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For that terrible malady " See other formats ? ” Pas : i + t - . oe r b # ; . ya as ef H ‘ De, r ‘ . 4 ; ; o a - = é RA © ae r ‘ Ne ys A * i + 4 = ei 4 7 A . te j * f ¥ a3 2 \ rh ae : e rs ote! 5 ret ee A ., Wate ianas Ne isis sch’, polelephee See yd bade ey oho Te ~ ae 2 Y f : . 2 * ? t Py < bY ‘ AN i ee ? € y w ; ¥ - { } > f s . "y a Pa: ay a ' 3 4 . ‘ \ - , a % - , y Ww ‘ ¥ } . a” ’ ft > 4 f Ye , 4 ~ a "i } — 4 ‘ ' ~ La y , : a # ~ ic) Ae < Be tere : neh Ave a A A POPULAR TREATISE ON THE VE NEREAL DISEASE: IN WHICH IS EXHIBITED ALL THE | RECENT DISCOVERIES; AND A Eertain Cure FOR THAT TERRIBLE MALADY. By ROBERT JOHN THORNTON, M.D. ‘MEMBER OF THE ROYAL LONDON COLLEGE OF PHYSICIANS. Wondon, PRINTED FOR D. Cox, BALL-ALLEY, LOMBARD.- STREET; AND MAY BE HAD OF ALL BOOKSELLERS IN TOWN AND COUNTRY. 1815, Lh ae =< a \ E* SO, } HISTORICAL MEDICAL Ve p AR He eee ee ama aE a aa I DE TERT TI J. M‘Creery, Printer, Black-Horse-Court, Fleet-Street, Loudon. A POPULAR TREATISE, &c. CHAP. I. THE MISERIES ARISING FROM THE VENEREAL DISEASE. ONE of the most dreadful of our diseases, that scourge, with which in this life offended Heaven chastens the indulgence: of - criminal desire, appears to have: its original from. the Americans.* By this retaliation on their con- querors, they have not only amply avenged their * Some poisons seem peculiarly to affect’ man; for brutes have no measles, or small pox, nor has inoculation of the venereal poison been found to have the least effect upon them. This is said to have arisen from the eating of human flesh. i xak B 2 own wrongs, but have also perhaps more than counterbalanced all the benefits which Europe has derived from the discovery of the New | World. Astonishment and terror accompanied this unknown affliction in its progress, and men began-to dread the extinction of the human race by such a hard visitation. ‘The disease at first was supposed to be propagated by the breath, and those affected with this dreadful distemper were exiled to the Borough by the laws of theland. Its true nature, however, soon became better understood, and the enemy by his frequent visits appeared less formidable, and the power of art was found at length able to overcome this Proteus-monster. Delicacy would have prevented me even mentioning the venereal poison; but when I consider that it belongs to a class of poisons whose action is slow and deceiving—when I 3 see the country people, once so blooming and robust, the proper stock for supporting the race of men, through the more frequent connexion with the city, from the greater facility of travelling,—when I see them very generally eat up by this most loathsome of all the poisons, the bones of the nose and palate rotted, the beauty of face and speech destroyed, the body covered with copper-coloured ulcers, the period of rest rendered to them the time of insufferable torment from pains along the shin-bones, and finally in the forehead. When see fine youths, the darlings of their parents, the hopes of their country, thus severely smarting perhaps for the folly of one unguarded moment—when I see it also sometimes insinuate itself privately into the circle of domestic felicity, and the virtuous wife a prey to a poison she does not understand, and extending its influence at the same time to B 2 4 the innocent offspring, I cannot refrain shewing the means of diminishing SO Ero PINE an evil,* nd * I might have also prodeced bore the ‘apology of Sydenham. “‘ T have met,” says this illustrious physician, “ with ‘several, who either with a good intent, in order to deter the incontinent from their vicious practices, by the apprehension of the succeeding punishment, or to acquire the character of chaste persons, haye not scrupled to assert, that the cure of the venereal disease ought to be kept secret. But I cannot be of their opinion, because I conceive that there would be very little room left for charity, unless the misfortunes which the inconsiderate bring upon themselves by their own fault were to be alleviated with humanity and tenderness. It belongs to Gop to punish the offence, hut it is our duty to assist the ‘distressed, and relieve the diseased to the best of our power, ‘and not to make too strict an inquiry into the cause of the evil, and irritate them ‘by our censures. For this reason, therefore, I. will deliver what I have . bserved and experienced. in this-disease ; not that I in- tend to make men’s minds more. vicious; but to cure their bodies, which is my province.” C It has long been my opinion, says. the. bene- volent Dr. Buchan, that:much of the mischief occasioned by the venereal disease might be prevented, and that whoever effects this. purpose, will be a great benefactor to society. . This im- portant point can only be accomplished by en- deavouring to advance the morals of the people; and when the disorder is obtained, to. point out the danger and the means by which its bad con- sequences*may in general be obviated. An attention to health, which ought to be a primary object in the education of children, is seldom considered as even a secondary one; while trifling accomplishments, of little impor- tance in the pursuits of life, generally engross the attention both of father, son, master, and scholar. Young men are prodigal of life. They throw 6 it wantonly away at the very time it is most worth preserving, nor do they know the value of health till it is lost. Many a painful hour might be prevented by a few cautions duly im- pressed on the young mind. Early impressions are seldom eradicated. They generally form the conduct, and become the rule of life. Were a young man taught to believe that the paths of pleasure lead to destruction ; that if he pursues them; he will never arrive at mature age, but fall the early victim of a loathsome disease, he would learn to consider pleasure as his greatest enemy. The genuine consequences of vice need only to be painted in their true colours, 10 order to make it an object of horror to the youthful mind. As example has more influence than precept, it might be of use to young men, were they occasionally taken to places where the unhappy 7 sufferers, under the venereal disease, are con- gregated. ‘They would there see the wretched condition to which thoughtless youth may be reduced by the act of one unguarded moment. I have known the first mistake made by a young man, in this way, cost him his life; and have seen others, who, from a single unhappy connexion, were rendered incapable ever after of enjoying connubial happiness. Though parents, tutors, and guardians, were - to use every endeavour to keep youth from the snares laid for them by bad women, yet, owing to the want of Police in cast great cities, they would find their efforts equally frustrated. It is there the corruption of youth is almost unavoid- able, and their destruction, alas! is but too often the consequence. Much might be done towards lessening the 8 ravages of. this baneful malady by the exertions of the public magistrate. But to effect -this purpose would require more skill and attention than few magistrates would wish to encounter: Improper interference in these matters does mischief, and to put bad women under proper regulations would require the most consummate wisdom. ‘This, however, is no reason why bad women should be suffered to prowl about the most public streets without the least restraint. ‘Were men to be seen at the corner of every street in a great city, armed with-swords and bludgeons, to put every one in: fear of ‘his life, who would not comply with their. demands ; the public mind would be quickly roused, and proper measures taken to suppress them: yet the danger is nearly equal, from those unhappy females who lie in wait to ensnare the unwary youth as he passes along. The young man 9 must have uncommon resolution mdeed who can always resist these temptations; yet -by yielding in a single instance, he may be undone. One step leads on to another, till the unhappy youth, immured in vice, finds it impossible to retreat. It signifies very little if a man is robbed of his health, or property, whether it is done under the influence of fear or lust. Even the delicacy of modest women is hurt by the number of common prostitutes which they daily see plying in the public streets, and their example must have an unfavourable in- fluence on the younger part of the sex. Were it my province here to dip into affairs “of Police, I should think it an easy matter to suggest a plan by which the public streets of great cities might be freed from those women, who by night and by day infest them, without BS 10 laying any unnecessary or improper restraints on the hberty of the subject.* But the grand corrector of this evil are suitable laws against seduction, which leads to all the after- misery attendant upona life of pleasure, or rather of misery, as it should be more justly called, such as is well described in the following lines by the late Enwarp RusuTown, of Liverpool. In a cottage embosom’d within a deep shade, Like a rose in a desert, oh! view the meek maid; Her aspect all sweetness, all plaintive her eye, And a bosom for which e’en a monarch might sigh. 4 Then in neat Sunday gown see her met by the squire, All attraction her countenance, his all desire: He accosts her, she blushes, he flatters, she smiles ; And soon Blue-eyed Mary’s sedue’d by his wiles. * The great public thoroughfares should certainly be eleared from Prostitutes, and on this score the present Lorp Mayor deserves great commendation. li Now with drops of contrition her pillow’s wet o’er, But the fleece when oncestain’d can know whiteness no more; The aged folks whisper, the maidens look shy ; To town the squire presses, how can she deny? There, behold her in lodgings, she dresses all gay, Vauxhall she attends, always goes to the play, Learns to squander, they quarrel, his love turns to hate, And soon Blue-eyed Mary is left to her fate. Still of beauty possess’d, and not yet void of shame, With a heart that recoils at the prostitute’s name ; She tries for a service, her character’s gone, And for skill at her needle, alas! ’tis unknown. Pale want now approaches, the pawnbroker’s near, And her trinkets and clothes, one by one disappear ; Till at length sorely pinch’d, and quite desperate grown, The poor Blue-eyed Mary is fore’d on the town. In a brothel next see her trick’d out to allure, And all ages, all humours, compell’d to endure ; Compell’d, though disgusted, to wheedle and feign, With an aspect all smiles, and a bosom all pain ; Now caressed, now insulted, now flattered, now scorn’d, And by ruffians and drunkards oft wantonly spurn’d, This worst of all misery she’s doom’d to endure, For the poor Blue-eyed Mary is now an impure. 12 Whilst thus the barb’d arrow sinks deep in her soul, She flies for relief to that traitor, the bowl; Grows stupid and bloated, and lost to all shame, Whilst a dreadful disease is pervading her frame. Now with eyes dim and languid the once blooming maid, In a garret on straw faint and helpless is laid! | _ Oh! mark her pale cheek, see, she scarce takes her breath, And lo! her blue eyes are now seal’d up in death! Or, the after-wretchedness described in the following ELEGY. WEEP o’er the mis’ries of a wretched maid, © Who sacrifiec’d to man her health and fame ; Whose love, and truth, and trust, were all repaid By want and woe, disease and endless shame. Curse not the poor lost wretch, who ev'ry ill ‘That proud unfeeling man can heap, sustains ; Sure she enough is curst, o’er whom his will, Inflam’d by brutal passion, boundless reigns. Spurn not my fainting body from your door, Here let me rest my weary weeping head — No greater mercy would my wants implore, My serrows soon shall lay me with the dead. 13 Who now beholds, but loaths my faded face, So wan and sallow, chang’d with sin and care? Or who can any former beauty trace In eyes so sunk with famine and despair? That I was virtuous.once, and beauteous too, And free from envious tongues my spotless fame : These but torment, these but my tears renew, These aggravate my present guilt and shame. Expell’d by all, enfore’d by pining want, | I’ve wept and wander’d many a midnight hour ; Implor’d a pittance Lust would seldom grant, Or sought a shelter from the driving show’r. Oft as I row’d, while beat the wintry storm, Unknowing what to seek, or where to stray ; To gain relief, entic’d each manly form, Each hideous form contemptuous turned away. Where were my virgin honours, virgin charms? Oh! whither fled the pride I once maintain’d? Or where the youths that woo’d me to their arms? Or where-the triumphs which my beauty gain’d? 14 Ah! say, insidious Damon! Monster! where? What glory hast thou gain’d by my defeat? Behold the miseries I am doomd to bear, © Such as have brought me to my winding-sheet. The law of the land for seduction, is a penalty of money to be levied by the father for the sup- posed incapacity of the daughter to earn. her livelihood; and such a law may be instantly seen to-be but the chicanery of law, a mere subterfuge. Nothing short of imprisonment in a solitary cell will ever restrain so licentious a passion as that of lust. The confinement of the woman should be short, but still she should be so punished. ‘That of the man should be longer. Or if the he- wretch was to be pilloried,* there would be * How ridiculous then would the seducer appear, and the feats of gallantry would no longer be his unfeeling sport. At present, owing to the punishment both for seduction and adultery being money, little or no disgrace 15 few or no seducers ; and he merits it as much as those she-devils who are ever prowling about, seeking whom they may devour. When a woman has had her fling of debau- chery (vide the Life of Ann Bellamy), she then sets up a regular traffic of sacrificing innocence to the shrine of gold. She even in different directions has her infants at school, and before they know a passion, carries the iniquitous rich old man to see her nieces, as she stiles them; and before they are ripe, the virgins are de- flowered by the villain. They are then brought is attached to either, and plans are hourly laid to make this the object of extortion, so easy is it for a nation to be corrupted by bad laws.—To encourage an innocent gratification of a proper and useful passion, every bachelor should pay, besides taxes, an income tax in proportion to his gains. This would prevent celibacy, and the worst vices. A heavy tax should be laid on those who have unmarried people of a certain age as servants, 16 forward to be the common sport of the world, false debts are contracted with the old Jezebel ; and when sickness. has eaten away the rose of health, and the object of desire has become but. little attractive, the. poor. wretches, are turned. adrift to seek a worse fortune in the streets. ‘They then-hire: clothes for: the night at an exorbitant price—pay, to use the vulgar expression, through the nose for every thing, and soon after become almost naked patients of some hospital, or perish unpitied, and for want, Youth should especially be told, that these women are almost certain of containing about them the venereal virus. .These indeed are scorpions of the worst kind. What_ person would be so insensate, or mad, as to play with the adder, or snake, forgetful of its power of injury. Even as a child, although such are fond of sweets, none venture to up-turn a bee- hive for the honey, and for what reason? for fear of the sting. But here is a more formi- dable sting, and equally as certain. Beware then, O youth! of being deceived like a foolish bird into the snares set out to en- tice thee. The pleasure (if such can deserve the name, which is ever enjoyed with fear and — trembling) is not worth the danger which ‘ac- companies it; and to say nothing of thy im- mortal soul, he must be a fool indeed, who shall pursue vices absolutely certain of leading to destruction; for although I have announced a new and safe cure, [have seen often such quick and decided ravages from the venereal virus, that the whole powers of manhood have been destroyed ina few hours, before any applica- tion could be employed. CHAP I. CONSIDERATION OF THE QUESTION, WHE- THER GONORRHGA AND LUES VENEREA ORIGINATE FROM THE SAME POISON. AN opinion has been generally received among practitioners, that gonorrhea virulenta and dues venerea are of the same nature, that they originate from the same contagion, and are only distinguished by the circumstance of go- norrhoea being a local disease, while the other is a general affection of the system. But as there is cause to imagine that these diseases arise from different specific contagions, and as the establishing of one or other of these opi- nions must undoubtedly influence the conduct 19 of the cure, it becomes, says Bell, in his ad- mirable Treatise, a matter of importance to institute an inquiry in to this part of the subject. Both diseases are contracted in a similar way; both, in the first instance, affect the same organs; and they occasionally appear at the same time in the same patient: hence it has been concluded, that they have a common origin, and one method of cure has been sup- posed applicable to both. The refusal of some patients to submit to the distress and inconveniency, the frequent result of a protracted mercurial course, and who nevertheless recovered from the usual symp- toms of gonorrhcea, first suggested a doubt of the two diseases being of a similar nature. It is well known that lues venerea can be certainly cured by mercury only; and the opinion re- 20 specting the existence of a specific contagion of gonorrhoea, arising from this obvious and marked difference in the method of cure, ap- pears to be fixed and established by the fol- lowing: facts. a The symptoms and consequences of ‘gonor- rhoea are perfectly different from those. which: take place in lues venerea. Both diseases have appeared, at different periods, in the same countries; and, in some instances, they have remained distinct and uncombined for a great length of time. - That the symptoms of the two diseases are different is universally known. .A_ particular detail of such as are peculiar to each will be given in the. ensuing sections. At present, it is, only necessary to observe, that gonorrhoea con- sists of a discharge of puriform matter from the 21 urethra; which, even by those who support a contrary opinion, is now admitted to be, in almost every instance, a local affection, and that it never does: contaminate the general habit of body: while lues venerea is a disease of the constitution, arising from the absorption of venereal virus from any part of the surface of the body, but most frequently from those. only covered’ with cuticle; by which are - pro- duced buboes, ulcers in various. parts, parti- ccularly’ in ‘the throat, pains and. swellings in the bones, with a variety of other symptoms, which it is not at present necessary to enu- merate. The first appearance of the lues venerea is, for the most part, in the form of a chancre or small ulcer, just as a pustule of the small-pox. It is universally admitted, that even the slightest affection’ of this nature is apt to produce the 22 pox, or a general affection of the system; inso-~ much, that no practitioner of experience will trust the cure of this symptom to local reme- dies. If the sore be left to itself, it almost always becomes worse. ‘The matter which it affords is taken up by the absorbents; and buboes, with the other symptoms mentioned above, very certainly ensue. ‘These are almost the universal consequences of a sore produced by the venereal virus ; but they also occur fre- quently where the skin remains sound and entire; that is, absorption of the venereal poison often takes place where no vestige of ulceration is perceptible. This, indeed, is denied by many, but I have met with various instances of it, and it will be admitted by every practitioner of ex- perience. Now, this being established, in the application of the venereal virus to every other part of the body, if the matter of gonorrhcea were of the same nature, why does it not, in 23 almost every instance, enter the system, and produce pox? So far as we know, the urethra is as plentifully supplied with absorbents as other parts of the body; the same kind of matter, when applied to them here, ought therefore to be productive of similar effects: and hence lues venerea ought frequently, per- haps in every instance, to be the consequence of gonorrhoea, were the matter, by which the two diseases are produced, the same. As this is a strong argument in favour of the two diseases proceeding from different kinds of contagion, much ingenuity has been exerted by those who support the contrary opmion, in endeavouring to account for it. In the first place, it has been said, that gonorrhoea sometimes terminates in pox, and therefore, that this of itself is a sufficient proof 24 of the two affections being of the’ same nature. Were it certain that this ever happened, no farther evidence would be required, as a few well-marked instances would be conclusive; but every unprejudiced practitioner will admit, that no sufficient proofs of it have ever - oc- curred. In order to support this opinion, data must be received, which we know to be inadmissible. We must admit, that a person with chancres only, communicates to another, not otly every symptom of pox, but of gonorrhoea ;’ and that another with gonorrhoea only gives to. all with whom she may have connexion, chancres with their various consequences. This ought,’ in- deed, to be a very common occurrence, inso- much that every practitioner should be able to 25 decide’ upon it with certainty, if this opinion was well founded ; instead of which, it will be admitted by all, that the one disease being pro- duced by the other, is even, in appearance, a very rare occurrence. I have paid much/atten- tion ‘to the point in question; and in almost every instance, ‘and where the most particular inquiries were made, it has proved, from in- quiry, that a person infected with gonorrhea, has received it from another evidently labouring under that disease, and that chancres have been communicated by such as were distressed with chancres only. _ ,. This, I am convinced, will be very commonly _ found to be clearly the case, so that a few in- stances, bearing some appearances of the con- trary, are much more readily explained on the idea of the two diseases being produced by dif- ferent kinds of contagion; and this may also be C 26 said of the few solitary cases that may be met with of chancre being supposed to terminate in gonorrhoea, and gonorrhoea in chancre, and Other symptoms of lues. We can more easily perceive that the same person should, in some instances, receive, and therefore be able to communicate both kinds of contagion, than that the incident we are considering should be so seldom met with, were the opinion well founded of the two diseases being originally of the same nature. However ill founded an established opinion may be, if it has received the sanction of being generally adopted, we know how difficult tt is to overturn it. There are few who enter so minutely into the consideration of such points, as to be able to decide upon them; and of those who do, there are very few who will take the trouble of engaging in such discussions as are 27 necessary for the conviction of others. 'This may be considered as the chief cause of the point in question remaining so long in obscu- rity, as well as of the explanation hitherto usually given of various circumstances in go- norrhoea and lues venerea having been uniformly made to support it. It will also serve to ac- count for circumstances being held forth as matter of fact, which, on inquiry, are perceived to be ill-founded; for, when once an opi- nion is admitted, we are apt to give such an explanation of whatever may seem to relate to it, as can in any way tend to support it. Thus, although few in the present age will assert, that gonorrhoea often terminates in lues venerea, yet by many we are told, that it is very apt to do so when it is improperly treated. Whatever puts a sudden stop to a severe or c0- pious discharge from the urethra, is by many c 2 28 supposed to do harm. Hence all, who con- demn the use of injections in gonorrhea, affirm, that they often convert a simple clap into a pox, by throwing into the blood what -otherwise would have been carried off. . This, however, is by no means supported by experience. A very stimulating injection will no doubt excite pain and inflammation in the urethra ; .and this, in some instances, will be productive of swelled testes, and perhaps of sympathetic swellings in the glands of the groin, but I have not known a single instance of lues induced in this manner; and as I have long been in the daily use of in- jections, many cases of it must have occurred, if the idea I have just stated were well founded. Till of late, indeed, a patient who was so.un- fortunate as to have a clap suddenly stopped, was so certainly considered as poxed, that he was immediately put under a very complete course of mercury, by which he was made to 29 undergo a very hurtful, unnecessary, and: dis- tressful confinement. ’ Although this practice, however, is now very commonly exploded, yet there are some who still adhere to it. I was called in, says Mr. Bell; to visit a gentleman, who in a gonorrheea, at- tended: with a good deal of inflammation, had been so foolish as to live freely, and to ride much on horseback. . This, with the un- guarded use of a very stimulating: injection, ‘put a sudden stop to the discharge, and at the same time it excited a very considerable degree of pain and inflammation along all the posterior part of the urethra, towards the prostrate gland: and neck of the bladder, attended with a painful and frequent desire to make water. On the idea of these being symptoms of lues, he was immediately put under a course of mer-: cury; and when [ first saw him, he had been using it for the space of six weeks. The sur- geon in attendance acknowledged, adds Mr. Bell, that no advantage had been derived from it; and the patient himself said, that his dis- tress was daily increasing. ‘They were both, therefore, easily persuaded to lay the mercury: aside; and by the repeated application of leeches to the perineum, of fomentations, and opiates, to allay the pain, the inflammation soon began to subside, and in a short time he was perfectly well. In December, 1788, a young man called upon me, with a painful hard swelling in his groin, of an oblong form, nearly an inch in, diameter, and reaching from the ring in the. external oblique muscle down to the top of the testis. It appeared suddenly about four months before, and seemed to be the conse-. 3k quence of a clap being too hastily stopped. He was at first attacked with severe pain at the neck of the bladder, which stretched to the groin, and down to the testis of the same side. This, together with a constant and painful in- clination to void urine, rendered his life miser- able. Nor was his distress in any degree abated by a course of mercury which he was immediately put under. On the contrary, the swelling, which at first was not thicker than a common quill, was now very considerable. My idea of the swelling was, that at first it had been “merely an inflammatory affection of the vas deferens, which by degrees had spread to the rest of the spermatic chord; but, what was un- usual, it had never affected either the testis or epididemis. As a considerable quantity of mercury had been taken, and as, instead of proving useful, it had rather appeared to do harm, the surgeon whom he employed was easily persuaded to trust the cure to other re- medies. Local blood-letting with leeches was frequently repeated, both in the perineum and groin. The parts were regularly fomented with a solution of saccharum saturni. His bowels were kept easy with gentle laxatives, and he was put upon a mild diet of milk and vegetables. Ina few days the pain abated, and the tumour gradually lessened; till. at last, in the course of five or six weeks, it was entirely _ gone. In the course of oleae I attended two different patients, with alarming symptoms about the neck of the bladder, evidently induced by the improper management of gonorrhoea. ‘The parts in both were not merely pained, but con- siderably swelled; and, at the same time, al- most a total suppression of urine took place. Although in both the discharge from the 33 urethra had been suddenly stopped, I did not advise mercury. ‘The patients being both ple- thoric, were plentifully blooded, first at the arm, and afterwards repeatedly with leeches in the permeum. This; with fomentations,. and opiates to allay the violence of the pain, as- sisted by a cooling regimen and gentle laxatives, very soon completed the cures. These instances’ are given out of a great number that might be adduced, merely to shew that’ the symptoms; which supervene on the sudden stoppage of a clap, are local, and not connected with any affection of the’ constitu- tion, which ‘they necessarily would be if they’ were of the same nature with Ines venerea. Tt will perhaps be said, that although this may have happeried-in a few cases, yet that in’ others there has been cause to suspect that lues’ c 5 34 venerea has been the consequence of a clap disappearing in this manner. In answer to this, it is sufficient for me to shew, that this is at least a rare occurrence; as I think I am entitled to do, from my never having met with an in- stance of it. It has been supposed, that the sudden check given to the discharge in cases of. clap, must necessarily throw the matter into the blood, and that pox must accordingly ensue from it. Were the matter of the two diseases the same, this would happen in every instance ; so that when we can shew that it seldom happens even in appearance, we are entitled, from. this argument alone, to conclude that they are pro- duced by two different kinds of contagion; and, where pox has appeared at the sudden termi- nation of gonorrhea, that the two kinds of in- fection had either been communicated together, or, what may more frequently perhaps be the case, the patient will be found to have received 39 the pocky contagion by communication with a diseased woman, at the very time he laboured under gonorrhoea. I have already remarked, that lues venerea is sometimes produced by ab- ~ sorption, while the skin remains entire, and where no chancre or excoriation is perceptible ;, there is therefore much cause to imagine, that in long continued cases of gonorrhoea, many may be infected with lues.venerea by commu- nication with others labourmg under it; and as this may happen without any external mark of it taking place, it is not surprizing that some fallacy should arise from this circumstance. The abettors of the opinion, that the matter of the two diseases is the same, admit that gonorrheea very seldom terminates in pox.* * This is even granted by one who keenly supports the opposite doctrine in every other point. In speaking And they attempt to account for this, that is, for the two diseases not being produced more of gonorrhoea and chancre not terminating so frequently as might be expected, in the production of each other, he says, “ Although it does not often happen, yet it sometimes does, at least there is great reason to believe .. so. I have seen cases where a gonorrhea came on, and in a few days after in some, in others as many weeks, a chancre has appeared : and I have also seen cases where a chancre has come first, | and in the course of its cure a running and pain in making water have suc- ceeded.” V. Treatise on the Venereal Disease, by John Hunter, page 16. This is what every practitioner has seen; but by admit- ting so clearly that it is a very rare occurrence, Mr. Hunter tends rather to strengthen the contrary opinion ; for, were the two diseases produced by the same kind of matter, the one would clearly'and necessarily often ter- minate in the other. In the few cases which Mr. Hunter, in the course of extensive practice, has met with, there is more cause to imagine, either that the two diseases were communicated at once, or that the one was given while 37 frequently by the application of the same matter, by saying, that this depends upon the difference of parts to which the matter is applied. They divide the different surfaces of the body chiefly into two kinds, what they term secreting surfaces and non-secreting surfaces. By the first they mean all the passages for extrane- ous matter, including also the ducts of glands, such as the mouth, nose, eyes, arms and ure- thra; and by non-secreting surfaces, the exter- nal skin in general. To which they add a third kind of surface, leading from. the one to. the other, as the glans penis, prolabium of the the patient laboured under the other, than that Nature should deviate so much from her ordinary course, as to produce them in a few instances so very differently from what obviously happens in the course of general obser- vation. | 38 mouth, the inside of the lips, and the female pudendum ;. which surfaces, partaking of the properties of each of the others, but in a less degree, are capable of being affected both ways, sometimes by being excited to secretion, and at other times to ulceration.* Upon this their theory or opinion of the point in question, is attempted to be established: when the contagion, either of gonorrhea or pox, and which they consider to be the same, is applied to any part of the external skin, par- ticularly to the glans, where the skin is very thin, chancre, or ulceration, they observe, will most readily ensue, as these are not secreting surfaces; while the same kind of matter applied to the urethra, must necessarily excite gonor- rhoea, from this being a secreting surface, and * Vide John Hunter on the Venereal Disease. 39. therefore not so easily affected with ulceration as with irritation, by which an increased dis- charge, attended with some change in the mucus of the part, must accordingly be pro- duced. This idea, however, is more ingenious than solid. It might answer the purpose of giving a specious appearance to an ill-founded opi- nion, but it will not stand the test of inquiry. In the first place, on the supposition of the matter of gonorrhoea and lues venerea being the same, the latter ought to be a much more fre- quent occurrence than the former, from the greater ease with which the matter of infection must, in every instance, be applied to those parts on which it can produce chancres, than to the urethra, where, instead of chancre or ulce- ration, it almost always excites gonorrheea. It 40 is difficult to conceive how the matter by which. the disease is communicated, should find access: to the urethra; while, on the contrary, all the: external parts, particularly the glans, must be: easily and universally exposed to it; and yet gonorrhoea is a much more frequent disease than pox. Cases of gonorrhoea are in propor- tion to those of chancre and pox, so far as my* observation goes, of about seven to one; while: it is obvious, that the very reverse should: happen: if the two diseases were produced by the same kind of matter.* Again, were this the case, should we not | _* Mr. Hunter supposes, that. the proportion the cases. of gonorrhoea, bear to those of chancre, is as four or five to one. Vide Treatise on the Venereal Disease, p. 217. This is surely a weighty argument against the opinion he endeavours to support, of gonorrhea and cliancre pro- ceeding from the same contagion. 4} find gonorrheea in almost every instance termi- nating in pox, and chancre in gonorrhoea; for every one knows, that in gonorrhoea the matter is at all times passing from the urethra over the glans and prepuce; and in chancre, that it is passing from the glans into the entrance of the urethra. It happens indeed, in a few instances, (Mr. Hunter, we see, has met with some cases of it) that the one disease supervenes upon the other: but we have also seen that these are rare occurrences, and where they have not been communicated by subsequent connexion with an infected person, that the two diseases have probably been given at one and the same time: Tt is no argument against this suggestion to say, -that mstances. have been’ met with of a go- norrhoea appearing during the continuance of chancres of several weeks duration, and vice versa; for every practitioner must have met with instances of these diseases both appearing 42 at the distance of two or three months. from any exposure to infection. ae ae I have at this moment a gentleman under cure, for a deep foul chancre, altogether within the urethra. It was of several weeks duration before I saw it, and yet no gonorrhoea took place. He is now getting well fast by the use of mercury. I have met with various cases of this, as every practitioner must have done. Mr. Bell relates the following case. I was called in to a gentleman with a painful chancre on each side of the urethra. The sore extended about the eigthth part of an inch up the passage ; and the parts being much inflamed, I hesitated to apply caustic. This rendered the cure tedious, but still no gonorrhoea took place. At last, after having taken a considerable quantity of 43 mercury, and when the chancres were looking clean, and in a healing state, he was seized with all the symptoms of a severe clap, with heat in making water, and a plentiful discharge of a thin green matter. ‘This, however, bore all the appearance of a recent infection. I at once said so to my patient, and he candidly acknow- ledged that he had imprudently exposed himself, by having connexion with a girl of the town. three or four days previous to the accession of these symptoms. We may also remark, that the discharge from gonorrheea frequently becomes so acrid as to excoriate the glands and preputium, and even to excite a very plentiful formation of matter; but every one knows that this is materially dif- ferent from chancre. It is altogether different in appearance, and so materially different in its effects, that scarcely any practitioner of expe- Ad rience will trust the cure of chancre to any thing but mercury; while in the other, mercury, T imagine, is seldom employed. However ex- tensive the excoriations may be, they are easily removed by local remedies, and I have never known an instance of pox succeeding to this kind of treatment. Nay, I have met with various instances of such affections, where mercury had been given in considerable quantities. with no advantage whatever, and where the cure was: effected by the use of an astringent injection. About eighteen months ago, a gentleman came to town from a considerable distance, with an extensive excoriation, attended with a discharge of a large quantity of thin offensive matter.. The quantity of matter indeed was so considerable, that at first sight it appeared to be the discharge from a very inveterate recent case of gonorrhoea; but on farther examination, 45 it was found to proceed entirely from the pre- puce, the clap by which it was produced being entirely gone. He had taken mercury for the ‘space of six weeks, and the parts had been regularly bathed an milk and water, but with no advantage. ‘The discharge continued as plentiful as ever, and the preputium was beginning to acquire some de- gree of thickness, and to be difficult to retract. In the space of a week he was completely cured, merely by bathing the parts from time to time with brandy and water, and applying, during the night, a poultice strongly impreg- nated with saccharum saturni. This, as, well as a variety of similar ‘affec- tions, which, were it necessary, I might enu- -merate, clearly evince not only that the matter of gonorrheea, when ‘confined to. the urethra, 46 does not terminate in pox, but that it proves equally inoffensive to the constitution, where it is even so sharp and acrid as to excoriate the surrounding parts. This points out a very marked difference between the matter of the two diseases. In pox, even the slightest sore never fails to throw matter into the system, while the most extensive affections proceeding from gonorrheea are so seldom found to injure the constitution, that I have never met with an instance of it. By those who wish to support the opposite doctrine, it is said, that the matter of gonor- rhoea would more frequently terminate in pox, were it not for the mucus of the urethra with which it is blended, and by which they suppose it to be rendered not only milder in its nature, but not so apt to be taken up by the absorbents. This, however, is merely ideal, and no proof fr A7 can be advanced in support of it. Besides, the force of the argument is entirely done away, when we see, from what has been observed before, that “even where the matter of gonor- rhoeais more acrimonious than almost ever occurs im cases of chancre, so as in some instances to produce very extensive excoriations, that still no affection of the constitution ensues from it. Nay, we see, even in such diseases as are found to proceed from what-is termed a trans- lation of the matter of gonorrhcea to other parts of the body, and which we suppose to happen through the sympathy of parts, as swelling of the testes, that still no affection of the consti- tution proceeds from them. I have seen some instances of ophthalmia proceeding from gonor- rhoea, and in which a considerable discharge took place of a puriform matter from the evye- lids, very similar to the matter of a recent 48 clap. I have also met with instances of patients labouring under gonorrhoea, being seized with a similar discharge from the membrane of the nose, but in none of these have I ever known lues venerea ensue. A considerable number of examples might be adduced of each of these, but the three following will be sufficient. Not long ago, a young man applied to me with a very ‘troublesome painful disease affecting both eyes. The eye-balls were not much inflamed outwardly; but as he experienced an intense degree of pain from the admission of light, I concluded that the retina, or other deep-seated parts of the eye, were in a state of inflammation ; and the membrane of the eye-lids was not only inflamed, but a constant and co- pious discharge took place from them of a greenish yellow matter, bearing much the ap- pearance of the matter of a recent clap. 49 The account I received of his disease was this: That he had for eight or ten days laboured under gonorrhoea, the symptoms of which, how- ever, were not more severe than usual ; when, after. being heated with drinking port wine, the discharge from the urethra, which had pre- viously been copious, disappeared almost entirely. His eyes, almost immediately thereafter became painful, and in less than twenty-four hours the discharge of matter had taken place from the eye-lids. The disease was at first treated with blisters, slight evacuations of blood, and the usual applica- tions of ointmentsand collyria. These not proving successful, a course of mercury was prescribed ; but although different attempts were made with it, mischief always ensued from it. It did not lessen the discharge, while it obviously increased the inflammation, and rendered the eyes more D 50 - . irritable. I therefore advised this remedy to be laid aside. A quantity of blood was taken from the temporal artery of one side; such vessels as were turgid upon the eye-balls were divided ; scarifications were made in the inflamed parts of the eye-lids ; poultices were applied over the eyes, in which opium and saccharum saturni were dissolved ; and gentle laxatives were pre- scribed. By these means the pain soon abated, the inflammation and discharge of matter lessened, and in the course of a fortnight no symptom of the disease remained, but a degree of irritability on exposure to much light, with which both eyes continued to be distressed for five or six months afterwards. In the course of the following year, on being attacked with gonorrhoea, but of a more violent nature than the former, he was again seized, after exposure to much cold, and riding on a1 horseback, to a similar affection of his eyes. In this. instance too, blood-letting, and the other remedies formerly prescribed, proved successful, and he has not since that period had any return of the disease. About two years ago I was desired to visit a patient, who, during confinement from a swelled testis imduced by a gonorrhoea, was suddenly seized with a profuse discharge of matter from one of his nostrils, very similar to the running of aclap. The membrane of the nostril appeared tender, and somewhat inflamed, but little or no pain occurred fromit. The dis- charge from the urethra had diminished con- siderably previous to the testis becoming in- flamed, and on this taking place from the nose, it disappeared entirely. This suggested the propriety of attempting to excite a return of the discharge by the urethra: but no advantage dD Qg 52 being derived from this, I advised the affection of the nose to be treated with injections similar to what we use in cases of clap. An astringent solution was thrown up, sometimes with a syringe, and at other times by inserting a_bit of sponge, immersed in it, up the nostril; and in the course of a few days the running ceased entirely. Since that period, the same patient has been’ twice affected in a similar manner, and the same kind of treatment proved equally success- ful. . No mercury was given, and no symptom of pox ever appeared. In the course of a few weeks after the re- covery of this patient from the first attack of the disease, I was desired to see a friend of his, who for several years had been distressed with a similar discharge from both his nostrils. ‘The DD | rumning had occurred during the continuance of a clap; and although it had frequently di- minished in quantity, yet at all times it was so considerable as. to. be productive of much un- easiness. No ulceration appeared on the mem- brane of the nostrils, but it was of a deep red colour, and tender over its whole extent. A variety of remedies had. been employed ; and at last, after the disease had gone on for upwards of three years, although no other symptom appeared, he was advised to undergo a course of mercury. This was done in the most at- tentive manner, but no advantage ensued from it. In this situation, I expected that the same plan of treatment which proved successful in the preceding case, and which had also done so in others, would likewise answer here. In this, however, I was disappointed; for al- ‘though every variety of injection was used a4 that I ever employed, yet no material advantage ensued from them. ‘The running was some- times indeed lessened by them, but it always returned equally severe as before; and although it has of late, even when no remedies were em- ployed, become considerably less, it still con- tinues in such quantities as to prove highly dis- tressful, No other symptom of the disease, however, has ever occurred. As a farther:proof of the: difference of the contagions of syphilis and gonorrhoea, it may be remarked, that no stage of pox has ever been known to induce gonorrhoea, which surely would: occasionally happen if the two diseases were of the same nature. We may also remark, that in numberless instances, people have been poxed by the matter of syphilis being by acci- dent applied to acut or a scratch, as oftenhappens — with surgeons in the dressing of chancres and — 595 buboes ; but no one ever heard of a pox being got in this manner from the matter of gonorrhcea. It has indeed been said, that chancres may be produced by insinuating the matter of gonorrhoea béneath the skin. But experiments upon this subject are productive of such anxiety and dis- tress, that they never have been, nor ever probably will be repeated so frequently as the nature of it would require. Nothing, therefore, can be admitted from this argument; for in order to avoid fallacy, and to give support to the opinion, these experiments would not only require to be conducted with accuracy, but to be numerous, and to be repeated on a variety of patients under every possible variety of cir- cumstances; whereas we have heard of only a single experiment or two being made by any in- dividual, and even these seem to have been made under the management of such as were strongly 36 and obviously. biassed. in favour of one side of the question. In opposition to these too, I may mention, that, induced by some late publications. upon this subject, two young gentlemen of Edinburgh have made some experiments upon themselves, with a view to ascertain the point in dispute, but the result was materially different from what appears to have happened in the experiments to which I allude. By the introduction of the matter of chancres, as well as of buboes, into the urethra, some pain and irritation were ex- cited, but no gonorrhoea ensued; and, by fretting the skin of the prepuce and glans with a lancet, and rubbing the parts with the matter of gonorrhcea, slight sores. were produced, but they never assumed the appearance of chaneres, and they healed easily without the use of mercury, o7 - For the reasons mentioned above, however, we cannot place much dependence upon these, or any other experiments that have yet been made upon this subject; we- must trust therefore to experience and observation in the ordinary course of practice, for means to ascertain it. The other fact, on which the doctrine we attempt to establish, rests, is, that gonorrhoea and syphilis have appeared at different times in the same countries, and in some instances have remained distinct and uncombined for a great length of time. If these two diseases were of the same nature, and proceeded from the same contagion, they ought to have appeared nearly at the same time in every country to which the infection was carried. This does not appear, however,: from the history of the disease, to have been. the pas va 58 case. From the earlier writers upon this sub- ject, it is evident that the lues venerea was known in Europe at least forty years before the gonorrhoea virulenta. Dr. Astruc, whose ac- ' curacy and minute attention to this subject has | not been equalled by any one, asserts, that in his time, gonorrhoea had not been long .known in China, although we know that the ues venerea had long prevailed in that: country; and it would appear, notwithstanding any thing that has been said to the contrary, that the lues venerea was imported to the Island of Otaheite a considerable time before gonorrhoea, It seems to have been carried to that and other islands in the South Seas by the very first European navigators who touched there; and to have remained distinct, without being con- nected. with gonorrhoea, for a very considerable time ; for when Captain Cook visited these islands in his second voyage, we have authority 59 for saying that gonorrhoea had not then appeared amongst the natives. These historical facts all tend to prove, that - where only one of these diseases has been im-— ported to any particular district, it has always remained distinct, without producing the other ; and which we cannot suppose would have hap- pened, if both were formed by the same con- tagion. And, in addition.to these, I may add another, not less remarkable, the truth of which may be ascertained by all who incline to inquire concerning it, as the scene of it lies in our own country. In various parts of the country of Scotland, particularly in some parts of the Highlands, in Galloway, and in Dumfries-shire, the common people have, for a great length of time, been afflicted with the /wes venerea, under the deno- 60 mination, as they termit, of Szbbens ; and which, from those distressed with it having no commu- nication with those infected with gonorrhea, has still retained its original unmixed form, without a single instance, so far as I know, of gonorrhea having been ever produced by it.*. There is evidence in some of these districts of this dis- ease having prevailed among them for upwards of seventy years. Nay, in some of them, it 1s said, from tradition, to have been left there by * This must have happened from the disease in these districts prevailing almost entirely among poor county people, whose manners do not expose them to the hazard of being infected with gonorrheea. None, however, can escape the sibbens who are much in company with those labouring under it; and so-much are they convinced of its being the same disease with lues venerea, that even those who get it in the most innocent manner, are so ashamed of it, that they never speak of it as long as it can possibly be kept secret. 61 the soldiers of Oliver Cromwell; and to have been given, since that period, by one generation to another: and although I have had opportu- nities, says Bell, of seeing many hundred people labouring: under it, with ulcers in the throat, nodes” of the bones,’ fungous excrescences, blotches over the body, with alrhost every other symptom of ‘syphilis; yet not an instance has occurred,to me, as I have observed above, nor have I heard. of any, where. gonorrhea took place in it.. Whether it is from those infected with it, concealing it longer than ‘usually hap- pens in towns, or what may be the cause of it, I shall not at present pretend to determine; but certain it is, that the symptoms produced by it are more inveterate than we usually find them to be in the ordinary form of ‘this disease.. They appear to be more particularly infectious, the slightest communication with those labouring under the disease being apt to produce it. The 62 symptoms spread more rapidly, and a greater quantity of mercury is, for the most part, re- quired to remove them ; but still gonorrhea is never produced in any stage of the disease. * A disease very similar to this broke out among the country people of Canada some years ago, Owing, as is imagined, to commu- nication with some of the soldiers quartered among them, who were infected with lues venerea. It is attended, as is the case with the sibbens in Scotland, with all the symptoms of syphilis in the most virulent form of that disease ; and it is so infectious, as to be often communicated by eating or drinking out of the same vessel, or employing the same cloth that has been used by those labouring under it. It often enters the constitution by absorption from the surface, without any previous ulcera- tion, in which case it afterwards breaks out in 63 buboes, nodes, ulcers, and other symptoms of a confirmed lues; but not an instance, I am in- formed, has happened of gonorrheea being pro- duced by it. ® This, as well as what has occurred in the progress of sibbens, is precisely what happened with the lues venerea when it first appeared in Europe, as well as at a late period in the South Seas; and there cannot be a doubt of the same circumstances taking place wherever the syphilis only is communicated. We have seen, in all these instances, that gonorrhoea has never been produced by it, which surely could not have happened if the two diseases were of the same nature, and produced by the same contagion, They could never, in that case, have remained for any length of time so distinct and precisely marked, for the one must necessarily in almost every instance, have soon been productive of the other. 5 64. As a farther support of this opinion, I may add, that if the two diseases were of the same nature, and produced by the same infection, — the remedies proving useful in the one might. be expected to prove likewise so in the other. | Instead of this, we find that those upon which we depend with most certainty in gonorrhoea, have no effect whatever in the cure of syphilis ; while. mercury, which is the only. remedy, as we have observed above, upon which any de- pendance can be placed for the cure of syphilis, does not in gonorrhoea produce any advantage. Nay, that in most cases it evidently does harm. We also know, that gonorrhcea will often terminate whether any remedy be employed or not, merely by moderate living, and keeping the parts regularly clean. ‘The disease by this alone will, in most instances, become gradually milder, till at last it will disappear entirely. No such thing, however, happens in- lues ve~ 65 nerea. In this, as we have already remarked, even the mildest symptom becomes daily worse, unless. mercury be employed; nor: will any practitioner of experience trust the cure even of the slightest chancre to any other remedy. _ Upon this evidence alone, of the method of cure of the two diseases being so essentially different, we might, I think, conclude that they are different in their nature, and that they pro- ceed from different contagions. Were they of the same nature; and proceeding from: the same cause, it is not possible to conceive that any medicine would act as a certain cure for the one, and do harm in the other; and yet every practitioner will admit, that mercury is the only remedy hitherto known, upon which we -can depend for the cure of lues venerea, while it evidently often does harm, as I have. already observed, in gonorrheea. 66 If the subject now under discussion was merely of a speculative nature, I should not have en- tered so minutely into it; for in that case it would have been a matter of indifference both to practitioners and patients, whether these dis- eases were of the same nature or not; but as the treatment of gonorrhoea must depend much upon this circumstance, I judged it proper, to enter fully into this, very curious controversy. For the above arguments for distinct dis- eases, we rest chiefly upon. the authority of Bell; and thinking the subject of that import- ance, I procured some young men,. induced by money, and under the promise of cure, to sub- mit to some experiments made upon them. But in six trials, the matter of chancre never produced gonorrhea, or the matter of gonor- rhea, chancre. They are, therefore, distinct diseases. CHAP. Il. OF THE CURE OF GONORRHGA. ‘Tsu of late years this disorder was confounded with the Lues Venerea, and treated in the same manner with mercury; and mavy have been the martyrs to this error im practice, which, I am sorry to say, yet exists, notwith- standing our advances in science. Whenever a smarting heat or scalding accom- panies making water, with a purulent discharge staining the linen, appearing a few days or _ weeks after impure connexion, we should imme- diately judge that the reckoning is come, and endeavour to ward off the impending evil. 68 The time of danger is arrived. That aw- ful command, “increase and multiply,” was never intended by Providence for the inter- course, without love and affection, with the most abandoned of wretches, whose faces belie their manners, being ‘ whitened sepulchres, but inwardly full of all manner of uncleanness.” Happy should the youth be, if with gonor- rhea, he has not also dues wvenerea, the itch, body and other lice, which are the common’ attendants on this class of degraded beings, who live in a state of prostitution. Behold in every street the name of surgeon over the door; and young men would do well to consider, that this numerous tribe flourish from this disease alone. Can any one of the slightest understanding, but perceive, that from a disease, which exists for 69 months, and years, in men of unprincipled cha-— racter, but that the same must be communi- cated to females of bad morals; who, had they the power, would not have the sense to. undergo a cure: so that this disease, so awful in its visitation, keeps on increasing in the land. But it is for ingenuous youths that I write; who deplore their condition; who feel a sense of shame; who resolve never to deviate from the right path again; and who should not, therefore, fall early victims: to so dreadful a calamity. One great misfortune attending those who are afflicted with this malady is the necessity of disguise. In many situations of life, a man may be ruined by its being known that he la- boured under the venereal disease. ‘The peace of many a family has been broken by the mis- 70 take of an unguarded moment, when all the in- jury might have been repaired, and the matter kept an absolute secret, had the unfortunate person known how easy a thing it is to remove this malady. on its first appearance. Were any apology necessary for extending the knowledge of this disease, the above would be more than sufficient. In all diseases it is of importance, as soon as possible, to know the nature and tendency of the complaint: but in none more so than in the venereal. ‘This dreadful malady, which, in its advanced stages, commits such ravages on the human system, as to destroy even its most solid parts, may be disarmed of all its vi- rulence. by some gentle applications on its first appearance. ‘To negligence, or to trifling with the first symptoms, we owe all the mischief arising from the venereal disease. 71 Other diseases often attack men unawares ; but this is seldom the case with the venereal disease. It is generally the effect of an overt act, of which the patient must have been con- scious, and has consequently reason to ex- pect it. When the unhappy sufferer by this disease perceives his situation, the same inclination to conceal it, too often induces him to apply to those pests of society, the advertising quack, who, while he promises a sudden and secret cure, generally disappoints him. Every man conversant in the cure of this disease, will rea- dily own, that the most deplorable cases he meets with are those which have been under the care of quacks; till the patient, convinced of their ignorance, had recourse to proper advice. The quack not only holds out the lures of 72 expedition and concealment, but of cheapness. To some patients this is a matter of great im- portance: in this expectation, however, they are sure to be disappointed. When the quack finds that the patient’s pocket will hold out no longer, he generally dismisses him, telling him he is cured, or leaving him to find a remedy where he can. No doubt the most ignorant pretender may sometimes succeed; but as un- toward circumstances will frequently occur, it is safer to be in the hands of one who knows how to treat them, than of him who practices at random, and looks at nothing else but getting of money. ‘These make a prey of the unwary, who ashamed to acknowledge the imposition to their friends, submit to be plundered of all they can by any means scrape together. If there needs any apology for writing on this disease, the above would be a sufficient one; when we so often see the fairest blossoms 73 of hope, thus untimely nipt, and becoming the early dupes of the most unprincipled of mankind. The disease in question is an highly inflam- matory disease; and hence the patient should avoid every thing which has the least inflamma- tory tendency. He should avoid, as much as possible, animal food and beer ; and drink toast and water, or barley water; all excesses now are attended with considerable risk. Drinking only a few glasses of wine, or violent exercise, has renewed the disorder, after it had ceased. His breakfast and supper should be milk porridge, and he should drink plentifully of tea. If to this was added the occasional use of linseed tea, by putting half an ounce of linseed to a quart of boiling water, and drinking a cup of this: warm, it would be of service; and all immoderate exercise must be avoided. The less exercise the better. Fruits are desirable. E 74 With respect to medicine, it must be a saline purgative, only of a mild kind, as . Magnes. vitriolat. dr. 3. Confect. Amygdal. dr. 1. Infus. rosze unc. 7. Pt. mist. capt. coch. larg. ii. hora somni, et primo mane, sing. diebus. That is, take of Vitriolated magnesia, three drachms. Almond confection, one drachm. Infusion of roses, seven ounces. Make into a mixture; of which take three large table-spoonsful night and morning. To this must be added the following in- jection. 7 R. Hydr. muriat. gr. 14. Aq. font. unc. 8. Ft. injectio ter die utend. | 75 That is, take of Muriated mercury, a grain and a half. Water, eight ounces. v This injection is to be used three times a day. In case of great pain attendant upon its use, it may be lowered, by the addition of water, but so as to excite some degree of pain. From an experience of twenty years, I have found this the most effectual of all injections. In case of chancre in the urethra, which some- times happens, as well as gonorrhoea, both dis- eases will yield to this remedy at the same time; and it acts in the following manner. The part assailed being accustomed to a stronger stimulus than the venereal, ceases to be acted upon by the latter, or it has some specific ope- ration over the virus itself. E Q 76 I have had cases of some months’, nay years’ continuance, which resisted all the common means, yet were cured by this application in a very short period; and at the same time we are using the means, we should be thankful to Providence, that his anger is of short duration, and He has furnished us with the means of re- moving so dire a disease. But although such be the general, and I had nearly said constant effects of this remedy; yet some constitutions are so framed, that all our endeavours prove abortive, and the following symptoms arise; a chordee, which is a painful and involuntary erection, accompanied with an incurvature of the penis downwards, and ex- quisite pain.—The adjacent parts sympathizing with those already affected, the bladder becomes irritable, and incapable of retaining its urine for 77 any length of time;—this gives the patient a frequent inclination to make water, and he feels an uneasiness about the scrotum, perineum, and fundament.—Sometimes the discharge is more copious from the external surface of the glans, or from the membrane of the prepuce, when phymosis or paraphymosis are not unfrequently produced.—Often there is an enlargement of the glands of the groin, which however is to be considered as depending merely upon irritation of the lymphatics, and not as a syphilitic bubo.— The inflammation sometimes extends along the whole course of the urethra, and even to the bladder itself, producing actual cystitis——In other instances it happens, more. especially in the protracted state of the disease, that, owing to the rupture of a small vessel, a hemorrhage arises. —Spasmodic stricture, with retention of urine, are likewise at times the effect of the great irritability of the parts; or a stricture 78 arises, when the bladder evacuates its contents with great difficulty, the ureters dilate, and the urine is thrown back upon the pelvis 6f the kidneys, which enlarge also; the symptoms are now very distressing to the patient; his spirits sink, the stomach sympathizes, nausea, frequent retching, rigors, considerable exacerbations of fever, and a long train of miseries afflict him. The stricture then sometimes inflames, or mor- tifies, or ulcerates; or suppurating, causes an -abscess in the corpus spongiosum, or perineum, ic. Occasionally the bladder partakes of the inflammation; coagulable lymph may then be thrown out, which, fillmg up its cavity, destroys the patient by the most dreadful sufferings. Here Providence points out, what prevails in the benignity of our laws, making examples of afew in order to deter the larger mass; and 79 happy ought the youth to be, if he has escaped with but a few scars in his first dangerous en- counter, in what the ancients have styled the wars of Venus. Where this disease has not been attended at first, it is apt to run on for years, and terminate at last in a troublesome gleet, whichis a serous discharge from the urethra, exhausting the frame, and laying the foundation of consump- tion, or a long train of nervous diseases, which destroy by inches; and sometimes even ends in madness itself. This disease is to be treated. by tonics, as bark, air, and exercise, and the cold-bath ; and fortunate will the youth be, if in the course of time he gets rid of so dreadful a sequel to a disease, so loathsome in its nature, and which is only certainly curable in its early stage. ~ ae a CHAP. IV. OF THE CURE OF THE LUES VENEREA. Tus disorder is at first local, like the inocu- lated small-pox, and begins with a sore of a peculiar form, having a hollow crater or exca- vation, with a prominent rising surrounding it, or as medical writers style it, a chancre is a sore, with a thick, red, and hardened basis. Now is the time to take alarm, and imme- diately think of getting rid of the horrid poison. The bite of a venomous serpent, or a mad dog, excites immediate consternation, but here is a 81 more alarming poison; for these kill with speed, the other consumes by slow degrees. In the next stage, the poison is arrested, by one or more glands in the groin, which are denominated buboes. ‘These usually appear six weeks after the chancre, and this last after a week from the time of impure cohabitation. Four or five months after this, copper-coloured eruptions break out over the surface of the body, which dry over in scales; or the throat becomes ulcerated, with a jagged-edged deep ulcer, having a brown slough in the center. All sore throats, which have a duration beyond a month, ought to be suspected. The last scene is horrible to name.. The bones become affected. Excrescencies arise, especially over the shin-bone. Sleep, which comes to all, is then denied. At last the hu- E 3 82 man face divine loses its chief ornament the nose. ‘The bones of the forehead decay, and the miserable being, perhaps from one un- guarded hour, pays away a life of torture, to the law which Nature always avenges, and which thoughtless youth disregards. But Heaven in its mercy has granted a re- medy, MERCURY. The best method of applying this is by une- tion: . R. Unguent Hydr. fort. unc. 2. Toungr. dr. 2, hora somni sing. noet. That is, take of the Strong mercurial ointment, two ounces. Rub into the inner part of the thigh two drachms, until the mouth becomes sore; then omit it for some time, so as to keep the mouth tender for a month or six weeks. If it purges, 683 ai graimoropiam may be taken at bed-time:: or two grains of calomel, and half a grain of Opium, may be taken each night; and one grain of calomel in the morning, with the same intention; but rubbing in the ointment is the safest method for the constitution. Sometimes a discovery, highly injurious to the party, would be made by using friction, then pills must be had recourse to. ‘The method now ta be employed is as follows: R, Calomel. ser. 1. Cons, Rose q: 8. P. pil: 20. Cap. pil. duas hora somni, et pil. unam primo mane. That is, make twenty grains of Calomel with conserve of roses into twenty pills; of which take two at bed time, and one early: - the following morning. If they purge, take twenty five drops of lau- danum, in some liquid, at bed-time. 84 @ The chancre should be drest with strong mer- curial ointment spread on lint, doubled, and placed between the skin and prepuce, by means of a slip of card. Medicines are daily advertised as contaming not a jot of mercury, for the cure of this dis- ease ; and the evils produced by mercury are aggravated by reporting its bad effects, if such happen, upon certain constitutions, as general.* Not only quacks of this description, now un- dertake to cure this disease; but every idle fel- low who does not chuse to follow some useful employment, sets up for doctor, assumes some fictitious name, and advertises an infallible spe- cific for the venereal disease. Some have even the effrontery to advertise an infallible preven- tative. ‘The apothecary’s man, or even the * See Mercury Stark-Naked, a recommendatory pamphlet for De Velno’s vegetable syrup, which, as Dr. Buchan affirms, never cured a single venereal case. 85 apothecary’s man’s man, often passes for an adept in curing this malady. Nor is it un- common for the fellow who brushed the sur- geon’s coat, or cleaned his shop, to step into his master’s shoes, and sometimes into his cha- riot, by his pretended skill in curing the lues venerea. The credulity of the sensible part of man- kind in regard to medicine, is truly astonishing. Even those who affect to be sceptical in other matters, are the easy dupes of every pretender to a secret medicine: they will neglect the advice of the most skilful physician, and run after the ignorant quack, because he promises them a cure, and without mercury; but, alas ! this cure, nine times out of ten, turns out to be no cure at all, and the disease is, by this means, trifled with, till it becomes nearly in- curable. 86 The most frequent dupes to quackery, how- ever, are the young and thoughtless. They credit the contents of every puff that 1s put into their hands as they walk the streets, and swal- low with eagerness. the drugs it recommends. I would beg leave just to hint to such inexpe- rienced youths, that the advertising quack is ten to one more ignorant of medicine than them- selves; that his sole aim-is to take their money, and when he has got that, he cares no more for the patient. I am warranted to say this from daily observation, and’ am sorry to add, that too many, from woful experience, know it to be true. So great, however, is the influence of quackery over the young mind, that I have seen one of those unfledged gentlemen, while I was writing a prescription for him, take up a newspaper, and casting his eye on an advertise~ ment, which promised to do in a few days what I had told him’ would require weeks, if not 87 months, to complete, put my prescription in his pocket, and haste away to the performers of quick and easy cures, From the prejudice raised against mercury, by the hue and cry of these legal murderers, the disgrace and pest of civilized society,* it is now become a difficult matter to persuade pa- tients to continue mercury a sufficient length of time. The wish to be soon well is natural, but it is productive of much mischief. The victims to quick cures are innumerable: yet men will run after those who make such pro- mises, though to their own destruction. Few days pass in which I do not see instances of the danger arising from imperfect cures of the lues venerea; and I have reason to believe, that * Is there no Member of the House who has courage to stem this torrent ? 88 those which are not seen, nor regarded, are still, more numerous. Nor is the difficulty much less in getting men to take mercury in sufficient doses. Mercury ; may be taken for any length of time, but if it is not administered in such quantities as to produce sufficient effects on the system, it will not subdue the poison. ‘This, however, is not an easy matter to estimate. The difference of constitutions is such, that two persons can hardly be treated exactly in the same way, and our conduct must be regulated chiefly by its effects on the system. Every symptom of this dreadful disease should be overcome at least a fortnight before mercury be discontinued, and even here we must admit of calculation rather than of certainty. The great art in administering mercury 1s to. 89 regulate the dose in such a manner as to keep the system fully saturated, without forcing it off by any of the outlets. This may generally be done by gradually increasing the dose till the mouth is sore, and then keeping it so by smaller doses. But it is difficult to persuade patients to let mercury be employed with due energy. A sore mouth and fever is an evil too great to be endured! I am poisoned with mercury, they exclaim. But what is this. to the devastation of so foul a disease? and what is this poison in comparison to the other? but. not yet feeling it invall its horrible effects, they choose often to desist before a sufficient. trial has been made, and thus bring themselves and mercury into disgrace. If a man could keep a medium he would be perfect; but this is not in his nature: he flies from one extreme to an- other, and is equally wrong in both. This has been strictly the case with regard to the 90 exhibition of mercury. ‘Many. constitutions were ruined by pushing it too far; and now effects equally hurtful are produced, from its being too sparingly administered. We are, therefore, to follow a middle path, and, if pos- sible, to avoid the bad consequences arising from either of the extremes. I do not mean to recommend the old and justly exploded practice of exhibiting mercury, so as. to raise a violent salivation. ‘This was productive of many bad consequences, and is by no means necessary. All the purposes of mercury may be answered in a much milder way: I mean, by a gentle salivation; or a moderate degree of soreness of the mouth being kept up for a considerable length of time. Another great evil is the want of precaution whilst employing mercury. The quack not only holds out the lures of expedition, se 91 crecy, and cheapness, but also that of em- ploying a remedy that will not oblige a man to take any peculiar precautions, or make any change in diet. With regard to expedition, there is no great difficulty in healing a chancre, and this is expeditiously done, for sake of the pay. The object is to touch the cash, and the poor deluded wretch is dismissed; and we are not surprised at the appearance afterwards of a sore throat, obstinate ulcers, and carious bones. The wish of following the usual mode of free life is great, and the greatest risk is incurred, and the dead tell no tales. The true science of medicine, however, teaches that the natural stimuli must be at first mo- derated, whilst under the influence of mercury, and catching of cold most anxiously avoided, as the effects of mercury are lasting, and the abstraction of stimuli difficult under the ope- vation of mercury, which wears down excite- 92 ment, and requires supporting, although this is not to be done until tewards the conclusion of the course, when tonic medicines, a gene- rous diet, and the benefit of country-air, are absolutely necessary. ‘ It would be happy for mankind, if some preparation of mercury, milder than those forms now in use, or some other remedy could be discovered for this disease. ‘The danger in the use of mercury must be acknowledged on all hands; and in the ensuing chapters, the public will judge how far such a desideratum is near its accomplishment. CHAP. V. OF THE CURE OF SYPHILIS BY OTHER SUBSTANCES THAN MERCURY. GiRTANNER was the first who alleged that the effects produced on the human body by the different preparations of mercury were entirely owing to their combined oxygen ; and that it was on the disengagement of this principle, which had a powerful action on the system producing the mercurial disease, that their anti-venereal effects depended. We do not find, however, that Dr. Girtanner had ever put this assertion to the proof, by ex- hibiting other substances, containing a large 94 proportion of oxygen, in the place of mercury, in the lues venerea. Mr. Scott, surgeon in the East India Com- pany’s service at Bombay, was the first whe attempted to verify this doctrine by actual ex- periment. ‘The nitric acid,* containing about four parts of pure air and one of azot, was the first substance that occurred to him as being fit * The acid of nitre is obtained in various degrees of oxygenation. _ When the proportion of oxygen to that of azot is less than three of the former to one of the Jatter, it is termed nitrous acid, and, in this state, fames of a red colour are very freely emitted. But when there are four parts of oxygen, by weight, combined with one part of. azot, the acid is transparent and colourless, emits no vapour, its constituent parts are more firmly united than in the other species, and it is denominated nitric acid. So that nitrous acid, is the acid of nitre containing a smaller proportion of oxygen, whereas, the nitric acid is super-oxygenated, or surcharged with that principle. 95 for a course of experiments in the venereal disease: he tried this acid also in some other complaints, the result of which it is not my present business to notice.* Mr. Scott’s first letter is dated April the 30th, 1796; at which time, he alleges, that the nitric acid had been tried so fully as to satisfy him of its efficacy. His words are as follows: “ I have now had a pretty extensive experience * The following observations of Mr. W. Scott are ex- tracted from a small pamphlet which was sent to Sir Joseph Banks, entitled, Some Letters upon the application of the Nitric Acid to Medicine, first published in the Bombay Courier, 1797. And it is curious to observe, that Sir Joseph gave these letters to Dr. Pearson, who was so laughed at by the different medical men to whom he mentioned their contents, that he returned them to Sir Joseph Banks, reporting his total want of success in the cause of science and humanity. 96 of the good effects of the nitric acid in syphilis, and I have reason to believe that it is not in general less effectual than mercury in removing that disease, in all its forms, and in every stage of its continuance. {[ think that, in some cases, it has even superior powers, for I have suc- ceeded completely with the acid, when mercury administered, both in this country and in Europe, for years together, had failed of success. q A mass of mercury in the circulation, pro- duces many disagreeable ‘effects, that make it often necessary to give over its use before it has answered its intention; but the nitric acid may be taken a long time without any material injury to the health ; nor are its effects on the mouth, in producing inflammation and a flow of saliva, so disagreeable as from mercury. As the acid I distil is not strong, and is of 97 unequal strength at different. times, I am regu- lated chiefly by the taste in giving it. I make two pints of gruel as acid as it can well be drunk. This quantity is finished every twenty- four hours, taking about a Madeira glass full - only at a time. ‘¢ [ have sometimes removed syphilitic symp- toms with the acid in five days; more com- monly, I think, they give way in a fortnight; but sometimes, though seldom, they continue for twenty days without any apparent relief. I have cured syphilis with the acid under a variety of forms, where no other. remedy had. ever been employed, and for two years I have seen no relapse in those cases. I have ad- ministered it against the primary symptoms ox the disease, and I have given it for exostoses, for carious bones, for nocturnal pains, for eruptions and ulcers of the skin, and for FE 98 all the train of misery that is attendant on dues.” This respectable writer concludes by hinting, “ that several of his friends had begun to use the nitric acid in syphilis, and that an account of their experience should make the subject of a future paper.” “1 hope,”. says he, “ this slight account will induce medical practitioners to try the effect of the nitric acid in syphilis; a'disease which, in this climate, (viz. the East Indies,) is so frequently the disgrace of their 2a e art The second letter of Mr. Scott is dated June the 11th, 1796. He therein endeavours to obviate an objection which might be made against the nitric acid, on account of its de- composing the teeth. His method is, to mix the congee of rice with it, or to sweeten it with 99 sugar, or liquorice root. Although these ad- ditions may deprive the remedy of some of its oxygen, he has not found that they diminish its effect. Mr. Scott also notices, that when the acid has been united with the earth of alum, it had the advantage of not acting in the same way on the teeth. From this nitric clay he obtained the same effects as from the nitric acid. . He concludes thus, ‘‘ In a few years, I think that mercury, as a remedy for lues venerea, will be banished by this acid; and in some of my dreams for the improvement of the condition of man, I even imagine that the poison of ‘syphilis may, ina great measure, be extinguished over the face of the earth, not by the doubtful efforts of the magistrate, but by an agent like this, safe, simple, and efficacious.” r@ 100 With a view, says Mr. Cruickshanks,* Sur- geon and Chymist to the Orduance, to satisfy ourselves of the antisyphilitic property of the nitrous acid, and, at the same time, to discover how far this might be owing to its oxygen, the following trials were instituted : The first substances employed were acids, such as are known to contain much oxygen, and which part with it readily ; as yet we have only used the nitrous, oxygenated muriatic, and citric acids. It is well known that the bases of these are different, and the only thing which. they have in common is oxygen; if, therefore, they should all produce the same, or nearly the same, effect on this disease, as well as on the consti+ tution, the natural inference. to be drawn is, * Vide Dr. Rollo’s most excellent work on the Diabetes, with the appendix by Mr. Cruickshanks, who is univer- sally acknowledged to be the first chemist in this country. 101 that this must depend upon their common principle. The only other substance which we have yet tried, is the oxygenated muriat of potash, a neutral salt, containing likewise: much oxygen, and which parts with it very easily. We mean, _ however, to extend our researches farther, when a proper opportunity shall offer, and to make trials with some of the other acids, the black oxyd of manganese, Xc. In detailing the following cases, we shall satisfy ourselves with describing the symptoms at the commencement, and any remarkable change which afterwards occurred during the cure; with enumerating the doses of the dif ferent medicines employed, and their effects in general on the disease and constitution; and with giving the final result and duration of the treatment. A more particular, or daily, ac-. 102 count (although such. was regularly kept,) would be tiresome, and could not afford any additional information, or satisfaction. It may be proper to observe, that most of the patients, whose cases are here related, were kept in a ward set apart for the purpose ; and where it was impossible, from the nature of a_ military hospital, they could procure any medi- cines but such as were given to them. ‘The cases were also selected, being primary affec- tions,* and such as were strongly and distinctly marked, and where no mercurial remedies had been employed. * Primary cases, according to John Hunter, are the best criterions of venereal infection. His words are: “ Of the symptoms of the second stage of the lues. venerea, it must be observed, that this stage of the disease is not so well marked as the former, aud as it is of more im- portance, it requires all our discernment to determine what the disease is.”—Vide page 527. 103 GENERAL ABSTRACT Of the Patients admitted in the Royal In- Sirmary at Woolwich, dividing ther Cases into the Primary and Secondary Nature of the Venereal Hs aoe specifying the. par- ticular Remedies employed, and the respective Numbers who have been treated. 1st. PRIMARY DISEASE. Number of Remedies employed. Patients. NTEFOUS AEN ra a tee tre ler atte Oe Oxygenated muriat of potash . . . . . 54 ——_—_—__—_——-manganese . a ee, 3 muriatic acid” Ss ee Lemon-juice SAY Ab. 1 wee Ge ef aid Nitrous acid and oxygenated muriat of pot- GE Se a ag ge ee et eee I Ditto and oxygenated muriat of manganese Mercury and the new remedies combined . 16 reat a ee Total 142 cured. 24d. SECONDARY DISEASE. PEO CAG a See a a APNG ht AE LU Oxygenated muriat ofpotah .... . 5 —_—_____——_——-manganese and potash 1 Nitrous acid and oxygenated muriat of potash 2 Total 13 cured... 104 It would appear from the cases just related, that the nitrous, citric, oxygenated, muriatic acids, and, more particularly, the oxygenated muriat of potash, are capable of removing the primary symptoms of the lues venerea, and that too without producing any thing like mercurial salivation. How far these cures may be per- manent, or whether the secondary symptoms may not hereafter supervene, can only be de- termined by further experience and observation ; as the primary symptoms, however, have not yet returned in any one instance, we should suppose that these have been completely re- moved; the only doubt therefore which can reasonably remain, must relate to the secondary ones; and if, ina Es cases, should even these make their appearance at some future period, it can form no solid objection to this mode of | treatment, as similar consequences frequently follow the use of mercury. 05 In our first trials, it, was thought proper to confine ourselves to cases of primary affections, these being always less equivocal and doubtful ;, we intend, however, when an opportunity shall offer, to employ the same substances inthe more advanced states of the disease, particularly where mercury has either failed, or had little effect. Before we attempt to explain the modus operandi of these remedies, it may be proper to take a review of the effects they were observed to produce on the constitution in general. The general effects from the acids were, an increase of appetite, an augmentation im the quantity of urine, more or less thirst, white tongue, and an increased action of the whole system, most generally accompanied with sizy blood. The oxygenated muriatic acid ap- peared to be the most active, and the citric ° _B OO: Z 106 acid the least so. The nitrous acid, in a few. instances, likewise affected the bowels. The oxygenated muriat of potash produced thirst, the white tongue, and the increased action of the system, in a more remarkable degree than the acids, but there was less alteration perceived in the quantity of urine, and on the appetite. The effects, therefore, induced in common by these different substances, appear to be a general increased action of the whole system, accompanied for the most part with sizy blood. That this mcreased action is occasioned by the disengagement of oxygen, is rendered highly probable from the following considerations : — Ist. It is now sufficiently known that oxygen 1s the substance which imparts to the different acids their activity, their tendency to combination, and other characteristic properties : 107 their radicals being all different, and possessed of powers either opposite, or in no respect similar to those of the compounds, or acids. 2d. The oxygenated muriat of potash ap- pears to be, in fact, nothing more than the common muriat, combined with nearly. half its weight of oxygen; for if this substance be ex- posed to heat in a retort, a very large quantity of the purest oxygen gas is disengaged, what remains being the common muriat of potash, amounting to a little better than half the weight of the saltemployed. Now it must be allowed, that the common. muriat, at mee in the. doses given upon the present occasion, could. not have produced the remarkable effects which we have ascribed to the oxygenated muriat. This difference of effect must, therefore, be owing to its combined oxygen, a circumstance rendered the more probable, when we reflect, that a 108 similar action is produced by the union of the same substance with the radicals of the acids. Sd. When oxygen gas has been inhaled into the lungs, a general increased action of the whole system has succeeded, and that some- times to a very remarkable degree. (See Doctor THorRNTON’s work on the Nature of Flealth and Disease, and the Laws of the Animal Qiconomy. From these ‘considerations, therefore, we would infer, that. the general, or constitutional effects, which have been observed to follow the use of these remedies, must be ascribed to the disengagement of their oxygen. How then does this increased action cure the local sores produced by the venereal virus? Is it true, that all general affections of the system 109 suspend for a time the local ones, proceeding from this poison, or must we have recourse to some specific powers, as has generally been the case In explaining the action of mercury? We are inclined to adopt.the first hypothesis, and to suppose, with Mr. Hunter, that mercury, as well as the remedies under consideration, cure this disease by exciting a new action in the system, in consequence of which, the syphilitic one is suspended ; and this suspension being continued for a sufficient length of time, the whole of the virus, from the change which the fluids naturally undergo, is at last completely expelled from the body. With regard to the last hypothesis, we would observe, that there can be little or no doubt if oxygen could be applied directly to this poison, it would destroy it specifically, in the same maimer as it destroys many others; but it is ex- 110 tremely difficult to conceive how this substance, so prone to combination, should, when taken in by the mouth, be applied in its pure state to. a remote, local sore, ina quantity sufficient to produce any sensible effect ; and this objection applies still more strongly to mercurial remedies, because in some of these, as the mercur. muriat. corrosiv. and mitis, the quantity - of oxygen disengaged must be extremely small. From these considerations, therefore, we are inclnmed to adopt the opinion, that these different remedies produce their effects by ex- citing a new disease, or action, in the system; and that this action, for the reasons already given, is produced by the disengagement of their oxygen. Should this’ theory be correct, we have no more reason to expect relapses after a course of these acids, &c. than after one of mercury ; nay, if we conceive the virus to. be absorbed, and carried into the general mass‘ of 111 circulation, where it must be exposed to the action of the disengaged oxygen, the patient, upon the whole, may be considered as. more secure, for there will be a greater chance in this case of its complete destruction and era- dication.. This is a point, however, which ex~- perience alone can determine. If these remedies should be found, from fur- ther experience, to be adequate to the cure of this disease in all its stages, the advantages which they possess over mercury are so great and important, that they must, in a great mea- sure, supersede its use. ‘They require no par- ticular regimen, no confinement, are not ac- companied with any disagreeable consequences during their operation, and they seem, in ge- neral to produce their effects more quickly and certainly, particularly the oxygenated muriat of potash. But what we consider to be of far 112 greater importance is, that they do not appear to excite, in any sensible degree, the action of other diseases, especially inflammations, one of the greatest inconveniences attending a mercu- rial course, and by which many have lost their constitutions, and several their lives. Mer= cury, besides its occasionally bringing other diseases into action, has also very deleterious effects upon some particular habits; and this has been so remarkable in certain cases, that from the necessity of occasionally leaving it off, cures have not only been protracted, but the complaint has had an opportunity of running through all its different stages, by which the: constitution has too often suffered an irrepar- able injury. No disagreeable consequences of this kind are likely to follow the use of these acids, or the oxygenated muriat of potash; for although they were given in several weak habits, the health did not suffer in the least ; 113 on the contrary, it, in general, seemed to have been improved, Although we suppose that mercury and the acids, &c. cure the venereal disease by exciting some peculiar action in the system, the nature of these we, nevertheless, conceive to be per- fectly different. The mercurial action must, no doubt, be owing in part to the metal, and not to oxygen; for all the mercurial preparations, whether oxyds, or combinations with acids, produce salivation, ulceration of the tongue and mouth, &c. very much alike; effects which, we have shewn, are not occasioned by oxygen disengaged under different circumstances. The mercurial action is also accompanied with an impaired appetite and general wasting, the re- verse of which takes place during the action of the new remedies, Indeed, the white tongue and sizy blood appear to be the only circum- 114 stances common to both, for in all other re- spects they differ essentially. We know it has been said, that the nitrous acid produces sali- vation, but this is certainly a mistake, which, has probably arisen from confounding the local and temporary sorevess in the gums and teeth, occasioned by the acid, with the inflammation and ulceration produced by mercury; for in no one instance, even where the common concen- trated acid was given to the quantity of three drachms daily, did we perceive any thing like mercurial salivation. ‘The mercurial action we, therefore, conceive, must be owing to the metal rendered active by its union with acids, &c. ; but that of the acids and oxygenated muriat of potash, to the disengagement of their oxygen. Of the different substances. which we have yet employed, we would prefer the nitrous acid and the oxygenated muriat of potash; the first, 115 _ because it may be readily procured, and seems in most cases sufficiently active; and the last, on account of its being the most efficacious and certain, producing, in most instances, an almost ‘immediate effect upon the disease, without in- juring the constitution. The nitrous acid which we have hitherto used, has never been perfectly pure, nor highly concentrated; in short, it was nothing more than the common fuming acid of the shops. The nitric acid has not been tried, nor do we conceive that it would possess any superior advantages. ‘This medicine for the most part produces a sensible effect in six, or eight days, and frequently ac- complishes a cure in fifteen or sixteen. We _ have generally begun with a drachm im the day, diluted with about a pint and a half of gruel; but where the acid is only of the usual strength, and free from any metallic impregnation, a drachm and half, or evea two drachms, we be- 116 believe, will seldom be found too much. We have never exceeded three drachms in the day, but we do not by any means suppose this to be the greatest quantity which can be taken with safety and advantage. Of the oxygenated mu- riat of potash, we have generally begun with three, or four grains, although in general six, or eight may be given, at first, four times a day; where it produces sickness, or griping (which is sometimes the case) the dose should be diminished. We have never yet exceeded the quantity of fifteen, or. sixteen grains four times a day, not but that more might have been given had it ever been found necessary. One of the greatest objections to the oxy- genated muriat is, the difficulty of preparing and purifying it; nor is there any process yet known, by which it can be manufactured and sold at a low price; for these reasons we have 117 no doubt that a very impure kind will be of- fered for sale, the consequences of which must be, want of success and disappointment to those who employ it. Its purity may be judged of by attending to the following circumstances: the crystals should be shining flat rhomboidal scales, or tablets, without any mixture of cubes; they should have little, or no taste, and when thrown upon red- hot coals, should detonate rapidly, with a very vivid flame, and without any decrepitation; but when the crystals feel rough, have a bitter saltish taste, and decrepitate much when thrown upon: live. coals, we may be certain that they contain a considerable proportion of the com- mon muriat of potash, which is always formed in great quantity during the process. ‘This salt, when perfectly pure, does, not decompose the nitrats of silver, or mercury. But this de- 118 gree of purity is not necessary when it is to be employed as a medicine; only when completely, or nearly freed from the common muriat, a smaller dose will be sufficient, and much less thirst excited. The oxygenated muriatic acid appears like- wise to be a very inefficacious remedy in this complaint; but in the way in which it is usually prepared, it always contains manganese, and not unfrequently lead, particularly when’ the -manganese employed has been procured from Bristol; for the manganese from the Mendip Hills very generally contains, more or less of this metal. In every case where either. the oxygenated muriat of potash, or oxygenated muriatic acid are prepared in a medicinal point of view, nothing but the purest crystallized manganese should be used; that upon Upton- pine, near Exeter, is the best. The acid given 119 in the four cases related above, was procured by adding the common muriatic acid to the oxyge- nated muriat of potash; by this, means a very large quantity of the purest oxygenated acid may be quickly obtained ; and it is this process we have been in the habit of using for some time, where a very pure acid for delicate che- mical experiments has been required. Instead of making the gas pass through water in the usual way, the oxygenated salt -was sometimes simply added to the common ‘muriatic acid, diluted with about an equal bulk of water; in this. case: the salt was slowly de- -composed, and the acid converted into. the oxygenated acid. About a drachm of the salt, when pure, was found to be sufficient for three ounces of the dilute acid: of this we have given to the extent of half an ounce in the day, al- ways beginning, however, with a much smaller quantity. 120 The philanthropic Dr. Beddoes at this time took up the question with his accustomed zeal and liberality, and through him we have copious - accounts of trials made in the Royal Hospital at Plymouth, by Mr. Hammick’s son,. with similar success, authenticated by the late Dr. Geach. To DR. BEDDOES. “& Sir, Royal‘Hospital, July 26, 1797. “‘ I do myself the honour, agreeably to your request, of writing to you, and assuring you that the patients, whose cases Mr. Hammick, junior, lately transmitted, were regularly at- tended by myself; and every circumstance was remarked as minutely as possible, and is strictly true. So great, indeed, has been the success of this nitric medicine in the venereal disorder, 121 that many patients, who had been broken down by an antecedent use of mercury, under which the disorder gained ground, recovered their health and strength without the assistance of — diet-drinks, change of air, the bark, or any other tonic medicine whatever. We have had but few imstances where the stomach and bowels have been affected by it; but the pre- _caution of taking it through a narrow glass tube has prevented the acid from affecting the teeth, and the medicine has been rendered more pa- latable by mixing simple syrup with it; and this addition, as far as we have hitherto noticed, has been effectual enough to prevent both mawkishness and pain. But although these circumstances have now and then succeeded the use of the nitrous acid, it does not affect the mouth, or produce-a ptyalism. Jt does not impair the appetite, it does not require any dietetic regimen, or confinement. Indurated G o buboes have yielded to it without: suppurating 5, phagedenic buboes. have. healed after unsuc- cessful trials with mercury. _ In chancres, how- ever large or sordid, and in excoriations of the scrotum, however fetid and extensive, the cure, by its use, goes on more rapidly than by.a mer- curial process. -Such chancres and excoriations have been dressed only with simple omtment, that the patient might not be mcommoded by, the friction. of thelinen, and that the effect of the medicine might be. better ascertained when there was no local application. ...We have not found, after the chancres. have been cured by: this medicine, that the throat has been affected; a circumstance not. unusual, especially when such ulcers have been dressed with :any mercu=: rial preparation. . ‘The cases sent by Mr. Ham- mick were the worst that were. received