piles attack
people in the lower class of life, and those who have to work hard for
their livelihood and are much in the open air, which accounts for the
prevalence of this disease in the upper ranks of society. The treatment
of piles is very simple, if proceeded with at the commencement of the
complaint, the grand object being to prevent constipation. An excellent
adjunct to the cure of incipient piles, is the warm bath. Its tendency
to overcome local congestions, and thereby equalize the circulation of
the blood, is well known. The best medicine a hœmorrhoidal patient can
take is Turkey rhubarb, to be chewed freely, or castor oil, in doses of
one or two teaspoonfuls every morning, or some mild electuary, which
should be continued until the piles subside.

The diet during this treatment should be temperate and laxative. Fruits
should be used freely, and also coarse bread, rye and Indian mush and
molasses; wine and exhilarating stimulants being avoided, and, where
admissible, as much out-door exercise taken as possible. An excellent
plan is also to inject half a pint or more of cold pump or spring water
up the rectum every morning, and suffer it to remain for twenty or
thirty minutes, if possible. Where the piles have been of several days’
continuance, and are very much swollen, puncturing them with a needle,
and so relieving the tension by evacuating, or at least diminishing
their contents, that the obstruction shall be overcome, is serviceable.
After this, pledgets of lint dipped in cold water, the patient
preserving the horizontal posture, may be applied, or an astringent
lotion may be used.

Where there is much swelling and inflammation, leeches applied to the
neighboring parts will afford relief. It is impolitic, although some
surgeons recommend it, to apply leeches on the tumor, as the bites
are oftentimes very difficult to heal. Where the piles will admit of
it, attempts should be made to empty them, and press them to their
places, after which a pad may be worn to prevent their descent. In the
commencement of the disease, where there is much heat and itching, a
mild and astringent ointment will prove of considerable utility, and a
wash of powdered opium, dissolved in flaxseed tea, will relieve pain
and soreness.

A very excellent and practical method in the treatment of piles (the
internal I am now speaking of) is to deposite a pear-shaped bougie or
pessary in the rectum, and suffer it to remain as long as possible. The
wearing of bougies gives no pain or even uneasiness, and the patient
may pursue his or her ordinary occupation without hinderance: the
bougie should be worn from one to several weeks. It affords constant
pressure against and support to the dilated veins, and enables them to
regain their tone and strength; and I have known numerous instances
where a lasting cure has been effected. One of the most alarming
consequences of piles is hœmorrhage or bleeding; and it is really
wonderful what an extensive loss of that fluid a patient can sustain.
Day after day, and week after week, have I known instances of constant
bleeding from internal piles, by which the constitution of the patient
has been almost broken up. This symptom mostly prevails with females,
nor is it limited, although more prevalent, to those who are pregnant.
There is naturally a strong objection on the part of a delicate and
susceptible female to submit to a professional examination, and
consequently it is rarely done, until the urgent necessity of the case,
lest death should ensue, induces the patient to consult her medical
adviser, that he becomes acquainted with the real nature of the case.
Where there is ulceration of the piles, and they are very numerous,
and the bleeding frequent and profuse, the only effectual cure is
their removal. Where the operation is objected to, the next method is
to employ astringent enemata, which must be regulated by the medical
attendant.

The celebrated Weir’s balsam (248½ Grand Street) has the credit of
effecting miraculous cures. It is a medicine of deserved repute, and
ranks high with professional men. Pitch pills have been extolled.

Now, where piles, both external and internal, do not yield to the
means suggested, or the patient may not think proper to avail himself
of them, the next best step is their removal; and this is done either
by excision or by ligature. Both processes are safe in the hands of a
medical man, and are neither attended with any pain nor suffering worth
notice.

Among the annoyances incident to the rectum, is an occasional
preternatural contraction of the sphincter muscle. It is generally the
consequence of local irritation set up by purgatives, by which the
orifice becomes sore and excoriated, which, if not timely relieved,
ulcerates, constituting cracks also, and in process of time a portion
sloughs away, and the adjacent edges unite, and thereby diminish the
calibre of the opening. This disease _may_ be congenital, that is,
the individual may be born with a contracted or narrow sphincter. The
treatment, naturally enough, is to dilate the orifice, which is to be
attempted by the introduction of bougies, after the mode advised for
the cure of stricture, of which this in reality is a form. The cracks
of the sphincter are occasionally obstinate to heal; and the ulceration
will spread within the rectum. When that is the case, the application
of any stimulative ointment will promote a healthy action.

In inveterate cases division of the sphincter is necessary, which is
to be done with a scalpel, and the incision should be made from within
laterally, by which injury to the perineum is avoided. The operation is
very simple, and by no means painful or dangerous: the cure is perfect.
Appropriate medical treatment must not be neglected.




                      PROLAPSUS OF THE RECTUM.


[Illustration]

THIS disease is often confounded with piles; and as patients are
generally diffident in submitting to an examination, any extraordinary
protrusion of piles they denominate a falling of the gut. _Prolapsus
Ani_ is distinguished from piles by the muscular coats of the intestine
descending with the mucous membrane, and forming a bag, like a
pendulum, to the length of many inches; the rectum, in fact, becomes
everted, as we see the finger part of gloves when turned inside out;
and the inner membrane being highly vascular, and the vessels in a
congested state, it assumes a blood-red appearance. The case is here
well portrayed. Of course the disease occasions much inconvenience and
if not abated by appropriate treatment, serious consequences ensue.
Piles are most commonly the cause of prolapsus, when, from the frequent
and hard straining, the gut at last descends, bringing the piles with
it, which will be seen winding around the upper part. When that is
the case, the best treatment is first to apply a ligature round the
hœmorrhoids, and then return them and the rectum together. Where
the gut protrudes from relaxation of the sphincter, the treatment
depends upon local support, for which there are many contrivances.[16]
Astringent injections should also be used to give tone to the parts,
and medicines given to render the alvine evacuations less hurtful.
Children are very liable to prolapsus, but with them a return of the
fallen gut, and a brisk purgative is all that is needed to prevent a
repetition, provided proper attention be paid to the bowels afterward—a
disturbance of the latter being, in most instances, the cause. Where a
rectum has been for a long time the seat of disease, excrescences are
apt to arise, resembling warts: they may be removed without much pain,
and with perfect safety.




                      STRICTURE OF THE RECTUM.


THE rectum, it is presumed, is known to be the lower portion of the
intestines that leads to the outlet called, in domestic language, the
fundament. Now some writers assert that the rectum answers the same
purpose to the bowels generally, as the urethra does to the bladder,
while others contend that it is a receptacle for the fæces previous
to their expulsion. We are all sensible, I think, that it must answer
both purposes; but it is also evident that it is employed more for
the former than the latter purpose. The moment the rectum is full,
there is a desire to empty it, which is the best proof of its office;
but circumstances oftentimes forbid us, for even hours, obeying the
summons, which establishes its capability as a recipient. Well, the
rectum, consisting of muscular and membranous coats, similar to the
urethra, is alike subject to irritation, inflammation, and ulceration,
and imitatively gives forth morbid and other secretions. The rectum,
from its situation and office, is very obnoxious to disease; and in
addition to those already enumerated, it is extremely liable to become
strictured.

Neither age nor sex are exempt from this strictural change, although
it more usually selects the grown up and female portion of society.
It is, generally speaking, the consequence of constipation, or
the reverse—diarrhœa or dysentery—or it may follow in the wake of
child-bearing. Piles are a frequent precursor. The ordinary symptoms
are at first a slight difficulty in voiding the fæces, which assume the
form of the passage through which they have to pass, presenting at one
time a flattened tape-like shape, at others a spiral appearance, and
again the natural form, but of very small diameter.

As the disease advances, the pain increases, upon going to the
water-closet, and after the act may be observed a small or copious
discharge of mucus, or blood, from the anus. If the bowels be
constipated, there is necessarily a great deal of straining during
fæcation, that soon establishes spots of inflammation that rarely
resolve, but run on to ulceration; small lodgments then of fæcal
matter take place in the cellular membrane; and without detailing the
pathological phenomena, it may suffice to say, that sooner or later
the whole rectum becomes diseased, and fistula, with its attendant
miseries, lends a speedy help to close life’s brief pilgrimage.

Patients afflicted with rectal diseases lose flesh rapidly. From
the constant pain and annoyance they endure, their general health
gets undermined, the digestion becomes faulty, the countenance flags
and looks care-worn, hectic fever awaits the break-up of functional
regularity, and a lingering exhaustion closes the scene.

Stricture of the rectum is a curable disease; but the less complicated,
the greater are the chances of recovery. The principles of treatment
bear a near resemblance to those for stricture of the urethra. After
having ascertained the situation and size of the contraction, a
proper-sized bougie may be introduced, and suffered to remain as long
as it occasions no inconvenience. The introduction should be repeated
every or every other day, increasing the size of the bougie until the
dilatation be fully perfected. After vigilance is necessary to prevent
a recurrence, and the bougie can not with propriety be entirely laid
aside, or the disease will return with increased violence. There are,
however, cases that require more imperative means, such as the use of
the _bistouri_, an instrument for the division of stricture of the
rectum, which, if the resort be objected to, it behooves persons with
the premonitory symptoms to attend to them, that the operation may be
rendered unnecessary. There are many excellent palliative medicines
that the invalid will derive much comfort from in diseases of the
rectum; and enemata constitute a powerful means of relief. The title of
stricture of the rectum is fortunately more familiar than the disease
is frequent; and what is more consolatory to persons of feeble health,
the complaint seldom extends beyond two or three inches from the
orifice, so that it need not be feared beyond the reach of relief. See
annexed drawing:—

[Illustration:
  1. Rectum.

  2. Orifice of Rectum.

  3. Stricture of the Rectum, with internal hæmorrhoids in
     the lower portion.]

There are some surgeons who state all diseases to emanate from a
disordered liver, a weak stomach, or a “broken wind;” and there
are others in this town who are never consulted but they deem the
use of the rectum bougie indispensable. The limit to structural
disorganization of the bowel is not afforded by stricture; there are,
unfortunately, many diseases springing therefrom, and many totally
independent of such; but their detail here would exceed the titular
object of the book. Enough has been stated to convince any person
teased with any of the enumerated symptoms, that however simple may be
his malady in his own opinion, it is impolitic to overlook or neglect
it.




                            THE URINE.


WE shall conclude our treatise by a few remarks on diseases of the
urine, to which many are subject. Before proceeding to speak of them,
it is necessary, for a full understanding of the subject, to state,
that the urine is secreted by two bodies called _kidneys_, placed one
on each side of the back-bone, as is shown in the cut. After being
formed, the urine passes through the _ureters_ into the bladder whence
it is voided, as every one knows, occasionally.

[Illustration:
  1—1. The Lungs.

    2. The Stomach.

  3—3. The Kidneys.

  4—4. The Ureters.

    5. The Bladder.]

The following diagram shows the bladder and its muscular coats, and
also its neck imbedded in the prostate gland. The bladder is seen
distended, and, of course, as detached from the body. The kidneys are
also seen—one in its natural state, the other divided to show its inner
structure: the kidneys and their ureters are crossed to save space in
the sketch.

[Illustration:
  1. The entire kidney. 2. Its cortical, or secreting part. 3. The
  papilla. 4. The pelvis. 5. The ureter. 6. The bladder. 7. The
  detrusor muscle. 8. The sphincter muscle. 9. Prostate gland.
  10. Neck of the bladder.]

The bladder and adjacent parts are seen more fully in the diagram at
the top of the succeeding page.

[Illustration:
  1. Corpus cavernosum.
  2. Bulb of urethra.
  3. Membranous portion of ditto.
  4. Prostate gland surrounding urethra.
  5. Seminal vesicles.
  6. The two vasa deferentia.
  7. The ureters.
  8. The bladder.]

It is a very common observation with patients, that they never were in
better health in their lives than at the moment of consulting their
medical adviser, except in the very particular malady, such as an
ulcered limb, a teazing cough, a gleety discharge, or an irritable
bladder, that they are seeking relief for; “they are quite well,” they
say, “in every other respect.” When illness attacks an individual, it
does not always announce its arrival by sound of trumpet. It does not
always come on like an apoplectic shock: some minor organization is
generally the first to indicate disturbance in the healthy economy by
even so simple a presage (I will take for example, more especially as
the ensuing remarks bear upon the subject) as excretion of disordered
urine. To resume; the patient will content himself, that the only
fault in his system is the disordered condition of his urine, and
he earnestly seeks for something to touch that particular symptom,
forgetting that trifling as he may fancy it, it is not merely owing to
the office of the kidneys and bladder, but to the blood itself, whence
the urine is formed, and to other circumstances in the economy that
influence it. Therefore, it is not merely the urine which is at fault,
but the state of it is a pretty good indication of the general state of
health; and when it becomes vitiated, the urine is generally, unless
restored to a healthy condition, a forerunner of some more serious
evil. Still there are many variations in the character and quality
of the urine, and each depending upon different causes—some upon a
disordered state of the fluids of the body, some upon one remote cause
or another, deranging the balance of the circulation, and inducing
excessive perspiration, and the like; and certainly not the least
important, nor the least influential, exist in the very structures
that make (as it were) and receive the urine, namely, the kidneys and
bladder. I may observe here, that chymists have detected upward of
twenty different substances, animal and saline, in its composition,
but in a state of complete solution. Of all these component parts, the
most important is an animal product named _urea_, which exists in about
the proportion of one in thirty to the water containing it, while the
other materials taken collectively, water excepted, yield only about
double the quantity of the urea: hence, when the urine is disordered,
its specific gravity[17] is increased or diminished, as the case may
be; according to the abundance of the urea, and the various proportions
of the saline ingredients of the urine, so is the urine thick, thin,
acid, or alkaline, pale, or what is called high colored. The various
conditions of the urine are ascertained by producing chymically certain
decompositions, or by suffering the urine to effect its own changes,
which, on being suffered to “stand,” sooner or later it will.

Healthy urine is perfectly transparent and of a light amber color;
it yields an odor when warm resembling violets. Its taste (for
pathologists trust not only to sight and smell) is saltish and
offensive. As the urine cools, it throws up what may be said to be a
“urinous smell.” As decomposition proceeds, the urine becomes cloudy,
thick, with shining floating patches on the surface; and lastly, a
thick deposite coats the bottom and sides of the vessel, the whole
giving forth at the same time a fetid ammoniacal exhalation, as is
perceived on entering public urinals.

The rapidity with which these several mutations occur, affords some
criterion of the healthy or disordered state of the excretion we are
talking about, and hence the usefulness of examining especially the
urine of persons laboring under any disorder of the urinary system and
functions connected therewith. A patient will complain, for instance,
of irritable bladder. The symptoms of that complaint, as far as pain
and frequent desire to micturate exist, very closely resemble those
affections known by the name of “Diabetes,” but which is distinguished
from the bladder affection in question by the quantity and character
of the urine. I purpose herein to enumerate, in as familiar a manner
as is possible, the various disordered states of the urine which my
experience has rendered me familiar with, and to present the same as
heretofore, in the form of cases that have fallen under my notice.

Now, the urinary disorders that I purpose to collect a description of,
and exemplify, may be thus enumerated:—

First, where too great a quantity of urine is voided.

Secondly, where too little is discharged; and also, where suppression
of it entirely occurs.

Thirdly, those states where the urine deposites a sediment, of which
two kinds are mostly prevalent, namely, the Lithates or Acid, and the
Earthy or Alkaline.

Fourthly, a brief exposition of the many but less frequent morbid
changes of the urine, in which certain salts and substances, not
existing in healthy urine, are precipitated or held in solution.

And lastly, to add a few to the number of those already presented
herein, of the infirmities of those organs which excrete the fluid
under consideration, namely, the kidneys and bladder.




                      ON INCONTINENCE OF URINE.


ALTHOUGH this is not the professional term for the disease I am
principally about to speak of, yet under this head will the reader, if
he be an invalid laboring under a complaint of this character, seek for
a description of his own case. Incontinence of urine implies a loss of
the retentive faculty of the bladder; but there is a species of disease
where micturition is carried to such an extent, that a patient will
attribute his leaky condition to the above cause. Not so, however,
is the case; the urine, in the disease alluded to, is generated or
excreted in great quantity, and the bladder merely fulfils its ordinary
duty. Of the affection known under the title of incontinence of urine,
most persons are aware that it is one of more frequent occurrence in
infancy than in adolescence; but the latter is by no means exempt.
In childhood it arises, in all probability, from drinking too much,
and the bladder becomes, during sleep, overloaded, and runs over; or,
perhaps, from the irritability induced by its distension, becomes
excited to action, and so empties itself, the drowsy state of the child
rendering it insensible to the passing circumstances.

The infirmity soon becomes a habit, which is often rendered worse by
the means taken to check it, namely, chastisement, which is highly
reprehensible. It is fortunately, however, a disease that wears itself
out as the child grows up; and it may at all times be materially
mitigated by a little care and attention, such as inducing the child
to micturate before going to bed, and even awakening it before the
anticipated time when it usually is attacked with the incontinence.
The last fluid meal, which should be a spare one, should be taken some
hours before retiring to rest; and if the complaint has gained much
ascendency, medicines which give tone to the bladder should be taken.
I have known the malady successfully removed, in a very short time, by
a combination of the sulphate of iron and quinine, and any sedative
extract, such as henbane or hops, given in small doses in the form
of pills. Female children are more susceptible of the annoyance than
males, probably owing to the shortness of the urethra. Every measure
tending to give strength to the child should be used, such as cold
bathing, fresh air, or a change of the same, especially if residing
in the city, to the country. Mechanical contrivances are to be had
to collect the escape of urine, whereby the offensive odor arising
from the continually soiled bed-linen may be avoided, and oftentimes
the fretting consequences of the urine passing over the person, which
induce excoriations and troublesome sores. There are contrivances for
both sexes. Where the disease prevails in mid-life, it is generally
traceable to early improvident habits, and of course is the result
of irritability and debility of the bladder. There are many patients
who can somewhat control the functions of that organ while awake, but
have no power over it when asleep. The treatment depends a great deal
upon the observance of abstemiousness both in eating and drinking:
a perseverance in chalybeate remedies, both taken and administered
internally (I have injected the bladder of a person subject to nightly
incontinence of urine with various tonic preparations, with very great
and permanent relief); the use of the warm bath, whereby the skin is
brought into healthier action (for it is generally arid, and parched
when much urine is voided), which tends to lessen the duty of the
kidneys and urinary system, should be adopted; nor should exercise,
that _pabulum vitæ_ of even all feeble persons, be disregarded. It is
of the utmost importance for the preservation of health, under all the
circumstances in which we may be placed. Escaping from this digression,
I now proceed to follow out the idea of the first paragraph of this
chapter, to treat of those complaints wherein the urine is voided in
excess. There is a disease commonly known by the name of diabetes,
wherein the prominent symptom is a continual aptitude to pass urine,
and in much greater quantities than the fluid consumed as ordinary
drink could supply. This is one form of ailment of this class; but
there is another, happily less inimical to life, and which, in the
order of its frequency and simplicity, should take precedence. It
is that state of health, where the patient is of that leaky habit,
that whatever he takes runs through him, and that very quickly too.
Of course, such a condition must depend upon a seriously-deranged
constitution: hence there is present a perpetual thirst, an entire
perversion of the perspiratory function, and a morbid condition of
many of the phenomena of life. Where this disease springs up in early
years, it becomes a habit proper to existence; and although it may not
seriously disturb the economy of the being so as to lessen the duration
of one’s stay here, yet it furnishes a source of much solicitude, by
depriving us of rest, and shutting us out from society.

The patient (for such he or she may be truly called, and the complaint
invades both sexes) appears to have a perpetual fever. Such is
the desire for drink, that attested cases record the circumstance
of individuals consuming from _one_ to _two pailfuls_ of water in
twenty-four hours! and I positively know an instance, at the moment of
writing this, of a child, fifteen years of age, consuming during the
night, notwithstanding a plentiful supply of liquids during the day,
a large jugful (two quarts) of water: the quantity of urine excreted
is nearly equivalent. In this case, the perspiration is profuse, and
the child enjoys tolerably good health, with the exception of being
occasionally nervous and hysterical. The case is under treatment, and
the quantity of fluid allowed is being daily diminished. The urine on
these occasions is aqueous, very pale, and of little specific gravity;
the properties of the urine otherwise are not altered. These cases
sometimes exist through life; and if they do not terminate fatally,
they ultimately enfeeble the health, and predispose the patient, or, in
other words, render him less able to combat with ordinary complaints
common to us all, and thereby tend to the break-up of his constitution.

There are many persons tipplers, not for the love of the specific
liquor, but from being always thirsty; and if we reflect a little, we
shall soon find how inclined we are to encourage the habit. Since the
introduction of tea into this country, what inordinate quantities of
that fluid are consumed by individuals. They must, of course, dispose
of it, after having drunk it: the stomach can not retain it, and it
escapes either by the skin or kidneys, more usually the latter. It is
no uncommon thing for nurses, washerwomen, and other females too, to
swallow nine or a dozen cups of tea at a sitting: they declare it is
their best meal.

Man is a great deal more careful of the quadruped world than the class
he belongs to himself. He will stint his horse drink, who works as much
beyond his strength as man does under his own, while he, the driver,
will swill till his mouth can scarcely receive another drop. The moral
of a volume might doubtlessly be expressed in very few words, but then
it would not be a volume, and, consequently, would not be purchased or
read; therefore, the proposition herein intended to be presented to
the reader would exist unheeded. It is one thing to observe, that we
all drink too much, or that too much fluids are hurtful to digestion
and other functions, the public require some illustration (which their
own reflection would furnish, if they used it), and hence this expense
of verbosity to prove the fact. As one of the consequences, then, of
too great an indulgence in fluids (I am here speaking of quantity
rather than quality), this form of complaint, wherein the patient is
perpetually desiring to urinate, is decidedly the result; and, as
all complaints have a beginning, this may be considered as the first
step toward setting up the several affections of the kidneys and
bladder hereafter treated upon. How important, then, is the arrest of
this practice. Where the inconvenience thus detailed is present, the
quantity of fluids must by degrees be diminished, the general state of
health must be studied. Dieting and warm-bathing are two sheet-anchors,
if properly applied. All remedies tending to afford strength to the
urinary system must be had recourse to; and where the bladder loses
any of its retentive power, I entertain the greatest benefit from an
injection.

The next form of urinary disturbance of a proximate nature to the
one just described, is also where the urine is discharged in large
quantities; but, unlike the former, excreted in greater abundance than
the supply. The character of the fluid is also different; it assumes
two appearances, modifications doubtlessly owing to the constitution
of the patient and the severity and length of the disease. It is known
by the name of diabetes: it is happily a complaint the least frequent
of urinary derangements, else, from its obstinacy and difficult
management, the slightest urinary disorder would excite much just dread
and apprehension.

The forms of the complaint thus vary: In the one instance, there is a
deficiency of the animal matter of the urine, namely, the urea, and in
the other, a superabundance of it. In the former instance the urine
is of a pale color, and transparent, and sometimes like clear water,
with a very faint slight odor; whereas, in the latter it is generally
of a higher color, and now and then so thick as to resemble brewer’s
porter: it is decidedly a disease of great debility. The symptoms are,
a wearisomeness and languor of the whole frame, a dry and crimpled
state of the skin, a sinking, gnawing pain at the pit of the stomach,
the bowels are obstinately bound, while a great thirst always prevails.
The body wastes to a mere skeleton, the discharge of urine being
almost constant, at least every hour, accompanied with a call that
must be immediately obeyed: the leading feature in the composition
of the urine, in addition to the varied presence of the urea, is the
saccharine matter contained therein. It rarely attacks others than
those who have led an irregular life, or else have suffered much from
other kinds of sickness.

Diabetes is supposed to depend upon a perverted action of the kidneys;
but there is little dispute of its being a malady involving the
whole process of animal economization. The quantity of urine got rid
of in a day has been known to amount to ten quarts; as the disease
continues, the patient becomes much emaciated, the feet swell, and he
sinks into a state of low hectic fever; the urine discharged continuing
all this time to exceed nearly double the amount of nourishment,
liquid or solid, that is taken, has given rise to the idea, that
water is absorbed from the atmosphere through the body. The disorder
is generally lingering, and, unless conquered, at last fatal. The
treatment embraces many remedies—bleeding, emetics, diaphoretics, and
sedatives, are mostly employed. It being a complaint involving the
necessity of constant professional watchfulness, a more lengthened
dissertation upon its peculiarities will but little serve the patient.
My own opinion is, that the invalid must look for recovery—presuming
the initiatory symptoms have been duly attacked and subdued—to careful
diet, fresh air, varied scenery, and cheerful society. Bathing, either
vapor or warm, is immensely useful; and, among the cases that have
travelled across my path (for patients laboring under diabetes, like
any other chronic ailment, generally take the round of the profession),
I have seen much and great good achieved by the frequent employment of
the bath.

As diabetes is mostly a sequence of some previous disturbance of the
urinary system, it the more behooves the afflicted to heed the first
noticial summons of attack: a handful of water will sometimes quench a
mouldering ember that, suffered to rise into a flame, an engineful can
not extinguish. I may add, there is no cause so destructive to virility
as these drainages from the system through the urethra—an additional
reason why they should be attended to upon their first appearance.

_Cases where but a small quantity of urine is voided, terminating in
suppression, of urine._—The most popular scientific synonymes for
complaints are but little understood by men really of education; for,
as yet, medical knowledge forms not one of the items of collegiate
lore, and few anticipate sickness to render such acumen necessary. The
term “Strangury,” from the frequency of its occurrence, is uppermost in
most men’s minds; and they use it on all occasions when there happens
an interruption to the process of making water. It is oftentimes
misapplied. Strangury implies a difficulty in voiding the urine, but
it does not include those cases wherein little is voided, because
there is little to void. The affection I am now about to make mention
of, is of the latter description. I have stated that the urine is
subject to a multitude of changes, that the human frame is constituted
to exist under a variety of circumstances, and that occurrences are
daily happening, wherein its integrity is put to the test. Excesses,
termed sensual, and others, which in themselves might destroy life,
are counterbalanced by what may be styled the _safety-valves_ of the
system. A violent fit of purging, perspiration, or micturition, is
often the means of warding off an otherwise fatal blow. The skin, the
bowels, and the kidneys, are severally to be acted upon as emergencies
demand: instance the specific operations of diet and medicines. The
color of the urine is altered by (to give a popular illustration)
_rhubarb_; its odor, by _turpentine_ (taken internally, or from an
inhalation of the vapor of them), and by the well-known vegetable
_asparagus_; and its composition by alkaline and other chymicals. The
function of cutaneous exhalation is augmented or diminished by warmth
or cold; and the action of the bowels is suspended or increased by
innumerable substances, forming portions of our daily food.

Analogous to these effects, is the result of certain conditions of
ill-health. A patient, laboring under fever or inflammation of any
important organ, will scarcely rid himself of a wineglassful of
blood-colored urine in the twenty-four hours; and there are many forms
of ailments, where the function of separating the urine from the blood,
or even the function of supplying the kidneys with that vital fluid,
are suspended, partially or entirely. Few of us have escaped attacks of
this kind; they are sure to follow long-pursued habits of dissipation,
or even occasional displays of it; and they are often the result
of accidents over which we have but little control. A patient will
complain of a frequent desire to make water; each effort so to do, will
be accompanied with excruciating pain. A small quantity, or a few drops
only, will dribble away, excoriating the passage as though vinegar was
passing over it, and putting on an appearance almost resembling muddy
port wine, or a thick solution or suspension of brick dust: there will
be present much fever and constitutional disturbance. The patient may
have shivering fits, pain round the loins, down the thighs, and over
the lower part of the abdomen. He will betray a readiness to submit to
anything, although conscious that his bladder is empty, notwithstanding
the violent and urgent efforts at straining, which he is continually
being called upon to make, as though his bladder were distended, and
ready to burst. On passing the catheter (I am supposing a severe case,
where retention of urine has at last occurred), not a drop will flow,
and the danger of the disease is thereby made apparent. Except very
severe measures be adopted, which it would be idle here to lay down,
the case is sure to terminate fatally. Instances are recorded, where
that event has been retarded upward of a week, during which time the
patient voided not one drop of urine.

The absolute cause of the disease is very obscure; but it has a
beginning, and to those only who suffer from a long-continued
diminution in this natural excretion, and who disregard it, is this
picture presented.

The treatment, in advanced stages of the disease, is strictly
professional; but the warning of the altered character of a customary
evacuation, should not for a moment be disregarded.

Suppression of urine is very different from retention: in the former,
there is none to excrete; in the latter, its escape is impeded. In the
chapter on stricture, the cause and manner of retention is explained,
and the mode of relief laid down, whereby the invalid himself has
a remedy at hand; but, in suppression, the resource is neither so
ready nor so effectual. It is, therefore, much wiser to notice the
first alteration, and to be prompt in seeking the nearest aid. Every
practitioner is acquainted with such. Although such are not ever
present, even in the most extensive practice, still they do occur; and
much as this mode of frightening a patient may be condemned, knowing
the frequently existing disinclination toward “laying up,” yet, if it
only induce a fellow-mortal to take the tenth instead of the eleventh
hour, one life may be saved, and the writer can well submit to the
disapproval and contempt of the thoughtless and indifferent.




                            THE GRAVEL.


UNDER the head of this disease may be classed all those urinary
affections, wherein a sandy deposite is observed, after the urine
has stood some time. This sandy excretion varies in its composition,
in the quantity voided, and in its continuance: and it is also often
separated, for it is held generally in solution in the urine as it
comes from the bladder, while in the bladder or in the kidneys; and
hence we find gravel in the kidneys, in the bladder, and in the
urine. Where it is precipitated, or formed in the kidneys or bladder,
it is apt to accumulate, and constitute what is called “Stone” in
those organs. As I have just observed, the composition of this gravel
differs, and differs also at different times in the same individual,
according to circumstances. Stones have been detected that, like the
rolling snowball, gather up, as they increase in size, whatever comes
in their way; and, accordingly, as the deposites are principally
composed of concretions, termed, in chymical phraseology, “Lithates”
and “Phosphates,” stones are frequently found to be formed, first of a
layer of one covering, then of another, and so on.

Gravel may exist for years without inducing much disturbance of
health, or it may produce serious inconvenience in a very short time.
The urine being acid, holds the salts which it contains in solution;
and, therefore, if the acid predominate, it becomes, through its own
excess, thrown down, when it is detected in the form of red sand; but
if there be an insufficiency of acid, the earths and salts of the
urine are thrown down, and they exhibit their existence in the form of
white gravel. Hence the two names “Red” and “White Gravel.” Acidulated
urine is looked upon as certainly indicative of health, and when in
excess, of a high tone of health; which, as the degree ascends, is
marked by inflammation and fever. Alkaline urine betokens feebleness of
constitution, or interrupted health. High living and an excited life
induce red gravel; irregular, or an impoverished living, with much
mental inquietude and physical exhaustion, establish white gravel.
The fact of gravel being known to exist without forming stone, is no
justification to suffer it to incur even the chance of such a finale.
There is no class of diseases so painful and distressing as those
wherein the function of the kidneys or bladder is interrupted, and the
majority of these affections are ushered in by a derangement of the
urinary fluid.

_Cause of Gravel._—The cause of gravel is owing to chymical affinities.
The urine, among its other constituents, contains _lithic acid_ and
_ammonia_, which two, in healthy urine, are combined and held in
solution. If any other acid, as may be instanced in expelled urine,
possessing a greater affinity for the _ammonia_ than the _lithic
acid_, be added, the _lithic_ will be thrown down. The same process
takes place when effected in the system, the source of which new acid
is the stomach, which, when in an irritable and feeble state, as in
indigestion, furnishes or abounds with muriatic acid. In like manner,
the urine containing salts, called phosphate of lime, ammonia, and
magnesia, on receiving an additional quantity of ammonia,[18] the
lime, for the less affinity to phosphoric acid than the ammonia,
is thrown down; and hence a salt, bearing its name, is generated,
either to be expelled like gravel, or to feed a nucleus already
existing in the bladder. These chymical changes are produced by the
causes before enumerated. We are subject to an infinitude of laws:
we are perpetually changing, and these changes may fairly be stated
as chymical affinities: it is owing to such, that the absorption of
fluids, and the deposition of substances, which exist more or less in
all derangements of health, ensue—to such, that we resist death, and
to such that we become its prey. Gravel is a disease not so productive
of fear or suffering, so long as it escapes when formed; but there are
so many circumstances that may give rise to the formation of stone,
that sandy urine should always command notice and treatment. A clot or
point of blood, that may have been discharged from irritation of the
kidney or bladder, is often found to form the nucleus of a stone: the
slightest substance, once in the bladder, is apt to form a basis for
accumulation: a pin, a fragment of a bougie, or any instrument, hair,
wood, and numberless other things that have found their way into the
bladder, have given rise to the formidable and distressing complaint of
stone.

_Treatment of Gravel._—It is not to be anticipated that every person
is prone to excrete gravelly urine, else certain dietetics, that
evidently give rise to the same in particular instances, had better
at once be removed from the list of articles of food, and their use
prohibited altogether; but there are instances where a constitutional
disposition exists in particular families, that is even transmitted
from generation to generation, to calculous diseases, and in those
cases, every precaution should be taken to avoid even their development.

The antidotes to the disposition to gravelly urine are, exercise,
temperance, and the adoption of all those means that tend to promote
a healthy action of the skin and kidneys, namely, the warm bath—it is
a perfect talisman in these affections—it needs but little eulogy;
the comfort and relief, where relief is sought, afforded on the first
experiment, best bespeak its praise. It is decidedly one of the most
useful adjunctive prophylactic measures we have.

I have already stated, that disorders of the urine arrange themselves
under two great heads—the acid and the alkaline prevalence. The
treatment is to neutralize the excess of either: the acid diathesis, as
it is called, is considered a less healthy deviation than the alkaline,
and is looked upon as indicative of greater constitutional break-up.
The medicines most in vogue in gravelly disorders are, turpentine (to
increase the formation of lithic acid), sulphuric, nitric, and muriatic
acids; while the antagonists to that form of the disease, wherein
the above are given, consist of ammonia, potass, and soda. The great
object, however, is to balance the health, to allay irritation, and
tranquillize the morbid uproar of the system. Here we have an extensive
field to select from in the class of sedatives. Opium, perhaps, is the
best—the most to be depended upon, its properties being best known; the
warm bath comes next; and lastly, the various tonics and astringents of
our pharmacopœia, of which quinine, uva ursi, pareira brava, achillæ
millefoliæ, buchu, &c., &c., stand foremost.

Although the lithic acid deposition is the most frequent, still, as the
disease advances, there is a strong tendency to the formation of the
alkaline; and as the remedies for the former are apt to accelerate the
latter disorder, it is most important that the urine should undergo
frequent examination to regulate the treatment. To recapitulate the
substance of this article, it may be stated, that gravel is a disease,
not dangerous in itself, but that it is always the forerunner, although
not always productive, of stone; stone being formed by the collection
and chymical union of the sand itself. This collection takes place
in the kidney, the ureters (the vessels that convey the urine to the
bladder), the bladder, and sometimes in the urethra. The stone so
formed varies in its composition and size, and is one of the saddest
ills that can befall human nature. Hence the importance of watching,
and attending to every urinary disturbance, of which gravel forms a
prominent feature, the treatment of which has been already stated; but
which, as it involves more practised judgment than a non-professional
invalid can be supposed to possess, had better be intrusted only to
professional hands.


                              THE END.




                              FORMULÆ


                               Form 1.

Four to six drachms of castor oil, the ordinary black draught,
a dose of salts, or a dose of Weir’s Compound Pills.

                               Form 2.

The following mixtures lessens the acrimony in making water,
abdues the irritability, and tends to diminish the discharge:—

Take of—
  Carbonate of potass                     1 drachm.
  Nitrate of ditto                        1 drachm.
  Mucilage of acacia                     5½ oz.
  Hydrocyanic acid                       10 drops.
  Syrup of Tolu                           2 drachms.
Mix. Take a tablespoonful in a wineglassful of water twice daily.

                               Form 3.

Take of—
  Linseed tea                             ½ pint.
  Spirits of Sweet Nitre                  2 drachms.
  Battley’s Sedative                     60 drops.
Mix. Take three tablespoonfuls, twice or thrice daily.

                               Form 4.

Where it is inconvenient for a patient to carry a bottle about his
person, the following electuary, combining the essential ingredients of
the former two, may be substituted:—

Take of—
  Lenitive electuary                      2 oz.
  Conserve of roses                       2 oz.
  Strong mucilage of acacia               2 oz.
  Nitrate of potass                       2 drachms.
Mix. Dose—Two teaspoonfuls twice or thrice a day.

                               Form 5.

A good combination, that may be taken even in the inflammatory stage.

Take of—
  Cubebs                                  2 oz.
  Carbonate of magnesia                   1 drachm.
Mix. Dose—A dessert- or tablespoonful twice or thrice daily.

                         SPECIFIC REMEDIES.

                               Form 6.

Take of—
  Balsam of copaiba                       1 oz.
  Powder of cubebs                        ½ oz.
  Mucilage of acacia                     6½ oz.
  Spirits of sweet nitre                  2 drachms.
  Battley’s sedative                     30 drops.
Or—
  Hydrocyanic acid (Scheele’s strength)   8 drops.
  Syrup of orange-peel                    2 drachms.
Mix. Dose—Two tablespoonfuls, once or twice daily, in water.

                               Form 7.

_Turpentine Pills._

Take of Venice turpentine 1 drachm, form it into pills by adding as
much rhubarb as is necessary, and take two, three times a day.

                               Form 8.

_Turpentine Mixture._

Take of—
  Venice turpentine                       1 scruple.
  Mucilage of gum arabic                  2 oz.
  Emulsion of bitter almonds              4 oz.
  Syrup of orange-peel                    ½ oz.
Mix. Dose—Two tablespoonfuls three times a day. Sedatives may be
conjoined with the above preparations, if they produce too much action
of the bowels. To the pills may be added one scruple of Dover’s powder
to the drachm of turpentine. To the mixture, thirty drops of laudanum.

                               Form 9.

Take of—

  Terebinthin chiœ                        1 oz.
  Extract of rhubarb                     1½ drachms.
  Camphor                                 1 drachm.
Mix and divide into pills of 5 grains each. Dose—Three, three times a
day.

                              Form 10.

Take of—
  Cahio turpentine  }
  Balsam of copaiba } Of each, equal parts.
  Oil of amber      }
Mix, according to art. The turpentine must be dissolved by warmth. The
dose is 30 or 40 drops three or four times a day. This medicine is very
nauseous, but very serviceable in long standing gleets and obstinate
claps. The best way to remove the flavor left in the mouth after taking
turpentine, copaiba, and other filthy medicines, is to chew a piece
of gingerbread or cheese, or suck a lemon, or put some salt upon the
tongue.

                              Form 11.

_Injections to diminish the pain on making water._

Take of—
  Rose-water                              3 oz.
  Solution of the acetate of morphine     2 drachms.
Mix.

                               Form 12.

Take of—
  Goulard water                           3 oz.
  Mucilage                                4 oz.
  Solution of the acetate of morphine     2 drachms.
Mix.

                              Form 13.

_Sedative draught to be taken at bed-time when annoyed with chordee._

Take of—
  Acetated liquor of ammonia              ½ oz.
  Camphor julep                           1 oz.
  Solution of the acetate of morphine    20 to 25 drops.
Mix.

                              Form 14.

Take of—
  Dover’s powder                         12 grains.
  James’s powder                          5 grains.
Mix.

                              Form 15.

Take of—
  Compound camphor liniment               ½ oz.
  Laudanum                                ½ oz.
Mix, to form a liniment.

                              Form 16.

_Injection for the ulceration of the glans penis._

Take of—
  Chloride of soda                        1 oz.
  Rose-water                              5 oz.
Mix.

                              Form 17.

Take of—
  Nitrate of silver                       1 scruple.
  Distilled water                         1 oz.
Mix.

                              Form 18.

Take of—
  Calomel                                 ½ drachm.
  Lime-water                              4 oz.
Mix.

                              Form 19.

_Emetic Powder._

Take of—
  Ipecacuanha powder                      1 scruple.
  Emetic tartar                           1 grain.
Mix. To be taken in a glassful of warm water, and repeated in twenty
minutes, if it do not produce vomiting.

                              Form 20.

_Iodine._

Take of tincture of iodine twenty drops twice or thrice a
day in a little water.

                              Form 21.

Take of—
  Hydriodate of potass                    ½ drachm.
  Mucilage of acacia                      ½ oz.
  Camphor julep                          5½ oz.
Mix. Dose—three tablespoonfuls three times a day.

_The Sedative Application to anoint a Bougie with._

                              Form 22.

Take of—
  Extract of Aconitine                    1 grain.
  Oil of Olives                           1 drachm.
Mix.

                              Form 23.

Or take of—
  Extract of Henbane                      5 grains.
  Lard or Olive Oil                       1 drachm.
Mix.

                              Form 24.

Or take of—
  Acetate of Morphine                     3 grains.
  Simple Cerate or Oil                    2 drachms.
Mix.

_Stimulating Application._

                              Form 25.

Take of powder of calcined alum, and dust the end of a bougie
previously oiled, and introduce it to the stricture in the usual
manner, and suffer it to remain until the obstacle be overcome.
Occasionally the bougie may be smeared with the balsam copaiba,
where the case is chronic, and there happens to be much secretion
from the part.

                              Form 26.

Take of—
  Iodide of potass                        1 drachm.
  Mercurial ointment                      1 do.
  Simple cerate                           4 do.
Mix. A portion to be rubbed over the scrotum night and morning, as long
as it can be borne.

                              Form 27.

_Strong caustic solution of Dr. Doane._

Take of—
  Caustic                                 ⅓ drachm.
  Distilled water                         1 oz.
Mix.

                              Form 28.

_Wash for Chancres._

Take of—
  The solution of chloride of soda        2 oz.
  Rose-water                              4 oz.
Mix.

                              Form 29.

_Black wash for Chancres._

Take of—
  Calomel                                 1 scruple.
  Lime-water                              3 ounces.
Mix.

                              Form 30.

_Red wash for Chancres._

Take of—
  Bi-chloride of mercury                  4 grains.
  Lime-water                              4 oz.
Mix.

                          Or, Form 31.

_Blue wash for Chancres._

Take of—
  Sulphate of copper                      5 grains.
  Distilled water                         1 oz.
Mix and strain.

For dressing chancres, lotions and washes generally answer better
than ointments; but their alternate use is sometimes serviceable.
In cracked sores near the prepuce, the blue ointment has wrought
a cure when all the lotions devised were ineffectual.

                              Form 32.

Take of—
  Red precipitate of mercury              4 grains.
  Ointment of spermaceti                  1 oz.
Mix.—A little to be smeared over the ulcer, twice a day.

                              Form 33.

_Active aperient in indolent Chancres._

Take of—
  Calomel                                 4 grains.
  Powder of jalap                        15 to 20 grains.
Mix.—To be taken in something thick, as jelly, honey, or tamarinds.

                              Form 34.

_Active aperient, to be mixed in water and (stirring it) to be drank
off quickly._

Take of—
  Chloride of mercury, or calomel         5 grains.
  Powder of jalap                        25 grains.
Mix.

                              Form 35.

_Ointment to promote absorption of Bubo._

Take of—
  Iodine of potassium                     1 drachm.
  Tincture of iodine                      1 drachm.
  Acetate of morphine                    10 grains.
Mix.—Apply constantly a plaister of some of this ointment spread upon
rag or lint, over the bubo, and occasionally rub a little of it gently
into the skin.—_Doane._

                          Or, Form 36.

Take of blue ointment a similar quantity, and use it in like manner to
the preceding. The reliance to be placed on this ointment is precisely
the same as the other, namely, to excite absorption. The following
ointment may also be used for the same purpose.

                              Form 37.

Take of—
  Calomel                                 2 drachms.
  Simple ointment                         6 drachms.
Mix.

                              Form 38.

_Stimulating ointments to promote the healing of indolent ulcerated
Buboes._

Take of—
  Red precipitate of mercury              5 grains.
  Ointment of spermaceti                  1 oz.
Mix.—The ulcer to be dressed with a small portion of this ointment
spread upon lint. Or the following, which is stronger:—

                              Form 39.

Take of—
  Red precipitate of mercury              5 grains.
  Yellow basilicon                        2 drachms.
  Ointment of spermaceti                  6 drachms.
Mix.—To be used like the preceding.

                          Or, Form 40.

Take of nitrated ointment of mercury, diluted with an equal proportion
of simple ointment.

Or, the unadulterated strong mercurial ointment.

                              Form 41.

_Styptic application for indolent Ulcers._

Take of—
  Caustic                                 ½ drachm.
Or, Sulphate of copper                    ½ do.
  Distilled water                         1 oz.
Mix and strain, and smear the surface of the sore with a hair pencil,
impregnated with either of the solutions: simple or astringent
dressings may be applied afterward.

                              Form 42.

Take of—
  Chloride of soda                        2 ounces.
  Rose-water                              2 do.
Mix.

                              Form 43.

_Preparation of Iron._

Take two drachms of carbonate of iron three times a day, gradually
increasing the dose to half an ounce, or even an ounce; the bowels
during the taking of this medicine should be kept open.

                              Form 44.

_The following is an excellent combination._

Take of compound iron pill two drachms, to be divided into 24 pills—two
to be taken three times a day.

                              Form 45.

_Quinine._

Take three grains of sulphate of quinine three times a day. Or,

                              Form 46.

Take of—
  Compound tincture of bark               2 ounces.
  Sulphate of quinine                    12 grains.
  Muriatic acid                          20 drops.
Mix.—Dose, a teaspoonful three times a day, in water.

                              Form 47.

_Strengthening Pills._

Take of—
  Ioduret of iron                         ½ drachm.
  Castile soap                            ½ do.
  Alkaline extract of gentian             1 do.
Mix.—To form 30 pills—take one twice daily.

                              Form 48.

_Tonic and Alterative Mixture._

Take of—
  Oxymuriate of mercury                   2 grains.
  Muriatic acid                          60 drops.
  Tincture of bark                        2 oz.
Mix.—A teaspoonful to be taken twice or three times a day in a little
water.

These drops are highly serviceable to persons of weak constitutions,
whom it is desirable to place under the influence of mercury. They
form the basis of most of the advertised anti-scorbutic drops of the
patent medicine venders.

                              Form 49.

_Compound decoction of Sarsaparilla._

Take of—
  Sarsaparilla root, sliced               4 ounces.
  Boiling water                           4 pints.
Macerate for four hours in a vessel lightly covered, and placed
near the fire; then take out the sarsaparilla and bruise it; return
it again to the liquor, and macerate in a similar manner for two
hours; boil it down to two pints, strain it, and then add—
  Sassafras root, sliced                  ¼ ounce.
  Guaiacum root, rasped                   ¼ do.
  Liquorice root, bruised                 ¼ do.
  Bark of mezeroon root                  1½ drachm.
Boil the whole together for a quarter of an hour, and strain.
Dose, from a quarter to half a pint, three times a day.

To avoid the tediousness of daily preparing the above, many
manufacturing chemists evaporate a large quantity, and preserve
the extract, which retains all the virtues of the decoction, and
is at all times ready for immediate use. Or,

                              Form 50.

Take of—
  Bruised root of Jamaica sarsaparilla    4 ounces.
  Liquorice root, sliced                  ½ ounce.
  Lime-water                              1 quart.
Macerate for 24 hours in a dark and cool place—strain and bottle it,
and take a pint daily in divided doses. This is a very superior form
of administering sarsaparilla. Or,

                              Form 51.

Take of—
  Oxymuriate of mercury                   2 grains.
  Muriatic acid                           5 drops.
  Compound extract of sarsaparilla        2 oz.
Dissolve the same in one quart of water, and take a wineglassful twice
a day.

                              Form 52.

_The Iodide of Potass Mixture._

Take of—
  Iodide of potassium                     1 drachm.
  Iodine                                  2 grains.
  Mucilage of acacia                      3 ounces.
  Hydrocyanic acid                       12 drops.
  Pure water                              5 ounces.
  White sugar                             ½ ounce.
Mix. Take a dessert- or tablespoonful twice or thrice daily in a
wineglassful of water.

                              Form 53.

Take of—
  Iodide of potassium                     1 drachm.
  Acetate of morphine                    10 grains.
  Spermaceti ointment                     1 oz.
Mix. Rub a portion, the size of a nut, over the affected part night and
morning. If much irritation be produced, it must be disused for a time.

Forms 54, 55, 56, 57 see pages 126–128.

                              Form 58.

Take of—
  Sarsaparilla sliced                     1 oz.
  China root                              1 oz.
  Dry rind of 20 walnuts.
  Antimony                                2 oz.
  Pumice stone                            1 oz.
(Tied in separate bags, and boiled with the other ingredients.)
  Distilled water                        10 pints.
Boil to one half, and strain.
Dose—An aleglassful twice or thrice daily.

Forms 59, 60, 61, 62 see page 132.

The best aperient for females is certainly a combination of castor
oil. The following form is a very good one:—

                              Form 63.

Take of—
  Castor oil                              1 oz.
  Mucilage of acacia                      2 oz.
  Spirits of sweet nitre                  1 drachm.
  Syrup of orange-peel                    ½ oz.
  Water                                   1 oz.
Mix. Take half for a dose.

Forms 64, 65, 66, 67, 68, 69, 70 see pages 156–158.

Forms 71, 72, 73, 74, 75, 76, 77, 78, 79 see pages 158–161.




                             FOOTNOTES


[1] A wash composed of one part of the chloride of soda, with five
of water, is as good as can be used; the same may be injected up the
urethra.

[2] Lining internal structures which have no outlet, as that in the
abdomen, called the peritoneal.

[3] To enter into a description of the pathological condition of
the bladder in the several states of irritability, paralysis, and
inflammation, would be to swell this article to an inordinate length,
and serve no useful purpose—the symptoms and treatment comprising the
most essential knowledge for the patient to possess. It may be briefly
stated, that the bladder is less subject to become disorganized (the
function being chiefly the disordered symptom), and sooner even regains
its tone than other organs not less important to life.

[4] Colles, Wallace, Ricord, of the Venereal hospital, Paris.

[5] _Mercury._

The preparations of mercury are various: but those chiefly employed
in the treatment of syphilis are the oxymuriate, or bi-chloride,
the submuriate, or chloride, the red precipitate, or the hydrargyri
nitrico-oxydum, the blue pill, the red sulphate for fumigations, and
the blue ointment.

Ptyalism or salivation, which implies an extraordinary secretion of
the salivary and other glands, occasioned by the taking of mercury,
inasmuch that when carried to an unwarrantable extent, ulceration is
the consequence, may be produced by the internal exhibition or external
application of almost any of its preparations. With this view, however,
the blue pill is usually administered in doses of five grains twice a
day, or the blue ointment is directed to be rubbed in on the inner part
of the legs and thighs, in quantities varying from one to two drachms
night and morning. Mercury, when given to excite ptyalism, is generally
taken in conjunction with sarsaparilla (see Form 51, or the fluid
extract). The symptoms whereby the effects of mercury are ascertained,
are a coppery taste in the mouth, followed by a tenderness of the gums
on mastication, an increased flow of the saliva, and a peculiar fœtor
of the breath. It is usual, on the tainted taste being perceptible, to
diminish or discontinue the further use of the medicine, unless the
case be very severe, or merely to keep up the effect produced. But it
can not be denied that, although sufficiently manageable in scientific
hands, mercury, or any one of its preparations, is too powerful to be
taken indiscriminately.

[6] _Antimony._

The preparations of antimony consist of the precipitated sulphuret,
called now the oxysulphuret of antimony, and the powder, as directed to
be made in the Pharmacopœia, or its secret modification, known by the
name of “Dr. James’s Powder.” The sulphuret enters into the composition
of the red or Plummer’s pills, which is an admirable alterative, given
in conjunction with sarsaparilla, in doses of five grains, once or
twice a day. The James’s powder, with the like intention, may be taken
in two or three grain doses twice or thrice a day.

[7] Wagner, translated by Dr. Willis.

[8] Some say eight days after.

[9] Instances of different conceptions following connexion at brief
intervals are of occasional occurrence.

A case is recorded of a negress having brought forth a negro and a
mulatto child, and who confessed having received the embraces of a
white and a negro the same evening. Drs. Dewees of Philadelphia, and
Francis of New York, adduce similar instances.

[10] The membrane containing the liquid comes away with the after-birth
or placenta; but when it is brought away with the child’s head, it is
named a “caul,” to which the ignorant attach a superstitious belief
that it saves the possessor from drowning, and hence it has been a
source of traffic between the cunning and the weak-minded. Cauls are
made by detaching the membrane from the placenta.

[11] Yellow wax may be substituted for the white wax, which renders
the ointment stronger and better adapted for excoriations that yield a
discharge.

[12] Every nurse is acquainted with the usefulness of starch, tutty
powder, Fuller’s earth, &c.

[13] Blundell.

[14] Dr. A. Sidney Doane has recorded a case, in his edition of
“Good’s Study of Medicine,” where a woman brought forth fifty-seven
children.—Vol. ii., p. 503.

[15] A patient was admitted into the ophthalmic wards of the Hotel
Dieu, Paris, with great weakness of sight, amounting almost to
amaurosis. He confessed that he was in the habit of polluting himself,
and that he was immediately seized with complete blindness whenever he
addicted himself to the practice. Cases very similar to the above have
been noticed by Dr. Doane, of New York, who has paid great attention to
diseases of this character.

[16] The convertibility of India-rubber to so many useful purposes
has not escaped the attention of surgeons, and it is found to be
an excellent material for trusses, pessaries, bougies, &c., and
consequently much used for them. I find them in my own practice
far preferable to metallic or any other description. Many cases of
hæmorrhoids, as well as of prolapsus, that have been given up as
incurable, on account of the parties objecting to wear metallic
instruments, or submit to the operation of excision or ligature,
have speedily yielded to the application of the same manufactured of
India-rubber; indeed, every day’s experience so convinces me of their
superiority and efficacy as a remedy in these disorders, that a patient
afflicted with the most formidable form of either disease need not
despair of a prompt and certain recovery.

[17] The specific gravity of the urine materially depends upon those
causes which act diuretically, and upon the quantity of fluids
swallowed, which, if taken in excess, of course increases the watery
portion of the urine, and vice versa. The density of the urine is
ascertained by an instrument called an “Hydrometer,” which, upon being
immersed in the urine, indicates its specific gravity. The usual
specific gravity of healthy human urine varies from 1.010 to 1.015,
while the temperature ranges from 75 degrees of Fahrenheit to 120. The
quantity averages from two to three pints per diem, but depends not
only upon the quantity of fluids consumed, but also upon the nature
of the food, vegetables generating more urine than animal substances.
In infancy and old age, the temperature of the urine is below this
standard, but nearly equivalent to each other; whereas it is only at
the period of puberty that the temperature noted exists.

[18] Furnished in the system by the decomposition of urea.


         —————————————————— End of Book ——————————————————




                   Transcriber’s Note (continued)


Obvious punctuation errors in the transcribed text have been repaired.

Variations in spelling are common in this book. In the case of medical
terms in which the ligatures ‘æ’ and ‘œ’ could be used, the variations
are numerous and noticeable. Thus we find the terms “hemorrhage”,
“hæmorrhage” and “hœmorrhage” being used interchangeably. Similarly for
“hæmorrhoids” and “hœmorrhoids” and all the words derived from the
foregoing terms.

Except as noted below, unusual or variable spelling and hyphenation as
published in the original book have been retained.

  Page 11 — “membraneous” changed to “membranous” (diminishes at the
            membranous portion)

  Page 16 — “then,” changed to “them” (that connects them together)

  Page 21 — “developes” changed to “develops” (the sooner develops the
            disease)

  Page 22 — “ay” changed to “any” (to resist any efforts)

  Page 24 — “arm-pits” changed to “armpits” (under the armpits)

  Page 29 — “gonorrhæa” changed to “gonorrhœa” (in curing gonorrhœa;)

  Page 30 — “head-ache” changed to “headache” (inclination to headache)

  Page 50 — “surfacial” changed to “surficial” (surficial and muscular
            membranes)

  Page 54 — “fœces” changed to “fæces” (the fœces pass in small
            quantities)

  Page 58 — “permaneut” changed to “permanent” (permanent irritability of
            the bladder)

  Page 62 — “now” changed to “how” (to show how imperative it is)

  Page 80 — “coherd” changed to “cohered” (where numbers cohered together)

  Page 85 — “empyrical” changed to “empirical” (by the most empyrical
            measures)

  Page 87 — “chancerous” changed to “chancrous” (a chancrous sore)

  Page 89 — “accompanying” changed to “above” (Witness the above
            wood-cut.)

  Page 102 — “incrustrations” changed to “incrustations” (similar
             incrustations are formed)

  Page 107 — “desquemated” changed to “desquamated” (the pimple has
             broken or desquamated)

  Page 109 — “raced” changed to “traced” (to such weknesses may be traced
             the relapses)

  Page 118 — “desquemate” changed to “desquamate” (exfoliate, or scurf,
             or desquamate)

  Page 125 — “are are” changed to “are” (There are also deep and painful
             fissures)

  Page 131 — “pecuiar” changed to “peculiar” (a peculiar contour of the
             countenance)

  Page 134 — “triflind” changed to “trifling” (trifling errors in diet)

  Page 137 — “unimpergnated” changed to “unimpregnated” (when
             unimpregnated, is very compact)

  Page 146 — “corpulant” changed to “corpulent” (like a very corpulent
             man)

  Page 149 — “ipresses” changed to “impresses” (the womb impresses upon
             the bladder)

  Page 167 — “Henry III.” changed to “Henry II.” (Henry II. consulted
             one Fernal for the infertility of his queen, Catherine de
             Medicis)

  Page 196 — “protusion” changed to “protrusion” (extraordinary
             protrusion of piles)

  Page 200 — “bladders” changed to “bladder” (into the bladder whence it
             is voided)

  Page 214 — “pharmacopœa” changed to “pharmacopœia” (of our pharmacopœia)

In anatomical references, the book uses “chord” throughout in place of
“cord” — see for example “umbilical chord” and “spermatic chord”.

There are seventy-nine treatment recipes/formulæ (“Forms”) in the
book. All are printed in a similar style. However fifty-five appear as
footnotes while the rest appear in page text. For ease of reference in
the transcription, all the footnoted Forms have been gathered together
and moved to a new FORMULÆ annex at the end of the book. Minor changes
to the page text consequent on the new arrangement are as follows:

  Page 31 — “[See annexed Formulæ 2, 3, 4, 5.]” changed to “[See Forms
            2, 3, 4, 5 in Formulæ annex.]”

  Page 33 — “Subjoined are” changed to “See Formulæ annex for”

  Page 34 — “(see note)” changed to “(see Formulæ annex)”

While the original style and content of the seventy-nine Forms has
been carefully preserved, minor corrections to the layout of some have
been made so that all are displayed to the reader in a consistent
format. This avoids small but distracting variations on a page that
look like errors in transcription. For the same reason, variations in
the spelling of dosage measures in the Forms have been regularised.
Thus “table spoonful”, “table-spoonful” and “tablespoonful” all appear
as “tablespoonful”. Similarly for “teaspoonful” and “wineglassful”.
Plural forms have been changed in the same way. For consistency, the
regularising of these words has also been applied to their appearance
elsewhere in the body text.

Ordinary footnotes have been re-indexed using numbers and moved to a
FOOTNOTES section placed after the FORMULÆ annex.



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